Epidemiology of swine cysticercosis in two rural communities of Zacapa, Guatemala.

Taeniasis/cysticercosis complex caused by Taenia solium, is a serious public health problem and causes major economic losses to swine producers in developing countries in Asia, Africa and the Americas. Despite scarce epidemiological data, Guatemala is considered endemic for T. solium. A cross-sectional study was conducted in Azacualpa and Malpais, two villages in the department of Zacapa, to assess the prevalence of swine cysticercosis and associated factors. Between March and October 2019, 149 pigs were examined by tongue palpation and serum samples were then collected to detect antibodies by ab-ELISA, and necropsy was performed on pigs that were positive by tongue palpation and/or ab-ELISA, to assess parasite load. Pig owners were asked to fill out a questionnaire on factors related to pig husbandry and occurrence of swine cysticercosis. Pearson's chi-square test and multivariate analysis were used to measure the association between serological results and other variables (p < 0.05 was considered significant). The seroprevalence of swine cysticercosis was 13.4% (13/97, 95% C.I. 6.6%-20.2%) and 25% (13/52, 95% C.I. 13.2%-36.8%) in Azacualpa and Malpais, respectively, yielding an overall seroprevalence of 17.4% (26/149, 95% C.I. 11.4%-23.5%). Parasite loads ranged from 1 to over 23,000 metacestodes per carcass. No bivariate association was found between exposure variables and seropositivity. A positive diagnosis by tongue palpation increased the odds of finding pigs seropositive for cysticercosis by a factor of 16.1 in the multivariate analysis. Despite the high prevalence and parasite load of T. solium, risk factors associated with cysticercosis were not significant in this study.

Disease-free survival and response to therapy of clinically node- negative Papillary Thyroid Cancer treated without central neck dissection: Retrospective study of 321 patients.

BACKGROUND AND OBJECTIVE: Nodal metastases in the central compartment are frequent in papillary thyroid cancer (PTC). However, they are mostly micrometastases with no impact on survival and their relevance on the risk of locoregional relapse is controversial. There is no consensus regarding optimal management of the central neck in patients with PTC cN0. In our center, we do not perform prophylactic central neck dissection (pCND). The objective of this study is to review our long-term results and compare them with the most recent literature. PATIENTS AND METHODS: Retrospective review of patients with PTC who underwent total thyroidectomy (TT) without CND between 2005 and 2017. Primary result was disease-free survival in the neck (DFS). RESULTS: 321 patients were identified, mostly T1-T2 tumors (94.1%). Median follow-up was 90 months. DFS in the central compartment was excellent (96.1% at 10 year's follow-up). 19 patients had cervical recurrence, of which 15 underwent salvage surgery. On their last visit, including salvage surgery when appropriate, 77% of patients had excellent response, 18.7% had indeterminate response, 3.1% had biochemically incomplete response and 1.2% had morphologically incomplete response. Recurrent laryngeal nerve (RLN) paralysis after TT was transient in 4.7% of patients and permanent in 0.9% of patients. There were no RLN paralysis after salvage surgery. Permanent hypoparathyroidism occurred in 3.4% of patients. Only one patient had hypoparathyroidism after salvage surgery and it was permanent. CONCLUSIONS: Based on long-term results and low rate of complications associated with salvage surgery in our experience, we consider routine pCND is not justified.

Genetic testing for primary aldosteronism in SPAIN: Results from the SPAIN-ALDO Registry and review of the literature.

PURPOSE: To determine the rate of genetic testing for familial hyperaldosteronism (FH) in the SPAIN-ALDO Registry and to describe the clinical characteristics of patients with FH. In addition, a literature review of reports of FH cases was performed. METHODS: A retrospective multicenter study of primary aldosteronism (PA) in patients followed in 35 Spanish tertiary hospitals (SPAIN-ALDO Registry). RESULTS: Twenty-five of the 855 patients (3%) with PA included in the registry underwent genetic testing for FH, with complete results available in only 24 patients. However, we found that there were 57 patients who met the criteria for performing a genetic study of PA. Only 8 out of these 57 patients were genetically tested (14.0%), while the reasons to perform a genetic study in the remaining 9 genetically studied cases were quite heterogeneous. A positive result for FH was found only in one case for FH type III (KCNJ5 pathogenic variant). A systematic review of the literature was performed and identified a total of 25 articles reporting 246 patients with FH type I; 12 articles reporting 72 patients with FH type II; 14 articles reporting 29 cases of FH type III and 3 articles reporting 12 patients with FH type IV. CONCLUSION: The genetic study of familial hyperaldosteronism is often scarce in real-world clinical practice, as 86% of patients with criteria to undergo genetic study were not evaluated in our cohort. Nevertheless, FH is an uncommon cause of PA, representing only 0.2% of cases in the SPAIN-ALDO Registry, although its prevalence may be as high as 4% among suspected cases might be studied.

Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism.

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension (HT), and is associated with a higher cardiometabolic risk than essential HT. However, PA remains underdiagnosed, probably due to several difficulties clinicians usually find in performing its diagnosis and subtype classification. The aim of this consensus is to provide practical recommendations focused on the prevalence and the diagnosis of PA and the clinical implications of aldosterone excess, from a multidisciplinary perspective, in a nominal group consensus approach by experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology, Spanish Association of Surgeons (AEC).

Practical consensus for the treatment and follow-up of primary aldosteronism: a multidisciplinary consensus document.

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and is associated with a higher cardiometabolic risk than essential hypertension. The aim of this consensus is to provide practical clinical recommendations for its surgical and medical treatment, pathology study and biochemical and clinical follow-up, as well as for the approach in special situations like advanced age, pregnancy and chronic kidney disease, from a multidisciplinary perspective, in a nominal group consensus approach of experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology and Spanish Association of Surgeons (AEC).

Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry.

INTRODUCTION: Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA. AIM: To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account. METHODS: A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy. RESULTS: Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18-0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52-1.73]). CONCLUSION: Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.

Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry.

AIM: To evaluate the impact of aldosterone excess on renal function in individuals with primary aldosteronism and to compare its evolution after surgery or mineralocorticoid receptor antagonist (MRA) treatment. METHODS: A multicentre, retrospective cohort study of primary aldosteronism patients in follow-up in 36 Spanish tertiary hospitals, who underwent specific treatment for primary aldosteronism (MRA or adrenalectomy). RESULTS: A total of 789 patients with primary aldosteronism were included, with a median age of 57.5 years and 41.8% being women. At primary aldosteronism diagnosis, the prevalence of chronic kidney disease (CKD) was 10.7% (n = 84), with 75% of cases classified as state 3a (n = 63). Primary aldosteronism patients with CKD had a longer duration of hypertension, a higher prevalence of type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. Unilateral adrenalectomy was performed in 41.8% of cases (n = 330), and 459 patients were treated with MRA. After a median follow-up of 30.7 months (range 13.3-68.4), there was a significant decline in the estimated glomerular filtration rate (eGFR) in operated patients and those receiving MRA. During follow-up, 24.4% of patients with CKD at the time of primary aldosteronism diagnosis had normalized renal function, and 39% of those with albuminuria had albuminuria remission. There were no differences in renal function or albuminuria regression between the two therapy groups. However, development of albuminuria was less common in operated than in medically treated patients (0 vs. 6.0%, P = 0.009). CONCLUSION: CKD affects around 10% of the patients with primary aldosteronism, with a higher risk in individuals with long-term hypertension, type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. At short-term, both MRA and surgical treatment lead to a reduction of renal function, but adrenalectomy led to higher renal protection.

Adrenal incidentalomas, cortisol secretion and cancer: is there a real crosstalk?

Background: Cortisol has immunomodulatory effects that increase the risk and evolution of several diseases. Cancer is characterized by a proinflammatory state in which cells exert impaired function and proliferation. The relation between cortisol secretion and increased risk of malignant neoplasm, or their behavior, has not been fully elucidated. Aim: To determine the relation between cortisol secretion and the prevalence and clinical outcome of malignant neoplasms in patients with adrenal incidentalomas (AIs). Methods: Multicenter retrospective study that included 935 patients with AIs. Cortisol secretion was defined by a cortisol post-dexamethasone suppression test > 1.8 µg/dL, and nonfunctioning AIs (NFAIs) as a value ≤ 1.8 µg/dL. Results: Cortisol secretion was evident in 30.8% of the patients and cancer in 23.6% (especially breast, colorectal, prostate and thyroid cancer). No differences in the cancer prevalence were found between patients with cortisol secretion and NFAIs (63.6% vs. 63.4%, p=0.10). After adjusting by age, cortisol secretion was not associated with the presence of cancer (OR 1.29, CI 0.93-1.78). However, cortisol secretion was significantly associated with stage IV of cancer at diagnosis (OR 2.68, CI 1.19- 6.00) and mortality (OR 3.2, CI 1.28- 7.97). Patients with NFAI and breast cancer required treatment with chemo- and radio-therapy more frequently that patients with cortisol secreting AI (90% vs 10% and 92.9% vs 7.1% respectively, p<0.05), similarly patients with prostate cancer required radiotherapy more frequently (90.9% vs 9.1%, p=0.05); also, patients with colorectal cancer and NFAI, tended to require chemotherapy more frequently(76.5% vs 23.5%, p=0.06). Conclusion: Cortisol secretion does not increase the risk of malignant neoplasm, but it affects its clinical course, treatment requirements and mortality, leading to a worst prognosis and higher mortality when compared with patients with NFAIs.

