ABSTRACT
BACKGROUND: Fatigue is a common symptom in hypothyroidism; however, the effect of levothyroxine on fatigue has been little studied. The aim of this study was to evaluate the effect of levothyroxine on fatigue in Latino patients with primary hypothyroidism, as well as the association of TSH and free T4 (FT4) with the severity and persistence of fatigue. METHODS: A prospective study was performed in 92 patients with primary hypothyroidism. Fatigue severity scale (FSS) scores and clinical and biochemical characteristics before and at 6 months of levothyroxine were evaluated. RESULTS: After 6 months of levothyroxine, a reduction in FSS (53 (47-57) vs. 36 (16-38); p = 0.001) and fatigue frequency (45.7% vs. 26.1%; p = 0.008) was evident. Both before and after 6 months of levothyroxine, there was a positive correlation of the FSS score with TSH and a negative correlation with FT4. Persistent fatigue was associated with a pretreatment FSS score (r = 0.75; p = 0.001) and diabetes (r = 0.40; p = 0.001). An FSS > 34 (RR 3.9 (95% CI 1.43-10.73; p = 0.008)), an FSS > 36 (RR 3.23 (95% CI 1.21-8.6; p = 0.019)), and diabetes (RR 5.7 (95% CI 1.25-9.6; p = 0.024)) before treatment were risk factors for persistent fatigue. CONCLUSIONS: Levothyroxine improved fatigue in most patients. Diabetes and an FSS score >34 or >36 before treatment were risk factors for persistent fatigue.
ABSTRACT
ABSTRACT: Bronchobiliary fistula (BBF) represents a rare disorder; it consists of abnormal interconnection between the biliary tract and bronchial trees. A 22-year-old woman with persistent chest pain, jaundice, and biliptysis was referred for hepatobiliary scintigraphy under clinical suspicion of a BBF. Patient medical history was consistent with biliary tree reconstruction secondary to an iatrogenic injury during cholecystectomy 4 years ago. Previous complementary studies (CT and MR cholangiopancreatography) were equivocal for diagnosis. Planar dynamic images of hepatobiliary scintigraphy in the first hour were inconclusive. A 24-hour SPECT/CT was performed and confirmed the BBF in a minimally invasive way.
Subject(s)
Biliary Fistula , Bronchial Fistula , Female , Humans , Young Adult , Adult , Biliary Fistula/diagnostic imaging , Biliary Fistula/complications , Bronchial Fistula/etiology , Bronchial Fistula/complications , Aniline Compounds , Single Photon Emission Computed Tomography Computed TomographyABSTRACT
OBJECTIVES: Universal screening for trisomy using cell-free DNA (cfDNA) has proven to be more effective than combined test, but it is not cost efficient currently. Contingent cfDNA screening on the results of the first-trimester combined test can improve the detection rate of the combined test and reduce the number of invasive tests at a lower cost than universal screening. In 2018, a contingent screening program was implemented in the community of Castilla y Leon (Spain). This study aims to compare the results achieved in Salamanca University Hospital during the first 3 years of contingent screening (2018-2020) with those of the previous 3 years (2015-2017) to assess the changes in the trisomy detection rate and the number of invasive tests. METHODS: A total of 9,903 singleton pregnancies without malformations nor nuchal translucency >p99 were included. 5,165 patients underwent combined screening and 4,738 had contingent screening based on the combined test risk. In the combined test group, women were offered an invasive test if the risk was ≥1:270, while risks under 1:270 were considered low risks, and no further testing was offered. In the contingent screening group, invasive testing was offered if the risk was ≥1:100 (≥1:50 from 2020 onwards), while cfDNA was offered if the combined test risk was between 1:100 and 1:1,000 (1:50-1:1,000 from 2020 onwards). When risk was <1:1,000, no further testing was offered. Aneuploidies detected by cfDNA were confirmed by invasive diagnostic testing. RESULTS: There were 33 cases of trisomy 21 (T21) throughout the 6 years of study. Four cases had low/intermediate risks and were spotted by cfDNA. Risk >1:1,000 threshold for contingent test detected 100% T21. There was a false-positive result for trisomy 13. There were no false-negative results. "No-call" cfDNA results were minimized by repeating blood collection 2 weeks later, as fetal fraction (FF) was doubled. Invasive testing had a drop rate of 84% after contingent screening implementation. DISCUSSION: The implementation of population-based contingent screening significantly reduces the number of invasive tests without lowering diagnostic accuracy. To achieve the maximum efficiency of the program, it is important to know the best cut-offs according to the population where the program is to be implemented. The number of uninformative results due to low FF can be reduced by repeating the test 2 weeks after the initial extraction: this increases the FF to twice the initial one, achieving informative results and avoiding unnecessary invasive tests.
