Volume 2, Issue 3, 2024
Editorial
Controversies in Thyroid Surgery: Debating Transoral Endoscopic Thyroidectomy versus Small Incision Thyroidectomy
Zuhair Dahham Hammood
In the ever-evolving landscape of thyroid surgery, one cannot ignore the ongoing debate surrounding the optimal approach for thyroidectomy. minimally invasive thyroidectomy techniques have been developed. However, there is currently no single accepted technique in minimally invasive thyroidectomy (MIT) [1]. Proponents of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) advocate for its minimally invasive nature and favorable cosmetic outcomes [2]. Experienced thyroid surgeons performing thyroidectomy with an anterior incision, shortening the classic Kocher incision by 2-3 cm without the need for additional complex instruments with simple preparation and minimal costs, have obtained better cosmetic results compared to open surgery [1]. Supporters of open thyroidectomy with or without endoscopic assistance through a 3 to 4-cm incision (small incision thyroidectomy; SIT) argue that their approach achieves similar minimally invasive results while maintaining the safety and efficacy of traditional open surgery [3,4].
TOETVA has garnered attention for its innovative approach, utilizing a natural orifice—the mouth—as the entry point for thyroidectomy. Advocates of TOETVA highlight its cosmetic advantages, as the incisions are hidden within the oral cavity, resulting in virtually scarless necks. Furthermore, TOETVA offers reduced postoperative pain and faster recovery times than traditional open surgery, enhancing patient satisfaction and quality of life. Proponents argue that the evolution of TOETVA represents a paradigm shift in thyroid surgery, offering patients a less invasive alternative with comparable oncological outcomes [5]. Conversely, proponents of SIT through a 3 to 4-cm incision contend that their approach achieves similar minimally invasive results while preserving the safety and efficacy of traditional open surgery. They argue that the smaller incision size of open thyroidectomy minimizes tissue trauma and postoperative pain, leading to faster recovery times and superior cosmetic outcomes compared to larger incisions (Figure 1,2).
Moreover, advocates of SIT emphasize the importance of tactile feedback and direct visualization in ensuring optimal surgical outcomes, which may be compromised in endoscopic approaches such as TOETVA [2,3,5].
Among these contrasting viewpoints, it is essential to recognize that TOETVA and SIT have their respective strengths and limitations. While TOETVA offers the attraction of scarless necks and enhanced cosmetic outcomes, concerns remain regarding its learning curve and technical challenges, particularly in cases of large or multifocal thyroid tumors. Conversely, SIT boasts a long-standing safety and efficacy track record, with established surgical technique and perioperative care principles. However, its neck incision may be perceived as a drawback by patients seeking minimally invasive alternatives. Addressing these controversies requires understanding patient preferences, tumor characteristics, and surgeon expertise. Individualized decision-making is paramount, carefully considering the risks and benefits of each approach. Moreover, ongoing research and innovation are essential to refining surgical techniques and optimizing outcomes in thyroid surgery.
Original Articles
Assessment of Nursing Skill and Knowledge of ChatGPT, Gemini, Microsoft Copilot, and Llama: A Comparative Study
Dilan S. Hiwa, Sarhang Sedeeq Abdalla, Aso S. Muhialdeen, Hussein M. Hamasalih, Sanaa O. Karim
Introduction
Artificial intelligence (AI) has emerged as a transformative force in healthcare. This study assesses the performance of advanced AI systems—ChatGPT-3.5, Gemini, Microsoft Copilot, and Llama 2—in a comprehensive 100-question nursing competency examination. The objective is to gauge their potential contributions to nursing healthcare education and future potential implications.
Methods
The study tested four AI systems (ChatGPT 3.5, Gemini, Microsoft Copilot, Llama 2) with a 100-question nursing exam in February of 2024. A standardized protocol was employed to administer the examination, covering diverse nursing competencies. Questions derived from reputable clinical manuals ensured content reliability. The AI systems underwent evaluation based on accuracy rates.
Results
Microsoft Copilot demonstrated the highest accuracy at 84%, followed by ChatGPT 3.5 (77%), Gemini (75%), and Llama 2 (68%). None achieved complete accuracy on all questions. Each of the AI systems has answered at least one question that only they got correctly.
Conclusion
The variations in AI answers underscore the significance of selecting appropriate AI systems based on specific application requirements and domains, as no singular AI system consistently surpassed others in every aspect of nursing knowledge.
Viral Meningitis (Enterovirus) Outbreak in The Pediatric Population of Sulaymaniyah Governorate, Iraq: A Multi-Center Experience
Zana Baqi Najmadden, Khalid Hama Salih, Bakhtyar Qadr Hama khurshid, Soran M. Ahmed, Safeen O....
