[Characterization of a cohort of pediatric patients with Congenital Adrenal Hyperplasia]. / Caracterización de una cohorte de pacientes pediátricos con Hiperplasia Suprarrenal Congénita.

Congenital adrenal hyperplasia (CAH) is the most common adrenal disorder in childhood. Objecti ve: To describe the clinical and laboratory characteristics of pediatric patients with CAH and perform an exploratory analysis comparing some clinical and laboratory variables according to the types of CAH. PATIENTS AND METHOD: Observational descriptive longitudinal study. Medical records from the pediatric endocrinology outpatients from four institutions in Medellín, Colombia were reviewed. Sociodemographic, clinical (type of CAH, salt-wasting crisis, associated endocrinopathies), labora tory (17-hydroxyprogesterone, testosterone, dehydroepiandrosterone sulfate, androstenedione, cor tisol, and adrenocorticotropic hormone) variables were analyzed. A descriptive statistical analysis was carried out. RESULTS: 132 patients (65% female) were included. The median age at diagnosis was 2 months, 44.7% neonatal diagnosis. Seventy-nine children with classical salt-wasting CAH, 31 with simple virilizing, and 22 with non-classical form were documented. Median 17-OHP at diagnosis was 4820 ng/dl. Sexual differentiation disorder was presented in 47% of patients and 48% presented with adrenal crisis (AC) at diagnosis; the median age of the first AC was 15 days. Ninety-three patients required fludrocortisone and 32 patients presented AC after diagnosis and treatment. Median height/ age (last appointment): -0.49 SD, difference between bone and chronological age: 26 months. More than 60% of patients had elevated androstenedione and/or testosterone at the last appointment. CONCLUSIONS: Sociodemographic and clinical characteristics are similar to those reported in the literature. In 48% of patients, AC was the initial manifestation, making neonatal screening important, as it would allow an early diagnosis. We found virilization in 71% of women in our study. A CAH should be suspected in a newborn with different genitalia.

Proteinuria persistente en pacientes pediátricos, caracterización histopatológica y su influencia en la progresión de la enfermedad renal crónica / Persistent proteinuria in pediatric patients, histopathological characterization and its influence on chronic kidney disease progression / Proteinúria persistente em pacientes pediátricos, caracterização histopatológica e sua influência na progressão da doença renal crónica

Objetivo: describir los hallazgos histopatológicos y la progresión a enfermedad renal crónica de los pacientes sometidos a biopsia renal en un hospital de referencia de la ciudad de Medellín entre 2005 y 2014. Metodología: estudio descriptivo retrospectivo. Se revisaron historias clínicas de pacientes menores de 18 años con diagnóstico de proteinuria persistente, a quienes se les realizó biopsia renal durante el período 2005-2014 en el Hospital Pablo Tobón Uribe. Se analizaron variables sociodemográficas, clínicas, histológicas y de laboratorio. Resultados: se incluyeron 71 pacientes. La edad promedio del diagnóstico de proteinuria persistente fue 10.07 años. El 69.1% y 20.6% de los pacientes presentaron hematuria e hipertensión arterial respectivamente. La glomerulonefritis por IgA fue el hallazgo histológico más frecuente (21.13%), seguido de la nefropatía lúpica (18.31%). Del total de pacientes, 69.0% recibieron inhibidores de la enzima convertidora de angiotensina y el 15.9% presentaron deterioro de la función renal al cuarto año de seguimiento. Conclusiones: la prevalencia de glomerulopatías en niños con proteinuria persistente fue alta. Se sugiere la realización de la biopsia renal con el fin de detectar tempranamente glomerulopatías primarias o secundarias asociadas para así instaurar un tratamiento oportuno que controle o retarde el deterioro de la función renal.

Objective: To describe the histopathological findings and their progression of chronic kidney disease in pediatric patients who underwent kidney biopsy due to persistent proteinuria during 2005-2015 at a high-complexity hospital in Medellin, Colombia. Methods: A retrospective, cohort study was carried out; the medical records of children under 18 with diagnosis of persistent proteinuria were reviewed. Sociodemographic, clinical, and histopathological variables were analyzed. Results: A total of 71 patients were included. The mean age at the diagnosis of persistent proteinuria was 10.07 years old. 69.1% and 20.6% of the patients had hematuria and hypertension, respectively. Overall, the predominant pathological diagnosis in the current study was IgA nephropathy (21.13%) followed by lupus nephropathy (18.31%). 69.0% of the patients received angiotensin-converting enzyme inhibitors. At the last follow-up, 15.9% presented impaired renal function. Conclusion: In our cohort, the prevalence of glomerulopathies in children with persistent proteinuria was high. We recommended performing kidney biopsy in children with persistent proteinuria. This allows early detection of primary or secondary glomerulopathies to retard progression of renal damage.

