Search

Abstract Background Acromegaly is associated with higher morbidity and mortality mainly due to cardiovascular disease. Data on the incidence and evolution of thyroid cancer in acromegaly are controversial. Our objective was to describe the characteristics of a group of acromegalic patients with differentiated thyroid carcinoma (DTC) and analyze their evolution. Methods This is a retrospective multicenter study of 24 acromegalic patients with DTC. The AJCC Staging System 8th Edition was used for TNM staging, and the initial risk of recurrence (RR), initial response and response at the end of follow-up (RFU) were defined according to the 2015 ATA Guidelines. As a control group, 92 patients with DTC without acromegaly were randomly included. Statistical analyses were done using SPSS Statistics 20.0. Results Median age of patients at diagnosis of acromegaly was 49.5 years (range 12–69). The median delay in diagnosis of acromegaly was 3 years (range 0.5–23). Mean baseline IGF-1 level was 2.9 ± 1.1 ULN. Median age at DTC diagnosis was 51.5 years (18–69). At the moment of diagnosis of DTC, 58.3% of the patients had active acromegaly. Median time from DTC diagnosis to acromegaly control was 1.25 years (0.5–7). Mean DTC tumor diameter of the biggest lesion was 14.6 ± 9.2 mm, being multifocal in 37.5%. All tumors were papillary carcinomas, two cases being of an aggressive variety. Lymph node dissection was performed in 8 out of 24 patients and 62.5% had metastases. Only one patient had distant metastases. Radioiodine ablation was given to 87.5% of patients. Nineteen patients (79%) were stage I, four (17%) stage II and one (4%) stage IVb. Initial RR was low in 87% (21/24), intermediate in 9% (2/24) and high in 4% (1/24) patient. RFU was: 83% (19/23) patients with no evidence of disease, 9% (2/23) with indeterminate response, 4% (1/23) with biochemical incomplete response and 4% (1/23) with structural incomplete response, at a median time of FU of 36.5 months. When comparing RFU between acromegalics and controls no statistically significant differences were found. Conclusions Patients with acromegaly and DTC mostly had a low initial RR. When compared with the control group, we found that DTC patients with acromegaly did not have a worse evolution.

SUMMARY The usual clinical presentation of non-functioning pituitary adenoma (NFPA) consists of symptoms of mass effect and hypopituitarism. NFPA is a rare condition in young women and an uncommon complication during pregnancy. We present the outcome of three patients with NFPA during pregnancy. Case 1: a 38-year-old woman was referred at 32nd week of spontaneous pregnancy because of diagnosis of a pituitary macroadenoma discovered in the context of progressive visual loss. Hormonal deficiency and hypersecretion were ruled out. Prolactin levels were high as expected. She developed diplopia and severe headache despite the use of dopamine agonists and corticosteroids, so pregnancy was interrupted at 34th week. After an uncomplicated delivery of a healthy newborn, transsphenoidal surgery was performed. The pathology was consistent with a gonadotroph adenoma. She recovered visual field, and remained with normal pituitary function. Postsurgical tumor remnant increased in size during the follow-up. Case 2: a 34-year-old woman was referred due to secondary amenorrhea and galactorrhea. A macroadenoma with suprasellar extension was discovered. Transsphenoidal surgery confirmed a gonadotroph adenoma. Two years after surgery she had a normal pregnancy. Six years after surgery a small tumor recurrence occurred. Case 3: a 23-year-old woman was referred due to a microincidental pituitary adenoma. Laboratory testing was normal. No findings on physical examination. A wait and see approach was decided. Two years after diagnosis, the patient got pregnant without complications. Image remained stable. This article may contribute new cases and provides an extensive review of NFPA during pregnancy.

BackgroundInternet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing. ObjectiveThis observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web. MethodsWe recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it. ResultsWe found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test. ConclusionsDespite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web.

