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Smoothed one-core and core-multi-shell regular black holes
No full textWe discuss the generic properties of a general, smoothly varying, spherically symmetric mass distribution D(r,theta), with no cosmological term (. is a length scale parameter). Observing these constraints, we show that (1.) the de Sitter behavior of spacetime at the origin is generic and depends only on D(0,theta), (2.) the geometry may posses up to 2(k + 1) horizons depending solely on the total mass M if the cumulative distribution of D(r,theta) has 2k + 1 inflection points, and (3.) no scalar invariant nor a thermodynamic entity diverges. We define new two-parameter mathematical distributions mimicking Gaussian and step-like functions and reduce to the Dirac distribution in the limit of vanishing parameter.. We use these distributions to derive in closed forms asymptotically flat, spherically symmetric, solutions that describe and model a variety of physical and geometric entities ranging from noncommutative black holes, quantumcorrected black holes to stars and dark matter halos for various scaling values of.. We show that the mass-to-radius ratio pi c(2)/G is an upper limit for regular-black-hole formation. Core-multi-shell and multi-shell regular black holes are also derived
Relationship between Thyroid Volume and Baseline Vitamin D Levels in New-Onset Graves Disease
No full textObjective: Serum vitamin D is shown to be decreased and associated with higher thyroid volumes in Graves disease (GD). We aimed to investigate the relationship between thyroid volume and baseline serum vitamin D status in newly diagnosed GD patients.
Methods: This was a single-center cross-sectional study with a total of 61 new-onset GD patients (n=61, F: 40, M: 21) who were divided into two groups, according to baseline serum vitamin D levels, as Group-1 (vitamin D <20; n: 42) and Group-2 (vitamin D =20; n=19). Thyroid volume (mL) and isthmus measurements (mm) were compared between the two groups.
Results: There was an inverse correlation between the baseline serum vitamin D levels and thyroid volume, thyroid receptor autoantibodies (TRAb), free triiodothyronine (fT3), and parathyroid hormone (PTH) levels (p=0.02, r=-0.31; p=0.005, r=-0.36; p=0.04, r=-0.26; p=0.02, r=-0.32, respectively). Thyroid volume was also correlated with serum free thyroxine (fT4), fT3, TRAb, and thyroid peroxidase autoantibodies (TPOAb; p=0.001, r=0.426; p=0.001, r=0.50; p=0.04, r=0.26; p=0.001, r=0.42, respectively). Low vitamin D and high thyroglobulin antibody (TgAb) levels were significantly associated with thyroid volume based on a regression analysis (p=0.03, odds ratio [OR]: 18.7, 95% confidence interval [CI]: 1.34-260.91 and p=0.04, OR: 16.6, 95% CI: 1.07-255.64, respectively).
Conclusion: Baseline serum vitamin D levels are inversely related with thyroid volumes, fT3, and TRAb levels in new-onset GD. In addition to several advantages, optimization of vitamin D levels would also be beneficial in the surveillance of these patients. However, larger scale studies are required to make further suggestions
Do Statins Affect Thyroid Volume and Nodule Size in Patients with Hyperlipidemia in a Region with Mild-to-Moderate Iodine Deficiency? A Prospective Study
No full textObjective: The objective of this study was to assess the anti-proliferative pleiotropic effects of statins on thyroid function, volume, and nodularity. Subjects and Methods: One hundred and six hyperlipidemic patients were included in this prospective study. The 69 patients in the statin groups received atorvastatin (16 received 10 mg and 18 received 20 mg) or rosuvastatin (20 received 10 mg and 15 received 20 mg). The 37 patients in the control group, assessed as not requiring drugs, made only lifestyle changes. Upon admission and after 6 months, all patients were evaluated by ultrasonography as well as for lipid variables (total cholesterol, high-and low-density lipoprotein cholesterol, and triglycerides) and thyroid function and structure. Results: After 6 months, no differences in thyroid function, thyroid volume, the number of thyroid nodules, or nodule size were observed in the statin and control groups. In a subgroup analysis, total thyroid volume had decreased more in patients receiving 20 mg of rosuvastatin than that in the control group (p < 0.05). Maximum nodule size had decreased more in those receiving 10 mg of rosuvastatin (p < 0.05). Conclusions: Our results suggest an association between rosuvastatin treatment and smaller thyroid volume and maximum nodule diameter; this could be attributable to the antiproliferative effects of statin therapy on the thyroid. (C) 2018 The Author(s) Published by S. Karger AG, Base
Lung Cancer Related Central Airway Obstruction: Who Benefits Better from Radiotherapy?
