The impact of COVID-19 pandemic on anxiety levels among patients who have to go to the hospital due to chronic illnesses: A prospective study.

INTRODUCTION: Cancer and hemodialysis (HD) patients are at high risk for COVID-19. In our study, we aimed to evaluate the effect of pandemic on anxiety in these patients. METHODS: One hundred and six oncology and 97 HD patients participated in the study. Anxiety levels were assessed by using the Beck Anxiety Inventory (BAI) and State-Trait Anxiety Inventory (STAI). At the end of 8-month follow-up, these questionnaires were re-administered. RESULTS: During this period, 38 patients (38/203; 18.7%) had COVID-19 infection. Twenty-three patients (23/203; 11.3%) died due to COVID-19 and/or other causes. One hundred and thirteen of the remaining patients were participated in the second questionnaire. Having COVID-19 was not the independent factor for changes in STAI, and BAI scores in any regression models. CONCLUSION: Having COVID-19 does not affect the increased anxiety levels in HD and oncology patients. The effect of the pandemic may have remained in the background, as these patients have more concerns about their own diseases.

Evaluation of the relationship between insulin resistance and visceral adiposity index in patients with acne vulgaris.

BACKGROUND: Acne vulgaris (AV) is a chronic inflammatory skin disease that is common among adolescents. Its etiology involves hormones, diet, genetics, and environmental factors. The aim of this study was to investigate the association between acne vulgaris and insulin resistance (IR) and visceral adiposity index (VAI). METHODS: The study included 184 individuals. Participants' height, weight, waist and hip circumference and blood pressure were measured. Morning fasting blood was obtained from all participants for measuring glucose, insulin, triglyceride (TG), and cholesterol levels. The HOMA index and visceral adiposity index were calculated. The collected data were analyzed using statistical methods. RESULTS: The patient and control groups exhibited similar age, gender, and body mass index (p > 0.05). There was no significant difference between the patient and control groups in HOMA index and VAI (p > 0.05). A positive correlation was observed between VAI and glucose, insulin, HOMA index, TG level, and waist circumference, whereas there was a negative correlation with high-density lipoprotein (HDL). DISCUSSION: Our study results demonstrated that IR and VAI were similar both in the AV and healthy control groups. There was no correlation between acne severity score and waist circumference, glucose, insulin, TG, HDL, HOMA index, and VAI. These results indicate that IR and visceral adipose tissue dysfunction alone are not effective in the development of acne.

Increased expression of ASRGL1 in invasive ductal carcinoma and its association with estrogen-progesterone receptor status of tumors.

AIMS: Human asparaginase-like protein 1 (ASRGL1) is closely related to tumor growth. ASRGL1 can significantly promote cell proliferation and suppress apoptosis. To date, high levels of expression of ASRGL1 have been reported in various tumors, but the function of ASRGL1 in carcinogenesis is still not well understood. In this study, we aimed to immunohistochemically investigate the expression of ASRGL1 in non-neoplastic breast tissue and invasive ductal carcinoma. METHODS AND RESULTS: ASRGL1 was evaluated immunohistochemically in 148 invasive ductal carcinomas and 105 nonneoplastic breast tissue samples to assess the impact on breast cancer development and its association with clinicopathologic features. ASRGL1 was observed positive in 63 (42.6%) and negative in 85 (57.4%) invasive ductal carcinoma. In nonneoplastic breast tissue, 24 (22.9%) cases were ASRGL1 positive and 81 (77.1%) were negative. A significant difference was observed between invasive ductal carcinoma and nonneoplastic breast tissue in terms of ASRGL1 expression, and ASRGL1 expression was increased in invasive ductal carcinoma (P = .001). Most estrogen receptor-negative tumors and progesterone receptor-negative tumors were also negative with ASRGL1 and the difference was significant (P = .006 and P = .001, respectively). The correlation between the ASRGL1 expression of the tumors and event-free survival or overall survival was not significant (P>.05). CONCLUSIONS: ASRGL1 may play a role in increasing cell proliferation and breast cancer development. ASRGL-1 expression in breast cancer closely correlates with the hormone receptor status of the tumor. In breast cancer, ASRGL-1 expression does not contribute to predicting tumor behavior.

Results of Excision of Unknown Papillary Neoplasms Detected on Core Biopsy.

OBJECTIVE: This study aimed to find out valuable parameters that predict the nature of breast papillary lesions before excision, and we compared our results with those in the literature. MATERIALS AND METHODS: We reviewed the medical records and pathology slides of patients diagnosed with papillary neoplasm after undergoing a core-needle biopsy between 2010 and 2020, who, subsequently, underwent surgical excision in a single tertiary care institution. The core biopsy results and pathology results of excision materials were compared with the radiological, pathological, and demographic findings. RESULTS: A total of 51 patients were included in the study. According to the excision results, the patients were divided into two groups: the atypical group, which included 20 patients (39.3%), and the benign group, which included 31 patients (61.7%). The results of the core biopsy showed that the loss of myoepithelial cell layer was identified in 18 patients in the atypical group, while it was present in all patients in the benign group. Tumor sizes were larger and patient ages were older in the atypical group compared with the benign group. No significant difference was found between atypical and benign groups in terms of breast imaging-reporting and data system (BI-RADS) classification and location (right vs left; central vs peripheral). The upgrade rate was between 0% and 16% in literature, while it was 4% in our study. CONCLUSION: There is no consensus on whether patients diagnosed with papillary neoplasia as a result of core biopsy will undergo excision. According to our results, patients with following criteria should have their lesions excised: those who are advanced in age, those who are diagnosed with a papillary lesion as a result of core biopsies with loss of myoepithelial cell layer, and those who are diagnosed with large-sized lesions without loss of myoepithelial cell layer. Patients diagnosed with small-sized lesions without loss of myoepithelial cell layer and who are young in age are to be followed up without the need for lesion excision. The lesions should be adequately sampled.

Assessment of testes with two-dimensional Shear Wave Elastography in patients with operated inguinal hernia.

AIM: We compared the two-dimensional shear-wave elastography (2D-SWE) values between the testes with same side operated inguinal hernia (IH) and the contralateral testes, as well as the testes of healthy volunteers without IH. MATERIAL AND METHODS: A total of 189 participants (117 unilateral [117 testes] and 8 bilateral operated IH patients [16 testes] and 64 healthy volunteers [128 testes]), providing a total of 378 testicles, were investigated prospectively. All patients underwent B-mode ultrasonography (US) and 2D-SWE examinations. Operation type, the period between diagnosis and operation, the period since the operation, testes volumes, and 2D-SWE values were compared. RESULTS: The B-mode US finding of the testes were normal in all participants. The mean testes' volume of same side operated IH was significantly lower comparing to contralat-eral testes and the healthy group (p<0.001). The 2D-SWE values of the testes with same side operated IH were significantly higher comparing to the contralateral testes and the healthy group (p<0.001). There was a statistically significant correlation between 2D-SWE values and IH severity, as well as the duration of the hernia (p=0.001). There was no significant correlation between the IH severity and testes volume (p=0.285). No significant difference was found between the direct and indirect IH in terms of testicular volume and SWE values and between the duration of the hernia, the time after sugery, testicular volume and SWE values according to operation techniques(p>0.005). CONCLUSIONS: The 2D-SWE can be used as an effective imag-ing method to evaluate testicular stiffness with objective numerical values, to estimate the severity of histologic damage in patients with operated IH.

Examination of Patients' Regular Participation at an Obesity Center to Evaluate the Effects on Mental Status and Blood Parameters.

