Differentiated Thyroid Carcinoma: Distant Metastasis as an Unusual Sole Initial Manifestation

Objective:The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomesMethods:A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected.Results:There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation.Conclusion:Distant metastases without a neck lump as the initial presentation of well-differentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature

Variation of PEFR with height, weight and waist-hip ratio in medical students

OBJECTIVE: The primary aim of our study was to assess the variation of PEFR with various medical students of Karachi, PakistanDESIGN: Cross-sectional studySetting: Medical students of Karachi Medical and Dental CollegeParticipants: 276 non-smoker healthy medical students composed of 168 females and 108 males.VARIABLE PARAMETERS: They include mean age, body height and body weight and PEFR. They were marked separately for each genderRESULTS: The mean waist hip ratio in females was observed to be 0.843±0.111in relation with that of mean PEFR value 452.97±65.84 L/min, whereas in males the mean waist hip ratio was 0.864±0.028 in relation with that of mean PEFR value 445.93±66.49 L/min. Also there is a statistically significant variation in PEFR with an increase in waist hip ratio. The mean height of males was 173.63 ±7.5 cm and weight was 61.81 ±11.25 Kg while mean height of females was 158.56±7.3 cm and weight was 49.33±9.04 Kg. PEFR is positively correlated with increase in height and weight up to a certain limit.CONCLUSION: The study concludes that PEFR is affected positively by variation in waist hip ratio; moreover young females have more waist hip ratio and PEFR values than their young male counterparts. A large sample size with accurate peak flow meter is required along with ethnic consideration of the study population for better, accurate and clear results

Frequency of dementia in elderly population in Karachi

Background: Dementia is one of the prevalent disabling diseases among South Asian population associated with many other problems. The medical community all around the world are aware of the fact that aging is associated (positively correlated) to dementia. Thus the research aims to identify the frequency of dementia in geriatrics in the multi care centers of Karachi. Objectives: 1. To determine the frequency of dementia in elderly population of Karachi at multi care centers. 2. To identify the socio-demographic factors responsible for development of dementia Methods: The study was comparative cross sectional survey. Participants aged between 60 and 95 years and not bed ridden were selected through non probability convenient sampling. Patients with severe mental health problem were excluded. Dementia was assessed by using a validated and reliable assessment tool Mini Mental State Examination (MMSE). Sample size for this study was calculated as 323 using the RAO soft formula. The data was entered on Statistical Package for Social Sciences (SPSS) version 16 and analyzed. Results: Out of 327, 5 (1.5%) patients were identified with severe dementia, 113 patients (34.6%) with moderate dementia, 112 patients (34.3 %) with mild dementia and 96 (29.4 %) were normal. Females and married have a significantly higher frequency of dementia Conclusions: Out of 327, 5 (1.5%) patients were identified with severe dementia, 113 patients (34.6%) with moderate dementia, 112 patients (34.3 %) with mild dementia and 96 (29.4 %) were normal. Females and married have a significantly higher frequency of dementia Key words: frequency of dementia elder patients 60 or abov

Disseminated Peritoneal Leiomyomatosis: A Case Report

Disseminated peritoneal leiomyomatosis is a benign disease with unknown etiology and an indolent course. The site of origin can be mesentery, omentum, or peritoneum. Diagnosis is challenging and more often lead to misdiagnosis. It can be managed both surgically or by nonsurgical options. The nonsurgical modalities include limiting hormonal exposure which has shown to decrease tumor size. Avoiding Oral contraceptive pills (OCP) and hormonal replacement therapy (HRT), and giving the patient gonadotrophin-releasing hormone agonist and aromatase inhibitor therapy have been found effective. However, there are no firm guidelines in the literature regarding the management of this condition. If left untreated, it can cause complications such as pain, bleeding, chronic constipation, and infertility. Prognosis is good but recurrence is possible after tumor resection. There is little evidence regarding the follow up of this condition

Assessing computer skills amongst dental undergraduate students at a public sector dental institution in Pakistan

