Does Graves' Disease Truly Increase the Risk of Complications After Total Thyroidectomy?

INTRODUCTION: Total thyroidectomy (TTx) has been reported to be more challenging in patients with Graves' disease, especially in those who are hyperthyroid at the time of surgery. Our aim was to compare outcomes in patients undergoing TTx for Graves' disease compared to other thyroid diseases at a large academic institution with high-volume fellowship-trained endocrine surgeons. METHODS: In our retrospective analysis from December 2015 to May 2023, patients undergoing TTx for Graves' disease were compared to those undergoing TTx for all other indications excluding advanced malignancy (poorly differentiated thyroid cancer and concomitant neck dissections). Patient demographics, biochemical values, and postoperative outcomes were compared. A subgroup analysis was performed comparing hyperthyroid to euthyroid patients at the time of surgery. RESULTS: There were 589 patients who underwent TTx, of which 227 (38.5%) had Graves' disease compared to 362 (61.5%) without. Intraoperatively in Graves' patients, nerve monitoring was used more frequently (65.6% versus 57.1%; P = 0.04) and there was a higher rate of parathyroid autotransplantation (32.0% versus 14.4%; P < 0.01). Postoperatively, transient voice hoarseness occurred less frequently (4.8% versus 13.6%; P < 0.01) and there was no difference in temporary hypocalcemia rates or hematoma rates. In our subgroup analysis, 83 (36%) of Graves' patients were hyperthyroid (thyroid-stimulating hormone < 0.45 and free T4 > 1.64) at the time of surgery and there were no differences in postoperative complications compared to those who were euthyroid. CONCLUSIONS: At a high-volume endocrine surgery center, TTx for Graves' disease can be performed safely without significant differences in postoperative outcomes. Hyperthyroid patients demonstrated no differences in postoperative outcomes.

Racial and socioeconomic disparities in triple-negative breast cancer treatment.

INTRODUCTION: Triple-negative breast cancer (TNBC) continues to be a significant concern, especially among minority populations, where treatment disparities are notably pronounced. Addressing these disparities, especially among African American women and other minorities, is crucial for ensuring equitable healthcare. AREAS COVERED: This review delves into the continuum of TNBC treatment, noting that the standard of care, previously restricted to chemotherapy, has now expanded due to emerging clinical trial results. With advances like PARP inhibitors, immunotherapy, and antibody-drug conjugates, a more personalized treatment approach is on the horizon. The review highlights innovative interventions tailored for minorities, such as utilizing technology like text messaging, smartphone apps, and targeted radio programming, coupled with church-based behavioral interventions. EXPERT OPINION: Addressing TNBC treatment disparities demands a multifaceted approach, blending advanced medical treatments with culturally sensitive community outreach. The potential of technology, especially in the realm of promoting health awareness, is yet to be fully harnessed. As the field progresses, understanding and integrating the socio-economic, biological, and access-related challenges faced by minorities will be pivotal for achieving health equity in TNBC care.

Feasibility of an Online Patient-Driven International Parathyroid Registry.

INTRODUCTION: Traditional parathyroid registries are labor-intensive and do not always capture long-term follow-up data. This study aimed to develop a patient-driven international parathyroid registry and leverage community connections to improve patient-centered care for hyperparathyroidism. METHODS: An anonymous voluntary online survey was developed using Qualtrics and posted in an international patient and advocate-run social media group affiliated with over 11,700 members. The survey was developed from a literature review, expert opinion, and discussion with the social media group managers. It consists of seven sections: patient demographics, past medical history, preoperative symptoms, laboratory evaluation, preoperative imaging studies, operative findings, and operative outcomes. RESULTS: From July 30, 2022, to October 1, 2022, 89 complete responses were received. Participants were from 12 countries, mostly (82.0%) from the United States across 31 states. Most participants were female (91.4%), White (96.7%) with a mean (±standard deviation) age of 58 ± 12 y. The most common preoperative symptoms were bone or joint pain (84.3%) and neuropsychiatric symptoms: including fatigue (82.0%), brain fog (79.8%), memory loss (79.8%), and difficulty with concentration (75.3%). The median (interquartile range) length from symptom onset to diagnosis was 40.0 (6.8-100.5) mo. Seventy-one percent of participants had elevated preoperative serum calcium, and 73.2% had elevated preoperative parathyroid hormone. All participants obtained preoperative imaging studies (88.4% ultrasound, 86.0% sestabimi scan, and 45.3% computed tomography). Among them, 48.8% of participants received two, and 34.9% had three imaging studies. The median (interquartile range) time from diagnosis to surgical intervention was 3 (2-9) mo. Twenty-two percent of participants traveled to different cities for surgical intervention. Forty-seven percent of participants underwent outpatient parathyroidectomy. Eighty-four percent of participants reported improved symptoms after parathyroidectomy, 12.4% required oral calcium supplementation for more than 6 mo, 32.6% experienced transient hoarseness after parathyroidectomy, and 14.6% required reoperation after initial parathyroidectomy. CONCLUSIONS: This international online parathyroid registry provides a valuable collection of patient-entered clinical outcomes. The high number of responses over 10 wk demonstrates that participants were willing to be involved in research on their disease. The creation of this registry allows global participation and is feasible for future studies in hyperparathyroidism.

