Lugol's Iodine Research Articles

P-71219659-1343 - Use of Lugol's Iodine as a Tool for Preliminary Oral Biopsies

P-71219659-1343 - Use of Lugol's Iodine as a Tool for Preliminary Oral Biopsies

Contrast-Enhanced Micro-CT Imaging of Murine Mandibles: A Multi-Method Approach for Simultaneous Hard and Soft Tissue Analysis.

To develop and evaluate a novel multi-method micro-computed tomography (μCT) imaging protocol for enhanced visualization of both hard and soft tissues in murine mandibles, addressing the limitations of traditional imaging techniques in dental research. We employed a contrast-enhanced (CE) μCT imaging technique using Lugol's iodine as a contrast agent to visualize the intricate structures of murine mandibles. The protocol involved the combination of conventional μCT imaging as well as CE-μCT, including decalcification with EDTA, allowing for simultaneous assessment of hard and soft tissues. The method is compared with standard imaging modalities, and the ability to visualize detailed anatomical features is discussed. The CE-μCT imaging technique provided superior visualization of murine mandibular structures, including dental pulp, periodontal ligaments and the surrounding soft tissues, along with conventional μCT imaging of alveolar bone and teeth. This method revealed detailed anatomical features with high specificity and contrast, surpassing traditional imaging approaches. Our findings demonstrate the potential of CE-μCT imaging with Lugol's iodine as a powerful tool for dental research. This technique offers a comprehensive view of the murine mandible, facilitating advanced studies in tissue engineering, dental pathology and the development of dental materials.

The evaluation of the Theraputic Effect of Aqueous Extract of Aloe Vera on Entamoeba histolytica in Vivo

Ameobiasis caused by Entameoba spp. It is a zoonotic disease that is the most prevalent. Thus, the study was conducted to evaluate the anti-ameobiasis efficacy of aqueous Aloe vera extracts in comparison with metronidazole in laboratory mice. Stool samples were collected from patients attending in Al-karamah teching Hospital suffering from diarrhea from November 1, 2022 to February 29, 2023, and 15samples were examined for both sexes microscopic by using the lugols iodine Stain to detect infected the parasite's cysts , Isolation and purification by flotation with normal solution and preserved in potassium dichromate for the purpose of using it in causing infection in laboratory mice. The experimental study was conducted on groups of 35 mice by oral administration of parasite cysts within the range of 95 cyst / ml except for the negative control group that was drenched with physiological saline. The feces of mice inoculated with cysts of parasites were microscopically examined using the modified lugols iodine Stain, After the mice were divided into seven groups with the uninfected and untreated group kept as a healthy negative control. The first group which included 21 mice was treated after it was divided into three subgroups A, B, C for each secondary group 7 mice they were treated with aqueous extract of A.vera at different concentrations 50, 100, 150 mg/ml on the respectively, while the second group which included 21 mice on three groups A, B, and C was treated with aqueous extract of A.vera at the previous concentrations for three consecutive days for each concentration. The third group was treated with metronidazole at a concentration of mg/ ml, and the positive control group remained infected with the parasite and was not treated. After treatment a microscopic examination was performed by evaluating the excretion average of parasite cysts using a hematocytometer slide. There was a decrease in the shedding of fecal cysts in the groups treated with aqueous extract at different concentrations, reaching a complete stop when treating with the highest concentrations at the end of the treatment period. Where, the average of shedding of fecal parasite cysts of groups of mice at concentrations 50, 100, 150 mg/ml reached 18.20, 0.200, 0 cyst/ml respectively. while the avrage of shedding of cysts in the group treated with metronidazole reached 60.20 cyst/ml in comparison with the infected positive control group in which the number of cysts continued to increase to 14.863 cyst/ml at the end of the treatment period. The results of the therapeutic efficacy of A.vera extract showed percentages of 82%, 90%, 100% for the aqueous extract at concentrations 50, 100, 150 mg/ml, respectively, while the therapeutic efficacy of metranidazol reached 84% at the end of the treatment period

Ventricular activation pattern of left ventricular septal pacing in a canine model.

Left bundle branch pacing (LBBP) is a feasible and effective physiological pacing technique. The QRS morphology of left ventricular septal pacing (LVSP) is similar to that of LBBP. The ventricular activation pattern of LBBP is well-known, whereas the pattern of LVSP still needs further investigation. The present study aimed to determine ventricular activation pattern difference between LVSP and LBBP in a canine model. All six canines underwent successful LBBP and LVSP through trans-ventricular septum using intracardiac echocardiography and intracardiac electrogram. Their hearts were isolated and stained with Lugol's iodine to determine the position of the pacing lead. The activation sequences of the left ventricular myocardium and His-Purkinje system were recorded by placing multiple electrode catheters. First, the left His-Purkinje system in LVSP was activated simultaneously from apical and basal regions to the left ventricular middle septal region, whereas the left ventricular septal myocardium was activated from the apical to basal region. The left His-Purkinje system activation in LBBP occurred in the direction of the apex from the pacing lead, but the left ventricular septal myocardium was activated in the apical to basal direction. Furthermore, the left intraventricular electrical synchrony was similar between LVSP and LBBP as determined by mapping the left ventricular septal to free wall activation time (46.7 ± 1.8ms vs. 45.0 ± 1.4ms, p = 0.11). The ventricular activation sequence of LVSP was similar to LBBP. LVSP can capture LBB due to the wide distribution of LBB. These findings suggest a rationale for clinical application of LVSP.

Investigating the pro-inflammatory differentiation of macrophages with bacterial ghosts in potential infection control.

In the complex realm of bacterial infections, particularly those caused by Staphylococcus aureus (S. aureus), macrophages play a pivotal role in orchestrating the immune response. During the initial stages of infection, the monocytes give rise to macrophages with a pro-inflammatory (M1 type) behaviour, engulfing and neutralizing the invading pathogens. However, under the sustained influence of S. aureus infection, monocytes can undergo a transition into an anti-inflammatory M2 state (pro-infection) rather than the M1 state (anti-infection), thereby compromising effective infection control. Therefore, it is necessary to develop a strategy that would preserve the pro-inflammatory functions of macrophages, in a safe and controlled manner. For this, we focused on harnessing the potential of S. aureus-derived ghost cells (GCs) which are non-live empty envelopes of bacterial cells, but with the antigenic determinants intact. Through a unique Lugol's-iodine treatment, we generated GCs and characterization of these GCs using gel electrophoresis, FTIR, flow cytometry, TEM, and SEM confirmed their structural integrity. Following this, we assessed the extend of cellular association of the GCs with RAW267.4 macrophages, and observed an immediate interaction between the two, as evident from the flowcytometry and microscopy studies. We then performed macrophage polarisation on a human monocyte-macrophage model cell line, THP-1. Our findings revealed that GCs effectively activated macrophages, and promoted a pro-inflammatory polarisation with the expression of M1 differentiation markers (CD86, TNFα, IL-1β, IL-6, IL-12) evaluated through both qPCR and ELISA. Interestingly an intermediary expression of M2 markers viz., CD206 and IL-10 was also observed, but was overruled by the enhanced expression of M1 markers at a later time point. Overall, our study introduces a novel approach utilizing GCs to guide naïve macrophages towards M1 subtypes, thereby potentiating immune responses during microbial infections. This innovative strategy can modulate macrophage function, ultimately improving outcomes in S. aureus infections and beyond.

Isolation and Diagnosis of Parasites from Domestic Cockroach Periplaneta americana in Mosul city, Iraq

Cockroaches are the greatest potential mechanical vector of various pathogenic microorganisms, some of which cause serious diseases in humans and domestic animals. The high prevalence of human pathogens carried by the cockroach has been reported in many countries. This study aimed to determine the prevalence of internal and external parasites parasitizing the American cockroach, Periplaneta americana, the effect of the sex of the cockroach and the area of sample collection on The type, number and types of parasites isolated, The current study was conducted for the period from July 2023 until April 2024, A samples of 111 male Periplaneta americana cockroaches were collected from some homes and schools in the city of Mosul. After the samples arrived at the laboratory, by placing them in clean, sterilized tubes in a refrigerator set at -4°C for 10 minutes Subsequently, 10 ml of normal saline solution was added to each tube. The tubes were then vigorously shaken for 5 minutes to dislodge parasites a salt solution was added to centrifuge tubes, which were spun at 2000 rotations per minute for 5 minutes. This mixture was shaken for 5 minutes and then, Cockroaches were dissected to isolate internal parasites The contents of the digestive tract were taken, and the solution was filtered through a mesh. Each sample was prepared by placing a drop of sediment on a glass slide, adding Lugol's iodine dye, and examining it under a microscope. The majority of the samples were infected with one or more types of parasites on their body surfaces and within their digestive tracts, infection rate of 96.40 %. This study involved the isolation and diagnosis of 19 parasitic species, including five types of worms: Ancylostoma duodenale, Leidynema, Strongyloides stercoralis, Hammerschmidtiella male, and Thelastoma. and six types of protozoan parasites, including both active and Nyctotherus ovalis cyst, active and cyst stages of Lophmonas, cyst stage of Entamoeba coli, and Gregarine. and Seven types of eggs, comprising eggs of each of Ancylostoma duodenale, Thelastoma, Leidynema, Strongyloides stercoralis, Hammerschmidtiella , Gryllophila, and in addition to the external parasitic Mite, The highest infection rate was recorded in worms, with 91 out of 111 samples i.e. (81.98% ). This was followed by protozoa, with a rate of 72% out of 80 samples. Finally, external mites, 52 samples i.e. (46.84%). In this study, it was observed that the number of parasites harbored by cockroaches in their digestive tracts exceeds more than that found on their external surfaces. Cockroaches collected from households were found to harbor a greater number of parasites compared to those collected from schools, underscoring the necessity of raising awareness about the dangers of cockroach presence in homes and keeping them away from food sources due to the parasites they carry, which may cause various diseases.

