RESUMEN

OBJECTIVE: The objective of this study was to examine the effects of orlistat use on metabolic control and weight loss in diabetic and nondiabetic patients. METHODS: A total of 119 patients with body mass index≥40 kg/m2 and receiving orlistat therapy, who applied to the Endocrinology polyclinic between January 2016 and October 2019, were included. The patients' weight changes and biochemical values (i.e., fasting glucose, HbA1c, ALT, creatinine, and lipid parameters) were evaluated at the drug beginning and the last polyclinic control. The patients were divided into groups, whether they had diabetes or used metformin, and compared. RESULTS: The mean age of the 119 patients in the study was 45.3±11.5 years. A total of 94.1% of the patients were females and 5.9% were males. A total of 38.7% of the patients had diabetes and 29.4% had prediabetes. When the patients were compared to whether they had diabetes or used metformin, there was a statistically significant difference between the groups according to weight loss. The mean weight change of patients without diabetes and receiving metformin and orlistat was statistically significantly higher than that of patients with diabetes and receiving metformin and orlistat. DISCUSSION: It was determined that the weight loss effect of orlistat in obesity was seen in all groups, but this effect decreased in the diabetic group.

Asunto(s)

RESUMEN

PURPOSE: Acromegaly is closely related to increased oxidative stress and endothelial dysfunction (ED). This study aimed to evaluate, for the first time in the literature, signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) and endothelial nitric oxide synthase e(NOS) levels in the setting of acromegaly. METHOD: A total of 56 acromegaly patients and a control group composed of 30 healthy volunteers were included in this study. In the postoperative follow-up, patients were grouped as active or in-remission according to their GH and IGF-1 levels in oral glucose stimulation test (OGST). After detailed physical examination of acromegaly patients and the control subjects, 8-hour fasting blood samples were collected to evaluate biochemical parameters including lipid profile, anterior pituitary hormones, and SCUBE-1 and e(NOS) levels. RESULTS: Inactive and active acromegaly was noted in 78.6% and 21.4% of patients, respectively. The median (min-max) SCUBE-1 levels were significantly higher in the inactive acromegaly and active acromegaly groups than in the control group (1.6(0.4-2.4) and 1.8(1.1-2.5) vs. 0.4(0.2-1.0) ng/mL, respectively, p < 0.001 for each). The median (min-max) e(NOS) levels were significantly higher in the inactive acromegaly and active acromegaly groups than in the control group (132.7 (26.8-602.9) and 137.3 (69.7-488.7) vs. 83.9 (16.4-218.7) pg/mL, p = 0.018 and p = 0.048, respectively). We have also detected positive correlations of e(NOS) with leukocyte (r = 0.307, p = 0.021) and neutrophil counts (r = 0.309, p = 0.021). CONCLUSION: Our study revealed for the first time in literature that SCUBE-1 levels, being a novel marker for ED, were significantly higher in acromegaly patients than in control subjects. When supported with clinical studies, SCUBE-1can be used as an early indicator of endothelial damage in acromegaly patients.

Asunto(s)

RESUMEN

SUMMARY OBJECTIVE: The objective of this study was to examine the effects of orlistat use on metabolic control and weight loss in diabetic and nondiabetic patients. METHODS: A total of 119 patients with body mass index≥40 kg/m2 and receiving orlistat therapy, who applied to the Endocrinology polyclinic between January 2016 and October 2019, were included. The patients' weight changes and biochemical values (i.e., fasting glucose, HbA1c, ALT, creatinine, and lipid parameters) were evaluated at the drug beginning and the last polyclinic control. The patients were divided into groups, whether they had diabetes or used metformin, and compared. RESULTS: The mean age of the 119 patients in the study was 45.3±11.5 years. A total of 94.1% of the patients were females and 5.9% were males. A total of 38.7% of the patients had diabetes and 29.4% had prediabetes. When the patients were compared to whether they had diabetes or used metformin, there was a statistically significant difference between the groups according to weight loss. The mean weight change of patients without diabetes and receiving metformin and orlistat was statistically significantly higher than that of patients with diabetes and receiving metformin and orlistat. DISCUSSION: It was determined that the weight loss effect of orlistat in obesity was seen in all groups, but this effect decreased in the diabetic group.

