Dental caries and associated factors among Turkish children and adults: Findings from the 3rd National Oral Health Survey.

BACKGROUND: Information on the current status of oral health and related risk factors is lacking in Turkiye. This study aimed to evaluate dental caries and associated factors among the Turkish population using the findings of the third national oral health survey. METHODS: This cross-sectional epidemiological survey was carried out between March and September in 2018 including five index ages and age groups (5-, 12-, 15-year-olds, 35-44 and 65-74 age groups). A multistage cluster sampling design was used to obtain a national representative sample of these age groups. Participants were interviewed face-to-face using a structured questionnaire, and oral examinations were performed based on the methods and criteria suggested by the World Health Organization. The adjusted prevalence ratio for dental caries was estimated considering sociodemographic and behavioural characteristics by using log-binomial and robust Poisson regression analysis in R and SAS software. RESULTS: After data cleaning, a total of 11 091 participants remained. The prevalence of dental caries was 76.5% (95% confidence interval: 75.4%-77.7%) and determined to be associated with age, dental visit, and pain or discomfort history during the previous year among the Turkish population. Prevalence was also associated with the mother's education level among 5-, 12- and 15-year-olds. For the 35-44 age group, individuals living in urban areas had lower dental caries than those living in rural areas. For 65-74 age group, none of the factors were significantly associated with dental caries. CONCLUSION: A high prevalence of dental caries was observed in Turkish children and adults. Therefore, it is necessary to strengthen current preventive oral health programs. Regular disease surveillance should be maintained. National oral health targets should be formulated in accordance with Turkiye's needs, resources and structure.

The effects of different taping methods on patellofemoral alignment, pain and function in individuals with patellofemoral pain: A randomized controlled trial.

BACKGROUND: Athletic taping has long been a physiotherapeutic application in individuals with patellofemoral pain (PFP). However, the therapeutic effects of local and proximal taping have not been fully determined. OBJECTIVE: To evaluate the effects of two different taping techniques applied in addition to exercise on patellofemoral alignment, pain, and function in individuals with PFP. DESIGN: Randomized controlled trial. SETTING: An outpatient hospital clinic. PARTICIPANTS: Individuals with PFP aged 18-50 years (n = 36). INTERVENTIONS: Group 1 underwent only the exercise program. Group 2 underwent the exercise plus McConnell patellar taping (MPT), and Group 3 underwent the exercise plus femoral rotational taping (FRT) (6 weeks). MAIN OUTCOME MEASURES: Bisect offset index (BOI) and patellar tilt angle (PTA) were measured in relaxed and maximum voluntary contractions of the quadriceps muscle (MVCq) using magnetic resonance imaging. Pain intensity was assessed by the Visual Analog Scale for three conditions: at daytime rest, during activity, and at nighttime. Functional level was assessed by the Kujala Patellofemoral Scoring System. RESULTS: Significant improvements in the BOI of Group 2 at rest (p = .015; r = 0.593) and in PTA of Group 3 at MVCq (p = .010; r = 0.613) were found. Improvements in pain under all three conditions were significant within groups (all, p values < .050 and r > 0.5). The change in pain was similar between groups (all, p values > .05). All groups showed significant improvement in functional level (all, p values < .010 and r > 0.5). However, the increase in Group 3 was higher than that in Group 1 (p = .019). CONCLUSION: This study shows that MPT and FRT applications increase functionality and can affect patellofemoral alignment in different ways. In the treatment of PFP, more successful results can be obtained with appropriate taping techniques for the local and proximal region.

The effects of plasma viscosity in thromboembolic events among patients with essential thrombocytosis: A case-control study.

