Anomalías metabólicas en las nefrolitiasis: manejo clínico y tratamientos en una población pediátrica hospitalaria

RESUMEN Introducción: La litiasis urinaria en los niños es multifactorial y con tendencia a recurrir. Las anomalías metabólicas son factores de riesgo importante. Objetivo: Describir las anomalías metabólicas, el manejo clínico y el tratamiento de la nefrolitiasis en una población pediátrica. Materiales y métodos: Estudio observacional descriptivo de corte transverso retrospectivo. Por muestreo de casos consecutivos fueron incluidos pacientes de 0 a 18 años del Servicio de Nefrología Pediátrica del Hospital General Pediátrico Niños de Acosta Ñu en el periodo de enero del 2020 a diciembre del 2021, con diagnóstico de nefrolitiasis, Variables: datos demográficos, estado nutricional, sintomatología, presencia de factores de riesgo y resultado del estudio de anomalías metabólicas. Los datos fueron recogidos en un formulario de Google y analizados en con el SPSSv21, utilizando estadísticas descriptivas. El protocolo fue aprobado por el comité de ética de la investigación con liberación del consentimiento informado. Resultados: Fueron incluidos 112 pacientes con edad mediana de 13 años, el 61,6% de sexo femenino, los síntomas más frecuentes fueron dolor lumbar, abdominal y hematuria. En 54,5% (n=61) se realizó el estudio metabólico. Se detectó anomalías metabólicas en el 90% (55/61). Las más frecuentes fueron la combinación de hipocitraturia e hipomagnesuria (34,4%). El tratamiento consistió en medidas dietéticas e individualizado de acuerdo a las anomalías detectadas. Conclusiones: La frecuencia de anomalías metabólicas en los pacientes sometidos a estudio fue del 90%. Las más frecuentes fueron la combinación de hipocitraturia e hipomagnesuria. El tratamiento consistió en medidas dietéticas y tratamiento específico de las anomalías detectadas.

ABSTRACT Introduction: Urolithiasis in children is multifactorial and tends to recur. Metabolic abnormalities are important risk factors. Objective: To describe the metabolic abnormalities, clinical management, and treatment of nephrolithiasis in a pediatric population. Materials and methods: This was a retrospective, cross-sectional, descriptive and observational study, performed by sampling of consecutive cases. Patients aged 0 to 18 years with a diagnosis of nephrolithiasis from the Pediatric Nephrology Service of the Children's General Pediatric Hospital of Acosta Ñu were included during the period from January 2020 to December 2021. Variables: Demographic data, nutritional status, symptoms, presence of risk factors and results of the study of metabolic abnormalities. The data was collected in a Google form and analyzed with SPSSv21, using descriptive statistics. The protocol was approved by the research ethics committee with the release of informed consent. Results: A total of 112 patients were included with a median age of 13 years, 61.6% female, the most frequent symptoms were lumbar and abdominal pain and haematuria. In 54.5% (n=61) metabolic studies were performed. Metabolic abnormalities were detected in 90% (55/61). The most frequent were the combination of hypocitraturia and hypomagnesuria (34.4%). The treatment consisted of individualized dietary measures, according to the abnormalities detected. Conclusions: The frequency of metabolic abnormalities in the patients studied was 90%. The most frequent were the combination of hypocitraturia and hypomagnesuria. The treatment consisted of dietary measures and specific treatment of the abnormalities detected.

Effect of Modified Cangfu Daotantang on Metabolism and Pregnancy in Patients with Polycystic Ovary Syndrome / 中国实验方剂学杂志

Objective:To observe the effect of modified Cangfu Daotantang on metabolism and pregnancy in patients with spleen deficiency and phlegm-dampness type polycystic ovary syndrome （PCOS）. Method:One hundred and twelve patients were randomly divided into control group and observation group according to the random number table. Both groups took non-pharmacological interventions， oral metformin hydrochloride， 500mg/time， 3 times/day； oral ethinyl estradiol and cyproterone tablets， 1 tablet/time， 1 time/day， starting from the third to fifth day of menstruation and lasting for twenty-one days， for a total of 3 menstrual cycles. Patients in control group additionally took Erchen pills orally， 10 g/time， 2 times/day， while patients in observation group additionally took modified Cangfu Daotantang orally， 1 dose/day. The course of treatment was six menstrual cycles in both groups （or termination after conception）. The waist-to-hip ratio （WHR）， body mass index （BMI）， insulin resistance index （HOMA-IR）， pancreatic <italic>β</italic>-cell function （HOMA-<italic>β</italic>）， triglycerides （TG）， low-density lipoprotein （LDL） and non-high-density lipoprotein （nHDL） elevation after treatment were compared. The number of ovulation cycles monitored by B-ultrasound （6 menstrual cycles）， ovulation rate， human chorionic gonadotropin （HCG） day endometrial thickness， follicle diameter， cervical mucus score>8 points and endometrial morphology type A rate were measured and recorded. The recovery of menstruation， pregnancy and early miscarriage were recorded. Luteinizing hormone （LH）， estradiol （E₂）， follicle stimulating hormone （FSH）， dehydroepiandrosterone sulfate （DHEAS）， testosterone （T）， anti-Müllerian hormone （AMH） levels， and insulin before and after treatment -Like growth factor-1 （IGF-1）， leptin （LP）， adiponectin （APN）， growth differentiation factor-9 （GDF-9） and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） levels were detected. Result:WHR， BMI and HOMA-IR levels of the observation group were lower than those of the control group （<italic>P</italic><0.05， <italic>P</italic><0.01）. HOMA-<italic>β</italic> level was higher than that in the control group （<italic>P</italic><0.01）. The increase rates of LDL， TG， and nHDL in the observation group were 19.61%（10/51），25.49%（13/51），23.53%（12/51）， respectively， lower than 41.18%（21/51），47.06%（24/51），45.10%（23/51）respectively in the control group （<italic>χ</italic>²=5.607， <italic>χ</italic>²=5.131， <italic>χ</italic>²=5.263， <italic>P</italic><0.05）. The menstrual recovery rate in the observation group was 90.20% （46/51）， higher than 72.55% （37/51） in the control group （<italic>χ</italic>²=5.239，<italic>P</italic><0.05）. The observation group had more ovulation cycles than the control group （<italic>P</italic><0.01）. The pregnancy rate in the observation group was 50.98% （26/51）， higher than 31.37% （16/51） in the control group （<italic>χ</italic>²=4.047，<italic>P</italic><0.05）. On HCG day after treatment， the endometrial thickness and follicle diameter in the observation group were better than those in the control group （<italic>P</italic><0.01）. The proportion of patients with cervical mucus score> 8 points was 78.43% （40/51） in the observation group， higher than 56.86% （29/51） in the control group （<italic>χ</italic>²=5.420，<italic>P</italic><0.05）. The intimal morphology type A rate in the observation group was 52.94% （27/51）， higher than 31.37% （16/51） in the control group （<italic>χ</italic>²=4.864，<italic>P</italic><0.05）. The levels of AMH， E₂， DHEAS， LH， T ， IGF-1， LP and TNF-<italic>α</italic> in the observation group were lower than those in the control group （<italic>P</italic><0.01）， while the APN and GDF-9 levels were superior to those in the control group （<italic>P</italic><0.01）. Conclusion:On the basis of conventional western medicine intervention， modified Cangfu Daotantang can regulate abnormal metabolism and reproductive endocrine in patients with PCOS， improve conception， and regulate the expression of IGF-1， GDF-9， adipocytokines and inflammatory factors， improve ovulation and improve pregnancy rate.

Evaluating the effects of Moringa oleifera on atherogenic lipoprotein indices of HIV infected Nigerian adults on tenofovir-based antiretroviral regimen

