Increased accumulation of the advanced glycation endproduct Ne(carboxymethyl) lysine in the intramyocardial vasculature in patients with epicarditis.

Advanced glycation end-products (AGEs) are implicated in the pathogenesis of vascular disease. In previous studies we have found increased deposition of N(e)-(carboxymethyl)lysine (CML) in intramyocardial vasculature in the heart in acute myocardial infarction and myocarditis. It is known that the process of inflammation plays a role in the formation of AGEs. In this study we have explored the presence of CML (a major AGE) in the heart of patients with epicarditis using a monoclonal anti-CML antibody. Nine patients with epicarditis (n = 9) died and their hearts were used for this study, control were hearts from patients who died from conditions unrelated to heart disease and without signs of myocarditis or epicarditis CML deposition and complement were significantly increased in patients with epicarditis compared to control hearts. Thus epicarditis increases CML depositions in the intramyocardial vasculature.

The cause of depression in adolescence: peer bullying.

OBJECTIVE: Depression affects adolescents worldwide and often predicts more serious disease manifestations in later lifetimes. Peer victimization or bullying, another form of child abuse, increases symptoms of depression. In this paper, the relationship between peer bullying and depression in adolescence was investigated. SUBJECTS AND METHODS: Each adolescent who was admitted to the adolescent unit completed forms referred to as the 'Depression Scale For Children' and the 'Multidimensional Peer Victimization Scale'. Sociodemographic features and results of the scales' evaluation were studied. SPSS 16.0 program was used for statistical analysis. The p-value below 0.05 was considered statistically significant. RESULTS: 239 adolescents, 120 of whom were male, were investigated. A positive relationship was determined among total and sub-scale scores of peer victimization-determining scale and depression scale scores. A negative relationship was determined between height, weight, age of the child, and sub-scale score of threat/intimidation. Both the total score of the peer victimization-determining scale and sub-scale scores of ridicule, open attack, and relational attack pertaining to patients with depression proved to be significantly higher than in those without depression. CONCLUSIONS: The awareness of educators and parents, notably adolescents, must be raised in regard to peer victimization, and activities for increasing the communicative skills of adolescents and for allowing them to be able to express their emotions should also be performed. Identifying and preventing peer victimization, one of the causes of depression, and launching the treatment process for this are the first steps to be taken in terms of a healthy adulthood.

One-year follow-up of the oxidative stress profile of patients after laparoscopic sleeve gastrectomy.

OBJECTIVE: Obesity is a major risk factor for developing a number of serious diseases, such as cardiometabolic changes and cancer. An increase in adipose tissue and a decrease in antioxidant capacity both contribute to the etiopathogenesis of these comorbidities. The most effective method in the treatment of morbid obesity is bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is the most preferred method in bariatric surgery today. In this study, the potential improvement effect of laparoscopic sleeve gastrectomy (LSG) surgery in the restoration of weight loss and endocrine and tissue-based deterioration was obtained by evaluating changes in oxidative stress, antioxidant agents, and lipid oxidation levels. PATIENTS AND METHODS: Fifty patients who had LSG surgery were chosen, along with 50 healthy volunteers who were the same age and gender as these patients. Serum total antioxidant capacity measurement, total oxidant capacity measurement, malondialdehyde (MDA) for the measurement of lipid peroxidation degree, and superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels for the measurement of antioxidant levels were measured colorimetrically with the help of a commercial kit. RESULTS: Oxidative stress indices, MDA levels, and GPx levels of patients with morbid obesity treated with LSG were observed to decrease significantly compared to the preoperative period, while no significant changes were observed in SOD levels. CONCLUSIONS: In patients with morbidly obese conditions, the weight control achieved by sleeve gastrectomy, which is a restrictive method and thus causes a decrease in adipose tissue, causes a decrease in oxidative stress and an increase in the antioxidant response.

Frail patients who fall and their risk on major bleeding and intracranial haemorrhage. Outcomes from the Fall and Syncope Registry.

