Afra Alkan

Diagnostic accuracy of Thyroid Imaging Reporting and Data System in the prediction of malignancy in nodules with atypia and follicular lesion of undetermined significance cytologies

Thyroid Imaging Reporting and Data System (TIRADS) is a simple and reliable reporting system for the prediction of malignancy. We aimed to determine the role of TIRADS in the prediction of malignancy in subcategories of Bethesda Category III, atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS).

Assessment of serum thiol/disulfide homeostasis in multiple myeloma patients by a new method.

Objectives: The etiology of multiple myeloma (MM) is not exactly known. This study investigated the role of thiol/disulfide homeostasis in the etiopathogenesis of MM. Methods: Some 50 patients with MM (aged 39–84 years) and 50 sex-matched healthy volunteer controls (aged 50–91 years) participated in this study. Venous blood samples were collected, and levels of native thiols, total thiols, and disulfide were measured. Results: Native and total thiol levels in the control group were determined to be higher than in the study and patient groups (P<0.001). Disulfide levels were found to be higher in the control group than in the study group and higher in newly diagnosed patients than in outpatients who were undergoing treatment (P=0.002). The ratios of thiol levels were found to be similar in both the study and control groups (P>0.05). Discussion: The results of the study show that although there was a decrease in the levels of disulfide, native thiol, and total thiol, the balance of thiol/disulfide was maintained. This is the first study to research the homeostasis of dynamic thiol/disulfide from the perspective of the new method that was used. We hope that this study will encourage and facilitate further studies in this area.

ADAMTS-3, -13, -16, and -19 levels in patients with habitual abortion

A disintegrin‐like and metalloproteinase domain with thrombospondin‐type 1 motifs (ADAMTS) protein superfamily includes 19 secreted metalloproteases. Proteolytic substrates of ADAMTS enzymes have been linked to reproductive function. The aim of this study was to investigate serum ADAMTS‐3, ‐13, ‐16, and ‐19 levels in women with habitual abortions compared with those in healthy controls. A total of 86 women were enrolled in this prospective case‐control study. ADAMTS‐3, ‐13, ‐16, and ‐19 values were recorded and analyzed in association with demographic and clinical parameters. There were no statistically significant differences between the two groups in terms of demographics. No statistically significant differences were observed between the groups with regard to ADAMTS‐13 and ‐19 levels (p > 0.05). However, ADAMTS‐3 and ‐16 were significantly higher in the study group than in the control group (p = 0.004 and p = 0.005, respectively). To estimate habitual abortions using an area under receiver operating characteristic curve analysis, the cutoff values for ADAMTS‐3 and ‐16 were found to be 87.28 ng/mL (sensitivity, 64.44%; specificity 68.29%) and 15.75 ng/mL (sensitivity, 66.67%; specificity 68.29%), respectively. In conclusion, the pregnancy‐loss rate seems to be affected by both ADAMTS‐3 and ‐16.

Neutrophil to lymphocyte ratio--not an independent prognostic factor in patients with the myelodysplastic syndrome.

PURPOSE Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). MATERIALS AND METHODS Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. RESULTS The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). CONCLUSIONS This first study of NLR and mortality did not show any significant correlation . In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than 50?109/l may be poor prognostic markers in MDS patients.

The Association Between Serological Markers of Celiac Disease and Idiopathic Recurrent Pregnancy Loss

ABSTRACT Introduction: Antiphospholipid syndrome, uterine anomalies, and chromosomal aberrations are identifiable causes of recurrent pregnancy loss (RPL). Herein, our aim is to investigate the relationship between celiac disease (CD) specific antitransglutaminase antibodies (ATA) and unexplained RPL. Materials and Methods: This was a cross sectional case-control study conducted on 86 women (45 RPL and 41 controls) in a tertiary level maternity hospital. Elisa kit was used to determine ATA IgA and IgG levels. Results: One (2.2%) patient with ATA IgG positivity was present in the RPL group. There were three (7.3%) cases with positive for ATA IgA in the control group, and one (2.2%) case in the study group. No statistically significant differences were observed between the groups in terms of ATA IgG and IgA. Conclusion: There is no association between CD markers and unexplained RPL. For the present, we do not recommend screening for ATA IgA and ATA IgG in patients with a history of RPL.

Paraoxonase and arylesterase activities in adults with vitamin B12 deficiency

Objective: The purpose of this study was to investigate paraoxonase (PON) and arylesterase (ARES) enzyme activity in adults with vitamin B12 deficiency, and specific changes in the activities of these enzymes following vitamin B12 treatment. Methods: A total of 46 patients with vitamin B12 deficiency (aged 18–82 years) and 45 healthy volunteer controls (aged 19–64 years) participated in this study. Venous blood samples were collected, and serum vitamin B12, homocysteine (HCY), methylmalonic acid, PON1, and ARES levels were measured. Results: Paired comparison showed that pre- and post-treatment values for PON and ARES were similar between patients and controls (both P > 0.05). There was no statistically significant relationship between patients’ pre-/post-treatment PON or HCY levels and serum vitamin B12 levels, compared with those of the control group (P > 0.05). Discussion: The results of the present study do not support the hypothesis that the antioxidant enzymes PON and ARES have an underlying role in vitamin B12 deficiency and related hyperhomocysteinemia. Our findings suggest that PON and ARES do not play a role in the systemic effects of vitamin B12 deficiency.

