Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease / Endarterite infecciosa na coarctação da aorta: dois espectros de uma doença pouco frequente

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Espesor de tejido adiposo epicárdico en escolares y adolescentes con obesidad, sobrepeso, y normopeso / Epicardial adipose tissue thickness in children and adolescents with obesity, overweight, and normal weight

Objetivo: Determinar la relación del espesor del tejido adiposo epicárdico (TAE) con el estado nutricional (obesidad, sobrepeso y normopeso) en escolares y adolescentes. Métodos: Estudio observacional, analítico y transversal. Participaron 53 escolares y adolescentes de 6 a 18 años, distribuidos de acuerdo al índice de masa corporal (IMC) en normopeso, sobrepeso y obesidad. Se tomaron medidas antropométricas y de tensión arterial (TA). Se midió el espesor del TAE por ecocardiografía bidimensional. Resultados: Hubo 21 (39,6%) participantes con normopeso, 13 (24,5%) con sobrepeso y 19 (35,9%) con obesidad. El espesor del TAE fue significativamente mayor en el grupo de obesos (3,24±0,46 mm) en comparación con sobrepeso (2,79±0,37 mm; p<0,003) y normopeso (2,20±0,34 mm; p<0,0001), y en el grupo de sobrepeso al compararlo con normopeso (p=0,0001). El espesor del TAE no fue diferente según edad y sexo. Se observó una correlación positiva estadísticamente significativa del espesor del TAE con el IMC (r=0,766; p=0,0001), la circunferencia de cintura (r=0,684; p=0,0001) y la TA sistólica (r=0,376; p=0,005). El análisis de regresión lineal múltiple mostró que el IMC (p=0,0001) fue la variable que más influyó sobre el espesor del TAE. Conclusión: El espesor del TAE aumenta con la adiposidad desde la edad escolar y la adolescencia, y podría ser una herramienta para evaluar riesgo cardiovascular.

Objective: To determine the ratio of the thickness of epicardial adipose tissue (EAT) with nutritional status (obesity, overweight and normal weight) in children and adolescents. Methods: Observational, analytical and cross-sectional study. Fifty-three children and adolescents from 6 to 18 years old were included, distributed according to body mass index (BMI) in obese, overweight and normal weight. Anthropometric measures and blood pressure (BP) were taken. TAE thickness was measured by two-dimensional echocardiography. Results: Twenty-one participants (39.6%) had normal weight, 13 (24.5%) overweight and 19 (35.9%) obesity. The thickness of EAT was significantly higher in the obese group (3.24±0.46 mm) compared to overweight (2.79±0.37 mm, p<0.003) and normal weight (2.20±0.34 mm; p<0.0001), and in the overweight group as compared with normal weight (p=0.0001). TAE thickness was no different by age and gender. A positive statistically significant correlation of thickness of EAT with BMI (r=0.766; p=0.0001), waist circumference (r=0.684; p=0.0001) and systolic BP (r=0.376; p=0.005) was observed. The multiple linear regression analysis showed that BMI (p=0.0001) was the variable that most influenced the thickness of EAT. Conclusion: The thickness of EAT increases with adiposity from school age and adolescence and could be a tool to assess cardiovascular risk.

Steatosis Hepática en Niños y Adolecentes obesos: Asociación con adiposidad, lípidos, insulina y enzimas hepática

Objetivos: Estudiar la frecuencia de presentación de esteatosis hepática (EH) en un grupo de niños y adolescentes obesos y su asociación con medidas antropométricas, niveles de lípidos sanguíneos, resistencia a la insulina y aminotransferasas. Métodos: Se incluyeron 22 niños y adolescentes obesos (IMC>pc97) entre 6 y 13 años de edad, con promedio de 9,28 ± 1,9 años, 59% de sexo masculino y 41% femenino. Se tomaron tensión arterial y medidas antropométricas, incluyendo cintura, y se calcularon índice de masa corporal (IMC), área grasa y área muscular. Se hicieron determinaciones sanguíneas de glicemia e insulina en ayunas y post-prandial, lípidos y aminotransferasas. Con estos datos se calculó el índice de resistencia insulínica, HOMA-IR. Se realizó ecografía hepática con transductores entre 3 y 5 MHz para determinar la presencia de EH de acuerdo a la presencia de ecogenicidad, atenuación del sonido y visualización de vasos y diafragma.Resultados: El 45% (10/22) de los participantes presentó EH, 6 de sexo femenino y 4 de masculino, diferencia que no llegó a ser significativa. En el 14% la EH fue leve, en el 27% moderada y en el 4% severa. Se observó asociación significativa de la presencia de EH con elevación de la aspartato aminotransferasa (AST; p=0,029) y de la alanina aminotransferasa (ALT; p=0,003). No fue significativa la asociación con resistencia a la insulina y alteraciones lipídicas. Los niños con EH presentaron valores significativamente más altos de IMC (p<0,005), cintura (p<0,005), área grasa (p<0,05), insulina post-prandial (p<0,05), AST (p<0,0001), ALT (p<0,0001) y fosfatasas alcalinas (p<0,0001) que aquellos sin EH. En el análisis de regresión logística, con la presencia de EH como variable dependiente, se encontró que el IMC fue la variable antropométrica explicativa más significante (p=0,018; IC 95%: 1,12-3,52), y la AST la variable bioquímica explicativa más significante (p=0,032; IC 95%; 1,02-1,63).Conclusiones: La EH es una complicación frecuente de la obesidad en niños y adolescentes, y se asocia con los indicadores de adiposidad, principalmente el IMC, así como con los niveles de aminotransferasas.

