Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study

Abstract Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study.

Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Synthetic phosphoethanolamine-modified oligosaccharides reveal the importance of glycan length and substitution in biofilm-inspired assemblies.

Bacterial biofilm matrices are nanocomposites of proteins and polysaccharides with remarkable mechanical properties. Efforts understanding and tuning the protein component have been extensive, whereas the polysaccharide part remained mostly overlooked. The discovery of phosphoethanolamine (pEtN) modified cellulose in E. coli biofilms revealed that polysaccharide functionalization alters the biofilm properties. To date, the pattern of pEtN cellulose and its mode of interactions with proteins remains elusive. Herein, we report a model system based on synthetic epitomes to explore the role of pEtN in biofilm-inspired assemblies. Nine pEtN-modified oligosaccharides were synthesized with full control over the length, degree and pattern of pEtN substitution. The oligomers were co-assembled with a representative peptide, triggering the formation of fibers in a length dependent manner. We discovered that the pEtN pattern modulates the adhesion of biofilm-inspired matrices, while the peptide component controls its stiffness. Unnatural oligosaccharides tune or disrupt the assembly morphology, revealing interesting targets for polysaccharide engineering to develop tunable bio-inspired materials.

Combination Therapy With Semaglutide and Dapagliflozin as an Effective Approach for the Management of Type A Insulin Resistance Syndrome: A Case Report.

Type A insulin resistance (IR) syndrome is a very uncommon genetic disorder affecting the insulin receptor (INSR) gene, characterized by severe IR without the presence of obesity. Patients with this condition will eventually develop diabetes, presenting a variable response to insulin-sensitizers, such as metformin and thiazolidinediones, and high doses of insulin. We report for the first time the results of the use of combination therapy with a glucagon-like peptide-1 receptor agonist and a sodium-glucose cotransporter 2 inhibitor for the treatment of diabetes in the context of type A IR syndrome.

Automated Laser-Transfer Synthesis of High-Density Microarrays for Infectious Disease Screening.

Laser-induced forward transfer (LIFT) is a rapid laser-patterning technique for high-throughput combinatorial synthesis directly on glass slides. A lack of automation and precision limits LIFT applications to simple proof-of-concept syntheses of fewer than 100 compounds. Here, an automated synthesis instrument is reported that combines laser transfer and robotics for parallel synthesis in a microarray format with up to 10 000 individual reactions cm- 2 . An optimized pipeline for amide bond formation is the basis for preparing complex peptide microarrays with thousands of different sequences in high yield with high reproducibility. The resulting peptide arrays are of higher quality than commercial peptide arrays. More than 4800 15-residue peptides resembling the entire Ebola virus proteome on a microarray are synthesized to study the antibody response of an Ebola virus infection survivor. Known and unknown epitopes that serve now as a basis for Ebola diagnostic development are identified. The versatility and precision of the synthesizer is demonstrated by in situ synthesis of fluorescent molecules via Schiff base reaction and multi-step patterning of precisely definable amounts of fluorophores. This automated laser transfer synthesis approach opens new avenues for high-throughput chemical synthesis and biological screening.

Diagnóstico y tratamiento de la rinosinusitis crónica en adultos. Consenso de expertos: Asociación Colombiana de Otorrinolaringología-2021. / Diagnosis and treatment of chronic rhinosinusitis in adults. Expert consensus: Asociación Colombiana de Otorrinolaringología -2021.

