Ultrasonographic determination of thyroid volume in infants and children from Aegean region of Turkey and comparison with national and international references

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Edis Çolak ◽  
Behzat Özkan ◽  
Sinan Genç ◽  
Burak Polat
Keyword(s):  
Standard Deviation Score ◽  
Body Height ◽  
Thyroid Volume ◽  
World Health Organisation ◽  
World Health ◽  
Turkish Children ◽  
Aegean Region ◽  
Normal Ranges

Abstract Objectives Accurate diagnosis and follow-up of pediatric patients with thyroid disorders, depends on the availability of appropriate data for normal thyroid volume (TV). The aim of this study was to determine the TV by ultrasonography (US) in subjects from the newborn period up to 18 years of age from the Aegean region of Turkey. Methods We measured the thyroid volumes in 513 children using US and compared them with the children’s age, gender, standard deviation score (SDS) of body height (BH-SDS), body weight (BW-SDS), body mass index (BMI-SDS), and body surface area (BSA-SDS). The 3rd, 50th, and 97th percentiles of the age-dependent distribution of the TV were calculated and compared with national and international references. Results The BH, BW, BMI, and BSA of all the participants were within the normal ranges for Turkish children. The TV was significantly positively correlated with age, gender, BH-SDS, BW-SDS, BMI-SDS, and BSA-SDS in all subjects (r=0.748, r=0.267, r=0.730, r=0.735, r=0.664 and r=0.735, respectively; p<0.0001 for all). The most important predictors for TV were age and BW-SDS, followed by BSA-SDS and BH-SDS. In multivariate regression, age and BW-SDS were the only significant independent predictors for TV. Our results were nearly similar to the corresponding data reported by the World Health Organisation in 2004. Conclusions The present study provides updated values for TV that can serve as a potential tool in differentiating the normal from the abnormal size of the thyroid gland in children aged 0–18 years from the Aegean region of Turkey.

scholarly journals The Safety Assessment of Toxic Metals in Commonly Used Herbs, Spices, Tea, and Coffee in Poland

2021 ◽  
Vol 18 (11) ◽  
pp. 5779
Author(s):  
Grażyna Kowalska
Keyword(s):  
Heavy Metals ◽  
Environmental Protection Agency ◽  
Inductively Coupled Plasma ◽  
Raw Materials ◽  
Hazard Quotient ◽  
World Health Organisation ◽  
World Health ◽  
Target Hazard Quotient ◽  
Plant Materials

The presented study was aimed at the determination of the level of contamination with heavy metals (Cd, Pb, As, and Hg) in 240 samples of plant materials, i.e., herbal raw materials, spices, tea, and coffee. Moreover, a probabilistic risk assessment (noncarcinogenic and carcinogenic risks) was estimated by models including target hazard quotient (THQ) and cancer risk (CR). The samples were subjected to microwave mineralisation with the use of HNO3 (65%), while the determination of the content of the elements was performed with the use of inductively coupled plasma mass spectrometer (ICP–MS) and a mercury analyser. The element which was characterised by the highest level of accumulation in the analysed samples was lead (from 0.010 to 5.680 mg/kg). Among the heavy metals under analysis, the lowest concentration was noted in the case of mercury (from 0.005 to 0.030 mg/kg). A notably higher level of contamination with heavy metals was noted in the analysed samples of herbs and spices (0.005–5.680 mg/kg), compared to samples of tea and coffee (0.005–0.791 mg/kg). According to the guidelines of the World Health Organisation (WHO) concerning the limits of contamination of samples of herbal raw materials with heavy metals, lead levels exceeding the limits were only noted in 24 samples of herbs (18%). In all of the analysed samples of spices, tea, and coffee, no instances of exceeded limits were noted for any of the analysed heavy metals. The values of TTHQmax (in relation to the consumption of the analysed products) were as follows: up to 4.23 × 10−2 for spices, up to 2.51 × 10−1 for herbs, up to 4.03 × 10−2 for China tea, and up to 1.25 × 10−1 for roasted coffee beans. As the value of THQ ≤1, there is no probability of the appearance of undesirable effects related to the consumption of the analysed group of raw materials and products of plant origin. The CR value for As (max. value) was 1.29 × 10−5, which is lower than the maximum acceptable level of 1 × 10−4 suggested by United States Environmental Protection Agency (USEPA).

