Natalya G. Kiseleva

Aim. To study the effect of glycated hemoglobin level, average daily glycemia and its variability on UV-induced skin autofluorescence in children and adolescents with type 1 diabetes.Materials and methods. The study included 47 children and adolescents with type 1 diabetes living in a restrictedaccess administrative and territorial unit. The autofluorescence spectra of the skin from the inner surface of the shoulder and nails of patients were recorded using an original compact spectrofluorometer based on STS-VIS OCEAN OPTICS © USA microspectrometer with UVA excitation. The statistical analysis was performed using Statsoft Statistica 12.0 software. The fluorescence spectra were normalized to the average value of the UV LED signal and the moving average smoothed using a 10 nm window. Then, the renormalization of spectra was carried out, minimizing their spread from the average sample spectrum.Results. The study revealed the most changeable regions of UV-induced skin autofluorescence spectrum with variations in the level of glycated hemoglobin, average daily glycemia, and glycemic variability.Conclusion. The study confirms the prospects of using skin autofluorescence measurements as a non-invasive tool for assessing the state of carbohydrate metabolism.

Type 1 diabetes mellitus is a disease that develops in genetically susceptible individuals, particularly in children, due to the destruction of pancreatic beta-cells leading to metabolic alterations, systemic inflammation, and vascular complications. Routine monitoring of key biochemical and physiological parameters is important for effective control of diabetes mellitus, and requires the development of novel minimally invasive or noninvasive methods. Advanced glycation end products (AGEs) and their receptors expressed either in tissues (RAGEs) or in the peripheral blood (sRAGEs) are promising diagnostic and prognostic biomarkers; however, there is a lack of protocols enabling their noninvasive assessment. The same is true for glycated hemoglobin (HbA1c), which is a well-established marker of diabetic decompensation. We developed original spectrofluorometer and a new approach to accurate noninvasive evaluation of HbA1c concentrations (within the range of 5%–12%) and sRAGE levels (within the range of 650–2200 pg/ml) in children with diabetes mellitus type 1 by analyzing skin fluorescence intensity at 408, 452, and 659 nm, and 363, 408, 452, and 659 nm, respectively. We confirm that gender, age, sexual maturity, and skin phototype should be taken into consideration, and multivariate regression analysis is effective in developing protocols of noninvasive detection of carbohydrate metabolism-related parameters with UV-induced fluorescence spectroscopy.

Objective: The analysis of clinical-laboratory peculiarities and the dynamics of glycemia clarifying the terms of blood glucose stabilization during the early neonatal period in children having risk factors of the development of such state.Methods: Open, retrospective , continuous, single-center study was conducted. It was aimed at getting preliminary data that is important for planning further tactics of examining newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation).The target group of the survey included 522 newborns of both genders in the early neonatal period (from 0 to 7 days of life).Results: There is data on the frequency of first indicated hypoglycemia in newborns having risk factors of the development of such state, clinicallaboratory peculiarities, the dynamics of glycemia during early neonatal period, and also the period of blood glucose stabilization (the age of reaching normoglycemia). Neonatal hypoglycemia was detected in 40.2% of examined children. Laboratory manifestation during the first day of life was noticed 62.9% of cases with the further normalization of glucose level in blood in 24 hours in 73.3% of newborns. Significant reduction of blood glucose was observed in 54.8% of cases requiring hypoglycemia therapy with parenteral prescription of 10% glucose solution. Hypoglycemia jugulated against oral correction of 5% glucoses solution in 40.5 % of cases. 4.8% of children got the level of glucose stabilized after introduction of supplementary feeding.Conclusion: The results of the newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation) examinations are presented. The peculiarities of neonatal hypoglycemia are: the absence of a typical clinical symptoms among 89% of children. Asymptomatic course of hypoglycemia confirms the importance and necessity of glycemia monitoring in the early neonatal period in order to conduct timely and adequate therapy.

The aim of the research. To identify the features of the onset of type-1 diabetes in children and adolescents residing in the territory of a closed city through studying the following manifestations: medical history characteristics, the gender composition and age of patients, the season of the appearance of the initial symptoms as well as clinical manifestations and indicators of carbohydrate metabolism during the initial visit to an endocrinologist. Material and methods. While carrying out the work, the data of the regional registry of diabetes mellitus for the past ten years were studied as well as the information from outpatient records of children and adolescents with type-1 diabetes living in a closed territorial administrative unit in the Krasnoyarsk Territory. Anamnestic and clinical laboratory data were analysed, a comparative analysis with similar data of children in the Krasnoyarsk Territory and Russia was carried out. Results. The study revealed approximately the same quantity of sick children of both genders. The onset of the disease was more oft en noted in the spring-autumn period, the trigger mechanism was viral infection in the overwhelming number of cases. At the moment of manifestation, the bulk of the children had harmonious physical development, the indicators of carbohydrate metabolism indicated significant decompensation. Conclusion. The article presents features of the course of the type-1 diabetes manifestation period in the studied cohort in relation to the age groups of children and the disease onset seasonality. For a broader understanding of the features of the type-1 diabetes onset in children and adolescents living in a closed city, it is necessary to continue research using data on the child population living in similar conditions.

The complexity of diagnosing and predicting the course of TNF-receptor-associated periodic syndrome TRAPS determines the importance of studying the dependence of clinical manifestations on the variant of genetic mutation and the presence of modifier genes. We observed 5 children with an identified diagnosis of TRAPS. It was established that the disease onset in most cases is defined as a juvenile arthritis with systemic onset. Genetic variants with the replacement of cysteine residues are associated with an early debut and an aggressive course, the c.362G> A p.R121Q mutation is associated with an erosive damage to the spine. The case of a favorable course of TRAPS in siblings with a newly detected mutation is described. The development of urgent complications of TRAPS was revealed when basic therapy with canakinumab was canceled.

Objective of the research: to study the results of levosimendan use in young children with heart failure (HF) of functional class IV (FC). Materials and methods: the analysis of observation of patients who received levosimendan: 2 with cardiomyopathies (CMP), 12 with congenital heart defects (CHD). The drug was administered intravenously 0,2 μg/kg/min. Results: in patients with CMP, the ejection fraction doubled after administration of levosimendan, in children with CHD heart contractility increased by 18%, and pulmonary artery pressure decreased by 17 mm Hg. There were no undesirable effects. Conclusion: administration of levosimendan provides an increase in cardiac output and a decrease in pulmonary resistance in children with HF IV FC without undesirable effects.