Evolution, antimicrobial susceptibility and assignment to international clones of methicillin-resistant Staphylococcus aureus isolated over a 9-year period in two Spanish hospitals.

Antimicrobial resistance profiles, restriction fragment length polymorphism of the coagulase gene and repetitive element sequence-based PCR were used to classify 210 methicillin-resistant Staphylococcus aureus isolates recovered between 1997 and 2005 in two hospitals in Vigo, north-west Spain. Representative isolates belonging to the epidemic clones were analysed by spa typing and multilocus sequence typing, and the staphylococcal chromosomal cassette (SCC)mec type was determined for all isolates. The New York/Japan clone (t002-ST5-II) was detected in Spain for the first time. However, the New York/Japan and the Brazilian (t037-ST239-IIIA) clones were replaced by EMRSA-16 (t018-ST36-II), which at present is the predominant clone.

Excreción urinaria de yodo en escolares de Galicia / Urinary iodine excretion among school children in Galicia (Spain)

Introducción: Conocer y valorar el estado nutricional de yodo, mediante la determinación de la yoduria, en los escolares gallegos de 6 a 12 años de edad. Sujetos y método: Se realizó un estudio transversal en los escolares de Educación Primaria de Galicia durante el año 2002. El territorio gallego se dividió en 3 zonas geográficas según criterios dietéticos: urbana, rural interior y rural costa, y en cada una de ellas se seleccionó una muestra de escolares mediante muestreo polietápico. A los niños autorizados se les recogió una muestra ocasional de orina, y se determinó la yoduria mediante la técnica colorimétrica de Dunn. Se estimaron los indicadores del nivel de ingesta de yodo, teniendo en cuenta el tipo de muestreo y se valoraron siguiendo los criterios de la Organización Mundial de la Salud (OMS). Resultados: Se recogieron 2.188 muestras de orina en 88 colegios, 744 en la zona urbana, 725 en la zona rural costa y 719 en el rural interior. La mediana de yoduria fue 102,9 µg/l (intervalo de confianza [IC] del 95%, 100,2-106,0) en Galicia, y 91,3 µg/l (IC del 95%, 86,0-99,9) en la zona rural interior. En global, el porcentaje de niños con yoduria 100 µg/l fue del 48,5% (IC del 95%, 45,0-52,0). Conclusiones: El nivel de ingesta de yodo en los escolares gallegos de 6 a 12 años se encuentra en el límite de lo recomendado por la OMS. Sin embargo, la zona rural interior presenta una yoduria baja, compatible con una ingesta insuficiente de yodo (AU)

Introduction: To identify and asses current iodine nutritional status by determining urinary iodine excretion among school children aged 6-12 years old in Galicia (Spain). Subjects and method: A cross-sectional study was conducted among children in primary schools in Galicia in 2002. The children were selected through multistage cluster sampling in three different geographical areas defined by dietary criteria: urban, inner-rural and coastal-rural. A urine sample was collected from authorized children to measure urinary iodine excretion by the Dunn colorimetric method. Indicators of iodine intake were estimated, taking into account the sample design, and were assessed following World Health Organization (WHO) criteria. Results: A total of 2,188 urine samples were collected in 88 schools: 744 in the urban area, 725 in the inner-rural area and 719 in the coastal-rural area. The median urinary iodine excretion was 102.9 mg/l (95% CI: 100.2-106.0) in Galicia and was 91.3 mg/l (95% CI: 86.0-99.9) in the inner-rural area. Overall, the percentage of children with urinary iodine excretion 100 mg/l was 48.5% (95% CI: 45.0-52.0). Conclusion: The level of iodine intake level among Galician school children aged 6-12 years old is at the limit of WHO recommendations. Nevertheless, urinary iodine levels in the inner-rural area were low, which is compatible with insufficient iodine intake (AU)

Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution.

This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years. Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine. Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001). The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.

Monitoring of treatment success in patients with acromegaly: the value of serum insulin-like growth factor binding protein-3 and serum leptin measurements in comparison to plasma insulin-like growth factor I determination.

