None of the type 1 diabetes children with high TG2-IgA titres would have needed endoscopy with duodenal biopsies to reach a CD diagnosis. Lower TG2-IgA-positive patients need to be biopsied.
Ultraviolet radiation (UV), mainly from sunlight, is the main risk factor of the most common human skin cancer, basal cell carcinoma (BCC). A positive effect of UV on the skin is its contribution to the synthesis of vitamin D, which is important in sustaining general health, but having high levels of vitamin D is considered a risk factor for BCC. However, vitamin D receptor has antagonistic effects to UV radiation in regulating Sonic Hedgehog pathway. This is a pilot study aimed at characterizing the sun-related behavior and vitamin D status of 52 BCC patients and 59 controls from our geographical area. Patients were included in 4 subgroups: Single, multiple, recurrent, and both multiple and recurrent BCCs. Patients, more than controls, had at least one sunburn in childhood and lentigines (P<0.001). Also, they spent daily, on average, more time in the sun than controls (P<0.001) (3.00-8.00 and 1.50-4.00 h respectively). Outdoor work was similar in both groups. Participants had lower vitamin D serum levels than expected. Due to the small number of cases, no statistically significant differences were found between the subgroups but some tendencies were noted. Patients with only one recurrent BCC had less sunburns than the ones who also developed tumors at multiple sites (P=0.2). Patients with multiple and recurrent tumors had slightly lower vitamin D levels compared with single BCC patients (P=0.1) although they used more vitamin D supplements after the BCC diagnosis (P=0.2). Having a diagnosis of BCC, made patients more compliant to the use of sunscreen cream, but even so, half of them still did not use it. In conclusion, more effort should be invested in sun-related education and public health actions should focus on vitamin D deficiencies.
The motivation of this article is to diagnose local insulin related dystrophies and their dynamic with an ultrasound (US) subcutis (SC) map, by comparison with clinical data. To improve insulin injection technique by identifying the real cutis/subcutis thickness (CST).We have enrolled 53 type 1 diabetic children (33 boys and 20 girls, aged between 2 and 15 years), with diabetes duration between 1 and 13 years. The clinical examination puts into evidence three types of local dystrophies: hypertrophy, nodular lumps and atrophy. The US technique has confirmed clinical findings and moreover has diagnosed their location, size, depth and echostructure. While mapping dystrophies we simultaneously have taken into consideration the CST of the nearest non-injured areas in order to be compared. The screening was also made again after a 6 months period.The US interrogation revealed a larger diversity of dystrophic phenomenon than the clinic one: SC diffuse hypertrophy, dominant nodular aspects, atrophies, associated muscular dystrophy or multiple layer dystrophies. After a 6 months period of not injecting, the clinical examination diagnosed the remission of some hypertrophies and nodular aspects. Also as a confirmation, the US technique identified more residual images and certified which types of echostructures had recovered or not.Local insulin dystrophy would be diagnosed, typified and mapped effectively by US unlike clinical severity. Reinjecting would be safer done after the US re-examination has certified the level of recovery. Being a comparative term as well as a condition for improving the injection technique the mapping of normal CST might be also part of a continuous specific education of insulin treated patients.
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