Balkan Medical Journal最新文献

Background: Echinococcus granulosus sensu lato (E. granulosus s.l.) is globally distributed and highly prevalent in parts of South America, the Mediterranean, Eastern Europe, the Middle East, Africa, China, and Australia. This systematic review explores the epidemiological and clinical features of urogenital system-cystic echinococcosis (UGS-CE).

Aims: To systematically review and synthesize available evidence on the epidemiological patterns, clinical presentations, diagnostic methods, and treatment approaches for UGS-CE.

Study design: Systematic review.

Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines and was registered in PROSPERO (CRD42024613418). A comprehensive literature search was conducted in the PubMed, Scopus, and Web of Science databases for articles published between 1990 and 2024. Studies based on individual data were included if the UGS-CE diagnosis was confirmed by imaging or laboratory methods.

Results: After screening 1976 records, 490 studies were finally included to comprise the following 698 UGS-CE cases: 561 (80.4%) involved the urinary system; 110 (15.8%) involved the female genital system; and 27 (3.9%) involved the male genital system. The kidney (478, 68.5%) was the most commonly affected organ, followed by the adrenal gland (64, 9.2%), the ovary (51, 7.3%), and the uterus (24, 3.4%). Radiological imaging, especially ultrasonography, was the primary diagnostic method used, which is often supported by computed tomography (CT). Treatment was mainly surgical and in combination with antiparasitic therapy. Among the 155 patients who underwent surgical treatment, 134 were initially misdiagnosed with either malignant or benign tumors.

Conclusion: Though rare and often non-specific, UGS-CE must be considered in patients with abdominopelvic or flank pain, hydatiduria, urinary symptoms, infertility, or dysmenorrhea, especially in endemic areas. Early detection and appropriate management are crucial to improving the outcomes. A radiological assessment is the primary diagnostic method, with ultrasonography as the most effective, often supported by CT. Treatment is mainly surgical and complemented by antiparasitic therapy to reduce the recurrence/relaps risk.

Background: Thyroid nodules are common in clinical practice, with malignancy detected in about 5% of cases. Current risk-stratification approaches, which rely on sonographic features and cytopathological assessment, have notable limitations, especially for indeterminate nodules categorized as Bethesda III.

Aims: To address these diagnostic challenges, this study evaluated the utility of preoperative serum interleukin (IL)-17A and calprotectin levels as potential biomarkers for distinguishing malignant from benign Bethesda III thyroid nodules.

Study design: This single-center prospective methodological study.

Methods: In this prospective study, 76 patients with Bethesda III nodules scheduled for thyroidectomy were enrolled. Based on histopathological findings, nodules were classified as benign (n = 41) or malignant (n = 35). Comprehensive patient information was collected, including demographics, medical history, and detailed clinical parameters related to nodule characteristics and laboratory results. Circulating biomarkers measured included thyroid-stimulating hormone, free T3, free T4, thyroglobulin (TG), anti-TG, anti-thyroid peroxidase, calcitonin, IL-17A, and calprotectin.

Results: Patients with malignant nodules (n = 35) exhibited significantly higher preoperative IL-17A and calprotectin levels compared with those with benign nodules (n = 41) (p < 0.001 and p = 0.038, respectively). Receiver operating characteristic analysis demonstrated promising diagnostic performance for IL-17A [area under the curve (AUC) = 0.733] and calprotectin (AUC = 0.639).

Conclusion: IL-17A and calprotectin emerge as promising biomarkers for refining Bethesda III nodule stratification. Incorporating these inflammatory markers into existing diagnostic protocols may substantially reduce unnecessary surgical interventions, thereby alleviating patient anxiety, surgical risks, and healthcare costs.