Vol 4-1 Mini Review

Perturbations in Cellular Bioenergetics: Childhood Obesity, Dyslipidemia, Diabetes and Hypoglycemia

Noura Al Hassani1, Abdul-Kader Souid2*

1Department of Pediatrics, Tawam Hospital, Alain, United Arab Emirates (UAE)

2Department of Pediatrics, College of Medicine and Health Sciences - UAE University, Alain, UAE

One-third of children and adolescents are currently classified as overweight or obese. This epidemic childhood disease is the origin of adult obesity and its associated cardiovascular diseases. Dyslipidemia is also well-recognized risk of cardiovascular disease that often starts in childhood. Breasfeeding lowers the risks of obesity and dyslipidemia later in life and it should be encouraged. Type 1 diabetes (T1D) is an immune-mediated destruction of the pancreatic islets. It is often associated with other autoimmune disorders, such as chronic lymphocytic thyroiditis and celiac disease. Children with T1D require insulin to ‎prevent fatty acid oxidation regardless of their blood glucose level. Exercise can induce hypoglycemia in a child with T1D, as glucose utilization and insulin sensitivity increase. Thus, children with T1D need to check their blood glucose before, during, and after the activity. Type 2 diabetes (T2D) represents an insulin deficiency due to obesity and genetic susceptibility; glucose is overproduced by the liver and underused by the muscles. Thus, healthy diet and regular exercise are the recommended remedies for this condition.

DOI: 10.29245/2578-2940/2020/1.1155 View / Download Pdf
Vol 4-2 Short Communication

Kawasaki Disease, Multisystem Inflammatory Syndrome in Children: Antibody-Induced Mast Cell Activation Hypothesis

Darrell O. Ricke1*, Nicole Gherlone2, Philip Fremont-Smith1, Philip Tisdall3, Maurice Fremont-Smith2

1MIT Lincoln Laboratory, USA

2Frank H. Netter MD School of Medicine – Quinnipiac University, USA

3Medical School Companion LLC, USA

Multisystem Inflammatory Syndrome in Children (MIS-C) is appearing in infants, children, and young adults in association with COVID-19 (coronavirus disease 2019) infections of SARS-CoV-2. Kawasaki Disease (KD) is one of the most common vasculitides of childhood. KD presents with similar symptoms to MIS-C especially in severe forms such as Kawasaki Disease Shock Syndrome (KDSS). The observed symptoms for MIS-C and KD are consistent with Mast Cell Activation Syndrome (MCAS) characterized by inflammatory molecules released from activated mast cells. Based on the associations of KD with multiple viral and bacterial pathogens, we put forward the hypothesis that KD and MIS-C result from antibody activation of mast cells by Fc receptor-bound pathogen antibodies causing a hyperinflammatory response upon second pathogen exposure. Within this hypothesis, MIS-C may be atypical KD or a KD-like disease associated with SARS-CoV-2. We extend the mast cell hypothesis that increased histamine levels are inducing contraction of effector cells with impeded blood flow through cardiac capillaries. In some patients, pressure from impeded blood flow, within cardiac capillaries, may result in increased coronary artery blood pressure leading to aneurysms, a well-known complication in KD.

DOI: 10.29245/2578-2940/2020/2.1157 View / Download Pdf
Vol 4-2 Mini Review

Monitoring Viscoelastic Blood Properties during Pediatric Cardiac Surgery: The Challenge of Data Driven Hemostasis

Zhe Amy Fang1, Meena Nathan2, Sirisha Emani2, Sitaram Emani2, Juan C. Ibla3*

1Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada

2Department of Cardiac Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

3Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

Thromboelastography, a point of care graphical representation of the activation of coagulation and fibrin polymerization process, assists clinicians in making diagnostic and transfusion-related decisions in the perioperative setting. There is growing interest in applying this technology to pediatric cardiac surgery and this article reviews the currently available evidence for the use of thromboelastography (TEG) and thromboelastometry (ROTEM) in this population. A few studies exist on the use of TEG/ROTEM to accurately guide transfusion and positively impacting patient outcomes, indicating a need for additional studies to validate its utility during pediatric cardiac surgery.

DOI: 10.29245/2578-2940/2020/2.1158 View / Download Pdf