Single-tube four-target lateral flow assay detects human papillomavirus types associated with majority of cervical cancers.

Isothermal nucleic acid amplification methods have many advantages for use at the point of care. However, there is a lack of multiplexed isothermal amplification tests to detect multiple targets in a single reaction, which would be valuable for many diseases, such as infection with high-risk human papillomavirus (hrHPV). In this study, we developed a multiplexed loop-mediated isothermal amplification (LAMP) reaction to detect the three most common hrHPV types that cause cervical cancer (HPV16, HPV18, and HPV45) and a cellular control for sample adequacy. First, we characterized the assay limit of detection (LOD) in a real-time reaction with fluorescence readout; after 30 min of amplification the LOD was 100, 10, and 10 copies/reaction of HPV16, HPV18, and HPV45, respectively, and 0.1 ng/reaction of human genomic DNA (gDNA). Next, we implemented the assay on lateral flow strips, and the LOD was maintained for HPV16 and HPV18, but increased to 100 copies/reaction for HPV45 and to 1 ng/reaction for gDNA. Lastly, we used the LAMP test to evaluate total nucleic acid extracted from 38 clinical samples; compared to qPCR, the LAMP test had 89% sensitivity and 95% specificity. When integrated with sample preparation, this multiplexed LAMP assay could be useful for point-of-care testing.

Influence of adenovirus 36 seropositivity on the expression of adipogenic microRNAs in obese subjects.

BACKGROUND: Infection by Adenovirus 36 (Ad-36) has been associated with adipogenesis using cell and animal models, and a high risk of developing obesity has been reported in Ad-36-seropositive individuals. However, molecular mechanisms involved in the maintenance over the years of adipogenesis associated with Ad-36 has not been investigated in human adipose tissue. Epigenetic mechanisms, such as micro-RNAs (miRNAs) that regulate gene expression at the post-transcriptional level, have shown an important role in the development and maintenance of metabolic diseases. AIM: This study investigated the expression of miRNA associated with the adipogenic process in visceral adipose tissue from obese individuals according to Ad-36 serology. METHODS: Obese individuals were separated according to their status of Ad-36 serology in seropositive (Ad-36 (+); n = 29) and seronegative (Ad-36 (-); n = 28) groups. Additionally, a group of lean controls (n = 17) was selected to compare with obese individuals. Biopsies of visceral adipose tissue were obtained to evaluate miRNA and gene expression. The study of Ad-36 serology was carried out by ELISA. The expression of pro-adipogenic (miR-17 and miR-210) and anti-adipogenic (miR-155, miR-130 and miR-27a) miRNAs was evaluated using Taqman advanced miRNA assays by qPCR. The expression of adipogenes encoding LEP, ADIPOQ, and PPARγ was evaluated by Taqman predesigned assays through qPCR. RESULTS: The obese group had higher LEP (p < 0.001) and PPARγ (p = 0.016) expression and lower ADIPOQ expression (p = 0.017), and also had higher expression of miR-210 (p = 0.039), whereas lower expression of miR-155 (p = 0.019) and miR-27a (p = 0.028) as compared to lean controls. Higher PPARγ expression (p = 0.008), but no influence on LEP or ADIPOQ expression was observed in Ad-36 (+) group. Those seropositive individuals also had higher expression of the miR-17 (p = 0.028) and lower levels of miR-155 (p = 0.031) in adipose tissue as compared to seronegative subjects. CONCLUSIONS: Individuals with previous infection by Ad-36 had higher expression of the pro-adipogenic miR-17 and lower expression of the anti-adipogenic miR-155, which could lead to an increased adipogenic status by positively modulating PPARγ expression in adipose tissue from obese subjects.

Adenovirus 36 seropositivity is related to obesity risk, glycemic control, and leptin levels in Chilean subjects.

