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RESUMEN Objetivo: Esta revisión busca proporcionar información actual de los avances de los últimos diez años reportados para mejorar el diagnóstico de enfermedad renal con marcadores como la cistatina C, en comparación con otros analitos convencionales utilizados en la práctica clínica. Materiales y métodos: Se llevó a cabo una búsqueda de artículos originales y de revisión en idioma inglés y español de los últimos diez años en las siguientes bases de datos: MedLine, Library Plus, ProQuest, NCBI y ScienceDirect. Resultados: Para la evaluación de la función renal se usan marcadores convencionales como la creatinina y el nitrógeno ureico en sangre. Sin embargo, estas pruebas están sometidas a diferentes fuentes de variabilidad biológica, razón por la cual se ve la necesidad de identificar otros marcadores que permitan detectar de forma precoz la lesión renal, y que no se vean influenciados por factores dependientes del paciente como la cistatina C, una proteína de bajo peso molecular propuesta como un marcador de función renal más exacto, específico y sensible que la creatinina en la estimación de la tasa de filtración glomerular. Conclusión: Se considera que la cistatina C cumple con características que la hacen un biomarcador más útil en la determinación de lesión renal, ya que muestra mayor utilidad diagnóstica que la creatinina sérica para detectar daño renal temprano, sin embargo, no se utiliza como prueba rutinaria en el diagnóstico de patologías renales por su alto costo al momento de realizar un montaje en el laboratorio clínico. ABSTRACT Objective: To provide current information about the progress of the last ten years reported to improve the diagnosis of kidney disease with markers such as cystatin C, with other usual analytes used in clinical practice. Materials and methods: A search for original and review articles in english and spanish in the last ten years was carried out in the following databases: MedLine, Library Plus, Pro-Quest, NCBI and ScienceDirect. Results: For the evaluation of renal function markers are used such as creatinine and blood urea nitrogen. However, these tests are sometimes determined to different sources of biological variability, which is why the need to identify other markers that detect kidney damage early, and that is not influenced by pacific-dependent factors such as Cystatin C, a molecular protein of low molecular weight proposed as a marker of renal function more accurate, specific and sensitive than creatinine in modifying the glomerular filtration rate. Conclusion: Cystatin C meets with characteristics that make it a more useful biomarker in the determination of renal injury, since it shows greater diagnostic utility than serum creatinine to detect early renal damage, however, it is not used as a routine test in the diagnosis of renal pathologies due to its high cost when assembling in the clinical laboratory.

Low levels of phosphate in blood secondary to a lack of phosphorous reabsorption in the renal tubule cause hypophosphataemic rickets. To increase blood calcium levels, bone calcium is released into the bloodstream by increasing the activity of osteoclasts in the bones. These alterations in bone metabolism lead to delayed growth and small height, diffuse bone pain, bone fragility with microfractures, and frequent fractures and bone deformities. Although management of some of these conditions is mainly conservative, in cases of bone deformities or severe osteomalacia surgery should be considered: from minimally invasive surgical techniques of guided growth in patients with less deformity and open physeal cartilage to correction osteotomies in three-dimensional deformities. This article briefly reviews the indications for surgery procedures to be performed in these patients, highlighting when to use aggressive and non-aggressive approaches.

Objective. To examine the expression of hypoxia-inducible factor-1α(HIF-1α), TfR1, and TfR1-attached terminal monosaccharides in placentas of women with IDAP and severe preeclampsia.Methods. TfR1 and HIF-1αwere detected by western blot. Immunoadsorption of TfR1 was performed to characterize the terminal monosaccharides by specific lectin binding.Results. There was no difference in the expression of TfR1 and HIF-1αbetween groups. Lectin blot analysis pointed out an overexpression of galactoseβ1-4N-acetylglucosamine (Gal-GlcNAc) and mannose in severe preeclampsia.Conclusion. The increase in Gal-GlcNAc may be due to the increased presence of antennary structures and the mannose glycans of TfR1 may indicate the presence of misfolded or incomplete proteins. These findings may be associated with the low expression of placental TfR1 in women with preeclampsia.

