The Relationship Between Gestational Diabetes Mellitus and Adipocytokine Levels.

Objectives: The aim of this study was to compare adiponectin, resistin, visfatin, and irisin levels between pregnant women diagnosed gestational diabetes mellitus (GDM) and healthy pregnant women and to evaluate the role of these parameters in GDM pathophysiology and early diagnosis. Methods: Fifty GDM and 50 healthy pregnant women were included in the study. Anthropometric measurements of pregnant women were performed. Fasting blood glucose, hemoglobin A1c, 75 gr OGTT, low density lipoprotein, triglyceride, and complete blood count results were recorded. Adiponectin, irisin, visfatin, resistin, and C-reactive protein (CRP) levels were evaluated. Results: Serum adiponectin levels were significantly lower (p<0.001) and serum resistin and CRP levels were significantly higher (p=0.000 and p=0.027, respectively) in pregnant women with GDM compared to healthy pregnants. There was no significant difference between groups according to serum irisin and visfatin levels (p=0.942 and p=0.332, respectively). There was a negative correlation between adiponectin level and FPG, visfatin, and resistin, while a positive correlation was found between irisin level. While there was a positive correlation between resistin and CRP levels, there was a negative correlation between adiponectin level. While there was a positive correlation between irisin and adiponectin levels, there was a negative correlation between weight and body mass index. Conclusion: In this study, we think that elevated serum resistin and CRP levels and decreased adiponectin levels in GDM patients may play a role in glucose metabolism changes. Further studies are needed on this subject.

Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules.

BACKGROUND: Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. OBJECTIVES: To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. MATERIAL AND METHODS: The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. RESULTS: Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%). CONCLUSIONS: Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

Does neutrophyl to lymphocyte ratio really predict chronic kidney disease progression?

PURPOSE: Chronic kidney disease (CKD) is an inflammatory process. In addition to increased morbidity and mortality, inflammation also contributes to the progression of CKD. Neutrophil/lymphocyte ratio (NLR) is a marker of inflammation. Some recent data suggest that NLR may predict the progression of CKD. METHODS: In this study, 5-year data of 740 patients with stage 2-4 CKD were reviewed retrospectively. Demographic data, NLR, CRP, albumin, the amount of proteinuria were recorded. At the beginning and the end of follow-up the glomerular filtration rate (GFR) and the annual GFR decline rate were calculated. Patients were divided to high and low NLR group according to median value of their baseline NLR. Reaching stage 5 CKD or initiation of renal replacement therapy was determined as end-point for follow-up. RESULTS: The mean age was 62.8 ± 0.57 years, eGFR 40 ml/min/1.73 m2, median NLR was 2.76. NLR increased as the CKD-stage increased. Mean follow-up time was 51.2 ± 30 months and 21.4% of patients reached the end-point. NLR was significantly increased at follow-up (from 3.22 to 5.68, p < 0.001). Annual GFR loss and baseline CRP were higher but baseline albumin and GFR were lower of patients with high NLR. The percent of patients reaching the end-point was not different between the groups with high and low baseline NLR. Kaplan Meier analysis showed that patients with high NLR had significantly lower mean renal survival (86.5 months) than patients with low NLR (105 months) (p < 0.001). In the Cox-regression analysis NLR was not an independent predictor in reaching the end-point but presence of diabetes mellitus, younger age and low baseline eGFR were found effective. CONCLUSIONS: NLR is an indicator of inflammation in chronic kidney disease. It may not be an independent predictor of CKD progression except that the CKD is in a more advanced stage and reflects the associated inflammation. Classical risk factors such as DM and lower GFR are more powerful predictors of progression.