Role of Zr loading into In2O3 catalysts for the direct conversion of CO2/CO mixtures into light olefins.

The effect of the ZrO2 content on the performance (activity, selectivity, stability) of In2O3-ZrO2 catalyst has been studied on the hydrogenation of CO2/CO mixtures. This effect is a key feature for the viability of using In2O3-ZrO2/SAPO-34 tandem catalysts for the direct conversion of CO2 and syngas into olefins via oxygenates as intermediates. The interest of co-feeding syngas together with CO2 resides in jointly valorizing syngas derived from biomass or wastes (via gasification) and supplying the required H2. The experiments of methanol synthesis and direct synthesis of olefins, with In2O3-ZrO2 and In2O3-ZrO2/SAPO-34 catalysts, respectively, have been carried out under the appropriate conditions for the direct olefins synthesis (400 °C, 30 bar, H2/COX ratio = 3) in an isothermal fixed bed reactor at low space time values (kinetic conditions) to evaluate the behavior and deactivation of the catalysts. The Zr/In ratio of 1/2 favors the conversion of CO2 and COX, attaining good oxygenates selectivity, and prevents the sintering attributable to the over-reduction of the In2O3 (more significant for syngas feeds). The improvement is more remarkable in the direct olefins synthesis, where the thermodynamic equilibrium of methanol formation is displaced, and methanation suppressed (in a greater extent for feeds with high CO content). With the In2O3-ZrO2/SAPO-34 tandem catalysts, the conversion of COx almost 5 folds respect oxygenates synthesis with In2O3-ZrO2 catalyst, meaning the yield of the target products boosts from ∼0.5% of oxygenates to >3% of olefins (selectivity >70%) for mixtures of CO2/COX of 0.5, where an optimum performance has been obtained.

Evaluation of the influence of main groundwater ions on arsenic removal by limestones through column experiments.

The influence of common groundwater major ions on arsenic (As) retention by native limestones was studied through column experiments. Columns were packed with rock particles (0.5-1.41 mm) and fed with solutions containing As, and chloride (Cl), sulfate, bicarbonate or fluoride (F) in concentrations similar to those measured in one of the most As-rich wells of Mexico. Besides, other solutions were also treated containing multiples or submultiples of those anion concentrations. Physico-chemical parameters, As, and each anion concentrations were determined weekly along 4 months. After the end of the experiments rocks collected from the top of the columns were analyzed by XRF, XRD, and SEM-WDS. Concentrations of As decreased from 1.2 mg/L to values below the Mexican drinking water standard (0.025 mg/L), since the first week in the solutions containing F or Cl keeping low values afterwards, indicating that they do not interfere with As removal. However, although As strongly decreased in the solutions containing sulfate since the first week, it started to increase from the 12th week in the highest concentrated solution. Bicarbonate was the anion affecting most As retention, since, after its decrease below 0.025 mg/L in the 2nd week for both solutions (30 mg/L and 300 mg/L), it started to increase since the 7th week in the most concentrated one, but maintained a low concentration in the least concentrated solution. Saturation index calculations and XRD analyses did not evidence the formation of As minerals. However, SEM elemental maps and XRF analyses showed the presence of As on the rocks after the treatments. Results indicate that As may be retained by sorption. Sulfate and bicarbonate compete with As for sorption sites. Results showed that native limestones are an option for treating As polluted water. Experiments also indicated that bicarbonate and sulfate may interfere with As removal depending on their concentrations.

[Growth hormone of dried blood spot for the diagnosis of growth hormone deficiency]. / Hormona de crecimiento en sangre de papel filtro para el diagnóstico de deficiencia de hormona de crecimiento.

