Quantification of Chlorate and Perchlorate in a Broad Range of Food Commodities, Including Baby Food, Nutritional Formulas, and Ingredients by LC-MS/MS: First Action AOAC 2022.06.

BACKGROUND: Chlorate is an effective herbicide, but also a byproduct of chlorinating agents used to disinfect water, which is one of the reasons why it is regularly found in food. Perchlorate is a ubiquitous contaminant, which is naturally occurring in the environment but also released from anthropogenic sources such as the industrial use of certain natural fertilizers. Chlorate affects the hematological system, and perchlorate the thyroid. OBJECTIVE: Implement and validate a simple and robust analytical method for the accurate determination of chlorate and perchlorate in baby food, infant and adult formulas, and ingredients thereof, which is suited for its application in routine environments where a broad variety of food commodities must be analyzed simultaneously. METHOD: Typically, analytes are extracted with a mixture of water, acidified methanol, and dichloromethane. Optionally, for dairy products and byproducts, extraction can be performed with water, acidified methanol, and EDTA, followed by two steps of cleanup (freezing out and dispersive solid-phase extraction with C18 in acetonitrile). Quantitative determination is carried out by isotopic dilution liquid chromatography tandem mass spectrometry (LC-MS/MS). RESULTS: The method was single-laboratory validated in five Nestlé Quality Assurance Centers (NQACs) in a comprehensive range of representative matrixes of different categories such as baby foods, infant/adult formulas, and ingredients, with results generally in agreement with the acceptance criteria of the Standard Method Performance Requirement (SMPR®) 2021.001 defined by AOAC INTERNATIONAL, in terms of representative matrixes validated, LOQs, trueness, and precision.The data generated during validation show that the method proposed is simple, accurate and robust enough to be implemented and applied in routine environments. CONCLUSION: The data generated during validation show that the method proposed is simple, accurate and robust enough to be implemented and applied in routine environments. HIGHLIGHTS: The AOAC Expert Review Panel approved the present method as AOAC Official First Action 2022.06.

Salvage brachytherapy for locally recurrent prostate cancer after single-fraction 19 Gy high-dose-rate brachytherapy: toxicity, prostate-specific antigen kinetics, and cancer control.

PURPOSE: To evaluate toxicity, prostate-specific antigen (PSA) kinetics, and cancer control of high-dose-rate brachytherapy (HDR-BT) as a salvage modality for men with locally recurrent prostate cancer, after primary HDR-BT failure. MATERIAL AND METHODS: Twelve patients with biochemical failure and a local relapse after 19 Gy single-fraction high-dose-rate brachytherapy (HDR-BT 19 Gy) were salvaged using two HDR-BT fractions. Salvage treatment consisted of two HDR-BT applications, one week apart, delivering 12 Gy to the prostate per application (HDR-BT 12 × 2). RESULTS: Median age and initial PSA prior to rescue treatment were 74 years (range, 65-80) and 5.29 ng/ml (range, 2.37-16.40), respectively. Forty-two percent had a low-risk and 58% presented with intermediate-risk prostate cancer. Median follow-up period was 26 months (range, 10-42). Median time to PSA nadir was 12 months, with a median value of 0.21 ng/ml. Most of the patients (11 of 12) achieved a PSA decline ≥ 90%. Acute grade 2 genitourinary (GU) toxicity occurred in 4 patients (33.3%) and none presented with acute gastrointestinal (GI) toxicity. Two patients (16.7%) suffered from late GU grade 2 toxicity. No grade 3 toxicity were recorded. To date, 2 patients (16.7%) have experienced biochemical failure after salvage treatment. CONCLUSIONS: Salvage HDR-BT 12 × 2 is a feasible and well-tolerated treatment, with acceptable toxicity rates for men with locally recurrent prostate cancer, who failed after HDR-BT with 19 Gy. Moreover, PSA kinetics and cancer control after salvage treatment suggest that this strategy might be efficacious in this clinical setting.

