Introduction
Myeloperoxidase (MPO), an enzyme linking obesity and cardiovascular (CV) risk in adults, has rarely been studied in young children and no studies assessed its association with renal ...function. We sought to explore a possible association between serum MPO levels, obesity, CV risk factors and renal function in prepubertal children.
Materials/Methods
Cross‐sectional evaluation of 309 children aged 8–9 years (161 normal weight, 148 overweight/obese), members of the birth cohort Generation
I (Portugal). Anthropometrics (body mass index (BMI), waist‐to‐height ratio (WHtR) and % body fat mass (%BFM) by bioelectrical impedance analysis), 24‐h ambulatory blood pressure monitoring and pulse wave velocity (PWV) were measured. Insulin resistance was estimated by the HOMA index (considering serum fasting glucose and insulin determinations). Serum MPO levels were assessed by immunoenzymatic assay.
Results
MPO levels were positively associated with obesity indices (BMI z‐score, WHtR and %BFM). Higher MPO levels were associated with higher 24‐h and night‐time mean arterial pressure, with nondipping and with higher values of insulin resistance. In normal weight children, the endothelial function, as evaluated indirectly by PWV, was an independent predictor of MPO levels. In overweight/obese children, estimated glomerular filtration rate increased significantly across tertiles of MPO (Ptrend = 0·031) and this association held after adjustment for age, sex, neutrophil and monocyte counts and CV risk factors.
Conclusions
Our results reinforce the role of MPO as a risk marker in obesity and related CV morbidities in young children. MPO levels associate with the dipping pattern and PWV and, among overweight/obese children, an association exists between MPO and renal function.
Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight ...and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts.
We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms.
Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms.
The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications.
Abstract Objectives: analyse the relation between the nutritional status of children with 0 to 60 months in São Tome and Principe (STP) and their mothers. Methods: characterization of the nutritional ...status of 1,169 children for the weight / length ratio (W/L) (≤24months) and Body Mass Index (BMI) for age (>24months) and their mothers. The Chi Square or Fisher tests were used for the study on the relation between the nutritional status of the mother and children, as appropriate. Results: fifty-five percent (55%) of the children are female (median = 21 months). There was a high percentage of global acute malnutrition in the children aged0≤24months (30.2%) and 24≤60months (22%) as well as global chronic malnutrition (32% and 41.1% respectively). We observed a high percentage of overweight /obese mothers (31.6%), with 16.5% of them being of a low height. We observed a significantly higher percentage of children with global acute malnutrition 47.5%) when compared with that which was reported for children of normal mothers (27.9%) or overweight /obese (22%) (p<0,001) mothers. Conclusions: It was observed a high prevalence of acute and chronic global malnutrition in the children studied and a high prevalence of overweight /obese mothers. We observed a statistically significant association between maternal and acute global malnutrition of the children.
We report here the first Portuguese case of acute fatal granulomatous encephalitis attributed to Balamuthia mandrillaris, initially thought to be a brain tumor, which had a progressive and fatal ...outcome. Balamuthia mandrillaris is a free-living amoeba recognized as an uncommon agent of granulomatous encephalitis. Infections have been identified in immunocompromised hosts and in immunocompetent pediatric patients. Balamuthia infections are very rare, with only two reported cases in Europe. The case presented here occurred in a previously healthy boy who died 5 weeks after the onset of the symptoms. No evidence of immunological deficiency was noted, and testing for human immunodeficiency virus antibodies was negative. The symptoms were initially thought to be the result of a tumor, but histopathologic examination showed evidence of amoebic infection. Immunofluorescence staining of brain tissue identified B. mandrillaris as the infectious agent. The diagnosis was confirmed with PCR by detecting Balamuthia DNA in formalin-fixed brain tissue sections. Despite initiation of empirical antimicrobial therapy for balamuthiasis, the patient died 3 weeks after being admitted to the hospital. No source of infection was readily apparent.
Antibiotic resistance driven by antibiotic use remains a major public health and professional concern. Our aim was to know the local prevalence of uropathogens and their antimicrobial susceptibility ...profile in acute pyelonephritis.
A prospective study of patients admitted in a level III Pediatric Department ward with acute pyelonephritis from 1994 to 2012 was performed in Northern Portugal. Etiological agents and their antimicrobial sensitivity profile were evaluated in four timed periods (G1: 1994-97; G2: 2002; G3: 2007; G4: 2012).
We evaluated 581 patients, 66% female with median age 22 months. Escherichia coli was the leading uropathogen and its prevalence remained stable during the last 18 years. It showed an increased sensitivity to amoxicillin-clavulanate from 71% in G1 to 81.5% in G4 (p = 0.001) and a decreased resistance rate from 8.7% in G1 to 2.8% in G4 (p = 0.008). Its sensitivity to 2nd and 3rd generation cephalosporin was more than 90% (p = ns) and more than 95% to nitrofurantoin (p = ns). Resistance rate of cotrimoxazole increased from 22% to 26% (p = 0.008).
Escherichia coli remains the main uropathogen responsible for acute pyelonephritis, reason why its antimicrobial sensitivity profile will determine the empirical therapeutic choice.
Amoxicillin-clavulanate remains a good first-line choice for empirical treatment of acute pyelonephritis in our inpatient health care.
Studies on long coronavirus disease (COVID) in children are scarce. We aimed to describe persistent symptoms and identify risk factors for its development. In our study population, 17.6% presented ...with long COVID, with respiratory symptoms more frequent in the first weeks and neuropsychiatric symptoms over time. Chronic conditions and obesity were risk factors, and adolescents were at a greater risk for long COVID.
Our aim was to evaluate the growth-promoting effect of growth hormone (GH) treatment in infants with chronic renal failure (CRF) and persistent growth retardation despite adequate nutritional and ...metabolic management.
The study design included randomized, parallel groups in an open, multicenter trial comparing GH (0.33 mg/kg per wk) with nontreatment with GH during 12 months. Sixteen infants who had growth retardation, were aged 12+/-3 months, had CRF (GFR<or=60 ml/min per 1.73 m2), and had adequate nutritional intake and good metabolic control were recruited from eight pediatric nephrology departments from Spain and Portugal. Main outcome measures were body length, body weight, bone age, biochemical and hormonal analyses, renal function, bone mass, and adverse effects.
Length gain in infants who were treated with GH was statistically greater (P<0.05) than that of nontreated children (14.5 versus 9.5 cm/yr; SD score 1.43 versus -0.11). The GH-induced stimulation of growth was associated with no undesirable effects on bone maturation, renal failure progression, or metabolic control. In addition, GH treatment improved forearm bone mass and increased serum concentrations of total and free IGF-I and IGF-binding protein 3 (IGFBP-3), whereas IGF-II, IGFBP-1, IGFBP-2, GH-binding protein, ghrelin, and leptin were not modified.
Infants with CRF and growth retardation despite good metabolic and nutritional control benefit from GH treatment without adverse effects during 12 months of therapy.
Abstract
Background
One of the strategies endorsed by the World Health Organization and the European Commission to promote physical activity (PA) is to incorporate PA content into the curricula of ...healthcare professionals.
Objectives
As part of the VANGUARD project (supported by the European Union Erasmus+ Programme), we aimed to analyse the acceptability of a course on PA and health among undergraduate medical students. The School of Medicine and Biomedical Sciences of the University of Porto (ICBAS) was invited to participate. An online survey was administered in June-July 2022 to solicit the input of the students regarding the importance and the operational procedures of implementing a PA and health course into their curricula.
Results
A total of 77 students answered the survey (median age of 21.0 years interquartile range, P25-P75, 20-24, 75.3% female). Students rated the importance of incorporating PA content in their medical degree program with a median (P25-P75) of 5 (4-5) on a scale of 1 to 5. Most students expressed an interest in PA and mental health (88.3%), cancer (75.3%), cardiovascular disease (75.3%), diabetes (68.8%), and pregnancy (68.8%). In terms of the operational aspects, students expressed their preference for a course offered in the second year (33.8%); as part of the epidemiology and public health discipline (27.3%); optional (58.4%); through a hybrid learning system (49.4% face-to-face activities + online live sessions + online self-paced learning); taught in Portuguese (66.2%); with face-to-face assessments (55.8%); with continuous evaluation (77.9%); and using quantitative grading (62.3%).
Conclusions
Medical students showed considerable acknowledgement regarding the importance of incorporating PA and health into their curricula. Additionally, they provided guidance on developing and implementing a course on this topic. A course is going to be offered to the students and proposed to the Council of Portuguese Medical Schools to be scaled up nationally.
Key messages
• Medical students considered PA and health as a very important topic for curricula.
• Medical students have specific preferences for embedding new courses in their curricula.
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