This study examined 221 patients with clinical presentations of goiter who underwent fine needle aspiration cytology (FNAC). 76 of these patients subsequently had surgery and histopathological examination. The study aimed to determine the diagnostic accuracy of FNAC for goiter diagnosis by comparing pre-operative FNAC results to post-operative histopathology. Key findings were a diagnostic accuracy of FNAC for goiter of 96.05%, and cyto-histological concordance in diagnosis of 95.7% of cases. FNAC was found to be a simple, safe and reliable first-line investigation for goiter diagnosis.
1) FNAC is a simple, safe, and minimally invasive outpatient procedure that provides a reliable diagnosis of thyroid nodules and goiters, avoiding unnecessary diagnostic surgery.
2) A study of 221 patients found that FNAC accurately diagnosed 92.3% of cases as benign and 2.3% as malignant. Histological examination of tissue from the 76 patients who underwent surgery confirmed the FNAC diagnoses in 94.7% of cases.
3) FNAC is a reliable first-line investigation for patients presenting with thyroid abnormalities that can help clinicians make an early and accurate diagnosis to guide appropriate treatment.
Accuracy and reliability_of_tzanck_test_compared_t (1)Eva Yustiana
This document compares the accuracy of the Tzanck test to histopathology for diagnosing basal cell carcinoma (BCC). The Tzanck test is a simple cytological examination that is faster and cheaper than histopathology, the gold standard. The study examined 26 patients clinically diagnosed with BCC using both tests. Histopathology confirmed BCC in 23 cases. The Tzanck test correctly identified BCC in 12 cases and ruled out the 3 non-BCC cases, but missed diagnosing BCC in 11 cases. The Tzanck test had a sensitivity of 52.2% and specificity of 100% compared to histopathology. While the Tzanck test can rapidly identify some BCC, it has
Plaque rupture relationship to plaque composition in coronary arteries. A 320...Apollo Hospitals
Coronary thrombosis leading to myocardial ischemia is now recognized as a diverse process arising from plaque rupture, erosion, or calcified nodules. These vulnerable plaques may not always cause significant stenosis of the artery, and therefore be missed on an invasive catheter angiogram (ICA). The advent of multidetector computed tomography (MDCT) imaging of the walls of the coronary artery has opened a unique window to these vulnerable plaques. Differentiation of calcified plaques from soft plaques presents no challenge on CT. Further characterization of the plaque into a ruptured plaque is possible by demonstration of discontinuity of the plaque surface and contrast pooling within the plaque substance.
Solitary Thyriod Nodule By Dr Irshad BalochZaib2268
This document discusses the evaluation and management of solitary thyroid nodules. It defines a solitary thyroid nodule and lists common complaints. It describes taking a thorough history and performing an examination, focusing on differentiating hypo- and hyperthyroidism and checking for signs of malignancy. Investigations discussed include thyroid function tests, ultrasound, FNAC, thyroid scan, and CT or MRI if needed. FNAC results are categorized and management is outlined depending on FNAC and test results. Thyroid neoplasms are also classified.
Reporting thyroid fine needle aspiration by the bethesda systemMonika Nema
This document summarizes guidelines for thyroid fine needle aspiration (FNA) cytopathology reports. It discusses classifications including nondiagnostic/unsatisfactory, benign thyroid lesions, atypia of undetermined significance/follicular lesion of undetermined significance, and includes examples of diagnostic criteria, imaging features and recommended reporting language for each classification. Thyroid FNA is presented as an accurate and cost-effective initial test for evaluating thyroid nodules that can help determine if surgery is needed.
This document discusses the use of ultrasound in diagnosing scrotal pathologies. It summarizes a study of 75 patients who underwent scrotal ultrasound exams. The most common sonographic finding was varicocele (37.33%), followed by hydrocele (16%). Varicocele most commonly affected men ages 21-30 and was usually found on the left side. Masses like cysts were most common in men ages 51-60 and usually affected the right testis. Hydroceles were most common in men ages 51-60. Epididymitis/orchitis mostly affected men ages 11-20. The study concludes that ultrasound is an effective tool for diagnosing various scrotal abnormalities.
Ultrasonography Diagnosis of Scrotal Pathologiesiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
1) FNAC is a simple, safe, and minimally invasive outpatient procedure that provides a reliable diagnosis of thyroid nodules and goiters, avoiding unnecessary diagnostic surgery.
2) A study of 221 patients found that FNAC accurately diagnosed 92.3% of cases as benign and 2.3% as malignant. Histological examination of tissue from the 76 patients who underwent surgery confirmed the FNAC diagnoses in 94.7% of cases.
3) FNAC is a reliable first-line investigation for patients presenting with thyroid abnormalities that can help clinicians make an early and accurate diagnosis to guide appropriate treatment.
