Ultrasonographic predictors of thyroid cancer in Bethesda III and IV thyroid nodules.

Background: Bethesda III and IV thyroid nodules continue to be difficult to manage. Although molecular testing may assist in decision-making, it is expensive, not widely available, and not without pitfalls. The objective of this study is to assess whether certain thyroid ultrasonographic features may predict the risk of thyroid cancer in patients with Bethesda III and IV thyroid nodules and be used as additional decision-making tools to complement cytopathological results in deciding on diagnostic thyroidectomy. Methods: We retrospectively evaluated the ultrasonographic features of Bethesda categories III and IV thyroid nodules in patients who underwent subsequent thyroidectomy. We used the final histopathological examination of the surgical specimens as the gold-standard test and analyzed individual preoperative ultrasonographic features as predictors of malignancy. Results: Of the 278 patients who were diagnosed with Bethesda III and IV thyroid nodules on fine needle aspiration cytology (FNAC), 111 (39.9%) had thyroid cancer, and 167 (59.9%) exhibited benign nodules. The malignancy rate was higher in patients with Bethesda IV nodules (28/50, 56%) than those with Bethesda III nodules (83/228, 36.4%; p=0.016). In univariate analysis, hypoechogenicity (55.6% in malignant vs. 35.3% in benign, p=0.006) and calcifications (54.5 in malignant vs. 35.4% in benign, p=0.008) were significantly different between the benign and malignant pathology groups, whereas the size of the dominant nodule, number of nodules, irregular borders, taller-than-wide shape, and the presence of lymph nodes were comparable between the two groups. These two ultrasonographic features (hypoechogenicity and calcifications) remained significantly associated with the risk of malignancy in multivariate logistic regression analysis (for hypoechogenicity, p=0.014, odds ratio: 2.1, 95% CI:1.0-3.7 and for calcifications, p=0.019, odds ratio: 1.98, 95% CI:1.12-3.50). The sensitivity, specificity, positive and negative predictive values, and accuracy were 31.5%, 83%, 55.6%,64.7%, and 62.6%, for hypoechogenicity, respectively and 32.4%, 82%, 54.5%, 67.8%, and 62%, for calcification, respectively. Conclusions: Hypoechogenicity and calcifications in Bethesda III and IV thyroid nodules are strong predictors of thyroid cancer and associated with a two-fold increased risk of malignancy.

The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study.

BACKGROUND: Dizziness is a common presenting complaint to emergency departments (ED) worldwide, with causes ranging from benign to life-threatening incidents. Computerized tomography (CT) of the brain remains a common diagnostic tool used by emergency physicians; however, it appears to be of low diagnostic value, especially in patients with normal neurological assessment while carrying multiple negative implications on both the patients and the healthcare systems. Our study aims to evaluate the diagnostic value of brain CT scans in assessing patients presenting to the ED with acute dizziness. MATERIALS AND METHODS: Retrospective review of medical records of patients presenting with complaints of dizziness to the ED at Salmaniya Medical Complex (SMC) who underwent a brain CT scan from January to June 2023. Collected data included patients' demographic information, presenting complaints, and CT scan results. A multivariable analysis of factors associated with positive CT scans was performed. RESULTS: A total of 481 participants were enrolled in the study, representing diverse age groups as follows: 18-30 years (12.3%), 31-40 years (15.8%), 41-50 years (17.7%), 51-60 years (22.0%), and those aged over 60 years (32.2%). Among the participants, 56.3% identified as male and 43.7% as female. In terms of head trauma history, 7.1% of participants reported such incidents, while the majority (92.9%) had no history of head trauma. Exploring comorbidities, 43.5% of participants had at least one associated medical condition. Among the 481 study participants, brain CT scans revealed that the majority (93.1%) exhibited unremarkable results. The remaining cases exhibited acute events, including 5.4% with infarcts, 1.1% with hemorrhages, and 0.4% with space-occupying lesions. CONCLUSION: This study provides evidence of the limited value of brain CT scans in dizzy patients with unremarkable clinical examinations. As for clinicians, it can serve as a steppingstone toward the formulation of a policy and a set of guidelines for requesting brain CT scans in patients presenting to the ED with dizziness. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans in providing valuable findings.

Intravesical urachal cyst masquerading as a bladder malignancy: a case report.

BACKGROUND: Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a unique case of a urachal cyst masquerading as a bladder malignancy. Unlike the typical location of urachal cysts along the course of the urachal tract, the cyst in this case was unexpectedly situated within the urinary bladder, leading to diagnostic difficulties. CASE PRESENTATION: A 2-year-old Bahraini boy presented with hematuria and dysuria for 2 weeks. There was no history of fever, abdominal pain, or vomiting. Physical examination yielded normal findings. Urinalysis showed numerous red blood cells and revealed positive results for nitrites and leukocyte esterase. Abdominal ultrasound showed a well-defined soft tissue lesion with internal vascularity located at the apex of the urinary bladder. Subsequently, magnetic resonance imaging demonstrated a thick-walled cystic structure arising from the anterosuperior wall of the bladder and protruding into its lumen. The patient underwent complete excision of the bladder lesion for the presumed diagnosis of rhabdomyosarcoma. Histopathological examination showed a fluid-filled space lined by stratified squamous epithelium with areas of intestinal metaplasia, revealing an unexpected diagnosis of a urachal cyst. The patient was discharged with complete resolution of symptoms. CONCLUSIONS: Intravesical urachal cysts are a rare type of congenital urachal anomaly that may simulate a bladder malignancy, particularly if associated with infection. This case emphasizes the importance of considering urachal cysts in the differential diagnosis of bladder masses, especially in children, and specifically when the lesion is midline in the anterosuperior wall of the bladder.

Osteoporosis Among Bahraini Women Based on Bone Mineral Density Measurements: A Retrospective Study.

Objectives The objective is to estimate the prevalence of osteoporosis among women in Bahrain who are aged ≥18 years. Methods In this retrospective study conducted at Salmaniya Medical Complex, a total of 590 Bahraini women were enrolled. Their bone mineral density measurements were obtained through dual-energy x-ray absorptiometry (DEXA) performed between January 2017 and December 2017. Six sites were chosen as the measurement targets. Patients were diagnosed with osteoporosis if their T-score was > -2.5 according to the World Health Organization guidelines. Results Osteoporosis was diagnosed in 27.1% of the patients; 53.2% had osteopenia, 0.3% had severe osteoporosis, and 19.3% had normal bone conditions. The prevalence of osteopenia as well as osteoporosis increased with age. Conclusion Osteoporosis and osteopenia are common among Bahraini women. This study provides useful information on the prevalence of osteoporosis among Bahraini women. Major steps by health authorities in the country are needed to reduce morbidity and improve the quality of life.