Małgorzata Stojewska

Assessment of Serum Apelin Levels in Girls with Anorexia Nervosa

CONTEXT Pilot studies in rats have suggested that apelin (APE) is involved in the control of appetite and food intake. APE is secreted in the organs involved in the control of hunger and satiety: the stomach, hypothalamus, and fat tissue. Anorexia nervosa (AN) is an eating disorder that represents a good biological model of chronic fat tissue atrophy in humans. To date, there are no reports of APE expression in the fat tissue and its circulating concentrations in patients with AN. OBJECTIVE Our objective was to assess serum APE concentrations in girls with AN. DESIGN, PARTICIPANTS, AND SETTING APE-36 and APE-12 serum concentrations were evaluated in 87 Polish girls with restrictive AN, in 61 healthy (H) controls, 17 girls with no otherwise specified eating disorders (NOS), and 30 girls with simple obesity (OB). RESULTS Mean serum APE-36 and APE-12 concentrations in patients with AN and NOS were significantly lower than in the H and OB groups. However, no differences between AN, H, and NOS groups were observed when APE concentrations were calculated per body mass index (BMI). In participants with normal BMI, serum APE-36 (r = 0.35) and APE-12 (r = 0.37) concentrations correlated positively with BMI. CONCLUSIONS We conclude that compared with H controls, serum APE-36 and APE-12 concentrations decreased as a result of fat tissue depletion in patients with AN. Conversely, obese adolescents had elevated APE-36 and APE-12 due to excessive fat mass as well as increased APE production in adipose tissue.

Assessment of serum visfatin levels in girls with anorexia nervosa.

Objective  Visfatin (VISF) is a recently described peptide regulating the process of adipocyte differentiation. Only one pilot study of VISF expression in the fat tissue and its circulating concentrations in a small group of patients with anorexia nervosa (AN) have been published, yet.

Rare case of nephrocalcinosis in a 14-year-old girl: Questions

A 14-year-old Caucasian girl with a history of primary hypoparathyroidism and unstable calcium and phosphorus levels and on ongoing treatment was admitted to the Department of Pediatric Nephrology because of the onset of nephrocalcinosis and difficulties achieving normocalcemia. Coexistence of hypoparathyroidism, oral candidiasis, dental enamel hypoplasia, and subclinical Hashimoto’s disease was strongly suggestive for autoimmune polyglandular syndrome (APS) type I. One of the clinical implications of this diagnosis is the high probability of future occurrence of adrenal insufficiency and hence the importance of maintaining a high level of suspicion in case of the onset of symptoms like weakness, fainting, hypotonia, or hyperkaliemia. Addison’s disease would, in fact, be quite challenging for the future management of this patient.This clinical quiz highlighted the importance of careful evaluation of all multiorgan symptoms occurring in a patient to prevent further complications.

Evaluation of serum chemokine RANTES concentration as a biomarker in the diagnosis of early-onset severe infections in neonates.

OBJECTIVE Only a few studies on improving the early diagnosis of severe neonatal infections have focused on the role of serum RANTES concentration (sRC). The aim of the study was to establish sRC in neonates with early-onset infections, according to their gestational age, sex, birth asphyxia, mode of delivery and value of some biochemical and hematological parameters. MATERIAL/METHODS The analysis comprised 129 neonates, including 89 infected (52 preterm, 37 full-term; 43 with sepsis, 39 with congenital pneumonia, 7 with severe urinary tract infection) and 40 healthy (control group, 25 full-term, 15 preterm). The sRC in peripheral vein blood was measured by the ELISA method using Quantikine Set (R & D systems, USA). RESULTS The sRC in infected neonates ranged from 10.83 to 122.55 μg/ml, in full-term neonates from 18.28 to 122.55 μg/ml, and in preterm from 10.83 to 118.24 μg/ml. The mean sRCs in full-term septic neonates (73.95±25.99 μg/ml) and with organ infections (58.43±29.24 μg/ml) were significantly higher than healthy ones (28.25±14.06 μg/ml). The mean sRCs in septic preterm neonates (59.17±28.29 μg/ml) and those with organ infections (50.86±28.16) were significantly higher than in healthy preterm neonates (25.61±8.29 μg/ml). Positive correlations between sRC and CRP value (r=0.3014, p=0.004) and between sRC and band cell count (r=0.2489, p=0.019) were found in all infected neonates. CONCLUSION The significant increase of serum RANTES concentration in early-onset infections in neonates, regardless of their gestational age, sex and birth asphyxia, not only proves the presence of an active immunological process but also may be a useful biomarker for diagnosis of severe neonatal infections.

Rare case of nephrocalcinosis in a 14-year-old girl: Answers

Hypoparathyroidism in childhood is predominantly due to congenital parathyroid agenesis or hypoplasia, associatedwith numerous conditions, the most common one being the Di George syndrome (approximately 70 % of children with isolated hypoparathyroidism) [1]. Rare conditions may include specific renal disturbances, such as steroid-resistant nephrotic syndrome, kidney dysplasia, hypoplasia or aplasia in Barakat syndrome [2]. From a nephrologist perspective, it is also worth noting that hypomagnesemia (e.g. during chronic cyclosporine or diuretic treatment) inhibits parathyroid hormone secretion and can mimic hypoparathyroidism. In the presented case, however, the coexistence of hypoparathyroidism, oral candidiasis, dental enamel hypoplasia and subclinical Hashimotos disease is strongly suggestive of autoimmune polyglandular syndrome (APS) type 1. One of the clinical implications of this diagnosis is the high probability of future occurrence of adrenal insufficiency, emphasizing the importance of maintaining a high level of suspicion with the onset of symptoms such as weakness, fainting, hypotonia or hyperkalemia. Addison’s disease would in fact represent quite a challenge in terms of the future management of this patient.