INTRODUCTION: The diagnosis of growth hormone deficiency (GHD) is difficult to determine, and could be associated with severe complications, especially in the neonatal period. The stimulation test of growth hormone (GH) secretion is considered the gold standard for diagnosis, but it has methodological complications and is associated with adverse effects. Neonates present physiological increased secretion of GH, representing a diagnostic window. OBJECTIVE: To evaluate if the dried blood spot on filter paper obtained in the neonatal period, as part of a neonatal screening for con genital hypothyroidism and phenylketonuria, allows differentiating patients with GHD from those who do not have it. PATIENTS AND METHOD: Study of cases and controls by measuring the GH concen tration in dried blood spot on filter paper obtained in the neonatal period, comparing controls with GHD with cases with discarded deficiency. The sample was extracted from the filter paper, obtaining two 0.125 inch discs per each patient from the center of the blood spot on the paper, for a highly sen sitive ELISA assay for human GH based on the use of polyclonal antibodies against 22 kDa recom binant human GH. RESULTS: Seven cases of GHD and ten controls were obtained. The median GH concentration of the dried blood spot in the cases is 2.0 ng/ml (Interquartile range 3.6 ng/ml) and 2.05 ng/ml (Interquartile range 2.0 ng/ml) in the controls, Mann-Whitney U test 30.5 (p = 0.68). The two cases with multiple pituitary-hormone deficiency (MPHD) present concentrations lower than 1 ng/ml. CONCLUSION: The dried blood spot sample did not differentiate GHD patients from control cases, although MPHD cases present much lower concentrations compared to isolated growth hor mone deficiency (IGHD).

Hormona de crecimiento en sangre de papel filtro para el diagnóstico de deficiencia de hormona de crecimiento / Growth hormone of dried blood spot for the diagnosis of growth hormone deficiency

INTRODUCCIÓN: El diagnóstico de deficiencia de hormona de crecimiento (DHC) es difícil de establecer, y se puede asociar a serias complicaciones, especialmente en el período neonatal. La prueba de estímulo de secreción de hormona de crecimiento (HC) se considera de elección para el diagnóstico, pero presenta complicaciones metodológicas y se asocia a efectos adversos. Los neonatos presentan aumento de la secreción de HC de forma fisiológica, siendo una ventana diagnóstica. OBJETIVO: Evaluar si la muestra de sangre en papel filtro tomada en el período neonatal, en contexto del tamizaje neonatal de hipotiroidismo congénito y fenilcetonuria, permite diferenciar pacientes con DHC, de los que no la presentan. PACIENTES Y MÉTODO: Estudio de casos y controles mediante determinación de concentración de HC en sangre de papel filtro extraída en período neonatal, comparando controles con DHC con casos con deficiencia descartada. Se realizó extracción de la muestra del papel filtro, obteniendo dos discos de 0,125 pulgada por cada uno de los pacientes desde el centro de la mancha de sangre del papel, para un ELISA de HC humana altamente sensible basado en el uso de anticuerpos policlonales dirigidos contra la HC humana recombinante de 22kDa de peso molecular. RESULTADOS: Se obtuvo un total de 7 casos de DHC y 10 controles. La mediana de concentración de HC de papel filtro en los casos es 2,0 ng/ml (Rango intercuartil 3,6 ng/ml) y controles 2,05 ng/mL (RIC 2,0 ng/ml), U de Mann-Withney 30,5 (p = 0,68). Los dos casos con deficiencia de hormonas hipofisarias múltiples (DHHM) presentan concentraciones menores a 1 ng/ml. CONCLUSIÓN: La muestra de papel filtro no permitió diferenciar a los pacientes con DHC de los casos controles, aunque los casos con DHHM presentaron concentraciones mucho menores, en comparación a la deficiencia de hormona de crecimiento aislada (DHCA).

INTRODUCTION: The diagnosis of growth hormone deficiency (GHD) is difficult to determine, and could be associated with severe complications, especially in the neonatal period. The stimulation test of growth hormone (GH) secretion is considered the gold standard for diagnosis, but it has methodological complications and is associated with adverse effects. Neonates present physiological increased secretion of GH, representing a diagnostic window. OBJECTIVE: To evaluate if the dried blood spot on filter paper obtained in the neonatal period, as part of a neonatal screening for con genital hypothyroidism and phenylketonuria, allows differentiating patients with GHD from those who do not have it. PATIENTS AND METHOD: Study of cases and controls by measuring the GH concen tration in dried blood spot on filter paper obtained in the neonatal period, comparing controls with GHD with cases with discarded deficiency. The sample was extracted from the filter paper, obtaining two 0.125 inch discs per each patient from the center of the blood spot on the paper, for a highly sen sitive ELISA assay for human GH based on the use of polyclonal antibodies against 22 kDa recom binant human GH. RESULTS: Seven cases of GHD and ten controls were obtained. The median GH concentration of the dried blood spot in the cases is 2.0 ng/ml (Interquartile range 3.6 ng/ml) and 2.05 ng/ml (Interquartile range 2.0 ng/ml) in the controls, Mann-Whitney U test 30.5 (p = 0.68). The two cases with multiple pituitary-hormone deficiency (MPHD) present concentrations lower than 1 ng/ml. CONCLUSION: The dried blood spot sample did not differentiate GHD patients from control cases, although MPHD cases present much lower concentrations compared to isolated growth hor mone deficiency (IGHD).