Subject(s)
Cell-Free Nucleic Acids , Down Syndrome , Maternal Serum Screening Tests , Down Syndrome/diagnosis , Down Syndrome/genetics , Female , Humans , Maternal Serum Screening Tests/methods , Nuchal Translucency Measurement/methods , Pregnancy , Pregnancy Trimester, First , Prenatal Diagnosis/methods , Trisomy/diagnosis , Trisomy/genetics , Trisomy 13 Syndrome/diagnosisABSTRACT
Non-obstetric vulvar hematomas are rare and few cases have been reported in the literature. There are no clinical guidelines for their management. In most cases they can be treated conservatively but in some cases surgical intervention will be necessary. We present the case of a patient with a traumatic vulvar hematoma who required surgical treatment; we also review the literature on this gynecological pathology. Our case highlights the importance of early surgical intervention to reduce associated morbidity and to minimize hospital stay.
ABSTRACT
The four-spotted coconut weevil, Diocalandra frumenti Fabricius (Coleoptera: Dryophthoridae), is a small weevil found attacking economically important palm species, such as coconut, date, oil, and Canary palms. Given the scarcity of detection and management tools for this pest, the availability of a pheromone to be included in trapping protocols would be a crucial advantage. Previous laboratory experiments showed evidence for aggregation behavior; thus, our main goal was to identify the aggregation pheromone in this species. The volatile profile of D. frumenti individuals was studied by aeration and collection of effluvia in Porapak-Q and also by solid phase microextraction (SPME) techniques. Moreover, solvent extraction of previously frozen crushed individuals was also performed. All resulting extracts and SPME fibers were analyzed by gas chromatography coupled to mass spectrometry (GC-MS). The comparison of male and female samples provided the candidate compound, 5-ethyl-2,4-dimethyl-6,8-dioxabicyclo[3.2.1]octane (multistriatin), whose biological activity was evaluated in olfactometer and field assays.
Subject(s)
Pheromones/isolation & purification , Weevils/chemistry , Animals , Behavior, Animal/drug effects , Dioxolanes/isolation & purification , Dioxolanes/pharmacology , Female , Gas Chromatography-Mass Spectrometry , Male , Olfactometry/methods , Pheromones/chemistry , Pheromones/pharmacology , Sex Attractants/chemistry , Sex Attractants/isolation & purification , Sex Attractants/pharmacology , Solid Phase Microextraction , Spain , Weevils/physiologyABSTRACT
Hand-held optical imagers are developed by various researchers towards reflectance-based spectroscopic imaging of breast cancer. Recently, a Gen-1 handheld optical imager was developed with capabilities to perform two-dimensional (2-D) spectroscopic as well as three-dimensional (3-D) tomographic imaging studies. However, the imager was bulky with poor surface contact (~30%) along curved tissues, and limited sensitivity to detect targets consistently. Herein, a Gen-2 hand-held optical imager that overcame the above limitations of the Gen-1 imager has been developed and the instrumentation described. The Gen-2 hand-held imager is less bulky, portable, and has improved surface contact (~86%) on curved tissues. Additionally, the forked probe head design is capable of simultaneous bilateral reflectance imaging of both breast tissues, and also transillumination imaging of a single breast tissue. Experimental studies were performed on tissue phantoms to demonstrate the improved sensitivity in detecting targets using the Gen-2 imager. The improved instrumentation of the Gen-2 imager allowed detection of targets independent of their location with respect to the illumination points, unlike in Gen-1 imager. The developed imager has potential for future clinical breast imaging with enhanced sensitivity, via both reflectance and transillumination imaging.