Background: The administration of tenofovir (TDF) based (tenofovir/ lamivudine/efavirenz) antiretroviral regimen for the management of HIV has remained a concern to both clinicians and patients, thus necessitating the need for suitable supplement for the management of ART induced metabolic abnormalities. The study evaluated the effects of Moringa supplementation on the atherogenic lipoprotein indices of HIV patients on TDF-based regimen at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.Methods: The study was designed as a time dependent investigation structured into 3 visits, visit 1 (cross sectional, baseline), visit 2 (4 weeks after administration) and visit 3 (12 weeks post administration). Subjects recruited (140) into this study comprised of two groups, TDF-M (n=56, administered Moringa Supplement) and TDF-NM (n=84, no supplement).Results: At baseline, more than 50% of the patients had at least one abnormal atherogenic lipoprotein indices (Log (TC/HDL-C) = 85.7%, TC/HDL-C=58.5% and LDL-C/HDL-C=51.4%), although at lower limits. At the end of 12 weeks of Moringa supplement administration, the results showed subjects in the TDF-M group who were at risk of CVD had fallen to 20%, indicating a dramatic (40.4%) decrease, while the prevalence of TDF-NM subject at risk of CVD rose to 53.6% (?2=26.67, P <0.001). HIV patients on TDF-based regime, who were at risk of CVD had elevated triglycerides and low-density lipoprotein cholesterols which inversely affected the levels of high-density lipoprotein and negatively impacting the atherogenic indices.Conclusions: Moringa oleifera supplementation may be helpful in ameliorating the metabolic abnormalities associated with HIV patients on TDF-based regimen.

Pathogenesis of diabetic cognitive dysfunction and intervention by traditional Chinese medicine / 中国药理学通报

Diabetic cognitive dysfunction (DCD) is a common chronic complication of diabetes mellitus with sophisticated path-ogenesis which has not yet been fully elucidated. In this review paper, the mechanisms of metabolic abnormalities, insulin re-sistance,endoplasmic reticulum stress,neuronal calcium dysho-meostasis, in ammation, blood brain barrier impairment, and mitochondrial injury associated with DCD are reviewed. In addi-tion,the prevention and treatment of DCD by traditional Chinese medicines (TCMs) and the effective compounds are comprehen-sively summarized, in order to provide an updated overview on the DCD pathogenesis,as well as the scientific evidence under-pinning the use of TCM interventions for the treatment and pre-vention of DCD.

Association of serum homocysteine levels with metabolic syndrome and its components in adults / 中华临床营养杂志

Objective To explore the relationship of serum homocysteine ( Hcy) level with metabolic syndrome (MS) and its components.Methods A cross-sectional study was conducted in 594 adults consec-utively sampled from people visiting Fuwai Hospital for physical examination between September and Decem-ber 2012, including 160 MS participants (MS group) and 434 without MS participancs (without MS group). Serum Hcy levels, serum biochemical parameters, and anthropometric measurements of all the participants were collected.Binary logistic regression was used to assess the association of serum Hcy levels with MS and its components.Results No significant difference in Hcy levels was observed comparing the MS group and the without MS group [(12.2 ±7.0) μmol/L vs.(12.6 ±8.4) μmol/L, P>0.05].Between participants with and without hyperhomocysteinemia (≥15 μmol/L vs.0.05).Among participants having 0 to 5 metabolic abnormalities, there were no significant differences in ser-um Hcy levels [ (12.3 ±7.4) μmol/L; (12.4 ±6.7) μmol/L; (13.2 ±11.2) μmol/L; (12.5 ± 7.8) μmol/L; (11.2 ±2.7) μmol/L; (12.4 ±4.3) μmol/L; all P>0.05].In a binary logistic re-gression model adjusted for age, gender, body mass index, total cholesterol, low-density lipoprotein choles-terol, and high-sensitivity C-reactive protein, neither MS nor its components were independent predictors of serum Hcy levels ( all P>0.05 ) .Conclusions Elevated serum Hcy levels are not associated with MS or its components in people without evident cardiovascular diseases .MS and elevated serum Hcy levels may cause cardiovascular diseases via different mechanisms .

The screening and treatment of abnormal glucose metabolism during pregnancy / 中国基层医药

Objective To screen the abnormal glucose metabolism in pregnant women without diabetes and to give early intervention to reduce perinatal maternal and fetal adverse complications.Methods 2 579 pregnant women who received obstetric examination and revealed no diabetes,underwent GCT screening and OGTr reexamination.The results confirmed the 263 GIGT patients,22 GDM patients.They were givien intervention therapy until delivery and their pregnancy outcome was compared with the normal pregnant women.Results The pregnancy outcome of GIGT pregnant women received intervention and the normal pregnant women had no significant difference.The incidence rates of macrosomia and cesarean section in GDM group were higher than those of normal pregnant women (P ＜0.05,P ＜ 0.01).Conclusion Development of gestational abnormal glucose tolerance screening is important to the early diagnosis and intervention of potential IGT,GDM patients,which can significantly reduce the incidence rate of maternal and fetal adverse complications.