BACKGROUND: Adenovirus 36 (Ad-36) has been associated to adiposity in animal and in vitro studies. Ad-36 seropositivity has also been reported to contribute to obesity risk in children and adult populations. We investigated the relationship of Ad-36 serology with obesity and metabolic parameters in a Chilean population. SUBJECTS AND METHODS: Clinical and anthropometric data were obtained and blood samples were drawn from 99 lean (BMI: 18.5-24.9 kg/m2) and 151 obese (BMI > 30 kg/m2) subjects. Laboratory tests included lipid profile as well as glucose, insulin, leptin, and adiponectin levels. Ad-36 seropositivity was evaluated in serum samples by enzyme-linked immunosorbent assay. RESULTS: Seroprevalence of Ad-36 was higher in the obese group (58%) than in lean controls (34%) demonstrating that individuals previously infected with Ad-36 have higher risk of obesity in the study population (OR: 2.67, 95%CI: 1.58-4.51, p < 0.001). Interestingly, Ad-36 was related to lower concentrations of triglycerides and VLDL cholesterol in lean subjects (p = 0.049) and lower leptin in obese individuals (p = 0.014). Previous Ad-36 infection was also related to lower glycemia, insulinemia, and HOMA-IR (p < 0.05) in obese subjects who were not under antidiabetic drugs. CONCLUSIONS: Our results provide evidence of the contribution of previous Ad-36 infection to an increased risk of obesity in adult Chilean population. Ad-36 seropositivity was also associated to lipid profile, glycemic control, and leptin levels in adult Chilean population.

Cholestasis secondary to hyperthyroidism in Graves' disease. Report of one case.

Hyperthyroidism can induce elevation in several liver function tests including aminotransferases, alkaline phosphatases and, less frequently, serum bilirubin. These alterations are usually mild and asymptomatic. We report a 26 year-old male presenting with palpitations, progressive jaundice, choluria and generalized itching. Laboratory tests were compatible with hyperthyroidism and a mild elevation of bilirubin, alkaline phosphatases and gamma glutamyl transpeptidase. A liver biopsy showed portal hepatitis with canalicular cholestasis. The patient was treated temporarily with glucocorticoids, cholestyramine and betablockade. Thereafter, he was treated with radioactive iodine, after which serum bilirubin decreased steadily until normalization in ten weeks.

Developing a Fluorescent Inducible System for Free Fucose Quantification in Escherichia coli.

L-Fucose is a monosaccharide abundant in mammalian glycoconjugates. In humans, fucose can be found in human milk oligosaccharides (HMOs), mucins, and glycoproteins in the intestinal epithelium. The bacterial consumption of fucose and fucosylated HMOs is critical in the gut microbiome assembly of infants, dominated by Bifidobacterium. Fucose metabolism is important for the production of short-chain fatty acids and is involved in cross-feeding microbial interactions. Methods for assessing fucose concentrations in complex media are lacking. Here we designed and developed a molecular quantification method of free fucose using fluorescent Escherichia coli. For this, low- and high-copy plasmids were evaluated with and without the transcription factor fucR and its respective fucose-inducible promoter controlling the reporter gene sfGFP. E. coli BL21 transformed with a high copy plasmid containing pFuc and fucR displayed a high resolution across increasing fucose concentrations and high fluorescence/OD values after 18 h. The molecular circuit was specific against other monosaccharides and showed a linear response in the 0-45 mM range. Adjusting data to the Hill equation suggested non-cooperative, simple regulation of FucR to its promoter. Finally, the biosensor was tested on different concentrations of free fucose and the supernatant of Bifidobacterium bifidum JCM 1254 supplemented with 2-fucosyl lactose, indicating the applicability of the method in detecting free fucose. In conclusion, a bacterial biosensor of fucose was validated with good sensitivity and precision. A biological method for quantifying fucose could be useful for nutraceutical and microbiological applications, as well as molecular diagnostics.

Engineered Bacteria for Short-Chain-Fatty-Acid-Repressed Expression of Biotherapeutic Molecules.

Short-chain fatty acids (SCFA) such as propionate and butyrate are critical metabolites produced by the gut microbiota. Microbiome dysbiosis resulting in altered SCFA profiles is associated with certain diseases, including inflammatory bowel diseases (IBD), characterized by a reduction in butyrate concentration and active intestinal inflammation. There is an increasing interest in the use of engineered bacteria as diagnostic and therapeutic tools for gut diseases. In this study, we developed genetic circuits capable of sensing SCFA concentrations to build biosensors that express a response protein (superfolder green fluorescent protein [sfGFP]) in amounts inversely proportional to the SCFA concentration. We also built biotherapeutics expressing the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) using the same logic. The propionate biotherapeutic expressed larger amounts of mouse GM-CSF in the absence of propionate. The butyrate biotherapeutics presented the expected behavior only at the beginning of the kinetics and an accelerated response in the absence of butyrate. Overall, these genetic systems may function as complementary diagnostic tools for measuring SCFAs and as delivery vehicles for biotherapeutic molecules. IMPORTANCE Short-chain fatty acids are key molecules produced by the gut microbiome. Their concentrations are altered in certain diseases. Here, we created molecular biosensors that quantify the absence of propionate and butyrate, using logic "NOT" gates and bacterial promoters. Finally, we show that these genetic systems could be useful for the delivery of therapeutic molecules in the gut, in the absence of these acids.

