Increase in subcutaneous adipose tissue in the frontal scalp may be associated with androgenetic alopecia and metabolic syndrome.

OBJECTIVE: Recent studies have suggested that androgenetic alopecia (AGA) may be associated with other disorders, especially metabolic syndrome (MetS). This study aimed to determine whether a connection exists between MetS and AGA based on the thickness of the subcutaneous adipose tissue in the scalp. PATIENTS AND METHODS: This cross-sectional study included 34 participants with AGA who had MetS and 33 participants with AGA who did not have MetS. The Hamilton-Norwood scale was employed for classifying AGA and MetS was identified using the US National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATP III criteria). The body mass index (BMI), blood pressure, and lipid profiles of the participants were assessed. Hepatosteatosis and the thickness of the subcutaneous adipose tissue in the scalp were examined using ultrasonography. RESULTS: Compared with the control group, the MetS+AGA group had higher BMI (p = 0.011), systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001) and waist circumference (p = 0.003). Furthermore, the MetS+AGA group had a higher prevalence of dyslipidemia, hypertension (HT) and diabetes mellitus (DM) and higher rates of grade 6 alopecia than the control group (p = 0.019). Compared with the control group, those with MetS had thicker subcutaneous adipose tissue in the frontal scalp (p = 0.018). CONCLUSIONS: The subcutaneous adipose tissue in the frontal scalp was thicker in individuals with AGA who had high Hamilton scores. The concomitance of AGA and MetS may be associated with a high increase in subcutaneous adipose tissue and less favorable metabolic parameters.

Vitamin B12, folic acid, vitamin D, iron, ferritin, magnesium, and HbA1c levels in patients with diabetes mellitus and dental prosthesis.

OBJECTIVE: Diabetic patients may have vitamin deficiencies, which are important in the follow-up and complications of diabetes for various reasons. It may be beneficial to include the use of dental prosthesis among the parameters that should be investigated as a cause of vitamin deficiency during the management and follow-up of diabetes mellitus. We aimed to investigate the association between serum vitamin B12, folic acid, 25-hydroxyvitamin D, ferritin, iron, magnesium, and HbA1c levels in diabetic patients with and without removable dental prosthesis and in non-diabetic patients with prosthesis. PATIENTS AND METHODS: This study is a single-center case-control study. Participants were classified into the following groups: 1) Diabetic patients (n = 528) with prosthesis, 2) non-diabetic patients with prosthesis (n = 121) and 3) diabetic patients without prosthesis (n = 100). Vitamin B12, 25-hydroxyvitamin D, folic acid, ferritin, iron, magnesium, and HbA1c levels were measured and compared across the groups. RESULTS: A significant difference was observed between the groups with respect to the above parameters. Vitamin B12 levels were determined to be higher in the diabetic group without prosthesis. 25-hydroxyvitamin D levels were found to be significantly higher in the non-diabetic group with a prosthesis than in the other two groups. There was no statistical difference in the iron levels between the groups. Ferritin levels were observed to be significantly higher in the diabetic group with prosthesis compared to the other two groups. Magnesium levels were significantly different between all the three groups. The highest magnesium levels were found in the non-diabetic group with prosthesis. HbA1c levels were found to be higher in the diabetic group with prosthesis. Magnesium levels were correlated with 25-hydroxyvitamin D levels, but a negative correlation was observed between these and HbA1c. CONCLUSIONS: Serum vitamin B12 levels were lower in the diabetic and non-diabetic groups with prosthesis compared to the diabetic group without prosthesis. 25-hydroxyvitamin D levels were lower and ferritin was higher in the diabetic groups with and without prosthesis. Magnesium levels were significantly lower in the diabetic group with a prosthesis than in the other two groups. The mean HbA1c level was higher in the diabetic group with prosthesis. The comparison of diabetic patients receiving metformin revealed a higher pronounced vitamin B12 deficiency in the diabetic group with prosthesis. These findings show that those diabetic patients with prosthesis should be evaluated for vitamin B12, 25-hydroxyvitamin D, and magnesium deficiency.

Investigation on the prevalence of thyroid cancer in Graves' patients in northeastern part of Turkey: is surgery a better option for patients with Graves' disease who develop antithyroid drug-related major adverse events?

