Serum cholesterol levels are inversely associated with the risk of malignancy in subjects with Bethesda category IV thyroid nodules.

INTRODUCTION: Some epidemiological data suggest that there may be an inverse relationship between cholesterol levels and the risk of thyroid cancer in the overall population. The present study was aimed to evaluate the lipid profile specifically in subjects with Bethesda category IV thyroid nodules, and compare whether there were any differences between those with benign and malignant nodules. METHODS: Single-centre, retrospective study on 204 subjects treated by partial or total thyroidectomy for excision of a Bethesda category IV thyroid nodule, who had undergone a blood lipid profile test in the 12 months prior to surgery. In addition to lipid measures, other demographic, clinical, biochemical and ultrasound data were collected. RESULTS: Seventy-five subjects (36.8%) were diagnosed with thyroid carcinoma in the definitive histopathological examination. Patients with thyroid cancer had lower levels of total cholesterol, LDL-cholesterol and non-HDL-cholesterol than subjects with benign thyroid diseases. There were no differences in HDL-cholesterol, triglycerides or total cholesterol/HDL-cholesterol ratio. There were no differences either between groups in other clinical, biochemical and ultrasound variables, including the use of lipid-lowering drugs. In multivariate analysis, only LDL-cholesterol was independently associated with malignancy. Subjects with follicular carcinoma showed the lowest cholesterol levels, while those with papillary carcinoma had intermediate values between the group with follicular carcinoma and the group with benign thyroid diseases. CONCLUSIONS: In subjects with cytologically indeterminate Bethesda category IV thyroid nodules, levels of total cholesterol, non-HDL-cholesterol and, particularly, LDL-cholesterol are lower among those with malignant nodules.

Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism.

PURPOSE: It has been suggested that increasing levothyroxine dose to lower TSH levels within the normal laboratory range might be a therapeutic option for patients with apparently well-controlled primary hypothyroidism who are dissatisfied with their treatment and complain of physical or psychological symptoms. This study assessed whether there is a relationship between TSH levels and health-related quality of life (HRQoL) among subjects with adequately treated hypothyroidism. METHODS: HRQoL was measured with the specific thyroid disease ThyPRO-39 questionnaire in 218 consecutive patients with primary hypothyroidism of any cause attending an Endocrinology Department in a single center. Patients had TSH values within the normal laboratory range on a blood test performed not before than 6 weeks prior to study participation, but they were not aware of their lab results. The association between TSH values and the different ThyPRO-39 scales was analyzed by means of multiple regression models, both linear and additive, in which, in addition to TSH, a wide set of clinical and sociodemographic variables potentially related to HRQoL were also considered. RESULTS: TSH levels and the use of anxiolytic and antidepressant drugs were the only variables that showed a positive linear correlation with the ThyPRO-39 composite scale in the multivariate regression analysis, indicating greater impairment in HRQoL with increasing TSH values. TSH was also independently correlated to scores of scales dealing on tiredness and emotional susceptibility. CONCLUSIONS: In patients with primary hypothyroidism, higher TSH values, even within the normal reference range, are associated with greater deterioration of HRQoL.

TSH Level and Risk of Malignancy in Patients with Bethesda Category IV Thyroid Nodules.

Fine needle aspiration biopsy does not permit to distinguish between benign and malignant follicular thyroid lesions (category IV in the Bethesda Cytopathology System). Some reports have suggested an association between increased serum TSH levels and thyroid cancer, so the aim of this study was to investigate the association between TSH levels and malignancy in patients with follicular thyroid nodules. Therefore, we conducted a retrospective study of all subjects who underwent surgical treatment for Bethesda IV thyroid nodules in a single center (years 2012-2017). A total of 127 patients were analyzed, and malignancy was present in 38.6% of the patients. Using ROC analysis, the best TSH cut-off point to differentiate benign from malignant disease was 2.1 mU/l and the age cut-off with better sensitivity and specificity was 47 years. The proportion of subjects with TSH ≥ 2.1 mU/l was greater among subjects with cancer than in those with benign diseases (65.3 vs 44.9%, P = 0.029). The concurrence of both cut-off points (TSH ≥ 2.1 mU/l and age ≥ 47 years) showed a higher diagnostic accuracy than either of the two variables separately. Therefore, the present study supports an association between serum concentrations of TSH and risk of malignancy among subjects with Bethesda IV thyroid nodules. TSH levels could modify the diagnostic and therapeutic approach of patients with Bethesda IV nodules.

Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics.

INTRODUCTION: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. DESIGN AND METHODS: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. RESULTS: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20-<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. CONCLUSION: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.

Adaptation and cross-cultural validation of the Spanish version of the Thyroid-Related Quality-of-Life Patient-Reported Outcome questionnaire.

