Stella González-Romero

Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life.

CONTEXT The association between thyroid function during pregnancy and the later mental and psychomotor development of the child is supported by numerous experimental, clinical, and epidemiological studies. OBJECTIVE The aim of the study was to evaluate the psychological development of infants aged 3 to 18 months whose mothers had received 300 microg of potassium iodide during the first trimester of their pregnancy and compare with infants whose mothers had received no iodine supplements. DESIGN AND STUDY SUBJECTS The study included 133 women who had received 300 microg of potassium iodine and 61 women who had received no iodine supplements. MAIN OUTCOME MEASURES The neuropsychological status of the children was evaluated with the Bayley Scales of Infant Development, and measurements were made of TSH, free T(3), free T(4), and urinary iodine. RESULTS Those children whose mothers had received an iodine supplement of 300 microg had a more favorable psychometric assessment than those of the other group of mothers. They had higher scores on the Psychomotor Development Index (P = 0.02) and the Behavior Rating Scale. CONCLUSIONS Dietary iodine supplements not only have no harmful effect on the neurodevelopment of the children, they may even be beneficial. Given the possible presence of confounding variables not controlled for in this study, these findings should be considered as preliminary.

Does the intake of nuts and seeds alter the appearance of menarche

Background. The nutritional state reportedly influences the age of menarche. In this work we investigated the potential relationship between the intake of various types of foods and the age of menarche, irrespective of body weight.

Incidence of lower limb amputations in individuals with and without diabetes mellitus in Andalusia (Spain) from 1998 to 2006

AIMS We studied the changes in the incidence of lower limb amputation (LLA) in Andalusia from 1998 to 2006 in the population with and without diabetes. METHODS We undertook a retrospective study of all LLA performed in Andalusia in people aged 30 years old, with or without diabetes, between 1 January 1998 and 31 December 2006. We obtained the crude and standardized incidence rates by year, and sex for three periods: 1998-2000, 2001-2003 and 2004-2006 and calculated the RR of requiring LLA in patients with diabetes. To test for time trend, Poisson regression models were fitted. RESULTS A total of 16,210 LLA were carried out in Andalusia, 72.6% in patients with diabetes mellitus and 66.4% in men. In the population with diabetes the standardized incidence of all LLA was found to be 344.0 per 100,000 (95% CI, 315.4-372.4) in 2004-2006. There was an estimated incidence increase for all LLA by 14% and for minor LLA by 13.6% in 2004-2006. In people with diabetes the RR increased by 31.6% as compared to the first period. CONCLUSIONS Despite the implementation of a care plan for patients with diabetes, the incidence of LLA has not fallen in Andalusia in recent years.

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Pregnant Women with Type 1 Diabetes

BACKGROUND Continuous subcutaneous insulin infusion (CSII) may be an alternative to multiple daily injections (MDI) in pre-gestational diabetes during pregnancy. However, no clear improvement in obstetric and perinatal outcome has so far been established for CSII treatment. METHODS In a case-control study, 35 pregnancies treated with CSII and 64 pregnancies treated with MDI treatment were evaluated. Metabolic control and obstetric and perinatal outcome were compared. RESULTS Women in the CSII group improved their metabolic control (hemoglobin A1c before CSII, 7.83 +/- 0.97%; 3-6 months after, 6.77 +/- 0.61%; P < 0.05). Hemoglobin A1c before pregnancy was lower in the CSII group (6.62 +/- 0.60%) than in the MDI group (7.59 +/- 1.61%) (P < 0.05). No other significant differences, either in metabolic control of diabetes or in obstetric and perinatal outcome, were found. CONCLUSIONS CSII treatment is safe in pregnancy, but it has not yet been associated with any improved pregnancy outcome.

Development of a new fear of hypoglycemia scale: FH-15.

Hypoglycemia is the most common adverse event associated with insulin treatment in diabetes. The consequences of hypoglycemia can be quite aversive and potentially life threatening. The physical sequelae provide ample reason for patients to fear hypoglycemia and avoid episodes. For these reasons, our purpose in this study was to develop a new measure that explores specific fear of hypoglycemia (FH) in adult patients with type 1 diabetes and to examine its psychometric properties. The instrument developed to assess FH was initially made up of 20 items, of which 18 were negative and 2 were positive, assessed on a 5-point Likert scale (1-5). This scale was completed by 229 patients with type 1 diabetes. Additionally, a structured interview and a closed question called subjective fear of hypoglycemia were included as diagnostic criteria. A factor analysis employing the principal-components method and promax rotation was carried out, resulting in a new scale composed of 15 items. Three factors (fear, avoidance, and interference) were obtained and explained 58.27% of the variance. The scale showed good internal consistency (Cronbachs α = .891) and test-retest reliability (r = .908, p < .001), as well as adequate concurrent and predictive validity. The cutoff score that provided the highest overall sensitivity and specificity was set at 28 points. The Fear of Hypoglycemia 15-item scale (FH-15) demonstrated good reliability and validity. This study suggests that the new instrument may serve as a valuable measure of specific FH for use in research and clinical practice.

