Kerem Sezer

Metoprolol, a Β-1 selective blocker, can be used safely in coronary artery disease patients with chronic obstructive pulmonary disease

The coexistence of coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) is frequent because of common etiological factors. Β-Blockers remain underutilized in patients with CAD who also have COPD. This study was performed to evaluate the safety of Β-1 selective blocker agents in CAD patients with COPD. Fifty patients (aged 57.3 ± 10.1 years) were enrolled in this study; 27 patients received metoprolol CR (controlled release), and 23 received metoprolol (conventional). The patients were stratified according to the severity of COPD (21 severe, 21 moderate, and 8 mild), started on metoprolol CR or conventional metoprolol, and titrated up to the maximum tolerated dose. The clinical controls were done during the first week and then at the first and third month. Patients received a mean total daily dose of 92.5 ± 18 mg of metoprolol CR or 189 ± 36.7 mg of metoprolol. Seven patients could not receive the maximum dose. There was no significant decrease in forced expiratory volume in 1 s (FEV1) in either group (basal vs last FEV1: 54.5% ± 13.4% vs 54.3% ± 13% in the metoprolol CR group and 49.6% ± 14.5% vs 53.2% ± 12.8% in the metoprolol group). No adverse event was experienced. Metoprolol, a Β-1 selective blocker, can be used safely at the maximum dose in CAD patients with COPD.

Plasma visfatin level in lean women with PCOS: relation to proinflammatory markers and insulin resistance

Objectives. The present study was undertaken to investigate the association between plasma visfatin concentrations and inflammatory markers such as interleukin-6 (IL-6) and high-sensitive C-reactive protein (hsCRP) in company with several metabolic parameters in lean women with polycystic ovary syndrome (PCOS). Methods. The study group consisted of 21 lean women with PCOS (BMI 20.74 ± 1.74 kg/m2) and 15 healthy, normally menstruating women (BMI 20.85 ± 2.08 kg/m2 control group). PCOS was defined according to the Rotterdam criteria. Visfatin, IL-6, hsCRP, hyperandrogenism markers and metabolic markers were examined in all PCOS and control women. Results. Plasma visfatin level in the PCOS group was higher than that in the control group. Plasma hsCRP and IL-6 levels in PCOS group were similar with the control group. Plasma visfatin levels were positively associated with total cholesterol, high density lipoprotein, hirsutism score, total testosterone and FAI. Plasma visfatin level was negatively associated with SHBG. However, there were no correlation between plasma visfatin level and IL-6 and hsCRP. In multivariate regression analyses, only FAI and high density lipoprotein-cholesterol (HDL-C) showed a significant association with serum visfatin. Conclusion.  Our data indicates that plasma visfatin levels are associated with HDL-C and markers of hyperandrogenism, but it is not associated with proinflammatory markers and insulin resistance in lean women with PCOS.

Intrasellar plasmacytoma: an unusual presentation of multiple myeloma

IntroductionPlasmacytomas are unusual causes of a sellar mass. Occasionally, they can be misdiagnosed as a nonfunctioning adenoma because of radiological and clinical similarities.Literature reviewWe reviewed the pertinent literature and discuss here in the light of an illustrative case of our own.DiscussionA 70-year-old woman presented with a recurrent hypophysial mass. Initial diagnosis of a nonfunctioning pituitary adenoma was later overruled by a repeat biopsy, which showed a plasmacytoma. The tumor stained positively for CD138 and kappa light chain. Further studies confirmed the diagnosis of multiple myeloma. The patient was successfully treated with radiotherapy followed by systemic chemotherapy. Because they have different therapeutic implications, extramedullary plasmacytomas involving pituitary gland should be considered in the differential diagnosis of a nonfunctioning pituitary mass.

Visfatin plasma concentrations in patients with hyperthyroidism and hypothyroidism before and after control of thyroid function

