Prospective study of maturation and injury in elite handball academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

The objective of this study is to describe the relationship between injury incidence (IL) and maturity in male elite handball's player (HbP). Prospective study during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball's players, under the UEFA methodology model for epidemiological studies. We discuss the maturity stage with different parameters, the Tanner's stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries for a total of 34.222 h of exposure were registered. The average total Injury Incidence (IIn) by categories was 5,6 injury/1000 h of exposure. Injury Incidence during competition: 21,8 injuries/1000 hs and in training: 3,1 injuries/1000 hs without statistically significant between IIn, chronological age and different maturity stage by ANOVA. The multivariate statistical analysis registers tendency associations between IIn in competition for category (P = 0,07), and the IIn in training for Tanner stage (P = 0,091) and puberty (P = 0,021). In conclusion: there is not a significant difference in total IIn by ages categories in handball players but there is statistically significance tendency respect to some maturity parameters under a multivariate analysis. This last result must be considered when planning training seasons and strategies for injury prevention in the context of the formative handball. (AU)

Tratamiento con hormona de crecimiento en pequeños para la edad gestacional en España / Growth hormone treatment in small for gestational age children in Spain

INTRODUCCIÓN: Desde su aprobación por la Agencia Europea del Medicamento, el tratamiento con hormona de crecimiento recombinante ha sido empleado en un gran número de pacientes nacidos pequeños para la edad gestacional en España. El propósito de este estudio es conocer objetivamente los resultados del mismo en la práctica habitual. MÉTODOS: Se ha recogido información procedente de los registros existentes en los comités asesores que autorizan dichos tratamientos en los hospitales públicos de 6 comunidades autónomas. RESULTADOS: Se han obtenido datos válidos de 974 pacientes. Todos ellos cumplían los criterios exigidos por la Agencia Europea del Medicamento. Los pacientes que recibieron el tratamiento se caracterizaron por tener la longitud al nacer más afectada que el peso, talla diana inferior a -1 desviación estándar (DE) y un 23% con antecedentes de prematuridad. La talla al iniciar el tratamiento fue de − 3,1 ± 0,8 DE (media ± DE) y la edad de comienzo 7,2 ± 2,8 años. La ganancia de talla en el primer año fue de 0,7 ± 0,2 DE, y de 1,2 ± 0,8 DE hasta los 2 años. La talla final, alcanzada por un 8% de pacientes, fue de -1,4 ± 0,7 DE. CONCLUSIONES: Los resultados concuerdan con las series nacionales e internacionales publicadas y son representativos de la práctica habitual en nuestro país. Se constata un inicio tardío del tratamiento, observándose, sin embargo, un adecuado crecimiento, tanto a corto plazo como en la talla final. En el primer año se identifica un 24% de pacientes con respuesta deficiente

INTRODUCTION: Since its approval by the European Medicines Agency, a great number of patients born small for gestational date have received recombinant growth hormone treatment in Spain. The aim of this study is to analyse its outcome in the setting of ordinary clinical practice. METHODS: Information was gathered from the registers of the assessment boards that authorise all growth hormone treatments prescribed in public hospitals in six autonomic communities (regions). RESULTS: Valid data from 974 patients was obtained. All of them complied with criteria established by the European Medicines Agency. Patients in the sample were smaller in length than weight at birth, with their median target height being below 1 standard deviation (SD), and 23% of them had been delivered prematurely. Treatment was started at 7.2 ± 2.8 years (mean ± SD). The mean patient height at start was − 3.1 ± 0.8 SD. They gained 0.7 ± 0.2 SD in the first year, and 1.2 ± 0.8 SD after two years. Final height was attained by 8% of the sample, reaching -1.4±0.7 SD. CONCLUSIONS: These results are similar to other Spanish and international published studies, and are representative of the current practice in Spain. Despite treatment being started at a late age, adequate growth is observed in the short term and in the final height. Up to a 24% of patients show a poor response in the first year

[Growth hormone treatment in small for gestational age children in Spain]. / Tratamiento con hormona de crecimiento en pequeños para la edad gestacional en España.

INTRODUCTION: Since its approval by the European Medicines Agency, a great number of patients born small for gestational date have received recombinant growth hormone treatment in Spain. The aim of this study is to analyse its outcome in the setting of ordinary clinical practice. METHODS: Information was gathered from the registers of the assessment boards that authorise all growth hormone treatments prescribed in public hospitals in six autonomic communities (regions). RESULTS: Valid data from 974 patients was obtained. All of them complied with criteria established by the European Medicines Agency. Patients in the sample were smaller in length than weight at birth, with their median target height being below 1 standard deviation (SD), and 23% of them had been delivered prematurely. Treatment was started at 7.2±2.8 years (mean±SD). The mean patient height at start was -3.1±0.8 SD. They gained 0.7±0.2 SD in the first year, and 1.2±0.8 SD after two years. Final height was attained by 8% of the sample, reaching -1.4±0.7 SD. CONCLUSIONS: These results are similar to other Spanish and international published studies, and are representative of the current practice in Spain. Despite treatment being started at a late age, adequate growth is observed in the short term and in the final height. Up to a 24% of patients show a poor response in the first year.

