ROLE OF SONOELASTOGRAPHY IN THE EVALUATION OF THYROID NODULES

Thyroid nodular disease is one of the most common endocrine disorder. B mode ultrasound provides useful characteristic information about thyroid nodules but it has noticeably low accuracy to differentiate benign from malignant. Fine needle aspiration is widely been used in differentiation of benign and malignant thyroid nodules but it is an invasive procedure. Sonoelastography is a newly developed non- invasive technique which uses ultrasound and gives information about the stiffness of tissue. It estimates the hardness of thyroid lesions in association with adjacent tissues and assists in the differentiation of benign from malignant nodules.Objective:The objective of this study was to evaluate the role sonoelastography in the evaluation of thyroid nodules. Methods:This study was conducted on 72 Patients of age between 18-80 years of either gender at Institute of Nuclear Medicine and Oncology Lahore (INMOL) Pakistan, from 25 March 2019 to 23 August 2019 for duration of five months. Elastography was performed using Toshiba Aplio 500.  Patient having one or more solid nodules in thyroid on conventional ultrasound examination were included in the study and the sonoelastography of nodules was confirmed with histopathological findings of nodules. Results: A total 72 participants were included in our study. The mean age of participants was 42.11 years. Gender distribution shows that 51.4% (n=37) were male and 48.6% (n=35) were female. Sonoelastographic strain ratio of 55.6% nodules (n=40) was more than 2.1(malignant feature) and 44.4% nodules (n=32) have less than 2.1 (benign). Histopathology showed 56.9% of participants (n=41) have malignant nodules and 43.1% (n=31) have benign nodules. The comparison of sonoelastography and histopathology in reference with nodules shows that the results of histopathology and sonoelastography were same and support each other. Conclusion: Sonoelastography is non-invasive and cost-effective imaging technique to diagnose thyroid nodules either benign or malignant. Keywords: Ultrasound Elastography, Thyroid Nodules, Benign, Malignant, Fine Needle Aspiration. DOI: 10.7176/JHMN/66-08 Publication date:September 30th 201

Clinical manifestations of active tuberculosis patients coinfected with severe acute respiratory syndrome coronavirus-2

Summary background: The coronavirus 2019 pandemic was caused by a new single-strand RNA virus that originated from Wuhan, China, and infected more than 190 countries. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) coinfection with tuberculosis posed a serious public health concern and complicated the prognosis and treatment of patients. Since both are respiratory diseases, the sign and symptoms may overlap and could have synergistic effects on the host that can increase mortality during coinfection. The present investigation reported the clinical characteristics of patients having coinfection of COVID-19 and tuberculosis (COVID-TB). Methods: We performed a retrospective investigation on COVID-19 infection in tuberculosis patients between the years 2020 and 2021. The SARS-CoV-2 was confirmed by PCR and the COVID-TB epidemiological and clinical findings were recorded on the day of admission and followed up for 25 days. Results: The mean age of the COVID-19 patients was 50 ± 15 years, 76.36% were male and 23.64% were female. Weight loss, sore throat, whooping cough, chest pain, and vomiting were common symptoms, and asthma, diabetes, arthritis, and hypertension were found as co-morbidities in COVID-TB. The D-dimer, lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate, and creatine kinase levels increased 14-fold, 12.5-fold, 11-fold, 10-fold, and 7-fold respectively during COVID-TB. The patients suffered from hyperferritinemia and lymphocytopenia which increased the likelihood of death. The levels of D-dimer, lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate, and creatinine kinase were positively correlated with patient age. The chest radiograph showed the infectious agents have consolidated opacity and peripheral dissemination in the lungs. Conclusion: Tuberculosis coinfection augmented the severity of COVID-19 and the likelihood of death, and high vigilance is recommended for respiratory pathogens in COVID-19

Study on awareness, knowledge, and practices towards antibiotic use among the educated and uneducated people of Khyber Pakhtunkhwa Province, Pakistan

