Onset of Type I Diabetes Followed by Scleroderma Syndrome in a Child After the COVID-19: A Case Report.

Morphea, is a chronic inflammatory disease of the dermis and subcutaneous tissue. Research has indicated a connection between morphea and Type I Diabetes (T1D). COVID-19 can cause autoimmune diseases like scleroderma, T1D, systemic lupus erythematosus, and others. A 12-year-old girl with type 1 diabetes who was on insulin therapy was brought into the clinic for a metabolic evaluation. The patient had induration, skin hardness, and cutaneous erythema upon inspection. The onset of T1D was following a mild COVID-19 infection. Signs of morphea merged 3 months after the onset of T1D. Known as "long-term COVID," this sickness phase that follows the acute stage of COVID-19 is most likely the result of autoimmune activation. As this patient under evaluation reveals, COVID-19 has been demonstrated in the literature to cause the production of autoantibodies and to either cause or worsen autoimmune disorders in people who have a genetic susceptibility.

DIABETIC NEPHROPATHY: NOVELTY ABOUT THE DIABETIC NEPHROPATHY TREATMENT IN CHILDREN.

OBJECTIVE: The aim: To analyze and discuss the main aspects of the DN treatment in children. PATIENTS AND METHODS: Materials and methods: Basic and modern data about the new aspects of the DN treatment analyzed in current review paper. Conclusions: DN is a major healthcare challenge and is a major cause of irreversible kidney damage. The DN course and progression leads to severe cardiovascular complications and early death. Treatment of DN is complicated clinical issue and requires individual and complex approach, including renoprotection, antihypertensive treatment. Nowadays, we are able to provide additional medications that can enhance the benefits of the renin-angiotensin-aldosterone (RAAS) blocking, Further search of neproprotective medicines for early DN correction in pediatric patients is still of high importance.

Clustering patterns of metabolic syndrome: A cross-sectional study in children and adolescents in Kyiv.

Objective: The aim: to identify subgroups by cluster analysis according parameters: original homeostatic model of insulin resistance (HOMA-1 IR), updated computer model of insulin resistance (HOMA-2 IR), ß-cell function (%B) and insulin sensitivity (%S) for the prognosis of different variants of metabolic syndrome in children for more individualized treatment selection. Patients and methods: The observational cross-sectional study on 75 children aged from 10 to 17 with metabolic syndrome according to the International Diabetes Federation criteria was conducted at the Cardiology Department of Children's Clinical Hospital No.6 in Kyiv. HOMA-1 IR was calculated as follows: fasting insulin (µIU/ml) × fasting glucose (mmol/L)/22.5. HOMA-2 IR with %B and %S were calculated according to the computer model in [http://www.dtu.ox.ac.uk]. All biochemical analysis were carried out using Cobas 6000 analyzer and Roche Diagnostics (Switzerland). The statistical analysis was performed using STATISTICA 7.0 and Easy R. The hierarchical method Ward was used for cluster analysis according the parameters: HOMA-1 IR, HOMA-2 IR, %B and %S. Results: Four clusters were identified from the dendrogram, which could predict four variants in the course of metabolic syndrome such that children in cluster 1 would have the worst values of the studied parameters and those in cluster 4 - the best. It was found that HOMA-1 IR was much higher in cluster 1 (6.32 ± 0.66) than in cluster 4 (2.19 ± 0.13). HOMA-2 IR was also much higher in cluster 1 (3.80 ± 0.34) than in cluster 4 (1.31 ± 0.06). By the analysis of variance using Scheffe's multiple comparison method, a statistically significant difference was obtained between the laboratory parameters among the subgroups: HOMA-1 IR (p < 0,001), glucose (p < 0.001), insulin (p < 0,001), HOMA-2 IR (p < 0.001), %B (p < 0.001), %S (p < 0.001), TG ( p = 0.005) and VLDL-C (p = 0.002). Conclusions: A cluster analysis revealed that the first two subgroups of children had the worst insulin resistance and lipid profile parameters. It was found positive correlation between HOMA-1 IR, HOMA-2 IR, %B and %S with lipid metabolism parameters TG and VLDL-C and negative correlation between %B and HDL-C in children with metabolic syndrome (MetS).The risk of getting a high TG result in the blood analysis in children with MetS was significantly dependent with the HOMA-2 IR >2.26.

Clinical and Apoptotic Factors Defining and Predicting Steroid Resistance in Nephrotic Syndrome in Children.

Introduction. Nephrotic syndrome (NS) is a kidney disease characterized by albuminuria, hyperlipidemia, edema, and hypoalbuminemia. Above 20 % of nephrotic children do not show response to steroid treatment. Molecular markers controlling apoptosis have not been studied as a predictors of steroid resistant NS (SRNS) and steroid sensitive NS (SSNS) in children. Aim of the Study. To identify clinical and molecular markers which define and predict the steroid-resistance phenomenon in children with NS. Methods. Fifty-six clinical cases of children hospitalized in Pediatric Hospital No. 7 (Kyiv, Ukraine) with NS (26 SSNS and 30 SRNS) studied. Stepwise logistic regression models used to analyze data. Data processed using GraphPad Prism 9.0 Software for Windows (USA, San Diego, CA). Results. Arterial hypertension, WBC and RBC count, serum creatinine, serum urea, serum cholesterol found to be factors defining and predicting SRNS. Apoptosis regulating BcL-xL, Bax but not caspase-8 found to be those defining SRNS. Among transcriptional factors HIF-1alfa selected as a factor predicting steroid resistance phenomenon. For SSNS group significant negative correlation observed between BcL-xL and Bax, BcL-xL and caspase-3, significant positive correlation observed between marker of cellular hypoxia HIF-1alfa and proapoptotic factor caspase-3. For SRNS group significant negative correlation observed between BcL-xL and Bax, BcL-xL and caspase-3 level, significant positive correlation observed between HIF-1alfa and proapoptotic factor caspase-3. Conclusions. Arterial hypertension, serum creatinine level, serum urea level, serum cholesterol level, WBC and RBC count, BcL-xL, Bax, caspase-3, and HIF-1alfa identified as candidate biomarkers to predict and define SRNS in pediatric NS.

Clinical, Laboratory, Instrumental, Anamnestic Characteristics in Children With Type I Diabetes Mellitus and Early Stage of Diabetic Nephropathy.

Type 1 diabetes (T1D) is mainly a disease of children and young adults. Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Aim of the study was analysis of clinical, laboratory, instrumental, anamnestic examinations data in pediatric patients with T1D and early stage of DN in order to evaluate possible factors associated with early stage of DN and predictors of DN development and progression. A survey of 105 children (62 males, 43 females) with T1D and DN aged 5 to 17 years in Endocrinology unit on Clinical Pediatric Hospital №6 (Kyiv, Ukraine) done. Following clinical and biochemical characteristics found associated with an early DN: inflammatory phenotype (increased ESR, decreased albumin/globulin ratio), functional cardiovascular disorders (increased systolic blood pressure, "minor" ECG changes), signs of secondary metabolic disorders (high HbA1c, increased serum cholesterol level, increase ALAT and ASAT levels). Kidney function impairment at early stage of DN shows: higher MAU grade, GFR decline, rise in serum creatinine level as compared to T1D group. Presence of concomitant kidney and endocrine disease; positive family history found in a bigger number of patients with DN. DKA episodes number found as a factor associated with higher levels of MAU in children with DN. Patients who had microalbuminuria and more than 5 episodes of DKA/year (poorly controlled T1D) have higher progression rate to macroalbuminuria as compared to those who have less than 5 episodes of DKA/year after a 6-year follow-up study.