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ABSTRACT: Background: There is a high prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) among pediatric patients. The identification of clinical predictors of these conditions would allow a timely treatment. Aim: To evaluate the relationship between serum alanine aminotransferase levels and parameters of metabolic syndrome in asymptomatic school students without hepatic illness. Subjects and Methods: A randomized sample of 175 children aged between 9 and 14 years (54% females) was selected, from a database of 3010 students living in Santiago, Chile. Weight, height, abdominal circumference, systolic and diastolic blood pressure were measured. A fasting blood sample was obtained to measure glucose, total cholesterol, HDL, LDL-cholesterol, triglycerides, alanine aminotransferase (ALT) and insulin levels. Results: Forty percent of participants were obese, 17% had metabolic syndrome and 13.1% had abnormal ALT levels. Compared with children with normal ALT levels, the latter had significantly higher waist obesity, body mass index, systolic and diastolic blood pressure and triglycerides. However on multiva-riate analysis, only waist obesity was independently associated with abnormal ALT levels (adjusted odds ratio 3.93, 95% confidence intervals 1.44-10.78, p = 0.008). Conclusions: Only waist obesity was independently associated with abnormal ALT levels in this sample of children.
Revista medica de Chile 07/2012; 140(7):896-901. · 0.33 Impact Factor
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ABSTRACT: Extremes of birthweight (BW) have been associated with increased rates of metabolic risks. The objective was to study the prevalence of metabolic risks markers among obese and overweight (OW) subjects according to BW.
A cross-sectional study was performed in a cohort of 1002 patients (2-18 years, 40.6% male) evaluated for OW or obese subjects in two private clinics. Anthropometrics, fasting lipids, glycemia, and insulin were obtained.
Of the subjects, 76.1% were born appropriate for gestational age (AGA), 10.9% small for gestational age (SGA), and 13% large for gestational age (LGA). Children born LGA presented a more severe degree of obesity compared with those born AGA and SGA (p<0.0001). No differences in glycemia, insulin, and lipid levels were detected among the groups. Abnormal glucose was found in 37 subjects: one with type 2 diabetes mellitus (from the previously glucose-intolerant subjects), 10 with glucose intolerance, and 27 with impaired fasting glucose. According to Boney criteria, 6.6% of the patients (6-18 years old) exhibited metabolic syndrome (MS) (69.4% AGA, 12.9% SGA, and 17.7% LGA).
Being born LGA represents a higher risk of severe obesity. At this age, the most frequent component of MS was an abnormal lipid profile with low high-density lipoprotein and high triglycerides. Finally, the most frequent finding associated with abnormalities of glucose tolerance was a family history of diabetes. Thus, BW, lipid profile, and family history are mandatory when these patients are evaluated.
Journal of pediatric endocrinology & metabolism: JPEM 01/2012; 25(1-2):51-6. · 0.88 Impact Factor
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Rodrigo Bancalari,
Carlos Díaz,
Alejandro Martínez-Aguayo,
Marlene Aglony,
Juanita Zamorano,
Verónica Cerda,
Manuel Fernández,
Flabia Garbin,
Gabriel Cavada,
María Valenzuela, Hernán García
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ABSTRACT: Hypertension in children is a frequently overlooked problem that is an important cardiovascular risk factor.
To determine the prevalence of hypertension among school age children.
Cross-sectional study of 2980 children aged 10 ± 2 years (48% females) from 10 schools of middle and lower class in Metropolitan Santiago. Blood pressure (BP) was measured in the sitting position on three occasions after a rest period, using a mercury sphygmomanometer with appropriate cuff arm diameter, averaging the results of the measurements. Systolic and diastolic hypertension were defined as blood pressure values over 95 percentile for age, sex and height.
The overall prevalence of hypertension was 12.2% in women and 15% in men (p < 0.05). According to nutritional status, the prevalence was 6.7, 8.9,13.6 and 26% in underweight, eutrophic, overweight and obese children, respectively (p < 0.01). Compared with normal weight children, the risk of being hypertensive for overweight children was 1.6 (95% confidence intervals (CI) 1.2-2.3) and for obese children was 3.6 (95% CI 2.8-4.7).
The studied children had a high prevalence of hypertension, that was directly related to a higher body mass index.
Revista medica de Chile 07/2011; 139(7):872-9. · 0.33 Impact Factor
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ABSTRACT: The higher prevalence of childhood obesity has led to search for metabolic syndrome (MS) in this age group.
To study the prevalence of MS in obese children and adolescents.