A multi-residue pesticide determination in fatty food commodities by modified QuEChERS approach and gas chromatography-tandem mass spectrometry.

A QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) based multi-residue method has been developed and validated for the extraction and determination of pesticides in fatty matrices by gas chromatography tandem mass spectrometry. Extraction and clean-up were performed according to QuEChERS principles widely used for non-fatty matrices, with main difference, a higher solvent/sample- ratio followed by a 6-fold preconcentration step, ensuring good extractability and sensitivity. A validation according to SANTE guidelines was performed using a olive and sunflower oils mixture 1:1, w/w as representative matrix, at 2 concentration levels (5 and 50 µg/kg) targeting 176 GC-amenable pesticides. Most compounds fulfilled the validation criteria, with a limit of quantification of 5 µg/kg for 137 compounds , and of 50 µg/kg for 24 compounds. Afterwards, the method performance was tested in six different fatty matrices with 73-90% of the analytes fulfilling the performance criteria at 5 µg/kg depending on the matrix.

Detection of Furan and five Alkylfurans, including 2-Pentylfuran, in various Food Matrices.

Next to furan, other alkylfurans such as 2- and 3-methylfuran, 2-ethylfuran, 2,5-dimethylfuran, and 2-pentylfuran have been found concurrently in thermal processed food and fruit juices. To ensure an accurate quantification of these compounds, a method based on isotope dilution using all six respective internal standards and gas chromatography coupled to mass spectrometry was developed. Two injection techniques, static head space (HS) and solid phase micro extraction (SPME), were tested and compared for their performance. Validation was based on a single laboratory validation under repeatability condition. Good data for both techniques in baby food and cereals were obtained. Furthermore, validation was conducted successfully on fruit juices and infant formula using SPME injection and on coffee using HS injection. LOQ for all matrices was established at 5 µg/kg and 200 µg/kg in coffee samples, which corresponds to the lowest fortification level. Recovery was between 80 % and 110 % and repeatability obtained below 16 % at 50 µg/kg (7.4 % at 10 mg/kg for coffee samples), except few slight outliers.

Quantification of folpet and phthalimide in tea and herbal infusions by LC- high-resolution MS and GC-MS/MS.

Two methods based on a modified QuEChERS sample preparation and either LC coupled to atmospheric pressure ionisation and high-resolution MS or GC coupled to electron ionisation and tripled quadrupole MS have been assessed for the quantification of folpet and phthalimide in tea and other dry herbal infusions. Both methods have been fully validated in green tea and further checked in black tea, verbena and rooibos, and they performed according to the SANTE/11813/2017 criteria at the target LOQ concentration level (50 µg/kg). These methods allow the accurate quantification of folpet in the selected matrices according to the new EU residue definition, which includes phthalimide. Phthalimide is the main metabolite and degradation product of folpet, although according to recent studies, it could be generated from different sources than folpet breakdown, such as food processing or analysis by GC.

Cambios en la presión intraocular en pacientes con neuralgia trigeminal sometidos a radiofrecuencia del ganglio de Gasser / Changes in intraocular pressure in patients with trigeminal neuralgia subject to radio frequency of the Gasserian ganglion

