Ayse Carlioglu

Mean platelet volume in euthyroid patients with Hashimoto's thyroiditis.

Mean platelet volume (MPV) is the measure of platelet size. MPV possibly is a simple way to estimate platelet activity. In this study, we aimed to investigate MPV levels in euthyroid Hashimotos thyroiditis patients. Fifty-one euthyroid patients with Hashimotos thyroiditis attending our outpatient clinic of the endocrinology department, and 51 age and BMI-matched healthy individuals were included in this study. All patients with euthyroid Hashimotos thyroiditis were at euthyroid state. None of the study patients was subjected to levothyroxine replacement therapy. Anti-thyroid peroxidase (anti-TPO) antibody and anti-tiroglobulin antibody were positive. All the study participants were evaluated by biochemical and platelet parameters. There were no significant differences in age (33.88 ± 12.87 and 30.18 ± 12.43 years, respectively; P > 0.05) and BMI (23.55 ± 3.34 and 22.25 ± 3.65 kg/m2, respectively, P > 0.05) between the study and the control groups. Anti-TPO and anti-tiroglobulin levels were significantly higher in the study group (anti-TPO 428.32 ± 668.39 IU/ml in the euthyroid Hashimotos thyroiditis group; 14.85 ± 9.66 IU/ml in the control group, P = 0.001; anti-tiroglobulin 320.46 ± 796.05 IU/ml in the euthyroid Hashimotos thyroiditis group, 21.28 ± 26.24 IU/ml in the control group, P = 0.09). There were no significant differences in terms of serum thyroid-stimulating hormone (TSH) (1.76 ± 0.79 and 1.85 ± 1.14 uIU/ml, respectively), FT3 (3.10 ± 0.37 and 3.29 ± 0.76 pg/ml, respectively) and FT4 (1.22 ± 0.42 and 1.46 ± 0.78 pg/ml, respectively) levels between the study and the control groups. Serum triglyceride levels were significantly higher in the study group than in the control group (133.81 ± 91.50 and 90.18 ± 41.15 mg/dl, respectively; P = 0.015). Mean MPV levels were significantly higher in the euthyroid Hashimotos thyroiditis group than in the control patients (8.8 ± 1.05 and 7.9 ± 0.79 fl, respectively; P = 0.0001). To assess the correlation with MPV, a Pearsons correlation analysis was performed on each variable. There were positive correlations between anti-TPO and MPV levels (r = 0.246, P = 0.042), and between anti-tiroglobulin and MPV levels (r = 0.256, P = 0.033). The multiple regression analysis of MPV and other risk factors was performed. Age, BMI, C-reactive protein and waist circumference were independent predictive factors of MPV. Adjustment for other factors did not alter these relative risks. Our results suggest that even if in euthyroid state, patients with euthyroid Hashimotos thyroiditis have higher MPV levels than the healthy controls. As higher MPV levels are closely related with cardiovascular diseases, euthyroid Hashimotos thyroiditis patients have greater risk of atherothrombotic complications than controls.

Cardiac flow parameters with conventional and pulsed tissue Doppler echocardiography imaging in patients with polycystic ovary syndrome

Background. Polycystic ovary syndrome (PCOS) is independently associated with the major cardiovascular risk factors. The aim of this study was to examine the echocardiographic profiles of patients with PCOS using conventional echocardiographic methods and tissue Doppler imaging. Methods. For this study, we have registered 48 women with PCOS and 21 healthy control subjects who were mathced with respect to age and body mass index. Standard two-dimensional and M-mode measurement, transmitral valve flows and tissue Doppler imaging of mitral and tricuspid anulus were recorded. Results. In PCOS and control groups, left ventricular and atrium diameters, ejection fraction, mitral E/A ratio, deceleration time and isovolumic relaxation time were similar. There were no significant differences between patients with PCOS and control subjects with respect to tissue Doppler profiles. Conclusion. Patients with PCOS execute echocardiographic measures of cardiac function that are similar to those of healthy women.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer

Abstract Objectives. NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer. Methods. This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation. Results. There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels. Conclusion. In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis

Is mean platelet volume a new activity criteria in Behçet's disease?

The aim of this study was to assess mean platelet volume (MPV) and its relationship with disease activity in patients with Behçets disease. Thirty-six patients with an age of 38.9 ± 11 (mean ± SD) years and 40 controls aged 36.5 ± 12 (mean ± SD) years were enrolled the study. Demographic data, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), MPV, clinical findings such as oral aphthae, genital aphthae, erythema nodosum, acne, central nervous system involvement, uveitis, arthritis and arthralgia were all recorded. The MPV value in patients with Behçets disease was 8.06 ± 1.0 (mean ± SD) and the MPV value of the control participants was 7.45 ± 0.6 (mean ± SD). MPV was statistically higher in patients with Behçets disease than in the controls (P = 0.003). There were also significant differences between patients and controls according to ESR and CRP values (P < 0.001 and P = 0.001, respectively). MPV was positively correlated with arthralgia (P < 0.001, r = 0.438), arthritis (P = 0.008, r = 0.307), erythema nodosum (P = 0.002, r = 0.354), central nervous system involvement (P = 0.002, r = 0.357), acne (P = 0.008, r = 0.312), genital aphthae (P < 0.001, r = 0.401) and oral aphthae (P = 0.001 r = 0.377). MPV can be easily obtained from the patients. It was a cheap and practical method. In the future, MPV may be used as a new marker to detect the activation of BD.

A forgotten but important risk factor for infective endocarditis in patients with prosthetic valve: Pedicure

We report a case of infective endocarditis developing after pedicure in a 36-y-old female. Methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis was diagnosed. Even aggressive therapy was ineffective. To our knowledge, we report the first case of infective endocarditis secondary to pedicure in the literature.

Serum nesfatin-1 levels are decreased in pregnant women newly diagnosed with gestational diabetes

OBJECTIVE To investigate serum nesfatin-1 levels at 24-28 weeks of pregnancy in women newly diagnosed with gestational diabetes and determine the association of nesfatin-1 with several metabolic parameters. SUBJECTS AND METHODS Forty women newly diagnosed with gestational diabetes at 24-28 weeks of pregnancy and 30 healthy pregnant women matched in age and gestational week were included in this cross-sectional study. Serum nesfatin-1 levels were analyzed using ELISA, and the relationship between nesfatin-1 and several metabolic parameters were assessed. RESULTS Serum nesfatin-1 levels were found to be lower in women with gestational diabetes compared to the pregnant women in the control sample (p = 0.020). Multiple linear regression analysis revealed that nesfatin-1 was lower in participants with gestational diabetes independently from gestational age, BMI, HOMA-IR, fasting plasma glucose, and age. In correlation analysis, the only variable that was found to have a statistically significant correlation with nesfatin-1 was gestational age (p = 0.015, r = 0.30). CONCLUSION Lower nesfatin-1 levels in women with gestational diabetes compared to the control group at 24-28 weeks of gestation draws attention to nesfatin-1 levels in gestational diabetes and motivates further research in this area.

Uzun süreli entübasyon yapılmış hastalarda laringofaringeal etkilerin değerlendirilmesi

Amac ,: Acik kardiyovaskuler cerrahiler hem operasyon suresi hem de postoperatif yogun bakimda takip suresi goz onune alindiginda entubasyon suresinin uzun oldugu bilinen ameliyatlardir. Biz bu calismada koroner cerrahisi sonrasi uzun sure entube kalmis hastalarda postoperatif donemde gozlenen laringeal ve faringeal etkilenmeyi incelemek ve bu etkilerin olusumuna zemin hazirlayan olasi nedenleri arastirmayi amacladik. Materyal ve Metodlar: Calismaya kardiyovaskuler cerrahi yapilan toplam 42 hasta dahil edildi. Tum hastalar preoperatif (preop) donemde ve postoperatif donemde (ortalama 7.gun) endoskopik muayene edildi ve muayene bulgulari kaydedildi. Bulgular: Hastalar ortalama 61±9.98 yasinda, ortalama entube kalma suresi 14.80±3.41saat, kullanilan entubasyon tupunun ic capi 8.02±0.4 mm idi. Preoperatif sigara icen hasta sayisi 25 (%59.52) ve preoperatif gastroozofageal reflu semptomu olan hasta sayisi 8 (% 19.04 ). Postoperatiflaringeal ve faringeal patolojik bulgu orani %38.09 bulundu. Postoperatif laringeal ve faringeal patolojik bulgu olan hastalarda yas, entubasyon suresi, preoperatif gastroozofageal reflu hastaligi sikayeti arasindaki iliski isitatiksel acidan anlamli bulundu (p˂0,05).Ancak postoperatif patolojik bulgu ile cinsiyet, entubasyon tupunun tipi ve capi, sigara kullanma arasinda anlamli iliski bulunmadi. Sonuc: Yas, gastroozofageal reflu hastaligi varligi, entubasyon suresinin uzunlugu postoperatif laringofaringeal bulgu olusumu icin risk faktoru olarak tespit edildi.

