Ultrasound Grading Research Articles

The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases

To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD). From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades. Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p = 0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p = 0.035) and hypothyroid (p = 0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US. In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

A RANDOMISED, PROSPECTIVE, PARALLELAND OPEN LABEL STUDY TO COMPARE EFFICACY AND SAFETY OF METFORMIN PLUS ROSUVASTATIN AND GLIMEPIRIDE PLUS ROSUVASTATIN IN PATIENTS OF COEXISTING NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND TYPE 2 DIABETES MELLITUS (T2DM)

Background and Objectives: NAFLD and T2DM has global prevalence of 55.5% with currently no approved treatment. There is insufcient data for its pharmacotherapy. The sharing of risk factors, most common being the insulin resistance between NAFLD and T2DM, makes the antidiabetic drugs, with effect on insulin resistance, the potential treatment options. The aim was to compare efcacy and safety of antidiabetic drugs i.e. Metformin and Glimepiride with concomitant Rosuvastatin in NAFLD coexistent with T2DM. Methods: Randomized, prospective, parallel and open-label study recruited 60 patients of concomitant NAFLD and T2DM after getting Institutional Review Board approval. Patients of either sex (20-60 years) with NAFLD (ultrasound diagnosed & raised AST 50-150 U/L) and T2DM(FBS> 126mg/dl) were recruited in medicine OPD after obtaining written informed consent. Chronic alcohol users and pregnancy cases were excluded. Patients were randomised into Group A[Rosuvastatin(10mg OD)+ Metformin(1gm BD)] & Group B[Rosuvastatin(10mg OD)+Glimepiride(3mg BD)]. Primary outcome was improvement in hepatic parameters and ultrasound grading of liver. Secondary outcomes were improvement in anthropometric, glycaemic and lipid parameters and assessment of safety. Results: Group A caused signicant(p<0.05) reduction in hepatic parameters(S.Bilirubin & AST). Group A and B showed non-signicant improvement(p>0.05) in ultrasound grading of liver, respectively (24% vs 20% patients). Intergroup difference was signicant(p<0.05) for weight and BMI in Group A. Both groups showed highly signicant(p<0.001) reduction in glycaemic parameters and signicant(p<0.05) reduction in lipid parameters. Both treatments were safe. Conclusion: Metformin plus Rosuvastatin seems to be more efcacious in NAFLD and T2DM over 90 days. These drugs could improve prognosis because of insulin sensitising action and additional benets in cancers, cardiovascular diseases. Further studies are required to strengthen these ndings which may help in nding a standard treatment for NAFLD and T2DM.

Short-Term Outcome in Patients with Acute Kidney Injury at Sohag University Hospital

Background: Acute kidney injury (AKI) is a common clinical situation with serious complications with long-term and short-term negative consequences as regards morbidity and mortality. Objective: To determine the short-term outcome of AKI among those patients and to evaluate the relationship between patient characteristics and the outcome of AKI. Patients and methods: A prospective study that was conducted on 70 Patients diagnosed with AKI using the Kidney Disease–Improving Global Outcomes (KDIGO) criteria based on serum creatinine (increase in serum creatinine by ≥ 0.3 mg/dL within 48h or increase in serum creatinine to ≥1.5 times baseline), which is known or presumed to have occurred within the prior 7 days. They were admitted to Internal Medicine Department, Sohag University Hospital from December 2019 to May 2020. Results: There was statistically significant relationship between patient age, history of diabetes, established chronic kidney disease (CKD) and AKI outcomes. Also there was statistically significant relation between AKI outcome and increased s. creatinine level, elevated white blood cells count, decreased hemoglobin level and increased serum potassium level. As regards the staging of AKI, We found statistically significant relationship between AKI outcomes and staging of studied population as stage 3 had worse outcomes. Also we found statistically significant relationship between AKI outcome and ultrasound grading of echogenicity of studied population as increased echogenicity had worse outcome than normal kidneys. Conclusions: Our study concluded that mortality and morbidity in patients with AKI were increased in advanced age, diabetics, CKD patients, patients with anemia, leucocytosis hyperkalemia and increased serum creatinine.

