Evaluación del tratamiento intensificado con conteo de hidratos de carbono en un grupo de niños con diabetes tipo 1 / Evaluation of treatment intensified with carbohydrate counting in a group of children with diabetes type 1

Introducción. Los resultados del Diabetes Control and Complications Trial (DCCT) demostraron que con la terapéutica intensificada, se logra mejorar el control glucémico, retrasando la aparición de complicaciones crónicas de la diabetes. Objetivo. Comparar el control metabólico en un grupo de niños con diabetes tipo 1 (DM1) seguidos en el Hospital Sor María Ludovica según el esquema utilizado: Tratamiento Convencional (TC) versus Tratamiento Intensificado (TI) con educación en Conteo de Hidratos de Carbono (CHC).Materiales y método. Estudio clínico comparativo, prospectivo, descriptivo y analítico en dos grupos: TI y TC. Se evaluó la edad cronológica al debut (EC), talla (T), Índice de Masa Corporal (IMC) según curvas OMS, tiempo de evolución de la diabetes e insulinas utilizadas. Se analizaron las insulinas utilizadas en cada grupo y las modificaciones en el IMC, Hemoglobina Glicosilada (HbA1C), y la presencia de hipoglucemias severas a los 6 meses del CHC.Resultados. La media de HbA1C al inicio fue de 10.11 ± 2.51% y a los 6 meses 8.10 ± 1.77% en TI, disminuyó 2.01% (p<0.0001). En TC la HbA1C al inicio fue de 8.86 ±1.87% y a los 6 meses de 9.78 ± 2.18%, aumentó un 0.92% (p=0.0002).Discusión. Los resultados muestran que el TI en niños puede llevarse a cabo logrando una reducción de la HbA1C sin aumentar las hipoglucemias y otros efectos adversos.

Evaluación del tratamiento intensificado con conteo de hidratos de carbono en un grupo de niños con diabetes tipo 1 / Evaluation of treatment intensified with carbohydrate counting in a group of children with diabetes type 1

Introducción. Los resultados del Diabetes Control and Complications Trial (DCCT) demostraron que con la terapéutica intensificada, se logra mejorar el control glucémico, retrasando la aparición de complicaciones crónicas de la diabetes. Objetivo. Comparar el control metabólico en un grupo de niños con diabetes tipo 1 (DM1) seguidos en el Hospital Sor María Ludovica según el esquema utilizado: Tratamiento Convencional (TC) versus Tratamiento Intensificado (TI) con educación en Conteo de Hidratos de Carbono (CHC).Materiales y método. Estudio clínico comparativo, prospectivo, descriptivo y analítico en dos grupos: TI y TC. Se evaluó la edad cronológica al debut (EC), talla (T), Indice de Masa Corporal (IMC) según curvas OMS, tiempo de evolución de la diabetes e insulinas utilizadas. Se analizaron las insulinas utilizadas en cada grupo y las modificaciones en el IMC, Hemoglobina Glicosilada (HbA1C), y la presencia de hipoglucemias severas a los 6 meses del CHC.Resultados. La media de HbA1C al inicio fue de 10.11 ± 2.51% y a los 6 meses 8.10 ± 1.77% en TI, disminuyó 2.01% (p<0.0001). En TC la HbA1C al inicio fue de 8.86 ±1.87% y a los 6 meses de 9.78 ± 2.18%, aumentó un 0.92% (p=0.0002).Discusión. Los resultados muestran que el TI en niños puede llevarse a cabo logrando una reducción de la HbA1C sin aumentar las hipoglucemias y otros efectos adversos.(AU)

Linear growth in children with congenital hypothyroidism detected by neonatal screening and treated early: a longitudinal study.

We performed a longitudinal study of a cohort of 74 children with congenital hypothyroidism (CH) detected by neonatal screening (Buenos Aires Province, Argentina) up to the age of 3 years old, in order to study linear growth and the relationship with the severity of CH at diagnosis. The mean age at diagnosis and the start of the treatment was 16.9 +/- 5.2 days. The patients were divided into group 1--severe CH (pretreatment T4 level <4 microg/dl) (n = 47)--and group 2--less severe CH (pretreatment T4 level > or = 4 microg/dl) (n = 27). Patients with CH treated early showed a sexually dimorphic pattern of growth: girls tended to be longer than boys at all ages. Boys showed some delay of growth during the first year. No difference was found in linear growth between the two groups (more/less severe CH). Height was normal in both sexes at the age of 3 years old.

Effect of the dithiocarbamate pesticide zineb and its commercial formulation azzurro. I. Genotoxic evaluation on cultured human lymphocytes exposed in vitro.

