[Intelligence quotient related with congenital hypotyroidism etiology]. / Coeficiente intelectual y etiología del hipotiroidismo congénito.

BACKGROUND: In Mexico, the congenital hypothyroidism (CH) is a public health problem that has a national incidence ranging from 1:1951 to 1:2458 live births. It is the main endocrine cause of mental retardation. The objective was to evaluate the intelligence coefficient (IQ) of patients with CH using the Wechsler Scale (WS) and to correlate the degree of involvement with its etiology. METHODS: We included patients with CH diagnosed by neonatal screening and treated by who attended the test of Wechsler. Data were obtained from the clinical records. Statistical descriptive were used. RESULTS: We included 15 male (21.7%) and 54 females (78.3%) patients. According to the dysgenesis aetiology was secondary in 51 patients (89.9%) and different from dysgenesis in 18 (26.1%). The age at diagnosis was 12.4 days. The initial replacement dose was 10-5 mg/kg/day. The average age at time of psychometric assessment was 6.4 years. The severity of hypothyroidism was 29 mild, 26 moderate and 14 severe. The mean IQ was 99.47. There was no relationship between IQ and the severity of hypothyroidism (p=0.31), age of initiation of treatment (p=0.271) and etiology (p=0.127). CONCLUSIONS: No relationship was found between the etiology nor the severity of CH with IQ.

Subclinical metabolic abnormalities associated with obesity in prepubertal Mexican schoolchildren.

Childhood obesity has increased to epidemic levels and is considered a public health problem due to its association with a number of metabolic abnormalities, which are being detected at earlier stages of life. The objective was to evaluate the association between the presence of subclinical metabolic abnormalities (SMA) and obesity in a sample of pre-pubertal Mexican schoolchildren. Children of both sexes and 6 to 13 years old were questioned for signs of puberty, underwent anthropometric measurement and had their Body Mass Index (BMI) calculated. Two groups were formed: those with obesity (case group) and those with normal weight paired by age and chosen randomly (control group). Fasting insulin, glucose and cholesterol were measured. 92 children were included, 46 in each group, mean age 9.9 and 9.5 years old, respectively (p = 0.97). A higher frequency of hyperinsulinism was found in the case group: Fasting insulin > 15 mU/ml, 75% vs. 21% (case group vs. control group, respectively); fasting glucose to insulin ratio < 6, 72% vs. 24%; HOMA IR > 2.7, 83% vs. 14%; and decrease in QUICKI (< 0.3), 80% vs. 19% (p = 0.000). Hypercholesterolemia was 25% vs. 15% (p = 0.22), impaired fasting glucose 28% vs. 8% (p = 0.01), and family history of diabetes mellitus (DM) 35% vs. 9% (OR = 5.6; 95% CI = 1.5-22.2; p = 0.002). In this sample of Mexican schoolchildren, obesity was associated to a higher frequency of SMA, such as hyperinsulinism and impaired fasting glucose, and to a family history of DM.

Structured interruptions of highly active antiretroviral therapy in cycles of 4 weeks off/12 weeks on therapy in children having a chronically undetectable viral load cause progressively smaller viral rebounds.

OBJECTIVES: To evaluate the viral, immune and clinical impact of a structured treatment interruption (STI) program of highly active antiretroviral therapy (HAART) in three cycles of 4 weeks off/12 weeks on therapy in a cohort of children with HIV infection under chronic viral control. METHODS: Using a single-group time series experimentation design and following informed consent, the HAART of children with HIV and a chronically undetectable viral load (VL) was discontinued for 4 weeks and then restarted and continued for 12 weeks for a total of three cycles. The VL, CD4+/CD8+ lymphocytes, and clinical status were evaluated at the end of each STI and at 6 and 12 weeks after HAART was resumed. RESULTS: Four children with a median age of 10.3 years (range 6.5-11.2 years) were included in the study. Their clinical immune categories were: A1 (n=2), A2 (n=1), and B3 (n=1). Treatment of all four patients was with zidovudine (AZT)+lamivudine (3TC)+ritonavir (RTV). At the end of the first STI, VL was a median 214000 copies/ml (range 27400-616000), corresponding to 5.3 log(10) (range 4.4-5.8). At the end of the second STI, VL was a median 72400 copies/ml (range 17800-126000) or 4.7 log(10) (range 4.2-5.1), which corresponds to a rebound 0.6 log(10) lower than the first. At the end of the third STI, VL was a median 28200 copies/ml (range 5370-140000) or 4.45 log(10) (range 3.7-5.1), a rebound 0.85 log(10) lower than the first. All rebounds were followed by a decrease in the VL to undetectable levels during the treatment periods. CD8+ T lymphocyte counts increased during viral rebounds and an initial decrease in CD4+ T lymphocyte counts was followed by a tendency to increase even exceeding CD8+ T cell counts. Only one event of transitory severe immunosuppression occurred. There were no symptoms related to the HIV infection. CONCLUSIONS: The STI of HAART in cycles of 4 weeks off/12 weeks on therapy in children with chronically undetectable VL can cause progressively lower viral rebounds followed by a decrease to undetectable levels, with a low risk of severe immunosuppression and without the occurrence of symptoms related to HIV.

Audiologic and vestibular findings in a sample of human immunodeficiency virus type-1-infected Mexican children under highly active antiretroviral therapy.

