Liver enzyme levels in adolescents with obesity and insulin resistance: a propensity score matching analysis.

BACKGROUND: Elevated liver enzyme levels have been associated with metabolic syndrome in both obese and non-obese pediatric populations. This study aims to compare the serum liver enzyme levels in obese adolescents with and without insulin resistance (IR). METHODS: A cross-sectional analysis was conducted involving obese adolescents aged 10-18. We assessed somatometry, serum insulin levels, lipid profiles, and liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma-glutamyl transferase [GGT]). Statistical differences between groups were evaluated using Student's t-test or the Chi-squared test, with IR (wIR) status matched by propensity scores based on body mass index (BMI) z-scores. RESULTS: The study included 365 adolescents with obesity, 229 wIR, and 136 without (woIR). Before matching, the wIR group had a significantly higher BMI z-score (2.21 vs. 2.14, p = 0.032). After matching for BMI z-scores (n = 122 each group), the wIR group displayed significantly higher levels of AST (32.3 vs. 24.7, p < 0.001) and ALT (42.4 vs. 30.9, p < 0.001), but no significant differences were observed in GGT levels (37.4 vs. 32.5, p = 0.855). CONCLUSION: Obese adolescent's wIR exhibit higher serum ALT and AST levels, suggesting that altered AST is a potential risk factor for IR.

INTRODUCCIÓN: Se ha observado asociación entre niveles elevados de enzimas hepáticas y síndrome metabólico en población pediátrica con y sin obesidad. El objetivo del estudio fue comparar los niveles séricos de enzimas hepáticas entre adolescentes con obesidad con y sin resistencia a la insulina (RI). MÉTODOS: Se realizó un estudio transversal en adolescentes con obesidad entre 10 y 18 años. Se analizaron los datos somatometricos, insulina sérica, perfil lipídico y niveles de enzimas hepáticas (aspartato aminotransferasa [AST], alanina aminotransferasa [ALT] y gamma-glutamil transferasa [GGT]). Análisis estadístico: se utilizó t de Student o la prueba de Chi-cuadrado para evaluar diferencias entre grupos. Los pacientes con RI se emparejaron con pacientes sin RI utilizando puntuaciones de propensión basadas en la puntuación z del IMC. RESULTADOS: Se incluyeron un total de 365 adolescentes con obesidad (229 con RI y 136 sin RI). El grupo con RI tuvo un IMC mayor (con RI 2.21 vs sin RI 2.14 p = 0.032). Después de emparejar los grupos según el IMCz (n = 122 por grupo), el grupo con RI tuvo niveles de AST (24.7 vs., 32.3, p < 0.001) y ALT (30.9 vs., 42.4, p < 0.001) significativamente más altos en comparación al grupo sin RI. Sin embargo, no hubo diferencia en los niveles de GTT (37.4 vs 32.5, p = 0.855). CONCLUSIONES: Los niveles séricos de ALT y AST en adolescents con obesidad y RI fueron mayores. La AST alterada fue un factor de riesgo para presentar RI.

Leptin receptor and prolactin in pubertal disorders and chronic kidney disease.

BACKGROUND: Knowledge of chronic kidney disease (CKD) with pubertal disorders (PD) in adolescent boys is limited as few studies have explored this disorder. This study aimed to identify the usefulness of assessing hormonal parameters in male adolescents with CKD and their correlation with PD in a 12-month follow-up period. METHODS: A prospective cohort study was conducted among male adolescents with CKD (stages IV and V). Data regarding the age at puberty onset were collected from the patients' clinical records and through interview. The patients were followed up for 12 months during their pubertal development. At the beginning, routine hormonal profile tests were performed to examine the patients' thyroid profile, prolactin levels, luteinizing hormone, follicle-stimulating hormone, testosterone, leptin, and receptor leptin. The hormonal profiles of patients with and without PD were compared. Comparisons between the groups were performed using the Student t-test and Fisher's exact tests. Logistic regression analysis was also performed. RESULTS: Data of 64 patients (26/64 with PD) were analyzed. The median age was 15 years and the median time for CKD evolution was 11 months. No differences between groups were noted in the general or biochemical characteristics of the patients. The hormonal parameters, prolactin levels were higher and the free leptin and free thyroxine levels were lower in patients with PD. Leptin receptor levels of >0.90 ng/mL (risk ratio [RR], 8.6; P = 0.004) and hyperprolactinemia (RR, 21.3; P = 0.049) were the risk factors for PD. CONCLUSIONS: Leptin receptor levels of >0.90 ng/mL and hyperprolactinemia are associated with the development of PD in male adolescents with CKD.

Efficacy and Safety of Vitamin D Supplementation to Prevent COVID-19 in Frontline Healthcare Workers. A Randomized Clinical Trial.

BACKGROUND: Associations between vitamin D (VD) deficiency and the risk of SARS-CoV-2 infection have been documented in cross-sectional population studies. Intervention studies in patients with moderate to severe COVID-19 have failed to consistently document a beneficial effect. OBJECTIVE: To determine the efficacy and safety of VD-supplementation in the prevention of SARS-CoV-2 infection in highly exposed individuals. METHODS: A double-blind, parallel, randomized trial was conducted. Frontline healthcare workers from four hospitals in Mexico City, who tested negative for SARS-CoV-2 infection, were enrolled between July 15 and December 30, 2020. Participants were randomly assigned to receive 4,000 IU VD (VDG) or placebo (PG) daily for 30 d. RT-PCR tests were taken at baseline and repeated if COVID-19 manifestations appeared during follow-up. Serum 25-hydroxyvitamin D3 and antibody tests were measured at baseline and at day 45. Per-protocol and intention-to-treat analysis were conducted. RESULTS: Of 321 recruited subjects, 94 VDG and 98 PG completed follow-up. SARS-CoV-2 infection rate was lower in VDG than in PG (6.4 vs. 24.5%, p <0.001). The risk of acquiring SARS-CoV-2 infection was lower in the VDG than in the PG (RR: 0.23; 95% CI: 0.09-0.55) and was associated with an increment in serum levels of 25-hydroxyvitamin D3 (RR: 0.87; 95% CI: 0.82-0.93), independently of VD deficiency. No significant adverse events were identified. CONCLUSIONS: Our results suggest that VD-supplementation in highly exposed individuals prevents SARS-CoV-2 infection without serious AEs and regardless of VD status.

