ABSTRACT
The purpose of this study is to compare group B Streptococcus (GBS) infection incidence in HIV-exposed uninfected (HEU) and HIV-unexposed (HU) infants in a Spanish cohort. We conducted a retrospective study in 5 hospitals in Madrid (Spain). Infants ≤ 90 days of life with a GBS infection were included from January 2008 to December 2017. Incidence of GBS infection in HEU and HU children was compared. HEU infants presented a sevenfold greater risk of GBS infection and a 29-fold greater risk of GBS meningitis compared to HU, with statistical significance. Early-onset infection was tenfold more frequent in HEU children, with statistical significance, and late-onset infection was almost fivefold more frequent in the HUE infants' group, without statistical significance. CONCLUSION: HEU infants presented an increased risk of GBS sepsis and meningitis. One in each 500 HEU infants of our cohort had a central nervous system infection and 1 in each 200, a GBS infection. Although etiological causes are not well understood, this should be taken into account by physicians when attending this population. WHAT IS KNOWN: ⢠HIV-exposed uninfected infants are at higher risk of severe infections. ⢠An increased susceptibility of these infants to group B Streptococcus infections has been described in low- and high-income countries, including a higher risk of meningitis in a South African cohort. WHAT IS NEW: ⢠Group B Streptococcal meningitis is more frequent in HIV-exposed uninfected infants also in high-income countries. ⢠Physicians should be aware of this increased risk when attending these infants.
Subject(s)
HIV Infections , Meningitis , Sepsis , Streptococcal Infections , Child , Infant , Humans , HIV Infections/complications , HIV Infections/epidemiology , Retrospective Studies , Risk Factors , Streptococcus agalactiae , Streptococcal Infections/complications , Streptococcal Infections/epidemiologyABSTRACT
OBJECTIVE: Kingella kingae is a common colonizer of the oropharynx in children that may lead to invasive infection, mainly osteoarticular infections. Invasive infections occur almost exclusively in young children, fundamentally fewer than two years old. K. kingae infections in children are probably underdiagnosed due to the difficulty in growing in routine cultures and the absence of systematic realization of molecular techniques to identify it. It is the most common bacteria involved in childhood osteoarticular infections in recent series and increasingly being recognized in Spain. We report our experience on the epidemiological and clinical characteristics of osteoarticular infections in children in recent years. METHODS: Retrospective analysis of septic arthritis by K. kingae identified by PCR in joint fluid in children during 2010-2016. Epidemiological, clinical and laboratory characteristics are presented. RESULTS: Five arthritis by K. kingae were identified, all of them in ≤6 years old children. Median leukocytes, CRP and ESR were 12950 leukocytes/µL, 4.84 mg/dL and 58 mm/h respectively, and 61,322 leukocytes /µL in joint fluid. All patients evolved favorably. CONCLUSIONS: Osteoarticular infections by K. kingae in children usually present low increase of inflammatory markers despite being invasive infections. The development of PCR in sterile samples has greatly improved the diagnostic yield of K. kingae infections improving the management of osteoarthritis in children.
Subject(s)
Arthritis, Infectious/etiology , Arthritis, Infectious/microbiology , Kingella kingae , Neisseriaceae Infections/complications , Neisseriaceae Infections/microbiology , Body Fluids/microbiology , Child , Child, Preschool , Female , Humans , Infant , Joints , Male , Osteomyelitis/microbiology , Polymerase Chain Reaction , Retrospective StudiesABSTRACT
BACKGROUND: The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. MATERIAL AND METHODS: A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). RESULTS: A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p<0.05). CONCLUSIONS: VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population.
