Prematurity-Related Hypertension in Children and Adolescents

Due to the functional and structural immaturity of different organ systems, preterms have a higher rate of morbidity and mortality. The prevention and treatment of the complications of prematurity is a major challenge in perinatal health care. Recently, there have been several multicenter research trials analysing the impact of prematurity or low birth weight on the health problems of children and adolescents. Many of these studies deal with the issue of pediatric hypertension. An analysis of 15 studies conducted in the years 1998–2011, in which blood pressure values in ex-preterm children were measured, was performed. Comparison was based on several issues: measurement method, cohorts age, size, and birthweight. It has been proven that hypertension occurs more often in former preterm infants; however the etiologic pathways that cause this condition still remain unclear. Moreover, pediatric hypertension is a significant problem, because of its transformation into adult hypertension and increased cardiovascular risk later in life. Therefore it is crucial to introduce wide-spread screening and detection of elevated blood pressure, especially among prematurely born children

Risk factors for cardiovascular disease in patients with metabolic-associated fatty liver disease:a machine learning approach

BACKGROUND: Nonalcoholic fatty liver disease is associated with an increased cardiovascular disease (CVD) risk, although the exact mechanism(s) are less clear. Moreover, the relationship between newly redefined metabolic-associated fatty liver disease (MAFLD) and CVD risk has been poorly investigated. Data-driven machine learning (ML) techniques may be beneficial in discovering the most important risk factors for CVD in patients with MAFLD. METHODS: In this observational study, the patients with MAFLD underwent subclinical atherosclerosis assessment and blood biochemical analysis. Patients were split into two groups based on the presence of CVD (defined as at least one of the following: coronary artery disease; myocardial infarction; coronary bypass grafting; stroke; carotid stenosis; lower extremities artery stenosis). The ML techniques were utilized to construct a model which could identify individuals with the highest risk of CVD. We exploited the multiple logistic regression classifier operating on the most discriminative patient’s parameters selected by univariate feature ranking or extracted using principal component analysis (PCA). Receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) were calculated for the investigated classifiers, and the optimal cut-point values were extracted from the ROC curves using the Youden index, the closest to (0, 1) criteria and the Index of Union methods. RESULTS: In 191 patients with MAFLD (mean age: 58, SD: 12 years; 46% female), there were 47 (25%) patients who had the history of CVD. The most important clinical variables included hypercholesterolemia, the plaque scores, and duration of diabetes. The five, ten and fifteen most discriminative parameters extracted using univariate feature ranking and utilized to fit the ML models resulted in AUC of 0.84 (95% confidence interval [CI]: 0.77–0.90, p < 0.0001), 0.86 (95% CI 0.80–0.91, p < 0.0001) and 0.87 (95% CI 0.82–0.92, p < 0.0001), whereas the classifier fitted over 10 principal components extracted using PCA followed by the parallel analysis obtained AUC of 0.86 (95% CI 0.81–0.91, p < 0.0001). The best model operating on 5 most discriminative features correctly identified 114/144 (79.17%) low-risk and 40/47 (85.11%) high-risk patients. CONCLUSION: A ML approach demonstrated high performance in identifying MAFLD patients with prevalent CVD based on the easy-to-obtain patient parameters

Evaluating the relationship of GDF-15 with clinical characteristics, cardinal features, and survival in multiple myeloma

Growth differentiation factor 15 (GDF-15), a member of the transforming growth factor-β superfamily, participates in processes associated with myeloma development and its end-organ complications. It plays a significant role in both physiological and abnormal erythropoiesis and regulates iron homeostasis through modulation of hepcidin. It is abnormally secreted in marrow stromal cells of patients with multiple myeloma (MM), which may reflect the tumor microenvironment. We analyzed the associations of serum GDF-15 with clinical characteristics of 73 MM patients (including asymptomatic MM) and the laboratory indices of renal function, anemia, and inflammation. Baseline serum GDF-15 was studied as the predictor of two-year survival. We defined five clinically relevant subgroups of patients (symptomatic MM only, patients with and without remission, patients on chemotherapy, and without treatment). Increased GDF-15 concentrations were associated with more advanced MM stage, anemia, renal impairment (lower glomerular filtration and higher markers of tubular injury), and inflammation. Most of the results were confirmed in the subgroup analysis. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin were associated with GDF-15 independently of other variables. In the studied MM patients, GDF-15 did not significantly predict survival (p=0.06). Our results suggest that serum GDF-15 reflects myeloma burden and shares a relationship with several markers of prognostic significance, as well as major manifestations