No full textWe aimed to assess the efficacy of external beam radiotherapy (EBRT) in central airway obstruction (CAO) and associated factors for metastatic lung cancer (MLC) patients. Records of 72 MLC patients presenting with CAO were retrospectively analyzed. The serial chests X-rays prior and after the EBRT were compared for response assessment. The primary end-point was radiologic response, while overall-(OS) and CAO-free survival, and predictors of better outcomes constituted secondary endpoints. The EBRT doses ranged between 8 to 40 Gy (1-13 fractions). Median follow-up and OS were 5.6 (range: 1.3-17.8) and 7.6 months (95% CI: 6.5-8.7), respectively. Objective CAO resolution was achieved in 58 patients (80.6%) on serial chest X-rays with a median time to maximum CAO response of 23 days (range: 3-86). In responders the response was durable (8.1 months) almost nearly for all their remaining life spans (8.3 months) with only 19.0% CAO recurrences. Median OS was also significantly longer in responders (8.3 vs. 2.4 months; p= 39 Gy (p= 39 Gy (p=0.008) were the factors to relate with better OS on multivariate analyses. The EBRT proves effective and durable CAO palliation with only 19.0% re-CAO rate in MLC patients. Better CAO responses may be achieved in patients treated with smaller tumor size, small-cell histology, and higher BED10 values
Case of an Unusual Suprascapular Neuropathy: Case Report and Literature Review
No full textSuprascapular neuropathy is a rare cause of shoulder pain and muscle weakness. Common causes include space-occupying lesions such as paralabral cysts, soft tissue or bone tumors, recurrent overhead activities in athletes, direct trauma, fractures of the scapula and iatrogenic causes. Diagnosis of suprascapular neuropathy can be difficult due to overlap in the clinical presentation with cervical region and other pathologies of the shoulder. We present a 33-year-old male patient admitted to our clinic with complaints of left shoulder pain and arm weakness starting in 8 months ago. The clinical and electrophysiological evaluations confirmed the left suprascapular nerve lesion at suprascapular notch level. This case is presented to emphasize that suprascapular neuropathy should keep in mind in the differential diagnosis of shoulder pain also without of a mass, trauma or excessive physical activity that may cause the neuropathy
An international survey on hypoglycemia among insulin-treated type I and type II diabetes patients: Turkey cohort of the non-interventional IO HAT study
No full textBackground: Limited real-world data are currently available on hypoglycemia in diabetes patients. The International Operations Hypoglycemia Assessment Tool (IO HAT) study was designed to estimate hypoglycemia in insulin-treated type I (T1DM) and type II (T2DM) diabetes mellitus patients from 9 countries. The data from Turkey cohort are presented here.
Methods: A non-interventional study to determine the hypoglycemia incidence, retrospectively and prospectively, in Turkish T1DM and T2DM patients using a 2-part self-assessment questionnaire.
Results: Overall, 2348 patients were enrolled in the Turkey cohort (T1DM = 306 patients, T2DM = 2042 patients). In T1DM patients, 96.8% patients reported hypoglycemic events (Incidence rate [IR]: 68.6 events per patient-year [ppy]), prospectively, while 74.0% patients reported hypoglycemic events (IR: 51.7 events ppy), retrospectively. In T2DM patients, 95.9% patients (IR: 28.3 events ppy) reported hypoglycemic events, prospectively, while 53.6% patients (IR: 23.0 events ppy) reported hypoglycemic events, retrospectively. Nearly all patients reported hypoglycemia during the prospective period.
Conclusions: This is a first patient-reported dataset on hypoglycemia in Turkish, insulin-treated diabetes patients. A high incidence of patient-reported hypoglycemia confirms that hypoglycemia remains under-estimated. Hypoglycemia increased healthcare utilization impacting patients' quality of life. Hypoglycemia remains a common side effect with insulin-treatment and strategies to optimize therapy and reduce hypoglycemia occurrence in diabetes patients are required
Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study
No full textObjective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC).
Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 ( 0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models.
Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR 0.15. The 5-year progression-free survival (PFS) rates for LNR 0.15 were 76.1%, and 58.5%, respectively (p= 0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR 0.15 (p= 0.005). LNR > 0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]= 2.05; 95% confidence interval [CI]= 1.07-3.93; p= 0.03) and OS (HR= 3.35; 95% CI= 1.57-7.19; p= 0.002).
Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC
Bone Cement Leakage in Transpedicular Percutaneous Vertebroplasty: Analysis of 20 Patients
No full textObjective: Percutaneous vertebroplasty (PVP) is one of the frequently preferred interventional methods in spinal surgery. Although it is classified as minimally invasive, the most common complication of this procedure is bone cement leakage. Leakage of bone cement is often asymptomatic, but can lead to serious complications such as paraplegia and pulmonary embolism. In this study, we aimed to investigate the complications and consequences of cement leakage in the percutaneous vertebroplasty procedure.
Methods: Between 2009 and 2015, 20 (14 female and 6 male, mean age 69.7) patients who underwent percutaneous vertebroplasty to 26 vertebrae were included in the study. 17 vertebrae were treated for osteoporotic compression (65.3%), 4 vertebrae for pathologic compression fractures (15.3%), 4 vertebrae for traumatic compression fractures (15.3%) and 1 vertebrae for painful hemangioma (3.8%). Leakage localizations of bone cement were classified as venous plexus, paravertebral soft tissue, spinal canal, intervertebral foramen, into the niddle channel and intervertebral disc space.
Results: Twelve vertebrae showed no leakage (46.1%). 5 vertebrae had leakage into the niddle channel (19.2%), and 3 had leakage to vertebra disc space leakage (11.5%) and 2 vertebrae had to venous plexus and paravertebral tissue leakage (7.6%) Foraminal and spinal canal leakage (3.8%) was observed in one patient on single level. Radicular pain was seen in one patient. Partial pain control was observed in 20% of the patients while 80% of the patients had complete pain control on follow ups.
Conclusion: Major complications following percutaneous vertebroplasty are mostly due to bone cement leaks. In order to prevent major complications, it is necessary to determine the possible causes of leakage. Performing the application with the correct technique with properly prepared bone cement is essential. Also usage of contast dye may be useful for pre-injection risk of leakage complications
Factors affecting mortality in rectus sheath hematoma: A retrospective study
No full textAim: Rectus sheath hematoma is a rare clinical condition. Because it could mimic various intra-abdominal pathologies suspicious approach and attention is needed for proper diagnosis and management of rectus sheath hematoma. The aim of this study is a review of factors affecting mortality in patients with rectus sheath hematoma besides clinical features, diagnosis modalities, treatment periods and results of patients with rectus sheath hematoma. Material and Method: Twenty-three patients with rectus sheath hematoma from January 2012 to March 2017 in a tertiary care center were included in the study. Patients' files were reviewed retrospectively. Reviewed variables were demographic and clinical features, symptom and findings, co-morbidities, medications, laboratory findings, diagnostic modalities, APACHE II scores, treatment approaches, transfused blood products and length of hospital stay. Results: Fifteen (65.2%) of the patients were women, and 8 (34.8%) of the patients were men. The mean age was 61.9 +/- 13.5. Seventeen (74%) of the patients had abdominal pain. Twenty (87%) of the patients had anticoagulant and antiplatelet therapy. The mean hematoma diameter was 6.3 +/- 3.6 cm. The mean APACHE II score for the patients was 13.1 +/- 7.3. One patient had undergone surgery. There was mortality in 3 (13%) of the patients. The median length of stay in hospital was 5 (5) days. Discussion: The diagnosis of rectus sheath hematoma should be kept in mind while assessing old female patients and patients on anticoagulants with a complaint of abdominal pain. In our study, we identify risk factors such as higher APACHE - II scores, the presence of a transient ischemic attack, need for transfusion of more units of packed erythrocytes and more extended hospital stay as factors associated with mortality
Methodology of a new inflammatory arthritis registry: TReasure
No full textBackground/aim: The TReasure registry, created in 2017, is an observational multicenter cohort that includes inflammatory arthritis patients. This article reviews the methodology and objectives of the TReasure registry established to collect data from rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients.
Methodology: Fifteen rheumatology centers in Turkey will contribute data to the TReasure database. The actual proprietor of the database is the Hacettepe Rheumatology Association (HRD) and Hacettepe Financial Enterprises. Pharmaceutical companies that operate in Turkey (in alphabetical or er), Abbvie, Amgen, BMS, Celltrion Healthcare, Novartis, Pfizer, Roche, and UCB, support the TReasure registry. TReasure is a web-based database to which users connect through a URL (https://www.trials-network.org/treasure) with their unique identifier and passwords provided for data entry and access. TReasure records demographic and clinical features, comorbidities, radiology and laboratory results, measures of disease activity, and treatment data.
Discussion: TReasure will provide us with various types of data, such as a cross-sectional view of the current nationwide status of the patients currently receiving these treatments, and retrospective data as much as allowed by the participating centers' records. Finally, a high-quality prospective dataset will be built over the ensuing years from patients with a new diagnosis of RA or SpA