Abstract Introduction In the STEMI care network, the number of inappropriate cases sent to cathlab remains high 1. The use of technological innovations to share the diagnostic ECG tracing with the cardiology department has been shown to be effective in improving patient discrimination. Objective Our aim was to study the characteristics and prognosis (at discharge and 1-year follow-up) of patients whose transfer to the cathlab was cancelled. Material and Method Prospective study analysing all STEMI alert activations in 2022. Information on ECG pattern and clinical history was transmitted using an APP (ODiSEA 2-3) and used for cancellation. Patient characteristics, myocardial infarction, ECG activation pattern, angiography results, final diagnosis and clinical events during admission and 1-year follow-up were recorded. Patients who underwent urgent coronary angiography were excluded from the study. Results A total of 406 infarction codes were activated through the ODISEA APP. 122 (30%) of these were cancelled. The characteristics of the patients are shown in Table 1. Reasons for cancellation based on ECG pattern are shown in Figure 1.B. The most common were ST depression (23%) and intraventricular conduction disturbances (22.9%). The final diagnosis was ACS in 32.8% (STEMI 2.5%, NSTEMI 27% and unstable angina 3.3%). In the remaining 67.2%, the final diagnosis was atypical chest pain with negative biomarkers in 22.9%, arrhythmia in 17.2%, pericarditis in 9%, gastrointestinal pathology in 4.9%, heart failure in 4.9%, aortic dissection in 3.2%, PTE in 1.6% and other pathologies in 3.5%. (Figure 1.A). Coronary angiography was performed in 41 patients (33.6%). There were 36.6% with one vessel, 9.8% with two vessels and 22% with three vessels. Percutaneous revascularisation was required in 70% of patients. Discharge from the emergency department occurred in 46% of the patients. Hospital mortality occurred in 14 patients (11.4%). Of these, 3 (2.4%) were due to cardiac causes. Regarding events at 12 months, 6 (4.9%) were deaths (5 natural deaths and 1 due to cancer). 5 patients (4%) had ACS, 3 patients (2.4%) had stroke and 1 patient (0.8%) had digestive bleeding. Conclusions STEMI alert cancelled transfer patients are older, have more comorbidities and are less likely to have a final diagnosis of ACS or to have coronary lesions. They have a high rate of non-cardiovascular in-hospital mortality and a low rate of cardiovascular events at one year of follow-up.A.Final diagnosis. B. ECG patternTable 1.Patients characteristics

Abstract Introduction The use of technological innovation in STEMI care networks has been shown to be effective in sharing diagnostic ECG tracing and clinical information with the cardiology department, reducing the number of inappropriate cases transferred to the cathlab. These inappropriate cases have been shown to be more likely to die than those undergoing urgent coronary angiography, but data on incidence, cause of cancellation and prognosis are limited1. Objective Our aim was to investigate the characteristics and prognosis of patients in whom transfer to the cathlab was cancelled, compared with those who underwent emergent coronary angiography (EC). Material and Methods Prospective study analysing all STEMI alert activations during the year 2022. Information on ECG pattern and clinical history was transmitted using an APP (ODiSEA2,3). Based on the ECG pattern and clinical history, cancellations were made. Patient characteristics, myocardial infarction, ECG activation pattern, angiography results and in-hospital mortality were studied. Results A total of 406 infarction codes were activated through the ODISEA APP, of which 284 (70%) underwent EC and 122 (30%) were cancelled. The cancelled patients had a higher comorbidity than the transferred patients. The reasons for cancellation based on ECG patterns are shown in Figure 1. The most common were ST depression (23%), concave ST elevation (18.8%) and intraventricular conduction disturbances (22.9%). In addition, coronary angiography was performed in 33% of the cancelled patients compared to 99% of the transferred patients (p<0.001). The number of patients with coronary arteries without lesions was significantly higher in the cancelled group (31.7% vs. 9.6% p<0.001). In the EC group, 90.5% of patients presented with a final diagnosis of ACS, whereas in the cancelled group this was 32.8% (final diagnosis of STEMI 2.5% in the cancelled group vs. 83.5% in the CE group, p<0.001). Discharge from the emergency department was 46% in the cancellation group versus 2.7% in the transfer group (p<0.001). Finally, the in-hospital mortality rate was significantly higher in the cancelled group: 14 patients (11.4%) vs. 12 patients (4.2%) in the transferred group (p<0.001). Discussion Compared to patients who are transferred to a centre with cathlab, the subgroup of patients initially activated as STEMI alerts and eventually cancelled have a high comorbidity, a low probability of a final diagnosis of ACS and a high in-hospital.Table 1.Patients characteristicsFigure 1.ECG pattern

