Mustafa Kocak

Increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels in patients with primary hyperparathyroidism

BACKGROUND AND OBJECTIVES Primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality and morbidity. Little is known about hemostatic features of patients with PHPT. To our knowledge, plasma tissue factor pathway inhibitor (TFPI) and thrombin-activatable fibrinolysis inhibitor (TAFI) levels in these patints have not been investigated. Therefore, the main purpose of this study was to evaluate the markers of endogenous coagulation/fibrinolysis, including TFPI and TAFI, and to investigate the relationships between serum calcium and PTH and these hemostatic parameters in patients with PHPT. DESIGN AND METHODS Twenty-four patients with PHPT and 20 age-, sex-, and-weight-matched healthy controls were included in the study. Tissue plasminogen activator (t-PA), tissue plasminogen activator inhibitor-1 (PAI-1), TFPI, and TAFI were measured. The relationships between serum calcium, phosphorus, and PTH and these hemostatic parameters were examinated. RESULTS Compared with the control subjects, t-PA, PAI-1, and PAI-1/t-PA ratios were significantly increased in patients with PHPT (P<0.0001), whereas TFPI levels were significantly decreased (P<0.0001). Plasma TAFI Ag levels did not significantly change in patients with PHPT compared with the controls. In patients with PHPT, serum phosphorus was negatively correlated with plasma PAI-1 Ag levels and PAI-1/t-PA ratio (r: -0.453, P<0.05; r: -0.580, P<0.01 respectively). There was a positive correlation between Cl/P ratio and plasma PAI-1 levels and PAI-1/t-PA ratio (r: 0.434, P<0.05; r: 0.528, P<0.05 respectively). iPTH was positively correlated with plasma PAI-1/t-PA ratio (r: 0.429, P<0.05). INTERPRETATION AND CONCLUSIONS In conclusion, we found some important differences in the hemostatic parameters between the patients with PHPT and healthy controls. Increased PAI-1, PAI-1/t-PA ratios and decreased TFPI levels in these patients represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess mortality due to cardiovascular disease seen in patients with PHPT.

Tip 2 diyabetes mellituslu hastalarda yaşam kalitesi ve ruhsal belirtiler / Quality of life and psychiatric symptoms in the patients with type 2 diabetes mellitus

Objective: The purpose of this study is to measure the depression and anxiety levels, to investigate their associations with sociodemographic variables and to emphasize the importance of multidisciplinary approach for the follow up and treatment of patients with type 2 diabetes mellitus (DM). Method: We enrolled randomly selected 100 consecutive patients with type 2 DM, admitted to the outpatient clinic of endocrinology. Age, gender and marital status matched 100 volunteers served as control group. Sociodemographic data form and Hospital Anxiety and Depression Scale (HAD), Short Form-36 (SF?36) were performed for all participants. Results: For SF?36, all subscale mean scores were found to be lower in type 2 DM patients as compared to control group. HAD-Anxiety (HAD-A) and HAD-Depression (HAD-D) mean scores in the group of patients were found to be higher than the mean scores of the control group. The difference was significant for HAD-D, whereas negligible for HAD-A. In both patient and control groups, subscales of life quality were found to be negatively correlated with both depression and anxiety. Comparing the HAD-A and the HAD-D mean scores according to the gender, both subscale mean points were higher in female than male in both groups. When the SF-36 subscale scores for males and females were compared, it was found that females have lower scores in all the subscales. HAD-A and HAD-D mean scores were found to be positively correlated with the duration of diabetes, however, this correlation was not statistically significant. Conclusions: In this study, it was found that type 2 DM have extremely deteriorated the quality of life of the patients and caused many psychological signs accompanying clinic. Thus, our study has shown the necessity of consultation and emphasizes the liaison for clinics.