Autoimmune sclerosing cholangitis might be triggered by SARS-CoV-2 infection in a child - a case report.

The spectrum of liver involvement during coronavirus disease 2019 (COVID-19) is broad and mainly includes elevated liver enzymes and cholestasis. Severe acute respiratory syndrome corona- virus-2 (SARS-CoV-2) infection most often leads to a transient moderate increase in liver enzymes that is not accompanied by disturbances in the synthetic function of the liver. However, there is increasing evidence that SARS-CoV-2 infection is associated with the development of autoimmune disorders. The pathogenesis of autoimmune hepatobiliary diseases is not fully understood, taking into account genetic and environmental factors such as viral infections. We present a pediatric case of autoimmune sclerosing cholangitis (ASC), which was diagnosed 2 months after SARS-CoV-2 infection. To the best of our knowledge, ASC potentially triggered by COVID-19 has not been reported in pediatric patients. Further studies are needed to describe the clinical impact of the development of autoimmune liver diseases potentially associated with SARS-CoV-2 infection in pediatric patients. Our observations indicate that children with liver injury potentially caused by COVID-19 require long-term monitoring of liver function parameters.

Depression as Compared to Level of Physical Activity and Internet Addiction among Polish Physiotherapy Students during the COVID-19 Pandemic.

OBJECTIVES: The aim of the survey was to assess the level of depression correlated with physical activity and internet addiction among physiotherapy students of Polish universities during the COVID-19 pandemic. METHODS: The survey was carried out via the internet among Polish physiotherapy students (141 respondents). The level of depression was assessed by the Beck Depression Inventory, physical activity by the International Physical Activity Questionnaire (IPAQ) in Polish and the level of internet addiction by the Kimberly Young Questionnaire. RESULTS: It was found that 31% of those surveyed stated that they suffered from moderate or severe depression. The overwhelming majority of the respondents (92%) considered the level of their internet addiction as low. More physical activity had a positive effect on mental health. The overuse of the internet exacerbated depressive symptoms. CONCLUSIONS: The prevalence of depression observed in students is mainly related to distant learning systems. Therefore, regular physical activity is recommended as it is associated with a lower level of depression. It is also advisable to provide students with necessary psychological care. Excessive use of social media is not recommended to elevate mood as it makes depression symptoms worse.

Chronic Back Condition and the Level of Physical Activity as Well as Internet Addiction among Physiotherapy Students during the COVID-19 Pandemic in Poland.

Objectives: The aim of this study was to assess back pain and its relation to physical activity as well as Internet addiction among Polish university students during the COVID-19 pandemic. Methods: The research was conducted via the Internet in student groups of three universities in Poland (141 people). Back pain was examined by ODI-The Oswestry Disability Index and NDI-Neck Disability Index. The Polish-language International Physical Activity Questionnaire (IPAQ) was used to assess physical activity and the level of Internet addiction was tested using the Kimberly Young Questionnaire. Results: The respondents mostly suffered from pain originating in the cervical spine. In the study group, only every fifth person had a high level of physical activity. Sex differentiates the level of the measures considered. Sitting in front of the computer affects the pain in the spine. Conclusions: Research results suggest that the pandemic is negatively affecting students. Frequent occurrence of back pain is observed with a simultaneous low level of physical activity. Maintaining regular activity during a pandemic, at least at home, is an indispensable preventive measure for physical health.

Predictive Role of Interleukin-18 in Liver Steatosis in Obese Children.

Introduction: Interleukin-18 (IL-18) is a proinflammatory cytokine associated with metabolic syndrome (MS). Nonalcoholic fatty liver disease (NAFLD) can be recognized as a feature of MS. Material and Methods: Serum IL-18 concentration was evaluated in serum of 108 obese children, determined with ELISA, and referred to degree of liver steatosis in USG or total intrahepatic lipid content assessed by magnetic resonance proton spectroscopy (1HMRS). Results: Fatty liver was confirmed in 89 children with USG and in 72 with 1HMRS. IL-18 concentration demonstrated significantly higher values in patients than in controls. Significant correlations between IL-18 and ALT, GGT, triglycerides, hsCRP, and the degree of liver steatosis were demonstrated. NAFLD children had significantly higher level of IL-18, ALT, GGT, HOMA-IR, waist circumference, and total lipids content in 1HMRS than other obese children. IL-18 level was also significantly higher in obese children with advanced liver steatosis. Measurement of serum IL-18 showed ability to differentiate children with fatty liver from those without steatosis. Conclusion: Elevated serum IL-18 concentration and its correlation with hepatocyte injury, systemic inflammation, and degree of liver steatosis support role in NAFLD pathomechanism. IL-18 can be considered to play a role in predicting advanced liver steatosis and fatty liver in obese children.

Hepatokines and non-alcoholic fatty liver disease.

