1
|
Hofman-Hutna J, Hutny M, Matusik E, Olszanecka-Glinianowicz M, Matusik P. Vitamin D Deficiency in Obese Children Is Associated with Some Metabolic Syndrome Components, but Not with Metabolic Syndrome Itself. Metabolites 2023; 13:914. [PMID: 37623858 PMCID: PMC10456245 DOI: 10.3390/metabo13080914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/22/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Vitamin D deficiency in children is a common nutritional issue in many populations worldwide, associated not only with skeletal malformations but, as recent studies suggest, also with the development of obesity and metabolic syndrome. The aim of this observational study was to assess the nutritional status of vitamin D in a group of Polish children with obesity and different grades of metabolic syndrome, with a consequent analysis of the correlation between vitamin D levels and the components of metabolic syndrome. For that purpose, the group of 78 participants (mean age: 14.18 ± 2.67 years) was recruited and further grouped in relation to vitamin D status into two groups of children with and without vitamin D deficiency. The biochemical parameters associated with obesity as well as anthropometric measures were assessed and analysed in search of significant differences between the groups. In the current group of children with obesity and vitamin D deficiency, HDL (45.00 ± 9.29) and adiponectin (7.21 ± 1.64) were found to be significantly lower than in their peers without vitamin D deficiency, whereas W/HtR (0.60 ± 0.04) and TG (171.31 ± 80.75) levels proved to be significantly higher. Body composition analysis using bioelectrical impedance returned no significant findings. The above findings suggest that vitamin D deficiency may influence lipid and glucose metabolism in children, leading to the development of abnormalities characteristic of the metabolic syndrome. A W/HtR parameter was shown to be a sensitive marker of abdominal obesity, which might provide an important means of assessing the correlation between vitamin D and this type of obesity. Independently, vitamin D deficiency may also influence the endocrinological function of adipose tissue, leading to lower concentrations of adiponectin. These in turn presented a linear correlation with the high results of the OGTT in the second hour of the test, hinting at its potential role in the pathophysiology of insulin resistance.
Collapse
Affiliation(s)
- Jagoda Hofman-Hutna
- Scientific Society of Medical Students, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Hutny
- Scientific Society of Medical Students, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Edyta Matusik
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Magdalena Olszanecka-Glinianowicz
- Unit of Public Health and Obesity, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Pawel Matusik
- Department of Paediatrics, Paediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| |
Collapse
|
2
|
Opala A, Blachowska A, Matusik P. Effectiveness of pamidronate therapy in chronic recurrent multifocal osteomyelitis (CRMO) with thoracic/lumbal spine localization – a case report. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
3
|
Gawlik A, Salonen A, Jian C, Yanover C, Antosz A, Shmoish M, Wasniewska M, Bereket A, Wudy SA, Hartmann MF, Thivel D, Matusik P, Weghuber D, Hochberg Z. Personalized approach to childhood obesity: Lessons from gut microbiota and omics studies. Narrative review and insights from the 29th European childhood obesity congress. Pediatr Obes 2021; 16:e12835. [PMID: 34296826 DOI: 10.1111/ijpo.12835] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 12/19/2022]
Abstract
The traditional approach to childhood obesity prevention and treatment should fit most patients, but misdiagnosis and treatment failure could be observed in some cases that lie away from average as part of individual variation or misclassification. Here, we reflect on the contributions that high-throughput technologies such as next-generation sequencing, mass spectrometry-based metabolomics and microbiome analysis make towards a personalized medicine approach to childhood obesity. We hypothesize that diagnosing a child as someone with obesity captures only part of the phenotype; and that metabolomics, genomics, transcriptomics and analyses of the gut microbiome, could add precision to the term "obese," providing novel corresponding biomarkers. Identifying a cluster -omic signature in a given child can thus facilitate the development of personalized prognostic, diagnostic, and therapeutic approaches. It can also be applied to the monitoring of symptoms/signs evolution, treatment choices and efficacy, predisposition to drug-related side effects and potential relapse. This article is a narrative review of the literature and summary of the main observations, conclusions and perspectives raised during the annual meeting of the European Childhood Obesity Group. Authors discuss some recent advances and future perspectives on utilizing a systems approach to understanding and managing childhood obesity in the context of the existing omics data.
