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INTRODUCTION: Pediatric thyroid nodules exhibit higher malignancy rates compared to adults and are associated with increased incidences of metastases and recurrences. The American Thyroid Association recommends surgery for indeterminate thyroid biopsies in children based on these higher malignancy risks, though this approach may lead to overtreatment. However, there remains a lack of comprehensive pediatric data to inform clinical decisions. This study examines the risk of malignancy (ROM) in pediatric thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and assesses the diagnostic accuracy of fine-needle aspiration biopsy (FNA) compared to histological outcomes. METHODS: A retrospective cross-sectional analysis was performed on patients under 19 years with thyroid nodules who underwent FNA and thyroidectomy at a tertiary care center. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM of cytological biopsies were evaluated using TBSRTC criteria, with histology serving as the gold standard. Two analyses were conducted to assess diagnostic accuracy: (a) TBSRTC II as negative and TBSRTC VI as positive, and (b) TBSRTC II as negative with TBSRTC V and VI as positive. For neoplasia detection, TBSRTC II was deemed negative, while TBSRTC IV, V, and VI were considered positive. TBSRTC categories III and I were excluded from the performance analysis and evaluated separately. Follicular neoplasm or lesions suspicious for follicular neoplasm (FN/SFN) were treated as positive outcomes, correlated with the presence of adenoma or carcinoma in the surgical specimen. RESULTS: Of 75 nodules from 73 patients, 28 (37.3%) were benign and 47 (62.6%) malignant. No significant differences in gender or age were noted between groups. The ROM in each TBSRTC were Bethesda I 0/2, 0%; II 0/13, 0%; III 2/7, 29%: IV 6/14, 43%; V 10/10, 100%, and VI 29/29, 100%, respectively. A sensitivity of 78.38% and specificity of 100% for FNA in detecting malignancy was found, with an even higher sensitivity (100%) for detecting neoplasia in TBSRTC IV. CONCLUSIONS: This study reveals that indeterminate thyroid nodules in pediatric patients exhibit a higher rate of malignancy compared to adults, yet align with rates previously reported in the pediatric population. These findings highlight the critical need for guidelines tailored specifically to the management of thyroid nodules and thyroid cancer in children.
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PURPOSE: Thyroid lobectomy (TL) is an appropriate treatment for up to 4 cm intrathyroidal differentiated thyroid cancer (DTC). There is scarce data regarding TL outside first-world centers. Our aim is to report a cohort of patients with DTC treated with TL in Chile. METHODS: We included DTC patients treated with TL, followed for at least 6 months, characterized their clinicopathological features and classified their risk of recurrence and response to treatment. RESULTS: Eighty-two patients followed for a median of 2.3 years (0.5-7.0). Seventy-three (89%) patients had papillary, 8 (9.8%) follicular and 1 (1.2%) high-grade DTC. The risk of recurrence was low in 56 (68.3%) and intermediate in 26 (31.7%). Eight (9.8%) patients required early completion thyroidectomy and radioiodine. At last follow-up, 52 (70.3%) had excellent, 19 (25.7%) had indeterminate, and 1 (1.4%) had structural incomplete response. CONCLUSION: In a developing country, TL is an adequate option for appropriately selected DTC patients.
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Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LNgrowth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusion: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.
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Ganglios Linfáticos , Metástasis Linfática , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Espera Vigilante , Humanos , Femenino , Masculino , Adulto , Estudios Retrospectivos , Tiroidectomía/métodos , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Persona de Mediana Edad , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Ganglios Linfáticos/patología , Estudios de Factibilidad , Cuello/cirugía , Carcinoma Papilar/cirugía , Carcinoma Papilar/patología , Disección del Cuello/métodos , Adulto JovenRESUMEN
ABSTRACT Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LN growth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusions: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.
