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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(1): 36-42, ene. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186145

RESUMO

Introduction: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. Study design: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. Results: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p = 0.007) and had more frequently high TSH levels (>2.5 μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p < 0.001). Conclusions: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain


Introducción: Los procedimientos a seguir para el diagnóstico y tratamiento de la disfunción tiroidea en la gestación no están del todo consensuados. Aún se discute el rango de normalidad de los valores de la hormona estimulante del tiroides (TSH) y el uso de screening para detectar hipotiroidismo gestacional (HG). El objetivo de este estudio es evaluar la forma de diagnóstico y tratamiento de la disfunción tiroidea durante la gestación en un grupo de hospitales de España. Diseño del estudio: Estudio retrospectivo, multicéntrico en mujeres embarazadas con HG atendidas en instituciones sanitarias españolas entre marzo de 2013 y julio de 2014. Las variables analizadas incluyeron criterios diagnósticos de HG (disponibilidad de screening universal para trastornos tiroideos gestacionales y valores de referencia de TSH según el trimestre gestacional); factores de riesgo de HG, ingesta de yodo mediante alimentos o suplementos, edad gestacional (al diagnóstico/tratamiento) y tratamiento con L-tiroxina. Resultados: Participaron un total de 14 centros. Únicamente la mitad de los centros empleaba el screening universal, y solo el 14% tenía valores de referencia de TSH propios. Se incluyeron un total de 257 embarazadas, 53,7% con diagnóstico de hipotiroidismo previo al embarazo (pre-HG) y 46,3% con hipotiroidismo diagnosticado durante el embarazo (intra-HG). Comparando los casos de pre-HG e intra-HG, las mujeres con intra-HG realizaban la primera visita más tarde (antes de la semana 12; 59,7% vs. 75,4% respectivamente, p = 0,007) y tenían más frecuentemente valores elevados de TSH (> 2,5 μUI/ml) durante el primer trimestre (94,4% vs. 67,0% respectivamente, p < 0,001). Conclusiones: Nuestros resultados sugieren que el HG puede estar infradiagnosticado o diagnosticado indebidamente en la mayoría de los centros sanitarios. Estos hallazgos sugieren la necesidad de mejorar la práctica actual en España


Assuntos
Humanos , Feminino , Gravidez , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Complicações na Gravidez/terapia , Fatores de Risco , Hipotireoidismo/complicações , Estudos Retrospectivos , Iodo/uso terapêutico , Suplementos Nutricionais , Idade Gestacional , Tiroxina/uso terapêutico
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1173-1175, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683409

RESUMO

Iodine nutrition surveillance of vulnerable population was conducted in 18 cities of Henan Province in 2015. The medians and quartiles of urinary iodine concentration in women of reproductive-age (n=3 318), pregnant women (n=36 366), lactating women (n=4 153), infants <2 years of age (n=1 017), and children aged 8-10 years (n=4 806) were 202.1(124.0, 310.0), 192.4(133.6, 262.4), 168.3(119.1, 248.3), 214.2(156.1, 272.3) and 90.0 (121.8, 285.6) µg/L, respectively. Iodine status of the vulnerable populations was generally regarded as adequate in Henan Province. But the median of urinary iodine concentration of reproductive-age women were slightly above the adequate level. The proportions above iodine adequate level were 26.7% in reproductive-age women, 29.4% in pregnant women and 22.5% in children aged 8-10 years.


Assuntos
Iodo/sangue , Iodo/deficiência , Estado Nutricional , Cloreto de Sódio na Dieta/administração & dosagem , Populações Vulneráveis , Adulto , Criança , Pré-Escolar , China , Cidades , Estudos Transversais , Feminino , Humanos , Lactente , Iodo/administração & dosagem , Iodo/uso terapêutico , Lactação , Masculino , Vigilância da População , Gravidez , Cloreto de Sódio na Dieta/uso terapêutico
3.
J Comput Assist Tomogr ; 43(4): 612-618, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268876

RESUMO

OBJECTIVE: The aim of this study was to determine if computed tomography (CT) angiography using an individualized transition delay (CTA-ID) would facilitate reductions in injection rate and iodine dose. METHODS: The CTA-ID was performed in 20 patients with routine injection rate and iodine dose; 20 patients with injection rate lowered by 1 mL/s; and 40 patients with injection rate lowered by 1 mL/s with 29% less iodine. Routine CTAs in the same or size-matched patients served as controls. Diagnostic image quality and intra-arterial CT numbers were assessed. RESULTS: The median transition delay between aortic threshold and CTA-ID image acquisition was significantly longer than with conventional bolus tracking (mean increase, 13.3 seconds; P < 0.0001), with image quality being the same or better. Intra-arterial CT numbers were 200 Hounsfield units or greater for 80 of 80 CTA-ID, but not for 6 of 49 (12%) internal control or for 11 of 80 (14%) size-matched control patients. CONCLUSION: The CTA-ID bolus-tracking software alters transition delays to permit diagnostic CTA examinations despite slower injection rate and less iodine.


