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We aimed to determine the influence of diabetes mellitus (DM) on uropathogens and antibiotic resistance pattern in urinary tract infection (UTI) in our center. Three hundred fifty-five DM patients and 165 non-DM patients with UTI were included in this retrospective study. Urine samples were processed in the laboratory following standard protocol. Mean age was higher in DM group (63.9 ± 12.4 vs 59.6 ± 17.3 years, respectively, P = 0.001). Females showed much higher UTI prevalence in both groups (85.6% in DM vs 70.3% in non-DM group, P = 0.000). Mean HbA1c level on admission was 9.3% (78 mmol/mol). Mean duration of DM was 13.9 ± 8.5 yr. E.coli was the predominant uropathogen for both (67.3% in DM and 61.8% in non-DM group). Most isolated microorganisms were sensitive to nitrofurantoin (87.0% in DM, vs 83.6% in non-DM group, P = 0.265). Mean DM duration of higher than 10,5 years showed greatest risk of multidrug resistance (MDR) (AUC = 0.58, sensitivity of 63.7% and specificity of 50%, P = 0.019). Diabetic patients with UTI had poor glycemic control and long-standing DM. Nitrofurantoin was the most appropriate antimicrobial agent for empirical use. The MDR was higher in patients with DM lasting longer than 10.5 years. [Med-Science 2019; 8(4.000): 881-6]

Background The optimal treatment modality for lowering the triglyceride level in patients with hypertriglyceridemia (HTG)-associated acute pancreatitis is unknown. We evaluated the efficacy of continuous insulin infusion and apheresis procedures as triglyceride-lowering therapy. Materials and methods Clinical, demographic, and laboratory data were retrospectively evaluated for patients with HTG-associated pancreatitis who received continuous insulin infusion or apheresis in a single tertiary center. The endpoints were modality effectiveness and clinical outcomes. Results The study included 48 patients (mean age, 40.4 ± 9.9 years). Apheresis and insulin infusion were performed in 19 and 29 patients, respectively, in the first 24 h of hospital admission. Apheresis procedures included therapeutic plasma exchange in 10 patients and double filtration plasmapheresis in nine patients. Baseline mean triglyceride level was higher in the apheresis group. The two groups were similar in terms of other baseline clinical and demographic characteristics. Seventeen patients (58.6%) in the insulin group and nine patients (47.4%) in the apheresis group exhibited Balthazar grades D-E. There was a rapid reduction (78.5%) in triglyceride level after the first session of apheresis. Insulin infusion resulted in a 44.4% reduction in mean triglyceride level in the first 24 h. The durations of fasting and hospital stay, and the rates of respiratory failure and hypotension, were similar between groups. More patients in the apheresis group experienced acute renal failure or altered mental status. Prognosis did not significantly differ between groups. Conclusion Although apheresis treatments are safe and effective, they provided no clear benefit over insulin infusion for HTG-associated pancreatitis.

The efficacy and safety of triglyceride (TG) apheresis in patients with type 2 diabetes mellitus (DM) is unclear. Diabetic complications may predispose patients to adverse events (AEs) associated with the apheresis procedure, and diabetic dyslipidemia may negatively affect the efficacy of therapeutic apheresis (TA). We investigated the effect of DM on the efficacy and complications of TA. Patients with severe hypertriglyceridemia who underwent apheresis for treatment or for the prevention of acute pancreatitis were included in this retrospective study. Epidemiological data, lipid parameters, and AEs were recorded before and after each therapeutic session. A total of 166 procedures were performed in 27 patients. Group 1 included 17 patients with type 2 DM, and Group 2 included 10 patients without DM. The mean percentage decrease in TG levels (TG%) was higher in Group 1 (71.9% vs 60.6%, P < .001). The TG% was negatively correlated with the duration of DM in Group 1 (r = -.49, P < .001). The total number of TA sessions was 142 in patients who underwent double filtration plasmapheresis and 24 in patients who underwent therapeutic plasma exchange. We observed 9 (5.4%) mild-to-moderate AEs. No intergroup difference was observed in the total number of AEs (P = .06). TA is safe and effective in patients with type 2 DM with severe hypertriglyceridemia.

