Certificació de l'aptitud esportiva en l'edat pediàtrica / Certificación de la aptitud deportiva en la edad pediátrica / Preparticipation physical evaluation in children

Fonament: la certificació medicoesportiva té com a objectiu prevenir i diagnosticar possibles alteracions que poguessin condicionar la pràctica esportiva en l'infant i l'a-dolescent. L'aspecte més important és la prevenció de lamort sobtada, situació dramàtica que ha generat gran in-terès i al mateix temps ansietat, tant entre la població general com entre les diferents institucions esportives. Objectiu: establir un criteri de certificació medicoesportivaen l'edat pediàtrica, analitzant i argumentant la disparitatde criteris entre la proposta europea i l'americana. Mètode: revisió bibliogràfica. Conclusions: la pràctica esportiva en infants i adolescentsexigeix un control de salut portat a terme pel pediatre i unarevisió medicoesportiva que ha de fer l'especialista enmedicina de l'esport, i que permetrà la certificació de l'ap-titud esportiva. En aquesta revisió incidirem en l'historialclínic i en l'exploració dels aparells locomotor i cardiovascular, d'acord amb l'algoritme d'actuació de la propostacatalana de prevenció de la mort sobtada de l'esportista. Laresta de l'exploració mèdica per aparells no difereix de laque fa el pediatre de capçalera en els controls de salu

Fundamento. La certificación médico-deportiva tiene como objetivo prevenir y diagnosticar posibles alteraciones que pudieran condicionar la práctica deportiva en el niño/a y adolescente. El aspecto más importante radica en la prevención de la muerte súbita, situación dramática que ha generado gran interés y al mismo tiempo ansiedad, tanto en la población general como en las diferentes instituciones deportivas. Objetivo. Establecer un criterio de certificación médico-deportiva, analizando y argumentando la disparidad de criterios entre la propuesta europea y la americana. Método. Revisión bibliográfica. Conclusiones. La práctica deportiva en niños/as y adolescentes exige un control de salud llevado a cabo por el pediatra y una revisión médico-deportiva realizada por el especialista en medicina del deporte, que permitirá la certificación de la aptitud deportiva. En esta revisión, incidiremos en el historial clínico, la exploración de los aparatos locomotor y cardiovascular, según el algoritmo del consenso catalán de prevención de la muerte súbita en deportistas. El resto de la exploración médica por aparatos no difiere de la que realiza el pediatra de cabecera en los controles de salud (AU)

Background. The aim of preparticipation physical evaluation for thletics is to prevent and diagnose conditions that would contraindicate the practice of sports for children and adolescents. The most important objective is to prevent sudden death, a dramatic situation that has generated great interest and anxiety in the general population as well as among athletic institutions. Objective. To define consensus criteria for preparticipation physical evaluation, considering the disparities between the European and the American proposals. Method. Literature review. Conclusions. The practice of sports in children and adolescents requires a medical evaluation for fitness by the pediatrician and by sports medicine. In this review, we focus on medical history and musculoskeletal and cardiovascular examination, following the guidelines of the Catalan consensus for prevention of sudden death in athletes. The rest of the medical examination does not differ from the exploration performed by the pediatrician in the routine health checks (AU)

Evaluación del autoconcepto de adolescentes con sobrepeso y obesidad (Estudio Obescat) / Evaluation of self awareness of adolescents with overweight and obesity (Obescat study)

Introducción. La obesidad y el sobrepeso no solo tienen consecuencias físicas, sino también psicológicas, que afectan a la autoestima del adolescente. Objetivo. Determinar el autoconcepto de adolescentes con obesidad y sobrepeso, y determinar su asociación con el grado de respuesta a la intervención educativa para reducir el índice de masa corporal (IMC). Método. Ensayo clínico multicéntrico de un año de duración en adolescentes de 10 a 14 años con obesidad y sobrepeso, realizado en consultas de pediatría de atención primaria en Catalunya. Se realiza intervención educativa para reducir el IMC: grupo intervención (GI), seis visitas (meses 0, 1, 3, 6, 9 y 12); y grupo control (GC), dos (meses 0 y 12). Se analiza la autoestima al inicio y al final del estudio con el cuestionario AF-5. Resultados. Participación de 174 adolescentes, y completan el estudio 125 (71,8%); media de edad: 11,81 años (1,21), y 50% de mujeres. Disminución del Z-score del IMC en ambos grupos (p<0,001). Rellenan el cuestionario AF-5 al inicio del estudio 160 adolescentes (GI 80 y GC 80), y al final lo hacen 100 (GI 49 y GC 51). Las dimensiones más afectadas: emocional y física. La niñas del GI en comparación con las del GC mejoraron significativamente en las dimensiones emocional (5,54 vs 4,36 p=0,031) y familiar (9,02 vs 7,96; p=0,006). Los niños empeoraron en las dimensiones académico-laboral (6,29 vs 7,27; p=0,031) y física (4,63 vs 6,10; p=0,014). Conclusiones. Nuestros adolescentes con obesidad y sobrepeso mostraban un bajo autoconcepto emocional y físico, que mejoró con la intervención educativa Obescat únicamente en las niñas (AU)

