Disseminated gonococcal disease in pediatrics: Case report and review of the literature.

Hematogenous spread of Neisseria gonorrhoeae, a sexually transmitted pathogen, results in disseminated gonococcal disease (DGD), also known as arthritis-dermatitis syndrome, due to the development of skin lesions, tenosynovitis, and arthritis. The most frequently affected population is young adults. We describe the case of an adolescent female who acutely developed skin lesions, arthritis, tenosynovitis, and constitutional symptoms. The causal agent was identified by a culture of vaginal secretion and treated with ceftriaxone for 7 days with complete recovery. It is important to differentiate this clinical picture from other types of arthritis developed in adolescence.

Design of a Rheumatology Transition Clinic for a Resource-Constrained Setting.

OBJECTIVES: To describe the design process of a medical care program for adolescents with pediatric onset rheumatic diseases (PRD) during the transition from pediatric to adult care in a resource-constrained hospital. METHODS: The model of attention was developed in three steps: 1) the selection of a multidisciplinary team, 2) the evaluation of the state of readiness of patients and caregivers for the transition, and 3) the design of a strategy of attention according to local needs. The results of the first two steps were used in order to develop the strategy of attention. RESULTS: The transition process was structured in three stages: pretransition (at pediatric rheumatology clinic), Transition Clinic for Adolescents with Rheumatic Diseases (TCARD, the main intervention), and post-transition (at adult rheumatology clinic). Each stage was divided, in turn, into a variable number of phases (8 in total), which included activities and goals that patients and caregivers were to accomplish during the process. A multidisciplinary approach was planned by pediatric and adult rheumatologists, nutritionists, physiatrists, psychiatrist, psychologist, nurse, and social worker. During TCARD, counseling, education, nutritional, physical, and mental health interventions were considered. CONCLUSIONS: The proposed transition model for patients with rheumatic diseases can be a useful tool in developing countries.

Prevalence of IgG antibodies induced by the SARS-COV-2 virus in asymptomatic adults in Nuevo Leon, Mexico.

Population-based immunoglobulin G (IgG) seroprevalence studies in asymptomatic individuals in Latin America are scarce. The objective of the study was to estimate the prevalence and geographic distribution of IgG antibodies induced by natural SARS-CoV-2 infection in asymptomatic adults, 5-8 months after the first case was reported in a northeastern state of Mexico. This was a population-based cross-sectional study carried out in Nuevo Leon during August-November 2020. Individuals ≥18 years with no previous diagnosis or symptoms suggestive of COVID-19 were consecutively screened in one of the busiest subway stations. Also, a search for eligible individuals was done from house-to-house, after selecting densely populated geographic sectors of each of the municipalities of the metropolitan area (n = 4495). The IgG antibodies to SARS-CoV-2 nucleocapsid protein were analyzed. The IgG antibody positivity rate was 27.1% (95% confidence interval [CI]: 25.8, 28.4); there were no differences by sex or age (p > 0.05). Analysis by month showed a gradual increase from 11.9% (August) to 31.9% (November); Week 39 had the highest positivity rate (42.2%, 95% CI: 34.2, 50.7). Most people did not have evidence of previous SARS-CoV-2 infection. Preventive measures and promotion of the COVID-19 vaccine should be strengthened.

Public Veterinary Medicine: Public Health Rabies virus variants identified in Nuevo Leon State, Mexico, from 2008 to 2015.

OBJECTIVE: To identify rabies virus variants (RVVs) isolated from bats and terrestrial mammals in Nuevo Leon between 2008 and 2015 and Coahuila in 2006. SAMPLE: RVVs isolated from 15 bats and terrestrial mammals in Nuevo Leon and from a cow (Bos taurus) in Coahuila, along with 46 reference rabies virus sequences. PROCEDURES: Antigenic characterization of the 16 isolates was performed with an indirect fluorescent antibody technique. Genomic sequencing of the nucleoprotein gene in the 16 isolates was performed with a reverse transcription PCR assay. Phylogenetic reconstruction of the 62 sequences was performed by means of Bayesian inference. RESULTS: 9 isolates from bats and 1 isolate from a domestic cat that became infected as a result of contact with a Mexican free-tailed bat all clustered in the lineage associated with Lasiurus spp in the Americas or the lineage associated with Tadarida brasiliensis mexicana. An isolate from a domestic dog was identified as a variant associated with the dog-coyote lineage. The RVV isolated from a fox clustered in an Arizona fox lineage. The 3 RVVs from skunks (Mephitis macroura) were placed in a lineage with variants isolated from spotted skunks (Spilogale putorius). The RVV isolated from the cow was clustered in a lineage associated with foxes in Texas and separate from the lineage for the fox from Nuevo Leon. CONCLUSIONS AND CLINICAL RELEVANCE: Results reinforced the need for Mexico to implement rabies surveillance and monitoring programs for bats and wild-living terrestrial carnivores.

