Estudio prospectivo comparativo de dos métodos de cálculo individual de la actividad de 131I en el tratamiento del hipertiroidismo / A prospective comparative study of two methods of individual calculation of 131I activity in the treatment of hyperthyroidism

OBJETIVO: El radioyodo (131I) constituye una modalidad establecida de tratamiento definitivo del hipertiroidismo. A pesar de la vasta experiencia existente, persisten varios aspectos por clarificar, como qué tipo de dosis emplear, ¿fijas o calculadas? El objetivo del estudio fue determinar si se podría mejorar la eficacia de este tratamiento implementando un método simple de cálculo dosimétrico que incluyera la estimación ecográfica del volumen tiroideo y una medida única de captación de 131I (24h). MÉTODOS: Diseñamos un estudio prospectivo de no inferioridad comparando entre dos modalidades de cálculo de la actividad de radioyodo: el método de dosis «semifijas» (A) y el de dosis «calculadas» (B). El primero consistió en escaladas de actividad (peldaños de 185MBq) teniendo en cuenta: etiología del hipertiroidismo, captación de 131I y objetivo terapéutico. El segundo se basó en el concepto de «compromiso dosimétrico», considerando como únicos factores la captación y el volumen tiroideos, empleando una vida media estándar de 5,5días. La dosis absorbida diana fue 150Gy, aunque tras un análisis preliminar (100 primeros casos) se aumentó a 200Gy en los bocios difusos tóxicos (BDT). RESULTADOS: Se incluyeron 212 pacientes. El métodoB resultó al menos igual de eficaz en cuanto al resultado final y funcional, con tendencia a más éxitos y menos hipotiroidismo. Además, las actividades administradas fueron significativamente menores. CONCLUSIÓN: En la terapia con radioyodo del hipertiroidismo se pudo implementar un método dosimétrico sencillo que proporcionó resultados al menos iguales a los de un método basado en dosis fijas, con actividades administradas inferiores

OBJECTIVE: Radioiodine (131I) is an established modality of definitive treatment of hyperthyroidism. In spite of the vast experience available, there are still several aspects to be clarified, such as whether fixed or calculated doses should be used. The aim of this study was to assess whether efficacy of this treatment could be improved by implementing a simple dosimetric calculation method including ultrasonographic estimation of thyroid volume and a single measurement of 24-hour 131I thyroid uptake. METHODS: A prospective non-inferiority study was designed to compare two procedures to calculate radioiodine activity: the «semi-fixed» dose method (A), and the «calculated» dose method (B). The first consisted of activity escalation (185MBq steps) based on etiology of hyperthyroidism, 131I uptake, and treatment objective. The second method was based on the «dosimetric compromise» concept, considering 24-hour uptake and thyroid volume as the only factors and using a standard half-life of 5.5 days. The target absorbed dose was 150Gy, but after a preliminary analysis (first 100 cases) it was increased to 200Gy in diffuse toxic goiters (DTGs). RESULTS: A total of 212 patients were included. MethodB was at least as effective in terms of final and functional outcome, with a trend to more success and less hypothyroidism. In addition, activities administered were significantly lower. CONCLUSION: In radioiodine therapy of hyperthyroidism, a simple dosimetric method that provided results at least equal to those of a fixed dose-based method, with lower administered activities, could be implemented

Variantes anatómicas en el canal mandibular en adultos jóvenes mayores de 30 años / Anatomical variants in the mandibular canal in young adults over 30 years

La correcta identificación del canal mandibular es esencial cuando se pretende realizar procedimientos quirúrgicos del sector posterior o incluso odontología clínica. La tomografía computarizada de haz cónico (CBCT) utiliza diferentes planos para la evaluación de este. Para conocer las variaciones anatómicas del canal mandibular se lleva a cabo un estudio en 100 adultos mayores de 30 años, donde la ubicación, la forma y la orientación se estudia mediante la tomografía computarizada de haz cónico. Así, el principal objetivo de nuestro estudio es conocer la variabilidad y tipo de presentación del canal bífido en el Canal mandibular en pacientes dentados o parcialmente edéntulos adultos mayores de 30 años.

