Thyroid surgery during the COVID-19 pandemic: results from a systematic review.

PURPOSE: During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. METHODS: We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ''Thyroid'' and "coronavirus" as search terms. RESULTS: Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2-3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. CONCLUSION: The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.

Hypercalcemia upon denosumab withdrawal in primary hyperparathyroidism: a case report and literature review.

Denosumab discontinuation is associated with a rapid increase in bone resorption and a decrease in bone mineral density. Spontaneous vertebral fractures may occur as a side effect of the rebound of bone resorption. Cases of rebound-linked hypercalcemia have also been described, moderate in women with osteoporosis and breast cancer and severe in children receiving oncological doses of denosumab. We report the case of an adult woman with primary hyperparathyroidism and moderate hypercalcemia, treated with denosumab for osteoporosis, who developed severe hypercalcemia and spontaneous vertebral fractures (SVFs) after denosumab discontinuation. An 86-year-old woman with densitometric osteoporosis was treated for 3 years with 60 mg of subcutaneous denosumab every 6 months. She was known to have primary hyperparathyroidism, with a serum albumin-corrected calcium of 2.82 mmol/l (NV 2.15-2.5) at the end of denosumab effect. Nine months after the last denosumab injection, she was hospitalized due to worsening overall health. Clinical evaluation revealed severe hypercalcemia (calcium 3.35 mmol/l). Very high values of bone turnover markers (BTMs) suggested a rebound effect due to denosumab discontinuation. An X-ray showed multiple new SVFs. After injection of denosumab 60 mg, serum calcium rapidly decreased and BTMs were dramatically reduced. A surgical approach by minimally invasive parathyroidectomy allowed for definite resolution of hyperparathyroidism and hypercalcemia. This case suggests that hypercalcemia can be a side consequence of denosumab discontinuation, which can become severe when other causes of hypercalcemia, such as primary hyperparathyroidism, are present.

Intrathecal 1% 2-chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer-blinded, randomised, controlled trial.

BACKGROUND: This prospective, observer-blinded, randomised, multicentre study aimed at determining the non-inferiority of 50 mg of plain 1% 2-chloroprocaine vs. 10 mg of 0.5% plain bupivacaine in terms of sensory block onset time at T10 after spinal injection. The study hypothesis was that the difference in onset times of sensory block to T10 between the two drugs is ≤ 4 min. METHODS: One hundred and thirty patients undergoing lower abdominal or lower limb procedures (≤ 40 min) were randomised to receive one of two treatments: 50 mg of plain 1% 2-chloroprocaine (Group C, n = 66) or 10 mg of plain 0.5% bupivacaine (Group B, n = 64). Times to sensory and motor block onsets, maximum sensory block level, readiness for surgery, regression of sensory and motor blocks, first analgesic requirements, unassisted ambulation, home discharge, and side effects after 24 h and 7 days were registered blindly. RESULTS: Chloroprocaine was comparable with plain 0.5% bupivacaine in terms of time to sensory block at T10 level. Group C showed faster onsets of motor block (5 vs. 6 min), maximum sensory block level (8.5 vs. 14 min), resolution of sensory (105 vs. 225 min) and motor (100 vs. 210 min) blocks, unassisted ambulation (142.5 vs. 290.5 min), first analgesic requirement (120 vs. 293.5 min), and home discharge (150 vs. 325 min) (all comparisons, P < 0.05). No chloroprocaine patient developed transient neurological symptoms. CONCLUSION: Spinal anaesthesia with 50 mg of plain 1% 2-chloroprocaine is similar to 10 mg of plain 0.5% bupivacaine in terms of onset of sensory block at T10 but shows quicker recovery from anaesthesia than with 0.5% bupivacaine.

Recomendaciones para el análisis de datos acumulados de susceptibilidad antimicrobiana en instituciones de salud / Recommendations for the analysis of cumulated data in antimicrobial susceptibility in health institutions

Due to the great variability in antimicrobial resistance patterns, local reports of cumulative antimicrobial susceptibility data are necessary in every health center. The purpose is to guide clinical decisions and the early detection of patterns that allow preventive measures to avoid dissemination of resistant strains. The main objective of this guide is to provide recommendations for the analysis of antimicrobial susceptibility data and elaboration of a local report. Recommendations provided in this guide are based on the Clinical and Laboratory Standards Institute (CLSI) document "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data" (3). Key aspects related to information gathering and data processing, analysis and presentation are described.

Considerando la gran variabilidad en la distribución de la resistencia microbiana, es una necesidad que cada centro de salud genere reportes locales de datos acumulados de susceptibilidad, con el propósito de guiar las decisiones clínicas y detectar tendencias que permitan establecer medidas de prevención para evitar la diseminación de cepas resistentes. Esta guía tiene como objetivo entregar recomendaciones para el análisis de susceptibilidad antimicrobiana y aportar datos útiles para la elaboración del informe local. Las recomendaciones que contenidas em este documento están basadas en el documento "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data de Clinical and Laboratory Standards Institute (CLSI) (3). Se describen aspectos claves relacionados con los requerimientos de la información, el procesamiento de los datos, el análisis y presentación de éstos.