Introducción: La neuralgia del trigémino es un cuadro caracterizado por ataques paroxísticos de dolor intenso, lancinante como descargas eléctricas, acompañado de sensación urente y de aparición periódica en la distribución de una o más ramas trigeminales. La relación anatómica entre el ganglio de Gasser y el seno cavernoso pudiera producir un incremento en la tensión intraocular después de la aplicación de la radiofrecuencia del ganglio trigeminal al modificar el drenaje venoso del ojo, situación que hasta el momento no se ha estudiado. El objetivo fue determinar si la aplicación de radiofrecuencia convencional en el ganglio de Gasser produce modificaciones en la tensión intraocular en pacientes con neuralgia trigeminal primaria de segunda y/o tercera rama. Material y métodos: Estudio longitudinal que incluyó a pacientes con diagnóstico de neuralgia del trigémino de segunda y/o tercera rama; en quirófano y bajo anestesia general, se les realizó procedimiento de radiofrecuencia en Ganglio de Gasser, con generador Neurotherm R 500, agujas de 100 mm de longitud y 22 G, con punta activa de 5 mm, estimulación sensitiva a 50 Hertz con 0,3-0,5 V aplicando 80 °C por 60 segundos en dos o tres fases. La presión intraocular se midió 24 horas previas al procedimiento, 24 horas posteriores al procedimiento y siete días después del mismo. El análisis de la presión intraocular, así como la escala EVA de dolor, se determinó mediante un análisis de ANOVA de medidas repetidas. Resultados: Se incluyeron 30 pacientes de los cuales 26 fueron mujeres, la edad promedio fue de 59,6 ± (DE 11,16). La tensión intraocular 24 h antes, un día después y una semana después de la realización de la radiofrecuencia del ganglio de Gasser no mostró modificaciones significativas con ANOVA para muestras repetidas (p = 0,916). Conclusiones: La tensión intraocular no se modificó a corto plazo después de realizar radiofrecuencia del ganglio de Gasser

Introduction: Trigeminal neuralgia is characterized by paroxysmal attacks of intense pain, lancinating as electric shocks, accompanied by burning sensation and periodic appearance in the distribution of one or more trigeminal branches. The anatomical relationship between the Gasser ganglion and the cavernous sinus could produce an increase in the intraocular tension after the application of the radiofrequency of the trigeminal ganglion when modifying the venous drainage of the eye, a situation that until now has not been studied. The objective was to determine if the application of conventional radiofrequency in the Gasser ganglion produces changes in the intraocular tension in patients with primary trigeminal neuralgia of second and / or third branch. Material and methods: Longitudinal study that included patients diagnosed with trigeminal neuralgia of second and / or third branch; In the operating room and under general anesthesia, radiofrequency procedure was performed in Gasser ganglion, with generator Neurotherm R 500, needles of 100 mm in length and 22 G, with active tip of 5 mm, sensory stimulation at 50 Hertz with 0.3 - 0.5 V applying 80º C for 60 seconds in 2 or 3 phases. Intraocular pressure was measured 24 hours before the procedure, 24 hours after the procedure and seven days after the procedure. The analysis of the intraocular pressure, as well as the EVA scale of pain was determined by an ANOVA analysis of repeated measures. Results: Thirty patients were included of which 26 were women, the average age was 59.6 ± (SD 11.16). Intraocular tension 24 h before, one day after and one week after performing radiofrequency of the Gasser ganglion, did not show significant changes with ANOVA for repeated samples (p 0.916). Conclusions: Intraocular tension was not modified in the short term after radiofrequency of the Gasser ganglion

Quantification of folpet and phthalimide in food by gas chromatography and mass spectrometry: Overcoming potential analytical artefacts.

Accurate quantification of folpet is problematic because it degrades into phthalimide during sample preparation and analysis by gas chromatography (GC). Thus, EU regulation was recently modified to include phthalimide in the folpet residue definition. However, recent studies have shown that phthalimide could also be generated from different sources, which could lead to an overestimation of the phthalimide content and therefore to false positives. GC coupled with either negative chemical ionisation and single quadrupole mass spectrometry, or electron ionisation with triple quadrupole mass spectrometry (GC-EI-MS/MS), were evaluated for the determination of folpet and phthalimide in food. Both methods were validated in 4 different matrices namely apple puree, rice flour, raspberry puree and infant formula. Better selectivity and precision were obtained with GC-EI-MS/MS. Negligible amounts of phthalimide was found in blank matrices, and validation results met the SANTE/11813/2017 criteria in all matrices at the LOQ concentration levels by using GC-EI-MS/MS.