BACKGROUND: Major bleeding, and intracranial bleeding specifically, are severe complications related to the use of anticoagulation. To what extent the risk for major bleeding is elevated among frail older people is not well known because they are underrepresented in the randomized clinical trials (RCTs). This study investigates the risk for major bleeding (MB) and intra cranial haemorrhage (ICH) in frail older people who fall. METHODS: All patients 65 years and older visiting the Fall and Syncope Clinic, between November 2011 and January 2020, and underwent a MRI of the brain were eligible. Frailty was assessed with a Frailty Index, based on the accumulation of deficits model. Cerebral small vessel disease was described and evaluated as proposed in the position paper of Wardlaw and colleagues in 2013. RESULTS: 479 patients were included in this analysis. Mean follow-up was 7 years per patient (ranging from 1 month to 8 years and 5 months). 368 patients (77%) were frail. A total of 81 patients used oral anticoagulation (OAC). 17 extracranial MB of which 3 were traumatic and 14 gastrointestinal, and 16 ICH occurred. There was a total of 603.4 treatment years with OAC, and 8 MBs occurred among patients on OAC (bleeding rate 1.32 per 100 treatment years), of which 2 ICHs (bleeding rate 0.33 per 100 treatment years). The risk for extracranial MB was increased by the use of antiplatelet agents (APA) (adjusted OR 6.9, CI 95% 1.2-38.3), and by the use of OAC (adjusted OR 9.8, CI 95% 1.7-56.1). The risk for ICH was only heightened by white matter hyperintensities (WMH) (adjusted OR 3.8, CI 95% 1.0-13.4). The use of APA (adjusted OR 0.9, CI 95% 0.3-3.3) or OAC (adjusted OR 0.6, CI 95% 0.1-3.3) did not elevate the risk for ICH. CONCLUSION: In contrast to common belief, frail patients on OAC with repeated falls show a comparable bleeding rate as in the large RCTs, and the use of OAC did not increase the risk for ICH. However, the number of MBs was low, and of ICHs very low, despite extensive follow-up in this registry.

Genetic, haplotype and phylogenetic analysis of Ligula intestinalis by using mt-CO1 gene marker: ecological implications, climate change and eco-genetic diversity.

Ligula intestinalis is a cestode parasite that affects freshwater fish in different countries of the world. The current study aims to reveal the phylogenetic, genetic and haplotype diversity of mt-CO1 gene sequences sent to the NCBI database from different countries by using in-silico analysis. The 105 mt-CO1 (371 bp) gene sequences of L. intestinalis obtained from NCBI were used for bioinformatics analyses. Sequences were subjected to phylogenetic and haplotype analysis. As a result of the haplotype analysis of L. intestinalis, 38 haplotypes were obtained from 13 different countries. Hap24 constituted 44.76% of the obtained haplotype network. Changes in nucleotides between haplotypes occurred at 1-84 different points. China and Turkey have highest fixation index (Fst) values of 0.59761, while the lowest (-0.10526) was found between Russia and Turkey. This study provides a baseline for future studies on extensive scale on the epidemiology, ecological aspects, distribution pattern, transmission dynamics and population dispersion of L. intestinalis worldwide.

A silent, trapped guest in the maxillary sinus: Oestrus ovis myiasis with unusual presentation (with CARE guideline).

INTRODUCTION: A sheep bot fly, Oestrus ovis, is an obligate parasite that is found worldwide, especially widespread in the Mediterranean areas and Middle Eastern. Interestingly, in this report, a case with an L3 larva trapped in the human maxillary sinus with other stage larvae is presented. CASE SUMMARY: A 32-year-old female patient has no symptoms until the larva is expelled by sneezing. Endoscopic examination was normal on admission. Paranasal sinus computed tomography (CT) revealed left maxillary sinus soft tissue density. Uncinectomy and middle meatal antrostomy was performed to remove the infection and larvae. DISCUSSION: Human ophthalmic and nasopharyngeal myiasis have been documented but asymptomatic maxillary sinus myiasis is unusual and not reported. Due to changes in environmental factors, this atypical infection may occur with an unexpected presentation.

