ACTA ENDOCRINOLOGICA (BUC)

Introduction. The recall rate in congenital hypothyroidism (CH) newborn screening programs depends on several factors such as primary screening strategy, sample collection guidelines, and cut-off. A recall rate of 0.05% is recommended but recall rates of 0.01-13% are reported worldwide. Objective. The aim of the study was to assess the recall rate in association with the age of the newborn at sample collection and with a lower cut-off. Design. This was a retrospective correlational study concerning TSH results in CH screening program. Subjects and methods. All newborns from a tertiary center in Targu Mures, Romania between 2013-2018 were included. Four groups were created and a correlation test between TSH median value and age in days was performed. The recall rate was calculated using three cut-off levels for 8182 TSH results performed in 2018. Results. 90% of the DBS were collected in days 3-5 after birth and 1/79 live births from this group had TSH above the lower cut-off used (10 mUI/L). 2% of the samples were collected in less than 48 hours after birth and 1/21 live birth from this group had TSH > 10 mUI/L. The recall rate in our center in 2018 was 0.08%, higher than the recommended rate of 0.05%. With the cut-off value recommended by the Health Ministry a 0.03% recall rate was obtained. Conclusions. Sample collection in less than 48 hours increases the recall rate in CH screening with TSH primary testing strategy. A lower cut-off raises the recall rate with a higher rate of false-positive cases (94.12%) but with 100% negative predictive value.

Context. Non-psychogenic polydipsia-induced hyponatremia is a rare clinical finding. The effects of severe hyponatremia on the electrical activity of the heart in this setting are far from clear. Case report. Resting ECG and 24-h ambulatory ECG monitoring performed in an 80-year-old hypertensive female accusing nonspecific symptoms of confusion, lethargy, disorientation, nausea, and palpitations, demonstrated significant intraatrial and atrioventricular conduction disorders and numerous atrial tachyarrhythmia episodes. Laboratory analysis revealed severe hyponatremia (108 mEq/L) as only significant disorder. Extensive endocrine, neurological, cardiology, and pulmonary examinations excluded the most common causes of hyponatremia, including the inappropriate antidiuretic hormone secretion syndrome. Careful history revealed excessive voluntary water intake of up to 6 L/day and low sodium intake, associated with long-term thiazidelike diuretic treatment. Correction of sodium levels was associated with complete resolution of both atrial arrhythmias and conduction disorders. Conclusions. This report presents the first case of severe hyponatremia caused by combined non-psychogenic polydipsia and thiazide-like diuretic use complicated with reversible cardiac conduction disorders and atrial arrhythmias. The close temporal relationship between the fully reversible cardiac electric abnormalities and severe hyponatremia strongly indicates hyponatremia as key feature in the pathogenesis of these electric abnormalities.

Context. Platelet indices change in relation to cardiovascular risk factors, including type 2 diabetes mellitus (T2DM). An increase of platelet indices over time in patients undergoing percutaneous coronary intervention (PCI) could be a predictor of mortality. The objective of this study was to assess differences in platelet indices in patients with and without T2DM undergoing PCI, prior and more than one month after the procedure. Subjects and Methods. In this retrospective observational study, patients undergoing PCI were included. Data were extracted from PCI Registry of the Emergency Institute for Cardiovascular Diseases and Transplantation of Tirgu Mures, Romania. Results. Of the 718 patients included in the study, 222 (30.9%) had T2DM; 61% of patient underwent PCI for SCAD, the rest for NSTE-ACS or STEMI. Prior to PCI, MPV, PDW and P-LCR were not higher in T2DM patients irrespective of the indication for PCI. At a follow-up time of 69 (46-98) days, platelet indices were not different between TD2M+ and T2DM-, except from MPV (11.0 vs. 10.6, p=0.02) which were higher in TD2M patients with SCAD. Intraindividual variability of platelet indices was not different in diabetics, but MPV, PDW and platelet count decreased over time (3.5% and 8.4% respectively) in diabetics with STEMI (p=0.02). Conclusions. Platelet indices were not higher in patients with T2DM undergoing PCI, but we observed an important variation in platelet indices in diabetics after STEMI related PCI.