Acanthosis Nigricans in the Knuckles of Infants: A Novel Clinical Marker of High Metabolic Risk.

INTRODUCTION: Acanthosis nigricans (AN) is an early clinical sign of insulin resistance (IR) primarily in adults. The prevalence and association of AN and IR in infants, however, remains uncertain. We aimed to describe the prevalence of AN and its association with IR in a group of Latin-American infants. METHODS: We studied a random sample of 227 healthy infants between 9 and 24 months of age. After a complete clinical history was obtained and a physical examination was performed, fasting plasma glucose and serum insulin were measured. Three blinded evaluators assessed AN in each patient. Infants with AN were categorized as cases. The HOMA-IR index cutoffs of ≥ 90th and ≥ 95th percentiles were considered IR. RESULTS: There were 49 infants with AN (21.6%) (cases) and 178 without AN (78.4%) (controls). Cases had a significantly higher mean serum insulin, fasting plasma glucose, and HOMA-IR levels of 3.67 ± 2.56 µU/ml vs. 2.42 ± 1.45 µU/ml, P = 0.005; 84.2 ± 12.6 mg/dL vs. 77 ± SD 9.9 mg/dL, P ≤ 0.001; HOMA-IR 0.77 ± 0.54 vs. 0.46 ± 0.28, P ≤ 0.001, respectively. More cases than controls presented HOMA-IR levels ≥ 95th percentile (cases 18.4%; controls 0.5%, P ≤ 0.001) and ≥ 90th percentile (cases 32.7%; controls 1.6%, P ≤ 0.001). AN in the knuckles had a high sensitivity and a negative predictive value (NPV) for detecting patients with HOMA-IR levels above the 95th percentile (sensitivity 90%; NPV 99.4%) and above the 90th percentile (sensitivity 84.2%; NPV 98.3%). CONCLUSION: AN in the knuckles is a prevalent, non-invasive, costless, and reliable screening clinical tool that can be used for early detection of infants with IR and a high metabolic risk.

Differences in omentin-1 levels in term newborns according to birth weight.

BACKGROUND: Adipokines are produced by adipose tissue and are involved in metabolic processes. Omentin-1 is an adipokine that has been shown in vitro to possibly be involved in insulin sensitivity modulation. The prenatal stage is a crucial period for development of metabolic diseases in the long term, therefore, small (SGA) and large (LGA) for gestational age newborns have an increased risk of type 2 diabetes and metabolic syndrome later in life. AIMS: To evaluate the differences in omentin-1 concentrations in umbilical cord blood from healthy term newborns according to birth weight and explore the association between omentin-1 and anthropometry, glucose, insulin and insulin sensitivity. STUDY DESIGN: This was a secondary analysis of stored umbilical cord blood of term newborns. SUBJECTS: Newborns classified according to birth weight as SGA (n = 30), adequate for gestational age (AGA) (n = 12) and LGA (n = 34). OUTCOME MEASURES: An analysis of omentin-1, glucose and insulin were performed. RESULTS: Differences were found in serum omentin-1 levels (ng/mL) between SGA 328.17 ±â€¯108.04, AGA 253.05 ±â€¯98.25 and LGA 250.91 ±â€¯100.48 (p = 0.009). In the linear regression analysis, the independent variables HOMA-IR, QUICK-I and FGIR were predictors of serum omentin-1 levels (r = 0.175, p = 0.003). CONCLUSIONS: Omentin-1 cord blood levels have a differentiated behavior according to weight for gestational age with LGA newborns having lower levels and SGA newborns higher levels. HOMA-IR, QUICK-I and FGIR weakly predicted omentin-1 in cord blood, suggesting that omentin-1 possibly has an implication in insulin sensitivity since birth.

Clozapine in the Treatment of Aggression in Conduct Disorder in Children and Adolescents: A Randomized, Double-blind, Controlled Trial.

OBJECTIVE: This study was conducted to compare the efficacy of clozapine vs. risperidone in the treatment of aggression in conduct disorder in children and adolescents. METHODS: Twenty-four children with conduct disorder aged 6 to 16 years were randomized in a prospective, double-blind trial into two groups to receive clozapine or risperidone for 16 weeks. The Modified Overt Aggression Scale score was used as the primary outcome of the study. Secondary outcomes were Child Behavior Checklist (CBCL) externalization (CBCL-E) and internalization factors; Aggression, Hyperactivity and Delinquency subscales of CBCL-E, Child Global Assessment Scale (CGAS), Barnes Akathisia Rating Scale, and Simpson-Angus Scale. RESULTS: Both antipsychotics were similarly effective in the primary outcome and in most of the secondary ones. Clozapine was more effective in CBCL-E, the delinquency subscale and the CGAS scores than risperidone (p =0.039, 0.010, and 0.021). Two subjects from the clozapine group were excluded due to a low neutrophil count at week four. CONCLUSION: Clozapine and risperidone are effective for short-term treatment of aggression in children and adolescents with conduct disorder. Clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents. Stronger efficacy of clozapine should be investigated in larger sample sizes using pharmacogenomic studies. White blood cell counts need to be monitored when prescribing clozapine.