BACKGROUND: Obesity is the main cause of type 2 diabetes, coronary artery disease, musculoskeletal disorders, some cancers, and mental disorders, and many other diseases leading to mortality. The aim of this study was to determine the effects of participation in an obesity center on patient mental status and blood parameters within 3 months and to show the relationship of this participation with depression, anxiety, and other parameters. METHODS: This was a descriptive and cross-sectional study. Of 2,591 patients admitted to an obesity center between November 1, 2018 and November 1, 2019, 317 met the inclusion criteria. This study was a descriptive and cross-sectional study of the data from those 317 patients. RESULTS: Of the patients enrolled in the study, 90.5% were female and 9.5% were male. Weight, occupation, body mass index, body fat percentage, waist circumference, hip circumference, glycosylated hemoglobin (HbA1c), Beck Depression Scale, and Beck Anxiety Scale were important determinants in our univariate analyses associated with the regular receipt of center education. HbA1c (odds ratio, 1.661; 95% confidence interval, 1.140-2.421; P=0.008) was shown to be multivariate predictors of amount of participation in center education. CONCLUSION: These results support that regular participation in obesity center education has a positive effect on patients mental status, blood parameters, and anthropometric measurements. Thus, increasing the number of obesity centers is of great importance in treating obesity and improving obese patient mental status.

Thiol-disulfide homeostasis in breast cancer patients.

OBJECTIVE: The aim of our study is to assess thiol-disulfide homeostasis (TDH), which is a biomarker of systemic oxidative stress, in breast cancer patients. MATERIALS AND METHODS: Thirty-seven breast cancer patients and 31 age-matched healthy volunteers were enrolled in this study. Serum native thiol, disulfide, and total thiol levels and disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were analyzed using a novel colorimetric method. RESULTS: Serum native thiol level was statistically significantly lower in breast cancer patients (350.39 ± 7.15) than in healthy controls (380.60 ± 7.35) (P = 0.008). Serum disulfide level was statistically significantly higher in breast cancer patients (24.96 ± 0.85) than in healthy controls (19.25 ± 1.34) (P = 0.002). CONCLUSION: To our knowledge, this study is the first study in the literature that investigated TDH in breast cancer patients. We have concluded that an alteration in TDH due to oxidative stress is likely to have a role in the pathogenesis of breast cancer.

Associations between night eating syndrome and metabolic parameters in pregnant women.

OBJECTIVE: In this study, we aimed to evaluate the incidence of night eating in pregnancy and the relationship between night eating scores and nutritional status, insulin resistance, and lipid profile in pregnant women. MATERIALS AND METHODS: In this study, 148 pregnant women who presented to the Gynecology and Obstetrics Clinics at Konya Training and Research Hospital in Konya were divided into two groups according to their night eating scores. These two groups were compared in terms of their nutritional attitudes and metabolic parameters. RESULTS: Comparisons of participants meeting night eating syndrome (NES) scores versus women without NES indicated that patients with NES exhibited fever hunger at breakfast time, more breakfast skipping (p<0.05) than those without NES. Also homeostatic model assessment insulin resistance, insulin, and high-density lipoprotein cholesterol parameters were significantly higher in pregnant women in the NES group (p<0.05). Also, correlations were found between higher night eating questionnaire total scores and higher HbA1c, insulin resistance, insulin, and more breakfast skipping. CONCLUSION: The results of this study suggest that night eating symptoms during pregnancy may increase and this is able to effect glucose metabolism.

The Role of Visceral Adiposity Index Levels in Predicting the Presence of Metabolic Syndrome and Insulin Resistance in Overweight and Obese Patients.

Background: To investigate visceral adiposity index (VAI) levels in obese patients with and without metabolic syndrome (MetS) and its relationship with insulin resistance (IR), and define cutoff value of VAI in the determination of patients with MetS and IR. Methods: Aged between 18 and 65, 92 patients with obesity were included. Levels of homeostasis model assessment of IR (HOMA-IR) and VAI were calculated. Results: Of 92 patients, HOMA-IR and VAI levels (P < 0.001 and P < 0.001, respectively) were found to be higher in 41 (44.6%) with MetS. The cutoff value of VAI in predicting MetS was found to be 2.205. The frequency of MetS was seen as 22.2% when VAI was below this value, but if over, was found to be 66%. There was a positive correlation between VAI and HOMA-IR levels. In 36 cases (39.1%) with HOMA-IR (≥2.5), VAI was detected to be higher than those without IR, and high-density lipoprotein-cholesterol levels were lower. The cutoff value of VAI in predicting IR was found to be 2.31. While the prevalence of IR was 23.4% in those with VAI of 2.31, IR frequency in patients with equal to or greater than 2.31 was determined as 55%. Conclusion: We found that MetS was present in almost half of overweight and obese individuals, and the cutoff values of VAI in predicting the presence of MetS and IR were 2.205 and 2.31, respectively. Our study was carried out in overweight and obese Turkish individuals, and we consider that further studies including normal weight individuals and larger population are required.

