Faruk Kılınç

Acoustic Radiation Force Impulse Imaging for Evaluation of Renal Parenchyma Elasticity in Diabetic Nephropathy

OBJECTIVE. The goal of this study is to evaluate the changes in the elasticity of the renal parenchyma in diabetic nephropathy using acoustic radiation force impulse imaging. SUBJECTS AND METHODS. The study included 281 healthy volunteers and 114 patients with diabetic nephropathy. In healthy volunteers, the kidney elasticity was assessed quantitatively by measuring the shear-wave velocity using acoustic radiation force impulse imaging based on age, body mass index, and sex. The changes in the renal elasticity were compared between the different stages of diabetic nephropathy and the healthy control group. RESULTS. In healthy volunteers, there was a statistically significant correlation between the shear-wave velocity values and age and sex. The shear-wave velocity values for the kidneys were 2.87, 3.14, 2.95, 2.68, and 2.55 m/s in patients with stage 1, 2, 3, 4, and 5 diabetic nephropathy, respectively, compared with 2.35 m/s for healthy control subjects. Acoustic radiation force impulse imaging was able to distinguish between the different diabetic nephropathy stages (except for stage 5) in the kidneys. The threshold value for predicting diabetic nephropathy was 2.43 m/s (sensitivity, 84.1%; specificity, 67.3%; positive predictive value, 93.1%; negative predictive value 50.8%; accuracy, 72.1%; positive likelihood ratio, 2.5; and negative likelihood ratio, 0.23). CONCLUSION. Acoustic radiation force impulse imaging could be used for the evaluation of the renal elasticity changes that are due to secondary structural and functional changes in diabetic nephropathy.

Is diabetes mellitus a negative prognostic factor for the treatment of advanced non-small-cell lung cancer?

BACKGROUND It has been demonstrated that there are a lot of different prognostic factors which are worthy of consideration whereas diabetes mellitus (DM) has not been clearly or consistently identified as a prognostic value in advanced non-small cell lung cancer (NSCLC). The aim of this study was to investigate the prognostic significance of the characteristics of patients in advanced NSCLC. Specifically, we investigated the impact of DM for progression-free survival (PFS) and overall survival (OS) in patients receiving first-line platinum-based doublets chemotherapy. METHODS We retrospectively reviewed 442 patients with advanced NSCLC. DM and other potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. RESULT The results of univariate analysis for OS were identified as having prognostic significance: performance status (p<0.001), stage (p<0.001), DM (p<0.001), liver metastasis (p=0.02) and brain metastasis (p<0.001). Stage, diabetes mellitus, and liver metastasis were identified as having prognostic significance for PFS. Multivariate analysis showed that poor performance status, presence of DM and advanced stage were considered independent negative prognostic factors for OS (p 0.001, p<0.001 and p<0.001 respectively). Furthermore, DM and stage were considered independent negative prognostic factors for PFS (p 0.005 and p 0.001 respectively). CONCLUSION In conclusion, DM at the time of diagnosis was associated with the negative prognostic importance for PFS and OS in the advanced stage patients who were receiving first-line platinum-based doublets chemotherapy. In addition poor performance status and advanced stage were identified as negative prognostic factors.

Early detection of macular and peripapillary changes with spectralis optical coherence tomography in patients with prediabetes

Abstract Purpose: To compare the retina ganglion cell complex (GCC) layer and peripapillary nerve fibre layer thickness (pRNFL) in patients with prediabetes and healthy subjects analysed by spectral domain optical coherence tomography (SD-OCT). Methods: This cross-sectional and comparative study included prediabetic patients and healthy subjects. All participants underwent SD-OCT measurement of pRNFL thickness, and GCC thickness. Results: A total of 30 eyes of the 30 patients with prediabetes and 30 eyes of 30 controls were included. The overall calculated pRNFL thicknesses were similar between the prediabetic and control subjects. The GCC thickness was significantly lower in all quadrants of the inner macula, and outer nasal quadrant in the prediabetes group when compared to the control group. Conclusion: Our study demonstrated that inner macular GCC thickness was significantly thinner in prediabetic subjects. As a result neurodegeneration may play role in the thinning of GCC.

