Mehmet Asik

Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis.

Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Epicardial fat tissue (EFT) is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess EFT thickness and carotid artery intima‐media thickness (CIMT) in patients with Hashimotos thyroiditis (HT) displaying overt and subclinical hypothyroidism (SCH).

Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance

We aimed to evaluate the prevalence of lactose intolerance (LI) in patients with Hashimoto’s thyroiditis (HT) and the effects of lactose restriction on thyroid function in these patients. Eighty-three HT patients taking l-thyroxine (LT4) were enrolled, and lactose tolerance tests were performed on all patients. Lactose intolerance was diagnosed in 75.9xa0% of the patients with HT. Thirty-eight patients with LI were started on a lactose-restricted diet for 8xa0weeks. Thirty-eight patients with LI (30 euthyroid and 8 with subclinical hypothyroidism), and 12 patients without LI were included in the final analysis. The level of TSH significantly decreased in the euthyroid and subclinical hypothyroid patients with LI [from 2.06xa0±xa01.02 to 1.51xa0±xa01.1xa0IU/mL and from 5.45xa0±xa00.74 to 2.25xa0±xa01.88xa0IU/mL, respectively (both Pxa0<xa00.05)]. However, the level of TSH in patients without LI did not change significantly over the 8xa0weeks (Pxa0>xa00.05). Lactose intolerance occurs at a high frequency in HT patients. Lactose restriction leads to decreased levels of TSH, and LI should be considered in hypothyroid patients who require increasing LT4 doses, have irregular TSH levels and are resistant to LT4 treatment.

Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding

Abstract Proton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249u2009714.29/µl, 197u2009314.29/µl, 193u2009941.18/µl, 183u2009500/µl, respectively). The platelet count decrease was statistically significant (pu2009<u20090.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69u2009000/µl, 97u2009000/µl and 49u2009000/µl respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.

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

BACKGROUNDnWomen 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.nnnMETHODSnThe 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.nnnRESULTSnAll 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.nnnCONCLUSIONSnOur 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.

The importance of education in diabetic foot care of patients with diabetic neuropathy.

OBJECTIVEnOur aim is to research the effect of the knowledge and routine gained from the diabetic foot (DF) care education program given to patients with Type 2 Diabetes Mellitus (DM) with diabetic neuropathy.nnnMATERIALS AND METHODnA total of 104 patients with Type 2 DM and diabetic neuropathy participated in a survey to evaluate standards of DF care, and knowledge of and behavior relating to personal care. The difference in knowledge and personal care between the group who had received education on diabetes and the group who had not was researched.nnnRESULTSnA total of 42.3% of patients reported receiving education about diabetes. The education for Type 2 DM patients increased the frequency of attending yearly check-ups (p:0.028), and helped develop the habit of having doctors check their feet (p:0.004). When comparing the daily practice of those who had received education about DF care with those who had not, positive effects of education were seen in all questions evaluating foot care, nail care and choice of shoe. The statistical analysis proved that the educated group were significantly better in terms of foot care such as using moisturizer (p:0.002) and using insoles (p:0.042).nnnCONCLUSIONnOur study reveal that educating diabetic patients about foot care is an effective method to develop their knowledge. However we observed that this education is not provided to all diabetic patients. We believe that every diabetic patient should receive education from the moment of diagnosis and repeated education during check-ups by doctors will increase effectiveness.

Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score

PurposeFine-needle aspiration biopsy (FNAB) of the thyroid is generally a well-tolerated procedure associated with weak levels of pain. However, pain may be very intense in some patients. The cause for the pain in these patients has not been identified. The hypothesis of this study is that there is a likely relationship between pain level and nodule depth during FNAB.Materials and methodsIncluded in the study were 98 patients with euthyroid nodular goiter who underwent FNAB. When ultrasound guided thyroid fine-needle aspiration biopsy was performed findings such as the distance of the nodule to the skin, the size of the nodule, visual analogue scale (VAS) score values were recorded.FindingsThe distance of nodule to skin and nodule size was measured, respectively, as 10.7xa0±xa02.8xa0mm and 21.7xa0±xa08.6xa0mm. Mean VAS score was 36xa0±xa016. FNAB-related pain was correlated with the nodule depth (rxa0=xa00.43, pxa0<xa00.001). In the logistic regression analysis, we also found that high VAS score class was effected by only nodule depth (Bxa0=xa0−1.619; OR 1.287; CI 1.057–1.565, pxa0<xa00.05).ConclusionOur results show that pain increased significantly during FNAB in patients who had more deeply situated nodules. Local anesthetic methods may be recommended for these patients.

Diagnosis of an ectopic adrenocorticotropic hormonesecreting bronchial carcinoid by somatostatin receptor scintigraphy

Diagnosis of an ectopic adrenocorticotropic hormonesecreting bronchial carcinoid by somatostatin receptor scintigraphy

Serum H-FABP levels in patients with hypothyroidism

SummaryObjectiveHypothyroidism (HT) has an increased risk for cardiovascular mortality and morbidity due to increased atherosclerosis. Heart-type fatty acid binding protein (H-FABP) is abundant in the cytosol of cardiomyocytes, and transports fatty acids into these cells. Although H-FABP has been shown to increase in several atherosclerotic and inflammatory conditions, there is no literature data indicating an alteration in other atherosclerotic processes such as HT.Material and methodsA total of 39 patients with subclinical hypothyroidism (SCH), 26 patients with overt hypothyroidism (OH), and 29 healthy subjects were enrolled in this study. Carotid artery intima media thickness (CIMT) was measured by high resolution B mode ultrasonography. H-FABP levels, thyroid function test, and biochemical tests of all subjects were measured. The associations between H-FABP and thyroid test and CIMT were examined with correlation and regression analysis.ResultsOH patients had higher H-FABP levels (mean, 6.18xa0±xa03.08xa0ng/mL) than both the SCH (mean, 3.81xa0±xa02.16xa0ng/mL) and the controls (mean, 2.12xa0±xa01.27xa0ng/mL) (Pxa0<xa00.01 and <xa00.001, respectively). SCH patients had increased serum H-FABP levels compared with control subjects (Pxa0<xa00.01). CIMT of both OH and SCH patients was also significantly greater