International Pediatric Multidisciplinary Management Using Telemedicine to Promote Equitable Care.

Objective: To evaluate the use of telemedicine as a collaboration tool between a pediatrician and subspecialists looking to address challenges, such as the lack of health care specialists, which are present in the Dominican Republic. Study design: During this 6-year study, 65 patients were evaluated by a medical team consisting of a local pediatrician and 17 subspecialists from a leading academic medical center in the Unites States. Patient's age ranged from 2 months to 16 years of age (mean 8 years old). The most common reasons for referral were masses or malignancies, vascular malformations, urogenital anomalies, stuttering, and cochlear implant programming. Results: A total of 39 out of 65 cases (60%) carried an initial diagnosis. Of the 65 cases, a change in medical management occurred in 92.31% of cases (60 cases). There was no change in medical diagnosis or treatment in 5 of 65 cases (8%). Conclusion: This protocol exhibited high patient satisfaction with the technology and platform and direct patient savings from transportation costs. It also demonstrated the importance of thorough diagnosis in providing appropriate treatment and solutions. Telemedicine use in comparable practices should be studied further to aid in the development of policies for the diagnosis and management of chronic illnesses that require referrals to subspecialists.

Neuropsychological Alterations in Patients with Congenital Hypothyroidism Treated with Levothyroxine: Linked Factors and Thyroid Hormone Hyposensitivity.

Eighty-five percent of the studies of patients with congenital hypothyroidism (CH) treated with Levothyroxine (L-T4) report neuropsychological sequelae throughout life. In neonates and infants, there is a deficit in sensorimotor skills (impaired balance). In preschool and elementary school children and adolescents, there are alterations in intellectual quotient (low scores), language (delayed phonological acquisition), memory (visual, verbal, visuospatial, visuoconstructive, autobiographical, and semantic), sensorimotor skills (impaired fine and gross motor control), and visuoconstructive-visuospatial domain (low scores in spatial location, block design, and object assembly). These neuropsychological domains are also affected in young adults, except for language (adequate verbal fluency) and visuoconstructive-visuospatial domain (no data). The onset and severity of neuropsychological sequelae in patients with treated CH depend on several factors: extrinsic, related to L-T4 treatment and social aspects, and intrinsic, such as severity and etiology of CH, as well as structural and physiological changes in the brain. In this review, we hypothesized that thyroid hormone hyposensitivity (THH) could also contribute to neuropsychological alterations by reducing the effectiveness of L-T4 treatment in the brain. Thus, further research could approach the THH hypothesis at basic and clinical levels to implement new endocrinological and neuropsychological therapies for CH patients.

An international telemedicine program for diagnosis of genetic disorders: Partnership of pediatrician and geneticist.

There is a shortage of genetics providers worldwide and access is limited to large academic centers. Telemedicine programs can facilitate access to genetic services to patients living in remote locations. The goal of this study was to improve access to genetic services in the Dominican Republic by creating a partnership model between a pediatrician and geneticist. This approach has been used within the United States but not in the setting of two different countries, healthcare system, and cultures. Patients were referred to the Centro de Obstetricia y Ginecologia program if a syndromic or genetic etiology was suspected by their local provider. Pediatrician first evaluated all patients prior to telemedicine appointment to review family and medical history. All genetic visits were scheduled within 2 weeks of referral in collaboration with telehealth program at Cincinnati Children's Hospital Medical Center. A total of 66 individuals were evaluated during a period of 5 years. Fifty-seven individuals underwent genetic studies, and a molecular diagnosis was made in 39 individuals. Exome sequencing was the most common first line test when differential diagnosis was broad (n = 40). The most common inheritance was autosomal recessive in 15 individuals, followed by 13 individuals with autosomal dominant disorders, 7 individuals X-linked disorders, and 4 individuals with chromosomal abnormalities. This study provides data to support utility of geneticist and pediatrician partnership to provide outreach telemedicine diagnostics and management services for rare diseases in an international setting.

Obesity is the main determinant of insulin resistance more than the circulating pro-inflammatory cytokines levels in rheumatoid arthritis patients / A obesidade é um determinante da resistência à insulina mais importante do que os níveis circulantes de citocinas pró-inflamatórias em pacientes com artrite reumatoide

ABSTRACT Background: Systemic blockade of TNF-α in Rheumatoid arthritis with insulin resistance seems to produce more improvement in insulin sensitivity in normal weight patients with Rheumatoid arthritis than in obese patients with Rheumatoid arthritis, suggesting that systemic-inflammation and obesity are independent risk factors for insulin resistance in Rheumatoid arthritis patients. Objectives: To evaluate the insulin resistance in: normal weight patients with Rheumatoid arthritis, overweight patients with Rheumatoid arthritis, obese Rheumatoid arthritis patients, and matched control subjects with normal weight and obesity; and its association with major cytokines involved in the pathogenesis of the disease. Methods: Assessments included: body mass index, insulin resistance by Homeostasis Model Assessment, ELISA method, and enzymatic colorimetric assay. Results: Outstanding results from these studies include: (1) In Rheumatoid arthritis patients, insulin resistance was well correlated with body mass index, but not with levels of serum cytokines. In fact, levels of cytokines were similar in all Rheumatoid arthritis patients, regardless of being obese, overweight or normal weight (2) Insulin resistance was significantly higher in Rheumatoid arthritis with normal weight than in normal weight (3) No significant difference was observed between insulin resistances of Rheumatoid arthritis with obesity and obesity (4) As expected, levels of circulating cytokines were significantly higher in Rheumatoid arthritis patients than in obesity. Conclusions: Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA.

RESUMO Introdução: O bloqueio sistêmico do Fator de Necrose Tumoral-α (TNF-α) nos indivíduos com artrite reumatoide (AR) com resistência à insulina (RI) parece produzir mais melhoria na sensibilidade à insulina em pacientes com AR com peso normal do que em pacientes obesos com AR. Isso sugere que a inflamação sistêmica e a obesidade são fatores de risco independentes para a RI em pacientes com AR. Objetivos: Avaliar a resistência à insulina em pacientes com peso normal com AR (AR-PN), pacientes com sobrepeso com AR (AR-SP), pacientes com AR obesos (AR-OB) e indivíduos controle com peso normal (PN) e obesidade (OB) pareados; e a associação com as principais citocinas envolvidas na patogênese da doença. Métodos: As avaliações incluíram: índice de massa corporal (IMC), resistência à insulina com o modelo de avaliação da homeostase (Homa-IR), método Elisa e ensaio colorimétrico enzimático. Resultados: Os resultados marcantes do presente estudo incluíram: (1) Em pacientes com AR, a RI estava bem correlacionada com o Índice de Massa Corporal (quanto maior o IMC, maior a RI), mas não com os níveis séricos de citocinas. Na verdade, os níveis de citocinas eram semelhantes em todos os pacientes com AR, independentemente de serem obesos, com sobrepeso ou peso normal. (2) A RI foi significativamente maior no grupo AR-PN do que no grupo PN. (3) Não houve diferença estatisticamente significativa entre a RI de pacientes AR-OB e OB. (4) Como esperado, os níveis circulantes de citocinas foram significativamente maiores em pacientes com AR do que em OB. Conclusões: A obesidade parece ser uma condição mais importante do que a inflamação em produzir RI em pacientes com AR. A dissociação dos componentes da inflamação e da obesidade na produção de RI sugere a necessidade de uma estratégia terapêutica independente em pacientes obesos com AR.

Obesity is the main determinant of insulin resistance more than the circulating pro-inflammatory cytokines levels in rheumatoid arthritis patients.

