Usos de la glutamina en pediatría

ResumenLa glutamina, aminoácido “condicionalmente indispensable” tiene un rol clave en la respuesta del intestino delgado ante diferentes agresiones. Bajo ciertas condiciones de estrés clínico y quirúrgico ocurren cambios y atrofi a en la mucosa intestinal, originando diversos grados de desnutrición. Investigadores han demostrado que el intestino es el órgano de mayor actividad de la glutamina y que su epitelio es considerado como blanco en la captura de la glutamina; asignándole un papel especial en la recuperación del intestino delgado. Se revisaron los trabajos recientes sobre su utilidad en el área pediátrica, con énfasis en el metabolismo intestinal y nutrición. Concluyendo que la glutamina puede ser benefi ciosa y absolutamente necesaria durante las situaciones críticas.[Marante J, Rodríguez R, López KC, González LG, Flores LS, Villalobos DC, et al. Usos de la glutamina en pediatría. MedUNAB 2005; 8 (1 Supl 1):S37-S42]Palabras clave: Glutamina, pediatría, intestino, aminoácido, nutrición enteral

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Manifestaciones gastrointestinales en trastornos del espectro autista.

Existen una serie de desordenes gastrointestinales no reconocidos, que pueden contribuir a los problemas de bienestar de los niños autistas no verbales. Se presentan algunos que permiten determinar la posible asociación entre el cerebro y las disfunciones gastrointestinales en niños con desórdenes autistas. · Intervención nutricional: dieta libre de gluten, caseína, colorantes y preservantes (dieta Feingold). · Tratamiento de las infecciones gastrointestinales: bacterianas, parasitarias o fúngicas. · Tratamiento para la enfermedad por reflujo gastroesofágico, esofagitis eosinofílica, gastritis por H. pylori, duodenitis por G. lamblia, inespecífica o eosinofílica · Manejo de la insuficiencia pancreática. · Probióticos: Lactobacillus GG. · L-glutamina. Unrecognized gastrointestinal disorders, may contribute to the behavioral problems of the non-verbal autistic patients. The objective of this article is to describe any observations about the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder

Manifestaciones gastrointestinales en trastornos del espectro autista

Unrecognized gastrointestinal disorders, may contribute to the behavioral problems of the non-verbal autistic patients. The objective of this article is to describe any observations about the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder

Manifestaciones Extradigestivas del Reflujo Gastroesofágico.

El reflujo gastroesofágico (RGE) es uno de los temas de la gastroenterología pediátrica que tal vez suscite mayor controversia. A pesar de las numerosas publicaciones en los últimos años, persiste aún gran confusión con respecto a sus aspectos conceptuales y prácticos, cuya mayor dificultad estriba en discernir entre el reflujo fisiológico del patológico. La relación entre el asma y el RGE es controversial. Las publicaciones evidencian asociación entre ambos, el efecto del asma sobre el reflujo y los efectos de reflujo y la terapia anti-reflujo sobre el asma. La terapia anti-reflujo reduce los síntomas y la medicación para el asma. La enfermedad respiratoria es común en los niños. El RGE induce apnea y laringoespasmo en cerca del 1% de los niños. El estridor laríngeo ocurre en 1 de cada 10 nacidos vivos y puede deberse a anomalías estructurales de la vía aérea o por el RGE. La existencia de numerosas técnicas de estudio desarrolladas en los últimos años indica que ninguna de ellas es completamente satisfactoria. El diagnóstico de RGE en niños con síntomas respiratorios se realiza, además de la historia clínica, a través de pHmetría de 24 horas, laringoscopia directa, lavado bronquial y estudios de medicina nuclear como la escintigrafía. Los objetivos fundamentales en el manejo del RGE están dirigidos a aliviar los síntomas y evitar las complicaciones.SUMMARY Gastroesophageal reflux (GER) is one of the subjects in pediatric gastroenterology the perhaps provokes the biggest controversy. In spite of numerous publications appearing in the last few years, there still exists confusion with respect to theoretical and practical concepts, which frequently results in an inadequate management of patients. The biggest confusion arises from the difficulty in discriminating between physiological and pathological reflux. The relationship between asthma and GER is controversial. These papers review the evidence for an association between them, the effect of asthma on GER, and the effects of GER and antireflux therapy of asthma. Antireflux therapy improves asthma symptoms and reduces medication, requirements but not pulmonary function. Problematic airway responses in infants are common. Reflux induced apnea affects nearly 1% of infants and involves closure or laryngospasm. Recurrent or chronic stridor caused by dynamic or structural airway anormalities, occurs in up to 1 in 100 babies. The existence of numerous techniques for studying reflux, which have been develop in the last few years, indicates that none of them is completely satisfactory. The diagnosis of GER in babies can be facilitated by a careful history in conjunction with esophageal Ph probe monitoring, laryngoscopic evaluation, bronchoalveolar lavage, or nuclear medicines scintigraphy. The objectives of therapy in GER are conservative lifestyle measuring and avoid complications

Redes neuronales artificiales en conducción de calor multidimensional transitorio

