Search

Introduction: Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow‐up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases. Methods: The integrated laboratory management system retrieved the thyroid FNACs from 2010 to 2018 and subsequent surgical pathology specimens. For the AUS/FLUS cases, data regarding patient demographics, cytology and histological diagnoses were recorded. The results were tabulated as the overall frequency of AUS/FLUS in thyroid FNACs, cytohistological correlation (benign and malignant) and ROM. Results: Over a period of 9 years, 256 (10.9%) cases out of 2342 thyroid FNACs were reported as AUS/FLUS at our institution. Mean age was 43.5 years. The majority (70.3%) of patients were female. Seventy‐two of 104 resection specimens (69.2%) were reported as benign and 32 cases (30.7%) had malignant diagnosis. Upper‐bound ROM was 30.7% (32 cases with malignant diagnosis out of 104 resection specimens). Lower‐bound ROM was calculated as 12.5% (32 cases with malignant diagnosis out of 256 total AUS diagnosis). Conclusion: The AUS/FLUS category of thyroid cytology and associated ROM remain an evolving area. Individual institutions should monitor the frequency and include ROM in the dashboard indicators to remain within the recommended range. This study describes the frequency of AUS/FLUS in thyroid gland fine needle aspiration cytology in a single institute in Pakistan and correlates this with the surgical outcomes of these cases. All institutions should monitor their performance and aim to be within the recommended range. [ABSTRACT FROM AUTHOR]

Carbapenem resistance in Pseudomonas aeruginosa is a major concern in the public health sector, primarily in developing countries such as Pakistan. Therefore, novel approaches such as Silver nanoparticles (AgNPs) can be used to address emerging concerns. Clinical isolates (n=200) were reconfirmed using selective media and API 20NE kit. The antibiogram was determined according to the CLSI 2016 guidelines. Molecular detection was carried out by PCR. Antibacterial activity in AgNPs was achieved by dilution method. Of 200 P. aeruginosa, mostly (n=82; 41%) were isolated from pus samples. Of 110 MDR P. aeruginosa, 70 (63%) were carbapenemase and 58 (52%) were MBL producers. Antimicrobial profile of MBL producing P. aeruginosa reported that all isolates were resistant to β-lactams, and 89% to levofloxacin and ciprofloxacin except colistin. Of 25 (35.7%) blaNDM producing P. aeruginosa, 12 isolates (48%) had MIC 16μg/mL to imipenem. Of 23 (32%) blaVIM producing P. aeruginosa, 12 (52%) contained MIC 16μg/mL to imipenem. However, 12 (17.1%) blaOXA-48 producing P. aeruginosa, 4 (33%) contained MIC 16μg/mL to imipenem. In vitro AgNPs activity inhibited and killed MBL producing isolates at 1 mg/mL and 2 mg/mL, respectively. AgNPs may be used as an alternative therapy followed by multiple clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: To find relationship of baseline Hemoglobin A1c (HbA1c) with visual outcomes, central macular thickness and number of intravitreal Bevacizumab at 12 months in patients with diabetic macular edema (DME). Study Design: Quasi experimental study. Place and Duration of Study: Prevention of blindness (POB) Hospital, Karachi, Pakistan between October 2018 and September 2019. Material and Methods: Two hundred and eighty patients with Diabetic macular edema (DME) presenting to the eye OPD of POB, who did not receive any treatment for DME were recruited. Patients who had concurrent retinal disease and were treated with intravitreal injections and/or laser were excluded. All patients were evaluated with history, ophthalmological examination and SD-OCT for central subfield macular thickness. Patients received 3 intravitreal injections of Bevacizumab one month apart. OCT was done after 3 months and retreatment for diabetic macular edema was based on the persistence of macular thickness more than 300 microns. All the data was analyzed using SPSS version 20. Results: There were 280 patients, 53.2% were males and 46.8% were females. Patients were divided into 3 groups; patients with HbA1C < 7.0, 7.1 - 8.0 and > 8.0. Central macular thickness decreased significantly from baseline in all 3 groups. Maximum vision improvement was seen in group 1 with HbA1C < 7.0 and group 2 with 7.1 - 8.0. Significant inverse correlation was seen between HbA1C and vision at 12 months (r = - 0.40, p < 0.01) and positive correlation with central macular thickness (r = 0.53 p < 0.01). Conclusion: Initial baseline HbA1C is strongly related with visual and anatomic outcome at 12 months. [ABSTRACT FROM AUTHOR]

