The association of sleep with inflammatory bowel disease in children and adolescents

Aim

To systematically review literature investigating sleep quality in children and adolescents with inflammatory bowel disease (IBD).

Methods

Electronic databases were searched (BASE, Cochrane Database of Systematic Reviews, DIMDI, PsychArticles, PsychInfo, Psychjournals, Psychline, PSYNDEX, Pubmed, Science Direct, Web of Science, Wiley Online Library) by two researchers. Eligible studies were all that studied sleep disorders in the context of IBD in children and adolescents (6–17 years of age).

Results

Out of 40 references identified, five studies (all cross-sectional, three of them controlled) were eligible and included in this study. The publications showed that children and adolescents with IBD have significant sleep problems, adding to their impaired quality of life.

Conclusion

The published data provide evidence suggesting an impact of IBD and its severity on sleep in children and adolescents. However, with regard to the low methodological quality, the incongruity of the studies concerning outcome measure, and their focus of exploration, further studies are warranted to highlight the interrelationship.

     

Predictors of sustained virological response in Greek and Egyptian patients with hepatitis C genotype 4: Does ethnicity matter?

Hepatitis C virus genotype 4 (HCV‐4) is spreading beyond Africa and the Middle East but data regarding treatment with pegylated interferon alpha and ribavirin of European populations infected with HCV‐4 remains limited. Interestingly, European (vs. Egyptian) origin has been associated with lower sustained virological response rates. Hence the aim of this study was to investigate the treatment outcomes of Greek (vs. Egyptian), treatment‐naïve patients infected with HCV‐4 (subtype a) and to identify factors influencing response rates. One hundred seventy‐seven consecutive patients (mean age: 44.6 ± 10.2, males: 143/177; 80.8%, Egyptians: 76/177; 42.9%) treated over a 7‐year period at the Hepatology clinics of three tertiary care hospitals in Greece were retrospectively evaluated. Overall, sustained virological response was achieved in 75/177 (42.4%) of the cohort without a significant difference between the two ethnic groups [Greek: 44/101 (43.6%); Egyptian 31/76 (40.8%), P = 0.7598]. In multivariate analysis, it was found that ethnicity was not associated with an impaired response but age ≥45 years [odds ratio (OR): 0.4225, 95% confidence interval (CI): 0.2135–0.8133; P = 0.0134], diabetes (OR: 0.2346, 95% CI: 0.0816–0.0674; P = 0.0071), advanced liver fibrosis (OR: 0.3964, 95% CI: 0.1933–0.8133; P = 0.0116), and treatment suspension (OR: 0.1738, 95% CI: 0.0482–0.6262; P = 0.0075) showed an independent negative association with response to antiviral treatment. In contrast to previous European data suggesting Egyptian ethnicity to be a positive predictor for a sustained virological response, there was no influence of Greek versus Egyptian ethnicity on treatment outcomes. Higher age, advanced liver fibrosis, and diabetes have been shown to reduce significantly response rates in patients infected with HCV‐4. J. Med. Virol. 84: 1217–1223, 2012. © 2012 Wiley Periodicals, Inc.     

Concentrations of α- and β-defensins in plasma of patients with inflammatory bowel disease

Background:  Impaired production/release of defensins, representative endogenous antimicrobial peptides, is associated with the pathogenesis of inflammatory bowel disease (IBD). Material and methods:  Employing in house radioimmunoassay, we examined concentrations of the major forms α-defensins, human neutrophil peptides (HNP) 1–3 and human β-defensin (HBD)-2 in plasma of 55 IBD patients consisting of 29 patients with ulcerative colitis (UC) and 26 with Crohn’s disease (CD) and 57 controls. Results:  The circulating HNP 1–3, but not HBD-2, levels in IBD patients were significantly higher than those in controls. Plasma HNP 1–3 concentrations in CD patients significantly correlated with Crohn’s disease activity index, peripheral white blood cell counts, serum CRP values and TNF-α levels. Conclusions:  Elevation of circulating α-defensins levels is suggestive of their physiopathological roles in IBD. Plasma HNP 1–3 concentrations may be an indicator for CD activity and their association with CRP and TNF-α supports a possible association with the inflammatory process. Received 2 June 2008; returned for revision 20 June 2008; received from final revision 25 June 2008; accepted by C. Kasserra 19 August 2008     

