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Introducción: la obesidad grave ha tenido un mayor aumento que la obesidad no grave en los escolares chilenos durante los últimos años. Desconocemos si el punto de corte actualmente utilizado para definir la obesidad grave (IMC ≥ + 3 DE, curvas OMS-2007) se asocia a un mayor daño biológico en nuestra población pediátrica. Objetivo: describir y comparar el riesgo cardiometabólico en escolares con obesidad grave y no grave. Método: se realizó un análisis secundario de una muestra de 3325 escolares en los que se estudiaron los factores de riesgo cardiometabólico. Se comparó la prevalencia de estos factores en los que presentaban obesidad según fuera esta grave o no, calculándose los OR respectivos. Resultados: de los 589 sujetos con obesidad, con una media de edad de 11,4 ± 0,98 años, el 46 % eran de género femenino y el 11,5 % presentaban obesidad grave, con mayor prevalencia de la mayoría de los factores estudiados y sin diferencias en cuanto a antecedentes parentales de enfermedad crónica u obesidad, educación de los padres y actividad física del niño. Los niños con obesidad grave tenían un mayor riesgo de obesidad central (OR: 12,9), resistencia insulínica (OR: 3,2), HTA (OR: 2,67) y síndrome metabólico (OR:1,92). Conclusión: esta definición de obesidad grave en la niñez favorece la identificación de los niños con mayor comorbilidad cardiometabólica, lo cual permite focalizar los esfuerzos de prevención secundaria y su tratamiento más oportuno (AU)

Introduction: severe obesity has had a greater increase than non-severe obesity in Chilean schoolchildren during the last years. We do not know whether the cut-off point currently used to define severe obesity in children (BMI ≥ + 3 DE, WHO-2007 curves) is associated with a greater biological risk in our population. Objective: to describe and compare cardiometabolic risk in schoolchildren with severe vs. non-severe obesity. Methods: a secondary analysis of a sample of 3,325 schoolchildren was performed, in which cardiometabolic risk factors were studied. The prevalence of these was compared in the subsample of 589 schoolchildren with obesity according to whether it was severe or not, and the respective ORs were calculated. Results: mean age was 11.4 ± 0.98 years, 46 % were girls, and 11.5 % of the sample had severe obesity, with a higher prevalence of most of the factors studied and no differences in chronic disease, obesity or education in parents, or physical activity of the child. The risk of those with severe obesity for central obesity, insulin resistance, high blood pressure, and metabolic syndrome reached an OR of 12.9, 3.2, 2.67, and 1.92, respectively, as compared to those with non-severe obesity. Conclusion: this definition of severe obesity in childhood favors the identification of children with higher cardiometabolic comorbidity, which allows to focus the efforts of secondary prevention and its most timely treatment (AU)

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Aniline is the simplest aromatic amine and therefore it is a prototypical system to study the microhydration and excited state dynamics of aromatic amines. However, to date a discrete spectrum of singly hydrated species has not been obtained. Here we present for the first time the IR/UV spectrum of, aniline1(H2O)1, aniline1(H2O)2, and aniline2(H2O)1. The origin band of the monohydrated complex is shifted around 700 cm-1 to the blue, as a result of large changes in geometry upon electronic excitation. In addition, massive fragmentation from higher-order clusters appears where the origin band was expected to be, helping the clusters to elude their detection for a long time. The addition of a second water or aniline molecule shifts the origin band back to the vicinity of that of aniline and fragmentation of these species is one of the sources of such fragmentation. The dramatic changes in the structure of monohydrated clusters that follow electronic excitation resemble the behavior of the solvent in other aromatic amine-water systems, reinforcing the idea of aniline-water as an interesting model system to study such behavior.

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The association of prenatal growth with metabolic syndrome (MS) components and insulin resistance (IR) in children has not been studied in Chile and most developing countries. Some associations found in developed countries are controversial. A retrospective cohort study was designed linking present information on MS components and IR in children with register-based information on birth weight (BW), birth length (BL) and gestational age (GA). Examinations included anthropometry and blood pressure (BP), as well as self-report of pubertal status. A fasting blood sample was taken to determine lipids, glucose, insulin and homeostasis model assessment (HOMA)-IR was calculated. The study cohort of 2152 children was on average 11.4 ± 1.0 years old. The prevalence of MS, IR and overweight were 7.6%, 24.5% and 34%, respectively. Elevated BP was negatively associated with dichotomized risk categories of the perinatal factors studied (BW, BL and GA). Contingency tables showed that high waist circumference (WC) and elevated BP had a U-shaped association with various categories of BW and BL, respectively. Stepwise linear regressions selected: (a) WC as inversely associated to GA and directly associated to BW, (b) BP as inversely associated to GA and (c) HOMA-IR as inversely associated to BL. Non-optimal prenatal growth seems to predispose to high WC, elevated BP and IR in school-age children, supporting the early life origin of several non-communicable diseases. Those associations were rather weak as estimated by the slopes of the regressions and probably reduced by their U-shaped nature; they would reasonably become stronger with a longer follow-up.

