Nail fold microangiopathy in adolescents with type 1 diabetes: Relation to diabetic vascular complications.

OBJECTIVES: Microangiopathy is implicated in the pathogenesis of diabetic vascular complications. Nail fold videocapillaroscopy (NVC) is an easy non-invasive tool of microvasculature assessment. This study compares the NVC changes in adolescents with Type1 diabetes (T1D) to healthy controls and correlates them to diabetic vascular complications. METHODS: Hundred thirty-five adolescents with T1D (disease duration 5 years) were compared to 135 matched controls. Diabetes duration, insulin therapy, fundus, and Toronto clinical scoring system (TCSS) were assessed. Fasting lipids, fraction-C of glycosylated hemoglobin (HbA1C), urinary albumin creatinine ratio (UACR), nerve conduction velocity, and NVC were performed. RESULTS: NVC changes were found in 120 adolescents with T1D (88.8%). These changes were significantly higher in adolescents with T1D than controls (p < .001). Significant positive relation was found between NVC changes and TCSS (p = .006), diabetes duration (p = .001), HbA1C (0.008), cholesterol (p = .011), LDL (0.016), UACR (p < .001), and nerve conduction velocity (p < .001). Multivariate logistic regression study revealed that diabetic nephropathy and neuropathy were independently associated with NVC changes (p < .001 and p = .007, respectively). CONCLUSION: Adolescents with T1D have significantly higher NVC changes than controls. These changes were more evident in those having vascular complications than those without. Thus, NVC can be a potential non-invasive tool for early assessment and follow-up of the microvasculature among adolescents with T1D.

Group A beta-hemolytic streptococcal pharyngitis and carriage rate among Egyptian children: a case-control study.

BACKGROUND: Improper prescription of antibiotics for treatment of acute pharyngitis predisposes to emergence of a carrier state and antibiotic-resistant strains of group A streptococci (GAS). We sought to identify the frequency and antimicrobial susceptibility patterns of group A streptococci among Egyptian children with acute pharyngitis compared with asymptomatic children. DESIGN AND SETTING: Case-control study conducted from September 2013 to August 2014 at a pediatric outpatient clinic in Egypt. PATIENTS AND METHODS: Throat swabs were collected from children with acute pharyngitis and from asymptomatic children. We evaluated the accuracy of McIsaac scores and the rapid antigen detection test (RADT) for diagnosis of GAS pharyngitis with throat culture as a reference test. Antimicrobial susceptibility testing of GAS isolates was done by the disc diffusion method. RESULTS: Of 142 children with acute pharyngitis (cases) and 300 asymptomatic children (controls) (age range, 4-16 years), GAS pharyngitis was diagnosed in 60/142 children (42.2%); 48/300 (16%) were found to be carriers. All GAS isolates in the case group were sensitive to penicillin; however, an MIC90 (0.12 micro g/mL) for penicillin is high and an alarming sign. The resistance rate to macrolides was 70% with the cMLSB phenotype in 65.1%. The sensitivities and specificities were 78.3% and 73.2% for McIsaac score of >=4 and 81.1% and 93.9% for RADT, respectively. GAS isolates in the control group were 100% sensitive to penicillin, while 12.5% and 37.5% were resistant to macrolides and tetracycline, respectively. CONCLUSION: An increased MIC90 for GAS isolates to penicillin is an alarming sign. A high frequency of resistance to macrolides was also observed.

Romiplostim in children with chronic refractory ITP: randomized placebo controlled study.

Romiplostim stimulates thrombopoietin receptor to increase platelet production of megakaryocytes in idiopathic thrombocytopenic purpura (ITP). This study aimed to evaluate the safety and efficacy of romiplostim in children with chronic ITP. Eighteen patients with chronic ITP, either none responsive or failed to maintain response on two or more therapeutic modalities, were enrolled. Patients were randomized (2:1) to receive romiplostim or placebo for 12 weeks, initiated at 1 µg/kg/week, escalated to 5 µg/kg/week, and then tapered. Median patients' age was 8.5 years, and the median baseline platelet count (PC) was 10.5 × 10(9)/L. The median weekly dose of romiplostim was 2 µg/kg. Fifty percent of patients in both romiplostim and placebo arms had at least one adverse event (AE); none was serious. Ten patients on romiplostim (83.3%) maintained the efficacy endpoint (PC > 50,000). Romiplostim was well-tolerated and efficient in treating the children with chronic refractory ITP with no unexpected AEs.