Predictors of low bone density and fracture risk in Loeys–Dietz syndrome

PurposeLoeys–Dietz syndrome (LDS) is a connective tissue disorder affecting multiple organ systems, including bone.MethodsWe defined the bone phenotype and clinical predictors of low bone density and fracture risk in 77 patients with LDS type 1 to type 5.ResultsPatients with LDS had dual-energy x-ray absorptiometry (DXA) Z-scores significantly < 0, and 50% of children and 9% of adults had Z-scores < –2. Sixty percent of patients had ≥1 fracture, and 24% of patients with spinal x-rays scans showed spinal compression fractures. Lower body mass index, asthma, male sex and eosinophilic gastrointestinal disease were correlated with lower DXA Z-scores. The count of 5 LDS-associated skeletal features (scoliosis, pes planus, arachnodactyly, spondylolisthesis, and camptodactyly) in patients with LDS was correlated with DXA Z-score. Adults with ≥1 skeletal features had DXA Z-scores significantly < 0, and children with >2 features had DXA Z-score significantly < –2. Bone turnover markers suggest accelerated bone resorption. Data from 5 patients treated with bisphosphonates suggest a beneficial effect.ConclusionAll LDS types are associated with reduced bone density and increased risk of fracture, which may be due to increased bone resorption. Clinical features can predict a subgroup of patients at highest risk of low bone density and fracture risk.     

Potentialization of β-lactams with colistin: in case of extended spectrum β-lactamase producing Escherichia coli strains isolated from children with urinary infections

Five strains producing extended-spectrum β-lactamases (ESBL) bacteria, identified as Escherichia coli, were isolated from children with urinary infections hospitalized at Roubaix hospital in the north of France. The DNA genotypes of these non-nosocomial isolates were determined by Random Amplified Polymorphic DNA (RAPD) method. Further, their DNA plasmids content revealed the presence of two distinct plasmids for S1, S2, S3 and one plasmid for S4 and S5. The antibacterial susceptibility of these ESBL bacteria was tested mainly against antibiotics of β-lactams family. The ESBL producing bacteria were resistant to ticarcillin and cefotaxime but the combination of these antibiotics with colistin has dropped the MIC of ticarcillin below its breakpoint (isolates S2, S3 and S4), and has almost reached the breakpoint for cefotaxime (isolate S2). Thus, kill curves analyses carried out with only isolates S1 and S2, strengthened the bactericidal activity of the combinations of colistin-ticarcillin and colistin-cefotaxime against ESBL E. coli. Indeed, reduction of 3 log₁₀ colony count were observed after 24 h of incubation.     

Treatment with double dose of omeprazole increases β-endorphin plasma level in patients with coronary artery disease

Introduction

The proton pump inhibitor empirical trial, besides the analysis of symptoms, is the main method in the diagnosis of gastro-oesophageal reflux disease-related chest pain. β-Endorphin acts as an endogenous analgesia system. The aim of the study was verify whether β-endorphin plasma level is affected by omeprazole administration and influences the severity of anginal symptoms and outcome of the “omeprazole test” in patients with coronary artery disease (CAD) and chest pain of suspected non-cardiac origin.

Material and methods

Omeprazole was administered to 48 patients with CAD in a randomized, placebo-controlled, crossover study design. At the beginning of the study, and again after the 14-day omeprazole and placebo treatment, the β-endorphin plasma concentration was determined.

Results

The level of plasma β-endorphin after the administration of omeprazole was significantly greater than at the start of the study and following the placebo. Responders to omeprazole had an average lower β-endorphin plasma concentration than subjects who failed to respond to this therapy. Subjects with symptoms in class III (according to the Canadian Cardiovascular Society classification) after omeprazole administration had a greater β-endorphin plasma level than subjects in class II for anginal symptom severity.

Conclusions

Fourteen-day therapy with a double omeprazole dose significantly increases the β-endorphin plasma concentration in patients with CAD. Circulating β-endorphin does not seem to be involved in the mechanism for the “omeprazole test” outcome, although an individually different effect on pain threshold cannot be excluded.     