Lipid Profile and Ultrasonographic Grading in Alcoholic and Non Alcoholic Fatty Liver Patients

Background Fatty liver disease (FLD) is a common and major chronic liver disease. It has been implicated that patients have disorders of lipid metabolism and are involved in the pathogenesis of fatty liver. Hence, it was designed to observe the association between lipid profile and fatty liver disease.
 Objective This study was undertaken to evaluate the association of lipid profile status, hemoglobin and albumin levels with fatty liver disease patients diagnosed based on ultrasonography (USG).
 Method This Cross-sectional study was undertaken in the Department of Internal Medicine with the collaboration of the Department of Radiology and Department of Biochemistry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from March 2019 to February 2020 in a total of 100 patients diagnosed with fatty liver disease by ultrasonography. The fasting blood was collected for lipid profile and carried out in the automated analyzer following standard protocol.
 Result In 100 cases, the male to female ratio was 1.8:1. Fifty six percent of the total cases presented with alcoholic fatty liver disease (AFLD) while the remaining 44% with non-alcoholic fatty liver disease (NAFLD). The spectrum of lipid abnormality was observed with increased total cholesterol (TC), Low Density Lipoprotein (LDL), increased triglycerides (TG), Very Low Density Lipoprotein (VLDL) in alcoholic fatty liver disease cases as compared to non-alcoholic fatty liver disease cases. However, it has been observed that TG/HDL and Non-HDL/HDL were higher in non-alcoholic fatty liver disease as compared to alcoholic fatty liver disease. Moreover, a statistically significant difference was observed in HDL between AFLG2 and NAFLG2 (p-value: 0.012).
 Conclusion Dyslipidemia and decreased HDL have been implicated in fatty liver diseases. USG in conjunction with Non-HDL/HDL, TG/HDL, hemoglobin, and albumin can be useful in early screening and monitoring of dyslipidemia in fatty liver patients.

Serum ferritin level as a noninvasive marker for detection and staging of hepatocellular injury, liver fibrosis, and steatosis in children and adolescents with nonalcoholic fatty liver disease

Background Pediatric nonalcoholic fatty liver disease (NAFLD) is a global health problem. Recently, serum ferritin level (SFL) has been reported to be correlated with NAFLD and the degree of liver fibrosis and steatosis. Aim The aim was to assess serum ferritin level as a noninvasive marker for detection and staging hepatocellular injury, liver fibrosis, and steatosis diagnosed by FibroScan in children and adolescents with NAFLD disease proven with ultrasound. Patients and methods The authors assessed serum ferritin in 40 children with NAFLD diagnosed ultrasonography as well as 20 age-matched and sex-matched healthy controls. The authors also assessed the correlation between SFL and the different stages of hepatic fibrosis and steatosis assessed by FibroScan. Results The authors found thatthe values of serum ferritin were significantly higher in patients than controls (P=0.0001). Moreover, there was a positive correlation between SFL and ultrasonographic grades of liver steatosis, FibroScan liver fibrosis grades, and FibroScan liver steatosis controlled attenuation parameter score and its values among patients with NAFLD. Area under the receiver operating characteristic curve (0.995) shows serum ferritin (ng/ml) has significant sensitivity as a diagnostic marker for liver fibrosis degrees diagnosed by FibroScan and liver steatosis stage diagnosed by FibroScan with area under the receiver operating characteristic curve of 1.000 among the studied patients with NAFLD (P=0.0001). Moreover, it has significant sensitivity as a diagnostic marker for liver steatosis grades diagnosed by abdominal ultrasonography among the studied patients with NAFLD (P=0.0001). Conclusion The data suggest that SFL can be used as a noninvasive marker for diagnosis and staging of hepatocellular injury, liver fibrosis, and steatosis in children and adolescents with NAFLD.

Estimation of Liver Fat by FibroScan in Patients With Nonalcoholic Fatty Liver Disease.

BackgroundAssessment of nonalcoholic fatty liver disease (NAFLD) includes estimation of liver fat (steatosis). Controlled attenuation parameter (CAP) value obtained by FibroScan® (Echosens, Paris, France) is an alternative to liver biopsy for diagnosing and estimating steatosis (S). This study aimed to estimate the liver fat by CAP in NAFLD patients.MethodsAn observational cross-sectional study was conducted at the Liver Unit of Bir Hospital, from January 2021 to May 2021 after ethical clearance from the Institutional Review Board of the National Academy of Medical Sciences. A convenient sampling method was used. Data were analyzed with descriptive and inferential statistics involving bivariate and multivariate analysis.ResultsA total of 127 NAFLD patients were enrolled. The mean (±SD) CAP value was 271.53 (±50.69) dB/m. Total cholesterol, triglyceride, and body mass index (BMI) correlated positively (p<0.05) while systolic blood pressure correlated negatively with CAP value (p=0.031). On multivariate analysis, patients with BMI ≥25 kg/m2 were found 3.7 times more likely to have CAP ≥291 dB/m (S3, severe steatosis) than those with BMI <25 kg/m2 (p=0.048, 95% CI 1.01, 13.50). The mean (±SD) CAP values were 276.19 (±49.93) and 246.60 (±48.50) dB/m among those with BMI ≥25 kg/m2 and <25 kg/m2, respectively (p=0.016, using independent t-test). CAP steatosis grading correlated positively with both the ultrasound grading (p<0.001) and fibrosis grading by liver stiffness measurement (p=0.004). ConclusionIn this observational cross-sectional study of NAFLD patients, the mean (±SD) CAP value was 271.53 (±50.69) dB/m, which corresponds to moderate steatosis (S2). Obese NAFLD patients with ≥25 kg/m2 were 3.7 times more likely to have severe steatosis (S3) than nonobese NAFLD patients with BMI <25 kg/m2.

Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Objectives:To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary fine needle aspiration (FNA) rates.Methods:218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for FNA.Results:77 (35.3%) nodules were malignant. Deeming ultrasound Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilising BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001.Conclusion:BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering ultrasound Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA.Advances in knowledge:BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold-standard. Using Grade 1–2 as benign and 4–5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA.

Relationship between Nonalcoholic Fatty Liver Disease and Vitamin D in Nepal

Background and Aims: Vitamin D deficiency has been frequently reported in many causes of chronic liver disease and has been associated with the development and evolution of non-alcoholic fatty liver disease (NAFLD).The study was done to explore associations between serum vitamin D concentrations among obesity, diabetes mellitus, hypothyroidism, and metabolic syndrome and its effects on liver fibrosis by ultra-sonogram and 2 d shear wave elastography in patients with non-alcoholic fatty liver disease (NAFLD).&#x0D; Methods: A hospital based prospective observational study was conducted from May 2019 for twelve months period in Gastroenterology Unit, NAMS, Nepal. Seventy patients with known fatty liver identified by Ultrasonogram criteria were enrolled. All patients were evaluated by different fibrosis scores (NAFLD Fibrosis, FIB4, APRI, AST/ALT ratio) and 2d shear wave score. Patients were evaluated for Vitamin D level and its effects on obesity, diabetes mellitus, thyroid related disease, dyslipidemias and NAFLD.&#x0D; Results: Among 70 patients, 39 (55.7%) were male and 31 (44.3%) were female with mean age of 44.3 years. Most of the patients were overweight with mean BMI of 28.2 kg/m2; among them 51 (72.9%) were more than 25.kg/m2. About 41.4% had diabetes mellitus, 77.1% had hypertension, 30% had hypothyroidism and 25.9% had metabolic syndrome. Majority of patients on ultrasound grading were mild with 64.28%; 25.72% were moderate and only 10 % were in severe groups. A study of 2 d shear wave elastography showed mean fibrosis of 7.07 kpa for mild grade, 8.22 kpa for moderate grade and 18.16 kpa for severe grade. The mean value of vitamin D was 22.61iu/ml for mild grade, 24.89 iu/ml for moderate grade and 17.4 iu/ml for severe grade.&#x0D; Conclusion: The results of this study showed high prevalence of serum 25(OH) vitamin D inadequacy in individuals with obesity, diabetes mellitus, hypothyroidism and metabolic syndrome which worsens as the stage of liver disease progresses.