Subject(s)
Communicable Diseases, Imported/epidemiology , Malaria/epidemiology , Travel-Related Illness , Adolescent , Africa South of the Sahara/ethnology , Antimalarials/therapeutic use , Asia/ethnology , Child , Child, Preschool , Communicable Diseases, Imported/prevention & control , Comorbidity , Delayed Diagnosis , Emigrants and Immigrants/statistics & numerical data , Equatorial Guinea/ethnology , Female , Hospitals, Urban/statistics & numerical data , Humans , Infant , Malaria/drug therapy , Malaria/prevention & control , Male , Retrospective Studies , Seasons , Spain/epidemiologyABSTRACT
Individual responses to growth hormone (GH) treatment are variable. Short-term generation of insulin-like growth factor-I (IGF-I) is recognized as a potential marker of sensitivity to GH treatment. This prospective, phase IV study used an integrated genomic analysis to identify markers associated with 1-month change in IGF-I (ΔIGF-I) following initiation of recombinant human (r-h)GH therapy in treatment-naïve children with GH deficiency (GHD) (n=166) or Turner syndrome (TS) (n=147). In both GHD and TS, polymorphisms in the cell-cycle regulator CDK4 were associated with 1-month ΔIGF-I (P<0.05). Baseline gene expression was also correlated with 1-month ΔIGF-I in both GHD and TS (r=0.3; P<0.01). In patients with low IGF-I responses, carriage of specific CDK4 alleles was associated with MAPK and glucocorticoid receptor signaling in GHD, and with p53 and Wnt signaling pathways in TS. Understanding the relationship between genomic markers and early changes in IGF-I may allow development of strategies to rapidly individualize r-hGH dose.
Subject(s)
Growth Disorders/drug therapy , Human Growth Hormone/deficiency , Human Growth Hormone/therapeutic use , Insulin-Like Growth Factor I/analysis , Polymorphism, Single Nucleotide , Turner Syndrome/drug therapy , Adolescent , Child , Child, Preschool , Cyclin-Dependent Kinase 4/genetics , Female , Gene Expression Profiling , Growth Disorders/blood , Growth Disorders/genetics , Hormone Replacement Therapy , Humans , Infant , Male , Prospective Studies , Recombinant Proteins , Transcriptome , Turner Syndrome/blood , Turner Syndrome/geneticsABSTRACT
OBJECTIVE: Individual sensitivity to recombinant human GH (r-hGH) is variable. Identification of genetic factors contributing to this variability has potential use for individualization of treatment. The objective of this study was to identify genetic markers and gene expression profiles associated with growth response on r-hGH therapy in treatment-naïve, prepubertal children with GH deficiency (GHD) or Turner syndrome (TS). DESIGN: A prospective, multicenter, international, open-label pharmacogenomic study. METHODS: The associations of genotypes in 103 growth- and metabolism-related genes and baseline gene expression profiles with growth response to r-hGH (cm/year) over the first year were evaluated. Genotype associations were assessed with growth response as a continuous variable and as a categorical variable divided into quartiles. RESULTS: Eleven genes in GHD and ten in TS, with two overlapping between conditions, were significantly associated with growth response either as a continuous variable (seven in GHD, two in TS) or as a categorical variable (four more in GHD, eight more in TS). For example, in GHD, GRB10 was associated with high response (≥ Q3; P=0.0012), while SOS2 was associated with low response (≤ Q1; P=0.006), while in TS, LHX4 was associated with high response (P=0.0003) and PTPN1 with low response (P=0.0037). Differences in expression were identified for one of the growth response-associated genes in GHD (AKT1) and for two in TS (KRAS and MYOD1). CONCLUSIONS: Carriage of specific growth-related genetic markers is associated with growth response in GHD and TS. These findings indicate that pharmacogenomics could have a role in individualized management of childhood growth disorders.
