Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea

ResumenObjetivoPresentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda.Materiales y métodosSe llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20.ResultadosSe estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 años. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%.ConclusionesEl ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.AbstractObjectivesWe present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification.Materials and methodsProspective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20.ResultsWe studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%.ConclusionThe elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI

Acute Demyelinating Disease after Oral Therapy with Herbal Extracts

Central nervous system demyelinating processes such as multiple sclerosis and acute disseminated encephalomyelitis constitute a group of diseases not completely understood in their physiopathology. Environmental and toxic insults are thought to play a role in priming autoimmunity. The aim of the present report is to describe a case of acute demyelinating disease with fatal outcome occurring 15 days after oral exposure to herbal extracts

Effect of rhizobacteria on growth and grain protein in wheat

Field-grown wheat, Triticum aestivum L. cv. ProINTA Isla Verde, was inoculated with two Bacillus species, B. simplex and B. firmus, isolated from wheat roots, in four experiments during three years at two sites, Buenos Aires and Castelar, Argentina. Plants were inoculated with a liquid inoculant twenty-two days after sowing, or seeds were pelleted with inoculated peat prior to sowing, according to the experiment. In all experiments a set of plots was left unfertilized, and another set was fertilized with 200 kg N/ha in a split fertilization, 100 kg at sowing and 100 kg at the booting stage. Inoculation affected the results in all experiments, augmenting biomass production by up to 77% in some experiments, through an increase in the number of ears per plot close to 50%. However, as the number of grains per ear was decreased by inoculation by more than 40%, grain yield was not consistently augmented. Inoculation always produced an increase in nitrogen accumulation by the crop, with the inoculated plants showing more than twice the N content of those not inoculated. The most remarkable result due to inoculation was the consistent increase from 9.4% to 15.6% dry matter (DM), with or without N fertilization. Our findings show that inoculation with adequate rhizobacteria consistently increases wheat grain quality and the efficiency of use of the applied fertilizer, with the potential benefit of reducing losses to the environment

Biological data on two Hector's beaked whales, Mesoplodon hectori, stranded in Buenos Aires province, Argentina

Beaked whales or ziphiids are the least known cetaceans, and are among the least studied of all mammalian groups. In August and September of 2002, a male and a female beaked whale stranded alive on the Argentine coast, 110km away from each other. The specimens died shortly after the stranding and their bodies were collected for dissection and analysis. The specimens were identified as belonging to the genus Mesoplodon. Further measurements of the skulls, shape and location of teeth as well as molecular analyses of the mtDNA control region and cytochrome b, allowed unambiguous identification of both specimens as Hector's beaked whale, Mesoplodon hectori. The color pattern was different between male and female. Standard length was 3.94 meters for the male and 3.84 meters for the female. The female's vertebral formula was C7 + T10 + L11 + Ca21 = 49. Histo-pathological analysis of the female revealed the presence of Sarcocystis sp. in the skeletal muscle, and lung lesions related to parasitic damage and pneumonia or chronic infection. The stomach of both individuals was empty. The digestive tract of both specimens was infected by larval stages L4 of Anisakis sp. The female was also infected by Tetrabothrius sp. and Bolbosoma sp. while Braunina cordiformis was only found in the male. Different composition of parasitic fauna suggests possible sex-related differences in the diet or individual variability. Total length, teeth eruption (in the male) and the degree of vertebral epiphyses fusion suggest that both individuals were mature