Prevalence of diabetes mellitus and impaired glucose metabolism in the adult population of the Basque Country, Spain.

AIMS: To assess the prevalence of diabetes mellitus and impaired glucose metabolism in the Basque Country and their relationship with cardiovascular risk factors. METHODS: A population-based, cross-sectional, cluster sampling design study was carried out in an adult (≥18 years) Basque population. A total of 847 participants completed a questionnaire on personal and family medical history and lifestyle. Anthropometric variables and blood pressure were measured and biochemical analysis and an oral glucose tolerance test (75 g) were also performed. RESULTS: The total prevalence of diabetes was 10.6% (95% CI 8.65-12.95). Among them 6.3% (95% CI 4.79-8.22) had previously been diagnosed and 4.3% (95% CI 3.04-5.92) were not aware that they had diabetes. Impaired glucose tolerance was present in 7.2% (95% CI 5.53-9.15) and impaired fasting glucose in 3.8% (95% CI 2.64-5.37) of the population. In total, 21.6% of the population had some type of glucose metabolism disturbance, with a higher rate among men (28.3 vs 16.3%; P<0.001) and with the rate increasing with age. Risk factors independently associated with the development of diabetes were: male sex [odds ratio 4.58 (95% CI 2.34-8.97)]; abdominal obesity [odds ratio 2.80 (95% CI 1.47-5.36)]; high triglyceride levels [odds ratio 2.46 (95% CI 1.26-4.81)]; hypertension [odds ratio 2.40 (95% CI 1.16-4.96)]; family history of diabetes [odds ratio 2.30 (95% CI 1.25-4.24)]; high LDL cholesterol levels [odds ratio 1.83 (95% CI 1.01-3.31)] and older age [odds ratio 1.08 (95% CI 1.05-1.10)]. CONCLUSIONS: The prevalence of diabetes in the Basque Country was lower than in Spain and was independently associated with family history of diabetes and with cardiovascular risk factors such as abdominal obesity, hypertension, high LDL cholesterol levels and high triglyceride levels, which were also observed in those with prediabetes.

Clinical and genetic characterization of congenital hyperinsulinism in Spain.

CONTEXT: Congenital hyperinsulinism (CHI) is a clinically and genetically heterogeneous disease characterized by severe hypoglycemia caused by inappropriate insulin secretion by pancreatic ß-cells. OBJECTIVE: To characterize clinically and genetically CHI patients in Spain. DESIGN AND METHODS: We included 50 patients with CHI from Spain. Clinical information was provided by the referring clinicians. Mutational analysis was carried out for KCNJ11, ABCC8, and GCK genes. The GLUD1, HNF4A, HNF1A, UCP2, and HADH genes were sequenced depending on the clinical phenotype. RESULTS: We identified the genetic etiology in 28 of the 50 CHI patients tested: 21 had a mutation in KATP channel genes (42%), three in GLUD1 (6%), and four in GCK (8%). Most mutations were found in ABCC8 (20/50). Half of these patients (10/20) were homozygous or compound heterozygous, with nine being unresponsive to diazoxide treatment. The other half had heterozygous mutations in ABCC8, six of them being unresponsive to diazoxide treatment and four being responsive to diazoxide treatment. We identified 22 different mutations in the KATP channel genes, of which ten were novel. Notably, patients with ABCC8 mutations were diagnosed earlier, with lower blood glucose levels and required higher doses of diazoxide than those without a genetic diagnosis. CONCLUSIONS: Genetic analysis revealed mutations in 56% of the CHI patients. ABCC8 mutations are the most frequent cause of CHI in Spain. We found ten novel mutations in the KATP channel genes. The genetic diagnosis is more likely to be achieved in patients with onset within the first week of life and in those who fail to respond to diazoxide treatment.

