Effect of hormone replacement on exercise cardiopulmonary reserve and recovery performance in subclinical hypothyroidism

Subclinical hypothyroidism (SH) patients present cardiopulmonary, vascular and muscle dysfunction, but there is no consensus about the benefits of levothyroxine (L-T4) intervention on cardiopulmonary performance during exercise. The aim of the present study was to investigate the effects of L-T4 on cardiopulmonary exercise reserve and recovery in SH patients. Twenty-three SH women, 44 (40-50) years old, were submitted to two ergospirometry tests, with an interval of 6 months of normalization of thyroid-stimulating hormone (TSH) levels (L-T4 replacement group) or simple observation (TSH = 6.90 μIU/mL; L-T4 = 1.02 ng/dL). Patients with TSH >10 μIU/mL were excluded from the study to assure that they would receive treatment in this later stage of SH. Twenty 30- to 57-year-old women with no thyroid dysfunction (TSH = 1.38 μIU/mL; L-T4 = 1.18 ng/dL) were also evaluated. At baseline, lower values of gas exchange ratio reserve (0.24 vs 0.30; P < 0.05) were found for SH patients. The treated group presented greater variation than the untreated group for pulmonary ventilation reserve (20.45 to 21.60 L/min; median variation = 5.2 vs 25.09 to 22.45 L/min; median variation = -4.75, respectively) and for gas exchange ratio reserve (0.19 to 0.27; median variation = 0.06 vs 0.28 to 0.18; median variation = -0.08, respectively). There were no relevant differences in cardiopulmonary recovery for either group at baseline or after follow-up. In the sample studied, L-T4 replacement improved exercise cardiopulmonary reserve, but no modification was found in recovery performance after exercise during this period of analysis.

Effect of triiodothyronine on the maxilla and masseter muscles of the rat stomatognathic system

The maxilla and masseter muscles are components of the stomatognathic system involved in chewing, which is frequently affected by physical forces such as gravity, and by dental, orthodontic and orthopedic procedures. Thyroid hormones (TH) are known to regulate the expression of genes that control bone mass and the oxidative properties of muscles; however, little is known about the effects of TH on the stomatognathic system. This study investigated this issue by evaluating: i) osteoprotegerin (OPG) and osteopontine (OPN) mRNA expression in the maxilla and ii) myoglobin (Mb) mRNA and protein expression, as well as fiber composition of the masseter. Male Wistar rats (~250 g) were divided into thyroidectomized (Tx) and sham-operated (SO) groups (N = 24/group) treated with T3 or saline (0.9%) for 15 days. Thyroidectomy increased OPG (~40%) and OPN (~75%) mRNA expression, while T3 treatment reduced OPG (~40%) and OPN (~75%) in Tx, and both (~50%) in SO rats. Masseter Mb mRNA expression and fiber type composition remained unchanged, despite the induction of hypo- and hyperthyroidism. However, Mb content was decreased in Tx rats even after T3 treatment. Since OPG and OPN are key proteins involved in the osteoclastogenesis inhibition and bone mineralization, respectively, and that Mb functions as a muscle store of O2 allowing muscles to be more resistant to fatigue, the present data indicate that TH also interfere with maxilla remodeling and the oxidative properties of the masseter, influencing the function of the stomatognathic system, which may require attention during dental, orthodontic and orthopedic procedures in patients with thyroid diseases.

Hypothyroidism decreases proinsulin gene expression and the attachment of its mRNA and eEF1A protein to the actin cytoskeleton of INS-1E cells

