3 articles
The widespread use of diagnostic imaging favored the increasing incidence of thyroid nodules. Although most of nodules are benign, their clinical importance lies in the need to exclude malignancy. In assessing and managing thyroid nodules may occur the phenomenon of overdiagnosis and overtreatment on one hand and the risk of missing an aggressive thyroid cancer on the other hand. The equilibrium that has to be reached by health care providers.
We conducted a PubMed, MEDLINE, ISI Web of Science, Cochrane databases search for the relevant and recent guidelines, meta-analysis, randomized controlled trial, reviews articles related to „thyroid nodules assessment”, „thyroid nodules management”, „thyroid nodules guidelines”, „thyroid nodules surgery”.
The initial assessment of thyroid nodules includes an evaluation of clinical, laboratory and sonographic risk factors. Due to the sonographic features and size, the nodules are selected for biopsy. Cytologically benign nodules are usually followed-up, minimally invasive techniques may be required in certain cases. In suspected or confirmed malignancy, the treatment options of thyroid nodules include surgery or active surveillance. The main controversies appear in management of nodules with inconclusive cytology, low-risk cancers, multinodular goiters, hyperfunctioning nodules, and thyroid incidentalomas.
Thyroid nodules due to the high incidence and heterogeneity of background diseases cannot be evaluated and managed in one standardized approach. In the existing literature, there are discussed multiple options for diagnosis and treatment of thyroid nodules. We have reviewed the guidelines recommendations, novel published data, and controversial questions for health care professionals, to understand and provide efficient, personalized, and cost-effective management of patients with thyroid nodules in order to avoid automatic intensive testing and intervention and balancing each case from the patient expectations and demands.
The incidence and prevalence of gout have increased worldwide in recent decades. Scientists at the Rochester Epidemiology Project (MN, USA) have seen a two-fold increase in the incidence of primary gout (patients without diuretic exposure) over a 20-year period, which ended in 1996. The increase of incidence may be related due to the difficulty and often unsatisfactory treatment options. The aim of the study was to systematize the recommendations on dietary treatment, and medication for patients with gout.
An analytical, qualitative, and secondary study was performed in the form of a synthesis article. 115 sources were identified and analyzed; from this list, 44 sources were selected according to the impact score during the publication period and according to the level of recommendations.
44 articles were included. Most studies were small, retrospective analyses performed in single centers, with concerns for bias. Eleven studies (including five randomized controlled trials) reported improved patient outcomes following pharmacological interventions with known efficacy in gout, including allopurinol, prednisolone, NSAIDs and anakinra. Eight studies reported improved outcomes associated with non-pharmacological interventions: inpatient rheumatology consultation and a hospital gout management protocol. No studies to date have prospectively evaluated strategies designed to prevent re-admissions of patients hospitalized for gout flares.
Urate crystals is completely soluble when we can lower the serum level of uric acid to normal values, but this often requires long-term treatment. The early onset of rehabilitation of affected joints helps to reduce the articular inflammatory process, the pain syndrome and it delays the progression of the underlying pathology while improving the quality of life in patients with gout. Further research is needed to enable healthcare providers to individualize and optimize gout treatment strategies, ensuring that patients with gout receive effective, safe, and high-quality care.
Chronic myeloid leukemia (CML) comprises 15-20% of all leukemia cases in adults, being the most common chronic myeloproliferative neoplasm, with the patients’ immunocompromised status in the advanced phases. The international periodical literature stipulates the increased susceptibility of patients with malignant tumors to SARS-CoV-2 infection, but the contagion risk is not determined in regard to the histological type of hematologic malignancies. The aim of the study was the comparative evaluation of the current epidemiological patterns and the contemporary diagnostics output in CML, axed on the optimization of tactics of diagnosis management in the context of the pandemic with COVID-19 infection.
An analytical, qualitative, secondary study was performed – the narrative review of literature in the form of a synthesis article. Fifty three relevant primary sources were identified and selected, according to the significance of the impact score, with the subsequent and scientific data extraction and analysis.
CML varies between 0.8 - 2.0 cases per 100000 population. The total number of patients diagnosed with CML increased annually by 2% during 2007-2016. In 2017, a comparatively high level of the age-standardized death rate (ASDR) (0.6 per 100,000 population, 95% IU) and the DALYs (disability-adjusted life-years) age-standardized rate (ASR) (16.71 per 100,000 population, 95% IU) were registered in quintiles with low SDI. By the quantitative RT-PCR analysis of blood cells for BCR-ABL p210 gene transcript, the published studies highlight its large variations: 21.84 - 100% IS. FISH and PCR are able to detect rare BCR-ABL gene variants and breakpoints that may go unnoticed by conventional cytogenetics.
Despite the declining overall trend of ASIR, ASDR and age-standardized DALYs at the expense of high SDI quintiles, the CML burden remains stable due to the growing population in developing countries and the aging population in developed countries. Management of patients with primary diagnosed CML, with high risk factors, should include enhanced surveillance for SARS-CoV-2 infection. Diagnostics management of patients with CML includes morphological, cytogenetic and molecular-genetic investigations of the peripheral blood and bone marrow regardless of the phase of clinical evolution, with FISH and RT-PCR as proving resolutive modalities.