Subject(s)
Human Growth Hormone/deficiency , Human Growth Hormone/therapeutic use , Polymorphism, Single Nucleotide , Protein Tyrosine Phosphatase, Non-Receptor Type 1/genetics , Son of Sevenless Proteins/genetics , Turner Syndrome/drug therapy , Turner Syndrome/genetics , Body Height/drug effects , Child , Child Development/drug effects , Drug Resistance , Female , Follow-Up Studies , GRB10 Adaptor Protein/genetics , GRB10 Adaptor Protein/metabolism , Genome-Wide Association Study , Growth Disorders/etiology , Growth Disorders/prevention & control , Hormone Replacement Therapy , Humans , LIM-Homeodomain Proteins/genetics , LIM-Homeodomain Proteins/metabolism , Male , Prospective Studies , Protein Tyrosine Phosphatase, Non-Receptor Type 1/metabolism , Recombinant Proteins/therapeutic use , Son of Sevenless Proteins/metabolism , Transcription Factors/genetics , Transcription Factors/metabolism , Turner Syndrome/blood , Turner Syndrome/metabolismABSTRACT
BACKGROUND: Whereas no clear relationship has been observed between varicocelectomy and serum inhibin B levels in men, in adolescents comparison between inhibin B levels before and after varicocelectomy is lacking. AIM: To evaluate the effect of varicocele surgical treatment on inhibin B levels in adolescents at the beginning of puberty compared to a group of healthy adolescents. SUBJECTS AND METHODS: We studied 28 adolescents in Tanner 2 pubertal stage with a grade III left-sided varicocele (patients) compared to 13 age and pubertal stage-matched healthy adolescents (controls). All patients underwent blood tests to determine serum inhibin B levels before and 6 months after varicocelectomy by Palomo procedure. For comparison we investigated inhibin B levels in controls and repeated this test 6 months later. Testicular ultrasound was performed for patients only. RESULTS: Baseline inhibin B concentrations of patients and controls were 109.90 ± 40.26 and 109.33 ± 38.34 pg/ml, respectively. No significant changes were observed in patients' inhibin B concentrations after varicocelectomy (116.00 ± 42.65 pg/ml), or in controls during the 6 months' follow-up (99.12 ± 30.09 pg/ml). Doppler examination after treatment shows a complete resolution of varicocele in all the patients without alterations in testicular parenchyma. CONCLUSIONS: Varicocelectomy performed on adolescents at T2 pubertal stage might be useful to avoid alteration in inhibin B production and consequently in testicular function. Further studies are necessary to confirm the prognostic value of inhibin B levels and the benefit of early varicocelectomy in preserving the fertility of these adolescents.
Subject(s)
Inhibins/blood , Varicocele/surgery , Adolescent , Child , Humans , Male , Testis/anatomy & histology , Testis/diagnostic imaging , Testis/physiology , Testis/surgery , UltrasonographyABSTRACT
INTRODUCTION: Kawasaki disease is the leading cause of acquired heart disease in children. In spite of the efficacy of intravenous immunoglobulin (IGIV), the absence of a specific diagnostic test and due to there being IGIV-refractory patients, Kawasaki disease is a major cause of coronary artery abnormalities (CAA). OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of Kawasaki disease, to evaluate the efficacy of treatments used and the CAA observed. METHODS: We retrospectively reviewed the medical records of children diagnosed with Kawasaki disease between January 2002 and December 2008 in a tertiary public Hospital in the South of Madrid. The diagnosis of Kawasaki disease was based on the clinical criteria proposed by the American Academy of Pediatrics in 2004. RESULTS: Twenty three children were identified. Median age was 26 months (range: 2 months-10 years). Nineteen children (82%) were younger than 5 years old. Fever and changes in the lips and oral cavity were present in all cases. Twenty-one patients (91%) received IGIV, all of them before the 10th day of disease. One child (4.7%) required the administration of more than one dose of IGIV, because persistence of fever. CAA was recorded in three patients [13.0%, (95% CI: 1-26%)], including a four month-old boy. All patients with CAA were treated with the recommended dose of IGIV, 2g/kg, between the 5th and 8th day of disease. CONCLUSIONS: Kawasaki disease was more common in children less than five years old. We observed a high rate of CAA in children with Kawasaki disease in spite of appropriate and timely treatment.
Subject(s)
Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/therapy , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
AIM: The aim of this paper was to evaluate the impact of thyroid morphology on auxological and neuropsychological development in children affected by congenital hypothyroidism (CH), treated with levothyroxine, up to 8 years of age. METHODS: Fifty-three children affected by CH divided into 3 groups on the basis of thyroid morphology determined at birth: patients with athyreosis (N=17), with ectopic gland (N=23), with in situ thyroid (N=13). The developmental quotient (DQ) was evaluated by the Brunet-Lezine test up to 3 years, and intelligent quotient (IQ) by the Terman-Merril test after 3 years of age. RESULTS: DQs at one year in athyreotic patients are lower (P<0,05) as compared to those determined in patients with other thyroid morphology. Later on these patients still showed lower DQ and IQ values than in other groups, although statistically not significant. CONCLUSION: Thyroid morphology seems to be fundamental in psychomotor development, in fact patients with athyreosis show a transient impairment at one year of age. This difference could be transient or to have repercussions on adult. Individualization of the starting dose of levothyroxine on the basis of thyroid morphology, could be useful.