The aim of this review is to increase awareness for prediabetes and help diagnose maximum number of prediabetic patients with minimum number of tests for physicians and health care workers. Prediabetes is a significant health problem because it can cause microvascular and macrovascular complications, accompany metabolic syndrome and predict the development of diabetes. It is common worldwide; however, most patients cannot be diagnosed because single tests used for scanning it have low diagnostic value alone. In addition; different definitions released by different organizations increase the clinicians’ concept of confusion. As a result; developing complications in initially undiagnosed patients call for greater efforts and costs. Therefore: an early and correct diagnosis of prediabetes is important. It is not rational to increase the number of tests for every case considering increased costs. According to this; classification of cases depending on risk status would be correct to assess the tests for scanning. The risk stratification is also discussed. Primary care physicians need to have a good understanding of screening for prediabetes as a core competency and to serve proactively. Bu derlemenin amacı hekimlerin prediyabet farkındalığını artırmak ve en az sayıda test ile en fazla sayıda prediyabetik hastanın teşhis edilmesine yardımcı olmaktır. Prediyabet mikrovasküler ve makrovasküler komplikasyonlar oluşturması, metabolik sendroma eşlik etmesi ve diyabet gelişimini öngürdürmesi açısından önemli bir sağlık sorunudur. Dünyada oldukça yaygın olup tek bir testle tanısal değeri düşük olduğu için hastaların çoğu teşhis alamamaktadır. Ek olarak değişik çalışma gruplarının ortaya koyduğu değişik yaklaşımlar klinisyenlerin konsept karmaşasını artırmaktadır. Sonuç olarak erken dönemde teşhis edilememiş hastalarda gelişen komplikasyonlar daha fazla çaba ve maliyete sebep olur. Bu yüzden prediyabetin erken ve doğru teşhisi gereklidir. Maliyetler gözönüne alındığında prediyabet teşhisine yönelik her hasta için çok sayıda test istenmesi de akla yakın gözükmemektedir. Buna göre; tanı için gerekli testlerin belirlenmesinde vakaların sahip olduları risk durumuna göre sınıflandırılması doğru olacaktır. Risk belirlenmesi konu içinde tartışılmıştır. Birinci basamak hekimlerinin prediyabete yönelik yeterliliklerinin sağlanması koruyucu hekimlik hizmeti sunmalarının da önünü açacaktır.

Purpose: Cardiovascular effects of hypothyroidism are well known. Osteopontin (OPN) is a new inflammatory marker which was first isolated from the bone. Flow-mediated dilatation (FMD), a noninvasive technique to measure this endothelium-dependent function, has been used in several clinical studies to show cardiovascular risks. The aim of our study was to assess FMD value in hypothyroidism patients and to investigate whether plasma OPN level is a parameter which can predict cardiovascular risks in this group of patients. Material and Method: This study included 39 patients who had high levels of thyroid-stimulating hormone (TSH) and 11 healthy euthyroid controls. Plasma TSH, free thyroxine, fibrinogen, high-sensitive C-reactive protein (hsCRP), fasting plasma glucose, total cholesterol (T-chol), low density lipoprotein (LDL), triglyceride and OPN levels were measured at the time hypothyroidism was first detected and after euthyroid state was achieved with levothyroxine treatment. In parallel with these assessments, brachial FMD measurements were also performed. Results: In hypothyroid patients cardiovascular risk factors such as T-chol, LDL and triglyceride levels were higher than in control group but fibrinogen and hsCRP levels were not different between the groups. OPN levels were similar in patient and control groups, but basal FMD levels were lower in patients with hypothyroidism. After euthyroidism was achieved, OPN levels significantly decreased and FMD levels significantly increased, but a correlation was not detected between these two parameters. Discussion: Our study did not show a significant correlation between OPN and cardiovascular risk parameters. Further studies are needed to use OPN as a cardiovascular risk marker in hypothyroid patients.

Betatrophin is defined as a new marker in glucose homeostasis and lipid metabolism. We aimed to investigate the role of serum betatrophin in full-blown polycystic ovary syndrome (PCOS) patients and 47-aged healthy women, 51 full-blown PCOS patients were included in this cross-sectional study. Betatrophin concentrations were significantly lower in PCOS group and displayed a positive correlation only with serum tryglyceride in control group (p .05). A cutoff level (464.5 ng/L) was determined for betatrophin according to Receiver Operating Characteristic curve. Using this value, 64.7% of PCOS patients were classified as below the cutoff and in this group betatrophin was found to correlate negatively with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (p = .038, p = .020, and p = .014, respectively), and positively with total testosterone (p = .041). In the rest of PCOS cases (35.3%) who had betatrophin higher than cutoff, positive correlation was found with low-density lipoprotein cholesterol (p = .009). In conclusion, betatrophin levels are reduced in full-blown PCOS patients who had worse metabolic phenotype.

Purpose: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women in reproductive age. Conflicting results are reported in the studies examining insulin resistance in lean PCOS subjects. We aimed to observe the controversial presence of insulin resistance in lean PCOS subjects with the gold standard method and assess the impacts of family history of type 2 diabetes mellitus (T2DM) on insulin resistance in these patients. Material and Method: Nineteen patients with PCOS and nine age-BMI matched control subjects were recruited into the study. Patients with PCOS were divided into two groups according to their FH of T2DM among their first degree relatives (FHneg vs FHpos). Insulin resistance was evaluated with homeostasis model assessment of insulin resistance (HOMA-IR) and hyperinsulinemic euglycemic clamp technique for all participants. Results: Mean M values were significantly higher in the control group when compared with PCOS patients (p=0.003). There was no statistically significant difference for HOMA-IR and M values when FHneg and FHpos patients were compared. Although HOMA-IR values were similar between all groups, M values were lower in FHneg and FHpos groups compared to the controls (p=0.02 and 0.004 respectively). Discussion: Lean PCOS patients have evident insulin resistance when compared to healthy subjects, and FH of T2DM seems to not affect insulin resistance. Even non-obese PCOS patients should be encouraged for healthy eating style and exercise to prevent the potential risks associated with insulin resistance. Furthermore these patients can see benefits from medical therapies which improve insulin sensitivity. Turk Jem 2015; 19: 55-59