INTRODUCTION: Essential thrombocythemia (ET) is an entity of classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), characterized by thrombocytosis with megakaryocytic hyperplasia where in the thrombocytes are increased with abnormal function.Thrombotic events are seen frequently and represent the main cause of morbidity and mortality in patients with MPNs, mainly polycythemia vera and ET. This study has aimed to research the effects of clonally increased thrombocytes on plasma viscosity (PV) levels among patients with ET and the relationship between PV and thromboembolism history, according to the hypotheses about the effects of PV in thromboembolic events among patients with ET. METHODS: A total of 55 patients were enrolled in the study group, 18 of who had been newly diagnosed with ET according to 2016 World Health Organization criteria and had not previously been treated. 37 of them had already been diagnosed with ET and had been treated. There were 47 healthy volunteers in the control group. 5 cc blood samples were taken from the patients into tubes including an anticoagulant to measure their PV levels. RESULTS: PV of the control group was found to be lower than in the study group and both each patient groups (p < 0.05). No relationship was found between the patient groups in terms of PV (p = 0.404). The mean PV levels of the 16 patients with a history of thromboembolism and the 39 patients with no such history were 2.42±0.17 cP and 2.33±0.20 cP, respectively. The mean PV levels were found to be similar according to their history of thromboembolism in all patient groups and in treated patients (p = 0.572 vs p = 0.991). CONCLUSION: We have found that PV levels were increased in clonally increased thrombocytes in patients with ET when compared with the control group. This is the first study in this field according to our knowledge.

Validity and Reliability of the Turkish Version of Mandibular Function Impairment Questionnaire.

OBJECTIVE: To assess the validity and reliability of the Turkish version of the Mandibular Function Impairment Questionnaire (MFIQ-TR). METHODS: Included in this study were 248 patients diagnosed with temporomandibular disorder (TMD) according to Diagnostic Criteria for TMD Axis I protocol. Construct-related validity was evaluated through internal and external construct validity; convergent and divergent validities were evaluated by the average variance extracted (AVE), composite reliability (CR), and bivariate correlations between factors. Reliability was assessed by internal consistency and test-retest reliability. RESULTS: All items of the MFIQ-TR had content validity and factor loadings above 0.5. The model statistics indicated a good fit. The convergent validity was very good (AVE > 0.5 and CR > 0.7), and the discriminant validity was satisfied. Internal consistency and test-retest reliability of the MFIQ-TR were excellent. CONCLUSION: The MFIQ-TR is a valid and reliable instrument for evaluating the impairment of mandibular function in Turkish patients with TMD.

A comparison of the effectiveness of splinting, exercise and electrotherapy in women patients with hallux valgus: A randomized clinical trial.

BACKGROUND: Hallux valgus (HV) is a very common foot deformity involving lateral deviation of the hallux and medial deviation of the first metatarsal head. OBJECTIVES: To investigate the effects of HV night splinting, exercise and electrotherapy on the HV angle, and foot-specific health-related quality of life. METHODS: Sixty women (120 feet) with bilateral HV deformity were randomly assigned to one of three groups - an HV night splint (SP) group, an exercise (EX) group, and a high-voltage galvanic stimulation (HVPGS) (EL) group. The patients in SP group used the HV night splints while resting or sleeping for at least 8 h a day and the patients in the EX group performed exercises 3-4 times a day with 10 repetitions for the duration of the one-month treatment period. Twenty-minute HVPGS was applied in total over three weekly sessions for four weeks in EL group. Angular degrees (hallux interphalangeal angle (HIPA), HV angle (HVA), and intermetatarsal angle (IMA)) were determined before (t0) and three months after treatment (t2). Foot-specific quality of life was assessed using the Manchester-Oxford Foot Questionnaire (MOFQ) at t0, after one month (t1), and at t2. RESULTS: All groups exhibited significant changes in the HIPA, HVA, and IMA angles and outcome measures (p ≤ 0.001). Decreases in the HIPA and IMA angles, and MOFQ-Pain subscale scores, were higher in the SP group than in the other two groups (p < 0.05). IMA angle at t2, MOFQ-Walking score at t1 and t2 and MOFQ-Pain subscale score at t1 were lower in the SP group (p < 0.05). CONCLUSION: The SP group exhibited more positive effects in the parameters measured than the other two groups. A combination of these conservative treatment approaches may be more beneficial to improve HV symptoms with longer follow-up periods. CLINICALTRIALS. GOV IDENTIFIER: NCT04393545.

