Risk factors for idiopathic granulomatous mastitis recurrence after patient-tailored treatment: Do we need an escalating treatment algorithm?

Objective: Idiopathic granulomatous mastitis (IGM) is a rare, relapsing, benign inflammatory breast disease. Due to the conflicting etiology and differential diagnosis, the effect of varied treatment regimens on high recurrence is controversial. Therefore, we aimed to report our clinical experience in determining risk factors for recurrence after patient-tailored treatment. Methods: This study evaluated 122 patients diagnosed with IGM according to sociodemographic characteristics, reproductive history, clinical presentation, time of diagnosis and radiological examinations, treatment management, and outcomes. The patients were classified into three groups based on curative treatment settings: medical therapy alone, surgery alone, and combined therapy. Results: The rates of patients receiving medical therapy alone, surgical therapy alone, and combined therapy were 23, 15.6, and 62.4%, respectively. Low vitamin B-12 levels, accompanying rheumatological disease, complaints-fistulae, number of complaints >= 3, presence of erythema nodosum, multicentricity, and treatment modality had a significant effect on disease recurrence (p = 3 complaints, 2 times greater for the presence of multicentricity, 2.3 times greater for the presence of erythema nodosum, and 4.5 times greater for the patients receiving medical therapy alone. Conclusion: Describing a low-risk patient profile can be an alternative while choosing monotherapy methods. For IGM patients at high risk of recurrence, an escalating treatment system may be effective in preventing relapses

Anesthesia Management in Total Hip Replacement

Hip fracture is usually seen in advanced age. Due to the presence of metastases in elderly patients, the density of bones decreases, and the possibility of fracture increases. Cytokines, released from osteoclasts resulting in post-bony destruction, cause pain by activating pain receptors; hence, pain-related motion restriction may occur. Bone marrow suppression and medulla spinalis pressure may be seen in metastatic bone tumors. Three major complications can be observed in hip fracture operations: (1) perioperative bleeding, (2) bone cementum implantation syndrome and (3) thromboembolism. These indicate superiority of general anesthesia: 1 –controlled respiration. 2 –Invasive interventions to be performed during shock treatment can be made more easily and smoothly. 3 – The safest way to ensure that patients remain immobilized on the operating table. 4 – Hemodynamic parameters can be better controlled. Regional anesthesia has benefits such as allowing early mobilization and postoperative pain control and few complications such as hypoxia, deep vein thrombosis and consciousness blurring. Various regional anesthesia methods such as spinal, epidural, combined spinal-epidural and peripheral nerve blocks are applied. The knowledge and experience of the anesthetist, the general condition and the mental state of the patient, the skill of the surgeon and the type of surgery determine the type of the anesthesia

Biofilm forming capacity and antibiotic susceptibility of Staphylococcus spp. with the icaA/icaD/bap genotype isolated from ocular surface of patients with diabetes

IntroductionBacterial biofilm is an exopolysaccharide matrix that is produced by bacteria while they adhere on abiotic or biotic surfaces. The bacteria living in this matrix are more resistant to antibiotics than planctonic bacteria. The biofilm formation property of the bacteria is determined by genes; and this is related to virulence of the microorganism. In ophthalmology, biofilms form especially on abiotic surfaces such as silicon tubes, contact lenses, intraocular lenses etc. AimOur aim was to investigate genotypic and phenotypic structures of biofilms that are produced by Staphylococcus spp., which was obtained from the eyes of diabetic patients and determine the effect on antibiotic susceptibility.MethodsThe study group was comprised with 83 isolates from diabetic patients and 21 isolates from non-diabetic patients. Presumptive isolates were detected and confirmed by a microbial identification system VITEK II. Automated EcoRI Ribotyping was performed. Biofilm production was detected by Congo Red Agar Plate and Microtiter Plate Assay. Disc diffusion method was used for determination of antibiotic susceptibility of isolates. ResultsOut of the 83 isolates from diabetic patients, 25 were weakly (30%), 20 were moderately (24%), and 25 were strongly (30%) biofilm positive. Seven isolates of S. aureus, 11 isolates of S.epidermidis, 2 isolates of S. warneri, 3 isolates of S.hominis, and 2 isolates of S.lugdunensis were identified as strong biofilm producers. Out of the 83 Staphylococcus isolates, 37 were cefuroxime, 18 ciprofloxacin, 11 vancomycin, 12 gatifloxacin, and 18 moxifloxacin resistant. In total, 37 strains were resistant to three or more antibiotics. There was a statistically significant relation between biofilm formation and multidrug resistance (against three or more antibiotics,p<0.001). In nondiabetic patients, 15(71%) isolates were non adherent or weakly adherent, and 2(10%) were strongly adherent biofilm positive. ConclusionIn conclusion, bacterial conjunctival flora of patients with diabetes is likely to produce biofilm. Biofilm formation is associated with multidrug rsistance in patients with diabetes