A novel tailed primer nucleic acid test for detection of HPV 16, 18 and 45 DNA at the point of care.

Cervical cancer is a leading cause of death for women in low-resource settings despite being preventable through human papillomavirus (HPV) vaccination, early detection, and treatment of precancerous lesions. The World Health Organization recommends high-risk HPV (hrHPV) as the preferred cervical cancer screening strategy, which is difficult to implement in low-resource settings due to high costs, reliance on centralized laboratory infrastructure, and long sample-to-answer times. To help meet the need for rapid, low-cost, and decentralized cervical cancer screening, we developed tailed primer isothermal amplification and lateral flow detection assays for HPV16, HPV18, and HPV45 DNA. We translated these assays into a self-contained cartridge to achieve multiplexed detection of three hrHPV genotypes in a disposable cartridge. The developed test achieves clinically relevant limits of detection of 50-500 copies per reaction with extracted genomic DNA from HPV-positive cells. Finally, we performed sample-to-answer testing with direct lysates of HPV-negative and HPV-positive cell lines and demonstrated consistent detection of HPV16, HPV18, and HPV45 with 5000-50,000 cells/mL in < 35 min. With additional optimization to improve cartridge reliability, incorporation of additional hrHPV types, and validation with clinical samples, the assay could serve as a point-of-care HPV DNA test that improves access to cervical cancer screening in low-resource settings.

An integrated isothermal nucleic acid amplification test to detect HPV16 and HPV18 DNA in resource-limited settings.

High-risk human papillomavirus (HPV) DNA testing is widely acknowledged as the most sensitive cervical cancer screening method but has limited availability in resource-limited settings, where the burden of cervical cancer is highest. Recently, HPV DNA tests have been developed for use in resource-limited settings, but they remain too costly for widespread use and require instruments that are often limited to centralized laboratories. To help meet the global need for low-cost cervical cancer screening, we developed a prototype, sample-to-answer, point-of-care test for HPV16 and HPV18 DNA. Our test relies on isothermal DNA amplification and lateral flow detection, two technologies that reduce the need for complex instrumentation. We integrated all test components into a low-cost, manufacturable platform, and performance of the integrated test was evaluated with synthetic samples, provider-collected clinical samples in a high-resource setting in the United States, and self-collected clinical samples in a low-resource setting in Mozambique. We demonstrated a clinically relevant limit of detection of 1000 HPV16 or HPV18 DNA copies per test. The test requires six user steps, yields results in 45 min, and can be performed using a benchtop instrument and minicentrifuge by minimally trained personnel. The projected per-test cost is <$5, and the projected instrumentation cost is <$1000. These results show the feasibility of a sample-to-answer, point-of-care HPV DNA test. With the inclusion of other HPV types, this test has the potential to fill a critical gap for decentralized and globally accessible cervical cancer screening.

[Comparison of band ligation with sclerotherapy for the treatment of bleeding esophageal varices]. / Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas.

BACKGROUND: Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy. AIM: To assess rates of re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endoscopic injection or band ligation. PATIENTS AND METHODS: Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116 patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16). Collection of data was retrospective for patients treated with sclerotherapy and prospective for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed. RESULTS: During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 39 and 72% of patients treated with band ligation and sclerotherapy, respectively (p < 0.01). The relative risk of bleeding after band ligation was 0.53 (95% confidence limits 0.390.73). Death rates until the end of follow up were 20 and 48% among patients with treated with band ligation and sclerotherapy, respectively (p < 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). CONCLUSIONS: Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.

Engineered Probiotics for Detection and Treatment of Inflammatory Intestinal Diseases.

