Incidence of Thyroid Cancer in Thyroid Swelling, Study of 200 Cases

Objective: The incidence of thyroid cancer has rapidly increased in the United States (US) and other developed countries over the past 30 years but there is no study to find out the true incidence of thyroid cancer in Bangladesh. The aim of this study is to compare FNAC with histopathology reports and to find out the true incidence of thyroid malignancy in thyroidectomy patients presenting with thyroid swelling. Methods: This is a prospective study of 200 thyroid swelling patients underwent thyroid surgery done at Shaheed Suhrawardy Medical College Hospital, a tertiary Care Hospital in Dhaka from July 2017 to December 2020. FNAC and histopathology reports were studied to find out the incidence of benign and thyroid malignancy among the thyroid swelling. Results: The age of the patients ranged from 8 to 75 years. The mean age was 37.2 years. There were 156 female and 44 male patients with female male ratio 3.54:1. Diagnostic categorization of 200 thyroid swelling underwent surgery, FNAC based on Bathesda classification showed that 163 (81.5%) cases were cytologically benign, 37 (18.5%) cases were malignant category. Out of 200 cases histopathology showed134 cases(67.0%) are benign and 66(33.0%) are malignant thyroid swelling. Among the benign lesions96.31% are colloid goiter and among the malignant lesions 93.4% are papillary thyroid carcinoma. Conclusion: Although FNAC is an essential diagnostic test to rule out thyroid malignancy but histopathological examination is the only way to give true incidence of thyroid malignancy among the thyroid swelling and it is observed that there is high incidence of thyroid malignancy(33.0%) among the thyroid swelling patient underwent thyroid surgery. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 12-16

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Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i2.45829 ◽

2020 ◽

Vol 27 (2) ◽

pp. 161-174

Author(s):

Mohammad Asraful Islam ◽

Rashedul Islam ◽

Debnath Talukder ◽

AHM Noor E As Sayeed ◽

SK Nurul Fattah Rumi ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Carcinoma ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Follicular Carcinoma ◽

Medullary Carcinoma ◽

Anaplastic Carcinoma ◽

Care Hospital ◽

Thyroid Malignancy ◽

Follicular Variant

Background: Among the endocrine malignancies thyroid cancer is the most common. It constitutes a heterogeneous group of malignancies ranking it as the fifth most common cancer worldwide. On health as well as health system it has severe implication. Thyroid cancer incidence is rising most rapidly worldwide. Different thyroid malignancy requires different management strategy. Proper addressing and prompt management of different thyroid malignancies can lessen the suffering. Objective: The study aimed to evaluate the pattern of primary thyroid malignancy in a tertiary care hospital. Methods: The study was a hospital based descriptive cross sectional study and was conducted in Dhaka Medical College Hospital, Dhaka for one-year period following approval of this protocol. Patients suffering from primary thyroid carcinoma admitted in or attending the outpatient department (OPD) in the department of Otolaryngology and Head-Neck Surgery was approached for inclusion in the study. Written informed consent was taken from the subject and ethical issues were ensured. A total of 50 individual suffering from primary thyroid carcinoma calculated by sample size formula was selected by inclusion and exclusion criteria and data was collected by interview using a semi-structured questionnaire and by personal document analysis. Collected data was analyzed by the SPSS 20 for windows. This study reflects the pattern of primary thyroid malignancy in a tertiary care hospital in Bangladesh. Results: Mean age of the participants was 32.7 years with SD ± 13.8 years, Minimum age was 17 years and maximum age was 70 years. Majority of the patients (46%) were in the age group of 31- 40 years. Among the participants, 70% were female and 30% were male. The majority of the patients belong to Dhaka and Rangpur divisions (26% & 22% respectively) of which maximum patients were from rural area (70%). By occupation, maximum (22%) of the study subjects were businessman, maximum study subjects were below SSC (24%) and maximum patients (42%) had relatively low income per month. Half of the participants had habit of tobacco. All patients (100%) had presented with palpable thyroid swelling. Among the total participants 54% had lymphadenopathy, 10% had dysphagia, 4% had hoarseness of voice and 4% had lumpiness in throat. Only 2% of patients had the symptom of dyspnoea. No palpable lymph nodes were found in 46% followed by Single node lymphadenopathy 26%, multiple nodules in one side in 18%, bilateral lymphadenopathy 8% and 20% participants had Central compartment lymphadenopathy. USG findings of thyroid revealed Single solid nodule in 22.0%, Single cystic nodule in 16.0%, multiple mixed (solid + cystic) nodules in 62.0% cases. FNAC findings revealed Anaplastic carcinoma in 2.0%, Follicular neoplasm in 16.0% and Follicular variant of papillary carcinoma in 8.0%. Papillary carcinoma found in maximum 70.0% cases. No lymphoma found whereas medullary carcinoma found in 4.0% cases. Histopathological findings confirmed Anaplastic carcinoma in 4.0%, Follicular carcinoma in 16.0%, Follicular variant of papillary carcinoma in 8.0% and Papillary carcinoma 68.0% cases. By histopathological examination no lymphoma found whereas medullary carcinoma found in 4.0% cases. Only 24% participants had hypertension and 76% had DM as co-morbid diseases. Distant metastasis of carcinoma was not present in any of the participants. Conclusion: In this study, middle age group and female sex prevalent thyroid cancer. Geographical distribution also has an important role. Business, low educational level, low socioeconomic status and tobacco smoking are found the most important risk factors. Histopathologically papillary carcinoma was predominant followed by follicular carcinoma, follicular variant of papillary carcinoma, anaplastic carcinoma and medullary carcinoma. No lymphoma found. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 161-174

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Mammography Trends in a Tertiary Care Hospital in Nepal

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i4.2268 ◽

2021 ◽

Vol 18 (4) ◽

pp. 667-671

Author(s):

Anamika Jha ◽

Ranjit Kumar Chaudhary

Keyword(s):

Breast Cancer ◽

Breast Density ◽

Breast Imaging ◽

Histopathological Examination ◽

Tertiary Care ◽

Developed Countries ◽

Diagnostic Group ◽

University Teaching ◽

Care Hospital ◽

Screening Programs

Background: Mammography is an established screening tool for early detection of breast cancer, with several protocols used worldwide. Such screening programs and related data are lacking in less developed countries. We documented and analyzed the mammographic trends at Tribhuvan University Teaching Hospital, a tertiary care referral center, in Kathmandu, Nepal, to develop baseline data which may be helpful in further researches.Methods: In this descriptive study, imaging findings of consecutive patients who had undergone mammography between July 2016 and March 2018 were reviewed after obtaining ethical clearance from the Institutional Review Committee. Ultrasonography and histopathological examination were done as needed. Demographics, presenting complaints, breast density, Breast Imaging, Reporting, Assessment and Data System category and final diagnosis were recorded and analyzed using appropriate statistical methods.Results: There were more diagnostic mammograms (62%) than screening with mastalgia the most common presenting complaint. Breast density was less in screening group. Overall, there were more benign lesions with incidence of breast cancer being 4.4% more in the diagnostic group. The age range varied from 22 to 86 years, with 15% (n=219) below 40 years age accounting for one-third of the cases of extremely dense breast and one-fourth of the suspicious lesions. Nearly 50% of breast cancers were seen in patients less than 50 years of age.Conclusions: The study showed greater number of diagnostic than screening mammograms, with malignancies detected more often in the diagnostic group and younger age. Fewer screening studies suggest a lack of breast cancer awareness in our population who seek medical help only when symptomatic. Keywords: BIRADS; Breast Cancer; Mammography

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Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.830 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s264

Author(s):

Jordan Polistico ◽

Avnish Sandhu ◽

Teena Chopra ◽

Erin Goldman ◽

Jennifer LeRose ◽

...

Keyword(s):

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Turnaround Time ◽

Care Hospital ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Rapid Pcr ◽

The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

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Safety huddles to proactively identify and address electronic health record safety

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw153 ◽

2016 ◽

Vol 24 (2) ◽

pp. 261-267 ◽

Cited By ~ 11

Author(s):

Shailaja Menon ◽

Hardeep Singh ◽

Traber D Giardina ◽

William L Rayburn ◽

Brenda P Davis ◽

...

