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PRCIS: Slow-coagulation CW-TSCPC is an efficacious, relatively safe, and non-incisional laser treatment option as an initial surgical glaucoma management choice, in secondary aphakic adult glaucoma that is medically uncontrolled. PURPOSE: This study evaluates the outcomes of slow-coagulation continuous wave transscleral cyclophotocoagulation (CW-TSCPC) laser for treating secondary aphakic adult glaucoma after complicated cataract surgery as a primary surgical intervention. MATERIALS AND METHODS: A retrospective chart review of adult aphakic eyes with medically uncontrolled glaucoma underwent slow-coagulation CW-TSCPC as a primary surgical glaucoma intervention was performed. Surgical success was the primary outcome measure. Success was defined as postoperative intraocular pressure (IOP) between 6 and 21 mm Hg with ≥20% reduction compared with baseline and no need for further glaucoma surgeries or development of vision-threatening complications. The secondary outcomes included changes in IOP, glaucoma medication numbers, visual acuity, and postoperative complications during the first year after laser treatment after laser treatment. RESULTS: This study included 41 eyes of 41 patients. The mean age of study participants was 66.7±13.1 years, with a mean follow-up duration of 19±3.5 months. At one year, the success rate was 63.4%. A statistically significant reduction of the IOP was observed, with the mean IOP decreasing from 29.6±5.8 mm Hg with a mean of 3.9±1.0 medications at baseline to a mean of 19.0±6.4 mm Hg with a mean of 2.5±1.2 medications at 12 months ( P <0.001). Four eyes received CW-TSCPC retreatment, and 2 eyes required incisional glaucoma surgeries. Reported postoperative complications included: visual acuity decline ≥2 lines in 7 eyes, iritis in 6 eyes, hyphema in 5 eyes, cystoid macular edema in 2 eyes, and transient hypotony in 1 eye. CONCLUSION: Slow-coagulation CW-TSCPC is an efficacious, relatively safe, and non-incisional laser treatment option as an initial surgical glaucoma management choice, in secondary aphakic adult glaucoma that is medically uncontrolled.
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Glaucoma , Presión Intraocular , Humanos , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Coagulación con Láser , Resultado del Tratamiento , Glaucoma/complicaciones , Glaucoma/cirugía , Cuerpo Ciliar/cirugía , Esclerótica/cirugíaRESUMEN
OBJECTIVES: The COVID-19 pandemic threatened standard hospital operations. We sought to understand how this stress was perceived and manifested within individual hospitals and in relation to local viral activity. DESIGN: Prospective weekly hospital stress survey, November 2020-June 2022. SETTING: Society of Critical Care Medicine's Discovery Severe Acute Respiratory Infection-Preparedness multicenter cohort study. SUBJECTS: Thirteen hospitals across seven U.S. health systems. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 839 hospital-weeks of data over 85 pandemic weeks and five viral surges. Perceived overall hospital, ICU, and emergency department (ED) stress due to severe acute respiratory infection patients during the pandemic were reported by a mean of 43% ( sd , 36%), 32% (30%), and 14% (22%) of hospitals per week, respectively, and perceived care deviations in a mean of 36% (33%). Overall hospital stress was highly correlated with ICU stress (ρ = 0.82; p < 0.0001) but only moderately correlated with ED stress (ρ = 0.52; p < 0.0001). A county increase in 10 severe acute respiratory syndrome coronavirus 2 cases per 100,000 residents was associated with an increase in the odds of overall hospital, ICU, and ED stress by 9% (95% CI, 5-12%), 7% (3-10%), and 4% (2-6%), respectively. During the Delta variant surge, overall hospital stress persisted for a median of 11.5 weeks (interquartile range, 9-14 wk) after local case peak. ICU stress had a similar pattern of resolution (median 11 wk [6-14 wk] after local case peak; p = 0.59) while the resolution of ED stress (median 6 wk [5-6 wk] after local case peak; p = 0.003) was earlier. There was a similar but attenuated pattern during the Omicron BA.1 subvariant surge. CONCLUSIONS: During the COVID-19 pandemic, perceived care deviations were common and potentially avoidable patient harm was rare. Perceived hospital stress persisted for weeks after surges peaked.
