[Blood pressure variability in 24 hours in obese and non-obese adolescents with breast development 4 and 5 of Tanner's criteria]. / Variabilidad de la presión arterial en 24 horas en adolescentes obesas y no-obesas con desarrollo mamario 4 y 5 de los criterios de Tanner.

OBJECTIVE: The aim of the study was to investigate the blood pressure variability during 24 h by using ambulatory blood pressure monitoring (ABPM) in a group of obese and non-obese female adolescents with breast development status 4 and 5 of Tanner´s criteria. METHODS: A cross-sectional study was conducted at the Cardiovascular Research Institute, Mexico. All subjects underwent 24 h non-invasive ABPM recording device. Pubertal status was determined by breast development. MEASUREMENTS: office systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Height, weight, body mass index (BMI), waist and hip circumferences, arm circumference, waist to hip ratio (W/H), and skinfold thickness measurements: triceps, subscapular, abdominal and supraspinal. RESULTS: Fifty-nine adolescents 13-16 years old; 29 obese (BMI 31.2±4.0), and 30 non- obese (BMI 21.2±2.2). Obese vs. non-obese: Office SBP 116.9 vs. 105.9±9.3 mmHg (p<0.001); ABPM in 24 h: SBP 113.8±6.3 vs. 107.6±5.7 mmHg (p<0.001); diurnal SBP 117.3 mmHg vs. 111.2 mmHg (p<0.001); nocturnal SBP 105.5±8 vs. 99.4 mmHg; absolute variability in 24 h DBP 10.0±1.8 vs. 8.7±1.5 (p<0.003); coefficient of variation 24 h DBP 17.3±3 vs. 15.4±2.6% (p<0.05); systolic non-dipper 16 (55.2%) vs. 9 (30%) (p<0.05); pulse pressure 24 h 49.3±8 vs. 43.5±9 mmHg (p<0.01). CONCLUSION: Obese adolescents are presenting changes in BP variability during 24-h in comparison with nonobese adolescents; it also includes higher pulse pressure. Thus, these can be early indicators for the development of hypertension or other cardiovascular diseases in the adult life.

Variabilidad de la presión arterial en 24 horas en adolescentes obesas y no-obesas con desarrollo mamario 4 y 5 de los criterios de Tanner / Blood pressure variability in 24 hours in obese and non-obese adolescents with breast development 4 and 5 of Tanner's criteria

Objetivo: Investigar el comportamiento de la presión arterial (PA) mediante monitoreo ambulatorio de la presión arterial (MAPA) en 24 h en un grupo de adolescentes obesas y no-obesas con estadios mamarios de Tanner 4 y 5. Métodos: Estudio transversal realizado en el Instituto de Investigación Cardiovascular en México, incluyendo 64 adolescentes entre 13 a 16 años de edad con estadios mamarios 4 o 5 de la clasificación de Tanner. Se midió PA en la oficina, frecuencia cardiaca (FC), índice de masa corporal (IMC), índice cintura-cadera, circunferencia de brazo, pliegues cutáneos tricipital, subescapular, abdominal y supraespinal. Se analizaron PA con MAPA en 24 h en obesas y no-obesas. Resultados: Cincuenta y nueve adolescentes, 29 obesas (IMC 31,2 ± 4,0) y 30 no-obesas (IMC 21,2 ± 2,2). Obesas vs no-obesas PAs en la oficina 116,9 vs 105,9 ± 9,3 mmHg (p < 0,001); MAPA en 24 h: PAS 113,8 ± 6,3 vs 107,6 ± 5,7 mmHg (p < 0,001); PAS diurno 117,3 mmHg vs 111,2 mmHg (p < 0,001); PAS nocturna 105,5 ± 8 vs 99,4 mmHg; variabilidad absoluta en 24 h PAD 10,0 ± 1,8 vs 8,7 ± 1,5 (p < 0,003); coeficiente de variación en 24 h PAD 17,3 ± 3 vs 15,4 ± 2,6% (p < 0,05); No-descendedores sistólicos 16 (55,2%) vs 9 (30%) (p < 0,05); presión de pulso en 24 h 49,3 ± 8 vs 43,5 ± 9 mmHg (p < 0,01). Conclusión: Cambios tempranos en la variabilidad de la PA en 24 h en adolescentes obesas, incluyendo presión de pulso, pudieran ser indicadores importantes para hipertensión arterial y riesgo cardiovascular en la edad adulta (AU)

Objective: The aim of the study was to investigate the blood pressure variability during 24 h by using ambulatory blood pressure monitoring (ABPM) in a group of obese and non-obese female adolescents with breast development status 4 and 5 of Tanner´s criteria. Methods: A cross-sectional study was conducted at the Cardiovascular Research Institute, Mexico. All subjects underwent 24 h non-invasive ABPM recording device. Pubertal status was determined by breast development. Measurements: office systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Height, weight, body mass index (BMI), waist and hip circumferences, arm circumference, waist to hip ratio (W/H), and skinfold thickness measurements: triceps, subscapular, abdominal and supraspinal. Results: Fifty-nine adolescents 13-16 years old; 29 obese (BMI 31.2 ± 4.0), and 30 non- obese (BMI 21.2 ± 2.2). Obese vs. non-obese: Office SBP 116.9 vs. 105.9 ± 9.3 mmHg (p < 0.001); ABPM in 24 h: SBP 113.8 ± 6.3 vs. 107.6 ± 5.7 mmHg (p < 0.001); diurnal SBP 117.3 mmHg vs. 111.2 mmHg (p < 0.001); nocturnal SBP 105.5 ± 8 vs. 99.4 mmHg; absolute variability in 24 h DBP 10.0 ± 1.8 vs. 8.7 ± 1.5 (p < 0.003); coefficient of variation 24 h DBP 17.3 ± 3 vs. 15.4 ± 2.6% (p < 0.05); systolic non-dipper 16 (55.2%) vs. 9 (30%) (p < 0.05); pulse pressure 24 h 49.3 ± 8 vs. 43.5 ± 9 mmHg (p < 0.01). Conclusion: Obese adolescents are presenting changes in BP variability during 24-h in comparison with nonobese adolescents; it also includes higher pulse pressure. Thus, these can be early indicators for the development of hypertension or other cardiovascular diseases in the adult life (AU)

Clinical decision rules to distinguish between bacterial and aseptic meningitis.

BACKGROUND: Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations. AIMS: To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules. METHODS: All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been included in a retrospective cohort study. Sensitivity and specificity were calculated by applying each rule to the patients. The best rule was a priori defined as the one yielding 100% sensitivity for bacterial meningitis, the highest specificity, and the greatest simplicity for a bedside application. RESULTS: Among the 166 patients included, 20 had bacterial meningitis and 146 had aseptic meningitis. Although three rules achieved 100% sensitivity (95% CI 84-100), one had a significantly lower specificity (13%, 95% CI 8-19) than those of the other two rules (57%, 95% CI 48-65; and 66%, 95% CI 57-73), which were not statistically different. The ease of manual computation of the rule developed by Nigrovic et al (a simple list of five items: seizure, blood neutrophil count, cerebrospinal fluid (CSF) Gram stain, CSF protein, CSF neutrophil count) was higher than the one developed by Bonsu and Harper. CONCLUSION: On our population, the rule derived by Nigrovic et al had the best balance between accuracy and simplicity of manual computation and could help to avoid two thirds of unnecessary antibiotic treatments and hospitalisations.

Single-crystal (57)Fe Q-band ENDOR study of the 4 iron-4 sulfur cluster in its reduced [4Fe-4S](1+) state.