Introduction. The inclusion of students with disabilities in higher education is a fundamental right recognised by the legal system since its recognition in the United Nations Convention on the Rights of Persons with Disabilities. However, the measures adopted by European countries to promote their incorporation are not always accompanied by parallel training actions that provide university professors with the necessary knowledge to incorporate people with intellectual disabilities into the classroom with the same guarantees and opportunities as people without intellectual disabilities. Objective. This paper aims to provide specific data on the self-perceived training needs of university teaching staff and thus lay the foundations for a specific training programme. Methods. A cross-sectional study was carried out by means of a survey designed to collect the teachers' perceptions of their own competences and the effectiveness of their knowledge, as well as the importance they attached to some aspects of intellectual disability. The survey was administered to teachers in Serbia, the Netherlands, Portugal, Italy and Spain, with a total sample of 1009 teachers. Results. The results obtained showed that the perception of self-perceived competence in educational skills is dependent on three main factors: previous specific training, teaching experience with people with intellectual disabilities and own personal experiences. Conclusion. The present study demonstrated the concern and need of the teaching staff to obtain specific training on people with intellectual disabilities in higher education. Uvod: Inkluzija studenata sa ometenošću u visokom obrazovanju je fundamentalno pravo koje prepoznaje pravni sistem od usvajanja Konvencije Ujedinjenih nacija o pravima osoba sa ometenošću. Međutim, mere koje su preduzele evropske zemlje u promovisanju tih prava nisu uvek praćene obukama koje bi univerzitetskim nastavnicima obezbedile neophodna znanja za uključivanje osoba sa intelektualnom ometenošću u nastavu sa istim garancijama i mogućnostima koje se nude osobama tipičnog razvoja. Cilj: Cilj ovog istraživanja je da utvrdi potrebe za obukom na osnovu vlastite percepcije univerzitetskog nastavnog osoblja i da na taj način postavi temelje specifčnog programa obuke. Metode: Sprovedeno je transferzalno istraživanje pomoću upitnika kojim su prikupljeni podaci o vlastitoj proceni nastavnika u pogledu kompetencija i efektivnosti njihovog znanja, kao i o značaju koji oni pridaju pojedinim aspektima intelektualne ometenosti. Ispitivanje je izvršeno na uzorku od 1009 nastavnika iz Srbije, Holandije, Portugalije, Italije i Španije. Rezultati: Dobijeni rezultati pokazuju da je samoprocena kompetencija u edukativnim veštinama zavisna od tri glavna činioca: specifčnog treninga u prošlosti, iskustva u podučavanju osoba sa intelektualnom ometenošću i ličnih iskustava, Zaključak: Dobijeni rezultati ukazuju na potrebu za specifčnom obukom nastavnog osoblja u oblasti rada sa osobama sa intelektualnom ometenošću u visokom obrazovanju.

This is a case report of women with pregnancy morbidity (PM), some of them associated with antiphospholipid syndrome (APS), in which the glycan patterns of immunoglobulin G (IgG) were investigated based on the theory of alteration of glycosylation in autoimmunity. We used lectin blot to determine changes in terminal glycosylation of polyclonal IgG from women with antiphospholipid (aPL) antibodies and PM plus vascular thrombosis (PM/VT) and seronegative-obstetric APS (SN-OAPS). In addition, we analyzed IgG from women with PM without aPL (PM/aPL-) and healthy women, as controls. Even though the SN-OAPS and PM/VT groups share the PM, only the SN-OAPS group showed a decreased expression of galactose compared to the healthy group. We also found the presence of mannosylated oligosaccharides in IgG from all patients being significantly higher in IgG from women of the PM/aPL- group. The differences in glycans presented here could relate to pathological mechanisms of PM associated with APS.