Simple determination of aflatoxins in rice by ultra-high performance liquid chromatography coupled to chemical post-column derivatization and fluorescence detection.

A fast and simple analytical method was developed and characterized for the determination of aflatoxins (B1, B2, G1 and G2) in rice. The procedure is based on a simple solid-liquid extraction without further clean-up, and analysis by ultra-high performance liquid chromatography coupled with fluorescence detection. Fluorescence emission of aflatoxins B1 and G1 was enhanced by post-column chemical derivatization using pyridinium bromide perbromide. The analytical method was satisfactorily characterized in white and brown rice. Under optimum conditions, external calibration in solvent could be used for quantification purposes and limits of quantification were below the maximum contents established by the European Union regulation for these contaminants/commodity group combination (0.07-0.14 µg/kg for white rice and 0.20-0.28 µg/kg for brown rice). Recovery studies carried out at three different concentration levels (0.5, 2 and 5 µg/kg) showed values in the range of 84.5-105.3%, and RSDs ≤ 5%.

Determination of pesticides in fatty matrices using gel permeation clean-up followed by GC-MS/MS and LC-MS/MS analysis: A comparison of low- and high-pressure gel permeation columns.

Two low-pressure columns (Bio-Beads SX-3) and three high-pressure GPC columns were compared for clean-up of a wide range of pesticides in fatty matrices of vegetable or animal origin. The GPC fractions were analyzed by GC-MS/MS and LC-MS/MS without additional clean-up. The performance of the GPC clean-up on the five column types was compared in terms of solvent consumption, lipid removal, pesticide recovery and repeatability. It was found that for fatty matrices, mainly consisting of high molecular weight triglycerides i.e. most vegetable oils and animal fats, good fractionation is obtained for the majority of the pesticides. On the other hand, for fats and oils containing relatively high amounts of low molecular weight triglycerides, i.e. butter fat and palm kernel oil, none of the columns provided sufficient clean-up and cause interferences and system contamination, especially in the case of GC-MS/MS analysis. For the latter case, best results in terms of lipid removal and pesticide recovery were obtained on a set (2×300mmlength) of narrow bore (7.5mm ID) columns packed with 5µm PL Gel material. Column loadability is, however, much lower on that set of columns compared the other evaluated GPC columns, impairing overall method sensitivity.

Method optimization and validation for the determination of eight sulfonamides in chicken muscle and eggs by modified QuEChERS and liquid chromatography with fluorescence detection.

A simple, effective and reliable method for the determination of eight sulfonamide antibiotics (sulfadiazine, sulfapiridine, sulfamerazine, sulfamethazine, sulfachloropiridazine, sulfamethoxazole, sulfadoxine, sulfadimethoxin) in chicken muscle and eggs by liquid chromatography and fluorescence detection has been developed and validated. Sulfonamides do not present native fluorescence, however their direct determination was achieved by on-line post-column photochemical derivatization by UV irradiation. Sample treatment was based on QuEChERS with several modifications depending on the matrix. Egg extracts were cleaned-up using PSA for the dispersive solid phase extraction step. On the other hand, a new clean-up sorbent, Supel™ QuE Z-Sep(+), has been successfully applied in chicken muscle extract and has proved to be effective for interference removal from this matrix. Under optimum conditions, recoveries from 65.9 to 88.1%, relative standard deviations lower than 10% (except for sulfachloropiridazine), and limits of quantification (LOQs) from 14 to 85 µg kg(-1) were achieved. Thus, the method complies with current European requirements.

[Clinical features of strabismus in psychomotor retardation]. / Características clínicas del estrabismo en retraso psicomotor.

BACKGROUND: In psychomotor retardation there is an abnormal development of mental, sensory and motor skills associated with ocular manifestations. There are biological and psychosocial risk factors that predispose an individual to neurological damage. From 50% to 80% of patients with strabismus retardation have special features that differentiate it from the rest of strabismus in healthy patients. OBJECTIVE: To determine the most common type of strabismus in patients with psychomotor retardation and their clinical features. MATERIAL AND METHODS: Patients with psychomotor retardation and strabismus were included. An ophthalmological examination was performed, as well as an evaluation of the characteristics of strabismus, including perinatal and post-natal history. RESULTS: Esotropia was the most frequent squint with 65.3%, followed by exotropia with 32.7%. The variability in the squint magnitude was 60% in both types, and 6 patients had dissociated vertical deviation. Most of the patients started to present strabismus since they were born. The most frequent perinatal risk factors were threatened miscarriage, pre-eclampsia, foetal distress, and hypoxia. CONCLUSIONS: Esotropia is the most common type of strabismus in psychomotor retardation. The variability of squint magnitude is a characteristic in these patients. The moderate variability is the most frequent in both esotropia and exotropia. The most common refractive error is hyperopic astigmatism in esotropia and the myopic kind in exotropia.

PAHs in baby food: assessment of three different processing techniques for the preparation of reference materials.

A feasibility study for producing a matrix reference material for selected polycyclic aromatic hydrocarbons (PAHs) in baby food is reported. A commercially available baby food, containing carrots, potatoes, tomato, white beans and meat, was spiked with the so-called 15 + 1 PAHs included in the PAHs priority list for food of the EU, at a mass fraction level of 1 µg/kg. The contaminated baby food was further processed by autoclaving, freezing or freeze drying. The homogeneity of the three materials (bottle-to-bottle variation) and their short-term (4 weeks) and long-term (18 months) stability at different temperatures were assessed. To this end, an analytical method based on a solid-liquid extraction followed by cleaning up with gel permeation chromatography (GPC) and solid phase extraction (SPE) and GC-IDMS determination, was validated in-house. It could be demonstrated that the procedure fulfilled the demands for application to the homogeneity and isochronous stability studies for the candidate reference materials targeted here. All three materials proved to be sufficiently homogeneous for the intended use. Measurements on the autoclaved material provided the most promising results in terms of envisaged shelf life, although freeze drying was also found to be a suitable processing technique for most of the investigated PAHs. These results are an important step towards the development of a matrix reference material for PAHs in a processed food matrix in a presentation very similar to routine samples.

Metabolic effects of the contraceptive skin patch and subdermal contraceptive implant in Mexican women: a prospective study.

BACKGROUND: The contraceptive skin patch (CSP) accepted by the U.S. FDA in 2001 includes ethinylestradiol and norelgestromine, whereas the subdermal contraceptive implant (SCI) has etonogestrel and is also approved by the FDA. In Mexico, both are now widely used for contraception but their effects on Mexican population are unknown. The objective of the study was to evaluate if these treatments induce metabolic changes in a sample of indigenous and mestizo Mexican women. METHODS: An observational, prospective, longitudinal, non-randomized study of women between 18 and 35 years of age assigned to CSP or SCI. We performed several laboratory tests: clinical chemistry, lipid profile, and liver and thyroid function tests. Also, serum levels of insulin, C-peptide, IGF-1, leptin, adiponectin, and C reactive protein were assayed. RESULTS: Sixty-two women were enrolled, 25 used CSP (0 indigenous; 25 mestizos) and 37 used SCI (18 indigenous; 19 mestizos). Clinical symptoms were relatively more frequent in the SCI group. Thirty-four contraceptive users gained weight without other clinical significant changes. After 4 months of treatment, significant changes were found in some biochemical parameters in both treatment groups. Most were clinically irrelevant. Interestingly, the percentage of users with an abnormal atherogenic index diminished from 75% to 41.6% after follow-up. CONCLUSIONS: The CSP slightly modified the metabolic variables. Most changes were nonsignificant, whereas for SCI users changes were more evident and perhaps beneficial. Results of this attempt to evaluate the effects of contraceptives in mestizo and native-American populations show that clinical symptoms are frequent in Mexican users of CSP and SCI. Although these medications may affect some metabolic variables, these changes seem clinically irrelevant. Induction of abnormalities in other physiological pathways cannot be ruled out.