Estandarización de la batería neuropsicológica de funciones ejecutivas y lóbulos frontales BaNFE-2 en muestra paraguaya con esclerosis múltiple tipo recaída remisión

Introducción: la esclerosis múltiple (EM), enfermedad crónica del sistema nervioso (SNC), compromete significativamente la cognición. Su prevalencia en Paraguay es 9,2/100.000 habitantes, 72% con recaída remisión (EMRR) e incidencia de 2-3mujeres/hombre, afecta más a personas en edad productiva, con altos costos económicos y afectivos. Objetivos: caracterizar al paciente con EMRR, evaluar sus funciones ejecutivas (FEs) con BaNFE-2; establecer valores de corte ajustados al país. Metodología: con fundamento en teoría de la neurociencia cognitiva, diseño no experimental, cuantitativo, descriptivo, empírico, retrospectivo y transversal; técnica psicométrica y entrevista neuropsicológica en una muestra por conveniencia de 40 pacientes, 82,5% mujeres y edad 25-55 años (37,78±7,89). Resultados: se reportaron datos demográficos y clínicos, se caracterizaron las escalas de BaNFE-2 cuya consistencia interna resultó significativa. Se obtuvo 52,5% de alteración en la escala prefrontal y 42,5% en FEs; relaciones significativas con escolaridad, discapacidad física (DF), cantidad de brotes y deterioro cognitivo (DC); diferencias significativas por sexo, escolaridad, DF y DC. Se calcularon puntuaciones tipificadas por escolaridad, z<-1 establece el corte entre normalidad y alteración. Conclusión: las pruebas de BaNFE-2 perfilan la afectación del tiempo de ejecución, atención, memoria de trabajo y FEs. Este estudio aporta baremos ajustados al país y abre una novedosa línea de investigación aplicando BaNFE-2 en EM.

Introduction: Multiple sclerosis (MS) is a chronic, neurodegenerative, inflammatory disease of the central nervous system (CNS) that significantly compromises cognitive functions. In Paraguay, it occurs with a prevalence of 9.2/100,000 inhabitants, 72% in the clinical form of relapsing remission (RRMS) and an incidence of 2 to 3 women/men, affecting more people of productive age with high economic and emotional costs. Objectives: To characterize the Paraguayan patient with RRMS, to assess the state of their executive functions (EFs) with the BaNFE-2 battery, and to establish cut-off values adjusted to the country. Methods: Research based on the theory of cognitive neuroscience of non-experimental, quantitative and descriptive design for analytical purposes. It is empirical, retrospective and cross-sectional. The psychometric technique and neuropsychological interview were used in a convenience sample of 40 patients aged 25 to 55 (37.78 ± 7.89) and 82.5% women. Results: Demographic and clinical data of the participants were reported. The BaNFE-2 coded and normalized scales were statistically characterized, the internal consistency of which was significant. 52.5% of the alteration was obtained in the anterior prefrontal scale and 42.5% in FEs; there are significant relationships with schooling, physical disability (PD), number of outbreaks and cognitive impairment (CI); there were also significant differences by sex, education, PD and CI. Standardized scores adjusted for schooling were calculated such that z<-1 establishes the cutoff between normality and abnormality. Conclusion: BaNFE-2 battery tests profile the affectation of execution time, attention, working memory, and FEs. This study provides the adjusted scales for the country and opens a new line of research applying the BaNFE-2 battery in people with MS.

Derechos de las personas con discapacidad en la pandemia por Covid-19. Síntesis rápida / The rights of people with disabilities in the Covid-19 pandemic Rapidreview

La pandemia por Coronavirus 2019 (Covid-19) ha profundizado las desigualdades preexistentes de las personas con discapacidad. Los afectados por Covid-19 se encuentran entre los grupos más vulnerables al ser uno de los grupos más excluidos de la sociedad. El objetivo del presente estudio esidentificarlas declaraciones y recomendaciones que las organizaciones supranacionales han emitido para garantizar los derechos de las personas con discapacidad en la actual pandemia. Se realizó una búsqueda amplia y sistemática; fueron consultadas 20 organizaciones y analizados 58 documentos en esta síntesis rápida. Los documentos encontrados fueron asignados en cuatro categorías dependiendo de su enfoque principal: principio de igualdad y no discriminación (25,8%), derecho al respeto de la dignidad inherente (10,3%), derecho a la accesibilidad (36,2%) y derecho a la salud (27,6%). Las organizaciones supranacionales hacen un llamado a los gobiernos a garantizar la protección y promoción de los derechos de las personas con discapacidad y a implementar medidas y estrategias razonables que aborden las necesidades especiales de esta población en la actual pandemia.

The Coronavirus 2019 (Covid-19) pandemic has deepened pre-existing inequalities for people with disabilities. Those affected by Covid-19 are among the most vulnerable groups as one of the most excluded groups in society. The objective of this study is to identify the declarations and recommendations that supranational organizations have issued to guarantee the rights of persons with disabilities in the current pandemic. A broad and systematic search was carried out; 20 organizations were consulted and 58 documents were analyzed in this rapid synthesis. The documents found were assigned into four categories depending on their main focus: principle of equality and non-discrimination (25.8%), right to respect for inherent dignity (10.3%), right to accessibility (36.2%) and right to health (27.6%). The supranational organizations call on governments to ensure the protection and promotion of the rights of persons with disabilities and to implement reasonable measures and strategies to address the special needs of this population in the current pandemic.

Diagnóstico del hiperaldosteronismo primario / Diagnosis of primary hyperaldosteronism

El hiperaldosteronismo primario (HAP) es la forma más frecuente de hipertensión arterial secundaria, y se asocia a un mayor riesgo cardiometabólico que el observado en pacientes con HTA esencial. Por tanto, es preceptivo mantener un alto índice de sospecha clínica para HAP. Si se confirma un cociente aldosterona/renina elevado se deben realizar pruebas de confirmación, habitualmente una prueba de sobrecarga salina intravenosa o de captopril, salvo en pacientes con HAP franco, con hipopotasemia espontánea, aldosterona plasmática > 20 ng/dL y renina suprimida, en los que no sería estrictamente necesario este paso para confirmar el diagnóstico de HAP. El último paso en el diagnóstico del HAP es el estudio de localización, siendo la tomografía axial computarizada (TC) de suprarrenales la prueba inicial de elección, y el cateterismo de venas adrenales (CVA), la prueba definitiva de localización en la mayor parte de los casos. En esta revisión se resumen los datos sobre el diagnóstico del HAP, desde el cribado al estudio de confirmación y de localización. (AU)

Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. Moreover, it is associated with a higher cardio-metabolic risk than the observed in patients with essential arterial hypertension (EHT). Therefore, a high index of clinical suspicion for PA is mandatory. If an elevated aldosterone/renin ratio is confirmed, confirmatory tests should be performed, with the exception in those patients with florid PA, with, with spontaneous hypokalaemia, plasma aldosterone > 20 ng/dL and suppressed renin, in whom this step would not be strictly necessary. Intravenous saline infusion test or captopril test are the commonly used confirmatory tests. The last step in the diagnosis of PA is the localization study, being the computerized axial tomography (CT) of the adrenal glands the initial test of choice, and adrenal venous sampling (AVS), the definitive localization test in most cases. This review summarizes the available data about the diagnosis of PA, from screening to confirmatory study and localization. (AU)

Vivencias de enfermería: ante el dolor del niño menor de un año / Nursing experiences: before the child’s pain less than one year

Objetivos: conocer vivencias, sentimientos y el actuar de los profesionales de Enfermería frente al dolor del niño menor de un año hospitalizado, con el propósito de ayudar a las (os) profesionales a replantearse y mejorar las prácticas de los cuidados brindados en los servicios pediátricos. Materiales y Método: El estudio se enmarca en el paradigma cualitativo. Se realizaron 15 entrevistas a profesionales de Enfermería y un focus group, seleccionados hasta alcanzar la saturación teórica de la información. El análisis de las entrevistas se desarrolla en tres etapas: reducción de datos; presentación de datos, extracción y verificación de las conclusiones.Resultados: En los discursos se observa que los profesionales que tienen mayor experiencia con niños tienen una actitud favorable frente al dolor, lo reconocen fácilmente y realizan cuidados más eficaces. Otro aspecto importante es la maternidad, que les ayuda a percibir precozmente el dolor en los niños. Finalmente, la mayoría de ellas menciona la existencia de un llanto diferente que constituye la primera alerta de dolor. Discusión: Los resultados muestran la necesidad depreparar, formar y orientar en forma continua a los profesionales de Enfermería novatos frente al dolor del niño menor de un año.