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COVID-19 , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Pandemias , Estudios de Cohortes , Estudios Prospectivos , HospitalesRESUMEN
Nuclear distribution element-like 1 (NDEL1) enzyme activity is important for neuritogenesis, neuronal migration, and neurodevelopment. We reported previously lower NDEL1 enzyme activity in blood of treated first episode psychosis and chronic schizophrenia (SCZ) compared to healthy control subjects, with even lower activity in treatment resistant chronic SCZ patients, implicating NDEL1 activity in SCZ. Herein, higher NDEL1 activity was observed in the blood and several brain regions of a validated animal model for SCZ at baseline. In addition, long-term treatment with typical or atypical antipsychotics, under conditions in which SCZ-like phenotypes were reported to be reversed in this animal model for SCZ, showed a significant NDEL1 activity reduction in blood and brain regions which is in line with clinical data. Importantly, these results support measuring NDEL1 enzyme activity in the peripheral blood to predict changes in NDEL1 activity in the CNS. Also, acute administration of psychostimulants, at levels reported to induce SCZ-like phenotype in normal rat strains, increased NDEL1 enzyme activity in blood. Therefore, alterations in NDEL1 activity after treatment with antipsychotics or psychostimulants may suggest a possible modulation of NDEL1 activity secondary to neurotransmission homeostasis and provide new insights into the role of NDEL1 in SCZ pathophysiology.
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Cisteína Endopeptidasas/metabolismo , Cisteína Endopeptidasas/fisiología , Esquizofrenia/metabolismo , Animales , Antipsicóticos/farmacología , Encéfalo/metabolismo , Estimulantes del Sistema Nervioso Central/uso terapéutico , Clozapina/farmacología , Cisteína Endopeptidasas/sangre , Haloperidol/farmacología , Hipocampo/metabolismo , Masculino , Núcleo Accumbens/metabolismo , Corteza Prefrontal/metabolismo , Trastornos Psicóticos/tratamiento farmacológico , Ratas , Ratas Endogámicas SHR , Ratas Wistar , Esquizofrenia/fisiopatologíaRESUMEN
The goal of the current study was to evaluate the impact of Tubulin Polymerization Promoting Protein (TPPP) methylation on structural and fractional anisotropy (FA) corpus callosum (CC) measures. TPPP is involved in the development of white matter tracts in the brain and was implicated in stress-related psychiatric disorders in an unbiased whole epigenome methylation study. The cohort included 63 participants (11.73 y/o ±1.91) from a larger study investigating risk and resilience in maltreated children. Voxel-based morphometry (VBM) was used to process the structural data, fractional anisotropy (FA) was determined using an atlas-based approach, and DNA specimens were derived from saliva in two batches using the 450 K (N = 39) and 850 K (N = 24) Illumina arrays, with the data from each batch analyzed separately. After controlling for multiple comparisons and relevant covariates (e.g., demographics, brain volume, cell composition, 3 PCs), 850 K derived TPPP methylation values, in interaction with a dimensional measure of children's trauma experiences, predicted left and right CC body volumes and genu, body and splenium FA (p < .007, all comparisons). The findings in the splenium replicated in subjects with the 450 K data. The results extend prior investigations and suggest a role for TPPP in brain changes associated with stress-related psychiatric disorders.
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Maltrato a los Niños , Cuerpo Calloso/patología , Metilación de ADN , Proteínas del Tejido Nervioso/metabolismo , Adolescente , Niño , Estudios de Cohortes , Cuerpo Calloso/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
Schizophrenia (SCZ) is a complex psychiatric disorder with severe impact on patient's livelihood. In the last years, the importance of neuropeptides in SCZ and other CNS disorders has been recognized, mainly due to their ability to modulate the signaling of classical monoaminergic neurotransmitters as dopamine. In addition, a class of enzymes coined as oligopeptidases are able to cleave several of these neuropeptides, and their potential implication in SCZ was also demonstrated. Interestingly, these enzymes are able to play roles as modulators of neuropeptidergic systems, and they were also implicated in neurogenesis, neurite outgrowth, neuron migration, and therefore, in neurodevelopment and brain formation. Altered activity of oligopeptidases in SCZ was described only more recently, suggesting their possible utility as biomarkers for mental disorders diagnosis or treatment response. We provide here an updated and comprehensive review on neuropeptides and oligopeptidases involved in mental disorders, aiming to attract the attention of physicians to the potential of targeting this system for improving the therapy and for understanding the neurobiology underlying mental disorders as SCZ.