The actions of thyroid hormone (TH) on pancreatic beta cells have not been thoroughly explored, with current knowledge being limited to the modulation of insulin secretion in response to glucose, and beta cell viability by regulation of pro-mitotic and pro-apoptotic factors. Therefore, the effects of TH on proinsulin gene expression are not known. This led us to measure: a) proinsulin mRNA expression, b) proinsulin transcripts and eEF1A protein binding to the actin cytoskeleton, c) actin cytoskeleton arrangement, and d) proinsulin mRNA poly(A) tail length modulation in INS-1E cells cultured in different media containing: i) normal fetal bovine serum - FBS (control); ii) normal FBS plus 1 µM or 10 nM T3, for 12 h, and iii) FBS depleted of TH for 24 h (Tx). A decrease in proinsulin mRNA content and attachment to the cytoskeleton were observed in hypothyroid (Tx) beta cells. The amount of eEF1A protein anchored to the cytoskeleton was also reduced in hypothyroidism, and it is worth mentioning that eEF1A is essential to attach transcripts to the cytoskeleton, which might modulate their stability and rate of translation. Proinsulin poly(A) tail length and cytoskeleton arrangement remained unchanged in hypothyroidism. T3 treatment of control cells for 12 h did not induce any changes in the parameters studied. The data indicate that TH is important for proinsulin mRNA expression and translation, since its total amount and attachment to the cytoskeleton are decreased in hypothyroid beta cells, providing evidence that effects of TH on carbohydrate metabolism also include the control of proinsulin gene expression.

The increased but non-predominant expression of Th17- and Th1-specific cytokines in Hashimoto’s thyroiditis but not in Graves’ disease

Hashimoto’s thyroiditis (HT) is considered to be mediated mainly by Th1 cells, but it is not known whether Graves’ disease (GD) is associated with Th1 or Th2 predominance. Th17 cells, a novel subset of Th cells, play a crucial role in the pathogenesis of various autoimmune disorders. In the present study, the expression of IL-17A and IFN-γ was investigated in patients with HT or GD. mRNA expression of IL-17A and IFN-γ in peripheral blood mononuclear cells (PBMC) from 43 patients with autoimmune thyroid disease (AITD) and in thyroid tissues from 40 AITD patients were measured by real-time qRT-PCR. The protein expression of IL-17A and IL-23p19 was examined by immunohistochemistry in thyroid tissues from 28 AITD patients. The mRNA levels of IL-17A and IFN-γ were higher in both PBMC and thyroid tissues of HT patients than in controls (mRNA levels are reported as the cytokine/β-actin ratio: IL-17 = 13.58- and 2.88-fold change and IFN-γ = 16.54- and 2.74-fold change, respectively, P < 0.05). Also, the mRNA levels of IL-17A and IFN-γ did not differ significantly in GD patients (P > 0.05). The high protein expression of IL-17A (IOD = 15.17 ± 4.8) and IL-23p19 (IOD = 16.84 ± 7.87) in HT was confirmed by immunohistochemistry (P < 0.05). The similar high levels of IL-17A and IFN-γ suggest a mixed response of Th17 and Th1 in HT, where both cells may play important roles in the destruction procedure by cell-mediated cytotoxicity.

Performance assessment of the single photon emission microscope: high spatial resolution SPECT imaging of small animal organs

The single photon emission microscope (SPEM) is an instrument developed to obtain high spatial resolution single photon emission computed tomography (SPECT) images of small structures inside the mouse brain. SPEM consists of two independent imaging devices, which combine a multipinhole collimator, a high-resolution, thallium-doped cesium iodide [CsI(Tl)] columnar scintillator, a demagnifying/intensifier tube, and an electron-multiplying charge-coupling device (CCD). Collimators have 300- and 450-µm diameter pinholes on tungsten slabs, in hexagonal arrays of 19 and 7 holes. Projection data are acquired in a photon-counting strategy, where CCD frames are stored at 50 frames per second, with a radius of rotation of 35 mm and magnification factor of one. The image reconstruction software tool is based on the maximum likelihood algorithm. Our aim was to evaluate the spatial resolution and sensitivity attainable with the seven-pinhole imaging device, together with the linearity for quantification on the tomographic images, and to test the instrument in obtaining tomographic images of different mouse organs. A spatial resolution better than 500 µm and a sensitivity of 21.6 counts·s-1·MBq-1 were reached, as well as a correlation coefficient between activity and intensity better than 0.99, when imaging 99mTc sources. Images of the thyroid, heart, lungs, and bones of mice were registered using 99mTc-labeled radiopharmaceuticals in times appropriate for routine preclinical experimentation of <1 h per projection data set. Detailed experimental protocols and images of the aforementioned organs are shown. We plan to extend the instrument's field of view to fix larger animals and to combine data from both detectors to reduce the acquisition time or applied activity.