Introducción: la Rinosinusitis Crónica se define como la inflamación crónica de la nariz y los senos paranasales por más de 12 semanas. La prevalencia varía entre el 5% - 30% de acuerdo con la zona geográfica según un estudio de carga de enfermedad (2012-2014), la prevalencia de las enfermedades respiratorias crónicas (rinitis y sinusitis crónica) varió entre el 10% y el 25%. Objetivo: establecer un conjunto de consideraciones basadas en consenso de expertos, para el diagnóstico y el tratamiento de la rinosinusitis crónica en pacientes adultos, en el contexto colombiano. Métodos: se llevó a cabo un consenso formal (Delphi y nominal). Se conformó un grupo de expertos, se definieron el alcance y las preguntas. Se realizaron dos rondas de calificación anónimas, y una discusión para las preguntas sin consenso. En las preguntas con opciones de uno a nueve, se consideró consenso con una mediana de uno a tres o de siete a nueve. En las preguntas tipo Likert, se consideró consenso un porcentaje igual o superior al 80% en acuerdos o desacuerdos. Resultados: se definieron y calificaron 18 preguntas, con la participación de 17 otorrinolaringólogos, de 8 ciudades colombianas, todos miembros de la Asociación Colombiana de Otorrinolaringología y con un promedio de experticia de 19.2 años (Desviación estándar [DE]: 10,2). Se obtuvieron 18 recomendaciones para el diagnóstico y el tratamiento de esta patología. Conclusiones: las recomendaciones emitidas por los expertos permiten orientar y estandarizar el diagnóstico y el tratamiento de la rinosinusitis crónica en adultos, en el contexto de los servicios de salud en Colombia.

Introduction: Chronic Rhinosinusitis is defined as chronic inflammation of the nose and paranasal sinuses for more than 12 weeks. The prevalence varies between 5% - 30% depending on the geographical area according to a disease burden study (2012-2014), the prevalence of chronic respiratory diseases (rhinitis and chronic sinusitis) varied between 10% - 25%. Objective: To establish a set of considerations based on expert consensus, for the diagnosis and treatment of chronic rhinosinusitis in adult patients, in the Colombian context. Methods: A formal consensus (Delphi and nominal) was carried out. A group of experts was formed, the scope and questions were defined. Two anonymous grading rounds were conducted, and a discussion for questions without consensus. In the Questions with options from one to nine were considered consensus with a median of one to three or seven to nine. In the Likert-type questions, a percentage equal to or greater than 80% in agreements or disagreements was considered consensus. Results: 18 questions were defined and scored, with the participation of 17 otorhinolaryngologists, from eight Colombian cities, all members of the Colombian Association of Otorhinolaryngology and with an average experience of 19.2 years (Standard desviation [SD]: 10.2). 18 recommendations were obtained for the diagnosis and treatment of this pathology. Conclusions: The recommendations issued by the experts allow to guide and standardize the diagnosis and treatment of chronic rhinosinusitis in adults, in the context of health services in Colombia.

Nasal Obstruction and Quality of Life Assessment After Septoplasty With Turbinoplasty: Correlation Between Subjective Scales.

BACKGROUND: Assessment of nasal obstruction is imprecise due to a low correlation between findings on the physical examination and objective measures with the severity of symptoms reported by the patient even after septoplasty with turbinoplasty is performed. The aim of this study is to evaluate the use of subjective scales, and the correlation between them for the evaluation of nasal obstruction after surgery. OBJECTIVE: To assess the impact of undergoing septoplasty with turbinoplasty to relieve nasal obstructive symptoms and the quality of life in a mid-term period by using the Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), and Glasgow Benefit Inventory (GBI). METHODS: A retrospective study was conducted of patients who underwent a septoplasty with turbinoplasty due to nasal septodeviation and secondary nasal obstructive symptoms at the Hospital Universitario Fundación Santa Fe de Bogotá. Three scales were used to measure the outcomes one year after surgery: VAS (0-10), NOSE (0-100), and GBI (-100 to 100). RESULTS: Data from 56 patients (21 females, mean age 37.5 years of age, SD 12.13) was collected. The results showed that 75% of the patients had a post-surgical NOSE score below 50 and a VAS score below 6. Regarding the GBI scale, 75% of the patients improved in their quality of life. An inverse proportional correlation was found between the NOSE and GBI scales (rho = -0.3682) (95% CI -0.579 to -0.111), and there was a directly proportional correlation between the NOSE and VAS scales (rho = 0.7440) (95% CI 0.595 to 0.844). CONCLUSION: Subjective measures suggest there was an improvement in nasal obstructive symptoms and quality of life after surgery. Non-anatomical causes such as rhinitis can be confounding factors to consider in subsequent studies. VAS stands out as a possible interchangeable scale with NOSE to measure nasal obstruction in these patients.

