Pediatric Endocrinology, Diabetes and Metabolism最新文献

Introduction: Overweight and obesity are an increasing public health problems in children. Currently, attempts are being made to identify differential markers between metabolically healthy individuals (MHO) and metabolically unhealthy children (MUHO). This study aimed to evaluate the differences in uric acid (UA) levels in children with overweight or obesity classified according to their metabolic phenotype using the 2018 Damanhoury criteria.

Material and methods: Retrospective cross-sectional study, included children aged 5-18 years who were evaluated at a pediatric endocrinology outpatient clinic. Eighty patients were evaluated; 36 were classified as MHO and 44 as MUHO according to the levels of triglycerides (TG), glucose, high-density lipoprotein cholesterol (HDL-C) and blood pressure. The mean difference in uric acid levels was evaluated using Student's t-test. In addition, three insulin resistance index and their possible relationships with UA levels were analyzed.

Results: The mean age was 11.6 years (SD 3.2 years). Uric acid levels showed a statistically significant difference between the MUHO group (mean 5.4 mg/dl -1.3 SD) and the MHO group (mean 4.5 mg/dl -1.4 SD) (p = 0.0069). A moderate positive correlation was found between uric acid levels and TyG ratio (correlation 0.4137) and TG/HDL index (0.3813).

Conclusions: Uric acid levels were higher in MUHO patients and correlated with insulin resistance indexes. These findings could be used as metabolic risk markers for the evaluation of children with overweight/obesity.

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder marked by hyperglycemia due to impaired carbohydrate metabolism. GLUT-2 , a key glucose transporter, regulates glucose homeostasis and insulin secretion. Medicinal plants, such as fig leaves ( Ficus carica L .), have shown potential as antidiabetic agents.

Aim of the study: To evaluate the effect of fig leaf extract on GLUT-2 expression in pancreatic β and hepatic cells, as well as fasting blood glucose (FBG) levels in Wistar rats induced with streptozotocin and nicotinamide (STZ-NA).

Material and methods: Thirty-six male Wistar rats were divided into six groups. Treatment groups received fig leaf extract at doses of 300, 500, and 700 mg/kg body weight for a period of two weeks. A glimepiride-treated group served as the positive control. Fasting blood glucose levels were measured before and after treatment. GLUT-2 expression was assessed using ELISA.

Results: Fig leaf extract significantly reduced FBG levels and increased GLUT-2 expression in both pancreatic and hepatic cells. However, these effects were not statistically significant when compared to the control group. Higher extract doses showed greater trends toward glycemic improvement.

Conclusions: Fig leaf extract may have beneficial effects in lowering FBG and enhancing GLUT-2 expression in STZ-NA-induced diabetic rats. The data on glucose levels suggest a statistically insignificant trend toward decreased glucose levels. Although the observed improvements were not statistically significant, the trends suggest potential antidiabetic activity, particularly at higher doses. The lack of significance may be attributed to the dosage of the extract used in this study.

Introduction: Insulin is primarily known for its role in glucose homeostasis regulation. Since the discovery that insulin crosses the blood-brain barrier (BBB) in the year 1954, the influence of insulin on the central nervous system (CNS) has been under continuous research.

Aim of the study: The aim of this paper is to review the current knowledge about the effects of insulin on CNS function in the pediatric population with special attention to diabetes type 1.

Material and methods: The PubMed and Cochrane search engines were used in the data searching process.

Conclusions: Recent studies have shown that insulin has substantial glycemic and non-glycemic effects on the human brain. In pediatric populations, insulin's non-glycemic effects on CNS function are of particular interest due to the critical role of insulin in brain development, cognitive maturation, and learning. Therefore, children and adolescents with diabetes type 1 (T1DM), resulting in insulin deficiency and dysregulated glucose metabolism, require special attention.

Conclusions: While insulin therapy is essential for glycemic control in pediatric patients with T1DM, researchers suggest that insulin also has a crucial effect on the central nervous system (CNS), which may have implications for neurodevelopment and cognitive function in this group of patients.