The correct identification of the mandibular canal is essential when trying to perform surgical procedures in the posterior sector or even clinical dentistry. Computed tomography (CBCT) uses different planes for the evaluation of this. In order to know the anatomical variations of the mandibular canal, a study is carried out in 100 adults over 30 years of age, where the location, shape and orientation is studied by cone beam computed tomography. The main objective of our study is to know the variability and type of presentation of the bifid canal in the mandibular duct in dentate or partially edentulous adult patients over 30 years.

A prospective comparative study of two methods of individual calculation of 131I activity in the treatment of hyperthyroidism. / Estudio prospectivo comparativo de dos métodos de cálculo individual de la actividad de 131I en el tratamiento del hipertiroidismo.

OBJECTIVE: Radioiodine (131I) is an established modality of definitive treatment of hyperthyroidism. In spite of the vast experience available, there are still several aspects to be clarified, such as whether fixed or calculated doses should be used. The aim of this study was to assess whether efficacy of this treatment could be improved by implementing a simple dosimetric calculation method including ultrasonographic estimation of thyroid volume and a single measurement of 24-hour 131I thyroid uptake. METHODS: A prospective non-inferiority study was designed to compare two procedures to calculate radioiodine activity: the «semi-fixed¼ dose method (A), and the «calculated¼ dose method (B). The first consisted of activity escalation (185MBq steps) based on etiology of hyperthyroidism, 131I uptake, and treatment objective. The second method was based on the «dosimetric compromise¼ concept, considering 24-hour uptake and thyroid volume as the only factors and using a standard half-life of 5.5 days. The target absorbed dose was 150Gy, but after a preliminary analysis (first 100 cases) it was increased to 200Gy in diffuse toxic goiters (DTGs). RESULTS: A total of 212 patients were included. MethodB was at least as effective in terms of final and functional outcome, with a trend to more success and less hypothyroidism. In addition, activities administered were significantly lower. CONCLUSION: In radioiodine therapy of hyperthyroidism, a simple dosimetric method that provided results at least equal to those of a fixed dose-based method, with lower administered activities, could be implemented.

Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review.

BACKGROUND: According to the World Health Organization, the elderly are at the highest risk of injury or death from a fall. Age-related changes in strength, balance and flexibility are degenerative factors that may increase the risk of falling, and an aquatic training may offer a favourable environment to improve these modifiable risk factors. METHODS: A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors. Electronic databases and reference lists of pertinent articles published between 2005 and 2018 were searched. Randomized controlled trials (RCTs) that directly or indirectly addressed the effect of aquatic exercise for the prevention of falls in healthy participants were included within the synthesis. Studies were included if they were reported between January 2005 and May 2018 within a population aged between 60 and 90 years old that were without exercise-effecting comorbidities. Data related to participant demographics, study design, methodology, interventions and outcomes was extracted by one reviewer. Methodological quality assessment was independently performed by two reviewers using the PEDro (Physiotherapy Evidence Database) scale. RESULTS: Fourteen trials met the inclusion criteria. Exercise intervention duration and frequency varied from 2 to 24 weeks, from 2 to 3 times per week, from 40 to 90 min per session. Fall rate was not reported in any of the studies analysed. However, aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling. CONCLUSIONS: There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.

El idioma inglés en medicina: de la conveniencia a la necesidad / English in medicine: from a convenience to a necessity

Introducción: Se analizan los factores que condicionan el bajo nivel de conocimientos en lengua inglesa por parte de algunos grupos de alumnos de doctorado y se plantea la conveniencia de incluir el inglés médico como disciplina en los planes de estudio de la licenciatura en medicina. Material y método: Se ha elaborado un cuestionario para valorar los conocimientos de inglés general y específico que ha sido cumplimentado de forma anónima por cada uno de los alumnos de tercer ciclo que han realizado sus estudios de doctorado a lo largo de los cursos académicos: 1990-1991 a 1995-1996 y que han concluido y defendido su tesis doctoral hasta el pasado curso 1998-1999. Resultados: La mayor parte de nuestros encuestados supera los 32 años y estudiaron francés en su formación preuniversitaria. Para la mitad de la muestra, el inglés se debería incluir como asignatura obligatoria en la licenciatura.Conclusiones: Un significativo porcentaje de nuestros estudiantes de tercer ciclo (86 per cent) necesita especial apoyo de inglés para preparar su tesis doctoral de forma eficaz (AU)