Introduction: Antimicrobial resistance developed through the inadequate use of antibiotics; is an overriding task for global public health. Objective: To explore awareness, knowledge, and practices, and compare the elements associated with antibiotic misuse in different University students and uneducated people of Khyber Pakhtunkhwa Province, Pakistan. Methods: Cross-sectional study was conducted from July to December 2020 using a validated questionnaire. Data were collected from eleven different university students and uneducated people of Khyber Pakhtunkhwa, Pakistan. Results: 3,600 questionnaires were completed, consisting of 56.9% Male and 43.0% Female. 1,999 (55.5%) of the antibiotic users reported through the survey used non-prescription antibiotics within a one-month study period. Out of the participants, 230 (6.3%) were uneducated or their education level was below matric rest were university students. 1999 (55.5%) reported buying Antibiotics with Medical Prescription. Most self-medicated participants (56.9%) stop taking antibiotics when they feel better. More than 90% of the respondents answered that doctors and pharmacist staff do not guide them well that how to use antibiotics. 2,171 (60.03%) respondents mistakenly believed that antibiotics improve restoration from coughs and colds. Only 720 (20%) respondents knew that antibiotics also disturb normal flora and 547 participants (15.9%) agree that unnecessary use of antibiotics causes bacterial resistance. Conclusion: Finding from this study may have important implications for public health policy in Khyber Pakhtunkhwa, Pakistan given the growing global resistance to antibiotics and the reported health issues related to their improper use

High-Molecular-Weight Dextran-Type Exopolysaccharide Produced by the Novel <i>Apilactobacillus waqarii</i> Improves Metabolic Syndrome: In Vitro and In Vivo Analyses

Metabolic syndrome is a leading medical concern that affects one billion people worldwide. Metabolic syndrome is defined by a clustering of risk factors that predispose an individual to cardiovascular disease, diabetes and stroke. In recent years, the apparent role of the gut microbiota in metabolic syndrome has drawn attention to microbiome-engineered therapeutics. Specifically, lactic acid bacteria (LAB) harbors beneficial metabolic characteristics, including the production of exopolysaccharides and other microbial byproducts. We recently isolated a novel fructophilic lactic acid bacterium (FLAB), Apilactobacillus waqarii strain HBW1, from honeybee gut and found it produces a dextran-type exopolysaccharide (EPS). The objective of this study was to explore the therapeutic potential of the new dextran in relation to metabolic syndrome. Findings revealed the dextran’s ability to improve the viability of damaged HT-29 intestinal epithelial cells and exhibit antioxidant properties. In vivo analyses demonstrated reductions in body weight gain and serum cholesterol levels in mice supplemented with the dextran, compared to control (5% and 17.2%, respectively). Additionally, blood glucose levels decreased by 16.26% following dextran supplementation, while increasing by 15.2% in non-treated mice. Overall, this study displays biotherapeutic potential of a novel EPS to improve metabolic syndrome and its individual components, warranting further investigation

Image_1_Teicoplanin associated gene tcaA inactivation increases persister cell formation in Staphylococcus aureus.JPEG

Staphylococcus aureus is part of normal human flora and is widely associated with hospital-acquired bacteremia. S. aureus has shown a diverse array of resistance to environmental stresses and antibiotics. Methicillin-resistant S. aureus (MRSA) is on the high priority list of new antibiotics discovery and glycopeptides are considered the last drug of choice against MRSA. S. aureus has developed resistance against glycopeptides and the emergence of vancomycin-intermediate-resistant, vancomycin-resistant, and teicoplanin-resistant strains is globally reported. Teicoplanin-associated genes tcaR-tcaA-tcaB (tcaRAB) is known as the S. aureus glycopeptide resistance operon that is associated with glycopeptide resistance. Here, for the first time, the role of tcaRAB in S. aureus persister cells formation, and ΔtcaA dependent persisters’ ability to resuscitate the bacterial population was explored. We recovered a clinical strain of MRSA from a COVID-19 patient which showed a high level of resistance to teicoplanin, vancomycin, and methicillin. Whole genome RNA sequencing revealed that the tcaRAB operon expression was altered followed by high expression of glyS and sgtB. The RNA-seq data revealed a significant decrease in tcaA (p = 0.008) and tcaB (p = 0.04) expression while tcaR was not significantly altered. We knocked down tcaA, tcaB, and tcaR using CRISPR-dCas9 and the results showed that when tcaA was suppressed by dCas9, a significant increase was witnessed in persister cells while tcaB suppression did not induce persistence. The results were further evaluated by creating a tcaA mutant that showed ΔtcaA formed a significant increase in persisters in comparison to the wild type. Based on our findings, we concluded that tcaA is the gene that increases persister cells and glycopeptide resistance and could be a potential therapeutic target in S. aureus.</p