Comparison of TI-RADS classification with FNAC for the Diagnosis of Thyroid Nodules

Background: Thyroid nodules are very common and its prevalence is largely dependent on the identification techniques. Recently high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. This study aimed to determine the efficacy of TI-RADS classification and its association with FNAC findings in thyroid lesions. Material and Methods: This prospective study was carried out in the Department of Radiology of Islamabad Diagnostic Centre, Islamabad for a period of 6 months from 6th January 2018 to 6th July, 2018. All male and female patients presenting with thyroid nodules were selected for the study. Ultrasound neck was performed with high frequency linear probes. Ultrasonography findings were classified according to Thyroid Imaging Reporting and Data System (TI-RADS) classification, as defined by Horvath et al. Patients with TI-RADS II-V were scheduled for US-guided Fine Needle Aspiration (FNA). All the specimens were sent to pathology laboratory for cytology (FNAC). Results: Total 123 patients of thyroid nodules were studied. Mean age of the patients was 45.78 ± 13.11 years, with a female predominance (73.2%). A significant association was seen between TI-RADS classification of thyroid nodules and findings on cytology. Thyroid nodules with TI-RADS II, III and IV a classification showed benign cytological findings, while TI-RADS class V had a significant association with malignant findings on cytology (P=0.001). Conclusions: TI-RADS classification is a reliable modality in differentiating benign thyroid nodules from malignant ones and circumvent the need for FNAC in every case with a thyroid nodule

Design, synthesis, characterization and computational docking studies of novel sulfonamide derivatives

This study reports three novel sulfonamide derivatives 4-Chloro-N-[(4-methylphenyl) sulphonyl]-N-propyl ben- zamide (1A), N-(2-hydroxyphenyl)-4-methyl benzene sulfonamide (1B) and 4-methyl-N-(2-nitrophenyl) ben- zene sulfonamide (1C). The compounds were synthesised from starting material 4-methylbenzenesulfonyl chlo- ride and their structure was studied through 1H-NMR and 13C-NMR spectra. Computational docking was per- formed to estimate their binding energy against bacterial p-amino benzoic acid (PABA) receptor, the dihydrop- teroate synthase (DHPS). The derivatives were tested in vitro for their antimicrobial activity against Gram+ and Gram- bacteria including E. coli, B. subtilis, B. licheniformis and B. linen. 1A was found active only against B. linen; 1B was effective against E. coli, B. subtilis and B. linen whereas 1C showed activity against E. coli, B. li- cheniformis and B. linen. 1C showed maximum activity with minimum inhibitory concentration (MIC) of 50, 100 and 150 µg/mL against E. coli, B. licheniformis and B. linen respectively. 1C exhibited maximum affinity to DHPS with binding free energy of -8.1 kcal/mol. It enriched in the top 0.5 % of a library of 7663 compounds, ranked in order of their binding affinity against DHPS. 1C was followed by 1B which showed a moderate to low level MIC of 100, 250 and 150 µg/mL against E. coli, B. subtilis and B. linen respectively, whereas 1A showed a moderate level MIC of 100 µg/mL but only agai st B. linen. These derivatives may thus serve as potential anti-bacterial alternatives against resistant pathogens

Frenectomy Using Diode Lasers: A Case Report

OBJECTIVES Lasers are used in almost every aspect of dentistry, be it surgeries, restorations, periodontal procedures, and even aesthetic dentistry. One certain area that requires extra emphasis and importance is the laser-assisted frenectomy. Frenectomy, as the name suggests, is the excision of frenum attachment to the underlying bone. Frenectomy is carried out in the mandible as well as the maxilla. This is a case of a patient undergoing orthodontic treatment who also required a frenectomy, and to minimize the postoperative pain and swelling, the procedure was carried out using a diode laser rather than the conventional surgical procedure

Excision of a Chronic Inflammatory Mass Using Diode Lasers: A Case Report

Photobiomodulation (PBM), also known as low level laser therapy (LLLT) or cold laser therapy uses light energy to elicit biological responses from the cell and help regulate cell function. From a clinical point of view PBM offers dental practitioners a non-invasive treatment modality that can be used as an adjunct to the traditional therapies or as a therapeutic tool on its own. This is a case of surgical excision of a fluctuant mass using a scalpel and diode laser 980nm wavelength

Adamantane-1-thio­amide

The title compound, C11H17NS, is an important inter­mediate for the synthesis of biologically active adamantlythia­zolo-oxadiazo­les. The adamantyl residue is disordered about a twofold rotation axis over two sites with site-occupation factors of 0.817 (3) and 0.183 (3). The crystal structure is stabilized by inter­molecular N—H⋯S hydrogen-bonding inter­actions

Coagulation Profile in Diabetes and Its Association with Diabetic Microvascular Complications