compared with control subjects (both of pxa0<xa00.01). H-FABP was significantly and positively correlated with age, systolic blood pressure, thyroid stimulating hormone (TSH) levels, and CIMT, and negatively correlated with fT4 levels. The H-FABP levels retained an independent and positive association with systolic blood pressure, and a negative association with fT4 levels.ConclusionSerum H-FABP levels progressively increased from the control group to the OH group. This suggests that H-FABP may be an indicator of low-level myocardial damage in HT, especially when used together with CIMT. Decreasing serum fT4 levels seem also to have an effect on H-FABP levels.ZusammenfassungZielBei Hypothyreose (HT) besteht wegen gesteigerter Atherosklerose ein erhöhtes Risiko für kardiovaskuläre Mortalität und Morbidität. Das Heart-type Fatty Acid Binding Protein (H-FABP) kommt im Zytosol der Kardiomyozyten im Überschuss vor und transportiert die Fettsäuren in diese Zellen. Obwohl gezeigt worden ist, dass H-FABP bei verschiedenen Zuständen der Atherosklerose und der Entzündung erhöht ist, gibt es in der Literatur keine Daten, die auf eine Veränderung der H-FABP Werte bei anderen atherosklerotischen Prozessen, wie der HT, hinweisen.Material und MethodenInsgesamt wurden 39 Patienten mit subklinischer Hypothyreose (SCH), 26 Patienten mit echter Hypothyreose (OH) und 29 gesunde Patienten in die Studie eingeschlossen. Die Intima Media Dicke der Arteria carotis (CIMT) wurde durch hoch auflösende B-Mode Ultrasonographie gemessen. Die Konzentration des H-FABP, der Schilddrüsenparameter und der biochemischen Tests wurden bei allen Personen erhoben. Mögliche Zusammenhänge zwischen H-FABP, Schilddrüsenwerten und CIMT wurden mittels Korrelations- und Regressionsanalyse berechnet.ErgebnissePatienten mit OH hatten höhere H-FABP Spiegel (6,18xa0±xa03,08xa0ng/mL) sowohl als die Patienten mit SCH (3,81xa0±xa02,16xa0ng/mL) als auch die Kontrollen (2,12xa0±xa01,27xa0ng/mL) (Pxa0<xa00,01 beziehungsweise <xa00,001). Die Serum H-FABP Werte der Patienten mit SCH waren auch im Vergleich zu den Kontrollen erhöht (Pxa0<xa00,01). Die CIMT der Patienten mit OH und der Patienten mit SCH waren signifikant dicker als die der Kontrollen (beide Vergleiche: pxa0<xa00,01). Die H-FABP Werte waren signifikant positiv mit dem Alter, dem systolischen Blutdruck, den TSH und den CIMT Werten korreliert. Es bestand eine signifikante negative Korrelation zum freien T4. Die H-FABP Assoziation blieb unabhängig und positiv mit dem systolischen Blutdruck – beziehungsweise signifikant negativ mit dem freien T4.SchlussfolgerungDie Serumspiegel des H-FABP stiegen von der Kontrollgruppe bis zur Gruppe der Patienten mit OH kontinuierlich. Vor allem bei gleichzeitigem Einsatz der CIMT Messung könnte dies darauf hinweisen, dass die H-FABP Spiegel ein Indikator einer geringen myokardialen Schädigung bei HT sind. Auch ein Abfall der Werte des freien T4 scheint eine Wirkung auf die H-FABP Werte zu haben.