scholarly journals Improving Risk Assessments by Sanitary Inspection for Small Drinking-Water Supplies—Qualitative Evidence

Resources ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 71 ◽  
Author(s):  
Katherine Pond ◽  
Richard King ◽  
Jo Herschan ◽  
Rosalind Malcolm ◽  
Rory Moses McKeown ◽  
...  
Keyword(s):  
Drinking Water ◽  
Assessment Tool ◽  
World Health Organisation ◽  
Ease Of Use ◽  
World Health ◽  
Remedial Action ◽  
Water Supplies ◽  
Qualitative Evidence ◽  
Operations And Maintenance

Small drinking-water supplies face particular challenges in terms of their management. Being vulnerable to contamination but often not monitored regularly nor well-maintained, small drinking-water supplies may pose consequences for health of users. Sanitary inspection (SI) is a risk assessment tool to identify and manage observable conditions of the water supply technology or circumstances in the catchment area that may favour certain hazardous events and introduce hazards which may become a risk to health. This qualitative research aimed to identify the strengths and weaknesses of the SI tool as published by the World Health Organisation to inform a review and update of the forms and to improve their robustness. The study identified a number of benefits of the approach, such as its simplicity and ease of use. Challenges were also identified, such as potential for inconsistencies in perception of risk between inspectors, in interpreting questions, and lack of follow-up action. The authors recommend a revision of the existing SI forms to address the identified challenges and development of complementary advice on possible remedial action to address identified risk factors and on basic operations and maintenance.

Imaging in low-grade glioma: a guide for neurologists

2017 ◽  
Vol 18 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Jennifer Larsen ◽  
Nigel Hoggard ◽  
Fiona M McKevitt
Keyword(s):  
Surgical Planning ◽  
World Health Organisation ◽  
Low Grade Glioma ◽  
World Health ◽  
Low Grade ◽  
The Central Nervous System ◽  
Contemporary Management

The management of low-grade glioma (LGG) is shifting as evidence has emergedthat refutes the previously commonplace imaging-based ‘watch and wait’ approach, in favour of early aggressive surgical resection. This coupled with the recent 2016 update to the World Health Organisation Classification of Tumours of the Central Nervous System is changing LGG imaging and management. Recently in Practical Neurology the contemporary management of low-grade glioma and the changes to this grading system were discussed in detail. 1 In this complementary article, we discuss the role of imaging in the diagnosis, surgical planning and post-treatment follow-up of LGG. We describe the principles of imaging these tumours and use several cases to highlight some difficult scenarios.

scholarly journals Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency

2000 ◽  
pp. 727-731 ◽  
Author(s):  
M Zimmermann ◽  
A Saad ◽  
S Hess ◽  
T Torresani ◽  
N Chaouki
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Classification Systems ◽  
World Health ◽  
Urinary Iodine Concentration ◽  
Thyroid Ultrasound ◽  
Iodine Deficiency Disorders ◽  
Goiter Prevalence

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Ait M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

scholarly journals Telehealth-based diagnostic testing in general practice during the COVID-19 pandemic: an observational study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0123
Author(s):  
Rae-Anne Hardie ◽  
Gorkem Sezgin ◽  
Chisato Imai ◽  
Emma Gault ◽  
Precious McGuire ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Diagnostic Testing ◽  
World Health Organisation ◽  
Estimating Equation ◽  
World Health ◽  
Test Collection ◽  
Face To Face ◽  
Health Technologies

BackgroundSince the World Health Organisation declared COVID-19 a pandemic on 11 March 2020, health technologies have been rapidly scaled up to ensure access to care. A significant innovation has been telehealth in general practice. Now widespread, it remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis.AimTo undertake a comparison of telehealth and face-to-face general practice consultations to: identify if there were differences in the proportion of pathology test referrals from 2019-2020; and quantify any change in pathology test collection and follow-up patterns.Design and SettingRetrospective observational study of routinely collected electronic patient data from 807 general practices across New South Wales and Victoria, Australia.MethodMultivariate generalised estimating equation models were used to estimate the proportion of pathology test referrals for: overall, face-to-face, and telehealth consultations. Pathology test follow-up was described through median (and interquartile range (IQR)) time.ResultsPathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low 4.5% during the first peak in April. Overall, pathology test referrals were lower for telehealth than face-to-face. Median time between referral and test collection was 3 days (IQR 1–14) for telehealth and 1 day (IQR 0–7) for face-to-face.ConclusionFor telehealth to become part of routine care, it is crucial that gaps in functionality, including difficulty in test referral processes, be addressed. Quality improvements supporting care practices will ensure clinicians’ workflows are supported and patients receive diagnostic testing.

