Evaluation of peripheral olfactory pathways in chronic autoimmune thyroiditis.

PURPOSE: In this study, we aimed to radiologically evaluate the olfactory bulb (OB) volume and olfactory sulcus (OS) depth of adult patients diagnosed with chronic autoimmune thyroiditis. METHODS: Sixty-eight patients over 18 years of age with Hashimoto's thyroiditis and 66 healthy controls with normal thyroid function tests were included in the study. OB volume and OS depth measurements were performed using cranial magnetic resonance imaging (MRI) obtained from coronal T2-weighted images. The relationship between thyroid function tests, autoantibodies, and measurements of the OB and OS were evaluated. RESULTS: The right and left OB volumes were significantly lower in the patients with Hashimoto's thyroiditis than in the control group (p < 0.05). No significant difference was found between the patient and control groups in terms of OS depth (p > 0.05). There were significantly negative correlations among TSH, thyroid antibodies, and the bilateral OB volume measurements. In the Bonferroni post hoc analysis, when people with euthyroid Hashimoto's thyroiditis and the control group were compared, there was no statistically significant difference between bilateral OB volumes and thyroid function tests. CONCLUSION: Diminished bilateral OB volumes were found in our patients with chronic autoimmune thyroiditis. Interestingly, the OB volumes were not affected in patients with euthyroid Hashimoto's thyroiditis. When a decrease in OB volume is detected on MRI, it should be kept in mind that odor dysfunction in hypothyroid patients with Hashimoto's thyroiditis may occur and patients should be clinically evaluated.

The Epidemiology, Clinical Manifestations, Radiology, Microbiology, Treatment, and Prognosis of Echinococcosis: Results of NENEHATUN Study.

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 ± 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important.

Fungal Infections in COVID-19 Intensive Care Patients.

Opportunistic fungal infections increase morbidity and mortality in COVID-19 patients monitored in intensive care units (ICU). As patients' hospitalization days in the ICU and intubation period increase, opportunistic infections also increase, which prolongs hospital stay days and elevates costs. The study aimed to describe the profile of fungal infections and identify the risk factors associated with mortality in COVID-19 intensive care patients. The records of 627 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Opportunistic fungal infection was detected in 32 patients (5.10%) of 627 patients monitored in ICU with a COVID-19 diagnosis. The average APACHE II score of the patients was 28 ± 6. While 25 of the patients (78.12%) died, seven (21.87%) were discharged from the ICU. Candida parapsilosis (43.7%) was the opportunistic fungal agent isolated from most blood samples taken from COVID-19 positive patients. The mortality rate of COVID-19 positive patients with candidemia was 80%. While two out of the three patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Opportunistic fungal infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided.

Assessment of erythrocyte morphology in patients with type 2 diabetes mellitus: a pilot study of electron microscopy-based analysis in relation to healthy controls

Background/aim: The present study aimed to assess erythrocyte morphology in newly diagnosed type 2 diabetes mellitus patients using scanning electron microscopy. Materials and methods: In total, 30 patients admitted to endocrine outpatient clinics were included in the study. The patients were divided into two groups according to their fasting blood glucose levels: type 2 diabetes mellitus (n = 15, fasting blood glucose levels ≥ 126 mg/dL) and control (n = 15, fasting blood glucose levels < 99 mg/dL). The patient's demographic characteristics, haemoglobin A1c levels, and scanning electron microscopy findings regarding erythrocyte morphology were recorded. Results: There was no significant difference between the control and type 2 diabetes mellitus group in terms of the participants' age (51.13 ± 8.53 vs. 50.33 ± 8.72 years, p = 0.8) and the male/female ratio (9/6 vs. 9/6). In the control group, discocytes were abundant, echinocytes were rare, and spherocytes were absent. On the other hand, discocytes were less common and echinocyte-shaped erythrocytes were more common in the type 2 diabetes mellitus group than in the control group. In addition, spherocytes were detected in the type 2 diabetes mellitus group. Moreover, the diameter of discocytes was significantly lower (p = 0.014), and blood glucose and haemoglobin A1c levels were significantly higher (p < 0.05 for both) in the type 2 diabetes mellitus group than in the control group. Conclusion: Our findings indicate that high glucose levels in type 2 diabetes mellitus patients lead to significant alterations in erythrocyte morphology, including decreased erythrocyte deformability and the formation of echinocytes and spherocytes due to eryptosis. The possibility of decreased erythrocyte deformability due to excessive eryptosis may disturb microcirculation in newly diagnosed, treatment-naïve type 2 diabetes mellitus patients who do not have any complications.