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Neuropéptidos/metabolismo , Péptido Hidrolasas/metabolismo , Esquizofrenia/metabolismo , Animales , Humanos , Neuropéptidos/efectos de los fármacos , Péptido Hidrolasas/efectos de los fármacos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/enzimologíaRESUMEN
Nuclear distribution element-like 1 (NDEL1) enzyme activity is important for neuritogenesis, neuronal migration, and neurodevelopment. We reported previously lower NDEL1 enzyme activity in blood of treated first episode psychosis and chronic schizophrenia (SCZ) compared to healthy control subjects, with even lower activity in treatment resistant chronic SCZ patients, implicating NDEL1 activity in SCZ. Herein, higher NDEL1 activity was observed in the blood and several brain regions of a validated animal model for SCZ at baseline. In addition, long-term treatment with typical or atypical antipsychotics, under conditions in which SCZ-like phenotypes were reported to be reversed in this animal model for SCZ, showed a significant NDEL1 activity reduction in blood and brain regions which is in line with clinical data. Importantly, these results support measuring NDEL1 enzyme activity in the peripheral blood to predict changes in NDEL1 activity in the CNS. Also, acute administration of psychostimulants, at levels reported to induce SCZ-like phenotype in normal rat strains, increased NDEL1 enzyme activity in blood. Therefore, alterations in NDEL1 activity after treatment with antipsychotics or psychostimulants may suggest a possible modulation of NDEL1 activity secondary to neurotransmission homeostasis and provide new insights into the role of NDEL1 in SCZ pathophysiology.
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BACKGROUND: Active travel has been linked with improved transportation and health outcomes, such as reduced traffic congestion and air pollution, improved mobility, accessibility, and equity, and increased physical and mental health. The purpose of this study was to better understand active travel characteristics, motivators, and deterrents in the El Paso, TX, region. METHODS: A multimodal transportation survey brought together elements of transportation and health, with a focus on attitudinal characteristics. The analysis consisted of an initial descriptive analysis, spatial analysis, and multivariate binary and ordered-response models of walking and bicycling behavior. RESULTS: The motivators and deterrents of active travel differed for walkers, bicyclists, and noncyclists interested in bicycling. The link between active travel and life satisfaction was moderated by age, with a negative association for older travelers. This effect was stronger for bicycling than it was for walking. CONCLUSIONS: Based on the findings, several interventions to encourage walking and bicycling were suggested. These included infrastructure and built environment enhancements, workplace programs, and interventions targeting specific subpopulations.
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Ciclismo/tendencias , Transportes/métodos , Viaje/tendencias , Caminata/tendencias , Adolescente , Adulto , Femenino , Humanos , Masculino , New Mexico , Encuestas y Cuestionarios , Texas , Adulto JovenRESUMEN
In the Americas, women with Indigenous American ancestry are at increased risk of intrahepatic cholestasis of pregnancy (ICP), relative to women of other ethnicities. We hypothesized that ancestry-related genetic factors contribute to this increased risk. We collected clinical and laboratory data, and performed biochemical assays on samples from U.S. Latinas and Chilean women, with and without ICP. The study sample included 198 women with ICP (90 from California, U.S., and 108 from Chile) and 174 pregnant control women (69 from California, U.S., and 105 from Chile). SNP genotyping was performed using Affymetrix arrays. We compared overall genetic ancestry between cases and controls, and used a genome-wide admixture mapping approach to screen for ICP susceptibility loci. We identified commonalities and differences in features of ICP between the 2 countries and determined that cases had a greater proportion of Indigenous American ancestry than did controls (p = 0.034). We performed admixture mapping, taking country of origin into account, and identified one locus for which Native American ancestry was associated with increased risk of ICP at a genome-wide level of significance (P = 3.1 x 10(-5), Pcorrected = 0.035). This locus has an odds ratio of 4.48 (95% CI: 2.21-9.06) for 2 versus zero Indigenous American chromosomes. This locus lies on chromosome 2, with a 10 Mb 95% confidence interval which does not contain any previously identified hereditary 'cholestasis genes.' Our results indicate that genetic factors contribute to the risk of developing ICP in the Americas, and support the utility of clinical and genetic studies of ethnically mixed populations for increasing our understanding of ICP.
