Polina Pavicevic

Minimally invasive inguinal technique for the management of duplex ureteric anomaly.

Study Type – Therapy (case series)

The Diagnosis of Prediabetes in Adolescents/Dijagnoza Predijabetesa Kod Adolescenata

Summary Background: Prediabetes is characterized by isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), and combined IFG/IGT. This study aimed to establish the prevalence of prediabetes and examine possible contributory factors in a cohort of obese adolescents. Methods: In this prospective study, we recruited 85 obese patients from the Obesity Clinic at the University Children’s Hospital and 17 normal weight controls. All patients were of Caucasian origin, 60 males/42 females, aged 7.4-18.3 years, with at least Tanner 2 stage of puberty. Results: Depending on criteria we used, insulin resistance was confirmed in 62-100% of obese patients, predominantly in the group with BMI SDS > 3. oGTT revealed isolated impaired fasting glucose (IFG) in 13.9%, impaired glucose tolerance (IGT) in 20.8% and combined IFG and IGT only in 2.8% of the obese patients. Patients in the prediabetes group were older (14±2.4 vs 12.8±2.5 p=0.04) and had higher glucose levels (p<0.001) during the whole oGTT compared to normal glucose tolerance (NGT) group. There was no difference between groups in respect to family history, BMI, lipids and fasting insulin. Insulinogenic index, WBISI and HOMA%B were significantly lower in the prediabetes group compared to the NGT group (p=0.07, 0.01 and 0.04 respectively). HbA1c level was measured in 58% of patients and was significantly higher in the prediabetes group (5.4±0.3 vs 5.7±0.4, p=0.002). Conclusion: Prediabetes occurrence was fairly high in our obese adolescents. Further studies should establish what would be the most appropriate screening test to diagnose these patients at risk for type 2 diabetes and initiate treatment without delay. Kratak sadržaj Uvod: Stanja kao što su izolovana povišena glikemija našte ili poremećaj tolerancije glukoze i kombinacija ova dva poremećaja glukoze mogu se definisati kao predijabetes. Cilj nam je bio ispitati prevalencu predijabetesa i odrediti potencijalne pridružene faktore u grupi gojaznih adolesce- nata. Metode: Prospektivna studija, sprovedena u Univerzitetskoj dečjoj klinici, uključila je 85 gojaznih ispitanika i 17 nor- malno uhranjenih pacijenata. Svi pacijenti su bili bele rase, 60 muškog, 42 ženskog pola, uzrasta 7,4-18,3 godina, sa prisutnim znacima puberteta. Rezultati: Zavisno od kriterijuma koje smo koristili, insulin- ska rezistencija je postojala kod 62-100% gojaznih pacije- nata, posebno izražena u grupi pacijenata sa ITM SDS > 3. Nakon oGTT-a, dijagnoza izolovane povišene glikemije našte je postavljena kod 13,9% pacijenata, poremećaj to- lerancije glukoze kod 20,8%, a udruženost ova dva pore- mećaja kod samo 2,8 gojaznih pacijenata. Pacijenti sa predijabetesom su bili stariji (14±2,4 vs 12,8±2,5 p=0,04) i imali više nivoe glukoze tokom celog testa (p<0,001). Nije na|ena statistički značajna razlika u odno- su na porodičnu anamnezu za tip 2 dijabetesa, ITM, vred- nosti lipida i insulina našte. Insulinogeni, ukupni indeks senzitivnosti, kao i HOMA%B bili su značajno niži u predijabetesnoj grupi u pore|enju sa grupom koja je imala normalnu toleranciju glukoze (p=0,07, 0,01 i 0,04). HbA1c je odre|en kod 58% pacijenata i bio je značajno viši u pre- dijabetesnoj grupi (5,4±0,3 vs 5,7±0,4, p=0,002). Zaključak: Dijagnoza pre-dijabetesa je postavljena u viso- kom procentu kod naših gojaznih adolescenata. Neop- hodna su dalja ispitivanja koja bi pokazala koji je najbolji test za rano prepoznavanje i lečenje ovih pacijenata sa rizikom za tip 2 dijabetesa.

Pseudoachondroplasia: A case report

INTRODUCTION Pseudoachondroplasia (PSACH) is an autosomal dominant osteochondrodysplasia due to mutations in the gene encoding cartilage oligomeric matrix protein. It is characterized by rhizomelic dwarfism, limb and vertebral deformity, joint laxity and early onset osteoarthrosis. We present the girl with the early expressed and severe PSACH born to clinically and radiographically unaffected parents. CASE OUTLINE A 6.5-year-old girl presented with short-limbed dwarfism (body height 79.5 cm, < P5;-32%) and normal craniofacial appearance and intelligence. The girl was normal until 3 months of age when she expressed growth retardation with apparently shorter extremities in relation to the torso. With age, her rhizomelic dwarfism became increasingly visible, and since completed 15 months of age, when she started to walk, the disease was complicated with genu varum, lumbar lordosis and abnormal gait. Beside visibly short forearms, short, broad and ulnar deviation of the hands, brachydactyly and joint hyperlaxity, the radiographic picture showed markedly flared metaphyses, small and irregular epiphyses and poorly formed acetabulum. CONCLUSION PSACH is an achondroplasia-like rhizomelic dwarfism recognized by the absence of abnormality at birth, normal craniofacial appearance, characteristic epiphyseal and metaphyseal radiographic finding and joint hyperlaxity.