BACKGROUND: Systemic blockade of TNF-α in Rheumatoid arthritis with insulin resistance seems to produce more improvement in insulin sensitivity in normal weight patients with Rheumatoid arthritis than in obese patients with Rheumatoid arthritis, suggesting that systemic-inflammation and obesity are independent risk factors for insulin resistance in Rheumatoid arthritis patients. OBJECTIVES: To evaluate the insulin resistance in: normal weight patients with Rheumatoid arthritis, overweight patients with Rheumatoid arthritis, obese Rheumatoid arthritis patients, and matched control subjects with normal weight and obesity; and its association with major cytokines involved in the pathogenesis of the disease. METHODS: Assessments included: body mass index, insulin resistance by Homeostasis Model Assessment, ELISA method, and enzymatic colorimetric assay. RESULTS: Outstanding results from these studies include: (1) In Rheumatoid arthritis patients, insulin resistance was well correlated with body mass index, but not with levels of serum cytokines. In fact, levels of cytokines were similar in all Rheumatoid arthritis patients, regardless of being obese, overweight or normal weight (2) Insulin resistance was significantly higher in Rheumatoid arthritis with normal weight than in normal weight (3) No significant difference was observed between insulin resistances of Rheumatoid arthritis with obesity and obesity (4) As expected, levels of circulating cytokines were significantly higher in Rheumatoid arthritis patients than in obesity. CONCLUSIONS: Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA.

Not all boronic acids with a five-membered cycle induce tremor, neuronal damage and decreased dopamine.

Several striatal toxins can be used to induce motor disruption. One example is MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), whose toxicity is accepted as a murine model of parkinsonism. Recently, 3-Thienylboronic acid (3TB) was found to produce motor disruption and biased neuronal damage to basal ganglia in mice. The aim of this study was to examine the toxic effects of four boronic acids with a close structural relationship to 3TB (all having a five-membered cycle), as well as boric acid and 3TB. These boron-containing compounds were compared to MPTP regarding brain access, morphological disruption of the CNS, and behavioral manifestations of such disruption. Data was collected through acute toxicity evaluations, motor behavior tests, necropsies, determination of neuronal survival by immunohistochemistry, Raman spectroscopic analysis of brain tissue, and HPLC measurement of dopamine in substantia nigra and striatum tissue. Each compound showed a distinct profile for motor disruption. For example, motor activity was not disrupted by boric acid, but was decreased by two boronic acids (caused by a sedative effect). 3TB, 2-Thienyl and 2-furanyl boronic acid gave rise to shaking behavior. The various manifestations generated by these compounds can be linked, in part, to different levels of dopamine (measured by HPLC) and degrees of neuronal damage in the basal ganglia and cerebellum. Clearly, motor disruption is not induced by all boronic acids with a five-membered cycle as substituent. Possible explanations are given for the diverse chemico-morphological changes and degrees of disruption of the motor system, considering the role of boron and the structure-toxicity relationship.

Analysis of risk factors associated to cytomegalovirus infection in dentistry students / Análisis de factores de riesgo asociados a la infección por citomegalovirus en estudiantes de odontología

The purpose of the study was to analyze the association between cytomegalovirus (CMV) infection in dental students with occupational risk factors and a genetic trait (NKG2C gene deletion). Study design: Case-control study. 176 students were included and divided in two groups according to CMV serological results: those with CMV infection (case group) and those without prior infection (control group). Demographic, occupational, and the presence of NKG2C gene deletion were compared between both groups. Results: The presence of CMV IgG antibodies was detected in 104 (59.1 percent) students (case group) while 72 (40.9 percent) students were CMV negative (control group). The frequency of patient contact, the use of protective barriers, and the number of reported accidents was compared between the study groups; no significant differences were noted. The appropriate use of infection-control measures was observed in the majority of students in both study groups. In the case group the frequency of NKG2C deletion was 9.7 percent compared to 5.6 percent in the control group (p=0.33). Conclusion: No association between the presence of CMV infection with occupational and genetic risk factors was found in this population. Dentists should be aware of the CMV prevalence and risks factors associated to this infection, particularly among child-bearing age dentist women...

