scholarly journals A Potential Role for GLUT4 in Predicting Sepsis in Critically ill Children

2020 ◽  
Author(s):  
Qiuyan Peng ◽  
Guangming Liu ◽  
Peiqing Li ◽  
Xiaohui Wu ◽  
Qiyi Zeng ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Septic Shock ◽  
Critically Ill ◽  
Potential Role ◽  
Glucose Transporter ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Critically Ill Children ◽  
Healthy Children ◽  
Glucose Levels

Abstract Background: Glucose transporter (GLUT) 4 is an insulin-sensitive transporter that uptakes blood glucose into muscles and adipose tissue. This study aimed to investigate serum GLUT4 levels in critically ill children and to examine the potential relationship between serum GLUT4 levels and illness severity.Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls; routine health check-up) who were admitted between 07/2015 and 05/2016. Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed.Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 µg/L, P<0.001), and in septic shock compared with sepsis (116.8 vs. 64.3 µg/L, P<0.05), but not compared to non-sepsis/systemic inflammatory response syndrome (105.7 µg/L, P>0.05). Compared to healthy children, hyperglycemic patients (n=48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P<0.001). Serum GLUT4 levels were higher in patients who died (n=16, P<0.05) than in those who survived (n=57). Serum GLUT4 levels were positively correlated with the neutrophil count, creatine kinase levels, and glucose levels (P<0.05). GLUT4 levels for the diagnosis of sepsis had an area under the curve of 0.70 (P=0.03) when using a 51-µg/L cut-off value, resulting in 74.6% sensitivity and 80% specificity.Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity in critically ill children.

scholarly journals Effects of 10-Week Concurrent Training on Insulin Resistance and the Serum Levels of Vaspin and Visfatin in Overweight Females

2019 ◽  
Vol 25 (3) ◽  
pp. 146-157
Author(s):  
Abdolreza Kazemi ◽  
◽  
Sareh Mahalati ◽  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Diseases ◽  
Intervention Group ◽  
Serum Levels ◽  
Analysis Of Covariance ◽  
Concurrent Training ◽  
Improve Insulin Sensitivity ◽  
Glucose Levels ◽  
Kerman City ◽  
Training Protocol

Aims: The present study investigated the effects of a 10-week concurrent training on the serum levels of vaspin and visfatin in overweight females. Methods & Materials: Twenty-four over-weight females from Kerman City, Iran (Mean±SD age: 11.23±0.62 years; Mean±SD weight: 64.83±2.70kg; Mean±SD BMI: 27.97±0.47 kg/m2) were randomly assigned into the control and concurrent training groups. The intervention group performed the training protocol as follows: endurance training: 65-85% of Vo2 max for 20 minutes per session, and resistance training: 50-60% of One Repetition Maximum (1RM) for 30 minutes per session and 3 days a week for 10 weeks. Fasting plasma vaspin, visfatin, and insulin levels were measured by ELISA method. To analyze the data, Analysis of Covariance (ANCOVA) was used. Findings: Performing 10 weeks of concurrent training significantly decreased vaspin and visfatin plasma levels, and insulin resistance resting levels (P≤0.05); however, there was no significant decrease in glucose levels. Conclusion: Concurrent training can decrease insulin resistance, probably by reducing vaspin and visfatin in overweight females. Therefore, it is suggested that overweight females use concurrent training to improve insulin sensitivity and prevent metabolic diseases.

scholarly journals P43 Pharmacokinetics and target attainment of antibiotics in critically ill children – a systematic review of current literature

2019 ◽  
Vol 104 (6) ◽  
pp. e35.1-e35
Author(s):  
S Hartman ◽  
R Brüggemann ◽  
L Orriëns ◽  
N Dia ◽  
M Schreuder ◽  
...  
Keyword(s):  
Critically Ill ◽  
Patient Population ◽  
Current Knowledge ◽  
Volume Of Distribution ◽  
Critically Ill Children ◽  
Therapeutic Drug ◽  
Healthy Children ◽  
Target Attainment ◽  
Critically Ill Adults ◽  
Ill Adults