Metallo-β-lactamases (MBLs) producing Pseudomonas aeruginosa are major threat for public health. They produce resistance against various antibiotics and remain low or no therapeutic options. A total of 200 clinical isolates of P. aeruginosa were collected from tertiary care hospital, Faisalabad. Isolates were sub-cultured on basic and selective media and confirmed by API 20NE. Phenotypic detection of carbapenamase, MBLs, antibiogram and MIC were determined as per CLSI guidelines. Molecular detection of blaVIM was performed using specific primers by PCR. Among 200 P. aeruginosa, majority (n=82) were isolated from pus samples followed by 28 from tracheal aspirates and 27 from sputum. Out of 110 (55%) MDR P. aeruginosa, 12 (11%) were positive for MHT and MBLs and blaVIM was identified in MBL positive isolates. Antibiogram revealed that all the isolates were resistant to β-lactam drugs including carbapenems followed by 95% to levofloxacin, 67% to doxycycline and more effective drugs were tigecycline and colistin. MIC value for imipenem drug was 16μg/mL and 8μg/mL against 6 and 5 isolates respectively while MIC value for meropenem against 6 and 3 isolates were 8μg/mL and 16μg/mL respectively. Our study concluded the high prevalence of blaVIM producing P. aeruginosa in our clinical settings. [ABSTRACT FROM AUTHOR]

Carbapenem resistance in Pseudomonas aeruginosa is a major concern in the public health sector, primarily in developing countries such as Pakistan. Therefore, novel approaches such as Silver nanoparticles (AgNPs) can be used to address emerging concerns. Clinical isolates (n=200) were reconfirmed using selective media and API 20NE kit. The antibiogram was determined according to the CLSI 2016 guidelines. Molecular detection was carried out by PCR. Antibacterial activity in AgNPs was achieved by dilution method. Of 200 P. aeruginosa, mostly (n=82; 41%) were isolated from pus samples. Of 110 MDR P. aeruginosa, 70 (63%) were carbapenemase and 58 (52%) were MBL producers. Antimicrobial profile of MBL producing P. aeruginosa reported that all isolates were resistant to β-lactams, and 89% to levofloxacin and ciprofloxacin except colistin. Of 25 (35.7%) blaNDM producing P. aeruginosa, 12 isolates (48%) had MIC 16μg/mL to imipenem. Of 23 (32%) blaVIM producing P. aeruginosa, 12 (52%) contained MIC 16μg/mL to imipenem. However, 12 (17.1%) bla OXA-48 producing P. aeruginosa, 4 (33%) contained MIC 16μg/mL to imipenem. In vitro AgNPs activity inhibited and killed MBL producing isolates at 1 mg/mL and 2 mg/mL, respectively. AgNPs may be used as an alternative therapy followed by multiple clinical trials.

Metallo-β-lactamases (MBLs) producing Pseudomonas aeruginosa are major threat for public health. They produce resistance against various antibiotics and remain low or no therapeutic options. A total of 200 clinical isolates of P. aeruginosa were collected from tertiary care hospital, Faisalabad. Isolates were sub-cultured on basic and selective media and confirmed by API 20NE. Phenotypic detection of carbapenamase, MBLs, antibiogram and MIC were determined as per CLSI guidelines. Molecular detection of blaVIM was performed using specific primers by PCR. Among 200 P. aeruginosa, majority (n=82) were isolated from pus samples followed by 28 from tracheal aspirates and 27 from sputum. Out of 110 (55%) MDR P. aeruginosa, 12 (11%) were positive for MHT and MBLs and blaVIM was identified in MBL positive isolates. Antibiogram revealed that all the isolates were resistant to β-lactam drugs including carbapenems followed by 95% to levofloxacin, 67% to doxycycline and more effective drugs were tigecycline and colistin. MIC value for imipenem drug was 16μg/mL and 8μg/mL against 6 and 5 isolates respectively while MIC value for meropenem against 6 and 3 isolates were 8μg/mL and 16μg/mL respectively. Our study concluded the high prevalence of blaVIM producing P. aeruginosa in our clinical settings.