Purpose: To evaluate bone mineral density (BMD) measurements and the presence of periodontitis in patients with acromegaly, as well as to inquire the impact of interfering factors. Material and Method: Forty-seven acromegalic patients with any accompanying condition known to affect calcium-bone metabolism and 60 age-matched healthy controls were included. Age, gender, duration and activity of acromegaly, past-present therapy options, pituitary hormone profiles, replacement therapies, and the results of periodontal analysis were recorded. Results: Eighteen patients were male (38.3%), 29 were female (61.7%). The mean age of the patients was 46.6±11.5 years, twenty-five (53.1%) had active, 22 (46.8%) had inactive acromegaly. The latter were older and had longer disease duration (p=0.04, p=0.003, respectively). Serum calcium and phosphorus levels, 24-hour urinary calcium excretion and BMD at the lumbar spine and femur neck insignificantly associated with disease activity (p>0.05). Osteoporosis was detected in 6 patients (12.76%). Periodontitis and advanced periodontitis were more common in control group (66.7% vs. 44.7%), (43.3% vs. 12.8%) (p=0.022, p=0.0001, respectively). There was no difference in chronic periodontitis and severity between active and inactive groups (48% vs. 40.9%; p=0.279). No difference was noted in other study parameters, as well. Repeated measures analysis of variance demonstrated statistically insignificant distribution between GH change in time and periodontitis subgroups. Discussion: We demonstrated that acromegaly exerted no clear negative impact on vertebral BMD in the absence of overt hypogonadism. Regardless of disease activity, acromegaly cases exhibited lower rates of periodontitis with less severity which remained unchanged in the presence of accompanying metabolic disorders known to have negative impact on periodontal tissue. Chronic exposure to excess GH may have a protective role against periodontitis. Turk Jem 2015; 19: 42-48

Objective: To evaluate the impact of mean platelet volume (MPV) on predicting disease course among patients with Graves’ disease (GD). Methods: This retrospective study was performed between 2013-2016 at the Outpatient Endocrinology Clinic of Baskent University Faculty of Medicine, Adana hospital on 65 patients with GD. Among participants, 30 cases experienced thyrotoxicosis again during the first six months after discontinuing anti-thyroid drug (ATD) sessions that had been carried out for at least 12 months prior to stopping (Relapse group). We also observed 35 patients who exhibited normal thyroid functions within six months following ATD withdrawal (Remission group). MPV levels and thyroid function tests were recorded and total duration of ATD therapy was calculated for all participants. Results: The mean MPV level that was measured at the time of drug withdrawal did not differ between groups, being 8.0±1.2 fL in the Relapse group vs. 8.0±1.0 fL in the Remission group (p=0.81). However, we found that the relapse MPV was higher than the withdrawal MPV in the Relapse group (9.2±1.3 fL) than it was in the Remission group (8.0±1.2 fL, p=0.00). Conclusions: Higher relapse MPV in Relapse group but similar MPV levels in both groups at ATD withdrawal may be attributed to hypermetabolism or hyperthyroidism rather than autoimmunity of GD. Abbreviations: BMI: Body mass index GD: Graves’ disease MPV: Mean platelet volume TSH: Thyroid-stimulating hormone TRAbs: Thyrotropin receptor antibodies ATD: Anti-thyroid drug fT4: Free thyroxine fT3: Free triiodothyronine CBC: Complete blood count PTC: Papillary thyroid carcinoma

Severe hypertriglyceridemia (SHGT) occurs when triglyceride values exceed 1,000 mg/dl which places patients at considerable risk of acute pancreatitis. Treatment of SHGT includes lipid lowering approches and dietary interventions. Insulin infusion is considered to decrease triglyceride levels in patients who display SHTG related acute pancreatitis. Plasmapheresis is an effective method and an extracorporeal process which may be used both in urgent and in selective cases. Plasma exchange and double cascade filtration are methods of plasmapheresis used in SHTG and possible following acute pancreatitis. In this article effect and mechanisms of plasmapheresis on SHTG and related acute pancreatitis will be discussed. [Med-Science 2020; 9(1.000): 274-7]

Purpose: Telmisartan has been reported to increase insulin sensitivity by acting as a partial PPAR-gamma agonist, regardless of its renin-angiotensin system inhibition, but losartan has no such activity. In this study, we compared the effects of telmisartan and losartan on insulin sensitivity among type 2 diabetic patients. Material and Method: Age-, sex- and weight-matched patients, who had been on telmisartan or losartan treatment for at least 3 months, were included. Their anthropometric measurements were performed, blood pressures were recorded. Fasting venous blood samples were obtained for analyzing the levels of glucose, HbA1C, insulin and adiponectin. HOMA-IR was calculated. An euglycemic hyperinsulinemic clamp procedure was performed in each subject and M index was calculated. Thereafter, telmisartan and losartan were withdrawn in both groups. A cross-over design was planned; following a wash-out period of 15 days, losartan group (Group 1) was given telmisartan 80 mg/day, telmisartan group (Group 2) was administered losartan 50 mg/day. After 12 weeks of therapy, all measurements, calculations and the euglycemic hyperinsulinemic clamp test were re-performed. Results: General characteristics of the patients at inclusion were similar. Nine cases in group 1 and 8 cases in Group 2 concluded the follow-up. In Group 1, among all follow-up parameters, only weight exhibited a significant decrease at final evaluation (p=0,034). In Group 2, only M value was found to increase (p=0,028). Discussion: Our findings indicated that losartan improved insulin sensitivity in patients with concomitant hypertension and type 2 diabetes, and telmisartan use resulted in more weight loss. Turk Jem 2013; 17: 92-7