Altered cardiometabolic profile in girls with central precocious puberty and adipokines: A propensity score matching analysis.

OBJECTIVE: To compare cardiometabolic factors and adipokines between patients with recently diagnosed CPP and controls without CPP, paired by BMI Z scores (BMIz) and classified into girls with adequate nutritional status and girls who are overweight or obese. METHODS: This cross-sectional study was performed from January 2012 to May 2015 at two tertiary care pediatric centers in Mexico City. We included female patients with idiopathic CPP without other chronic pathology and healthy controls. Patients were divided into groups, BMI < 85th and BMI ≥ 85th percentile, according to 2000 CDC Growth Charts. Anthropometric data and fasting plasma concentrations of lipids, glucose, insulin, and leptin were assessed. RESULTS: There were 73 patients with CPP and 82 without CPP. Sixty-six patients were matched between the groups; no significant difference was noted between the groups according to zBMI. However, differences in the bone/chronological age relationship, birth weight and proportions in different Tanner stages were observed. Among girls with normal BMI, the percentage of body fat (24.6% vs 18.9%, p < 0.001), serum triglycerides (102.9 vs 54.3 mg/dl, p < 0.001), leptin (7.46 vs 5.4 ng/ml, p = 0.010) and free leptin (0.44 vs 0.29 ng/ml, p = 0.044) were higher in those with CPP; additionally, girls with CPP presented a higher proportion of hypertriglyceridemia. In the overweight/obese group, adiponectin levels were lower in girls with CPP (6.23 vs 7.28 pg/ml, p = 0.011). CONCLUSIONS: Girls with CPP and normal BMI at diagnosis had a worse cardiometabolic profile, as reflected by higher levels of free leptin, and higher proportion of hypertriglyceridemia than girls without CPP.

Glenn surgery: a safe procedure in the path of univentricular correction / Cirugía de Glenn: un procedimiento seguro en el camino de la corrección univentricular

Abstract Background: This study describes 35 years of experience in a tertiary care level hospital that treats cardiac patients with univentricular heart physiology who underwent Glenn surgery. Methods: The study consisted of a retrospective analysis of patients who underwent Glenn surgery, including variables related to pre-operative, intra-operative, and post-operative morbidity and mortality. Results: From 1980 to 2015, 204 Glenn surgeries were performed. The most common heart disease was tricuspid atresia IB (19.2%). In 48.1% of the cases, the procedure was performed with antegrade flow. A bilateral Glenn procedure was performed in 12.5% of the cases and 10.3% were carried out without using a cardiopulmonary bypass pump. Reported complications included infections, bleeding, arrhythmias, chylothorax, neurological alterations, and pleural effusion. The mortality rate was 2.9% Conclusions: Glenn surgery is a palliative surgery with good results. It significantly improves patient quality of life over a long period until a total cavopulmonary shunt is performed. The complications observed are few, and the mortality rate is low. Therefore, it is a safe surgery that should be used for univentricular congenital heart disease.

Resumen Introducción: El objetivo de este trabajo fue describir la experiencia de 35 años en un hospital de tercer nivel con pacientes cardiópatas con fisiología univentricular que fueron sometidos a cirugía de Glenn. Métodos: Se presenta un análisis retrospectivo de los pacientes sometidos a cirugía de Glenn. Se incluyeron variables relacionadas con la morbilidad y la mortalidad preoperatorias, transoperatorias y posoperatorias. Resultados: Desde 1980 hasta 2015 se realizaron 204 cirugías de Glenn para la corrección de cardiopatías. De ellas, la más frecuente fue la atresia tricuspídea IB (19.2%); en el 48.1% se realizó Glenn con flujo anterógrado, en el 12.5% Glenn bilateral y el 10.3% de las cirugías fueron sin apoyo de bomba de circulación extracorpórea. Las complicaciones reportadas fueron infecciones, sangrado, arritmias, quilotórax, alteraciones neurológicas y derrame pleural. La mortalidad fue del 2.9%. Conclusiones: La cirugía de Glenn es un procedimiento paliativo que se ha utilizado con buenos resultados. Mejora en forma importante la calidad de vida del paciente durante un largo periodo mientras que se realiza la derivación cavopulmonar total. Presenta pocas complicaciones y muy baja mortalidad, por lo que es una cirugía segura que debe ser utilizada para cardiopatías congénitas univentriculares.

Cardiometabolic Factors in Pediatric Patients with Chronic Diseases.

