ABSTRACT
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Subject(s)
Humans , Female , Child , Receptors, Thyroid Hormone/analysis , Receptors, Thyroid Hormone , Receptors, Thyroid Hormone/isolation & purification , CD3 Complex , Graves Disease/complications , Graves Disease/diagnosis , Graves Disease/drug therapy , Antithyroid Agents/therapeutic use , Follow-Up Studies , Goiter/complications , Graves Ophthalmopathy/complications , Graves Ophthalmopathy/diagnosisABSTRACT
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Subject(s)
Humans , Female , Child , Diabetes Mellitus, Type 1/diagnosis , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Risk Factors , Diagnosis, DifferentialABSTRACT
INTRODUCCIÓN: El tratamiento con radioyodo en la enfermedad de Graves (EG) es una opción terapéutica curativa cada vez más utilizada en niños por encima de 5 años. En Estados Unidos su uso está muy extendido, pero en Europa sigue existiendo controversia respecto a su indicación en la edad pediátrica. OBJETIVO: Presentar nuestra experiencia con la administración de I131 en la EG en edad pediátrica y analizar su eficacia y seguridad. PACIENTES Y MÉTODOS: Estudio retrospectivo descriptivo de los pacientes pediátricos (< 18 años) diagnosticados de EG en nuestro hospital desde 1982 hasta 2012. Al alcanzar la pubertad, se ofreció una opción curativa a aquellos pacientes que no habían respondido al tratamiento con fármacos antitiroideos (AT). Analizamos las características de los pacientes, niveles de hormona tirotropa, T3 y T4, y autoanticuerpos, respuesta a AT, frecuencia de la remisión de la enfermedad post-I131, aparición de hipotiroidismo y efectos secundarios del I131.ResultadosDesde 1982 hasta 2012 fueron diagnosticados de EG 50 pacientes. Todos recibieron como tratamiento inicial AT, con una duración media 35,3 ± 25,9 meses. Se consiguió remisión permanente en el 46%. Se realizó tiroidectomía a 5 pacientes y se administró I131 a 14 pacientes. La dosis de yodo administrada osciló entre 8,5 y 13 mCi (10,9 ± 1,09). Se obtuvo remisión en el 100%. La tasa de hipotiroidismo permanente fue del 90%. No se observaron progresión de la oftalmopatía ni efectos secundarios en ningún paciente tratado con I131. CONCLUSIONES: El tratamiento con 131I en la EG pediátrica es seguro, lleva a la remisión completa a costa de hipotiroidismo y no exacerba la oftalmopatía. Puede considerarse su utilización en mayores de 5 años cuando no existe respuesta a AT o ante efectos secundarios importantes con esta medicación
INTRODUCTION: Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. AIM: To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. PATIENTS AND METHODS: We retrospectively studied our paediatric population (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I131, side effects, and hypothyroidism rates. RESULTS: A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I131 (mean dose: 10.9±1.09 mCi). Remission with I131 was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patientst reated with I131.CONCLUSION: Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication
Subject(s)
Humans , Male , Female , Child , Adolescent , Graves Disease/drug therapy , Iodine Compounds/therapeutic use , Retrospective Studies , Patient Safety , Treatment OutcomeABSTRACT
INTRODUCTION: Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. AIM: To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. PATIENTS AND METHODS: We retrospectively studied our paediatric population (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I(131), side effects, and hypothyroidism rates. RESULTS: A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I(131) (mean dose: 10.9±1.09 mCi). Remission with I(131) was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patients treated with I(131.) CONCLUSION: Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication.
