Nutrizione iodica globale nel 2020

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Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

Genetic alterations in medullary thyroid cancer: diagnostic and prognostic markers

Abstract Medullary thyroid carcinoma (MTC) is a rare calcitonin producing neuroendocrine tumour that originates from the parafollicular C-cells of the thyroid gland. The RET proto-oncogene encodes the RET receptor tyrosine kinase, with consequently essential roles in cell survival, differentiation and proliferation. Somatic or germline mutations of the RET gene play an important role in this neoplasm in development of sporadic and familial forms, respectively. Genetic diagnosis has an important role in differentiating sporadic from familiar MTC. Furthermore, depending on the location of the mutation, patients can be classified into risk classes. Therefore, genetic screening of the RET gene plays a critical role not only in diagnosis but also in assessing the prognosis and course of MT

Anaplastic thyroid carcinoma

Abstract Thyroid cancers represent about 1% of all human cancers. Differentiate thyroid carcinomas (DTCs), papillary and follicular cancers, are the most frequent forms, instead Anaplastic Thyroid Carcinoma (ATC) is estimated to comprise 1-2% of thyroid malignancies and it accounts for 14-39% of thyroid cancer deaths. The annual incidence of ATC is about one to two cases/million, with the overall incidence being higher in Europe (and area of endemic goiter) than in USA. ATC has a more complex genotype than DTCs, with chromosomal aberrations present in 85-100% of cases. A small number of gene mutations have been identified, and there appears to be a progression in mutations acquired during dedifferentiation. The mean survival time is around 6\u2009months from diagnosis an outcome that is frequently not altered by treatment. ATC presents with a rapidly growing fixed and hard neck mass, often metastatic local lymph nodes appreciable on examination and/or vocal paralysis. Symptoms may reflect rapid growth of tumor with local invasion and/or compression. The majority of patients with ATC die from aggressive local regional disease, primarily from upper airway respiratory failure. For this reason, aggressive local therapy is indicated in all patients who can tolerate it. Although rarely possible, complete surgical resection gives the best chance of long-term control and improved survival. Therapy options include surgery, external beam radiation therapy, tracheostomy, chemotherapy, and investigational clinical trials. Multimodal or combination therapy should be useful. In fact, surgical debulking of local tumor, combined with external beam radiation therapy and chemotherapy as neoadjuvant (before surgery) or adjuvant (after surgery) therapy, may prevent death from local airway obstruction and as best may slight prolong survival. Investigational clinical trials in phase I or in phase II are actually in running and they include anti-angiogenetic drugs, multi-kinase inhibitor drugs

Postoperative insulin-like growth factor 1 levels reflect the graft's function and predict survival after liver transplantation

Background The reduction of insulin-like growth factor 1 (IGF-1) plasma levels is associated with the degree of liver dysfunction and mortality in cirrhotic patients. However, little research is available on the recovery of the IGF-1 level and its prognostic role after liver transplantation (LT). Methods From April 2010 to May 2011, 31 patients were prospectively enrolled (25/6 M/F; mean age +/- SEM: 55.2 +/- 1.4 years), and IGF-1 serum levels were assessed preoperatively and at 15, 30, 90, 180 and 365 days after transplantation. The influence of the donor and recipient characteristics (age, use of extended criteria donor grafts, D-MELD and incidence of early allograft dysfunction) on hormonal concentration was analyzed. The prognostic role of IGF-1 level on patient survival and its correlation with routine liver function tests were also investigated. Results All patients showed low preoperative IGF-1 levels (mean +/- SEM: 29.5 +/- 2.1), and on postoperative day 15, a significant increase in the IGF-1 plasma level was observed (102.7 +/- 11.7 ng/ml; p65 years) or extended criteria donor grafts. An inverse correlation between IGF-1 and bilirubin serum levels at day 15 (r = -0.3924, p = 0.0320) and 30 (r = -0.3894, p = 0.0368) was found. After multivariate analysis, early (within 15 days) IGF-1 normalization [Exp(b) = 3.913; p = 0.0484] was the only prognostic factor associated with an increased 3-year survival rate. Conclusion IGF-1 postoperative levels are correlated with the graft's quality and reflect liver function. Early IGF-1 recovery is associated with a higher 3-year survival rate after LT

The iodine nutritional status in the Italian population: data from the Italian National Observatory for Monitoring Iodine Prophylaxis (OSNAMI) (period 2015\u20132019)

