Rendimiento diagnóstico de los hallazgos ecográficos de los nódulos tiroideos en la detección de lesiones malignas

ObjetiveTo evaluate the diagnostic efficiency of sonographic findings (nodule size, the presence of microcalcifications and echogenicity) compared with the results of fine-needle aspiration biopsy (FNAB) of thyroid nodules.MethodsThe results of cytology and the ultrasound characteristics of 341 thyroid nodules were analyzed.ResultsA total of 25.5% of the FNAB were inadequate, 65.1% were benign and 7.9% were suspicious or malignant. The percentage of inadequate samples was clearly larger in nodules smaller that 15 mm but that of malignant cytologies was also larger in this group of nodules (11.1 versus 2.8%: p=0.04). The percentage of inadequate samples among nodules smaller than 10 mm was 66.7% and no malignancies were detected. A notable finding was the absence of suspicious or malignant FNAB in hyperechogenic and anechogenic nodules. In contrast, the echogenic feature most frequently associated with malignancy was hypoechogenicity, although echogenicity, as a whole, was not significantly associated with malignancy (p=0.313). Most cases with microcalcifications (6 of 10) were malignant compared with four of the 239 nodules (1.7%) without calcifications (p<0.001). Multivariate logistic regression revealed that the only variable maintaining a significant association with malignancy was the presence of microcalcifications.ConclusionsThyroid cytology is an efficient method to evaluate thyroid nodules larger than 10 mm. The presence of nodule microcalcifications is significantly associated with malignancy, while hyperechogenicity and anechogenicity are associated with benign nodules.     

Evaluación de los parámetros de hipoacusia laboral en trabajadores activos y su relación con los niveles de glucemia basal

IntroductionHearing loss due to noise is considered within the prevention plans of the most common occupational diseases. In addition to evaluation of working conditions, other personal factors increasing the risk of hypoacusis, such as diabetes, should be taken into account.ObjectivesTo explore hearing loss in the workplace and its relationship to impaired fasting baseline blood glucose levels.MethodsAn observational, cross-sectional study enrolling 1636 workers from service companies was conducted. Full audiometric evaluation was performed at different frequencies: high frequency (HF), early loss index (ELI), speech average loss (SAL), and monaural and binaural loss. Results were categorized by baseline blood glucose levels: G1 (< 100 mg/dl), G2 (100-125 mg/dl), and G3 (> 125 mg/dl).ResultsBased on both HF and ELI, 11% of workers had clear indication of deafness. Women with G3 levels showed significant differences in the results of HF and ELI indexes as compared to the G1 group (P = .038 and .046, respectively). A positive association was found between hearing loss and G3 blood glucose levels in HF (OR: .338; p = .002), ELI (OR: .407; p = .007), and the monaural test in the left ear (OR: 4.77 × 10-5; p = .006).ConclusionsDespite the methodological limitations of this study, there is evidence for an increased risk of high frequency hearing loss in workers with high baseline blood glucose levels.     

Evolución del estado de nutrición de yodo en los escolares de la Comunidad Autónoma del País Vasco

BackgroundAn epidemiologic survey showed in 1992 iodine deficiency and endemic goiter in schoolchildren from the Basque Country.Objectives1) To determine the percentage of homes of schoolchildren where iodized salt (IS) is used; 2) to assess iodine nutrition status in schoolchildren and to compare the data collected to those available from previous epidemiological studies.Design and MethodsA cross-sectional study in 720 randomly selected schoolchildren. Urinary iodine concentration (UIC) was measured using high-performance liquid chromatography(HPLC) with electrochemical detection.ResultsIS was used at 53.0% of the homes (95% confidence interval [CI], 49.2-56.7%). Median UIC has increased by 226%, from 65 μg/L in 1992 to 147 μg/L (percentile [P], P₂₅, 99 μg/L; P₇₅, 233 μg/L) today. Both schoolchildren consuming IS and those using unfortified salt at their homes had UICs corresponding to adequate iodine intakes (165 and 132 μg/L respectively). UICs experienced great seasonal fluctuations, being 55% higher during the November-February period than in June-September period (191 μg/L vs 123 μg/L; p < 0.001)ConclusionsSchoolchildren from the Basque Country have normalized their iodine nutrition status. The strong seasonal pattern of UICs suggests that consumption of milk and iodine-rich dairy products coming from cows feed iodized fodder is one of the most significant factors involved in the increase in iodine intake since 1992.     

Evaluación de la utilización de las prestaciones específicas de los sistemas de infusión subcutánea de insulina y su relación con el control metabólico en pacientes con diabetes tipo 1

Background and objectivePatients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII) have available several specific features of these devices. The aim of this study was to evaluate the relationship between real use of them and the degree of glycemic control in patients using this therapy.Patients and methodsForty-four T1DM patients on CSII therapy with or without real-time continuous glucose monitoring (CGM) were included. Data from 14 consecutive days were retrospectively collected using the therapy management software CareLink Personal/Pro^® and HbA1c measurement performed at that period. The relationship between the frequency of usie of specific features of insulin pumps (non-sensor augmented or sensor-augmented) and glycemic control was analyzed.ResultsMean HbA1c in the group was 7.5 ± .8%. Mean daily number of boluses administered was 5.1 ± 1.8, with 75.4% of them being bolus wizards (BW). Daily number of boluses was significantly greater in patients with HbA1c < 7.5% than in those with HbA1c > 7.5% (5.3 ± 1.6 vs. 4.3 ± 1.6, P = .056). There was a trend to greater use of BW in patients with better control (82.8 ± 21.4% vs. 69.9 ± 29.1%, P = .106). HbA1c was lower in patients using CGM (n = 8) as compared to those not using sensor-augmented pumps (7.6 ± .8 vs 7.1 ± .7, P = .067), but the difference was not statistically significant.ConclusionsMore frequent use of BW appears to be associated to better metabolic control in patients with T1DM using pump therapy. In standard clinical practice, augmentation of insulin pump with CGM may be associated to improved glycemic control.     