BackgroundPharmacokinetics (PK) are severely altered in critically ill patients due to changes in volume of distribution (Vd) and/or drug clearance (Cl). To what extent this affects the PK of antibiotics in critically children is largely unknown. We aimed to identify gaps in current knowledge and to compare published PK parameters and target attainment of antibiotics in critically ill children to healthy children and critically ill adults.MethodsSystematic literature search in PubMed, EMBASE and Web of Science. Articles were labelled as relevant when they included information on PK of antibiotics in critically ill, non-neonatal, pediatric patients. Extracted PK-parameters included Vd, Cl, trough concentrations, AUC, probability of target attainment, and elimination half-life.Results45 relevant articles were identified. Studies focusing on vancomycin were most prevalent (15/45). Other studies included data on penicillins, cephalosporins, carbapenems and aminoglycosides, but data on ceftriaxone, ceftazidime, penicillin and metronidazole could not be found. Critically ill children generally show a larger Vd and higher Cl than healthy children and critically ill adults. Reduced target attainment was described in critically ill children for multiple antibiotics, including amoxicillin, piperacillin, cefotaxime, vancomycin, gentamicin, teicoplanin, amikacin and daptomycin. 32/45 articles included information on both Vd and Cl, but a dosing advice was given in only 18 articles.ConclusionThe majority of studies focus on agents where therapeutic drug monitoring is applied, while other antibiotics lack data altogether. The larger Vd and higher Cl that is observed in critically ill children might warrant a higher dose or extended infusions of antibiotics in this patient population to increase target attainment. Studies frequently fail to provide a dosing advice for this patient population, even if the necessary information is available. Our study shows gaps in current knowledge and encourages future researchers to provide dosing advice for special populations whenever possible.Disclosure(s)Nothing to disclose

scholarly journals RBP4: A Culprit for Insulin Resistance in End Stage Renal Disease That Can Be Cleared by Hemodiafiltration

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Fabrizio Grosjean ◽  
Pasquale Esposito ◽  
Rosario Maccarrone ◽  
Carmelo Libetta ◽  
Antonio Dal Canton ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Kidney Transplant ◽  
Glucose Transporter ◽  
Serum Levels ◽  
Tissue Expression ◽  
Serum Glucose ◽  
Retinol Binding Protein ◽  
Retinol Binding Protein 4 ◽  
Glut4 Expression

Introduction. Retinol Binding Protein 4 (RBP4) is mainly excreted by the kidney and plays a pivotal role in insulin resistance (IR). In our study, we evaluated the association between RBP4 and IR in hemodialysis subjects (HD). We also assessed how circulating RBP4 could be influenced by kidney transplant or different dialytic techniques.Methods. RBP4 serum levels were evaluated in HD (n=16) and matched healthy controls (C;n=16). RBP4 and glucose transporter type 4 (GLUT4) mRNA expressions were also determined in adipose tissue. Circulating RBP4 was evaluated after kidney transplant (n=7) and in hemodialysis patients (n=10) enrolled in a cross-over study treated with standard bicarbonate dialysis (BD) or hemodiafiltration (HDF).Results. HOMA index (P<0.05) and serum RBP4 (P<0.005) were higher in HD compared to C. RBP4 levels positively correlated with fasting serum glucose (P<0.05). RBP4 mRNA was lower in HD compared to C (P<0.05) and positively correlated with kidney function (P<0.05) and GLUT4 mRNA (P<0.001). Transplant or HDF reduced circulating RBP4 (P<0.01andP<0.05, resp.). Our results demonstrate that IR is associated with high circulating RBP4 and that suppressed RBP4 adipose tissue expression is accompanied by reduced GLUT4 expression in HD. Renal transplantation or HDF are effective in lowering serum RBP4 levels.

Bowel Frequency in Critically III Children

2004 ◽  
Vol 9 (3) ◽  
pp. 187-191
Author(s):  
Karen D. Dominguez ◽  
Matthew E. Borrego
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Male Gender ◽  
Stool Frequency ◽  
Critically Ill Children ◽  
Healthy Children ◽  
Stepwise Linear Regression ◽  
Bowel Movements

BACKGROUND Bowel frequency in healthy children has been determined, but it is not well documented in critically ill children. The objectives of this prospective observational study were to determine if critical illness alters stool frequency in children and to identify risk factors that may increase or decrease stool frequency. METHODS Stool frequency was assessed in children admitted to the pediatric intensive care unit (PICU) over a five month period. The median daily number of bowel movements during admission to the PICU was compared to the patient's estimated number of bowel movements prior to illness. Stepwise linear regression was performed to determine which factors best predicted stool frequency in critically ill children. RESULTS Daily stool frequency was significantly reduced (P &lt; 0.001) during PICU stay (median = 0.5; interquartile: 0, 0.8) compared to preadmission stool frequency estimates (median = 2; interquartile: 1, 2.5). Covariates associated with an increase in stool frequency included male gender and length of stay in the PICU. Conversely, the administration of opioids decreased stool frequency. CONCLUSIONS Bowel frequency was reduced by 75% in children admitted to the PICU. The use of opioids was associated with decreased bowel frequency. Male gender and increased PICU stay was associated with increased bowel frequency.