Screening staining agents for contrast-enhanced microCT of vascular tissues: Assessing the effect on microstructural and mechanical properties

Cardiovascular tissues possess a complex microstructure, which remodel and adapt due to ageing and diseases. This complex and evolving microstructure is intrinsically linked to the tissue’s mechanical properties. To better understand how changes in the microstructure can impact the mechanical behavior, 4D-contrast-enhanced microCT (4D-CECT) can be used (i.e. in situ mechanical loading combined with 3D microstructural visualization). Since absorption-based CECT requires the use of contrast-enhancing staining agents (CESAs), we investigated six different CESAs for their suitability for 4D-CECT imaging of arterial tissue, considering their ability to provide good microstructural visualization and segmentation while ensuring the preservation of the mechanical properties. For this purpose, the penetration speed, contrast-enhancement, volume change, and stiffness change of porcine arterial tissue stained with the different CESA solutions were studied. Based on our results, we selected 1:2 Hafnium-substituted Wells-Dawson Polyoxometalate as the most suited CESA for 4D-CECT of arterial tissue. Phosphotungstic acid (PTA) and Lugol iodine with Sorensen’s buffer (Lugol), despite being the reference in the state-of-the-art as CESA and having excellent contrast-enhancement properties, were the only ones that significantly affected the mechanical properties of porcine arterial tissue. Additionally, for these two solutions, tissue shrinkage was observed, resulting in a volume reduction of approximately − 12 % for PTA and − 17 % for Lugol. Finally, it was observed that the penetration speed of all CESA solutions exhibited a ratio of 60–40 % from the intimal side to the adventitial side, which is likely due to the denser packing of elastic lamellae towards the adventitia. Overall, our study offers valuable new insights for selecting and comparing various CESA solutions for (4D-)CECT.

Deep Learning and High-Resolution Anoscopy: Development of an Interoperable Algorithm for the Detection and Differentiation of Anal Squamous Cell Carcinoma Precursors-A Multicentric Study.

High-resolution anoscopy (HRA) plays a central role in the detection and treatment of precursors of anal squamous cell carcinoma (ASCC). Artificial intelligence (AI) algorithms have shown high levels of efficiency in detecting and differentiating HSIL from low-grade squamous intraepithelial lesions (LSIL) in HRA images. Our aim was to develop a deep learning system for the automatic detection and differentiation of HSIL versus LSIL using HRA images from both conventional and digital proctoscopes. A convolutional neural network (CNN) was developed based on 151 HRA exams performed at two volume centers using conventional and digital HRA systems. A total of 57,822 images were included, 28,874 images containing HSIL and 28,948 LSIL. Partial subanalyses were performed to evaluate the performance of the CNN in the subset of images acetic acid and lugol iodine staining and after treatment of the anal canal. The overall accuracy of the CNN in distinguishing HSIL from LSIL during the testing stage was 94.6%. The algorithm had an overall sensitivity and specificity of 93.6% and 95.7%, respectively (AUC 0.97). For staining with acetic acid, HSIL was differentiated from LSIL with an overall accuracy of 96.4%, while for lugol and after therapeutic manipulation, these values were 96.6% and 99.3%, respectively. The introduction of AI algorithms to HRA may enhance the early diagnosis of ASCC precursors, and this system was shown to perform adequately across conventional and digital HRA interfaces.

Effect of vinegar supplementation on patients with esophageal lesions lightly stained with Lugol's iodine solution: Prospective single-centre trial.