Objectives: to know experiences, feelings and actions how nursing professionals face the pain of the hospitalized child under one year, with the aim of helping professionals to rethink and improve practices of care provided in pediatric services. Material and Methods: Is part of the qualitative paradigm. 15 interviews with nursing professionals and a focus group, selected to achieve theoretical saturation of information took place. The analyses of the interviews were carried out in three stages: data reduction; presentation of data collection and testing of the findings. Results: Regarding experience, professionals who have more experience with children have a favorable attitude toward pain, easily recognized and made more effective care, as an important aspect is motherhood, which helps them perceive pain early in children, on the other hand most of them named the existence of a different kind of cry that is the first warning of pain. Discussion: The results shows the need to prepare, train and guide continuously at novice nursing professionals face the pain of children under one year.

Guía práctica sobre la evaluación inicial, seguimiento y tratamiento de los incidentalomas adrenales. Grupo de patología adrenal de la Sociedad Española de Endocrinología y Nutrición / Practical guide on the initial evaluation, follow-up, and treatment of adrenal incidentalomas Adrenal Diseases Group of the Spanish Society of Endocrinology and Nutrition

La evaluación inicial de los incidentalomas adrenales se centra en dos objetivos: descartar malignidad y descartar funcionalidad. Para ello se debe realizar una historia clínica detallada, obtener una valoración radiológica adecuada y un estudio bioquímico-hormonal completo. La entidad que más dudas genera, por la falta de consenso en su definición, es la secreción autónoma de cortisol. Nuestra recomendación es que, salvo para valores de cortisol < 1,8 μg/dl en el test de supresión con dexametasona que descartan secreción autónoma de cortisol, y ≥ 5 μg/dl que establecen el diagnóstico; se debe emplear una definición combinada de test de supresión con dexametasona ≥ 3 μg/dl y al menos uno de los siguientes: cortisol libre urinario elevado, ACTH < 10 pg/ml o cortisol nocturno (sérico y/o salival) elevado para establecer el diagnóstico de secreción autónoma de cortisol. En el seguimiento se debe repetir el test de supresión con dexametasona, generalmente de forma anual, individualizando en función de los resultados de las pruebas previas y de la presencia de comorbilidades potencialmente relacionadas con el hipercortisolismo. La prueba radiológica inicial de elección para la caracterización de los incidentalomas adrenales es la tomografía axial computarizada sin contraste, pero no existe acuerdo unánime sobre el seguimiento posterior. Nuestra recomendación general es repetir la prueba de imagen a los 6-12 meses del diagnóstico (en función de las características radiológicas de la lesión). Si la lesión se mantiene estable y no existen características indeterminadas, no serían necesarios más estudios radiológicos. Consideramos que los pacientes con secreción autónoma de cortisol con comorbilidades potencialmente relacionadas con el hipercortisolismo, especialmente si existe un control deficiente y se trata de pacientes jóvenes, se pueden beneficiar de una suprarrenalectomía unilateral. La indicación de suprarrenalectomía unilateral es clara en pacientes con síndromes hormonales manifiestos o sospecha de malignidad. Como conclusión, los incidentalomas adrenales deben ser valorados de forma integral, teniendo en cuenta las posibles manifestaciones clínicas y comorbilidades relacionadas con síndromes hormonales o malignidad; un estudio hormonal completo (teniendo en cuenta las situaciones que pueden conllevar resultados falsamente positivos y negativos) y radiológico adecuado. En base a los resultados de la evaluación inicial se planificará el seguimiento y/o tratamiento

Initial evaluation of adrenal incidentalomas should be aimed at ruling out malignancy and functionality. For this, a detailed clinical history should be taken, and an adequate radiographic assessment and a complete blood chemistry and hormone study should be performed. The most controversial condition, because of the lack of consensus in its definition, is autonomous cortisol secretion. Our recommendation is that, except when cortisol levels < 1.8 μg/dL in the dexamethasone suppression test rule out diagnosis and levels ≥ 5 μg/dL establish the presence of autonomous cortisol secretion, diagnosis should be based on a combined definition of dexamethasone suppression test ≥ 3 μg/dL and at least one of the following: elevated urinary free cortisol, ACTH level < 10 pg/mL, or elevated nocturnal cortisol (in serum and/or saliva). During follow-up, dexamethasone suppression test should be repeated, usually every year, on an individual basis depending on the results of prior tests and the presence of comorbidities potentially related to hypercortisolism. The initial radiographic test of choice for characterization of adrenal incidentalomas is a computed tomography scan without contrast, but there is no unanimous agreement on subsequent monitoring. Our general recommendation is a repeat imaging test 6-12 months after diagnosis (based on the radiographic characteristics of the lesion). If the lesion remains stable and there are no indeterminate characteristics, no additional radiographic studies would be needed. We think that patients with autonomous cortisol secretion with comorbidities potentially related to hypercortisolism, particularly if they are young and there is a poor control, may benefit from unilateral adrenalectomy. The indication for unilateral adrenalectomy is clear in patients with overt hormonal syndromes or suspected malignancy. In conclusion, adrenal incidentalomas require a comprehensive evaluation that takes into account the possible clinical signs and comorbidities related to hormonal syndromes or malignancy; a complete hormone profile (taking into account the conditions that may lead to falsely positive and negative results); and an adequate radiographic study. Monitoring and/or treatment will be decided based on the results of the initial evaluation