Introduction
Viral meningitis, often caused by enteroviruses in children, is prevalent globally but is difficult to distinguish from bacterial forms. Molecular testing like PCR is vital; however. This study investigates the characteristics of viral meningitis in pediatric patients during an outbreak in Sulaymaniyah Governorate, Iraq.
Methods
This is a multicentered prospective study that included children with a confirmed diagnosis of viral meningitis who have visited pediatric clinics throughout Sulaimani, Halabja, Kalar, and Ranya cities during the period from May 2023 to June 2023.
Results
In total, 116 cases were included, of whom 75 (64.7%) were male and had a mean age of 6.5 ± 3.2. Most were between the ages of 4-6 (38, 32.8%) and 7-12 years (55, 47.4%). Only 53.4% had contact with another patient. Common symptoms included fever (63.8%) and headache (62.1%). Lymphocyte predominance was observed in 46.6% of CSF samples. Upon molecular diagnosis, the inflammation in all of the cases was due to enterovirus infection. Most of the patients (75%) received empirical antibiotics. The average hospital stay was 10 days. While 95.7% of patients had no complications during recovery, a few experienced issues like weakness and malaise. All had good clinical outcomes.
Conclusion
The viral meningitis outbreak in Sulaymaniyah Governorate is caused by enterovirus, with epidemiological, clinical, and laboratory findings similar to that of the literature. The condition has resulted in a high prescription rate of empirical antibiotics due to late diagnosis.
CaReL Guidelines: A Consensus-Based Guideline on Case Reports and Literature Review (CaReL)
Sakshi Prasad, Mahmoud Nassar, Ahmed Y. Azzam, Francisco García-Muro-San José, Mahnaz Jamee,...
Introduction
Clinical case reports enrich medical literature by presenting rare medical issues. However, case reports that do not adhere to a standard template often lack rigor and limit their usefulness in clinical guidance. Several guidelines for reporting case reports have been structured, while further improvements are still required. The current guideline (CaReL) aims to enhance the comprehensiveness of case reports by integrating a detailed literature review.
Methods
In total, 56 researchers were selected based on specific publication criteria for structuring the guidelines. The guideline development was based on a two-step consensus process, including a literature review and survey distribution. Responses underwent scrutiny to ensure reliability and validity. Content validity was assessed, with revisions made to achieve a content validity index exceeding 0.78. The guideline's feasibility and effectiveness were evaluated by pilot testing, with feedback incorporated for finalization, ensuring the robustness and practicality of the guideline.
Results
The CaReL guidelines can improve the quality of case reports through a comprehensive checklist with an increased emphasis on literature review. In addition to traditional sections with their subsections discussed in previous guidelines, the checklist also focuses on literature review in the abstract and discussion.
Conclusion
The CaReL guidelines offer a comprehensive structure for documenting case reports. They highlight the importance of incorporating a literature review to better introduce medical issues to readers and scholars and embedding reported cases into the current scientific state of the art. Implementing these guidelines can promote knowledge sharing and improve patient care
Variation in Parameters of Complete Blood Count Using Ethylene Diamine Tetra Acetic Acid (EDTA), Sodium Citrate and Lithium Heparin: A Cross-Sectional Study
Sharaza Qadir Omer, Rawezh Q. Salih, Shvan Luqman Ezzat, Dahat A. Hussein, Ayman M. Mustafa, Aga...
Introduction
The primary anticoagulants utilized in hematology are ethylene diamine tetra acetic acid (EDTA), lithium heparin, and citrate. Although various studies have investigated their impact on complete blood count (CBC) in various animals, limited data are available concerning humans. This study explores the differences in CBC parameters when using these anticoagulants.
Methods
This study was a cross-sectional study comprising 250 participants who underwent CBC tests with different anticoagulants. Blood samples were examined using the Medonic M51. Statistical analyses, including one-way ANOVA, intra-class correlation coefficient, and concordance correlation coefficient, were employed as applicable, with significance level set at p-values <0.05.
Results
One hundred eight participants (43.2%) were male, and 142 (56.8%) were female, with a mean age of 40.88±17.06 years ranging from 7 to 91 years. Comparing K2EDTA with lithium heparin, comparable values were found in 14 out of 23(60.87%) CBC parameters, while citrate showed similar results in 13(56.52%) parameters. Using K2EDTA as the standard, citrate showed perfect or substantial agreement in assessing 9 out of 23 CBC parameters (39.13%). Similarly, Lithium heparin showed perfect or substantial agreement in determining 9 out of 23(39.13%) parameters. Compared to K2EDTA, lithium heparin exhibited high precision and accuracy in estimating 13 out of 23(56.52%) CBC parameters. In contrast, citrate was accurate in 9 out of 23(39.13%) parameters.
Conclusion
Using citrate instead of K2EDTA for CBC estimation may yield inaccurate outcomes, whereas lithium heparin could serve as an alternative anticoagulant, requiring careful monitoring.