Analysis of the incidence of different metabolic abnormalities and cardiovascular in hospitalized hypertension patients / 中国基层医药

Objective To investigate the epidemiological characteristics of hospitalized hypertension patients with different metabolic abnormalities associated with cardiovascular disease.Methods 1 843 patients with diagnosis of hypertension were selected,including 327 patients with metabolic syndrome as the research object.Metabolic syndrome of different age,gender,abnormal components epidemic status were analyzed.Results Positive rates of overweight,dyslipidemia,hyperglycemia,cardiovascular disease in 327 patients were 42.20％,37.92％,35.17％,71.25％,the highest positive rate for cardiovascular disease was significantly higher than the other three indexs(x2 =56.22,73.28,85.51,all P ＜ 0.05).There was no significant differences in the rates of overweight between men and women (x2 =0.42,P ＞ 0.05).Dyslipidemia and hyperglycemia incidence of women were significantly more than those of men,there was statistically significant difference (x2 =5.73,6.47,all P ＜ 0.05).The incidence of cardiovascular disease in males was high than that in females (x2 =24.66,P ＜ 0.05).Conclusion Preventive different metabolic abnormalities need to take different measures according to age and gender.Weight control,blood lipids and blood sugar are the key to the prevention of cardiovascular disease.

Monitoring and managing metabolic syndrome in persons with mental illness: the case for

Background: Metabolic syndrome is a constellation of risk factors that enhance the risk for coronary artery disease,cardiovascular accident, and diabetes mellitus. Persons with severe mental illness have a higher risk for metabolic syndrome,particularly when they are treated with certain antipsychotics.Objective: We appraise the metabolic syndrome in persons with mental illness and suggest lines for future research.Conclusions: Metabolic disturbances are common in patients with a psychotic illness, especially when maintained onantipsychotic medications, yet regular monitoring and management of these adverse effects remain below acceptablelevels. There are many gaps in our understanding of the causes and predictors of the syndrome in psychiatric patients, yetwe argue that there are sufficient reasons why mental health clinicians should monitor metabolic problems in their patientsand facilitate appropriate therapeutic interventions. We outline strategies that could usefully be adopted by services tothis end.

Multiple correspondence analysis on multiple metabolic abnormalities and family history in adults / 中华流行病学杂志

Objective To investigate the relationship between phenomenon of aggregation on multiple metabolic abnormalities and their family history.Methods A random cluster sampling was carried out to study the phenomenon of multiple metabolic abnormalities among the adult inhabitants in a county of Henan province.Questionnaire,physical examination and biochemical tests were admitted.Multiple correspondence analyses were used to explore the aggregation of multiple metabolic abnormalities among objects including hyperlipidemia,diabetes,coronary heart disease etc.Corresponding relationships between objects and their parents on multiple metabolic abnormalities were also analyzed.Results In total,3901 people were investigated including 1428 (36.6％) males and 2473 (63.4％) females.The mean age of them was 32.8 ± 6.3.Data showed that the Cronbach' s α were 0.547 and 0.387 while Eigen values were 1.971 and 1.535 in two dimensions,regarding the correspondence analysis on their parents' multiple metabolic abnormalities.Cronbach' s α levels were 0.598 and 0.457 together with Eigen values as 2.263 and 1.743 in two dimensions on the correspondence analysis of the objects' and their parents' multiple metabolic abnormalities.Results from Multiple correspondence analysis diagrams showed that there was an aggregation of varietymetabolic abnormalities in both objects and their parents but not between objects and their parents or between fathers and mothers,though x2 test showed a weak correlation between some of the categories.The ranges of contingency coefficients between metabolic abnormalities were 0.04 to 0.11,0.04 to 0.08 and 0.04 to 0.11 between parents,objects and fathers,objects and mothers,respectively.When compared with simple obesity,the central obesity aggregated appeared more obviously with other metabolic abnormalities.Conclusion Both objects and their parents showed an aggregation of variety metabolic abnormalities.Aggregation of central obesity showed more obvious on other metabolic abnormalities than the simple obesity.Family histories of metabolic abnormalities played a moderate role in the generations suffering from multiple metabolic abnormalities.

