Epidemiología del cáncer de tiroides en un Instituto Oncológico. Efecto de las nuevas recomendaciones clínicas / Incidence of thyroid cancer in an oncological clinic of Santiago, Chile

Background: In Chile, Thyroid cancer (TC) is included in a list of diseases that have a guaranteed access to treatment, endorsed by the Ministry of Health. The care burden of the disease will depend on its incidence. Aim: To estimate the incidence of TC in Chilean patients with access to thyroid surgery and describe its histopathological characteristics. Material and methods: Analysis of the registry of all thyroidectomies performed at a private oncological clinic in Metropolitan Santiago, between 2016 and 2018. Incidence was estimated the number of persons affiliated to an insurance system managed by the same clinic, separated by age and gender. Results: TC adjusted incidence varied from 60.8 cases per 100,000 persons/year in 2016 to 48.7 cases per 100,000 persons/year in 2018. The proportion of microtumors was 34% when the diameter of all foci was considered. Papillary and follicular carcinomas were the pathological diagnoses in 96 and 2% of cases respectively. Twenty-one percent of tumors had extra-thyroidal invasion. Conclusions: The TC incidence herein reported is higher than the figure of 7.9 cases per 100,000 persons/year reported by us in 2014. This difference could be due to a true increase in the incidence of TC, following worldwide trends or to differences in the methods used in both studies.

[Incidence of thyroid cancer in an oncological clinic of Santiago, Chile]. / Epidemiología del cáncer de tiroides en un Instituto Oncológico. Efecto de las nuevas recomendaciones clínicas.

BACKGROUND: In Chile, Thyroid cancer (TC) is included in a list of diseases that have a guaranteed access to treatment, endorsed by the Ministry of Health. The care burden of the disease will depend on its incidence. AIM: To estimate the incidence of TC in Chilean patients with access to thyroid surgery and describe its histopathological characteristics. MATERIAL AND METHODS: Analysis of the registry of all thyroidectomies performed at a private oncological clinic in Metropolitan Santiago, between 2016 and 2018. Incidence was estimated the number of persons affiliated to an insurance system managed by the same clinic, separated by age and gender. RESULTS: TC adjusted incidence varied from 60.8 cases per 100,000 persons/year in 2016 to 48.7 cases per 100,000 persons/year in 2018. The proportion of microtumors was 34% when the diameter of all foci was considered. Papillary and follicular carcinomas were the pathological diagnoses in 96 and 2% of cases respectively. Twenty-one percent of tumors had extra-thyroidal invasion. CONCLUSIONS: The TC incidence herein reported is higher than the figure of 7.9 cases per 100,000 persons/year reported by us in 2014. This difference could be due to a true increase in the incidence of TC, following worldwide trends or to differences in the methods used in both studies.

Plenitud ótica como primer síntoma en patología del espacio parafaríngeo / Otic fullness as a first symptom in parapharyngeal space pathology

RESUMEN Los tumores del espacio parafaríngeo (EP) son poco frecuentes, representando el 0,5%-1% de las neoplasias de cabeza y cuello. La distribución de los tumores del EP constituye: 40% tumores de glándulas salivales, seguidos de tumores neurogénicos y adenopatías. Presentamos un caso de una paciente de 52 años que acude por presentar sensación de taponamiento ótico izquierdo y molestias faríngeas de 3 meses de evolución. Tras una exploración otorrinolaringológica completa se sospecha patología del espacio parafaríngeo, que se confirma con las pruebas de imagen. Se realiza exéresis quirúrgica mediante abordaje transcervical-transparotídeo, con buena evolución posoperatoria y sin recidiva tras 1 año de seguimiento. El estudio anatomopatológico informa adenoma pleomorfo de parótida. En este trabajo se ha realizado una revisión de la etiopatogenia, diagnóstico y tratamiento de estas lesiones. Consideramos crucial realizar una exploración física otorrinolaringológica completa ante la presencia de un paciente con sintomatología inespecífica ya que el EP constituye un área anatómica difícil de explorar y que a menudo pasa desapercibida, por lo que la patología del EP representa un reto diagnóstico y terapéutico.

