bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitant medullary thyroid carcinoma with paraganglioma-like pattern and papillary thyroid carcinoma
Authors: Greco C , Brigante G , Taliani E , Corrado S , Simoni M , Madeo B 
Published: January 2020

Summary
A 74-year-old man was referred to the Endocrinology Unit because of multinodular goiter. The dominant nodule (1.7 × 1.9 × 2.4 cm), at the medium-superior third of the left lobe, was inhomogeneously hypoechoic, with irregular margins, macrocalcifications and intranodular vascularization. Fine-needle aspiration biopsy (FNAB) was performed. The cytological diagnosis was TIR 2, benign, according to the 2013 Italian thyroid cytology classification system. Moderately high serum calcitonin (s-Ct) (61.5 pg/mL, n.r. 0–7.5) and normal CEA were detected. The Ct level in FNAB wash-out fluid (Ct-FNAB) was 1450 pg/mL. Based on s-Ct and Ct-FNAB levels, patient underwent total thyroidectomy. Macroscopically, a dominant circumscribed nodule of 2 ecm was described; the histological and immunohistochemical features identified medullary thyroid carcinoma (MTC) with paraganglioma (PG)-like pattern positive for Ct, CEA and chromogranin and negative for S-100 sustentacular cells (SC). Moreover, papillary carcinoma of 3 mm in the right lobe was also associated. No areas of hyperaccumulation of the tracer were documented at Ga68 PET/CT. No RET-proto-oncogene mutations were found. Post-surgery s-Ct levels were within normal range (4 pg/mL). Two years after thyroidectomy, the patient is still disease-free. We reported a case of sporadic and rare variant of MTC: this is the ninth described case of PG-like MTC. In this case, cytologically benign, the clinical suspicion arose from high Ct values at FNAB wash-out fluid. Even if clinical behavior of this variant seems indolent, additional studies are necessary to understand prognoses and predictive factors.

Learning points:

Several unusual histological variants of medullary thyroid carcinoma (MTC) have been described such as spindle cell, giant cell, clear cell, melanotic, squamous, angiosarcoma-like variants; even rarer is the paraganglioma (PG)-like pattern.

We here describe a case of medullary PG-like thyroid carcinoma in a 74-year-old man. This is a rare histological variant of MTC hardly diagnosed by cytology, since immunohistochemical investigations are necessary.

Measurement of calcitonin both in serum and in wash-out fluid from fine-needle aspiration could be an additional tool for an early and non-invasive identification of these variants.
Complex management decisions in a woman with concurrent primary hyperparathyroidism and metastatic papillary thyroid carcinoma, both presenting during pregnancy
Authors: Arnez Lorena , Lawrence Victor 
Published: January 2020

Summary
A 40-year-old woman was hospitalised at 25-week gestation following a diagnosis of severe symptomatic hypercalcaemia (adjusted serum calcium 3.02 mmol/L). A diagnosis of primary hyperparathyroidism (PHP) was made on the basis of elevated parathyroid hormone (PTH) 11.2 pmol/L (reference range 1.5–6.9) and exclusion of familial hypocalciuric hypercalcaemia. Ultrasound examination of the neck did not convincingly demonstrate an abnormal or enlarged parathyroid gland and parathyroid scintigraphy was not performed due to maternal choice relating to perceived radiation risk to the foetus. At neck exploration during the 28th week of pregnancy a right lower pole parathyroid lesion was excised together with two abnormal lymph nodes (largest 1.6 cm). Histology confirmed a parathyroid adenoma and also papillary thyroid carcinoma deposits in the two resected lymph nodes. Post-operatively, levels of adjusted serum calcium normalised and pregnancy progressed uneventfully to term. Total thyroidectomy was performed 2 weeks after delivery revealing two small foci of papillary micro-carcinoma (largest 2.3 mm, one in each thyroid lobe) with no evidence of further metastatic tumour in lymph nodes removed during functional neck dissection. Radioiodine remnant ablation (RRA) was performed 2 months post thyroidectomy to allow for breast involution. The patient remains in full clinical and biochemical remission 9 years later. We present and review the difficult management decisions faced in relation to the investigation and treatment of PHP in pregnancy, further complicated by incidentally discovered locally metastatic pT1aN1aM0 papillary thyroid carcinoma.