Evaluation of Anthropometric and Metabolic Parameters in Obstructive Sleep Apnea

Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA). Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI) <5 (n = 25) and OSA group with an AHI ≥5 (n = 25). Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%, p = 0.034). There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol. Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism.

Improvement of minimally invasive parathyroidectomy outcomes by real time ultrasonography performed by a surgeon and radiologist team.

AIMS Minimally invasive parathyroidectomy (MIP) has become the first line of treatment for primary hyperparathyroidism caused by solitary parathyroid adenoma. In order to increase the sensitivity of high-resolution ultrasonography (hUS), surgeon performed ultrasonography (SUS) has been increasingly used preoperatively. However, a radiologist and surgeon performing ultrasonography (RSUS) has not been a usual practice. In this study, we aimed to evaluate the clinical contribution of RSUS on MIP. MATERIAL AND METHODS From 2012 to 2014, a total of 30 consecutive patients (4 male, 26 female, mean age 48.87+/-14.52 years) with solitary parathyroid adenoma, were included in the study. All patients underwent preoperative hUS and Technetium-99m sestamibi scintigraphy. In patients, demographic characteristics, diagnostic tools used, levels of biochemical parameters, duration of operation, and length of hospital stay were recorded. RESULTS Adenomas were successfully localized by US in all patients and the surgical approach was determined according to this localization. Parathyroidectomy with MIP was successfully performed under local anesthesia in all patients. Mean operation time was 19.87+/-3.35 min. Postoperative PTH and calcium values were significantly decreased. All patients were discharged from the hospital in the same day. None of the patients had complications such as recurrent laryngeal nerve injury, hematoma, or injury to nearby organs. None of the patients had drains placed. CONCLUSIONS Adenoma is well localized by US and thus, MIP can be completed under local anesthesia. US provides a very important clinical contribution to the success of MIP. In addition to these, RSUS helps in determining the location of the incision and the shortest way to achieve the lesion; therefore, it provides a small incision and shortens duration of the operation with a minimal dissection.

Association of clinical and laboratory parameters with ambulatory arterial stiffness index in acromegaly patients

Objective: In this study, we determined the relationship between the ambulatory arterial stiffness index (AASI) and clinical and laboratory parameters in patients with acromegaly. Methods: Sixty-five patients with acromegaly, who visited to Dicle University Medical Faculty Department of Endocrinology (33 females and 32 males), were included in this study. The study control group consisted of 65 subjects. Demographic and clinical data were recorded. Laboratory data (complete blood count, blood urea nitrogen, creatinine, electrolytes, albumin, lipid profile, growth hormone [GH], insulin-like growth factor-1, and the 75-g oral glucose tolerance test) performed over the last year were evaluated. The AASI was obtained from 24-hour ambulatory blood pressure monitoring records of all patients. This study was completed in 15 months from 2013 to 2015. Results: Twelve patients (18.4%) had diabetes and 21 patients (32%) had hypertension. The mean AASI value was 0.41 ± 0.14. The mean AASI value in the control group was 0.25 ± 0.09. Growth hormone (GH) levels were positively correlated with the AASI values. AASI values tended to be higher in hypertensive subjects than that in normotensive individuals. Conclusions: Our results show that the AASI value increased in patients with acromegaly, independent of the increase in blood pressure. The AASI was strongly dependent on the degree of the GH increase in patients with acromegaly and may have an important role predicting cardiovascular risk in patients with acromegaly.

