Results and analysis of an intercomparisons study for individual monitoring services of Latin American and Caribbean regions.

The aim of this paper is to present the results obtained by the Latin-American and Caribbean personal dosimetry services that participated, with the support of IAEA, in the 2020-Eurados whole-body dosemeter intercomparison for photon radiation. All participant services in this study use thermoluminescent dosimetry (TLD) systems except one that uses optically stimulated luminescence (OSL) dosemeters. Data analysis shows that 93.4% of the results are within the acceptance range, according to International ISO Standard ISO 14146: 2018. The evaluation of the trumpet curves shows that only three laboratories presented a few dosemeters results outside the limits of acceptability. Participation in this Eurados intercomparison exercise gave the Latin American and Caribbean laboratories the opportunity to show compliance with their own quality management system, to compare results with other participants and to develop plans for improving their dosimetry systems. It also gave the assurance that occupational doses are being measured properly and following the international standards in the regions.

Tiroiditis de Hashimoto: manifestaciones clínicas, bioquímicas y su asociación con enfermedades autoinmunes y no autoinmunes / Hashimoto's thyroiditis: clinical and biochemical manifestations and their association with autoimmune and non-autoimmune diseases

Introducción: la tiroiditis de Hashimoto es la causa más frecuente de disfunción tiroidea en niños, con una incidencia del 1 al 2%. Esta enfermedad autoinmune suele estar relacionada con otras patologías. El objetivo es determinar si existen asociaciones en pacientes pediátricos con tiroiditis de Hashimoto tanto clínicas, como bioquímicas, con otras enfermedades para establecer directrices para su detección y tratamiento oportuno. Material y métodos: estudio observacional descriptivo y transversal en un periodo de 15 años de pacientes con diagnóstico de tiroiditis de Hashimoto menores de 15 años que llevaron seguimiento en la Unidad Médica de Alta Especialidad #25 de Monterrey, Nuevo León, México. Se analizaron variables como antecedentes heredofamiliares de enfermedad tiroidea, autoinmune o neoplásica, sexo, edad, motivo de consulta, función tiroidea en el momento del diagnóstico y la presencia de comorbilidades autoinmunes y no autoinmunes. Resultados: se analizaron 110 pacientes. El motivo de consulta más frecuente en el momento del diagnóstico fue una detección casual de hormona estimulante de la glándula tiroides (TSH) elevada. El 80% debutó con un hipotiroidismo franco bioquímico. El 26% de los pacientes presentó una segunda enfermedad autoinmune no tiroidea, donde predominó la diabetes mellitus tipo 1 en un 18% y, con menor frecuencia, otras como vitíligo, lupus eritematoso sistémico y enfermedad de Addison. La obesidad fue la comorbilidad no autoinmune más frecuente. Conclusiones: los pacientes pediátricos con tiroiditis de Hashimoto tienen alto riesgo de presentar una enfermedad autoinmune no tiroidea, principalmente diabetes mellitus tipo 1. Se encontró que los pacientes en edad pediátrica de sexo masculino con tiroiditis de Hashimoto tienen alto riesgo de desarrollar una enfermedad autoinmune no tiroidea (AU)

Introduction: Hashimoto thyroiditis is the most frequent cause of thyroid dysfunction in children, with an incidence of 1 to 2%. This autoimmune disease is usually associated with other pathologies. The objective of the study was to determine whether Hashimoto thyroiditis (clinical or biochemical) is associated with other diseases in paediatric patients, and to establish guidelines for early detection and treatment.Material and methods: we conducted a cross-sectional observational and descriptive study over a 15-year period in patients with Hashimoto thyroiditis aged less than 15 years managed by Specialty Care Unit #25 in a north-eastern region in Mexico. We analysed variables such as the familial clustering or history of thyroid, autoimmune or malignant disease, sex, age, reason for seeking medical care, thyroid function at diagnosis and the presence of autoimmune and non-autoimmune comorbidities.Results: the sample included 110 patients. The most frequent reason for seeking care at the time of diagnosis was the chance detection of TSH elevation. Eighty percent had onset with overt biochemical hypothyroidism. Twenty-six percent of patients had an associated non-thyroid autoimmune disease, most frequently type 1 diabetes mellitus, found in 18%, followed by others such as vitiligo, systemic lupus erythematosus and Addison disease. Obesity was the most frequent non-autoimmune comorbidity.Conclusions: paediatric patients with Hashimoto thyroiditis are at high risk of non-thyroid autoimmune disease, chiefly type 1 diabetes mellitus. We found that male paediatric patients with Hashimoto thyroiditis were at high risk of having non-thyroid autoimmune disease. (AU)

