Pheochromocytoma: A three-decade clinical experience in a multicenter study.

OBJECTIVE: To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). DESIGN AND METHODS: A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. RESULTS: A total of 106 patients (61 [57.5%] women, mean age 52.3 ±â€¯14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ±â€¯14.2 years vs 54.5 ±â€¯13.9 years, p < .001). Familial PCCs were more frequently associated with MEN2A (n = 8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3 cm (3-6 cm); 27.7% of the patients had tumors ≥6 cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4 cm [2.4-5.0 cm] vs 5.6 cm [4.0-7.0 cm], p < .001). Scintigraphy by ¹²³I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). CONCLUSIONS: PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low.

Feocromocitoma: experiencia clínica de tres décadas en un estudio multicéntrico / Pheochromocytoma: A three-decade clinical experience in a multicenter study

Objetivo Analizar las características clínicas y analíticas, las pruebas diagnósticas, los tratamientos y los resultados del feocromocitoma (FCC). Diseño y métodos Estudio multicéntrico retrospectivo en pacientes con FCC tratados quirúrgicamente y seguidos en 3 hospitales terciarios de referencia españoles. Resultados Se analizó a un total de 106 pacientes (61 [57,5%] mujeres, edad media 52,3 ± 14,8 años). En el diagnóstico, el FCC fue sintomático en el 62% de los casos y esporádico en el 83%. Los pacientes con FCC familiar eran significativamente más jóvenes que aquellos que presentaban la enfermedad esporádica (40,8 ± 14,2 años vs. 54,5 ± 13,9 años, p < 0,001). El FCC familiar se asociaba con mayor frecuencia a la MEN2A (n = 8). Los niveles de metanefrinas en orina de 24h se relacionaron positivamente con el tamaño del tumor. El diámetro tumoral máximo fue 4,3cm (3-6cm); el 27,8% de los pacientes tenían tumores ≥ 6cm. Los FCC incidentales eran significativamente más pequeños que los FCC sintomáticos (3,4cm [2,4-5,0cm] vs. 5,6cm [4,0-7,0cm], p < 0,001). La gammagrafía con 123I-metaiodobencilguanidina mostró una alta sensibilidad (81,9%). En el 93,6% de los casos se usó el bloqueo alfa preoperatorio con fenoxibenzamina y con doxazosina en los demás casos. En 2/3 de los pacientes se empleó la cirugía laparoscópica, con una baja tasa de conversión (1,9%) a cirugía abierta. Aproximadamente en el 20% de los pacientes aparecieron complicaciones perioperatorias, principalmente crisis hipertensivas (9,4%). La enfermedad recurrente apareció en el 10% de los casos y el FCC maligno fue raro (6,3%). Conclusiones Los FCC tratados quirúrgicamente en España suelen ser tumores grandes, sintomáticos y esporádicos diagnosticados alrededor de la sexta década de vida. El FCC hereditario está generalmente asociado con MEN2A. La cirugía laparoscópica es el tipo principal de técnica quirúrgica utilizada y la prevalencia del FCC metastásico es baja (AU)

Objective To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). Design and methods A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. Results A total of 106 patients (61 [57.5%] women, mean age 52.3 ± 14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ± 14.2 years vs. 54.5 ± 13.9 years, p<.001). Familial PCCs were more frequently associated with MEN2A (n=8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3cm (3-6cm); 27.7% of the patients had tumors ≥6cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4cm [2.4-5.0cm] vs. 5.6cm [4.0-7.0cm], p<.001). Scintigraphy by 123I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). Conclusion PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low (AU)

Pheochromocytoma: A three-decade clinical experience in a multicenter study. / Feocromocitoma: experiencia clínica de tres décadas en un estudio multicéntrico.

OBJECTIVE: To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). DESIGN AND METHODS: A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. RESULTS: A total of 106 patients (61 [57.5%] women, mean age 52.3 ± 14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ± 14.2 years vs. 54.5 ± 13.9 years, p<.001). Familial PCCs were more frequently associated with MEN2A (n=8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3cm (3-6cm); 27.7% of the patients had tumors ≥6cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4cm [2.4-5.0cm] vs. 5.6cm [4.0-7.0cm], p<.001). Scintigraphy by 123I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). CONCLUSIONS: PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low.