Troska o zdrowie w aspekcie społecznym. Cz. 1

Praca recenzowana / peer-reviewed pape

Zonulin-related peptides in the setting of multiple myeloma — evaluation of a candidate molecule with respect to anemia, chronic kidney disease, and tumor burden: a pilot study

Introduction: The zonulin-related family of peptides is implicated in the regulation of intestinal permeability, inciting chronic inflammation and potentially in the incidence of cancer due to increased antigen trafficking. Scarce data are available on the potential role of serum zonulin-related peptides (ZRP) as biomarkers of hematologic cancer and related organ involvement.Objectives: This study aimed to evaluate correlations between ZRP as assessed by the commercially — available Immunodiagnostik enzyme-linked immunosorbent assay (ELISA) assay, complete blood count, multiple myeloma (MM) stage, and renal impairment among MM patients.Materials and methods: We analyzed a population of 73 patients with MM and evaluated the relationship between disease characteristics and long-term outcomes. The control group included 21 healthy volunteers (11 women, 10 men) between 24 and 69 years old. Serum ZRP were assayed using a commercially available kit (Immundiagnostik, Bergen, Germany).Results: Twenty-six patients had eGFR &lt; 60 mL/min/1.73 m2. Median (IQR) serum concentration of ZRP in the studied group was 23.9 (19.9; 27.4) ng/mL. ZRP did not differ between subjects with and without anemia (defined as hemoglobin below the lower reference limit, p = 0.4). Significant correlations were detected with serum albumin (R = 0.30; p = 0.009), log (creatinine) (R = –0.28; p = 0.018), eGFR (R = 0.26; p = 0.025), ferritin (R = 0.34; p = 0.013), and log (NT-proBNP) (R = –0.32; p = 0.006). Moreover, in patients with symptomatic MM, ZRP correlated with monoclonal protein in serum (R = –0.29; p = 0.046), blood hemoglobin (R = 0.27; p = 0.027), and age (R = –0.24; p = 0.044). In multiple regression, serum concentrations of monoclonal protein and ferritin, as well as the International Staging System for multiple myeloma (ISS) stage 3, were identified as independent predictors of ZRP concentrations.Conclusions: Serum concentrations of zonulin-related peptides only weakly correlate with kidney failure (creatinine and eGFR) in MM patients and anemia (hemoglobin concentration) in symptomatic MM patients. Serum ZRP assay is of little benefit in the setting of MM, exhibiting only weak correlations with indices of organ involvement, and it cannot be used to assess prognosis in MM

On the search for the right definition of heart failure with preserved ejection fraction

The definition of heart failure with preserved ejection fraction (HFpEF) has evolved from a clinically based “diagnosis of exclusion” to definitions focused on objective evidence of diastolic dysfunction and/or elevated left ventricular filling pressures. Despite advances in our understanding of HFpEF pathophysiology and the development of more sophisticated imaging modalities, the diagnosis of HFpEF remains challenging, especially in the chronic setting, given that symptoms are provoked by exertion and diagnostic evaluation is largely conducted at rest. Invasive hemodynamic study, and in particular — invasive exercise testing, is considered the reference method for HFpEF diagnosis. However, its use is limited as opposed to the high number of patients with suspected HFpEF. Thus, diagnostic criteria for HFpEF should be principally based on non-invasive measurements. As no single non-invasive variable can adequately corroborate or refute the diagnosis, different combinations of clinical, echocardiographic, and/or biochemical parameters have been introduced. Recent years have brought an abundance of HFpEF definitions. Here, we present and compare four of them: 1) the 2016 European Society of Cardiology criteria for HFpEF; 2) the 2016 echocardiographic algorithm for diagnosing diastolic dysfunction; 3) the 2018 evidence-based H2FPEF score; and 4) the most recent, 2019 Heart Failure Association HFA-PEFF algorithm. These definitions vary in their approach to diagnosis, as well as sensitivity and specificity. Further studies to validate and compare the diagnostic accuracy of HFpEF definitions are warranted. Nevertheless, it seems that the best HFpEF definition would originate from a randomized clinical trial showing a favorable effect of an intervention on prognosis in HFpEF

