The thyroid hormone enhances mouse embryonic fibroblasts reprogramming to pluripotent stem cells: role of the nuclear receptor corepressor 1.

Introduction: Pluripotent stem cells can be generated from somatic cells by the Yamanaka factors Oct4, Sox2, Klf4 and c-Myc. Methods: Mouse embryonic fibroblasts (MEFs) were transduced with the Yamanaka factors and generation of induced pluripotent stem cells (iPSCs) was assessed by formation of alkaline phosphatase positive colonies, pluripotency gene expression and embryod bodies formation. Results: The thyroid hormone triiodothyronine (T3) enhances MEFs reprogramming. T3-induced iPSCs resemble embryonic stem cells in terms of the expression profile and DNA methylation pattern of pluripotency genes, and of their potential for embryod body formation and differentiation into the three major germ layers. T3 induces reprogramming even though it increases expression of the cyclin kinase inhibitors p21 and p27, which are known to oppose acquisition of pluripotency. The actions of T3 on reprogramming are mainly mediated by the thyroid hormone receptor beta and T3 can enhance iPSC generation in the absence of c-Myc. The hormone cannot replace Oct4 on reprogramming, but in the presence of T3 is possible to obtain iPSCs, although with low efficiency, without exogenous Klf4. Furthermore, depletion of the corepressor NCoR (or Nuclear Receptor Corepressor 1) reduces MEFs reprogramming in the absence of the hormone and strongly decreases iPSC generation by T3 and also by 9cis-retinoic acid, a well-known inducer of reprogramming. NCoR depletion also markedly antagonizes induction of pluripotency gene expression by both ligands. Conclusions: Inclusion of T3 on reprogramming strategies has a potential use in enhancing the generation of functional iPSCs for studies of cell plasticity, disease and regenerative medicine.

Acute liver failure secondary to malignant infiltration: A single center experience.

Acute liver failure (ALF) requires early and very precise treatment decisions for a diagnosis that is not often easy and may lead to erroneous decisions. Accordingly, we undertook a review of ALF secondary to malignant infiltration given the rarity of the condition, plus its singularity and therapeutic implications. This review should aid in establishing future frameworks for action. Analyze cases of ALF secondary to malignant infiltration in our center during the last 5 years and review the literature. We undertook a retrospective review of all cases of ALF due to malignant infiltration in our center between January 2015 and December 2019. Data were recorded on demographic characteristics, clinical presentation, type of tumor, diagnostic techniques used, treatment and evolution. We also undertook a literature review on the subject and compared the results. AFL secondary to malignant infiltration was diagnosed in five patients, four women and one man with a median age 58 years. The most common clinical presentation was jaundice. Three cases were due to infiltration by hematological tumors (non-Hodgkin lymphoma and histiocytosis), one a cholangiocarcinoma and one lung cancer. In all cases a liver biopsy was required for diagnosis, this being conclusive in four cases; diagnosis in the non-conclusive case was by analysis of the hepatectomy sample after transplantation. Three patients died due to AFL in a mean of 13.8 days, another died 5 months after diagnosis as a consequence of the tumor while the patient with a diagnosis of non-Hodgkin lymphoma and transplant recipient remains alive after a follow-up of 6 years and after receiving chemotherapy. AFL due to malignant infiltration is a very unusual condition but with a high rate of mortality. It requires a rapid and precise diagnosis given the relevant treatment options.

Plant hormesis: Revising of the concepts of biostimulation, elicitation and their application in a sustainable agricultural production.

Current research in basic and applied knowledge of plant science has aimed to unravel the role of the interaction between environmental factors and the genome in the physiology of plants to confer the ability to overcome challenges in a climate change scenario. Evidence shows that factors causing environmental stress (stressors), whether of biological, chemical, or physical origin, induce eustressing or distressing effects in plants depending on the dose. The latter suggests the induction of the "hormesis" phenomenon. Sustainable crop production requires a better understanding of hormesis, its basic concepts, and the input variables to make its management feasible. This implies that acknowledging hormesis in plant research could allow specifying beneficial effects to effectively manage environmental stressors according to cultivation goals. Several factors have been useful in this regard, which at low doses show beneficial eustressing effects (biostimulant/elicitor), while at higher doses, they show distressing toxic effects. These insights highlight biostimulants/elicitors as tools to be included in integrated crop management strategies for reaching sustainability in plant science and agricultural studies. In addition, compelling evidence on the inheritance of elicited traits in plants unfolds the possibility of implementing stressors as a tool in plant breeding.

