Metales pesados en el ambiente: síndrome de Guillain-Barré / likeHeavy metals in the enviroment: Guillain-Barré like syndrome

El síndrome de Guillain-Barré constituye una entidad de etiología diversa, que se caracteriza por debilidad muscular aguda, simétrica, ascendente y progresiva, y es una de las polineuropatías adquiridas más frecuentes en la infancia. Entre los diagnósticos diferenciales, deben considerarse las neuropatías producidas por metales pesados, mercurio y plomo, y metaloides, como el arsénico, plaguicidas organofosforados y el tetracloruro de carbono.Se presenta a un paciente de 14 años con diagnóstico de síndrome de Guillain-Barré sin respuesta al tratamiento convencional con gammaglobulina. Considerando otras etiologías, se sospechó neuropatía producida por metales pesados, y se confirmó intoxicación por mercurio.El objetivo de esta presentación es concientizar a los pediatras acerca del impacto de los tóxicos ambientales en la salud infantil para realizar un diagnóstico precoz pesquisando datos clave a través de la historia clínica ambiental

Guillain-Barré syndrome is an entity of diverse etiology, characterized by acute, symmetric, ascending and progressive muscle weakness, being one of the most frequent acquired polyneuropathies in childhood. Neuropathies produced by heavy metals, mercury and lead, and metalloids, such as arsenic, organophosphorus pesticides and carbon tetrachloride, should be considered among the differential diagnoses.We present a 14-year-old patient with a presumptive diagnosis of Guillain-Barré syndrome without response to conventional treatment with gamma globulin. Considering other etiologies, heavy metal neuropathy was suspected, and mercury poisoning was confirmed.The aim of this presentation is to make pediatricians aware about the impact of environmental toxic agents on children's health in order to make an early diagnosis by researching key data through the environmental clinical history.

[Heavy metals in the enviroment: Guillain-Barre like syndrome]. / Metales pesados en el ambiente: smdrome de Gmllam-Barre like.

Guillain-Barré syndrome is an entity of diverse etiology, characterized by acute, symmetric, ascending and progressive muscle weakness, being one of the most frequent acquired polyneuropathies in childhood. Neuropathies produced by heavy metals, mercury and lead, and metalloids, such as arsenic, organophosphorus pesticides and carbon tetrachloride, should be considered among the differential diagnoses. We present a 14-year-old patient with a presumptive diagnosis of Guillain-Barré syndrome without response to conventional treatment with gamma globulin. Considering other etiologies, heavy metal neuropathy was suspected, and mercury poisoning was confirmed. The aim of this presentation is to make pediatricians aware about the impact of environmental toxic agents on children's health in order to make an early diagnosis by researching key data through the environmental clinical history.

El síndrome de Guillain-Barré constituye una entidad de etiología diversa, que se caracteriza por debilidad muscular aguda, simétrica, ascendente y progresiva, y es una de las polineuropatías adquiridas más frecuentes en la infancia. Entre los diagnósticos diferenciales, deben considerarse las neuropatías producidas por metales pesados, mercurio y plomo, y metaloides, como el arsénico, plaguicidas organofosforados y el tetracloruro de carbono. Se presenta a un paciente de 14 años con diagnóstico de síndrome de Guillain-Barré sin respuesta al tratamiento convencional con gammaglobulina. Considerando otras etiologías, se sospechó neuropatía producida por metales pesados, y se confirmó intoxicación por mercurio. El objetivo de esta presentación es concientizar a los pediatras acerca del impacto de los tóxicos ambientales en la salud infantil para realizar un diagnóstico precoz pesquisando datos clave a través de la historia clínica ambiental.

Valores de referencia pediátricos de cromo y mercurio en orina del área de la Ciudad de Buenos Aires y alrededores / Pediatric reference values for chromium and mercury in urine in the City of Buenos Aires and Greater Buenos Aires

Introducción. Debido a la fuerte industrialización de la Ciudad de Buenos Aires y alrededores, la población podría estar expuesta a metales. Para poder evaluar el nivel de exposición de los niños al cromo y al mercurio, es fundamental tener valores de referencia (VR) propios. El objetivo fue determinar los VR pediátricos para cromo y mercurio en la muestra aislada de orina. Población y métodos: Se incluyeron niños y niñas no expuestos a los contaminantes evaluados que concurrieron al Servicio de Bajo Riesgo y al Consultorio del Jardín Maternal del Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan". Se cuantificó cromo (UCr), mercurio (UHg) y creatinina urinarios. Se calcularon los p95 con su intervalo de confianza del 95 % [IC 95 %] según el concepto para VR de la German Human Biomonitoring Commission. Resultados: Se incluyeron 160 pacientes en el estudio. Se obtuvieron 144 muestras de niños y niñas de entre 1 y 17 años (mediana: 7 años). Se cuantificó UCr a 137 muestras y UHg a 129. La mediana y rango de cromo fue 0,54 (indetectable -3,06) µg/g de creatinina y la de mercurio fue 0,49 (indetectable -7,57) µg/g de creatinina.Conclusiones: Los VR fueron, para UCr, hasta 1,5 µg/l [1,2-2,8] y hasta 2,2 µg/g de creatinina [1,8-3,0] y para UHg, hasta 2,5 µg/l [1,8-4,8] y 3,2 µg/g de creatinina [2,5-4,7