Evaluation of the Effectiveness of Liquid Platelet-Rich Fibrin and Deproteinized Bovine Bone Mineral Mixture on Newly Formed Bone in Maxillary Sinus Augmentation: A Split-Mouth, Histomorphometric Study.

OBJECTIVE: We aimed to investigate the effectiveness of the liquid PRF-DBBM mixture on new bone formation in maxillary sinus augmentation. MATERIAL AND METHODS: Seven patients requiring two-stage bilateral maxillary sinus augmentation were included in the study. The patients were selected according to the criteria of having an alveolar bone height of at least 2 mm in the atrophic region. The elevated sinus cavities were randomly grafted with DBBM + liquid PRF (test) or DBBM alone (control) in a split-mouth design. Bone samples were collected during implant surgery with a trephine bur for histomorphometric evaluation after 4 months. RESULTS: In the control group, the newly formed bone was 39.49%, the mature bone was 15.66%, the residual graft was 15.62%, and the fibrous tissue ratio 28.59%, while in the test group, the newly formed bone (NFB) was 45.95%, the mature bone was 14.40%, the residual graft was 10.32%, and the fibrous tissue was 29.31%. No statistically significant difference was found between the groups in terms of the parameters studied (p > 0.05). The mean osteocalcin score in the control group was 2.70 ± 0.39, while it was 2.81 ± 0.36 in the test group. There was no statistically significant difference between the averages of osteocalcin scores of the groups (p > 0.05). CONCLUSION: The results of our study showed that DBBM is a reliable graft material for maxillary sinus augmentation even in the early period. Combining of DBBM with liquid-PRF contributed to new bone formation over a four-month period, but this contribution was not statistically significant.

Demographics of Cystic Echinococcosis Patients Treated Surgically in Lahore, Pakistan: A Single Centre Study from 2007 - 2018.

Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. These parasites have a worldwide geographic distribution and pose a serious threat to livestock industry as well as human health in the endemic areas. CE is widely distributed in Pakistan. However, very few reports are available related to the regional transmission of E. granulosus. A retrospective analysis was conducted of surgically confirmed CE patients who were treated at Shoukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Punjab Province, Pakistan from 2007 - 2018. In total, 536 CE patients were evaluated during the study period. Cases originated from the provinces of Khyber Pakhtunkhwa (n=336), Punjab (n=147), Baluchistan (n=18), Sindh (n=3), Islamabad (n=2), Gilgit Baltistan (n=1), and Azad Jammu and Kashmir (n=1). An additional 28 cases were from Afghanistan. The highest number of CE cases was reported in 2013 (n=90). Females made up a larger proportion of cases (n=310; 57.8 %) than males (n=226; 42.2 %). Most patients were members of the Pashtun (n=197; 36.7 %), Hindku (n=142; 26.5 %), and Punjabi (n=118; 22.0 %) ethnic groups. The largest number of cysts was obtained from the liver (137/536; 25.6 %). This study showed that CE is likely present throughout Pakistan. In order to control the disease, a comprehensive control program and regional surveillance are needed.

A Rare Case of Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: a Case Report.

Tuberculosis (TB) is still a worldwide problem. We present a case of flexor tenosynovitis due to tuberculosis in the hand and wrist. A 42-year-old man presented to the outpatient clinic with a 2-year history of a slowly growing mass over the volar aspect of the left wrist. His MRI showed multiple rice bodies in the wrist and hand. An open biopsy was performed. Pathology specimens showed granulomatous lesions with central necrosis. The purified protein derivative (PPD) test was positive. In this case, granulomatous lesions with central necrosis, rice bodies, and positive PPD test confirmed the diagnosis of TB in the wrist and hand. There was no other concurrent evidence of TB elsewhere. Antituberculosis chemotherapy was commenced. Tuberculous tenosynovitis of the wrist and hand is very rare. The tuberculous tenosynovitis should be kept in mind as an infectious agent when patients are presenting with atypical clinical. Key words: tuberculosis, rice bodies, flexor tenosynovitis, wrist, hand.