Rasagiline-Induced Hypoglycemia

Address for Correspondence: Yusuf Bilen MD, Atatürk University Faculty of Medicine, Department of Hematology, Erzurum, Turkey E-mail: bilenyusuf@hotmail.com Received: 19/04/2015 Accepted: 04/10/2015 Dear Editor, Hypoglycemia that results from an absolute or relative decline in blood sugar is a clinical condition with various manifestations and mortality rate up to 11-27% (1). Rasagiline is a second generation irreversible monoamine oxidase B (MAO-B) inhibitor which is indicated for the treatment of Parkinson’s disease (2). We aimed to present a patient with Parkinson’s disease who developed hypoglycemia due to rasagiline use. The case is unique in the literature, because she had no concomitant diseases or medication usage. A 42-year-old female patient presented to the outpatient clinic with the complaints of dizziness, weakness, fatigue, nervousness, tension, cold sweating, and hunger sensation over the past year. She was having the diagnosis of Parkinson’s disease for years and was using rasagiline 0.5 mg/day. The patient was alert, oriented, and cooperative. On physical examination, the skin was cold and moist. Rhythmic heartbeats and tachycardia (105/minute) were observed. Laboratory tests revealed the followings: WBC: 4600/ mL hemoglobin: 11.8 g/dL hematocrit: 35.2% platelet: 342x106/ mL, mean corpuscular volume: 79 fL, urea: 79 mg/dL, glucose: 55 mg/dL (measurement was repeated two times, the results were in accordance with the previous ones) calcium: 8.8 mg/dL, creatinine: 0.6 mg/dL, K: 4.6 mmol/L, sodium: 135 mmol/dL, total protein: 7.6 g/dL, cortisol: 8.9 mcg/dL, and prolactin: 6.9 ng/mL. Hypoglycemia was observed at admission (blood glucose level: 55 mg/dL). The patient was awake and conscious, she received 20 grams oral carbohydrate as a first intervention in the outpatient clinic and, then, she was hospitalized. Hypoglycemia symptoms were improved after oral carbohydrate. The patient was evaluated for possible causes of hypoglycemia and the following results were obtained: Adrenocorticotropic hormone: 23.4 ng/mL, cortisol 12.02 mcg/dL (repeated), ferritin: 24 mg/dL, free T4: 1.04 ng/dL thyroid-stimulating hormone: 0.696 m IU/l, 25-hydroxy vitamin D: 21.4 ng/mL, insulin-like growth factor-1: 102 ng/mL, insulin: <2 mIU/mL, C-peptide: 0.583 ng/mL, and growth hormone: 0.741 ng/mL. The patient had mild iron-deficiency anemia. According to the examination and laboratory and imaging studies, any pathology other than hypoglycemia due to rasagiline medication for Parkinson’s disease was not detected. The symptoms related to hypoglycemia were not detected after discontinuation of rasagiline. Parkinsonism treatment was organized by the department of neurology. A diet program was created. During outpatient follow-up, we did not detect any sign and symptom of hypoglycemia for two months, thus, follow-up for hypoglycemia was terminated. Rasagiline is a selective MAO-B inhibitor. It is used in Parkinson’s disease either as monotherapy or in combination with levodopa. Rasagiline treatment may come with some adverse effects, such as gastrointestinal symptoms, hypotension, sleep disorders, headache, anxiety, and edema. There have been post-marketing information obtained, the use range in the about 166.000 Parkinson’s disease patients with estimated 399.120 patient/ year usage across the world a serious adverse effect did not reported until the date 2010 (3). However, accompanying possible hypoglycemic effects of selegiline, which is also a selective MAO-B inhibitor, have been reported in animal and human studies (4). According to Food and Drug Administration reports of the adverse effects related to rasagiline therapy, until December 2013, only two out of 1.380 patients have been reported to have hypoglycemia due to rasagiline use. These two patients were over the age of 60, the both patients had systemic diseases other than Parkinson’s disease such as type 2 diabetes mellitus, hypertension, and rheumatoid arthritis (5). As these features were present in both patients, rasagiline was not the possible cause of hypoglycemia. Our patient did not have any accompanying systemic disease and drug use; symptoms and signs of hypoglycemia improved after cessation of rasagiline therapy. Any other possible cause of hypoglycemia was not detected. When all these facts were considered, rasagiline was found to be the sole factor inducing hypoglycemia in our patient. This case is unique in the literature. Atatürk University Faculty of Medicine, Department of Internal Medicine, Erzurum, Turkey *Erzurum Research and Training Hospital, Clinic of Endocrinology, Erzurum, Turkey **Atatürk University Faculty of Medicine, Department of Hematology, Erzurum, Turkey Nurhan Bilen, Ayşe Çarlıoğlu*, Yusuf Bilen** Rasagiline-Induced Hypoglycemia Rasajiline Bağlı Hipoglisemi DOI: 10.4274/tjem.3129

