Histomorphological features of atypical small acinar proliferations (ASAP) that favor malignancy

Objective: Cases diagnosed as atypical small acinar proliferation (ASAP) in prostate transrectal ultrasound (TRUS) biopsies typically require rebiopsies, which are invasiveand associated with increased risk of complications. Therefore, reduction in the rates of ASAP diagnoses during initial biopsy interpretation will decrease the need forrebiopsy and limit the burden of new diagnostic procedures. The current study aimed to investigate patient demographics, serum PSA levels, and histopathological features of cases identified as “ASAP” during initial prostate biopsies and as “benign” or “malignant” in the rebiopsies. Methods: This retrospective study included 187 cases and 257 core biopsies with a diagnosis of ASAP. Initial age and serum PSA levels were recorded, and the cores were analyzed histopathologically. The presence of nuclear enlargement, prominence of nucleoli, cytoplasmic amphophilia, luminal acellular secretions, cristalloids, infiltrative growth pattern, atrophy, inflammation, and number of the suspicious acini were recorded. Adenocarcinomas were identified using the Gleason score. Results: The mean age and serum PSA levels were significantly higher in the intermediate- high grade malignant group compared to the other groups, while nuclear enlargement (>2 times) and prominent nucleoli were more frequently observed in the malignant group compared to the benign group. Amphophilic cytoplasm and luminal acellular amorphous eosinophilic secretions were more frequently observed in malignant groups, while the benign group exhibited higher rates of inflammation. Conclusion: The findings of the current study showed enlargement of the nuclei (≥2 times), nucleolar prominence, amphophilic cytoplasm, luminal amorphous acellular secretion, and absence of inflammation were associated with malignancy. Moreover, higher mean age and serum PSA level were related with intermediate-high grade malignancy, and consideration of these factors during evaluation of initial TRUS biopsies may decrease the prevalence of ASAP diagnoses and prevent unnecessary interventions

Lessons to be learned: The knowledge, attitudes, and practices of Turkish people towards the COVID-19 pandemic

Background: The world experienced the greatest pandemic of the 21st century with the emergence of a new and readily transmissible the coronavirus disease. Understanding knowledge, attitudes, and practices (KAP) of the public towards the pandemic is an essential part of developing effective preventive strategies. Aim: The objective of this study was to investigate the knowledge, attitudes, and practices (KAP) concerning the coronavirus (COVID 19) among population in Istanbul. Methods: This is a cross sectional and multi stage, stratified random sampling based on multi center population of Istanbul. A total of 5,414 persons were contacted and 4361 participants (80.5%) gave consent. The data were analyzed using descriptive and multiple regression analyses. Results: There were significant differences between low education and high educational level with respect to age groups, gender, occupation, income, residence, number of rooms and family members (P < 0.001). Responses concerning knowledge of COVID 19 indicated that subjects with high education level were significantly higher regarding knowledge of the signs and symptoms of COVID 19 and methods of detecting COVID 19 respectively. Majority of the participants consider COVID 19 risk is higher than AIDS or Cancer (75.8% of low education vs. 67.2% of high education level (P < 0.001). Multivariate stepwise regression analysis revealed that monthly income status (P < 0.001), appropriate method of detecting COVID 19 (P < 0.001), occupational status (P < 0.001), medical mask prevent against COVID 19 (P < 0.001), eating or contacting wild animals (P < 0.001), isolation and treatment of people reduce risk (P < 0.001), isolation 14 days (P < 0.001), avoid going to crowded places such as train metro, bus, restaurants and shopping (P = 0.003), COVID 19 spreads via respiratory droplets (P = 0.004), afraid of travel (P = 0.026) were significantly associated with COVID 19 knowledge. Conclusions: The current study results revealed that the educational level and occupation especially sedentary are correlated positively with knowledge, attitude and practices. This finding is not surprising since higher education levels and professional status are associated with good KAP in most epidemic diseases including COVID 19. Nevertheless, the recent experience with COVID 19 has provided lessons on strategy and policy making

Benign infantile hydrocephalus: In which child, when should we think, what should we do?

