Fettah Acibucu

Correlations between the Expression Levels of Micro- RNA146b, 221, 222 and p27Kip1 protein mRNA and the Clinicopathologic Parameters in Papillary Thyroid Cancers

CONTEXT It has been shown that miRNA 221, 222 and 146b are increasingly expressed while p27(Kip1) is suppressed in papillary thyroid cancer (PTC). OBJECTIVE We investigated the association between the disease recurrence risk and the expression of miRNA 221, 222, 146b and p27(Kip1) protein mRNA in these tumors. We also measured the changes in miRNAs in the presence of Hashimotos thyroiditis (HT). METHODS We examined formalin fixed tissue samples obtained from 77 patients. 11 out of 77 samples were identified as well differentiated tumor with uncertain malignant potential (WDT-UMP), 46 were PTC and 20 were normal thyroid tissue. RESULTS Data analysis revealed that the higher risk of recurrence was associated with the higher miRNA expression levels in thyroid cancers. Higher expression levels of miRNA 146b, 221 and 222 were detected in thyroid cancer patients presenting with capsule invasion, vascular invasion or lymph node metastasis, when compared to the patients lacking these features. Furthermore miRNA expression levels were found to be significantly elevated in patients with distant metastases. A negative correlation was found between the p27(Kip1) protein mRNA level and the expression levels of miRNA 221, 222 and 146b. While the expression levels of miRNA 221, 222 and 146b were found to be higher in the cases of WDT-UMP comparing to normal thyroid tissue, the p27Kip1 protein mRNA expression level was lower. No difference was found between the patients with HT and without HT regarding miRNAs expression levels. CONCLUSIONS The expression levels of miRNA 221, 222 and 146b were found to be increased in cases of thyroid cancer with a high risk of recurrence. It is important to understand that these molecular changes such as miRNA expression may eventually be used to predict risk of recurrence.

INSPIRATORY MUSCLE STRENGTH IS CORRELATED WITH CARNITINE LEVELS IN TYPE 2 DIABETES

Introduction. Plasma carnitine insufficiency has been known to cause muscle weakness. Carnitine levels and pulmonary functions were lower in patients with diabetes. Patients and Methods. To determine whether pulmonary functions are correlated with carnitine levels in patients with type 2 diabetes. In this study, we evaluated pulmonary functions and carnitine concentrations in 49 patients with type 2 diabetes and 34 healthy controls. Results. Carnitine levels were lower in type 2 diabetes group than control group (52.56 ± 12.38 and 78.96 ± 10.66 hmol/mL, respectively, p < 0.0001). Pulmonary functions were not significantly different between groups. Carnitine levels were not correlated with age, duration of diabetes, fasting blood glucose levels, and glycemic control (HbA1c%) in patients with type 2 diabetes. However, carnitine levels in patient group were correlated with % forced vital capacity (FVC%) (r = 0.35, p = 0.016), % forced expiratory volume in 1 s (FEV1%) (r = 0.318, p= 0.029), FEV1/FVC (r= 0.302, p= 0.039), inspiratory muscle strength (PImax) (r = 0.407, p = 0.023), and PImax% (r = 0.423, p= 0.018). Conclusion. This study suggests that low carnitine levels may be associated with lower PImax and PImax% in type 2 diabetes.

Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage

Background: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. Objectives: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia. Patients and Methods: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ≥30 are categorized as control, mild, moderate and severe, respectively. Results: One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner. Conclusions: We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.

Effect of Vitamin D Treatment on Serum Sclerostin Level

Objective Sclerostin is an osteocyte-secreted endogenous inhibitor of Wnt signaling. Several systemic and local factors have been suggested as possible regulators of sclerostin expression by osteocytes. In this study, we examined the effect of vitamin D treatment on sclerostin levels. Subject and Methods 44 patients with diagnosis of vitamin D deficiency (25(OH)D≤20 ng/ml) were involved in the study. Patients had monthly intramuscular injection of 300.000 IU cholecalciferol for 3 consecutive months. Sclerostin, 25(OH)D, parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) levels were measured during the diagnosis and after the replacement of vitamin D. Results 8 male and 36 female patients were enrolled in the study. Minimum age, maximum age and average age were 21, 55 and 32.02±9.26 years, respectively. A statistically significant difference was observed between the pre-treatment and post-treatment values in 25(OH)D levels (p:0.001, 10.27±4.62 ng/ml and 51.40±14.62 ng/ml, respectively), PTH levels (p:0.001, 50.32±19.05 pg/ml and 33.97±13.12 pg/ml, respectively) and sclerostin levels (p:0.002, 858.98±351.63 pg/ml and 689.52±197.92 pg/ml, respectively). No statistically significant difference, however, was found between the pre-treatment and post-treatment calcium, phosphorus and ALP levels. Correlation analysis made on pre-treatment and post-treatment sclerostin levels and 25(OH)D, PTH, calcium, phosphorus and ALP levels revealed no statistically significant correlation. Conclusion Our findings show that the sclerostin level of patients with vitamin D deficiency decreases considerably through treatment.