Accuracy and reliability_of_tzanck_test_compared_t (1)Eva Yustiana
This document compares the accuracy of the Tzanck test to histopathology for diagnosing basal cell carcinoma (BCC). The Tzanck test is a simple cytological examination that is faster and cheaper than histopathology, the gold standard. The study examined 26 patients clinically diagnosed with BCC using both tests. Histopathology confirmed BCC in 23 cases. The Tzanck test correctly identified BCC in 12 cases and ruled out the 3 non-BCC cases, but missed diagnosing BCC in 11 cases. The Tzanck test had a sensitivity of 52.2% and specificity of 100% compared to histopathology. While the Tzanck test can rapidly identify some BCC, it has
Plaque rupture relationship to plaque composition in coronary arteries. A 320...Apollo Hospitals
Coronary thrombosis leading to myocardial ischemia is now recognized as a diverse process arising from plaque rupture, erosion, or calcified nodules. These vulnerable plaques may not always cause significant stenosis of the artery, and therefore be missed on an invasive catheter angiogram (ICA). The advent of multidetector computed tomography (MDCT) imaging of the walls of the coronary artery has opened a unique window to these vulnerable plaques. Differentiation of calcified plaques from soft plaques presents no challenge on CT. Further characterization of the plaque into a ruptured plaque is possible by demonstration of discontinuity of the plaque surface and contrast pooling within the plaque substance.
Solitary Thyriod Nodule By Dr Irshad BalochZaib2268
This document discusses the evaluation and management of solitary thyroid nodules. It defines a solitary thyroid nodule and lists common complaints. It describes taking a thorough history and performing an examination, focusing on differentiating hypo- and hyperthyroidism and checking for signs of malignancy. Investigations discussed include thyroid function tests, ultrasound, FNAC, thyroid scan, and CT or MRI if needed. FNAC results are categorized and management is outlined depending on FNAC and test results. Thyroid neoplasms are also classified.
Reporting thyroid fine needle aspiration by the bethesda systemMonika Nema
This document summarizes guidelines for thyroid fine needle aspiration (FNA) cytopathology reports. It discusses classifications including nondiagnostic/unsatisfactory, benign thyroid lesions, atypia of undetermined significance/follicular lesion of undetermined significance, and includes examples of diagnostic criteria, imaging features and recommended reporting language for each classification. Thyroid FNA is presented as an accurate and cost-effective initial test for evaluating thyroid nodules that can help determine if surgery is needed.
This document discusses the use of ultrasound in diagnosing scrotal pathologies. It summarizes a study of 75 patients who underwent scrotal ultrasound exams. The most common sonographic finding was varicocele (37.33%), followed by hydrocele (16%). Varicocele most commonly affected men ages 21-30 and was usually found on the left side. Masses like cysts were most common in men ages 51-60 and usually affected the right testis. Hydroceles were most common in men ages 51-60. Epididymitis/orchitis mostly affected men ages 11-20. The study concludes that ultrasound is an effective tool for diagnosing various scrotal abnormalities.
Ultrasonography Diagnosis of Scrotal Pathologiesiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Factors affecting mortality in burns: a single center studyKETAN VAGHOLKAR
Background: Burns injury continues to be the greatest challenge to the trauma surgeon. A multitude of factors determine the mortality in burns patients. The present study aims at identifying those factors which have a significant impact on mortality in burns patients.
Methods: A total 80 patients presenting with burns injury were studied prospectively. Various factors which included age, sex, aetiology, mode of injury, total body surface area which is burnt (BSA), duration of stay, time interval up to admission, pregnant state, inhalation injury, systemic complications, wound complications, and psychological impact were studied.
Results: The mean age was 24.07 years. 59 were females, 21 were males. 19 (23.75%) cases were suicidal in aetiology whereas the remaining 61(76.25%) were accidental. Flame injury was the most common mode of injury in 65 patients (81.25%). The mean BSA in the study was 53.5% whereas the mean BSA in those patients who expired was 71.4%. Mean duration of stay in hospital was 6.55 days whereas mean time interval between burns injury and admission to hospital was 101.33 minutes. All 12 pregnant women had spontaneous miscarriages with a mortality in 11 patients. Inhalation injury was seen in 49 patients (61%) with mortality of 42 (83.7%) patients. Systemic complications seen in 60 patients mortality and BSA was high in patients who had infection. 31 patients in the study had severe depression with a mortality of 91.32%. 50 out of the 80 patients studied expired.
Conclusions: Increased age, BSA, mode of injury, presence of inhalation injury, systemic complication, pregnant state, wound infection and depression had a significant impact on the mortality of burns patients.
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...James Hilbert
The document summarizes three clinical trial designs:
1) A phase 3 trial compared doxorubicin alone versus doxorubicin plus ifosfamide as first-line chemotherapy for advanced soft tissue sarcoma. It found the combination improved response rates and progression-free survival but not overall survival, and was more toxic.
