Reference intervals for serum TSH concentrations of healthy children from the Central Region of Brazil

ABSTRACT Objective: The objective of this study was to determine the serum thyroid-stimulating hormone (TSH) concentration reference intervals (RIs) of healthy children aged 1 to 10 years of both sexes, living in the Central Region of Brazil. Subjects and methods: 1,735 children [869 (50.1%) female; 866 (49.9%) male] enrolled in the morning shift of 47 pre- and 83 public elementary schools in the municipality of Cuiabá, Mato Grosso, were studied by gathering anthropometric and social data and their medical history. A blood sample was collected from each child to determine the TSH concentration using the electrochemiluminescence method on a Cobas® 6000 modular analyzer (Analyzer series, Roche Diagnostics). Results: The RIs were determined using the 2.5 and 97.5 percentile and the mean ± 2 standard deviations methods. After identifying the homoscedastic groups by age and sex, outliers higher or lower than three standard deviations were excluded. The distribution of serum TSH concentrations showed no significant age or sex differences. Based on the percentile method, TSH RI ranged from 0.93 to 5.86 μIU/mL. Based on the mean ± 2 standard deviations, TSH RI ranged from 0.30 to 5.29 μIU/mL. Conclusion: The normal serum TSH concentration of the Brazilian children evaluated in this study differ from those of populations from other countries. Other regional population studies may validate the RIs found in this study and enable its safer use in pediatric clinical practice.

Seroprevalence of Toxoplasma gondii Infection in Children With Visual and/or Hearing Disability in Comparison With Healthy Children in Iraq

@#Introduction: Infection with Toxoplasma gondii is very prevalent in Iraq. The aim of this study was to determine the seroprevalence of T. gondii infection among children with visual, hearing or both disabilities (VHDC) and among healthy children (HC) living in Diyala and Baghdad provinces in Iraq. Methods: For this study, 100 VHDC children (attending the Al-Amal Centers for Blind, Dumb and Deaf Children) and 100 age-matched healthy children were recruited. Blood was obtained from all disabled and healthy children and the sera were examined for the presence of the specific antibodies (IgG and IgM) of T. gondii. Results: Among VHDC children, the seropositivity of IgG antibodies (24.0%) was significantly higher (OR= 7.6; 95% CI= 2.5-22.8; P= 0.0003) than that in HC children (4.0%). Disabled boys (OR= 5.7; P= 0.009) and disabled girls (OR= 12.7; P= 0.0183) showed significantly higher seropositivity than healthy children. The greatest risk was in disabled children who are their mothers had one or more abortion (OR= 6.89; P= 0.0005), followed by children who have brother or sister with visual and/or hearing disabilities (OR= 5.6; P= 0.0039), children whose their mothers got infection during pregnancy (OR= 2.9; P= 0.0256), and then children whose their mothers have taken treatment (OR= 2.9; P= 0.0256). The presence of stray cats in the houses was identified as a risk factor (OR= 4.05; P= 0.0186). Conclusion: In children with visual and/or hearing disabilities, the seropositivity of IgG antibodies was significantly higher than that in healthy children.

Serum Vitamin A Content among Malnourished and Healthy Children in Kisangani City, DRC

Summary: Vitamin A is an essential micronutrient needed by the body for various physiological functions. Its deficiency is associated with several functional disorders. The objective of this study is to determine blood vitamin A levels in malnourished and healthy children. Methods: It is a cross-sectional analytical study, consisting of determining the vitamin A content in the blood of children suffering from malnutrition and those in good nutritional status. Our sampling was casual and 59 children aged 6 to 59 months were retained. Among them 30 healthy children chosen from those attending preschool consultation at U HC and 29 malnourished children from those followed at M TNU for the management of malnutrition. The serum vitamin A assay was performed according to the method described by Tietz. Children with serum vitamin A level below 30 μg / 100 ml had vitamin A deficiency and those with a serum level greater than or equal to 30 μg / 100 ml had good vitamin A status. Percent, average and standard deviation calculations were performed. The Chi square statistical test was used to compare serum vitamin A content in healthy and malnourished children, as well as other maternal parameters for a significance level of 0.05. Results: from 59 children examined, 30 or 50.8% were 6-17 months old, the average age was 21.9 ± 13 months. 45.7% had a serum retinol level between 50-59 μg/100 ml; the average value was 46.84 μg ± 14.27. The prevalence of VAD was 20.3% and this deficit was more marked in children aged 6-17 months that is 50% (P<0.014). Among 12 children with VAD, 10 or 83.3% were the wealthy and two were the malnourished, the difference was statically significant (P< 0.011). Conclusion: Vitamin A deficiency remains a major health problem in the DRC. This affect all children regardless of their current nutritional status. Supplementation with this vitamin remains one of the palliative solutions.

Hallazgos capilaroscópicos en niños sanos / Capillary findings in healthy children

RESUMEN En el niño, la microcirculación cutánea (MCC) experimenta cambios desde sus primeros días de vida hasta la adolescencia. Mediante la video capilaroscopia (VC), se puede acceder a la visualización in vivo e incruenta de la MCC, en niños de cualquier edad. El sitio de elección es el pliegue peri ungular de los dedos de las manos. Se observan las asas capilares, dispuestas en corona sobre la matriz peri ungular y el plexo vascular superficial. Los recién nacidos presentan una red primitiva. Posteriormente, evolucionaalcanzando alrededor de los 10 años, los parámetros similares al adulto.El conocimiento de los parámetros de la MCC preservada en niños,será de gran importancia en la exploración diagnóstica de las patologías que afectan este territorio vascular, como las enfermedades reumáticas.