Evaluation of epicardial fat tissue thickness in patients with hyperthyroidism

SummaryBackgroundThyroid hormones have several effects on the cardiovascular system, and recent studies have found that thyroid disorders affect coronary intima-media thickness (CIMT) in particular. Despite increased CIMT in patients with hyperthyroidism, the extent of the relationship between CIMT and epicardial fat thickness (EFT) in those patients is unknown. Furthermore, there is no report evaluating the relationship between EFT and overt hyperthyroidism (OH) in the literature. In this study, we aim to evaluate the effectiveness of EFT in predicting atherosclerosis as well as CIMT in patients with OH.MethodsA total of 30 newly diagnosed, untreated overt hyperthyroid patients and 44 control subjects were included in the study. EFT was measured using a commercially available echocardiography machine (VIVID 7; General Electric Medical Systems, Norway) with a 2.5-MHz probe. The echo-free space between the visceral and parietal pericardium on the anterior wall of the right ventricle was diagnosed as EFT. A linear-array imaging probe of the same echocardiography probe was used to evaluate the CIMT of the right common carotid artery.ResultsThe hyperthyroid patients had a significantly greater EFT (mean: 4.31xa0±xa01.12xa0mm) than the healthy subjects (mean: 3.11xa0±xa00.84xa0mm; pxa0<xa00.001). CIMT was also significantly greater in the hyperthyroid patients (mean: 0.62xa0±xa00.17xa0mm) than in the healthy subjects (mean: 0.50xa0±xa00.11xa0mm; pxa0<xa00.01).ConclusionIn conclusion, the present study shows that mean EFT and CIMT were significantly higher in OH patients, irrespective of confounding factors such as hypertension.ZusammenfassungHintergrundSchilddrüsenhormone haben verschiedene Wirkungen auf das kardiovaskuläre System. Kürzlich publizierte Studien haben berichtet, dass Schilddrüsenerkrankungen vor allem die Intima-Media-Dicke der Koronarien (CIMT) beeinflussen. Obwohl die CIMT bei Patienten mit Hyperthyreose erhöht ist, ist über das Ausmaß eines Zusammenhangs zwischen CIMT und der Dicke des epikardialen Fetts (EFT) bei diesen Patienten nichts bekannt. Es gibt außerdem in der Literatur keine Berichte über mögliche Zusammenhänge zwischen EFT und manifester Hyperthyreose. In der vorliegenden Studie versuchen wir die Wirksamkeit der EFT bei der Vorhersage einer Atherosklerose sowie der CIMT bei Patienten mit Hyperthyreose zu prüfen.MethodikDreißig neu diagnostizierte, unbehandelte Patienten mit manifester Hyperthyreose und 44 Kontrollpersonen wurden in die Studie aufgenommen. Die EFT wurde mittels eines kommerziell erhältlichen Echokardiographiegeräts (VIVID 7; General Electric Medical Systems, Norwegen) mit einer 2,5xa0MHz Sonde erhoben. Der echofreie Raum zwischen viszeralem und parietalem Epicard der Vorderwand des rechten Ventrikels wurde als EFT definiert. Eine bildgebende Linear Array Sonde des gleichen Echokardiographiegeräts wurde zur Evaluierung der CIMT der rechten Arteria carotis communis verwendet.ErgebnisseDie Patienten mit Hyperthyreose hatten eine signifikant größere EFT (Mittelwert: 4,31xa0±xa01,12xa0mm) als die gesunden Kontrollpersonen (Mittelwert: 3,11xa0±xa00,84xa0mm; pxa0<xa00,001). Auch die CIMT war bei den hyperthyreoten Patienten signifikant dicker (MW.: 0,62xa0±xa00,17xa0mm) als bei der gesunden Kontrolle (MW: 0,50xa0±xa00,11xa0mm; pxa0<xa00,01).SchlussfolgerungDie vorliegende Studie zeigt, dass die mittlere EFT und CIMT bei Patienten mit manifester Hyperthyreose unabhängig von anderen Faktoren wie Hypertonie signifikant höher als bei einer Kontrollpopulation ist.

Effect of systemic carnitine therapy on serum fibronectin level in diabetic rats

BACKGROUNDnL-carnitine has been shown to enhance wound healing. There has, however, not been sufficient research on the effect carnitine has on diabetic wound healing. We investigated the relationship between the viability of full thickness skin grafts (FTSGs) and fibronectin (FN) serum levels in diabetic rats that were administered carnitine.nnnMATERIALS AND METHODSnA total of 40 rats were divided into four groups of 10 rats each and operated on. The FTSG model was 10 × 3 cm, with the dorsal flap extending from the tip of the scapula to the hip joint. After surgery, group 1 (nondiabetic control, n = 10) and group 2 (diabetic control, n = 10) were given a sterile saline solution at 0.9% with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Group 3 (diabetic sham, n = 10) contained diabetic rats and did not receive any agent after the surgery. The diabetic rats in group 4 (carnitine study diabetic, n = 10) were given carnitine with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery.nnnRESULTSnThe percentages of viable areas in groups 1-4 were 70.38 ± 6.10%, 62.66 ± 1.55%, 62.59 ± 2.94%, and 73.48 ± 4.43%, respectively. The mean levels of FN, measured in milligram per deciliter, in groups-4 were 23.57 ± 3.27 mg/dL, 21.58 ± 2.35 mg/dL, 22.04 ± 2.71 mg/dL, and 27.11 ± 2.79 mg/dL, respectively. Furthermore, we found that there was a strong positive correlation (R = 0.509; P = 0.001) between FN and the viability of the FTSG.nnnCONCLUSIONSnWe demonstrated that administering carnitine leads to an increase in diabetic wound healing. Further increasing the levels of the FN serum might have a role in this process.