Diabetes , Endocrine And Metabolism Pediatric Unit Research Articles

Growth hormone therapy response in children with short stature

BackgroundShort stature is one of the main causes of children referral to pediatric endocrinologists. Common etiologies include idiopathic growth hormone deficiency (IGHD), small for gestational age (SGA), and idiopathic short stature (ISS).ObjectivesThe aim of this study was to assess and compare the response of children with IGHD, ISS, and SGA to growth hormone (GH) therapy.MethodsThis was a mixed cohort study that included 40 children with short stature (classified into IGHD, ISS, and SGA) following up at Diabetes, Endocrine, and Metabolism Pediatric Unit (DEMPU), Cairo University Children’s Hospital. Ages ranged between 3 and 18 years. Recruited cases were evaluated for their 1-year response to GH therapy. In addition to history taking, physical examination, and anthropometric measurements, serum levels of IGF-1 were assayed at recruitment.ResultsAmong the 3 groups, height gain (cm/year) was significantly higher in the IGHD group (6.59 cm/year), followed by the ISS (4.63 cm/year) and SGA groups (4.46 cm/year) (p = 0.039). Using the Bang criterion for first-year responsiveness to GH therapy, most cases (30/40, 75%) were considered poor responders.ConclusionThere is a male predominance in children seeking medical advice for short stature. Starting GH therapy at an older age was associated with poor response. Children with IGHD respond better to GH therapy than those with ISS and SGA.

Categorization of differences of sex development among Egyptian children and the role of antimullerian hormone and inhibin B.

Differences of sex development (DSD) are congenital conditions linked to atypical development of chromosomal, gonadal, or anatomical sex. The aim of this study was to demonstrate our experiences at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU), Faculty of Medicine, Cairo University in the field of DSD by focusing on the clinical presentation, laboratory profile, classification, and etiological diagnosis of these conditions. In addition, the present study intended to delineate the importance of serum anti-Müllerian hormone (AMH) and inhibin B in detecting the presence of functioning testicular tissue. This cohort study included 451 infants and children with various clinical presentations of DSD. The study performed a retrospective analysis on medical records of established DSD cases to evaluate the clinical importance of AMH and inhibin B. In addition, newly diagnosed patients were prospectively analyzed. Three hundred thirty-six (74.5%) patients were 46,XY DSD, 98 (21.7%) were 46,XX DSD, 14 patients had other karyotypes and 3 had missing karyotypes. Among the 46XY DSD patients, the most common cause was partial androgen insensitivity. In contrast, congenital adrenal hyperplasia constituted the most common diagnosis in 46,XX DSD cases. The cut off value of serum AMH was 14.5 ng/ml with 100% sensitivity and 55.1% specificity. Partial androgen insensitivity was the most important cause of 46,XY DSD in Egyptian children, and congenital adrenal hyperplasia was the most common cause of 46,XX DSD. AMH was valuable in detecting functioning testicular tissue.

Clinical significance of serum gonadotropin and androgen levels among Egyptian overweight/obese pubertal girls.

Evaluate the association between overweight/obesity with serum gonadotropin and androgen levels in Egyptian pubertal girls. A case-control study carried out in "Obesity Clinic" of "Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU)", Pediatric Hospital, Cairo University. It included 40 overweight and obese girls and 40 age-matching normal weight (control) ones, aged 12-18 years. Anthropometric assessment (weight, height and hip and waist circumferences) was done, and waist/hip and BMI were calculated. Laboratory investigations: lipid profile, serum gonadotropin (LH, FSH), androgen (free and total testosterone), estradiol, insulin, and FBG were quantified, while insulin resistance (IR) was calculated. Hypogonadotropins (FSH and LH) and hyperandrogenaemia (total and free testosterone) were significantly prominent among obese girls. Correlation between gonadotropin, androgen and all of the studied variables, for the three studied groups (obese, overweight and control) revealed constant relations. Gonadotropin and androgens showed opposing correlations. Gonadotropin had significant negativ e correlations with the anthropometric parameters of obesity (BMI, Waist C, and W/H ratio), insulin, insulin resistance and lipid profile (triglycerides, total cholesterol and LDL), whereas androgens had significant positiv e ones. In addition, gonadotropin showed significant positiv e correlations with estradiol and HDL, while androgens showed significant negative ones. Overweight/obesity had no effect on the correlations between gonadotropin and androgen on one side, with the anthropometric measurements and laboratory investigations on the other one. Alterations in androgen levels occur at earlier ages than gonadotropin, among both overweight and obese girls.

