Predictive Markers of Early Cardiovascular Impairment and Insulin Resistance in Obese Pediatric Patients.

BACKGROUND: The increased prevalence of obesity among children determined the rising number of its comorbidities in children and adults, too. This study aimed to evaluate certain markers of inflammation and insulin resistance in obese pediatric patients, identifying those who are more likely to develop further complications. METHODS: We included 115 obese pediatric patients: 85 overweight and obese patients in the study group and 30 normal-weight patients in the control group. We calculated the body mass index (BMI) and we evaluated markers (biological, inflammatory) and the hormones profile. RESULTS: Low-threshold inflammation was assessed by measuring interleukin 6 IL-6 and Intercellular Adhesion Molecules (ICAM). The analysis showed that IL-6 is significantly correlated with glucose (p = 0.001) and BMI value (p = 0.031). ICAM correlates significantly with triglycerides (p = 0.001), glucose (p = 0.044) and BMI percentile (p = 0.037). For pediatric obese patients, endotoxemia has been significantly correlated only with BMI percentile (p = 0.001). Plasma cortisol did not show significant correlations with total cholesterol, triglycerides, glucose or BMI percentile. The results indicated a significant predictive power of BMI percentile on inflammatory markers: IL-6 (AUC = 0.803, p < 0.001), ICAM (AUC = 0.806, p < 0.001) and endotoxemia (AUC = 0.762, p = 0.019). Additionally, BMI percentile has a significant predictive power for metabolic markers of insulin resistance (insulin value: AUC = 0.72, p < 0.001 and HOMA index: AUC = 0.68, p = 0.003). CONCLUSIONS: The study highlighted the importance of early markers of cardiovascular risk in obese pediatric patients represented by IL-6, ICAM, endotoxemia and their correlation with metabolic markers of insulin resistance represented by insulinemia, HOMA index and plasma cortisol. It can clearly be considered that the BMI percentile has significant predictive power for metabolic markers of insulin resistance.

INFLUENCE OF SLEEP ON OBESITY IN CHILDREN.

Childhood obesity is a global epidemic with long term implications. The main cause of obesity is an increase in calorie intake and a decrease in physical activity, but also there is clear evidence suggesting a link between the duration and quality of sleep and obesity risk. Good sleep habits are involved in increased ability to concentrate at school, improvement of general state, immune system development, increased quality of life. On the other hand, there are several mechanisms by which chronic sleep deprivation induces weight gain: disturbance of hormones that control hunger center, increased time for meals, reduced physical activity, metabolic changes. Recently, nighttime sleep duration has declined, in contrast with the increasing prevalence of obesity. Childhood sleep habits have a long term effect on weight, with repercussions even into adulthood. This is the reason why there is increasing interest to include sleep quality on the list for childhood obesity prevention. Sleep represents an important and independent risk factor of obesity in children and adolescents and it should be taken into consideration in the management of obesity.

Magnesium in Pediatric Nephrotic Syndrome.

Aim: In the present study, we aimed to evaluate serum Mg concentration in children with nephrotic syndrome and highlight the relationship between Mg concentration and acute nephropathy. Material and Methods: We conducted a clinical study in 27 patients, aged 2 to 17 years, admitted to the Nephrology clinic of the Iasi "Sf. Maria" Children's Hospital between 2011-2015, with the diagnosis of idiopathic nephrotic syndrome (NS), first episode or relapse. In each patient, we investigated serum urea and creatinine, total cholesterol, total serum proteins, serum magnesium, urinary proteins, creatinine clearance and renal histopathology. We also used a control group of 14 children with normal renal function. Results: 12 patients had NS in the acute phase, 6 steroid responsive and 6 steroid resistant. The remaining 15 patients were in the remission phase of NS, 7 steroid responsive and 8 steroid resistant. Significantly decreased serum Mg levels were found in NS active group compared to control group. Renal histopathological analysis in steroid responsive patients revealed the following pathological aspects: optically normal glomeruli (1 case), minimal mesangial changes (5 cases), IgM nephropathy (4 cases), mesangioproliferative glomerulonephritis (4 cases). Conclusions: The variations of serum and urinary Mg levels in children with acute nephropathy may be useful for early diagnosis and improving therapy.

Changes in Some Divalent Cations Concentrations In An Experimental Rat Model of Gentamicin-Induced Acute Renal Failure.

