INTRODUCTION:Te 1yp diabetes mellitus (DM1) requires lifelong insulin administration. Standards of care on children with DM1 may vary between countries. Since 2022, many war refugees from Ukraine with DM1 have continued treatment in Poland. AIM OF THE RESEARCH:To compare Polish (PL) and Ukrainian (UA) children with DM1 with respect to methods of insulin administration, glucose monitoring, auxological development, and comorbidities, and to re-assess UA children after 1 year of stay in Poland. MATERIAL AND METHODS:The retrospective analysis included 35 UA school-aged refugees and 70 PL children, matched with respect to sex, age, and DM1 duration. RESULTS:Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) were significantly more frequently used by PL children than by UA ones. Glycated hemoglobin (HbA1c) levels were lower in PL than in UA patients, in both CGM and CSII users. Patients' height standard deviation score (SDS) was significantly lower in UA than in PL children, while body mass index (BMI) SDS was significantly lower in UA patients on constant insulin doses. The incidence of overweight and obesity depended on the used centile charts (national for PL or UA children, or World Health Organization). After 1 year, more UA children used CSII and CGM, with an increase of height SDS and BMI SDS, while there was no effect on HbA1c. Vitamin D deficiency and autoimmune thyroiditis were common comorbidities. CONCLUSIONS:Use of CSII and especially of CGM is associated with improved DM1 control and auxological development. The migration of children with DM1 was associated with modification of their treatment and challenges in proper assessment of nutritional status.
INTRODUCTION:Glucose and lipid metabolism are tightly regulated by hormonal signaling, nutrition, and physical activity. Adolescence and young adulthood represent critical developmental periods characterized by puberty-related hormonal shifts and fluctuating insulin sensitivity. At the same time, sports supplement use has increased markedly in these age groups. AIM OF THE RESEARCH:This narrative review examined regulatory mechanisms of glucose and lipid metabolism and evaluated the available evidence regarding the metabolic effects of commonly used sports supplements in adolescents and young adults, considering baseline metabolic status such as obesity, insulin resistance, and diabetes. Relevant findings from adult populations were considered when youth-specific data were limited. MATERIAL AND METHODS:A literature search of PubMed/MEDLINE and Scopus was conducted for studies published up to 2025. Eligible publications included randomized controlled trials, observational studies, systematic reviews, meta-analyses, and experimental research. Supplements of interest were creatine, carnitine, citrulline, taurine, caffeine, branched-chain amino acids (BCAAs), whey protein, arginine, and -alanine. RESULTS:Taurine, carnitine, and citrulline were associated with modest improvements in fasting glucose, insulin resistance, triglycerides, and non-high-density lipoprotein cholesterol, particularly in individuals with obesity or insulin resistance. Creatine appeared metabolically neutral or mildly beneficial when combined with exercise. Elevated BCAA levels were associated with impaired insulin sensitivity. Whey protein showed short-term insulinotropic effects without clear long-term benefits. Caffeine induced transient, dose-dependent reductions in insulin sensitivity. Arginine and -alanine had minimal metabolic impact. Regular physical activity remained the most consistent modulator of glucose and lipid metabolism. CONCLUSIONS:Sports supplements exert heterogeneous metabolic effects in youth. While selected supplements may provide modest benefits in specific populations, regular physical activity remains fundamental for metabolic regulation. Professional supervision and cautious use are recommended.
Childhood obesity is currently a major global health challenge affecting a growing proportion of pediatric patients. Increasing consumption of highly processed foods, excess calorie intake, and reduced physical activity are considered major contributing factors. In recent years, research has focused on other factors, one of which is the influence of gut microbiota composition. The purpose of our study was to summarize the current knowledge regarding the relationship between gut microbiota composition and metabolic diseases in the pediatric population. We searched the PubMed and Scopus databases, primarily for studies published between 2020 and 2026. The analysis showed that alterations in the composition of the gut microbiota have been reported in overweight or obese children with associated type 2 diabetes, type 1 diabetes, or hyperlipidemia. It was found that the composition of the gut microbiota also varies according to non-modifiable factors such as gender, age, and ethnicity. The limitations of the analyzed studies primarily include small research groups and the lack of consideration of coexisting diseases and other factors influencing the results. Despite these limitations, the evidence available indicates that the gut microbiota may contribute to the development and progression of obesity in children. Further research in this area is necessary to identify potential therapeutic approaches and preventive strategies targeting the gut microbiota and its composition in order to reduce the risk and progression of obesity in children.