Collapse
Affiliation(s)
- Aneta Gawlik
- Department of Paediatrics and Paediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ching Jian
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Chen Yanover
- Healthcare Informatics, IBM Research-Haifa, Haifa, Israel
| | - Aleksandra Antosz
- Department of Paediatrics and Paediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - Michael Shmoish
- Bioinformatics Knowledge Unit, The Lokey Centre, Technion - Israel Institute of Technology, Haifa, Israel
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Abdullah Bereket
- School of Medicine, Department of Paediatric Endocrinology, Marmara University, Istanbul, Turkey
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit, Laboratory for Translational Hormone Analytics, Division of Paediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University, Giessen, Germany
| | - Michaela F Hartmann
- Steroid Research & Mass Spectrometry Unit, Laboratory for Translational Hormone Analytics, Division of Paediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University, Giessen, Germany
| | - David Thivel
- University Clermont Auvergne, UFR Medicine, Clermont-Ferrand, France
| | - Pawel Matusik
- Department of Paediatrics and Paediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - Daniel Weghuber
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Ze'ev Hochberg
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Matusik P, Gach A, Zajdel-Cwynar O, Pinkier I, Kudela G, Gawlik A. A Novel Intronic Splice-Site Mutation of the CYP11A1 Gene Linked to Adrenal Insufficiency with 46,XY Disorder of Sex Development. Int J Environ Res Public Health 2021; 18:ijerph18137186. [PMID: 34281122 PMCID: PMC8295740 DOI: 10.3390/ijerph18137186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022]
Abstract
A novel CYP11A1: c.1236 + 5G > A was identified, expanding the mutation spectrum of the congenital adrenal insufficiency with 46,XY sex reversal. In a now 17-year-old girl delivered full-term (G2P2, parents unrelated), adrenal failure was diagnosed in the first year of life based on clinical picture of acute adrenal crisis with vomiting, dehydration, weight loss, hypotension, and electrolyte disturbances. At the time, hormonal tests revealed primary adrenocortical insufficiency and steroid profiles showed lack of products of steroidogenesis, and since then the patient has been treated with substitution doses of hydrocortisone and fludrocortisone. At the age of 14, considering the absence of puberty symptoms, extended diagnostic tests revealed elevated LH levels (26.5 mIU/mL) with pre-puberty FSH levels (4.9 mIU/mL), low estradiol (28 pmol/L), testosterone (<2.5 ng/mL), and extremely high levels of ACTH (4961 pg/mL). A cytogenetic study revealed a 46 XY karyotype. A molecular examination confirmed the missense mutation and a novel splice-site mutation of CYP11A1 gene. Compound heterozygosity for the CYP11A1 gene with a known pathogenic variant in one allele and a novel splice site mutation in the second allele is most probably responsible for congenital adrenal insufficiency with 46,XY sex reversal. We discuss the necessity of cytogenetic test in the case of early onset of adrenal failure in the absence of steroidogenesis metabolites in the steroid profile.
Collapse
Affiliation(s)
- Pawel Matusik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-207-1654
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (A.G.); (I.P.)
| | | | - Iwona Pinkier
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (A.G.); (I.P.)
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| |
Collapse
|
5
|
Esteban-Cornejo I, Reilly J, Ortega FB, Matusik P, Mazur A, Erhardt E, Forslund A, Vlachopapadopoulou EA, Caroli M, Boyland E, Weghuber D, Thivel D. Paediatric obesity and brain functioning: The role of physical activity-A novel and important expert opinion of the European Childhood Obesity Group. Pediatr Obes 2020; 15:e12649. [PMID: 32459068 DOI: 10.1111/ijpo.12649] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
While most of the time unconsidered, child and adolescent obesity has been also associated with impaired brain health and function that can definitely affect their social interaction and integration, and then well-being and mental health. The European Childhood Obesity Group recently gathered experts in the field who discussed the main available and reliable evidence regarding the role of physical activity on brain health and cognitive functioning in children and adolescents with obesity and who propose here their main conclusions and recommendations.
Collapse
Affiliation(s)
- Irene Esteban-Cornejo
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - John Reilly
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Pawel Matusik
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Artur Mazur
- Pediatric Department, Clinical Provincial Hospital No. 2 in Rzeszów, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland.,European Childhood Obesity Group, Brussels, Belgium
| | - Eva Erhardt
- European Childhood Obesity Group, Brussels, Belgium.,Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Anders Forslund
- European Childhood Obesity Group, Brussels, Belgium.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elpis Athina Vlachopapadopoulou
- European Childhood Obesity Group, Brussels, Belgium.,Department of Endocrinology, Children's Hosp. P. & A. Kyriakou, Athens, Greece
| | - Margherita Caroli
- European Childhood Obesity Group, Brussels, Belgium.,Paediatric Department, Brindisi Hospital, Brindisi, Italy
| | - Emma Boyland
- European Childhood Obesity Group, Brussels, Belgium.,Appetite & Obesity Research Group, Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Daniel Weghuber
- European Childhood Obesity Group, Brussels, Belgium.,Department of Pediatrics, Paracelsus Medical University, Austria, Salzburg.,Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - David Thivel
