A case of maturity onset diabetes of the young

Department of Pediatric Endocrinology, Republican Clinical Hospital for Children “E. Coțaga”, Department of Molecular Biology and Genetics, SMPhU “Nicolae Testemițanu”, Primul Congres Naţional al Societăţii Endocrinologilor cu participare internaţională dedicat jubileului de 50 ani de la fondarea serviciului endocrinologic din Republica Moldova 9-11 octombrie 2014Diabetes is a worldwide problem with polygenic etiology. Nevertheless 10% of patients with type 1 and 5% of patients with type 2 diabetes have a monogenic form of this disease which has different treatment options and usually has fewer complications. We present a case analysis of a patient that has an unusual type of diabetes, presumably MODY, successfully treated with metformin.Un caz de diabet zaharat al tinerilor cu debut la maturitate Diabetul este o problemă mondială cu etiologie poligenică. Cu toate acestea 10% dintre pacienții cu tipul 1 și 5% din pacienții cu diabet zaharat de tip 2 au o formă monogenică a acestei boli, care are diferite opțiuni de tratament și, de obicei, are mai puține complicații. Prezentăm o analiză de caz al unui pacient care are un tip neobișnuit de diabet, probabil MODY, tratat cu succes cu metformin

Flegmonul cervical – evoluție nefavorabilă a abcesului periamigdalian

Background. Cervical phlegmon is an extremely severe complication, most commonly caused by dental pathology, peritonsillar abscess, infected wounds, inflammation of the lymph nodes and salivary glands. International studies report the occurrence of cervical phlegmon in 28.74% of cases as a result of peritonsillar abscess. Objective of the study. Identifying the specific features of the evolution of cervical phlegmon to make their diagnosis and management more efficient. Material and Methods. In the ENT Clinic of theTimofei Moșneaga Republican Clinical Hospital, between 2020 and 2022, were treated 8 patients with cervical phlegmon as a complication of a peritonsillar abscess. The age of the patients ranged from 37 to 81 years. The onset of clinical manifestations was noted on the 3-5th day after the incision and drainage of peritonsillar abscess. Results. In all cases, surgery (cervicotomy and tonsillectomy) was performed at one time, associated with intravenous antibacterial therapy, anti-inflammatory, analgesic, hydro-electrolytic and acid-base rebalancing. Bacteriological analysis of the pathological material determined Gram + pathogens in 6 cases and anaerobic infection - in 2 cases. From the group of operated patients, 2 patients mediastinitis and 1 patient – pleurisy on the same side. In addition, 3 of patients included in the study have been tested positive for SARS-CoV2 infection. Conclusions. The success of complex surgical cases depends on the patient’s multimodal approach, effective teamwork with thoracic surgeons and anesthesiologist the individualization of treatment according to the particularities of each case: extension of phlegmon, complications, age, and general conditions associated.Introducere. Flegmonul cervical reprezintă o complicație deosebit de severă, cel mai frecvent fiind determinată de patologia dentară, abcesele periamigdaliene, plăgile infectate, inflamația ganglionilor limfatici și a glandelor salivare. Studiile internaționale raportează apariția unui flegmon cervical în 28,74% cazuri ca urmare a unui abces periamigdalian. Scopul lucrării. Identificarea particularităților de evoluție a flegmoanelor cervicale pentru eficientizarea diagnosticului și managementului acestora. Material și metode. În cadrul Clinicii ORL a Spitalului Clinic Republican „Timofei Moșneaga”, în perioada anilor 2020 – 2022 au fost tratați 8 pacienți cu flegmon cervical ca complicație a unui abces periamigdalian. Vârsta pacienților a fost cuprinsă în intervalul 37-81 ani. Debutul manifestărilor clinice s-a remarcat la a 3-5-a zi după incizia și drenarea abcesului periamigdalian. Rezultate. În toate cazurile s-a practicat intervenție chirurgicală – cervicotomie și amigdalectomie unimomentan, asociată cu terapie intravenoasă antibacteriană, antiinflamatorie, antialgică, reechilibrare hidro-electrolitică și acido-bazică. Analiza bacteriologică a determinat germeni patogeni Gram+ în 6 cazuri și infecție anaerobă – în 2 cazuri. Din lotul de pacienți studiați, 2 pacienți au prezentat mediastinită anterioară și 1 pacient – pleurezie ipsilaterală. Totodată, 3 dintre pacienți au fost testați pozitiv la infecția SARS-CoV2. Concluzii. Succesul cazurilor chirurgicale complexe depinde de abordarea multimodală a pacientului, lucrul eficient de echipă cu medicii specialiști Chirurgie toracică și medicii ATI, precum și de individualizarea tratamentului în funcție de particularitățile fiecărui caz