2) A phase 3 placebo-controlled trial of pazopanib versus placebo in patients with soft tissue sarcoma whose disease progressed on prior chemotherapy.
3) A phase 3 placebo-controlled trial of regorafenib in patients with gastrointestinal stromal tumor progressing on prior treatments including imatinib and sunitinib, with a cross-over design allowing patients
1. This study evaluated the diagnostic accuracy of fine needle aspiration cytology (FNAC) for thyroid gland lesions by analyzing 300 patients.
2. The most common lesions found on FNAC were colloid goiter (65%) and thyroid cyst (15.34%). Rare malignancies identified included papillary carcinoma (0.66%) and anaplastic carcinoma (0.33%).
3. Histopathological examination of 36 surgical specimens showed high accuracy of FNAC, with a sensitivity of 100%, specificity of 97.61%, and accuracy of 97.72%.
Viet Nam has a population of over 97 million people. In 2020, there were approximately 182,563 new cancer cases and 122,690 cancer deaths reported in the country. The most common cancers among males were liver, lung, and stomach cancer, while among females the most common were breast, lung, and colorectal cancer. Overall, the cancers with the highest incidence rates were liver, lung, breast, stomach, and colorectal cancer. Cancer remains a significant health issue in Viet Nam, as the risk of developing and dying from cancer before age 75 remains high.
The Importance of College Students Joining the NMDPMeagan Rudy
This is my work product from my internship course that I took over the summer last year. In this presentation, I discuss the importance of why college students should become bone marrow/stem cell donors and describe how a bone marrow drive works.
This document summarizes the use of sentinel lymph node biopsy (SLNB) in gynecological malignancies, specifically vulvar cancer. It discusses how SLNB can help stage and predict prognosis in vulvar cancer patients, with a lower morbidity than traditional inguinal lymphadenectomy. Several studies demonstrated high detection rates of over 95% and low false negative rates of less than 10% when using radiotracer and blue dye to map sentinel lymph nodes in vulvar cancer patients. Larger multicenter trials provide further support for the accuracy and reduced complications of SLNB compared to lymphadenectomy in early stage vulvar cancer.
This document provides information on the management of diffuse gliomas, including:
1. It defines diffuse gliomas and discusses their WHO classification, typically involving infiltration of normal brain tissue without clear borders.
2. Symptoms can include raised intracranial pressure, seizures, focal neurological deficits, and others depending on the tumor location.
3. Managing diffuse gliomas requires a multidisciplinary team including radiologists, neurosurgeons, oncologists and others.
4. Trial evidence is discussed regarding the use of radiotherapy and chemotherapy at different doses and timings for diffuse low-grade gliomas.
The document summarizes findings from a study on the appropriateness of upper endoscopy referrals in Italy. Key findings include:
1) 22% of over 13,000 endoscopies were deemed inappropriate based on guidelines. Relevant findings were found in 51% of appropriate referrals and 32% of inappropriate ones.
2) Common relevant findings included esophagitis, gastric erosions, esophageal varices, and ulcers. New cancers were found in 1.6% of patients.
3) Guidelines had high sensitivity but low specificity for relevant findings and cancer. A simple rule using age and alarm symptoms had similar accuracy to guidelines.
4) Over 20% of endoscopy
The document summarizes a study on malaria cases admitted to a military fever hospital in Egypt between 2018-2022. It finds that the majority of cases were young male military staff from Greater Cairo with a history of previous malaria infections. Nearly half of cases were uncomplicated, while over a third had severe non-cerebral malaria. Complicated cases were more likely to have disturbed consciousness, vomiting, jaundice and require ICU admission.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
The document summarizes an HIV/AIDS prevention project conducted by OSD Pakistan from 2011-2012. The project provided harm reduction services to 400 injecting drug users, 138 men who have sex with men, and 137 transgender individuals in Rawalpindi, Pakistan. Services included syringe exchanges, condom distribution, counseling, and education. Testing showed HIV prevalence of 9.2% overall, with the highest (12%) among injecting drug users. Challenges included lack of government support and high prices of condoms and syringes.
Study I examined associations between promoter methylation of 10 tumor suppressor genes (e.g. RASSF1A, GSTP1) in breast tumor tissue and prognosis in a population-based cohort of breast cancer patients followed for 8 years. Methylation of certain genes like GSTP1 and TWIST1 were associated with increased breast cancer mortality. Patients with more methylated genes had higher mortality, with a 41% increased risk of breast cancer death for each additional methylated gene. Overall, DNA methylation shows potential as a prognostic biomarker for breast cancer outcomes.
Pattern of chemical poisoning in baghdad 2012munir salman
This document summarizes a study on patterns of chemical poisoning among consultation requests to the Poisoning Consultation Center in Iraq in 2012. Some key findings include:
- Males comprised 58% of the total sample of 1,705 cases. The average age was 24.3 years.