Validation of Serbian Version of Dysfunctional Voiding Symptom Score (DVSS) Questionnaire

Objective: The aims of our study were to translate the dysfunctional voiding symptom score (DVSS) from English to Serbian; culturally adopt the items; assess the internal consistency and the test–retest reliability of DVSSSR in patients with dysfunctional voiding (DV); evaluate and test the construct and divergent validity of DVSSSR against demographic parameters (gender and education); and examine the level of explained variability for each item of DVSSSR against demographic parameters (gender and education). Methods: The cross-sectional observational study included 50 patients with dysfunctional voiding aged 5 years and above. The DVSS questionnaire was translated from English into Serbian by the forward–backward method. Internal consistency was assessed with Cronbach α and test–retest reliability with intraclass correlation coefficient (ICC). For validity testing we performed construct and divergent validity analyses. Results: There was excellent internal consistency for every item except for Item 6 (0.787) and Item 3 (0.864), where internal consistency was good. The observed test/retest ICC for average measures was more than 0.75 (excellent) for all DVSSSR items. Gender and educational level does not correlate significantly with each item of DVSSSR (p > 0.05). For divergent validity, there were no significant differences in mean values of each item of DVSSSR between genders and different levels of education (p > 0.05). Variability that can be explained for gender and educational level was below 10%. Conclusion: Translated DVSSSR is of adequate validity and reliability for assessing DV in children.

Serum Neutrophil Gelatinase-Associated Lipocalin and Urinary Kidney Injury Molecule-1 as Potential Biomarkers of Subclinical Nephrotoxicity After Gadolinium-Based and Iodinated-Based Contrast Media Exposure in Pediatric Patients with Normal Kidney Function

Background New renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) show promise in early diagnosis of contrast media induced acute kidney injury (CI-AKI). The purpose of our study was to compare the subclinical nephrotoxicity (a condition without changes in standard renal biomarkers) of gadolinium-based contrast media (Gd-DTPA, gadopentetate dimeglumine) and iodinated-based contrast media (iopromide) in pediatric patients with normal kidney function. Material/Methods The first group (n=58) of patients included in the study were undergoing angiography with iopromide, and the second group (n=65) were undergoing magnetic resonance (MR) angiography/urography with Gd-DTPA administration. The concentrations of NGAL and KIM-1 were measured four times in the urine (pre-contrast, then at four hours, 24 hours, and 48 hours after contrast administration), and serum NGAL was measured at 0 (baseline), 24 hours, and 48 hours after contrast exposure. Results After 24 hours, serum NGAL increase of ≥25% was noticed in 32.6% of the patients in the iopromide group and in 25.45% of the patients in the gadolinium group, with significantly higher average percent of this increase in first group (62.23% vs. 36.44%, p=0.002). In the Gd-DTPA group, we observed a statistically significant increase in urinary KIM-1 24 hours after the procedure. Normalized urinary KIM-1, 24 hours after contrast exposure, was a better predictive factor for CI-AKI than other biomarkers (AUC 0.757, cut off 214 pg/mg, sensitivity 83.3%, specificity 54.2%, p=0.035). Conclusions In children with normal renal function, exposure to iodinated-based and gadolinium-based media might lead to subclinical nephrotoxicity, which could be detected using serum NGAL and urinary KIM-1.

Effectiveness of Wharton’s jelly stem cells in gastroschisis repair using the inner surface of the umbilical cord as a patch: long-term results

ObjectiveThis retrospective study was designed to assess and compare the anatomical, functional, and esthetic appearance of the umbilical area in patients after repair of gastroschisis using the inner surface of the umbilical cord (UC) and in patients with omphalocele conservatively treated. BackgroundOur procedure transformed gastroschisis into an ‘artificial–surgical omphalocele’ in which the prolapsed intestine was covered with an umbilical patch, the inner surface of which contained Wharton’s jelly (WJ). MethodsWe have summarized an experience of 17 years in repairing gastroschisis using the inner surface of the UC. From 1986 to 2003, 21 infants with gastroschisis and one with a ruptured omphalocele were treated with this technique. We used Eagle’s medium to prove the validity of the umbilical stump and the duration of its viability. The inner surface of the umbilical patch is a ‘live’ structure with WJ, which contains mucoid connective tissue and fibroblast-like cells – that is, stem cells producing cutis, adipose, and connective tissue. ResultsUsing our method, early control assessment of 18 of 21 patients with gastroschisis, at intervals of 1–3 months, showed good functional and esthetic results. Clinical long-term results in terms of anatomical, clinical, and functional findings were excellent. Besides clinical testimony, we used high-frequency ultrasonography to make an appraisal of the effectiveness of WJ stem cells in the repair of gastroschisis, and compared our results with healthy volunteers and patients with omphalocele conservatively treated. ConclusionThis paper describes the effect of the local application of WJ – that is, mesenchymal stromal cells derived from the inner surface of the umbilical stump – and its influence on the healing process of the birth defect and wound.