Prevalence of thyroid dysfunction in a Large Southern European Population. Analysis of modulatory factors. The APNA study.

CONTEXT: To study the prevalence of thyroid dysfunction in a very large unselected population. OBJECTIVE: To determine the prevalence of abnormal thyroid function and evaluate potential modulatory factors. DESIGN AND SETTING: The Estudio de Atención Primaria de Navarra, The APNA Study, is a cross-sectional study conducted in northern Spain. It involved 303 883 people, of 20 years of age and older, who live in the Navarra region. Participants are covered by the public healthcare system and medical records are digitalized. MAIN OUTCOME MEASURES: The information was gathered from e-registered data regarding serum thyrotropin (TSH), thyroid hormones, thyroid antibody concentration and clinical context. Measurements were logged (demographic information and potential thyroid function modulatory factors). RESULTS: Serum TSH (mU/L) normal range was established at 0.7-4.28. At the time of the study, 87% of the Navarra population had a TSH level within the normal range. Mean serum TSH in euthyroid individuals was higher in women (2.15) than in men (1.96) (P < .001) and higher in the obese with body mass index (BMI) ≥30 kg/m2 (2.12) as compared to the non-obese BMI <30 kg/m2 (2.06) (P < .001). Mean TSH for the entire population was 1.9. The native Spanish population had statistically significantly lower TSH (1.87) than non-native Spanish (2.15) (P < .001). Additionally, we observed that serum TSH levels decreased with age and an increase in the prevalence of hypothyroidism in the elderly and among people with low-income levels. The prevalence of thyroid dysfunction in Navarra was 12.3%. The prevalence of hypothyroidism (or high TSH) in the population was 8.8% (13.3% in women, 4.2% in men), and the prevalence of hyperthyroidism (or low TSH) was 4.3% (5.6% in women, 3.0% in men). CONCLUSIONS: Nearly 15% of the general population suffers from biochemical thyroid dysfunction. The serum TSH level appears to be influenced by sex, BMI, age, ethnic origin and socio-economic status.

Does metformin have a "buffer effect" on serum TSH levels in euthyroid diabetic patients?

OBJECTIVE: In the last few years a number of studies have found that metformin has a thyrotropin (TSH)-lowering effect in patients with type 2 diabetes (DM2) and that this effect disappears after discontinuation of the drug. Initial studies were carried out in hypothyroid patients on levothyroxine (LT4) treatment. However, this effect was observed only when serum TSH levels were elevated. The aim of this study was to assess the effect of metformin treatment on serum TSH levels in euthyroid DM2 patients. DESIGN: A retrospective study was conducted in seven primary health care centers in Spain. The study included 278 DM2 patients (110 females). Serum TSH level was tested before and one year after the onset of metformin treatment. We compared both TSH levels by paired t-tests. The sample was divided into four hierarchical clusters (C1 to C4), according to the Euclidean distance of the initial TSH level. No patient received LT4 treatment. RESULTS: Pre-metformin serum TSH level (2.00 ± 0.76 mU/L) was statistically significantly lower than post-metformin level (2.20 ± 0.87 mU/L; P <0.001). Interestingly, this trend was observed only in clusters 1 and 2 (those with lower baseline TSH levels), whereas the trend was lost in clusters 3 and 4. The difference between pre- and post-metformin TSH levels follows a mathematical model. According to this model, the TSH threshold point level is 3.00 mU/L. CONCLUSION: Metformin seems to induce a "buffer effect" on TSH secretion in euthyroid diabetic individuals. Hence, our study found an unreported TSH behavior after metformin treatment.

A compilation of field surveys on gaseous elemental mercury (GEM) from contrasting environmental settings in Europe, South America, South Africa and China: separating fads from facts.