Evaluación de la calidad composicional, microbiológica y sanitaria de la leche cruda en el segundo tercio de lactancia en vacas lecheras / Evaluation of the compositional, microbiological and sanitary quality of raw milk in the second third of lactation in dairy cows

RESUMEN Introducción: Uno de los parámetros más importantes asociados a la producción de leche y su transformación es contar con condiciones higiénico-sanitarias adecuadas que permitan mejorar las condiciones del productor y empresas transformadoras y, por ende, garantizar inocuidad alimentaria al consumidor garantizando su bienestar y salud. Objetivo: Se evaluaron características composicionales, microbiológicas y sanitarias de leche cruda durante el segundo tercio de lactancia en vacas lecheras. Materiales y métodos: Se tomaron muestras de leche por duplicado cada 10 días a siete vacas lecheras durante su segundo tercio de lactancia. Posteriormente, se realizaron las siguientes pruebas: análisis composicional, adulterantes, presencia de antibióticos, recuento de células somáticas (RCS/ ml), identificación de Staphylococcus aureus y antibiograma por el método de Kirby-Bauer. Resultados: Se detectó la presencia de Staphylococcus aureus en el 66,2% de las muestras y 4,6% resultaron positivas para Listeria sp. No hubo presencia de antibióticos, peróxidos y almidones. Se evidenciaron muestras positivas para cloruros y neutralizantes, además se determinó que por cada kilogramo de leche se obtiene 30, 25 y 84 g de proteína, caseína y sólidos no grasos (SNG), respectivamente; donde la caseína representó el 83% de la proteína. Para el caso del RCS/ml se encontraron valores superiores a un millón de RCS/ml. Conclusiones: Para el caso estudiado la calidad composicional, sanitaria y microbiológica de la leche cruda en el segundo tercio de lactancia en vacas lecheras no es adecuada debido a que se obtuvieron valores que sobrepasan algunos lineamientos de la Norma Técnica Colombiana (NTC) 399 de 2002, en la cual se establece un conteo de mesófilos y de células somáticas (RCS/ml) máximo de 700.000/ml de leche cruda, a partir del cual se debe descartar el consumo de leche o su transformación.

ABSTRACT Introduction: One of the most important parameters associated with the production of milk and its transformation, is to have adequate hygienic-sanitary conditions in terms of milk quality that allow improving the conditions of the producer and processing companies, and therefore to provide food safety to the consumers, guaranteeing their well-being and health. Objetive: Compositional, microbiological and sanitary characteristics of raw milk were evaluated during the second third of lactation in dairy cows. Materials and methods: Two milk samples were taken every 10 days from 7 dairy cows during their second third of lactation. Then the following tests were carried out: compositional analysis, adulterants, presence of antibiotics, somatic cell count (SCC/mL), identification of Staphylococcus aureus and antibiogram by the Kirby-Bauer method. Results: Staphylococcus aureus was evidenced in 66.2% of the samples, and 4.6% of them gave positive for Listeria sp. No traces of antibiotics, peroxides and starches were found. Positive samples were found for chlorides and neutralizers, and it was determined that for each kilogram of milk, 30, 25 and 84 grams of protein, casein and non-fatty solids (NFS) were obtained, with 83% of the protein formed by casein. In the case of SCC/mL, values higher than one million SCC/mL were found. Conclusions: The compositional, sanitary and microbiological quality of the studied raw milk in the second third of lactation in dairy cows was not adequate, because values found lied above the Colombian technical standard 399 of 2002, which establishes a maximum of mesophile and somatic cell count (SCC/ mL) of 700000/ml in raw milk, therefore not allowing its consumption and transformation.