ABSTRACT Parapharyngeal space (PPS) tumors are infrequent and account for 0.5%-1% of head and neck neoplasms. Therefore, they represent a diagnostic challenge. The distribution of PPS tumors is as follows: 40% salivary tumors, followed by neurogenic tumors and adenopathies. We report a case of a 50 year old woman that presented with a 3-month history of otic fullness and pharyngeal disturbances. The otolaryngological examination showed PPS pathology that was confirmed by radiological images. Surgical excision by transcervical-transparotid approach was performed followed by uncomplicated healing with no recurrence in one year. The histological examination reported a pleomorphic parotid adenoma. The authors provide a discussion of the etiopathogenesis, diagnosis and treatment of this type of lesions. This clinical manuscript may shed light on the importance of a complete otolaryngological examination in a patient with unspecific symptoms considering that the PPS is a complex anatomic region and its pathology can easily go unnoticed.

Zika y casos de microcefalia en el estado Zulia: aspectos clínicos y epidemiológicos del brote, año 2016 / Zika and cases of microcephaly in the state of Zulia: clinical and epidemiological aspects of the sprout, year 2016

El Zika es una enfermedad emergente en Venezuela y en el estado Zulia, evoluciona generalmente de manera benigna y puede producir complicaciones como síndrome Guillain Barré y microcefalia en recién nacidos. Se plantea describir los aspectos clínicos, epidemiológicos del brote de Zika y los casos de microcefalia. La investigación es descriptiva, transversal, realizada de mayo 2016 a marzo 2017. La población fue de 1.155 casos sospechosos, la muestra 228 pacientes, resultando 108 positivos por PCR en tiempo real. El mayor número de casos se presentó en la edad de 17 a 33 años (59,3%), predomina el sexo femenino (81,5%), en los municipios Maracaibo y San Francisco (75%). En relación a la sintomatología, la frecuencia fue erupción (84,3%), cefalea y fiebre (76,9%), menos común la artralgia (65,7%) y mialgias (47,2%). Durante el brote, se presentaron dos muertes del sexo masculino, representando el 1,9%; 146 casos con el síndrome de Guillain Barré y 7 casos con microcefalia correspondiente al sexo masculino (85%), con una edad gestacional del recién nacido de 37,4 semanas y sobrevida de 85%. La principal recomendación, debe estar orientada al control del vector transmisor de la enfermedad y hacer el diagnóstico de los casos sospechosos para su confirmación.

Zika is an emerging disease in Venezuela and in the state of Zulia, it generally evolves in a benign manner and can produce complications such as Guillain-Barré syndrome and microcephaly in newborns. Itis proposed to describe the clinical and epidemiological aspects of the Zika outbreak and the cases of microcephaly. The research is descriptive, cross-sectional, conducted from May 2016 to March 2017. The population consisted of 1,155 suspected cases, with a sample of 228 patients, resulting in 108 positive PCR in real time. The largest number of cases occurred at the age of 17 to 33 years (59.3%), with a predominance of females (81.5%), in the municipalities of Maracaibo and San Francisco (75%). In relation to the symptomatology, the frequent are rash (84.3%), headache and fever (76.9%), while arthralgia (65.7%) and myalgia (47.2%) are less common. During the outbreak, there were two deaths of the male sex, representing 1.9%; 146 cases with Guillain-Barré syndrome and 7 cases with microcephaly, corresponding to the male sex (85%), with a newborn gestational age of 37.4 weeks and 85% survival. The main recommendation should be directed to the control of the transmitting vector of the disease and to make the diagnosis of the suspicious cases for their confirmation.

Current status of prenatal diagnosis in Cuba: causes of low prevalence of Down syndrome.

