Carcinoma de tiroides una verdadera pandemia?

El diagnóstico de cáncer de tiroides se ha incrementado y las posibilidades de detección de una enfermedad subclínica son altas, toda vez que disponemos de herramientas de detección más sensibles y de fácil acceso. Por ende, el clínico requiere conocer la historia natural del nódulo tiroideo y del carcinoma papilar de tiroides de bajo riesgo para brindar a su paciente el mejor tratamiento basado en la evidencia clínica. El objetivo de esta revision es reconocer los elementos clínicos que han condicionado el aumento inusitado de casos de cáncer de tiroides. Conclusión: El sobrediagnóstico del cáncer de tiroides es una realidad, que se posibilita por el uso extendido de biopsia por aspiración con aguja fina ((BACAF)) después de la detección de un nódulo tiroideo, en gran parte de manera incidental, sin acarrear la mayoría de las veces un mejor pronóstico después de su tratamiento.

Osteomielitis esternal: utilidad de las pruebas de diagnóstico por imágenes con enfoque en medicina nuclear

Introducción: El diagnóstico de osteomielitis esternal post-esternotomía resulta difícil empleando síntomas clínicos o de laboratorio y las imágenes morfológicas orientan a sospecha más que al diagnóstico. Un diagnóstico precoz ofrece calidad de vida y el mejor tratamiento para reducir una mortalidad que oscila entre 14% y 47%. La gammagrafía con leucocitos marcados ofrece el mejor rendimiento diagnóstico para infecciones y se destaca como el patrón de oro diagnóstico. Objetivo: Identificar el desempeño y utilidad de la gammagrafía con leucocitos autólogos marcados con 99mTc-HMPAO en los estudios realizados para la evaluación de osteomielitis esternal. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo de prueba diagnóstica en la Fundación Cardioinfantil de Bogotá entre enero/2010 y mayo/2015 evaluando gammagrafías con leucocitos marcados ante la sospecha de osteomielitis posterior a esternotomía. Resultados: Se evaluaron 52 pacientes, en los que la gammagrafía con leucocitos mostró 23 pacientes (44,2%) con osteomielitis esternal, logrando una sensibilidad y especificidad del 88,46% y 100% respectivamente. El valor predictivo positivo fue de 100%, y el valor predictivo negativo fue de 89,66%. El impacto de una prueba negativa no modificó el manejo médico inicial en el 93% de los casos mientras que una prueba positiva lo modificó en el 83%. Conclusiones: La gammagrafía con leucocitos autólogos radiomarcados con 99mTc-HMPAO continúa siendo el patrón de oro de referencia no invasiva para el diagnóstico de osteomielitis, y en el caso de osteomielitis esternal se convierte en la prueba de elección pertinente en la selección de pacientes que ameritan una re-intervención quirúrgica.

Caracterización del ausentismo laboral de una IPS que presta servicios de consulta externa de medicina general, 2014

RESUMEN El ausentismo laboral genera un gran impacto económico en las empresas y a la sociedad en general. Es un problema difícil de manejar ya que es multifactorial, porque a pesar de que en su gran mayoría es generado por enfermedad general, al analizarlo se puede encontrar otros factores que conlleven a la ausencia del trabajador y con ello producir alteración al normal funcionamiento de la empresa, por lo que resulta indispensable estudiar este tema. Objetivo Caracterizar las principales causas de ausentismo laboral en los médicos generales de una IPS que presta servicios de consulta externa de medicina general a nivel nacional durante el año 2014. Materiales y Métodos: es un estudio de corte transversal sobre datos secundarios correspondientes al registro de incapacidades que presento la IPS durante el año 2014. Los criterios de inclusión fueron los médicos generales con los que contaba la IPS que presta servicios de salud a nivel nacional durante el año 2014 y los criterios de exclusión fueron las licencias de maternidad y paternidad. El tamaño de la muestra final fue de 202 médicos y el número de incapacidades que se presentó durante el año 2014 fue 313. Se realizó análisis de distribución de frecuencias, porcentaje y prevalencia de las incapacidades. Resultados: durante el año 2014 se presentaron 313 incapacidades, en una población de 202 médicos generales con prevalencia en las mujeres. El diagnóstico más frecuente de las incapacidades fue la categoría diagnostica “otros” en el cual se encuentra migraña, vértigo, alteraciones de la mama con 59 incapacidades, seguida por enfermedades gastrointestinales con 25 incapacidades. Conclusiones y recomendaciones: Las incapacidades fueron más frecuentes en mujeres que en hombres. El diagnóstico de las incapacidades más frecuente fue “enfermedad genérica o ausencia de diagnóstico”. La incapacidad más frecuente de un día que se presentaron 46 registros. El médico que mayor número de incapacidades presento fue de 18 para el año 2014. Se recomienda a la empresa tener un seguimiento de las incapacidades repetitivas, ya que estas podrían tener relación con enfermedad laboral que aún no ha sido calificada. Se recomienda complementar la base de datos con información como el antecedente de enfermedad crónica y el sedentarismo, lo que puede permitir realizar nuevos estudios respecto al riesgo cardiovascular de esta población.