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Molecular testing contributes to improving the diagnosis of indeterminate thyroid nodules (ITNs). ThyroidPrint® is a ten-gene classifier aimed to rule out malignancy in ITN. Post-validation studies are necessary to determine the real-world clinical benefit of ThyroidPrint® in patients with ITN. A single-center, prospective, noninterventional clinical utility study was performed, analyzing the impact of ThyroidPrint® in the physicians' clinical decisions for ITN. Demographics, nodule characteristics, benign call rates (BCRs), and surgical outcomes were measured. Histopathological data were collected from surgical biopsies of resected nodules. Of 1272 fine-needle aspirations, 109 (8.6%) were Bethesda III and 135 (10.6%) were Bethesda IV. Molecular testing was performed in 155 of 244 ITN (63.5%), of which 104 were classified as benign (BCR of 67.1%). After a median follow-up of 15 months, 103 of 104 (99.0%) patients with a benign ThyroidPrint® remained under surveillance and one patient underwent surgery which was a follicular adenoma. Surgery was performed in all 51 patients with a suspicious for malignancy as per ThyroidPrint® result and in 56 patients who did not undergo testing, with a rate of malignancy of 70.6% and 32.1%, respectively. A higher BCR was observed in follicular lesion of undetermined significance (87%) compared to atypia of undetermined significance (58%) (P < 0.05). False-positive cases included four benign follicular nodules and six follicular and four oncocytic adenomas. Our results show that, physicians chose active surveillance instead of diagnostic surgery in all patients with a benign ThyroidPrint® result, reducing the need for diagnostic surgery in 67% of patients with preoperative diagnosis of ITN.
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Neoplasias de la Tiroides , Nódulo Tiroideo , Humanos , Estudios Prospectivos , Perfilación de la Expresión Génica/métodos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/genética , Nódulo Tiroideo/cirugía , Biopsia con Aguja FinaRESUMEN
Applied behavior analysis (ABA) has featured an increasing concern for understanding and considering the cultural diversity of the populations behavior analysts serve in recent years. As an expression of that concern, the new BACB's Ethics Code for Behavior Analysts is more explicit and comprehensive in its inclusion of ethical obligations concerning cultural diversity. The purpose of this paper is to offer a discussion on the limitations of both our capacity and willingness to know and overcome our ignorance about our own and other cultures. We examine different ways in which our ignorance of other cultures plays out even in willful compliance with the BACB ethics code. We suggest part of the problem is that the BACB ethics code seems to operate under the assumption that practitioners are always aware or can be aware of what they do not know and of their biases. In contrast, we offer a reflection on a more complex picture of our understanding of ourselves and other cultures, where we cannot assume people are aware of what they ignore and of their biases. Ethically, we find that in some cases these blindspots are accounted for by the BACB ethics code and should be foreseen and addressed by the behavior analyst (BA). But in other cases, when a person is not aware of what they ignore, understanding the connection between cultural diversity ignorance and professional behavior requires a different approach. Our analysis suggests an attitude of being thoughtfully diligent and humble while learning about cultural diversity issues and examining the areas where we might be ignorant and not aware of our ignorance. We argue that BAs' obligations to respect the dignity of clients and their families and to provide effective treatment call for this attitude of diligence and humility that goes beyond mere compliance.
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OBJECTIVE: Warthin-like papillary thyroid cancer (WL-PTC) is an uncommon variant of PTC, usually associated with lymphocytic thyroiditis. Scarce evidence suggests that WL-PTC has similar clinical presentation to classic PTC (C-PTC), with no studies comparing risks of recurrence and response to treatment between both variants. Our objective was to describe the clinical presentation and prognosis of WL-PTC and compare it to C-PTC. METHODS: Retrospective analysis of a prospective cohort, including 370 (96%) patients with C-PTC and 17 (4%) with WL-PTC, consecutively treated with total thyroidectomy with or without RAI, followed for at least 6 months. We compared clinical presentation, risk of mortality and recurrence, as well as response to treatment between both variants. RESULTS: Of the total cohort: 317 (82%) female, 38 ± 13.5 years, median follow-up 4 years (0.5-28.5); most of them stage I and low/intermediate risk of recurrence. We found no differences regarding clinical-pathological data and risk of recurrence. WL-PTC was associated with a higher rate of anti-thyroglobulin antibodies (TgAb) (65% vs. 36%, p = 0.016) and lymphocytic thyroiditis (59% vs. 34%, p = 0.03). The rates of biochemical and structural incomplete responses were similar in both variants. WL-PTC had a lower rate of excellent response (23% vs. 54%, p = 0.01), which became non-significant when performing analysis by TgAb presence (50% vs. 67%, p = NS). CONCLUSION: WL-CPT and C-CPT have similar clinical presentation and rate of recurrence. The lower rate of excellent response to treatment in WL-PTC is due to a higher frequency of TgAb. WL-PCT should not be considered an aggressive variant of PTC.
