ABSTRACT
Background Although serum thyroid-stimulating hormone (TSH) is one of the basic investigations to assess thyroid nodules, its role in thyroid oncogenesis remains unclear. Previous literature has conflicting findings regarding TSH levels and the prediction of malignancy. This study aims to investigate the association between TSH levels and the risk of malignancy and advanced staging in patients who underwent thyroidectomy for nodular thyroid disease. Additionally, it aims to assess if higher TSH correlates with malignancy in Bethesda staging III, IV, and V. Methodology This retrospective cohort study was conducted among participants who underwent near-total/total thyroidectomy or hemithyroidectomy at King Abdulaziz Medical City between 2016 and 2021. Results A total of 378 cases were included, and 50.3% of the cases had malignant nodules in the surgical histopathology findings. The median TSH levels were higher in malignant nodules compared to benign ones (1.64 mIU/L versus 1.49 mIU/L; p < 0.001). Additionally, higher TSH levels were not associated with advanced staging or malignancy in patients with Bethesda stage III-V. Conclusions Higher TSH levels are associated with an increased risk of malignancy in patients with nodular thyroid disease. Using TSH levels as an adjunctive tool for identifying high-risk patients with thyroid nodules would aid in management planning.
ABSTRACT
INTRODUCTION: While only a few cases have been reported in pediatrics, subaortic stenosis (SAS) is a gradually progressive disorder rarely seen at birth and infancy, however, it is the most common type of aortic stenosis. It obstructs the blood flow across the left ventricular outflow tract (LVOT). Although the cause is still not well known, different etiologies have been suggested by the literature. While surgical resection is the definitive treatment, recurrence is observed in many patients, nonetheless, LVOT gradient usually progresses over years of follow-up. CASE PRESENTATION: We report the clinical and diagnostic course of a 41-months-old Saudi boy, asymptomatic child who was found to have progressive recurrent subaortic stenosis within a few months which required two redo sternotomy for sub-aortic membrane resection throughout a period of two years. DISCUSSION: SAS is usually detected incidentally in asymptomatic patients requiring an echocardiogram to assess other accompanying congenital heart defects (CHD), or rather potentially arising after repair of CHD. Patient close monitoring is important aspect given the nature of disease progression, re-operation for recurrence demonstrate significant increase over years, re-resection rate was 0 % after one year, 6 % after five years, and 8 % after 10 years. CONCLUSION: Recurrence of LVOT obstruction following sub-aortic membrane resection is common. Long-term follow-up care in postoperative patients is crucial. Majority of patients will need re-operation for recurrence at certain point during course of the disease.
ABSTRACT
Background Unintentional injuries and poisoning among children are prevalent and severe causes of hospitalization and impairment. The number of accidental injuries among children increases every year, leading to a huge burden on communities and health institutions. Methods This study is a retrospective analytical cross-sectional study. Charts from January 2014 to December 2018 were reviewed to estimate the epidemiological distribution and types of unintentional injuries among children aged 14 years or younger, including newborns, who were admitted to King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. Results In this study, 353 children were included. Patients were those admitted to King Abdulaziz Medical City (KAMC), Jeddah, due to unintentional injuries and whose age varies from birth to 14 years. Most of the injured children were males (60.1%), but interestingly more female patients suffered from fracture injuries than males. The most common injury was found to be falling (38.5%), followed by road traffic accidents (RTA) (26.1%). The frequency of different types of injuries varied among different age groups. Infants' injuries were mainly falling (50%), while RTA was the most common injury among adolescents (94.7%). Moreover, the head and neck area was the most affected site contributing 39.1% of all sites. Outcomes of the accidental injuries were assessed as full recovery, disability, or death. Conclusion This study showed the proportion of unintentional injuries among children from birth to 14 years old in KAMC, Jeddah, Saudi Arabia. Overall, the most prevalent type of injury found in our study was falling. Moreover, injuries were more common among male patients. We concluded that most injuries could be avoided if parents or children's guardians practiced protective strategies mainly by ensuring a safe and clear environment for the children.