Inflammatory intestinal diseases such as Crohn's disease and ulcerative colitis have seen an increase in their prevalence in developing countries throughout the current decade. These are caused by a combination of genetic and environmental factors, altered immune response, intestinal epithelium disruption and dysbiosis in the gut microbiome. Current therapies are mainly focused on treating symptoms and are often expensive and ineffective in the long term. Recently, there has been an increase in our understanding of the relevance of the gut microbiome and its impact on human health. Advances in the use of probiotics and synthetic biology have led to the development of intestinal biosensors, bacteria engineered to detect inflammation biomarkers, that work as diagnostic tools. Additionally, live biotherapeutics have been engineered as delivery vehicles to produce treatment in situ avoiding common complications and side effects of current therapies. These genetic constructs often express a therapeutic substance constitutively, but others could be regulated externally by specific substrates, making the production of their treatment more efficient. Additionally, certain probiotics detecting specific biomarkers in situ and responding by generating a therapeutic substance are beginning to be developed. While most studies are still in the laboratory stage, a few modified probiotics have been tested in humans. These advances indicate that live biotherapeutics could have great potential as new treatments for inflammatory intestinal diseases.

Ectopic pituitary adenoma of the TSH-secreting sphenoidal sinus with excellent response to somatostatin analogs. Theory of the embryogenesis and literature review from a clinical case.

Ectopic thyrotropin-secreting pituitary adenomas are rare, with only 10 published cases. We report the case of a 52-year-old woman who was referred for primary hypothyroidism, who showed clinical signs of hyperthyroidism and had been under treatment with levothyroxine. Her exams revealed high levels of thyroid stimulating hormone (TSH), at odds with free thyroxin (FT4) and raised triiodothyronine (T3), which remained elevated after medication suspension, suggesting possible central hyperthyroidism. Sellar MRI showed normal pituitary gland, with a mass in the sphenoid sinus of 24 mm. A possible ectopic TSH secreting pituitary tumor of sphenoid sinus was hypothesized. After a intramuscularly (IM) single dose of a sustained-relase of a somatostatin analog (octreotide) 20 mg, plasma levels of thyroid hormones were normalized and a significant tumor reduction was demonstrated in MRI control at 7-weeks' follow-up. The tumor was removed by transsphenoidal endoscopy, and the biopsy confirmed an adenoma with positive immunostaining for TSH and GH. Hyperthyroidism recurrence was observed in hormonal controls 4 weeks after surgery. Treatment with sustained-release octreotide was reinitiated, every 60-days for two years, with normalization of the thyroid hormone profile, but with a residual lesion with the appearance of a tumor in the MRI. A second tumor resection was performed, achieving sustained hormonal cure and no residual tumor lesion at 2-years' follow-up. To our knowledge, this is the first report of an ectopic thyrotropin-secreting pituitary adenoma of the sphenoid sinus. Clinical and laboratory aspects relevant to this entity are reviewed, emphasizing the usefulness of octreotide in the management of the reported case.

The combination of quantitative faecal occult blood test and faecal calprotectin is a cost-effective strategy to avoid colonoscopies in symptomatic patients without relevant pathology.

BACKGROUND: Faecal occult blood test (FOBT) has demonstrated effectiveness in colorectal cancer (CRC) screening. Faecal calprotectin (FC) has proven efficient for evaluating activity in inflammatory bowel disease (IBD), but its value in CRC detection is less established. Most symptomatic patients have benign pathologies, but still undergo colonoscopy in many settings. AIMS: To evaluate the diagnostic accuracy and cost-effectiveness of the combination of FOBT plus FC in symptomatic patients. METHODS: Patients who completed colonic investigations and returned stool samples, on which FOBT and FC were performed, were recruited prospectively. CRC, advanced adenoma, IBD and angiodysplasia were considered as relevant pathologies. RESULTS: A total of 404 patients were included, of whom 87 (21.5%) had relevant pathologies. Sensitivity and specificity were 50.6% and 69.6% for FOBT, 78.2% and 54.4% for FC. Negative predictive value (NPV) was 90.1% for FC and 86.9% for FOBT. NPV for the combination of FOBT and FC was 94.1%, with a sensitivity and specificity of 88.5% and 50.3%. The area under ROC (receiver operator curve) (AUC) was 0.741 for FOBT, 0.736 for FC and 0.816 for the combination. The total cost for visits and procedures was €233,016 (€577/patient). Using a combination of FOBT and FC as pre-endoscopic tool allows colonoscopies to be reduced by 39.4%, reducing total costs by 20.5%. CONCLUSION: The combination of FOBT and FC has a better diagnostic accuracy compared with each test alone. Performing both tests before colonoscopy is a less costly and more effective strategy, reducing unnecessary procedures and complications.