The Effect of Laparoscopic Sleeve Gastrectomy and Gastric Bypass Surgery on Non-Alcoholic Steatohepatitis in Iranian Patients with Obesity.

BACKGROUND Non-alcoholic steatohepatitis (NASH) is a serious comorbidity in patients with obesity and because of the high risk of cirrhosis and the extreme mortality rate of NASH, approaching effective treatment methods, and improvements are crucial. Following few studies comparing the impact of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (LSG) surgery on NASH, our study was conducted to assess the effect of these two surgical methods separately in patients with NASH through ultrasonography, and concurrently, on other factors such as lipid profiles and blood pressure to reduce the complications of complex obesity surgeries on patients and also provide a solution to prevent NASH-related cirrhosis. METHODS This study was performed at Imam Khomeini Hospital Complex; Vali-e-Asr Hospital affiliated to Tehran University of Medical Sciences.All patients with obesity who had undergone bariatric surgery at Vali-e-Asr Hospital during 2017 and 2018 were included in this prospective cohort study. Weight, body mass index (BMI), blood pressure, Alanine transaminase(ALT), Aspartate transaminase(AST),lipid profile and Fasting blood sugar(FBS)were evaluated before and one year after surgery. The patients underwent an ultrasound examination before surgery to determine the fatty liver grade. The type of operation (sleeve or bypass) was governed by the patient him/herself after receiving thorough clarifications about the available methods, their complications, and expected outcomes. In addition, by the separation of fatty liver grading with ultrasound modality, the correlation between ultrasound grading, laboratory results, and the rate of weight loss in patients who undergone both sleeve and bypass surgeries were evaluated and compared during a one-year follow-up. RESULTS In this study, 44 patients were included. 22 patients underwent laparoscopic sleeve gastrectomy (LSG), and 22 patients underwent laparoscopic gastric bypass (LGB) surgery. The mean age of the patients was 40.45 ± 12.01 years. 35 patients (79.5%) were women, and 9 patients (20.5%) were men. Most patients (81.8%) had grade I and II in terms of preoperative liver ultrasonography results. Bariatric surgery (LSG and LGB) greatly enhanced NASH's hepatic status in liver ultrasonography. Since the liver status of patients with preoperative ultrasonography was not significantly different between the two groups, there was no substantial distinction among the two groups in this regard, postoperatively. Weight and BMI, lipid profile, liver enzymes, FBS, and mean arterial blood pressure (MAP) were significantly reduced individually in both groups and all patients one year after surgery. None of the postoperative variables and their modifications had a prominent difference between the two groups except for High-density lipoprotein(HDL)level after surgery. The postoperative HDL was considerably higher in the LGB group (p = 0.014). However, the changes in HDL were not statistically different between both groups. The levels of AST, ALT, total cholesterol, LDL, and FBS were associated with the NASH grade. CONCLUSION Both types of LSG and LGB bariatric surgeries have been shown to significantly reduce BMI and improve lipid profiles, liver enzymes, and blood glucose levels in patients one year after surgery. The NASH status was also ameliorated considerably. The two types of surgery were not remarkably different in these modifications. Besides, there was a significant correlation between AST, ALT, total cholesterol, LDL, and FBS levels with the NASH grade.

A novel grey scale and Power Doppler ultrasonographic score for idiopathic inflammatory myopathies: Siena Myositis Ultrasound Grading Scale.

