High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?

The use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC

Infantile B-lymphoblastic leukemia: a case series and review of the literature

Infantile leukemia is a rare hematological malignancy that occurs in the first year of life. It is an aggressive disease with peculiar immunophenotypic, cytogenetic, and molecular characteristics. It can be myeloid or lymphoid in origin. More than 80% of cases involve KMT2A gene rearrangement in the lymphoblastic subset, versus 50% in the myeloid subset. In this study, we present three cases of this rare entity to add knowledge about its clinical presentation and diagnostic profiles. These cases of infantile B-lymphoblastic leukemia (B-ALL) were retrospectively reviewed at the Department of Hematology, Section Cytogenetics at Indus Hospital and Health Network. The clinical characteristics, complete diagnostic profile, immunophenotypic profile, fluorescence in situ hybridization (FISH) results, treatments, and outcomes of the patients were assessed. All three infants were girls who presented with hyperleukocytosis, and they were diagnosed by eight-color flow cytometry. FISH studies revealed KMT2A gene rearrangement in two of the three patients. Infantile B-ALL is a biologically distinct disease carrying a poor prognosis. Female preponderance, hyperleukocytosis, and hepatosplenomegaly are common findings in this subgroup. No standard protocol for this rare entity has proven ideal for managing these young infants

Robot-Assisted Lung Biopsy: A Safer Approach to Lung Lesions

Purpose This article evaluates the feasibility, safety, and technical success of robot-assisted computed tomography (CT)-guided percutaneous lung biopsy

Recurrent Hemorrhoids—Efficacy, Utility and Initial Experience with the Use of Stapled Hemorrhoidopexy in Recurrent Hemorrhoids

Overview Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods The present prospective case series enrolled a total of 87 patients (54 male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. A modification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results Stapled hemorrhoidectomy (SD) was performed in 13 patients who had history of previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD

Impact of Clinical Nutritional Practices and Holistic Care Interventions of Pediatric Oncology Patients: A Single Centre Experience from Jammu and Kashmir

Introduction: Nutrition is a fledgling determinant in managing and suppressing various chronic and life-threatening diseases like cancer. Nutritional status of pediatric oncology patients is particularly an important determinant of their ability to cope with the demands of cancer and its treatment, and ensure proper growth and development. Nutritional assessment and grading each child per their degree of malnutrition helps devise adequate and individualized nutritional intervention. Adequate and timely intervention can largely contribute in improving the nutritional status of the patients and therefore, overall outcome of the treatment.There are limited studies done to understand the area of impact of nutritional interventions in improving the nutritional status of children affected with cancer, therefore with this aim we conducted a study to see the impact of nutritional intervention on nutritional status. Materials and Methods: This, first of its kind study on understanding the impact of nutritional intervention on pediatric oncology patients was conducted in the medical oncology department of Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura,Srinagar,India, Srinagar, from 1st May 2018 to 31st December 2019. Anthropometric measurement, demographic profiles, and etiological analysis were done and collected pre and post-intervention. 24 hours dietary recalls were collected pre and post-intervention. Food frequency tables were also put forward. Besides these, personal interviews and observation methods were used. Results: Nutritional interventions had a measurable positive outcome on the nutritional profiles of the pediatric oncology patients in SKIMS, Soura,Srinagar,India. The grades of nutritional status substantially improved from 46.4%, 24.8%, 16%, and 8% of the well-nourished, mildly malnourished, moderately malnourished, and severely malnourished, to 56.8%, 20%, 12.8%, and 4.8%, respectively, clearly indicating that with appropriate dietary advice and interventions there is a significant impact on improving the grade of malnutrition