Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes. An Italian multicenter study

WSTĘP. Celem badania była ocena chorobowości w przypadku, potwierdzonej w biopsji, choroby trzewnej u włoskich dzieci i młodzieży, chorych na cukrzycę typu 1 oraz określenie zależności między wiekiem, w którym ujawniła się cukrzyca typu 1, a rozpoznaniem choroby trzewnej. MATERIAŁ I METODY. Badanie obejmowało grupę kliniczną dzieci i młodzieży w okresie dojrzewania, chorych na cukrzycę typu 1, leczonych w 25 ośrodkach we Włoszech. Co roku wykonywano u nich badania przesiewowe w kierunku celiakii, przy użyciu przeciwciał przeciwgliadynowych IgA/IgG i przeciwciał IgA przeciwko endomysium. WYNIKI. Potwierdzoną w biopsji chorobę trzewną stwierdzono u 292 z 4322 dzieci i młodzieży [chorobowość 6,8%, 95-procentowy przedział ufności (CI, confidendial interval) 6,0-7,6]; ryzyko wystąpienia choroby trzewnej było wyższe u dziewcząt niż u chłopców [współczynnik ryzyka (OR, odds ratio) 1,93; 1,51-2,47]. W 89% przypadków cukrzycę rozpoznano przed ujawnieniem się choroby trzewnej. Analiza regresji logistycznej wykazała, że młody wiek, płeć żeńska i zaburzenia czynności tarczycy były niezależnie związane z ryzykiem zachorowania na cukrzycę lub chorobę trzewną. W porównaniu z osobami, u których cukrzyca ujawniła się powyżej 9. roku życia, u osób, u których początek choroby wystąpił poniżej 4. roku życia, OR wynosił 3,27 (2,20-4,85). WNIOSKI. W niniejszej pracy wykazano, że: 1) chorobowość w przypadku potwierdzonej biopsją choroby trzewnej u dzieci i młodzieży jest wysoka (6,8%); 2) ryzyko wystąpienia obu schorzeń jest 3-krotnie wyższe u dzieci i młodzieży z cukrzycą typu 1, u których ujawniła się ona przed ukończeniem 4. roku życia niż w przypadku, kiedy początek choroby wystąpił powyżej 9. roku życia; 3) ryzyko wystąpienia obu schorzeń u dziewcząt jest wyższe niż u chłopców.INTRODUCTION. To estimate the prevalence of biopsy- confirmed celiac disease in Italian children and adolescents with type 1 diabetes and to assess whether age at onset of type 1 diabetes is independently associated with diagnosis of celiac disease. MATERIAL AND METHODS. The study group was a clinic-based cohort of children and adolescents with type 1 diabetes cared for in 25 Italian centers for childhood diabetes. Yearly screening for celiac disease was performed using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies. RESULTS. Of the 4,322 children and adolescents (age 11.8 ± 4.2 years) identified with type 1 diabetes, biopsy-confirmed celiac disease was diagnosed in 292 (prevalence 6.8%, 95% confidence interval [CI] 6.0–7.6), with a higher risk seen in girls than in boys (odds ratio [OR] 1.93, 1.51–2.47). In 89% of these, diabetes was diagnosed before celiac disease. In logistic regression analyses, being younger at onset of diabetes, being female, and having a diagnosis of a thyroid disorder were independently associated with the risk of having diabetes and celiac disease. In comparison with subjects who were older than 9 years at onset of diabetes, subjects who were younger than 4 years at onset had an OR of 3.27 (2.20–4.85). CONCLUSIONS. We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age 9 years; and 3) girls have a higher risk of having both diseases than boys

Non-Occlusive Mesenteric Ischemia in Children With Diabetic Ketoacidosis: Case Report and Review of Literature

IntroductionDespite the use of technology, recurrent diabetic ketoacidosis (DKA) prevention remains an unmet need in children and adolescents with T1D and may be accompanied by life-threatening acute complications. We present a rare case of non-occlusive mesenteric ischemia (NOMI) with overt manifestation after DKA resolution and a discussion of recent literature addressing DKA-associated NOMI epidemiology and pathogenesis in children and adolescents.Case PresentationA 13-year-old female with previously diagnosed T1D, was admitted at our emergency department with hypovolemic shock, DKA, hyperosmolar state and acute kidney injury (AKI). Mildly progressive abdominal pain persisted after DKA correction and after repeated ultrasound evaluations ultimately suspect for intestinal perforation, an intraoperative diagnosis of NOMI was made.ConclusionThe diagnosis of DKA-associated NOMI must be suspected in pediatric patients with DKA, persistent abdominal pain, and severe dehydration even after DKA resolution

Highly specific memory B cells generation after the 2nd dose of BNT162b2 vaccine compensate for the decline of serum antibodies and absence of mucosal IgA

Specific memory B cells and antibodies are a reliable read-out of vaccine efficacy. We analysed these biomarkers after one and two doses of BNT162b2 vaccine. The second dose significantly increases the level of highly specific memory B cells and antibodies. Two months after the second dose, specific antibody levels decline, but highly specific memory B cells continue to increase, thus predicting a sustained protection from COVID-19. We show that although mucosal IgA is not induced by the vaccination, memory B cells migrate in response to inflammation and secrete IgA at mucosal sites. We show that the first vaccine dose may lead to an insufficient number of highly specific memory B cells and low concentration of serum antibodies, thus leaving vaccinees without the immune robustness needed to ensure viral elimination and herd immunity. We also clarify that the reduction of serum antibodies does not diminish the force and duration of the immune protection induced by vaccination. The vaccine does not induce sterilizing immunity. Infection after vaccination may be caused by the lack of local preventive immunity because of the absence of mucosal IgA

Performance of the CMS Cathode Strip Chambers with Cosmic Rays

The Cathode Strip Chambers (CSCs) constitute the primary muon tracking device in the CMS endcaps. Their performance has been evaluated using data taken during a cosmic ray run in fall 2008. Measured noise levels are low, with the number of noisy channels well below 1%. Coordinate resolution was measured for all types of chambers, and fall in the range 47 microns to 243 microns. The efficiencies for local charged track triggers, for hit and for segments reconstruction were measured, and are above 99%. The timing resolution per layer is approximately 5 ns