Berrin Cetinarslan

Hemostatic System as a Risk Factor for Cardiovascular Disease in Women with Subclinical Hypothyroidism

Hypothyroidism has been associated with atherosclerosis. The mechanisms of atherosclerosis in patients with thyroid failure remain controversial. Hypofibrinolysis might be a risk factor for thromboembolic disease in subclinical hypothyroidism (SH). We measured fibrinolytic activity in patients with SH before and after levothyroxine (LT(4)) treatment and compared it to those of controls. We prospectively included 35 patients with SH and 30 healthy controls. We treated patients with LT(4) until almost 6 months after the euthyroid state has been achieved. We measured fibrinogen, D-dimer, antithrombin III (ATIII), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA) activity, and factor VII. Clinical and anthropometric variables were recorded for both groups. We found increased levels of fibrinogen, PAI-1, and factor VII and decreased levels of ATIII activity in patients compared to control (p < 0.001 and p < 0.05). Decrease of tPA was not significant (p > 0.05). At the end of the LT(4) treatment, significant decreases were determined in PAI-1 and factor VII (p < 0.05). In conclusion, our data suggest an important role of hypofibrinolytic and hypercoagulable state on the development of atherosclerosis in patients with SH and beneficial effects of LT(4 )treatment for decreasing the risk of atherosclerosis.

Association between Circulating Tumor Necrosis Factor-Alpha, Interleukin-6, and Insulin Resistance in Normal-Weight Women with Polycystic Ovary Syndrome

BACKGROUND Insulin resistance is a common finding in both obese and lean women with polycystic ovary syndrome (PCOS). Factors contributing to insulin resistance are still controversial. The purpose of the study was to compare the tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) concentrations in normal weight women with PCOS and a weightmatched healthy control group, and also to evaluate the role of these cytokines in the pathogenesis of insulin resistance. METHODS Thirty-two women with PCOS and 25 age- and weight-matched healthy controls participated in this study. Patients were evaluated clinically and by pelvic ultrasound. Fasting insulin, glucose, lipid profile, follicle-stimulating hormone (FSH), leutinizing hormone (LH), prolactin, testosterone, sex hormone binding globulin (SHBG), 17-hydroxyprogesterone, IL-6, TNF-alpha concentrations, and insulin sensitiviy indices homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were measured. RESULTS TNF-alpha and IL-6 concentrations were significantly higher in women with PCOS than in the control group. Significant correlations were found between TNF-alpha serum concentrations and Body Mass Index (BMI), waist circumference, triglyceride concentrations, fasting insulin, and insulin resisitance indices (p < 0.001). IL-6 concentrations were correlated with fasting glucose and insulin resistance (p < 0.05). CONCLUSIONS The study demonstrated that TNF-alpha and IL-6 concentrations were elevated in normal weight women with PCOS. The findings may contribute to evidence of insulin resistance in lean women with PCOS.

Homocysteine Concentrations in Subclinical Hypothyroidism

Hyperhomocysteinemia is considered to be an independent risk factor for atherosclerotic heart disease, including coronary artery disease (CAD). It is already known that overt hypothyroidism gives rise to a slight hyperhomocysteinemia. However, the effects of subclinical hypothyroidism on the levels of homocysteine are not known. In this study, we have evaluated homocysteine levels and the effect of L‐thyroxine treatment in patients with subclinical hypothyroidism. For the purpose of the study we selected 33 women patients with the diagnosis of subclinical hypothyroidism but without clinical CAD. After a euthyroidism development period of almost four months, a further study was done on patients who had been treated with thyroid hormone. The patient group was compared with 25 healthy control female subjects who were of similar age. In the patient group, homocysteine levels prior to treatment were significantly higher than in the control group (P < 0.001). After L‐thyroxine treatment, homocysteine levels were reduced significantly. In summary, we found that homocysteine levels were in the normal range in subclinical hypothyroidism. However, when compared with the healthy control group, the difference between them was significant. On the other hand, therapy to produce euthyroidism caused a significant reduction in homocysteine levels.

