Proportion of thyroid cancer and other cancers in the democratic republic of Congo.

BACKGROUND: Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo (DRC). The proportion of thyroid cancer has increased over the past three decades. There are very few studies on cancer epidemiology, and in particular on thyroid cancer in the DRC. AIM: To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers. METHODS: This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa. This study included all cancer cases recorded in the registers between 2005 and 2019. RESULTS: From a sample of 6106 patients, including all cancer types, 68.3% cases were female and 31.7% were male. Breast and cervical cancer were the most common types of cancer in women and, prostate and skin cancer were the most common types in men. Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers. Papillary carcinoma was the most common of thyroid cancers. Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7% and 2%, respectively. CONCLUSION: Newer diagnostic tools led to a surge in cancer diagnoses in the DRC. Thyroid cancer has more than doubled its proportion over the last several decades in the country.

Ultrasound performance using the EU-TIRADS score in the diagnosis of thyroid cancer in Congolese hospitals.

The thyroid imaging reporting and data systems by the European Thyroid Association (EU-TIRADS) has been widely used in malignancy risk stratification of thyroid nodules. However, there is a paucity of data in developing countries, especially in Africa, to validate the use of this scoring system. The aim of the study was to assess the diagnostic value of the EU-TIRADS score in Congolese hospitals, using pathological examination after surgery as the gold standard in Congolese hospitals. This retrospective and analytical study examined clinical, ultrasound and pathological data of 549 patients aged 45 ± 14 years, including 468 females (85.2%), operated for thyroid nodule between January 2005 and January 2019. In the present study, only the highest graded nodule according to the EU-TIRADS score in each patient was taken into account for the statistical analyses. So 549 nodules were considered. Nodules classified EU-TIRADS 2 and 3 on the one hand, and, on the other hand, 4 and 5, were considered respectively at low and high risk of malignancy. The sensitivity and specificity of the EU-TIRADS score were calculated. The significance level was set at 5%. Of all patients, 21.7% had malignant nodules. They made 48.4% of the nodules in patients younger than and at 20 years old, and 31.1% in those aged 60 or over. Malignant nodules were more frequent in men than in women (30.9% vs. 20.1%; p = 0.024). Papillary carcinoma (67.2%) and follicular carcinoma (21.8%) were the main types. The malignancy rate was 39.7% and 1.5% among nodules rated EU-TIRADS 4 and 5, and those with EU-TIRADS score 2 and 3, respectively (p < 0.001). The EU-TIRADS score had a sensitivity of 96.6% and a specificity of 59.3%. The ROC curve indicated an area under the curve of 0.862. In a low-income country, a well performed thyroid ultrasound, using the EU-TIRADS score, could be an important tool in the selection of thyroid nodules suspected of malignancy and requiring histopathological examination in the Congolese hospital setting.Trial registration: The research protocol had obtained the favorable opinion of the DRC national health ethics committee no. 197/CNES/BN/PMMF/2020. The data was collected and analyzed anonymously.

A Case Report of Premalignant Plasma Cell Dyscrasia-Induced Renal Failure in a 31-Year-Old Female.

Monoclonal gammopathy of renal significance (MGRS) is a rare disorder in which monoclonal immunoglobulin secreted by nonmalignant B cell or plasma cell clone causes kidney damage. Although MGRS is a premalignant condition, it can cause severe kidney disease and end-stage renal disease (ESRD) at any age. Herein, we present a 31-year-old female with past medical history of lupus nephritis who presented with signs of volume overload and worsening renal function despite adequate immunosuppressive therapy. Renal biopsy revealed heavy and light chain deposition consistent with MGRS. This case report demonstrates the importance of including MGRS in the differential diagnosis of worsening renal function despite adequate treatment, raising awareness of this premalignant yet morbid condition.

A Case Report of DVT following the Johnson and Johnson Vaccine against the Novel SARS-CoV-2.