Assuntos
Abdome , Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste , Iodo , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Meios de Contraste/administração & dosagem , Meios de Contraste/uso terapêutico , Humanos , Iodo/administração & dosagem , Iodo/uso terapêutico , Masculino , Radiografia Abdominal , Estudos Retrospectivos , Fatores de Tempo
4.
J Comput Assist Tomogr ; 43(4): 599-604, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162238

RESUMO

OBJECTIVE: The objective of this study was to evaluate the role and limit of iodine maps by dual-energy computed tomography (CT) single scan for pancreatic cancer. METHODS: Thirty patients with suspected solitary pancreatic cancer were enrolled in this study and underwent CT perfusion and iodine maps. The parameters of pancreatic cancer and normal pancreatic tissue were calculated. Pearson correlation and paired t test were used for evaluating 2 techniques. RESULTS: Iodine concentration had a moderate positive correlation with blood flow or blood volume (P < 0.05 for both). All values of iodine concentration and blood flow, iodine concentration, and blood volume had significant positive correlations (P < 0.001 for both). The mean effective dose for CT perfusion and iodine maps had significant difference (8.61 ± 0.00 mSv vs 1.13 ± 0.14 mSv, P < 0.001). CONCLUSIONS: Iodine maps had the potential to replace routine CT perfusion for pancreatic cancer with low radiation dose.


Assuntos
Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/epidemiologia , Imagem de Perfusão , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Tomografia Computadorizada por Raios X , Idoso , Meios de Contraste/uso terapêutico , Feminino , Humanos , Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Doses de Radiação
5.
BMC Cancer ; 19(1): 261, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30902074

RESUMO

BACKGROUND: The immune system is a crucial component in cancer progression or regression. Molecular iodine (I2) exerts significant antineoplastic effects, acting as a differentiation inductor and immune modulator, but its effects in antitumor immune response are not elucidated. METHODS: The present work analyzed the effect of I2 in human breast cancer cell lines with low (MCF-7) and high (MDA-MB231) metastatic potential under both in vitro (cell proliferation and invasion assay) and in vivo (xenografts of athymic nude mice) conditions. RESULTS: In vitro analysis showed that the 200 µM I2 supplement decreases the proliferation rate in both cell lines and diminishes the epithelial-mesenchymal transition (EMT) profile and the invasive capacity in MDA-MB231. In immunosuppressed mice, the I2 supplement impairs implantation (incidence), tumoral growth, and proliferation of both types of cells. Xenografts of the animals treated with I2 decrease the expression of invasion markers like CD44, vimentin, urokinase plasminogen activator and its receptor, and vascular endothelial growth factor; and increase peroxisome proliferator-activated receptor gamma. Moreover, in mice with xenografts, the I2 supplement increases the circulating level of leukocytes and the number of intratumoral infiltrating lymphocytes, some of them activated as CD8+, suggesting the activation of antitumor immune responses. CONCLUSIONS: I2 decreases the invasive potential of a triple negative basal cancer cell line, and under in vivo conditions the oral supplement of this halogen activates the antitumor immune response, preventing progression of xenografts from laminal and basal mammary cancer cells. These effects allow us to propose iodine supplementation as a possible adjuvant in breast cancer therapy.


Assuntos
Antineoplásicos/farmacologia , Neoplasias da Mama/tratamento farmacológico , Imunidade Celular/efeitos dos fármacos , Iodo/farmacologia , Animais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/imunologia , Neoplasias da Mama/patologia , Linfócitos T CD8-Positivos/efeitos dos fármacos , Linfócitos T CD8-Positivos/imunologia , Movimento Celular/efeitos dos fármacos , Movimento Celular/imunologia , Proliferação de Células/efeitos dos fármacos , Feminino , Fatores de Transcrição Forkhead/genética , Humanos , Iodo/uso terapêutico , Linfócitos do Interstício Tumoral/efeitos dos fármacos , Linfócitos do Interstício Tumoral/imunologia , Camundongos , Camundongos Nus , Camundongos Transgênicos , Invasividade Neoplásica/imunologia , Invasividade Neoplásica/prevenção & controle , Ensaios Antitumorais Modelo de Xenoenxerto
7.
J Foot Ankle Surg ; 58(2): 278-281, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30612875

RESUMO

No consensus exists regarding which cleansing technique, solution, and concentration should be used in orthopedic surgery. The aim of this randomized, controlled trial was to compare the effect of chlorhexidine 0.5%/70% alcohol with iodine 1%/70% alcohol on lowering positive cultures before elective foot surgery and to study any wound complications, infections and allergic reactions. Consecutive patients ≥18 years of age scheduled for a hallux valgus correction or arthrodesis of the first metatarsophalangeal joint were included. Swabs were taken from 2 sites before and twice after preparing the skin and were quantitatively and qualitatively analyzed. The study group consisted of 49 patients with a mean age of 52.3 ± 14.4 (range 22 to 75) years of whom 42 (86%) were female. No significant differences were observed for positive cultures between the chlorhexidine (73%, 2%, and 12%) and iodine (68%, 7%, and 9%) group at any time point. Coagulase-negative staphylococci were the most commonly isolated micro-organisms found after skin preparation. Occasionally, Bacillus spp and Corynebacterium spp were cultured. The complication rate 2 weeks postoperatively was 0% in the chlorhexidine group versus 8.7% (n = 2) in the iodine group (delayed wound healing; p = .215). The complication rate at 6 weeks postoperatively was, respectively, 3.8% (n = 1) versus 4.3% (n = 1; both showed swelling and redness; p > .999). There was no significant difference in postoperative wound problems or infection rates between the 2 skin preparation solutions. Chlorhexidine 0.5%/70% alcohol and iodine 1%/70% alcohol both decreased the amount of positive cultures in elective foot surgery.