Dental care and risk of developing severe COVID-19 / Atención odontológica y el riesgo de complicación por COVID-19

RESUMEN Durante la pandemia por la COVID-19 la atención odontológica fue recomendada solo en casos de urgencia y dolor. La reducción de citas dentales puede afectar la economía de los dentistas, principalmente la de aquellos que no cuentan con seguridad financiera. Los odontólogos por necesidades económicas requieren brindar atención a pesar del riesgo de ser infectados por SARS-COV-2. Objetivo : Describir la frecuencia de la atención odontológica y el riesgo de complicación por COVID-19 en odontólogos de Ixtlahuaca, Estado de México, México. Material y métodos : Estudio transversal, muestreo no probabilístico desarrollado desde agosto hasta septiembre de 2020. Se aplicó un cuestionario por redes sociales para identificar la frecuencia de la atención odontológica. Resultados: La muestra estuvo conformada por 121 odontólogos; el promedio de edad fue de 32,3 años. La mayor parte de la muestra estuvo conformada por mujeres (74,4 %). Los odontólogos mostraron un riesgo medio a desarrollar complicaciones por COVID-19 (92,5 %). Los odontólogos de práctica privada realizaron más tratamientos no urgentes durante el semáforo epidemiológico rojo y naranja, mostrando diferencias estadísticamente significativas (p ≤ 0,05). El 30 % de la muestra presentó un peso no saludable. Conclusiones : Los odontólogos tienen un riesgo medio a enfermar gravemente por COVID-19. El riesgo se encuentra asociado al peso no saludable. Los odontólogos realizaron tratamientos no urgentes a pesar de las recomendaciones gubernamentales. Los profesionales de práctica privada realizaron una mayor cantidad de tratamientos no urgentes. Los dentistas brindan atención a pesar del riesgo epidemiológico por COVID-19 debido a las necesidades económicas.

ABSTRACT During the COVID-19 pandemic, dental care was recommended only in urgent and severe pain cases. Reduced dental appointments may affect the financial situation of dentists, especially those who are not financially secure. Due to economic necessity, dentists are required to provide care despite the risk of being infected with SARS-COV-2. Objective: To describe the frequency of dental care and the risk of complications due to COVID-19 among dentists in Ixtlahuaca, State of Mexico, Mexico. Material and methods: Cross-sectional study, non-probabilistic sampling carried out from August to September 2020. A survey was carried out through social networks to identify the frequency of dental care. Results: The sample consisted of 121 dentists with an average age of 32.3 years. Women comprised most of the sample (74.4%). Dentists had a medium risk of suffering complications due to COVID-19 (92.5%). Private practice dentists performed more non-urgent treatments during the red and orange epidemiological risk periods, showing statistically significant differences (p≤0.05). Unhealthy weight was present in 30% of the sample. Conclusions: Dentists have a medium risk of becoming seriously ill from COVID-19. The risk is associated with unhealthy weight. Dentists performed non-urgent treatments despite government recommendations. Private practitioners performed a greater number of non-urgent treatments. Dentists provide care despite epidemiological risk related to COVID-19 due to economic necessity.

Multimorbilidad y resultados clínicos de una población pediátrica con sospecha de COVID-19 atendida en un hospital mexicano / Multimorbidity and clinical results of a pediatric population with suspected COVID-19 treated in a Mexican hospital