- European Childhood Obesity Group, Brussels, Belgium.,Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Clermont Auvergne University, Clermont-Ferrand, France.,Auvergne Regional Center for Human Nutrition, Clermont-Ferrand, France
| |
Collapse
|
6
|
Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M, Nosalski R, Pelka P, Nowakowski D, Wilk G, Mikolajczyk TP, Schramm-Luc A, Furtak A, Matusik P, Koziol J, Drozdz M, Munoz-Aguilera E, Tomaszewski M, Evangelou E, Caulfield M, Grodzicki T, D'Aiuto F, Guzik TJ. Causal association between periodontitis and hypertension: evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy. Eur Heart J 2019; 40:3459-3470. [PMID: 31504461 PMCID: PMC6837161 DOI: 10.1093/eurheartj/ehz646] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/25/2019] [Accepted: 08/21/2019] [Indexed: 01/07/2023] Open
Abstract
AIMS Inflammation is an important driver of hypertension. Periodontitis is a chronic inflammatory disease, which could provide a mechanism for pro-hypertensive immune activation, but evidence of a causal relationship in humans is scarce. We aimed to investigate the nature of the association between periodontitis and hypertension. METHODS AND RESULTS We performed a two-sample Mendelian randomization analysis in the ∼750 000 UK-Biobank/International Consortium of Blood Pressure-Genome-Wide Association Studies participants using single nucleotide polymorphisms (SNPs) in SIGLEC5, DEFA1A3, MTND1P5, and LOC107984137 loci GWAS-linked to periodontitis, to ascertain their effect on blood pressure (BP) estimates. This demonstrated a significant relationship between periodontitis-linked SNPs and BP phenotypes. We then performed a randomized intervention trial on the effects of treatment of periodontitis on BP. One hundred and one hypertensive patients with moderate/severe periodontitis were randomized to intensive periodontal treatment (IPT; sub- and supragingival scaling/chlorhexidine; n = 50) or control periodontal treatment (CPT; supragingival scaling; n = 51) with mean ambulatory 24-h (ABPM) systolic BP (SBP) as primary outcome. Intensive periodontal treatment improved periodontal status at 2 months, compared to CPT. This was accompanied by a substantial reduction in mean SBP in IPT compared to the CPT (mean difference of -11.1 mmHg; 95% CI 6.5-15.8; P < 0.001). Systolic BP reduction was correlated to periodontal status improvement. Diastolic BP and endothelial function (flow-mediated dilatation) were also improved by IPT. These cardiovascular changes were accompanied by reductions in circulating IFN-γ and IL-6 as well as activated (CD38+) and immunosenescent (CD57+CD28null) CD8+T cells, previously implicated in hypertension. CONCLUSION A causal relationship between periodontitis and BP was observed providing proof of concept for development of clinical trial in a large cohort of hypertensive patients. ClinicalTrials.gov: NCT02131922.
Collapse
Affiliation(s)
- Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Grzegorz Osmenda
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Mateusz Siedlinski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Richard Nosalski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Piotr Pelka
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Daniel Nowakowski
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Grzegorz Wilk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Tomasz P Mikolajczyk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Agata Schramm-Luc
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Aneta Furtak
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Pawel Matusik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Joanna Koziol
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | | | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Mark Caulfield
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-107 Krakow, Poland
| | | | - Tomasz J Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
7
|
Kaminska H, Wieczorek W, Matusik P, Czyzewski L, Ladny JR, Smereka J, Filipiak KJ, Szarpak L. Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association Guidelines. Kardiol Pol 2018; 76:642-647. [PMID: 29313566 DOI: 10.5603/kp.a2018.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/06/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Recent American Heart Association guidelines from 2010 and 2015 stressed the importance of high-quality chest compression and defined standards for compression rate, depth, recoil, and maximal acceptable time for interruptions. High-quality cardiopulmonary resuscitation (CPR) is the "cornerstone" of a system of care that can optimise outcomes beyond the return of spontaneous circulation. METHODS One hundred medical students were enrolled to the study. Study participants, after attending a Basic Life Support Course according to American Heart Association 2015 guidelines, performed 2-min CPR on a Resusci Anne® QCPR Mani-kin. The following data were collected: age, sex, and health status. The study made use of a Tanita MC-980 MA for body composition analysis. RESULTS Mean height of participants was 170.2 ± 8.3 cm, and mean weight was 65 ± 11.8 kg. Mean body mass index was 22.1 ± 2.7, and mean fat-free mass (FFM) was 50.1 ± 10.5 kg. The mean fat mass (FAT%) was 22.9 ± 7.6. Basal metabolic rate, FFM, trunk muscle mass, left arm muscle mass, and right arm muscle mass were positively correlated with compression depth (all p for trend < 0.05). Mean compression depth was 49.7 ± 8.4 (for female 48.7 ± 7.9 mm, for male 42.4 ± 9.5 mm; p = 0.144). Compression rate for males and females was the same, at 114 ×/min (p = 0.769). CONCLUSIONS In our study, basal metabolic rate, FFM, trunk muscle mass, and left and right arm muscle mass were positively correlated with compression depth. Moreover, an arm muscle mass rise of 1 kg caused a rise of compression depth param-eter of 7.3 mm, while when chest compression was performed by females, a fall of compression depth of 3.3 mm was seen.