Seroepizootiological investigation on Goat Warble Fly Infestation (Przhevalskiana silenus) in Pothwar Plateau, Pakistan.

Goat Warble Fly Infestation (GWFI) is also known as subcutaneous myiasis caused by Przhevalskiana silenus (Diptera: Oestridae). It is widely distributed in tropical and sub-tropical areas of the world. In goats, WFI is usually detected through conventional procedure which underestimated the infestation. The current study was designed to determine the serodiagonsis of GWFI (through IDEXX Hypodermosis serum antibody test) and also aimed to investigate its seroepizootiological profile in Pothwar region, Pakistan from 2013-14. The results showed that average seropositivity (ELISA kit) of GWFI was 18.5% whereas, it was 11% by using conventional procedure (Palpation method) depicting a significant difference (p<0.05). Higher seropositivity (30.8%) was observed in Jhelum district as compared to e Attock district (6%). The L1 larvae were found in September, while nodules start appearing in October to December and last until the end of February. The month wise peaks of optical density (OD) was higher in December which gradually decrease along with the end of winter season. The prevalence of GWFI revealed no significant difference among three host breeds (Jattal, Beetal and Tedy). According to the results, high infestation rate (28%) was observed in young animals of age group < 1 year as compared to old animals (> 2 years). Topographically, hilly areas (33%) provide favourable climatic conditions for the propagating of larval stages. Sex difference showed no significant difference. The seroprevalence varied significantly with respect to age, month, districts and topographical location. The current study proved that serologic diagnosis (commercial ELISA kit) as more sensitive and accurate for timely diagnosis of GWFI than traditional method. The information on the epizootiology of P. silenus in goats of Pothwar region would help in devising effective control strategies.

Gynecomastia as a presenting symptom of Graves' disease in a 49-year-old man.

SUMMARY: Gynecomastia is a symptom with a potential high disease burden. It has a variety of underlying causes, such as malignant, drug-related or hormonal. The presence of gynecomastia can be explained in thyrotoxicosis due to a concomitant disbalance of sex hormones. Interestingly, it rarely is the presenting symptom of Graves' disease. A 49-year-old man presented to our outpatient clinic with right-sided gynecomastia. After thorough history taking, more symptoms of thyrotoxicosis were present. Treatment was started with thiamazole and later levothyroxine. Three months after this treatment the gynecomastia and other symptoms resolved completely. A disbalance of sex hormones due to an increased expression of the protein sex hormone-binding globulin (SHBG) caused by thyrotoxicosis could result in gynecomastia. In vitro and in vivo research in mice suggest that the pathophysiology of thyrotoxicosis-associated gynecomastia is due to upregulation of hepatocyte nuclear factor-4α (HNF4A) in liver cells. Subsequent increase of SHBG results in a decrease of free testosterone levels. LEARNING POINTS: Gynecomastia is a common finding (up to almost 40%) on physical examination in patients with hyperthyroidism. In gynecomastia, thyroid function tests should be examined on initial presentation because of the relative simple treatment. The pathophysiology of thyrotoxicosis-associated gynecomastia is well understood by a sex-hormonal disbalance due to an increased expression of SHBG. Due to the well explainable pathophysiology, reduction of symptoms can be expected after treatment. The underlying mechanism of an increased expression of SHBG is not well understood. However, in vitro and in vivo research in mice suggests that thyrotoxicosis causes an increased expression of HNF4A in liver cells. Thus, upregulating the expression of SHBG. Interestingly, HNF4A is suspected to play an important role in MODY. Future research will clarify the importance of this gene and might open up new insights for therapy.