Comparison of minimally invasive preperitoneal (MIP) single-layer mesh repair and total extraperitoneal (TEP) repair for inguinal hernia in terms of postoperative chronic pain: a prospective randomized trial.

OBJECTIVES: The aim of this study was to compare minimally invasive preperitoneal (MIP) single layer mesh repair with total extraperitoneal (TEP) inguinal hernia repair in terms of complications, recurrence, and chronic pain. MATERIAL AND METHODS: A total of 240 patients who underwent elective, primary, unilateral inguinal hernia operation between April 2011 and September 2012 were divided into two randomized groups. The first group underwent MIP repair and the second group underwent TEP repair. Visual Analogue Scale (VAS) and Sheffield Scale (SS) were used to evaluate chronic pain. RESULTS: In all, 225 (95%) of the patients completed follow-up and were included in analyses. A significant difference was not detected between groups in terms of demographics, operative time, or intraoperative, early, or late complications. Length of time before return to work was significantly shorter in the TEP group (p <0.001). Recurrence was seen in 1 (0.88%) patient in the MIP group and 1 (0.89%) patient in the TEP group (p= 0.993). Evaluation of chronic pain revealed no significant difference between groups in VAS and SS values at postoperative 6th, 12th, and 24th months. CONCLUSION: In conclusion, it was observed that MIP repair for inguinal hernia has all of the advantages of preperitoneal repair and eliminates disadvantages of TEP repair. MIP technique is as safe as TEP repair and has similar qualities in terms of chronic pain, even though it is an open intervention.

Evaluation of varenicline usage on ventricular repolarization after smoking cessation.

BACKGROUND: Varenicline, which is a selective partial agonist of the alpha4-beta2 nicotinic acetylcholine receptor, is used for the smoking cessation pharmacotherapy. Cardiovascular adverse effects have been reported after varenicline usage in patients who stop smoking. We investigated the effect of varenicline usage on ventricular repolarization after smoking cessation. METHODS: In this prospective cohort study, we evaluated the cardiac arrhythmic effects of varenicline by comparing smoking patients (n = 214) before and after varenicline usage. Varenicline administered patients were also compared to ex-smoker individuals (n = 50) who quit smoking without varenicline usage in terms of ventricular repolarization parameters. RESULTS: After calculated according to Fridericia's and Framingham's formulas, QTc intervals were significantly increased when patients compared before and after smoking cessation with varenicline (402.9 ± 24.5 ms vs. 409.1 ± 25.0 ms p < 0.001 and 376.5 ± 15.2 ms, vs. 380.6 ± 13.5 ms; p < 0.001, respectively). There was no arrhythmic event during the follow-up. The change in Tp-e and QTc following varenicline usage was negatively correlated with the smoking packet/year. (ρ: -0.443, p < 0.001 and ρ = -0.601, p < 0.001) CONCLUSION: Varenicline usage was demonstrated to prolong ventricular repolarization parameters similar to animal studies. Varenicline may have a role to predispose cardiac dysrhythmias after utilization in smoking cessation.

Effectiveness of Superb Microvascular Imaging for the differentiation of intraductal breast lesions.

AIMS: The aim of this study was to compare the diagnostic performance of superb microvascular imaging (SMI) and power Doppler imaging (PDI) for the differentiation of intraductal breast lesions. MATERIALS AND METHODS: A total of 54 intraductal breast lesions (39 benign, 10 atypical, and 5 malignant) in 53 patients were examined using B-mode ultrasonography, PDI, and SMI. Vascularity grading, distribution of microvessels, and penetrating vessels were evaluated using each Doppler technique. The diagnostic performances of both methods were compared. RESULTS: SMI was more efficient in detecting flow signals than PDI (p=0.004). The highest diagnostic accuracy rates were achieved with SMI using vascular grading. When hypervascularity was used as a cut-off value to differentiate malignant and atypical lesions from benign lesions, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.6%, 80.7%, 66.6%, 80.7%, and 75.6%for PDI, and 86.6%, 76.9%, 68.4%, 90.9%, and 80.4% for SMI, respectively. CONCLUSIONS: SMI is more sensitive than PDI for detecting subtle blood flow in intraductal breast lesions with statistical significance. This novel and promising vascular imaging technique may be helpful in B-mode ultrasonography to distinguish intraductal breast lesions.

Visceral Adiposity Index Levels in Patients with Hypothyroidism.

OBJECTIVE: To assess visceral adiposity index (VAI) as a sign of cardio-vascular diseases (CVD) in hypothyroidism patients and to compare CVD risks in overt or subclinical hypothyroidism patients. MATERIALS AND METHODS: Sixty-eight hypothyroidism patients (29 with overt and 39 with subclinical hypothyroidism) and 33 age- and gender-matched control patients were included. VAI levels were calculated with the following formula: (waist circumference (WC)/[36.58+(1.89xbody mass index (BMI))])x[(triglyceride (TG) (mmol/L)/0.81)x(1.52xhigh-density lipoprotein cholesterol (HDL-cholesterol) (mmol/L))] and (WC/[39.68+(1.88xBMI)])x[(TG (mmol/L)/1.03)x(1.31xHDL-cholesterol (mmol/L))], respectively. RESULTS: While body weight (p < 0.01), BMI (p < 0.01), TG and VAI levels (p < 0.01) were higher in hypothyroidism patients than controls, HDL-cholesterol levels were lower (p = 0.02). When patients were divided to groups as subclinical (n = 39) and overt hypothyroidism (n = 29) and compared with each other and controls (n = 33), body weight (p = 0.02 and p = 0.02, respectively), BMI (p = 0.01 and p < 0.01, respectively) and TG (p < 0.01 and p = 0.03, respectively) were higher in overt and subclinical hypothyroidism groups than controls. HDL-cholesterol was lower only in the group with overt hypothyroidism than controls (p = 0.01). Although found similar to each other in overt and subclinical hypothyroidism groups, VAI levels were observed to be higher in both groups than controls (p < 0.01 and p = 0.02, respectively). In correlation analysis, a positive correlation was determined between thyroid stimulating hormone (TSH), BMI and VAI levels (p = 0.03 and p < 0.01, respectively). CONCLUSIONS: Due to the association between increased VAI levels, and metabolic syndrome and CVDs, we consider that several measures should be promptly taken to decrease these risk factors, and further studies with a larger sample size should be performed.

Evaluation of 25-Hydroxyvitamin D Levels in Central Anatolia, Turkey.

BACKGROUND/AIM: The aim of this study is to evaluate serum 25-hydroxyvitamin D levels measured within one year at an Education and Research Hospital in Turkey to identify vitamin D insufficiency/deficiency (which is very commonly seen in the society) and to provide a current approach to treatment management. MATERIALS AND METHODS: This retrospective descriptive study was carried out by examining the data relating to 35,667 individuals. RESULTS: Of the individuals participating in the study, 94.47% had a serum 25-hydroxyvitamin D level less than 30 ng/ml, 76.25% had a serum 25-hydroxyvitamin D level less than 20 ng/ml, and 32.20% had a serum 25-hydroxyvitamin D level less than 10 ng/ml. The mean serum 25-hydroxyvitamin D level of all individuals included in the study was 15.2±8.8 ng/ml. The mean serum 25-hydroxyvitamin D level was 14.5±8.8 ng/ml among women and 18.1±8.4 ng/ml among men, respectively (p<0.001). CONCLUSION: Vitamin D deficiency/insufficiency is widespread in the world and in Turkey. The data obtained from this study suggest that without measuring serum 25-hydroxyvitamin D level will be cost-effective in every age group (except for those are at risk of toxicity) as in children aged 0-1 year old in Turkey and that making a decision in this direction will make a great contribution to the economy of the country.

