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.

Profiles of Circulating MiRNAs Following Metformin Treatment in Patients with Type 2 Diabetes.

BACKGROUND: Metformin, a widely used biguanide class of anti-diabetic drug, has potential to increase insulin sensitivity and reduce blood glucose to treat type 2 diabetes (T2D). It has been reported that metformin has an activity on regulation of miRNAs by targeting several downstream genes in metabolic pathways. However, molecular mechanism underlying the process is still not fully known. In this study, it was aimed to identify differential expression profiles of plasma derived miRNAs following 3 months metformin treatment in patients with T2D. METHODS: The plasma samples of 47 patients with T2D (received no anti-diabetic treatments) and plasma samples of same 47 patients received 3 months metformin treatment was recruited to the study. Total RNAs were isolated from plasma and reverse transcribed into cDNA. Profiles of differential expressions of miRNAs in plasma were assessed by using of micro-fluidic based multiplex quantitative real time -PCR (BioMarkTM 96.96 Dynamic Array). RESULTS: Our results showed that expression profiles of 13 candidate miRNAs; hsa-let-7e-5p, hsa-let-7f-5p, hsa-miR- 21-5p, hsa-miR-24-3p, hsa-miR-26b-5p, hsa-miR-126-5p, hsa-miR-129-5p, hsa-miR-130b-3p, hsa-miR-146a-5p, hsamiR- 148a-3p, hsa-miR-152-3p, hsa-miR-194-5p, hsa-miR- 99a-5p were found significantly downregulated following metformin treatments in patients with T2D (p<0.05). CONCLUSIONS: In conclusion, our finding could provide development of better and more effective miRNAs based therapeutic strategies against T2D.

Prevalence and Related Factors of Euthyroid Sick Syndrome in Children with Untreated Cancer According to Two Different Criteria

OBJECTIVE: In this study, we evaluated the frequency of euthyroid sick syndrome (ESS) among patients with childhood cancer and its association with the stage of disease, nutritional parameters and cytokines levels. METHODS: Eighty newly diagnosed children were included in the study. ESS was assessed in two different ways. According to criteria 1 ESS was present if free triiodothyronine (fT3) was below the lower limit and free thyroxine was within the normal or low limits, thyroid-stimulating hormone (TSH) was in the normal range. According to criteria 2, in addition to the above, it was required that reverse triiodothyronine (rT3) be performed and was higher than normal limits. RESULTS: Three of our pediatric patients had subclinical hypothyroidism and two had subclinical hyperthyroidism. Out of 75 patients, ESS was identified in 14 (17.3%) according to criteria 1 and in eight (10.6%) according to criteria 2. Only fT3 levels were significantly different in the ESS (+) and ESS (-) groups (p<0.05) according to criteria 1. A significantly negative correlation between interleukin (IL)-6 and fT3 was found, according to both sets of criteria. tumor necrosis factor alpha was negatively correlated with fT3 levels only in the criteria 1 group. There were no correlations between IL-1ß and fT3, free thyroxine, rT3 and TSH levels. CONCLUSION: ESS may occur in childhood cancer and thyroid function testing should be performed routinely when cancer is diagnosed.

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.

Behcet's Disease and Endocrine System.

Behcet's disease (BD) is a chronic disease which is characterized by recurrent oral apthous ulcerations, recurrent genital ulcerations, skin eruptions, ocular involvements and other various systemic manifestations as well as systemic vasculitis. Endocrine involvement in BD regarding various systems can be seen. Hypophysis is one of the best and dense vascularized organs of the body, thus it is likely that it can be affected by BD. Not only anterior hypophysis functions, but posterior hypophysis functions as well can be affected. As BD is a disease of autoimmune process, it may be possible that adrenal insufficiency or alterations in the cortisol levels could be expected. Another concern is whether or not there is insulin resistance in patients with BD. The avaliable data suggests that there is an increased susceptibility to insulin resistance in patients with BD.

Impact of first trimester and postpartum period thyroid autoantibodies on abortus incidence in Turkish pregnant women.

OBJECTIVE: Abortus is a common problem and is observed approximately in one third of all pregnancies. In this study, we aimed to evaluate in euthyroid pregnant population the effect of thyroid autoantibodies of both first trimester and postpartum period on abortus incidence. DESIGN AND METHOD: Euthyroid 128 pregnant women were included in the study. All pregnants were required having a history of maximum one abortus without any previous endocrinological, immunological disorders. Thyroid autoimmunity was defined as having serum levels of either antithyroidperoxidase or antithyroglobulin antibodies higher than 34 and 115 IU/ml, respectively. RESULTS AND CONCLUSIONS: One hundred of 128 pregnant women (78.1%) had no thyroid autoantibodies, whereas 28 pregnant women (21.9%) had positivity for one of thyroid autoantibodies. One hundred pregnant women (78.1%) gave healthy births, whereas 28 (21.9%) had abortus. Abortus incidence was 28.6% in autoantibody positive group, whereas it was 20% in autoantibody negative group. Serum anti-Tg levels both in first trimester and both in postpartum period were higher in pregnants abortus group when compared with healthy births group. Although, we found no correlation between abortus incidence and thyroid autoantibodies presence, first trimester serum levels of anti-Tg levels may have correlated with abortus incidence and may be an indicator of a closer follow-up. In sight of this study, it can be concluded that autoimmunity against thyroid may continue after termination of pregnancy and this was the first study evaluating the postpartum antibodies levels which may be helpful in subsequent pregnancies.

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.

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.

Metoprolol, a beta-1 selective blocker, can be used safely in coronary artery disease patients with chronic obstructive pulmonary disease.

The coexistence of coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) is frequent because of common etiological factors. Beta-blockers remain underutilized in patients with CAD who also have COPD. This study was performed to evaluate the safety of beta-1 selective blocker agents in CAD patients with COPD. Fifty patients (aged 57.3 +/- 10.1 years) were enrolled in this study; 27 patients received metoprolol CR (controlled release), and 23 received metoprolol (conventional). The patients were stratified according to the severity of COPD (21 severe, 21 moderate, and 8 mild), started on metoprolol CR or conventional metoprolol, and titrated up to the maximum tolerated dose. The clinical controls were done during the first week and then at the first and third month. Patients received a mean total daily dose of 92.5 +/- 18 mg of metoprolol CR or 189 +/- 36.7 mg of metoprolol. Seven patients could not receive the maximum dose. There was no significant decrease in forced expiratory volume in 1 s (FEV(1)) in either group (basal vs last FEV(1): 54.5% +/- 13.4% vs 54.3% +/- 13% in the metoprolol CR group and 49.6% +/- 14.5% vs 53.2% +/- 12.8% in the metoprolol group). No adverse event was experienced. Metoprolol, a beta-1 selective blocker, can be used safely at the maximum dose in CAD patients with COPD.

Predictive value of P-wave signal-averaged electrocardiogram for atrial fibrillation in acute myocardial infarction.

BACKGROUND: Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) with a reported incidence of 7-18%. Recently, P-wave signal-averaged electrocardiogram (P-SAECG) has been used to assess the risk of paroxysmal AF attacks in some diseases. The aim of this study was to determine prospectively whether patients with AMI at risk for paroxysmal AF would be identified by P-SAECG and other clinical variables. METHODS: A total of 100 patients (mean age: 59+/-12, 77 male, 23 female) with ST segment elevation AMI were enrolled in this study. Patients with chronic AF were excluded. At entry, all patients underwent standard 12-lead ECG and in the first 24 hours, P-SAECG was taken, and echocardiography and coronary angiography were performed on the patients. Patients are followed for a month in terms of paroxysmal AF attacks and mortality. RESULTS: AF was determined in 19 patients (19%). In patients with AF, abnormal P-SAECG more frequently occurred than in patients without AF (37% vs 15%, P<0.05). Patients with AF were older (70+/-14 vs 56+/-10, P<0.001) and had lower left ventricular ejection fraction (42%+/-8 vs 49%+/-11, P<0.05). AF was less common in thrombolysis-treated patients (47% vs 74%, P<0.05). Thirty-day mortality was higher in patients with AF (16% vs 2%, P=0.05). CONCLUSIONS: An abnormal P-SAECG may be a predictor of paroxysmal AF in patients with AMI. Advanced age and systolic heart failure were detected as two important clinical risk factors for the development of AF.