Subject(s)
Image Enhancement/instrumentation , Image Interpretation, Computer-Assisted/instrumentation , Imaging, Three-Dimensional/instrumentation , Pattern Recognition, Automated/methods , Tomography, Optical/instrumentation , Transducers , Computer-Aided Design , Equipment Design , Equipment Failure Analysis , Miniaturization , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Studies about the sex pheromone of the mealybug Dysmicoccus grassii , a main pest of Canary Islands banana cultivars, showed strong evidence that (-)-(R)-lavandulyl propionate and acetate in a 6:1 ratio are principal components of it. Volatile collection and GC-MS analysis from aeration of virgin females allowed the structural elucidation of the compounds. The activity and stereochemistry of both substances were established by means of relative attraction of mealybug males to synthetic standards in competitive Petri dish bioassays. (R)-Lavandulyl propionate induced a stronger attractive effect when compared to (R)-lavandulyl acetate. The attractiveness of the mixture of the two compounds at the original source ratio showed no statistically significant difference from that of the sum of each of the single compounds alone, suggesting that both components are not synergistic but additive.
Subject(s)
Hemiptera/chemistry , Sex Attractants/chemistry , Sex Attractants/pharmacology , Acetates/chemistry , Acetates/pharmacology , Animals , Drug Synergism , Female , Gas Chromatography-Mass Spectrometry , Hemiptera/physiology , Insect Hormones/analysis , Insect Hormones/chemistry , Insect Hormones/pharmacology , Male , Molecular Structure , Monoterpenes/analysis , Monoterpenes/chemistry , Monoterpenes/pharmacology , Sex Attractants/analysis , Sexual Behavior, Animal/drug effectsABSTRACT
Objetivo: Valorar el conocimiento que enfermos y cuidadores principales tienen sobre el roldel psicólogo y sus funciones. Detectar qué tipo de demandas realizan y recoger el grado de satisfacción percibido en la intervención. Método y material: Estudio descriptivo analítico transversal. Se empleó una encuesta voluntaria de elaboración propia que fue cumplimentada por un total de 152 sujetos (84 pacientes y68 cuidadores principales), todos ellos atendidos en la Unidad de Cuidados Paliativos (UCP) del Hospital Virgen de la Poveda y en las Unidades de Cuidados Paliativos Domiciliarios (UCPD) de la AECC de las áreas VIII y V de la Comunidad de Madrid. Resultados: El 73,81% de la población de enfermos estudiados conoce al menos una función de las que desempeña el psicólogo de la salud en cuidados paliativos y solicita ayuda específica de este. El 98% de la población estudiada manifiesta haber percibido una ayuda real por parte de este profesional. Paralelamente en cuidadores principales, el 76,47% conoce al menos una función del psicólogo (..) (AU)
Objective: To assess the knowledge that patients and primary caregivers have about the role and functions of a psychologist. To detect the types of demands made by the participants and assess their level of satisfaction with the psychological intervention received. Method and material: A descriptive cross-sectional study. A questionnaire developed for the purpose of the study was completed for a total of 152 participants (84 patients and 68 caregivers). All participants were being treated in the Palliative Care Unit (PCU) at Virgen de la Poveda Hospital or by the Palliative Home Care Service (PHCS) of the Asociación Española Contra el Cáncer (AECC) in areas VIII and V of Madrid county. Results: 73.81% of the patients knew at least one role of the health psychologist in palliative care and requested specific support from this healthcare professional. 98% of the patients say they perceived real support from this healthcare professional. In parallel 76.47% of primary (..) (AU)