Total sleep deprivation decreases saliva ghrelin levels in adolescents.

Ghrelin, a regulator of food intake and energy expenditure, has been shown to be associated with insufficient sleep. The goal of the present study was to investigate the effect of a single night of total sleep deprivation on fasting saliva ghrelin and on nocturnal variation of saliva ghrelin concentration. A further aim of the study was to investigate the influence of body mass index on changes in saliva ghrelin levels. Altogether 35 adolescents (18 boys; age: 13.8 ± 1.14 years) were studied on two subsequent days (sleep and total sleep deprivation). Saliva samples were collected during the two experimental nights at 21:00 hours, 01:00 hours and 06:00 hours. Total-ghrelin concentration showed a continuous increase from the evening until 06:00 hours. This increase was blunted significantly (p = 0.003) by total sleep deprivation. Total-ghrelin level was significantly lower (p = 0.02) during total sleep deprivation at 06:00 hours (median 403.6 pg ml-1 ; 95% confidence interval: 343.1-468.9 pg ml-1 ) as compared with values during the sleep condition (median 471.2 pg ml-1 ; 95% confidence interval: 205.4-1578.7 pg ml-1 ). Acyl-ghrelin levels did not present any change at the three time points, and were not affected by total sleep deprivation. Stratifying the study population according to body mass index (normal weight and overweight/obese groups), the blunting effect of total sleep deprivation was more pronounced in the obese/overweight group (sleep: median 428.2 pg ml-1 ; 95% confidence interval: 331.3-606.9 pg ml-1 versus total sleep deprivation: median 333.1 pg ml-1 ; 95% confidence interval: 261.5-412.9 pg ml-1 ; p = 0.0479). Saliva total-ghrelin concentrations gradually increased during the night, and total sleep deprivation significantly blunted this increase. This blunting effect was mainly observed in subjects with overweight/obesity. The physiological and clinical implications of the present observation are to be clarified by further studies.

Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in healthcare workers / A BNT162b2 mRNS-Pfizer-BioNTech-védooltás hatásosságának és immunogenitásának monitorozása egészségügyben dolgozókon.

Összefoglaló. Bevezetés: A SARS-CoV-2 koronavírus okozta COVID-19 általános egészségügyi és gazdasági krízist idézett elo. Célkituzés: A megfigyeléses vizsgálat célja a BNT162b2 mRNS-Pfizer-BioNTech-vakcina hatásosságának, biztonságosságának és immunogenitásának igazolása a Budai Irgalmasrendi Kórház dolgozóin. Módszer: A vakcina adása után elemeztük a COVID-19-fertozés elofordulását, az oltások utáni reakciókat, valamint a "spike" (S-) protein és a nukleokapszid (N)-protein elleni ellenanyag szintjének változását. Eredmények: A felmérésben részt vevo 295 dolgozó közül az oltást megelozoen 36 dolgozó esett át COVID-19-fertozésen (COVID-19-pozitív csoport). A második oltás után a megfigyelési idoszak három hónapjában COVID-19-fertozés nem alakult ki a felmérésben részt vevo oltott dolgozók körében. Az oltási reakciók enyhék voltak. A COVID-19-pozitív csoportban az N-antitestek medián küszöbértékindexe az elso vakcina után 4 héttel mérve szignifikánsan magasabb volt (28,37), mint a COVID-19-negatív (0,085) csoportban (p<0,0001). Az elso vakcina után 4 héttel az S-antitestek medián értéke (8015 U/ml) a COVID-19-pozitív csoportban szignifikánsan magasabb volt (p<0,0001), mint a COVID-19-negatív csoportban (23,18 U/ml). A COVID-19-negatív csoport S-antitest-középértéke a második vakcina után szignifikáns (p<0,0001), mintegy 500×-os emelkedést mutatott (23,18 U/ml rol 1173 U/ml-re). Egy vakcina hatásosságát a fertozések terjedésének megakadályozása igazolja. Következtetések: A második vakcina utáni megfigyelési idoszakban új COVID-19-fertozés nem volt az oltott dolgozók körében. A fertozésen át nem esett COVID-19-negatív egyének esetén az S-antitest emelkedése mérsékelt az elso oltás után, míg a második oltás után lényegesen emelkedik. A COVID-19-fertozésen átesett egyének csoportjában már az elso vakcina is jelentos S-antitest-termelodést vált ki. Orv Hetil. 2021; 162(39): 1551-1557. INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic caused global public health and economic crises. OBJECTIVE: The aim of this observation study was to estimate the effectiveness, safety and elicited immune response of the BNT162b2 mRNA Pfizer-BioNTech vaccine in healthcare workers of the Buda Hospital of the Hospitaller Order of St. John of God. METHOD: After vaccination, the infection rate, adverse events and the kinetics of anti-SARS-CoV-2 spike (S) protein and anti-SARS-CoV-2 nucleocapsid (N) protein antibodies were evaluated. RESULTS: Before vaccination, from the 295 healthcare workers 36 recovered from prior COVID-19 infection (COVID-19-positive group). After the second vaccination, there was no COVID-19 infection during the three-month follow-up period. The adverse events were mild. In the COVID-19-positive group, the median cut-off index of anti-N antibodies measured at 4 weeks after the first vaccination were significantly (p<0.0001) higher (28.37) than in the COVID-19-negative group (0.085). After the first vaccine, the median titer of anti-S antibodies was significantly higher (p<0.0001) in the COVID-19-positive group (8015 U/ml) compared to the COVID-19-negative group (23.18 U/ml). In the COVID-19-negative group, the median titer of anti-S antibodies increased significantly (p<0.0001) after the second vaccine (from 23.18 U/ml to 1173 U/ml), showing an increase of 500×. CONCLUSIONS: After the second vaccination, there was no COVID-19 infection during the follow-up. In the COVID-19-negative group, the anti-S antibody titer is moderate after the first vaccination and increases significantly after the second vaccine. In the COVID-19-positive group, the first vaccine induces significant anti-S antibody production. Orv Hetil. 2021; 162(39): 1551-1557.