LinkedIn Usage Trends Among Surgeons at a Large Academic Institute.

INTRODUCTION: Social networking platforms have evolved into a self-promotional space. The LinkedIn platform allows users to share knowledge, research accomplishments, and network in an academic setting. Our objective was to determine LinkedIn usage trends among surgeons at a large academic institution. METHODS: A list of surgeons within the department of surgery at a large academic institute was compiled. All publicly available profiles were analyzed for their LinkedIn activity and followership. Active accounts were defined as users who have posted or interacted with any posts within the last year. Comparisons of LinkedIn usage grouped by gender, surgery division, and rank were analyzed. RESULTS: A total of 133 surgeons were included. Among these surgeons, 88 had a LinkedIn profile (66.2%); however, only 43 surgeons had active usage on this platform (32.3%). The median number of followers among surgeons with a profile was 110 (IQR [24-427]). Male surgeons had a higher median of followers (167 IQR [38-502]) compared to female (54 IQR [21-209]). A greater percentage of male surgeons had a profile compared to female surgeons (68.5% M versus 61.0% F, P = 0.12). The transplant surgery division had the highest percentage of LinkedIn accounts (90.9%) followed by surgical oncology (87.5%). However, active usage was led by the pediatric surgery division (80.0%), followed by the plastic surgery division (71.4%). Instructors, assistant professors, associate professors, and professors all had LinkedIn accounts; however, instructors were the least active users with 33.3% being active on their LinkedIn. The lowest percentage of those with LinkedIn accounts were instructors (50%). Professors were found to be the most active users at 57.1%. CONCLUSIONS: Social media use is on the rise in academic surgery. Within a department of surgery at a large academic institution, only 32.3% were active users of LinkedIn, suggesting that there is room for improvement in utilizing this resource as a tool for mentorship, professional development, and networking.

Surgical Treatment of Hyperthyroidism Can Be Performed Safely Before a Euthyroid State is Achieved.

Background: The 2016 American Thyroid Association guidelines recommend that hyperthyroid patients should be euthyroid before thyroidectomy. This recommendation is based on low-quality evidence. In this retrospective cohort study, we compare peri- and post-operative outcomes of patients with hyperthyroidism who were controlled versus uncontrolled at the time of thyroidectomy. Methods: A retrospective cohort study was performed on 275 hyperthyroidism patients at a single institution from December 2015 to November 2022. Patients were defined as hyperthyroid if they had a diagnosis of hyperthyroidism with at least one suppressed thyrotropin (TSH). Patients were considered uncontrolled if triiodothyronine or thyroxine (T4) was elevated immediately before surgery. Patient demographics, perioperative data, and postoperative outcomes were compared with Chi-square and Wilcoxon Rank Sum tests, as appropriate. Results: Of the 275 patients, 84.3% were women and 51.3% were uncontrolled at time of surgery. Controlled patients had higher median [interquartile range] TSH (0.4 [0.0, 2.4] mIU/L vs. 0.0 [0.0, 0.0] mIU/L, p < 0.001) and lower free T4 (fT4) (0.9 [0.7, 1.1] ng/dL vs. 3.1 [1.9, 4.4] ng/dL, p < 0.001), respectively. Uncontrolled patients were more likely to be diagnosed with Grave's disease (85.1% vs. 67.9%, p < 0.001) and to undergo surgery due to medication intolerance (12.1% vs. 6%) or history of thyroid storm (6.4% vs. 1.5%) (p = 0.008). Uncontrolled patients were also more likely to take a larger number of preoperative medications (2.3 vs. 1.4, p < 0.001). No patient in either group experienced thyroid storm precipitated by surgery. Controlled patients had shorter operative times (7.3% vs. 19.8% <1 hour, p < 0.014) and decreased median estimated blood loss (15.0 [5.0, 30.0] mL vs. 20.0 [10.0, 50.0] mL, p = 0.002). Both groups experienced similar, low rates of postoperative complications, apart from an increase in temporary hypocalcemia in the uncontrolled group (13.4% vs. 4.7%, p = 0.013). Conclusion: Our study is the largest to date examining the postoperative outcomes of patients with uncontrolled hyperthyroidism who undergo thyroidectomy. Our results affirm that thyroidectomy in actively thyrotoxic patients is safe and will not precipitate thyroid storm.