Objective: To investigate the hemostatic parameters and to assess their relationship with microvascular complications in patients with type-2 diabetes mellitus. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: Patients with type-2 diabetes aged 40-70 years of both genders were included. We included sixty subjects with diabetes and sixty healthy individuals. HBA1c, prothrombin time, activated partial thrombin time, and fibrinogen levels were measured in both groups, and retinal photographs were taken. Results: The platelet count was in the normal range for both groups but significantly lower in cases compared to controls (177.5±18.3 vs 231.2±18.1, p<0.001). Similarly, the mean fibrinogen level was significantly higher among cases compared to controls (298.2±11.4 vs 256.6±6.5, p<0.001). No significant difference was found between mean prothrombin time and activated partial thromboplastin time among the groups. Most complicated cases belonged to the group with more than 7% glycosylated haemoglobin compared to non-complicated cases (p<0.001). A significant association between the level of HBA1c and diabetic retinopathy was found. Conclusion: The study showed that with a rise in glycemic index, the coagulation profile derangement occurs, with an increase in fibrinogen levels, decrease in platelets count and increase in microvascular complications

The Molecular Organization of Human cGMP Specific Phosphodiesterase 6 (PDE6): Structural Implications of Somatic Mutations in Cancer and Retinitis Pigmentosa.

In the cyclic guanosine monophosphate (cGMP) signaling pathway, phosphodiesterase 6 (PDE6) maintains a critical balance of the intracellular concentration of cGMP by catalyzing it to 5' guanosine monophosphate (5'-GMP). To gain insight into the mechanistic impacts of the PDE6 somatic mutations that are implicated in cancer and retinitis pigmentosa, we first defined the structure and organization of the human PDE6 heterodimer using computational comparative modelling. Each subunit of PDE6αβ possesses three domains connected through long α-helices. The heterodimer model indicates that the two chains are likely related by a pseudo two-fold axis. The N-terminal region of each subunit is comprised of two allosteric cGMP-binding domains (Gaf-A & Gaf-B), oriented in the same way and interacting with the catalytic domain present at the C-terminal in a way that would allow the allosteric cGMP-binding domains to influence catalytic activity. Subsequently, we applied an integrated knowledge-driven in silico mutation analysis approach to understand the structural and functional implications of experimentally identified mutations that cause various cancers and retinitis pigmentosa, as well as computational saturation mutagenesis of the dimer interface and cGMP-binding residues of both Gaf-A, and the catalytic domains. We studied the impact of mutations on the stability of PDE6αβ structure, subunit-interfaces and Gaf-cGMP interactions. Further, we discussed the changes in interatomic interactions of mutations that are destabilizing in Gaf-A (R93L, V141 M, F162 L), catalytic domain (D600N, F742 L, F776 L) and at the dimer interface (F426A, F248G, F424 N). This study establishes a possible link of change in PDE6αβ structural stability to the experimentally observed disease phenotypes

The Impact of the COVID-19 Pandemic on Pregnant Women with Perinatal Anxiety Symptoms in Pakistan: A Qualitative Study

The impact of coronavirus disease 2019 (COVID-19) on people with existing mental health conditions is likely to be high. We explored the consequences of the pandemic on women of lower socioeconomic status with prenatal anxiety symptoms living in urban Rawalpindi, Pakistan. This qualitative study was embedded within an ongoing randomized controlled trial of psychosocial intervention for prenatal anxiety at a public hospital in Rawalpindi. The participants were women with symptoms of anxiety who had received or were receiving the intervention. In total, 27 interviews were conducted; 13 women were in their third trimester of pregnancy, and 14 were in their postnatal period. The data were collected through in-depth interviews and analyzed using framework analysis. Key findings were that during the pandemic, women experienced increased perinatal anxiety that was linked to greater financial problems, uncertainties over availability of appropriate obstetric healthcare, and a lack of trust in health professionals. Women experienced increased levels of fear for their own and their baby’s health and safety, especially due to fear of infection. COVID-19 appears to have contributed to symptoms of anxiety in women already predisposed to anxiety in the prenatal period. Efforts to address women’s heightened anxiety due to the pandemic are likely to have public health benefits.</jats:p

The antibacterial activity of acetic acid against biofilm-producing pathogens of relevance to burns patients

Introduction: Localised infections, and burn wound sepsis are key concerns in the treatment of burns patients, and prevention of colonisation largely relies on biocides. Acetic acid has been shown to have good antibacterial activity against various planktonic organisms, however data is limited on efficacy, and few studies have been performed on biofilms. Objectives: We sought to investigate the antibacterial activity of acetic acid against important burn wound colonising organisms growing planktonically and as biofilms. Methods: Laboratory experiments were performed to test the ability of acetic acid to inhibit growth of pathogens, inhibit the formation of biofilms, and eradicate pre-formed biofilms. Results: Twenty-nine isolates of common wound-infecting pathogens were tested. Acetic acid was antibacterial against planktonic growth, with an minimum inhibitory concentration of 0.16-0.31% for all isolates, and was also able to prevent formation of biofilms (at 0.31 %). Eradication of mature biofilms was observed for all isolates after three hours of exposure. Conclusions: This study provides evidence that acetic acid can inhibit growth of key burn wound pathogens when used at very dilute concentrations. Owing to current concerns of the reducing efficacy of systemic antibiotics, this novel biocide application offers great promise as a cheap and effective measure to treat infections in burns patients

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely