Higher vitamin D levels in HIV-infected out-patients on treatment with boosted protease inhibitor monotherapy.

OBJECTIVES: We investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy (cART), including boosted protease inhibitor (PI) monotherapy. METHODS: For this cross-sectional study, out of 450 HIV-infected patients followed in the Hospital Severo Ochoa (Madrid, Spain), we selected 352 patients for whom vitamin D levels had been measured (January 2009 to December 2010). We collected the following data: demographics, cART duration, main cART regimen, viral load (VL), CD4 cell count, and concentrations of 25(OH)-vitamin D [25(OH)-D], parathyroid hormone (PTH), albumin and calcium. Vitamin D status cut-off points were: (1) deficiency (vitDd): 25(OH)-D < 20 ng/mL; (2) insufficiency (vitDi): 25(OH)-D from 20 to 29.99 ng/mL; and (3) optimal (vitDo): 25(OH)-D ≥ 30 ng/mL. RESULTS: The percentages of patients with vitDd, vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty-nine out of 30 (96.7%) Black patients had vitDd or vitDi, vs. 71.6% in the global sample (P < 0.001). Former injecting drug users (IDUs) had a higher prevalence of vitDo (P < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL ≤ 50 HIV-1 RNA copies/mL were 77.4, 68 and 91%, respectively (P < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels (P = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs. Caucasian ethnicity [odds ratio (OR) 10.6; 95% confidence interval (CI) 1.2-94; P = 0.033]; heterosexual (OR 2.37; 95% CI 1.13-4.93; P = 0.022) or men who have sex with men (MSM) (OR 3.25; 95% CI 1.25-8.50; P = 0.016) transmission category vs. former IDU; and VL > 50 copies/mL (OR 2.56; 95% CI 1.10-7.25; P = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment (OR 0.08; 95% CI 0.01-0.6; P = 0.018). CONCLUSIONS: Our data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.

Análisis de diferentes variables antropométricas y bioquímicas y su relación con hábitos de vida familiares en población obesa / Analisis of different anthropometric and biochemical variables and its relation to life habits in children with obesity

Objetivo: El objetivo de este estudio ha sido analizar si existe correlación entre el índice da masa corporal (IMC) de los niños con obesidad con los parámetros antropométricos familiares, hábitos de vida y parámetros bioquímicos. Pacientes: niños entre 2-17 años .Todos los pacientes y sus padres rellenaron encuestas donde se recogieron datos personales y habitos de vida. Resultados: Participaron en el estudio 108 niños con obesidad 44,4% niños. Edad media de 10 años (2-17 años). El 56% prepuberales. El IMC medio de 27,8 % (+4,4DS). No encontramos correlación entre el IMC del niño y el nivel de estudios familiar ni con la situación laboral familiar, ni con quién le acompaña por las tardes. Sólo el 4,6% obtienen una puntuación < 3, en calidad de la dieta (KIDMED). Los niños dedican 3,3 horas al día a actividades sedentarias. Se encontró correlación entre el nº total de actividades sedentarias y el IMC del niño (r=0,205;p=0,004). También el peso con IMC de los progenitores(r= 0,427;P<0,001).Solo se correlacionan con el IMC la insulina, péptido C y índice HOMA, por encima de los valores normales. Conclusiones: La actividad sedentaria es uno de los parámetros fundamentales en el desarrollo de la obesidad. Dada la relación del IMC, la insulinemia y el índice HOMA, y teniendo en cuenta que estos valores están por encima de los valores normales, el mantenimiento de esta situación en el tiempo, podría ser el responsable del síndrome metabólico en el adulto (AU)

Objetive: The objective of this study has been to analyze if there is correlation between the body mass index (BMI) of children with obesity with the anthropometric parameters of their relatives and habits of life. Patients: children between 2-17 years of age. All the patients and their parents filled up a survey where they gathered data on anthropometry, and life style. Results: 108 children participated in the study. 44,4% boys. Average age of 10 years (2-17 years). 56% prepubertal. BMI means of 27,8% (+4,4DS). We didn´t found any correlation between the BMI of the child and the familiar level of studies neither with their labor situation. Only 4,6% obtain a score < 3, in quality of the diet (KIDMED). The children dedicate 3.3 hours of the day to sedentary activities. There was correlation between total nº of sedentary activities and the BMI of the boy (r=0,205; p=0,004), and the weight with BMI of the ancestors (r= 0,427; P< 0,001) too. Insulin, peptide C and index HOMA are correlated with BMI, these values are over the normal range. Conclusions: Sedentary activity is one of the fundamental parameters in the development of the obesity. Given the relation between BMI, insulinemia and index HOMA, and considering that these values are upon the normal values, the maintenance of this situation in time, could be the responsible of the metabolic syndrome in the adult (AU)

[The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children]. / Indice HOMA y QUICKI, insulina y péptido C en niños sanos. Puntos de corte de riesgo cardiovascular.

