Neoplasia folicular tiroidea no invasiva con características nucleares de tipo papilar (Noninvasive follicular thyroid neoplasm with papillary-like nuclear features o NIFTP): en qué estamos hoy, a propósito de un caso / Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): we are we today, about a case

Es bien conocido que ha existido en las últimas décadas un incremento en los casos de cáncer diferenciado de tiroides, especialmente los microcarcinomas. Diversos factores han contribuido a pesquisar pequeños cánceres como el aumento de la disponibilidad de exámenes imagenológicos. Estos pequeños cánceres tiroideos pueden tener un comportamiento no agresivo y no producir letalidad; esto es lo que se conoce como sobrediagnóstico. Esto último tiene implicancias tanto médicas como económicas por terapias agresivas. Así, desde el año 2015, un grupo de expertos cambia la nomenclatura en anatomía patológica del carcinoma papilar tiroideo variante folicular encapsulado (NIEFVPTC de sus siglas en inglés) por Neoplasia folicular tiroidea no invasiva con características nucleares de tipo papilar (NIFTP de sus siglas en inglés). Este cambio se basó en un estudio de Nikiforov donde los NIEFVPTC no tenían efectos adversos ni mortalidad en su seguimiento. Así, la intención inicial del cambio de nomenclatura es eliminar la palabra cáncer y evitar los sobretratamientos innecesarios. Presentamos un caso clínico de una paciente que se sometió a cirugía por un nódulo tiroideo clasificado Bethesda III donde la biopsia definitiva posterior a cirugía evidenció que se trataba de un NIFTP. A raíz de este caso analizamos la literatura hasta la fecha de esta nueva entidad y hacemos un repaso histórico de los carcinomas papilares tiroideos variante folicular. Además, desarrollamos nuevas interrogantes que se plantean desde este nuevo diagnóstico anatomopatológico, de cómo sospecharlo previo a una cirugía, cuál es la cirugía de elección, y cómo debiera ser el seguimiento una vez diagnosticado.

It is well known that there has been an increase in cases of differentiated thyroid cancer in recent decades, especially microcarcinomas. Several factors have contributed to diagnose small cancers such as the increased availability of imaging tests. These small thyroid cancers can have a non-aggressive behavior and not cause lethality, this is what is known as overdiagnosis. The latter has medical as well as economic implications for aggressive therapies. Thus, since 2015, a group of experts has changed the nomenclature in pathological anatomy of encapsulated variant papillary thyroid carcinoma (NIEFVPTC) for non-invasive thyroid follicular neoplasia with papillary nuclear characteristics (NIFTP). This change was based on a Nikiforov study where the NIEFVPTC had no adverse effects or mortality in their follow-up; thus, the initial intention of the nomenclature change is to eliminate the word cancer and avoid unnecessary over-treatments. We present a clinical case of a patient who underwent surgery for a thyroid nodule classified Bethesda III where the definitive biopsy after surgery showed that it was a NIFTP. Following this case, we analyze the literature to date of this new entity and make a historical review of the follicular variant papillary thyroid carcinomas. In addition, we develop new questions that arise from this new pathological diagnosis, how to suspect it prior to surgery, what is the surgery of choice, and what should the follow-up once diagnosed.

Diabetes mellitus y covid-19: epidemiología, fisiopatología, manejo ambulatorio e intrahospitalario: revisión / Diabetes mellitus and covid-19: epidemiology, pathophysiology, outpatient and inpatient management: review

La diabetes mellitus ha sido asociado a una mayor probabilidad de enfermedad más grave por Covid-19. Los estudios epidemiológicos evidencian que los pacientes diabéticos tienen un riesgo mayor de un cuadro grave que requiera UCI, ventilación mecánica y probabilidad de morir. Un buen control metabólico parece fundamental para disminuir este riesgo. En el caso del manejo ambulatorio es importante asegurar la continuidad de los tratamientos crónicos, medir los niveles de glicemia capilar y minimizar la posibilidad de infección. En caso de infección por SARS-Cov2 el paciente diabético deberá hacer los ajustes necesarios en su tratamiento tanto para lograr un control glicémico adecuado como para disminuir los riesgos de algunos fármacos antidiabéticos. El uso de telemedicina constituye una excelente herramienta para facilitar el logro de los objetivos terapéuticos. En caso de requerir hospitalización, se ha evidenciado que los pacientes diabéticos tienen altos requerimientos de insulina y rápida tendencia a producir cetosis. Considerando la situación actual de pandemia las metas intrahospitalarias pueden ser más laxas y seguras, en especial en pacientes no críticos. En caso de pacientes críticos idealmente se debe mantener las metas glicémicas entre 140-180 mg/dL.

