RESUMEN
OBJECTIVE: This study aimed to evaluate different auditory regions with audiological tests, based on the presumption that there may be damage to the structures in the hearing system after coronavirus disease 2019. METHODS: Twenty individuals with no history of coronavirus disease 2019 and 27 individuals diagnosed with coronavirus disease 2019 were compared. Pure tone, speech and extended high-frequency audiometry, acoustic immitansmetry, transient evoked and distortion product otoacoustic emissions testing, and auditory brainstem response testing were conducted. RESULTS: The pure tone audiometry and extended high-frequency mean threshold values were higher in the coronavirus disease 2019 group. The transient evoked otoacoustic emissions signal-to-noise ratios were bilaterally lower at 4 kHz in individuals with a coronavirus disease 2019 history. In the auditory brainstem response test, only the interpeak latencies of waves III-V were significantly different between groups. CONCLUSION: Coronavirus disease 2019 may cause damage to the hearing system. Patients should be followed up in the long term with advanced audiological evaluation methods in order to determine the extent and level of damage.
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COVID-19/complicaciones , Trastornos de la Audición/etiología , Adulto , Audiometría , Audiometría de Respuesta Evocada , Audiometría de Tonos Puros , Umbral Auditivo , Estudios de Casos y Controles , Femenino , Trastornos de la Audición/diagnóstico , Trastornos de la Audición/virología , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
In robotics and augmented reality applications, model-based 3-D tracking of rigid objects is generally required. With the help of accurate pose estimates, it is required to increase reliability and decrease jitter in total. Among many solutions of pose estimation in the literature, pure vision-based 3-D trackers require either manual initializations or offline training stages. On the other hand, trackers relying on pure depth sensors are not suitable for AR applications. An automated 3-D tracking algorithm, which is based on fusion of vision and depth sensors via extended Kalman filter, is proposed in this paper. A novel measurement-tracking scheme, which is based on estimation of optical flow using intensity and shape index map data of 3-D point cloud, increases 2-D, as well as 3-D, tracking performance significantly. The proposed method requires neither manual initialization of pose nor offline training, while enabling highly accurate 3-D tracking. The accuracy of the proposed method is tested against a number of conventional techniques, and a superior performance is clearly observed in terms of both objectively via error metrics and subjectively for the rendered scenes.
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Algoritmos , Inteligencia Artificial , Periféricos de Computador , Imagenología Tridimensional/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Imagen de Cuerpo Entero/métodos , Actigrafía/instrumentación , Actigrafía/métodos , Simulación por Computador , Sistemas de Computación , Humanos , Aumento de la Imagen/instrumentación , Aumento de la Imagen/métodos , Transductores , Juegos de Video , Imagen de Cuerpo Entero/instrumentaciónRESUMEN
Insulin resistance is a major feature of type 2 diabetes mellitus, obesity and nonalcoholic fatty liver disease (NAFLD). Several studies pointed out the possible role of increased leptin in NAFLD in humans. The aim of this study is to determine the effect of metformin on plasma leptin levels in obese patients with type 2 diabetes mellitus and NAFLD compared with lifestyle interventions. Thirty-four obese patients with newly diagnosed type 2 diabetes mellitus were prospectively followed for 6 months. All patients had ultrasonographic evidence of NAFLD at baseline. The patients were randomized into two groups: group 1 (n = 15) followed lifestyle changes only and group 2 (n = 19) received metformin (1,700 mg/day). At the end of treatment, BMI, WHR, HbA1c, fasting glucose, leptin, HOMA-IR, alanine aminotransferase values decreased in both groups. No significant difference in the end-points was observed between two groups. Only in group 2, LDL decreased and HDL increased significantly. Liver echogenity decreased significantly at the end of study in both groups. The percentage of patients who no longer had evidence of NAFLD was not significantly different between the groups (20% of patients on lifestyle intervention vs. 16% of patients on metformin). The data demonstrate that, metformin and lifestyle interventions equally affected the plasma leptin levels, BMI and degree of NAFLD in obese patients with type 2 diabetes mellitus. In addition, the effects of metformin on the variables were not found to be mediated by leptin.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Ejercicio Físico , Hígado Graso/sangre , Leptina/sangre , Estilo de Vida , Metformina/uso terapéutico , Obesidad/sangre , Adulto , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/rehabilitación , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Hipertensión/epidemiología , Hipoglucemiantes/uso terapéutico , Insulina/sangre , Resistencia a la Insulina , Lipoproteínas/sangre , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/rehabilitación , Triglicéridos/sangreRESUMEN
