Aysegul Atmaca

Personality characteristics and body image in obese individuals

The aim of this study was to determine the personality characteristics of obese and morbidly obese individuals with no psychiatric disorder and the correlation between these characteristics and body image and self‐esteem.

Neuropad® indicator test for diagnosis of sudomotor dysfunction in type 2 diabetes

Neuropad® is a new indicator test used to diagnose sudomotor dysfunction, a component of autonomic neuropathy. In this cross-sectional study, Neuropad is evaluated and compared with corrected QT (QTc), another test used in the diagnosis of autonomic neuropathy. The indicator test measures sweat production on the basis of a color change of cobalt (II) chloride solution from blue to pink upon absorption of water. This study involved 105 patients (43 men, 62 women) with type 2 diabetes with a mean age of 56.2±11.5 y and a mean disease duration of 10.0±6.3 y. Age, sex, disease duration, glycosylated hemoglobin, and QTc were compared between patients with normal and abnormal test results. The QTc interval was measured and the new indicator test was applied in all patients. The 2 tests were compared, and the sensitivity, specificity, positive predictive value, and negative predictive value for the indicator test were calculated. Autonomie neuropathy was diagnosed in 40 patients (38.1%) with QTc interval measurement and in 72 patients (68.6%) with the new indicator test (P=.001). The sensitivity, specificity, positive predictive value, and negative predictive value for the indicator test were 87.5%, 43.1 %, 48.6%, and 84.8%, respectively. Patients with abnormal test outcomes had longer QTc than those whose test results were normal (0.433 vs 0.398 s; P=.002). Study results suggest that the new indicator test has an acceptable sensitivity but a low specificity and is not superior to other tests in the diagnosis of sudomotor dysfunction.

Quality of life is impaired not only in vitamin D deficient but also in vitamin D-insufficient pre-menopausal women

Background: Vitamin D deficiency may be more common in pre-menopausal women than previously thought and it may impair quality of life (QoL). Aim: The aim of this study is to evaluate QoL in pre-menopausal women with vitamin D deficiency and insufficiency. Subjects and methods: This is a cross-sectional study in which subjects were enrolled between September 1st and November 30th, 2011. Healthy pre-menopausal women with weakness, fatigue and non-specific pain were assigned into three groups according to their 25-hydroxyvitamin D (25-OHD) levels: ≤20 ng/ml (vitamin D deficient, no.=30), 21–29 ng/ml (vitamin D insufficient, no.=30) and ≥30 ng/ml (vitamin D sufficient, no.=20). Short form-36 (SF-36) scores, age, calcium (Ca), phosphorus (P), and PTH levels were compared among the groups and correlations of SF-36 scores with age, serum 25-OHD, Ca, P, and PTH were done. Results: There were significant differences among the groups with regard to PTH (p=0.008), physical component score (p=0.02), mental component score (p=0.035), physical functioning score (p=0.0001), and vitality score (p=0.05). Apart from PTH and physical functioning score, the results were significant when vitamin D-insufficient and -sufficient women were compared. Serum 25-OHD, but not PTH was correlated with some of the scales of SF-36. Conclusions: Some components of QoL are impaired not only in vitamin D deficient but also in insufficient pre-menopausal women, and impairment is related to 25-OHD rather than PTH levels.

Radiation-associated secondary brain tumors after conventional radiotherapy and radiosurgery

Although there is not enough strong molecular evidence for radiation to be a causal factor for the development of secondary brain tumors, a relationship has still been found. There is a slight but significant 2–2.7% increased risk of secondary brain tumors after conventional radiotherapy. However, this risk is small and should not preclude the use of radiotherapy as an effective treatment for uncontrolled pituitary tumors. The risk of radiosurgery-associated secondary brain tumors has not been precisely determined. Taking into account the considerable number of patients who received radiosurgery worldwide and the small number of secondary brain tumors, radiosurgery seems to be a safe treatment modality. This review summarizes the pathogenesis, prevalence and characteristics of secondary brain tumors after conventional radiotherapy and stereotactic radiosurgery for pituitary adenomas.

Evaluation of body weight, insulin resistance, leptin and adiponectin levels in premenopausal women with hyperprolactinemia

The effects of hyperprolactinemia on metabolic parameters are not clear and a few data evaluating adiponectin levels in prolactinoma and idiopathic hyperprolactinemia exist. The aim of this study was to evaluate the effects of hyperprolactinemia on body weight, insulin resistance, beta cell function, and leptin and adiponectin levels in premenopausal women with hyperprolactinemia. Forty premenopausal women with prolactinoma or idiopathic hyperprolactinemia were compared to 41 age-matched healthy premenopausal women with regard to body weight, body mass index, waist and hip circumferences, waist to hip ratio, fasting plasma glucose, insulin levels, insulin resistance measured by homeostasis model assessment (HOMA)-insulin resistance index, beta cell function measured by HOMA-β index, leptin and adiponectin levels. Plasma insulin levels and HOMA indexes (both insulin resistance and beta indexes) were significantly higher in hyperprolactinemic women. The other parameters were similar between both groups. There was a positive correlation between prolactin levels and fasting plasma glucose in hyperprolactinemic women. The results of this study showed that high prolactin levels may be associated with hyperinsulinemia and insulin resistance in premenopausal women. This effect seems to be independent of body weight, leptin and adiponectin levels. High prolactin levels may directly stimulate insulin secretion from pancreas and directly cause hepatic and whole-body insulin resistance.

Effect of bisphosphonate as an adjunct treatment for chronic periodontitis on gingival crevicuar fluid levels of nuclear factor-κB ligand (RANKL) and osteoprotegerin in postmenopausal osteoporosis

Osteoporosis and periodontal disease are linked by an altered receptor activator of nuclear factor κB ligand and osteoprotegerin ratio (RANKL/OPG), and medical treatment with bisphosphonate (BP) may help control these molecules. The effect of BP on clinical findings and gingival crevicular fluid (GCF) values of RANKL and OPG using enzyme-linked immunosorbent assays was evaluated in postmenopausal women; 13 patients with both chronic periodontitis and osteoporosis (group A), 12 systemically healthy patients with chronic periodontitis (group B), 12 periodontally healthy patients with osteoporosis (group C), and 10 systemically and periodontally healthy individuals (group D). Recordings were repeated at the end of months 1, 6, and 12 in groups A, B, and C. At the baseline, groups A and B exhibited the lowest OPG values (P < 0.05). After periodontal treatment, OPG values were markedly increased at the end of 6th month in group A and 12th month in group B (P < 0.008). There was no significant difference in GCF RANKL values among groups (P > 0.05) or during the observation period (P > 0.008). The use of BP may be effective in preventing periodontal breakdown by controlling the levels of these markers in osteoporosis as an adjunct to periodontal treatment.

The effects of zoledronic acid treatment on depression and quality of life in women with postmenopausal osteoporosis: A clinical trial study

Background: Osteoporosis affects quality of life (QoL) and may lead to depression in women. The purpose of this study was to evaluate the effects of zoledronic acid (ZA) treatment on depression and QoL in women with postmenopausal osteoporosis (PO). Materials and Methods: A total of 88 newly diagnosed women with PO were included in this study. All patients were treated with once-yearly ZA (5 mg). A QoL questionnaire from the European Foundation for Osteoporosis and Beck Depression Inventory were given to patients at baseline and at 12 months. The results for baseline and post - 12th month were compared, and bone mineral density (BMD) levels were compared. Results: The consumption of once-yearly ZA (5 mg) treatment increases BMD at levels of lumbers 1–4 (P = 0.026), total Hip T scores P value is same as femoral neck (P: 0,033). ZA 5 mg treatment also improved QoL (P = 0.001) and reduced depression (P = 0.001). Conclusion: ZA treatment increases BMD levels and QoL while reducing depression. Once-yearly ZA (5 mg) may be considered for postmenopausal women as a first-line treatment.

Assessment of balance performance and fear of falling in acromegalic patients: A comparative study

Background: Acromegaly may lead to balance disturbances and fear of falling due to changes in body composition and co-morbidities. Aim: The aim of this study was to evaluate balance and fear of falling in acromegalic patients and their relation with disease characteristics. Materials and methods: Forty-eight acromegalic patients and 41 age- and gender-matched controls were enrolled in the study. The median ages of the patients and controls were 48 (25–75) and 50 (25–67) yr, respectively. Berg Balance Scale (BBS) and one-leg stance test (OLST) were used to compare dynamic and static balance respectively, 50 meters walking test was used to compare functional capacity and falls efficacy scale-international (FES-I) was used to compare fear of falling between the groups. Results: Balance tests (BBS and 50 meter walking test) and fear of falling (FES-I) were significantly disturbed in patients compared with controls. There was no significant difference in OLST. BBS and OLST were negatively and FES-I was positively correlated with age. FES-I was negatively correlated with BBS and OLST was positively correlated with 50 meters walking test. Only OLST was negatively correlated with disease duration. Logistic regression analysis revealed that balance was not affected by the presence of co-morbidities, postoperative vision loss and disease control. Conclusions: This is the first study showing that balance is disturbed in acromegalic patients. This disturbance is not related to disease control and co-morbidities but somewhat to disease duration.

Pegvisomant tedavisi sonuçlarımız ve literatürün gözden geçirilmesi

Akromegali, artmis buyume hormonu (BH) sekresyonu ve artmis insulin benzeri buyume hormonu-1 (IGF-1) seviyeleri ile karakterize kronik bir hastaliktir. Akromegalide tedavi secenekleri cerrahi, radyoterapi ve medikal tedavidir. Medikal tedavide somatostatin analoglari, dopamin agonistleri ve pegvisomant kullanilmaktadir. Pegvisomant, buyume hormonu reseptor antagonisti olup etkisini reseptor dimerizasyonunun engellenmesi ile birlikte IGF-1 salinimi icin gerekli intraseluler yolaklari engelleyerek gosterir. Cerrahi ve maksimum doz ve kombinasyonda medikal tedaviye ragmen biyokimyasal yanit saglanamayan hastalarda ucuncu basamak tedavide kullanilir. Bu derlemede, akromegali tedavisinde diger seceneklere gore nispeten yeni olan pegvisomant tedavisi klinigimizdeki tedavi sonuclarimiz ile birlikte guncel literatur isiginda tekrar gozden gecirilmistir.