Learning points:

PHP may have serious consequences during pregnancy and usually requires surgical management during pregnancy to reduce the risk of maternal and foetal complications. The indications for and optimal timing of surgical management are discussed.

Localisation by parathyroid scintigraphy is controversial during pregnancy: modified dose regimes may be considered in preference as an alternative to unguided neck exploration.

Breastfeeding is contraindicated for 6–8 weeks before radioactive-iodine remnant ablation (RRA) to prevent increased breast uptake. Breastfeeding is further contra-indicated until after a subsequent pregnancy.

Incidentally discovered differentiated thyroid carcinoma (DTC) in cervical lymph nodes in some cases may be managed expectantly because in one quarter of thyroidectomies the primary tumour remains occult.
Serum insulin levels are associated with vulnerable plaque components in the carotid artery: the Rotterdam Study
Authors: Mujaj Blerim , Bos Daniel , Kavousi Maryam , van der Lugt Aad , Staessen Jan A , Franco Oscar H , Vernooij Meike W 
Published: January 2020

Background
To investigate the association between fasting serum insulin and glucose levels with atherosclerotic plaque composition in the carotid artery. Impaired insulin and glucose levels are implicated in the etiology of cardiovascular disease; however, their influence on the formation and composition of atherosclerotic plaque remains unclear.

Methods
In 1740 participants (mean age 72.9 years, 46% women, 14.4% diabetes mellitus) from the population-based Rotterdam Study, we performed carotid MRI to evaluate the presence of calcification, lipid core, and intraplaque hemorrhage in carotid atherosclerosis. All participants also underwent blood sampling to obtain information on serum insulin and glucose levels. Using logistic regression models, we assessed the association of serum insulin and glucose levels (per s.d. and in tertiles) with the different plaque components, while adjusting for sex, age, intima-media thickness, and cardiovascular risk factors.

Results
Serum insulin levels were associated with the presence of intraplaque hemorrhage (adjusted odds ratio (OR): 1.42 (95% CI: 1.12–1.7)) We found no association with the presence of calcification or lipid core. Sensitivity analyses restricted to individuals without diabetes mellitus yielded similar results. No associations were found between serum glucose levels and any of the plaque components.

Conclusions
Serum insulin levels are associated with the presence of vulnerable components of carotid plaque, specifically with intraplaque hemorrhage. These findings suggest a complex role for serum insulin in the pathophysiology of carotid atherosclerosis and in plaque vulnerability.
Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology
Authors: Lizotte Marie-Hélène , Barrington Keith J. , Sultan Serge , Pennaforte Thomas , Moussa Ahmed , Lachance Christian , Sureau Maia , Zao Yilin , Janvier Annie 
Published: January 2020

BACKGROUND AND OBJECTIVES:
Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives.

METHODS:
Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present.

RESULTS:
Thirty-one participants’ videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations &gt;9 out of 10 and were all ranked top 10 communicators.

CONCLUSIONS:
During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication.
Taking the Ache Out of Sh(ake)speare: Teaching Shakespeare's Plays Through Performance
Authors: Lindell Kiki 
Published: January 2020

This paper discusses the experience of teaching Shakespeare’s plays in performance, staging the plays with the students as part of the learning experience.

The learning outcomes are treated in three sections – the first relating the effects of performance on the students’ linguistic proficiency, the second giving some examples of how the students discover and learn to master the mechanics of Renaissance theatre from the inside, and the third and final section trying to show how making the play their own, understanding and identifying with their part, gives the students new insights that are applicable in a wider context.
ÇOCUK YOĞUN BAKIM ÜNİTESİNDE YATAN HASTALARIN RETROSPEKTİF DEĞERLENDİRİLMESİ
Authors: KİŞİOĞLU Merve , BÜYÜKKAYHAN Derya , DUYU Muhterem 
Published: January 2020

