Prevalence, risk factors, and consequences of hypothyroidism among pregnant women in the health region of Lleida: A cohort study.

BACKGROUND: Primary maternal hypothyroidism is defined as the increase of TSH levels in serum during pregnancy. Hypothyroidism in pregnancy is the second most common endocrine disease, after diabetes mellitus, with a prevalence ranging between 3.2 and 5.5%. Its variability depends on ethnical differences. Hypothyroidism in pregnancy is associated with other chronic diseases and fetal and maternal outcomes. OBJECTIVE: To analyze the prevalence of hypothyroidism among multiethnic pregnant women, and to evaluate the comorbidity with chronic diseases and outcomes leaded during pregnancy and newborn. METHODS: Retrospective observational cohort study in pregnant women during the years 2012-2018 in the health region of Lleida. The relationship of hypothyroidism with different variables was analyzed by calculating the adjusted odds ratio (aOR) and the 95% confidence intervals (CI) with multivariate logistic regression models. RESULTS: We analyzed a sample of 17177 pregnant women, which represents more than 92% of the total of pregnant women in the health region of Lleida. The annual prevalence of hypothyroidism was 5.7-7.1%. According to the region of origin, the lowest prevalence was found in the population from Sub Saharian Africa (2.1%), while the highest was from Asia and the Middle East (8.6%). Other factors associated with hypothyroidism were age, hypertension, diabetes mellitus, and dyslipidemia. In addition, we did not observe an effect of hypothyroidism on the course of pregnancy, childbirth, and on the newborn. Finally, there was a good control of the disease during pregnancy. CONCLUSIONS: The prevalence of hypothyroidism in pregnancy was 6,5% in this study which depends on the country of origin, lower values were found in Sub Saharian African women and higher in those from Asia and the Middle East. Hypothyroidism was associated with age, diabetes mellitus, arterial hypertension, or dyslipidemia, and was not related to the Apgar score or the weight of the newborn.

Enterovirus-A71 Rhombencephalitis Outbreak in Catalonia: Characteristics, Management and Outcome.

BACKGROUND: Between April and June 2016, an outbreak of rhombencephalitis (RE) caused by enterovirus (EV) A71 was detected in Catalonia, Spain-the first documented in Western Europe. The clinical characteristics and outcome of patients with this condition differed from those reported in outbreaks occurring in Southeast Asia. METHODS: Observational, multicenter study analyzing characteristics, treatment and outcome of patients with EV-A71 rhombencephalitis diagnosed in 6 publicly funded hospitals within the Catalonian Health Institute. A review of clinical characteristics, diagnosis, treatment and outcome of these patients was conducted. RESULTS: Sixty-four patients met the clinical and virologic criteria for rhombencephalitis caused by EV-A71. All patients had symptoms suggesting viral disease, mainly fever, lethargy, ataxia and tremor, with 30% of hand-foot-mouth disease. Intravenous immunoglobulin therapy was given to 44/64 (69%) patients and methylprednisolone to 27/64 (42%). Six patients (9%) required pediatric intensive care unit admission. Three patients had acute flaccid paralysis of 1 limb, and another had autonomic nervous system (ANS) dysfunction with cardiorespiratory arrest. Outcome in all patients (except the patient with hypoxic-ischemic encephalopathy) was good, with complete resolution of the symptoms. CONCLUSIONS: During the 2016 outbreak, rhombencephalitis without ANS symptoms was the predominant form of presentation and most patients showed no hand-foot-mouth disease. These findings contrast with those of other patient series reporting associated ANS dysfunction (10%-15%) and hand-foot-mouth disease (60%-80%). Complete recovery occurred in almost all cases. In light of the favorable outcome in untreated mild cases, therapies for this condition should be reserved for patients with moderate-severe infection. The main relevance of this study is to provide useful information for setting priorities, management approaches and adequate use of resources in future EV-A71 associated rhombencephalitis outbreaks.

Lactant de 6 setmanes amb tumefacció preauricular I febre d'aparició sobtada / No disponible

No disponible

Infecció per SARS-CoV-2 I escolarització / No disponible

No disponible

Subthreshold yellow laser for fovea-involving diabetic macular edema in a series of patients with good vision: effectiveness and safety of a fovea-sparing technique.

PURPOSE: Patients with center-involved diabetic macular edema (CI-DME) with good visual acuity (VA) represent a controversial clinical scenario in which a subthreshold laser might be a reasonable approach. We report a case series of patients with CI-DME with VA better than 20/32 who were treated with a subthreshold 577 nm (yellow) laser. METHODS: The area of retinal thickening on OCT was treated with confluent laser spots at individually titrated power. The fovea was spared from treatment. Effectiveness and safety were evaluated through OCT and autofluorescence (AF) as well as BCVA. RESULTS: A total of 23 eyes from 19 patients were treated. VA ranged from 20/20 to 20/30. The follow-up period ranged from 6 to 18 months. Edema in OCT resolved completely at the end of follow-up in 56.5% (13/23) of the cases. Central retinal thickness was reduced at 12 weeks and at the end of follow-up, with a mean reduction of 16.9 µm and 22 µm, respectively (paired t-test p = 0.001 and 0.0003). VA remained stable. The laser was invisible (OCT, AF, Fundoscopy) in 91,3% (21/23) of eyes. CONCLUSIONS: A fovea-sparing yellow subthreshold laser was safe and effective for treating CI-DME patients with good VA in this case series. This technique is of interest to prevent the progression of mild edema and might avoid or reduce the use of more invasive and expensive therapies. Excluding the fovea from the treated area does not seem to affect the results, which is of interest to novel laser practitioners.

Diagnòstic retrospectiu d'infecció congènita per citomegalovirus per PCR de prova del taló / Diagnóstico retrospectivo de infección congénita por citomegalovirus por PCR de prueba de talón / Retrospective diagnosis of congenital cytomegalovirus infection

Introducció: el citomegalovirus (CMV) és el principal agent infecciós causant de morbimortalitat infantil d'origen congènit en els països desenvolupats, amb una prevalença d'entre el 0,3 i el 2,4% dels nounats. La presentació clí-nica en el nounat és variable, i en la majoria dels casos és asimptomàtic. Quan la sospita diagnòstica es planteja més enllà dels 15 dies de vida cal fer diagnòstic diferencial amb formes postnatals. S'ha assajat la detecció de citomegalovirus mitjançant tècniques de reacció en cadena de la polimerasa (PCR) en la mostra de sang seca en el paper utilitzat per a la prova de detecció precoç dels nadons. Cas clínic: el primer cas és una lactant de 8 mesos amb microcefàlia detectada als 6 mesos de vida, associada a retard psicomotor global i pobra resposta auditiva. El segon cas és una lactant de 4 mesos derivada per estancament del perímetre cranial. En l'exploració destaca un pobre seguiment visual i hipotonia. En totes dues pacients es va practicar RM cerebral i es van detectar troballes compati-bles amb infecció congènita per citomegalovirus. Es va sol•licitar la mostra de sang seca per fer la determinació de PCR de citomegalovirus i es va confirmar el diagnòstic. Comentaris: la infecció congènita per CMV continua pre-sentant grans interrogants. A Espanya no es fa cribratge serològic sistemàtic per CMV durant l'embaràs. L'únic mètode per distingir entre infecció congènita o adquirida més enllà de les dues setmanes de vida és la realització de PCR per citomegalovirus en la sang utilitzada per la prova del taló

Introducción. El citomegalovirus (CMV) es el principal agente infeccioso causante de morbimortalidad infantil de origen congénito en los países desarrollados, con una prevalencia de entre el 0,3% y el 2,4% de los recién nacidos. La presentación clínica en el recién nacido es variable, y en la mayoría de los casos es asintomático. Cuando la sospecha diagnóstica se plantea más allá de los 15 días de vida hay que hacer diagnóstico diferencial con formas postnatales. Se ha ensayado la detección de citomegalovirus mediante técnicas de reacción en cadena de la polimerasa (PCR) en la muestra de sangre seca en el papel utilizado para la prueba de detección precoz de los recién nacidos. Caso clínico. El primer caso es una lactante de 8 meses con microcefalia detectada a los 6 meses de vida, asociada a retraso psicomotor global y pobre respuesta auditiva. El segundo caso es una lactante de 4 meses derivada por estancamiento del perímetro craneal. En la exploración destaca un pobre seguimiento visual e hipotonía. En ambas pacientes se practicó RM cerebral y se detectaron hallazgos compatibles con infección congénita por citomegalovirus. Se solicitó la muestra de sangre seca para realizar la determinación de PCR de citomegalovirus y se confirmó el diagnóstico. Comentarios. La infección congénita por CMV sigue presentando grandes interrogantes. En España no se realiza cribado serológico sistemático por CMV durante el embarazo. El único método para distinguir entre infección congénita o adquirida más allá de las dos semanas de vida es la realización de PCR por citomegalovirus en la sangre utilizada para la prueba del talón (AU)

