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AIMS: To evaluate the relationship between SARS-CoV-2 infection and autoimmunity in type 1 diabetes (T1D) and SARS-CoV-2 antibodies frequency at diagnosis of T1D during pandemic. METHODS: The presence of T1D-specific autoimmunity was evaluated in a cohort of 99 children and adolescents without diabetes that contracted SARS-CoV-2 infection. Moreover, the frequency of IgM- and IgG-SARS-CoV-2 antibodies was evaluated in 41 newly diagnosed T1D patients not yet vaccinated against SARS-CoV-2 disease, collected during the pandemic, compared to healthy subjects (CTRL). RESULTS: None of the 99 patients that contracted SARS-CoV-2 infection during the pandemic period was found positive for T1D autoantibodies. The frequency of SARS-CoV-2 antibodies was not significantly different in patients newly diagnosed with T1D (12.2%), compared with CTRL (8.4%). Among SARS-CoV-2 antibody positive T1D patients, 80% were target of diabetes autoantibodies and 60% had another concomitant autoimmune disease. Among the CTRL subjects positive for SARS-CoV-2Abs (n = 10), none was found positive for T1D autoantibodies. CONCLUSIONS: The results of the present study do not confirm, at least in the short term, a role of COVID-19 as a potential trigger of T1D autoimmunity and do not provide evidence of an increased frequency of SARS-CoV-2 antibodies in newly diagnosed T1D patients in comparison with healthy population.
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COVID-19 , Diabetes Mellitus Tipo 1 , Niño , Adolescente , Humanos , Diabetes Mellitus Tipo 1/epidemiología , Autoinmunidad , SARS-CoV-2 , COVID-19/epidemiología , Voluntarios Sanos , AutoanticuerposRESUMEN
BACKGROUND: Hepatitis B virus (HBV) vaccine reduced the incidence of Hepatitis B worldwide. Genetic variability, by the presence of specific haplotypes of HLA system (HLA-DR3, HLA-DR4), influences the response to the vaccination. Subjects affected by type 1 diabetes (T1D), contrary to non-diabetics, have a high prevalence of Hepatitis B. METHODS: The objective of the study was to evaluate anti-HBs antigen (anti-HBsAg) antibody (Ab) in a group of 201 children (age range: 2-18 years), regularly vaccinated against HBV according to the national vaccination schedule. Patients with anti-HBs Ab≥10 mIU/mL have been defined "responders" and those with anti-HBs Ab<10mIU/mL have been defined "non-responders." The possible association between the T1D and a low immune response to the vaccine has been subsequently valued. Besides the presence of T1D, other possible influential variables have been studied: sex, age, presence of celiac disease and Hashimoto's thyroiditis, intervening years from the diagnosis of diabetes and presence/absence of diabetic ketoacidosis at time of diagnosis. RESULTS: Among the 201 subjects with T1D, 90 (44.8%) were responders, while 111 (55.2%) were non-responders; among the 145 subjects without T1D, 86 (59.3%) were responders and 59 (40.7%) non-responders. We invited "Subjects with T1D non-responders" to undergo a booster dose of the same vaccine. Of these, 21 refused the booster, reducing the sample to 90 patients. After 4 weeks from the booster dose 81 patients showed seroconversion ("false non-responders"), and 9 did not ("true non-responders"). CONCLUSIONS: After the booster dose, immune response in our cross-section has been similar to general population. Given the high frequency of "false non-responders" anti-HBsAg Ab should be tested in T1D patients and a booster dose should be administrated in non-responders.
