Hacer Sen

Evaluation of affective temperament and anxiety-depression levels of patients with polycystic ovary syndrome.

BACKGROUND Women with polycystic ovary syndrome (PCOS) are reported to experience depressive episodes at a higher rate than healthy controls (HC). Affective temperament features are psychiatric markers that may help to predict and identify vulnerability to depression in women with PCOS. Our aim was to evaluate the affective temperaments of women with PCOS and to investigate the association with depression and anxiety levels and laboratory variables in comparison with HC. METHODS The study included 71 women with PCOS and 50 HC. Hormonal evaluations were performed for women with PCOS. Physical examination, clinical history, Hospital Anxiety and Depression Scale (HADS) and TEMPS-A were performed for all subjects. Differences between groups were evaluated using Students t-tests and Mann-Whitney U tests. Correlations and logistic regression tests were performed. RESULTS All temperament subtype scores, except hyperthymic, and HADS anxiety, depression, and total scores were significantly higher in patients with PCOS compared to HC. A statistically significant positive correlation was found between BMI and irritable temperament, and insulin and HADS depression scores in patients with PCOS. Additionally, hirsutism score and menstrual irregularity were correlated with HADS depression, anxiety and total scores in PCOS patients. In logistic regression analysis, depression was not affected by PCOS, hirsutism score or menstrual irregularity. However, HADS anxiety score was associated with hirsutism score. CONCLUSIONS Our study is the first to evaluate the affective temperament features of women with PCOS. Consequently, establishing affective temperament properties for women with PCOS may help clinicians predict those patients with PCOS who are at risk for depressive and anxiety disorders.

Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome

Objective: We aimed to study the predictive value of the neutrophil-lymphocyte ratio (NLR) for left ventricular systolic dysfunction (LVSD) in patients with non ST-elevated acute coronary syndrome (NST-ACS). Methods: A total of 405 patients (mean age 62 years and 75% male) with NST-ACS were included in the study. The study population was divided into tertiles based on admission NLR values. The low, medium and high tertiles defined as NLR≤1.81 (n=135), 1.813.2 (n=135), respectively. Results: The patients in the high NLR group were older (p<0.001), have higher rate of diabetes mellitus (p=0.028) and non-ST elevated myocardial infarction (NSTEMI) (p<0.001) and have lower left ventricular ejection fraction (LVEF) (p<0.001). Baseline WBC (p=0.02) and neutrophil (p<0.001) levels and NLR (p<0.001) were significantly higher, baseline hemoglobin (p=0.044), hematocrit (p=0.019) and lymphocyte (p<0.001) levels were significantly lower in the high NLR group. NLR was negatively correlated with LVEF in correlation analysis. An NLR >3.2 and age ≥70 were found to be an independent predictor of systolic dysfunction in multivariate analyses. Conclusion: An NLR >3.2 is a useful predictor for LVSD in patients with NST-ACS. The practice of using an NLR count on admission may be useful for identifying high-risk patients and their associated treatment methods.

Evaluation of Epicardial Fat Tissue Thickness in Patients with Primary Hyperparathyroidism

OBJECTIVE Primary hyperparathyroidism (pHPT) affects the cardiovascular system, and epicardial fat tissue (EFT) thickness is closely associated with cardiovascular diseases and atherosclerosis. Despite this, the association between EFT thickness and pHPT has not been studied in a clinical setting. This study aimed to assess EFT thickness in patients with pHPT. METHODS The study included 38 patients with pHPT and 40 healthy controls. EFT thickness, carotid intima-media thickness (CIMT), serum levels of parathormone (PTH) and calcium, and blood chemistry profiles were determined in all subjects. Correlation and regression analyses were performed with EFT thickness and CIMT as dependent variables and age; systolic and diastolic blood pressure; body mass index (BMI); presence of diabetes mellitus; and free plasma glucose (FPG), PTH, and serum calcium (Ca) levels as independent variables. RESULTS Both the mean EFT thickness and the mean CIMT were significantly greater in the pHPT group than the control group (P < .001 for both). Correlation analysis showed that EFT thickness was significantly correlated with CIMT, age, systolic blood pressure, and PTH and serum Ca levels. Furthermore, the regression analysis revealed that EFT thickness retained its independent and positive association with FPG and serum Ca levels. CONCLUSIONS The results of this study indicate that EFT thickness may be a useful marker of early atherosclerosis in patients with pHPT. Furthermore, the increase in EFT thickness appears to be due to hypercalcemia.

Number of metabolic syndrome risk parameters associated with TAFIa/ai antigen levels.

Thrombin activatable fibrinolysis inhibitor (TAFI) is an important procoagulant factor. Patients with metabolic syndrome (MetS) also have an elevated procoagulant status. However, TAFI and its association with MetS are still not well known. We aimed to investigate TAFI in type 2 diabetes mellitus patients with MetS. We enrolled a total of 55 patients who had MetS (n = 30) and 25 healthy controls. MetS was diagnosed using National Cholesterol Education Program Adult Treatment Panel III criteria. We measured activated and inactivated TAFI (TAFIa/ai) antigen in plasma samples using a commercially available ELISA kit (Imubind TAFIa/ai antigen ELISA; American Diagnostica Inc., Stamford, Connecticut, USA). TAFIa/ai levels were then evaluated for links to MetS parameters. Mean TAFIa/ai levels were 156.6 ± 66.9 ng/dl in patients with MetS and 104.1 ± 60.3 ng/dl in the control group (P = 0.005). None of the MetS parameters, including blood pressure, fasting plasma glucose, waist circumference, triglycerides or high-density lipoprotein cholesterol (HDL-C) levels were correlated with TAFIa/ai levels. However, TAFIa/ai level had a strong correlation with the number of metabolic risk components, which increased proportionally when MetS parameters were over three. When there were increased numbers of MetS risk components, we detected a rise in TAFIa/ai levels. TAFIa/ai levels could be an indicator of atherosclerotic tendency in patients with MetS.

Less aggressive disease in patients with primary squamous cell carcinomas of the thyroid gland and coexisting lymphocytic thyroiditis

Aim of the study Primary squamous cell carcinoma (SCC) of the thyroid gland is extremely rare. Infrequently, primary SCC of the thyroid gland is accompanied by other thyroid diseases such as Hashimotos thyroiditis (HT). Recently, studies have demonstrated that differentiated thyroid cancer with coexisting HT has a better prognosis. However, the prognosis of patients with primary SCC of the thyroid gland and coexistent HT has not been clearly identified. We compared the clinical characteristics and disease stages of patients with primary SCC with and without lymphocytic thyroiditis (LT). Material and methods We reviewed reports of primary SCC of the thyroid gland published in the English literature. Results and conclusions We identified 46 papers that included 17 cases of primary SCC of the thyroid gland with LT and 77 cases of primary SCC of the thyroid gland without LT. Lymph node metastasis and local invasion rates did not differ between these two groups. Distant metastases were absent in patients with LT, and were observed in 13 (16.9%) patients without LT. A greater proportion of patients without LT had advanced stage disease (stage IV A-B-C) than patients with LT (p < 0.05). Patients with primary SCC of the thyroid gland and coexisting LT had lower tumour-node-metastasis stage and frequency of distant metastasis than those without LT. Lymphocytic infiltration in patients with SCC appears to limit tumour growth and distant metastases.

Right ventricular function and its relationship with grade of hepatosteatosis in non-alcoholic fatty liver disease.

Summary Objective This study was designed to assess right ventricular systolic and diastolic function and its relationship with grade of hepatosteatosis (HS) in non-alcoholic fatty liver disease (NAFLD) patients using conventional and tissue Doppler echocardiography. Methods NAFLD was diagnosed in 32 individuals (15 males, 17 females; 59% were grade I HS, 41% grade II–III HS) by means of ultrasonography. Twenty-two individuals, whose ultrasonography data did not show HS, comprised the control group (11 males, 11 females) and were included in the study. Right ventricular systolic and diastolic function and their relationship with grade of HS were assessed by conventional and tissue Doppler echocardiography. Additionally, right ventricular global function was assessed by myocardial performance index (MPI). Results When compared by conventional echocardiographic parameters, there were no significant differences between the two groups. With tissue Doppler parameters, the tricuspid annulus peak early diastolic velocity and ratio of early-tolate diastolic velocity were lower in the patients than in the controls (p = 0.03, p = 0.02, respectively). The isovolumetric relaxation time and MPI were significantly higher (p < 0.001, p < 0.001, respectively) in the patient group. HS grade was positively correlated with right ventricular isovolumetric relaxation time and MPI index (r = 0.295, p = 0.03, r = 0.641, p < 0.001, respectively). Conclusion These results show that right ventricular diastolic dysfunction (RVDD) in patients with NAFLD and degree of HS was associated with RVDD.

Gastrointestinal bleeding associated with dabigatran in a patient with panhypopituitarism

