Estándares de crecimiento infantiles: ¿cuáles son los más adecuados? / Growth charts: which are the appropriate?

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[Hidden renal failure and drug prescription in hospitalized patients]. / Insuficiencia renal oculta y prescripción de fármacos en pacientes hospitalizados.

OBJECTIVE: Equations used to estimate glomerular filtarion rate (GFR) are useful to detect "hidden" renal failure (RF) ( coexistence of normal serum creatinine together with GFR < 60 ml/mto/1.73 m2 ). The aim of this study was to analyze the prevalence of this phenomenon in hospitalized patients and how this affects drugs prescription. PATIENTS AND METHOD: 567 patients admitted to the internal medicine section of Barbastro Hospital (Huesca, Spain) during a three months period (april-june 2006) were included. GFR was estimated applying abbreviated MDRD equation. By means of logistic regression analysis we analyzed the factors associated with the presence of "hidden" RF. We also recorded the potentially dangerous drugs prescribed at discharge from hospital. RESULTS: Prevalence of "Hidden" RF was 10.8 %. NKF chronic kidney disease stages 3.4 or 5 were present in 35.2 % of patients. Variables associated with presence of "hidden" RF were age (expB = 1.035; IC95% 1.012 - 1.060; p = 0.004) and female sex (expB = 4.669; IC95% 2.461 - 8.856; p < 0.0001). Only in 1.8 % of cases GFR was calculated during hospitalisation period. A considerable number of patients with "hidden" RF received treatment with potentially dangerous drugs taking into account his degree of renal failure. CONCLUSIONS: Our results support the introduction of GFR estimation by means of MDRD equation in laboratory reports.

Insuficiencia renal oculta y prescripción de fármacos en pacientes hospitalizados / Hidden renal failure and drug prescription in hospitalized patients

Fundamento y objetivo: Con la utilización de fórmulas para el cálculo de la tasa de filtrado glomerular se puede detectar la presencia de la denominada Insuficiencia renal “oculta” (IRO) (coexistencia de cifras de creatinina sérica normales junto con un aclaramiento inferior a 60 mL/min/1,73 m2). El objetivo de este estudio fue analizar la prevalencia de IRO en pacientes hospitalizados y como ello repercute en la prescripción de fármacos. Pacientes y método: Se incluyeron 567 pacientes ingresados en la Sección de Medicina Interna del Hospital de Barbastro (Huesca) en un periodo de tres meses (abril-junio de 2006). Se cálculo el FG aplicando la fórmula MDRD abreviada. Mediante regresión logística se analizaron los factores asociados a la presencia de IRO. Se registraron los fármacos potencialmente peligrosos prescritos en el informe de alta. Resultados: La prevalencia de IRO se situó en el 10,8%. El 35,2% de la muestra presentaba un estadio de enfermedad renal crónica grado 3, 4 ó 5 según los criterios de la National Kidney Foundation (NKF). Las variables que se asociaron con la presencia de IRO fueron la edad (expB = 1,035; IC95% 1,012 – 1,060; p = 0,004) y el sexo femenino (expB = 4,669; IC95% 2,461 – 8,856; p < 0,0001). En sólo el 1,8 % de los pacientes se calculó el aclaramiento de creatinina durante el ingreso. Un número considerable de pacientes con IRO recibieron tratamiento con fármacos potencialmente perjudiciales dado su grado de función renal. Conclusiones: Nuestros resultados apoyan que se introduzca el filtrado glomerular estimado mediante la fórmula MDRD en los informes de los laboratorios como medida de la función renal

Objetive: Equations used to estimate glomerular filtarion rate (GFR) are useful to detect “hidden” renal failure (RF) ( coexistence of normal serum creatinine together with GFR < 60 ml/mto/1.73 m2 ). The aim of this study was to anayze the prevalence of this phenomenon in hospitalized patients and how this affects drugs prescription. Patients and method: 567 patients admitted to the internal medicine section of Barbastro Hospital (Huesca, Spain) during a three months period (april-june 2006) were included. GFR was estimated applying abreviated MDRD equation. By means of logystic regresion analysis we analyzed the factors associated with the presence of “hidden” RF. We also recorded the potentialy dangerous drugs prescibed at discharge from hospital. Results: Prevalence of “Hidden” RF was 10.8 %. NKF cronic kidney disease stages 3.4 or 5 were present in 35.2 % of patients. Variables asociated with presence of “hidden” RF were age (expB = 1.035; IC95% 1.012 – 1.060; p = 0.004) and female sex (expB = 4.669; IC95% 2.461 – 8.856; p < 0.0001). Only in 1.8 % of cases GFR was calculated during hospitalitation period. A considerable number of patients with “hidden” RF received treatment with potentialy dangerous drugs taking into account his degree of renal failure. Conclusions: Our results support the introduction of GFR estimation by means of MDRD equation in laboratory reports

[Secular trends of body adipose tissue in prepubertal children]. / Tendencia secular del tejido adiposo corporal en niños prepúberes.

OBJECTIVE: To determine whether there is a significant difference between anthropometric measurements of prepubertal children and the measurements of another sample with similar characteristics, studied fifteen years ago. MATERIAL AND METHODS: We studied 859 children, 453 males and 406 females, from the age of 5.0 to 10.0 years. Weight, height, arm circumference and skinfold thicknesses in the biceps, triceps, subscapular and suprailiac were determined. Body mass index, body density, total fat and percentage fat were calculated and their values compared with those obtained 15 years ago in 1,617 children with similar characteristics. Difference between means were calculated with Student's single-sample t-test. RESULTS: Weight increased in all the ages, with significant differences in males at 7, 8 and 9 years (p<0.001) and in females after the age of 6 years (p< 0.05). Height significantly increased at all ages and in both sexes, except in females at the age of 5 years. Body mass index increased only at the ages of 8 and 9 years in males (p<0.01). Skinfold thicknesses significantly increased in both sexes and at all ages (p<0.05). Body density decreased (p<0.01) and body fat increased, both in kilograms and in percentage (p<0.01). CONCLUSIONS: During the 15 years studied, height and weight increased significantly. Body mass index did not increase significantly, whereas body fat (skinfold thicknesses and fat compartment) significantly increased.

Amebiasis intestinal y absceso hepático amebiano

La amebiasis es una parasitosis producida por la Entamoeba histolytica, de gran prevalencia en países tropicales. La transmisión de la enfermedad es por vía fecal-oral o bien de forma indirecta, mediante el agua de bebida o ingesta de alimentos contaminados. La afectación intestinal cursa con síndrome disentérico, fundamentalmente, y la hepática mediante la formación de absceso amebiano. El diagnóstico se fundamenta en la visualización del parásito en heces, en pruebas serológicas y en técnicas de imagen en los casos de absceso hepático. El tratamiento más efectivo es mediante metronidazol (AU)

Tendencia secular del tejido adiposo corporal en niños prepúberes / Secular trends of body adipose tissue in prepubertal children

Objetivo : Demostrar si existe diferencia significativa entre las medidas antropométricas de niños prepúberes con las medidas de otra muestra de parecidas características estudiada 15 años antes. Material y métodos Se han estudiado 859 niños, 453 varones y 406 mujeres, de 5,0-10,0 años de edad. Se han determinado en ellos peso, talla, perímetro del brazo izquierdo y pliegues cutáneos de bíceps, tríceps, subescapular y suprailíaco. También se han calculado el índice de masa corporal, densidad corporal, grasa total y porcentaje de grasa. Sus valores se han comparado con los obtenidos hace 15 años en 1.617 niños de similares características. Estadística: cálculo de la diferencia entre medias mediante el test de la t de Student para datos no apareados. Resultados El peso se ha incrementado en todas las edades, con diferencias significativas en varones de 7, 8 y 9 años (p < 0,001) y a partir de los 6 años en mujeres (p < 0,05). La talla se ha incrementado significativamente en todas las edades y en ambos sexos, excepto en las mujeres de 5 años. El índice de masa corporal sólo se ha incrementado a los 8 y 9 años en varones (p < 0,01) y los pliegues cutáneos han aumentado significativamente en ambos sexos en todas las edades (p < 0,05). La densidad corporal ha disminuido (p < 0,01) y la grasa corporal se ha incrementado, tanto en porcentaje como en kilos totales (p < 0,01). Conclusiones Se evidencia un aumento significativo de la talla y el peso a lo largo de los 15 años estudiados. Se demuestra que el índice de masa corporal, en conjunto, no se ha aumentado significativamente, mientras que se observa un aumento de la grasa corporal, objetivado por un aumento significativo de los pliegues cutáneos y del compartimiento graso corporal (AU)