Symbol Digit Modalities Test: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data on the Symbol Digit Modalities Test (SDMT) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the SDMT as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models explained 29-56% of the variance in SDMT scores. Although there were gender differences on the SDMT in Mexico, Honduras, Paraguay, and Guatemala, none of the four countries had an effect size greater than 0.3. As a result, gender-adjusted norms were not generated. CONCLUSIONS: This is the first normative multicenter study conducted in Latin America to create norms for the SDMT; this study will have an impact on the future practice of neuropsychology throughout the global region.

Brief Test of Attention: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data on the Brief Test of Attention (BTA) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,977 healthy adults who were recruited from Mexico, Argentina, Peru, Paraguay, Honduras, Chile, Cuba, Puerto Rico, Guatemala, El Salvador, and Bolivia. Each subject was administered the BTA as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models explained between 11-41% of the variance in BTA scores. Although men had higher scores on the BTA in Honduras, there were no other significant gender differences, and this one effect size was small. As a result, gender-adjusted norms were not generated. CONCLUSIONS: This is the first normative multicenter study conducted in Latin America to create norms for the BTA; this study will have an impact on the future practice of neuropsychology throughout Latin America.

Trail Making Test: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data on the Trail Making Test (TMT) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,977 healthy adults who were recruited from Mexico, Argentina, Peru, Paraguay, Honduras, Chile, Cuba, Puerto Rico, Guatemala, El Salvador, and Bolivia. Each subject was administered the TMT as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models for the TMT-A explained 23- 50% of the variance, and the final multiple linear models for the TMT-B explained 22- 49% of the variance. Although there were gender differences on the TMT in Mexico, Peru, Paraguay, and Honduras, only Honduras had an effect size greater than 0.3. As a result, gender-adjusted norms were generated for the Trail Making Test-A, but not B, in this country. CONCLUSIONS: The present study is the first to create norms for the TMT in Latin America. As a result, this study will have important implications for the practice of neuropsychology in the future.

Hopkins Verbal Learning Test- Revised: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data on the Hopkins Verbal Learning Test- Revised (HVLT-R) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the HVLT-R as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models explained 17- 45% of the variance in HVLT-R scores. Although t-tests showed significant differences between men and women in Guatemala on the HVLT-R, it was a small effect size. As a result, gender-adjusted norms were not generated. CONCLUSIONS: The results from this study will have a substantial impact on the practice of neuropsychology in Latin America, as this is the first normative multicenter study to develop norms for the HVLT-R in this region.

Test of Memory Malingering (TOMM): Normative data for the Latin American Spanish speaking adult population.

BACKGROUND: The Test of Memory Malingering (TOMM) is an instrument used to assess purposeful embellishment or fabrication of memory difficulties for personal gain. Although the TOMM can be use in non-English speaking cultures, it has not been validated in Spanish-speaking Central and South American contexts. OBJECTIVE: To generate normative data on TOMM across 7 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 2,266 healthy adults who were recruited from Argentina, Bolivia, Chile, Mexico, Paraguay, Peru, and Puerto Rico. Each subject was administered the TOMM as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: t-tests did not show significant differences in TOMM performance between men and women in any countries of the TOMM Trial 1 or 2. As a result, gender-adjusted norms were not generated. CONCLUSIONS: The results from this study will have a large impact on the practice of neuropsychology in Latin America, as this is the first normative multicenter study to create norms for the TOMM in this global region.

Eficacia, seguridad y eficiencia de las nuevas tecnologías en cirugía tiroidea / Effectiveness, safety and efficiency of new technologies in thyroid surgery

Introduction: Surgery of the thyroid gland is the most performed procedure by the endocrine surgeon. In the last years, new techniques have been incorporated in this procedure. Our objective is to analyse the impact of these techniques in our department. Methods: We performed a retrospective and comparative study among three samples of patients submitted for total thyroidectomy. Group I: Sample of 96 patients operated between 2004 and 2007 performing total thyroidectomy. In this period we didn't use ultrasonic scalpel (US) nor intraoperative neuromonitoring (INM). Group II: Sample of 108 patients operated between 2008 and 2010. In this group we used US for hemostasis. Group III: Sample of 82 patients operated between 2011 and 2012. In this group we used both US and INM. The groups are compared: complications, postoperative stay, surgical time and costs per patient. Results: We analysed the following complications: haemorrhage, postoperative hipocalcemia and recurrent nerve palsy. We didn't find significant differences among the samples of patients but there were a less percentage of recurrent palsy in the third group (4.9 percent vs 12.5 and 11.1 percent). We found significant differences when stay, surgical time and costs were analysed. Conclusion: The use of new techniques in thyroid surgery has supposed an improvement not only in the clinic outcomes but in the surgical time.

Objetivo: La cirugía de la glándula tiroides representa el procedimiento más frecuente que realiza el cirujano endocrino. En los últimos años se han ido incorporando nuevas técnicas aplicadas a este procedimiento. El objetivo de nuestro trabajo es analizar el impacto que dichas técnicas han tenido en nuestro servicio. Material y Métodos: Estudio retrospectivo y comparativo entre tres muestras de pacientes a los que se realizó tiroidectomía total. Grupo I: Muestra de 96 pacientes intervenidos entre 2004 y 2007 a los que se realizó tiroidectomía total. En este período no se utilizó bisturí ultrasónico (BU) ni neuromonitorización intraoperatoria (NMI). Grupo II: Muestra de 108 pacientes intervenidos entre 2008 y 2010. En este grupo se realizó hemostasia con BU. Grupo III: Muestra de 82 pacientes intervenidos entre 2011 y 2012. Se utilizó tanto el BU como la NMI. Se comparan los grupos en cuanto a: complicaciones, estancia postoperatoria, tiempo quirúrgico y coste por paciente. Resultados: Las complicaciones analizadas fueron: hemorragia, hipocalcemia postoperatoria y parálisis del nervio laríngeo recurrente. No encontramos diferencias significativas entre los grupos aunque sí hay una menor tasa de parálisis recurrenciales en el tercer período (4,9 por ciento vs 12,5 y 11,1 por ciento). Hemos obtenido diferencias significativas en estancia, tiempo quirúrgico y coste por paciente. Conclusión: La inclusión de las nuevas técnicas en cirugía tiroidea ha supuesto una mejora en los resultados clínicos así como un ahorro de tiempo de quirófano.

Treatment of mining acidic leachates with indigenous limestone, Zimapan Mexico.

An experimental study to evaluate the potential of using indigenous limestones in a passive system to treat acid mine drainage, at a mining zone of Mexico was carried out. Chemical and mineralogical characteristics of four types of native rocks (KIT1, KIT2, KSS, QZ) showed distinct CaCO3 contents. Synthetic aqueous leachates from an old tailings impoundment had a pH of 2.18, 34 mg/L As, 705 mg/L Fetotal, and 3975 mg/L SO4(2-). To evaluate dissolution behavior of rocks, kinetic batch experiments with an acid Fe-rich solution were performed. Decaying kinetic constants adjusting H(+) concentration to a first order exponential process were: KIT1 (k = 2.89), KIT2 (k = 0.89) and KSS (k = 0.47). Infrared spectrum and XRD of precipitates showed schwertmannite formation. To determine As and heavy metals (Fe, Cd, Zn, Al) removal from the synthetic leachates, batch experiments using KIT1 were developed. Arsenic decreased from 34.00 mg/L to 0.04 mg/L, Fe and Al were totally removed, and concentrations of Zn and Cd decreased 88% and 91% respectively. Analyses by IR and SEM-EDS indicate that co-precipitation with Fe-Hydroxides formed upon leachate interaction with limestone is the main As removal process. Chamosite, identified by XRD may participate in the removal of Al, SiO2 and a fraction of Fe.

Large mitochondrial DNA deletion in an infant with addison disease.

