Relación entre hipotiroidismo y cáncer de tiroides en el Hospital Pablo Arturo Suárez de la ciudad de Quito de enero 2014 a diciembre 2017 / Relationship between hypothyroidism and thyroid cancer at Hospital Pablo Arturo Suárez of Quito from January 2014 to December 2017

Introducción: el Ecuador es un lugar endémico de patología de la glándula tiroides, el cáncer tiroideo se encuentra dentro de las cinco neoplasias tanto en hombres como mujeres y el hipotiroidismo presenta una mayor incidencia comparada con otros países con mayor población en Sudamérica como Brasil y Perú. Objetivo: describir la relación entre hipotiroidismo y carcinoma de tiroides en el Hospital Pablo Arturo Suárez en los años 2014 a 2017. Métodos: se realizó un estudio transversal. Los datos se obtuvieron de las historias clínicas registradas en estadística. Resultados: se registraron 105 casos de cáncer de tiroides: 15 varones (14.3%) y 90 mujeres (85.7%). En los paraclínicos prevaleció el hipotiroidismo subclínico con promedio de TSH (tirotropina): de 5.5 uUl/mL y FT4 (tetrayodotironina libre) de 0.9 ng/dL, un 62% de los pacientes con cáncer de tiroides presentó alteración de la TSH: (50.5%) con hipotiroidismo subclínico y un (11.4%) con hipotiroidismo manifiesto. Conclusión: la neoplasia de tiroides se asoció en mayor porcentaje con hipotiroidismo subclínico.

Introducction: Ecuador is an endemic place of thyroid pathology, thyroid cancer is within the five neoplasms in men and women and hypothyroidism has a higher incidence compared to other countries with greater population in South America like Brazil and Peru. Objective: to describe the relationship between hypothyroidism and thyroid carcinoma at the Hospital Pablo Arturo Suárez in the years 2014 to 2017. Methods: a cross-sectional study was conducted in Quito-Pichincha-Ecuador. Data were obtained from clinical records registered in statistics. Results: 105 cases of thyroid cancer were reported: 15 men (14.3%) and 90 women (85.7%). In the paraclinics, subclinical hypothyroidism with an average of TSH prevailed: 5.5 uUl / mL and FT4 of 0.9 ng / dL. 62% of patients with thyroid cancer had TSH alteration: (50.5 %) with subclinical hypothyroidism and (11.4%) with symptomatic hypothyroidism. Conclusion: thyroid neoplasia was associated with subclinical hypothyroidism.

Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills.

CONTEXT: Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills. OBJECTIVES: The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists. METHODS: Twenty hospitalists were randomized to control vs. a CSD SBML intervention. Hospitalists conducted a baseline standardized patient encounter (pretest) that was scored using a 19-item CSD checklist and controls completed a repeat standardized patient encounter six months later (post-test). Intervention group hospitalists received at least one two-hour training session featuring deliberate practice and feedback and were expected to meet a minimum passing score (MPS) on the post-test of 84% set by an expert panel. RESULTS: Only two of the 20 hospitalists met the MPS at pretest. Seventy percentage of intervention hospitalists achieved the MPS after a single training session. Post-test median checklist scores were higher for intervention hospitalists compared with controls (16.5 vs. 12.0, P = 0.0001). Intervention hospitalists were significantly more likely to ask about previous experiences with end-of-life decision making (70% vs. 20%, P = 0.03), explore values/goals (100% vs. 50%, P = 0.01), ask permission to make a recommendation regarding code status (60% vs. 0%, P = 0.003), and align recommendations with patient values/goals (90% vs. 40%, P = 0.02) than controls. CONCLUSION: Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.

RTP801 regulates maneb- and mancozeb-induced cytotoxicity via NF-κB.

Environmental factors have been implicated in the pathogenesis of neurodegenerative diseases. Maneb (MB) and mancozeb (MZ) have been extensively used as pesticides. Exposure to MB lowers the threshold for dopaminergic damage triggered by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. MB and MZ potentiate 1-methyl-4-phenylpyridium (MPP(+))-induced cytotoxicity in rat pheochromocytoma (PC12) cells partially via nuclear factor kappa B (NF-κB) activation. RTP801 dramatically increased by oxidative stresses and DNA damage is the possible mechanism of neurotoxins-induced cell death in many studies. This study demonstrated that MB and MZ induced DNA damage as seen in comet assay. The expressions of RTP801 protein and mRNA were elevated after MB and MZ exposures. By knocking down RTP801 using shRNA, we demonstrated that NF-κB activation by MB and MZ was regulated by RTP801 and cell death triggered by MB and MZ was associated with RTP801 elevation. This revealed that the toxic mechanisms of dithiocarbamates are via the cross talk between RTP801 and NF-κB.

Increased complication rates of cardiac rhythm management devices in ESRD patients.

BACKGROUND: Patients with end-stage renal disease (ESRD) have a high incidence of sudden cardiac death and may benefit from implantable cardioverter defibrillators (ICDs). However, ESRD also may predispose patients to device-related complications, potentially offsetting some of the benefits of prophylactic ICD placement. The purpose of this study is to compare the incidence of complications after cardiac rhythm management device (CRMD) implantation in patients with and without ESRD. METHODS: An observational study was performed on 41 patients with ESRD and 123 controls without ESRD who had a CRMD (permanent pacemaker or ICD) implanted at a single institution from 1998 to 2005. Controls were matched for age, sex, type of device, and calendar year of device implantation. Primary and secondary end points were any complication and complications requiring intervention, respectively. RESULTS: 23 complications occurred in 16 of 41 patients with ESRD (39%) versus 13 complications in 13 of 123 matched controls (11%; P < 0.001). Major complications occurred in 29% of patients with ESRD versus 5% of controls (P < 0.001), whereas minor complications occurred in 17% and 6%, respectively (P < 0.03). Hematoma, thrombosis, and device-related complications, including elevated defibrillation thresholds, were more common in patients with ESRD (P < 0.05 for all), and there also was a nonsignificant trend toward greater infection risk (P = 0.1). There were no fatal complications in either group. CONCLUSIONS: Patients with ESRD had greater complication rates after CRMD implantation compared with matched controls, but these complications did not result in death. These results should be considered when evaluating patients with ESRD for prophylactic CRMD implantation, but do not support withholding such therapy.