Discriminative capacity of volumetry by CT scan to identify autonomous cortisol secretion in incidental adrenal adenomas

Context Incidentally discovered adrenal adenomas are common. Assessment for possible autonomous cortisol excess (ACS) is warranted for all adrenal adenomas given the association with increased cardiometabolic disease. Objective To evaluate the discriminatory capacity of three-dimensional volumetry on computed tomography (CT) to identify ACS. Design, Setting, Patients Two radiologists, blinded to hormonal levels, prospectively analyzed CT images on 149 adult patients with unilateral, incidentally-discovered, adrenal adenomas. Main Outcome Measures Diameter and volumetry of the adenoma, volumetry of the contralateral adrenal gland, and the adenoma volume-to-contralateral gland volume (AV/CV) ratio were measured. ACS was defined as cortisol≥1.8 mcg/dL after 1mg dexamethasone suppression test (DST) and a morning ACTH ≤15 pg/mL. Results We observed that ACS was diagnosed in 35 (23.4%) patients. Cortisol post-DST was positively correlated with adenoma diameter and volume, and inversely correlated with contralateral adrenal gland volume. Cortisol post-DST was positively correlated with the AV/CV ratio (r=0.46, p<0.001) and ACTH was inversely correlated (r=-0.28, p<0.001). The AV/CV ratio displayed the highest Odds Ratio (1.40 CI 95% 1.18-1.65) and area under curve (0.91 CI 95% 0.86-0.96) for predicting ACS. An AV/CV ratio ≥1 (48% of the cohort) had a sensitivity of 97% and a specificity of 70% to identify ACS. Conclusions CT volumetry of adrenal adenomas and contralateral adrenal glands has a high discriminatory capacity to identify ACS. The combination of this simple and low-cost radiological phenotyping can supplement biochemical testing to substantially improve the identification of ACS.

Precocious puberty: diagnosis and management

Precocious puberty is commonly defined as puberty that starts before age 8 years in girls and 9 years in boys. The causes of it may range from a variant of normal development to various pathologic conditions. The etiology of precocious puberty is classified by the underlying pathogenesis into gonadotropin dependent central precocious puberty and peripheral precocious puberty which is independent of gonadotropin but due to different other causes. Variants of precocious puberty include premature thelarche, premature puberche and isolated premature menarche which imply onset of isolated changes without any other signs of sexual development. Precocious puberty might have an impact on final stature owing to premature epiphyseal fusion and also it has got influence on psychosocial wellbeing. Evaluation includes a detailed history, physical examination, biochemical testing and imaging directed towards suspected etiology. Gonadotropin releasing hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the specific cause. Pubertal variants are usually non-progressive and need no treatment but should be monitored carefully. BIRDEM Med J 2022; 12(1): 62-69

Diversity of Bacillus spp. from soybean phyllosphere as potential antagonist agents for Xanthomonas axonopodis pv. glycines causal of pustule disease

Nurcahyanti SD, Wahyuni WS, Masnilah R, Nurdika AAH. 2021. Diversity of Bacillus spp. from soybean phyllosphere as potential antagonist agents for Xanthomonas axonopodis pv. glycines causal of pustule disease. Biodiversitas 22: 5003-5011. Pustule disease caused by Xanthomonas axonopodis pv. glycines (Xag) is an important disease in soybean. Bacteria from soybean phyllosphere is one of the potential biological agents against this disease. This is because the microorganisms have similarity. This study aimed to determine the diversity and species of bacteria from the soybean phyllosphere that have potential as biological agents. The research was carried out by morphological observation, physiological - biochemical testing, and molecularly with BOX AIR primer. Molecular identification was carried out by amplifying the 16S-rRNA gene with 27F and 1492R primers. The results showed that 11 isolates could inhibit Xag in vitro which showed morphological, biochemical, and molecular diversity. These bacteria were identified as Bacillus spp. which consisted of 4 groups, namely Bacillus siamensis, B. subtilis. B. amyloliquifaction and B. velezensis. The diversity of phyllosphere bacteria allows them to be used as biological agents because they do not inhibit each other and have diverse living abilities in various environmental conditions.

Detection of Salmonella sp. on Bulk Meatballs and Packaged Meatballs at Sepanjang Market, Sidoarjo

Background: Bacterial contamination in food can cause congenital diseases in the form of infections. Meatballs are one of the foods that are in demand by the public and foods that can be contaminated with salmonella bacteria. Detection of Salmonella sp bacteria can determine the quality of bulk meatballs and packaged meatballs. Salmonella sp bacteria should not contaminate the meatballs according to the quality requirements of the BSNI (Badan Standarisasi Nasional Indonesia). Purpose: To determine the contamination of Salmonella sp bacteria in bulk meatballs and packaged meatballs sold at Sepanjang market, Taman District, Sidoarjo Regency. Methods: The Salmonella sp. test on meatballs was carried out in four stages, pre-enrichment using Buffered Pepthone Water solution, enrichment using Tetrathionate Brothbase solution, isolation using Salmonella Shigella Agar media, and biochemical testing using Triple Sugar Iron Agar media. The samples used were 10 samples each. Result: The test proved that 20% of the samples were positively contaminated with Salmonella sp. both on bulk meatballs and on packaged meatballs. Conclusion: Food hygiene and sanitation must be applied properly and correctly in every process because food products circulating in public, especially meatball products, can avoid microbial contamination and be safe for consumption.

