Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p<0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p<0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved

Analysis of the pterygium size inducing marked refractive astigmatism

PURPOSE. Astigmatic changes induced by the pterygium and their relation to its size and morphology were analysed to establish the critical size for surgery before significant astigmatism occurs

Wird COVID-19 von den Medizinstudierenden in der Schweiz als Bedrohung für die Chancengleichheit zur Erlangung des Berufes wahrgenommen? Eine Querschnittsstudie aus Bern und Genf

Introduction: Students frequently rely on part-time jobs to earn a living wage. We sought to evaluate the sociodemographic status of Swiss medical students and their perception regarding equal career opportunities in view of impaired part-time job opportunities under the COVID-19 pandemic.Methods: We conducted an anonymous online survey among Swiss medical students from Bern and Geneva over a period of 4 months between December 2020 and April 2021. We evaluated sociodemographic data, current living situation, part-time job occupation as well as other sources of income to fund living expenses, and, by means of a five-point Likert scale (1=strongly disagree and 5=strongly agree), whether COVID-19 was perceived as impeding equal career opportunities.Results: Of 968 participants, corresponding to around 13.8% of all medical students in Switzerland, 81.3% had part-time jobs. Amongst the employed, 54.8% worked to afford living expenses and 28.9% reported a negative financial impact due to reduced part-time jobs under the pandemic. The loss of part-time jobs was perceived to make medical studies a privilege for students with higher socioeconomic status (4.11±1.0), whose opportunity to study is independent of a regular income. A governmental backup plan was considered crucial to support affected students (4.22±0.91).Discussion: COVID-19 and its sequelae are perceived as a threat for Swiss medical students and lead to a disadvantage for those with lower socioeconomic status. Nationwide measures should be established to foster equal career opportunities.Einleitung: Studierende sind häufig auf Nebenjobs angewiesen, um ihren Lebensunterhalt zu bestreiten. Wir untersuchten den soziodemographischen Status von Schweizer Medizinstudierenden und deren Einschätzung, ob reduzierte Teilzeitarbeitsmöglichkeiten im Rahmen der COVID-19-Pandemie eine Bedrohung der Chancengleichheit zur Erlangung des Berufes darstellt.Methoden: Wir unternahmen eine anonyme Online-Umfrage unter Schweizer Medizinstudierenden aus Bern und Genf über einen Zeitraum von 4 Monaten zwischen Dezember 2020 und April 2021. Abgefragt wurden soziodemografische Daten, die aktuelle Lebenssituation, Teilzeitbeschäftigung sowie etwaige weitere Einkommensquellen zur Finanzierung des Lebensunterhalts. Zudem wurde mittels einer fünfstufigen Likert-Skala (1=stimmt überhaupt nicht zu, 5=stimmt voll und ganz zu) abgefragt, ob die Auswirkung der COVID-19-Pandemie hierauf als Beeinträchtigung der beruflichen Chancengleichheit wahrgenommen wird.Ergebnisse: Von den 968 Teilnehmenden, die rund 13,8% aller Medizinstudierenden in der Schweiz darstellen, hatten 81,3% einen Teilzeitjob. Von den Erwerbstätigen arbeiteten 54,8% neben dem Studium, um den Lebensunterhalt zu bestreiten, wobei 28,9 % über negative finanzielle Auswirkungen aufgrund der reduzierten Teilzeitstellen während der Pandemie berichteten. Der Verlust von Teilzeitjobs machte das Medizinstudium aus Sicht der Studierenden zu einem Privileg für Studierende mit höherem sozioökonomischem Status (4,11±1,0), deren Möglichkeit zu studieren eher unabhängig von einem regelmäßigen Einkommen ist. Ein staatlicher Notfallplan für betroffene Studierende wurde dabei als wichtige Massnahme zur Unterstützung angesehen (4,22±0,91).Diskussion: Die COVID-19-Pandemie und ihre Folgen werden von den Befragten als Bedrohung wahrgenommen und bringen eine Benachteiligung für Schweizer Medizinstudierende mit niedrigerem sozioökonomischem Status. Es sollten gesamtschweizerische Massnahmen zur Förderung der beruflichen Chancengleichheit ergriffen werden

Texas Business Review, February 1961

Review of Texas Business-1960; Texas Industrial Growth Still Strong; State Agriculture at Near Record Level; Texas Building Shows Mixed Movement; Texas Retail Sales For 1960 Fall Short of 1959Bureau of Business Researc

Intertumor heterogeneity in 60 pancreatic neuroendocrine tumors associated with multiple endocrine neoplasia type 1

Abstract Background Patients with multiple endocrine neoplasia type 1 (MEN-1) develop multiple pancreatic neuroendocrine neoplasias (PNENs). Size at diagnosis and growth during follow-up are crucial parameters. According to the WHO 2017, grading is another important parameter. The impact of grading compared to size (WHO 2000) on the clinical course needs to be evaluated. Methods Sixty PNENs of six patients with MEN-1 were retrospectively evaluated. Results Fifty-one tumors with a diameter of < 20 mm were graded as G1. Two of 9 tumors with diameters of ≥20 mm were graded as G2. Tumor size of ≥20 mm correlated significantly with higher proliferation (p = 0.000617). Lymph node metastases were documented in two patients with a total of 19 tumors. In one patient, all 13 tumors (diameter: 0.4 to 100 mm) were classified as G1. However, metastases were documented in 9/29 lymph nodes. In the other patient, 5 tumors (3.5 to 20 mm) were classified as G1. The sixth tumor (30 mm) was classified as G2 (Ki-67: 8%). Metastases were revealed in 2/20 lymph nodes. Conclusions Tumor size of ≥20 mm seems to correlate with more aggressive MEN-1 related pancreatic disease, regardless of individual proliferation. Tumors ≥20 mm and tumors graded as G2 should be treated surgically regardless of their size