[Phenotype proposal for early diagnosis of possibility of metabolic syndrome in school children aged 6 to 15 years]. / Propuesta de fenotipo para diagnóstico temprano de posibilidad de síndrome metabólico en escolares de seis a 15 años.

INTRODUCTION AND OBJECTIVES: Obesity and metabolic syndrome (MS) continue to be a problem at a socioeconomic level, causing high morbidity and mortality in the adult population. Prevention of risk factors should be carried out from an early age. Currently, there is no consensus on the opportune moment to start an intervention or treatment, regarding metabolic syndrome. The objective of the study is to describe the phenotype to predict early diagnosis of metabolic syndrome in schoolchildren. MATERIAL AND METHODS: Observational, prospective, cross-sectional and analytical study in schoolchildren from 6 to 15 years old, conducted in Guayaquil. Anthropometric measurements and a survey were performed, obtaining signing informed consent. The IBM Watson artificial intelligence (AI) platform with its software Modeler Flow, were used for the analysis. RESULTS: A population of 1025 students between 6 and 15 years old (mean of 12 years for men and 13 years for women) was examined, of whom 62.3% were men and 37.7% women. 23.9% of the population was overweight and 14% obese. A greater tendency to weight alteration was observed in men than in women (51.37% vs 47.79%), and a lower waist circumference in men (85 cm vs 87 cm, respectively). Males had a higher level of systolic blood pressure (SBP), being within the 90th percentile (mean SBP of 123 mmHg) 61.2%, compared to 38.8% of women, with a p < 0.001. Sedentary lifestyle is similar in both groups, with an average of 4.79 hours in front of the screen and/or video games. A statistically significant correlation was demonstrated between SBP and the waist/height ratio (WHtR) in the 90th percentile and 95th percentile (X2 9.075, p < 0.028, and X2 23,54, p < 0,000 respectively), as well as a relationship between 95th percentile and sex (X2 11.57, p < 0.001). The Modeler Flow software showed us that if WHtR, > 0.46, weight > 56.1 kg and height > 1.61 m, the probability of presenting metabolic syndrome, was of 82.4%. The statistic of this study has a predictive accuracy of 90% (error deviation of 0.009). The importance in the predictors of metabolic syndrome, range from 97.57% to 100%. CONCLUSIONS: A prevalence of 33.9% of metabolic syndrome was observed in schoolchildren from 6 to 15 years old, with pathological cut-off points of: WHtR > 0.46, weight > 56.1 kg, pure sedentary lifestyle > 3 hours in front of the screen/playing video games, and SBP within the 90th percentile (> 123 mmHg). With these four indicators, we can predict a probability of early diagnosis of metabolic syndrome of 97% to 100%.

Aporte de los inmigrantes a la tuberculosis en un Servicio de Salud de Chile / Contribution of immigrants to tuberculosis in a Health Service in Chile

La evaluación del Programa de Control de la Tuberculosis de Chile muestra un creciente aumento de casos de tuberculosis en pacientes extranjeros en las comunas de Santiago de mayor incidencia de esta enfermedad. Mediante la evaluación de los casos diagnosticados durante una década se comprobó un creciente aporte de casos de tuberculosis en el grupo de inmigrantes, desde cerca de 10% el año 2005 hasta cerca de 30% en 2014. La mayor proporción de casos de extranjeros ocurre en la comuna de mayor incidencia (Santiago), con cifras iniciales de 17% el año 2005, llegando a 29% en 2015. La eficacia del tratamiento en los inmigrantes (87,6%) está cerca de la meta nacional (90%) y es mejor que la de los chilenos (81,5%). Encontramos una proporción mayor de casos extranjeros que abandonan la terapia (11%) en relación a los chilenos (7,7%), pero la letalidad en extranjeros es menor (1,5%) que la de los chilenos (10,6%). Se deberán reforzar las estrategias de control de tuberculosis, focalizadas en la población extranjera.