Mercury is transported globally in the atmosphere mostly in gaseous elemental form (GEM, [Formula: see text]), but still few worldwide studies taking into account different and contrasted environmental settings are available in a single publication. This work presents and discusses data from Argentina, Bolivia, Bosnia and Herzegovina, Brazil, Chile, China, Croatia, Finland, Italy, Russia, South Africa, Spain, Slovenia and Venezuela. We classified the information in four groups: (1) mining districts where this contaminant poses or has posed a risk for human populations and/or ecosystems; (2) cities, where the concentration of atmospheric mercury could be higher than normal due to the burning of fossil fuels and industrial activities; (3) areas with natural emissions from volcanoes; and (4) pristine areas where no anthropogenic influence was apparent. All the surveys were performed using portable LUMEX RA-915 series atomic absorption spectrometers. The results for cities fall within a low GEM concentration range that rarely exceeds 30 ng m(-3), that is, 6.6 times lower than the restrictive ATSDR threshold (200 ng m(-3)) for chronic exposure to this pollutant. We also observed this behavior in the former mercury mining districts, where few data were above 200 ng m(-3). We noted that high concentrations of GEM are localized phenomena that fade away in short distances. However, this does not imply that they do not pose a risk for those working in close proximity to the source. This is the case of the artisanal gold miners that heat the Au-Hg amalgam to vaporize mercury. In this respect, while GEM can be truly regarded as a hazard, because of possible physical-chemical transformations into other species, it is only under these localized conditions, implying exposure to high GEM concentrations, which it becomes a direct risk for humans.

The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis.

CONTEXT: Thyroid dysfunction is one of the leading endocrine disorders. Previous data show that about half of the population with thyroid dysfunction remains undiagnosed. OBJECTIVE: Our objective was to estimate epidemiologic data on thyroid dysfunction in Europe. DATA SOURCES: PubMed, EMBASE, and SCOPUS databases were searched to identify studies that evaluated the prevalence and/or incidence of thyroid dysfunction in Europe published between 1975 and 2012. STUDY SELECTION: Of the 541 identified abstracts examined, 178 were considered for evaluation and 17 were included. Studies were excluded if they included participants with an underlying disease or were limited by age or gender. DATA EXTRACTION: Results were grouped into 3 categories: 1) prevalence of undiagnosed thyroid dysfunction, 2) prevalence of thyroid dysfunction, and 3) incidence of thyroid dysfunction. Extraction was conducted independently by 2 investigators. DATA SYNTHESIS: An empirical Bayesian random-effects model was used. The prevalence of undiagnosed thyroid dysfunction was assessed in 7 studies with a mean result of 6.71% (95% credibility interval, 6.49%-6.93%): 4.94% (4.75%-5.13%) and 1.72% (1.66%-1.88%) for undiagnosed hypothyroidism and hyperthyroidism, respectively. The prevalence of both previously diagnosed and undiagnosed thyroid dysfunction was assessed in 9 studies with a mean result of 3.82% (3.77%-3.86%): 3.05% (3.01%-3.09%) and 0.75% (0.73%-0.77%) for hypothyroidism and hyperthyroidism, respectively. The incidence rate of thyroid dysfunction was assessed in 7 studies with a mean result of 259.12 (254.39-263.9) per 100 000 per year: 226.2 (222.26-230.17) and 51 (49.23-52.88) per 100 000 per year for hypothyroidism and hyperthyroidism, respectively. CONCLUSION: This meta-analysis provides extensive data on the prevalence and incidence of thyroid dysfunction in Europe.

A cross-sectional study of the association between circulating TSH level and lipid profile in a large Spanish population.

OBJECTIVE: Some evidence suggests that high serum TSH levels are associated with an adverse lipid profile, but this association is not clear when plasma TSH is within the reference range. Nevertheless, these studies have never been conducted in Spain, a country with a strong adherence to the Mediterranean diet. The study aim was to analyse the association between blood TSH levels and circulating lipids in a large Spanish population and set up a TSH reference range in different age, gender and Body Mass Index (BMI) subpopulations from our cohort. DESIGN: Cross-sectional study on 20 783 subjects. PATIENTS: We analysed circulating levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG) and compared them with TSH serum levels. Discriminant function analysis was used to determine the TSH cut-off level from where hyperlipidaemia developed. RESULTS: In individuals free of thyroid dysfunction, the mean and the 95% TSH (mU/l) reference limits were 2·20 and 0·72-4·43, respectively. We observed a sex-related difference in TSH concentration (men, 2·07 and 0·72-4·29; women, 2·29 and 0·72-4·49; P < 0·01). We also observed a weight-related difference in TSH concentration (BMI < 30 kg/m(2) , 2·16 and 0·72-4·39; BMI ≥ 30 kg/m(2) , 2·28 and 0·71-4·47; P < 0·01). TSH was positively associated with TC, TG and LDLc levels and negatively with HDLc. CONCLUSION: We found an association between TSH and lipids in that as TSH increased, the lipid profile became less favourable, even within the normal range. Additionally, TSH reference ranges varied according to gender, age and BMI.

