Association of serum proprotein convertase Subtilisin/Kexin Type 9 (PCSK9) level with thyroid function disorders.

OBJECTIVE: We aimed at demonstrating the effect of thyroid function status on proprotein convertase subtilisin kexin type 9 (PCSK9) and determining the effect of thyroid hormones on lipid metabolism by comparing the PCSK9 levels of patients with subclinical hypothyroidism, overt hypothyroidism, and hyperthyroidism. PATIENTS AND METHODS: 124 patients with thyroid disorders, aged between 18 and 65 years, were included in this study. The participants were divided into 3 groups. Group 1 comprised 52 patients with subclinical hypothyroidism, Group 2 comprised 40 patients with overt hypothyroidism, and Group 3 comprised 32 patients with hyperthyroidism. In all of these groups, the thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, total cholesterol, fasting serum glucose, antithyroid peroxidase antibody, antithyroglobulin antibody, and PCSK9 levels were measured. RESULTS: No significant difference was found between the 3 groups in terms of age, gender, and body mass indices. Median PCSK9 measurements were 14.55 ng/mL in Group 1, 14.895 ng/mL in Group 2, and 9.775 ng/mL in Group 3. There was a significant difference in the PCSK9 levels between Group 1-Group 3 and Group 2-Group 3 (p <0.0001 and p <0.0001, respectively). A positive correlation between PCSK9 and the TSH levels (r = 0.211, p= 0.019), and a negative correlation (r = -0,239, p = 0.009 and r = -, 0.218, p = 0.015) between the fT3 and fT4 levels were found. CONCLUSIONS: The serum PCSK9 levels were shown to be associated with thyroid dysfunction. However, no relationship was observed between the serum PCSK9 level and thyroid autoantibody positivity, and obesity in this study.

Evaluation of retinal microvascular changes in patients with prediabetes.

AIM: Diabetic retinopathy is a chronic progressive complication with neuronal cell and retinal microvascular involvement and is closely associated with blood sugar and blood pressure levels. Studies have shown that retinal neural dysfunction takes place before the microvascular changes in patients with Type 2 diabetes mellitus. The aim of this study is to compare the retinal microvascular changes of patients who are at the prediabetes stage and healthy volunteers. METHOD: Our study included 41 patients with prediabetes who were referred to the internal medicine outpatient clinic and 47 healthy volunteers. All patients underwent ophthalmologic examinations, including best visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination. Refractive error measurements were performed with the same automatic refractor-keratometer device. Typically, 3 × 3 mm macular images centered on foveola were obtained by using XR Avanti Optical Coherence Tomography Angiography with AngioVue (RTVue XR AVANTI, Optovue, Fremont, CA, USA) device. In the statistical analysis of the measurements, it was examined by Kolmogorov Smirnov test. Conditions expressed as IFG or IGT are considered as prediabetes; IFG is defined as fasting blood sugar to be between 100 and 125 mg/dL, while IGT is the condition in which the second hour value of the oral glucose tolerance test is 140-199 mg/dL. RESULTS: There was no statistically significant difference between the control and pre-DM groups in terms of mean age. The distribution of males and females between groups was statistically similar (P = 0.087). In the pre-DM group, 24 (58.6%) patients had IFG, 16 (39.0%) had IFG + IGT, and 1 (2.4%) had IGT. There were no statistically significant differences between the groups for the nonflow area (NFA) and the foveal avascular zone (FAZ) area (P > 0.05). The mean values of superficial and deep capillary plexus (DCP) density were not statistically significant differences between the groups. No statistically significant difference was found between the control group and pre-DM group in terms of the mean measurements of clinical ocular findings (P > 0.05). Retinal thicknesses were also not statistically significant differences between the groups (P > 0.05). CONCLUSION: All of the retinal measurements of both patients with prediabetes and healthy volunteers are similar. We did not find any difference between prediabetes and control groups. The ophthalmologic examinations which contain best-visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination are similar.

The easy way of evaluating exocrine pancreatic insufficiency in type 2 diabetes : listen to the patients' complaints and look in their eyes!