Subject(s)
Congenital Hypothyroidism/complications , Congenital Hypothyroidism/pathology , Psychomotor Disorders/etiology , Thyroid Gland/pathology , Child , Child, Preschool , Follow-Up Studies , Humans , Infant , Time FactorsABSTRACT
INTRODUCTION: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. METHODS: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. RESULTS: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months - 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. CONCLUSIONS: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective.
Subject(s)
Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Adolescent , Amphotericin B/therapeutic use , Animals , Antiprotozoal Agents/therapeutic use , Child , Child, Preschool , Female , Humans , Infant , Leishmaniasis, Visceral/parasitology , Male , Meglumine/therapeutic use , Meglumine Antimoniate , Organometallic Compounds/therapeutic use , Retrospective StudiesABSTRACT
INTRODUCTION: Attention deficit disorder and hyperactivity (ADDH), is a condition that affects the normal development of children. The symptoms include difficulty of controlling physical activity, inattention and learning disorders. The ADDH must be diagnosed in accordance with the clinical findings defined in the DSM IV. OBJECTIVE: To describe the epidemiology and clinical characteristics of children diagnosed with ADDH in our hospital. MATERIAL AND METHODS: Biannual observational study. Variables evaluated were: age, sex, personal and family medical history, symptoms, therapy and treatment response. RESULTS: There 83 participants (87 % Male and 13 % Female), of which 32.5 % were diagnosed during the study. Ages ranged from 3-8 years (84 %). There was a family history related to ADDH in 38 % of patients, and personal history of prematurity, acute foetal distress, small for gestational age, convulsions were reported. Association of hyperactivity and attention deficit was found in 65 % of participants. Other related symptoms were cognitive disorder (62 %), language disabilities (41 %) and motor disorders (35 %). Treatment was on-going in 65 % of the patients, 27.7 % of them having adverse effect. Evolution with therapy was favourable in 61 %. CONCLUSIONS: These findings suggest that ADDH is one of the most common childhood psychiatric disorders, mainly affecting boys. There is usually a family history. Failure in school was one of the principal conditions. Association between attention deficit and hyperactivity, mainly hyperactivity, is the most common presentation. Other disorders such as motor and language disabilities are also common in these patients. Methylphenidate showed favourable outcomes in 61 % of the patients studied.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Retrospective StudiesABSTRACT
INTRODUCTION: Group B Streptococcus (GBS) is a major cause of neonatal infection. Two forms of the disease have been described according to the age of presentation: early, beginning in the first 6 days of life, and late, occurring from day 7 up to 3 months of age. OBJECTIVES: To analyze the epidemiology of the late onset form of GBS disease in a tertiary hospital after implementing preventive strategies aimed to reduce the rate of vertical transmission. METHODS: We retrospectively reviewed the medical records of children diagnosed with late GBS infection between January 2000 and December 2006. Diagnostic criteria included a positive blood culture and/or a positive cerebrospinal fluid (CSF) culture for GBS in any patient aged between 7 and 89 days. RESULTS: 24 patients were identified, most of them presenting after January 2005. Median age was 36.2 days (range 9 to 81). GBS isolates in blood were found in 20 patients, 1 in CSF and 3 in both. Most frequently children presented with fever (70.8 %) and irritability (54.1 %). Five patients (20.8 %) had a cellulitis-adenitis syndrome. Cefotaxime and ampicillin were the most often used antibiotic combination. No ampicillin resistances were found. CONCLUSIONS: The number of children with late GBS disease has increased in our center. Accordingly, the recent recommendations for the prevention of perinatal GBS vertical transmission were not effective for reducing late GBS infection. This may be due to horizontal infections from maternal sources, community or cross infections. It is important to maintain clinical suspicion of late GBS infection and start early antibiotic treatment.