Alterations in thyroid function are associated with changes in body weight, metabolism, and low-grade inflammation. In several studies, plasma levels of visfatin were found to be associated with body mass index, diabetes, and metabolic syndrome. In our study we aimed to evaluate visfatin levels according to thyroid dysfunction. The study cohort comprised 56 Hashimoto thyroiditis patients with hypothyroidism (43.94±14.27 yr), 56 Graves patients with hyperthyroidism (45.87±13.28 yr), and 56 euthyroid healthy subjects (45.23±7.11 yr) as a control group. In addition, we evaluated the effect of therapy on plasma visfatin levels in 16 hypothyroid and in 25 hyperthyroid patients. Markedly low visfatin levels were found in hyperthyroid patients [9.44 (8.07–10.8) ng/ml] compared with the hypothyroid [49.93 (40.72–59.1) ng/ml] and control groups [38.6 (30.6–46.6) ng/ml] (p<0.001, p<0.001). Plasma visfatin levels in patients with hypothyroidism decreased significantly following treatment [58.58 (10.21–190.7) ng/ml vs 40.00 (10.01–102.6) ng/ml; p=0.001 ]. Plasma visfatin levels increased significantly after antithyroid therapy in patients with hyperthyroidism [7.86 (1.02–19.23) ng/ml vs 12.63 (3.48–110.9) ng/ml; p<0.001]. There were negative correlations between visfatin levels with free T3 (r=-0.719, p<0.001), and free T4 (r=−0.716, p<0.001) levels. There was a positive correlation between visfatin and TSH levels (r=0.701, p<0.001). There was a negative correlation between delta visfatin levels with delta free T3, delta free T4 (r=−0.686, p<0.001; r=−0.624, p<0.001). Visfatin thus seems to be regulated by thyroid hormones. While the influence of thyroid dysfunction on adipocytokine production and release is still poorly understood, the results of our study suggest that the effects of hyper- and hypothyroidism on various metabolic parameters may be partly mediated by visfatin.

Valsartan-Induced Hepatotoxicity in a HBs-Ag-Positive Patient

TO THE EDITOR: Hepatotoxicity caused by angiotensin II receptor blockers is a very rare disorder. We report the first case with acute hepatic injury associated with valsartan, which is an antihypertensive agent. A 52-yr-old hypertensive woman was admitted to our hospital with complaints of weakness, nausea, jaundice, and right subcostal abdominal pain. Her past medical history was unremarkable except for primary hypertension and hepatitis B surface antigen (HBs-Ag) positivity. She had been followed as a HBs-Ag carrier for 4 yr without clinical and laboratory symptoms and signs of acute or chronic liver disease in our hospital. She had been treated for primary hypertension by valsartan for 1 month. There was no other medication. The patient had manifested pruritic erytematous skin changes 1 wk before this admission. After this complaint, moderate nausea, jaundice, and right subcostal abdominal pain developed. On admission, her physical examination revealed no abnormality except for painful mild hepatomegaly. Laboratory findings were as follows: complete blood count was normal and eosinophilia was present. Her total and direct bilirubin levels were 3.2 mg/dl and 2.8 mg/dl, respectively, on admission, and peaked 7.8 and 6.9, respectively on the 7th day of admission. Liver enzymes peaked at the 6th day as follows: ALT 780 U/L, AST 1292 U/L, -glutamyl transferase 945 U/L, and liver-specific ALP 1840 U/L. Serological tests for hepatitis virus were negative (anti-hepatitis A virus IgM, anti-hepatitis B core IgM and IgG, hepatitis B virus DNA by polymerase chain reaction, hepatitis C virus antibody hepatitis C virus RNA by polymerase chain reaction, anti-Epstein-Barr virus IgM, and anti-cytomegalovirus IgM and IgG), except for HBs-Ag positivity. Markers for toxoplasmosis, herpes simplex virus, and HIV were all negative. International Normalized Ratio (INR) and PT were mildly elevated. Hepatobiliary ultrasonography revealed mild hepatomegaly. Liver biopsy was considered, but the patient refused. Valsartan therapy was discontinued at once. Hepatic failure and related complications were not seen. The complaints of the patient were resolved within 2 wk under conservative management. Liver enzymes and bilirubin levels decreased rapidly within 2 wk and returned to normal limits within 3 months. She has been followed for 6 months asymptomatically. As far as we know, this is the first case of valsartanassociated hepatotoxicity in a patient with HBs-Ag positivity. There is just one case report of valsartan-associated hepatic injury from Spain (1). There are not a lot of cases of angiotensin II receptor antagonists associated hepatotoxicity, and in this case, presumably this association is a hypersensitivity reaction together with pruritic skin changes. Valsartan is eliminated mainly by hepatic clearance. Headache, dizziness, and fatigue were the most common adverse events in placebocontrolled studies; the incidence of these adverse events was not significantly different between placebo and valsartan recipients (2). Rash and angioedema have been reported with angiotensin II receptor antagonists very rarely (3). Drug-induced hepatic injury associated with losartan was reviewed by Tabak et al. (4). The importance of HBs-Ag positivity in this hepatotoxicity remains unknown, and the physicians who recommended these agents should be careful about this complication.

Impact of first trimester and postpartum period thyroid autoantibodies on abortus incidence in Turkish pregnant women.