Objetivo: evaluar y comparar valores de facetas de desgaste y de cortisol salival en niños con y sin bruxismo posible y con bajos y altos niveles de inestabilidad emocional. Métodos: Se recolectaron datos en 17 niños sanos con bruxismo posible (B) según la lista de comportamientos orales de los Criterios Diagnósticos para Trastornos Temporomandibulares, diferenciando bruxismo de sueño (BS) y de vigilia (BV). Se aparearon por género y edad con un grupo control, sin reporte de bruxismo (C). Cinco odontopediatras identificaron facetas de desgaste con el índice de desgaste dentario (IDD) (kappa interobservador 0,94). El dosaje de cortisol se realizó con saliva completa matinal mediante electro-quimio-luminiscencia. La inestabilidad emocional (Ie) se evaluó en los mayores de 8 años con el cuestionario “Big Five” de personalidad para niños y adolescentes. Resultados: La edad media fue 11,3±2,7, con 59,6 % de género femenino. En el grupo de bruxismo; Original35,3 % reportó BS, 35,3 % BS + BV y 29,4 % BV. No se hallaron diferencias en el desgaste promedio para dientes primarios (p=0,3858) ni para permanentes (p=0,7478) entre ambos grupos. La media de cortisol salival fue 0,181 ± 0,183 para el grupo de estudio y 0,183 ± 0,161 para el grupo control (p=0,9863). Para la Inestabilidad emocional baja la media de niveles de cortisol fue 0,142 ± 0,08 ug/dl y en Ie alta 0,149 ± 0,07 (p=0,0437). Todos los pacientes con BS + BV, presentaron inestabilidad emocional alta (p= 0,006). Conclusiones: El desgaste en ambas denticiones no mostró diferencias significativas. Los valores de cortisol salival obtenidos en este estudio no permitirían considerarlo factor relevante para el diagnóstico de bruxismo. En condiciones de inestabilidad emocional extremas se hallaron diferencias en los niveles de cortisol salival y en la frecuencia que reportan ambos tipos de bruxismo.

La Dentinogénesis Imperfecta es una anomalía dentaria determinada genéticamente y caracterizada clínicamente por una apariencia ámbar opalescente de la dentina. Se presenta la resolución clínica, con seguimiento y control a 12 años de un paciente de 3 años de edad al momento de la consulta, con diagnóstico de Dentinogénesis Imperfecta tipo I asociada a Osteogénesis Imperfecta tipo IB. La identificación temprana de esta entidad y el tratamiento oportuno y multidisciplinario, contribuyen a mejorar el pronóstico de la misma.

BackgroundLatina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors—one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). ObjectiveThe objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. MethodsEighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. ResultsOn average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie,

Objective: To evaluate and compare the degree of tooth wear and salivary cortisol levels in bruxing and non-bruxing children with low and high levels of emotional instability. Methods: Data were collected from a sample of 17 healthy children with possible bruxism (B) according to the Oral Behaviors Checklist (OBC) of the Diagnostic Criteria for Temporomandibular Disorders differentiating sleep (BS) and wakefulness (BV) bruxism. They were matched by sex and age to a control group without report of bruxism (C). Five pediatric dentists calibrated for the tooth wear index (TWI) (kappa interobserver 0.94) registered the occurrence of incisor/occlusal tooth wear (probable bruxism). The dosage of cortisol was performed in a sample of morning saliva by electrochemiluminescence. Emotional instability was measured by the BFQ Big Five Questionnaire for Children (for children older than 8 years of age). Results: Sample´s mean age was: 11.3 ± 2.7, 59.6 % were female. In bruxism group 35.3 % reported BS, 35.3 % BS + BV and 29.4 % BV. No differences were found between both groups for tooth wear in primary (p=0.3858) and permanent dentition (p=0.7478). In the study group average of cortisol level was 0.181 ± 0.183 and 0.183±0.161 in control group (p=0.9863). Mean cortisol level was 0.142 ± 0.08 ug/dl for low emotional instability, and 0.149 ± 0.07 for high (p=0.0437). All the patients who had both SB and AB were in the high emotional instability group (p=0.006). Conclusions: Tooth wear in both dentitions showed no differences. Results obtained suggest that the dosage of salivary cortisol would not be relevant as a biomarker for the suggestion of bruxism in children. Patients exhibiting extreme conditions of emotional instability, showed significant differences in salivary cortisol levels and in the frequency they reported both types of bruxism.

