scholarly journals Evaluation of thyroid nodule in pediatric population in a tertiary care hospital

2019 ◽  
Vol 6 (5) ◽  
pp. 2152
Author(s):  
Mukul Singh ◽  
Manju Kumari
Keyword(s):  
Thyroid Nodule ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Care Hospital ◽  
Pediatric Age Group ◽  
Thyroid Cytopathology ◽  
Rule Out

Background: Thyroid nodules are commonly present in adult population but are rare in pediatric age group. Inspite of being rare, thyroid nodule have a higher chance of malignancy in children. Thus, pediatric patients presenting with thyroid nodule found clinically or incidentally should be worked up to rule out any possibility of malignancy. The besthesda system for reporting thyroid cytopathology (TBSRTC) is widely used for reporting in adults. The present study aims to use TBSRTC for pediatric thyroid lesions reporting.Methods: All pediatric patients with age ≤ 18 years presenting with thyroid nodule during January 2018 to April 2019 were included in the study, fine needle aspiration (FNA) was done and findings were compared with histology. Statistical analysis was done using SPSS version 18.Results: 42 pediatric patient were included in the study, out of which 2.38% were malignant and suspicious for nmalignant each and 83% were benign.Conclusion: TBSRTC is quite sensitive and specific reporting guideline in pediatric population as in adult population with 100% accuracy in diagnosing benign and malignant cases. This is useful for avoiding unnecessary surgeries.

scholarly journals Diagnostic Accuracy of the Bethesda System of Reporting Thyroid Cytopathology in the Evaluation of Thyroid Nodule in a Tertiary Care Hospital of Kolkata

2021 ◽  
Vol 8 (05) ◽  
pp. 241-245
Author(s):  
Sweta Verma ◽  
Mita Saha Dutta Chowdhury ◽  
Souradeep Ray ◽  
Ruma Guha
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Care Hospital ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System

BACKGROUND Thyroid cancer has the most rapidly increasing incidence of all major cancers in India. The overall prevalence of thyroid malignancy is approximately 1 - 5 % of all cancers in women and less than 2 % in men. Thyroid nodules are a common clinical finding and have a reported prevalence of 4 – 7 % in the general population. The vast majority of these nodules are non-neoplastic or benign and the risk of malignancy varies from 5 to 10 %. Fine needle aspiration cytology (FNAC) is an efficient and reliable means for the evaluation of thyroid nodules. A key challenge for clinicians is to choose which thyroid nodule is to be investigated further and treated. Early detection and treatment of malignant thyroid nodules is associated with excellent outcomes. The aim of our study is to compare and correlate between fine needle aspiration cytology and histopathology of resected specimen and to determine the diagnostic accuracy of TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology) in thyroid nodule. METHODS This is a cross sectional validation study conducted in a tertiary care hospital (R.G. Kar Medical College) of Kolkata to find the sensitivity, specificity and diagnostic accuracy of TBSRTC in evaluation of thyroid nodule. RESULTS We have observed that TBSRTC is highly sensitive and specific in stratifying the malignancy risk of thyroid nodule. CONCLUSIONS It aids the clinician to choose the thyroid nodules which require further evaluation and intervention. It also guides the clinician to decide the operability of thyroid nodule. TBSRTC is highly accurate and is highly specific in stratifying the risk of malignancy of thyroid nodule. KEYWORDS TBSRTC, FNAC, Thyroid Nodules, Thyroid Cancer

scholarly journals Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: Experience of a Tertiary Care Referral Center

2019 ◽  
Vol 144 (4) ◽  
pp. 473-477 ◽  
Author(s):  
Amer Heider ◽  
Stacy Arnold ◽  
Xin Jing
Keyword(s):  
Thyroid Nodules ◽  
Pediatric Population ◽  
Adult Population ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
American Thyroid Association ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
Undetermined Significance