Resumen: Introducción: El presente estudio revisa la epidemiología, las manifestaciones clínicas y el manejo de los casos de osteomielitis aguda (OA) ingresados en un hospital pediátrico de tercer nivel. Metodología: Estudio descriptivo de los pacientes menores de 15 años ingresados con el diagnóstico de OA entre 2000 y 2011, retrospectivo hasta 2006, y posteriormente prospectivo. Resultados: Se identificaron 50 pacientes (52% varones) con una mediana de edad de 2 años. La sintomatología preponderante al ingreso fue dolor (94%), impotencia funcional (90%) y fiebre (72%). Las localizaciones más frecuentes fueron el fémur (32%), la tibia (28%) y el calcáneo (22%).Se encontró leucocitosis > 12.000/μl en el 56%, VSG elevada > 20 mm/h en un 26 y un 64% con PCR superior a 20 mg/l. El 20% de los hemocultivos resultó positivo, siendo Streptococcus del grupo A el germen más frecuente (11%).La gammagrafía ósea con 99Tc permitió el diagnóstico de confirmación en todos los casos.El tratamiento antibiótico fue intravenoso (i.v.) durante una media de 10 días ± 3 DE, continuándose por vía oral (v.o.) una media de 18 días ± 6 DE. Tres pacientes requirieron drenaje quirúrgico. La evolución en todos los pacientes fue excelente, salvo 3 excepciones, que se resolvieron con el tiempo. Conclusiones: La actual pauta corta de tratamiento i.v. disminuyó la estancia hospitalaria. Tras su instauración no se encontraron diferencias estadísticamente significativas en la duración de la clínica, ni en la PCR en el momento del alta en comparación con las pautas prolongadas previas a 2006. Abstract: Background and aims: The present study focuses on the epidemiology, clinical and laboratory data, and management of osteomyelitis in a pediatric third level hospital. Methodology: All cases of children under 15 years-old admitted with osteomyelitis between 2000 and 2011 were retrospectively reviewed until July 2006, then prospectively from then until 2011. Results: A total of 50 patients were identified (52% males) with median age at diagnosis of 2 years. Principal onset manifestations were pain (94%), functional impairment (90%) and fever (72%). The femur (32%), fibula (28%) and calcaneus (22%) were most affected bones.Leucocytosis > 12.000/μl was found in 56%, elevated ESR > 20 mm/h in 26%, and elevated CRP > 20 mg/L in 64%. Blood culture was positive in 20%, with group A streptococcus being the most frequently isolated bacteria (11%).All diagnoses were confirmed by a 99Tc scintigraphy bone scan.Antibiotic therapy was initially intravenously (mean time of administration: 10 days ± 3 SD), followed by oral medication (mean time of administration: 18 days ± 6 SD). Surgery was necessary in 3 patients. Evolution of all cases was excellent, despite 3 exceptions that resolved over time. Conclusions: The current short-term intravenous therapy led to shorter hospitalizations. There were no statistically significant differences between time from clinical onset or in CRP levels at discharge compared to long-term therapies prior to 2006.

To compare the retinal nerve fibre layer (RNFL) thickness in eyes of migraine patients with age-matched healthy subjects using optical coherence tomography.The study was designed as an observational cross-sectional study. 70 eyes of 70 patients (mean age 28.2 (SD 7.9) years) with migraine with or without aura according to the criteria of the Headache International Society and 53 eyes of 53 age-matched healthy controls (mean age 28.0 (8.1) years) were included. Optical coherence tomography was performed with the Stratus OCT (model 3000, software ver. 4.0.2; Carl Zeiss Meditec, Dublin, CA) after pupillary dilation. The fast RNFL thickness (3.4) scan acquisition protocol was used.In the migraine group, the mean Migraine Disability Assessment Score (MIDAS), the mean number of attacks per 3 months, and the length of migraine history were 34.3 (15.2), 17.0 (6.7) and 14.8 (5.6), respectively. The RNFL average thickness in the migraine was within the normal range, but the temporal quadrant RNFL thickness in the migraine patients was significantly lower than that of the control group, 62.2 (10.8) mum vs 70.8 (12.4) mum, respectively (p = 0.0001). However, there was no difference between migraineurs and controls in the superior, inferior, and nasal quadrants, p = 0.8810, p = 0.1531, and p = 0.8300, respectively. Within the migraine group, the average RNFL thickness was significantly correlated with the MIDAS disability score (r = -0.93, p0.0001) and the frequency of migraine attacks (r = -0.86, p0.0001). There were no statistically significant differences, between study groups, in disc area or cup/disc area ratio, p = 0.8102 and p = 0.7236, respectively. Considering the clinical examination, RNFL, and optic disc parameters, no one in the migraine group was qualified as having glaucomatous damage.The RNFL in the temporal quadrant was found to be thinner in migraine patients. In addition, we found a strong correlation between migraine severity and the RNFL average thickness parameters.