CD4 CD25 T Cells in Children with Recent Onset Type 1 Diabetes

Abstract Background: Type 1 diabetes (T1D) results from T-cell-mediated autoimmune destruction of the insulin-producing pancreatic islet Beta cells. This breakdown of immunological self-tolerance results in auto reactivity to islet self-antigens. This requires genetic susceptibility as well as environmental factors (gene environmental interaction). It is believed that numerical and functional balance between killer cells (CD4+ and CD8+) and regulatory T-cells in the pancreatic infiltrate determines the extent of Beta cell destruction. Aim of Study: To study the number and function of Treg CD4+ CD25+ T-cells in infants and children with recent onset type 1 diabetes and to compare the results with the Treg CD4+ CD25+ T-cells in the siblings of the diabetic child and control subjects. Patients and Methods: This study was performed on60 patients meeting the diagnostic criteria of type I diabetes, together with 20 children of their non diabetic siblings were recruited at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU) at Cairo University Children’s Hospital in the period from December 2011 to October 2012. In addition to 20 children with age and sex-matched, none of whom had either a personal or family history of diabetes or other autoim-mune pathologies as control were included in the study. Results: Show no statistically significant relation of CD4 CD25 T-lymphocytes to age, anthropometric measures (weight & height), laboratory data including HBA1C, lipid profile or thyroid function tests, the insulin dose and the severity of the case presentation (whether classic onset or DKA). Also there was no statistically significant difference between the 3 groups (diabetic – non diabetic siblings – controls) regarding CD4CD25 T- lymphocytes levels by the one-way ANOVA test. Conclusion: The sensitivity of CD4 CD25 T-lymphocytes in case of type 1 diabetes was 60% and the specificity was 47%. The PPV (positive predictive value) and the NPV (neg-ative predictive value) were 55% and 67% respectively. Such results conclude that CD4 CD25 T-lymphocytes cannot be taken as a valid marker in case of type I diabetes.

Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt

Background and aimsTo determine the effect of high protein and high fat meals on post prandial glycemia in patients with type 1 diabetes. MethodsThis study included 51 children and adolescents with type 1 diabetes who were following up at Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Abo Elrish Children’s hospital, Cairo University.Post prandial blood glucose levels were recorded and compared following three breakfast meals with varying protein and fat content (standard carbohydrate meal, high fat meal, and high protein meal) over a period of 5 hours on 3 consecutive days. ResultsHigh protein meal resulted in hyperglycemia with the peak level at 3.5 hours and continued for 5 hours post prandial while high fat meal caused early hyperglycemia reached the peak at 2 hours then declined towards 5 hours.Comparison of the three different breakfast meals revealed statistically significant difference regarding the postprandial glycemia at 30, 60, 90,120, 180, 210, 240, 270, 300 min. ConclusionMeals high in protein caused sustained increase in postprandial glucose levels over a period of 5 h. However, high fat meals caused early postprandial hyperglycemia. Protein and fat content of meals affect the timing and values of the peak blood glucose as well as the duration of postprandial hyperglycemia. Therefore, fat/protein unit should be taken in consideration while calculating the bolus insulin dose and anticipating the postprandial glucose response.

Clinical characteristics and precipitating factor(s) associated with diabetic ketoacidosis presentation in children with newly diagnosed diabetes

Background. To compare the demographic and clinical characteristics of children with newly clinically diagnosed type 1 diabetes (T1DM) who presented with diabetic ketoacidosis (DKA) versus non DKA presentation and to identify the precipitating factor(s) related to progression to DKA. Methods. Over a 3 month period, 99 patients newly diagnosed with T1DM were recruited from Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Cairo University, with 53 patients presented with DKA and 46 were non DKA. Results. Polyuria, polydipsia, weight loss, polyphagia and nocturia were the most common symptoms preceding the diagnosis among the whole study group (93.8%, 92% and 80.8%, 76.8%, 46.5 % respectively) with no difference between DKA and non DKA groups. Delayed diagnosis occurred in 98.1% and 58.7% of DKA and non DKA groups respectively. In the DKA group the diagnosis of diabetes was missed in 69.8% and in 28.3% the initiation of insulin therapy was delayed despite diagnosis. Multivariate analysis performed to identify the most significant precipitating factor(s) associated with the development of DKA at diabetes diagnosis showed that delayed start of insulin therapy was the most significant factor (OR = 1.267, P value = 0.023). Conclusion. The prevalence of DKA is high among Egyptianchildren at diagnosis of type 1 diabetes. It is not only caused by misdiagnosis and mismanagement of diabetes, but also delayed initiation of insulin therapy in those diagnosed. This highlights the importance of increasing awareness concerning clinical features of diabetes in children and the urgency of insulin therapy among primary health care professionals and the community.