Makrosefalinin en sık sebeplerinden biri olan benign infantil hidrosefali, beyin omurilik sıvısının emiliminden sorumlu araknoid villusun olgunlaş mamasından kaynaklandığı düşünülen kendini sınırlayan bir klinik durum dur. Baş çevresinin normalin üzerinde olması ve geniş ön fontanel bulgula rı olan vakaların zamanla araknoid villusların olgunlaşması ile beyin omu rilik sıvısının emilimi normale döner ve 18-24 ay civarında bulgular gerile meye başlar. Hastalık nörolojik açıdan herhangi bir sekel bırakmadan ken diliğinden düzelir. Bu nedenle, baş çevresinde artış olması çocuğu takip eden hekim ve ebeveynlerde anksiyeteye neden olsa da, sadece mental motor gelişmenin geri kaldığı veya 2 yaşına kadar subaraknoid boşluktaki genişlemenin düzelmediği çocuklarda ileri tetkik yapılmalıdır. Bu olguyu sunmaktaki amacımız; makrosefali saptanan çocuklarda “benign infantil hidrosefali” düşünülüyorsa ve nörolojik muayene normal, nörogelişimsel geriliği yok ise, çocuğu yakın takibin yeterli olacağını, ileri incelemelerin yapılmasının gerekli olmadığını vurgulamaktır. Olgumuz; doğumda ve ilk üç ayda baş çevresi normal sınırlarda seyreden, daha sonraki izlemlerinde hızla artarak >97 persentil’e çıkan bir hastadır. Yapılan tetkikleri sonucu benign infantil hidrosefali olarak değerlendiril miştir.Benign infantile hydrocephalus, one of the most common causes of macrocephaly, is a self-limiting clinical condition thought to be caused by the immaturity of the arachnoid villi responsible for the absorption of cerebrospinal fluid. In cases with the findings of an increase in head circumference and large anterior fontanel, the absorption of cerebrospinal fluid returns to normal with the maturation of the arachnoid villi over time and the findings begin to regress at around 18 to 24 months of age. The disease resolves spontaneously without leaving any neurological sequelae. Therefore, although the increase in head circumference causes anxiety in the physicians and parents, further examinations should be performed only in children whose mental motor development is delayed or whose enlargement in the subarachnoid space does not improve by the age of 2 years. Our aim in presenting this case report is to emphasize that if “benign infantile hydrocephalus” is considered in children with macrocephaly and if the neurological examination is normal and there is no neurodevelopmental retardation, close follow-up of the child will be sufficient and further investigations are not necessary. Our case was a patient whose head circumference was within normal limits at birth and in the first three months, and increased rapidly during follow-up to >97 percentile. As a result of the examinations, it was evaluated as benign infantile hydrocephalus

Clinical and pathological features of adrenal myelolipoma and myelolipomatous metaplasia cases in our hospital over 13 years

BACKGROUND/AIMS: The development and widespread use of abdominal imaging techniques has increased the incidence of unexpected adrenal tumors called adrenal incidentaloma. Adrenal myelolipomas are the second most common incidentalomas. Similar myelolipomatous morphology appears as a secondary degenerative change in other adrenal lesions and is called myelolipomatous metaplasia. This study investigated the adrenal entities of the last 13 years which had myelolipomatous components.MATERIALS AND METHODS: In this retrospective observational study, cases diagnosed as adrenal myelolipoma or myelolipomatous metaplasia between January, 2009 and January, 2022 were re-examined regarding their age, gender, localization, lesion size, and secondary histopathological changes, accompanying pathological diagnoses as well as clinical and radiological data.RESULTS: Eleven adrenal myelolipoma cases and 6 myelolipomatous metaplasia cases were detected. In myelolipomas, the mean age was 55.45 years, 73% were female and 82% were located on the right side. The lesions were encapsulated and their mean size was 7 cm. One case had a diagnosis of subclinical Cushing's syndrome and the others were hormonally inactive. Some cases were accompanied with hypertension (27%), type 2 diabetes (18%), and asthma (18%). All myelolipomatous metaplasias, which are non-encapsulated, were detected in adrenocortical adenomas. The mean age was 58 years; nonencapsulated and 67% were located on the right side with no gender predilection. Concomitant hypertension (50%), diabetes /33%, and asthma (33%) were frequent.CONCLUSION: Adrenal myelolipoma and myelolipomatous metaplasia both contain adipose and myeloid components. Myelolipoma is a benign and encapsulated neoplasia which is usually detected incidentally. They frequently coexist with chronic diseases such as hypertension, diabetes and asthma

Effect of urolithiasis in the differential diagnosis of acute abdominal pain in pediatric age population