Diabetes mellitus has been associated with a higher probability of severe disease due to Covid-19. Epidemiological studies show that diabetic patients have an increased risk of a serious condition requiring ICU, mechanical ventilation and of course the probability of dying. Good metabolic control seems essential to reduce this risk. In the case of outpatient management, it is very important to ensure the continuity of chronic treatments, measure capillary blood glucose levels and minimize the possibility of infection. In case of SARS-Cov2 infection, the diabetic patient should make the necessary adjustments in their treatment, both to achieve adequate glycemic control and to reduce the risks of some antidiabetic drugs. Telemedicine is an excellent tool to facilitate the achievement to therapeutic goals. In case of requiring hospitalization, it has been shown that diabetic patients have high insulin requirements and rapid tendency to produce ketosis. Considering the current situation of a pandemic, intrahospital goals may be laxer and safer, especially in non-critically ill patients. In the case of critically ill patients, the glycemic goals should ideally be maintained between 140-180 mg/dL.

Hiponatremia grave en paciente con anorexia nerviosa: caso clínico y revisión de la literatura / Severe hyponatremia in a patient with anorexia nervosa: case report and review of literature

Electrolyte disorders are a not infrequent alteration in patients with anorexia nervosa. Itsmechanisms are multifactorial, depending on the electrolytic alteration. Hyponatremia is described in 7% of patients and generally does not reach serious values. We present the case of a female patient with difficult-to-manage anorexia nervosa who was hospitalized for hyponatremia with values not described in the literature, with a good final outcome. Literature and the main physiopathological mechanisms are reviewed.

Infundibuloneurohipofisitis: caso clínico y revisión de la literatura / Infundibuloneurohypophysitis: clinical report and literature review

Infundibuloneurohypophysitis is a rare condition, which is part of the group of hypophysitis, of relatively recent description (1993). The main clinical manifestation is diabetes insipidus, whose natural evolution is towards chronicity. The differential diagnosis with other thickening of the hypophysial stem is very important, where the clinic, imaging, laboratory and eventually biopsy are a main support for a correct diagnosis. We present a clinical case that shows the usual picture of infundibuloneurohypophysitis, and illustrates the imaging evolution in a female patient, with diabetes insipidus as the main clinical manifestation

Caracterización de los pacientes diabéticos y prediabéticos portadores de VIH en hospital terciario de Concepción / Characterization of diabetic and prediabetic patients carriying of HIV in a tertiary hospital in Concepcion

The increased survival of patients with Human Immunodeficiency Virus (HIV), due in great part to antiretroviral therapy, has led to the disease becoming a chronic condition. The result of this new picture, is the development of several chronic metabolic diseases, including diabetes mellitus. The aim of this retrospective study is to evaluate the prevalence of diabetes mellitus and prediabetes in HIV people that is controlled in a tertiary Chilean hospital and other epidemiological aspects of this condition. The results show a prevalence of 2.95 percent of diabetes and 13.0 percent of prediabetes in HIV patients, similar results to the international literature. The vast majority of these patients acquire diabetes or prediabetes after the HIV debut. It is important to know our local prevalence of metabolic comorbidities in these patients, in this case diabetes and prediabetes, to improve our research and adequate treatment in this population.