In properly selected patients with differentiated thyroid cancer, antithyroglobulin antibodies decline after thyroidectomy and their sole presence should not be an indication for radioiodine ablation.

OBJECTIVE: Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. SUBJECTS AND METHODS: This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. RESULTS: Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. CONCLUSIONS: In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.

Factores facilitadores y obstaculizadores del aprendizaje a través de la simulación

Objetivo: Identificar los factores que facilitan y dificultan el aprendizaje a través de la simulación y el ECOE, desde la perspectiva de los estudiantes y los docentes en la carrera Técnico en Enfermería de Nivel Superior. Material y Método: Estudio cualitativo con diseño fenomenológico, donde se aplicó encuesta en línea y se desarrollaron entrevistas semiestructuradas y grupos focales. El muestreo fue no probabilístico por conveniencia y participaron diez estudiantes y diez profesores pertenecientes a la carrera en una universidad privada en la ciudad de Santiago (Chile). Para llevar a cabo el proceso de análisis, codificación y clasificación de los datos, se utilizó el software de análisis NVivo. Se consideraron los principios y responsabilidades de la Declaración de Singapur sobre Integridad en la Investigación. Resultados: Los elementos favorecedores para las habilidades procedimentales son la metodología; la práctica y repetición; los profesores; los insumos y materiales y la motivación. Los elementos obstaculizadores fueron el nerviosismo, la falta de insumos y el tiempo escaso. Las limitaciones se dieron por el contexto sanitario, que implicó recoger información a distancia. Conclusiones: Se identificaron aspectos favorecedores y obstaculizadores para el logro de las habilidades procedimentales en la formación de técnicos en enfermería. Estos resultados pueden ser considerados insumos para realizar propuestas de diseño curricular que aborden aspectos didácticos, metodológicos y humanos.

Objective: To identify the factors that facilitate and hinder learning through simulation and OSCE, from the perspective of students and instructors in the field of licensed practical nurses (known as TENS in Chile). Materials and Methods: Qualitative study with a phenomenological design, in which an online survey was administered, and semi-structured interviews and focus groups were carried out. Non-probabilistic convenience sampling was used and ten students and ten instructors belonging to a TENS training program of a private university in Santiago de Chile participated. NVivo analysis software was used to carry out the data analysis, coding, and classification process. The principles and responsibilities of The Singapore Statement on Research Integrity were considered. Results: Facilitating elements for procedural skills were methodology, practice and repetition, instructors, supplies and materials, as well as motivation. Hindering elements were nervousness, lack of supplies and time scarcity. Limitations were caused by the healthcare setting, which involved having to collect information remotely. Conclusions: Facilitating and hindering aspects for the achievement of procedural skills in the training of TENS nurses were identified. These results may contribute to outline curriculum design proposals that address didactic, methodological, and person-related aspects.

Objetivo: Identificar os fatores que facilitam e dificultam a aprendizagem através da simulação e do ECOE, da perspectiva dos estudantes e professores no âmbito dos técnicos de enfermagem (conhecidos como TENS no Chile). Materiais e Método: Estudo qualitativo com desenho fenomenológico, onde foi aplicado uma pesquisa on-line e foram realizadas entrevistas semiestruturadas e grupos focais. Foi utilizada uma amostragem não- probabilística por conveniência e participaram 10 estudantes e 10 professores pertencentes à um programa de formação de TENS de uma universidade privada em Santiago do Chile. Para realizar o processo de análise, codificação e classificação dos dados, foi utilizado o software de análise NVivo. Foram considerados os princípios e responsabilidades da Declaração de Singapura a Integridade em Pesquisa. Resultados: Os elementos facilitadores das competências processuais foram a metodologia, a prática e repetição, os professores, os materiais e a motivação. Os elementos que dificultam são o nervosismo, a falta de materiais e o tempo escasso. As limitações foram causadas pelo contexto da saúde, o que implicou a recolha de informação à distância. Conclusões: Foram identificados os aspectos favoráveis e obstáculos à obtenção de competências processuais na formação de técnicos de enfermagem. Estes resultados podem ser considerados como contributos para propostas de concepção curricular que abordem aspectos didáticos, metodológicos e humanos.

