Indications for thyroid FNA and pre-FNA requirements: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-Needle Aspiration (FNA) State of the Science Conference on October 22–23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational website and several on-line discussions between May 1 and December 15, 2007 ( http://thyroidfna.cancer.gov ). This document summarizes the indications for performing an FNA of a nodule discovered by physical examination or an imaging study; the indications for using ultrasound versus palpation for guidance when performing a thyroid FNA; the issues surrounding informed consent for thyroid FNA; and the information required on a requisition form that accompanies a thyroid FNA specimen. ( http://thyroidfna.cancer.gov/pages/info/agenda/ ) Diagn. Cytopathol. 2008;36:390–399. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58658/1/20827_ftp.pd

La imperiosa necesidad de la ambulancia en las villas y barrios populares

Los curas compartimos la vida con nuestros vecinos, viviendo en la villa. Todos los días, los más pobres se encuentran con la vida y la muerte, con la salud y la enfermedad, luchando por una vida digna. Muchas veces hemos manifestado el dolor que produce la privación de oportunidades y derechos por vivir en barrios llamados marginales: falta de vacante en escuelas, inseguridad en sentido amplio, rechazo en trabajos por vivir en una villa, transporte público deficiente, sistema de salud expulsivo... En este último punto queremos focalizar esta declaración. Desde hace décadas, en las villas del llamado “AMBA” (ciudad de Buenos Aires y Conurbano) es insuficiente, hasta deficiente, el servicio de emergencias médicas. Hubo causas judiciales pero sigue sucediendo que muchas veces la ambulancia llega más tarde de lo estipulado. En todo este tiempo ha pasado numerosas veces que la persona falleció antes de que llegara la emergencia médica. ¡Cuántas muertes se habrían evitado si la ambulancia hubiera llegado a tiempo! Demasiados vecinos de barrios pobres fallecieron desangrados mientras la ambulancia no llegaba. No consideramos que sea excusa la imposibilidad de llegar a los pasillos. Siempre hay un punto al que el móvil puede llegar y entre los vecinos y las fuerzas de seguridad acompañar al personal de salud hasta el domicilio o lugar donde se encuentra el damnificado. Durante este tiempo de pandemia y cuarentena se han visibilizado retrasos con consecuencias indeseables..

Rayas de agua dulce (Potamotrygonidae) de Suramérica. Parte II. Colombia, Brasil, Perú, Bolivia, Paraguay, Uruguay y Argentina

El libro es la continuación de una iniciativa de hace ya unos años (2012), donde varios países del área de distribución de la familia, decidieron unirse al ver como este recurso estaba disminuyendo o bien, era prácticamente desconocido. Este grupo tiene un gran impacto principalmente por su importancia como recurso pesquero ornamental, aunque también se usa como alimento, en la pesca deportiva y tiene incidencia en la salud pública. Para poder mitigar la posible sobreexplotación, surgió la necesidad de regular el comercio e intentar convertir la pesca ornamental de rayas en una actividad sostenible. Por ello, desde 2012 el IAvH junto a varios países propusieron la inclusión de varias especies al Apéndice III de Cites. Una de las limitantes de esta propuesta y por la cual no prosperó en su inicio, fue la falta de información sobre las especies.Bogotá, D. C

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care