Symptomatic hyponatremia during the diabetic ketoacidosis in 5 years old child with new onset diabetes - own experience.

Hyponatremia is the one of the most common electrolyte abnormality in the clinical practice and is associated with increased morbidity and mortality. Decreased serum sodium levels are occasionally observed in patients with diabetes mellitus, especially in those, who pre-sent with the diabetic ketoacidosis. It can develop at the each stage of a treatment, as a complication of hyperglycemia and intensity of the therapy, but also the other underlying causes should be consider. In this report we present a patient with symptomatic hyponatremia in the new diagnosed patient with type 1 diabetes mellitus.

Evaluation of white matter structure changes, as assessed in tractography, and cognitive dysfunctions in patients with early onset schizophrenia and their first-degree relatives. / Ocena zaburzen struktury istoty bialej ocenianych w badaniach traktograficznych i zaburzen pamieci operacyjnej u chorych na schizofrenie o wczesnym poczatku i ich krewnych pierwszego stopnia.

OBJECTIVES: The aim of the project was to assess the differences in the white matter (WM) fiber structure between patients with early onset schizophrenia (EOS), their first degree relatives and controls using Fractional Anisotropy (FA), and an independent evaluation of the severity of working memory disturbances in the study groups. METHODS: The study included 20 patients diagnosed with paranoid EOS (diagnosed before the age of 18), a group of 20 parents of patients, matched for gender, and 18 healthy controls. All study participants were examined with Diffusion Tensor Imaging (DTI,1.5 T) and selected neuropsychological tests to assess working memory, immediate memory and attention (Trail Making Test parts A and B: TMT-A and TMT-B, Digit Span Forward and Backward). RESULTS: No significant differences in FA parameters were found between the analyzed groups. The group of patients took significantly longer to perform the TMT-A and TMT-B than the control group, and achieved worse outcomes in Digit Span tests. The relatives of the patients achieved lower scores in Digit Span tests and needed more time to perform TMT-B compared to controls. There were no significant differences between all groups in terms of the number of errors when performing TMT-A and TMT-B. CONCLUSIONS: The results of our study indicate a reduction in the capacity of immediate memory, working memory, cognitive plasticity and divided attention, both in EOS patients and their first degree relatives compared to healthy subjects. The reported neuropsychological deficits were not reflected in WM integrity, as assessed with FA.

Impact of lithium alone or in combination with haloperidol on oxidative stress parameters and cell viability in SH-SY5Y cell culture.

BACKGROUND: It has been reported that lithium may inhibit lipid peroxidation and protein oxidation. Lithium salts also appear to stimulate cell proliferation, increase neurogenesis, and delay cell death. Oxidative stress and neurodegeneration may play an important role in the pathophysiology of bipolar disorder and the disease course thereof. The aim of this research is to estimate the influence of lithium (alone and in combination with haloperidol) on the parameters of oxidative stress and viability of SH-SY5Y cell lines in neutral and pro-oxidative conditions. METHODS: The evaluated oxidative stress parameter was lipid peroxidation. The viability of the cell lines was measured utilising the MTT test. RESULTS: In neutral conditions, higher levels of thiobarbituric acid reactive substances were observed in those samples which contained both haloperidol and lithium than in other samples. However, these differences were not statistically significant. Cell viability was significantly higher in therapeutic lithium samples than in the controls; samples of haloperidol alone as well as those of haloperidol with lithium did not differ from controls. CONCLUSIONS: The results of our study may indicate that lithium possess neuroprotective properties that may be partly due to antioxidative effects. The combination of lithium and haloperidol may generate increased oxidative stress.

Impact of lithium alone or in combination with haloperidol on selected oxidative stress parameters in human plasma in vitro.

OBJECTIVES: Lithium may inhibit lipid peroxidation (LP) and protein oxidation, stimulate cell proliferation, increase neurogenesis, and delay cell death. Oxidative stress (OxS) is a state of imbalance between oxidative processes and antioxidant defenses, which may play an important role in the pathophysiology and disease course of bipolar disorder (BD). The aim of this study was to estimate the influence of lithium, administered alone or in combination with haloperidol, on selected OxS parameters in human plasma in vitro. METHODS: The OxS parameters evaluated were thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC). Plasma samples from healthy volunteers were incubated with drug concentrations used in psychiatry. RESULTS: Incubation of plasma with lithium or haloperidol alone did not produce statistically significant changes of TBARS levels in comparison with control samples. However, significantly higher TBARS levels were observed in samples incubated with haloperidol plus lithium compared to control, haloperidol, or lithium samples. The TAC value did not differ between samples. CONCLUSIONS: Lithium does not influence OxS parameters in human plasma in vitro during short-term observation when applied at concentrations used in psychiatry. However, lithium increased the TBARS level in the samples when given in combination with haloperidol, which may be one of the mechanisms behind the neurotoxicity associated with combined lithium and haloperidol administration.