OBJECTIVE: To determine the prevalence of thyroid cancer in Graves' patients who underwent surgical intervention with and without a history of anti-thyroid drug related major adverse events. PATIENTS AND METHODS: The data of 530 patients with Graves' disease between 2015 and 2020 were retrospectively reviewed. Preoperative ultrasonography reports and thyroid-stimulating hormone receptor antibody values and postoperative histopathological findings were available for 94 patients that had undergone total thyroidectomy procedure. We compared the prevalence of thyroid cancer between patients with and without a history of anti-thyroid drug related major adverse events. RESULTS: Thyroid cancer was detected in 31 of 94 patients that had undergone total thyroidectomy. Of these patients, 18 had at least one nodule; however, thyroid cancer was incidentally detected in 13 patients without nodule. The 31 patients had the following cancer subtypes: 22 had papillary microcarcinoma, 8 papillary carcinoma and 1 noninvasive follicular thyroid neoplasm with papillary-like nuclear features. While thyroid cancer was present in half of the patients operated owing to anti-thyroid drug-related major adverse event, it was detected in 30% of the patients operated due to other reasons. CONCLUSIONS: In the present study, the prevalence of thyroid cancer among patients with Graves' disease was found to be much higher than those of other studies in the literature, suggesting that surgery can be considered primarily for the treatment of Graves' disease. Considering the surgical option in the first plan instead of radioactive iodine therapy appears to be reasonable in patients who develop anti-thyroid drug-related major adverse events.

Risk factors for diabetic foot ulcers in metreleptin naïve patients with lipodystrophy.

AIM: Patients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population. METHODS: Ninety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers). RESULTS: Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95% CI: 3.31-503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95% CI: 2.97-246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95% CI: 1.96-90.67, p = 0.008). CONCLUSIONS: Our study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm.

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

Prevention of bone loss by Panax ginseng in a rat model of inflammation-induced bone loss.

This study evaluated the protective effect of Panax Ginseng (PG) on bone metabolism in an experimental ovariectomy (OVX) model of osteoporosis in which inflammation was induced by subcutaneous magnesium silicate. The groups were: sham control (Group1, SH), sham+inflammation (Group2, SHinf), OVX (Group3), OVX+inflammation (Group4, OVXinf), OVX+inflammation+PG 100 mg/kg (Group5, OVXinf+PG1), OVX+inflammation+PG 200 mg/kg (Group6, OVXinf+PG2), OVX+PG 100 mg/kg (Group7, OVX+PG1), OVX+PG 200 mg/kg (Group8, OVX+PG1). After the OVX surgery, all the groups were allowed to recover for two months. On the 59th day after the OVX, inflammation was induced in Groups 2, 4, 5, and 6 by subcutaneous injections of magnesium silicate in the back of the animals. Groups 5 and 7 were administered oral PG 100 mg/kg, and Groups 6 and 8 were administered oral PG 200 mg/kg from the 60th to the 80th day. PG 200 mg/kg was able to restore BMD, up to values measured in both the OVX and the SH animals. The levels of OC and OP decreased in OVXinf+PG1 and OVXinf+PG2 groups. The serum levels of TNF­α, IL­1ß, and IL­6 were increased significantly in the OVXinf rats compared with the SH group. The present data showed that PG protected against in the OVX model and in inflammation-induced bone loss rat model.

Central retinal vein thrombosis and hyperhomocysteinemia in a young patient with renal transplantation.

A 28-year-old woman was admitted with a sudden loss of vision in the right eye. She underwent renal transplantation in June 1999 for chronic renal failure secondary to amyloidosis. Upon ophthalmologic examination, the patient was diagnosed with central retinal vein occlusion. Physical and laboratory examinations failed to disclose any remarkable pathology except for high homocysteine levels. Hyperhomocysteinemia has been reported as a potential risk factor requiring treatment and a significant association has been found between this condition and central retinal vein thrombosis.

Indirect role of beta2-adrenergic receptors in the mechanism of anti-inflammatory action of NSAIDS.

