Diagnostic algorithm of hyperglycemia in children

Universitatea de Medicină şi Farmacie ”Grigore T.Popa”,Iaşi, România, Spitalul clinic de urgentă pentru copii “Sf.Maria”, Iaşi, RomâniaDefi nim hiperglicemia prin creşterea glicemiei a jeun peste 110 mg/dl sau printr-o glicemie oricand in cursul zilei peste 140 mg/dl. În practica pediatrică, aceste valori pot fi cauzate de anumite medicamente, de stres sau pun problema apariţiei diabetului zaharat. Dintre medicamentele care pot determina hiperglicemie menţionăm steroizii, tiazidele, hormonul de creştere şi unele antipsihotice. Acestea din urmă au fost asociate cu o incidenţă crescută a diabetului de tip 2 si cu înrăutăţirea controlului metabolic în diabetul de tip 1. Hiperglicemia de stres poate avea cauze minore, spre exemplu o infecţie de tract respirator superior, sau cauze severe, chirurgicale. Hiperglicemia din infecţiile minore poate anunţa apariţia unui diabet de tip 1 sau diabet MODY şi trebuie investigată ulterior. Dacă valorile glicemiei sunt peste 126 mg/dl a jeun şi peste 200 mg/dl în cursul zilei, se stabileşte diagnosticul de diabet zaharat. În peste 90% din cazuri, în copilărie şi adolescenţă se diagnostichează diabetul de tip 1, pe baza simptomelor tipice si prin confi rmarea patogeniei autoimune, respectiv a markerilor de autoimunitate. Există şi posibilitatea unui diabet secundar asociat anumitor afectiuni, cum ar fi fi broza chistică, talasemia, feocromocitomul sau afecţiuni genetice. Când valorile glicemiei a jeun sunt între 100-125 mg/dl, pentru a diferenţia diabetul zaharat de tip 2 de un diabet monogenic sau de un prediabet, se recomandă efectuarea testului oral de toleranţă la glucoză asociat cu determinarea hemoglobinei glicozilate A1c, a anticorpilor anticelule insulare ( ICA ), a anticorpilor antiinsulinici şi a peptidului C. În prezent, se remarcă o crestere a incidenţei diabetului zaharat de tip 2 la populatia pediatrică, şi anume la pacientii cu obezitate şi istoric familial pozitiv de obezitate şi/sau diabet de tip 2, cu valori normale sau crescute ale peptidului C şi fără autoanticorpi prezenţi. Diabetul de tip MODY apare la 2-3,5 % din cazurile de diabet zaharat, copiii având un fenotip extrem de variabil, nu prezinta autoanticorpi, iar transmiterea autosomal dominanta este demonstrata de istoricul familial de diabet la 2-3 generaţii. În concluzie, hiperglicemia la copil pune probleme de diagostic diferenţial între debutul diabetului zaharat, un diabet secundar, o hiperglicemie indusa medicamentos sau o hiperglicemie de stres.Hyperglycemia is defined as an increase of the fasting blood glucose level above 110 mg/dl or by random blood glucose level above 140 mg/dl. In pediatric practice, these values may be caused by certain medications, by stress or they may be an indication of diabetes mellitus. Here are some of the medications that may cause hyperglycemia: steroids, thiazides, growth hormone, and some antipsychotics. The latter was associated with an increased incidence of type 2 diabetes and with poor metabolic control in type 1 diabetes. Hyperglycemia caused by stress may have minor causes, for instance, an upper respiratory tract infection, or severe surgical causes. Hyperglycemia caused by minor infections may be the precursor of type 1 diabetes or of MODY diabetes and it should be further and more thoroughly analyzed. When the fasting blood glucose levels exceed 126 mg/dl and when the blood glucose levels are over 200 mg/dl at any time during the day, the diabetes mellitus diagnosis is set. Type 1 diabetes is diagnosed during childhood and adolescence in over 90% of the cases, based on specific symptoms and when confirmed by autoimmune pathogenicity, i.e. autoimmunity markers. There is also the possibility of secondary diabetes associated with certain conditions such as cystic fibrosis, thalassemia, pheochromocytoma, or genetic disorders. When fasting blood glucose levels are between 100-125 mg/dl, in order to distinguish type 2 diabetes from monogenic diabetes or from prediabetes, an oral glucose tolerance test is recommended together with the determination of glycosylated hemoglobin A1c, anti-islet cells (ICA), anti-insulin antibodies, and peptide C. Nowadays, there is an increase in the incidence of type 2 diabetes in the pediatric population, namely in patients with obesity and family history of obesity and/or type 2 diabetes, with normal or elevated C-peptide levels and no autoantibodies present. MODY diabetes occurs in 2-3.5% of the cases of diabetes, as children have a very variable phenotype, do not show autoantibodies, and dominant autosomal transmission is demonstrated by family history of diabetes in 2-3 generations. To conclude, hyperglycemia in children poses a differential diagnosis problem, as it is difficult to distinguish between the onset of diabetes mellitus, secondary diabetes, medication-induced hyperglycemia, or stress-caused hyperglycemia

