Background: Obese individuals are often in a chronic inflammatory condition due to the malfunction of immune-related activities in the adipose tissue, involving a transient infiltration of neutrophils within the abdominal fat and their binding to adipocytes. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are considered cost-effective markers for the detection of subclinical inflammation. Our study intends to assess the early stages of inflammation associated with overweight and obesity in children. Materials and Methods: We performed a prospective study with 164 children, aged between 5 and 18 years, admitted to a Pediatric Tertiary Hospital in Romania between January 2018 and January 2019. The patients were divided according to body mass index (BMI) into two groups: Group 1: 77 overweight and obese children (BMI percentile ≥85), and Group 2: 87 children with a normal BMI, in order to evaluate the correlation between BMI and laboratory parameters (CBC, ESR, transaminase, total protein, albumin, and blood glucose levels), inflammatory biomarkers, NLR and PLR, and changes in abdominal ultrasound findings. Results: We found that the leukocyte, lymphocyte, erythrocyte, platelet, CRP, and transaminase levels were significantly higher in the overweight/obese group ( p = 0.0379, p = 0.0002, p = 0.0003, p = 0.0006, p < 0.0001, p = 0.0332, and p < 0.0001, respectively). No significant statistical differences between the two groups in terms of neutrophil, hemoglobin, albumin, total protein, and glycemia levels were noted ( p > 0.05). Moreover, NLR and PLR did not differ significantly between the two groups ( p = 0.4674 and p = 0.9973, respectively). Conclusions: Obesity is associated with systemic low-grade inflammation which is reaching alarming rates worldwide among both children and adults. Our study proved that leukocyte, lymphocyte, erythrocyte, and platelet levels are significantly higher in overweight/obese children, emphasizing the inflammatory status related to this condition. Therefore, obesity-related studies involving pediatric patients are of major interest in order to develop appropriate methods to prevent the development of further complications in adulthood.
Innate immunity represents the first barrier against bacterial invasion. Toll-like receptors (TLRs) belong to the large family of pattern recognition receptors (PRRs), and their activation leads to the induction of inflammatory cytokines, chemokines, antigen-presenting molecules, and costimulatory molecules. Recent studies have focused on identifying the association between TLRs andHelicobacter pylori- (H. pylori-) related diseases. Therefore, this minireview focuses on assessing the role of these TLRs in the development ofH. pylori-related gastropathies. Both TLR2 and TLR were found to be involved inH. pyloriLPS recognition, with contradictory results most likely due to both the inability to obtain pure LPS in experimental studies and the heterogeneity of the bacterial LPS. In addition,TLR2was found to be the most extensively expressed gene among all the TLRs in gastric tumors. High levels of TLR4 were also associated with a higher risk of gastric cancer. TLR5 was initially associated with the recognition ofH. pyloriflagellin, but it seems that this bacterium has developed mechanisms to escape this recognition representing an important factor involved in the persistence of this infection and subsequent carcinogenesis. TLR9, the only TLR with both anti- and proinflammatory roles, was involved in the recognition ofH. pyloriDNA. The dichotomous role of TLR9, promoting or suppressing the infection, depends on the gastric environment. Recently, TLR7 and TLR8 were shown to recognize purifiedH. pyloriRNA, thereby inducing proinflammatory cytokines.TLR1andTLR10gene polymorphisms were associated with a higher risk for gastric cancer inH. pylori-infected individuals. Different gene polymorphisms of these TLRs were found to be associated with gastric cancer depending mostly on ethnicity. Further studies are required in order to develop preventive and therapeutic strategies againstH. pyloriinfections based on the functions of TLRs.