To evaluate the tear-film meniscus with optical coherence tomography (OCT) in patients with Graves' disease (GD).Patients with GD without clinical features of thyroid-associated ophthalmopathy (TAO) (Group 1, n=35), patients with signs of TAO (Group 2, n=31) and healthy participants (Group 3, n=31) were enrolled. Palpebral fissure width, Schirmer test, tear break-up time (TBUT) test and tear-film meniscus height and area obtained with Fourier-domain-OCT were analyzed.TBUT test scores were 8 s (2-25) in Group 1, 8 s (2-15) in Group 2 (p=0.380); and 10 s (5-17) in Group 3 (p=0.000 Group 1 versus 3, and 0.000 for Group 2 versus 3). Tear-film meniscus height did not significantly differ between Groups 1 and 2 (257.5 µm (86-962) and 258 µm (99-1340), respectively, p=0.980). In Group 3, tear-film meniscus height was 316 µm (122-720) (p=0.005 Group 1 versus 3 and 0.004 for Group 2 versus 3). Tear-film meniscus area did not significantly differ between Groups 1 and 2 (0.025 mm(2) (0.004-0.250) and 0.024 mm(2) (0.003-0.316), respectively, p=0.850). In Group 3, tear-film meniscus area was 0.048 mm(2) (0.006-0.75) (p=0.000 Group 1 versus 3 and 0.000 for Group 2 versus 3).Tear function is significantly disturbed in GD. OCT is an effective way to assess the tearing function also in patients with GD.

Objective: Regular physical exercise has been shown to be substantial for health. For this purpose, walking on most days of the week is considered an appropriate choice. This study was de - signed to determine the rate of compliance to walking type exercise among healthy obese women and the results of 12-week exercise. Material and Methods: Six hundred and forty-eight healthy women aged 18-55 years with a body mass index (BMI) between 30-35 kg/m 2 and with adequate SF-36 scores for continuing physical activity were randomly assigned into a walking group (gr-I), a treadmill group (gr-II), a treadmill group supported by a visual apparatus (gr-III) and finally a fitness center group (gr-IV). The compliance of the subjects to walking was determined for a 12-week period. Body weight of the cases were mesured once at the beginning of the study and once at the end whereas the follow up was performed monthly. Results: The compliance from highest to lowest was in gr-I, followed by gr-III, gr-II and gr-IV and showed a significant fall during the three-month period for all groups. The weight loss was highest in gr-I and lowest in gr-III. Subgroup analysis showed that advanced age was associated with low compliance as well as low body weight loss. Conclusion: Ex - ercise prescription is needed to be established with respect to the compliance pattern of the obese, which may be related to safety, environmental and time-related factors. It should be kept in mind that age and rational use of time are important determinants of exercise compliance.

Insulin resistance, which provides a convenient milieu for platelet activation, has been closely associated with atherosclerotic disorders. Although it often accompanies hyperprolactinemia, findings conflict concerning its clinical impact in macroprolactinemia. In order to investigate the relationship between hyperprolactinemia and platelet activation evidenced by ADP-stimulated P-selectin expression on flow cytometry, we studied hyperprolactinemic, macroprolactinemic, and normoprolactinemic subjects. Thirty-four hyperprolactinemic and 44 age- and body mass index-matched euprolactinemic premenopausal women were included. They were matched regarding insulin sensitivity status, waist circumference, blood pressures, and plasma lipids. In order to detect macroprolactinemia among hyperprolactinemic cases, prolactin was measured before and after polyethylene glycol (PEG) precipitation in patients’ sera. P-selectin expression was significantly higher in the hyperprolactinemic group (P = 0.001), and 41.2% of them exhibited macroprolactinemia. Expression of P-selectin was comparable between the macroprolactin-negative (monomeric hyperprolactinemia; n = 20) and -positive (n = 14) subgroups (P = 0.90). Both subgroups showed greater expression compared with normoprolactinemic controls (P = 0.014 and 0.005, respectively). Platelet activation accompanies the atherosclerotic disorders closely associated with insulin resistance. Among groups matched with regard to insulin-sensitivity markers, both monomeric hyperprolactinemia and macroprolactinemia appeared to promote platelet activation.