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Colestasis Intrahepática/diagnóstico , Colestasis Intrahepática/genética , Hispánicos o Latinos/genética , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/genética , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Ácidos y Sales Biliares/sangre , Bilirrubina/sangre , Estudios de Casos y Controles , Chile , Colestasis Intrahepática/sangre , Cromosomas Humanos Par 2/genética , Femenino , Predisposición Genética a la Enfermedad , Humanos , Polimorfismo de Nucleótido Simple , Embarazo , Complicaciones del Embarazo/sangre , Factores de Riesgo , Estados Unidos , Adulto Joven , gamma-Glutamiltransferasa/sangreRESUMEN
Previous research on culture and emotion regulation has focused primarily on comparing participants from individualistic and collectivistic backgrounds (e.g., European Americans vs. Asians/Asian Americans). However, ethnic groups that are equally individualistic or collectivistic can still vary notably in cultural norms and practices regarding emotion regulation. The present study examined the association between expressive suppression and well-being in two collectivistic ethnic groups (i.e., Chinese Americans and Mexican Americans). Results indicated that suppression of positive emotions was related to lower hedonic and eudaimonic well-being among Mexican Americans but not among Chinese Americans. Moreover, post hoc analysis revealed that Mexican Americans with a stronger collective identity reported lower eudaimonic well-being when suppressing positive emotions than Mexican Americans with a weaker collective identity. Suppression of negative emotions, by contrast, was unrelated to hedonic and eudaimonic well-being for both ethnic groups. Overall, our findings underscore the importance of taking into account the role that culture and the characteristics of emotion (e.g., valence) may play in the link between emotion regulation and well-being.
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OBJECTIVE: To evaluate the presence of clinical signs consistent with suspected glaucoma in Haitian Afro-Caribbean individuals residing in South Florida who do not receive regular eye examinations. DESIGN: Retrospective, cross-sectional study. SETTING: Community health center in the Little Haiti district of Miami, Florida. PATIENT POPULATION: We reviewed medical records and screening forms from five health screenings between October 2011 to October 2013 of 939 Afro-Caribbean individuals older than 18 years, who were never diagnosed with glaucoma or had an eye examination within the last ten years. PROCEDURES: Measurements of distance visual acuity (VA), intraocular eye pressure (IOP), central corneal thickness (CCT), cup-to-disc ratio (CDR), frequency doubling technology (FDT) perimeter visual field (VF). MAIN OUTCOME MEASURES: Proportion of glaucoma suspects, based on IOP greater than or equal to 24 mm Hg or CDR greater than or equal to 0.7 in either eye, and determinants of CDR and IOP. RESULTS: One hundred ninety-one (25.5%) of 750 patients were identified as glaucoma suspects. Glaucoma suspects were common in both the youngest and oldest age groups (<40 years, 20.9%; 95% confidence interval [CI], 17.9-23.9; >70 years, 25.0%; 95% CI, 21.8-28.2) and higher in men than women less than 70 years; the reverse was true after 70 years. Among all patients, mean IOP was 19.2±4.5 mmHg, mean CDR was 0.37±0.17, and mean CCT was 532±37.1 µm. In multiple linear stepwise regression analysis, determinates of increased CDR included increasing age (Pâ=â0.004), lack of insurance (Pâ=â0.019), and higher IOP (P<0.001), while increasing CDR (P<0.001) and thicker CCT (P<0.001) were associated with higher IOP. CONCLUSIONS: This first glaucoma survey in a U.S. Haitian Afro-Caribbean population indicates glaucoma suspect status is high across all age groups, and suggests glaucoma monitoring in people less than 40 years of age is indicated in this population.
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Glaucoma/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Florida , Glaucoma/epidemiología , Haití/etnología , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Pruebas de Visión , Agudeza VisualRESUMEN
The descriptions of medical caring and of highly technical specialism and science utilize different vocabularies and language. Medical caring has an ancient glossary of words, gestures, and behavior which is rapidly being transformed by specialization and advances in the technology of communication. The technologic capabilities of intensive care have, for example, exceeded the human life span and forced redefinition of the meaning of being olive. There are risks for the contemporary profession as linguistic and technical evolution proceed at a faster pace than the evolution of human health and illth. The accentuation and acceleration of generational disparity between the young and the old diminishes the solidarity of the profession and the quality of care that it provides.
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Conducta Cooperativa , Difusión de Innovaciones , Medicina General/tendencias , Relaciones Intergeneracionales , Estudiantes de Medicina , Comunicación , Humanos , Atención al PacienteRESUMEN
The landscape of medical practice and health care has been transformed by specialization over the past Century. There has been an extraordinary acceleration in the proliferation of specialty practice, coincident with rapid growth in technological devices and their clinical applications during the past fifty years. Medicine and medical care are evolving rapidly, a process that has similarities to biologic evolution. Medical educators, policy makers, and practitioners might find a Darwinian overview of medicine and health care of interest.
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Evolución Cultural , Médicos Generales/tendencias , Especialización/tendencias , Chile , HumanosRESUMEN
BACKGROUND: The pathophysiology of male lower urinary tract symptoms (LUTS) is highly complex and multifactorial. The shift in perception that LUTS are not sex or organ specific has not been followed by significant innovations regarding the available drug classes. OBJECTIVE: To review pathophysiologic mechanisms and clinical and experimental data related to the development of new pharmacologic treatments for male LUTS. EVIDENCE ACQUISITION: The PubMed database was used to identify articles describing experimental and clinical studies of pathophysiologic mechanisms contributing to male LUTS and, supported by them, new pharmacotherapies with clinical or experimental evidence in the field. EVIDENCE SYNTHESIS: Several pathologic processes (eg, androgen signaling, inflammation, and metabolic factors) and targets (eg, the urothelium, prostate, interstitial cells, detrusor, neurotransmitters, neuromodulators, and receptors) have been implicated in male LUTS. Some newly introduced drugs, such as phosphodiesterase type 5 inhibitors and ß3-adrenergic agonists, have just started broad use in clinical practice. Drugs with potential benefit, such as vitamin D3 receptor analogs, gonadotropin-releasing hormone antagonists, cannabinoids, and drugs injected into the prostate, have been evaluated in experimental studies and have progressed to clinical trials. However, safety and efficacy data for these drugs are still scarce. Some compounds with interesting profiles have only been tested in experimental settings (eg, transient receptor potential channel blockers, Rho-kinase inhibitors, purinergic receptor blockers, and endothelin-converting enzyme inhibitors). CONCLUSIONS: New pathophysiologic mechanisms of male LUTS are described that lead to the continuous development of new pharmacotherapies. To date, few drugs have been added to the current armamentarium, and several are in various phases of clinical or experimental investigation.
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Descubrimiento de Drogas/tendencias , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Terapia Molecular Dirigida , Agentes Urológicos/uso terapéutico , Animales , Predicción , Humanos , Síntomas del Sistema Urinario Inferior/diagnóstico , Síntomas del Sistema Urinario Inferior/metabolismo , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Transducción de Señal/efectos de los fármacos , Resultado del TratamientoRESUMEN
Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) commonly affect older men. Fifty percent of men in their sixties and 80% of men in their nineties will be affected. Many of these men will seek care for their bothersome symptoms and decreased quality of life. There is a poor association between LUTS and objective measures such as post void residual, voided volumes, or maximal flow. Pressure flow studies are considered the gold standard for detecting bladder outlet obstruction. These studies tend to be cumbersome, expensive, and have exposure to ionizing radiation. There are several techniques which may offer noninvasive methods of detecting bladder outlet obstruction (BOO) in men.
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Síntomas del Sistema Urinario Inferior/diagnóstico , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Presión , Próstata/patología , Hiperplasia Prostática/complicaciones , Vejiga Urinaria/patología , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , Urodinámica/fisiologíaRESUMEN
The Integrative Medicine Program at MD Anderson Cancer Center was first established in 1998. Our mission is to empower patients with cancer and their families to become active partners in their own physical, psycho-spiritual, and social health through personalized education and evidenced-based clinical care to optimize health, quality of life, and clinical outcomes across the cancer continuum. The program consists of three main components: clinical care, research, and education. The Integrative Medicine Center provides clinical services to patients through individual and group programs. The clinical philosophy of the center is to work collaboratively with the oncology teams to build comprehensive and integrative care plans that are personalized, evidence-based, and safe with the goal of improving clinical outcomes. The individual services comprise of integrative oncology consultation, acupuncture, meditation, music therapy, nutrition, and oncology massage. The center also provides a variety of group programs including meditation, yoga, tai chi, cooking classes and others. Over the past 13 years, over 70,000 patients and families have participated in services and programs offered by the center. The research portfolio focuses on three main areas: mind-body interventions, acupuncture, and meditation. This lecture will focus on providing an overview of the Integrative Medicine Program at MD Anderson with a focus on the clinical services provided. Participants will learn about the integrative clinical model and how this is applied to the care of cancer patients at MD Anderson Cancer Center. Current and future research topics will be discussed as well as patient cases.
