Işılay KALAN SARI ,
Alev EROĞLU ALTINOVA ,
Çiğdem ÖZKAN ,
Müjde AKTÜRK ,
Ceyla KONCA DEĞERTEKİN ,
Ethem Turgay CERİT ,
MEHMET MUHİTTİN YALÇIN ,
Füsun BALOŞ TÖRÜNER ,
Ayhan KARAKOÇ ,
İlhan YETKİN ,
Göksun AYVAZ ,
Nuri ÇAKIR
Objective: Pregnant women with type 1 diabetes mellitus
(T1DM) have increased risk of fetal, maternal, and perinatal
complications. In this report, we aimed to evaluate the effects
of continuous subcutaneous insulin infusion (CSII) therapy on
pregnancy outcomes, glycemic control, and acute complications
in pregnant women with T1DM. Material and Methods: We
retrospectively analyzed the data of 15 women with T1DM who
were on CSII therapy during their pregnancy, and who were followed up at our clinic between 2008 and 2014. Acute complications, fetal/maternal, and perinatal complications, and glycemic
control were analyzed. Results: The mean age of the patients
was 28.2±3.6 years, and the mean duration of diabetes was
8±5.4 years. We did not observe severe hypoglycemic episodes
and diabetic ketoacidosis during their pregnancy. The mean
HbA1c levels at 4-8 weeks of pregnancy decreased from
7.4±1.3% to 6.3±0.7% at 34-38 weeks of pregnancy. The mean
duration of pregnancy and neonatal birth weight were 37.1±1.2
weeks and 3.537±794 g, respectively. There were no stillbirths,
perinatal infant deaths, or congenital malformations noted.
There were two preterm births due to preeclampsia, one of
whom had a low birth weight (1.800 g). We recorded one macrosomic baby (4.730 g). Conclusion: We observed that glycemic control improved with CSII therapy during pregnancy. We
did not detect severe hypoglycemia or diabetic ketoacidosis in
our research. In pregnant women with T1DM who had inadequate glycemic control with multiple daily insulin injection therapy, CSII might be a safe and appropriate treatment regimen.
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Objective: Several lines of evidence suggest that the symptoms
of hypothyroidism, including psychological symptoms and metabolic effects, persist in a significant percentage of patients
treated with levothyroxine (L-T4). A hypothesis to explain this
phenomenon is that the triiodothyronine (L-T3) serum levels
may not be completely normalized. This study aimed to compare the level of serum free T3 (FT3) in patients who are
biochemically euthyroid after L-T4 monotherapy with different
underlying causes of hypothyroidism. Material and Methods:
This cross-sectional study was conducted on patients with
hypothyroidism who received L-T4 monotherapy and were biochemically euthyroid. The serum levels of thyroid-stimulating
hormone (TSH), free T4 (FT4), FT3, and FT3/FT4 ratio were
measured in these patients. Patients were divided into three
groups based on the cause of hypothyroidism (radioiodine therapy, thyroidectomy and Hashimoto), and the results of biochemical tests of the thyroid were compared in three groups.
Results: Of the 78 patients studied, 12 (15.4%) cases were
male, and 66 (84.6%) cases were female. Among the variables
studied, only the mean value of FT3 was significantly different
in the three groups (p=0.006), where the highest mean value
was seen in the Hashimoto group, and the lowest mean value
was seen in the radioiodine therapy group. Conclusion: The results of this study showed that although hypothyroidism patients can be optimally treated with L-T4 alone, in many of these
patients, the level of FT3 will not be in therapeutic range, and
the mean serum FT3 levels in these patients could be related to
their hypothyroidism causes.
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Objective: This study aimed to explore the scientific performance in research of endocrinology and metabolism and its
correlation with the socioeconomic indicators in the MiddleEast countries. Material and Methods: Scientometrics and
social network analysis methods were used for this study. Data
were extracted from the Web of Science, World Bank, and UIS
data center of UNESCO. Results: The majority of scientific
productions (79.6%) were published by authors affiliated with
upper-middle and high income countries which includes Turkey, Israel, and Iran. From co-authorship analysis, Saudi Arabia, Egypt, and Turkey with most degree centrality, had the
highest collaborative ranking with other Middle-East countries.