[Carotid artery intima-media thickness (cIMT) in young type 1 diabetic patients in relation to comorbid additional autoimmune diseases and microvascular complications]. / Ocena grubosci kompleksu intima-media (cIMT) tetnicy szyjnej wspólnej u mlodych pacjentów z cukrzyca typu 1 w zaleznosci od towarzyszacych chorób autoimmunizacyjnych oraz powiklan naczyniowych cukrzycy.

INTRODUCTION: Atherosclerosis, which is the cause of diseases of the cardiovascular system, and frequent and serious complications of type 1 diabetes (T1DM), has an autoimmune origin. Some diseases of this type, as rheumatoid arthritis, but also Hashimoto thyroiditis or celiac disease are associated with a higher incidence of heart disease. So far no studies evaluated the preclinical phase of development of atherosclerosis (cIMT) in young patients with T1DM and the comorbid additional autoimmune diseases. AIM OF THE STUDY: was evaluation of cIMT (carotid intima media thickness) carotid arteries and the risk factors of atherosclerosis in young patients with type 1 diabetes according to the comorbid autoimmune diseases and a comparison group of patients with known vascular complications and a group of healthy people. PATIENTS AND METHODS: The study involved a group of 90 adolescents and young adults with T1DM in middle age 17,1±3years, with an average disease duration of 10,5±3,3 years. Diabetes patients were divided into 4 groups - diabetes without complications - C, diabetes with celiac disease - CC, diabetes with Hashimoto's thyroiditis - CH, diabetes with vascular complications - CN. The control group (K) consisted of 22 healthy age-matched volunteers. In statistical analysis rated: average A1C of all the years of illness, BMI, blood pressure, lipid values, duration of illness, presence of diabetes complications, daily insulin dose and cIMT thickness of the common carotid artery. RESULTS: cIMT of T1DM patients was significantly higher: 0,470 mm than in healthy: 0,409 mm. In the group with vascular complications of diabetes was found the highest rate of cIMT: 0,501 mm in comparison to the group of diabetes without complications: 0,462 mm, diabetes with celiac disease: 0,462 mm, and diabetes with Hashimoto's thyroiditis: 0,453 mm. HbA1c was highest in the group CN: 9,84±1,5%, compared to CH: 9,04± 1,2%, CC: 8,84±1,8% and C without complications: 8,55±1,2%. BMI was highest in the group CN: 23,3± 4,4kg/m2and CH: 22,6 ± 2,4 kg/m2. It was the same with waist circumference: CN: 79,33± 9,39and CH: 79,2 ± 9,56 cm. Patients with vascular complications were characterized by the higher value of blood pressure and lipids compared to patients with additional autoimmune disease. Coexistence of celiac disease was not associated with a greater value of cIMT and cardiovascular risk factors in young patients with type 1 diabetes. CONCLUSIONS: 1. Increased value of cIMT, and thus increased risk of early disease of the cardiovascular system depends primarily on metabolic compensation and classic risk factors for atherosclerosis. 2. The coexistence of additional autoimmune disease does not significantly affect the value of cIMT in the study population. 3. Young patients with diabetes type 1 and coexisting Hashimoto disease have greater BMI and waist circumference, what can lead to earlier macroangiopathy in the future.

[Internal capsule integrity and its sex-related structural differences in early-onset schizophrenia - diffusion tensor imaging study]. / Zaburzenia integralnosci torebki wewnetrznej oraz róznice strukturalne zalezne od plci w schizofrenii o wczesnym poczatku - badanie DTI.

OBJECTIVES: In schizophrenia, the most repeatable DTI findings concern reduced FA in temporal and frontal lobes with associated abnormalities in connecting neural fibers. The goal of study was to evaluate the differences in FA of the internal capsule in EOS-patients and healthy controls and to place emphasis on the sex as a potential factor determining a predominant pathological pattern of described changes. METHODS: 30 EOS patients and 30 healthy controls were studied using DTI. FA measures within internal capsules were performed in selected ROIs. For statistical analyses the one-way ANOVA test was used (p<0.05). RESULTS: Significant differences of FA between EOS-patients and controls in the right ALIC with lower values of FA in EOS were observed. Within the women sub-groups, statistical differences of FA were observed only for the right ALIC. There were no statistically significant differences within men sub-groups. CONCLUSIONS: 1. Statistically significant differences were found between EOS - subjects (subgroups of woman only) and the control group within the WM diffusivity of the brain in the right ALIC. 2. These results indicate possible involvement of the structures of internal capsule in the EOS development.

