Insights from structure-activity relationships and the binding mode of peptidic α-ketoamide inhibitors of the malaria drug target subtilisin-like SUB1.

Plasmodium multi-resistance, including against artemisinin, seriously threatens malaria treatment and control. Hence, new drugs are urgently needed, ideally targeting different parasitic stages, which are not yet targeted by current drugs. The SUB1 protease is involved in both hepatic and blood stages due to its essential role in the egress of parasites from host cells, and, as potential new target, it would meet the above criteria. We report here the synthesis as well as the biological and structural evaluation of substrate-based α-ketoamide SUB1 pseudopeptidic inhibitors encompassing positions P4-P2'. By individually substituting each position of the reference compound 1 (MAM-117, Ac-Ile-Thr-Ala-AlaCO-Asp-Glu (Oall)-NH2), we better characterized the structural determinants for SUB1 binding. We first identified compound 8 with IC50 values of 50 and 570 nM against Pv- and PfSUB1, respectively (about 3.5-fold higher potency compared to 1). Compound 8 inhibited P. falciparum merozoite egress in culture by 37% at 100 µM. By increasing the overall hydrophobicity of the compounds, we could improve the PfSUB1 inhibition level and antiparasitic activity, as shown with compound 40 (IC50 values of 12 and 10 nM against Pv- and PfSUB1, respectively, IC50 value of 23 µM on P. falciparum merozoite egress). We also found that 8 was highly selective towards SUB1 over three mammalian serine peptidases, supporting the promising value of this compound. Finally, several crystal 3D-structures of SUB1-inhibitor complexes, including with 8, were solved at high resolution to decipher the binding mode of these compounds.

Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study.

BACKGROUND: Surgeons are increasingly using larger femoral head sizes in total hip arthroplasty (THA) to improve stability and reduce the rate of dislocation, 1 of the leading causes of revision surgery. Large ceramic head sizes up to 48 mm can now be used with monoblock acetabular components. National registries have shown promising results at short-term with large diameter ceramic-on-ceramic THA, with very low revision rates.This study reports on the average 3-year follow up of a press-fit monoblock large diameter acetabular shell with a pre-assembled ceramic liner, with emphasis on the radiographic outcome, complications related to the implantation of the cup, and the patient's clinical outcome. METHODS: 170 hips in 169 patients were reviewed at an average 38 ± 5.8 months following surgery. RESULTS: The radiographic review revealed no acetabular cup loosening, no osteolysis and no cup migration. 1 acetabular cup was revised for malposition. The patient clinical outcome and the satisfaction rate were excellent. At 3 years, 7.1% of patients complained of groin pain and 3.5% spontaneously reported hip joint generated noise. 1 patient sustained a non-recurrent traumatic hip dislocation 2 years post surgery. CONCLUSIONS: New technology should be introduced cautiously on the market. This is especially true for the large diameter ceramic monoblock acetabular component used in this study since it involves a new acetabular component design. At short term, we have not identified new modes of failure with this implant. Longer follow-up is still needed to assess the safety of large ceramic bearing in THA.

Extracellular vesicles released by J774A.1 macrophages reduce the bacterial load in macrophages and in an experimental mouse model of tuberculosis.

BACKGROUND: Tuberculosis is the leading cause of death by an infectious microorganism worldwide. Conventional treatment lasts at least six months and has adverse effects; therefore, it is important to find therapeutic alternatives that reduce the bacterial load and may reduce the treatment duration. The immune response against tuberculosis can be modulated by several mechanisms, including extracellular vesicles (EVs), which are nano-sized membrane-bound structures that constitute an efficient communication mechanism among immune cells. METHODS: The EVs released by the J774A.1 mouse macrophage cell line, both spontaneously (S-EV) and after infection with Mycobacterium tuberculosis H37Rv (Mtb-EV), were purified by ultra-centrifugation and size-exclusion chromatography. The size distribution and chemical composition of these EVs were evaluated, and their effect on the bacterial load and the production of cytokines was determined in both in vitro and in vivo models of M. tuberculosis infection. RESULTS: Mtb-EV are larger than S-EV, they contain M. tuberculosis-specific antigens (not detected in EVs released from M. fortuitum-infected J774A.1 cells) and are rich in phosphatidylserine, present in their outer membrane layer. S-EV, but not Mtb-EV, reduced the bacterial load and the production of MCP-1 and TNF-α in M. tuberculosis-infected macrophages, and these effects were reversed when phosphatidylserine was blocked with annexin V. Both S-EV and Mtb-EV significantly reduced the lung bacterial load in mice infected with M. tuberculosis after 60 days of treatment, but they had no effect on survival or on the lung pneumonic area of these mice. CONCLUSION: J774A.1 macrophages infected with M. tuberculosis H37Rv released EVs that differed in size and phosphatidylserine content from spontaneously released EVs, and these EVs also had different biological effects: S-EV reduced the mycobacterial load and the cytokine production in vitro (through a phosphatidylserine-dependent mechanism), while both EVs reduced the lung bacterial load in vivo. These results are the basis for further experiments to evaluate whether EVs improve the efficiency of the conventional treatment for tuberculosis.