Free triiodothyronine levels and age influences the metabolic profile and COVID-19 severity parameters in euthyroid and levothyroxine-treated patients.

Metabolic reprogramming is required to fight infections and thyroid hormones are key regulators of metabolism. We have analyzed in hospitalized COVID-19 patients: 40 euthyroid and 39 levothyroxine (LT4)-treated patients in the ward and 29 euthyroid and 9 LT4-treated patients in the intensive care unit (ICU), the baseline characteristics, laboratory data, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), the FT3/FT4 ratio, 11 antiviral cytokines and 74 metabolomic parameters. No evidence for significant differences between euthyroid and LT4-treated patients were found in the biochemical, metabolomic and cytokines parameters analyzed. Only TSH (p=0.009) and ferritin (p=0.031) showed significant differences between euthyroid and LT4-treated patients in the ward, and TSH (p=0.044) and FT4 (p=0.012) in the ICU. Accordingly, severity and mortality were similar in euthyroid and LT4-treated patients. On the other hand, FT3 was negatively related to age (p=0.012), independently of sex and body mass index in hospitalized COVID-19 patients. Patients with low FT3 and older age showed a worse prognosis and higher levels of the COVID-19 severity markers IL-6 and IL-10 than patients with high FT3. IL-6 negatively correlated with FT3 (p=0.023) independently of age, body mass index and sex, whereas IL-10 positively associated with age (p=0.035) independently of FT3, body mass index and sex. A metabolomic cluster of 6 parameters defined low FT3 ward patients. Two parameters, esterified cholesterol (p=4.1x10-4) and small HDL particles (p=6.0x10-5) correlated with FT3 independently of age, body mass index and sex, whereas 3-hydroxybutyrate (p=0.010), acetone (p=0.076), creatinine (p=0.017) and high-density-lipoprotein (HDL) diameter (p=8.3x10-3) were associated to FT3 and also to age, with p-values of 0.030, 0.026, 0.017 and 8.3x10-3, respectively. In conclusion, no significant differences in FT3, cytokines, and metabolomic profile, or in severity and outcome of COVID-19, were found during hospitalization between euthyroid patients and hypothyroid patients treated with LT4. In addition, FT3 and age negatively correlate in COVID-19 patients and parameters that predict poor prognosis were associated with low FT3, and/or with age. A metabolomic cluster indicative of a high ketogenic profile defines non-critical hospitalized patients with low FT3 levels.

Regulation of metabolic and transcriptional responses by the thyroid hormone in cellular models of murine macrophages.

Oncogene-immortalized bone marrow-derived macrophages are considered to be a good model for the study of immune cell functions, but the factors required for their survival and proliferation are still unknown. Although the effect of the thyroid hormones on global metabolic and transcriptional responses in macrophages has not yet been examined, there is increasing evidence that they could modulate macrophage functions. We show here that the thyroid hormone T3 is an absolute requirement for the growth of immortal macrophages. The hormone regulates the activity of the main signaling pathways required for proliferation and anabolic processes, including the phosphorylation of ERK and p38 MAPKs, AKT, ribosomal S6 protein, AMPK and Sirtuin-1. T3 also alters the levels of metabolites controlling transcriptional and post-transcriptional actions in macrophages, and causes widespread transcriptomic changes, up-regulating genes needed for protein synthesis and cell proliferation, while down-regulating genes involved in immune responses and endocytosis, among others. This is not observed in primary bone marrow-derived macrophages, where only p38 and AMPK activation is regulated by T3 and in which the metabolic and transcriptomic effects of the hormone are much weaker. However, the response to IFN-γ is reduced by T3 similarly in immortalized macrophages and in the primary cells, confirming previous results showing that the thyroid hormones can antagonize JAK/STAT-mediated signaling. These results provide new perspectives on the relevant pathways involved in proliferation and survival of macrophage cell culture models and on the crosstalk between the thyroid hormones and the immune system.

Hypothyroidism confers tolerance to cerebral malaria.

The modulation of the host's metabolism to protect tissue from damage induces tolerance to infections increasing survival. Here, we examined the role of the thyroid hormones, key metabolic regulators, in the outcome of malaria. Hypothyroidism confers protection to experimental cerebral malaria by a disease tolerance mechanism. Hypothyroid mice display increased survival after infection with Plasmodium berghei ANKA, diminishing intracranial pressure and brain damage, without altering pathogen burden, blood-brain barrier disruption, or immune cell infiltration. This protection is reversed by treatment with a Sirtuin 1 inhibitor, while treatment of euthyroid mice with a Sirtuin 1 activator induces tolerance and reduces intracranial pressure and lethality. This indicates that thyroid hormones and Sirtuin 1 are previously unknown targets for cerebral malaria treatment, a major killer of children in endemic malaria areas.