Relationship between fasting plasma glucose in early pregnancy and gestational glucose metabolic disorders / 中华围产医学杂志

Objective To investigate the relationship between early pregnancy fasting plasma glucose (FPG) and gestational glucose metabolism disorders. Methods Six hundred and fifty-six pregnant women who were singleton, non-diabetes before pregnancy and had FPG examined during 5-13 weeks of pregnancy were admitted into this study from January 1, 2009 to May 31, 2009. All these subjects had routine prenatal examination and finally delivered in the Department of Obstetrics of Peking University First Hospital. The FPG, 50 g glucose challenge test (GCT) after 24 weeks of pregnancy, 75 g oral glucose tolerance test (OGTT), gestational diabetes mellitus (GDM),gestational impaired glucose tolerance (GIGT) were analyzed with receiver operating characteristic (ROC) curve. Results (1) Relationship between FPG and GCT were analyzed with ROC curve.The maximum area under curve was 0. 539 (95% CI: 0. 493-0. 586) and there was no correlation between the FPG and GCT results(P=0. 057). (2) Relationship between early pregnancy FPG and abnormal FPG examined after 24 gestational weeks were also analyzed . The maximum area under curve was 0. 796(95% CI: 0. 672-0. 920). If 5. 05 mmol/L was taken as the cutoff value, the sensitivity and specificity was 54. 5% and 83. 2%, respectively. There was significant relationship between the two values (r=0. 432, P=0. 000). (3) There were no relationship between early pregnancy FPG and the blood glucose value of 1, 2 and 3 h in 75 g OGTT (r=0. 093, 0. 036 and 0. 107, P=0.122, 0. 549 and 0. 074 respectively). OGTT 0 h value was positively related to OGTT 1, 2 and3 h glucose level (r=0.493, 0.421 and 0.368, P=0.000, respectively). (4) All early pregnant FPG values in this study were under 6.1 mmol/L. Twenty-two GDM and 27 GIGT patients were diagnosed in this study. Early pregnancy FPG did not relate to the GDM and GIGT diagnosis.Conclusions Early pregnancy FPG could not replace 50 g GCT as an early screening for glucose metabolic abnormality in pregnancy, but FPG during early pregnancy is necessary.

Cutoff of Percent Body Fat to Predict Obesity and Metabolic Risk in Children and Adolescents: 2007 Children and Adolescent Physical Growth Standard / 가정의학회지

BACKGROUND: Body mass index (BMI) for gender and age and percentage-weight-for-height (PWH) for gender and height have been frequently used to diagnose childhood obesity. However, few studies have examined the optimal cutoff of percent body fat (%BF) to predict metabolic abnormalities in obese children. METHODS: One thousand fifteen obese children aged 10 to 15 years were enrolled in this study. The %BF cutoff values were calculated by ROC analysis for metabolic abnormalities. We also calculated %BF cutoff values corresponding to a BMI of > 85th or 95th percentile for gender and age and a PWH of > 120% for gender and height based on the 2007 Korean children and adolescents growth standard chart. To define metabolic abnormalities in children, we used the criteria of metabolic syndrome recommended by International Diabetes Federation consensus for children and adolescents. RESULTS: The %BF cutoff corresponding to the group having more than one metabolic abnormality in this study population were 38.4% (sensitivity 40.1%, specificity 84.4%) in total, 38.4% (sensitivity 35.4%, specificity 84.8%) in boys and 39.5% (sensitivity 38.9%, specificity 90.9%) in girls. The %BF cutoff values corresponding to a BMI > or = 95 percentile were 38.1% (sensitivity 50.5%, specificity 72.7%), a BMI > or = 85 percentile were 34.5% (sensitivity 69.3%, specificity 74.2%), and a PWH > or = 120% were 36.4% (sensitivity 72.3%, specificity 64.4%) in total. CONCLUSION: The optimal cutoff value of percent body fat to predict metabolic abnormalities in obese children may be 38.4% (boys 38.4, girls 39.5%) and we suggest 34.5% as a cutoff value of %BF for screening childhood obesity.