La política comercial de Estados Unidos en el marco de la Organización Mundial del Comercio. Discurso vs. comportamiento con relación a prácticas anticompetitivas

El objetivo principal de esta monografía es identificar cuáles son las razones que justifican las contradicciones entre el discurso y el comportamiento de Estados Unidos en el marco de la Organización Mundial del Comercio, particularmente con relación a prácticas anticompetitivas derivadas del programa de protección a la agricultura del país. Para ello se analizan el interés nacional y los elementos de la seguridad nacional a partir de los cuales éste se ha construido. También se evalúan los procesos de formulación de política comercial y las interacciones entre los representantes políticos, las asociaciones de productores y el sector privado para mostrar como este comportamiento contradictorio corresponde a la legitimización de un interés particular.

Natural resources, redistribution and Human capital formation

How do resource booms affect human capital accumulation? We exploit time and spatial variation generated by the commodity boom across local governments in Peru to measure the effect of natural resources on human capital formation. We explore the effect of both mining production and tax revenues on test scores, finding a substantial and statistically significant effect for the latter. Transfers to local governments from mining tax revenues are linked to an increase in math test scores of around 0.23 standard deviations. We find that the hiring of permanent teachers as well as the increases in parental employment and improvements in health outcomes of adults and children are plausible mechanisms for such large effect on learning. These findings suggest that redistributive policies could facilitate the accumulation of human capital in resource abundant developing countries as a way to avoid the natural resources curse.

O Contributo da Fisioterapia em Meio Aquático na Educação Especial

A paralisia cerebral (PC) trata-se de uma condição que pode ser bastante incapacitante para a criança, gerando um forte impacto social e económico. A fisioterapia em meio aquático pode constituir um fator de promoção da melhoria do quadro clínico naquela população, contribuindo para uma inclusão escolar mas efetiva. Contudo, esta relação não está, ainda, determinada. Objetivo: investigar a opinião dos professores e dos fisioterapeutas sobre o contributo da fisioterapia em meio aquático na educação especial em crianças com PC. Metodologia: Recorreu-se a um estudo descritivo, cuja amostra, constituída por 13 sujeitos, foi selecionada por conveniência. Foi construído e aplicado um questionário à amostra. Resultados: A amostra deste estudo foi constituída por sujeitos maioritariamente do género feminino (n=11), com idades superiores a 30 anos. Todos os participantes do estudo (n=13) consideram importante o contributo da fisioterapia em meio aquático na educação especial de crianças com PC. Conclusões: Apesar de algumas limitações, considera-se que este estudo é de grande importância para a comunidade científica preocupada com a expressiva incidência da PC e dos custos associados. A fisioterapia em meio aquático parece ser uma estratégia importante na melhoria do estado de saúde das crianças com PC, contribuindo para a inclusão escolar. PALAVRAS-CHAVE:

Estudo da presença de Mycobacterium avium subespécie paratuberculosis numa exploração leiteira no Litoral Centro de Portugal Continental

