Retrospective analysis of thyroid incidentalomas detected by [68Ga]Ga-PSMA-11 PET/CT.

BACKGROUND: Prostate cancer patients, undergo imaging procedures, with [68Ga]Ga-PSMA-11 PET/CT (prostate-specific membrane antigen based positron emission tomography/computed tomography) utilized for primary and secondary staging. PSMA thyroid incidentalomas (PTI) are discovered in the thyroid gland while imaging prostate cancer patients with [68Ga]Ga-PSMA-11 PET/CT. AIMS: The aim of the study was to determine the clinical significance of PTIs detected on [68Ga]Ga-PSMA-11 PET/CT. Another goal was to identify a possible threshold for the maximum standardized uptake value (SUVmax), above which a malignant growth could be suspected. STUDY DESIGN: A retrospective cross-sectional study. METHODS: 769 patients with prostat cancer who underwent [68Ga]Ga-PSMA-11 PET/CT scans in the nuclear medicine department of a tertiary care hospital between January 2020 and December 2022 were retrospectively screened in this study. We analyzed 67 patients in whom PTI was detected. Patients who exceeded the inclusion criteria had their thyroid ultrasonography and ultrasonography -guided fine needle aspiration findings analyzed. RESULTS: PTI was discovered in 67 patients (8%). 42 patients who met the inclusion and exclusion criteria were included in the study. Of the 4 malignant patients (9.5%) in the study population, 2 were classified as TIRADS 3 and 2 were classified as TIRADS 4. The cut-off SUVmax value was found to be 5.6. With 100% sensitivity and 47.37% specificity, a cutoff SUVmax of 5.3 was determined through receiver-operator characteristic analysis in order to predict malignant cytology. CONCLUSION: PTI is a significant clinical finding; most of diffuse and focal uptakes are frequently related to benign diseases. Each center should establish its own a possible SUVmax cut-off over which a malignant lesion should be suspected.

Assessment of Nasal Carriage of Staphylococcus Aureus and Axillar Flora in Patients With Acromegaly.

PURPOSE: Recent study showed that patients with acromegaly have typical skin findings including increased sebum secretion, decreased transepidermal water loss, more alkaline, and colder skin surface correlated with serum growth hormone and insulin-like growth factor 1 levels. Different anatomic localizations and texture of the skin differ in bacterial concentrations.Nasal carriage of Staphylococcus aureus and axillar flora in patients with acromegaly was compared with normal population with regard to duration of acromegaly as well as the growth hormone and insulin-like growth factor 1 levels. METHODS: This patient-control prospective study was conducted in university hospitals in Mersin, Turkey. The study consisted of 30 active acromegalic patients and 60 healthy adults who had no previously diagnosed chronic illness as a control group. A total of 90 volunteers were enrolled in this study; nasal and axillar cultures were obtained. Axillar and nasal specimens from anterior nares of the individuals were taken using sterile swabs. RESULTS: Nasal colonization of Staphylococcus aureus was 13.3% in acromegalic patients, but 43.4% in control group. This difference was statistically significant (P = 0.004). Patients and control group compared according to axillar cultures, the authors determined proteus colonization 16.7% in patients with acromegaly but no proteus colonization in control group. This result was statistically significant (P = 0.001). Proteus colonization was negatively correlated only with disease duration in acromegalic patients (P = 0.017). CONCLUSION: The authors demonstrated that compared with healthy subjects, acromegalic patients had low percentage of nasal carriage of Staphylococcus aureus and more gram-negative basili in the axillar flora. These nasal and axillar flora changes should be considered for prophylactic antibiotics use before surgery and ampiric antibiotics use after surgery.

Mean platelet volume and related factors in patients at different stages of diabetic nephropathy: a preliminary study.

INTRODUCTION: Mean platelet volume (MPV) is an independent cardiovascular disease predictor, and characteristics of MPV in patients with diabetic nephropathy (DN) are not well known. AIM: To determine the MPV levels in patients at different stages of DN. PATIENTS AND METHODS: The MPV levels were investigated in healthy participants (group 1, n = 157), patients with type 2 diabetes mellitus without complication (group 2, n = 160), diabetic patients with clinical proteinuria (group 3, n = 144), and in patients with chronic kidney disease due to DN (group 4, n = 160). FINDINGS: The MPV level was higher in all diabetic patients than that in normal participants (P < .05). The MPV values had a positive correlation with the serum creatinine and proteinuria, and a negative correlation with the glomerular filtration rate ([GFR] P < .001 for all, r values; .72, and .82, and -.92, respectively). CONCLUSION: The MPV values were higher in diabetic groups than that in normal participants. Both GFR and proteinuria were the most powerful determinants of MPV.