Patrones de excreción urinaria de Sodio en población adulta en muestras de orina espontánea / Urinary sodium excretion patterns in adult population in spot urine samples

Introducción: El presente estudio describe los patrones de natriuresis según las características clínicas y sociodemográficas en una población adulta de Asunción. Métodos: Estudio transversal tipo encuesta y toma de muestra de orina a personas que acudieron al Mercado de Abasto y al Policlínico Municipal durante los meses de junio-setiembre del 2014. Se estimó natriuria en muestras de orina espontánea a primera hora de la mañana y en ayunas. Se incluyeron sujetos de 18 a 65 años. Se compararon las medianas de los valores de natriuria en mmol/L, utilizándose el test U de Mann-Whitney para comparar las variables de dos categorías y Kruskal-Wallis para las que tienen más de dos categorías. Resultados: Se aplicó la encuesta y se tomó muestra de orina a 463 personas. El 69,5% (322) eran mujeres. La media de edad fue 50,5 años (DE: 14,2). El 26,6% (123) negó antecedentes patológicos. La mediana de natriuria global fue 97,5 mmol/L (RIC: 59,3­139,3). Los niveles de natriuria no presentaron diferencias por sexo. Las personas menores de 30 años, con bajo consumo de verduras y mayor consumo de frituras presentaron valores de natriuria altos y estadísticamente significativos. El grupo de sujetos sanos mostró mayor excreción de sodio que los que refirieron diabetes o hipertensión arterial. Conclusiones: La mayor excreción de sodio en orina observada se presenta en personas jóvenes, sin antecedentes patológicos y, al mismo tiempo son los que también presentan los peores hábitos alimenticios. Estos resultados muestran la necesidad de intervención en el ámbito de la salud pública a fin de prevenir la patología cardiovascular y renal del futuro.

Introduction: The present study describes natriuresis patterns according to clinical and sociodemographic characteristics in adult population of Asuncion. Methods: Cross-sectional study of convenience sampling to people who attended the Mercado de Abasto and the Municipal Polyclinic during June to September 2014. People from 18 to 65 years old were included. Sodium was estimated from urine samples of spot urine taken in the morning and fasting. Median values of natriuresis in mmol/L were compared using the test Mann-Whitney and Kruskal-Wallis. Results: 463 people participated. 69.5% (322) were women. The mean age was 50.5 years (SD 14.2). 26.6% (123) denied pathological medical history. The median overall natriuresis was 97.5 mmol/L (IQR: 59.3-139.3). Natriuresis levels did not differ by sex. High values with statistically significant were presented in people under 30 years old, with low consumption of vegetables and increased consumption of fried food. The group of healthy subjects showed increased sodium excretion than those who reported diabetes or high blood pressure. Conclusions: The increased natriuresis occurs in young people without having pathological medical history and also having the worst eating habits. Public health policies must focus at this level to prevent future cardiovascular and renal disease it is at this level where public health must intervene to prevent future cardiovascular and renal disease.

Epidemiologia de la obesidad en el Paraguay / Epidemiology of obesity in Paraguay

Introducción: Paraguay no escapa a la epidemia global de obesidad. Este estudio describió la prevalencia y los determinantes sociodemográficos, clínicos y conductuales asociados en el país. Métodos: Estudio transversal tipo encuesta poblacional con representatividad nacional, incluyó personas entre edades de 15 y 74 años. El muestreo fue probabilístico, trietápico sin reemplazo. STEPSwise fue la metodología y encuesta aplicada durante junio-setiembre 2011. Se consideró obesidad un índice de masa (IMC) corporal >=30. Este valor se distribuyó según las variables sociodemográficas, clínicas y conductuales. Por regresión logística se estimó asociación entre las variables, en odd ratios (OR) con intervalos de confianza del 95%(IC95%). Resultados: Se incluyeron 2501 participantes. Fueron obesos 23,5% de la población, 20,2% y 26,0% hombres y mujeres, respectivamente. Además del sexo, mostraron diferencias significativas: tener >35 años 3,17(2,11-4,76) que los menores; hombres con residencia urbana 1,94(1,35-2,79) veces más que los del área rural. Los hombres en pareja 2,52(1,80-3,53) veces más obesos que los solteros; funcionario público 2,57(1,57-4,26) veces más que otros trabajos. Baja actividad física presentó obesidad 1,75(1,19-2,57) veces más que tener una actividad física mínimamente aceptable. En hombres el quintil de ingreso superior presentó 3,87(2,17-6,92) más obesidad que el quintil inferior. En mujeres el bajo nivel educativo es 2,01(1,43-2,83) veces más que un mayor nivel. Conclusiones: El patrón observado de la distribución de la obesidad describe entornos y conductas más obesogénicos que otros en Paraguay. Estos resultados sirven para tomar decisiones e intervenciones específicas en salud pública, más allá de las medidas poblacionales.