Background. Overweight and obesity may not only have adverse physical consequences, but may also impact the adolescents’ selfesteem. Objective. To determine the self-esteem of adolescents with obesity and overweight, and to determine its association with the response to the lifestyle counseling to reduce the body mass index (BMI). Method. One-year randomized clinical trial in adolescents 10-14 years old with obesity and overweight attending pediatric primary care units of Catalonia. A lifestyle counseling to reduce BMI was performed, including an intervention group (IG) seen for six visits (months 0, 1, 3, 6, 9, and 12) and a control group (CG) seen for two visits (months 0 and 12). Self-esteem was determined at enrollment and at the end of the intervention using the AF-5 Questionnaire. Results. One hundred seventy-four adolescents were enrolled, and 125 (71.8%) completed the study. Average age was 11.81 years (1.21) and 50% were females. BMI Z-scores decreased in both groups (p<0.001). One hundred and sixty participants (80 IG and 80 CG) completed the questionnaire at enrollment, and 100 at completion of the study (49 IG and 51 CG). The most affected dimensions were emotional and physical. Compared with the CG, girls in the IG had significantly improved emotional (5.54 vs. 4.36; p=0.031) and family (9.02 vs. 7.96; p=0.006) dimensions. By contrast, boys in the IG had significantly worse academic/work (6.29 vs. 7.27; p=0.031) and physical (4.63 vs. 6.10; p=0.014) dimensions at the end of the study. Conclusions. Our adolescents with obesity and overweight showed a low emotional and physical self-esteem. Improvements in selfesteem with the Obescat lifestyle-counseling program were seen only in girls (AU)

Relative hypoadiponectinemia, insulin resistance, and increased visceral fat in euthyroid prepubertal girls with low-normal serum free thyroxine.

A lower activity of the thyroid axis within the clinical reference range is related to a dysmetabolic phenotype in adult populations. We posited that such an association is already present as early as in prepubertal childhood. Serum thyroid stimulating hormone (TSH) and free T4, body fat (bioelectric impedance), insulin resistance (homeostasis model assessment of insulin resistance (HOMA(IR))), total and high molecular weight (HMW)-adiponectin and serum lipids were assessed in 234 euthyroid prepubertal children (113 boys and 121 girls) attending primary care clinics. Visceral fat (abdominal ultrasound) was measured in a subset of these subjects (n = 147; 74 boys and 73 girls). Explants of visceral adipose tissue from an additional six prepubertal children (three boys and three girls) were used to study the regulation of total and HMW-adiponectin by thyroid hormone. Serum free T4 was in girls independently associated with HMW-adiponectin, HOMA(IR) and visceral fat, so that circulating HMW-adiponectin decreased by 30% (ß = 0.305 P < 0.005, R(2) = 0.13) and HOMA(IR) and visceral fat increased, respectively, by 90% (ß = -0.255 P < 0.01, R(2) = 0.05) and 30% (ß = -0.369, P < 0.005, R(2) = 0.12) from the highest to the lowest tertile of serum free T4. Nonsignificant differences in these parameters were found in boys. Treatment of visceral fat explants with thyroid hormone increased total and HMW-adiponectin by 70% and 53%, respectively, above control values (P < 0.01). In conclusion, a dysmetabolic phenotype, consisting of relative hypoadiponectinemia, insulin resistance and increased visceral fat, is associated with low-normal serum free thyroxine in euthyroid prepubertal girls. These associations may be partly explained by a positive regulation of HMW-adiponectin secretion by thyroid hormone.

