Alteraciones craneofaciales en niños y adolescentes obesos

El crecimiento y desarrollo craneofacial implica la interacción de factores locales y sistémicos, tales como la genética, la disponibilidad de nutrientes, las fuerzas musculares y parafunciones 1. Aunque el papel de las alteraciones hormonales inherentes a la obesidad en la niñez y adolescencia sobre el crecimiento pondoestatural es bastante conocido, se ha estudiado poco los efectos de la obesidad sobre el crecimiento craneofacial

Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality

Obesity as a thrombogenic and cardiovascular risk factor in children

A obesidade leva a um risco maior de fenômenos tromboembólicos em adultos. Poucos estudos avaliaram a relação de obesidade com risco trombogênico na infância. O objetivo desse trabalho foi avaliar o estado pró trombótico de crianças obesas e comparar com crianças saudáveis, além de comparar a evolução das variáveis metabólicas e de hemostasia após perda de peso e correlacionar com as seguintes adipocinas: leptina e adiponectina. Foram realizados Teste de Geração de Trombina, Fibrinogênio, Dímero D, além de parâmetros metabólicos, em 72 crianças pré púberes, 47 obesas e 25 eutróficas. Foi encontrado um aumento significante da geração de trombina, fibrinogênio, dímero D e dislipidemia entre os pacientes obesos, confirmando a hipótese de que um estado pró trombótico em crianças obesas já se inicia na fase pré púbere. Ao comparar as variáveis pré e após perda de peso observamos diminuição na geração de trombina, diminuição do dímero D, assim como melhora nos marcadores metabólicos. Houve correlação positiva entre o Índice de massa corpórea e as variáveis hemostáticas, porém não encontrado correlação com insulina. A adiponectina foi a adipocina com melhor correlação com os marcadores pró trombóticos, confirmando sua importância antitrombótica já na infância. O IMC mostrou-se mais relevante do que a resistência insulínica como fator trombogênico. Medidas preventivas contra a obesidade, além de tratamento precoce devem ser iniciados já na infância para proteção de eventos trombóticos e cardiovascularesObesity leads to increased risk of thromboembolic events in adults but few studies have addressed the relationship between obesity and thrombogenic risk during childhood. The aim of this study was to evaluate the prothrombotic state of obese children in comparison to healthy children. We also studied the effect of weight loss on metabolic and hemostatic variables, and how it correlates with the levels of two major adipokines, leptin and adiponectin. Thrombin generation, fibrinogen, and D-dimer levels, along with metabolic parameters, were measured in 72 prepubertal children, of which 47 were obese, and 25 eutrophic. A significant increase in thrombin generation, fibrinogen, D-dimer, and dyslipidemia was found among obese patients, confirming the hypothesis that a prothrombotic state develops early in life, during prepubertal phase. Comparison of variables before and after weight loss showed a reduction in thrombin generation and D-dimer values, and an improvement in metabolic markers, associated with weight loss. There was a positive correlation between body mass index (BMI) and hemostatic variables, although no correlation was found between BMI and insulin. Adiponectin was more strongly associated with prothrombotic markers than leptin, supporting its key anti-thrombotic role already in childhood. In addition, BMI was shown to be a more important prothrombotic risk factor than insulin resistance. Our findings highlight the importance of implementing childhood obesity preventive measures, in addition to early treatment strategies, in order to protect children from thromboembolic event

Endocrine dysfunction associated with anorexia nervosa: importance of IGF-1 and leptin