Research work at the Center for Personalized Precision Medicine of Tuberculosis (cPMTb)

Tuberculosis (TB) is a leading cause of death worldwide and South Korea has the highest incidence and mortality rate of the disease of all the OECD countries. Professor Jae-Gook Shin is a pharmacologist based at the Center for Personalized Precision Medicine of Tuberculosis (cPMTb), which was established based on the premise of adopting a personalised approach to TB prevention and treatment. A key focus for Shin and his collaborators is personalised precision treatment and monitoring of TB patients, with 67 professors and clinicians from 20 clinical research cohort sites in the Republic of Korea involved in this pursuit. cPMTb has 30 years' personalised precision medicine R&D experience behind it. In their work, the researchers are using model-informed precision dosing to allow for the initial dose suggestion and then a dose adjustment during treatment for TB. Their personalised approach involves the use of epidemiological and clinical information, biochemical testing and genetic profiles of individuals. The goal is to improve the effectiveness of treatment and also reduce adverse drug reactions. A 'bench-to-bedside' approach is taken, with cPMTb's central laboratory facilitating in vitro and in vivo drug absorption, distribution, metabolism and excretion (ADME) studies as well as genotyping. This has meant that the researchers have been able to validate the role of NAT2 and SLCO1B1 variants in the cPMTb cohort. The team has been successful in establishing a hollow fibre infection model for TB research and will expand this work to support personalised dosing using clinical isolates.

Characterization of a New L-Glutaminase Produced by Achromobacter xylosoxidans RSHG1, Isolated from an Expired Hydrolyzed L-Glutamine Sample

As significant biocatalyst, L-glutaminases find potential applications in various fields, from nourishment to the pharmaceutical industry. Anticancer activity and flavor enhancement are the most promising applications of L-glutaminases. In this study, L-glutaminase was isolated and purified from an old glutamine sample. A selected bacterial isolate was characterized taxonomically by morphological characters, biochemical testing and 16S rDNA sequence homology testing. The taxonomical characterization of the isolate identified it as Achromobacter xylosoxidans strain RSHG1. The isolate showed maximum enzyme production at 30 °C, pH 9, with Sorbitol as a carbon source and L-Glutamine as a nitrogen and inducer source. L-Glutaminsae was purified by using column chromatography on a Sephadex G-75. The enzyme has a molecular weight of 40 KDa, pH optimal 7 and is stable in the pH range of 6–8. The optimum temperature for the catalyst was 40 °C and stable at 35–50 °C. The kinetic studies of the purified L-glutaminase exhibited Km and Vmax of 0.236 mM and 443.8 U/mg, respectively. L-Glutaminase activity was increased when incubated with 20 mM CaCl2, BaCl2, ZnSO4, KCl, MgSO4 and NaCl, whereas EDTA, CoCl2, HgCl, ZnSO4 and FeSO4 decreased the activity of the enzyme. The addition of 8% NaCl enhanced the glutaminase activity. L-Glutaminase immobilized on 3.6% agar was stable for up to 3 weeks.

Differences in clinical presentation and management between pre- and postsurgical diagnoses of urinary bladder paraganglioma: is there clinical relevance? A systematic review

Purpose Paraganglioma of the urinary bladder (UBPGL) is a rare neuroendocrine tumor diagnosed in many patients only after surgery. We, therefore, assessed clinical clues relevant to presurgical diagnosis and clinical consequences in patients with a missed presurgical diagnosis of UBPGL. Materials and methods Case reports describing a UBPGL (published from 1–1–2001 and 31–12–2020) were identified in Pubmed. Two authors independently performed data extraction and assessed data quality according to the PRISMA guideline. Patients were divided into two groups: UBPGL diagnosis before and after surgery. Results We included 177 articles reporting 194 cases. In 90 (46.4%) patients, the UBPGL was diagnosed before and in 104 (53.6%) after surgery. In presurgically diagnosed UBPGL, hypertension and catecholamine-associated symptoms were 2- to 3-fold (p < 0.001) more frequent than in postsurgically diagnosed patients whereas hematuria was twofold (p = 0.003) more prevalent in those with postsurgical diagnosis. Hypertension was an independent factor for presurgical biochemical testing (OR 4.45, 95% CI 1.66–11.94) while hematuria (OR 0.23, 95% CI 0.09–0.60) was an independent factor for not performing presurgical biochemical testing. Most patients diagnosed after surgery were not pretreated with alpha-adrenoceptor blockade (95.2%), underwent more frequently transurethral resection instead of cystectomy (70.2% vs. 23.1%) and had more frequent peroperative complications and residual tumor mass. Conclusions In nearly half of all patients with a UBPGL, the diagnosis was not established before surgery. Hypertension and hematuria contributed independently to a presurgical diagnosis. Postsurgical diagnosis, which was associated with suboptimal presurgical and surgical management, resulted in more peroperative complications and incomplete tumor resections.

Primary hyperparathyroidism misdiagnosed as metastatic disease, with trans-oral endoscopic surgical management

Primary hyperparathyroidism is not so uncommon a disease. In high-income countries, with the introduction of routine biochemical testing in 1980s, it is diagnosed early, and the majority are seen as asymptomatic disease. However, in India, a severe symptomatic form is still seen, and many times patients are undiagnosed, thus continuing to suffer debilitating disease. Here, we report such a patient who was being treated as having bony metastases from an unknown primary source, when in fact he had osteitis fibrosa cystica due to primary hyperparathyroidism and was cured after surgery.