Quiste dermoide en base de cráneo con trayecto fistuloso a punta nasal en un paciente pediátrico: reporte de caso / Skull base dermoid cyst fistulizing to the nasal tip in a pediatric patient: case report

El quiste dermoide es una lesión congénita poco frecuente, secundario a una regresión incompleta de tejido ectodérmico, y su incidencia es de 1/20 000-40 000 nacidos vivos. Debe realizarse una resección quirúrgica oportuna para prevenir el compromiso intracraneal y/o las complicaciones. El estudio imagenológico determina su extensión. Se han recomendado diferentes enfoques quirúrgicos, los cuales deben cumplir con los cuatro principios de Pollock. El siguiente estudio presenta el caso de un paciente pediátrico, de nueve meses de edad, con un quiste dermoide en la base del cráneo asociado con un trayecto fistuloso a punta nasal. La resonancia magnética nuclear (RMN) contrastada evidenció una masa quística en la región anterior a la crista galli comunicada con el tracto fistuloso a la punta nasal. El paciente fue llevado a cirugía para realizar la resección del quiste mediante rinoplastia externa combinada con abordaje endoscópico transnasal. Los resultados funcionales y estéticos fueron satisfactorios, sin recurrencia. Se evidenció una fístula de líquido cefalorraquídeo intraoperatoria corregida en el mismo tiempo quirúrgico.

The dermoid cyst is a rare congenital lesion, secondary to an incomplete regression of ectodermal tissue. Its incidence is 1/20,000-40,000 live births. Timely surgical resection must be performed to prevent intracranial involvement and/or complications. Imaging study determines its extension. Different surgical approaches have been recommended; all must adhere to Pollock's 4 principles. The following study presents the case of a pediatric patient, 9 months old, with a dermoid cyst at the skull base with a fistulous path to the nasal tip. Contrasted nuclear magnetic resonance revealed a cystic mass in the region anterior to the crista galli communicated with a fistulous tract at the nasal tip. The patient was taken to surgery for cyst resection by external rhinoplasty combined with a transnasal endoscopic approach with satisfactory functional and aesthetic results, without recurrence. A Cerebrospinal fluid fistula was evidenced, as an intraoperative complication, it was corrected in the same surgical time.

Lista de chequeo preoperatorio para la cirugía endoscópica de hipófisis / Preoperative checklist for endoscopic pituitary surgery

Introducción: las listas de chequeo son herramientas que buscan evitar errores y complicaciones al momento de realizar un procedimiento. El adenoma hipofisiario es la primera causa de cirugía endoscópica transnasal de la región selar, y se estima que ocurren hasta un 20 % de complicaciones derivadas de esta cirugía. Objetivo: desarrollar una lista de chequeo preoperatoria que sirva como una guía para la evaluación prequirúrgica de los pacientes a quienes se les realicen cirugías de la región selar. Metodología: se realizó una revisión de la literatura para desarrollar una lista de chequeo preliminar y una serie de declaraciones que resumían los puntos importantes de la lista. Se construyó un comité de expertos en cirugía endoscópica de la base de cráneo conformado por neurocirujanos y otorrinolaringólogos de hospitales de Bogotá. Utilizando la metodología Delphi modificada, se llegó a un consenso para la realización de la lista de chequeo final. Resultados: se describieron 15 declaraciones; de estas, hubo una discrepancia en 6 declaraciones. Por esta razón, se realizaron modificaciones en 5 declaraciones, y se llegó a un consenso entre los expertos participantes. La lista de chequeo final aprobada está compuesta por 4 ítems. Discusión/conclusiones: la cirugía para el manejo de la patología de la región selar es compleja y requiere de un equipo quirúrgico entrenado y disciplinado para lograr los mejores desenlaces posibles. Consideramos que nuestra lista de chequeo es una herramienta que permitirá a los equipos que realizan estas cirugías en Colombia tener una visión más completa del paciente y, eventualmente, ayudar a evitar errores y posibles complicaciones.