Iodine deficiency (ID) causes goiter, cretinism, neonatal hypothyroidism, irreversible mental retardation, and child and infant death. Over one billion people are at risk, most of them in developing countries. While ID is the primordial factor in these conditions, other environmental and host factors significantly modify the magnitude and clinical presentation of iodine deficiency disorders. The interactions and mechanisms by which these factors operate are complex and mostly unknown, requiring more investigation.

Previous epidemiological studies have shown a significant statistical correlation (P < 0.005 to P < 0.0005) between goiter prevalence and rock types in the watersheds that supply 37 localities in Western Columbia. Bacterial contamination has also been implicated as a cause of endemic goiter. We, therefore, did bacteriological studies to incorporate this variable into the statistical model in 34 of the 37 localities previously surveyed. Samples of the water in the 34 localities were taken at the water source or intake of water supply and at the pipeline system in households and schools. Samples were collected in sterile bottles and cultured on several media for 48 h. The number of bacteria per ml was determined by Quebec's camera and the bacteria (E. coli, Bacillus sp., K. pneumoniae, Proteus sp., and Neisseria sp.) were identified according to conventional methods. Multiple regression analysis and the logistic regression model were used to analyze the data. Only two variables had significant relationships with goiter prevalence: K. pneumoniae in the water source (P < 0.01) is related to a lower prevalence and the overall concentration of bacteria in the pipeline system (P < 0.05) is related to a higher prevalence. Multiple regression analysis to compare the effects of bacteriological variables to those of geological variables indicating rock types showed sedimentary rocks in the watershed associated (P < 0.005) with higher goiter prevalence and an increased concentration of K. pneumoniae in the water source again associated (P < 0.025) with lower goiter prevalence. Bacterial concentration in the pipeline system was of marginal importance (0.05 < P < 0.10). Thus, the presence of sedimentary rocks was the best indicator of disease. A second best indicator was the concentration of K. pneumoniae in the water source. We hypothesize that the lower goiter prevalence associated with K. pneumoniae may be a natural example of biodegradation of the organic contaminants that produce goiter.

A large number of agents in the environment, both naturally occurring and man-made, are known to interfere with thyroid gland morphology and function, posing the danger of thyroid disease (Table 1). Thyroid enlargement or goitre is the most prominent effect of these agents. They may cause the goitrous condition by acting directly on the thyroid gland (Fig. 1), but also indirectly by altering the regulatory mechanisms of the thyroid gland and the peripheral metabolism and excretion of thyroid hormones (Gaitan 1988, 1989a, 1990).

