Associations between prenatal metal and metalloid mixtures in teeth and reductions in childhood lung function.

BACKGROUND: Metal(oid)s have been cross-sectionally associated with lung function outcomes in childhood but there is limited data on their combined effects starting in utero. Child sex may further modify these effects. OBJECTIVE: Examine associations between in utero and early life exposure to metals assessed via novel dentine biomarkers and childhood lung function and explore effect modification by child sex. METHODS: Analyses included 291 children enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study, a longitudinal birth cohort study in Mexico City. Weekly dentine levels of arsenic (As), cadmium (Cd), cobalt (Co), copper (Cu), manganese (Mn), nickel (Ni), and lead (Pb) were measured from 15 weeks pre-birth to 15 weeks post birth in deciduous children's teeth. Lung function was tested at ages 8-14 years and then modeled as age, height and sex adjusted z-scores. Associations were modeled using lagged weighted quantile sum (LWQS) regression to evaluate the potential for a time-varying mixture effect adjusting for maternal age and education at enrollment and exposure to environmental tobacco smoke in pregnancy. Models were also stratified by sex. RESULTS: We identified a window of susceptibility at 12-15 weeks pre-birth in which the metal mixture was associated with lower FVC z-scores in children aged 8-14 years. Cd and Mn were the largest contributors to the mixture effect (70 %). There was also some evidence of effect modification by sex, in which the mean weights and weighted correlations over the identified window was more evident in males when compared to females. In the male stratum, Cd, Mn and additionally Pb also dominated the mixture association. CONCLUSIONS: Prenatal metal(oid) exposure was associated with lower lung function in childhood. These findings underscore the need to consider both mixtures and windows of susceptibility to fully elucidate effects of prenatal metal(oid) exposure on childhood lung function.

Recent ambient temperature and fine particulate matter (PM2.5) exposure is associated with urinary kidney injury biomarkers in children.

BACKGROUND: Limited research has examined associations between exposure to ambient temperature, air pollution, and kidney function or injury during the preadolescent period. We examined associations between exposure to ambient temperature and particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) with preadolescent estimated glomerular filtration rate (eGFR) and urinary kidney injury biomarkers. METHODS: Participants included 437 children without cardiovascular or kidney disease enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors birth cohort study in Mexico City. eGFR and urinary kidney injury biomarkers were assessed at 8-12 years. Validated satellite-based spatio-temporal models were used to estimate mean daily temperature and PM2.5 levels at each participant's residence 7- and 30-days prior to the date of visit. Linear regression and distributed lag nonlinear models (DLNM) were used to examine associations between daily mean temperature and PM2.5 exposure and kidney outcomes, adjusted for covariates. RESULTS: In single linear regressions, higher seven-day average PM2.5 was associated with higher urinary alpha-1-microglobulin and eGFR. In DLNM analyses, higher temperature exposure in the seven days prior to date of visit was associated with a decrease in urinary cystatin C of -0.56 ng/mL (95 % confidence interval (CI): -1.08, -0.04) and in osteopontin of -0.08 ng/mL (95 % CI: -0.15, -0.001). PM2.5 exposure over the seven days prior to date of visit was associated with an increase in eGFR of 1.77 mL/min/1.73m2 (95 % CI: 0.55, 2.99) and urinary cystatin C of 0.19 ng/mL (95 % CI: 0.03, 0.35). CONCLUSIONS: Recent exposure to ambient temperature and PM2.5 were associated with increased and decreased urinary kidney injury biomarkers that may reflect subclinical glomerular or tubular injury in children. Further research is required to assess environmental exposures and worsening subclinical kidney injury across development.

Síndrome inflamatorio multisistémico post-COVID en niños: reporte de casos en Montevideo, Uruguay, 2020-2021 / Multsystemic inflammatory syndrome in post-Covid children: clinical case studies in Montevideo, Uruguay, 2020-2021 / Sindrome inflamatório multisistêmico pós-COVID em crianças: relato de casos em Montevdéu, Uruguai, 2020-2021

El síndrome inflamatorio multisistémico asociado a COVID-19 es una presentación postinfecciosa, que puede ser particularmente grave, pudiendo producir una severa disfunción multiorgánica. Se presenta una serie de 6 casos clínicos, asistidos en Servicio Médico Integral, Montevideo-Uruguay, con el fin de exponer las características clínicas y paraclínicas de este nuevo síndrome, y la evolución clínica de los mismos. Se realiza un estudio observacional descriptivo. La edad media fue de 6 años, con predominio en sexo femenino. Estos pacientes tuvieron una presentación clínica leve a moderada, con buena evolución Las manifestaciones clínicas principales fueron: fiebre, compromiso gastrointestinal, mucocutáneo y afectación ocular; dos de estos pacientes presentaron compromiso cardiovascular. Todos tuvieron alteraciones en la paraclínica, destacándose reactantes de fase aguda elevados. Todos los pacientes recibieron inmunoglobulina intravenosa y corticoides, tres de ellos recibieron heparina de bajo peso molecular por valor de D-dímeros 5 veces por encima del valor de referencia. No descartamos el impacto del diagnóstico y tratamiento precoz en la buena evolución de estos niños.