SUMMARY The child's skin microcirculation (MCC) undergoes changes from the first days of life until adolescence. Through video capillaroscopy (VC), in vivo and non-invasive visualization of the CCM is accessed in children of any age. The site of the election is the nail fold of the fingers of the hands. The capillary loops arranged in a crown over the nail matrix and the superficial vascular plexus are observed. The newborns present a primitive network, which later evolves reaching around 10 years the parameters similar to the adult. There are structural differences in MCC if the findings in children are compared with those of adults. In children the capillary density per linear millimeter is lower, the tortuosity index is higher, the superficial vascular plexus is more visible and bizarre capillary forms are found Knowledge of the parameters of MCC preserved in children will be of great importance in the diagnostic exploration of pathologies that affect this vascular territory such as rheumatic diseases.

Prevalence of Fecal Carriage of CTX-M-15 Beta-Lactamase-Producing Escherichia coli in Healthy Children from a Rural Andean Village in Venezuela

OBJECTIVES: Antimicrobial resistant extended-spectrum-β-lactamase-producing Enterobacteriaceae (ESBL-PE) have been shown to be present in healthy communities. This study examined healthy children from the rural Andean village of Llano del Hato, Mérida, Venezuela, who have had little or no antibiotic exposure to determine the prevalence of fecal carriage of ESBL-producing Escherichia coli (ESBL-EC). METHODS: A total of 78 fecal samples were collected in healthy children aged from 1 to 5 years. ESBL-EC were selected in MacConkey agar plates with cefotaxime and further confirmed by the VITEK 2 system. ESBL were phenotypically detected and presence of bla genes and their variants were confirmed by molecular assays. Determination of phylogenetic groups was performed by PCR amplification. Risk factors associated with fecal carriage of ESBL-EC-positive isolates were analyzed using standard statistical methods. RESULTS: Of the 78 children studied, 27 (34.6%) carried ESBL-EC. All strains harbored the bla(CTX-M-15) allele. Of these, 8 were co-producers of bla(TEM-1), bla(TEM-5), bla(SHV-5) or bla(SHV-12). Co-resistance to aminoglycosides and/or fluoroquinolones was observed in 9 strains. 51.9% of ESBL-EC isolates were classified within phylogroup A. A significant, positive correlation was found between age (≥2.5 – ≤5 years), food consumption patterns and ESBL-EC fecal carriage. CONCLUSION: This is the first study describing the high prevalence of fecal carriage of ESBL-EC expressing CTX-M-15- among very young, healthy children from a rural Andean village in Venezuela with scarce antibiotic exposure, underlining the importance of this population as a reservoir.

Safety and Immunogenicity of an Egg-Cultivated Quadrivalent Inactivated Split-virion Influenza Vaccine (GC3110A) in Healthy Korean Children: a Randomized, Double-blinded, Active-controlled Phase III Study

BACKGROUND: The frequency with which the 2 B lineages have been found to cocirculate in a season has been on the rise, which has spurred the need for a quadrivalent influenza vaccine (QIV) to protect against both B lineages. The World Health Organization (WHO) recommended that QIV include both B lineages beginning in the 2013–2014 flu season. This study was conducted to evaluate the immunogenicity and safety of an egg-cultivated QIV in healthy Korean children and adolescents aged ≥ 6 months to < 19 years. METHODS: A total of 528 subjects were randomized 4:1 to receive either a QIV (GC3110A) or a trivalent influenza vaccine. Hemagglutination inhibition antibody responses were assessed 28 days after the last dose. Safety was also evaluated. RESULTS: The proportion of subjects in the GC3110A group who achieved seroconversion was confirmed to exceed 40% across all age groups. The proportion of subjects aged ≥ 6 months to < 3 years in the GC3110A group who achieved seroprotection failed to meet the Ministry of Food and Drug Safety (MFDS) standard of 70%. Potential causes may include the small number of subjects, as well as the small dosage. However, results pertaining to the other age groups satisfied the MFDS standard. The safety profile was also comparable to that of the control. CONCLUSION: The new quadrivalent split influenza vaccine may offer broader protection to children and adolescents aged ≥ 3 years to < 19 years of age against both influenza B lineages than the existing trivalent influenza vaccines (Registered at the ClinicalTrials.gov NCT02541253).