Assuntos
Clorexidina/uso terapêutico , Desinfetantes/uso terapêutico , Iodo/uso terapêutico , Procedimentos Ortopédicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Carga Bacteriana/efeitos dos fármacos , Etanol/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Medição de Risco , Resultado do Tratamento , Adulto Jovem
8.
Nutrients ; 11(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30650544

RESUMO

In Australia, pregnant women are advised to take an iodine supplement (I-supp) (150 µg/day) to reduce risks to the foetus associated with iodine deficiency (ID). To examine the impact of this recommendation on iodine status, and to identify factors that contribute to adequacy during gestation, supplement use and Urinary Iodine Concentration (UIC) was measured in 255 pregnant women (gestation range 6 to 41 weeks) in Tasmania. The median UIC (MUIC) of 133 µg/L (Inter-quartile range 82⁻233) was indicative of ID, being below the 150⁻249 µg/L range for adequacy during pregnancy. Women taking an iodine-containing-supplement (I-supp) had a significantly higher MUIC (155 µg/L) (n = 171) compared to the combined MUIC (112.5 µg/L) (n = 84) of those who had never (120 µg/L) (n = 61) or were no longer taking an I-supp (90 µg/L) (n = 23) (p = 0.017). Among women reporting I-supp use, the MUIC of those commencing the recommended 150 µg/day prior to conception was significantly higher than those starting supplementation following pregnancy confirmation: 196 (98⁻315) µg/L (n = 45) versus 137.5 (82.5⁻233.5) µg/L (n = 124), p = 0.032. Despite recommendations for iodine supplementation pregnant Tasmanian women remain at risk of ID. Commencing an I-supp of 150 µg/day prior to conception and continuing throughout pregnancy is required to ensure adequacy. Timely advice regarding the importance of adequate iodine nutrition, including supplementation is needed to reduce the risk of irreversible in utero neurocognitive damage to the foetus.


Assuntos
Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais , Iodo/uso terapêutico , Estado Nutricional , Cuidado Pré-Concepcional , Complicações na Gravidez/prevenção & controle , Adolescente , Adulto , Austrália , Deficiências Nutricionais/complicações , Feminino , Fertilização , Humanos , Iodo/deficiência , Iodo/urina , Pessoa de Meia-Idade , Gravidez , Tasmânia , Adulto Jovem
9.
Diabetes Metab Syndr ; 13(1): 678-680, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641788

RESUMO

The aim of this Study is to investigate whether the Iodine Supplementation Programme is successful or not. This Programme was implemented in Nyala to treat the Iodine deficiency. In this Study Nyala was selected to act as (a study area), due to the history of Iodine deficiency of this region, while Khartoum was selected to act as (a control area). 2000 samples were collected from Khartoum versus 450 samples from Nyala. Thyroxine (T4) and triiodothyronine (T3) levels in two regions were measured and performed by using radioimmunoassay (RIA), also the immunoradiometric assay (IRMA) used for measurement of thyroid stimulating hormone (TSH). The obtained results analyzed by using Statistical Package for Social Sciences (SPSS). (Coherent retrospective) used to determine differences between the study groups. The results of this study showed, there was no significant difference between the mean serum concentrations of T3 and TSH for Khartoum and Nyala. T4of Khartoum (117.93 ±â€¯42.797) nmol/L and the mean serum T4 of Nyala (114.54 ±â€¯45.526) nmol/L, the (P-value = 0.133).T3for Khartoum (1.8040 ±â€¯0.99047) nmol/L and T3of Nyala (1.7307 ±â€¯0.96508) nmol/L, the (P-value = 0.153). TSH for Khartoum (1.4480 ±â€¯0.95807)mIU/Land the mean serum TSH of Nyala (1.4553 ±â€¯1.0244) mIU/L, the (P-value = 0.885). The study showed a clear observation of improvement of hypothyroidism cases in Nyala while the ratio decreased from 64.09% to 0.6%. All the results were carried out according to normal range of Sudanese. The conclusion from this study the iodine supplementation programme is successful. The study recommends rising the health awareness among people by explain the severity of iodine deficiency, and continue in iodine supplementation programme, also establishment of monitoring system including monitoring the presence of iodized diets (sugar, salt, oils, and bread) in the markets. Finally, further studies are needed in other parts of Sudan to assess the size of iodine deficiency problem.


Assuntos
Suplementos Nutricionais , Iodo/uso terapêutico , Glândula Tireoide/fisiologia , Humanos , Iodo/sangue , Iodo/deficiência , Programas Nacionais de Saúde , Sudão , Resultado do Tratamento
10.
Tidsskr Nor Laegeforen ; 139(2)2019 01 29.
Artigo em Norueguês | MEDLINE | ID: mdl-30698392

RESUMO

BACKGROUND: In 2016, the Norwegian National Nutrition Council concluded that inadequate iodine intake is widespread in sections of the Norwegian population, and that effective measures should be undertaken immediately. This literature review aims to summarise articles published since January 2016 that describe the iodine intake in Norway. MATERIAL AND METHOD: Literature searches were conducted in PubMed and Embase. Altogether thirteen articles that reported intake of iodine from the diet or urinary iodine concentration were included. RESULTS: The recent studies confirm that inadequate iodine intake is widespread among women of fertile age, pregnant and breastfeeding women, infants who are exclusively breastfed, elderly persons, vegans and immigrants. There are few sources of iodine in the diet, and persons who avoid or have a low intake of milk and white fish are particularly vulnerable. INTERPRETATION: Inadequate iodine intake is a matter of particular concern in women of fertile age. Healthcare personnel should be aware of this and in certain cases recommend iodine-rich foods or iodine supplements to these and other vulnerable groups.