El objetivo de este estudio fue analizar la asociación entre la infección por citomegalovirus (CMV) en estudiantes de odontología con factores de riesgo ocupacionales y un polimorfismo genético (deleción del gen NKG2C). Diseño del Estudio: Estudio de casos y controles. 176 estudiantes fueron incluidos y divididos en dos grupos de acuerdo al resultado serológico para CMV: aquellos con la infección por CMV (grupo de casos) y aquellos que no presentaron infección por CMV (grupo control). Las características demográficas, ocupacionales y la presencia de la deleción del gen NKG2C fueron comparadas entre ambos grupos. Resultados: La presencia de anticuerpos IgG de CMV fue detectada en 104 (59.1 por ciento) estudiantes (grupo de casos) mientras que 72 (40.9 por ciento) estudiantes fueron negativos a CMV (grupo control). Se comparó la frecuencia de contacto con el paciente, el uso de barreras protectoras y el número de accidentes ocupacionales reportados entre los grupos de estudio. No fueron detectadas diferencias significativas. El uso apropiado de las medidas de control de infección fue observado en la mayoría de los estudiantes de ambos grupos. En el grupo de casos la frecuencia de la deleción de NKG2C observada fue de 9.7 por ciento comparada con un 5.6 por ciento en el grupo control (p=0.33). Conclusión: No se encontró asociación entre la infección por CMV con los factores de riesgo ocupacionales y genéticos de esta población. Los dentistas deben conocer la frecuencia de la infección por CMV, así como los factores de riesgo asociados, particularmente las mujeres odontólogas en edad fértil...

Efecto de la suplementación de omega 3 sobre IMC, ICC y composición corporal en mujeres obesas / Effect of Omega 3 fatty acids on body female obese composition

La evidencia sobre los posibles mecanismos de utilización de los ácidos grasos Omega 3 para mediar la obesidad requiere continuar con estudios clínicos con metodologías concretas. El objetivo fue evaluar mediante impedancia bioeléctrica el efecto de la suplementación de omega 3 sobre el Indicé de Masa Corporal (IMC), Índice Cintura Cadera (ICC) y composición corporal en mujeres obesas. Participaron 60 mujeres obesas adultas (IMC >30 Kg/m²) que fueron aleatorizadas en 3 grupos: Grupo 1) placebo, vitamina E (200 UI), Grupo 2) 1 g de omega 3) y Grupo 3) 2 g de omega 3. Todas recibieron dieta hipocalórica y ejercicio moderado. Se midieron; peso, IMC, índice cintura cadera y distribución grasa al inicio y cada mes por tres meses. Los resultados muestran que la suplementación con omega 3 tuvo una relación dosis respuesta disminuyendo significativamente el peso, IMC y la masa grasa total, en comparación con el grupo control. Estos efectos dependieron del tiempo y cantidad de Omega 3 suplementada, cuando se ajustó por el grado de cumplimiento de ejercicio, apego a la dieta y edad. Concluimos que la suplementación con Omega 3 es un coadyuvante eficaz en el manejo de la obesidad en mujeres premenopáusicas.

Evidence on the possible mechanisms for the use of Omega 3 fatty acids to mediate obesity requires clinical studies continue with specific methodologies. The aim was to assess the effect of omega-3 supplementation on Body Mass Index (BMI), Wais - Hip Index (WHI) and body composition of obese women using bioelectrical impedance. Subjects 60 premenopausal obese women (BMI > 30Kg/m²) were randomly assigned to 3 groups: Group 1) placebo, vitamin E (200 IU), group 2) 1 g of omega and group 3) 2 g of omega-3. All of them received a low calorie diet and moderate exercise. Weight, BMI, WHI, and fat distribution were measured at the beginning and every month for three months. The results show us Omega-3 supplementation significantly reduced weight, BMI, and total fat mass, compared to the control group, a dose-response effect. These effects depended on the time and amount of Omega 3 supplemented, when the degree of compliance of exercise, adherence to the diet and age were controlled. In conclusion the supplementation with omega- 3 is an efficient method in the management of obesity in premenopausal women.

Biochemical characteristics and risk factors for insulin resistance at different levels of obesity.