Brachydactyly is a very rare congenital defect involving shortened fingers and/or toes. It can be a component of congenital or genetic syndromes, but it can also occur as an isolated defect, most often inherited in an autosomal dominant pattern. The current classification includes five main types of the disease (A-E) depending on the characteristic constellation of affected fingers and bones. According to the literature, some types may also be associated with height deficiency. To our best knowledge, this article is the first documented example of the effects of recombinant human growth hormone (rhGH) therapy on a child with short stature and brachydactyly type C with normal growth hormone secretion in stimulation tests. In this paper, we present the boy's good response to the treatment and the safety of this therapy, as well as a review of the current literature regarding rhGH therapy in children with isolated brachydactyly.
Obesity is a significant inflammatory disease that has become increasingly prevalent among children from different ethnic groups. Lifestyle choices, diet, and maternal obesity are key contributors to its development. This condition is associated with metabolic diseases, including cardiovascular disease and type 2 diabetes, due to chronic low-grade inflammation, even in children. Adipose tissue contributes to this inflammatory profile through increased infiltration of immune cells and the secretion of pro-inflammatory cytokines. In this narrative review, we summarize the current and limited understanding of adipose tissue development and expansion in children, as well as emerging evidence suggesting that maternal obesity may significantly influence the offspring's metabolic profile.
INTRODUCTION:Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with increased obstetric complications. However, its impact on the neurodevelopment of preterm neonates remains underexplored, particularly in low-resource settings. The study aimed to assess the association between maternal PCOS and the risk of neurodevelopmental disorders in preterm neonates. MATERIAL AND METHODS:A prospective case-control study was conducted at Azadi Teaching Hospital, Kirkuk, Iraq, from June 2023 to June 2025. A total of 200 women with preterm labor were enrolled and divided into two groups - Group A (PCOS, n = 100) and Group B (non-PCOS, n = 100) - based on the Rotterdam criteria. Neonatal outcomes - including gestational age, birth weight, Apgar scores, neonatal intensive care unit (NICU) stay, intraventricular hemorrhage (IVH), periventricular leukomalacia, seizures, and neurodevelopment - were assessed. Neurodevelopmental evaluation was performed at 6, 12, and 24 months using the Denver II screening test. Logistic regression was used to identify predictors of developmental delay. RESULTS:Neonates born to mothers with PCOS had significantly lower birth weights, longer NICU stays, higher rates of IVH and seizures, and lower Apgar scores. Developmental delays - particularly in fine motor, language, and gross motor domains - were significantly more prevalent in the PCOS group (p < 0.001). Logistic regression identified maternal PCOS, NICU stay, Homeostatic Model Assessment for Insulin Resistance, IVH, and 1-minute Apgar score as independent predictors of neurodevelopmental delay. CONCLUSIONS:Maternal PCOS is associated with an increased risk of neurodevelopmental disorders in preterm neonates. Targeted screening and follow-up are necessary for women at high risk.
INTRODUCTION:Individuals with Down syndrome (DS) are at increased risk of metabolic disturbances, including oxidative stress (OS) and insulin resistance (IR). The relationship between OS and IR in this population remains unclear. AIM OF THE STUDY:To assess OS and IR in Libyan individuals with DS and examine the influence of adiposity and age. MATERIAL AND METHODS:Fifty individuals with DS (aged 5-25 years) and 58 age-, sex-, and body mass index-matched individuals (comparison group, CG) were included. Anthropometric measurements, fasting glucose, insulin, malondialdehyde (MDA), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were assessed. Associations between MDA, HOMA-IR, and body composition were evaluated. RESULTS:No significant correlation was found between MDA and HOMA-IR (r = 0.064, p = 0.661). No significant difference in HOMA-IR was observed between the DS group and the CG (p = 0.822), although 44% of DS subjects showed elevated HOMA-IR. In contrast, MDA levels were significantly higher in the DS group compared to the CG (p < 0.001), but remained within the normal range. CONCLUSIONS:IR in DS appears to be mainly driven by adiposity rather than the syndrome itself, while OS is elevated but largely independent of IR.
