Implicaciones clinicoterapéuticas de la deficiencia de yodo en España / Clinical and therapeutic implications of iodine deficiency in Spain

El yodo es un nutriente imprescindible para el organismo humano (esencial para la formación de las hormonas tiroideas), cuya principal fuente de abastecimiento son los pescados de mar y los mariscos; se precisa una ingesta diaria mínima de 100 mg en la primera infancia, 120 hasta la pubertad, 150 en la edad adulta y no menos de 250 durante el embarazo y la lactancia. Hoy día, la Organización Mundial de la Salud estima en más de 2.200 millones de personas en riesgo por habitar en áreas yododeficientes, entre las que se incluye una gran parte de Europa. En España, los estudios realizados confirman también este déficit, que es leve en la población escolar de todas las comunidades autónomas estudiadas, salvo en Asturias, donde el programa de profilaxis con sal yodada iniciado en 1983 ha mostrado tener eficacia. Las gestantes, sin embargo, son el segmento de población más vulnerable, y presentan una marcada deficiencia, que se manifiesta también en los recién nacidos, demostrada por los valores de tirotropina (TSH). Aunque sólo hay 2 estudios en preescolares (Mataró y Asturias), ambos sugieren un estado de nutrición aceptable. Se sabe que la reducción de los trastornos por deficiencia de yodo como grave problema de salud pública ha sido posible con el cambio de los hábitos alimentarios de la población mundial, lo que indica la necesidad de lograr que el consumo de sal yodada en España sea una realidad que alcance al 95% de las familias y, además, que las gestantes y las madres en período de lactancia utilicen suplementos farmacológicos de yodo

Iodine is an essential nutrient for the human organism (for the formation of thyroid hormones), and its main sources are fish and shellfish, requiring a daily minimal intake of 100 micrograms in early childhood, 120 until puberty, 150 in adulthood and not less than 250 during pregnancy and breastfeeding. The World Health Organization estimates that currently 2,200 million persons are at risk for iodine deficiency as they live in iodine-deficient areas, which include a large part of Europe. Studies performed in Spain confirm this deficiency in our country, which is mild in the school-aged population of all the autonomous communities studied, except in Asturias, where the prophylaxis program with iodized salt initiated in 1983 has been shown to be effective. Pregnant women, however, are the most vulnerable segment of the population and show marked iodine deficiency. This deficiency is also manifested in newborns, demonstrated by thyroid-stimulating hormone levels. Although only two studies have been performed in preschool children (Mataró and Asturias) both suggest acceptable nutritional status. It is known that a reduction in iodine deficiency disorders as a serious public health problem can be achieved with a change in diet in the world population, indicating the need to make iodine intake a reality in Spain. Such an intervention should include 95% of families; moreover, pregnant and breastfeeding women should use iodine supplements

Déficit de yodo en España: situación actual / Iodine deficiency in Spain: current situation

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Comparison of the diagnostic criteria for diabetes mellitus, WHO-1985, ADA-1997 and WHO-1999 in the adult population of Asturias (Spain).

AIMS: To estimate the prevalence of diabetes mellitus with three diagnostic criteria (WHO-1985 and 1999 and ADA-1997), evaluate their concordance and analyse the sensitivity and specificity of the different screening strategies for diabetes. METHODS: A cross-sectional population study with two-step sampling. One thousand and 34 people were selected randomly. A 75-g oral glucose tolerance test (OGTT) was performed and venous blood samples were obtained fasting and at 2 h. RESULTS: The prevalence of known Type 2 diabetes mellitus (DM-2) is 4%[95% confidence interval (CI) 2.8, 5.1]. By WHO-1985 criteria the prevalence of unknown DM-2 is 5.9% (4.5, 7.4); by ADA-1997 criteria 3.5% (2.5, 4.6) and by WHO-1999 criteria 7.3% (5.8, 8.8). Diagnostic overlap and statistical concordance (coefficient K) are WHO-1985/ADA-1997 29.3%, K=0.42; WHO-1985/WHO-1999 80%, K=0.88; ADA-1997/WHO-1999 48%, K=0.63. If only fasting glucose was used (following ADA-1997), 36.3% of those with diabetes (2-h glucose > or =11.1 mmol/l) would be diagnosed. If OGTT was performed (i) in those with a fasting glucose between 6.1 mmol/l and 6.9 mmol/l (9.8% of the population) we would diagnose 66.6%, and (ii) in all those between 5.7 mmol/l and 6.9 mmol/l (18.9% of the population) 81.8% would be diagnosed. CONCLUSIONS: The ADA criteria decrease the prevalence of DM in the adult population of Asturias by 2.4% and concordance with the classical criteria (WHO-1985) was only 29.3%. Using fasting glucose only (ADA-1997) diagnoses 36.3% of those with diabetes. The recent recommendations of the WHO-1999 increases this to 66.6%. To improve the diagnostic strategy for diabetes and detect up to 81.8% of patients, we propose the use of OGTT for all those with a fasting glucose between 5.7 mmol/l and 6.9 mmol/l.

[Prevalence of diabetes mellitus and glucose intolerance in the population aged 30 to 75 years in Asturias, Spain]. / Prevalencia de diabetes mellitus e intolerancia a la glucosa en población entre 30 y 75 años en Asturias, España.