[Secular increase of adipose tissue in adolescents from Zaragoza from 1980 to 1995]. / Incremento secular del tejido adiposo en adolescentes zaragozanos desde 1980 hasta 1995.

BACKGROUND: To quantify the differences between anthropometric measurements obtained nowadays in male and female adolescents and those obtained 15 years ago in a sample of similar characteristics. SUBJECTS AND METHODS: We have studied 658 healthy individuals, 329 males and 329 females from 10.0 to 15.0 years of age, from different socioeconomic levels. Weight, height, arm circumference and left skinfold thickness (biceps, triceps, subscapular and suprailiac) have been measured. We have calculated the body mass index (BMI), density, total body fat, percentage of body fat and the body adipose muscular index (BAMI), which is the ratio between body fat (kg) and non fat mass (kg). The values obtained have been compared with those obtained fifteen years ago, in another sample of 1,465 children with similar characteristics. The research team and the material used were the same in both studies. Mean differences were compared using the unpaired t-test. RESULTS: Weight has increased significantly (p < 0.05), except for males at 12 years and females at 13 and at 14 years. Height has increased significantly at all ages and in males and females (p < 0.05). BMI has only increased significantly at 10 and at 11 years in males, and at 10 years in females. Skinfold thicknesses have also increased significantly, except for biceps in males between ages of 12 and 14 years and biceps and subscapular in females at 14 years. Body fat mass and percentage of body fat have also increased significantly and, in consequence, the density has decreased and BAMI has increased both significantly (p < 0.05). CONCLUSIONS: Secular increase in weight and height during fifteen years has occurred. In general, BMI has not increased but skinfold thicknesses and body fat have increased significantly, this fact demonstrates that there has been increase in the body fat compartment.

[Assessment of the submandibular adipose skinfold for the determination of a nutritional status in children and adolescents]. / Valoración del pliegue adiposo submandibular para la determinación del estado nutricional en la infancia y adolescencia.

OBJECTIVE: The aim of this study was to show the validity of a new skinfold thickness for measuring nutritional status in children. We also compare submandibular skinfold thickness with other anthropometric measures and indices. PATIENTS AND METHODS: We have studied 899 boys and 837 girls between 3.0 and 15.1 years of age. All of them were healthy and from different socioeconomic statuses. We measured weight, height, obesity indices, circumferences, indices of body fat distribution and indices of body fat. Data were divided according to age and sex. We calculated the percentiles of submandibular skinfold thickness and correlations between this parameter and all other measurements were performed. The mean values of the two sexes were compared by using Student's t-test. RESULTS: Submandibular skinfold is an easy and fast skinfold to measure. Its value is maximum at 10 and 11 years in girls and boys, respectively. This measurement is higher in girls than in boys at 5, 7, 10, 13 and 14 years of age (p < 0.05). There was a high correlation between this skinfold value and almost all of the measurements and indices studied, especially with the body mass index (r = 0.589), the sum of the four conventional skinfolds (r = 0.844), arm circumference (r = 0.513), arm fat area (r = 0.776) and percentage body fat (r = 0.830). CONCLUSIONS: Submandibular skinfold thickness in children and adolescents shows a high correlation with body fat indices. It is for this reason that it could be used as a new measurement to assess nutritional status and obesity in children.

[Bone maturation in obese Aragonese children of both sexes]. / Estudio de la maduración ósea en niños obesos aragoneses de ambos sexos.

