Evaluation of pupil diameter for pain assessment in interventional headache management.

OBJECTIVES: Pain is a subjective experience. Besides, sensory, affective and behavioral responses, and autonomic response are part of pain response to noxious stimuli. Evaluation of pupil diameter by pupillometry has been used as an alternative method for pain assessment. In algologic procedures like interventional headache management have not been addressed in the literature. Herein, we investigated changes in pupil diameter during interventional headache management as an objective method for pain assessment. METHODS: Demographic data of the patients were collected before the bilateral major occipital nerve blockage (MONB) procedure. Numeric rating score (NRS) and pupil diameter measurements by pupillometer were recorded before MONB. Standard MONB procedure was applied to all patients. Pain assessment and pupillary diameter measurements were obtained after nerve blockage. RESULTS: Twenty-eight patients were included in this study. Mean age was 41.03+-12.63 years. There is no difference between the hemodynamic parameters before and after the procedure. Post-procedure NRS and pupil diameter values were significantly lower than pre-procedure values. There was a positive correlation between changes in NRS scores and changes in the right and left pupil diameters. CONCLUSION: There was a significant correlation between NRS score and pupil diameter in patients who underwent MONB. Monitoring of pupil diameter can be used for pain assessment during headache treatment. Evaluation of pupil diameter is a new approach in pain palliation. Future research is needed to study the effect of other parameters, that is, gender, age, origin of pain, acute, and chronic pain on pupil diameter and to evaluate its application in different algological procedures.

Assessment of renal function in obese and overweight children with NGAL and KIM-1 biomarkers.

INTRODUCTION: Aim and background: the incidence of obesity has increased among children, and obesity has been considered an independent risk factor for chronic kidney disease. We aimed to determine the degree of kidney function impairment by evaluating urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels. Materials and methods: in total, 15 obese, 26 overweight, and 26 control adolescents aged 10 to 16 years were enrolled into the study. Urine samples were evaluated for NGAL and KIM-1 levels using enzyme-linked immunosorbent assay kits. We investigated the association between obesity and related comorbidities with urinary NGAL and KIM-1 excretion. Results: no significant differences were noted between the obese, overweight, and control groups in urinary NGAL and KIM-1 excretion (p = 0.327 and p = 0.917, respectively). In the obese and overweight groups urinary NGAL levels were 50.39 [30.88-74.22] in females and 26.67 [23.24-45.59] in males (p = 0.013). Also, urinary NGAL levels were increased in obese and overweight adolescents with LDL dyslipidemia at 64.12 [30.98-114.32] as compared to those without LDL dyslipidemia: 39.51 [25.59.56.37] (p = 0.024). Furthermore, a correlation was observed between insulin and homeostasis model assessment of insulin resistance levels with the NGAL/creatinine ratio in the overweight group (r = 0.515; p = 0.008, and r = 0.483; p = 0.014, respectively). Such correlation was not found in the obese group. Conclusion: the effect of obesity on renal function could not be determined in children. A longer exposure may be required for obesity-induced disruption of renal function in children. Renal function may be disrupted by dyslipidemia in obese adolescents. Furthermore, obesity impaired renal function in female adolescents. The normalization of these urinary markers as related to urine creatinine should be discussed.

INTRODUCCIÓN: Introducción: la incidencia de la obesidad en la edad infantil ha aumentado. Se considera la obesidad como un factor de riesgo independiente para el desarrollo de la enfermedad renal crónica. El objetivo de este estudio fue valorar el grado de alteración de la función renal evaluando los niveles urinarios de NGAL y KIM-1. Material y métodos: el estudio incluyó a 15 adolescentes con obesidad, 26 con sobrepeso y 26 controles sanos.Edades de los participantes entre los 10 y los 16 años. Los niveles de NGAL y KIM-1 en orina se determinaron mediante kit ELISA. Se investigó asociación entre obesidad y su comorbilidad con excreción urinaria de NGAL y KIM-1. Resultados: no se encontraron diferencias significativas en la excreción urinaria de NGAL y KIM-1 entre los sujetos con obesidad, los sujetos con sobrepeso y los controles sanos (p = 0,327 y 0,917, respectivamente). En el grupo con sobrepeso y obesidad, los niveles de NGAL en las niñas fueron de 50,39 (30,88-74,22), mientras que en los niños fueron de 26,67 (23,24-45,59) (p = 0,013). Para los sujetos con dislipemia de LDL, el nivel de NGAL fue de 64,12 (30,98-114,32) frente a 39,5 (25,59-56,37) entre los que no la tenían (p = 0,024). Se encontró correlación entre los nivles de insulina, el HOMA-IR y la ratio NGAL/creatinina en el grupo con sobrepeso (r = 0,515; p = 0,008, y r = 0,483; p = 0,014, respectivamente). En el grupo con obesidad no se encontró dicha correlación. Conclusiones: se precisa una duración más prolongada para encontrar alterada la función renal en los niños con exceso de peso. La función renal puede alterarse por la dislipemia en el caso de los adolescentes con obesidad. La función renal se afecta más en las adolescentes femeninas.

Assessment of Neurocognitive Functions in Children and Adolescents with Obesity.

Obesity is linked to adverse neurocognitive outcomes including reduced cognitive functioning. We aimed to investigate the differences in neuropsychological test performance of Turkish children and adolescents with obesity and healthy peers. Study includes 147 children and adolescents ranging in age from 8 to 16 years: 92 with obesity and 55 with healthy controls. After the participants were administered the Children's Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor speed, Processing speed, Reaction time, Complex attention, Executive Function, Cognitive flexibility), and a summary score (Neurocognition Index [NCI]). There was a statistically significant difference between the obesity and control groups on all cognitive domains. The mean NCI score of the obesity group was 81.3 ± 10.24 compared to 97.29 ± 4.97 for the control group. The mean NCI score in the obesity group was significantly lower than that of the control group (p < 0.001). The mean scores of other domains of obese patients were also found to be significantly lower than those of the control participants (p < 0.001). The mean SCARED scores of the participants with obesity were found to be significantly higher than those of the control participants (p < 0.05). However, no statistically significant relationship was found between the SCARED and the CNSVS scores. Cognitive dysfunction in children and adolescents with obesity should be taken into consideration when assessing and managing this population.