Analyzing Citizens' and Health Care Professionals' Searches for Smell/Taste Disorders and Coronavirus in Finland During the COVID-19 Pandemic: Infodemiological Approach Using Database Logs.

BACKGROUND: The COVID-19 pandemic has prevailed over a year, and log and register data on coronavirus have been utilized to establish models for detecting the pandemic. However, many sources contain unreliable health information on COVID-19 and its symptoms, and platforms cannot characterize the users performing searches. Prior studies have assessed symptom searches from general search engines (Google/Google Trends). Little is known about how modeling log data on smell/taste disorders and coronavirus from the dedicated internet databases used by citizens and health care professionals (HCPs) could enhance disease surveillance. Our material and method provide a novel approach to analyze web-based information seeking to detect infectious disease outbreaks. OBJECTIVE: The aim of this study was (1) to assess whether citizens' and professionals' searches for smell/taste disorders and coronavirus relate to epidemiological data on COVID-19 cases, and (2) to test our negative binomial regression modeling (ie, whether the inclusion of the case count could improve the model). METHODS: We collected weekly log data on searches related to COVID-19 (smell/taste disorders, coronavirus) between December 30, 2019, and November 30, 2020 (49 weeks). Two major medical internet databases in Finland were used: Health Library (HL), a free portal aimed at citizens, and Physician's Database (PD), a database widely used among HCPs. Log data from databases were combined with register data on the numbers of COVID-19 cases reported in the Finnish National Infectious Diseases Register. We used negative binomial regression modeling to assess whether the case numbers could explain some of the dynamics of searches when plotting database logs. RESULTS: We found that coronavirus searches drastically increased in HL (0 to 744,113) and PD (4 to 5375) prior to the first wave of COVID-19 cases between December 2019 and March 2020. Searches for smell disorders in HL doubled from the end of December 2019 to the end of March 2020 (2148 to 4195), and searches for taste disorders in HL increased from mid-May to the end of November (0 to 1980). Case numbers were significantly associated with smell disorders (P<.001) and taste disorders (P<.001) in HL, and with coronavirus searches (P<.001) in PD. We could not identify any other associations between case numbers and searches in either database. CONCLUSIONS: Novel infodemiological approaches could be used in analyzing database logs. Modeling log data from web-based sources was seen to improve the model only occasionally. However, search behaviors among citizens and professionals could be used as a supplementary source of information for infectious disease surveillance. Further research is needed to apply statistical models to log data of the dedicated medical databases.

[Licorice as the cause of elevated blood pressure and headache?]. / Lakritsiko kohonneen verenpaineen ja päänsäryn syynä?

Physicians are familiar with the effect on potassium metabolism of glycyrrhizine acid contained in licorice and salmiac. Even so, glycyrrhizine acid as the cause of even severe symptoms may escape attention, especially in an emergency situation. We describe a patient, who sought medical advice from an endocrinologist for recurrent, severe and symptomatic hypertension. After the patient had stopped eating salmiac and licorice, the headache that had persisted for years disappeared, fluctuations in weight stabilized and occasional edemas of the lower limbs vanished. Since the cessation of using licorice products normalized the blood pressure, it is likely that the patient had licorice-induced hypertension.

BRAF V600E mutation does not predict recurrence after long-term follow-up in TNM stage I or II papillary thyroid carcinoma patients.

The BRAF V600E mutation may serve as a marker of disease recurrence in well-differentiated papillary thyroid cancer (PTC). Our aim was to study if TNM stage I or II PTC patients, with and without recurrence after long-term follow-up would differ in BRAF status. BRAF status was retrospectively determined in tumour tissue from a cohort of low-risk PTC patients (n = 461) with and without recurrence after 16 years of follow-up. Initial treatment was total thyroidectomy (TTE) and radioiodine remnant ablation (RRA). Forty-six patients (9.9%) experienced disease recurrence. BRAF mutation was positive in 66% (17/26) of patients with and 68% (17/25) without recurrence (p = NS). Fifty per cent of BRAF positive and 53% of BRAF negative patients experienced disease recurrence (p = NS). Time to recurrence was 52 (range 18-144) and 36 (range 16-71) months, respectively (p = NS). Primary tumour size, nodal metastasis and local infiltration at presentation did not differ between BRAF positive and negative patients (2.0 vs 2.2 cm, 21% vs 35% and 6% vs 12%, respectively, all p = NS). Taken together, BRAF V600E is common in Finnish patients with low-risk PTC but does not predict recurrence after long-term follow-up after initial treatment with TTE and RRA.