The aim of our study was to investigate the impact of interleukin (IL)-6 190C/T, IL-6 174G/C, IL-6 572G/C, tumor necrosis factor-alpha (TNF-α) 308G/A, and angiotensin-converting enzyme (ACE) I/D gene polymorphisms on Helicobacter pylori (H. pylori) infection in children.A cross-sectional study was performed on 126 children (57 children with H. pylori infection and 69 children without H. pylori infection) aged between 3 and 18 years presenting to a Pediatrics Tertiary Hospital from Romania. Children were assessed clinically, endoscopically, histopathologically, and genetically.In our study, we found that the presence of the CT and CT+TT genotypes of IL-6 190C/T (P < .002 and P = .04), allele G of IL-6 572 G/C polymorphism (P = .01), genotypes GA and AA of TNF-α 308 G/A polymorphism (P = .04, P = .01), and genotype II of ACE I/D polymorphism (P = .02) were associated with H. pylori infection, while the CC genotype of IL-6 174G/C polymorphism was scarcely encountered in children with H. pylori infection [P = .02, odds ratio (OR) = 0.06; 95% confidence interval (95% CI): 0.003–0.128]. Taking under consideration the 4 variant genotypes (IL-6 572G/C, IL-6 190C/T, TNF-α 308G/A, and ACE I/D), we noticed a 2 times higher incidence of H. pylori infection (OR = 6.34; 95% CI: 2.15–25.8).We may consider that the IL-6 190C/T, IL-6 174G/C, IL-6 572G/C, TNF-α 308G/A, and ACE I/D gene polymorphisms may increase the children's susceptibility for acquiring H. pylori infection; therefore, they may contribute to the pathogenesis of H. pylori gastritis.
Neutrophil to lymphocyte ratio (NLR) is a simple, noninvasive, inexpensive inflammatory marker that can useful in the assessment of inflammatory activity, especially in pediatric ages. The aim of our study was to establish correlations between the presence of Helicobacter pylori (HP) proved histologically and NLR in children. A prospective, case–control study was performed on 137 pediatric patients aged between 1 and 18 years, admitted in a Pediatric Tertiary Hospital from Romania, between April 2016 and January 2018. According to the histologic examination, the children were divided into 2 groups: group 1: 50 children with HP infection, and group 2: 87 children without any pathologic findings. The mean age for the study group was 12.86 ± 3.796 years, whereas for control group, it was 12.10 ± 3.879 years ( P = .3001). HP infection was significantly more frequent among children from rural area ( P = .0089). Epigastric pain and loss of appetite were significantly associated with HP infection ( P = .0350 / P = .0281). We noticed that the leukocyte and neutrophil counts were significantly higher in group 1 ( P = .0076/ P = .0306). We did not find any significant statistical differences between the 2 groups in terms of lymphocytes, erythrocyte sedimentation rate, and NLR or other assessed laboratory parameters. Regarding the IgA antibodies anti-HP and rapid urease test, they were both significantly associated with histologically confirmed HP infection ( P < .0001). Even though, we did not identify significant differences in term of NLR between HP-induced gastritis children and healthy controls, the mean NLR values were higher HP-positive patients.
Rationale:The treatment of iron-deficiency anemia with oral iron supplements can present side-effects on the GI tract mucosa including necrosis, ulceration, or ischemia. The particular endoscopic findings and the histopathological exam will establish the diagnosis of erosive gastritis with iron deposits in the gastric mucosa.Patient concerns:We present the case of a 14-year-old female admitted in our clinic for upper digestive hemorrhage, nausea, melena, and abdominal pain. Her personal history revealed iron deficiency anemia receiving oral iron supplements for approximately 2 weeks.Diagnosis:The laboratory tests at the moment of admission pointed out anemia, increased level of serum iron, increased liver transaminases, a decreased level of ferritin, but with normal levels of both total iron-binding capacity and transferrin.Interventions:The eso-gastro-duodenoscopy revealed multiple brown deposits on the surface of the gastric mucosa and multiple hemorrhagic lesions, under the aspect of erosions all over the gastric mucosa, but more severe in the antral part, and the histopathological exam confirmed the presence of iron deposits at this level.Conclusion:Iron-pill induced gastritis is a rare, under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact.
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