Do community-dwelling pregnant women know about pelvic floor disorder?

Our study aimed to assess the knowledge and awareness regarding pelvic floor disorders (PFDs) among pregnant women. We additionally evaluated whether the knowledge of PFDs was different in relation to gestational age, parity, the attendance to an antenatal education (ANE), and history of urinary incontinence (UI) and/or pelvic organ prolapse (POP). A cross-sectional descriptive study was conducted in pregnant women from all trimesters of pregnancy. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and three questions were used for knowledge and awareness. Two hundred and forty-one women participated in the study. Of them, 18.6% (n = 46) and 3.6% (n = 9) had UI and POP, respectively. The median of the PIKQ-UI and the PIKQ-POP scores were 6 (min-max: 0-11) and 5 (min-max: 0-12), respectively. The median PIKQ-UI and PIKQ-POP scores were higher in women who had attended ANE. There was no significant difference in terms of gestational age, parity, the attendance to ANE, and the history of pelvic floor disorder (p > .05). Knowledge and awareness were low among the women in all trimesters. Education programs involving pelvic floor training should be organized for pregnant women.

Are clinicopathological features of the isthmic thyroid nodule different from nodules in thyroid lobes? A single center experience

ABSTRACT Objectives: Thyroid nodules located in isthmus were found less prevalent, although papillary thyroid cancer in this location was reported to be more aggressive behaviour in some studies. Our aim was to evaluate hormonal,ultrasonographic, and cytopathologic features of nodules located in isthmus (isthmic nodules). Subjects and methods: Patients who underwent thyroidectomy between 2006-2014 reviewed retrospectively. Hormonal, ultrasonographic, and cytopathologic features compared between patients with isthmic (Group-1) and with lober (non-isthmic, Group-2) nodules. Results: Group-1 and Group-2 consisted of 251 and 2076 patients, respectively. 260 isthmic (5.5%) and 4433 non-isthmic (94.5%) nodules were compared.However,most ultrasonographical features such as presence of microcalcification and halo, diameters, echogenicity, texture, margin, and vascularity were similar between groups, macrocalcification rate was lower in isthmic nodules (18.8%, 25.9%; p = 0.012). Cytologic results were also similar.Although malignancy rate was lower in isthmic nodules (6.2%, 12.5%; p = 0.002), type of thyroid cancer was similar in isthmic and non-isthmic nodules.When malignant isthmic (n = 16,2.8%) and malignant non-isthmic nodules (n = 553, 97.2%) were compared, diameter and type of tumor, lymphovascular and capsular invasions, extrathyroidal extension and multifocality rates were not statistically significant.Malignant isthmic nodules (n = 16, 6.2%) had smaller size [10.1 (7.5-34.5) mm, 19.95 (8.4-74.1) mm; p = 0.002], and higher hypoechogenicity rate (31.3%, 5.7%, p = 0.003) compared to benign isthmic nodules (n = 244, 93.8%). Negative predictive value was higher and positive predictive value was lower in isthmic nodules compared to non-isthmic nodules (p = 0.033, p = 0.047, respectively). Conclusion: Isthmic nodules appear to be indolent because of having lower malignancy rate. FNAB might be required in isthmic nodules even if it has relatively small size.The surgery with limited extent or follow-up might seem to be reliable in the management of patients having isthmic nodules especially with indeterminate cytology.

The value of serum thyroglobulin alteration after ultrasonography-guided fine-needle biopsy of suspicious cervical lymph nodes in the diagnosis of metastasis in patients with differentiated thyroid cancer.