Resumen Introducción: Datos de varios países del mundo sugieren que los niños con COVID-19 podrían presentar síntomas diferentes y menos graves que los adultos. Sin embargo, los patrones epidemiológicos y clínicos en este grupo poblacional son poco claros. Métodos: El presente es un estudio observacional, con una caracterización inicial transversal-analítica, y con un componente longitudinal o de seguimiento a un grupo de menores con sospecha y/o diagnóstico confirmado de COVID-19, que presentaron desenlaces como mejoría, traslado a un nivel superior de atención o defunción por sintomatología respiratoria. Los niños recibieron atención médica en el Hospital General Regional con Medicina Familiar N.° 1 (HGR C/MF N.° 1), y se les realizó prueba de reacción en cadena de la polimerasa en tiempo real (RT-PCR). Resultados: Se estudiaron 98 niños como casos sospechosos para COVID-19, a quienes se les realizó RT-PCR. Del total, 24 resultaron positivos y 74 fueron negativos. La mediana de edad de los participantes fue 64,4 meses (0 a 203 meses), 55 menores eran de sexo masculino, 59 niños tuvieron manejo ambulatorio, y de estos, 14 presentaron resultado positivo. Entre los que requirieron manejo hospitalario (39), 10 niños dieron positivo para SARS-CoV-2, 84,7% alcanzaron mejoría y fueron dados de alta, 4 fueron trasladados a hospitales de nivel superior de atención. De los 98 niños en estudio, 11 fallecieron, 7 con resultado negativo y 4 con resultado positivo para SARS-CoV-2. Conclusiones: Los principales síntomas de la población pediátrica en este estudio fueron fiebre, tos y malestar general. De los niños que fallecieron, 4 presentaron resultado positivo para SARS-CoV-2, no obstante, estos presentaban otras comorbilidades.

Abstract Introduction: Data from several countries around the world suggest that children with COVID-19 may present different and less severe symptoms than adults. However, the epidemiological and clinical patterns in this population group have been unclear. Methods: This is an observational study, with an initial cross-analytical characterization, and with a longitudinal or follow-up component in a group of minors with suspected and or confirmed case of COVID-19, which have outcomes such as improvement, transfer to a higher level of care or death due to respiratory symptoms. The children received medical attention at the Regional General Hospital with Family Medicine No 1 (HGR C / MF No 1), and underwent a Real Time Polymerase Chain Reaction test (RT-PCR). Results: 98 children were studied as suspected cases for COVID-19, who underwent RT-PCR. Of the total 24 were positive and 74 were negatives. The median age was 64.4 months (0 to 203 months), 55 minors were male, 59 children had outpatient management, and of these, 14 had a positive result. Among those who required hospital management (39), 10 children were positive for SARS-CoV-2, 84.7% achieved improvement and were discharged, and four were transferred to a higher level of care hospital. Of the 98 children in the study, 11 died, seven had a negative result and four a positive result for SARS-CoV-2. Conclusions: The main symptoms of the pediatric population in this study were fever, cough and general discomfort. Four of those who died had a positive result for SARS-CoV-2, however, they had other comorbidities.

Correlation between skinfold thickness and bioelectrical impedance analysis for the evaluation of body composition in patients on dialysis.

INTRODUCTION: Patients on dialysis have important changes in body composition. OBJECTIVES: To determine the correlation between skinfold thickness (SKF) and bioimpedance analysis (BIA) for estimating fat mass (FM) and lean body mass (LBM) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). METHODS: Cross-sectional study. We included 50 patients under dialysis treatment. To measure SKF, we used the Lange® skinfold caliper (Beta Technology, California, USA) and we carried out the impedance analysis with the Bodystat Quadscan 4000® (Quadscan, Isle of Man, UK). The measurements were performed post-hemodialysis. The PD patients were measured with and without peritoneal dialysate and body weight was corrected for peritoneal fluid. We determined the Pearson's correlation coefficient between SKF and BIA for estimating FM and LBM. We also evaluated the influence of age, sex, diuretic use, dialysis vintage, extracellular water (ECW), and intracellular water (ICW) through a multivariate regression analysis. RESULTS: Of the 50-patient total, 29 were men (58%) and patient mean age was 46.3 ± 16.5 years. The correlation between SKF and BIA was r = 0.784 (p < 0.001) for FM and r = 0.925 (p < 0.001) for LBM. Age and sex influenced the variability of FM, whereas sex, age, and ECW influenced the variability of LBM, both evaluated through the SKF and BIA methods. CONCLUSION: SKF and BIA are useful methods in clinical practice. The strong and statistically significant correlations between the two methods show they are interchangeable. Age, sex, ECW, and ICW influence the variability of FM and LBM.