Obesidad y azúcar: aliados o enemigos / Obesity and sugar: allies or enemies

En las últimas tres décadas, la prevalencia de obesidad en los países desarrollados ha alcanzado dimensiones epidémicas y continua en aumento 1. Existen múltiples factores que influyen en la incidencia de obesidad, y junto con el descenso de actividad física ,el exceso de ingesta, juega un papel preponderante en la aparición de este problema de salud pública 2. Aunque existe una clara relación entre la ingesta de grasas y la ganancia de peso, el papel de los carbohidratos y más concretamente el de la sacarosa en el desarrollo de obesidad es más controvertido. Gran parte de esta controversia se debe a la creciente demanda de bebidas azucaradas y al posible incremento calórico en la dieta asociado a su consumo. A pesar de la publicación de múltiples estudios y comunicaciones a este respecto en los últimos años, siguen existiendo numerosas incógnitas acerca del papel que juegan las dietas ricas en azúcares en el incremento de incidencia y prevalencia de obesidad en los últimos años (AU)

In the last three decades, the prevalence of obesity in developed countries has reached epidemic proportions, and continues rising. Many factors have influence on the incidence of obesity, and with the decline of physical activity, overeating plays a role in the emergence of this public health problem. Although a clear relationship between fat intake and weight gain has been established, the role of carbohydrates and more specifically from sucrose and the development of obesity is more controversial. Much of this controversy is due to the growing demand for sweetened drinks and caloric increase posed by these in the diet. Despite multiple studies and communication son this subject in recent years, there are still many areas of uncertainty about the role played by diets rich in sugars over the increase in obesity in last years (AU)

Temperatura de almacenamiento y cantidad de ARN extraído de plasma materno / Temperature of storage and amount of RNA extracted from maternal plasma

El descubrimiento de los ácidos nucleicoscirculantes en plasma materno abrió nuevas posibilidadespara el diagnóstico prenatal no invasivo. No obstante,se desconocen los factores que afectan la concentracióndel ARN de origen feto-placentario en muestras deplasma materno. Fue investigado el efecto del tiempo dealmacenamiento (inmediatamente, 4 y 24 horas, 15 y 30 días),temperatura de almacenamiento (4ºC, -20°C y ambiente) yTrizol (con o sin) sobre la cantidad del ARN en muestrasde plasma de gestantes, antes de la semana 20 de embarazo.Se analizaron por espectrofotometría 33 muestras de ARNextraídas de plasma La temperatura afecta la concentraciónde ARN, más que el tiempo de almacenamiento y laadición de Trizol. De igual forma, la cantidad de ARN fueestadísticamente menor en muestras almacenadas a -20°C.El tiempo de almacenamiento y la presencia o ausenciade Trizol no incidió en la concentración de ARN. Enconclusión la temperatura es factor clave en la extracción deARN, donde probablemente el proceso de congelamientodescongelamientoincide negativamente en la concentraciónde ARN...

The discovery of nucleic acids in maternal plasma unlocked new possibilities for noninvasive prenataldiagnosis. However, the factors affecting the concentration of fetal RNA in maternal plasma samplesare unspecified. Here we studied the effect of storage time (15 to 30 days) and temperature (4°C, -20°Cand ambient) and of the presence of Trizol on the concentration of RNA in plasma samples taken frompregnant women before their 20th week. Thirty-three RNA samples were extracted from plasma andanalyzed by spectrophotometry. The amount of RNA was statistically lower in samples stored at -20°Cwhereas storage time and the presence or absence of Trizol did not affect RNA level. Temperature affectedthe concentration of RNA, rather than time and the addition of Trizol. In conclusion, temperature is akey factor in the extraction of RNA, and the freeze-thaw process most likely affects RNA concentrationsnegatively...

