Skeletal metastasis is a frequent complication of cancer resulting in significant morbidity as well as mortality. We highlight a case of a 73-year old gentleman with metastatic squamous cell carcinoma of the sternum. He denied dysphagia, shortness of breath, goitre, and presence of chronic non-healing ulcer. He was anaemic and carcinoembryonic antigen (CEA) was 18.7. Chest radiograph on lateral view showed a suspicious cortical irregularity. Computed tomography (CT) scan of thorax revealed an aggressive sternal lesion with soft tissue component. Ultrasound guided biopsy was performed and the biopsy was consistent with metastatic squamous cell carcinoma. Squamous cell carcinoma has a predilection to metastasize via haematogenous spread, but direct extension of tumour into the bone is not frequently seen. Finding the primary cause is utmost importance either via imaging modalities or invasive procedures. Isolated secondary lesion is extremely rare but unfortunate among defaulters. We discuss its diagnostic work-up and treatment options conserved to manage this condition.
Iodine is an essential micronutrient for normal physical and mental development. Iodine deficiency is endemic in 130 countries worldwide, including Malaysia. This is a cross-sectional study done to determine the prevalence and risk factors of iodine dejiciency among 342 rural mothers attending antenatal clinics in Bachok, Kelantan. A self-adrninistered questionnaire on the knowledge, attitudes, practices and other risk factors relating to iodine deficiency was done. Physical examination for thyroid enlargement was carried out and urine samples were taken for urine iodine determination. The prevalence of iodine deficiency based on urine iodine Q level of less than 100 mcg/l was 63.0 % (95% CI: 57.8, 68.2). The mean urinary iodine level was 87.3 mcg/l with a median of 78.0 mcg/l. However, the goiter prevalence was only 9.4%. The total mean scores of knowledge, attitudes and practices were generally low at 58.6 (SD 7.9), 52.9 (SD 7.9) and 42.9 (SD 10.9) respectively. Logistic regression analysis found that a smoking husband is a risk for iodine deficiency (OR=2.0). In conclusion, iodine deficiency disorders among rural antenatal mothers were still prevalent in Bachok. Their level of knowledge on the causes, effects, prevention and clinical presentations of Q iodine deficiency disorders were poor. In addition, having a husband who is a smoker increases the risk of the antenatal mothers developing iodine denciency.
Study site: Antenatal clinic (klinik kesihatan), Bachok, Kelantan, Malaysia
Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.
Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy.
Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.
BACKGROUND: To determine the prevalence of goiter and to study the factors influencing goiter among people of the rural community in Karnataka state, a community based study. Setting and Study Design: A cross sectional study was carried out to find out the prevalence of goiter in a rural community of Belgaum district. The study was conducted by house-to-house survey for a period of one month.
MATERIALS AND METHODS: Two villages (Handiganur and Gundwad) were selected randomly from Belgaum and Raibag taluks of Belgaum district. All the family members in each household were examined for the presence of goiter using WHO criteria. Iodine content of the salt sample obtained from each household was estimated by using spot testing kits. Information regarding the determinants of goiter was collected and recorded in a pre tested proforma. Data collected was analyzed using SPSS statistical packages.
RESULTS: The prevalence of goiter among rural population was found to be 16.6%. Goiter of grade 1 was 15.7% and that of grade 2 was 0.9%. Prevalence among males and females were 7.2% and 21.8%, respectively. The prevalence of goiter was highest among adolescents. Estimation of iodine content in the salt sample revealed that 50% of samples had adequate iodine content (>/=15 ppm). Multiple Logistic Regression Analysis revealed that females of the age group 10-49 years were independently associated with goiter.
CONCLUSION: Prevalence of goiter was relatively high and therefore constituted a public health problem in this region.
KEYWORDS: Determinants; goiter; multiple logistic regression analysis; prevalence