Cardiovascular evaluation and endothelial dysfunction in Cushing syndrome following remission: a prospective study.

PURPOSE: Cushing syndrome (CS) is a well-known risk factor for cardiovascular morbidities. We aimed to evaluate endothelial and cardiovascular functions, endothelial mediators and pro-inflammatory cytokines in patients with CS before and after remission. METHODS: Adult patients with newly diagnosed endogenous CS were included. Metabolic [body mass index (BMI), glucose, and lipid values] and cardiovascular evaluation studies [24-h ambulatory blood pressure monitoring, carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and echocardiography] were performed, and endothelial mediators [asymmetric dimethyl arginine (ADMA) and endothelin-1 (ET-1)] and pro-inflammatory cytokines [interleukin-1ß (IL-1ß) and tumor necrosis factor-alpha (TNF-α)] were measured. Control group was matched in terms of age, gender, and BMIs. RESULTS: Twenty-five patients, mean age 40.60 ± 14.04 years, completed the study. Compared to controls (n = 20) mean arterial pressure (MAP) and CIMT were higher (p < 0.005 and p = 0.012, respectively), and FMD (p < 0.001) and mitral E/A ratio (p = 0.007) lower in the patients during active disease. Baseline serum ADMA, ET-1, and IL-1ß were similar between the groups, while TNF-α was lower in the patients (p = 0.030). All patients were in complete remission 1 year following surgery. BMI, LDL cholesterol, serum total cholesterol, fasting plasma glucose, MAPs, and CIMT significantly decreased (p < 0.005), while there was no improvement in FMD (p = 0.11) following remission. There was no significant change in ADMA, IL-1ß, and TNF-α levels, but ET-1 increased (p = 0.011). CONCLUSIONS: Remission in CS improves some cardiovascular parameters. ADMA and ET-1 are not reliable markers for endothelial dysfunction in CS. Metabolic improvements may not directly reflect on serum concentrations of TNF-α and IL-1ß following remission of CS.

Effect of placenta previa on umbilical cord hematocrit value.

OBJECTIVE: Placenta previa is one of the causes of neonatal anemia. This condition is mainly explained by antenatal hemorrhage and incision of the anteriorly located placenta during cesarean section. However, the mechanism of neonatal anemia in placenta previa has not been extensively studied or well elucidated. This study investigates whether placenta previa is associated with lower hematocrit levels in newborns with no antenatal hemorrhage and placental incision. KEY FINDINGS: This prospective study investigated 47 patients with previa and 43 control patients who gave birth with a cesarean section at 34-38 weeks of gestation. Blood samples were obtained from the fetal end of the umbilical vein. The mean umbilical cord hematocrit value was 49.3% in the control patients and 46.7% in the patients with previa, and the difference was statistically significant (p = .029). No significant association was observed between hematocrit value and birth weight, gestational age, newborn gender, placenta position, or preoperative maternal hemoglobin level. CONCLUSION: The study findings reveal that even if not complicated by antepartum or intrapartum hemorrhage, placenta previa may be associated with lower hematocrit values in newborns. Although in none of the cases, the umbilical cord hematocrit value was not as low as to be defined as anemia, this effect of previa on newborns should be considered because of the importance of iron status.

A postpartum arteriovenous malformation case diagnosed with late postpartum bleeding.

Postpartum hemorrhage is the most important and also preventable cause of maternal morbidity and mortality worldwide. Arteriovenous malformation (AVM) is a rare cause of postpartum hemorrhage. We present a case of arteriovenous malformation, which may be one of the rare but potentially fatal causes of postpartum hemorrhage (PPH). In the case report, on the postpartum 52nd day, the patient presented to the emergency department with a complaint of vaginal bleeding. Doppler ultrasonography revealed a lesion compatible with the vascular structure, the largest diameter of 28 * 28 mm, in the uterus. The patient was found not eligible for embolization, and a hysterectomy was then indicated. After the hysterectomy, the pathology diagnosis supported the initial clinical and radiological suspicions of AVM. Hysterectomy is the definitive treatment method of AVM and should be considered in patients who are not eligible for embolization. This case is presented to draw the attention of physicians to AVM as a possible cause of secondary PPH.

Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever.

OBJECTIVE: To investigate the association between maternal serum neutrophil-to-lymphocyte ratios (NLRs) and pregnancy outcomes in women with familial mediterranean fever (FMF). BACKGROUND: FMF exists worldwide, it primarily affects Mediterranean countries METHODS: We retrospectively analysed data from 269 pregnant women, who underwent a routine prenatal follow-up and delivery in our hospital from 2016 to 2020. Clinical and demographic data, including age, gravida, parity, abortus, proteinuria in the first trimester, NLR, obstetrical complications, gestational age at delivery, birthweight were retrieved from the patients' medical records. Data from 67 pregnant women with FMF and 202 healthy pregnant women were compared. RESULTS: Patients with FMF showed higher rates of preeclampsia and primary caesarean delivery; however, there were no differences between the groups in terms of other obstetric complications or adverse neonatal outcomes. In both the FMF and control groups, NLRs in the third trimester were significantly higher than those in the first trimester. Additionally, patients in the FMF group demonstrated higher NLRs than patients in the control group in the third trimester. CONCLUSIONS: The NLRs are a haematological parameter that can be used to predict subclinical inflammation and the effects of ongoing subclinical inflammation on the pregnancy outcomes in women with FMF (Tab. 4, Ref. 39).

Vitamin D intoxication due to misuse: 5-year experience.

INTRODUCTION: Vitamin D intoxication (VDI) is a well-known cause of hypercalcemia in children and leads to serious kidney, heart, and neurological problems. In the treatment of VDI, the goal is to correct hypercalcemia. Our aim was to evaluate the clinical features of patients with VDI, identify the causes of VDI in our region, and help guide precautions and treatment of VDI. MATERIALS AND METHODS: The medical records of patients with VDI presenting between January 2015 and December 2019 were retrospectively analyzed. RESULTS: In total, 38 patients aged 0.3-4 years including 20 males (52.6%) were included in the study. Vomiting (65.8%), loss of appetite (47.4%), and constipation (31.6%) were the most common symptoms. The cause of intoxication was prescribed D3 vials in 23 patients, non-prescribed D3 vials in nine patients, and incorrectly produced fish oil supplement in six patients. Admission serum calcium and 25 (OH) D levels were 3.75±0.5mmol/L and 396±110ng/mL, respectively. A statistically significant correlation was found between the serum calcium levels at the time of diagnosis and the dose of vitamin D received, serum 25 (OH) D, phosphorus, and parathyroid (PTH) levels. Nephrocalcinosis was present in 15 (39.5%) patients. The mean time to achieve normocalcemia was 6.18±2 days. The mean time to achieve normocalcemia in patients treated with pamidronate was 5.94±0.7 days. CONCLUSION: Stoss therapy should not be administered for children of families with problems of adherence to treatment. It should be noted that VDI may develop as a result of improperly produced nutritional supplements. General practitioners and pediatricians must be aware of VDI risks and explain them to parents. Pamidronate is effective for treating VDI in children.

Molecular skin changes in Cushing syndrome and the effects of treatment.