Objective: Increased QT interval dispersion (QTd) is an electrocardiographic parameter shown to be associated with malignant ventricular arrhythmias and sudden death, and QT dispersion corrected for heart rate (QTc) has emerged as a potentially important predictor of cardiac death. Increased QTd has been detected to be directly related to thyroid-stimulating hormone (TSH) levels in overt hypothyroidism, however not much is known about subclinical hypothyroidism (SH). This study was conducted to investigate the QTc in SH and determine the changes following normalization of TSH levels with L-thyroxine. Subjects and Methods: Fifty-eight women with naive SH due to Hashimoto’s thyroiditis, mean age 39.37 ± 10.43 years, and 54 age-, sex- and weight-matched controls with normal TSH were included after exclusion of any factor that might interfere with cardiac conductibility. Electrocardiographic measurements were performed with a magnifier and Bazett’s formula was used to calculate QTc. The patients were separated into two groups regarding basal TSH levels (subgroup A: 5 > TSH > 10 mIU/l, n = 36; subgroup B: TSH > 10 mIU/l, n = 22). L-Thyroxine 1–2 µg/kg/day was administered to subgroup B. Results: Mean QTc interval of the study group was significantly longer than that of the control group (100 ± 30 vs. 76 ± 30 ms, p = 0.000). It was also longer in subgroup A (5 > TSH > 10 mIU/l, n = 36) and subgroup B (p = 0.001, p = 0.000, respectively). In subgroup B, following normalization of serum TSH, mean post-treatment QTc measurement was similar to that of the control group (75 ± 40 vs. 76 ± 30 ms, p > 0.05). Conclusion: We detected prolonged QTc among SH cases. Prolongation remained significant for the whole group as well as the two subgroups. The differences in QTc were corrected when TSH levels of >10 mIU/l returned to normal.

Objective: The aim of this study was to determine the cardiometabolic risk factors in different polycystic ovary syndrome (PCOS) phenotypes. Subjects and Methods: This cross-sectional study was performed between 2010 and 2011. Eighty-nine patients with PCOS and 25 age- and weight-matched healthy controls were included in the study. Patients were grouped using the Rotterdam 2003 criteria as: group 1, oligomenorrhea and/or anovulation (ANOV) and hyperandrogenemia (HA) and/or hyperandrogenism (n = 23); group 2, ANOV and polycystic ovaries (PCO; n = 22); group 3, HA and PCO (n = 22); group 4, ANOV, HA and PCO (n = 22); group 5, controls (n = 25). Laboratory blood tests for diagnosis and cardiometabolic risk assessments were performed. Insulin resistance (IR) was calculated in all patients with the homeostasis model assessment of IR (HOMA-IR) formula. An euglycemic hyperinsulinemic clamp test was performed on 5 randomly selected cases in each subgroup, making 25 cases in total, and indicated as the ‘M' value (mg/kg/min), which is the total body glucose disposal rate. Results: The mean BMl values of the groups were: group 1, 26.1 ± 5.3; group 2, 27.9 ± 5.2; group 3, 24.3 ± 4.2; group 4, 27.9 ± 7.5; group 5, 24.7 ± 5.2 (p > 0.05). There were no differences in the lipid profile, plasma glucose, HOMA-IR, insulin and M values between the groups (p > 0.05). Phenotypes with oligomenorrhea/anovulation (groups 1, 2 and 4) were more obese than group 3 (p = 0.039). Conclusions: The cardiometabolic risk profile was similar among the PCOS subgroups. This finding could be attributed to the mean BMl values, which, being below 30, were not within the obesity range. Obesity appeared to be an important determinant of high cardiovascular risk in PCOS.

WOS: 000249773700004 PubMed ID: 17728607 Objective The aim of this study was to evaluate the use of Tc-99m(V)-dimercaptosuccinic acid (Tc-99m(V)-DMSA) scintigraphy for the assessment of disease activity in patients with Graves' ophthalmopathy (GO) and compare their clinical parameters. Methods The study involved 20 patients who were clinically inactive and eight patients who were clinically active, a total 28 GO patients (18 female, 10 male; mean age: 39.2 +/- 13.4 years) and 12 control subjects (six female, six male; mean age: 57.12 12 years). Planar and SPECT orbital images were obtained 4 h after the intravenous injection of 555-740MBq Tc-99m(V)-DMSA, using low-energy, high-resolution, parallel-hole collimators with dual-head detectors. All SPECT data were reconstructed on conventional axial, sagittal and coronal projections using an iterative reconstruction. Semi-quantitative evaluation was performed comparing the orbital activity with nasal activity based on four grades. GO was classified according to the NOSPECS classification of the American Thyroid Association. Disease was considered clinically active if symptoms and signs deteriorated over 3 months. Results No significant correlation was detected between clinical activity and classification (P=0.192). However, clinical activity and Tc-99m(V)-DMSA uptake were significantly correlated (P=0.0001). There was no correlation between the clinical classification and scintigraphic grading. Bilateral orbital index of the active group was significantly higher than that of the inactive group (P=0.0001). Conclusion Tc-99m(V)-DMSA imaging discriminates the active from inactive GO as well as showing an ongoing subclinical inflammation in the orbits of the patients with GO, regardless of the disease activity clinically. Our results revealed that Tc-99m(V)-DMSA is a promising agent for the diagnosis of active Graves' ophthalmopathy.