Late pregnancy is one of the most critical stressed periods of reproductive lives of ewes that can effectively affect the whole animal subsequent productive life. Propolis is considered as an effective enhancer of rumen fermentation and the whole animal health conditions in growing and dairy cattle; however no study has confirmed these positive effects in late pregnant ewes. The aim of this study was to evaluate the beneficial effects of supplementing red propolis extract (RPE) on apparent digestibility, purine derivatives, methane (CH4) emission and blood metabolites of late pregnant ewes. Eighteen Santa Inês ewes (52.5 ± 2.50 kg body weight) were kept individually in indoor pens. The trail lasted for 44 d of which 14 d were for adaptation and 30 d for data collection. Ewes were allotted into a randomized complete block design (9 blocks × 2 dietary treatments). The treatments were: control diet (CTL); the basal diet without supplementations and propolis diet (RPE); the basal diet supplemented with 3 g RPE/ ewe/ day. The GC/MS analysis of RPE showed 20 different components all belonging to the flavonoids class were detected. Propolis supplementation increased (P = 0.02) organic matter and crud protein digestibility compared to the control. Higher intake of nitrogen (P = 0.03) and body N retention (P = 0.01) were observed with RPE supplementation compared to CTL, also, the retained N expressed as g/g N intake tended to increase (P = 0.063). The administration of RPE increased (P < 0.05) urinary allantoin derivative excretion and also total purine derivatives (PD) tended to increase (P = 0.06) for RPE compared to CTL. Enhanced individual, total short chain fatty acids and acetate/propionate ratio were exhibited (P < 0.05) by RPE supplementation compared to CTL. Additionally, RPE decreased (P < 0.05) CH4 emission compared to CTL. All hematological parameters and biochemical parameters including total protein, globulin and glucose were enhanced (P < 0.05) by RPE supplementation compared to CTL. Propolis supplementation decreased (P < 0.05) the tested hormones cortisol, triiodothyronine and thyroxine compared to CTL. This study illustrated that RPE represent a promising diet natural supplement for supporting body activates during the transition from late pregnancy to lactation without adverse impact on either animal productivity or environment.

Millet diets rich in C-glycosylflavones (C-GF) are goitrogenic, and its three most abundant C-GF inhibit in vitro thyroid peroxidase, suggesting that these compounds are the goitrogens in millet. However, proof of a cause and effect relationship between C-GF and goitrogenesis requires a demonstration of in vivo antithyroid activity by the purified isolated compounds. Vitexin, one of the three major C-GF in millet, was used to test this hypothesis. Twenty-four female Wistar rats, divided into groups of six rats each and fed Purina iodine-rich diet (12 micrograms I-/day.rat), were administered acutely by gastrointestinal tube goitrogen-free water (controls), methimazole (0.5 mumol), and vitexin (20 and 80 mumol). 125I (1 microCi) was injected ip 1 h later, and the rats were killed 2 h after the injection. The thyroid glands were removed and analyzed for their content of total 125I and 125I-labeled compounds. Rats given vitexin, in contrast to those receiving methimazole, did not show suppressed thyroid 125I uptake. However, significant inhibition of the coupling mechanism (high 125I-labeled monoiodotyrosine plus diiodotyrosine/125T3 plus T4 ratio and low 125T3 and T4 concentrations) did occur with the highest dose of vitexin. These results provide direct evidence in vivo of C-GF antithyroid activity, strongly supporting the concept that C-GF are the goitrogens in millet.

We evaluated whether differences in serological nutrient indicators between cases and controls were likely to be due to different usual levels for cases or to altered metabolism due to disease. Blood samples obtained as part of a case-control study of invasive cervical cancer conducted in Latin America were evaluated for case-control differences and for trends with stage of disease. Serum alpha- and beta-carotene, cryptoxanthin, and alpha- and gamma-tocopherol showed no trend with extent of disease, although Stage IV cases had lower alpha- and beta-carotene values than did other cases. A slight trend of decreasing values with stage was observed for serum retinol, lycopene, and lutein. For cholesterol and triglyceride concentrations, an inverse trend was observed with stage of disease, which suggested a clinical effect of the disease on blood lipids. Adjustment for smoking, alcohol intake, or oral contraceptive use did not alter observed relations, nor was there evidence that the altered blood nutrient levels differed by histological type. These data suggest that serum values for some carotenoids from Stage I, II, and III cervical cancer are suitable for etiological studies, but spurious results may be obtained if late-stage cases are included. Evidence of trends with severity of disease for cholesterol and triglycerides, and possibly for retinol, lycopene, and lutein, suggest that special attention be given to disease effects of these nutrients in studies of cervical cancer.