Deep vein thrombosis (DVT) is the formation of a blood clot typically in the deep veins of the extremities. The risk factors for venous thrombosis are primarily related to hypercoagulability, which can be genetic, acquired, or due to immobilization and venous stasis. The Johnson and Johnson (J&J) vaccine developed against the novel SARS-CoV-2 has been linked to more specific cases of thrombosis, associated with low platelet levels similar to that seen in heparin-induced thrombocytopenia. In this case report, we present a female who developed a DVT four days after receiving the J&J vaccine. We propose that the administration of this vaccine may further increase the risk of developing DVTs in patients with previous risk factors, and we hope to use this case to support screening all patients for previous risk factors for thrombosis before administration of the J&J vaccine.

A Rare Case of Systemic Sarcoidosis in a Middle-Aged Female with a Solitary Thyroid Nodule.

Sarcoidosis is a multisystem inflammatory disease characterized by the presence of noncaseating granulomas. Sarcoidosis can affect any organ of the body, the lung being the most affected. Sarcoidosis rarely affects the thyroid gland, and only a few cases of thyroid-related sarcoidosis have been reported in the literature. Herein, we report a case of systemic sarcoidosis with multiple organ involvement in a patient with a solitary left thyroid nodule and benign Fine Needle Aspiration (FNA) findings. The patient was eventually diagnosed with thyroid sarcoidosis using a core needle biopsy of the thyroid nodule. With this case report, we highlight the limitations of the FNA. This case report has the objective to encourage clinicians to include thyroid sarcoidosis in the differential diagnosis of thyroid nodules in patients with systemic sarcoidosis even with unremarkable FNA findings.

Management of West Nile Encephalitis: An Uncommon Complication of West Nile Virus.

West Nile virus disease (WNVD) is a mosquito-borne disease that affects the meninges and central nervous system, causing West Nile virus (WNV) encephalitis, a debilitating, life-threatening condition, especially in the elderly. While there is a lot of research discussing different aspects of the disease, the treatment is mainly unknown. We conducted a literature review to explore the wide variety of treatment options that consolidate the knowledge about the most recent management of WNV encephalitis. We did a combined advanced search and Medical Subject Headings (MeSH) search on PubMed. Inclusion criteria included papers written in the English language and human subjects research for the past 25 years. We initially gather 110 papers, and after applying the inclusion/exclusion criteria, we end up with 30 articles for the paper's discussion. This review aims to provide clinicians with an overview of the latest approach in treating and managing hospitalized WNVD patients. It discusses case reports and the outcome of different treatment regimens done in vitro and in vivo. The study discusses all the advancements in treatment and prophylaxis and compares their effectiveness. However, more research is warranted to gain further insight to develop a single guideline for the management of this disease. This review discusses the following treatment modalities: ribavirin, interferon-alpha, intravenous immunoglobulin (IVIG), and other less-used drugs. More studies about ribavirin are needed to know if the drug is useful for WNV encephalitis. Interferon-alpha has been shown to have both protective and disease limiting properties. At the moment, there are no guidelines for the treatment of WNV encephalitis, nor is there a single Food and Drug Administration (FDA)-approved drug. For the time being, IVIG offers the best results in treating WNV encephalitis.

Horner's Syndrome Secondary to Epidural Anesthesia After Scoliosis Correction: A Case Report.

Horner's syndrome is a clinical triad composed of ptosis, miosis, and facial anhidrosis. Overall, this complication is rare but well-documented in the obstetric population receiving labor epidural analgesia, which usually follows a relatively benign transient course. Less commonly, few cases of Horner's syndrome have been reported in the pediatric population following surgical correction of scoliosis with epidural placement. We present a rare case of a pediatric patient that developed Horner's syndrome secondary to epidural anesthesia following surgical correction of scoliosis.

Chronic Pain Secondary to a Cervical Intramedullary Ependymoma: A Case Report.