Assuntos
Iodo , Estado Nutricional , Adolescente , Adulto , Idoso , Aleitamento Materno , Criança , Pré-Escolar , Dieta , Suplementos Nutricionais , Emigrantes e Imigrantes , Feminino , Humanos , Lactente , Iodo/administração & dosagem , Iodo/deficiência , Iodo/uso terapêutico , Iodo/urina , Fenômenos Fisiológicos da Nutrição Materna , Leite Humano/química , Noruega , Gravidez , Complicações na Gravidez , Recomendações Nutricionais , Veganos
11.
Biomaterials ; 188: 12-23, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30317112

RESUMO

To improve the inherent defects of chemotherapy and photothermal therapy (PTT), we design a novel thermochromism-induced temperature self-regulation and alternating photothermal system based on iodine (I2)-loaded acetylated amylose nanohelix clusters (ILAA NHCs) under the guidance of molecular dynamic simulation in which I2 is loaded into the helical cavity of acetylated amylose (AA) by hydrophobic interaction. ILAA NHCs perform versatile photothermal conversion through their unique reversible thermochromism. Upon irradiation, I2 is gradually released and the ILAA NHCs turn into colorless. The laser is then penetrated deeply into the tissue for deep-seated heating, and the ILAA NHCs' color can be recovered by reversible thermochromism because of I2 reloading into the ILAA NHCs. When the process is repeated, the temperature can be controlled in a certain range. This alternating light-to-heat conversion significantly improve the effect of PTT. Meanwhile, I2 efficiently acts dual functions of chemotherapy and PTT. Results show that the photothermal depth by ILAA NHCs is 2.1-fold than other common photothermal agents (PTAs), and the irradiated region exhibits a lower surface temperature. In vitro and in vivo experiments both provide ILAA NHCs an excellent comprehensive antitumor effect with synergistic chemo/PTT, indicating versatile potential for tumor chemo/PTT.


Assuntos
Antineoplásicos/uso terapêutico , Hipertermia Induzida/métodos , Iodo/uso terapêutico , Neoplasias/terapia , Amilose/análogos & derivados , Animais , Antineoplásicos/administração & dosagem , Terapia Combinada/métodos , Portadores de Fármacos/química , Células HeLa , Humanos , Iodo/administração & dosagem , Luz , Masculino , Camundongos Endogâmicos BALB C , Camundongos Nus , Simulação de Dinâmica Molecular , Fototerapia/métodos
12.
Trop Anim Health Prod ; 51(4): 905-910, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30554365

RESUMO

Dermatophytosis is a contagious fungal disease among animal communities. The major concerns of dermatophytosis are cost of treatment, difficulty of control, and the public health consequences. The objective of the present study was to compare the clinical efficacy of Sumaq and Neem extract cream with that of traditional treatments, eniloconazole and glycerine iodine, on dermatophytosis in Arabian horses. For this purpose, 37 Arabian horses with dermatophytosis had been used. Fungal isolation and identification for each horse were carried out by standard microbiological procedures. Sumaq (Rhus coriaria Linn.) and Neem (Azadirachta indica) seed extracts were selected based on in vitro effectiveness. Horses were randomly allocated into four groups. The first group (n = 8) was treated with glycerine iodine 10% daily for 7 days. The second group (n = 10) was treated using eniloconazole 10% emulsified concentrate four times with 2 days interval. The third group (n = 11) was treated with Neem seeds extract (20% cream) daily for 10 days, and the fourth group (n = 8) was treated with Sumaq extract (5% cream) daily for 10 days. Clinical and mycological evaluations were assessed at 0, 7, 14, 21, and 28 days post-treatment. The Sumaq and eniloconazole were more effective on clinical index score after 7 days of treatment followed by Neem seed 20% cream. At 28 days post-treatment, a complete healing was obtained by Sumaq 5% cream and eniloconazole (median clinical sum score = zero) followed by Neem (median clinical sum score = 1.5). Moreover, Dermatophytes spp. was isolated only from two horses, one from Neem group and the other from glycerin iodine group. The present results indicate that Sumaq 5% and Neem seed extract are effective alternative treatment for dermatophytosis in Arabian horses.


Assuntos
Azadirachta , Doenças dos Cavalos/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Rhus , Tinha/veterinária , Animais , Glicerol , Cavalos , Iodo/uso terapêutico , Fitoterapia/veterinária , Sementes , Tinha/tratamento farmacológico
13.
Cochrane Database Syst Rev ; 10: CD007462, 2018 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-30346040

RESUMO

BACKGROUND: The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section (CS) than for vaginal birth. With the increasing rate of CS, it is important to minimise the risks to the mother as much as possible. This review focused on different forms and methods of preoperative skin preparation to prevent infection. This review is an update of a review that was first published in 2012, and updated in 2014. OBJECTIVES: To compare the effects of different antiseptic agents, different methods of application, or different forms of antiseptic used for preoperative skin preparation for preventing postcaesarean infection. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (27 November 2017), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised trials, evaluating any type of preoperative skin preparation agents, forms, and methods of application for caesarean section.Comparisons of interest in this review were between different antiseptic agents used for CS skin preparation (e.g. alcohol, povidone iodine), different methods of antiseptic application (e.g. scrub, paint, drape), different forms of antiseptic (e.g. powder, liquid), and also between different skin preparations, such as a plastic incisional drape, which may or may not be impregnated with antiseptic agents.Only studies involving the preparation of the incision area were included. This review did not cover studies of preoperative handwashing by the surgical team or preoperative bathing. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed all potential studies for inclusion, assessed risk of bias, and extracted the data using a predesigned form. We checked data for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: For this update, we included 11 randomised controlled trials (RCTs), with a total of 6237 women who were undergoing CS. Ten trials (6215 women) contributed data to this review. All included studies were individual RCTs. We did not identify any quasi- or cluster-RCTs. The trial dates ranged from 1983 to 2016. Six trials were conducted in the USA, and the remainder in Nigeria, South Africa, France, Denmark, and Indonesia.The included studies were broadly methodologically sound, but raised some specific concerns regarding risk of bias in a number of cases.Drape versus no drapeThis comparison investigated the use of a non-impregnated drape versus no drape, following preparation of the skin with antiseptics. For women undergoing CS, low-quality evidence suggested that using a drape before surgery compared with no drape, may make little or no difference to the incidence of surgical site infection (risk ratio (RR) 1.29, 95% confidence interval (CI) 0.97 to 1.71; 2 trials, 1294 women), or length of stay in the hospital (mean difference (MD) 0.10 day, 95% CI -0.27 to 0.46 1 trial, 603 women).One-minute alcohol scrub with iodophor drape versus five-minute iodophor scrub without drapeOne trial compared an alcohol scrub and iodophor drape with a five-minute iodophor scrub only, and reported no surgical site infection in either group (79 women, very-low quality evidence). We were uncertain whether the combination of a one-minute alcohol scrub and a drape reduced the incidence of endomyometritis when compared with a five-minute scrub, because the quality of the evidence was very low (RR 1.62, 95% CI 0.29 to 9.16; 1 trial, 79 women).Parachlorometaxylenol with iodine versus iodine aloneWe were uncertain whether parachlorometaxylenol with iodine before CS made any difference to the incidence of surgical site infection (RR 0.33, 95% CI 0.04 to 2.99; 1 trial, 50 women), or endometritis (RR 0.88, 95% CI 0.56 to 1.38; 1 trial, 50 women) when compared with iodine alone, because the quality of the evidence was very low.Chlorhexidine gluconate versus povidone iodineLow-quality evidence suggested that chlorhexidine gluconate before CS, when compared with povidone iodine, may make little or no difference to the incidence of surgical site infection (RR 0.80, 95% CI 0.62 to 1.02; 6 trials, 3607 women). However, surgical site infection appeared to be slightly reduced for women for whom chlorhexidine gluconate was used compared with povidone iodine after we removed four trials at high risk of bias for outcome assessment, in a sensitivity analysis (RR 0.59, 95% CI 0.37 to 0.95; 2 trials, 1321 women).Low-quality evidence indicated that chlorhexidine gluconate before CS, when compared with povidone iodine, may make little or no difference to the incidence of endometritis (RR 1.01, 95% CI 0.51 to 2.01; 2 trials, 2079 women), or to reducing maternal skin irritation or allergic skin reaction (RR 0.60, 95% CI 0.22 to 1.63; 2 trials, 1521 women).One small study (60 women) reported reduced bacterial growth at 18 hours after CS for women who had chlorhexidine gluconate preparation compared with women who had povidone iodine preparation (RR 0.23, 95% CI 0.07 to 0.70).None of the included trials reported on maternal mortality or repeat surgery.Chlorhexidine 0.5% versus 70% alcohol plus drapeOne trial, which was only available as an abstract, investigated the effect of skin preparation on neonatal adverse events, and found cord blood iodine concentration to be higher in the iodine group. AUTHORS' CONCLUSIONS: There was insufficient evidence available from the included RCTs to fully evaluate different agents and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most effective for preventing postcaesarean surgical site infection, or for reducing other undesirable outcomes for mother and baby.Most of the evidence in this review was deemed to be very low or low quality. This means that for most findings, our confidence in any evidence of an intervention effect is limited, and indicates the need for more high-quality research.This field needs high quality, well designed RCTs, with larger sample sizes. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), and application methods (scrubbing, swabbing, or draping). We found four studies that were ongoing; we will incorporate the results of these studies in future updates of this review.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Cesárea/efeitos adversos , Endometrite/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Bandagens , Clorexidina/uso terapêutico , Etanol/uso terapêutico , Feminino , Humanos , Iodo/uso terapêutico , Iodóforos/uso terapêutico , Tempo de Internação , Povidona-Iodo/uso terapêutico , Gravidez , Cuidados Pré-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Campos Cirúrgicos , Xilenos/uso terapêutico
14.
Zhonghua Gan Zang Bing Za Zhi ; 26(4): 298-304, 2018 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-29996343