Tissue-engineered bone with β-tricalcium phosphate as scalffold

INTRODUCTION　　Bone biomaterials have been well developed in recentyears and frequently usedclinically in orthopedic,traumatic and odontological surgeries. Amongst,bioceram-ics is similar to the mineral constituents of our skeleton and highly appraised due toits excellentcharacteristics in bio-compatibility,mechanical and bio-degradable prop-erties,and bone-inductivity. Great progresses have been made during the pastdecade in the improvementof the bio-materials themselvesconsidering their…     

The spectrum of neurological manifestations and genotype–phenotype correlation in Indian children with Gaucher disease

Gaucher disease (GD), one of the most frequent autosomal recessive lysosomal storage disorders, occurs due to bi-allelic pathogenic variants in the GBA1. Worldwide, the c.1448T>C (L483P) homozygous pathogenic variant is reported to be associated with neurological GD phenotype. Clinical distinction between GD1 and GD3 may be challenging due to subtle neurological features. Objective methods to evaluate neurological signs and saccades may help in early diagnosis. This study was conducted to assess the neurological phenotype, and its severity using a modified severity scoring tool (mSST), and the genotype–phenotype correlation. A total of 45 children aged 2 years 6 months to 15 years with a confirmed enzymatic and molecular diagnosis of GD with or without therapy were recruited. mSST tool was used to assess the severity of the neurological phenotype. A digital eye movement tracker (View Point Tracker) was used to assess eye movements. Clinical and genetic findings were analyzed. Out of 45 patients, 39 (86.7%) had at least one neurological phenotype detected using the mSST tool, with impairment of cognitive function (68.8%, 31/45) being the commonest feature. Thirty-two of 45 (71%) were assessed for saccadic eye movements using the eye tracker. Of these, 62.5% (20/32) had absent saccades. Four children (8.9%, 4/32) without clinical oculomotor apraxia had absent saccades on the viewpoint eye tracker. Overall, 77.7% (35/45), had homozygosity for c.1448T>C in GBA1 of which 91.4% (32/35) had neurological manifestations. Other alleles associated with neurological phenotype included c.1603C>T(p.R535C), c.1184C>T (p.S395F), c.115+1G>A (g.4234G>A), c.260G>A (p.R87Q) and c.1352A>G (p.Y451C). To conclude, in India, the c.1448T>C pathogenic variant in GBA1 is the commonest  and is associated with neurological phenotype of GD. Therefore, every patient of GD should be assessed using the mSST scoring tool for an early pick up of neurological features. The routine use of a viewpoint eye tracker in children with GD would be useful for early recognition of saccadic abnormalities.     

Muscle stiffness of the rectus femoris and vastus lateralis in children with Osgood–Schlatter disease

BackgroundThe relevance of the mechanical properties of muscles in relation to Osgood–Schlatter disease (OSD) remains unclear. The present study aimed to examine rectus femoris (RF) and vastus lateralis (VL) muscle stiffness in children with OSD.MethodsA total of 28 legs affected by OSD and 26 legs without OSD were assessed. The shear-wave velocity (SWV) of the RF and VL (in m/s) during passive knee flexion (0° (i.e., fully extended position), 45°, and 90° knee joint flexion) and isometric contraction (50% of maximal voluntary contraction) was measured using shear-wave elastography.ResultsThe SWV of the RF was higher in subjects with OSD than in those without OSD at 45° and 90° flexion (P = 0.033 and P = 0.035, respectively); however, the SWV of the RF did not significantly differ at 0° flexion (P = 0.469). Similarly, the SWV of the VL exhibited no significant difference between the tested groups (P > 0.05). No significant difference in the SWV of both muscles during isometric contraction was observed between the two groups (P > 0.05).ConclusionsThe results suggest that a stiffer RF under stretched conditions (45° and 90° flexion) is related to the presence of OSD. Furthermore, both muscles under unstretched and contracted conditions and the VL under stretched conditions have limited association with the presence of OSD. These results have important implications for understanding the association between the mechanical properties of muscles and OSD.     