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Carcinoma Papilar , Neoplasias de la Tiroides , Femenino , Humanos , Recurrencia Local de Neoplasia , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Tiroglobulina , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
ABSTRACT Objective Warthin-like papillary thyroid cancer (WL-PTC) is an uncommon variant of PTC, usually associated with lymphocytic thyroiditis. Scarce evidence suggests that WL-PTC has similar clinical presentation to classic PTC (C-PTC), with no studies comparing risks of recurrence and response to treatment between both variants. Our objective was to describe the clinical presentation and prognosis of WL-PTC and compare it to C-PTC. Subjects and methods Retrospective analysis of a prospective cohort, including 370 (96%) patients with C-PTC and 17 (4%) with WL-PTC, consecutively treated with total thyroidectomy with or without RAI, followed for at least 6 months. We compared clinical presentation, risk of mortality and recurrence, as well as response to treatment between both variants. Results Of the total cohort: 317 (82%) female, 38 ± 13.5 years, median follow-up 4 years (0.5-28.5); most of them stage I and low/intermediate risk of recurrence. We found no differences regarding clinical-pathological data and risk of recurrence. WL-PTC was associated with a higher rate of anti-thyroglobulin antibodies (TgAb) (65% vs. 36%, p = 0.016) and lymphocytic thyroiditis (59% vs. 34%, p = 0.03). The rates of biochemical and structural incomplete responses were similar in both variants. WL-PTC had a lower rate of excellent response (23% vs. 54%, p = 0.01), which became non-significant when performing analysis by TgAb presence (50% vs. 67%, p = NS). Conclusions WL-CPT and C-CPT have similar clinical presentation and rate of recurrence. The lower rate of excellent response to treatment in WL-PTC is due to a higher frequency of TgAb. WL-PCT should not be considered an aggressive variant of PTC.
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Humanos , Femenino , Neoplasias de la Tiroides/cirugía , Carcinoma Papilar , Pronóstico , Tiroglobulina , Tiroidectomía , Estudios Prospectivos , Estudios Retrospectivos , Cáncer Papilar Tiroideo , Recurrencia Local de NeoplasiaRESUMEN
INTRODUCCIÓN: La extensión de la cirugía es motivo de controversia en el manejo de nódulos y cáncer diferenciado de tiroides (CDT). En nódulos benignos e indeterminados que requieran cirugía, la lobectomía es de elección, mientras que en CDT debe considerarse en tumores intratiroideos ≤ 4 cm. NUESTRO OBJETIVO objetivo fue reportar la primera cohorte chilena de nódulos tiroideos y CDT tratados con lobectomía por un equipo multidisciplinario. SUJETOS Y MÉTODOS: Se incluyeron pacientes sometidos a lobectomía por nódulos tiroideos y CDT que cumplieran: 1) tumor intratiroideo ≤4cm si punción aspirativa (PAF) Bethesda I, III, IV, V o VI; sin límite de tamaño si PAF Bethesda II, y 2) sin hallazgos sospechosos en la ecografía preoperatoria. En pacientes