Correlation between skinfold thickness and bioelectrical impedance analysis for the evaluation of body composition in patients on dialysis / Correlación entre la plicometría y el análisis de bioimpedancia eléctrica para la evaluación de la composición corporal en pacientes en diálisis

Introduction: Patients on dialysis have important changes in body composition. Objectives: To determine the correlation between skinfold thickness (SKF) and bioimpedance analysis (BIA) for estimating fat mass (FM) and lean body mass (LBM) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Methods: Cross-sectional study. We included 50 patients under dialysis treatment. To measure SKF, we used the Lange® skinfold caliper (Beta Technology, California, USA) and we carried out the impedance analysis with the Bodystat Quadscan 4000® (Quadscan, Isle of Man, UK). The measurements were performed post-hemodialysis. The PD patients were measured with and without peritoneal dialysate and body weight was corrected for peritoneal fluid. We determined the Pearson’s correlation coefficient between SKF and BIA for estimating FM and LBM. We also evaluated the influence of age, sex, diuretic use, dialysis vintage, extracellular water (ECW), and intracellular water (ICW) through a multivariate regression analysis. Results: Of the 50-patient total, 29 were men (58%) and patient mean age was 46.3 ± 16.5 years. The correlation between SKF and BIA was r = 0.784 (p < 0.001) for FM and r = 0.925 (p < 0.001) for LBM. Age and sex influenced the variability of FM, whereas sex, age, and ECW influenced the variability of LBM, both evaluated through the SKF and BIA methods. Conclusion: SKF and BIA are useful methods in clinical practice. The strong and statistically significant correlations between the two methods show they are interchangeable. Age, sex, ECW, and ICW influence the variability of FM and LBM (AU)

Introducción: los pacientes en tratamiento con diálisis presentan cambios importantes en la composición corporal. Objetivos: determinar la correlación entre la plicometría y el análisis de bioimpedancia eléctrica (BIE) para la estimación de la masa grasa (MG) y la masa magra (MM) en pacientes sometidos a hemodiálisis (HD) y diálisis peritoneal (DP). Métodos: diseño transversal-analítico. Se incluyeron 50 pacientes en tratamiento con diálisis. Se utilizó el plicómetro Lange® (Beta Technology, California, USA) para la medición de pliegues cutáneos y la BIE fue realizada con el Bodystat Quadscan 4000 ® (Quadscan, Isle of Man, UK). Las mediciones fueron realizadas poshemodiálisis. Los pacientes en DP fueron medidos con y sin líquido peritoneal y el peso corporal fue corregido. Determinamos el coeficiente de correlación de Pearson entre la plicometría y la BIE en la estimación de la MG y la MM. Se evaluaron otras variables como edad, sexo, uso de diuréticos, tiempo en tratamiento de diálisis, agua extracelular (AEC) e intracelular (AIC) a través de un análisis de regresión multivariada. Resultados: veintinueve pacientes (58%) son del sexo masculino; la edad promedio de 46,3 ± 16,5 años. Se obtuvo una correlación significativa y positiva entre la plicometría y la BIE [r = 0,784 (p < 0,001) para MG y r = 0,925 (p < 0,001)] para MM. La edad y el sexo influyeron en la variabilidad de la MG, mientras que el sexo, la edad y el AEC influyeron en la variabilidad de la MM, evaluados con ambos métodos. Conclusiones: la plicometría y la BIE son métodos útiles en la práctica clínica. La correlación que se obtuvo entre los dos métodos muestra que son intercambiables. Por otro lado, variables como la edad, el sexo, el agua AEC y AIC se identificó que influyen en la variabilidad de la MG y MM (AU)

Deep Water Running na redução da gordura corporal e aumento da força muscular em mulheres obesas: estudo piloto / Deep water running on body fat reduction and increased muscle strength in obese women: pilot study