In-silico Analysis of Mt-CO1 Gene of Taenia Hydatigena Sheep Isolates.

Taenia hydatigena is a tapeworm that affects herbivores in different regions of the world. Cysticercus tenuicollis (larvae of T. hydatigena), is prevalent in ruminants and pigs. In the current study, phylogenetic analysis of the published mt-CO1 gene of C. tenuicollis sheep isolates was analyzed using in-silico method and vertical and horizontal transmission at the global level by using a meta-analysis approach. A total of 82 mt-CO1 nucleotide sequences (339 bp) of C. tenuicollis sheep isolates from the NCBI database (Italy -Sardinia-, Iran, Palestine, Iraq, Finland, India and China) were used to investigate haplotype and genetic relationships. Tajima's D (-2,2984) value was negative for the mt-CO1 sequences signifying the population expansion and/or purifying selection. The highly negative Fu's Fs (-60,528) values determined for the sequences reflecting the existence of uncommon haplotypes. The mt-CO1 of C. tenuicollis haplotype network had 47 haplotypes arranged within a star-like configuration with a main haplotype, which encompassed 25.6 % of the total isolates. In the mt-CO1 haplotype network analyzed, there were 80.5 % unique single haplotype and highest ratio was observed in C. tenuicollis from sheep originating from Iran, followed by Sardinia, Palestine and Finland. If the current condition continues, genetic differences in T. hydatigena will be able to rise, and possible new strains and/or genotypes that may influence the host adaptation and life cycle of the parasite may emerge.

Coexistent subclinical hypothyroidism is associated with an increased risk of new cardiovascular events in rheumatoid arthritis: an explorative study.

Objective: Autoimmune thyroid disease often coexists with rheumatoid arthritis (RA) and is associated with elevated cardiovascular (CV) risk. However, studies in RA patients are scarce. Our aim was to investigate whether autoimmune thyroid disease increases the risk of new cardiovascular disease (CVD) in RA.Method: Thyroid-stimulating hormone (TSH) and serum free thyroxine (FT4) were assessed in 323 RA patients participating in an ongoing prospective cohort study designed to assess CV risk factors, morbidity, and mortality. Cox proportional hazard models were used to calculate hazard ratios (HRs) for new CVD and adjusted for age, gender, smoking, prevalent CVD, thyroxine replacement therapy, and RA duration.Results: Of the 323 participants, 65.3% were female, and mean ± sd age was 63 ± 7 years. At baseline, 8.1% were hypothyroid (n = 26, 16 clinical, 10 subclinical), 6.8% hyperthyroid (n = 22, 13 clinical, 9 subclinical), and 85.1% (n = 275) euthyroid. A new CV event developed in 94 patients (29.1%) during follow-up. Compared to euthyroid patients, the HR adjusted for age, gender, and prevalent CVD was 2.83 [95% confidence interval (CI) 1.13-7.09; p = 0.026] for subclinical hypothyroidism. Further adjustment for smoking, thyroxine replacement therapy, and RA duration resulted in an HR of 3.0 (95% CI 1.19-7.54; p = 0.02) for CV events in patients with subclinical hypothyroidism.Conclusion: There was no difference in CVD between RA patients with hypothyroidism and hyperthyroidism versus euthyroid patients. Coexistence of subclinical hypothyroidism with RA is associated with a higher occurrence of new CV events. Treatment trials are needed to determine whether thyroxine supplementation can further improve CV outcome in these patients.

Accuracy of an algorithm to identify rheumatoid arthritis in the Longitudinal Ageing Study Amsterdam population: a validation study.

