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Background: the standard treatment for endemic goiter is usually total thyroidectomy. In low- and middle-income countries, the management of thyroid disease, which is commonplace in fully developed countries, is not always possible. The purpose of this study is to establish a treatment algorithm to calculate the extent of thyroidectomy based on the risk factors of each patient. Methods: this is a retrospective observational study conducted during the period between 2017 and 2019. A total of 287 patients with thyroid pathology were treated in Maragua Hospital (Kenya). The results of surgical treatment were analyzed after the implementation of an individualized treatment protocol. Results: one hundred and sixty patients with different types of goiter underwent surgery: solitary nodule (54.4%), multi-nodular goiter (30.6%), diffuse goiter (10.6%), and intrathoracic goiter (3.8%). The techniques used were hemithyroidectomy (78.8%), Dunhill thyroidectomy (9.4%), bilateral subtotal thyroidectomy (6.9%), and total thyroidectomy (3.1%). There was no mortality. The surgical morbidity rate was 16% (only one major complication (3b)). Two cases of dysphonia were resolved in the first week. There were three cases of symptomatic hypocalcaemia, two of which resolved in the first week and the other of which was definitive. The follow-up at 6 months was 67%. The cancer rate found in the resection specimens was 5%. Discussion: the implementation of individualized surgical protocols for thyroid surgery in sub-Saharan Africa can improve outcomes. The cooperation projects can increase access to complex surgical treatment for patients with limited resources in low- and middle-income countries.

This paper proposes a test statistic for discriminating between two partly non-linear regression models whose parametric components are non-nested. The statistic has the form of a J-test based on a parameter which artificially nests the null and alternative hypotheses. We study in detail the realistic case where all regressors in the non-linear part are discrete and then no smoothing is requiered on the estimating the non-parametric components.We also consider the general case where continuous and discrete regressors are present. The performance of the test in finite samples and discussed in the context of some Monte Carlo experiments. The test is well motivated for specification testing of Engel curves. We provide an application using data from the 1980 Spanish Expenditure Survey. Publicado

This paper presents and discusses a nonparametric test for detecting serial dependence. We consider a Crameer-von Mises statistic based on the difference between the joint sample distribution and the product of the marginals. Exact critical values can be approximated from the asymptotic null distribution, or by resampling, randomly permuting the original series. A Monte Carlo experiment illustrates the test performance with small sample sizes. The paper also includes an application, testing the random walk hypothesis of exchange rate returns for several currencies.

Models for long-memorya time series are considered in which the autocovariance sequence is parameterized only at very long lags or the spectral density is parameterized only at very low frequencies. reently proposed methods for estimating the differencing parameters are reviewed and are applied to an economic time series of sprices of Spain.