A Paratuberculose, conhecida também como Doença de Johne, é uma afeção infecciosa que provoca uma enterite granulomatosa crónica causada pelo agente Mycobacterium avium subespécie paratuberculosis (Map). É uma doença de carácter contagioso, de distribuição mundial, atingindo os mamíferos, particularmente os pequenos e grandes ruminantes, equinos, suínos, búfalos, coelhos, etc. Tem um grande impacto económico, nomeadamente na redução da produção leiteira, na redução dos teores de proteína no leite, na susceptibilidade a outras doenças, no refugo de animais e no aumento dos custos na sanidade. Pensa-se que também terá impacto a nível de Saúde Pública uma vez que o Map pode estar associado á doença de Crohn em humanos em que o leite cru, leite em pó ou leite pasteurizado podem ser os veículos de transmissão, porém não existem estudos suficientes para sustentar este acontecimento. A técnica de diagnóstico “Gold Standard” é a cultura microbiológica de fezes, no entanto é um procedimento muito demorado podendo levar até 4 meses para se observarem as colónias bacterianas, uma vez que o seu crescimento é muito lento. Deste modo, existem outros testes, tais como o PCR e ELISA, com elevada especificidade para o agente que fornecem resultados mais rápidos e que permitem minimizar os falsos-positivos, apesar da sua reduzida sensibilidade (por volta dos 50%). Este estudo é baseado na observação das instalações da exploração e consequente comparação com parâmetros analisados e documentados em literatura. Para além disso, são utilizadas informações fornecidas pelo Software da exploração com o intuito de estudar a incidência da Paratuberculose, ao longo dos anos, de modo a comprovar se as medidas de maneio e de higiene adotadas pela exploração afetada contribuem ou não de alguma maneira para o controlo/erradicaçãoda doença de Johne.

Forage production and nutrient availability in small-scale dairy systems in central Mexico using linear programming and partial budgeting

Small-scale dairy systems play an important role in the Mexican dairy sector and farm planning activities related to resource allocation have a significant impact on the profitability of such enterprises. Linear programming is a technique widely used for planning and ration formulation, and partial budgeting is a technique for assessing the impact of changes on the profitability of an enterprise. This study used both methods to optimise land use for forage production and nutrient availability, and to evaluate the economic impact of such changes in small-scale Mexican dairy systems. The model showed satisfactory performance when optimal solutions were compared with the traditional strategy. The strategy using fresh ryegrass, maize silage and oat hay, and the strategy using a combination of alfalfa hay, maize silage, fresh ryegrass and oat hay appeared attractive options for providing a better nutrient supply and maintaining a higher stocking rate throughout the year than the traditional strategy.

Exploring costs and benefits of HACCP: a pilot study in the dairy and meat products industry in the European Union

Since 1995 the Directive 93/43/EEC prescribes the application of HACCP principles in food production. However, despite the major importance of food safety, there is a fundamental lack of information on the economic impact of this directive. This project aims to study costs and benefits of HACCP, including the impact of HACCP on public health. Due to the complexity of the issue, we propose to start with a pilot study, limited to dairy and meat products industry in NL, UK and I. Information will be obtained at two levels: production chain and public health. Integration of these results will result in recommendations at the levels of EU member states and industry for regulation and supporting measures, and in recommendations for an effective and efficient approach for a more comprehensive project on costs and benefits of HACCP, covering major parts of the food industry in EU member states.

New scientific paradigms for probiotics and prebiotics

The inaugural meeting of the International Scientific Association for Probiotics and Prebiotics (ISAPP) was held May 3 to May 5 2002 in London, Ontario, Canada. A group of 63 academic and industrial scientists from around the world convened to discuss current issues in the science of probiotics and prebiotics. ISAPP is a non-profit organization comprised of international scientists whose intent is to strongly support and improve the levels of scientific integrity and due diligence associated with the study, use, and application of probiotics and prebiotics. In addition, ISAPP values its role in facilitating communication with the public and healthcare providers and among scientists in related fields on all topics pertinent to probiotics and prebiotics. It is anticipated that such efforts will lead to development of approaches and products that are optimally designed for the improvement of human and animal health and well being. This article is a summary of the discussions, conclusions, and recommendations made by 8 working groups convened during the first ISAPP workshop focusing on the topics of: definitions, intestinal flora, extra-intestinal sites, immune function, intestinal disease, cancer, genetics and genomics, and second generation prebiotics. Humans have evolved in symbiosis with an estimated 1014 resident microorganisms. However, as medicine has widely defined and explored the perpetrators of disease, including those of microbial origin, it has paid relatively little attention to the microbial cells that constitute the most abundant life forms associated with our body. Microbial metabolism in humans and animals constitutes an intense biochemical activity in the body, with profound repercussions for health and disease. As understanding of the human genome constantly expands, an important opportunity will arise to better determine the relationship between microbial populations within the body and host factors (including gender, genetic background, and nutrition) and the concomitant implications for health and improved quality of life. Combined human and microbial genetic studies will determine how such interactions can affect human health and longevity, which communication systems are used, and how they can be influenced to benefit the host. Probiotics are defined as live microorganisms which, when administered in adequate amounts confer a health benefit on the host.1 The probiotic concept dates back over 100 years, but only in recent times have the scientific knowledge and tools become available to properly evaluate their effects on normal health and well being, and their potential in preventing and treating disease. A similar situation exists for prebiotics, defined by this group as non-digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria. Prebiotics function complementary to, and possibly synergistically with, probiotics. Numerous studies are providing insights into the growth and metabolic influence of these microbial nutrients on health. Today, the science behind the function of probiotics and prebiotics still requires more stringent deciphering both scientifically and mechanistically. The explosion of publications and interest in probiotics and prebiotics has resulted in a body of collective research that points toward great promise. However, this research is spread among such a diversity of organisms, delivery vehicles (foods, pills, and supplements), and potential health targets such that general conclusions cannot easily be made. Nevertheless, this situation is rapidly changing on a number of important fronts. With progress over the past decade on the genetics of lactic acid bacteria and the recent, 2,3 and pending, 4 release of complete genome sequences for major probiotic species, the field is now armed with detailed information and sophisticated microbiological and bioinformatic tools. Similarly, advances in biotechnology could yield new probiotics and prebiotics designed for enhanced or expanded functionality. The incorporation of genetic tools within a multidisciplinary scientific platform is expected to reveal the contributions of commensals, probiotics, and prebiotics to general health and well being and explicitly identify the mechanisms and corresponding host responses that provide the basis for their positive roles and associated claims. In terms of human suffering, the need for effective new approaches to prevent and treat disease is paramount. The need exists not only to alleviate the significant mortality and morbidity caused by intestinal diseases worldwide (especially diarrheal diseases in children), but also for infections at non-intestinal sites. This is especially worthy of pursuit in developing nations where mortality is too often the outcome of food and water borne infection. Inasmuch as probiotics and prebiotics are able to influence the populations or activities of commensal microflora, there is evidence that they can also play a role in mitigating some diseases. 5,6 Preliminary support that probiotics and prebiotics may be useful as intervention in conditions including inflammatory bowel disease, irritable bowel syndrome, allergy, cancer (especially colorectal cancer of which 75% are associated with diet), vaginal and urinary tract infections in women, kidney stone disease, mineral absorption, and infections caused by Helicobacter pylori is emerging. Some metabolites of microbes in the gut may also impact systemic conditions ranging from coronary heart disease to cognitive function, suggesting the possibility that exogenously applied microbes in the form of probiotics, or alteration of gut microecology with prebiotics, may be useful interventions even in these apparently disparate conditions. Beyond these direct intervention targets, probiotic cultures can also serve in expanded roles as live vehicles to deliver biologic agents (vaccines, enzymes, and proteins) to targeted locations within the body. The economic impact of these disease conditions in terms of diagnosis, treatment, doctor and hospital visits, and time off work exceeds several hundred billion dollars. The quality of life impact is also of major concern. Probiotics and prebiotics offer plausible opportunities to reduce the morbidity associated with these conditions. The following addresses issues that emerged from 8 workshops (Definitions, Intestinal Flora, Extra-Intestinal Sites, Immune Function, Intestinal Disease, Cancer, Genomics, and Second Generation Prebiotics), reflecting the current scientific state of probiotics and prebiotics. This is not a comprehensive review, however the study emphasizes pivotal knowledge gaps, and recommendations are made as to the underlying scientific and multidisciplinary studies that will be required to advance our understanding of the roles and impact of prebiotics, probiotics, and the commensal microflora upon health and disease management.

Bacterial pathogen evolution: breaking news

The immense social and economic impact of bacterial pathogens, from drug-resistant infections in hospitals to the devastation of agricultural resources, has resulted in major investment to understand the causes and conse- quences of pathogen evolution. Recent genome se- quencing projects have provided insight into the evolution of bacterial genome structures; revealing the impact of mobile DNA on genome restructuring and pathogenicity. Sequencing of multiple genomes of relat- ed strains has enabled the delineation of pathogen evo- lution and facilitated the tracking of bacterial pathogens globally. Other recent theoretical and empirical studies have shown that pathogen evolution is significantly influenced by ecological factors, such as the distribution of hosts within the environment and the effects of co- infection. We suggest that the time is ripe for experi- mentalists to use genomics in conjunction with evolu- tionary ecology experiments to further understanding of how bacterial pathogens evolve.

