Bethesda cytopathologic diagnosis system in the pathology of thyroid

[ES] Introducción y objetivo: Se ha demostrado en la literatura que la punción-aspiración con aguja fina (PAAF) de tiroides es el método más útil para el estudio de un nódulo tiroideo. Además de ser una técnica no invasiva y de bajo coste. A raíz de una reunión multidisciplinar de expertos en patología tiroidea se crea el sistema Bethesda que establece seis categorías diagnósticas, y permite seleccionar pacientes candidatos a tratamiento quirúrgico. Material y método: Sistema Bethesda 2010. Resultados y discusión: En este artículo se realiza una breve revisión de los hallazgos citológicos de las distintas categorías diagnósticas del sistema Bethesda con correlación histológica. Conclusiones: El sistema Bethesda permite a los patólogos realizar informes de PAAF sistematizados, unificados y homogéneos y establecer una actitud terapéutica seleccionando los pacientes candidatos a tratamiento quirúrgico. [EN] Introduction and objective: Fine needle aspiration (FNA), a non invasive, low-cost technique, has been proved to be the most useful method for diagnosis of thyroid nodules. The Bethesda system for reporting thyroid cytopathology resulted from a multidisciplinary conference and led to standardization of FNA reports based on six diagnostic categories, selecting candidate patients for surgical treatment. Method: Bethesda system 2010 Results and Discussion: In this article, a brief revision of cytologic findings with histological correlation in Bethesda diagnostic categories is performed. Conclusions: Bethesda system allows pathologists to ellaborate systematized, unified and homogeneous FNA reports in order to establish a therapeutic attitude and choose candidate patients for surgical treatment

Memoria del II Coloquio Internacional sobre Diversidad Cultural y Estudios Regionales

Desde la Sede de Occidente y, específicamente, en el seno de la Coordinación de Investigación y con el apoyo de la Dirección de la Sede y las Coordinaciones de Docencia, Administración y Acción Social, así como de la Vicerrectoría de Investigación, se han celebrado en el 2011 y en el 2012 dos coloquios internacionales sobre diversidad cultural y estudios regionales. El propósito de ambos consistió principalmente en motivar a investigadores e investigadoras de las distintas unidades académicas de la Universidad de Costa Rica y de otras instituciones de Educación Superior, así como a representantes de Centros e Institutos de Investigación nacionales e internacionales, a presentar resultados de investigaciones que contribuyeran a un mayor conocimiento de los procesos culturales y que dieran a conocer resultados que permitieran la comprensión de las realidades de distintos sectores y regiones. En el 2011 se presentaron cuarenta y seis ponencias y se dictaron tres conferencias magistrales, y en el 2012 se expusieron cincuenta ponencias y se impartieron tres conferencias magistrales.UCR::Sedes Regionales::Sede de Occidente::Recinto San Ramón::Centro de Investigaciones sobre Diversidad Cultural y Estudios Regionales (CIDICER

Sistema Bethesda en el diagnóstico citopatológico de la patología de tiroides

Introduction and objective: Fine needle aspiration (FNA), a non invasive, low-cost technique, has been proved to be the most useful method for diagnosis of thyroid nodules. The Bethesda system for reporting thyroid cytopathology resulted from a multidisciplinary conference and led to standardization of FNA reports based on six diagnostic categories, selecting candidate patients for surgical treatment. Method: Bethesda system 2010 Results and Discussion: In this article, a brief revision of cytologic findings with histological correlation in Bethesda diagnostic categories is performed. Conclusions: Bethesda system allows pathologists to ellaborate systematized, unified and homogeneous FNA reports in order to establish a therapeutic attitude and choose candidate patients for surgical treatment.Introducción y objetivo: Se ha demostrado en la literatura que la punción-aspiración con aguja fina (PAAF) de tiroides es el método más útil para el estudio de un nódulo tiroideo. Además de ser una técnica no invasiva y de bajo coste. A raíz de una reunión multidisciplinar de expertos en patología tiroidea se crea el sistema Bethesda que establece seis categorías diagnósticas, y permite seleccionar pacientes candidatos a tratamiento quirúrgico. Material y método: Sistema Bethesda 2010. Resultados y discusión: En este artículo se realiza una breve revisión de los hallazgos citológicos de las distintas categorías diagnósticas del sistema Bethesda con correlación histológica. Conclusiones: El sistema Bethesda permite a los patólogos realizar informes de PAAF sistematizados, unificados y homogéneos y establecer una actitud terapéutica seleccionando los pacientes candidatos a tratamiento quirúrgico

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection