Tiempo óptimo para medición de paratohormona como predictor de hipocalcemia en pacientes posterior a tiroidectomía total / Optimal time for measurement of parathormone as a predictor of hypocalcemia in patients after total thyroidectomy

Introducción. La hipocalcemia posterior a tiroidectomía total es una complicación frecuente en la cirugía de tiroides. La hormona paratiroidea ha demostrado ser un predictor confiable para detectar los pacientes con alto riesgo de hipocalcemia significativa y la consecuente necesidad de administrar suplemento de calcio. El objetivo de este estudio fue determinar el tiempo óptimo de medición de la paratohormona para dicho fin. Métodos. Estudio prospectivo realizado en dos instituciones de nivel III en Popayán, Colombia, entre abril de 2016 y febrero de 2018, en el cual se midieron niveles de paratohormona prequirúrgico, a las 0, 2, 4 y 12 horas del postoperatorio, y se compararon con los valores obtenidos a los 3 meses de seguimiento en pacientes sometidos a tiroidectomía total. Se consideró como grupos de riesgo y con necesidad de suplemento de calcio un valor de paratohormona menor de 10 pg/ml o una disminución mayor del 80 % con respecto al valor prequirúrgico. Resultados. Se incluyeron 34 pacientes intervenidos. Tomando como umbral un valor menor de 10 pg/ml, la medición de paratohormona a las 4 horas fue sensible y específica (60 y 93,1 % respectivamente). Para una disminución mayor del 80 % con respecto al valor prequirúrgico, la sensibilidad fue del 60 % y la especificidad del 96,5 %, presentando un valor predictivo positivo de 75 % y negativo del 93,3 %, con una p < 0,001. Discusión. Una disminución mayor del 80 % del valor de paratohormona prequirúrgico medida a las 4 horas después de la tiroidectomía total permite identificar aquellos pacientes con alto riesgo de hipocalcemia significativa, que requieren administración temprana de suplementos de calcio, comparado con la determinación de la disminución a las 0, 2 y 12 horas postoperatorias

Introduction.Hypocalcemia after total thyroidectomy is a common complication in thyroid surgery.Parathyroid hormone has been shown to be a reliable predictor for detectingpatients with at high risk ofsignificant hypocalcemia and the consequent need for calcium supplementation. The objective of this study was to determine the optimal time for measuring parathormone for this purpose.Methods.Prospective study carried out in two level 3 institutions in Popayán, Colombia, between April 2016 and February 2018, in which levels of preoperative parathormone were measured at 0, 2, 4 and 12 hours postoperatively, and compared with the values obtained at 3 months of follow-up in patients undergoing total thyroidectomy. A parathormone value less than 10 pg/ml or a decrease greater than 80% with respect to the pre-surgical value was considered as risk groups and in need of calcium supplementation.Results. Thirty-four operated patients were included. Taking as a threshold a value of less than 10 pg/ml, the measurement of parathormone at 4 hours was sensitive and specific (60% and 93.1%, respectively). For a decrease greater than 80% with respect to the presurgical value, the sensitivity was 60% and the specificity was 96.5%, presenting a positive predictive value of 75% and a negative predictive value of 93.3% (p <0.001).Discussion.A decrease of more than 80% in the preoperative parathyroid hormone value measured at 4 hours after total thyroidectomy allows the identification of those patients at high risk of significant hypocalcaemia, who require early administration of calcium supplements, compared with the determination of the decrease at 0, 2 and 12 hours postoperatively

Effect of formulation and baking conditions on the structure and development of non-enzymatic browning in biscuit models using images.

The aim of this research was to determine the effect of composition (dietary fiber = DF, fat = F, and gluten = G) and baking time on the target microstructural parameters that were observed using images of potato and wheat starch biscuits. Microstructures were studied Scanning Electron Microscope (SEM). Non-enzymatic browning (NEB) was assessed using color image analysis. Texture and moisture analysis was performed to have a better understanding of the baking process. Analysis of images revealed that the starch granules retained their native form at the end of baking, suggesting their in complete gelatinization. Granules size was similar at several different baking times, with an average equivalent diameter of 9 and 27 µm for wheat and potato starch, respectively. However, samples with different levels of DF and G increased circularity during baking to more than 30%, and also increasing hardness. NEB developed during baking, with the maximum increase observed between 13 and 19 min. This was reflected in decreased luminosity (L*) values due to a decrease in moisture levels. After 19 min, luminosity did not vary significantly. The ingredients that are used, as well as their quantities, can affect sample L* values. Therefore, choosing the correct ingredients and quantities can lead to different microstructures in the biscuits, with varying amounts of NEB products.