Bebé colodión transitorio / Self-healing collodion baby

Introducción. El bebé colodión neonatal es una forma clínica de presentación de la ictiosis congénita. En el estudio colaborativo español de malformaciones congénitas (ECEMC) la frecuencia es inferior a un caso cada 100.000 recién nacidos. Caso clínico. Presentamos el caso clínico de un recién nacido afectado de esta patología que, a pesar de la espectacularidad de la exploración clínica en el periodo neonatal, presentó una buena evolución posterior. Comentarios. Se plantea el diagnóstico diferencial de las posibles entidades que pueden debutar en el periodo neonatal en forma de bebé colodión y se comenta la posibilidad de efectuar estudios genéticos moleculares(AU)

Introduction. Congenital ichthyosis, which presents as collodion baby, is a very rare disorder. In our national collaborative study of congenital malformations (ECEMC) only one out of more than 100.000 newborns is diagnosed as having congenital ichthyosis. Case report. We describe the case of a trasient collodion baby who, despite the prominent clinical findings at birth, had a bening course. Bebè col·lodió transitori M. Mar Garcia González 1, Mar Calvo 1, Pilar Villalobos 1, Stephan Schneider 1, Elena Riera 1, M. Jesús Muntané 2, Miquel Just 3, Vicente Villa 4 1 Servei de Pediatria 2 Servei d’Anatomia Patològica; 3 Servei de Dermatologia; Fundació Salut Empordà. Figueres (Girona). 4 Servei de Dermatologia. Hospital Sant Joan de Déu. Barcelona Comments. The differential diagnosis of possible clinical disorders that can manifest as collodion baby in the perinatal period is discussed. Molecular genetic studies are also reviewed(AU)

Prenatal programming of renal function: the estimated glomerular filtration rate is influenced by size at birth in apparently healthy children.

Prenatal growth is known to affect glomerular function in adult life. It is unknown, however, whether this association is also present in children. In a cross-sectional study, we examined whether birth weight (BW) is associated with serum creatinine (measured by an improved Jaffe method) and GFR (estimated by the Haycock-Schwartz formula; eGFR) in 73 apparently healthy school-age children (35 boys and 38 girls; age 9.5 +/- 0.4 yr). All children were born after singleton term pregnancies (gestational age 39.6 +/- 0.2 wk) with normal BW (3.2 +/- 0.04 kg). A significant decrease in serum creatinine and increase in the eGFR was evident by tertiles of BW-SD score (SDS) (p = 0.001 and p < 0.0001). eGFR was correlated with BW-SDS (r = 0.45; p < 0.0001), so that each unit increase in BW-SDS was associated with an increase in eGFR of 10 (95% CI 5-14) ml/min per 1.73 m. In summary, estimates of glomerular function are in apparently healthy school-age children influenced by size at birth. These findings suggest early effects for the prenatal programming of renal function in humans.

Heritability of explosive power and anaerobic capacity in humans.

There is a disparity in the information about the heritability of the response of muscle anaerobic metabolism to exercise and the use of explosive power, as well as a lack of information concerning the genetic determinants of this form of work, as measured using different specific physical tests. We applied a battery of some of the commonly employed procedures (Ergojump, Wingate, maximal accumulated oxygen deficit, excess post-exercise oxygen consumption, and delta lactate concentration) to a group of 32 Caucasian male twins, 8 monozygotic and 8 dizygotic pairs, who had similar environmental backgrounds. Results were studied using a heritability index (HI). Zygosity was determined using the identity of erythrocyte antigens, protein and enzyme polymorphism and human leucocyte antigen serologic types between co-twins. Significant HI values (P< 0.05) were found in the following tests: maximal 5 s power (HI = 0.74) and total power in a 30 s interval (HI = 0.84) in the Wingate test, maximal lactate concentration (HI = 0.82) and delta lactate concentration (HI = 0.84) in the maximal progressive test, as well as in the 2nd (HI = 0.93) and in the 3rd min (HI = 0.92) of recovery after the deficit test. In this study, the most relevant findings were: firstly, significant HI values for many of the variables studied; secondly, the HI values of the parameters used to evaluate explosive power were higher than those of lactic acid capacity and thirdly, the HI of certain variables from different tests measuring, in theory, similar qualities, were different.

Investigation of metal complexes with metallothionein in rat tissues by hyphenated techniques.

The potential of hyphenated techniques based on a combination of microbore reversed-phase (RP) HPLC or capillary zone electrophoresis (CZE) with inductively coupled plasma (ICP) or electrospray (ES) mass spectrometry (MS) was demonstrated for the characterization of metal complexes with metallothionein in rat liver and kidney. The mixture of MT complexes was isolated from the tissues by size-exclusion LC and further characterized in neutral pH conditions (pH 6.8-7.2) by RP-HPLC or CZE. The metal stoichiometry and the molar mass of the eluted complexes was measured by ICP-MS and ES-MS, respectively. An additional dimension to the analysis was achieved by post-column acidification of the chromatographic eluent that allowed the determination of the molecular weight of the demetallated complexes with 10-fold higher sensitivity. The approach allowed the detection of two major metallothionein (MT) isoforms (MT-1 and MT-2) in liver and one MT isoform in kidney. The actual number of peaks in chromatograms and electropherograms was bigger because of the formation of mixed Cd-Cu complexes of the same MT isoform that showed different hydrophobicities.