Neonatal hyper- and hypothyroidism alter the myoglobin gene expression program in adulthood

Myoglobin acts as an oxygen store and a reactive oxygen species acceptor in muscles. We examined myoglobin mRNA in rat cardiac ventricle and skeletal muscles during the first 42 days of life and the impact of transient neonatal hypo- and hyperthyroidism on the myoglobin gene expression pattern. Cardiac ventricle and skeletal muscles of Wistar rats at 7-42 days of life were quickly removed, and myoglobin mRNA was determined by Northern blot analysis. Rats were treated with propylthiouracil (5-10 mg/100 g) and triiodothyronine (0.5-50 µg/100 g) for 5, 15, or 30 days after birth to induce hypo- and hyperthyroidism and euthanized either just after treatment or at 90 days. During postnatal (P) days 7-28, the ventricle myoglobin mRNA remained unchanged, but it gradually increased in skeletal muscle (12-fold). Triiodothyronine treatment, from days P0-P5, increased the skeletal muscle myoglobin mRNA 1.5- to 4.5-fold; a 2.5-fold increase was observed in ventricle muscle, but only when triiodothyronine treatment was extended to day P15. Conversely, hypothyroidism at P5 markedly decreased (60%) ventricular myoglobin mRNA. Moreover, transient hyperthyroidism in the neonatal period increased ventricle myoglobin mRNA (2-fold), and decreased heart rate (5%), fast muscle myoglobin mRNA (30%) and body weight (20%) in adulthood. Transient hypothyroidism in the neonatal period also permanently decreased fast muscle myoglobin mRNA (30%) and body weight (14%). These results indicated that changes in triiodothyronine supply in the neonatal period alter the myoglobin expression program in ventricle and skeletal muscle, leading to specific physiological repercussions and alterations in other parameters in adulthood.

Novel cancer-related regulatory targets for the signalling sphingolipids sphingosine-1-phosphate and sphingosylphosphorylcholine

The signalling sphingolipid sphingosine-1-phosphate (S1P) is necessary for development of the immune system and vasculature and on a cellular level regulates migration, proliferation and survival. Due to these traits S1P has an important role in cancer biology. It is considered a primarily cancer-promoting factor and the enzyme which produces it, sphingosine kinase (SphK), is often over-expressed in tumours. S1P is naturally present in the blood, lymph, tissue fluids and cell cytoplasm and functions through its cell surface receptors (S1P1-5) and as an intracellular second messenger. Sphingosylphosphorylcholine (SPC) is closely related to S1P and has similar regulatory functions but has not been extensively studied. Both S1P and SPC are able to evoke either stimulatory or inhibitory effects on cancer cells depending on the context. The aim of this thesis work was to study novel regulatory targets of S1P and SPC, which mediate the effects of S1P/SPC signalling on cancer cell behaviour. The investigated targets are the transcription factor hypoxia-inducible factor 1 (HIF-1), the intermediate filament protein vimentin and components of the Hippo signalling pathway. HIF-1 has a central role in cancer biology, as it regulates a multitude of cancer-related genes and is potently activated by intratumoural hypoxia through stabilization of the regulatory subunit HIF-1α. Tumours typically harbour high HIF-1α levels and HIF-1, in turn, facilitates tumour angiogenesis and metastasis and regulates cancer cell metabolism. We found S1P to induce follicular thyroid cancer cell migration in normal oxygen conditions by increasing HIF-1α synthesis and stability and subsequently HIF-1 activity. Vimentin is a central regulator of cell motility and is also commonly over-expressed in cancers. Vimentin filaments form a cytoskeletal network in mesenchymal cells as well as epithelial cancer cells which have gone through epithelial-mesenchymal transition (EMT). Vimentin is heavily involved in cancer cell invasion and gives tumours metastatic potential. We saw both S1P and SPC induce phosphorylation of vimentin monomers and reorganization of the vimentin filament network in breast and anaplastic thyroid cancer cells. We also found vimentin to mediate the anti-migratory effect of S1P/SPC on these cells. The Hippo pathway is a novel signalling cascade which controls cancer-related processes such as cellular proliferation and survival in response to various extracellular signals. The core of the pathway consists of the transcriptional regulators YAP and TAZ, which activate predominantly cancer-promoting genes, and the tumour suppressive kinases Lats1 and Lats2 which inhibit YAP/TAZ. Increased YAP expression and activity has been reported for a wide variety of cancers. We found SPC to regulate Hippo signalling in breast cancer cells in a two-fold manner through effects on phosphorylation status, activity and/or expression of YAP and Lats2. In conclusion, this thesis reveals new details of the signalling function of S1P and SPC and regulation of the central oncogenic factors HIF-1 and vimentin as well as the novel cancer-related pathway Hippo.