- Baghdad province accounted for 74.1% of cases. Hepatic-related complaints had the highest rate of positive laboratory findings at 59.2%.
- Of the 575 cases found to have significant poisoning, external chemical poisoning accounted for 180 cases (31.3%), with the most common chemicals being sedatives (31.7%), analgesics (23.9%), and heavy metals (18.3%).
The document summarizes a gastroenterology audit conducted at SPHMMC in November 2018. 57 colonoscopies were performed and data was collected on patient demographics, indications for procedures, findings, and challenges. The most common indications were ruling out colorectal cancer (26.3%) and lower GI bleeding (14%). The most common findings were normal (28%), hemorrhoids (22.8%), and colorectal carcinoma (14%). Opportunities for improvement included standardizing report formats, assessing bowel prep quality, and monitoring key performance indicators like adenoma detection rates.
This document discusses liver cancer rates in the Arab world. It finds that liver cancer incidence has tripled over the last three decades. The majority of new cancer cases and deaths occur in less developed regions like the Arab world. Hepatitis B and C are major risk factors and their high prevalence in the Arab world helps explain the region's high liver cancer rates. For example, Egypt has very high rates of hepatitis C and over 90% of its liver cancers are associated with the virus. The document calls for increased regional cooperation through a Pan Arab hepatocellular carcinoma group to address the growing challenge of liver cancer in the Arab world.
This document provides an annual report on Kuwait's newborn screening program for 2018. It includes statistics on the number of samples received and tested, the screening panel used, positive results, confirmed cases, and performance indicators. A total of 59,655 samples were received in 2018 from various hospitals in Kuwait. Of these, 931 screened positive for various conditions. Further testing confirmed 67 cases across different metabolic disorders and endocrine conditions. Key performance metrics like detection rate, false positive rate, and positive predictive value are provided. The report concludes by thanking the newborn screening team and various doctors for their efforts in the program's success.
1) Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide and the 3rd leading cause of cancer death. The incidence of HCC in the US has doubled from 1985-1998.
2) Risk factors for HCC include hepatitis B and C infection, alcohol use, non-alcoholic fatty liver disease, and hereditary conditions. Cirrhosis of the liver greatly increases the risk of developing HCC.
3) Screening high-risk patients such as those with cirrhosis every 6-12 months with ultrasound and alpha-fetoprotein blood tests can help detect HCC at an early stage when more treatment options are available.
The document discusses laparoscopy procedures for various gynecological conditions such as infertility, chronic pelvic pain, ectopic pregnancy, and oncological issues. It notes that laparoscopy can be used for both diagnostic and operative purposes. It then discusses different techniques for laparoscopic access such as direct trocar insertion versus Verres needle insertion. It reviews studies comparing complication rates between different access techniques. The document emphasizes the importance of evidence-based medicine and following guidelines from organizations like NICE when determining appropriate diagnostic tests and treatments for conditions like infertility.
The document discusses laparoscopy procedures for various gynecological conditions. It begins by outlining conditions that can be diagnosed or treated via laparoscopy, including infertility, ectopic pregnancy, adhesions, endometriosis, ovarian masses, hysterectomy, uterine fibroids, and gynecological oncology issues. It then discusses different laparoscopy access techniques such as direct trocar insertion, open laparoscopy, and Verres needle insertion. It provides data on complication rates for different access methods. The document also discusses techniques for avoiding major vascular injuries during access. In summary, the document provides an overview of laparoscopy procedures and techniques for gynecological conditions.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Factors affecting mortality in burns: a single center studyKETAN VAGHOLKAR
Background: Burns injury continues to be the greatest challenge to the trauma surgeon. A multitude of factors determine the mortality in burns patients. The present study aims at identifying those factors which have a significant impact on mortality in burns patients.
Methods: A total 80 patients presenting with burns injury were studied prospectively. Various factors which included age, sex, aetiology, mode of injury, total body surface area which is burnt (BSA), duration of stay, time interval up to admission, pregnant state, inhalation injury, systemic complications, wound complications, and psychological impact were studied.
Results: The mean age was 24.07 years. 59 were females, 21 were males. 19 (23.75%) cases were suicidal in aetiology whereas the remaining 61(76.25%) were accidental. Flame injury was the most common mode of injury in 65 patients (81.25%). The mean BSA in the study was 53.5% whereas the mean BSA in those patients who expired was 71.4%. Mean duration of stay in hospital was 6.55 days whereas mean time interval between burns injury and admission to hospital was 101.33 minutes. All 12 pregnant women had spontaneous miscarriages with a mortality in 11 patients. Inhalation injury was seen in 49 patients (61%) with mortality of 42 (83.7%) patients. Systemic complications seen in 60 patients mortality and BSA was high in patients who had infection. 31 patients in the study had severe depression with a mortality of 91.32%. 50 out of the 80 patients studied expired.
