scholarly journals Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Jessica Hier ◽  
Galit Avior ◽  
Marc Pusztaszeri ◽  
Joshua R. Krasner ◽  
Noura Alyouha ◽  
...  
Keyword(s):  
Chart Review ◽  
Thyroid Nodules ◽  
Retrospective Chart Review ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Control Group ◽  
Molecular Testing ◽  
Pathology Report ◽  
Mcgill University ◽  
University Teaching Hospitals

Abstract Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed. Methods A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups. Results When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186). Conclusions In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding. Graphical abstract

Maternal mortality in the last triennium of the Millennium Development Goal Era at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

2017 ◽  
Vol 38 (2) ◽  
pp. 189-193 ◽  
Author(s):  
Ibraheem Olayemi Awowole ◽  
Olusegun Olalekan Badejoko ◽  
Oluwafemi Kuti ◽  
Omotade Adebimpe Ijarotimi ◽  
Oluwaseun Oludotun Sowemimo ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Millennium Development Goal ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Development Goal ◽  
University Teaching Hospitals

Suspected Down Syndrome in one of non-identical twins in Ile-Ife: A case report

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Akaninyene Eseme Ubom ◽  
Keyword(s):  
Down Syndrome ◽  
Trisomy 21 ◽  
Advanced Maternal Age ◽  
Identical Twins ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Nigerian Women ◽  
Chromosomal Disorder ◽  
Port Harcourt ◽  
University Teaching Hospitals

Nigerian women of southwest extraction have the highest rate of dizygotic twinning worldwide, with a reported incidence as high as 49 per 1000 deliveries. Among the risk factors for dizygotic twinning is advanced maternal age, which is also an independent risk factor for Down syndrome (trisomy 21). Down syndrome is the most common chromosomal disorder affecting live born neonates. It occurs very rarely in twins, seen in 14-15 per million non-identical twins. Down syndrome in one of non-identical twins was first reported in Nigeria by Otaigbe in Port Harcourt, in 2007. Herein, we report another case of suspected Down syndrome in one of non-identical twins born to a 41-year-old grand multiparous woman at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria. Keywords: Down Syndrome; dizygotic; fraternal; dichorionic; diamniotic.

scholarly journals Trainees need more psychiatric teaching sessions and role models: exposure to psychiatry in the Foundation Programme

2013 ◽  
Vol 37 (6) ◽  
pp. 207-209
Author(s):  
Adam Moreton ◽  
Andrew Collier
Keyword(s):  
Role Models ◽  
Active Role ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Clinical Implications ◽  
General Hospitals ◽  
Foundation Programme ◽  
The Mean ◽  
University Teaching Hospitals ◽  
North Western

Aims and methodTo determine the provision of teaching in psychiatry for foundation doctors up to the point of making specialty applications. Data for the cohort of foundation doctors entering training in 2010 were collected from teaching programmes across the Mersey Deanery and North Western Foundation Schools.ResultsIn the 17 hospitals that provided data, ‘protected teaching’ totalled 2354 h; 1.8% of time was dedicated to psychiatry, with 4 hospitals providing no teaching on mental health topics. The mean duration of psychiatry teaching was higher in university teaching hospitals (3 h 34 min) than district general hospitals (2 h 57 min); and almost a quarter of teaching sessions were titled only ‘psychiatry’.Clinical implicationsFor many foundation doctors their only experience of psychiatry will be through teaching sessions, and this is potentially the only time to change opinions and build interest in the specialty. Psychiatrists need to take a more active role in the provision of high-quality teaching for foundation doctors and become the visible role models which are currently lacking.

A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls

2016 ◽  
Vol 30 (2) ◽  
Author(s):  
Ellen N. Jopling ◽  
Sarosh Khalid-Khan ◽  
Shivani F. Chandrakumar ◽  
Shira C. Segal
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mortality Rate ◽  
Chart Review ◽  
Adult Population ◽  
Retrospective Chart Review ◽  
Borderline Personality ◽  
Control Group ◽  
Disruptive Disorders

Abstract With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%–20% of the patients in mental health outpatient facilities and 15%–40% in mental health inpatient facilities. Further, while 75%–80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.

scholarly journals P0597TRAINING IS NOT ENOUGH: RESISTANCE TO THE APPLICATION OF THE AGREED CRITERIA (KDIGO) FOR THE DIAGNOSIS OF ACUTE KIDNEY INJURY IN INTENSIVE CARE UNITS IN EGYPT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Samar Abd ElHafeez ◽  
Yasmine Naga ◽  
Graziella D'arrigo ◽  
Giovanni Tripepi ◽  
Carmine Zoccali
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Diagnosis ◽  
Kidney Injury ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Icu Admission ◽  
Kdigo Guidelines ◽  
University Teaching Hospitals

Abstract Background and Aims Acute kidney injury (AKI) is one of the most serious complications of patients admitted to intensive care units (ICUs). It is associated with high short- and long-term mortality and resource utilization. The definition of AKI has been established by the KDIGO guidelines based on changes in serum creatinine, urine output or both. However, in clinical practice physicians may ignore the standard criteria and rely on clinical judgement. We therefore aimed to assess the degree of physicians’ compliance with the KDIGO guidelines in diagnosis of AKI. Method We collected data (demographic, clinical, and biochemical) in a multicenter prospective cohort study from all adults admitted to ICUs (10 surgical and 8 medical) units at Alexandria University Teaching Hospitals from February 1st, 2016 till August 1st, 2016. Alexandria Teaching Hospitals cover four governorates of Northern Egypt and serve approximately 14 million people. Doctors were preliminarily instructed to apply KDIGO criteria for the diagnosis of AKI. Personal and clinical experience data were collected from the treating physicians. We followed patients for thirty days from study entry until discharge, death or study end. Written informed consent was obtained from all participants. AKI was defined and classified based on KDIGO 2012 criteria. In parallel, we registered the actual clinical diagnosis made by the treating physicians. We used frequencies and means for qualitative and quantitative variables as appropriate. Results The study included 532 patients who were on average 46 year old (±18), 41.7% were males, 23.5% with smoking, 23.1% had diabetes, 34.8%, were hypertensive, 11.3 % with pre-existing chronic kidney disease, and 30.1% had cardiovascular diseases. There were 140 physicians responsible for treating the enrolled subjects, with mean age 30 ±3 years, 57% were males, 20% were nephrologists, and the median years of experience was 3 years (inter-quartile range: 2-4years). The AKI incidence was 62.2% according to KDIGO criteria versus 49.9% based on the clinical diagnosis of treating physicians. Among those not reported to have AKI by the treating physicians; 19.1% were in stage 1, 26.4% in stage 2, and 12.9% in stage 3 AKI based on KDIGO. About 24% of patients who had AKI at ICU admission and 15% of those who developed AKI after ICU admission were not appropriately identified as AKI patients according to the physicians. There was a significant association between the physician speciality (nephrology vs other specialties) and the correct AKI diagnosis based on KDIGO criteria (X2=47.06, p<0.001). Conclusion To streamline a correct and timely identification of AKI, treating physicians in ICUs at a large hospital in North Africa, like the Alexandria University Teaching Hospitals in Egypt, need well focused training and knowledge verification post training on KDIGO guidelines for identifying AKI patients. Implementation of electronic alerts could help in proper diagnosis and management.

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