Extracellular Vesicles Released from Mycobacterium tuberculosis-Infected Neutrophils Promote Macrophage Autophagy and Decrease Intracellular Mycobacterial Survival.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis (Mtb). In the lungs, macrophages and neutrophils are the first immune cells that have contact with the infecting mycobacteria. Neutrophils are phagocytic cells that kill microorganisms through several mechanisms, which include the lytic enzymes and antimicrobial peptides that are found in their lysosomes, and the production of reactive oxygen species. Neutrophils also release extracellular vesicles (EVs) (100-1,000 nm in diameter) to the extracellular milieu; these EVs consist of a lipid bilayer surrounding a hydrophilic core and participate in intercellular communication. We previously demonstrated that human neutrophils infected in vitro with Mtb H37Rv release EVs (EV-TB), but the effect of these EVs on other cells relevant for the control of Mtb infection, such as macrophages, has not been completely analyzed. In this study, we characterized the EVs produced by non-stimulated human neutrophils (EV-NS), and the EVs produced by neutrophils stimulated with an activator (PMA), a peptide derived from bacterial proteins (fMLF) or Mtb, and observed that the four EVs differed in their size. Ligands for toll-like receptor (TLR) 2/6 were detected in EV-TB, and these EVs favored a modest increase in the expression of the co-stimulatory molecules CD80, a higher expression of CD86, and the production of higher amounts of TNF-α and IL-6, and of lower amounts of TGF-ß, in autologous human macrophages, compared with the other EVs. EV-TB reduced the amount of intracellular Mtb in macrophages, and increased superoxide anion production in these cells. TLR2/6 ligation and superoxide anion production are known inducers of autophagy; accordingly, we found that EV-TB induced higher expression of the autophagy-related marker LC3-II in macrophages, and the co-localization of LC3-II with Mtb inside infected macrophages. The intracellular mycobacterial load increased when autophagy was inhibited with wortmannin in these cells. In conclusion, our results demonstrate that neutrophils produce different EVs in response to diverse activators, and that EV-TB activate macrophages and promote the clearance of intracellular Mtb through early superoxide anion production and autophagy induction, which is a novel role for neutrophil-derived EVs in the immune response to Mtb.

Miocardiopatía puerperal: Reporte de un caso / Peripartum cardiomyopathy: Report of a case / Cardiomiopatia puerperal: relatório de umcaso

Resumen: Es una entidad poco frecuente, la incidencia en Uruguay es de 1/3000 a 1/4000, Haití 1/300 y Estados Unidos 1/5000 recién nacidos vivos. Presentamos el caso clínico de una paciente de 40 años que comienza a dos meses del parto con elementos de falla cardíaca global, confirmándose una cardiopatía dilatada con disminución de la fracción eyección. Se realizó tratamiento médico con buena evolución clínica, tal cual sucede en el 50% de los casos de esta patología.

Abstract: It is a rare entity, the incidence in Uruguay is 1/3000 to 1/4000, Haiti 1/300 and the United States 1/5000 live births. We report the clinical case of a 40-year-old female patient who started two months of delivery with elements of global heart failure, confirming dilated heart disease with decreased ejection fraction. Medical treatment was performed with good clinical evolution, as it happens in 50% of the cases of this pathology.

