Elevated Serum Concentrations of Remnant Cholesterol Associate with Increased Carotid Intima-Media Thickness in Children and Adolescents.

OBJECTIVE: To evaluate the relationship between remnant cholesterol and carotid intima-media thickness (cIMT), a surrogate marker for atherosclerosis, in children and adolescents. STUDY DESIGN: Anthropometric, laboratory, liver, and carotid ultrasonographic data were obtained from 767 youths (594, overweight/obese; 173, normal weight). Fasting remnant cholesterol was calculated from the standard lipid profile. cIMT ≥0.56 mm (corresponding to the 90th percentile of values observed in normal-weight children) was chosen to define elevated cIMT. Logistic regression analysis was used to estimate the risk of elevated cIMT according to tertiles of remnant cholesterol levels. RESULTS: In the entire cohort, the mean concentration of remnant cholesterol was 17.9 ± 10.3 mg/dL and mean cIMT value was 0.51 ± 0.8 mm. Remnant cholesterol significantly correlated with age, sex, body mass index, waist circumference, blood pressure, lipids, liver enzymes, and insulin resistance. cIMT value increased progressively with rising remnant cholesterol tertiles (Pfor trend < .001). Compared with subjects in the lowest remnant cholesterol tertile, those in the middle and highest remnant cholesterol tertiles had a 2.3- and 2.4-fold increased risk of elevated cIMT, independently of age, sex, pubertal stage, body mass index, and apolipoprotein B (all Padj ≤ .003). When the effects of overweight/obesity on the association between remnant cholesterol and cIMT were determined, normal-weight as well as overweight/obese subjects in the highest remnant cholesterol tertile had a 3.8- and 2.3-fold increased risk to have elevated cIMT compared with the respective study groups in the lowest tertile, after adjustment for conventional risk factors (Padj = .038 and Padj = .003, respectively). CONCLUSIONS: In youths, elevated levels of remnant cholesterol might represent a marker of early atherosclerotic damage.

Metabolic syndrome, clustering of cardiovascular risk factors and high carotid intima-media thickness in children and adolescents.

OBJECTIVE: The clinical utility of screening for pediatric metabolic syndrome (MetS) in children and adolescents is still controversial. We examined the performance of pediatric MetS vs. clustering of cardiovascular risk factors (which are the components of MetS) for predicting high carotid intima-media thickness (cIMT) in children and adolescents. METHODS: Participants included 2427 children and adolescents aged 6-17 years from population-based studies in three countries (Brazil, China and Italy). Pediatric MetS was defined using either the modified National Cholesterol Education Program Adult Treatment Panel III criteria or the modified International Diabetes Federation criteria. Clustering of cardiovascular risk factors was calculated as the sum of five components of MetS (i.e. central obesity, elevated blood pressure, elevated triglycerides, reduced HDL-cholesterol and elevated fasting blood glucose). High cIMT was defined as cIMT at least 95th percentile values for sex and age developed from European children. RESULTS: Presence of one, two or at least three cardiovascular risk factors (using the National Cholesterol Education Program Adult Treatment Panel III criteria), as compared with none, was associated with gradually increasing odds of high cIMT [odds ratios (95% confidence intervals): 1.60 (1.29-1.99), 2.89 (2.21-3.78) and 4.24 (2.81-6.39), respectively]. High cIMT was also associated with presence (vs. absence) of MetS (odds ratio = 2.88, 95% confidence interval = 1.95-4.26). However, clustering of cardiovascular risk factors predicted high cIMT markedly better than MetS (area under the curve of 0.66 vs. 0.54, respectively). Findings were similar using the International Diabetes Federation criteria for pediatric MetS. CONCLUSION: In children and adolescents, a graded score based on five cardiovascular risk factors (used to define MetS) predicted high cIMT markedly better than MetS. These findings do not support the clinical utility of MetS for screening youth at increased cardiovascular risk, as expressed in this study by high cIMT.

Giant cell hepatitis with autoimmune hemolytic anemia in early childhood: long-term outcome in 16 children.

OBJECTIVE: To assess the outcome of giant cell hepatitis combined with autoimmune hemolytic anemia in early childhood. STUDY DESIGN: We report on 16 children with this disease evaluated over a 28-year period. RESULTS: Children (nine boys; median age, 6 months) presented with jaundice, hepatomegaly, elevated aminotransferases, a positive Coombs test, and diffuse giant-cell transformation of hepatocytes on histology. Treatment with prednisone and azathioprine, plus, in three children, cyclosporine, resulted in complete remission in eight, partial remission in six, and failure in two. Relapses of hepatitis and/or anemia occurred in 11 and 10 children, respectively, requiring prolonged high levels of immunosuppression, and splenectomy or Rituximab, respectively. Treatment was stopped after a mean duration of 6 years, with no relapse, in seven children, with a median follow-up of 14 years. One child is alive 9 years after liver transplantation. Four children died of sepsis or multiple organ failure. CONCLUSIONS: Giant cell hepatitis combined with autoimmune hemolytic anemia requires rigorous treatment. Immunosuppressive therapy results in remission in most cases. A complete cure can be expected after several years of intensive treatment. Liver transplantation may be associated with prolonged survival.

Avaliação do sistema de alojamento conjunto na maternidade D. Francisca Cintra Silva da Santa Casa de São Carlos-SP / Evaluation of the rooming-in at the \"D. Francisca Cintra Silva\" maternity - Santa Casa Hosppital at the municipality of São Carlos-SP

O alojamento conjunto foi implantado em uma maternidade do município de São Carlos-São Paulo em 1997. Este estudo analisa a aceitação do sistema pelas mães e como a Enfermagem participa deste trabalho. Os resultados mostraram que as mães estão satisfeitas. Entretanto, a Enfermagem não concorda, sugerindo a necessidade de se aumentar e qualificar o quadro de funcionários.