Bell violation with entangled photons, free of the fair-sampling assumption

The violation of a Bell inequality is an experimental observation that forces one to abandon a local realistic worldview, namely, one in which physical properties are (probabilistically) defined prior to and independent of measurement and no physical influence can propagate faster than the speed of light. All such experimental violations require additional assumptions depending on their specific construction making them vulnerable to so-called "loopholes." Here, we use photons and high-efficiency superconducting detectors to violate a Bell inequality closing the fair-sampling loophole, i.e. without assuming that the sample of measured photons accurately represents the entire ensemble. Additionally, we demonstrate that our setup can realize one-sided device-independent quantum key distribution on both sides. This represents a significant advance relevant to both fundamental tests and promising quantum applications

Exploring changes in bacterial communities to assess the influence of fish farming on marine sediments

Changes in bacterial assemblages along an environmental gradient determined by the distance to aquaculture installations were analysed, using denaturing gradient gel electrophoresis to assess the influence of fish farming on marine sediments. Our findings show that changes in the structure of the bacterial community are a useful indicator for determining the environmental impact of aquaculture farms, due to the rapid response to changes in nutrient load, and could be an alternative strategy for monitoring programmes. Delta and Epsilonproteobacteria linked to the sulphur cycle were detected in the sediments beneath the cages. Since these groups were not found in the sediments at control stations, they serve as indicators for assessing the impact of the organic load from fish farming on marine sediments.This study forms part of the ‘Selección de indicadores, determinación de valores de referencia, diseño de programas y protocolos de métodos y medidas para estudios ambientales en acuicultura marina’ project funded by the ‘Spanish National Plans of Aquaculture’ (JACUMAR). The research was supported by Spanish Ministry of Economy and Competitiveness project CLG2015_66686-C3-3 (JA), which was also supported by financing from the European Regional Development Fund (FEDER). ERP thanks the Generalitat Valenciana for a postdoctoral grant (APOSTD-2016-091)

The Involvement of Epigenetic Mechanisms in HPV‐Induced Cervical Cancer

High‐risk human papillomavirus (HPV) genotypes infection associates with cervical dysplasia and carcinogenesis. hr‐HPV transforming potential is based on E6 and E7 viral oncoproteins actions on cellular proteins. A persistent infection with hr‐HPV leads to progression from precursor lesions to invasive cervical cancer inducing changes in host genome and epigenome. Pathogenesis and development of cancer associated with both genetic and epigenetic defects alter transcriptional program. An important role for malignant transformation in HPV‐induced cervical cancer is played by epigenetic changes that occur in both viral and host genome. Furthermore, there are observations demonstrating that oncogenic viruses, once they integrated into host genome, become susceptible to epigenetic alterations made by host machinery. Epigenetic regulation of viral gene expression is an important factor in HPV‐associated disease. Gene expression control is complex and involves epigenetic changes: DNA methylation, histone modification, and non‐coding RNAs activity. Persistent infection with hr‐HPV can cause viral DNA integration into host genome attracting defense mechanisms such as methylation machinery. In this chapter, we aim to review HPV infection role in chromatin modification/remodeling and the impact of HPV infection on non‐coding RNAs in cervix oncogenesis. The reversible nature of epigenetic alterations provides new opportunities in the development of therapeutic agents targeting epigenetic modification in oncogenesis