scholarly journals Septic shock and vasopressor requirement is associated with lower vitamin D levels in critically ill children

Critical Care ◽  
2011 ◽  
Vol 15 (S3) ◽  
Author(s):  
K Madden ◽  
HA Feldman ◽  
E Smith ◽  
CM Gordon ◽  
S Keisling ◽  
...  
Keyword(s):  
Vitamin D ◽  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Vitamin D Levels ◽  
Lower Vitamin

scholarly journals Myocardial Injury in Critically Ill Children: A Case Control Study

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Basheir Hassan ◽  
Saed Morsy ◽  
Ahmed Siam ◽  
Al Shaymaa Ali ◽  
Mohamed Abdo ◽  
...  
Keyword(s):  
Disease Severity ◽  
Critically Ill ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Case Control Study ◽  
Troponin T ◽  
Critically Ill Children ◽  
Cardiac Troponin T ◽  
Healthy Children ◽  
Control Study

Objectives. The aim of this study was to investigate the occurrence of myocardial injury in critically ill children through assessment of cardiac troponin T levels and whether levels are associated with disease severity and myocardial dysfunction measured by echocardiography. Methods. Over a 6-month period, this case control study included 50 patients admitted to Pediatric Intensive Care Unit of Zagazig University Children’s Hospital. Twenty-five healthy children were included as a control group. Demographic and clinical data including the pediatric index of mortality II score were recorded. Echocardiographic examination was done and level of cardiac troponin T was measured using Elecsys Troponin T STAT Immunoassay. Results. Cardiac troponin T levels were significantly higher in critically ill in comparison to healthy children (median 22 (18–28) pg/mL versus 10 (10-10) pg/mL, P<0.05). Cardiac troponin T levels correlated positively with duration of ventilation as well as with disease severity and correlated negatively with left ventricular fractional shortening. Moreover, cardiac troponin T levels were significantly higher in nonsurvivors when compared to survivors (median 34.5 (27.5–41.5) pg/mL versus 20 (18–24) pg/mL, P<0.05). Conclusion. In critically ill children, cardiac troponin T levels were elevated and were associated with duration of ventilation and disease severity.

scholarly journals Distribution of the homeostasis model assessment of insulin resistance in Mexican children and adolescents

2012 ◽  
Vol 166 (2) ◽  
pp. 301-306 ◽  
Author(s):  
Celia Aradillas-García ◽  
Martha Rodríguez-Morán ◽  
María Eugenia Garay-Sevilla ◽  
Juan Manuel Malacara ◽  
Ramón Alberto Rascon-Pacheco ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Children And Adolescents ◽  
Fasting Glucose ◽  
Population Based ◽  
Healthy Children ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Mexican Children

ObjectiveSeveral cutoff points of the homeostasis model assessment of insulin resistance (HOMA-IR; varying from 2.5 to 4.0) have been suggested for diagnosing IR in youth. In this study, we determined the distribution of the HOMA-IR in Mexican children and adolescents.Design and methodsA total of 6132 children and adolescents from San Luis Potosi, León, Queretaro, and Durango, which are cities in central and northern Mexico, were enrolled in a population-based cross-sectional study. Eligible participants were apparently healthy children and adolescents aged 6–18 years. Pregnancy and the presence of chronic illnesses were exclusion criteria.ResultsA total of 3701 (60.3%) girls and 2431 (39.7%) boys were included in this study. In the overall population, the mean body mass index, insulin levels, and fasting glucose levels were 21.8±1.3 kg/m2, 7.1±3.2 μU/ml, and 86.2±10.0 mg/dl respectively. The concentrations of insulin and fasting glucose gradually increased from 6 to 12 years of age, whereas the concentrations tended to plateau in the 13- to 18-year-old population. The absolute mean of the HOMA-IR was 2.89±0.7. The HOMA-IR gradually increased with age and reached a plateau at 13 years of age.ConclusionsBecause the insulin concentrations, glucose levels, and HOMA-IR exhibited a gradual increase with age that was not related to obesity, our results suggested that the evaluation of IR in children should be based on percentiles of the HOMA-IR rather than a dichotomous value derived from a single cutoff point.

