ABSTRACT
Introduction: Breastfed infants under one year of age may not get enough vitamin D; therefore a vitamin supplement is needed. The adherence to this policy has not yet been evaluated in Chile. Objective: To evaluate the adherence to vitamin D supplementation in children less than one year old and the determinant factors involved. Patients and Method: A cross-sectional study was carried out in three Catholic University Health Network centers. Breastfed infants under one year of age were included in the study. Their parents/guardians filled out a questionnaire about adherence to supplementation and its determinant factors. Results: 170 infants were recruited. 164 of them received supplementation, with a good adherence of 68.9%. The main reason for non-adherence was due to maternal forgetfulness. The identified risk factor for poor adherence was the number of maternal children. Conclusions: Vitamin D supplementation in Chile reaches high levels, but its adherence is poor. More education to parents on ways to avoid forgetting the supplement is needed as well as on identifying risk factors during medical consultations.
Introducción: Los lactantes menores de un año alimentados con leche materna poseen múltiples factores que impiden una adecuada adquisición de vitamina D, haciendo la suplementación necesaria. La adherencia a esta política de salud no ha sido evaluada en Chile. Objetivo: Evaluar la adherencia a la suplementación con vitamina D en niños menores de un año y conocer los factores determinantes que intervienen en ella. Pacientes y Método: Estudio transversal en tres Centros de Salud pertenecientes a Red de Salud Universidad Católica. Se reclutaron lactantes menores de 1 año que recibían lactancia materna y se realizó una encuesta a sus tutores indagando sobre adherencia a la suplementación y factores determinantes de ésta. Resultados: Se reclutaron 170 lactantes. Recibían suplementación 164 de ellos, reportando buena adherencia en un 68,9%. La principal causa para no adherir fue el olvido materno. El factor de riesgo identificado para mala adherencia fue el número de hijos maternos. Conclusiones: La suplementación con vitamina D en Chile alcanza niveles altos, pero la adherencia a ésta es deficiente. Se necesita de mayor educación a los padres al respecto, reforzando maneras de evitar el olvido e identificando los factores de riesgo en todas las consultas médicas.
Subject(s)
Female , Humans , Infant , Male , Breast Feeding , Dietary Supplements , Vitamin D/administration & dosage , Vitamins/administration & dosage , Chile , Cross-Sectional Studies , Medication Adherence , Parents , Risk Factors , Surveys and QuestionnairesABSTRACT
From a clinical point of view, three dimensional quantitative computed tomography has not replaced dual energy X ray absortiometry (DEXA) as the test of choice to assess bone mass in adults and children. This is particularly true in postmenopausal osteoporosis and in patients without significant disturbances of body size. However, in particular diseases such as skeletal dysplasia, Turner syndrome and other endocrine diseases associated to stunting, QCT-3D can provide accurate information about bone health. It is also informative when the trabecular/cortical bone ratios are altered. QCT-3D is widely used for research purposes and it became available in Chile recently.
Subject(s)
Humans , Bone Density , Bone Diseases , Imaging, Three-Dimensional , Tomography, X-Ray Computed , Densitometry , Bone and Bones , Radiographic Image Interpretation, Computer-AssistedABSTRACT
Introducción: La insuficiencia suprarrenal primaria (ISRP) es producida por diversas etiologías, congénitas o adquiridas. Su sintomatología es poco específica, exigiendo un alto índice de sospecha. Objetivo: Presentación de dos casos clínicos y revisión de ISRP. Casos Clínicos: Dos niños de 9 y 6 años, ambos con astenia y adinamia, dolor abdominal, baja de peso y vómitos, con avidez por la sal, con mal estado general, lipotimia, hiperpigmentación de piel y mucosas. Se confirmó el diagnóstico de ISRP con compromiso en la secreción de cortisol, y mineralocorticoides. Ambos tuvieron anticuerpos antiadrenales positivos. Conclusiones: La ISRP es poco frecuente en pediatría, sin embargo, es potencialmente de riesgo vital, de manera que reconocer precozmente sus síntomas permitirá realizar un diagnóstico y tratamiento oportuno.