A descoberta dos ácidos nucleicos no plasmamaterno abriu novas possibilidades para o diagnóstico prénatalnão-invasivo. Desconhecem-se no entanto os fatoresque afetam a concentração do RNA de origem maternofetalnas amostras do plasma materno. Investigou-se o efeitodo tempo de armazenamento (15 a 30 dias), da temperaturade armazenamento (4°C, -20°C e ambiente), e de Trizol(com ou sem) sobre a quantidade de RNA nas amostras deplasma de gestantes, antes da vigésima semana de gravidez.33 amostras de RNA extraídas do plasma foram analisadaspor espetrofotometria. A temperatura afecta a concentraçãode RNA, mais que o tempo de armazenamento e de adiçãode Trizol. Da mesma forma, a quantidade de RNA foisignificativamente menor nas amostras armazenadas a -20°C. O tempo de armazenamento e a presença ou ausênciade Trizol não afetou os níveis de RNA. Em conclusão, atemperatura é um fator chave para a extração de RNA,onde provavelmente, o processo de congelamento edescongelamento afeta negativamente a concentração deRNA...

Prevalencia de hipertensión arterial en alumnos de 4° básico a 1° medio en un colegio de Santiago (Chile) / Prevalence of hypertension in students of 4th grade to 9th grade in a school in Santiago (Chile)

Objetivo: Determinar el comportamiento de la presión arterial en niños de 9 a 16 años y comprobar si existe asociación entre la presencia de HTA con diversos factores considerados como posibles riesgos por la literatura. Material y método: Estudio de tipo no experimental, exploratorio, descriptivo y transversal. La muestra estuvo constituida por 109 alumnos de ambos sexos. La variable "presión arterial" se obtuvo mediante la técnica estandarizada de medición de presión arterial del Ministerio de Salud de Chile en dos ocasiones. Resultados: Se observaron alteraciones de la presión arterial en el 19,6 % del total con una cantidad de cuatro niños hipertensos, equivalente al 3,6 %. Discusión y conclusiones: No se encontró asociación entre los factores de riesgo estudiados y la HTA; lo anterior podría atribuirse a que probablemente estos factores actúan a largo plazo. Los datos sobre colesterol fueron obtenidos mediante una ficha encuesta, no por medio de exámenes de laboratorio, ya que la muestra obtenida fue pequeña. La presencia y riesgo de HTA en niños revela una debilidad en la pesquisa de esta y sugiere la necesidad de implementar normas para la obligatoriedad de la medición de presión arterial en el control de niño sano.

Objective: High Blood Pressure (BP) is one of the principal cardiovascular risks. Nevertheless, it is not included in the physical examination of people younger than 15 years old, which does not allow high BP early detection. The aim of the study is to determine the presence of elevated arterial blood pressure in children's from 9 to 16 years old, and to verify if there exists an association with risk factors considered by literature. Materials and methods: Non-experimental, exploratory, descriptive and transversal study. The sample consisted of 109 children of both sexes. The arterial pressure was obtained through the standardized measurement of arterial blood pressure of the Chilean ministry of health in two occasions. Results: Alterations of the arterial blood pressure were detected in 19,6% of the children, with 4 children's presenting high BP, equivalent to 3,6%. Discussion and conclusions: There was no association between the studied risk factors and the high BP. This might be attributed to the fact that the studied factors operate in the long term, cholesterol data were obtained through a survey, not through laboratory tests and the obtained sample was small. The presence and risk of high BP in children reveal a weakness in its screening and suggest including measurement of arterial blood pressure as an obligation in children's health controls.

Alteraciones en la superficie ocular y en la película lagrimal en fumadores activos / Alterations in the ocular surface and tear film in active smokers

El consumo de cigarrillo es un factor de riesgo para enfermedades cardiovasculares, pulmonares, de piel y mucosas. Objetivo: evaluar las alteraciones en la calidad y en la cantidad de la película lagrimal, así como en la superficie ocular, en sujetos fumadores activos y en no fumadores. Materiales y métodos: estudio observacional-transversal. Se incluyeron 30 sujetos fumadores y 30 no fumadores, con edades entre los 18 y los 40 años. Se aplicó una encuesta de antecedentes. Quienes cumplieron los criterios de inclusión firmaron el consentimiento informado y se les realizó BUT, Schirmer con anestesia, tinción con fluoresceína y citología de impresión. Se usaron la prueba de Mann-Whitney, chi cuadrado y la razón de prevalencia (RP). Resultados: en el grupo de fumadores se encontró una disminución estadísticamente significativa en la calidad de la película lagrimal (p = 0,000) y aumento significativo en el grado de metaplasia escamosa (p = 0,001), con respecto al grupo de no fumadores. La prevalencia de alteraciones en la película lagrimal fue del 76,7 % en los fumadores (cantidad: 20 % y calidad: 76,7 %). El 60 % presentó algún cambio en la superficie ocular (córnea: 10 % y metaplasia escamosa: 56,7 %). Se estableció una RP de 1,5 (IC 95 %: 0,94-2,0) entre el hábito de fumar y el BUT, y una RP = 2,3 (IC 95 %: 1,8-2,9) entre el hábito de fumar y el grado de metaplasia escamosa conjuntival. Conclusiones: el consumo de cigarrillo mostró una asociación con la disminución en la calidad de la película lagrimal y el aumento en el grado de metaplasia escamosa conjuntival.