Introduction. Due to the heavy industrialization of the Autonomous City of Buenos Aires and Greater Buenos Aires, the population may have become exposed to metals.To assess the level of exposure to chromium and mercury in children, it is critical to have local reference values (RVs). Our objective was to determine pediatric RVs for chromium and mercury in a single urine sample.Population and methods: Children who were not exposed to the studied contaminants and who attended the Department of Low Risk Conditions and the Daycare Center Office of Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" were included. Urinary chromium (UCr), urinary mercury (UHg), and urinary creatinine were measured. The p95 and its corresponding 95 % confidence interval (CI) were estimated based on the RV concept proposed by the German Human Biomonitoring Commission.Results: The study included 160 patients. A total of 144 samples from children aged 1-17 years (median: 7 years) were collected. UCr was measured in 137 samples and UHg, in 129 samples. The median value of chromium was 0.54 µg/g of creatinine (range, undetectable to 3.06), while that of mercury was 0.49 µg/g of creatinine (range, undetectable to 7.57). Conclusions: The RVs for UCr were up to 1.5 µg/L [1.2-2.8] and up to 2.2 µg/g of creatinine [1.8-3.0], and for UHg, up to 2.5 µg/L [1.8-4.8] and 3.2 µg/g of creatinine [2.5-4.7]

Pediatric reference values for chromium and mercury in urine in the City of Buenos Aires and Greater Buenos Aires. / Valores de referencia pediátricos de cromo y mercurio en orina del área de la Ciudad de Buenos Aires y alrededores.

INTRODUCTION: Due to the heavy industrialization of the Autonomous City of Buenos Aires and Greater Buenos Aires, the population may have become exposed to metals. To assess the level of exposure to chromium and mercury in children, it is critical to have local reference values (RVs). Our objective was to determine pediatric RV s for chromium and mercury in a single urine sample. POPULATION AND METHODS: Children who were not exposed to the studied contaminants and who attended the Department of Low Risk Conditions and the Daycare Center Office of Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" were included. Urinary chromium (UCr), urinary mercury (UHg), and urinary creatinine were measured. The p95 and its corresponding 95 % confidence interval (CI) were estimated based on the RV concept proposed by the German Human Biomonitoring Commission. RESULTS: The study included 160 patients. A total of 144 samples from children aged 1-17 years (median: 7 years) were collected. UCr was measured in 137 samples and UHg, in 129 samples. The median value of chromium was 0.54 µg/g of creatinine (range, undetectable to 3.06), while that of mercury was 0.49 µg/g of creatinine (range, undetectable to 7.57). CONCLUSIONS: The RVs for UCr were up to 1.5 µg/L [1.2-2.8] and up to 2.2 µg/g of creatinine [1.8-3.0], and for UHg, up to 2.5 µg/L [1.8-4.8] and 3.2 µg/g of creatinine [2.5-4.7].

Introducción. Debido a la fuerte industrialización de la Ciudad de Buenos Aires y alrededores, la población podría estar expuesta a metales. Para poder evaluar el nivel de exposición de los niños al cromo y al mercurio, es fundamental tener valores de referencia (VR) propios. El objetivo fue determinar los VR pediátricos para cromo y mercurio en la muestra aislada de orina. Población y métodos: Se incluyeron niños y niñas no expuestos a los contaminantes evaluados que concurrieron al Servicio de Bajo Riesgo y al Consultorio del Jardín Maternal del Hospital de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan". Se cuantificó cromo (UCr), mercurio (UHg) y creatinina urinarios. Se calcularon los p95 con su intervalo de confianza del 95 % [IC 95 %] según el concepto para VR de la German Human Biomonitoring Commission. Resultados: Se incluyeron 160 pacientes en el estudio. Se obtuvieron 144 muestras de niños y niñas de entre 1 y 17 años (mediana: 7 años). Se cuantificó UCr a 137 muestras y UHg a 129. La mediana y rango de cromo fue 0,54 (indetectable -3,06) µg/g de creatinina y la de mercurio fue 0,49 (indetectable -7,57) µg/g de creatinina. Conclusiones: Los VR fueron, para UCr, hasta 1,5 µg/l [1,2-2,8] y hasta 2,2 µg/g de creatinina [1,8-3,0] y para UHg, hasta 2,5 µg/l [1,8-4,8] y 3,2 µg/g de creatinina [2,5-4,7].

Age-specific thyroid hormone and thyrotropin reference intervals for a pediatric and adolescent population.

BACKGROUND: Establishment of reliable reference intervals remains valuable for confirming validity and advancing standardization across methods and populations. Moreover, knowledge of the measurement uncertainty (U) and of the reference change value (RCV) has important applications in clinical chemistry. METHODS: Starting from the information available in the laboratory data base (29,901 subjects) an initial selection was carried out by eliminating all subjects with a clinical or laboratory pathological report; data from 7581 0- to 20-year-old subjects (53.87% girls) remained in the study. These subjects, divided into nine age groups, were used to define reference distribution percentiles (2.5th, 50th and 97.5th) of serum thyrotropin (TSH), triiodothyronine (T3), thyroxine (T4), and free T4 (fT4), as well as U and RCV of these assays. RESULTS: In early infancy, T4 and fT4 values were higher than in the older age groups. Serum T4 95th percentile reference value, useful for the diagnosis of hyperthyroidism, was 142.9 in 20-year-old boys and 230.4 nmol/L in early infants and serum T3 95th percentile was 2.6 and 3.5 nmol/L, respectively, while fT4 2.5th percentile reference value, useful for the diagnosis of hypothyroidism, was 9.6 and 13.0 pmol/L, respectively. Serum TSH 97.5th percentile showed less age variation, 4.38-4.88 mIU/L. Performance of the four assays resulted in approximately 20% Us, reflecting simple and complex imprecision, trueness, analytical and functional sensitivity. RCV of serum TSH (58.6%) was larger than for thyroid hormones (28.3%-34.7%), probably due to the high biological variation of this hormone. CONCLUSIONS: We have established reference interval for TSH and thyroid hormones, as well as Us for assessing reliability of measurements, and RCVs to alert users on the presence of clinical significant changes.