BACKGROUND: The prevalence of chronic diseases (CDs) in the pediatric population has increased due to technological advances that decrease mortality and increase survival. AIM OF THE STUDY: To compare the frequency of cardiometabolic factors (CFs) among pediatric patients with CDs with those among children with obesity and overweight without CDs. METHODS: This study was a cross-sectional study. Pediatric patients from 6-17 years of age were included. A total of 333 patients with CD were studied, and of these patients, 77 had difficult-to-control epilepsy, 183 had chronic kidney disease (CKD), and 73 underwent kidney transplants; in addition, a comparison group was included, consisting of 286 overweight and obese children without any other pathologies. We performed anthropometry, blood pressure, glucose, insulin, and lipid profiling on all of the patients. Statistical analysis was conducted as follows: Chi2 tests were used to compare the CFs between the groups. RESULTS: We included 619 patients from 6-17 years old. Patients with CDs had a low frequency of obesity (12.4%) but a high frequency of the remaining CFs. Hypertriglyceridemia (65%), hypoalphalipoproteinemia (49%) and systemic arterial hypertension (46.5%) were the most common CFs, particularly among subjects with CKD and kidney transplantation. When comparing the frequencies of these CFs with those in the obesity/overweight group, hypertriglyceridemia (p <0.05) was more common in patients with CDs. CONCLUSIONS: In patients with CDs, dyslipidemia, hypertension, and hyperglycemia occur at frequencies that are the same as or higher than those in overweight/obese children, but when the CD patients are overweight/obese, it increases their frequency.

Glenn surgery: a safe procedure in the path of univentricular correction.

BACKGROUND: This study describes 35 years of experience in a tertiary care level hospital that treats cardiac patients with univentricular heart physiology who underwent Glenn surgery. METHODS: The study consisted of a retrospective analysis of patients who underwent Glenn surgery, including variables related to pre-operative, intra-operative, and post-operative morbidity and mortality. RESULTS: From 1980 to 2015, 204 Glenn surgeries were performed. The most common heart disease was tricuspid atresia IB (19.2%). In 48.1% of the cases, the procedure was performed with antegrade flow. A bilateral Glenn procedure was performed in 12.5% of the cases and 10.3% were carried out without using a cardiopulmonary bypass pump. Reported complications included infections, bleeding, arrhythmias, chylothorax, neurological alterations, and pleural effusion. The mortality rate was 2.9%. CONCLUSIONS: Glenn surgery is a palliative surgery with good results. It significantly improves patient quality of life over a long period until a total cavopulmonary shunt is performed. The complications observed are few, and the mortality rate is low. Therefore, it is a safe surgery that should be used for univentricular congenital heart disease.

Factores que impactan sobre la percepción de la menstruación en las adolescentes / Factors that impact on the perception of menstruation among female adolescents

Introducción. Se ha descrito que la menstruación se percibe como un evento natural pero molesto, con un impacto negativo en la vida diaria de la mujer. El objetivo del estudio fue identificar la percepción de la menstruación en adolescentes y los factores que podían influir sobre esta.Material y métodos. Estudio transversal observacional comparativo en adolescentes posmenárquicas con y sin enfermedades crónicas, en 2 hospitales pediátricos y 2 escuelas de nivel primario y secundario. Se recabaron los datos de edad, escolaridad, tipo de población, fecha de menarca y presencia de dismenorrea. Se aplicó un cuestionario previamente validado para evaluar la percepción sobre la menstruación.Resultados. Se incluyó un total de 346 adolescentes. Se encontró que la percepción más frecuente hacia la menstruación fue la negativa en un 65,6 % (n = 227), positiva en el 16 % (n = 55), sigilosa en el 13 % (n = 45) e indeterminada en el 5,4 % (n = 19). La presencia de enfermedad crónica demostró ser un factor protector de la percepción negativa de la menstruación (odds ratio 0,4 [intervalo de confianza del 95 %: 0,20-0,78], p = 0,007).Conclusiones. Más de la mitad de las adolescentes presentaron una actitud negativa hacia la menstruación, pero la presencia de una enfermedad crónica la mejoró

Introduction. It has been described that menstruation is perceived as a natural but cumbersome event, with a negative impact on women's daily life. The objective of this study was to identify the perception of menstruation among female adolescents and the factors that may affect it.Material and methods. Observational, cross-sectional, comparative study in postmenarcheal adolescents with and without chronic conditions in two children's hospitals and two primary and secondary schools. Age, education level, type of population, date of menarche, and presence of dysmenorrhea were recorded. A previously validated questionnaire was administered to assess the perception of menstruation. Results. A total of 346 female adolescents were included. The most common perception of menstruation was negative in 65.6 % (n = 227), positive in 16 % (n = 55), discreet in 13 % (n = 45), and indefinite in 5.4 % (n = 19). The presence of a chronic condition demonstrated to be a protective factor against a negative perception of menstruation (odds ratio: 0.4 [95 % confidence interval: 0.20-0.78], p = 0.007).Conclusions. More than half of female adolescents had a negative attitude toward menstruation, but the presence of a chronic condition improved it.

Factors that impact on the perception of menstruation among female adolescents. / Factores que impactan sobre la percepción de la menstruación en las adolescentes.

INTRODUCTION: It has been described that menstruation is perceived as a natural but cumbersome event, with a negative impact on women's daily life. The objective of this study was to identify the perception of menstruation among female adolescents and the factors that may affect it. MATERIAL AND METHODS: Observational, crosssectional, comparative study in postmenarcheal adolescents with and without chronic conditions in two children's hospitals and two primary and secondary schools. Age, education level, type of population, date of menarche, and presence of dysmenorrhea were recorded. A previously validated questionnaire was administered to assess the perception of menstruation. RESULTS: A total of 346 female adolescents were included. The most common perception of menstruation was negative in 65.6 % (n = 227), positive in 16 % (n = 55), discreet in 13 % (n = 45), and indefinite in 5.4 % (n = 19). The presence of a chronic condition demonstrated to be a protective factor against a negative perception of menstruation (odds ratio: 0.4 [95 % confidence interval: 0.20-0.78], p = 0.007). CONCLUSIONS: More than half of female adolescents had a negative attitude toward menstruation, but the presence of a chronic condition improved it.

