Hulya Parildar

Frequency of Vitamin D deficiency in pregnant diabetics at Baskent University Hospital, Istanbul.

Objective: To find out the frequency of vitamin D deficiency and its relation with glucose parameters and the incidence of gestational diabetes (GDM). Methodology: Gestational diabetes was diagnosed with 75 gram oral glucose tolerance test. Forty-four pregnant women diagnosed with GDM and 78 non-GDM pregnant women were enrolled as case and control group, respectively in this descriptive study. Vitamin D status was classified as deficiency at ≤20 ng/ml for serum 25(OH)D concentrations. Results: The mean ages were 33.4±5.2 (18-44) years and 29.7±4.1 (21-39) years, mean BMI was 30.6±5.9 kg/m² (19.5-46.1) and 25.9±4.4 kg/m2 (16.5-38) in case and control groups, respectively. The frequency of GDM was found 9.38%. The mean serum vitamin D levels in GDM group were significantly lower than in non-GDM subjects (p=0.07). A total of 56.8% of GDM patients were compared with 35.8% of control group which had Vitamin D deficiency and the difference was significant (p= 0.02). There was no significant association between vitamin D levels and fasting glucose, insulin and HbA1c. Vitamin D levels were inversely correlated with clothing style, parathyroid hormone levels, dental problems and muscle cramps. Conclusions: The association of maternal Vitamin D status with the markers of glucose metabolism in pregnancy needs prospective studies.

Depression, coping strategies, glycemic control and patient compliance in Type 2 diabetic patients in an endocrine outpatient clinic

Objective: Diabetes is a multifactorial disorder posing a great challenge to public health. In this study, we aimed to evaluate the relationship between depression, coping strategies, glycemic control and patient compliance in type 2 diabetic patients. Methods: Total 110 outpatients (mean (SD) age: 57.9 years (10.5), 56.4% were females) with type 2 diabetes mellitus were included in this descriptive and cross-sectional study. They were followed-up in the endocrinology outpatient clinic at Baskent University Istanbul Hospital Turkey. A questionnaire including items on sociodemographics, patient compliance, Beck Depression Inventory (BDI) and Ways of Coping Questionnaire (WCQ) were used. Glycemic control was measured by HbA1c levels. Results: Mean depression score was 12.6(9.2) with moderate to severe depression in 30.9% of study participants. Overall scores for BDI, fatalism and helplessness approaches were significantly higher among females compared with male patients. Depression scores were correlated positively to duration of disease (r=0.190, p=0.047), fatalistic (r=0.247, p=0.009), helplessness (r=0.543, p=0.000) and avoidance (r=0.261, p=0.006) approaches, and negatively to educational status (r=-0.311, p=0.001) and problem solving-optimistic approach (r=-0.381, p=0.000). Conclusions: Likelihood of depression was frequent, consistent with literature and was associated with gender, educational status, coping strategies, duration of diabetes and patient compliance with treatment in our study. Screening for depression and patient education may improve the quality of life in diabetic patients.

Clinical immunology Vitamin D deficiency is related to thyroid antibodies in autoimmune thyroiditis

Introduction It has been known that vitamin D has some immunomodulatory effects and in autoimmune thyroid diseases, vitamin D deficiency was more prevalent. In this study, our aim was to investigate the relationship between thyroid autoantibodies and vitamin D. Material and methods Group 1 and 2 consisted of 254 and 27 newly diagnosed Hashimotos thyroiditis (HT) and Graves’ disease (GD) cases, respectively; age-matched 124 healthy subjects were enrolled as controls (group 3). All subjects (n = 405) were evaluated for 25OHD and thyroid autoantibody [anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-tg)] levels. Results Group 2 and group 1 patients had lower 25OHD levels than group 3 subjects 14.9 ±8.6 ng/ml, 19.4 ±10.1 ng/ml and 22.5 ±15.4 ng/ml, respectively (p < 0.001). Serum 25OHD levels inversely correlated with anti-tg (r = –0.136, p = 0.025), anti-TPO (r = –0.176, p = 0.003) and parathormone (PTH) (r = –0.240, p < 0.001). Group 2 patients had higher anti-tg and anti-TPO levels than group 1 and 3 (p < 0.001). Conclusions In this study, we found that patients with autoimmune thyroid disease (AITD) present with lower vitamin D levels and GD patients have higher prevalence. Since we found an inverse correlation between vitamin D levels and thyroid antibody levels, we may suggest that vitamin D deficiency is one of the potential factors in pathogenesis of autoimmune thyroid disorders.

Better knowledge and regular vaccination practices correlate well with higher seasonal influenza vaccine uptake in people at risk: Promising survey results from a university outpatient clinic

HIGHLIGHTSPeople at risk or people who were vaccinated previously were associated with higher vaccine uptake and better knowledge of influenza and vaccination.Periodic vaccination policies could increase vaccination uptake for people and their families.Getting official information or a recommendation from a physician could influence peoples decision about influenza vaccination. Background: The knowledge, beliefs, opinions, and attitudes of patients and their relatives regarding seasonal influenza vaccination were evaluated. Methods: This descriptive study was undertaken in the outpatient clinics of Baskent University Hospital. There were 566 responders who completed a self‐administered questionnaire. Results: The mean age of participants was 48.35 years, and 16.8% were ≥65 years. Of the responders, 21.7% were vaccinated this year, whereas 57.8% did not desire to get it. Vaccination rates were significantly higher among responders ≥65 years of age (56.4%), those having at least 1 chronic illness (46.5%), and those who were vaccinated regularly every year (22.2%). Half of the responders did not know that the vaccine was reimbursed for people at risk. The most common reason for refusing the influenza vaccine was not getting the flu frequently (51.2%). Fear of side effects, concerns about vaccines effectiveness, and belief that vaccine causes the flu were other common reasons for not being vaccinated. Of the responders, 77% believed that getting official information or a recommendation from a physician would influence their decision about seasonal influenza vaccination. Conclusions: People who are at risk or vaccinated regularly display a higher vaccine uptake and better knowledge of influenza and vaccination. The opinions and attitudes of this study population may assist in developing strategies for changing attitudes of the public toward influenza vaccination.

Should Iodine be Supported in Pregnancy? A Hospital Based Study

Objective: Iodine deficiency causes adverse effects in pregnant women and neurological-cognitive disorders in their babies. Our aim was to define the status of iodine deficiency among pregnant women, who attended our hospital outpatient polyclinics. Materials and Methods: This cross-sectional and descriptive study was performed in 2014 with 94 pregnant women. Iodine levels in spot urine and serum thyroid hormones have been analyzed. The iodine levels of spot urine less than 150 µg/L were accepted as iodine deficiency. Results: The mean age was 30.6±3.92 years, mean gestational age was 18.9±9.64 weeks. Mean urinary iodine concentrations (UIC) were 160.32±5.88 μg/L and the ratio of pregnant women whose UIC less than 150 μg/L was 33% (n=31) and the percentage of the women, who declared iodised salt use was 90.2%. Conclusion: In this study, in one-third of pregnant women the urine iodine concentrations were inadequate despite the high rate of iodised salt intake. Nevertheless, most prenatal vitamins and salts do not include adequate iodine, iodine monitoring and supplementation may be recommended before and during pregnancy. Giris: Iyot eksikligi, gebelerde olumsuz etkilere, bebeklerinde ise norokognitif bozukluklara neden olmaktadir. Calismamizda hastanemiz polikliniklerine basvuran gebe kadinlarda iyot eksikliginin arastirilmasi amaclanmistir. Yontem: Bu kesitsel ve tanimlayici calismaya, 2014 yilinda takip edilen, 94 gebe dahil edilmistir. Calismaya alinan gebelerin, anlik (spot) idrarda iyot duzeyleri ve tiroid fonksiyon testleri analiz edilmistir. Spot idrarda iyot duzeyi <150 µg/L ise iyot eksikligi olarak kabul edilmistir. Bulgular: Calismamizda ortalama yas 30,6±3,92 yil, ortalama gebelik yasi 18,9±9,64 hafta idi. Ortalama idrar iyot atilimi 160,32±5,88 μg/L olarak saptanmis olup, iyot eksikligi olanlarin orani %33 olarak bulunmustur. Iyot katkili tuz kullandigini belirten gebelerin orani %90,2 idi. Sonuc: Iyot katkili tuz kullaniminin yuksek oranda olmasina karsin, gebelerin ucte birinde idrar iyot duzeyleri yetersiz duzeyde saptanmistir. Bulgularimiz, gebelerde iyot eksikligi prevalansinin onemli bir duzeyde oldugunu vurgulamaktadir. Ulkemizde prenatal vitaminlerin cogunda ve tuzlarda yeterli iyot bulunmamaktadir, bu nedenle gebelik sirasinda veya oncesinde iyot durumunun degerlendirilmesi ve desteklenmesi onerilebilir.