Diabetes mellitus secundario a episodio único de pancreatitis aguda: caso clínico y revisión de la literatura / Diabetes mellitus after a single episode of acute pancreatitis: report of one case

Diabetes mellitus secondary to pancreatic diseases is classified as type 3C and it can appear after a single episode of acute pancreatitis. We report a 25 years old female with a family history of diabetes. She was admitted to the hospital due to an acute pancreatitis of biliary origin. She received parenteral nutrition and required up to 82 units of insulin per day to maintain blood glucose levels. A CT scan showed a pseudocyst. A percutaneous drainage, followed by necrotic tissue debridement were performed. She was discharged two months after admission requiring insulin to maintain metabolic control.

Carcinoma tiroideo papilar oncocítico variante Warthin-like tumor: caso clínico y revisión de la literatura / Oncocytic variant of papillary thyroid carcinoma with lymphocytic stroma (Warthin-like variant): report of one case

Recently, an oncocytic variant of papillary thyroid carcinoma with lymphocytic stroma, called Warthin like tumor, has been described. Its evolution is similar to the usual papillary carcinoma. We report a 61 years old female with a multinodular goiter and a predominant nodule in the right lobe. A fine needle aspiration biopsy was compatible with a papillary thyroid carcinoma. A total thyroidectomy was performed and the pathological examination revealed a Warthin tumor of 2.2 cm. The patient was treated posteriorly with radioiodine and after six months of follow up, there is no evidence of disease...

Hiperandrogenismo avanzado en una mujer postmenopáusica: Caso clínico / Virilization caused by an ovarian tumor: Report of one case

We report a 76-year-old woman with a virilization syndrome characterized by progressive androgenic alopecia, clitoris enlargement and hirsutism predominating in the face. Plasma testosterone was 711 ng/dl. Magnetic resonance imaging showed slightly enlarged ovaries with a cyst in the left. A bilateral oophorectomy was performed, demonstrating the presence of a Leydig cell hilar tumor in the right ovary. The patient had a good postoperative evolution with reduction of androgen levels and reversion of alopecia.

Caracterización del compromiso óseo previo al trasplante hepático / Bone mineral density of patients with cirrhosis prior to liver transplantation

Osteoporosis is a common complication after liver transplantation. Aim: To assess bone mineral density of patients prior to liver transplantation. Material and Methods: Retrospective review of medical records of patients with liver cirrhosis, subjected to liver transplantation that had a measurement of bone mineral density prior to the operation. Results: Twenty nine of 112 transplanted patients complied with the inclusion criteria. Their mean age was 55 +/- 11 years, their body mass index was 26.9 +/- 3.2 k/m2, 73 percent were males and the period of clinical evolution prior to transplantation lasted 3.7 +/-2.9 years. Twenty four percent had an alcoholic liver disease, 21 percent C hepatitis and 14 percent non-alcoholic steatohepatitis. The main risk factors for osteoporosis were medication intake in 79 percent, alcohol in 52 percent, smoking in 41 percent and concomitant diseases in 31 percent. Bone mineral density was normal in 31 percent and showed osteopenia and osteoporosis in 48 and 21 percent of patients, respectively. Patients with a normal mineral density were younger than the rest of patients (46.9 +/- 13.4 and 58.5 +/- 7.4 years respectively p < 0.01). Conclusions: Patients subjected to liver transplantation had a high frequency of osteoporosis or osteopenia prior to the surgical procedure.

Psicosis e hipotiroidismo o Mixedema madness: un caso demostrativo / Mixedema madness: report of one case

Cognitive impairment among patients with hypothyroidism is a well known condition, but its pathophysiology is not fully understood. Thyroid hormones may influence several processes in the brain, including cerebral perfusion, cerebral metabolism and neurotransmitter activity and could partially explain the neuropsychiatric manifestations of hypothyroidism. Acute psychosis is rare as a manifestation of hypothyroidism, but is potentially reversible. We report a 37 years old female without a previous history of psychiatric illness, presenting with an acute psychosis that required hospital admission. Her serum TSH was 122.2 uUI/mL (normal 0.3-4.2 uUI/mL), her total T4 was 1.1 ug/dL (normal 4.6-12 ug/dL), her free T4 was 0.1 ng/dL (VN 0.9-1.7 ng/dL), her total T3 was 30.5 ng/dlL (normal 84-201 ng/dL), and her antiTPO antibodies were 5464 UI/mL (normal < 12 UI/mL). Thyroid substitution was started with an important remission of psychotic symptoms. One month later, anti-psychotic medication was discontinued.

Observations of Teachers in llorin; Nigeria on their Practices of Corporal Punishment that are Potentially Injurious to their Pupils' Eyes

Objective: To document the observations of elementary school teachers (ESTs) in Ilorin; Nigeria on their practice of some types of corporal punishment (CP) that could result in eye injuries among their pupils. Materials and Methods: A short battery of questions that explored ESTs' observations on attitudes to; and knowledge of some commonly used CP practices was self-administered on 172 consenting teachers from six sampled schools. The potentials for their pupils to sustain eye injuries while receiving such CP practices were inferred from the usage of items with sharp and protruding ends to administer CP; and the application of CP onto pupils' body parts that are in close proximity to the eye such as the head and face. Results: Only 50 of the 172 ESTs favored the practice of CP of pupils by their teachers. Analyses of several potentially moderating variables on this response such as ESTs' ages; years of EST teaching experience; school; and class or grade that EST teaches did not prove significant. Over three-quarters of ESTs (80.2) had ever observed that pupils were being disciplined by ESTs with a cane. About a fifth of them had also bserved that ESTs applied CP to the head (19.8) and the face (16.3) of pupils. Conclusion: Findings suggest that ESTs' commonly employed CP practices have significant injurious potential to their pupils' eyes. It is recommended that CP be abolished in elementary schools; and instead alternative nonabusive methods of disciplining erring pupils by teachers be introduced

Computed tomography scan of rhinosinusitis, current practice, and requirements for endoscopic surgery of paranasal sinuses

To evaluate the current practice in requesting and performing paranasal sinuses CT scan for patients scheduled for endoscopic sinus surgery, and to describe the current hospital's practice in performing these scans. This cross-sectional questionnaire study was conducted in the King Hussein Medical Center, Amman, Jordan between April and May 2010. Three forms were designed to collect data from our study groups, which included: Ear, Nose and Throat [ENT] surgeons, radiologists, and the radiology sections in 3 hospitals. The first was designed for ENT surgeons and aimed at investigating, whether or not they perform endoscopic sinus surgery, and if they have specific requirements for a CT scan of the sinuses. The second was designed for the radiologist to investigate their specifications in performing CT of the sinuses. The last was designed to evaluate the current practice of performing CT of the sinuses at the 3 hospitals. Twenty-four ENT surgeons participated, 83.3% surgeons performed endoscopic sinus surgery, and 83.3% requested specific specifications for the sinuses CT scan, and the most requested specification was coronal plane in 42%. Of the 24 radiologists, 71% prefer the prone position, 71% prefer the coronal plane, and 71% preferred direct coronal. In all 3 hospitals, the axial plane with reconstructed coronal images, the current practice with a slice thickness of 2-3 mm, and the total number of images was 40-50. Differences between ENT surgeons, radiologists, and hospital's practice and other hospitals guidelines found in literature are present. Therefore, we are in need of an agreed upon guideline protocol to obtain the best data with the least radiation dose

Hiperparatiroidismo primario con normocalcemia, una asociación de diagnóstico complejo: a propósito de un caso clínico / Normocalcemic hyperparathyroidism: report of one case

We report a 59 years old female with a history of nephrolithiasis and progressive worsening of her bone mineral density. High serum PTH levels were detected, with normal serum calcium. Causes of secondary hyperparathyroidism were discarded. The patient was followed during six years, period in which she maintained elevated serum PTH and normal serum calcium. During the second year of follow up, hydrochlorothiazide was indicated. Serum calcium raised progressively and after six years, it became abnormally high. The patient was subjected to a total left lobe and subtotal right lobe thyroidectomy. The surgeon found a 1.6 mm diameter left parathyroid nodule. After surgery the patient is asymptomatic and is receiving levothyroxine supplementation.

