Effectiveness of Cord blood as a Strategy to rule out Conjugated Hyperbilirubinemia.

Early detection of biliary atresia is crucial for timely intervention and improved outcomes in infants with elevated conjugated bilirubin levels. This study aims to investigate the viability of cord blood gas analysis as a novel method for assessing conjugated bilirubin levels. Infants with high heel stick levels also showed elevated cord blood bilirubin levels, indicating that cord blood testing could replace the need for repeat heel stick tests, especially benefiting low birth weight infants. Ongoing research, including larger cohorts and alternative bilirubin measurement methods, will further validate this innovative screening approach. Infants with biliary atresia have high conjugated bilirubin levels at birth. As a result, infants can be screened with newborn conjugated bilirubin measurements, to allow for early detection, timely treatment, and the best chances of delaying or even avoiding the need for a liver transplant [1]. An important limitation of screening, however, is that infants must undergo a separate blood test. To overcome this limitation, we investigated whether conjugated bilirubin measurements from cord blood could be useful.

Dawn-to-dusk dry fasting decreases circulating inflammatory cytokines in subjects with increased body mass index.

Background: The circadian rhythm involves numerous metabolic processes, including sleep/awakening, body temperature regulation, hormone secretion, hepatic function, cellular plasticity, and cytokine release (inflammation), that appear to have a dynamic relationship with all the processes above. Studies have linked various cytokines to the chronic state of low-grade inflammation and oxidative stress in obesity. Dawn-to-dusk dry fasting (DDDF) could alleviate the adverse effects of obesity by decreasing inflammation. This study examined the effects of DDDF on circulating inflammatory cytokines in subjects with increased body mass index (BMI). Methods: The current observational prospective study included adult subjects with a BMI equal to or greater than 25 kg/m2 who practiced the annual religious 30-day DDDF. Individuals with significant underlying medical conditions were excluded to limit confounding factors. All subjects were evaluated within two weeks before 30-day DDDF, within the fourth week of 30-day DDDF, and within two weeks after 30-day DDDF. Multiple cytokines and clinical health indicators were measured at each evaluation. Results: Thirteen subjects (10 men and three women) with a mean age of 32.9 years (SD = 9.7 years) and a mean BMI of 32 kg/m2 (SD = 4.6 kg/m2) were included. An overall associated decrease in the levels of multiple cytokines with DDDF was observed. A significant decrease in the mean interleukin 1 beta level was observed within the fourth week of 30-day DDDF (P = 0.045), which persisted even after the fasting period (P = 0.024). There was also a significant decrease in the mean levels of interleukin 15 (IL-15) (P = 0.014), interleukin 1 receptor antagonist (P = 0.041), macrophage-derived chemokine (MDC) (P = 0.013), and monokine induced by interferon gamma/chemokine (C-X-C motif) ligand 9 (P = 0.027) within the fourth week of 30-day DDDF and in the mean levels of fibroblast growth factor 2 (P = 0.010), interleukin 12 p40 subunit (P = 0.038), interleukin 22 (P = 0.025) and tumor necrosis factor alpha (P = 0.046) within two weeks after 30-DDDF. In terms of anthropometric parameters, there was a decrease in mean body weight (P = 0.032), BMI (P = 0.028), and hip circumference (P = 0.007) within the fourth week of 30-day DDDF and a decrease in mean weight (P = 0.026), BMI (P = 0.033) and hip circumference (P = 0.016) within two weeks after 30-day DDDF compared with the levels measured within two weeks before 30-day DDDF. Although there was no significant correlation between changes in weight and changes in circulating inflammatory cytokines, there was a significant positive correlation between changes in waist circumference and changes in specific inflammatory cytokines (e.g., IL-15, MDC, platelet-derived growth factor, soluble CD40L, vascular endothelial growth factor A) within the fourth week of 30-day DDDF and/or two weeks after 30-day DDDF. A significant decrease in mean average resting heart rate within the fourth week of 30-day DDDF was also observed (P = 0.023), and changes between average resting heart rate and changes in interleukin-8 levels within the fourth week of 30-day DDDF compared with baseline levels were positively correlated (r = 0.57, P = 0.042). Conclusion: DDDF appears to be a unique and potent treatment to reduce low-grade chronic inflammation caused by obesity and visceral adiposity. Further studies with more extended follow-up periods are warranted to investigate the long-term anti-inflammatory benefits of DDDF in individuals with increased BMI.

Cystic fibrosis-related diabetes screening at a large pediatric center.

OBJECTIVE: Cystic Fibrosis Foundation guidelines recommend annual diabetes screening by oral glucose tolerance test (OGTT) in pediatric patients with cystic fibrosis (CF) starting at the age of 10 years. Adherence to these guidelines proves to be challenging, and the nationwide screening rates are still considered suboptimal. The aim of this study was to assess and improve the screening rates at our large pediatric center. METHODS: A 4-year retrospective audit of OGTT completion among pediatric patients with CF of age ≥10 years who are not yet diagnosed with diabetes was conducted. A collaborative working group was formed to identify the barriers to screening and formulate a quality improvement plan, which was monitored and evaluated for a 9-month period. RESULTS: Diabetes screening rates determined by OGTT completion at our center showed a gradual decline during the COVID-19 pandemic from 2019 to 2022. Following the implementation of the quality improvement plan during the summer of 2023, there was a marked increase in OGTT ordering compliance by providers as well as test completion by patients. Notably, the fractional OGTT completion rate rose from 45% during the preintervention phase (January-April 2023) to 70% during the postintervention phase (May-September 2023). CONCLUSION: Diabetes screening in pediatric patients with CF can be effectively improved by refining practices related to patient experience, care coordination, and laboratory testing strategies.

SARS-CoV-2 Antibody Titers and Severity of Multisystem Inflammatory Syndrome in Children.

OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) is a rare yet serious pathological consequence of SARS-CoV-2 infection which is reported 4-12 weeks after the onset of COVID-19 in children and adolescents. The most common hyper-inflammatory conditions mimicking the clinical presentation of MIS-C include Kawasaki disease and toxic shock syndrome. The surveillance criteria of MIS-C were recently revised by US Center for Disease Control and Prevention to improve diagnostic precision. Although previous studies have shown that SARS-CoV-2 antibody titers correlate with COVID-19 severity, their relation to MIS-C severity remains poorly understood and the aim of the study was to investigate this. METHODS: As all the MIS-C patients get a SARS-CoV-2 antibody test performed on the first day of hospitalization, here we attempted to stratify risk for adverse outcomes due to MIS-C based on the SARS-CoV-2 antibody titers. RESULTS: Our studies demonstrated that SARS-CoV-2 antibody titers, specifically Total (IgG/IgM/partial IgA), Nucleocapsid IgG, and Spike IgM, do not correlate with MIS-C severity assessed based on the ICU admission, inotropic support, and mechanical respiratory support requirements. CONCLUSION: Therefore, it might not be appropriate to predict the clinical course of patients presenting with MISC based on quantitative serology testing.

A Retrospective Chart Review of Patients Who Underwent Cardiac Evaluation Before Bariatric Surgery.

BACKGROUND: Overweight and obesity are considered to be a global pandemic. Its associations with hypertension, diabetes and hyperlipidemia are important risk factors for cardiovascular diseases. METHODS: This was a retrospective, observational chart review of obese patients who were seen in our outpatient clinic for cardiovascular clearance prior to an intended bariatric surgery between 2004 and 2020. Data from patient's demographics, risk factors, presence of coronary artery disease (CAD) and other cardiovascular diseases were collected from medical charts. They underwent clinical evaluation, non-invasive workup including electrocardiograms, echocardiograms, treadmill exercise tests and some of them myocardial perfusion studies and coronary angiograms when indicated, based on their symptoms and/or risk factors for CAD. RESULTS: From 761 patients studied, 7.6% (58 patients) underwent coronary angiograms, based on their non-invasive workup and their history. Among them, we found that 17 patients had significant CAD. It should be mentioned that this is a selected group of patients with the intention to undergo a bariatric surgical procedure, which this makes them somewhat different from the general population, and this could be considered among the limitations of our study. CONCLUSIONS: Data from our selected population chart review showed that in this specific population, there was no high prevalence of cardiovascular disease, specifically coronary atherosclerosis, dilated cardiomyopathy, left ventricular hypertrophy, heart failure, atrial fibrillation, stroke, venous thrombosis and obstructive sleep apnea.