OBJECTIVE: The aim of this study was to establish the reference values of the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check (QUICKI) indexes, as well as those of insulin and C-peptide levels in healthy children and adolescents with a view to determining reference percentiles to detect those at cardiovascular risk. MATERIAL AND METHODS: A total of 372 children boys and girls of different ages and at distinct pubertal stages with normal body mass index participated in the study. Fasting glucose, insulin and C-peptide values were measured by chemiluminescence and the HOMA and QUICKI indexes were calculated. RESULTS: Fasting glucose levels were normal in all children. The mean values obtained for each variable were (mean (SD)): fasting glucose 87(7.75) mg/dL, insulin 7.74 (5.35) microU/mL, C-peptide: 1.76 (0.79) ng/mL, HOMA index 1.72 (1.27) and QUICKI index 0.72 (0.29). All the variables progressively increased with age, with statistically significant differences between prepubertal and pubertal children. The QUICKI index showed an inverse relationship. In addition, significant differences were found between sexes. The 90th percentile for all the variables was as follows: insulin 15.05 microU/mL, C-peptide: 2.85 ng/mL, HOMA index 3.43 and QUICKI index 1.10. CONCLUSIONS: Values of fasting glucose, insulin, C-peptide and the HOMA index significantly increased with age and pubertal stage, while the QUICKI index decreased. We defined the 90th percentile for all the parameters studied as the cut-off point to identify children at cardiovascular risk in our population.

Índice HOMA y QUICKI, insulina y péptido C en niños sanos. Puntos de corte de riesgo cardiovascular / The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children

Objetivo: El objetivo de este trabajo ha sido establecer los valores de referencia de los índices Homeostasis Model Assessment (HOMA) y Quantitative Insulin Sensitivity Check Index (QUICKI), insulina y péptido C en ayunas en niños sanos, y con ello obtener percentiles de referencia a partir de los cuales establecer un punto de corte para valorar el riesgo cardiovascular en nuestra población infantil. Material y métodos: En este estudio participan 372 niños de ambos sexos y diferente estadio puberal con un índice de masa corporal (IMC) normal. Se determinan los valores de glucemia, insulina y péptido C (mediante quimioluminiscencia), y se calculan los índice HOMA y QUICKI. Resultados: Todos los niños presentan niveles de glucemia normales (media [DE]): 87 (7,75) mg/dl. Los valores medios obtenidos para cada variable son: insulina 7,74 (5,35) μU/ml, péptido C: 1,76 (0,79) ng/ml, índice HOMA: 1,72 (1,27), e índice QUICKI 0,72 (0,29). De forma global se objetiva un aumento progresivo de los valores de glucosa, insulina, péptido C y el índice HOMA en relación con la edad, existiendo diferencias estadísticamente significativas entre estadios prepuberales y puberales para ambos sexos, siguiendo el índice QUICKI un patrón inverso. Así mismo existen diferencias significativas entre sexos para todas las variables e índices estudiados. Los valores obtenidos para el percentil P90 para cada variable e índice de forma global son: insulina 15,05 μU/ml, péptido C: 2,85 ng/ml, índice HOMA 3,43 e índice QUICKI: 1,10. Conclusiones: Los valores de glucemia, insulina, péptido C y el índice HOMA aumentan con la edad y el estadio puberal de forma significativa. El índice QUICKI por el contrario disminuye. Establecemos el percentil P90 de estas variables que nos servirá como punto de referencia para valorar el riesgo cardiovascular en nuestra población

Objective: The aim of this study was to establish the reference values of the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check (QUICKI) indexes, as well as those of insulin and C-peptide levels in healthy children and adolescents with a view to determining reference percentiles to detect those at cardiovascular risk. Material and methods: A total of 372 children boys and girls of different ages and at distinct pubertal stages with normal body mass index participated in the study. Fasting glucose, insulin and C-peptide values were measured by chemiluminescence and the HOMA and QUICKI indexes were calculated. Results: Fasting glucose levels were normal in all children. The mean values obtained for each variable were (mean (SD)): fasting glucose 87(7.75) mg/dL, insulin 7.74 (5.35) mcU/mL, C-peptide: 1.76 (0.79) ng/mL, HOMA index 1.72 (1.27) and QUICKI index 0.72 (0.29). All the variables progressively increased with age, with statistically significant differences between prepubertal and pubertal children. The QUICKI index showed an inverse relationship. In addition, significant differences were found between sexes. The 90th percentile for all the variables was as follows: insulin 15.05 mcU/mL, C-peptide: 2.85 ng/mL, HOMA index 3.43 and QUICKI index 1.10. Conclusions: Values of fasting glucose, insulin, C-peptide and the HOMA index significantly increased with age and pubertal stage, while the QUICKI index decreased. We defined the 90th percentile for all the parameters studied as the cut-off point to identify children at cardiovascular risk in our population

Fluorouracil-based chemotherapy in patients with gastrointestinal malignancies: influence of nutritional folate status on toxicity.