Subject(s)
Streptococcal Infections/epidemiology , Streptococcus agalactiae/isolation & purification , Age of Onset , Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Hospitals/statistics & numerical data , Humans , Incidence , Infant , Infant, Newborn , Prevalence , Retrospective Studies , Spain/epidemiology , Streptococcal Infections/cerebrospinal fluid , Streptococcal Infections/drug therapyABSTRACT
INTRODUCTION: The quantity, type and composition of snack foods may play a role in the development and maintenance of obesity in children. A high consumption of energy-dense snacks may promote fat gain. AIMS: To assess the type and number of snacks consumed weekly by a large sample of 8- to 10-year-old children, as well as to assess its relationship with body size. RESULTS: The children consumed on average 4 snacks per day. There was no statistical difference in the number of servings per day between obese and nonobese children. However, the mean energy density of the foods consumed was significantly higher for obese and overweight children than for normal weight children [6.8 (0.3) kJ/g, 6.8 (0.16) kJ/g, and 6.3 (0.08) kJ/g, respectively; P < 0.05]. Logistic regression analysis showed that the energy density of the snacks (kJ/g), their savory taste (servings/week), television viewing (hours/day) and sports activity (hours/week) independently contributed to predict obesity in children. However, when the parents' body mass index was included among the independent variables of the regression, only salty foods and sports activity showed an independent association with childhood obesity. CONCLUSIONS: Parents' eating habits and lifestyle influence those of their children, as suggested by the association between parents' obesity and their children's energy-dense food intake at snacktime, the savory taste of snacks and sedentary behavior. However, regardless of parents' body mass index, the preference for savory snacks seems to be associated with overweight in prepubertal children.
Subject(s)
Child Nutritional Physiological Phenomena/physiology , Diet Surveys , Energy Intake/physiology , Exercise/physiology , Overweight/epidemiology , Taste , Body Mass Index , Child , Feeding Behavior/physiology , Female , Humans , Leisure Activities , Life Style , Logistic Models , Male , Nutritive Value , Overweight/etiology , Parents/psychology , Predictive Value of Tests , Prevalence , Risk Factors , Surveys and QuestionnairesABSTRACT
GH replacement therapy exhibits a wide spectrum of response in terms of growth. Nevertheless, standardized doses are still given in clinical practice. In order to optimize the therapy, it is necessary to identify its markers of responsiveness. Given the presence of GH receptors in the circulating lymphocytes, accessible by means of a simple blood withdrawal, blood becomes the tissue of choice as a source of RNA for in vivo gene expression analysis. Hence, the purpose of the present paper is to develop a method of preparation of RNA from lymphocytes suitable for microarray analysis, focusing on the reduction of the blood volume withdrawal in order to perform the analysis on pediatric subjects. After lymphocyte isolation and total RNA extraction from 6 ml of blood, we carried out an amplification procedure preserving the relative abundance of each transcript. Thereafter, we hybridized the labeled amplified RNA on an oligo chip (Human 30K A, MWGBiotech), but the unsuccessful detection of a good signal to noise ratio indicates that labeled RNA is still insufficient. Therefore, we suggest performing pools of total RNA from different subjects with similar responsiveness to the therapy. It can be speculated that, upon comparison of the obtained data with those derived from pools of controls properly responding to the therapy, specific hallmarks of the condition of low responsiveness, devoid of inter-individual variability, will be evidenced.
Subject(s)
Gene Expression Profiling , Growth Disorders/drug therapy , Growth Hormone/therapeutic use , Hormone Replacement Therapy , Lymphocytes/chemistry , Oligonucleotide Array Sequence Analysis , RNA, Messenger/isolation & purification , Adolescent , Child , Chromatography , Female , Growth Disorders/blood , Growth Disorders/genetics , Humans , Lymphocytes/metabolism , Male , Molecular Diagnostic Techniques , Nucleic Acid Hybridization , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Staining and LabelingABSTRACT
AIM: The aim of this study was to examine an international population of children who started toilet training in the first year of life. METHODS: Two hundred eighty-six participants completed an anonymous questionnaire. Main outcomes variables were: presence of elimination signals (ES), elimination pattern consistency (EPC), stool toileting refusal (STR), and toilet training completion age. The analysis included the differences in completion age regarding each of the following variables: start age range, presence of ES, EPC, STR and country of residency for those who completed either bowel or bladder training at the time of survey completion. RESULTS: Over 90% of the respondents reported that their children showed ES. STR was nearly 12%. For those who completed toilet training at the time of survey completion mean completion ages for daytime dryness and bowel control were 17.4 and 15.0 months, respectively; those who initiated toilet training during the first 6 months completed training earlier than those who started later; those who showed STR at the beginning of training completed bowel training later than those who did not (P<0.001); those who exhibited ES for voiding or bowel movements completed day-dryness and bowel training earlier than those who did not (P<0.001). Among countries of residency, those children who resided in the USA and Canada completed bowel training the earliest (P<0.001). CONCLUSION: This is the first report which provides data on the current infant toilet training method, which is based mainly on ES and patterns, and practiced by motivated caregivers. Notable side effects were not observed.