OBJECTIVE: We investigated newly diagnosed patients with endogenous CS for molecular changes in skin by biopsy before and a year after treatment of CS. PATIENTS AND METHODS: 26 Patients with CS and 23 healthy controls were included. All the patients were evaluated before and a year after treatment. Skin biopsies were obtained from abdominal region before and a year after treatment in patients with CS and once from healthy volunteers. Total RNA was isolated from the skin biopsy samples and the real-time PCR system was used to determine the expression levels of 23 genes in the skin biopsy. RESULTS: Skin expression levels of HAS 1, 2 and 3 mRNAs were lower and COL1A2, COL2A1, COL3A1 mRNAs were higher in patients with CS than in normal controls. MMP-9, TIMP-1 and elastin mRNA expression levels were similar in two groups. Skin IL-1ß mRNA expression level was significantly higher in patients with CS. None of these parameters changed significantly 12 months after treatment. Patients with CS showed higher skin GH and HSD11B1 mRNA expressions and lower GHR and IGF-1R mRNA expression compared to control. Expression levels of IGF-1, GR and HSD11B2 mRNA were similar in two groups. None of these parameters changed significantly 12 months after treatment. CONCLUSION: CS is associated with increased expression levels of skin COL1A2, COL2A1, COL3A1 mRNAs (which are correlated with increased expression level of skin GH mRNA). Decreased skin HAS may cause decreased synthesis of HA that contributes to thinning of skin in CS. Increased local inflammatory cytokine and HSD11B1 mRNAs may be related to the acne formation in CS. Treatment of CS was not able to reverse these changes and ongoing changes were detected after treatment.

Seroprevalence of Toxoplasma gondii infections in Syrian pregnant refugee women in Turkey.

OBJECTIVE: Congenital infections in refugee women have been very rarely studied. The purpose of this study is to investigate the Toxoplasma gondii (T. gondii) seroprevalence in Syrian pregnant refugee women living in Turkey and to discuss the differences with Turkish pregnant women. STUDY DESIGN: This is a retrospective cohort study including 752 pregnant refugee women and is based on the nine-year data of a reference public hospital in Ankara. RESULTS: In the study group, T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) seropositivity rates were 47 % and 0.4 %, respectively. Compared with a recent study conducted in the same center on Turkish native pregnant women, there was a significant difference in IgG seropositivity and no significant difference in IgM seropositivity. CONCLUSION: Due to the seroprevalence difference between the indigenous and refugee groups, the Syrian refugee women has to be specifically considered in the prevention of congenital toxoplasmosis infections in Turkey.

ARE THE FACTORS AFFECTING ADVERSE PREGNANCY OUTCOMES DIFFERENT IN OBESE GESTATIONAL DIABETES PREGNANT WOMEN RECEIVING DIET OR INSULIN TREATMENT?

CONTEXT: We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. SUBJECTS AND METHODS: The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. RESULTS: The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. CONCLUSION: The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome.

LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED?

PURPOSE: To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. METHODS: Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. RESULTS: Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). CONCLUSION: Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Knowledge, perspectives and attitudes about allergen-specific immunotherapy for respiratory allergic disease among paediatricians in Turkey.

BACKGROUND: Allergen-specific immunotherapy (ASI) is the only effective treatment for allergic respiratory diseases which has the potential to change the natural course of the disease. In this present study we aimed to evaluate the paediatricians' knowledge, perspectives and attitudes about ASI for allergic respiratory diseases. MATERIALS AND METHODS: The study was conducted between September 2014 - January 2015. A survey of 25 questions assessing paediatricians' knowledge, perceptions and attitudes about ASI was developed by an expert panel and applied by physicians in hospitals in Izmir, Turkey, where the paediatricians work. Data were recorded in SPSS for Windows v.16. Descriptive statistics, chi square analysis was used. P<0.05 was considered as significant. RESULTS: Fully completed surveys from 180 paediatricians were analysed. The respondent paediatricians had an age of 37±8.2 years, and 56 of them were male. The majority of the respondents (n: 146) were working fewer than five years as a paediatric specialist. 93.9% of the paediatricians believed that ASI was effective for the treatment of allergic respiratory diseases. There was satisfactory knowledge of the characteristics, aims, effects and limits of ASI. CONCLUSION: ASI is generally well-known and accepted among paediatricians. A better synergy between paediatricians and paediatric allergy specialists can provide more use of this treatment method for allergic respiratory diseases in childhood.

Treatment with Doxycycline of Generalized Annular Elastolytic Giant Cell Granuloma Associated with Borrelia burgdorferi Infection.

This is a case of generalized annular elastolytic giant cell granuloma (AEGCG) associated with borrelia infection and genes of p-30, p-31, p-39. A possible cross-mediated reaction from the T-cell type which might have induced the AEGCG is discussed from the concept of "heat-shock proteins (HSPs) and molecular mimicry".

Primary Intestinal-type Adenocarcinoma of the Nasal Cavity: A Case Report.

We report a rare case of sinonasal intestinal-type adenocarcinoma in the nasal cavity. A 31-year old man represented with headache and epistaxis. We identified a malignant tumour, which is a rare pathology, with detailed physical examination, anterior rhinoscopy, computed tomography scan, magnetic resonance imaging and histopathologic examination. Endoscopic excision of the tumour was performed. After three years of follow-up of the patient in our clinic, there was no sign of any recurrence.

Breathing-enhanced upper extremity exercises for patients with multiple sclerosis.

OBJECTIVE: To explore the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis. DESIGN: Randomized controlled study of six-week duration. SUBJECTS: Forty patients with multiple sclerosis (age 39.2 +/- 7 years; Kurtzke Expanded Disability Status Scale scores: 4.51 +/- 1.55) randomly divided into two groups. METHODS: The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. Controls performed no exercises. All subjects submitted to baseline and post-training tests of spirometry, respiratory muscle strength and 6-minute walking. They were also assessed with pulmonary dysfunction and exertion fatigue indices. RESULTS: Spirometry revealed clear improvement in forced expiratory volume in 1 second (FEV1) (+13%, P = 0.003) resulting in higher FEV1/FVC (forced vital capacity) (+8.5%, P = 0.03). Maximal inspiratory pressure (P (Imax)) increased by +7.1% but not significantly. Maximal expiratory pressure (P(Emax)) and FVC were significantly higher (by +7.1%, P = 0.0066 and +4.8%, P = 0.036 respectively) with respect to baseline measures. Pulmonary dysfunction was reduced (-9%, P = 0.002) while 6-minute walking distance was longer (+16%, P = 0.029) at equal exertion fatigue level. CONCLUSIONS: The programme improved most pulmonary performance measures and had clinical significance. Its sustained application may prevent respiratory complications frequently observed in the later stages of multiple sclerosis.

Effects of home exercises on motor performance in patients with Parkinson's disease.

OBJECTIVE: To investigate the effect of home exercises on the motor performance of patients with Parkinson's disease. DESIGN: A prospective blinded study with allocation of patients into their groups by alternate weeks. SETTING: A University Hospital neurology and physiotherapy department. SUBJECTS: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinson's disease, classified as Hoehn and Yahr Grades I, II and III. INTERVENTIONS: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n = 15) were given a schedule of exercises to undertake at home; the others (n = 15) did not receive this instruction. MEASURES: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. RESULTS: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). CONCLUSIONS: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.

Effects of Different Fruits and Storage Periods on Microbiological Qualities of Fruit-Flavored Yogurt Produced in Turkey.

Comparative microbiological analyses of fruit-flavored yogurt, plain yogurt, and plain yogurt with 8% sugar were conducted in this research. The fruit-flavored yogurts were produced from evaporated cow's milk (19.75% dry matter) containing 16% jam prepared with an equal weight of sugar and fruit (sour cherry, orange, strawberry, or banana). The total plate count, lactic acid and coliform bacteria, and yeast and mold counts were determined in yogurt samples stored for 1, 3, 5, 7, 9, and 13 days. In conclusion, it is suggested that these types of yogurt should not be stored longer than 7 days, because when a carryover culture is used for yogurt production, most likely yeast contamination will occur. Otherwise, pure starter culture should be utilized in yogurt production.