Isolation and analysis of genetic characteristics of a new strain of enterovirus EV-C99 from a healthy child in Yunnan Province / 中华微生物学和免疫学杂志

Objective To isolate and analyze the genetic characteristics of a new strain of entero-virus EV-C99 from a healthy child in Yunnan Province in 2016. Methods Virus isolation was performed ac-cording to the World Health Organization ( WHO) recommended procedures. Viral RNA was extracted from the supernatant of cell culture. RT-PCR and sequencing analysis of VP1 gene were used for virus identifica-tion. VP1 sequence was edited and stitched by Sequencher 5. 0 software. The edited sequence was BLAST searched in GenBank and the preliminary result indicated that it was an EV-C99 virus. Nucleotide (nt) and amino acid (aa) identities were calculated by MEGA5. 2 software. Serotype of the virus was identified ac-cording to the standard for enterovirus sequence typing. Results The virus could be amplified by 494/496 and 495/497 primer pairs and the edited sequence was about 1 200 bp. Result of the " BLAST" search showed that it was a new strain of enterovirus EV-C99. Comparative analysis with the prototype strain BAN00-10461 (GenBank ID:EF015008) by MEGA5. 2 software showed that the VP1 gene of that virus was 909 bp and the identities between them were 77. 05% in nt sequence and 90. 04% in aa sequence. According to the standard for enterovirus sequence typing,the virus was a new strain of enterovirus EV-C99 belonging to hu-man enterovirus species C (EV-C). Conclusion A new strain of enterovirus EV-C99 was isolated during an investigation of enteroviruses among healthy children in Yunnan Province in 2016. To our knowledge,this is the third report of EV-C99 in China. Phylogenetic analysis reveals that the EV-C99 Yunnan strain,Xinjiang strains and Shandong strains all belong to genotype B,but group into different clusters,indicating that Chinese strains have diverse genetic characteristics.

Valoración de la intervención de enfermería pediátrica para detectar alteraciones en el desarrollo de los infantes: revisión breve de literatura / Evaluation of the pediatric nursing intervention to detect alterations in the development of infants: brief literature review / Avaliação da intervenção de enfermagem pediátrica para detectar alterações no desenvolvimento das crianças: revisão breve de literatura

ResumenLa valoración del desarrollo pretende cuantificar el nivel de maduración alcanzado por un infante según las conductas esperadas para su edad, con el fin de detectar variaciones a la norma y establecer criterios individuales, razón por la que urge contar con un profesional de salud idóneo que la ejecute, de manera que se fortalezca la vigilancia del desarrollo en las consultas de niño sano en el primer nivel de atención. El método utilizado fue el de la enfermería basada en la evidencia, cuya intención es disponer de la mejor evidencia científica para responder a una pregunta clínica. En cuanto a los estudios, fueron recopilados de las bases de datos EBSCO, Web of Sciences, Science Direct y Pub Med. Los resultados de la búsqueda fueron delimitados según criterios de inclusión y exclusión. Posteriormente, se analizó los hallazgos a través de la herramienta FLC 2.0 y el grado de recomendación fue asignado según la Canadian Task Force on Preventive Health Care. Durante la fase de búsqueda, se obtuvo siete artículos que responden la pregunta PICO de manera parcial, sin embargo seis de ellos fueron eliminados según criterios de inclusión-exclusión, mientras que el artículo restante fue sometido a la lectura crítica, en la cual se obtuvo un nivel de evidencia media y un grado de recomendación I. El estudio analizado plantea la importancia de utilizar instrumentos validados para valorar el desarrollo y discute el rol de los profesionales de enfermería en el proceso de vigilancia del desarrollo. Se concluye que la evidencia se clasifica como de mediana calidad y no responde de manera directa a la pregunta clínica formulada, sin embargo, en el estudio se destaca la función del profesional de enfermería a cargo de la valoración y vigilancia del desarrollo infantil, aun cuando se plantea mejoras.

AbstractDevelopment assessment aims to quantify the level of maturity reached by the infant expected behaviors according to their age, allowing detect variations to the standard and set individual criteria. Which is why there is an urgent need of having the appropriate health professional for execution, so monitoring strengthen development in well-child visits at the primary care level. The method used was Evidence-Based Nursing, whose intention is to have the best scientific evidence to answer a clinical question posed. The studies were collected from databases: EBSCO, Web of Sciences, Science Direct and Pub Med. The search results were defined as inclusion and exclusion criteria. Subsequently, the findings were analyzed through the FLC 2.0 tool and the Canadian Task Force on Preventive Health Care assigned the grade of recommendation. During the research, were obtained seven articles that answered partially the question PICO, however six of them were eliminated by inclusionexclusion criteria. The other article was subjected to critical reading, in which an average level of evidence and grade of recommendation was obtained I. The study analyzed raises the importance of using validated for the assessment of development tools and discusses the role that owns the nurses in the monitoring process of development. The recovered evidence is classified as medium quality and does not respond directly to the clinical question way, however, in studying the role of the nurse in charge of the assessment and monitoring of child development stands out, even when raised improvements.

ResumoA avaliação do desenvolvimento pretende quantificar o nível de amadurecimento alcançado por uma criança segundo as condutas esperadas para sua idade, com o fim de detectar variações à norma e estabelecer critérios individuais, razão por que urge contar com um profissional de saúde idôneo que a execute, de manera que se fortaleça a vigilância do desenvolvimento nas consultas de crianças sadias no primeiro nível de atenção. O método utilizado foi o da enfermagem baseada na evidência, cuja intenção é dispor da melhor evidência científica para responder a uma pergunta clínica. Enquanto aos estudos, foram recopilados das bases de dados EBSCO, Web of Sciences, Science Direct e Pub Med. Os resultados da pesquisa foram delimitados segundo critérios de inclusão e exclusão. Posteriormente, se analisaram os resultados através da ferramenta FLC 2.0 e o grau de recomendação foi asignado segundo a Canadian Task Force on Preventive Health Care. Durante a fase de pesquisa, se obtiveram sete artigos que respondem a pergunta PICO de maneira parcial, no entanto seis deles foram eliminados segundo critérios de inclusão-exclusão, enquanto que o artigo restante foi submetido a leitura crítica, na qual se obteve um nível de evidência média e um grau de recomendação I. O estudo analisado coloca a importância de utilizar instrumentos válidos para avaliar o desenvolvimento e discute o rol dos profissionais de enfermagem no proceso de vigilância do desenvolvimento. Conclui-se que a evidência se classifica como de média qualidade e não responde de maneira direta a pergunta clínica formulada, no entanto, no estudo se destaca a função do profissional de enfermagem a cargo da avaliação e vigilância do desenvolvimento infantil, mesmo quando se estabelecem melhoras.