Collapse
Affiliation(s)
| | - Wojciech Wieczorek
- Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland; Department of Emergency Medicine, Medical University of Warsaw, 4 Lindleya Str, 02-005 Warsaw, Poland.
| | | | | | | | | | | | | |
Collapse
|
8
|
Matusik P, Lelakowski J, Malecka B, Bednarek J, Noworolski R. Management of Patients with Atrial Fibrillation: Focus on Treatment Options. J Atr Fibrillation 2017; 9:1450. [PMID: 28496929 DOI: 10.4022/jafib.1450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
Atrial fibrillation (AF) is leading cardiac arrhythmia with important clinical implications. Its diagnosis is usually made on the basis on 12-lead ECG or 24-hour Holter monitoring. More and more clinical evidence supports diagnostic use of cardiac event recorders and cardiovascular implantable electronic devices (CIED). Treatment options in patients with atrial fibrillation are extensive and are based on chosen rhythm and/or rate control strategy. The use and selected contraindications to AF related pharmacotherapy, including anticoagulants are shown. Nonpharmacological treatments, comorbidities and risk factors control remain mainstay in the treatment of patients with AF. Electrical cardioversion consists important choice in rhythm control strategy. Much progress has been made in the field of catheter ablation and cardiac surgery methods. Left atrial appendage occlusion/closure may be beneficial in patients with AF. CIED are used with clinical benefits in both, rhythm and rate control. Pacemakers, implantable cardioverter-defibrillators and cardiac resynchronization therapy devices with different pacing modes have guaranteed place in the treatment of patients with AF. On the other hand, the concepts of permanent leadless cardiac pacing, atrial dyssynchrony syndrome treatment and His-bundle or para-Hisian pacing have been proposed. This review summarizes and discusses current and novel treatment options in patients with atrial fibrillation.
Collapse
Affiliation(s)
- Pawel Matusik
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland.,Jagiellonian University, Medical College, Kraków, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University, Medical College, Kraków, Poland
| | - Barbara Malecka
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University, Medical College, Kraków, Poland
| | - Jacek Bednarek
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland
| | | |
Collapse
|
9
|
Matusik P, Klesiewicz M, Klos K, Stasiulewicz M, Barylak A, Nazarkiewicz P, Malecka-Tendera E. Baseline Body Composition in Prepubertal Short Stature Children with Severe and Moderate Growth Hormone Deficiency. Int J Endocrinol 2016; 2016:4563721. [PMID: 27656208 PMCID: PMC5021497 DOI: 10.1155/2016/4563721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/14/2016] [Indexed: 12/02/2022] Open
Abstract
Objective. To compare body composition parameters in short children with severe versus moderate and no growth hormone deficiency (GHD). Design and Method. 61 children (40 boys) were studied. Height SDS, BMI Z-score, waist/height ratio (W/HtR), and body composition parameters (BIA) as fat tissue (FAT%), fat-free mass (FFM%), predicted muscle mass (PMM%), and total body water (TBW%) were evaluated. GH secretion in the overnight profile and two stimulation tests and insulin-like growth factor 1 (IGF-1) level were measured. Results. Overall, in 16 (26%) moderate (7.0 > peak GH < 10 ng/mL) and in 11 (18%) severe (GH ≤ 7.0 ng/mL) GHD was diagnosed. In children with sGHD BMI Z-score, W/HtR and FAT% were significantly higher, while FFM%, PMM%, and TBW% were significantly lower versus mGHD and versus noGHD subgroups. No significant differences between mGHD and noGHD were found. There were no differences in height SDS and IGF-1 SDS between evaluated subgroups. Night GH peak level correlated significantly with FAT%, FFM%, PMM%, and TBW%, (p < 0.05) in the entire group. Conclusions. Only sGHD is associated with significant impairment of body composition. Body composition analysis may be a useful tool in distinguishing between its severe and moderate form of GHD.