Context.— The Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer from The American Thyroid Association recommends fine-needle aspiration (FNA) as an essential tool for evaluation and management of pediatric thyroid nodules, and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) as a guideline to categorize FNA cytologic findings. A few publications have focused on TBSRTC categorization in children. Objective.— To evaluate our institutional experience of using TBSRTC in the pediatric population. Design.— We conducted a retrospective data search for thyroid FNA specimens from patients younger than 21 years who were assessed by using TBSRTC categorization between January 1, 2011, and September 30, 2017. Cytologic and histologic diagnoses, rate of surgical follow-up, rate of histology-proven malignancy, and cytologic-histologic concordance were assessed in comparison with our previously published adult experience. Results.— Among a total of 201 specimens, benign category accounted for 103 (51.2%), followed by 35 (17.4%) malignant, 30 (14.9%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 14 (7.0%) nondiagnostic, 10 (5.0%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), and 9 (4.5%) suspicious for malignancy (SFM) categories. Surgeries were subsequently performed in 100 of the 201 cases (49.8%). All surgically removed nodules categorized as malignant and SFM by FNA showed malignancy, while malignancy was evident in various proportions of specimens classified as AUS/FLUS (5 of 16; 31.3%), FN/SFN (1 of 9; 11.1%), and nondiagnostic (1 of 7; 14.2%). No malignancy was identified in the benign category. Cytologic-histologic concordance achieved 100% in malignant, SFM, and FN/SFN categories, and exceeded beyond 85% and 50% for benign and AUS/FLUS categories, respectively. Conclusions.— TBSRTC is effective for appropriate categorization of pediatric thyroid nodules. Risk of malignancy in thyroid nodules is higher for the pediatric than adult population. Understanding the difference in TBSRTC categorization between children and adults may aid in achieving more appropriate evaluation and management of pediatric thyroid nodules.

scholarly journals Pharmacoepidemiological assessment of off-label drug use in pediatric ambulatory departments at four tertiary care hospital in Pakistan

2020 ◽  
Vol 19 (10) ◽  
pp. 2219-2225
Author(s):  
Rabeea Sharif ◽  
Muhammad Aamir ◽  
Faisal Shakeel ◽  
Shah Faisal ◽  
Jamshaid Ali Khan
Keyword(s):  
Drug Use ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Care ◽  
High Rate ◽  
Care Hospital ◽  
Off Label ◽  
Optimal Drug ◽  
Tertiary Healthcare ◽  
To Receive

Purpose: To assess the frequency and possible predictors of off-label drug use in ambulatory pediatric units of four tertiary healthcare institutions in a Pakistani city.Methods: A prospective study was conducted at the pediatric ambulatory department of four tertiary care hospitals of Peshawar, Pakistan. A total 1589 patients were included in the study which to evaluate their prescriptions for off-label drug use with the aid of Thomson Healthcare Micromedex DRUGDEX database.Results: A total of 79 different drugs were prescribed 5668 times to pediatric patients. A high rate of offlabel drug use (71.8 %) was observed in this study. Compared to corresponding reference categories, infants (OR 4.134, 95 % CI 2.076-8.235) and children (OR 1.857, 95 % CI 0.967-3.568) were more likely to receive off-label prescriptions. However, pediatric patients receiving less than four drugs (OR 0.414, 95 % CI 0.312-0.548) were less likely to receive off-label prescriptions.Conclusion: A high incidence of off-label drug use has been observed in the ambulatory pediatric population studied, especially in infants. More research is needed to identify and evaluate the contributory factors to off-label use of drugs in ambulatory pediatric population in developing countries to achieve optimal drug therapy for pediatrics. Keywords: Pediatric population, Ambulatory, Off-label drug use

scholarly journals SAT-079 Is There an Association Between the Detection Method for Pediatric Thyroid Nodules and the Risk of Malignancy?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Liane Eng ◽  
Jarreau Spencer Sim Chen ◽  
Leslie S Lam
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Detection Method ◽  
Pediatric Population ◽  
Needle Aspiration ◽  
High Rate ◽  
Sample Population ◽  
Risk Of Malignancy ◽  
Potentially Malignant