INTRODUCTION:Autoimmune Addison's disease (AAD) is a rare endocrine disorder characterised by immune-mediated destruction of the adrenal cortex. AAD may occur in isolation or as part of a broader autoimmune polyendocrine syndrome (APS). Distinguishing the two is essential owing to implications for patient screening and prognosis. Earlier identification of APS patients is crucial for preserving residual adrenal function and developing future targeted therapies. This study aimed to define clinical and laboratory features of paediatric isolated AAD and APS. MATERIAL AND METHODS:This retrospective cohort study recruited 55 paediatric patients; 27/55 had isolated AAD and 28/55 had APS. They were followed at the Children's Welfare Teaching Hospital, Baghdad, Iraq, between 2009 and 2024. Data collected and compared included: demographic variables (age, gender, family history, duration of symptoms), presenting clinical features and adrenal crisis, and laboratory parameters. RESULTS:Male predominance was observed in both groups, although the difference was not significant. Positive family history was more frequent in APS (p = 0.03). Clinically, hyperpigmentation, weight loss, poor appetite, and hypoglycaemia-induced seizures were significantly higher in isolated AAD (p = 0.0001, 0.0002, 0.042, 0.041). Adrenal crises were more frequent in APS cases (p = 0.18). Major risk factors for adrenal crisis included poor treatment compliance and infections. Laboratory parameters showed that hyperkalaemia and hypoglycaemia were significantly more pronounced in AAD (0.0079 and 0.00002). CONCLUSIONS:Distinguishing isolated AAD from APS may be clinically useful. Differences were observed in metabolic severity, family history, weight loss, hyperpigmentation, and risk of adrenal crisis. These findings suggest that management of both conditions may benefit from a tailored approach, emphasizing treatment adherence and infection prevention in both groups.
INTRODUCTION:Graves' disease (GD) and autoimmune hepatitis (AIH) represent distinct autoimmune disorders affecting the thyroid and liver, respectively. CASE PRESENTATION:This report discusses a case of a 13-year-old boy with rare coexistence of GD and AIH. The patient was admitted to the Department of Pediatric Endocrinology, presenting with suspected hyperthyroidism. Clinical manifestations included ocular exophthalmos, tachycardia, reduced exercise tolerance, and motor restlessness. Initial laboratory assessments revealed mildly elevated transaminases, prompting further investigation. A primary diagnosis of GD was confirmed by relevant laboratory parameters. Antithyroid drugs (ATD) were administered, resulting in proper control of thyroid dysfunction. However, despite the gradual reduction of ATD, a further increase in hepatic biomarkers was observed and required a comprehensive diagnostic investigation, culminating in a liver biopsy. The findings of the biopsy yielded a definitive diagnosis of AIH. CONCLUSIONS:In pediatric patients presenting with GD-associated liver dysfunction, AIH should be considered as a potential comorbidity, warranting vigilance in patients with hyperthyroidism and elevated transaminase levels.