Introduction: checklists that seek to avoid errors are very useful tools for any surgical practice. Pituitary adenomas are the leading indication to perform a transnasal endoscopic surgery in the sellar region and up to 20 % complications have been reported related to this procedure. Objetive: develop a preoperative checklist, based on an expert consensus, to serve as a guide for the skull base teams to consistently evaluate preoperatively all patients with pathologies in the sellar region. Methods: a literature review was conducted to develop a preliminary checklist and a series of statements summarizing the most important items on the list. A committee of experts in endoscopic skull base surgery was summoned, made up of neurosurgeons and otolaryngologists from hospitals in Bogotá. Using the modified Delphi methodology, a consensus was reached for the completion of the final checklist. Results: fifteen statements were developed. A discrepancy was seen in six statements. Modifications were made for five statements, thus reaching a consensus among the participating experts. The final approved checklist is made up of 4 items. Conclusion: surgery for treating different pathologies in the sellar region is complex and requires a welltrained and disciplined surgical team to achieve the best possible outcomes. We consider that our preoperative checklist is a valuable resource for skull base surgical teams performing transnasal endoscopic surgery of the sellar region. This tool will allow skull base surgical teams in Colombia to have a more comprehensive view of the patient and eventually help to avoid errors and possible complications.

Corrigendum: Mucins and Pathogenic Mucin-Like Molecules Are Immunomodulators During Infection and Targets for Diagnostics and Vaccines.

[This corrects the article DOI: 10.3389/fchem.2019.00710.].

Mucins and Pathogenic Mucin-Like Molecules Are Immunomodulators During Infection and Targets for Diagnostics and Vaccines.

Mucins and mucin-like molecules are highly O-glycosylated proteins present on the cell surface of mammals and other organisms. These glycoproteins are highly diverse in the apoprotein and glycan cores and play a central role in many biological processes and diseases. Mucins are the most abundant macromolecules in mucus and are responsible for its biochemical and biophysical properties. Mucin-like molecules cover various protozoan parasites, fungi and viruses. In humans, modifications in mucin glycosylation are associated with tumors in epithelial tissue. These modifications allow the distinction between normal and abnormal cell conditions and represent important targets for vaccine development against some cancers. Mucins and mucin-like molecules derived from pathogens are potential diagnostic markers and targets for therapeutic agents. In this review, we summarize the distribution, structure, role as immunomodulators, and the correlation of human mucins with diseases and perform a comparative analysis of mucins with mucin-like molecules present in human pathogens. Furthermore, we review the methods to produce pathogenic and human mucins using chemical synthesis and expression systems. Finally, we present applications of mucin-like molecules in diagnosis and prevention of relevant human diseases.

Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review.

Extracranial internal carotid artery (ICA) pseudoaneurysms are uncommon in the pediatric population and are usually secondary to direct trauma to the vessel. Treatment options include surgery (ligation), anticoagulation therapy and endovascular treatment. Endovascular covered stents have shown good results in adult populations, resulting in occlusion of the aneurysm and preservation of the artery without significant complications. However, there have been only limited reports in the literature reporting endovascular carotid stent placement in the pediatric population. We report a case of a 9-year-old boy patient, who developed a cervical ICA pseudoaneurysm after a parapharyngeal tumor resection. He was successfully treated by primary endovascular covered stent placement. During a follow-up of 6 months the patient has been asymptomatic, without any adverse event. Additionally, a literature review is done.

