Teleconsultation in General Surgery during COVID-19 pandemic, satisfaction survey and feasibility for future.

BACKGROUND: The COVID-19 pandemic has made us to respond to the needs of the community. Telemedicine has gained worldwide acceptance. We describe our experience with teleconsultation in surgical patients during the first wave of the COVID-19 pandemic and evaluate patient satisfaction and the feasibility of maintaining it as a future strategy in selected patients. METHODS: An observational, retrospective, single-site cohort study was carried out by reviewing electronic medical records and conducting a telephone survey. RESULTS: During this time, 1706 teleconsultations have been carried out: 59.5% of patients were rescheduled, 26.1% have been solved and of these 57.3% (255 patients) have been discharged; 12.19% were not contacted. The 73.6% considered that teleconsultation was able to fully or partially resolve the reason for their medical appointment; 61.6% were willing to continue with teleconsultation; 15.2% of the patients needed some kind of help or required a second call to speak with a family member, and 37.2% would prefer a face-to-face visit because of difficulties with the teleconsultation. The overall satisfaction was 8.7 out of 10. CONCLUSIONS: Telemedicine has demonstrated to be a useful tool even for surgical patients during COVID-19 pandemic. A high proportion of patients can be managed by telephone call. Patients reported a high degree of satisfaction. Teleconsultation is a feasible strategy not also during the current COVID-19 pandemic but also for future.

What happens to the bone structure after normocalcemic primary hyperparathyroidism surgery?

BACKGROUND: Bone disease in primary hyperparathyroidism is a clear indication for surgical treatment. However, it is not known whether surgery benefits hypercalcemic primary hyperparathyroidism and normocalcemic primary hyperparathyroidism equally. The aim of our study was to evaluate the bone changes in patients undergoing parathyroidectomy based on the biochemical profile 1 and 2 years after surgery. METHODS: This prospective study included 87 consecutive patients diagnosed with primary hyperparathyroidism who underwent surgery between 2016 and 2018. Bone densitometry (1/3 distal radius, lumbar, and femur) and bone remodeling markers (osteocalcin, type 1 procollagen [P1NP], ß-cross-linked telopeptide of type I collagen [BCTX]) were performed preoperatively and postoperatively. Postoperative changes in bone mineral density and bone markers were compared and evaluated according to the clinical characteristics and the individual biochemical profile. RESULTS: One year after surgery, all patients showed an increase in bone mineral density at the lumbar site (mean, 0.029 g/cm2; range, 0.017-0.04; P < .001) and femur neck (mean, 0.025 g/cm2; range, 0.002-0.05; P < .001); however, there were no changes in the distal third of the radius (mean, -0.003 g/cm2; range, -0.008 to 0.002; P = NS). There were no significant differences when comparing normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism. Serum osteocalcin (37 ± 17.41), P1NP (67.53 ± 31.81) and BCTX (0.64 ± 0.37) levels were elevated before surgery. One year after the surgery, we observed a significant decrease in P1NP (33.05 ± 13.16, P = .001), osteocalcin (15.80 ± 6.19, P = .001), and BCTX (0.26 ± 0.32, P < .001) levels. CONCLUSION: Our findings indicate that parathyroidectomy has similar benefits for normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism in terms of bone improvement. Although the most substantial improvement occurred during the first postoperative year in both groups, we consider that studies with longer follow-up are warranted.

Primary thyroid tuberculosis: a case report.

Involvement of the thyroid gland by tuberculosis is very rare and is usually secondary to disseminated infection. Very few cases of primary thyroid tuberculosis have been described even in countries with a high incidence of this disease. We present the case of a Spanish patient operated for a suspicious thyroid nodule that was finally diagnosed as primary thyroid tuberculosis.

La afectación de la glándula tiroidea por tuberculosis es muy rara y generalmente es secundaria a una enfermedad ­diseminada. Se han descrito muy pocos casos de tuberculosis tiroidea primaria incluso en paises con alta incidencia de esta enfermedad. Presentamos el caso de una paciente española operada por un nódulo tiroideo sospechoso que fue finalmente diagnosticado como tuberculosis tiroidea primaria.