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Background: Multinodular goiter (MNG) occurs due to repeated hyperstimulation of thyroid gland due to iodine deficiency, goitrogens, antithyroid drugs and genetic defects. MNG can have different complications which include treacheal compression, retrosternal extension, malignancy and secondary thyrotoxicosis. The aim of the work was to study the clinical features and histopathology of MN in patients admitted for thyroidectomy in surgical wards of a tertiary care hospital in north Kerala.Methods: A prospective hospital based observational study in the patients in surgical wards of a tertiary care hospital in north Kerala from April 2011 to March 2012. The clinical data of patients who are subjected to thyroidectomy for MNG (clinical and fine needle aspiration cytology diagnosis) were included in this study. Patients undergoing completion thyroidectomy for recurrence or malignancy were excluded from this study.Results: MNG is more common in females. Female to male ratio 24:1 Majority are in the age group of 30-50 years (64%) with a mean age of 41 years. 38% (38 cases) had pressure symptoms in the form of dysphagia or dyspnea. Secondary thyrotoxicosis seen in 17% (17 cases). Fine needle aspiration cytology (FNAC) is not an error-proof investigation in MNG. 14 % of our patients had malignancy inspite of being reported as benign in FNAC. Among the malignancies papillary carcinoma thyroid was found to be most common accounting for 12% of cases (12/100) followed by follicular carcinoma.Conclusions: FNAC is not an error proof investigation in MNG. Incidental thyroid cancer in MNG is about 14 % with papillary carcinoma thyroid being the commonest.
RESUMO
Introduction: Chronic Obstructive Pulmonary Disease(COPD) is a major health problem globally. Spirometry is theGold standard for the diagnosis of COPD and it also gradesit’s severity. 6MWT is a simple reproducible test to assess thepatient’s functional capacity. It is of help in management andprediction of prognosis. Objective: This study was done to findcorrelation between 6MWT results with patient’s clinical andspirometric parameters. The study also assessed if 6 minutewalk distance (6MWD) can be an alternative to spirometry inpredicting severity of COPD in resource poor setup.Material and methods: This was a hospital based crosssectional study. 60 consecutive confirmed patients of COPD(by GOLD guidelines) were included in the study afterapplying inclusion and exclusion criteria. Severity wasassessed by pre and post-bronchodilator spirometry test. Thiswas followed by 6MWT as per ATS guidelines. 6MWD wasrecorded and % predicted 6MWD was also calculated. Resultsof 6MWT were correlated with spirometric and clinicalparameters of the patients.Results: 6MWD had statistically significant (p <.05) positivecorrelation with following parameters: Height, FEV1, %predicted FEV1, FVC, FEV1/FVC and PEFR. Correlationwith age, weight and BMI was not significant. % 6MWDsignificantly correlated with Height, FEV1, % predictedFEV1, FVC and PEFR. Distances in meters walked bydifferent severity groups were as follows: Mild: 410 + 15;Moderate: 367.66 + 57.71; Severe: 364.60 + 62.91 and Verysevere: 281.21 + 55.99. On one way analysis of variance(ANOVA) these differences were found significant (p <.01)Conclusion: In this study 6MWD and percent 6MWD hadsignificant positive correlation with patients’ parameters(Height, FEV1, %FEV1, FVC and PEFR). The severity ofCOPD may be assessed with 6MWT.