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Diabetes Mellitus Tipo 1 , Hepatitis B , Humanos , Niño , Preescolar , Adolescente , Virus de la Hepatitis B , Inmunización Secundaria , Vacunas contra Hepatitis B/uso terapéutico , Antígenos de Superficie de la Hepatitis B , Anticuerpos contra la Hepatitis B , Hepatitis B/prevención & control , InmunidadRESUMEN
INTRODUCTION: Type 1 diabetes (T1D) represents a risk factor for bone loss and impaired bone quality. MATERIAL AND METHODS: We conducted an exploratory retrospective cross-sectional study involving youths with new-onset T1D, to investigate the relationship between lumbar spine dual-energy X-ray absorptiometry (DXA) and phalangeal quantitative ultrasound (QUS) measurements, along with their correlation with markers of bone turnover, glucose homeostasis, and residual ß-cell function. RESULTS: 17 children and adolescents (8 females) with recent-onset T1D were enrolled into this study. Lumbar spine areal bone mineral density (aBMD) and age-adjusted amplitude-dependent speed of sound (AD-SoS) Z-scores were indicative of low BMD status (≤ -2.0 SD) in 11.7% and 17.6% of participants, respectively. Spearman's correlation analysis revealed significant inverse correlations between AD-SoS values and circulating levels of ß-CrossLaps, alkaline phosphatase, and osteocalcin, along with a significant positive correlation between bone transmission time (BTT) values and fasting plasma C-peptide (FCP) levels. There was no statistically significant correlation between DXA-QUS parameters, fasting plasma glucose (FPG), and glycated haemoglobin (HbA1c). Finally, there was a significant positive correlation between lumbar spine aBMD and BTT values. CONCLUSIONS: Our study suggests that DXA and/or QUS parameters may be altered in a small proportion of T1D children and adolescents at the disease onset. Additionally, residual ß-cell function may represent a protective factor against T1D-related detrimental skeletal changes. Large and long-term prospective studies are needed to confirm these preliminary findings since the present study is limited by the retrospective cross-sectional design and by its small sample size.
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Diabetes Mellitus Tipo 1 , Falanges de los Dedos de la Mano , Absorciometría de Fotón , Adolescente , Fosfatasa Alcalina , Glucemia , Densidad Ósea/fisiología , Péptido C , Niño , Estudios Transversales , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Femenino , Hemoglobina Glucada , Humanos , Osteocalcina , Estudios RetrospectivosRESUMEN
Objective: Early diagnosis of syndromic monogenic diabetes allows for proper management and can lead to improved quality of life in the long term. This report aimed to describe 2 genetically confirmed cases of Wolfram syndrome, a rare endoplasmic reticulum disorder characterized by insulin-dependent diabetes mellitus, optic nerve atrophy, and progressive neurodegeneration. Case Report: A 16-year-old Caucasian male patient and a 25-year-old Caucasian female patient with a history of diabetes mellitus and optic nerve atrophy presented at our medical center. Both patients were initially diagnosed with type 1 diabetes but negative for islet autoantibodies. Their body mass indexes were under 25 at the diagnosis. Their history and presentation were highly suspicious for Wolfram syndrome. Discussion: The genetic tests revealed a known Wolfram syndrome 1 (WFS1) pathogenic variant (homozygous) in the 16-year-old male patient and 2 known WFS1 pathogenic variants (compound heterozygous) in the 25-year-old female patient with diabetes mellitus and optic nerve atrophy, confirming the diagnosis of Wolfram syndrome. The first patient had a moderate form, and the second patient had a milder form of Wolfram syndrome. Conclusion: Providers should consider monogenic diabetes genetic testing, including WFS1 gene, for patients with early-onset diabetes who are negative for islet autoantibodies and lean. Two patients described in this article could have been diagnosed with Wolfram syndrome before they developed optic nerve atrophy. Genetic testing is a valuable tool for the early detection of Wolfram syndrome, which leads to proper management and improved quality of life in patients with this rare medical condition.
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Type 1 diabetes (T1DM) ethiopathogenesis is still being studied, since the role of environmental factors , especially viruses, is not yet clear. This study was conducted on 31 paediatric patients with T1DM at onset. We analysed: Coxsackieviruses A (CoxA), Coxsackieviruses B (CoxB), Echoviruses (Echo); Influenzavirus A and B (IV-A and IV-B); Adenovirus (AdV); Parainfluenza viruses 1-2 and 3 (PiV 1-2-3); Cytomegalovirus (CMV) and Respiratory Syncytial Virus (RSV). Enteroviruses, especially CoxB and Echo, are most represented. Unexpectedly, Parainfluenza viruses were detected in seasonal subgroups, with peaks in autumn and spring, and spread homogeneously in different age groups.