OBJECTIVE: To establish the biochemical characteristics of nonobese, overweight, and obese children as well as to determine the risk factors associated with insulin resistance in nonobese children and with non-insulin resistance in obese children in the age strata of 6 to 11 years. METHODS: A total of 3512 healthy children were enrolled in a cross-sectional study. In the absence of obesity, fasting hyperinsulinemia and hypertriglyceridemia defined nonobese, insulin-resistant (NO-IR) children. In the absence of metabolic abnormalities of fasting insulin and triglycerides levels, obese children were defined as obese, not insulin-resistant (O-NIR) children. RESULTS: The gender- and age-adjusted prevalence of NO-IR and O-NIR was 6.6% and 21.3%, respectively. In the age-, gender-, and birth weight-adjusted analysis, family history of hypertension (FHH) in both maternal and paternal branches (odds ratio [OR]: 1.514; 95% confidence interval [CI]: 1.2-3.9; P = .04) was associated with NO-IR children. In the analysis adjusted by gender, age, waist circumference (WC), BMI, FHH, and family history of diabetes, high birth weight was associated with NO-IR children (OR: 1.319; 95% CI: 1.2-2.1; P = .04). Finally, in the gender-, age-, family history-, and birth weight-adjusted analysis, a WC lower than the 95th percentile was associated with a lower odds of insulin resistance among obese children (OR: 0.96; 95% CI: 0.91-0.98; P < .0005). CONCLUSIONS: FHH and high birth weight are associated with NO-IR children, and a low WC is associated with lower odds of O-IR children.

Effect of rosuvastatin on cytokines after traumatic head injury.

OBJECT: The favorable effect of statin treatment after traumatic brain injury (TBI) has been shown in animal studies and is probably true in humans as well. The objective of this study was to determine whether acute statin treatment following TBI could reduce inflammatory cytokines and improve functional outcomes in humans. METHODS: The authors performed a double-blind randomized clinical trial in patients with moderate to severe TBI. Exclusion criteria were as follows: prior severe disability; use of modifiers of statin metabolism; multisystem trauma; prior use of mannitol, barbiturates, corticosteroids, or calcium channel blockers; isolated brainstem lesions; allergy to statins; previous hepatopathy or myopathy; previous treatment at another clinic; and pregnancy. Patients were randomly selected to receive 20 mg of rosuvastatin or placebo for 10 days. The main goal was to determine the effect of rosuvastatin on plasma levels of tumor necrosis factor-α, interleukin (IL)-1ß, IL-6, and IL-10 after 72 hours of TBI. Amnesia, disorientation, and disability were assessed 3 and 6 months after TBI. RESULTS: Thirty-six patients were analyzed according to intention-to-treat analysis; 19 patients received rosuvastatin and 17 received placebo. The best-fit mixed model showed a significant effect of rosuvastatin on the reduction of tumor necrosis factor-α levels (p = 0.004). Rosuvastatin treatment did not appear to affect the levels of IL-1ß, IL-6, and IL-10. The treatment was associated with a reduction in disability scores (p = 0.03), indicating a favorable functional outcome. Life-threatening adverse effects were not observed. CONCLUSIONS: The authors' data suggest that statins may induce an antiinflammatory effect and may promote recovery after TBI. The role of statins in TBI therapy should be confirmed in larger clinical trials.

Atherogenic indices and prehypertension in obese and non-obese children.

We evaluate the relationship between different lipoproteins and atherogenic indices with pre-hypertension in 297 obese and 942 non-obese children with Tanner stage 1 enrolled in a multicentre, community-based cross-sectional study. Height, weight, fasting glucose and insulin levels, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), non-HDL-c, LDL/HDL-c, triglycerides/cholesterol and total cholesterol/HDL-c ratios were measured. Mean age was 8.4 ± 1.2 years; pre-hypertension was identified in 104 (8.4%) participants, 46 (15.5%) obese and 58 (6.1%) non-obese children. The pre-hypertensive non-obese children show a high proportion of family history of hypertension (41.6 and 24.7%, p = 0.002) and elevation of insulin at a relatively low body mass index. The triglycerides:HDL-c ratio, but not other lipoproteins or atherogenic indices, was associated with pre-hypertension in obese (1.15, 95% confidence intervals 1.06-1.26) and non-obese children (1.38 95% confidence intervals 1.22-1.57). The triglycerides:HDL-c ratio is related to pre-hypertension in children; the family history of hypertension seems to be a risk factor in developing pre-hypertension.

[Effect of Omega 3 fatty acids on body female obese composition]. / Efecto de la suplementación de omega 3 sobre IMC, ICC y composición corporal en mujeres obesas.