SummaryObjective Recent studies have shown close association between serum Immunoglobulin G4 (IgG4) levels and forms of autoimmune thyroiditis. However, there are limited data about the relationship between IgG4 and Graves’ ophthalmopathy (GO). In the present study, we aimed to determine the possible association between IgG4 and GO. Design Cross-sectional study. Patients Sixty-five patients with Graves’ disease (GD) and 25 healthy controls were recruited into the study. Thirty-two of these patients had GO. Measurements Serum IgG4 levels, thyroid functions and thyroid volumes were measured in all participants. Ophthalmological examination including Hertel's exophthalmometer readings (HER), Schirmer's test (ST), ‘NO SPECS’ classification and clinical activity score evaluation (CAS) were performed to all patients with GD. Results IgG4 levels were significantly elevated in patients with Graves’ disease compared to controls (P = 0·0001). Also, IgG4 levels were significantly higher in patients with and without GO when compared to control subjects (P = 0·0001 and P = 0·002, respectively). Furthermore, IgG4 levels were significantly higher in the GO group compared with GD patients without GO (P = 0·024). IgG4 levels were observed to increase in parallel to CAS. Compared with other GD patients, 15 GD patients with serum IgG4 levels ≥135 mg/dl had higher CAS scores (P = 0·012). None of the factors including, TSH, T3, T4 levels, thyroid volume, HER and ST measurements, affect IgG4 levels as an independent factor. Conclusion IgG4 levels are evidently increased in patients with GD, and there is a possible relationship between IgG4 and GO. Our results suggest that IgG4 may be helpful in screening GD patients with high risk for GO and may well become a good indicator for the selection of right medication in the future.

We aimed to observe the association between degree of obesity and metabolic syndrome and plasma thyrotropin levels in obese, euthyroid Turkish patients. 947 obese and overweight patients who admitted to our outpatient clinic were assessed retrospectively. 150 healthy euthyroid cases were also recruited as the control group. Cases with metabolic syndrome were determined. Patients were divided into various subgroups as overweight, obese, morbid obese, men, and women. No statistical significance was determined when all the patients’ and subgroups’ plasma thyrotropin levels were compared to normal weight control group. No association was shown between the presence of metabolic syndrome and plasma thyrotropin levels for both all patients and subgroups. Also there was not any association between each component of metabolic syndrome and plasma thyrotropin levels. In conclusion, we did not found any significant association between plasma thyrotropin levels and obesity and metabolic syndrome in our euthyroid subjects.

ObjectiveTo determine plasma fetuin-A levels in hypothyroid patients before and after treatment withl-thyroxine (T4) and to determine the relation between plasma fetuin-A levels with cardiovascular risk factors.DesignA prospective, controlled, single-blind study.MethodsForty-four treatment-naive female patients diagnosed with hypothyroidism and 39 age- and sex-matched control subjects were enrolled. Anthropometric measurements, blood pressure, plasma TSH, fetuin-A, free T4, LDL-cholesterol, triglyceride, C-reactive protein, fibrinogen levels, and brachial artery flow-mediated dilatation were measured. All measurements were repeated after 3 months in the control group and 3 months after the attainment of euthyroidism withl-T4replacement in the hypothyroid group.Baseline data were compared between the two groups. Posttreatment plasma fetuin-A levels of hypothyroid patients were compared with baseline levels of both groups. The relationship between plasma fetuin-A, TSH levels, and other cardiovascular risk factors was evaluated.ResultsPlasma fetuin-A levels were ∼20% lower in hypothyroid female patients compared with the controls (P=0.0001). Fetuin-A levels increased by ∼20% in hypothyroid patients after achievement of euthyroidism (P=0.0001) and were no longer different compared with controls (P=0.38). There was a negative correlation between plasma TSH and fetuin-A levels (r=−0.79;P=0.001). There was no significant correlation between plasma fetuin-A levels and cardiovascular risk factors within or between groups. The fetuin-A levels were normalized with thyroid hormone treatment.ConclusionPlasma fetuin-A levels are reduced in female patients with hypothyroidism, which are restored to normal during restoration of euthyroidism. There was no relation with cardiovascular risk factors.

Metastatic insulinomas may sometimes present with recurrent life-threatening hypoglycemia episodes. Such patients usually fail to respond to various therapeutic agents which causes constant dextrose infusion requirement. Herein, we present a resistant case of inoperable malignant insulinoma who was treated with many therapeutic agents and interventions including somatostatin analogues, Yttrium-90 radioembolization, everolimus, radiotherapy, and chemoembolization. Close blood sugar monitorization during these therapies showed the most favourable response with everolimus. Everolimus treatment resulted in rapid improvement of hypoglycemia episodes, letting us discontinue dextrose infusion and discharge the patient. However, experience with everolimus in such patients is still limited, and more precise data can be obtained with the increasing use of this agent for neuroendocrine tumours.