Continuous glucose monitoring (CGM) systems have revolutionized diabetes management by providing real-time glycemic data, improving control, and reducing the risk of both acute and chronic complications. With an increasing range of CGM systems available on the market, selecting the most appropriate system has become a challenge for both patients and healthcare professionals. This narrative review aims to analyze the available CGM systems and identify the factors that influence the personalized selection of a CGM system for patients with diabetes, based on system functions and features. Factors influencing CGM choice are discussed, including patient age, fear of puncture, physical activity, aesthetics, and financial considerations.

Introduction: To characterise severe hypertriglyceridaemia (HTG) in Indian children, focusing on clinical and genetic profiles.

Material and methods: A retrospective analysis from January 2017 to December 2023 included children up to 14 years old with triglyceride (TG) levels > 500 mg/dl, excluding children with known secondary causes.

Results: Among 18 children with severe HTG, 7 had secondary causes. Data from 11 patients (7 boys, median age at diagnosis 0.9 [0.45-2.4] years) revealed presenting features such as lipemic serum (63.3%), failure to thrive (36.3%), loss of subcutaneous fat (18.2%), and abdominal distension (18.2%). Genetic aetiology was identified in 10 cases, with familial chylomicronaemia syndrome (FCS) being the most prevalent (6 cases) caused by the lipoprotein lipase (LPL) and apolipoprotein A-V (APOA5) gene mutations. One each had mutations in the 1-acylglycerol-3-phosphate O-acyltransferase 2 (AGPAT2), lamin A/C (LMNA), glucose-6-phosphatase catalytic subunit (G6PC), and glycerol kinase (GK) genes. FCS patients presented earlier and were resistant to treatment targets, requiring drug therapy. At the final follow-up (mean duration 1.75 ±1.0 years) of 9 patients, the median TG levels for the FCS and non-FCS groups were 1240 (610-1,685) and 412 (247.5-993) mg/dl, respectively. Only 2 patients (40%) with FCS had TG levels < 1000 mg/dl, while all but one (75%) non-FCS subjects had TG levels < 500 mg/dl at the last follow-up. One child developed acute pancreatitis during the said duration.

Conclusions: Paediatric HTG is often detected incidentally. Genetic characterisation is crucial for prognosis because baseline TG levels are non-predictive. Drug therapy helps to reach treatment targets in most of the patients.

Introduction: Excessive growth syndromes are a heterogeneous group of rare congenital disorders characterized by increased body size from the neonatal period or early childhood. In addition to accelerated growth, these conditions frequently co-occur with dysmorphic features and other medical problems, including intellectual disability, organ defects, and an increased risk of cancer. The objective of this study is to present a comprehensive overview of selected dysmorphic syndromes associated with excessive growth, with particular emphasis on syndromes with confirmed or strongly suspected monogenic etiology. The following aspects are discussed in this text: the pathogenesis of the condition, its inheritance, the characteristic clinical symptoms, the diagnostic approach, and the potential treatment options.

Material and methods: A comprehensive analysis of data pertaining to syndromes of excessive growth, accompanied by either a recognized or postulated monogenic basis, was conducted based on scientific literature. A particular emphasis was placed on the examination of endocrinological, oncological, and prognostic aspects. The usefulness of genetic testing in the diagnostic process was also evaluated.

Results: A number of excessive growth syndromes were identified, including Sotos syndrome, Beckwith-Wiedemann syndrome, Simpson-Golabi-Behmel syndrome, Bannayan-Riley-Ruvalcaba syndrome, Marshall-Smith syndrome, Weaver syndrome, Nevo syndrome, and Elejalde syndrome. Clinical symptoms, prevalence of endocrine disorders, and risk of developing cancer were meticulously documented. Following a thorough analysis, a set of diagnostic schemes and indications for monitoring selected complications were proposed.

Conclusions: The diagnosis of overgrowth syndromes is a complex process that requires a meticulous clinical evaluation and the application of contemporary genetic methodologies. Early identification of characteristic phenotypic and molecular features facilitates prompt implementation of appropriate treatment and monitoring of complications. The adaptation of therapeutic strategies to a specific syndrome and patient is pivotal to improving prognosis.