Elicitores: implicaciones bioéticas para la agricultura y la salud humana / Elicitors: bioethical implications for agriculture and human health / Elicitores: implicações bioéticas para a agricultura e a saúde humana

Resumen Los compuestos agroquímicos se han utilizado en la agricultura en las últimas décadas para evitar pérdidas por plagas, nutrir la tierra, aumentar el rendimiento y la calidad de los cultivos. Sin embargo, el uso de estas sustancias en muchas ocasiones representa una fuente de contaminación ambiental y riesgos a la salud. Por ello, han surgido nuevas alternativas en la producción alimentaria, como el uso de elicitores, para consolidar una agricultura más sostenible y sin efectos adversos a la salud del consumidor. Los elicitores pueden estimular el metabolismo propio de las plantas para producir compuestos que resultarán en rasgos agronómicos deseados, como metabolitos secundarios de uso nutracéutico. En el presente artículo se muestra la perspectiva científica y ética de proyectos de investigación en los cuales se emplean diferentes elicitores para sustituir el uso de agroquímicos.

Abstract In recent decades, agrochemicals have been used in agriculture to increase crop yields and quality and avoid losses due to pests. However, the use of these substances often imply environmental contamination and potential health risks. To move towards a more sustainable agriculture with less undesirable effects to human health, a novel line of research has recently emerged, proposing alternatives for the use of agrochemicals, such as elicitors. Elicitors, either biotic or abiotic, can stimulate plants biochemical mechanism to produce compounds that will result in desired agronomic traits, such as secondary metabolites to be used as nutraceuticals. This article shows the scientific and the ethic perspective of research projects evaluating the role of different elicitors in replacing the use of agrochemicals.

Resumo Nas últimas décadas, compostos agroquímicos têm sido utilizados na agricultura para evitar pragas, nutrir o solo e aumentar a produtividade e a qualidade das plantas. No entanto, o uso dessas substâncias muitas vezes contamina o meio ambiente e traz riscos à saúde. Por isso, novas alternativas, como os elicitores, surgiram na produção alimentar a fim de consolidar uma agricultura mais sustentável, sem efeitos adversos para a saúde do consumidor. Os elicitores podem estimular o próprio metabolismo das plantas para produzir compostos que resultarão em características agronômicas desejadas, como metabólitos secundários para uso nutracêutico. Este artigo mostra a perspectiva científica e ética de projetos de pesquisa em que diferentes elicitores substituem agroquímicos.

MicroRNAs and thyroid hormone action.

MicroRNAs (miRNAs) are small noncoding RNAs that post-transcriptionally repress gene expression by binding generally to the 3'-untranslated regions of their target mRNAs. miRNAs regulate a large fraction of the genome, playing a key role in most physiological and pathological processes. The thyroid hormones (T4 and T3) are major regulators of development, metabolism and cell growth. The thyroid hormones (THs) are synthetized in the thyroid gland and enter the cells through transporter proteins. In the cells, T4 and T3 are metabolized by deiodinase enzymes and bind to nuclear receptors (TRs), which have a higher affinity by T3. TRs act as hormone dependent transcription factors by binding to thyroid hormone response elements (TREs) in the target genes and recruiting transcriptional coregulators. There is increasing evidence that a variety of miRNAs target deiodinases and the receptor, thus regulating TH signaling is different tissues. In turn, the THs have been shown to modulate the expression of specific miRNAs and their mRNA targets in different cell types and organs. In many cases, the existence of TREs in the regulatory regions of these miRNAs has been identified, and the hormone bound receptors transcriptionally regulate expression of these molecules. Changes in the levels of miRNAs have been demonstrated to mediate some of the important actions of the THs in processes such as muscle and heart function, lipid liver metabolism or skin physiology. In addition, miRNA regulation is involved in the effects of TRs on cell proliferation and cancer.

Whole-Genome DNA Methylation Analysis in Hydrogen Peroxide Overproducing Transgenic Tobacco Resistant to Biotic and Abiotic Stresses.

Epigenetic regulation is a key component of stress responses, acclimatization and adaptation processes in plants. DNA methylation is a stable mark plausible for the inheritance of epigenetic traits, such that it is a potential scheme for plant breeding. However, the effect of modulators of stress responses, as hydrogen peroxide (H2O2), in the methylome status has not been elucidated. A transgenic tobacco model to the CchGLP gene displayed high H2O2 endogen levels correlated with biotic and abiotic stresses resistance. The present study aimed to determine the DNA methylation status changes in the transgenic model to obtain more information about the molecular mechanism involved in resistance phenotypes. The Whole-genome bisulfite sequencing analysis revealed a minimal impact of overall levels and distribution of methylation. A total of 9432 differential methylated sites were identified in distinct genome regions, most of them in CHG context, with a trend to hypomethylation. Of these, 1117 sites corresponded to genes, from which 83 were also differentially expressed in the plants. Several genes were associated with respiration, energy, and calcium signaling. The data obtained highlighted the relevance of the H2O2 in the homeostasis of the system in stress conditions, affecting at methylation level and suggesting an association of the H2O2 in the physiological adaptation to stress functional linkages may be regulated in part by DNA methylation.

Nuclear receptors: Lipid and hormone sensors with essential roles in the control of cancer development.

Nuclear receptors (NRs) are a superfamily of ligand-activated transcription factors that act as biological sensors and use a combination of mechanisms to modulate positively and negatively gene expression in a spatial and temporal manner. The highly orchestrated biological actions of several NRs influence the proliferation, differentiation, and apoptosis of many different cell types. Synthetic ligands for several NRs have been the focus of extensive drug discovery efforts for cancer intervention. This review summarizes the roles in tumour growth and metastasis of several relevant NR family members, namely androgen receptor (AR), estrogen receptor (ER), glucocorticoid receptor (GR), thyroid hormone receptor (TR), retinoic acid receptors (RARs), retinoid X receptors (RXRs), peroxisome proliferator-activated receptors (PPARs), and liver X receptors (LXRs). These studies are key to develop improved therapeutic agents based on novel modes of action with reduced side effects and overcoming resistance.

Stress erythropoiesis in atherogenic mice.

Bone marrow erythropoiesis is mainly homeostatic and a demand of oxygen in tissues activates stress erythropoiesis in the spleen. Here, we show an increase in the number of circulating erythrocytes in apolipoprotein E-/- mice fed a Western high-fat diet, with similar number of circulating leukocytes and CD41+ events (platelets). Atherogenic conditions increase spleen erythropoiesis with no variations of this cell lineage in the bone marrow. Spleens from atherogenic mice show augmented number of late-stage erythroblasts and biased differentiation of progenitor cells towards the erythroid cell lineage, with an increase of CD71+CD41CD34-CD117+Sca1-Lin- cells (erythroid-primed megakaryocyte-erythroid progenitors), which is consistent with the way in which atherogenesis modifies the expression of pro-erythroid and pro-megakaryocytic genes in megakaryocyte-erythroid progenitors. These data explain the transiently improved response to an acute severe hemolytic anemia insult found in atherogenic mice in comparison to control mice, as well as the higher burst-forming unit-erythroid and colony forming unit-erythroid capacity of splenocytes from atherogenic mice. In conclusion, our work demonstrates that, along with the well stablished enhancement of monocytosis during atherogenesis, stress erythropoiesis in apolipoprotein E-/- mice fed a Western high fat diet results in increased numbers of circulating red blood cells.

Hematopoiesis in aged female mice devoid of thyroid hormone receptors.

Hypothyroidism is often associated with anemia and immunological disorders. Similar defects are found in patients and in mice with a mutated dominant-negative thyroid hormone receptor α (TRα) and in knockout mice devoid of this receptor, suggesting that this isoform is responsible for the effects of the thyroid hormones in hematopoiesis. However, the hematological phenotype of mice lacking also TRß has not yet been examined. We show here that TRα1/TRß-knockout female mice, lacking all known thyroid hormone receptors with capacity to bind thyroid hormones, do not have overt anemia and in contrast with hypothyroid mice do not present reduced Gata1 or Hif1 gene expression. Similar to that found in hypothyroidism or TRα deficiency during the juvenile period, the B-cell population is reduced in the spleen and bone marrow of ageing TRα1/TRß-knockout mice, suggesting that TRß does not play a major role in B-cell development. However, splenic hypotrophy is more marked in hypothyroid mice than in TRα1/TRß-knockout mice and the splenic population of T-lymphocytes is not significantly impaired in these mice in contrast with the reduction found in hypothyroidism. Our results show that the overall hematopoietic phenotype of the TRα1/TRß-knockout mice is milder than that found in the absence of hormone. Although other mechanism/s cannot be ruled out, our results suggest that the unoccupied TRs could have a negative effect on hematopoiesis, likely secondary to repression of hematopoietic gene expression.