con CDT se describió presentación clínica, complicaciones y tipo de respuesta a tratamiento según ATA 2015 y MINSAL 2020. RESULTADOS: Se incluyeron 105 pacientes, edad 38±11 años, 84 (80%) mujeres, diámetro 2,2±1,5cm: 41 (39%) benignos y 64 (61%) CDT. De los CDT, 44 (69%) tenían cáncer papilar, 7 (11%) cáncer folicular y 13 (20%) NIFTP. Todos eran etapa I. Según MINSAL, 55 (85,9%) de riesgo muy bajo/bajo y 9 (14,1%) intermedio. Según ATA, 51 (80%) y 13 (20%) de riesgo bajo e intermedio, respectivamente. Se indicó totalización precoz y ablación con radioyodo en 6 (9,4%) pacientes: 4 por invasión venosa y 2 por CPT variedad sólida. De los 39 no totalizados seguidos ≥6 meses, no hubo casos de respuesta incompleta. Respecto a las complicaciones, ningún paciente tuvo hipocalcemia y 10 (9,5%) tuvieron disfonía transitoria. CONCLUSIONES: En pacientes con nódulos tiroideos o CDT seleccionados, la lobectomía es una alternativa adecuada. En CDT logra buen control de enfermedad sin necesidad de tratamiento adicional en cerca de 90% de los pacientes, con muy baja morbilidad asociada.
INTRODUCTION: The extension of surgery is a matter of debate in the management of thyroid nodules and differentiated thyroid cancer (DTC). While lobectomy is the procedure of choice in benign and indeterminate nodules that require surgery, it is an option in intrathyroidal DTC up to 4 cm. OUR OBJECTIVE was to report the first Chilean cohort of patients with thyroid nodules and DTC treated with lobectomy by a multidisciplinary team. SUBJECTS AND METHODS: We included patients with thyroid nodules treated with lobectomy, who met the following inclusion criteria: 1) intrathyroidal tumor ≤ 4cm if fine-needle aspiration biopsy (FNA) was Bethesda I, III, IV, V o VI; without size limit if FNA was Bethesda II, and 2) non-suspicious findings in preoperative ultrasound. In patients with DTC we described clinical presentation, complications and response to treatment according to ATA 2015 and MINSAL 2020. RESULTS: We included 105 patients, 38±11 years old, 84 (80%) female, diameter 2.2±1.5cm: 41 (39%) benign and 64 (61%) DTC. Among DTC, 44 (69%) had papillary thyroid cancer, 7 (11%) follicular thyroid cancer and 13 (20%) NIFTP. All had stage I DTC. According to MINSAL, 55 (85.9%) were very low/low, and 9 (14.1%) intermediate risk. According to ATA, 51 (80%) and 13 (20%) were low and intermediate risk, respectively. Six (9.4%) patients required early completion thyroidectomy and radioiodine ablation: 4 due to angioinvasion and 2 due to solid variant PTC. None of the 39 non-completed patients followed for at least 6 months had incomplete response. Regarding complications, there were no cases of hypocalcemia and 10 (9.5%) patients had transient dysphonia. CONCLUSIONS: In properly selected patients with thyroid nodules or DTC, lobectomy is an appropriate treatment option. In DTC, lobectomy accomplishes adequate disease control without need of further treatment in nearly 90% of patients, with very low associated morbidity.
