Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019)

CONTEXT

In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking.

OBJECTIVE

The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program.

METHODS

From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism.

RESULTS

The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 μg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%.

CONCLUSION

Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.

Expanded Newborn Screening in Italy Using Tandem Mass Spectrometry: Two Years of National Experience

Newborn screening (NBS) for inborn errors of metabolism is one of the most advanced tools for secondary prevention in medicine, as it allows early diagnosis and prompt treatment initiation. The expanded newborn screening was introduced in Italy between 2016 and 2017 (Law 167/2016; DM 13 October 2016; DPCM 12-1-2017). A total of 1,586,578 infants born in Italy were screened between January 2017 and December 2020. For this survey, we collected data from 15 Italian screening laboratories, focusing on the metabolic disorders identified by tandem mass spectrometry (MS/MS) based analysis between January 2019 and December 2020. Aminoacidemias were the most common inborn errors in Italy, and an equal percentage was observed in detecting organic acidemias and mitochondrial fatty acids beta-oxidation defects. Second-tier tests are widely used in most laboratories to reduce false positives. For example, second-tier tests for methylmalonic acid and homocysteine considerably improved the screening of CblC without increasing unnecessary recalls. Finally, the newborn screening allowed us to identify conditions that are mainly secondary to a maternal deficiency. We describe the goals reached since the introduction of the screening in Italy by exchanging knowledge and experiences among the laboratories.

Geographical epidemiology of neonatal transitory hypothyroidism. Trend evidence in central Italian region

AIM

To study the geographical distribution of high thyroid-stimulating hormone (TSH) level in the Marche region (central Italy).

METHODS

Data were drawn from the Register of Neonatal Screening for Congenital Hypothyroidism (CH) of the Marche region (Italy), located at the Child Neuropsychiatry Department of Civil Hospital in Fano (Marche, Italy). Data were analyzed by Ohno's method.

RESULTS

The findings of this study show a nonuniform distribution of high TSH levels in the Marche region, with an evident gradient from North to South.

CONCLUSIONS

It is not possible to provide a definitive interpretation of these findings, although the specialized literature suggests that a high level of TSH in neonates should be interpreted as a marker of insufficient iodine uptake. Other factors affecting TSH level are also taken into consideration.

Total knee replacement: prevention of deep-vein thrombosis using pharmacological (low-molecular-weight heparin) and mechanical (intermittent foot sole pump system) combined prophylaxis. Preliminary results

AIM

The aim of this study was to determine the role of combined mechanical and pharmacological prophylaxis in the prevention of deep venous thrombosis (DVT) after total knee replacement (TKR).

DESIGN

prospective case series study.

METHODS

Between October 2002 and June 2003, 38 total knee procedures were carried out on 34 patients (4 patients had bilateral TKR). To exclude the presence of a concomitant DVT echo-color-flow of the legs was performed between 2 and 1 week prior to surgery, in the postoperative period (before discharging) and 30 days after surgery. Patients received one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight). An intermittent foot sole pump (IFSP) was applied in the recovery room postoperatively, in both feet for about 5 h a day and all night long, and continued at home until the 15(th) day.

RESULTS

No major perioperative or rehabilitation phase-related complications were observed (2 patients required manual drainage of blood clots from the wound). The incidence of DVT was 7.9% (3 cases). In one of these cases we observed a previous DVT so it was classified as rethrombosis. All were successfully treated with therapeutic introduced low molecular weight heparin (LMWH) therapy. No pulmonary embolism or deaths associated with the use of LMWH or IFSP were observed.

CONCLUSIONS

In our experience the combined prophylaxis with nadroparin calcium and IFSP significantly reduced the incidence of DVT.

Current trends in periprosthetic hip fractures: a review of the literature and an analysis of three clinical cases

It is the purpose of this study to review current trends and guidelines in the treatment of periprosthetic hip fractures, and to report three cases of patients operated on and treated by different types of instrumentation: Modified Mennen plate by De Puy, Dall-Miles trochanteric grip, Zimmer cable-ready plate.

Myositis ossificans as a complication of a muscle tendon junction strain of long head of biceps. A case report

An unusual case of myositis ossificans secondary to a muscle tendon junction (MTJ) strain of long head of biceps in a young athlete is reported. Plain radiographs, ultrasonography and MRI in association with clinical assessment showed the appearance and the evolution of this pathological entity. This case had a resolution of pain and function after 3 months of conservative treatment. At 6 months follow-up, the athlete became asymptomatic and he gradually returned back to his sports activity.

Is the birthdate a risk factor for congenital hypothyroidism? A statistical answer based on personal experience

BACKGROUND

To verify statistically the hypothesis that birthdate represents a risk factor for Congenital Hypothyroidism, as proposed by some European Authors. Moreover, to verify the existence of seasonal cyclic trends in TSH levels.

METHODS

For the verification of birthdate as a risk factor, we considered retrospectively a data set of all consecutives newborns of Marche Region (Italy) affected by Congenital Hypothyroidism, in the period 1981-1996 (n = 92). For the evaluation of seasonal cyclic trends in TSH, we considered the level of the hormone in all newborns of Marche Region screened in the period 1989-1996. Data were collected from Neonatal Screening Register of Marche Region. All the statistical analyses are based on circular statistics techniques (Rayleigh test, Roger test, estimation of density by kernel method, Mardia test for circular-linear correlation, Maximization of Mean Vector Length).

RESULTS

No cyclic trend was pointed out with regard to Congenital Hypothyroidism; neither seasonal rhythms nor other cyclic patterns of TSH levels were evidenced.

CONCLUSIONS

Neither the hypothesis of birthdate as a risk factor for Congenital Hypothyroi-dism, nor the existence of seasonal variations in TSH hormone releasing were confirmed.