BACKGROUND AND STUDY AIMS: The objective of this study is to determine the prevalence of exocrine pancreatic insufficiency (EPI) in diabetic patients, and to investigate whether there is a relationship between EPI and diabetes period, gastrointestinal complaints and other diabetic microvascular complications. PATIENTS AND METHODS: A total of 93 participants, consisting of 57 type 2 diabetes patients and 36 healthy volunteers have been included in our cross-sectional study. Participants were questioned for abdominal complaints and weight loss. Fecal elastase-1 (FE-1) was determined in fecal spot samples received from participants. The relationship between EPI and blood glucose, HbA1c, and duration and complications of diabetes were investigated. RESULTS: FE-1 levels were significantly lower in diabetic group compared to control group (p=0.007). The number of patients with FE-1 levels of <200µg/g were significantly higher in diabetic group (p=0.002). A statistically significant negative correlation was determined between FE-1 levels and the duration of diabetes (r= -0.453 p<0.001). FE-1 levels were significantly lower in patients with retinopathy (p= 0.014). In the post-hoc analysis, this difference was due to patients in the proliferative retinopathy group. A significant negative correlation was determined between the presence of retinopathy and FE-1 levels (r=-0.32, p=0.02). Abdominal pain and distension complaints were independent predictive factors that estimate EPI. CONCLUSIONS: An important part of type 2 diabetes patients has EPI and it should be considered in diabetes patients upon abdominal pain and distension. Determination of proliferative retinopathy in the eye examination may also suggest an idea on the possible presence of EPI.

The role of insulin - like growth factor - 1 on steatohepatitis.

PURPOSE: Recent studies have revealed that growth hormone and STAT5 were related to hepatosteatosis in mice. Loss of signal transducer and activator of transcription factor-5 leads to hepatosteatosis and impaired liver regeneration. We aimed to investigate the role of IGF-1 in steatosis with normal (SNLFT) and disturbed liver function tests (SDLFT) in humans. METHODS: We included 272 NAFLD patients and 110 age, sex and body mass index (BMI)-matched healty controls. We measured routine blood biochemistry and complete blood count, IGF-1, insulin, c-peptide, ferritin, hsCRP, ESR and HOMA-IR. We subdivided NAFLD patients into SNLFT and SDLFT subgroups. RESULTS: ge, sex and BMI were similar between NAFLD and controls. IGF-1 levels were significantly lower in NAFLD patients (120,6±48,2) than controls (148,9±53,8), (<0,0001). IGF-1 levels were also lower in SDLFT subgroup (93,4±27,8) than SNLFT subgroup (123,1±49,0), (p:0,032). Waist circumference, fasting blood glucose, HbA1c, uric acid, hsCRP, AST, ALT, GGT, WBC, hemoglobin, hematocrit, ferritin, insulin, c-peptid and HOMA-IR measurements were significantly higher in NAFLD patients than controls (for all values: p<0,0001).Cholesterol (p:0,026), triglycerides (p<0,0001), ESR (p:0,006) were significantly higher in NAFLD patients than controls. HDL-chelesterol levels were significantly lower (p:0,002) in NAFLD patients than controls. CONCLUSION: This study supported previous findings of experi-mental studies in that, IGF-1 levels were lower in SNLFT and SDLFT. Growth hormone-IGF-1 system may be involved in the pathogenesis of NAFLD.

Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy.

OBJECTIVE: To evaluate the patients diagnosed with atypical endometrial hyperplasia preoperatively, and compare preoperative and postoperative results. MATERIALS AND METHOD: We investigated the files of 58 patients diagnosed with atypical endometrial hyperplasia who were treated surgically after clinical evaluation. We compared sociodemographic diagnosis, preoperative and postoperative diagnosis. RESULTS: Mean-age of patients was 51.7. Obesity, diabetes mellitus, hypertension and infertility were seen, respectively, in eight cases (13.7%), 12 cases (20.6%), 19 cases (32.7%) and four cases (6.8%). While endometrial cancer was not found postoperatively in patients preoperatively diagnosed with simple atypical endometrial hyperplasia, we determined well differentiated endometrial adenocarcinoma in 44.7% of the patients. CONCLUSION: In the literature the probability of developing well differentiated endometrial cancer from complex atypical endometrial hyperplasia is 40-50%. All patients diagnosed with complex atypical hyperplasia should be evaluated preoperatively for well differentiated adenocarcinoma and undergo an appropriate surgical technique and staging.

The relationship between serum ferritin levels and disease activity in systemic lupus erythematosus.

OBJECTIVE: The aim of this study is to investigate the relationship between serum ferritin levels and disease activity in patients with systemic lupus erythematosus (SLE). METHODS: Serum ferritin levels of 72 SLE patients were measured. The SLE patients were subdivided into two groups according to SLE disease activity index (SLEDAI) as < or = 10 and > or = 11. The results were compared with 31 patients with rheumatoid arthritis (RA). 36 patients among 72 with SLE were evaluated before and after treatment. RESULTS: Serum levels of ferritin in SLE patients were higher than RA patients (p < 0.001). There was a significant difference in ferritin levels before and after treatment. The levels of ferritin in SLE were positively correlated with SLEDAI scores. Patients with SLEDAI scores > or = 11 had significantly higher serum ferritin levels. CONCLUSION: Serum ferritin levels may be a useful marker of disease activity in SLE patients.