Transport d’iode par le transporteur de sodium/acide monocarboxylique SMCT1

Le transporteur de Na+/ acide monocarboxylique sensible à l’ibuprofène (SMCT1) est exprimé dans la membrane apicale de plusieurs épithélia. Son rôle physiologique dans la glande thyroïde reste cependant obscur mais on présume qu’il pourrait agir comme un transporteur apical d’iode nécessaire pour la synthèse des hormones thyroïdiennes. Récemment, on a montré que SMCT1 possède un courant de fuite anionique sensible à [Na+]e qui permettrait de transporter l’iode de façon électrogénique. Cependant, un efflux d’iode sensible à l’ibuprofène, mais indépendant de la [Na+]e a été aussi observé sur des cultures primaires des thyrocytes porcins, suggérant un autre mécanisme de transport d’iode par SMCT1. Ce travail vise à comprendre les caractéristiques de ce genre de transport en utilisant comme modèle d’expression les ovocytes de Xenopus laevis. Les résultats obtenus des essais de captation d’iode radioactif montrent que SMCT1 présente un transport d’iode sensible à l’ibuprofène de l’ordre de 30nmol/ovocyte/h. Si ce transport est non saturable en iode (0-100 mM), il nécessite du Na+ dans la solution externe. En effet, le remplacement du Na+ extracellulaire par le NMDG inhibe complètement le transport. En outre, on s’est intéressé à exclure la possibilité de différents artefacts. En ayant trouvé que la grande majorité de l’iode radioactif se trouve dans la partie soluble de l’ovocyte, on exclut une liaison non spécifique de l’iode à la membrane cellulaire. Cependant, une bonne proportion de l’iode transporté pourrait être liée à des protéines à l’intérieur de l`ovocyte. En effet, on observe une réduction du transport d’iode dans les ovocytes exprimant SMCT1 de 81,6 ± 2 % en présence de 2 % BSA dans la solution extracellulaire. Également, on écarte la possibilité que le transport d’iode soit le résultat de la surexpression de protéines de transport endogènes dont les canaux chlore. Le transport d’iode semble spécifique à l’expression de SMCT1 et de manière intéressante à l’expression d’un autre transporteur de monocarboxylates, MCT1. L’analyse de l’ensemble des essais, y compris le fait que l’amplitude du transport observé est 20 fois plus grande que celle du courant de fuite nous mène à proposer que SMCT1 puisse transporter l’iode de façon électroneutre. Cependant, le mécanisme par lequel ceci est accompli n’est pas évident à identifier. L’utilisation d’un autre modèle cellulaire serait surement utile pour répondre à cette question.

Le double fardeau de la malnutrition à l’âge scolaire en milieu urbain : une étude au Burkina Faso

Ce travail financé par l'ACDI a été réalisé au Laboratoire TRANSNUT de l'Université de Montréal (Canada)en collaboration avec le Laboratoire National de Santé Publique (Burkina Faso) et HKI-Burkina Faso.