Subject(s)
Male , Child , Humans , Addison Disease/diagnosis , Addison Disease/immunology , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/immunology , Autoimmunity , Abdominal Pain/immunology , Hyperpigmentation/immunology , Adrenal Insufficiency/complications , Reference ValuesABSTRACT
The study of endocrine emergencies in childhood is important due to their high mortality and residual morbidity, that can be reduced with an adequate diagnosis and/or therapy. In this article, we review hypoglycemia, adrenal crisis, hypocalcemia, hypercalcemia and thyroid storm in children, with focus on initial diagnostic approach and management.
Subject(s)
Child , Child, Preschool , Humans , Infant , Infant, Newborn , Adrenal Insufficiency/diagnosis , Hypercalcemia/diagnosis , Hypocalcemia/diagnosis , Hypoglycemia/diagnosis , Thyroid Crisis/diagnosis , Acute Disease , Adrenal Insufficiency/etiology , Adrenal Insufficiency/therapy , Age Factors , Calcium/blood , Emergencies , Hypercalcemia/etiology , Hypercalcemia/therapy , Hypocalcemia/etiology , Hypocalcemia/therapy , Hypoglycemia/classification , Hypoglycemia/therapy , Severity of Illness Index , Thyroid Crisis/physiopathology , Thyroid Crisis/therapyABSTRACT
La osteoporosis es una enfermedad cada día más frecuente en el niño, debido al aumento del diagnóstico y tratamiento de enfermedades crónicas, tanto genéticas como adquiridas. Se requiere un alto nivel de sospecha para un diagnóstico precoz y manejo preventivo. Se revisan los conceptos actuales en el enfrentamiento clínico, interpretación adecuada de las herramientas de laboratorio bioquímico y radiológico, y tratamientos específicos, reportando la experiencia local.
Subject(s)
Humans , Child , Bone Density , Bone Development , Bone and Bones/metabolism , Osteoporosis/diagnosis , Osteoporosis/etiology , Osteoporosis , Osteoporosis/prevention & controlABSTRACT
Background: Chronic diseases in children may determine limited sun exposure, use of drugs, and other risk factors of osteopenia. Objective: to evaluate vitamin D deficiency and their risk factor, in children with chronic diseases with suspected osteopenia. Methods: We measured bone mineral density, bone remodeling markers, calcium, phosphate, parathormone, and 25 hydroxyvitamin D levels, and wrist X-ray. Results: We found 8 children of 25 with suspected osteopenia, with biochemical abnormalities suggestive of vitamin D deficiency. All children had low levels of 25 hydroxyvitamin D, 5 had reduced bone mineral density, 4 had hyperparathyroidism, 2 had hyperphosphatasemia, and 1 hypocalcemia and hypophosphatemia. None had rickets. Discussion: Osteopenia in chronic sick children is due to multiple factors; however, vitamin D deficiency is a preventable disorder. We recommend that all children with a chronic disease with risk factors for vitamin D deficiency should be monitored with 25 hydroxyvitamin D serum levels
Subject(s)
Humans , Adolescent , Child, Preschool , Child , Vitamin D Deficiency , Bone Diseases, Metabolic , Anticonvulsants , Epidermolysis Bullosa/complications , Osteoporosis , Arthritis, Rheumatoid , Vitamin D Deficiency , Bone Diseases, Metabolic , 25-Hydroxyvitamin D 2 , Densitometry , Hydroxycholecalciferols , Chronic DiseaseABSTRACT
Background: The early diagnosis and therapy of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency can prevent adrenal crises and erroneous gender assignment in affected newborns. To achieve this goal neonatal mass-screening programs have been developed, measuring blood 17 alpha-hydroxyprogesterone (17OHP). In Chile there is no experience with this type of screening. Aim: To develop a method for measuring 17OHP in filter paper blood specimens. To obtain reference ranges and determine neonatal 17OHP threshold levels according to gestational age and birth weight. To analyze factors affecting the cost-efficiency ratio and suggest recommendations for the organization of a neonatal screening program for CAH in Chile. Material and methods: Nine hundred twenty two newborns were studied. 