Mediha Ayhan

The relationship between mean platelet volume with microalbuminuria and glycemic control in patients with type II diabetes mellitus

Microalbuminuria is the best predictor of diabetic nephropathy development in patients with type II diabetes mellitus (DM). It is also accepted as an indicator of diabetic microangiopathy. Increased activation of platelets has been suggested to be involved in the pathogenesis of vascular complications. In light of these findings, this study was designed to investigate the association of microalbuminuria — an indicator glycemic control and microangiopathy — with mean platelet volume (MPV). Subjects underwent laboratory analyses and their MPV, HbA1c, serum creatinine, fasting, and postprandial blood glucose levels and 24-hour urine albumin levels were recorded. All statistical analyses were performed using SPSS v13.0 for Windows XP. Mann–Whitney U-test, students t-test, spearman correlation analysis, ROC analysis, categorical regression analysis, and chi-square test were used for statistical evaluations. The study included 354 patients with type II DM. The median MPV value of microalbuminuria-positive patients was 9 (8–9.5) fl while MPV of patients without microalbuminuria was 8.5 (8–9.2) fl and the difference was statistically significant (p = 0.004). We determined positive correlation between MPV and 24-hour urine microalbuminuria (r = 0.14, p = 0.009). There were no significant differences between patients with HbA1c levels below and above 7% in terms of MPV (p > 0.05). We determined no correlation between MPV and HbA1c levels (r = −0.36, p = 0.64). This study determined a significant positive relationship between microalbuminuria — a microvascular complication of diabetes — and MPV. No significant correlation was identified between poor glycemic control and MPV in diabetic patients. However, we are in the opinion that the association between poor glycemic control and MPV in type II diabetic patients should be investigated in prospective studies with larger samples.

The effect of pioglitazone on antioxidant levels and renal histopathology in streptozotocin-induced diabetic rats.

Objective. Diabetic nephropathy is the most commonly seen cause of chronic renal failure, and oxidative stress is important in etiology. In the present study, favorable effects (if any) of the treatment with a thiazolidinedione group drug, pioglitazone, on antioxidant enzyme levels in the renal tissue, renal histopathology, and inflammatory cytokine levels have been investigated. Method. Forty male Wistar rats were divided into 4 groups as the control, diabetic control, and 10 and 30 mg pioglitazone-administered diabetic groups. After 4 weeks, antioxidant enzyme levels in renal tissues and inflammatory markers were investigated. Results. Blood glucose levels did not differ between the diabetic control and drug-administered groups. In pioglitazone-administered rats, histopathological findings such as tubular dilation, necrotic tubular epithelium, glomerular focal necrosis, and vascular consolidation were observed at a lesser extent than the diabetic control group. Any difference was not detected between the diabetic groups with respect to the levels of malondialdehyde, superoxide dismutase, catalase, glutathione, nitric oxide, interleukin-6, and tumor necrosis factor-alpha. Conclusion. Pioglitazone regressed development of histopathological lesions such as glomerular focal necrosis, tubular epithelial necrosis, tubular dilation, and vascular wall consolidation. However, any favorable effect on antioxidant enzyme levels in renal tissues and inflammation markers was not detected.

Hypoglycemia induced by hydroxychloroquine in a patient treated for rheumatoid arthritis.

THE CASE A 72-year-old woman had been diagnosed with RA 4 years ago. She was using HCQ 200 mg daily, leflunomide 20 mg daily for 4 years, and methylprednisolone 12 mg/d for 8 months. She presented to the emergency service for abrupt syncope and loss of consciousness. Her serum glucose level was 15 mg/dL. She was administered intravenous 250 mL of dextrose 10%. When her serum glucose level reached 150 mg/dL, she regained consciousness and her symptoms disappeared. The patient was hospitalized to investigate the cause of her hypoglycemia. In her physical examination, her conjunctivas were pale; her elbows, metacarpophalangeal joints, and proximal interphalangeal joints were swollen; and there was swan-neck deformity at the first finger of each hand. Because the patient had similar symptoms at hospitalization, her fingertip glucose level was measured again and was found to be 38 mg/dL, whereas simultaneous venous blood glucose level was 26 mg/dL, serum insulin level was 121 KIU/mL (reference range, 0Y28.4KIU/mL), C-peptide level was 15.6 ng/mL (reference range, 1.1Y5 ng/mL), and cortisol levelwas 13.6Kg/dL. With recurrent incidents of hypoglycemia during follow-up, the patient was started on intravenous infusion of dextrose 10%. Her insulin/glucose level was high at 4.65, and her emergency computed tomographic (CT) scan of the pancreas obtained to assess her preliminary diagnosis of insulinoma yielded normal findings. Intragastric endoscopic ultrasonography was planned for the differential diagnosis of insulinoma. In the laboratory examination of the patient, HbA1c value was 6.8%, hemoglobin was 10.9 g/dL, hematocrit level was 32.8%, leukocyte count was 10,000/KL, platelet count was 231,000/KL, and mean corpuscular volume was 90 fL. Serum urea, creatinine, liver enzymes, thyroid functions tests, serum albumin, international normalized ratio, iron, iron saturation, vitamin B12, and ferritin levels were normal. Esophagogastroduodenoscopy and colonoscopy for the cause of anemia did not demonstrate any finding of malignancies. The patient was also examined for causes that may lead to fasting hypoglycemia and noninsulinoma malignancies. No finding suggestive of a malignancy was observed in either abdominal CT scan, lung radiograph, or cranial CT scan. She was questioned about her drugs for causative hypoglycemic medications. Her drugs did not include oral antidiabetics and insulin. Hydroxychloroquine was stopped for its potential hypoglycemic effect as reported in the literature. Dextrose infusion was also discontinued because her capillary glucose levels remained greater than 200 mg/dL during her follow-up. Her capillary blood glucose levelwas measured hourly. A 72-hour fasting test was performed because hypoglycemia did not recur during follow-up. This 72-hour measurement did not demonstrate hypoglycemia. The patient’s repeat fasting blood glucose level in venous blood was measured as 262 mg/dL, whereas her fasting blood insulin was 28.1 KIU/mL and postprandial blood glucose level was 320 mg/dL after the patient began oral feeding. The patient was diagnosed with diabetes mellitus (DM). Metformin 2 g daily was given to the patient. The diagnosis diverged from investigating for a possible insulinoma because a marked hyperglycemia persisted after cessation of HCQ, and the patient did not have hypoglycemia and was diagnosed with DM. Endoscopic ultrasonography was not performed. The patient is currently at month 11 of her follow-up on metformin, and no incidences of hypoglycemia have been observed.