Homocisteína y actividad física / Homocysteine and physical activity

Introducción. Se estudia la relación entre la homocisteína y la actividad física, teniendo en cuenta la asociación con otros factores como el sexo, la edad, la vitamina B12 y el ácido fólico. Método. Muestra de 40 adultos, trabajadores del Hospital Universitario Virgen de la Victoria de Málaga. La actividad física se midió mediante podómetro y por encuesta retrospectiva. Resultados. En la muestra global, la homocisteína está relacionada inversamente con la actividad física, medida mediante podómetro, con el sexo femenino, con el ácido fólico y directamente con la edad. En el análisis multivariante, la asociación significativa permanece únicamente con el sexo. Las mujeres muestran más actividad física diaria y valores de homocisteína más bajos, que en los varones. Los datos de ejercicio físico obtenidos por encuesta no revelan ninguna asociación, aunque los varones tiene una tendencia, no significativa, a realizar más ejercicio físico estructurado. Conclusiones. A la vista de las referencias bibliográficas existentes, se comentan los resultados con la finalidad práctica de matizar las recomendaciones que se realizan a la población en el ejercicio físico con fines preventivos y promotores de salud (AU)

Introduction. We examined the relationship between homocysteine levels and physical activity, taking into account other factors such as gender, age, folic acid and vitamin B12. Methods. The sample included 40 adults, workers of the Hospital Universitario Virgen de la Victoria of Málaga (Spain). The physical activity was measured by pedometer and by retrospective questionnaire. Results. In the overall sample homocysteine is inversely related with physical activity, measured by pedometer, but not when done by a retrospective questionnaire on structured physical exercise, with the female sex and with the folic acid levels, and was directly related with the age. Multivariant step by step statistical study shows that the significany association remains only with gender. Women have higher values of homocysteine than men. The women also accomplished higher physical activity than men, when the pedometer results were calculated, but not by the results of the retrospective questionnaire. In the last case, the values were higher, but with no significant differences between sexes. Conclusions. These results suggest, according to the literature, the need for qualifying the interplay of the different existing factors when making recommendations for the population to carry out physical exercise in order to improve their health status (AU)

[Blood glucose and ketone monitoring in type 1 diabetic patients in the controlled environment of a summer camp]. / Glucemia y cetonemia en diabéticos tipo 1 en el ambiente controlado de una colonia de verano.

INTRODUCTION: Control of blood ketone levels and glycemia is advisable in certain situations in type 1 diabetic children and adolescents. The aims of this study were to assess the relationship between glycemia, ketonemia and ketonuria in children and adolescents in a summer camp under different conditions (fasting, casual hyperglycemia, moderate physical exercise) and to assess the utility of ketonemia determinations in diabetes control during this time. PATIENTS AND METHODS: There were 47 participants (25 boys and 22 girls), with a mean HbA1c determination prior to enrollment of 7.7 +/- 1.5 %. The mean age was 11.7 +/- 1.8 years and the mean time from onset of diabetes was 3.0 +/- 2.7 years. The mean body mass index was 18.3 +/- 3.9 kg/m2 (SDS -0.16 +/- 0.44), the mean insulin dose was 0.8 +/- 0.4 U/kg/ day, and the number of doses per day was between 2 and 4 (median = 3). Blood glucose and ketones (both measured with the Optium system, Abbott Diabetes Care) and urine ketones (Ketodiastix, Bayer) were determined in different situations. Statistical analysis was performed with the SPSS 11.5 program. RESULTS: Ketonemia results 45 minutes before and after moderate physical activity showed no significant increase in ketones (0.1 +/- 0.03 vs 0.23 +/- 0.07 mmol/l, ns). Preprandial blood ketone levels of > or = 0.5 mmol/l were found in 17.02 % of participants. Ketonemia was resolved during the first hour in all participants except one, in whom ketonemia resolved in 3 hours. Blood ketones were higher before breakfast than during the rest of the day (0.12 +/- 0.17 vs 0.02 +/- 0.05, p < 0.001). The mean glycemia level with ketosis (beta -HB > or = 0.5 mmol/l) was 174.5 +/- 64.7 mg/dl, a value slightly higher than the overall mean glycemia value (156.87 +/- 87.8 mg/dl). Ketonuria could not be measured in a high percentage of participants due to the difficulty of obtaining samples (between 24.5 % and 58.6 % in the different study groups). CONCLUSIONS: Measurement of glycemia together with ketonemia in a summer camp allows reliable follow-up of glycemic control to be performed. Ketonemia usually occurred before breakfast in parallel with slightly elevated glycemia, but resolved quickly. Moderate physical activity for 45 minutes does not seem to significantly increase blood ketones if metabolic control is normal. beta -HB is a useful parameter to determine whether moderate physical exercise is advisable or not. The lack of urinary ketone tests due to the difficulties of obtaining a sample can currently be solved by blood ketone measurement.