Cholestasis secondary to hyperthyroidism in Graves disease: report of one case / Colestasia en un paciente con hipertiroidismo por enfermedad de Graves: informe de un caso

ABSTRACT Hyperthyroidism can induce elevation in several liver function tests including aminotransferases, alkaline phosphatases and, less frequently, serum bilirubin. These alterations are usually mild and asymptomatic. We report a 26 year-old male presenting with palpitations, progressive jaundice, choluria and generalized itching. Laboratory tests were compatible with hyperthyroidism and a mild elevation of bilirubin, alkaline phosphatases and gamma glutamyl transpeptidase. A liver biopsy showed portal hepatitis with canalicular cholestasis. The patient was treated temporarily with glucocorticoids, cholestyramine and betablockade. Thereafter, he was treated with radioactive iodine, after which serum bilirubin decreased steadily until normalization in ten weeks.

El hipertiroidismo puede producir elevación de aminotransferasas, fosfatasas alcalinas y, menos frecuentemente, de bilirrubina sérica. Habitualmente, estas alteraciones son leves y asintomáticas. Reportamos un hombre de 26 años con hipertiroidismo secundario a enfermedad de Basedow-Graves, que debutó con un cuadro colestásico, inicialmente estudiado por sospecha de patología hepática autoinmune que incluyó biopsia hepática. Posteriormente, se diagnosticó hipertiroidismo que fue tratado con glucocorticoides, colestiramina y beta bloqueo como puente a terapia definitiva con radioyodo. La evolución mostró disminución progresiva hasta la normalización de bilirrubina sérica.

[Pulmonary schistosoma nodule simulating neoplasia: case report]. / Nódulo pulmonar esquistossomótico simulando neoplasia: relato de caso.

Healthy patient in which during ordinary examination a pulmonary schistosomotic nodule with an adult parasite, was detected 25 years far from endemic region and after specific treatment with oxamniquine. Clinically the nodule simulated neoplasia.

In properly selected patients with differentiated thyroid cancer, antithyroglobulin antibodies decline after thyroidectomy and their sole presence should not be an indication for radioiodine ablation

ABSTRACT Objective Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. Subjects and methods This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. Results Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. Conclusions In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.

Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas / Comparison of band ligation with sclerotherapy for the treatment of bleeding esophageal varices

Background: Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy. Aim: To assess rates of re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endos-copic injection or band ligation. Patients and Methods: Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16). Collection of data was retrospective for patients treated with sclerotherapy and prospective for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed. Results: During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 39 and 72% of patients treated with band ligation and sclerotherapy, respectively (p < 0.01). The relative risk of bleeding after band ligation was 0.53 (95% confidence limits 0.390.73). Death rates until the end of follow up were 20 and 48% among patients with treated with band ligation and sclerotherapy, respectively (p < 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). Conclusions: Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.

Controvérsias sobre o tratamento do neuroblastoma metastático (IV-S) em lactente / Controversies of the treatment of metastatic neuroblastoma (IV-S) in infants

Objetivos: Descrever caso de neuroblastorna em sua forma menos freqüente (estágio IV-S), com metástases avançadas em fígado e medula óssea em lactente de cinco meses, relatando as divergências entre as opiniões dos autores de uma extensa revisão de literatura em relação às condutas e aos resultados. Descrição: Lactente de cinco meses apresentou-se com febre e hepatomegalia a esclarecer. Ultra-sonografia abdominal demonstrou fígado com dimensões aumentadas, ecotextura heterogénea às custas de numerosas imagens hipoecóicas difusamente distribuídas e, na supra-renal direita, massa hiperecóica de contornos bem definidos, medindo, aproximadamente, 65 cm³. Biópsia de medula óssea e de fígado revelou neoplasia maligna de pequenas células redondas e azuis compatíveis com neuroblastoma. O tratamento consistiu de sete ciclos de quimioterapia. seguida pela ressecção do tumor. O exame anátomo-patológico evidenciou ganglioneuroblastoma, "intermixed". Comentários: Não na uma padronização de conduta em relação ao neuroblastoma estadiado como IV-S. Alguns autores sugerem que não se deve tratar esse tumor em pacientes menores de um ano, peia alta taxa de regressão espontânea. Outros consideram a quimioterapia a conduta mais adequada. A ressecção cirúrgica imediata ou após a quimioterapia é também controversa.