Resumo: É umaentidade rara, a incidência no Uruguai é 1/3000 a 1/4000, Haiti 1/300 e os Estados Unidos 1/5000 nascidos vivos. Relatamos o caso clínico de uma paciente do sexo feminino de 40 anos que inicioudois meses de parto com elementos de insuficiência cardíaca global, confirmando a doença cardíaca dilatada comdiminuição da fração de ejeção. O tratamento médico foi realizado com boa evolução clínica, como acontece em 50% dos casos destapatologia.

Molecular Basis of Membrane Association by the Phosphatidylinositol Mannosyltransferase PimA Enzyme from Mycobacteria.

Phosphatidyl-myo-inositol mannosyltransferase A (PimA) is an essential glycosyltransferase that initiates the biosynthetic pathway of phosphatidyl-myo-inositol mannoside, lipomannan, and lipoarabinomannan, which are key glycolipids/lipoglycans of the mycobacterial cell envelope. PimA belongs to a large family of membrane-associated glycosyltransferases for which the understanding of the molecular mechanism and conformational changes that govern substrate/membrane recognition and catalysis remains a major challenge. Here, we determined that PimA preferentially binds to negatively charged phosphatidyl-myo-inositol substrate and non-substrate membrane model systems (small unilamellar vesicle) through its N-terminal domain, inducing an important structural reorganization of anionic phospholipids. By using a combination of single-point mutagenesis, circular dichroism, and a variety of fluorescence spectroscopy techniques, we determined that this interaction is mainly mediated by an amphipathic α-helix (α2), which undergoes a substantial conformational change and localizes in the vicinity of the negatively charged lipid headgroups and the very first carbon atoms of the acyl chains, at the PimA-phospholipid interface. Interestingly, a flexible region within the N-terminal domain, which undergoes ß-strand-to-α-helix and α-helix-to-ß-strand transitions during catalysis, interacts with anionic phospholipids; however, the effect is markedly less pronounced to that observed for the amphipathic α2, likely reflecting structural plasticity/variability. Altogether, we propose a model in which conformational transitions observed in PimA might reflect a molten globule state that confers to PimA, a higher affinity toward the dynamic and highly fluctuating lipid bilayer.

Tooth microstructure and feeding biology of the brittle star Ophioplocus januarii (Echinodermata: Ophiuroidea) from northern Patagonia, Argentina / Microestructura dental y biología alimentaria del Ophioplocus januarii (Echinodermata: Ophiuroidea) del norte de Patagonia, Argentina

Abstract Ophioplocus januarii is a common brittle star on soft and hard substrates along the Argentinian and Brazilian coasts. Based on stomach contents, tooth microstructure and field observations we identified its food. Opposed to previous suggestions, O. januarii appears to be a microphagous species feeding on macroalgal fragments (found in 60.0 % of the analyzed stomachs with content), plant debris (28.0 %), animal cuticle structures (13.0 %), and unidentifiable material (30.7 %). Less frequent items found were foraminiferans, ostracods, an amphipod, a juvenile bivalve, and other crustaceans. Electronic microscope revealed digested material, diatoms and small crustacean appendices. Thus, O. januarii is an omnivorous species, feeding mainly on algae, complemented opportunistically with other items. Suspension feeding was observed in the field. It has an fenestrated arrangement intermediate between the previously described uniform and compound teeth. Rev. Biol. Trop. 63 (Suppl. 2): 353-360. Epub 2015 June 01.

Resumen El ofiuroideo Ophioplocus januarii se distribuye a lo largo de las costas de Argentina y Brasil, encontrándose tanto en substratos duros como blandos. En base al análisis de contenidos estomacales y la microestructura de los dientes, junto a observaciones de campo, se describe el comportamiento alimentario de esta especie. Opuesto a suposiciones previas, O. januarii es una especie micrófaga que se alimenta de fragmentos de macroalgas (encontrados en el 60.0 % de los estómagos analizados que presentaban contenido), detritos vegetales (28.0 %), estructuras cuticulares animales (13.0 %) y material inidentificable (30.7 %). Menos frecuente, se encontraron foraminíferos, ostrácodos, un anfípodo, un bivalvo juvenil y otros crustáceos. Pequeñas porciones del material inidentificable fueron analizadas en el microscopio electrónico de barrido, resultando ser material digerido, diatomeas y pequeños apéndices de crustáceos. Así, O. januarii es una especie omnívora, que se alimenta principalmente de algas, complementando su dieta de manera oportunista con otros ítems. Las observaciones de campo revelaron alimentación suspensívora. El análisis de la microestructura del estereoma del diente resultó en un arreglo del tipo fenestrado intermedio, que se encuentra entre los dos tipos de arreglos descriptos hasta ahora, los dientes de tipo uniforme y los compuestos. De estos últimos, el primero ha sido encontrado en especies macrófagas mientras que el segundo se corresponde a ofiuroideos micrófagos. En el presente trabajo, se propone la existencia de un nuevo tipo de arreglo intermedio en la matriz dental de los ofiuroideos.