This study assessed the long-term effects of dorzolamide 2% BID added to timolol maleate 0.5% BID on intraocular pressure (IOP), retrobulbar blood flow, and the progression of visual field damage in patients with primary open-angle glaucoma.This was a prospective, 4-year, open-label intervention study. All consecutive patients with a clinical diagnosis of open-angle glaucoma in both eyes (mean defect greater than -6 dB) who presented for a regular check-up between January and July 2001 at the Instituto Galego de Oftalmoloxía were screened for study eligibility. All participants had been treated with timolol 0.5% BID in both eyes for at least 6 months before the screening visit. Dorzolamide 2% BID was added to timolol 0.5% BID in the eye with the larger visual field defect (study eye), whereas timolol 0.5% BID was continued in the eye with the smaller visual field defect (control eye). Variables evaluated at baseline and every 6 months for 48 months included retrobulbar hemodynamic parameters (using color Doppler imaging), progression of visual field damage, and IOP. Progression of visual field damage was defined according to modified Anderson criteria. Visual field progression-free survival rates for the study and control eyes were plotted using Kaplan-Meier analysis and were compared using a log-rank test.Forty-five patients met the inclusion criteria, of whom 5 were lost to follow-up. Thus, 80 eyes of 40 patients were included in the analysis. Patients' mean (SD) age was 68.0 (7.1) years; all patients were white and 21 (52.5%) were male. Mean baseline IOP was 19.18 (1.34) and 18.23 (1.64) mm Hg in the study and control eyes, respectively (P=0.006). The combination of dorzolamide and timolol was associated with significant increases from baseline in enddiastolic velocity in the ophthalmic and short posterior ciliary arteries (P0.001) and significant decreases in the resistivity index in both arteries (P0.001). Twenty-three of the 80 eyes (28.8%) had progression of visual field damage (7 study eyes and 16 control eyes). On Kaplan-Meier survival analysis, the risk of progression was significantly lower in the eye treated with dorzolamide and timolol compared with the eye treated with timolol alone (hazard ratio=0.41; 95% CI, 0.17 to 0.94; P=0.035). Mean changes in IOP from baseline to month 48 were -1.10 mm Hg in the dorzolamide and timolol group (95% CI, -1.73 to -0.51; P0.001) and 1.27 mm Hg in the control group (95% CI, -2.74 to 1.72; P=NS).In this 4-year, open-label study in patients with primary open-angle glaucoma, dorzolamide 2% BID added to timolol 0.5% BID was associated with a significant reduction in IOP and significant increases in retrobulbar hemodynamic parameters in both the ophthalmic and short posterior ciliary arteries. Dorzolamide added to timolol may be effective in preventing progression of glaucomatous visual field damage.

To compare the hemodynamic parameters in the retrobulbar vessels in pseudoexfoliative syndrome (PXS), pseudoexfoliative glaucoma (PXG), and age-matched healthy subjects by using color Doppler imaging (CDI). 72 eyes from 72 patients with PXS, 70 eyes from 70 patients with PXG, and 66 eyes from 66 age-matched healthy subjects who met the inclusion/exclusion criteria were included in this prospective cross-sectional study. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and Pourcelot resistance index (RI) were assessed in the ophthalmic artery (OA), central retinal artery (CRA), and temporal short-posterior ciliary arteries (SPCA). Visual function was assessed using the 24–2 Swedish Interactive Threshold Algorithm (SITA). The main outcomes of the study were PSV, EDV and RI in the OA, SPCA, and CRA. The EDV in the OA, SPCA and the CRA was decreased significantly (p

When a single medication does not adequately control intraocular pressure, additional intraocular hypotensive agents are often added to the therapeutic regime. However, regimen complexity has been associated with reduced patient compliance. Treatment with a fixed combination may, therefore, increase compliance as a result of simplifying the dosage regimen. Bimatoprost/timolol fixed combination (BTFC) combines two clinically effective agents that decrease elevated intraocular pressure by independent mechanisms. In two clinical studies, BTFC was more effective than its individual components. Furthermore, in a non-inferiority study BTFC has been shown to be as effective as the association of its individual components. BTFC was clinically effective and generally well tolerated, with no unexpected adverse reactions reported for the BTFC compared with those reported for bimatoprost or timolol monotherapies.