Esophageal chromoendoscopy with iodine solution is important for detecting early esophageal cancer. The effect of routine treatment for lesions lightly stained with Lugol's iodine solution is limited, and the addition of natural substances to a regular diet is becoming increasingly common. Vinegar has antitumor effects as reported in previous studies. To evaluate whether vinegar supplementation could improve the prognosis of patients with lightly stained esophageal lesions. This prospective single-centre trial included consecutive patients with lightly stained lesions between June 2020 and April 2022. Patients in the experimental group received increased amounts of vinegar for 6 months. The primary outcome of the study was the clinical therapeutic effect. Complications related to vinegar ingestion and adverse events were also recorded in detail. A total of 166 patients were included in the final analysis. There was no significant difference in the baseline data between the two groups. Intention-to-treat (ITT) analysis demonstrated that the rates at which endoscopic characteristics improved were 33.72% in the experimental group and 20.00% in the conventional group (P = 0.007); and the rates at which biopsy pathology improved were 19.77% and 8.75%, respectively (P = 0.011). Additional vinegar consumption had a statistically protective effect on the rate at which endoscopic characteristics improved [hazard ratio (HR) ITT = 2.183, 95%CI: 1.183-4.028; HRper-protocol (PP) = 2.307, 95%CI: 1.202-4.426] and biopsy pathology improved (HRITT = 2.931, 95%CI: 1.212-7.089; HRPP = 3.320, 95%CI: 1.295-8.507). No statistically significant effect of increased vinegar consumption on preventing high-grade intraepithelial neoplasia or early cancer was observed (HRITT = 0.382, 95%CI: 0.079-1.846; HRPP = 0.382, 95%CI: 0.079-1.846). The subgroup analyses indicated that the overall therapeutic improvement of endoscopic characteristics and biopsy pathology seemed more obvious in older (age > 60) male patients with small lesions (lesion size ≤ 0.5 cm). Three patients in the experimental group reported acid regurgitation and heartburn. No adverse event during gastroscopy were recorded during follow-up. A moderately increased ingestion of vinegar could not directly reduce the risk of esophageal cancer in the mucosa dysplasia population, but it improved the endoscopic characteristics and ameliorated the biopsy pathology to a certain extent. Further research is needed to verify the effect of nutritional intervention on precancerous esophageal lesions.

Endemic status of urogenital schistosomiasis and the efficacy of a single-dose praziquantel treatment in unmapped rural farming communities in Oyo East Local Government Area, Oyo State, Nigeria.

Schistosomiasis is endemic in Nigeria, and the treatment is largely concentrated on children enrolled in schools. Consequently, the coverage of non-enrolled school-aged children is often neglected. Ajagba and Awosan are two communities in Nigeria that have never had any control intervention. Hence, this survey was designed to determine the endemicity of urogenital schistosomiasis and to evaluate the efficacy of a single-dose praziquantel in the communities. Urine sample (10 mL) of each participant from Ajagba and Awosan communities was filtered through 12μm polycarbonate filter. The filter was placed on a microscope slide, and stained with a drop of 1% Lugol iodine solution. The stained slides were examined under the microscope and the numbers of S. haematobium eggs were counted. Water contact sites were searched for snail hosts and the snails collected were shed for Schistosoma cercariae. Data were analyzed using SPSS version 24.0 and the significance level was set at 95%. The overall prevalence of infection in the Ajagba community was 45.6% with a mean intensity of 61.1 ± 144.5 eggs/10 mL of urine, while the prevalence of infection in the Awosan community was 5.7% with a mean intensity of 1.4 ± 6.8 eggs/10 mL of urine. The school-aged children had a prevalence and mean intensity of infection of 73.1% and 111.6 ± 177.9 eggs/10 mL of urine, respectively. Following treatment, women had a higher egg reduction rate than men (p = 0.0283). Bulinus globosus were found in Ajagba but not in Awosan, with 5.7% shedding Schistosoma spp, cercariae. Urogenital schistosomiasis was hyperendemic in the Ajagba community, and hypoendemic in the Awosan community. The presence of Bulinus globosus supported the transmission of the schistosomiasis in the Ajagba community. Communities where schistosomiasis is still actively transmitted in Nigeria should be identified for effective intervention through the MDA programs.

