Using Kisspeptin to Predict Pubertal Outcomes for Youth With Pubertal Delay.

CONTEXT: The management of youth with delayed puberty is hampered by difficulty in predicting who will eventually progress through puberty and who will fail to attain adult reproductive endocrine function. The neuropeptide kisspeptin, which stimulates gonadotropin-releasing hormone (GnRH) release, can be used to probe the integrity of the reproductive endocrine axis. OBJECTIVE: We sought to determine whether responses to kisspeptin can predict outcomes for individuals with pubertal delay. DESIGN, SETTING, AND PARTICIPANTS: We conducted a longitudinal cohort study in an academic medical center of 16 children (3 girls and 13 boys) with delayed or stalled puberty. INTERVENTION AND OUTCOME MEASURES: Children who had undergone kisspeptin- and GnRH-stimulation tests were followed every 6 months for clinical evidence of progression through puberty. Inhibin B was measured in boys. A subset of participants underwent exome sequencing. RESULTS: All participants who had responded to kisspeptin with a rise in luteinizing hormone (LH) of 0.8 mIU/mL or greater subsequently progressed through puberty (n = 8). In contrast, all participants who had exhibited LH responses to kisspeptin ≤ 0.4 mIU/mL reached age 18 years without developing physical signs of puberty (n = 8). Thus, responses to kisspeptin accurately predicted later pubertal outcomes (P = .0002). Moreover, the kisspeptin-stimulation test outperformed GnRH-stimulated LH, inhibin B, and genetic testing in predicting pubertal outcomes. CONCLUSION: The kisspeptin-stimulation can assess future reproductive endocrine potential in prepubertal children and is a promising novel tool for predicting pubertal outcomes for children with delayed puberty.

Multimodal Endovascular approach in a Case of Multiple Dural Arteriovenous Fistulae.

Dural arteriovenous fistulae (DAVF) are vascular abnormalities in which arteriovenous shunts are contained in between the periosteal and meningeal lamellae of the dura matter. Rarely, multiple DAVF are diagnosed in a single patient; occurring in only about 8% of the diagnosed cases. We describe a rare presentation of DAVF in a patient with multiple DAVF, at 3 separate sites within the cranial cavity; associated with a medical history of two traumatic motor-vehicle accidents, total anomalous pulmonary venous return (TAPVR), and acquired aplastic anemia. We describe our approach in the treatment of this complex condition.

Metformin in tuberculosis: beyond control of hyperglycemia.

Two global epidemics, diabetes mellitus (DM) and tuberculosis (TB), have converged making their control even more challenging. We herein have reviewed metformin's (MTF) effect on patients with active and latent TB, as well as discussed its newly discovered biological mechanisms in mycobacteria. Mounting evidence suggests that MTF provides better outcomes in TB patients, especially those with DM. The mechanisms by which MTF produces its benefits are multiple. Though metformin's potential has been proven in patients with DM, larger and more thorough clinical trials, in DM and non-DM-TB patients, need to be conducted. MTF could be added to the arsenal of anti-TB drugs, aiding in the goal of TB eradication worldwide.

Comics as a Medium for Parent Health Education: Improving Understanding of Normal 9-Month-Old Developmental Milestones.

Multimodal literacy, a product of modern technology, can aid in the recall of simple-to-complex information for both children and adults. Health education information presented using educational comics takes advantage of multimodal formats and designs based on theoretical models of learning. In this study, we utilized a quasi-experimental design with both pre- and post-intervention testing. The parents of every other patient that attended the well-child appointments of their child aged <9 months were invited to participate in this study. Participants were drawn from three pediatric clinics, with a total of 280 parents included in the study. Each parent completed a pre-intervention test consisting of an eight-item questionnaire regarding the developmental milestones of a 9-month-old child. After responding to the questionnaire, the parents received a comic about a 9-month-old child reaching age-appropriate developmental milestones. Four to six weeks after the comics were provided to the parents, they responded to the same questionnaire by phone, which consisted of the same eight questions plus an additional question regarding possible additional uses of the comic. Parents significantly increased their recall of information of developmental milestones when the pre- and post-intervention test results were compared, with a significance of p < 0.001 at a 95% confidence level. Additional uses of the comic reported by parents included calling their pediatrician with doubts about their own child's appropriate achievement of milestones, and lending the comics to relatives or friends. The educational comic appeared to assist parents in making meaningful connections between the simplified pictures and the developmental milestones of their child. Comics may provide an alternative for parental education using this multimodal format to explain simple-to-complex issues.

Developing Trans-Affirming Health Services in an Underserved Area: An Intersectional Approach.