Analyse systématique de la relation entre l’exposition prénatale aux biphényles polychlorés et les effets neurodéveloppementaux et thyroïdiens chez l’enfant

Les biphényles polychlorés (BPC) sont des contaminants de l’environnement, omniprésents dans la chaîne alimentaire, qui ont une propension à la bioaccumulation dans le corps humain. Ils traversent la barrière placentaire et sont suspectés d’induire des altérations du développement mental ou moteur chez des enfants exposés aux BPC pendant la vie intrautérine. Ces effets s’expliqueraient notamment par la capacité des BPC à perturber l’homéostasie de la fonction thyroïdienne chez la femme enceinte ou le nouveau-né. Malgré le nombre considérable d’études épidémiologiques réalisées, la relation entre l’exposition prénatale aux BPC et les altérations du développement mental et moteur ou de la fonction thyroïdienne n’a pas encore été clairement établie ; d’une part, différents bioindicateurs de l’exposition ont été employés (différents congénères de BPC mesurés et différentes matrices biologiques ou unités de mesure) limitant la comparaison directe entre les études et, d’autre part, le lien de causalité entre les BPC et les effets ciblés n’a pas été vérifié avec des critères épidémiologiques reconnus. Cette étude a été réalisée afin d’analyser la relation « concentration biologique de BPC – effet » entre l'exposition aux BPC de la mère pendant la grossesse et le développement mental et moteur de l’enfant ainsi que les paramètres de la fonction thyroïdienne chez la femme enceinte et le nouveau-né à partir d’une analyse systématique des études épidémiologiques disponibles en standardisant les données biologiques entre les études. Sur la base de considérations toxicocinétiques et en appliquant des facteurs de conversion établis à partir de la littérature épidémiologique publiée, les concentrations des BPC rapportées dans les différentes études revues ont été standardisées en termes d’équivalent de BPC totaux par kilogramme de lipides dans le plasma maternel (µg PCBMPEQ/kg de lipides). Afin d’analyser la possibilité d’une association causale entre l’exposition aux BPC et les effets d’intérêt, les critères de Hill ont été appliqués systématiquement à l’ensemble des associations « concentrations biologiques standardisées – effet ciblés ». En appliquant cette approche aux données publiées de 20 études épidémiologiques sur la relation entre les BPC et le poids à la naissance, l’exposition prénatale aux BPC, aux niveaux décrits (moyenne < 1920 µg PCBMPEQ/kg de lipides), n’apparaît pas associée de manière significative à un poids à la naissance inférieur à 2500 g dans les populations étudiées. Par ailleurs, en considérant des études menées sur le suivi de neuf cohortes d’enfants, la probabilité qu’une altération cognitive ou motrice cliniquement significative, qui persiste entre la naissance et l’âge scolaire, soit observée à des concentrations de BPC totaux inférieures à 1000 µg PCBMPEQ/kg de lipides semble faible. Aussi, à partir de l’analyse systématique des données de 17 études épidémiologiques, l’exposition aux BPC aux niveaux standardisés décrits (moyenne < 1000 µg PCBMPEQ/kg de lipides) ne semble pas induire de variation des hormones thyroïdiennes ou de TSH en dehors des intervalles physiologiques reconnus chez la femme enceinte et le nouveau-né. Ainsi, la valeur biologique de référence établie à 1000 µg PCBMPEQ/kg de lipides pour prévenir les effets sur le développement devrait aussi prévenir les effets sur le poids à la naissance et la fonction thyroïdienne chez la femme enceinte ou le nouveau-né. Les résultats présentés dans cette thèse fournissent aux autorités de santé publique responsables de l’établissement de directives et des normes de l’information utile à la révision des critères sanitaires visant à protéger des effets des BPC sur le développement de l’enfant et la fonction thyroïdienne chez la femme enceinte et le nouveau-né.