Nowadays non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver pathology both in adults and children. NAFLD manifestation ranges from a simple liver steatosis to steatohepatitis (nonalcoholic steatohepatitis - NASH), which may progress to advanced fibrosis, cirrhosis and end-stage liver disease. Due to the coexistence of visceral obesity, insulin resistance and dyslipidemia, NAFLD is considered to be the hepatic manifestation of metabolic syndrome. In recent years, in the pathogenesis of metabolic syndrome, type 2 diabetes mellitus, cardiovascular disease and also NAFLD, more and more attention has been paid to the so-called organokines, proteins with both paracrine or/and endocrine activities. These include most known adipokines (mainly produced by adipose tissue), myokines (mainly produced by skeletal muscles) and hepatokines exclusively or predominantly produced by the liver. It was shown that the liver may affect the lipids and glucose metabolism by hepatokines released into the blood and NAFLD seems to be associated with altered hepatokines production. Fetuin-A, fibroblast growth factor-21 (FGF-21), selenoprotein P, sex hormone-binding globulin (SHBG), angiopoietin-related growth factor (also known as angiopoietin-related protein 6) and leukocyte derived chemotaxin 2 (LECT2) are considered as the most important hepatokines. In this review, we provide an overview of the main hepatokines and we summarize the association of liver-derived proteins with the development and progression of NAFLD.

Chemerin as a novel non-invasive serum marker of intrahepatic lipid content in obese children.

BACKGROUND: Ectopic hepatic lipid accumulation is closely related to the development of insulin resistance, which is regarded as one of the most significant risk factors of non-alcoholic fatty liver disease (NAFLD). The current study has shown that fat tissue constitutes an important endocrine organ with its own production and metabolism of many biologically active substances, among which adipokines play an important role. Classic adipokines (e.g. leptin, adiponectin, resistin) are fat-derived hormones which serum level is altered in patients with NAFLD. The role of novel adipokines in the pathomechanism of this disease is not clear. Therefore, the aim of our study was to evaluate the serum concentrations of chemerin, omentin and vaspin in obese children with NAFLD. METHODS: Forty-five obese children, aged 7-17 years old, were admitted to our Department with suspected liver disease (hepatomegaly, and/or ultrasonographic liver brightness, and/or increased ALT activity). Viral hepatitides, as well as autoimmune and metabolic liver diseases were excluded. Fasting serum levels of chemerin, omentin and vaspin were determined. The grade of liver steatosis in ultrasound was graded according to Saverymuttu. (1)HMR spectroscopy was performed with a 1.5 T scanner and with PRESS sequencing. RESULTS: Fatty liver was confirmed in 39 children by ultrasound and in 33 patients by (1)HMRS (19 of them also had increased ALT activity /NAFLD/). Chemerin and vaspin levels were significantly higher in children with NAFLD compared to the control group (n = 30). The concentration of chemerin was significantly higher in children with advanced liver steatosis compared to non-hepatopathic patients (p = 0,02). Significant positive correlations were found between the total liver lipids in (1)HMRS and chemerin (r = 0,33; p = 0,02) and vaspin (r = 0,4; p = 0,006). The ability of serum chemerin (cut-off = 190 ng/ml, Se = 75%, Sp = 58%) to differentiate children with fatty liver in (1)HMRS from those without steatosis was significant (AUC = 0,7, p = 0,04). Omentin and vaspin did not allow a useful prediction to be made. CONCLUSION: Chemerin seems to be the most suitable non-invasive biomarker in predicting both intrahepatic lipid content in obese children and advanced liver steatosis in children with NAFLD.

Serum fetuin A concentration is elevated in children with non-alcoholic fatty liver disease.

PURPOSE: To assess the serum fetuin A concentration as a potential marker of subclinical atherosclerosis in obese children with NAFLD. MATERIAL/METHODS: A prospective analysis of 45 obese children initially diagnosed with liver pathology (elevated serum ALT activity and/or ultrasonographic liver brightness and/or hepatomegaly) was conducted. The diagnosis of NAFLD was established in the children with elevated serum ALT activity and liver steatosis on ultrasound examination. Viral hepatitis, autoimmune, metabolic liver diseases (Wilson disease, alpha-1-antitrypsin deficiency, cystic fibrosis) and drug and toxin-induced liver injury were excluded in all children. The degree of liver steatosis was graded according to Saverymuttu scale and the total liver lipids concentration was assessed using proton magnetic resonance spectroscopy ((1)H MRS). RESULTS: Serum fetuin A concentration was significantly higher in examined children compared to the control group (n=30) (p=0.00002). Higher serum fetuin A concentration was also observed in children with NAFLD (n=19) in comparison to the controls (p=0.000026). Additionally, higher BMI values, waist circumferences, ALT and GGT activity, intensity of liver steatosis on ultrasound and total concentration of lipids in the liver in (1)H MRS were found in children with NAFLD compared to the rest of the examined obese patients (n=26). There was not found any correlation of the investigated glycoprotein with any other assessed parameters both in children with NAFLD and obese children without NAFLD. CONCLUSION: Higher serum fetuin A concentration found in children with NAFLD compared to the control group support the hypothesis that atherosclerotic processes may develop faster in hepatopatic obese patients.