Conclusions: Increased age, BSA, mode of injury, presence of inhalation injury, systemic complication, pregnant state, wound infection and depression had a significant impact on the mortality of burns patients.
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...James Hilbert
The document summarizes three clinical trial designs:
1) A phase 3 trial compared doxorubicin alone versus doxorubicin plus ifosfamide as first-line chemotherapy for advanced soft tissue sarcoma. It found the combination improved response rates and progression-free survival but not overall survival, and was more toxic.
2) A phase 3 placebo-controlled trial of pazopanib versus placebo in patients with soft tissue sarcoma whose disease progressed on prior chemotherapy.
3) A phase 3 placebo-controlled trial of regorafenib in patients with gastrointestinal stromal tumor progressing on prior treatments including imatinib and sunitinib, with a cross-over design allowing patients
1. This study evaluated the diagnostic accuracy of fine needle aspiration cytology (FNAC) for thyroid gland lesions by analyzing 300 patients.
2. The most common lesions found on FNAC were colloid goiter (65%) and thyroid cyst (15.34%). Rare malignancies identified included papillary carcinoma (0.66%) and anaplastic carcinoma (0.33%).
3. Histopathological examination of 36 surgical specimens showed high accuracy of FNAC, with a sensitivity of 100%, specificity of 97.61%, and accuracy of 97.72%.
Viet Nam has a population of over 97 million people. In 2020, there were approximately 182,563 new cancer cases and 122,690 cancer deaths reported in the country. The most common cancers among males were liver, lung, and stomach cancer, while among females the most common were breast, lung, and colorectal cancer. Overall, the cancers with the highest incidence rates were liver, lung, breast, stomach, and colorectal cancer. Cancer remains a significant health issue in Viet Nam, as the risk of developing and dying from cancer before age 75 remains high.
The Importance of College Students Joining the NMDPMeagan Rudy
This is my work product from my internship course that I took over the summer last year. In this presentation, I discuss the importance of why college students should become bone marrow/stem cell donors and describe how a bone marrow drive works.
This document summarizes the use of sentinel lymph node biopsy (SLNB) in gynecological malignancies, specifically vulvar cancer. It discusses how SLNB can help stage and predict prognosis in vulvar cancer patients, with a lower morbidity than traditional inguinal lymphadenectomy. Several studies demonstrated high detection rates of over 95% and low false negative rates of less than 10% when using radiotracer and blue dye to map sentinel lymph nodes in vulvar cancer patients. Larger multicenter trials provide further support for the accuracy and reduced complications of SLNB compared to lymphadenectomy in early stage vulvar cancer.
This document provides information on the management of diffuse gliomas, including:
1. It defines diffuse gliomas and discusses their WHO classification, typically involving infiltration of normal brain tissue without clear borders.
2. Symptoms can include raised intracranial pressure, seizures, focal neurological deficits, and others depending on the tumor location.
3. Managing diffuse gliomas requires a multidisciplinary team including radiologists, neurosurgeons, oncologists and others.
4. Trial evidence is discussed regarding the use of radiotherapy and chemotherapy at different doses and timings for diffuse low-grade gliomas.
The document summarizes findings from a study on the appropriateness of upper endoscopy referrals in Italy. Key findings include:
1) 22% of over 13,000 endoscopies were deemed inappropriate based on guidelines. Relevant findings were found in 51% of appropriate referrals and 32% of inappropriate ones.
2) Common relevant findings included esophagitis, gastric erosions, esophageal varices, and ulcers. New cancers were found in 1.6% of patients.
3) Guidelines had high sensitivity but low specificity for relevant findings and cancer. A simple rule using age and alarm symptoms had similar accuracy to guidelines.
4) Over 20% of endoscopy
The document summarizes a study on malaria cases admitted to a military fever hospital in Egypt between 2018-2022. It finds that the majority of cases were young male military staff from Greater Cairo with a history of previous malaria infections. Nearly half of cases were uncomplicated, while over a third had severe non-cerebral malaria. Complicated cases were more likely to have disturbed consciousness, vomiting, jaundice and require ICU admission.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
The document summarizes an HIV/AIDS prevention project conducted by OSD Pakistan from 2011-2012. The project provided harm reduction services to 400 injecting drug users, 138 men who have sex with men, and 137 transgender individuals in Rawalpindi, Pakistan. Services included syringe exchanges, condom distribution, counseling, and education. Testing showed HIV prevalence of 9.2% overall, with the highest (12%) among injecting drug users. Challenges included lack of government support and high prices of condoms and syringes.