Subject(s)
Graves Disease/radiotherapy , Iodine Radioisotopes/therapeutic use , Child , Female , Humans , Male , Retrospective Studies , Treatment OutcomeABSTRACT
Introducción: La obesidad en la edad pediátrica es cada vez más prevalente. La población hispana inmigrante tiene un alto riesgo de obesidad y de diabetes tipo 2. Objetivo: Analizar la influencia étnica en la prevalencia del síndrome metabólico (SM) y sus componentes en una población pediátrica obesa. Pacientes y métodos: Estudio retrospectivo de 616 niños y adolescentes obesos ([IMC>2 DE (Hernández 1998-2004)]: 142 hispanos y 474 caucásicos. Se comparan la prevalencia de SM y sus componentes (criterios modificados Cook 2003): obesidad y ≥2 de los siguientes: colesterol HDL<40mg/dl, triglicéridos >110mg/dl, presión arterial sistólica y/o diastólica >p90 (Task Force 2004) y alteración del metabolismo hidrocarbonado (ADA 2011). Se evalúa también: historia familiar de SM, HbA1c, insulinorresistencia (HOMA), función hepática y evolución del IMC al año de tratamiento con cambios en el estilo de vida. Resultados: El 30,5% de los hispanos presentan SM frente al 15,5% de los caucásicos (OR=2,4 [IC del 95%, 1,5-3,8]), p<0,005]) y OR de 2,5 al ajustar por sexo, IMC-DE y pubertad. Los hispanos presentan mayor insulinorresistencia (58,6% vs 42,86%, p<0,005) y peor evolución del IMC al año de seguimiento. No hubo diferencias en el resto de datos analizados. Encontramos una peor adherencia a las medidas de cambio de alimentación y ejercicio físico en el grupo hispano. Conclusiones: La prevalencia de SM es superior en la población pediátrica hispana obesa que en la caucásica. La peor adherencia al tratamiento de los niños y adolescentes obesos hispanos hace que este grupo de pacientes tenga un riesgo potencialmente mayor de enfermedades cardiovasculares en la vida adulta (AU)
Introduction: Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. Objective: To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. Patients and methods: A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. Results: Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<0.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. Conclusion: There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Metabolic Syndrome/complications , Metabolic Syndrome/diagnosis , Metabolic Syndrome/ethnology , Obesity/complications , Obesity/diagnosis , Obesity, Morbid/complications , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Metabolic Syndrome/physiopathology , Metabolic Syndrome/rehabilitation , Retrospective Studies , Insulin Resistance/genetics , Insulin Resistance/physiology , Indicators of Morbidity and MortalityABSTRACT
INTRODUCTION: Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. OBJECTIVE: To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. PATIENTS AND METHODS: A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. RESULTS: Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. CONCLUSION: There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood.
Subject(s)
Metabolic Syndrome/complications , Metabolic Syndrome/epidemiology , Obesity/complications , Adolescent , Child , Female , Humans , Latin America , Male , Metabolic Syndrome/ethnology , Prevalence , Retrospective Studies , White PeopleABSTRACT
Introducción: El consenso internacional recomienda el cribado de las alteraciones hidrocarbonadas (AH) en fibrosis quística (FQ) mediante sobrecarga oral de glucosa (SOG) anual desde los 10 años de edad y/o iniciada la pubertad. Objetivos: Evaluar la presencia de AH y su posible repercusión clínica (cambios nutricionales y de función pulmonar) en pacientes impúberes con FQ. Pacientes y métodos: Estudio retrospectivo en 19 pacientes impúberes con FQ (68% varones). Según la SOG, clasificamos (Consenso 2010): tolerancia normal glucosa (TNG) o AH (alteración tolerancia glucosa [ATG], alteración indeterminada glucosa (AIG), diabetes [DRFQ]). Analizamos: SOG (glucemia e insulinemia), estado nutricional (IMC), función pulmonar (espirometría forzada) y función pancreática exocrina. Estudio estadístico con programa SPSS, versión-15.0 mediante pruebas no paramétricas. Resultados: Edad media primera SOG: 8,5 años (5,8-9,8); seguimiento medio: 2 años (2-3). Al inicio: el 53% TNG y el 47% AH; evolutivamente: 4/10 pacientes con TNG desarrollan AH (3ATG, 1DRFQ), 3/4 AIG desarrollan 2ATG y 1DRFQ. Edad media aparición AH: 8,6 años (6,4-11,1). El 69% tuvo deterioro nutricional y/o de la función pulmonar el año previo al diagnóstico de AH. Dos pacientes con AH eran suficientes pancreáticos exocrinos. La insulinemia basal y el área bajo la curva de la SOG fueron comparables entre TNG y AH. El índice insulinogénico fue inferior en AH (p=0,006). Todos los pacientes tuvieron un pico de secreción de insulina retrasado. Conclusiones: La frecuente detección de AH en pacientes impúberes con FQ y su repercusión clínica plantean la necesidad de adelantar su cribado. La suficiencia pancreática exocrina no excluye el desarrollo de AH(AU)
Introduction: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). Aims: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. Patients and methods: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. Results: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. Conclusions: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Nutritional Status/physiology , Forced Expiratory Flow Rates , Forced Expiratory Flow Rates/physiology , Glucose/analysis , Cystic Fibrosis/physiopathology , Cystic Fibrosis , Retrospective Studies , Spirometry/methods , Mass Screening/methods , Predictive Value of Tests , Body Mass IndexABSTRACT
INTRODUCTION: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). AIMS: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. PATIENTS AND METHODS: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. RESULTS: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. CONCLUSIONS: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening.
Subject(s)
Cystic Fibrosis/complications , Glucose Intolerance/etiology , Child , Child, Preschool , Female , Humans , Male , Retrospective StudiesABSTRACT
Collagenous gastritis is a rare disease in the general population and collagenous colitis has seldom been reported in children. We report a girl with both diseases and review the literature on this association afetr a systematic search of Pubmed, Medline and Embase databases.. The girl, diagnosed of collagenous colitis at the age of 2 years, started with abdominal pain and anaemia at the age of 9 years and was diagnosed of collagenous gastritis in the gastric biopsies. After review of the literature, we found 66 reported cases (33 children, 33 adults, 68% females), 56 patients with collagenous gastritis and 16 children with collagenous colitis. Both disorders coexisted in 20 patients. The main presenting symptoms are abdominal pain and anaemia in patients with collagenous gastritis and diarrhoea and weight loss in patients with both disorders. Hypoalbuminemia was found in 9 patients with both diseases and protein losing enteropathy was demonstrated in 3 cases. Deposits of collagen in the duodenum were observed in 13 of 19 patients with both diseases. Seventeen of 66 patients had associated autoimmune disorders, particularly in patients with both diseases (35%). These conditions have a chronic course but gastric or colonic malignancies have not been communicated to date. In conclusion, collagenous gastritis and collagenous colitis mainly affects women and can occur at any age. Their association is exceptional. These disorders, although rare, should be considered in patients with anaemia and epigastric pain, watery diarrhoea or protein losing enteropathy.
Subject(s)
Colitis, Collagenous/complications , Colitis, Collagenous/pathology , Gastritis/complications , Gastritis/pathology , Child , Female , HumansABSTRACT
La anemia hemolítica autoinmune es un trastorno infrecuente en niños. Suele ser idiopático o precedido por infecciones virales, agudo y autolimitado, pero en ocasiones se trata de un trastorno crónico refractario a los tratamientos habituales. Los corticoides constituyen la primera línea de tratamiento, con buenos resultados en el 80% de los casos. La esplenectomía y los agentes inmunosupresores, como la ciclofosfamida o la azatioprina, se utilizan como segunda opción en casos resistentes a corticoides. En la actualidad existen nuevos tratamientos que se presentan con alternativa en casos refractarios, como el rituximab, un anticuerpo monoclonal que actúa selectivamente contra los linfocitos B y que ha obtenido buenos resultados en varios estudios prospectivos en niños refractarios al tratamiento estándar. Otras medidas terapéuticas utilizadas en esta enfermedad son la trasfusión de hemoderivados, la plasmaféresis y la infusión de inmunoglobulina intravenosa (AU)
Autoimmune hemolytic anemia is an uncommon disorder in children. It is generally idiopathic or preceded by acute and self-limited viral infections, but may sometimes be a chronic disorder refractory to the usual treatments. Corticosteroids are the first line of treatment, with good results in 80% of the cases. Splenectomy and immunosuppressive agents such as cyclohosphamide or azathioprine are used as a second option in corticosteroid-resistant cases. Currently, there are new treatments that are presented as an alternative in refractory cases, such as rituximab, a monoclonal antibody tat selectively acts against lymphocytes B and that has obtained good results in several prospective studies in children refractory to the standard treatment. Other therapeutic measures used in this disease are blood transfusion, plamapheresis and intravenous immunoglobulin infusion (AU)