Autoimmunity affects health-related quality of life in patients with Hashimoto's thyroiditis

Hashimotos thyroiditis (HT) is the most common endocrine disorder leading to hypothyroidism. HT is characterized by the presence of elevated circulating antibodies, especially anti‐thyroid peroxidase (anti‐TPO) and anti‐thyroglobulin (anti‐Tg). In our study, we aimed to reveal the effects of autoimmunity on health‐related quality of life of euthyroid HT patients. Patients who were admitted to the Adnan Menderes University Outpatient Clinic were enrolled. The medical records of the patients were surveyed and their demographical data were collected. By using communication data, the patients were invited to our clinic, to inform them about our study and to fill out the health‐related quality of life questionnaire. A total of 84 euthyroid HT patients older than 18 years who completed the short form‐36 questionnaire, were enrolled. As all patients were euthyroid, there was a significant negative correlation between each domain score and the antibody levels, individually. Patients who had higher anti‐TPO and anti‐Tg levels had significantly lower quality of life domain scores (p < 0.001). There was statistically no significant correlation between the antibody levels and thyroid function tests (p > 0.05). Additionally, all dimension scores were significantly higher both in the anti‐Tg and anti‐TPO negative groups, indicating a better quality of life than that in the antibody positive groups. Our study revealed that higher thyroid antibody levels were negatively correlated with life quality scores. Thus, patients who had higher anti‐TPO and anti‐Tg levels had significantly lower quality of life domain scores. We believe that apart from hypothyroidism, a high antibody level was one of the contributing factors for the development of HT‐associated symptoms, leading to a lower quality of life. Other probable contributing factors such as selenium deficiency, thyroid hormone fluctuation, and disease awareness should keep in mind.

Blood count parameters can predict the severity of coronary artery disease

Background/Aims Because of the inflammatory nature of coronary artery disease (CAD), both platelets and white blood cells have been investigated for years. The aim of this study was to investigate the relationships between some prominently hematologic blood count parameters (mean platelet volume [MPV], neutrophil to lymphocyte ratio [NLR]) and the severity of CAD by using Gensini scores. Methods A total of 194 patients, who had undergone coronary angiography, enrolled in this study. The control group consisted of 42 patients who had normal coronary arteries. Remaining CAD patients were divided into two groups according to their Gensini scores. Results NLR and MPV were higher in the severe atherosclerosis group compared with the mild atherosclerosis group (p = 0.007, p = 0.005, respectively). The Gensini score showed significant correlations with NLR (r = 0.20, p = 0.011), MPV (r = 0.23, p = 0.004) and high density lipoprotein cholesterol (r = –0.161, p = 0.047). Using a cut-off level of 2.54, NLR predicted severe atherosclerosis with a sensitivity of 74% and specificity of 53% (area under curve [AUC], 0.627; 95% confidence interval [CI], 0.545 to 0.704; p = 0.004). MPV values above 10.4 predicted severe atherosclerosis with a sensitivity of 39% and specificity of 90% (AUC, 0.631; 95% CI, 0.549 to 0.708; p = 0.003). In the multiple logistic regression analysis, high levels of NLR (odds ratio [OR], 1.450; 95% CI, 1.080 to 1.945; p = 0.013) and MPV (OR, 1.622; 95% CI, 1.147 to 2.295; p = 0.006) were found to be independent predictors of severe atherosclerosis. Conclusions Our study suggests that both NLR and MPV are predictors of severe atherosclerosis and may be used for the prediction and identification of cardiac risks in CAD patients.