Study I examined associations between promoter methylation of 10 tumor suppressor genes (e.g. RASSF1A, GSTP1) in breast tumor tissue and prognosis in a population-based cohort of breast cancer patients followed for 8 years. Methylation of certain genes like GSTP1 and TWIST1 were associated with increased breast cancer mortality. Patients with more methylated genes had higher mortality, with a 41% increased risk of breast cancer death for each additional methylated gene. Overall, DNA methylation shows potential as a prognostic biomarker for breast cancer outcomes.
Pattern of chemical poisoning in baghdad 2012munir salman
This document summarizes a study on patterns of chemical poisoning among consultation requests to the Poisoning Consultation Center in Iraq in 2012. Some key findings include:
- Males comprised 58% of the total sample of 1,705 cases. The average age was 24.3 years.
- Baghdad province accounted for 74.1% of cases. Hepatic-related complaints had the highest rate of positive laboratory findings at 59.2%.
- Of the 575 cases found to have significant poisoning, external chemical poisoning accounted for 180 cases (31.3%), with the most common chemicals being sedatives (31.7%), analgesics (23.9%), and heavy metals (18.3%).
The document summarizes a gastroenterology audit conducted at SPHMMC in November 2018. 57 colonoscopies were performed and data was collected on patient demographics, indications for procedures, findings, and challenges. The most common indications were ruling out colorectal cancer (26.3%) and lower GI bleeding (14%). The most common findings were normal (28%), hemorrhoids (22.8%), and colorectal carcinoma (14%). Opportunities for improvement included standardizing report formats, assessing bowel prep quality, and monitoring key performance indicators like adenoma detection rates.
This document discusses liver cancer rates in the Arab world. It finds that liver cancer incidence has tripled over the last three decades. The majority of new cancer cases and deaths occur in less developed regions like the Arab world. Hepatitis B and C are major risk factors and their high prevalence in the Arab world helps explain the region's high liver cancer rates. For example, Egypt has very high rates of hepatitis C and over 90% of its liver cancers are associated with the virus. The document calls for increased regional cooperation through a Pan Arab hepatocellular carcinoma group to address the growing challenge of liver cancer in the Arab world.
This document provides an annual report on Kuwait's newborn screening program for 2018. It includes statistics on the number of samples received and tested, the screening panel used, positive results, confirmed cases, and performance indicators. A total of 59,655 samples were received in 2018 from various hospitals in Kuwait. Of these, 931 screened positive for various conditions. Further testing confirmed 67 cases across different metabolic disorders and endocrine conditions. Key performance metrics like detection rate, false positive rate, and positive predictive value are provided. The report concludes by thanking the newborn screening team and various doctors for their efforts in the program's success.
1) Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide and the 3rd leading cause of cancer death. The incidence of HCC in the US has doubled from 1985-1998.
2) Risk factors for HCC include hepatitis B and C infection, alcohol use, non-alcoholic fatty liver disease, and hereditary conditions. Cirrhosis of the liver greatly increases the risk of developing HCC.
3) Screening high-risk patients such as those with cirrhosis every 6-12 months with ultrasound and alpha-fetoprotein blood tests can help detect HCC at an early stage when more treatment options are available.
The document discusses laparoscopy procedures for various gynecological conditions such as infertility, chronic pelvic pain, ectopic pregnancy, and oncological issues. It notes that laparoscopy can be used for both diagnostic and operative purposes. It then discusses different techniques for laparoscopic access such as direct trocar insertion versus Verres needle insertion. It reviews studies comparing complication rates between different access techniques. The document emphasizes the importance of evidence-based medicine and following guidelines from organizations like NICE when determining appropriate diagnostic tests and treatments for conditions like infertility.
The document discusses laparoscopy procedures for various gynecological conditions. It begins by outlining conditions that can be diagnosed or treated via laparoscopy, including infertility, ectopic pregnancy, adhesions, endometriosis, ovarian masses, hysterectomy, uterine fibroids, and gynecological oncology issues. It then discusses different laparoscopy access techniques such as direct trocar insertion, open laparoscopy, and Verres needle insertion. It provides data on complication rates for different access methods. The document also discusses techniques for avoiding major vascular injuries during access. In summary, the document provides an overview of laparoscopy procedures and techniques for gynecological conditions.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
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Thyroid paper
1.
2. INTRODUCTION
• Thyroid nodules - common clinical findings - prevalence -
4% to 7% of adult population.
• Common in women.
• Incidence ↑’s- Age, h/o radiation exposure and a diet
containing goitrogenic material.
• Commonest enlargement- Adenomatous and colloid
goiters.
• Especially- iodine deficient goiter belt areas.
• .Prevalence- 40%.
3. • Difficult by clinical evaluation alone to make a correct
diagnosis. Hence it is essential that correct diagnosis is
made as early as possible.
• FNAC- simple, safe, minimally invasive, reliable
outpatient procedure.
• Performed in children, adults, aged and pregnant
women.
• First line of investigation in goiters and a reliable
procedure to obtain accurate diagnosis avoiding
diagnostic surgery.