Effect of serum fibroblast growth factor receptor 2 and CAPS proteins on calcium status in β-thalassaemia major patients who are free from overt inflammation

Bone disorders and disturbed calcium (Ca) homeostasis are common disorders in β-thalassaemia major (β-TM). In the present study, two bone related markers are studied in β-TM patients with negative C-reactive protein for the first time; fibroblast growth factor receptor 2 (FGFR2) and CAPS protein. Another goal is to estimate the correlation between the recent parameters and bone biomaterials as a function of iron status parameters in β-TM patients. The results revealed that, in patients with β-TM serum FGFR2, CAPS, alkaline phosphatase (ALP) and Mg significantly increased while serum Ca levels were low as compared with controls. Ca status is correlated with iron overload in β-TM. A significant correlation was present between CAPS and FGFR2. In conclusion, FGFR2 and CAPS associated with Ca status and subsequent bone disturbances in β-TM patients. Their level can be predicted from the equation: CAPS =0.001ALP +0.48FGFR2-1.26Ca – 3.95Pi +12.76 with acceptable applicability.     

Localization of phospholipase C β3 in the major salivary glands of adult mice

Phospholipase C (PLC)β has a role in saliva secretion by controlling intracellular Ca²⁺ via its product, IP₃. The present study was attempted to localize PLCβ isoforms in mouse salivary glands in situ. A single major band was detected for PLCβ3 in immunoblots of the parotid and sublingual glands (PG, SLG), while no such band was seen in the submandibular gland (SMG). No bands were detected for PLCβ1 or 4 in the three glands. In immuno-light microscopy of PG and SLG, substantial immunoreactivity for PLCβ3 was seen in the cytoplasm including the plasmalemma of almost all ductal cells, while no distinct immunoreactivity was discerned in most acinar cells except for sublingual demilune cells. Numerous ductal cells exhibited higher immunoreactivity for PLCβ3 in their apical/supranuclear cell domain including the plasmalemma than in the basal/infranuclear domain, indicating an apico-basal polarity. In immuno-gold electron microscopy of PG ducts and SLG ducts and demilunes, most gold particles were found in association with plasma membranes as well as various intracellular membranes, most of which formed small oblong or flattened vesicles and vacuoles. A few particles were seen without association with any membranous structures. The present finding supports the previous physio-pharmacological result that Ca²⁺-signaling proteins as well as initial intracellular Ca²⁺ changes occur in the apical cell domain including the plasma membranes of the exocrine cells.     

Role of β-defensins in oral epithelial health and disease

The oral epithelium functions as a mechanical and protective barrier to resist bacterial infection. β-Defensins are a group of antimicrobial peptides mainly produced by epithelial cells of many organs including skin, lung, kidney, pancreas, uterus, eye, and nasal and oral mucosa. This review focuses on β-defensins (BDs) in oral epithelia and discusses their importance in oral epithelial health and disease. BDs exhibit antimicrobial activity against oral microbes including periodontitis-related bacteria, Candida, and papilloma virus. Alterative expression of BDs was observed in oral epithelial diseases, including oral inflammatory lesions with and without microbial infection and oral cancer. BDs may be useful in the treatment of oral infectious diseases, ulcerative lesions, and cancer. BDs play an important role in protection against oral microbes and may be used in clinical applications.     

Lack of change in serum sCD36 concentration in children with non-alcoholic fatty liver disease – A preliminary study

PurposeNon-alcoholic fatty liver disease (NAFLD) is increasingly being recognized in the pediatric population, therefore, the search for non-invasive parameters to predict progression of NAFLD is of great interest. The aim of this study was to assess serum concentration of sCD36 in children with obesity and to determine its diagnostic value in pediatric NAFLD.Patients and methodsThe study group consisted of 50 children with obesity aged 8–17.5 years, admitted to our Department because of suspected liver pathology. Selected liver diseases were excluded in the examined group. Anthropometry, laboratory tests (including the concentration of sCD36) and liver ultrasound, were performed in all subjects.ResultsNAFLD was confirmed in 16 out of 50 patients with obesity. There was significantly higher activity of ALT, AST, GGT, and increased waist-hip ratio WHR in individuals with NAFLD in comparison to non-hepatopathic children with obesity. We did not find a significant difference between sCD36 concentration in patients with obesity and NAFLD and non-hepathopathic patients with obesity. We also did not find a significant difference between sCD36 concentration in children with obesity in comparison to the control group and between mild (grade 1) vs. advanced (grade ≥2) steatosis. Correlation of sCD36 concentration with anthropometric, biochemical, and bioimpedance parameters in children with obesity was confirmed only with body fat percentage.ConclusionssCD36 is not a suitable parameter to differentiate children with NAFLD from non-hepatopathic children with obesity and controls without obesity. Further studies on a larger pediatric population are needed to confirm these findings.