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Humanos , Masculino , Femenino , Adulto , Tiroidectomía/métodos , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Grupo de Atención al Paciente , Complicaciones Posoperatorias , Chile , Estudios de Cohortes , Estudios de Seguimiento , HipocalcemiaRESUMEN
BACKGROUND: Thyroid dysfunction is associated with negative neonatal and obstetric outcomes. Large differences in thyroid function reference intervals exist across different populations. These differences can be explained by population-specific factors, such as iodine status. Many countries in Latin America report iodine sufficiency, but relatively few countries have published up-to-date data on iodine levels and thyroid function in the overall population, and especially in pregnant women. We evaluated the iodine status of pregnant women in Chile and determined thyroid hormone reference ranges in this population. METHODS: This was a prospective observational study of healthy Chilean women at their first prenatal visit before week 14. Thyroid-stimulating hormone (TSH), total thyroxine (T4), free T4, antithyroid peroxidase antibody (TPOAb), and iodine levels from spot urine samples were measured. Iodine status and the reference ranges for TSH were calculated. RESULTS: A total of 1,022 pregnant women in the first trimester were selected. Urinary iodine levels were measured in 302 randomly-selected women. The median urinary iodine concentration was 173.45 µg/L (interquartile range, 108.11 to 249.35).The reference ranges of TSH were calculated in 670 patients selected according to the National Academy of Clinical Biochemistry guidelines. The median TSH level was 1.88 µIU/mL (2.5th percentile: 0.13 to 97.5th percentile: 5.37). Using the reference range in the 1,022 women, the prevalence of clinical hypothyroidism was 1.76%, and that of subclinical hypothyroidism was 3.92%. TPOAb positivity was more common in women with TSH levels above 3.5 µIU/mL. CONCLUSION: We found adequate iodine intake and a right-shifted distribution of serum TSH levels in pregnant women in Chile. The prevalence of hypothyroidism in our sample of pregnant women was higher than has been described in the literature.
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Background: Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk of developing osteoporosis. Aim: To determine the frequency and severity of Vitamin D deficiency, secondary hyperparathyroidism and low bone mass in patients undergoing HCT. Patients and Methods: Analysis of the database of patients undergoing HCT in our institution in the 2010-2015 period. We searched for patients with measurements of 25-OH vitamin D (25OHD), parathyroid hormone (PTH) and bone densitometry by double beam X ray absorptiometry (DXA) prior and up to one year after HCT. Results: Ninety patients were included, 53 were evaluated prior to HCT and 37 after HCT. They represent 73% of all patients undergoing HCT in the period. Median 25OHD was 12 ng/ml (range 4-41.4). Ninety seven percent of patients had levels considered insufficient and 85% compatible with deficiency. Median PTH was 60.5 pg/ml (range 21-186). Forty five percent of patients had secondary hyperparathyroidism. DXA was performed in 65 patients (prior to HCT in 54 and after HCT in 11). Of these, 11% had had a low bone mineral density. Conclusions: Patients undergoing HCT have a high risk of vitamin D deficiency, secondary hyperparathyroidism and low bone mineral density.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Hormona Paratiroidea/análisis , Vitamina D/análisis , Deficiencia de Vitamina D/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Hiperparatiroidismo Secundario/etiología , Osteoporosis/etiología , Densidad Ósea , Estudios RetrospectivosRESUMEN
Previous studies have shown that telehealth can be an effective way to deliver behavior-analytic services. In this study, we provided a demonstration of the use of telehealth to assess and initiate treatment of problem behavior in an outpatient clinic. We coached parents of children with autism via telehealth to conduct functional analyses during 1 appointment that lasted 1 hr and subsequently coached them as they implemented functional communication training during 3 subsequent appointments (15 min each). Social functions were identified for most children, and problem behavior was reduced by an average of 65.1%.
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Trastorno del Espectro Autista/psicología , Trastorno del Espectro Autista/rehabilitación , Problema de Conducta/psicología , Telemedicina/métodos , Niño , Preescolar , Comunicación , Femenino , Humanos , Masculino , Pacientes Ambulatorios/psicología , Resultado del TratamientoRESUMEN
Research has shown that differential reinforcement of alternative behavior (DRA) can be an effective intervention to address problem behavior maintained by negative reinforcement emitted by young children. However, few studies have evaluated the variables that are related to long-term maintenance (i.e., persistence) of treatment effects. Research on behavioral persistence predicts that the rate of reinforcement provided for a target behavior is correlated with its persistence when challenged. There were 2 purposes of the current investigation. First, we evaluated the effects of the rate of negative reinforcement on the persistence of task completion. Second, we applied the findings regarding rate of reinforcement to a treatment context for 3 participants who engaged in destructive behavior that was reinforced by escape from demands. Results were evaluated within a multielement design and indicated that the rate of negative reinforcement had a moderate influence on the persistence of task completion. These results contribute to the existing literature by extending analyses of persistence to treatment contexts.