Assessment of Left Atrial Functions in Patients with Prediabetes

Background: LA volumes and functions are reported to be independent predictors of cardiovascular events in general and diabetic population. The aim of this is to evaluate the effects of prediabetes on LA volumes and functions and parameters that effect LA volumes and functions in patients with prediabetes. Methods: 114 patients (83 female, mean age 48.6 ± 7.4 years) with prediabetes and 70 controls (46 female, mean age 46.5 ± 9.4 years) were included in the study. LA volumes (indexed maximal LA volume-Vmax, pre-atrial contraction volume-Volp, minimal LA volume-Vmin) and functions (passive emptying volume-fraction (PEV-PEF), active emptying volume-fraction (AEV-AEF), total emptying volume-fraction (TEV-TEF) were evaluated with 2- dimentional echocardiography and indexed to body surface area. Results: LA diameter, indexed Vmax, Volp, Vmin, AEV, and TEV were found to be significantly higher in preDM group compared with control group (P<0.05). There were significant positive correlation between all three LA volumes and body mass index (BMI), triglyceride, HbA1c, fasting glucose, high sensitive C-reactive protein, mitral A wave and deceleration time. Additionally, there were positive correlation between AEV, TEV and BMI. Multivariate analysis showed that the BMI had statistically significant effect on LA diameter, indexed V max, indexed Volp, indexed PEV and indexed TEV whereas prediabetes had statistically significant effect on indexed Vmax, indexed Volp and indexed Vmin. HT had only statistically significant effect on indexed Vmax. Conclusion: BMI and prediabetes have significant effect on LA volumes, but BMI is the only factor that has significant effect on LA functions. On the basis of these findings, we speculate that impairment of LA volumes and functions may be present before overt DM begins and this finding was mainly due to prediabetes and BMI.

Amyloid Goiter Due to Familial Mediterranean Fever in a Patient with Byler Syndrome: A Case Report

BACKGROUND Familial Mediterranean Fever (FMF), also inherited with autosomal recessive trait, is characterized by recurrent episodes of fever, arthritis, and serositis. Congenital Byler Syndrome (Progressive Familial Intrahepatic Cholestasis) inherited with autosomal recessive trait and characterized by defective secretion of bile acids. FMF associated Amyloid A deposition occurs in many tissues and organs, but amyloid goiter is a rare entity that leads to enlargement and dysfunction of the thyroid. CASE REPORT We present a rare case of 24 year old male patient who had liver and kidney transplantation due to Byler Syndrome and secondary amyloidosis related to FMF, diagnosed as rapidly growing large amyloid goiter. Deposits of extracellular amyloid and dense adipose metaplasia diagnostic for amyloid goiter are determined upon histopathological examination of thyroidectomy material. CONCLUSION When goiter was detected in cases with history of systemic amyloidosis and rapidly growing goitre, amyloid goiter should be remembered at first. This case is unique since two autosomal genetic disorders are together in the same patient and important as it emphasizes the consequences of consanguineous marriage, early diagnosis and treatment compliance of FMF and the awareness of amyloid goiter in patients followed by primary care physicians and healthcare professionals.