Glucemia y cetonemia en diabéticos tipo 1 en el ambiente controlado de una colonia de verano / Blood glucose and ketone monitoring in type 1 diabetic patients in the controlled environment of a summer camp

Introducción: La medida del β -hidroxibutirato (β-HB), además de la glucemia es, en ciertas ocasiones, de gran utilidad en niños y adolescentes con diabetes. Se realizó un estudio con el objetivo de observar la relación entre glucemia, cetonemia y cetonuria en la población pediátrica y adolescente con diabetes mellitus tipo 1 (DM1) en una colonia de vacaciones en diferentes circunstancias: ayunas, hiperglucemia aguda, ejercicio físico moderado, y para determinar la utilidad de la determinación de cetonemia en el control de la diabetes durante dicha época. Pacientes y métodos: Un total de 47 participantes (25 varones y 22 mujeres), cuya media de la última hemoglobina glucosilada (HbA1C) previa al estudio fue de 7,7 ± 1,5 %, participaron en este seguimiento. La media de edad de los niños fue de 11,7 ± 1,8 años, con 3,0 ± 2,7 años de evolución de la diabetes. Su índice de masa corporal fue de 18,3 ± 3,9 kg/m2 (SDS ­0,16 ± 0,44), la dosis de insulina 0,8 ± 0,4 U/kg/día y el número de dosis por día entre 2 y 4, con una mediana de 3. Se registraron las determinaciones de glucemia y cetonemia (medidas ambas con el sistema OptiumO, Abbott Diabetes Care) y cetonuria (KetodiastixO, Bayer) en distintas situaciones. Para el análisis estadístico se usó el programa SPSS 11.5. Resultados: Los datos de cetonemia antes y 45 min antes y después del ejercicio físico moderado no mostraron elevaciones significativas de cuerpos cetónicos (0,1 ± 0,03 mmol/l frente a 0,23 ± 0,07 mmol/l, respectivamente; ns). Un 17,02 % de los participantes presentó niveles de cuerpos cetónicos igual o superior a 0,5 mmol/l preprandiales, si bien se resolvieron antes de 1 h (menos una, que se resolvió a las 3 h). Se encontró una mayor presencia de β -HB antes del desayuno (0,12 ± 0,17 mmol/l) que en cualquier hora del día (0,02 ± 0,05 mmol/l) (p < 0,001). La media de las glucemias que cursaron con cetosis (β -HB ≥ 0,5 mmol/l) fue de 174,5 ± 64,7 mg/dl, discretamente superior a la media global de las glucemias (156,87 ± 87,8 mg/dl). Hubo un alto porcentaje de casos en los que no se pudieron determinar los cuerpos cetónicos en orina por la dificultad de obtener la muestra (entre 24,5 y 58,6 % de los casos en los diferentes grupos de estudio). Conclusiones: La medida conjunta de la glucemia con la cetonemia en una colonia de verano permitió hacer un seguimiento seguro de los participantes y observar que la mayoría de las cetonemias registradas se produjeron antes del desayuno, con glucemias discretamente elevadas, y que desaparecieron rápidamente. Un total de 45 min de ejercicio físico moderado no parecen contribuir a la formación de cuerpos cetónicos si el control metabólico es bueno. El β -HB es un buen parámetro para discriminar cuándo es adecuada la práctica de ejercicio físico. La dificultad de la medida de cuerpos cetónicos en orina por falta de muestra se salva con la posibilidad de medir cuerpos cetónicos en sangre

Introduction: Control of blood ketone levels and glycemia is advisable in certain situations in type 1 diabetic children and adolescents. The aims of this study were to assess the relationship between glycemia, ketonemia and ketonuria in children and adolescents in a summer camp under different conditions (fasting, casual hyperglycemia, moderate physical exercise) and to assess the utility of ketonemia determinations in diabetes control during this time. Patients and methods: There were 47 participants (25 boys and 22 girls), with a mean HbA1c determination prior to enrollment of 7.7 ± 1.5 %. The mean age was 11.7 ± 1.8 years and the mean time from onset of diabetes was 3.0 ± 2.7 years. The mean body mass index was 18.3 ± 3.9 kg/m2 (SDS ­0.16 ± 0.44), the mean insulin dose was 0.8 ± 0.4 U/kg/ day, and the number of doses per day was between 2 and 4 (median = 3). Blood glucose and ketones (both measured with the Optium(R) system, Abbott Diabetes Care) and urine ketones (Ketodiastix®, Bayer) were determined in different situations. Statistical analysis was performed with the SPSS 11.5 program. Results: Ketonemia results 45 minutes before and after moderate physical activity showed no significant increase in ketones (0.1 ± 0.03 vs 0.23 ± 0.07 mmol/l, ns). Preprandial blood ketone levels of ≥ 0.5 mmol/l were found in 17.02 % of participants. Ketonemia was resolved during the first hour in all participants except one, in whom ketonemia resolved in 3 hours. Blood ketones were higher before breakfast than during the rest of the day (0.12 ± 0.17 vs 0.02 ± 0.05, p < 0.001). The mean glycemia level with ketosis (β -HB ≥ 0.5 mmol/l) was 174.5 ± 64.7 mg/dl, a value slightly higher than the overall mean glycemia value (156.87 ± 87.8 mg/dl). Ketonuria could not be measured in a high percentage of participants due to the difficulty of obtaining samples (between 24.5 % and 58.6 % in the different study groups). Conclusions: Measurement of glycemia together with ketonemia in a summer camp allows reliable follow-up of glycemic control to be performed. Ketonemia usually occurred before breakfast in parallel with slightly elevated glycemia, but resolved quickly. Moderate physical activity for 45 minutes does not seem to significantly increase blood ketones if metabolic control is normal. β -HB is a useful parameter to determine whether moderate physical exercise is advisable or not. The lack of urinary ketone tests due to the difficulties of obtaining a sample can currently be solved by blood ketone measurement

Concordancia analítica de la tiroglobulina estimulada con tirotropina recombinante humana y tras privación hormonal previa a la terapia con 131I en pacientes con cáncer diferenciado de tiroides / Concordance between thyroglobulin determinations after diagnostic recombinant human TSH stimulation and after hormone withdrawal prior to131I therapy in patients with differentiated thyroid cancer

