Fevzi Balkan

The relationship between microvascular complications and vitamin D deficiency in type 2 diabetes mellitus.

BackgroundVitamin D deficiency is reported as a possible risk factor for the development of diabetes in several epidemiologic studies. In this study, we investigated the frequency of 25-OH vitamin D deficiency in type 2 diabetes mellitus and the relationship between 25-OH vitamin D deficiency and the prevalence of microvascular complications.MethodsIn this retrospective study, we evaluated the medical records of 557 patients with type 2 diabetes admitted to the Endocrinology Outpatient Clinic from January to March 2010 and 112 healthy controls randomly selected from individuals admitted to the hospital for a check-up and who had a laboratory result for serum 25-OH vitamin D concentrations at screening. The levels of 25-OH vitamin D in patients with type 2 diabetes and the relationship between 25-OH vitamin D deficiency and microvascular complications were investigated.ResultsNo significant difference in serum 25-OH vitamin D concentrations was observed between the diabetic and control groups. No correlation was observed between HbA1C and serum 25-OH vitamin D levels. Serum 25-OH vitamin D levels were lower in diabetic patients with nephropathy, and patients not using any medication, i.e., those treated with dietary changes alone, had a higher prevalence of nephropathy.ConclusionVitamin D deficiency is more common in diabetic patients with nephropathy. When microvascular complications were evaluated, vitamin D levels were found to be lower in patients in whom these complications were more severe. Vitamin D deficiency is therefore associated with microvascular complications in diabetic patients.

Role of serum levels of irisin and oxidative stress markers in pregnant women with and without gestational diabetes

Abstract Irisin regulates glucose levels, lipid levels, insulin sensitivity, and low-grade inflammation. Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy, and is associated with increased rates of perinatal problems. Oxidative stress biomarkers have a role in the pathogenesis of patients with GDM. In total, 94 patients were included in our study including 46 control patients and 48 patients with GDM. Fasting blood glucose, HOMA-IR, total oxidative stress (TOS), irisin, and oxidative stress index (OSI) levels of the patients were measured. Serum OGTT, OSI, irisin HOMA, TOS, and insulin levels were statistically significantly higher in the patient group than in the control group. This was the first study to investigate the relation between serum irisin levels and oxidative stress markers in patients with GDM. The results revealed that irisin is an oxidative stress marker and a metabolic protective hormone.

Evaluation of the ovarian reserve function in patients with metabolic syndrome in relation to healthy controls and different age groups

ObjectiveTo evaluate the ovarian reserve function in female patients with metabolic syndrome (MetS).MethodsThis study evaluated 136 subjects, 67 with MetS and 69 controls. Subjects were divided into three age groups. Group I included 49 subjects aged 20–29 years, 22 with MetS and 27 controls; group II included 45 subjects aged 30–39 years, 22 with MetS and 23 controls; and group III included 42 subjects aged 40–49 years, 23 with MetS and 19 controls. Demographic characteristics, anthropometrics, blood biochemistry, and gonadotrophic hormones were compared as total ovarian volume and antral follicle count on ovarian transvaginal ultrasonography.ResultsSerum levels of FSH, LH, E2 and progesterone were similar in the MetS and control groups, while testosterone levels were significantly higher in MetS patients than controls, both in the overall population (p = 0.024) and in those aged 20–29 years (p = 0.018). Total ovarian volume was significantly lower in MetS patients than controls, in both the overall population (p = 0.003) and those aged 20–29 years (p = 0.018), while antral follicle counts were similar. Ovarian volume correlated positively with antral follicle count (AFC) (r = 0.37; p < 0.001) and negatively with age (r = 0.34; p < 0.001) and FSH concentration (r = 0.21; p = 0.013). AFC was negatively correlated with age (r = 0.36; p < 0.001).ConclusionOvarian reserve function is significantly lower in MetS patients than in healthy control subjects, particularly in women aged 20–29 years.

Is IL-33 useful to detect early stage of renal failure?

