ABSTRACT
Objective: Differentiated thyroid cancer (DTC) is the most common pediatric endocrine cancer but studies are scarce. Latest recommendations advocate for an individualized risk-based approach to select patients for additional therapy. Lymphovascular invasion is not considered, despite being a well-known risk factor in the adult population. The aim of our study was to describe the outcomes of a cohort of DTC patients diagnosed at pediatric age and to evaluate the impact of lymphovascular invasion on the risk of persistence/recurrence. Methods: We conducted a retrospective study of patients diagnosed with DTC at pediatric age from 2010 to 2022 at our center. All patients had total thyroidectomy. Radioactive iodine therapy (RAI) was used in selected patients. The response to therapy and occurrence of persistent/recurrent disease were evaluated. Results: A total of 21 DTC were diagnosed, mostly papillary thyroid carcinoma (PTC) (81.0%, 17). Six patients (28.6%) had nodal involvement and one (4.8%) had lung metastasis at the time of the diagnosis. Lymphovascular invasion was present in 11 patients (52.4%). After surgery, 13 patients (61.9%) were submitted to RAI. The mean follow-up time was 5.7 ± 3.1 years. Overall, 6 patients (31.6%) experienced persistent/recurrent disease during the follow-up time. Among PTC patients, persistent/recurrent disease was more frequent in the presence of lymphovascular invasion [55.6% (5/9) vs 0.0% (0/6), p=0.031]. Conclusion: An individualized risk-based approach is recommended. Our study suggests that lymphovascular invasion may be associated with a higher risk of persistence/recurrence and should therefore be considered for decision making in children and adolescents with PTC.
ABSTRACT
INTRODUCTION: Genetic causes are responsible for half of the cases of hearing loss, most of them being the result of non-syndromic genetic changes resulting from autosomal recessive inheritance. Parental consanguinity might be an indicator to consider in the diagnosis of these cases. The aim of this study was to assess its importance as a risk factor for childhood hearing loss. MATERIAL AND METHODS: A retrospective cohort study conducted in a district hospital, between 2014 and 2018. We included all live births born during this period and excluded those with risk factors for childhood hearing loss other than parental consanguinity and those without hearing screening. We formed two study groups: newborns with parental consanguinity and newborns without risk factors. All the participants underwent hearing screening with the primary outcome of this study being the result of the screening. Those with a not normal result or with parental consanguinity also underwent diagnostic audiological evaluation. RESULTS: Among 8513 live births, we studied 96 newborns with first-degree parental consanguinity and 96 newborns without risk factors. We found a statistically significant difference (p = 0.007) between the groups, with a 'refer' screening result rate of 24% in the group with parental consanguinity and 9.4% in the group without risk factors. We diagnosed one case of sensorineural hearing loss and another of mixed hearing loss in the first group and none of these cases in the second. CONCLUSION: Parental consanguinity was associated with a higher risk of a refer screening result in newborns, which suggests the need to consider this as a risk factor for childhood hearing loss.
Subject(s)
Deafness , Hearing Loss , Infant, Newborn , Child , Humans , Consanguinity , Retrospective Studies , Hearing Loss/diagnosis , Hearing Loss/epidemiology , Hearing Loss/genetics , ParentsABSTRACT
Objetivo: Verificar a eficácia da aplicação da bandagem elástica na musculatura supra-hióidea de pacientes com paralisia cerebral. Método: Estudo clínico prospectivo com análise da técnica de aplicações padronizadas de bandagem elástica em musculatura suprahioídea, realizada por oito semanas, consistindo na sua troca por três vezes por semana. Para analisar a eficácia do procedimento, questionários foram aplicados (qualidade de vida, controle de deglutição da saliva, de frequência e gravidade da sialorreia) e foi realizada avaliação do estadiamento da sialorreia em períodos pré e pós-terapias. Foram comparados dois grupos de pacientes, um denominado por espera assistida e outro, experimental, ambos com quatro sujeitos no grupo, divididos igualitariamente entre os sexos, com idades entre quatro e doze anos (9 anos ± 3,55) para o grupo experimental e entre três e sete anos (4,25 ± 1,89) o de espera assistida. A bandagem elástica foi considerada eficaz quando o total de pontos obtidos após o procedimento foi igual ou superior a três pontos. Resultados: Houve diminuição da sialorreia em todos os sujeitos do grupo experimental por meio da aplicação da bandagem elástica e melhora na qualidade de vida, de acordo com seus responsáveis. No entanto, no grupo de espera assistida não foi observado progresso. Conclusão: A eficácia da aplicação da bandagem elástica para o controle da sialorreia foi comprovada no grupo experimental, contribuindo para o conhecimento na área da motricidade orofacial, além de enfatizar a reflexão acerca de procedimentos fonoterapêuticos não invasivos.