Juvenile osteoporosis is an increasingly recognized long-term complication in pediatric oncology. While advances in cancer therapy have improved survival, aggressive treatment protocols - chemotherapy, glucocorticoids, radiotherapy, surgery - often disrupt skeletal development during key phases of bone accrual. This review outlines the multifactorial pathophysiology of therapy-induced bone loss in children with cancer. The imbalance between bone formation and resorption is driven by inflammation, oxidative stress, hormonal deficits and direct drug toxicity. Agents such as methotrexate and glucocorticoids impair osteoblast function and enhance osteoclastogenesis. Endocrinopathies - particularly hypogonadism and growth hormone deficiency - further compromise peak bone mass acquisition. Compounding these effects are post-treatment nutritional deficits, physical inactivity, and psychological fatigue. Many survivors consume high-fat, low-nutrient diets and avoid exercise, worsening musculoskeletal health. These behaviors often stem from insufficient rehabilitation support and emotional exhaustion, perpetuating deconditioning and elevating fracture risk. Genetic factors are also implicated. Mutations in low-density lipoprotein receptor-related protein 5 (LRP5) and estrogen receptor 1 (ESR1) are associated with reduced bone mineral density in pediatric patients. Diagnosis is complicated by evolving pediatric criteria for bone density and growth-related variability in biomarkers. Nonetheless, early identification and continuous monitoring are essential. Interventions such as individualized physical activity programs, nutritional repletion, endocrine evaluation, and bisphosphonate therapy may counteract skeletal decline. In conclusion, secondary osteoporosis in pediatric cancer survivors reflects a convergence of oncologic, metabolic, behavioral, and genetic factors. Effective management requires early, multidisciplinary strategies targeting modifiable risks and predictive markers to preserve bone integrity and improve long-term quality of life.

This article examines the legal and ethical obligations of physicians towards minor patients with type 1 diabetes in situations where their legal representatives hinder or prevent treatment. This issue is gaining importance in the context of the observed increase in parents forgoing insulin therapy or follow-up visits in favor of alternative medicine. In such situations, physicians face a dilemma: how to reconcile the parents' right to decide on their child's treatment with their own obligation to protect the child's life and health. The study discusses the scope of physicians' obligations under the law, with particular emphasis on civil and criminal law, including the requirement to notify the family court. It also emphasizes the importance of taking conciliatory measures - such as a written request for the guardian to attend a visit with the child - as a form of early intervention before notifying the authorities. The conclusions point to the need to develop clear procedures for intervention in cases of minor patients with chronic diseases failing to report, to strengthen interinstitutional cooperation, and to provide health education for parents. The article aims to show that the physician's responsibility in such cases goes beyond the medical sphere - it also includes the obligation to respond legally and ethically to a threat to the child's well-being. The article draws on legal provisions and legal acts relevant to the issue under study. Legal literature, including commentaries and scholarly articles, was also analyzed. Documents and materials relevant to the topic were also considered. The study was conducted using a dogmatic method, allowing for a systematic interpretation of legal provisions. A literature review was also employed to organize the positions of the doctrine. Additionally, elements of comparative analysis of available sources were employed to better understand the issues under investigation.

Introduction: Meliponine honey, derived from stingless bees, has significant therapeutic potential due to its bioactive compounds, such as polyphenols and flavonoids, which contribute to its antioxidant and antidiabetic properties. However, the variations in honey quality based on bee species and geographical origin still require further exploration to maximize its benefits. This study aimed to evaluate the variations in antioxidant and antidiabetic properties of meliponine honey based on stingless bee species and their geographical origins.

Material and methods: This scoping review follows the Joanna Briggs Institute methodology, including a comprehensive literature search in major scientific databases such as PubMed, Scopus, DOAJ, Wiley Online, and Google Scholar. Data from relevant studies were extracted and analyzed using a thematic synthesis approach to identify patterns in the bioactivity of Trigona honey.

Results: A total of 23 articles met the inclusion criteria. The analysis revealed that the antioxidant properties of meliponine honey are influenced by phenolic and flavonoid content, which vary according to geographical origin, local flora, and bee species. The antidiabetic activity of the honey is associated with its ability to inhibit a-amylase and a-glucosidase enzymes and enhance insulin release. Honey from regions such as Kalimantan and Sarawak exhibited higher bioactive content compared to other areas.

Conclusions: Meliponine honey is a promising natural therapeutic agent for diabetes management, with its bioactive quality influenced by bee species, geographical origin, and botanical sources. This study supports further development to optimize the benefits of meliponine honey through holistic approaches and broader clinical trials.