The in vitro cytogenetic effects exerted by the dithiocarbamate fungicide zineb and one of its commercial formulations currently used in Argentina, azzurro, were studied in whole blood human lymphocyte cultures. The genotoxicity of the fungicides was measured by analysis of the frequency of chromosomal aberrations and sister chromatid exchanges (SCEs) and cell cycle progression assays. Both zineb and azzurro activities were tested within the range 0.1-100.0 microg/ml immediately after in vitro lymphocyte stimulation. Only concentrations of 50.0 and 100.0 microg/ml zineb and azzurro induced a significant increase in SCE frequency over control values. Furthermore, this genotoxicity appears to be correlated with its cytotoxicity, measured as cell cycle kinetics, since both a significant delay in cell cycle progression and a significant reduction in proliferative rate index were only observed in those cultures treated with these fungicide concentrations. For both chemicals, a progressive dose-related inhibition of the mitotic activity of cultures was observed when increasing the fungicide concentration. Moreover, only the mitotic activity statistically differed from control values when doses of zineb or azzurro <10 microg/ml were employed. For both fungicides the mitotic index reached the minimal value at doses of 100 microg/ml. Both products induced a significant dose-dependent increase in the number of abnormal cells, chromatid-type and chromosome-type aberrations as well as in the total number of aberrations in the 0.1-100.0 microg/ml dose range. Based on these results, the evaluation of zineb as a controversial genotoxic/non-genotoxic compound for human health should be reconsidered. Instead, we demonstrate that the fungicide induces large DNA alterations and should be considered as a clastogenic mutagen.

[Effect of estrogen therapy on the growth of Turner syndrome in girls treated with growth hormone]. / Efecto del tratamiento con estrógenos sobre el crecimiento en niñas con sindrome de Turner tratadas con hormona de crecimiento.

Two groups of patients with Turner Syndrome (TS) were studied to analyse the effect of estrogens on their growth. Group 1 (G1): 14 patients treated with growth hormone (GH) who started estrogens (SO) (Premarín) at 15.3 +/- 0.9 years old. Group 2 (G2): 10 girls not treated with GH who started Premarín at 14.3 +/- 2.3 years old. Height SDS improvement in periods of time of GH and GH plus estrogen treatment was evaluated and compared between both groups. The gain in stature during estrogen therapy (final height-projected height at SO) was calculated. In G1 multiple regression was used to examine factors influencing the gain in stature during GH treatment (final height-projected height at the start of GH): bone age at the SO, chronological age at the SO and the time of GH treatment prior to SO. In G1 the height SDS improvement was 0.43 +/- 0.11 cm during GH treatment and 0.59 +/- 0.18 cm during GH plus oestrogens (p = 0.064). The height SDS improvement during estrogen therapy in G2 was 0.14 +/- 0.19 cm, smaller than in G1 (p < 0.001). Gain in stature during estrogen therapy was 5.3 +/- 1.8 cm in G1 and -0.6 +/- 4.2 cm in G2 (p = 0.001). In G1 the time of GH treatment prior to SO was the strongest predictor of the gain in stature during GH treatment (r = 0.89).

[Relationship between maternal and neonatal iron stores]. / Relación entre las reservas de hierro maternas y del recién nacido.

OBJECTIVE: To establish the relationship of normal, low, and moderate blood iron values in mothers and their newborns. MATERIAL AND METHODS: A cross-sectional study was conducted among 163 pregnant women and their newborns, users of Hospital de Ginecología y Obstetricia número 15, Instituto Mexicano del Seguro Social, from Chihuahua, Mexico. The mothers' clinical histories were collected and analyzed; hemoglobin, hematocrit, and ferritin serum levels were measured in maternal and umbilical cord samples. Iron maternal stores were determined by ferritin (microgram/l) values as follows: low: < or = 11; moderate: 12-20; and normal: > or = 20.1. The Kruskal-Wallis test was used to establish differences among group; the chi-squared test to determine differences of proportions; and Pearson's correlation coefficient for assessing the association between maternal and newborn iron stores. RESULTS: A weak correlation between maternal and neonatal ferritin was found (r = 0.14, p = 0.07). Geometric means of neonatal ferritin for low, moderate, and normal maternal iron stores were 4.77, 4.85, and 5.02 respectively (p = 0.12). The maternal iron stores changed after iron supplementation (p = 0.01). CONCLUSIONS: Iron stores in mothers and their newborns are closely related. Women who take iron supplements during pregnancy have significantly higher iron stores at the end of pregnancy.