Purpose: Gender-nonconforming patients are at higher risk for medical problems that require prompt medical and mental health intervention. Barriers to healthcare for transgender individuals have been well characterized in the literature, but not in low resource settings. The purpose of this paper is to present the barriers encountered when bringing healthcare to transgender children, adolescents, and adults in a medically underserved, predominantly Hispanic area of the United States. Methods: In this medically underserved area on the U.S.-Mexico border, there is a severe shortage of medical expertise for transgender individuals at both the primary- and specialty-care levels. Further, given the mainly Hispanic population, there is an additional culturally based barrier to obtaining medical care for transgender patients. Results: It is important for academic centers in these regions to collaborate to overcome these barriers through a multidisciplinary approach that includes providing education for medical students and physicians in training and identifying medical providers who are able and willing to provide transgender-competent care adapted to local culture and gender norms. Conclusion: In this manuscript, we will describe the efforts of various groups to address the needs of the transgender community in the region.

The Short Child.

Growth is one of the most important characteristics of human development. This process occurs from the moment of conception through the final stages of puberty. There are multiple factors that contribute to growth in humans. Although it may seem complex, a pediatrician should note that growth can be fairly predictable. The advantage to predictable changes in growth is that clinicians should be able to promptly detect any deviation and evaluate it in a timely manner. One of the most helpful tools to assess changes in growth is the use of a growth chart. This article provides the clinician with the necessary tools to identify growth abnormalities, investigate appropriately to arrive at an accurate diagnosis, and either treat or, when indicated, provide a timely referral to a pediatric endocrinologist. [Pediatr Ann. 2018;47(1):e29-e35.].

Programmed cell death-1, PD-1, is dysregulated in T cells from children with new onset type 1 diabetes.

BACKGROUND: Programmed death cell 1 (PD-1) is an inhibitor of T cell activation and is also functionally linked to glycolysis. We hypothesized that PD-1 expression is defective in activated T cells from children with type 1 diabetes (T1D), resulting in abnormal T cell glucose metabolism. METHODS: In this pilot study, we enrolled children with new onset T1D within 2 weeks of diagnosis (T1D), unaffected siblings of T1D (SIBS), unaffected, unrelated children (CTRL), children with new onset, and untreated Crohn disease (CD). We repeated the assays 4-6 months post-diagnosis in T1D (T1D follow up). We analyzed anti-CD3/-CD28-stimulated peripheral blood mononuclear cells (PBMC) subsets for PD-1 expression by flow cytometry at baseline and after 24 h in culture. We measured cytokines in the culture medium by multiplex ELISA and glycolytic capacity with a flux analyzer. RESULTS: We enrolled 37 children. T cells derived from subjects with T1D had decreased PD-1 expression compared to the other study groups. However, in T1D follow-up T cells expressed PD-1 similarly to controls, but had no differences in PBMC cytokine production. Nonetheless, T1D follow up PBMCs had enhanced glycolytic capacity compared to T1D. CONCLUSIONS: Activated T cells from T1D fail to upregulate PD-1 upon T-cell receptor stimulation, which may contribute to the pathogenesis of T1D. T1D follow up PBMC expression of PD-1 normalizes, together with a significant increase in glycolysis compared to T1D. Thus, insulin therapy in T1D children is associated with normal PD1 expression and heightened glycolytic capacity in PBMC.

Microbiome Changes during Tuberculosis and Antituberculous Therapy.

The critical role of commensal microbiota in the human body has been increasingly recognized, and our understanding of its implications in human health and disease has expanded rapidly. The lower respiratory tract contains diverse communities of microbes known as lung microbiota, which are present in healthy individuals and in individuals with respiratory diseases. The dysbiosis of the airway microbiota in pulmonary tuberculosis (TB) may play a role in the pathophysiological processes associated with TB disease. Recent studies of the lung microbiome have pointed out changes in lung microbial communities associated with TB and other lung diseases and have also begun to elucidate the profound effects that antituberculous drug therapy can have on the human lung microbiome composition. In this review, the potential role of the human microbiome in TB pathogenesis and the changes in the human microbiome with Mycobacterium tuberculosis infection and TB therapy are presented and discussed.

Percepción de la imagen corporal y su relación con el estado nutricional y emocional en escolares de 10 a 13 años de tres escuelas en Barranquilla (Colombia) / Perception of body image and its relationship to the nutritional and emotional state in schoolchildren 10-13 years of three schools in Barranquilla (Colombia)