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Terapias Mente-Cuerpo , Medicina Integrativa , NeoplasiasRESUMEN
BACKGROUND: To evaluate a method for treating uncorrected refractive error in adults in the developing world. DESIGN: Prospective, cross-sectional study in outpatient community health centres. PARTICIPANTS: Eight hundred and forty subjects aged 18 and older from rural villages in Haiti and Belize. METHODS: Undilated refractive error screening exams were conducted over a 5-day period in rural Haiti and Belize using portable autorefractors. Isometropic, spherical, ready-made spectacles were provided to patients with bilateral refractive error, astigmatism ≤ 1 dioptre in each eye and visual acuity worse than 6/9 in each eye. Visual acuity was measured with and without corrective spectacles. MAIN OUTCOME MEASURES: The mean visual improvement and median final visual acuity after treatment with ready-made glasses. RESULTS: Eight hundred and forty patients aged 18 and older were screened with autorefractors. One hundred and eighty-nine subjects (22.5%) were found to have visually significant bilateral refractive error. Fifty-eight per cent (110/189) of these patients met criteria for treatment with ready-made spectacles. Visual acuity improved an average of 4.2 lines in the better eye and 4.1 lines in the worse eye with corrective glasses. The median visual acuity in the better eye was 6/6 after treatment. CONCLUSION: Autorefractors and ready-made spectacles allow for effective treatment of uncorrected refractive error in adults in the developing world.
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Países en Desarrollo , Anteojos , Refracción Ocular , Errores de Refracción/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Belice/epidemiología , Estudios Transversales , Diseño de Equipo , Femenino , Estudios de Seguimiento , Haití/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Pacientes Ambulatorios , Estudios Prospectivos , Errores de Refracción/epidemiología , Errores de Refracción/fisiopatología , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
OBJECTIVE: To determine whether environmental perchlorate exposure adversely affects thyroid function in women in the first trimester of pregnancy. METHODS: First-trimester pregnant women were recruited from prenatal clinics in the Los Angeles County Hospital, Los Angeles, California, and in the Hospital Universitario de Maternidad dependent Universidad Nacional de Córdoba, Córdoba, Argentina, between 2004 and 2007. Spot urine and blood specimens were obtained during the clinic visit. Urinary perchlorate, iodine, and creatinine were measured, and thyroid function tests were performed. RESULTS: The study included 134 pregnant women from Los Angeles, California (mean gestational age ± SD = 9.1 ± 2.2 weeks), and 107 pregnant women from Córdoba, Argentina (mean gestational age = 10.0 ± 2.0 weeks). Median urinary iodine values were 144 µg/L in California and 130 µg/L in Argentina. Urinary perchlorate levels were detectable in all women (California: median, 7.8 µg/L [range, 0.4-284 µg/L] and Argentina: median, 13.5 µg/L [range, 1.1-676 µg/L]). Serum thyroperoxidase antibodies were detectable in 21 women from California (16%) and in 17 women from Argentina (16%). Using Spearman rank correlation analyses, there was no association between urinary perchlorate concentrations and serum thyrotropin, free thyroxine index, or total triiodothyronine values, including within the subset of women with urinary iodine values less than 100 µg/L. In multivariate analyses using the combined Argentina and California data sets and adjusting for urinary iodine concentrations, urinary creatinine, gestational age, and thyroperoxidase antibody status, urinary perchlorate was not a significant predictor of thyroid function. CONCLUSIONS: Low-level perchlorate exposure is ubiquitous, but is not associated with altered thyroid function among women in the first trimester of pregnancy.
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Percloratos/efectos adversos , Mujeres Embarazadas , Glándula Tiroides/efectos de los fármacos , Argentina/epidemiología , California/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Yodo/orina , Los Angeles/epidemiología , Percloratos/farmacología , Percloratos/orina , Embarazo , Complicaciones del Embarazo/inducido químicamente , Complicaciones del Embarazo/epidemiología , Primer Trimestre del Embarazo/sangre , Primer Trimestre del Embarazo/efectos de los fármacos , Enfermedades de la Tiroides/inducido químicamente , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/epidemiología , Enfermedades de la Tiroides/orina , Pruebas de Función de la Tiroides , Contaminantes Químicos del Agua/efectos adversos , Contaminantes Químicos del Agua/farmacologíaRESUMEN
Charles Darwin experienced a major earthquake in the Concepción-Valdivia region of Chile 175 years ago, in February 1835. His observations dramatically illustrated the geologic principles of James Hutton and Charles Lyell which maintained that the surface of the earth was subject to alterations by natural events, such as earthquakes, volcanoes, and the erosive action of wind and water, operating over very long periods of time. Changes in the land created new environments and fostered adaptations in life forms that could lead to the formation of new species. Without the demonstration of the accumulation of multiple crustal events over time in Chile, the biologic implications of the specific species of birds and tortoises found in the Galapagos Islands and the formulation of the concept of natural selection might have remained dormant.