Intramedullary spinal cord tumors (IMSCT) are a rare subset of neoplasms classified based on anatomical location. The most common presenting symptom is pain; however, the high prevalence of back pain in the general public secondary to common causes including degenerative disc disease or osteoarthritis, makes diagnosing spinal cord tumors a challenge. We present a case of a 43-year-old male with a cervical intramedullary ependymoma to discuss the clinical presentation, diagnosis, and treatment of these spinal tumors.

An Unusual Cause of Secondary ITP in a 34-Year-Old Hispanic Male.

Secondary immune thrombocytopenic purpura (ITP) associated with Helicobacter pylori (H. pylori) infection has been described in the literature. It appears to have a geographic distribution; mostly encountered in countries with a higher prevalence for H. pylori such as Italy or Japan. H. pylori eradication has been recommended in the management of ITP with studies showing improvement in the platelet count in some patients. Substantial platelet count increases in patients with severe thrombocytopenia (platelet counts <30 × 103 microliter), however, are uncommon with H. pylori treatment alone. Here, we present a 34-year-old Hispanic male with worsening chronic thrombocytopenia that resolved following eradication of his H. pylori infection. Herein, we highlight a rare and reversible cause of secondary ITP. With this case report, we hope to encourage physicians to include H. pylori testing in the evaluation of thrombocytopenia.

Anesthetic Management in Familial Hyperkalemic Periodic Paralysis: A Case Report.

Hyperkalemic periodic paralysis (HyperPP) is the rarer of two forms of potassium-associated familial paralysis characterized by episodic flaccid weakness secondary to an increase in serum potassium. The rarest of the dyskalemic paralyzes, the incidence of the hyperkalemic variety has been estimated to be 1:500,000. Known precipitating factors are potassium intake, fasting, hypothermia, infection, stress, rest after exercise, and anesthesia. The key to successful management is avoidance of triggering factors, vigilant monitoring of potassium, and aggressive treatment of hyperkalemia. We present a case of a 41-year-old male with HyperPP who underwent general anesthesia successfully.

Transient Brugada Pattern Induced by Loperamide Abuse.

Brugada syndrome (BrS) is classically a malignant, genetically determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts. An exceedingly rare cause of an induced electrocardiogram (ECG) pattern mimicking BrS is secondary to loperamide abuse. The following case describes the onset of a transient Brugada pattern secondary to loperamide abuse in a young healthy male.

Caseous calcification of posterior mitral annulus: a forgotten benign condition mimicking atrial mass.

Caseous calcification of posterior mitral annulus is considered a variant of mitral annular calcification and accounts for less than 1% cases of mitral valve calcification (MAC). Usually benign and asymptomatic and has typical features on imaging studies but may contribute to unnecessary investigations and interventions in some patients, transthoracic echocardiography (TTE) is most useful tool in the diagnosis of this condition, whether it is associated with increased risk of atherosclerosis is unknown. We are presenting a case of caseous calcification of posterior mitral annulus that is discovered during elective coronary angiography in a patient with extensive history of coronary heart disease who had abnormal stress test.

A Rare Presentation of Epstein-Barr Virus-induced Hepatitis With an Interesting Twist: A Case Report Involving a Clinical Pearl.

An Epstein-Barr Virus (EBV) infection generally presents with the classic infectious mononucleosis symptomatology-sore throat, lymph node enlargement, and fatigue. However, there are cases in which induced hepatitis does occur. The liver enzymes leaked during the acute damage would be apparent in the serum as an elevation of transaminases and alkaline phosphatase. These elevations are almost always mild in nature. In addition, the associated presenting symptomatology is a generalized weakness, lethargy, and fatigue. Aside from the marked elevation of liver enzymes, what makes our case a rarity is the fact that the chief complaint was polydipsia and polyuria. Furthermore, an initial negative hepatitis A panel was found to be positive weeks later. The insight offered by this case is a true clinical pearl-namely, that the seroconversion of hepatitis A takes several weeks to occur.