Hyperglycemia is associated with simultaneous alterations in electrical brain activity in youths with type 1 diabetes mellitus.

OBJECTIVE: To assess the association between hyperglycemia and electrical brain activity in type 1 diabetes mellitus (T1DM). METHODS: Nine youths with T1DM were monitored simultaneously and continuously by EEG and continuous glucose monitor system, for 40 h. EEG powers of 0.5-80 Hz frequency bands in all the different brain regions were analyzed according to interstitial glucose concentration (IGC) ranges of 4-11 mmol/l, 11-15.5 mmol/l and >15.5 mmol/l. Analysis of variance was used to examine the differences in EEG power of each frequency band between the subgroups of IGC. Analysis was performed separately during wakefulness and sleep, controlling for age, gender and HbA1c. RESULTS: Mean IGC was 11.49 ± 5.26 mmol/l in 1253 combined measurements. IGC>15.5 mmol/l compared to 4-11 mmol/l was associated during wakefulness with increased EEG power of low frequencies and with decreased EEG power of high frequencies. During sleep, it was associated with increased EEG power of low frequencies in all brain areas and of high frequencies in frontal and central areas. CONCLUSIONS: Asymptomatic transient hyperglycemia in youth with T1DM is associated with simultaneous alterations in electrical brain activity during wakefulness and sleep. SIGNIFICANCE: The clinical implications of immediate electrical brain alterations under hyperglycemia need to be studied and may lead to adaptations of management.

The use of continuous glucose monitoring systems in a pediatric population with type 1 diabetes mellitus in real-life settings: the AWeSoMe Study Group experience.

AIMS: The aim of the study was (a) to compare annual glycemic control in pediatric patients with type 1 diabetes mellitus (T1DM) who used a healthcare-funded continuous glucose monitoring system (RT-CGMS) to that of those who performed self-monitoring blood glucose (SMBG) only, in a real-life setting, and (b) to define parameters associated with compliance and glycemic control. METHODS: A total of 149 youth with T1DM (52.3 % females), mean age 11.8 ± 3.6 years, and 83 in the CGMS group were followed prospectively for 12 months. Glycemic control parameters and compliance to RT-CGMS were assessed periodically. RESULTS: Glycemic parameters did not differ significantly between the groups during follow-up periods. The time spent with RT-CGMS decreased and only 38 % used it for more than 75 % of the time during the 12 months (consistent users). Mean HbA1c decreased by 0.27 % in consistent users and increased by 0.21 % among intermittent users (used RT-CGMS less than 75 % of time), p = 0.013. Consistent users were younger 10. 6 ± 4.2 vs. 12.5 ± 3.6, p = 0.07, and had higher frequency of SMBG at baseline, 10.6 ± 4.9 vs. 6.3 ± 2.8, p = 0.011. CONCLUSIONS: The adoption of RT-CGMS was low, even in a healthcare system that funds its use. Caregivers should consider patient characteristics when recommending RT-CGMS use.

Parental sleep quality and continuous glucose monitoring system use in children with type 1 diabetes.

To compare sleep quality and sleep-wake patterns in parents of children with type 1 diabetes before routine use of the continuous glucose monitoring system (CGMS) and while using it. Thirteen parents completed the Pittsburg Sleep Quality Index (PSQI), a 7-day sleep diary, and wore an actigraph (a wristwatch-size motion detector) during the night for 1 week before pediatric use of CGMS and 4-8 weeks after initiating routine use of the CGMS. Mean age of parents (ten mothers, three fathers) was 39 (range 32-47) years; mean age of children was 9.3 years (range 5.5-16.5 years); mean disease duration was 3.4 (range 0.6-11.2) years. PSQI total score demonstrated similar quality of sleep with and without use of the CGMS (4.6 and 4.9, respectively, p = 0.45). Six of the 13 parents reported severe sleep problems (PSQI ≥ 5) with and without the CGMS. The sleep diary indicated a greater number of awakening episodes during CGMS use than without the CGMS (1.6 and 1, respectively, p = 0.03), and actigraphy documented an increase in the number of wake bouts (22.9 and 19.7, p = 0.03) as well as in total wake time (48.3 and 42.2 min, p = 0.03) during CGMS use as compared with the period prior to CGMS use. Although self-perception of sleep quality remained unchanged, CGMS use appeared to affect actual parental sleep continuity somewhat negatively. This should be made clear to parents who may hold expectations of improvement in sleep quality following initiation of CGMS use.

