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

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

Effectiveness of vitamin D supplementation in the early gestational period on lactational mastitis development: A new framework in the risk assessment

Background: Vitamin D (VD) deficiency is known to play a role in many infectious diseases with its immunomodulator effect. We aimed to determine whether optimal VD replacement for women who are deficient in VD, starting from early pregnancy was significantly protective against lactational mastitis (LM). Methods: This retrospective study was conducted with 132 lactating women applied to general surgery outpatient clinic of a university hospital between February 2021 and May 2021 and divided into two groups as those who used VD supplementation (Group 2) starting from the early gestational period and those who did not receive this supplementation (Group 1). The primary outcome was the effect of treatment of maternal VD deficiency or insufficiency on LM, an inflammatory condition of breast during lactational period ranging from a mild to severe forms. The demographic, birth and breastfeeding-related data including nipple crack and occurrence of LM and laboratory parameters concerning VD metabolism were analyzed and compared between the groups. Results: The rates of nipple crack, mastitis attack, recurrent mastitis attack and abscess drainage were statistically significantly higher in Group 1 (p < 0.05). Further analysis revealed that increased VD use and higher VD levels during lactation (25 ng/ml) decreased the incidence of mastitis attacks by 1.2 and 1.9 times, respectively. Conclusions: VD deficiency was found to be a noticeable risk factor for the development of LM. Concerted efforts with randomized controlled trials are necessary to further analyze this manageable risk factor, especially by promoting a well-designed and schematized replacement treatment based on VD levels starting from early pregnancy

Monocyte-to-high-density lipoprotein cholesterol ratio: A candidate parameter for a risk assessment model in COVID-19

Background: COVID-19 has become a pandemic and threatened human public health across the world. Determining effective predictive biomarkers that can classify patients according to risk levels is critical to identify cases that can potentially progress to severe complications and death with the rapid progression of the disease. Therefore, we aimed to investigate the utility of the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), a recently emerging inflammatory marker, as a clinically useful inflammation-based marker in determining patients at higher risk of decreased overall survival in patients with COVID-19. Methods: The demographics, laboratory data, and MHR of 127 patients with laboratory confirmed COVID-19 were evaluated in terms of clinical outcomes. The patients discharged from the hospital constituted the survivor group, while those that died were evaluated as the non-survivor group. Results: The MHR values were found to be significantly higher in the non-survivor group compared to the survivors (p 0.05). Spearman's analyses revealed no correlation between the MHR values and white blood cell, neutrophil, ferritin, D-dimer, and C-reactive protein (CRP) in the non-survivor group (p > 0.05). According to the binary logistic regression analysis model, the neutrophil, ferritin, D-dimer, CRP, and MHR values the most significant factors in predicting survival (p = 0.021, p = 0.004, p = 0.000, p = 0.001, and p = 0.016, respectively), and an increase in the neutrophil, ferritin, D-dimer, CRP and MHR values decreased the survival rate by 1.1, 1.5, 1.8, 1.6, and 1.7 times, respectively. Conclusions: MHR can help predict the severity of the COVID-19 disease and patient outcomes. Therefore, this parameter can serve as a clinically useful and potentially predictive inflammation-based marker for identifying patients with COVID-19 who are at higher risk of decreased overall survival. Considering the serious consequences of the current and possible future pandemics, the establishment of a risk assessment model, including MHR in COVID-19 and similar infections is of vital importance in reducing morbidity and mortality by identifying potential risk factors that can predict the course of the disease. (Clin. Lab. 2022;68:xx-xx. DOI: 10.7754/Clin.Lab.2022.210755

Evaluation of the circulating serum endotrophin in women with and without gestational diabetes mellitus during second trimester

Purpose: Endotrophin is a newly discovered adipokine, and its clinical utility in diagnosing gestational diabetes mellitus (GDM) remains unclear. We aimed to investigate the possible association between endotrophin and GDM and determine its correlation with maternal metabolic parameters. Methods: Screening and diagnosis for GDM were carried out between the 24th and 28th weeks of gestation. The study included 50 patients with GDM and 37 healthy pregnant women. Endotrophin was assayed by a commercially available enzyme-linked immunosorbent assay kit. Results: The endotrophin level was significantly higher in the GDM group compared to uncomplicated pregnancies (121.98 ± 104.08 vs 72.5 ± 76.2, p < 0.05). Furthermore, the fasting glucose, fasting insulin, and HOMA-IR values of and plasma glucose levels obtained at 1 and 2 h after 75 g oral glucose administration were significantly higher in the GDM group than in the control group (p < 0.05). The Spearman analysis showed a statistically significant correlation between the endotrophin level and the fasting glucose, first-hour glucose, fasting insulin, HOMA-IR, and pre-pregnancy and current body mass indexes (BMI) in the GDM group (p < 0.05). Conclusion: Although oral glucose tolerance test (OGTT) is still the gold standard in the diagnosis of GDM, considering the technical difficulties and disadvantages of OGTT, endotrophin measurement at 24–28 weeks of pregnancy in healthy risk-free pregnant women seems to be an appropriate approach to limit the use of OGTT

Thymoquinone attenuates doxorubicin‐cardiotoxicity in rats

Contrary to the fact that doxorubicin is a powerful chemotherapeutic agent for the treatment of neoplastic diseases, cardiotoxicity is too important to be ignored. Thymoquinone serves as a powerful free radical scavenger. In the study, the effects of thymoquinone against doxorubicin-cardiotoxicity will be evaluated. Forty rats were divided into five groups. Group I: control group (n = 8); group II: olive oil group (n = 8); group III: thymoquinone group (n = 8); given 10 mg/kg thymoquinone intraperitoneally per day throughout the experiment; group IV: doxorubicin group (n = 8); injected with a single dose of 15 mg/kg ip doxorubicin on the 7th day of the experiment; group V: doxorubicin + thymoquinone group (n = 8); administered with 10 mg/kg thymoquinone per day during the experiment and 15 mg/kg doxorubicin ip on the 7th day. The experiment was planned for 14 days. Immunohistochemically, heat shock protein (HSP) 70 and HSP90, glucose-regulated protein 78 (GRP78), caspase-3 were stained. We made terminal deoxynucleotidyl transferase dUTP nick end labeling for apoptotic evaluation. Total oxidant status (TOS) levels and total antioxidant status (TAS) were measured in the heart tissue. Atrial natriuretic peptide (ANP) and pro-B type natriuretic peptide (proBNP) were evaluated. In the study, HSP70, HSP90, GRP78, and caspase-3 levels increased in group IV. TOS and TAS levels were significant compared to group I. Doxorubicin significantly increased ANP and NT-proBNP levels. Thymoquinone revealed significant differences in these values. Thymoquinone can be an important cardioprotective agent against doxorubicin-cardiotoxicity