Efecto del tratamiento con estrógenos sobre el crecimiento en niñas con sindrome de Turner tratadas con hormona de crecimiento. / [Effect of estrogen therapy on the growth of Turner syndrome in girls treated with growth hormone]

Two groups of patients with Turner Syndrome (TS) were studied to analyse the effect of estrogens on their growth. Group 1 (G1): 14 patients treated with growth hormone (GH) who started estrogens (SO) (Premarín) at 15.3 +/- 0.9 years old. Group 2 (G2): 10 girls not treated with GH who started Premarín at 14.3 +/- 2.3 years old. Height SDS improvement in periods of time of GH and GH plus estrogen treatment was evaluated and compared between both groups. The gain in stature during estrogen therapy (final height-projected height at SO) was calculated. In G1 multiple regression was used to examine factors influencing the gain in stature during GH treatment (final height-projected height at the start of GH): bone age at the SO, chronological age at the SO and the time of GH treatment prior to SO. In G1 the height SDS improvement was 0.43 +/- 0.11 cm during GH treatment and 0.59 +/- 0.18 cm during GH plus oestrogens (p = 0.064). The height SDS improvement during estrogen therapy in G2 was 0.14 +/- 0.19 cm, smaller than in G1 (p < 0.001). Gain in stature during estrogen therapy was 5.3 +/- 1.8 cm in G1 and -0.6 +/- 4.2 cm in G2 (p = 0.001). In G1 the time of GH treatment prior to SO was the strongest predictor of the gain in stature during GH treatment (r = 0.89).

Screening of the municipal water system of La Plata, Argentina, for human intestinal parasites.

The La Plata River, though severely contaminated by intestinal parasites through the discharge of tons of crude fecal material from a main sewage channel, nevertheless provides drinking water to two-thirds of La Plata, Argentina, after conventional purification at a processing plant. With intestinal parasitosis being endemic here, we investigated the importance of this water in transmitting such pathogens to the city's populace by means of standard methodology for sample acquisition and processing involving filter-concentration of waterborne particulates. Of 14 tap-water samples collected from the distribution network, 12 pertained to four zones (A-D) within the city center; while the remaining 2 were obtained near the processing plant, 15 kilometers outside the city. Although parasites were found within the samples derived from the four urban zones, none were detected in the specimens obtained near the plant. The four downtown areas differed from each other as to the quantity and nature of the parasites present in their water: whereas zones A and B registered similar lower levels of contaminants, C and D exhibited higher values significantly different from the former two and from each other. Given an average parasite count/l citywide of 0.38 and a probability of encountering a parasite within 11 of water of 0.32, the municipal network is seen to contribute to the transmission of intestinal parasites. A routine system of water-quality control is therefore needed throughout the city along with the establishment of infrastructures for locating and eliminating peripheral sources of contamination.

[Prediction of final height in girls with Turner syndrome treated with growth hormone]. / Predicción de la estatura final en niñas con síndrome de Turner tratadas con hormona de crecimiento.

Treatment with growth hormone (GH) in girls with Turner syndrome (TS) would improve growth velocity (GV) and final height (FH) prediction. A total of 21 girls with TS treated with GH for 1 (n = 21), 2 (n = 18) and 3 years (n = 10) were studied. At the onset of GH treatment, the mean chronological age was 11.6 +/- 2.6 years and the mean bone age was 9.7 +/- 2.4 years. The mean height SDS was: -0.04 +/- 1.0 at the beginning, 0.4 +/- 1.0 at 1st year, 0.9 +/- 1.1 at 2nd year and 1.25 +/- 0.56 at 3rd year of treatment (p = 0.0001, p < 0.0001 and p < 0.05 respectively). The mean GV SDS was 1.6 +/- 1.8 at the beginning, 2.5 +/- 1.7 at 1st year, 3.8 +/- 2.9 at 2nd year and 2.2 +/- 2.0 at 3rd year (p = 0.01, p = 0.04 and p = 0.29 respectively). The FH prediction by Bayley-Pinneau method was: 142.8 +/- 5.2 cm at the beginning, 143.8 +/- 6.0 at 1st year, 146.0 +/- 5.9 at 2nd year and 145.6 +/- 6.4 at 3rd year (p = 0.026, p = 0.05 y p = 0.87 respectively). The mean ending height treatment (EH), in 8 patients, was 145.1 cm +/- 6.7. In conclusion, 1) studied patients showed systematic bone age delay at the beginning of GH treatment; 2) during the treatment, GV increment and improvement in relative heights and in FH prediction were observed; 3) the EH, nearest to the FH prediction, previously made at 3rd year of treatment, was 7.2 cm higher than mean FH's for Argentinean girls with TS without GH treatment.

