RISK FACTORS FOR ACUTE KIDNEY INJURY ASSOCIATED WITH SEVERE HYPOTHYROIDISM.

Objective: This study aims to investigate the factors affecting development of acute kidney injury (AKI) in patients with severe hypothyroidism. Methods: This retrospective observational study involved patients with primary hypothyroidism and thyroid stimulating hormone (TSH) levels of more than 50 mIU/L at their review in the endocrinology outpatient clinic, between January 2015 and April 2021. Factors affecting the development of AKI were examined by logistic regression analysis. Results: A total of 100 patients, 20 (11 male (M), 9 female (F)) in the AKI (case) group and 80 (23 M, 57 F) patients in control group, were included in our study. The median age of the case group (56 years, interquartile range (IQR) 44.3-68.5) was significantly higher than the control group (49 years, IQR 32.3-60; p = 0.027), and the ratio of males to females was significantly higher in the case group (p = 0.001). Multivariate logistic regression analyses showed that hypothyroidism diagnosed after the age of 60 years (odds ratio (OR) 59.674, 95% confidence intervals (CI) 5.955-598.031; p = 0.001), free triiodothyronine (FT3) < 1.3 pg/mL (OR 17.151, 95% CI 2.491-118.089; p = 0.004) and creatine kinase (CK) > 1000 U/L (OR 1.522, 95% CI 1.602-82.848; p = 0.015) were predictors for the development of AKI in patients with severe hypothyroidism. Conclusion: We recommend close follow-up and monitoring of patients with AKI caused by severe hypothyroidism if patients who are diagnosed at age > 60 years, CK > 1000 U/L or FT3 < 1.3 pg/mL.

RISK OF HYPERCALCEMIA IN ELDERLY PATIENTS WITH HYPERVITAMINOSIS D AND INTOXICATION.

OBJECTIVE: We aimed to determine the risk of hypercalcemia in a geriatric population with very high dose levels of 25-hydroxy-vitamin D (25(OH)D). PATIENTS AND METHOD: This study was designed as a retrospective, cross-sectional two-center study for examining the elderly patients with very high 25(OH)D levels (>88ng/mL) between January 2014 and December 2019. After recruitment, subgroup analyses of the patients were performed based on their calcium and vitamin D levels. RESULTS: A total of 81.101 elderly patients, who had been evaluated for their vitamin D levels, were screened. Of the 458 (0.6%) elderly patients with 25(OH)D>88 ng/mL according to our criteria, 217 patients with complete data were accepted into our study. The median 25(OH)D level was 103.7ng/mL (min-max:88.2-275.9). Most of the elderly patients (86.6%) with very high 25(OH)D levels were normocalcemic. When patients with hypercalcemia were compared with normocalcemic group, no difference was observed in the levels of 25(OH)D, intact parathormone (iPTH), phosphorus, alkaline phosphatase (ALP), and their age. However, the PTH suppression rate was significantly higher in hypercalcemic group (p=0.005). CONCLUSION: The elderly patients with very high 25(OH)D levels would appear to be mostly normocalcemic whereas life-threatening hypercalcemia would also occur. Treatment and follow-up planning should be done according to the clinical guideline recommendations.

Relationship between central corneal thickness and parameters of optic nerve head topography in healthy subjects.

PURPOSE: To investigate the relationship between central corneal thickness (CCT) and topographic parameters of optic nerve head (ONH) in healthy eyes. METHODS: Right eyes of 208 healthy subjects between 40 and 59 years of age with refractive error less than 1 D were enrolled in this cross-sectional study. Ultrasonic pachymeter was used to measure CCT, and the ONH parameters were obtained by using confocal scanning laser ophthalmoscope. Relationship of various topographic parameters to age and sex were also investigated. For statistical analysis Student t test, analysis of variance, Pearson and Spearman test, and partial correlation coefficients were used. RESULTS: Mean CCT of subjects was 540.71+/-35.53 micronm (462-621 micronm), and the mean disc area was 2.37+/- 0.44 mm2 (1.28-3.66 mm2). CCT showed negative correlations to disc area, rim area, rim volume, and retinal nerve fiber layer (RNFL) area. These correlations were found to be stronger in females. Negative correlations were demonstrated between age and the mean cup depth, maximum cup depth, RNFL thickness, and RNFL cross sectional area. Women had lesser rim volumes, but bigger cup to disk (C/D) area and linear C/D ratios compared to those of men. CONCLUSIONS: In addition to its effect in the accuracy of intraocular pressure measurements, CCT has a structural relationship with the ONH in healthy nonglaucomatous eyes. Therefore, its effect on disc area might be especially important to explain the structural strength of the ONH in the pathogenesis of glaucoma.