Evidence on the possible mechanisms for the use of Omega 3 fatty acids to mediate obesity requires clinical studies continue with specific methodologies. The aim was to assess the effect of omega-3 supplementation on Body Mass Index (BMI), Wais - Hip Index (WHI) and body composition of obese women using bioelectrical impedance. Subjects 60 premenopausal obese women (BMI > 30Kg/m2) were randomly assigned to 3 groups: Group 1) placebo, vitamin E (200 IU), group 2) 1 g of omega and group 3) 2 g of omega-3. All of them received a low calorie diet and moderate exercise. Weight, BMI, WHI, and fat distribution were measured at the beginning and every month for three months. The results show us Omega-3 supplementation significantly reduced weight, BMI, and total fat mass, compared to the control group, a dose-response effect. These effects depended on the time and amount of Omega 3 supplemented, when the degree of compliance of exercise, adherence to the diet and age were controlled. In conclusion the supplementation with omega-3 is an efficient method in the management of obesity in premenopausal women.

The administration of food supplemented with cocoa powder during nutritional recovery reduces damage caused by oxidative stress in rat brain.

Malnutrition contributes to the development of oxidative damage in the central nervous system. The selective administration of nutrients tends to show positive results in individuals who have suffered from malnutrition. To determine the effect of the administration of cocoa powder on the peroxidation of lipids and glutathione level during the nutritional recovery in brain, rats of 21 days old were subjected to a protocol that resembles malnutrition (MN) by feeding them with 60% of the daily food consumption of the control group (WN) and later to nutritional recovery with regular rodent feed (RFR) or added with cocoa (10 g of cocoa powder/kg of regular rodent feed) (CCR). Animals fed with regular rodent food showed significant reduction in brain glutathione: RFR (84.18 ± 6.38 ng/mg protein) vs. CCR (210.61 ± 50.10 ng/mg protein) and WN (186.55 ± 33.18 ng/mg protein), but with similar level to that of MN (92.12 ± 15.60 ng/mg protein). On the contrary, lipid peroxidation in RFR-fed animals increased RFR (1.32 ± 0.2 µM malondialdehyde/g of tissue), CCR (0.86 ± 0.07 µM malondialdehyde/g of tissue), WN (0.89 ± 0.09 µM malondialdehyde/g of tissue), but their thiobarbituric acid reactive substances concentration is similar to that of MN group (1.50 ± 0.2 µM malondialdehyde/g of tissue). Consumption of cocoa powder as a source of antioxidants favors the restoration of the concentration of glutathione and reduces the damage caused by oxidative stress during nutritional recovery in rat brain.

Association between caries, obesity and insulin resistance in Mexican adolescents.

AIM: To determine the association among dental caries, obesity and insulin resistance in Mexican adolescents. METHODS: Body mass index, obesity (OB) blood pressure, insulin level, insulin resistance (IR), triglycerides level, serum HDL-cholesterol (cHDL), DMFT index and salivary flow were measured. RESULTS: Anthropometric measures showed a significant statistical difference (p < 0.05). Insulin level was 8.98 for healthy subjects, whereas for OB-IR group was 25.35, there was a statistical significant difference (p < 0.05). Triglycerides level was 88.50 for healthy subjects and 169.40 mg/dL for OB-IR; cHDL was 52.88 for healthy and 41.82 mg/dL for OB-IR group, both showed a statistically significant difference (p < 0.05). Salivary flow was 4.30 for healthy and for OB-IR group was 5.48 ml/min showed a significant statistical difference (p < 0.05). DMFT index was 3.02 for healthy and for OB-IR adolescents was 4.78, showed a significant statistical diference (p < 0.05). The caries component of DMFT index was 1.84 for healthy and was 3.52 for OB-IR adolescents, showed a significant statistical difference (p < 0.05). According to the multivariate analysis, DMFT (OR = 3.10; IC 95% = 0.20-1.02, p = 0.042) and decay (OR = 3.30; IC 95% = 0.19-1.0, p = 0.011) were associated with subjects with OB-IR. CONCLUSION: OB-IR Mexican adolescents showed a positive association with DMFT.

Birth weight, family history of diabetes, and metabolic syndrome in children and adolescents.