Dear Editor: In the April 2019 issue of the Journal, Campanozzi et al. (1) reported results of a study aimed at assessing dietary iodine intake in a national sample of Italian schoolchildren and adolescents (aged 6–18 y) using 24-h urine collections [24-h urinary iodine excretion (UIE)]. The study was conducted in the framework of the program MINISAL-GIRSCI (2). The authors conclude that the nutritional iodine intake is still inadequate in the Italian population 14 y after the approval of law n.55/2005, which introduced a nationwide program of iodine prophylaxis on a voluntary basis in our country (3). Their results and conclusion do not reflect the current iodine nutritional status of the Italian population, which appears to be adequate as ascertained by the second survey (period 2015–2019) conducted by the Italian National Observatory forMonitoring Iodine Prophylaxis (OSNAMI) (4; De Angelis et al. 2019, communication at the 40th National Meeting of the Italian Society of Endocrinology). Specifically, it should be considered that the young population the authors studied was recruited in 2009 when the program MINISAL-GIRSCI was implemented (2). In the same period, consistently, the first survey conducted by OSNAMI (2007–2012) on 7455 schoolchildren (age 11–14 y) residing in 9 Italian regions showed that most of the regions were iodine deficient at that time [median spot urinary iodine concentration (UIC) <100 μg/L]; only the Liguria, Tuscany, and Sicily regions showed iodine sufficiency [median UIC ranging from 100 to 160 μg/L). In addition, only 43% of salt sold in Italy was iodized at that time, and the prevalence of goiter in schoolchildren (range: 6%–9%) was slightly higher than the threshold value of 5% in all the examined regions (5). After this time, the General Direction of Food Safety and Nutrition at the Ministry of Health together with the panel of OSNAMI experts at the National Institute of Health decided to intensify nationwide informative campaigns on the use of iodized salt promoting the slogan “less salt but iodized,” in agreement with the nationwide strategy of reducing sodium intake in the population. These efforts have led to the achievement of iodine sufficiency in our country, as demonstrated by the preliminary results of the second OSNAMI survey conducted on 2523 schoolchildren (age 11–13 y) residing in rural (42%) and urban areas (58%) of 7 Italian regions (Liguria, Toscana, Emilia Romagna,Marche, Umbria, Lazio, Sicilia). Analysis of data regarding 3 further regions (Veneto, Lombardia, Calabria) is still ongoing. These preliminary results showed the use of iodized salt in 75% of the Italian school canteens, a median UIC of 118 μg/L (rural areas: 119 μg/L; urban areas: 117 μg/L), and a prevalence of goiter <5% in 6 of the 7 regions (range 1%–4.7%). Only Umbria showed a borderline goiter prevalence value (5.4%). In regard to this, it is important to underline that the assessment of goiter in schoolchildren by ultrasound is an indicator of long-lasting adequate iodine intake in a population. In fact, it has been demonstrated that iodine prophylaxis is able to prevent the development of goiter in children born after the implementation of iodized salt and to further control thyroid enlargement in older children, although it is less effective in reducing goiter size in children exposed to iodine deficiency in the first years of life (6). In their study Campanozzi et al. (1) also suggest to continue monitoring the iodine intake in the Italian population by using 24-h UIE measured in children to properly document changes in iodine intake over the years. They support this conclusion on the basis of the observation that significant discrepancies between 24-h UIE and UIC were found in the first (<7.8 y) and second (7.8–10 y) quartiles of age, where the average 24-h urinary volume was <1 L, but not in the third (>10–12.5 y) and fourth (>12.5–18 y) quartiles of age of the young population they recruited. In particular, they underline that the measurement of UIC in spot samples could lead to an underestimation of iodine deficiency in younger subjects because of the age-related smaller urine volumes producing spuriously higher iodine concentrations. Actually, we believe that the collection of 24-h UIE in a large number of schoolchildren to monitor the iodine nutritional status in the population is not necessary. UIC from spot samples is the recommended indicator for population assessment and monitoring of iodine interventions globally (7, 8). According to the WHO classification, adequate iodine status is indicated by a population median UIC ≥100 μg/L with no more than 20% of samples <50 μg/L; where the median value is <100 μg/L the iodine intake is considered inadequate. If a large number of samples are collected, variations in hydration among individuals (9) and day-today variation in iodine intake (10) generally even out, so that the median UIC in spot samples correlates well with the median from 24-h samples (8). Therefore, if the daily volume of urine produced by a group approximates 1 L/d, as Campanozzi et al. (1) demonstrated to occur in schoolchildren aged>10 y, then the UIC (in micrograms per liter) is interchangeable with the 24-h UIE. Because both OSNAMI surveys were conducted in schoolchildren at such an age that their urine volume can be assumed to be ∼1 L, we are confident that the results so far obtained by OSNAMI are reliable. Furthermore, considering that spot urine samples are far simpler to obtain than 24-h urine collections, in the future the UIC assessment will allow monitoring of iodine nutritional status in the Italian population more frequently than would be possible if 24-h urine collections were undertaken. Consequently, this higher frequency will provide the advantage of a more accurate evaluation of the sustainability of iodine sufficiency just achieved in our country

Risk of hyponatraemia in cancer patients treated with targeted therapies: A systematic review and meta-analysis of clinical trials

Hyponatraemia has been reported with targeted therapies in cancer patients. Aim of the study was to perform an up-to-date meta-analysis in order to determine the incidence and relative risk (RR) in cancer patients treated with these agents.The scientific literature regarding hyponatraemia was extensively reviewed using MEDLINE, PubMed, Embase and Cochrane databases. Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% Confidence Intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies.4803 potentially relevant trials were identified: of them, 13 randomized phase III studies were included in this meta-analysis. 6670 patients treated with 8 targeted agents were included: 2574 patients had hepatocellular carcinoma, whilst 4096 had other malignancies. The highest incidences of all-grade hyponatraemia were observed with the combination of brivanib and cetuximab (63.4) and pazopanib (31.7), while the lowest incidence was reported by afatinib (1.7). The highest incidence of high-grade hyponatraemia was reported by cetuximab (34.8), while the lowest incidences were reported by gefitinib (1.0). Summary RR of developing all-grade and high-grade hyponatraemia with targeted agents was 1.36 and 1.52, respectively. The highest RRs of all-grade and high-grade hyponatraemia were associated with brivanib (6.5 and 5.2, respectively). Grouping by drug category, the RR of high-grade hyponatraemia with angiogenesis inhibitors was 2.69 compared to anti-Epidermal Growth Factor Receptors agents (1.12).Treatment with biological therapy in cancer patients is associated with a significant increased risk of hyponatraemia, therefore frequent clinical monitoring should be emphasized when managing targeted agents

Univariate and multivariate analysis of risk factors affecting patient survival.

<p>IGF-1, insulin-like growth factor 1; LT, liver transplantation; ECD, extended criteria donor; DMELD, donor age x Model for End Stage Liver Disease; EAD, early allograft dysfunction; DRI, Donor Risk Index; HCV, hepatitis C virus; HCC, hepatocellular carcinoma; POD, postoperative day.</p