The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach.

Despite aggressive efforts to cure head and neck cancer patients, including altered fractionation and the addition of chemotherapy to radiation, locoregional recurrence remains a serious issue to face in clinical practice. Indeed, recurrent and second primary tumors occurring in previously irradiated area are common clinical challenge. Whenever possible, patients are advised to undergo salvage surgery. Nevertheless, few patients are suitable candidates for curative resection. In such cases, chemotherapy alone has traditionally been considered, with a poor response rate. It has been questioned whether re-irradiation toxicity outweighs the potential benefits, considering that the median survival of re-irradiated patients marginally exceeds the benefits observed with chemotherapy alone. However, full-dose re-irradiation is a viable treatment option, offering long-term survival for selected patients. Moreover, several prognostic factors should be considered for patients undergoing re-irradiation, such as basic patient characteristics, performance status, the location and extension of recurrent disease, patient co-morbidities, current speech and swallowing function, the interval from the initial radiation therapy to recurrence, previously received doses by critical structures and prior treatment toxicity. Nevertheless, several questions remain unanswered. The purpose of this review is to evaluate the major issues in the field of re-irradiation regarding the current evidence. Therefore, the major selection criteria and new treatment strategies are discussed to define the ideal candidates to undergo re-irradiation and describe a practical approach to these patients. Given the limited evidence in this field, the optimal treatment of recurrent and second primary cancers remains to be defined. Future prospective study of this approach is warranted.

[Variations in Posner's test for diagnosis of dissociated strabismus]. / Variantes de la maniobra de Posner para el diagnóstico del estrabismo disociado.

BACKGROUND: A particular feature of dissociated strabismus is that the frequency of presentation and its magnitude is variable. It is common to find that in certain examinations is very obvious, and in others not so much. To facilitate exploration some maneuvers are described: Bielchowsky's maneuver, Bielchowsky's phenomenon and Posner test. OBJECTIVE: to compare the presence and magnitude of the ocular movement in dissociated strabismus in Posner's Test using opaque versus translucent occluders. METHODS: Prospective, transversal, descriptive study. Patients with diagnosis of were included. Posner's test in two ways: 1) With opaque occluders, and 2) with translucent occluders was perforned. RESULTS: Ninety-five percent of the patients presented horizontal deviation. Posner's test with opaque occluder was positive in all cases (100%). Posner's test with translucent occluders was positive in 94% of the patients (p= 8). The magnitude of the ocular movement was significantly smaller using translucent occluders than opaque occluders. (p= 0.0001). CONCLUSIONS: The Posner's test using opaque occluders was more efective to demonstrate clearly and precisely the size of the ocular movement in dissociated strabismus.

Antecedentes: una característica particular del estrabismo disociado es la variabilidad en la magnitud y en la frecuencia de presentación. En ciertas exploraciones es muy evidente y en otras no tanto. Para facilitar su exploración se han descrito algunas maniobras: de Bielchowsky, del fenómeno de Bielchowsky y la prueba de Posner. Objetivo: determinar la magnitud del movimiento ocular en el estrabismo disociado al aplicar la maniobra de Posner y comparar dos modalidades de ésta: oclusores opacos y oclusores translúcidos. Material y métodos: estudio prospectivo, transversal, descriptivo y observacional efectuado en pacientes con estrabismo disociado a quienes se realizó la maniobra diagnóstica de Posner en dos modalidades: 1) con oclusores opacos, y 2) con oclusores translúcidos. Resultados: la maniobra de Posner con oclusores opacos resultó positiva en 100% de los casos. Al utilizar oclusores translúcidos la prueba diagnóstica resultó positiva en 94% de los casos (p= 0.8). La magnitud del movimiento de recuperación fue considerablemente menor con el oclusor translúcido comparado con el oclusor opaco (p= 0.0001). Conclusión: la maniobra de Posner con oclusores opacos demostró ser más efectiva para mostrar en forma más clara y precisa la magnitud del movimiento en el estrabismo disociado al compararlo con oclusores translúcidos.

