ABSTRACT
Objectives: This study compares the utilization of osteoporosis and osteoporosis complication healthcare services before and during the COVID-19 pandemic in Romania. Methods:The descriptive nationwide population study has used secondary data collected from the national health information system. We have calculated and compared the procedures performed for osteoporosis diagnosis and screening, standardized incidence and hospitalization rate for osteoporosis and osteoporosis fractures before and during the COVID-19 pandemic. Results:A 37.84% reduction in the number of DXA scans performed in 2020 have been observed, decreasing from 30,698 in 2019 to 12,064 in 2020. The standardized incidence for osteoporosis was 212.97 cases/100.000 person-years in 2018, 234 cases/100,000 person-years in 2019, and 185.97 cases/100,000 person-years in 2020. The hospitalization rates for osteoporosis have decreased by 68% compared with 2019 and the continuous hospitalization rate for osteoporotic fracture by 48% compared with 2019. Conclusions:The COVID-19 pandemic affected the utilization of healthcare services for osteoporosis management, posing a threat due to a magnified effect on osteoporotic fracture burden. More efforts are further needed to progress and re-engage with osteoporotic fracture prevention in our country and to develop and shape an optimal implementation of prevention and management strategies for all level of health care in Romania.
ABSTRACT
AIM: Anaplastic thyroid carcinoma (ATC), poorly differentiated thyroid carcinoma (PTDC) and lymphoma are aggressive forms of neoplasia. Although all carry a poor prognosis there is an important heterogeneity of overall survival (OS) between individual patients. The decision of total thyroidectomy is often based on fine-needle aspiration biopsy (FNAB) which has important limitations in this setting. Our aim was to assess the OS of aggressive thyroid cancer diagnosed on FNAB in a single university center. METHODS: We retrospectively reviewed all the ATC, PDTC and lymphoma cases diagnosed on FNAB during 2007-2013 (15 cases). All FNAB examinations were performed by the same specialized pathologist. Data on demographics, laboratory tests, imaging studies, FNAB/pathology reports, treatment and survival time were recorded. All patients had serum calcitonin levels under 5 pg/mL. Five patients had total thyroidectomy. RESULTS: The OS was 2.2 (0.6, 18.5) months. The survival rate at 3 and 12 months was 46.6% and 33.3% respectively. There were no significant differences between ATC and PDTC/lymphoma patients for age, TSH, largest tumoral diameter and cervical lymph involvement. Patients with ATC (8 cases) had a median OS of 0.8 months, significantly shorter than 6 months for patients with PDTC/lymphoma (7 cases). Patients treated with total thyroidectomy had a median OS of 20 months compared with 1.87 months for patients without surgical intervention (p=0.06). CONCLUSIONS: The differences between groups and the heterogeneity of individual cases suggest that a diagnosis of aggressive thyroid cancer on FNAB should not preclude the surgical intervention. The decision to operate should be based on accurate imaging rather than on discouraging FNAB result.