The assessment of Chilean Tuberculosis Control Program shows a growing increase of tuberculosis cases in foreign patients in communes of the city of Santiago with higher incidence of this disease. Through the evaluation of the cases diagnosed in a decade we found an increasing contribution of foreigners, ranging from about 10% in 2005 to 30% in 2014. The greatest proportion of tuberculosis cases in foreigners was detected in Santiago, the commune with the highest incidence. In this area, tuberculosis incidence ranged from 17% in 2005, to 29% in 2015. Treatment efficiency in foreigners (87.6%) is close to our national goal (90%) and better than in Chilean patients (81.5%). We found a higher proportion of foreign cases defaulting therapy (11%) in relation to Chilean (7.7%), but the death rate in foreigners was less than in Chileans (1.5 versus 10.6%). We must strengthen tuberculosis control strategies focused on foreigner populations.

Aporte de los inmigrantes a la tuberculosis en un Servicio de Salud de Chile / Contribution of immigrants to tuberculosis in a Health Service in Chile

The assessment of Chilean Tuberculosis Control Program shows a growing increase of tuberculosis cases in foreign patients in communes of the city of Santiago with higher incidence of this disease. Through the evaluation of the cases diagnosed in a decade we found an increasing contribution of foreigners, ranging from about 10% in 2005 to 30% in 2014. The greatest proportion of tuberculosis cases in foreigners was detected in Santiago, the commune with the highest incidence. In this area, tuberculosis incidence ranged from 17% in 2005, to 29% in 2015. Treatment efficiency in foreigners (87.6%) is close to our national goal (90%) and better than in Chilean patients (81.5%). We found a higher proportion of foreign cases defaulting therapy (11%) in relation to Chilean (7.7%), but the death rate in foreigners was less than in Chileans (1.5 versus 10.6%). We must strengthen tuberculosis control strategies focused on foreigner populations.

La evaluación del Programa de Control de la Tuberculosis de Chile muestra un creciente aumento de casos de tuberculosis en pacientes extranjeros en las comunas de Santiago de mayor incidencia de esta enfermedad. Mediante la evaluación de los casos diagnosticados durante una década se comprobó un creciente aporte de casos de tuberculosis en el grupo de inmigrantes, desde cerca de 10% el año 2005 hasta cerca de 30% en 2014. La mayor proporción de casos de extranjeros ocurre en la comuna de mayor incidencia (Santiago), con cifras iniciales de 17% el año 2005, llegando a 29% en 2015. La eficacia del tratamiento en los inmigrantes (87,6%) está cerca de la meta nacional (90%) y es mejor que la de los chilenos (81,5%). Encontramos una proporción mayor de casos extranjeros que abandonan la terapia (11%) en relación a los chilenos (7,7%), pero la letalidad en extranjeros es menor (1,5%) que la de los chilenos (10,6%). Se deberán reforzar las estrategias de control de tuberculosis, focalizadas en la población extranjera.

Children with moderate-high infection with Entamoeba coli have higher percentage of body and abdominal fat than non-infected children.

BACKGROUND: Intestinal parasites, virus and bacterial infections are positively associated with obesity and adiposity in vitro and in animal models, but conclusive evidence of this relationship in humans is lacking. The aim of this cross-sectional study was to determine differences in adiposity between infected and non-infected children, with a high prevalence of intestinal parasitic infection and obesity. SUBJECTS: A total of 296 school-aged children (8.0 ± 1.5 years) from a rural area in Querétaro, Mexico, participated in this study. Anthropometry (weight, height and waist circumference) and body fat (DXA) were measured in all children. A fresh stool sample was collected from each child and analysed for parasites. Questionnaires related to socioeconomic status and clinical history were completed by caretakers. RESULTS: Approximately 11% of the children were obese, and 19% were overweight. The overall prevalence of infection was 61%. Ascaris lumbricoides was the most prevalent soil transmitted helminth (16%) followed by hookworm. Entamoeba coli was the predominant protozoa (20%) followed by Endolimax nana, Balantidium coli, Entamoeba histolytica/dispar, Iodamoeba bütschlii and Giardia lamblia. Children with moderate-heavy infection of E. coli had significantly higher waist circumference, waist-to-height ratio, body and abdominal fat than children not infected or with light-intensity infection (p < 0.05). CONCLUSION: These findings raise the possibility that a moderate or heavy infection with E. coli may contribute to fat deposition and thereby have long-term consequences on human health. Further studies are needed to better understand if E. coli contributes directly to fat deposition and possible mechanisms.

Interaction of zinc or vitamin A supplementation and specific parasite infections on Mexican infants' growth: a randomized clinical trial.

BACKGROUND: The efficacy of micronutrient supplementation on growth may be modified by specific gastrointestinal parasite infections. METHODS: We carried out a double-blind placebo-controlled trial to evaluate the effect of vitamin A and zinc supplementation on gastro-intestinal pathogen infections and growth among 584 infants in Mexico City. Children aged 5-15 months were assigned to receive either a vitamin A supplement every 2 months (20,000 IU of retinol for infants < or =; 1 year or 45,000 IU for infants >1 year), a daily supplement of 20 mg of zinc, a combined vitamin A-zinc supplement or a placebo, and were followed up for 1 year. Weight and length were measured once a month and morbidity histories were recorded twice a week for 12 months. Monthly stool samples were screened for Giardia duodenalis, Ascaris lumbricoides and Entamoeba spp. Growth velocity slopes, generated from the linear regression of individual child length, and height-for-age z-scores on time were analyzed as end points in regression models, adjusting for the presence of parasite infections. RESULTS: The main effect of vitamin A supplementation was in height improvement (P<0.05), and was only found in the model evaluating infants with any parasite. There was an interaction effect of slower growth (P<0.05) found in infants infected with any parasite and supplemented with vitamin A in slower growth (P<0.05). In addition, the interaction of zinc supplementation and Giardia duodenalis or A. lumbricoides was associated with reduced growth (P<0.05). CONCLUSION: Gastro-intestinal parasite infections may modify the effect that zinc or vitamin A supplementation has on childhood growth.

Atresia esofágica, análisis y seguimiento / Esophageal atresia: analysis and follow-up

Se presenta la evolución y seguimiento de 54 niños con atresia esofágica tratados en la Unidad de Recién Nacidos Patológicos del Hospital Luis Calvo Mackenna, analizando la muestra según la presencia (grupo A) o ausencia (grupo B) de fístula traqueoesofágica. Los niños con atresia esofágica y fístula traqueoesofágica (grupo A) se subdividen en: grupo A1, peso de nacimiento mayor a 1.500 g y sin malformaciones asociadas; grupo B, recién nacidos con atresia esofágica y sin fístula traqueoesofágica. El grupo A1 está formado por 28 recién nacidos con 100 por ciento de sobrevida. El promedio de hospitalización fue 20,7 días cuando la corrección quirúrgica se efectuó en un tiempo. En el seguimiento, los problemas más frecuentes fueron reflujo gastroesofágico (62,5 por ciento), estenosis esofágica (30,4 por ciento), incoordinación en la deglución (26 por ciento). El 36,3 por ciento está sano. El grupo A2 está formado por 21 recién nacidos con una mortalidad en el período neonatal de 33,3 por ciento y durante el primer año de vida de 57,1 por ciento. Las malformaciones asociadas más frecuentes fueron cardiológicas, anorrectal y urológicas. Siete niños están en seguimiento, tres sin patología. El grupo B está formado por cinco niños, dos con trisomía 21, uno con hidrocefalia y dos sin malformaciones asociadas. La solución de la atresia esofágica es larga y difícil. Se concluye que la mortalidad está dada por las malformaciones asociadas y la evolución posterior no está exenta de problemas

[Non-fatal reactions to iodinated contrast media: 29 years of experience]. / Reacciones a medios de contraste yodados sin muertes. Experiencia durante 29 años.

178 439 cases of patients exposed to iodinated contrast media (ICM) corresponding to 137 147 to patients for excretory urography and 41 292 to cholangiography were studied. A direct interrogation making emphasis on personal antecedents of allergy to contrast media, iodinated products usage, nervous system and cardiovascular illnesses was made. Cutaneous test for iodinated contrast media was applied. If the result was positive no study with the ICM was made or it was made with special guidelines. 4302 positives and 1276 false negatives were found. 287 positive cases were premeditated and preventive medication was administered in cases of urticaria asthma/and angioedema with negative cutaneous test histories. There were no deaths registered.