scholarly journals Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programmes: the Mozambique experience

2019 ◽  
Author(s):  
Laurence Ahoua ◽  
Thierry Tiendrebeogo ◽  
Shino Arikawa ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Retention In Care ◽  
World Health Organisation ◽  
Retention Rates ◽  
World Health ◽  
Hiv Positive ◽  
Appointment Adherence ◽  
Art Initiation ◽  
Sensitivity Specificity

Abstract Background: Failure of retention of HIV-positive pregnant women on ART leads to increased mortality for the mother and her child. This study evaluated different retention measures intended to measure women’s engagement along the continuum of care for PMTCT option B+ services in Mozambique. Methods: We compared ‘point’ retention (patient’s presence in care at 12-months post-ART initiation or any time thereafter) to the following definitions: alive and in care at 12 months post-ART initiation (Ministry of Health); attendance at a health facility up to 15 months post-ART initiation (World Health Organisation); alive and in treatment at 1, 2, 3, 6, 9, and 12 months post-ART initiation (Inter-Agency Task Team); and alive and in care at 12 months post-ART initiation with ≥75% appointment adherence during follow-up (i.e. ‘appointment adherence’ retention) or with ≥75% appointment done on-time during follow-up (i.e. ‘on-time adherence’ retention). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as our reference to estimate sensitivity, specificity, and proportion of misclassified patients. Results: Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12 months post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘ ≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively). Conclusion: More stringent definitions indicated lower retention rates for PMTCT programmes. Policy makers and programme managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scaling up, and monitoring of interventions.

scholarly journals Poor outcome of patients with pulmonary arterial hypertension with insufficient response to phosphodiesterase-5 inhibitors alone or in combination with other specific therapy: a registry-based study

2020 ◽  
Vol 10 (3) ◽  
pp. 204589402095855
Author(s):  
Clara Hjalmarsson ◽  
Oisin Butler ◽  
Roger Hesselstrand ◽  
Katsiaryna Holl ◽  
Kjell Jansson ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
World Health Organisation ◽  
Functional Class ◽  
World Health ◽  
Walking Distance ◽  
Phosphodiesterase 5 Inhibitors ◽  
Pulmonary Arterial ◽  
Phosphodiesterase 5

Phosphodiesterase-5 inhibitors are commonly used in pulmonary arterial hypertension but, as suggested by the RESPITE study, phosphodiesterase-5 inhibitor therapy (mono-/combination) does not always have a satisfactory treatment effect. This study aimed to investigate the clinical course of pulmonary arterial hypertension patients not at treatment goal after at least 90 days of treatment with phosphodiesterase-5 inhibitors, alone or in combination with other pulmonary arterial hypertension therapies. The study included 106 incident patients from the Swedish Pulmonary Arterial Hypertension Registry, treated with phosphodiesterase-5 inhibitors for ≥90 days, who were not at a pre-specified treatment goal, i.e. in World Health Organisation functional class III, with 6-min walking distance 165–440 m, and N-terminal prohormone of brain natriuretic peptide >300 ng/L. Changes in World Health Organisation functional class, 6-min walking distance, N-terminal prohormone of brain natriuretic peptide, and risk group between index and follow-up were assessed. Of patients with complete follow-up data, ( n = 53) 77% were on combination therapy and risk assessment yielded 98% at intermediate risk at index. At follow-up, 11 patients transitioned from World Health Organisation functional class III to World Health Organisation functional class II, the median (Q1; Q3) change in 6-min walking distance was 6 (−30; 42) meters and in N-terminal prohormone of brain natriuretic peptide 47 (−410; 603) ng/L, while 89% remained at an intermediate risk. Of those without complete follow-up data, 11 patients died and 2 underwent lung transplantation. In conclusion, pulmonary arterial hypertension patients treated with phosphodiesterase-5 inhibitors, as single or combination therapy and not achieving the pre-specified treatment goals after ≥90 days have an unfavourable clinical course.