Predicción de la estatura final en niñas con síndrome de Turner tratadas con hormona de crecimiento. / [Prediction of final height in girls with Turner syndrome treated with growth hormone]

Treatment with growth hormone (GH) in girls with Turner syndrome (TS) would improve growth velocity (GV) and final height (FH) prediction. A total of 21 girls with TS treated with GH for 1 (n = 21), 2 (n = 18) and 3 years (n = 10) were studied. At the onset of GH treatment, the mean chronological age was 11.6 +/- 2.6 years and the mean bone age was 9.7 +/- 2.4 years. The mean height SDS was: -0.04 +/- 1.0 at the beginning, 0.4 +/- 1.0 at 1st year, 0.9 +/- 1.1 at 2nd year and 1.25 +/- 0.56 at 3rd year of treatment (p = 0.0001, p < 0.0001 and p < 0.05 respectively). The mean GV SDS was 1.6 +/- 1.8 at the beginning, 2.5 +/- 1.7 at 1st year, 3.8 +/- 2.9 at 2nd year and 2.2 +/- 2.0 at 3rd year (p = 0.01, p = 0.04 and p = 0.29 respectively). The FH prediction by Bayley-Pinneau method was: 142.8 +/- 5.2 cm at the beginning, 143.8 +/- 6.0 at 1st year, 146.0 +/- 5.9 at 2nd year and 145.6 +/- 6.4 at 3rd year (p = 0.026, p = 0.05 y p = 0.87 respectively). The mean ending height treatment (EH), in 8 patients, was 145.1 cm +/- 6.7. In conclusion, 1) studied patients showed systematic bone age delay at the beginning of GH treatment; 2) during the treatment, GV increment and improvement in relative heights and in FH prediction were observed; 3) the EH, nearest to the FH prediction, previously made at 3rd year of treatment, was 7.2 cm higher than mean FHs for Argentinean girls with TS without GH treatment.

Reflexiones sobre casos clínicos en la recuperación ambulatoria de niños desnutridos / Reflections about clinic cases in the ambulatory recuperation of underweighting children

La experiencia histórica ya enseña a la medicina que cuando una sociedad se empobrece, es previsible un empeoramiento de las condiciones de salud de sus integrantes. Datos del CESNI nos revelan que de la información disponible no surgen tasas elevadas de desnutrición grave ni aguda, siendo frecuente la formación crónica con claras diferencias regionales. Cuando la tarea que ocupa nuestros dias de labor se encuentra dirigida a resolver esta problemática de desnutrición de niños inmersos en situación de pobreza, se nos presenta como un desafío prioritario la búsqueda de alternativas desde lo biológico y lo social que en muchas oportunidades las vivenciamos como impotencia, éxito o fracaso frente a cada niño y su familia. Quizás frente a la desnutrición es donde más se dispersan las acciones médicas y se confunden los tiempos para resolver una patología con una alta carga social. Objetivo: transmitir las vivencias de un grupo de pediatras en el seguimiento de niños desnutridos de 0 a 2 años a través de casos clínicos en un consultorio de riesgo social. Estas reflexiones surgen al revisar historias de niños desnutridos del Consultorio Ayuda a la Crianza del Niño en Riesgo, donde sólo el poder obeservar que la impotencia sobre muchos casos, el fracaso frente a otros, es sostenido por el éxito de la verdadera recuperación de aquellos niños que no engrosan las tasas de desnutrición grave ni aguda y que su seguimiento permite mejorar su calidad de vida. (AU)

Reflexiones sobre casos clínicos en la recuperación ambulatoria de niños desnutridos / Reflections about clinic cases in the ambulatory recuperation of underweighting children

La experiencia histórica ya enseña a la medicina que cuando una sociedad se empobrece, es previsible un empeoramiento de las condiciones de salud de sus integrantes. Datos del CESNI nos revelan que de la información disponible no surgen tasas elevadas de desnutrición grave ni aguda, siendo frecuente la formación crónica con claras diferencias regionales. Cuando la tarea que ocupa nuestros dias de labor se encuentra dirigida a resolver esta problemática de desnutrición de niños inmersos en situación de pobreza, se nos presenta como un desafío prioritario la búsqueda de alternativas desde lo biológico y lo social que en muchas oportunidades las vivenciamos como impotencia, éxito o fracaso frente a cada niño y su familia. Quizás frente a la desnutrición es donde más se dispersan las acciones médicas y se confunden los tiempos para resolver una patología con una alta carga social. Objetivo: transmitir las vivencias de un grupo de pediatras en el seguimiento de niños desnutridos de 0 a 2 años a través de casos clínicos en un consultorio de riesgo social. Estas reflexiones surgen al revisar historias de niños desnutridos del Consultorio Ayuda a la Crianza del Niño en Riesgo, donde sólo el poder obeservar que la impotencia sobre muchos casos, el fracaso frente a otros, es sostenido por el éxito de la verdadera recuperación de aquellos niños que no engrosan las tasas de desnutrición grave ni aguda y que su seguimiento permite mejorar su calidad de vida.