Reclassification of risk in an emergency referral center: the need for a specific tool for the classification of onco-hematological patients. A cross-sectional study

Abstract Background In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador. Methods From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records. Results Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients’ median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15–5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine. Conclusion Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.

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The relationship between pulmonary and swallowing functions in patients with neuromuscular diseases followed up by a tertiary referral center: a cross-sectional study

Logopedics Phoniatrics Vocology ◽

10.1080/14015439.2021.1879254 ◽

2021 ◽

pp. 1-7

Author(s):

Max Sarmet ◽

Laura Davison Mangilli ◽

Geovanna Pereira Costa ◽

Juliana Peres Ribeiro Soares Paes ◽

Vitor Martins Codeço ◽

...

Keyword(s):

Neuromuscular Diseases ◽

Cross Sectional Study ◽

Sectional Study ◽

Tertiary Referral ◽

Cross Sectional ◽

Tertiary Referral Center ◽

Referral Center ◽

The Relationship

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Role of Computed Tomography in Imaging and Classification of Acute Pancreatitis based on Revised Atlanta Classification: A 1-year Hospital-based Cross-sectional Study

International Journal of Contemporary Medicine Surgery and Radiology ◽

10.21276/ijcmsr.2018.3.2.34 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

Virupaxi. V. Hattiholi ◽

Sandhya A Yadav

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Dermatoses among patients aged 60 years and above attending a tertiary referral center: A cross-sectional study from North Kerala

Journal of Skin and Sexually Transmitted Diseases ◽

10.25259/jsstd_52_2020 ◽

2021 ◽

Vol 0 ◽

pp. 1-7

Author(s):

Muhammed Kutty Simin ◽

Sarita Sasidharanpillai ◽

Uma Rajan ◽

Najeeba Riyaz

Keyword(s):

Fungal Infections ◽

Significant Proportion ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Tertiary Referral ◽

Cross Sectional ◽

Tertiary Referral Center ◽

Referral Center ◽

Life Expectancy At Birth

Objectives: With the rise in life expectancy at birth, geriatric population contributes to a significant proportion of those seeking medical aid. Skin problems in the elderly are very common and vary according to region and ethnicity. It is essential for dermatologists to have a better understanding of the pathophysiology of geriatric skin disorders to formulate quality management guidelines. This study was undertaken to document the frequency and the clinical pattern of various physiological and pathological changes in the elderly skin. Materials and Methods: A cross-sectional study was carried out in 200 consecutive patients aged 60 years and above and who attended the Dermatology outpatient clinic of a tertiary referral center in North Kerala. A pre-set pro forma was used to document the patient characteristics, the comorbidities, the medications used, and the clinical findings. Results: All the study participants (100%) had one or more dermatoses. The age of the study population ranged from 60 to 89 years (mean 67.7 ± 6.2 years). This was a female preponderant study with a female to male ratio of 1.4:1. Hypertension (36%), hyperlipidemia (27%) and diabetes mellitus (26%) were the common comorbidities observed. Graying of hair was the most common physiological change, followed by wrinkling. Pruritus was the most common presenting complaint (136, 68%). Statistically significant association was noted between xerosis and generalized pruritus. Fungal infections (30.5%) outnumbered other infections and infestations. Changes of severe photoaging were less frequent. One patient had skin malignancy (basal cell carcinoma). Significant association was noted between photoaging and male sex, smoking, and sun exposure. Limitations: Study conducted in a tertiary referral center not reflecting the status in the community was the major limitation. Conclusion: Photoaging and skin cancers are less frequent in darker skin type. Healthy lifestyle, nutritious diet, frequent application of emollient, better skin care, and judicious use of sunscreen can delay the process of cutaneous aging. More prospective studies in different population groups may go a long way in improving the current knowledge about the less known aspects of geriatric dermatoses.

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Role of MRI in the Diagnosis and Pre-Operative Classification of Perianal and Anal Fistulas - A Cross-Sectional Study, Southern Rajasthan

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/574 ◽

2021 ◽

Vol 8 (33) ◽

pp. 3156-3162

Author(s):

Hari Ram Jat ◽

Neel Patel ◽

Sitaram Barath ◽

Pooja Yadav

Keyword(s):

Perianal Fistula ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Anal Fistulas ◽

Chi Square ◽

Cross Sectional ◽

Perianal Fistulas ◽

Operative Assessment

BACKGROUND Perianal fistulas account for a substantial discomfort and morbidity to the patient thus affecting productive man hours and quality of life. Accurate pre-operative assessment of course of the primary fistulous track and secondary extension or abscesses is required for successful surgical management of anal fistulas. The purpose of this study was to diagnose and classify pre-operative perianal fistulas. METHODS This is a cross-sectional study at Department of Radiodiagnosis in a tertiary level hospital of southern Rajasthan from November 2018 to November 2020. The study included a total of 50 patients referred to department of radiology for magnetic resonance imaging (MRI). Statistical analysis was done using chi square test and student t test. RESULTS Out of these patients, 56 % were having secondary tract on MRI, 12 % patients were having abscess and 4 % were having horseshoe abscess on MRI. The commonest type of ano-rectal fistula encountered in the study was Grade -II seen in 32 %. CONCLUSIONS MRI is a highly accurate, rapid and non-invasive tool in pre-operative evaluation of the perianal and anal fistulas. MRI evaluation and classification of perianal fistulae has a high degree of diagnostic accuracy. The use of MRI for the diagnosis and classification of perianal fistula can provide reliable information which has both pre-operative and prognostic value. St James University Hospital classification, which is an MR imaging-based grading system for perianal fistula is very useful for effective radiological-surgical communication thus contributing to improved patient care and reduced rate of recurrence. KEYWORDS MR Fistulogram, Perianal Fistula, Anal Fistula, Fistula Classification, Fistulography

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Quality of life in adolescents with primary headaches

Paediatrica Indonesiana ◽

10.14238/pi53.6.2013.350-4 ◽

2013 ◽

Vol 53 (6) ◽

pp. 350

Author(s):

Naomi Riahta ◽

Muhammad Ali ◽

Bistok Saing ◽

Yazid Dimyati ◽

Johannes Saing

Keyword(s):

Quality Of Life ◽

Cross Sectional Study ◽

Primary Headaches ◽

Sectional Study ◽

Quality Oflife ◽

Cross Sectional ◽

The Mean ◽

Common Problems

Background Headaches are common problems in adults,adolescents, and children. Headaches impact a child's life, theirfamily life, and even society. An assessment of quality of life inadolescents with primary headaches may help to determine actionsnecessary to improve the quality of life of these patients.Objective To assess the quality oflife of adolescents with primaryheadach es compared to healthy adolescents.Methods We conducted a cross-sectional study in December2009 on adolescents aged 13 to 18 years. The headache groupconsisted of children with primary headaches according to theInternational Classification of Headache Disarders and the controlgroup consisted of healthy adolescents. Subjects were selected byconsecutive sampling, with 75 subjects in each group. Subjectsfilled the Pediatric Quality of Life Inventary version 4.0 (PedsQL4.0) questionnaire.Results The mean PedsQL total score was significantly lowerin the headache group than in the contra 1 group [ l 7 5. 7 vs.392.2, respectively, (95%CI of differences -28.l to -219.3, P =0.001)]. However, out of23 items in the questionnaire, 9 werenot significantly different between the headache and controlgroups.Conclusions Primary headaches in adolescents is associatedwith lower quality of life. Most quality of life domains scoresare significantly lower in adolescents with primary headachescompared to those without primary headaches.

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