Amaç: Akut karın ağrısı çocuklarda acil servise en sık başvuru sebeplerinden biridir. the most common reason of admission to emerKarın ağrısı, enfeksiyon gibi kolay tedavi edigency in children. Acute abdomimal pain may lebilir nedenlerden olabileceği gibi ciddi morbidite ve mortalite nedeni olabilecek durumlardan da kaynaklanabilir. Bu durumların sık resulted in severe morbidity or mortality. Urolitgörülenlerinden biri de üriner sistem taş hashiasis is one of these commonly seen conditions.talığıdır (ÜSTH).Gereç ve Yöntemler: Akut karın ağrısı ren presented to the emergency service with acute abdominal pain were reviewed. Routine şikayeti ile acil servise başvuran 442 hasta çalışmaya dahil edildi. Tüm hastalara rutin fizik physical examination and abdominal ultrasomuayene ve batın ultrasonografisi yapıldı.nography were performed.Bulgular: Karın ağrısının en sık saptanan medikal nedenleri sıklık sırasına göre, üriner minal pain are, urinary infection (n=55, 12.4%), enfeksiyon n=55 %12.4, üriner sistem taş hasurolithiasis n=38, 8.6%, mesenteric lymphadenitalığı n= 38 %8,6 mezenterik lenfadenit n=34 tis n=34, 7.7%, problems of hepatobiliary system %7.7, hepatobilier sistem kaynaklı problemler n=22, 5%, urinary tract anomalies n=12, 2.7% n=22 ( %5), üriner sistem anomalileri n=12 and idiopathic abdominal pains n=11, 2.5%. %2.7 ve nedeni belirlenemeyen karın ağrısı Surgical reasons were 6.1% n=27. Abdominal n=11 %2.5 idi. Cerrahi nedenler n=27 %6,1 ultrasonography was normal in 243 children.vakada karın ağrısı sebebi olarak saptandı. 243 hastada yapılan tüm batın ultrasonografi tetkiki normal sınırlarda bulundu.Sonuç: Çocuklarda ÜSTH böbrek yetmezliğine kadar varabilen ciddi morbidite nedenidir. ÜSTH'nin ilk ve en sık klinik prezentasyonu karın ağrısıdır. Bu sebeple hastaneye karın abdominal pain.ağrısı şikayeti ile başvuran çocuklarda ÜSTH ön planda düşünülmelidirObjectives: Acute abdominal pain is one of the most common reason of admission to emergency in children. Acute abdomimal pain may be a symptom of simple conditions such as infections or due to serious conditions which can be resulted in severe morbidity or mortality. Urolithiasis is one of these commonly seen conditions. Material and Methods: A total of 442 children presented to the emergency service with acute abdominal pain were reviewed. Routine physical examination and abdominal ultrasonography were performed. Results: The most common causes of abdominal pain are, urinary infection (n=55, 12.4%), urolithiasis n=38, 8.6%, mesenteric lymphadenitis n=34, 7.7%, problems of hepatobiliary system n=22, 5%, urinary tract anomalies n=12, 2.7% and idiopathic abdominal pains n=11, 2.5%. Surgical reasons were 6.1% n=27. Abdominal ultrasonography was normal in 243 children. Conclusion: Pediatric urolithiasis is a serious condition which can cause severe morbidity. Acute abdominal pain is the first and most common sypmtom of urolithiasis, therefore urolithiasis must be primarily in mind in children presented to the emergency room with acute abdominal pai

Predictors risk factors for acute complex appendicitis pain in patients: Are there gender differences?

Objective: The purpose of this study is to determine the predictive risk factors for appendicitis and the cost-effectiveness of using abdominal helical computed tomography (CT) in comparison to abdominal ultrasonography (US) for the diagnosis of acute appendicitis in patients.Subjects and methods: The typical case was a patient with abdominal pain in the right lower quadrant and suspicion of appendicitis. A total of 643 patients who were consequently treated with appendectomy upon diagnosis of acute appendicitis between January 2015 and December 2018 were included in the study. The four diagnostic alternatives chosen were US, CT, biochemistry parameters, and physical examination in the hospital.Results: There were statistically significant differences between male and female patients with regards to age, BMI, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of gastrointestinal discomfort (GI), anxiety (P < 0.001), red eye (P = 0.006), dizziness (P = 0.021), headache (P < 0.001), muscular symptoms, weakness and cramps (P < 0.001), bloating or swollen stomach (P < 0.001), UTI (P < 0.001), chest pain (P < 0.001), guarding (P < 0.001), loss of appetite (P = 0.004), nausea (P < 0.001) vomiting (P = 0.042), anorexia (P = 0.009), and constipation (P = 0.002). Moreover, there were statistically significant differences between male and female patients for pain (P < 0.001), pain right belly (P = 0.027), severe crumps (P = 0.007), high temperature and fever (P < 0.001), irritable bowel syndrome (P < 0.001), right iliac fossa (RIF) pain (P = 0.008), rebound tenderness (P = 0.024), positive bowel sounds (P = 0.029), and pointing tenderness (P < 0.001). Multivariate stepwise logistic regression showed nausea (P < 0.001), C-reactive protein (CRP) (P < 0.001), dizziness (P = 0.016), vomiting (P < 0.001), muscular symptoms (P = 0.007), irritable bowel syndrome (P = 0.034), guarding (P = 0.040), and loss appetite (P = 0.046) were considered at higher risk as predictors for appendicitis patients.Conclusions: CT is more cost-effective than the US and clinical examination for determining appendicitis. The current study suggested that nausea, C-reactive protein, dizziness, vomiting, muscular symptoms, irritable bowel syndrome, guarding, and loss appetite were considered as higher risk predictors for appendicitis patients