Review Articles
Predatory Publishing Lists: A Review on the Ongoing Battle Against Fraudulent Actions
Hiwa O. Abdullah, Berun A. Abdalla, Fahmi H. Kakamad, Jafaar O. Ahmed, Hiwa O. Baba, Marwan N....
Predatory journals challenge the scholarly community by muddling the boundary between legitimate and dubious publishing practices. Despite the awareness of predatory publishers, there are no globally accepted criteria for identifying them. Various warning lists have emerged as predatory practices evolve, but they are not impervious to criticism despite their utility. This study reviewed the most common of the predatory lists. Beall's list, the pioneer in exposing predatory publishers, received criticism for its inclusion criteria. It is now anonymously managed and poorly updated. Cabells' list has a broad range of inclusion criteria; however, some have been criticized for redundancy and lack of alignment with predatory practices. Kscien's list shows promise as an alternative for spotting predatory journals and publishers. However, it requires refinement since the included journals, based on their core criteria, are not distinguished from those included using traditional criteria. The Early Warning List of International Journals is a recent compilation with diverse criteria. Despite attracting the scientific community's attention, there are questions about the reliability of its inclusion criteria. However, these lists are crucial in flagging predatory publishers; researchers can depend on them while preparing their manuscripts.
Efficacy of Sorafenib in the Management of Non-Small Cell Lung Cancer: A Systematic Review
Rebaz M. Ali, Sami S. Omar, Fahmi H. Kakamad, Diyar A. Omar, Yousif M. Mahmood, Mohammed Q....
Introduction
The current standard treatment approach for non-small cell lung cancer (NSCLC) is surgery. Recently, targeted therapy has emerged as a promising new treatment option. In this systematic review, the efficacy of sorafenib, when given alone or combined with erlotinib, in managing NSCLC is reviewed.
Methods
To identify English language studies published up to March 8th, 2024, the Google Scholar, CINAHL, PubMed/MEDLINE, Cochrane Library, Web of Science, and EMBASE databases were screened, and the data were assessed.
Results
The systematic search revealed 208 papers; however, only 10 were eligible to be included. The sample size was 1080 patients, of which 848 were in the sorafenib group, and 232 were in the sorafenib with erlotinib combination group. In the sorafenib group, the partial response was 2.4%, stable disease was reported in 25%, and 56 cases (6.6%) had progressive disease. In the combination group, partial response, stable disease, and progressive disease were 16.8%, 48.3%, and 19.8%, respectively. In the combination group, the median overall survival was 231 days, and the progression-free survival (PFS) was 141 days. However, in the sorafenib group, the median overall survival was 180 days, and the PFS was 82 days. Fatigue was the most common adverse event, reported in 325 (30.1%) patients. Among them, 235 cases (27.7%) were in the sorafenib group, and 90 cases (38.8%) were in the combination group.
Conclusion
Combination therapy may result in better overall survival and PFS than sorafenib alone, with slightly similar adverse events.
Hydatid Cysts of the Tongue: A Systematic Review of the Literature
Nawshad Muhammed, Gulmina Saeed Orakzai, Shamsul Hadi, Usman Ashraf, Tri Shaikh, Abul Khair...
Introduction
Hydatid cysts, caused by Echinococcus granulosus, typically affect the liver and lungs but can rarely occur in the tongue, hence presenting as a diagnostic challenge
Methods
This is a systematic review of the reports of hydatid cysts in the tongue up to April 2024, emphasizing diverse clinical presentations, diagnostic complexities, treatment modalities, and outcomes.
Results
Six cases of tongue hydatid cysts were reported in the literature, of whom three were male, two were female, and the gender of one patient was not determined. The patients were between 3 and 35 years old, with a mean age of 15 years. Only one case has hydatid cysts in the other organs, namely the liver and lung. Four cases were reported in developing countries. Clinical presentations varied, including tongue swelling, speech articulation difficulties, and swallowing impairments.
Conclusion
Hydatid cyst of the tongue has a possible endemic nature. It usually presents with painless tongue swelling. The primary management strategy is surgical excision, which has a favorable outcome.
Thyroid Collision Tumors: A Systematic Review
Ari M. Abdullah, Aras J. Qaradakhy, Rawa M. Ali, Rebaz M. Ali, Yousif M. Mahmood, Sami S. Omar,...
Introduction
Collision tumors in the thyroid gland are exceedingly uncommon, comprising approximately 1.0% of all thyroid malignancies. This study aims to systematically review the presentation and management of collision tumors of the thyroid gland.
Methods
A systematic review of published studies on thyroid collision tumors was conducted. All studies concerning thyroid collision tumors meeting the following criteria were included: 1) Confirmation of collision tumors via diagnostic methods, surgical exploration, or histopathological examination. 2) Presentation of case details within the study. 3) Tumors located precisely in the thyroid gland.
