Thyroid fine needle aspiration reporting rates and outcomes before and after Bethesda implementation: A single-center experience over 8 years

Aimː To evaluate data from our hospital system before and after the implementation of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and comparison of our data with the previously published studies. Methods: Seven hundred seventy-one patients with thyroid nodules who underwent fine needle aspiration biopsy (FNAB) and surgery at our institution were analyzed retrospectively. FNAB results were divided into two parts in terms of the period they related to: pre-TBSRTC (between 2005 and 2010) and TBSRTC (between 2011 and 2013). Results: 341 FNAB were applied in the period of TBSRTC. Of the 341 FNAB, 53(16%) were non diagnostic, 82(24%) were benign, 62(18%) were atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 28(8%) were follicular neoplasms and/or suspicion of follicular neoplasms (FN/SFN), 95(28%) were suspicion for malignancy (SuspM), and 21(6%) were malignant. Rates of malignancy reported on follow-up histopathological examination were non diagnostic in 11%, benign in 4.9%, AUS/FLUS in 23%, FN/SFN in 32%, SuspM in 44%, and malignant in 95.3%. Conclusions: In this study, the distribution of cases in TBSRTC categories and malignancy rates, differed from, recommended by TBSRTC and some studies. Implementation of TBSRTC did significantly affect our institution’s reporting rates

Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach

The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed “screening and diagnostic” algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN

Pituitary hypoplasia and growth hormone deficiency in a woman with glycogen storage disease type Ia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Growth retardation is one of the cardinal manifestations of glycogen storage disease type Ia. It is unclear which component of the growth hormone and/or insulin-like growth factor axis is primarily disrupted, and management of growth impairment in these patients remains controversial. Here we report the first case in the literature where glycogen storage disease type Ia is associated with pituitary hypoplasia and growth hormone deficiency.</p> <p>Case presentation</p> <p>A 20-year-old woman with glycogen storage disease type Ia was admitted to our endocrinology department because of growth retardation. Basal and overnight growth hormone sampling at 2-hour intervals demonstrated low levels; however, provocative testing revealed a relatively normal growth hormone response. A hypoplastic anterior pituitary with preserved growth hormone response to provocative testing suggested the possibility of growth hormone neurosecretory dysfunction and/or primary pituitary involvement.</p> <p>Conclusion</p> <p>Pituitary hypoplasia may result from growth hormone-releasing hormone deficiency, a condition generally known as growth hormone neurosecretory dysfunction. It is an abnormality with a spontaneous and pulsatile secretion pattern, characterized by short stature, growth retardation and normal serum growth hormone response to provocative testing. However, in the case described in this report, a normal although relatively low growth hormone response during insulin tolerance testing and pituitary hypoplasia suggested that primary pituitary involvement or growth hormone neurosecretory dysfunction may occur in glycogen storage disease type Ia. This is a potential cause of growth failure associated with a lower somatotroph mass, and may explain the variable responsiveness to growth hormone replacement therapy in people with glycogen storage disease.</p

The effects of zoledronic acid treatment on depression and quality of life in women with postmenopausal osteoporosis: A clinical trial study

Background: Osteoporosis affects quality of life (QoL) and may lead to depression in women. he purpose of this study was to evaluate the effects of zoledronic acid (ZA) treatment on depression and QoL in women with postmenopausal osteoporosis (PO). Materials and Methods: A total of 88 newly diagnosed women with PO were included in this study. All patients were treated with once-yearly ZA (5 mg). A QoL questionnaire from the European Foundation for Osteoporosis and Beck Depression Inventory were given to patients at baseline and at 12 months. he results for baseline and post - 12th month were compared, and bone mineral density (BMD) levels were compared. Results: he consumption of once-yearly ZA (5 mg) treatment increases BMD at levels of lumbers 1-4 (P = 0.026), total Hip T score's P value is same as femoral neck (P: 0,033). ZA 5 mg treatment also improved QoL (P = 0.001) and reduced depression (P = 0.001). Conclusion: ZA treatment increases BMD levels and QoL while reducing depression. Once-yearly ZA (5 mg) may be considered for postmenopausal women as a first-line treatment

Efficiency of inferior petrosal sinus sampling in the diagnosis of Cushing's disease and comparison with magnetic resonance imaging

WOS: 000460612600009PubMed: 31180374OBJECTIVE: The purpose of this study is to assess the efficiency of inferior petrosal sinus sampling (IPSS) in the diagnosis of adrenocorticotropic hormone-dependent Cushing's disease and to compare it with magnetic resonance imaging (MRI). METHODS: The diagnostic efficiency of IPSS in the differentiation of pituitary Cushing's disease from ectopic Cushing's disease was retrospectively evaluated in 37 patients who had IPSS in our clinic. Six patients were excluded from the study due to missing data. Hypophysis MRI examinations of 31 patients before IPSS were also evaluated. The contributions of MRI and IPSS to the detection of pituitary adenoma and the determination of lateralization were researched. RESULTS: Bilateral IPSS was successfully performed in 30 patients of the 31 patients in the study group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of IPSS in differentiating between central and ectopic Cushing's syndrome before corticotrophin-releasing hormone (CRH) stimulation were 93.3%, 100%, 100%, 33.3%, and 93%, respectively, whereas after CRH stimulation were 100%, 100%, 100%, 100%, and 100%, respectively. The accuracy of both the rates was significantly higher compared with MRI. CONCLUSION: IPSS has the highest diagnostic efficiency in differentiating central Cushing's disease from ectopic Cushing's disease

Predictive value of hemogram parameters in malignant transformation of the endometrium in patients with different risk factors

Objectives To investigate whether the pretreatment hemogram parameters and their ratios can be used in predicting the endometrial transformation in patients with abnormal uterine bleeding. Material and methods Records of all patients who underwent an endometrial histopathological evaluation between 2011 and 2021 were investigated. Hemogram, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were analyzed. Chi square and Mann Whitney U tests were used for analysis. PResults 427 patients were included, of whom 117 were presented with endometrial hyperplasia without atypia (27.4%; mean age, 42±9.7; Group II), 70 with atypia (16.3%; mean age, 53.4±9; Group III), 102 with early endometrial cancer (EC) (23.8%; mean age, 63±7.8; Group IV) and 38 with advanced disease (8.8%; mean age, 63.3±10.5; Group V). Patients without pathology constituted the control group (23.4%; mean age, 42.2±9.5; Group I). Risk factors for atypia and carcinoma were determined as age, postmenopausal state, obesity, diabetes, and increased estrogen exposure (each, p0.05). However, hemoglobin and hematocrit levels were higher in Groups IV and V (13.9 vs 13.1 mg/dL, and 39.1 vs 38.8%, respectively; pConclusions Our findings support the impact of inflammation on malign transformation from normal endometrial mucosa to atypia and carcinoma. NLR and PLR values showed no statistical difference. Instead, thrombocytosis may have a predictive role in EC