OBJECTIVE: Type 1 diabetes and autoimmune thyroid disease are commonly associated. Few studies have addressed islet-cell autoimmunity and its relation with glucose homeostasis in Hashimoto's thyroiditis. The aims of this study were: (1) to determine the prevalence of islet-cell autoimmunity, and (2) to compare insulin sensitivity and secretion patterns between normal glucose tolerant glutamic acid decarboxylase antibodies (GA-D-Ab) positive and negative patients with Hashimoto's thyroiditis. METHODS: Two hundred fifty-three consecutive patients with Hashimoto's thyroiditis were recruited. After excluding 38 patients with diabetes mellitus, 215 were screened for presence of GAD-Ab. Nine GAD-Ab positive and 8 age, sex and body mass index (BMI) matched GAD-Ab negative patients from the same cohort were included. Frequently sampled intravenous glucose tolerance tests (FSIGTT) were applied. Using glucose and insulin data from FSIGTT, fasting glucose to insulin ratio, HOMA-IR and HOMA-beta-cell function, using the minimal model analysis (MIN-MOD) program, the first phase insulin secretion in response to glucose, the insulin sensitivity index and glucose sensitivity index were calculated. RESULTS: Eleven patients were positive for GAD-Ab (5.1%). There was no difference in any insulin sensitivity or secretion parameters between the GAD-Ab positive and negative patients. CONCLUSIONS: Our results suggest that the prevalence GAD-Ab in Hashimoto's thyroiditis is around 5%. GAD-Ab antibody positivity per se does not appear to be associated with any disturbances in insulin sensitivity or insulin secretion in this specific population. The presence of islet-cell autoimmunity does not seem to influence insulin secretion or action in normal glucose tolerant subjects with Hashimoto's thyroiditis in this pilot study. Whether the presence of GAD-Ab per se or along with other antibodies impairs insulin dynamics or predicts the development of diabetes in autoimmune thyroiditis remains to be determined in future studies.
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Autoanticuerpos/sangre , Glutamato Descarboxilasa/inmunología , Enfermedad de Hashimoto/inmunología , Insulina/metabolismo , Adulto , Femenino , Enfermedad de Hashimoto/sangre , Humanos , Secreción de Insulina , Masculino , Persona de Mediana EdadRESUMEN
Diabetic foot is a serious complication of diabetes mellitus and the risk of lower extremity amputation is very high in this population when compared with people without diabetes. We have previously reported the lower-extremity amputation rate and significant factors in determining the risks for patients who had been admitted to Hacettepe University Hospital, a tertiary reference center for Turkey, between the years 1992 and 1996. In January 2000, a diabetic foot care team including an infectious diseases specialist, orthopaedic surgeons, endocrinologists, a plastic and reconstructive surgeon, a radiologist, and a diabetic foot nurse was assembled. To determine whether a change has occurred in the rate and the risk factors of lower extremity amputations after the establishment of this team, medical records of 66 patients (39 men, 27 women) with diabetic foot who had been admitted to Hacettepe University Hospital between 2000 and 2002 have now been retrospectively analysed. The grade distribution of diabetic foot according to Wagner classification was quite similar in the two studies (grade 1: 0 % vs. 4.5 %, grade 2: 15.6 % vs. 19.7 %, grade 3: 48 % vs. 33.3 %, grade 4: 24.4 % vs. 30.3 %, grade 5: 11.5 % vs. 12.1 % in the former and current study, respectively). The overall amputation rate in the current study was 39.4 % (36.7 % in the former study). Ray amputation (35 %) and below-knee amputations (30 %) were the two most commonly applied procedures. The rates of Syme, above knee, other amputations (i.e., Boyd, talonavicular amputations and partial calcanectomy) were 8 %, 8 % and 19 %, respectively. These data suggest that amputation is still a frequently encountered outcome for our patients with diabetic foot, but the amputation profile has changed. The implementation of a diabetic foot care team has relatively decreased the rate of major amputations in an attempt for limb salvage to improve the quality of life of the patients. Presence of osteomyelitis, peripheral vascular disease and gangrene still remain as significant predictors of amputation in our population.