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BACKGROUND: DiGeorge anomaly, velocardiofacial syndrome and conotruncal anomaly face syndrome are part of a group of congenital malformations of the chromosome 22q11 microdeletion syndrome, since they share certain phenotypic features as well as a common genetic abnormality. The malformations include mild facial dysmorphic features, conotruncal heart defects, thymic and parathyroid hypoplasia or aplasia and cleft palate. AIM: To describe the initial clinical presentation of children with clinical and molecular diagnosis of 22q11 microdeletion. PATIENTS AND METHODS: Ten children (seven male) with the phenotypic features of 22q11 microdeletion syndrome are reported. Microdeletion was detected in peripheral lymphocytes by fluorescent in situ hybridisation (FISH) with the TUPLE-1 DNA probe. RESULTS: Two children had abnormal karyotypes, one of them had a visible deletion and another child had an unbalanced translocation inherited from his mother who had a balanced translocation between chromosomes 14 and 22. Two of the 10 patients had an anterior laryngeal web, a malformation infrequently described in this syndrome. Five patients had the diagnosis of DiGeorge anomaly, had a more serious clinical presentation and a higher early mortality. CONCLUSIONS: The high frequency of the 22q11 microdeletion syndrome, estimated at 1:5.000 newborns, and its variable presentations requires a high level of awareness for its early diagnosis and appropriate management of associated complications.

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OBJECTIVE: To describe an additional case of a large retroperitoneal liposarcoma. METHODS/RESULTS: A case of a large retroperitoneal liposarcoma in a young male is presented. Treatment was by surgery. The clinical and pathological features, diagnosis, course and treatment of this lesion are discussed. CONCLUSIONS: Retroperitoneal tumors constitute a heterogeneous group of uncommon neoplasms of unknown etiology. Liposarcoma is the most frequent lesion in this group. It is usually asymptomatic and is often identified by the presence of a large abdominal mass. It is considered to be a peculiar lesion because of its biological and morphological features and course.

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OBJECTIVE: To review the pathogenesis, clinical features, diagnosis and treatment of metastatic carcinoma of the penis. METHODS: We report four cases of metastatic carcinoma of the penis with special reference to the clinical features, diagnosis and treatment. RESULTS: Two cases were due to prostatic cancer and the rest were secondary to bladder cancer and colorectal cancer. All patients received palliative treatment and survival has been poor. CONCLUSIONS: Penile metastases are rare and are usually secondary to other genitourinary primaries, priapism is the most frequent symptom, although increased penile size, ulceration and nodes formation have also been described. Diagnosis must be established by biopsy of the lesion to rule out other benign disease. Treatment is generally palliative; the options of surgery, radiotherapy and chemotherapy are available. Hyperthermia in combination with radiation therapy has been shown to be an effective modality in the treatment of penile metastases. Prognosis, however, is very poor.

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OBJECTIVES: To study the prevalence and histopathological behaviour of precancerous lesions of the oral mucous membrane, leukoplakia and lichen planus, among the geriatric population attended. DESIGN: A prospective, descriptive study. SETTING: Urban out-patient clinic and health centre in Health Area V in Asturias (population covered: 80,000). PATIENTS: All patients over 65 in whom one of the lesions under study was observed. MAIN MEASUREMENTS: All the patients had a complete oral examination. A clinical history was taken for those patients in whom a lesion under study was found, and a sample of the lesion by an incisional or excisional biopsy was taken. Later there were periodic checks and new biopsies were taken. RESULTS: During the study period, approximately 52,000 mouth and teeth examinations took place. 34 precancerous lesions were detected in patients over 65. The commonest type of lesion was Lichen planus with 20 cases. CONCLUSIONS: The prevalence found in the sample analysed was similar to that of other studies. The fact that the majority of the lesions had not been noticed clinically, along with the greater susceptibility of these patients to the activation of factors which could trigger malignant degeneration, may have made the presence of 7 lesions with dysplastic histological alterations possible.

