Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability.

Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.

Comparison of Two Strategies for Hypercholesterolemia Detection through Point-of-Care Testing.

BACKGROUND: Childhood dyslipidemia is a common condition that can lead to atherosclerotic cardiovascular disease in adulthood. It is usually multifactorial. Screening for cholesterol disorders in children varies based on risk factors, with some guidelines recommending cascade screening for children with a clear family history of familial hypercholesterolemia, targeted screening for those with specific risk factors, and universal screening. Point-of-care testing (POCT) cholesterol tests offer potential advantages, including ease of use, portability, increased patient access, low cost, fewer medical or laboratory visits, and instant results. This study aimed to evaluate the effect of POCT cholesterol screening on the diagnosis of hypercholesterolemia in children in a family practice setting. METHODS: We used a POCT cholesterol analyzer to perform two different (universal and targeted) screening approaches for dyslipidemia in children. We used the NCEP guidelines for the classification of the results. RESULTS: We screened 183 children, 105 in the universal screening group and 78 in the targeted screening group. Eight patients in the targeted screening group had elevated cholesterol levels (p = 0.02). CONCLUSIONS: All participants received instant feedback and recommendations. Using a targeted screening approach, POCT could be a practical and effective tool for identifying at-risk children with hypercholesterolemia.

Closed reduction evaluation in dysplastic hip with the Ömeroglu system in children aged 24 to 36 months.

Closed reduction (CR) as an initial treatment for developmental hip dysplasia of the hip (DDH) in children aged 24 to 36 months is debatable; however, it could have better results than open reduction (OR) or osteotomies, because it is minimally invasive. The purpose of this study was to evaluate the radiological results in children (24-36 months) with DDH initially treated with CR. Initial, subsequent, final anteroposterior pelvic radiological records were retrospectively analyzed. The International Hip Dysplasia Institute was used to classify the initial dislocations. To evaluate the final radiological results after CR (initial treatment) or additional treatment (CR failed), the Ömeroglu system was used (6 points excellent, 5 good, 4 fair-plus, 3 fair-minus, and ≤2 poor). The degree of acetabular dysplasia was estimated using the initial acetabular index and the final acetabular index, Buchholz-Ogden classification was used to measure avascular necrosis (AVN). A total of 98 radiological records were eligible, including 53 patients (65 hips). Fifteen hips (23.1%) were redislocated, OR with femoral osteotomy and pelvic osteotomy was the preferred surgical treatment 9 (13.8%). The initial acetabular index versus final acetabular index in total population was (38.9º ± 6.8º) and (31.9º ± 6.8º), respectively (t = 6.5, P < .001). The prevalence of AVN was 40%. Overall AVN in OR, femoral osteotomy and pelvic osteotomy were 73.3% versus CR 30%, P = .003. Unsatisfactory results ≤ 4 points on the Ömeroglu system were observed in hips that required OR with femoral and pelvic osteotomy. Hips with DDH treated with CR initially might had better radiological results than those treated with OR and femoral and pelvic osteotomies. Regular, good, and excellent results, ≥4 points on the Ömeroglu system, could be estimated in 57% of the cases, in whom CR was successful. AVN is frequently observed in hips with failed CR.

Desnutrición y talla baja como indicadores de salud.

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Alteraciones puberales en adolescentes con leucemia en fase de vigilancia.

OBJECTIVE: To evaluate which factors are associated with alterations in pubertal development in pediatric patients with leukemia in the surveillance phase. METHOD: A case-control study was carried out, including patients aged 8-14 years with diagnosis of acute lymphoblastic leukemia under surveillance. Demographic data were collected, age at diagnosis, type of leukemia, risk of leukemia, duration and type of treatment received, time of surveillance phase; and pubertal development was assessed by Tanner stage, bone age, pelvic ultrasound for women, and LH levels. Fisher's exact test and Mann-Whitney U-test were used. RESULTS: Twenty-five pediatric patients with a diagnosis of acute lymphoblastic leukemia between 8 and 14 years of age with a median of 8 were included, only 4 (16%) presented pubertal alterations, 1 had pubertal delay and 3 advanced puberty. The history of radiotherapy was related to pubertal alterations (p = 0.03). CONCLUSIONS: The antecedent of having received radiotherapy as part of the treatment in patients with acute lymphoblastic leukemia is a risk factor for developing pubertal abnormalities.

[Hepatic steatosis (HS) as a factor associated with the presence of metabolic risk in schoolchildren and obese adolescents]. / Esteatosis hepática (EH) como factor asociado a la presencia de riesgo metabólico en escolares y adolescentes obesos.

INTRODUCTION: One of the complications associated with obesity is nonalcoholic fatty liver disease (NAFLD), which is defined as an excessive accumulation of fat in hepatocytes, and is characterized by chronic elevation of aminotransferases and ultrasonographic abnormalities (increased echogenicity). In the USA it is now the most common liver disease. Prevalence is around 15-25% in the general population, and this increases to 57.5-75% in obese people. The aim of this study was to evaluate whether hepatic steatosis is a factor associated with the presence of metabolic risk in children and obese adolescents. MATERIALS AND METHODS: A retro- and perspective cross-sectional study in the High Specialty Medical Unit No. 25 of the Mexican Social Security Institute in Monterrey, Nuevo Leon, Mexico, in which the clinical records of patients from 5 to 15 years of age, referred with a diagnosis of obesity, were reviewed in the period of January 1, 2012 to June 30, 2013. Children and adolescent patients diagnosed with obesity were included, but we excluded patients with a history of acute and chronic viral hepatitis and use of antiepileptic and hepatotoxic drugs. For descriptive analysis we used absolute frequencies, percentages, means, and standard deviations. For inferential analysis we used chi-square test, Fisher exact test, and Student t test to establish the association of NAFLD with the studied variables. The odds ratio was measured, considering 95% CI and statistical significance p < 0.05. RESULTS: 160 children and adolescent patients were included with median age 11.23 ± 2.2 years, of which 85 (53.1%) were male and 75 (46.9%) were female. All were obese, with BMI and abdominal circumference greater than the 95th percentile for age. In total, 131 (81.8%) patients had NAFLD and 29 (18.2 %) patients did not. HOMA index was increased by 3.9 ± 2.1 (p < 0.05) in patients in the NAFLD group with a mean of 6.4 ± 4.9 in the group without NAFLD. The cutoff point we found for insulin resistance associated with NAFLD was 9. We found four subjects with high LDL levels of (> 130), and none in the control group. Transaminase levels were significantly higher in the group of patients with NAFLD, ALT greater than 40 U/l in 127 (96.94%) of patients with NAFLD (OR: 63.5; 95% CI: 18.5-217; p < 0.005). LDL-C greater than 130 mg/dl occurred in four (3%) patients with NAFLD, and in none of the patients without NAFLD (p = 0.0001). Acanthosis nigricans was found in 128 (97.7%) patients with NAFLD and in only one (3.4 %) in the group without NAFLD (OR: 1194.7; 95% CI: 119.8-1191.5; p = 0.0001). CONCLUSION: Obesity and insulin resistance are risk factors for the development of fatty liver in children and adolescents.