Vaspin, a Compensatory Mechanism Against High Glucose Levels Since Birth?

Objective: Hormones produced by fat tissue, adipokines, produced during intrauterine life have recently been implicated in fetal growth. Vaspin is an adipokine expressed in visceral adipose tissue and has insulin-sensitizing effects. Elevated serum vaspin concentrations are associated with alterations in insulin sensitivity. We aimed to determine if vaspin concentrations in cord blood from healthy, term newborns differ among those born small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). A secondary objective was to determine whether an association existed between vaspin and anthropometric measurements, glucose and insulin levels in the newborn. Methods: The study population included healthy term newborns, 30 subjects in the SGA, 12 in the AGA, and 34 in the LGA group. Anthropometry was documented in all subjects. Blood was taken from the umbilical cord vein from each child for later analysis for vaspin, insulin and glucose concentrations. Results: Cord blood vaspin, insulin and glucose concentrations were not different between the three study groups. A negative correlation between vaspin and glucose concentrations was demonstrated in the whole cohort (r=-0.364, p=0.001). This correlation was also observed in the LGA group (r=-0.482, p=0.004). Glucose concentrations significantly predicted vaspin concentrations (r2=0.132, p=0.001). Conclusion: We found a negative association between glucose and vaspin concentrations in umbilical cord blood. In addition there was a predictive association between blood glucose and resulting vaspin concentration, suggesting that vaspin can be used as a predictor of alterations in the insulin-glucose metabolism from birth.

Adding Multiple Adipokines into the Model do not Improve Weight Gain Prediction by Leptin Levels in Newborns.

OBJECTIVE: Most adipose tissue programming is realized in early life. Also, the postnatal three months, rather than the later phases of infancy, may be more relevant in the development of an adverse cardiometabolic risk profile. The adipokines phenotype, as a predictor of early-life weight gain, has been recently explored in cord blood. To determine whether in addition to leptin levels in cord samples, adiponectin, interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), resistin, plasminogen activator inhibitor-1 (PAI-1), and tumor necrosis factor alpha (TNF-α) levels improve weight gain prediction during the first three months of life. METHODS: Adiponectin, IL-6, MCP-1, leptin, resistin, PAI-1, and TNF-α were measured by multiplex immunoassay in a subsample of 86 healthy term newborns. RESULTS: Leptin levels significantly predicted weight gain at 3 months of follow-up (r2=0.09, p=0.006). In the multivariate analysis, including additional adipokines in the model, stepwise or all at once, did not increase the prediction of weight gain after the first three months of life. CONCLUSION: Adding adiponectin, IL-6, MCP-1, resistin, PAI-1, and TNF-α to the prediction model of weight gain in healthy newborns did not prove to be useful. It is probable that their relative contribution to weight gain is not important. Only leptin was relevant as a predictor of weight gain at the 3-month endpoint.

Measurement of Leptin by RIA Versus MIA in a Population of Healthy Newborns.

BACKGROUND: Assays based on multiplex immunoassay (MIA) technology have demonstrated advantages over enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA). Its acceptance depends on how well it performs in comparison to older techniques. The aim is to compare the results of leptin using RIA versus MIA. METHODS: We analyzed 81 samples of umbilical cord blood of healthy term newborns by RIA and MIA. RESULTS: The concordance correlation coefficient was 0.158 (95% CI 0.10-0.21). Pearson's correlation coefficient was 0.6651 (95% CI 0.52-0.77; P < 0.0001). In the Bland-Altman plot, concordance is acceptable because most of the measurements are within a mean of ±1.96 SD. CONCLUSIONS: As shown by the Bland-Altman plot, there is concordance by both methods, but with a weak correlation.

Association between umbilical cord leptin and weight gain according to feeding type in the early postnatal period, a brief report.

BACKGROUND: Weight gain in infancy depends on in utero nutritional status, with postnatal growth also dependent on feeding practices, culture, food accessibility and parents' education. OBJECTIVE: To evaluate the relationship between umbilical cord blood leptin levels and feeding mode (breast-fed vs. formula) on weight gain at three months of life. MATERIAL AND METHODS: Ninety-nine full-term newborns (male, n = 48; female, n = 51) were included in two groups according to feeding type: breast-fed (n = 49) and formula-fed (n = 50). Leptin was measured in blood obtained from the umbilical cord vein. RESULTS: Umbilical cord leptin levels and weight gain at three months had a significant inverse correlation in formula-fed infants (r = -0.294, P = 0.038). This finding was not reflected in breast-fed infants (r = -0.212, P = 0.144). CONCLUSIONS: In our Mexican breastfeeding cohort, umbilical cord leptin levels were a significant predictor of weight gain in formula-fed infants.