Síndrome nefrótico resistente a corticoides en pediatría, actualización / Steroid-resistant nephrotic syndrome in pediatrics, an update

El síndrome nefrótico (SN) constituye la glomerulopatía más frecuente en pediatría. El pilar del tratamiento con-tinúa siendo la terapia con corticoides. Dependiendo de la respuesta se clasifica en síndrome nefrótico corti-coresistente (SNCR) y corticosensible. La mayoría de los pacientes con SNCR tienen glomeruloesclerosis focal y segmentaria, asociada con 50% de riesgo de enfermedad renal terminal, por lo que se recomienda biopsia renal. Es importante realizar pruebas genéticas, ya que ciertas mutaciones resultan en corticorresistencia, siendo la mutación del gen NPHS2 (podocina) la más relacionada. Este artículo es una revisión de la literatura mundial y nacional acerca del SNCR en pediatría, enfatizando en nuevos enfoques de diagnóstico y tratamiento

Nephrotic syndrome (NS) is the most frequent glomerulopathy in pediatrics. The mainstay of treatment continues to be corticosteroid therapy. Depending on the response, it is classified as corticosteroid nephrotic syndrome (SNCR) and corticosensitive syndrome. Most patients with SNCR have focal and segmental glomerulosclerosis, associated with a 50% risk of end-stage renal disease, and renal biopsy is recommended. It is important to perform genetic tests, since certain mutations result in corticoresistance, with the mutation of NPHS2 gene (podocin) being the most related. This article is a review of the global and national literature on SNCR in pediatrics, emphasizing new approaches to diagnosis and treatment.

Obesidad infantil, nuevo reto mundial de malnutrición en la actualidad / Childhood obesity, new worldwide challenge of malnutrition

Antecedentes: La obesidad infantil es un problema grave de salud pública que a lo largo del tiempo ha ganado importancia ya que años atrás el concepto de gordura era sinónimo de belleza. La obesidad es una enfermedad crónica, compleja y multifactorial, de inicio en la infancia, causada por una interacción genética y ambiental. Es el principal factor de riesgo para diferentes enfermedades crónicas. Objetivo: Profundizar el conocimiento a través de la identificación, valoración y análisis de las causas, factores de riesgo, comorbilidades y abordaje médico.Metodología: El presente documento es resultado de una investigación de tipo analítico producto de búsqueda bibliográfica de bases de datos como Pubmed, Ovid, Rima, UpToDate y Clinical Key. Además se recolectó una muestra de pacientes locales con el fin de tener un dato estadístico propio. Resultados: Con la revisión se eviden-cióel incremento mundial de la prevalencia de esta entidad asociada a otras comorbilidades. Los niños obesos sin tratamiento mantendrán esta condición hasta la adultez desarrollando prematuramente patologías cardiovascu-lares. Conclusión: La obesidad infantil es la epidemia mundial del siglo XXI, donde no hay exclusión de clase social, género o cultura por lo que se debe implementar un estilo de vida saludable desde el núcleo familiar y escuelas, apoyado por los medios de comunicación y autoridades gubernamentales. Con la muestra recolectada a nivel local se corroboró que nuestra población no es ajena a esta problemática global.

Background: The childhood obesity is a serious public health problemthat over time has acquired importance because years ago the concept of fatness was synonym of beauty. Obesity is a chronic, complex and mulifactorial disease. It begins in childhood and can be caused started in the childhood caused by genetical and environmental interaction. It is the main risk factor to different chronic pathologies. Objective: Increase knowledge by means of the identification, evaluation and analysis of the causes, risk factors, comorbidities and appropiate medical assessment. Methods: The present article is an analytical study product of bibliographical research of databases like Pubmed, Ovid, Rima, UpToDate and Clinical Key. Besides a local patient sample was collected with the purpose to get own statistics. Results: With the current research we proved worldwide prevalence increase of this disease associated to other comorbidities. Obese chidren without treatment will keep this condition until adulthood get-ting prematurely cardiovascular diseases. Conclusion: Childhood obesity is the XXI century worlwide epidemicwith no social, gender or cultural exclusion. Therefore it is important to implement a healthy lifestyle from the nuclear family and schools supported by the communication media and governmental authorities. The collected local sample showed that our population is not outside of to this global problematic.

Distribution of HLA class II alleles and haplotypes in Mexican Mestizo population: comparison with other populations.