OBJECTIVE: There is little information about audiologic and vestibular disorders in pediatric patients infected with the Human Immunodeficiency Virus type-1 (HIV-1). The aim of this study was to evaluate audiologic and vestibular disorders in a sample of HIV-1-infected children receiving Highly Active Antiretroviral Therapy. METHODS: Patients underwent pure tone audiometry, speech discrimination testing, auditory brainstem responses, electronystagmography, and rotatory testing. HIV-1 viral load and absolute CD4+ cell counts were registered. RESULTS: Twenty-three patients were included, aged 4.5 years (median, range 5 months to 16 years). Pure tone audiometry was carried out in 12 children over 4 years of age: 4 (33%) showed hearing loss, 2 were conductive. Auditory brainstem responses were measured in all 23 patients, suggesting conductive hearing loss in 6 and sensorineural hearing loss in 2. Most patients with conductive hearing loss had the antecedent of acute or chronic suppurative otitis media but with dry ears at the time of evaluation (p=0.003). Abnormal prolongations of interwave intervals in auditory brainstem responses were observed in 3 children (13%, 4 ears), an abnormal morphology in different components of auditory brainstem responses in 4 (17.4%, 7 ears), and abnormal amplitude patterns in 11 patients (48%, 17 ears). Vestibular tests were abnormal in all six patients tested, with asymmetries in caloric and rotatory tests. Although differences were not significant, in general, audiologic abnormalities were more frequent in patients with more prolonged HIV-1 infections, higher viral loads, or lower absolute CD4+ cell counts. CONCLUSIONS: Conductive hearing loss associated with previous otitis media events, abnormalities in auditory brainstem responses suggesting disorders at different levels of the auditory pathways, and unilateral vestibular hyporeflexia were frequent findings in our sample of HIV-1-infected children under Highly Active Antiretroviral Therapy. These findings suggest that HIV-1-infected children should be submitted to audiologic and vestibular evaluation as early as possible in order to reduce their impact on the psychosocial development of these patients.

High-virulence clone of group B streptococci unable to grow at high temperatures is present in serotypes other than type III.

Highly virulent clonotypes of serotype III seem to cause much of the perinatal morbidity and mortality attributed to Streptococcus agalactiae (group B streptococci, GBS), One of these clonal types, designated the "high-virulence clone" (HVC), was identified by its inability to grow at 40 degrees C in a chemically defined medium. In the present study, this inability to grow at high temperatures was used as a marker to identify HVC in a sample of 286 Mexican GBS isolates. Forty-three isolates (15%) were identified as belonging to this clone: 15 were invasive isolates, 33 were serotype III (77%), and 10 were of serotypes other than type III (23%). These results demonstrate that HVC is more prevalent in Mexico than previously reported and that this clone is not restricted to serotype III isolates.

Serotypes of 286 group B streptococci isolated from asymptomatic carriers and invasive disease cases in Mexico.

BACKGROUND: Group B Streptococcus (GBS) remains as a leading cause of neonatal sepsis and meningitis in developed countries, where type III is the most common serotype. Although GBS is considered an uncommon cause of perinatal pathology in Mexico, a vaginal colonization rate of 14% in pregnant women and a neonatal infection rate of 1/1500 live births have been reported. The aim of this study was to determine the serotype distribution in a collection of 286 GBS strains isolated in Mexico from asymptomatic carriers and in adult and neonatal invasive disease cases. METHODS: The collection included GBS strains isolated between January 1988 and April 1998 at the Instituto Nacional de Perinatologia and Hospital de Pediatria in Mexico City. GBS and serotype were confirmed by latex agglutination. RESULTS: Most strains were isolated from asymptomatic carriers (66%). 30% were invasive isolates, and 10% of them were from neonates. 48.6% were type I, 32.9% type III, 14% type II, and 4% were non-typeable. CONCLUSION: Serotype I is predominant in Mexico but participation of serotype III is increasing, and a decrease of non-typeable isolates was detected.

Identification of the high-virulence clone of group B streptococci by using a probe containing a putative aldolase gene.

A high-virulence clone (HVC) was proposed as causing much of the morbidity and mortality when a collection of group B Streptococcus (GBS) isolates was examined by multi-locus enzyme electrophoresis. HVC isolates could be further distinguished by their inability to grow at 40 degrees C, and a temperature-sensitive aldolase was identified as responsible for this characteristic. In the present study, the HVC was sought in a collection of 57 GBS isolates by hybridization with a probe containing a putative aldolase gene on genomic DNA restriction enzyme digests. Isolates were initially classified as HVC or non-HVC by their inability to grow at 40 degrees C. Three serotype III invasive isolates had the HVC control restriction/hybridization pattern. They were also unable to grow at 40 degrees C. The remaining 11 invasive and all carrier isolates showed a pattern identical to that of the non-HVC control. These results provide additional support for the existence of a highly virulent clonal group among serotype III isolates and suggest that hybridization with a probe containing the aldolase gene on DNA restriction enzyme digests can be an alternative method for identifying highly virulent isolates.

Response to two consecutive protease inhibitor combination therapy regimens in a cohort of HIV-1-infected children.

The response to 2 consecutive protease inhibitor (P1) combination regimens was evaluated in a cohort of HIV-1-infected children. Twelve children, most of whom had been heavily treated, received a 3-drug treatment: saquinavir in hard gelatin capsules (SQVhgc) + zidovudine (ZDV) + didanosine. When this treatment failed it was replaced by a 4-drug regimen: ritonavir + SQVhgc + ZDV + lamivudine. A mild and temporary decrease in viral load (VL) was observed with the initial regimen (p = 0.22). Therapy failure occurred in 7 patients (58%) within 9 months and in another 3 (25%) within 9-18 months. The 7 children who failed within 9 months received the subsequent boosted regimen, leading to a significant and lasting reduction in VL (p = 0.001). None of the patients failed on the boosted regimen: 5/7 achieved a VL of < 400 copies/ml and 3/7 achieved a VL of < 50 copies/ml. Our results suggest that a 4-drug regimen including 2 PIs produces a better and more sustained response than a 3-drug regimen including only 1 PI, and that a good, sustained response is possible with subsequent boosted regimens even in heavily treated children.