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Amputación Quirúrgica/estadística & datos numéricos , Pie Diabético/terapia , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/mortalidad , Antibacterianos/uso terapéutico , Prótesis Vascular , Complicaciones de la Diabetes , Pie Diabético/mortalidad , Pie Diabético/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Pronóstico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/microbiología , Procedimientos Quirúrgicos VascularesRESUMEN
OBJECTIVE: The goal of this study was to evaluate the insulin resistance and glucose tolerance in hyperandrogenemic and normoandrogenemic groups of patients with polycystic ovary syndrome (PCOS). STUDY DESIGN: In this cross-sectional study, 17 hyperandrogenemic and 14 normoandrogenemic, age and weight-matched non-obese women with PCOS were studied. All patients had clinical hyperandrogenism and chronic anovulation with polycystic ovaries on ultrasound. Insulin resistance and glucose tolerance were determined by measuring insulin and glucose concentrations following a 75 g oral glucose tolerance test (OGTT). Fasting glucose to insulin ratio (FG:I ratio), insulin area under the curve (AUC(insulin)) during OGTT, and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated. RESULTS: Hyperandrogenemic group of patients had fasting hyperinsulinemia, lower FG:I ratio, higher AUC(insulin), and HOMA-IR compared with normoandrogenemic group. The differences between two groups were statistically significant. CONCLUSION: PCOS has variable biochemical features. Hyperandrogenemia associated with insulin resistance differs from normoandrogenemia in this syndrome. Fasting insulin concentrations, FG:I ratio, AUC(insulin), and HOMA-IR are convenient markers for determining insulin resistance in PCOS.
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Andrógenos/sangre , Hiperandrogenismo/complicaciones , Resistencia a la Insulina , Síndrome del Ovario Poliquístico/sangre , Adulto , Anovulación , Glucemia/análisis , Ayuno , Femenino , Prueba de Tolerancia a la Glucosa , Homeostasis , Humanos , Insulina/sangre , Ovario/diagnóstico por imagen , Síndrome del Ovario Poliquístico/diagnóstico por imagen , UltrasonografíaRESUMEN
There are studies concerning the association among endogenous sex steroids, growth hormone (GH), insulin-like growth factor-I (IGF-I) and bone mineral density (BMD) in both men and women. However, little is known concerning the association of these parameters with markers of bone turnover in healthy elderly men. We studied the association of BMD (dual energy X-ray absorptiometry of spine, hip and forearm) and markers of bone turnover (bone-specific alkaline phosphatase, serum C-terminal propeptide of type I collagen, and serum osteocalcin reflecting formation, urine deoxypyridinoline and calcium excretion in relation to creatinine excretion reflecting resorption) with endogenous sex steroids, GH and IGF-I in 14 elderly normal men (age range 60-79 years). There was a negative correlation between age and dehydroepiandrosterone sulphate (DHEAS) (r=-0.60, p=0.022) and a positive correlation between GH and IGF-I (r=0.53, p=0.048). Serum estradiol concentrations correlated with BMD at distal 1/3 radius (r=0.41, p=0.1) and mid-radius (r=0.47, p=0.08), and negatively correlated with age (r=-0.45, p=0.09). There was no correlation of estradiol with bone turnover markers, testosterone, free testosterone, DHEAS, GH and IGF-I. Serum GH and IGF-I levels showed no correlation with BMD (all sites) and bone turnover markers. Serum total testosterone concentrations positively correlated with BMD at distal 1/3 radius (r=0.47, p=0.09), femoral neck (r=0.56, p=0.037) and Ward's triangle (r=0.49, p=0.07). These data suggest that serum estradiol and testosterone levels are associated with BMD in elderly men, possibly indicating their contribution to skeletal maintenance in old age. However, correlations of IGF-I, GH and DHEAS with BMD and bone turnover markers are lacking in the group studied.
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Envejecimiento , Densidad Ósea , Remodelación Ósea , Hormonas Esteroides Gonadales/sangre , Hormona de Crecimiento Humana/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Absorciometría de Fotón , Anciano , Fosfatasa Alcalina/sangre , Biomarcadores/sangre , Sulfato de Deshidroepiandrosterona/sangre , Estradiol/sangre , Humanos , Masculino , Persona de Mediana Edad , Osteocalcina/sangre , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Valores de Referencia , Testosterona/sangreRESUMEN
OBJECTIVE: To describe a case of isolated adrenocorticotropic hormone (ACTH) deficiency associated with thyroid autoimmunity, subclinical hypothyroidism, and transient hyperprolactinemia. METHODS: We present a detailed case report, including results of laboratory studies and magnetic resonance imaging, and discuss potential contributing factors in this setting. RESULTS: In a 23-year-old woman with isolated ACTH deficiency accompanied by thyroid autoimmunity (Hashimoto's thyroiditis), subclinical primary hypothyroidism, and hyperprolactinemia, magnetic resonance imaging of the pituitary showed normal findings but dynamic stimulation testing of the pituitary gland indicated an isolated ACTH deficiency with intact growth hormone and gonadotropin secretory reserves. The cortisol response to the short ACTH stimulation test was subnormal. Therapy with prednisolone (5 mg/day) and levothyroxine (100 microg/day) was initiated. Results of thyroid function tests were normalized after 1 month, the prolactin level decreased to normal after 1 year, and titers of thyroid autoantibodies decreased substantially after 1.5 years of treatment. CONCLUSION: The correction of the related glucocorticoid deficiency resulted in resolution of the hyperprolactinemia and a decrease in titers of thyroid autoantibodies.
