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Acute Bilateral Cataract in Type 1 Diabetes Mellitus. 1型糖尿病并发急性双侧白内障。
Pub Date : 2015-01-01 Epub Date: 2015-10-02 DOI: 10.6084/m9.figshare.13251911.v1
Dimitrios T Papadimitriou, Christina Bothou, Filippos Skarmoutsos, Vassiliki Papaevangelou, Anastasios Papadimitriou

We report a case of a 17-year old boy, who presented acute bilateral cataract and complete vision loss within six days, three months after the diagnosis of Type 1 Diabetes Mellitus (T1DM) under optimal metabolic control (HbA1c 6%). At presentation (HbA1c 10.4%) and after correction of diabetic ketoacidosis (pH 6.917) and the beginning of intensified insulin treatment with insulin glargine once daily and insulin aspart before meals,the patient underwent full ophthalmologic examination,which was completely normal. Only few cases with acute bilateral cataract - all relatively shortly after the diagnosis of T1DM - have been reported. Several hypotheses have been drawn but the exact mechanism of this phenomenon remains unclear. The interesting finding in our case was the clearly elevated insulin autoantibodies (IAA) at the time of cataract formation, negative however at presentation. The relation between the elevation of IAA and cataract formation should be further investigated in diabetic patients.

我们报告一例17岁的男孩,在最佳代谢控制(HbA1c 6%)下诊断为1型糖尿病(T1DM)后3个月,6天内出现急性双侧白内障和完全视力丧失。患者就诊时(糖化血红蛋白10.4%),糖尿病酮症酸中毒(pH值6.917)纠正后,开始强化胰岛素治疗,每日1次甘精胰岛素,餐前分开胰岛素,患者行全面眼科检查,完全正常。只有少数病例的急性双侧白内障-所有相对较短的诊断T1DM -已被报道。人们提出了几种假设,但这种现象的确切机制尚不清楚。本病例有趣的发现是在白内障形成时胰岛素自身抗体(IAA)明显升高,但在就诊时呈阴性。糖尿病患者IAA升高与白内障形成的关系有待进一步研究。
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引用次数: 3
The Role of Vitamin D in Pediatric Asthma. 维生素D在儿童哮喘中的作用。
Pub Date : 2015-01-01
Selene K Bantz, Zhou Zhu, Tao Zheng

The detrimental effects of vitamin D deficiency in pediatrics have become increasingly apparent and extend beyond skeletal health. Unfortunately, vitamin D deficiency is highly prevalent in atopic pediatric patients, in whom it may disrupt the immune system and induce significant worsening of reactive airways. This review presents evidence that lung development and immune regulatory functions are vitamin D-dependent. We also review clinical studies that explore how vitamin D supplementation may prevent respiratory infections and help improve asthma control, and we elaborate how these effects may vary among populations. We reveal the strong need of screening measures for vitamin D deficiency in high risk pediatric populations, particularly African-Americans, Hispanic-Americans, and children with obesity. Finally, we emphasize that all children, especially those who are asthmatic, should be assessed to ensure adequate intake or supplementation with at least the minimum recommended doses of vitamin D. The simple intervention of vitamin D supplementation may provide significant clinical improvement in atopic disease, especially asthma.

儿科维生素D缺乏的有害影响已经变得越来越明显,并且超出了骨骼健康的范围。不幸的是,维生素D缺乏症在特应性儿科患者中非常普遍,在他们中,维生素D缺乏症可能会破坏免疫系统,导致反应性气道严重恶化。本文综述了肺部发育和免疫调节功能依赖维生素d的证据。我们还回顾了探索补充维生素D如何预防呼吸道感染和帮助改善哮喘控制的临床研究,并详细说明了这些效果在人群中的差异。我们揭示了对高危儿童人群,特别是非洲裔美国人、西班牙裔美国人和肥胖儿童进行维生素D缺乏筛查的强烈需求。最后,我们强调,所有儿童,特别是哮喘儿童,都应该进行评估,以确保摄入或补充至少最低推荐剂量的维生素D。补充维生素D的简单干预可能会对特应性疾病,特别是哮喘,提供显着的临床改善。
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引用次数: 0
Underlying Rationale and Approach to Treat Hypertension in Adolescents by Physicians of Different Specialty. 不同专科医师治疗青少年高血压的基本原理和方法。
Pub Date : 2013-01-01
Esther Y Yoon, Julie S Weber, Brigitte McCool, Albert Rocchini, David Kershaw, Gary Freed, Frank Ascione, Sarah Clark

Objective: To describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with hypertension.

Methods: We conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each participant was asked to "think aloud" regarding their approach to a hypothetical patient - 12 year old boy with persistent hypertension for 6 months. Standardized open-ended questions about potential factors that could affect physicians' diagnosis and treatment strategies (e.g., patient age) were used. Interviews were audio-recorded; transcribed verbatim; transcripts were independently coded by 2 investigators; emergent themes identified and inter-coder agreement achieved. Thematic analysis was performed based on grounded theory.

Results: Nineteen participants included 5 general pediatricians, 5 pediatric cardiologists, 5 pediatric nephrologists and 4 family physicians. Five themes emerged: 1) Accuracy of blood pressure measurement and hypertension diagnosis, 2) Shift in the epidemiology of pediatric hypertension from secondary to primary hypertension, 3) Patient characteristics considered in the decision to initiate workup, 4) Obesity-centered choice of diagnostic tests and lifestyle modifications, and 5) Variable threshold for initiating antihypertensive pharmacotherapy vs. referral to hypertension specialists.

Conclusions: There is variation across primary care and specialty physicians who provide care for children and adolescents with hypertension. Key areas of variability include the willingness to initiate antihypertensive medications, the use of diagnostic tests (e.g., ambulatory blood pressure monitoring), and the perceived need for specialty referral. Further study is needed to assess whether different treatment paradigms result in differential patient outcomes.

目的:描述普通儿科医生、家庭医生、儿科心脏病专家和儿科肾病专家在治疗青少年高血压时的潜在临床决策依据。方法:采用半结构化电话访谈的方法,方便抽取上述4个专科的医师。每个参与者都被要求“大声思考”他们对一个假设病人的方法——一个患有持续高血压6个月的12岁男孩。使用了关于可能影响医生诊断和治疗策略的潜在因素(如患者年龄)的标准化开放式问题。采访录音;转录逐字;转录本由2名调查员独立编码;确定了紧急主题并达成了编码间协议。在扎根理论的基础上进行主题分析。结果:19名被试包括5名普通儿科医生、5名儿科心脏科医生、5名儿科肾病科医生和4名家庭医生。出现了五个主题:1)血压测量和高血压诊断的准确性;2)儿童高血压的流行病学从继发性到原发性高血压的转变;3)决定开始检查时考虑的患者特征;4)以肥胖为中心的诊断测试和生活方式改变的选择;5)开始抗高血压药物治疗与转诊高血压专家的不同阈值。结论:在为患有高血压的儿童和青少年提供护理的初级保健和专科医生之间存在差异。关键的可变性领域包括开始使用降压药物的意愿、诊断测试的使用(例如,动态血压监测)以及认为需要专科转诊。需要进一步的研究来评估不同的治疗模式是否会导致不同的患者预后。
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引用次数: 0
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Annals of pediatrics & child health
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