No clear-cut guidelines exist on the use of diagnostic procedures for idiopathic inflammatory myopathies (IIM) and only minimal and conflicting data report the use of ultrasound (US). In this regard, we aimed to assess if grey-scale (GS) and Power Doppler (PD) US, graded with a 0-3-point scale, may be a reliable tool in a cohort of patients affected by IIM. All patients underwent US examination of both thighs in axial and longitudinal scans. Oedema and atrophy, both assessed in GS and PD, were graded with a 0-3-point scale. Spearman's test was used to identify the correlations between US and clinical and serological variables. A total of 20 patients were included. Six and two patients were evaluated twice and three times, respectively. Muscle oedema was found to be directly correlated with physician global assessment (PhGA), serum myoglobin and PD and negatively with disease duration. PD score was positively correlated to PhGA and negatively to disease duration. Muscle atrophy directly correlated with Myositis Damage Index, disease duration and patient's age. The single-thigh sub-analysis evidenced a direct correlation between PD score and Manual Muscle Test. In our cohort, we found that oedema and PD are strictly related to early, active myositis, suggesting that an inflamed muscle should appear swollen, thickened and with Doppler signal. Conversely, muscle atrophy reflects the age of the patient and the overall severity of the disease. Such findings shed a new, promising, light on the role of US in diagnosis and monitoring of IIMs.

Biological measures of synovial inflammation predict pain, symptoms, and ultrasound measures of synovitis in knee OA

Purpose: Synovial inflammation (synovitis or effusion-synovitis) measured via clinical imaging (i.e., magnetic resonance imaging (MRI), ultrasound (US)) has been shown to be related to worse outcomes in people with knee OA, including worse pain, higher risk of OA incidence and progression, and increased risk of requiring a total knee arthroplasty (TKA). Recent studies have shown associations between synovial histopathology and structural features of knee OA and MRI measures of synovitis. However, the relationship between histopathology and patient symptoms remains unclear. Histopathology measures of synovial inflammation represent a set of measures that are related to biological disease activity in OA. Therefore, the aim of this study was to establish the link between synovial inflammation and clinical outcomes. Methods: Patients were recruited from the Western Ontario Registry for Early Osteoarthritis (WOREO): Knee Study. Ninety-two people with severe symptoms and radiographic damage (Kellgren-Lawrence (KL) grades 3 or 4) undergoing surgery for end-stage knee OA were included. Patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire specific to each knee and a self-reported patient global assessment (PGA). An investigator global assessment (IGA) was also completed for each patient. Musculoskeletal-US was used to measure effusion-synovitis in suprapatellar mid-line, lateral, and medial windows (0-3; None-Severe; summed (0-9) and maximum effusion depth (mm). Power Doppler signal was also assessed as absent or present (0 or 1). Lateral suprapatellar synovial biopsies were obtained at time of surgery. Routine histopathology was scored in six domains, on 5 slides per patient; mean scores were binned into categories 0, 0.5-1.5, and 2-3 (none, mild, moderate-severe). Composite histopathology scores were created based on previously published literature, principal component analysis (Eigen values ≥ 1.0), and biological rationale. We fitted a series of multivariate linear or logistic regression models to evaluate the association of histopathology (individual and composite) scores with clinical outcomes and US imaging measures of synovitis. All analyses were adjusted for age, sex, and body mass index (BMI). Robust sandwich estimators were used. Results include unstandardized β coefficients or odds ratios (OR) with 95% confidence intervals (CIs). All analyses completed using StataIC 15.1. Results: A total of 92 patients were included (Table 1). Of the 6 histopathology domains, more severe perivascular edema was most strongly associated with lower (worse) KOOS pain, ADL, and QoL subscale scores (Table 2). Synovial lining and sub-synovial infiltrate scores were significantly associated with more severe effusion-synovitis measured by US grading and maximum effusion depth (Table 3). Vascularization was associated with higher synovitis score, while more severe fibrosis was associated with high QoL scores (Table 2) and lower US synovitis score (Table 3). Synovial histopathology principal components accounted for approximately 70% of the variance in the dataset but there were minimal associations with clinical and imaging outcomes (Table 4). The histopathology inflammatory composite scores were most strongly associated with KOOS subscale scores (Table 4). Conclusions: Inflammation measured with synovial histopathology is associated with knee-specific pain, symptoms and US imaging measures of inflammation in patients with end-stage knee OA. These findings may help us to better understand OA overall. We provide biological evidence supporting the known relationship between knee inflammation and OA outcomes, which is largely based on imaging assessment in the literature.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of Bariatric Surgery on Body Composition and Metabolism among Obese Asian Indians with Prediabetes and Diabetes

