Purpose The coronavirus-19 (COVID-19) pandemic requires the use of online media to ensure monitoring of type 1 diabetes mellitus (T1DM) in children. Thus, this study aims to determine whether online education effectively improves the quality of life (QoL) in children with T1DM during the coronavirus-19 pandemic. Patients and Methods The study, conducted from March to October 2020, utilized the paired t -test before and after online education. Moreover, it adopts the recommended Pediatric Quality of Life Inventory (PedsQL) 3.2 diabetes module for the 33 patients registered in the Pediatric Endocrine Outpatient Clinic of Dr. Soetomo Hospital, Surabaya, Indonesia. Results The QoL of all children ( p = 0.011), parents ( p = 0.001), and both children and parents (overall; p = 0.002) have shown significant improvement after the treatment. The QoL of parents, as a subcriterion, improved after the treatment. However, the improvement in the children in subcriterion treatment II ( p = 0.186) was not significant. Conclusion Online education has proven to create a better QoL almost in all children with T1DM during the coronavirus-19 pandemic.
Background: More than 40 genes influence the progression of type 1 diabetes mellitus (T1DM), including human leukocyte antigen (HLA) alleles. Different HLA genotype patterns result in diverse rates of T1DM development. HLA class II DR, DQ, and DP vary among different populations and ethnicities. Data on HLA polymorphism in T1DM in Indonesia are lacking. Therefore, this study was designed to evaluate the gene polymorphism of HLA-DQA1 and HLA-DQB1 in Indonesian children with T1DM. Patients and Methods: In this study, 31 patients with T1DM and 31 controls were enrolled from April 2020 to April 2021. This study was conducted at Dr. Soetomo Hospital, Indonesia. We evaluated the gene polymorphism of HLA-DQA1 and HLA-DQB1 using polymerase chain reaction-restriction fragment length polymorphism. The primers used were as follows: for HLA-DQA1, DQAS34: 5ʹ-GGTGTAAACTTGTACCAG-3ʹ (forward) and DQAA261: 5ʹ-ATTGGTAGCAGCGGTAGA-3ʹ (reverse); for HLA-DQB1, DQBS43: 5ʹ-TGCTACT-TCACCAA(C/T)GGG-3ʹ (forward) and DQBA249: 5ʹ-GTAGTTGTGTCTGCA (C/T)AC-3ʹ (reverse). Results:The most common HLA-DQA1 subtype in the T1DM group was 0101/0102 accounting for 67.6%, and 01/03 and 02/03 were found in the T1DM group only. Meanwhile, the most common HLA-DQB1 subtype in the T1DM group was 0301, accounting for 54.8%. Most subjects in this study were Javanese. Conclusion: HLA-DQA1 0101/0102 and HLA-DQB1 0301 were commonly found in Indonesian children with T1DM.
We aimed to evaluate the cytotoxic T-lymphocyte-associated protein 4 +49A/G (CTLA-4 +49A/G) gene polymorphism in Down syndrome (DS) children with Hashimoto’s thyroiditis (HT). This case–control study, conducted from February 2020 to February 2022 at Dr. Soetomo General Hospital, Surabaya, enrolled 40 DS children with HT and 50 healthy children. The DNA sequencing was performed to identify the polymorphism (Sanger sequencing). Thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), thyroid-stimulating hormone (TSH), and free thyroxine (FT4) levels were analyzed by enzyme-linked immunosorbent assay (ELISA). The mean age of DS children with HT was 1.78 years. Males predominated in the study population. Subjects with GG genotype were diagnosed earliest with hypothyroidism (8 months) compared with other studies. The most common thyroid dysfunction was central hypothyroidism, with TgAb positivity present in all patients. The AA genotype (odds ratio [OR] 0.265, 95% confidence interval [CI] 0.094–0.746; P = 0.012) and A allele (OR 0.472, 95% CI 0.309–0.721; P = 0.0002) were significantly more frequent in the control group. The AG genotype (OR 2.65, 95% CI 0.094–0.746; P = 0.003) and G allele (OR 2.116, 95% CI 1.386–3.23; P = 0.003) were more frequent in the DS with HT group. The age of the subjects in this study was younger than in previous studies. The AG genotype and the G allele were more prevalent in the DS with HT group and may be a risk factor in HT development in DS children. Furthermore, the AA genotype may act as a protective factor against HT in DS children.
Deficiencies of Selenium (Se) is correlated with the risk and onset of autoimmune thyroid disease (AITD). The aim of this study was to determine the association between Se supplementation and AITD. Methods: Electronic data searches of 4 databases were performed. We assessed the included studies using PRISMA for protocol assurance. Five studies met our inclusion criteria and were analyzed. The predictor covariate in the present study was Se administration. The outcome measures were levels of thyroid peroxidase antibodies (TPO-Ab), thyroglobulin antibody (Tg-Ab), free thyroxine (fT4), and thyroid volume. Results: Of the five studies that met the inclusion criteria, one randomized controlled trial (RCT) was included in the qualitative review, whereas four quasi-experimental studies were included in the meta-analysis. The results showed that Se supplementation significantly reduced TPO-Ab levels (MD 90.85; 95% CI 61.71–120.00; p<0.00001) and fT4 levels (MD 1.52; 95% CI, 0.55–2.50; p=0.002), while the RCT showed that Se supplementation significantly reduced Tg-Ab levels. Conclusions: Se supplementation significantly reduces TPO-Ab and fT4 levels in children and adolescents with AITD. The limited number of studies and population sizes emergence of further studies especially RCTS are needed to make a better meta-analysis
Background Vitamin D (VD) plays a role in reducing the risk of diseases related to the immune system, including autoimmune diseases, by inhibiting proinflammatory cytokines such as IFN-γ. Children with Down syndrome (DS) are known to have interferonopathy due to trisomy 21 and have lower VD levels. This study aimed to evaluate the VD profile in Indonesian children with DS and its correlation with IFN-γ.Methods This study was conducted from March 2020 to June 2021 at Dr. Soetomo General Hospital, Surabaya. Data on sociodemographic status, milk, fish, and meat consumption, and sun exposure were obtained using a self-report questionnaire. VD and IFN-γ levels were measured using an ELISA kit. The chi-square test, t-test, Mann–Whitney test, and linear and logistic regression analysis were performed, with a significance threshold of p < 0.05.Results Of the 122 participants, 80 children had DS and 42 did not. The median VD levels in the DS and non-DS groups were 31.98 ng/mL and 56.19 ng/mL, respectively. The IFN-γ level was higher in the DS group, but this difference was not statistically significant (122.978 ± 123.420 vs. 100.715 ± 97.137 ng/mL, p = 0.548). Children with DS had lower daily milk consumption (300 cc/day vs. 380 cc/day; p = 0.027), sun exposure (17.5 vs. 150 hours/week; p = 0.000), and weekly meat and fish consumption (1 vs. 4 slices/week; p = 0.000). Daily milk consumption was a significant contributing factor for VD adequacy in the DS group (p = 0.000 [OR = 1.008]). VD levels had a significant role in decreasing IFN-γ levels in the DS group (p = 0.039; R2 = 5.8%).Conclusions VD levels in children with DS are lower than in children without DS. Adequate milk consumption can reduce the risk of autoimmunity through the role of VD in reducing IFN-γ levels in children with DS.
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