Kinetic Parameters of Thymidine Kinase and DNA Synthesis During Liver Regeneration: Role Ofthyroid Hormones

The role of thyroid hormones in DNA synthesis and in the activity of Thymidille kinase (TK), a key regulatory enzyme of DNA synthesis was studied in proliferating hepatocytes in vivo. Liver regeneration after partial hepatectomy was used as a model for controlled cell division in rats having different thyroid status - euthyroid, hypothyroid and 3,3',5'-triiodo-L-thyronine (T))-heated hypothyroid. Partial hepatectomy caused a significant elevation of DNA synthesis (p<0.01) in all the three groups compared to their sham-operated counterparts. Hypothyroid liepatectomised animals showed significantly lower (p<0.01) level of DNA synthesis than euthyroid hepatectomised animals. A single subcutaneous close of 1'3 to hypothyroid shamoperated animals resulted in a significant increase (p<0.01) of DNA synthesis in the intact liver. 17tis was comparable to the level of DNA synthesis occurring in regenerating liver of euthyroid animals. In hypothyroid hepatectomised animals, "1'3 showed an additive effect on l)NA synthesis and this group exhibited maximum level of DNA synthesis (p<0.0I ). Studies of the kinetic parameters of TK show that the Michelis-Menten constant, (K111) of TK for thymidine was altered by the thyroid status. K11 increased significantly (p<0.01) in untreated hypothyroid animals when compared to the euthyroid rats. '13 treatment of hypothyroid animals reversed this effect and this group showed the lowest value for K111 (p<0.01). Thus our results indicate that thyroid hormones can influence DNA synthesis during liver regeneration and they may regulate the activity of enzymes such as 17rymidine kinase which are important for DNA synthesis and hence cell division.

Hypothyroidism of hypothalamic origin in pyridoxine-deficient rats

Pyridoxine-deficient young rats (3 weeks old) had significantly reduced levels of pituitary TSH, serum thyroxine (T4) and tri iodothyn nine (T,,) Compared with pyridoxine-supplemented rats. The status of the pituitary-thyroid axis of normal, pyridoxine-supplemented and pyridoxine-deficient rats was evaluated by studying the binding parameters of [3H](3-nicthylhistidine2) TRH in the pituitary of these rats. The effects of TRH and 1'4 injections on pituitary TSH and serum TSH, T4 and T3 of these two groups were also compared. The maximal binding of TRH receptors in the pituitary of pyridoxine-deficient rats was significantly higher than that of pyridoxine-supplemented control and normal rats, but there was no change in the binding affinity. Treatment with TRH stimulated TSH synthesis and release. It also increased serum T4 and T3 in both pyridoxine-supplemented and pyridoxine-deficient rats. Treatment with T4 decreased serum and pituitary TSH in both pyridoxine-supplemented and pyridoxine-deficient rats, compared with saline-treated rats. The increased pituitary TRH receptor content, response to TRH administration and the fact that regulation at the level of the pituitary is not affected in the pyridoxinedeficient rat indicates a hypothalamic origin for the hypothyroidism of the pyridoxine-deficient rat.

Adrenergic and serotonergic function in dna synthesis during rat liver regeneration and in hepatocyte cultures

The adult mammalian liver is predominantly in a quiescent state with respect to cell division. This quiescent state changes dramatically, however, if the liver is injured by toxic, infectious or mechanic agents (Ponder, 1996). Partial hepatectomy (PH) which consists of surgical removal of two-thirds of the liver, has been used to stimulate hepatocyte proliferation (Higgins & Anderson 1931). This experimental model of liver regeneration has been the target of many studies to probe the mechanisms responsible for liver cell growth control (Michalopoulos, 1990; Taub, 1996). After PH most of the remaining cells in the renmant liver respond with co-ordinated waves of DNA synthesis and divide in a process called compensatory hyperplasia. Hence, liver regeneration is a model of relatively synchronous cell cycle progression in vivo. In contrast to hepatomas, cell division is terminated under some intrinsic control when the original cellular mass has been regained. This has made liver regeneration a useful model to dissect the biochemical and molecular mechanisms of cell division regulation. The liver is thus, one of the few adult organs that demonstrates a physiological growth rewonse (Fausto & Mead, 1989; Fausto & Webber, 1994). The regulation of liver cell proliferation involves circulating or intrahepatic factors that are involved in either the priming of hepatocytes to enter the cell cycle (Go to G1) or progression through the cell cycle. In order to understand the basis of liver regeneration it is mandatory to define the mechanisms which (a) trigger division, (b) allow the liver to concurrently grow and maintain dilferentiated fimction and (c) terminate cell proliferation once the liver has reached the appropriate mass. Studies on these aspects of liver regeneration will provide basic insight of cell growth and dilferentiation, liver diseases like viral hepatitis, toxic damage and liver transplant where regeneration of the liver is essential. In the present study, Go/G1/S transition of hepatocytes re-entering the cell cycle after PH was studied with special emphasis on the involvement of neurotransmitters, their receptors and second messenger function in the control of cell division during liver regeneration