Introducción. Se ha descrito que la menstruación se percibe como un evento natural pero molesto, con un impacto negativo en la vida diaria de la mujer. El objetivo del estudio fue identificar la percepción de la menstruación en adolescentes y los factores que podían influir sobre esta. Material y métodos. Estudio transversal observacional comparativo en adolescentes posmenárquicas con y sin enfermedades crónicas, en 2 hospitales pediátricos y 2 escuelas de nivel primario y secundario. Se recabaron los datos de edad, escolaridad, tipo de población, fecha de menarca y presencia de dismenorrea. Se aplicó un cuestionario previamente validado para evaluar la percepción sobre la menstruación. Resultados. Se incluyó un total de 346 adolescentes. Se encontró que la percepción más frecuente hacia la menstruación fue la negativa en un 65,6 % (n = 227), positiva en el 16 % (n = 55), sigilosa en el 13 % (n = 45) e indeterminada en el 5,4 % (n = 19). La presencia de enfermedad crónica demostró ser un factor protector de la percepción negativa de la menstruación (odds ratio 0,4 [intervalo de confianza del 95 %: 0,20-0,78], p = 0,007). Conclusiones. Más de la mitad de las adolescentes presentaron una actitud negativa hacia la menstruación, pero la presencia de una enfermedad crónica la mejoró.

Hyperprolactinemia as a prognostic factor for menstrual disorders in female adolescents with advanced chronic kidney disease.

BACKGROUND: In adolescents with chronic kidney disease (CKD), menstrual disorders (MD) are common, which can make the management of CKD difficult and can sometimes delay renal transplantation. This study aimed to identify the usefulness of hormonal measurements in adolescents with CKD and their relationships with MD during a 1-year follow-up. METHODS: A prospective cohort study was designed. Adolescents with CKD stages IV and V were included. Through clinical files and via interview, the ages at puberty onset, menarche and the date of last menstruation were identified. A 1-year follow-up was conducted over a menstrual cycle calendar. At the beginning of follow-up, routine hormonal profiles (thyroid profiles, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol) were assessed. We compared the hormonal profiles of the patients with and without MD (wMD vs. woMD). Comparisons between groups were made by Wilcoxon and Fisher's tests. Logistic regression analysis was used. RESULTS: Fifty-seven patients, including 30 patients classified as wMD, were analyzed. The median age was 15 years, and the median time of CKD evolution was 18 months. There were no differences in general and biochemical characteristics between patients wMD and woMD. In terms of hormonal measurements, the levels of thyroid-stimulating hormone (TSH) and prolactin were higher in the wMD patients. A prolactin level ≥ 36.8 ng/ml was a risk factor for presenting with MD (RR 34.4, p = 0.002). CONCLUSIONS: Hyperprolactinemia is correlated with MD in adolescents with CKD.

Validación de un instrumento para medir la calidad de vida en niños con mucositis orofaríngea en tratamiento por cáncer / Validation of an instrument to measure the quality of life in children with oropharyngeal mucositis undergoing cancer treatment

Resumen Introducción: La mucositis orofaríngea (MO) es una de las principales complicaciones del tratamiento oncológico que reduce significativamente la calidad de vida (CV) del paciente. El objetivo fue traducir, adaptar de manera cultural y validar una nueva versión en español del instrumento Oropharyngeal Mucositis-Specific Quality-of-Life (OMQoL) en pacientes pediátricos. Métodos: Estudio transversal de validación, multicéntrico, realizado para la traducción y adaptación del OMQoL del inglés al español en pacientes de entre 8 y 16 años con MO. Se midió la confiabilidad mediante el Alfa de Cronbach; la validez del contenido y el constructo, con un análisis factorial exploratorio; y la validez convergente, con las correlaciones de las escalas para MO de la Organización Mundial de la Salud (OMS), la Oropharingeal Mucositis Assessment Scale (OMAS) y con el Pediatric Quality of Life-3 (PedsQL-3) módulo cáncer en español. Resultados: Participaron en el estudio 193 niños con una media de edad de 10.91 ± 2.38 años, de los cuales 101 (52.3%) fueron de sexo femenino. En esta muestra, 80 niños (41.5%) presentaron leucemia aguda linfoblástica y 111 (57.5%) presentaron MO grado 2 y 3. El análisis factorial resultó con cuatro dimensiones con cargas > 0.40. De los 31 ítems del OMQoL, seis fueron eliminados. El Alfa de Cronbach del OMQoL español fue de 0.954. Las correlaciones de Spearman (r) con las escalas de la OMS y OMAS fueron significativas (r = −0.720 y r = −0.689; p<0.01, respectivamente); con el PedsQL-3 módulo cáncer existió una moderada correlación (r = 0.426; p < 0.01). Conclusiones: La nueva versión del OMQoL en español demostró propiedades psicométricas adecuadas, y resulta un instrumento confiable y válido para medir la CV en niños con MO.

Abstract Background: Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients. Methods: A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish. Results: One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = −0.720 and r = −0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01). Conclusions: OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.

Validation of an instrument to measure the quality of life in children with oropharyngeal mucositis undergoing cancer treatment.

Background: Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients. Methods: A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish. Results: One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = -0.720 and r = -0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01). Conclusions: OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.