OBJECTIVE: To evaluate whether a coupled family history of diabetes (FHD) and low birth weight (LBW) or high birth weight (HBW) is associated with metabolic syndrome (MetS) in children and adolescents. STUDY DESIGN: A total of 1262 children and adolescents age 7-15 years were randomly selected to enroll in this cross-sectional, community-based study. RESULTS: In the overall population, HBW (odds ratio [OR] = 1.4; 95% confidence interval [CI] = 1.2-10.9), but not LBW (OR = 0.97; 95% CI = 0.6-2.1), was significantly associated with MetS. In the group without FHD, HBW (OR = 1.730; 95% CI = 1.1-2.7), but not LBW (OR = 1.139; 95% CI = 0.7-23), was associated with MetS. In the group with FHD, both LBW (OR = 2.690; 95% CI = 1.4-15.1) and HBW (OR = 3.289; 95% CI = 1.3-30.6) were associated with MetS. Both LBW (OR = 4.710; 95% CI = 1.4-39.7) and HBW (OR = 3.127; 95% CI = 1.3-45.1) were associated with MetS in children and adolescents with FHD in the maternal branch but not in the paternal branch. CONCLUSIONS: HBW or LBW, in combination with positive FHD in the maternal branch, are determinants of MetS.

Family history of hypertension and cardiovascular risk factors in prepubertal children.

BACKGROUND: To determine the relationship between family history of hypertension (FHH) and cardiovascular risk factors (CVRF) in healthy prepubertal children. DESIGN: Cross-sectional, population-based study. SETTING: Elementary schools from San Luis Potosi and Durango, cities in middle and northern Mexico. PARTICIPANTS: A total of 358 randomly enrolled, healthy boys and girls aged 6-10 years in Tanner stage 1, with and without FHH. OUTCOME MEASURES: Odds ratio (OR) that estimates the relationship between FHH and CVRF. RESULTS: FHH was identified in 72 (20.1%) children; 212 (59.2%) children had at least one CVRF, where low high-density lipoprotein (HDL)-cholesterol (36.3%), elevated waist circumference (WC) (29.3%), and hypertriglyceridemia (28.8%) were the most frequent; high-blood pressure (HBP) and hyperglycemia were recognized in 10 (3.3%) and 1 (0.3%) children. Metabolic syndrome and hyperinsulinemia were identified in 36 (10.0%) and 48 (13.4%) children. In all subjects, hyperinsulinemia (OR 2.0; 95% confidence interval (CI) 1.2-8.4), but not other CVRF was significantly associated with FHH. Subsequent analysis stratified by WC showed that FHH was not associated with CVRF in children with elevated WC. Among children with nonelevated WC, FHH in the maternal branch, but not in the paternal branch, was associated with hyperinsulinemia (OR 1.5; 95% CI 1.1-5.5), HBP (OR 4.0; 95% CI 1.3-30.1), hypertriglyceridemia (OR 1.6; 95% CI 1.1-7.2), and low HDL-cholesterol (OR 1.3; 95% CI 1.1-3.0). CONCLUSION: Results show that FHH in the maternal branch is associated with CVRF in children with nonelevated WC.

Obesity and family history of diabetes as risk factors of impaired fasting glucose: implications for the early detection of prediabetes.

OBJECTIVE: To determine whether the association between family history of diabetes (FHD) and impaired fasting glucose (IFG) is independent of body mass index (BMI) in children and adolescents. METHODS: In all 443 (11.9%) children and adolescents with FHD, and 3280 (88.1%) without FHD were enrolled in a population-based cross-sectional study. Eligible subjects to participate were apparently healthy children and adolescents aged 7-15 yr from Middle and Northern Mexico. Obesity was defined by age- and gender-specific BMI >or= 95th percentile. FHD was defined as positive if at least one first degree relative had diabetes. The IFG was defined by fasting plasma glucose >or= 100 mg/dL and < 126 mg/dL. RESULTS: IFG was identified in 390 (88.0%) and 62 (1.9%) children and adolescents with and without FHD, respectively. In the group with positive FHD, IFG was diagnosed in 146 (37.4%), 79 (20.2%), and 165 (42.3%) children and adolescents who were obese, overweight, and normal-weight, respectively. On the other hand, in the group without FHD, IFG was identified in 21 (33.9%), 14 (22.6%), and 27 (43.5%) children and adolescents who were obese, overweight, and normal-weight, respectively. In the overall population, the age-, sex-, and BMI-adjusted logistic regression analysis showed a strong and independent association between FHD and IFG [odds ratio (OR) -11.7; 95% CI 9.5-21.2]. This association remained strong for girls and boys in a subsequent analysis stratified for BMI category. CONCLUSIONS: The presence of FHD in a first degree relative is associated with IFG, even in the absence of obesity.