Introdução: DWR-IT é um método de treinamento que visa melhorar a capacidade funcional, aptidão física e qualidade de vida, além de contribuir para controle da obesidade. Objetivo: investigar a influência do DWR-IT na composição corporal, circunferência abdominal, qualidade de vida, capacidade funcional, força e resistência muscular em mulheres obesas de meia idade. Método: trata-se de um estudo piloto de ensaio clínico não controlado, do tipo antes e depois. Foi avaliada a circunferência abdominal, a composição corporal e aplicados 6MWT, CST, ACT e IWQOL-LITE pré e pós-intervenção em sete mulheres obesas de meia idade. O período da intervenção foi de 10 semanas com frequência de três dias por semanas. Resultados e Discussão: houve redução da circunferência abdominal (de 94,71 ± 8,32 cm para 88,43 ± 6,29cm) e da massa gorda (29,50 ± 4,35 kg para 26,47 ± 4,85 kg),aumento da força e resistência muscular dos membros superiores (de 12,86 ±3,44 para 22,71 ±5,71 repetições) e inferiores (de10, 43 ± 2,30 para 14,14±2,67 repetições) e melhora nos domíniosfunção física (de 38,0; 37,0 - 45,0 para 47,00; 46,0 -49,50) e autoestima (de 27,00; 26,50-27,50 para 30,00; 28,0-33,00) do questionário IWQOL-LITE. Conclusão: 10 semanas de DWR-IT foramefetivas em promover melhora da composição corporal, da força eresistência muscular, da função física, da autoestima e melhoras em relação ao sobrepeso e obesidade.

Introduction: DWR-IT is a training method that aims to improve functional capacity, physical fitness and quality of life, in addition to contribute to the control of obesity. Objective: the objective was to investigate the influence of DWR-IT on body composition, abdominal circumference, quality of life, functional capacity, strength and muscular endurance in obese middle-aged women. Methods: this is a pilot study of an uncontrolled clinical trial, before and after. Abdominal circumference, body composition, and the application of 6MWT, CST, ACT and IWQOL-LITE were evaluated before and after intervention in seven obese middle-aged women. The intervention period lasted 10 weeks with a frequency of three days per week. Results and Discussion: there was a reduction in abdominal circumference (94.71 ± 8.32 cm for 88.43 ± 6.29 cm) and fat mass (29.50 ± 4.35 kg for 26.47 ± 4.85 kg), increase of muscle strength and endurance of the upper limbs (from 12.86 ± 3.44 to 22.71 ± 5.71 repetitions) and lower limbs (from 10.43 ± 2.30 to 14.14 ± 2.67 repetitions) and improvement in the physical function domains (from 38.0; 37.0 - 45.0 to 47.00; 46.0 - 49.50) and self-esteem (from 27.00 to 26.50-27.50 for 30.00; 28.0-33.00) in the IWQOL-LITE questionnaire. Conclusion: ten weeks of DWR-IT were effective to promote the improvement of body composition, strength and muscular endurance, physical function and self-esteem, and the improvement in overweight and obesity.

Respostas agudas glicêmicas e cardiovasculares do Deep Water Running em mulheres obesas / Glycemic and cardiovascular acute responses of Deep Water Running in obese women

Introdução: Deep Water Running no sistema de treinamento intervalado (DWR-STI) é um método de treinamento e reabilitação física que pode contribuir para o controle dos fatores de risco da obesidade. Objetivo: investigar as respostas agudas imediatas pós-sessão de DWR-STI na glicemia capilar, pressão arterial (PA) e frequência cardíaca (FC) em mulheres obesas. Métodos: participaram 14 voluntárias obesas, com idade de 50,28 ± 4,24 anos. Foram realizados testes da glicemia capilar, medidas da PA e FC pré e pós-sessão de DWR-STI. Resultados: houve diferença nos valores da glicemia capilar pré e pós-sessão (de 102,36 ± 27,19 mg/dl para 84,64 ± 10,48 mg/dl). Conclusão: conclui-se que uma sessão de DWR-STI reduz a glicemia capilar em mulheres obesas. Contudo, ainda são necessários mais estudos para tentar desvendar os mecanismos e as respostas fisiológicas agudas imediatas do DWR-STI nas variáveis cardiovasculares e na glicemia capilar.

Introduction: Deep Water Running in the interval training system (DWR-ITS) is a method of training and physical rehabilitation that can contribute to the control of the risk factors of obesity. Objective: investigate the immediate post-session DWR-ITS acute responses in capillary glycemia, blood pressure (BP) and heart rate (HR) in obese women. Methods: participants were 14 obese volunteers, aged 50.28 ± 4.24 years. Capillary glycemia tests were performed, measurements of BP and HR pre and post-session of DWR-ITS. Results: there was a difference in pre and post-session capillary glycemia values (from 102.36 ± 27.19 mg/dl to 84.64 ± 10.48 mg/ dl). Conclusion: it is concluded that a DWR-STI session reduces capillary glycemia in obese women. However, further studies are needed to better understand the mechanisms of physiological immediate responses after DWR-STI in cardiovascular and capillary glycemia variables.

