ABSTRACT
INTRODUCTION: The current study aims to report a rare case of metastatic papillary thyroid carcinoma (PTC) of the cervical lymph nodes with hobnail variant and anaplastic de-differentiation. In addition to the primary disease, there was a second pathology which was caseating granulomatous lymph adenitis suggestive of tuberculosis. CASE REPORT: A 91-year-old female presented with a painful right sided neck swelling for two weeks, increased in size suddenly. On clinical examination, there was a well-defined firm painful right sided neck mass. On ultrasound examination, there was multiple well defined solid hypoechoic, hypervascular nodules. These resembled lymph nodes of variable size and shape, mostly in the right side. The patient underwent right lateral cervical lymph node dissection. After the operation, she was sent for radiotherapy. DISCUSSION: The hobnail variant of PTC is genetically identical to poorly differentiated thyroid carcinoma in that its mutations are in the p53 and TERT promoters are more common in this variant than in conventional PTCs. The proportion of hobnail features have no effect on the outcome. Additionally, 10% of tumor cells with hobnail features were previously linked to a more aggressive clinicopathological aspect. CONCLUSION: Although it is rare, metastatic PTC with hobnail variant could undergo anaplastic dedifferentiation.
ABSTRACT
BACKGROUND: Computerized physician order entry (CPOE) systems are recommended to improve patient safety and outcomes. However, their effectiveness has been questioned. Our objective was to evaluate the impact of CPOE implementation on the outcome of critically ill patients. METHODS: This was an observational before-after study carried out in a 21-bed medical and surgical intensive care unit (ICU) of a tertiary care center. It included all patients admitted to the ICU in the 24 months pre- and 12 months post-CPOE (Misys®) implementation. Data were extracted from a prospectively collected ICU database and included: demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, admission diagnosis and comorbid conditions. Outcomes compared in different pre- and post-CPOE periods included: ICU and hospital mortality, duration of mechanical ventilation, and ICU and hospital length of stay. These outcomes were also compared in selected high risk subgroups of patients (age 12-17 years, traumatic brain injury, admission diagnosis of sepsis and admission APACHE II > 23). Multivariate analysis was used to adjust for imbalances in baseline characteristics and selected clinically relevant variables. RESULTS: There were 1638 and 898 patients admitted to the ICU in the specified pre- and post-CPOE periods, respectively (age = 52 ± 22 vs. 52 ± 21 years, p = 0.74; APACHE II = 24 ± 9 vs. 24 ± 10, p = 0.83). During these periods, there were no differences in ICU (adjusted odds ratio (aOR) 0.98, 95% confidence interval [CI] 0.7-1.3) and in hospital mortality (aOR 1.00, 95% CI 0.8-1.3). CPOE implementation was associated with similar duration of mechanical ventilation and of stay in the ICU and hospital. There was no increased mortality or stay in the high risk subgroups after CPOE implementation. CONCLUSIONS: The implementation of CPOE in an adult medical surgical ICU resulted in no improvement in patient outcomes in the immediate phase and up to 12 months after implementation.
Subject(s)
Brain Injuries/diagnosis , Critical Illness/therapy , Medical Order Entry Systems/organization & administration , Outcome Assessment, Health Care/methods , Perioperative Care/statistics & numerical data , Quality Assurance, Health Care , APACHE , Adolescent , Adult , Aged , Brain Injuries/surgery , Brain Injuries/therapy , Decision Support Systems, Clinical , Female , Hospital Mortality/trends , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Multivariate Analysis , Patient Admission/statistics & numerical data , Qualitative Research , Respiration, Artificial , Saudi Arabia , Sepsis/diagnosis , Sepsis/therapyABSTRACT
Polyhydroxyalkanoate (PHA) from one fermentation process shows diverse physical properties when extracted using different methods. Pseudomonas aeruginosa strain has been previously isolated from the Egyptian ecosystem was cultivated on olive oil as a carbon source under PHA accumulation conditions. PHA was extracted using four different extraction methods and the polymer give different biological properties. Leucocytes grown in different rate on each preparation. RBCs haemolysis test was used to determine the polymers toxicity. PHA isolated directly with chloroform give the highest leucocytes number (19.4 10(4) cells/48 hr) and the lowest Haemolytic index (2.28). Bioassays used in this study are recommended for evaluating the in vitro polymer biocompatibility aiming to in vivo application or as a cell line-supporting matrix.
