MON-456 Clinical Profile of Thyroid Papillary Microcarcinoma in Brazil

Abstract INTRODUCTION: The thyroid papillary microcarcinoma (TPMC) is defined as a tumor ≤ 1 centimeter. This variant of thyroid papillary carcinoma is generally characterized by slow progression and minimal invasion. Although the TPMC subtype usually has good prognosis, itʼs early recognition has clinical relevance because it may present with regional lymph node metastasis, as well as increased risk of recurrence. AIM OF THE STUDY: The aim of the study is to identify the epidemiologic profile of the population diagnosed with TPMC, as well as the signs and symptoms observed in these patients. This study intends to guide early clinical suspicion of thyroid tumors; in order to propose assertive forms of management and prevention of undesirable outcomes. PATIENTS AND METHODS: Retrospective cohort study based on medical records of patients diagnosed with TPMC at University Hospital of Brasilia-Brasil, from 1999 to 2017. The clinical aspects analysed were: gender; race; age of the patient when the diagnosis was made; symptoms reported by the patients regarding the pathology and comorbidities. RESULTS: Fifty-eight patients who underwent thyroidectomy for variable thyroid criteria were included in this study. 87,93% were women, (seven fold higher female prevalence of the TPMC). Mean age of diagnosis was 42, 94 ± 11,4. Regarding the race, the majority of the patients had self-entitled as mixed race, which corresponds to 39,65% of the sample. Symptoms reported included dysphagia (29,31%), dyspnea (17,24%) and feeling of neck compression (13,79%). Even though these aspects of the clinical approach are significant diagnosis tools, only 26,5% of the patients in this sample attested those kinds of signs/symptoms. Considering that actual clinical manifestation is relatively rare, total inclusion of the anatomic specimen is useful in this unsettling scenarios. Among the most commonly reported comorbidities, benign thyroid affections were the most prominent, such as multinodular goiter and hypothyroidism. CONCLUSION: Analysis of the data endorses that the TPMC does not have a well defined clinic presentation. Nonetheless, dysphagia is the most reported symptom. Analysis of the data pointed to a higher prevalence of the pathology in women in their 40s, which can be used as parameter of investigation on patients that have symptoms that cannot be explained by other pathologies. Although TPMC usually presents with good prognosis, the non incidental groups may present with aggressive behavior and should be treated as papillary thyroid carcinoma. Despite that, fine needle aspiration and ultrassonografy are the preferable methods in the evaluation of thyroid tumors.

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Epidemiological Trends in Attempted Suicide in Adolescents and Young Adults Between 1996 and 2004

Crisis ◽

10.1027/0227-5910.30.3.115 ◽

2009 ◽

Vol 30 (3) ◽

pp. 115-119 ◽

Cited By ~ 10

Author(s):

Stephanie De Munck ◽

Gwendolyn Portzky ◽

Kees Van Heeringen

Keyword(s):

Young Adults ◽

Attempted Suicide ◽

Suicide Attempts ◽

Epidemiological Studies ◽

Adolescents And Young Adults ◽

University Hospital ◽

International Studies ◽

Suicide Attempters ◽

Increased Risk ◽

Epidemiological Trends

Background: Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. Aims: This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). Methods: Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. Results: Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. Conclusions: The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.

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THE USE OF MEDICINES IN TREATING HYPERTENSION IN HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.2.11 ◽

2016 ◽

pp. 76-84

Author(s):

Khoa Bao Chau Thai ◽

Thi Hong Phuong Vo

Keyword(s):

Blood Pressure ◽

Channel Blocker ◽

Enzyme Inhibitor ◽

Antihypertensive Drugs ◽

Good Prognosis ◽

Target Blood Pressure ◽

University Hospital ◽

Key Words Hypertension ◽

Cross Sectional ◽

Positive Effects

Background: Hypertension is a common condition in the world as well as in Viet Nam. If hypertension isn’t treated well, it can cause many serious complications. Controlling target blood pressure will bring positive effects on reducing mortality rate and also disabilities caused by diseases related to hypertension. Objectives: (1) Analyzing the use of medicines in treating hypertension. (2) Evaluating the effects of medicine usage in treating hypertension at the hospital of Hue University of Medicine and Pharmacy. Materials and methods: 388 patients were diagnosed as having hypertension with inpatient care at the Cardiovascular Department of Hue University of Medicine and Pharmacy’s hospital, using cross-sectional descriptive study methods. Results: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. Angiotensin converting enzyme inhibitor and calcium channel blocker were the two most popular drug groups (96.6% and 71.4%, respectively). The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens in both initial therapies (64.7%>35.3%) and final therapies (61.9%>38.1%). The rate of patients having interactions between antihypertensive drugs and the other kinds of drugs was 7.5%. The rate of patients having reasonable prescriptions was 84.3%. Evaluating the effects of medicine usage in treatments showed that the rate of patients reaching target blood pressure before leaving the hospital was 67.3%. Most patients were evaluated as having good prognosis after treatment, up to 81.7%. Conclusions: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens. The rate of drug interactions was quite low; most patients were evaluated as having good prognosis after treatment. Key words: hypertension, antihypertensive drugs.