Introduction. Cytomegalovirus (CMV) is the leading infectious agent causing congenital infant morbidity and mortality in developed countries, with an estimated prevalence of 0.3% to 2.4% of newborns. The clinical presentation in the newborn is variable, although it is asymptomatic in most cases. When the diagnosis is suspected beyond 15 days of life it is necessary to consider a differential diagnosis with postnatal forms. Detection of CMV DNA by polymerase chain reaction (PCR) of dry blood spots collected for routine neonatal screening from all newborns has been proposed for congenital CMV infection screening. Case report. The first case is an eight months old infant with microcephaly detected at 6 months of life associated with poor auditory response and psychomotor retardation. The second case is a 4 months old infant with stagnation of head circumference. Examination revealed poor visual tracking and hypotonia. In both patients brain MRI disclosed typical alterations associated with congenital CMV infection. Dried blood sample obtained from heel stick at birth was used for determination of CMV infection by PCR. Comments. Congenital CMV infection continues to present major challenges. In Spain no systematic serological screening of CMV is performed during pregnancy. The only method for distinguishing between congenital or acquired infection beyond the two weeks of life is the PCR test using dry blood obtained for newborn screening (AU)

Nen de 3 anys amb tumoració supraclavicular / No disponible

No disponible

Feasibility and safety of an early discharge strategy after low-risk acute myocardial infarction treated with primary percutaneous coronary intervention: the EDAMI pilot trial.

OBJECTIVES: This pilot trial evaluated the feasibility and safety of an early discharge strategy (EDS: ≤72 h, followed by outpatient lifestyle interventions), in comparison with a conventional discharge strategy (CDS) for low-risk (Zwolle risk score ≤3) ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty. METHODS: One hundred patients were randomized to an EDS (n = 54) or a CDS (n = 46). The primary end point was the feasibility of the EDS: (1) ≥70% of EDS patients discharged ≤72 h, (2) ≥70% visited by a nurse ≤7 days after discharge, (3) ≥70% with ≥3 visits by the nurse and (4) ≥70% visited by a cardiologist ≤3 months. RESULTS: The mean age was 59.2 ± 12.2 years and ejection fraction 54.0 ± 7.1%. Eighty-six percent were male (12% diabetics). Vascular access was radial in 91%. Ischemic time was ≤4 h in 75%. Length of stay was shorter in EDS as compared with CDS (70.1 ± 8.1 vs. 111.8 ± 28.3 h, p < 0.001). EDS feasibility was: (1) 72.2%; (2) 81.5%; (3) 76.9%; (4) 72.2%. There were no adverse events or differences in intervention goals and quality of life between groups. CONCLUSIONS: An EDS in low-risk STEMI patients is feasible and seems to be safe. A shorter hospital stay could benefit patients and health care systems.

Chlorhexidine-methanol burns in two extreme preterm newborns.

Safe and effective antiseptic use in neonatal intensive care units is mandatory. High efficacy and a low number of side-effects from chlorhexidine have permitted avoidance of the use of mercurials and iodine derivatives, but methanol use can be unsafe in extreme preterm newborns. We report two cases of chemical burn after skin cleansing, due to alcoholic chlorhexidine (0.5%) use in extremely premature infants used for umbilical catheter insertion. Although this formulation is less concerning for use in full-term newborns, nonalcoholic preparations are preferable for use in preterm newborns.

Aleteo auricular transitorio en recién nacido prematuro / No disponible

No disponible

In vitro lead-induced cell toxicity and cytoprotective activity of fetal calf serum in human fibroblasts.

The underlying mechanisms by which lead ions produce their deleterious effects prior to the onset of clinical symptoms are incompletely understood. This study aimed to assess lead-induced cell toxicity mechanisms by focusing on the effects of the metal on cell growth, DNA synthesis, cellular ATP, intracellular hexosaminidase activity and lysosomal function, and examine the possible cytoprotective role of fetal calf serum (FCS). Several human dermal cultured fibroblast lines were exposed to Pb (400 microM) for 1-6 days with 2, 5, and 10% FCS. The earliest toxic effect of Pb was significant inhibition of DNA synthesis after 24 h direct exposure; this harmful effect was not progressive during the first 3 days, but worsened clearly on the 4th day regardless of the FCS concentration. Atime-dependent depletion of intracellularATP content was also caused by ionic lead, thereby compromising the cell energy charge which precedes cell death. Fibroblast growth was progressively and significantly inhibited from day 2 onwards; the greatest noxious effect was observed in the presence of 2% FCS: 49% reduction in cell proliferation after 5 days. Lead salts produced loss of cell adhesion to the culture dish which worsened from the 2nd day and was more pronounced when FCS in growth medium was decreased. Toxic actions on lysosomal membrane integrity provoked a decrease in neutral red uptake (NRU) which was exposure time-dependent and more marked with 2% FCS. In contrast, increased relative NRU (to 20% at 4 days), suggestive of endocytosis-induced lysosome enlargement, was observed in Pb-exposed cells. Intracellular hexosaminidase activity was not negatively affected until 5 days after exposure to Pb salts. FCS had a significant cytoprotective effect on Pb-induced toxicity.