Amaç
: Bu çalışmadaki
amacımız yeni açılmış olan çocuk yoğun bakım ünitemizin bir yıllık verilerini;
hastaların yoğun bakımda kalış süresi, mekanik ventilatör (MV) ihtiyacı,
gelişen komplikasyonlar, mortalite ve mortaliteye etki eden risk faktörlerini
ortaya koyarak vermiş olduğumuz hizmetin kalitesini artırmak, yetersiz sayıda
ve yüksek maliyeti olan çocuk yoğun bakım yataklarını ihtiyacı olan hastalar
için daha etkin kullanılmasına katkıda bulunmaktır. Materyal ve Metod: Çalışma 1 Şubat 2015 – 1 Şubat 2016 tarihleri arasında
Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi, Çocuk Yoğun Bakım
Ünitesi’nde gerçekleştirilmiştir. Hastaların, cinsiyet, yaş, altta yatan
hastalık, eşlik eden kronik hastalık varlığı, hastanın geldiği yer, yoğun bakım
yatış süresi, önceki yoğun yoğun bakım yatış öyküsü, yoğun bakım ile ilişkili
enfeksiyon varlığı, mekanik ventilasyon ihtiyacı, pozitif inotrop tedavi
ihtiyacı, renal replasman tedavi ihtiyacı, kan transfüzyonu ihtiyacı, yatışında
hiponatremi durumu, çoklu organ
yetmezliği ve yaygın damar içi pıhtılaşma varlığı verileri kaydedildi. Bu
faktörler ile mortalite arasındaki ilişki araştırıldıBulgular: Hastaların yaşları ortalama 60.5±61.3
aydı. Hastaların %36.8’i
kız, %63.2’si erkekti. Hastaların %54.2’sini hastanemiz acil servisi
ya da dış merkezden gelen, %45.8’ini ise hastanemiz yataklı servislerinden
gelen hastalar oluşturmaktaydı. Altta yatan hastalık dağılımına
bakıldığında, ilk sırada %33.5 oran ilea kciğer hastalığı yer
almaktaydı. Yoğun bakımda yatışı ortalama 11.9±16.9 gün idi. Hastaların %64.5’i
mekanik ventilatör desteği aldı. Yoğun bakım ilişkili enfeksiyonlarda ilk
sırada ventilatör ilişkili pnömoni (%29.1) yer almaktaydı. Mortalite oranı
%17.4 bulundu. Başvuruda mekanik ventilatör ihtiyacı olması, akciğer hastalığı
nedeni ile yatış, eşlik eden kronik hastalık öyküsü yoğun bakım mortalite
oranını anlamlı olarak arttırmaktaydı (p=0.001, p=0.002, p=0.003). Kan
transfüzyonu uygulaması, inotropik ajan kullanımı, çoklu organ yetmezliği
kliniği olması, yaygın damar içi pıhtılaşma kliniği olması ile mortalite
arasında anlamlı ilişki bulundu (p=0.027, p&lt;0.001, p&lt;0.001, p&lt;0.001).

Sonuç: Yoğun bakım
ilişkili enfeksiyon varlığı, eşlik eden kronik hastalık varlığı, başvuruda
mekanik ventilasyon ihtiyacının olması, kan transfüzyonu uygulaması ve çoklu
organ yetmezliği kliniği tek değişkenli analizlerde mortalite üzerinde istatistiksel olarak anlamlı etkileri olduğu
görülmesine rağmen çoklu değişken analizi değerlendirmesinde, bu faktörler ile
mortalite arasında istatistiksel olarak anlamlı ilişki bulunamamıştır. Altta
yatan hastalığın akciğer hastalığı olması, mortalite oranını 6.34 kat, yaygın
damar içi pıhtılaşma varlığı durumunda mortalite oranı 5.11 kat, inotrop tedavi
gereksinimi isemortalite oranını 18.04 kat arttırmaktaydı.
DESIGN AND EVALUATION OF A HIGHER EDUCATION DISTANCE EAP COURSE BY USING THE ADDIE MODEL
Authors: Koc Ebru 
Published: January 2020

Due to inadequate support, most university students have difficulty
with writing academic texts, such as research articles and dissertations.
Therefore, the aim of this research is to design a web-based academic writing course
for university students by using the ADDIE (Analysis, Design, Development,
Implementation and Evaluation) model, which is supported by individual
instructional and socio-cultural theories on the design of online instruction.
The first group of participants in the study included undergraduate and
graduate students studying in a variety of departments at a state university in
Turkey. The second group of participants included university instructors. To
diagnose the needs of the students, semi-structured questions were asked in
interview sessions. Additionally, a questionnaire was used. After
diagnosis of the students’ academic writing needs, course content and
materials were designed for topics such as formality, paraphrasing, and the
IMRaD (Introduction, Method Results and Discussion) model. The data collected with
the questionnaire were analysed through item analysis. The frequencies and
percentages of responses to each item in the questionnaire were calculated.
Content analysis was used to analyse the transcribed interview data. The
findings elucidate how the current academic online courses can be implemented more
efficiently.
Comparative lipid profile study between ischemic and haemorrhagic stroke
Authors: Singh Vijaiendre , Bajia Kamalesh Kumar , Ram Chaina , Kumar Ajay , Mathur Ajay , Bansal Pradeep Kumar 
Published: January 2020

Background: Stroke is one of the major global health problems. Stroke is the most common clinical manifestation of cerebrovascular disease of which more than 99% are due to arterial involvement and less than 1% due to venous involvement in the form of Cerebral Venous Thrombosis (CVT). Among arterial causes 85% are due to infarction and 15% due to haemorrhage.1,2 There is difference in serum lipid levels in subtypes of strokes to guide lipid-lowering therapy which can reduce incidence of stroke and stroke related mortality by adapting primary and secondary preventive measures.3,4 Authors have endeavoured to correlate severity of lipid derangement and stroke.Methods: In this study 64 consecutive eligible ischaemic stroke cases and 64 eligible hemorrhagic stroke cases would be included. Cases of strokes will be divided into ischaemic and hemorrhagic as per clinical features and with help of brain imaging by CT scan and MRI at the time of admission and 8 hour fasting lipid profile was collected from all cases. All this information will be filled in preformed format.Results: Serum lipid profile of two categories of stroke showed raised serum total cholesterol in 39.1% patients of ischaemic stroke in contrast to 18.8% patients with haemorrhagic stroke (p=0.019).Stroke patients showed raised in LDL cholesterol in 29.7% patients of ischaemic stroke in contrast to 9.4% patients with haemorrhagic stroke, (p=0.007).Conclusions: Based on the finding of our study we conclude that ischemic stroke patient had higher lipid derangement as compare to haemorrhagic stroke in terms of raise total cholesterol, LDL cholesterol and decrease HDL cholesterol.
Influence of obesity on serum levels of thyroid hormones among Indian adult population
Authors: Bhandari Vinod , Kosta Susmit , Bhandari Mahak , Behl Simran 
Published: January 2020

Background: Obesity and thyroid dysfunction are two most common clinical conditions that have been linked together closely in adult. The link has become more relevant in the context of an unprecedented rise in the prevalence of obesity worldwide. Obesity is normally observed by patients as being secondary dysfunction on serum levels of thyroid hormones. Objective: The Purpose of this study to assess serum thyroid hormones levels (fT3, fT4, TSH) variation in patients with obesity and normal thyroid function among Indian adults and to correlate serum levels of thyroid hormones with their classes of Body Mass Index (BMI).Methods: Authors performed a retrospective study of adult patients who were examined and analyzed serum levels of thyroid hormones at authors centre between February 2018 to November 2019.Results: A total of 231 adult patients were included. 122(52.8%) were males, mean age was 35.4±10.4 and mean BMI 34.2±5.8 respectively. Obesity was found higher in female 58(53.2%) than male 37(30.3%) participants (p<0.001), respectively. The mean TSH serum levels were significantly increased with increased BMI (2.04±1.19,2.51±1.22 and 3.39±1.19; p=<0.001). No association was found of serum fT4 (p=0.227) and serum fT3 (p=0.063) with BMI.Conclusions: Mean TSH serum levels showed a significantly increased with increased BMI. BMI was negatively associated with serum fT4 but had no association with serum fT3.
Doctors'self-prescribing behavior: an exploratory study
Authors: Mir Shakeel Ahmad , Ahangar Junaid Ahmed , Shakeel Danish 
Published: January 2020

Background: Self-prescribing among doctors is common. But the General Medical Council (GMC) and American Medical Council recommend that doctors should avoid prescribing for themselves, and close family members. Self-prescribing can lead to serious consequences. The present study reports the prevalence and pattern of self-prescribing among doctors working in various healthcare facilities of Kashmir Valley.Methods: Pre-validated questionnaires were sent to 200 doctors selected by convenience sampling. Only 184 returned the completely filled questionnaires.Results: At which 95.7% male doctors and 97.8% female doctors were self-prescribing. 100% doctors above the age of 40 years were self-prescribing. 100% post graduate students and consultants were practicing self-prescribing. 98.0% of those active as doctors for 1-5 years and 95.1% of those active for more than five years were self-prescribing. 60.7% doctors cited convenience, 40.4% time saving, 27.0% quick relief, 60.7% confidence, 14.6% low cost of treatment, and 15.7% crowd avoidance as a reason for self-prescribing. Major diseases self-treated were: headache (78.7%), respiratory symptoms (79.8%), fever (53.9%) and pain syndromes (31.5%). Major drugs used were: analgesics (80.9%), antipyretics (68.5%), antibiotics (58.4%), decongestants (49.4%) and antispasmodics (33.7%).Conclusions: The observed prevalence of self-prescribing was very high in this study. The issue of self-prescribing is common and requires attention.
Awareness of post partum intra uterine contraceptive device and reasons for its low acceptance in an urban Indian population
Authors: Chawla Raina , Ahuja Rashmi , Sharma Priyanka 
Published: January 2020

Background: The safety and efficacy of the Post-Partum Intra Uterine Contraceptive Device (PPIUCD) has been documented worldwide. With increasing institutional deliveries and greater sensitization, the aim is to increase PPIUCD insertions. Many areas still report poor acceptance. Objectives of this study to determine the proportion of antenatal women willing to accept PPIUCD insertion and the reasons behind refusal to accept this method.Methods: A prospective questionnaire study was done between January 2019 to June 2019 of 200 women. Inclusion criteria were antenatal women in the 2nd/3rd trimester. Exclusion criteria were those opting for a permanent method of contraception and those with a contra-indication.Results: Eighty-four women (42%) had never used any method of contraception. Earlier Intrauterine device (IUD) use (including both interval and PPIUCD) was in only 18.9% of all contraceptive users. Only 2 women in the group had ever used PPIUCD. 79% of women were aware of IUDs. Those unaware were mainly nulliparous. Amongst those aware of an IUD, 88 (56%) were aware it could be inserted postpartum. Only 18% were aware it could be inserted intra-cesarean. All women who participated were offered the option for a PPIUCD. Fifty-nine (29.5%) of all women expressed their willingness but on follow up till delivery only 18 of these women got a PPIUCD inserted. Amongst those not willing for the PPIUCD insertion the commonest reason was general apprehension (39%) followed by partner refusal (33%) and fear of complications (31%). Six women (4.2%) gave history of complications following earlier use and were unwilling for its repeat use. Conclusion: The large unmet need for contraception in India can be solved through repeated counselling and discussions with the woman during her antenatal visits. Alleviating apprehension and addressing concerns of the couple will increase PPIUCD acceptance.
Evaluate the adequacy of disclosure as a solution to the problem of conflict of interest in medical research
Authors: Moklif Alanazi Mansour , Ratoubi Alanazi Mohammed 
Published: January 2020

A potential risk of conflict of interest currently exists in research. The financial considerations play a greater role in the decisions that are necessary in the process of research. Traditional pharmaceutical companies began to invest, not just in the commercial development of biomedical discoveries for the marketplace, but in the research centres that could deliver the discoveries. Cooperation and interdependence between industry and research institutions is not inherently wrong, but these unions must be regulated and managed through regulatory mechanisms. When a financial relationship is been disclosed, it would be closely evaluated in order to determine the risk of an undue influence leading to bias, or loss of scientific objectivity. To sum up, a conflict of interest is a potential, but not a certain occurrence. Banning funding for university research by industry is unrealistic. The only effective way to proceed is to implement oversight and regulation that makes both industry funding entities and researchers aware that their activities will be monitored for the benefit of public safety as the more valued concern.