A background survey was applied, and those who met the inclusion criteria signed the informed consent, and they were submitted to BUT, Schirmer with anesthesia, fluorescein staining and impression cytology. The Mann-Whitney, Chi-squared and prevalence ratio (PR) tests were performed. Results: A statistically significant decrease in the quality of the tear film (p = 0.000) and significant increase in squamous metaplasia (p = 0.001) was found in the smokers’ group compared to the group of non-smokers. The prevalence of alterations in the tear film was 76.7 % in smokers (Quantity: 20 % and quality: 76.7 %). 60 % showed a change in the ocular surface (cornea: 10 % and squamous metaplasia: 56.7 %). A PR of 1.5 (95 % CI 0.94-2.0) was established between the habit of smoking and BUT, and a PR = 2.3 (95% CI 1.8-2.9) between the habit of smoking and degree of conjunctival squamous metaplasia. Conclusions: Cigarette consumption was associated with a decrease in the quality of the tear film and the increased conjunctival squamous metaplasia.

Identification of messenger RNA of fetoplacental source in maternal plasma of women with normal pregnancies and pregnancies with intrauterine growth restriction / Identificacion de RNA mensajero de origen fetoplacentario en plasma materno de mujeres con embarazos normales y gestantes con restriccion de crecimiento intrauterino

Objective: to quantify placenta-specific RNA in plasma of women carrying foetuses with intrauterine growth restriction and pregnant women with normal pregnancies. Materials and methods: 8 pregnant women with foetuses with intrauterine growth restriction were studied as well as 18 women with uncomplicated pregnancies in the third pregnancy trimester. Total free RNA was quantified in maternal plasma by spectrophotometry and the gene expression of hPL (Human Placental Lactogen) at the messenger RNA level through technical Real Time-Chain Reaction Polymerase. Results: plasma RNA of fetoplacental origin was successfully detected in 100% of pregnant women. There were no statistically significant differences between the values of total RNA extracted from plasma (p = 0.5975) nor in the messenger RNA expression of hPL gene (p = 0.5785) between cases and controls. Conclusion: messenger RNA of fetoplacental origin can be detected in maternal plasma during pregnancy.(AU)Objective: to quantify placenta-specific RNA in plasma of women carrying foetuses with intrauterine growth restriction and pregnant women with normal pregnancies. Materials and methods: 8 pregnant women with foetuses with intrauterine growth restriction were studied as well as 18 women with uncomplicated pregnancies in the third pregnancy trimester. Total free RNA was quantified in maternal plasma by spectrophotometry and the gene expression of hPL (Human Placental Lactogen) at the messenger RNA level through technical Real Time-Chain Reaction Polymerase.Results: plasma RNA of fetoplacental origin was successfully detected in 100% of pregnant women. There were no statistically significant differences between the values of total RNA extracted from plasma (p = 0.5975) nor in the messenger RNA expression of hPL gene (p = 0.5785) between cases and controls.Conclusion: messenger RNA of fetoplacental origin can be detected in maternal plasma during pregnancy

Objetivo: cuantificar RNA específico de placenta en el plasma de mujeres con embarazos con fetos con Restricción de Crecimiento Intrauterino y gestantes con embarazos normales. Materiales y métodos: se estudiaron 8 mujeres con embarazos con fetos con Restricción de Crecimiento Intrauterino y 18 mujeres con embarazos sin complicaciones, en el tercer trimestre de embarazo. Se cuantificó el RNA total libre en plasma materno por espectrofotometría y la expresión del gen hPL (Lactógeno Placentario Humano) a nivel de RNA mensajero por medio de la técnica Reacción en Cadena de la Polimerasa en Tiempo Real. Resultados: se logró detectar RNA en plasma de origen fetoplacentario en el 100% de las gestantes. No se encontraron diferencias estadísticamente significativas entre los valores de RNA total extraído de plasma (p=0,5975) ni en la expresión del RNA mensajero del gen hPL (p=0,5785) entre casos y controles. Conclusión: es posible detectar RNA mensajero de origen fetoplacentario en plasma materno durante el embarazo.