A Case of Mauriac Syndrome: A Teenage Girl With Poorly Controlled Diabetes.

Mauriac syndrome is a rare complication of longstanding, poorly controlled type 1 diabetes in pediatric patients. Mauriac syndrome is characterized by hepatomegaly and growth retardation. This case report discusses a 14-year-old girl with persistent, poorly controlled type 1 diabetes mellitus (T1DM) admitted to the pediatric intensive care unit (PICU), where she was ultimately diagnosed with Mauriac syndrome. The patient presented with severe hypoglycemia and a history of multiple admissions for diabetes ketoacidosis (DKA) despite insulin therapy. The patient had a history of poor glycemic control and growth retardation, and on physical exam, she was found to have hepatomegaly. Based on clinical presentation, history of poorly controlled diabetes hepatomegaly, imaging, and laboratory findings, the diagnosis of Mauriac syndrome was made. Management of the patient included diabetes education, optimizing insulin therapy, nutritional support, and closely monitoring labs in a multi-disciplinary approach. The patient responded well to insulin therapy and was started on closed-loop insulin administration. Liver enzymes and hepatomegaly normalized, and growth parameters improved over the subsequent months. This case emphasizes the importance of early recognition, monitoring, and management of an extremely rare syndrome that is crucial in preventing the short-term complications of lactic acidosis and rapidly progressing retinopathy and the long-term complications of hepatic dysfunction and growth impairment.

Effects of exercise in hot and humid conditions and bovine colostrum on salivary immune markers.

The purpose of this study was to examine the effects of exercise in a hot and humid environment on salivary lactoferrin and lysozyme. A secondary aim was to quantify the effects of 14-day bovine colostrum (BC) supplementation on salivary lactoferrin and lysozyme at rest and following exercise in hot and humid conditions. Using a randomized, double-blind, and counterbalanced design, ten males (20 ± 2 years, VO2max 55.8 ± 3.7 mL kg-1 min-1, 11.8 ± 2.7% body fat) ran for 46 ± 7.7 min at 95% of ventilatory threshold in a 40 °C and 50% RH environment after 14-days of supplementation with either BC or placebo. Saliva was collected pre, post, 1-h, and 4-h post exercise, and was analyzed for lactoferrin and lysozyme using ELISA. There was an immediate increase in the concentration and secretion rate of lactoferrin and lysozyme (p < 0.05) with exercise, but BC had no effect (p > 0.05). Saliva flow rate was not different between conditions [(PLA: pre: 0.54 ± 0.3, post: 0.44 ± 0.3, 1-h: 0.67 ± 0.3, 4-h: 1.0 ± 0.4 mL min-1); (BC: pre: 0.58 ± 0.2, post: 0.37 ± 0.1, 1-h: 0.63 ± 0.2, 4-h: 0.83 ± 0.4 mL min-1)]. There were no differences in thermoregulatory markers (core temperature or physiological strain index) between BC and placebo trials. Interestingly, exercise-induced heat stress did not impair mucosal immune parameters, instead participants showed a transient increase in salivary lactoferrin and lysozyme. Further, 14-day BC supplementation had no effect on mucosal immunity at any time point.

Bovine colostrum supplementation does not affect plasma I-FABP concentrations following exercise in a hot and humid environment.

PURPOSE: To quantify the impact of a 14-day bovine colostrum (BC) supplementation on intestinal cell damage following exercise in a hot and humid environment. METHODS: Ten male participants (20 ± 2 years, VO2max 55.80 ± 3.79 mL kg-1 min-1, 11.81 ± 2.71% body fat) ran for 46 ± 7.75 min at 95% of ventiliatory threshold in 40 °C and 50% RH following a 14-day double-blinded supplementation with either BC or placebo (Plac). Core temperature, skin temperature, heart rate, and rating of perceived exertion were recorded every 5 min during exercise. Blood was taken pre, post, 1 h, and 4 h post exercise. Intestinal cell damage was assessed via intestinal fatty acid binding protein (I-FABP). RESULTS: I-FABP concentrations were similar between conditions at all time points [pre 989.39 ± 490.88 pg ml-1 (BC) 851.35 ± 450.71 pg ml-1 (Plac) post 1505.10 ± 788.63 pg ml-1 (BC) 1267.12 ± 521.51 pg ml-1 (Plac) 1-h, 1087.77 ± 397.06 pg ml-1 (BC) 997.25 ± 524.74 pg ml-1 (Plac) 4-h, 511.35 ± 243.10 pg ml-1 (BC) 501.46 ± 222.54 pg ml-1 (Plac)]. I-FABP was elevated pre to post exercise for both BC (162 ± 50%) and Plac (162 ± 56%) (p < 0.05). BC had no effect on mean body temperature [beginning 36.11 ± 0.30 °C, ending: 39.52 ± 0.28 °C (BC); beginning:35.96 ± 0.43 °C, ending:39.42 ± 0.38 °C (Plac)]. CONCLUSIONS: While BC supplementation may protect against enterocyte damage during exercise in thermonuetral environments, our data suggest that BC supplementation may not be an effective technique for preventing enterocyte damage during exercise when core temperature exceeds 39 °C.