[The prevalence of allergic diseases in children with short bowel syndrome]. / Prevalencia de enfermedades alérgicas en niños con síndrome de intestino corto.

BACKGROUND: Short bowel syndrome is the result of an extensive surgical resection that leaves the length of the small intestine at a critical value for the proper nutritional absorption. An increased risk of food allergy has been described in patients who suffer from this condition. OBJECTIVE: To describe the prevalence of allergic diseases in a group of patients with short bowel syndrome. METHODS: A descriptive, cross-sectional, and ambispective study was carried out; it included patients with short bowel syndrome who had attended the nephrology service of the National Institute of Pediatrics in a period of 18 months. Information about medical records, surgery history, diet history, and food tolerance was collected with prior authorization of parents or legal guardians. Likewise, there was questioning about history of atopy, and validated questionnaires for allergic diseases were applied in Spanish. The following tests were carried out: skin tests with allergen extracts, determination of four foods specific immunoglobulin E, patch test, and open oral food challenge. The protocol was authorized by the research ethics committee. RESULTS: Fifteen patients with a median age of 44 months (range of 8-128 months) and with a male/female ratio of 2:1 were included. The most common causes of SBS were necrotizing enterocolitis and intestinal atresia. 27% of the patients had a family history of atopy and 40 % of the patients had a personal history that suggested an allergy to cow's milk in infancy. Allergic diseases were found in 40 %. CONCLUSIONS: Allergic diseases seem to have high prevalence in patients with SBS. More studies in large populations are required in order to confirm this discovery.

Antecedentes: El síndrome de intestino corto es el resultado de una resección quirúrgica extensa que deja la longitud del intestino delgado en un valor crítico para una adecuada absorción nutricional. Se han descrito un incremento en el riesgo de alergia alimentaria en pacientes que sufren esta condición. Objetivo: Describir la prevalencia de enfermedades alérgicas en un grupo de pacientes con síndrome de intestino corto. Métodos: Se llevó a cabo un estudio descriptivo transversal y ambispectivo, en el cual se incluyeron pacientes con síndrome de intestino corto que acudieron al servicio de nefrología del Instituto Nacional de Pediatría en un período de 18 meses. Con previa autorización del padre o tutor se recabaron los expedientes médicos, los antecedentes de la cirugía, historial de alimentación y tolerancia a alimentos. De igual manera, se interrogaron antecedentes de atopia y se aplicaron cuestionarios validados en español para enfermedades alérgicas. Se realizaron pruebas cutáneas con extractos alergénicos, determinación de inmunoglobulina E específica para cuatro alimentos, prueba del parche y reto oral abierto con alimentos. El protocolo fue autorizado por el comité de ética e investigación. Resultados: Se incluyeron 15 pacientes con una mediana de 44 meses (rango 8-128 meses) y la relación hombre/mujer fue de 2:1. Las causas más frecuentes de síndrome de intestino corto fueron enterocolitis necrozante y atresia intestinal. El 27 % tenía historia familiar de atopia y 40 % antecedentes personales sugestivos de alergia a las proteínas de la leche de vaca en la infancia. Se encontraron enfermedades alérgicas en 40 %. Conclusiones: Las enfermedades alérgicas parecen tener una alta prevalencia en pacientes con síndrome de intestino corto. Se requieren más estudios en poblaciones extensas para confirmar este hallazgo.

High depression rates among pediatric renal replacement therapy patients: A cross-sectional study.

Depression is common in pediatric chronic kidney disease (CKD) patients. Depression is associated with inferior long-term outcomes. There is a paucity of studies that evaluate depression and possible associated factors in children and adolescents requiring renal replacement therapy (RRT). Cross-sectional study using Children`s Depression Inventory in a cohort from a large urban center. Forty-seven pediatric RRT patients (26 female, 12 peritoneal dialysis (PD), 17 hemodialysis (HD), 18 after successful kidney transplantation (KTX)) with a mean age at the time of assessment of 13.9 ± 2.3 years. Symptoms of depression were found in 30 (64%, 11KTX, 11HD, 8PD) patients. We found no association with age, sex, renal function, dialysis adequacy markers, anemia, electrolytes, socioeconomical status, IQ, educational status of the child including school attendance and distance from the house to the hospital among HD patients. Significant differences only applied for age at diagnosis of CKD, RRT vintage and deceased donor for KTX. The group with depression had a higher age at diagnosis of CKD and less time on RRT than the group without depression. There was also a high rate of depression in KTX patients. In this cohort, depression was a common comorbidity of RRT in children and adolescents with RRT and also for KTX patients, even though biomarkers of kidney function and time for RRT are much improved.

[Prevalence of allergic diseases in children with secondary renal tubular acidosis attending a tertiary care pediatric center]. / Prevalencia de enfermedades alérgicas en niños con acidosis tubular renal secundaria que acudieron a un hospital pediátrico de tercer nivel.

BACKGROUND: It has been suggested a high prevalence of allergic disease in children with RTA. OBJECTIVE: To describe the prevalence of allergic diseases in children with secondary RTA (renal tubular acidosis) in the nephrology department of the National Institute of Pediatrics (NIP), México. METHODS: An observational, prospective, cross-sectional, descriptive study. Children with secondary RTA < 18 years who attended the outpatient nephrology service in the NIP for 24 months, were included. ISAAC questionnaire and the EAACI guidelines were applied. To prove a suspected allergy, skin tests, total and specific IgE, patch testing and food challenge were performed. Using SPSS 19, frequency of allergic diseases was described. RESULTS: 113 patients were included. Age 8 to 168 months. Male: 53.9 %. RTA types: Distal (64.6 %), proximal (26.5 %), mixed (1.8 %) and undetermined (7 %). Age of onset between 1 and 96 months. Serum bicarbonate 10.1 to 20 mEq/L. Allergic diseases were found in 24.8 %: allergic rhinitis (18.4 %), food allergy (9.7 %), atopic dermatitis (8 %), asthma (8 %) and allergic conjunctivitis (6.1 %). Total IgE was increased in 9 patients. Positive skin tests in 14.2 %. Positive chemiluminescence in 18 children; positive open food challenge in 11 children and patch tests in 4. CONCLUSION: Secondary RTA is common in children attending tertiary care hospitals. The prevalence of allergic disease in children with secondary ATR, is similar to that described in the general population.

Antecedentes: Se ha sugerido elevada prevalencia de enfermedades alérgicas en niños con acidosis tubular renal. Objetivos: Describir la prevalencia de enfermedades alérgicas en niños con acidosis tubular renal secundaria atendidos en el Servicio de Nefrología del Instituto Nacional de Pediatría, México. Métodos: Estudio observacional, prospectivo, transversal, descriptivo. Se incluyeron niños atendidos durante 24 meses. Se aplicó el cuestionario ISAAC y los criterios de la guía EAACI. Ante sospecha de alergia se realizaron pruebas cutáneas, IgE total y específica, pruebas del parche y reto alimentario. Resultados: Se incluyeron 113 pacientes con edades entre 8 y 168 meses; 53.9 % del sexo masculino. Tipos de acidosis tubular renal: distal (64.6 %), proximal (26.5 %), mixta (1.8 %) y no determinada (7 %). La edad de inicio osciló entre 1 y 96 meses. Se registró 10.1 a 20 mEq/L de bicarbonato sérico; 24.8 % mostró enfermedades alérgicas: 18.4 % rinitis alérgica, 9.7 % alergia alimentaria, 8 % dermatitis atópica, 8 % asma y 6.1 % conjuntivitis alérgica. Se observó IgE total elevada en 9 pacientes. En 14.2 % las pruebas cutáneas fueron positivas y la quimioluminiscencia en 18 niños; el reto abierto con alimentos fue positivo en 11 y las pruebas del parche en 4. Conclusiones: La prevalencia de enfermedades alérgicas en niños con acidosis tubular renal secundaria fue similar a la de la población general.

Prevalence of sensitization to inhaled and food allergens in a group of children with primary renal tubular acidosis.

OBJECTIVE: Some reports associate certain illnesses of the urinary system with allergies. Thus, we decided to examine the prevalence of sensitization to allergens in a group of children with primary renal tubular acidosis (RTA). METHODS: Children with primary RTA who attended the nephrology department at a third level pediatric hospital during a four-month period, were included. With informed parental consent, a questionnaire and skin prick test, total IgE, specific IgE and milk precipitins were performed. RESULTS: Forty-three children were included, aged 5 months to 9 years (mean, 3.4 ± 1.8 years), and a male/female ratio of 1.7:1. The age of onset of ATR ranged from 2 to 18 months. The most common symptoms at the beginning of disease were: failure to thrive and lack of appetite. Twenty-one parents (48.8%) noticed an association between the introduction of cow´s milk and the beginning of symptoms. Skin tests were positive in 27.9%. Total IgE levels were elevated in 34.9%, ranged from 5.9 to 324 IU/mL. Allergen-specific IgE was positive in 25.6%, mainly for milk, wheat and egg white. The milk precipitins test was positive in 9 patients (21%). CONCLUSIONS: Although this study demonstrated the existence of allergen sensitization in a group of children with RTA, it is necessary to look for this association in studies with larger sample size and to use tests with higher specificity and sensitivity.

