QTL analysis of cooking time and quality traits in dry bean (Phaseolus vulgaris L.).

KEY MESSAGE: Three robust QTL for dry bean cooking time shortened cooking time 11-26 min and co-localized with QTL for increased cooked seed protein concentration. Cooking time is a major factor associated with consumer preference of dry beans (Phaseolus vulgaris L.). The genetic control of cooking time was investigated with a quantitative trait loci (QTL) study on a recombinant inbred line (RIL) population developed from TZ-27 (slow cooking) and TZ-37 (fast cooking). The RIL population of 146 lines was grown on research farms over 2 years in Arusha and Morogoro, Tanzania. Arusha is an important mid-altitude bean-growing region, with moderate temperatures and reliable rainfall, whereas the low altitude and high temperatures in Morogoro make it unfavorable for bean production. The population exhibited large variation for cooking time with a range of 22-98 min. On average, beans grown in Arusha cooked 15 min faster than those grown in Morogoro. A linkage map developed with 1951 SNP markers was used for QTL analysis. Ten QTL were identified for cooking time, three of which were found in multiple environments. RILs with all three QTL (CT3.1, CT6.1, and CT11.2) cooked on average 11 min faster in Arusha and 26 min faster in Morogoro than RILs with none. Seed attributes were related to cooking time such that seeds with greater seed mass and less seed coat percentage cooked faster. Cooked seed protein concentration ranged from 17.8 to 30.8% across the years and locations. All three of the most robust cooking time QTL co-localized with QTL for protein concentration, and TZ-37 always contributed faster cooking time and increased protein concentration.

Variabilidad en la medición del índice acetabular / Variability in measurement of acetabular index

Introducción: La Displasia del desarrollo de la cadera (DDC) es un espectro de enfermedades que abarca desde la luxación franca de la cadera hasta la displasia acetabular leve. El screening de detección de DDC se realiza de rutina en nuestro país, mediante una radiografía de pelvis a los 3 meses. El índice acetabular medido en estas radiografías se utiliza para evaluar la cadera displásica, tanto en la presentación inicial como durante el seguimiento posterior. Objetivo: Evaluar la variabilidad tanto intra como inter observador en la medición del índice acetabular, entre profesionales médicos. Material y Métodos: Cuatro evaluadores (un cirujano-ortopédico infantil, un médico general, un pediatra y un radiólogo) realizaron la medición del índice acetabular en 100 radiografías de screening (200 caderas), en tres ocasiones, separadas por un mes cada una (600 mediciones totales). Un observador independiente evaluó la reproductibilidad en la medición. Se utilizó el coeficiente de correlación intraclase para determinar diferencias significativas. Resultados: La variabilidad intra observador fue menor que la interobservador. La variabilidad intra observador fue similar para los diferentes evaluadores, +/- 1,5°. La variabilidad inter observador fue de +/- 3,4°. Conclusiones: Demostramos una alta concordancia entre las mediciones, determinando una alta reproductibilidad del índice acetabular. El índice acetabular es un método seguro para el diagnóstico y seguimiento de displasia acetabular.

Developmental dysplasia of the hip (DDH) is a spectrum of diseases ranging from frank dislocation of the hip to mild acetabular dysplasia. DDH screening for detection is performed routinely in our country using pelvic x-ray at 3 months of age. The radiographic measured acetabular index is used to evaluate the dysplastic hip, at initial presentation and during follow-up. Objective: Evaluation of the intra- and inter-observer variability, among medical professionals, when measuring acetabular index. Methods: Four reviewers (a children orthopedic surgeon, a general practitioner, a pediatrician and a radiologist) performed acetabular index measurement in 100 radiographs (200 hips), on three occasions, separated each by one month (600 total measurements). An independent observer evaluated the measurement reproducibility. The intra-class correlation coefficient to determine significant differences was used. Results: The intra-observer variability was less than the inter-observer variability. The intra-observer variability was similar among the different assessors, +/- 1.5 degrees. The inter-observer variability was +/- 3.4 degrees. Conclusions: A high concordance among measurements was reported, evidencing a high reproducibility of the acetabular index; this index is a reliable method for the diagnosis and follow-up of acetabular dysplasia.