Collapse
Affiliation(s)
- Pawel Matusik
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marta Klesiewicz
- Scientific Society of Medical Students, Medical University of Silesia, Katowice, Poland
| | - Karolina Klos
- Scientific Society of Medical Students, Medical University of Silesia, Katowice, Poland
| | - Martyna Stasiulewicz
- Scientific Society of Medical Students, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Barylak
- Scientific Society of Medical Students, Medical University of Silesia, Katowice, Poland
| | - Patrycja Nazarkiewicz
- Scientific Society of Medical Students, Medical University of Silesia, Katowice, Poland
| | - Ewa Malecka-Tendera
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
10
|
Matusik E, Durmala J, Matusik P. Association of Body Composition with Curve Severity in Children and Adolescents with Idiopathic Scoliosis (IS). Nutrients 2016; 8:71. [PMID: 26828519 PMCID: PMC4772035 DOI: 10.3390/nu8020071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/28/2015] [Accepted: 01/19/2016] [Indexed: 01/05/2023] Open
Abstract
The link between scoliotic deformity and body composition assessed with bioimpedance (BIA) has not been well researched. The objective of this study was to correlate the extent of scoliotic-curve severity with the anthropometrical status of patients with idiopathic scoliosis (IS) based on standard anthropometric measurements and BIA. The study encompassed 279 IS patients (224 girls/55 boys), aged 14.21 ± 2.75 years. Scoliotic curve severity assessed by Cobb's angle was categorized as moderate (10°-39°) or severe (≥40°). Corrected height, weight, waist and hip circumferences were measured and body mass index (BMI), corrected height z-score, BMI Z-score, waist/height ratio (WHtR) and waist/hip ratio (WHR) were calculated for the entire group. Body composition parameters: fat mass (FAT), fat-free mass (FFM) and predicted muscle mass (PMM) were determined using a bioelectrical impedance analyzer. The mean Cobb angle was 19.96° ± 7.92° in the moderate group and 52.36° ± 12.54° in the severe group. The corrected body heights, body weights and BMIs were significantly higher in the severe IS group than in the moderate group (p < 0.05). Significantly higher FAT and lower FFM and PMM were observed in the severe IS group (p < 0.05). The corrected heights and weights were significantly higher in patients with severe IS and normal weight (p < 0.01). Normal and overweight patients with a severe IS had significantly higher adiposity levels assessed by FAT, FFM and PMM for normal and BMI, BMI z-score, WHtR, FAT and PMM for overweight, respectively. Overweight IS patients were significantly younger and taller than underweight and normal weight patients. The scoliotic curve severity is significantly related to the degree of adiposity in IS patients. BMI z-score, WHtR and BIA seem to be useful tools for determining baseline anthropometric characteristics of IS children.
Collapse
Affiliation(s)
- Edyta Matusik
- Department of Rehabilitation, School of Health Sciences, Medical University of Silesia, Ziolowa 45-47, 40-635 Katowice, Poland.
| | - Jacek Durmala
- Department of Rehabilitation, School of Health Sciences, Medical University of Silesia, Ziolowa 45-47, 40-635 Katowice, Poland.
| | - Pawel Matusik
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Medykow 16; 40-752 Katowice, Poland.
| |
Collapse
|
11
|
Januszek-Trzciakowska A, Matusik P, Klimek K, Malecka-Tendera E. Evaluation of L-thyroxine therapy in obese children with subclinical hypothyroidism. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Matusik P, Gawlik A, Januszek-Trzciakowska A, Malecka-Tendera E. Isolated Subclinical Hyperthyrotropinemia in Obese Children: Does Levothyroxine (LT4) Improve Weight Reduction during Combined Behavioral Therapy? Int J Endocrinol 2015; 2015:792509. [PMID: 26229533 PMCID: PMC4503571 DOI: 10.1155/2015/792509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/20/2015] [Accepted: 06/23/2015] [Indexed: 11/21/2022] Open
Abstract
Objective. The study aim was to analyze whether anthropometrical parameters and TSH values in obese children with isolated subclinical hypothyroidism (IsHT) treated with levothyroxine (LT4) and weight reduction program differ from those managed by dietary and behavior counselling only. Material and Methods. 51 obese children with IsHT, who were treated according to the same weight reduction program, were retrospectively analyzed. They were divided into two groups: Group 1, n = 26, and Group 2, n = 25, without or with LT4 therapy, respectively. Changes in anthropometrical (delta BMI z-score) and hormonal (delta TSH) status were analyzed at the first follow-up visit. Results. In both groups significant decrease of TSH and BMI z-score values were noted. TSH normalized in 80.9% of children from Group 1 versus 90.5% from Group 2, p = NS. Delta BMI z-score was insignificantly higher in Group 1 compared to Group 2. Delta TSH was significantly related to initial TSH level in children treated by lifestyle intervention program only. Conclusions. In obese children with sHT dietary-behavioral management intervention contributed to reduction of body mass index, irrespective of levothyroxine use. This finding suggests that moderately elevated levels of TSH are a consequence rather than cause of overweight and pharmacological treatment should be avoided.
Collapse
Affiliation(s)
- Pawel Matusik
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
- *Pawel Matusik:
| | - Aneta Gawlik
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| | - Aleksandra Januszek-Trzciakowska
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| | - Ewa Malecka-Tendera
- School of Medicine in Katowice, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| |
Collapse
|
13
|
Durmala J, Matusik E, Durmala J, Matusik P, Wadolowski K. The usefulness of bioelectrical body composition analysis (BIA) in the proper assessment of nutritional status in children and adolescents with idiopathic scoliosis (IS). Scoliosis 2013. [PMCID: PMC3848355 DOI: 10.1186/1748-7161-8-s2-o35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
14
|
Mazur A, Matusik P, Revert K, Nyankovskyy S, Socha P, Binkowska-Bury M, Grzegorczyk J, Caroli M, Hassink S, Telega G, Malecka-Tendera E. Childhood obesity: knowledge, attitudes, and practices of European pediatric care providers. Pediatrics 2013; 132:e100-8. [PMID: 23753085 DOI: 10.1542/peds.2012-3239] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.