[Permanent consecutive exotropia in children treated with botulinum toxin]. / Exotropía consecutiva permanente en niños tratados con toxina botulínica.

BACKGROUND: Congenital esotropia is the most frequent type of strabismus. Botulinum toxin is a treatment option with variable results. We undertook this study to determine the frequency and associated factors with consecutive permanent esotropia in patients diagnosed with congenital esotropia treated with botulinum toxin. METHODS: A retrospective review was achieved in patients with congenital esotropia treated with botulinum toxin and who remained in esotropia after a minimal follow-up of 6 months. Pre- and postnatal background, cycloplejia, magnitude of the pre-application deviation, injected dose and number of applications were analyzed. RESULTS: A total of 84 patients were included. Of all patients,12 (14.28%) remained in consecutive esotropia (six males and six females). Age range was from 5 months to 2 years (average: 10.75 months). Initial esotropia ranged from 20-50 prism diopters (PD) with an average of 37.9 ± 9.64 PD. One patient had variability in the magnitude of the deviation prior to treatment. During the maximum follow-up, the magnitude of the esotropia was from 10 to 40 (average, SD 18 ± 8.01 PD). In five subjects a variability was observed in the magnitude of the angle of deviation by a range of 10-40 PD, and in seven subjects the deviation was stable with an average of 20 PD. Eleven subjects had some degree of psychomotor delay (91.66%) and one subject had a non-significant history. CONCLUSIONS: In patients with consecutive permanent esotropia after application of botulinum toxin, the most prevalent characteristic is neurological.

[Modification of horizontal position with unilateral tucking of inferior rectus muscle in the surgical treatment of dissociated vertical deviation]. / Modificación de la posición horizontal con el plegamiento unilateral del músculo recto inferior para el tratamiento quirúrgico de la desviación vertical disociada.

BACKGROUND: Unilateral tucking of the inferior rectus muscle is a therapeutic alternative in the surgical treatment of dissociated vertical deviation (DVD). It is usually performed in asymmetric DVD associated with monocular low vision. Adduction is a secondary action of the inferior rectus muscle. If excessive reinforcement is done, the horizontal position can be modified toward esotropia. We undertook this study to evaluate the horizontal position modification after unilateral tucking of the inferior rectus muscle. METHODS: Unilateral tucking of the inferior rectus muscle was done in 10 patients with spontaneous DVD, without horizontal surgery and poor monocular vision. Follow-up was done for 6 months. Horizontal deviation in prism diopters (PD) was measured. For statistical analysis, Mann-Whitney U test was used with a significance level of 0.05. RESULTS: Preoperatively, horizontal deviation was between 20 PD of exotropia and 10 PD of esotropia (+/-10.34 SD). Postoperatively, horizontal deviation was between 12 PD of exotropia and 15 PD of esotropia (+/-7.82 SD). Horizontal deviation was modified between 2 and 15 PD towards esotropia, on average 9.4 PD (+/-3.70 SD) ( p = 0.03). CONCLUSIONS: Monocular inferior rectus muscle reinforcement modifies the horizontal position on average 9.4 PD towards esotropia.

