Benign thyroid disease in pregnancy: A state of the art review

Thyroid dysfunction is the commonest endocrine disorder in pregnancy apart from diabetes. Thyroid hormones are essential for fetal brain development in the embryonic phase. Maternal thyroid dysfunction during pregnancy may have significant adverse maternal and fetal outcomes such as preterm delivery, preeclampsia, miscarriage and low birth weight. In this review we discuss the effect of thyroid disease on pregnancy and the current evidence on the management of different thyroid conditions in pregnancy and postpartum to improve fetal and neonatal outcomes, with special reference to existing guidelines on the topic which we dissect, critique and compare with each other.  Overt hypothyroidism and hyperthyroidism should be treated appropriately in pregnancy, aiming to maintain euthyroidism. Subclinical hypothyroidism is often pragmatically treated with levothyroxine, although it has not been definitively proven whether this alters maternal or fetal outcomes. Subclinical hyperthyroidism does not usually require treatment and the possibility of non-thyroidal illness or gestational thyrotoxicosis should be considered.  Autoimmune thyroid diseases tend to improve during pregnancy but commonly flare-up or emerge in the post-partum period. Accordingly, thyroid auto-antibodies tend to decrease with pregnancy progression.  Postpartum thyroiditis should be managed based on the clinical symptoms rather than abnormal biochemical results

De Quervain subacute thyroiditis.

From Europe PMC via Jisc Publications RouterHistory: ppub 2021-07-01Publication status: Publishe

Biostimulatory Action of Arbuscular Mycorrhizal Fungi Enhances Productivity, Functional and Sensory Quality in ‘Piennolo del Vesuvio’ Cherry Tomato Landraces

Arbuscular mycorrhizal fungi (AMF) are a promising tool to improve plant nutrient use efficiency (NUE) and tolerance against abiotic stresses. Moreover, AMF can potentially increase plant productivity and reduce the negative externalities of the agricultural sector. Our study aimed to elucidate whether AMF (containing Rhizoglomus irregulare and Funneliformis mosseae) could positively affect not only tomato growth and productivity but also the nutritional and nutraceutical quality of yellow-pigmented type (‘Giagiù’) and red-pigmented type (‘Lucariello’) tomatoes (Solanum lycopersicum L.). These cherry tomatoes are landraces of the Protected Designation of Origin (PDO) ‘Pomodorino del Piennolo del Vesuvio’ (PPV), one of the most typical agricultural products of the Campania region (Southern Italy). AMF rose fruit yield by increasing the number of fruits per plant (+49% and +29% in ‘Giagiù’ and ‘Lucariello’, respectively) but not of the fruit mean mass. AMF increased lycopene (+40%), total ascorbic acid (TAA; +41%), alanine (+162%), gamma-Aminobutyric acid (GABA; +101%) and branched-chain amino acids (BCAAs; +53%) in ‘Lucariello’. In ‘Giagiù’, AMF increased calcium (+63%), zinc (+45%), ASP (+70%), GABA (+53%) and the essential amino acids arginine (+58%) and lysine (+45%), also indicating a genotype-specific response. In both landraces, AMF improved nutrient uptake and biosynthesis of important molecules involved in the control the oxidative stress and cellular pH. In addition to the beneficial effects of human health, the molecules influenced by the AMF treatment are expected to extend the shelf life of tomato fruits, thus further promoting the useful agronomic application of AMF for premium tomatoes marketed fresh or in pendulums (‘piennoli’)

Impact of autoimmune thyroiditis on primary hyperparathyroidism

Aim. Primary hyperparathyroidism (PHPT) often coexists with thyroid diseases. Current guidelines advise preoperative ultrasound (US) examination of the thyroid gland for thyroid nodular disease or concomitant malignancy but not evaluation for autoimmune thyroiditis (AIT). The impact of autoimmune thyroiditis on the clinical presentation and intraoperative course of PHPT is not clear. Material and methods. We retrospectively assessed the medical records of 21 patients with PHPT who underwent parathyroidectomy. Clinical, biochemical, ultrasonographic and intraoperative data were evaluated. Results. There was a longer duration of parathyroidectomy in patients with AIT than in those without (113.3 min vs. 93.9 min, P=0.03). A lower rate of kidney stones was noted in patients with autoimmune thyroiditis (44.4% vs. 0%, P=0.03). Patients with AIT were more symptomatic, but this was not significant. There was no difference between the two groups in the prevalence of osteoporosis or thyroid nodular disease. Conclusions. A significantly longer duration of parathyroidectomy was seen in PHPT patients with AIT. Patients with PHPT undergoing surgery should be investigated for autoimmune thyroiditis, as this may affect surgical planning

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance