Exophytic and fungating papillary thyroid carcinoma: A rare and complex presentation of a well-differentiated malignancy

@#Papillary thyroid carcinoma is the most common well-differentiated thyroid malignancy accounting for more than 80 to 90% of all thyroid tumors. It has an overall excellent prognosis owing to advances in screening via imaging and ultrasound-guided fine-needle aspiration biopsy, which have facilitated early detection, diagnosis, and surgical treatment followed by adjuvant radioactive iodine therapy. Exceptionally rare cases of papillary thyroid tumors may present with enormous growth due to delayed consultation and, thus, late diagnosis, posing a challenge to definitive management, quality of life, overall survival, and prognosis. We report a case of a 35-year-old woman who presented with a 4-year history of a bleeding exophytic and fungating anterior neck mass. Computed tomography showed a fungating mass arising from the left thyroid lobe that measured 14.1 x 14.0 x 11.1 cm with areas of necrosis and hemorrhage, left internal jugular vein thrombus formation, and compression of the left internal carotid artery. The mass causes a displacement of the trachea to the right side and multiple bilateral cervical lymphadenopathies. The patient was fully aware, and she consented to undergo wide excision, total thyroidectomy, neck dissection, and pectoralis major muscle flap reconstruction. However, she went into arrest intraoperatively attributed to massive pulmonary embolism. Papillary thyroid cancer is well known for its excellent prognosis. However, outcomes may not be favorable and can even be fatal in advanced and extensive cases. Although fungating papillary cancers are rare, they remain more common in the developing countries, where early detection and access to healthcare remains limited. They also represent a big challenge to surgeons. Even if the outcome was not good, we opted to report this case as there were many learning points. If only patients with good and excellent outcomes are reported in the literature, it will overestimate the treatment success of these complex cases.

Evaluation of an arnis-based exercise program for community-dwelling older adults in the Philippines: An exploratory study protocol

BACKGROUND@#Arnis is the national martial art of the Philippines. Similar to Tai Chi, a martial art with established therapeutic effects, it can improve the balance control of older adults. However, no study has been conducted to prove this.@*OBJECTIVE@#This study aims to design and evaluate an Arnisbased exercise program to improve the static and dynamic balance control of community-dwelling Filipino older adults@*METHODOLOGY@#: A qualitative exploratory study will be conducted. An Arnis-based exercise program for older adults will be age-appropriately designed and video-recorded by the researchers. A heterogeneous group of resource persons composed of a Physical Therapist, Geriatrician, Sports Scientist, Arnis Expert, and Senior Citizen will be invited to watch the videos and evaluate the exercise program. Using the Delphi method and semi-structured interviews via the different online meeting platforms, they will provide feedback and comments about the exercise program based on their unique professional background, experience, and perspective. Thematic analysis will be employed in examining the gathered information. The modification of the exercise program and additional rounds of validation and feedback from the resource persons will be conducted as necessary until consensus is achieved@*EXPECTED RESULTS@#This will produce an alternative and culturally relevant exercise program that can be implemented by physical therapists and other health professionals caring for older adults in improving their balance control to reduce their risk of falling.

A case report on cerebrogenic fatal cardiac arrhythmia in a patient with acute ischemic stroke

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Patients with acute ischemic stroke are susceptible  to  cardiac  arrhythmias  however,fatal arrhythmias  are  rare  in  the  absence  of  cardiac  disease.Cardiac arrhythmias can develop in lesions at the right side of the brain specifically the insular,frontal and parietal area.Data that show the direct relationship of ischemic stroke and arrhythmia are scarce but they are indirectly attributed to an imbalance in the autonomic nervous system.This paper aims to present a rare case of an association between a fatal arrhythmia and right thalamic infarct.   <br /><strong>CASE:</strong> Presenting a case of a 39-year-old admitted as a survivor of sudden cardiac death from ventricular fibrillation.She presented with a history of left sided weakness a week prior but no work-up was done. Baseline serum electrolytes and  cardiac markers were all normal.Electrocardiogram (ECG) post-cardioversion showed sinus tachycardia.Echocardiogram   and cardiac computed tomography (CT) angiography were normal.  Magnetic resonance imaging (MRI) and angiography (MRA) of the brain showed an acute infarct at the right thalamus and an absent left internal carotid artery (ICA).Electroencephalogram (EEG) was negative.Bisoprolol was given and an Automatic Implantable Cardioverter Defibrillator (AICD) was subsequently placed.No recurrence of cardiac arrhythmia was noted on continuous cardiac telemetry monitoring during her hospitalization and on six months of follow-up.<br /><strong>CONCLUSION:</strong> Fatal cardiac arrhythmias, can occur in patients with  acute  thalamic  infarct  even  beyond  24  hours  in  the presence of other confounding factors despite the absence of cardiac pathology. This case showed the association of heightened  autonomic  imbalance  caused  by  an  acute stroke, decreased cerebral flow, and fatal arrhythmia. This elucidates the importance of cardiac monitoring in acute ischemic stroke. With the paucity of information on serious cardiac arrhythmia and ischemic stroke, a future study on this correlation will be useful.</p>