Identifying patient-related predictors of permanent growth hormone deficiency.

Objective: Isolated childhood growth hormone deficiency (GHD) can persist into adulthood, and re-testing at the transition period is needed to determine whether continued growth hormone therapy is indicated. Here, our objective was to identify predictors of permanent GHD. Design: Retrospective single-centre study of patients with childhood-onset GHD who were re-tested after adult height attainment. Methods: Auxological, clinical, laboratory, and MRI data throughout follow-up were collected. Results: We included 101 patients. At GH treatment initiation, age was 8.1 ± 0.4 years, height -2.25 ± 0.8, and BMI -0.27 ± 0.1 SDS. The 29 (28.7%) patients with persistent GHD had lower height SDS (-2.57 ± 0.1 vs. -2.11 ± 0.1, p<0.001) and mean GH peaks (8.4 ± 1.0 vs.13.2 ± 0.5 mIU/L, p<0.001) at GHD diagnosis; at adult height, they had lower IGF1 (232 ± 19.9 vs. 331 ± 9.1 ng/mL, p<0.001) and higher BMI SDS (-0.15 ± 0.27 vs. -0.73 ± 0.13, p<0.005). By multivariate analysis, the best predictive model included height and BMI SDS, both GH peaks, and MRI findings at diagnosis. Patients with height at diagnosis <-3 SDS had a 7.7 (95% IC 1.4-43.1, p=0.02) fold higher risk of persistent GHD after adjustment on BMI SDS. An abnormal pituitary region by MRI was the strongest single predictor (7.2 times, 95% CI 2.7-19.8) and after multivariate analysis adjustment for GH peaks and height SDS at diagnosis, the risk increased to 10.6 (1.8 - 61.3) times. Conclusions: Height <-3 SDS at GHD diagnosis and pituitary MRI abnormalities should lead to a high index of suspicion for persistent GHD.

Estudio de la variación de la inclinación de la cabeza y la evolución de la dentición - Parte I: Dentición Primaria Completa y Mixta Primera Fase / Study of the variation of the head tilt and the evolution of the dentition - Part I: Complete Primary Dentition and First Transitional Period of the Mixed Dentition Stage

Objetivo: estudiar y comparar la inclinación de la cabeza entre niños con dentición primaria completa y dentición mixta primera fase. Materiales y métodos: el estudio incluyó a 80 voluntarios entre 4 y 9 años, a quienes se les tomó una fotografía facial de perfil derecho estandarizada, en Posición Natural de Cabeza. Éstas fueron analizadas mediante software de edición de imágenes para determinar la inclinación de la cabeza de cada voluntario. Para ello, se definió un plano (plano t-ex) formado por el punto Intertrágico (t) y Exocanto (ex) y se comparó respecto a la horizontal verdadera. Los datos obtenidos fueron tabulados, clasificados en dos grupos según el tipo de dentición y analizados estadísticamente. Resultados: el promedio de inclinación del plano t-ex fue de 22,7º en el grupo de niños con dentición primaria completa y de 25,8º en el grupo de niños con dentición mixta primera fase. La diferencia entre ambos grupos fue de 3,1º, con significancia estadística (p = 0,006). Conclusión: la inclinación de la cabeza de los niños con dentición mixta primera fase es mayor en sentido antihorario, respecto a la de los niños con dentición primaria completa.

Objective: to study and compare head tilt among children with complete primary dentition and first transitional period of the mixed dentition stage. Materials and methods: the study included 80 volunteers between 4 and 9 years of age, who were taken a standardized right profile facial photograph in a Natural Head Position. These photographs were analyzed using image editing software to determine the head tilt of each volunteer. For this, a plane (plane t-ex) formed by the Intertragic point (t) and Exocanth (ex) was defined and compared with respect to the true horizontal. The data obtained were tabulated, classified into two groups according to the type of dentition and statistically analyzed. Results: the average t-ex plane inclination was 22.7º in the group of children with complete primary dentition and 25.8º in the group of children with first transitional period of the mixed dentition stage. The difference between both groups was 3.1º, with statistical significance (p = 0.006). Conclusion: the head tilt of children with first transitional period of the mixed dentition stage is greater in an anti-clockwise direction, compared to that of children with complete primary dentition.

Cronología y secuencia de erupción en el primer periodo transicional / Chronology and sequence of tooth eruption in the first transitional period

Los cambios producidos entre los 6 y 9 años de edad a nivel de crecimiento craneofacial y de desarrollo de oclusión se consideran decisivos para lograr una oclusión favorable debido a que la erupción dental determina en gran porcentaje este crecimiento, al ser un estímulo director de la formación ósea maxilar durante estas edades. Es fundamental que el odontólogo general, el odontopediatra y el ortodoncista conozcan los cambios que se dan en este periodo puesto que son las edades adecuadas para prevenir e interceptar diversas maloclusiones. El objetivo de esta revisión fue analizar la cronología y secuencia de erupción en el primer periodo transicional de la dentición mixta. En la revisión se muestra el análisis de varios estudios nacionales e internacionales para lograr un mejor entendimiento de los diversos factores que pueden modificar este proceso de erupción.