[In vitro susceptibility patterns of bacterial species isolated in outpatients of the Metropolitan Región, Chile, year 2007]. / Susceptibilidad bacteriana a antimicrobianos. Especies aisladas en pacientes ambulatorios de la Región Metropolitana, Chile, año 2007.

A partial surveillance of bacterial in vitro susceptibility to antibiotics, performed by a outpatient clinic, at Santiago, Chile, during year 2007, has yielded the following results: Staphylococcus aureus (n: 232) 3% of methicillin (oxacillin) resistance; Streptococcus pyogenes (n: 120) 6% of macrolides resistance; Haemophilus influenzae nt (n: 60) 12% of ampicillin and 3% of chloramphenicol resistance; Neisseria gonorrhoeae (n: 170): 78% of penicillin, 56% of tetracyclin and 32% of ciprofloxacin resistance; Escherichia coli obtained from uriñe: (adults n: 3.066, children n: 260) 27-28% of sulpha-trimethoprim resistance, 15% (children) -21 % (adults) of cefadroxil resistance.

Susceptibilidad bacteriana a antimicrobianos: especies aisladas en pacientes ambulatorios de la Región Metropolitana, Chile, año 2007 / In vitro susceptibility patterns of bacterial species isolated in outpatients of the Metropolitan Región, Chile, year 2007

A partial surveillance of bacterial in vitro susceptibility to antibiotics, performed by a outpatient clinic, at Santiago, Chile, during year 2007, has yielded the following results: Staphylococcus aureus (n: 232) 3 percent of methicillin (oxacillin) resistance; Streptococcus pyogenes (n: 120) 6 percent of macrolides resistance; Haemophilus influenzae nt (n: 60) 12 percent of ampicillin and 3 percent of chloramphenicol resistance; Neisseria gonorrhoeae (n: 170): 78 percent of penicillin, 56 percent of tetracyclin and 32 percent of ciprofloxacin resistance; Escherichia coli obtained from uriñe: (adults n: 3.066, children n: 260) 27-28 percent of sulpha-trimethoprim resistance, 15 percent (children) -21 percent (adults) of cefadroxil resistance.

Una vigilancia parcial de la susceptibilidad bacteriana a antimicrobianos en la comunidad de Santiago, Chile, en el año 2007, efectuada por un centro de atención ambulatoria, ha dado las siguiente frecuencia de resistencia in vitro: Staphylococcus aureus (n: 232) 3 por ciento a meticilina (cloxacilina); Streptococcus pyogenes (n: 120) 6 por ciento a macrólidos; Haemophilus influenzae nt (n: 60) 12 por ciento a ampicilina y 3 por ciento a cloranfenicol; Neisseria gonorrhoeae (n: 170): 78 por ciento a penicilina, 56 por ciento a tetraciclina y 32 por ciento a ciprofloxacina; Escherichia coli uropatógenas: (adultos n: 3.066, niños n: 260) 27-28 por ciento a cotrimoxazol, 15 por ciento (niños) -21 por ciento (adultos) a cefadroxilo.

[In vitro activity of telithromycin against community acquired respiratory pathogens]. / Estudio de la actividad comparativa in vitro de telitromicina en patógenos respiratorios adquiridos en la comunidad en 13 centros clínicos chilenos.

BACKGROUND: Telithromycin is a new ketolide antimicrobial, that can be useful for the treatment of respiratory infections. AIM: To compare in vitro activity of telithromycin against respiratory pathogens, isolated in outpatient clinics. MATERIAL AND METHODS: Two hundred eighty strains isolated from patients with respiratory infections, were studied. The strains studied were S pneumoniae, penicillin sensitive (SPNS:57); intermediate (SPNI:35), resistant (SPNR:25); S pyogenes (SP:57); H influenzae (HIN 51); M catarrhalis (MC:25) and S aureus meticillin sensitive (SAUS:30). Minimal inhibitory concentration (MIC) by broth microdilution was studied for telitrhomycin and levofloxacin in all strains. Other antimicrobials studied, but not in all strains were erythromycin, clindamycin, trimetoprim sulphamethoxazole, oxacillin, amoxicillin-clavulanic acid and cefuroxime. RESULTS: All strains were sensible to telithromycin at a concentration -4 microg/ml. MIC 90 and its range for SPNS was 0.03 microg/ml (-0.004-0.12), for SPNI was 0.03 microg/ml (-0.004-025), for SPNR was 0.06 microg/ml (-0.004-0.25), for HIN was 2 microg/ml (0.12-4), for SP was 0.5 microg/ml (-0.004-2), for MC was 0.5 microg/ml (0.06-2) and for SAU was 0.25 microg/ml (0.06-0.25). CONCLUSIONS: All studied pathogens were sensible to telithromycin in vitro. This antimicrobial is an alternative for the treatment of community acquired respiratory infections.