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Cushing’s disease (CD) is an endocrine disorder originated by a corticotroph tumor. It is linked with high mortality and morbidity due to chronic hypercortisolism. Treatment goals are to control cortisol excess and achieve long-term remission, therefore, reducing both complications and patient’s mortality. First-line of treatment for CD is pituitary’s surgery. However, 30% of patients who undergo surgery experience recurrence in long-term follow-up. Persistent or recurrent CD demands second-line treatments, such as pituitary radiotherapy, adrenal surgery, and/or pharmacological therapy. The latter plays a key role in cortisol excess control. Its targets are inhibition of adrenocorticotropic hormone (ACTH) production, inhibition of adrenal steroidogenesis, or antagonism of cortisol action at its peripheral receptor. Retinoic acid (RA) is a metabolic product of vitamin A (retinol) and has been studied for its antiproliferative effects on corticotroph tumor cells. It has been shown that this drug regulates the expression of pro-opiomelanocortin (POMC), ACTH secretion, and tumor growth in corticotroph tumor mouse cell lines and in the nude mice experimental model, via inhibition of POMC transcription. It has been shown to result in tumor reduction, normalization of cortisol levels and clinical improvement in dogs treated with RA for 6 months. The orphan nuclear receptor COUP-TFI is expressed in normal corticotroph cells, but not in corticotroph tumoral cells, and inhibits RA pathways. A first clinical human study demonstrated clinical and biochemical effectiveness in 5/7 patients treated with RA for a period of up to 12 months. In a recent second clinical trial, 25% of 16 patients achieved eucortisolemia, and all achieved a cortisol reduction after 6- to 12-month treatment. The goal of this review is to discuss in the context of the available and future pharmacological treatments of CD, RA mechanisms of action on corticotroph tumor cells, and future perspectives, focusing on potential clinical implementation.

Antecedentes y objetivos. La esteatosis hepática no alcohólica es la manifestación hepática del síndrome metabólico relacionado con la insulinorresistencia. El factor de crecimiento insulínico tipo 1 (IGF-1) es producido principalmente por los hepatocitos y su secreción está estimulada por la hormona de crecimiento. Nuestro objetivo fue evaluar posibles cambios en los niveles de IGF-1 en pacientes con diferentes estadios ecográficos de esteatosis hepática y su relación con hiperlipidemia, intolerancia a la glucosa, diabetes tipo 2 no insulino-dependiente, circunferencia de cintura, obesidad e hipertensión arterial. Métodos. Fueron evaluados 110 pacientes consecutivos. Resultados. Los niveles de IGF-1 fueron disminuyendo a medida que la esteatosis hepática empeoraba. Encontramos una diferencia estadísticamente significativa entre los grados leve-moderado por un lado, y severo por el otro (142 vs. 110, P < 0,05). El índice de resistencia insulínica (HOMA) y los niveles de insulina mostraron una tendencia de correlación inversa con IGF-1, pero no fue estadísticamente significativo. El HOMA aumentó significativamente en la esteatosis severa cuando se comparó con el estadio leve-moderado (6,20 vs. 3,99, P < 0,05). Los niveles de insulina también mostraron un aumento significativo (3,01±0,61 vs. 2,59±0,56, P < 0,05). El índice de masa corporal (IMC) mostró una significativa correlación inversa con los niveles de IGF-l (r = -0,19, P < 0,05). La circunferencia de cintura aumentó significativamente a medida que la esteatosis empeoraba. Conclusiones. Los niveles de IGF-1 disminuyeron a medida que la esteatosis hepática empeoraba. Esta diferencia fue estadísticamente significativa entre los estadios leve-moderado y severo. La correlación inversa entre IGF-1 e IMC también fueron significativos.

Objective: The My Guide smartphone application was developed to improve quality of life and symptom burden (primary outcomes) for Latina breast cancer survivors (BCS) and tested in a pilot randomized controlled trial compared to an attention-control condition (My Health smartphone application). This secondary analysis examined effects on breast cancer knowledge, coping, and cancer-related self-efficacy (intervention targets).Method: Latina BCS (N = 78) were randomized to My Guide or My Health for six weeks. Linear mixed-effects modeling evaluated the effects of time and study condition on the intervention targets. Effects by engagement were explored. Results: Both conditions showed improved breast cancer knowledge (p < 0.001), with a trend for greatest improvement among My Guide high users (p = 0.082). My Guide participants reported less self-blame overall than My Health participants (p = 0.020). There were no effects on cancer-related self-efficacy (ps > 0.05). Conclusion: Culturally-informed smartphone applications may enhance breast cancer knowledge and promote adaptive coping among Latina BCS. [ABSTRACT FROM AUTHOR]