Surgical outcome after thyroidectomy due to Graves’ disease and Lugol iodine treatment: a retrospective register-based cohort study

PurposeThis study aimed to investigate the relationship between Lugol iodine treatment in a rescue setting and surgical outcomes in Graves’ disease patients.MethodsThe retrospective register-based cohort study included 813 patients who had undergone primary total thyroidectomy with a primary diagnosis of Graves’ disease (ICD-code E05.0) at Karolinska University Hospital in Stockholm, Sweden, between January 2008 and December 2015. Of 813 patients, 33 (4.1%) were given Lugol iodine before surgery and the remaining, the non-Lugol group, did not. The study’s primary outcomes were post-operative calcium treatment day 1, calcium and vitamin D supplements at discharge and follow-up. Secondary outcomes were laryngeal nerve damage and bleeding (defined as re-operation).ResultsDifferences were found between the Lugol and non-Lugol groups in the treatment of calcium day 1 (45.5% vs 26.7%, p = 0.018), at discharge (36.4% vs. 16.2%, p = 0.002) and vitamin D supplements at discharge (36.4% vs. 19.1%, p = 0.015) as surrogate variables for hypocalcemia post-operatively. No differences could be seen at 4–6 weeks and six-months follow-up. There were no differences between the Lugol and non-Lugol groups in terms of operation time, laryngeal nerve damage, and bleeding.ConclusionPatients in our cohort undergoing thyroidectomy due to Graves’ disease pre-operatively treated with Lugol iodine as a rescue therapy had a higher risk of experiencing short term post-operative hypocalcemia.

Utility of Lugol’s iodine in assessing the margin status of early stage oral cavity cancer-could it be a simple and effective way to achieve R0 resection?

Background: It is often challenging to distinguish between dysplastic and normal mucosa during surgery. Use of staining agents that will identify abnormal mucosa may improve results. Because Lugol's iodine is readily available, simple to use, and cost-effective, it was chosen as the preferred staining agent. To determine the effectiveness of Lugol’s iodine application in achieving R0 resection in early-stage oral cavity malignancy and thereby leading to better outcomes after treatment. Methods: In this study we included 49 patients and randomized them into two arms. One arm we did wide excision for early-stage oral cavity cancers guided by subjective assessment of margins by surgeons and in another arm, we used Lugol’s iodine to define the margin. We analysed the margin status and thereby the need for the adjuvant therapy between these two groups. Results: In those 49 patients, two of them had microscopically positive margin. One belonged to Lugol’s iodine arm and other belonged to control arm. 17 patients had close margin at mucosal site (less than 5 mm) out of which 11 belonged to control arm and 5 belonged to Lugol’s iodine arm. Conclusions: Lugol’s iodine may be a simple and reliable method in achieving better resection margins and R0 resections for early-stage oral cavity cancer. By using this simple and cost-effective method we may reduce the possibility of ending up with positive or close margins and thereby avoiding the need of chemotherapy and radiation as adjuvant therapy in those patients.

Buffered Lugol's Iodine Preserves DNA Fragment Lengths.

Museum collections play a pivotal role in the advancement of biological science by preserving phenotypic and genotypic history and variation. Recently, contrast-enhanced X-ray computed tomography (CT) has aided these advances by allowing improved visualization of internal soft tissues. However, vouchered specimens could be at risk if staining techniques are destructive. For instance, the pH of unbuffered Lugol's iodine (I2KI) may be low enough to damage deoxyribonucleic acid (DNA). The extent of this risk is unknown due to a lack of rigorous evaluation of DNA quality between control and experimental samples. Here, we used formalin-fixed mice to document DNA concentrations and fragment lengths in nonstained, ethanol-preserved controls and 3 iodine-based staining preparations: (1) 1.25% weight-by-volume (wt/vol.) alcoholic iodine (I2E); (2) 3.75% wt/vol. I2KI; and (3) 3.75% wt/vol. buffered I2KI. We tested a null hypothesis of no significant difference in DNA concentrations and fragment lengths between control and treatment samples. We found that DNA concentration decreases because of staining-potentially an effect of measuring intact double-stranded DNA only. Fragment lengths, however, were significantly higher for buffered I2KI and control samples, which were not, themselves, significantly different. Our results implicate buffered I2KI as the appropriate choice for contrast-enhanced CT imaging of museum wet collections to safely maximize their potential for understanding genetic and phenotypic diversity.

Human Papillomavirus Types and Cervical Cancer Screening among Female Sex Workers in Cameroon.

