Eda Demir Onal

Serum levels of MMP-9 and TIMP-1 in primary hypertension and effect of antihypertensive treatment☆

BACKGROUND Matrix metalloproteinases, a family of proteolytic enzymes are thought to be involved in extracellular matrix accumulation during development of hypertensive target organ disease. The present study was designed to compare hypertensive patients with normotensive individuals with respect to serum levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 and to search for the effect of antihypertensive treatment on the serum enzyme levels. METHODS Thirty-three patients with stage 1 primary hypertension and sixteen age- and sexmatched control subjects were enrolled into the study. Serum MMP-9 and TIMP-1 levels were assessed in the hypertensive group before and after a 3-month-antihypertensive treatment (candesartan 8 mg/day to 17 patients and lisinopril 10 mg/day to 16 patients). RESULTS Pre-treatment serum MMP-9 levels were higher in the hypertensive group (p=0.309) while serum TIMP-1 levels were lower (p=0.296). Serum MMP-9 levels were decreased (p<0.001) and TIMP-1 levels were increased (p=0.022) after the antihypertensive treatment. CONCLUSIONS In hypertensive patients, increased MMP-9 activity could result in increased degradation of elastin relative to collagen and non-elasticity, while decreased TIMP-1 activity could lead to accumulation of poorly cross-linked, immature and unstable fibril degradation products, which result in misdirected deposition of collagen. Our study is important for revealing the role of the MMP enzyme system in the pathogenesis of hypertensive target organ disease.

Anti-Müllerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease

Abstract There is an increased incidence of autoimmune thyroid disease (AITD) in women with infertility. We hypothesized that serum anti-Müllerian hormone (AMH) levels will be lower in premenopausal women with AITD than controls. We evaluated ovarian reserve in women with AITD (n = 85) and healthy controls (n = 80), all <40 years old. Detailed data on reproductive history were obtained. Gonadotrophins, steroids, AMH, and inhibin B levels were measured during the follicular phase. The number of pregnancies as well as live births was lower in women with AITD (p < 0.01). No difference was observed in terms of FSH, estradiol, and inhibin B. AMH levels were lower in AITD women than in controls (1.16 + 0.17 versus 1.28 + 0.25 ng/ml, mean + SD, p = 0.001). According to the multiple regression analysis, even after age adjustment, AITD was significantly and independently affected AMH levels (t = 2.674, p = 0.008). Women with AITD seem to have a diminished ovarian follicular reserve and measurement of serum AMH level has the potential to be used to predict this comorbidity.

Thyroid autoimmunity in patients with hyperprolactinemia: an observational study

OBJECTIVE To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. MATERIALS AND METHODS The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. RESULTS The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). CONCLUSION HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity.

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.

Choroidal Changes and Duration of Diabetes

Abstract Purpose: We investigate changes in macular choroidal thickness in eyes without diabetic retinopathy of patients with various durations of diabetes, using enhanced depth imaging optical coherence tomography (EDI OCT). Methods: The 134 Type-2 diabetic patients who presented without diabetic retinopathy were prospectively imaged using EDI OCT on Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) sd-OCT. The patients with diabetes were classified into three groups, according to the duration of diabetes: Group I (5–9 years, n = 63); Group II (10–14 years, n = 37); Group III (15–40 years, n = 34). The retinal and choroidal thickness was evaluated between these groups at central fovea and at the regions at 500-mm intervals up to 1500 mm temporal and nasal to the fovea. Results: The central foveal retinal thickness was significantly different between groups (group I: 273.05 ± 19.51 µ, group II: 267.12 ± 20.78 µ, group III: 261.34 ± 22.27 µ; p = 0.04). The choroidal thickness measurements at central fovea, at 500, 1000, and 1500 micron intervals temporal and nasal to the center of the fovea were not significantly different between groups. The duration of diabetes was weakly correlated with choroidal thickness in all measured distances and they were not statistically significant. The central foveal choroidal thickness was weakly correlated with serum creatinine (r = −0.18, p = 0.03). Conclusıon: Foveal retinal thickness was significantly decreased in patients with longer duration of diabetes. Duration of diabetes does not seem to be related to foveal chorodial thickness. On the other hand, the weak relation between creatinine and choroidal thickness may be evaluated further. The choroidal thickness changes that may be an early sign of nephropathy can be submitted to an easy, noninvasive scanning test at the same time.

Vitamin D Deficiency and Gallbladder Stasis

Cholelithiasis or presence of calculi/gallstones in the gallbladder occurs more frequently in pregnant women. Vitamin D deficiency is suggested to be associated with gallbladder stasis, and a role for vitamin D supplementation is thought to have potential to prevent gallstones in this special population.

Association between vitamin D deficiency & paediatric tuberculosis

Sir, I read with great interest the article by Khandelwal et al1. They undertook a study to determine the baseline 25-hydroxy vitamin D levels in children suffering from intrathoracic tuberculosis and its association with type and outcome of tuberculosis. Majority of Indian children with newly diagnosed intrathoracic tuberculosis were found to be deficient in vitamin D and children who did not demonstrate sputum conversion after intensive phase of antituberculosis therapy had lower baseline 25-hydroxy vitamin D levels as compared to those who did1. The article has important messages. But there are some issues which need to be clarified. First issue is the absence of a control group. We think that a control group is a “sine quanone” for that kind of a study and all the subjects in the control group should have tuberculin skin test and chest radiography to screen for latent tuberculosis. Another issue is that the authors should have better statistically analyzed the impact of the presence of cavitary disease on smear conversion because the presence of cavitary disease has been previously reported to be associated with a longer time to sputum smear conversion in patients with active pulmonary tuberculosis2. This parameter may interfere with the proposed effect of vitamin D deficiency on smear conversion. As a last point, was there any patient who had paradoxical response to antituberculosis therapy in this series? Paradoxical deterioration during antituberculosis therapy is defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves3 and it has been observed in upto 16 per cent of patients in another study4. Following the antituberculosis therapy, improved immune function leading to a greater inflammatory reaction is thought to be responsible for paradoxical deterioration. We think that the answer to our question is important because the absence of any paradoxical response in the vitamin D insufficient and deficient groups may provide indirect evidence for impaired immune reconstitution in these groups of patients.

What is the effect of radioiodine therapy on Helicobacter pylori infection

BACKGROUND/AIM Helicobacter pylori is an important human pathogen associated with gastric and duodenal ulcers, gastric mucosa- associated lymphoid tissue lymphoma, and adenocarcinoma. Radioiodine (RAI) treatment plays an important role in the management of differentiated thyroid cancer and primary hyperthyroidism. It is known that during RAI treatment, a considerable amount is absorbed by the stomach as well. In this study we aimed to reveal any therapeutic impact of RAI on H. pylori infections. MATERIALS AND METHODS Eighty-seven patients who were hospitalized for RAI treatment were consecutively included in this study. Of those, 76 patients had differentiated thyroid cancer and 11 had primary hyperthyroidism. The urea breath test (UBT) was performed on the day before RAI, and the test was repeated after 2 months. RESULTS The dose of RAI was 115 ± 3.3 mCi (range: 100-150 mCi) in the patients with malignant disease and 22.7 ± 1.4 mCi (range: 20-30 mCi) in the remaining patients. Among the patients with differentiated thyroid cancer, 44 (57%) had positive and 32 (43%) had negative UBT tests prior to RAI. Four (36%) patients with hyperthyroidism had pretreatment positive UBT tests and 7 (64%) had negative tests. The results of UBT conducted 2 months after RAI therapy were identical in every patient, which means that none of the patients with positive UBT became UBT-negative (P = 1). CONCLUSION RAI does not have any therapeutic effect on H. Ovlori infection.

Primary Thyroid Disorders in Patients with Endogenous Hypercortisolism: An Observational Study

Cushings syndrome (CS) may alter the performance of the hypothalamic-hypophyseal-thyroid axis. We searched for a relationship between hypercortisolism and primary thyroid disorders. The medical records of 40 patients with CS were retrospectively examined. Thyroid ultrasonography (USG), basal thyroid function test results (TFT), and antithyroglobulin and antithyroperoxidase antibodies were analyzed. In 80 control subjects, matched by age and gender with CS patients, thyroid USG, TFTs, and autoantibody panel were obtained. Among the CS patients, 17 had nodular goiter, versus 24 controls (42.5% versus 30%, P > 0.05). Among the twenty-five patients with an available TFT and autoantibody panel—before and after surgical curative treatment—autoantibody positivity was detected in 2 (8%) patients before and 3 (12%) after surgery (P = 0.48). Regarding TFT results, 1 (2.5%) patient had subclinical hyperthyroidism and 1 (2.5%) had subclinical hypothyroidism, whereas 1 (2.5%) control had hyperthyroidism. In total, 21 (52.5%) patients and 32 (40%) controls had ≥1 of the features of thyroid disorder, including goiter, positive thyroid autoantibody, and thyroid function abnormality; the difference was not significant (P > 0.05). The prevalence of primary thyroid disorders is not significantly increased in patients with CS.

Screening interval for celiac disease in patients with type 1 diabetes mellitus.

We read with great interest the article by Bakker et al. [1]. They made a retrospective evaluation of 118 patients with both type 1 diabetes mellitus (T1DM) and celiac disease (CD). They collected data on sex distribution, age of onset of T1DM, age of CD diagnosis, CD complaints and duration of CD complaints before CD diagnosis. And they found that 33% of T1DM + CD patients reported CD related complaints for at least 5 years before CD diagnosis. The authors concluded that a delay of CD diagnosis is frequently found in adult T1DM patients and more frequent screening for CD in particularly adult T1DM patients is required, preferably by a 5 year interval. The article has important messages. But there are some items to be clarified. First issue of our concern is the ratio of patients (n = 24) who reported CD related complaints for at least five years before CD diagnosis. If the authors aim to provide any evidence for a screening policy they should take into consideration all of the CD patients regardless of the presence of CD related complaints. And twenty-four should be divided by the total number of patients (n = 118) but not only the number of symptomatic patients (n = 72). In this way, the percentage of patients with prolonged symptoms (N5 years) would be twenty but instead of thirty-three. This means that a five-year-interval screening would detect one in every five but not three patients. Another issue of our concern is that there are no signs or symptoms specific for CD. Gastrointestinal symptoms are already more prevalent in diabetic patients in comparison to the general population and have a negative effect on the quality of life [2,3]. Diarrhea or increased stool frequencymay occur because of pancreatic insufficiency, bacterial overgrowth, consumption of artificial sweeteners, islet cell tumors, fecal incontinence andmetformin therapy in addition to coexistent CD [4]. Iron deficiency anemia in some European countries was reported as high as 13.5% in premenopausalwomen andmenstrual bleeding is probably the main cause [5]. And hypoglycemia in T1DM is frequently caused by exogenously delivered insulin which is not subject to normal physiologic