Management of subclinical hyperthyroidism.

The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient's medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves' disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation).

Dental research productivity in Argentina (1993 to 2003).

The scientific presentations at the annual meetings of the Argentine Division of the I.A.D.R. (S.A.I.O.) are proof of the scientific production of this country in dental research. Our annual meetings provide a forum for the rapid communication and discussion of research. However, only peer-reviewed articles, published in journals indexed in worldwide-accepted databases such as MEDLINE are permanent records of the research work and can reach out to a global audience. A useful indicator of quality and publication efficiency of research work is the rate of publication (RP), i.e. relationship between the quantity of presentations and subsequent publications in peer-reviewed journals. Previous works analyzed the two periods: 1980-1989 and 1990-1995 (Acta Odont. Latinoamer 7(2):39-46,1993 and Acta Odont. Latinoamer. 10(1):63-69, 1997). The aim of this work was to update the informatiod and study the publication rate of national Dental research works. The 1669 works produced by national research centers presented at the Annual Meetings of the S.A.LO. from 1993 to 2003 were evaluated. Employing the authors' index of the programs of the Annual Meetings of the S.A.I.O. we searched for possible publications in MEDLINE. The references obtained were compared with the presentations (title and authors) disregarding those that had not been communicated previously at our Division meeting. Presentations and the corresponding publications were grouped according to research center and within each center according to subject area. The following parameters were obtained: PR, time between Presentation and publication and language of publication. PR increased in 1993-2003 (1/4.8, 20.79%) when compared to the periods studied previously (1/8, 12%). Most of the publications were in English and had been published within 4 years after presentation. The increase in the number of S.A.I.O. presentations published in peer-reviewed journals shows an improvement in terms of research productivity in dental research in Argentina.

Dental research productivity in Argentina: 1993 to 2003

La investigación odontológica del país esta representada por los trabajos presentados en la Reunión Anual de la División Argentina de la I.A.D.R. La presentación de trabajos de investigación en reuniones científicas permite la comunicación rápida y su discusión entre pares. Sin embargo, la divulgación global efectiva y útil para toda la comunidad médico-odontológicasólo se obtiene mediante la publicación de los trabajos en revistas científicas indizadas en bases de datos bibliográficas especializadas como el MEDLINE de la Biblioteca Nacional de Medicina de los Estados Unidos. En trabajos anteriores se evaluaron los períodos comprendidos entre 1980-1989 y 1990-1995 (Acta Odont Latinoamer 7(2) :39-46,1993 y Acta Odont Latinoamer. 10(1):63-69, 1997).El objetivo de este trabajo ha sido actualizar dicha información y evaluar la evolución de la tasa de publicación en el área de investigación odontológica argentina. Con ese fin se consideraronlos 1669 trabajos de centros de investigación nacionales presentados en las reuniones anuales de la S.A.I.O.en el período 1993-2003. Se compararon las citas obtenidas con los datos de las presentaciones, seagruparon según Centro de investigación y área de desarrolllo. Se obtuvo la TP, se calculó el tiempo transcurrido entre la presentación y la publicación de los trabajos y se consideró el idioma de publicación.Se observó un marcado aumento de TP con respecto a los períodos anteriormente analizados. La mayoría de las publicaciones se hicieron en inglés y dentro de los 4 años post presentación. El aumento en el número de publicaciones sometidas a juiciode expertos de los trabajos presentados en las reuniones de la S.A.I.O. evidencia una mejora en la producción científica de la investigación odontológica argentina (AU)