Modificación de la posición horizontal con el plegamiento unilateral del músculo recto inferior para el tratamiento quirúrgico de la desviación vertical disociada / Modification of horizontal position with unilateral tucking of inferior rectus muscle in the surgical treatment of dissociated vertical deviation

Introducción: La cirugía de reforzamiento unilateral del recto inferior es una alternativa terapéutica en el tratamiento quirúrgico de la desviación vertical disociada (DVD), indicada en casos de DVD muy asimétrica con mala visión monocular. Dado que el músculo recto inferior tiene como acción secundaria la aducción, al realizar un reforzamiento amplio de éste puede modificarse hacia adentro la posición horizontal. El objetivo del presente estudio fue conocer la modificación de la posición horizontal después del plegamiento monocular en U del músculo recto inferior del ojo con mala visión. Material y métodos: Se realizó plegamiento del recto inferior monocular en 10 pacientes con DVD espontánea, sin cirugía horizontal y mala visión monocular; se llevó a cabo seguimiento mínimo de seis meses. Se cuantificó la magnitud de la desviación horizontal en dioptrías prismáticas (dp) en el pre y posoperatorio. El análisis estadístico se realizó con U de Mann- Whitney, con nivel de significancia de 0.05. Resultados: La desviación preoperatoria osciló entre 20 dp de exotropía y 10 dp de endotropía (± 10.34); en el posoperatorio, de 12 dp de exotropía a 15 dp de endotropía (± 7.82). La posición horizontal se modificó entre 2 y 15 dp hacia adentro, con una media de 9.4 ± 3.70 dp (p = 0.03). Conclusiones: El reforzamiento monocular del recto inferior modifica 9.4 dp en promedio la posición horizontal hacia adentro.(aU)

BACKGROUND: Unilateral tucking of the inferior rectus muscle is a therapeutic alternative in the surgical treatment of dissociated vertical deviation (DVD). It is usually performed in asymmetric DVD associated with monocular low vision. Adduction is a secondary action of the inferior rectus muscle. If excessive reinforcement is done, the horizontal position can be modified toward esotropia. We undertook this study to evaluate the horizontal position modification after unilateral tucking of the inferior rectus muscle. METHODS: Unilateral tucking of the inferior rectus muscle was done in 10 patients with spontaneous DVD, without horizontal surgery and poor monocular vision. Follow-up was done for 6 months. Horizontal deviation in prism diopters (PD) was measured. For statistical analysis, Mann-Whitney U test was used with a significance level of 0.05. RESULTS: Preoperatively, horizontal deviation was between 20 PD of exotropia and 10 PD of esotropia (+/-10.34 SD). Postoperatively, horizontal deviation was between 12 PD of exotropia and 15 PD of esotropia (+/-7.82 SD). Horizontal deviation was modified between 2 and 15 PD towards esotropia, on average 9.4 PD (+/-3.70 SD) ( p = 0.03). CONCLUSIONS: Monocular inferior rectus muscle reinforcement modifies the horizontal position on average 9.4 PD towards esotropia.

[Results with botulinum toxin in patients with esotropia and psychomotor deficit]. / Resultados con la aplicación de toxina botulínica en pacientes con endotropía y retraso psicomotor.

OBJECTIVE: We undertook this study to evaluate the results of the treatment with botulinum toxin in patients with esotropia and psychomotor delay. METHODS: Patients with esotropia and delayed psychomotor development, in rehabilitation therapy and without previous surgery were included. A complete ophthalmological and strabismological exploration was performed including cycloplegic refraction with atropine 1%. Botulinum toxin was applied under sedation in both internal recti. Results were evaluated 1 week, 1 month, 3 and 6 months and after 1 year of application. The reinjection was decided if a 25 DP esotropia or greater was obtained before 3 months of the first application. A good result was considered in patients who had 10 DP of deviation and variability <10 DP. RESULTS: Thirty two patients were included. There were 14 were women and 18 men with an age range from 5 months to 5 years (average 16.8 months). Eighteen patients had variability in the angle of deviation from 20 to 45 DP of esotropia and 14 without variability with an average of 39.12 DP. Thirteen patients were reinjected. A good result was obtained in 10 patients, fair in 17 patients and poor in 5 patients due to persistence of variability in four cases and 15 DP hypertropia in one. CONCLUSIONS: Application of botulinum toxin is a therapeutic alternative in patients with esotropia and psychomotor delay.