The utility of glucose area under the curve from the oral glucose tolerance test as a screening tool for cystic fibrosis-related diabetes.

BACKGROUND: Consistently abnormal glucose levels on oral glucose tolerance test (OGTT) are the most effective screening tool for cystic fibrosis-related diabetes (CFRD). However, some cystic fibrosis (CF) patients demonstrate abnormal glucose profiles not reaching levels required for CFRD diagnosis and are, therefore, left untreated. Since CFRD is associated with disease deterioration, early diagnosis and treatment are desirable. AIM: To explore the association between the area under the curve of glucose (G-AUC) obtained during a five-point 2-h standard OGTT and CF disease severity parameters. METHODS: All CF patients referred for an annual routine OGTT at the Hadassah CF Center between 2002 and 2018, were included. Disease severity parameters were correlated with the G-AUC. RESULTS: Two hundred forty-two OGTTs were performed in 81 patients (mean age 19.7 ± 9.0 years); 54% were normal, 14% showed impaired glucose tolerance (IGT), 5% had values in the indeterminate range (INDET), 11% had both IGT and INDET and 16% were diagnosed with CFRD. A gradual increase in mean G-AUC was observed among the groups. In multivariate regression models, G-AUC ≥ 295 mg h/dl was independently associated with an increased number of pulmonary exacerbations (PEx). Not all the patients having this value met the CFRD definition. CONCLUSION: Patients who do not fulfill the criteria for CFRD may have abnormal glucose metabolism identifiable by abnormally high G-AUC values, which may be associated with more PEx. The potential advantage of treating these patients with insulin and the subsequent reduction in PEx needs further investigation.

[Staphylococcus aureus osteomyelitis in children]. / Atypisch beloop van osteomyelitis doorStaphylococcus aureus bij kinderen.

Osteomyelitis is an infectious disease of the bone that primarily affects children. Here we discuss three patients, aged 11-13 years that were diagnosed with osteomyelitis. Despite the fact that in all three patients the infection was caused by the Staphylococcus Aureus bacteria, the clinical presentation and diagnostic results in all three was different. This case report presents various courses of the same disease, each with a slightly different treatment and outcome. Although the incidence of osteomyelitis is decreasing, it is of great importance to consider osteomyelitis as a diagnosis in pediatric bone complaints so that it can be recognized and treated in time to decrease the risk of bone destruction and growth disorders.