Altered bioavailability due to changes in the formulation of a commercial preparation of levothyroxine in patients with differentiated thyroid carcinoma

In July 1995 we began noticing an unusually high rate of elevated TSH levels in patients with differentiated thyroid cancer treated with levothyroxine — specifically the brand Levothroid®— becoming more obvious from September 1995. Faced with the possibility that these findings had some relationship to the drug taken, we carried out a prospective study, changing this brand of levothyroxine for another.

Depresión en la diabetes mellitus tipo 1 y factores asociados

BACKGROUND AND OBJECTIVE In recent years, there has been an increased interest in depression and diabetes risk factors. Our objectives were 1) Study the variables associated with the presence of depression in patients with type 1 diabetes mellitus (DM1), 2) to analyze potential risk factors for depression in these patients, and 3) to study a possible explanatory model of depression scores in these patients. PATIENTS AND METHODS 207 patients with DM1. We evaluated sociodemographic and biomedical variables by means of a structured interview. We assessed psychological variables by means of the Scale for Depression in Type 1 Diabetes (EDDI-1) and the Spanish version of Diabetes Quality of Life (Es DQOL). RESULTS Prevalence of depression was 21,7%. Variables associated with risk of depression in this sample were to be female; be unemployed; smoking; having complications of diabetes or other physical conditions; not perceiving family support or support from friends or colleagues in relation to diabetes; having a high number of weekly hyperglycemia; and a poor quality of life. A model based on previous research was obtained. This model explains a high percentage of the variability in the scores of patients in the EDDI-1. CONCLUSIONS These results provide an empirical support to the knowledge of the risk factors associated with depression in patients with DM1. Glycemic control and quality of life have an important effect on the scores of depression in these patients, providing information for their treatment.

Clinical dilemmas arising from the increased intake of iodine in the Spanish population and the recommendation for systematic prescription of potassium iodide in pregnant and lactating women (Consensus of the TDY Working Group of SEEN).

Iodine deficiency is one of themost easily preventable public health problems, but despite that, it still affects a very great number of people worldwide (1). Over half of the European population lives in countries where the iodine intake is insufficient (2, 3). Iodine deficiency in Spain has been recognized since 1899 (4), and has been found in 15 of the 17 autonomous regions of Spain where it has been studied, no information being available in the other 2. In 1980 the Spanish Society of Endocrinology and Nutrition (SEEN) formed a Working Group on Iodine Deficiency Disorders (the TDY Group of the SEEN). This group has actively studied the problem in Spain, bringing it repeatedly to the attention of Public Health authorities and promoting several monographs collecting data from the various studies carried out in Spain on iodine deficiency disorders up to 1993 (5, 6). More recently, 8 scientific societies have joined in a manifesto presented at a meeting held in Malaga, Spain, stressing the need for a more active Public Health policy to eradicate iodine deficiency disorders in Spain (See Appendix). Spain still lacks a national plan for the eradication of iodine deficiency, although certain autonomous regions have undertaken campaigns and put in practice policies to increase the urinary iodine concentration in school-age children and reduce the prevalence of goiter (7). Currently, the national Ministry of Health and the regional ministries are setting up programs to increase the consumption of iodised salt and, as in the case of Andalusia, recommend the prescription during pregnancy and lactation of a preparation containing at least 150 μg of iodine per day (8). Although many multivitamin-mineral preparations that contain different amounts of iodine are sold in Spain, a preparation of potassium iodide (Recordati formulation) has recently been promoted and subsidized by public funding with individual doses of 100 and 200 μg of iodine/tablet (130.8 μg KI and 261.6 μg KI, respectively) that helps implementation of the recommendations of the TDY Group of the SEEN for pregnant and lactating women. This has resulted in the frequent expression of concerns by gynecologists and general practitioners, as well as some specialists in endocrinology and nutrition, about the risks and benefits of the use of iodised salt in the general population and, especially, about the indications and contraindications of potassium iodide supplements during pregnancy and lactation. The aim of this report is to draw up a guideline for good clinical practice by answering dilemmas expressed by the medical community concerning the increasing use of iodine-containing products in the general Spanish population, especially among pregnant women.

Diabetic ketoacidosis following chlorothalonil poisoning

Dear Editor, We report the first case of diabetic ketoacidosis (DKA) in a worker recently exposed to high levels of the fungicide chlorothalonil. In April 2011, a 56-year-old male farmer was admitted with severe dehydration, hypotension, vomiting and general malaise. Blood tests showed glucose 861 mg/dL (70–110), HbA1c 14.3% (4–6), pH 7.05 (7.37–7.43) and bicarbonate 3.8 mEq/L (20–24). A urinalysis showed intense ketonuria. A diagnosis of DKA was made. However, the presentation of DKA was unusual; the patient was a healthy man, he had no evidence of prior hyperglycaemia or risk factors for diabetes and type 1 autoantibodies were negative. Since the symptoms suggested an occult noxa we questioned him more thoroughly. Two months before admission, he had been hired to clean a farm …