Evaluation of the role of ultrasonography in diagnosis of autoimmune thyroiditis in goitrous children.

OBJECTIVES: To evaluate the role of thyroid ultrasound in children with autoimmune thyroiditis diagnosed either on cytopathology or by the presence of thyroid peroxidase antibodies. DESIGN AND SETTINGS: Children presenting for the first time to the Thyroid Clinic at the Institute of Nuclear Medicine and Allied Sciences for the complaint of goiter over a two year period (January 2005-December 2006) were studied. SUBJECTS: 695 school children (244 boys and 451 girls) aged 5-18 year were studied. METHODS: Children were subjected to thyroid ultrasound, cytopathology, thyroid peroxidase antibody and thyroid function tests. RESULTS: Overall, 16% of goitrous children had hypoechogenicity on ultrasound, 15.2% had cytopathological evidence of thyroiditis, 10.6% had positive thyroid peroxidase antibodies and 25.2% had abnormal thyroid function tests. Subjects with hypoechogenicity had higher percentage of thyroiditis on cytopathology (41.4% vs. 10.3%; P<0.01), thyroid peroxidase antibody positivity (30.6% vs. 6.8%; P<0.01) and thyroid dysfunction (46.8% vs. 21.2%; P<0.01) than those with normal echogenicity. CONCLUSION: Thyroid USG has a useful, though limited, role in excluding thyroid disease in children. The sensitivity of echogenicity for the diagnosis of autoimmune thyroiditis in children is less than that reported in adults.

Ultrasound evaluation of thyroid size: a large nationwide study of schoolchildren in India.

BACKGROUND: Ultrasound assessment of thyroid volume is considered a more objective method than clinical palpation for the diagnosis of goitre. We used ultrasonography to establish normal reference cut-off points of thyroid volume in schoolchildren of different socioecomonic groups in India and compared the results with international norms. METHODS: In a cross-sectional study, we clinically examined 27,250 children from the lower and higher socioeconomic strata (SES) from all over India to determine their goitre staging. A single sonologist, using ultrasonography, assessed the thyroid volume in a subset of 15,986 children (8463 from the lower and 7523 from the higher SES). Students were recruited from at least one school each representing the higher and the lower SES, from cities located in 5 zones of India. Children with known thyroid disorders were excluded from the study. RESULTS: Clinical evaluation revealed a mean goitre prevalence of 19.9% (23.2% in girls; 16.5% in boys; 17.1% in the higher SES; 23.5% in the lower SES). The thyroid volume as assessed by ultrasonography was significantly higher in children from the lower SES (mean 5.65 ml, SE 0.02) compared with those from the higher SES (mean 5.02 ml, SE 0.02) after adjusting for the imbalance in body surface area (p < 0.001). Using international norms (WHO 2004), the prevalence of goitre in various body surface area categories among children who had no goitre on clinical examination ranged from 48.2% to 75.1% for boys and 23.2% to 67.4% for girls. CONCLUSION: The striking discrepancy in the prevalence of goitre assessed by using clinical examination and ultrasound techniques suggests that the norms recommended by WHO based on ultrasound techniques are not appropriate for India.

Radioprotective effects of diltiazem on cytogenetic damage and survival in gamma ray exposed mice.

Diltiazem, a calcium ion channel blocker, already in use in cardiovascular therapeutics, has been observed to protect against bone marrow damage (cytogenetic damage, cell death) and mortality in whole body irradiated mice. The micronuclei fraction in bone marrow cells of whole body irradiated (60Co gamma rays, 2.0 Gy) mice was reduced from 2.24 +/- 0.23% to about 0.74 +/- 0.33% by preirradiation administration (-20 min) of 110 mg/kg body wt. diltiazem (ip). Endogenous colony forming unit counts in spleen of mice administered 110 mg/kg body wt. (-20 min) of diltiazem before 10 Gy whole body irradiation were 6 times more than untreated irradiated controls. Pretreatment with diltiazem accelerated the recovery of radiation induced weight loss also. Diltiazem (110 mg/kg body wt, -20 min) enhanced 30 day survival to about 95% and 85% after lethal whole body absorbed dose of 9 and 10 Gy respectively and also mitigated radiation induced life- span shortening. Post-irradiation (10 Gy) administration of diltiazem (+20 to 30 min) enhanced survival from about 2 to 15% only but was highly significant (P < 0.001). Possible modes of radioprotective action of diltiazem have been discussed.

Demographic survey of opinions towards smoking: a pilot study.

A survey was conducted by means of a questionnaire, on 865 smokers to analyse their opinions towards some general aspects of smoking. The subjects were mostly males (97.11%) and belonged to the age group of 21 to 50 years (80%). Heavy smoking is injurious to health is the opinion of most of the smokers (90.41%) particularly when maintained with other addictions (80%); tobacco is harmful not only when smoked but also when used in other forms (63%) and moderate smoking may not be much harmful (43%). However, smoking is not necessary to make or maintain relations with others (70%). Statutory warning has no marked effect on the habit (69.83%), the role of legal restrictions is dubious but advertisements encourage the habit definitely (62.54%). Three out of 4 persons know the problems of smoking and almost the same proportion of the people think that smoking can be stopped or at least checked. But there is difference of opinion about the person to be consulted, if any such problems arises from the habit of smoking. Family physicians may play an important role in controlling the habit.

The natural history of smoking.

This study is a small collection of the natural history of smoking of 865 persons - all smokers and majority (97.11%) of them were males, more than 80% were between 21-50 years, most (90%) were Hindus and 75% were service holders. It revealed that most of the subjects started smoking between 10 and 25 years of age, frequently being requested by their friends but felt nothing mentionable at their first experience. Most of them (64%) were smoking for more than 10 years, 48.56% were smoking more than 10 cigarettes in a day, filter-tipped more often (by 64% subjects) and without any history of break by 56% subjects. Majority (80%) used to inhale the smoke and 40% had no specific time of choice. Most of the subjects (80%) like to smoke in deep thoughts, 66% during excitement, 60% when depressed, 82% when relaxed and 62.5% when alone. But most of them (64%) did not smoke when busy. Majority (70.87%) felt relaxed when smoking. Most of the people (45%) stood reasonable having no cigarette in their stock. Majority (84%) used to smoke even when not offered. Tobacco was consumed largely as smoke by 75% subjects; 78% subjects smoked only cigarettes and about half of the smokers smoked even when they did not enjoy it.

Renal involvement in kala-azar.

Fifty one patients in a series of 1000 parasitologically confirmed patients of kala-azar showing proteinuria were studied from the point of view of renal involvement. Forty two out of these patients showed blood urea above 40 mg/dl and 12 had decreased glomerular filtration rate as well. Serum creatinine level was normal in all patients including those with blood urea of more than 100 mg/dl. It is therefore suggested that although there may be glomerular involvement in some patients of kala-azar, the changes are reversible.