Background: This study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified. Methods: Cases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery ( > 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated. Results: A total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001). Conclusions: Independent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ≥ 89.5 mg/dL or HbA1C ≥ 5.485% should be closely followed for AIT in specified centers. doi: http://dx.doi.org/10.4021/jocmr1515w

Introduction Glucagon-like peptide-1 (GLP-1) originates from the gastrointestinal system in response to the presence of nutrition in the intestinal lumen and potentiates postprandial insulin secretion. Also, it acts as an immune-modulator which has influences on cell-mediated immunity. The aim of this study was to determine the impact of early enteral nutrition versus late enteral nutrition on plasma GLP-1 levels and the relationship between GLP-1 changes and cell-mediated immunity. Materials and methods The study was designed as a prospective, single-blinded study and carried out in the neurology intensive care unit (ICU) of a university hospital. Twenty-four naive patients with acute thromboembolic cerebrovascular events, with National Institute of Health (NIH) stroke scores between 12 and 16, were included. Any condition interfering with GLP-1 and immunity was regarded as exclusion criterion. Two patients died, and two dropped out of the study due to complicating conditions. Patients were randomly subjected to early enteral feeding within the first 24 hours (Group 1), or late enteral feeding, beginning 48 hours after admission (Group 2) via a nasogastric tube. Calculated daily energy requirement was supplemented with parenteral nutrition, starting on the first study day for both groups. Blood samples were obtained before, and at 5, 15, 30, 60 and 120 minutes after the first enteral feeding for GLP-1 assays; this procedure was repeated on the third day. Before and 24 hours after the first enteral feeding, samples were also taken for immunological analysis. Clinical observations were recorded. Pre- and post-feeding plasma GLP-1 changes between the two groups and within groups were evaluated. Lymphocyte subgroup changes before and 24 hours after the first enteral feeding in relation to GLP-1 changes were sought as well. Results Group 1 and Group 2 exhibited similar GLP-1 levels in the pre-feeding and post-feeding periods for both the first time and the third day of enteral feeding. Also, no significant change in pre-/post-feeding GLP-1 levels was observed within groups. T-helper and T-regulatory cells increased, T-cytotoxic cells decreased significantly in Group 1 (P = 0.02; P = 0.036; P = 0.0019), but remained the same in Group 2 after enteral feeding. Positive but statistically insignificant clinical effects in terms of predisposition to infections (10% vs 40%) and median time of ICU stay (10 vs 15 days) were observed in Group 1. Conclusions Depending on our findings, we propose that early enteral feeding may cause amelioration in cell-mediated immunity via factors other than GLP-1 in ICU patients with acute thromboembolic stroke. However, the possible deleterious effects of parenteral nutrition cannot be ruled out.

Aim of this prospective study is to evaluate the effect of repaglinide t.i.d. (three times a day) plus single-dose insulin glargine regimen in low-risk type 2 diabetic patients during Ramadan fasting. Participants had been taking the regimen for at least 3 months. Patients with a history of diabetic coma, severe hypoglycemic crisis or repeating attacks of hypoglycemia were excluded. Hypoglycemic unawareness, kidney or liver disease or HbA1c over 8% were also accepted as exclusion criteria. Eleven patients who insisted on this worship and eight non-fasting cases were involved. All were told to make home-glucose-monitorisation weekly and report any hypoglycemic event throughout Ramadan. Fasting blood glucose (FBG), post-prandial blood glucose (PBG) and fructosamine levels, body weights and blood pressures were recorded just before and after Ramadan. Seven patients in each group concluded the follow-up. Any significant change was detected in the parameters in either groups (P > 0.05). Glucose control remained unchanged; fructosamine 318.14 ± 65.38 versus 317.28 ± 52.80 mmol/L in fasting group, 290.71 ± 38.48 versus 290 ± 38.56 mmol/L in non-fasting group. None of them exhibited either a major or a minor hypoglycemic event. The results of this pilot study indicated that repaglinide t.i.d. plus single-dose insulin glargine regimen was safe for low-risk type 2 diabetic patients who insisted on fasting during Ramadan.

To evaluate the short-term effects of Lanreotide Autogel on insulin sensitivity markers among acromegalic patients with pituitary tumors.Prospective clinical trial with six months of follow-up.A tertiary endocrinology clinic.Naïve patients (patient No. 1 and patient No. 3) and patients who experienced prior somatostatin analogue treatment (patient No. 2, patient No. 4, and patient No. 5) were included. Before and after 6 months of Lanreotide Autogel therapy, insulin sensitivity in each subject was determined using homeostasis model assessment of insulin resistance and beta-cell function formula. Euglycemic hyperinsulinemic clamp test was also performed to evaluate whole insulin sensitivity and was indicated as an 'M' index.All patients experienced reduction in their HOMA-beta. We noted major HOMA-beta decreases accompanied by pronounced increases in M indices for patients Nos. 1, 2 and 3 (1.03 vs. 8.22, 2.98 vs. 4.70, and 5.09 vs. 13.09, respectively). The increases in M indices of these patients were with marked decreases in GH levels (34.20 vs. 15.30 microg/l, 4.25 vs. 0.74 and 5.0 vs. 0.66 ng/mL, respectively). Minor decline in HOMA-beta and worsened M index and almost stable GH were observed in patients Nos. 4 and 5. Except for patient No. 3, all participants showed declining HOMA-IR.Short-term Lanreotide Autogel treatment has been observed to improve M indices of acromegalic patients whose GH levels exhibited marked reduction. This amelioration seemed to be related to decreases in GH levels rather than to a direct drug effect.

