ABSTRACT
BACKGROUND: If not diagnosed at birth, congenital hypothyroidism (CH) can cause deleterious, irreversible neurodevelopmental sequels. The importance of thyroid newborn screening (NBS) is therefore well established. OBJECTIVE: To evaluate the efficacy of NBS for CH in North-East Romania. METHODS: Retrospective, descriptive study involving 271662 newborns screened between 2010 and 2019 for CH and phenylketonuria in maternities from six Romanian North-Eastern counties by measuring neonatal TSH (neoTSH) in the whole blood extracted from the heel between days 3 and 5 after birth. Values found higher than a cut-off level of 10 mIU/L were followed by serum evaluation of TSH and fT4 for the confirmation of CH. Thyroid ultrasound was further performed at children found with CH. RESULTS: NeoTSH was found elevated in 417 newborns, but CH was subsequently confirmed in only 57 cases (1/4766 newborns). Mean age at the time when diagnosis was communicated was of 37.2 ± 15 days (between 9 and 157 days). Mean age when therapy was started was of 44.2 ± 17.9 days (between 13 and 160 days) with a mean delay of one week from diagnosis (between 0 and 62 days). Thyroid ultrasound revealed athyreosis in only 3 cases, atrophic thyroid gland in other 10 cases, whereas the thyroid was described as present in the remnant 44 cases. The number of first year follow-up visits greatly varied from 0 to 5, with an average of 2. CONCLUSIONS: NBS allowed rapid diagnosis of CH in North East Romania. The communication of diagnosis to families and therapy onset were however often delayed. Diagnosis and therapy onset before the age of two weeks, as well as a tighter follow-up should be assured by the healthcare system. Etiological diagnosis should be more accurate, for a better prognosis of disease severity, as well as the possibility of genetic advice in selected cases.
ABSTRACT
This paper addresses new developments in the ongoing proof mining programme, i.e. the use of tools from proof theory to extract effective quantitative information from prima facie ineffective proofs in analysis. Very recently, the current authors developed a method of extracting rates of metastability (as defined by Tao) from convergence proofs in nonlinear analysis that are based on Banach limits and so (for all that is known) rely on the axiom of choice. In this paper, we apply this method to a proof due to Shioji and Takahashi on the convergence of Halpern iterations in spaces X with a uniformly Gâteaux differentiable norm. We design a logical metatheorem guaranteeing the extractability of highly uniform rates of metastability under the stronger condition of the uniform smoothness of X. Combined with our method of eliminating Banach limits, this yields a full quantitative analysis of the proof by Shioji and Takahashi. We also give a sufficient condition for the computability of the rate of convergence of Halpern iterations.