Serum Ferritin Levels in Poorly‐ and Well‐Controlled Diabetes Mellitus

Serum ferritin level is related to body iron stores and is influenced by several diseases. We aimed to evaluate the association between serum ferritin concentration and the complications and nature of diabetes mellitus (DM). We examined association of ferritin concentration, fasting and post‐prandial glucose levels and glycated hemoglobin in 329 patients with type 2 diabetes mellitus and 269 healthy controls. In the present study, 41 of 150 poorly controlled diabetic patients and 31 of 119 cases had hyperferritinemia. We confirmed that serum ferritin was increased in diabetic patients as long as glycemic control is not achieved. There was also a correlation between ferritin level and diabetic retinopathy. In conclusion, this study showed an independent positive association between serum ferritin concentration and markers of glucose homeostasis.

Abnormal QT dispersion in Behçet's disease.

Behçets disease, which was originally described by Hulusi Behçet in 1937, is a generalized chronic inflammatory disease characterized by recurrent oral and genital ulcerations, ocular and dermal manifestations. Cardiac manifestations include pericarditis, myocarditis, conduction system disturbances, coronary arteritis, mitral valve insufficiency, dilated cardiomyopathy, ventricular arrhythmias and sudden cardiac death. There is little knowledge about the mechanism of ventricular arrhythmias in Behçets disease. In this study, we examined the value of dispersion of ventricular repolarization as a diagnostic tool to assess the risk for ventricular arrhythmias and sudden cardiac death in Behçets disease. We examined 38 patients (age: 34 +/- 4.6 years, 20F, 18M) with Behçets disease and 30 age-matched healthy subjects were selected to serve as the control group. Repolarization dispersion parameters were calculated as the difference between maximal and minimal values of QT, QTc, JT and JTC from 12-lead ECG recordings at 25 or 50 mm/s. We found QTd, QTc-d, JTd and JTc-d intervals of 60.65 +/- 16.1, 78.45 +/- 11.4, 71.51 +/- 18.3 and 92.33 +/- 15.4 ms in Behçets disease patients, these values in control subjects were 40.1 +/- 9.7, 56.36 +/- 7.5, 41.66 +/- 4.3 and 53.92 +/- 9.2 ms respectively (p < 0.001). Striking increases in QT and JT dispersion indicating regional inhomogeneity of ventricular repolarization were noted in patients with Behçets disease. This new finding suggests a possible explanation for the presence of ventricular arrhythmias in patients with Behçets disease.

Lipid Profile and Lipoprotein (a) as a Risk Factor for Cardiovascular Disease in Women with Subclinical Hypothyroidism

This study evaluated changes of lipids and lipoprotein (a) [Lp (a)] as atherosclerotic risk factors and the effects of levothyroxine (LT4) treatment on these parameters in patient with subclinical hypothyroidism (SH), defined by increased concentrations of thyrotropin (TSH) and normal thyroid hormone concentrations. We prospectively included 35 female patients with SH and 30 healthy controls. Serum lipid measurements and clinical score as well as fT3, fT4, and TSH levels were assessed at baseline. Body mass index (BMI) was also calculated. Women with proven SH received LT4 treatment that continued for 6 months. Twenty‐six of 35 patients completed the study. At the end of treatment period, the same parameters were determined. Total cholesterol was significantly increased in patients with SH when compared with those of controls (p < 0.01), but increase of LDL‐cholesterol (LDL‐C) and Lp (a) were not significant (p > 0.05). In the levothyroxine‐treated group, total cholesterol and LDL‐C were significantly reduced when compared with the baseline values of women with SH (p < 0.05). Zulewski clinical score assessing symptoms and signs of hypothyroidism improved significantly with treatment (p < 0.001). In conclusion, serum lipids as important atherosclerotic risk factors increased before treatment and decreased with treatment. Levothyroxine therapy is effective in SH and improvements in serum lipids suggests that LT4 treatment also decreases the risk of atherosclerotic diseases.

PREVALENCE AND COMPARISONS OF FIVE DIFFERENT DIAGNOSTIC METHODS FOR HELICOBACTER PYLORI IN DIABETIC PATIENTS

Helicobacter pylori is now regarded as a major gastroduodenal pathogen that is etiologically linked with duodenal and gastric disease. It has been suggested recently as an important factor for nongastroenterologic conditions such as coronary heart disease and diabetes mellitus. In this study, we planned to investigate the prevalence of H. pylori in diabetic patients and to evaluate five different diagnostic tests. Group I consisted of 67 patients with type II diabetes mellitus and seventy-three aged-matched health people served as control in group II. Group I was divided in two subgroups with good (Group IA) and poor (Group IB) glycemic control. H. pylori was diagnosed by five different tests: 1) biopsy, 2) culture, 3) gram staining, 4) imprint cytology and 5) brushing cytology. The usefulness of each test for each group was statistically compared. There was a higher prevalence for H. pylori in diabetic patients. This study showed that two positive out of five tests was most reliable for predicting the H. pylori in diabetic and nondiabetic patients. In conclusion, the prevalence of H. pylori is high in diabetic patients. Peristaltic activity, and impaired nonspecific immunity must be evaluated as risk factors in diabetics. We recommend that the ‘gold standard’ should be regarded as two positive out of these five different tests.