Clinical characteristics and diabetes associated autoantibodies in patients with both type 1 diabetes mellitus and asthma.

OBJECTIVE: Type 1 diabetes mellitus (DM1) and asthma are mediated by opposite arms of the cellular immune system, namely T helper (Th)1 and Th2 CD4+ cells, respectively. It is not known whether their coexistence affects their clinical manifestations. METHODS: The number of asthma exacerbations, frequency of hypoglycemic events, HbA1c levels, diabetes associated autoantibody status and diabetes associated late complications were determined in three paired groups of patients (n = 11) matched by gender and age: DM1 and asthma, asthma only, and DM1 only. RESULTS: Patients with both diseases had a higher prevalence of hypoglycemic events per month compared to patients with DM1 only: 5.67 +/- 4.27 vs 1.45 +/- 2.06, respectively (p = 0.008). The co-existence of the two diseases did not modify the remaining clinical and laboratory parameters. CONCLUSION: Patients with both DM1 and asthma have similar clinical characteristics to patients with only one of these diseases apart from a higher rate of hypoglycemic events compared to patients with DM1 without asthma.

Evidence-based review of treatment and follow up of pediatric patients with differentiated thyroid carcinoma.

Childhood onset differentiated thyroid cancer (DTC) is distinct from the adult-onset disease being more aggressive at the time of initial evaluation with a higher risk category for disease recurrence; however, it is ultimately less lethal. International groups have outlined consensus statements detailing follow up and management guidelines for adult DTC, but since disease progression and markers are significantly different in childhood DTC compared to adults, management protocols may differ. Unfortunately, there is no consensus regarding the means of follow up, timing and management strategy regarding pediatric DTC. We performed an evidence-based review of DTC in children targeted to address the following questions: What is the most appropriate initial treatment? What is the goal of thyroid hormone replacement management? What is the approach to follow-up of childhood DTC? and, How should tumor recurrence/persistence be assessed and treated? We conducted a literature search using PubMed, Cochrane databases, guidelines from various international groups, and studies pertaining to pediatric DTC management and outcome in order to answer these questions. We suggest a pre-set algorithm and approach for the management of children with DTC according to our review.

Decrease in asthma mortality rate in Israel from 1991-1995: is it related to increased use of inhaled corticosteroids?

BACKGROUND: Asthma mortality rates (AMRs) during the last several decades increased in many countries with developed medical services, including Israel. The reasons for this trend were never established. Recent data suggested that this trend is changing. OBJECTIVES: We sought to compare the AMR in Israel during 1991-1995 with that of the previous decade and to investigate a possible correlation between mortality rates and use of inhaled corticosteroids (ICSs) and beta(2)-agonists. METHODS: Statistical data on the AMR in Israel during 1981-1995 were extracted. Data were analyzed for 5- and 10-year periods (1981-1990) and compared with a 5-year period (1991-1995). Data on ICS and beta(2)-agonist sales were extracted from the marketing companies' official reports. RESULTS: The mean AMR per 100,000 population per year during 1981-1990 in the 5- to 34-year-old group was 0.393 +/- 0.055 and decreased to 0.202 +/- 0. 046 during the 1991-1995 period (P =.03). There was no significant difference between changes in mean AMR in the 35- to 64-year-old or in the 5- to 64-year-old group during the same periods (4.568 vs 4. 063 and 2.480 vs 2.133). The mean ICS unit sales rates (per 100,000 population per year) between 1982-1990 and 1991-1995 were 21.70 and 190.45, respectively (P <.05). The correlation between ICS sales and AMR was -0.631 (P =.016). Sales of beta(2)-agonists did not change significantly during the study period. CONCLUSIONS: We identified a trend of decreased AMRs in Israel during 1991-1995. The decline in AMRs paralleled the increase in ICS sales, whereas the sales of inhaled beta(2)-agonists did not change significantly. One may speculate that the decrease in AMR may be the result of better anti-inflammatory treatment, as reflected by the increased use of ICSs. The feasibility of reducing AMRs in a country such as Israel, with low AMRs to start with, by improving medical treatment is encouraging.

Indoor survey of moulds and prevalence of mould atopy in Israel.

BACKGROUND: Moulds are ubiquitous indoor as well as outdoor allergens and therefore potential candidates for indoor environmental control measures. However, very few studies have been performed to examine the significance of indoor moulds in allergic diseases and the effectiveness of measures to reduce the quantity of indoor moulds has not been established. OBJECTIVE: To determine the significance and the contribution of moulds to allergic manifestations. METHODS: Prevalence of allergic rhinitis and asthma in 395 members of a rural community were examined by questionnaire and examination of medical files. The atopic status in general and allergy to moulds was determined by skin-prick tests (SPTs) to a panel of aeroallergens including Aspergillus, Penicillium, Alternaria and Cladosporium. A study of indoor mould levels was performed by placing SDA plates in 59 houses. The type of fungi and the number of colonies from each species were recorded. RESULTS: Forty-two subjects, comprising 10.9% of the study group had positive SPT to moulds, 61.9% of those were classified as symptomatic. When taking into account individuals with a borderline positive SPT to moulds, an additional 23 had positive results. Of the 65 mould-positive subjects, 48% were symptomatic and of the 13 who were allergic to moulds alone, only two had allergic symptoms. Viable moulds were recovered from all 59 houses examined. The most common isolated genus was Aspergillus, followed by Penicillium, Alternaria and Cladosporium. Aspergillus was also the most abundant mould in houses. There was no significant correlation between the abundance of moulds, positive SPT to that mould and symptomatology. CONCLUSIONS: Viable moulds are common in houses in temperate climates. Allergy to moulds itself has a low predictive value to development of allergic symptoms, but allergy to moulds in otherwise atopic subjects increases the risk of symptomatic allergic disease.

[Correlation between exposure to allergenic pollens and allergic manifestations].

Due to increase in allergic morbidity, better understanding of the relationships between environmental parameters and clinical responses of patients is needed. Serious analysis of such correlations requires examination of an entire population. So far there has been no study in Israel that examined an entire population in order to establish the distribution of inhalant allergens, the prevalence of skin hypersensitivity and allergic clinical morbidity. To examine these parameters we studied the population of Kibbutz Netzer Sereni, a rural community exposed to large amounts of various pollen allergens. Of the 505 members aged 4-70 years, 395 (78.2%) responded. Air sampling, once a month throughout the year, identified the most prevalent inhaled allergens and measured amounts. Allergic profiles were evaluated using prick tests with allergenic extracts, clinical questionnaires and medical records. The most prevalent allergenic pollens in the air were pecan, olive, cypress and palm trees, grasses and weeds such as English plantain, sagebrush, pigweed and lamb's quarters. Over 45% of 395 participants were atopic to 1 or more of the 27 allergenic extracts. The most prevalent causes of atopy were the house dust mite (28.9%), sagebrush (16.5%), grasses (18.2%), pecan (13.2%) and cypress (11.1%). Over 50% of atopic residents were symptomatic, while 22.9% of those non-atopic reported symptoms that could be attributed to allergy. This investigation provides solid data for the prevalence of atopy and allergy in the region of this kibbutz.

The importance of the pecan tree pollen in allergic manifestations.

BACKGROUND: Pecan tree pollen is considered to be highly allergenic. However, no specific scientific data about its role in causing allergic diseases are available. OBJECTIVE: To study the role of pecan tree pollen in the development of allergy. METHODS: The presence of pecan tree pollen was determined by weekly and monthly counting of airborne grains. The incidence of pecan tree pollen atopy and clinical manifestations were studied in 395 participants, aged 4-70 years, who comprised 78.2% of the whole eligible population of a rural community. The participants were skin tested for different extracts of allergens, completed detailed questionnaires, and their medical files were evaluated. RESULTS: During May, pecan tree pollen grains comprised 70% of the total airborne grains. A positive skin-prick test (SPT) to pecan was shown by 46 (11.6%) participants, constituting 25.4% of the atopic population. Of those who were found atopic to one or more allergens 50.3% had symptoms, whereas the parallel figure for those atopic to pecan pollen was 76.1% (P < 0.005); 58.7% of the pecan atopic participants had hay fever, 43.5% had asthma, and 31.5% had both hay fever and asthma. Among pecan atopic participants the incidence of hay fever increased with age (P = 0.05), while the incidence of bronchial asthma, as a sole manifestation of allergy, decreased in the > 17-year-old age group (P < 0.01). Of the pecan atopics 65.2% had clinical symptoms coinciding only with the pecan pollen season and an additional 10.9% had perennial symptoms. CONCLUSION: Pecan tree releases highly allergenic pollen grains, which are correlated to the incidence of hay fever in the exposed population. The contribution of pecan tree pollen to the symptoms was highly significant after discounting olive and cypress trees that also pollinate in the spring. In children, the pecan tree constitutes a possible etiologic agent for the development of asthma.