RESUMEN

The most common cause of ectopic Cushing's syndrome is small cell lung cancer; less common causes include pancreatic and thymic neuroendocrine tumors. A 35-year male was investigated after detecting low potassium in the tests performed for weakness. The patient was admitted for exclusion of Cushing's syndrome because of high cortisol (108 µg/dl) and ACTH (827ng/L) levels. There was no suppression in the high-dose dexamethasone test, and the patient was thought to have ectopic Cushing's syndrome. A mass in the thymus was detected in thorax tomography. Postoperative ACTH and cortisol levels decreased rapidly. Postoperatively, ACTH did not drop to normal, suggesting the possibility of residual tumor. Radiotherapy was given to the patient because the surgical margin was positive in the pathology report. No functional focus was detected in Ga 68 DOTATATE PET CT after radiotherapy. This case is presented because of the rare association of a thymic neuroendocrine tumor with ectopic Cushing's syndrome, which was revealed during the investigation of the etiology of hypokalemia. Key Words: Hypokalemia, Cushing syndrome, Thymic neuroendocrine tumor.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the factors leading to the development of gastrointestinal bleeding (GIB) by comparing patients with diabetes mellitus Type 2 (T2DM) with dyspeptic complaints without GIB; and patients with T2DM who had GIB, regardless of the presence of helicobacter pylori. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Department of Endocrinology and Gastroenterology, Faculty of Medicine, Karadeniz Technical University, from January 2018 to June 2019. METHODOLOGY: The patients were divided into GIB and dyspepsia groups. After the identification of patients in both groups, demographic characteristics, drugs, comorbidities, presence of diabetic macro- and micro-vascular complications, and endoscopic findings were examined retrospectively for each patient. RESULTS: There were 106 patients, with 53 patients in each group. Mean age was significantly higher in the GIB group compared to the dyspepsia group (p<0.001). Body mass index (BMI) was significantly lower in the GIB group (p<0.001). Frequency of congestive heart failure (CHF), chronic kidney disease (CKD), and cerebrovascular disease (CVD), heart valve disease, and cardiac arrhythmia was significantly higher in GIB group (p <0.05 for all). No significant correlation was found between acetylsalicylic acid (ASA) use and GIB (p=0.103). The use of nonsteroidal anti-inflammatory drugs (NSAID), novel oral anticoagulants (NOAC), and clopidogrel was significantly higher in the GIB group (p=0.032, p=0.031, and p=0.032, respectively). Proton pump inhibitor (PPI) use was significantly higher in the dyspepsia group (p=0.002). CONCLUSION: Age, and poly medications were associated with increased frequency of GIB. The use of ASA, when not administered with other agents that may induce GIB, does not increase the risk of developing GIB in obese T2DM patients younger than 65 years of age, who have increased HbA1c levels. Key Words: Type 2 diabetes mellitus, Dyspepsia, Gastrointestinal bleeding, Acetylsalicylic acid, Risk factors, Obesity, Medication.

Asunto(s)

RESUMEN

BACKGROUND & AIMS: Trace elements act as co-factors and/or in co-enzymes in many metabolic pathways and its deficiency contributes to metabolic and infectious complications. The aim of this study was to determine serum zinc, selenium, cobalt, chromium, copper and ceruloplasmin levels for identify the need for post intensive care unit (ICU) nutritional follow-up. METHODS: This study was prospectively conducted in medical ICU. Adult patients (≥18 years) who stayed in ICU more than 48 h and transferred to ward were included in the study. Blood samples of trace element levels were sampled at discharge. RESULTS: We enrolled 100 patients. The median age was 60 (40-70) years with Acute Physiology and Chronic Health Evaluation II (APACHE II) score 15 (11-21) . The median C-Reactive Protein (CRP) level was 53.9 (24.8-116.0) mg/L at discharge. Median serum zinc (24.4 mcg/dl:14.2-38.7) and chromium (0.22 mcg/dl:0.17-0.34) levels were below reference values, while median copper (111.9 (73.0-152.5) mcg/dl) and selenium (54.8 (36.4-95.25) mcg/L) values were within ranges. Serum concentrations of chromium, zinc, and selenium were lower than the normal values in 98, 90, and 36% of patients, respectively. The 28-day ICU mortality were correlated with low serum selenium levels (p = 0.03). CONCLUSION: Serum chromium and zinc levels were below reference values at discharge, but this finding was in context of inflammation. Low serum selenium level observed in 36% was associated to 28-day ICU mortality.

Asunto(s)

RESUMEN

INTRODUCTION: We aimed to see whether insulin glargine U300 can provide better blood glucose control while reducing hypoglycaemia in a more homogeneous population compared to previous studies. MATERIAL AND METHODS: The retrospective study included type 1 diabetes mellitus (T1DM) patients with frequent hypoglycaemia. For evaluation of fasting blood glucose, haemoglobin glycated (HbA1c) and weight at 6 months and 12 months (final), observation windows of 120-240 days (4-8 months) and 240-480 days (9-16 months) after insulin glargine U300 initiation, respectively, were permitted. Mean follow-up time was 12 months. Hypoglycaemia was defined as blood glucose level < 70 mg/dl, either symptomatic or asymptomatic, measured in hospital or at home. RESULTS: Forty-four patients were included in the study, and 35 patients completed the study - 20 (57.1%) females and 15 (42.9%) males, with a mean age of 24.1 ±6.6 years. Mean body mass index was 24.4 ±7.4 kg/m2. A significant decrease was not found between baseline and HbA1c values at 6 months (p = 0.199), but a significant decrease was found in the final period (between 9-16 months) (p = 0.025). Hypoglycaemic events occurred in all patients (100%) before using insulin glargine U300, while the incidence of hypoglycaemic events gradually decreased to 74.3%, 68.6%, and 68.6% between months 1-3, 3-6, and 6-9, respectively. Of the 26 patients who declared their level of satisfaction, 23 (88.5%) were satisfied, 2 (7.7%) indicated that there was no significant difference, and 1 (3.8%) patient was unsatisfied. CONCLUSIONS: Over 9-16 months of follow-up, insulin glargine U300 led to a significant reduction not only of HbA1c levels but also of the frequency of hypoglycaemia, and also yielded high satisfaction rates.