OBJECTIVE: To analyze the relation between height and bone maturation in obese children in Aragón. MATERIAL AND METHODS: A group of 86 obese children (36 boys, 50 girls) was studied. Height, weight, cranial circumference, skinfold thickness, Quetelet's index, body fat percentage, total body fat and lean body mass were determined. Bone maturation was calculated according to the three variants of TW2-Aragón method. RESULTS: The patients showed an increase of bone maturation on the three system scores, independently of sex or sexual maturation stage; being the RCC score the most discriminative. Increase of bone maturation was significantly correlated with increase of height (p < 0.001). Regression analysis showed in boys and girls (prepubertal and pubertal) a high statistical significance between bone maturation and anthropometrics parameters estimating body fat (weight, skinfold thickness, total body fat and indices). CONCLUSIONS: The obese children of our study showed an increase of height (p < 0.001) in relation with increase of bone age. Increase of both, bone maturation and height, were significantly correlated with adiposity indices estimating body fat.

[Blastocystis hominis and abdominal pain in childhood]. / Blastocystis hominis y dolor abdominal en la infancia.

We report the clinical features observed in 10 children, ranging from 5 1/12 to 13 7/12 years of age, with intestinal infections caused by Blastocystis hominis. A parasitological study of the stools was made by using the ethyl-acetate formol concentration technique and a count of the number of B. hominis per field was performed. In 8 of the cases, no other enteropathogens (viruses, bacteria or other parasites) were found, whereas in 2 cases Giardia lamblia was also isolated. Nine out of ten of the patients presented with abdominal pain. In three of the cases it appeared as a pseudo-appendicular ailment which led to an appendectomy. Those children who were treated with metronidazole and those who were not treated with antibiotic recovered satisfactorily.

[Salmonellosis in infancy and childhood: epidemiologic aspects]. / Salmonelosis en la infancia: aspectos epidemiológicos.

Diarrheic processes from an infectious origin constitute a frequent pathology during childhood. We have analyzed, from a epidemiological point of view, a series of 117 children diagnosed as having diarrhea and having stool cultures bacteriologically positive for Salmonella. Special reference has been made to the epidemiological chain of this infection. Of the patients studied, 68 (58.2%) were boys and 49 (41.8%) were girls. Their ages ranged between 1 month and 14 years. An epidemiological environment was recognized in 34.1% of the cases. The most frequent serotype was Salmonella Enteritidis (72.6%).

[Diet-induced changes as risk factors in obese children: arterial pressure, glycoregulation and lipid profile]. / Modificaciones inducidas por la dieta de algunos factores de riesgo en niños obesos: presión arterial, glucorregulación y perfil lipídico.

In 52 both sex obese children (mean age was 9.7 +/- 2.5), blood pressure and biochemistry parameters in blood were studied after controlled hypocaloric diet. The data, collected in two out patient visits in intervals of one year and half and four years, were: blood pressure; total, HDL and LDL cholesterol; apoproteins A1 and B; NEFA; triglycerides; phospholipids; haematocrit; haemoglobin; glycosylated haemoglobins A1 and A1C; glucose; insulin; seric proteins: fibrinogen; platelets; Quick time and activated partial thromboplastin time. The group of obese children with a successful response to the hypocaloric diet treatment (significant loss of weight) showed a decrease in the plasmatic levels of Apoproteins A1 and B, triglycerides, NEFA and insulin together with an increase in the level of HDL cholesterol. These changes weren't so significant in the group of obese children who didn't lose weight. When we took into account plasmatic cholesterol, the obese patients with normal plasmatic level of cholesterol showed a significant descend in the risk factors. However, in the obese children with high cholesterol despite the dietetic treatment, the pathologic plasmatic profile didn't show any change. Finally, while the group with maintained high level of insulin showed a significant increase of apoproteins A1 and B, and total and HDL cholesterol, the group where the insulin levels became normal after treatment showed a good development of the biochemistry parameters studied. The fibrinogen level and blood precision which remained high in both visits were studied taking into account age and growth pattern.