scholarly journals The Association Between Vitamin E Deficiency and Critically Ill Children With Sepsis and Septic Shock

2021 ◽  
Vol 8 ◽  
Author(s):  
Hongxing Dang ◽  
Jing Li ◽  
Chengjun Liu ◽  
Feng Xu
Keyword(s):  
Septic Shock ◽  
Vitamin E ◽  
Critically Ill ◽  
Serum Vitamin ◽  
Independent Effect ◽  
Critically Ill Children ◽  
Vitamin E Deficiency ◽  
Suspected Infection ◽  
Sepsis And Septic Shock ◽  
Vitamin E Status

Background: Literature is scarce on the assessment of vitamin E status in septic children. We aim to investigate the prevalence of vitamin E deficiency in critically ill children with sepsis and septic shock and its association with clinical features and outcomes.Methods: We compared serum vitamin E status between the confirmed or suspected infection and no infection groups, the sepsis shock and no sepsis shock groups upon pediatric intensive care unit admission. Clinical characteristics were compared in subgroup patients with and without vitamin E deficiency. The association between vitamin E deficiency and septic shock were evaluated using univariate and multivariable methods.Results: 182 critically ill children with confirmed or suspected infection and 114 without infection were enrolled. The incidence of vitamin E deficiency was 30.2% in the infection group and 61.9% in the septic shock subgroup (P &lt; 0.001). Thirty-days mortality in critically ill children with vitamin E deficiency was significantly higher than that without vitamin E deficiency (27.3 vs. 14.2%, P &lt; 0.05). Vitamin E levels were inversely associated with higher pediatric risk of mortality (r = − 0.238, P = 0.001) and cardiovascular sequential organ failure assessment (r = −0.249, p &lt; 0.001) scores in critically ill children with infection. In multivariable logistic regression, vitamin E deficiency showed an independent effect on septic shock (adjusted OR: 6.749, 95%CI: 2.449–18.60, P &lt; 0.001).Conclusion: Vitamin E deficiency is highly prevalent in critically ill children with sepsis and contributed to the septic shock.

15 hz Electroacupuncture at St36 Improves Insulin Sensitivity and Reduces Free Fatty Acid Levels in Rats with Chronic Dexamethasone-Induced Insulin Resistance

2016 ◽  
Vol 34 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Chung-Yuh Tzeng ◽  
Yu-Chen Lee ◽  
Jui-Jung Chung ◽  
Jen-Chieh Tsai ◽  
Ying-I Chen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Fatty Acid ◽  
Insulin Sensitivity ◽  
Free Fatty Acid ◽  
Rat Model ◽  
Glucose Transporter ◽  
Challenge Test ◽  
Area Under The Curve ◽  
Intravenous Glucose Tolerance Test ◽  
Intravenous Glucose

Objective To evaluate the effect of electroacupuncture (EA) in a rat model of chronic steroid-induced insulin resistance (SIIR). Methods An SIIR rat model was created using daily intraperitoneal injections of clinically relevant doses of dexamethasone (1 mg/kg) for 5 days to induce chronic insulin resistance. Thirty-six SIIR rats were randomly divided into the SIIR+EA group (n=18), which received 15 Hz EA at ST36 for 60 min, and the SIIR group (n=18), which remained untreated. Plasma glucose and free fatty acid (FFA) levels were measured in serial blood samples taken without further manipulation (n=6 per group) and during insulin challenge test (ICT, n=6 per group) and intravenous glucose tolerance test (ivGTT, n=6 per group). Insulin receptor substrate (IRS)-1 and glucose transporter (GLUT)-4 were measured using Western blotting and expressed relative to β-actin. Results Following EA, area-under-the-curve (AUC) for glucose was reduced (7340±291 vs 10 705±1474 mg/dL/min, p=0.049) and FFA levels significantly lower at 30/60 min in the SIIR+EA versus SIIR groups. Similar effects on glucose AUC were seen during the ICT (5568±275 vs 7136±594 mg/dL/min, p<0.05) and igVTT (11 498±1398 vs 16 652±1217 mg/dL/min, p<0.01). FFA levels were lower at 30 and/or 60 min in SIIR+EA versus SIIR groups (p<0.01). Relative expression of IRS-1 and GLUT4 were significantly increased by EA (p<0.01). Conclusions EA decreased the FFA level and increased insulin sensitivity in SIIR rats. Further clinical studies are needed to determine whether EA is an effective alternative treatment for the reduction of insulin resistance in patients requiring chronic use of dexamethasone.

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