Cervical phlegmon - unfavorable evolution of peritonsillar abscess

Introduction. Cervical phlegmon is an extremely severe complication, most commonly caused by dental pathology, peritonsillar abscess, infected wounds, inflammation of the lymph nodes and salivary glands. International studies report the occurrence of cervical phlegmon in 28.74% of cases as a result of peritonsillar abscess. Purpose. Identifying the specific features of the evolution of cervical phlegmons to make their diagnosis and management more efficient. Material and methods. In the ENT Clinic of the Republican Clinical Hospital "Timofei Moșneaga", between 2020 and 2022, were treated 8 patients with cervical phlegmon as a complication of a peritonsillar abscess. The age of the patients ranged from 37 to 81 years. The onset of clinical manifestations, such as cervical swelling, pain, hyperemia, odynophagia, fever, was noted on the 3-5th day after the incision and drainage of peritonsillar abscess. Results. In all cases, surgery (cervicotomy and tonsillectomy) was performed at one time, associated with intravenous antibacterial therapy, anti-inflammatory, analgesic, hydro-electrolytic and acid-base rebalancing. Bacteriological analysis of the pathological material determined Gram + pathogens in 6 cases and anaerobic infection - in 2 cases. From the group of operated patients, 2 patients mediastinitis and 1 patient - pleurisy on the same side. Also, 3 of patients included in the study have been tested positive for SARS-CoV2 infection. Conclusions. The success of complex surgical cases depends on the patient's multimodal approach, effective teamwork with thoracic surgeons and anaesthesiologist, also the individualization of treatment according to the particularities of each case: location and extension of phlegmon, complications, age and general conditions associated

The impact of the rehabilitation methods in children with type 1 diabetes mellitus - an update

Department of Pediatrics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Institute of Mother and Child, Chisinau, Republic of Moldova, Department of Therapeutic Dentistry, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. In children with Type 1 diabetes mellitus (T1DM) is necessary to implement prevention and treatment measures, aimed to reduce the risk of premature morbidity and mortality. Purpose. To evaluate the impact of rehabilitation methods of children with T1DM. Material and methods. The study was conducted between 22.07.2019 and 08.08.2019, on 34 children (21 boys, 13 girls), age range 3-15 years. Evaluated medical records (average of pre- and postprandial glucose, daily summary insulin dose, etc.). Treatment (aerohelio-thalassotherapy, sludge applications, laser therapy, massage, aeroion therapy, inhalations, alkaline mineral water) within the "Sergheevca" Children's Rehabilitation Center. Training in a cycle of lessons - "School of Diabetes". Food - according to physiological needs, with carbohydrate calculation. Performed at least 5 daily glucose with adjusting insulin doses (Glargine, Detemir, Aspart, Glulisin). Results. The total daily insulin dose (units/kg, see Fig.1) decreased by 18% in pediatric subjects with diabetes > 5 years (0.87→0.71) and 8% in those with 10 years, and under 10 years - 2% (0.85→) vs. - 9.7% (0.82→0.74)). In children > 10 years old there was a0.83 decrease of 13%, and in those under 10 years - 7%. The average blood glucose/24h, in children with diabetes > 5 years decreased by 5.6% (9.37→8.84 mmol/l), and in those with duration < 5 years - absent, and in the participants under 10 years a decrease of 8.5 % was noted (9.47→8.67 mmol/l), and in those over 10 years – absent. Conclusions. The rehabilitation methods have a positive impact for children with T1DM, expressed by a reduction of the total daily dose of insulin according to age, gender and duration of the disease

Congenital adrenal hyperplasia with complete virilization in girls: diagnosis, treatment and management approach