4. AIMS AND OBJECTIVES
• To study the advantage of FNAC as a simple procedure
for the diagnosis of goiter and to utilize it on the patient’s
first visit to the hospital.
• To compare the preoperative FNAC with postoperative
histopathology and to determine the diagnostic accuracy
of this test in the diagnosis of goiter.
• To study the age and sex incidence of goiter and to
study the geographical distribution of the lesion.
5. MATERIALS AND METHODS
• A prospective study was conducted at ASRAMS
hospital, Eluru from June 2010 to May 2012.
• 221 patients between ages of 10-60 years with clinical
presentation of simple and nodular goiters were selected
for FNAC. There was no sex distinction.
• These cases comprised of a heterogenous population
from various areas of West godavari & Krishna districts.
• All the patients underwent complete history taking,
physical examination and hormonal assay.
6. • Careful palpation of the thyroid was done to guide
precisely the location for doing aspiration.
• Details of the procedure were explained to the patients.
• Aspiration was done with the patient lying comfortably in
a supine position and the neck was extended with a
pillow under the shoulder so as to make the thyroid
swelling appear prominent.
• Under aseptic precautions 23 gauge needle was inserted
into the lesion without attachment of a syringe and to
and fro movement performed quickly.
7. • The material gets collected in the bore by capillary
suction. The needle hub was attached to air-filled syringe
and the plunger was pushed down to expel the material
onto a clean, labeled glass slide.
• The same procedure was repeated at different sites
depending on size of the swelling.
• Several smears were made in each case, fixed in 95%
ethyl alcohol and stained by H&E method and Pap
method, other was air dried and stained with MGG stain.
8. • Out of 221 patients, 76 patients underwent surgeries like
hemithyroidectomy, subtotal and near total
thyroidectomies.
• Histopathological examinations of these specimens were
also done.
• All the specimens were fixed in 10% formalin. Detailed
gross examination was done and 3-10 tissue bits were
selected from representative areas and all the bits were
processed and stained with H&E stain.
• Cytological diagnosis was correlated with histopathology
and the efficacy of FNAC was estimated.
9. RESULTS AND OBSERVATIONS
• Study design:
The present study deals with the fine needle
aspiration cytology of simple and nodular goiters and
determination of diagnostic accuracy of aspiration
cytology.
• A total of 221 patients with clinical presentation of goiters
were subjected to FNAC during a period of 2 years from
june 2010 to may 2012.
• Of these 76 patients underwent surgery subsequently
and histopathological examination of the excised
specimens was done.
10. • Pre-operative diagnosis by FNAC was compared with
histopathology reports of the operative specimens.
• The important observations of the study have been
represented in tabular and graphial forms.
11. Table1:Age distribution with Sex
Age in Females Males Total
Years
No. % No. % No. %
10-20 08 3.79 01 10 09 4.07
21-30 54 25.59 02 20 56 25.34
31-40 71 33.65 03 30 74 33.48
41-50 60 28.44 02 20 62 28.05
51-60 14 6.64 00 00 14 6.33
61-70 04 1.90 02 20 06 2.71
Total 211 95.48 10 4.52 221 100
12.
13.
14. Table2: Duration Of Complaints
Duration of complaints %
No.
Upto 6 months 99 44.80
6months to 1 year 89 40.27
1 to 10 years 30 13.57
>10 years 03 1.36
Total 221 100
29. • Cyto-histological concordance in the diagnosis of goiter
is 95.7%.(68/71 cases).
• Analysis of the FNAC results obtained were compared
with the histological findings in the cases of goiter
yielded the following diagnostic values:
• Sensitivity- 100%.
• Specificity- 62.5%.
• Positive predictive value- 95.7%.
• Negative predictive value- 100%.
• Diagnostic accuracy- 96.05%.
30. Fig 1: Colloid goiter. Abundant thick colloid with few
clusters of follicular epithelial cells(H&E, scanner view)
31. Fig 2: Colloid goiter. Varying sized follicles lined by
flattened epithelium filled with colloid (H&E,x 10)
32. Fig 3: Nodular colloid goiter. Clusters and sheets of
follicular cells with colloid background(H&E, x10)
62. Discussion
• Thyroid nodules are a common clinical problem.
• In iodine deficient areas the incidence of goiters among
thyroid nodules is much higher.
• An accurate and reliable diagnosis of goiter is thus
important to avoid unnecessary surgeries and impose
burden on the healthcare system.
63. • The present study deals with the fine needle aspiration
cytology of goiters in 221 patients of which 76 of them
underwent surgery subsequently.
• The results of the patients were compared wherever
available to determine the diagnostic accuracy of FNAC
in the diagnosis of goiter.