BACKGROUND: It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules. We aimed to determine whether TG is increased after ultrasonography (US)-guided fine needle capillary biopsy (FNC) of suspicious cervical lymph nodes (LNs) in thyroidectomised patients and investigate the possible association between change in TG and cytology results. MATERIAL AND METHODS: Data of 188 patients who underwent FNC of suspicious cervical LNs were retrospectively evaluated. Demographical, laboratory and ultrasonography features of LNs were noted. TG levels before FNC (TGb-FNC ), after FNC (TGa-FNC ), TGa-FNC /TGb-FNC ratio and the number of patients with increased TG were determined. Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results. RESULTS: TGa-FNC , TGb-FNC /TGa-FNC and rate of patients with increased TG were significantly higher in malignant cytology group than other groups (P < .001). The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%. TG increase was not associated with age, sex, Thyroid-stimulating hormone (TSH) level, anti-TG positivity and US features of LNs while significantly lower in patients who received radioactive iodine (RAI) treatment. Among 31 patients with positive anti-TG, TGb-FNC /TGa-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups. CONCLUSIONS: Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients. Increase in TG after FNC might be an additional tool for determining LN metastasis.

Papillary thyroid microcarcinomas that metastasize to lymph nodes.

PURPOSE: We aimed to determine clinicopathological features that can predict lymph node metastasis (LNM) in papillary thyroid microcarcinomas (PTMC). METHODS: Medical records of 872 patients with papillary thyroid cancer >1 cm (PTC > 1 cm) and 1184 patients with papillary thyroid microcancer (PTMC) (≤1 cm) were reviewed retrospectively. Demographical, clinical and histopathological features of (PTC > 1 cm) and PTMC were compared. Association between clinicopathological features and LNM in PTMC was investigated. RESULTS: The median age of patients with PTMC was significantly higher than patients with PTC > 1 cm (49 vs 46 years old, p < 0.001). Multifocality, capsular invasion, vascular invasion, extrathyroidal extension (ETE) and LNM were more frequent in patients with PTC > 1 cm compared to patients with PMTC (p < 0.001 for each). In PTMC group, those with LNM had significantly higher proportion of multifocality, capsular invasion, vascular invasion and ETE compared to those without LNM (p = 0.007, <0.001, p = 0.011 and p < 0.001, respectively). Multifocality and ETE were significant factors for LNM with logistic regression analysis. Multifocality increased the risk of LNM by 1.737 times (95% CI: 1.079-2.979) and ETE increased the risk by 3.528 times (95%: 1.914-6.503). Primary tumor diameter ≥ 5.75 mm was predictive for LNM with a sensitivity of 0.782 and a specificity of 0.517 in PTMC. CONCLUSIONS: LNM should be investigated more carefully in patients with PTMC in the presence of tumor diameter ≥ 5.75 mm, multifocality or ETE.

Are clinicopathological features of the isthmic thyroid nodule different from nodules in thyroid lobes? A single center experience.

OBJECTIVE: Thyroid nodules located in isthmus were found less prevalent, although papillary thyroid cancer in this location was reported to be more aggressive behaviour in some studies. Our aim was to evaluate hormonal, ultrasonographic, and cytopathologic features of nodules located in isthmus (isthmic nodules). METHODS: Patients who underwent thyroidectomy between 2006-2014 reviewed retrospectively. Hormonal, ultrasonographic, and cytopathologic features compared between patients with isthmic (Group-1) and with lober (non-isthmic, Group-2) nodules. RESULTS: Group-1 and Group-2 consisted of 251 and 2076 patients, respectively. 260 isthmic (5.5%) and 4433 non-isthmic (94.5%) nodules were compared. However, most ultrasonographical features such as presence of microcalcification and halo, diameters, echogenicity, texture, margin, and vascularity were similar between groups, macrocalcification rate was lower in isthmic nodules (18.8%, 25.9%; p = 0.012). Cytologic results were also similar. Although malignancy rate was lower in isthmic nodules (6.2%, 12.5%; p = 0.002), type of thyroid cancer was similar in isthmic and non-isthmic nodules. When malignant isthmic (n = 16,2.8%) and malignant non-isthmic nodules (n = 553, 97.2%) were compared, diameter and type of tumor, lymphovascular and capsular invasions, extrathyroidal extension and multifocality rates were not statistically significant. Malignant isthmic nodules (n = 16, 6.2%) had smaller size [10.1 (7.5-34.5) mm, 19.95 (8.4-74.1) mm; p = 0.002], and higher hypoechogenicity rate (31.3%, 5.7%, p = 0.003) compared to benign isthmic nodules (n = 244, 93.8%). Negative predictive value was higher and positive predictive value was lower in isthmic nodules compared to non-isthmic nodules (p = 0.033, p = 0.047, respectively). CONCLUSION: Isthmic nodules appear to be indolent because of having lower malignancy rate. FNAB might be required in isthmic nodules even if it has relatively small size. The surgery with limited extent or follow-up might seem to be reliable in the management of patients having isthmic nodules especially with indeterminate cytology.