Pain reduction of topical sevoflurane vs intravenous opioids in pressure ulcers.

Recently, it has been reported that topical irrigations of liquid sevoflurane on the bed of painful wounds produce a rapid, intense, and lasting analgesic effect. In this paper, A cohort of 112 patients with painful pressure ulcers who were refractory to opioids (or who exhibited undesirable adverse events to them) was treated with topical sevoflurane as per local institutional policy. These patients were recruited from an intensive care unit for a period of 3 years. The main aim was to determine the effectiveness of topical sevoflurane in reducing the pain of PUs and reducing the ulcer area. Study findings are reported and discussed herein and suggest that sevoflurane is a viable and promising treatment option for PUs.

Thyroid Hormone Receptor ß Inhibits Self-Renewal Capacity of Breast Cancer Stem Cells.

Background: A subpopulation of cancer stem cells (CSCs) with capacity for self-renewal is believed to drive initiation, progression, and relapse of breast tumors. Methods: Since the thyroid hormone receptor ß (TRß) appears to suppress breast tumor growth and metastasis, we have analyzed the possibility that TRß could affect the CSC population using MCF-7 cells grown under adherent conditions or as mammospheres, as well as inoculation into immunodeficient mice. Results: Treatment of TRß-expressing MCF-7 cells (MCF7-TRß cells) with the thyroid hormone triiodothyronine (T3) decreased significantly CD44+/CD24- and ALDH+ cell subpopulations, the efficiency of mammosphere formation, the self-renewal capacity of CSCs in limiting dilution assays, the expression of the pluripotency factors in the mammospheres, and tumor initiating capacity in immunodeficient mice, indicating that the hormone reduces the CSC population present within the bulk MCF7-TRß cultures. T3 also decreased migration and invasion, a hallmark of CSCs. Transcriptome analysis showed downregulation of the estrogen receptor alpha (ERα) and ER-responsive genes by T3. Furthermore, among the T3-repressed genes, there was an enrichment in genes containing binding sites for transcription factors that are key determinants of luminal-type breast cancers and are required for ER binding to chromatin. Conclusion: We demonstrate a novel role of TRß in the biology of CSCs that may be related to its action as a tumor suppressor in breast cancer.

Nutrición enteral domiciliaria en el paciente con patología neurológica de un área de salud del sureste español / Home enteral nutrition in patients with neurological disease in an area of the southeast of Spain

Introducción: la desnutrición en el paciente neurológico presenta una alta prevalencia, aumentando las complicaciones y disminuyendo la calidad de vida. La nutrición artificial minimiza el riesgo de malnutrición. En los últimos años, en Murcia, se pone en marcha una vía clínica de adecuación a la Guía Nacional de Nutrición Enteral Domiciliaria (NED) para optimizar este recurso y reducir la variabilidad de prescripción. Objetivo: analizar las características de la NED en el paciente neurológico, de un área de salud de Murcia, antes y después de la adecuación a las directrices nacionales. Método: diseño observacional de corte transversal. Análisis y comparación de las muestras NED de adultos del Área 1 de salud de Murcia, en 2010 y 2014. Resultados: la patología más asociada a las prescripciones de NED fue la neurológica. La vía de administración más utilizada fue la oral, aunque desciende en la muestra de 2014 a favor de la sonda de nutrición y ostomía. El tipo de fórmula más usado en 2010 fue la no específica. Tras la vía clínica se reduce el uso de fórmulas específicas, disminuyendo especialmente las fórmulas hiperproteicas y/o hipercalóricas. Conclusiones: la implementación de una vía clínica de adecuación a la Guía Nacional NED ha provocado un cambio en la realidad de este tipo de nutrición artificial en el Área 1 de salud del Servicio Murciano de Salud, consiguiendo normalizar su uso bajo criterios unificados y profesionales especializados. Finalmente, estos logros se han generalizado a toda la región