Abstract IL-33 is a proinflammatory cytokine that is a member of IL-1 family. Previously the effect of IL-33 on kidney injury is showed in animal models. In this study, we searched if we can use IL-33 to show the early stage of kidney injury in diabetic patients. Three groups are identified: 26 patients in Group 1: Healthy group, that do not have any chronic diseases and not taking any medication; 42 patients in Group 2: DM (diabetes mellitus) group without any known kidney disease and with normal kidney functions; 32 patients in Group 3: DM + MA (microalbuminuria) group that are assumed to have nephropathy. IL-33 level of DM patient group is greater than healthy group; also IL-33 level of DM + MA patient group is greater than healthy group; but there is not any difference between DM and DM + MA group. The increase in IL-33 levels in diabetic nephropathy is not associated with kidney injury but the increase could be resulting because of diabetes. So IL-33 cannot be used in early recognition of diabetic nephropathy.

THYROID NODULES WITH 2 PRIOR INADEQUATE FINE-NEEDLE ASPIRATION RESULTS: EFFECT OF INCREASING THE DIAMETER OF THE NEEDLE

OBJECTIVE The major limitation of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) procedures of thyroid nodules are the cytologically nondiagnostic results. The role of increasing the diameter of the needle in the third FNAB (FNAB#3) due to inadequate cytology has as yet not been investigated. The aim of the present study was to evaluate whether increasing the needle diameter could improve the cytologic sampling of thyroid nodules following 2 previous nondiagnostic US-FNAB results. METHODS Between July 2012 and December 2012, 140 consecutive patients with 2 prior nondiagnostic US-FNAB results were enrolled in this prospective investigation. Group 22G consisted of 70 patients (78.5% women; mean age, 52 years) having nodules examined with a 22-gauge (G) needle. Group 27G consisted of 70 patients (75.7% women; mean age, 53 years) having nodules examined with a 27-G needle. RESULTS The rate of nondiagnostic FNAB results was 42.8% (30 of 70) in group 22G and 64.3% (45 of 70) in group 27G, which was a significant difference (P = .011). The large-bore (22 G) needle was found to be statistically significantly superior compared with the small-bore (27 G) needle in diagnostic ability for predominantly solid (P = .014), irregular (P = .013), and halo-free (P = .021) nodules. The accuracy rate was 64.6 and 38% for large-bore (22 G) and small-bore (27 G) needles, respectively. CONCLUSION The results of our study showed that increasing the needle lumen diameter significantly improves diagnostic performance in terms of adequate aspirated material and diagnostic accuracy rate following 2 prior nondiagnostic US-FNABs.

Mean platelet volume (MPV): could it be used as a predictive marker for gestational diabetes? -

An abnormal glucose tolerance which is first detected during pregnancy and disappears after completion of pregnancy is known as “gestational diabetes mellitus”. Early detection of this condition helps preventing potential maternal and fetal complications. Some studies reported that platelets may have a role in the pathogenesis and development of gestational diabetes. In the present study, we aimed to evaluate and compare the platelet function and morphology among pregnant women with gestational diabetes and healthy pregnant women. Values of complete blood count were reviewed for pregnant women between weeks 24 and 28 of gestation while performing oral glucose tolerance tests for from January 2013 to September 2013. After screening, a total of 89 pregnant women were enrolled in the study including 38 women with gestational diabetes and 51 healthy pregnant women. The mean platelet volume (MPV) was 8.76 ± 1.53 fl in the group with gestational diabetes and 7.80 ± 1.34 fl in the healthy pregnant group, with a statistically significant difference between two groups (p=0.02). There was no statistically significant difference between two groups in platelet counts (p=0.25). Dissimilar results were reported by a small number of studies on this subject. MPV and other platelet parameters may be considerably helpful in detecting diabetic pregnant women who are at risk for vascular complications. In this study, significantly greater MPV was found among pregnant women with gestational diabetes compared to control group (p

Metabolik Sendromda Kanser Riski Artar mı

Genetik ve cevresel etmenlerin birlikte rol aldigi metabolik sendrom ve iliskili sorunlardan obezite, hipertansiyon ve diyabetes mellitus dunya genelinde giderek artan oranda gorulmektedir. Kanser ise tum dunyada ve ulkemizde kardiyovaskuler hastaliklara bagli mortaliteden sonra ikinci sirada olum nedenidir. Metabolik sendrom bilesenlerinin cogu tumor gelisimi ile baglantilidir. Duzenli beslenme ve egzersiz ve stresi azaltmayi kapsayan multidisipliner bir yaklasim, insulin direncini ve metabolik sendrom sikligini azaltmada ve kanser prognozunu iyilestirmede oldukca onemli faydalar saglayabilir. Anahtar Kelimeler: Metabolik sendrom, obezite, diyabet, kanser

