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INTRODUCCCIÓN: Las hormonas tiroideas (HT) mantienen la homeostasis del organismo. La gestación implica cambios fisiológicos de la glándula tiroidea materna. Durante el embarazo, las HT son fundamentales en el desarrollo fetal. Las alteraciones en la función tiroidea producen resultados adversos en la gestante, en el feto y el recién nacido (RN). Los valores de las HT en el embarazo difieren de la población general y cambian a lo largo de la gestación. Para su evaluación, se requiere intervalos de referencia apropiados. OBJETIVOS: Establecer los intervalos de referencia (IR) de tirotrofina (TSH) y tiroxina libre (T4L) en población gestante para cada trimestre. Conocer la prevalencia del hipotiroidismo. MATERIALES Y MÉTODOS: Se analizaron concentraciones séricas de TSH y T4L de gestantes en cada trimestre. Se determinaron los intervalos de referencia por método directo siguiendo lineamientos de la International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) en la Guía C28 A3 de Clinical and Laboratory Standard Institute(CLSI). RESULTADOS: Se encontró que no correspondió particionar los intervalos de referencia para TSH por trimestre de gestación. Para T4L se obtuvo un intervalo de referencia para el primer trimestre, y otro para el segundo y tercero. Se obtuvo una prevalencia global de 1,8 % de hipotiroidismo en el embarazo. CONCLUSIÓN: Los IR constituye un aporte para el estudio de la función tiroidea en el embarazo, permite instalar un tratamiento temprano y disminuir implicancias de enfermedad tiroidea. Asiste al médico en la toma de decisiones clínicas asegurando el bienestar de la gestante y del feto.

ABSTRACTBy deploying the Public Digital Bookkeeping System (SPED), tax administration seeks to increase the subjective perception of risk between taxpayers and reduce the tax gap. The objective of this research is to verify whether the implementation of Accounting SPED had an influence on the economic and financial results declared by companies (gross revenue and net profit). The null hypothesis of the research - the lack of relationship between these variables - was tested through the regression model with panel data. The sample was selected from the 500 largest companies listed in the database Best and Biggest, by Exame Melhores e Maiores magazine. The data collected comprise financial statements of these companies on the calendar years 2004 to 2009. Regression models were estimated using random effects, with unbalanced panels. The Accounting SPED showed significance in all regression models of gross revenue and net profit, allowing the rejection of the null hypothesis of no relationship between these variables. Finally, according to the analysis models of tax evasion exposed in the literature review, considering that the Accounting SPED increases the effectiveness and efficiency of auditing mechanisms of the tax administration, an increase on the economic and financial results declared by companies of the sample was expected, which was confirmed in research.RESUMOAo implantar o Sistema Público de Escrituração Digital (SPED), a administração tributária brasileira buscou ampliar a percepção de risco subjetivo entre os contribuintes, e reduzir a brecha fiscal. Esta pesquisa tem como objetivo verificar se a implementação do SPED Contábil teve influência sobre os resultados econômico-financeiros declarados pelas empresas (lucro líquido legal e faturamento bruto). A hipótese nula da pesquisa – ausência de relação entre essas variáveis – foi testada por meio de um modelo de regressão com dados em painel. A amostra foi selecionada a partir da lista das 500 maiores empresas do banco de dados da revista Exame Melhores e Maiores. Foram coletados os dados referentes às demonstrações financeiras dessas empresas relativas aos anos-calendário de 2004 a 2009. As regressões foram efetuadas por meio de modelos com efeitos aleatórios, com a utilização de painéis desbalanceados. O SPED Contábil apresentou significância nos modelos de regressão do faturamento bruto e lucro líquido legal, permitindo a rejeição da hipótese nula. Por fim, de acordo com os modelos de análise da sonegação fiscal expostos na revisão bibliográfica, considerando-se que o SPED Contábil aumenta a eficácia e a eficiência dos mecanismos de auditoria da administração tributária, esperava-se um incremento nos resultados econômico-financeiros declarados pelas empresas integrantes da amostra, o que foi confirmado na pesquisa.RESUMENAl implantar el Sistema Público de Escritura Digital (SPED), la administración tributaria busca la percepción de riesgo subjetivo entre los contribuyentes y reducir la brecha fiscal. Esta investigación tiene por objetivo averiguar si la implementación del SPED Contable influyó sobre los resultados económico-financieros, declarados por las empresas (lucro beneficio neto y facturación bruta). La hipótesis nula del estudio –ausencia de relaciones entre estas variables– se comprobó a través del modelo de regresión con los datos en panel. La muestra se seleccionó a partir de la lista de las 500 mayores empresas de la base de datos de la revista Exame Melhores e Maiores. Se recopilaron datos referentes a las demostraciones financieras de esas empresas en relación a los años naturales de 2004 hasta 2009. Las regresiones se realizaron a través de los modelos con efectos aleatorios, con la utilización de paneles sin balance. El SPED Contable resultó significativo en los modelos de regresión de la facturación bruta y beneficio neto legal, permitiendo el rechazo de la hipótesis nula. Por último, de acuerdo a los modelos de análisis de evasión de impuestos expuesta en la revisión bibliográfica, teniendo en cuenta que el SPED Contable aumenta la eficacia y la eficiencia de los mecanismos de la auditoría de la administración tributaria, se esperaba un aumento sobre los resultados económico financieros declarados por las empresas participantes en la muestra, lo cual quedó confirmado en el estudio.

Background: It is crucial to assess the levels of protection generated by natural infection or SARS-CoV-2 vaccines, mainly in individuals professionally exposed and in vulnerable groups. Measuring T-cell responses may complement antibody tests currently in use as correlates of protection. Our aim was to assess the feasibility of a validated assay of T-cell responses., Methods: Twenty health-care-workers (HCW) were included. Antibody test to SARS-CoV-2 N and S-proteins in parallel with a commercially available whole-blood-interferon-gamma-release-assay (IGRA) to S-peptides and two detection methods, CLIA and ELISA were determined., Results: IGRA test detected T-cell responses in naturally exposed and vaccinated HCW already after first vaccination dose. The correlation by the two detection methods was very high (R>0.8) and sensitivity and specificity ranged between 100 and 86% and 100-73% respectively. Even though there was a very high concordance between specific antibody levels and the IGRA assay in the ability to detect immune response to SARS-CoV-2, there was a relatively low quantitative correlation. In the small group primed by natural infection, one vaccine dose was sufficient to reach immune response plateau. IGRA was positive in one, with Ig(S) antibody negative vaccinated immunosuppressed HCW illustrating another advantage of the IGRA-test., Conclusion: Whole-blood-IGRA-tests amenable to automation and constitutes a promising additional tool for measuring the state of the immune response to SARS-CoV-2; they are applicable to large number of samples and may become a valuable correlate of protection to COVID-19, particularly for vulnerable groups at risk of being re-exposed to infection, as are health-care-workers., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Severe combined immunodeficiency (SCID), the most severe form of T-cell immunodeficiency, can be screened at birth by quantifying T-cell receptor excision circles (TREC) in dried blood spot (DBS) samples. Early detection of this condition speeds up the establishment of appropriate treatment and increases the patient's life expectancy. Newborn screening for SCID started in January 2017 in Catalonia, the first Spanish and European region to universally include this testing. The results obtained in the first three years and a half of experience (January 2017 - June 2020) are shown here, using EnLite Neonatal TREC kit (Perkin Elmer) with 20 copies/µL as TREC detection cutoff. Of 222,857 newborns screened, 48 tested positive: three patients were diagnosed with SCID (incidence 1:74,285); 17 patients had clinically significant T-cell lymphopenia (non-SCID) with an incidence of 1 in 13,109 newborns; twenty two patients were considered false-positive cases because of an initially normal lymphocyte count with normalization of TREC between 3 and 6 months of life; one case had transient lymphopenia due to an initially low lymphocyte count with recovery in the following months; and five patients are still under study. The results obtained provide further evidence of the benefits of including this disease in newborn screening programs. Even longer follow-up could be necessary to define the exact incidence of SCID in Catalonia.

The Catalonian Newborn Screening Program (CNSP) began in 1969, in Barcelona. It was promoted by Dr. Juan Sabater Tobella and supported by Barcelona Provincial Council and Juan March Foundation. That is how the Institute of Clinical Biochemistry was born, whose aims were diagnosis, research and teaching, along with the spirit of contributing to the prevention of mental retardation. The CNSP began with the detection of phenylketonuria (PKU), and, in 1982, the Program was expanded with the inclusion of congenital hypothyroidism detection. Towards 1990, the Program covered almost 100% of all newborns (NB) in Catalonia. In 1999, the CNSP was expanded with the incorporation of cystic fibrosis. It took fourteen years, until 2013, to make the largest expansion so far, with the incorporation of 19 metabolic diseases to the screening panel. The detection of sickle cell disease began in 2015 and in 2017 the detection of severe combined immunodeficiency was included. Currently, the CNSP includes 24 diseases in its main panel. Since 1969, 2,787,807 NBs have been screened, of whom 1,724 have been diagnosed with any of these diseases, and 252 of other disorders by differential diagnosis with those included in the main panel. The global prevalence is 1: 1,617 NBs affected by any of the diseases included in the CNSP and 1: 1,140 NBs if incidental findings diagnosed through the CNSP are included.

Introduction and Objectives: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period., Materials and Methods: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005 to 2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated., Results: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab., Conclusions: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications., (Copyright © 2020 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Objective: To compare the incidence of severe hepatitis in HIV-infected patients receiving rifampicin plus pyrazinamide (RZ) for antituberculosis prophylaxis with that of patients receiving a conventional isoniazid-based regime for 6 to 12 months (6-12H)., Methods: Meta-analysis of randomized controlled trials, in which RZ was compared with 6-12H, the standard regimen for latent tuberculosis infection in HIV-infected patients. A systematic search of studies published between 1986 and 2007 was carried out, and 5 randomized clinical trials conducted in Spain (2), the USA (1), Haiti (1), and Zambia (1) were identified. The absence or presence of severe hepatoxicity, which was defined as toxicity causing the death of the patient or requiring treatment withdrawal, was assessed as a binary response, and the outcome measure was the difference in the risk of hepatotoxicity between patients receiving RZ and those receiving 6-12H (controls)., Results: Among the 5 trials retrieved, 1 was excluded from the final analysis because of incomplete data on the development of hepatotoxicity. A final total of 2657 patients were included (1324 patients receiving RZ and 1333 receiving 6-12H). The development of severe hepatotoxicity was lower in the RZ group than in the 6-12H group (1.208% vs. 2.851%; P=0.0042, 95% CI: -0.028 to -0.005). The meta-analysis showed no statistical evidence of heterogeneity between the studies or publication bias. The difference in the risk of severe hepatotoxicity favored the RZ regimen in both the fixed effects model (-0.0119, 95% CI: -0.0206 to -0.0033) and random effects model (-0.0147, 95% CI: -0.0289 to -0.0006)., Conclusions: The meta-analysis did not demonstrate an increased risk of severe hepatoxicity in HIV-infected patients receiving tuberculosis prophylaxis with the rifampicin/pyrazinamide combination compared to the conventional 6- or 12-month isoniazid-based regimen., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

The Law to Promote Personal Autonomy and Care for people dependent on continual at home treatment has had strong repercussions not only in social relationships but in scientific health forums as well. At present time, what most concerns professionals and society at large is the development of a system which includes resources and services capable to ensure treatment to those who must continually depend on someone else for their basic care-needs. But, what is happening with our health care? In this review article, the authors propose to analyze health system coverage for those who depend on others for their continuous basic care-needs in our country.

Against the background of the renewed interest aroused in recent years by the influenza pandemic of 1918-1919, and the leading role now played by research analysing the process of innovation in medicine, this paper assesses the role played by serums and vaccines - the new resources of the medical science of the time 0 in the fight against the influenza outbreak of 1918-1919. The paper highlights the dependence on combined scientific, social, economic and professional factors, and also shows the main consequences arising from the fine-tuning and implementation of these therapeutic and prophylactic resources.

Renal cell carcinoma have a great capacity of dissemination and have a great variety of clinical presentation. We exposed a clinical note of a patient diagnosed of renal cell carcinoma who developed hematuria and acute urinary retention due to a penis metastasis. Next we review the literature about this topic.

Background: Increases in total plasmatic homocysteine (tHcy) represents a risk factor for neural tube defects. We studied the effects of levofolinic acid (l,5-formyl-tetrahydrofolic) on the plasmatic tHcylevels in women of child-bearing age., Materials and Method: Healthy women aged 18-35 years (n = 30) received levofolinic acid, 5 mg/day,orally for 30 days. Both tHcy and intraerythrocytic folate levels were measured before treatment (day 0), on days 2, 5, 10 and 30 within the treatment period and on days 30 (day 60) and 60 (day 90) after the treatment was finished. Plasmatic tHcy was measured by fluorescence polarisation immunoassay and intraerythrocyticfolates by chemiluminescent immunoassay., Results: Plasmatic tHcy decreased from the second day of treatment onwards (day 0 vs. 2: mean of difference: -1.24 micromol/l; CI 95% = -0.84 to -1.63; p < 0.001). The maximum decline (32.3%) was observed after 30 days (mean of difference = -2.72 micromol/l; CI 95% = -2.20 to -3.24; p < 0.001).After finishing the treatment, the hypohomocysteinic effect persisted up to days 60 (mean of difference = -2.67 micromol/l; CI 95% = -2.07 to -3.26; p < 0.001)and 90 (mean of difference = -1.49 micromol/l; CI 95% = -0.94 to -2.03; p < 0.001). The response was greater when the plasmatic tHcy concentration was >= 9 micromol/l., Conclusions: Levofolinic acid leads to a earlier, intense and persistent drop of the plasmatictHcy levels.

In 1996 the Navarra Occupational Health Institute, an autonomous technical organization that integrates the functions and means related to occupational health matters, drew up the Occupational Health Diagnosis of Navarra, which is a region characterised by its important industrial sector and its high proportion of small and medium size companies. The results emphasise the high accident rate in the construction sector, the constant increase of professional diseases through "fatigue of tendon pods", as well as the importance of osteo-muscular processes as a cause of temporary and permanent disability. Forty sentinel occupational tumors, mainly mesothelioma, and 27 Obligatory Statement Diseases of occupational origin, mainly brucellosis, were identified in a period of seven years and three years, respectively. Verification was made of a lack of systematised information about population exposure to occupational risks, a scarce development of medical surveillance of exposed workers, and a lack of information about the incidence of occupational injuries in self-employed workers.

The present research show, an statistical study of the effects of ammonium metavanadate (AMV) on size, weight and number of offsprings of 56 albino swiss mice (male and female) was carried out. These mice ingested AMV in concentration of 100 and 200 ppm "ad libitum" since birth, continuing throughout breasting until mating. The control group received water free from the metal. The statistical results, obtained by the Duncan and Tukey method, were the following: a significant drop in body size in 200 ppm concentration of AMV, and in tail size in a concentrations of 100 and 200 ppm. A significant increase was observed in the number of the offsprings on the groups treated with AMV on a concentration of 200 ppm with respect to the control group.

In this study the analysis of the theoretical bases on which "the regulatory project on public prophylaxis for infectious diseases" was based reflects the influence of the 1918-19 influenza pandemic, and the social and political circumstances of this period. This document, based on theoretical elements of social medicine, and particularly economic and reformist criteria, proposed public prophylaxis for infectious diseases based on cooperation between the new science and social security programs as the principal social measure.

The different etiological theses which were defended before the Real Academia Nacional de Medicina (Royal National Academy of Medicine) during the 1918-19 epidemic have been studied using the annals of the afore mentioned Academy for the years 1918 and 1919. Apart from the official stance, which considered Pfeiffer's bacillus to be responsible, numerous other hypoteses formulated by researches throughout the world were also discussed. The clinical academicians were the staunchest defenders of traditional etiology whereas, those who questioned this belief, quite to the contrary were from a health background. However, the oportunity offered by the 1918-19 epidemic to gain advances in the knowledge of influenza was lost as Pfeiffer's bacillus was not rejected as the agent of the disease, despite not meeting the requirements of new medical science.

The benefit of the immunomodulation properties of thymic hormones in patients receiving chemotherapy for malignant diseases is yet to be defined. The efficacy of thymostimulin (TP-1) on hematological tolerance is evaluated, the performance level, the number and severity of the infections and skin reactions in two groups of homogeneous and randomized patients, diagnosed as having lymphoma and myeloma. Both patient groups (receiving or not receiving treatment) consisted of 20 persons. This observation was carried out in 96 courses of chemotherapy in each group; no significant differences having been noted in respect of the performance status at the beginning nor at the end of the study period between the 2 treatment groups. The hematological tolerance to chemotherapy, skin reactions and number and severity of infections registered were not significantly different between the 2 groups. In conclusion, we were unable to confirm an improvement in the clinical parameters of the myeloma and lymphoma patients receiving chemotherapy and thymostimulin during the period of observation.

Fibromyalgia syndrome is characterized by generalized musculoskeletal pain and abnormal sensitivity to palpation of characteristic myofascial areas. We evaluated its prevalence in the 673 patients seen as first consultations in a hospital rheumatological outpatient clinic during one year, and we made an automatized review of the Spanish literature about this condition in the last 17 years. We found 70 cases (10.4%) of fibromyalgia syndrome, none of which had been referred to the hospital with this diagnosis. We report their clinical features. In our bibliographical search we found only one article describing this condition. We conclude that it is a common clinical syndrome, unknown in nonspecialized milieus. Generally, the patients are inadequately diagnosed and treated, and/or referred to hospital.