The Multisystem Inflammatory Syndrome associated with COVID-19 is a postinfectious presentation, which can be particularly serious, and can produce severe multiorgan dysfunction. A report of 6 clinical cases, assisted in the Comprehensive Medical Service, Montevideo-Uruguay, is presented in order to expose the clinical and paraclinical characteristics of this new syndrome, and their clinical evolution. A descriptive observational study was carried out. The mean age was 6 years, with a predominance of females. These patients had a mild to moderate clinical presentation, with good evolution. The main clinical manifestations were: fever, gastrointestinal and mucocutaneous involvement, and ocular involvement; two of these patients had cardiovascular compromise. All had alterations in the paraclinical, standing out elevated acute phase reactants. All patients received intravenous immunoglobulin and corticosteroids, three of them received low molecular weight heparin with a value of D-dimers 5 times higher than the reference value. We do not rule out the impact of early diagnosis and treatment on the positive evolution of these children.

A Síndrome Inflamatória Multissistêmica associada à COVID-19 é uma apresentação pósinfecciosa, que pode ser particularmente grave e produzir disfunção grave de múltiplos órgãos. Apresentamos um relato de 6 casos clínicos, atendidos no Serviço Médico Integral, Montevidéu-Uruguai, com o objetivo de expor as características clínicas e para clínicas desta nova síndrome, e sua evolução clínica. Tratase de um estudo observacional descritivo. A média de idade foi de 6 anos, com predomínio do sexo feminino. Esses pacientes tinham apresentação clínica leve a moderada, com boa evolução. As principais manifestações clínicas foram: febre, envolvimento gastrointestinal, muco cutâneo e ocular; dois desses pacientes apresentaram comprometimento cardiovascular. Todos apresentavam alterações para clínicas, destacandose elevados reagentes na fase aguda. Todos os pacientes receberam imunoglobulina e corticosteroides endovenosos, três deles receberam heparina de baixo peso molecular com valor do dímero D 5 vezes acima do valor de referência. Não descartamos o impacto do diagnóstico e tratamento precoces na evolução positiva dessas crianças.

Prevención de bacteriemia asociada a catéteres intravenosos en UCIN mediante la implementación de un protocolo de trabajo / Prevention of catheter-related bacteremia in the Pediatrics Critical Care Unit by means of a protocol

Introducción: la bacteriemia asociada al uso de catéter venoso central (BCVC) es una causa frecuente de infección intrahospitalaria en las unidades de cuidados intensivos pediátricos. Objetivo: evaluar el impacto sobre la incidencia de BCVC de la implementación de un paquete de medidas destinadas a su prevención en la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell. Metodología: se realizó un estudio descriptivo intervencionista desde el 1 de mayo de 2013 al 31 de octubre del mismo año. Se aplicó un paquete de medidas en la colocación de catéteres venosos centrales (CVC). Las mismas consistieron en higiene de manos, uso de barreras asépticas máximas, asepsia de la piel con clorhexidina, evitar el uso del acceso femoral, retiro temprano de los CVC y cuidados posteriores del CVC. Se determinó la densidad de incidencia de BCVC. Resultados: se incluyeron 45 niños con CVC colocados en UCIN, con un total de 51 CVC y 419 días de cateterización. Se identificó un caso de BCVC. La densidad de incidencia de BCVC fue 2,38 casos/1.000 días de CVC. El cumplimiento del paquete de medidas para la prevención de la BCVC fue elevado. Conclusiones: la incidencia de BCVC ha descendido a partir del año 2010. El protocolo de trabajo propuesto fue implementado como pauta de UCIN.

Introduction: intravascular-device bacteremia is a frequent cause of intrahospitalary infections in the Pediatrics Critical Care Units. Objective: to establish the impact of a bunddle of strategies on the incidence of catheter-related bacteremia in the Pediatrics Critical Care Unit of Centro Hospitalario Pereira Rossell. Method: an observational descriptive study was conducted from May 1, 2013 to October 31, 2013. Patients hospitalized in the Pediatrics Critical Care Unit with a central catheter were included. Six interventions were applied as a bundle at the moment of insertion of catheter. Data were collected from the patients’ clinical history and from the checklist filled at the moment of insertion of catheter. Density of the incidence of of bacteremia related to central catheter was calculated. Results: 45 children were included in the study, adding up to 51 central venous access and 419 days of catheterization. One case of catheter-related bacteremia was identified, there being 2.38 cases/ 1000 days of catheterization. The isolation was coagulase negative Staphylococcus. The bundle of interventions was highly accepted. Conclusions: the incidence of catheter-related bacteremia has diminished since 2010. The bundle of interventions has been established as a guide in the Pediatrics Critical Care Unit of Centro Hospitalario Pereira Rossell.