Impact of treatment with metformin on adipokines in patients with polycystic ovary syndrome

BACKGROUND Adipose tissue synthesizes various adipokines such as resistin, adiponectin and visfatin, which have an effect on insulin resistance. This study was designed to show the effect of metformin, one of the most important drugs used to reduce insulin resistance in patients with polycystic ovary syndrome (PCOS), on these adipokines. METHODS The study group consisted of 24 women with PCOS and 25 healthy, age- and weight-matched, normally menstruating women. Hormone and lipid profiles, visfatin, adiponectin and resistin were measured in all cases, before and after metformin treatment. RESULTS Serum visfatin levels were found to be significantly higher in patients with PCOS, compared to controls. Following metformin treatment, a significant decrease was observed in visfatin levels compared to the baseline. A positive correlation was found between serum visfatin levels and BMI, waist circumference, HOMA, insulin and triglyceride levels. No statistically significant difference was observed in terms of serum adiponectin levels in women with PCOS before and after treatment, or in healthy controls. Serum resistin levels were significantly reduced by metformin treatment. CONCLUSION These findings suggest that visfatin may be related to the obesity and insulin resistance that is frequently encountered in patients with PCOS. A reduction in serum visfatin and resistin levels was shown with metformin treatment, in patients with PCOS.

Plasma visfatin level in women with polycystic ovary syndrome.

Objective. The aim of this study is to compare the serum level of visfatin between patients with polycystic ovary syndrome (PCOS) and control subjects matched for age and body mass index (BMI) and to assess the possible correlations of visfatin to the hormonal and metabolic parameters of the syndrome. Material and method. Fifty-five patients with PCOS diagnosis composed of 25 obese, 13 overweight, 17 normal weight subjects and 49 women without concomitant disease matched for age and BMI were included in this study. Results. Serum visfatin levels were similar in normal weight PCOS and control group. Visfatin levels in obese and overweight patients with PCOS were higher than that found in control women with similar BMI, and visfatin had positive linear correlation with BMI, waist circumference and HOMA-IR. Obese women with PCOS had also significantly higher visfatin levels than normal weight women with PCOS. Conclusion. Visfatin levels in obese and overweight patients with PCOS were higher than that found in females without concomitant disease with similar BMI, and visfatin had positive linear correlation with BMI, waist circumference and HOMA-IR.

Duration of the P wave and P wave dispersion in subclinical hyperthyroidism.

OBJECTIVE To determine whether the values for P wave dispersion (Pdis) and adjusted Pdis, which are simple noninvasive electrocardiographic markers to detect paroxysmal atrial fibrillation, differ in patients with endogenous subclinical hyperthyroidism in comparison with those in healthy control subjects. METHODS We measured the maximal P wave duration and the difference between the maximal and the minimal P wave duration (Pdis) from the 12-lead surface electrocardiogram of 36 patients with endogenous subclinical hyperthyroidism and of 22 age- and sex-matched healthy control subjects. Adjusted Pdis (Pdis/square root of the number of measured electrocardiographic leads) was also calculated from each electrocardiogram. RESULTS The minimal P wave duration was significantly shorter in patients with subclinical hyperthyroidism than in healthy control subjects (P<0.001). Pdis and adjusted Pdis were also significantly higher in the patient group than in the control subjects (P<0.05). By univariate analysis, only thyrotropin levels were found to be associated with adjusted Pdis (r = -0.28; P = 0.03). CONCLUSION Pdis and adjusted Pdis differed in patients with endogenous subclinical hyperthyroidism in comparison with those values in healthy control subjects. Thus, these simple electrocardiographic markers may be useful for identifying patients with endogenous subclinical hyperthyroidism who are at risk for paroxysmal atrial fibrillation.