Dabigatran is a direct thrombin inhibitor that is used to reduce the risk of systemic embolism in patients with atrial fibrillation (AF). It does not require international normalised ratio (INR) monitoring during the course of treatment, and this arise from the most important advantage of this drug when compared with coumadin. The main complication of dagibatran is bleeding of the gastrointestinal system [1]. Bleeding diathesis, renal dysfunction, age, and concomitant antiplatelet medications are associated with bleeding complications [2]. Sheehan’s syndrome (SS) is a postpartum pituitary deficiency caused by necrosis of the pituitary gland. It is characterized by varying degrees of anterior pituitary dysfunction. Panhypopituitarism has been associated with bleeding disorders in some previous studies and case reports [3]. However, a relationship of panhypopituitarism and dabigatran associated bleeding has not been reported. This article describes a patient who had dabigatranassociated gastrointestinal bleeding and undiagnosed panhypopituitarism. A 74-year-old female patient was admitted to the emergency department with complaint of weakness and melena for past 3 days. Physical examination revealed that arterial blood pressure was 80/50 mmHg and heart rate was 95/min and arrhythmic. Pale skin and conjunctiva was observed. The patient had no history of abnormal bleeding and did not take any antiplatelet medication. Serious bleeding did not occur preceding the present admission. However, 1 year previously, warfarin 5 mg daily dosage to the patient was started in the department of cardiology because of paroxysmal atrial fibrillation. Coumadin therapy was changed to dabigatran (220 mg/day) 1 month ago because of nonadherence to the INR follow-up. Laboratory values showed hemoglobin (Hb): 3.8 g/dL, mean corpuscular volume: 86 fL, platelet: 418,000 K/mm, Na: 135 mEq/L, K: 3.8 mEq/L, urea: 42 mg/dL, creatinin: 0.78 mg/dL, prothrombin time (PT): 15.1 s, INR: 1.37, activated partial thromboplastin time (aPTT): 48.3 s, and creatinin clearance: 70.5 mL/min. Firstly, we stopped the dabigatran and transfused 3 units of red blood cells and then Hb increased to 9.2 g/dL. Profound hyponatremia (Na: 119 mEq/L) and progressive lethargy developed on the third day of hospitalization. Evaluated for hyponatremia revealed that, she had adrenal insufficency and central hypothyroidism, with measured levels of adrenocorticotropic hormone: 12.5 pg/ mL, cortisol: 5.99 μg/dL, thyroid stimulating hormone: 2.5 IU/mL (normal range: 0.35–4.94 IU/mL), and free thyroxine: 0.52 ng/dL (normal range: 0.70–1.48 ng/dL). Insulin tolerance test could not be performed because of her old age. A synacthhen stimulation test showed that 30 and 60th min cortisol levels were 9.48 μg/dl and 12.72 μg/dl, respectively. Also, other anterior pituitary hormones were consistent with panhypopituitarism, with measured follicle-stimulating hormone: 0.6 mIU/ F. Gunes, MD () · E. Binnetoglu · H. Sen · O. İ. Bilen Department of Internal Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey e-mail: drfgunes@gmail.com

Significant improvement of hyperglycemia after treatment in a patient with primary aldosteronism

Primer aldosteronizm, surrenal korteksten asiri miktarda aldosteronun sentez ve saliniminin oldugu, genellikle tek tarafli adenom veya iki tarafli hiperplaziden kaynaklanan bir sendromdur (1). Primer aldosteronizme en sik neden olan adrenokortikal adenom (aldosteronoma), Conn sendromu olarak da bilinir (2). Primer aldosteronizmin klasik bir bulgusu olan hipertansiyon, orta siddette veya yuksek olarak saptanir ve genellikle antihipertansif tedaviye direnclidir. Adrenalektomi sonrasi kan basinci belirgin olarak duzelir ya da normale doner. Primer aldosteronizm, insulin direnci ile iliskilendirilmistir. Deneysel kanitlar mineralokortikoid hormonlarin ve insulin arasindaki islevsel etkilesimi gostermektedir (3) . Buna bagli olarak hastalarda, ek olarak glukoz metabolizma bozukluklari gorulebilmektedir. Adrenalektomi sonrasi, hiperglisemisi duzelen hastayi literatur esliginde tartismayi amacladik.

Aşikar ve subklinik hipotiroidili hastalarda karotis arter intima media kalınlığı ve nötrofil lenfosit oranı

Objective: Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Neutrophil-lymphocyte (N/L) rate is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess N/L rate and carotid artery intima-media thickness (CIMT) in patients with overt and subclinical hypothyroidism (SCH). Methods: The study included 36 patients with SCH and 28 patients with overt hypothyroidism (OH) as well as 30 healthy controls. CIMT, thyroid hormone levels, complete blood count and lipid parameters were measured in all subjects. Correlation analysis and linear regression analysis were performed for N/L rate. Results: Mean CIMT was 0.51 ± 0.15, 0.58 ± 0.16, 0.67 ± 0.24 mm in control, SCH, and OH groups, respectively. CIMT of OH patients was high compared with control subjects (P 0.05). It was no correlation that CIMT between N/L ratio (p > 0.05).

Gaucher disease with pathological femoral neck fracture

Fractures of the femoral neck are rare and usually result from serious and high-energy trauma in the skeleton in young adults. Gauchers disease (GD) is a lysosomal storage disorder that has progressive course and is rarely seen. Research has shown that a pathological femoral neck fracture with GD mostly emerges in childhood. But in adults, there are no reports of pathological femoral neck fractures with GD. We present a unique case of GD with a pathological femoral neck fracture in a 54-year-old woman who did not undergo surgery because of haematological problems including thrombocytopaenia.