Collapse
Affiliation(s)
- Artur Mazur
- Medical Faculty, University of Rzeszow, Rzeszow, Poland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Janczyk W, Socha P, Lebensztejn D, Wierzbicka A, Mazur A, Neuhoff-Murawska J, Matusik P. Omega-3 fatty acids for treatment of non-alcoholic fatty liver disease: design and rationale of randomized controlled trial. BMC Pediatr 2013; 13:85. [PMID: 23702094 PMCID: PMC3672084 DOI: 10.1186/1471-2431-13-85] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/07/2013] [Indexed: 12/16/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a liver manifestation of metabolic syndrome since obesity and insulin resistance are the main pathogenic contributors for both conditions. NAFLD carries increased risk of atherosclerosis and cardiovascular diseases. There is an urgent need to find effective and safe therapy for children and adults with NAFLD. Data from research and clinical studies suggest that omega-3 fatty acids may be beneficial in metabolic syndrome-related conditions and can reduce the risk of cardiovascular disease. Methods/design We are conducting a randomized, multicenter, double-blind, placebo-controlled trial of treatment with omega-3 fatty acids in children with NAFLD. Patients are randomized to receive either omega-3 fatty acids containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or placebo for 24 weeks. The dose of omega-3 (DHA+ EPA) ranges from 450 to 1300 mg daily. Low calorie diet and increased physical activity are advised and monitored using validated questionnaires. The primary outcome of the trial is the number of patients who decreased ALT activity by ≥ 0,3 of upper limit of normal. The main secondary outcomes are improvement in the laboratory liver tests, liver steatosis on ultrasound, markers of insulin resistance and difference in fat/lean body mass composition after 6 months of intervention. Discussion Potential efficacy of omega-3 fatty acids in the treatment of NAFLD will provide needed rationale for use of this safe diet supplement together with weight reduction therapy in the growing population of children with NAFLD. Trial registration NCT01547910
Collapse
Affiliation(s)
- Wojciech Janczyk
- Department Gastroenterology, Hepatology and Eating Disorders, Children's Memorial Health Institute, Warsaw, Poland.
| | | | | | | | | | | | | |
Collapse
|
16
|
Malecka-Tendera E, Klimek K, Matusik P, Olszanecka-Glinianowicz M, Lehingue Y. Obesity and Overweight Prevalence in Polish 7- to 9-Year-Old Children. ACTA ACUST UNITED AC 2012; 13:964-8. [PMID: 15976137 DOI: 10.1038/oby.2005.112] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Secular trend in childhood obesity is a well-known phenomenon, and it is important to monitor it in cross-sectional studies. The study aim was to estimate prevalence of obesity and overweight in Polish 7- to 9-year-old children and to compare the results with a French study based on the same protocol. RESEARCH METHODS AND PROCEDURES The study was conducted in 2001 according to the protocol of the European Childhood Obesity Group. Height and weight were measured, and BMI was calculated to define nutritional status in a randomly selected group of 2916 (1445 girls and 1471 boys) primary school children. Obesity and overweight were estimated according to International Obesity Task Force references with curve for obesity and overweight passing through 30 and 25 kg/m(2) at age 18, respectively. RESULTS Overweight (including obesity) was found in 15.4% of Polish children (in 15.8% of girls and 15.0% of boys) and obesity in 3.6% (3.7% of girls and 3.6% of boys) compared with 18.1% of overweight and 3.8% of obese children in French study. There was no significant difference in nutrition status between Polish and French children except for higher frequency of overweight in French 9-year-old boys. The same trend of decreasing overweight through age classes was observed in both populations. DISCUSSION The prevalence of obesity and overweight (including obesity) in prepubertal children estimated in two European countries according to the same protocol and using the same references showed little differences between the two populations despite higher prevalence of obesity in Polish than French adults.
Collapse
Affiliation(s)
- Ewa Malecka-Tendera
- Department of Pediatric Endocrinology and Diabetes, Silesian University School of Medicine, Medyków 16, 40 752 Katowice, Poland.
