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Aim: To present a patient with a diagnosis of Type 2 diabetes mellitus (T2DM) in childhood and to raise awareness of the increasing incidence of T2DM in the pediatric population and the importance of early detection and treatment. Case report: During the neurological treatment of a nine-year-old boy, it was found that the boy was overfed and had acanthosis on the neck. Laboratory tests revealed elevated liver enzymes, and ultrasound examination of the abdomen revealed diffuse echogenicity of the liver with homogeneous echoes. From the family history, it was learned that both parents suffer from T2DM, and the sister had gestational diabetes during pregnancy. Only two years later, the boy comes to see a gastroenterologist because of elevated liver enzymes. Due to obesity, he was referred to an endocrinologist. According to laboratory tests, he was admitted for newly diagnosed diabetes – fasting blood glucose was elevated (11.3 mmol/L) as well as glycosylated hemoglobin (HbA1c) (9.3%). They denied symptoms of polyuria, polydipsia and weight loss. Based on age, obesity, acanthosis and positive family history, a diagnosis of T2DM was made. Negative antibodies to T1DM – ICA (Islet cell antibodies), GAD (glutamic acid decarboxylase), IA2 (Islet antigen 2) – confirmed the diagnosis of T2DM. During hospitalization, hypertriglyceridemia and hypertension were diagnosed. Metformin therapy was introduced and the boy and his parents were educated about the importance of lifestyle changes, a balanced diet and daily physical activity. Metabolic control of the disease is poor, and check-ups are irregular. Conclusion: The differential diagnosis of T2DM should be considered in those children and adolescents with diabetes who are obese and have a positive family history of T2DM. The fact that these patients usually already have one or more comorbidities at the time of diagnosis can be helpful in making a diagnosis of T2DM. [ABSTRACT FROM AUTHOR]

Objective This paper aimed to emphasize the importance of considering the diagnosis of PROP1 mutation in all cases where multiple members of the same family are affected by combined pituitary hormone deficiencies (CPHD). Case Report - We describe two brothers of unrelated parents with a mutation in the PROP1 gene. Both brothers presented with growth impairment - the older one at the age of 2.5 years, and the younger one at the age of 3.3 years. Central hypothyroidism and GH deficiency were established in both of them. Replacement therapy was started using levothyroxine and recombinant growth hormone. Pituitary magnetic resonance imaging was normal. Genetic analysis identified a pathogenic homozygous frameshift variant c.301_302delAG in the PROP1 gene. Conclusion - Patients with PROP1 mutation must be closely followed up to reveal other possible hormonal defects and to avoid possible life-threatening adrenal crisis in the future. PROP1 mutation should be considered in all familial forms of CPHD and in all patients who have a deficiency of two or more pituitary hormones. [ABSTRACT FROM AUTHOR]

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus characterized by hyperglycemia, acidosis and ketosis. The main principles of treatment include fluid replacement, insulin therapy and correction of electrolyte disbalance. Fluids form a crucial component of DKA therapy. There is a lot of debate regarding choice and volume of fluid as well as the rate of fluid correction because of their possible role in causing cerebral edema. Insulin therapy should be started at least 1 hour after starting fluid replacement therapy. The aim of this review article is to address a few key issues in the management of DKA in children and adolescents. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective -- The aim of this paper was to emphasize the importance of a complete physical examination of a child referred to a pediatric endocrinologist due to short stature. Although short stature is usually considered to be a sign of an endocrinological disease, a broad spectrum of other pediatric disorders may be the cause of growth retardation. Case Report -- A 9-year-old girl was referred to a pediatric endocrinologist due to short stature. Physical examination revealed her height to be 120 cm (-2.7 SD) and her weight to be 17.75 kg (-3.93 SD). In addition, she looked extremely pale and had tachycardia (130 bpm). Laboratory tests revealed severe microcytic anemia. A wide diagnostic work-up was performed, without revealing a clear cause of the disease. It was found out that the girl had never started eating solid food and that her diet was extremely limited. Psychological and psychiatric evaluation were done. She received 7 doses of iron sucrose in total. During her hospital stay she was fed with enteral formulas, and food intake was gradually increased with the introduction of solid foods. Complete laboratory recovery from anemia was achieved within 2 months. In parallel with nutritional replenishment, her height and weight improved. Conclusion -- This case demonstrates the importance of a thorough physical examination and preventive routine periodic evaluation in order to prevent further health impairment and possible life-threatening complications. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Type 1 diabetes mellitus is the most common chronic endocrine disease worldwide in children and adolescents and its incidence has been rising. The disease is associated with acute and chronic complications. While acute complications are part of everyday life, chronic complications are rare in children and adolescents. Chronic complications of type 1 diabetes mellitus include retinopathy, nephropathy, neuropathy and macrovascular disease. Good glycemic control, intensive insulin treatment and screening may prevent or delay onset or progression of complications. Screening should start from age 11 years with 2-5 years diabetes duration. We present a case of a female adolescent with a long-term extremely poor metabolic control of type 1 diabetes mellitus who has developed multiple chronic complications of illness - albuminuria, neuropathy, gastroparesis and rethinopathy. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unified definition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother's value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother's unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother's renal function. [ABSTRACT FROM AUTHOR]

Type 1 diabetes mellitus is the most common chronic endocrine disease worldwide in children. It is characterised by autoimmune destruction of the β cells leading to insulin deficiency. This process occurs in genetically susceptible persons, and is probably triggered by one or more environmental factors. The incidence of type 1 diabetes mellitus is rising, especially in young children (age < 5 years). The signs and symptoms of disease in children usually develop quickly, over a period of a few weeks. Typical symptoms include polyuria, polydipsia and weight loss. In some patients diabetic ketoacidosis, a life-threatening metabolic state, can be the initial presentation of type 1 diabetes mellitus. Diabetes management is complex and challenging, particularly during childhood and adolescence. Insulin therapy is the mainstay in management of type 1 diabetes mellitus. There are many different insulin preparations and delivery systems available. Intensive insulin therapy compared with conventional therapy improves glycemic control and decreases long-term complications of diabetes. Another important issue in the management of children with type 1 diabetes mellitus includes nutrition. The main therapeuthic goal is good glycemic control of the disease (glycated haemoglobin <7,5 %) in order to prevent short and long term diabetic complications. The most common complications of type 1 diabetes mellitus in children include hypoglycemia, hyperglycemia and diabetic ketoacidosis. [ABSTRACT FROM AUTHOR]

Aim: To report an unusual clinical course of an infant with congenital laryngeal stridor. Indications for endoscopic examination of airways in such cases have also been discussed. Case report: A full-term male newborn was admitted to the Department of Paediatrics because of the symptoms of acute scrotum as well as because of breathing difficulties and severe hypoxemia. Soon after surgery the child was extubated but breathing difficulties persisted. A loud inspiratory stridor together with rapid respiratory deterioration occurred. The infant was intubated and underwent mechanical ventilation again. In the following period several trials of extubation were repeatedly unsuccessful despite favourable weaning parameters. Just few hours after each trial of extubation symptoms of acute laryngotracheobronchitis were apparent. Because of extubation failure, tube dependency and persistent atypical symptoms of croup unresponsive to standard pharmacotherapy, endoscopic assessment was performed at the age of one month. Concentric central membranous subglottic stenosis was visualized. While preparing for the endoscopic laser ablation treatment, stridor was getting less pronounced. Two weeks later patient underwent endoscopy again and significant regression of subglottic membrane narrowing was documented. Planned laser intervention was canceled. At the age of four months stridor disappeared. Conclusion: Laryngomalacia is the most common cause of congenital laryngeal stridor and endoscopic evaluation is usually not indicated in such cases. However, there are other causes of congenital stridor which are not so common, including congenital subglotttic stenosis. In this case an unusual spontaneous regression of congenital membranous subglottic stenosis was reported. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Edema is defi ned as abnormal accumulation of fl uid in the interstitium. Diff erential diagnosis of generalized edema is very broad. Most often, renal and cardiac causes lead to generalized edema. The potential gastrointestinal causes of edema are liver failure and protein losing enteropathy including celiac disease and protein malnutrition. Generalized edema is rarely an initial manifestation of celiac disease. Hereby, we present a case of a 3-year-old boy with celiac disease, initially presented with generalized edema and hypoproteinemia. [ABSTRACT FROM AUTHOR]

Background: Dextranomer/hyaluronic acid copolymer (Dx/HA) has been the most widely used bulking agent for the endoscopic treatment of vesicoureteral reflux. Case presentation: Here we report on a case of an 18-month-old male who underwent endoscopic treatment with Dx/HA for persistent high-grade unilateral vesicoureteral reflux (VUR). Three months later, due to the reappearance of contralateral VUR and indicated endoscopic treatment, a second cystoscopy was performed. A submucosal, well-vascularized mass localized on the left trigone and anteromedially to the left orifice was noted. Since it differed from the other similar implants previously detected on cystoscopy, it was misdiagnosed with a bladder tumor, indicating further evaluation. Extensive laboratory and imaging studies revealed normal findings, apart from high levels of neuron-specific enolase (NSE). A hypothesis made at that point was that the elevated level of NSE is due to the implantation of the Dx/HA. To test the hypothesis, two other healthy children previously treated with a Dx/HA implant were identified and their NSE levels measured. In both cases, the levels of NSE were elevated. Conclusion: The presented cases revealed that elevated levels of NSE are most likely due to a previous implantation of Dx/HA. This observation should be taken into consideration whenever there is a tentative diagnosis of bladder tumor following the endoscopic treatment of VUR with Dx/HA in a child. [ABSTRACT FROM AUTHOR]