Elastosonographic evaluation of patients with a sonographic finding of thickened endometrium

OBJECTIVE To evaluate if elastosonography of the endometrium can differ between normal endometrial tissue and abnormal pathology. STUDY DESIGN One hundred and six women with a sonographic finding of thickened endometrium were enrolled in this study. All patients underwent B-mode scanning and elastosonography, performed by the same operator who was blinded to the study design. After sonographic evaluation, all patients underwent endometrial tissue sampling via dilatation and curettage. Histopathological results indicated that 22 patients had endometrial hyperplasia, 20 patients had endometrial polyps, and 64 patients had normal pathology results, with or without abnormal uterine bleeding. Groups were formed according to histopathological results, and ultrasonographic findings (strain ratio, endometrial thickness) were compared. RESULTS Median age was 46 [interquartile range (IQR) 4] years, 37 (IQR 10) years and 36 (IQR 10) years for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively. Median age of the endometrial hyperplasia group was significantly higher compared with the endometrial polyps and normal pathology groups (p<0.001). Median parity was 3 (IQR 2), 2 (IQR 1) and 3 (IQR 1) for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively; differences between the groups were not significant (p=0.102). No differences were found between the groups in terms of endometrial thickness (p>0.05). When elastosonographic strain (B/A) ratios were compared between the groups, the endometrial hyperplasia and endometrial polyps groups had significantly lower B/A ratios (higher elasticity) than the normal pathology group (p<0.001). There was no significant difference in B/A ratios between the endometrial hyperplasia and endometrial polyps groups (p>0.05). CONCLUSION The elasticity of endometrial tissue, measured non-invasively via elastosonography, was similar in women with endometrial polyps and endometrial hyperplasia, but differed significantly compared with women with normal pathology who had a sonographic finding of thickened endometrium and abnormal bleeding as the presenting complaint. According to these results, elastosonography cannot be used as a diagnostic tool to differentiate between endometrial hyperplasia and endometrial polyps. However, elastosonography can be used to differentiate between pathological endometrial changes and normal endometrium in patients presenting with a sonographic finding of thickened endometrium.

Psoriasis management in actual clinical practice: a 6-year retrospective study of 845 patients

Abstract Background: Over the past years, with the availability of relatively well tolerated, very effective but expensive drugs, biologics, treatment of psoriasis has dramatically shifted from inpatient modalities to outpatient ones. Relatively little is known about true life practices regarding psoriasis treatment in our country. Aims: To assess the impact of introduction of conventional drugs and biological drugs on medical resource use of psoriasis patients. Study design: A retrospective chart review was performed. Methods: Patients with the diagnosis of psoriasis who were seen in the period between 2010 and 2015 were included in the study. Data including hospital resource use (inpatient, outpatient, day ward) and treatment modalities were collected. Results: The study population comprised 845 patients with 1053 different treatment modalities. There was not any significant difference between number of in-hospital days and frequency of hospitalization between biological drugs and cyclosporine. There was significant (p < .05) decline in the length of hospitalization after the year 2012 in biological treatment group. Conclusions: Treatment of MSP with classical drugs requires fairly similar medical resource expenditures as biologics.

Factors causing occurrence of artificial dif: A simulation study for dichotomous data

ABSTRACT In modern test theory, differential item functioning (DIF) appears where respondents from two different groups have the same ability but different probability to respond to an item correctly. If some items favouring one group lead to the appearance of DIF in any other item favouring the other group, this type of problem is called artificial differential item functioning (A-DIF). The purpose of this paper is to deal with the effect of different factors causing A-DIF under the Rasch theoretical model for dichotomous responses. A simulation study was conducted to explore how various factors affect real DIF and simultaneous A-DIF expected proportion including total sample size, percentage of individuals in focal and reference groups, percentage of items exhibiting real DIF and DIF magnitude for two item sets including 10 and 20 items. It is concluded that DIF magnitude is the most essential factor while evaluating A-DIF for each item set. This is followed by percent of items exhibiting real-DIF.

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

Background/aim: This study aimed to evaluate the impact of body fat distribution measured by body mass index (BMI), waist circumference (WC) and Pfannenstiel incision site tissue thickness, and elastosonography on bleeding and operation time during cesarean delivery.Materials and methods: A prospective study was made of 52 healthy, term pregnant women with prior cesarean deliveries. The impact of BMI, WC, incision site thickness, and elastosonography on preoperative and postoperative differences in hemoglobin (Hb) and hematocrit (Htc) levels and operation times was evaluated.Results: A moderate negative relationship was found between Htc levels and WC. Htc levels were found to decrease by 0.148 units for each 1-cm increase in WC. Skin-to-fascia time was found to increase by 0.697 s with each 1-unit increase in BMI, whereas fascia-to-uterus time was found to increase by 1.117 s with each 1-cm increase in Pfannenstiel site tissue thickness. None of the elastosonographies or differences in Hb levels were found to be significant for any parameter.Conclusion: Each of the evaluated parameters was found to have an impact on different factors: WC on Htc levels, BMI on skin-to-fascia time, and Pfannenstiel tissue thickness on fascia-to-uterus time.