The main Middle-East collaborators having scientific outputs in
this field were the researchers from the USA, England, and
Germany. Israel, Turkey, and Saudi Arabia had the most collaboration (63.8%) with other countries. Also, there was a
strong positive correlation between total collaborations with
global countries and the number of citations. Conclusion: Due
to the correlation among scientific productions, citations, scientific collaborations, Gross domestic expenditure on research
and development, and specialist human resources indicators,
the supplementary budget should be directed toward research
in the Middle-East countries and establishing global networks
to conduct joint projects. This could increase the trend of scientific productions and obtain higher citations in the Web of
Science, eventually leading to scientific, social as well as economic development in the region.
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Pseudopseudohypoparathyroidism is a rare clinical entity of
autosomal dominant inheritance, which shows phenotypic similarity to pseudohypoparathyroidism. However, the main difference lies in their biochemical profiles. The former disease
is characterized by normal serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) level, whereas the latter shows features suggestive of PTH resistance. Our patient
presented after post blunt trauma of head with diabetes insipidus and short stature. Investigations revealed multiple pituitary hormone deficiency. Further examination was
conducted for pseudohypoparathyroidism, keeping in mind
short metacarpals, knuckle knuckle dimple dimple sign, and
short stature, but normal calcium, phosphorus, vitamin D and
PTH value led to the diagnosis of pseudopseudohypoparathyroidism. GNAS mutation analysis is necessary to confirm the
diagnosis, which could not be performed in this patient due to
the high cost. This case shows that pseudopseudohypoparathyroidism, although a rare disease, should be appropriately
investigated in such patients if they present with peculiar skeletal features of pseudohypoparathyroidism.
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Abbas Ali TAM, Didem ÖZDEMİR, Berna EVRANOS ÖĞMEN, Fatma Dilek DELLAL, Afra ALKAN, Oya TOPALOĞLU, Reyhan ERSOY, Bekir ÇAKIR
Abbas Ali TAM, Didem ÖZDEMİR, Berna EVRANOS ÖĞMEN, Fatma Dilek DELLAL, Afra ALKAN, Oya TOPALOĞLU,
... Devamını oku
Objective: The aim of the present study was to investigate the possible association between obesity and thyroid functions and thyroid morphology. Material and Methods: A total of 674 subjects-121 obese and 553 nonobese-were included in the study. Body mass index, serum thyrotrophic, free triiodothyronine (fT3), free thyroxine (fT4), antithyroid peroxidase antibody, and antithyroglobulin antibody (antiTg) were evaluated in each subject. The subjects with thyroid nodules in ultrasonography (USG) were excluded. The thyroid volume of each subject was calculated and analyzed. Results: Obesity was significantly associated with increased age and low fT4 in univariate analysis (p<0.05). With multivariate analysis, the odds of obesity was found to increase by 21.8% (95% CI: 12.4-31.9%) for each 5-year increase in age anddecrease by 53.1% (95% CI: 0.4-77.9%) for each 1 ng/dL increase in fT4. The odds of obesity in patients with positive antiTg was 1.603 (95% 1.047-2.454) times higher than the odds of obesity in patients with negative antiTg. The median total thyroid volume was significantly higher in obese as compared to nonobese subjects (12.11 mL vs. 10.77 mL, p<0.001). Heterogeneous gland with negative thyroid antibodies was observed in 17 (14%) obese and 40 (7.2%) nonobese subjects (p=0.024). Conclusion: Obesity was positively associated with antiTg and age, whereas negatively associated with fT4. Approximately, in every seven obese subjects, one showed heterogeneity in US despite negative thyroid autoantibodies. This suggests that the value of US in the diagnosis of autoimmune thyroiditis might decrease in obese patients.