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Hormona Adrenocorticotrópica/deficiencia , Hiperprolactinemia/complicaciones , Tiroiditis Autoinmune/complicaciones , Hormona Adrenocorticotrópica/uso terapéutico , Adulto , Hormona Liberadora de Corticotropina/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Terapia de Reemplazo de Hormonas , Hormonas/sangre , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Hidrocortisona/sangre , Hiperprolactinemia/tratamiento farmacológico , Hipotiroidismo/complicaciones , Hipotiroidismo/patología , Hormona Luteinizante/uso terapéutico , Imagen por Resonancia Magnética , Prednisolona/uso terapéutico , Pruebas de Función de la Tiroides , Tiroiditis Autoinmune/tratamiento farmacológico , Tiroxina/uso terapéuticoRESUMEN
We compared the efficacy of treatment protocols with an angiotensin converting enzyme (ACE) inhibitor alone (enalapril, 5 mg) or angiotensin II (ATII) receptor blocker (losartan, 50 mg) or both enalapril plus losartan in patients with microalbuminuria in a prospective, randomized clinical trial. Normotensive type 2 diabetic patients with microalbuminuria documented by at least 3 consecutive urinary albumin excretion analyses were recruited for the study. Patients were grouped randomly into one of the protocols which consisted of treatment with 5 mg enalapril daily (group 1; n=12), 50 mg losartan daily (group 2; n=12) or both drugs (group 3; n=10). They were reevaluated with regard to HbA1c levels, lipid profiles, blood pressure and urinary albumin excretion rates (UAER) at 3-month intervals for 12 months. Mean age, duration of diabetes, body mass index, plasma lipid profiles and blood pressure levels were similar at the initial visit. In group 1, UAER returned to normal levels in 10 patients. Normalization of UAER occurred in 8 and 7 patients in groups 2 and 3, respectively. Percentage of reduction in UAERs at the end of 12 months were 58%, 59% and 60% (p=0.0001; p=0.0002; p=0.0003, respectively). The amount of reduction in UAER did not differ significantly among the three groups (p=0.346). ACE inhibitors and angiotensin II receptor blockers have similar efficacy in treating diabetic microalbuminuria, and the combination of the two drugs does not add any further benefit.
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Albuminuria/tratamiento farmacológico , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Antihipertensivos/farmacología , Diabetes Mellitus Tipo 2/orina , Enalapril/farmacología , Losartán/farmacología , Albuminuria/orina , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Enalapril/uso terapéutico , Hemoglobina Glucada/análisis , Humanos , Losartán/uso terapéutico , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: The alteration of endothelin (ET) levels in diabetic patients with cardiac autonomic neuropathy (CAN) has not been studied extensively and its correlation with cardiac function parameters has not been discussed. HYPOTHESIS: The aim of the present study was to discuss the correlation between the degree of cardiac autonomic neuropathy, plasma big-ET levels, and cardiac functions in diabetic patients who were clinically free of cardiovascular disease. METHODS: Twenty subjects (32.1 +/- 7.8 years, 11 men, 9 women) with insulin-dependent diabetes mellitus (IDDM) were studied to evaluate the relationship between circulating big-endothelin (big-ET1) levels, CAN, and cardiac functions. The severity of CAN was scored according to Ewing's criteria. Cardiac functions were assessed using Doppler echocardiography. RESULTS: Left ventricular systolic function in the patient group was within normal limits and comparable with the values of the control group (n = 10). The mean E/A values of diabetics with CAN (1.15 +/- 0.33, p = 0.004) and without CAN (1.34 +/- 0.17) were significantly lower than those of controls (1.57 +/- 0.27). Diabetics with CAN had significantly higher big-ET1 values (81.1 +/- 94 pg/ml) compared with others (12.4 +/- 5.9 and 21.1 +/- 17.7 pg/ml, p = 0.04). Circulating big-ET1 levels showed a significant correlation with E/A values in the control group (p = 0.01, r = -0.7) and with peak A values (p = 0.003, r = 0.64) in diabetics. The CAN score correlated negatively with E/A values (p = 0.01, r = 0.54). CONCLUSIONS: High big-ET levels might have an important role in the pathogenesis or consequences of diastolic dysfunction in diabetics with CAN. Their role in cardiac autonomic neuropathy and diastolic dysfunction should be investigated further.
