Criterios para la selección del tipo de tratamiento quirúrgico en cáncer de tiroides

Objective: to evaluate the procedure for the surgical management of the thyroid cancer and the criteria for the selection Patients and method: eighteen patients with cancer of thyroid programmed to surgical procedures. Results: the 83, 3% of the series was 45 years or more. No exist T1. Twelve patients were intermediate risk. Radiologic studies and the fine needle aspiration were the methods of evaluation preoperative. Total thyroidectomy was the most common surgery and the histology more frequent was papilar carcinoma. The neoplasies of 4cms or more, the frozen section and the findings in the operating room were be used to adapt the surgical plan in the 66,6% of the serie. Neck dissection was indicated in the clinics lymph nodes. Conclusions: the surgical extension depends of the tumoral size, the presence of cervical metastasis, the infiltration of adjacent structures and frozen sections. The thyroidectomy total with or without lymphadenectomy were the procedures more frequent, other intervention of salvage and palliative intention represents surgical options. The sanitary crisis determinates some problems in the therapeutic process

Aplasia medular congénita de serie roja: Anemia de Diamond Blackfan. A propósito de un caso

Pure red cell aplasia medullary is a disorder characterized by anemia with almost complete absence of red cell precursors in the bone marrow, with leukocyte count and platelets. The Diamond-Blackfan anemia is a failure syndrome characterized by bone marrow anemia, reticulocytopenia and decreased erythroid precursors in the bone marrow. the case of an infant under 2 months of age presented no family or perinatal history major, whose mother progressive skin pallor evidence mucosa associated with hyporexia; go to health center where they perform paraclinical reporting hemoglobin 1.7 g / dL. peripheral blood smear where erythroid frankly affected with normal megakaryocytic granulocytic count shown is made; It biopsied and bone marrow aspirate concluding marrow red cell aplasia; possible anemia Diamond-Blackfan in light of other clinical findings arises. It stays with glucocorticoid treatment, however insufficient response, begins erythropoietin dose progressively increasing, despite it, warrants blood transfusions on a regular basis; compatibility studies performed with first-degree resulting positive, currently a candidate for allogeneic bone marrow transplantation. It is concluded that despite being a rare syndrome should be suspected in severe anemia where there is acute blood loss, ruling out other etiologies; also timely initiation of treatment is critical to the survival of these patients.

Índice de masa corporal, peso ideal y porcentaje de grasa corporal en personas de diferentes grupos etarios

The objective is to compare BMI with the percentage of body fat and ideal weight, to supplement BMI in the diagnosis of obesity, from a group of adults. METHODS: descriptive, cross-cutting, prospective and correlational study, in a sample of 797 adults between 17 and 96 years old, attended in different clinical centers of Caracas, between 2015 and 2018. The variables are: age, weight, size and BMI was calculated, percentage of body fat (BFP) and ideal weight (IW). They were classified by sex, age group and BMI in normality and obesity. Two formulas were used for BFP: Deurenberg and Regression; and three formulas for IW: Lorenz, Ramirez-Lopez et al and Broca. Descriptive measures, association, correlation, average comparison and normality test were obtained, using Excel software, Epidat.2. RESULT: BMI and BFP averages increase to 40 years and decrease to age 79, the variables Size – IW Broca, and BMI- BFPR correlate well (r>0.75). The average BMI, BFPD, BFPR, IW Broca and IW Lorenz, depending on gender, are significant (p<0.000); for BMI, in Normality and Obesity, the weight averages, BMI, BFPD and BFPR are higher in the Obesity group, and significant (p<0,000). The Shapiro-France normality test found that the distribution of BMI, BFPD, BFPR and IW Lorenz, comes from a normally distributed population (p< 0.000). CONCLUSIONS: BMI even though it is most commonly used to diagnose obesity, it classifies normally, those with a high percentage of body fat.