Female sex workers (FSWs) are at high risk for sexually transmitted infections (STIs), including infection with human papillomavirus (HPV) and cervical cancer due to occupational exposure. The objective of this study was to estimate the prevalence of HPV, HPV types, and precancerous lesions of the cervix among FSWs in Cameroon. In this cross-sectional study, FSWs in Cameroon aged 30 years and above were screened for cervical cancer using high-risk HPV testing and genotyping and visual inspection with acetic acid and Lugol's iodine (VIA/VILI) enhanced using digital cervicography (DC) simultaneously. Those who were positive for VIA/VILI-DC were provided treatment with thermal ablation (TA) immediately for cryotherapy/TA-eligible lesions while lesions meeting the criteria for large loop excision of the transformation zone (LLETZ) were scheduled at an appropriate facility for the LLETZ procedure. HPV-positive FSWs without any visible lesion on VIA/VILI-DC were administered TA. Bivariate analyses were conducted to compare demographic and clinical characteristics. Crude and adjusted logistic regression models were computed for HPV infection status and treatment uptake as outcomes in separate models and their ORs and 95% confidence intervals (95% CI) were reported. Among the 599 FSWs aged 30 years and older that were screened for HPV and VIA/VILI-DC, 62.1% (95% CI: (0.58-0.66)) were positive for one or more HPV types. HPV type 51 had the highest prevalence (14%), followed by types 53 (12.4%) and 52 (12.2%). Type 18 had the lowest prevalence of 2.8% followed by type 16 with 5.2%. In the multivariable model, HIV-positive FSWs were 1.65 times more likely to be infected with HPV compared to their HIV-negative counterparts (AOR: 1.65, CI: 1.11-2.45). A total of 9.9% of the 599 FSWs were positive for VIA/VILI-DC. The prevalence of HPV infection among FSWs in Cameroon is higher than the worldwide pooled FSW prevalence. HPV types 51 and 53 were the most prevalent, while types 18 and 16 were the least prevalent. HIV status was the only variable that was significantly associated with infection with HPV.

Experimental assessment of diffusible iodine-based contrast-enhanced computed tomography (diceCT) protocols.

Diffusible iodine-based contrast-enhanced computed tomography (diceCT) is an increasingly used digital complement, supplement, or alternative to traditional dissection-based anatomical research. The diceCT protocol, which has evolved and expanded over the past decade, employs passive diffusion of Lugol's iodine (KI3) to increase soft tissue radiodensity and improve structure contrast in the CT or microCT imaging of specimens. The development and application of diceCT has focused largely on specimens under 1 kg, and the varying reporting of methods on studies of both small and large specimens has initiated, but not yet established, an effective diceCT protocol for larger specimens based on monitored experiments of several fundamental variables (e.g., Lugol's iodine concentration, duration, and impacts of Lugol's iodine on tissues). In this study, we have experimentally assessed the efficacy of diceCT protocols for imaging whole-body specimens of the 1-4.5 kg Australian brushtail possum (Trichosurus vulpecula) using sequential CT imaging assessment across experimental conditions. We assessed the impact of varying Lugol's iodine concentration, the presence/absence of skin, solution volume and agitation on tissue radiodensity changes through weekly CT-based monitoring of tissue radiodensities over an 8-week experimental period. We have also quantified tissue volumetric changes across our experiment to assess the impact of diceCT applications on subsequent analyses of imaging datasets. Our results indicate that substantial changes in both soft-tissue radiodensity and soft-tissue volume occur within the first 28 days of Lugol's iodine treatment, followed by a slower rate of progressive soft-tissue radiodensity and volume changes across the experiment duration. Our results demonstrate the negligible benefit of skinning larger specimens to improve solution diffusion, and document significant soft-tissue volumetric changes with high concentration solutions (e.g., 10%) and long-duration exposure (e.g., beyond 5 weeks) that should guide individual diceCT protocol design and/or quantification and analysis for mammal specimens above 1 kg.

Effectiveness of cryotherapy delivered by nurses for treatment of cervical preneoplasic lesions

Introduction. Cervical cancer is a relevant public health problem for low- and middleincome countries. Follow-up of positive-screened women and compliance with treatment of precancerous lesions are major challenges for these settings. Objective. To evaluate the efficacy of cryotherapy delivered by nurses for cervical intraepithelial neoplasia (CIN). Materials and methods. Direct visual inspection with acetic acid and lugol iodine (VIAVILI), and colposcopy/biopsy were performed on women 25 to 59 years old, residents of low-income areas in Bogotá, Colombia. Trained nurses offered immediate cryotherapy to every woman with positive visual inspection. Colposcopy/biopsy was performed before treatment and at a 12-month follow-up. The effectiveness was measured as cure (outcome: no-lesion) and regression (outcome: CIN1) rates of CIN2/3 using colposcopic and histological verification. Results. A group of 4.957 women with VIA/VILI was valuated. In total, 499 were screen positive and 472 accepted immediate treatment. A total of 365 women (11 CIN2/3) received cryotherapy by nurses. Cure rate was 72% (95%CI: 39%-94%) and 40% (95%CI: 22%-85%) by colposcopic and histological verification, respectively. Regression rates were 100% and 60%. There were two related non-serious adverse events. Conclusions. Cure and regression rates by colposcopic verification are like those reported for cryotherapy delivered by doctors. The sample size (CIN2/3) hinders comparisons by type of verification. Our findings support the implementation of screen-and-treat algorithms by nurses among populations with limited access to health services.