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Enfermedades del Sistema Nervioso Autónomo/sangre , Diabetes Mellitus Tipo 1/complicaciones , Neuropatías Diabéticas/sangre , Endotelinas/sangre , Cardiopatías/sangre , Corazón/inervación , Precursores de Proteínas/sangre , Adulto , Enfermedades del Sistema Nervioso Autónomo/etiología , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Biomarcadores/sangre , Diabetes Mellitus Tipo 1/sangre , Neuropatías Diabéticas/etiología , Neuropatías Diabéticas/fisiopatología , Endotelina-1 , Femenino , Corazón/fisiopatología , Cardiopatías/etiología , Cardiopatías/fisiopatología , Humanos , Masculino , Contracción Miocárdica , Pronóstico , Radioinmunoensayo , Función Ventricular IzquierdaRESUMEN
OBJECTIVE: To discuss our experience with a case of Riedel's thyroiditis manifesting in conjunction with several other fibrosclerotic lesions. METHODS: We describe a case of multifocal fibrosclerosis and its response to glucocorticoid therapy. RESULTS: A 46-year-old man with dyspnea, dysphagia, and hoarseness was found to have Riedel's thyroiditis, sclerosing cholangitis, retroperitoneal fibrosis, and renal cortical fibrosis. Treatment with high-dose glucocorticoids in the early stages of the disease and maintenance therapy with low-dose glucocorticoids in later stages of the disease had a beneficial effect. Serial follow-up assessments with determination of the erythrocyte sedimentation rate and computed tomographic imaging of the abdomen and thorax are recommended for monitoring of disease activity. CONCLUSION: Glucocorticoids are currently the treatment of choice for progressive multifocal fibrosclerosis. Accumulation of further clinical data is needed to determine more precise treatment strategies.
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Colangitis Esclerosante/complicaciones , Corteza Renal/patología , Espacio Retroperitoneal/patología , Tiroiditis/complicaciones , Antiinflamatorios/uso terapéutico , Colangitis Esclerosante/diagnóstico , Colangitis Esclerosante/tratamiento farmacológico , Fibrosis , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Tiroiditis/tratamiento farmacológico , Tiroxina/uso terapéuticoRESUMEN
In this prospective study we aimed to compare insulin plus acarbose with insulin plus gliclazide with respect to their effect on insulin requirement, lipid profiles and body mass index (BMI) while achieving good glycemic control. Forty patients with type 2 diabetes mellitus who were on conventional insulin therapy (subcutaneous insulin therapy consisting of regular and NPH insulin, two times a day) were included in the study. They were randomized to double blind treatment with insulin in combination with gliclazide or acarbose for 6 months. For both groups, acceptable glycemic control was achieved at the end of study period. The mean HbA(1c) levels decreased from 8.32+/-0.26 to 7.13+/-0.18% in acarbose group and 8. 6+/-0.15 to 7.48+/-0.21% in the gliclazide group. The difference between groups was not significant (P 0.29). In the acarbose group, total cholesterol and LDL concentration decreased significantly while other parameters did not change. In the gliclazide group, HDL levels decreased significantly from 46.6+/-2.48 mg/dl to 41.3+/-2.09 mg/dl (P 0.001) BMI increased significantly from 27.60+/-1.21 kg/m(2) to 28.69+/-1.26 kg/m(2). (P 0.003) Total daily insulin dose was not changed in the acarbose group significantly, but increased from 42.6+/-2.73 to 49.27+/-3.58 U/day, which was significant in gliclazide group of (P 0.016). In the acarbose group, there were no significant differences between responders and nonresponders with respect to fasting and stimulated C-peptide, HbA(1c) levels and baseline BMI values. But in the gliclazide group, baseline BMI values were significantly higher in the nonresponding group compared to responders (P 0.02). In conclusion, combination of insulin with acarbose can be a good alternative for type 2 diabetic patients on insulin therapy; seems more beneficial than combination with gliclazide; may have advantage of achieving good glycemic control without increasing insulin dose and BMI; also may have the advantage of providing a decrease in LDL level, which are all important to prevent atherosclerosis.