Efficacy of simvastatin in children with hyperlipidemia secondary to kidney disorders.

Children with hyperlipidemia secondary to renal disease develop premature atherosclerosis and glomerulosclerosis. The aims of this pilot study were to find the dosage and short-term efficacy of simvastatin and potential adverse events in children with chronic kidney diseases. This was a random, double-blind, placebo-controlled, cross-over clinical trial performed on children with hyperlipidemia secondary to kidney disorders. After being placed on a diet for 3 months, patients were randomly placed in one of two balanced group blocks and treated with diet plus placebo or simvastatin at doses of 5 mg for children weighing 30 kg or less and 10 mg for children weighing over 30 kg, for 1 month, and then doubled for two more months. After this treatment, patients were placed on a diet for a 3-month washout period. During the last trial phase, patients previously treated with simvastatin were administered a placebo, and vice versa. A total of 25 patients with ages ranging from 4 years to 17 years were included in the study. A significant decrease in the levels of serum cholesterol (26.4%), low-density lipoprotein (LDL) (35.4%) and triglycerides (23.1%) was noted during the study, primarily during the simvastatin treatments, in which case cholesterol, LDL and triglycerides decreased by 23.3%, 33.7% and 21%, respectively. High-density lipoprotein (HDL) levels increased moderately (10.7%) during the study but without differences during simvastatin treatment. No differences were found across groups with respect to adverse events. In the short-term the combination of diet and simvastatin was effective in lowering hyperlipidemia in children with renal disorders.

Respuesta metabólica ante la cirugía: modificaciones energéticas y adaptación metabólica en neonatos (tercera de tres partes) / Metabolic response to a surgical intervention Energetic changes and metabolic adjustment in neonates: (thrid of tree parts)

Durante la cirugía se mantiene un aporte energético adecuado a los órganos vitales mediante incrementos en glucogénesis, gluconeogénesis y lipólisis, preservándose en lo posible la utilización oxidativa de los aminoácidos esenciales, mediante incrementados de adrenalina, glucagon, cortisol y hormona de crecimiento, y disminución transitoria de insulina. En la etapa neonatal las adaptaciones locales y sistémicas muestran menor efectividad a nivel fagocitario, existe una menor reserva de nutrientes y de efectividad enzimática, y se presentan fácilmente desequilibrios hidroelectrolíticos y ácido-base

Respuesta metabólica ante la cirugía: modificaciones sistémicas (segunda de tres partes) / Metabolic response to surgery: systemic changes. (seconf o three parts)

En respuesta a la cirugía se producen cambios vasculares periféricos que aseguran una composición corporal, concentración electrolítica, volumen vascular, tonicidad y metabolismo ácido-base adecuados tanto para el trauma quirúrgico como para las características de salud o enfermedad del paciente. Estos cambios están modulados por factores neuroendocrinos hipotálamo-hipofisiarios, renales, suprarrenales y cardiacos

Respuesta metabólica ante la cirugía: modificaciones locales (primera de tres partes) / Metabolic response to surgical intervention: local changes (first of three parts)

En la respuesta inflamatoria local a la cirugía intervienen diversas substancias tales como histamina, kalikreínas, prostaglandinas, leucotrienos, complemento, interleucinas, factor de necrosis tumoral, factor derivado de plaquetas y radicales de oxígeno, que modulan la formación de edema. Migración de leucocitos y reparación tisular necesarios para existencia de condiciones microambientales satisfactorias para la nutrición, crecimiento y regeneración tisulares

Termorregulación / Termoregulation

Se hace una revisión extensa de los mecanismos involucrados en el control de la temperatura corporal. Se analizan los conceptos de homeotermia y límites críticos de temperatura, y la importancia que tiene su conservación, Así como los mecanismos termorreguladores involucrados en esta homeostasis. Se describen con detalle las modificacioens metabólicas involucradas en la producción de calor, los cambios vasomotores responsables de la eliminación del mismo, y las conductas biosociales que más frecuentemente se adoptan para favorecer la interacción entre la temperatura ambiental y la superficiel del cuerpo. Se ejemplifican interacciones entre estos tres parámetros en diversas situaciones clínicas, tanto en respuesta a cambios bruscos de temperatura ambiental y corporal, como en términos de modificaciones a largo plazo. Para cada uno de los aspectos involucrados en la termorregulación, se describen adaptaciones bioquímicas, fisiológicas y anatómicas que se consideran importantes para la valoración clínica del fenómeno de la temorregulación. Se revisa la bibliografía pertinente.