LC-MSMS assays of urinary cortisol, a comparison between four in-house assays

2018 ◽  
Vol 56 (7) ◽  
pp. 1109-1116 ◽  
Author(s):  
Julie Brossaud ◽  
Monique Leban ◽  
Jean-Benoit Corcuff ◽  
Florence Boux de Casson ◽  
Anne-Gaëlle Leloupp ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
High Performance ◽  
Cushing Syndrome ◽  
Urinary Free Cortisol ◽  
Normal Ranges ◽  
Free Cortisol ◽  
Solid Liquid

Abstract Background: Twenty-four hour urinary free cortisol (UFC) determination can be used for screening and follow-up of Cushing syndrome (CS). As immunoassay methods lack specificity for UFC measurement, the use of high-performance liquid chromatography coupled to mass spectrometer (LC-MSMS) is recommended. The aim of our study was to compare UFC results using four LC-MSMS methods performed in four independent laboratories in order to evaluate interlaboratory agreement. Methods: Frozen aliquots of 24-h urine samples (78 healthy volunteers and 20 patients with CS) were sent to four different laboratories for analysis. Following liquid-liquid or solid-liquid extraction, UFC were determined using four different LC-MSMS assay. Results: UFC intra- and interassays variation coefficients were lower than 10% for each centre. External quality control results were not significantly different. UFC normal ranges (established from healthy volunteers) were 17–126, 15–134, 12–118 and 27–157 nmol/day, respectively. Classification of UFC from healthy volunteers and patients with CS using a 95th percentile threshold was similar. However, for extreme UFC values (<50 or >270 nmol/day), negative or positive bias was noted. Conclusions: Even for highly specific methods such as LC-MSMS, variations of results can be found depending on analytical process. Validation of LC-MSMS methods including determination of the reference range is essential.

scholarly journals Early retention among pregnant women on ‘Option B + ’ in urban and rural Zimbabwe

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anesu N. Chimwaza ◽  
Hannock Tweya ◽  
Owen Mugurungi ◽  
Angela Mushavi ◽  
Solomon Mukungunugwa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
World Health Organisation ◽  
World Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mtct Rate ◽  
Post Test ◽  
Early Retention ◽  
Mother To Child

Abstract Background In 2013, the World Health Organisation (WHO) recommended Option B+ as a strategy to prevent mother-to-child transmission (PMTCT) of HIV. In option B+ , lifelong antiretroviral therapy (ART) is offered to all HIV positive pregnant and breastfeeding women to reduce MTCT rate to less than or equal to 5%. Its success depends on retaining women on ART during pregnancy, delivery and breast-feeding period. There is limited data on early retention on ART among pregnant women in Zimbabwe. We therefore assessed early retention among women on Option B + from antenatal care (ANC) until 6 months post ANC booking and at delivery in Bulawayo city and Mazowe rural district of Zimbabwe. Methods We collected data for pregnant women booking for ANC between January and March 2018, comparing early retention among ART naïve women and those already on ART. The two cohorts were followed up for 6 months post ANC booking, and this was done in two districts. Data were collected from routine tools used at facility level which include ANC, delivery and ART registers. The Kaplan-Meier survival analysis was used to estimate retention probabilities at 1, 3 and 6 months post-delivery and for retention at delivery proportions were used. Poisson regression was used to investigate factors associated with non-retention at 6 months post ANC booking. Results A total of 388 women were included in the study with median age of 29 years (IQR: 25–34). Two-thirds booked in their second trimester. Retention at 3 and 6 months post ANC booking was 84% (95% CI 80–88) and 73% (95% CI 69–78) respectively. At delivery 81% (95% CI 76–84) were retained in care, 18% lost-to-follow-up and 1% transferred out. In this study we did not find marital status, gestation age, facility location, ART status at ANC booking, to be associated with loss to follow-up. Conclusion In this study, we found low retention at 3, 6 months and delivery, a threat to elimination of Mother-to-child Transmission of HIV in Zimbabwe. Our findings emphasize the need for enhanced interventions to improve early retention such as post-test counselling, patient tracing and visit reminders.

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