Abstract Background Thyroid nodules are less common in children compared to adults, but have a higher likelihood of malignancy. There are few studies, particularly in the pediatric population, examining the association between how and by whom the nodule is detected and the risk of malignancy. Several adult studies have suggested a high rate of malignancy in incidentally discovered thyroid nodules (1,2). However, this was not similarly seen in pediatric thyroid nodules according to one study (3). As fine needle aspiration (FNA) in pediatric patients may be more labor intensive and diagnostic excision is the recommendation for nodules with indeterminate or potentially malignant cytology, if the detection method can be a predictive measure of malignancy, it may enhance the evaluation of pediatric thyroid nodules. Objective The aim of this study is to determine if there is an association between how and by whom a thyroid nodule is detected and the risk of malignancy in the pediatric population. Study Design and Methodology We retrospectively reviewed the medical records of pediatric patients (≤21 years of age) who had a thyroid nodule with definitive cytologic or pathologic diagnosis from January 2010 to June 2019. Patients were categorized into 3 groups based on how and by whom the nodule was detected: (1) patient or parent, (2) provider, or (3) imaging obtained for non-thyroid indications (incidental). Characteristics that were evaluated included rate of malignancy, size of the nodule, location of the nodule, and size of the cancer (if present). Results A total of 78 patients with concerning thyroid nodules were analyzed. Within the study, the cancer rate was 27% (21/78), which is comparable to the reported malignancy rate of pediatric thyroid nodules in the literature (22-26%) (4), suggesting that our sample population may be representative of the general pediatric thyroid nodule population. In our study, though the absolute numbers were small, there was a higher rate of malignancy in the incidental group (3/5, 60%) compared to the patient/parent (9/34, 26%) and provider (9/39, 23%) groups. The average size of the thyroid nodule was similar in all 3 groups. The strength of this study was the inclusion of only patients with definitive diagnosis of the thyroid nodule and the possibility of the findings being applicable to the general pediatric population. Conclusions In our sample study, incidentally discovered pediatric thyroid nodules had a higher rate of malignancy as compared to those discovered by patients/parents or providers. References 1. Kang HW, et al. Thyroid 2004; 14(1):29-33. 2. Liebeskind A, et al. J Ultrasound Med 2005; 24(5):629-634. 3. Gupta A, et al. J Pediatr 2014; 164(3):658-660. 4. Francis GL, et al. Thyroid 2015; 25(7):716-758.

scholarly journals Clinical pattern of cutaneous infestations in pediatric age group attending a tertiary care centre

2021 ◽  
Vol 8 (1) ◽  
pp. 35
Author(s):  
Raghavon U. U. ◽  
Neela V. Bhuptani ◽  
Bharti K. Patel ◽  
Sagar Bhimani
Keyword(s):  
Pediatric Patients ◽  
Dietary Habits ◽  
Skin Diseases ◽  
Tertiary Care ◽  
Outpatient Department ◽  
Health Concern ◽  
Care Hospital ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group

<p class="abstract"><strong>Background:</strong> Skin diseases are a serious health concern for children of all ages, and they are linked to a high rate of morbidity. In comparison to adults, children's dermatological problems are more impacted by socioeconomic position, dietary habits, climatic exposure, and the external environment. The purpose of this study was to determine the prevalence of infestations among pediatric patients who visited the dermatology outpatient department in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> From December 2019 to September 2020, all newly diagnosed, untreated male and female pediatric patients (from neonates to adolescents of 14 years of age) attending dermatology outpatient department (OPD) were assessed to determine the prevalence of Infestations within the pediatric population. A thorough history was gathered, followed by a meticulous dermatological examination and if indicated, regular investigations were done and were recorded in predesigned performa.<strong></strong></p><p class="abstract"><strong>Results:</strong> The analysis included 50 patients who had been infested. There were 43 cases (86%) of scabies and 7 cases (14%) of pediculosis capitis.</p><p class="abstract"><strong>Conclusions:</strong> The infestations in the pediatric age group are associated with a high communicable rate so it’s important to diagnose these conditions early to contain the spread and limit the morbidity.</p>

scholarly journals Acute Kidney Injury in Pediatric Treated with Vancomycin and Piperacillin-Tazobactam in Tertiary Care Hospital

