BackgroundAsthma is a heterogeneous disease with variable symptoms especially in children. Exhaled nitric oxide (FeNO) has proved to be a marker of inflammation in the airways and has become a substantial part of clinical management of asthmatic children due to its potential to predict possible exacerbation and adjust the dose of inhalant corticosteroids.ObjectivesWe analyzed potential factors that contribute to the variability of nitric oxide in various clinical and laboratory conditions.Materials and methodsStudy population consisted of 222 asthmatic children and 27 healthy control subjects. All children underwent a panel of tests: fractioned exhaled nitric oxide, exhaled carbon monoxide, asthma control test scoring, blood sampling, skin prick tests, and basic spirometry.ResultsFeNO and other investigated parameters widely changed according to clinical or laboratory characteristics of the tested children. Asthmatics showed increased levels of FeNO, exhaled carbon monoxide, total serum IgE, and higher eosinophilia. Boys had higher FeNO levels than girls. We found a significant positive correlation between FeNO levels and the percentage of blood eosinophils, %predicted of forced vital capacity, total serum IgE levels, and increasing age.ConclusionsVarious phenotypes of children's asthma are characterized by specific pattern of the results of clinical and laboratory tests. FeNO correlates with total serum IgE, blood eosinophilia, age, and some spirometric parameters with different strength. Therefore, the coexistence of atopy, concomitant allergic rhinitis/rhinoconjunctivitis, and some other parameters should be considered in critical evaluation of FeNO in the management of asthmatic children.

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Background: Considering a dramatic increase in the incidence of type 1 diabetes (T1D) worldwide, current research focuses on complex etiology of T1D where immune system, environmental and genetic factors play a significant role. Glutathione S-transferase family of enzymes protects tissue from oxidative damage which is discussed in the context of T1D. The aim of the study was to investigate an association of glutathione S-transferase mu 1 (GST M1) and glutathione S-transferase theta 1 (GST T1) polymorphisms with type 1 diabetes. Methods: 163 children, 116 with type 1diabetes and 47 healthy controls, at the age 6-19 years were enrolled to the study. Basic anthropometric, biochemical parameters and GST T1 diabetes and M1 polymorphisms were established in each subject. Results: Subjects with T1D had significantly lower concentration of uric acid compared to the healthy subjects (212.85±57.10 µmol/l vs. 269.57±72.53; p<0.001). GST T1 null genotype was more frequent in patients with diabetes compared to the healthy controls (36.2% vs. 21.3%) and represented 2.1-fold increased risk of T1D of borderline statistical significance (OR=2.1; 95% CI=0.949-4.648; p=0.06). GST T1 null/M1 wild genotype combination was more frequent in patients with diabetes (25.9% vs. 10.6%) and represented 2.9-fold increased risk for T1D development (OR=2.93; 95% CI=1.061-8.095; p=0.032). Conclusion: The study indicates that GST T1 null genotype and GST T1 null/M1 wild combination could be considered a risk factor for type 1 diabetes development in Slovak children and adolescents.

The aim of the study was to establish the frequency of hypovitaminosis D in children with type 1 diabetes mellitus (T1D), its influence on biochemical and densitometric parameters and the relation to diabetic nephropathy. 58 children with T1D at the age 9-19 years were enrolled to the study. Vitamin D concentration less than 30 ng/ml was considered as insufficient. 37 children (63.79%) had vitamin D level under 30 ng/ml, from these 19 subjects (32.7%) had vitamin D level under 20 ng/ml and 2 subjects (3.44%) under 10 ng/ml. Children with vitamin D deficiency had significantly lower magnesium concentration and lower Z score of lumbar spine (-1.34 +/- 1.24 vs. -.030 +/- 1.21, p = 0.01) compared to diabetics with sufficient vitamin D concentration. No significant difference was found in parameters calcium, phosphorus or glycosylated hemoglobin. Patients with diabetic nephropathy (n = 18) showed no significant difference in vitamin D, glycosylated hemoglobin or Z score of lumbar spine compared to the patients without nephropathy (n = 40). Subjects with nephropathy had significantly longer diabetes duration, significantly higher cholesterol and triacylglycerol concentration. In our cohort of patients nearly two thirds of children had insufficient vitamin D concentration what supports the need to monitor and eventually supplement vitamin D in T1D subjects.

