Hashimoto’s thyroiditis-a tertiary level hospital based study

Background: Hashimoto’s disease is a chronic, autoimmune form of thyroiditis and is one of the most common causes for hypothyroidism. Many studies have found an association between Hashimoto’s thyroiditis and various other thyroid pathologies, including cancers. The objectives of the study were to look for any association between Hashimoto’s thyroiditis and other forms of thyroid diseases and to analyse the pattern of patients treated with Hashimoto’s thyroiditis.Methods: This was a retrospective study conducted at a tertiary care centre from December 2008 to January 2014. Patients with Hashimoto’s thyroiditis confirmed by histology were selected as the cases. Their clinical and biochemical data and post-operative histopathological reports were collected and analysed.Results: 300 patients who underwent thyroidectomy were found to have a diagnosis of Hashimoto’s thyroiditis. 97.33% of the patients were females. Maximum patients belonged to the 31-40 age group. Of the 300 patients, 61.67% had other associated pathologies. The maximum association was with colloid goiters, followed by adenomas and malignancies. Among the malignancies, 80.65% were papillary cancers while the rest were follicular cancers. There were no cases of other malignancies associated with Hashimoto’s thyroiditis.Conclusions: Hashimoto’s thyroiditis is fairly common in the studied population, mostly among females. It is associated with other thyroid pathologies including differentiated cancers. Lymphoma is not found to be associated with Hashimoto’s disease in our population. Hashimoto’s thyroiditis thus forms a major share of goiters leading to thyroidectomy in Indian population. However, the decision to operate should be primarily governed by the associated cytology

Gall bladder stones and the associated histopathology– a tertiary care centre study

Background: Gall stones form one of the main reasons for recurrent upper abdomen pain. Cholecystectomy has turned out to be one of the commonest laparoscopic procedures done all over the world. The objectives of the study were to analyse the histopathological changes in gallstone disease and to study the clinical and biochemical factors that are seen in gall stone disease.Methods: This was a hospital based cross sectional study conducted at a tertiary care centre from January 2013 to December 2014. 108 patients admitted with diagnosis of cholelithiasis and posted for cholecystectomy were studied. Their clinical and biochemical data and post-operative stone analysis results and histopathological reports were collected and analyzed.Results: 63% of the patients were females with a female to male ratio of 1.7:1. Of the group, 64.8% had a BMI between 25 and 29.9. 65.7% patients got operated within one year of the onset of symptoms. Serum cholesterol levels were found elevated in majority of patients. 61% patients had multiple gall stones. 62% had stones composed of cholesterol, bilirubin, calcium carbonate and calcium oxalate. 102 out of the 108 specimens showed histological features of chronic cholecystitis only. One case showed a premalignant change in the form of pyloric metaplasia.Conclusions: Cholelithiasis is seen mostly in females, most of them having elevated cholesterol levels. The commonest histopathological change associated with cholelithiasis is chronic cholecystitis. Premalignant lesions are seen only in a small minority only. Hence early elective cholecystectomy can prevent malignant transformation in asymptomatic gall stones

Diagnostic accuracy of ultrasonography in goiters: a tertiary centre experience

Background: Thyroid diseases are highly prevalent in India, especially in the southern states. Evaluation of thyroid pathologies revolves mainly on imaging and cytology. Recent advances in thyroid imaging have greatly improved the diagnosis, treatment and follow-up in thyroid diseases. Though there are advanced modalities including Computed Tomography and Magnetic Resonance Imaging, Ultrasonography remains the cornerstone for the evaluation of thyroid gland, due to its ubiquitous availability and cost-effectiveness. The objectives of the study were to find out the diagnostic accuracy of ultrasonography in thyroid swellings and to find out the most reliable diagnostic feature of thyroid malignancy in ultrasonography.Methods: This was an observational study, conducted on 71 patients admitted to the General surgical wards of Government Medical College, Trivandrum, with thyroid swellings, for a period of 18 months. For all these patients, ultrasound scan of the thyroid gland was done on an ultrasound machine with a 17/5 MHz linear transducer, by experienced faculty.Results: Ultrasonography was found to have a sensitivity of 87.2% and a specificity of 79.2% in diagnosing thyroid pathologies. The most common malignancy of thyroid found in the study was papillary carcinoma and the most reliable ultrasound finding suggestive of malignancy was microcalcification.Conclusions: As per the present study, it is concluded that high resolution ultrasonography is very useful in diagnosing the nature of thyroid swellings, with an accuracy rate of 84.5%. Ultrasonography is a valuable diagnostic tool in the evaluation of thyroid diseases and is the imaging modality of choice

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

ASSOCIATION OF LOW LYING PUBIC TUBERCLE WITH INGUINAL HERNIA

This is a Case-control study which was carried out on 44 patients to find the association between a low lying pubic tubercle and the prevalence of inguinal hernia, due to a probable reduction in efficiency of shutter mechanism of inguinal canal. The Excel sheet contains the anthropometric details of the patients including the pelvimetric values. We found significant correlation between low lying pubic tubercle and the development of inguinal hernia. We conclude that early identification of the anthropometric risk factors in adulthood could help in the prediction of occurrence of hernia and thus plan for early repair

CAPSULAR DISSECTION REDUCES RECURRENT LARYNGEAL NERVE INJURY AND HYPOCALCEMIA IN THYROIDECTOMY

Methods: The study objective was to detect the incidence of hypocalcaemia and recurrent laryngeal nerve palsy in patients undergoing total thyroidectomy with capsular dissection technique. This was a prospective cohort study, done on 178 patients who underwent total thyroidectomy. Patients were recruited for 6 months from June 2019 to November 2019. After surgery, they were followed up for 9 months with calcium estimation and indirect laryngoscopy as per pre-determined schedule.Results: Out of the 178 patients studied, 19.1% (34) developed hypocalcaemia during the follow up. Among these, 0.6% (1) developed permanent hypocalcaemia while 18.5% (33) developed temporary hypocalcaemia. 5.1% (9) patients developed temporary laryngeal nerve palsy and none (0) developed permanent laryngeal nerve palsy. Larger nodules were associated with more incidence of hypocalcemia while smaller nodules are associated with nerve palsy.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

RIPASA AND AIR SCORING SYSTEMS ARE SUPERIOR TO ALVARADO SCORING IN ACUTE APPENDICITIS : DATA SET

The objective was to find the predictive accuracy of MASS and two new systems namely Appendicitis Inflammatory Response (AIR) score and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, in a diagnostic test evaluation study. From January 2018 to January 2019, 107 consecutive patients admitted with a diagnosis of suspected appendicitis were assessed with these three scores. Sensitivities, specificities, positive predictive values (PPV), nega¬tive predictive values (NPV), positive and negative likelihood ratios (LR) and Area Under Curve (AUC) were determined for each score. The raw data for the study is being uploaded here

RIPASA AND AIR SCORING SYSTEMS ARE SUPERIOR TO ALVARADO SCORING IN ACUTE APPENDICITIS : DATA SET

The objective was to find the predictive accuracy of MASS and two new systems namely Appendicitis Inflammatory Response (AIR) score and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, in a diagnostic test evaluation study. From January 2018 to January 2019, 107 consecutive patients admitted with a diagnosis of suspected appendicitis were assessed with these three scores. Sensitivities, specificities, positive predictive values (PPV), nega¬tive predictive values (NPV), positive and negative likelihood ratios (LR) and Area Under Curve (AUC) were determined for each score. The raw data for the study is being uploaded here