Introducción: La mucositis orofaríngea (MO) es una de las principales complicaciones del tratamiento oncológico que reduce significativamente la calidad de vida (CV) del paciente. El objetivo fue traducir, adaptar de manera cultural y validar una nueva versión en español del instrumento Oropharyngeal Mucositis­Specific Quality-of-Life (OMQoL) en pacientes pediátricos. Métodos: Estudio transversal de validación, multicéntrico, realizado para la traducción y adaptación del OMQoL del inglés al español en pacientes de entre 8 y 16 años con MO. Se midió la confiabilidad mediante el Alfa de Cronbach; la validez del contenido y el constructo, con un análisis factorial exploratorio; y la validez convergente, con las correlaciones de las escalas para MO de la Organización Mundial de la Salud (OMS), la Oropharingeal Mucositis Assessment Scale (OMAS) y con el Pediatric Quality of Life-3 (PedsQL-3) módulo cáncer en español. Resultados: Participaron en el estudio 193 niños con una media de edad de 10.91 ± 2.38 años, de los cuales 101 (52.3%) fueron de sexo femenino. En esta muestra, 80 niños (41.5%) presentaron leucemia aguda linfoblástica y 111 (57.5%) presentaron MO grado 2 y 3. El análisis factorial resultó con cuatro dimensiones con cargas > 0.40. De los 31 ítems del OMQoL, seis fueron eliminados. El Alfa de Cronbach del OMQoL español fue de 0.954. Las correlaciones de Spearman (r) con las escalas de la OMS y OMAS fueron significativas (r = −0.720 y r = −0.689; p<0.01, respectivamente); con el PedsQL-3 módulo cáncer existió una moderada correlación (r = 0.426; p < 0.01). Conclusiones: La nueva versión del OMQoL en español demostró propiedades psicométricas adecuadas, y resulta un instrumento confiable y válido para medir la CV en niños con MO.

Early discharge of pediatric patients with cancer, fever, and neutropenia with low-risk of systemic infection / Egreso temprano en pacientes pediátricos con cáncer, fiebre y neutropenia con bajo riesgo de infección sistémica

Abstract: Background: Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI). Methods: Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment. Outcomes: fever resolution, readmissions, and mortality. Results: Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04). Conclusions: Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.

Resumen: Introducción: El tratamiento ambulatorio en pacientes con cáncer, fiebre y neutropenia de bajo riesgo parece ser una alternativa segura y efectiva. El objetivo de este trabajo fue comparar la efectividad y la seguridad del tratamiento antimicrobiano en la modalidad de egreso temprano vs. el tratamiento intrahospitalario en niños con cáncer y neutropenia febril (NF), con bajo riesgo de infección bacteriana invasiva (IBI). Métodos: Diseño cuasi-experimental con un grupo control histórico. Se incluyeron niños con cáncer durante un episodio de NF con bajo riesgo de IBI. El grupo control fue constituido por pacientes que recibieron tratamiento hospitalario con piperacilina-tazobactam intravenosa. Los pacientes en el grupo de egreso temprano recibieron 48 horas de tratamiento intravenoso y egresaron con antimicrobianos por vía oral. Desenlaces: resolución de la fiebre, reingreso al hospital y muerte. Resultados: Se incluyeron 80 pacientes con NF de bajo riesgo; la mediana de edad fue de 6 años; 43 pacientes (54%) eran de sexo femenino. Los diagnósticos principales fueron tumores sólidos (52) y leucemia o linfoma (28). Cuarenta y tres pacientes recibieron tratamiento hospitalario y 37 fueron seleccionados para egreso temprano. En el grupo de egreso temprano, 31 pacientes recibieron ciprofloxacino y 6 recibieron amoxicilina-clavulanato. Dos pacientes reingresaron, uno por fiebre secundaria a progresión tumoral y otro por epistaxis. Los efectos adversos se presentaron en el 21.6% de los pacientes en el grupo de egreso temprano y en el 12% del grupo de tratamiento hospitalario (p = 0.04). Conclusiones: El egreso temprano para niños con cáncer y NF de bajo riesgo es una alternativa aceptable y segura.

Early discharge of pediatric patients with cancer, fever, and neutropenia with low-risk of systemic infection.

Background: Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI). Methods: Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment. Outcomes: fever resolution, readmissions, and mortality. Results: Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04). Conclusions: Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.

Introducción: El tratamiento ambulatorio en pacientes con cáncer, fiebre y neutropenia de bajo riesgo parece ser una alternativa segura y efectiva. El objetivo de este trabajo fue comparar la efectividad y la seguridad del tratamiento antimicrobiano en la modalidad de egreso temprano vs. el tratamiento intrahospitalario en niños con cáncer y neutropenia febril (NF), con bajo riesgo de infección bacteriana invasiva (IBI). Métodos: Diseño cuasi-experimental con un grupo control histórico. Se incluyeron niños con cáncer durante un episodio de NF con bajo riesgo de IBI. El grupo control fue constituido por pacientes que recibieron tratamiento hospitalario con piperacilina-tazobactam intravenosa. Los pacientes en el grupo de egreso temprano recibieron 48 horas de tratamiento intravenoso y egresaron con antimicrobianos por vía oral. Desenlaces: resolución de la fiebre, reingreso al hospital y muerte. Resultados: Se incluyeron 80 pacientes con NF de bajo riesgo; la mediana de edad fue de 6 años; 43 pacientes (54%) eran de sexo femenino. Los diagnósticos principales fueron tumores sólidos (52) y leucemia o linfoma (28). Cuarenta y tres pacientes recibieron tratamiento hospitalario y 37 fueron seleccionados para egreso temprano. En el grupo de egreso temprano, 31 pacientes recibieron ciprofloxacino y 6 recibieron amoxicilina-clavulanato. Dos pacientes reingresaron, uno por fiebre secundaria a progresión tumoral y otro por epistaxis. Los efectos adversos se presentaron en el 21.6% de los pacientes en el grupo de egreso temprano y en el 12% del grupo de tratamiento hospitalario (p = 0.04). Conclusiones: El egreso temprano para niños con cáncer y NF de bajo riesgo es una alternativa aceptable y segura.

Resistin levels are not associated with obesity in central precocious puberty.

OBJECTIVE: To compare serum resistin concentrations between prepubertal girls with a BMI > 85th percentile and girls with precocious puberty (CPP) who have and have not undergone GnRH analog treatment. PATIENTS AND METHODS: This is a cross-sectional study in girls with a BMI > 85th percentile and a median age of 8 years. We included 31 girls with CPP who did not receive treatment (CPPoT), 23 girls with CPP who were treated with leuprolide (CPPT), 22 prepubertal girls and 24 pubertal girls. Anthropometric data and the fasting plasma concentrations of lipids, glucose, insulin, and resistin were measured. RESULTS: The z-BMI scores were similar among the groups (p = 0.344), and body fat percentage (BF%) was similar among CPPT, CPPoT and prepubertal girls (p = 0.151). Resistin and insulin levels were lower in girls with CPP (CPPT and CPPoT) than in prepubertal and pubertal girls (median resistin level: CPPT 11.8 pg/ml vs CPPoT 11 pg/ml vs prepubertal 16 pg/ml vs pubertal 16 pg/ml, p = 0.001; median insulin level: CPPT 10.7 µUI/mL vs CPPoT 10.2 µUI/mL vs prepubertal 14.4 µUI/mL vs pubertal 32 µUI/mL p = 0.02). ANCOVA analysis, after adjustments for pubertal stage, BF% and z-BMI, showed that CPP modifies resistin levels (F = 31.4; p = 0.0001) independently of these parameters (p < 0.05). CONCLUSIONS: In the group of girls with overweight or obesity, the resistin level was lower in girls with CPP than in prepubertal and pubertal girls. More studies are needed to understand the role of resistin in CPP patients.

Experiencia en el tratamiento de la hemorragia uterina anormal en adolescentes con enfermedad renal crónica / Experience in the treatment of uterine hemorrhage in adolescents with chronic renal disease

Resumen: Introducción: La enfermedad renal crónica (ERC) se asocia con alteraciones menstruales, y el manejo del sangrado uterino suele ser complejo por las condiciones de este grupo de pacientes. El objetivo de este trabajo fue describir la respuesta clínica al tratamiento hormonal de las alteraciones menstruales de adolescentes con ERC. Métodos: Se presentan los datos de una serie de casos de pacientes adolescentes con ERC que cursaron con alteraciones menstruales y que recibieron tratamiento desde el año 2008 al 2012. Se identificaron las características del trastorno menstrual, del tratamiento hormonal recibido y de la respuesta al mismo. El análisis estadístico fue descriptivo. Resultados: Se estudiaron 11 pacientes de sexo femenino con edad promedio de 14.5 años, que se encontraban en prediálisis (n = 1), diálisis peritoneal (n = 7) y hemodiálisis (n = 3). Las pacientes presentaron hiperpolimenorrea asociada a la opsomenorrea (n = 3), en su mayoría clasificadas como hemorragia uterina anormal secundaria. El tratamiento, en general, fue con progestágenos de manera inicial (clormadinona con o sin medroxiprogesterona) o bien con anticonceptivos combinados. En la mayoría de las pacientes se obtuvo una respuesta favorable; sin embargo, hubo casos en los que fue necesario modificar la dosis y el tiempo de tratamiento. Conclusiones: La mayor parte de las adolescentes con ERC que han sido tratadas por hemorragia uterina anormal en nuestro estudio tuvieron una respuesta favorable al tratamiento hormonal.

Abstract: Background: Chronic kidney disease (CKD) is associated with menstrual abnormalities and management of uterine bleeding is often complex because of the conditions in this group of patients. The aim of this study was to describe the clinical response to hormonal treatment of menstrual alterations in adolescents with CKD. Methods: We present data of cases of adolescent patients with CKD who had undergone menstrual changes and received treatment during the period 2008 to 2012. The characteristics of the menstrual disorder, hormone treatment received, and response to treatment were evaluated. The statistical analysis aplicated to analyze the results was descriptive. Results: We studied 11 patients with a mean age of 14.5 years, who were in predialysis (n = 1), peritoneal dialysis (n = 7), hemodialysis (n = 3). Patients had hyperpolymenorrhea associated with opsomenorrhea (n = 3), mostly classified as secondary abnormal uterine bleeding. Treatment, in general, was with progestins initially (chlormadinone with or without medroxyprogesterone) or combined contraceptives. In the majority of the patients, a favorable response was obtained; however, there were cases where it was necessary to modify the dose and time of treatment. Conclusions: The majority of adolescents with CKD who have been treated for abnormal uterine bleeding in our study had a favorable response to hormonal treatment.

[Experiencia en el tratamiento de la hemorragia uterina anormal en adolescentes con enfermedad renal crónica]. / Experience in the treatment of uterine hemorrhage in adolescents with chronic renal disease.