OBJECTIVES: To analyze trends in cytogenetic prenatal diagnosis in Cuba and to analyze possible causes leading to a low Down syndrome prevalence in a country where the triple test is not available. METHODS: An analysis of the Cuban program in prenatal cytogenetic diagnosis from 1984 to 2012 was conducted. Results are described, with particular emphasis on indications, abnormal results, types of invasive procedures, and terminations of pregnancy. RESULTS: Cytogenetic prenatal diagnostic analyses (n = 75,095) were conducted; maternal age was the indication for 77.9% of the amniocenteses and chorionic villus samplings. The detection rate of chromosomally abnormal pregnancies was 2.3% for maternal age and increased to 8-9% for other indications. When a chromosomal abnormality was identified, 88.5% terminated the pregnancy. In 2002, the live birth prevalence of Down syndrome was 8.4 per 10,000 live births, and in 2012, 7 per 10,000. CONCLUSION: Prenatal diagnosis in Cuba has contributed to a significant reduction in chromosomal aberrations. The impact increased because of the demographic trends of the population, the high index of terminations of pregnancy, and the establishment of a network of cytogenetic laboratories throughout Cuba.

[Strengths and difficulties in emotional adjustment of Aymara children from the perspective of children, parents and teachers]. / Fortalezas y dificultades para el ajuste emocional en niños aymara desde la perspectiva de los menores, padres y profesores.

OBJECTIVE: To describe capabilities and difficulties in emotional adjustment experienced by children living in the Chilean Aymara city of Arica. PATIENTS AND METHOD: 610 students between 5th and 8th grade, in addition to their parents and teachers were surveyed using the Strengths and Difficulties Questionnaire (SDQ), comparing Aymara children to those without indigenous heritage. 25 items divided into five scales were evaluated: Emotional, behavioral problems, hyperactivity, relationship problems with peers and prosocial behaviors, classifying the respondents into three levels, Normal, Border and Abnormal. RESULTS: There were no significant differences among the groups studied, where discrepancies in almost all cases show a slight effect (d≥|0.2|). Also, no relevant effects were observed regarding the type of assessor on the assessment of each dimension. Despite this, it was observed that Aymara children showed lower scores than their peers in "behavioral problems" according to their teachers, but this difference was also mild (partial η2>0.01). CONCLUSIONS: Aymara Children showed similar strengths and difficulties than non-Aymara students in situations that require emotional adjustment.

[Screening for congenital hypothyroidism, phenylketonuria, galactosemia and biotinidase deficiency in a sample of mentally retarded patients in the city of Havana]. / Cribado de hipotiroidismo congénito, fenilcetonuria, galactosemia y deficiencia de biotinidasa en una muestra de retrasados mentales de Ciudad de La Habana.

INTRODUCTION: Congenital hypothyroidism (CH), phenylketonuria (PKU), galactosemia (GAL) and biotinidase deficiency (BD) are innate errors in metabolism that share varying degrees of mental retardation (MR) as a common characteristic. AIMS. The aim of our study was to screen individuals with MR of unknown origin for CH, PKU, GAL and BD. PATIENTS AND METHODS: Venous blood samples were collected on SS 903 specimen collection paper from 55 individuals with MR of unspecific origin born within the period 1977 1997. CH diagnosis was performed through determination of total thyroxine (T4) and thyroid stimulating hormone (TSH), using the UMELISA T4 and neonatal TSH reagent kits, respectively, and the detection of PKU, GAL and BD was conducted by determining phenylalanine (Phe), total galactose (Gal) and biotinidase enzyme activity (Biot) using UMTEST PKU, GAL and BIOTINIDASA. RESULTS: The mean values obtained for the analytes that were evaluated were: 0.8 mUI of TSH/L of total blood (EEM: 0.2), 113.1 nmol of T4/L of serum (EEM: 5.4), 67.7 mol of Phe/L of total blood (EEM: 0.1), 0.1 mmol of Gal/L of total blood (EEM: 0.01), and Biot activity was normal in all cases. CONCLUSIONS: This study enabled us to determine the T4, TSH, Phe and Gal levels in a sample from the Cuban population with MR of unknown causation. In addition, slightly higher levels of T4 were found in children who had hyperkinesis

Factores de riesgo de Crystosporidium en niños menores de un año con enfermedad diarreica aguda en la provincia de Ciego de Avila, Cuba

Se efectúa un estudio analítico de casos y controles en niños con enfermedad diarreica aguda menores de un año en el hospital provincial Dr. Antonio Luaces Iraola de la provincia de Ciego de Avila, Cuba. Se estudian 37 casos y 185 controles efectuándose el apariamiento por grupos de edades, sexo o procedencia urbana o rural. Fuente de informaciónde las variables analizadas fueron encuestas aplicadas a las madres y la revisión de la historia clínic. Se aplicó el programa Epinfo versión 6 para el cálculo de Odds Ratio (OR). Se detectaron como factores de riesgo el uso de la lactancia mixta o artificial, la presencia de animales domésticos en la vivienda y el lavado de las manos por las madres antes de preparar los alimentos. (AU)

[Nursing research on the rehabilitation of neurological and neurosurgical patients]. / Papel de la enfermera en la rehabilitacion del paciente neurologico y neuroquirurgico.