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OBJECTIVE: To evaluate the levels of lipoprotein (a) (Lp(a)) as a marker of familiar history of cardiovascular risk. MATERIAL AND METHODS: We have studied 176 children and adolescents between the ages of 3 and 18 years with hypercholesterolemia. In these children we determined Lp(a) levels and collected the family history concerning cardiovascular risk factors (hypercholesterolemia and cardiovascular disease under 55 years of age). RESULTS: Of the cases studied, 67.04% had a family history of cardiovascular risk. In this group, levels of Lp(a) were significantly higher than in the group without a family history of cardiovascular risk. Lp(a) levels higher than 30 mg/dl were found in 3.44% of the patients without a family history of cardiovascular risk in contrast to 28,43% and 37.5% of the cases with familiar history of hypercholesterolemia and cardiovascular disease, respectively. CONCLUSIONS: The levels of lipoprotein (a) in children and adolescents with hypercholesterolemia are a marker of family history of cardiovascular disease and hypercholesterolemia.

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Supraventricular tachycardias (SVT) are the most frequent cause of tachycardia in children. Its pharmacological treatment has adverse effects, is not curative, and is not always effective. During the last few years radiofrequency ablation (RF-A) has changed the treatment. The purpose of this study is to evaluate our experience in RF-A in children with SVT. Between 1990 and 1995, 92 patients (1 month to 17 years old) underwent electrophysiological study after the diagnosis of SVT. RF-A was attempted in 55 patients with accessory pathways (AP), slow-pathway of the atrioventricular node, or ectopic focus. The site of ablation was decided according to the electrical signals and the catheter position. The success of the RF-A was confirmed by the interruption of the tachycardia, the change in the sequence of activation of the intracardiac signals, the regression of the preexcitation, and the inability to reinduce tachycardia. RF-A was successful in 81% of the patients; 88% in those with a left AP, 56% in those with a right AP, and 100% in those with nodal reentry. Complications were seen in 7% of the patients: 3 with arterial obstruction, one with a minimal pneumothorax, and one with cardiac tamponade. During a follow up of 16.6 months there was no relapse nor late complications. We conclude that RF-A is a safe and effective procedure in pediatric patients with SVT.

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This study was designed to assess "tracking" of serum lipids and apolipoproteins in three age groups of Spanish children over a 5 year period. A total of 84 6-year-old, 89 10-year-old and 64 14-year-old children were evaluated in 1989 (with measurement of serum total cholesterol, triglycerides, lipoproteins and apolipoproteins A1 and B), and re-evaluated in 1994. Correlation coefficients between initial and final lipid and apolipoprotein values were as follows: total cholesterol, 0.66; low-density lipoprotein (LDL) cholesterol, 0.65; high-density lipoprotein (HDL) cholesterol, 0.61; triglycerides, 0.61; apolipoprotein A1, 0.60; apolipoprotein B, 0.66. When age groups were analysed separately, children who were 14 years old at the beginning of the study showed higher correlation coefficients, particularly for total cholesterol and LDL cholesterol ( > 0.7 in both cases). More than 70% of children who were in the top quintile of total, LDL or HDL cholesterol as well as apolipoprotein A1 or B in 1989 remained in the top quintile 5 years later.

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We measured urinary albumin excretion in 2,224 school-children (1,168 boys, 1,056 girls) aged 2-18 years, between 1989 and 1990 to establish reference values. We recorded all pathological antecedents and findings from physical examination, including anthropometric parameters and arterial blood pressure. The analytical study included serum total protein, albumin and creatinine. The second-morning urine and the nightly (rest) 10-h urine sample were collected and we determined the concentration of albumin and creatinine. We found a positive statistically significant correlation between the urinary albumin excretion (micrograms/10 h) and age, height, weight and body surface area. We suggest that it would be useful to relate the urinary albumin excretion to body surface area. The mean value for albumin excretion was 3.49 micrograms/ml in boys and 3.63 micrograms/ml in girls. The urinary albumin/creatinine ratio showed a high correlation with the albumin excretion (r = 0.958).