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Bilateral Psoas Muscle Abscess Associated with Emphysematous Cystitis

Case Reports in Medicine ◽

10.1155/2015/285652 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jae-Ki Choi ◽

Jae-Cheol Kwon

Keyword(s):

Urinary Tract ◽

Early Recognition ◽

Interventional Procedure ◽

Psoas Muscle ◽

Good Prognosis ◽

Emphysematous Pyelonephritis ◽

Perinephric Abscess ◽

Emphysematous Cystitis ◽

Tract Infections ◽

Prolonged Antibiotic Therapy

Psoas muscle abscess associated with emphysematous urinary tract infection is very rare. There were very few reports about urinary tract infections such as renal abscess, perinephric abscess, and emphysematous pyelonephritis complicated with psoas muscle abscess; however, psoas muscle abscess associated with emphysematous cystitis has not yet been reported. Here, we report a case of bilateral posas muscle abscess following emphysematous cystitis in an 81-year-old nondiabetic man, who was treated successfully with prolonged antibiotic therapy and supportive care. Early recognition of psoas muscle abscess can prevent aggressive interventional procedure and warrant good prognosis.

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Early recognition of PIMS-TS: a single centre retrospective review

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-001011 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001011

Author(s):

Roshni Mistry ◽

Nicola Scanlon ◽

James Hibberd ◽

Fionnghuala Fuller

Keyword(s):

Early Recognition ◽

Febrile Illness ◽

Final Diagnosis ◽

University Hospital ◽

Single Centre ◽

Retrospective Case ◽

Reactive Protein ◽

Review Reports ◽

Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

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Caspase-14—From Biomolecular Basics to Clinical Approach. A Review of Available Data

International Journal of Molecular Sciences ◽

10.3390/ijms22115575 ◽

2021 ◽

Vol 22 (11) ◽

pp. 5575

Author(s):

Agnieszka Markiewicz ◽

Dawid Sigorski ◽

Mateusz Markiewicz ◽

Agnieszka Owczarczyk-Saczonek ◽

Waldemar Placek

Keyword(s):

Cell Death ◽

Physiological Role ◽

Skin Barrier ◽

Clinical Aspects ◽

Clinical Approach ◽

Search Term ◽

Caspase Family ◽

Skin Conditions ◽

Theoretical Science

Caspase-14 is a unique member of the caspase family—a family of molecules participating in apoptosis. However, it does not affect this process but regulates another form of programmed cell death—cornification, which is characteristic of the epidermis. Therefore, it plays a crucial role in the formation of the skin barrier. The cell death cycle has been a subject of interest for researchers for decades, so a lot of research has been done to expand the understanding of caspase-14, its role in cell homeostasis and processes affecting its expression and activation. Conversely, it is also an interesting target for clinical researchers searching for its role in the physiology of healthy individuals and its pathophysiology in particular diseases. A summary was done in 2008 by Denecker et al., concentrating mostly on the biotechnological aspects of the molecule and its physiological role. However, a lot of new data have been reported, and some more practical and clinical research has been conducted since then. The majority of studies tackled the issue of clinical data presenting the role of caspase in the etiopathology of many diseases such as retinal dysfunctions, multiple malignancies, and skin conditions. This review summarizes the available knowledge on the molecular and, more interestingly, the clinical aspects of caspase-14. It also presents how theoretical science may pave the way for medical research. Methods: The authors analyzed publications available on PubMed until 21 March 2021, using the search term “caspase 14”.

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Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project

Open Heart ◽

10.1136/openhrt-2020-001554 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001554

Author(s):

Laura H van Dongen ◽

Peter P Harms ◽

Mark Hoogendoorn ◽

Dominic S Zimmerman ◽

Elisabeth M Lodder ◽

...

Keyword(s):

Cardiac Arrest ◽

Prognostic Model ◽

Early Recognition ◽

Sudden Cardiac Arrest ◽

Clinical Genetic ◽

Innovative Strategy ◽

Rare Variant Analysis ◽

Increased Risk ◽

Gp Care

IntroductionEarly recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information.AimTo describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA.MethodsThe RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA.ConclusionThe RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.

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Causes of death and comorbidities in hospitalized patients with COVID-19

Scientific Reports ◽

10.1038/s41598-021-82862-5 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 3

Author(s):

Sefer Elezkurtaj ◽

Selina Greuel ◽

Jana Ihlow ◽

Edward Georg Michaelis ◽

Philip Bischoff ◽

...

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Pulmonary Infection ◽

Diffuse Alveolar Damage ◽

University Hospital ◽

Health Conditions ◽

Teaching Hospitals ◽

Increased Risk ◽

Clinical Records ◽

Full Body

AbstractInfection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.