RESUMO

Objective: To explore the factors affecting the prognosis of patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT), and to analyze the clinical value of transcatheter arterial chemoembolization (TACE) combined with iodine-125 seed implantation in such patients. Methods: A retrospective analysis of 53 patients with HCC combined with PVTT was performed. In the study group, 32 cases were treated with TACE combined with iodine-125 seed implantation, and 21 cases in the control group were treated with TACE combined with sorafenib. Survival analysis was carried out on eight factors such as gender, age, Child-Pugh classification, alpha fetoprotein level, portal vein tumor thrombosis (PVTT) type, forms of liver tumor, extra-hepatic metastasis and treatment modalities. The efficacy of TACE combined with iodine-125 seed implantation and TACE combined with sorafenib was further compared. The χ (2) test was used to evaluate the efficacy of the two groups. A single factor survival analysis was calculated by Kaplan-Meier estimator and multifactor survival analysis by Cox proportional hazards model. Results: All 53 patients were successfully treated. The median tumor progression time (mTTP) and median overall survival (mOS) were 8 months and 11 months, respectively. The disease control rate (DCR) of the study group for PVTT was 93.8%, which was significantly higher than that of the control group (61.9%, χ (2) = 6.448, P = 0.011). The difference was statistically significant; the objective remission rate of the study group for PVTT was 75.0%. Significantly higher than 9.5% in the control group, P < 0.05, the difference was statistically significant; the DCR of the primary tumor in the study group was 50.0%, which was lower than the 70.0% of the PVTT in the control group, P = 0.231, the difference was not statistically significant. The progression of primary HCC lesions in patients with multivariate survival analysis: Child-Pugh grade A patients were compared to grade B [Hazard ratio (HR) = 0.236, P = 0.003]; no extra-hepatic metastasis (HR = 0.258, P = 0.002); and TACE combined with iodine-125 seed implantation group compared with TACE combined sorafenib group (HR = 0.372, P = 0.002), the differences were statistically significant. Multivariate survival analysis of patients with overall survival: AFP < 400 ng/mL vs. AFP≥400 ng/mL (HR = 0.389, P = 0.030); Child-Pugh grade A vs. B (HR = 0.263, P = 0.006); and no extra-hepatic metastasis (HR = 0.306, P = 0.006), the differences were statistically significant. Conclusion: TACE combined with iodine-125 seed implantation for the treatment of HCC with PVTT can effectively control the progression of PVTT and intrahepatic lesions and improve the prognosis of patients.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Radioisótopos do Iodo , Iodo/uso terapêutico , Neoplasias Hepáticas/terapia , Veia Porta/patologia , Sorafenibe/uso terapêutico , Trombose Venosa/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica/métodos , Criança , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Estudos Retrospectivos , Trombose , Resultado do Tratamento , Trombose Venosa/complicações
15.
Endocrinol Diabetes Nutr ; 65(8): 458-467, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30030155

RESUMO

Iodine is an essential component of thyroid hormones, and iodine deficit is the leading cause of preventable mental retardation worldwide. Spain was considered iodine-deficient until 2003. Although iodine urinary levels have been in the optimal range in Spain since 2004, the WHO recognizes that our country does not meet the necessary requirements to ensure that the whole population is not at risk of an iodine deficiency disorder. The aim of this article is to review the current iodine status in Spain. Data from several studies emphasize the low consumption of iodized salt at home. Despite the progress made in recent decades, Spanish children are not exempt from suffering an iodine deficiency disorder. Policies that allow for controlling iodine nutrition and promote universal consumption of iodized salt should therefore be implemented.


Assuntos
Iodo/deficiência , Iodo/uso terapêutico , Criança , Deficiências Nutricionais/tratamento farmacológico , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/urina , Humanos , Iodo/urina , Estado Nutricional , Espanha/epidemiologia
16.
Adv Nutr ; 9(3): 207-218, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29767699

RESUMO

Double-fortified salt (DFS) containing iron and iodine has been proposed as a feasible and cost-effective alternative for iron fortification in low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis from randomized and quasi-randomized controlled trials to 1) assess the effect of DFS on biomarkers of iron status and the risk of anemia and iron deficiency anemia (IDA) and 2) evaluate differential effects of DFS by study type (efficacy or effectiveness), population subgroups, iron formulation (ferrous sulfate, ferrous fumarate, and ferric pyrophosphate), iron concentration, duration of intervention, and study quality. A systematic search with the use of MEDLINE, EMBASE, Cochrane, Web of Science, and other sources identified 221 articles. Twelve efficacy and 2 effectiveness studies met prespecified inclusion criteria. All studies were conducted in LMICs: 10 in India, 2 in Morocco, and 1 each in Côte d'Ivoire and Ghana. In efficacy studies, DFS increased hemoglobin concentrations [standardized mean difference (SMD): 0.28; 95% CI: 0.11, 0.44; P < 0.001] and reduced the risk of anemia (RR: 0.59; 95% CI: 0.46, 0.77; P < 0.001) and IDA (RR 0.37; 95% CI: 0.25, 0.54; P < 0.001). In effectiveness studies, the effect size for hemoglobin was smaller but significant (SMD: 0.03; 95% CI: 0.01, 0.05; P < 0.01). Stratified analyses of efficacy studies by population subgroups indicated positive effects of DFS among women and school-age children. For the latter, DFS increased hemoglobin concentrations (SMD: 0.32; 95% CI: 0.03, 0.60; P < 0.05) and reduced the risk of anemia (SMD: 0.48; 95% CI: 0.34, 0.67; P < 0.001) and IDA (SMD: 0.37; 95% CI: 0.25, 0.54; P < 0.001). Hemoglobin concentrations, anemia prevalence and deworming at baseline, sample size, and study duration were not associated with effect sizes. The results indicate that DFS is efficacious in increasing hemoglobin concentrations and reducing the risk of anemia and IDA in LMIC populations. More effectiveness studies are needed.


