Multidisciplinary thyroid disease management in The Gambia: Results of a 6-year multinational collaboration
Bibliographic record
Abstract
Background Thyroid disease remains prevalent in West Africa, with pathogenetic contributions from dietary and genetic factors. Specialist services for the management of thyroid disease were previously unavailable at Serrekunda General Hospital, leaving a considerable unmet need at this large urban referral hospital in The Gambia. This study sought to document clinical characteristics and outcomes among patients attending a multidisciplinary, collaborative, 1-stop clinic offering surgical and medical management of thyroid disease in The Gambia. Methods We retrospectively evaluated demographic, clinical, and outcome data from patients with thyroid disease who were medically or surgically treated from March 2012 through January 2018 by visiting teams representing Medicos en Accion (MEA), a Canadian nonprofit organization. Variables evaluated included history of presenting concern, comorbidities, current medications, thyroid function status, surgical procedure, histopathology, and postoperative outcomes, including surgical complications. Patients were followed up at least biannually; long-term follow-up was defined as ≥1 year after thyroidectomy. A subset of surgical specimens underwent histopathologic analysis. Results A total of 352 patients were assessed (331 female; median age, 36 years). Primary diagnoses included toxic multinodular goitre (MNG, 30.6%), nontoxic MNG (37.5%), solitary nodule (8.6%), and Graves’ disease (13.8%). Hyperthyroidism was present in 49.2% of patients at initial assessments, yet only 28.5% of these patients were on appropriate medical therapy. Hypertension was found in 33.8% of all patients, but less than half (42.9%) of these were on treatment at presentation. Thyroidectomy was performed for 83 patients (23.6%): 35 total thyroidectomies and 48 partial thyroidectomies. At the end of a median follow-up duration of 12 months, all patients were disease-free with reference to their initial surgical indications. Serious postoperative complications occurred in 2 patients, both of whom recovered fully with no long-term sequelae. Conclusions This study demonstrated the feasibility of establishing a multidisciplinary thyroid clinic in a low-resource setting, leading to improved access to care and public awareness of thyroid disease, as evidenced by the annual increase in patients managed through the study period at Serrekunda General Hospital. These results provide previously unavailable evidence on the profile of thyroid disease in The Gambia.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".