Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution

2017 ◽  
Vol 30 (10) ◽  
Author(s):  
Courtney Olmsted ◽  
Rajalakshmi Arunachalam ◽  
Xiang Gao ◽  
Liuska Pesce ◽  
Geeta Lal
Keyword(s):  
Radioactive Iodine ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Free Survival ◽  
Care Institution ◽  
Group A ◽  
Tertiary Care Institution ◽  
Group B ◽  
Over 40 Years

AbstractBackground:This study aims to analyze changes in characteristics, practice and outcomes of pediatric differentiated thyroid cancer (DTC) at our tertiary care institution.Methods:Patients <21 years of age diagnosed between 1973 and 2013 were identified. Clinicopathological data, treatment and outcomes were obtained by a retrospective review.Results:Thirteen males and 68 females were divided into Group A (n=35, diagnosed before July 1993) and Group B (n=46, diagnosed after July 1993). Group B was more likely to undergo neck ultrasound (US) (70% vs. 23%, p<0.0001) and fine-needle aspiration (FNA) biopsy (80% vs. 26%, p<0.0001). Patients in Group B more often underwent total thyroidectomy as a definitive surgical treatment (87% vs. 69%, p=0.04). There was no difference in radioactive iodine use. Recurrence-free survival was similar.Conclusions:Increased use of US and FNA has affected initial surgical management in the latter part of the study, possibly due to extension of adult DTC guidelines. The effects of the new pediatric DTC guidelines need further study.

scholarly journals Covid-19 and Co-Infection in Children: The Indian Perspectives

2021 ◽  
Author(s):  
Dibyendu Raychaudhuri ◽  
Mihir Sarkar ◽  
Aniket Roy ◽  
Debapriya Roy ◽  
Kalpana Datta ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Viral Infections ◽  
Severe Disease ◽  
Tertiary Care ◽  
Supportive Therapy ◽  
Appropriate Treatment ◽  
Group A ◽  
Study Population ◽  
Tertiary Care Institution ◽  
Group B

Abstract BACKGROUND AND OBJECTIVES Assessing the co-infections with COVID-19 is crucial to delineate its true clinical impact. Pediatric information in this aspect is limited. Our study aims to analyze the spectrum of co-infections in pediatric COVID-19 patients and determine the clinical as well as laboratory parameters predicting co-infection. METHODOLOGY In this prospective observational study conducted from June to December, 2020 in a single tertiary care institution, data pertaining to demographic, illness and treatment-related variables were analyzed among two subsets of pediatric patients of age 1 month -12 years with RTPCR-confirmed COVID-19 infection-Group A: those with confirmed co-infection and Group B: moderate to severe disease without co-infection. Among Group A, etiology of co-infection was characterized through relevant microbiological examination within 48 hours admission. RESULT Among our study population, 15.03% and 20.6% had co-infections and moderate to severe disease respectively. Among those with confirmed co-infection, 32.5%, 11.6% and 6.97% recorded blood culture, respiratory secretion and CSF growth respectively, the picture being dominated by Methicillin resistant and sensitive Staph. Aureus. Serum serology demonstrated Scrub typhus infection to be most prevalent. Concurrent respiratory viral infections were seen in 11.6%. Children with co-infection had significantly higher morbidity and need for supportive therapy. Predictors of co-infection were localization of infection, Neutrophil count &gt;/= 10 x 109, age specific lymphopenia, CRP &gt; 100 mg/dL and hyper-ferritinemia. CONCLUSION Co-infections are an important factor prognosticating pediatric Covid infection .Their early detection, prompt and appropriate treatment is of paramount importance.

scholarly journals Cosmetic outcomes of grafted tubularized incised plate urethroplasty in primary distal penile hypospadias: prospective comparative study with the classic Snodgrass repair

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Shabib Ahmed ◽  
Yasser A. Noureldin ◽  
Hammoda Sherif ◽  
Ahmed Zahran ◽  
Rabea Omar
Keyword(s):  
Success Rate ◽  
Operative Time ◽  
Tertiary Care ◽  
Meatal Stenosis ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Prospective Comparative Study ◽  
Tertiary Care Institution ◽  
Cosmetic Outcomes ◽  
Group B

