Incidence of type 1 diabetes in Chilean children between 2006 and 2021: significant increase during the COVID-19 pandemic.

AIMS: An increase in type 1 diabetes (T1D) incidence has been observed in several countries during the COVID-19 pandemic. The objective of this study is to determine T1D incidence trends in Chilean children between 2006 and 2021, and specifically evaluate the effect of the COVID-19 pandemic in this population. METHODS: We reviewed mandatory notifications of T1D in Chile's public and private health system in youth < 20 years between 2006 and 2021, and compared COVID-19 pre-pandemic and pandemic incidence. RESULTS: In Chile, 9472 new T1D cases in children were confirmed between 2006 and 2021. The mean annual T1D incidence in the entire period was 12.7/100,000 inhabitants, with an incidence of 11.7/100,000 between 2006 and 2019 vs. 20.2/100,000 during 2020-2021 (ß = 0.691, [95%CI 0.479-0903], p < 0.001.) The highest incidence was observed in the 10-14 years age group, but a significant increasing incidence was observed in all age groups. The second year of the COVID-19 pandemic, 2021, had the highest incidence rate of the study period. While a 5% mean annual increase was observed between 2006 and 2019, in 2021 the T1D incidence jumped 28.5% compared with the two previous years. We found a higher T1D incidence in population with private insurance than public insurance (14.8 vs. 11.7/100.000, respectively, RR = 1.26 [95%CI 1.03-1.53], p < 0.027). CONCLUSIONS: T1D incidence rates in Chilean youth doubled between 2006 and 2018, subsequently presenting a striking increase during the COVID-19 pandemic.

Acid dissolution of ultrathin glass-ceramic and its correlation with flexural strength.

STATEMENT OF PROBLEM: When glass-ceramics are treated with hydrofluoric acid (HF), not only the area of application is affected but also other surfaces. Information regarding the correlation of the dissolution caused by HF and the flexural strength of the ceramic is lacking. PURPOSE: The purpose of this in vitro study was to investigate the effect of HF etching protocols on the flexural strength of 2 glass-ceramics, the correlation of their flexural strength with the internal and lateral dissolution, and the differences in Weibull characteristics concerning the etching protocols. MATERIAL AND METHODS: Specimens (4×12×0.3mm) of leucite-reinforced glass-ceramic-LEU (IPS Empress) and of lithium disilicate-reinforced glass-ceramic-LD (IPS e.max) were prepared. The specimens were divided into 5 groups (n=12) according to etching protocol: control-untreated; hydrofluoric acid (HF) 5% for 20 seconds (HF5%20s); HF5%60s; HF10%20s; and HF10%60s. Flexural strength was evaluated through 3-point bend testing. The fractured specimens were submitted to a morphological and metrical analysis of each pattern (LEU I-IV, LD I-III) on the lateral surface (LS) and of the dissolution areas (µm2) on the internal surface (IS) using a scanning electron microscopy (SEM) and a software program (FIJI). Flexural strength (MPa) values were analyzed by 1-way ANOVA, Bonferroni test, and Weibull and the correlation between flexural strength and dissolution by Pearson correlation coefficient (α=.05). RESULTS: ANOVA revealed that the HF etching protocol was significant (P<.001) for LEU ceramic. When HF10%60s was applied, LEU showed Weibull characteristic strength (σθ) values lower than those of the other protocols. LD showed no difference in σθ and reliability (m) among the groups. The internal dissolution areas concerning LEU had a significant high negative correlation with the flexural strength (r=-0.6; P<.001). LEU-IV on the LS was the only pattern to show a significant decrease in flexural strength (r=-0.3, P<.05). CONCLUSIONS: Special care should be taken when applying hydrofluoric acid on glass-ceramic restorations. Protocols with higher hydrofluoric acid concentrations and longer application times were more related to greater internal areas of dissolution which reduced the flexural strength of leucite ceramics.

Dissolution Depth and Surface Morphological Alterations in Ultrathin Glass Ceramic Etched with Different Hydrofluoric Acid-etching Protocols.