Objective.Abortus is a common problem and is observed approximately in one third of all pregnancies. In this study, we aimed to evaluate in euthyroid pregnant population the effect of thyroid autoantibodies of both first trimester and postpartum period on abortus incidence. Design and method.Euthyroid 128 pregnant women were included in the study. All pregnants were required having a history of maximum one abortus without any previous endocrinological, immunological disorders. Thyroid autoimmunity was defined as having serum levels of either antithyroidperoxidase or antithyroglobulin antibodies higher than 34 and 115 IU/ml, respectively. Results and conclusions.One hundred of 128 pregnant women (78.1%) had no thyroid autoantibodies, whereas 28 pregnant women (21.9%) had positivity for one of thyroid autoantibodies. One hundred pregnant women (78.1%) gave healthy births, whereas 28 (21.9%) had abortus. Abortus incidence was 28.6% in autoantibody positive group, whereas it was 20% in autoantibody negative group. Serum anti-Tg levels both in first trimester and both in postpartum period were higher in pregnants abortus group when compared with healthy births group. Although, we found no correlation between abortus incidence and thyroid autoantibodies presence, first trimester serum levels of anti-Tg levels may have correlated with abortus incidence and may be an indicator of a closer follow-up. In sight of this study, it can be concluded that autoimmunity against thyroid may continue after termination of pregnancy and this was the first study evaluating the postpartum antibodies levels which may be helpful in subsequent pregnancies.

Predictive Value of P‐Wave Signal‐Averaged Electrocardiogram for Atrial Fibrillation in Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) with a reported incidence of 7–18%. Recently, P‐wave signal‐averaged electrocardiogram (P‐SAECG) has been used to assess the risk of paroxysmal AF attacks in some diseases. The aim of this study was to determine prospectively whether patients with AMI at risk for paroxysmal AF would be identified by P‐SAECG and other clinical variables.

Cushing Syndrome Caused by Topical Corticosteroid: A Case Report

Development of iatrogenic Cushing syndrome from topical steroid therapy is very rare in adults. A 48-year-old woman with a diagnosis of Cushing syndrome caused by long-term topical clobetasol propionate application was presented. Laboratory studies were consistent with adrenal suppression that improved after discontinuation of the use of topical glucocorticoids. Patients who will take treatment with steroids, even with topical steroids, should be offered information about the dose, duration, and type of the treatment and its systemic side-effects.

Behcet's Disease and Endocrine System

Behcets disease (BD) is a chronic disease which is characterized by recurrent oral apthous ulcerations, recurrent genital ulcerations, skin eruptions, ocular involvements and other various systemic manifestations as well as systemic vasculitis. Endocrine involvement in BD regarding various systems can be seen. Hypophysis is one of the best and dense vascularized organs of the body, thus it is likely that it can be affected by BD. Not only anterior hypophysis functions, but posterior hypophysis functions as well can be affected. As BD is a disease of autoimmune process, it may be possible that adrenal insufficiency or alterations in the cortisol levels could be expected. Another concern is whether or not there is insulin resistance in patients with BD. The avaliable data suggests that there is an increased susceptibility to insulin resistance in patients with BD.

Assessment of Nasal Carriage of Staphylococcus Aureus and Axillar Flora in Patients With Acromegaly.

Purpose: Recent study showed that patients with acromegaly have typical skin findings including increased sebum secretion, decreased transepidermal water loss, more alkaline, and colder skin surface correlated with serum growth hormone and insulin-like growth factor 1 levels. Different anatomic localizations and texture of the skin differ in bacterial concentrations. Nasal carriage of Staphylococcus aureus and axillar flora in patients with acromegaly was compared with normal population with regard to duration of acromegaly as well as the growth hormone and insulin-like growth factor 1 levels. Methods: This patient-control prospective study was conducted in university hospitals in Mersin, Turkey. The study consisted of 30 active acromegalic patients and 60 healthy adults who had no previously diagnosed chronic illness as a control group. A total of 90 volunteers were enrolled in this study; nasal and axillar cultures were obtained. Axillar and nasal specimens from anterior nares of the individuals were taken using sterile swabs. Results: Nasal colonization of Staphylococcus aureus was 13.3% in acromegalic patients, but 43.4% in control group. This difference was statistically significant (P = 0.004). Patients and control group compared according to axillar cultures, the authors determined proteus colonization 16.7% in patients with acromegaly but no proteus colonization in control group. This result was statistically significant (P = 0.001). Proteus colonization was negatively correlated only with disease duration in acromegalic patients (P = 0.017). Conclusion: The authors demonstrated that compared with healthy subjects, acromegalic patients had low percentage of nasal carriage of Staphylococcus aureus and more gram-negative basili in the axillar flora. These nasal and axillar flora changes should be considered for prophylactic antibiotics use before surgery and ampiric antibiotics use after surgery.