RESUMEN

AIMS: Insulin degludec/aspart (IDegAsp) and insulin glargine U300 (IGlarU300) have recently emerged as popular new-generation insulin analogues. The aim of this real-life study was to investigate the patient profiles in which IGlarU300 and IDegAsp were preferred and the insulin combinations after which each of them were mostly used and also to analyse the effect of these two insulin analogues on blood glucose regulation and hypoglycaemia. MATERIALS AND METHODS: The retrospective study included 174 patients that were switched from basal insulin, basal-bolus insulin, or premixed insulin to IGlarU300 or IDegAsp due to uncontrolled blood glucose levels or history of hypoglycaemia. Hypoglycaemia, body weight, body mass index (BMI), fasting plasma glucose (FPG) and HbA1c levels over 3-month periods were evaluated for each patient. RESULTS: There were 84 and 90 patients in the IGlarU300 and IDegAsp groups, respectively. Body weight was similar in both groups. Baseline FPG and HbA1c levels in the IGlarU300 and IDegAsp groups were 9.0%, 175.5 mg/dL and 9.4%, 193.5 mg/dL, respectively. A significant decrease was found in FPG and HbA1c levels in both groups (138.5, 7.8 vs 141.5, 8.2; P < .001 for all). Moreover, a significant weight gain was observed in both groups (P < .05 for both). The prevalence of hypoglycaemia in both groups decreased significantly and consistently between months 1 and 9 (P < .001). At month 12, although this decrease continued in the IGlarU300 group (P = .013), no significant decrease was observed in the IDegAsp group (P = .057). CONCLUSION: Both twice-daily IDegAsp ± bolus insulin and IGlarU300 basal bolus insulin therapies are effective and safe treatment modalities.

Asunto(s)

Asunto(s)

RESUMEN

The aim of this study was to determine whether there is a difference between men and women in terms of suicide age, suicide method and suicide reason in Turkey. This study recruited 17,327 cases that had committed suicide between 1990 and 2000. Of all the cases who committed suicide during a period of 11 years, 61.1% were men, 38.9% women. The highest suicide score fell into the age group 15-24 (P<0.001). The most frequently used methods for suicide were self-hanging (48.2%) and use of firearms (19.2%) (P<0.001). The proportion of those committing suicide taking chemicals (drugs, etc.) was higher in women than in men (P<0.001). The most frequently seen reasons for suicide were illness and (33.8%) unsatisfactory relationships (33.0%) (P<0.001, each one). Women committed suicide much more because of unsatisfactory relationships, whereas for men it was due to illness (20.8% and 14.6%, respectively). There were significant differences between men and women in terms of suicide age, suicide method and suicide reason in Turkey. When evaluating suicide cases it is essential that the differences between sexes be taken into consideration.

Asunto(s)

Asunto(s)

RESUMEN

According to the Turkish Penal Code, Section 456, an assailant is punished in a correlation to the severity of the victim's injury. In this study, the injury scale used in Turkey in the basis code 456 is compared with Abbreviated Injury Scale (AIS). For this aim, a total of 984 cases out of the total amount reported at the Traumatology Section of the Turkish Council for Forensic Medicine were randomly selected and evaluated retrospectively. In all, 40.7% of injuries were caused by blunt trauma, whereas 59.3% were caused by a penetrating trauma. According to the Turkish Injury Scale (TIS), 40.3% of the cases were scored to be of a first degree of injury, 15.6% as second degree and 44.1% as third degree. When compared, the score points 3, 4 and 5 in the AIS were seen to be nearly equivalent to the TIS of third degree. From this point of view, in the modified AIS 91.1% of first degree of injury, 51.2% of second degree and 97.2% of third degree of injury are harmonious with TIS. Generally, 83.2% of the cases are harmonious with the AIS system. The purpose of this study is to determine what was the source of differences and to focus on particular traumatic lesions in order to determine a possible rearrangement of the Turkish Injury Scale.

Asunto(s)