Objectives: A case of neuroblastoma in its less frequent form (stage IV-S) with advanced metastases in liver and bone marrow in a five-month-old infant is described. Description: The patient presented fever and hepatomegaly. Abdominal ultrasonography showed liver with augmented dimensions, heterogeneous echotexture due to numerous and diffusely distributed hypoechoic images. A 65 cm³ hyperechoic mass in right adrenal, with well-defined contours was detected. Biopsy of bone marrow and liver revealed malignant neoplasm of small round blue cells, compatible with neuroblastoma. Treatment consisted of seven chemotherapy cycles followed by tumor resection. Histological examination revealed intermixed ganglioneuroblastoma, Comments: A discussion on different approaches to treatment of I V-S stage neuroblastoma is made.

Estudo prospectivo de 100 casos de core biópsia dirigida por ultra-som e revisão da literatura / Prospective study of 100 patients submitted to ultrasound-guided core biopsy and review of the literature

OBJETIVO: Mostrar a eficácia do método para evitar biópsias excisionais, verificar suas dificuldades técnicas, definir entre seguimento e biópsia excisional nos nódulos categoria IV do BI-RADSÕ e agilizar o procedimento cirúrgico nos casos de nódulos altamente suspeitos de malignidade (categoria V). MATERIAIS E MÉTODOS: As pacientes foram submetidas a exame clínico de rotina, mamografia e ultra-som. A "core" foi feita com pistola automática e agulha número 14, e foram colhidas de quatro a oito amostras. RESULTADOS: Das 100 lesões estudadas, 47 foram submetidas à cirurgia, além da "core", e diagnosticaram-se 34 carcinomas (34,0 por cento). Das 23 lesões classificadas como categoria III, identificou-se apenas um carcinoma (4,34 por cento); das 43 classificadas como categoria IV, sete (16,28 por cento); e das 34 classificadas como categoria V, 26 (76,47 por cento). Evitou-se a biópsia excisional em 53 casos (53,0 por cento). Identificou-se dificuldade no método da "core" em sete casos (7,0 por cento), devido a material insuficiente, risco para malignidade envolvendo lesões esclerosantes complexas e discordância entre imagem e histologia. As 33 lesões com resultados de malignidade à punção biópsia por agulha grossa foram confirmadas após a biópsia cirúrgica. Em um caso o diagnóstico pela "core" foi de hiperplasia ductal atípica e após a biópsia cirúrgica da peça diagnosticou-se carcinoma, correspondendo a um resultado falso-negativo. Não houve nenhum resultado falso-positivo.

OBJECTIVE: To demonstrate the efficacy of core-needle biopsy to avoid unnecessary surgery; to assess the technical difficulties of this method; to establish decision criteria for clinical follow-up or surgery in patients with lesions classified as suspicious for malignancy (BI-RADS IV); to expedite surgery in patients with lesions classified as highly suspicious for malignancy (BI-RADS V).MATERIALS AND METHODS: The patients were submitted to clinical examination, mammography and ultrasound. Core-needle biopsy was done using a 14-gauge needle, and 4-8 cores per lesion were obtained.RESULTS: A hundred lesions were studied, 47 of them underwent surgery and biopsy, and 34 cancers were diagnosed. In 23 lesions classified as probably benign (III) only one case of cancer was diagnosed (4.34%). In 43 lesions classified as IV, seven (16.28%) cancers were found whereas in 34 lesions classified as V, 26 (76.47%) cases of cancer were identified. It was possible to avoid surgery in 53 cases (53%). Difficulties in core-needle biopsy occurred in seven cases including insufficient material, risk of malignancy due to sclerosing lesions and lack of correlation between imaging and core-needle biopsy results. All the core biopsy diagnoses of malignancy were confirmed by surgery. There was one false negative result when the core biopsy specimen examination showed atypical hyperplasia while surgery specimen analysis revealed a carcinoma. There were no false positive cases.