Thyroid Malignancy among Fine Needle Aspiration Cytology of Thyroid Lesions in a Tertiary Care Centre

Introduction

The most prevalent endocrine cancer in the world is thyroid cancer, and its incidence is on the rise. The distinction between benign and malignant thyroid nodules must be made, which is why fine needle aspiration cytology of thyroid lesion is necessary and required. This study aimed to find out the prevalence of thyroid malignancy among fine needle aspiration cytology of thyroid lesions in a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among fine needle aspiration cytology of thyroid lesions in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data from 13 April 2020 to 13 April 2023 was collected between 19 May 2023 to 19 June 2023. All the patients with complete hospital record data were included in this study. However, repetitive fine needle aspiration cytology of thyroid lesion were excluded from the study. Fine needle aspiration cytology diagnoses were categorized in this study as per the Bethesda system for reporting thyroid cytopathology. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 398 fine needle aspiration cytology of thyroid lesions, thyroid malignancy was seen in 12 (3.02%) (1.34-4.70, 95% Confidence Interval) patients.

Conclusions

The prevalence of thyroid malignancy was found to be lower than other studies done in similar settings.

Keywords

cytology; malignancy; prevalence; thyroid.

Longitudinally extensive transverse myelitis, a disabling disorder with a good prognosis: a case series from Nepal

Introduction

Longitudinally extensive transverse myelitis (LETM) is a rare spinal cord disorder with variable etiologies and presentations. It can present solely or as an association with other neurological disorders.

Methodology

It was a series of cases of LETM in a tertiary care hospital.

Clinical presentation and outcomes

The initial three cases presented with bilateral lower extremity weakness and were diagnosed as transverse myelitis while, the fourth case, already diagnosed as LETM presented with seizure followed by loss of consciousness. All four cases had a good prognosis to date with continued physiotherapy.

Conclusion

The early diagnosis of the disease helps to guide the optimal management and decide the potential need for physiotherapy.

Prevalence of pre-operative anxiety and associated risk factors among patients awaiting elective surgery in a tertiary care hospital

Background

Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60-92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country.

Methods

This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability convenience sampling was adopted and a total of 205 cases were included. The researchers themselves collected the data on the day before surgery using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately.

Results

The prevalence of pre-operative anxiety was 25.85%. The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272-4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107-5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety compared to those from a joint family and those having past history of surgery respectively. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265-0.985, p = 0.045).

Conclusions

One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.

Portal Hypertension among Patients with Chronic Liver Disease Admitted to the Department of Internal Medicine of a Tertiary Care Centre

Introduction

Portal hypertension is increased pressure within the portal vein. A portal pressure gradient of more than 10 mmHg is defined as "clinically significant portal hypertension" due to manifestations such as splenomegaly, gastroesophageal varices, ascites, hepatorenal syndrome, hepatopulmonary syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis. The aim of this study was to find out the prevalence of portal hypertension among patients with chronic liver disease admitted to the Department of Internal Medicine of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among patients with chronic liver disease in the Department of Internal Medicine of a tertiary care centre from 1 January 2021 to 31 December 2022 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 247 patients with chronic liver disease, the prevalence of portal hypertension was 38 (15.38%) (10.88-19.88, 95% Confidence Interval). A total of 16 (42.11%) patients were in the age group of 51-60 years and males were 36 (94.74%). Ascites as a complication were found in 4 (10.53%).

Conclusions

The prevalence of portal hypertension among chronic liver disease inpatients in a tertiary care centre was found to be lower than other studies done in international settings.

Keywords

inpatients; liver disease; portal hypertension; prevalence.

Distinct non-contrast computerized tomography head findings in a patient with secondary polycythemia in rural Nepal: a captivating case report highlighting diagnostic challenges

Introduction

Tetralogy of Fallot is a cyanotic congenital heart disease which if untreated leads to death by adulthood. In rare cases who survive this can lead to secondary polycythemia due to chronic hypoxia who can present with multiple indistinct symptoms leading to diagnostic dilemma.

Case presentation

The authors present a rare case of secondary polycythemia diagnosed in early fifties with the unique non-contrast computerized tomography head findings who presented with a spectrum of long standing symptoms and a history of neurological manifestations.

Clinical discussion

Patients diagnosed with polycythemia in adulthood can have a background of an untreated congenital heart disease, which can be complemented further by appropriate radiological investigations in a resource poor setting.

Conclusion

Polycythemia secondary to an untreated congenital heart disease in the age beyond 50 is a rare occurrence. The presentation of these patients might present clinicians with a diagnostic challenge which can be mitigated with an appropriate knowledge of the peculiar non-contrast computerized tomography head findings.