Aim: The changes in divalent cations concentration were assessed in and experimentally gentamicin-induced renal failure in white Wistar rats. Material and Methods: The white male Wistar rats were distributed into 4 groups of 7 animals each and were treated intraperitoneally as follows: Group I (Control): distilled water in a volume of 0.5ml/100g rat/day for10 days; Group II (Ge): gentamicin 80 mg/kbw/day for 7 days; Group III (Ge+Zn): gentamicin 80 mg/kbw/day for 7 days and ZnCl2 5 mg/kbw/day for 10 days prior to administration of Ge and then another 7 days simultaneously with Ge administration; Group IV (Zn): ZnCl2 5 mg/kbw/day for 17 days. Before starting the experiment (I0) and at 3, 7 and 10 days after the first Ge administration, magnesium, copper and zinc plasma concentrations and urinary magnesium levels were determined. Results: Zn administration significantly decreased (p<0.001) plasma Mg concentrations in Ge+Zn group compared to Ge group after 7 days in the experiment, and induced a lower urinary elimination of Mg in Ge+Zn group (p<0.05) than in Ge group (p<0.01). Also, Zn induced a slight augmentation of Cu concentration in Ge+Zn group (p<0.05) compared to Ge group after 7 and 10 days. Conclusions: The variation in divalent cation concentrations in the context of renal diseases may be helpful for an early diagnosis and effective alternative therapeutic measures.

Influence of montelukast on cisplatin-induced experimental acute renal failure.

AIM: To investigate the influence of Montelukast (MK) in acute renal failure (ARF) experimentally induced by cisplatin (CIS). MATERIAL AND METHODS: The experiment was carried out in male Wistar rats (280-320g), divided into 4 groups of 12 animals each, treated as follows: Group I (Control); Group II (CIS): CIS, 5 mg/kbw, single dose, i.p.; Group III (CISMK): CIS, 5 mg/kbw, single dose, i.p and MK 2 mg/kbw, p.o., 10 days; Group IV (MK): MK 2 mg/kbw, p.o., 10 days. Blood and urine (24 h) samples were taken before the start of experiment (Io) and at 3, 7, 10 and 14 days after CIS administration. The following were determined: urea, creatinine, Ca, Mg serum levels and creatinine, proteins, Ca and Mg urinary levels. For histological evaluation, 3 rats of each group were sacrificed at 3, 7, 10 and 14 days. The severity of histopathological changes was evaluated using scores on a 1-4 point scale. RESULTS: Both in CIS and CISMK group, serum levels of urea and creatinine and urinary protein levels were significantly higher compared with Io values and control group at 3 and 7 days, (p < 0.01 and p < 0.05, respectively). Urinary creatinine levels were significantly decreased at 3 and 7 days, (p < 0.01) and (p < 0.05) in CIS and CISMK group compared to Io and control group. The degree of severity of histopathological changes was similar in CIS and CISMK group. CONCLUSIONS: The obtained results showed that MK at a dose of 2 mg/kbw had no protective effect in CIS-induced experimental acute renal failure.

Divalent cations levels change in nephrotic syndrome.

UNLABELLED: Divalent cations (calcium, magnesium, zinc, cooper, manganese) play an important role in various biological processes. Different acute or chronic renal disorders in children or adults modify the urinary excretion of these cations and may influence their concentrations in organism. AIM: Evaluation of the changes of some divalent cations levels (Cu, Zn, Mg, Ca) in acute renal diseases. MATERIAL AND METHODS: We measured plasma concentrations and urinary excretion of cations in pediatric patients with acute urinary infections. We also evaluated malondyaldehide (MDA) and total antioxidant capacity (TAC) plasma levels. RESULTS: The obtained results show that serum levels of Ca, Cu, Zn are decreased in patients with acute urinary infections compared with a control group of healthy children, while urinary excretion of Cu and Zn there were higher in group study compared with control group. There are no significant differences of the serum magnesium concentration. Increased plasma MDA levels and decreased plasma TAC, Cu and Zn concentrations indicate an increased oxidative stress in patients with acute renal diseases. CONCLUSIONS: Our preliminary data show that in some acute urinary conditions, such as lower urinary tract infection and pyelonephritis, appear disturbances of plasma and urinary concentrations of divalent cations. We consi der that trace elements should be measured routinely in children with renal disorders.