Introducción: La enfermedad renal crónica (ERC) se asocia con alteraciones menstruales, y el manejo del sangrado uterino suele ser complejo por las condiciones de este grupo de pacientes. El objetivo de este trabajo fue describir la respuesta clínica al tratamiento hormonal de las alteraciones menstruales de adolescentes con ERC. Métodos: Se presentan los datos de una serie de casos de pacientes adolescentes con ERC que cursaron con alteraciones menstruales y que recibieron tratamiento desde el año 2008 al 2012. Se identificaron las características del trastorno menstrual, del tratamiento hormonal recibido y de la respuesta al mismo. El análisis estadístico fue descriptivo. Resultados: Se estudiaron 11 pacientes de sexo femenino con edad promedio de 14.5 años, que se encontraban en prediálisis (n = 1), diálisis peritoneal (n = 7) y hemodiálisis (n = 3). Las pacientes presentaron hiperpolimenorrea asociada a la opsomenorrea (n = 3), en su mayoría clasificadas como hemorragia uterina anormal secundaria. El tratamiento, en general, fue con progestágenos de manera inicial (clormadinona con o sin medroxiprogesterona) o bien con anticonceptivos combinados. En la mayoría de las pacientes se obtuvo una respuesta favorable; sin embargo, hubo casos en los que fue necesario modificar la dosis y el tiempo de tratamiento. Conclusiones: La mayor parte de las adolescentes con ERC que han sido tratadas por hemorragia uterina anormal en nuestro estudio tuvieron una respuesta favorable al tratamiento hormonal. Background: Chronic kidney disease (CKD) is associated with menstrual abnormalities and management of uterine bleeding is often complex because of the conditions in this group of patients. The aim of this study was to describe the clinical response to hormonal treatment of menstrual alterations in adolescents with CKD. Methods: We present data of cases of adolescent patients with CKD who had undergone menstrual changes and received treatment during the period 2008 to 2012. The characteristics of the menstrual disorder, hormone treatment received, and response to treatment were evaluated. The statistical analysis aplicated to analyze the results was descriptive. Results: We studied 11 patients with a mean age of 14.5 years, who were in predialysis (n = 1), peritoneal dialysis (n = 7), hemodialysis (n = 3). Patients had hyperpolymenorrhea associated with opsomenorrhea (n = 3), mostly classified as secondary abnormal uterine bleeding. Treatment, in general, was with progestins initially (chlormadinone with or without medroxyprogesterone) or combined contraceptives. In the majority of the patients, a favorable response was obtained; however, there were cases where it was necessary to modify the dose and time of treatment. Conclusions: The majority of adolescents with CKD who have been treated for abnormal uterine bleeding in our study had a favorable response to hormonal treatment.

[Utilidad del índice de choque para predecir la mortalidad en pacientes pediátricos con sepsis grave o choque séptico]. / Shock index utility to predict mortality in pediatric patients with septic shock or severe sepsis.

Introducción: La sepsis en pediatría es la principal causa de muerte hospitalaria. Se han intentado crear herramientas que faciliten su identificación, como el índice de choque (IC), definido como el cociente entre frecuencia cardíaca y tensión arterial sistólica. El objetivo de este trabajo fue identificar el mejor momento del IC para predecir la mortalidad en pacientes pediátricos con sepsis grave y choque séptico. Métodos: Cohorte retrospectiva con 165 pacientes pediátricos que desarrollaron sepsis grave y choque séptico en la Unidad de Terapia Intensiva Pediatrica. Se calculó el IC al diagnóstico (IC0), a las dos, cuatro y seis horas posteriores al mismo (IC2, IC4 e IC6). Se crearon dos grupos según el desenlace (sobrevivientes/muertos). La comparación estadística se realizó con prueba U-Mann Whitney y χ2. Se compararon los factores de riesgo entre los sobrevivientes y muertos, calculando la razón de momios (RM). Resultados: Se comparó el valor del IC entre grupos; en el grupo de choque séptico, el IC se encontró más elevado en IC4 e IC6 (p = 0.010 y p = 0.005). Se encontró que, en los pacientes muertos, el IC incrementó progresivamente su valor en IC4 e IC6 (p < 0.05). Los valores de IC4 e IC6 elevados incrementaron el riesgo de muerte en los pacientes (IC4, RM: 442.1; IC 95% [intervalo de confianza al 95%]: 54.2-3,601.7; p < 0.001; e IC6, RM: 81,951.3; IC 95%: 427.1-15,700,000; p < 0.001). Conclusiones: La elevación del valor del IC se asocia con mayor mortalidad de la sepsis. El valor de IC6 es el más útil para predecir mortalidad. Background: Pediatric sepsis is considered the main cause of hospital death around the world. Many groups have tried to create tools that facilitate its early identification, as the shock index (SI) defined as the ratio between cardiac frequency and systolic blood pressure. The objective of this study was to determine the utility of SI to predict mortality in pediatric patients with severe sepsis and septic shock. Methods: Retrospective cohort with 165 pediatric patients with severe sepsis or septic shock in the Pediatric Intensive Care Unit. SI was calculated at diagnosis, 2, 4 and 6 hours after (SI2, SI4 and SI6). We divided the population in two groups depending their outcome: survivors and non-survivors. The statistical analysis was performed with U Mann-Whitney and chi squared tests. The risk factors were compared between the survivors and the dead, and we calculated the odds ratio (OR). Results: The median value of SI was compared between groups; in the group of septic shock, SI showed a tendency to remain high in SI4 and SI6 (p = 0.010 and p = 0.005, respectively). Among the survivors and the non-survivors, we found that in the latter, SI was progressively increased in SI4 and SI6 (p < 0.05). High values of SI4 and SI6 increased the risk of death in patients (SI4: OR: 442.1; CI 95% [confidence interval 95%]: 54.2-3,601.7; p < 0.001 and SI6: OR: 81,951.3; CI 95%: 427.1-15,700,000]; p < 0.001). Conclusions: High values of SI are associated with increased mortality. The IS6 value is the most useful to predict mortality.