La crisis de sibilancias del niño preescolar: de la bronquiolitis al asma / The episodes of high pitched wheezes in the pre-school child: from bronchiolitis to asthma

Las infecciones respiratorias virales graves durante la época de lactante (sobre todo por virus respiratorio sincitial y por rinovirus) pueden tener una repercusión, tanto aguda como a largo plazo, en el desarrollo del pulmón y del sistema inmune, con un incremento del riesgo de evolucionar hacia asma. En muchos niños, en primer episodio de bronquiolitis continúa con episodios recurrentes de sibilancias. Las causas de recurrencia pueden variar con cada niño y con el paso del tiempo, debido a interacciones entre factores genéticos y el medio ambiente. En niños muy pequeños estas crisis pueden ser precursoras de asma. Tanto la inflamación como el remodelado de la vía aérea, procesos patogénicos fundamentales e interrelacionados en el asma, aparecen a una temprana edad. Todavía queda por dilucidar si es el grado de riesgo atópico lo que determina una mayor susceptibilidad a una infección viral o bien es la infección viral la que conduce a una sensibilización, y como estos dos procesos que aparentemente se superponen interactúan en el contexto del desarrollo de asma a una edad temprana. La identificación de los lactantes y niños pequeños sintomáticos que están desarrollando asma puede ser importante para una intervención temprana dirigida a cambiar la historia natural de la enfermedad. Una clasificación fenotípica de las crisis de sibilancias puede dar valiosos indicios sobre s naturaleza y su tratamiento. Los primeros estudios demostraron que muchas crisis de sibilancias tempranas son transitorias ("sibiladores tempranos"), aunque una minoría sustancial de estos niños las crisis persisten hasta la edad escolar ("sibiladores persistentes"). Actualmente se han reconocido dos fenotipos clínicos de crisis recurrentes de sibilancias, aunque con un considerable solapamiento entre los dos grupos (...) (AU)

Severe respiratory viral infections during infancy (mainly for respiratory syncytial virus and for rinovirus) may have an acute and long-term impacto n lung and immune system development, resulting in an increased risk for childhood asthma. In many children, a first episode of bronchiolitis is followed by more symptoms or recurrence of wheezing. Causative factors for recurrent wheeze may vary from child to child and within a child over time, due to a large number of interactions between genetics factors and the environment. In very young children, wheezing may be a precursor of asthma. Inflammation and airway remodeling, fundamental and interrelated pathogenic processes in asthma, occurs at an early age. The degree to which atopic atopic risk determines susceptibility to viral infection versus viral infection driving sensitization, and how these apparently overlapping processes interact in the context of asthma development in early life, is yet to be resolved. The identification of symptomatic infants and young children who are developing asthma may be important for the early intervention aimed at changing the natural course of the disease. A phenotypic classification of childhood wheezing can provide valuable insights into is nature and treatment. The first studies demonstrated that most early life wheezing is a transient entity ("transient wheezers"), although a substantial minority of early life wheezing persist up to the school age ("persistentn wheezers"). Actually two groups have been recognized of clinical phenotypes of recurrent wheeze, but it should be stressed that the overlap between these groups in considerable (...) (AU)

¿Es segura la preparación casera del biberón? / Is home preparation of baby's formula safe?

Introducción. La leche en polvo para lactantes (LP) no es un producto estéril y puede contener bacterias patógenas, aunque en escaso número. Los patógenos oportunistas pueden multiplicarse en el producto reconstituido y causar infecciones en el lactante. Tanto la OMS/FAO como la ESPGHAN han publicado guías para una segura preparación, manejo del biberón en una muestra de padres, así como compararlas con las recomendaciones de la OMS/FAO y de la ESPGHAN. Material y métodos. Se obtuvo información sobre el conocimiento y práctica de preparación del biberón en su domicilio de 180 padres de lactantes que tomaban lactancia artificial o mixta, de edades comprendidas entre 1 mes y 1 año, durante su hospitalización por enfermedad aguda en un hospital terciario. Resultados. El 62% de los padres creen que la LP es estéril. El 25% de los padres fueron instruidos directamente por el pediatra en la preparación del biberón de LP y otro 47,7% se guió por las instrucciones del pictograma del envase de LP. El 91,6% de los padres se lavan las manos con agua y jabón antes de comenzar a preparar el biberón, pero solo el 51,6% esterilizan la botella y la tetina antes de cada toma. Las normas de dar el biberón inmediatamente después de reconstituido, de desechar el sobrante de la toma y de hacer la dilución con agua tibia, a 40-45%ºC, las siguen casi el 100% de los padres. Conclusiones. La gran mayoría de padres tiene prácticas seguras en el manejo y reconstitución del biberón. Mientras que la OMS/FAO recomienda usar agua muy caliente, casi a punto de ebullición, para hacer la disolución, no lo hace la ESPGHAN por los posible efectos adversos sobre la estabilidad y pérdida de nutrientes de la fórmula. En este estudio casi el 100% de los padres preparan el biberón con agua a 40-45%ºC, siguiendo las instrucciones del pediatra y de los pictogramas del envase. El riesgo de enfermedad de origen alimentario en el lactante puede reducirse si los padres cumplen estrictamente las formas higiénicas (AU)

Introduction. Powdered infant formula (PIF) i not a sterile product and may contain pathogenic bacteria in low quantity. Opportunistic pathogens could multiply in the reconstituted product resulting in infant infections. WHO/FAO and PGHAN have issued guidelines for safe preparation, storage and handling of PIF. The objective of this study was to know the formula handling practices of a sample of parents and compare against the WHO/FAO and ESPGHAN guidelines. Material and methods. Information on knowledge and formula handling practices at home was collected from 180 parents of children aged 1 month - 1 year during their hospitalization for acute illness in a tertiary hospital. Results. Sixty two percent of parents appear to be confident in sterility of PIF. A total of 25% of parents had been instructed on PIF preparation by pediatrician, but the 47,7% of the parents were using the instructions found in the labels to prepare the product. The 91.6% of the parents wash their hands with water and soap before preparation, but only the 51,6% of the parents sterilize the bottle and nipple at each feed. The norms of use immediately of the reconstituted formula, discard the remaining and prepare the bottle feed with water at 40-45ºC is followed by near the 100% of the parents. Conclusions. Safer options were generally chosen by parents in the cleaning and handling procedures of reconstitution of PIF, WHO/FAO recommends to use water close to boiling point but the ESPGHAN do not, because of possible adverse effects on physical stability and nutrient content of the formula. Nearly the 100% of the parents in this study prepare the bottle feed with water at 40-45ºC, following the instructions of the PF labels. Risk of food-borne illness in infants could be reduced when parents strictly adhere to hygienic practices (AU)

Thermoluminescent dosimetry in veterinary diagnostic radiology.

This paper presents the results of Environmental and Personnel Dosimetry made in a radiology area of a veterinary hospital. Dosimetry was realized using thermoluminescent (TL) materials. Environmental Dosimetry results show that areas closer to the X-ray equipment are safe. Personnel Dosimetry shows important measurements of daily workday in some persons near to the limit established by ICRP. TL results of radiation measurement suggest TLDs are good candidates as a dosimeter to radiation dosimetry in veterinary radiology.

First Report of Cylindrocladiella parva and C. peruviana Associated with Black-foot Disease of Grapevine in Spain.