17OHP was measured using double antibody radioimmunoassay in filter paper blood samples obtained 48 h after birth. Reference ranges were determined according to gestational age and birth weight and a cutoff point of 25 ng/ml was established. Results: Seventeen newborns had 17OHP over the cutoff value. They were assessed by a pediatric endocrinologist and in none of them, CAH was confirmed. Therefore the false positive rate of the determination was 1.8 percent. Among these newborns with elevated 17OHP, 66 percent had a birth weight below 1.5 kg and 5.8 percent, a birth weight between 1.5 and 2.5 kg. The cost per reported result was US $ l. Timing of the recall was between the 3 and 10 days of life. No newborn missed the follow-up. Discussion: To increase the cost-efficiency ratio of an eventual neonatal screening program, newborns with birth weights below 1.5 kg should be excluded and cutoff points should be defined according to birth weight
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , 17-alpha-Hydroxyprogesterone/blood , Adrenal Hyperplasia, Congenital/diagnosis , Pregnancy Complications/diagnosis , Birth Weight , Gestational Age , 17-alpha-Hydroxyprogesterone/metabolism , Prenatal DiagnosisSubject(s)
Humans , Thyroid Gland/physiology , Thyroid Diseases/classification , Thyroid Hormones/pharmacology , Thyroid Gland/anatomy & histology , Goiter , Graves Disease/etiology , Hypothyroidism , Pregnancy Complications , Thyroid Neoplasms , Thyroid Nodule , Thyroiditis, Autoimmune/etiology , Thyroiditis/immunology , ThyrotoxicosisSubject(s)
Humans , Male , Female , Adolescent , Puberty/physiology , Disorders of Sex Development/classification , Psychosexual Development/physiology , Puberty, Delayed/etiology , Puberty, Delayed/drug therapy , Puberty, Precocious/diagnosis , Puberty, Precocious/drug therapy , Puberty, Precocious/etiology , Disorders of Sex Development/drug therapyABSTRACT
Los macroprolactinomas son raros en niños y adolescentes. En adultos el tratamiento con bromocriptina (BC) ha sido exitoso. Existe escasa información en relación a su uso en edad pediátrica. Se describen tres casos de adolescentes con macroprolactinomas, tratados con bromocriptina, dos mujeres de 14 y 17,6 años con amenorrea, galactorrea, cefalea y un varón de 18 años con retardo del crecimiento y el desarrollo puberal, hipotiroidismo y déficit de hormona de crecimiento. Todos tenían hiperprolactinemia (>150 ng/ml) y tumor selar mayor de 10 mm. Después de tratamiento con bromocriptina se consiguió en dos de ellos prolactinemia normal y desaparición completa del tumor. Una de las niñas respondió sólo parcialmente al tratamiento. La bromocriptina es pues un tratamiento efectivo, aún en pacientes con deterioro del campo visual e hipopituitarismo y como en adultos, debería ser considerada el tratamiento de primera elección en adolescentes con macroprolactinomas
Subject(s)
Humans , Male , Female , Adolescent , Bromocriptine/administration & dosage , Pituitary Neoplasms/drug therapy , Prolactinoma/drug therapyABSTRACT
Se presenta el caso clínico de una paciente de 51 años, ingresada al Servicio de Ginecología del Hospital Van Buren de Valparaíso, con el diagnóstico de tumor mamario derecho, observación: cáncer de mama inflamatorio, a la cual se procedió a efectuar una cuadrantectomía mamaria, enviándose la pieza operatoria a estudio, revelando posteriormente la histopatología la presencia de un cisticerco (Cisticerco. Forma larvaria del parásito Taenia Solium) rodeado de reacción inflamatoria en la glándula mamaria. Se presenta este caso clínico por su extrema rareza, al ser ésta una ubicación no descrita anteriormente en los casos de esta histoparasitosis. Se investigó otras posibles localizaciones de cisticercosis, estudio que resultó negativo