We describe the analysis of the Major Histocompatibility Complex (MHC) class II polymorphism in Mexican Mestizo population. The study provides the HLA-DRB1, DQA1 and DQB1 allele frequencies in 99 Mexican Mestizos. DNA from these individuals was typed by PCR followed by hybridization using sequence specific oligonucleotides (PCR-SSO). The relationship with other worldwide populations was studied by using HLA data from 69 different populations and calculating neighbor-joining dendrograms and correspondence multidimensional values. The highest frequencies were for DRB1*0802 (allele frequency = 0.151), DRB1*0701 (allele frequency = 0.111) and DRB1*0407 (allele frequency = 0.106). Among the eight DQA1 alleles detected, the most frequent were DQA1*03011 (allele frequency = 0.257), DQA1*0501 (allele frequency = 0.227) and DQA1*0401 (allele frequency = 0.166). Twelve DQB1 alleles were found and four of them, DQB1*0302 (allele frequency = 0.237), DQB1*0301 (allele frequency = 0.176), DQB1*0201 (allele frequency = 0.166) and DQB1*0402 (allele frequency = 0.166) showed the highest frequencies. The haplotype DRB1*0802-DQA1*0401-DQB1*0402 (0.151) predominated clearly, followed by DRB1*0701-DQA1*0201-DQB1*0201 (0.111) and DRB1*0407-DQA1*03011-DQB1*0302 (0.101). Both genetic distances and correspondence analyses showed that Mexicans clustered with Amerindian population. These results suggest that the Mexican Mestizo population be principally characterized by haplotypes presents in Amerindian and Caucasian populations with a low frequency of Black haplotypes. In summary, the HLA class II haplotype frequencies demonstrated the tri-racial component existing in Mexican Mestizos.

[Alternatives to chronic cardiac stimulation in patients with mechanical tricuspid prosthesis and atrioventricular block]. / Alternativas de estimulación cardiaca crónica en pacientes con prótesis mecánica tricuspídea y bloqueo atrioventricular.

One of the complications of tricuspid valve replacement (TVR) is the complete heart block (CHB). In these patients an epicardial permanent pacemaker is frequently used but its insertion is another major operation and higher thresholds are needed. Two patients are reported, both women, with rheumatic heart disease and TVR who required a permanent pacemaker because they developed CHB. The first patient underwent mitral valve replacement with a disc valve seventeen years before and TVR recently. A single chamber pacemaker was implanted. Left ventricular pacing was achieved through the great cardiac vein. The acute and chronic pacing thresholds were adequate. The second patient underwent tricuspid and mitral replacement with a Starr-Edwards (SE) valve. Eighteen years later this patient had atrial fibrillation with slow ventricular response and heart failure. The pacemaker lead had to be inserted across the tricuspid SE valve because ventricle pacing through the coronary veins was unsuccessful. The endocardial pacing resulted in mild tricuspid regurgitation and has continued the same way for four years. To conclude, ventricle pacing through the coronary veins is safe, produces excellent results and fewer complications. On the other hand, ventricle pacing across a prosthetic tricuspid valve remains questionable because of possible damage to the prosthesis itself leading to valve insufficiency and because of damage to the pacing lead.

Alternativas de estimulación cardiaca crónica en pacientes con prótesis mecßnica tricuspÝdea y bloqueo atrioventricular / Alternatives to chronic cardiac stimulation in patients with mechanical tricuspid prosthesis and atrioventricular block

One of the complications of tricuspid valve replacement (TVR) is the complete heart block (CHB). In these patients an epicardial permanent pacemaker is frequently used but its insertion is another major operation and higher thresholds are needed. Two patients are reported, both women, with rheumatic heart disease and TVR who required a permanent pacemaker because they developed CHB. The first patient underwent mitral valve replacement with a disc valve seventeen years before and TVR recently. A single chamber pacemaker was implanted. Left ventricular pacing was achieved through the great cardiac vein. The acute and chronic pacing thresholds were adequate. The second patient underwent tricuspid and mitral replacement with a Starr-Edwards (SE) valve. Eighteen years later this patient had atrial fibrillation with slow ventricular response and heart failure. The pacemaker lead had to be inserted across the tricuspid SE valve because ventricle pacing through the coronary veins was unsuccessful. The endocardial pacing resulted in mild tricuspid regurgitation and has continued the same way for four years. To conclude, ventricle pacing through the coronary veins is safe, produces excellent results and fewer complications. On the other hand, ventricle pacing across a prosthetic tricuspid valve remains questionable because of possible damage to the prosthesis itself leading to valve insufficiency and because of damage to the pacing lead.