The aim of the present study was to determine the value of serum insulin-like growth factor binding protein-3 (IGFBP-3) and serum leptin measurements in comparison with plasma insulin-like growth factor I (IGF-I) measurements as indicators of treatment success in patients with acromegaly. Thirty-five acromegaly patients, 25 female and 10 male, divided into groups of patients with postadenomectomy "active" acromegaly (n = 20) and patients with postadenomectomy "controlled" acromegaly (n = 15), and 44 healthy volunteers sex- and age-matched with the acromegaly patients were included in the present study. We comparatively analyzed plasma IGF-I, serum IGFBP-3, and serum leptin levels in the aforementioned groups. Because serum leptin has sex dimorphism, the groups were divided into sexes when leptin was evaluated. As expected, the patients with active acromegaly had significantly higher mean values of plasma IGF-I and serum IGFBP-3 and lower mean values of serum leptin (only in women) than the control group. However, individual evaluation showed that 1 of 20, 9 of 20, and many patients with postadenomectomy active acromegaly patients had values that overlapped values of control subjects for plasma standard deviation score (SDS)-IGF-I, serum SDS-IGFBP-3, and sex-adjusted serum leptin, respectively. Application of the receiver operating characteristic (ROC) curves method shows that plasma IGF-I measurement has the best discriminatory power to differentiate patients with postsurgical active acromegaly from healthy people. Its area under the curve (AUC) was 0.95, with a sensitivity and specificity of 86% and 94%, respectively. Its positive and negative likelihood ratios were 14 and 0.15. Serum IGFBP-3 has certain discriminatory power, its AUC being 0.89, with a sensitivity and specificity of 83% and 77%. Its positive and negative likelihood ratios were 3.6 and 0.22. Serum leptin, both in women and in men, has a poor performance with sensitivity and specificity of 53% and 50% for women and 55% and 56% for men and positive and negative likelihood ratios of 1.06 and 0.94 for women and 1.26 and 0.8 for men. Application of the ROC curves method and the determination of positive and negative likelihood ratios in comparative evaluation of serum IGFBP-3 and serum leptin with plasma IGF-I as indicators of treatment success in acromegalic patients showed that neither serum IGFBP-3 nor serum leptin determinations have accuracy better than or similar to that of plasma IGF-I for monitoring treatment success in acromegaly patients. Serum IGFBP-3 is accurate but does not increase accuracy for age-adjusted plasma IGF-I, whereas determination of serum leptin level has no value in monitoring these patients.

Effect of iodine supplementation on a pediatric population with mild iodine deficiency.

A cross-sectional study in two stages consisted of healthy children to assess the effect of iodine supplementation on a pediatric population with mild iodine deficiency in an ongoing program in the Province of Pontevedra, northwestern Spain. In the first survey (1984), 1565 schoolchildren and in the second survey (1995) 907 schoolchildren were randomly selected from the population. In January 1985, a mandatory consumption of iodized salt in our region was begun. In both surveys we studied prevalence of goiter, urinary iodine excretion, and prevalence of thyroid dysfunction. Similar prevalences of goiter were observed in both surveys, 3.7% versus 3.9%; however, significantly lower prevalence of Ib and II degree goiters were observed in the second survey. The mean iodine excretion was 88.6 +/- 73 microg/L (median 66.3) and 146.4 +/- 99 microg/L (median 115.7), p < 0.01 for the first and second surveys, respectively. Finally, the overall prevalence of thyroid dysfunction was similar in both surveys, 9.2% versus 7.0%; however, significantly lower prevalence of suppressed serum thyrotropin (TSH), considered as a marker of subclinical hyperthyroidism, was observed in the second survey when compared to the first, 0.1% versus 2%, p < 0.01. Our results are in agreement with the recent data from Denmark, where the prevention of subclinical hyperthyroidism occurring in the elderly as a consequence of longstanding mild iodine deficiency is the reason that the Danish finally started iodine supplementation on a national basis. In conclusion, long-term correction of mild iodine deficiency in a pediatric population has beneficial effects on the prevalence of high-degree goiters, and this correction reduces significantly the prevalence of subclinical hyperthyroidism. The present observation constitutes a strong argument for correcting even mild iodine deficiency.

