Marmara Seawater Desalination by Membrane Distillation: Direct Consumption Assessment of Produced Drinking Water

Drinking water was produced from Marmara seawater by membrane distillation (MD). The best operating conditions were determined by batch experiments as: 0.45 μm PTFE, 30°C distillate temperature and temperature difference, and 270–360 L/h cross‐flow rates in feed‐distillate. Seawater desalination was carried out with 99.93% solute rejection and 17.2 L/m2h permeate flux in 66% concentration ratio by lab‐scale pilot system. Since the desalinated water contained no organic carbon, turbidity, and nitrate, it seemed to be very suitable for immediate service with quality of 7.3 pH, clear, odor‐free, 76.0 µS/cm, 47.1 mg TDS/L, <0.001 color, and 0.01 mg boron/L. The product water lacked of vital cations, especially Na+, K+, Ca2+, Mg2+ that are essentials for promoting osmotic balanced body liquid and healthy development. A holistic management approach towards satisfying specific water quality requirements in direct service of MD effluents to human consumption was proposed that jointly included in injecting into urban potable water, adding appropriate chemicals into the effluent, and mixing effluents with raw or concentrated seawater (1:250/1:1000 for Marmara seawater) or brackish natural waters under hygienic precautions

Can eosinophil to monocyte ratio be a new marker for recurrence in graves&apos; disease?

Prognostic parameters are crucial in the choice of treatment in Graves&apos; disease (GD), thus,these parameters may not be easily achievable in all situations. However hematological parameters is important in inflammation and easy to obtain. In this study we aimed to elucidate whether these parameters could determine the prognosis in patients with Graves Disease. This retrospective analysis consisted of 114 individuals with a diagnosed with GD. The enrolled patients were treated with anti-thyroid drugs for an average of 14 months and the mean follow-up period after treatment discontinuation was 17.4 months. After the follow-up period subjects have been segmented to 2 groups as: Group 1 relapsed (n:61) and Group 2 non-relapsed (n:53). The neutrophil to lymphocyte ratio (NLR) of the relapsing individual was statistically significantly higher compared to other group, while the eosinophil to monocytes ratio (EMR) was lower. In the multiregression analysis, both parameters were found to be independent risk factors in predicting relapse [(OR=3.1, p:0.026 for NLR) (OR=1.5, p [Med-Science 2022; 11(4.000): 1436-40

Malignancy outcomes and the impact of repeat fine needle aspiration of thyroid nodules with Bethesda category III cytology: A multicenter experience

Background The clinical management of Bethesda III category thyroid nodules has some undefined points and differs among centers and conflicting malignancy rates are present in the literature. The aim of this study was to investigate the Bethesda category III thyroid nodule outcomes in our centers, to determine malignancy rates and also to evaluate clinical and sonographic features which may help to predict malignancy. Methods This retrospective study included 333 patients with thyroid nodules who had Bethesda category III on fine needle aspiration (FNA) in three tertiary medical centers of Turkey. Results Among 333 patients, 302 had appropriate follow up. Eighteen patients received thyroidectomy after the first FNA, with a malignancy rate of 38.89% (7/18) and 284 patients received a second FNA. After the second FNA, thyroidectomy was performed in 80 patients and 41 patients needed the third FNA. Thirteen thyroidectomies were performed after the third FNA. Totally 111 patients received thyroidectomy with a malignancy rate of 48.65% (54/111) among patients with surgery and the lower bound was detected as 17.88% (54/302). Of these patients the malignancy rates of patients receiving thyroidectomy with two and three FNAs were 47.50% (38/80) and 69.23% (9/13), respectively. Hypoechogenicity, microcalcification, and irregular margin were found as good predictors for malignancy. Conclusion We demonstrated that the malignancy rate was 48.65% in patients receiving thyroidectomy. We showed a higher malignancy rate than the traditionally rate of 5%-15%. This study showed that repeat FNAs decrease the rate of unnecessary surgery performed for benign lesions by increasing the rate of malignancy detection

Laboratory Parameters Predict Complications in Primary Hyperparathyroidism: A Multicenter Cross-sectional Study