This study aimed to prospectively evaluate the potential influence of folate status on the toxicity induced by 5-fluorouracil (5-FU)-based chemotherapy in patients with gastrointestinal tumors. 105 patients with colorectal, pancreatic or gastric cancer were entered into the study. Treatment regimens consisted of bolus 5-FU/leucovorin or infusional 5-FU combined with cisplatin. Baseline homocysteine, vitamin B(12) and folic acid serum levels were determined in all patients. Univariate and multivariate logistic regression models were used to identify predictive factors for toxicity. Univariate analysis showed a significant association between older age, low BSA, gastric/pancreatic cancer and treatment with 5-FU/cisplatin and the incidence of grade 3-4 hematological toxicity, and between female sex, low BSA and gastric/pancreatic cancer and the incidence of severe non-hematological toxicity. Variables that retained independent prognostic value in the multivariate model were tumor type, chemotherapy schedule and BSA for both hematological and non-hematological toxicities. Baseline homocysteine, vitamin B(12) or folate status were not significant predictors of any kind of toxicity either according to univariate or multivariate analysis. This study failed to demonstrate a significant association between a patient s nutritional folate status and the toxicity induced by fluoropyrimidine-based chemotherapy in a cohort of patients with various gastrointestinal malignancies.

[Values of thyrotropin, free triiodothyronine and free thyroxine using chemiluminescence in children and adolescents in the Autonomous Community of Madrid (Spain)]. / Valores de tirotropina, triyodotironina libre y tiroxina libre en niños y adolescentes en la Comunidad Autónoma de Madrid mediante quimioluminiscencia.

OBJECTIVE: To establish the reference ranges of thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) with the chemiluminescence method in healthy children and adolescents in Madrid, Spain. METHOD: A total of 371 children and adolescents of both sexes, with different ages and at different pubertal stage participated in the study. Serum values of TSH, FT3, and FT4 were determined by chemiluminescence. RESULTS: TSH, FT4 and FT3 reference ranges decreased inversely with chronological age. Significant differences were found between prepubertal and pubertal groups. In some groups, there were also occasional differences between sexes. CONCLUSIONS: Thyroid hormone levels decrease with chronological age. Because of the differences in hormone levels between prepubertal and pubertal subjects, we believe that different pubertal stages should be included in the standard reference values of these hormones.

[Once-daily gentamicin dosing versus thrice-daily dosing in infants with acute pyelonephritis]. / Gentamicina en dosis única diaria frente a tres dosis diarias en lactantes con pielonefritis aguda.

BACKGROUND: Once-daily dosing (ODD) of gentamicin is advocated as an effective and safe treatment of Gram-negative bacterial infections in adults. There are insufficient data in the literature to justify its use in infants. OBJECTIVES: To compare the efficacy of ODD of gentamicin with that of classical thrice-daily (t.i.d.) administration in infants with acute pyelonephritis. METHODS: We performed a quasi-experimental study comparing 33 infants who received ODD of gentamicin with a historical control group of 25 infants treated with gentamicin t.i.d. Leukocytosis, C-reactive protein, creatinine, gentamicin dose, peak and trough values, time required for disappearance of fever, and outcome were analyzed. RESULTS: The mean doses of gentamicin (mg/kg/day) were higher in the t.i.d. group (6.4 1.14) than in the ODD group (5.06 0.22; p < 0.001). Peak serum gentamicin concentrations (micro g/ml) were significantly higher in the ODD group (9.32 1.4) than in the t.i.d. group (5.09 1.15; p < 0.001). Mean trough gentamicin concentrations (micro g/ml) were lower in the ODD group than in the t.i.d. group (0.23 0.26 vs 0.78 0.45; p 0.001). There were no significant differences in the duration of fever between the groups (30.64 32 hours in the t.i.d. group vs. 28.57 32 hours in the ODD group). Serum creatinine levels were normal during treatment in both groups. In all patients outcome was good and no adverse effects were noted. CONCLUSIONS: Treatment with ODD of gentamicin in our population of infants with acute pyelonephritis was as effective as traditional administration t.i.d. and possibly was equally safe or safer.