PURPOSE: To evaluate the effect of different HF-etching protocols on the dissolution depth and micromorphology of the etched and adjacent surfaces of ultrathin glass-ceramic specimens. MATERIALS AND METHODS: One hundred twenty specimens (6 x 6 x 0.3 mm) of leucite-reinforced glass-ceramic (LEU, IPS Empress, Ivoclar Vivadent) and lithium-disilicate-reinforced glass-ceramic (LD, IPS e.max, Ivoclar Vivadent) were prepared. Specimens were divided into 5 groups (n = 12) according to etching protocol: G1: control, untreated; G2: 5% hydrofluoric acid (HF) etching for 20 s (HF5%20s); G3: HF5%60s; G4: HF10%20s; and G5: HF10%60s. To analyze the dissolution depth, specimens were sectioned into two similarly sized halves using a chisel to create an internal surface (IS). Specimens were analyzed with scanning electron microscopy (SEM) on the following surfaces: HF application surface (AS), lateral surface (LS), internal surface (IS), and the surface opposite to the AS (OS). Dissolution patterns were identified. Data were submitted to one-way ANOVA and Bonferroni's test (α = 0.05). Dissolution depth data were submitted to Kruskal-Wallis and Mann-Whitney U-tests (α = 0.05). The prevalence of different dissolution patterns was analyzed using SEM. RESULTS: HF gel applied on the AS also affected the adjacent surfaces of all specimens. Different dissolution patterns were observed, which were dependent of HF-etching protocol and proportion of the glass phase in the ceramic. These patterns were categorized into four types for LEU (I-IV) and three for LD (I-III) according to the micropore size. The greater the micropore size, the more pronounced the etching pattern (p < 0.001). Higher HF times and concentrations showed prevalence of more severe etching patterns. HF10%60s produced greater dissolution depth in both materials when compared with other HF-etching groups (p < 0.05). CONCLUSION: Hydrofluoric acid etching not only affects the surface upon which it is applied, but internal, lateral and even opposite edges of glass ceramic. Different dissolution patterns and depths can be formed which are dependent of hydrofluoric acid concentration, application time, and proportion of the glass phase in the ceramic.

Urinary Extracellular Vesicles as a Source of NGAL for Diabetic Kidney Disease Evaluation in Children and Adolescents With Type 1 Diabetes Mellitus.

Background: Tubular damage has a role in Diabetic Kidney Disease (DKD). We evaluated the early tubulointerstitial damage biomarkers in type-1 Diabetes Mellitus (T1DM) pediatric participants and studied the correlation with classical DKD parameters. Methods: Thirty-four T1DM and fifteen healthy participants were enrolled. Clinical and biochemical parameters [Glomerular filtration Rate (GFR), microalbuminuria (MAU), albumin/creatinine ratio (ACR), and glycated hemoglobin A1c (HbA1c)] were evaluated. Neutrophil gelatinase-associated lipocalin (NGAL), Hypoxia-inducible Factor-1α (HIF-1α), and Nuclear Factor of Activated T-cells-5 (NFAT5) levels were studied in the supernatant (S) and the exosome-like extracellular vesicles (E) fraction from urine samples. Results: In the T1DM, 12% had MAU >20 mg/L, 6% ACR >30 mg/g, and 88% had eGFR >140 ml/min/1.72 m2. NGAL in the S (NGAL-S) or E (NGAL-E) fraction was not detectable in the control. The NGAL-E was more frequent (p = 0.040) and higher (p = 0.002) than NGAL-S in T1DM. The T1DM participants with positive NGAL had higher age (p = 0.03), T1DM evolution (p = 0.03), and serum creatinine (p = 0.003) than negative NGAL. The NGAL-E correlated positively with tanner stage (p = 0.0036), the median levels of HbA1c before enrollment (p = 0.045) and was independent of ACR, MAU, and HbA1c at the enrollment. NFAT5 and HIF-1α levels were not detectable in T1DM or control. Conclusion: Urinary exosome-like extracellular vesicles could be a new source of early detection of tubular injury biomarkers of DKD in T1DM patients.

Mandatory notifications of type 1 diabetes incident cases in Chilean children, 2006 to 2014: A population-based study.