Objective: To verify the efficacy of elastic bandaging in supra-hyoid muscles in patients with cerebral palsy. Method: Prospective clinical study with the technique of standardized applications of elastic bandage in suprahyoid muscles, performed for 8 weeks, consisting of three times a week. In order to analyze the efficacy of the procedure, questionnaires were applied (quality of life, control of saliva swallowing, frequency and severity of sialorrhea) and evaluation of sialorrhea staging in pre and post-therapy periods. There were compared two groups of patients, one called as assisted waiting and the other experimental , were compared with four subjects in the group, equally divided between sexes, aged between four and twelve years (9 years ± 3.55) for the experimental group and between three and seven years (4.25 ± 1.89) the assisted waiting period. Elastic bandage was considered effective when the total score obtained after the procedure was equal to, or greater than three points. Results: According to the responsible persons there was a decrease in sialorrhea in all subjects of the experimental group by the use of elastic bandage, and improvement in quality of life. However, no progress was observed in the assisted waiting group. Conclusion: The efficacy of elastic bandaging for the control of sialorrhea was confirmed in the experimental group, contributing to the knowledge in the area of orofacial motricity, besides emphasizing the reflection about noninvasive speech therapy procedures.
Objetivo: Verificar la eficacia de la aplicación del vendaje elástico en la musculatura suprahioidea en pacientes con parálisis cerebral. Método: Estudio clínico prospectivo con análisis de la técnica de aplicaciones estandarizadas de vendaje elástico en la musculatura suprahioidea, realizada por 8 semanas, consistiendo en cambio tres veces por semana. Para analizar la eficacia del procedimiento, cuestionarios fueron aplicados (calidad de vida, control de deglución de la saliva, de frecuencia y gravedad de la sialorrea) y se realizó evaluación de la estadificación de la sialorrea en períodos pre y pos-terapias. Se compararon dos grupos de pacientes, uno denominado por espera asistida y otro experimental, ambos con cuatro sujetos en el grupo, divididos igualitariamente entre los sexos, con edades entre cuatro y doce años (9 años ± 3,55) para el grupo experimental y entre tres y siete años (4,25 ± 1,89) el de espera asistida. El vendaje elástico se considera eficaz cuando el total de puntos obtenidos tras el procedimiento fue igual o superior a tres puntos. Resultados: Hubo disminución de la sialorrea en todos los sujetos del grupo experimental por medio de la aplicación del vendaje elástico y mejora en la calidad de vida. No obstante, en el grupo de espera asistida no se observó progreso. Conclusion: La eficacia de la aplicación del vendaje elástico para el control de la sialorrea fue comprobada en el grupo experimental, contribuyendo para el conocimiento en el área de la motricidad orofacial, además de enfatizar la reflexión acerca de procedimientos fonoterapéuticos no invasivos.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Athletic Tape , Cerebral Palsy , Sialorrhea , Speech Therapy , Speech, Language and Hearing SciencesABSTRACT
The delayed-interval delivery is a rare, flexible and complex procedure. In light of these facts, there is no consensus on the best approach to achieve it successfully. This case report is of an asynchronous delivery, in a twin pregnancy, with a 32-day interval between births of siblings. Our obstetric management at a critical gestational age improved the outcome of the second newborn. The probability of success of delayed-interval delivery depends on the proper selection of the candidates, the appropriate active management and the continuous monitoring for early detection of complications.