Is there a decline in cognitive functions after combined electroconvulsive therapy and antipsychotic therapy in treatment-refractory schizophrenia?

An analysis of literature shows that there is still little evidence concerning the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic therapy in a group of treatment-resistant schizophrenia patients. More precisely, its influence on cognitive functions is still equivocal. The aim of this study was to assess the influence of ECT combined with antipsychotic therapy on working memory, attention, and executive functions in a group of treatment-refractory schizophrenia patients. Twenty-seven patients completed the study: 14 men and 13 women, aged 21 to 55 years (mean age, 32.8 years), diagnosed with treatment-resistant schizophrenia. Each patient underwent a course of ECT sessions and was treated with antipsychotic medications. Before the ECT and within 3 days after the last ECT session, the participants were assessed with the following neuropsychological tests: Trail Making Test (TMT) and Wisconsin Cart Sorting Test (WCST). There were no significant differences in the TMT and WCST results after combined ECT and antipsychotic therapy in treatment-refractory schizophrenia patients. According to the results of the neuropsychological tests, there was no decline in attention, executive functions, or working memory. The current study shows no significant difference in attention, working memory, or executive functions after treatment with a combination of electroconvulsive and antipsychotic therapy. This suggests that combined electroconvulsive therapy may not have a negative influence on the neuropsychological functioning of patients with treatment resistant schizophrenia.

Figural fluency and immediate visual memory in patients with at-risk mental state for psychosis: empirical study.

AIM: Although a number of cognitive functions have been assessed in the ultra-high risk (UHR) population, only one study has reported on figural fluency. Visual memory was measured by different tests providing inconsistent results. The aim of the present study was to compare figural fluency and visual immediate memory performance in UHR patients and normal subjects. METHODS: The UHR sample consisted of 55 help-seeking individuals meeting CAARMS criteria. The control group consisted of 65 subjects. They were matched as a group by age, gender and education level. Figural fluency (RFFT) and immediate visual memory (BVRT) were assessed within 2 weeks after inclusion in the study in the UHR patient group. RESULTS: Significant differences were obtained in RFFT and BVRT results. In BVRT, UHR patients scored lower in number of correct designs (P < 0.001) and higher in number of errors (P < 0.0001), especially omissions (P < 0.001) and distortions (P < 0.0001). UHR subjects accurately recalled fewer designs, omitted and distorted more test figures. In RFFT, they scored lower in production of novel designs (P < 0.0001) and higher in the error ratio index (P < 0.008). They produced fewer novel designs and made more preservative errors. CONCLUSIONS: The current study concerns non-verbal cognitive functions in UHR samples. Our results suggest that figural fluency and visual immediate memory are impaired in help-seeking UHR individuals as compared with matched controls.

PORT (Programme of Recognition and Therapy): the first Polish recognition and treatment programme for patients with an at-risk mental state.

AIM: To present the activities of the first early intervention centre in Poland and the Programme of Recognition and Therapy (PORT) run by the centre. METHODS: An overview of the admission process, diagnostic procedures and therapeutic interventions offered to individuals with an at-risk mental state. RESULTS: The PORT programme, developed in 2010, included 81 individuals, aged 15-29 years so far. The diagnostic procedures consists of evaluation of symptoms with the use of the Comprehensive Assessment of At-Risk Mental State (CAARMS), assessment of premorbid and current personality traits and the evaluation of cognitive functions. Therapeutic interventions include cognitive behavioural therapy, diet supplementation with omega-3 fatty acids and pharmacological treatment. Overall rate of conversion into psychosis within the years 2010-2103 was 18.5%. The programme has also been a source of research in the field of early psychosis. CONCLUSIONS: The PORT programme enables young people with an ARMS an easy access to the specialized service offering treatment tailored to their specific needs.

Augmentation of antipsychotics with electroconvulsive therapy in treatment-resistant schizophrenia patients with dominant negative symptoms: a pilot study of effectiveness.