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Diabetes Mellitus Tipo 1 , Infecciones por Enterovirus , Infecciones por Paramyxoviridae , Infecciones del Sistema Respiratorio , Virus , Niño , Humanos , Lactante , Estaciones del AñoRESUMEN
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by an absolute deficiency of insulin secretion. T1D management rests on three pillars: insulin therapy, correct diet and physical exercise. The aim is to focus the attention on diet and mainly on vegetarian diet, in order to evaluate if this kind of food style can offer the correct supply of nutrients, necessary for growth and well control glycaemic management. This paper is a short commentary on vegetarianism in the pediatric and adolescent population with Type 1 Diabetes. In all non-omnivorous diets there is a risk of a lack of some nutrients, as B12 vitamin and n 3 fatty acids which must therefore be measured. It is also important to monitor eating disorders especially in adolescent girls. About vegan diet, attention must be paid to the possible injury on growth brain already at risk, in diabetic children compared to the general population, due to insults related to frequent glucose variability (periods of prolonged hyperglycaemia alternating with hypoglycaemic episodes). In conclusion, vegetarian diet could be suitable for children with type 1 diabetes; vegan diet could be too restrictive but with appropriate additions can be followed by these patients.
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Diabetes Mellitus Tipo 1/complicaciones , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/complicaciones , Adolescente , Factores de Edad , Niño , Preescolar , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/terapia , Femenino , Humanos , Intercambio Plasmático , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/terapiaAsunto(s)
Complicaciones de la Diabetes/metabolismo , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/fisiopatología , Glucosa/metabolismo , Enfermedades de la Tiroides/metabolismo , Adolescente , Autoanticuerpos/análisis , Niño , Preescolar , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/inmunología , Femenino , Humanos , Lactante , Masculino , Enfermedades de la Tiroides/epidemiología , Enfermedades de la Tiroides/inmunología , Pruebas de Función de la Tiroides , Tiroiditis Autoinmune/complicacionesRESUMEN
We provide an overview on the current knowledge about the association between epilepsy and type 1 diabetes mellitus (T1DM). People with T1DM have a 2-6-fold higher risk of epilepsy than the general population. The onset of T1DM anticipates the onset of epilepsy by a mean period between 1,5 and 2,8 years. These two disorders share four potential distinct pathogenic factors: a) genetic predisposition; b) factors involved in autoimmune responses (i.e. anti-glutamic acid decarboxylase antibodies-GADAbs); c) effects of hypo/hyperglycaemia; d) cerebrovascular damages resulting in ischaemic processes. Seizures semiology prominently includes focal (up to patterns of epilepsia partialis continua) or secondarily generalized seizures but also reflex seizures and various forms of generalized seizures. EEG abnormalities are more common in people with an inappropriate metabolic control with a prominent involvement of fronto-temporal regions. Epilepsy management does not differ between patients with and without diabetes and insulin, nutritional recommendations and physical activity may also produce significant benefits on seizures control. Possible therapeutic alternatives in selected cases include immunosuppressive drugs (in patients with GADAbs) and ketogenic diet.
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Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/fisiopatología , Epilepsia/epidemiología , Epilepsia/fisiopatología , Adolescente , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
Helicobacter pylori (H. pylori) is a highly prevalent, serious and chronic infection that has been associated causally with a diverse spectrum of extragastric disorders including iron deficiency anemia, chronic idiopathic thrombocytopenic purpura, growth retardation, and diabetes mellitus. The inverse relation of H. pylori prevalence and the increase in allergies, as reported from epidemiological studies, has stimulated research for elucidating potential underlying pathophysiological mechanisms. Although H. pylori is most frequently acquired during childhood in both developed and developing countries, clinicians are less familiar with the pediatric literature in the field. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae. A further clinical challenge is whether the progressive decrease of H. pylori in the last decades, abetted by modern clinical practices, may have other health consequences.
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Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Helicobacter pylori , Anemia Ferropénica/microbiología , Asma/microbiología , Niño , Ensayos Clínicos como Asunto , Diabetes Mellitus/microbiología , Trastornos del Crecimiento/microbiología , Humanos , Hipersensibilidad/microbiología , Púrpura Trombocitopénica Idiopática/microbiologíaRESUMEN
OBJECTIVE: In this study, the authors have compared data concerning the pediatric triage that is carried out in 2 large emergency departments (EDs) in Rome, one located in a university pediatric clinic with qualified staff and the other one in a general hospital with a high flow of users and pediatric admissions. METHODS: A total of 324 children were selected (162 per hospital) with ages between 0 and 3 years who went to the ED in the period from October to December 2009 for respiratory pathologic findings at the lower respiratory tracts' expense. We took and compared the following data: assignation of the color code, congruity of the color code, and realization of the reevaluation. DISCUSSION: This study reveals several differences between the 2 structures considered with a clear tendency of nurses of the general ED to underestimate color codes, giving undertriage rates in a significant number of cases. Another significantly important difference was found on the detection of children's vital parameters. One last important parameter that emerged from this study was the lack of attention to the reevaluation of the patient after admission in ED. RESULTS: In the light of what we pointed out, it is necessary to implement the educational and informative quality of the triage operators and educators, planning periodical triage training courses to reduce errors. Particular emphasis must be placed on providing pediatric continuing education for nurses practicing in general ED.
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Servicio de Urgencia en Hospital/organización & administración , Hospitales Generales/organización & administración , Hospitales Universitarios/organización & administración , Triaje/organización & administración , Preescolar , Humanos , Lactante , Servicio Ambulatorio en Hospital/organización & administración , Pediatría , Ciudad de RomaRESUMEN
To determine whether there is an airway IFN response in infants with acute bronchiolitis and to establish whether the rate of such a response is related to the severity of illness, the expression of some IFN-induced genes was measured in nasopharyngeal washes from 39 infants with acute bronchiolitis. The results indicate that in infants with a virus-associated acute bronchiolitis there is a strong activation of IFN system and that the severity of illness is inversely related to the level of expression of IFN-induced genes. This suggests that the IFN response plays an important role in determining virus-associated respiratory disease in early life.
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Bronquiolitis/genética , Regulación de la Expresión Génica , Interferones/farmacología , Bronquiolitis/fisiopatología , Bronquiolitis/virología , Citocinas/genética , Regulación de la Expresión Génica/efectos de los fármacos , Humanos , Lactante , Consumo de Oxígeno , Reacción en Cadena de la Polimerasa , Virus Sincitiales Respiratorios/aislamiento & purificación , Rhinovirus/aislamiento & purificaciónRESUMEN
Detection of a broad number of respiratory viruses is not undertaken currently for the diagnosis of acute respiratory infection due to the large and always increasing list of pathogens involved. A 1-year study was undertaken on children hospitalized consecutively for acute respiratory infection in a Pediatric Department in Rome to characterize the viruses involved. Two hundred twenty-seven children were enrolled in the study with a diagnosis of asthma, bronchiolitis, bronchopneumonia, or laringo-tracheo bronchitis. A molecular approach was adopted using specific reverse transcription (RT)-PCR assays detecting 13 respiratory viruses including metapneumovirus (hMPV) and the novel coronaviruses NL63 and HKU1; most amplified fragments were sequenced to confirm positive results and differentiate the strain. Viral pathogens were detected in 97 samples (42.7%), with 4.8% of dual infections identified; respiratory syncytial virus (RSV) was detected in 17.2% of children, followed by rhinovirus (9.7%), parainfluenza virus type 3 (PIV3) (7.5%), and influenza type A (4.4%). Interestingly, more than half the patients (9/17) that have rhinovirus as the sole respiratory pathogen had pneumonia. HMPV infected children below 3 years in two peaks in March and June causing bronchiolitis and pneumonia. One case of NL63 infection is described, documenting NL63 circulation in central Italy. In conclusion, the use of a comprehensive number of PCR-based tests is recommended to define the burden of viral pathogens in patients with respiratory tract infection.