Frecuencia de colonización y sensibilidad de Staphylococcus aureus en un grupo de niños sanos en Asunción

Introducción: La portación nasal de Staphylococcus aureus (SA) en individuos sanos constituye una fuente potencial de infección. La prevalencia de infecciones por SA adquiridas en la comunidad ha aumentado entre los niños sanos. Aunque la epidemiología de la colonización e infección por SA en otros países se ha estudiado ampliamente, los datos son limitados en el Paraguay. Objetivos: Determinar la prevalencia de la portación nasal por SA y su susceptibilidad antimicrobiana en una población de escolares sanos en Asunción, y evaluar factores de riesgo asociados a la colonización. Material y métodos: Estudio multicéntrico, prospectivo, descriptivo y analítico, sobre la colonización nasal por SA en niños de 5 a 16 años, durante el periodo comprendido entre junio y julio del 2016. Previa autorización de los padres y la escuela, se recogieron datos demográficos y factores de riesgo para la colonización. La determinación de SA se realizó mediante muestras de hisopado de las narinas de los niños. Se realizaron pruebas de susceptibilidad antimicrobiana en Agar Mueller y la sensibilidad a la vancomicina se realizó mediante tiras de E-Test®. Los datos fueron registrados en planillas Excel y analizados con el software R v.3.4.2 Resultados: 299 niños fueron incluidos en el estudio. De estos, 58%(173) eran mujeres con una media de edad de 10,6 (±2,5) años. El 79,9% procedía de Asunción y vivía con una media de 5,1 (±1,8) habitantes en el domicilio. Se determinó la presencia de SA en el 30,8% (92/299) de los niños. El 63% de los niños refirió algún factor de riesgo para la colonización por SA. Se objetivo que el antecedente de una enfermedad previa OR=1,92 (95%IC 0,88-4,28), el uso de antibióticos previos OR=1,51 (95%IC 0,89-2,55), la convivencia con mascotas OR=1,42(95%IC 0,81-2,50) y los tratamientos crónicos OR=1,20 (95%IC 0,55-2,61) fueron las variables asociadas a un mayor riesgo de presentar colonización por SA. Conclusión: En el presente estudio se objetivó que el 30,8% de los niños incluidos en el estudio presentaba colonización por SA y que los factores asociados a un mayor riesgo de colonización han sido el antecedente de una enfermedad previa, el uso de antibióticos, la convivencia con mascotas y los tratamientos crónicos.

Introduction: Staphylococcus aureus (SA) nasal carriage in healthy individuals is a potential source of infection. The prevalence of SA infections acquired in the community has increased among healthy children. Although the epidemiology of colonization and infection by SA in other countries has been studied extensively, data are limited in Paraguay. Objectives: To determine the prevalence of nasal carriage by SA and its antimicrobial susceptibility in a population of healthy schoolchildren in Asunción, and to evaluate risk factors associated with colonization. Material and methods: This was a multicenter, prospective, descriptive and analytical study on nasal colonization by SA in children aged 5 to 16 years between June and July 2016. After obtaining authorization from parents and the school, we collected data on demographics and on risk factors for colonization. The SA colonization determination was made by swabbing samples from the children's nostrils. Antimicrobial susceptibility tests were performed on Mueller Agar and the sensitivity to vancomycin was made using E-Test® strips. The data were recorded in Excel spreadsheets and analyzed with the R v.3.4.2 software. Results: 299 children were enrolled in the study. Of these, 58% (173) were female with an average age of 10.6 (± 2.5) years. 79.9% came from Asunción and lived with an average of 5.1 (± 1.8) inhabitants at home. The presence of SA was detected in 30.8% (92/299) of the children. 63% of children reported some risk factor for colonization by SA. We found that a history of a previous disease OR = 1.92 (95% CI 0.88-4.28), the use of previous antibiotics OR = 1.51 (95% CI 0.89-2.55), cohabitation with pets OR = 1.42 (95% CI 0.81-2.50) and chronic treatments OR = 1.20 (95% CI 0.55-2.61) were the variables associated with an increased risk for colonization by SA. Conclusion: In the present study it was found that 30.8% of the children enrolled in the study were colonized by SA and that factors associated with an increased risk of colonization were a history of a previous disease, the use of antibiotics, coexistence with pets and chronic treatments.

Dificultades en la alimentación de niños sanos en Montevideo-Uruguay / Feeding difficulties in healthy children, in Montevideo, Uruguay

Introduction. Feeding difficulties is a perception that the child not feds correctly. It is a common concern of young children caregivers. Objective. To define characteristics of 1 to 5 years, users of public and private Montevideo institutions children with feeding difficulties and identify associated variables. Subjects and Methods. Healthy children between 1 and 5 years were included. They were questioned if they had feeding difficulties. Personal history, features food and nutritional status were. Results. 205 children were included; 42,4% had feeding difficulties. These children did not have more pathological antecedents, or alterations in nutritional status, they were more distracting during the meal, received more rewards and punishments to feed and were fed by their mothers in a greater proportion. Conclusions. Feeding difficulties prevalence was similar to the reported in other studies. They were identified as association factors specific characteristics of the food environment and behavior adult responsible.

Introducción: Se denomina dificultad alimentaria a la percepción de que el niño no se alimenta adecuadamente. Es una preocupación frecuente de los cuidadores de niños pequeños. Objetivo: definir las características de niños entre 1 y 5 años, usuarios de instituciones públicas y privadas de Montevideo, con dificultades alimentarias, e identificar variables asociadas. Sujetos y métodos: Se incluyeron en el estudio niños sanos entre 1 y 5 años de edad. Se interrogó si presentaban dificultad alimentaria. Se registraron los antecedentes personales, características de la alimentación y estado nutricional. Se compararon estas variables entre niños con y sin dificultades alimentarias. Resultados: Se incluyeron 205 niños; 42,4% presentaba dificultades alimentarias. Estos niños no presentaban más antecedentes patológicos, ni alteraciones del estado nutricional, tenían más distractores durante la comida, recibían más premios y castigos por alimentarse y eran alimentados por sus madres en una mayor proporción. Conclusiones: La prevalencia de dificultades en la alimentación fue similar a la reportada en otros estudios. Se detectaron como factores de asociación determinadas características del ambiente donde se desarrollaba la comida y de la conducta del adulto responsable.

Surveillance for enteroviruses in healthy children in Yunnan Province from 2014 to 2015 / 中华微生物学和免疫学杂志

Objective To investigate the enterovirus ( EV)-carrying status and the circulating se-rotypes in healthy children from inner and border areas of Yunnan Province in 2014 and 2015 and to analyze the genetic characteristics of echovirus 6 (ECHO6), ECHO25 and ECHO11 strains. Methods Stool sam-ples were collected from children less than 15 years old living in 6 to 7 counties of 3 inner prefectures/cities and 8 to 9 counties of border prefectures/cities. Altogether 921 samples were collected including 453 sam-ples in 2014 (213 samples in inner counties and 240 samples in border counties) and 468 samples in 2015 (195 samples in inner counties and 273 samples in border counties). Viruses were isolated from the stool samples and their serotypes were identified by gene sequencing. Results The numbers of EV strains isola-ted from the samples collected in inner counties and border counties in 2014 were 20 ( isolating rate:9.39%, 20/213) and 16 (isolating rate: 6. 67%, 16/240), respectively. The overall isolating rate for 2014 was 7. 95% (36/453). The predominant species was enterovirus B, accounting for 88. 89% of all iso-lated strains (32/36), followed by enterovirus A species (11. 11%, 4/36). No strains of enterovirus spe-cies C (including poliovirus) and D was detected in 2014. In total, 46 EV strains were isolated in 2015 with an overall isolating rate of 9. 83% (46/468), including 13 strains in inner counties (isolating rate:6. 67%, 13/195) and 33 strains in border counties (isolating rate:12. 09%, 33/273). Most of the strains were enterovirus B species, accounting for 78. 26% (36/46), followed by enterovirus C species (19. 57%, 9/46) and enterovirus A species (2. 17%, 1/46). Altogether 82 EV strains were isolated in 2014 and 2015 with an isolating rate of 8. 90% (82/921), of which 33 strains were isolated in inner counties (8. 09%, 33/408) and 49 strains were isolated in border counties (9. 55%, 49/513). Among the 82 EV strains, 9 strains were polioviruses (0. 98%, 9/921) and all of them were Sabin-like polioviruses. The rest of the strains were non-polio enterovirus (7. 93%, 73/921). Conclusion In 2014, the EV isolating rate in inner counties (9. 39%) was higher than that in border counties (6. 67%). However, the EV isolating rate in border counties (12. 09%) was higher than that in inner counties (6. 67%) in 2015. Enterovirus B was the predominant species in both 2014 and 2015. No wild type polioviruses and enterovirus D species were detec-ted. Polio-free status was maintained well in Yunnan Province.

Valores de insulina basal y post carga de glucosa oral, homa-ir y quicki, en niños y adolescentes de la ciudad de Mérida, Venezuela: Influencia del sexo y estadio puberal (estudio credefar)

Objetivo: Obtener valores de insulina basal, post carga de glucosa oral, HOMA-IR y QUICKI, y establecer su relación con el sexo y el estadio puberal en niños y adolescentes sanos del Municipio Libertador de la ciudad de Mérida, Venezuela. Materiales y métodos: Participaron 922 sujetos de 9 a 18 años de instituciones públicas y privadas. Se recogieron datos antropométricos. Se determinaron glucemia e insulina (Quimioluminiscencia) en ayunas y 2 horas post carga de glucosa oral. Se calcularon los índices HOMA-IR y QUICKI. Se realizó la distribución percentilar de las variables por sexo y estadio puberal. Resultados: El 51,6% eran de sexo femenino y el 48,4% masculino; el 52,7% de instituciones públicas y el 47,3% de privadas. El 20,4% era prepúber, el 18,3% se encontró en el estadio II de Tanner, el 11,8% en el III, el 16% en el IV y el 33,4% en estadio puberal V. Los valores de insulina y HOMA-IR fueron mayores en el sexo femenino. Los valores más altos se observaron en los estadios II, III y IV. La insulina 2 horas postcarga mostró sus máximos valores en los estadios IV y V. En nuestra población, se proponen valores altos (>pc95) de insulina en ayunas aquellos mayores de 9 mU/mL en el prepúber y de 12 mU/mL en el púber; de insulina 2 horas postcarga mayores de 35 mU/mL en el prepúber y de 65 mU/mL en el púber; de HOMA-IR mayores de 2 en el prepúber y de 2,5 en el púber. Se consideran disminuidos aquellos valores de QUICKI menores de 0,31 (