Post-ablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma: a 16-year follow-up study.

OBJECTIVE: To study whether post-surgical and/or post-ablative thyroglobulin (Tg) concentrations may serve as independent predictors of disease recurrence in patients treated for TNM stage I or II well-differentiated thyroid carcinoma (WDTC). DESIGN: An observational retrospective study with a median follow-up of 16 years (range 10-24). PATIENTS AND MEASUREMENTS: Post-operative and post-ablative Tg concentrations, age, tumour size, local infiltration and nodal metastasis at primary surgery as well as disease recurrences and cancer-specific deaths were evaluated in 495 low-risk (TNM stages I and II) patients, the majority of whom had total thyroidectomy and radioactive iodine remnant ablation as initial treatment. RESULTS: Fifty-one patients (10.3%) experienced disease recurrence during follow-up. In multiple logistic regression analysis, post-ablative Tg concentrations (odds ratio (OR) 3.72, confidence interval (CI) 1.71-8.05, P=0.0009) and local infiltration on primary surgery (OR 2.66, CI 1.03-6.90, P=0.04) were the only independent predictors of recurrence. CONCLUSIONS: Post-ablative Tg concentration is a strong predictor of disease recurrence in WDTC.

Health-related quality of life in long-term follow-up of patients with cured TNM Stage I or II differentiated thyroid carcinoma.

OBJECTIVE: The purpose of this study was to assess the impact of cured low-risk differentiated thyroid carcinoma (DTC) on health-related quality of life (HRQoL) after long-term follow-up. DESIGN: A cross-sectional study including an age- and gender-standardized sample of the general population. PATIENTS AND METHODS: HRQoL was assessed by the 15D in 341 DTC patients, whose initial treatment for stage I or II DTC was performed 12.4 years (range 5-20) earlier. The results were compared to those of an age- and gender-standardized sample of the general population (n= 6001). Determinants of HRQoL in DTC patients were assessed by the Tobit model. RESULTS: Mean total 15D scores did not differ between patients and control subjects. In single dimensions, DTC patients were significantly worse off with regards to sleeping, speech and distress (P= 0.001, 0.002 and 0.012, respectively), but better off with regards to discomfort and symptoms (P < 0.001). Within the patient group, the only significant independent predictor of HRQoL was age at the time of the initial treatment (P < 0.001). CONCLUSIONS: After long-term follow-up, overall HRQoL in DTC patients is comparable to that of the general population. DTC patients demonstrate an age-related decline in HRQoL, similar to that seen in the population in general.

Long-term outcome of 495 TNM stage I or II patients with differentiated thyroid carcinoma followed up with neck ultrasonography and thyroglobulin measurements on T4 treatment.

OBJECTIVE: Recent guidelines for surveillance of patients with differentiated thyroid carcinoma emphasize TSH-stimulated serum thyroglobulin (Tg) measurements and neck ultrasonographies (US) over Tg measurements on T(4) and diagnostic whole body scans (DxWBS). We evaluated the safety and efficacy of a surveillance paradigm comprising yearly T(4)-suppressed Tg measurements and neck US every second year, with an increase in Tg to a detectable level being a prompt indication for DxWBS. DESIGN: A retrospective study with a median follow-up of 11.6 years. PATIENTS AND MEASUREMENTS: Recurrences, cancer-specific deaths and number of neck US, fine needle aspiration biopsies (FNABs) and operations performed were evaluated in 495 low-risk (TNM stage I and II) patients, the majority of whom had total thyroidectomy and radioactive iodine remnant ablation as initial treatment. RESULTS: Forty-four patients (8.9%) experienced a recurrence in the neck and one patient died. Recurrences were established histopathologically in 26 and by a new uptake in DxWBS in 16 cases. A combination of neck US and high Tg revealed 42 of 44 recurrences. Of 993 ultrasonographies, 149 led to FNAB and 28 FNABs to surgery. Serum Tg was elevated 173 times, indicating a recurrence in 23 patients. CONCLUSIONS: Although longer follow-up is still needed, monitoring low-risk differentiated thyroid carcinoma patients with neck US and T(4)-suppressed Tg appears to be safe, provided radioactive iodine remnant ablation has been given and a low-alarm threshold for Tg indicating further evaluation, is used. The number of additional studies caused by this surveillance paradigm was reasonable. DxWBS was helpful in selected cases. Comparative studies are warranted to show how much rhTSH-stimulation tests add to this surveillance scheme.