Adiponectin: an adipocyte-derived hormone, and its gene encoding in children with chronic kidney disease

BACKGROUND: The prevalence of cardiovascular disease (CVD) and inflammation is high in patients with chronic kidney disease (CKD). Adiponectin (ADPN) is an adipocytokine that may have significant anti-inflammatory and anti-atherosclerotic effects. Low adiponectin levels have previously been found in patients with high risk for CVD. METHODS: On seventy eight advanced CKD (stages 4 and 5) pediatric patients undergoing maintenance hemodialysis( MHD) or conservative treatment (CT) the following parameters were studied: body mass index, left ventricular mass index(LVMI), serum adiponectin , cholesterol, HDL-cholesterol, high sensitivity C-reactive protein (hs CRP),interleukin 6(IL6) and single-nucleotide polymorphisms (SNPs) in the ADIPOQ gene at positions 45, and 276. Seventy age-and gender-matched healthy subjects served as control subjects. RESULTS: Markedly (P = 0.01) elevated plasma adiponectin levels were observed in CKD patients, especially CT patients, compared to control subjects. The wild type of ADIPOQ 45T > G (T) allele is the main gene for patients and controls. MHD and CT patients had significantly higher frequency of the TT genotypes of +276G > T gene (P = 0.04) compared with control subjects. A significant positive correlation was observed between plasma adiponectin and IL6 level, whereas negative correlations were found between adiponectin level, cholesterol, HDL cholesterol and hs CRP. In a stepwise backward multiple regression model only IL6 (P = 0.001) was independently associated with plasma adiponectin levels. The adiponectin gene the 276 GT+TT genotypes were associated with a higher level of adiponectin . CONCLUSIONS: The present study demonstrated that ADPN is related to several metabolic and inflammatory CV risk factors in a manner consistent with the hypothesis that this protein might have a protective role against these factors. We observed an association between the +276G>T SNP in the adiponectin gene and CKD in children. Genetic variation of +276 gene seemed to have a positive impact on circulating adiponectin levels in CKD patients

Hepcidin and its Related Hematological Biomarkers of Anemia in Children on Hemodialysis: Role of Carnitine Deficiency

BACKGROUND: Anemia is one of the most common complications in end-stage renal disease (ESRD) patients. Hepcidin is a hormone that regulates iron homeostasis in patients with ESRD. Carnitine deficiency is commonly seen in hemodialysis (HD) patients. AIM: This study aimed to investigate the relationship between hepcidin and inflammatory and other anemia markers in children with ESRD and to evaluate the association of carnitine deficiency with anemia in these patients. SUBJECTS AND METHODS: Thirty pediatric patients with ESRD undergoing HD, and thirty healthy, age- and sex-matched children served as controls were included in the study. Serum levels hepcidin, iron status, high-sensitivity C-reactive protein, and total carnitine were measured. RESULTS: Statistically significant increases in serum levels of hepcidin (100.7 ± 0.99 ng\ml vs. 77.43 ± 0.8 ng\ml, p = 0.000), was found in HD children as compared to healthy controls. Statistically significant increase in serum levels of hs-CRP (3.94 ± 0.19 mg/l vs. 1.36 ± 0.07 mg/l, p = 0.04) was found in HD children as compared to healthy controls. However, serum levels of carnitine (29.59 ± 2.46 μmol/L vs. 36 ± 2.39 μmol/L, p = 0.000) showed statistically significant decreases in HD children as compared to healthy controls positive correlation was found between hepcidin and hs-CRP (r = 0.059, p = 0.042). Furthermore, a positive correlation was present between serum carnitine levels and serum iron levels (r = 0.651, p = 0.042). CONCLUSION: Serum hepcidin may be a more useful biomarker of functional iron deficiency in children on HD. The efficacy of carnitine treatment for children on HD with carnitine deficiency and its effect on anemia needs to be studied

Systematic Review of Potential Health Risks Posed by Pharmaceutical, Occupational and Consumer Exposures to Metallic and Nanoscale Aluminum, Aluminum Oxides, Aluminum Hydroxide and Its Soluble Salts

Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007). Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of “total Al”assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al+ 3 to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)+ 2 and Al(H2O)6 + 3] that after complexation with O2•−, generate Al superoxides [Al(O2•)](H2O5)]+ 2. Semireduced AlO2• radicals deplete mitochondrial Fe and promote generation of H2O2, O2 • − and OH•. Thus, it is the Al+ 3-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer\u27s disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances

A link between the COVID-19 pandemic and Kawasaki-like multi-system inflammatory syndrome in children

Introduction. COVID-19 (coronavirus disease 2019) – the epidemic outbreak caused by coronavirus-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – is a global public health problem. Children are less affected and have a mild form of the illness. The association between SARS-CoV-2 disease, COVID-19 and late symptoms of vasculitis is often suspected, in particular in young asymptomatic patients, especially due to the post-viral immune response. Objective. The aim of the review is to describe the characteristics of children and adolescents affected by the development of Kawasaki-like mult-system inflammatory syndrome (KD) (MIS-C), and assesses its possible temporal association with SARS-CoV-2 infection. Brief description of the state of knowledge. A group of children who presented with KD-type MIS-C during the COVID-19 pandemic have been identified in the United Kingdom, the United States, and Italy. Some children were diagnosed with SARS- CoV-2 infection by real-time polymerase chain reaction and IgG antibodies. SARS-CoV-2 infection and hyperinflammation in COVID-19 can serve as an ‘initial trigger’ for KD. IVIG should be administered within seven days of onset of illness until KD symptoms disappear and COVID-19 test is negative. Large numbers of children in African countries with the SARS-CoV-2 epidemic are likely to be affected by KD, and in such cases, a shortage of IVIG supplies is expected. Conclusions. This article suggests a correlation between COVID-19 and Kawasaki-like MIS-C, which is important for the care of sick children. However, the definitive relationship between childhood KD and COVID-19 needs to be confirmed by a large cohort study on a large numbers of infant and children patients worldwide