Objective: In view of global ageing and the scarcity of knowledge about disease determinants in older individuals with rheumatoid arthritis (RA), an algorithm with optimal diagnostic accuracy was developed to identify RA patients in the Longitudinal Ageing Study Amsterdam (LASA).Method: Four case ascertainment algorithms were constructed and assessed for validity in LASA, an ongoing cohort study (≥ 55 years) representing the general older population of the Netherlands. Data sources used to identify the diagnosis RA were: self-reported morbidity, specialist diagnosis, and medication. A validation subsample of LASA participants was taken to verify RA diagnosis by a standard procedure using a checklist.Results: Data from 272/300 (91%) participants were verified. Four algorithms were developed: 'treatment', 'diagnosis', 'treatment or diagnosis', and 'treatment and diagnosis'. The algorithm 'treatment and diagnosis' showed the best measurement properties: specificity 100%, positive predictive value 100%, and area under the receiver operating characteristics curve 0.72. Applying this algorithm in the LASA sample (mean age 71 years) revealed a prevalence of RA of 1.0% (19/1908 participants).Conclusion: An algorithm for RA identification in the LASA population was developed, with high diagnostic accuracy. It provides an accurate tool to identify older adults with RA in LASA and, after validation, may be applicable in other large population-based studies.

Investigation of temporal illicit drugs, alcohol and tobacco trends in Istanbul city: Wastewater analysis of 14 treatment plants.

Wastewater-based drug monitoring is a complementary tool that has been used worldwide in recent years, and many cities have periodically reported monitoring results. However, this study is the first to analyze drugs in wastewater in a single city with a high population during four periods simultaneously from 14 treatment plants. The aim was to estimate the consumption of conventional illicit drugs [amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, cocaine, and heroin], tobacco, and alcohol in 2019 for quarterly periods in Istanbul city, which has a population of almost 20 million, to aid in implementing evidence-based measures. Additionally, the seasonal variations among the 14 wastewater treatment plants and their weekday/weekend comparison of drug use patterns and consumption per substance were examined. Solid phase extraction was followed by liquid chromatography-tandem mass spectrometry and a previously validated method was enhanced by adding new parameters (morphine, cotinine, and ethyl sulfate), and satisfactory results were obtained. In this study, alcohol, nicotine, and cannabis had the highest estimated per capita consumption with mean values of 29655.3 mL/1000 inh/day, 5507.6 mg/1000 inh/day and 3607.0 mg/1000 inh/day, respectively. These results were followed by heroin and cocaine consumption with mean values of 557.0 and 200.9 mg/1000 inh/day, respectively, whereas AMP-type stimulants had the lowest values among the targeted substances. METH and cannabis were also highly consumed drugs when compared with the results of other metropolitan cities, whereas heroin consumption was remarkably high owing to Turkey's location on a possible heroin trafficking route. Because Istanbul is the business center of the country and has the potential to attract tourists in all four seasons, meaningful seasonal consumption differences were not observed for all substances.

The effect of anti-TNF treatment on body composition and insulin resistance in patients with rheumatoid arthritis.

Given the link between systemic inflammation, body composition and insulin resistance (IR), anti-inflammatory therapy may improve IR and body composition in inflammatory joint diseases. This study assesses the IR and beta cell function in rheumatoid arthritis (RA) patients with active disease compared to osteoarthritis (OA) patients and investigates the effect of anti-TNF treatment on IR, beta cell function and body composition in RA. 28 Consecutive RA patients starting anti-TNF treatment (adalimumab), and 28 age, and sex-matched patients with OA were followed for 6 months. Exclusion criteria were use of statins, corticosteroids, and cardiovascular or endocrine co-morbidity. Pancreatic beta cell function and IR, using the homeostasis model assessment (HOMA2), and body composition, using dual-energy X-ray absorptiometry (DXA) were measured at baseline and 6 months. At baseline, IR [1.5 (1.1-1.8) vs. 0.7 (0.6-0.9), 100/%S] and beta cell function (133% vs. 102%) were significantly (p < 0.05) higher in RA patients with active disease as compared to OA patients. After 6 months of anti-TNF treatment, IR [1.5 (1.1-1.8) to 1.4 (1.1-1.7), p = 0.17] slightly improved and beta cell function [133% (115-151) to 118% (109-130), p <0.05] significantly improved. Improvement in IR and beta cell function was most pronounced in RA patients with highest decrease in CRP and ESR. Our observations indicate that IR and increased beta cell function are more common in RA patients with active disease. Anti-TNF reduced IR and beta cell function especially in RA patients with highest decrease in systemic inflammation and this effect was not explained by changes in body composition.