Results
In total, 57 studies were compatible with the inclusion criteria. Most cases were female 87 (71.31%), and the remaining 35 (28.69%) were male. The patients' ages were between 12 and 88 years old, with a mean of 49.87 ± 14.48 years. The most commonly presented symptom was neck swelling (45.08%). The most prevalent surgical procedure observed was total thyroidectomy combined with lymph node dissection, performed in 40 cases (32.78%). The predominant histopathological findings consisted of the simultaneous presence of papillary thyroid carcinoma and medullary thyroid carcinoma, identified in 51 cases (41.80%). The recurrence rate was observed in only 10 cases (8.20%).
Conclusion
Thyroid collision tumors may primarily affect females, with the most frequent collisions being papillary and medullary thyroid carcinoma. Total thyroidectomy with lymph node dissection is the prevalent management option, and the recurrence rate can be lower than 10%.
Effect of Sunitinib in the Management of Lung Cancer: A Systematic Review of Clinical Trials
Rebaz M. Ali, Sami S. Omar, Fahmi H. kakamad, Harem K. Ahmed, Diyar A. Omar, Yousif M. Mahmood,...
Introduction
Lung cancer is the most common cancer in terms of both incidence and mortality. Although usually managed with surgery, novel immunotherapies are gradually becoming more popular. The effect of sunitinib with and without erlotinib in the management of lung cancer is reviewed.
Methods
Eligible search engines and databases were screened to identify studies published in English. Any randomized clinical trials studying the effect of sunitinib, either alone or in combination with erlotinib, were included.
Results
Thirteen studies with a total sample size of 1,062 cases were included. Males (59.5%) were more common than females (40.5%), and the average age of patients was 64 ± 5.03. Most of the patients (71.5%) had a positive smoking status, and non-small cell carcinoma was the most common lung cancer type (95.4%). Almost all of the adverse events, such as headache (100%), weight loss (100%), constipation (100%), leukocytopenia (96%), pain (92.3%), hypertension (90%), dyspnea (88.7%), cough (84.3%), fatigue (81.6%), fever/chills (77.3%), thrombocytopenia (75%), nausea (73.8%), neutropenia (72%), anorexia (71.4%), vomiting (65.1%), anemia (61.3%), and diarrhea (54.5%) were more common in the sunitinib-only group. The mean overall survival for patients receiving sunitinib alone was 213 days, whereas, for patients receiving sunitinib combined with erlotinib, it was 270 days.
Conclusion
Adverse events may be encountered more frequently in treatment with sunitinib alone compared to the combination of sunitinib and erlotinib. However, sunitinib alone may result in higher disease stability and lower disease progression. Nevertheless, combination therapy may yield a longer median overall survival.
Role of Inflammatory Markers in Severity, ICU Admission, and Mortality in COVID-19: A Systematic Review and Meta-analysis of 79,934 Patients
Hiwa O. Abdullah, Sadraldin A. Braim, Maria A. Rasool, Dashne M. Abdalla, Dyari Q. Hamad, Daban...
Introduction
Despite extensive investigations into the roles of inflammatory biomarkers in the prognosis of COVID-19 through systematic reviews and meta-analyses, they are limited by small sample sizes and focus on a specific marker. This meta-analysis investigated the role of 11 inflammatory biomarkers in severity, intensive care unit (ICU) admission, and mortality among COVID-19 patients.
Methods
Studies up to October 25, 2023, were identified through a search of Google Scholar, limited to human studies published in English. Inclusion criteria required confirmed COVID-19 cases diagnosed via reliable laboratory methods, original articles from eligible journals, proper grouping of severity status, ICU admission, or mortality outcomes, and presentation of continuous data in mean and standard deviation, median with range, or interquartile range.
Results
A total of 241 studies, comprising 79,934 cases of COVID-19, were included in this study. Albumin levels significantly declined in severe, ICU, and dead cases compared to mild, moderate, non-ICU, and survived cases (p<0.001). C-reactive protein (CRP), D-dimer, erythrocyte sedimentation rate (ESR), ferritin, fibrinogen, Interleukin-6 (IL-6), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), procalcitonin, and white blood cell (WBC) were all significantly (p<0.001) increased and correlated with the severity of COVID-19. CRP, D-dimer, ferritin, fibrinogen, IL-6, LDH, NLR, procalcitonin, and WBC were all significantly (p<0.05) elevated and correlated with the risk of ICU admission (except fibrinogen) and mortality in COVID-19 in both fixed and random effects.
Conclusion
Inflammatory biomarkers like albumin, CRP, D-dimer, ferritin, IL-6, LDH, NLR, procalcitonin, and WBC all significantly impact severity status, ICU admission, and mortality in COVID-19.