64. Table 17: Comparison of Age
Studies Range of age Median age
in years in years
Mahar et al 13-76 39
Mubarik et al 20-60 41
Saddique et al 10-70 35
Basharat et al 10-70 33
Handa et al 5-80 37
Present study 10-70 35
65. Table 18: Comparison of Sex
Studies Total Males Females M:F ratio
cases
Mubarik et al 54 7 47 1:6.7
Safirullah et al 300 30 270 1:9
Saddique et al 60 8 52 1:6.5
Haberal et al 260 42 218 1:5
Handa et al 434 - - 1:6.3
Present study 221 10 211 1:21
66. Table 19: Comparison of Age and Sex for
Simple and Nodular goiter
Studies Median age in Female to Male
years ratio
Handa et al 39 6:1
Charugupta et al 32 7:1
Present study 27 17:1
67. Table 20: Comparison of TSH levels
Studies Normal Decreased Increased Total
Basharat et al 48 2 0 50
Godinho- 109 11 4 124
Matos et al
Handa et al 80 25 15 120
Present 177 31 13 221
study
68. Table 21: Comparison of Presenting Symptoms
Studies Swelling Pain Dysphagia Palpitation Weight Total
front of & Anxiety gain
neck
Godinho- 144 8 11 11 4 144
Matos et al
Handa et al 434 10 6 15 6 434
Present 221 3 6 27 11 221
study
69. Table 22: Comparison of Size of the Swelling
Studies 1-5cm 6-10cm Total
Basharat et al 35 15 60
Present 157 64 221
study
70. Table 23: Comparison of lesions on FNAC
Studies Benign Follicular Malignant Inadequate Total
Handa et al 381 14 17 22 434
Charugupta 470 _ 30 7 507
et al
Bagga & 228 17 3 4 252
Mahajan
Mahar et al 63 44 15 3 125
Present 204 10 5 2 221
study
71. Table 24: Comparison of Individual Lesions on Cytology
Disease Nongrum Bhatta et al Mosawi et Mubarik et Present study
et al n=60 n=90 al n=78 al n=54 n=76
Simple & Nodular 34 58 52 38 40
colloid goiter
Nodular goiter with 0 13 4 5 28
cystic degeneration
Hyperplastic goiter 4 0 6 0 3
Hashimoto’s 14 6 3 1 2
thyroiditis
Follicular neoplasm 5 3 3 7 2
Papillary 2 9 4 1 1
carcinoma
Anaplastic 1 1 0 0 0
carcinoma
Undifferentiated 0 0 0 2 0
carcinoma
Suspicious 0 0 3 0 0
Non diagnostic 0 0 3 0 0
72. Table 25: Comparison of Cyto-Histological
Concordance in the Diagnosis of Goiter
Studies No. %
Mathur et al 130/134 97
Schnurer et al 264/284 93
Hag et al 32/35 91.4
Saddique et al 29/30 96.7
Mubarik et al 40/43 93
Present study 68/71 95.7
73. Table 26: Comparison of False Negativity Rate
Studies No. of FN cases FNR
Mahar et al 6/125 3.78%
Mathur et al 9/154 5.8%
Saddique et al 3/60 5%
Mubarik et al 1/54 1.85%
Haberal et al 6/260 2.3%
Bhatta et al 1/20 5%
Present study 3/76 3.95%
74. • False negative rates reported in literature range from 1.5
to 9%.
• The false negative FNAC results may occur because of:
-Inadequate samples.
-Geographic misses of lesion.
-Dual pathology and errors of interpretations.
-Presence of cystic neoplasm.
75. • Intermediate FNAC results and
cytodiagnostic errors are unavoidable due to
overlapping cytological features, particularly
among hyperplastic adenomatoid nodules,
follicular neoplasms and follicular variants of
papillary carcinoma.
76. Table 27: Comparison of diagnostic values in goiter
Studies Sensitivit Specificity Positive Negative Diagnostic
y predictive predictive accuracy
value value
Nongrum et 100% 50% 75% 100% 80%
al
Beneragama 82.25% 87.77% 82.25% 87.25% _
et al
Present study 100% 62.5% 95.7% 100% 96.05%
77. CONCLUSION
• It is concluded that FNAC is a simple, minimally invasive
first line diagnostic procedure for evaluation of simple
and nodular goiter with significant efficacy in
differentiating malignant from benign lesions of thyroid.
• FNAC thus is a fairly accurate and reliable modality for
diagnosis of goiters and is a very useful tool to select
patients who would require surgery, thereby reducing
unnecessary surgeries.
• Strict adherence to adequacy criterion and meticulous
examination of all the smears are of paramount
importance in achieving a high rate of diagnostic
accuracy.
78. • FNAC is highly sensitive and specific diagnostic
procedure. But it can give false negative result. So final
diagnosis and treatment pattern should be based upon
histopathology.
• This study also concludes that these areas are endemic
for thyroid disease as goiter is common presentation. It
is because of low intake of iodized salt. Medical
education should be given in these areas.