Keyword(s):

Situational Awareness ◽

Tertiary Care ◽

The United States ◽

Care Hospital ◽

Design Data ◽

Software Application ◽

Safety Concerns ◽

Hardware System ◽

Error Taxonomy ◽

Electronic Health

Objective: Methods to identify and study safety risks of electronic health records (EHRs) are underdeveloped and largely depend on limited end-user reports. “Safety huddles” have been found useful in creating a sense of collective situational awareness that increases an organization’s capacity to respond to safety concerns. We explored the use of safety huddles for identifying and learning about EHR-related safety concerns. Design: Data were obtained from daily safety huddle briefing notes recorded at a single midsized tertiary-care hospital in the United States over 1 year. Huddles were attended by key administrative, clinical, and information technology staff. We conducted a content analysis of huddle notes to identify what EHR-related safety concerns were discussed. We expanded a previously developed EHR-related error taxonomy to categorize types of EHR-related safety concerns recorded in the notes. Results: On review of daily huddle notes spanning 249 days, we identified 245 EHR-related safety concerns. For our analysis, we defined EHR technology to include a specific EHR functionality, an entire clinical software application, or the hardware system. Most concerns (41.6%) involved “EHR technology working incorrectly,” followed by 25.7% involving “EHR technology not working at all.” Concerns related to “EHR technology missing or absent” accounted for 16.7%, whereas 15.9% were linked to “user errors.” Conclusions: Safety huddles promoted discussion of several technology-related issues at the organization level and can serve as a promising technique to identify and address EHR-related safety concerns. Based on our findings, we recommend that health care organizations consider huddles as a strategy to promote understanding and improvement of EHR safety.

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Women with Abnormal Endometrial Pathology: Experienced at a Tertiary Care Hospital in Bangladesh

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v5i1.16198 ◽

2013 ◽

Vol 5 (1) ◽

pp. 11-13

Author(s):

Mst Syeeda Showkat ◽

Lubna Khondker ◽

Shahryar Nabi ◽

Bishwajit Bhowmik

Keyword(s):

Endometrial Hyperplasia ◽

Histopathological Examination ◽

Tertiary Care ◽

Cross Sectional Study ◽

Transvaginal Sonography ◽

Common Disease ◽

Care Hospital ◽

Cross Sectional ◽

Examination Result ◽

Endometrial Pathology

Background: Transvaginal sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective: This study was undertaken to see the clinicalpathological characteristics of endometrial hyperplasia. Methodology: This cross sectional study was carried out from January 2007 to December 2008 for a period of two years. All suspected cases of endometrial hyperplasia were included for this study. Transvaginal sonography (TVS) performed and confirmation was done by histopathological examination. Result: A total number of 40 cases were enrolled for this study. The most common diagnosed endometrial pathology was endometrial hyperplasia which was 42.5% cases. Endometrial polyp was diagnosed in 32.5% cases. Endometrial carcinoma was in 7.5% patients and submucosal fibroid was in 10.0%. Conclusion: Endometrial hyperplasia is the most common disease among the women presented with endometrial pathology. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16198 J Shaheed Suhrawardy Med Coll, 2013;5(1):11-13

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Retrospective analysis of the most common cause of rejection of donors for blood donation

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210604 ◽

2021 ◽

Vol 8 (3) ◽

pp. 444

Author(s):

Garima Vijayvergiya ◽

Parag Fulzele ◽

Naveen Vairyamoorthy

Keyword(s):

Blood Pressure ◽

Blood Donor ◽

Blood Donation ◽

Tertiary Care ◽

Geographical Area ◽

Rejection Rate ◽

Developed Countries ◽

Care Hospital ◽

Systemic Examination ◽

Safe Blood

Background: A significant imbalance in access to safe blood is seen between the developing and developed countries. Donor selection has a pivotal role in preventing transfusion related complications and provide safety to the recipients. In this study, we aimed to find out rate and causes of blood donor rejection in our hospital. Methods: A retrospective study conducted in a tertiary care hospital involving both the voluntary and replacement donors during the period September 2017 to December 2018. We included all those donors who were considered unfit for blood donation. All those who came for blood donation at our hospital were asked to fill up an enrolment form for a blood donor. A general and systemic examination were done. We calculated the rejection rate, listed the reasons for donor rejection, and analyzed the data.Results: Among 150 rejected blood donors, most were males [129 (86%)], and the rest were females [21 (14%)]. The rejection rate in our study was 3.29%. We found that the rejection rate of donors was different among voluntary and replacement donors. It showed that the most common reason for the temporary rejection of blood donation was low hemoglobin level, followed by abnormal blood pressure. Conclusions: A vast majority of donors were rejected temporarily [132 (88%)], while the rest of them were rejected permanently [18 (12%)]. Low Hb in females and abnormal blood pressure in males were the commonest causes of blood donor rejection. Many factors affect the similarities and variations between the most typical causes of blood donor rejection, such as geographical area, cultural, socio-economic, and educational factors.

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Nasomaxillary swellings: our experience at tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210680 ◽

2021 ◽

Vol 7 (3) ◽

pp. 469

Author(s):

Mukesh Rawat ◽

Archana Lall ◽

Kavita Sachdeva

Keyword(s):

Tertiary Care Hospital ◽

Histopathological Examination ◽

Tertiary Care ◽

Final Diagnosis ◽

Inverted Papilloma ◽

Nasal Endoscopy ◽

Common Symptom ◽

Fungal Sinusitis ◽

Care Hospital ◽

Malignant Lesions

Background: A wide spectrum of lesions may present as nasomaxillary swellings ranges from benign to malignant lesions including fungal sinusitis and fibro vascular lesions example: JNA (Juvenile nasopharyngeal angiofibroma) and Inverted papilloma. Many Pathologies ranging from benign to malignant tumors may mimic a simple Nasomaxillary mass. It is diagnostic challenge to determine pathology behind it. A detailed clinical evaluation with nasal endoscopy and relevant pre-operative investigations including radiological imaging and histopathological examination is essential to reach up to final diagnosis. The aim of the study was to do clinicopathological evaluation of patients presenting with nasomaxillary swelling and correlation of clinical, radiological and Histopathological findings.Methods: This was a prospective observational study on 50 nasomaxillary swelling patients who are presented in the Department of ENT and Head and Neck Surgery of N.S.C.B. MCH Jabalpur, a tertiary care Hospital, between March 2018 to August 2019. A detailed history taking and clinical examination with nasal endoscopy and relevant preoperative investigations including CECT Nose and PNS and histopathological examination was done in all patients.Results: 50 Nasomaxillary swelling patients were selected for this study. 30 patients were male and 20 were females. Ages of patients were varied from 12 years to 72 years. 23 patients (46%) were malignant and 27 (54%) were benign. Histopathological examination results shows benign lesions like JNA (6 cases), fungal sinusitis (6 cases), dermoid cyst (1 case), inverted papilloma (3 cases), sebaceous cyst (1 case), jaw lesions (10 cases), (odontogenic like radicular/ infected cyst, dentigerous cyst, cystic ameloblastoma and non-odontogenic like fibrous dysplasia) and malignant lesions like SCC (squamous cell carcinoma) (12 cases), spindle cell sarcoma (2 cases), undifferentiated carcinoma (3 cases), adenocarcinoma (3 cases), adenoid cystic carcinoma (1 case), Invasive pleomorphic sarcoma (1 case) and malignant melanoma (1 case). SCC was most common lesion f/b JNA and fungal sinusitis. Well differentiated SCC was most common histological type (10 out of 12 cases of SCC). Most common symptom was nasal obstruction (66% cases) f/b epistaxis (52% cases) but epitasis was most common symptom among malignant and JNA cases. In 6 cases (3 JNA, 1 inverted papilloma, 1 malignancy and 1 radicular cyst) radiological diagnosis were not correlated with histological findings.Conclusions: Most our cases were malignant nasomaxillary lesions followed by fungal sinusitis and JNA. Most patients presented in advanced stage of disease so rapidly evaluation including nasal endoscopy should be done. CECT scan is essential to determine tumors extent and bony lesions. All patients should undergo hisotopatholigical examination. The final diagnosis should be made on the basis of clinical, radiological and histopathological findings.