Prevalence of childhood overweight in Northwestern Spain: a comparative study of two periods with a ten year interval.

OBJECTIVE: To determine the prevalence of overweight children and its modifications over a period of 10 y and whether changes in overweight prevalence is similar in the inland and coastal areas in our country. DESIGN: Cross-sectional study in two stages, the initial survey being in 1985 and the second in 1995. SUBJECTS: 1131 children (827 and 304 from coastal and inland areas respectively) in the initial survey, and 903 children (695 and 208 from coastal and inland areas) in the second survey, of both sexes, aged from 6 to 15 y were selected by a random process from the total school population in the Province of Pontevedra, North-western Spain. MEASUREMENTS: Overweight was defined in terms of body mass index (BMI), using Spanish standards. Children having BMI at or above the 85th percentile were classed as overweight and at or above the 95th percentile as very overweight. RESULTS: Overall prevalence of overweight and very overweight were significantly higher in the second survey than in the first, 18.1% vs 11.7%, P<0.05 for overweight prevalence and 6.8% vs 2.7%, P<0.05 for very overweight prevalence respectively. When we compared modifications in overweight prevalence over the period 10 y between the inland and coastal areas of our country, increase prevalence was observed in the inland area 9.8% vs 19.7%, P<0.05 for initial and secondary surveys respectively, whereas in the coastal area overweight prevalence remains stable, 20.2% vs 17.6%, P>0.05. CONCLUSION: An increased prevalence of overweight children of both sexes in over a period of 10 y was observed, however, this increase was particularly caused by an increased prevalence in the inland area whereas in coastal area it remained stable. We speculate that differences in overweight prevalence between both areas might be due to differences in physical activity associated with different degrees in technological development between inland and coastal areas.

Fine-needle aspiration biopsy of thyroid nodules: impact on clinical practice.

UNLABELLED: The aim of the present study was to analyze the changes in our clinical practice due to the use of FNAB in the management of nodular thyroid disease. Patients attended the thyroid unit for thyroid nodules. The study comprises three periods: First, from January 1980 to May 1984, 226 patient. Second, from June 1985 to December 1990, 166 patients. Third, from January 1991 to December 1993, 403 patients. DESIGN: retrospective the 1st period and prospective the 2nd and 3rd periods. During the 1st and 2nd periods, decision for surgery was based on clinical parameters together with results of 99Tc radionucleotide scan and B mode ultrasound studies. In the 3rd period surgical decision was based principally on cytologic results. We comparatively studied the frequency of surgical operation and frequency of malignancy in surgical thyroid specimens between the study periods. Determination of sensitivity, specificity and accuracy of the diagnostic methods was done. We observed a decrease in the frequency of patients requiring surgery, 89.9%, 67.8% and 46.6% for the 1st, 2nd and 3rd study periods, X2 = 114.7, p < 0.0001; and an increase in the frequency of malignancy in the surgical specimens, 14.7%, 24.4% and 32.9% for 1st, 2nd and 3rd periods respectively, X2 = 4.5, p < 0.05. The sensitivity 92.5% and 93.5%, the specificity 50.6% and 61.1%, and the accuracy 60.9% and 71.8% of the FNAB for the second and third periods respectively. The rates of false negative cytological specimens were 1.8% and 2.1% for 2nd and 3rd respectively, p > 0.05. Since the introduction of FNAB in the evaluation of our patients around 70% of these had a definitive preoperative diagnosis of either benign or malignant disease. Simplification in management of patients with nodular thyroid disease is the most important impact for the use of FNAB. Furthermore, a decrease in the number of patients requiring surgical treatment and an increase of malignant nodules in the specimens obtained by surgery were also observed. We think that FNAB is the most direct and accurate method in the management of patients with thyroid nodules.