(57)Fe Q-band ENDOR has been used to study the [4Fe-4S](1+) state created by gamma irradiation of single crystals of the synthetic model compound [N(C(2)H(5))(4)](2)[Fe(4)S(4)(SCH(2)C(6)H(5))(4)] enriched in (57)Fe. This compound is an excellent biomimetic model of the active sites of many 4 iron-4 sulfur proteins, enabling detailed and systematic studies of its oxidized [4Fe-4S](3+) and reduced [4Fe-4S](1+) paramagnetic states. Taking advantage of the fact that Q-band ENDOR, in contrast with X-Band ENDOR, allows for a very good separation of the (57)Fe transitions from those of the protons, the complete hyperfine tensors of the four iron atoms for the [4Fe-4S](1+) species has been measured with precision. For each iron atom, the electron orbital and electron spin isotropic contributions have been determined separately. Moreover, it is remarkable that two (57)Fe hyperfine tensors attributed to the ferrous pair of iron atoms are very different. In effect, one tensor presents a much larger anisotropic part and a much smaller isotropic part than those of the other. This difference has been interpreted in terms of a differential electron orbital hyperfine interaction among the two ferrous ions.

[Treatment with LHRH analogues in girls with precocious puberty does not improve final height. Longitudinal study compared with a control group]. / El tratamiento con análogos de la LHRH en la pubertad avanzada de la niña no modifica la talla final. Estudio longitudinal frente a un grupo control.

BACKGROUND: We analysed the effectiveness of therapy with LHRH analogues in girls with a puberty onset at age 8 years. PATIENTS AND METHOD: We performed a non-randomised clinical study of 32 girls with advanced puberty. These included 16 treated with triptorelin LHRH analogue(3.75 mg/month during 1 year) and 16 control subjects. We carried out anthropometric measurements and determined the pubertal height growth (gain in height from the puberty onset up to the final height) and the pubertal duration (time in years from the puberty onset up to the age at which final height is attained). RESULTS: Treatment with LHRH analogue delayed the menarche age (11.5 [1.46]vs 10.37 [0.67] years of age; p = 0.03), led to an involution in secondary sexual characteristics and a temporary decrease ingrowth rate, and delayed skeletal maturation. However, pubertal duration, pubertal height growth and final height were all similar in both groups. In addition, no significant differences in body fat mass were observed. CONCLUSIONS: Treatment with LHRH analogues in advanced puberty modifies pubertal development, without modifying pubertal duration or pubertal height growth. Furthermore, this treatment does not improve final height.

[Testosterone treatment of delayed puberty: a longitudinal study in relation to a control group]. / Tratamiento con testosterona en la pubertad diferida: estudio longitudinal en relación a un grupo control.

OBJECTIVE: Delayed puberty is a very common clinical situation that affects a great number of adolescents. We analyzed the effects that testosterone therapy produces in this situation, including the start of puberty and, therefore, lessening the psychological effects that this delay causes. PATIENTS AND METHODS: We carried out a longitudinal study, in which we followed the growth and maturation of 32 boys from the age of 14 to 19 years. The sample was divided into a control group (n = 17) and a treatment group (n = 15). The treatment group received 50 mg/month of testosterone enantate depot during 6 months. None of the subjects, neither in the control group nor in the treatment group, had started puberty or if so, they had started it in an insufficient way for their age. RESULTS: The boys treated with testosterone developed a greater growth velocity compared to the control group during the first year of observation (9.07 +/- 1.11 cm/year vs 6.9 +/- 1.76, respectively, p < 0.0001). They had a higher increment in the muscular area of the arm (p < 0.005) and pubertal stage G changes occurred more quickly. On the other hand, the growth of the testicular volume was similar in both groups. At 19 years of age, no significant difference between the groups was observed in any of the clinical parameters studied. CONCLUSIONS: Treatment wit testosterone at the dose used promotes a significant response that leads to the start of puberty, but without stopping the maturation of the hypothalamic-pituitary axis that is produced in normal puberty, allowing a normal testicular evolution. The treatment does not show any long-term effects. It is, therefore, an effective treatment of delayed puberty.