The Role of Cardiorespiratory Fitness in Children with Cardiovascular Risk

Cardiorespiratory fitness is an outcome of physical activity, enabling the transport of oxygen from the atmosphere to the mitochondria to perform physical work and therefore reflects the overall capacity of the cardiovascular and respiratory systems to perform the prolonged exercise. In recent decades, it has declined in the paediatric population. Cardiovascular fitness measurement has yet to be standardised in children but is a powerful marker of health in youth and is strongly associated with inflammation and inversely associated with cardiovascular risk factors, especially obesity. Notably, youth with low cardiorespiratory fitness levels have a higher risk of developing cardiovascular diseases during adulthood. Lowered cardiorespiratory fitness has been demonstrated most often in children with obesity and associated cardiovascular comorbidities, however, these can be associated with cardiorespiratory fitness independently to body mass index. The benefits of physical activity on health have been well demonstrated during growth and it should be encouraged in children with cardiovascular risk to prevent further reduction of cardiorespiratory fitness and the development of other comorbidities. Along with appropriate physical exercise and diet in childhood, breastfeeding in the first year of life is recommended

Cardiovascular Risk Factors in Children

Cardiovascular morbidity and mortality are still increasing in developed countries with emphasis on the obesity epidemic. Children and young adults are no exception. With modern lifestyle, traditional cardiovascular risk factors, such as hypertension, obesity, dyslipidemia, insulin resistance, kidney damage, are increasingly present in children leading to premature cardiovascular events in adult life. Cardiovascular risk factor can accelerate naturally progressing atherosclerosis, which should be prevented to facilitate quality and longevity of life. Primary and primordial prevention in the pediatric population are of utmost importance. However, if a cardiovascular risk factor is already present, frequent monitoring of possible development of other cardiovascular risk factors and evaluation of end organ damage should be implemented to intervene in time

Obesity in Children: Recent Insights and Therapeutic Options

Obesity in children, including adolescents, is nowadays, in the light of the COVID-19 pandemic, an even more pressing problem than before it, leading to increased prevalence of obesity and its comorbidities at young age. A simple and correct approach to diagnosis is essential, and some new insights in epidemiology, pathophysiology, and diagnosis are currently under investigation. Obesity in preschool children and metabolically healthy obesity are new entities that are recently being defined and written about. Additionally, several new factors that might influence obesity development are being researched, such as pollutants, sleep duration, and gut microbiota. In this chapter, we briefly present them as possible therapeutic targets in the future along with current therapeutic options in the pediatric population, namely lifestyle change, pharmaceutical options, and surgery. A child is always significantly affected by his/her family lifestyle, home, and social environment, which has to be considered in childhood obesity management

The role of ultrasound elastography and some newer biomarkers in the management of chronic nephrologic paediatric patients

Cilj preventivne nefrologije pri otrocih je zgodnje odkrivanje otrok s povečanim tveganjem srčno-žilne ogroženosti in kronične ledvične bolezni, ki sta med seboj vzajemno povezani. V doktorski nalogi smo se osredotočili na raziskovanje ultrazvočne elastografije, novejše ultrazvočne metode, ki omogoča oceno elastičnosti tkiv, ter nekaterih novejših označevalcev ledvične oziroma srčno-žilne poškodbe. V raziskavo smo vključili 129 preiskovancev: 46 pediatričnih bolnikov s kronično ledvično boleznijo, 50 bolnikov s povišanim krvnim tlakom ter 33 zdravih preiskovancev, ki so služili kot kontrolna skupina. Pri vseh udeležencih smo opravili antropometrične meritve. Celotno skupino preiskovancev smo dodatno opredelili kot čezmerno težke ali normalno prehranjene, izmerili krvni tlak, hitrost pulznega vala in telesno sestavo, opravili ultrazvočno elastografijo jeter in ledvic ter odvzeli kri in urin za osnovne in dodatne preiskave novejših bioloških označevalcev. Rezultati raziskave so pakazali zmanjšano elastičnost jeter v obeh raziskovalnih skupinah, ki jo poslabša prisotnost čezmerne telesne teže. Ob čezmerni telesni teži je hkrati zmanjšana tudi elastičnost ledvic, kar kaže na negativen učinek kopičenja dejavnikov tveganja srčno-žilnih bolezni. Izmed novejših bioloških označevalcev sta pri ocenjevanju srčno-žilne ogroženosti razvidni potencialna uporaba molekule salusin-β ter potreba po nadaljnjem raziskovanju receptorja za interlevkin 2 in uromodulina pri določenih skupinah bolnikov.The goal of preventive nephrology in children is the early detection of children who have an increased risk of cardiovascular damage and chronic kidney disease. In the doctoral thesis, we focused on researching ultrasound elastography, a newer ultrasound method that enables the assessment of tissue elasticity, as well as some newer markers of renal or cardiovascular damage. 129 subjects were included in the study: 46 paediatric patients with chronic kidney disease, 50 patients with hypertension and 33 healthy subjects who served as a control group. We performed anthropometric measurements and additionally defined the entire group of subjects as over- or normal-weight, we measured blood pressure, pulse wave velocity and body composition, performed ultrasound elastography of the liver and kidneys, and collected blood and urine for basic and additional investigations of newer biological markers. Reduced elasticity of the liver in both research groups was found, aggravated by the presence of excess body weight. With excess body weight, the elasticity of the kidneys was also reduced, which indicates a negative effect of the clustering cardiovascular risk factors. When determining newer biological markers, the potential use of the salusin-β molecule in the assessment of cardiovascular risk was evident, as well as the need for further research of the receptor for interleukin 2 and uromodulin in certain groups of patients