Enfermedad de von Hippel Lindau en una familia chilena: diagnóstico clínico y genético / Von Hippel Lindau disease: report of an affected family

Von Hippel Lindau disease is a hereditary syndrome characterized by the appearance of benign and malignant tumors in different organs. Its incidence is 1 case per 36000 born alive. We report a family with the disease. The index case was a male with a bilateral pheochromocytoma and cerebelar and retinal hemagioblastomas that had a sudden death due to a cerebrovascular accident at the age of 52 years. One sibling had central nervous system and retinal hemangioblastomas and other was operated for an unilateral pheochromocytoma. Both siblings had the R167Q VHL mutation of the syndrome. Other family members did not have the mutation.

Solitary extramedullary plasmacytoma of the tonsil

We report a rare case of extramedullary plasmacytoma of the left tonsil in a 45 year old male patient. He presented with a two months history of left sided throat discomfort, clinical examination revealed a left sided diffuse tonsillar enlargement. Histopathologic examination of the tonsillectomy specimen was consistent with plasmacytoma. Serum electrophoresis failed to detect any myeloma component. Assays for Bence Jones protein were negative. All other screening tests to rule out multiple myeloma were negative. These findings confirmed the diagnosis of extramedullary plasmacytoma. The patient received full course of radiotherapy and he is currently without evidence of disease twelve months postoperatively

Hiperparatiroidismo primario en el adolescente: caso clínico / Primary hyperparathyroidism in an adolescent: report of one case

We report a 13 year-old mate with a history of multiple fractures and kidney stones. The laboratory showed a hypercalcemia of 11.5 mg/dl, a PTH of 112.6 pg/ml and 24 hour urinary calcium of 571 mg. Bone densitometry showed spine and fémur Z scores of -2.9 and -1.6, respectively, kidney ultrasound showed nephrocalcinosis and a MIBI-SPECT scintigram showed a higher uptake in the ríght lower parathyroid gland. The diagnosis of primary hyperparathyroidism was made and the patient was operated, excising the ríght lower parathyroid gland. After surgery, serum calcium and PTH levels returned to normal values. In children, the proportion of cases with parathyroid hyperplasia is higher than in adults. Therefore, during surgery all four parathyroid glands must be explored. There is also a higher frequency of ectopic adenomas. Family history must be explored to discard the presence of a multiple endocrine neoplasia (MEN I or II), a familial hyperparathyroidism or a syndrome of primary hyperparathyroidism associated to mandibular tumor.

Evaluation of post-tonsillectomy hemorrhage

The major risk for tonsillectomy is postoperative hemorrhage, which can traditionally be classified as: 1] Primary post-tonsillectomy hemorrhage, 2] secondary hemorrhage. Recent studies have focused on the control of primary hemorrhage in order to determine the appropriate length of postoperative observation. The main aim of this study was to ascertain the number of episodes of post-tonsillectomy hemorrhage that required surgical treatment under general anesthesia and to identify the sufficient follow up period for tonsillectomy patients. The sample of this study comprised 202 patients who undergone inpatient tonsillectomy in Queen Alia Hospital, between July 2003 and July 2004. Patients were discharged two days after the surgery and were followed up for one month. Eleven patients [5.4%] had experienced post- tonsillectomy bleeding that required surgical hemostasis under general anesthesia. Seven patients from this group [63.6%] had experienced primary hemorrhage and were treated immediately, four patients [36.4%] experienced secondary hemorrhage. The results of this study suggest that patients can be safely discharged from hospital at the second post-operative day. Bleeding episodes that occur beyond 10 days are very rare therefore a follow-up period of 10 days appears to provide sufficient time to control all cases of secondary post-tonsillectomy hemorrhage

Post immunization Hib antigen detection in the CSF of a patient with meningococcal meningitis

We report a case of meningococcal meningitis where the cerebrospinal fluid was negative for neisseria meningitidis but positive for haemophilus influenzae type b by rapid antigen detection test. We believe that this was due to prior immunization with haemophilus influenzae type b vaccine. We recommend caution in interpretation of the rapid antigen detection tests especially in patients who had been vaccinated against organisms screened by these tests