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ObjectiveDiabetic autonomic neuropathy (DAN) is one of the chronic complications of diabetes mellitus which can involve one or more organ systems. DAN without apparent symptoms is more often in childhood and adolescence. While heart rate variability (HRV) and Ewing's battery of cardiovascular tests are regarded as a gold standard for the diagnosis of DAN, the examination of cough reflex sensitivity (CRS) is another possibility. The aim of this study was to compare HRV and CRS in children with diabetes mellitus.Materials and methodsSixty one patients (37 girls, 24 boys) aged 15-19 suffering from diabetes mellitus type 1 completed the study. Based on HRV, patients were divided into 2 groups - with DAN (n = 25) and without DAN (n = 32), 4 patients were excluded because of ambiguous results. CRS was studied in each patient by inhalation of gradually increasing concentration of capsaicin.ResultsSubjects with DAN required a significantly higher concentration of capsaicin needed to evoke 2 coughs (median 625 μmol/l, IQR 68.4-625.0 μmol/l vs. median 29.3 μmol/l, IQR 9.8-156.3 μmol/l, P < 0.001) and 5 coughs (median 2500.0 μmol/l, IQR 1250.0-2500.0 μmol/l vs. median 312.5 μmol/l, IQR 117.2-625.0 μmol/l, P < 0.001) compared with those without DAN. Moreover, a strong negative correlation between HRV and CRS was established.ConclusionDiabetes mellitus lowers the cough response. Cough reflex sensitivity appears to be another sensitive method for the evaluation of DAN in diabetes.

The aim of the study was to determine if cardiovascular autonomic neuropathy (CAN) is associated with changed concentration of exhaled carbon monoxide (eCO) in adolescents with type 1 diabetes (T1D). A total of 46 T1D patients and 25 healthy controls (15-19 years) were enrolled. The parameters eCO and carboxyhemoglobin (HbCO) were established using a MICRO-4 Smokerlyser. CAN was examined by standard cardiovascular tests. Adolescents with T1D did not significantly differ in eCO compared to healthy subjects. eCO and HbCO were significantly lower in CAN-positive subjects (n=19) (1.36 ± 1.65 ppm vs. 3.09 ± 2.31, p=0.01 and 0.58 ± 0.49% vs. 1.04 ± 0.44, p<0.01, respectively) compared to CAN-negative subjects (n=27), whereas no significant difference was found in other measured parameters. By multivariate logistic regression, eCO and HbCO were associated with higher risk of CAN (OR=1.824, p<0.05 and OR=10.989, p<0.01). Our results indicate that eCO is decreased in CAN-positive diabetic subjects. Further studies are necessary to investigate the possible role of eCO as a marker for CAN.

Background: Insulin resistance (IR) plays a key role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Hypovitaminosis D is associated with several diseases, including hepatic steatosis and obesity. Vitamin D (VD) affects insulin secretion and improves tissue sensitivity to insulin, suggesting that hypovitaminosis D is also associated with IR. The leptin-to-adiponectin ratio (LAR) was investigated as a new marker of IR. Aim: The aim of our study was to determine the association between the VD status, NAFLD and IR in paediatric overweight or obese patients. Methods: The study ran from January 2018 to August 2020 and included 100 subjects. We measured their anthropometric parameters, determined their basic laboratory parameters and the level of leptin and adiponectin, calculated BMI, WHR, WHtR, LAR and HOMA-IR. We measured the degree of hepatic steatosis by obtaining the hepatorenal index (HRI) using ultrasonography, and used real-time elastography to determine the elasticity of the liver parenchyma (LFI). Subsequently, we compared the groups of patients with and without hepatic steatosis and looked for correlations in relation to the level of VD and IR. Results: 4.4% of patients had a severe VD deficiency, 55% of the children had hypovitaminosis D, 28.6% had VD insufficiency and 12% of patients had sufficient VD levels. Patients with significant hepatic steatosis (HRI 1.5 and more) had the lowest level of VD (16.61 ±5.62 μg/l, P = 0.015). The level of VD in patients with hepatic steatosis was inversely correlated with waist circumference, hip circumference, height, weight, triacylglycerols, GMT, C-peptide, insulin, HOMA-IR, HRI and LFI. Leptin levels were highest in patients with hepatic pre-steatosis. LAR was highest in the group with hepatic steatosis, but we did not observe significant correlations in relation to other parameters. Conclusion: VD levels are inversely associated with the degree of hepatic steatosis in overweight or obese paediatric patients. HOMA-IR inversely correlates with VD levels and positively with LFI. The LAR value was highest in the group of patients with steatosis, although we did not find out any significant correlations in relation to VD status and HRI. Key words: vitamin D – non-alcoholic fatty liver disease – insulin resistance – leptin – adiponectin – obesity – childhood