Suplementación de hormona tiroidea en pacientes pediátricos críticos con síndrome eutiroideo enfermo

Introducción : el síndrome del eutiriodeo enfermo en enfermedades graves es factor de pobre pronóstico. La suplementación con hormona tiroidea mejora la contractibilidad miocardica y estimula la producción de surfactante pulmonar; sin embargo existe controversia debido a las complicaciones secundarias, ausencia de efectos a nivel hemodinámico y de estancia hospitalaria. Objetivo : determinar el efecto de la suplementación oral de hormonas tiroideas en pacientes con choque refractario y necesidad de más de dos inotrópicos con respecto a estabilidad hemodinámica, arritmias, requerimientos de inotrópicos y mortalidad asociada al tratamiento. Metodología : estudio longitudinal observacional de variables repetidas con análisis previo y posterior a la intervención. Realizado en pacientes con choque refractario de la unidad de cuidado intensivo pediátrico del Hospital Simón Bolívar, desde el 1 de enero del 2007 hasta 1 enero del 2009. Resultados: la suplementación tiroidea mostró una disminución significativa en el requerimiento de los inotrópicos adrenérgicos: dopamina, adrenalina y noradrenalina con rangos de [4,78-2.4], [3.92 - 2.98] y [3.58- 2.24] (p <0.001) respectivamente, sin haber diferencia en los vasodilatadores, inodilatadores y diuréticos. No se encontró asociación entre su uso y la presencia de arritmias. Discusión y conclusiones: La hormona tiroidea mostró efecto benéfico en términos de disminución de soporte inotrópico. resultado en concordancia con la literatura y relacionado con la función moduladora de la hormona tiroidea favoreciendo la inotropía miocardica y los índices de contractilidad ventricular izquierda.

Prevalencia de síntomas de la voz y factores asociados en trabajadores de la central de llamadas Fonosanitas

Cada día se tiene más conocimiento acerca de la voz como un elemento fundamental en el desempeño laboral. Los diferentes sectores económicos tienen como estrategias de comunicación las asesorías personales a través de las centrales de llamadas telefónicas, aumentado así el reporte de síntomas vocales en trabajadores. El objetivo de este estudio fue conocer la prevalencia de los síntomas de la voz en agentes de llamadas y los factores asociados como antecedentes médicos, ocupacionales y extraocupacionales, a través de una encuesta aplicada a los trabajadores. La población de estudio fue de 495 trabajadores de la central de llamadas de la Organización Sanitas Internacional – Fonosanitas-sede Bogotá. Colombia; de la cual se obtuvo una muestra de forma randomizada y aleatorizada. Es necesario destacar que en Colombia no se encontraron estadísticas relacionadas con este tema. El 91.3 % de los asesores de llamadas reportaron más de dos síntomas vocales de una escala de once (11) síntomas. Tanto los hombres como las mujeres reportaron síntomas por igual, aunque en la distribución de la población predomino el género femenino (64.2%). Entre los hallazgos más importantes, el síntoma principal fue la sensación de mucosidad de la garganta en un 72%, seguido por la voz tensa en un 59.2 % y por la voz ronca en un 51.6 %, principalmente al final de la jornada 62.6%. El 54% de los trabajadores notaron un deterioro progresivo de la voz durante la jornada laboral. Los factores biológicos con mayor significancia estadística fueron las patologías respiratorias altas, el reflujo gastroesofágico,tensión cervical y patología tiroidea. Las características del ambiente laboral podrían llegar a aumentar la prevalencia de estos síntomas, incrementando las incapacidades y afectando la productividad.