Sonographic Evaluation of Endometrial Thickness in Postmenopausal Women- A Systemic Review

Postmenopausal bleeding (PMB) is highly suspicious of being a sign for the presence of endometrial cancer (EC) and around 5–12% of PMB results from EC. Endometrial cancer is the most common gynecologic malignancy in developed countries. A thin endometrium (≤4 mm) has a very high negative predictive value (99%). A thickened endometrium has been regarded as an indication for an invasive evaluation. Endometrial sampling is recommended, with a cutoff value of 4 mm or 5 mm, for symptomatic postmenopausal women. However, different guidelines use different cut-off values of endometrial thickness, varying from 3 mm-5 mm, for excluding endometrial malignancy. The widespread use of sonography has also allowed the incidental finding of endometrial thickening in asymptomatic postmenopausal women. There are few data on the workup of these women, and the best cut-off value for the endometrial thickness that should warrant endometrial sampling is not known. However, it has been suggested that the 4‐ or 5‐mm limits generally used for excluding malignancy in symptomatic postmenopausal women are not transferable to asymptomatic patients. The objective of this study was to sonographic evaluation of endometrial thickness in postmenopausal women. About 9 studies were selected for this systemic review. We extracted the following information: Study design, Age of patient mean and range, Duration of menopause mean and range, Body mass index mean and range, and Endometrial thickness mean and range. From the above analysis we concluded that, the endometrial thickness with a recommended change in the cut-off to 3mm in routine ultrasound practice should be done in high risk women to detect malignancy earlier in postmenopausal women and ultrasound is proved to be a useful tool for the disgnostic purpose. Keywords: Postmenopausal bleeding, Endometrial  thickness, Endometrial Carcinoma. DOI: 10.7176/JHMN/82-04 Publication date: November 30th 202

Antibiotics, Acid and Heat Tolerance of Honey adapted Escherichia coli, Salmonella Typhi and Klebsiella pneumoniae

The medicinal importance of honey has been known for many decades due to its antimicrobial properties against life-threatening bacteria. However, previous studies revealed that microorganisms are able to develop adaptations after continuous exposure to antimicrobial compounds. The present study was conducted to explore the impact of subinhibitory concentrations of branded honey (Marhaba) and unbranded honey (extracted from Ziziphus mauritiana plant) locally available in Pakistan on Escherichia coli ATCC 10536, Salmonella Typhi and Klebsiella pneumoniae by investigating the development of self- or cross-resistance to antibiotics (gentamicin, kanamycin and imipenem). Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of autoclaved honeys were determined. The bacterial cells of E. coli ATCC 10536, S. Typhi and K. pneumoniae were subjected to honey adaptation by exposing to ¼ × MIC (4 passages) and ½ × MIC (4 passages) of both honeys. Moreover, tolerance to low pH and high temperature was also studied in adapted and unadapted cells. The decreasing trend in growth pattern (OD600nm) of E. coli ATCC 10536, S. Typhi and K. pneumoniae was observed with increases in the concentration of honeys (6.25–50% v/v) respectively. Our results showed that continuous exposure of both honeys did not lead to the development of any self- or cross-resistance in tested bacteria. However, percent survival to low pH was found to be significantly higher in adapted cells as compared to unadapted cells. The results indicate that both branded honey (Marhaba) and unbranded honey (extracted from Ziziphus mauritiana plant) were effective in controlling the growth of tested pathogenic bacteria. However, the emergence of tolerance to adverse conditions (pH 2.5, temperature 60 °C) deserves further investigation before proposing honey as a better antibacterial agent in food fabrication/processing, where low pH and high temperatures are usually implemented