Type 1 diabetes mellitus (T1D) incidence in children varies across regions and countries, showing a continuous rise globally. Chile has mandatory T1D notification and guaranteed access to diagnosis and treatment since 2005, providing a strong model to evaluate T1D epidemiology. OBJECTIVE: To determine T1D incidence in Chilean population under 20 years between 2006 and 2014. METHODS: We reviewed mandatory notifications of T1D in Chile's public health system. RESULTS: A total of 4153 T1D cases in population under 20 years were notified from 2006 to 2014. Median age was 14 years and 51% were male. The average annual T1D incidence was 12 per 100 000 population, with an increase from 10.2 in 2006 to 13.8 in 2014 (ß 0.5 95% confidence interval [CI] 0.4-0.7, P < .001). A significantly increasing linear trend of T1D incidence was observed in groups of 0 to 4 years (ß 0.33, 95% CI 0.06-0.59, P = .02), 5 to 9 years (ß 0.68 95% CI 0.27-1.10, P = .006), and 10 to 14 (ß 0.94, 95% CI 0.67-1.20, P < .001), but increase was less pronounced in the oldest children aged between 15 and 19 years (ß 0.22, 95% CI -0.03 to 0.44, P = .052). The lowest regional T1D incidence was observed in the Araucanía region, which has the highest rate of indigenous population. CONCLUSION: Incidence rates of T1D in Chile, evaluated through a mandatory notification program, are rapidly increasing in children and adolescents. If increasing trends persist, Chile will reach T1D incidence rates of Western developed countries in the next decade.

[Pseudohypoparathyroidism: report of two cases of late presentation]. / Pseudohipoparatiroidismo de presentación tardía: reporte de dos casos.

Pseudohypoparathyroidism (PHP) is a group of rare genetic disorders that share organ targeted resistance to the action of parathyroid hormone (PTH) as a common feature. Biochemically, they may present with hypocalcemia, hyperphosphatemia and elevated PTH. Some forms present with a specific phenotype: short stature, round facies, short neck, obesity, brachydactyly and subcutaneous calcifications, called Albrigth's Hereditary Osteodystrophy (AHO). This spectrum of disorders are caused by several alterations in the gene coding for the alpha subunit of the G protein (GNAS): an ubiquitous signaling protein that mediates the action of numerous hormones such as PTH, TSH, gonadotropins, and ACTH, among others. According to their inheritance with maternal or paternal imprinting, they may manifest in a diversity of clinical forms. Although most commonly diagnosed during childhood, PHP may manifest clinically during adolescence or early adulthood. We report two late presenting cases of pseudohypoparathyroidism. A 21-year-old female with biochemical abnormalities characteristic of pseudohypoparathyroidism who was misdiagnosed as epilepsy and a 13-year-old boy with the classic AHO phenotype but without alterations in phospho-calcium metabolism, compatible with pseudopseudohypoparathyrodism.

Pseudohipoparatiroidismo de presentación tardía: reporte de dos casos / Pseudohypoparathyroidism: report of two cases of late presentation

Pseudohypoparathyroidism (PHP) is a group of rare genetic disorders that share organ targeted resistance to the action of parathyroid hormone (PTH) as a common feature. Biochemically, they may present with hypocalcemia, hyperphosphatemia and elevated PTH. Some forms present with a specific phenotype: short stature, round facies, short neck, obesity, brachydactyly and subcutaneous calcifications, called Albrigth's Hereditary Osteodystrophy (AHO). This spectrum of disorders are caused by several alterations in the gene coding for the alpha subunit of the G protein (GNAS): an ubiquitous signaling protein that mediates the action of numerous hormones such as PTH, TSH, gonadotropins, and ACTH, among others. According to their inheritance with maternal or paternal imprinting, they may manifest in a diversity of clinical forms. Although most commonly diagnosed during childhood, PHP may manifest clinically during adolescence or early adulthood. We report two late presenting cases of pseudohypoparathyroidism. A 21-year-old female with biochemical abnormalities characteristic of pseudohypoparathyroidism who was misdiagnosed as epilepsy and a 13-year-old boy with the classic AHO phenotype but without alterations in phospho-calcium metabolism, compatible with pseudopseudohypoparathyrodism.