Application of narrow band imaging and Lugol's iodine staining in screening for nasopharyngeal carcinoma

BackgroundTo investigate the diagnostic value of conventional white light endoscopy (WLE), narrow band imaging (NBI) endoscopy, and Lugol's iodine staining under WLE (endoscopic iodine staining) in the screening and early diagnosis of nasopharyngeal carcinoma.MethodsPatients with nasopharyngeal lesions requiring biopsy attending the Department of Otolaryngology Head and Neck Surgery in our hospital between January 2021 and April 2023 were included in this study. Before biopsy, all subjects underwent conventional WLE, NBI endoscopy, and endoscopic iodine staining. On WLE, according to nasopharyngeal lesion morphology and color, patients were diagnosed with nasopharyngeal carcinoma ( +) or chronic hyperplastic nasopharyngitis (-). On NBI endoscopy, according to nasopharyngeal lesion vascular morphology, patients with type V manifestations (nasopharyngeal carcinoma) were categorized as NBI ( +) and patients with type I-IV manifestations (chronic hyperplastic nasopharyngitis) were categorized as NBI (-). Endoscopic iodine staining (1.6% Lugol's iodine solution) was positive ( +) if the mucosal surface was brown with no white patches, or negative (-) if there was no or light brown staining of the mucosal surface. Patients were divided into 2 groups based on histopathological diagnosis: nasopharyngeal carcinoma or chronic hyperplastic nasopharyngitis. Endoscopic diagnoses were compared with histopathological findings. The diagnostic performance of WLE, NBI endoscopy and endoscopic iodine staining for nasopharyngeal carcinoma were determined.ResultsThis study included 159 patients. On histopathology, 29 patients were diagnosed with nasopharyngeal carcinoma, and 130 patients were diagnosed with chronic hyperplastic nasopharyngitis. There were no significant differences in the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic (ROC) curve (AUC) of conventional WLE, NBI endoscopy or endoscopic iodine staining for differentiating nasopharyngeal carcinoma and chronic hyperplastic nasopharyngitis. The diagnostic performance of the combination of conventional WLE, NBI endoscopy and endoscopic iodine staining was significantly improved compared to any procedure alone.ConclusionsConventional WLE, NBI endoscopy or endoscopic iodine staining had good diagnostic performance for differentiating nasopharyngeal carcinoma and chronic hyperplastic nasopharyngitis. In particular, NBI endoscopy and endoscopic iodine staining alone or combined had clinical utility for identifying patients with nasopharyngeal lesions that are eligible for a watch-and-wait strategy.

Cervical cancer screening in Doukoula- the far north region of Cameroon

With a morbidity of 600,000 cases and 375,000 lethal cases per year, cervical cancer (CC) is the second most prevalent gynecological cancer all over the world. Because of the absence of a widespread preventative campaign, CC has a significant impact in developing countries. An acceptable, efficient, and cost-effective screening technique in low-income nations is the visual inspection of the cervix with acetic acid and Lugol's iodine. By conducting a CC screening exercise in Doukoula, we hope to ignite the culture of CC screening campaigns in the Kar-Hay health district in the extreme north of Cameroon. Methods: Doukoula District Hospital hosted a one-week CC screening and treatment exercise from the 3rd of November 2021 to the 9th of November 2021. Treatments for dysplastic lesions included thermal coagulation and LEEP. To improve cervix visibility, a MobileODT colposcopic gadget was used. Results: 306 women in all agreed to take part in the study. A screening uptake of 82% was achieved, with 251 of them completing the process. 7 (2.8%) declared being HIV positive. The mean age of this study was 37.33. We had 31 cases of dysplasia (12.75%) and 1 case of cervical cancer (0.4%). Out of 251 participants, only 3 (1.2%) had undergone CC screening, and just one had received an HPV vaccination in the past. Five CIN-1 cases, aged 25 years and below, did not receive any treatment. The 11 cases of CIN 1 aged over 25 years and the 13 CIN 2 cases were eligible for thermotherapy. The two CIN-3 cases had a LEEP, and a sample was taken for pathology analysis. 20 presented themselves for treatment. The total uptake for treatment was 76.72%. Conclusion: Despite growing recognition that cervical cancer is a disease that can be prevented, relatively little is being done to increase vaccine, screening, and treatment rates. While waiting for the development of efficient national screening systems, the use of a “see and treat” screening strategy is a reasonable method of approach for the prevention of CC in low-income countries.