Dos fórmulas para calcular el IMC, y su relación con otros indicadores antropométricos en adultos

Descriptive, prospective, transversal and correlational study, whose objective is to relate two formulas for calculating BMI, with other indicators, in a group of adults. METHODS: The sample is of 137 adult patients who attended consultation at the University Hospital of Caracas. The variables are: age, weight, size, BMI-Q, BMI-O, WC, WSI, WCWP and BFP. Averages, deviations, percentages and z-tests and Mann Whitney were obtained to compare averages and Median. RESULTS: Similar BMI-Q averages in both sexes, and older BMI-O in female sex. The two formulas for calculating BMI result in the highest percentage with BMI-O, higher overweight percentage with BMI-Q and significant (p<0.000) and percentages of Healthy Weight and Obesity equal. Equal averages, per group, of BFP for the two BMI formulas, and increase from Healthy Weight to Obesity. The Coefficient of Variation reveals more homogeneity in BMI-O (18.41% vs 25.21%). BMI-Q correlates with weight (0.91), WC (0.92) and WSI (0.93); IMC-O with weight (0.97), WC (0.83) and WCWI (0.90). Whitney's test reveals that averages by sex are significant (p<0,000), as are IPCC averages per sex (p<0.000). In addition, the BMI Oxford, WC, WSI and WCWI indicators have sensitivity of 92,3%, 92.3% and 92.3%, respectively. CONCLUSION: The BMI Oxford for its somewhat complicated calculation formula is not recommended to evaluate overweight and obesity, in adults.

Presentación atípica de celulitis orbitaria en recién nacido

Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended. Key word: Celullitis, orbital abcess, new born

Análisis de la curva ROC en la evaluación de indicadores antropométricos

Evaluation of the Waist Weight-Circumference Index (WWCI) using Logistic Regression. Descriptive, prospective and cross-sectional study shows 1095 adults and older adults, aged between 20 and 96 years. Methods: variables: age, weight, size, Waist Circumference (WC), BMI, Waist-Size Index (WSI). Results: Similar BMI in both sexes; higher WC and WSI averages in a ≥ age of 65; major WWCI in group 20-59 years; WWCI risk rate (54.1%) higher in WC (44.7%) WSI (78.2%). WWSI significantly associated with BMI, WC and WSI (p<0.000); positive predictive value 0.92 and negative predictive value 0.70, indicate discriminatory capacity; Relative Risk, 1.92; Wald test statistic indicates statistical significance for the coefficients of risk probability equations; area under the ROC curve is 0.803 and 0.903 (P<0.000), high sensitivity and specificity. Conclusion: WWCI can be considered to evaluate overweight and obesity in adults, given its high discriminatory capacity.

Virus de papiloma humano y lesión intraepitelial cervical en adolescentes embarazadas

Aim: To compare the presence of Human Papilloma Virus (HPV) and Squamous Intraepithelial Lesion (SIL) in pregnant and non-pregnant adolescents treated at the “Maternidad Dr. Armando Castillo Plaza” in Maracaibo, Venezuela. Patients and Methods: A comparative research with non-experimental transectional and field design was performed; where 46 pregnant adolescents (cases) and 46 non-pregnant adolescents (controls) was included, chosen by random probability sampling, who underwent identification of factors associated with the pathology, evaluation by pap-smear and HPV genotyping by chain reaction of polymerase (PCR). Results: It was found that 32.6% of pregnant women had low grade SIL ( HPV or CIN 1) compared to 21.7% in non-pregnant women, with a risk twice higher (OR [95% CI] = 2.44 [1.05 -5.65]). The molecular diagnosis was positive in half of the total sample, being higher in pregnant women (52.1 vs. 47.9p <0.05); infections with high-risk genotypes predominated 47.8 vs 30.5; p <0.05). HPV 16 was the most prevalent among pregnant women (21.7%) and co-infection by low-risk genotypes (6-11) in non-pregnant women (17.4%). Conclusions: adolescent pregnant women have a higher prevalence of LIE and genital HPV infection, associated with a significant risk of twice the probability of presenting an LIE compared to non-pregnant adolescents.