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Acarbosa/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Gliclazida/uso terapéutico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Glucemia/metabolismo , Péptido C/sangre , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Método Doble Ciego , Quimioterapia Combinada , Hemoglobina Glucada/análisis , Humanos , Estudios Prospectivos , Triglicéridos/sangreRESUMEN
In this cross-sectional study, we evaluated 15 premenopausal women to elucidate whether bone turnover is increased and bone mineral density is reduced due to endogenous subclinical hyperthyroidism. Each patient had normal free thyroxine (FT4) and free triiodothyronine (FT3) levels associated with a stable suppression (<0.1 mU/L) of serum thyrotropin (TSH) levels during a period ranging between 6 and 11 months. Metabolic parameters of bone turnover (serum osteocalcin, bone specific alkaline phosphatase, procollagen I C-terminal peptide reflecting bone formation; urinary deoxypyridinoline and calcium excretion reflecting bone resorption) were assessed. Bone mineral density was measured at lumbar 1-4 vertebrae, femoral neck, and the forearm (midshaft radius and distal radius) by dual energy x-ray absorptiometry. All measurements were compared with 15 healthy age-, height-, and weight-matched premenopausal women who served as control group. Our findings suggest that endogenous subclinical hyperthyroidism is not associated with increased bone turnover, and bone mineral density is not reduced in premenopausal women, at least in the short term.
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Densidad Ósea/fisiología , Huesos/metabolismo , Hipertiroidismo/metabolismo , Premenopausia/fisiología , Adulto , Biomarcadores , Resorción Ósea/metabolismo , Femenino , Humanos , Hormonas Tiroideas/sangre , Tiroxina/sangre , Triyodotironina/sangreRESUMEN
Helicobacter pylori (HP) is the most common cause of nonerosive nonspecific gastritis. Gastric and duadenal ulcer both are found to be associated with HP infection. Another consequence of HP infection is that it may progress to chronic atrophic gastritis which is a well recognized risk factor for adenocarcinoma of the stomach. So by extension, HP infection can be accepted as a risk factor for gastric cancer. From this aspect, identification of risk groups is increasingly important. It is well-known that patients with diabetes mellitus are more prone to infection. Besides this, presence of gastroparesis diabeticorum may lead to bacterial overgrowth in the upper gastrointestinal (GI) tract. The present crossectional study was planned to study the presence of HP infection in diabetic patients with alterations in upper GI motility and to compare the results with healthy control group. Group I consisted of 51 patients with type II diabetes mellitus (as defined by National Data Group criteria) without any dyspeptic symptoms. Twenty-five age-matched healthy people served as a control in group II. Radionuclide-labelled solid meals were used to calculate gastric emptying time (GET). According to the results, patients in group I were divided into two groups. Patients with prolonged GET were grouped as group IA, while group IB consisted of patients with normal or shortened GET. Presence of HP gastritis is determined by histopathologic examination of endoscopic biopsy specimen. The results showed that the prevalence of HP gastritis in group I and II were 80.4% and 56% respectively and the difference was significant statistically (p: 0.03). In group IA, the prevalence of HP infection was estimated to be 88.2%, while in group IB it was 76.5% but the difference was not significant (p: 0.31). We have not found any correlation between HbA1c levels and the presence of HP infection in both group IA and IB (p values 0.26 and 0.15 respectively). We conclude that the prevalence of HP gastritis is higher in asymptomatic diabetic patients compared with healthy people. But there is no association between the alterations in GET and the presence of HP gastritis as indicated by our results. So prolonged GET may not be regarded as a specific pathogenic mechanism or a cause of HP infection in NIDDM patients.
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Diabetes Mellitus Tipo 2/microbiología , Diabetes Mellitus Tipo 2/fisiopatología , Vaciamiento Gástrico , Gastritis/microbiología , Infecciones por Helicobacter/fisiopatología , Helicobacter pylori , Estudios Transversales , Bases de Datos como Asunto , Diabetes Mellitus Tipo 2/patología , Femenino , Gastritis/epidemiología , Gastritis/fisiopatología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Radiofármacos , Valores de Referencia , Azufre Coloidal Tecnecio Tc 99m , TurquíaRESUMEN
To determine the frequency of severe hypoglycaemia during conventional insulin therapy in juvenile-onset and adult-onset type 1 and in type 2 diabetes mellitus (DM), we retrospectively analysed the medical records of 165 Turkish diabetic patients who have been treated with conventional insulin. Patients were divided into 3 subgroups with respect to the type of diabetes: 33 had juvenile-onset Type 1 DM, 18 had adult-onset type 1 DM, and 114 had type 2 DM. The diabetic subgroups were found to be comparable with regard to mean frequency of severe hypoglycaemia (juvenile-onset type 1 DM: 0.20 episode x patient(-1) x year-1, adult-onset type 1 DM: 0.10 episode x patient(-1) x year(-1), type 2 DM: 0.15 episode x patient(-1) x year(-1)). Frequency of severe hypoglycaemia necessitating in-hospital treatment was 0.05 episode x patient(-1) x year(-1) for all diabetic subgroups. The data clearly indicate that the extent of the problem of severe hypoglycaemia during conventional insulin therapy in type 2 DM is comparable with both juvenile and adult-onset forms of type 1 DM in Turkish diabetic population.
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Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Adolescente , Adulto , Anciano , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemia/inducido químicamente , Masculino , Registros Médicos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Turquía/epidemiologíaRESUMEN
BACKGROUND AND OBJECTIVES: The aim of our study was to review the imaging characteristics, endocrinologic screening and histologic diagnoses of adrenal incidentaloma cases encountered in our institute. METHODS: Thirty-three adrenal incidentaloma cases that had been evaluated in Hacettepe University Hospital between 1985 and 1995 were reviewed retrospectively. Adrenal masses were discovered incidentally by abdominal ultrasonography (USG) and/or computed tomography (CT). Detailed endocrine evaluation was carried out to rule out a possible functioning mass. RESULTS: Among these incidentaloma cases, 2 silent Cushing syndrome (6.06%) cases, 6 silent pheochromocytoma (18.18%) cases, 2 adrenocortical carcinoma (6.06%) cases, and 2 metastatic masses (6.06%) were diagnosed. CONCLUSIONS: An optimal diagnostic approach to an adrenal incidentaloma would consider the results of the biochemical tests and a review of anatomical qualities depicted on CT or magnetic resonance imaging (MRI) while taking into account the previous clinical epidemiologic data.
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Neoplasias de las Glándulas Suprarrenales/diagnóstico , Síndrome de Cushing/diagnóstico , Feocromocitoma/diagnóstico , Abdomen/diagnóstico por imagen , Adenoma/diagnóstico , Adenoma/patología , Neoplasias de la Corteza Suprarrenal/diagnóstico , Neoplasias de la Corteza Suprarrenal/patología , Neoplasias de las Glándulas Suprarrenales/patología , Adulto , Anciano , Síndrome de Cushing/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Feocromocitoma/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
In this study we have investigated the contribution of the ACE genotype to the development of left-ventricular hypertrophy (LVH) and systolic and diastolic dysfunctions in acromegalic patients. The study group consisted of 30 acromegalic patients (21 women and 9 men, age: 37.9 +/- 10.8 years, disease duration: 9.0 +/- 6.9 years). The distribution of the DD, ID and II genotypes was 40.0 (n = 12), 46.6 (n = 14) and 13.3% (n = 4), respectively, being similar to frequencies observed in a healthy population. Plasma ACE levels were 55.0 +/- 12.0 (45-84), 28.7 +/- 15.7 (8-58) and 24.5 +/- 12.0 (16-33) U/I in patients with the DD, ID and II genotype, respectively. The mean serum ACE activity in the DD genotype was significantly higher than in the heterozygous group (p < 0.0001). Serum ACE activity showed a significant negative association with the mean growth hormone level (r = -0.52, p = 0.007). The LV early diastolic flow velocity/LV presystolic flow velocity (E/A) ratios were 1.2 +/- 0.4 for the DD genotype, 1.3 +/- 0.3 for the ID genotype and 0.7 +/- 0.1 for the II genotype. The E/A ratio was considerably lower in acromegalic patients with the II genotype compared to the other genotypes (p = 0.03). The LV mass index (LVMI) values were 131.5 +/- 4.2 g/m2 for the DD genotype, 141.7 +/- 50.3 g/m2 for the ID genotype and 159.6 +/- 48.2 g/m2 for the II genotype. However, there was no significant difference in LVMI among allelic groups. All other indices of systolic and diastolic function were not statistically different in the acromegalic patients. The present data fail to support a role of ACE gene polymorphism in determining LVH in acromegalic patients. However, the I allele may prove as a useful marker predicting the development of diastolic dysfunction in acromegalic patients.
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Acromegalia/genética , Hipertrofia Ventricular Izquierda/genética , Peptidil-Dipeptidasa A/genética , Polimorfismo Genético/genética , Disfunción Ventricular Izquierda/genética , Acromegalia/enzimología , Adolescente , Adulto , Secuencia de Bases , Ecocardiografía , Femenino , Hemodinámica/fisiología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/enzimología , Modelos Lineales , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Peptidil-Dipeptidasa A/metabolismo , Reacción en Cadena de la Polimerasa , Probabilidad , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/enzimologíaRESUMEN
To determine the lower extremity amputation rate and the risk factors for amputation, we analysed the medical records of 147 Turkish diabetic patients who have been referred to the clinic with diabetic foot. Eleven patients (7.5%) had type 1, and 136 patients (92.5%) had type 2 diabetes mellitus. Fifty-four patients (36.7%) have undergone amputation due to diabetic foot. Femoropopliteal by-pass has been performed in 4 patients in the non-amputees group who did not have gangrene. None of the patients in the amputees group has undergone a revascularisation procedure. Considering all lower-extremity amputations in the group studied, 25.9% were transphalangial amputations, 3.7% were transmetatarsal amputations, 7.4% were Syme type amputations, 51.9% were below-knee amputations, and 11.1% were above-knee amputations. In a logistic regression model, age, gender, duration of diabetes, smoking history, hypertension, retinopathy, nephropathy, and peripheral neuropathy were insignificant factors in determining the risk of amputation. In contrast, presence of peripheral vascular disease (odds ratio 4.0, 95% CI 1.17-13.4; p = 0.03), osteomyelitis (odds ratio 3.73, 95% CI 1.08-12.6; p = 0.04) and gangrene (odds ratio 30.8, 95% CI 7.39-121.5; p < 0.0001) were found to be the significant predictors of amputation. The mortality rate due to amputation during hospital stay was 13.2%. These data suggest that lower extremity amputation is a frequently encountered outcome of the hospitalized patients in Turkish diabetic population with diabetic foot which mainly occur due to peripheral vascular disease, osteomyelitis and gangrene. Lack of adequate vascularisation procedures might have contributed to a high percentage of major amputations in the group studied. Population-based studies should be undertaken in order to determine the status of lower extremity amputation as a whole in Turkish diabetic population.
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Amputación Quirúrgica/estadística & datos numéricos , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Angiopatías Diabéticas/complicaciones , Femenino , Gangrena/complicaciones , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Osteomielitis/complicaciones , Enfermedades Vasculares Periféricas/complicaciones , Factores de Riesgo , TurquíaRESUMEN
Calcitriol has been widely used in the management of osteoporosis, but its efficiency is a matter of controversy. It is not known whether combinations of calcitriol and antiresorptive agents such as etidronate and calcitonin are superior to calcitriol alone in the treatment of postmenopausal osteoporosis. To make this determination, 30 Turkish women with postmenopausal osteoporosis between 45 and 68 years of age were randomized to receive either intermittent cyclical etidronate (400 mg/day, for 14 days) followed by 60 days of cyclical calcitriol therapy 0.25 microg twice daily (group 1; n = 10), or calcitriol 0.25 microg twice daily (group 2; n = 10), or calcitriol 0.25 microg/day in combination with 100 IU intranasal salmon calcitonin taken every other day (group 3; n = 10) through a 1-year period. Bone mineral density (BMD) of lumbar spine (L2 to L4) was determined for each patient by dual-photon absorptiometry (153Gd) at baseline, after 6 months, and at the end of the study. There was no significant difference among groups with respect to mean spinal BMD at baseline, after 6, and after 12 months. No significant spinal BMD changes occurred in any group from baseline, after 6 months, and after 12 months. Four patients in groups 1 and 2 and five patients in group 3 developed hypercalcemia at least once during therapy. Hypercalciuria occurred at least once in 9, 10, and 7 patients in groups 1, 2, and 3, respectively. One patient in group 2 developed a renal stone at the end of the study. Mean urine hydroxyproline levels did not change significantly in any group with respect to baseline. The data suggest that one-year treatment with calcitriol, given either alone or in combination with antiresorptive agents, does not improve spinal BMD in Turkish women with postmenopausal osteoporosis, and is associated with a high rate of adverse events.