| | | | | | | | | |
Collapse
|
17
|
Matusik P, Guzik B, Weber C, Guzik TJ. Do we know enough about the immune pathogenesis of acute coronary syndromes to improve clinical practice? Thromb Haemost 2012; 108:443-56. [PMID: 22872109 DOI: 10.1160/th12-05-0341] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/17/2012] [Indexed: 11/05/2022]
Abstract
Morbidities related to atherosclerosis, such as acute coronary syndromes (ACS) including unstable angina and myocardial infarction, remain leading causes of mortality. Unstable plaques are inflamed and infiltrated with macrophages and T lymphocytes. Activated dendritic cells interact with T cells, yielding predominantly Th1 responses involving interferon-gamma (IFN-γ) and tumour necrosis factor-alpha (TNF-α), while the role of interleukin 17 (IL-17) is questionable. The expansion of CD28nullCD4 or CD8 T cells as well as pattern recognition receptors activation (especially Toll-like receptors; TLR2 and TLR4) is characteristic for unstable plaque. Inflammation modifies platelet and fibrin clot characteristics, which are critical for ACS. Understanding of the inflammatory mechanisms of atherothrombosis, bridging inflammation, oxidative stress and immune regulation, will allow for the detection of subjects at risk, through the use of novel biomarkers and imaging techniques including intravascular ultrasound, molecular targeting, magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET). Moreover, understanding the specific inflammatory pathways of plaque rupture and atherothrombosis may allow for immunomodulation of ACS. Statins and anti-platelet drugs are anti-inflammatory, but importance of immune events in ACS warrants the introduction of novel, specific treatments directed either on cytokines, TLRs or inflammasomes. While the prime time for the introduction of immunologically inspired diagnostic tests and treatments for atherosclerosis have not come yet, we are closer than ever before to finally being able to benefit from this vast body of experimental and clinical evidence. This paper provides a comprehensive review of the role of the immune system and inflammation in ACS.
Collapse
Affiliation(s)
- Pawel Matusik
- Translational Medicine Laboratory, Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Kracow, Poland
| | | | | | | |
Collapse
|
18
|
Caroli M, Malecka-Tendera E, Epifani S, Rollo R, Sansolios S, Matusik P, Mikkelsen BE. Physical activity and play in kindergarten age children. ACTA ACUST UNITED AC 2011; 6 Suppl 2:47-53. [DOI: 10.3109/17477166.2011.613671] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
|
20
|
Bokor S, Frelut ML, Vania A, Hadjiathanasiou CG, Anastasakou M, Malecka-Tendera E, Matusik P, Molnár D. Prevalence of metabolic syndrome in European obese children. ACTA ACUST UNITED AC 2009; 3 Suppl 2:3-8. [PMID: 18850405 DOI: 10.1080/17477160802404509] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED The rapid rising prevalence of childhood obesity is related to increased risk of obesity-related diseases during adulthood. The aim of the present study was to review the data concerning the prevalence of metabolic syndrome (MS) in European children and adolescents (Part 1) and to determine and compare the prevalence of MS among overweight and obese children, and adolescents in five European countries using four MS definitions (Part 2). In total, 1 241 European obese children from five different countries (France: n =283, Greece: n =145, Italy: n =274, Poland: n =90, and Hungary: n =449) were studied for MS according to the definition of Ferranti et al., the World Health Organisation, the National Cholesterol Education Program and the International Diabetes Federation. We used age- and sex-specific cut-off values for the diagnosis of high blood pressure and increased waist circumference. The prevalence of MS was 35.7%, 31.4%, 20.3%, and 16.4%, respectively, according to the above-mentioned definitions. Only 6.3-8.8% of obese adolescents were free from any risk factors and the clustering of three risk factors or more was very high: 20.3-35.7% (depending on the type of definition). A total of 12.2% of children had MS and 55.8% were free from MS according to all four definitions. CONCLUSIONS The prevalence of MS is high among European obese children whatever criteria are used. There is an urgent need to achieve consensus concerning the definition of MS in adolescents and children.
Collapse
Affiliation(s)
- Szilvia Bokor
- Department of Pediatrics, University of Pécs, Pécs, Hungary.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVE To assess the frequency of obesity, overweight and underweight (thinness) in Polish 7-9-year-old children using a population specific definition as compared to the French, US and IOTF references based on body mass index (BMI). DESIGN Height and weight were measured and BMI was calculated in a randomly selected representative sample of 7-9-year-old Polish children (N = 2916; 1445 girls; 1471 boys) to define their nutritional status. Overweight (including obesity) was estimated according to four and underweight (thinness) according to three definitions Polish national references; French references; United States references and International Obesity Task Force references. RESULTS According to Polish, French, U.S. and IOTF references overweight (including obesity) was found in 12.1, 14.3, 20.7 and 15.4% of children, respectively; 3.5, 9.4 and 3.6% of children were obese according to national, U.S. and IOTF references, respectively while underweight (thinness) was present in 6.9, 2.6 and 4.2% of children according to Polish, French and U.S. references, respectively. A trend of decreasing overweight and increasing underweight through age classes was observed. CONCLUSION The rates of underweight (thinness), overweight and obesity in Polish 7-9-year-old children calculated according to the national, French, U.S. and IOTF references were significantly different. Therefore even if the IOTF reference is considered superior for international epidemiological studies, population specific standards should probably coexist for clinical practice.