Interplay of Epigenetics with Gynecological Cancer

Recent data on the cell deregulation that occurs during the progression to cancer underlines the cooperation between genetic and epigenetic alterations leading to a malignant phenotype. Unlike genetic alterations, the epigenetic changes do not affect the DNA sequence of the genes, but determine the regulation of gene expression acting upon the genome. Moreover, unlike genetic changes, epigenetic ones are reversible, making them therapeutic targets in various conditions in general and in cancer disease in particular. The term epigenetics includes a series of covalent modifications that regulate the methylation pattern of DNA and posttranslational modifications of histones. Gene expression can also be regulated at the posttranscriptional level by microRNAs (miRNAs), a family of small noncoding RNAs that inhibit the translation of mRNA to protein. miRNAs can act as ‘oncomiRs’, as tumor suppressors, or both. In this chapter, we will (1) summarize the current literature on the key processes responsible for epigenetic regulation: DNA methylation, histone modifications and posttranscriptional gene regulation by miRNAs; (2) evaluate aberrant epigenetic modifications as essential players in cancer progression; (3) establish the roles of microenvironment-mediated epigenetic perturbations in the development of gynecological neoplasia; (4) evaluate epigenetic factors involved in drug resistance

Role of environmental chemicals in the development of obesity

Universitatea de Medicină şi Farmacie ”Grigore T. Popa”, Spitalul clinic de urgență pentru copii “Sf. Maria”, Iaşi, RomâniaNumeroşi factori pot avea un rol în dezvoltarea obezităţii – principala problemă de sănătate publică a secolului 21. Ipoteza mediului obezogen sugerează că expunerea prenatală şi precoce la diferite substanţe, cum ar fi chimicale, ce determină disrupţie endocrină pot predispune la creşterea masei grase şi exces ponderal. Lista chimicalelor studiate ca posibili obezogeni continuă să crească şi include dietilstilbestrolul (DES), bisfenolul A (BPA), ftalaţii, organotinele, eterii difenil-polibrominaţi (PBDEs), chimicalele polifluoroalkil (PFCs), organoclorinele (OC) pesticidele şi bifenil-policlorinatele (PCBs). Diverse mecanisme explică rolul chimicalelor obezogene, majoritatea având efecte disruptive asupra homeostaziei balanţei energetice, metabolismului glucozei şi lipidelor şi controlului adipogenezei. Aceste chimicale afectează mecanismele epigenetice, structurale şi funcţionale care controlează homeostazia energetică, metabolismul lipidic, reglarea apetitului şi adipogeneza. Expunerea la aceste chimicale are efecte diferite: în cursul perioadei fetale şi copilăriei efectele pot fi ireversibile şi pot persista in perioada de adult, iar expunerea la doze mici în cursul perioadelor critice ale diferenţierii pot schimba programarea dezvoltării şi pot cauza obezitate. Fumatul matern prenatal este asociat cu apariţia în creştere a supraponderalităţii la copil şi adolescent. Unele consecinţe asupra sănătăţii pot deveni aparente nu numai în copilărie, ci şi în perioada de adult. Alte chimicale au impact asupra retardului de creştere intrauterină, greutăţii mici la naştere şi prematurităţii, fi ind documentate ca factori predispozanţi ai obezităţii. Concluzie. Obezitatea epidemică ar putea fi considerată o boală complexă multifactorială. Efectul potenţial al chimicalelor asupra dezvoltării obezităţii este mare şi sunt necesare mai multe studii asupra expunerii chimice în timpul dezvoltării pre- şi perinatale şi apariţiei obezităţii mai târziu.Numerous factors may have a role in the development of obesity - the principal public health disease of the 21st century. The environmental obesogen hypothesis suggests that prenatal or early-life exposure to certain substances as endocrine- disrupting chemicals may predispose individuals to increased fat mass and excess weight. The list of chemicals studied as possible obesogens continues to grow and includes diethylstilbestrol (DES), bisphenol A (BPA), phthalates, organotins, polybrominated diphenyl ethers (PBDEs), polyfluoroalkyl chemicals (PFCs), organochlorine (OC) pesticides, and polychlorinated biphenyls (PCBs). Diverse mechanisms explained the role of obesogen chemicals, the majority having disruptive effects on the homeostasis of energy balance, glucose and lipid metabolism, and control of adipogenesis. These chemicals disrupt some epigenetic, structural, and functional mechanisms, which control energy homeostasis, lipid metabolism, appetite regulation, and adipogenesis Exposure to these chemicals has different effects: during fetal and infancy periods may be irreversible and long-lasting for adulthood and exposure to low doses during critical times of differentiation can change the developmental programming and may result in obesity. Prenatal maternal smoking is associated with increased occurrence of overweight among children and early adolescents. Such health consequences may become apparent not only in childhood but also in adulthood. Other chemicals have an impact on intrauterine growth retardation, low birth weight, and prematurity which are documented as predisposing factors for obesity. Conclusion. The obesity epidemic should be considered a multifactorial complex disorder. The potential effect of chemicals on the developmental programming of obesity is great and there are necessary more studies on chemical exposures during pre- and perinatal development to assess later obesity

Evaluación del desarrollo del lenguaje expresivo en niños de una I.E.I.P del distrito de Chaclacayo según sexo y edad

Esta investigación titulada “Evaluación del lenguaje expresivo en niños de una I.E.P.I del distrito de Chaclacayo según sexo y edad”, se justifica en la medida que sus resultados sirven para incrementar el bagaje teórico del lenguaje expresivo en niños en edad preescolar, además brinda información sobre los aspectos involucrados en el desarrollo del lenguaje expresivo, así como también describe las diferencias en los distintos grupos evaluados según sexo y edad. Por lo tanto, en este estudio se plantea como hipótesis: ¿Existen diferencias en el desarrollo del lenguaje expresivo en niños de una I.E.P.I del distrito de Chaclacayo, según sexo y edad? Para la realización de este estudio se utiliza pruebas que abarcan todos los componentes del lenguaje dentro del proceso expresivo: el Test Figura Palabra de Vocabulario Expresivo GARDNER Adaptado, Test para Evaluar Procesos de Simplificación Fonológica TEPROSIF-R, Protocolo pragmático y la muestra de lenguaje que permitió obtener la longitud media del enunciado. Los resultados demuestran que no existen diferencias significativas en el desarrollo del lenguaje expresivo según sexo, sólo se hallaron diferencias en cuanto a habilidades conversacionales en la categoría toma de turnos, obteniendo las mujeres el mayor puntaje. Por otro lado, se encontraron diferencias significativas en el desarrollo del lenguaje expresivo según edad, ya que los niños de 5 años tuvieron los puntajes más altos. En conclusión se puede comprobar parcialmente la hipótesis general ya que existen diferencias en el desarrollo del lenguaje expresivo en niños de una I.E.I.P. del distrito de Chaclacayo, según sexo y edadThis research entitled "Evaluation of expressive language in children of an IEPI of the Chaclacayo district by sex and age", is justified to the extent that the results for the theoretical baggage of expressive language in preschool children, in addition to information involved in the development of the express language, as well as describing the differences in the groups evaluated according to sex and age. Therefore, this research is presented as a hypothesis: Are there differences in the development of expressive language in children of a secondary school in the Chaclacayo district, by sex and age? To carry out this study, tests are used that cover all the components of the language within the expressive process: the Test Figure Word Word of Vocabulary Expressive GARDNER Adapted, Test to Evaluate Processes of Phonological Simplification TEPROSIF-R, Pragmatic Protocol and the sample of language Please get the average length of the sentence. The results show that there are no significant differences in language development expressed by sex, only differences were found in terms of conversational skills in the turn-taking category, with women obtaining the highest score. On the other hand, in the development of the expressive language by age, that the children of 5 years had the highest scores. In conclusion, you can verify the general hypothesis that already exists in the development of expressive language in children of an I.E.I.P. of the Chaclacayo district, by sex and age.Tesi