OBJECTIVE: To know the prevalence of type 2 diabetes mellitus (DM2) and glucose intolerance (GIT) in the adult population in Asturias. METHODS: Population based, cross-sectional study. A total of 1,034 individuals (54,1%, women) aged 30-75 years were randomly selected. Individuals responded to a questionnaire, underwent physical examination, and an oral glucose overload test; vein blood was extracted to determine both basal and 2-hour glucose levels. The diagnostic criteria set up by the World Health Organization in 1985 were used. RESULTS: The overall DM2 prevalence was 9.9% (8.2% to 11.7%), known DM 4% (2.8% to 5.1%), unknown DM 5.9% (4.5% to 7.4%). The unknown diabetes/hnown diabetes ratio was 1.5/1. The prevalence of GIT was 13.3 % (11.3% to 15.2%). The prevalence of DM for the Segi population (30-64 years) was 8.2% among men and 5.2% among women. Factors independently associated with DM included age, increased blood pressure, family history of diabetes, obesity, and hypertriglyceridemia. CONCLUSION: The prevalence of DM2 in the adult population of Asturias (9.9%) is moderately high and similar to that observed in our country and other white populations in the world. More than half of patients with DM are unaware of their condition; thus, planning strategies for and early diagnosis would be helpful for the high risk populations.

Prevalencia de diabetes mellitus e intolerancia a la glucosa en población entre 30 y 75 años en Asturias, España / Prevalence of diabetes mellitus and glucose intolerance in the population aged 30 to 75 years in Asturias, Spain

Fundamento. Conocer la prevalencia de diabetes mellitus tipo 2 (DM2) e intolerancia a la glucosa (ITG) en la población adulta de Asturias. Métodos. Estudio poblacional transversal. Mil treinta y cuatro personas (54,1 por ciento mujeres) entre 30 y 75 años que fueron seleccionadas aleatoriamente. Se realizó cuestionario, exploración y sobrecarga oral de glucosa con extracción venosa basal y dos horas. Se utilizaron los criterios diagnósticos establecidos por la Organización Mundial de la Salud en 1985.Resultados. Prevalencia de DM2 global 9,9 por ciento (8,2 por ciento-11,7 por ciento), DM conocida 4 por ciento (2,8 por ciento-5,1 por ciento), DM ignorada 5,9 por ciento (4,5 por ciento-7,4 por ciento)- Ratio diabetes ignorada/conocida: 1,5/1. Prevalencia de ITG 13,3 por ciento (11,3 por ciento-15,2 por ciento). Prevalencia de DM para la población de Segi (30-64 años), 8,2 por ciento en varones y 5,2 por ciento en mujeres. Los factores que se asocian a DM de manera independiente son la edad, la hipertensión arterial, tener antecedentes familiares de diabetes, la obesidad y la hipertrigliceridemia. Conclusión. La prevalencia de DM2 en la población adulta de Asturias (9,9 por ciento) es moderadamente elevada y similar a la observada en nuestro país y en otras poblaciones blancas en el mundo. Más de la mitad de las personas con DM desconocen su condición, por lo que podría ser útil plantear estrategias de diagnóstico precoz en los grupos de población de alto riesgo (AU)

Síndrome de cushing por hiperplasia adrenal macronodular bilateral ACTH-independiente / Cushing's syndrome due to ACTH-independent bilateral macronodular adrenal hyperplasia

La hiperplasia suprarrenal macronodular bilateral ACTH-independiente (HAMAI) se considera hoy día una entidad diferente y separada del resto de causas de síndrome de Cushing. Su etiología es incierta aunque en los últimos años se ha demostrado la existencia de respuesta anormal de glándulas suprarrenales a distintas hormonas que estimulan la secreción de cortisol. En este artículo presentamos un caso de hipercortisolismo no suprimible con dexametasona, cifras de ACTH indetectables, hiperplasia suprarrenal bilateral de aspecto nodular y resonancia magnética nuclear hipofisaria normal. Se realizó suprarrenalectomía bilateral, objetivando cifras detectables de ACTH a los 3 meses (AU)

[The nerve endings in contact with the parafollicular cells of the thyroid]. / Etude des terminaisons nerveuses au contact des cellules parafolliculaires de la thyroïde.

We studied nerve endings in the parafollicular cells of thyroid glands in necropsy examinations of 50 young males with no know thyroid disorder. The Jabonero and Maillet techniques. ultrastructural and morphology study were performed together with a statistical analysis of nerve endings. Optic microscope visualized preterminal and exceptionally terminal nerve endings located near parafollicular cells. Swellings of the axons without Schwann's cell sheath were identified close to the par follicular cells with electronic microscopy, these swellings had an ellipsoidal or spherical shape and laid close to the cellular membrane (30 nm). Three types of synaptic-like vesicles were found in these nerve endings. a) Abundant clear vesicles, generally spherical in shape (average diameter 50.40 +/- 5.91 nm); b) A few large granural vesicles with an electron-dense core (average diameter 105.49 +/- 9.98 nm); and c) Several small granular vesicles with an electron-dens core (average diameter 55.09 +/- 6.56 nm). Emphasis should be given to the finding of nerve endings (cholinergic-like, adrenergic-like and peptidergic-like nerve endings) in the parafollicular cells. We discuss their possible function.