[Iodine deficiency and pregnancy. Current situation]. / Embarazo y déficit de yodo. Situación actual.

OBJECTIVE: Several studies performed in Spain have reported iodine deficiency in pregnant women but data from Valencia are lacking. The aim of the present study was to determine the degree of implantation of iodine supplementation in pregnant women in our health area. PATIENTS AND METHOD: A total of 232 pregnant women were studied in the first trimester of pregnancy. Thyroid-stimulating hormone (TSH), free thyroxine, and antiperoxidase antibodies were measured. A survey was performed on intake of iodized salt and pharmacological iodine supplements. Neonatal TSH concentrations were measured, based on screening of metabolopathies, in the newborns of participating women. RESULTS: Then mean age was 30.5+/-4.4 years. A total of 60.8% of the women consumed iodized salt, 51.3% took iodine polyvitamins and only 14.2% consumed potassium iodide. The median urinary iodine concentration was 100 microg/l; 66% had urinary iodine concentrations below the recommended level (150 microg/l). A positive association was found between pharmacological iodine intake and urinary iodine (p=0.016). Ten percent of the women had mild hypothyroxinemia, while 5.7% of the newborns had elevated TSH levels. CONCLUSIONS: Iodine intake in pregnant women in our health area is low, despite current recommendations. Our data support the need to promote the use of iodized salt in every home and to systematically administer potassium iodide supplements in all pregnant women.

Active post-marketing surveillance of the intralesional administration of human recombinant epidermal growth factor in diabetic foot ulcers

Background: After several exploratory and confirmatory clinical trials, the intralesional administration of human recombinant epidermal growth factor (hrEGF) has been approved for the treatment of advanced diabetic foot ulcers (DFU). The aim of this work was to evaluate the effectiveness and safety of this procedure in medical practice.Methods: A prospective, post-marketing active pharmacosurveillance was conducted in 41 hospitals and 19 primary care polyclinics. Patients with DFU received hrEGF, 25 or 75 μg, intralesionally 3 times per week until complete granulation of the ulcer or 8 weeks maximum, adjuvant to standard wound care. Outcomes measured were complete granulation, amputations, and adverse events (AE) during treatment; complete lesion re-epithelization and relapses in follow-up (median: 1.2; maximum 4.2 years). Results: The study included 1788 patients with 1835 DFU (81 porcent Wagners grades 3 or 4; 43 porcentischemic) treated from May 2007 to April 2010. Complete granulation was observed in 76 porcent of the ulcers in 5 weeks (median). Ulcer non-ischemic etiology (OR: 3.6; 95 porcent CI: 2.8-4.7) and age (1.02; 1.01-1.03, for each younger year) were the main variables with influence on this outcome. During treatment, 220 (12 porcent) amputations (171 major) were required in 214 patients, mostly in ischemic or Wagners grade 3 to 5ulcers. Re-epithelization was documented in 61 porcent of the 1659 followed-up cases; 5 porcent relapsed per year. AE (4171) were reported in 47 porcent of the subjects. Mild or moderate local pain and burning sensation, shivering and chills, were 87 porcent of the events. Serious events, not related to treatment, occurred in 1.7 porcent of the patients. Conclusions: The favorable benefit/risk balance, confirms the beneficial clinical profile of intralesionalhrEGF in the treatment of DFUs(AU)

Embarazo y déficit de yodo. Situación actual / Iodine deficiency and pregnancy. Current situation