Sheehan’s syndrome

Abstract Sheehan’s syndrome (SS) is characterized by various degrees of hypopituitarism, and develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Increased pituitary volume, small sella size, disseminated intravascular coagulation and autoimmunity are the proposed factors in the pathogenesis of SS. Hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism, are observed in patients. The first most important issue in the diagnosis is being aware of the syndrome. Lack of lactation and failure of menstrual resumption after delivery that complicated with severe hemorrhage are the most important clues in diagnosing SS. The most frequent endocrine disorders are the deficiencies of growth hormone and prolactin. In patients with typical obstetric history, prolactin response to TRH seems to be the most sensitive screening test in diagnosing SS. Other than typical pituitary deficiency, symptoms such as anemia, pancytopenia, osteoporosis, impairment in cognitive functions and impairment in the quality of life are also present in these patients. Treatment of SS is based on the appropriate replacement of deficient hormones. Growth hormone replacement has been found to have positive effects; however, risk to benefit ratio, side effects and cost of the treatment should be taken into account.

Assessment of bone mineral density in patients with Sheehan's syndrome.

Abstract Introduction: The number of studies concerning bone mineral density (BMD) in patients with Sheehans syndrome (SS) are scarce. We aimed to investigate the relationship between BMD and deficient hormones in patients with newly diagnosed SS. Material and methods: Thirty-four patients with SS and age–gender–weight matched 22 controls were included in the study. Results: We found osteoporosis in 61.8%, osteopenia in 32.3%, and normal dual energy X-ray absorptiometry (DEXA) findings in 5.9% patients. In the control group, 68.2% of individuals were osteopenic and 31.8% of them were normal. The number of osteoporotic patients was found to be higher and BMD values were lower in the patient group compared with the control group. There was no relation of DEXA measurements with the period between the last delivery and the initial diagnosis and the estradiol levels. While there was no relation between insulin-like growth factor 1 (IGF-1) and T and Z scores of femur head, the relation between the IGF-1 and L1-L4 T scores was statistically significant. There was a significant relation between the IGF-1 and L1-L4 Z scores. Conclusions: SS patients should also be assessed in terms of osteoporosis at the time of diagnosis and then proper treatment should be initiated afterwards.

Metabolik sendromda ürik asit düzeyi ile nonalkolik yağlı karaciğer hastalığı arasındaki ilişki

Ozet Amac. Bu calismanin amaci metabolik sendrom (MS) hastalarinda non-alkolik yagli karaciger hastaliginin (NAYKH) sikligini ve serum urik asit degeri ile arasindaki iliskiyi arastirmaktir. Yontem. Calismaya 26’si erkek ve 34’u kadin toplam 60 MS olgusu ile 21’i erkek ve 21’i kadin toplam 42 saglikli birey alindi. On iki saatlik aclik sonrasi alinan kan orneklerinde; aclik kan sekeri (AKŞ), trigliserid, yuksek dansiteli lipoprotein, dusuk dansiteli lipoprotein (LDL), urik asit duzeyleri ve insulin degerlerine bakildi. Insulin direncini belirlemek icin HOMA-IR formulu kullanildi. Karaciger yaglanmasinin derecesi ultrasonografik olarak degerlendirildi. Bulgular. Calismamizda MS grubundaki urik asit duzeyleri, kontrol grubu olgularinin urik asit duzeylerinden istatistiksel olarak anlamli olacak sekilde yuksekti (p<0,05) ve MS komponentleri arttikca urik asit seviyelerinin de yukseldigi gozlendi. MS olgularimizda %78,3 oraninda karaciger yaglanmasinin oldugu; urik asit degerlerinin bu hastalarda anlamli derecede yuksek oldugu, bu artisin yaglanmanin derecesi ile dogru orantili oldugu saptandi. Sonuc. MS ile serum urik asit degeri ve NAYKH arasinda yakin bir iliski mevcuttur. Calismamizda ozellikle serum urik asit seviyesinin artisi karacigerdeki yaglanmanin derecesi ile dogrudan baglantili bulunmustur. Bundan yola cikarak, serum urik asit seviyesi artisinin, NAYKH’nin patogenezinde rol oynayabilecegini dusunmekteyiz. Anahtar sozcukler: Metabolik sendrom, karaciger yaglanmasi, urik asit Abstract Aim. The purpose of this study is to investigate the frequency of non-alcoholic fatty liver disease (NAFLD) in patients diagnosed as metabolic syndrome (MS) and also to find out its relation with serum uric acid levels. Methods. A total of 60 MS patients (26 male, 34 female) and 42 healthy individuals (21 male, 21 female) were included in the study. After a fasting period of 12 hours, serum glucose, triglyceride, high density lipoprotein, low density lipoprotein, uric acid and insulin levels were determined. HOMA-IR formula was used to determine insulin resistance. Ultrasonography was used in showing the grade of hepatosteatosis. Results. Mean serum uric acid level of the MS group was significantly higher than the control group in our study (p<0.05) and we observed that serum uric acid levels increase as the number of MS components increase. We found the frequency of hepatosteatosis in our metabolic syndrome patients to be 78.3%. Serum uric acid levels were significantly elevated in these patients and this elevation showed a positive correlation with the grade of hepatosteatosis. Conclusion. There is a close relationship between MS and serum uric acid levels and also with NAFLD. Especially the increase in serum uric acid levels were found to be directly related with the degree of hepatosteatosis. Relying on this fact; we think that the increased uric acid levels in MS patients could have played a role in the NAFLD pathogenesis. Keywords: Metabolic syndrome, hepatosteatosis, uric acid