Julio Espinoza M

Adopción: Una familia para un niño o una forma de hacer familia

Adoption has a main objective to give a home to a child in a situation of abandon. To reach this stage, the biological mother has had a long and painful road to travel, an ache that does not finish with the delivery of her child. The child suffers the abandon of his mother and her caretakers before reaching his definitive family. The adoptive parents, frequently have suffered a period of medical tests, procedures and treatments before verifying that they are incapable of having biological children. The adoptive family will live the development stages of the child along with the problems that adoption bears. Paedriatricans and related specialists must help all the participants in order that the adoptive process is harmonic and leads to the well-being and happiness of the child or adolescent.

Cryptosporidiosis: estudios en niños de comunidades de nivel socioeconómico bajo

Cryptosporidium was detected in 2 (1.5%) out of 132 children under 2 years with acute diarrhea; in 2 (3.2%) out of 63 patients under 2 years with persistent diarrhea; in 1 (3.9%) out of 26 malnourished patients younger than 2 years with an episode of acute diarrhea and in 7 (1.4%) out of 516 pediatric ambulatory patients who consulted for acute or chronic diarrhea or recurrent abdominal pain. The clinical histories of the 5 infants with cryptosporidiosis who belonged to the first 3 studies, are presented. All they had prolonged diarrhea (more than 15 days long), and one of them showed low IgG and IgA serum concentrations, but normal proportions of T lymphocyte populations.

Estudios clínicos avanzados en la investigación pediátrica en Chile: 1994-2003

Introduccion: Entre las modalidades de investigacion cientifica en Medicina, los ensayos clinicos son los que tienen mayor importancia e impacto. Objetivo: Analizar los articulos cientificos fase III y IV en temas pediatricos, publicados en Revistas con o sin indice de impacto, en el decenio 1994-2003. Metodos: A partir de la base electronica de publicaciones cientificas ISI de PubMed y de la revision de las Revistas nacionales no indexadas, se analizaron los estudios clinicos Fase III o Fase IV que incluian a sujetos £ 18 anos. Se consigno: autores, institucion ejecutora, area pediatrica analizada. Resultados: Se encontraron 71 trabajos en revistas ISI y 11 trabajos en revistas nacionales no ISI (x = 8,2 trabajos/ano). Del total, 40 articulos aparecen bajo el alero de la Universidad de Chile, 16 de la Universidad Catolica, 4 de la Universidad de Santiago, 3 de la Universidad de Valparaiso, 2 de la Universidad de Concepcion, 1 de la Universidad de La Frontera y 1 de la Universidad Austral. Ademas hubo 6 trabajos del Centro de Vacunas, 6 de Hospitales pediatricos, 2 de Clinicas privadas y 1 del Centro de Planificacion Familiar. Las areas tematicas principales fueron: Nutricion (n = 17), Endocrinologia (n = 11), Broncopulmonar (n = 10), Vacunas (n = 8), Infectologia (n = 6), Neonatologia (n = 5) y Gastroenterologia (n = 4). La mayoria de los trabajos fueron efectuados por grupos de investigacion conocidos. Conclusiones: Los estudios clinicos fase III y IV son de baja frecuencia en Chile, con tendencia estacionaria en la ultima decada. La mayoria de los trabajos han sido efectuados por las Universidades y por grupos de investigacion consolidados. Las areas tematicas mas frecuentes fueron: Nutricion, Endocrinologia, Vacunas y Broncopulmonar. Se requieren estrategias para mejorar el nivel de investigacion cientifica pediatrica en Chile

CONSTIPACIÓN EN PEDIATRÍA

La constipacion es causa frecuente de consulta en pediatria general y del especialista gastrenterologo. Cada vez mas frecuentemente los malos habitos alimentarios, el consumo escaso de fibra dietaria y trastornos psicologicos ocasionados por el ambiente en que se desarrolla el nino: estres intrafamiliar y en el colegio, son la causa de dicho incremento. Nuevas terapeuticas se han incorporado con exito relativo porque crear nuevos habitos requiere tiempo prolongado y por la poca adhesividad al tratamiento, por parte del nino y sus familiares o cuidadores

Colonización bacteriana anormal del intestino delgado alto en escolares de nivel socioeconómico alto y bajo

Microbiological contamination ol the enviroment induces chronic enviromental enteropathy, characlerized by mild to moderate morphological and functional changes o( the small intestinal mucosa. Bacterial colonization was evaluated in 31 1 school aged children (1 55 of the high (H-SES] and 1 56 of the low (L-SES) socioeconomic strata) by means of Ihe breath H2 test. Samples were obtained after overnight fast and every 15 minutes for 240 minutes following the ingestion of 1 50 mg • kg laclulose. A health queslionaire that included information about food and medicines ingestion, alcohol consumption, smoking and intolerance to foodstuffs was also applied. In 30% of the children basal H2 excretion was above 10 ppm. In 18,1% of the H-SES and 4.5% of the L-SES (p 20 ppm between 90 and 240 minutes) were detected in 78./% of the H-SES and 40,4% of the L-SES [p< 0.0001). In 1 8.7% and 48.7% of the H-SES and L-SES, respectively, curves were flat (basal excretion < 10 ppm and increments < 20 ppm). Chronic environmental enteropathy is already present in school age children. The lower breath H? excretion observed in low socioeconomic individuals may be due to diferences in quality and quantity of the diet.

Enfermedad celíaca en la adolescencia

Nutritional status, sexual maturation and intestinal absorption were assessed in 16 adolescent celiac patients (12femalesl at ages 12 and 18 year. Weight/age, height/age and weight/height were 75.5% (51.6-94,8), 90.3% (76.8-104.6) and 99.1% (76.3-112.9) at 12 years and 85.6% (64.0-105.2), 93.8% (85.9-101.2) and 110% (76.5-121.9) at18 years of age, respectively. Sexual maturation (Tanner) was at stage I in 31%, and at stage II in 43.7% of patientsat age 12 years and it had reached maturity in 75% of them at 18 years. Menarchy occurred between 12 and 14years of age, except in 3 patients in whom it was retarded. Mean serum carotene levels were 125 and 1 08,5 ug/dl atages 12 and 18 years respectively. Delayed weight and height progress in this particular group of patients might beexplained by low socio-economic conditions, late diagnosis, and poor adherence to gluten-free diet.(Key words: celiac disease, gluten free diet, nutrition, sexual development, intestinal absorption.)

Morbilidad y estado nutricional en lactantes de alto riesgo. Estudio de terreno

Morbidity and nutritional status in children of high risk of morbidity. A field study A predictive model which identifies infanls with four or five times higher morbidity rotes than unselecled populalion, was used to evaluate 108 infants.. 41 of whom lost 10% or more of their weighl/age ratio along a six monlh follow up. Frecuencies and type of diseases did not allow to differenciale patients whose nutrition deteriorated from Ihose in which it did not. The greatest decreases of weigh for age were observed in the second six months of life. In 77.1 % of children weight gain improved after 1 2 months of age, when energetic requirements decrease. Results suggesl that the risk for health of those children may be rather associated with maternal inappropriate practices than lo biological or environmental variables.