Objectives
International growth charts have been used in the past decades to identify atypical growth and diagnose the nutritional status of individuals. The aim of this study was to construct and ...compare growth patterns of normo‐nourished children between 6–59 months from Afghanistan, Haiti, and the Democratic Republic of the Congo, to assess if it would be worth developing growth charts at a national level.
Methods
We used an international sample of 46 466 subjects (53.7% female; 46.3% male) from the aforementioned regions. To create the growth charts, we used different statistical methodologies: the Lambda‐Mu‐Sigma (LMS), LMSP, and LMST models, and regression models based on fractional polynomials. The LMSP models were the ones that fitted our data best and were therefore the ones used to make comparisons between countries using percentiles (3rd, 50th, and 97th).
Results
We found that Haitian children were both, taller and heavier than their Afghan and Congolese equals of the same ages. Moreover, differences were bigger in the highest percentiles (i.e., 97th percentile). These differences might be the result of the influence that genetics and diverse social and environmental contexts have on growth rates.
Conclusions
Using the same international reference standards for all populations could result in the overestimation or underestimation of the proportion of malnourished children. In light of our results, we recommend the future development of national and regional growth charts to provide health workers with more precise tools to evaluate the nutritional status in the child population.
The estimation of the sex of the individual is a parameter of great value in forensic contexts and, above all, in archaeological contexts, where it is more difficult to apply genetic studies. In ...contrast with methods based on non-metric variables, we propose the use of a random generalized linear model for the determination of sex, starting from the Howells craniometric database and testing them on the dataset of known sex of the Forensic Data Bank, with 2524 and 1314 individuals respectively. After eliminating the individual’s considered outliers or with missing data, we proceeded to analyse which variables were more dimorphic between sexes (bizigomatic width, ZYB; bijugal width, JUB; mastoid height, MDH; glabela-occipital length, GOL; bifrontal width, FMB); these were used to build the statistical model. Subsequently, a comparison was made between the functions proposed by other authors and our model to determine their capacity in absolute terms, as well as by sex. The result is a random generalized linear model made up of 300 bags that, based on the five measures mentioned, reached 86.26% precision classifying the sex of individuals from the Forensic Data Bank (89.7% in the male sample and 82.82% in the female one). Although the method presented here should be taken with caution and not as the only way to estimate sex, it has proven to be statistically accurate in addition to having a non-regional vocation.
ObjectivesThe Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal ...cut‐off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut‐off point. In addition, the creation of MUAC growth charts is presented for reference use.Materials and MethodsThis study was carried out with a database developed by Action Against Hunger, composed, after the data pre‐processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k‐means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method.ResultsOur research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k‐means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group.ConclusionsAll statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.
We report the occurrence of non-obstructive totally anomalous pulmonary venous connection to the superior caval vein in a child conceived by intracytoplasmic injection of sperm, a type of assisted ...reproductive technology. Totally anomalous pulmonary venous connection is an uncommon congenital anomaly, in which all the pulmonary veins connect to the morphologically right atrium, or one of its tributaries. To our knowledge, this malformation has not been previously described in a child conceived on the basis of assisted reproductive technology.
Resumen Introducción y objetivos Las cardiopatías congénitas ( CC ) son las malformaciones congénitas más frecuentes. En España no hay datos de su incidencia a nivel nacional. El objetivo del estudio ...es analizar la incidencia y evolución de las CC en España. Métodos Estudio observacional retrospectivo utilizando el conjunto mínimo básico de datos durante 10 años (2003-2012), en menores de un año, seleccionando las altas hospitalarias con códigos de CC (Clasificación Internacional de Enfermedades, 9.a revisión, modificación clínica). Se describió la evolución anual de la incidencia acumulada y su distribución geográfica, y se analizó mediante riesgos relativos de incidencia y razón de incidencias estandarizadas por comunidad autónoma. Resultados Durante el periodo analizado 64.831 menores de un año fueron diagnosticados de CC al alta hospitalaria sobre 4.766.325 nacimientos con una incidencia del 13,6‰. La incidencia excluyendo la comunicación interauricular fue del 7,29‰. Los códigos más frecuentes fueron: comunicación interauricular (6,31‰), comunicación interventricular (3,48‰), ductus arteriosus persistente (2,71‰), coartación de aorta (0,55‰), estenosis pulmonar (0,50‰), trasposición de grandes vasos (0,49‰), canal auriculoventricular (0,45‰) y tetralogía de Fallot (0,41‰). La distribución geográfica de las cardiopatías graves y muy graves no resultó uniforme presentando Castilla y León junto con Extremadura la mayor incidencia, y Madrid y Cantabria la menor. Conclusiones Durante el tiempo de estudio se observa un aumento de cardiopatías leves que puede estar influido por la mejora de las técnicas diagnósticas, el uso extendido de la ecocardiografía y la propia codificación Clasificación Internacional de Enfermedades, 9.a revisión, modificación clínica y una disminución de las cardiopatías muy graves cuyo análisis presenta mayor validez al estar menos influido por factores externos. La incidencia de cardiopatías graves y muy graves no fue uniforme en España.
A 12-year-old boy had painful lesions on both soles. He had had a similar episode several months before that resolved spontaneously. Physical examination showed erythematous, extremely tender nodules ...on both plantar surfaces and the toes. The second and third left toes had small pustules on top of the nodules. There was no palmar involvement. The clinical features, pathologic findings, and self-limited course suggested recurrent palmoplantar hidradenitis. This distinctive entity of unknown origin appears during childhood and is characterized histologically by a neutrophilic infiltrate affecting the eccrine glands. We report the case of a patient with unusual clinical features. (J Am Acad Dermatol 2002;47:S263-5.)
Resumen Introducción y objetivos Las cardiopatías congénitas suponen una de las principales causas de mortalidad infantil en países desarrollados. En España no hay publicaciones sobre mortalidad de ...las cardiopatías congénitas a nivel nacional. El objetivo del estudio es determinar la tasa de mortalidad infantil de las cardiopatías congénitas, así como la letalidad de las distintas cardiopatías, durante un periodo de 10 años. Material y métodos Estudio observacional retrospectivo utilizando el conjunto mínimo básico de datos de 2003 a 2012 en niños ingresados con diagnóstico de cardiopatía congénita. Se realiza un análisis descriptivo de los pacientes y se calcula la tasa de mortalidad y los riesgos relativos de mortalidad mediante regresión de Poisson. Resultados Fallecieron 2.970 menores de un año sobre una población de 64.831 pacientes con cardiopatías congénitas (4,58%). El 73,8% fallecieron la primera semana de vida. La tasa de mortalidad infantil en niños con cardiopatías congénitas fue de 6,23 por 10.000 nacidos vivos, cifra que se mantuvo constante a lo largo de los 10 años estudiados y que supone el 18% de la mortalidad infantil total. Las cardiopatías con mayor letalidad fueron el síndrome del corazón izquierdo hipoplásico (41,4%), la interrupción del arco aórtico (20%) y el drenaje venoso pulmonar anómalo total (16,8%), y las de menor letalidad la comunicación interauricular (1%) y la estenosis pulmonar (1,1%). Conclusiones Las cardiopatías congénitas constituyen una causa importante de mortalidad infantil, que no ha presentado variaciones importantes durante el tiempo de estudio. La proporción de niños que fallecen es similar a la de los países de nuestro entorno. Pese a los actuales avances, algunas cardiopatías presentan letalidad elevada.
Objectives
The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal ...cut‐off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut‐off point. In addition, the creation of MUAC growth charts is presented for reference use.
Materials and Methods
This study was carried out with a database developed by Action Against Hunger, composed, after the data pre‐processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k‐means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method.
Results
Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k‐means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group.
Conclusions
All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.
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