Babassu (Orbignya phalerata), a palm-tree coconut fruit, mixed with mandioca (Manihot utilissima) is the staple food of people living in the endemic goiter area of Maranhao in Brazil, where goiter prevalence among schoolchildren was still 38% in 1986 despite an adequate iodine intake in most of the population. Therefore, the question arose as to whether or not the ingestion of babassu alone or mixed with mandioca contributed to the persistence of endemic goiter in this area of Brazil. In this investigation we examined the potential antithyroid effects of babassu and mandioca by means of in vivo studies in Sprague-Dawley rats, in vitro studies in porcine thyroid slices and using a purified porcine thyroid peroxidase (TPO) system. Samples of various edible parts of babassu and mandioca flour were homogenized and extracted in goitrogen-free water (GFW) for in vivo experiments, and in methanol (100 g/l), GFW or 0.06 mol/l phosphate buffer (pH 7.0) for in vitro experiments. The edible parts of babassu produced significant in vivo antithyroid effects (p < 0.05- < 0.001) in rats on a high iodine intake (14 micrograms I- day-1.rat-1), as well as distinct and reproducible antithyroid and anti-TPO activities in both in vitro systems, their action being similar to that of the thionamide-like antithyroid drugs propylthiouracil and methimazole.(ABSTRACT TRUNCATED AT 250 WORDS)

To the Editor.—The American Thyroid Association (ATA) in 1990 and 1991 issued guidelines for use of laboratory tests in thyroid disorders.1,2These ATA position papers update previous recommendations because of the development and availability of improved thyrotropin (thyroid-stimulating hormone [TSH]) methods capable of clearly separating normal from subnormal serum TSH levels. The highly sensitive TSH assay constitutes a practical, useful, and significant laboratory advance in clinical thyroidology. There is agreement among thyroid specialists that measurement of serum TSH level, complemented by an appropriate free thyroxine (FT4) estimate, represents the best and most efficient combination of blood tests for diagnosis and follow-up of most patients with thyroid disorders. Currently in the investigation of thyroid disease there is a trend to replace a combination of tests (eg, total T4+ triiodothyronine resin uptake + FT4+ total T3+ TSH) by a discriminating single thyroid function test. This trend reflects

Goiter in iodine-sufficient areas has been linked to water-borne goitrogens in watersheds and aquifers rich in coal and shale. In the present study, the potential antithyroid and goitrogenic effects of coal-water extracts (CWE) were investigated in vivo in rats after chronic and acute oral administration of CWE, and in vitro by a thyroid peroxidase (TPO) enzyme system. CWE was prepared by continuous extraction of ground (40 mesh) Appalachian coal with goitrogen-free water (GFW). Female Buffalo rats fed on Purina iodine-rich diet (12 micrograms I-/day/rat), were given ad lib CWE (50 mg/ml; approximately 20 mL/day/rat) or GFW (controls) for 2 months. At the end of the experiment, 125I 1 microCi, was injected i.p. and 4 h later the thyroid glands were removed, weighed, and analyzed histologically and for total 125I and 125I-labeled compounds. Rats on CWE had larger thyroid glands [7.2 +/- 0.3 mg/100 g (mean +/- SE) vs 5.0 +/- 0.5 controls; p < 0.005] with distinct histological changes of smaller thyroid follicles, some with columnar epithelium, and with more dense colloid than in controls, and had significant inhibition of the coupling mechanism for production of thyroid hormones [125MIT + DIT/125T3 + T4: 5.1 +/- 0.2 vs 3.9 +/- 0.1 controls, p < 0.005; and 125T3 + T4 (%): 10.6 +/- 0.3 vs 12.6 +/- 0.4 controls, p < 0.005]. Female Sprague-Dawley rats under the same conditions as Buffalo rats were given acutely by GI tube 2 mL of CWE (5 g/mL) or GFW (controls).(ABSTRACT TRUNCATED AT 250 WORDS)