Objetivo: descrever os descobrimentos histopatológicos e a progressão a doença renal crónica dos pacientes submetidos a biopsia renal num hospital de referência da cidade de Medellín entre 2005 e 2014. Metodologia: estudo descritivo retrospectivo. Se revisaram histórias clínicas de pacientes menores de 18 anos com diagnóstico de proteinuria persistente, a quem se lhes realizou biopsia renal durante o período 2005-2014 no Hospital Pablo Tobón Uribe. Se analisaram variáveis sócio-demográficas, clínicas, histológicas e de laboratório. Resultados: se incluíram 71 pacientes. A idade média do diagnóstico de proteinúria persistente foi de 10.07 anos. 69.1% e 20.6% dos pacientes apresentaram hematúria e hipertensão arterial respectivamente. A glomerulonefrite por IgA foi a descoberta histológico mais frequente (21.13%), seguido da nefropatia lúpico (18.31%). Do total de pacientes, 69.0% receberam inibidores da enzima convertedora de angiotensina e 15.9% apresentaram deterioro da função renal ao quarto ano de seguimento. Conclusões: a prevalência de glomerulopatias em crianças com proteinúria persistente foi alta. Se sugere a realização da biopsia renal com o fim de detectar precocemente glomerulopatias primárias ou secundárias associadas para assim instaurar um tratamento oportuno que controle ou retarde o deterioro da função renal.

Supercritical fluids as a green technology for the pretreatment of lignocellulosic biomass.

One of the main drawbacks for using lignocellulosic biomass is related to its recalcitrance. The pretreatment of lignocellulosic biomass plays an important role for delignification and crystallinity reduction purposes. In this work rice husk (RH) was submitted to supercritical pretreatment at 80°C and 270 bar with the aim to determine the effect on lignin content, crystallinity as well as enzymatic digestibility. The yields obtained were compared with dilute sulfuric acid pretreatment as base case. Additionally a techno-economic and environmental comparison of the both pretreatment technologies was performed. The results show a lignin content reduction up to 90.6% for the sample with 75% moisture content using a water-ethanol mixture. The results for crystallinity and enzymatic digestibility demonstrated that no reductions were reached. Supercritical pretreatment presents the best economical and environmental performance considering the solvents and carbon dioxide recycling.

Clinical description and evolution of renal transplant pediatric patients treated with alemtuzumab.

BACKGROUND: Renal transplantation is the most effective treatment for children with end-stage renal disease. Recent work suggests that induction with alemtuzumab in the pediatric population permits the use of lower doses of maintenance immunosuppressive therapy. In addition, it has a low cost compared with other induction therapies. OBJECTIVE: To conduct a clinical description of pediatric renal transplant patients comparing induction protocols to evaluate graft and patient survival, infections complications, and lymphoproliferative diseases. MATERIALS AND METHODS: This descriptive and retrospective study, of evaluated pediatric renal transplant patients between 2006 and 2010. RESULTS: The agents for induction therapy were: alemtuzumab (61.5%), daclizumab (19.25%), and thymoglobulin (19.25%). Graft survival was better among the alemtuzumab group (87.5%) compared with the other two induction therapies (80%). The frequency of acute rejection episodes during the first year posttransplantation as well as chronic rejection was lower among the alemtuzumab group. Cytomegalovirus infection was noted in 30% of patients with greater frequency among those induced with alemtuzumab. CONCLUSION: Induction therapy with alemtuzumab was safe in a pediatric population not predisposing to a greater risk of acute or chronic rejection. Except for a greater incidence of Cytomegalovirus, there was no difference in other complications.

Allergenic cross-reactivity between Blomia tropicalis and Blomia kulagini (Acari: Echymiopodidae) extracts from optimized mite cultures.

BACKGROUND: At present, data about the cross-reactivity of Blomia spp. comes from studies made among different genera of mites, and no results have been published involving different species of the genus Blomia. OBJECTIVE: The aim of this study was to find out the level of cross-reactivity between the two main species of Blomia causing allergy, and its implication in the diagnosis of Blomia sensitization. METHODS: Using extracts from optimal growth phases of Blomia kulagini (Zakhvatkin, 1936) and Blomia tropicalis (van Bronswijk, Cock and Oshima, 1973) as allergenic material, the allergenic cross-reactivity between both house dust mites was evaluated by means of cutaneous tests, specific IgE values, ImmunoCAP-inhibition and SDS-PAGE-IgE-immunoblotting-inhibition. RESULTS: The results demonstrated that IgE-binding components belonging to both species are very similar from the immunological point of view, showing high correlations between both species when using cutaneous tests (R2=0.915) or specific IgE (R2=0.980). ImmunoCAP-inhibition and SDS-PAGE-IgE-Immunoblotting-inhibition probed with human sera, showed a total inhibition of specific IgE reactions by the heterologous antigens. CONCLUSION: The results obtained strongly suggest the great resemblance between the allergenic composition of both species.

