Remote monitoring of adolescents with type 1 diabetes mellitus using a mobile application

Background: The prevalence of type 1 diabetes mellitus (T1DM) in childhood is increasing every year. Adolescence is the most challenging age for achieving optimal metabolic control of T1DM. Telemedicine has already been shown to be ­effective in children with the condition, but there are not enough studies in adolescents. The use of mobile apps may be associated with better glycemic control in patients with type 1 diabetes.Aims: To assess the effectiveness and safety of a model of medical care for adolescents with type 1 diabetes using remote counseling and a mobile application.Materials and methods: Were included adolescents aged ≥14 and 18 years with a T1DM duration> 3 months, a glycated hemoglobin level (HbA1c)> 7%. The duration of the study was 26 weeks. There were 3 face-to-face and at least 4 remote visits using a mobile application. All patients underwent standard examination and anthropometry, study of HbA1c, registration and analysis of indicators, assessment and correction of the treatment. The quality of life of adolescents was assessed at baseline and at the end of the study. Adolescents and physicians were interviewed about program evaluation.Results: 56 patients were included, 7 adolescents withdrew. HbA1c significantly decreased by the 12th week of the study (–0.3%; p = 0.005), by the end of the study the change in HbA1c was –0.5% (p <0.001). There was an increase in the percentage of glucose measurements in the target range (+5.3 pp; p = 0.016) and a decrease in blood glucose variability (-3.1 pp; p =  0.015). There was a significant improvement in both the total assessment of the quality of life by patients (+2.9 points; p = 0.008) and individual components of its indicators: attitude to diabetes (+3.0 points; p = 0.049), attitude to treatment (+4.6 points; p = 0.010) and communication with others (+4.5 points; p = 0.015). The majority of doctors and patients assessed their participation in the study positively. The incidence of adverse events did not change significantly during the study from baseline.Conclusion: Remote counseling using a mobile app is a safe and effective approach for adolescents with T1DM in terms of glycemic control and quality of life, and provides convenience and speed of interaction

СЛОЖНЫЙ СЛУЧАЙ ТЕЧЕНИЯ КЛЕЩЕВОГО ЭНЦЕФАЛИТА С ИСХОДОМ В КОЖЕВНИКОВСКУЮ ЭПИЛЕПСИЮ

The article presents a case of severe encephalitis in a child of 11 years old with lesion of CNS (meningoencephalitis), and the outcome in epilepsy. В статье представлен случай тяжелого течения клещевого энцефалита у ребенка 11 лет с поражением ЦНС (менингоэнцефалитом) и исходом в эпилепсию.

Организация грудного вскармливания в отделениях реанимации и интенсивной терапии недоношенных детей: дискуссионные вопросы

The priority of breastfeeding in the care of premature infants is not in doubt. For preterm babies, breastfeeding provides a dual effect, reducing the risk of both immediate and long-term effects associated with prematurity. In this regard, extraordinary efforts are being made at the international level to promote and support breast-feeding of newborns, including in intensive care units. Mother’s own milk is the first choice for feeding a premature baby. In recent years, the problems of quality and safety of expressed breast milk — both pasteurized and fresh — for newborn patients of intensive care units are discussed. The authors point out that the treatment procedures and storage conditions of expressed breast milk differ significantly; there are no common criteria for its microbiological safety, which limits the use of this unique product, especially in premature infants. In addition to the risk of bacterial infection, the risk of infection with cytomegalovirus (CMV) when using fresh milk from a CMV — seropositive mother is discussed for premature infants. The review examines the criteria for the risk of CMV infection in children and indications for selective treatment of breast milk for inactivation of a probable pathogen.Приоритетность обеспечения грудного вскармливания при выхаживании недоношенных младенцев не подвергается сомнению. Для детей, родившихся преждевременно, вскармливание грудным молоком обеспечивает двойной эффект, снижая риск как ближайших, так и отдаленных последствий, связанных с недоношенностью. В этой связи на международном уровне предпринимаются чрезвычайные шаги по поощрению и поддержке вскармливания новорожденных грудным молоком, в том числе в отделениях интенсивной терапии. Собственное молоко матери является первым выбором для кормления недоношенного ребенка. В последние годы обсуждаются проблемы качества и безопасности сцеженного грудного молока — как пастеризованного, так и свежего — для новорожденных пациентов отделений реанимаций и интенсивной терапии. Авторы указывают, что процедуры обработки и условия хранения сцеженного грудного молока существенно различаются, отсутствуют единые критерии его микробиологической безопасности. Все это ограничивает использование сцеженного грудного молока, прежде всего у недоношенных новорожденных. Помимо опасности бактериального инфицирования, в отношении недоношенных младенцев обсуждается риск заражения цитомегаловирусом (ЦМВ) при использовании свежего молока ЦМВ-серопозитивной матери. В обзоре рассматриваются критерии риска инфицирования детей ЦМВ и показания к избирательной обработке грудного молока для инактивации вероятного патогена