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Mohammed Al Nuhait ◽  
Laila C. Abu Esba ◽  
Khalid Al Harbi ◽  
Meshary Al Meshary ◽  
Rami T. Bustami
Keyword(s):  
Acute Kidney Injury ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Empirical Therapy ◽  
Retrospective Chart Review ◽  
Concomitant Treatment ◽  
Care Hospital ◽  
Increased Risk

Background. Vancomycin and piperacillin-tazobactam (PTZ) are commonly used as empirical therapy for patients with health care associated infections. Vancomycin has been recognized as a nephrotoxic agent and in a few cases in the literature PTZ has been associated with interstitial nephritis nevertheless; the combination of these agents has routinely been used for many years. However, there have been some observational studies that showed high rates of acute kidney injury (AKI) in patients receiving vancomycin and PTZ concomitant treatment compared to patients receiving vancomycin alone. The incidence of AKI in adult patients receiving vancomycin and PTZ concomitant treatment was reported in these studies to be relatively high. Similar studies in pediatric patients are lacking. Method. We conducted a single center retrospective chart review of 248 pediatric patients receiving one of the following treatments: vancomycin alone 36 patients, vancomycin/PTZ 62 patients, vancomycin/ceftazidime 99 patients, and vancomycin/ceftriaxone 51 patients. Result. Our results showed a low incidence of AKI in patients on vancomycin/PTZ concomitant treatment where overall incidence was only (4.8%) three cases and only one of them (2.0%) in a patient receiving the vancomycin/ceftriaxone concomitant treatment. No cases of AKI present in patients receiving vancomycin with ceftazidime or vancomycin alone. There were no statistically significant differences between the four treatment groups in terms of AKI incidence, vancomycin trough, and use of nephrotoxins. Conclusion. Overall, the incidence of AKI was low in our study sample with no statistically significant increased risk when PTZ was used in combination with vancomycin in a pediatric population. However, further investigation with an equal larger sample size is needed to confirm our findings.

scholarly journals Etiopathological study of pediatric neck masses in a rural population

2018 ◽  
Vol 4 (5) ◽  
pp. 1206
Author(s):  
Mudassar A. Shariff
Keyword(s):  
Pediatric Patients ◽  
Histopathological Examination ◽  
Pediatric Population ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Age Group ◽  
Medical College ◽  
Pediatric Age Group ◽  
Neck Masses ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Neck mass in pediatric age group is a common clinical condition encountered by an ENT Specialist. Detailed clinical examination and knowledge of the common neck masses in children, which differ from those in adults is vital in early diagnosis and treatment. Diagnostic modalities such as Ultrasonography, Computerised Tomography, Fine needle aspiration cytology (FNAC) and histopathological examination aids in the diagnosis of superficial neck masses. The majority of neck masses in the pediatric population are congenital or inflammatory in origin and some are neoplastic. This study was conducted to establish the various causes of neck masses and the site of origin of neck masses in pediatric patients attending ENT OPD.</p><p class="abstract"><strong>Methods:</strong> 50 patients in the age group of 1 month to 18 years presenting with neck masses to the ENT OPD of Vinayaka Mission’s Medical College and Hospital, Karaikal were included in the study. This was a prospective study conducted for a period of 2 years. All the cases underwent FNAC. Biopsy and histopathological examination was done in cases where the cytological diagnosis was inconclusive.  </p><p class="abstract"><strong>Results:</strong> Of the 50 cases clinically evaluated, 24 were lymph node swellings, 7 were thyroid swellings, 8 were salivary gland swellings, 10 were congenital neck swellings, with 1 swelling being due to other cause.</p><p class="abstract"><strong>Conclusions:</strong> Inflammatory swelling arising from the Lymph nodes were the commonest cause of neck swelling in pediatric patients. Neck swellings were located most commonly in the Submandibular triangle in the study.</p>

scholarly journals Genomic analyses of human adenoviruses unravel novel recombinant genotypes associated with severe infections in pediatric patients