IMSP Institutul Mamei şi Copilului, IMSP Spitalul Clinic Republican pentru Copii „Emilian Coţaga”Congenital adrenal hyperplasia refers to a group of inherited disorders of the adrenal glands. The most common cause of the disease is 21-hydroxylase deficiency due to mutation of gene CYP21A2 and this condition involves excessive production of sex steroids. Total virilization in girls is very rare. In addition to life-long treatment problems these children have difficulty to determine the gender assignment. The case study listed below show the importance of hormonal and genetic analysis for diagnostic procedure. The correct gender assignment is not possible yet and this family needs to be assisted in this difficult period. Disfuncţia cortico-suprarenală congenitală este o patologie endocrină ereditară. Deficitul 21-hidroxilazei determinat de mutaţia genei CYP21A2 este cauza cea mai frecventă a maladiei şi se manifestă prin hiperproducţie de androgeni suprarenalieni. Formele cu virilizare totală la fetiţe sunt foarte rar întâlnite. Alături de tratamentul permanent hormonal de substituţie, aceşti copii prezintă dificultăţi şi la etapa de apreciere corectă a sexului. Exemplul cazului clinic prezentat mai jos demonstrează importanţa testelor hormonale şi genetice pentru stabilirea corectă a diagnosicului. Alegerea sexului copilului nu este posibilă încă şi familia va necesita în continuare asistenţă specializată

Diabetic ketoacidosis in children

Catedra Endocrinologie USMF „Nicolae Testemiţanu” IMSP Spitalul Clinic Republican pentru Copii “E.Coţaga”Diabetic ketoacidosis (DK) is the most frequent acute complication of diabetes mellitus type 1 in children and adolescents. Our study of 73 ketoacidosis cases has established a late diagnosis and violation of treatment regimen to be the main causes of the disease decompensation. DK was present at the onset of diabetes in 62.71 per cent of cases being more frequent in children of an early and puberty age. A comparative analysis of clinical and paraclinical data showed a severe metabolic disbalance in children with both primary and existing diabetes. Such symptoms as thirst, polyuria, nausea, vomiting, abdominal pains, lack of appetite, respiratory impairment resulting from hyperglycemia, ketonuria, alkaline deficiency and acidosis are highly frequent being very important in diagnosis. Cetoacidoza diabetică este cea mai frecventă complicaţie acută a diabetului zaharat tip 1 la copii şi adolescenţi. Studiul efectuat pe 73 cazuri de cetoacidoză a stabilit că diagnosticul tardiv şi încălcarea regimului de tratament reprezintă principalele cauze de decompensare a maladiei. Această gravă complicaţie a fost prezentă la debutul diabetului în 62,72% cazuri, fiind mult mai frecventă la copiii de vârstă fragedă şi pubertară. Analiza comparativă a datelor clinice şi paraclinice a evidenţiat un dezechilibru metabolic sever atât la copiii cu diabet zaharat primar cât şi la cei cu diabet cunoscut. Simptome ca setea, poliuria, greţurile, vomele, durerile abdominale, scăderea apetitului, dereglările de respiraţie pe fond de hiperglicemie, cetonurie, deficit alcalin, acidoză se întâlnesc cu o frecvenţă înaltă şi sunt importante pentru diagnostic

Optimizarea insulinoterapiei copiilor şi adolescenţilor cu diabet zaharat de tip 1

IMSP Institutul Mamei şi Copilului, Clinica „Emilian Coţaga”, Catedra Endocrinologie, USMF ”Nicolae Testemiţanu”, Primul Congres Naţional al Societăţii Endocrinologilor cu participare internaţională dedicat jubileului de 50 ani de la fondarea serviciului endocrinologic din Republica Moldova 9-11 octombrie 2014Diabetul zaharat de tip 1 este cea mai frecventă formă care afectează copiii şi adolescenţii. În Republica Moldova sunt înregistrate 339 cazuri de maladie la această vârstă. Compensarea adecvată a metabolismului glucidic este o condiţie obligatorie pentru profilaxia complicaţiilor tardive, iar tratamentul cu insulină necesită a fi adaptat cu grijă pentru minimalizarea riscului de hipoglicemii. În studiul dat s-a făcut analiza comparativă a diferitor regimuri de tratament cu insuline umane şi analogi de insulină în depenţă de vârstă şi durata diabetului zaharat la copii. Analogii de insulină au fost mai eficienţi în scăderea hemoglobinei glicozilate, la o doză sumară şi o frecvenţă mai mică a hipoglicemiilor.Optimization of insulin treatment in children and adolescents with type 1 diabetes mellitus Type 1 diabetes mellitus is the most common in children and adolescents. In Republic of Moldova 339 cases are recorded in this age group. Appropriate glucose control is a prerequisite for prevention of late diabetic complications and insulin treatment should be adapted carefully to minimize the risk of hypoglycemia. This study conducted a comparative analysis of different treatment regimens with human insulin and analogues in children depending of age and duration of disease. Insulin analogues were more effective in lowering HbA1c with a lower sumar dosis and a more frequently hypoglicemic events