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Trastorno del Espectro Autista/rehabilitación , Terapia Conductista/métodos , Trastornos de la Conducta Infantil/rehabilitación , Refuerzo en Psicología , Agresión/fisiología , Niño , Preescolar , Extinción Psicológica , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk of developing osteoporosis. AIM: To determine the frequency and severity of Vitamin D deficiency, secondary hyperparathyroidism and low bone mass in patients undergoing HCT. PATIENTS AND METHODS: Analysis of the database of patients undergoing HCT in our institution in the 2010-2015 period. We searched for patients with measurements of 25-OH vitamin D (25OHD), parathyroid hormone (PTH) and bone densitometry by double beam X ray absorptiometry (DXA) prior and up to one year after HCT. RESULTS: Ninety patients were included, 53 were evaluated prior to HCT and 37 after HCT. They represent 73% of all patients undergoing HCT in the period. Median 25OHD was 12 ng/ml (range 4-41.4). Ninety seven percent of patients had levels considered insufficient and 85% compatible with deficiency. Median PTH was 60.5 pg/ml (range 21-186). Forty five percent of patients had secondary hyperparathyroidism. DXA was performed in 65 patients (prior to HCT in 54 and after HCT in 11). Of these, 11% had had a low bone mineral density. CONCLUSIONS: Patients undergoing HCT have a high risk of vitamin D deficiency, secondary hyperparathyroidism and low bone mineral density.
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Trasplante de Células Madre Hematopoyéticas/efectos adversos , Hiperparatiroidismo Secundario/etiología , Hormona Paratiroidea/análisis , Deficiencia de Vitamina D/etiología , Vitamina D/análisis , Adolescente , Adulto , Anciano , Densidad Ósea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/etiología , Estudios Retrospectivos , Adulto JovenRESUMEN
Experimental conditions similar to those described by Lieving and Lattal (2003) were used within two experiments to evaluate the resurgence of mands with humans. Two mands from the same operant class were trained with three participants with developmental disabilities during Experiment 1 and with two participants with developmental disabilities and a history of problem behavior during Experiment 2. The two mands were then placed on extinction. Both persisted, but showed different response strength during extinction. The mand with the weaker response strength was targeted for additional functional communication training and the alternative mand was placed on extinction. Following steady levels of occurrence of the targeted mand and no occurrences of the alternative mand, both mands were placed on extinction again. At least one instance of resurgence of the alternative mand occurred with every participant and resurgence of problem behavior occurred for both participants during Experiment 2.
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BACKGROUND: Assessment for learning is a paradigm that is taking shape in the field of medical education. This approach aims to embed the assessment process within the educational and learning process. AIM: To evaluate the impact of curricular changes, from a focus of assessment of learning to one of assessment for learning, in the perception of undergraduate students of medicine and their final grades obtained in a theoretical course (TCG). MATERIAL AND METHODS: In the year 2011 lectures were reduced and intermediate assessments followed by a feedback session were introduced. The activities of each program course, surveys about student perceptions of the course and the final grades of students (assessments with multiple choice questions) were compared between the periods prior and after curricular changes (2005-2010 and 2011-2013). RESULTS: As a consequence of curricular changes, time for lectures was reduced by 19.5%, time for summative assessments was increased by 8.5%, and feedback activity, occupying 7.3% of the course time was added. There were significant improvements in student is perceptions in all areas assessed by surveys, emphasizing feedback and assessments. The overall grade assigned to the course dictated after implementing the changes increased from 6.18 to 6.59 (p < 0.001, 1-7 scale). The grades of students also improved from an average of 5.78 to 6.43 (p < 0.001, 1-7 scale). CONCLUSIONS: Assessment for learning achieved the desired educational impact without increasing the assigned curricular time. Programmatic assessment is favorably perceived by students.