Echinoderm diversity in the Southwestern Atlantic / Diversidad de equinodermos del Atlántico suroccidental

Abstract Studies of biodiversity of echinoderms from South America have increased in recent years. Here we summarize sampling done on three expeditions along the Argentinean coast (35º - 55º S) and near the Antarctic Peninsula. The first campaign, Mejillón II (M-II; 2009), was carried out between 35º - 39º S and covered a depth range between 10 to 140 m. The second was part of the Summer Antarctic Campaign 2011 (CAV-III; 2011) that took place around the Antarctic Peninsula, South Shetland and South Orkney Islands (depth range between 67 to 754 m). The last cruise was the final stretch of the Summer Antarctic Campaign 2011 (CAV-IV; 2011), from 39º - 55º S and between 30 - 140 m depth. As result, 74 stations have been studied, of which 68 had at least one echinoderm specimen. From the total number of stations, the occurrence percentages for each class were Asteroidea (68 %), Echinoidea (64 %), Ophiuroidea (55 %), Holothuroidea (51 %) and Crinoidea (20 %). In the M-II campaign, echinoderms were presented in 94 % of the sampled stations, with Echinoidea most frequent (74 %). In the CAV-III campaign echinoderms were presented in all the stations; Ophiuroidea were found in all stations. The lowest occurrence of echinoderms was found in the CAV-IV campaign (82 %), where Asteroidea was present in the 73 % of the samples, and crinoids were absent. Rev. Biol. Trop. 63 (Suppl. 2): 115-120. Epub 2015 June 01.

Resumen En los últimos años se han incrementado los estudios sobre la biodiversidad de equinodermos de Latinoamérica. En el presente trabajo, se exponen los resultados sobre muestras obtenidas en tres expediciones a lo largo de la costa argentina (35 - 55º S) y cerca de la Península Antártica. La primera campaña analizada, Mejillón II (M-II; 2009), se llevó acabo entre 35º - 39º S cubriendo profundidades entre 10 y 140 m. La segunda, parte de la Campaña Antártica de Verano 2011 (CAV-III; 2011), tuvo lugar en el área de la Península Antártica, Shetland del Sur e islas Orcadas del Sur (profundidad entre 67 hasta 754 m). La última expedición analizada en este trabajo fue el último tramo de la Campaña Antártica de Verano (CAV-IV; 2011) desde 39º - 55º S y entre 30 - 140 m de profundidad. Como resultado, 74 estaciones fueron estudiadas, en las cuales en 68 se encontró al menos un espécimen del Phylum Echinodermata. Considerando todas las estaciones, el porcentaje de encuentro para cada clase fue Asteroidea (68 %), Echinoidea (64 %), Ophiuroidea (55 %), Holothuroidea (51 %) and Crinoidea (20 %). En la campaña M-II, los equinodermos estuvieron presentes en el 94 % de las estaciones muestreadas, siendo Echinoidea el más frecuente (74 %). En relación a la Campaña CAV-III, los equinodermos estuvieron presentes en todas las estaciones muestreadas; Ophiuroidea fue la clase más representativa en número de estaciones (100 %). El valor más bajo de aparición de equinodermos fue encontrado en la campaña CAV-IV (82 %), donde Asteroidea estuvo presente en el 73 % de las muestras, y los crinoideos estuvieron ausentes.