Gentamicina en dosis única diaria frente a tres dosis diarias en lactantes con pielonefritis aguda / Once-daily gentamicin dosingversus thrice-daily dosing in infants with acute pyelonephritis

Antecedentes. La gentamicina en dosis única diaria se considera un tratamiento seguro y eficaz en adultos para las infecciones por gérmenes gramnegativos. Existen escasos datos en la literatura que justifiquen su uso en lactantes. Objetivos. Comparar la eficacia del tratamiento de la pielonefritis aguda en lactantes con gentamicina en única dosis diaria (UDD) frente a la pauta clásica de tres dosis diarias (TDD).Métodos. Estudio cuasi experimental en el que se compara el grupo de intervención tratado con gentamicina en UDD frente a una cohorte histórica de niños tratados con TDD. Se analizan leucocitosis, proteína C reactiva (PCR), creatinina, dosis de gentamicina, niveles pico y valle, tiempo necesario para la desaparición de la fiebre y evolución clínica. Resultados. Se estudian 58 lactantes con edades entre 1 y 20 meses. Veinticinco de ellos recibieron gentamicina TDD y 33 gentamicina UDD. La dosis de gentamicina en el grupo TDD fue algo superior que en el tratado con UDD 6,4+/- 1,14 mg/kg/día y 5,06+/-0,22 mg/kg/día, respectivamente; p < 0,001). El nivel pico de gentamicina fue superior en el grupo UDD (9,32+/- 1,4 g/ml) que en el grupo TDD (5,09+/- 1,15 g/ml) con p < 0,0001. Los niveles valle fueron inferiores en el grupo UDD que en TDD (0,23+/- 0,26 g/ml frente a 0,78+/- 0,45 g/ml, respectivamente; p= 0,001). No se encontraron diferencias en el tiempo necesario para la desaparición de la fiebre; 30,64+/- 32 h en el grupo TDD y 28,57+/-32 h en el grupo UDD. Los valores de creatinina durante el tratamiento fueron normales en ambos grupos. La evolución fue buena en todos los pacientes y no se observaron efectos secundarios. Conclusiones. El tratamiento con gentamicina en UDD en nuestra población de lactantes con pielonefritis aguda es tan eficaz como el TDD tradicional y, posiblemente, igual o incluso más seguro (AU)

Valores de tirotropina, triyodotironina libre y tiroxina libre en niños y adolescentes en la Comunidad Autónoma de Madrid mediante quimioluminiscencia / Values ofthyrotropin, free triiodothyronine and freethyroxine using chemiluminescence in children and adolescents inthe Autonomous Community of Madrid. Spain

Objetivo. El objetivo del presente trabajo ha sido establecer los valores de referencia de las hormonas tiroideas (tirotropina [TSH], triyodotironina [T3] libre y tiroxina [T4] libre) mediante quimioluminiscencia en niños y adolescentes de la Comunidad Autónoma de Madrid. Método. 371 niños y adolescentes de ambos sexos, diferentes edades y estadios puberales, participaron en este estudio. Los valores de TSH y T3 y T4 libres en suero se determinaron mediante quimioluminiscencia. Resultados. Los valores de TSH y T4 y T3 libres descienden de forma inversamente proporcional a la edad cronológica con diferencias significativas entre los grupos prepuberales y puberales. Existen, además, diferencias puntuales entre sexos en algunos grupos. Conclusiones. Los valores de las hormonas tiroideas disminuyen con la edad cronológica. A la vista de las diferencias en los valores de estas hormonas entre sujetos prepuberales y puberales consideramos necesario incluir los diferentes estadios puberales en la estandarización de estas hormonas (AU)

[Focal myositis: report of a case in pediatric age and review of the literature]. / Miositis focal: a propósito de un caso en edad pediátrica y revisión de la literatura.

INTRODUCTION AND CLINICAL CASE: We present the case of a 13 years old boy with a year-old history of a painful tumour on the external and distal third of the right thigh. The imaging tests suggested a soft tissue tumour but the muscle biopsy revealed the typical findings of focal myositis. Focal myositis is a benign inflammatory pseudotumour of the skeletal muscle recognized as a distinct clinicopathological entity, but there have been descriptions of the cases initially diagnosed as focal myositis that have latter behaved as evident polymyositis. We have not found laboratory data to support a diagnosis of polymyositis in our patient. CONCLUSION: Although focal myositis is considered a self-limited disease, we believe a long-term clinical and biochemical follow-up is warranted, to confirm the absence of recurrence signs and/or the development of a generalized myopathy.

[Type C hereditary brachydactyly]. / Braquidactilia hereditaria tipo C.

We report 2 generations with type C hereditary brachydactyly of dominant autosomal inheritance of variable expressiveness. The most characteristic data was the shortening of the middle phalanges of the second, third and fifth finger as well as the first metacarpal. Short stature was observed in three of the patients studied. The goal of this study was aimed at stimulating GH pharmacologically and determining its 24 h physiologic secretion, as well as somatomedin C levels. All the determinations were within the normal range. The deficient growth shown by these patients is a constitutional growth delay, possibly an expression of type C brachydactyly.