Polikistik Over Sendromlu hastalarda artmış ürik asit düzeyleri ve klinik ile ilişkisi

Amac: Polikistikover sendromu (PKOS) ureme cagindaki kadinlari etkileyen en sik endokrin bozukluktur. Klinik ve biyokimyasal ozellikleri metabolik sendrom ile benzerlik gostermektedir. Metabolik sendromlu hastalarda insulin direnci, serum urik asit duzeyi ile iliskilidir. Calismamizda PKOS hastalarinda serum urik asit duzeylerinin laboratuar ve klinik ile iliskisini incelemeyi amacladik. G erec ve Yontemler: Hastanemiz Endokrin Kliniginde takip edilen 172 PKOS hastasi, 34 yas ve vucut kitle indeksi (VKI) uyumlu kontrol grubu toplam 206 olgu katilmistir. Erken follikuler fazda, 12 saat aclik sonrasi kan ornekleri alinmistir. Bazal serum hormon duzeyleri immunoassay ile degerlendirildi. Bulgular: Urik asid duzeylerinin PKOS grubunda kontrol grubuna gore istatistiksel olarak anlamli bir sekilde daha yuksek saptanmistir (4,25 ± 1,07 PKOS, 3,7 ± 0,79 kontrol, P = 0,048). Urik asit ile VKI, total kolesterol, insulin, siklus suresi, Ferriman Gallwey skoru arasinda pozitif anlamli korelasyon, HDL kolesterol ile anlamli negatif korelasyon bulunmustur. Cok degiskenli logistik regresyon yapildiginda urik asit duzeylerinin PKOS grubunda yas ve VKI’den bagimsiz olarak iki kat daha yuksek oldugu saptanmistir. Sonuclar: Calismamizda PKOS grubunda urik asit duzeyleri anlamli bir sekilde yuksek bulunmus ve bu yuksekligin yas ve VKI’den bagimsiz oldugu gorulmustur. Urik asit ile kardiyovaskuler risk faktoru olan kolesterol, Trigliserit, VKI, insulin arasinda pozitif korelasyon gorulmustur. Klinik gosterge olan Ferriman Gallwey, siklus suresi acisindan da pozitif korelasyon saptanmistir. Artmis urik asit duzeyleri PKOS hastalarinda kardiyovaskuler hastalik olusumu icin bagimsiz bir risk faktoru olabilir, klinikte olumsuz sonuclari gosterebilir. Anahtar Kelimeler: Kardiyovaskuler, polikistik over sendromu, urik asit

Elevated neutrophil-lymphocyte ratio in patients with euthyroid chronic autoimmune thyreotidis.

Abstract Objective. The neutrophil-lymphocyte ratio (NLR), determined from peripheral blood, is accepted as an available and practical indicator of the systemic inflammation. In this study, we aimed to determine whether the NLR was higher in euthyroid chronic autoimmune thyreotidis (CAT) patients compared to a healthy control group. Methods. A total of 112 patients were enrolled in this study, including 59 patients with euthyroid CAT on any form of therapy and 53 healthy controls. Th e CAT patients were similar in age to the healthy control group (mean 33.9±12.8 years versus 30.2±12.4 years, p=0.10). Measurements were available for the white blood cells (WBC), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), thyroid peroxidase immune antibody (anti-TPO), and anti-thyroglobulin immune antibody (anti-TG). The NLR and platelet-lymphocyte ratio (PLR) were calculated. Differences between the CAT and control groups were tested using the student’s t-test and the correlations were determined using Pearson’s correlation coefficients. Results. There were no differences between the CAT and control groups for WBCs (7.9±0.3 and 7.4±0.2, respectively; p=0.1) or neutrophils (5.5±0.3 and 5.4±1.1; p=0.9), but lymphocytes were higher in the CAT group (3.1±0.5 vs. 2.04±0.1; p=0.05) as was the NLR (4.0±0.7 vs. 2.0±0.1; p=0.01). Th e NLR was positively correlated with CRP (r=0.6, p<0.001), anti-TPO (r=0.3, p<0.001), anti-TG (r=0.3, p=0.006), WBCs (r=0.4, p<0.001), and the PLR (r=0.73, p<0.001). The PLR was also higher in the CAT than the control group (p=0.02). Conclusions. In this study, we found that NLR values were higher in euthyroid CAT patients than in a healthy control group and that NLR correlated with autoantibodies used to diagnose the disease.