Advantages of b-mode ultrasound combined with strain elastography in differentiation of idiopathic granulomatous mastitis from malignant breast lesions

Background/aim: To evaluate the diagnostic performance of strain elastography (SE) combined with B-mode ultrasound in distinguishing between idiopathic granulomatous mastitis (IGM) and malignant breast lesions. Materials and methods: Seventy-seven malignant breast lesions and 36 IGM were assessed using B-mode ultrasound and SE. Ultrasonographic findings for all the breast lesions were classified based on the 2013 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS-US), and the SE findings were evaluated based on the strain ratio and a five-point scale. The diagnostic performances of B-mode ultrasonography, SE, and the combination of both methods were compared. Results: Significant differences in strain ratio and elastography scores were found between IGM and malignant breast lesions. When the lesions were assessed with B-mode ultrasound alone, in order to distinguish between IGM and malignant breast lesions, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94.8%, 66.7%, 85.9%, 85.7%, and 85.8%, respectively. However, when assessed with a combination of B-mode ultrasonography and SE, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 96.1%, 100%, 100%, 92.3%, and 97.3%, respectively. Conclusion: The combination of SE and B-mode ultrasound has better diagnostic performance in the differentiation of IGM and malignant breast lesions than B-mode ultrasonography alone.

Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques.

OBJECTIVES: This retrospective study aims at demonstrating the success rate, effectiveness, and advantages of alcohol as a scolicidal and sclerosing agent for the percutaneous treatment of liver hydatid cysts. METHODS: A total of 554 liver hydatid cysts obtained from 347 patients admitted between January 2008 and February 2016 were retrospectively investigated. Of these, 435 (78.5%), 91 (16.4%), and 28 (5%) were classified as Gharbi type 1, 2, and 3, respectively. Type 1 and 2 cysts were treated using PAIR (puncture, aspiration, injection, respiration) and single puncture catheterization methods; type 3 lesions were treated using a modified catheterization technique. Alcohol was used as a scolicidal and sclerosing agent in all procedures. RESULTS: After excluding three lesions (0.5%) because of lack of parenchymal support during catheterization, 274 (49.7%), 250 (45.3%), and 27 (4.9%) of 551 lesions were treated with PAIR, single puncture catheterization, and modified catheterization techniques, respectively. Therefore, a 99.5% of technical success rate was obtained. Major complications in 2 patients (0.5%) and minor complications were observed in 36 patients (10.3%). Mean hospital stay was 1.55±2.3 days (range: 0-23 days). Patients were followed-up for mean 19.6 months (range: 6-83 months), during which recurrences were detected in 19 patients (5.4%). CONCLUSIONS: The use of alcohol as a scolicidal and sclerosing agent during the percutaneous treatment of liver hydatid cysts is associated with a high success rate and low rates of recurrence and complications, and should be considered an important alternative to surgical procedures.

Successful percutaneous treatment of extrahepatic cystic echinococcosis through PAIR and single puncture catheter techniques.

PURPOSE: To demonstrate the successful percutaneous treatment of extrahepatic cystic echinococcosis as an alternative to surgical procedures. MATERIALS AND METHODS: A total of 27 extrahepatic hydatid cysts in 12 patients, the spleen in 8 patients, muscles and soft tissues in 3 patients each and right adrenal gland in 1 patient were treated with PAIR (puncture, aspiration, injection, respiration) or single puncture catheterization methods. As a scolicidal and sclerosing agent, alcohol was used in all patients. RESULTS: Of 27 extrahepatic lesions of hydatid cysts, 24 (88.9%) were Gharbi type 1 (WHO CE 1), and 3 (11.1%) were Gharbi type 2 (WHO CE 3A). Of hydatid cystic lesions, 20 with PAIR and 7 with single puncture catheterization methods were treated. No major complications developed in any patients. Abscesses were detected in two patients (16.6%). Mean total hospital stay was calculated between 1 and 14 days (mean 2.3 days). Follow-up periods ranged between 10 and 62 months (mean 22.3 months). CONCLUSION: Percutaneous treatment for extrahepatic hydatid cystic lesions is an important alternative to surgical procedures because of the high therapeutic success rate, lower rate of complications and shorter hospital stays.