Transportadores de lípidos biliares: una revisión actualizada / Biliary lipids transporters: an update review

Las sales biliares, colesterol y fosfatidilcolina son los lípidos más importantes de la bilis; su transporte está regulado por una red compleja de proteínas de las familias Casete de Unión a ATP y transportadora de solutos. Los transportadores de lípidos biliares son proteínas que intervienen en la fisiopatología de numerosas enfermedades del sistema gastrointestinal, por lo tanto, son importantes moléculas de estudio y en un futuro pueden ser nuevas dianas terapéuticas que eviten la prevalencia de enfermedades como hipercolesterolemia, cálculos biliares, colestasis, trastornos de la bilirrubina, entre otras. La presente revisión hace una evaluación actualizada sobre la función específica de los transportadores de lípidos biliares, su regulación genética e implicación fisiopatológica

Bile salts, cholesterol and phosphatidylcholine are the major lipids of bile; its secretion is regulated by an elaborate network of family proteins such as ATP Binding Cassette and the Solute Carrier. Biliary lipids transporters are proteins involved in physiopathology of many diseases of gastrointestinal system, therefore it are important molecules of study and the future it may be new therapeutic targets to prevent the prevalence of diseases, such as hypercholesterolemia, gallstones, cholestasis, bilirubin disorders among other. This review makes a current evaluation on the specific role of biliary lipids transporters, its genetic regulation and physiopathological implications

Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results.

PURPOSE: Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention. METHODS: In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment. RESULTS: After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%. CONCLUSIONS: Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.

Common variants on 9q22.33 and 14q13.3 predispose to thyroid cancer in European populations.

In order to search for sequence variants conferring risk of thyroid cancer we conducted a genome-wide association study in 192 and 37,196 Icelandic cases and controls, respectively, followed by a replication study in individuals of European descent. Here we show that two common variants, located on 9q22.33 and 14q13.3, are associated with the disease. Overall, the strongest association signals were observed for rs965513 on 9q22.33 (OR = 1.75; P = 1.7 x 10(-27)) and rs944289 on 14q13.3 (OR = 1.37; P = 2.0 x 10(-9)). The gene nearest to the 9q22.33 locus is FOXE1 (TTF2) and NKX2-1 (TTF1) is among the genes located at the 14q13.3 locus. Both variants contribute to an increased risk of both papillary and follicular thyroid cancer. Approximately 3.7% of individuals are homozygous for both variants, and their estimated risk of thyroid cancer is 5.7-fold greater than that of noncarriers. In a study on a large sample set from the general population, both risk alleles are associated with low concentrations of thyroid stimulating hormone (TSH), and the 9q22.33 allele is associated with low concentration of thyroxin (T(4)) and high concentration of triiodothyronine (T(3)).

Local full-thickness excision as first line treatment for sessile rectal adenomas: long-term results.

OBJECTIVE: Removing rectal adenomas not only relieves symptoms, but also eradicates the incidence of carcinoma. There are many techniques for local removal of rectal polyps. Transanal endoscopic microsurgery (TEM) is the most recent. The purpose of this study is to present our long-term results using TEM for rectal adenomas, paying special attention to the risk factors of harboring a malignancy. METHODS: Data from all patients undergoing TEM from December 1995 to December 2005 were collected prospectively. The selection criteria were benign sessile adenomas below the peritoneal reflection. In the study period, 173 patients were operated on for an apparently benign rectal adenoma. The mean distance of lower tumor was 7.6 cm (range, 1-18 cm), and the mean distance to upper edge was 11 cm (2-20 cm). Full-thickness local excision was performed in all procedures. Patients were followed for a minimum of 1 year. RESULTS: According to the histologic findings, 14% of the specimens were invasive carcinomas. No statistical differences were found when comparing the histologic findings by tumor size, distance to the anal verge, or location.In 10 (5.8%) cases, the dissection was considered uncompleted because of a normal mucosa margin smaller than 1 mm. The mean hospital stay was 4 days (2-30 days). The morbidity rate was 14.5%. There was 1 postoperative death (0.6%). There were 9 (5.4%) histologically proven recurrences. Four of the patients with recurrence had uncompleted microscopic circumferential resection (P = 0.001). At a mean follow-up of 35 months (range, 12-82 months), all carcinoma patients were alive with no evidence of disease. CONCLUSIONS: In conclusion, a significant number of adenomas that we assumed preoperatively to be benign were already carcinomas and we were unable to find any reliable predictor to identify them. TEM full-thickness excision provided a low rate of postoperative morbidity and potentially avoided a significant number of major abdominal operations and local recurrences.