Collapse
Affiliation(s)
- P Matusik
- Department of Paediatric Endocrinology and Diabetes, Faculty of Pharmacy, Silesian University School of Medicine, Katowice, Poland.
| | | | | |
Collapse
|
22
|
Małecka-Tendera E, Matusik P, Jarzab B, Dobrowolska-Wiciak B. [Fine-needle aspiration biopsy in the diagnosis of nodular thyroid disease in children]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2003; 5:79-83. [PMID: 12818090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Fine-needle aspiration biopsy (FNAB) is a standard diagnostic procedure for adult patients with thyroid nodules. However, it is still controversial whether in pediatric patients thyroid nodules should be aspirated or excised. The aim of the study was to determine the usefulness of FNAB in clinical evaluation and follow up of children with nodular thyroid disease. MATERIAL AND METHODS The study group comprised 36 children (33 girls and 3 boys) aged from 10 to 18 years (mean age 13.6 years) with nodular goiter. All children were in euthyreosis and their goiter size ranged from IAo to IIIo according to WHO criteria. In all the patients FNAB was performed and in 13 it was repeated after 4-8 months. RESULTS Cytology of the first FNAB in 25 (69.5%) children showed colloid nodules, in 3 (8.3%)--carcinoma papillare, in 3 (8.3%)--neoplasma folliculare (NF), in 4 (11.1%)--Hashimoto thyroiditis and in 1 (2.8%)--thyroiditis granulosa de Quervaine. In one girl, in whom colloid nodule was cytologically diagnosed, FNAB was repeated after 4 months because of the nodule growth and change in the USG structure revealed papillary carcinoma. In one boy NF diagnosed in first biopsy was not confirmed in the second one (patient's parents refused the consecutive biopsy). All children with malignant or suspicious cytology and three with goiter size IIIo were operated and postoperative histopathological examination was performed. All colloid nodules were confirmed histopathologically, but in one patient with a large colloid goiter follicular adenoma was found. In two children with NF in cytology--follicular adenoma was found and in three patients with papillary carcinoma in FNAB--the diagnosis was confirmed. In all children in whom thyroid nodules did not expand in the volume, did not change their structure or regressed on USG, repeated FNAB confirmed the first diagnosis. CONCLUSIONS 1. FNAB is useful in diagnosis and management of nodular thyroid disease in children. 2. Cytology of repeated biopsies of the nodules that decreased or did not increase in size confirms the primary diagnosis. 3. All children with thyroid nodules have to be carefully followed-up, and in case of nodule growth and/or change of the USG picture, repeated FNAB is necessary.
Collapse
Affiliation(s)
- E Małecka-Tendera
- II Katedra i Zakład Patofizjologii Slaskiej AM, ul. Medyków 18, 40-752 Katowice
| | | | | | | |
Collapse
|
23
|
Abstract
BACKGROUND AND STUDY AIMS There has been a tendency in recent years to omit endoscopy in dyspeptic patients younger than 45 years with no so-called "alarm symptoms." This study was conducted to test whether this policy might lead to an increased rate of delayed diagnosis of gastric cancer, especially in a population with a high prevalence of the disease. PATIENTS AND METHODS The study included 860 patients (465 women, 395 men; median age 44) referred for the first time for upper gastrointestinal endoscopy because of suspected upper gastrointestinal pathology, to a secondary referral center between 1983 and 1993. Symptoms were assessed using a special questionnaire prior to endoscopy. The endoscopic diagnosis was always confirmed by histology. RESULTS Gastric cancer was found in 83 patients (12 early cancers, 71 advanced). Patients with cancer were predominantly male (68 %, compared with 44 % in the no-cancer group; P < 0.001), and significantly older (median age 56, 44 and 42 years for advanced, early cancer, and no cancer, respectively; P < 0.001). As many as 24 % of patients with cancer were aged under 45 years. Symptoms occurring more frequently in the gastric cancer group compared with the no-cancer group were weight loss (11 % vs. 0.1 %; P < 0.001), gastrointestinal bleeding (18 % vs. 8 %; P < 0.001), anorexia (43 % vs. 25 %; P < 0.001), and fatigue (53 % vs. 30 %; P < 0.001). In 27 % of cancer patients none of the above symptoms was observed. No statistical difference was seen for pain, nausea, vomiting, and other symptoms. The mean symptom score (1 point for one symptom) was higher in patients with cancer compared with those without (3.1 vs. 2.4; P < 0.001). The duration score (1 to 4 points for durations of less than 6, less than 12, less than 24, and more than 24 months) was lower (1.3 vs. 1.8; P < 0.001) in cancer patients. In three-quarters of cancer patients the duration of symptoms was shorter than 6 months. CONCLUSIONS Symptoms suggesting gastric cancer are gastrointestinal bleeding, weight loss, and to a lesser degree anorexia and fatigue. Gastric cancer patients show a greater intensity but shorter duration of symptoms than patients with no cancer. Age and alarm symptoms cannot determine the need for upper gastrointestinal endoscopy, at least in areas of high prevalence of gastric cancer.
Collapse
Affiliation(s)
- H Bołdys
- Department of Gastroenterology, Silesian University School of Medicine, ul. Medyków 14, 40-752 Katowice, Poland.
| | | | | | | | | |
Collapse
|