2021 ◽  
Author(s):  
Joyce Odeke Akello ◽  
Richard Kamgang ◽  
Maria Teresa Barbani ◽  
Franziska Suter-Riniker ◽  
Christoph Aebi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Clinical Importance ◽  
Genomic Analysis ◽  
Sudden Infant ◽  
Whole Genome ◽  
Care Hospital ◽  
Human Adenoviruses ◽  
Severe Infections

Human Adenoviruses (HAdVs) are highly contagious pathogens of clinical importance, especially among the pediatric population. Studies on comparative viral genomic analysis of cases associated with severe and mild infections due to HAdV are limited. Using whole-genome sequencing (WGS), we investigated whether there were any differences between circulating HAdV strains associated with severe infections (meningitis, sepsis, convulsion, sudden infant death syndrome, death, and hospitalization) and mild clinical presentations in pediatric patients hospitalized between the years 1998 and 2017 in a tertiary care hospital group in Bern, Switzerland covering a population base of approx. 2 million inhabitants. The HAdV species implicated in causing severe infections in this study included HAdV species C genotypes (HAdV1, HAdV2, and HAdV5). Clustering of the HAdV whole-genome sequences of the severe and mild cases did not show any differences except for one sample (isolated from a patient presenting with sepsis, meningitis, and hospitalization) that formed its own cluster with HAdV species C genotypes. This isolate showed intertypic recombination events involving four genotypes, had the highest homology to HAdV89 at complete genome level, but possessed the fiber gene of HAdV1, thereby representing a novel genotype of HAdV species C. The incidence of potential recombination events was higher in severe cases than in mild cases. Our findings confirm that recombination among HAdVs is important for molecular evolution and emergence of new strains. Therefore, further research on HAdVs, particularly among susceptible groups, is needed and continuous surveillance is required for public health preparedness including outbreak investigations.

scholarly journals Genomic analyses of human adenoviruses unravel novel recombinant genotypes associated with severe infections in pediatric patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joyce Odeke Akello ◽  
Richard Kamgang ◽  
Maria Teresa Barbani ◽  
Franziska Suter-Riniker ◽  
Christoph Aebi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Clinical Importance ◽  
Genomic Analysis ◽  
Sudden Infant ◽  
Whole Genome ◽  
Care Hospital ◽  
Human Adenoviruses ◽  
Severe Infections

AbstractHuman adenoviruses (HAdVs) are highly contagious pathogens of clinical importance, especially among the pediatric population. Studies on comparative viral genomic analysis of cases associated with severe and mild infections due to HAdV are limited. Using whole-genome sequencing (WGS), we investigated whether there were any differences between circulating HAdV strains associated with severe infections (meningitis, sepsis, convulsion, sudden infant death syndrome, death, and hospitalization) and mild clinical presentations in pediatric patients hospitalized between the years 1998 and 2017 in a tertiary care hospital group in Bern, Switzerland covering a population base of approx. 2 million inhabitants. The HAdV species implicated in causing severe infections in this study included HAdV species C genotypes (HAdV1, HAdV2, and HAdV5). Clustering of the HAdV whole-genome sequences of the severe and mild cases did not show any differences except for one sample (isolated from a patient presenting with sepsis, meningitis, and hospitalization) that formed its own cluster with HAdV species C genotypes. This isolate showed intertypic recombination events involving four genotypes, had the highest homology to HAdV89 at complete genome level, but possessed the fiber gene of HAdV1, thereby representing a novel genotype of HAdV species C. The incidence of potential recombination events was higher in severe cases than in mild cases. Our findings confirm that recombination among HAdVs is important for molecular evolution and emergence of new strains. Therefore, further research on HAdVs, particularly among susceptible groups, is needed and continuous surveillance is required for public health preparedness including outbreak investigations.

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