INTRODUCTION: The ThyPRO questionnaire is the most widely used tool for measuring quality of life in patients with benign thyroid diseases. The purpose of this study was to adapt and validate a Spanish translation of the ThyPRO and its abbreviated version (ThyPRO-39). MATERIAL AND METHODS: Adaptation to the Spanish language was performed using the forward-backward translation method, followed by a pretesting study on five representative patients. The final questionnaire (ThyPROes) was administered to 155 patients with thyroid disorders recruited in a tertiary Spanish hospital. Psychometric properties were evaluated by multitrait scaling and estimation of internal consistency reliability (Cronbach's alpha coefficient). Data from a previous sample of 902 Danish patients were used to analyze differential item functioning (DIF) between the Spanish and the original Danish versions of the questionnaire using ordinal logistic regression. RESULTS: Three of 85 items in ThyPROes and four of the 39 items in ThyPRO-39es lacked convergent validity, while lack of discriminant validity was found for in nine and 14 items of each version respectively. Cronbach's alpha was >0.7 for 12 of 13 scales in the ThyPRO and 10 of 12 scales in the ThyPRO-39es. Eight items in the ThyPROes were flagged with DIF (one with non-uniform DIF), as were two items in the ThyPRO-39es. DIF magnitude was small (explained variance in the item score <3%) in most cases, with a minor impact on scale scores. CONCLUSIONS: The Spanish versions of the ThyPRO and ThyPRO-39 show acceptable psychometric properties and good cross-lingual validity, and are suitable for use in clinical studies.

Estudio cualitativo del Programa DiabetIMSS en una Unidad de Medicina Familiar de San Luis Potosí / DiabetIMSS Program qualitative study in a Family Medicine Unit in San Luis Potosi

Resumen

Introducción: las enfermedades no transmisibles son la principal causa de mortalidad en todo el mundo, pues cobran más vidas que la combinación de los fallecimientos por otras patologías. El IMSS diseñó un programa preventivo en el año 2008 y titulado: DiabetIMSS.

Objetivo: analizar las perspectivas de los actores directos e indirectos del equipo multidisciplinario de salud involucrado en el programa DiabetIMSS en una Unidad de Medicina Familiar. Metodología: estudio cualitativo con modelización sistémica, interpretativo de investigación-acción para evaluar la implementación del Programa DiabetIMSS. Se trata de un estudio de tipo cualitativo, realizado en la Unidad de Medicina Familiar No. 47 del IMSS de la Ciudad de San Luis Potosí, México. Se utilizó una cédula de datos sociodemográficos, observación participante, diario de campo, entrevista semiestructurada y grupo focal.

Resultados: los resultados del presente estudio permitieron identificar y describir cómo se implementa el Programa DiabetIMSS desde las perspectivas de los actores que lo operan tomando como referencia cinco categorías: 1) Contexto, 2) Estructura, 3) Actividades y funciones, 4) Roles y relaciones y 5) Áreas de oportunidad.

Conclusiones: el Programa DiabetIMSS continúa siendo una intervención educativa con énfasis en la atención médica integral; es decir, es el medio para un adecuado control de la diabetes a través de diversas acciones fundamentales, como una valoración y exploración física de los pacientes.

Abstract

Introduction: Non communicable diseases are the leading cause of death worldwide, claim more lives because the combination of deaths from other diseases. In response to this phenomenon the Mexican Social Security Institute (IMSS) design a preventive program that was launched and implemented in 2008 and titled; DiabetIMSS.

Objective: Conduct a qualitative study of the DiabetIMSS program of a Family Medicine Unit in San Luis Potosí based on the analysis of the perspectives of the direct and indirect actors involved in the multidisciplinary health team.

Methods: Qualitative study with systemic, interpretative modeling of action research to evaluate the implementation of the DiabetIMSS Program. This is a qualitative study, carried out at the Family Medicine Unit No. 47 of the IMSS of the City of San Luis Potosí, Mexico.

Results: The results of this study allowed us to identify and describe how it implements the DiabetIMSS program from the perspectives of the actors who operate by reference to five categories: 1) Background, 2) Structure, 3) Activities and Functions, 4) Roles and Relationships and 5) Areas of opportunity.

Conclusions: The DiabetIMSS program remains an educational intervention with emphasis on comprehensive health care, is the means for adequate control of diabetes through various key actions.

[Impact of an educational institutional program in the control of the diabetic patient]. / Impacto de un programa institucional educativo en el control del paciente diabético.

OBJECTIVE: to assess the impact of an educational institutional program in the control of type 2 diabetic patient. METHODS: intervention educational study, with quasi-experimental and self-controlled subjects. A convenience non-probabilistic sample was used including 151 patients from the program for the integral care of diabetic patients. Demographic variables: gender, age, type of insurance, somatometric and metabolic profile. The assistance to a one-year length, educational program was necessary. Descriptive and inferential parametric statistics were used. RESULTS: 106 women and 45 men, with age range between 15 and 87 years, and with an average of 57.22 ± 11.47, were studied. A significant decrease in body mass index, waist circumference, venous glucose fasting and post-prandial values, cholesterol, systolic blood pressure, triglycerides and glycosylated hemoglobin (t Student semi-detached, p < 0.05) was observed. There were no changes in diastolic blood pressure (p = 0.334). CONCLUSIONS: one year afterwards, the strategy based on education for the control of the diabetic patient shown a favorable pattern in most of somatometric and metabolic parameters. We suggest to extend this study over a longer period to determine if the effects persist over time.