From 2007 to 2009, Cylindrocladiella-like isolates were recovered from grapevine (Vitis vinifera L.) roots with symptoms of black-foot disease in Spain, where the causal agents of this disease have been previously reported as Campylocarpon and Cylindrocarpon species (1,2). Three representative isolates were selected to confirm their identity: CPa1 and CPa2 from Asturias (northern Spain), and CPe523 from Cuenca (central Spain). Isolates were incubated on malt extract agar (MEA) and Spezieller Nährstoffarmer Agar (SNA) with carnation leaves (4) at 25°C for 10 days in darkness. On MEA, colonies developed light brown, cottony mycelium. On SNA, all three isolates produced chlamydospores in chains, and conidia were zero-to one-septate, but CPa1 and CPa2 produced longer conidia (10.4 to 18.9 [15.3] × 1.7 to 3.1 [2.4] µm) than CPe523 (6.4 to 12.3 [9.7] × 1.6 to 3.3 [2.4] µm). A fragment of the beta-tubulin gene from all isolates was sequenced with primers T1 and Bt2b (1) and deposited in GenBank (Accession Nos. JQ693133, JQ693134, and JQ693135). CPa1 and CPa2 showed high similarity (99%) to Cylindrocladiella parva (AY793486) and CPe523 showed high similarity (99%) to C. peruviana (AY793500), which is in agreement with the corresponding morphological features of these species (4). Pathogenicity tests were conducted with inoculum produced on wheat (Triticum aestivum L.) seed soaked for 12 h in 300 ml of distilled water and autoclaved three times. Inoculum was prepared by inoculating two fungal disks (8 mm in diameter) of a 2-week-old culture of each isolate grown on potato dextrose agar to wheat seed and incubation at 25°C for 4 weeks. One-month-old grapevine seedlings were planted individually in 220-cc pots filled with a potting medium of sterilized peat moss and 10 g of inoculum, and grown in the greenhouse at 25°C in a completely randomized design. Controls were inoculated with sterile, noninoculated wheat seed. There were six replicate plants per isolate, with an equal number of controls, and the experiment was repeated once. Symptoms developed in all plants by 20 days post-inoculation and consisted of reduced vigor, necrotic root lesions, and occasionally mortality, all of which resembled the symptoms from grapevines in the field from which the isolates were originally recovered. Mean shoot dry weights of inoculated plants (0.25, 0.16, and 0.28 g for CPa1, Cpa2, and CPa523, respectively) were significantly lower (P < 0.05) than that of the controls (0.74 g). Mean root dry weights of inoculated plants (0.28, 0.16, and 0.29 g for CPa1, Cpa2, and CPa523, respectively) were also significantly lower (P < 0.05) than that of the controls (0.68 g). Isolates recovered from the roots of inoculated plants were identical morphologically and molecularly to C. parva and C. peruviana, thereby satisfying Koch's postulates. No symptoms were observed on the control plants. These Cylindrocladiella spp. have been reported from nurseries or vineyards in South Africa and New Zealand (3). To our knowledge, this is the first report of C. parva and C. peruviana associated with black-foot disease of grapevine in Spain, and in Europe. References: (1) S. Alaniz et al. Plant Dis. 91:1187, 2007. (2) S. Alaniz et al. Plant Dis. 95:1028, 2011. (3) E. E. Jones et al. Plant Dis. 96:144, 2012. (4) L. Lombard et al. Mycol. Progress DOI 10.1007/s11557-011-0799-1, 2012.

Efficacy of epoetin-beta 30.000 IU/week in correcting anaemia in patients with gastrointestinal tumours subjected to concomitant chemoradiotherapy

OBJECTIVE: The aim of the project was to assess the effectiveness and safety of weekly epoetin-beta (EB) in patients with gastrointestinal cancer (GIC) subjected to concomitant chemoradiotherapy (CCTRT). METHODS: In this clinical prospective and multicentre cohort study EB was administered at a dose of 30,000 IU/ week, during CCTRT and in the four weeks thereafter, and suspended if haemoglobin (Hb) increased >2 g/dl or Hb >12-13 g/dl. Effectiveness was defi ned as Hb increase ≥1 g/dl vs. baseline. Time to response, treatment toxicity and transfusion requirements were also assessed. RESULTS: EB was effective in 75.8% of the evaluable population within a median of four weeks from EB initiation, without blood transfusions. Over 80% of all patients remained below the threshold (Hb ≤13 g/dl) and no study drug-related adverse reactions were recorded. CONCLUSION: Weekly EB proved to be effective and well tolerated by patients with GIC subjected to CCTRT (AU)

Clavícula supernumeraria: reporte de un caso / Supernumerary clavicle: a case report

Comunicamos un caso de clavícula supernumeraria izquierda en un paciente varón, de 3 años de edad, con imposibilidad a la flexoextensión y lateralización cervical desde el nacimiento y que al estudiotomográfico se observa la presencia de un cuerpo óseo del lado izquierdo con forma de S itálica, que se articulaba con la mandíbula y región esternoclavicular. Previa valoración del servicio de rehabilitación, se somete a excéresis de la lesión, confirmándose anatomopatológicamente que se trataba de tejido óseo con superficies distales articulares y médula ósea central (AU)

