Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis.

Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.

Comparative efficiency of different methods of gluten extraction in indigenous varieties of wheat / Eficacia comparativa de diferentes métodos de extracción de gluten en variedades autóctonas de trigo

The present study investigated six varieties of locally grown wheat (Lasani, Sehar, Miraj-08, Chakwal-50, Faisalabad-08 and Inqlab) procured from Punjab Seed Corporation, Lahore, Pakistan for their proximate contents. On the basis of protein content and ready availability, Faisalabad-08 (FD-08) was selected to be used for the assessment of comparative efficiency of various methods used for gluten extraction. Three methods, mechanical, chemical and microbiological were used for the extraction of gluten from FD-08. Each method was carried out under ambient conditions using a drying temperature of 55°C. Mechanical method utilized four different processes viz:- dough process, dough batter process, batter process and ethanol washing process using standard 150 mesh. The starch thus obtained was analyzed for its proximate contents. Dough batter process proved to be the most efficient mechanical method and was further investigated using 200 and 300 mesh. Gluten content was determined using sandwich ω-gliadin enzyme-linked immunosorbent assay (ELISA).The results of dough batter process using 200 mesh indicated a starch product with gluten content of 678 ppm. Chemical method indicated high gluten content of more than 5000 ppm and the microbiological method reduced the gluten content from 2500 ppm to 398 ppm. From the results it was observed that no gluten extraction method is viable to produce starch which can fulfill the criteria of a gluten free product (20ppm).

El presente roduc seis variedades de trigo cultivado localmente (Lasani, Sehar, Miraj-08, Chakwal-50, Faisalabad-08 e Inqlab) obtenidos por sus contenidos proximales en Punjab Seed Corporation, Lahore, Pakistán. Sobre la base del contenido de roduct y su fácil disponibilidad, Faisalabad-08 (Fd-08) fue seleccionado para ser utilizado para la evaluación de la eficacia comparadativa de los diferentes métodos utilizados para la extracción de gluten. Tres métodos fueron utilizados para la extracción de gluten; mecánico, químico y microbiológico realizados en condiciones ambientales utilizando una roduct e de secado de 55°C. El método mecánico roduct cuatro procesos diferentes, a saber: proceso de masa, proceso de rebozado de masa, proceso de pasta y proceso de lavado en etanol empleando malla estándar de 150 mesh. El almidón obtenido se analizó por sus contenidos proximales. El contenido de gluten se roduct usando roduct ω-gliadina, ensayo de inmunoabsorción ligado a enzimas (ELISA). El proceso de rebozado de masa fue el método roduct más eficiente y se investigó adicionalmente usando malla 200 y 300 mesh. El proceso de rebozado de masa usando malla 200 generó un almidón con contenido de gluten de 678 ppm. El método químico produjo un contenido de gluten de más de 5.000 ppm, y el método microbiológico redujo el contenido de gluten de 2500 ppm a 398 ppm. A partir de estos resultados se roduct que ningún de estos métodos de extracción de gluten fue es viable para roduct almidón que pueda cumplir los criterios de un roduct libre de gluten (20 ppm).