Subacute thyroiditis and rapidly developing goiter in a 16-year-old female: a case report / Tiroiditis Sub-aguda asociada a bocio nodular en una paciente de 16 años; reporte de un caso

Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid gland with multiple etiologies and clinical features, often challenging to recognize. The classic presentation is the painful, granulomatous thyroiditis (DeQuervain's) characterized by diffuse swelling of the gland, usually preceded by an upper respiratory tract infection. A painless variant, also referred to as autoimmune subacute thyroiditis, has been documented and is strongly linked to postpartum state, reported following ~10% of pregnancies. It can be differentiated from the former by the presence of anti-thyroid antibodies, which classifies it as an autoimmune thyroiditis. Any spontaneous development of painful swelling of the thyroid gland warrants a complete work up that includes thyroid hormones, thyroid autoimmune panel, acute phase reactant titers, and, if available, imaging that may lead to the diagnosis of an inflammatory or infectious cause of thyroiditis.

Tiroiditis Subaguda, es una enfermedad inflamatoria de la glándula Tiroides que tiene muchas etiologías y características clínicas, y frecuentemente difícil de reconocer. La presentación clásica es: tiroiditis granu-lomatosa dolorosa caracterizada de hinchazón difusa de la glándula del Tiroides, usualmente precedida de una infección respiratoria de las vías áreas superior (como una infección viral). Existe una variante sin dolor, tam-bién referida como tiroiditis subaguda autoinmune, ha sido documentado y es muy ligada al estado postparto, en un 10% de los embarazos. La Tiroiditis postparto Puede ser diferenciada de la anterior por la presencia de anticuerpos lo que la clasifica como una tiroiditis auto-inmune. Cualquier desarrollo espontaneo de una hin-chazón dolorosa de la tiroides garantiza su evaluación de una manera formal, que incluye las hormonas del tiroides, panel tiroideo de autoinmunidad títulos de los factores que reaccionan agudamente, y si está disponible imágenes como una ultrasonografía que conlleva al di-agnóstico de una Tiroiditis inflamatoria o de origen in-feccioso.

Índice PaO2/FiO2/PEEP como predictor de mortalidad en pacientes COVID-19 / PaO2/FiO2/PEEP ratio as a predictor of mortality in COVID-19 patients / PaO2 /FiO2 /PEEP index como preditor de mortalidade em pacientes com COVID-19

Resumen: Introducción: existe una necesidad urgente de identificar factores pronósticos, tanto clínicos como paraclínicos que permitan estratificar el riesgo del paciente y activamente controlar la COVID-19. En nuestro medio, no se han publicado estudios que evalúen el índice PaO2/FiO2/PEEP (P/F/PEEP) como predictor de mortalidad en pacientes COVID-19. Objetivo: determinar si el índice PaO2/FiO2/PEEP actúa como factor asociado con mortalidad en los pacientes COVID-19. Material y métodos: estudio retrospectivo, analítico y transversal en pacientes con diagnóstico de COVID-19 grave. Resultados: para el índice PaO2/FiO2 se identificaron valores más bajos entre los casos que fallecieron 143.23 ± 76.54 versus 162.79 ± 64.86 en los sobrevivientes; sin embargo, no se presentó significancia (p = 0.263). En el índice PaO2/FiO2/PEEP, las diferencias también disminuyeron entre los casos que fallecieron 140.27 ± 94.78 versus los sobrevivientes 191.25 ± 108.7 (p = 0.030). Conclusiones: el índice PaO2/FiO2/PEEP es un factor predictor de mortalidad en los pacientes COVID-19, se asocia significativamente con una AUC superior al índice PaO2/FiO2 para predecir la mortalidad en un punto de corte de ≤ 80 como factor de mortalidad con un buena especificidad y alta sensibilidad.

Abstract: Introduction: there is an urgent need to identify prognostic factors, both clinical and paraclinical, that allow patient risk stratification and active control of COVID-19. In our setting, there have been no published studies evaluating the PaO2 /FiO2 /PEEP (P/F/PEEP) index as a predictor of mortality in COVID-19 patients. Objective: to determine if the PaO2/FiO2/PEEP index acts as a factor associated with mortality in COVID-19 patients. Material and methods: retrospective, analytical and cross-sectional study in patients diagnosed with severe COVID-19. Results: lower values were identified for the PaO2/FiO2 index among the cases that died: 143.23 ± 76.54 vs 162.79 ± 64.86 in the survivors, however, there was no significance (p = 0.263). In the PaO2/FiO2/PEEP index, the differences also decreased between the cases that died 140.27 ± 94.78 vs the survivors 191.25 ± 108.7 (p = 0.030). Conclusions: the PaO2/FiO2/PEEP index is a predictor of mortality in COVID-19 patients, it is significantly associated with an AUC higher than the PaO2/FiO2 index to predict mortality at a cut-off point of ≤ 80 as a mortality factor with a good specificity and high sensitivity.

Resumo: Introdução: há uma necessidade urgente de identificar fatores prognósticos, tanto clínicos quanto paraclínicos, que permitam a estratificação de risco do paciente e o controle ativo do COVID-19. Em nosso meio, não foram publicados estudos que avaliem a PaO2/FiO2/PEEP (P/F/PEEP) como preditor de mortalidade em pacientes com COVID-19. Objetivo: determinar se o índice PaO2/FiO2/PEEP atua como fator associado à mortalidade em pacientes com COVID-19. Material e métodos: estudo retrospectivo, analítico e transversal em pacientes diagnosticados com COVID-19 grave. Resultados: foram identificados valores menores para o índice PaO2/FiO2 entre os casos que foram a óbito: 143.23 ± 76.54 vs 162.79 ± 64.86 nos sobreviventes, porém, não houve significância (p = 0.263). No índice PaO2/FiO2/PEEP, as diferenças também diminuíram entre os casos que faleceram 140.27 ± 94.78 vs os sobreviventes 191.25 ± 108.7 (p = 0.030). Conclusões: o índice PaO2/FiO2/PEEP é um preditor de mortalidade em pacientes com COVID-19, está significativamente associado a uma AUC maior que o índice PaO2/FiO2 para prever mortalidade em um ponto de corte ≤ 80 como fator de mortalidade com uma boa especificidade e alta sensibilidade.

Temporomandibular disorder or not? A case report.

OBJECTIVES: The purpose of this case study is to show the need for a good differential diagnosis of suspected temporomandibular disorder (TMD) with otologic symptoms. METHODS/RESULTS: This study is a clinical case referring to a patient seeking treatment for pain in the right maxilla. The usual Medical History for diagnosis of a TMD was applied. Anamnesis revealed the patient had had a right maxillary pain for one month, a slight hearing loss and dizziness for the past five to six months, and two implants placed in the upper jaw two years previously. Clinical examination showed right temporomandibular joint (TMJ) clicking and tenderness in the lateral pterygoid muscles and in the right masseter muscle. Temporomandibular disorder and orofacial pain were diagnosed, and the appropriate treatment was initiated. In addition, a cranial magnetic resonance imaging (MRI) evaluation was requested and revealed acoustic neuroma. CONCLUSION: The coexistence of TMD with otovestibular symptoms suggests the need for a cranial MRI evaluation, especially if the dental or TMD treatment has not been positive.

Factors associated with tender point count in Puerto Ricans with fibromyalgia syndrome.

OBJECTIVE: To examine the factors associated with fibromyalgia syndrome (FMS) tender point count (TPC) in a group of Hispanic patients from Puerto Rico. METHODS: A cross-sectional study was performed in 144 FMS patients as determined using American College of Rheumatology [ACR] classification). Sociodemographic features, clinical manifestations, comorbidities, and pharmacologic agents were determined during the study visit. Tender points were assessed as described in the ACR classification for FMS. A t-test and one-way ANOVA test were used to examine the relationships between continuous, dichotomous, and nominal variables. RESULTS: The mean (standard deviation, [SD]) age of the FMS patients in this study was 50.2 (9.9) years; 95.1% were females. The mean (SD) TPC was 15.0 (4.7). Dysmenorrhea, the sicca syndrome, subjective swelling, increased urinary frequency, shortness of breath, headache, constipation, paresthesia, cognitive dysfunction, arthralgia, tiredness, morning stiffness, depression, and anxiety were associated with higher TPC. No associations were seen between socio-demographic features and FMS pharmacologic therapies. CONCLUSION: In this group of Puerto Ricans with FMS, TPC was associated with several FMS symptoms and comorbidities. This study suggests that TPC may be a simple and effective tool for assessing disease severity in FMS patients.