Evolución de la infección fúngica invasora en los últimos 30 años

Clinical mycology is in continuous development. The appearance of new clinical guidelines has made it possible to improve the approach to opportunistic fungal infections, especially in immunosuppressed patients (oncohematological and/or transplant recipients). At the same time, the development of new diagnostic tools and new antifungals with a greater spectrum of action and fewer side effects have led to faster diagnoses and treatments that are more effective. Along with these advances, there has been a change in the epidemiology of invasive fungal infection (IFI), with the appearance of new patients (e.g., COPD, liver cirrhosis, post-influenza) and new microorganisms (Candida auris, Lomentospora prolificans, mucorales), and resistant fungi (isolates of Aspergillus resistant to azoles) which the clinician must take into account when choosing the treatment of a patient with an IFI. In this paper we will briefly review the advances in recent decades and the emerging problems.     

Asociación entre la longitud de los telómeros y deterioro cognitivo en adultos mayores

IntroductionCognitive impairment is a transition stage between normal aging and dementia, the prevalence of last one increases with age; the damage of the functions and physical integrity, places the older adult in a greater susceptibility to get sick. Telomere length is a hallmark of aging to characterize this phenotype, as well as a biomarker that reflects the underlying state of the cell. In this work, the relative length of telomeres in older adults with cognitive impairment was correlated.Material and methodsObservational-analytical study, in samples of adult patients older than 65 years with and without cognitive impairment, in whom the relative length of telomeres was measured.ResultsNinety samples of older adults were included in the study and in the association analysis according to multivariate logistic models, cognitive impairment showed almost five times more risk for telomere shortening in relation to the presence of the diagnosis of cognitive impairment (Odds ratio 4.88, p = 0.027).ConclusionsWhen correlating the relative length of telomeres in older adults diagnosed with cognitive impairment, this association was confirmed for shorter.     

Valor pronóstico de los instrumentos de evaluación de enfermedad avanzada y de final de vida en ancianos ingresados en un centro sociosanitario

Objective

To apply 3 advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality.

Lista de los helechos y licófitos de Cuba

This paper presents an up-to-date list of the ferns and lycophytes of Cuba. The list contains 599 species in 131 genera and 37 families. In total, Cuba harbors 93 endemic species (17 lycophytes and 76 ferns) that represent a 15.5% of the total species of ferns and lycophytes. For each taxon the distribution in Cuba is given according to three phytogeographical subprovinces: Western Cuba, Central Cuba, and Eastern Cuba. The following new combinations are made: Amauropelta balbisii var. longipilosa, Amauropelta piedrensis var. heterotricha, Amauropelta scalpturoides var. glabriuscula, Christella hispidula var. inconstans, Cyathea × acunae, Didymoglossum caluffii, Didymoglossum micropubescens, Goniopteris alata var. subpinnata, Goniopteris sclerophylla var. latifolia, Pteris hexagona var. multifida . A new name, Goniopteris moranii, is given for Thelypteris guadalupensis. New records reported herein for Cuba are Megalastrum macrotheca, Polystichopsis argillicola, and Pteris propinqua.     

Valoración de la utilidad del test de estimulación intraarterial con calcio en el diagnóstico de localización del hiperinsulinismo endógeno

Background and objectiveThe aim of this study was to assess the utility of arterial calcium stimulation with hepatic venous sampling (ASVS) in the localization of tumors in patients with endogenous hyperinsulinism not detected with other methods.Patients and methodsWe performed a retrospective study of 26 patients admitted to our hospital for hypoglycemia who underwent ASVS because the source of hyperinsulinism was not clearly identified by other imaging techniques. The histopathological result in patients who underwent a surgical procedure was considered the reference for statistical study of the accuracy of this technique. Statistical analysis was performed by comparing proportions with the chi-squared test with Yates’ correction for contingency tables, and Cohen′s kappa coefficient as a measure of interrater agreement between two observations.ResultsSurgery was performed in 17 patients, 13 with positive ASVS and the remaining four with negative results. An insulinoma was removed in 12 patients, and 10 of these were detected in the ASVS. A total of 76.9 % of positive ASVS tests corresponded to a histological diagnosis of insulinoma, and 83% of these insulinomas were positive in ASVS. This association was statistically significant (chi cuadrado = 7.340; p = 0.012). Two of three patients with nesidioblastosis had a positive response in the ASVS. A good and statistically significant agreement was obtained between histopathologic diagnosis and ASVS results (κ=0.556, p = 0.007).ConclusionsASVS is a useful procedure in the localization diagnosis of endogenous hyperinsulinism not detected by other imaging tests. This technique allows tumors in the pancreatic gland to be identified and may be useful in the choice of the surgical technique to be used.