A descriptive study was carried out on the main aspects related to the rehabilitation of neurological and neurosurgical patients. A review was made on books, symposium papers and theses; specialists were also consulted. Several variables were studied, among them, basic objectives and purposes of the rehabilitation program; peculiarities of the patient's psychologic adaptation to physical disability; assessment of handicaps; and the nurse's role in rehabilitation.

Validación del testimonio en menores victimas de abuso sexual

Se presentó un estudio en 34 casos de victimas de delitos sexuales en Sancti Spíritus en el período comprendido entre septiembre de 1990 y abril 1991 con el fin de conocer la importancia de los criterios descriminativos y orientadores en la confiabilidad del testimonio de estas victimas. Se brinda en la introducción una breve reseña de los criterios descriminativos y orientadores, así como la posible correspondencia de los resultados de la investigación médico-legal y la policial. Estas victimas se clasificaron según sexo, edad, características psicopatológicas y distribución por tipificación delictiva. Se evidencia la correspondencia entre los resultados de las conclusiones policiales y la exploracíon médico-legal. Estos resultados se muestran en tablas. Se brindan las conclusiones a que dan lugar los resultados, demostrándose la gran imortaancia de los criterios descriminativos en la validación del testimonio de estos menores victimas de abuso sexual.(AU)

Validación del testimonio en menores víctimas de abuso sexual

Se presentó un estudio en 34 casos de víctimas de delitos sexuales en Sancti Spíritus en el período comprendido entre septiembre de 1990 y abril 1991 con el fin de conocer la importancia de los criterios descriminativos y orientadores en la confiabilidad del testimonio de estas víctimas. Se brinda en la introducción una breve reseña de los criterios descriminativos y orientadores, así como la posible correspondencia de los resultados de la investigación médico-legal y la policial. Estas víctimas se clasificaron según sexo, edad, características psicopatológicas y distribución por tipificación delictiva. Se evidencia la correspondencia entre los resultados de las conclusiones policiales y la exploración médico-legal. Estos resultados se muestran en tablas. Se brindan las conclusiones a que dan lugar los resultados, demostrándose la gran importancia de los criterios descriminativos en la validación del testimonio de estos menores víctimas de abuso sexual.(AU)

[Incorporation of transferrin into the erythron in anemic and polycythemic conditions]. / Incorporación de la transferrina al eritrón en estados anémicos y policitémicos.

A ferrokinetic study was performed in 79 patients, 25 with absolute polycythaemia, 19 with relative polycythaemia and 35 presenting anaemia of different aetiology. The incorporation of transferrin into the erythron (ITE) was estimated on each case. The mean ITE values found in absolute primary and secondary polycythaemia and in secondary polycythaemia were, respectively, 281 +/- 85, 181 +/- 99 and 74 +/- 19 mumol/L tb/d (i.e., micromoles per litre of total blood per day). The mean ITE in iron deficiency anaemia was 110 +/- 43 mumol/L tb/d, in haemolytic anaemia this was 274 +/- 151 mumol/L tb/d, and in patients with myelodysplastic syndromes such values was 116 +/- 49 mumol/L tb/d. Significant differences were found for each group of patients with respect to a normal control group. Such findings are in accordance with the pathophysiology of the different pathologies studied. The values found in haemolytic anaemia and myelodysplastic syndromes are similar to those reported by others. The results of this study stress the advantages of evaluating the erythropoietic activity of the bone marrow by means of the ITE.