Comparative study of insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 (IGFBP-3) level and IGF-I/IGFBP-3 ratio measurements and their relationship with an index of clinical activity in the management of patients with acromegaly.

To evaluate the utility of measuring the serum insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) level and the IGF-I/IGFBP-3 ratio in the management of acromegalic patients, we comparatively studied the basal concentration of the aforementioned parameters with determination of plasma IGF-I levels and an index of clinical activity of acromegaly in 16 newly diagnosed acromegalic patients (aged 34 to 64 years) before and after hypophysectomy. After adenomectomy, 10 patients remained with "active" disease and six were "cured." Twenty-nine healthy sex- and age-matched volunteers were also studied. Comparison of individual values between untreated acromegalic patients and control subjects showed that none of the patients had overlapping values for IGF-I, whereas five of 16 and three of 16 patients had overlapping values for serum IGFBP-3 and IGF-I/IGFBP-3 ratio, respectively. When we compared the study parameters between the patients who remained with active disease after adenomectomy and the controls, two of 10 had overlapping values for IGF-I, but six of 10 and five of 10 had overlapping values for serum IGFBP-3 and IGF-I/IGFBP-3 ratio, respectively. Moreover, comparison of these parameters between cured and active patients after hypophysectomy showed that none had overlapping values for IGF-I, whereas three of six and one of six had overlapping values for serum IGFBP-3 and IGF-I/IGFBP-3 ratio, respectively. All biochemical variables studied showed significant relationships with an index of clinical activity of disease. In conclusion, our results seem to indicate that among determinations of plasma IGF-I, serum IGFBP-3, and the ratio IGF-I/IGFBP-3 in the evaluation of acromegalic patients, measurement of the plasma IGF-I level has the most discriminative value in the management of these patients.

Incidence of different forms of thyroid dysfunction and its degrees in an iodine sufficient area.

STUDY OBJECTIVE: The aim of the study was to determine the incidence of thyroid dysfunction in an iodine sufficient area (Vigo city, Galicia, North-West of Spain). DESIGN: Case-finding study during a 3-year (1990-1992) period. SUBJECTS: Subjects from a random sample of the population with abnormal results on FT4, sensitive-TSH or antithyroid autoantibodies. MEASUREMENTS: Thyroid size by ultrasound study. FT4 by RIA; TSA Ab by radio receptor assays; TSH, Tg Ab and TMS Ab by IRMA. MAJOR RESULTS: Overall incidence of thyroid dysfunction was 97.96 per 100,000 per year (CI 95% 78.86-117.06); female 162.45, male 17.44. Incidence rate of hyperthyroidism was 52.37 per 100,000 per year (CI 95% 38.41-66.36); 24.24 for Graves' disease, 11.63 for nodular hyperthyroidism, 13.57 for iatrogenic hyperthyroidism and 2.90 for others causes. Incidence rate of hypothyroidism was 45.58 per 100,000 per year (CI 95% 32.55-58.620 27.15 for hypothyroid autoimmune thyroiditis, 8.72 for postoperative hypothyroidism, 4.89 for miscellaneous hypothyroidism, 1.93 for amiodarone induced hypothyroidism and 2.90 for secondary hypothyroidism. CONCLUSIONS: This investigation provides extensive data on incidence of clinical and subclinical thyroid dysfunction and its different forms in an iodine sufficient area.

Testicular adrenal-like tissue in a patient with 17 alpha-hydroxylase deficiency.

Testicular adrenal-like tissue (TALT) have been observed in patients with congenital adrenal hyperplasia, and is usually associated with 21-hydroxylase deficiency; in 3 cases with 11 beta-hydroxylase deficiency. We report a case of male pseudohermaphroditism with 17 alpha-hydroxylase deficiency (17OHD) who also had TALT. To our knowledge, this is the first report about the association of 17OHD and TALT. Also, the patient had high levels of serum aldosterone--an unusual finding in patients with 17OHD. A possible pathogenic mechanism is discussed.