Revisiting serum thyroglobulin in the follow-up of patients with differentiated thyroid carcinoma

This study analyzed serum thyroglobulin (Tg) during hypothyroidism in 207 patients with differentiated thyroid carcinoma treated with total thyroidectomy and radioiodine ablation and undetectable anti-Tg antibodies. Disease staging was defined by clinical examination, stimulated Tg, pre- and post-ablative radioiodine scanning, and other imaging methods (X-Ray, US, CT and MIBI-scan). The average interval from initial therapy was 2.3 years. 153 patients (74%) had no evident disease, 34 (16.4%) presented neck/mediastinal disease, and 20 (9.6%) had distant metastases (Mt). The best cut-off for Tg was 1 ng/ml, showing 100% sensitivity for distant Mt and 88.2% for local recurrence or lymph node Mt, and 88.8% specificity for any Mt and 74.8% for distant Mt. In patients with Tg <1 ng/ml, 2.8% showed cervical lymph nodes Mt. Cervical or mediastinal disease were 26% of cases with Tg between 1 and 5 ng/ml. Tg from 5 to 10 ng/ml was associated to distant Mt in 14.2% of the cases and others showed lymph nodes Mt. In patients with Tg >10 ng/ml, 51.3% presented distant Mt. We suggest the need for neck US even in cases with Tg <1 ng/ml. In addition, patients with Tg levels <5 ng/ml should be investigated by neck US and mediastinal CT only, and empirical therapy should be limited to patients with a minimum Tg level >5 ng/ml.     

Chronic Pain and Psychological Distress Among Undocumented Latinx Immigrants in the USA

BackgroundUndocumented immigration is often accompanied by multiple and complex stressors, which over time may increase the risk for chronic pain.ObjectiveThis study aimed to identify the prevalence of chronic pain and its association with psychological distress among undocumented Latinx immigrants in the USA.Design/ParticipantsWe used respondent-driven sampling to collect and analyze data from clinical interviews with 254 undocumented Latinx immigrants, enabling inference to a population of 22,000.Main MeasuresChronic pain was assessed using the World Health Organization Composite International Diagnostic Interview (CIDI) Chronic Conditions Module. For all analyses, inferential statistics accounted for design effects and sample weights to produce weighted estimates. We conducted logistic regression analyses to assess the association between chronic pain and psychological distress after controlling for age, years in the USA, and history of trauma.ResultsA total of 28% of undocumented Latinx immigrants reported having chronic pain, and 20% of those had clinically significant psychological distress. Significant differences in the prevalence of chronic pain were reported across age groups, years in the USA, and trauma history. After controlling for relevant covariates, chronic pain was significantly associated with psychological distress (OR = 1.06, 95% CI [1.02, 1.09]), age (OR = 1.05, 95% CI [1.02; 1.09]), and history of trauma (OR = 1.10 per additional traumatic event, 95% CI [1.02; 1.19]; C-statistic = 0.79).ConclusionAmong undocumented Latinx immigrants, chronic pain is significantly associated with psychological distress, older age, and trauma history. Given that undocumented immigrants have restricted access to healthcare and are at high risk for chronic pain, developing alternatives to facilitate access to chronic pain interventions and risk-reduction prevention are needed.KEY WORDS: chronic pain, distress, mental health, undocumented immigrants, Latinx

Chronic pain is a global health concern associated with detrimental pathophysiological, functional, economic, and social consequences.¹ Chronic pain is generally defined as continuous or intermittent pain or discomfort that persists for at least 3 months.² Approximately 1.5 billion people live with chronic pain worldwide, with US national estimates exceeding 100 million.³ Furthermore, in the USA, racial/ethnic disparities exist with regards to experiencing chronic pain.¹ For instance, Latinxs tend to report a lower prevalence of chronic pain and less pain interference with daily functioning when compared with non-Latinx whites, but greater pain severity.⁴ Likewise, disparities between these groups exist in accessing, seeking, and responding to treatment for pain.⁴ Nonetheless, less is known about the prevalence of pain and the pain experience among Latinxs who are hidden or hard-to-reach, such as undocumented immigrants.The undocumented immigration path is often accompanied by multiple and complex stressors, which over time may increase the risk for chronic pain. Hazardous working conditions, limited healthcare access, exploitation, and stigmatization are factors that could make undocumented immigrants vulnerable to chronic pain. For instance, undocumented immigrants are more likely than their documented counterparts to undertake physically demanding jobs in industries with high rates of injuries and exposure to hazardous conditions.^5–7 Non-job-related trauma is another cause of pain in immigrants^8,9—approximately 83% of undocumented immigrants report a lifetime history of trauma.¹⁰ Compounding these problems, limited healthcare access and lack of insurance force immigrants to pay out of pocket for healthcare; turn to unsafe or non-evidence-based healing practices (e.g., herbal remedies, hueseros, or bone/muscle therapy); or neglect healthcare altogether.¹¹ All of the aforementioned risk factors suggest that undocumented immigrants may be vulnerable population to chronic pain.Information about the prevalence of chronic pain among undocumented immigrants is needed to inform prevention, intervention, advocacy, and policy efforts. To our knowledge, no prior studies have addressed chronic pain among undocumented immigrants. Therefore, this study aimed to (1) assess the prevalence of chronic pain and associated vulnerabilities, including history of trauma, among undocumented Latinx immigrants residing near the US–Mexico border and (2) determine whether there is an association between chronic pain and psychological distress in this immigrant population.     

Is conceptual implicit memory impaired in schizophrenia? Evidence from lexical decision and category verification

Introduction. Implicit memory tasks differ along two orthogonal dimensions, tapping the relative involvement of perceptual/conceptual and identification/production processes. Previous studies have documented a dissociation between perceptual (spared) and conceptual (impaired) implicit memory, using in the latter case a production task (category exemplar generation), in which there is high response competition during the retrieval phase. The present study sought to determine whether the perceptual/conceptual dissociation held when comparing two identification tasks, in which there is no response competition at retrieval.

Methods. In two experiments, repetition priming was assessed in 44 schizophrenic patients and 46 healthy controls in lexical decision (a test based on perceptual identification processes) and category verification (a test based on conceptual identification processes).

Results. Schizophrenic patients achieved a priming as high as that of controls in the lexical decision task. In contrast, only controls exhibited significant priming in the category verification task.

Conclusions. It is concluded that schizophrenia is associated with a specific deficit in conceptual implicit memory, irrespective of the degree of response competition in the test phase.     

Digestive endoscopy and portal hypertension. North Italian Endoscopic Club

Improved knowledge of pathophysiology of portal hypertension and technological progress have contributed to development of new endoscopic techniques and pharmacological approaches to treatment of this condition. To put the role of endoscopy in the right perspective, it is important to consider that liver transplantation has greatly modified prognosis of cirrhosis. Because of the increase of indications for transplantation, these complications are no longer regarded as the last, but rather as an intermediate stage before a possible transplantation. We have reviewed some pathophysiologic, diagnostic and therapeutic aspects on portal hypertension, especially the role of endoscopy in diagnosis, natural history and therapeutic options for complications of cirrhosis. In addition to sclerotherapy, new endoscopic methods have been developed, with a low complication rate and possibility of being applied for treatment of gastric varices, i.e. injection of tissue adhesives and rubber band ligation. Besides oesophageal varices, gastric varices and portal hypertensive gastropathy (and portal colopathy) are important findings in cirrhosis. Further information is needed on natural history and treatment of these conditions. Digestive haemorrhage is the most important consequence of portal hypertension, so treatment should be aimed at controlling acute bleeding, rebleeding and, more important, at preventing first haemorrhagic episode. Good results will probably be obtained using a combination of drugs, a combination of endoscopic methods or a combination of both. All will need evaluation in randomised, controlled trials. These considerations renew interest in strategies for diagnosis and treatment of portal hypertension and a multidisciplinary approach may be necessary, involving gastroenterologists, endoscopists, interventionist radiologists and surgeons, ideally in a departmental environment.     

Primary versus post-treatment apical periodontitis: microbial composition,lipopolysaccharides and lipoteichoic acid levels,signs and symptoms

Clinical Oral Investigations - To compare the microbial load and composition and to determine the lipopolysaccharides (LPS) and lipoteichoic acid (LTA) concentrations found in primary apical...     

Long‐term dexamethasone treatment alters the histomorphology of acinar cells in rat parotid and submandibular glands

Glucocorticoids (GCs) induce insulin resistance (IR), a condition known to alter oral homeostasis. This study investigated the effects of long‐term dexamethasone administration on morphofunctional aspects of salivary glands. Male Wistar rats received daily injections of dexamethasone [0.1 mg/kg body weight (b.w.), intraperitoneally] for 10 days (DEX), whereas control rats received saline. Subsequently, glycaemia, insulinaemia, insulin secretion and salivary flow were analysed. The parotid and submandibular glands were collected for histomorphometric evaluation and Western blot experiments. The DEX rats were found to be normoglycaemic, hyperinsulinaemic, insulin resistant and glucose intolerant (P < 0.05). DEX rat islets secreted more insulin in response to glucose (P < 0.05). DEX rats had significant reductions in the masses of the parotid (29%) and submandibular (16%) glands (P < 0.05) that was associated with reduced salivary flux rate. The hypotrophy in both glands observed in the DEX group was associated with marked reduction in the volume of the acinar cells in these glands of 50% and 26% respectively (P < 0.05). The total number of acinar cells was increased in the submandibular glands of the DEX rats (P < 0.05) but not in the parotid glands. The levels of proteins related to insulin and survival signalling in both glands did not differ between the groups. In conclusion, the long‐term administration of dexamethasone caused IR, which was associated with significant reductions in both mass and flux rate of the salivary glands. The parotid and submandibular glands exhibited reduced acinar cell volume; however, the submandibular glands displayed acinar hyperplasia, indicating a gland‐specific response to GCs. Our data emphasize that GC‐based therapies and insulin‐resistant states have a negative impact on salivary gland homeostasis.