We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0–18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05–0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers.
Obesity is a chronic disease related to adipokines production, which contribute to inflammation and metabolic abnormalities. The Roux‐en‐Y gastric bypass is an alternative therapy for the treatment of severe obesity, reaching weight loss superior to conventional therapies. The aim was observed the inflammatory and metabolic changes after 6 months of Roux‐en‐Y gastric bypass. Nine women aged 24 – 48 years old, BMI > 35 kg/m2 (50.9±9.6), submitted to Roux‐en‐Y gastric bypass. Plasma concentrations evaluated: glucose (mg/dL), leptin (pg/mL), adiponectin (ng/mL), TNF‐α (pg/mL) and IL‐6 (pg/mL). Anthropometric assessment: weight (kg), BMI (kg/m2) and fat mass (FM: kg). We observed reduction in body weight (130.1±23.8 × 98.5±25.2, p<0.01) and FM (72.1±17.4 × 40.8±8.3, p<0.01). Significant metabolic changes were found, such as reduction in leptin [431.3 (303.8 – 532.2) × 96.7 (62.0 – 176.8), p<0.01] and glucose [97.0 (84.5 – 107.5) × 82.0 (74.7 – 85.0), p=0.04] and increased adiponectin (62.7±21. 2 × 206.0±120.8, p<0.01). With respect to pro‐inflammatory parameters, no significant changes were observed in TNF‐α (0.44±0.69 × 0.3±0.5, p=0.20) and IL‐6 [4.7 (3.2 – 7.6) × 1.8 (0.9 – 3.8), p=0.12]. Six months after surgery decreased fat mass and resulting in changes as decreased leptin and glucose and increased adiponectin. In other hand in this period there was no change in inflammatory parameters.
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