The scientific presentations at the annual meetings of the Argentine Division of the I.A.D.R. (S.A.I.O.) are proof of the scientific production of this country in dental research. Our annual meetings provide a forum for the rapid communication and discussion of research. However, only peer-reviewed articles, published in journals indexed in worldwide-accepted databases such as MEDLINE are permanent records of the research work and can reach out to a global audience. A useful indicator of quality and publication efficiency of research work is the rate of publication (RP), i.e. relationship between the quantity of presentations and subsequent publications in peerreviewed journals. Previous works analyzed the two periods: 1980-1989 and 1990-1995 (Acta Odont. Latinoamer 7(2):39-46,1993 and Acta Odont. Latinoamer. 10(1):63-69, 1997). The aim of this work was to update the information and study the publication rate of national Dental research works. The 1669 works produced by national research centers presented at the Annual Meetings of the S.A.I.O. from 1993 to 2003 were evaluated. Employing the authorsã index of the programs of the Annual Meetings of the S.A.I.O. we searched for possible publications in MEDLINE. The references obtained were compared with the presentations (title and authors) disregarding those that had not been communicated previously at our Division meeting. Presentations and the corresponding publications were grouped according to research center and within each center according to subject area. The following parameters were obtained: PR, time between Presentation and publication and language of publication. PR increased in 1993-2003 (1/4.8, 20.79%) when compared to the periods studied previously (1/8, 12%). Most of the publications were in English and had been published within 4 years after presentation. The increase in the number of S.A.I.O. presentations published in peer-reviewed journals shows an improvement in terms of research productivity in dental research in Argentina.(AU)

Dental research productivity in Argentina: 1993 to 2003

La investigación odontológica del país esta representada por los trabajos presentados en la Reunión Anual de la División Argentina de la I.A.D.R. La presentación de trabajos de investigación en reuniones científicas permite la comunicación rápida y su discusión entre pares. Sin embargo, la divulgación global efectiva y útil para toda la comunidad médico-odontológicasólo se obtiene mediante la publicación de los trabajos en revistas científicas indizadas en bases de datos bibliográficas especializadas como el MEDLINE de la Biblioteca Nacional de Medicina de los Estados Unidos. En trabajos anteriores se evaluaron los períodos comprendidos entre 1980-1989 y 1990-1995 (Acta Odont Latinoamer 7(2) :39-46,1993 y Acta Odont Latinoamer. 10(1):63-69, 1997).El objetivo de este trabajo ha sido actualizar dicha información y evaluar la evolución de la tasa de publicación en el área de investigación odontológica argentina. Con ese fin se consideraronlos 1669 trabajos de centros de investigación nacionales presentados en las reuniones anuales de la S.A.I.O.en el período 1993-2003. Se compararon las citas obtenidas con los datos de las presentaciones, seagruparon según Centro de investigación y área de desarrolllo. Se obtuvo la TP, se calculó el tiempo transcurrido entre la presentación y la publicación de los trabajos y se consideró el idioma de publicación.Se observó un marcado aumento de TP con respecto a los períodos anteriormente analizados. La mayoría de las publicaciones se hicieron en inglés y dentro de los 4 años post presentación. El aumento en el número de publicaciones sometidas a juiciode expertos de los trabajos presentados en las reuniones de la S.A.I.O. evidencia una mejora en la producción científica de la investigación odontológica argentina

The scientific presentations at the annual meetings of the Argentine Division of the I.A.D.R. (S.A.I.O.) are proof of the scientific production of this country in dental research. Our annual meetings provide a forum for the rapid communication and discussion of research. However, only peer-reviewed articles, published in journals indexed in worldwide-accepted databases such as MEDLINE are permanent records of the research work and can reach out to a global audience. A useful indicator of quality and publication efficiency of research work is the rate of publication (RP), i.e. relationship between the quantity of presentations and subsequent publications in peerreviewed journals. Previous works analyzed the two periods: 1980-1989 and 1990-1995 (Acta Odont. Latinoamer 7(2):39-46,1993 and Acta Odont. Latinoamer. 10(1):63-69, 1997). The aim of this work was to update the information and study the publication rate of national Dental research works. The 1669 works produced by national research centers presented at the Annual Meetings of the S.A.I.O. from 1993 to 2003 were evaluated. Employing the authors’ index of the programs of the Annual Meetings of the S.A.I.O. we searched for possible publications in MEDLINE. The references obtained were compared with the presentations (title and authors) disregarding those that had not been communicated previously at our Division meeting. Presentations and the corresponding publications were grouped according to research center and within each center according to subject area. The following parameters were obtained: PR, time between Presentation and publication and language of publication. PR increased in 1993-2003 (1/4.8, 20.79%) when compared to the periods studied previously (1/8, 12%). Most of the publications were in English and had been published within 4 years after presentation. The increase in the number of S.A.I.O. presentations published in peer-reviewed journals shows an improvement in terms of research productivity in dental research in Argentina.