Clinical, hormonal and molecular-genetic characteristics of monogenic diabetes mellitus associated with the mutations in the <i>INS</i> gene

Background: Currently more than 50 mutations of the INS gene are known to affect the various stages of insulin biosynthesis in the beta cells of the pancreas. However only individual cases of diabetes mellitus (DM) associated with heterozygous mutations in the coding region of the INS gene were reported in Russian Federation. We report a group of patients with a clinical manifestation of DM caused by mutations in both coding and non-coding regions of the INS gene. The patients with a mutation in the intron of the INS gene are reported for the first time in Russian FederationMaterials and methods: 60 patients with an isolated course of neonatal DM (NDM), 52 patients with a manifestation of DM at the age of 7–12 months and the absence of the main autoimmune markers of type 1 DM, 650 patients with the MODY phenotype were included in the study. NGS technology was used for molecular genetic research. Author’s panel of primers (Custom DNA Panel) was used for multiplex PCR and sequencing using Ion Ampliseq™ technology. The author’s panel “­Diabetes Mellitus” included 28 genes (13 candidate genes of MODY and other genes associated with DM).Results: 13 heterozygous mutations were identified in 16 probands and 9 relatives. The majority of mutations were detected in patients with PNDM (18.75%) and in patients with an onset of DM at the age of 7–12 months (9.6%). Mutations in the INS gene were detected in 2 patients (0.3%) in the group with the MODY phenotype. Mutations in the INS gene were not detected in patients with transient NDM (TNDM). Analysis of clinical data in patients with PND and onset of diabetes at the age of 7–12 months did not show significant differences in the course of the disease. The clinical characteristics of the cases of MODY10 and diabetes caused by a mutation in the intron of the INS gene are reported in details.Conclusion: The role of INS gene mutations in NDM, MODY, and DM with an onset at the age of 7–12 months was analyzed in a large group of patients. The clinical characteristics of DM due to a mutation in the intron of the INS gene are reported for the first time in the Russian Federation

Znachenie glikirovannykh belkov pri kozhnykh oslozhneniyakh u detey s sakharnym diabetom 1 tipa

У больных СД 1, даже хорошо контролируемых, накапливаются гликированные протеины в тканях, играющие большую роль в развитии диабетических осложнений. Сумма гликированных белков плазмы (аналогичная информация за предшествующие 18 дней) определяется как фруктозамин, основную часть которого составляет гликированный альбумин, обусловливающий длительность циркуляции фруктозамина в сосудистом русле. Диабетические осложнения связаны с действием конечных продуктов гликирования (КПГ), которые образуются при длительно существующей гипергликемии. Взаимодействие повышенного содержания КПГ с сосудистой стенкой приводит к нарушению ее проницаемости, накоплению под интимой белка липопротеинов, повышению резистентности к ок?сиду азота, что имеет место при СД и старении. При плохом контроле СД и повышенных значениях НвА1с повышение уровня гликирования белков и их накопления во всех слоях кожи коррелирует с уровнем НвА1с. Доказано, что нарушения эластических волокон коррелируют с повышением "слабости кожи", присущей старению, и являются маркером тяжести сосудистых осложнений при СД. Микроангиопатические нарушения слабо коррелируют с другими специальными показателями старения кожи

A COMPLEX CASE OF THE COURSE OF TICK-BORNE ENCEPHALITIS WITH AN OUTCOME IN EPILEPSY OF KOZHEVNIKOV

The article presents a case of severe encephalitis in a child of 11 years old with lesion of CNS (meningoencephalitis), and the outcome in epilepsy

Stroke in children and adolescents: topical problems of pre-hospital diagnostics

The article is devoted to the urgent problem of pediatrics and pediatric neurology, pre-hospital diagnosis of stroke in children. A review of domestic and foreign literature on the early diagnosis of stroke in children and adolescents, as well as epidemiological data on pediatric stroke, is presented. Particular attention is paid to the features of the symptoms of stroke and stroke-like conditions («stroke masks») in the pediatric population and the analysis of the main factors that influence errors in the early diagnosis of stroke in children and adolescents. Currently, in the diagnosis of ischemic stroke, its «masks» are found in 53.9 % of cases, with hemorrhagic stroke, in 36.3 %, and with transient ischemic attacks, in 9.8 % of cases. One of the most common diseases with which it is necessary to differentiate ischemic stroke in children is migraine. This problem is covered in academic writings that highlight the leading differential diagnostic criteria for migraine and stroke, and also represent a diagnostic algorithm. The clinical features of pediatric stroke, especially manifest symptoms, make it difficult to apply adult screening stroke scales in pediatrics. The article discusses the main scales for the early diagnosis of stroke in adults, and their potential application in pediatric practice. Currently accumulated experience in prehospital and early diagnosis of stroke in children determines the main directions of work to reduce the time of diagnosis of acute cerebrovascular accidents in children, followed by the introduction of reperfusion therapy in pediatric practice