Autoimmunity & Type 1 diabetes patients: Review Article

Background: Increased blood glucose levels (hyperglycemia) are a hallmark of type 1 diabetes mellitus (T1DM), a chronic autoimmune illness marked by insulin insufficiency as a result of the destruction of the pancreatic islet cells. T1DMs a widespread metabolic disorder in children. The loss of cells is due to autoimmunity in mostndividuals (70-90%) with T1DM(concomitant with the formation of T1DM-associated autoantibodies). Autoantibodies are often detected months or even years before the start of symptoms in people with T1DM. These autoantibodies are indicators of the onset of autoimmunity rather than pathogens. Many autoimmune diseases have symptoms of T1DM. Such factors may profoundly impact clinical care of the illness, particularly in children. The four most common autoimmune disorders are vitiligo, Addison's disease, celiac disease, and autoimmune thyroid disease. Objectives: To outline the association of T1DM as an autoimmune disease with other comorbid autoimmune illnesses Conclusion: Several endocrine and non-endocrine autoimmune diseases are strongly linked to type 1 diabetes mellitus

Relation between vitamin D deficiency and recurrent acute diarrhea in children under the age of five years in Qena university hospitals

Background: Worldwide, children have a very high prevalence of vitamin D deficiency. Epidemiological evidence connects vitamin D deficiency to immune system dysfunction and an elevated risk of infections. For the therapy of acute diarrhea in children, it may be useful to know how vitamin D deficiency affects the severity of the condition. Objectives: To study the relation between vitamin D deficiency and recurrent acute diarrhea in children. Patients and Methods: A Hundred Egyptian children (1 month to 5 years old) with a history of recurrent attacks of acute diarrhea were enrolled in the study. They were subjected to complete history, clinical examination and laboratory investigation including vitamin D assays. Results: we found a positive correlation between vitamin D deficiency and recurrent acute diarrhea. Vitamin D deficiency was deficient in 15%, insufficient in 17%, and sufficient in 68% of children with recurrent acute diarrhea. There was a significantly decreased percentage of vitamin D supplementation in deficient patients (20%) when compared with insufficient patients (64.7%) and sufficient patients (63.2%). There was a highly significantly increased total number of diarrhea episodes in deficient patients (5.6 ± 1.1) when compared with insufficient patients (4.3 ± 1.5) and sufficient patients (2.2 ± 0.9). Conclusion: This study pays attention to the role of vitamin D in the susceptibility to infection-related illness in children

Prevalence of celiac-related antibodies and its impact on metabolic control in Egyptian children with type 1 diabetes mellitus

Abstract Objective The simultaneous presence of celiac disease and type 1 diabetes (T1DM) is coupled with more hazards of comorbidities and complications. This current study aimed to screen for celiac disease in Egyptian children with type 1 diabetes and evaluate its impact on glycemic control. Methods A cross-sectional study was verified with 200 Egyptian children diagnosed with T1DM and having a diabetic duration of less than five years. Testing for anti-tissue transglutaminase IgA (tTG-IgA), anti-tissue transglutaminase IgG (tTG-IgG), anti-Endomysial IgA (EMA), and Hb A1c levels were done. Results The serological screening revealed that 11 cases (5.5%) tested positive; 8 children with T1DM (4.0%) showed tTG-IgA antibodies ≥ 10 times the upper limit of normal (ULN) with at least one symptom; and 3 cases (1.5%) had levels between 20 and 50 IU/ml (considering a cut-off point of 10 U/ML for positive results). Intestinal biopsy was performed for these three cases, with one case detected to have subtotal villous atrophy, resulting in an overall prevalence of celiac disease in T1DM as 4.5%. Children with positive screening exhibited a higher insulin dose, a higher HbA1c, an increased frequency of hypoglycemic attacks, and recurrent DKA compared to negative cases. A negative correlation was detected between tTG-IgA antibodies with height Z score and hemoglobin level, while a positive correlation was found between tTG-IgA antibodies and HbA1c level. Conclusion Undiagnosed celiac disease in children with T1DM negatively impacted metabolic control and affected their general health

Evaluation of pulmonary function changes in children with type 1 diabetes mellitus in Upper Egypt

Background: Diabetes mellitus is a leading cause of morbidity and mortality among children across the world and is responsible for a growing proportion of global healthcare expenditure. However, limited data are available on lung dysfunction in children with diabetes. Aim: The aim of this study was to evaluate the pulmonary function changes in children with type 1 diabetes mellitus (T1DM). Methods: We studied 60 children with T1DM (mean age 10.5 ± 2.32 years; disease duration 2.45 ± 0.6 years, and 50 healthy control children (mean age 9.9 ± 2.5 years). Spirometry was performed for all individuals to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Glycemic control was assessed on the basis of glycated hemoglobin (HbA1c), with HbA1c values <8% considered to indicate good glycemic control, and HbA1c values ⩾8% to indicate poor control. Results: There was significant reduction in all spirometeric parameters in diabetic children in comparison with healthy control children. Children with poor glycemic control had significant impairment in lung functions compared with those with good glycemic control. Conclusions: T1DM in children leads to impairment of lung functions and this impairment increases with poor glycemic control

A comparison between plasmapheresis and intravenous immunoglobulin in children with Guillain–Barré syndrome in Upper Egypt

Objective: The aim of our study is to assess the clinico-electrophysiological profile of children with Guillain–Barré syndrome (GBS) in Upper Egypt and to compare the efficacy of plasmapheresis versus other treatment modalities. Patients and methods: This was a retrospective study of children from January 2010 to October 2014 diagnosed as GBS. It included 62 cases. Results: Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most prevalent type of GBS in our locality. As regards the treatment, 32 cases received plasmapheresis while 30 patients received intravenous immunoglobulin. We found a significant decrease in the duration of hospitalization and a significant increase in the number of children with complete recovery in cases treated with plasmapheresis. Conclusion: GBS is not uncommon in children of Upper Egypt, with AIDP the most prevalent type. Plasmapheresis is the best treatment modalities for GBS as it reduces the duration of hospital stay and hastens the recovery of those children