Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule

ABSTRACT Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. Materials and methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Soluble L-selectin, vascular endothelial growth factor and endothelin-1 in patients with ulcerative colitis

Recent evidence increasingly suggests that ulcerative colitis [UC] is the result of dysfunctional immunoregulation manifested by an inappropriate production of mucosal cytokines. An abnormal microcirculatory system has also been implicated in its pathogenesis. The objective of this study was to assessed serum concentrations of soluble L-selectin [sL-selectin] and vascular endothelial growth factor [VEGF] and the plasma level of endothelin-1[ET-1] in the patients with UC, compared with healthy controls, and to analyze the results depending on the stage of the disease. This study was conducted on two groups of subjects, the patient group including 30 patients with active ulcerative colitis [UC], and the control group which included 15 healthy volunteers. We assessed serum sL-selectin, VEGF and Plasma ET-1 Level at the beginning of the study in patients and controls then measured again in patients after remission. The levels of sL-selectin, VEGF, and ET-1 were significantly higher in active UC than those in the controls [p < 0.001]. But in remission there was no significant difference between UC patients and controls in VEGF and ET-1 levels. We also found that serum Level of sL-selectin, VEGF, and Plasma Level of ET-1 were significantly higher in patients with active UC compared with patients in remission [p < 0.001]. In addition, it is shown that UC patients in remission have significantly lower levels of sL-selectin than controls. There was a significant positive correlation among the serum levels of VEGF and the plasma level of ET-1; that is, elevated VEGF, and ET-1 levels correlated well with each other in active UC patients [r= 0.631, p < 0.001]. The most common form of the disease observed in our patient population was of mild to moderate severity. Pro-inflammatory cytokines, including sL-selectin, VEGF, and ET-1 appear to play a significant role in the pathogenesis of ulcerative colitis [UC]. Their levels were higher during exacerbation while it is low in periods of remission in UC patients

Long- term cardiac sequelae in patients with initial isolated rheumatic arthritis: a study of 100 patients in Alexandria, Egypt

The study was undertaken to assess the risk of development of rheumatic heart disease [RHD] in patients with initial isolated rheumatic arthritis [RA] and to identify the risk factors behind it. Clinical data of 100 patients with initial RA, who met the revised Jones criteria for acute rheumatic fever [ARF], diagnosed at the Alexandria University Children's Hospital, and their diagnoses dated back at least one year were retrospectively reviewed. Age at diagnosis was 7.9 +/- 3.29 years [mean +/- SD, range 3-16 years]. Echocardiographic findings at the initial episode were obtained from the hospital charts. The average duration of follow up of our patients was 7.5 +/- 4.42 years [range 1-21 years], and age at the time of enrollment was 15.4 +/- 5.09 years [mean +/- SD, range 7-31 years]. Complete clinical and echocardiographic examinations were done for all patients to detect the presence and severity of cardiac involvement [if any]. Our results showed that 23 patients had got one or more recurrences during the period of follow-up with a total of 39 episodes of recurrent rheumatic activity. Migratory polyarthritis constituted 66.7% of these episodes, carditis 17.9%, and 15.4% were in the form of chorea. Twelve of the 23 patients had definite valve lesions, although 6 of them did not experience carditis during recurrences. Seventeen patients had no clinical evidence of recurrent rheumatic activity, still developed RHD. So, a total of 29 of our patients [29%] developed RHD at the end of follow- up period. About 60% of them developed RHD within the first 5 years of the acute episode. Mitral regurgitation was the commonest valve lesion. Echo proved to be of great value in detecting cases with abnormal valve regurgitation in the absence of clinically audible murmur [silent murmur]. Patients with initial isolated RA should be carefully monitored, undergone frequent echo examinations for early detection of valve lesion which will influence the prognosis of these patients. Development of RHD in these patients should be considered while deciding the duration of secondary prophylaxis in these patients