Serum ghrelin levels: Is there any association with malnutrition and depression in peritoneal dialysis patients?

BACKGROUND: Ghrelin is a physiologic regulatory hormone of appetite and body weight, and its concentrations increase in chronic kidney disease. This study aimed to analyze the effects of malnutrition and depression on the plasma ghrelin levels in peritoneal dialysis (PD) patients. METHODS/PATIENTS: The relationship between fasting serum ghrelin concentration, type of dialysate solution, malnutrition-inflammation score (MIS), and depressive symptoms of 87 PD patients were analyzed. Depressive symptoms were evaluated using the Beck Depression Inventory. RESULTS: No significant relationship between ghrelin concentration and body mass index (BMI), MIS or depression scores was detected. The mean serum ghrelin concentration in patients using amino acid-based solutions was higher than in non-users (p <0.001). The mean serum ghrelin concentration of the patients using icodextrin-based solutions was found to be significantly higher than non-users (8.69 ± 5.04 vs 6.61 ± 2.8 ng/ml respectively, p =0.02). There was no significant difference in MIS between the patients in terms of amino-acid and/or icodextrin usage. CONCLUSIONS: There is no association between BMI, MIS, and depression with ghrelin concentrations in PD patients. Icodextrin and/or amino acid-based solutions usage may increase the serum ghrelin concentration without a significant effect on BMI and measures of malnutrition. HIPPOKRATIA 2018, 22(1): 43-48.

Nd:YAG laser iridotomy in the management of secondary glaucoma associated with Behçet's disease.

PURPOSE: To report the outcome of Nd:YAG laser iridotomy in the management of secondary glaucoma associated with Behçet's disease (BD). METHODS: In this prospective study, Nd:YAG laser iridotomy was performed on eyes with secondary angle-closure and pupillary block glaucoma associated with BD. The pretreatment and post-treatment intraocular pressures (IOP) and the number of antiglaucoma medications were compared by Mann-Whitney U test. RESULTS: The study consisted of 16 eyes of 11 patients (2 female, 9 male, mean age 39.2+/-8.9 years). Post-treatment follow-up ranged from 6 to 36 months (mean 13.8+/-8.9). The mean IOP was 21.6+/-2.5 mmHg on 2.5+/-0.6 medications before iridotomy. IOP reduced to 17.7+/-2.5 mmHg on 1+/-0.6 medications at the first month and 17.1+/-3.2 mmHg on 1.7+/-0.9 medications at the sixth month of treatment. The differences between IOP and number of antiglaucoma medications at baseline and at the sixth month of the treatment was statistically significant (p<0.00001). For four eyes trabeculectomy with mitomycin C and for one eye Ahmed valve implantation were performed in the follow-up period. CONCLUSIONS: Nd:YAG laser iridotomy can provide reduction of IOP and the number of antiglaucoma medications in selected cases with secondary glaucoma associated with Behcet's disease.

Glaucoma and increased central corneal thickness in aphakic and pseudophakic patients after congenital cataract surgery.

AIM: To compare the mean central corneal thickness (CCT) among aphakic and pseudophakic patients following congenital cataract surgery with age matched controls. METHODS: This study included 43 eyes of 43 aphakic and pseudophakic patients following congenital cataract surgery. 44 healthy, age and sex matched volunteers were recruited for comparison with the patients. After a complete eye examination, corneal thickness and intraocular pressure were measured. RESULTS: In the study group, 33 eyes were aphakic, and the remaining 10 eyes were pseudophakic. The median CCT was 556.0 microm (range 490-640 microm) in the control group and 626 microm (range 523-870 microm) in the study group (p<0.05). There was a significant difference in CCT between aphakic and pseudophakic eyes in which an intraocular lens (IOL) had been implanted at the time of congenital cataract surgery (p = 0.011). The same difference was not observed between aphakic and pseudophakic eyes in which an IOL had been implanted secondarily (p = 0.835). The median age of the patients at the time of lensectomy was 24 months (range 1 week to 120 months). There was a negative correlation between the age at lensectomy and CCT (r = -0.485, p = 0.001). CONCLUSION: Aphakic and pseudophakic patients have significantly thicker corneas than age matched controls. This difference can have an important effect on interpreting intraocular pressures in these patients. It is also important to assess the effects of early surgery for congenital cataracts, as well as those of primary and secondary IOL implantation, on CCT.

The comparison of eyelash lengthening effect of latanoprost therapy in adults and children.

PURPOSE: To compare the eyelash lengthening effect of latanoprost in adults and children with glaucoma. METHODS: Twenty eyes of 13 men and 7 women (mean age: 54.9, range 42-69 years) with primary open-angle glaucoma and 20 eyes of 9 boys and 11 girls (mean age: 10.7, range 6-16 years) with glaucoma were included in this prospective study. In 19 children, juvenile glaucoma and in one, pseudophakic glaucoma had been detected. A single eyelash was pulled from the center of the upper eyelid before latanoprost therapy and at the sixth month of therapy, and measured. RESULTS: In adult cases, the mean eyelash length was 5.79+/-0.18 mm (5.5-6.1 mm) at baseline and 6.45+/-0.21 mm (6.2-6.8 mm) at the sixth month. In children, the mean length was 5.66+/-0.22 mm (5.3-6.0 mm) at baseline and 6.39+/-0.37 mm (5.9-6.9 mm) at the sixth month. The mean difference in eyelash lengths at baseline and the sixth month was 0.67+/-0.09 mm (0.5-0.7 mm) in adults and 0.75+/-0.25 mm (0.4-1.2 mm) in children. CONCLUSIONS: The differences in mean eyelash lengths at baseline and at the sixth month of latanoprost therapy were statistically significant in both adults and children (p=0.000). The mean of the difference of the eyelash length in children was higher than in adults but the result was not statistically significant (p=0.678).

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire.

BACKGROUND AND STUDY AIMS: Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure. PATIENTS AND METHODS: Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness. RESULTS: PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure. CONCLUSIONS: The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

Behavioral metabolomics analysis identifies novel neurochemical signatures in methamphetamine sensitization.

Behavioral sensitization has been widely studied in animal models and is theorized to reflect neural modifications associated with human psychostimulant addiction. While the mesolimbic dopaminergic pathway is known to play a role, the neurochemical mechanisms underlying behavioral sensitization remain incompletely understood. In this study, we conducted the first metabolomics analysis to globally characterize neurochemical differences associated with behavioral sensitization. Methamphetamine (MA)-induced sensitization measures were generated by statistically modeling longitudinal activity data for eight inbred strains of mice. Subsequent to behavioral testing, nontargeted liquid and gas chromatography-mass spectrometry profiling was performed on 48 brain samples, yielding 301 metabolite levels per sample after quality control. Association testing between metabolite levels and three primary dimensions of behavioral sensitization (total distance, stereotypy and margin time) showed four robust, significant associations at a stringent metabolome-wide significance threshold (false discovery rate, FDR <0.05). Results implicated homocarnosine, a dipeptide of GABA and histidine, in total distance sensitization, GABA metabolite 4-guanidinobutanoate and pantothenate in stereotypy sensitization, and myo-inositol in margin time sensitization. Secondary analyses indicated that these associations were independent of concurrent MA levels and, with the exception of the myo-inositol association, suggest a mechanism whereby strain-based genetic variation produces specific baseline neurochemical differences that substantially influence the magnitude of MA-induced sensitization. These findings demonstrate the utility of mouse metabolomics for identifying novel biomarkers, and developing more comprehensive neurochemical models, of psychostimulant sensitization.