BACKGROUND: Mitochondrial diseases are a group of disorders caused by mutations in nuclear DNA or mitochondrial DNA, usually involving multiple organ systems. Primary adrenal insufficiency due to mitochondrial disease is extremely infrequent and has been reported in association with mitochondrial DNA deletion syndromes such as Kearns-Sayre syndrome. AIM: To report a 3-year-old boy with Addison disease, congenital glaucoma, chronic pancreatitis, and mitochondrial myopathy due to large mitochondrial DNA deletion. METHOD: Molecular analysis of mitochondrial DNA samples obtained from peripheral blood, oral mucosa, and muscle tissue. RESULTS: A novel large mitochondrial DNA deletion of 7,372bp was identified involving almost all genes on the big arch of mtDNA. CONCLUSIONS: This case reaffirms the association of adrenal insufficiency and mitochondrial DNA deletions and presents new evidence that glaucoma is another manifestation of mitochondrial diseases. Due to the genetic and clinical heterogeneity of mitochondrial disorders, molecular analysis is crucial to confirm diagnosis and to allow accurate genetic counseling.

Antiangiogenesis in myelodysplastic syndrome.

One of the best examples of the bench-to-bedside paradigm in recent years could be the myelodysplastic syndromes (MDS). New insight into the pathophysiology of this heterogeneous group of diseases has led to relevant clinical changes. We have now the World Health Organization classification of MDS, the International Prognostic Score System to evaluate risk according to some clinical and laboratory parameters, and the approval by most of the regulatory agencies around the world of 5-azacitidine, decitabine and lenalidomide to treat MDS patients. In the last decade a robust body of evidence supports the importance of angiogenesis and angiogenesis related molecules as having a key role in the pathophysiology of hematologic malignancies including of MDS. A group of researchers around the globe is testing drugs with angiogenesis-regulatory characteristics with some success. Experience from those trials has shown angiogenesis in MDS as a dynamic process, a "moving target". Lenalidomide hit one and, although experience is being gained the complete answer is not there yet. Combinations of drugs with different mechanisms of actions are options that need to be tested. Herein we present some of the accumulated experience with these novel antiangiogenic-drugs.

Leuprolide acetate gonadotrophin response patterns during female puberty.

OBJECTIVE: To assess normative data and the usefulness of spontaneous and LHRH analogue-stimulated serum LH and FSH levels measured by immunoradiometric assays (IRMA) in the evaluation of normal puberty. DESIGN: Prospective. Healthy girls in Tanner I and Tanner II from the local community were invited to participate (n = 47). METHODS: A leuprolide acetate test (500 mcg/m(2); sc) was performed. LH and FSH levels were determined using IRMA. Tanner II girls were assessed every 6 months until Tanner V. Girls who progressed from Tanner II to Tanner III in the next 6 months were called Tanner II-2; otherwise, they were called Tanner II-1. RESULTS: The prepubertal upper limit (CI 95%) was 0.49 IU/l for basal LH and 5.1 IU/l for stimulated LH. Taking into account these LH cut-off limits, 72.2% and 66.7% of Tanner II-1 and 41.6% and 41.7% of Tanner II-2 subjects presented overlapping values for basal and stimulated LH, respectively, as compared with the Tanner I group. The cut-offs for basal and stimulated LH to predict progression from Tanner II to Tanner III in the next 6 months were a basal LH level > or =0.49 IU/l (Sensitivity = 0.58; 1-Specificity = 0.33) and a poststimulated LH level > or =4.75 IU/l (Sensitivity = 0.67; 1-Specificity = 0.44). CONCLUSION: According to an IRMA, the basal and leuprolide acetate gonadotrophin response patterns during the beginning stages of puberty overlapped between Tanner I and Tanner II, and the cut-offs of basal and stimulated LH levels to predict progress from Tanner II to Tanner III had low sensitivities for the following 6 months.

[Optical coherence tomography and macular phototoxicity]. / OCT y fototoxicidad macular.

CASE REPORT: Ocular examinations and optical coherence tomography (OCT) were performed in three patients with retinal phototoxicity lesions. Fluorescein angiography depicted a window defect. OCT exhibited hyporeflectivity at the outer foveal retina and fragmentation of the inner reflective layers, corresponding to the junction between the inner and outer photoreceptor segments. DISCUSSION: Retinal damage after light exposure has a rapid onset and shows different patterns in OCT examination. OCT findings suggest that decreased visual acuity may be associated with full-thickness photoreceptors and retinal pigment epithelium (RPE) involvement. OCT is a useful tool for objective assessment of retinal pathology in phototoxicity cases where fundus changes may be minimal or absent.