INTRODUCTION:Dysmorphic syndromes are characterised by congenital anomalies affecting craniofacial features, body proportions, and organ structure. They are frequently caused by complex genetic alterations, including deletions, duplications, and microdeletions, which impede optimal growth regulation. AIM OF THE STUDY:The objective of this paper is to present a synopsis of selected dysmorphic syndromes associated with excessive growth, with particular emphasis on syndromes with confirmed or strongly suspected chromosomal aetiology or associated with DNA methylation disorders (epigenetic disorders) with dynamic mutation. The following aspects are discussed in this text: the pathogenesis of the condition, its inheritance, the characteristic clinical symptoms, the diagnostic approach and potential treatment options. The following essay will provide a comprehensive overview of the relevant literature on the subject. MATERIAL AND METHODS:A thorough search of various databases yielded 50,385 scientific studies. After applying strict criteria for quality and relevance, 36 studies were selected for final analysis. The selection focused on the most recent peer-reviewed studies and case studies published in English. RESULTS:This review identified several key chromosomal abnormalities, dynamic mutations and methylation defects linked to overgrowth syndromes. The findings consistently associated these aberrations with core clinical features such as macrocephaly, developmental delay, and musculoskeletal abnormalities. Furthermore, the study confirmed that mosaic forms and specific genetic mechanisms, such as those found in hemihyperplasia, contribute significantly to the phenotypic variability of these disorders. CONCLUSIONS:Overgrowth syndromes are a heterogeneous group of disorders characterised by excessive growth and additional congenital anomalies. Diagnosis relies on clinical evaluation supported by molecular genetic testing. Effective management requires ongoing, collaborative care from a diverse team to promote the patient's health and development throughout their life.
The insulin tolerance test (ITT) is the most reliable method for diagnosing growth hormone deficiency (GHD). Our study aimed to determine a new glycemic threshold that allows for an adequate growth hormone (GH) response without increasing the risk of deleterious outcomes. This study was conducted retrospectively on children who were suspected of GHD. There were two groups of children: group 1 (G1) consisted of children who underwent an ITT and reached a hypoglycemic level of 2.2 mmol/l, and group 2 (G2) included those who did not reach biochemical hypoglycemia but exhibited clinical hypoglycemic symptoms, which led to cessation of the test. Our population consisted of 129 patients. The mean nadir blood glucose level was 1.798 ±0.25 mmol/l in G1, significantly lower than in G2, at 2.57 ±0.28 mmol/l (p < 10-3). GH in G1 reached a mean peak of 4.71 ±3.20 ng/ml, significantly lower than in G2 (8.56 ±5.99 ng/ml) (p = 0.01). Among G1, 86% of the patients presented a GHD, compared to 55.6% in G2. The proportion of somatotrophic deficiency was significantly higher in G1 compared to G2 (p = 0.01). Receiver operating characteristic curve analysis revealed a threshold of 2.44 mmol/l with a sensitivity of 90% and a specificity of 60% (area under the curve = 0.915; confidence interval 95% (0.87-0.96). Based on our findings, we recommend implementing this new threshold when hypoglycemic symptoms are present. This higher threshold offers several benefits, including reduced risk to patients, while maintaining accurate interpretation of the test with good sensitivity and specificity.
INTRODUCTION:Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases in childhood, with its incidence increasing globally. The coronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in severity of cases of diabetic ketoacidosis. AIM OF THE STUDY:Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases in childhood, with its incidence increasing globally. The coronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in severity of cases of diabetic ketoacidosis. MATERIAL AND METHODS:A retrospective cohort study was conducted, using patients' clinical records, between March 2016 and March 2024. The sample was divided in three groups: pre-pandemic (March 2016 to March 2020), pandemic (March 2020 to March 2021), and post-pandemic (March 2021 to March 2024). RESULTS:A retrospective cohort study was conducted, using patients' clinical records, between March 2016 and March 2024. The sample was divided in three groups: pre-pandemic (March 2016 to March 2020), pandemic (March 2020 to March 2021), and post-pandemic (March 2021 to March 2024). CONCLUSIONS:There was an improvement in the post-pandemic period, with a lower severity at presentation. However, the rate of ketoacidosis remained high, and the focus must remain on implementing preventative measures.