Assuntos
Anemia/prevenção & controle , Alimentos Fortificados , Hemoglobinas/metabolismo , Iodo/uso terapêutico , Ferro na Dieta/uso terapêutico , Ferro/uso terapêutico , Cloreto de Sódio na Dieta , Adulto , Anemia/sangue , Anemia Ferropriva/sangue , Anemia Ferropriva/prevenção & controle , Criança , Países em Desenvolvimento , Feminino , Humanos , Iodo/farmacologia , Ferro/sangue , Ferro/deficiência , Ferro/farmacologia , Ferro na Dieta/sangue , Ferro na Dieta/farmacologia , Masculino , Gravidez
17.
Adv Nutr ; 9(3): 219-237, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29767700

RESUMO

Hypothyroidism due to iodine deficiency can impair physical development, most visibly in the marked stunting of myxedematous cretinism caused by severe in utero iodine deficiency. Whether iodine repletion improves growth in noncretinous children is uncertain. Therefore, the aim of our systematic review was to assess the effects of iodine fortification or supplementation on prenatal and postnatal growth outcomes in noncretinous children. Following Cochrane methods and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we searched 10 databases including 2 Chinese databases (latest search February 2017). We included randomized and nonrandomized controlled trials (RCTs; non-RCTs), controlled before-after (CBA) studies, and interrupted time-series studies in pregnant women and children (≤18 y), which compared the effects of iodine (any form, dose, regimen) to placebo, noniodized salt, or no intervention on prenatal and postnatal growth outcomes. We calculated mean differences with 95% CIs, performed random-effects meta-analyses, and assessed the quality of evidence with the use of GRADE (Grading of Recommendations Assessment, Development and Evaluation). We included 18 studies (13 RCTs, 4 non-RCTs, 1 CBA) (n = 5729). Iodine supplementation of severely iodine-deficient pregnant women increased mean birthweight [mean difference (MD): 200 g; 95% CI: 183, 217 g; n = 635; 2 non-RCTs] compared to controls, but the quality of this evidence was assessed as very low. Iodine repletion across the other groups showed no effects on primary growth outcomes (quality of evidence mostly low and very low). Meta-analyses showed a positive effect in moderate-to-mildly iodine-deficient schoolchildren on insulin-like growth factor-1 (MD: 38.48 ng/mL; 95% CI: 6.19, 70.76 ng/mL; n = 498; 2 RCTs, low-quality evidence) and insulin-like growth factor binding protein-3 (MD: 0.46 µg/mL; 95% CI: 0.25, 0.66 µg/mL; n = 498; 2 RCTs, low-quality evidence). In conclusion, we identified few well-designed trials examining the effects of iodine repletion on growth. We are uncertain whether prenatal iodine repletion increases infant growth. Postnatal iodine repletion may improve growth factors but has no clear effects on somatic growth. Our systematic review was registered with PROSPERO as CRD42014012940.


Assuntos
Deficiências Nutricionais/complicações , Suplementos Nutricionais , Retardo do Crescimento Fetal/prevenção & controle , Alimentos Fortificados , Transtornos do Crescimento/prevenção & controle , Iodo/uso terapêutico , Cloreto de Sódio na Dieta , Peso ao Nascer/efeitos dos fármacos , Feminino , Retardo do Crescimento Fetal/etiologia , Transtornos do Crescimento/etiologia , Humanos , Iodo/deficiência , Iodo/farmacologia , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cloreto de Sódio na Dieta/farmacologia , Cloreto de Sódio na Dieta/uso terapêutico , Somatomedinas/metabolismo
18.
Proc Nutr Soc ; 77(3): 302-313, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29704906

RESUMO

Iodine deficiency (ID) in women of childbearing age remains a global public health concern, mainly through its impact on fetal and infant neurodevelopment. While iodine status is improving globally, ID is still prevalent in pregnancy, when requirements increase. More than 120 countries have implemented salt iodisation and food fortification, strategies that have been partially successful. Supplementation during pregnancy is recommended in some countries and supported by the WHO when mandatory salt iodisation is not present. The UK is listed as one of the ten countries with the lowest iodine status globally, with approximately 60 % of pregnant women not meeting the WHO recommended intake. Without mandatory iodine fortification or recommendation for supplementation in pregnancy, the UK population depends on dietary sources of iodine. Both women and healthcare professionals have low knowledge and awareness of iodine, its sources or its role for health. Dairy and seafood products are the richest sources of iodine and their consumption is essential to support adequate iodine status. Increasing iodine through the diet might be possible if iodine-rich foods get repositioned in the diet, as they now contribute towards only about 13 % of the average energy intake of adult women. This review examines the use of iodine-rich foods in parallel with other public health strategies, to increase iodine intake and highlights the rare opportunity in the UK for randomised trials, due to the lack of mandatory fortification programmes.