Resumen Objetivo: evaluar la percepción de la imagen corporal y su relación con el estado nutricional y emocional en escolares de 10 a 13 años en tres colegios públicos de Barranquilla. Materiales y métodos: estudio descriptivo transversal, en muestra de 262 escolares de tres colegios públicos. Previo consentimiento informado de padres y asentimiento de participantes, se tomaron mediciones biométricas y realizaron encuestas, empleando cuestionario de factores sociodemográficos, Test Krece Plus sobre hábitos alimentarios y de Actividad Física, Escala de Autoestima de Rosemberg, cuestionario Goldberg para ansiedad y depresión y test de las siluetas para imagen corporal. Resultados: La media de edad fue de 11.39 años (± 1.11) y el 61.5 % varones. El 22,6 % de la población presentó distorsión en su imagen corporal; el 67,8 % de los adolescentes con imagen distorsionada tuvo un Índice de Masa Corporal normal; de ellos, el 21.8 % tuvo malos hábitos alimentarios y el 17.2 % malos hábitos de actividad física; las alteraciones emocionales se presentaron en un 8.8 % baja autoestima, en un 7.3 % ansiedad y en un 6.9 % depresión. Se obtuvo tendencia en la asociación como factor determinante con el sexo masculino (p=0.008) y protector para la actividad fisca (p=0.000) y el IMC bajo (p=0.000) Conclusiones: Predominó la adecuada percepción de imagen corporal. La distorsión fue mayor en hombres, en el estado nutricional normal, los inadecuados hábitos alimentarios y de actividad física y autoestima baja. Hubo tendencia a la asociación con el sexo masculino, protector para la actividad física y el IMC bajo.

Abstract Objective: To evaluate the perception of body image and its relationship to the nutritional and emotional status in school children 10-13 years in three public schools in Barranquilla. Methods: Cross-sectional study in a sample of 262 students from three public schools. Prior informed consent of parents and assent of participants, and biometric measurements were taken surveys conducted using: a questionnaire on sociodemographic factors, test Krece Plus on eating habits and physical activity, Rosenberg Self Esteem Scale, Goldberg questionnaire for anxiety and depression and test for body image silhouettes. Results: Mean age was 11.39 years (± 1.11) and 61.5% were male. 22.6% of the population showed distorted body image; 67.8% of adolescents had a distorted image index normal weight, of which 21.8% had poor eating habits and 17.2%, poor physical activity habits; emotional disturbances occurred in 8.8% low self esteem, anxiety, 7.3% and 6.9% depression. Trend was obtained in the association as a factor in males (p = 0.008), and protection for Fisca activity (p = 0.000) and low BMI (p = 0.000) Conclusions: The prevailing perception of appropriate body image. The distortion was higher in men, in the normal nutritional status, inadequate food and physical activity habits and low self esteem. There was a trend toward association with the male protector for physical activity and low BMI.

Direct Coexistence Methods to Determine the Solubility of Salts in Water from Numerical Simulations. Test Case NaCl.

The solubility of NaCl, an equilibrium between a saturated solution of ions and a solid with a crystalline structure, was obtained from molecular dynamics simulations using the SPC/E and TIP4P-Ew water models. Four initial setups on supersaturated systems were tested on sodium chloride (NaCl) solutions to determine the equilibrium conditions and computational performance: (1) an ionic solution confined between two crystal plates of periodic NaCl, (2) a solution with all the ions initially distributed randomly, (3) a nanocrystal immersed in pure water, and (4) a nanocrystal immersed in an ionic solution. In some cases, the equilibration of the system can take several microseconds. The results from this work showed that the solubility of NaCl was the same, within simulation error, for the four setups, and in agreement with previously reported values from simulations with the setup (1). The system of a nanocrystal immersed in supersaturated solution was found to equilibrate faster than others. In agreement with laser-Doppler droplet measurements, at equilibrium with the solution the crystals in all the setups had a slight positive charge.

Modified colloidal primitive model as a homogeneous surface charge distribution: ζ-potential.

An integral equations theory is derived and applied to a modified colloidal primitive model (MCPM), for finite concentration colloidal dispersions. In MCPM, the charge on the colloidal particle is assumed to be smeared on its surface. We find important quantitative and qualitative differences of the ζ-potential, induced charge, and the colloid-colloid electric effective force, calculated in the MCPM, with those obtained from the colloidal primitive model (CPM), where the colloidal charge is assumed to be in the center of the particle, in spite of the fact that, due to Gauss's law, both models have the same particle distribution function. In particular, for the same parameters, while the ζ-potential is positive in MCPM, is negative in the CPM, implying opposite electrophoretic mobilities, µ. An inverse µ has been theoretically predicted in the past, for infinite dilution colloidal dispersions. The MCPM could be a better model for some colloidal particles. In both models, the CPM and the MCPM, it is found a very long-range colloid-colloid correlation, in accordance with previous Monte Carlo simulations. The electrostatic, as well as entropic, like-charged colloid-colloid forces are oscillatory, implying a long-range attraction.

Polarity inversion of ζ-potential in concentrated colloidal dispersions.

A concentrated colloidal dispersion is studied by applying an integral equations theory to the colloidal primitive model fluid. Important effects, attributed to large size and charge and to the finite concentration of colloidal particles, are found. We observe a polarity inversion of ζ-potential for concentrated colloidal dispersions, while it is not present for a single colloidal particle at infinite dilution. An excellent qualitative agreement between our theoretical predictions and our computer simulations is observed.