Effect of rosuvastatin on amnesia and disorientation after traumatic brain injury (NCT003229758).

Amnesia is a common sequela following traumatic brain injury (TBI), for which there is no current treatment. Pleiotropic effects of statins have demonstrated faster recovery of spatial memory after TBI in animals. We conducted a double-blind randomized clinical trial add-on of patients with TBI (16-50 years of age), with Glasgow Coma Scale (GCS) scores of 9-13, and intracranial lesions as demonstrated by computed tomography (CT) scan. We excluded those patients with recent head injury or severe disability; administration of known drugs as modifiers of statin metabolism; multisystemic trauma; prior use of mannitol, barbiturate, corticosteroids, indomethacin or calcium antagonists; surgical or isolated lesion in brainstem; allergy to statins; previous hepatopathy or myopathy; previous management in another clinic; or pregnancy. Each patient received the same treatment and was randomly allocated to receive either rosuvastatin (RVS) or placebo over a period of 10 days. The primary outcome measures assessed were amnesia and disorientation times using Galveston Orientation Amnesia Test. Additionally, we evaluated plasma levels of interleukin (IL) 1beta, tumor necrosis factor (TNF) alpha, and IL-6, as well as disability at 3 months. We analyzed eight patients with RVS and 13 controls with similar basal characteristics. Using Cox regression analysis, administration of RVS showed a reduction of amnesia time with a hazard ratio of 53.76 (95% confidence interval [CI], 1.58-1824.64). This was adjusted for early intubation, basal leukocytes, basal Marshall and Fisher score, change of IL-1beta levels, and lesion side. IL-6 values at day 3 were increased in the RVS group (p = 0.04). No difference was detected in disability at 3 months. While statins may reduce amnesia time after TBI, possibly by immunomodulation, further trials are needed in order to confirm this positive association.

Prediabetes in rural and urban children in 3 states in Mexico.

The authors studied the frequency, distribution, and factors associated with prediabetes (fasting glucose, 100-125 mg/dL) in rural and urban children from San Luis Potosí, León, and Querétaro in central Mexico. Family history, somatometry, and levels of fasting insulin, glucose, and lipids were collected in 1238 children 6 to 13 years of age. The authors found no cases of type 2 diabetes and a 5.7% frequency of prediabetes. The group with prediabetes had higher homeostasis model assessment of insulin resistance scores and total cholesterol and high-density lipoprotein cholesterol levels. Prediabetes was more frequent in León, with similar distribution in rural and urban children. The frequency of insulin resistance was 24.1%, with higher figures in urban groups and in San Luis Potosí. In multivariate analysis, prediabetes was associated with insulin resistance and residence in León. The authors concluded that in central Mexico the frequency of prediabetes is significant, and it is associated with insulin resistance and a geographic location, but not with obesity or urban vs rural dwelling.

Discrimination between active and inactive neurocysticercosis by metacestode excretory/secretory antigens of Taenia solium in an enzyme-linked immunosorbent assay.

To detect IgG antibodies to Taenia solium, a controlled double-blind study was conducted using 91 coded cerebrospinal fluid samples from patients with neurocysticercosis (NCC) and other neurologic disorders. Samples were tested in an enzyme-linked immunosorbent assay (ELISA) using metacestode excretion/secretion antigens. The results were correlated with data from medical records on the diagnosis of NCC (based on computed tomography and magnetic resonance imaging criteria) and other neurologic disorders. The ELISA results were positive in 22 of the 24 cases with active NCC. In contrast, six cases with calcified cysts (inactive NCC), as well as one case in a transitional stage, were negative. One case with a calcified granuloma and another with a granuloma plus calcifications (classified as inactive NCC) had positive results. The remaining negative results corresponded to other neurologic disorders (58 cases). The results of the ELISA showed a significant difference between active and inactive NCC (P = 0.0034).