Maturity onset diabetes of the young: Diagnosis and treatment options

Diabetes is a complicated disease, so multiple factors are involved in its development. Nevertheless some of the patients with type 1 and 2 diabetes mellitus have a monogenic form of this disease which has different treatment options and usually fewer complications. It is estimated that about 5% of patients with type 2 diabetes melitus (T2DM) and about 10% of type 1 diabetes melitus (T1DM) are misdiagnosed and have maturity onset diabetes of the young (MODY). We present a review study of the management of most frequent monogenic forms of diabetes such as MODY 1, 2 and 3 and the possibilities of their diagnosis including in resource limited situations

Impactul metodelor de reabilitare la copiii cu diabet zaharat de tipul 1 – reactualizare

Background. In children with Type 1 diabetes mellitus (T1DM) is necessary to implement prevention and treatment measures, aimed to reduce the risk of premature morbidity and mortality. Objective of the study. To evaluate the impact of rehabilitation methods of children with T1DM. Material and Method. The study was conducted between 22.07.2019 and 08.08.2019, on 34 children, age range 3-15 years. Evaluated medical records. Treatment within the "Sergheevca" Children's Rehabilitation Center. Training in a cycle of lessons - "School of Diabetes". Food - according to physiological needs, with carbohydrate calculation. Performed at least 5 daily glucose with adjusting insulin doses. Results. The total daily insulin dose (units/kg) decreased by 18% in pediatric subjects with diabetes > 5 years (0.87→0.71) and 8% in those with < 5 years (0.62→0.57) ((girls - 4% (0.63→ 0.61), boys - 20% (0.60→0.48) aged > 10 years, and under 10 years - 2% (0.85→0.83) vs. - 9.7% (0.82→0.74)). In children > 10 years old there was a decrease of 13%, and in those under 10 years - 7%. The average blood glucose/24h, in children with diabetes > 5 years decreased by 5.6% (9.37→8.84 mmol/l), and in those with duration < 5 years - absent, and in the participants under 10 years a decrease of 8.5 % was noted (9.47→8.67 mmol/l), and in those over 10 years – absent. Conclusion. The rehabilitation methods have a positive impact for children with T1DM, expressed by a reduction of the total daily dose of insulin according to age, gender and duration of the disease. Introducere. La copiii cu diabet zaharat de tip 1(DZ1) se impune implementarea măsurilor de profilaxie și de tratament, direcţionate spre reducerea riscului de morbiditate și de mortalitate premature. Scopul lucrării. Evaluarea impactului metodelor de reabilitare la copiii cu DZ1. Material și Metode. Studiul efectuat (22.07- 08.08.2019) pe 34 copiii, interval de vârstă 3-15 ani. Evaluate fișele medicale. Tratament în cadrul Centrului de Reabilitare pentru copii „Sergheevca”. Instruire într-un ciclu de lecții – „Școala diabetului”. Alimentație – conform necesităților fiziologice, cu calculul carbohidraților. Efectuate minim 5 glicemii zilnice, cu adaptarea dozelor de insulină. Rezultate. Doza zilnică totală de insulină (Un/kg corp) a scăzut cu 18% la subiecții pediatrici cu durata de diabet >5 ani (0,87 →la 0.71) și cu 8% la cei cu durata < 5 ani (0,62→0,57) ((fete - 4% (0,63→0,61), băieți - 20% (0,60→0,48) cu vârsta > 10 ani, iar sub 10 ani – 2% (0,85→0,83), vs – 9,7% (0,82→0,74)). La copiii cu vârsta > 10 ani s-a înregistrat o scădere de 13%, iar la cei sub 10 ani – 7%. Media glicemiilor/24h, la copiii cu durata de diabet > 5 ani a scăzut cu 5,6% (9,37→8,84 mmol/l), iar la cei cu durata < 5 ani – absente, iar la participanții sub 10 ani s-a atestat o scădere de 8,5% (9,47→8,67 mmol/l), iar la cei de peste 10 ani – absente. Concluzii. Metodele de reabilitare au un impact pozitiv pentru copiii cu DZ1, exprimat printro reducere a dozei zilnice totale de insulină atât în funcție de vârstă, gen, cât și de durata bolii