Enemy Beyond the Wall: Clinicopathological Features of Intrathyroidal Papillary Thyroid Carcinoma (T1-T3a) That Metastasize to Lymph Nodes Without Extrathyroidal Extension.

The aim of this study was to determine the clinicopathological features of papillary thyroid carcinomas (PTC) without extrathyroidal extension (ETE) and with lymph node metastasis (LNM). PTC > 1 cm increased the risk of LNM by 2.161 times compared to papillary thyroid microcarcinoma. The risk increased by 3.774 times in males and 1.553 times in the presence of multifocality. Presence of vascular invasion (VI) increased the risk of LNM by 3.093 times in patients without capsular invasion (CI). Clinicians should be careful about possible LNM in patients with large primary tumor diameter, multifocal tumors, CI and VI.

Effect of Ramadan Fasting on Thyroid Hormone Levels in Patients on Levothyroxine Treatment.

OBJECTIVE: To evaluate the changes in thyroid functions in Ramadan, and compare late evening and pre-seheri use of levothyroxine in patients with hypothyroidism. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Endocrinology, Ankara Ataturk Education and Research Hospital and Ankara Yildirim Beyazit University, Turkey, from May to June 2018. METHODOLOGY: Patients who were on levothyroxine treatment and having normal thyroid functions were recruited for the study in the last one week before Ramadan. Patients were offered to take levothyroxine at 22.30-23.00 pm before sleep or between 01:30-03:00 am at least 30 min pre-seheri. RESULTS: There were 53 (85.5%) female and 9 (14.5%) male patients. Basal thyrotrophin (TSH) was 2.02 µIU/mL (0.27-4.14) and insignificantly increased at the end of Ramadan [2.18 µIU/mL (0.04-19.69), p=0.167]. Free-triiodothyronine (fT3) decreased while free-thyroxine (fT4) increased (p<0.001 for both). Eighteen patients preferred to take levothyroxine in late evening and 44 preferred to take at pre-seheri. There were insignificant increases in TSH in both groups (p=0.401 and p=0.276, respectively). At the end of Ramadan, TSH increased in 39 (63.9%), decreased in 22 (36.1%), and did not change in one patient. CONCLUSION: Increase in TSH was not significant after Ramadan. While there was an insignificant increase in median TSH, about one-third of patients had lower TSH, indicating for the need to evaluate every patient individually and follow closely during Ramadan. Clinical studies with larger sample sizes will be helpful to determine the optimal time for levothyroxine use during Ramadan. Key Words: Thyroid functions, Ramadan fasting, Hypothyroidism, Levotyhroxine.

Effects of kinesio tape application on pain, anxiety, and menstrual complaints in women with primary dysmenorrhea: A randomized sham-controlled trial.

AIM: To investigate the effects of kinesio tape (KT) application on pain, anxiety, and menstrual complaints in women with PD and compare this application with control and sham tape (ST). METHODS: Fifty-one women with PD were randomized into three groups: KT, ST, and control groups. No tape application was performed in the control group. KT was applied on the sacral and suprapubic regions with the ligament technique in the KT group, while it was applied on the trochanter major with no technique in the ST group. Pain, anxiety level, and menstrual complaints were assessed before and after the applications. RESULTS: The decreases in pain, anxiety levels, and some menstrual complaints after the application were higher in the KT group than those in the other two groups (p < 0.05). CONCLUSION: KT application seems to be an effective method in decreasing pain, anxiety level, and some menstrual complaints in women with PD.