Objective: To obtain values of fasting insulin levels and 2 hours post glucose oral test, values of HOMA-IR and QUICKI and its association with sex and pubertal stages in healthy children and adolescents from the Libertador Municipality of Mérida, Venezuela. Material and methods: We evaluated 922 students between 9 to 17,9 years from publics and privates educational institutions. Anthropometric variables were taken. Fasting glucose and insulin and 2 hours post glucose oral test were measured, and the HOMA and QUICKI indexes were calculated. The percentile distribution of the studied variables according to sex and pubertal stages was performed. Results: The 51.6% were female and 48.4% male; 52.7% were from public and 47.3% from private institution. According to Tanner Stages: 20.4% were Tanner I, 18.3% Tanner II, 11.8% Tanner III, 16% Tanner IV and 33.4% were Tanner V. Values of insulin levels and HOMA were higher in female sex. The higher levels were observed in stages II, III and IV. Insulin 2 hours post oral glucose test levels showed the highest values in Tanner stages IV and V. To our population, we propose more than 9 mU/mL as a high value (>pc95) of fasting insulin in the pre-pubertal stage and 12 mU/mL in pubertal stage; insulin 2 hours post glucose oral test higher than 35 mU/mL in the pre-pubertal and 65 mU/mL for the pubertal stage; HOMA-IR higher than 2 in the pre-pubertal and 2.5 in the pubertal stage. QUICKI levels under 0.31 (

Nasal carriage of Panton Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus in healthy preschool children / Colonización nasal de Staphylococcus aureus Meticilino Resistente portador de la Leucocidina Panton-Valentine en preescolares

Objective Determining the prevalence of nasal carriage of S. aureus, both sensitive to methicillin and resistant to it, in preschool children and evaluating the presence of Panton-Valentine leukocidin genes in the isolates. Methods This was a cross-sectional study in which cultures from anterior nares were obtained from healthy preschool children. Isolates were identified as S. aureus based on morphological and biochemical tests. Antibiotic susceptibility profiles were determined by the disk diffusion method. All the isolates were further analyzed by multiplex PCR to determine the presence of mecA and PVL genes; methicillin-resistant isolates were also SCCmec typed by multiplex PCR. Results Overall S. aureus nasal colonization prevalence was 38.5 % and 4.8 % for methicillin-resistant strains. All the methicillin-resistant isolates carried the genes for PVL; two isolates possessed the SCCmec type IV, two were SCCmec type I and one was SCCmec type II. Conclusion This study revealed high PVL-positive, methicillin-resistant S. aureus colonization prevalence in healthy preschool children from Cartagena, which may play a key role in the epidemiology of community-associated infection by methicillin-resistant S. aureus in healthy children from this particular geographical area.

Objetivo Determinar la prevalencia de colonización nasal de S. aureus, tanto sensible como resistente a meticilina, en niños preescolares y evaluar la presencia de los genes de la leucocidina Panton-Valentine en estos aislamientos. Métodos Estudio de corte transversal en el que se realizaron cultivos de flora nasal de niños preescolares. Los aislamientos fueron identificados como S. aureus con base en su morfología y pruebas bioquímicas. La susceptibilidad a antibióticos se determinó por el método de difusión en disco. Todos los aislamientos fueron analizados por PCR múltiple para determinar la presencia de los genes mecA y PVL, y para la tipificación del casete cromosómico SCCmec de los aislamientos resistentes a meticilina. Resultados La colonización nasal por S. aureus fue 38,5 %, y la de cepas meticilino-resistentes fue 4,8 %. Todos los aislamientos SARM portaban los genes para PVL, dos portaban el elemento SCCmec tipo IV, dos fueron tipo I y uno fue tipo II. Conclusión Encontramos una alta prevalencia de colonización por cepas meticilino-resistentes, PVL-positivos en la población estudiada, lo que podría jugar un papel clave en la epidemiología de las infecciones por S.aureus meticilino-resistente en esta área geográfica.

