Weight loss thresholds to detect early hypernatremia in newborns / Limites de perda de peso para detecção de hipernatremia precoce em recém-nascidos

ABSTRACT Objective: The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. Methods: A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium ≥ 145 mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. Results: There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity = 77.6%; specificity = 73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. Conclusions: The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.

RESUMO Objetivo: A literatura indica um único ponto de corte universal na perda de peso após o nascimento para risco de hipernatremia, sem considerar outros fatores. Nosso objetivo foi criar e validar internamente pontos de corte para o percentual de perda de peso associado ao risco de hipernatremia considerando fatores de risco. Métodos: Foi feito um estudo prospectivo que incluiu 165 neonatos com idade gestacional ≥ 35 semanas, acompanhados por três dias. A principal variável de resultado foi hipernatremia leve ou moderada (sódio sérico ≥ 145 mmol/L). As variáveis secundárias (fatores de risco) foram variáveis maternas e dos neonatos. Um modelo multivariado de regressão logística foi criado para diagnosticar hipernatremia, obteve sua probabilidade e o ponto de corte discriminativo ideal para hipernatremia (análise da Característica de Operação do Receptor). Com base nesse ponto, obtivemos então os valores limites de perda de peso de acordo com as outras variáveis. Esses valores foram internamente validados por. Resultados: Há 51 casos (30,9%) de hipernatremia. O percentual de perda de peso para neonatos hipernatrêmicos foi 8,6% e 6,0% para o restante. As variáveis associadas no modelo multivariado incluíram maior perda de peso, sexo masculino, maior nível de escolaridade, multiparidade e cesárea. O modelo apresentou uma área sob a curva da Característica de Operação do Receptor de 0,84 (sensibilidade = 77,6%; especificidade = 73,2%). Valores semelhantes foram obtidos na validação da bootstrapping. O menor percentual de perda de peso foi 4,77% para cesárea em neonatos do sexo masculino de mães com maior nível de escolaridade. Conclusões: Os valores percentuais de perda de peso dependem do tipo de parto, paridade, sexo do recém-nascido e nível de escolaridade materna. São necessários estudos externos para validar esses valores.

Enfermedad de Hashimoto en una cohorte de 29 niños y adolescentes: Epidemiología, evolución y comorbilidad a corto y largo plazo / Hashimoto's disease in a cohort of 29 children and adolescents: Epidemiology, clinical course, and comorbidities in the short and long term

La tiroiditis de Hashimoto es la causa más común de bocio e hipotiroidismo en niños y adolescentes. Las manifestaciones clínicas y la evolución son variables. El objetivo de este trabajo es revisar las particularidades clínicas y evolutivas de la enfermedad de Hashimoto en población pediátrica. Se analizaron datos clínicos, analíticos, ecográficos, epidemiológicos y evolutivos de los pacientes con tiroiditis autoinmune del Hospital Universitario San Juan de Alicante desde enero de 2010 hasta enero de 2016. En el estudio, se incluyeron un total de 29 pacientes. Se observó una mayor prevalencia en niñas con una relación 2:1. El principal motivo de consulta fue la detección casual de una hormona estimulante de la tiroides elevada o de positividad de anticuerpos antitiroideos en una analítica por otro motivo. En la analítica inicial, el 53,3% de los pacientes presentaba hipotiroidismo subclínico y tan solo el 10% de ellos, hipotiroidismo franco. Dos de los pacientes desarrollaron cáncer de tiroides.

Hashimoto's thyroiditis is the most common cause of goiter and hypothyroidism among children and adolescents. Its clinical manifestations and course vary. The objective of this study was to review the clinical and evolutionary characteristics of Hashimoto's disease in the pediatric population. Clinical, analytical, ultrasound, epidemiological, and evolutionary data of patients with autoimmune thyroiditis seen at Hospital Universitario San Juan de Alicante between January 2010 and January 2016 were analyzed. A total of 29 patients were included in the study. A higher prevalence of girls was observed, at a 2:1 ratio. The main reason for consultation was the accidental detection of high thyroid stimulating hormone levels or positive anti-thyroid antibodies in a lab test done for other reason. In the initial analysis, 53.3% of patients had subclinical hypothyroidism and only 10% of them had frank hypothyroidism. Two patients developed thyroid cancer.

Prevalencia del síndrome metabólico y sus componentes en adolescentes de la Ciudad de Monterrey, Nuevo León / Metabolic syndrome prevalence in teenagers of Monterrey, Nuevo León

Objetivo: Determinar la prevalencia del síndrome metabólico (SM) y de sus componentes en adolescentes del área metropolitana de Monterrey, Nuevo León, México (AMM). Método: Se realizó un estudio transversal de población, que incluyó a 254 escolares con edades entre 10 a 19 años. Se investigó: características personales, mediciones antropométricas, glucosa, triglicéridos y colesterol-HDL. Para determinar si un sujeto padecía SM, se adaptó la definición recomendada por el Nacional Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII). Resultados: La prevalencia de SM fue de 9.4% (IC95%: 5.8 a 13.0), sin que se observaran diferencias significativas entre sexos. Los distintos componentes de SM tuvieron la siguiente prevalencia: hipertigliceridemia, 24.4%; obesidad abdominal, 20.1%; colesterol de alta densidad (HDL-c) bajo, 19.0%; niveles de glucosa elevados, 11.4 %, e hipertensión arterial: 9.1% diastólica y 5.9% sistólica. Los fenotipos de predicción de SM fueron índice de masa corporal (IMC) (OR = 4.93, IC95%: 2.26, 10.73), e interacción entre el IMC del adolescente y sus antecedentes familiares de obesidad (OR = 1.37, IC95%: 1.0, 1.87). Se observó que la diabetes tipo 2 familiar sólo tuvo un efecto marginal. Conclusiones: La prevalencia de SM en escolares del AMM es alta, situación que resulta alarmante si este riesgo se mantiene durante el desarrollo y hasta la vida adulta. La obesidad en familiares de primero y segundo grados, junto con IMC del adolescente, son factores de predicción importantes de SM.

Objective: To determine the prevalence of the metabolic syndrome (SM) and its components in teenagers from the metropolitan area of Monterrey Nuevo Leon, Mexico (AMM). Method: A transversal research involving 254 teenage students from 10 to 19 years old. To research investigated their personal characteristics, anthropometrics measures, glucose, triglycerides and cholesterol HDL. The SM definition was adapted from the one suggested by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII). Results: The SM prevalence was 9.4 % (IC95%: 5.8 to 13.0), there was not a difference between the sexes. The prevalence among each SM component was: 24.4% for high triglycerides, 20.1% for abdominal obesity, 19.0% for cholesterol of lipoproteins of a high density (HDL-c) low, 11.4 % for high glucose and for high blood pressure (9.1% diastolic and 5.9% systolic). The prevalent SM phenotypes were corporal mass (IMC) (OR = 4.93, IC95%: 2.26, 10.73) and the IMC interaction of the teenager with a family history of obesity (OR = 1.37, IC95%: 1.0, 1.87). It was observed that those with a family history of diabetes type 2 only experienced a marginal effect. Conclusion: The SM prevalence in teenagers from AMM is high it was an alarming situation if it continues into adulthood. The existence of obesity in relatives of the first and second grade, altogether with teenager IMC are important prediction factors of SM.