Transition of Chronic Pediatric Nephrological Patients to Adult Care Excluding Patients on Renal Replacement Therapy with Literature Review

(1) Background: The transition of children with chronic kidney disease to adult care has become a well-handled issue. However, other patients with normal or mildly decreased renal function also requiring further management and transition are neglected. (2) Methods: A questionnaire was sent to patients with kidney pathology, aged 17 years and older.(3) Results: The patients were mostly high-school (55%) or college students (39%), living with their parents (94%). One third did not know how their disease affected their choice of profession and reproductive health. Furthermore, 46% of the respondents did not know who would continue with their care, and 44% still had a primary pediatrician. (4) Conclusions: A review of the literature on the topic was performed and summarized here. Regular education is the key for successful transfer, not only in chronic kidney and transplant patients, but also in others in whom a decline in renal function can be expected in the future

HEALING OF CRONIC WOUNDS WITH SEMICONDUCTOR LED LASER PHOTOTHERAPY

Fototerapija z laserjem je fizikalna metoda za spodbujanje celjenja akutnih in kroničnih ran. Laserje, ki proizvajajo koherentno svetlobo, vse pogosteje nadomeščajo laserske polprevodniške LED diode, ki proizvajajo nekoherentno svetlobo. Namen raziskave je bil raziskati, ali fototerapija z LED laserjem vpliva na hitrejše celjenje ran in zmanjšanje bolečine. Raziskovalna metodologija. V randomizirani paralelni prospektivni raziskavi smo pri bolnikih opazovali dinamiko bolečine in celjenja ran znotraj 6 tednov. Vzorec raziskave je zajemal 20 bolnikov s kroničnimi ranami 2. in 3. stopnje. V skupini 10 bolnikov smo izvajali lasersko zdravljenje, ostali bolniki pa so bili vključeni v kontrolno skupino. Rezultati. Relativna površina ran glede na vrednost pred raziskavo je že po enem tednu zdravljenja bila manjša v skupini bolnikov zdravljenih z laserjem (mediana = 98 %) v primerjavi s kontrolno skupino (mediana = 102 %) (p < 0,001). Površina ran se je v skupini zdravljenih z laserjem nadalje zmanjševala in v zadnjem 6. tednu dosegla mediano 78 %, medtem ko je površina ran v kontrolni skupini znašala še vedno visokih 109 % (p = 0,002). V prvem in četrtem tednu zdravljenja nismo ugotovili statističnega zmanjšanja bolečine (p = 0,28), ugotovili pa smo jo v 2., 3., 5. in 6. tednu. Zadnji teden se je bolečina v skupini bolnikov zdravljenih z laserjem zmanjšala na mediano 79 % v primerjavi s kontrolno skupino, kjer je relativna bolečina še višja (118 %) (p = 0,005). Patronažne medicinske sestre so mnenja, da je zdravljenje z lasersko terapijo hitra in enostavna metoda, ki ne povzroča bolečin, ampak jih celo zmanjša. Sklep. Analiza rezultatov nakazuje, da zdravljenje z LED laserjem lahko vpliva na celjenje kroničnih ran in zmanjšanje bolečine.Phototherapy with (semiconductor LED) laser is a physical method for stimulating the healing of acute and chronic wounds. Lasers, which produce coherent light , have recently been more and more replaced by laser semiconductor LED diodes that produce incoherent light. The research was to investigate whether phototherapy with LED laser influences a faster healing of wounds and moreover, if it reduces pain. Research methodology. With parallel random prospective research, we were pursuing the dynamics of pain and healing of the patients wounds within six weeks. The research sample consisted of 20 patients with chronic wounds, ranging from 2nd to 3rd degree. In the group of 10 patients, we were using laser treatment while the rest 10 patients were included in the control group. Results. The relative surface of wounds regarding the pre- research assessment was already smaller after the first week of the treatment in the patients group, treated by laser (median = 98 %) in comparison with the control group (median = 102 %) (p < 0,001). In the group, treated by laser, the wound surface continued to reduce and reached median 78 % in the last 6th week while the wound surface in the control group still remained at high 109 % (p = 0,002). During the first and fourth week of the treatment, we did not find out a statistical pain decrease (p = 0,28), but we could find it out in the 2nd, 3rd, 5th and 6th week. During the last week, the pain in the group of patients, treated by laser, was reduced to median 79 % in comparison with the control group where the relative pain is still higher (118 %) (p = 0,005). Nurses in the home care service are convinced that laser therapy treatment is a fast and simple method which does not cause pain, but it even reduces it. Conclusion. The analysis of results indicates that the treatment with LED laser can stimulate the healing of chronic wounds and it can also reduce pain

Current Knowledge of Selected Cardiovascular Biomarkers in Pediatrics: Kidney Injury Molecule-1, Salusin-&alpha; and -&beta;, Uromodulin, and Adropin

Cardiovascular diseases are the leading cause of morbidity and mortality in the modern world. Their common denominator is atherosclerosis, a process beginning in childhood. In pediatrics, the aim of preventive measures is to recognize children and adolescents at risk for accelerated atherosclerosis and possible premature cardiovascular events in adulthood. Several diagnostic procedures and biomarkers are available for cardiovascular risk assessment in adults. However, reliable markers in pediatrics are still insufficiently studied. In this contribution, we discuss five potential biomarkers of particular interest: kidney injury molecule-1, salusin-&alpha; and -&beta;, uromodulin, and adropin. Studies regarding the pediatric population are scarce, but they support the evidence from studies in the adult population. These markers might entail both a prognostic and a therapeutic interest