Цель статьи: описать особенности дифференциальной диагностики гипофосфатазии с рахитоподобными заболеваниями на примере нескольких клинических случаев. Основные положения. Причиной гипофосфатазии является снижение активности щелочной фосфатазы (ЩФ), приводящее к поражению всех органов и тканей различной степени тяжести с многообразными проявлениями. Неспецифическая клиническая картина редкого наследственного метаболического заболевания, низкая осведомленность врачей о проблеме определяют трудности диагностики гипофосфатазии. Единственный метод патогенетического лечения гипофосфатазии-пожизненная ферментная заместительная терапия препаратом асфотаза альфа. В статье приведены клинические случаи перинатальной (более тяжелой) и детской формы заболевания. Заключение. Наличие гипофосфатазии следует проверять у всех пациентов с признаками гипоминерализации костей в сочетании с полиорганными нарушениями и/или судорожным синдромом, патологией зубочелюстного аппарата и снижением активности ЩФ. Важно отметить, что показатели активности ЩФ имеют возрастные особенности, следовательно, лечащий врач должен убедиться, что сообщаемые лабораторией результаты отражают нормальный для пациента конкретного возраста уровень ЩФ. Ключевые слова: гипофосфатазия, щелочная фосфатаза, метаболические заболевания, дети, асфотаза альфа.
RATIONALE: Continuous subcutaneous insulin infusion (CSII) is an effective method for optimizing glycemic control in children with type 1 diabetes mellitus (DM1). However, the use of CSII does not always result in adequate glycemic control. Telehealth can be applied as one of the methods to improve the effectiveness of treatment.AIMS: To evaluate the use of remote medical support of children and adolescents with DM1 and its influence on glycemic control, quality of life, and incidence of acute complications of DM1.MATERIALS AND METHODS: We conducted a 24-week multi-institutional prospective open-label controlled clinical trial. 180 children and adolescents were included in this study and divided into the following categories: 1) age 8–18 years; 2) DM1 at least 1 year; 3) pump insulin therapy Medtronic Paradigm (Medtronic MiniMed, USA) at least 6 months; 4) self-monitoring of glycemia at least 4 times a day and replacement of the insulin pump infusion system at least once every 3 days; 5) inadequate glycemic control of DM1: the level of glycated hemoglobin (HbA1c) 7.5% or higher. Patients were assigned to a remote consultation group (RC; n=100) or a traditional control group (TC; n=80). All patients were trained on the basic principles of DM1 and CSII, and we measured initial HbA1c, then after 12 and 24 weeks, also registered and analyzed glycemic indicators and daily doses of insulin, evaluated and corrected the treatment. Patients or their parents in the RC group sent pump data via the Internet to the pump insulin therapy center at least once every 2 weeks at home and received treatment recommendations in response.RESULTS: The total number of patients included in the study in all institutions was 180 children at 8–18 years. Patients in both groups did not differ in age, gender, duration of DM1 and CSII, and HbA1c level. The total amount of remote consultations for all institutions was 949. The decrease in the level of HbA1c by the end of the study against the initial one was statistically significantly greater in the RC group: 1.17% compared to 0.59% in the TC group (p<0.05). The proportion of patients who reached the target level of HbA1c (<7.5%) was significantly higher in the RC group (32%) compared to the TC group (12.5%, p<0.05). During the study, the incidence of DKA and severe hypoglycemia in the RC group was statistically significantly lower.CONCLUSIONS: Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency). The accumulation of evidence on the effectiveness and safety of telehealth in DM should contribute to implementing this approach in practical health care.
Childhood obesity is an urgent problem of pediatric endocrinology due to the widespread occurrence, the development of metabolic complications and their steady tracking into adulthood. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of obesity, methods of its diagnosis and treatment based on the principles of evidence-based medicine.