Rutin check-up muayenesi ile insidental tiroid nodulü ve tiroid kanseri saptanma oranı: Tek merkezli çalışma

Objective: Check-up examinations have gained importance in the last decade and become a common reason for people to refer to healthcare institutions to seek medical help. Thyroid nodules are frequently detected during check-up examinations. This study aimed to determine the frequency of thyroid nodules and the rate of thyroid cancer development in patients presenting for a check-up and to define the role of variables in thyroid cancer detection. Method: The computer database of the patients, who applied for a check-up examination, was systematically screened, and the records of thyroid ultrasonography (US) were accessed. Patients with any known history of thyroid disease or thyroid cancer and those using medication for an existing thyroid disease were excluded. The demographic data, thyroid US reports, cytology and histopathology results, and free t3 (fT3), free t4 (fT4), and thyroid-stimulating hormone (TSH) levels were evaluated and recorded. Body mass index (BMI) was calculated. Data were analyzed using SPSS v. 25. Results: Of the 30,449 check-up patients, 24,362 were evaluated. Incidental thyroid nodules were detected in 5.645 (23.17%) patients. The mean BMI of these patients was 56±2.01 kg/m², and their mean TSH, fT3 and fT4 values were 2.87±0.45 mIU/mL, 3.76±0.87 pg/mL and 1.23±0.24 pg/mL, respectively. The mean nodule size was 1.31±0.56 mm. While 2.936 (52.01%) of the nodules were solid, 1.377 (24.39%) were cystic and 1.332 (23.59%) were mixed. Of all the nodules, 1.916 (33.94%) were in the TIRADS 2 category, 3.273 (57.98%) in the TIRADS 3 category, 234 (4.31%) in the TIRADS 4a category, 114 (1.27%) in the TIRADS 4b category, 72 (1.27%) in the TIRADS 4c category, and 36 (0.63%) in the TIRADS 5 category. For 392 patients that underwent a biopsy, the results were reported as benign for 224 (57.14%), suspected malignancy for 100 (25.51%), and malignant for 68 (17.34%). The rates of patients diagnosed with papillary, follicular and medullary thyroid cancers were 63.15%, 34.21% and 2.63%, respectively. When the multinominal logistic regression analysis was applied to all significant variables in the univariate analysis, the risk of thyroid cancer was increased 1.7-fold by increased BMI [odds ratio (OR): 1.71, 95% confidence interval (CI): 1.43-2.96], 1.8- fold by female gender [OR: 1.79, (CI): 1.21-2.67], 1.6-fold by solid structure nodule type [OR: 1.62, (CI): 1.27-3.54], 2.7-fold by increased nodule size [OR: 2.71, (CI): 1.11-3.31], and 4.7-fold by increased TIRADS [OR: 4.73, (CI): 1.76-7.31]. Conclusion: The main difficulty in evaluating and managing thyroid nodules is to avoid the inappropriate overuse of thyroid US, thyroid biopsy, and surgery while trying to identify clinically significant malignant nodules. Concerning the diagnosis of thyroid cancer through a checkup examination, the data obtained as a result of more detailed studies should be evaluated, and it should be kept in mind that the increase in the incidence of thyroid cancer in the last three decades may be due to not only overdiagnosis but also a real increase in incidence. However, considering that early diagnosis of thyroid cancer without lymph node involvement can reduce both surgical complications and prevent the risks of radioactive iodine treatment, it is concluded that thyroid cancer being detected at an early stage constitutes