Grosor de íntima-media carotídea en niños sanos por técnica ecográfica computarizada / Arterial intima-media thickness in healthy Chilean children using an ultrasonographic computerized technique

Introduction: Vascular endothelium is a target organ in metabolic syndrome. Ultrasound measurement of intimae-media thickness (IMT) is used in adults to predict cardiovascular risk, but normal values in children are unknown. Objective: To describe arterial intima-media thickness in healthy children, by means of an ultrasonographic technique and a specific software. Subjects and Methods: Seventy-four healthy children, 39 males, ages 5-15 y.o., body mass index (BMI) 10-85 percentile were selected from an upper-middle socioeconomic background. Subjects were grouped by age. Three measurements were carried out to each subject at the middle third of the right common carotid for maximal intima-media thickness using a Phillips iU22 ultrasound system; a 12-5 MHz lineal transducer and QLAB advanced quantification software, which includes a specific program for automated IMT measurements, were used. Weight, stature, BMI, and abdominal circumference were registered. Results: No significant differences in the IMT values according to age or gender were found. Median IMT was 0.41 mm (0.40-0.56 mm); 5 children presented IMT 0.50-0.56 mm (> 75th percentile). The median IMT for those children with abdominal circumference < 50th percentile was the same for those over 50th percentile (0.41 mm). Conclusions: Measurements of carotid intima-media thickness for healthy Chilean children were found to be in the expected range, in relation with adult known values.

Introducción: Uno de los sitios de daño asociado a síndrome metabólico es el endotelio vascular; la medición ecográfica del grosor de intima-media carotídea (GIMC) es usado en adultos como un indicador de daño vascular, pero no se conocen valores de normalidad en niños. Objetivo: Estudiar el grosor de intima-media carotídea mediante programa computacional específico, en niños chilenos sanos. Pacientes y Método: Se seleccionaron 72 niños (percentiles 10-85 de IMC sin enfermedad conocida), 5 a 15 años de edad, de estratos socioeconómicos medio-altos, 33 niñas y 39 varones, agrupados por tramos de edad; se les efectuó y promedió 3 mediciones ecográficas en tercio medio de arteria carótida común derecha, mediante equipo Phillips modelo ÍU22; se usó un transductor lineal 12-5 MHz y un software de cuantificación avanzada QLAB, con programa específico de medición automática para grosor de GlMC Además se les midió: peso, talla, 1MC, perímetro abdominal (PA). Se solicitó previamente el consentimiento escrito a padres y niños. Resultados: No hubo diferencias en las mediciones de GlMC de acuerdo a edad o sexo, la mediana fue de 0,41 mm (0,40-0,56 mm); hubo 5 niños entre 0,50 y 0,56 mm (> percentil 75); no hubo correlación con PA o 1MC; los niños con PA < percentil 50 tuvieron una mediana de GlMC igual a aquellos con PA > percentil 50 (0,41 mm). Conclusiones: Las mediciones de grosor de intima-media carotídea de niños y adolescentes chilenos sanos mediante técnica ecográfica y programa computarizado, están dentro de valores esperados para la edad, comparados con valores conocidos de adultos.

Status of enterovirus infection and molecular identification among healthy children at the areas bordering Myanmar, in Yunnan province,China / 中华流行病学杂志

Objective To explore the enterovirus infection status among healthy children under 15 years old in the border areas of Yunnan province that connecting Myanmar.Methods A total of 319 stool samples were collected from healthy children in the 10 entrance ports.Enterovirus was isolated from these stool samples and then poliovirus and adenovirus were serotyped by neutralization test using specific anti-sera.All the non-polio enteroviruses(NPEVs)were identified by partial sequencing of VP1 gene.Results All 53 enterovirus were isolated from 319 stool samples and 16.6% of them carried the virus.23 polio virus(PVs)and 30 NPEVs were isolated with rates of carrying the virus were 7.2% and 9.4% respectively.4 adenovirus were also isolated with a rate as 1.25%.1 isolate could not be amplified by any Pan-enterovirus primers or by RT-PCR so was not able to be sequenced.The results of NPEVs sequencing showed that:1 isolate(3.3%)was classified into 1 serotype of HEV-A while 20 isolates(66.7%)were classified into 11 serotypes of HEV-B and 8 isolates(26.7%)were classified into 3 serotypes of HEV-C.However,we could not isolate any viruses that belong to HEV-D.nt.Result from the aa identify calculation showed that the nt and aa identification between isolates and corresponding standard strains were more than 75% and 85% respectively.The findings were similar to the international standards.Conclusion Our results showed that the rate of carrying the enterovirus especially poliovirus in some areas of Yunnan province that bordering Myanmar was higher than that of rate through the routine acute flaccid paralysis detection system.Of the enterovirus isolated,HEV-B group appeared the predominant with the wide spread of enterovirus serotype.Some newer enterovirus were also detected such as EV73(2 strains),EV75(1 strain),EV80(1 strain)and EV96(4 strains).

Analysis of cytosine adenine(CA) repeat polymorphism of the IGF-I gene and influence on serum IGF-I levels in healthy children and adolescents / 소아과

