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Context Radiofrequency ablation (RFA) is used in the United States to treat benign thyroid nodules; however, experience with treating cervical recurrence/persistence of papillary thyroid cancer (PTC) is limited. Objective To evaluate the efficacy RFA for the treatment of cervical recurrence/persistence of PTC in the United States. Methods This is a retrospective, multicenter study of 8 patients who underwent RFA of 11 cervical metastatic PTC lesions between July 2020 and December 2021. The volume reduction (VR) of the lesions, thyroglobulin (Tg) levels and complications following RFA were assessed. Energy applied per unit volume (E/V) during RFA was also determined. Results Nine out of 11 (81.8%) lesions had initial volume under 0.5 ml and showed a complete (n = 8) or near complete (n = 1) response. The two lesions with initial volume over 1.1 ml had a partial response; one of which had regrowth. There was a median VR of 100% (range: 56.3–100%) after a median follow-up period of 453 days (range: 162–570 days), with corresponding decline in Tg levels from a median of 0.7 ng/ml (range: 0–15.2 ng/ml) to a median of 0.3 ng/ml (range: 0–1.3 ng/ml). All patients with an E/V of at least 4483 J/ml or higher had a complete or near complete response. There were no complications. Conclusion RFA performed in an endocrinology practice is an efficacious treatment option for selected patients with cervical metastases of PTC, particularly those who cannot or do not want to undergo further surgery.

Objective: To assess factors affecting disease awareness in diabetics, and its association with glycemic control. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from Jan to Apr 2019. Methodology: Outdoor patients with type-II diabetes mellitus were selected using a consecutive sampling technique. Disease awareness was assessed with a modified Diabetes Knowledge Questionnaire, with scores >70% considered satisfactory. Recent HbA1c levels were used to determine glycemic control (

Objective: To document overall adherence to haemodialysis, medications, fluid restriction and dietary prescription in patients with end-stage renal disease and to study factors that could predict poor adherence. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi, from Jul to Sep 2018. Methodology: Adult patients on haemodialysis for at least three months were selected using consecutive sampling technique. Patients with acute kidney injury, patients on haemodialysis for less than 3 months, those on infrequent haemodialysis and unwilling patients were excluded. Demographic data was recorded. Adherence to management was assessed by administering End Stage Renal Disease Adherence Questionnaire in direct face- to-face interviews. Results: There were a total of 101 patients having a mean age of 51.05 ± 13.80 years. Median haemodialysis vintage was 9 months (interquartile range 3-24 months). Mean adherence scores were 970.54 ± 149.43. Mean perception scores were 7.22 ± 1.37. Only 49 (48.51%) patients had good adherence, whereas 52 (51.49%) had poor adherence to management. Increasing age was associated with poor adherence (β=-0.038; Odds Ratio=0.963, 95% CI 0.928- 1.000, p=0.048). No other demographic parameter could predict poor adherence. Conclusion: Non-adherence to different aspects of management plan was a significant problem, more so in younger patients.

Bernard Soulier Syndrome is a genetically inherited platelet disorder that commonly presents with symptoms of impaired blood coagulation, such as epistaxis, menorrhagia, and petechiae formation. Here we present a case of Bernard Soulier Syndrome in which the individual has presented with melena, which is the appearance of black tarry stools due to bleeding from the upper gastrointestinal tract. This presentation is rare and should be discussed so that appearance of the less common symptoms can be caught early, leading to an early diagnosis and consequently earlier and more effective management options.

A history of systemic lupus and discontinuation of medications for 3 months led to increased disease activity.

Objective To determine if radiofrequency ablation (RFA) performed by endocrinologists for recurrent thyroid cancer in the neck is a treatment option in the outpatient community setting in the USA. Methods A review of 9 patients with 12 recurrent thyroid cancer lesions in the neck who were treated with RFA was conducted (July 2020 to November 2021). Recurrence was defined as biochemical and structural identification of disease. Recurrence was confirmed with ultrasound guided fine needle aspiration (US-FNA) cytology and measurement of thyroglobulin (Tg) washout concentration in cases of papillary thyroid cancer (PTC) and calcitonin washout concentration in medullary thyroid cancer (MTC). Informed consent was obtained. RFA was done in the outpatient setting with standard aseptic techniques, conscious sedation, and local anesthesia. Real time US imaging was used to perform hydro-dissection and a limited "moving shot" technique with a medial to lateral approach. Node volume in mL (length x depth x width×0.525) and tumor markers were recorded before at 6 to 12 weeks and at 6 months (m) after RFA. The volume reduction percentage (VRP) for each nodule was calculated using the following equation: VRP = {[baseline volume in mL - final volume in mL]/baseline volume in mL}×100 A VRP of more than 50% was considered a significant response, and VRP of 100% was considered complete response. Results A total of 9 patients with 12 nodes were included in the study. 7 patients had nodal recurrence of PTC in the neck. RFA was recommended for 1 patient as palliative treatment while on treatment with chemotherapy. 1 patient had recurrent MTC. There were no serious complications. 6 m data was unavailable for 2 patients. 9 of 10 (90%) nodes for which data is available had a volume decrease of at least 50% at 6 m. The only patient without at least a partial response to therapy was on chemotherapy. 4 of the 10 (40%) metastatic nodes of papillary thyroid cancer had a complete response. Mean volume reduction for all lesions at 6 mos was 0.339 mL, P = 0. 012. Median change in Tg level at 6 months was 0.4 IU/ml with a downward trend in 4/5 (80%) of patients with recurrent papillary thyroid cancer who were not receiving chemotherapy. Discussion Complete response may be expected in about 40% of patients after RFA at 6 m, however, this may potentially be improved with extended follow up time or multiple RFA sessions. Patients who are not surgical candidates, refuse surgery, or require palliative treatment may be potential candidates for this procedure. Therefore, RFA appears to be a viable treatment option in selected patients with recurrent thyroid carcinoma. Presentation: No date and time listed