OBJECTIVES: The aim of the study was to determine the effectiveness of the augmentation of antipsychotics (AP) with electroconvulsive therapy (ECT) in treatment-resistant schizophrenia (TRS) patients with dominant negative symptoms. METHODS: The study encompassed 34 patients aged 21-55 years, 47.1% of whom were female, who were diagnosed with TRS. Each patient underwent a course of ECT sessions combined with AP medications which had previously been found to be ineffective. Prior to ECT and within 3 days after the final ECT session, the participants were evaluated on the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia and the Clinical Global Impression scales. RESULTS: Augmentation of AP therapy with ECT led to a significant decrease in symptom severity in TRS patients with dominant negative symptoms, 58.8% of whom demonstrated at least a 25% decrease in the total PANSS score. The greatest reductions were observed in the general and positive PANSS subscales (mean ± SD: 11.35 ± 7.43 and 6.79 ± 5.23 patients), and the least significant in the negative symptoms subscale (5.03 ± 4.36 patients). CONCLUSION: Augmentation of AP therapy with ECT in a group of TRS patients with dominant negative symptoms induced a significant decrease in symptom severity. The greatest reductions were obtained in general and positive symptoms and the least in negative symptoms.

Temperament traits and preference for surgical or nonsurgical specialties in year 6 medical students.

BACKGROUND: Personality traits may also be associated with preference for a particular specialty. However, little is known about the relationship between the surgical career preferences of medical students and their temperament traits. PURPOSES: The aim of the study was to explore the relationship between surgical or nonsurgical specialties and temperament in 6th-year medical students. METHODS: The study included 409 students (283 women, 126 men) of the 6th year at the Medical University of Lodz. The subjects fulfilled a career preference and demographic questionnaire as well as the Formal Characteristics of Behaviour-Temperament Inventory by Zawadzki and Stelau. RESULTS: The surgical specialty was preferred by 30.1% of the students and by 64.5% of the nonsurgical; 5.4% were undecided. The specialty preference of the medical students was associated with temperament traits. An analysis of variance showed differences in Emotional Reactivity, F(1, 380)=3.888, p=049, η2=01; Endurance, F(1, 380)=10.973, p=001, η2=028; and Briskness, F(1, 380)=10.252, p=001, η2=026. Students preferring surgical specialty scored significantly higher on Endurance (M=11.21, SD=4.8) and Briskness (M=16.54, SD=2.82) scales than students choosing a nonsurgical specialty (M=9.12, SD=4.51) and (M=15.19, SD=3.21), respectively. Those preferring a surgical specialty scored lower on the Emotional Reactivity (M=8.91, SD=4.55) scale than students choosing nonsurgical specialty (M=10.53, SD=4.22). CONCLUSIONS: The findings suggest that certain temperament traits may be related to preference of surgical or nonsurgical specialties. This knowledge of temperament traits could be a useful tool in helping graduates choose a fulfilling career best suited to their psychological well-being and diagnosing work related issues in the medical profession.

Analysis of vitamin D status in major depression.

OBJECTIVE: The goals of this study were to determine the serum level of 25 hydroxyvitamin D (25[OH]D), a vitamin D metabolite, in patients with recurrent depression, to assess risk factors for vitamin D deficiency, and to evaluate whether the severity of symptoms of depression and response to treatment were associated with serum vitamin 25(OH)D level. METHOD: Ninety-one patients 18 to 65 years of age meeting the ICD-10 criteria for recurrent depression were evaluated for depressive symptoms using the Hamilton Depression Rating Scale. The control group consisted of 89 healthy subjects matched according to sex and age. Serum levels of 25(OH)D, parathyroid hormone (PTH), and calmodulin-dependent protein kinase II (Ca) were determined in all group members. RESULTS: A significantly decreased serum level of 25(OH)D was observed in the group of patients with recurrent depression compared with healthy subjects. PTH and Ca levels were within the reference values in a substantial majority of patients. No correlation was found between 25(OH)D serum level and age, sex, height, body mass index, disease duration, number of depressive episodes, type of pharmacotherapy, or effectiveness of treatment. CONCLUSIONS: Low serum levels of 25(OH)D in patients with recurrent depression suggest that these patients are an important risk group for vitamin D deficiency. However, no relationship was found between these low levels of 25(OH)D and response to treatment for depression. Nevertheless, the results indicate the need to monitor the concentration and supplementation of products containing calciferol in such patients.

Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms.

