Levent Kebapcilar

High mean platelet volume, low-grade systemic coagulation and fibrinolytic activation are associated with androgen and insulin levels in polycystic ovary syndrome

ObjectivesThe present study was designed to determine (a) the coagulation parameters, WBC and MPV levels; (b) whether there was any association between androgen and mean platelet volume and low-grade systemic coagulation in PCOS patients.MethodsA total of 48 patients with non-diabetic PCOS were studied in order to evaluate and compare with a non-PCOS group of 30 subjects.ResultsD-dimer, homeostatic model assessment (HOMA-IR), insulin, androgens, glucose, WBC and MPV concentrations were higher in women with PCOS. No difference was observed in fibrinogen, activated partial thromboplastin time and prothrombin time values between the two groups. Free testosterone was positively correlated with D-dimer, insulin, DHEAS, and MPV levels. In multiple stepwise regression analyses, free testosterone positively associated with D-dimer and DHEAS. MPV was positively correlated with insulin levels, HOMA-IR values, DHEAS and free testosterone levels in PCOS patients. In multiple stepwise regression analyses, MPV positively associated with insulin and DHEAS.ConclusionPCOS patients had low-grade systemic coagulation and fibrinolytic activation as evidenced by elevated D-dimer, and increased WBC and MPV levels suggesting that hematological parameters could potentially be used as indicators of risk factor for atherosclerosis in PCOS women.

Evaluation of postpartum carbohydrate intolerance and cardiovascular risk factors in women with gestational diabetes

We aimed to evaluate the predictors of subsequent development of postpartum carbohydrate intolerance, metabolic syndrome and cardiovascular risk factors in women with previous GDM. Two hundred fifty-two consecutive women with GDM were enrolled. After exclusion of women who did not attend to the hospital for follow-up visits for minimum 1 year, data of 195 patients were evaluated. Seventy-one lean women with negative screening for GDM were included as a control group. The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose and metabolic syndrome was significantly higher in women with previous GDM than healthy controls. Women with previous GDM were more insulin resistant, had an atherogenic lipid profile and increased carotid IMT. The most important predictors of postpartum diabetes were the need for insulin treatment during index pregnancy and glucose values on antepartum OGTT. Among women with previous GDM, the development of postpartum diabetes and metabolic syndrome was associated with increased carotid IMT. Our data show that women with previous GDM are at high risk for developing carbohydrate intolerance, metabolic syndrome and atherosclerosis. Antepartum prediction of high risk subjects for the subsequent development of postpartum carbohydrate intolerance and metabolic syndrome seems to be vital to prevent cardiovascular outcomes.

The effect of Helicobacter pylori eradication on macrophage migration inhibitory factor, C-reactive protein and fetuin-a levels

OBJECTIVES To determine the effect of Helicobacter pylori (H. pylori) eradication on blood levels of high-sensitivity C-reactive protein (hs-CRP), macrophage migration inhibitory factor and fetuin-A in patients with dyspepsia who are concurrently infected with H. pylori. METHODS H.pylori infection was diagnosed based on the 14C urea breath test (UBT) and histology. Lansoprazole 30 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily were given to all infected patients for 14 days; 14C UBT was then re-measured. In 30 subjects, migration inhibitory factor, fetuin-A and hs-CRP levels were examined before and after the eradication of H. pylori infection and compared to levels in 30 healthy subjects who tested negative for H. pylori infection. RESULTS Age and sex distribution were comparable between patients and controls. Migration inhibitory factor and hs-CRP levels were higher, and fetuin-A levels were lower, in H. pylori-infected patients (p<0.05). Following eradication of H. pylori, migration inhibitory factor and hs-CRP levels were significantly decreased, whereas fetuin-A levels were increased. However, eradication of the organism did not change lipid levels (p>0.05). CONCLUSION These findings suggest that H. pylori eradication reduces the levels of pro-inflammatory cytokines such as migration inhibitory factor and hs-CRP and also results in a significant increase in anti-inflammatory markers such as fetuin-A.