The levels of HbA1c in patients with thyroid dysfunction

Thyroid hormones increase the hepatic glyconeogenesis, glycogenolysis and the absorption of glucose. Glucose intolerance is common in thyroid dysfunction. HbA1c is the most important determinant of long term glysemic status in diabetic patients. HbA1c is affected from various factors. In this study we evaluated the relation between thyroid function tests and HbA1c in non-diabetic patients with thyroid dysfunction. Non-diabetic 43 patients with hyperthyroidism, 20 patients with hypothyroidism and for control group 29 euthyroid patients which appealed to Ankara Numune Training and Research Hospital Internal Outpatient Clinic between June 2008 and January 2009 were recruited to this study. Fasting blood sugar, urea, creatinine, hemoglobine, HbA1c, TSH, FT3, FT4 and albumine levels of all of the patients that recruited to study were determined. There was no statistically significant difference for the mean age (p=0.271) and gender distribution (p=0.23) in the cases of hyperthyroidism, hypothyroidism and euthyroid controls. HbA1c levels were significantly higher in hyperthyroid group when compared to hypothyroid and euthyroid groups (p<0,001). Fasting blood glucose levels were found significantly higher in hyper thyroid group than hypothyroid and euthyroid groups (p=0.018). A positive correlation was revealed between the increasing age and HbA1c levels. A statistically significant difference was found in the levels of HbA1c values in patients with hyperthyroidism according to euthyroid and hypothyroid patients and this finding is in compliance with the results of current literature. This makes us to think that here is a relation between insulin resistance and hyperthyroidism. Therefore, it is suggested that monitorisation of blood glucose levels regularly is useful for the early diagnose of type II diabetes mellitus in patients with hyperthyroidism, both during the therapy and post treatment period.

Thyroid hemiagenesis: report of two cases and literature review -

Hemiagenesis of the thyroid gland is a rare anomaly in which one thyroid lobe fails to develop during embriological development. Only during investigations for other thyroid diseases leads to the occasional detection of thyroid hemiagenesis. Although hemiagenesis of the thyroid gland is a benign condition, most of the patients reported as having thyroid hemiagenesis had several thyroid disorders.

TANI AMAÇLI UYGULANAN İYOT-131 İLE ABLATE OLAN EKTOPİK TİROİD DOKUSU: OLGU SUNUMU

The presence of ectopic thyroid tissue has been reported at a rate of 10% in autopsy studies. The significance of ectopic thyroid tissue among asymptomatic individuals is unknown. However, there are reports in literature suggesting an increased risk of thyroid cancer in the presence of ectopic thyroid tissue. Iodine-131 is used for detecting ectopic thyroid tissue. Screening scintigraphy is performed using low doses (2-5 mCi). Iodine-131 given for ablative purposes is approximately 6 MBq (160 μCi) per gram of thyroid gland. In this report 42-year-old woman who underwent bilateral subtotal thyroidectomy 14 years ago, with a diagnosis of diffuse toxic goiter was performed completion thyroidectomy with a diagnosis of recurrent nodular diffuse toxic goiter. At six months after the operation, midline, at the level of the hyoid bone, 12X24 mm in size, ectopic thyroid tissue was present in patient. “Atypia of undetermined significance” was reported in FNA results. The thyroglobulin level was 300 in washing samples drawn up during FNA. In order to evaluate the presence of malignancy and metastasis, wholebody scan with 3 mCi of iodine-131 was performed and only the activity accumulation leads to star artifact was observed in the neck. Ectopic thyroid tissue was not observed in the neck ultrasound performed after three months because of cytologic findings . There was no findings to suggest ectopic thyroid tissue in the thyroid scintigraphy after cessation treatment of L-thyroxine. It was concluded that thyroid tissue was ablated after application of iodine-131 treatment.