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Susceptibility of Clinical Isolates of Staphylococcus aureus to Ceftaroline

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46121.14442 ◽

2021 ◽

Author(s):

Harsha Sreedharan ◽

KB Asha Pai

Keyword(s):

Staphylococcus Aureus ◽

Tertiary Care Hospital ◽

Methicillin Resistance ◽

Descriptive Analysis ◽

Tertiary Care ◽

The United States ◽

Clinical Isolates ◽

Diffusion Method ◽

Clinical Samples ◽

Care Hospital

Introduction: Methicillin-Resistant Staphylococcus aureus(MRSA) infection is a major global healthcare problem, the prevalence of which varies from 25-50% in India. It is known to cause Skin and Soft tissue Infections (SSI), endovascular infections, endocarditis, pneumonia, septic arthritis, osteomyelitis, and sepsis. Vancomycin is the drug of choice for treating severe MRSA infections. Ceftaroline, a fifth-generation cephalosporin has been approved by the United States Food and Drug Administration (US FDA) for treating acute bacterial SSI caused by susceptible micro-organisms including MRSA, Community acquired respiratory tract infection, MRSA bacteremia and endocarditis. Aim: To assess the susceptibility of clinical isolates of S. aureusto ceftaroline, in a Tertiary Care Hospital. Materials and Methods: This prospective study was conducted in the Department of Microbiology of a Tertiary Care Hospital over a period of two months from June 2019 to July 2019. S.aureus isolates from various clinical samples were screened for methicillin resistance by disc diffusion method using cefoxitin disc and ceftaroline susceptibility of these isolates was assessed by E-strip method. The isolates were classified as ceftaroline susceptible, Susceptibility Dose Dependent (SDD) and ceftaroline resistant respectively as per CLSI guidelines. A descriptive analysis of the data was done and the results were presented as frequencies and percentages. Results: All the S.aureus isolates were found to be susceptible to ceftaroline. Methicillin Sensitive Staphylococcus aureus(MSSA) isolates had lower Minimum Inhibitory Concentration (MIC) when compared to MRSA. The highest MIC among MRSA was 0.5 μg/mL. Conclusion: Ceftaroline can be considered as an effective alternative for treatment of infections caused by MRSA.

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Frequency and Pattern of Bronchiectasis in Patients with Chronic Obstructive Pulmonary Disease Presenting in a Tertiary Care Hospital

Proceedings of Shaikh Zayed Medical Complex Lahore - October to December ◽

10.47489/pszmc-809-35-3-54-57 ◽

2021 ◽

Vol 35 (3) ◽

pp. 54-57

Author(s):

Asifa Karamat

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Tertiary Care ◽

Lower Lobe ◽

The United States ◽

Diagnostic Tools ◽

Chronic Obstructive ◽

High Morbidity ◽

Care Hospital ◽

Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a high burden respiratory issue all over the world. It has high morbidity and mortality in the United States. Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) and is under diagnosed as diagnostic tools like HRCT though easily available but an expensive test in developing countries like Pakistan. We aim to establish the frequency and patterns of bronchiectasis in patients of COPD. Aims and Objectives: To establish the frequency and pattern of bronchiectasis in COPD in our population so that we can improve patient care and quality of life of these patients. Place and duration of study: We did a cross sectional survey in Department of Pulmonology, Gulab Devi Hospital, Lahore. Study was completed from 1st September 2017 to 28th February 2018. Material & Methods: After taking an informed consent 150 already diagnosed COPD patients were included. Bronchiectasis was seen on high resolution CT scan (HRCT). Data was collected on a structured proforma and analyzed on SPSS version 20. Results: Bronchiectasis was observed in 76 (50.6%) patients of COPD while 74 patients had no bronchiectasis. Out of 76, cylindrical bronchiectasis was seen in 82%. Lower lobe and bilateral involvement was more common. Means of age, gender, exacerbations of COPD, and history of pulmonary tuberculosis were not related to bronchiectasis while pack years of smoking, duration of illness and Modified Medical Research Council (MMRC) Dyspnea Scale were significantly related to bronchiectasis. Conclusion: This is observed that bronchiectasisis quite common (50.6%) in patients of COPD in our population.

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Association of Obesity and Thyroid Cancer at a Tertiary Care Hospital in Pakistan

Cureus ◽

10.7759/cureus.2364 ◽

2018 ◽

Author(s):

Adnan Ali ◽

Yumna Mirza ◽

Urooj Faizan ◽

Nida Zahid ◽

Muhammad S Awan

Keyword(s):

Thyroid Cancer ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital

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