The kidney, subclinical thyroid disease and cardiovascular outcomes in older patients.

OBJECTIVE: Thyroid hormones have been implicated to play a role in cardiovascular disease, along with studies linking thyroid hormone to kidney function. The aim of this study is to investigate whether kidney function modifies the association of subclinical thyroid dysfunction and the risk of cardiovascular outcomes. METHODS: In total, 5804 patients were included in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). For the current analysis, 426 were excluded because of overt thyroid disease at baseline or 6 months, 266 because of inconsistent thyroid function at baseline and 6 months, 294 because of medication use that could influence thyroid function, and 16 because of missing kidney or thyroid values. Participants with normal fT4 were classified, based on TSH both at inclusion and 6 months, into three groups: subclinical hypothyroidism (TSH >4.5 mIU/L); euthyroidism (TSH = 0.45-4.5 mIU/L); and subclinical hyperthyroidism (TSH <0.45 mIU/L). Strata of kidney function were made based on estimated glomerular filtration rate into three clinically relevant groups: <45, 45-60, and >60 mL/min/1.73 m2. The primary endpoint consists of death from coronary heart disease, non-fatal myocardial infarction and (non)fatal stroke. RESULTS: Mean age was 75.3 years, and 49.0% patients were male. Mean follow-up was 3.2 years. Of all participants, 109 subjects (2.2%) had subclinical hypothyroidism, 4573 (94.0%) had euthyroidism, and 182 (3.7%) subclinical hyperthyroidism. For patients with subclinical hypothyroidism, euthyroidism, and subclinical hyperthyroidism, primary outcome occurred in 9 (8.3%), 712 (15.6%), and 23 (12.6%) patients, respectively. No statistically significant relationship was found between subclinical thyroid dysfunction and primary endpoint with adjusted hazard ratios of 0.51 (0.24-1.07) comparing subclinical hyperthyroidism and 0.90 (0.58-1.39) comparing subclinical hypothyroidism with euthyroidism. Neither was this relationship present in any of the strata of kidney function, nor did kidney function interact with subclinical thyroid dysfunction in the association with primary endpoint (P interaction = 0.602 for subclinical hyperthyroidism and 0.388 for subclinical hypothyroidism). CONCLUSIONS: In this secondary analysis from PROSPER, we found no evidence that the potential association between thyroid hormones and cardiovascular disease is modified by kidney function in older patients with subclinical thyroid dysfunction.

Preliminary Evidence for the Occurrence of ß-tubulin Isotype 3 Polymorphisms in Fasciola Hepatica Isolates in Cattle and Sheep in Turkey.

Fasciolosis caused by Fasciola hepatica is a common parasitic disease of livestock especially sheep and cattle. In this study molecular characterization of ß-tubulin isotype 3 gene in Fasciola hepatica isolates from cattle and sheep in Turkey was carried out. For this purpose a total of 80 adult Fasciola hepatica isolates were collected from 20 sheep and 20 cattle in Kayseri and Erzurum provinces. PCR-RFLP was performed on ß-tubulin isotype 3 gene and MboII revealed two fragments of approximately 350 bp and 390 bp, whereas HphI enzyme yielded 210, 340 and 540 bp bands, HindII yielded 380 and 450 bp bands in all samples. A total of 80 isolates were tested by SSCP and all of them presented the same band profiles. Six samples (4 sheep and 2 cattle) were randomly selected and DNA sequence of a 935 bp coding fragment of ß-tubulin isotype 3 was performed. Sheep samples were more polymorphic than the cattle. This ß-tubulin isotype 3 gene polymorphism of F.hepatica isolates from sheep and cattle of two distinct geographical areas of Turkey have been investigated for the first time.