SAT488 Wolff-Chaikoff’s Revenge: There-and-Back Again Graves Thyrotoxicosis

Abstract Disclosure: A. Akofu: None. S.A. Brietzke: None. N. Sheung: None. A. Uddin: None. N. Akabogu: None. S. Dejhansathit: None. F. marium: None. Grave’s disease is due to autoantibodies activating TSH receptors, driving downstream effects of iodine organification, iodotyrosine coupling, and release of T4 and T3 from intracellular stores. Severe thyrotoxicosis is traditionally treated with high dose thionamides to block thyroid hormone synthesis, iodides to slow iodine transport and block thyroid hormone release (collectively known as the Wolff-Chaikoff effect), and beta-blockers to slow heart rate and relieve tremulousness. We report the case of a health-conscious patient who had taken OTC iodide for years, and whose thyrotoxic condition abruptly worsened with discontinuation of his iodide supplement. A 67-year-old man was found in a delirious state wandering in the woods and was taken to the hospital ED. He had afib with RVR and evidence of high-output CHF. Diffuse goiter twice normal size was obvious on exam, and he was tremulous and diaphoretic. Serum TSH was <0.005 mcU/ml, with FT4 > 7.77 ng/dl and FT3 7.8 pg/ml. Initial treatment was metoprolol 25 mg TID, propylthiouracil (PTU) 300 mg TID, cholestyramine 4g BID and Lugol’s iodine 10 drops TID. Encephalopathy resolved after 2 days and FT4 decreased to 3.72 ng/dl after 8 days. Cholestyramine and Lugol’s iodine were thus discontinued. 2 days later, FT4 further declined to 2.75 ng/dl and he was switched from PTU to methimazole 30 mg twice daily. After 3 days, FT4 had increased to 5.17 ng/dl, and in response methimazole was increased to 40 mg TID. 3 days later FT4 increased further to 6.43 ng/dl, prompting a switch from methimazole back to PTU 300 mg TID. Because of further increase in FT4 and FT3, cholestyramine and Lugol's iodine were resumed. 3 days later, FT4 had declined from > 7.7 to 5.4 ng/dl, and he was discharged with plan to perform thyroidectomy once FT4 and FT3 reached nearly normal levels. Near the end of his hospitalization, he divulged that he had taken iodide drops for “thyroid health” for many years independent of medical advice, but hadn’t taken it for several days during the period of being lost in the woods prior to admission. Possible explanations for resistance of thyrotoxicosis to aggressive prescribed treatment include medication non-adherence, drug malabsorption, hyperaccelerated drug metabolism, anti-drug antibodies and antagonism of thionamide action by excessive intrathyroidal iodine. In this case, we hypothesize that his use of iodide serendipitously attenuated severity of Graves disease, by giving him a prolonged Wolf-Chaikoff effect. Discontinuation of iodide over a matter of days allowed reversal of this phenomenon and prevented control of his hyperthyroid condition until the deliberate restoration of the Wolf-Chaikoff effect with therapeutically prescribed Lugol’s solution. Whenever response to usual hyperthyroidism treatment is ineffective or paradoxical, as in this case patients should be specifically queried regarding use of OTC iodine preparations. Presentation Date: Saturday, June 17, 2023

Optical imaging for early detection of cervical cancer: state of the art and perspectives.

Cervical cancer is one of the major causes of death in females worldwide. HPV infection is the key cause of uncontrolled cell growth leading to cervical cancer. About 90% of cervical cancer is preventable because of the slow progression of the disease, giving a window of about 10 years for the precancerous lesion to be recognized and treated. The present challenges for cervical cancer diagnosis are interobserver variation in clinicians' interpretation of visual inspection with acetic acid/visual inspection with Lugol's iodine, cost of cytology-based screening, and lack of skilled clinicians. The optical modalities can assist in qualitatively and quantitatively analyzing the tissue to differentiate between cancerous and surrounding normal tissues. This work is on the recent advances in optical techniques for cervical cancer diagnosis, which promise to overcome the above-listed challenges faced by present screening techniques. The optical modalities provide substantial measurable information in addition to the conventional colposcopy and Pap smear test to clinically aid the diagnosis. Recent optical modalities on fluorescence, multispectral imaging, polarization-sensitive imaging, microendoscopy, Raman spectroscopy, especially with the portable design and assisted by artificial intelligence, have a significant scope in the diagnosis of premalignant cervical cancer in future.