Progressive multifocal leukoencephalopathy in the background of chlorambucil treated chronic lymphocytic leukemia: a case report from Nepal

Introduction

Progressive multifocal leukoencephalopathy is a rare manifestation in itself. Although many immunosuppressive states are associated with the disease, its occurrence in the setting of chronic lymphocytic leukaemia treated with chemotherapy is seldom reported to date.

Case presentation

A 67-year-old woman with known chronic lymphocytic leukaemia who was previously receiving chlorambucil treatment was identified as having progressive multifocal leukoencephalopathy; her prognosis is currently good.

Clinical discussion

Although a rare disease in an immunocompromised setting, progressive multifocal leukoencephalopathy often leads to a grave outcome. However, the authors describe a case with a good prognosis to date.

Conclusion

Progressive multifocal leukoencephalopathy should be in differentials in immunocompromised patients with dementia. Given that the later prognosis of the disease is unpredictable, an earlier diagnosis would be better for immunological reconstitution.

A Giant Pheochromocytoma Presenting in Pheochromocytoma Crisis: A Case Report

Giant pheochromocytomas are rare tumors, with the majority being clinically silent. Clinically manifesting pheochromocytoma can present with symptoms of catecholamine excess, but nonspecific symptoms and variable clinical patterns of hypertension make it difficult to diagnose. Missing the diagnosis can lead to cardiovascular catastrophes like a pheochromocytoma crisis and even death. We report a 45-year-old woman on antihypertensives, repeatedly visiting a hospital for recurrent headaches finally presented in a hypertensive crisis at an emergency department. Management was started along with an injection of labetalol, which led to an unpredicted abrupt blood pressure fall, and was successfully resuscitated. Imaging and plasma metanephrine studies revealed an underlying giant pheochromocytoma, which was cured after successful surgical resection. A high degree of clinical suspicion, elaborate and focused history-taking, and initial ultrasound imaging can guide us toward the early diagnosis of pheochromocytoma. Before the alpha blockade, beta-blockers should not be used in any cases of pheochromocytoma.

0106 The Effects of Caffeine on Blood Pressure and Cognitive Performance in Hypoxic Conditions on the Slopes of Mt. Everest

Introduction

140 million people live above 2,400m worldwide. High altitude (HA) exposure can lead to sleep disruption, impaired cognitive performance, acute mountain sickness (AMS), elevated blood pressure (BP) and an increase in cardiovascular events in healthy people. Because caffeine can also increase BP, caffeine might need to be avoided at HA. Caffeine is the most widely used drug in the world but has yet to be studied extensively in hypoxic conditions. Therefore, the aim of the current study was to examine the effects of caffeine on cardiovascular variables and cognitive function at HA.

Methods

We conducted a non-randomized, single-blind, mixed model design at 4,300m on Mt. Everest. Thirty-three trekkers (nine females), aged 29.5±10.4 (mean±SD), ingested the study drug (placebo or 200 mg of caffeine) 1.5 hours after awakening. To control for withdrawal effects of caffeine, participants that self-reported consuming less than 47 mg of caffeine per day received the placebo while those that consumed more than that received caffeine. Cognitive function was tested using the Stroop task before and after the pill administration. BP was measured by a trained clinician using auscultatory method prior to and 30, 60 and 90 min after the pill administration.

Results

Caffeine improved cognitive performance when compared to the pretreatment measurement but was worse in the caffeine group prior to the pill administration when compared to the pretreatment placebo group. Additionally, caffeine did not have any major effect on BP when compared to pretreatment measures or the placebo group.

Conclusion

Caffeine does not seem to have an additive effect on increasing BP with HA. Additionally, because cognitive performance was worse in the chronic caffeine users prior to the pill administration, caffeine users might be more dependent on caffeine to perform optimally at HA. Based off of these data, caffeine seems to be a safe and beneficial drug at HA.

Support

NIH BUILD EXITO, University of Alaska Faculty Development Grant

Fetal Ascites Mimicking Maternal Ovarian Tumor: A Rare Cause of Obstructed Labour

Fetal ascites has been diagnosed more frequently these days because of routine ultrasound scanning in pregnancy. However as a cause of dystocia in labour, it is very rare. Twenty four years second gravida of 28 weeks 6 days of gestation presented to labour room with preterm obstructed labour. Abdominal examination revealed less readily palpable fetal parts and distantly localized fetal heart sounds. An urgent ultrasound showed huge maternal ovarian cyst. She then underwent emergency cesarean section; delivered a male baby with grossly distended abdomen. However, the ovaries were normal looking. Routine antenatal ultrasounds help in identifying maternal and congenital fetal anomalies. They also guide in planning the most appropriate management. Whenever fetal ascites is diagnosed antenatally, possibility of dystocia in labour should be kept in mind.