Assuntos
Laticínios , Deficiências Nutricionais/prevenção & controle , Dieta , Suplementos Nutricionais , Alimentos Fortificados , Iodo/deficiência , Alimentos Marinhos , Deficiências Nutricionais/sangue , Ingestão de Energia , Comportamento Alimentar , Feminino , Humanos , Iodo/sangue , Iodo/uso terapêutico , Necessidades Nutricionais , Estado Nutricional , Gravidez , Cloreto de Sódio na Dieta
19.
J Obstet Gynaecol ; 38(6): 756-761, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29526129

RESUMO

The objective of this study was to determine the effectiveness of routine iodine supplementation among pregnant women in areas of high prevalence of an iodine insufficiency, using WHO criteria to determine the iodine status. A longitudinal study was conducted on pregnant women attending antenatal care at a tertiary hospital. The urine iodine concentration was measured in the first trimester and after 150 µg of iodine supplementation in the third trimester. A total of 327 pregnant women met the inclusion criteria with a complete follow-up. The prevalence of an iodine insufficiency was significantly lower in the third trimester, when compared to the first trimester (21.41% vs 55.35%, p < .001). However, 21.4% of cases still had an iodine insufficiency and 35.17% had an 'above-requirement' in the third trimester. In the areas of high prevalence of iodine insufficiency, an iodine supplementation significantly reduces the number of women with insufficiency; however, it was associated with unnecessarily high UICs, leading to the risk of excess iodine. Impact statement What is already known on this subject: Iodine insufficiency is highly prevalent in many geographical areas. Half of the pregnant women in the northern part of Thailand had an iodine insufficiency in the first trimester. What do the results of this study add: Iodine supplementation (daily 150-mcg of potassium iodide) could significantly reduce the number of women with the insufficiency. About one-fifth of women still had an iodine insufficiency in spite of iodine supplementation. Universal supplementation could be associated with unnecessarily high UICs, potentially at risk of iodine excess. What are the implications of these findings for clinical practice and/or further research: Physicians should guard against the occurrence of adverse effect from an iodine excess when there is routine iodine supplementation for pregnant women. Further study is required to establish the best strategy for an iodine supplementation in pregnancy.


Assuntos
Suplementos Nutricionais , Iodo/deficiência , Iodo/uso terapêutico , Complicações na Gravidez/terapia , Adulto , Feminino , Humanos , Iodo/urina , Estudos Longitudinais , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/urina , Primeiro Trimestre da Gravidez/urina , Terceiro Trimestre da Gravidez/urina , Prevalência , Estudos Prospectivos , Tailândia/epidemiologia , Resultado do Tratamento
20.
BMC Vet Res ; 14(1): 87, 2018 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-29530037

RESUMO

BACKGROUND: Mammary cancer has a high incidence in canines and is an excellent model of spontaneous carcinogenesis. Molecular iodine (I2) exerts antineoplastic effects on different cancer cells activating re-differentiation pathways. In co-administration with anthracyclines, I2 impairs chemoresistance installation and prevents the severity of side effects generated by these antineoplastic drugs. This study is a random and double-blind protocol that analyzes the impact of I2 (10 mg/day) in two administration schemes of Doxorubicin (DOX; 30 mg/m2) in 27 canine patients with cancer of the mammary gland. The standard scheme (sDOX) includes four cycles of DOX administered intravenously for 20 min every 21 days, while the modified scheme (mDOX) consists of more frequent chemotherapy (four cycles every 15 days) with slow infusion (60 min). In both schemes, I2 or placebo (colored water) was supplemented daily throughout the treatment. RESULTS: mDOX attenuated the severity of adverse events (VCOG-CTCAE) in comparison with the sDOX group. The overall tumor response rate (RECIST criteria) for all dogs was 18% (interval of reduction 48-125%), and no significant difference was found between groups. I2 supplementation enhances the antineoplastic effect in mDOX, exhibiting a significant decrease in the tumor epithelial fraction, diminished expression of chemoresistance (MDR1 and Survivin) and invasion (uPA) markers and enhanced expression of the differentiation factor known as peroxisome proliferator-activated receptors type gamma (PPARγ). Significant tumor lymphocytic infiltration was also observed in both I2-supplemented groups. The ten-month survival analysis showed that the entire I2 supplementation (before and after surgery) induced 67-73% of disease-free survival, whereas supplementation in the last period (only after surgery) produced 50% in both schemes. CONCLUSIONS: The mDOX+I2 scheme improves the therapeutic outcome, diminishes the invasive capacity, attenuates the adverse events and increases disease-free survival. These data led us to propose mDOX+I2 as an effective treatment for canine mammary cancer.


Assuntos
Antineoplásicos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Doxorrubicina/uso terapêutico , Iodo/uso terapêutico , Neoplasias Mamárias Animais/tratamento farmacológico , Terapia Neoadjuvante/veterinária , Animais , Antineoplásicos/administração & dosagem , Cães , Doxorrubicina/administração & dosagem , Feminino , Iodo/administração & dosagem , Terapia Neoadjuvante/métodos
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