Mapping of parathyroid neoplasms based on grey scale ultrasound images and histopathological whole slide images.

PURPOSE: In this study, echogenicity and histopathological projections of parathyroid neoplasia in grey mode ultrasonography were compared with whole side imaging (WSI). The utility of the data obtained for clinical assessment was evaluated. METHODS: In 57 patients operated for hyperparathyroidism, the parathyroid gland was sampled in the sagittal plane. The lesion slides were scanned. The WSI was rendered digital. The histopathological slide images scanned with USG images were matched. With the Image J program, the areas of cell types and morphological changes were measured. RESULTS: In parathyroid neoplasms, hypoechoic areas were found to be matched with 21% [55.3%] chief cell, 2 [5.0%] oncocytic cell and 8%[20.0%] cystic morphology. Of the 57 patients, 26 [45.61%] had a cystic area. It was seen that hyperechogenic areas match more connective tissue areas than chef cell [p < 0.05]. There was less clear cell in hyperechogenic areas than iso-hyperechogenic areas [p < 0.05]. The ratio of fat tissue echogenicity was lower in hypoechoic areas than hyperechoic [p < 0.05]. There was a positive correlation between PTH and the entire tissue area [r = 0.377, p = 0.004]. A positive directional moderate linear relationship was found between blood calcium level and parathyroid adenoma [rho = 0.530, p = 0.009] and percentage [rho = 0.416, p = 0.048]. When atypical adenomas and adenoma cases were compared, no significant difference was found between the cystic and chief cell areas [p > 0.05]. CONCLUSION: The hypoechogenicity seen in USG was observed to be compatible with chief cell, hyperechogenic areas in USG were compatible with connective tissue and fat tissue. As the cystic area increased, blood calcium levels were higher in adenomas. We think that the results of this study will be guiding to evaluate the reflections of the detailed morphometric studies.

Ultrasound elastography score and strain index in different parathyroid lesions.

BACKGROUND: Despite significant improvement in imaging quality and advanced scientific knowledge, it may still sometimes be difficult to distinguish different parathyroid lesions. The aims of this prospective study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether strain index can help to differentiate parathyroid lesions. METHODS: Patients with biochemically confirmed hyperparathyroidism and localised parathyroid lesions in ultrasonography were included. All patients underwent B-mode US and USE examination. Ultrasound elastography scores and strain index of lesions were determined. Strain index was defined as the ratio of strain of the thyroid parenchyma to the strain of the parathyroid lesion. RESULTS: Data of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%) parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of parathyroid hyperplasia. Median serum Ca was significantly higher in atypical parathyroid adenoma patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher in APA compared to PA patients (P < 0.001). In 221 (90.2%) of the parathyroid lesions, USE score was 1 or 2. The median SI of atypical parathyroid adenomas was significantly higher than parathyroid adenomas and hyperplasia lesions (1.5 (0.56-4.86), 1.01 (0.21-8.43) and 0.91 (0.26-2.02), respectively, P = 0.003). CONCLUSION: Our study revealed that SI of parathyroid lesions as well as serum calcium, parathyroid hormone levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ultrasound elastography can be used to differentiate among parathyroid lesions and guide a surgical approach.