OCT y fototoxicidad macular / Optical coherence tomography and macular phototoxicity

Caso clínico: Se realiza una exploración ocular y tomografía de coherencia óptica (OCT) en tres pacientes con lesiones fototóxicas retinianas. Las angiografías fluoresceínicas muestran un defecto ventana. La OCT muestra hiporreflectividad en la porción externa de la fóvea y fragmentación de las capas más internas entre la porción interna de los fotorreceptores y los segmentos externos. Discusión: Las lesiones retinianas tras exposición a la luz aparecen precozmente mostrando diferentes patrones en la OCT. La OCT sugiere que la disminución de visión asocia una lesión de fotorreceptores y epitelio pigmentario retiniano (EPR). La OCT es útil para objetivar la retinopatía fototóxica donde los cambios oftalmoscópicos pueden estar ausentes o ser mínimos

Case report: Ocular examinations and optical coherence tomography (OCT) were performed in three patients with retinal phototoxicity lesions. Fluorescein angiography depicted a window defect. OCT exhibited hyporeflectivity at the outer foveal retina and fragmentation of the inner reflective layers, corresponding to the junction between the inner and outer photoreceptor segments. Discussion: Retinal damage after light exposure has a rapid onset and shows different patterns in OCT examination. OCT findings suggest that decreased visual acuity may be associated with full-thickness photoreceptors and retinal pigment epithelium (RPE) involvement. OCT is a useful tool for objective assessment of retinal pathology in phototoxicity cases where fundus changes may be minimal or absent (Arch Soc Esp Oftalmol 2008; 83: 267-272)

Monitorización continua de la glucosa en la edad pediátrica: indicaciones y aplicación clínica de los resultados / Continuous glucose monitoring in children with type 1 diabetes: indications and clinical application of the results

Los avances desarrollados en los últimos años en el tratamiento de la diabetes, que incluyen cambios en la terapia insulínica (generalización de la pauta de multidosis e incorporación de bombas de infusión continua) y una frecuente monitorización de las glucemias capilares, son puntos cruciales en el manejo de los pacientes pediátricos con diabetes mellitus tipo 1. Sigue habiendo límites para conseguir un control metabólico óptimo de esta enfermedad, como la escasa información que aportan las glucemias capilares en relación con el perfil glucémico continuo de los pacientes. El continuous glucose subcutaneous monitoring system (CGMS) es un sistema de monitorización continua de glucosa intersticial que aporta 288 lecturas en 24 horas y guarda una buena correlación con las glucemias plasmáticas. Su información detalla todas las fluctuaciones de la glucosa a lo largo del día, y es de gran utilidad para mejorar el control metabólico en estos pacientes, así como para detectar las hipoglucemias y, por tanto, prevenirlas. Los estudios con CGMS en niños muestran una elevada prevalencia de hipoglucemias nocturnas y de excursiones hiperglucémicas posprandiales, incluso en pacientes que tienen una buena cifra de hemoglobina glucosilada. Por ello, debemos seguir en la búsqueda de un tratamiento más fisiológico para esta enfermedad que, además, ofrezca una mejor calidad de vida para los pacientes

Recent advances in diabetes care, including multiple-dose insulin, continuous subcutaneous insulin infusion and frequent self-monitoring of blood glucose, have become critical tools in the management of children with type 1 diabetes mellitus. However, barriers to adequate control still exist. One of the greatest barriers is the paucity of blood glucose information throughout the day. The continuous glucose monitoring system (CGNS) records a total of 288 measurements per day, thus providing a more complete picture of blood glucose trends. This information has been useful both in improving metabolic control in children with type 1 diabetes and in detecting and preventing nocturnal hypoglycemia. Studies involving the CGMS in children show frequent nocturnal hypoglycemia, as well as postprandial glycemic excursions in these patients, although their HbA1c is often adequate. Thus, we should continue to search for newer, more physiological and convenient types of therapy for children with type 1 diabetes