Homocisteína en niños y adolescentes. Relación con historia familiar de enfermedad cardiovascular / Serum homocysteine in children and adolescents. Relation with family history of cardiovascular disease

BACKGROUND: Hyperhomocysteinemia is an independent cardiovascular risk factor that depends on folate and vitamin B12 nutrition. AIM: To measure homocysteine, folic acid and vitamin B12 serum levels in healthy children with and without a family history of cardiovascular disease. SUBJECTS AND METHODS: Forty children aged 6 to 15 years with a family history of cardiovascular disease, and 40 age and sex matched children without such history were studied. Serum homocysteine, folic acid and vitamin B12 were measured in a fasting blood sample. Homocysteine was measured by a fluorescence polarization immunoassay (FPIA), vitamin B12 by enzymatic microparticle assay, covered with intrinsic factor and folic acid by ionic capture, using commercial kits. RESULTS: Children with family history of cardiovascular disease had higher homocysteine levels than their counterparts without family history (7.9 +/- 3 and 5.8 +/- 2 mumol/l respectively, p < 0.03), but similar folic acid (5.2 +/- 1.8 and 5.5 +/- 1.4 pg/ml respectively) and vitamin B12 levels (431 +/- 213 and 445 +/- 209 ng/ml respectively). There was a negative and significant correlation between homocysteine and folic acid and vitamin B12 levels. CONCLUSIONS: Children with a family history of cardiovascular disease have higher levels of serum homocysteine than those without such history, despite having similar levels of folic acid and vitamin B12.

[Lipid profile in newborns with intrauterine growth retardation]. / Perfil lipídico en recién nacidos con retardo del crecimiento intrauterino.

BACKGROUND: The X syndrome, related to coronary disease in adults, could be possibly programmed priory to delivery, in children with intrauterine growth retardation. AIM: To measure serum lipids in newborns with symmetrical or asymmetrical intrauterine growth retardation. PATIENTS AND METHODS: One hundred thirty-five newborns with intrauterine growth retardation and 116 normal term newborns, with 38 to 41 gestational weeks, were studied. Total, HDL, and LDL cholesterol, triglycerides and apoproteins. A1 and B were measured in umbilical cord blood samples. RESULTS: No differences in total, HDL, LDL cholesterol, apoproteins A1 and B were observed between the study groups. Triglycerides were higher in newborns with intrauterine growth retardation, compared to normal term newborns (45 +/- 27 and 36 +/- 19 mg/dl respectively, p < 0.001). Differences in serum triglyceride levels respect to controls were observed in both male and female newborns with asymmetrical growth retardation. Likewise the differences respect to controls were observed in newborns with mild or severe but not with moderate growth retardation. CONCLUSIONS: Newborns with intrauterine growth retardation have higher triglyceride levels than normal term newborns.

[Impact of hypertensive disease of pregnancy on intrauterine growth retardation]. / Impacto del sindrome hipertensivo del embarazo en el retardo del crecimiento intrauterino.

BACKGROUND: Intrauterine growth retardation, associated to hypertensive disease of pregnancy, is responsible for a higher perinatal mortality and morbidity. AIM: To assess obstetrical, perinatal and neonatal features of intrauterine growth retardation associated to hypertensive disease of pregnancy. PATIENTS AND METHODS: One hundred thirty seven newborns with intrauterine growth retardation, whose mothers had hypertensive disease of pregnancy, were compared to 165 similar newborns but whose mothers did not have the disease. RESULTS: The incidence of intrauterine growth retardation associated to hypertensive disease of pregnancy was 45.4%. Maternal obesity at the start and end of pregnancy, a pregestational weight over 65 kg and a weight increment of more than 20 kg during pregnancy were risk factors for hypertensive disease of pregnancy with relative risks of 1.76, 1.62, 1.62 and 2.09 respectively. Relative risks for cesarean section and prematurity were also higher among women with hypertensive disease of pregnancy. Intrauterine growth retardation associated to maternal hypertension was symmetrical and severe in 37.9% of newborns. All seven neonatal deaths occurred in newborns with severe retardation. CONCLUSIONS: Neonatal and perinatal morbidity and mortality are higher in newborns with intrauterine growth retardation. Hypertensive disease of pregnancy was associated with a twice higher incidence of asymmetrical intrauterine growth retardation.

[Lipids, lipoproteins and apolipoproteins in normal newborns]. / Lípidos, lipoproteínas y apolipoproteínas en recién nacidos normales.

