Diagnosis, treatment, and management of gestational hypothyroidism. The TIROGEST study.

INTRODUCTION: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. STUDY DESIGN: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. RESULTS: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p=0.007) and had more frequently high TSH levels (>2.5µIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p<0.001). CONCLUSIONS: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain.

Microbiota intestinal y salud en humanos: obesidad y diabetes mellitus tipo 2 / Gut microbiota and healthy in human: obesity and type 2 diabetes mellitus

RESUMEN Introducción La cantidad y la diversidad bacteriana intestinal están relacionadas con las enfermedades metabólicas e inflamatorias. El objetivo de este trabajo fue caracterizar la composición de la microbiota intestinal en heces y su relación con variables bioquímicas y el patrón de consumo de alimentos en individuos sanos, obesos y pacientes con diabetes mellitus tipo 2, en Mallorca (España). Métodos Las bacterias en heces se caracterizaron por PCR tiempo real. El ADN se aisló a partir de sujetos sanos (23), obesos (no diabéticos) (24) y diabéticos tipo 2 (no obesos) y se amplificó con cebadores específicos para identificar Roseburia, Clostridium leptum, Lactobacillus y Clostridium coccoides-Eubacterium rectale (Firmicutes); Prevotella y Bacteroides (Bacteroidetes); Bifidobacterium (Actinobacteria) y el cebador Universal (para total de bacterias), para la amplificación de la región V4 del gen 16S rRNA. Los resultados se analizaron estadísticamente utilizando SPSS v.21. Resultados En una población rural y urbana de Baleares, se detectaron niveles de insulina significativamente superiores en obesos (12,2 + 1,3 md/dL). En diabéticos, los niveles de triglicéridos, glucosa en sangre, hemoglobina glucosilada y albúmina en orina fueron superiores que en controles y obesos (por encima del rango normal). La mayor dispersión de las variables bioquímicas en sangre se identificó con: Clostridium coccoide-Eubacterium rectale, Bacteroides y Bifidobacterium, como posibles marcadores en obesos y diabéticos y Prevotella y Lactobacillus, como marcadores de salud. El contenido total de bacterias es mayor en controles y la relación entre reinos bacterianos es menor en este grupo. Los patrones de consumo de alimentos fueron diferentes en los tres grupos lo cual está relacionado con la variación en los patrones bacterianos. Conclusión La variabilidad en el consumo de alimentos estuvo relacionada con cinco marcadores bacterianos principales que contribuyeron a la mayor variabilidad de marcadores bioquímicos entre grupos de sujetos: Clostridium coccoide-Eubacterium rectale, Bacteroides, Bifidobacterium, Prevotella y Lactobacillus, en una población de Mallorca (España). Gut microbiota and healthy in human: obesity and type 2 diabetes mellitus.

ABSTRACT Introduction The amount and bacterial diversity in the bowel are associated to metabolic and inflammatory diseases. The aim was to characterize the gut microbiota composition in faeces and food consumption pattern in healthy, obese and Type 2 diabetes mellitus subjects from Majorca (Spain). Methods Bacteria in faeces were characterized by Real-time PCR. DNA was isolated from healthy subjects (23), obese patients (not diabetic) (24) and type 2 diabetic patients (12) and amplified with specific primers for the identification of Roseburia, Clostridium leptum, Lactobacillus and Clostridium coccoides-Eubacterium rectale (Firmicutes); Prevotella and Bacteroides (Bacteroidetes); Bifidobacterium (Actinobacteria); and Universal primer (for all bacteria), referred to amplification of 16S rRNA gene V4 region. Results were statistically analyzed by SPSS v.21. Results A rural and urban population from Balearic Islands was tested. The insulin levels were highest in obese group (12.2 + 1.3 md/dL) while the triglyceride, blood glucose, glycosylated haemoglobin and urine albumin levels were highest in diabetic group. The major dispersion of the blood variables was identified to a bacteria core: Clostridium coccoide-Eubacterium rectale, Bacteroides and Bifidobacterium as possible markers for obese and diabetic patients; and Prevotella and Lactobacillus levels as markers of health. The total amount of bacteria is the highest in control group, such as the ratio between phyla is the lowest. The food consumptiom patterns were different among which is related to the variation in the bacterial patterns. Conclusion The variability in the foods consumption among groups was related to five bacterial markers which contributed to the major variability in blood markers: Clostridium coccoide-Eubacterium rectale, Bacteroides, Bifidobacterium, Prevotella y Lactobacillus; in a population from Majorca, Spain.