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Vol’no-Nadezhdinskoye, Russia

Chobot A.,Clinical Hospital no. 1
Diabetologia Doswiadczalna i Kliniczna | Year: 2011

In the foetus, the predominant energy supply is glucose transported across the placenta from the mother. As pregnancy progresses, the amount of glucose transported increases, with glycogen and fat stores being laid down, principally in the third trimester. In the well-term baby, there is hormonal and metabolic adaptation in the perinatal period to ensure adequate fuel supply to the brain and other vital organs after delivery, but in the preterm infant, abnormalities of glucose homeostasis are common. After initial hypoglycemia, due to limited glycogen and fat stores, preterm babies often become hyperglycaemic because of a combination of insulin resistance and relative insulin deficiency. Hyperglycaemia is associated with increased morbidity and mortality in preterm infants, but what should be considered optimal glucose control, and how best to achieve it, has yet to be defined in these infants. Copyright © 2011 Via Medica.

Hyperglycemic hyperosmolar syndrome (HHS) is one of the most severe acute complications of type 2 diabetes, but may also be developed in type 1 diabetes. Similar to ketoacidosis, HHS still remains one of the major causes of morbidity and mortality in patients with diabetes, despite a significant progress in understanding its pathogenesis and greater consensus on HHS diagnosis and treatment. It is mainly observed in elderly patients with type 2 diabetes. However, it may also occur in children, especially in infants and those with concomitant central nervous system (CNS) defects or suffering from severe infections associated with dehydration. The authors report a case of HHS in a 20-month-old child with central nervous system abnormality. Symptoms observed in our patient are characteristic for HHS. It must be emphasized that HHS may accompany diabetes onset also in children.

Malikov V.E.,Russian Academy of Medical Sciences | Arzumanyan M.A.,Russian Academy of Medical Sciences | Donetskaya O.P.,Clinical Hospital no. 1
Cardiovascular Therapy and Prevention (Russian Federation) | Year: 2011

Aim: To investigate the associations between the severity of inflammatory reaction and bio-energetic insufficiency development in patients with coronary heart disease (CHD) and reduced cardiac contractility; to assess the effectiveness of the pharmacological correction of these disturbances.Material and methods: This randomised, controlled study included 92 CHD patients (mean CHD duration 5,4±4,8 years) with effort and rest angina, Stage II-III arterial hypertension, and cardiac arrhythmias and blocks of various aetiology. The control group (CG) received standard treatment, while the main group (MG) was also administered a cardio-tonic and cardio-protective medication, adenocin, for 10-14 days. Venous blood levels of pro- and anti-inflammatory cytokines, aldosterone, and redox NAD/NADH potential were measured.Results: Adenocin treatment was associated with an improvement in chronic heart failure (CHF) symptoms, cardiac remodelling regression, increased velocity of circular shortening of myocardial fibres, increased ejection fraction (EF), and normalised diastolic function. The improvement in intra-cardiac hemodynamics correlated with increased plasma NAD/NADH potential. In the CG, the summary ratios of pro- and anti-inflammatory cytokine levels did not change, while in the MG, they nearly halved after the treatment course.Conclusion: Myocardial remodelling regression, induced by adding adenocin to the complex therapy of CHD patients with CHF and left ventricular dysfunction, was associated with improved cardiac geometry, systolic and diastolic function, increased redox potential, and reduced maladaptation of immune and inflammatory reactions.

Stanczyk J.,Out Patients Diabetes Clinic | Chobot A.,Clinical Hospital no. 1 | Polanska J.,Silesian University of Technology
International Journal of Diabetes in Developing Countries | Year: 2014

Transition from pediatric to the adult care system is an important issue for diabetes management. The objective was to evaluate the transition of young adults with type 1 diabetes (T1DM) from pediatric to adult diabetes care. Questionnaires were sent to all T1DM patients (166), who left pediatric diabetes care in Katowice, Poland (2003–2007). Analyzed parameters included: date of first visit and visit frequency in adult care, HbA1c (mean and final at pediatric care, HbA1c_M and F respectively, reported in questionnaire – HbA1c_Q), and history of acute complications. 132(82.5 %) responses were received. 96(73 %) patients undertook their first visit at adult clinic ≤3 months after finishing pediatric care, 8(6 %) – after 4-6 months, 10(7 %) >6 months, and 12(9 %) remained under the observation of a GP. Subgroup >6 months differed significantly by HbA1c_Q from the <3 months subgroup (10.5 ±3.34 vs. 7.53 ±1.50, P = 0.041). The later the patients take up adult care, the less often they attend visits (P < 0.001). Visit frequency also decreased with age and diabetes duration (P = 0.034 and P = 0.032 respectively). Additionally, patients with fewer visits annually, at all times had poorer glycemic control (HbA1c_M: P = 0.015; HbA1c_F: P = 0.016; and HbA1c_Q: P = 0.012). Changes of HbA1c(d = HbA1c_Q-HbA1c_F) were higher in patients treated with insulin pump therapy compared to multiple daily injections (0.77 ± 1.65 vs. -0.06 ± 1.84; P = 0.045). Nearly 25 % of young adults with T1DM discontinue systematic specialist care after transfer in adult clinics. Patients with poorer glycemic control and fewer visits during pediatric care, as well as those treated with a personal insulin pump, require additional attention during the transition process. © 2014, Research Society for Study of Diabetes in India.

Chobot A.,Clinical Hospital no. 1 | Polanska J.,University of Silesia | Deja G.,University of Silesia | Jarosz-Chobot P.,University of Silesia
Acta Diabetologica | Year: 2015

Aims: The incidence of pediatric type 1 diabetes mellitus (T1DM) in Poland is intermediate relative to the rest of the world. T1DM prevalence in the region of Silesia approximates national estimates for all of Poland. This epidemiologic study aimed to analyze the changes in incidence rates of T1DM among children ages 0–14 years from 1989 to 2012 in this region. Methods: Data collection methods for the registry followed EURODIAB criteria. To estimate overall population size, data from the Central and regional Statistical Office in Katowice were used. T1DM incidence rates/100,000 children ages 0–14 years/annum and their 95 % CI were calculated for all children and in age subgroups (0–4, 5–9, 10–14 years). For comparative analysis incidence rates were age and sex standardized to the population of Poland in 2005. For statistical analyses open source R Bioconductor software was used. Results: During this 24-year period, 2,215 new cases (1,146 boys) were diagnosed. The standardized incidence rate rose about 7 % annually. The mean standardized incidence rates estimated in four 6-year time periods (1989–1994, 1995–2000, 2001–2006, 2007–2012) separately showed significant increases from 5.80/100,000/year (1989–1994) through 10.44/100,000/year (1995–2000) and 15.05/100,000/year (2001–2006) to 18.94/100,000/year (2007–2012). From 1989 to 2012, the greatest relative rise in annual incidence (/100,000/year) was among the very young: 2.58–14.00 (0–4 years); 4.96–19.43 (5–9 years); 8.84–22.15 (10–14 years). The highest average annual increment of the incidence rate was in the middle age subgroup (5–9 years). No significant sex difference was observed. Conclusions: The overall incidence rate increased 3.8 times, suggesting an epidemic of pediatric T1DM in Silesia, Poland. These temporal changes confirm that Poland currently has one of the highest incidence rates of pediatric T1DM in Europe. © 2014, Springer-Verlag Italia.

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