Aim: There is no study predicts the development of complications with laboratory parameters in patients with primary hyperparathyroidism (PHPT). We aimed to determine the laboratory parameters that predict the development of osteoporosis or nephrolithiasis in patients with PHPT and identify high-risk patients. Methods: This multicenter retrospective cross-sectional study was conducted between January 2018 and January 2020. The study group consisted of 389 patients who were diagnosed with PHPT (68 patients without surgical indications and 321 patients with PHPT who underwent surgery), and 451 individuals without any additional disease as a control group. Patients' data was obtained from the hospital automation system. All patients were divided into three groups (control, unoperated and operated), and laboratory parameters were compared. Results: The Wisconsin index (WIN), which is used to detect hyperfunctional glands in addition to parathyroid adenoma in PHPT, and the Parathyroid functional index (PFIndex), which is used to differentiate HPT secondary to vitamin D deficiency, can identify patients at high risk of nephrolithiasis or osteoporosis in patients with PHPT. In patients who have been operated on due to PHPT-related complications, the WIN value of 283.29 showed 95% sensitivity and 72% specificity in predicting osteoporosis, while the PFIndex of 36.43 had 86% sensitivity and 68% specificity for predicting nephrolithiasis. Conclusion: The WIN and PFIndex can be used to refer patients with PHPT for surgery before the onset of osteoporosis or nephrolithiasis. Although no risk factor could be found for nephrolithiasis, WIN was found as an independent risk factor for osteoporosis

Exenatide improves cardiovascular risk factors in obese patients with type 2 diabetes mellitus: a prospective study

Background/aim: The aim of this study was to evaluate the effects of a 6-month treatment regimen with exenatide on the lipid profile, high-sensitivity C-reactive protein (hsCRP), carotid intima media thickness (CIMT), visceral adiposity, and nonalcoholic fatty liver disease (NAFLD), all of which are important cardiovascular risk factors. Materials and methods: This study included 45 obese patients with type 2 diabetes mellitus (T2DM). Baseline clinical findings, laboratory parameters, and ultrasonography findings were recorded. An exenatide recipe was given twice daily to the patients and, after 6 months of therapy, the same variables were compared. The compared parameters were lipid profiles, hsCRP, aspartat aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, liver craniocaudal diameter, visceral fat volume, subcutaneous fat thickness, and CIMT. Liver diameter, visceral fat volume, subcutaneous fat thickness, and CIMT were measured by ultrasonography. Results: After therapy, statistically significant improvements were achieved in lipid profile, hsCRP, liver enzymes, body mass index, and waist and hip circumferences. Also, statistically significant decreases were obtained in liver craniocaudal diameter, subcutaneous fat thickness, visceral fat volume, and CIMT. The reduction of CIMT and liver diameter were not correlated with BMI and HbA1c reduction. Conclusion: This study showed improvement in lipid profile and hsCRP levels with exenatide treatment. We also showed decrease in both visceral fat volume and subcutaneous fat thickness. We demonstrated significant decrease in liver enzymes with significant decrease in liver diameter. These findings support the use of exenatide in patients with NAFLD and T2DM. Additionally, this study showed that exenatide treatment given twice daily reduces CIMT in obese T2DM patients

The role of therapeutic plasmapheresis in patients with hyperthyroidism

Background: Hyperthyroidism is characterized by excess hormone secretion from the thyroid gland. Anti-thyroid drugs (ATDs), surgery, and radioactive iodine can be used in treatment. Plasmapheresis is a rapid and effective treatment option in cases where rapid euthyroidism is needed to be obtained due to complications of thyrotoxicosis and major adverse effects of ATDs. Material and method: We present patients receiving plasmapheresis to provide immediate euthyroidism due to severe hyperthyroidism, adverse effects of ATDs, or non-thyroid surgery from January 2012 to December 2016. Results: This study included 18 patients. The etiology of hyperthyroidism was TDG in seven patients, TDMNG in two, TA in two, TMNG in four, and one patient had AIT. Plasmapheresis was performed to achieve euthyroidism before surgery in two patients. The mean plasmapheresis session was 5.35. The mean number of sessions needed for patients with TDG and TDMNG was 4, whereas it was 6.5 for patients with TA and TMNG (p = 0.07). The decrease of mean free thyroxine and free triiodothyronine were 57 % and 73 %, respectively (p < 0.001). After plasmapheresis, total thyroidectomy was performed in 14 patients. Euthyroidism was achieved with RAI in one patient and with medical therapy in three patients. Conclusions: Plasmapheresis therapy is a reliable and effective treatment option for patients who cannot use ATDs because of their adverse events and those with hyperthyroidism that does not resolve with these drugs, or to achieve euthyroidism before total thyroidectomy, RAI or non-thyroid emergency surgery. However, it cannot be used widely because it is expensive and invasive