an important advantage for the healthy population undergoing a check-up.Amaç: Check-up muayeneleri son on yılda önem kazanmış ve tıbbi yardım isteme amaçlı sağlık kurumlarına başvuruların en yaygın nedenleri arasında yerini almıştır. Tiroid nodülleri, check-up muayenesi sırasında sıklıkla tespit edilmektedir. Çalışmamızın amacı, check-up muayenesine başvuran bireylerde tiroid nodülü sıklığını ve tiroid kanseri gelişme oranını belirlemek ve tiroid kanseri saptanmasında değişkenlerin rolünü tanımlamaktır. Yöntem: Check-up muayenesi için başvuran hastaların bilgisayar database kayıtları sistematik biçimde taranarak, tiroid ultrasonografisi (USG) yapılan hasta kayıtlarına erişildi. Öncesinde bilinen herhangi bir tiroid hastalığı veya tiroid kanseri öyküsü olan ve mevcut bir tiroid hastalığı için ilaç kullanan hastalar çalışma dışı bırakıldı. Hasta grubunun demografik bilgileri, tiroid USG raporları, sitoloji ve histopatoloji sonuçları ile serbest T3 (sT3), serbest T4 (sT4) ve tiroid stimulan hormon (TSH) düzeyleri değerlendirilerek kaydedildi. Vücut kitle indeksleri (VKİ) hesaplandı. Veriler, SPSS 25 istatistik paket programı ile analiz edildi. Bulgular: Otuz bin dört yüz kırk dokuz check-up hastasının 24.362’si değerlendirildi. Beş bin altı yüz kırk beş (%23,17) hastada insidental tiroid nodülü saptandı. Bu hastaların ortalama VKİ’si 56±2,01 kg/m², TSH değeri 2,87±0,45 mIU/mL, sT3 değeri 3,76±0,87 pg/mL ve sT4 değeri 1,23±0,24 pg/mL idi. Ortalama nodül boyutu 1,31±0,56 mm iken, nodüllerin 2,936’sı (%52,01) solid nodül, 1,377’si (%24,39) kistik nodül, 1,332’si (%23,59) mikst nodül olarak gözlendi. Nodüllerin 1,916’sı (%33,94) TIRADS 2, 3,273’ü (%57,98) TIRADS 3,234’ü (%4,31) TIRADS 4a, 114’ü (%1,27) TIRADS 4b, 72’si (%1,27) TIRADS 4c ve 36’sı (%0,63) TIRADS 5 kategorisindeydi. Biyopsi yapılan 392 hastanın 224’ünün (%57,14) sonucu benign, 100’ünün (%25,51) şüpheli malign ve 68’inin (%17,34) malign olarak raporlandı. Papiller tiroid kanseri tanısı konulan hastaların oranı %63,15, foliküler tiroid kanseri %34,21 ve medüller tiroid kanseri %2,63 olarak tespit edildi. Univariate analizlerde anlamlı bulunan tüm değişkenlere multinominal lojistik regresyon analizi uygulandığında artan VKİ’nin 1,7 kat [olasılık oranı (OO): 1,71, %95 güven aralığı (GA): 1,43-2,96], kadın cinsiyetin 1,8 kat [OO: 1,79, (GA): 1,21-2,67], solid nodül yapısının 1,6 kat [OO: 1,62, (GA): 1,27-3,54], artan nodül çapının 2,7 kat [OO: 2,71, (GA): 1,11-3,31], ve artan TIRADS skorunun 4,7 kat [OO: 4,73, (GA): 1,76-7,31] tiroid kanseri gelişimini artırıcı etkisi olduğu tespit edildi. Sonuç: Tiroid nodüllerini değerlendirme ve yönetmedeki ana zorluk bir yandan tiroid US, tiroid biyopsisi ve cerrahinin uygunsuz aşırı kullanımından kaçınırken, diğer yandan klinik olarak önemli malign olanları tanımlamaya çalışmaktır. Check-up muayenesi ile tiroid kanseri tanısı koyma ile ilgili olarak, daha ayrıntılı çalışmaların sonucunda elde edilen veriler değerlendirilmeli ve son otuz yılda tiroid kanseri insidansının artmasının sadece aşırı tanıdan değil, gerçek bir insidans artışından kaynaklanabileceği akılda tutulmalıdır. Öte yandan lenf nodu tutulumsuz erken tanı tiroid kanseri ile hem cerrahi komplikasyonların azaltılabileceği hem de radyoaktif iyot tedavisinin risklerinden korunabileceği göz önünde bulundurulduğunda, evrece erken yakalanmış tiroid kanserlerinin, checkup amacıyla başvuran sağlıklı popülasyon için önemli bir avantaj olduğu kanısına varılmıştır

