Diabetic ketoacidosis is the most serious acute complication of insulin-dependent diabetes mellit... more Diabetic ketoacidosis is the most serious acute complication of insulin-dependent diabetes mellitus and the most frequent reason for hospital admission of diabetic children. The most frequent cause of death of these patients is also the diabetic ketoacidosis. The mortality rate of the disease has not changed since the seventies (1-2%). In this work, the data of 89 patients with diabetic ketoacidosis were analyzed. These patients were admitted to the 1. Department of Pediatrics of the Semmelweis University of Medicine between 1992-1997. The data (metabolic parameters, the causes of ketoacidosis and the length of hospital stay) of previously known diabetic children was compared with the data of previously unknown diabetic children. Our patients were divided in 2 groups: serious (n = 11), and mild-to-moderate (n = 48) acidosis. Their laboratory findings, their intravenous infusion-, and insulin demand and the length of their hospital stay were compared. The state of consciousness at their hospitalisation and the concomitant complications were also examined. Significant difference was found only in the duration of intravenous insulin administration (with the exception of pH and BE, of course). There was no relationship between the seriousness of the disease and the duration of hospital treatment. It is noteworthy that even the previously known diabetic children with the shortest hospitalization spent more than 7 days at the department.
Multiple immune mediators have been mentioned as playing a role in the pathomechanism of type1 DM... more Multiple immune mediators have been mentioned as playing a role in the pathomechanism of type1 DM. Interleukin (IL)-1beta, and tumor necrosis factor (TNF)-alpha play a central role in the autoimmune destruction of pancreatic beta-cells, whereas IL-6 inhibits TNF-alpha secretion, and may have some protecting effects. In our study, we aimed to investigate the association between these three cytokines' single nucleotide polymorphisms (IL-6 gene G(-174)C, TNF-alpha gene G(-308)A and IL-1beta gene C(3954)T polymorphisms) and age-at-onset of type 1 diabetes mellitus (T1DM) in 165 diabetic children (median age: 17 years). Polymorphisms were determined using the PCR-RFLP method. We found that the age-at-onset of T1DM was significantly different in patients with a different IL-6 genotype (median age-at-onset of T1DM was: 8, 6 and 4.5 years in children with the (-174)GG, GC and CC genotypes, respectively; p < 0.01). Adjusted for TNF-alpha and IL-1beta polymorphisms, patients with a IL-6 (-174)CC genotype have a 3.0-fold (95% CI: 1.2-7.1) increased risk of developing diabetes before the age of 6 years than (-174)G allele carrier patients. However, we found this association to be present only in patients who carried the TNF-alpha (-308)A or IL-1beta (3954)T allele, i.e. in patients with high TNF-alpha and high IL-1beta producer genotypes. We suppose that in the case of high TNF-alpha and IL-1beta producer genotypes, elevated proinflammatory cytokine levels result in a higher production of IL-6 in (-174)G allele carrier patients. This elevated IL-6 level may have a protective effect against the development of T1DM and may delay the destruction of pancreatic beta-cells.
According to the most recent classification of diabetes mellitus the latent autoimmune diabetes i... more According to the most recent classification of diabetes mellitus the latent autoimmune diabetes in adults belongs to the group of type 1 autoimmune diabetes mellitus, as a slowly progressive form. It is not clear whether LADA is a distinct clinical entity or it is a part of the clinical spectrum of type 1 diabetes mellitus. The authors compare the antropologic (body mass index, waist to hip ratio), immunologic (occurrence of islet cell cytoplasmic autoantibodies and autoantibodies against glutamic acid decarboxylase and tyrosin phosphatase), genetic (HLA DR and DQ alleles known to be associated to type 1 diabetes mellitus) characteristics and occurrence of the features of the metabolic syndrome in the groups of type 1 and type 2 diabetes and LADA. 81 type 1 and 190 type 2 diabetics and 38 LADA patients were involved into the study. Freshly diagnosed type 1 diabetics served for controls of the autoantibody study: 48 patients manifested < or = 16 years of age and 89 type 1 diabetic...