An association study of bipolar mood disorder (type I) with the 5-HTTLPR serotonin transporter polymorphism in a human population isolate from Colombia.

The short variant of a functional length polymorphism in the promoter region of the serotonin transporter has been associated with several behavioural and psychiatric traits, including bipolar mood disorder. The same short allele has also been implicated as a modifier of the bipolar phenotype. Here we evaluate the etiologic/modifier role of this polymorphism in a case (N=103) / control (N=112) sample for bipolar mood disorder (type I) collected from an isolated South American population. We did not detect an association between bipolar disorder and the 5-HTT promoter polymorphism in this sample. However, an excess of the short allele was seen in younger cases and in cases with psychotic symptoms. When combined with data from the literature, the increased frequency of the short allele in patients with psychotic symptoms was statistically significant.

Neonatal tetanus experience at the National Institute of Pediatrics in Mexico City.

Clinical charts of 44 neonates admitted to the National Institute of Pediatrics with the diagnosis of neonatal tetanus from 1970 to 1990 were reviewed. All patients had an epidemiologic and clinical findings compatible with neonatal tetanus. Delivery had occurred at the homes of the patients in 89% of the cases and in 11% at clinics. The incubation periods ranged from 2 to 10 days, with a mean of 6.2 days. Cole's periods varied from 1 to 144 hours, with a mean of 21 hours. Spasticity, irritability, refusal to feed, lack of sucking and trismus were present in all cases. Thirty-three patients (70.4%) developed complications, the most frequent being sepsis and bronchopneumonia. The most frequent noninfectious complication was atelectasis, followed by renal failure and electrolytic imbalance. Overall mortality was 25%. It is noteworthy that in the most recent decade (1980 to 1990) mortality was 12.9%, considerably lower than that of the previous decade (1970 to 1980) which was 46.6% (P < 0.008). This decrease was probably a result of the greater availability of mechanical ventilation and the intensive care offered at neonatal services. Mortality was associated with the severity of the disease (P < 0.003) and with the presence of complications (P < 0.025).

[Uterine contraction induced by carbachol is inhibited by melatonin]. / La contracción uterina inducida por carbacol es inhibida por melatonina.

It has been suggested that the pineal gland has a specific role in the regulation of reproductive functions. Melatonin, secreted by pineal gland, is involved in the control of mammalian reproduction. Previous investigations have show that melatonin reduced the smooth muscle contraction. The purpose of the present study was to investigate the effect of melatonin on the uterine contraction provoked by carbachol. This effect was studied in isolated uterus were taken from Wistar rats pretreated with diethylstilboestrol. Here, we describe the effects of various concentrations of melatonin was found to inhibit the carbachol-induced uterine contraction. Our results show that CE50 of carbachol increment in present to 10(-9) and 10(-6) M/ml of melatonin. The degree of the inhibitory effect of melatonin to concentration of 10(-9) M/ml is most evident that 10(-6) M/ml. Thus, it is concluded that melatonin has an pharmacological inhibition effect on the contraction uterine provoked by carbachol, act as physiological antagonist.

Effects of chronic toluene inhalation on avoidance conditioned behavior in rats.

Thirty-two Wistar albino rats were distributed at random in a factorial design 2 x 2, with two age groups (20 and 90 days old), and two treatments (chronically exposed to toluene vapors 30,000-40,000 ppm in air/15 minutes per day for 30 days, and controls with only air). Twenty-four hours after the last exposure, the rats were tested for conditioned behavior in a "T" maze of avoidance electric shock. Latency of initial response to escape (LIRE) and latency of escape (LE) were measured in seconds. Adult rats both exposed to chronic toluene inhalation and non-exposed showed higher values of LIRE and LE with respect young rats. Animals exposed to chronic toluene inhalation also presented higher values of latency in both LIRE and LE when compared to non-exposed to toluene (controls) of the same age. The differences were evaluated by Friedman's test. The findings are suggestive of brain dysfunction associated with chronic toluene inhalation, and may represent a delay to respond to a displeasure stimulus probably due to defect of internal mechanisms of facilitation-inhibition of neural impulses, mediated by neurotransmitters.