To compare the efficacy and tolerability of a once daily evening dose of the latanoprost/timolol fixed combination (LTFC) with that of a once-daily evening dose of the bimatoprost/timolol fixed combination (BTFC) in patients with open-angle glaucoma with elevated intraocular pressure (IOP) insufficiently responsive to monotherapy with prostaglandin analogues/prostamides.Prospective, randomized, evaluator masked, single-center study.36 patients with a diagnosis of open-angle glaucoma, with or without pseudoexfoliation, and inadequate control of IOP, insufficiently responsive to monotherapy with prostaglandin analogues/prostamides.The primary end-points were the change in IOP at 9:00 am from baseline to week 4, and the difference between treatment groups in the mean diurnal IOP reduction from baseline to week 4.BTFC provided significantly greater mean diurnal IOP reduction [mean (standard deviation)] 2.8 (0.9) mmHg, compared with LTFC 2.1 (0.6) mmHg, p = 0.0214. Both treatments significantly reduced the IOP from baseline at each IOP time-point measured, p0.0001, and for the mean diurnal IOP; p = 0.0049 for the LTFC, and p0.0001 for the BTFC. There were no significant differences in average hyperemia scores among groups, 1.25 (0.5) vs. 1.62 (0.69), p = 0.3835, for the LTFC and the BTFC, respectively.The results of this study showed a significantly higher IOP-lowering effect of a once-daily evening dose of the BTFC compared to that of a once-daily evening administration of the LTFC.

To evaluate the intraocular pressure lowering effect of the dorzolamide/timolol fixed combination (DTFC) in non-responder glaucoma patients to prostaglandin analogs/prostamides (prostas).All glaucoma patients treated with DTFC, between June 2003 and December 2005, who were unresponsive to prostaglandin analogs/prostamides, were identified through a retrospective medical records review. A non-responder was defined as an intraocular pressure (IOP) lowering effect less than 15% compared with baseline measurement. Two 12-hour IOP diurnal curves, measured between 8:00 a.m. and 8:00 p.m. (8:00 a.m., 10:00 a.m., 12:00 noon, 2:00 p.m., 4:00 p.m., 6:00 p.m. and 8:00 p.m.), were obtained retrospectively from the records of 31 patients, the first while on prostaglandin analogs/prostamides (baseline IOP) and the second while receiving DTFC (DTFC IOP). The study outcomes were the change in mean diurnal IOP and the reduction in IOP fluctuation as a result of receiving DTFC in patients unresponsive to prostas. The IOP was evaluated by intragroup comparisons with a two-tailed paired Student's t-test. A chi-square test was adopted for analysis of categorical variables.31 patients were included in this retrospective study. DTFC significantly reduced IOP in the patients overall, from 25.4 (3.5) to 20.2 (1.0) mmHg, p0.0001. The majority of patients were diagnosed with pseudoexfoliative glaucoma (PEX) (58%; 18/31). DTFC reduced the mean IOP fluctuations over 12 hours (highest minus lowest IOP reading within the 12-hours pressure curve) from 8.6 (3.2) to 4.3 (1.4) mmHg, p0.0001. The most common adverse events were ocular burning (16%) and taste perversion (13%). There were no serious treatment-related adverse events.DTFC significantly reduced the IOP in patients with glaucoma who did not respond to prostaglandin analogs/prostamides. Further research is needed to confirm these results.

Molecular technologies offer the greatest potential for laboratories in resource-rich countries because they have the highest sensitivity and specificity. Continued use of new technologies will be crucial in elucidating the true epidemiology and pathogenesis of a disease, including the less well studied diseases. Continued development of affordable, sensitive, and specific diagnostic tools will be required for use in resource-poor settings, where the incidence of disease is highest.

Our work has studied the relationship between nocturnal growth hormone (GH) surges, sleep and glycemia in seven conventionally treated type 1 diabetic patients under continuous sleep monitoring and the results were compared to those found in five age-matched healthy controls. On the experimental day, sleep was monitored from 24.00 to 07.00. Blood glucose levels and GH were assayed in both groups. As a group the diabetics had nocturnal GH responses higher than those in controls. However, the sleep-related GH release is not abnormally high in patients who maintain strict normoglycemia. Early-night hypoglycemia and/or rapidly decreasing blood glucose concentrations enhance sleep-related GH secretion in diabetics, whereas hypoglycemia not associated with slow-wave sleep (SWS) causes a moderate increase in GH. Late-onset nocturnal hypoglycemia is not potent enough to stimulate GH. It is proposed that in diabetics sleep-related GH production is probably not abnormally elevated within a wide range of stable glucose levels, but when these thresholds are crossed or when there is a rapid decrease in blood glucose, then GH secretion is inversely related to the changing blood glucose. Therefore, our study supports the conclusion that sleep-related GH secretion is finely modulated by the actual glycemic fluctuations in diabetic patients.

