Elastosonographic Evaluation of Endometrium in Postmenopausal Bleeding

OBJECTIVE: The aim of this study was to evaluate the elastosonographic changes of endometrium in postmenopausal women with uterine bleeding. STUDY DESIGN: A total of 80 women in their postmenopausal period were enrolled for the study; 19 with postmenopausal bleeding and 61 normal healthy controls. All patients with a history of previous uterine surgery (including myomectomy) and/or endometrial interventions such as endometrial ablation, polyp removal, hysteroscopic interventions (except solely diagnostic procedures) and endometrial sampling within one year were excluded from the study because of the possibility of endometrial changes that may interfere with elastosonographic starin ratios. B-mode scanning, Doppler and real-time tissue elastography (RTE) were performed by the same single operator, blinded to the study design. The ultrasonographic findings (strain ratio, endometrial thickness, uterine artery Doppler indices) were evaluated between groups. RESULTS: The means of age were 57.84±5.36 years and 56.34±3.32 years for the study group and the controls respectively. The groups were similar in regard to age (p=0.328). The parity of the postmenopausal bleeding group was significantly higher than the controls (p<0.001). When uterine artery Doppler indices were compared between groups, study group was found to have lower values in regard to controls (p<0.001). The medians of endometrial thickness were 4.30 (IQR=3.80)mm in the study group and 2.60 (IQR=0.90) mm in the control group and the difference was found to be significant (p<0.001). The medians of elastosonographic B/A ratios were 0.98 (IQR=0.18) and 1.27 (IQR=1.78) for the study group and controls respectively. The B/A ratios were found to be significantly lower in the study group (lower tissue elasticity) (p<0.001). CONCLUSION: Tissue biopsy for histopathologic evaluation is still the gold standart in cases with postmenopausal bleeding. However, the need for a noninvasive method with high sensitivity and specificity is still under search. Some women who had been offered biopsy but did not accept the intervention because of the invasive nature of the procedure will be eft undiagnosed for a possible malignancy. Evaluation of the endometrium with real-time tissue elastosonography is one of the noninvasive methods with this potential and the diagnostic value of RTE could be possible with multicentric studies including more subjects

Diagnostic Value of Elastosonographic Evaluation of Cervix in Idiopathic Recurrent Spontaneous Miscarriage in the First Trimester

Aim: To detect prognostic role of cervical elastosonography (ES) among women with a history of idiopathic recurrent spontaneous miscarriage (IRSM) in early pregnancy. Methods: There were 40 women enrolled in the study. Of the 40, 20 were women diagnosed with IRSM in the first trimester and 20 were healthy women who had at least one childbirth experience. All patients underwent ES evaluation of the cervix. Strain ratio values of certain cervical tissue were recorded for all women. Results: The results of elastosonographic measures showed that external part of the upper lip of the cervix was significantly softer than the internal part and lower lip in women with IRSM. However, for women who had not experienced miscarriage, the results were not different. There were no significant differences observed between cervical length and elasticity among either group. Conclusion: Although we found that Region A was softer than Region C and D in women with IRSM, we also found similar results for women who have not experienced miscarriage. Our results support that cervical elasticity may not play a central role in the detection of etiopathogenesis of IRSM. Further studies with larger groups are needed

Membranous nephropathy in Turkey: Turkish society of nephrology glomeruler diseases (TSN-Gold) database results

...ERA EDT

Clinical and pathologic features of primary membranous nephropathy in Turkey: A multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group

Background: We aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people. Methods: This is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed. Results: A total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m2 (IQR, 75.4–116.3), and median proteinuria was 6000 mg/d (IQR, 3656–9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed. Conclusions: Despite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people

The Score for Allergic Rhinitis study in Turkey, 2020

International audienceObjective: This study aimed to determine how prevalent allergic rhinitis (AR) is in Turkey and to compare the current prevalence with the figures obtained 10 years earlier.Methods: This study included 9,017 participants. The minimum number of participants required from each center was determined via a stratified sampling technique according to regional demographic characteristics as ascertained from the last census. For each region, both men and women were administered the score for allergic rhinitis (SFAR) questionnaire and a score for each participant was calculated based on the responses supplied.Results: A total of 9,017 individuals (55.3% men and 44.7% women) took part in this study. Of these, 94.4% were urban residents and 5.6% lived in a rural setting. Of the men, 38.5% self-reported as suffering from AR. The corresponding figure in women was 40.5%. The overall prevalence of AR, as deduced on the basis of the SFAR, was found to be 36.7%. Comparing the prevalence in different regions, we found that AR was the least prevalent in the Black Sea region with a frequency of 35.8%. The highest prevalence was in the Mediterranean region, where the prevalence was 37.7%. There was no statistical significance in the apparent differences in prevalence between different geographical regions. Despite this, however, there was a clear increase in the frequency of AR over the preceding decade. This increase was most pronounced in the South-Eastern Anatolian region, where the frequency rose from 21.0% to 36.9%.Conclusion: Our results indicate that there has been a marked increase in the prevalence of AR in every region in Turkey over the last 10 years. This could be related to living conditions in urban environments. Alterations in lifestyle, urban living, air pollution causing impairments in immune defense mechanisms, and other aspects of modern lifestyles may account for the increase in AR in Turkey