Estudio de la actividad comparativa in vitro de telitromicina en patógenos respiratorios adquiridos en la comunidad en 13 centros clínicos chilenos / In vitro activity of telithromycin against community acquired respiratory pathogens

Background: Telithromycin is a new ketolide antimicrobial, that can be useful for the treatment of respiratory infections. Aim: To compare in vitro activity of telithromycin against respiratory pathogens, isolated in outpatient clinics. Material and methods: Two hundred eighty strains isolated from patients with respiratory infections, were studied. The strains studied were S pneumoniae, penicillin sensitive (SPNS:57); intermediate (SPNI:35), resistant (SPNR:25); S pyogenes (SP:57); H influenzae (HIN 51); M catarrhalis (MC:25) and S aureus meticillin sensitive (SAUS:30). Minimal inhibitory concentration (MIC) by broth microdilution was studied for telitrhomycin and levofloxacin in all strains. Other antimicrobials studied, but not in all strains were erythromycin, clindamycin, trimetoprim sulphamethoxazole, oxacillin, amoxicillin-clavulanic acid and cefuroxime. Results: All strains were sensible to telithromycin at a concentration ¡4 µg/ml. MIC 90 and its range for SPNS was 0.03 µg/ml (¡0.004-0.12), for SPNI was 0.03 µg/ml (¡0.004-025), for SPNR was 0.06 µg/ml (¡0.004-0.25), for HIN was 2 µg/ml (0.12-4), for SP was 0.5 µg/ml (¡0.004-2), for MC was 0.5 µg/ml (0.06-2) and for SAU was 0.25 µg/ml (0.06-0.25). Conclusions: All studied pathogens were sensible to telithromycin in vitro. This antimicrobial is an alternative for the treatment of community acquired respiratory infections.

Problemas de resistencia en streptococcus pyogenes / Antimicrobial resistance in streptococcus pyogenes

Los problemas de resistencia de streptococcus pyogenes son relativos a la adquisición de resistencia a macrólidos lo cual ocurre mediante dos mecanismos: modificación del sitio de acción en el ribosoma, resistencia tipo MLSb codificada por el gen erm que se asocia con resistencia a lincosamidas y streptogramina B, y por reflujo activo codificado por gen mef con resistencia sólo a macrólidos, siendo éste el mecanismo más frecuentemente encontrado en este microorganismo. En Chile se han aislado cepas de streptococcus pyogenes resistentes a macrólidos desde 1994, con porcentaje de resistencia promedio en los últimos seis años de 7 por ciento en el área metropolitana

Encuesta sobre los métodos de diagnóstico microbiológico de la infección urinaria / Survey on methods for the microbiological diagnosis of urinary tract infection

La infeccióm del tracto urinario (ITU), patología infecciosa altamente prevalente, debe ser confirmada por un diagnóstico microbiológico. El Comité de Microbiología Clínica de la Sociedad Chilena de Infectología realizó una encuesta retrospectiva para conocer la situación actual de algunos laboratorios asistenciales sobre metodología y criterios diagnósticos empleados empleados en el diagnóstico de ITU. Respondieron la encuesta 15 centros hospitalarios y laboratorios privados recopilándose información sobre 49.632 urocultivos. Es destacable que la totalidad de los laboratorios consideraron como criterio microbiológico de ITU un recuento microbiano > 100.000 ufc/ml. No fue posible analizar datos con recuentos inferiores por no disponerse de datos métodos sobre obtención de muestra, resultados del estudio microscópico (sedimiento urinario) concominate y sintomatología clínica. Utilizando este criterio diagnóstico la positividad varió entre 2,3 por ciento en varones y 33 por ciento en mujeres, porcentajes con una mayor dispersión en niños. Sólo 13 por ciento de las intituciones procesaron la muestra de orina en conocimiento del tiempo transcurrido desde la obtención de la muestra. Todos los laboratorios utilizaron el mismo criterio para considerar contaminada una muestra: > 3 microorganismo; algunos de ellos registraron 17 por ciento de contaminación. Si bien esta encuesta fue retrospectiva limitando la calidad del diagnóstico de situación, ella motivó al Comite de Microbiología Clínica a elaborar recomendaciones para el diagnóstico microbiológico de la infección urinaria

Conjuntivitis meningocóccica recurrente / Recurrent meningococcal conjunctivitis

An infant with meningococcal conjunctivitis is reported. In spite of intravenous penicillin and local treatment with chloramphenicol infection recurred after sixty days. Possible explanations are discussed and a review of literature related to risk of systemic disease after conjunctival infection is presented