We report a case of left sided supernumerary clavicle in a male child, 3 years old with impossibility to the flexion and extension of the neck and lateralization since birth, in the 3D CAT SCAN we could appreciate the presence of bone tissue with italic S shape that was articulated with the jaw and the left sternun clavicle region. Previous evaluation from the rehabilitation service the patient underwent the removal of the lesion. The pathology study confirmed that this piece was osseous tissue with distal joints surfaces and central bone marrow (AU)

[Supernumerary clavicle: a case report]. / Clavicula supernumeraria: reporte de un caso.

We report a case of left sided supernumerary clavicle in a male child, 3 years old with impossibility to the flexion and extension of the neck and lateralization since birth, in the 3D CAT SCAN we could appreciate the presence of bone tissue with italic S shape that was articulated with the jaw and the left sternun clavicle region. Previous evaluation from the rehabilitation service the patient underwent the removal of the lesion. The pathology study confirmed that this piece was osseous tissue with distal joints surfaces and central bone marrow.

Epistaxis y anemia por Hirudo medicinalis (sanguijuela) / Epistaxis and anemia due to Hirudo medicinalis (medicinal leech)

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A study on the influence of emulsion droplet size on the skin penetration of tetracaine.

OBJECTIVES/AIMS: The influence of emulsion droplet size on the skin penetration of a model drug, tetracaine, was studied. For this purpose, in vitro dermal and transdermal delivery of tetracaine from 6 emulsions (3 macro-emulsions with droplet sizes >1 microm and 3 nano-emulsions with droplet sizes <100 nm) were tested. METHODS: Two approaches were used: in the first one, the composition of the emulsions was kept constant, while in the second one, the surfactant concentration in the aqueous phase was kept constant by varying the overall surfactant concentration. RESULTS: The results from emulsions differing only in droplet size did not provide statistically significant evidence for the anticipated increase in transdermal or dermal delivery (after 24 h) when reducing emulsion droplet size. The same results were obtained when the surfactant concentration in the aqueous phase was kept constant, indicating that there is no influence of emulsion droplet size on the skin penetration of tetracaine within the droplet size range studied. CONCLUSION: This is in contrast to what has been reported in various publications that claim penetration to increase with reducing droplet size. It should be noted that the results reported so far are based on emulsions that apart from droplet size also differed in composition and/or system components.

Introducción temprana o tardía de la alimentación complementaria. Datos de 248 niños / No disponible

Antecedentes: En España se ha descrito un buen cumplimiento de la edad recomendada de la introducción de la alimentación complementaria en la dieta del lactante. Objetivo: Conocer cuándo y por qué comienzan la alimentación complementaria las madres de nuestra región y las consecuencias nutricionales del comienzo temprano o tardío. Métodos. Se recogió información sobre la introducción de alimentación complementaria de 248 madres de niños de edades entre 1 y 2 años ingresados en el hospital por enfermedad aguda. Se excluyeron prematuros, partos múltiples y también los niños con anomalías congénitas o enfermedad crónica. Resultados: A los 3 meses de edad tomaban lactancia materna exclusivo sólo el 33,8% de los niños. La media de edad de introducción de la alimentación complementaria fue de 4,1 meses, con un 35,7% que comenzaron antes de los 4 meses de edad. El comienzo antes de los 3 meses estuvo asociado con lactancia artificial y con la percepción de las madres de que su bebé quedaba insatisfecho y hambriento. La media de edad de introducción de la carne fue de 8,1 meses, con un 32,2% que comenzaron después de los 9 meses.la deficiencia de hierro y la anemia ferropénica fueron del 17,5% y del 6,2%, respectivamente, en el grupo de introducción tardía de la carne frente al 4,7% y el 1,5% del grupo con introducción temprana de la carne. Conclusión: en este estudio no fue bueno el cumplimiento de las recomendaciones sobre el calendario de introducción de la alimentación complementaria y de la carne. Las principales repercusiones nutricionales de las prácticas alimentarias inadecuadas fueron la deficiencia de hierro y la anemia ferropénica (AU)