Evaluation of malignancy with thyroid imaging reporting and data system (TI-RADS) in thyroid nodules with persistent nondiagnostic cytology

Background/aim: We aimed to evaluate the utility of thyroid imaging reporting and data system (TI-RADS) in prediction of malignancy in thyroid nodules with persistent nondiagnostic (ND) cytology. Materials and methods: A total of 246 thyroid nodules which were surgically removed and had at least two fine-needle aspirations (FNAs) with ND cytology were included in this study. Ultrasonography features and TI-RADS scores were recorded. Results: Of 246 nodules, 218 (88.6%) had benign and 28 (11.4%) had malignant final histopathology. Frequencies of taller than wide shape, solidity, hypoechogenicity, microcalcifications, and presence of irregular borders were similar between benign and malignant nodules (P > 0.05). The number of nodules categorized as TI-RADS 3, 4a, 4b, and 4c were 12 (4.9%), 53 (21.5%), 104 (42.3%), and 77 (31.3%), respectively. There was not any nodule in TI-RADS 5 category. Malignancy rates of categories 3, 4a, 4b, and 4c were 0%, 13.2%, 9.6%, 14.3%, respectively. No significant differences were detected in TI-RADS categories between benign and malignant nodules (P > 0.05). Conclusion: In this study, we did not demonstrate any suspicious ultrasound (US) finding predictive for malignancy in thyroid nodules with persistent ND cytology and did not determine any difference between malignant and benign nodules regarding TI-RADS scores. Whereas, we found that thyroid nodules in 4a, 4b, and 4c TI-RADS categories had higher malignancy rates than those previously reported in ND cytology. We think that TI-RADS categories in thyroid nodules with persistent ND cytology can be helpful in treatment decision.

Diagnostic accuracy of intestinal ultrasound and magnetic resonance enterography for the detection of endoscopy-based disease activity in ileocolonic Crohn's disease.

BACKGROUND: Crohn's disease (CD) is characterised by chronic gastrointestinal inflammation with relapsing-remitting behaviour and often requires endoscopic and/or radiologic assessment. OBJECTIVE: The objective of this study was to compare the diagnostic accuracy of intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) for the assessment of disease activity in CD using a simple endoscopic score for CD as a reference standard. PATIENTS AND METHODS: A prospective observational study was carried out in 71 consecutive adult patients with known CD, attending our tertiary inflammatory bowel disease clinic, between November 2014 and July 2016. Ileocolonoscopy, IUS and MRE were performed within 1 month prospectively. The simple endoscopic score-CD 0-2 was accepted as remission. RESULTS: The sensitivity of IUS and MRE for detecting endoscopic activity was found similar with regard to bowel wall thickening and mesenteric fibrofatty proliferation (P>0.05). The overall accuracy for detecting mural lesions was similar between IUS and MRE. When mural lesions were analysed, the sensitivity of MRE in detecting the loss of wall stratification and stenosis was significantly higher than IUS (P<0.001 for both). IUS showed higher specificity for bowel wall thickening, loss of wall stratification and stenosis (P=0.009, P<0.001 and P<0.001, respectively). Sensitivity and accuracy of IUS were higher in detecting ascites in active disease (P=0.002). DISCUSSION: Our results showed that IUS and MRE were equally accurate in detecting endoscopic activity. IUS may be the preferred technique for the evaluation of disease activity and for the follow-up of CD.

Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer?

BACKGROUND: The suppressive effect of the increase in thyroid hormone in patients with toxic nodular goiter is thought to protect the extranodular thyroid tissue from thyroid malignancy. In this study, we aimed to evaluate the prevalence and features of thyroid cancer in patients with toxic nodular goiter who underwent thyroidectomy. METHODS: Medical data of patients who had solitary toxic or nontoxic nodules and underwent total thyroidectomy were reviewed retrospectively. We reviewed the clinical, laboratory, and histopathologic features of patients with toxic nodular goiter and nontoxic solitary nodules. RESULTS: There were 73 patients with toxic nodular goiter and 366 patients with nontoxic solitary nodules. Median age was greater in the toxic nodular goiter compared with nontoxic solitary nodules patients (50 years; range: 18-73 vs 42 years; range: 18-83, P < .001). Median nodule diameters were 40.9 mm (range: 11.0-98.0) and 23.3 mm (range: 4.9-99.0) in patients with toxic nodular goiter and nontoxic solitary nodules, respectively (P < .001). Histopathologic examination revealed thyroid cancer in 14 patients (19%) with toxic nodular goiter and 132 (36.1%) patients with nontoxic solitary nodules (P = .008). Median tumor diameters were 6 mm (range: 1-50) in toxic nodular goiter and 14 mm (range: 1-80) in nontoxic solitary nodules (P = .150). The malignant nodule was the hyperfunctioning nodule in 7 patients with toxic nodular goiter; 4 were follicular and 3 were papillary thyroid cancer. The other 7 malignant foci were located in the suppressed contralateral lobe, and all were papillary microcarcinomas. The incidence of thyroid cancer outside the main nodule was similar in 2 groups (P = .934). CONCLUSION: Thyroid cancer in patients operated for toxic nodular goiter was 19%, which is not as rare as previously thought. A careful histopathologic examination of both the hyperfunctioning nodule and the extranodular thyroid tissue might help to disclose an unexpected tumor foci when thyroidectomy is performed in patients with toxic nodular goiter.

Turkish translation of the Prolapse and Incontinence Knowledge Questionnaire: validity and reliability.

INTRODUCTION AND HYPOTHESIS: To translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Turkish and test its validity and reliability. METHODS: The study included 341 women. The translation of the PIKQ, which comprised of the urinary incontinence (PIKQ-UI) and pelvic organ prolapse (PIKQ-POP) sections, was performed in accordance with international recommendations. The Incontinence Quiz (IQ) and the Visual Analog Scale (VAS) were applied to assess the level of knowledge about POP and UI. Psychometric analyses consisted of assessing the following: (1) construct validity by confirmatory factor analysis, (2) criterion and known group validity, (3) internal consistency reliability by the KR-20 coefficient, and (4) test-retest reliability over 1 week with the intraclass correlation coefficient (ICC). RESULTS: All fit indices except the Standardized Root Mean Square Residual indicated acceptable fit for the final models. Criterion validity was supported by moderate correlations between the PIKQ-UI and the IQ (rho = 0.679, p < 0.001). There were positive and weak linear correlations between the PIKQ-UI and PIKQ-POP scores and their corresponding perceived knowledge scores (rho = 0.351, p = 0.013 and rho = 0.345, p = 0.014, respectively). The known group validity did not show differences indicating that participants did not have enough knowledge about UI and/or POP even when they had the condition or acquaintance with them (p = 0.852 and p = 0.185, respectively). Reliability was excellent as indicated by the ICCs of 0.91-0.90, and KR-20 of 0.67-0.75 indicated good internal consistency for the PIKQ-UI and PIKQ-POP, respectively. CONCLUSIONS: The Turkish version of the PIKQ is a valid and reliable instrument to assess the knowledge of UI and POP.

Comparison of BALP, CTX-I, and IL-4 levels around miniscrew implants during orthodontic tooth movement between two different amounts of force.

OBJECTIVES: To evaluate the Interleukin-4 (IL-4), bone-specific alkaline phosphatase (BALP), and C-telopeptide of type I collagen (CTX-I) levels in peri-miniscrew crevicular fluid (PMCF) during orthodontic tooth movement between 75 and 150 g of distalization force. MATERIALS AND METHODS: Thirty miniscrews were placed bilaterally between the maxillary second premolars and first molars. The right and the left maxillary canines were moved distally using either 75 or 150 g of force. PMCF samples were collected before loading (T0); at 2 hours (T1) and 24 hours (T2) later; and on days 7 (T3), 14 (T4), 21 (T5), 30 (T6), and 90 (T7) after force application. Enzyme-linked immunosorbent assay kits were used to determine BALP, CTX-I, and IL-4 levels. RESULTS: There was no significant difference between the force groups at all time points with respect to BALP, CTX-I, and IL-4 levels (P > .05). There was no significant difference among time points for the two force groups in terms of BALP and IL-4 levels (P > .05). The CTX-I level at T3 was significantly higher than at T0 for both force groups (P < .05). CONCLUSIONS: Both 75 g and 150 g of orthodontic force are within optimal force limits, and there is no difference in biochemical markers of bone turnover.