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Background: Factors related to hyperhomocystinemia in the pediatric population of our geographical area with a parental history of premature coronary disease (PCD) are not well known., Objectives: To evaluate the possible association between plasma total homocysteine (tHcy), the B vitamins involved in its metabolism (folate, vitamin B12 and B6), and 677C T polymorphism of methylenetetrahydrofolate reductase (MTHFR) in a group of children with a parental history of PCD., Methods: A cross-sectional analytical study of 80 children (aged 5-18 years old) with a parental history of PCD was performed. Values found in these children were compared with reference values for similar age groups. Plasma tHcy and vitamin B6 were evaluated by high-performance liquid chromatography with fluorometric detection. Folate and vitamin B12 concentrations were determined by radioimmunoassay. Detection of 677C T polymorphism of MTHFR was performed using polymerase chain reaction amplification and Hinfl digestion. Statistical analysis was performed using the SPSS program, version 10.0. Concentrations of tHcy and vitamins were compared using the Mann-Whitney U-test and Spearman's correlation coefficient. The association between phenotype, hyperhomocystinemia and low vitamin concentrations was analyzed using the chi-squared test. ResultsPlasma tHcy values in the children aged more than 10 years with a parental history of PCD were significantly higher (p < 0.001) than the reference values. Vitamin B12 levels were significantly lower (p 0.015), but neither folate nor vitamin B6 levels differed from the reference values. A negative correlation (p < 0.0001) was observed between tHcy and folate (r 0.47) and between tHcy and vitamin B12 levels (r 0.51). Eighty percent of the children with the TT genotype of MTHFR showed hyperhomocystinemia. Suboptimal vitamin B levels were also associated with the TT genotype of MTHFR., Conclusions: Hyperhomocystinemia detected in children with a parental history of PCD is associated with the TT genotype of MTHFR and with low folate levels. Because hyperhomocystinemia can be corrected by vitamin B supplementation, tHcy determination is recommended in the offspring of patients with PCD.

Background: Urinary tract infection (UTI) is one of the most common infections in infants. It presents certain peculiarities compared with other pediatric age groups in terms of symptomatology, diagnosis and the therapeutic approach employed to prevent sequels., Objective: To analyze the epidemiology, clinical and laboratory findings, etiology, diagnosis and treatment of first-time UTI in healthy infants., Material and Methods: Between January and December 1999, we performed a retrospective study of 131 previously healthy infants admitted to our hospital with a diagnosis of first-time UTI. Demographic data, clinical characteristics, urine dipstick, urinalysis and urine culture (vesical catheterization), blood cell count and PCR, kidney ultrasonography, voiding cystourethrogram and DMSA scintigraphy were reviewed., Results: We studied 131 patients (median age: 90 days). In infants younger than 30 days, UTI was more prevalent in males. The most frequent symptom was fever (73.3 %). Seventy-one patients fulfilled the criteria for acute pyelonephritis. The presence of nitrituria was low. Escherichia coli was isolated in 90.1 % of the patients. Voiding cystourethrogram detected vesicoureteric reflux in 18.4 % of the patients. Scintigraphy revealed renal scarring in 15.1 %. No significant correlations were found between renal scarring in late scintigraphy and a diagnosis of acute pyelonephritis and/or alterations in the cystourethrogram., Conclusions: Fever was the main symptom. E. coli was the most commonly isolated microorganism. Nitrituria had low sensitivity in infants. Ultrasonography had low specificity. Scintigraphy showed the highest sensitivity and specificity in the detection of renal scarring. Predictability improved when scintigraphy was performed a few months after acute infection.

The objective of this study was to determine the prevalence of bacteria isolated from middle ear effusions in infants with otitis media in our environment. Data collected from 50 patients of the Infant Section of the Unidad Integrada Hospital Clínico-San Juan de Dios were evaluated prospectively from October 1, 1992 to March 7, 1994. Patients between 1 month and 1 year of age, with unilateral or bilateral otitis media diagnosed by otoscopy criteria and positive myringotomy, were recruited for study. Those who had received any antibiotic during the previous 3 days or had been admitted to the hospital more than 5 days before were excluded. We found that failure to thrive (18%) is a common form of onset of otitis media in children under one year of age. Rhinorrhea and nasal obstruction (60%), cough (50%) and fever (46%) were the most frequent symptoms at the moment of diagnosis. Blood analysis does not add any information for diagnosing otitis media. The difference between acute otitis media and otitis media with effusion is likely to be more clinical rather than microbiological. The recovery of pathogens from 62% of the ear cultures correlates with the figures reported in the literature. The predominance of S. pneumoniae (38%), followed by H. influenzae (25%), is in agreement with previous findings internationally. In our study, there is no evidence of viruses alone causing otitis media in infants. Consequently, antibiotic therapy should be indicated in every child with otitis media.

Three cases of luetic nephropathy are presented. The authors review the literature on the subject stressing the current clinical and etiopathogenic concepts. They also emphasize, as a conclusion, the need for an early diagnosis and treatment and the consideration of this entity in the differential diagnosis of the nephrotic syndrome of the infant.