Nonfunctional adrenal incidentalomas may be related to bisphenol-A.

PURPOSE: Bisphenol-A (BPA) is an endocrine-disrupting chemical that may affect the hormones and their receptors. The aim of this study is to determine whether BPA has an effect on the development of nonfunctional adrenal incidentaloma (NFAI). METHODS: Fifty patients who were admitted to endocrinology outpatient clinics and diagnosed as NFAI were included in the study. Fifty healthy people without adrenal mass and adrenal pathology in the upper abdominal computerized tomography or magnetic resonance imaging were also included as control group. Age, gender and body mass index of the study groups were similar. The serum samples for BPA were stored at -80 °C in refrigerator until working in the lab. Serum BPA levels were measured using ELISA technique. RESULTS: Mean serum BPA level was 7.06 ± 3.96 ng/ml in NFAI patients and 4.79 ± 3.01 ng/ml in control group. Serum BPA level was significantly higher in NFAI group than control group (p = 0.001). Serum BPA levels were also found to be significantly higher in women with NFAI than in men with NFAI (p = 0.019). CONCLUSIONS: The mechanisms of NFAI development have not been clarified yet. Increased BPA exposure with developed industrialization may play a role in NFAI formation. For the reduction of BPA exposure, the use of plastic prepacked products, plastic containers, and safety measures are essential for public health.

Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction.

OBJECTIVES: This study aims to investigate the effect of chiropractic manipulative treatment on sacroiliac joint dysfunction (SIJD) and its relationship to oxidative stress (OXS) parameters. PATIENTS AND METHODS: Thirty-three patients diagnosed with SIJD (20 males, 13 females; mean age 36.3±9.7 years; range, 18 to 60 years) and 30 healthy volunteers (20 males, 10 females; mean age 36.4±12.2 years; range, 20 to 57 years) were included in this cross-sectional, case-control study conducted between February 2017 and September 2017. Manipulation was applied to the patients once a week for a duration of four weeks. The patients were evaluated at pre-treatment and one month after treatment with visual analog scale, SIJD test, and total thiol, native thiol, disulphide, and ischemia-modified albumin (IMA) as OXS indicators. RESULTS: Prior to treatment, we demonstrated that serum native thiol (µmol/L) and total thiol (µmol/L) levels in the patient group were lower compared to control subjects (p=0.03 and p=0.02, respectively). Serum IMA levels were higher in the patient group (p=0.01). There was no change in OXS parameters after manipulative treatment in the patient group. CONCLUSION: Manipulation is useful in SIJD. Thiol/disulphide homeostasis and serum IMA levels may be used to measure the OXS in patients with SIJD.

Detecting pain severity with full cup test in painful diabetic peripheral neuropathy.

OBJECTIVES: The aim of this study was to test the utility and validity of the full cup test (FCT) to assess the severity of pain in subjects with painful diabetic peripheral neuropathy (PDPN). METHODS: Subjects with diabetic PDPN were enrolled for this prospective, cross-sectional study. Other causes of PDPN and subjects with cognitive impairment were excluded. The diagnosis of neuropathic pain was made using the results of a physical examination and the Douleur Neuropathique 4 questionnaire. Pain severity was assessed with a FCT and a visual analog scale (VAS) administered before and after treatment. The correlation of FCT with VAS was evaluated to examine validity. RESULTS: A total of 43 (33 female, 10 male) subjects were included. The mean age was 61.9±8.25 years and the mean disease duration was 13.02±7.6 years. Type I diabetes mellitus (DM) was present in 2 (4.7%) subjects and Type II DM in 41 (95.3%) subjects. The mean glycated hemoglobin level was 8.9±1.9 mmol/mol. When the mean VAS and FCT scores were analyzed, the results were 6.7±2.05 and 66.35±23.2, respectively, pretreatment and 4.6±2.2 and 41.36±23.5 posttreatment, which were both statistically significant (p<0.001, p<0.001). The mean control period was 23.4 days (min-max: 15-30 days). The VAS and FCT scores in pretreatment and posttreatment demonstrated a high positive correlation (rs=0.86, p<0.001; rs=0.843, p<0.001). CONCLUSION: The FCT can be useful to detect pain severity in PDPN.

Fatty acid transport receptor soluble CD36 and dietary fatty acid pattern in type 2 diabetic patients: a comparative study.