Objetivo: diversos estudios realizados en España demuestran una ingesta deficiente de yodo en gestantes, pero no hay datos de la Comunidad Valenciana. Se busca conocer el grado de implantación de la toma de suplementos de yodo en gestantes de nuestra área sanitaria. Pacientes y método: Se ha estudiado a 232 mujeres en el primer trimestre de embarazo. Se midió tirotropina (TSH), tiroxina libre (T4l), anticuerpos antiperoxidasa y yoduria, y se encuestó sobre consumo de sal yodada y suplementos farmacológicos de yodo. Se recogió el valor de la TSH neonatal del cribado de metabolopatías en los recién nacidos de las mujeres participantes. Resultados: la media de edad fue 30,5 ± 4,4 años. el 60,8% consumía sal yodada, el 51,3% tomaba polivitamínico con yodo, y sólo el 14,2% tomaba yoduro potásico. la mediana de las yodurias fue de 100 µg/l. el 66% tenía yodurias por debajo de la recomendada (150 µg/l). la relación entre ingesta farmacológica de yodo y yoduria fue positiva y significativa (p = 0,016). Presentaron una hipotiroxinemia leve el 10% de las mujeres. el 5,7% de los recién nacidos tenían una TSH elevada. Conclusiones: la ingesta de yodo de nuestras gestantes es baja, a pesar de las recomendaciones vigentes. los datos respaldan la necesidad de potenciar el uso de sal yodada en todos los hogares y administrar sistemáticamente un suplemento con yoduro potásico a toda mujer embarazada (AU)

Objective: Several studies performed in Spain have reported iodine deficiency in pregnant women but data from Valencia are lacking. The aim of the present study was to determine the degree of implantation of iodine supplementation in pregnant women in our health area. Patients and method: A total of 232 pregnant women were studied in the first trimester of pregnancy. Thyroid-stimulating hormone (TSH), free thyroxine, and antiperoxidase antibodies were measured. A survey was performed on intake of iodized salt and pharmacological iodine supplements. Neonatal TSH concentrations were measured, based on screening of metabolopathies, in the newborns of participating women. Results: Then mean age was 30.5 ± 4.4 years. A total of 60.8% of the women consumed iodized salt, 51.3% took iodine polyvitamins and only 14.2% consumed potassium iodide. The median urinary iodine concentration was 100 µg/l; 66% had urinary iodine concentrations below the recommended level (150 µg/l). A positive association was found between pharmacological iodine intake and urinary iodine (p = 0.016). Ten percent of the women had mild hypothyroxinemia, while 5.7% of the newborns had elevated TSH levels. Conclusions: Iodine intake in pregnant women in our health area is low, despite current recommendations. Our data support the need to promote the use of iodized salt in every home and to systematically administer potassium iodide supplements in all pregnant women (AU)

Cetoacidosis derivada del mal empleo de la pluma precargada de insulina detemir / Diabetic ketoacidosis due to incorrect use of insulin detemir precharged pen

Los problemas técnicos en el manejo de dispositivos subcutáneos de administración de insulina han disminuido su frecuencia desde la introducción en el mercado de las plumas precargadas de insulina. Sin embargo, todavía se deben tener presentes en el caso de pacientes con diabetes inestable o cetoacidosis diabética aparentemente idiopática. Se presenta el caso de una paciente de 37 años con diabetes mellitus tipo 1 de 12 años de evolución, con mal control metabólico por la inestabilidad de sus glucemias, que ingresó por una cetoacidosis diabética aparentemente idiopática, tras cambiar el análogo de acción retardada glargina por detemir. Posteriormente se comprobó que la paciente desconocía el sistema de aplicación de la pluma precargada de insulina detemir, lo que causó la cetoacidosis. Siempre se debe tener en cuenta esta posibilidad ante un mal control metabólico a pesar de tratamiento insulínico intensivo o ante una cetoacidosis diabética aparentemente idiopática

Technical problems associated with subcutaneous insulin administration devices have become much less frequent since the introduction of precharged insulin systems. Nevertheless, they remain a cause of unstable diabetes or idiopathic diabetic ketoacidosis. We report the case of a 37-year-old woman with type 1 diabetes mellitus of 12 years' duration and unstable metabolic control. The patient was admitted for apparent idiopathic diabetic ketoacidosis after being switched from the long-acting insulin analogue, glargine, to detemir. The patient's insulin administration technique was subsequently discovered to be incorrect, causing the diabetic ketoacidosis. This possibility should always be kept in mind in patients with unstable diabetes despite intensive insulin treatment, as well as in those with idiopathic diabetic ketoacidosis