Background: The aim of this study was to evaluate the changes in body composition, central obesity (visceral and liver fat), and pro-inflammatory markers after bariatric surgery in obese Asian Indians with prediabetes and diabetes. Materials and Methods: This is 1-year follow-up study of 30 obese patients (BMI of 30–40 kg/m2) with prediabetes and diabetes who underwent bariatric surgery at tertiary diabetes center in South India. HbA1c, adiponectin, liver enzymes, ferritin, and high-sensitivity C-reactive protein (hs-CRP) were tested before surgery and at 6 and 12 months postoperatively. Body composition analysis and ultrasound hepatic fat grading were done before and at 6 and 12 months’ post-surgery. Results: The baseline HbA1c were 8.3 ± 1.8% which reduced to 6.1 ± 0.8% at 12 months. The percent body fat, visceral fat area, and slim lean mass reduced significantly at 12 months compared with baseline (P &lt; 0.001). Hepatic steatosis and liver enzymes also significantly reduced at 12 months compared with baseline. hs-CRP and ferritin significantly reduced (P &lt; 0.05) at 12 months post-op [2.9 ± 2.8 mg/L, 39 ± 29 ng/mL] compared with baseline [7.5 ± 3.5 mg/L, 61 ± 44 ng/mL], respectively. Serum adiponectin levels significantly increased from 26.4 ± 1.4 to 67 ± 3.5 ng/mL after the surgery. Conclusion: Bariatric surgery is effective in reducing total body fat and visceral fat area, hepatic steatosis with an improvement in liver enzyme levels after bariatric surgery. hs-CRP, ferritin, and adiponectin also significantly improved following surgery.

The Efficacy of Plantago major Seed on Liver Enzymes in Nonalcoholic Fatty Liver Disease: A Randomized Double-Blind Clinical Trial.

Objective This study aims to evaluate the effects of Plantago major (P. major) seed on liver enzymes and ultrasound patterns in nonalcoholic fatty liver disease (NAFLD). Design In this randomized double-blind placebo-controlled clinical trial, 74 patients with NAFLD were administered either 2 g P. major or placebo twice daily for 12 weeks. All patients were advised to follow the recommendations for daily exercise and diet modification. Levels of liver enzymes as well as other laboratory indexes were measured at the beginning of the study and after 12 weeks. Indeed, the alteration in ultrasound grade was evaluated in NAFLD patients. Results Sixty-three participants completed the study in the intervention and control groups. The mean age of participants was 43.3 (±8.927) and 38.7 (±8.48) years in the intervention and control groups, respectively. P. major group showed significant reduction in alanine aminotransferase (ALT) (47.32 ± 21.77 IU/L vs. 50.03 ± 21.19, P = 0.021), aspartate aminotransferase (AST) (28.29 ± 10.49 IU/L vs. 32.03 ± 13.30, P = 0.004), triglyceride (TG) (200.93 ± 106.741 mg/dl vs. 183.75 ± 73.96, P = 0.001), waist circumference (WC) (101.25 ± 9.27 cm vs. 101.18 ± 8.63, P = 0.027), and grade of fatty liver in ultrasonography (P = 0.038), comparing to the placebo group. There was no significant difference between the two groups regarding serum levels of fasting blood sugar (FBS), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, and other outcomes. Conclusion P. major supplementation with a daily dose of 2 g for 12 weeks improved serum levels of ALT, AST, and TG in patients with NAFLD. Further studies with a larger sample size are recommended.

Pancreatic Steatosis Is Associated with Both Metabolic Syndrome and Pancreatic Stiffness Detected by Ultrasound Elastography.