Plasma and urinary concentrations of amino acids were investigated during diabetic ketoacidosis (... more Plasma and urinary concentrations of amino acids were investigated during diabetic ketoacidosis (DKA) and 12, 24, 72 hours after initiation of therapy. In DKA plasma concentration of glutamic acid, asparaginic acid, valine, leucine and isoleucine significantly increased while that of asparagine and glutamine decreased compared to levels in well controlled diabetic patients. Despite the elevated urinary excretion of branched chain amino acids, histidine, serine and threonine, urinary excretion and clearance of glutamic acid, glutamine, glycine and taurine were reduced. Among the different amino acids histidine excretion had the highest variability. Strong correlation was found between the urinary excretion of several amino acids and that of the beta-2-microglobulin characterizing tubular dysfunction. Changes in the excretion of different amino acids reflect the altered metabolic state and renal function due to diabetic ketoacidosis.
Csecsemő-és gyermekgyógyászat: 1. E. S. S. Tierney [et al.]: A béta-blokkoló-kezelés nem változta... more Csecsemő-és gyermekgyógyászat: 1. E. S. S. Tierney [et al.]: A béta-blokkoló-kezelés nem változtatja meg Marfan-szindrómás gyermekek aortagyök-tágulatát = Beta-blocker therapy does not alter the rate of aortic root dilatation in pediatric patients with Marfan syndrome Diabetológia: 1. J.-B. Du Prell - A. Icks - M. Grabert [et al.]: A szocioökonómiai háttér és a gyermekkori 1-es típusú diabétesz kapcsolatának vizsgálata Észak-Rajna Vesztfáliában, Németországban = Socioeconomic conditions and type 1 diabetes in childhood in North Rhine–Westphalia, Germany Mikrobiológia és fertőző betegségek: 1. D. Y. Hyun - D. L. Palazzi: Serdülő sternumának és olecranonjának brucellosisa = Brucellosis of the Sternum and Olecranon in an Adolescent Onkológia: 1. N. Mutrie [et al.]: Korai stádiumú mellrákos nők edzésprogramjának kedvező hatásai = Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial Reumatológia: 1. J. G. Boulton - J. T. Bourne: Rheumatoid arthritises és anti-TNF-α-val kezelt beteg labilissá vált diabétesze = Unstable diabetes in a patient receiving anti-TNF-α for rheumatoid arthritis Szív- és érbetegségek: 1. R. Belladinelli [et al.]: A mérsékelt edzés javítja a funkcionális kapacitást, az életminőséget, az endothelfüggő értágulást a krónikus szívelégtelen betegeken, akik beültetett cardioverter-defibrillátort kaptak, s akik reszinkronizációs kezelésben részesültek = Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilatation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therap
A szerző az új generációs bólusanalógok gyermek- és serdülőkorban történő alkalmazását ismerteti.... more A szerző az új generációs bólusanalógok gyermek- és serdülőkorban történő alkalmazását ismerteti. Leírja az élettani és farmakológiai hátteret, amely ezeknek a készítményeknek a fejlesztését szükségessé tette és ismerteti az oda vezető utat. Röviden leírja az első generációs bólusanalógok sajátosságait, majd részletesen kifejti a második generációs ultragyors hatású inzulinanalógok kémiai szerkezetét, legfontosabb farmakodinámiás és farmakokinetikei tulajdonságaikat. Részletesen ismerteti a gyermek- és serdülőkorban egyedül alkalmazható ultragyors hatású bólusanalóggal, a gyors aszparttal végzett klinikai vizsgálatok eredményeit. Röviden megemlíti azokat a készítményeket is, amelyek jelenleg még a kipróbálás fázisában vannak, de ebben a korosztályban egyelőre még nem alkalmazhatóak. A közleményt a szerző egy rövid jövőbe tekintéssel fejezi be.