Neural networks to prediet the multidimensional unsteady-state temperature projile in a solidhave been used; convective and Dirichlet boundmy conditions for the mathematical model wereapplied to salve the model. For computer simulations several neural networks following theMultilayer Perceptron architecture were trained using the Levenberg-Marquardt algorithm. Resultsshowed an excellent agreement between numerical solutions afthe mathematical model and theneural network predictions.Este artículo ilustra la aplicabilidad de las Redes Neuronales Artificiales en la predicción de latemperatura de algunos fenómenos de conducción de calor multidimensional transitorio. Seplantean dos casos en una dimensión con condición inicial constante y condiciones de frontera,para uno, de Dirichlet y para el otro, convectivas. Con estas mismas condiciones, se abordangeometrías en dos y tres dimensiones y se desarrollan sus soluciones analiticas para obtener lospatrones de entrada y salida utilizados en elposterior entrenamiento, verificación y generalizaciónde las redes neuronales artificiales. Para predecir la temperatura de los casos estudiados a partirde variables espaciales y temporales mediante la inteligencia artificial, Redes NeuronalesArtificiales, se empleó el Perceptrón multicapa con conexiones hacia adelante, función deactivación tangente hiperbólica para los nodos de la(s) capa(s) oculta(s) y lineal para el nodode salida, algoritmo de aprendizaje Levenberg - Marquardt y raíz de la suma de los cuadrados ypreprocesamiento rango como normalizaciones de las variables de entrada y salidarespectivamente. Una vez determinadas las especificaciones se llevaron a cabo las etapas dedesalTollo: entrenamiento, verificación y generalización de las redes de cada caso de conducciónde calor considerado empleando diversas configuraciones con el fin de seleccionar la másadecuada de acuerdo a los criterios: convergencia en el entrenamiento, capacidad degeneralización y simplicidad en su estructura

Mapping rootable depth and root zone plant-available water holding capacity of the soil of sub-Saharan Africa

In rainfed crop production, root zone plant-available water holding capacity (RZ-PAWHC) of the soil has a large influence on crop growth and the yield response to management inputs such as improved seeds and fertilisers. However, data are lacking for this parameter in sub-Saharan Africa (SSA). This study produced the first spatially explicit, coherent and complete maps of the rootable depth and RZ-PAWHC of soil in SSA. We compiled geo-referenced data from 28,000 soil profiles from SSA, which were used as input for digital soil mapping (DSM) techniques to produce soil property maps of SSA. Based on these soil properties, we developed and parameterised (pedotransfer) functions, rules and criteria to evaluate soil water retention at field capacity and wilting point, the soil fine earth fraction from coarse fragments content and, for maize, the soil rootability (relative to threshold values) and rootable depth. Maps of these secondary soil properties were derived using the primary soil property maps as input for the evaluation rules and the results were aggregated over the rootable depth to obtain a map of RZ-PAWHC, with a spatial resolution of 1 km2. The mean RZ-PAWHC for SSA is 74 mm and the associated average root zone depth is 96 cm. Pearson correlation between the two is 0.95. RZ-PAWHC proves most limited by the rootable depth but is also highly sensitive to the definition of field capacity. The total soil volume of SSA potentially rootable by maize is reduced by one third (over 10,500 km3) due to soil conditions restricting root zone depth. Of these, 4800 km3 are due to limited depth of aeration, which is the factor most severely limiting in terms of extent (km2), and 2500 km3 due to sodicity which is most severely limiting in terms of degree (depth in cm). Depth of soil to bedrock reduces the rootable soil volume by 2500 km3, aluminium toxicity by 600 km3, porosity by 120 km3 and alkalinity by 20 km3. The accuracy of the map of rootable depth and thus of RZ-PAWHC could not be validated quantitatively due to absent data on rootability and rootable depth but is limited by the accuracy of the primary soil property maps. The methodological framework is robust and has been operationalised such that the maps can easily be updated as additional data become available

Endoscopia digestiva superior en pediatría

La endoscopia digestiva superior (EDS) es una técnica eficaz, segura, con riesgos y complicaciones mínimos para la exploración en niños del tracto digestivo superior que permite la evaluación, diagnóstico y manejo terapéutico adecuados en la enfermedad gastrointestinal. A pesar de los consensos sobre sus indicaciones, hay pocos estudios controlados sobre los efectos y las técnicas terapéuticas en pediatría. Para facilitar el procedimiento se recomienda usar sedación o anestesia. Puede haber complicaciones cardiopulmonares, infecciosas, perforación, hemorragia y las derivadas de la sedación. En resumen, la esofagogastroduodenoscopia permite el diagnóstico, seguimiento y tratamiento adecuado en la enfermedad gastrointestinal.. The upper gastrointestinal endoscopy is a safe and efficient technique with minimum complications; it is the preferred diagnostic procedure for evaluation of the children’s upper gastrointestinal gut. Although there is a consensus over the indications for endoscopy in children, there are few controlled studies about the therapeutic technique and its effects in pediatric patients. Sedation in children is mandatory to make easier the procedures. There are some complications, such as cardiopulmonary problems, infections, hemorrhage, bowel perforations and the complications related to sedation. We came to the conclusion that through esophagogastroduodenoscopy we are able to make diagnostics and treatment of the gastrointestinal diseases

Endoscopia digestiva superior en pediatría

The upper gastrointestinal endoscopy is a safe and efficient technique with minimum complications; it is the preferred diagnostic procedure for evaluation of the children's upper gastrointestinal gut. Although there is a consensus over the indications for endoscopy in children, there are few controlled studies about the therapeutic technique and its effects in pediatric patients. Sedation in children is mandatory to make easier the procedures. There are some complications, such as cardiopulmonary problems, infections, hemorrhage, bowel perforations and the complications related to sedation. We came to the conclusion that through esophagogastroduodenoscopy we are able to make diagnostics and treatment of the gastrointestinal diseases