Stress response in shoulder surgery under interscalene block, randomized controlled study comparing ultrasound guidance to nerve stimulation

Background: Shoulder surgeries are known to cause moderate to severe pain. Many techniques have been used successfully to minimize that stress response including interscalene block. Ultrasound guided techniques are becoming widely spread and commonly used for regional anesthesia. The objective of the present randomized controlled study is to compare the ultrasound guidance with nerve stimulation for interscalene brachial plexus block (IBPB) regarding the effect on stress response. Patients and Methods: 50 patients, American Society of Anesthesiologists physical status I, II, and III, undergoing shoulder surgery were enrolled in the current study. Group U patients (n = 25) received ultrasound guided IBPB and Group N patients (n = 25) received IBPB using nerve locator. IBPB was done under ultrasound guidance using the linear 13-6 MHz transducer of the SonoSite M-Turbo ultrasonic device. In both groups, venous blood samples to measure cortisol level and assess stress response as a primary outcome were collected. Results: The current study demonstrated that the stress response, as indicated by the cortisol level in blood, showed no significant difference in the preoperative blood level between Group U and Group N, as well as blood level after block and before skin incision. However, it differed significantly between the two groups postoperatively. Conclusion: The current study concluded that the use of ultrasound guidance for IBPB in shoulder surgeries offered a significant suppression of the stress response intraoperatively and postoperatively as indicated by the low cortisol level with less complications and easier technique compared to nerve location

Bupivacaine constant continuous surgical wound infusion versus continuous epidural infusion for post cesarean section pain, randomized placebo-controlled study

Background: Cesarean section is considered as one of the most commonly done surgical procedures, which have a rising rate of performance. Postoperative pain may lead to poor patient satisfaction and interfere with early rehabilitation. Increasing evidence is now suggesting that less invasive regional analgesic techniques may be as beneficial as epidural analgesia. This study aimed to compare efficacy, safety and side effect of bupivacaine continuous wound infusion using constant flow PainFusor system with epidural infusion for post-cesarean section analgesia. Methods: 60 patients, ASA physical status I & II, aged 19–42 years, with full-term pregnancy undergoing elective cesarean section were randomly divided into two groups. All patients enrolled in the study performed cesarean section under standardized protocol of general anesthesia. Group A patients received continuous surgical wound infiltration, while group B patients received bupivacaine continuous epidural infusion. Pain was assessed using Visual analogue scale (VAS). Diclofenac sodium 75 mg was administered IM as a rescue analgesic. Results: The current study showed no significant difference between the two groups in the hemodynamic parameters, respiratory parameters as well as pain scores at rest during the whole period of study. Side effects were statistically non-significant, and only patients who requested analgesia were significantly higher in group A. Furthermore, pain VAS scores on mobilization were significantly lower in group B during the first postoperative day. Conclusion: The current study demonstrated that bupivacaine administered by continuous epidural infusion provided a significantly lower pain scores with mobilization, and hence better analgesia for post cesarean section pain in the first postoperative day compared to continuous bupivacaine wound infusion through fenestrated catheter using the constant flow PainFusor system

Effect of activated recombinant factor VII versus tranexamic acid infusion on bleeding during spine surgery, randomized, controlled, double blinded trial

Background: Antifibrinolytic drugs, such as tranexamic acid are medications that facilitate hemostasis and decrease blood loss and the need for blood transfusion during major surgery. Activated recombinant coagulation factor VII is a novel hemostatic agent, studies revealed that it is helpful hemostatic in disorders with impaired hemostasis, as well as in patients with normal hemostatic function to minimize perioperative blood loss. This study aimed to compare the efficacy of activated recombinant factor VII with tranexamic acid in reducing the perioperative blood loss. Methods: 50 patients undergoing spine surgery were enrolled in this study. Group A patients were given activated recombinant factor VII and group T patients given tranexamic acid. In both groups, anesthesia was induced using fentanyl 3 μg/kg and propofol 2 mg/kg; muscle relaxation was initiated using cisatracurium 0.2 mg/kg. Transfusion of blood and its products was done according to a value guide. The primary outcome variable of the study was the total volume of blood loss in the perioperative period. Secondary outcome variables include perioperative transfusion requirement, and the number of patients who needed transfusion, as well as time of operation. A P-value less than 0.05 is considered statistically significant. Results: The current study showed that the total perioperative blood loss in group A was significantly lower than group T. None of the patients required ICU admission, as well as reentry to operating theater. Furthermore, no significant difference was detected in the number of patients needed blood transfusion. Intraoperative bleeding was associated with a slight decrease of hemoglobin in group A. Conclusion: The present study concluded that administration of activated recombinant factor VII in spine surgery reduces the total perioperative blood loss and the total volume of intraoperative blood transfusion compared with tranexamic acid, with no evidence of adverse effects