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INTRODUCTION: One of the complications associated with obesity is nonalcoholic fatty liver disease (NAFLD), which is defined as an excessive accumulation of fat in hepatocytes, and is characterized by chronic elevation of aminotransferases and ultrasonographic abnormalities (increased echogenicity). In the USA it is now the most common liver disease. Prevalence is around 15-25% in the general population, and this increases to 57.5-75% in obese people. The aim of this study was to evaluate whether hepatic steatosis is a factor associated with the presence of metabolic risk in children and obese adolescents. MATERIALS AND METHODS: A retro- and perspective cross-sectional study in the High Specialty Medical Unit No. 25 of the Mexican Social Security Institute in Monterrey, Nuevo Leon, Mexico, in which the clinical records of patients from 5 to 15 years of age, referred with a diagnosis of obesity, were reviewed in the period of January 1, 2012 to June 30, 2013. Children and adolescent patients diagnosed with obesity were included, but we excluded patients with a history of acute and chronic viral hepatitis and use of antiepileptic and hepatotoxic drugs. For descriptive analysis we used absolute frequencies, percentages, means, and standard deviations. For inferential analysis we used chi-square test, Fisher exact test, and Student t test to establish the association of NAFLD with the studied variables. The odds ratio was measured, considering 95% CI and statistical significance p < 0.05. RESULTS: 160 children and adolescent patients were included with median age 11.23 ± 2.2 years, of which 85 (53.1%) were male and 75 (46.9%) were female. All were obese, with BMI and abdominal circumference greater than the 95th percentile for age. In total, 131 (81.8%) patients had NAFLD and 29 (18.2 %) patients did not. HOMA index was increased by 3.9 ± 2.1 (p < 0.05) in patients in the NAFLD group with a mean of 6.4 ± 4.9 in the group without NAFLD. The cutoff point we found for insulin resistance associated with NAFLD was 9. We found four subjects with high LDL levels of (> 130), and none in the control group. Transaminase levels were significantly higher in the group of patients with NAFLD, ALT greater than 40 U/l in 127 (96.94%) of patients with NAFLD (OR: 63.5; 95% CI: 18.5-217; p < 0.005). LDL-C greater than 130 mg/dl occurred in four (3%) patients with NAFLD, and in none of the patients without NAFLD (p = 0.0001). Acanthosis nigricans was found in 128 (97.7%) patients with NAFLD and in only one (3.4 %) in the group without NAFLD (OR: 1194.7; 95% CI: 119.8-1191.5; p = 0.0001). CONCLUSION: Obesity and insulin resistance are risk factors for the development of fatty liver in children and adolescents.
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BACKGROUND: Reference values according to age groups for each population are needed for the diagnosis and follow-up of pediatric patients with thyroid diseases. Such values are unknown for Mexican infants and children younger than six years. OBJECTIVE: To determine the reference values of total TT3, FT4 and TSH by chemiluminescence immunoassay in infants and children younger than six year old in Northeastern Mexico. MATERIAL AND METHODS: Thyroid hormone serum levels were determined by chemiluminescence immunoassay in healthy infants and children younger than six years old. RESULTS were analyzed according to gender in seven age groups: Newborns (NB), 1 to 6, 7 to 12, 13 to 18, 19 to 23, 24 to 35, and 36 to 71 months. RESULTS: A total of 405 infants and children were included, 209 male and 196 female, 1.6 ± 1.4 years of age (4 days to 5.6 years). Thyroid hormones: Although there were not significant differences according to gender, in NB TSH and FT4 serum levels were higher (p = 0.001 and p = 0.000, respectively) and TT3 levels were lower (p = 0.000). CONCLUSIONS: Serum levels of TSH and TT4 were higher and TT3 lower in newborns, which has been previously reported even for other measurement methods and other populations. These results allow counting with reference values of these hormones for this region.
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INTRODUCTION: Liver transplantation is indicated for the treatment of pediatric patients with progressive liver disease in which an expected survival of less than a year would be achieved with the transplant. The aim of this study was to determine the evolution of pediatric liver transplant patients in a tertiary care hospital in the northeast country. RESULTS: Twelve patients subjected to liver transplantation included nine females and three males; one case required retransplantation. Age at transplantation was 3.3 years (range 0.11-14). The weight at transplantation was 12.4 kg (5.7-35.5). The most common indication for transplantation was biliary atresia in six patients (50%). According to the type of graft, 12 (92.3%) were from cadaveric donors, of which seven were segmental. The most common complications were infectious ones in nine patients (75%); surgical complications occurred in eight children (66.6%), with immediate postoperative bleeding in five cases (41.6%). The three-year survival in the entire series was 50%. CONCLUSIONS: This study demonstrates that pediatric liver transplantation is possible in this institution, with a better survival expectancy of patients in the future.