Anormalidades metabólicas en la deficiencia de la hormona de crecimiento / Metabolic Abnormalities in growth hormone deficiency

Increased cardiovascular morbidity and mortality has been reported in adult subjects with growth hormone deficiency (GHD). Long term follow up of a large cohort of patients with adult onset GHD, suggests that GH therapy may contribute to a reduced risk of nonfatal stroke, particularly in women and in a decline in nonfatal cardiac events in GHD men(1,2). Adult hypopituitary patients with untreated growth hormone deficiency have been shown to have a cluster of cardiovascular risk factors such as increased visceral adiposity, disturbances in lipoprotein metabolism, premature atherosclerosis, impaired fibrinolytic activity, increased peripheral insulin resistance, abnormal cardiac structure, impaired cardiac performance and endothelial dysfunction (3,4). Several of these risk factors have now been confirmed in double blind, randomized, placebo controlled trials (5,6). Metabolic changes in GH deficient children and adolescents have been evaluated only quite recently and superficially. In this article we will discuss these metabolic abnormalities and their underlying mechanism in untreated GHD subjects and we will review the beneficial effect of growth hormone therapy in adults, adolescents and children with GHD.

Se ha reportado un aumento en la morbilidad y mortalidad de pacientes adultos con deficiencia de la hormona de crecimiento (DHC). El seguimiento a largo plazo de una cohorte de pacientes con DHC sugiere que la administracion de hormona de crecimiento puede contribuir a una reducción en el número de los accidentes cerebrovasculares no fatales, particularmente en mujeres y de eventos cardíacos en hombres(1,2). Pacientes adultos con hipopituitarismo y una DHC cursan con un acúmulo de factores de riesgo cardiovascular tales como un aumento en la adiposidad visceral, alteraciones en el metabolismo lipoproteico, ateroesclerosis prematura, actividad fibrinolítica alterada, resistencia a la insulina, masa y función cardíaca alterada y disfunción endotelial (3,4). Varios de estos factores de riesgo han sido comprobados en estudios doble ciego, randomizados con placebo (5,6). Las alteraciones metabólicas en niños y adolescentes deficientes de hormona de crecimiento han sido evaluadas sólo recientemente y de manera aún superficial. En este manuscrito discutiremos estas anormalidades y los mecanismos etilógicos subyacentes en sujetos DHC no tratados y revisaremos el efecto beneficioso de la terapia con hormona de crecimiento en niños, adolescentes y adultos.

Medical diagnosis and treatment of polycystic ovary syndrome / 대한내과학회지

No abstract available.

MR Imaging of Medullary Streaks in Osteosclerosis: A Case Report

We present a case of medullary sclerosis of the appendicular skeleton in a patient with chronic renal insufficiency for whom MR imaging findings were char-acteristic. T1- and T2-weighted MR images showed multiple vertical lines (medullary streaks) of low signal intensity in the metaphyses and diaphyses of the distal femur and proximal tibia.

Analysis of the combination of impaired glucose tolerance and metabolic abnormalities and its outcome in geriatric patients / 中华内分泌代谢杂志

Objective To analyze the combination of impaired glucose tolerance (IGT) and metabolic abnormalities and its outcome in geriatric population. Methods 75goral glucose tolerance test (OGTT), blood lipid profile, blood uric acid and urinary albumin excretion rate were determined in 1059 geriatric cases with IGT and followed up every 2 years. Results Among 1059 cases with IGT followed up for 8 years, 222 cases deterioratedintodiabetesmellitus(DM)(21.0%),47casesreversedto normal glucose tolerance (NGT, 4.4%),and 790 cases remained IGT (74.6%). From NGT to IGT to DM,body mass index, systolic blood pressure, plasma glucose after loading (including postprandial 2 h glucose, 1 h and 2 h plasma glucose of OGTT) were gradually increased in baseline (P