[Iodine deficiency disorder persistance after introduction of iodized salt in a previously endemic goiter area]. / Persistencia de un trastorno por déficit de yodo tras la introducción de sal yodada en un área con antecedentes de bocio endémico.

OBJECTIVE: Correction of iodine deficiency diminishes the incidence of toxic nodular goitre. The aim of this study was to assess the etiology of thyrotoxicosis in two areas with different goitre prevalence in Galicia, fifteen years after the institutional campaign of salt iodination. Results of the present survey are compared with those from a study performed ten years ago. METHODS: Two hundred and two thyrotoxic patients attended in La Coruña (coastal zone) and Lugo (inland zone) from January 2000 to May 2002 were included. Clinical and exploratory data were recorded. Thyroid hormones, thyroid-directed antibodies and thyroid stimulating immunoglobulin (TSI) were measured. A thyroid 99m technetium or 123 iodine scintigram was performed. RESULTS: In the whole group 58.6% of the cases were diagnosed of nodular goitre, 30.3% of Graves disease, 7.1% of iodine induced thyrotoxicosis and 3.5% of subacute thyroiditis. In coastal zone these percentages were 52.2, 37.0, 5.4 and 4.3%, respectively. In the inland area, 64.2% nodular goitre, 24.5% Graves disease, 8.5% iodine induced thyrotoxicosis and 2.8% subacute thyroiditis. The most frequent diagnosis in both the whole group and in each area was toxic multinodular goitre. CONCLUSIONS: In some areas of Spain, toxic nodular goitre continues to be the most frequent cause of thyrotoxicosis. It is necessary to insist on implementation and monitoring of iodine supplementation programs.

[Early detection and control of risk factors in diabetic nephropathy]. / Detección precoz y control de factores de riesgo de la nefropatía diabética.

Diabetic nephropathy is an important complication of diabetes. Established nephropathy is preceded by a long silent phase of incipient nephropathy characterized by a subclinical increase in albumin excretion know as microalbuminuria (30-300 mg/d). There is evidence that the progression of nephropathy and its associated mortality can be ameliorated by a number of interventions if started at a nearly stage: glycaemic control, that should be optimized as far as possible, and hypertension control. Angiotensin-converting enzyme (ACE) inhibitors are promoted as first-line agent for treating hypertension in diabetic patients; as well as their systemic hypotensive action, these drugs may have an additional beneficial effect in reducing intraglomerular pressure.