Plasma Thiobarbituric Acid-Reactive Substance Levels in Subclinical Hypothyroidism

Objective: The purpose of this study was to determine thiobarbituric acid-reactive substance (TBARS) levels in subclinical hypothyroidism and to examine the effect of levothyroxine replacement on TBARS levels. Subjects and Methods: A cohort of 28 female patients with subclinical hypothyroidism and 24 healthy controls were enrolled in this study. The levels of plasma TBARS, serum lipids, and high-sensitive C-reactive protein (CRP) in patients with subclinical hypothyroidism at baseline and after achieving euthyroid state by levothyroxine were assessed. Results: TBARS levels of the patients were similar to those of the control group in the subclinical hypothyroid state and after restoration of euthyroidism by levothyroxine replacement. TBARS levels decreased after levothyroxine treatment, but did not reach statistical significance. There was no significant correlation between TBARS, lipid and CRP levels. Serum CRP levels were higher in subclinical hypothyroidism (4.28 ± 0.9 mg/l) than in the control group (1.95 ± 0.34 mg/l) and the difference was statistically significant (p = 0.03). After achieving euthyroid state, CRP levels decreased significantly in patients with subclinical hypothyroidism from 4.28 ± 0.9 to 2.32 ± 0.6 mg/l (p = 0.006). Conclusion: Our findings suggest that there is no significant alteration of plasma TBARS levels neither in subclinical hypothyroid state nor after achieving euthyroid state. Serum CRP level is higher in patients with subclinical hypothyroidism than in the control group. Normalization of thyroid state seems to effectively reduce serum CRP levels in subclinical hypothyroidism without any correlation with TBARS activity.

Increased pulse wave velocity and relationship with inflammation, insulin, and insulin resistance in inflammatory bowel disease.

Objective Both ulcerative colitis and Crohn’s disease are forms of inflammatory bowel disease (IBD), which is characterized by chronic, progressive inflammation of the gastrointestinal tract. Recent studies have shed new light on the importance of inflammation in the pathogenesis of arterial stiffness. Aim This study aimed to evaluate the relationship between pulse wave velocity (PWV) measurement and biochemical parameters in inactive and active IBD patients without cardiovascular risk factors and perform a comparison with the control group. Materials and methods We enrolled 102 IBD patients without cardiovascular risk factors and 74 matched controls, and evaluated each patient in active and inactive disease periods. All patients completed a standard questionnaire form and we assessed various laboratory parameters. We carried out vascular measurements using a Mobil-O-Graph 24-h pulse wave analysis monitor, an automatic oscillometric device. Results Although cardiovascular risk factors, such as total cholesterol and low-density lipoprotein cholesterol, were significantly lower (P<0.05) in IBD patients than the controls, 24 h, day and night PWV values, erythrocyte sedimentation rate, C-reactive protein, insulin, homeostasis model assessment of insulin resistance, and homocysteine were higher in patients with active and inactive IBD than the controls (P<0.05). Multiple linear regression analysis showed that PWV was correlated positively with age and duration of IBD. Conclusion This study showed increased PWV, homocysteine, erythrocyte sedimentation rate, C-reactive protein, insulin, and homeostasis model assessment of insulin resistance in patients with active and inactive IBD and provides evidence of the potential contribution of inflammation and inflammation-related factors toward arterial stiffening independent from conventional cardiovascular risk factors.

Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas

Background: Because of the increased use of imaging interventions, more subjects have been diagnosed with adrenal incidentaloma in recent years. Aim: To evaluate the risk of mass enlargement, hormone hypersecretion and development of adrenal carcinomas during short-term followup. Subjects and methods: There were 317 subjects with incidentally discovered adrenal tumors in the registry. Forty subjects were excluded because of clinically overt hormone secretion at diagnosis and subjects with complete data were included in radiological (no.=150) and hormonal (no.=150) follow-up. Radiological evaluation was performed with computed tomography (CT) and/or magnetic resonance imaging (MRI). There were 143 subjects with adrenal adenomas and 7 subjects with other tumor types (cyst or myelolipoma). Median follow-up duration was 24 months. Results: Increase in tumor size was detected in 25 subjects (17.4%) with adenomas and 1 subject with adrenal myelolipoma (14.3%). Decrease in tumor size was found in 7 subjects (4.8%) with adrenal adenomas. One patient was diagnosed with adrenocortical carcinoma during follow-up. In subjects with non-functioning adrenal adenoma (NFA, no.=120) or subclinical Cushing syndrome (sCS) (no.=30), no subject developed clinically overt hormone hypersecretion, while 8 (6%) subjects in the NFA group developed sCS. Tumor diameter and follow-up duration were significantly higher in subjects who developed sCS. Conclusion: In conclusion, we demonstrated that, despite being infrequent, adrenal tumors may increase in size, develop overt or subclinical hormone secretion or feature malignant transformation. Therefore, radiological and hormonal follow-up should be recommended to the patients. More investigations are needed for the establishment of long-term follow-up protocols.

