ObjectivesTo associate prognostic factors present at diagnosis with damage accrual in childhood-onset systemic lupus erythematosus (cSLE) patients.MethodsWe designed a cohort study of eligible children age 16 or younger who fulfilled the 1997 American College of Rheumatology (ACR) classification criteria for SLE. Excluded were those with previous treatment of steroids or immunosuppressants. The diagnosis date was cohort entry. We followed up on all subjects prospectively for at least 2 years. Two experts assessed the disease activity with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Mexican-SLEDAI (MEX-SLEDAI) every 3–6 months. Damage was measured annually, applying Pediatric Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) to their last visit. We analyzed prognostic factors by relative risks (RR) and used logistic regression to construct the clinimetric table.ResultsNinety patients with a median age of 11.8 years at diagnosis had a SLEDAI score of 15.5 (2–40) and a MEX-SLEDAI score of 12 (2–29); and of them, forty-eight children (53%) had SDI ≥ 2. The associated variables to damage (SDI ≥ 2) are as follows: neurologic disease RR 9.55 [95% CI 1.411–64.621]; vasculitis RR 2.81 [95% CI 0.991–7.973], and hemolytic anemia RR 2.09 [95% CI 1.280–3.415]. When these three features are present at diagnosis, the probability of damage ascends to 98.97%.ConclusionAt diagnosis, we identified neurologic disease, vasculitis, and hemolytic anemia as prognostic factors related to the development of damage in cSLE. Their presence should lead to a closer follow-up to reduce the likelihood of damage development.

The clinical outcome of patients with membranoproliferative glomerulonephritis (MPGN) varies, with some patients progressing to end-stage renal disease. The aim of this retrospective study was to analyze the initial clinical signs and laboratory test results associated with an MPGN prognosis. The study cohort consisted of 47 patients with idiopathic MPGN Type I treated at the National Institute of Pediatrics, Mexico City, between 1971 and 2001. The median follow-up was 3 years. The three different outcomes of interest were death, renal failure, and nephrotic syndrome. The patients' ages ranged between 4 and 16 years. All patients had different degrees of proteinuria, hyperlipidemia, and microscopic/macroscopic hematuria, and 85.1% of them showed hypocomplementemia. Clinical outcomes varied, however, the most common was nephrotic syndrome, either alone or combined with other syndromes, which accounted for 74.5% of all cases. Fifteen patients died. Treatment with methylprednisolone improved the patient's condition, while the use of chloroquine or cyclophosphamide worsened it. Twenty-two patients had some degree of renal failure; glomerular filtration rate (GFR) levels and albumin values were negatively associated to renal failure, while treatment with methylprednisolone decreased the probability of renal failure. Nephrotic syndrome persisted in 18 patients; hemolytic complement and hemoglobin values were negatively associated with nephrotic syndrome, while macroscopic hematuria was positively associated with it. Signs that suggested a poor prognosis during diagnosis were low GFR, low albumin, low hemolytic complement, and macroscopic hematuria. Treatment with methylprednisolone seemed to improve prognosis, however, this needs to be confirmed with randomized studies.

ANTECEDENTES: En los estudios de prueba diagnóstica puede hacerse la distinción en cinco fases que corresponden a diferentes objetivos. La fase III se denomina: estudio de exactitud diagnóstica.OBJETIVO: Ofrecer a los médicos y a otros profesionales de la salud una introducción actualizada de los conceptos y herramientas estadísticas de estudio de exactitud diagnóstica.DESCRIPCIÓN: El estudio de exactitud diagnóstica tiene como propósito determinar si la prueba de interés distingue a los sujetos con y sin la enfermedad de entre quienes se sospecha la enfermedad en una situación clínica cotidiana. Para cumplir este objetivo son decisivas: la selección del estándar de referencia válido, evitar los sesgos característicos de esta fase, identificar los parámetros que cuantifican la bondad de la exactitud diagnóstica y efectuar análisis estadísticos adecuados.CONCLUSIONES: Tanto para el uso de la información como para la realización del estudio de exactitud diagnóstica es necesario distinguir claramente esta fase de estudio como parte de los ensayos diagnósticos. Es importante conocer que la utilidad de la información de las fases II y III es muy diferente. Los usuarios de la prueba diagnóstica deben saber aplicar correctamente los datos locales para que la utilidad diagnóstica generada por la prueba sea adecuada al contexto clínico.

Objective. We tested the effectiveness of the I prefer plain water educational strategy used to increase water consumption in elementary school children. Materials and methods. A community intervention trial was performed in eight public elementary schools in Mexico City. The schools were randomized into an intervention (IG) and a control (CG) group. Each school was provided water dispensers inside the classrooms. The IG received the educational strategy. The strategy was considered effective if the students increased their water consumption by ≥220 ml. Results. Water consumption in the IG increased 167 ml vs. 37 ml in CG (p < 0.001). The goal of the educational strategy for water consumption was achieved in 166/413 children in the IG and 95/364 children in the CG (p < 0.001). Conclusions. I prefer plain water, associated with free access to water inside the classrooms, proved to be effective to increase water consumption.

<p>La acidosis tubular renal se caracteriza por acidosis metabólica hiperclorémica. El diagnóstico del tipo de acidosis tubular renal se realiza mediante la medición del transporte tubular máximo de bicarbonato y de la capacidad de acidificación urinaria; sin embargo, estas pruebas son invasivas y requieren determinaciones especializadas.</p><p>Objetivo: comparar la utilidad de la recolección urinaria de dos horas, una prueba relativamente simple y al alcance de muchos laboratorios, con la medición del transporte tubular máximo de bicarbonato y con la capacidad de acidificación urinaria (procedimientos de referencia) para clasificar el tipo de acidosis tubular renal en pacientes pediátricos.</p><p>Material y método: el estudio se realizó en niños con diagnóstico de acidosis tubular renal. El primer día se recolectó la muestra sérica y urinaria de dos horas. Al día siguiente se efectuaron los procedimientos de referencia administrando bicarbonato de sodio en 8 horas; las muestras se colectaron cada hora y se determinaron la reabsorción de bicarbonato y la acidificación urinaria. </p><p><br />Resultados: se incluyeron 19 pacientes y en 17 casos la colección urinaria de dos horas confirmó el diagnóstico de los procedimientos de referencia. La recolección urinaria de dos horas tuvo sensibilidad de 0.94 y especificidad de 0.67 para el diagnóstico de acidosis tubular renal distal.</p><p>Conclusión: la recolección de orina de dos horas se realiza en forma menos invasiva y ofrece resultados semejantes a los procedimientos de referencia.</p><p> </p>