‘Once a miner, always a miner’: Poverty and livelihood diversification in Akwatia, Ghana

This paper offers an alternative viewpoint on why people choose to engage in artisanal mining – the low tech mineral extraction and processing of mainly precious metals and stones – for extended periods in sub-Saharan Africa. Drawing upon experiences from Akwatia, Ghana’s epicentre of diamond production since the mid-1920s, the analysis challenges the commonly-held view that the region’s people are drawn to artisanal mining solely because of a desire ‘to get rich quick’. A combination of events, including the recent closure of Ghana Consolidated Diamonds Ltd’s industrial-scale operation and decreased foreign investment in the country’s diamond industry over concerns of it potentially harbouring ‘conflict’ stones from neighbouring Coˆte D’Ivoire, has had a debilitating economic impact on Akwatia. In an attempt to alleviate their hardships, many of the town’s so-called ‘lifetime’ diamond miners have managed to secure employment in neighbouring artisanal gold mining camps. But their decision has been condemned by many of the country’s policymakers and traditional leaders, who see it solely as a move to secure ‘fast money’. It is argued here, however, that these people pursue work in surrounding artisanal gold mining communities mainly because of poverty, and that their decision has more to do with a desire to immerse in activities with which they are familiar, that offer stable employment and consistent salaries, and provide immediate debt relief. Misdiagnosis of cases such as Akwatia underscores how unfamiliar policymakers and donors are with the dynamics of ASM in sub-Saharan Africa.

Sting jets in intense winter North-Atlantic windstorms

Extratropical cyclones dominate autumn and winter weather over western Europe. The strongest cyclones, often termed windstorms, have a large socio-economic impact due to the strong surface winds and associated storm surges in coastal areas. Here we show that sting jets are a common feature of windstorms; up to a third of the 100 most intense North Atlantic winter windstorms over the last two decades satisfy conditions for sting jets. The sting jet is a mesoscale descending airstream that can cause strong near-surface winds in the dry slot of the cyclone, a region not usually associated with strong winds. Despite their localized transient nature these sting jets can cause significant damage, a prominent example being the storm that devastated southeast England on 16 October 1987. We present the first regional climatology of windstorms with sting jets. Previously analysed sting jet cases appear to have been exceptional in their track over northwest Europe rather than in their strength.

New dimensions in early flood warning across the globe using grand-ensemble weather predictions

Early and effective flood warning is essential to initiate timely measures to reduce loss of life and economic damage. The availability of several global ensemble weather prediction systems through the “THORPEX Interactive Grand Global Ensemble” (TIGGE) archive provides an opportunity to explore new dimensions in early flood forecasting and warning. TIGGE data has been used as meteorological input to the European Flood Alert System (EFAS) for a case study of a flood event in Romania in October 2007. Results illustrate that awareness for this case of flooding could have been raised as early as 8 days before the event and how the subsequent forecasts provide increasing insight into the range of possible flood conditions. This first assessment of one flood event illustrates the potential value of the TIGGE archive and the grand-ensembles approach to raise preparedness and thus to reduce the socio-economic impact of floods.

Embedding arts and humanities in the creative economy: the role of graduates in the UK

The recent change in funding structure in the UK higher education system has fuelled an animated debate about the role that arts and humanities (A&H) subjects play not only within higher education but more broadly in the society and the economy. The debate has engaged with a variety of arguments and perspectives, from the intrinsic value of A&H, to their contribution to the broader society and their economic impact, particularly in relation to the creative economy, through knowledge exchange activities. The paper argues that in the current debate very little attention has been placed on the role that A&H graduates play in the economy, through their work after graduation, and specifically in the creative economy. Using Higher Education Statistical Agency data, we analyse the performance of A&H graduates (compared with other graduates) and particularly explore how embedded they are with the creative economy and its associated industries. The results highlight a complex intersection of different subdisciplines of the A&H with the creative economy but also reveal the salary gap and unstable working conditions experienced by graduates in this field.