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Bilal KATİPOĞLU, Mustafa ÇOMOĞLU, İhsan ATEŞ, Nisbet YILMAZ, Dilek BERKER
Bilal KATİPOĞLU, Mustafa ÇOMOĞLU, İhsan ATEŞ, Nisbet YILMAZ, Dilek BERKER
Objective: Though the C-peptide index (CPI) has been a reliable marker for estimation of the beta-cell reserve, its association with microvascular complications in Type 2 diabetes mellitus (DM) patients has not been elucidated as yet. This study, therefore, aimed to investigate the relationship between C-peptide levels and CPI with microvascular complications in Type 2 DM patients. Material and Methods: Type 2 DM patients, over 18 years of age, whose C-peptide levels were analyzed in the endocrinology and internal medicine clinics between 2014 and 2018, having normal kidney functions (glomerular filtration rate >60 mL/min) and who are not dependent on any insulin secretagogue oral antidiabetic agent (i.e., sulfonylurea) were enrolled the study. Blood samples were collected after at least 12 h of fasting, without any drug or insulin administration. Hemogram, hemoglobin A1c (HbA1c), lipid, glucose, C-peptide parameters were analyzed from the same serum sample. The patients were classified into three groups according to the spot urine albumin/ creatinine ratio. Patients with no proteinuria, patients with microalbuminuria, and patients with macroalbuminuria were defined as group 1, group 2, and group 3, respectively. Results: A statistically significant difference between CPI levels in the groups was observed (p<0.001). CPI levels of Groups 2 and 3 were lower than that of group 1 (p=0.007 and p<0.001). In addition, the CPI level of group 3 was significantly lower than that of group 2 (p=0.015). An inverse association between CPI level and proteinuria was thus recognized. HbA1c and proteinuria were found to be positively correlated (p<0.001). Conclusion: This study highlights the association between C-peptide, CPI, and diabetic nephropathy in Type 2 DM patients.
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Özlem HALİLOĞLU, Mesude TÜTÜNCÜ,
SERDAR ŞAHİN , Özge POLAT KORKMAZ, Melis dila ÖZER, Zeynep OŞAR SİVA
Özlem HALİLOĞLU, Mesude TÜTÜNCÜ,
SERDAR ŞAHİN ,
Özge POLAT KORKMAZ, Melis dila ÖZER, Zeynep OŞAR SİVA
Objective: Fatigue is a common symptom in diabetes mellitus. The aim of this study was to determine the factors leading to fatigue and to investigate the effect of insulin use on fatigue among the diabetic population. Material and Methods: Onehundred diabetic patients attending the diabetes clinic of Cerrahpasa Medical Faculty between October 2017-January 2018 and 42 healthy controls were evaluated in this cross-sectional study. Questionnaires including demographic and disease characteristics, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), quality of life scale (SF-36), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Ages (47.6±14.8 and 45.7±14.1 years; p=0.47) and body mass indices (26.6±4.1 and 25.3±3.5 kg/m2; p=0.08) of 100 patients with diabetes (Type 1 Diabetes/Type 2 Diabetes= 29/71) and 42 healthy volunteers were similar. The diabetic group had worse FIS total (p=0.05), FIS psychological (p=0.04) scores and SF–36 scores compared to the healthy controls. When the patients with diabetes were divided into two groups according to insulin use and compared with healthy controls, the ESS and PSQI were similar but all FIS parameters (total p=0.005, cognitive p=0.007, physical p=0.01, psychological p=0.009) and BDI (p=0.05) were significantly worse in patients with insulin use than non-insulin and control groups. The relationship between fatigue and insulin use was independent of glycemic control and duration of diabetes but was affected by the BDI (p=0.001). Conclusion: Insulin use leads to fatigue in patients with diabetes, regardless of diabetes type, and this effect is influenced by depressive mood. Psychotherapeutic approaches prior to insulin treatment might yield fruitful results.