Is COVID-19 pushing us to the Fifth Industrial Revolution (Society 5.0)?

The coronavirus disease 2019 (COVID-19) pandemic may further promote the development of Industry 4.0 leading to the fifth industrial revolution (Society 5.0). Industry 4.0 technology such as Big Data (BD) and Artificial Intelligence (AI) may lead to a personalized system of healthcare in Pakistan. The final bridge between humans and machines is Society 5.0, also known as the super-smart society that employs AI in healthcare manufacturing and logistics. In this communication, we review various Industry 4.0 and Society 5.0 technologies including robotics and AI being inspected to control the rate of transmission of COVID-19 globally. We demonstrate the applicability of advanced information technologies including AI, BD, and Information of Technology (IoT) to healthcare. Lastly, we discuss the evolution of Industry 4.0 to Society 5.0 given the impact of the COVID-19 pandemic in accordance with the technological strategies being considered and employed.

Exploring the Potential of Artificial Intelligence and Machine Learning to Combat COVID-19 and Existing Opportunities for LMIC: A Scoping Review.

BACKGROUND: In the face of the current time-sensitive COVID-19 pandemic, the limited capacity of healthcare systems resulted in an emerging need to develop newer methods to control the spread of the pandemic. Artificial Intelligence (AI), and Machine Learning (ML) have a vast potential to exponentially optimize health care research. The use of AI-driven tools in LMIC can help in eradicating health inequalities and decrease the burden on health systems. METHODS: The literature search for this Scoping review was conducted through the PubMed database using keywords: COVID-19, Artificial Intelligence (AI), Machine Learning (ML), and Low Middle-Income Countries (LMIC). Forty-three articles were identified and screened for eligibility and 13 were included in the final review. All the items of this Scoping review are reported using guidelines for PRISMA extension for scoping reviews (PRISMA-ScR). RESULTS: Results were synthesized and reported under 4 themes. (a) The need of AI during this pandemic: AI can assist to increase the speed and accuracy of identification of cases and through data mining to deal with the health crisis efficiently, (b) Utility of AI in COVID-19 screening, contact tracing, and diagnosis: Efficacy for virus detection can a be increased by deploying the smart city data network using terminal tracking system along-with prediction of future outbreaks, (c) Use of AI in COVID-19 patient monitoring and drug development: A Deep learning system provides valuable information regarding protein structures associated with COVID-19 which could be utilized for vaccine formulation, and (d) AI beyond COVID-19 and opportunities for Low-Middle Income Countries (LMIC): There is a lack of financial, material, and human resources in LMIC, AI can minimize the workload on human labor and help in analyzing vast medical data, potentiating predictive and preventive healthcare. CONCLUSION: AI-based tools can be a game-changer for diagnosis, treatment, and management of COVID-19 patients with the potential to reshape the future of healthcare in LMIC.

Knowledge and Attitude of General Pakistani Population Towards Antibiotic Resistance.

Introduction The emergence and continuous spread of drug resistant bacteria has become one of the leading health concerns globally. Persistent failure to develop and/or discover new antibiotics along with irrational use of existing antibiotics is associated with rise in antibiotic resistance. There is poor understanding of antibiotics usage and their preciousness among the masses which result in careless utilization and hence, the emerging antibiotic resistance. The aim of this study is to evaluate the knowledge and attitude of Pakistanis towards antimicrobial resistance (AMR). Methods This observational cross-sectional survey was designed in the form of an online pro forma circulated in January 2019. It was a self-structured pro forma which included age, gender, and 10 questions - five to assess the knowledge and five to assess the attitude towards AMR. Each question was to be responded with a "Yes" or a "No." For knowledge assessing questions "do not know" was also an option. Data was entered and analysed using SPSS version 22 (IBM Corp., Armonk, NY). Results Of 1,132 participants, 837 (73.9%) thought that it was alright to stop antibiotics course whenever they felt better, 505 (44.6%) thought that frequent and unnecessary use of antibiotics actually decrease their effectiveness, and 208 (18.4%) participants thought it was correct to take antibiotics for cold and influenza. There were 157 (13.9%) participants who had not followed the duration of treatment as given in their doctor's prescription, 49 (4.4%) who had changed their antibiotic dose without doctor consultation, 467 (41.3%) who had reused leftover antibiotics from their previous prescription, 700 (61.8%) who had suggested it to their doctors to prescribe them antibiotics and 378 (33.4%) participants who had purchased antibiotics without any prescription in the last one year. Conclusion Pakistani individuals are not as knowledgeable about antibiotic resistance as severe the issue is in this region. Their attitude towards utilization of antibiotics is not very promising. It becomes essential to initiate antibiotic stewardship programs and educate the masses regarding efficacious and safe use of antibiotics in this region.