[The effects of amiodarone on the thyroid]. / Trastornos tiroideos por amiodarona.

BACKGROUND: Amiodarone is a drug widely used for the treatment of arrhythmias. In 16% of amiodarone-treated patients it causes changes in the thyroid function. The aim of this study was to determine the importance of amiodarone-induced thyroid dysfunction in the population of Navarre, studied between 2001 and 2007. METHODS: We present a retrospective study that considers the characteristics of 182 amiodarone-treated patients with thyroid dysfunction who had been referred to our Institute. We determined a series of biochemical and instrumental investigations (measurement of thyrotrophin, free thyroid hormones and thyroid autoantibodies; thyroid sonography and thyroid scintigraphy uptake). RESULTS: Screening of the thyroid function, recommended before starting amiodarone treatment, was carried out in only 20.9 % of the patients. Forty-one percent of patients developed amiodarone induced hypothyroidism; in 76% of them the drug was withdrawn. Hypothyroidism appears after 21 (+/- 12) months of amiodarone treatment. Forty-eight point six developed permanent hypothyroidism. This group of patients had higher serum levels of TSH (thyrotropin) and were treated for less time with amiodarone. Fifty-nine percent of patients developed amiodarone induced thyrotoxicosis; 59.4 % were diagnosed with thyrotoxicosis (AIT) type 1, 30.6% AIT type 2 and the remaining 10 % were diagnosed with mixed thyrotoxicosis. Thyrotoxicosis appears after 29.5 (+/- 17) months of amiodarone treatment. The serum levels of free thyroxine were significantly higher in the AIT type 2 than in the AIT type1. All patients were treated with antithyroid drugs and/or corticoids. Some patients were admitted to hospital due to the severity of their illness. CONCLUSIONS: In our study, amiodarone induced thyrotoxicosis was more frequent than hypothyroidism (59% vs 41%) because Navarre is an iodine-deficient area. It is necessary to control the thyroid function after 2-3 years of amiodarone treatment.

Animal models in ocular toxocariasis.

Ocular toxocariasis is a clearly defined disease. However, much remains to be learned concerning the migratory route, ocular changes, diagnosis and treatment. Studies in paratenic hosts have contributed to our understanding and will yield more information. Various experimental animals have been used, such as mice, rabbits, guinea pigs, primates, hamsters and gerbils. Of these, the last appear to be the most appropriate model due to their high susceptibility to ocular infection. Results obtained from different animal models are often not comparable due to the fact that dose and routes of inoculation are diverse. Early stages in the pathogenesis of ocular toxocariasis are manifested by haemorrhages in the anterior chamber and iris, replaced in time by accumulations of white cells. Ocular migration produces an early cell reaction, formed by an infiltration of neutrophils accompanied by vasculitis and retinal microinfarcts. Over a period of time, an increase of macrophages and the distribution of the infiltrates is observed. Later, granulomatous lesions are formed. These do not necessarily contain a larva and their appearance varies in different animal models. Local production of IgE and the presence of specific IgG have been described.

[Evaluation of the quality of care of diabetic patients in 3 health centers]. / Evaluación de la calidad asistencial prestada a pacientes diabéticos en tres centros de salud.

The results of a retrospective health care quality assurance study are presented. This study was designed to evaluate the quality of health care rendered to diabetic patients who were diagnosed and/or treated in three medical centres. Nineteen criteria were chosen for the evaluation stage (385 diabetics, analysed) and 20 were used in the reevaluation (108 diabetics). The complementary test group met the most criteria, and the explorations group met the least, with the exception of blood pressure readings (77% of record). In the reevaluation stage, the percentage met of all the criteria under study increased, with statistically significant differences in all but three of the criteria. The standard of 100% was not attained in any of the cases, but the 85% mark was exceeded in 7 of the 20 criteria. A substantial improvement in the number of criteria recorded in the histories was observed, with an increase to 36.09% of histories with 17 or more criteria met, and a reduction, from 26.02% to 11.11%, of histories with 6 or less criteria met.