Is there any relationship between imatinib mesylate medication and hypothalamic‐pituitary‐adrenal axis dysfunction?

Background:  Imatinib mesylate [tyrosine kinase (TK) inhibitor] is a novel medication in the treatment of chronic myelogenous leukaemia (CML). TK is also essential in hypothalamo‐pituitary‐adrenal (HPA) axis.

Mean Platelet Volume Could be a Possible Biomarker for Papillary Thyroid Carcinomas

Thyroid cancer is the most prevalent endocrine cancer and is evident in nearly 5% of thyroid nodules. The correlation between mean platelet volume (MPV) and many other cancer types has been investigated previously. However, the correlation between papillary thyroid carcinoma (PTC) and MPV has not yet been studied in detail. The aim of this study was to examine whether MPV would be a useful inflammatory marker to differentiate PTC patients from cases of benign goiter and healthy controls. Preoperative MPV levels in patients with PTC were found to be significantly higher when compared with benign goiter patients and healthy controls ((respectively, 8.05 femtoliter (fl), 7.57 fl, 7.36 fl, p=0.001). After surgical treatment of PTC patients, a significant decrease in MPV levels was seen (8.05 fl versus 7.60 fl, p=0.005). ROC analysis suggested 7.81 as the cut-off value for MPV (AUC=0.729, sensitivity 60%, specificity 80%). In conclusion, maybe changes in MPV levels can be used as an easily available biomarker for monitoring the risk of PTC in patients with thyroid nodules, enabling early diagnosis of PTC.

Does Imatinib Mesylate Therapy Cause Growth Hormone Deficiency

Objective: The purpose of this study was to determinewhether or not imatinib mesylate therapy induces growth hormone deficiency (GHD). Subjects and Methods: Seventeen patients with chronic myloid leukemia (CML) were enrolled in the study. The glucagon stimulation test (GST), and standard deviation scores (SDSs) of insulin-like growth fac- tor 1 (IGF-I) and insulin-like growth factor binding protein (IGFBP-3) were used to determine GHD. The L-dopa test was performed on those with IGF-I SDSs above the –1.8 cut-off level. Results: Of the 17 patients in the study, 12 (70%) had severe GHD (serum GH level <3 μg/l after GST). IGF-I SDSs and IGFBP-3 SDSs were below –1.8 in 12 patients (70%) and below –0.9 in 10 subjects (58%). Four of the 5 remaining subjects with IGF-I SDS >–1.8 showed insufficient GH response to L-dopa stimulation. Nine subjects (52%) had both severe GHD based on GST response and IGF-I SDS below –1.8. If an IGF-I SDS cut-off value l<–3 were used,5 out of 17 subjects (30%) would be classified as GH deficient. These same patients also showed severe GHD based on GST response. Conclusions: The data showed that a large number of patients on imatinib mesylate therapy had GH deficiency. A study involving a larger number of patients with a matched control group is needed to confirm the present observations.

Macrophage migration-inhibitory factor is elevated in pregnant women with gestational diabetes mellitus

Objective: In reports, abnormal macrophage migration-inhibitory factor (MIF) production has been associated with several diseases. Furthermore, despite scarce data, increasing evidence suggest that MIF plays a central role in glucose homeostasis and in the development of type 1 and type 2 diabetes. However, serum MIF levels in gestational diabetes mellitus (GDM) have not yet been investigated. To address this question, we performed a prospective study between a group of pregnant women with GDM and healthy pregnant controls. Materials and methods: GDM group consisted of 43 pregnant women, whereas the control group consisted of 40 healthy pregnant women. In the morning after an overnight fast, venous blood was sampled for the measurement of serum concentrations of insulin and MIF. Serum was separated by centrifugation and immediately stored at −80°C until the assay. Results: There was no significant difference between the groups for maternal characteristics. Women with GDM had significantly higher levels of serum insulin (14.37 ± 9.92 µU/ml vs. 8.78 ± 4.35 µU/ml; p = 0.001) and serum MIF concentrations (11.31 ± 4.92 ng/ml vs. 5.31 ± 4.07 ng/ml; p < 0.001) when compared with healthy pregnant control group. Conclusion: Our data demonstrated that serum levels of MIF are significantly elevated in patients with GDM. Our findings indicate that MIF might have a role in GDM; however, there is a need for further investigation.