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Cemile İDİZ, Selda ÇELİK, Elif BAĞDEMİR, Melike DİŞSİZ, İlhan SATMAN
Cemile İDİZ, Selda ÇELİK, Elif BAĞDEMİR, Melike DİŞSİZ, İlhan SATMAN
Objective: Education is the cornerstone of diabetes management, and numerous educational studies used Diabetes Knowledge Level Tests to determine the effectiveness of education. Our study was planned to adopt the revised Diabetes Knowledge Test (DKT2) of the Michigan Diabetes Research and Training Center for the Turkish population. Material and Methods: A total of 296 diabetic subjects using insulin were included in the study. After the determination of the validity of the language and content of the test, it was applied to the patients. The reliability of the study was assessed using Cronbach’s alpha coefficient. The results of the DKT2 demographic values, and laboratory tests of the patients were noted. Results: Cronbach’s alpha values were 0.60, 0.59, and 0.70 for the first part, second part, and complete test, respectively. The test-retest reliability values were 0.76 and 0.87 (p<0.001), respectively. The correct response rate to the first part was 32.68±2.47% in patients with Type 1 diabetes and 32.16±2.66% in patients with Type 2 diabetes using insulin. The correct response rate to the second part was 19.68±2.05% and 19.55±2.96%, respectively. Discussion: The Turkish adapted version of DKT2 is a reliable tool to measure patients’ level of diabetes knowledge. However, in order to increase the level of knowledge of the patients, education of diabetes should be improved.
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Asena GÖKÇAY CANPOLAT, Sule CANLAR, Berna İmge AYDOĞAN, Sevim GÜLLÜ, Murat Faik ERDOĞAN
Asena GÖKÇAY CANPOLAT, Sule CANLAR, Berna İmge AYDOĞAN, Sevim GÜLLÜ, Murat Faik ERDOĞAN
Novel biological agents are available for the treatment of malignancies, and apart from their utility, they may also have several side effects. The effects on the endocrine system are frequently observed, among which thyroid dysfunctions are common and well-characterized, whereas parathyroid dysfunctions are rare and not well characterized. Herein, we describe two of our patients that displayed hypoparathyroidism and were treated with epidermal growth factor receptor (EGFR) inhibitor erlotinib, vascular endothelial growth factor receptor, and EGFR inhibitor vandetanib.
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Objective: Adrenocortical cancer (ACC) is one of the rare
endocrine system cancers that are aggressive. Despite surgical
treatment, the mortality rate is quite high. This study
aimed to examine prognostic factors affecting survival in patients
with ACC, the role of dehydroepiandrosterone sulfate
(DHEA-S), and the maximum standard uptake (SUVmax) values
on predicting mortality through the single-center data.
Material and Methods: A total of 21 patients who were diagnosed
with adrenal cancer and followed from a single center
were included in the study. Patients who survived
follow-ups were included in the survived group (n=6), and
those who died were included in the dead group (n=15). The
demographic, anatomical, pathological, and clinical characteristics
of the patients were analyzed. Positron emission tomography-
computerized tomography imaging and SUVmax
values of adrenal masses were compared. The effect of all
these data on survival was examined. Results: The mortality
rate among patients with ACC was 71%. According to
the Kaplan-Meier survival analysis, the average life expectancy
was 23.66±2.79 (95% CI=18.18-29.13) months. The
mass size of the survived and dead groups was 9.2±3.82
cm and 10.84±4.74 cm, respectively. The production rate of
adrenal hormone was higher in the dead group (p<0.01;
80%). Moreover, the DHEA-S level and SUVmax values were
statistically significantly higher in the dead group (p<0.001;
p<0.05, respectively). Although no metastases were observed
in the survived group during follow-ups after the operation,
distant metastases were observed in 8 people from the
dead group (53%; p<0.05). Conclusion: The mortality rate
was very high in ACC despite surgical and medical treatments.
The higher DHEA-S and SUVmax values may indicate
that the overall survival duration was low.
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