Zagrożenia zdrowotne wśród dzieci i młodzieży. T. 1

Praca recenzowana / Peer-reviewed pape

Niestandardowy sposób wykorzystania osobistej pompy insulinowej u chorej na cukrzycę typu 1 stosującej dietę ketogeniczną — opis przypadku

Prezentowany przypadek przedstawia niecodzienne wykorzystanie pompy insulinowej przez 28-letnią kobietę chorującą na cukrzycę typu 1, stosującą od 5 miesięcy dietę ketogeniczną. Pacjentka została przy­jęta w trybie pilnym na Oddział Chorób Wewnętrznych i Diabetologii z powodu utrzymujących się od kilku dni wymiotów i biegunki. Na co dzień była leczona przy zastosowaniu osobistej pompy insulinowej, którą wykorzystywała jedynie przez kilka godzin dziennie (5-godzinny wlew podstawowy insuliny szybkodziała­jącej, wynoszący 0,6 j./godz.), aby wyeliminować efekt brzasku, w ogóle nie przyjmując insuliny doposiłkowej. W celu samokontroli glikemii chora stosowała zsyn­chronizowany z pompą 24-godzinny system ciągłego monitorowania glikemii. Ponadto pacjentka podawała sobie 30 j. długodziałającej insuliny analogowej przed snem. Chora nie wyraziła zgody na zmianę swojego dotychczasowego sposobu leczenia; wypisała się z oddziału na własne życzenie. Przypadek opisanej pa­cjentki zwraca uwagę na potrzebę przeprowadzenia du­żych badań oceniających bezpieczeństwo i skuteczność zastosowania diety ketogenicznej, jak również pokazuje, że nowoczesne narzędzia, takie jak pompa insulinowa, mające służyć poprawie kontroli glikemii, mogą być wykorzystywane przez pacjentów w niekonwencjonalny sposób.

An unusual use of personal insulin pump by a patient with type 1 diabetes on a ketogenic diet — a case report

In this case report we present a 28-year-old woman with type 1 diabetes mellitus on a ketogenic diet for 5 months, using a personal insulin pump in an unusual way. The patient was admitted to the Department of Internal Medicine and Diabetology due to vomiting and diarrhea that had lasted for several days. On a daily basis, she used personal insulin pump for only several hours a day (a 5-hour basal rate of 0.6 units/hour of fast-acting insulin) in order to avoid dawn phenom­enon, without any prandial insulin, and she used continuous glucose monitoring for 24 hours a day for glycemia control. Additionally she was taking 30 units of long acting insulin analog before sleep. The patient was unwilling to change her treatment method and she was discharged from the hospital against medical advice. Due to the increase in popularity of ketogenic diet, there is a need for large studies assessing its safety and efficacy. Moreover, our case draws attention to the fact that patients can use modern technologies, which are developed to improve the glycemic control, in un­conventional ways.Prezentowany przypadek przedstawia niecodzienne wykorzystanie pompy insulinowej przez 28-letnią kobietę chorującą na cukrzycę typu 1, stosującą od pięciu miesięcy dietę ketogeniczną. Pacjentka została przyjęta w trybie pilnym do Oddziału Chorób Wewnętrznych i Diabetologii z powodu trwających od kilku dni nudności i wymiotów. Na co dzień leczona była przy zastosowaniu osobistej pompy insulinowej, którą wykorzystywała jedynie przez kilka godzin (5-godzinny wlew podstawowy wynoszący łącznie 3 j) dziennie aby wyeliminować efekt brzasku. W celu samokontroli glikemii stosowała zsynchronizowany z pompą system ciągłego monitorowania glikemii. Ponadto pacjentka podawała sobie 30j. długodziałającej insuliny analogowej przed snem, w ogóle nie stosując insuliny doposiłkowej. Pacjentka nie wyrażała zgody na zmianę swojego dotychczasowego sposobu leczenia; wypisała się z oddziału na własne życzenie. Przypadek opisanej pacjentki zwraca uwagę zarówno na potrzebę przeprowadzenia dużych badań oceniających bezpieczeństwo i skuteczność zastosowania diety ketogenicznej, jak również pokazuje, że nowoczesne narzędzia - jak pompa insulinowa, mające służyć poprawie kontroli glikemii, mogą być wykorzystywane przez pacjentów w niekonwencjonalny sposób