There is increasing evidence that pancreatic steatosis (PS) is associated with metabolic syndrome (MS). However, it is not known whether it is associated with PS grade and pancreatic stiffness, or not. We aimed to evaluate the relationship between PS and its grade detected by transabdominal ultrasound, and pancreatic stiffness determined by two-dimensional shearwave elastography (2D-SWE), whether it has clinical significance and its relationship with MS. Patients with and without PS were evaluated prospectively. Patients with PS had higher odds ratio for MS (OR 5.49). Also, ultrasonographic grade of PS was associated with MS parameters and hepatosteatosis. Pancreatic SWE value was significantly higher in PS group and positively correlated with PS grade, liver fat, MS, number of MS criteria. PS and its grade were associated with MS. In this first comprehensive PS-SWE study, we found that pancreas stiffness increased in the presence of PS, in correlation with PS grade and MS.

Association between serum interleukin (IL)-12 level and severity of non-alcoholic fatty liver disease (NAFLD).

What is new? Serum IL-12 level is associated with NAFLD severity. Elevation in serum IL-12 level is in line with more severe NAFLD based on BARD score and NAFLD fibrosis score. Positive correlation is observed between serum IL-12 level and BARD score.Introduction. Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide. Lipid accumulation in the liver triggers inflammation and leads to NAFLD. Prolonged inflammation will worsen the disease progression. Pro-inflammatory cytokines, including interleukin (IL)-12, plays a role in the inflammatory process. This study aimed to determine the association between IL-12 and NAFLD severity.Methods. A cross-sectional study was conducted between January and July 2019 in Haji Adam Malik Hospital Medan, Indonesia. Subjects were patients aged 18 years or older diagnosed with NAFLD based on ultrasound. Exclusion criteria were excessive alcohol consumption, other primary liver diseases, malignancies, and cardio-metabolic disturbances. Serum IL-12 level was determined using an enzyme-linked immunosorbent assay method. The severity of NAFLD was assessed using the BARD score and NAFLD fibrosis score.Results. A total of 100 subjects were enrolled with male predominant. The mean age of subjects was 54.97 ± 8.85 years, and the most frequent comorbidity was obesity. Most subjects had mild to moderate disease progression. Serum IL-12 level was higher in more severe NAFLD based on ultrasound grading (P < 0.001), BARD score (P = 0.003), and NAFLD fibrosis score (P = 0.005). A positive correlation was observed between serum IL-12 level and BARD score (P < 0.001) with sufficient accuracy (AUC = 0.691, P = 0.014).Conclusion. Serum IL-12 level was associated with the severity of NAFLD. Higher serum IL-12 level was observed in more severe NAFLD progression.

STUDY ON EFFICACY OF ULTRASOUND AND FOB IN CONFIRMING THE PLACEMENT OF LARYNGEAL MASK AIRWAY

Ultrasound is a safe and non invasive technique for assessing the airway . In this observational study, 60 patients belonging to ASAClasses I and II scheduled for elective general surgery without any airway abnormality were included. Squared wave of capnogramTransverse neck ultrasound was performed using linear probe (8- 13Hz) started from hyoid bone (hyperechoic supercial inverted Ushaped linear structure)probe moved caudally with slight cephalad angle visualization of vocal cord &amp; arytenoids. The Ultrasound arytenoid grade had a signicant correlation with LMA rotation grade.The incidence of LMAMalposition by ultrasound was found to be 80% .With regard to the test performance ,US was found to have a sensitivity of 92%,with a positive predictive value of 94% to detect the LMA rotation of any number of degrees. The specicity was 62% with a negative predictive value of 55%. FOB Examination is the gold standard tool for conrmation of the correct placement of LMA. ,we evaluated USG as a tool to conrm the placement comparing with the FOB examinationThe FOB examination is invasive &amp; interrupts the ventilation during procedure. It cannot be done frequently intra-operatively compromising ventilation. These problems can be overcome by using ultrasound.USG detects the rotation of LMAeven if it is positioned at optimal depth thereby predicting the chance of dislodgement during the course of surgery.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis and Grading of Hepatic Steatosis in Patients With Non-alcoholic Fatty Liver Disease: Comparison With Ultrasonography and Magnetic Resonance Spectroscopy

Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of cirrhosis. Although magnetic resonance spectroscopy (MRS) is considered the gold standard, it has a few limitations. The role of diffusion-weighted imaging (DWI), which is a simpler sequence, in the diagnosis and grading of fatty liver is not well studied. The aim of the study was to investigate the value of DWI in the diagnosis and grading of hepatic steatosis in patients with NAFLD. Fifty-one adults (mean age: 38 years; 28 men, 23 women) with NAFLD, diagnosed clinically and by ultrasonography (USG), were included in the study after obtaining informed consent and approval from the institute ethics committee. USG was performed for grading of hepatic steatosis in all patients, followed by magnetic resonance imagingwith DWI and MRS, on a 1.5T scanner. The mean apparent diffusion coefficient (ADC) values and proton density fat fraction (PDFF) were calculated, and MRS was used as the gold standard. The mean ADC values were compared with the PDFF and USG grades. There was a weak correlation between ADC values and PDFF (r= -0.36; P < 0.05). In addition, there was a weak correlation between the ADC values of the liver and USG grade (r= -0.34; P < 0.05). However, an overall increase in USG grades and PDFF was associated with decrease in the mean ADC value (P < 0.001). DWI is not accurate in the diagnosis and grading of hepatic steatosis in patients with NAFLD. However, a significant increase in fat deposition in the liver lowers the ADC values.

Air bronchogram integrated lung ultrasound score to monitor community-acquired pneumonia in a pilot pediatric population

AimsChest ultrasound is a non-invasive method for evaluating children with suspected community-acquired pneumonia (CAP). We evaluated the prognostic role of change of ultrasonographic (US) air bronchogram in management of CAP in terms of: rate of complicated CAP, change of empiric antibiotic therapy, relationship to defervescence time, and length of hospitalization.MethodsPatients with CAP and radiographic evidence of lung consolidation were prospectively enrolled. Chest US examinations were performed within 12 h from admission and after 48 h. A new grading system (USINCHILD score) based on presence and features of air bronchogram was adopted.ResultsThirty six patients were stratified into two groups according to the presence of an increase of at least 1 grade of US score (Δ US grade), expression of an improvement of lung consolidation. Δ US grade after 48 h ≥ 1 was associated with an increased risk of complicated CAP (p value 0.027) and a longer defervescence time (p value 0.036). Moreover, Δ US grade ≥ 1 was predictive of a short hospitalization (p value 0.008).ConclusionsUSINCHILD score could be an innovative biotechnology tool for the management of pediatric CAP.Trial registration number and date of registrationNCT03556488, June 14, 2018.Graphic abstract

The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study

ObjectivesDespite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. MethodIn an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. ResultsOf 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007).At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. ConclusionsOnly moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD.

Doppler Ultrasound in Prostate Cancer: It’s Utility for the Diagnosis of High-Grade Tumors

Purpose: The aim of the present study was to evaluate the association between prostate vascularization seen in Doppler ultrasound and histopathological grade (Gleason score) in patients with a diagnosis of prostate cancer. Methods: A Gleason score &gt;7 was the dependent variable and Doppler ultrasound findings (vascular analysis, presence of nodule and prostate weight) were the independent variables. Univariate analysis was performed considering advanced tumors (Gleason &gt;7) as the dependent variable and area of hypervascularization, age and PSA as the independent variables. Multivariate analysis was performed using a binary regression model with the occurrence of advanced tumors (Gleason &gt;7) as the dependent variable. Results: In the univariate analysis, samples with Gleason ≤7 had a lower chance of being hypervascularized (OR: 0.44, 95% CI: 0.29-0.69), whereas those with Gleason scores &gt;7 had a fourfold greater chance of being hypervascularized (OR: 4.136, 95% CI: 2.598-6.554, p&lt;0.001). Moreover, hypervascularized tumors had a 7.4-fold greater chance of having a score &gt;7. Conclusion: The present study reveals an association between tumor hypervascularization detected using Doppler ultrasound and higher Gleason scores (more aggressive tumors), enabling an indirect inference of a worse prognosis for hypervascularized prostatic tumors. These findings should be confirmed in longitudinal studies.