Objectives: To study the frequency of hepatic steatosis (HS) in a group of obese children and adolescents and its association with anthropometric measurements, blood lipid levels, insulin resistance and aminotransferase. Methods: Twenty-two obese children (BMI> PC97) between 6 and 13 years old, (9.28 ± 1.9 years), 59% male and 41% female were included. Blood pressure and anthropometric measurements, including waist, were taken, and body mass index (BMI), fat and muscle area were calcaulated. Determinations of blood glucose and insulin in fasting and post-prandial, lipids and aminotransferases were made. With these data insulin resistance index, HOMA-IR was calculated. A liver ultrasound with transducers between 3 and 5 MHz was performed to study the presence of HS, according to the echogenicity, sound attenuation and visualization of vessels and diaphragm.Results: Forty-five percent (45%) of participants presented HS, 6 female and 4 male, a difference that did not become significant. In 14% the HS was mild, 27% moderate and 4% severe. Significant association was ob-served between the presence of HS and the elevated levels of aspartate aminotransferase (AST, P = 0.029) and alanine aminotransferase (ALT, P = 0.003). There was not a significant association with insulin resistance and lipid abnormalities. Those children with HS showed significantly higher values of BMI (p <0.005), waist (p <0.005), fat area (p <0.05), postprandial insulin (p <0.05), AST (p < 0.0001), ALT (p <0.0001) and alkaline phosphatase (p <0.0001) than those without HS. The logistic regression analysis, with the presence of HS as the dependent variable, showed that BMI was the most significant explanatory anthropometric variable (p=0.018, CI 95%: 1,12-3,52), and AST the most significant explanatory biochemistry variable (p = 0.032, CI 95%, 1,02-1,63).Conclusion: Hepatic steatosis is a common complication of obesity in children and adolescents, and it is associated with indicators of adiposity, mainly BMI, and with aminotransferase levels.

Relación entre el índice de masa corporal y las cifras de tensión arterial en adolescentes

Objetivos: Investigar la relación entre el índice de masa corporal (IMC) y las cifras de tensión arterial en adolescentes de la ciudad de Mérida, dada su asociación con el desarrollo de enfermedades crónicas no trasmisibles en el adulto. Métodos: Se estudiaron 385 adolescentes, 62,3% de sexo femenino y 37,7% de masculino, entre 12 y 15 años de edad, con promedio de 15,17±1,71 años. Se les tomaron las medidas antropométricas, para el cálculo del IMC, y la tensión arterial (TA) en posición sentada. Se consideraron normales el IMC y la TA comprendida entre los percentiles 10 y 90 para las curvas venezolanas, de acuerdo a edad y sexo; se consideró sobrepeso y obesidad sobre el pc 90 y Pre-hipertensión (Pre-HTA) e hipertensión arterial (HTA) sobre el pc 90. Resultados: El 75,3% de los adolescentes presentaron un IMC normal, el 11,2% un IMC bajo y el 13,6% sobrepeso y obesidad. El 1,1% presentò TA sistólica sobre el pc 90 y el 6,3% presentó TA diastólica sobre la norma. No se observó asociación del IMC y de la TA con el sexo ni el estrato socio-económico. Se encontró una alta y significativa asociación entre el sobrepeso/obesidad y la Pre-HTA/HTA (p=0,0001). El riesgo de un adolescente con IMC sobre el pc 90 de presentar Pre-HTA o HTA fue 9,76 veces mayor (Odss ratio) que el adolescente con IMC menor al pc 90 (IC 95%: 4,09-23,27; p=0,0001). Conclusión: Se comprobó una asociación estadística entre el IMC y los valores de TA sistólica y diastólica, por lo que adolescentes que tengan IMC altos deben ser seguidos y sometidos a algún tipo de intervención tendiente a disminuir la incidencia de enfermedades crónicas no transmisibles en la edad adulta.

Objective: To investigate the relationship between body mass index (BMI) and the blood pressure (BP) values in adolescents of the city of Mérida, given its association with the development of non-transmissible chronic diseases in adults. Methods: We studied 385 adolescents, 62.3% female and 37.7% male, between 12 and 15 years of age, with average of 15.17 ± 1.71 years. Anthropometric measures and blood pressure (BP) were taken. The body mass index (BMI) was calculated. BMI and BP between 10th and 90th percentile from Venezuelan curves, according to age and sex, were considered normal. Obesity/overweight and pre-hypertension/hypertension (Pre-HTA/HTA) were considered when the BMI and the BP were located above the 90th percentile. Results: A total of 75.3% of the adolescents had a normal BMI, 11.2% a low BMI and 13.6% had overweight and obesity. The systolic BP was above the 90th percentile in 1.1% and the diastolic BP in 6.3% of the adolescents. No association was observed between BMI and BP with the sex and socio-economic stratum. It was found a high and significant association between overweight/obesity and Pre-HTA/HTA (p=0.0001). The risk for Pre-HTA/HTA of an adolescent with a BMI over 90th percentile was 9.76 times higher (Odss ratio) than in adolescents with a BMI less than 90th percentile (95% CI 4.09-23.27; p = 0.0001). Conclusion: It was found a statistical association between BMI and the values of systolic and diastolic BP. Those adolescents with high BMI should be monitored and subject to any intervention aimed at reducing the incidence of non-transmissible chronic diseases in adulthood.