Background: In Spain are described good compliance patterns to the recommended age of introduction of complementary feeding to the diet of infants. Objectives. to know when and why the mothers of out area start the weaning and some nutritional consequences of early or late begin. Methods: Information on introduction of complementary feeding was collected from 248 mothers of children aged 1-2 years during their hospitalization for acute illness. Children with congenital anomalies, chronic illness and premature or multiple birth were excluded. Results, The 33,8% of the infants were exclusively breastfed at 3 months of age. The mean age of introduction of complementary foods was 4.1 months, with 35,7% commencing before 4 months of age. Weaning before 3 months was associate with bottle feeding and the mother´s perception that their baby was hungry. The mean age of introduction that their baby was hungry. The mean age of introduction of meat was 8.1 months, with 32.2% commencing after 9 months. Iron deficiency and iron deficiency anemia was 17.5% and 6.2% in the group of late introduction of meat vs. 4.7% and 1.5% in the group of early introduction of meat. Conclusions: Compliance with the current recommendations on the timing of introduction of first supplementary food and introduction of meat is not good in this study. Iron deficiency and iron deficiency anemia was the main nutritional repercussion of inadequate feeding practices (AU)

[25-Hydroxyvitamin D levels in infants. Relation with breast-feeding]. / Niveles de 25-hidroxivitamina D en lactantes. Relación con la lactancia materna.

OBJECTIVE: To determine the prevalence of subclinical vitamin D deficiency among infants in Valencia, Spain (latitude 39.5 degrees N) and its relation with breast- feeding. MATERIAL AND METHODS: Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (PTH) were measured in 60 term infants aged between 1 and 6 months (mean age: 3.9 months), with no known bone, gastrointestinal or renal disease (33 exclusively breast-fed, 27 bottle-fed). Data on vitamin D supplementation and weekly direct sunlight exposure were also gathered. RESULTS: All infants had normal serum calcium, phosphate and PTH levels. Five infants (8.3 %) had 25-OHD levels < 10 ng/ml (lower limit of normality) and all of these infants were breast-fed (15.1 % of the group). None of these five infants received vitamin D supplementation. Infants with vitamin D deficiency had slightly elevated serum alkaline phosphatase. Only 48 % of breast-fed infants received regular vitamin D supplementation. The mean serum 25-OHD concentration of breast-fed infants in winter (16.8 ng/ml) was significantly lower than that in bottle-fed infants in summer (23.6 ng/ml, p < 0.05). CONCLUSIONS: In breast-fed infants, the association of limited sunshine exposure and poor dietary vitamin D supplementation confers a high risk of subclinical vitamin D deficiency, even in regions with a temperate climate.

Niveles de 25-hidroxivitamina D en lactantes. Relación con la lactancia materna / 25-Hydroxyvitamin D levels in infants. Relation with breast-feeding

Objetivo: Determinar la prevalencia de la deficiencia subclínica de vitamina D en lactantes del área de Valencia, España (latitud 39,5° N) y su relación con la lactancia materna. Material y métodos: Se midieron los niveles séricos de calcio, fosfato, fosfatasas alcalinas, 25-hidroxivitamina D (25[OH]D) y hormona paratiroidea (PTH) intacta en 60 lactantes entre 1 y 6 meses de edad, nacidos a término (media de edad 3,9 meses), sin enfermedad ósea, gastrointestinal o renal (33 alimentados con lactancia materna exclusiva y 27 con lactancia artificial). Se recogieron datos de suplementación con vitamina D y de tiempo semanal de exposición solar. Resultados: Todos los lactantes tenían niveles normales de calcio, fosfato y PTH. En cinco de ellos (el 8,3 %), los niveles de 25(OH)D eran menores de 10 ng/ml (límite inferior de la normalidad). Todos ellos estaban alimentados con lactancia materna (el 15,1 % del grupo) y ninguno estaba suplementado con vitamina D. Los lactantes con hipovitaminosis D tenían ligeramente elevadas las fosfatasas alcalinas. Sólo el 48 % de los lactantes alimentados al pecho recibían habitualmente suplementos de vitamina D. La media de niveles de 25(OH)D en invierno del grupo con lactancia materna (16,8 ng/ml) fue significativamente más baja que la del grupo con alimentación artificial en verano (23,6 ng/ml; p < 0,05). Conclusiones: La asociación de escasa exposición al sol y ausencia de suplementación con vitamina D confiere a los niños con lactancia materna un alto riesgo para la deficiencia subclínica de vitamina D, incluso en regiones de clima templado