Lung function impairment in women aged over 40 years: The critical role of abdominal obesity.

SUMMARY: It is known that obesity causes to impairment of pulmonary functions. This impairment worsens with aging. There are studies about obesity showing that the uses of abdominal measurements instead of BMI are more accurate.: PURPOSE: The aim of our study is to investigate the correlation of waist circumference in the women aged over 40 years with obesity to the respiratory function tests and chest expansion. MATERIALS AND METHODS: In our study, BMI, waist circumference and chest expansion of 64 women over 40-year old were measured and the values obtained were compared with the results of respiratory function tests. RESULTS: There was a positive correlation between the age of the patients with waist circumference and DLCO/VA. A negative correlation was found between the age and MVV. The weight increase was associated with an increase in waist circumference and DLCO/VA. It was observed that waist circumference and DLCO/VA were increased and chest expansion was decreased when BMI was increased. A positive correlation was determined between MVV and the other respiratory function parameters, FEV1, FVC, FEV1/FVC and FIVC (p < 0.01). Similarly, the increase in DLCO was found to be correlated with the values of FEV1, FVC and FIVC. FIVC was correlated only with FEV1 and FVC. CONCLUSION: In this study, it was observed that respiratory function tests of women over 40-year old with obesity were associated with anthropometric measurements. But, studies with larger sample sizes and prospective studies are needed to provide more accurate information about the importance of DLCO/VA for the assessment of pulmonary function in obese women.

Insulin receptor substrate-2 gene polymorphism: is it associated with endometrial cancer?

OBJECTIVE: The G1057D polymorphism in the insulin receptor substrate-2 (IRS-2) gene has been reported to be associated with insulin resistance, obesity and type 2 diabetes. However little is known about its possible association with cancer. To investigate this association, we determined the distribution of its genotypes and frequency of alleles in endometrial cancer patients. METHODS: The study population consisted of 184 subjects: 44 patients with endometrial cancer and 140 controls without cancer. All the patients were primarily treated with surgical intervention. DNA was extracted from the leucocytes by high pure polymerase chain reaction (PCR) template preparation kit. Genetic polymorphism of IRS-2 G1057D was detected by using PCR-based restriction fragment-length polymorphism. RESULTS: For IRS-2 G1057D polymorphism, there was a significant difference in genotype distribution and allele frequency between endometrial cancer patients and controls (p < 0.001). The risk for endometrial cancer was 4.87 times higher in the individuals with the IRS-2 DD genotype compared to the GG genotype [95% confidence interval (CI): 1.74-13.63 p = 0.003]. Also individuals with the IRS-2 D allele had a significantly higher risk of endometrium cancer compared with individuals with the IRS-2 G allele, with a relative risk of 2.23 (95% CI: 1.36-3.67, p = 0.001) for cases compared with population controls. CONCLUSION: These results suggest that IRS-2 G1057D polymorphism may be associated with endometrial cancer.

Association of G1057D variant of insulin receptor substrate-2 with endometriosis.

OBJECTIVE: To investigate whether the insulin receptor substrate (IRS)-2 G1057D polymorphism is associated with the risk of endometriosis, and to evaluate potential correlation of IRS2 gene polymorphism with the stages of endometriosis. DESIGN: Case-control study. SETTING: Gynecology clinics in university hospital. PATIENT(S): Women with (n = 135) or without (n = 135) endometriosis. Afterward, the women with endometriosis were divided into two groups according to the stage: group 1 included 63 women in stages I-II, and group 2 included 72 women in stages III-IV. INTERVENTION(S): Genotyping by polymerase chain reaction-based restriction fragment-length polymorphism method. MAIN OUTCOME MEASURE(S): Genotype distribution of the G1057D polymorphism in the IRS2 gene. RESULT(S): The genotype distribution of the IRS2 G1057D polymorphism in the endometriosis group was significantly different from that of the control group (GG/GD/DD rates were 43.0%/39.3%/17.7% and 55.6%/36.3%/8.1% for the endometriosis and control groups, respectively). Further subgroup analyses according to the stage of endometriosis also revealed a positive association between the IRS2 DD genotype expression and stage III-IV endometriosis patients in the population studied. CONCLUSION(S): These results suggest that the IRS2 G1057D polymorphism may be associated with an increased risk for endometriosis.

Use of Chinese herbal medicine 'meizitanc' in pregnancy: report of three cases.

The Chinese herbal medicine 'meizitanc', known as 'LiDa Dai Dai Hua Jiao Nang' (Kunming Dali Industry and Trade, Kunming, Yunnan, China) has been used by many women to support weight loss, even though life-threatening side-effects and deaths have been reported. We report the outcomes of three cases of exposure to 'meizitanc' during early pregnancy. In the first case, the pregnancy continued after the patient stopped taking the drug and at 38 weeks of gestation, the patient delivered a healthy infant. However, in the second and third cases fetal cardiac activities were not detected on obstetric follow-up and both pregnancies were terminated due to missed abortion. To our knowledge, this is the first report of exposure to meizitanc during pregnancy. Although herbal medicines are presumed to be safe because of their natural origin, consumption of such products may be dangerous due to the content of undeclared drugs, adulteration with multiple substances and contamination with toxic metals.

Normal CA 19-9 levels in Hashimoto's thyroiditis.

Carbohydrate antigen 19-9 (CA 19-9) is a glycosphingolipid of the Lewis blood group that for years has been proposed as a useful marker for epithelial type gastrointestinal cancers. It is well known that moderately increased concentrations of CA 19-9 can be found in 15-36 % of patients with benign conditions such as pancreatic, liver, biliary diseases and benign hydronephrosis. In current study, we investigated whether there was any tendency for CA 19-9 elevation in 71 patients with Hashimoto's thyroiditis. Patients with malignancy, benign pancreas, liver, lung and biliary diseases, inflammatory bowel diseases, urinary tract infection, hydronephrosis, endometriosis, diabetes mellitus and chronic renal failure were excluded. In the Hashimoto's thyroiditis cases, mean serum CA 19-9 level was 12.5-/+10.4 (range, 2.5-55), while it was 11.9-/+ 9 (range, 2.5-29.3) and 10.3-/+ 8 (range, 2.5-28.9) in patients with Graves' and healthy volunteers respectively, without any significant intergroup differences. Although the American Society of Clinical Oncology does not recommend tumor markers like CA 19-9 in screening for malignancies, they may be used for this purpose. In contrast to case reports showing possible elevation of CA 19-9 in Hashimoto's thyroiditis, we did not detect such a relation. Moreover, there was no pointers to change in CA 19-9 levels in patients with hypo-, hyper- or eu-thyroidism.

Plasma visfatin level in lean women with PCOS: relation to proinflammatory markers and insulin resistance.

OBJECTIVES: The present study was undertaken to investigate the association between plasma visfatin concentrations and inflammatory markers such as interleukin-6 (IL-6) and high-sensitive C-reactive protein (hsCRP) in company with several metabolic parameters in lean women with polycystic ovary syndrome (PCOS). METHODS: The study group consisted of 21 lean women with PCOS (BMI 20.74 +/- 1.74 kg/m(2)) and 15 healthy, normally menstruating women (BMI 20.85 +/- 2.08 kg/m(2) control group). PCOS was defined according to the Rotterdam criteria. Visfatin, IL-6, hsCRP, hyperandrogenism markers and metabolic markers were examined in all PCOS and control women. RESULTS: Plasma visfatin level in the PCOS group was higher than that in the control group. Plasma hsCRP and IL-6 levels in PCOS group were similar with the control group. Plasma visfatin levels were positively associated with total cholesterol, high density lipoprotein, hirsutism score, total testosterone and FAI. Plasma visfatin level was negatively associated with SHBG. However, there were no correlation between plasma visfatin level and IL-6 and hsCRP. In multivariate regression analyses, only FAI and high density lipoprotein-cholesterol (HDL-C) showed a significant association with serum visfatin. CONCLUSION: Our data indicates that plasma visfatin levels are associated with HDL-C and markers of hyperandrogenism, but it is not associated with proinflammatory markers and insulin resistance in lean women with PCOS.

The correlation of thrombolysis in myocardial infarction frame count with insulin resistance in patients with slow coronary flow.

BACKGROUND: It has been reported that coronary endothelial dysfunction plays an important pathogenetic role in patients with slow coronary flow (SCF). Insulin resistance is defined as impairment of insulin-stimulated glucose and/or lipid metabolism, while endothelial dysfunction is defined as paradoxical or inadequate endothelial-mediated vasodilation. In this study, we aimed to evaluate insulin resistance in patients with SCF. METHODS: The study population included 25 patients with SCF and 28 healthy controls. Insulin resistance was estimated via homeostasis model assessment insulin resistance index (HOMA-IR). RESULTS: Patients with SCF had higher high-sensitive C-reactive protein (hs-CRP) and HOMA-IR scores (P<0.05) than controls. Mean thrombolysis in myocardial infarction frame count had significant correlation with hs-CRP, fasting plasma insulin levels and HOMA-IR score (r=0.566, P<0.05; r=0.883, P<0.05; r=0.884, P<0.05, respectively). CONCLUSION: In patients with SCF, thrombolysis in myocardial infarction frame counts and hs-CRP are correlated with increased insulin resistance and thus, it can be suggested that insulin resistance and inflammation may, in part, have a role in the pathogenesis of SCF.

Serum IL-18 levels in patients with type 1 diabetes: relations to metabolic control and microvascular complications.

The study was designed to examine serum IL-18 level and its relation to metabolic control parameters and microvascular complications in type 1 diabetes mellitus (DM). Sixty two patients with type 1 DM and 30 healthy individuals were enrolled in the study. Serum IL-18 levels of patients with type 1 DM were significantly increased compared to controls (293.4+/-133.4 vs 211.2+/-63.9 pg/ml, P=0.003). Patients with poor glycemic control had higher levels of IL-18 than patients with well glycemic control (329.9+/-141.0 vs 226.3+/-89.6 pg/ml, P=0.02). There was no significant difference between the serum IL-18 levels of patients with microvascular complications and those of patients without microvascular complications (307.6+/-127.6 vs 293.2+/-145.6 pg/ml, P>0.05). IL-18 correlated positively with HbA(1c) (r=0.32, P=0.01) and postprandial blood glucose (PPBG) (r=0.26, P=0.02); and negatively with HDL-cholesterol (HDL-C) (r=-0.38, P=0.007). By linear regression analysis, PPBG was determined as the most explanatory parameter for the alterations in serum IL-18 levels (P=0.02). High levels of IL-18 in patients with type 1 DM is related to short and long term glycemic control and HDL-C levels but not to microvascular complications.

Cushing syndrome caused by topical corticosteroid: a case report.

Development of iatrogenic Cushing syndrome from topical steroid therapy is very rare in adults. A 48-year-old woman with a diagnosis of Cushing syndrome caused by long-term topical clobetasol propionate application was presented. Laboratory studies were consistent with adrenal suppression that improved after discontinuation of the use of topical glucocorticoids. Patients who will take treatment with steroids, even with topical steroids, should be offered information about the dose, duration, and type of the treatment and its systemic side-effects.

Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms.

AIM: To investigate the risk factors for infection of the diabetic foot with multidrug resistant microorganisms. METHODS: Amongst 102 diabetic patients with evidence of soft tissue infection of the foot who presented to our health center over a three year period, we investigated risk factors that might be predictive of multi-antibiotic resistance of the infecting organism. RESULTS: Of 102 patients with a diabetic foot wound, bacteria were cultured from 73, yielding a total of 104 isolates. The number of multidrug resistant isolates was 42 from 36 cases and the number of isolates other than multidrug resistant ones was 62 from 37 cases. Previous antibiotic therapy (p=0.002) and its duration (p=0.0001), frequency of hospitalization for the same wound (p=0.000), duration of hospital stay (p=0.000) and osteomyelitis (p=0.001) were significant risk factors for infections with multidrug resistant microorganisms. CONCLUSION: In conclusion, an appropriate antibiotic should be initiated promptly, wound perfusion should be effective, duration of hospital stay should be as short as possible and optimum hygiene should be provided during wound care to prevent infections of diabetic foot wound with multidrug resistant microorganisms.

Effects of rosiglitazone treatment on the pentose phosphate pathway and glutathione-dependent enzymes in liver and kidney of rats fed a high-fat diet.

BACKGROUND: Animals fed high-fat diets have been shown to develop hyperglycemia, insulin resistance, hyperlipidemia, and moderate obesity, which resemble the human metabolic syndrome. Obesity, the metabolic syndrome, and some thiazolidinediones, which act as insulin sensitizers, may increase oxidative stress, and/or influence the levels of cellular reducing equivalents and homeostasis. OBJECTIVE: This study investigated the effects of a high-fat diet, rosiglitazone, or a high-fat diet plus rosiglitazone on metabolic syndrome parameters and crucial liver and kidney enzyme activities in rats. METHODS: Male Wistar rats were assigned to 4 groups (n = 6 per group): (1) the fat (F) group was fed a rodent diet comprising 45 kcal% fat, (2) the rosiglitazone (R) group was fed a standard rat chow comprising 4.97 kcal% fat plus rosiglitazone (3 mg/kg.d), (3) the fat + rosiglitazone (FR) group was fed a rodent diet comprising 45 kcal% fat (as lard, product D12451) plus rosiglitazone (3 mg/kg.d), and (4) the control (C) group was fed a standard rat chow comprising 4.97 kcal% fat. Animals were housed for 4 weeks, at which time the liver and kidney were isolated for spectrophotometric determination of enzyme activities. Body weight was measured before treatment (baseline) and then weekly throughout the study. Adiposity was measured at the end of the 4 weeks. RESULTS: The activities of glucose-6-phosphate dehydrogenase (G6PD), 6-phosphogluconate dehydrogenase (6-PGD), glutathione reductase (GR), and glutathione-S-transferase (GST) were significantly reduced in the livers of groups F, R, and FR compared with group C (all P < 0.05). Kidney G6PD, 6-PGD, and GR were found to be significantly lower in group R compared with the other groups (all P < 0.05). Kidney GST was similar in all groups. Plasma glucose, triglyceride, and insulin concentrations were significantly higher than in group F versus the other groups (all P < 0.05). Adiposity was increased in groups F and FR compared with groups C and R (all P < 0.05). Serum cholesterol concentrations were similar in all groups. CONCLUSIONS: In this study, high-fat diet in rats decreased the enzyme activities responsible for pentose phosphate pathway and glutathione-dependent metabolism in liver but not in kidney. Similarly, these enzyme activities were inhibited with rosiglitazone treatment alone in both organs.

A comparison of four different alpha1-blockers in benign prostatic hyperplasia patients with and without diabetes.

OBJECTIVE: The aim of this study was to evaluate the intensity of lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) with and without diabetes. We also determined whether alpha1-blockers improve subjective and objective symptoms similarly in these patients. MATERIAL AND METHODS: The study subjects comprised 281 patients (60 with diabetes and 221 non-diabetics with clinically diagnosed BPH) who were treated with alpha1-blockers (doxazosin, terazosin, alfuzosin and tamsulosin). The international prostate symptom score (IPSS), bother score, maximum flow rate (Q(max)) and post-void residual urine volume (PVR) were determined at baseline and after treatment for a minimum of 6 months. RESULTS: Diabetic patients had a lower baseline Q(max) than non-diabetics (p < 0.001), while the IPSS, bother score and PVR did not differ significantly between the two groups. After treatment with alpha1-blockers, lower urinary tract symptoms improved significantly. The improvement rates of the IPSS and bother score were significantly higher in the diabetic patients than in the non-diabetics (p < 0.01). The relationship between the duration of diabetes and the effect of alpha1-blockers on IPSS, bother score, Q(max) and PVR was not statistically significant (p > 0.05). CONCLUSIONS: The voiding function of the bladder may be more affected by diabetes than the storage function in patients with BPH. Treatment with alpha1-blockers appears to be useful for diabetic patients with BPH and its effectiveness is not altered by the duration of diabetes.