Central aortic pressure, arterial stiffness and echocardiographic parameters of children with overweight/obesity and arterial hypertension.

BACKGROUND: A non-invasive estimation of central aortic pressure and echocardiographic parameters, and appropriate interpretation thereof make it possible to determine the status of the vascular wall and myocardium. These parameters are early markers of unfavorable remodeling of the cardiovascular system. OBJECTIVES: The aim of this study was to analyze the central aortic pressure and echocardiographic parameters of overweight/obese children (with or without concomitant arterial hypertension). MATERIAL AND METHODS: The study included 84 children (mean age: 15 years) - 45 with primary arterial hypertension, 39 normotensive, and 38 controls. Central aortic systolic (cSys) and diastolic (cDia) pressures, pulse wave augmentation index (Aix@75), peripheral resistance, pulse wave reflection and pulse wave velocity (PWV) were determined by means of brachial oscillometry. A number of echocardiographic parameters were recorded. RESULTS: Obese children with arterial hypertension showed the highest values of cSys, cDia and PWV, as well as interventricular septal end-diastolic thickness (IVS), left atrial diameter (LAD), left ventricular mass index (LVMI), elongation index and cardiac output (CO). Patient age, cSYS, cDIA and LAD were identified as significant predictors of PWV. The groups did not differ in terms of Aix@75, peripheral resistance and pulse wave reflection values. CONCLUSIONS: Children with overweight/obesity present with elevated values of cSys, PWV, LVMI, LAD and CO. The risk of these abnormalities is further increased due to concomitant arterial hypertension.

Plasma levels of IL-17, VEGF, and adrenomedullin and S-cone dysfunction of the retina in children and adolescents without signs of retinopathy and with varied duration of diabetes.

The study objective was to assess chosen biochemical parameters of blood and bioelectric function of the retina in patients with T1DM. The study group consisted of 41 patients with T1DM with no signs of diabetic retinopathy. The control group included 21 pediatric patients. We performed (1) S-cone ERG testing with retina response stimulation in both eyes at the luminance of 0.1, 0.2, and 0.5 (cd × s/m(2)) with the 440 nm blue flash and light application of the amber background (300 ph cd/m(2), 495 nm wavelength), (2) anthropometric measurements, (3) biochemical investigations: IL-17, VEGF, and ADM by the ELISA method. A comparison of the ERG results with biochemical investigations indicates a likely correlation between the worsening of retinal bioelectric function and VEGF levels growing with diabetes duration. We showed a negative correlation between ADM and HbA1c and described possible causes of ADM reduction observed in subgroup I. We demonstrated the presence of bioelectric retinal dysfunction already before the diagnosis of diabetic retinopathy, which provides new possibilities in the diagnosis of preclinical chronic complications of diabetes. The changes observed in the levels of IL-17, ADM, and VEGF suggest their involvement in the diabetic pathogenesis of eye diseases.

[Changes in the cardiovascular system in selected endocrinopathies in children]. / Zmiany w ukladzie krazenia w wybranych endokrynopatiach u dzieci.

Hormones have influence on many tissues and organs including the cardiovascular system. This article analyzes fluctuations that happen in a child's cardiovascular system in selected endocrinopathies. We are pointing out the higher risk, in the course of diabetes, of development of arterial hypertension and atherosclerosis including participating mechanisms in their pathogenesis - disorders of the lipid metabolism, hiperinsulinaemia, insulin resistance or/and autonomic neuropathy. We are describing how the increased and reduced action of thyroid hormones on certain molecular pathways in the heart and vasculature causes relevant cardiovascular derangement. In the article, we are signaling also that the cardiovascular consequences of cortisol excess are elevation of blood pressure, obesity, hyperinsulinemia and/or dyslipidemia. This review analyzes the relationship of cortisol excess to these cardiovascular risk factors and to putative mechanisms for hypertension. In reference to clinical studies we are describing how the deficiency of the growth hormone is connected with a development of risk factors of cardiovascular diseases. In conclusion we underlined that early diagnosis and proper treatment of illnesses of the endocrine system can protect our pediatric patients from serious cardiac complications in later years.

[Usefulness of short-term usage of real time continuous glucose monitoring system in achieving metabolic control improvement in adolescents with type 1 diabetes]. / Przydatnosc krótkoterminowego wykorzystania systemu ciaglego monitorowania glikemii w czasie rzeczywistym w uzyskaniu poprawy metabolicznej u nastolatków z cukrzyca typu 1.

INTRODUCTION: Experience with use of real-time continuous glucose monitoring systems (RT-CGMS) in teenagers with diabetes type 1 is limited, and in unselected groups of young patients did not show improvement in metabolic control. AIM OF THE STUDY: The objective of this study was to assess short-term RT-CGMS usage in teenagers with type 1 diabetes, in terms of possibility to improve metabolic control and acceptance of the system. MATERIAL AND METHODS: 40 subjects, aged 14.5±2 years on insulin pump therapy were included in the study. Mean diabetes duration was 6±3 years and HbA1c level before the study was 8.4±1.5%. The analysis was based on single 5-6 days long sensor usage, connected with education of the family. We analysed several parameters of glycaemic variability during the study, and HbA(1)c level before and 2 months after the study. Patients' satisfaction was assessed on the basis of a questionnaire. RESULTS: HbA(1)c level in the whole teenagers group decreased insignificantly by 0.3%; from 8.4±1,% to 8.1±1.6%. In 24 (60%) patients we showed improvement in HbA(1)c by at least 0.5% (mean 0.9%, from 8.1±1.3% to 7.2±1.2%; p=0.03). HbA(1)c level was slightly higher in girls than in boys at the beginning of the study and a greater reduction in HbA(1)c was shown for boys. After two months the difference was significant: 8.6±1.9% in girls vs. 7.6±1.3% in boys, p=0.03. In the group with HbA(1)c decrease and in boys we demonstrated improvement in mean glycaemia and glycaemic variability parameters on the last day of the sensor usage, compared to the first day. In boys however, increased AUC <70 mg/dl/ min was noticed. The patients from the group with HbA(1)c decrease reported fewer problems with system calibration: 3.2 vs. 2.6 score, p=0.03. This group also reported higher satisfaction score connected with new knowledge: 4.0 vs. 3.5, and with quality of life: 4.1 vs. 3.6. CONCLUSIONS: Short-term usage of RT-CGMS, combined with satisfaction questionnaire performed in teenagers with diabetes type 1 can be useful in defining the group of young patients who can benefit from RT-CGMS usage in long-term metabolic control improvement.