Subject(s)
Child Development , Defecation , Infant Behavior , Toilet Training , Urination , Analysis of Variance , Canada , Child Behavior , Child, Preschool , China , Europe , Female , Health Surveys , Humans , Infant , Male , Surveys and Questionnaires , United StatesABSTRACT
Toilet training is an essential issue in child education, and its completion represents a developmental milestone. Although for the last 40 years the Western medical community has recommended to start toilet training after 18 months of age, today a growing number of parents are accepting assistant infant toilet training that can begin relatively soon after birth. As currently practiced, assisted infant toilet training emphasizes infant-caregiver communication for the gradual acquisition of bowel and bladder control. Signals emitted by the infant lead the caregiver during elimination assistance. This review will help the reader to understand this new phenomenon.
Subject(s)
Toilet Training , Child Rearing/trends , Child, Preschool , Humans , InfantSubject(s)
Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Osteogenesis Imperfecta/drug therapy , Respiratory Function Tests , Respiratory Insufficiency/diagnosis , Fatal Outcome , Female , Humans , Infant , Osteogenesis Imperfecta/complications , Osteogenesis Imperfecta/genetics , Point Mutation , Respiratory Insufficiency/etiologyABSTRACT
Subclinical hypothyroidism is defined as a serum TSH level above the statistically set reference range, associated to normal free thyroid hormone concentrations. Genetic and environmental factors contribute to the inter- and intra-individual biological variations of TSH levels, sometimes leading to uncertainty of treatment in the clinical practice, especially when moderate elevations above the upper limit of the reference range are considered (5< TSH <10 mIU/l). In this view, the study of association between subclinical hypothyroidism and possible molecular effectors, such as polymorphisms in the TSH receptor (TSHR) gene, could be interesting. In this paper, we analyzed the TSHR gene polymorphisms in 103 hyperthyrotropinemic infants. A control group of 120 newborns of the same ethnic background was used to evaluate the frequencies of each polymorphism in the population. We found a statistically significant difference in the allelic frequency of the P52T polymorphism, being that the T variant was more represented in the control group (p=0.03). However, no significant results have been obtained in the analysis of the association between genotypes and serum TSH levels. In conclusion, we analyzed 7 polymorphic variants of TSHR gene in subclinical hypothyroidism. The only significant result refers to the allelic frequency of A in the P52T polymorphism, which is statistically reduced when compared with that of a control group.
Subject(s)
Hypothyroidism/metabolism , Polymorphism, Genetic/genetics , Receptors, Thyrotropin , Child , Child, Preschool , Female , Genetic Linkage/genetics , Humans , Hypothyroidism/genetics , Infant , Infant, Newborn , Male , Receptors, Thyrotropin/genetics , Receptors, Thyrotropin/physiologyABSTRACT
Bone development is a key process in the growing child. It is, therefore, of paramount importance to survey this process, which is characterized by increasing length and size of the bone together with its progressive mineralization. The bone status can be evaluated by different techniques, each of them having its pros and cons. Furthermore, it should be underlined that the results of bone assessment depend not only from the employed technique but also from the auxological characteristics of the subjects. It is, therefore, the aim of this review to examine the characteristics of the various methods of bone evaluation, such as dual energy X-ray absorptiometry (DEXA), peripheral quantitative computed tomography (pQCT), ultrasound and metacarpal index and to explain how changes in bone structure and geometry may influence the results.