BACKGROUND: In Chile, there is a high prevalence of cardiovascular diseases. Because atherosclerosis starts in childhood, it is important to assess serum lipid levels in children. AIM: To measure serum lipid levels in normal Chilean newborns. SUBJECTS AND METHODS: A sample of umbilical cord venous blood was obtained from 156 normal newborns (76 male) immediately after delivery. Total and HDL cholesterol, triglycerides, apoprotein A1, B and lipoprotein (a) were measured. RESULTS: Mean values for total cholesterol in males, females and in the total sample were 60.6, 67.8 and 64 mg/dl respectively. The figures for HDL cholesterol were 24.9, 29.3 and 27 mg/dl, for LDL cholesterol were 28.3, 32.4 and 30 mg/dl, for triglycerides were 37.5, 30.3 and 35 mg/dl, for apoprotein A1 were 69, 79 and 74 mg/dl, for apoB were 23, 25 and 24 mg/dl and for lipoprotein (a) were 1.58, 1.79 and 1.69 mg/dl. Total cholesterol, HDL cholesterol, triglycerides and apoprotein A1 were significantly different between sexes. Percentiles 5 and 95 for total cholesterol were 37 and 111, for HDL cholesterol were 14 and 40, for LDL cholesterol were 13 and 57, for triglycerides were 20 and 69, for apoprotein A1 were 53 and 101, for apoprotein B were 11 and 48 and for lipoprotein (a) were 1.3 and 2.1 mg/dl. Five percent of children had apoprotein B values over 48 mg/dl. CONCLUSIONS: The detection of high levels of apoprotein B in newborns, could allow the early identification of individuals with high cardiovascular risk.

[Serum lipid levels in children and teenagers from Concepción, Chile]. / Perfil lipídico y prevalencia de dislipidemias en niños y adolescentes de Concepción, Chile.

BACKGROUND: There is a relationship between serum lipid levels in children with those of adults. Preventive measures to reduce serum lipid levels should start in childhood. AIM: To study serum lipid levels in a representative sample of children and teenagers from Concepción, Chile. SUBJECTS AND METHODS: Serum total, HDL cholesterol and triglycerides were measured in 1,286 males and 816 females from 5 to 18 years old in the city of Concepción. RESULTS: Mean total cholesterol levels were 159 +/- 30 and 162 +/- 31 mg/dl in males and females respectively. The figures for HDL cholesterol were 46 +/- 11 and 47 +/- 11 mg/dl, for LDL cholesterol were 94 +/- 27 and 96 +/- 29 mg/dl and for triglycerides were 80 +/- 35 and 87 +/- 38 mg/dl. Nine percent of males and 12% of females had a total cholesterol over 200 mg/dl. Likewise 10% of males and 11% of females had a LDL cholesterol over 130 mg/dl. CONCLUSIONS: These numbers will help to plan and perform interventions in children, in order to prevent cardiovascular diseases.

[Lipoprotein in children and adolescents: relationship with family history of coronary artery disease]. / Lipoproteína en niños y adolescentes: relación con historia familiar de enfermedad coronaria.

BACKGROUND: Lipoprotein (a) is considered an independent cardiovascular risk factor. AIM: To study lipoprotein (a) levels in children of 18 years old or less with or without family history of coronary artery disease. SUBJECTS AND METHODS: Forty four children aged between 3 and 18 years old with a family history of coronary artery disease and 44 age and sex matched controls were studied. A fasting blood sample was obtained to measure total, HDL and LDL cholesterol, triglycerides, A1 and B apoproteins and lipoprotein (a). RESULTS: Compared to controls, children with a family history of coronary disease had higher total cholesterol (177 +/- 35 and 159 +/- 23 mg/dl respectively), LDL cholesterol (112 +/- 34 and 94 +/- 21 mg/dl respectively), triglycerides (89 +/- 38 and 71 +/- 25 mg/dl respectively), apoprotein B (85 +/- 17 and 65 +/- 13 mg/dl respectively) and lipoprotein (a) (40 +/- 50 and 22 +/- 31 mg/dl respectively). Thirty two percent of children with positive family history had lipoprotein (a) levels over 30 mg/dl, compared to 23% of controls. CONCLUSIONS: Children with family history of coronary artery disease have higher levels of cholesterol, triglycerides and lipoprotein (a) than matched controls.

[Influence of ethnic and environmental factors the lipid profile in school children from the VIII Region]. / Influencia de la etnia y el ambiente sobre el perfil lipídico en escolares de la VIII región.

We studied fasting total, HDL cholesterol and triglycerides in 329 children aged from 6 to 15 years. One hundred and ten lived in Concepción and were considered urban. Two hundred nineteen lived in Alto Bio-Bio and were considered rural; of these, 173 had a pehuenche aboriginal origin. Rural pehuenche, rural non pehuenche and urban children had a total cholesterol of 123.7 +/- 23, 133.7 +/- 25.8 and 153.7 +/- 29.7 mg/dl respectively, a HDL cholesterol of 39.2 +/- 9.1, 38.8 +/- 9.1 and 46.2 +/- 11.3 mg/dl respectively and triglycerides of 83.3 +/- 33.5, 96.7 +/- 33.5 and 81.9 +/- 33.3 mg/dl respectively. Lipid levels were above safe values in 2.9% of pehuenche, 8.7% non pehuenche rural and 13.6% or urban children. It is concluded that the higher lipid levels of urban and non pehuenche children supports the favorable effect of rural environment and pehuenche ethnic origin on cardiovascular risk factors.