Enteropathy-Associated T-cell Lymphoma: A diagnostically challenging complication of celiac disease

WOS: 000382751900019Enteropathy-associated T-cell Lymphoma (EATL) is a rare, but fatal complication of celiac disease. EATL may occasionally present simultaneously with celiac disease. In most cases, the clinical features of EATL are very similar to celiac disease in the initial stages, which usually leads to a late diagnosis. EATL is primarily observed during the sixth decade of life in patients with celiac disease who have no diet restrictions. In this article, we describe the diagnostic features of a case of EATL that was identified in a patient with celiac disease

Case report: A rare cause of piriformis syndrome, venous varix compression of the sciatic nerve

Conference: World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO) Location: Paris, FRANCE Date: APR 04-07, 2019...Int Osteoporosis Fdn; ESCEO; Mylan; UCB; IBSA; Medimaps; Lilly; Hologic; Strax Corp; Kyowa Kirin; Galgo Med; EffRx; Amgen; Abiogen Pharma; Medi; Fidia Pharma Grp; TRB Chemedica Sa; AgNovos Healthcare GmbH; Expanscience Labs; Wisepress Com; GE; Pierre Fabre; Roche; Echolight; Thuasne; Theramex; Bindex; Gedeon Richter; Sinklar Conf Management B

Assessment of the Gail model in estimating the risk of breast cancer: Effect of cancer worry and risk in healthy women

Background: There has been substantial interest in developing methods to predict the risk of breast cancer. The Gail model is one the first model have been widely used to identify women at higher risk of breast cancer. Aim: This study aimed to determine the 5-year and the general life-time risk of breast cancer and also to determine breast cancer predictors in women using the Gail model. Methods: We used the Gail model to estimate the risk of breast cancer in female Turkish outpatients aged above 35 years in this cross-sectional study. Age, life-style habits, breast-feeding duration, family history of breast cancer, and body mass index were compared between high and low-risk subjects. We have performed the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) tools on patients regarding depression and anxiety. We also assessed the association of these covariates with the estimated risk of breast cancer in multivariate linear regression analysis. Results: We enrolled 1065 subjects with a mean age of 52.9 ± 8.4 years. The mean of the five-year risk for breast cancer was 1.33%±0.6. Meanwhile, the mean of lifetime risks for breast cancer was 10.15%±3.18, respectively. Nearly one-third of the participants had one child, 55.9% had breast-fed their children more than six months. Meanwhile, 18.5% of the subjects had a high depression score, 15.2% had a high anxiety score. Higher age, age at first birth, and parity; lower age at menarche; presence of menopause and family history of breast cancer were higher in the high-risk group. Higher age, and age at first birth; lower age at menarche; family history of breast cancer, presence of menopause, and parity were independently associated with higher breast cancer risk. Conclusion: We identified certain risk factors for breast cancer in our study population and Gail model is a reliable and useful breast cancer risk prediction model for clinical decision-making. This study contributes to the body of evidence in order to facilitate early detection and better plan for possible malignancies in Turkish population

The Impact of COVID-19 Pandemic Disease Exposed with Mental Health in Turkey

Aim: The aim of the study was to investigate the knowledge, attitude, and practice (KAP) of COVID-19 in community.Subjects and Methods: This is a cross-sectional community-based survey and conducted among the population of Turkish on their level of awareness of COVID 19.The survey based on structured questionnaire methods were conducted to survey the KAP level about COVID-19. A multi-stage stratified random sampling method was performed between March to June 2020, a total of 5500 persons were approached and 4422 (63.7% of males and 36.3% of females) (80.4%) participants completed the questionnaire. The data were analyzed using descriptive statistical analysis.Results: Of the total number of subjects surveyed, 90% of subjects recognized the term “COVID-19”. Educational level inreses awareness of COVID -19 virus. The majority 89% use medical masks and gloves to prevent against COVID-19 virus. Most people believe that there is no effective treatment or vaccine for COVID-2019, although, early prevention may help most patients contracted from the infection. In addition, a wide majority think that risk of COVID-19 is higher than AIDS or Cancer (70.6%). Over 88% people are afraid to travel due to COVID-19 virus and also majority 87% fearing to contact relatives or friend with COVID positive.Conclusion: The survey revealed a high level of fatigue, stress and fear among the respondents. The recent experience with COVID-19 provided lessons on policy making.Keywords:COVID-19, pandemic, fear, depression, OCD, fatigue