Barkai László et al. Az MDT tevékenysége és jövőképe Diabetologia Hungarica | XXX. évfolyam 2. sz... more Barkai László et al. Az MDT tevékenysége és jövőképe Diabetologia Hungarica | XXX. évfolyam 2. szám 105 105 105 105 A gyermekdiabetológia helyzete, jövőbeli céljai 2022. június
Diabetic ketoacidosis is the most serious acute complication of insulin-dependent diabetes mellit... more Diabetic ketoacidosis is the most serious acute complication of insulin-dependent diabetes mellitus and the most frequent reason for hospital admission of diabetic children. The most frequent cause of death of these patients is also the diabetic ketoacidosis. The mortality rate of the disease has not changed since the seventies (1-2%). In this work, the data of 89 patients with diabetic ketoacidosis were analyzed. These patients were admitted to the 1. Department of Pediatrics of the Semmelweis University of Medicine between 1992-1997. The data (metabolic parameters, the causes of ketoacidosis and the length of hospital stay) of previously known diabetic children was compared with the data of previously unknown diabetic children. Our patients were divided in 2 groups: serious (n = 11), and mild-to-moderate (n = 48) acidosis. Their laboratory findings, their intravenous infusion-, and insulin demand and the length of their hospital stay were compared. The state of consciousness at their hospitalisation and the concomitant complications were also examined. Significant difference was found only in the duration of intravenous insulin administration (with the exception of pH and BE, of course). There was no relationship between the seriousness of the disease and the duration of hospital treatment. It is noteworthy that even the previously known diabetic children with the shortest hospitalization spent more than 7 days at the department.
Multiple immune mediators have been mentioned as playing a role in the pathomechanism of type1 DM... more Multiple immune mediators have been mentioned as playing a role in the pathomechanism of type1 DM. Interleukin (IL)-1beta, and tumor necrosis factor (TNF)-alpha play a central role in the autoimmune destruction of pancreatic beta-cells, whereas IL-6 inhibits TNF-alpha secretion, and may have some protecting effects. In our study, we aimed to investigate the association between these three cytokines' single nucleotide polymorphisms (IL-6 gene G(-174)C, TNF-alpha gene G(-308)A and IL-1beta gene C(3954)T polymorphisms) and age-at-onset of type 1 diabetes mellitus (T1DM) in 165 diabetic children (median age: 17 years). Polymorphisms were determined using the PCR-RFLP method. We found that the age-at-onset of T1DM was significantly different in patients with a different IL-6 genotype (median age-at-onset of T1DM was: 8, 6 and 4.5 years in children with the (-174)GG, GC and CC genotypes, respectively; p < 0.01). Adjusted for TNF-alpha and IL-1beta polymorphisms, patients with a IL-6 (-174)CC genotype have a 3.0-fold (95% CI: 1.2-7.1) increased risk of developing diabetes before the age of 6 years than (-174)G allele carrier patients. However, we found this association to be present only in patients who carried the TNF-alpha (-308)A or IL-1beta (3954)T allele, i.e. in patients with high TNF-alpha and high IL-1beta producer genotypes. We suppose that in the case of high TNF-alpha and IL-1beta producer genotypes, elevated proinflammatory cytokine levels result in a higher production of IL-6 in (-174)G allele carrier patients. This elevated IL-6 level may have a protective effect against the development of T1DM and may delay the destruction of pancreatic beta-cells.
According to the most recent classification of diabetes mellitus the latent autoimmune diabetes i... more According to the most recent classification of diabetes mellitus the latent autoimmune diabetes in adults belongs to the group of type 1 autoimmune diabetes mellitus, as a slowly progressive form. It is not clear whether LADA is a distinct clinical entity or it is a part of the clinical spectrum of type 1 diabetes mellitus. The authors compare the antropologic (body mass index, waist to hip ratio), immunologic (occurrence of islet cell cytoplasmic autoantibodies and autoantibodies against glutamic acid decarboxylase and tyrosin phosphatase), genetic (HLA DR and DQ alleles known to be associated to type 1 diabetes mellitus) characteristics and occurrence of the features of the metabolic syndrome in the groups of type 1 and type 2 diabetes and LADA. 81 type 1 and 190 type 2 diabetics and 38 LADA patients were involved into the study. Freshly diagnosed type 1 diabetics served for controls of the autoantibody study: 48 patients manifested < or = 16 years of age and 89 type 1 diabetic...
Plasma and urinary concentrations of amino acids were investigated during diabetic ketoacidosis (... more Plasma and urinary concentrations of amino acids were investigated during diabetic ketoacidosis (DKA) and 12, 24, 72 hours after initiation of therapy. In DKA plasma concentration of glutamic acid, asparaginic acid, valine, leucine and isoleucine significantly increased while that of asparagine and glutamine decreased compared to levels in well controlled diabetic patients. Despite the elevated urinary excretion of branched chain amino acids, histidine, serine and threonine, urinary excretion and clearance of glutamic acid, glutamine, glycine and taurine were reduced. Among the different amino acids histidine excretion had the highest variability. Strong correlation was found between the urinary excretion of several amino acids and that of the beta-2-microglobulin characterizing tubular dysfunction. Changes in the excretion of different amino acids reflect the altered metabolic state and renal function due to diabetic ketoacidosis.
Csecsemő-és gyermekgyógyászat: 1. E. S. S. Tierney [et al.]: A béta-blokkoló-kezelés nem változta... more Csecsemő-és gyermekgyógyászat: 1. E. S. S. Tierney [et al.]: A béta-blokkoló-kezelés nem változtatja meg Marfan-szindrómás gyermekek aortagyök-tágulatát = Beta-blocker therapy does not alter the rate of aortic root dilatation in pediatric patients with Marfan syndrome Diabetológia: 1. J.-B. Du Prell - A. Icks - M. Grabert [et al.]: A szocioökonómiai háttér és a gyermekkori 1-es típusú diabétesz kapcsolatának vizsgálata Észak-Rajna Vesztfáliában, Németországban = Socioeconomic conditions and type 1 diabetes in childhood in North Rhine–Westphalia, Germany Mikrobiológia és fertőző betegségek: 1. D. Y. Hyun - D. L. Palazzi: Serdülő sternumának és olecranonjának brucellosisa = Brucellosis of the Sternum and Olecranon in an Adolescent Onkológia: 1. N. Mutrie [et al.]: Korai stádiumú mellrákos nők edzésprogramjának kedvező hatásai = Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial Reumatológia: 1. J. G. Boulton - J. T. Bourne: Rheumatoid arthritises és anti-TNF-α-val kezelt beteg labilissá vált diabétesze = Unstable diabetes in a patient receiving anti-TNF-α for rheumatoid arthritis Szív- és érbetegségek: 1. R. Belladinelli [et al.]: A mérsékelt edzés javítja a funkcionális kapacitást, az életminőséget, az endothelfüggő értágulást a krónikus szívelégtelen betegeken, akik beültetett cardioverter-defibrillátort kaptak, s akik reszinkronizációs kezelésben részesültek = Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilatation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therap
A szerző az új generációs bólusanalógok gyermek- és serdülőkorban történő alkalmazását ismerteti.... more A szerző az új generációs bólusanalógok gyermek- és serdülőkorban történő alkalmazását ismerteti. Leírja az élettani és farmakológiai hátteret, amely ezeknek a készítményeknek a fejlesztését szükségessé tette és ismerteti az oda vezető utat. Röviden leírja az első generációs bólusanalógok sajátosságait, majd részletesen kifejti a második generációs ultragyors hatású inzulinanalógok kémiai szerkezetét, legfontosabb farmakodinámiás és farmakokinetikei tulajdonságaikat. Részletesen ismerteti a gyermek- és serdülőkorban egyedül alkalmazható ultragyors hatású bólusanalóggal, a gyors aszparttal végzett klinikai vizsgálatok eredményeit. Röviden megemlíti azokat a készítményeket is, amelyek jelenleg még a kipróbálás fázisában vannak, de ebben a korosztályban egyelőre még nem alkalmazhatóak. A közleményt a szerző egy rövid jövőbe tekintéssel fejezi be.
Barkai László et al. Az MDT tevékenysége és jövőképe Diabetologia Hungarica | XXX. évfolyam 2. sz... more Barkai László et al. Az MDT tevékenysége és jövőképe Diabetologia Hungarica | XXX. évfolyam 2. szám 105 105 105 105 A gyermekdiabetológia helyzete, jövőbeli céljai 2022. június
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