Calidad de vida del niño asmático y su cuidador en centros públicos y privadosde Montevideo (2009 a 2010) / Quality of life of asthmatic children and their caregivers in public and private schools Montevideo

Introducción: medir la calidad de vida en asma es importante para su tratamiento ya que refleja el estado funcional del paciente.Objetivo: conocer la calidad de vida de los niños asmáticos y de sus cuidadores en 3 centros de salud y determinar la relación entre la calidad de vida y el control de la enfermedad.Métodos: estudio descriptivo, transversal,multicéntrico con niños asmáticos entre 7 y 15 años,durante el período de marzo 2009 a julio de 2010. Se aplicaron dos cuestionarios de calidad de vida en asma (PAQLQ para el niño y PACQLQ para el cuidador) de Juniper previamente validado en Uruguay. Se consideró alteración de la calidad de vida a un promedio menor de 5 puntos. Se clasificó a los niños en asmáticos controlados y no controlados según GINA. Se analizó la relación entre la calidad de vida y el control de la enfermedad. Se utilizaron promedio, mediana y porcentajes. Para el análisis estadístico se utilizó c2 considerando como significativo un p < 0,05.Resultados: se encuestaron 195 pacientes y cuidadores pero la clasificación según los criterios de Gina se realizó en 174 pacientes. Presentaron afectación de la calidad de vida global el 28,7% de los niños y el 60% de los cuidadores. El 70% se clasificó como asma controlada. La afectación de la calidad de vida se presentó en el 73% de los paciente con asma no controlada (p<0,05).No hubo diferencias en cuanto a la edad (niños versus adolescentes) y sexo . La afectación de la calidad de vida en los tres dominios(limitación de actividades, función emocional y síntomas) se asoció a falta de control del asma en los niños. Los cuidadores presentaron mayor afectación de la calidad de vida global, de la función emocional y limitación de actividades que los niños asmáticos.Conclusiones: en el grupo analizado, la mayoría delos niños no presentaron afectación de la calidad de vida. Existe relación entre el control de la enfermedad y la calidad de vida. La percepción de la enfermedad entre niños...

Effect of Swimming Training on the Rectus Abdominis Muscle of rats: Morphological and Histochemical Aspects / Efecto de la Natación Sobre el Músculo Recto del Abdomen de la Rata: Aspectos Morfológicos e Histoquímicos

We investigated the effect of swimming training in rats on morphological characteristics, hypertrophy levels and metabolic and contractile adaptations of different fiber types in rat the rectus abdominis muscle. Rats were randoverly assigned to one of three groups (N = 5 each): a) swimming training for 1 h, twice a week (2x/w), b) 1 h five times a week (5x/w) for 9 consecutive weeks, or c) without any swimming training (Control). Body weight increased in 2x/w rats and decreased in the 5x/w ones. Muscle fiber diameters increased in both trained groups, with higher values in the 2x/w group. Aerobic exercise increased slow oxidative (SO) + fast-oxidative-glycolytic (FOG) fibers and decreased fast glycolytic (FG) fibers. In addition, SO fibers were increased and FOG + FG fibers were decreased in trained rats. Small and angulated atrophic fibers were also observed. These results corroborate that swimming exercise increases aerobic metabolism and thus oxidative and low contraction fibers. However, the used protocol induced, to a variable degree, changes in the muscle fiber morphology.

Se estudió el efecto de la natación en las características morfológicas, niveles de hipertrofia y las adaptaciones metabólicas y contráctiles de diferentes tipos de fibras en el músculo recto del abdomen de ratas. Las ratas fueron asignadas en tres grupos (N = 5 cada uno): a) natación por 1 hora dos veces a la semana (2x/s), b) 1 hora, cinco veces por semana (5x/s) por nueve semanas consecutivas y c) sin natación (control). El peso corporal se incrementó en las ratas 2x/s y disminuyó en 5x/s. El diámetro de las fibras musculares aumentó en ambos grupos entrenados, con mayores valores en las ratas 2x/s. El ejercicio aeróbico incrementó las fibras de oxidación lenta (OL) + las fibras de glicólisis oxidativa rápida (GOR) y disminuyeron las fibras de glicólisis rápida (GR). Además, las fibras OL aumentaron y las fibras GOR y GR disminuyeron en las ratas entrenadas. Se observó una pequeña atrofia y deshidratación de las fibras. Estos resultados corroboran que la práctica de la natación incrementa el metabolismo aeróbico, las fibras de contracción lenta y la oxidación. Sin embargo, el protocolo utilizado induce cambios en grado variable en la morfología de las fibras musculares.