Postoperative morbidity of biliopancreatic diversion depending on common limb length.

BACKGROUND: Laparoscopic gastric bypass, currently the most popular surgical method for bariatric therapy, have proved to be effective in weight loss, but some matters regarding its long-term efficacy for super-obese patients (BMI >50 kg/m2) have arisen. Biliopancreatic diversion (BPD) is a complex technique that has shown good results in the treatment of the super-obese patient. We analyze our >5 years results, evaluating weight loss, morbidity and mortality of this operation, depending on the length of the common and alimentary limbs. METHODS: We studied two series of patients: 150 patients with BPD of Scopinaro (50-200 cm) and 70 patients with modified BPD (75-225 cm). The results have been analyzed in terms of weight loss, co-morbidity improvement, and postoperative morbidity using BAROS. RESULTS: Range of follow-up is 1-12 years. Weight loss was slightly higher for the Scopinaro group than for the Modified group but with no significant difference. There was more prevalence of malnutrition and of iron deficiency in the Scopinaro group (16% and 60%) than in the modified group (2% and 40%), with similar postoperative morbidities. CONCLUSION: The modified BPD method (75-225 cm) shows long-term effectiveness in weight loss and comorbidity improvement for super-obesity. Proteins, vitamins and oligoelement deficits appear distant in time, and thus it is necessary to maintain strict followup of these patients and supplement against deficiencies for the rest of their lives.

Síndrome de Marine-Lenhart: etiopatogenia, clasificación, clínica y diagnóstico / Marine-Lenhart: pathogenesis, clinical classification and diagnosis

OBJETIVOS: Determinar la incidencia del síndrome de Marine-Lenhart (SML) en una serie homogénea de tiroidectomías, estudiar su epidemiología, clínica y los medios diagnósticos adecuados, comparándolos con los pacientes afectos de síndrome de Plummer (SP), para establecer diferencias etiopatogénicas y clínicas entre ambas entidades. MATERIALES Y MÉTODOS: De la serie previamente reportada de hipertiroidismos, estudiamos a los pacientes con SMI- (definido como hipertiroidismo difuso con 1 ó más nódulos captantes, con o sin uno o más nódulos fríos), describiéndose características epidemiológicas, clínicas y morbilidad postoperatoria, comparándolas con las de un grupo de pacientes con SP. RESULTADOS: El SML representó el 1,2 por ciento de todas las tiroidopatías y 4,3 por ciento de los hipertiroidismos estudiados. La edad de los pacientes, el tiempo de evolución y el peso de la glándula fueron significativamente diferentes entre SML y SP. Las manifestaciones clínicas del SML se expresaron en 66 por ciento de los pacientes, por síntomas compresivos y, en casi todos ellos, por signos y síntomas funcionales asociados. En cuatro pacientes se detectó exoftalmos, y en un caso un carcinoma. La Tiroidectomía Total presentó una morbilidad paratiroidea y recurrencial similar a la Subtotal. CONCLUSIONES: El SML tiene un tiempo de evolución más prolongado, se manifiesta principalmente en la forma de síndrome compresivo, tiene más posibilidades de producir exoftalmos y su manejo con tiroidectomía subtotal es el ideal.

Valores normales de la hormona estimulante de la tiroides en el recién nacido sano / The levels normals of the stimulate thyroid hormone in newborns

Se estudió la concentración de la hormona estimulante de la glándula tiroides (TSH) en muestras de sangre del condón umbilical y de la sangre capilar obtenida de neonatos entre las 18 y 24 horas de vida. En 90 por ciento de 121 muestras de sangre del condón umbilical, la TSH fue menor de 30 uUI/ml. De las 49 muestras de sangre capilar, la TSH estuvo por debajo de 24 uUI/ml. Un niño tuvo 47.13 uUI/ml en muestra de sangre capilar, cifra arriba de dos desviaciones estándar de la media; al mes de nacido se le determinó la T3, la T4 y la TSH, y los resultados fueron normales. No se encontraron diferencias estadísticamente significativas entre las concentraciones de la TSH de las muestras tomadas del condón umbilical y de la sangre capilar. Se comenta la importancia de los programas de investigación masiva de hipotiroidismo congénito, así como la necesidad de implantarlos en nuestro país.