Estudio prospectivo de maduración, desarrollo e incidencia lesional en balonmano formativo de élite. ¿Puede el estado madurativo ser un factor determinante de la incidencia lesional en balonmano? / Prospective study of maturity, development, and injury incidence in a professional Handball Academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

El objetivo de este estudio es describir la relación entre incidencia lesional (IL) y estado madurativo de jugadores varones de balonmano formativo (BmF) de alto nivel competicional. Se analizan durante 2 temporadas la incidencia de lesión deportiva de forma prospectiva en 133 jugadores, los criterios de maduración biológica y la carga física de exposición. Se siguieron los criterios para estudios de epidemiología lesional según el consenso UEFA. Las variables utilizadas para analizar el estado madurativo son los estadios de Tanner, la pubertad, el pico de velocidad de crecimiento, el volumen testicular y la edad ósea. Se registraron 190 lesiones para un total de 34.222 h de exposición. La IL total media de todas las categorías fue de 5,6 lesiones/1.000 h de exposición. En competición, el valor fue de 21,8 lesiones/1.000 h, y en entrenamiento, de 3,1 lesiones/1.000 h. No se encontraron diferencias estadísticamente significativas entre IL, la edad cronológica y los diferentes estados madurativos por ANOVA. El análisis estadístico multivariante registra cierta tendencia entre las asociaciones de IL en competición para categoría (p = 0,07), y en la IL en entrenamientos para Tanner (p = 0,091) y pubertad (p = 0,021). En conclusión, si bien no se detectaron diferencias significativas en la IL por edades en jugadores de BmF, sí se aprecia una tendencia real en determinados estadios madurativos mediante el análisis multivariante. Esto deberá tenerse en cuenta para planificación entrenamientos y estrategias de prevención de la lesión deportiva en el contexto del BmF

The objective of this study is to determine the relationship between injury incidence (IL) and maturity stage in male elite handball players. A prospective study was conducted during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball players, using the UEFA methodology model for epidemiological studies. The maturity stage with different parameters is presented, as well as Tanner’s stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries from a total of 34,222 hours of exposure were registered. The mean total Injury Incidence (IL) by categories was 5.6 injuries/1000 hours of exposure. Injury incidence during competition: 21.8 injuries/1000 hours and in training: 3.1 injuries/1000 h, with no statistically significant differences between IL, chronological age, and different maturity stages using ANOVA. The multivariate statistical analysis showed a tendency of associations between IL in competition category (P = .07), and the IL in training for Tanner (P = .091) and puberty (P = .021). In conclusion: There was a significant difference in total IL by age categories in handball players, and there was a statistically significance tendency as regards some maturity stages using multivariate analysis. This last result should be taken into account when planning training seasons and strategies for injury prevention in the context of the handball training

Ovario: estrógenos, gestágenos, andrógenos, globulina fijadora de hormonas sexuales, inhibinas y cariotipo / Ovary: estrogens, gestagens, androgens, sex hormone-binding globulin, inhibins and karyotipe

El ovario es un órgano con capacidad germinal y endocrina, que sintetiza estrógenos, progesterona, andrógenos, factores locales de crecimiento, inhibinas, activina y folistatina. En este artículo se revisa: 1. La fisiología del eje hipófiso-gonadal y las diferentes técnicas de laboratorio utilizadas en la determinación de los parámetros informativos de la función germinal y endocrina, así como sus aplicaciones clínicas en entidades como la pubertad precoz y retrasada, los trastornos de la ovulación, el hiperandrogenismo ovárico y los trastornos gonadales secundarios a trastornos inmunológicos, radioterapia y quimioterapia. 2. Las pruebas de estimulación y supresión utilizadas en el diagnóstico diferencial de los trastornos puberales y del hiperandrogenismo ovárico. 3. La utilidad del cariotipo en la caracterización de los trastornos gonadales, específicamente el síndrome de Turner y el fallo ovárico precoz (AU)

The ovary has both endocrine and reproductive functions and synthesizes estrogens, progesterone, androgens, growth factors, inhibins, activins and follistatin. The present article reviews the following: 1. The physiology of the pituitary-gonadal axis and the laboratory techniques used to assess both reproductive and endocrine functions, as well as their clinical application, specifically in precocious and delayed puberty, ovulatory dysfunction, ovarian hyperandrogenism, and gonadal abnormalities due to autoimmune diseases, chemotherapy and radiotherapy. 2. The stimulation and suppression tests used in the differential diagnosis of pubertal disorders and ovarian hyperandrogenism. 3. The usefulness of karyotype in the characterization of gonadal disorders, specifically Turner's syndrome and premature ovarian failure (AU)