To assess the effects of dorzolamide/timolol fixed combination (DTFC) and latanoprost 0.005% on the retrobulbar haemodynamics and intraocular pressure (IOP) of open-angle glaucoma patients.22 consecutive subjects with newly diagnosed, open-angle glaucoma were included in this prospective, examiner masked, randomized, crossover study. The patients were randomized into two different arms. Peak systolic velocity (PSV), end-diastolic velocity (EDV), Pourcelot's resistance index (RI) and intraocular pressure (IOP) were determined at baseline and after 1 month of medical treatment with DTFC or latanoprost 0.005% in both groups. A 4-week washout period, without medical treatment, between study arms was carried out. Primary efficacy variables were the PSV, EDV and RI in the ophthalmic artery (OA) and short posterior ciliary artery (SPCA) and intraocular pressure (IOP). Inter- and intra-group comparisons were performed with a one-way ANOVA test and two-tailed paired Student's t-test respectively.Intraocular pressure (IOP) and colour Doppler imaging (CDI) measurements were similar at baseline. Compared to baseline and washout measurements, only the fixed combination dorzolamide/timolol significantly increased the EDV in the OA and in the SPCA, p = 0.00012 and p = 0.00012, respectively and decreased the resistance index in the ophthalmic and short posterior ciliary arteries, p = 0.00011 and p = 0.00031, respectively. There were no statistically significant differences in the IOP lowering effect of either treatment.Over a treatment period of 1 month, only the fixed combination dorzolamide/timolol seems to have a vascular effect on retrobulbar vessels. Further research is necessary to confirm these results.

CONTEXT: Patients with antiphospholipid syndrome and alloimmunity have poor pregnancy outcomes. Several diagnostic and therapeutic options exist for these disorders, although there is no consensus as to the best treatment. CASE REPORT: We present here the clinical course and treatment of a woman with a history of two miscarriages who joined our program 10 years ago and has been followed up ever since. After antiphospholipid syndrome and alloimmune failure were diagnosed, she was given preconceptional treatment using unfractionated heparin, aspirin, prednisone and lymphocyte immunizations. She delivered two premature babies in the following two pregnancies. At present both children are healthy and are attending school. The fifth pregnancy was unsuccessful, in spite of having undergone a similar but postconceptional therapeutic scheme. We discuss this case focusing on the pathogenic mechanisms and the therapeutic aspects of these disorders.

Fundamento y objetivo La obesidad esta asociada con factores de riesgo cardiovascular y fallo cardiaco. Sujetos y metodo Se comparo a 30 ninos que presentaban sobrepeso u obesidad con 30 ninos sanos. Se midieron los intervalos QT corregido (QTc), dispersion del QT (QTd), masa del ventriculo izquierdo, indice de masa del ventriculo izquierdo, fraccion de eyeccion y fraccion de acortamiento. Resultados Los intervalos QTc y QTd, masa del ventriculo izquierdo e indice de masa del ventriculo izquierdo fueron significativamente mayores en los ninos con sobrepeso u obesidad que en los controles. Conclusiones Los ninos con sobrepeso u obesidad tienen un incremento de los intervalos QTc, QTd, del volumen y masa del ventriculo izquierdo, y un mayor riesgo de arritmias que los controles. Estos resultados hacen considerar la necesidad de una especial monitorizacion cardiaca de los ninos obesos, en especial de los que tienen formas graves.

We have just finished the first tests at the telescope of an infrared camera designed and developed at the Instituto de Astrofisica de Canarias (IAC). This camera, based on a 256 X 256 focal plane array, has been built to operate at the 1.5 m Carlos Sanchez IR telescope (CST) in the Observatorio del Teide (Canary Islands, Spain). In this paper we describe the final configuration and performance of the camera. Some images taken during two telescope commissioning periods are shown.