PURPOSE: The aim of the present study was to investigate the role of polymorphic cytosine adenine (CA) repeat of the IGF-I gene in the age-related alterations of serum IGF-I levels in healthy children. METHODS: Two hundred and forty three normal healthy children (136 boys; 107 girls) aged between 7 and 15 years were enrolled in the present study. The primers were designed to cover the promoter regions containing the polymorphic CA repeat. Data were analyzed using GeneMapper software, version 3.7. All analyses were performed using MEDCALC software packages. RESULTS: Deletion of 2 bp (G, A) following 3' of CA repeat were observed in all Korean children. The CA repeat sequences ranged from 17 to 23, and 19 CA repeat were the most common with an alleles frequency of 39.3 percent. Considering genotypes, 63.8 percent of subjects were homozygote or heterozygote for 19 CA repeat (192 bp allele), suggesting that this is wild type allele from which all other alleles originated in Korean children. Homozygote for 19 CA repeat were 14.7 percent, heterozygote for 19 CA repeat was 49.1 percent and 19 CA noncarriers totalled 36.2 percent. In 19 CA repeat noncarriers, the mean height, weight and serum IGF-I level were lower compared with those of 19 CA homozygous carriers, but statistically not significant. Correlations between serum IGF-I level and age according to the IGF-I genotypes revealed statistically significant relationships in the all groups, in the 19 CA repeat carrier group and, even in the noncarrier group. CONCLUSIONS:There were no significant differences of the mean height, weight and serum IGF-I levels among three different genotype groups. Also, there were no significantly different correlations between 19 CA repeat polymorphisms and serum IGF-I levels, according to genotype. Our results suggest that the IGF-I 19 CA repeat gene polymorphism is not associated with circulating IGF-I levels in healthy children.

Two Pediatric Patients with Neutropenia and Thrombocytopenia Associated with Parvovirus B19 Infection / 소아과

Parvovirus B19, a member of the Erythrovirus genus, is the only member of the Parvoviridae family known to be pathogenic in humans. Haematological consequences of B19 infection arise due to a direct cytotoxic effect on erythroid progenitors in bone marrow, resulting in interruption of erythrocyte production. The physiology of host haematopoiesis and competence of the immune response each determines clinical manifestations of B19 infection. A search of the literature revealed that neutropenia and thrombocytopenia due to B19 have been rarely reported in healthy individuals. In Korea, B19 infection has been reported among individuals with underlying disorders such as leukemia or congenital spherocytosis. Among otherwise healthy persons, there have been few reported cases of B19 infection which resulted in anemia, leukopenia, and thrombocytopenia. We herein report, for the first time in Korea, of two children who experienced leukopenia and thrombocytopenia, but not anemia, after B19 infection and recovered uneventfully.

Typing of Epstein-Barr Virus in Healthy Korean Children and Adults

PURPOSE: Recently, the list of Epsterin-Barr Virus (EBV)-associated diseases has been growing. It is now known that there are two types (type 1 & 2) of EBV, but it has yet to be fully investigated as to whether type B EBV differs in any way from type A virus in terms of geographical distribution or disease association. We performed this study to find out the prevalence of the two types of EBV in EBV seropositive healthy children and adults by using one step Polymerase chain reaction(PCR). METHODS: Fifty-four viral capsid antigen (VCA) IgG positive healthy children (5 to 15 yrs of age) and 60 healthy adults (20 to 50 yrs of age) were involved in this study. DNA extracted from saliva samples of healthy study children and adults were subjected to amplification using the modified one step general PCR, which was developed by M. Kunimoto et al for detection of EBV types. And B95-82 cells (type 1) and Jijoye cells (type 2) were used as positive controls, and K-562 cells was used as a negative control. RESULTS: EBV was detected in mouth washing saliva of 8 (14.8%) of 54 healthy children. Five EBV detected cases contained type 1 and the remaining three cases contained type 2. EBV was detected in mouth washing saliva of 21 (35%) of 60 healthy adults. Twenty EBV detected cases contained type 1 and the remaining one was type 2. In total, EBV was detected in the saliva samples of 29 cases (25.4%), and 25 (86.2%) contained type 1. CONCLUSION: The results of our study indicate that type 1 is highly dominant in Korea, and EBV excretion is more frequent in EBV positive healthy adults compared to EBV positive healthy children in Korea.

A Study of Serum Total and House Dust Mite-Specific IgE, and ECP Levels in Healthy Korean Children Under 7 Years of Age / 소아알레르기및호흡기학회지

PURPUSE: Serum IgE have been shown to be related to allergic disease and used for an initial diagnosis of allergic diseases. House dust mite such as Dermatophagoides pteronyssinus(Dp) and D. farinae(Df) is very important for inhalant allergens, which may be a cause and/or triggering factor of atopic diseases. On the other hand, eosinophil cationic protein (ECP) causes epithelial damages of the airway, and bronchial hyperresponsiveness has been used as a useful indication of allergic inflammation. To date, there are few studies on the longitudinal patterns of total and inhalant allergen-specific IgE, and ECP in normal children in Korea. The present study was performed to determine the reference levels of serum total and Dp- and Df-specific IgE and ECP in healthy children under 7 years of age by the groups of different age and gender. METHODS: Total, and Dp- and Df-specific IgE and ECP concentrations were measured by fluoroimmunoassay(UniCAP, Pharmacia-UpJohn, Sweden) in serum from 449 healthy children under 7 years of age by using a population-based cohort followed from 1996 through 1997. All subjects were enrolled from eight large health organizations in geographically defined area such as Seoul and four local cities. RESULTS: Serum total IgE concentration showed steady increase with age from birth to 4 years, and a plateau. In contrast, Dp- and Df-IgE levels showed apparently continuous increments after 4 years of age. ECP showed variable increase until 4 years of age and slow decrease afterwards. There were no statistically significant differences in those results by gender and/or the living area, but much higher increments of Dp- and Df-IgE of boys from 3 years of age through 6 years were found. CONCLUSION: We found feasible results of total, Dp- and Df-specific IgE, and ECP in serum from healthy children under seven years of age, which may be useful for a reference.