BACKGROUND: According to research, only 38% of patients reach glycated hemoglobin targets. It is possible to improve the effectiveness of medical care for children with T1D using modern technologies, including continuous glucose monitoring (CGM). AIMS: To evaluate the effectiveness of outpatient monitoring of children and adolescents with T1D with regular use of professional continuous glucose monitoring. METHODS: The inclusion criteria: age 812 years; T1D at least 1 year; insulin therapy by multiple injections of insulin; inadequate glycemic control of T1D: НbА1с level of 7.5% and higher and / or children and adolescents with frequent episodes of hypoglycemia (usually 4 times a week) or with a history of severe hypoglycemia; signed informed consent. All patients initially and 12 weeks after inclusion in the study conducted a study of the level of НbА1с, and also performed CGM for 6 days. Based on the results of CGM, glycemia indicators and daily doses of insulin were recorded, treatment was evaluated and corrected, and recommendations for self-monitoring were made. Glucose monitoring was carried 120144 hours using the blind method iPro2 (Medtronic, USA). RESULTS: In all, 99 children aged 818 years were included in the study in all centers. The decrease in the level of НbА1с by the end of the study was 0.72%, while the proportion of patients who reached the target level of НbА1с (defined as 7.5%) was statistically significantly higher at the end of the study (15.5% and 2%, respectively; p0.05). During the study, patients showed a trend towards a decrease in the average level and variability of glycemia by the end of the study, however, statistical significance was achieved only in relation to the average level of glycemia (p=0.04). Conducted insulin therapy, determined by the average daily doses of long-acting and short-acting insulin, did not statistically significantly change at the end of the study. The frequency of DKA episodes and severe hypoglycemia did not statistically significantly differ from the initial level. CONCLUSIONS: For children with poor glycemic control of T1D, the use of professional CGM is effective in terms of glycemic control and a safe method.
Aim. To study the relationship between obesity of the mother, the body weight of the newborn and the formation of metabolic disturbances in subsequent periods of life.Materials and methods. A prospective study was conducted in which 1,000 women of reproductive age and their newborns were included by the random number method. The mean age is 29.5 [25.0; 33.5] years. The examination included the collection of anamnesis, measurement of body height and body weight, blood pressure, waist circumference and body mass index determination. Micro- and macrosomia in term infants was diagnosed with a birth weight less than 15 and more than 97 percentiles (WHO, 2005). The laboratory study included the determination of glucose, cholesterol, triglycerides, high and low density lipoproteins, insulin and C-peptides of basal and stimulated levels, leptin, adiponectin, determination of insulin resistance indices (HOMA-IR) and pancreatic β-cell function (HOMA-β). The statistical analysis of the material was carried out using the Statistica 10 software package, SPSS 13.0. Statistically significant differences were taken into account at a level of p < 0.05.Results. It was found that when pregnancy occurs, 41.0% of women are overweight or obese. In the study, the pathological mass of the body in the neonatal period was detected in every fourth newborn (24.8%), including microsomia (11.3%) and macrosomia (13.5%). As a result, differences in the body weight of newborns were found, depending on the maternal pregestational BMI. For example, women with obesity of the first degree were more likely to have children with macrosomia in 33.3% of cases than women with normal body weight, whose incidence of children with macrosomia was detected in 12.0% of cases (OR 6.8; 95% CI 2.66–17.56; p < 0.001). In women in the reproductive period, macrosomia at birth was more characteristic for people with a metabolic syndrome, and was associated with hormone-metabolic changes.Conclusion. Тhe results demonstrate the effect of pre-gestational body weight in women with obesity on the body weight of offspring at birth. Both macrosomia and microsomia at birth can be risk factors for the development of the metabolic syndrome in the long term, which confirms the importance of preventing overweight and obesity in women of childbearing age in the pre-gestational period.
Background. Comparative study of antiepileptic drugs allows to make the optimal choice in therapy.The aim of the study: a comparative analysis of the administration of two similar by chemical structure antiepileptic drugs (zonisamide and topiramate) in the outpatient practice in epilepsy in children, taking into account the efficacy and tolerability.Materials and methods. A retrospective analysis of outpatient charts of equal in number (n = 18) groups of patients with different forms of epilepsy treated with zonisamide and topiramate in monotherapy and in combined therapy was carried out.Results. In general, no statistically significant difference in the efficacy of zonisamide and topiramate was obtained (p = 0.692). Efficacy in structural focal epilepsy was also comparable (absence of seizures 54.6 % and 45.5 %, respectively). With comparable efficacy, zonisamide was administered to patients much later in the antiepileptic drugs (Me = 5) than topiramate (Me = 3). Side effects on zonisamide were registered in 27.8 %, side effects on topiramate – in 38.9 % (p = 0.480). The difference in the effect of these drugs on cognitive functions was noted.Conclusions. Zonisamide shows its effectiveness in different forms of epilepsy in children, despite the later appointment in practice. The drug is well tolerated and probably has less negative effect on children’s cognitive functions than topiramate.
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