Plasma urotensin II levels in primary Raynaud's phenomenon and systemic sclerosis

Background/aim: The pathogenesis of Raynauds phenomenon (RP) has not yet been fully elucidated. RP is characterized by exaggerated cold-induced vasoconstriction. Urotensin II (UII) is a potent vasoconstrictor. The aim of the present study was to evaluate plasma UII levels in both primary RP and secondary RP associated with systemic sclerosis (SSc).Materials and methods: Fifteen patients with primary RP, 30 patients with RP secondary to SSc, and 30 healthy controls (HC) were included in the study. Raynaud condition scores (RCS) were determined in the primary RP and SSc groups. Modified Rodnan skin score (MRSS) was determined for the SSc patients. Plasma UII level was analyzed by the ELISA method. Results: When compared to the HC group, plasma UII level was lower in the secondary RP group, but not in the primary RP group. Plasma UII level was not directly related to RCS in either the primary or secondary RP group. Moreover, it was not correlated with MRSS in the secondary RP group.Conclusion: The results of the present study suggest that UII is not associated with primary RP. Its level was lower in the secondary RP (SSc) patients. Therefore, it can be concluded that decreased UII level is related to SSc instead of RP.

İNFERTİL BİR ERKEKTE 46XX TESTİKÜLER BOZUKLUK

46 XX erkek cinsel gelisim bozuklugu cok nadir gorulen bir hastaliktir. Y kromozomuna yerlesmis olan SRY (sex-determining region Y) geni cinsiyet belirleyen gendir. Bu gen bolgesini iceren Y kromozomunun bir parcasinin X kromozomuna transloke olmasiyla hastaligin gelistigi dusunulmektedir. Otuz bes yasinda erkek hasta infertilite, cinsel istekte azalma sikayetleriyle poliklinigimize basvurdu. Fizik muayenesinde yuzde kirisikliklar, killanma azligi, kisa boy, kucuk testisler mevcuttu. Hastada hipergonadotropik hipogonadizm ve azospermi saptandi. Hastanin karyotip analizi 46 XX olarak rapor edildi. SRY gen analizi pozitif bulundu. Bu hastalarda spermatogenez olmadigindan testis biyopsisi ile sperm elde edilemez. Hastaligin baslica tedavisi testosteron yerine koyma tedavisidir. Infertilite ile basvuran primer hipogonadizmli hastalarin ayirici tanisinda bu nadir hastalik dikkate alinmalidir.

A case of mediastinitis accompanied with hyperosmolar nonketotic coma

Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patients symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling.

Factors influencing insulin usage among type 2 diabetes mellitus patients: A study in Turkish primary care

Abstract Background: DM (diabetes mellitus) patients with poorly regulated blood glucose levels are at risk of increased morbidity and mortality. There are different factors that cause resistance to the initiation of insulin therapy such as beliefs and perceptions concerning diabetes and its treatment and the nature and consequences of insulin therapy. Objectives: We aimed to explore the reasons for this reluctance and how these obstacles could be overcome so that DM patients who require insulin could initiate therapy. Methods: This was a cross-sectional, descriptive study of diabetic patients with glycated haemoglobin A1c (HbA1C) levels above 7.0%, who were followed-up at a primary care and endocrinology outpatient clinic. Results: Ninety-four patients (57.4% females, 42.6% males) were recruited for this study. Most patients (57.4%) considered that insulin was a drug of last resort. Among all patients, 34.1% thought that insulin lowered blood glucose levels to an extreme degree and 14.9% disagreed. The patients thought that self-injection was hard (27.6%), required someone else to administer the injection (27.6%), insulin injection was painful (33.0%). 59.6% of all patients believed that their religion did not restrict the use of insulin, 52.1% stated that their family physicians had sufficiently informed them. Conclusion: Our most significant finding is that a lack of adequate information relating to insulin appears to be the major factor behind DM patients’ refusal of insulin treatment. The fact that patients consider insulin treatment as a final solution to DM could be related to resistance to the initiation of insulin therapy. KEY MESSAGES The diabetic patients’ awareness of insulin and education of diabetes treatment are crucial in the treatment and follow-up of patients with diabetes mellitus. Family physicians play a major role in the education and follow-up regarding management of patients with diabetes mellitus.