Benign cytology does not rule out malignancy in thyroid nodules larger than 4 cm

Background For thyroid nodules >= 4 cm, the accuracy of fine-needle aspiration biopsy (FNAB) is controversial and the approach is unclear. We aimed to compare FNAB and operation of thyroid nodules and to determine the accuracy of FNAB. Material and Methods All total thyroidectomies performed between January 2015 and December 2021 were evaluated. In the study, 301 patients were included. Euthyroid patients with preoperative thyroid ultrasound, FNAB results and operation results were recorded retrospectively. Results The nodule size was = 4 cm in 20.9%. In patients with nodule size >= 4 cm, 50.8% of FNAB results were reported as benign, and 43.7% of these patients were found to be malignant at the end of the operation. In nodules = 4 cm nodules. Conclusions For thyroid nodules, diagnostic lobectomy may be necessary because the false-negative rate of FNAB was high, especially in nodules >= 4 cm. In addition, intermediate results, such as AUS/FN, have a higher risk of malignancy in nodules of >= 4 cm compared to nodules of <4 cm

The Detection of Preoperative Parathyroid Lesions: The Success of Ultrasonography, Technetium-99m Methoxyisobutylisonitrile Parathyroid Scintigraphy, and Single-Photon Emission Computed Tomography-Computed Tomography

Objective: We aimed to find and compare the efficacy of ultrasonography (US), technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy (MIBI-S), and single-photon emission computed tomography-computed tomography (SPECT-CT) in detecting the localization of parathyroid adenomas in patients with primary hyperparathyroidism. Methods: In total, 348 patients were included in this study. Preoperative parathyroid imaging with US, MIBI-S, and SPECT-CT was evaluated and compared with operative findings. The results of the imaging methods were compared with pathology and operation reports. Results: In 318 patients (91.3%), one of the imaging methods was able to localize the lesion correctly. US detected the localization of the parathyroid lesions correctly in 268 patients (77%), whereas SPECT-CT and MIBI-S were correct in 254 (73%) and 209 (60%) patients, respectively. There was a statistically significant relationship between the parathyroid hormone (PTH) level and 3 imaging methods' success rates (P < .05). The PTH cut-off value, which best determined the correct localization, was 152.5 pg/mL for US, 143 pg/mL for MIBI-S, and 143 pg/mL for SPECT-CT. It was observed that the correct localization rate for parathyroid lesions increased with higher PTH levels. Conclusion: In our study population, US was more successful, in most cases, than other imaging methods in localizing parathyroid lesions but SPECT-CT was more accurate in localizing mediastinal lesions. In addition, it was found that preoperative PTH levels affect the accuracy of imaging methods. (c) 2021 AACE. Published by Elsevier Inc. All rights reserved

The Effect of Sequential and Simultaneous Supplementation of Waste-Derived Volatile Fatty Acids and Methanol as Alternative Carbon Source Blend for Wastewater Denitrification

Supplementation of alternative carbon sources is a technological bottleneck, particularly in post-denitrification processes due to stringent effluent nitrogen levels. This study focuses on enhancing the sustainability of wastewater treatment practices by partially replacing conventionally used fossil-derived methanol with organic waste-derived volatile fatty acids (VFAs) in moving bed biofilm reactors (MBBRs). In this regards, results of denitrification batch assays with sequential or simultaneous addition of VFA effluent from acidogenic fermentation of potato starch residue (AD-VFAPPL) and chicken manure (AD-VFACKM), simulated synthetic VFAs solutions (sVFAs), and methanol as carbon source were presented and discussed. Although methanol has proven superior in the conversion of nitrate to nitrite, VFAs are more effective when it comes to reducing nitrite. Although solely added AD-VFAPPL had a slower denitrification capability (0.56 ± 0.13 mgNOx-N removed/m2/day) than methanol (1.04 ± 0.46 mgNOx-N removed/m2/day), up to 50% of the methanol can be replaced by waste-derived AD-VFAPPL and achieve comparable performance (1.08 ± 0.07 mgNOx-N removed/m2/day) with the pure methanol. This proves that the co-addition of VFAs together with methanol can fully compete with pure methanol in performance, providing a promising opportunity for wastewater treatment plants to potentially reduce their carbon footprint and become more sustainable in practice while benefiting from recovered nutrients from waste