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Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

BMC Infectious Diseases ◽

10.1186/s12879-021-05914-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Damlin ◽

Katarina Westling

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Clinical Characteristics ◽

National Registry ◽

Injection Drug ◽

University Hospital ◽

Prosthetic Heart Valves ◽

Increased Risk ◽

History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P < 0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P < 0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P < 0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P < 0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P < 0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P < 0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P < 0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P < 0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P < 0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

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Individuals with familial hypercholesterolemia have increased risk of re-hospitalization after acute myocardial infarction compared with controls

European Heart Journal ◽

10.1093/ehjci/ehaa946.2962 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Svendsen ◽

H.W Krogh ◽

J Igland ◽

G.S Tell ◽

L.J Mundal ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Familial Hypercholesterolemia ◽

Cox Regression ◽

Public Institution ◽

University Hospital ◽

Funding Source ◽

Hazard Ratios ◽

Increased Risk ◽

University Of Oslo

Abstract Background and aim We have previously reported that individuals with familial hypercholesterolemia (FH) have a two-fold increased risk of acute myocardial infarction (AMI) compared with the general population. The consequences of having an AMI on re-hospitalization and mortality are however less known. The aim of the present study was to compare the risk of re-hospitalization with AMI and CHD and risk of mortality after incident (first) AMI-hospitalization between persons with and without FH (controls). Methods The original study population comprised 5691 persons diagnosed with FH during 1992–2014 and 119511 age and sex matched controls randomly selected from the general Norwegian population. We identified 221 individuals with FH and 1947 controls with an incident AMI registered in the Norwegian Patient Registry (NPR) or the Cardiovascular Disease in Norway Project during 2001–2017. Persons with incident AMI were followed until December 31st 2017 for re-hospitalization with AMI or coronary heart disease (CHD) registered in the NPR, and for mortality through linkage to the Norwegian Cause of Death Registry. Risk of re-hospitalization was compared with sub-hazard ratios (SHR) from competing risk regression with death as competing event, and mortality was compared using hazard ratios (HR) from Cox regression. All models were adjusted for age. Results Risk of re-hospitalization was 2-fold increased both for AMI [SHR=2.53 (95% CI: 1.88–3.41)] and CHD [SHR=1.82 (95% CI: 1.44–2.28)]. However, persons with FH did not have increased 28-day mortality following an incident AMI (HR=1.05 (95% CI: 0.62–1.78), but the longer-term (>28 days) mortality after first AMI was increased in FH [HR=1.45 (95% CI: 1.07–1.95]. Conclusion This study yields the important finding that persons with FH have increased risk of re-hospitalization of both AMI and CHD after incident AMI. These findings call for more intensive follow-up of individuals with FH after an AMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Oslo and Oslo University Hospital

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GCT-10. CAN HIGH LEVEL SERUM hCG-β BE CONSIDERED EQUIVALENT TO A DIAGNOSIS OF CHORIOCARCINOMA IN PRIMARY CENTRAL NERVOUS SYSTEM GERM-CELL TUMOR?

Neuro-Oncology ◽

10.1093/neuonc/noaa222.231 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii329-iii330

Author(s):

Hiroaki Motegi ◽

Shigeru Yamaguchi ◽

Yukitomo Ishi ◽

Michinari Okamoto ◽

Akihiro Iguchi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Germ Cell ◽

Germ Cell Tumor ◽

Good Prognosis ◽

Cell Tumor ◽

University Hospital ◽

Kaplan Meier ◽

Beta Human Chorionic Gonadotropin ◽

High Level

Abstract BACKGROUND Primary central nervous system(CNS) choriocarcinoma(CC) is very rare and has the poorest prognosis among germ cell tumor (GCT). CC usually has extremely high level (HL) of serum beta-human chorionic gonadotropin (bhCG) over than 1,000 mIU/ml. Some studies assign HL bhCG cases to poor prognosis group even without biopsy. The purpose of this study was to find out if there was a good prognosis subset in the HL bh group. MATERIALS AND METHODS We analyzed 103 cases diagnosed with GCT from 1998 to 2019 in Hokkaido University Hospital and reviewed the literature of CNS CC and bhCG. Survival was assessed using Kaplan-Meier method and log-rank statistics between the group with CC component and that with no CC component but HL bhCG. RESULTS One out of 103 our cases was diagnosed as a mixed GCT with CC component and did not respond to treatment and died 9 months later. Two cases were treated as CC because of HL bhCG (1,226 and 2,739 mIU/ml) despite that the biopsy showed only germinomas and survived(105 and 37 months), that is, no CC component. Combining our cases with 69 cases in the literature, all 7 cases with no CC component but HL bhCG survived but the median survival of the other 65 cases with CC component was 38.2 months (P=0.02). CONCLUSION This study has a limitation of selection bias, however, it suggests that patients with no CC component but HL bhCG may have a better prognosis.

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