Our aim was to determine the relationship between body fat percentage (BF%) and body mass index (BMI) and to evaluate the validity of World Health Organisation's BMI cut-off values for obesity. Adult out-patients (n=909, 249 men, 660 women), mean age; 40.5 +/- 14.1 years were included. According to WHO's BMI criteria, 440 subjects were obese (79 men, 361 women). The BF% of participants were measured using a bioelectrical impedance analysis (BIA) system (TANITA). Randomly selected 30 patients were also subjected to the dual-energy X-ray absorptiometry (DEXA) procedure for evaluation of the validity of TANITA measurements. The BF% results obtained by DEXA and TANITA revealed good correlation (r =0.952, p= 0.382). There was a positive correlation between BF% and BMI (p0.001) for both methods. Cut-off values for BMI were calculated as 28.0 kg/m2 for women, 28.2 kg/m2 for men, if obesity was defined as BF= 25% in men,= 35% in women according to WHOfs criteria. Using the new cut-off values, the frequency of obesity increased up to 33.9% in our group. The increase was more pronounced in men (67.1% vs. 26.6%). The WHO cut-off values underestimated the frequency of obesity in this population. Further studies are warranted for different ethnic groups.

Background: Strontium ranelate (SR) is a new antiosteoporotic agent with antiresorptive and bone-forming properties. The exact mechanism by which SR exerts its effects is not clearly understood. Bone resorption requires interaction between osteoblasts and osteoclasts. Osteoblasts produce a ligand for receptor activator of nuclear factor-κB (RANK). They also secrete osteoprotegerin, a decoy protein that blocks the interaction of RANK with its ligand, thereby inhibiting the differentiation and activity of osteoclasts. SR also has been associated with osteoblast proliferation and decreased osteoblast-induced osteoclast differentiation via increased osteoprotegerin messenger RNA expression in human osteoblasts. Objective: The aim of this study was to investigate the relationship between SR treatment and serum osteoprotegerin concentration in women with post-menopausal osteoporosis (PMO). Methods: This open, prospective study was conducted in women admitted to the outpatient endocrinology clinic of Baskent University Faculty of Medicine, Adana Medical Center, Ankara, Turkey, for the evaluation of PMO. Women with PMO who enrolled were administered elemental calcium 1000 mg/d and vitamin D 800 IU/d for 1 month before the study period. After obtaining baseline serum samples for determining osteoprotegerin concentrations, patients were assigned to the treatment or control groups at a 5:2 ratio and SR 2 g/d was administered to the treatment group. The control group continued to receive only calcium and vitamin D. Serum osteoprotegerin concentration was measured again after 3 months of treatment. Results: Thirty-five women (treatment group: n = 25; mean [SD] age, 59.80 [7.38] years; control group: n = 10; mean [SD] age, 56.60 [5.06] years) enrolled in the study. A total of 32 women—24 in the treatment group and 8 in the control group—completed the study. Compared with baseline, mean [SD] serum osteoprotegerin concentration did not change significantly after 3 months in either the treatment group (4.91 [1.24] pmol/L vs 4.71 [1.19] pmol/L) or the control group (5.36 [2.82] pmol/L vs 5.10 [2.19] pmol/L). Conclusion: The results of this small study found that serum osteoprotegerin concentrations were not significantly changed by SR treatment for 3 months among women with PMO.

Recently, the term of "possible" polycystic ovary syndrome (PCOS) has been used for defining cases in which biochemical evaluations are incomplete but clinical phenotypes are suggestive of PCOS. The aim of this study was, by using Rotterdam 2003 criteria, to detect possible PCOS cases and compare their characteristics and insulin sensitivity status with confirmed PCOS subjects. One-hundred-eighteen women who admitted with complaints and symptoms suggesting PCOS were included. Insulin sensitivity status of the cases was calculated with Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Cases fulfilling Rotterdam 2003 criteria were defined as confirmed PCOS, whereas indeterminate subjects as possible PCOS. Confirmed PCOS was detected in 70 (59.3%) and possible PCOS in 48 (40.7%) cases. Confirmed PCOS was most prevalent among subjects with hirsutism and menstrual dysfunction; 32 (80.0%) vs. 8 (20%), (p=0.000). Body mass index and HOMA-IR values did not differ between groups: confirmed PCOS versus possible PCOS; 25.46+/-5.55 kg/m(2) vs. 26.75+/-7.55 kg/m(2), 3.37+/-4.12 vs. 3.21+/-2.50, (p>0.05). Family history of type-2 diabetes mellifus was similar within both groups (p>0.05). Many PCOS patients seem to be undiagnosed due to inadherence to diagnostic work-up and/or to not fulfill Rotterdam 2003 criteria. These criteria may not be sufficient to cover the entire spectrum of PCOS.