Examination of Routine Activities Theory by the property crime

The studies on crime prevention, causes of crime and the theories associated with it are very essential topics in criminology. Routine Activities Theory (RAT) is also the basis for the many criminological theories. Although it has some shortcomings it is very usual that the theorists and practitioners on crime prevention can benefit from such a strong theory. This study explains the applicability of Routine Activities Theory in prevention and reducing of property crimes in the context of some parameters related to burglary and auto theft incidents in US. The study aims to give some information of the routine activity theory and investigate its relationship with prevention of property crimes. The results of study suggest that Routine Activity Theory may be used as a useful tool by crime reduction or prevention practitioners to evaluate crime problems and also take routine precautions and measures that reduce crime opportunities in people’s daily activities

Crime Mapping and Geographical Information Systems in Crime Analysis

As essential apparatus in crime analysis, crime mapping and Geographical Information Systems (GIS) are being progressively more accepted by police agencies. Development in technology and the accessibility of geographic data sources make it feasible for police departments to use GIS and crime mapping. GIS and crime mapping can be utilized as devices to discover reasons contributing to crime, and hence let law enforcement agencies proactively take action against the crime problems before they become challenging. The purpose of this study is to conduct a literature review of Geographical Information System and Crime Mapping in Crime Analysis and to propose policy recommendations regarding to implementation of crime mapping and GIS. To achieve this purpose, first a historical evaluation of GIS and crime mapping will be rendered and then the importance of place will be explained in terms of assessing crime problems accurately

Suburban Advantage: Opportunity Hoarding and Secondary Attainment in the Postwar Metropolitan North

© 2011 by The University of Chicago. All rights reserved.This study examines urban/suburban differences in educational outcomes in light of Tilly's conception of "opportunity hoarding." Data from the U.S. Census reveal the changing circumstances of 17-year-olds in central city and suburban settings across the post-World War II period. Focusing on the metropolitan Northeast and Eastern Midwest, we consider a range of factors associated with differences in educational attainment. Using a multilevel analytic strategy, we find evidence that clear distinctions emerged in this period, marking the educational status of youth in central city and suburban settings. While there were signs of urban/suburban inequality in certain metropolitan contexts and for specific types of suburbs in 1940, 40 years later the urban-suburban divide was clearly evident across all metropolitan settings. A wide range of factors became associated with this form of spatial differentiation in school experiences during the postwar era, suggesting that a prolonged process of systematic exclusion characterized this dimension of metropolitan development. We close with a brief discussion of policy implications for addressing school-related factors that may contribute to these differences. (Contains 6 tables and 11 notes.

Categorization by Organization: Manipulation of Disability Categories in a Racially Desegregated School District

We propose and test the concept of categorical manipulation, a process in which subordinate group demands for greater access to high status categories are met with reversals in the hierarchy of existing categories. The analysis addresses a school district’s response to pressure from a racial desegregation movement to improve black access to a high status majority-white disability category. The district complied, but it also allowed whites to migrate to a low status majority-black category, from which blacks then were excluded. This category was enhanced with benefits desirable to whites. The original categorical hierarchy was restored during resegregation 20 years later. In categorical manipulation, subordinate groups gain greater access to high status categories, but these categories suffer in value as dominant groups reaffiliate with previously low status categories, which may be revised for improvements. This is different from more familiar forms of resistance to change such as symbolic compliance, ritualization, and tokenism.Division of Social and Economic Sciences of the National Science Foundation under Grant Number 1154843