Nodular lesions and thyroid cancer in Graves' disease

Thyroid nodules in patients with Graves' disease (GD) are common and much controversy surrounds the incidence of coexistent thyroid cancer. In order to more accurately estimate this frequency we studied retrospectively 103 patients operated for GD in the University Clinic St Luc in Brussels, Belgium between 1990 and 2000. The patients were classified as Group I - with a solitary palpable nodule (n = 5; 4,9%); Group II - with multiple palpable nodules (n = 13; 12,6%); Group III - with a large diffuse goiter without clinical evidence of thyroid nodules (n = 85). Group III was subdivised in: Group IIIa - with nodule(s) evidenced by imaging techniques - radionuclide imaging and/or ultrasonography (n = 18; 17,5%) and Group IIIb - with diffuse goiter (n = 67; 65%). Our study shows that 35% (36/103) of a cohort of 103 subjects with GD had thyroid nodules. Eight patients (8/103 - 7,8%) had differentiated papillary cancer, all but one tumour were microcarcinomas. Malignancies were significantly more frequent when nodules were found on clinical examination (p = 0,03). We also observed more thyroid cancers in the total group of patients with nodules than in those with non-nodular diffuse goiter (p = 0,02). Our results suggest that thyroid nodules are frequent in GD and that differentiated cancers have high prevalence in GD patients with nodular lesions. Although in most cases there is no aggressive histological pattern, caution is needed in the follow-up

Targeting vivax malaria in the Asia Pacific: the Asia Pacific malaria elimination network vivax working group

The Asia Pacific Malaria Elimination Network (APMEN) is a collaboration of 18 country partners committed to eliminating malaria from within their borders. Over the past 5 years, APMEN has helped to build the knowledge, tools and in-country technical expertise required to attain this goal. At its inaugural meeting in Brisbane in 2009, Plasmodium vivax infections were identified across the region as a common threat to this ambitious programme; the APMEN Vivax Working Group was established to tackle specifically this issue. The Working Group developed a four-stage strategy to identify knowledge gaps, build regional consensus on shared priorities, generate evidence and change practice to optimize malaria elimination activities. This case study describes the issues faced and the solutions found in developing this robust strategic partnership between national programmes and research partners within the Working Group. The success of the approach adopted by the group may facilitate similar applications in other regions seeking to deploy evidence-based policy and practice

Targeting vivax malaria in the Asia Pacific: The Asia Pacific Malaria Elimination Network Vivax Working Group

The Asia Pacific Malaria Elimination Network (APMEN) is a collaboration of 18 country partners committed to eliminating malaria from within their borders. Over the past 5 years, APMEN has helped to build the knowledge, tools and in-country technical expertise required to attain this goal. At its inaugural meeting in Brisbane in 2009, Plasmodium vivax infections were identified across the region as a common threat to this ambitious programme; the APMEN Vivax Working Group was established to tackle specifically this issue. The Working Group developed a four-stage strategy to identify knowledge gaps, build regional consensus on shared priorities, generate evidence and change practice to optimize malaria elimination activities. This case study describes the issues faced and the solutions found in developing this robust strategic partnership between national programmes and research partners within the Working Group. The success of the approach adopted by the group may facilitate similar applications in other regions seeking to deploy evidence-based policy and practice