Assessment of health-related quality of life in Egyptian adolescents with type 1 diabetes: DEMPU survey.

Type 1 diabetes (T1D) is a serious chronic illness that imposes significant morbidity and mortality with a major impact on the quality of life (QoL) that became a core issue in diabetes care. Understanding the effect of diabetes on QoL is important for day-to-day clinical management and also for public health policy initiatives aiming at improving health outcomes for those with diabetes. The objective of the study was to assess the QoL in adolescents with T1D and assess the applicability of the use of the "Quality of Life for Youth" questionnaire at the Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU) clinic. One hundred and fifty adolescents (82 males and 68 females) (10-18 years), with T1D of at least 1 years' duration, completed the questionnaire that evaluated symptoms related to diabetes, treatment, activities, parent issues, worries about diabetes and health perception. Higher scores indicated a more negative impact of diabetes and poorer QoL. Males showed a significantly better mean QoL score than females (p=0.004). Different age groups showed different QoL scores (p=0.047). Urban adolescents had a better QoL than rural counterparts (p=0.02). Adolescents with poor QoL had generally lower educational level (p=0.02). Better metabolic control was associated with a better QoL (p=0.01). However, duration of diabetes and body mass index (BMI) had no statistically significant effect on QoL. QoL had a variable significant association with certain socio-demographic and clinical characteristics of diabetics (sex, residence, educational level as well as metabolic control).

Language Profile in Congenital Hypothyroid Children Receiving Replacement Therapy

Objective: The aim of this work was to evaluate receptive and expressive language skills in children with congenital hypothyroidism receiving early hormonal replacement treatment before the age of 3 months and to identify any subtle areas of weaknesses in their language development to check the necessity for future language intervention. Patients and Methods: The study was conducted on 30 hypothyroid children receiving hormonal replacement. They were subdivided into group I (5-8 years 11 months; 12 cases) and group II (9-12 years 11 months; 18 cases). All patients were subjected to a protocol of assessment applied in the Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU) and evaluation of language skills by the REAL scale. Results: The younger group reached average Arabic language scores, while the older group showed moderate language delay. Conclusion: Early replacement therapy supports language development in young children. However, longitudinal and follow-up studies are required to identify difficulties presenting at older ages that may affect children in the academic settings.

Dyslipidemia in type 1 diabetes mellitus: Relation to diabetes duration, glycemic control, body habitus, dietary intake and other epidemiological risk factors

BackgroundDiabetes is associated with a high risk of cardiovascular disease (CVD). The classic “diabetic dyslipidemia” is mostly described as hypertriglyceridemia and low levels of HDL-C. Elevated LDL-C is an established risk factor for CVD. ObjectiveIdentify the pattern of dyslipidemia in children and adolescents with type 1 diabetes mellitus regularly following at Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU) at Children’s Hospital of Cairo University; and to detect its relation to different risk factors. MethodsSixty children and adolescents with T1DM, (34 males and 26 females, mean age 12.5±2.4years and mean duration of diabetes 4.3±2.7years) were evaluated by full history and clinical examination including 3day dietetic history for analysis, BMI and waist circumference. Records were revised for mean blood glucose and HbA1c. Fasting lipid profile (total cholesterol, triglycerides, HDL-C and LDL-C) was performed. Thirty-nine healthy age and sex matched children were included as control for lipid profile. ResultsDyslipidemia significantly more frequent among T1DM children and adolescents compared to control subjects (39/60, 65% vs. 11/39, 28.2%, p<0.001); and the dyslipidemic (39/60) compared to normoalbuminuric (21/60) children had significantly higher mean waist circumference. Both groups were comparable regarding age, age at onset and duration of diabetes, family history of diabetes and CVD, degree of glycemic control and dietary analysis. ConclusionDyslipidemia is significantly more frequent in children and adolescents with T1DM compared to non-diabetic peers. The most frequent type of dyslipidemia was high LDL-C and low HDL-C in the dyslipidemic group.