Objetivo: evaluar el impacto de un programa institucional educativo en el control del paciente diabético tipo 2. Métodos: estudio de intervención educativa cuasi experimental y sujetos como su propio control. Muestreo no probabilístico por conveniencia. Se incluyeron 151 pacientes del programa para la atención integral del paciente diabético. Variables demográficas: Género, edad, tipo de aseguramiento, somatometría y perfil metabólico. Se aplicó un programa educativo de un año de duración. Se utilizó estadística descriptiva e inferencial paramétrica. Resultados: se estudiaron 106 mujeres y 45 hombres cuyo rango de edad iba de 15 a 87 años, con una media de 57.22 ± 11.47. Se observó una disminución significativa en su índice de masa corporal, perímetro de cintura, glucosa venosa en ayuno, glucosa posprandial, colesterol, tensión arterial sistólica, triglicéridos y hemoglobina glucosilada (t de Student pareada, p < 0.05). No hubo cambios en la tensión arterial diastólica (p = 0.334). Conclusiones: la estrategia educativa para el control del paciente diabético presentó un comportamiento favorable en la mayoría de los parámetros somatométricos y metabólicos a un año de seguimiento. Se sugiere que se extienda el estudio a un periodo mayor para determinar si los efectos perduran con el tiempo.

[Sensitivity and specificity of a utility model of the detection of diabetic neuropathy]. / Sensibilidad y especificidad de un modelo de utilidad para la detección de neuropatía diabética.

OBJECTIVE: To determine whether a utility model can be used with acceptable sensitivity and specificity for the diagnosis of diabetic peripheral neuropathy (DPN). METHODS: Cross sectional study, non-probability sampling, in 381 type 2 diabetic patients with diabetic foot risk. To determine the DPN, it was evaluated the protective sensation in 10 sites on the foot. It was a positive diagnosis if three or more points showed insensitivity at the touch of the skin with Semmes-Weinstein monofilament (SWM). Monofilament was compared to the utility model (MMU); the diagnostic methods of application were the same for both. RESULTS: Mean age was 62 years, 11 years of development of DM, mean body mass index of 29 kg/m2, average glucose 129 mg/dL (78-264 mg/dL). With sensitivity of 73.68%, 97.67% of specificity, positive predictive value 77.78%, negative predictive value 97.10%, the positive likelihood ratio was 31.59 and the negative likelihood ratio 0.27. CONCLUSION: Currently, diagnostic devices for tactile sensory loss are not readily available in our country; therefore, the results of this research will help to make the diagnosis of the MMU timely, inexpensive and easily accessible.

High levels of lipoprotein(a) are associated with a lower prevalence of diabetes with advancing age: results of a cross-sectional epidemiological survey in Gran Canaria, Spain.

BACKGROUND: Recent data suggest that concentrations of lipoprotein(a) [Lp(a)] may be inversely associated with the risk of diabetes. This study analyzed the relationships between Lp(a) and both diabetes and insulin resistance in an adult cohort from the island of Gran Canaria, Spain. METHODS: Lp(a), homeostasis model assessment for insulin resistance (HOMA-IR) and conventional risk factors for diabetes were assessed in a sample of 1,030 adult individuals participating in a cross-sectional population-based epidemiological survey in the city of Telde. Diabetes was defined according to the WHO 1999 criteria, or as a previous diagnosis of diabetes. To identify patients at risk for diabetes, an Lp(a) cutoff level of 46 mg/dl was selected previously using classification and regression tree analysis. A multivariate logistic regression model with L2-regularization was used to assess the independent effect of Lp(a) on diabetes and its interactions with variables traditionally linked to the disease. Additionally, to investigate the effect of Lp(a) on insulin resistance, a parametric model was developed to describe the relationship between age and HOMA-IR values in subjects with levels of Lp(a) ≤ 46 or >46 mg/dl. RESULTS: Along with variables known to be associated with diabetes, including age, mean blood pressure, serum triglycerides, and an interaction term between age and low HDL cholesterol, the logistic model identified a significant inverse association for diabetes and the interaction term between age and Lp(a) levels >46 mg/dl. According to the proposed parametric model, HOMA-IR was significantly lower in subjects of all ages who had Lp(a) levels >46 mg/dl. CONCLUSIONS: These results suggest that the age-related increase in the probability of having diabetes is significantly lower in subjects with Lp(a) levels >46 mg/dl. This could be explained in part by a lower insulin resistance in this subset of the population.

Escherichia coli como causa de diarrea infantil / Escherichia coli as a cause of infantile diarrhea

Se realiza una revisión de la literatura médica reciente sobre Escherichia coli productora de diarrea. Se presentan los diferentes grupos de E. coli y se plantean los mecanismos patogénicos, así como el cuadro clínico asociado y su incidencia en la diarrea infantil, según estudios realizados en diferentes partes del mundo. Se señalan los elementos relacionados con el diagnóstico y se plantean las orientaciones terapéuticas recomendadas.