Objetivos: Comparar los resultados de tiroglobulina obtenidos ante estimulación con tirotropina recombinante humana (rhTSH) con fines diagnósticos y tras privación hormonal previa a la terapia con 131I. Pacientes y método: Se evaluó a 31 pacientes en seguimiento por cáncer diferenciado de tiroides (CDT) a los que se indicó dosis terapéutica de 131I. Fueron sometidos de forma consecutiva a ambos protocolos de estimulación, y el tratamiento con radioyodo distó 1-2 meses del procedimiento diagnóstico con rhTSH. Se realizaron determinaciones analíticas de TSH, tiroglobulina (Tg) y anticuerpos anti-Tg por métodos inmunométricos. Resultados: Las medianas de Tg obtenidas tras rhTSH y privación fueron de 1,10 y 1,80 ng/ml, respectivamente. Analizados como positivos o negativos, dichos valores mostraron un índice kappa de concordancia de 0,633. Los casos discordantes mostraron una mayor elevación de Tg en estímulo con rhTSH (3 casos) y sólo en 1 caso se obtuvo un resultado negativo con estimulación con rhTSH que luego se positivizó en la dosis ablativa. Conclusiones: El estímulo con rhTSH consigue elevaciones diagnósticas de TSH en todos los casos aplicados. Los valores de Tg obtenidos con ambos estímulos muestran un grado de concordancia elevado (AU)

Objectives: To compare the results of thyroglobulin (Tg) determination after diagnostic recombinant human thyroid-stimulating hormone (rhTSH) stimulation and after hormone withdrawal prior to 131I therapy. Patients and method: Thirty-one patients followed-up for differentiated thyroid cancer were evaluated. In all patients 131I therapy was indicated. All patients underwent both stimulation methods, with an interval of 1-2 months between diagnostic rhTSH administration and radioiodine therapy. Laboratory determinations of TSH, Tg and Tg antibodies were carried out by immunometric methods. Results: Median Tg values obtained after rhTSH stimulation and hormone withdrawal were 1.10 and 1.80 ng/ml, respectively. Considered as positive or negative, these values showed a kappa value of 0.633. Discordant cases showed greater elevation after rhTSH stimulation (3 patients). Only one patient showed a negative result after rhTSH stimulation, which was then positive after the ablative dose. Conclusions: Stimulus with rhTSH achieved diagnostic elevations of TSH in all patients. Tg levels after both stimulation methods showed a high degree of agreement (AU)

Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides / Application of recombinant human TSH in the diagnostic protocol of differentiated thyroidcarcinoma

Objetivos: Describir los resultados preliminares de la aplicación de esta nueva técnica en la práctica diagnóstica habitual en el manejo del cáncer diferenciado de tiroides (CDT). Material y métodos: Se realizó rastreo corporal total (RCT) con 131I tras estimulación con TSH recombinante humana (rhTSH) en un grupo de 102 pacientes con CDT en seguimiento, todos tratados mediante tiroidectomía total. La pauta de administración fue de 0,9 mg rhTSH los días primeros y segundo del procedimiento, seguidos de 185 MBq de 131I administrados vía oral el día siguiente y posterior rastreo gammagráfico a las 48 horas. Se determinaron TSH, tiroglobulina (Tg) y anticuerpos antitiroglobulina en suero, mediante técnicas inmunométricas, a las 24 y 72 horas de la última administración de la rhTSH. Resultados. Los valores de TSH a las 24 horas tras estimulación con rhTSH fueron de 147,54 ± 46,46 mUI/l. En 62 pacientes se obtuvieron valores de Tg negativa (< 1 ng/ml), de los que 50 presentaron rastreo negativo y doce positivo. Entre los que tuvieron Tg positiva (37), 17 presentaron rastreo negativo (confirmándose presencia de enfermedad en 7 pacientes mediante otras técnicas de imagen) y 20 positivo. Conclusiones: La administración de rhTSH produjo en todos los casos un significativo aumento de la TSH, permitiendo la realización de los controles habituales de seguimiento de los pacientes de forma similar a la supresión hormonal. No han existido evidencias de efectos secundarios significativos, y su utilización permite obviar los inconvenientes derivados de la supresión, manteniendo una buena calidad de vida en los pacientes

Objectives: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC).Material and methods: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. Results: TSH values at 24 hours after exogenous stimulation were 147.54 ± 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. Conclusions: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients

[Application of recombinant human TSH in the diagnostic protocol of differentiated thyroid carcinoma]. / Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides.

OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.