In this study we investigated both intact and adrenalectomized rats to determine whether or not the anti-inflammatory effects of indomethacin, diclofenac sodium, ibuprofen, nimesulide, tenoxicam and aspirin (IDINTA) are related to adrenal gland hormones in carrageenan-induced inflammation model of rats. Also, we investigated the anti-inflammatory action mechanism of hormones (adrenalin, cortisol) which perform a role in the anti-inflammatory effect of IDINTAon the adrenergic receptors. he results show that IDINTA produces significant anti-inflammatory effects in intact rats (ID(50): 9.82, 10.81, 95.21, 75.23, 8.21 and 61.84 mg/kg), but insignificant effects in adrenalectomized rats (ID(50): 152.97, 188.17, 1275.0, 433.67, 188.16 and 1028.17 mg/kg). In addition, adrenalin and prednisolone caused anti-inflammatory effect rates of 78.3% and 95.7% respectively in adrenalectomized rats. The anti-inflammatory effects of adrenalin and prednisolone did not change when prazosin (alpha(1)-receptor blocker), yohimbine (alpha(2)a2-receptor blocker) and phenoxybenzamine (alpha(2)- and alpha(2)-receptor blocker) were given to rat groups; however, in adrenalectomized rats administered with propranolol (a non-selective blocker of beta(1) and beta(2)-receptors) the anti-inflammatory effect of adrenalin was lost, and that of prednisolone decreased to 36.2%. It was also found that metoprolol (a selective blocker of beta(1)-receptors) did not alter the anti-inflammatory effects of the drugs. As a result, it was shown that anti-inflammatory effects of IDINTA are related to adrenalin and cortisol (corticosterone in rats). It was also determined for the first time that adrenalin (totally) and prednisolone (partially) triggered anti-inflammatory effects via the beta(2)-receptors but not via the alpha(1), alpha(2) and beta(1)-receptors.

Performance of glucose dehydrogenase (GDH) based and glucose oxidase (GOX) based blood glucose meter systems at moderately high altitude.

OBJECTIVE: Self-monitoring of blood glucose (SMBG) is a fairly efficient method of preventing hypoglycaemia in diabetic patients. Blood glucose meters (BGMs) are influenced by factors such as altitude, temperature, blood oxygen concentration, low atmospheric pressure or humidity. In this study we aimed at evaluating the performance of glucose dehydrogenase (GDH) or glucose oxidase (GOX) based glucometers at moderately high altitude. METHOD: A total of 286 female or male patients, most of whom had type 2 diabetes, were included in this study. The simultaneous readings made by two different glucometers were compared with the readings made at the reference laboratory. RESULTS: Blood glucose levels measured by a GDH based glucometer at moderately high altitude were significantly (p=0.007) higher compared to those measured at the reference laboratory. Although blood glucose levels measured by a GOX based glucometer were lower compared to those measured at the reference laboratory, the difference was not significant (p=0.54). The difference between GOX and GDH readings with regard to blood glucose levels was also significant (p=0.001). Blood glucometers were influenced by moderately high altitude. CONCLUSION: The use of a GOX based glucometer at moderately high altitude may be useful in detecting hypoglycaemia at these conditions, since significantly higher blood glucose levels were measured with a GDH based glucometer compared to reference readings.

Follicular thyroid carcinoma: metastasis to the sternum, 13 years after total thyroidectomy.

Primary and metastatic malignancies of the sternum are uncommon. Secondary lesions to the sternum occur more commonly in patients with lung and breast cancer, and only a few cases of sternal metastasis arising from a follicular thyroid carcinoma have been reported in the literature. Rarely, metastases to the sternum present in the guise of primary sternal tumours may be treated surgically with that diagnosis in mind. We describe a case of a sternal mass treated by radical surgery, which ultimately proved to be a solitary metastasis from a follicular carcinoma of the thyroid, appearing 13 years after total thyroidectomy and radioactive iodine therapy. Late metastatic thyroid carcinoma to the sternum should be kept in mind in the differential diagnosis of sternal lesions. For patients with thyroid carcinoma and sternal metastasis, we recommend surgical resection of the metastasis, not only as a curative or palliative measure but also to maximise the effect of subsequent radioiodine treatment.

The effect of high dose losartan on erythropoietin resistance in patients undergoing haemodialysis.

AIM: In some of the patients undergoing haemodialysis, (HD) resistance might develop against recombinant human erythropoietin (rHuEPO) used for treatment of anaemia. Recently, angiotensin-converting enzyme (ACE) inhibitors that are used to treat hypertension and congestive heart failure in HD patients have been suggested to contribute to anaemia as well by inhibiting erythropoiesis. Our purpose in this study is to investigate whether or not losartan, an angiotensin II (ATII) receptor antagonist, is causing rHuEPO resistance. METHODS: In this prospective study of 12 months, we compared the effects of high dose losartan (100 mg/day) and amlodipine (10 mg/day) on rHuEPO requirement in 40 hypertensive patients receiving rHuEPO for more than 12 months on maintenance HD. Twenty normotensive rHuEPO dependent patients served as control group. Iron deficiency, hyperparathyroidism, aluminium intoxication, infections and inflammations were excluded in all patients. RESULTS: The mean haemoglobin level was found >8 g/dl in all groups. The mean weekly rHuEPO dose increased in the losartan group (p<0.0001 vs before) and remained constant in the other groups. No significant differences were found with PTH, iron status, aetiologies of renal failure in all groups. CONCLUSION: High-dose losartan increases rHuEPO requirement and should be reserved for dialysis patients with hypertension uncontrollable with other antihypertensive medications.