Serum adenosine deaminase in the early diagnosis of typhoid fever.

To study the usefulness of the enzyme adenosine deaminase for the early diagnosis of typhoid fever, its activity in serum was assayed in 277 children admitted to the Hospital Guillermo Grant Benavente at Concepción, Chile, from March, 1988, to December, 1990. The children were distributed into seven groups: control, N = 82; bacteremia, N = 8; acute viral respiratory infection, N = 43; febrile children with miscellaneous etiologies, N = 49; pulmonary tuberculosis, N = 3; hepatitis A virus infection, N = 30; and typhoid fever, N = 62. The medium serum adenosine deaminase values were significantly higher in children with typhoid fever (P < 0.0001) in relation to the values in the control group (122.2 +/- 40.7 vs 28.1 +/- 8.4 units/liter at 37 degrees C). This test had a sensitivity of 91.9% and a specificity of 92.5% in identifying the patient with typhoid fever when using 80 units/liter as the cutoff values. The positive predictive value of the test was 83.8% and the negative predictive value was 96%. Determination of adenosine deaminase values in serum could be helpful in the early diagnosis of typhoid fever.

[Adenosine deaminase in typhoid fever and other febrile diseases]. / Adenosina deaminasa en fiebre tifoidea y otras enfermedades febriles.

The contribution of serum adenosine deaminase (ADA) activity to the diagnosis of typhoid fever was assessed in 246 children and in 46 adults, by Giusti's original technique. Children included otherwise healthy patients admitted for elective surgical conditions or under follow up for epilepsy which were considered to be a control group (n: 81), presumptive viral diseases (n: 31), miscellaneous febrile diseases except for typhoid fever (n: 41), different kinds of bacteremia (n: 6), diarrhea due to Salmonella typhimurium (n: 14), viral hepatitis (n: 24), and culture proven typhoid fever (n: 49). Adult's group included 39 healthy controls and 7 patients with culture proven typhoid fever. Among children mean ADA activity was as follows: control group 28 +/- 7.8, viral disease 35.3 +/- 13.1, miscellaneous febrile disease 36.1 +/- 15.6, bacteremia group: 30.3 +/- 10.3, salmonellosis group 51.6 +/- 9, hepatitis group 68.3 +/- 34.5, typhoid fever group 124.4 +/- 40.8 U/I 37 degrees C. Among adults, values were 18.4 +/- 7.5 for controls and 112.8 +/- 19.2 U/I 37 degrees C in typhoid fever patients. In both adults and children ADA activity was significantly higher in the typhoid fever group (p < 0.0001). Untreated typhoid fever patients had their higher ADA activity between 10th and 15th day of illness. When ADA cut point was set at 80 U/I, sensitivity of the test was 91.8% and specificity was 91.4% as a preliminary clue to the recognition of typhoid fever.

[Risk factors of cardiovascular disease in a Chilean school population: I: Blood lipids in 552 children and adolescents 6-15 years of age]. / Factores de riesgo de enfermedad cardiovascular en una población de escolares Chilenos: I parte: lípidos séricos en 552 niños y adolescentes de 6-15 años.

The distribution of serum cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL)-cholesterol and triglycerides (TG), and the prevalence of risk-considered values were studied in school children from Concepción, Chile (6 to 15 years old; 326 boys, 226 girls). The mean TC levels were 146 mg/dl for boys and 154 mg/dl for girls but 9.1% of the sampled children had TC values between 175 and 190 mg/dl, and 10% were over 190 mg/dl. Mean LDL-C was 83 mg/dl in boys and 89 mg/dl in girls; 6% of samples showed values between 130 and 159 mg/dl, and 1.3% over 160 mg/dl. Mean HDL-C was 46 mg/dl for boys and 48 mg/dl for girls. The mean TG values were 80 mg/dl for boys and 93 mg/dl for girls.

Hiperbilirrubinemia no hemolitica congenita. / Congenital nonhemolytic hyperbiblirubinemia

Se presenta dos casos de ninos portadores de sindrome de Crigler Najjar. Su diagnostico ha sido confirmado por estudio enzimatico y de microscopia electronica. Se clasifican en tipo I y II de acuerdo con su respuesta al tratamiento con fenobarbital. Se revisan brevemente las hiperbilirrubinemias no hemoliticas congenitas destacando que a pesar del conocimiento actual queda aun mucho por investigar