Anorexia nervosa e transtorno alimentar não especificado (TANE) são os transtornos alimentares mais frequentes na adolescência. Cursam com alterações hormonais e amenorreia. Este projeto tem como objetivo a maior compreensão das alterações laboratoriais e hormonais que ocorrem concomitantemente com esses transtornos alimentares na adolescência, em especial a relação com o retorno dos ciclos menstruais, a recuperação nutricional e a secreção de leptina e IGF-1. Vinte e oito adolescentes do sexo feminino, portadoras de anorexia nervosa ou TANE foram submetidas a coletas de amostras de sangue para dosagem de leptina, LH, FSH, PRL, estradiol, GH, IGF-1, TSH, T4L, T4, T3, proteínas totais e frações, função renal, hemograma, ferro, ferritina e eletrólitos no início do estudo e a cada cinco semanas num total de cinco coletas. Densitometria óssea foi realizada no início do acompanhamento e após seis meses para avaliar comprometimento ósseo. As principais complicações clínicas observadas foram amenorreia (78%) e osteoporose (14,8%). No início do estudo, 12 pacientes encontravam-se desnutridas com z score de IMC -2. As alterações hormonais presentes foram: diminuição do T3, estradiol, leptina, LH e IGF-1. As pacientes evoluíram com boa recuperação nutricional (variação da média de IMC ao longo do estudo IMC p 340ng/mL (p = 0,04)Anorexia Nervosa (AN) and eating disorder not otherwise specified (EDNOS) are the most frequent eating disorders in adolescence. The patients show hormonal alterations as well as amenorrhea. The aim of this study was to improve the knowledge of hormonal disturbances that occur together with AN and EDNOS, especially with regard to menstrual cycles, nutritional recovery as well as leptin and IGF-1 secretion. Twenty eight female adolescents with AN or EDNOS had blood collected for the following dosages: leptin, LH, FSH, PRL, estradiol, GH, IGF-1, TSH, FT4, T4, T3, total proteins and fractions, renal function, CBC, iron , ferritin, electrolytes in the beginning of the study and at every 5 weeks totalizing 5 samples per patient. Bone densitometry was performed at the start and after 6 months. The main clinical complications were amenorrhea (78%) and osteoporosis (14.8%). Twelve patients were undernourished at the start of the study (BMI z score = -2). Hormonal alterations were low T3, estradiol, leptina, LH, and IGF-1. The patients had good nutritional recovery, evaluated as a variation of BMI (p < 0.001) and improved clinical and hormonal parameters. IGF-I was the best marker of nutritional recovery (p = 0.0001) and correlated very well with menstrual cycles recovery. At the time when the patients resumed menstrual cycles, IGF-1 was above 340ng/mL (p = 0.04

Interrupção do tratamento em criança nascida a termo pequena para idade gestacional

Small-for-gestational-age children have been associated with up to 20% delayed growth and delayed development, increased childhood morbimortality, and poor quality of life. Prepubertal growth hormone administration results in increased growth and musculoskeletal development. The present case report illustrates the negative impact of growth hormone disruption in a 6-year-old patient, resulting in impaired growth and development. Close clinical and laboratory monitoring is recommended for small-for-gestational-age children receiving growth hormone treatment, and family counselling should be encouraged.info:eu-repo/semantics/publishedVersio

Review of a three-year study on the dental care of onco-hematological pediatric patients

The aim of this study was to provide an updated review of dental procedures undertaken at the dental unit of the Onco-hematology service of the Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (ICr/HC-FMUSP). We retrospectively reviewed 565 of 1902 medical and dental records of patients diagnosed with onco-hematological diseases who were seen in a 3-year study (January 2015 to December 2017). We assessed data regarding population characteristics, onco-hematological diagnosis and dental procedures performed. Of the selected medical records, preventive dentistry was the most common procedure undertaken in this population, followed by oral maxillofacial surgeries, restorative dentistry and oral mucositis treatment. The most prevalent malignant diagnosis was acute lymphocytic leukemia, and the most prevalent nonmalignant diagnosis was sickle-cell anemia. Preventive dental procedures represent most of the dental procedures undertaken in hospitalized onco-hematological pediatric patients

Laparoscopic sleeve gastrectomy in severely obese adolescents: effects on metabolic profile

ABSTRACT Objective: The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). Subjects and methods: This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. Results: The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months’ post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. Conclusions: LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic