The Effects of Long-term Administration of rhPTH(1-84) in Hypoparathyroidism by Bone Histomorphometry.

Hypoparathyroidism is a rare disorder that is associated with abnormal bone properties. Recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] in short-term studies has beneficial skeletal effects. Although rhPTH(1-84) will likely be used indefinitely, long-term effects on skeletal microstructure are unknown. We therefore studied histomorphometric changes with transiliac crest bone biopsies before and after 8.3 ± 1 years of rhPTH(1-84) in 13 hypoparathyroid subjects compared with 45 controls. Before institution of rhPTH(1-84), skeletal remodeling indices were markedly suppressed. With long-term treatment, indices of bone remodeling increased. Mineralizing surface increased by 26-fold (0.3 ± 1 to 7.9 ± 7%, p = 0.003), bone formation rate increased by 15-fold (0.003 ± 0.01 to 0.047 ± 0.05 µm2 /µm/day, p = 0.007), osteoid width doubled (1.9 ± 1 to 4.3 ± 1 lamellae, p = 0.017), and osteoid surface tripled (3.3 ± 3 to 10.8 ± 6%, p = 0.011). Bone resorption as measured by eroded surface increased (4.6 ± 2 to 7.5 ± 3%, p = 0.021). Structural changes demonstrated intratrabecular tunneling, with increases in cancellous bone volume (19.6 ± 5 to 29.1 ± 11%, p = 0.017) and trabecular number (1.8 ± 1 to 2.5 ± 1 #/mm, p = 0.025). Cortical porosity tended to increase (6.3 ± 5 to 9.5 ± 3%, p = 0.07). Mineralizing surface, osteoid surface, and eroded surface surpassed control levels, as did cancellous bone volume, trabecular number, and cortical porosity. These data, the first to reflect such long exposure of any PTH for any disease, illustrate that PTH establishes and maintains a new skeletal state for at least 8 years in hypoparathyroidism. © 2018 American Society for Bone and Mineral Research.

Knowledge of asthma in school teachers in nine Spanish cities.

OBJECTIVE: To analyze the knowledge of asthma and its management in Spanish school teachers using the Newcastle Asthma Questionnaire (NAKQ). DESIGN: Descriptive, observational prevalence study, using a self-report questionnaire on knowledge about childhood asthma and its management by teachers in pre-school, primary, and secondary schools in nine Spanish cities. Age, sex, academic training, teaching experience, courses in which they taught, and personal and family history of asthma, were collected from each teacher. For knowledge determination, the validated Spanish version of the NAKQ was used. RESULTS: A total of 208 centers participated, including 7,494 teachers. The questionnaire was completed by 4,679 teachers (62.4%). The mean score of correct responses was 16.0 ± 4.8 points out of 31 (median = 17, range: 0-30). Only 6.8% of teachers were capable of pointing out the three main symptoms of the disease; 1.5% knew the triggering factors of an asthma attack; 8.6% knew two medicines useful during an asthma attack; 32.7% knew that inhaled medications had less side effects than pills, and only 3.8% knew of ways to prevent asthma attacks during exercise. In the multivariate analysis, variables significantly associated with a higher questionnaire score were a "lower age" (Beta coefficient = -0.09), "male gender" (Beta = 0.77), "being asthmatic" (Beta = 2.10), or "having close relatives with asthma" (Beta = 1.36) and "teaching in a private school" (Beta = 0.66) or in "compulsory secondary education" (Beta = 0.59). CONCLUSIONS: Teachers have a low level of knowledge about asthma, with an important limitation in some aspects of the disease. They should be trained to recognize the main symptoms of the disease, on how to act in the event of symptoms, and the early identification of situations in which the pupils require health care assistance. Pediatr Pulmonol. 2016;51:678-687. © 2015 Wiley Periodicals, Inc.

Assessment of methods to recover DNA from bacteria, fungi and archaea in complex environmental samples.

DNA extraction from environmental samples is a critical step for metagenomic analysis to study microbial communities, including those considered uncultivable. Nevertheless, obtaining good quality DNA in sufficient quantities for downstream methodologies is not always possible, and it depends on the complexity and stability of each ecosystem, which could be more problematic for samples from tropical regions because those ecosystems are less stable and more complex. Three laboratory methods for the extraction of nucleic acids from samples representing unstable (decaying coffee pulp and mangrove sediments) and relatively stable (compost and soil) environments were tested. The results were compared with those obtained using two commercial DNA extraction kits. The quality of the extracted DNA was evaluated by PCR amplification to verify the recovery of bacterial, archaeal, and fungal genetic material. The laboratory method that gave the best results used a lysis procedure combining physical, chemical, and enzymatic steps.

Tratamiento quirúrgico ambulatorio del quiste del conducto tirogloso en el paciente pediátrico, Hospital Provincial Universitario Carlos Manuel de Céspedes Bayamo, Granma, Cuba / Ambulatory surgical treatment of the thyroglossal duct cyst in the pediatric patient, Province University Hospital Carlos Manuel de Cespedes Bayamo, Granma, Cuba

Se realizó una investigación observación al, retrospectiva y descriptiva de 80 pacientes con diagnóstico clínico e histológico de quistes del conducto tirogloso tratado ambulatoriamente. Con el objetivo de mostrar los resultados de este método en pacientes pediátricos y valorar los factores que influyeron en el tiempo de estadía. La edad fue inferior a los diez años en 20 por ciento de la serie estudiada. Todos los pacientes acudieron al hospital el día de la operación La cirugía empezó antes de la 1PM en 100 por ciento de los casos. El tiempo medio de anestesia fue de 70 minutos y el tiempo medio quirúrgico fue de 50 minutos. La técnica de Sistrunk fue realizada en 92,5 por ciento de los casos. Los factores que significativamente impactaron en el tiempo de estadía fueron el uso de drenaje y los signos postoperatorios inestables. El seguimiento mínimo de los pacientes fue de un año. Ocho pacientes mostraron recidivas y fueron reintervenidos a los 10 meses. La cirugía ambulatoria para la exeresis del quiste del conducto tirogloso es segura con el paciente adecuado. La planificación para la cirugía ambulatoria se presento usando técnicas quirúrgicas meticulosas, y evitando drenajes cuando la hemostasia fue adecuada.

An observation retrospective, and descriptive investigation of 80 patients with clinical and histopalogycal diagnosis of cysts of the thyroglossal duct, who recived ambulatory care. The goal of this estudy was to show the results of this procedure in operated pediatric patient and to value the factors that influrnced in the period of stay. The age was under 10 years in 20 % of the studied group.All patients went to the hospital on the day of their surgery. It began before 1PM in 100% of the cases. The mean time of anaesthesia was 70 minutes and the surgical 50 minutes. Sistrunk technique was performed in 92.5% of the cases.These factores that determined mainly the stay period were the use of drainage and unstable postoperative signs. The minimun follow-up of the patients lasted one year. Eight patients had relapse and received surgical treatment 10 month later. Ambulatory surgery for excision of the cyst in the thyroglossal duct can be safe with the adequate patient. Planning for ambulatory surgery should begin the day before, using careful surgical procedure, and avoiding drainage when hemoistasis is adequate.

Valoración de la gravedad y estimación de los recursos sanitarios en los pacientes ingresados por neumonía adquirida en la comunidad / Evaluation of severity and estimation of resource use in patients hospitalized for community-acquired pneumonie

Introducción: Los recursos sanitarios que se precisan para el adecuado tratamiento de la neumonía adquirida en la comunidad (NAC) podrían estar en relación con la gravedad del proceso. Objetivos: Comprobar la distribución de grupos relacionados con el diagnóstico (GRD) en los pacientes ingresados por NAC, así como determinar si el peso específico, como medida del uso de recursos sanitarios, está relacionado con la gravedad clínica de la NAC. Métodos: Estudio retrospectivo con pacientes ingresados en nuestra unidad y diagnosticados de NAC durante un año, que recoge datos demográficos, clínicos, así como datos referentes a GRD, peso específico y estancia hospitalaria. Resultados: Se estudió a 129 pacientes con una edad media de 71 años (DE: 17), el 70 por ciento de los cuales se asignaron a las clases de riesgo más alto (clases IV y V). Los GRD más frecuentes fueron: GRD 89 (35,7 por ciento), GRD 90 (34 por ciento) y GRD 541 (17,8 por ciento). A excepción de la clase I, no hubo diferencias entre el peso específico de las clases de riesgo. Se observó una correlación muy baja entre el peso específico y la puntuación por la escala de Fine o la estancia hospitalaria. Los pacientes fallecidos, a pesar de que presentaban un mayor grado de gravedad que los supervivientes, no tienen diferencias significativas con respecto al peso específico de los que no fallecieron. Conclusiones: Los pacientes ingresados por neumonía tienen un alto nivel de gravedad clínica y los GRD asignados al alta más frecuentes en nuestra serie fueron aquellos relacionados directamente con la neumonía (89 y 90). La gravedad clínica de los pacientes con NAC no parece reflejarse en el peso específico asignado (AU)