Introduction/Objectives: Information and Communication technology (ICT) is an important tool in dental education and practice, and its use is rapidly increasing. The aim of the study is to assess the information and communication technologies (ICT) skills of a public sector dental students in Pakistan. Methods: Cross sectional survey was conducted, and dental students from all four years attending Karachi Medical & Dental College (KM&DC), Pakistan responded to the self-reported and pre-tested study questionnaire. Information related to generic and basic ICT skills, frequency of computer use (hours/week), years of computer use, reasons for use and access to computers were inquired. Results: In total, 159 students with an overall response rate of 63.6% participated in the study. 97.5% of the study population mentioned that they had access to computers. The mean (±SD) months of computer use and hours per week spent in using computer were 104.80 (±43.54) months and 8.67 (±7.30) [hours/week], respectively. The highest levels of competence assessed using the generic ICT score were for email, file management, internet and word. Of the 16 basic skills evaluated, only 4 (turning computer on and off, using a mouse, printing, and setting up mailbox) were present in 80% of the participants. The mean (±SD) of the generic scores were 16.09 (± 6.52) out of a maximum score of 33 and for the specific ICT skills the mean (±SD) were 10.77 (±3.85) out of a maximum score of 16. The two scores were significantly correlated, r = 0.672 (p \u3c 0.001). Conclusion: Our study has found a low level of ICT skills, thus attention is required to improve ICT skills for personal and professional development of these dental students. Keywords: ICT, medical education, Dental Students, Computer literac

Primary Neuroendocrine tumor of Uterus - A case report

Background: Endometrial neuroendocrine carcinoma is a rare histological subtype of endometrial cancer, divided into low-grade neuroendocrine carcinoma (carcinoid) and high grade neuroendocrine carcinoma (small cell & large cell neuroendocrine carcinoma).It is characterized by high invasiveness and poor prognosis. Small cell neuroendocrine carcinoma (SCNEC) is an extremely rare pathological type of endometrial carcinoma. Case Presentation: A 65 years old post-menopausal lady presented with vaginal bleeding. Baseline imaging showed soft tissue lesion of uterine origin with unusual findings and biopsy showed neuroendocrine features. Positron emission tomography (PET) scan showed metastatic disease and she underwent chemotherapy which had an interestingly excellent response. Conclusion: Despite being rare and aggressive, neuroendocrine tumors must be considered as a differential possibility on imaging. Specific tracer of PET imaging can be useful as a non-invasive tool to restage the disease and monitor treatment response as highlighted by the imaging aspects of this rare entity in our case

Large cell neuroendocrine carcinoma of cervix: A rare and distinct clinicopathological entity

Large cell neuroendocrine carcinoma (LCNEC) is a rare malignancy and accounts for only 1% of cervical malignancies. The mean age is 34 years, ranges from 21 to 62 years. It usually presents with abnormal Pap smear or vaginal bleeding. LCNEC shows an aggressive behavior, similar to lung counterpart, with early metastases to regional lymph nodes and liver, lung, bone and brain. Median survival is <2 years. Due to the rarity of this malignancy, the management of LCNEC is difficult and associated with uncertainty. An interdisciplinary approach is necessary because most studies investigating the treatment of neuroendocrine tumors have been performed in patients with tumors in organs other than cervix, mostly the lung and pancreas. The biology of LCNEC is different from the squamous cell carcinoma or adenocarcinoma of the cervix regarding a number of characteristics. LCNEC is more likely to invade the lymph nodes at the time of diagnosis and local and distant relapses occur more often in LCNEC. Overall survival is significantly poor compared to squamous cell carcinoma and adenocarcinoma of the cervi

Numerical simulation of thermal fatigue behavior in a cracked disc of AISI H-11 tool steel

International audienceThermal fatigue is one of the key reasons of material failure in components which are exposed to high temperature cycles. Prediction of crack initiation site and crack propagation speed during thermal cycling helps us predict the life of a component in service. In this research numerical simulation of crack propagation due to thermal cycling on a circular disc has been carried out. The thermal profiles used in the simulation are taken from actual thermal fatigue experiments. The effect of the length of cracks and interaction between adjacent cracks has been investigated. 50 sets of numerical simulation models with different crack numbers and crack lengths have been simulated. The variation in Stress Intensity Factor (SIF), hoop stress and Crack Mouth Opening Displacement (CMOD) has been plotted as a function of primary/second-ary crack lengths and number of cracks. Envelopes of possible crack growth have been identified and correspond well to the experimental observations. Results show a significant drop in hoop stress, SIF and CMOD with increase in number of cracks, thus limiting the number of cracks possible in a thermal fatigue crack network