Effects of energy expenditure gene polymorphisms on obesity-related traits in obese children.

OBJECTIVE: To assess the frequencies of common polymorphisms of genes associated with energy expenditure among Hungarian obese children and investigate their influences on obesity-related traits and metabolic complications of common childhood obesity. RESEARCH METHODS AND PROCEDURES: In a total of 528 obese children (age 13.2±2.6 years) an oral glucose tolerance test and determination of fasting serum lipid levels were carried out, blood pressure and resting energy expenditure were measured and the children were genotyped for the following gene polymorphisms: Trp64Arg of ß3-adrenoreceptor (ADRB3), -3826 A/G of uncoupling protein (UCP)-1, exon 8 45 bp del/ins and -866 G/A of UCP-2, -55 C/T of UCP-3, and Pro12Ala of peroxisome-proliferator activated receptor gamma-2. RESULTS: Carriers of the ADRB3 Arg64 allele had a significantly higher relative body weight and relative body mass index compared with non-carriers. The UCP-2 exon 8 del/ins polymorphism was associated with higher degree of obesity, insulin resistance, dyslipideamia and lower adjusted metabolic rate. Children with UCP-3 -55 T/T genotype had a significantly lower adjusted metabolic rate than the C allele carriers. CONCLUSION: We found evidence for associations between common polymorphisms of the ADRB3, the UCP-2 and UCP-3 genes and basic metabolic rate as well as level and metabolic consequences of common obesity among Hungarian school-aged children.

Acute and long-term effects of corticosteroid therapy on bone metabolism in patients with kidney diseases.

AIM: The aim of our study was to examine parameters of bone metabolism during pulse and long-term methylprednisolone (MP) treatment in patients with kidney diseases. METHODS: In 13 patients with RPGN, treated with intravenous MP pulses, followed by tapering oral doses, osteocalcin (OC) and ß-CrossLaps (ß-CL) were measured before treatment, after the 3rd pulse, then 1 and 3 months later ("acute study"). In a separate set of analyses serum markers of bone metabolism and bone mineral density (BMD) were studied in 40 patients on maintenance MP therapy ("chronic study"). RESULTS: Immediately after the 3rd MP pulse serum OC decreased to 38 ± 23%, ß-CL increased to 200 ± 121% of the baseline (p = 0.002 for OC and p = 0.003 for ß-CL, respectively), and the OC/ß-CL ratio decreased from 55 ± 35 to 9 ± 7 (p = 0.002). OC remained below and ß-CL above baseline even at 3 months post pulse steroid treatment. Patients in the "chronic study" who were on maintenance oral steroid therapy received 13,844 ± 7,454 mg MP over 53 ± 47 months. BMD at the end of follow-up revealed reduced bone mineral density in 72.5% of the participants. Z-scores both at the hip and at the lumbar spine were significantly correlated with duration of steroid treatment and also with the cumulative steroid dose. CONCLUSION: MP pulse causes immediate, profound suppression of osteoblast function, and significant increase of osteoclast activity, suggesting uncoupling of bone formation and resorption. Prolonged high dose steroid treatment causes significant bone loss in patients with chronic kidney disease. Appropriate systematic follow up of bone metabolism, preventive measures and therapy when needed would be important for the bone health of this patient population.

Effects of mono- and dual blockade of the renin-angiotensin system on markers of cardiovascular status in hypertensive patients with mild and moderate renal failure.

BACKGROUND/AIMS: Dual renin-angiotensin system (RAS) blockade has no more efficiency to decrease cardiovascular mortality than mono-blockade. Our goal was to explore differences between other cardiovascular markers in patients with RAS blockade. METHODS: We analyzed two groups of patients treated with a long-term ACE inhibitor (MONO-group, n = 20) and an ACE inhibitor and angiotensin II receptor blocker (DUAL-group, n = 15). Ambulatory blood pressure monitoring, echocardiography, arterial stiffness and levels of catecholamine, endogenous ouabain (EO), pro-brain natriuretic peptide and more types of urinary albumin measurements were performed. RESULTS: In the DUAL-group, we found significantly better cardiac parameters, but the levels of EO and urinary albumins were similar in both groups. The level of EO correlates with nighttime mean arterial blood pressure (R = 0.556, p = 0.032) and arterial ß-stiffness (R = 0.512, p = 0.042). Urinary immuno-unreactive albumin showed a relationship with diastolic dysfunction of the heart (R = -0.508, p = 0.045) diurnal index of diastolic blood pressure (R = -0.569, p = 0.021) in the MONO-group. CONCLUSION: Cardiac parameters were more prosperous in the DUAL-group, but the levels of EO did not differ between groups. The level of EO correlated with blood pressure and arterial stiffness markers in the MONO-group only. The urinary immuno-unreactive albumin may be a new marker of cardiovascular conditions.

Ghrelin and acyl ghrelin in preterm infants and maternal blood: relationship with endocrine and anthropometric measures.

OBJECTIVE: The objective of the present study was to examine the association of acylated and total ghrelin levels at birth in preterm infants with anthropometric features and with related hormones in infants and their mothers. DESIGN: Prospective, descriptive study. METHODS: In total 23 pregnant women and their 26 preterm infants were involved in the study (3 twin pregnancies; gestational age, 25-35 weeks). Maternal and umbilical vein blood samples were taken after the delivery. Serum acylated and total ghrelin, leptin, cortisol, insulin, GH, and glucose were determined. RESULTS: The mean level of acylated ghrelin concentration was higher in the maternal than in the cord blood (P<0.01) and there was a significant correlation between the fetal and maternal acylated ghrelin levels (P<0.01). The total ghrelin concentration was higher in neonates than in mothers (P<0.01), but there was no correlation between them. The multivariate regression analysis for fetal acylated and maternal total ghrelin as dependent variables shows that the fetal acylated ghrelin has two independent predictors, the maternal acylated ghrelin (P<0.01) and the fetal cortisol (P<0.05), whereas the maternal total ghrelin has only one independent predictor, the maternal glucose (P<0.05). CONCLUSIONS: These data provide the first evidence that umbilical cord acylated ghrelin concentrations are lower than in maternal blood and support the hypothesis that the acylation process in the fetus is partly affected by cortisol and the placenta may play a role in this process.

Urinary cytokine response to asymptomatic bacteriuria in type 1 diabetic children and young adults.

It has been reported that urinary interleukin-6 (IL-6) and IL-8 levels are decreased in adult diabetic women with asymptomatic bacteriuria (ASB) when compared with non-diabetic women with ASB. Such impaired cytokine excretion might play a role in the higher prevalence of ASB among diabetic subjects. The aim of this study was to examine the urinary IL profile in children and young adults with type 1 diabetes mellitus (T1DM) with and without ASB. Midstream clean voiding urine samples were collected and cultured from 133 patients with T1DM (age: 15.6 +/- 5.7 yr) and 178 controls (14.1 +/- 4.7 yr) for two consecutive days. ASB was diagnosed in the case of >or=10(5) bacteria/mL. The urinary IL-6 and IL-8 concentrations were determined, and the presence of leukocyturia was also recorded. The prevalence of ASB was 16.5% in diabetic subjects and 2.8% in controls (p = 0.001). There was no difference between the diabetic and the control groups in the prevalence of 'IL-6-uria' (21.9 vs. 18.0%; p = 0.41), but IL-8 was more frequently detectable in the diabetic group (47.4 vs. 27.5%; p = 0.001). In individuals with ASB, the IL-8 level was similar in the diabetic (median: 70.0 pg/mg creatinine) and control group (42.3 pg/mg creatinine; p = 0.8). Indeed, the IL-8 levels were higher in diabetic subjects with ASB as compared with those without it (70.0 vs. <3.1 pg/mg creatinine; p = 0.001), and there was a significant association between the urinary IL-8 concentration and the bacterial count (p = 0.001). Diabetic patients with leukocyturia had higher IL-8 concentration than those without it (20.9 vs. <3.1 pg/mg creatinine; p = 0.003). Weak significant correlation was found between urinary IL-8 and hemoglobin A1c (HbA1c) (r = 0.4; p = 0.002). The sensitivity and specificity of leukocyturia were 50 and 89.9% in the whole population and those of IL-8 were 74.1 and 67.5%, respectively. In diabetic patients, 36.4% of the bacteriuria were gram-negative and 63.6% gram-positive. Our results suggest that diabetic children with ASB mount an IL-8 response to pathogens, which is comparable to non-diabetic children with bacteriuria. Thus, early in the natural history of diabetes, there are no significant changes in the IL response of children with ASB, as previously reported in adults.

Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretion.

UNLABELLED: There is increasing evidence that obesity may damage the kidney in otherwise healthy individuals. Our study investigated the effect of childhood obesity on urinary albumin and beta-2-microglobulin excretion, and the association of these with obesity-related cardiovascular risk factors. Random morning spot urine samples were collected from clinically healthy obese (n = 86; median age 12.9 years, range 8.9-17.2 years; median weight 80.6 kg, range 46.1-136.8 kg; median body mass index 30.4 kg/m2, range 24.5-43.2 kg/m2) and normal weight children (n = 79; median age 13.5 years, range 10.7-14.9 years; median weight 51.0 kg, range 27.3-72.5 kg; median body mass index 18.2 kg/m2, range 13.2-23.9 kg/m2). The obese children were examined for the presence of common obesity-related cardiovascular risk factors including hyperinsulinaemia, impaired glucose tolerance (IGT), dyslipidaemia, hypercholesterolaemia, and hypertension. Obese children had a significantly higher urinary albumin/creatinine ratio (U-ACR) (median 11.7 mg/g, interquartile range 12.9 mg/g versus median 9.0 mg/g, interquartile range 5.1 mg/g; P = 0.003) and urinary beta-2-microglobulin/creatinine ratio (U-BMCR) (median 63.9 microg/g, interquartile range 34.7 microg/g versus median 34.6 microg/g, interquartile range 44.1 microg/g; P < 0.001) than normal weight children. Among the obese children, the U-ACR was associated with fasting hyperinsulinaemia, IGT, and hypercholesterolaemia (all P < 0.05), and significantly correlated with the fasting (r = 0.23, P < 0.05) and 2-h (r = 0.37, P < 0.001) plasma glucose levels measured during an oral glucose tolerance test. Obese children with no more than one of the features of the metabolic syndrome had significantly lower U-ACRs than obese children with two or more features (median 10.4 mg/g, interquartile range 5.8 mg/g versus median 15.3 mg/g, interquartile range 14.9 mg/g; P < 0.05). CONCLUSION: According to our results, clinically healthy obese children have a higher degree of albuminuria and beta-2-microglobulinuria than normal weight children, indicating early renal glomerular and tubular dysfunction as a consequence of childhood obesity. The urinary albumin/creatinine ratio in the obese children was associated with certain metabolic derangements linked to obesity, and also with the clustering of features of the metabolic syndrome.