Quantitative SUMO-1 modification of a vaccinia virus protein is required for its specific localization and prevents its self-association.

Vaccinia virus (VV), the prototype member of the Poxviridae, a family of large DNA viruses, carries out DNA replication in specialized cytoplasmic sites that are enclosed by the rough endoplasmic reticulum (ER). We show that the VV gene product of A40R is quantitatively modified by SUMO-1, which is required for its localization to the ER-enclosed replication sites. Expression of A40R lacking SUMO-1 induced the formation of rod-shaped cytoplasmic aggregates. The latter likely consisted of polymers of nonsumoylated protein, because unmodified A40R interacted with itself, but not with the SUMO-1-conjugated protein. Using a bacterial sumoylation system, we furthermore show that unmodified A40R is mostly insoluble, whereas the modified form is completely soluble. By electron microscopy, the A40R rods seen in cells were associated with the cytosolic side of the ER and induced the apposition of several ER cisternae. A40R is the first example of a poxvirus protein to acquire SUMO-1. Its quantitative SUMO-1 modification is required for its proper localization to the viral "mini-nuclei" and prevents its self-association. The ability of the nonsumoylated A40R to bring ER membranes close together could suggest a role in the fusion of ER cisternae when these coalesce to enclose the VV replication sites.

Trastornos temporomandibulares en niños y adolescentes / Temporomandibular joint disorders in children and adolescents

Actualmente es frecuente que niños y adolescentes presenten bruxismo y trastornos temporomandibulares, los odontopediatras carecen de respuesta para estas patologías y parafunciones. El objetivo de este artículo es alertar sobre el problema, describir el examen clínico y radiográfico y presentar los distintos tratamientos desde un equipo interdisciplinario acorde al diagnóstico de pacientes en crecimiento y desarrollo (AU)

Trastornos temporomandibulares en niños y adolescentes / Temporomandibular joint disorders in children and adolescents

Actualmente es frecuente que niños y adolescentes presenten bruxismo y trastornos temporomandibulares, los odontopediatras carecen de respuesta para estas patologías y parafunciones. El objetivo de este artículo es alertar sobre el problema, describir el examen clínico y radiográfico y presentar los distintos tratamientos desde un equipo interdisciplinario acorde al diagnóstico de pacientes en crecimiento y desarrollo

Comportamiento del gasto cardíaco durante la prueba de resistencia a la fatiga de los músculos inspiratorios en pacientes con estenosis mitral severa: comunicación preliminar / Cardiac output during the inspiratory muscle resistance to fatigue test in patients with severe mitral stenosis: preliminary report

En un estudio previo se demostró que la resistencia a la fatiga (RF) de lo músculos inspiratorios en pacientes con estenosis mitral severa, evaluada a través de la mediación de la presión inspiratoria máxima sostenible, (PIMS), estaba disminuída. Para investigar mecanismos que pudieran explicar esta alteración en 5 pacientes con EMS se estudió gasto cardíaco (GC), presión media de la arteria y capilar pulmonares (PAP y PCP respectivamente), en condiciones basales y durante la mediación de la PIMS. La presión inspiratoria máxima promedio fue de 99ñ15 cm H2O. Los valores de PIMS y carga máxima sostenible fueron de 56ñ8 cm H2O y 330ñ45 g respectivamente (xñES). El GC promedio basal fue de 3.37ñ1 L/min y al final de la prueba de 3.0ñ0.5 L/min. La PAP, PCP y el pulso aumentaron significativamente al final de la prueba. En 3 sujetos sanos, sexo masculino, se midieron estas mismas variables hemodinámicas durante la prueba, observándose un aumento del GC de 5.4ñ0.3 a 7ñ0.9 L/min, además de una leve alza del resto de las variables. Se concluye que los pacientes no fueron capaces de aumentar su GC frente a un esfuerzo como fue el inspirar contra cargas crecientes, lo que podría significar una falla de la perfusión hacia los músculos inspiratorios cuando los requerimientos de energía estaban aumentados. Siendo las demandas de energía mayores que los aportes se favorecería la fatiga precoz de ellos, lo que se traduciría en una disminición de la RF de esta musculatura