The beneficial effect of cervical cytology in reducing the incidence of invasive cervical cancer is well accepted, but many issues regarding specific patterns of screening remain to be resolved, and preventive programmes need to be adapted to regional characteristics. In a case-control study conducted in Latin America, we investigated cytological screening histories of 759 cases of invasive cervical cancer and 1430 controls, with participation rates of 99% and 96%, respectively. Fifty per cent of the cases and 29% of the controls reported never having been screened. Screening was less common among older, less educated and less parous women; non-users of oral contraceptives and women without histories of venereal diseases. There was also evidence that older women and those with multiple partners had longer intervals between examinations. The relative risk (RR) associated with no prior screening was approximately 3 and was not modified by other risk factors. Women reporting a Pap smear within 24-47 months before interview had the same RR as those examined within 12-23 months. Women tested longer ago had higher risks, but still much lower than women never examined. There was evidence that one examination is associated with less reduction in risk than two, regardless of the interval since last Pap smear. Screening appeared to reduce risk of both squamous cell carcinomas and adenocarcinomas. As expected, cases presenting at advanced stages were less likely to have been screened and reported longer intervals since their last examination. These results support the need to concentrate limited resources in the groups that need screening most, mainly older and less educated women who have never been screened.

Endemic goiter in iodide-sufficient areas of the United States and Colombia has been linked to watersheds rich in coal and shale, which several reports suggest are the source of water-borne goitrogens. In this report the potential antithyroid activities of aqueous coal and shale extracts and of compounds identified in aqueous effluents from coal conversion processes were assayed in thyroid peroxidase (TPO) and thyroid slice systems. Aqueous extracts of coal and black shale were potent inhibitors of TPO or 125I organification by thyroid slices. The most abundant water-soluble compounds derived from coal are dihydroxy-phenols, thiocyanate, disulfides, and hydroxypyridines. The dihydroxyphenols resorcinol, 2-methylresorcinol, and 5-methylresorcinol (orcinol) were 26.7, 22.5, and 7.2 times more potent, respectively, than the antithyroid drug 6-propylthiouracil (PTU). Other dihydroxyphenols and thiocyanate were less potent but comparable in activity to PTU. All dihydroxypyridines and 3-hydroxypyridine produced inhibitory effects comparable to PTU. None of the disulfides inhibited TPO. The antiperoxidase effects of combinations of two dihydroxyphenols or one dihydroxyphenol and SCN were additive, whereas the effects of a combination of four dihydroxyphenols at threshold inhibitory concentrations were synergistic, resulting in net effects equivalent to or greater than the sum of the individual effects. Thus, antithyroid effects may be greatly amplified by exposure to multiple coal-derived goitrogens and could be many times that produced by any one of the contributing pollutants. These results demonstrate that potent water-borne goitrogens are derived from coal and shale and that their contamination of water supplies could pose a serious threat of thyroid disorders.

Although small intervention trials have suggested that folate supplementation reduces cervical dysplasia, the association of blood folate concentrations with invasive cervical cancer risk has not been investigated in well-controlled epidemiological studies. A study was conducted with newly diagnosed Stage I and II invasive cervical cancer cases and controls in 4 Latin American countries. Ninety-five% of subjects donated blood samples, resulting in 330 case and 565 control serum samples analyzed for folate concentrations by radioassay. Cases did not differ significantly from controls in mean levels of folate (5.00 and 4.90 ng/ml, respectively). No associations were observed between quartiles of serum folate and risk of cervical cancer after adjustment for other risk factors, and no interactions with established risk factors were observed. Folate levels were also unrelated to risk among women who might have compromised folate status because of recent or extended oral contraceptive usage or multiple pregnancies. Further, mean levels of folate were similar by stage of disease, arguing against an effect of disease progression on serum values. These results do not support a role for serum folate in the etiology of invasive cervical cancer.