Clinical and biochemical outcome of renal amyloidosis.

AA amyloidosis is a relatively rare disease which complicates chronic inflammatory diseases, chronic infections, familial Mediterranean fever (FMF) and malignant diseases. Although amyloid deposition may be found in many organs, renal involvement dominates the clinical picture. We reviewed 63 patients with AA amyloidosis who presented to our nephrology department between 1995 and 2000. Prognostic markers, detailed history, physical examination and laboratory tests were evaluated. The causes of AA amyloidosis were as follows: FMF 42 (66.6%), pulmonary tuberculosis 9 (14.2%), chronic osteomyelitis 4 (6.3%), bronchiectasia 4 (6.3%), rheumatoid arthritis 1 (1.5%), juvenile idiopathic arthritis 1 (1.5%), inflammatory abdominal aortic aneurysm 1 (1.5 %), unknown aetiology 1 (1.5%). The diagnosis was made on renal biopsies in 63.4% of the patients, while the remaining 36.6% were diagnosed as a result of rectal biopsies. Sixteen patients died. A low serum albumin, high creatinine and high 24-hour urine albumin excretion were associated with high mortality.

Increased serum ferritin levels in active Behçet's disease.

There is no routine test to evaluate the activity of Behçet's disease (BD). Ferritin as a serum predictor of iron storage is an important acute phase reactant. In this study, we assessed serum ferritin levels in patients with active BD and compared them with those of patients with inactive BD. We aimed to show the relationship between ferritin and BD. The patients with BD were subdivided into two groups according to disease activity: active (24 patients; 18 men and 6 women, average age 36.5 +/- 4.9 [28-45] years), and inactive (20 patients; 16 men and 4 women, average age 37.2 +/- 5.2 [30-49] years). Twenty healthy volunteers (15 men and 5 women; average age 38.2 +/- 4.6 [30-47] years) served as controls. Patients with active BD had significantly higher serum ferritin levels (p=0.0001) than the inactive and control groups. Ferritin levels in patients with inactive BD did not differ significantly from healthy control subjects (p=0.687). We concluded that in patients with active BD, serum ferritin levels are increased and do not reflect serum iron levels.

Effect of losartan treatment on the proteinuria in normotensive patients having proteinuria due to secondary amyloidosis.

Secondary amyloidosis (AA amyloidosis) is a well known cause of nephrotic syndrome and renal failure. Several studies in patients with nephrotic syndrome have suggested a beneficial effect of angiotensin-converting enzyme inhibitors (ACEI). Angiotensin II (ATII) receptor antagonists effect on the long term is not known. In this study, we intended to study the effect of losartan, as an ATII receptor antagonist, on proteinuria and renal functions in patients with normotensive secondary amyloidosis. In total 44 patients with biopsy proven AA amyloidosis associated with nephrotic proteinuria were included. The first group of patients (n=22) was treated with losartan 50 mg/day. The second group of patients (n=22) did not receive any specific antiproteinuric treatment. Urinary protein loss was effectively lowered by losartan from 4.38 +/- 1.0 to 2.8 +/- 0.61 g/day (p<0.0001), whereas the control group showed a slight fall in proteinuria as 4.21 +/- 1.06 to 4.12 +/- 1.07 g/day (p = 0.176). Hypoalbuminemia improved significantly from 2.52 +/- 0.69 to 2.78 +/- 0.46 g/dl (p = 0.004), in the losartan group, whereas serum albumin had fallen in the control group from 2.44 +/- 0.57 to 2.27 +/- 0.41 (p = 0.041). Serum creatinine increased in the control group from 1.52 +/- 0.42 to 2.39 +/- 0.51 mg/dl (p<0.0001), and in the losartan group from 1.59 +/- 0.50 to 1.84 +/- 0.6 mg/dl (p<0.001), after 24 months of treatment. The ATII receptor blocker losartan is effective in protecting against the progression of nephropathy due to AA amyloidosis. Symptomatic treatment of proteinuria with losartan is therefore to be considered, especially with severe proteinuria even in normotensive patients.