Objective: To determine the prevalence of subclinical vitamin D deficiency among infants in Valencia, Spain (latitude 39.5 degrees N) and its relation with breast- feeding. Material and methods: Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (PTH) were measured in 60 term infants aged between 1 and 6 months (mean age: 3.9 months), with no known bone, gastrointestinal or renal disease (33 exclusively breast-fed, 27 bottle-fed). Data on vitamin D supplementation and weekly direct sunlight exposure were also gathered. Results: All infants had normal serum calcium, phosphate and PTH levels. Five infants (8.3 %) had 25-OHD levels < 10 ng/ml (lower limit of normality) and all of these infants were breast-fed (15.1 % of the group). None of these five infants received vitamin D supplementation. Infants with vitamin D deficiency had slightly elevated serum alkaline phosphatase. Only 48 % of breast-fed infants received regular vitamin D supplementation. The mean serum 25-OHD concentration of breast-fed infants in winter (16.8 ng/ml) was significantly lower than that in bottle- fed infants in summer (23.6 ng/ml, p < 0.05). Conclusions: In breast-fed infants, the association of limited sunshine exposure and poor dietary vitamin D supplementation confers a high risk of subclinical vitamin D deficiency, even in regions with a temperate climate

Lactante con acrocianosis simétrica de ambos pies / Infant with symmetric acrocyanosis of both feet

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Deficiencias nutritivas en niños vegetarianos / Nutritional deficiencies in vegetarian children

Presentamos a cuatro niños vegetarianos, de edades comprendidas entre 1 y 3 años, con múltiples deficiencias nutritivas. En sus dietas se incluían pequeñas cantidades de leche y de huevos (lacto-ovo-vegetarianos) pero no tomaban carne, pescado ni suplementos vitamínicos. En la encuesta nutricional encontramos una ingesta insuficiente de energía, calcio, hierro y vitamina B12. Todos los niños tenían una talla normal, pero con puntuaciones Z bajas (entre -0,77 y -1,28) y un peso muy disminuido (puntuación Z entre - 1,92 y -2,38). Un niño tenía raquitismo clínico con hipocalcemia y déficit de vitamina D. Otro niño tenía raquitismo clínico con niveles normales de vitamina D, sugiriendo que la causa del raquitismo era la deficiencia en calcio. Los datos de laboratorio mostraron en todos lo niños una anemia por déficit de vitamina B12 entre 102 y 130 pg/ml, niveles normales, 180-900 pg/mL ) con VCM elevado, homocisteína sérica elevada y ferritina sérica muy baja, indicando el déficit de hierro. Todos los niños tuvieron una buena respuesta al tratamiento con suplementos nutricionales de vitaminas, calcio, hierro y una modificación parcial de sus dietas, de acuerdo con los padres (AU)

We report four vegetarian children aged between 1 and 3 years old with multiple nutritional deficiencies. Their diets included milk eggs in small amount (lacto-ovo-vegetarian) but not received meat, fish or supplementary vitamins. In the dietary recall we found an inadequate intake of energy, calcium, iron and vitamin B12. All children had normal height but in lower Z-score (between -0.77 an -1.28) and greatly decreased weight (Z-score between -1.92 and -2.38). One children had clinical rickets with hypocalcemia and vitamin D deficiency. Another children had clinical rickets with normal vitamin D levels. This suggests that the calcium deficiency was the cause of rickets. Laboratory data revealed in all children a vitamin B12 deficiency anemia (vitamin b 12 levels between 102 and 130 pg/ml, normal range 180-900 pg/ml) with high MCV, high homocysteine serum levels and low ferritin serum levels. All children responded well to nutritional supplementation with vitamins, calcium, iron and moderate adjustment of diets by mutual agreement with the parents (AU)

Hepatoesplenomegalia y retraso motor en un lactante de 6 meses / Hepatosplenomegaly and motor delay in a 6-month old infant

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