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OBJECTIVE: To study the relation between diet and serum lipid and apolipoprotein levels in a large, homogeneous group of Spanish children. DESIGN: Survey. SETTING: Eleven schools chosen at random in Madrid City and the surrounding area. SUBJECTS AND METHODS: Subjects comprised 1682 children, 2 to 12 years of age. Dietary data were obtained with a 24-hour record performed by the child's main caregiver. For statistical analysis the sample was divided into tertiles on the basis of calorie-adjusted consumption of dietary components. RESULTS: Children in the highest tertile of total fat consumption, compared with children in the lowest tertile, had significantly higher mean serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (Apo A) and apolipoprotein B-100 (Apo B). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of TC, LDL-C, and Apo B, and lower mean levels of HDL-C and Apo A. Children in the highest tertile of monounsaturated fat consumption, compared with children in the lowest tertile, had significantly higher mean levels of HDL-C and Apo A, and lower mean levels of TC, LDL-C, and Apo B. CONCLUSIONS: Our findings suggest that diet composition strongly influences lipid profile in children and point out the importance of monounsaturated fatty acids as modulators of serum lipid and apolipoprotein levels.

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OBJECTIVE: To determine the effectiveness and compliance of dietary restriction in a group of children and adolescents with hypercholesterolemia. RESEARCH DESIGN: Prospective clinical trial. SETTING: Pediatric hospital in Madrid, Spain. PARTICIPANTS: Four hundred fifty-one children and adolescents of both sexes aged 2 to 18 years diagnosed as having hypercholesterolemia and treated with dietary restriction (American Heart Association Step-One and Step-Two Diets). The follow-up period ranged from 6 months to 2 years and was performed by one pediatrician. RESULTS: Total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 levels as well as the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio decreased significantly (P < .01) from the first month of dietary restriction, whereas the high-density lipoprotein cholesterol level increased (P < .01). The apolipoprotein A-I level increased significantly (P < .01) only after 6 months of diet therapy. After 12 months of follow-up, 30.7% (58/189) of patients did not follow the diet strictly. In this group, significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 were found. CONCLUSIONS: Diet therapy is effective in the treatment of hypercholesterolemia in children and adolescents. Dietary restriction has a beneficial effect not only on total cholesterol and low-density lipoprotein cholesterol levels but also on apolipoprotein A-I and B-100 levels.

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BACKGROUND: The aim of this study was to evaluate the association between socioeconomic status and the presence of cardiovascular risk factors in children from Madrid. METHODS: We studied 2224 boys and girls, ages 2-18 years, attending five different school centers. They were divided into three socioeconomic groups: low class, middle-low class and middle high class, in regard to their parent's occupation and educational attainment. The evaluation included a blood analysis of serum triglycerides (TG), total cholesterol (CT), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), apolipoprotein A1 (ApoA), apolipoprotein B100 (Apo B), and the Apo A/Apo B and LDL/HDL ratios. RESULTS: There was a positive correlation between socioeconomic status and total cholesterol, Apo A, Apo B and Apo A/Apo B, whereas socioeconomic status and triglycerides were inversely related. The LDL/HDL ratio varied according to age. CONCLUSIONS: Unlike some previously published studies, we found that children belonging to high socioeconomic status have a more atherogenic lipid profile than those of middle low or low socioeconomic levels.

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The relation between smoking and blood lipids and apolipoproteins (A1,B100) were studied in a group of 1024 12- to 18-year-old school children in the Comunidad de Madrid. The percentage of smokers was 19% (17% for girls and 21% for boys). The average consumption of cigarettes per day was 7.83 +/- 5.06 in boys and 6.04 +/- 3.49 in girls (p less than 0.05). As compared with male nonsmokers, male smokers showed a higher mean level of low-density lipoprotein (LDL) cholesterol (112 versus 100 mg/dL, p less than 0.05), a higher LDL cholesterol to HDL-cholesterol ratio (2.27 versus 1.94, p less than 0.001), a higher mean level of apolipoprotein B100 (59 versus 53 mg/dL, p less than 0.05), and a higher apolipoprotein B100 to apolipoprotein A1 ratio (0.45 versus 0.40, p less than 0.01). Female smokers tended to show the same results, although significant differences were only found for LDL cholesterol to HDL cholesterol ratio and apolipoprotein B100 to apolipoprotein A1 ratio (1.8 versus 1.59 and 0.41 versus 0.38 respectively, both p less than 0.05). This work provides new data about the effects of smoking on apolipoproteins in adolescents and emphasizes on the need for preventive programs.

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We report 3 patients with congenital A-V block whose mothers had anti-Ro or anti-La antibodies. One of them had systemic lupus with serum anti-Ro antibodies; the other had anti-Ro antibodies and no clinical manifestations; the third had an undifferentiated connective tissue disorder with anti-La antibodies in the serum. The epidemiology of this association is discussed as well as some therapeutic options.

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