Recently, it has been remarked that dietary fatty acids and fatty acid receptors might be involved in the aetiology of diabetes. Therefore, this study was conducted to determine the relationship between dietary fatty acid pattern, fatty food preferences and soluble CD36 (sCD36) and insulin resistance in type 2 diabetes mellitus (DM). The study was carried out with thirty-eight newly diagnosed type 2 DM patients and thirty-seven healthy volunteers, aged 30-65 years. In the study, socio-demographic characteristics, dietary fat type and fatty acid pattern of individuals were recorded. After anthropometric measurements were taken, blood CD36, glucose, TAG and insulin levels were analysed. The results showed that although the type of fatty acid intake did not differ between the groups (P>0·05), the consumption of olive oil in the type 2 DM group was lower than the control group (P0·05). Crucially, elevated sCD36 levels increased the type 2 DM risk (OR 1·21, P<0·05). In conclusion, sCD36 level may be a possible biomarker, independent from the dietary fatty acid pattern, for type 2 DM owing to its higher levels in these patients. Therefore, the new insights make CD36 attractive as a therapeutic target for diabetes.

Choroidal thickness in obese women.

BACKGROUND: Excessive weight is a well-known risk factor for microvascular diseases. Changes in thickness in a vascular tissue, such as the choroid, can be useful to evaluate the effect of obesity on the microvascular system. The aim of this study was to evaluate the choroidal thickness (CT) changes in obese women, using optical coherence tomography (OCT). METHODS: The prospective clinical study included examination of the right eyes of 72 patients. The right eyes of 68 patients were examined and served as the controls. A complete ophthalmological examination and OCT imaging were performed for each group studied. The CT in each eye was measured using OCT. RESULTS: The obese group consisted of 72 female patients with a mean age of 37.27 ± 1.18 years. The control group included 68 female subjects with a mean age of 37.85 ± 7.98 years (p > 0.05). There was no statistical significant difference for the foveal retinal thickness measurements between the two groups (p > 0.5). Our study revealed significant choroidal tissue thickening subfoveally and at areas 500 µm temporal, 500 µm nasal, and 1500 µm nasal to the fovea in the obese group (all p < 0.05). There was a positive correlation between body mass index (BMI) and CT changes. CONCLUSIONS: CT may increase in obese women and a positive correlation was found between BMI and CT. The trial protocol was approved by the Local Ethical Committee of the Kirikkale University, date of registration: April 27, 2015 (registration number: 10/11).

The importance of speckle tracking echocardiography in the early detection of left ventricular dysfunction in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is characterized by hormonal and metabolic abnormalities and is thought to increase a risk for cardiovascular diseases. In this study we use speckle tracking echocardiography (STE) to evaluate left ventricular (LV) dysfunction in the early period of the disease. We enrolled 31 patients with PCOS and 32 healthy volunteers as a control group. The participants' ages ranged between 18 and 40 years. PCOS was diagnosed according to the Rotterdam criteria. LV strain (LS) and strain rate (SR) were evaluated using apical two-chamber (2C), three-chamber (3C), and four-chamber (4C) imaging. Global LS and SR were calculated as average of three apical views. The waist-to-hip ratio, homeostasis model assessment-insulin resistance (HOMA-IR), and fasting insulin and triglyceride levels were higher in the PCOS group than in the controls (p=0.001, p=0.001, p=0.001, and p=0.005, respectively). In the PCOS group, the mitral A wave, deceleration time (DT), and isovolumetric relaxation time (IVRT) were significantly higher than in the controls (all p<0.05). The LV global longitudinal strain (GLS) and global longitudinal SR systolic (GLSRS) were significantly lower in the PCOS patient group (both p= 0.001). There were strong negative correlations between GLS and both fasting insulin (r=-0.64) and DT (r=-0.62) (both p<0.05). The study demonstrated that PCOS patients had decreased LV function using STE. Therefore, STE imaging appears to be useful for the early detection of subclinical LV dysfunction in patients with PCOS.

Mean platelet volume in a patient with male hypogonadotropic hypogonadism: the relationship between low testosterone, metabolic syndrome, impaired fasting glucose and cardiovascular risk.

Isolated male hypogonadotropic hypogonadism (IHH) can be congenital or acquired. Mean platelet volume (MPV), determinant of platelet function, is an independent risk factor for cardiovascular disease (CVD). The aim of this study was to evaluate MPV values in male IHH and the relationships between MPV, low testosterone levels, metabolic syndrome, impaired fasting glucose (IFG) and cardiovascular risk. Thirty-one patients with untreated, normosmic, isolated, male IHH (mean age 22.5 ± 7.58 years) and 30 age and BMI-matched healthy individuals (mean 22.51 ± 4.94 years) were included in the study. All hormonal analyses were done by chemiluminesance assay. All study participants were evaluated by biochemical and platelet parameters. MPV were significantly higher in IHH than controls (8.6 ± 0.65 and 7.6 ± 0.54 fl, respectively; P = 0.000). MPV had a positive correlation between metabolic syndrome (r = 0.444; P = 0000), IFG (r = 0.371; P = 0.04), insulin (r = 0.820; P = 0.02), homeostasis model assessment (HOMA)-IR (r = 0.822; P = 0.0023) and BMI (r = 0.373; P = 0.012). MPV had a negative correlation between total testosterone (r =  -0.586; P = 0.0000), free testosterone (r =  -0.634; P = 0.0000), luteinizing hormone (r =  -0.471; P = 0.0000) and FSH (r =  -0.434; P = 0.0000). Although control patients did not have metabolic syndrome and IFG, IHH patients had metabolic syndrome and IFG significantly more often (P < 0.001, P = 0.003, respectively). Age, metabolic syndrome, IFG, BMI, fasting glucose, insulin, CRP and HOMA-IR were independent predictive factors of MPV in the multiple regression analysis. These results suggest that men with IHH are susceptible to increased platelet activation and increased MPV values that contribute to an increased risk of cardiovascular complications. From this study, it has been observed that IHH with low testosterone may be a feature of the metabolic syndrome, IFG, increased MPV levels and cardiovascular risk in young adult males.

Mean platelet volume in euthyroid patients with Hashimoto's thyroiditis.

Mean platelet volume (MPV) is the measure of platelet size. MPV possibly is a simple way to estimate platelet activity. In this study, we aimed to investigate MPV levels in euthyroid Hashimoto's thyroiditis patients. Fifty-one euthyroid patients with Hashimoto's thyroiditis attending our outpatient clinic of the endocrinology department, and 51 age and BMI-matched healthy individuals were included in this study. All patients with euthyroid Hashimoto's thyroiditis were at euthyroid state. None of the study patients was subjected to levothyroxine replacement therapy. Anti-thyroid peroxidase (anti-TPO) antibody and anti-tiroglobulin antibody were positive. All the study participants were evaluated by biochemical and platelet parameters. There were no significant differences in age (33.88 ±â€Š12.87 and 30.18 ±â€Š12.43 years, respectively; P > 0.05) and BMI (23.55 ±â€Š3.34 and 22.25 ±â€Š3.65 kg/m, respectively, P > 0.05) between the study and the control groups. Anti-TPO and anti-tiroglobulin levels were significantly higher in the study group (anti-TPO 428.32 ±â€Š668.39 IU/ml in the euthyroid Hashimoto's thyroiditis group; 14.85 ±â€Š9.66 IU/ml in the control group, P = 0.001; anti-tiroglobulin 320.46 ±â€Š796.05 IU/ml in the euthyroid Hashimoto's thyroiditis group, 21.28 ±â€Š26.24 IU/ml in the control group, P = 0.09). There were no significant differences in terms of serum thyroid-stimulating hormone (TSH) (1.76 ±â€Š0.79 and 1.85 ±â€Š1.14 uIU/ml, respectively), FT3 (3.10 ±â€Š0.37 and 3.29 ±â€Š0.76 pg/ml, respectively) and FT4 (1.22 ±â€Š0.42 and 1.46 ±â€Š0.78 pg/ml, respectively) levels between the study and the control groups. Serum triglyceride levels were significantly higher in the study group than in the control group (133.81 ±â€Š91.50 and 90.18 ±â€Š41.15 mg/dl, respectively; P = 0.015). Mean MPV levels were significantly higher in the euthyroid Hashimoto's thyroiditis group than in the control patients (8.8 ±â€Š1.05 and 7.9 ±â€Š0.79 fl, respectively; P = 0.0001). To assess the correlation with MPV, a Pearson's correlation analysis was performed on each variable. There were positive correlations between anti-TPO and MPV levels (r = 0.246, P = 0.042), and between anti-tiroglobulin and MPV levels (r = 0.256, P = 0.033). The multiple regression analysis of MPV and other risk factors was performed. Age, BMI, C-reactive protein and waist circumference were independent predictive factors of MPV. Adjustment for other factors did not alter these relative risks. Our results suggest that even if in euthyroid state, patients with euthyroid Hashimoto's thyroiditis have higher MPV levels than the healthy controls. As higher MPV levels are closely related with cardiovascular diseases, euthyroid Hashimoto's thyroiditis patients have greater risk of atherothrombotic complications than controls.