Abstract Background To compare the outcomes between classic tubularized incised plate (C-TIP), known as Snodgrass urethroplasty, and grafted TIP (G-TIP) in the repair of primary distal penile hypospadias. Methods Parents of all children presented to our tertiary care institution with primary distal penile hypospadias were asked to participate in this study. Patients were equally randomized using closed envelope method into two groups; Group A underwent repair using G-TIP and Group B underwent repair using the C-TIP. Circumcised cases and/or cases with penile chordee > 30 degrees were excluded from this study. Urethral catheter was kept for 7 to 10 days after surgery. The success rate and cosmetic outcomes assessed by HOSE score were evaluated at 6-month postoperatively. Results A total of 55 patients were recruited in each group. One hundred and seven patients of the 110 patients (54 and 53 in groups A and B, respectively) were evaluated at 6-month postoperatively using HOSE score. All preoperative data were comparable in both groups. Success was documented in 49/54 patients (90.7%) in group A. The five failures were secondary to two cases of glans dehiscence and three cases of residual postoperative chordee. Whereas, success was documented in 48/53 patients (90.5%) in group B. Complications were: a case of meatal stenosis, three cases of fistula, and a case of combined meatal stenosis and fistula. The HOSE score was comparable between the two groups (15.4 ± 1.09 vs. 15.6 ± 0.55; p = 0.29). However, the operative time was statistically longer in the G-TIP compared with the C-TIP (91.4 ± 6.2 min vs. 85.2 ± 6.3 min; p < 0.001), respectively. Conclusion The G-TIP urethroplasty provided comparable results with C-TIP in terms of cosmoses, success rate, and complications. However, G-TIP was accompanied with significantly longer operative time.

scholarly journals Utility of Stimulated Thyroglobulin in the Differentiate Thyroid Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A874-A874
Author(s):  
Fabiola Romero ◽  
Sandra Galeano ◽  
Francisco Cabrera ◽  
Liliana Vigo ◽  
Carlos Laterza ◽  
...  
Keyword(s):  
High Risk ◽  
Radioactive Iodine ◽  
Differentiated Thyroid Carcinoma ◽  
Low Risk ◽  
Intermediate Risk ◽  
Body Scan ◽  
Risk Patients ◽  
Group A ◽  
Total Body ◽  
Group B

Abstract Introduction: The treatment of differentiated thyroid cancer has changed considerably, total thyroidectomy and radioactive iodine ablation represented the initial treatment for these patients, currently with a great debate around the choice of which patient should undergo ablation with radioactive iodine in the post-surgical period. Objective: To determine the values of stimulated thyroglobulin (in hypothyroidism) in patients with differentiated thyroid carcinoma who have had surgery and its relationship with the ATA 2015 recurrence risk stratification and the presence of distant or locoregional metastasis in post ablative total body scan with I131 Methodology: Retrospective study, which included patients with differentiated thyroid carcinoma, patients who have had total thyroidectomy surgery and subsequent ablation with I131 in 45 days at the Central Hospital of Instituto de Prevision Social, from 2011 to 2018. There were evaluated: post-surgical thyroglobulin dosage in hypothyroidism, antithyroglobulin antibody measurement, and total body scan results at 72 hours post ablation with I131. There were excluded: Patients with positive antithyroglobulin antibodies, eu /hyperthyroidism, or incomplete data. Results: 100 patients conformed by women (88.0%), whose average age was 44.7 (± 16.1), intermediate risk 60%, high risk 31% and low risk 9%. According to the stimulated thyroglobulin values, 3 groups were classified: Group A thyroglobulin less than 1 ng/dl 32%, Group B 1 to 10 ng/dl 39%, Group C greater than 10 ng/dl 29%. Of the patients at intermediate risk n: 60, 23 (38%) belonged to group A, 27 (45%) to group B and 10 (17%) to group C. Of high-risk patients n: 31, 7 (22%) belonged to group A, 8 (26%) to group B, and 16 (52%) to group C. Of low risk patients n: 9, 2 (22%) belonged to group A, 4 (44%), group B, and 3 (33%) to group C. Post-ablative body scan detected locoregional or distant metastases in 23 (23%) patients, of which 2 (8.6%) belonged to group A, 6 (26%) to group B, 15 (65%) to group C. They were intermediate risk 10 (43%) and high risk 13 (57%) of them. No low-risk patient presented a positive RCT. There was found a relationship between thyroglobulin and high ATA risk (p &lt;0.05) with positive RCT. Association between thyroglobulin&gt; 10ng / dL and the presence of metastasis (p = 0.0001), Exp (B) 15.1 with R2 25 and 35%. Conclusion: A stimulated postoperative thyroglobulin dosage greater than 10 ng/ dL increases the chances of recurrence 15 times, with 25 to 37% chance of it. So, it would be important to consider ablation with iodine 131 in this type of patients.

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

2018 ◽  
Vol 7 (1) ◽  
pp. 35-41
Author(s):  
Muhammad Usman Khan ◽  
Ghazala Noor Nizami ◽  
Ali Farhad
Keyword(s):  
Pain Intensity ◽  
Adhesive Capsulitis ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

scholarly journals Diagnosis and Management of Thyroid Cancer

1995 ◽  
Vol 2 (2) ◽  
pp. 107327489500200
Author(s):  
Christopher L. Alexander ◽  
Roberto E. Izquierdo ◽  
James Figge ◽  
John Horton
Keyword(s):  
Thyroid Carcinoma ◽  
Radioactive Iodine ◽  
Imaging Techniques ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
The Past ◽  
Locally Recurrent ◽  
Improvement In Survival ◽  
Radioactive Iodine Ablation ◽  
Radionuclide Scanning

Thyroid carcinoma, which comprises the majority of endocrine malignancies, has a substantial annual morbidity and mortality based on age and other predisposing factors. Diagnosis of a growing thyroid nodule can be difficult, but ultrasonography, radionuclide scanning, and fine needle aspiration allow the majority of nodules to be properly characterized. Treatment of differentiated thyroid carcinoma remains controversial. Surgical resection continues to be the most important modality with long survival if the tumor is resected early. Newer imaging techniques have improved the diagnosis of locally recurrent or metastatic disease. Radioactive iodine ablation is indicated for patients with “high-risk” tumors or advanced age. Few patients respond to cytotoxic chemotherapy. In the past decade, advances in the screening and diagnosis of medullary thyroid carcinoma have led to earlier detection with improvement in survival.

scholarly journals Post-Operative Outcomes of Intravenous Lidocaine Infusion on Major Abdominal Surgery in Pediatric Patients: A Randomized Control Trial in a Tertiary Care Hospital

2018 ◽  
Vol 10 (1) ◽  
pp. 23-27
Author(s):  
Nirupama Saha ◽  
Nadiuzzaman Khan ◽  
Mirza Kamrul Zahid ◽  
Shah Alam Talukder ◽  
ASM Meftahuzzaman
Keyword(s):  
Abdominal Surgery ◽  
Tertiary Care ◽  
Major Abdominal Surgery ◽  
P Value ◽  
Care Hospital ◽  
Intravenous Lidocaine ◽  
Operative Outcomes ◽  
Group A ◽  
Randomized Control ◽  
Group B

Background: Post-operative outcomes of a major abdominal surgery depend on careful & effective post-operative management. But it is a critical job especially in children. Obtaining adequate analgesia after major surgery is a problematic issue and postoperative pain still imposes a major burden of suffering in surgical patients.Objectives: The principle objectives of the study is to evaluate the effects of intravenous lidocaine infusion in pain management of pediatric population undergone in major abdominal surgery; to reduce post-operative morbidity & enhance better surgical outcome in children.Methodology: This is a randomized control trial carried out from January 2015-June2015,in a tertiary care hospital among 60 cases of 4 to 14 years children with major abdominal surgery without having any pulmonary, cardiac, hepatic or renal insufficiency. Grouping of patients that is lidocaine infusion group (Group A) and control group (Group B) was made among admitted cases for elective abdominal surgery by simple random technique by means of lottery. For assessment of postoperative pain FLACC Scale was used in both groups. Clinical examination findings & specifically designed data collection sheet with a set questionnaire were used as research instruments. Formulated data was analyzed by SPSS version 17, taking p value <0.05 as significant.Results: It is noted that, after 24 hours of operation most of the patients 56.7% of group A had mild pain whereas 90% patients of group B had moderate pain (p<0.001)& during that time there was no patient with severe pain in group A whereas in group B 10% patients were with severe pain. At 48 hours, pain was absent in 13.3% children of group A and 6.7% in group B. In group A most of the children 76.7%had mild pain compared to moderate pain 18 (60%) in group B children at that hours (P<0.001). Again, regarding required amount of analgesics, patients received I/V lidocaine required less amount of analgesics than its counterpart. In present study, complications was noted only 3.3% patien in group A, where as in the opposite group it was found in 23.3% & p was <0.05. In group A, in 50% patients post operative bowel sound was returned within 72 hours, compared to 73.3% patients in group B. The p value was 0.001. About post-operative hospital stay, 83.3% children of the group A were released from hospital after 5th P.O.D whereas, in group B, only 50% children were released after 7th P.O.D of operation. The P value was 0.03 that is also significant.Conclusion: Intravenous lidocaine could improve immediate and late post-operative pain with early recovery after major abdominal surgery in children & it can contribute to rapid postoperative rehabilitation programs.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 23-27

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