Introduction: malnutrition in patients with neurological disease is very prevalent, worsening their complications and diminishing their quality of life. For that reason, nutritional support can provide a reduction in comorbidities. Over the past years, in Murcia (southeast of Spain), a clinical pathway has been stablished in accordance to the National Home Enteral Nutrition guide (HEN) to optimize this resource and reduce the prescription gap. Objective: to analyze the HEN characteristics in neurological patients in an area of Murcia, before and after the adequacy of the national recommendations. Method: observational cross-sectional study. Analysis and comparison of HEN in health area no. 1 in Murcia in 2010 and 2014. Results: the most prevalent cause for HEN was neurological disease. In 2010, oral nutrition was the most used way compared with 2014, when it had changed to enteral nutrition through feeding tube or ostomy. Non-specific formula was the most frequently used in 2010. However, after the establishment of the clinical pathway there was a reduction in specific enteral formula use, specially hypercaloric and hyperproteic. Conclusions: the implementation of a clinical pathway according to the National HEN guide has caused a change in the reality of artificial nutrition in health area no. 1 in Murcia (Spain), which means a standardization of its use under unified criteria made by specialized professionals. Finally, due to these results, this clinical pathway has been generalized to the rest of the region

Early detection of neonatal hearing loss by otoacoustic emissions and auditory brainstem response over 10 years of experience.

OBJECTIVES: A number of different screening protocols for detecting neonatal hearing loss currently exist. We present our 10 years of experience with using auditory brainstem response (ABR) complementary to otoacoustic emissions (OAEs) in the three phases hearing screening process in our hospital. Furthermore, we want to demonstrate the usefulness of these screening techniques used in combination, that remain valid to identify cases of neonatal hearing loss and meet the well-established program quality criteria for these screening protocols. METHODS: Data were collected retrospectively from patient record forms completed on 9698 newborns from 2007 to 2017. The screening protocol for neonatal hearing loss in our centre is carried out in three phases. First phase, prior to discharge from the hospital, consists of carrying out the OAE evaluation on the newborn. Second phase is carried out in the paediatric consultation department. There, the newborns who did not pass the first phase are again studied with OAE. If this phase is not passed either, the child is referred to a third phase for the realization of ABR, in the clinical neurophysiology service. Newborns with risk factors for hearing loss, identified in the first phase, also go on to this third phase. When this hearing threshold exceeds 30 dB, it is considered abnormal. Cases with abnormal ABR, has a re-test conducted within the next six months from the initial ABR assessment. RESULTS: A total of 9390 (97.1%) OAEs were performed during first phase, with 8245 newborns (87.8%) passing the screening test, while 1145 children (12.1%) presented an abnormal OAE and were included in the second screening phase. Second phase involving a repeat OAE examination performed on 1077 newborns (94%). In this second phase, 941 newborns (87.3%) passed the test. Nevertheless, 136 newborns (12.6%) failing the retest and were referred to continue on to phase three. Furthermore, 181 newborns (1.8%) presented high-risk factors at birth and were also included in this third phase. However, in the registries of children referred to this phase, only 255 (80%) ABR evaluations were confirmed. In total, 227 newborns (2.3%) were missed from the first to third phases of the screening process. According to the database of the clinical neurophysiology service, ABRs evaluations were performed in 352 newborns referred between December 2007 and December 2017. Of this sample, 38.9% were boys and 61.1% were girls. From among cases underwent ABR, 34% of newborns did not pass the OAEs. The most common risk factor was prematurity (with admission to the neonatal intensive care unit for more than five days), affecting 28%. Abnormal ABRs waveforms were found in 43.9%, with 12.3% having a sensorineural hearing loss, 26.5% showing mixed hearing loss and, conductive hearing loss being present in 61.9%. Considering sensorineural hearing loss and other types of severe hearing loss, affected patients constituted only 1.7% of the total number of individuals studied. Finally, regarding quality control of the program participation in the first phase of care included 97.2% of all newborns, yielding a third phase referral rate of 2.9%, confirmation of a diagnosis before the fourth month of life in more than 90% of cases with an average of 3.4 months of age, and a hearing impairment detection rate as an outcome indicator of 4.5%. CONCLUSIONS: Our data are similar to those of previous studies on screening for hearing loss in newborns. We have demonstrated the advantages of carrying out this protocol in three phases using the otoacoustic emissions together with auditory brainstem response, diagnostic tools that remain as a Gold Standard. Also, we want to highlight and demonstrate the importance of interdisciplinary coordination between the paediatric and clinical neurophysiology services in the implementation of this screening protocol. The foregoing has allowed us to comply with the proposed quality indicators, reaching coverage percentages of more than 95%, confirming the diagnosis of hearing loss within the first six months of life and making timely referrals to benefit the newborns with hearing impairment by way of treatment and follow-up in the early stages of development, avoiding future disabilities.