Cross sectional study of 255 obese children and adolescents aged 11.3 ± 2.4 years, 45% males, 60% pubertal, with a body mass index (BMI) z score of 2.7 ± 0.6, who were evaluated for obesity. MS was defined as the presence of at least three of the following criteria, according to Ferranti: fasting glucose (FG) ≥ 100 mg/dl, triglycerides (TG) ≥ 100 mg/dl, HDL < 50 mg/dl, waist circumference (WC) > percentile (p) 75 and blood pressure (BP) > p90. Patients were also classified using Cook criteria: FG ≥ 100 mg/dl, TG ≥ 110 mg/dl, HDL < 40 mg/dl, WC > p 90, BP > p 90.
MS was observed in 45 and 22.7% of patients, according to Ferranti and Cook definitions, respectively. WC was the most frequent criteria and glucose was the most uncommon. Males had higher body mass index, WC and TG levels than females. According to Ferranti and Cook definitions, MS prevalence was 53.5 and 28% in males and 37.6 and l8.4% in females (p < 0.05). Fifty and 26.1% of pubertal patients exhibited MS vs 36.9 and 17.5% in pre-pubertal subjects (p < 0.05) using Ferranti and Cook criteria, respectively. The frequency of MS increased along with a higher BMI.
MS is a prevalent condition in obese children and adolescents, especially in males and pubertal children. It is necessary to have a better and universal definition for MS in pediatrics including all ages, in order to be focused in obesity prevention and treatment.
Revista medica de Chile 06/2011; 139(6):732-8. · 0.33 Impact Factor
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Marlene Aglony,
Alejandro Martínez-Aguayo,
Cristian A Carvajal,
Carmen Campino, Hernán García,
Rodrigo Bancalari,
Lillian Bolte,
Carolina Avalos,
Carolina Loureiro,
Pamela Trejo,
Karin Brinkmann,
Vinka Giadrosich,
Verónica Mericq,
Ana Rocha,
Alejandra Avila,
Viviana Perez,
Andrea Inostroza,
Carlos E Fardella
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ABSTRACT: Familial hyperaldosteronism type 1 is an autosomal dominant disorder attributed to a chimeric CYP11B1/CYP11B2 gene (CG). Its prevalence and manifestation in the pediatric population has not been established. We aimed to investigate the prevalence of familial hyperaldosteronism type 1 in Chilean hypertensive children and to describe their clinical and biochemical characteristics. We studied 130 untreated hypertensive children (4 to 16 years old). Blood samples for measuring plasma potassium, serum aldosterone, plasma renin activity, aldosterone/renin ratio, and DNA were collected. The detection of CG was performed using long-extension PCR. We found 4 (3.08%) of 130 children with CG who belonged to 4 unrelated families. The 4 patients with CG had very high aldosterone/renin ratio (49 to 242). In addition, we found 4 children and 5 adults who were affected among 21 first-degree relatives. Of the 8 affected children, 6 presented severe hypertension, 1 presented prehypertension, and 1 presented normotension. High serum aldosterone levels (>17.7 ng/dL) were detected in 6 of 8 subjects (range: 18.6 to 48.4 ng/dL) and suppressed plasma renin activity (≤0.5 ng/mL per hour) and high aldosterone/renin ratio (>10) in 8 of 8 children (range: 49 to 242). Hypokalemia was observed in only 1 of 8 children. We demonstrated that the prevalence of familial hyperaldosteronism type 1 in a pediatric hypertensive pediatric population was surprisingly high. We found a high variability in the clinical and biochemical characteristics of the affected patients, which suggests that familial hyperaldosteronism type 1 is a heterogeneous disease with a wide spectrum of presentations even within the same family group.
Hypertension 06/2011; 57(6):1117-21. · 6.21 Impact Factor
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ABSTRACT: Precocious pubarche (PP), defined as the development of sexual pubic hair before 8 years of age in females and before 9 years in males, is usually a benign condition but it can also be the first sign of an underlying disease.
To analyze the etiology and perform a short term follow up in a cohort of patients with PP.
A group of 173 patients (158 females) consulted for PP with a mean age of 7.4+/-0.1 years. These patients were followed between 15 to 60 months. Anthropometric measurements, bone age, serum levels of total testosterone, 17 OH progesterone (17 OHP) and dehydroepiandrosterone sulphate (DHEAS) were evaluated.
Mean birth weight and length was 3024.1+/-50.5 g and 48.5+/-0.3 cm, respectively. Ten percent of children were small for gestational age at birth. Bone age was accelerated by 1.1+/-0.01 years. One hundred and twelve patients were classified as having idiopathic PP (64.7%; 105 females), 29 as central precocious puberty (16.8%; only females), 16 as exaggerated adrenarche (EA 9.2%; 13 females) and 16 as non classical adrenal hyperplasia (9.2%; 11 females).
PP represents a common and usually benign sign. However, 26% of cases had a pathologic underlying condition. Therefore, all children with PP should be evaluated by a pediatric endocrinologist. Low birth weight was not frequent in this cohort and these patients did not show EA .
Revista medica de Chile 02/2009; 137(1):31-8. · 0.33 Impact Factor
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Diabetes care 06/2007; 30(5):e28-9. · 8.09 Impact Factor
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M Elena Cabrera, Hernán García,
Vivian Lois,
Alvaro León,
Karina Peña,
Alberto Rossle,
Berta Cerda,
Hernán Rojas,
Pedro Meneses,
Carlos Merino,
Augusto Aspillaga,
Cecilia Vittini de,
Jacqueline Oliva,
Cecilia Hales,
Janet Rosas
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ABSTRACT: Hodgkin lymphoma is a highly curable disease.
To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile.
Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively.
Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61% of cases. Age over 40 was an adverse prognostic factor (p<0.001). The rate of PFS at 5 and 10 years for early stages was 73% and 66% with RT, 80% and 74% with C-MOPP+RT, 73% and 71% with C-MOPP/ABV, 59% and 59% with NOVP+RT, and 81% with ABVD+RT, at 5 years, being significantly lower for NOVP (p=0.02). The rate of OS at 5 and 10 years for advanced stages was 82% and 70% with RT, 82% and 76% with C-MOPP+RT, 82% and 80% with C-MOPP/ABV, 68% and 60% with NOVP, and 85% with ABVD at 5 years, also significantly lower for NOVP (p=0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49% and 43% with C-MOPP, 69% and 62% with C-MOPP/ABVD or C-MOPP/ABV, and 71% at 5 years with ABVD, significantly lower for C-MOPP (p=0.01). The rate of OS at 5 and 10 years was 52% and 46% with C-MOPP, 70% and 63% with C-MOPP/ABVD or C-MOPP/ABV and 76% with ABVD at 5 years, significantly lower for C-MOPP (p=0.0002).
Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early and advanced stages.
Revista medica de Chile 03/2007; 135(3):341-50. · 0.33 Impact Factor
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ABSTRACT: Because of the important glutamatergic mediation of the behavioral effects of ethanol, glutamatergic agents have attracted attention for the treatment of ethanol abuse and dependence in preclinical and clinical studies. In the present study, we investigated the effect of pharmacological doses of the natural polyamines putrescine, spermine, and spermidine and the synthetic polyamine N,N'-bis-(3-aminopropyl)cyclohexane-1,4-diamine (DCD) on alcohol consumption in a free-choice paradigm carried out in genetically high-ethanol-consumer UChB rats. Short 3-day treatment with either polyamine, administered p.o., significantly reduced ethanol intake without modifying water and food intakes. Neither polyamine was able to increase markedly blood acetaldehyde in rats submitted to a standard challenge dose of ethanol, to rule out a disulfiram-like effect. Besides, blood ethanol disappearance after a test dose of ethanol was not affected by the synthetic polyamine DCD. Long-term treatment with DCD dose-dependently reduced ethanol intake in UChB rats without producing any observable effect on overt behavior, food consumption, and total fluid intake. The present results indicate that pharmacological doses of polyamines can reduce ethanol consumption in genetically drinking rats without producing significant side effects, suggesting that modulation of brain N-methyl-d-aspartate receptors by polyamines could represent a suitable strategy to reduce appetite for ethanol. However, caution must be exercised in interpreting the results because polyamines can also affect neuronal excitability by acting at other receptor targets, such as AMPA and kainate receptors, as well as at some voltage-dependent ion channels.