INTRODUCTION:The aim of the study was to analyse whether children whose obesity occurred during the pandemic differed metabolically from children who were obese earlier and to assess the effect of one-year treatment following the end of pandemic restrictions. MATERIAL AND METHODS:A prospective study of 55 children aged 10-18 years who were referred to the outpatient's clinic during the pandemic due to obesity was conducted. The following clinical data were analysed: time of obesity onset, body mass index (BMI) z-score, body mass composition, blood pressure, abdominal ultrasound, biochemical parameters of lipid and carbohydrate metabolism, aminotransferases and fetuin-A concentration. Participants received recommendations to improve their diet and increase physical activity (PA). After 3, 6 and 12 months, we assessed: BMI z-score, compliance with recommendations, and biochemical parameters. RESULTS:No significant differences between pandemic obesity and non-pandemic obesity were observed at the beginning and after one year. Children who followed the dietary recommendations had a significantly lower BMI z-score after 3 months (median 2.08 vs. 1.89, p = 0.044). Children who reported increased PA (47.3%) also showed lower BMI z-scores after 6 (median 2.12 vs. 1.86, p = 0.53) and 12 months (median 2.12 vs. 1.78, p = 0.008). The beneficial effect of PA was demonstrated in lower levels of fetuin-A in children with increased PA after 6 months (median 480 vs. 395 mg/ml, p = 0.07). CONCLUSIONS:The "obesity pandemic" does not appear to be metabolically distinct from obesity that developed earlier and lasted longer. An increase in PA and compliance with dietary recommendations remain important elements of therapy, particularly in the context of metabolic complications. Fetuin-A may serve as a potential parameter for assessing compliance with PA recommendations and the rate of obesity progression.
INTRODUCTION:Patients with Turner syndrome (TS) are at increased risk of metabolic complications, partly as a consequence of truncal obesity, which can already appear in childhood. Growth hormone (GH) therapy is widely used in this population and is known to exert a beneficial effect on body composition (BC). The study aims to evaluate the impact of GH therapy on BC and explore associations between BC parameters and components of metabolic syndrome in girls with TS during a 5-year follow-up. MATERIAL AND METHODS:Twenty-one TS patients were enrolled. Auxological, BC, and biochemical parameters were assessed at baseline (V1), after 3 years (V3), and after 5 years (V5) of GH therapy. Results were available for 21, 20, and 13 patients, respectively. Biochemical phenotypes were determined using carbohydrate and lipid parameters. RESULTS:The only BC parameter that significantly increased during GH therapy was fat-free mass (FFM). Along with rising insulin-like growth factor 1 levels, fasting and postprandial insulin concentrations, as well as insulin resistance, increased during treatment. Total cholesterol decreased, although without significant changes in its fractions. No significant correlations were found between BC parameters, glucose, and total cholesterol during the GH 5-year follow-up. CONCLUSIONS:Growth hormone therapy exerts a beneficial effect on BC in girls with TS, reflected by an increase in FFM. However, carbohydrate metabolism should be closely monitored, in line with national program requirements, due to the increased insulin resistance during GH therapy. Lifestyle recommendations promoting healthy behaviors should be provided to all patients with TS.
INTRODUCTION:Diabetes mellitus remains a critical global health challenge, necessitating effective therapeutic interventions. AIM:This study evaluated the hypoglycemic and pancreatic protective effects of Caesalpinia bonduc leaf extract in streptozotocin-induced diabetic rats. MATERIAL AND METHODS:Twenty-five diabetic rats were randomly assigned to treatment groups receiving 150, 200, and 400 mg/kg leaf extract, glibenclamide (positive control), and placebo for two weeks. Blood glucose levels were measured at baseline, after STZ induction, and at 0, 2, 4, 6, and 24 hours after treatment. Histological assessments of pancreatic tissue were performed, and phytochemical screening identified flavonoids, tannins, and saponins. RESULTS:The extract significantly reduced blood glucose levels, with the 150, 200, and 400 mg/kg doses lowering glucose from baseline averages of 237.40 ±7.81 mg/dl, 324.00 ±42.26 mg/dl, and 336.00 ±23.34 mg/dl to 103.00 ±4.60 mg/dl, 199.40 ±67.73 mg/dl, and 116.20 ±8.65 mg/dl, respectively, at 6 hours after treatment. Histopathological improvements included reduced necrosis, inflammation, and improved pancreatic morphology. CONCLUSIONS:These findings underscore the extract's dual mechanisms of action - antioxidant protection and insulin secretion enhancement - likely driven by flavonoids. The robust hypoglycemic response and pancreatic tissue protection provided by C. bonduc leaf extracts highlight their potential as valuable adjuncts in diabetes therapy. Further clinical evaluations and mechanistic studies are necessary to substantiate their clinical applicability.
