Jaime Cerda

High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome

High sodium (HS) diet is associated with hypertension (HT) and insulin resistance (IR). We evaluated whether HS diet was associated with a dysregulation of cortisol production and metabolic syndrome (MetS).

Overexpression of 11β-hydroxysteroid dehydrogenase type 1 in visceral adipose tissue and portal hypercortisolism in non-alcoholic fatty liver disease.

The enzyme 11β‐hydroxysteroid‐dehydrogenase type 1 (11β‐HSD1) catalyses the reactivation of intracellular cortisol. We explored the potential role of 11β‐HSD1 overexpression in visceral adipose tissue (VAT) in non‐alcoholic fatty liver disease (NAFLD) assessing sequential changes of enzyme expression, in hepatic and adipose tissue, and the occurrence of portal hypercortisolism in obese mice. 11β‐HSD1 expression was also assessed in tissues from obese patients undergoing bariatric surgery.

Prevalence of habitual snoring and associated neurocognitive consequences among Chilean school aged children.

OBJECTIVE To assess the prevalence of habitual snoring and symptoms of sleep disordered breathing (SDB) and their association with neurocognitive consequences in school-aged children. METHODS A population based cross-sectional study was carried out in a low income urban setting in Santiago, Chile. A parental SDB-questionnaire was adapted and applied to a community based sample of children aged 7-17 years. Hyperactive/inattentive behavior was assessed using the Conners rating scale. School grades were obtained and the associations between questionnaires results and risks for poor academic performance were investigated. RESULTS Of 700 questionnaires sent; 523 (75%) returned correctly filled in. Mean age of the subjects was 11.0±2.5 years; 246 (47%) were boys. Prevalence of habitual snoring was 18%. The Conners rating scale correlated significantly with the SDB-questionnaires score (r(s)=0.47). Children with habitual snoring showed significantly lower (mean±standard deviation) school grades in Spanish language (5.6±1.2 vs. 5.4±0.9, p-value=0.04) and general average school grades (5.9±0.6 vs. 5.7±0.6, p-value=0.05). After adjustment for possible confounding factors, children with an abnormal SDB questionnaire score had significantly higher risk for poor academic performance in Spanish language, odds ratio (95% confidence interval): 1.82 (1.01-3.27) and physical education 1.85 (1.05-3.26). DISCUSSION There was a high prevalence of habitual snoring and symptoms of SDB in this survey of Chilean children, being among the highest reported. The presence of habitual snoring and an abnormal SDB questionnaire were associated with poor academic performance and hyperactive behavior.

Increased urinary glucocorticoid metabolites are associated with metabolic syndrome, hypoadiponectinemia, insulin resistance and β cell dysfunction.

Metabolic syndrome (MetS) may have increased cortisol (F) production caused by 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) in liver and adipose tissue and/or by HPA axis dysregulation. F is then mainly metabolized by liver reductases into inactive tetrahydrometabolites (THMs). We measured THM levels in patients with or without MetS and evaluate the correlation between THMs and anthropometric and biochemical parameters. We recruited 221 subjects, of whom 130 had MetS by ATP III. We evaluated F, cortisone (E), adipokines, glucose, insulin and lipid profiles as well as urinary (24h) F, E and THM levels. β Cell function was estimated by the HOMA Calculator. We observed that patients with MetS showed higher levels of THMs, HOMA-IR and leptin and lower levels of adiponectin and HOMA-β but no differences in F and E in plasma or urine. THM was associated with weight (r = +0.44, p<0.001), waist circumference (r = +0.38, p<0.01), glycemia (r = +0.37, p<0.01), and triglycerides (r = +0.18, p=0.06) and negatively correlated with adiponectin (r = -0.36, p<0.001), HOMA-β (r = -0.21, p<0.001) and HDL (r = -0.29, p<0.01). In a logistic regression model, THM levels were associated with hypertension, hyperglycemia and dyslipidemia. We conclude that MetS is associated with increased urinary THMs but not with F and E levels in plasma or urine. Increased levels of THM, reflecting the daily cortisol production subsequently metabolized, are correlated with hypoadiponectinemia, hypertension, dyslipidemia, insulin resistance and β cell dysfunction. A subtle increased in glucocorticoid production may further account for the phenotypic and biochemical similarities observed in central obesity and Cushings syndrome.

Higher latitude and lower solar radiation influence on anaphylaxis in Chilean children

Recent studies suggest an association between higher latitude, a proxy of vitamin D (VD) status, and allergic diseases. Chile provides an ideal setting to study this association due to its latitude span and high rates of VD deficiency in southern regions. The aim of this study is to explore the associations of latitude and solar radiation with anaphylaxis admission rates.

Effectiveness of Asthma Education with and Without a Self-Management Plan in Hospitalized Children

Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.

Uso de curvas ROC en investigación clínica: Aspectos teórico-prácticos

Una amplia gama de tests diagnosticos reportan sus resultados cuantitativamente, utilizando escalas continuas. El analisis de curvas ROC (receiver operating characteristic curve) constituye un metodo estadistico para determinar la exactitud diagnostica de estos tests, siendo utilizadas con tres propositos especificos: determinar el punto de corte de una escala continua en el que se alcanza la sensibilidad y especificidad mas alta, evaluar la capacidad discriminativa del test diagnostico, es decir, su capacidad de diferenciar sujetos sanos versus enfermos, y comparar la capacidad discriminativa de dos o mas tests diagnosticos que expresan sus resultados como escalas continuas. En base a una investigacion clinica real, el presente articulo ilustra el sustrato teorico subyacente a la construccion de curvas ROC, con el objetivo de ayudar a lectores e investigadores a interpretar correctamente sus resultados.

Morbid obesity in a developing country: the Chilean experience

Chile is a country of 16 million people of whom 88% live in an urban setting. Life expectancy is 78.3 years, gross na-tional income per capita is US

Surveillance System for Infectious Diseases of Pets, Santiago, Chile

4360 and 13.7% of the population lives be-low the national poverty line. Health conditions in Chile have changed strik-ingly in the past 50 years. In a brief period of time, Chile has undergone major demographic, epidemiological and nutritional transitions. The pro-portion of malnutrition among chil-dren aged less than 6 years decreased from 37% to 2.9% in the period concentrations of high-density lipo1960–2000;

Vitamin D levels and vitamin D receptor gene polymorphisms in asthmatic children: a case-control study*

Pet diseases may pose risks to human health but are rarely included in surveillance systems. A pilot surveillance system of pet infectious diseases in Santiago, Chile, found that 4 canine and 3 feline diseases accounted for 90.1% and 98.4% of notifications, respectively. Data also suggested association between poverty and pet diseases.