Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross-sectional study

AIMS

To describe the baseline clinical and laboratory findings and treatment modalities of 367 children and adolescents diagnosed with Type 2 diabetes in various paediatric endocrinology centres in Turkey.

METHODS

A standard questionnaire regarding clinical and laboratory characteristics at onset was uploaded to an online national database system. Data for 367 children (aged 6-18 years) newly diagnosed with Type 2 diabetes at 37 different paediatric endocrinology centres were analysed.

RESULTS

After exclusion of the children with a BMI Z-score < 1 SD, those with genetic syndromes associated with Type 2 diabetes, and those whose C-peptide and/or insulin levels were not available, 227 cases were included in the study. Mean age was 13.8 ± 2.2 (range 6.5-17.8) years, with female preponderance (68%). Family history of Type 2 diabetes was positive in 86% of the children. The mean BMI was 31.3 ± 6.5 kg/m² (range 18.7-61) and BMI Z-score was 2.4 ± 0.8 (range 1-5). More than half (57%) of the children were identified by an opportunistic diabetes screening due to existing risk markers without typical symptoms of diabetes. Only 13% (n = 29) were treated solely by lifestyle modification, while 40.5% (n = 92) were treated with metformin, 13% (n = 30) were treated with insulin, and 33.5% (n = 76) were treated with a combination of insulin and metformin initially. Mean HbA_1C levels of the insulin and combination of insulin and metformin groups were 98 (11.1%) and 102 mmol/mol (11.5%), respectively, and also were significantly higher than the lifestyle modification only and metformin groups mean HbA_1C levels (70(8.6%) and 67 mmol/mol (8.3%), respectively).

CONCLUSIONS

An opportunistic screening of children who are at high risk of Type 2 diabetes is essential, as our data showed that > 50% of the children were asymptomatic at diagnosis. The other important result of our study was the high rate of exclusion from the initial registration (38%), suggesting that accurate diagnosis of Type 2 diabetes in youth is still problematic, even for paediatric endocrinologists.

Does amnioreduction increase success of emergency cervical cerclage in cases with advanced cervical dilatation and protruding membranes?

OBJECTIVE

To investigate whether amnioreduction has any impact on emergency cervical cerclage outcome.

MATERIALS AND METHODS

Data of women who underwent emergency cervical cerclage for advanced cervical dilatation and protruding membranes were analyzed retrospectively.

RESULTS

During the study interval, a total of 56 women who were underwent amnioreduction (n=26) and who did not (n=30) were eligible for analysis of the study. Gestational age at cerclage, delivery, and prolongation of pregnancy interval were comparable between the groups (21.3 ±3.3 vs. 20.6 ±3.1 weeks; p = 0.44; 28.3 ±6.1 vs. 28.1 ±5.6 weeks; p = 0.74; 53.7± 46.1 vs. 47.3± 36.7 days; p = 0.56 respectively). Number of live birth rates and perinatal mortality rates were also not statistically significantly different between the groups (73.1% vs. 70.0%; p = 0.80; 15.4% vs. 13.3%; p = 0.83).

CONCLUSIONS

Emergency cerclage yields live take home baby rates in more than half of the patients. The decision to perform amnioreduction should be based on suspicion of chorioamnionitis and patient's motivation to know exactly what is the risk of chorioamnionitis.

Does removal of CU-IUD in patients with biofilm forming candida really maintain regression of clinical symptoms?

OBJECTIVE

To evaluate whether symptoms and recurrence would differ with and without Cu-IUD removal in patients with concomitant biofilm forming Candida spp.

METHODS

The data of 270 consecutive patients wearing TCu380A Cu-IUD were evaluated. Among these patients, 100/270 were found to have Candida spp. isolated from the tail of Cu-IUD or vaginal samples. These patients were investigated in four groups: Group 1 (n = 24; Biofilm (+), Cu-IUD removed), Group 2 (n = 14; Biofilm (+), Cu-IUD not removed), Group 3 (n = 29; Biofilm (-), Cu-IUD removed), Group 4 (n = 33; Biofilm (-), Cu-IUD not removed). Patients in each group were followed for clinical signs and symptoms for 8-16 months and compared to each other.

RESULTS

Symptoms, physical findings and candida positivity have decreased statistically significantly in Group 1 one year after removal of Cu-IUD (95.8% vs. 4.2%, p < 0.01; 95.8% vs. 4.2%, p < 0.01; 100% vs. 8.3%, p < 0.01 respectively). In Group 2, symptoms, physical findings and candida positivity have decreased after follow-up, but without a statistical significance. In Group 3, all the parameters have decreased, but only decrease in candida positivity has reached statistical significance (100% vs. 48.3%, p < 0.01). In Group 4 - as in Group 1- symptoms, physical findings and candida positivity have decreased statistically significantly (48.5% vs. 18.2%, p = 0.01; 72.7% vs. 48.5%, p = 0.05; 100% vs. 51.5%, p < 0.01 respectively).

CONCLUSION

Biofilm forming microorganisms should be considered in the management of vaginal infections or symptoms for safer use of intrauterine devices.

Integrating cervical length measurement into routine antenatal screening and only emergency cerclage when indicated

PURPOSE

To integrate cervical length measurement into antenatal screening and apply emergency cerclage when indicated to prevent spontaneous deliveries at < 34 weeks of gestation.

METHODS

Cervical length measurements of 400 pregnant volunteers were obtained at gestational weeks 12-14, 18-20 and 28-32. Whenever a cervical measurement < 30 mm was observed, vaginal cultures and bacterial vaginosis were investigated, and weekly cervical length measurements were performed thereafter. Emergency cerclage was performed whenever complete cervical effacement and > or = 3 cm cervical dilatation were observed before 32 completed weeks of gestation. We adopted and tested a strategy of only emergency cerclage application when clinically indicated after ultrasound screening and microbial monitoring of short cervices. Patients were given cyclooxygenase-inhibitors, progesterone, and antibiotics in the postoperative period.

RESULTS

Spontaneous preterm births at < 34 weeks of gestation occurred in 15 women (3.8%). We performed five emergency cerclages according to the presented screening strategy between 20-28 weeks of gestation all of which reached > 34 weeks. We successfully postponed 62.5% (5/8) of deliveries before 32 completed weeks and 33.3% (5/15) of deliveries before 34 completed weeks.

CONCLUSION

Routine cervical length measurement combined with serial transvaginal sonograms and vaginal microbial monitoring of the short cervices will avoid unnecessary prophylactic cerclages while increasing the success of emergency cerclages performed upon solid clinical findings.

GABAergic modulation of yawning behavior

The hypothetical modulation by GABAergic neurons of yawning behavior in the rat was explored with GABA-active drugs. Gamma-acetylenic-GABA, a specific inhibitor of GABA-T, increases yawning frequency when injected at a dose of 7 mg/kg. Baclofen, a GABAB agonist (3 mg/kg), inhibits yawning completely; GABA antagonists, bicuculline and picrotoxin, at subconvulsant doses, also decrease yawning. All drugs were injected intraperitoneally with the exception of apomorphine, which was injected subcutaneously. It is suggested that GABAB receptors play a role in yawning behavior by modulating ACh release, and that GABAA receptors may modify yawning frequency by modulating inhibitory influences on ACh neurons.