Insulin autoantibodies: evidence of autoimmune disease among a group of Puerto Rican children with newly diagnosed type 1 diabetes mellitus.

Type 1 diabetes is a chronic disease caused by a cell-specific destruction of the insulin producing cells of the pancreas. Although Puerto Rico has the highest incidence of type 1 diabetes among Latin American countries, there is scanty data on the presence of antibodies against insulin producing cells. To this end, 20 children (8 males, 12 females), ages 1-15 years, admitted to the University Pediatric Hospital with type 1 diabetes de novo between November 2000 and April 2001 were prospectively studied to determine the presence of serum antibodies against Islet cells (ICA), glutamic acid decarboxylase (GAD-65) and insulin autoantibodies (IAA). IAA was found to be present in 45% of the subjects with 85% of positive rate in subjects under age 5. GAD-65 was present in 66% and ICA was present in 23% of the subjects. We found evidence of autoimmunity against islet cell surface and intracellular components among a cohort of Puerto Rican children with newly diagnosed type 1 diabetes. These findings compared favorably with reports from other ethnicities.

American Academy of Pediatrics. Committee on Children with Disabilities. The treatment of neurologically impaired children using patterning.

This statement reviews patterning as a treatment for children with neurologic impairments. This treatment is based on an outmoded and oversimplified theory of brain development. Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted.

American Academy of Pediatrics. Committee on Children With Disabilities. Care coordination: integrating health and related systems of care for children with special health care needs.

Care coordination is a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of the children and provide them with optimal health care. Care coordination often is complicated because there is no single entry point to multiple systems of care, and complex criteria determine the availability of funding and services among public and private payers. Economic and sociocultural barriers to coordination of care exist and affect families and health care professionals. In their important role of providing a medical home for all children, primary care pediatricians have a vital role in the process of care coordination, in concert with the family.

Reversible growth failure among Hispanic children: instances of psychosocial short stature.

OBJECTIVE: Psychosocial short stature (PSS), is the only known variant of reversible growth hormone deficiency (GHD)-like state. Herein we present three cases of Puerto Rican children with PSS, which will aid the uninitiated to the entity and assist in making the appropriate diagnosis. All of them demonstrated catch up growth and reversible GHD state as determined by increased insulin-like growth factor 1 (IGF-1) production and growth hormone secretion after pharmacologic stimulation. METHODS: Three boys ages 4.5 to 15.5 years were evaluated because of poor growth at the University Pediatric Hospital in San Juan, Puerto Rico. Medical evaluation excluded organic causes for growth failure. Psychosocial evaluation revealed the presence of repeated instances of psychological abuse by caretakers and the subjects demonstrated patterns of bizarre behavior. These findings prompted evaluation toward the possibility of PSS. The three children were removed from their caretakers' homes and placed in foster nurturing environments. RESULTS: Once relocated, the three children were able to demonstrate marked weight gain, growth acceleration, and improved social behavior. These changes were accompanied by biochemical evidence of GH-axis recovery as determined by the augmented insulin-like growth factor 1 levels and GH secretion. They have continued thriving at their foster homes. These results were felt to be compatible with PSS Type 2. CONCLUSION: We conclude that infants and children with growth failure without apparent organic cause, should be suspected of having PSS. Early relocation is critical for a successful outcome.

Incidence of IDDM in children living in Puerto Rico. Puerto Rican IDDM Coalition.

OBJECTIVE: To determine incidence, geographic distribution, and seasonal variation of IDDM in children 0-14 years of age living in Puerto Rico. Because these data have been collected through the infrastructure of the World Health Organization's DiaMond project, these results are directly comparable with incidence data from other population worldwide involved in this study. RESEARCH DESIGN AND METHODS: Beginning in 1990, new cases of IDDM were registered retrospectively from 1985 and prospectively to 1994 by review of medical records from island hospitals. Included in the hospital registry are 1,527 cases of IDDM. Validation of the primary source was by three secondary lists of cases obtained through diabetic camps, surveys of schools, and a government registry. Long linear modeling (capture-recapture) was used to correct incidence. RESULTS: Mean incidence of IDDM from 1985-1994 was 18.0 cases/100,000 children per year (95% CI 17.6-18.3). There was a slight female rather than male predominance: 51% of the cases were girls, and 49% were boys. Although Puerto Rico has marked variation in rainfall, altitude, and genetic markers, no significant differences are found in the incidence rates of different areas or seasons of the island. CONCLUSIONS: This registry of Puerto Rican children is the largest IDDM registry of minority children in the U.S. The results of this study indicate that the annual incidence of IDDM of children living in Puerto Rico is higher than the incidence of other multiracial ethnic groups living in the U.S.

Thyroid cancer in pediatric patients: the University Pediatric Hospital experience.

Seven patients with differentiated thyroid carcinoma were diagnosed and treated at the University Pediatric Hospital, San Juan, Puerto Rico during the years 1978 to 1983. Ages at the time of diagnosis were 6 to 17 years. Survival rate has been 100% at the time of this report. The clinical outcome is presented and the controversy regarding the appropriate surgical treatment for this type of thyroid carcinoma is reviewed. Two of 3 patients who underwent total thyroidectomy were free of disease with 131I one and 3 years after surgery. Hypothyroidism was eventually manifested in all patients and permanent hypoparathyroidism in 3, 2 of those who underwent total thyroidectomies. Follow up interval ranged from one to 10 years.

Incidence of insulin dependent diabetes mellitus in Puerto Rico: the University Pediatric Hospital experience.

The incidence of newly-diagnosed Insulin-dependent diabetes mellitus (IDDM) in a pediatric population has been found to increase with colder seasons in countries at latitudes where a marked weather change presumably triggers a higher prevalence of viral infections (especially respiratory), that may induce an insulitis which could be etiologically related with IDDM. In order to assess whether the opposite is true for a country with rather uniform climate, like Puerto Rico, we have studied the seasonal pattern of newly diagnosed IDDM seen at our institution during a 10 year period (1973-1982). Also, recent reports on a higher mortality from diabetes in Puerto Rico going from 16.6 in 1977 to 31.0 in 1983, prompted us to look at a possible secular trend of increasing incidence of IDDM. There were a total of 269 new cases of IDDM or 27 cases/year, with standard deviation (SD) of +/- 5.3, range 18 to 33, and no secular trend at all. Sex distribution was quite variable, having male:female (m/f) ratios from 1:2 to 3:1, and an over-all m/f of 13.3/13.6. Incidence of IDDM per month of year went from a low of 1.7 for April and November to a high of 3.0 for March and 2.9 for September, 2.8 for October, with a mean of 2.24 +/- 0.48 cases/month. Again, no significant seasonal differences were noted. Mean incidence for our "cold" months (November to April was 2.25/month; for our "hot" season (May to October) was 2.3/month; for our "rainy" season (July to December) 2.3 and for our "dry" season (January to April) 2.3/month. Thus, it appears that there are no such seasonal trends of IDDM In Puerto Rico.