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Curriculum , Educación de Pregrado en Medicina/métodos , Gastroenterología/educación , Aprendizaje , Evaluación Educacional , Humanos , Conocimiento Psicológico de los Resultados , Percepción , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Patients with systemic sclerosis frequently have Raynaud's phenomenon and digital ischemic ulcers. Iloprost, a synthetic prostacyclin analogue, may be effective in these cases. Searching in Epistemonikos database, which is maintained by screening 20 databases, we identified three systematic reviews including seven randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded iloprost may lead to little or no difference in the frequency or severity of secondary Raynaud, and it is associated to adverse effects and important costs.
Los pacientes con esclerodermia presentan con frecuencia fenómeno de Raynaud asociado y úlceras digitales isquémicas. El iloprost, un análogo sintético de prostaciclina, podría ser efectivo en estos casos. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 20 bases de datos, identificamos tres revisiones sistemáticas que en conjunto incluyen siete estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que iloprost podría disminuir poco o nada la frecuencia y gravedad de los episodios de Raynaud secundario, y se asocia a efectos adversos y costos importantes.
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Iloprost/uso terapéutico , Enfermedad de Raynaud/tratamiento farmacológico , Esclerodermia Sistémica/complicaciones , Bases de Datos Factuales , Humanos , Iloprost/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad de Raynaud/etiología , Enfermedad de Raynaud/fisiopatología , Esclerodermia Sistémica/tratamiento farmacológico , Vasodilatadores/efectos adversos , Vasodilatadores/uso terapéuticoRESUMEN
Background: Assessment for learning is a paradigm that is taking shape in the field of medical education. This approach aims to embed the assessment process within the educational and learning process. Aim: To evaluate the impact of curricular changes, from a focus of assessment of learning to one of assessment for learning, in the perception of undergraduate students of medicine and their final grades obtained in a theoretical course (TCG). Material and Methods: In the year 2011 lectures were reduced and intermediate assessments followed by a feedback session were introduced. The activities of each program course, surveys about student perceptions of the course and the final grades of students (assessments with multiple choice questions) were compared between the periods prior and after curricular changes (2005-2010 and 2011-2013). Results: As a consequence of curricular changes, time for lectures was reduced by 19.5%, time for summative assessments was increased by 8.5%, and feedback activity, occupying 7.3% of the course time was added. There were significant improvements in student is perceptions in all areas assessed by surveys, emphasizing feedback and assessments. The overall grade assigned to the course dictated after implementing the changes increased from 6.18 to 6.59 (p < 0.001, 1-7 scale). The grades of students also improved from an average of 5.78 to 6.43 (p < 0.001, 1-7 scale). Conclusions: Assessment for learning achieved the desired educational impact without increasing the assigned curricular time. Programmatic assessment is favorably perceived by students.
Asunto(s)
Humanos , Curriculum , Educación de Pregrado en Medicina/métodos , Gastroenterología/educación , Aprendizaje , Evaluación Educacional , Conocimiento Psicológico de los Resultados , Percepción , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Constrictive Pericarditis (CP) is an unusual disease. Its most common causes are idiopathic or secondary to cardiac surgery. Less frequently it is caused by connective tissue diseases. We report a 30 years old woman hospitalized due to progressive dyspnea, chest pain and signs of right sided heart failure. During her stay, a Systemic Lupus Erythematosus (SLE) was diagnosed. The echocardiogram suggested a CP and the diagnosis was confirmed by cardiac catheterization. Pericardiectomy was successfully performed. The biopsy confirmed a nonspecific chronic pericarditis, with extensive fibrosis and absence of caseating granulomas. The patient had a satisfactory recovery.
Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Pericarditis Constrictiva/etiología , Adulto , Cateterismo Cardíaco , Enfermedad Crónica , Femenino , Humanos , Pericardiectomía , Pericarditis Constrictiva/diagnósticoRESUMEN
AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.