Clinicopathologic characteristics of recurrent endometrioid endometrial cancer patients and analysis of methods used duriing surveillance.

OBJECTIVE: To determine cilinicopathologic characteristics of recurrent endometrioid type endometrial cancer patients and analyze the methods applied in detection of recurrent disease during follow-up period. METHODS: We have retrospectively reviewed the file records of the 226 patients who had endometrioid type carcinoma. Bimanual pelvic examination, speculum examination, carcinogenic antigen-125 (CA125) testing, vaginal cuff cytologic screening, transabdominal ultrasound (TAUS) and transvaginal ultrasound(TVUS) imagings were performed within the context of routine follow-up control examinations in the post-treatment period in every 3 months within the first 2 years and in every 6 months in the following 2 years and with annual control in the consecutive years. RESULTS: Mean follow-up durations was 25.7±18.9 months while recurrence rate was 3.1%. The study patient group underwent totally 1116 times TVUS and 1084 times whole TA-US evaluations, 973 times vaginal cuff cytological screening, 1125 times pelvic and general physical examinations beside 1060 times CA-125 testings were performed in accordance with our routinely performed follow-up protocol. The asymptomatic recurrent cases ; one of those was dignosed with pelvic examination while diagnosis was established using TA-USG evaluation in the other asymptomatic patient. The other 5 cases were symptomatic. Pelvic examination, Computed Tomograhy and Magnetic Resonance Imaging were utilized in diagnosing 1, 3 and 1 of those patients, respectively. CONCLUSION: The presence of symptoms and pelvic examination seem to be the most effective modalities in detecting recurrence in follow-up of endometrial cancer. It would be reasonable to optimize intervals between follow-up visits and to determine the appropriate evaluations by considering risk levels of the patients.

Poverty-associated emerging infection of Cystic Echinococcosis in population of Northern Pakistan: A hospital based study.

Cystic Echinococcosis (CE) is one of the most important zoonotic parasitic diseases in human, livestock, and wildlife globally. The prevalence of CE depends upon human behavioral risk factors, the diversity and ecology of animal host interactions and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. It is a neglected, economic and socio-cultural problem in Pakistan. The available data about the incidence of CE is very limited and no extensive study has been reported in Pakistan. The current study was aimed to analyze the hospital reported cases of CE and the associated risk factors related to the incidence of CE. The hospital-based data of CE for the time period of January 2012-December 2017 was collected from Islamabad, Rawalpindi and Peshawar. The data covered demographic characteristics including age, gender, and cyst localization of infected individuals and socioeconomic determinants. The data was analyzed based upon different risk factors along with the different socioeconomic parameters that has an important impact on the distribution of disease. A total of 228 cases were presented in the selected hospitals of different cities during the study period. Out of total 228 patients, 59.21% were males and 40.78% were females (P<0.001). Most infections have been recorded in young adults (>20-30) showing 22.8% of total infected individuals followed by children (0-10) showing 10.5% (n=24), respectively (P<0.001). Liver was the most vulnerable organ (58.77%, n=134) followed by lungs (14.47%, n=33) (P<0.001). The infection was higher among rural communities (84.2%) than urban (12.8%) (P<0.001). Socioeconomic and demographic factors had an important impact on the intensity of disease (P<0.001). The occurrence of cases in children and young adults was an important finding as it indicated an active transmission of the parasite in Pakistan along with the poverty index. Emergence of echinococcosis in Pakistan showed that emerging health issues in Pakistan could bring the disease to limelight for future research. This finding, together with the fact that 1 hospital reported 214 cases over 6 years 325 underlines the need for a program for prevention/control of this disease in Pakistan. The timely measure needs to be taken to hamper the disease development and establishment. In order to control the disease, complete surveillance should be done which in turn weighs down the disease progress.