Alcohol 08/2005; 36(3):169-77. · 2.47 Impact Factor
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ABSTRACT: This report describes the design and synthesis of the synthetic polyamine DCD (N,N'-bis-(3-aminopropyl)cyclohexane-1,4-diamine, tetramethanesulfonate), a structural analog of spermine, and its in vivo activity as an inhibitor of alcohol consumption in a free-paradigm carried out on genetically high-ethanol-consuming UChB rats. After acute treatment with DCD (daily single dose, 20 mg/kg, p.o., 3 days), a 19% decrease in ethanol intake was obtained, without affecting the levels of food and water intake. After chronic treatment (daily single dose, 20mg/kg, p.o., 60 days) a decrease of up to 60% in ethanol intake with respect to the basal period was provoked; this effect was significantly maintained during the post-treatment period and, according to the data obtained from the determination of acetaldehyde levels in blood, was not related to a possible disulfiram-like effect. The design of this new compound was carried out using molecular modeling techniques, with the structures of natural polyamines (putrescine, spermidine, and spermine) and biosynthetically related diamines (1,3-diaminopropane; DAP) as templates. These polyamines have shown activity as inhibitors of ethanol appetite in the same experimental model.
Bioorganic & Medicinal Chemistry 08/2005; 13(14):4375-82. · 2.92 Impact Factor
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Diabetes Care 04/2005; 28(3):758-9. · 8.09 Impact Factor
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ABSTRACT: In rats submitted to a C-fiber reflex response paradigm, intravenous (i.v.) administration of 2.5, 5 and 10 mg/kg of the synthetic polyamine N,N'-bis-(3-aminopropyl) cyclohexane-1,4-diamine (DCD) dose-dependently reduced both the integrated C reflex responses and wind-up activity. Inhibitory effects of the polyamine on spinal cord nociceptive transmission are likely to be consequence of blockade by extracellular DCD of NMDA receptor channels localized in dorsal horn neurons, although modulatory actions at supraspinal level and at other ion channels could also be possible.
Brain Research 11/2004; 1022(1-2):257-60. · 2.73 Impact Factor
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ABSTRACT: During the last decade, the importance of glycemic control in the prevention of the microvascular complications of type 1 Diabetes Mellitus (DM1) was clearly demonstrated.
To evaluate the metabolic and anthropometric results of a multidisciplinary intensified treatment program of DMI in children and adolescents.
Report of 54 patients treated during 2001. The intensified treatment consisted of: multiple daily doses of insulin, frequent glycemic control, nutritional, psychological and educational support, and permanent availability of a diabetes nurse for telephonic support.
Thirty one patients were female, their mean age was 10.4 +/- 0.5 years old and 52% were experiencing puberty. Fifty three percent of the patients used 3 insulin doses per day, 95% changed rapid insulin dose based on glucose levels and 18% considered carbohydrates in their rapid insulin dosing. Mean glycosilated hemoglobin was 8.18 +/- 0.23% without differences by sex or pubertal status. Sex, pubertal stage and the number of insulin doses did not contribute to glycosilated hemoglobin changes. There were no differences in weight or BMI, but there was a decrease in height Z score from the admission to the program until the last control (0.1 +/- 0.1 vs--0.3 +/- 0.1 DS; p < 0.01).
A modified intensified modality of DM1 therapy for pediatric patients in a public hospital in Chile is feasible, achieving similar metabolic control, compared to international large centers.
Revista medica de Chile 08/2003; 131(8):857-64. · 0.33 Impact Factor
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ABSTRACT: The beginning of puberty is marked by breast growth in girls and testicular enlargement in boys. These occur at the age of 10.5 +/- 2.0 years in females and 11.5 +/- 2.0 years in males. Recent but controversial publications suggest that these events are being observed at younger ages, at least in the USA. There are no studies demonstrating that this is true in Chile. For this reason we still consider that puberty is precocious when it occurs before 8.0 years in girls and before 9.0 years in boys. True or central precocious puberty (CPP) must be distinguished from peripheral or pseudoprecocious puberty (PPP), from premature telarche and from premature adrenarche. We suggest that the workup of a patient with premature development should include an LHRH test to demonstrate if the hypothalamic-pituitary axis is activated, plasma levels of sex steroids, bone age and pelvic ultrasound in girls. All children with CPP should have a CAT scan or MNR of the brain, since a lesion of the central nervous system is observed in 15% of the girls and 50% of the boys with CPP. Additional studies are needed in cases of PPP. The aim of treating CPP is to avoid adult short stature that results from premature fusion of the epiphysis and to avoid eventual emotional and psychological stress. Treatment consists of monthly intramuscular injections of a depot preparation of LHRH analogs. Suppression of pituitary and gonadal activity produces regression of secondary sex characteristics and slowing down of growth velocity and bone maturation. The opportunity, duration of treatment and their effect on final stature are discussed.
Revista medica de Chile 02/2003; 131(1):95-110. · 0.33 Impact Factor