Correlación clínico patológica de los ganglios cervicales en pacientes con cáncer de cabeza y cuello

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who underwent classical radical, modified radical and selective neck dissection. Results: average age 56 years, 77.8% male. The most frequent histological type was squamous carcinoma 81.5%. The most used type of dissection was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: The relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statistically significant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity and specificity.

Perfil nutricional de adultos mayores que asisten a un club de abuelos

Introducción: En este estudio se determinó el perfil nutricional de un grupo de adultos mayores. Métodos: investigación de campo, tipo prospectiva, de corte transversal con enfoque descriptivo. Se evaluó la población de cuarenta (40) adultos mayores que asisten regularmente a las actividades del Club de Abuelos “Juventud Acumulada”, Charallave, Estado Miranda, aplicándose un cuestionario estructurado en preguntas abiertas y cerradas para recolectar la información y se tomaron mediciones antropométricas (peso y estatura, áreas grasa y magra). Resultados: edad promedio 68,5±7,6 años, mayor en mujeres; peso y talla 58,7±9,8 kg y 1,63±0,1c m, mayor en hombres; IMC promedio 22,2±3,7 kg/m2, similar en los dos sexos; 20,0% con Déficit, 55,0% Normopeso, 25,05 % Sobrepeso; 42,5% tienen HTA; 10,0%, Diabetes Mellitus 2 o Dislipidemia. Desayuno: 75,0% arepa; 60,0% pan; 50,0% embutidos; 40,0% café con leche; Almuerzo: 72,5% arroz; 55,0% leguminosas; 47,5% pasta; 47,5% tubérculos; 35,0% pescado; Cena: 82,5% arepa; 62,5% pan; 52,5% pasta; 50,0% huevos y tortillas. Adecuación 79,2% en hombres y 98,5% en mujeres; 7,5% fuma y 50,0% consume bebidas alcohólicas; 35,0% practica alguna actividad física Conclusiones: relación talla-peso dentro del rango sugerido en ambos sexos; promedio de área grasa y área muscular adecuado; 20,0% de hombres y 31,2% de mujeres con sobrepeso; las mujeres con mayor riesgo debido a enfermedades crónicas e ingesta calórica por debajo del requerimiento; patrón de consumo evidencia bajo consumo de leche, vegetales y frutas. Se hace necesario la implementación de un programa de intervención nutricional.

Esteroides y COVID-19: una revisión de la evidencia en crecimiento durante la pandemia

El mecanismo específico por el cual los esteroides actuarían sobre la inflamación pulmonar sostenida, así como la definición del mejor fármaco a utilizar e incluso la duración adecuada del tratamiento, siguen siendo objetivo de estudio de los ensayos clínicos en curso. Como médicos clínicos, creemos que las potentes propiedades antiinflamatorias de los esteroides sintéticos están bien definidas, y aún falta evidencia definitiva de que otras estrategias antiinflamatorias proporcionen una mejor eficacia, al menos en el COVID-19. Aunque los esteroides sintéticos comparten una marcada acción antiinflamatoria y escasos efectos mineralocorticoides, su bioequivalencia y diferentes cinéticas deben considerarse cuidadosamente, debido a la elevada variabilidad de la farmacocinética individual, uso y prescripción adecuada de estos fármacos, ya que pueden desencadenar efectos adversos diversos que podrían impactar negativamente el curso clínico del paciente con COVID-19. Además, muchos de los fármacos actualmente considerados en el manejo del paciente con esta patología pueden potenciar la vida media y la aparición de efectos adversos de los corticoesteroides, o algunos efectos adversos de estos otros fármacos pueden simular complicaciones asociadas al uso de corticoesteroides, lo que podría conllevar a una suspensión precoz e inoportuna de los mismos. Números estudios clínicos y artículos basados en revisiones narrativas han servido de guías para los médicos clínicos en medio de esta pandemia, sin embargo, sus resultados deben interpretarse con cautela. Por estas razones, hemos realizado un análisis con base en el sistema GRADE de estos estudios para contrastar la información incluida en los estudios clínicos y minimizar el error de análisis.