ABSTRACT
Objectives@#This is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography.@*Methodology@#This cross-sectional study was conducted at a tertiary care hospital with 83 patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot.@*Results@#Modified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7-91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant - 100%, Resident - 95.5%) with relatively lower sensitivity (Consultant - 94%, Resident - 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile’s method, but specificity was low. Lahey’s method was a better clinical method to palpate lymph nodes compared to the other three.@*Conclusion@#Examination in modified Rose’s position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey’s method is a better method to examine cervical lymph nodes.
ABSTRACT
Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement inMEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on ⁶⁸Ga-DOTANOC PET/CT done as part of post ¹⁷⁷Lu-DOTATATE therapy (PRRT) follow-up. Further ¹⁸F-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.
Subject(s)
Humans , Adenoma , Endocrine Glands , Follow-Up Studies , Gastrinoma , Hyperparathyroidism , Islets of Langerhans , Multiple Endocrine Neoplasia Type 1 , Neuroendocrine Tumors , Parathyroid Neoplasms , Parathyroidectomy , Pituitary Gland, Anterior , Positron Emission Tomography Computed Tomography , Receptors, Somatostatin , SomatostatinABSTRACT
Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement inMEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on â¶â¸Ga-DOTANOC PET/CT done as part of post ¹â·â·Lu-DOTATATE therapy (PRRT) follow-up. Further ¹â¸F-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.
ABSTRACT
This review describes the basic and clinical pharmacology of sulfonylureas. It undertakes a balanced assessment of the advantages and limitations of sulfonylureas, and compares the use of various sulfonylureas in different clinical situations. The authors suggest pragmatic guidance to facilitate safe and effective use of this class of drugs, and thus help make maximal use of this economical therapeutic option in resource challenged settings such as developed nations
Subject(s)
Diabetes Mellitus , Hypoglycemic Agents , Gliclazide , Glipizide , Glyburide , Safety , PharmacogeneticsABSTRACT
This article discusses the rationale and method of screening for diabetes in a primary care setting. It describes guidelines laid down by international organizations, while adding pragmatic suggestions based upon reality in South Asian and other developing countries
Subject(s)
Humans , Mass Screening , Glucose Tolerance Test , Glycated HemoglobinABSTRACT
The diagnosis of diabetes is not as straightforward as it may seem. This brief communication describes how to diagnose [and not to diagnose] diabetes in a simple manner. This information will be of use to general practitioners as well as students of diabetology