The changes that occurred in the craniofacial growth and the occlusion development between 6 and 9 years old are crucial for achieving a favorable occlusion due in a great percentage to tooth eruption, being this process a director of the stimulus in the maxillary bones during these ages. It is essential that the general dentist, pedodontist and orthodontist know the changes that occur in this period because these are the adequate ages to prevent and intercept some malocclusions. The objective of this review was to examine the timing and sequence of eruption in the first transitional period in mixed dentition. In this review, we present an analysis of several national and international studies in order to show a better understanding of the multiple factors that can modify the dental eruption process.

Efeito da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no periparto / Effect of propylene glycol, cobalt and vitamin B12 on the metabolic profile and enzymatic in Santa Inês ewes in peripartum

O presente estudo teve por objetivo avaliar a influência da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no período do periparto. Foram utilizadas 18 ovelhas prenhes, pesando em torno de 40kg. Aproximadamente 30 dias antes da data prevista para o parto foram separadas de maneira aleatória em três grupos e administrados os suplementos conforme a seguir: (G1/n=6) grupo que recebeu propileno glicol (30mL por via oral diariamente); (G2/n=6) grupo que recebeu cobalto (1mg de cloreto de cobalto a 1%, via oral diariamente) associado a vitamina B12 (2mg via intramuscular, semanalmente) e (G3/n=6) grupo controle. As amostras de sangue das ovelhas para avaliação do perfil metabólico e enzimático (glicose, β-hidroxibutirato-BHB, NEFA, proteína total, albumina, uréia, creatinina, AST, GGT, FA e CK) foram colhidas 30 dias antes da data prevista para o parto, uma semana antes (ante-parto), no parto, às 24h, 72h, 5 dias, 15 dias e 30 dias após o parto. Não foi observado cetonúria nos momentos que antecederam ao parto. A administração dos suplementos não influenciou sobre o perfil metabólico, protéico e energético, assim como não houve comprometimento hepático das ovelhas no período do periparto.(AU)

The aim of this study was to evaluate the influence of the administration of propylene glycol and cobalt associated with vitamin B12 on the metabolic profile and enzymatic activity of Santa Inês ewes in the peripartum period. A total of 18 pregnant ewes, weighing around 40kg were used. Approximately 30 days before the expected date of delivery were randomly separated into three groups and administered supplements as follows: (G1/n = 6) group received propylene glycol (30mL orally daily); (G2/n = 6) group receiving cobalt (1mg cobalt chloride 1%, orally daily) associated with vitamin B12 (2mg intramuscular weekly) and (G3/n = 6) control group. Blood samples from ewes to evaluate the enzymatic and metabolic profile (glucose, β-hydroxybutyrate, BHB, NEFA, total protein, albumin, urea, creatinine, AST, GGT, ALP and CK) were taken 30 days before the date set for delivery, one week before (ante partum), delivery at 24h, 72h, 5 days, 15 days and 30 days after delivery. ketonuria was not observed in pre partum. The administration of supplements had no effect on the metabolic profile, protein and energy, and no liver disorders was observed in peripartum.(AU)

Efeito da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no periparto / Effect of propylene glycol, cobalt and vitamin B12 on the metabolic profile and enzymatic in Santa Inês ewes in peripartum

(AU)O presente estudo teve por objetivo avaliar a influência da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no período do periparto. Foram utilizadas 18 ovelhas prenhes, pesando em torno de 40kg. Aproximadamente 30 dias antes da data prevista para o parto foram separadas de maneira aleatória em três grupos e administrados os suplementos conforme a seguir: (G1/n=6) grupo que recebeu propileno glicol (30mL por via oral diariamente); (G2/n=6) grupo que recebeu cobalto (1mg de cloreto de cobalto a 1%, via oral diariamente) associado a vitamina B12 (2mg via intramuscular, semanalmente) e (G3/n=6) grupo controle. As amostras de sangue das ovelhas para avaliação do perfil metabólico e enzimático (glicose, β-hidroxibutirato-BHB, NEFA, proteína total, albumina, uréia, creatinina, AST, GGT, FA e CK) foram colhidas 30 dias antes da data prevista para o parto, uma semana antes (ante-parto), no parto, às 24h, 72h, 5 dias, 15 dias e 30 dias após o parto. Não foi observado cetonúria nos momentos que antecederam ao parto. A administração dos suplementos não influenciou sobre o perfil metabólico, protéico e energético, assim como não houve comprometimento hepático das ovelhas no período do periparto.(AU)

The aim of this study was to evaluate the influence of the administration of propylene glycol and cobalt associated with vitamin B12 on the metabolic profile and enzymatic activity of Santa Inês ewes in the peripartum period. A total of 18 pregnant ewes, weighing around 40kg were used. Approximately 30 days before the expected date of delivery were randomly separated into three groups and administered supplements as follows: (G1/n = 6) group received propylene glycol (30mL orally daily); (G2/n = 6) group receiving cobalt (1mg cobalt chloride 1%, orally daily) associated with vitamin B12 (2mg intramuscular weekly) and (G3/n = 6) control group. Blood samples from ewes to evaluate the enzymatic and metabolic profile (glucose, β-hydroxybutyrate, BHB, NEFA, total protein, albumin, urea, creatinine, AST, GGT, ALP and CK) were taken 30 days before the date set for delivery, one week before (ante partum), delivery at 24h, 72h, 5 days, 15 days and 30 days after delivery. ketonuria was not observed in pre partum. The administration of supplements had no effect on the metabolic profile, protein and energy, and no liver disorders was observed in peripartum.(AU)