Utilidad del índice de choque para predecir la mortalidad en pacientes pediátricos con sepsis grave o choque séptico / Shock index utility to predict mortality in pediatric patients with septic shock or severe sepsis

Resumen Introducción: La sepsis en pediatría es la principal causa de muerte hospitalaria. Se han intentado crear herramientas que faciliten su identificación, como el índice de choque (IC), definido como el cociente entre frecuencia cardíaca y tensión arterial sistólica. El objetivo de este trabajo fue identificar el mejor momento del IC para predecir la mortalidad en pacientes pediátricos con sepsis grave y choque séptico. Métodos: Cohorte retrospectiva con 165 pacientes pediátricos que desarrollaron sepsis grave y choque séptico en la Unidad de Terapia Intensiva Pediatrica. Se calculó el IC al diagnóstico (IC0), a las dos, cuatro y seis horas posteriores al mismo (IC2, IC4 e IC6). Se crearon dos grupos según el desenlace (sobrevivientes/muertos). La comparación estadística se realizó con prueba U-Mann Whitney y χ2. Se compararon los factores de riesgo entre los sobrevivientes y muertos, calculando la razón de momios (RM). Resultados: Se comparó el valor del IC entre grupos; en el grupo de choque séptico, el IC se encontró más elevado en IC4 e IC6 (p = 0.010 y p = 0.005). Se encontró que, en los pacientes muertos, el IC incrementó progresivamente su valor en IC4 e IC6 (p < 0.05). Los valores de IC4 e IC6 elevados incrementaron el riesgo de muerte en los pacientes (IC4, RM: 442.1; IC 95% [intervalo de confianza al 95%]: 54.2-3,601.7; p < 0.001; e IC6, RM: 81,951.3; IC 95%: 427.1-15,700,000; p < 0.001). Conclusiones: La elevación del valor del IC se asocia con mayor mortalidad de la sepsis. El valor de IC6 es el más útil para predecir mortalidad.

Abstract Background: Pediatric sepsis is considered the main cause of hospital death around the world. Many groups have tried to create tools that facilitate its early identification, as the shock index (SI) defined as the ratio between cardiac frequency and systolic blood pressure. The objective of this study was to determine the utility of SI to predict mortality in pediatric patients with severe sepsis and septic shock. Methods: Retrospective cohort with 165 pediatric patients with severe sepsis or septic shock in the Pediatric Intensive Care Unit. SI was calculated at diagnosis, 2, 4 and 6 hours after (SI2, SI4 and SI6). We divided the population in two groups depending their outcome: survivors and non-survivors. The statistical analysis was performed with U Mann-Whitney and chi squared tests. The risk factors were compared between the survivors and the dead, and we calculated the odds ratio (OR). Results: The median value of SI was compared between groups; in the group of septic shock, SI showed a tendency to remain high in SI4 and SI6 (p = 0.010 and p = 0.005, respectively). Among the survivors and the non-survivors, we found that in the latter, SI was progressively increased in SI4 and SI6 (p < 0.05). High values of SI4 and SI6 increased the risk of death in patients (SI4: OR: 442.1; CI 95% [confidence interval 95%]: 54.2-3,601.7; p < 0.001 and SI6: OR: 81,951.3; CI 95%: 427.1-15,700,000]; p < 0.001). Conclusions: High values of SI are associated with increased mortality. The IS6 value is the most useful to predict mortality.

Uso de la tarjeta colorimétrica visual para la detección oportuna de atresia de vías biliares / Colorimetric card use for early detection visual biliary atresia

Resumen: Introducción: La atresia de vías biliares (AVB) es una condición que provoca obstrucción al flujo biliar, y de no corregirse quirúrgicamente, provoca cirrosis y la muerte antes de los 2 años de edad. En México, a partir del año 2013 se incorporó la tarjeta colorimétrica visual (TCV) para la detección oportuna de la AVB a la Cartilla Nacional de Salud (CNS). El objetivo de este estudio fue evaluar el impacto de la TCV para la detección de AVB antes y después de su incorporación a la CNS. Métodos: Estudio ambispectivo, observacional y analítico. Se incluyeron pacientes con AVB atendidos en dos hospitales pediátricos de tercer nivel de atención. Se compararon la edad de referencia, el diagnóstico y la cirugía antes y después de la incorporación de la TCV. Además, se realizó un cuestionario a los padres para conocer su percepción sobre la TCV. Resultados: En 59 niños no hubo diferencias en la edad al diagnóstico (75 vs 70 días) ni en la edad al momento de la cirugía (84 vs 90 días) entre antes y después de la implementación de la TCV. Solo el 30% de los padres recibieron información del uso de la TCV y solo el 38% identificaron las evacuaciones anormales. Conclusiones: Este estudio no mostró cambios en el tiempo para la detección oportuna de AVB mediante el uso de la TCV. Por lo tanto, es necesario reforzar el programa en los tres niveles de atención en nuestro país.

Abstract: Background: Bile duct atresia (BVA) is a condition that causes obstruction to biliary flow, not corrected surgically, causes cirrhosis and death before 2 years of age. In Mexico from 2013 the visual colorimetric card (VVC) was incorporated for the timely detection of BVA to the National Health Card (NHC). The aim of this study was to evaluate the impact of VCT for the detection of BVA before and after the use of NHC incorporation. Methods: Ambispective, analytical observational study. We included patients with AVB treated in two pediatric hospitals of third level care. We compared the age of reference, diagnosis and surgery before and after incorporation of the TCV. In addition, a questionnaire was made to the parents to know their perception about the TCV. Results: In 59 children, there were no differences in age at diagnosis (75 vs 70 days) and age at surgery (84 vs 90 days) between the pre and post-implementation period of the VVC. The questionnaire showed that 10 (30%) of the parents received information about the use of the VVC and 13 (38%) identified the abnormal evacuations. Conclusions: This study did not show changes in time for the timely detection of BVA by using VVC. Therefore, it is necessary to reinforce the program in the three levels of care in our country.