[Analysis of body composition with the use of bioimpedance in children with type 1 diabetes]. / Analiza skladu ciala z uzyciem metody bioimpedancji u dzieci z cukrzyca typu 1.

INTRODUCTION: Patients with diagnosed type 1 diabetes are a group particularly exposed to cardiovascular complications related to obesity. According to some previous data, one of the useful methods to analyze body composition may be a method of bioelectrical impedance. AIM OF THE STUDY: The aim of this research was to make an attempt of finding a correlation between anthropometric indicators and results of lipids profile and data obtained from bioelectrical impedance tests in children with diabetes. MATERIAL AND METHODS: The research sample comprised of 104 children with diabetes type 1 and 313 children without diabetes (a reference group). Anthropometric measurements were made in both groups. Furthermore data from lipids profile results was collected, as well as data from bioelectrical impedance analysis, such as: percentage and quantity (in kilograms) content of adipose tissue, fat-free body mass and total water content in the body. RESULTS: The tested and the reference groups were not different in respect of percentage content of adipose tissue, fat mass, fat-free body mass and total water content in the body. Substantially lower fat mass was noticed among children with overweight or obesity and diabetes than in the control children with overweight/obesity. In the whole sample a connection between percentage fat content and fat mass and standardized body mass index and waist circumference was noticed. The connection was stronger in the reference group, than among children with diabetes. Correlation between percentage content of adipose tissue with the fraction HLD-cholesterol and LDL-cholesterol and values of blood pressure were observed in the whole sample. CONCLUSIONS: The results of our research the confirm correlation between anthropometric parameters and the data collected from bioelectrical impedance. Those connections are, however, stronger in the group of children without diabetes than with diabetes, which questions the usefulness of this method in evaluation of adipose tissue among children treated with insulin.

Thigh circumference as a useful predictor of body fat in adolescent girls with anorexia nervosa.

BACKGROUND/AIM: Girls with anorexia nervosa (AN) demonstrate severe depletion of body fat. The aim of this study was to determine an accurate anthropometric measurement for clinical assessment of fat depletion in girls with AN in connection with body composition measured by dual-energy X-ray absorptiometry (DXA). METHODS: In 64 female AN patients aged 12.8-23.1 years (mean 16.0 ± 1.8), body mass index (BMI), skinfold thickness (subscapular, abdominal and triceps), mid-upper arm and thigh circumference, fat mass (FM) and lean mass were determined and compared with the data of 71 controls. RESULTS: Girls with AN had lower anthropometric traits and were fat depleted compared to controls (14.9 ± 7.3 vs. 27.4 ± 6.4% of FM using DXA; all p < 0.001). BMI, thigh circumference and subscapular skinfold thickness demonstrated a very similar predictive value for DXA assessment of body fat. Based on the receiver-operating characteristic curve analysis and the determination of the positive predictive value, thigh circumference appeared the most specific and sensitive anthropometric predictor of fatness discriminating between AN and healthy girls, with the AUC value reaching 0.95 (95% CI = 0.92-0.97). Using a cutoff value of 49.6 cm, accuracy was 90.6%, sensitivity 93% and specificity 88.7%. CONCLUSIONS: Thigh circumference strongly correlates with DXA-FM and demonstrates a slight clinical advantage over BMI. This simple measurement might also serve as a useful predictor of body fatness in adolescent girls with AN and should therefore be further evaluated in independent cohort studies.

The characteristics of fractures in Polish adolescents aged 16-20 years.

The aim of the study was to identify associations between fractures in childhood and family, anthropometric and lifestyle factors. Among 1,246 subjects aged 16.3-20.6 years (539 boys, 707 girls), based on a questionnaire, 869 were fracture-free while 377 (30.26%) had fractures. Of those reporting fractures, 146 reported multiple fractures (12% of studied population, 39% of all fractures). More boys had fractures than girls (35.6% vs 24.9%, p < 0.001). Fracture sites included: forearm (37%), fingers (23%) wrist (16%), ankle (14%), humerus (10%), tibia (8%) clavicle (7%) and femoral shaft / neck (3%). Among adolescents with multiple fractures, 52% also reported fractures in at least one family member, compared with 29% of those without a fracture history. Fractures in siblings and mothers (but not fathers) accounted for 44% of the liability in adolescents' fractures. Subjects with multiple fractures reported more time at the computer than those without fractures and reported more time participating in team sports, and 18.6% avoided milk, whereas 12.4% of those without fractures reported milk-free diets. Using a logistic regression model, none of the lifestyle factors, except for computer use, were independently associated with fractures. Fractures, particularly multiple fractures, are common in childhood and adolescence. Familial clustering of fractures suggests shared genetic and environmental factors are responsible.