Introduction: Paraguay has not escaped from the global epidemic of obesity. This study described the prevalence and socio-demographic, clinical and behavioral determinants associated to obesity. Methods: Cross-sectional study with a nationally representative survey, included people among 15 and 74 years old. The sampling was probabilistic, three-stage without replacement. STEPSwise was the methodology and survey applied during June-September 2011. Obesity was considered a body mass index (BMI) >=30 kg/m2. This value was distributed by sociodemographic, clinical, and behavioral variables. A logistic regression among obesity and variables was estimated for obtain odd ratios (OR) with confidence intervals of 95% (95% CI) of association. Results: 2501 participants were included. Were obese 23.5%, men and women were 20.2% and 26.0%, respectively. In addition to gender, showed significant differences: >35 years-old 3.17(2.11-4.76) than younger; men in urban residence 1.94(1.35-2.79) odds more than those in rural areas. No single men 2.52(1.80-3.53) odds more obese than single; civil servants 2.57(1.57-4.26) odds more than other jobs. Low physical activity 1.75(1.19-2.57) odds were more obese than a acceptable physical activity. In mans with the top income quintile showed 3.87(2.17-6.92) more obesity than the bottom quintile. In women, low educational level was 2.01(1.43-2.83) odds more than a higher. Conclusions: The observed pattern of obesity distribution in Paraguay described some behaviors and obesogenic environments. These results serve to take decisions and specific interventions in public health, beyond the population measures.

Mechatronic design and manufacturing of an affordable healthcare robotic bed.

The design and manufacturing of affordable medical assistive devices represents a major challenge for developing countries where resources are much more limited than in rich countries. The engineering design process focuses on developing better devices and systems with a low impact on the environment and the most functional and efficient performance, at the lowest possible price. In this context, the mechatronic design is perhaps the most complete way of thinking about performing concurrent design tasks which provide fully of mechanical, electronic, informatics and intelligent control systems integration. This design process can take advantage of many computer-aided tools, which play a key role in the modern methods of optimization and reduce the cost of prototyping. This work presents the mechatronic design process of an affordable assistive robotic bed, from the main requirements through the mechanical design and up to the integration of the electronics and the embedded control, while industrial design suitably merges to all the modules of the robotic bed. The work was developed in cooperation with a set of experts at the Hospital Juarez de Mexico who provided their very specific necessities for the designers and more important for the patients.

[Impact of prenatal steroids on morbimortality of eutrophic premature newborns]. / Impacto del uso de los esteroides antenatales sobre la morbimortalidad de neonatos prematuros eutróficos.

Although there is evidence that the use of prebirth steroids promote maturity of premature newborn, in the United States of America it has been estimated that only 50% of the women who have had a premature delivery (with babies with weight between 501 and 1500 g) have been treated with steroids. We analyzed the morbimortality and the need of assisted ventilation in 91 premature newborns with gestational age of less than 34 weeks and weight of 1,500 g or less. They were divided in two groups: one group included 50 newborns whose mothers received at least one full course of steroids and the other group included 41 newborns whose mothers did not receive it. Newborn pathologies, the need of assisted ventilation and the mortality were higher in the group that did not receive prebirth steroids. We conclude that the use of prebirth steroids diminishes the morbimortality of the premature newborn.