Estudios de pronóstico de cáncer de mama y linfoma con marcadores de laboratorio clínico / Studies on prognosis of breast cancer and lymphoma with markers of clinical laboratory

Se estudiaron 85 pacientes de cáncer de mama a las que se les realizó 18 pruebas de laboratorio antes y a 3 meses del tratamiento; no se encontró asociación alguna con el pronóstico a 3 años de evolución. Simultáneamente se estudiaron 71 pacientes de linfoma a los que se les realizó los mismos análisis y se encontró una asociación con el pronóstico y las zonas de albúmina, alfa 1 y gamma de la electroforesis de proteínas, hierro, eritrosedimentación, PCR y fosfatasa alcalina en el linfoma de Hodgkin, mientras que en el linfoma no Hodgkin tuvieron valor pronóstico la zona alfa 2, la haptoglobina, la ceruloplasmina y la eritrosedimentación. Estas conservaron su valor pronóstico aun dentro de un mismo estadio, en el linfoma no Hodgkin, mientras que en el linfoma de Hodgkin se asocian al estadio

Estudios de pronóstico de cáncer de mama y linfoma con marcadores de laboratorio clínico / Studies on prognosis of breast cancer and lymphoma with markers of clinical laboratory

Se estudiaron 85 pacientes de cáncer de mama a las que se les realizó 18 pruebas de laboratorio antes y a 3 meses del tratamiento; no se encontró asociación alguna con el pronóstico a 3 años de evolución. Simultáneamente se estudiaron 71 pacientes de linfoma a los que se les realizó los mismos análisis y se encontró una asociación con el pronóstico y las zonas de albúmina, alfa 1 y gamma de la electroforesis de proteínas, hierro, eritrosedimentación, PCR y fosfatasa alcalina en el linfoma de Hodgkin, mientras que en el linfoma no Hodgkin tuvieron valor pronóstico la zona alfa 2, la haptoglobina, la ceruloplasmina y la eritrosedimentación. Estas conservaron su valor pronóstico aun dentro de un mismo estadio, en el linfoma no Hodgkin, mientras que en el linfoma de Hodgkin se asocian al estadio

[Mortality by crushing in domestic pigs: study of the causes and their relationship to the time and the month of the year in the climatic conditions of Cuba]. / Mortalidad por aplastamiento en el ganado porcino: estudios sobre sus causas y sobre la relación con la época y mes del año en las condiciones climáticas de Cuba.

In the course of 3 years a complex of 25,000 pigs were investigated once per week for the dead among the 398 sucking piglets, and in the case of losses due to crushing to death the type of lesions and the connection with diseases was investigated. Of the piglets investigated, 88 were crushed to death (21.2%), among them 65 (73.8%) diseased--mainly infected by coli bacilli (60 = 68.2%)--and 23 (5.8%) healthy animals. The losses due to crushing to death were highest in January and differed from all other months of the year (p less than 0.05). Another peak of losses in July was only significant (p less than 0.05) as compared with the values of April and November. January and July also exhibited the highest proportion of coli-infected piglets. The most frequent lesions were edema and cyanosis of the skin, of the mucous membrane, and the hypodermic tissue, haemothorax and haemoperitonaeum, liver cracks, lung cracks, kidney cracks, stomach cracks, large intestine cracks, and multiple fractures of the ribs and of the skull. It is concluded that the losses due to crushing to death can be related to the decrease in vitality of the piglets due to diseases, caused in winter by decreased vitality and in summer by pressure caused by coli infection.

Inapparent genital herpes simplex infection in women attending a venereal disease clinic.

The purpose of this study was to determine the prevalence of asymptomatic genital infection with herpes simplex virus in women attending a venereal disease clinic in Puerto Rico. Genital samples were obtained from 123 consecutively enrolled patients. Vero cells were used for viral isolation; isolates demonstrating cytopathic effect were stored at -70 C and were typed by use of monoclonal antibodies. Herpes simplex virus was isolated from six patients, three of whom were free of any possible complaint that might be associated with a genital herpes virus infection. One patient was diagnosed as having herpetic cervicitis, and the remaining two were clinically diagnosed as well as laboratory confirmed cases of genital herpes. Virus isolated from all six women was identified as herpes simplex virus type 2. Thus the prevalence of laboratory confirmed genital herpes infection in women attending this clinic was 4.9% (6/123). Inapparent virus infection was detected in 2.5% (3/120) of the patients.