The effectiveness and predictors of response to electroconvulsive therapy (ECT) combined with antipsychotics (AP) in treatment-resistant schizophrenia patients with the dominance of negative symptoms (TRS-NS) have not been studied systematically so far. 29 patients aged 21-55 years diagnosed with TRS-NS underwent ECT combined with antipsychotics (ECT+AP). Prior to the ECT, the symptom profile and severity were evaluated using Positive and Negative Syndrome Scale (PANSS). Demographic and medical data was collected; ECT parameters and pharmacotherapy results were evaluated. After the combined ECT+AP therapy a significant decrease in symptom severity was found. A response to treatment was achieved by 60% of patients. The greatest reductions were obtained in general and positive PANSS subscale (median change: 11 and 7 pts.) and the smallest, but still significant, ones in negative symptoms subscale (median: 3.5 pts.). Patients who responded to ECT+AP demonstrated a significantly shorter duration of the current episode in comparison with patients who did not experience at least a 25% reduction in symptom severity (median: 4 vs. 8 months). A combination of ECT and antipsychotic therapy can provide a useful treatment option for patients with TRS-NS. The only significant predictor of response to treatment was a shorter duration of the current episode.

Olanzapine-induced triglyceride and aminotransferase elevations without weight gain or hyperglycemia normalized after switching to aripiprazole.

Olanzapine induced a marked elevation in triglyceride and cholesterol levels and in liver transaminase enzymes after 12 weeks of treatment in a patient with schizophrenia. These changes were not seen in an earlier 10-week course of treatment with risperidone, and improved substantially 1 week after the patient stopped olanzapine and began treatment with aripiprazole. The patient did not exhibit weight gain or hyperglycemia with any of the medications. This case and a review of the literature suggest that olanzapine may have unique properties that affect hepatic enzyme pathways, independent of any effects on weight and glucose, that may lead to hyperlipidemia and transaminitis in some patients.

[Neurological soft signs as a candidate for endophenotype of schizophrenia]. / Miekkie objawy neurologiczne jako kandydat na endofenotyp schizofrenii.

A concept of an endophenotype, also termed as an internal endophenotype, is used in genetic studies on psychiatric disorders. Neurological soft signs are also considered candidates for endophenotypes of schizophrenia. Neurological soft signs are, objectively measured, non-localizing abnormalities, not related to impairment of a specific brain region, reflecting improper cortical-subcorical and intercortical connections. This paper presents the main domains of NSS, methods of measurement of NSS, their neuroanatomical substrate, association of NSS with schizophrenia symptoms the and analysis of the literature in order to check whether NSS meet the criteria of the phenotype. A marker can be considered a phenotype if it meets the following criteria: 1) association with a disease in a population, 2) heritability, 3) state-independence, 4) familial association (the endophenotype is more prevalent in the affected individuals, their affected and non-affected family members in comparison to the normal population), 5) co-segregation (the endophenotype is more prevalent among ill family members of ill probands compared with healthy relatives). Currently, there is an ample evidence that the NSS, especially these representing impaired motor coordination, meet certain criteria of an endophenotype. However, there are still several unresolved questions concerning NSS: studies on relatives of schizophrenic patients included small groups of subjects, many of the studies included individuals with schizophrenia, as well as schizophrenia spectrum disorders, the available date-base of twins (schizophrenia-concordant and schizophrenia non -concordant) is not sufficiently large, there are too few studies evaluating the relationship of NSS and individual genes, there are no objective and quantitative methods of measurement of NSS. Therefore, NSS still represent only candidates for an endophenotype of schizophrenia. Finding correlations of selected NSS with other endophenotypes and their genetic correlates also needs further investigation and may provide a definitive answer to the question of the usefulness of NSS as the endophenotype of schizophrenia.

Two grams of sarcosine in schizophrenia - is it too much? A potential role of glutamate-serotonin interaction.

Glutamate is the main excitatory neurotransmitter in the central nervous system. Dysfunction of the glutamatergic system plays an important role in the pathogenesis of schizophrenia. Therefore, glutamatergic agents such as N-methyl-D-aspartate receptor co-agonists (ie, glycine, D-cycloserine) and glycine transporter type 1 inhibitors (eg, sarcosine) are studied for their efficacy in ameliorating negative and cognitive symptomatology in patients with schizophrenia. We report the case of a 23-year-old schizophrenic patient treated with quetiapine and citalopram, who was offered concomitant sarcosine treatment. After obtaining an informed consent, we started administration of 2 g of sarcosine per day to treat persistent negative and cognitive symptoms. The patient's activity and mood improved within 2 weeks, but in the following 2 weeks the patient reported increased drive, activity, libido, unpleasant inner tension, and irritability. We ruled out hypomania and decided to decrease the daily dose of sarcosine to 1 g, which resulted in reduction of drive and irritability. Activity and mood improved compared with his state before adding sarcosine. We suggest a sarcosine dose between 1 g and 2 g per day with an initial dose of 2 g, but if side effects occur, the dose should be decreased to 1 g per day. We would like to emphasize the clinically important glutamate-serotonin interaction during concomitant use of sarcosine, citalopram, and quetiapine in our patient, which may lead to serious discomfort.

Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis.

Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.

Obstetrical complications and Apgar score in subjects at risk of psychosis.

The objective of the study was to identify associations between a history of obstetrical complications (OCs) and the future development of symptoms indicating risk of psychosis (At Risk Mental State - ARMS). The frequency of OCs was assessed in 66 ARMS subjects, 50 subjects with the first episode of schizophrenia (FES) and 50 healthy controls. Obstetrical data was obtained from medical documentation and evaluated with the Lewis and Murray Scale. Definite OCs, according to the Lewis and Murray Scale, occurred significantly more frequently in the ARMS group compared to the controls (χ(2) = 7.79, p = 0.005; OR = 4.20, 95% CI = 1.46-12.11), as well as in the FES subjects compared to the controls (χ(2) = 8.39, p = 0.004; OR = 4.64, 95% CI = 1.56-13.20). Apgar scores in the first (Apgar 1) and the fifth minute after birth (Apgar 5) were significantly lower in the FES subjects compared to the controls (for Apgar 1 score Z = 4.439, p < 0.0001; for Apgar 5 score Z = 5.250, p < 0.0001). The ARMS subjects demonstrated significantly lower Apgar 5 scores compared to the healthy controls (Z = 3.458, p = 0.0016). The results indicate that OCs and low Apgar 5 score should be considered important factors in identifying subjects at risk of developing psychosis.

Undiagnosed normal pressure hydrocephalus as a cause of diagnostic difficulties in a patient with depression.

Normal pressure hydrocephalus is characterized by gait disturbance, urinary incontinence, cognitive impairment, and the finding of ventriculomegaly in imaging studies. It is one of the causes of potentially reversible dementia. The authors present the case of a patient with depression complicated by hydrocephalus. The combination of symptoms led to a delay in proper diagnosis and treatment.

[Prevalence of autoimmune diseases and microangiopathy in children with diabetes type 1 over the years 2000-2010]. / Wystepowanie chorób autoimmunizacyjnych oraz mikroangiopatii u dzieci z cukrzyca typu 1 w latach 2000-2010.

INTRODUCTION: In the past decade the number of patients with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) has increased rapidly. Treatment of the disease is focused on proper physical development and the prevention of complications. Aim of the study was to analyze changes in the treatment and clinical picture of type 1 diabetes in children over the years 2000 to 2010 with particular emphasis on the presence of autoimmune diseases and microangiopathy. MATERIAL AND METHODS: The study included 567 children diagnosed with type 1 diabetes under the care of outpatient diabetes clinic. We compared 251 children, diabetes outpatient clinic patients in 2000, with 316 children in 2010. Data were obtained from the outpatient and hospital records. We compared baseline demographic, anthropometric data, treatment regimen, type of insulin, metabolic control, prevalence of autoimmune diseases and microangipathy. RESULTS: In 2010 there was a reduction in the age of diagnosis of diabetes from 10 to 8 years (p=0.039). Significantly increased the proportion of children treated with CSII (up to 60.1%) and decreased the percentage of children using conventional insulin for the benefit of insulin analogs. The increase in HbA1c from 7.4 to 8.0% (p<0.001) has been shown and increase in proportion of patients with HbA1c >7.5% in 2010. The percentage of children with obesity increased from 5.2 to 13.7% (p=0.004) and there was a significant increase in SDS-BMI. The percentage of children with autoimmune diseases such as celiac (from 0,4 to 7,3%, p<0,001) and thyroid (from 6.9 to 21.3%, p<0.001) has increased. The incidence of retinopathy decreased from 6 to 1% (p=0.04), and albuminuria decreased insignificantly. CONCLUSIONS: Over the last decade, a significant change in the method of treatment in children diagnosed with type 1 diabetes has occurred. The deterioration of metabolic control, despite the frequent use in the treatment of CSII, may be due to increased frequency of obesity and additional autoimmune diseases in today´s patients. More similar to physiologic way of insulin infusion in nowadays treatment may influence the decrease in the prevalence of retinopathy.