Alteraciones puberales en adolescentes con leucemia en fase de vigilancia.

OBJECTIVE: To evaluate which factors are associated with alterations in pubertal development in pediatric patients with leukemia in the surveillance phase. METHOD: A case-control study was carried out, including patients aged 8-14 years with diagnosis of acute lymphoblastic leukemia under surveillance. Demographic data were collected, age at diagnosis, type of leukemia, risk of leukemia, duration and type of treatment received, time of surveillance phase; and pubertal development was assessed by Tanner stage, bone age, pelvic ultrasound for women, and LH levels. Fisher's exact test and Mann-Whitney U-test were used. RESULTS: Twenty-five pediatric patients with a diagnosis of acute lymphoblastic leukemia between 8 and 14 years of age with a median of 8 were included, only 4 (16%) presented pubertal alterations, 1 had pubertal delay and 3 advanced puberty. The history of radiotherapy was related to pubertal alterations (p = 0.03). CONCLUSIONS: The antecedent of having received radiotherapy as part of the treatment in patients with acute lymphoblastic leukemia is a risk factor for developing pubertal abnormalities.

[Factors associated with advanced thyroid cancer in pediatric patients in a high specialty medical unit in Northeast Mexico]. / Factores asociados a estadios avanzados de cáncer tiroideo en pacientes pediátricos de una UMAE del noreste de México.

INTRODUCTION: Thyroid cancer represents 2% of all childhood malignances. Its incidence rises 1.1% per year. In comparison with adults, childhood thyroid cancer is detected in a more advanced stage, but with a survival rate above 95%. The objective of this study was to evaluate whether there are factors associated with advanced stages of thyroid cancer in pediatric patients. RESULTS: Nineteen patients were included, 13 (68.4%) were female and six male, all between 7-15 years, with a median of 11 years. Fifteen in advanced and four in early stage. The median age of patients in advanced stage at time of diagnosis was 10.6 years (7-15) and 13.2 (12-14) were in early stage (p=0.075). There was a delay of nine months to get a diagnosis in advanced stage, and 7.2 in early stage (p=0.931). Three of the patients with advanced stage and two with early stage were from Nuevo León (Mexico) and the rest were foreign (p=0.567). In the group with advanced stage, two had thyroid cancer familiar history, and none in the early stage group (p=0.452). Nine patients in advanced stage and three in early stage presented thyroid nodule as the first sign of illness. Six patients in advanced stage and one in early stage presented goiter (p=0.590). None of the studied patients had radiation history. Six patients in advanced stage and one in early stage suffered from Hashimoto's Thyroiditis (p=0.590). Eleven in advanced stage and one in early stage had papillary histologic variety. Four in advanced stage and three in early stage had papillary histologic variety with a follicular patter (p=0.083). Eight patients presented lung metastasis at time of diagnosis (p=0.061). CONCLUSIONS: There are no factors associated with advanced stage thyroid cancer in pediatric populations. Although half of studied patients presented lung metastasis, treatment response and survival is satisfactory.

Muscular dystrophies at different ages: metabolic and endocrine alterations.

Common metabolic and endocrine alterations exist across a wide range of muscular dystrophies. Skeletal muscle plays an important role in glucose metabolism and is a major participant in different signaling pathways. Therefore, its damage may lead to different metabolic disruptions. Two of the most important metabolic alterations in muscular dystrophies may be insulin resistance and obesity. However, only insulin resistance has been demonstrated in myotonic dystrophy. In addition, endocrine disturbances such as hypogonadism, low levels of testosterone, and growth hormone have been reported. This eventually will result in consequences such as growth failure and delayed puberty in the case of childhood dystrophies. Other consequences may be reduced male fertility, reduced spermatogenesis, and oligospermia, both in childhood as well as in adult muscular dystrophies. These facts all suggest that there is a need for better comprehension of metabolic and endocrine implications for muscular dystrophies with the purpose of developing improved clinical treatments and/or improvements in the quality of life of patients with dystrophy. Therefore, the aim of this paper is to describe the current knowledge about of metabolic and endocrine alterations in diverse types of dystrophinopathies, which will be divided into two groups: childhood and adult dystrophies which have different age of onset.