Higher Serum Bisphenol A Levels in Diabetic Hemodialysis Patients.

BACKGROUND: Bisphenol A (BPA) has been implicated as an 'endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients. METHODS: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods. RESULTS: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 ± 1.2 vs. 4.06 ± 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 ± 0.6 vs. 3.9 ± 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters. CONCLUSION: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels.

The phenotypic and molecular genetic spectrum of Alström syndrome in 44 Turkish kindreds and a literature review of Alström syndrome in Turkey.

Alström syndrome (ALMS) is an autosomal recessive disease characterized by multiple organ involvement, including neurosensory vision and hearing loss, childhood obesity, diabetes mellitus, cardiomyopathy, hypogonadism, and pulmonary, hepatic, renal failure and systemic fibrosis. Alström Syndrome is caused by mutations in ALMS1, and ALMS1 protein is thought to have a role in microtubule organization, intraflagellar transport, endosome recycling and cell cycle regulation. Here, we report extensive phenotypic and genetic analysis of a large cohort of Turkish patients with ALMS. We evaluated 61 Turkish patients, including 11 previously reported, for both clinical spectrum and mutations in ALMS1. To reveal the molecular diagnosis of the patients, different approaches were used in combination, a cohort of patients were screened by the gene array to detect the common mutations in ALMS1 gene, then in patients having any of the common ALMS1 mutations were subjected to direct DNA sequencing or next-generation sequencing for the screening of mutations in all coding regions of the gene. In total, 20 distinct disease-causing nucleotide changes in ALMS1 have been identified, eight of which are novel, thereby increasing the reported ALMS1 mutations by 6% (8/120). Five disease-causing variants were identified in more than one kindred, but most of the alleles were unique to each single patient and identified only once (16/20). So far, 16 mutations identified were specific to the Turkish population, and four have also been reported in other ethnicities. In addition, 49 variants of uncertain pathogenicity were noted, and four of these were very rare and probably or likely deleterious according to in silico mutation prediction analyses. ALMS has a relatively high incidence in Turkey and the present study shows that the ALMS1 mutations are largely heterogeneous; thus, these data from a particular population may provide a unique source for the identification of additional mutations underlying Alström Syndrome and contribute to genotype-phenotype correlation studies.

Relationship between mean platelet volume and retinopathy in patients with type 2 diabetes mellitus.

OBJECTIVES: To evaluate the effect of mean platelet volume (MPV) on diabetic retinopathy in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: In this study, ocular findings and MPV values were retrospectively reviewed in 192 patients with type 2 diabetes mellitus. The patients were classified into four groups according to ocular findings, as follows: group 1, diabetic patients without diabetic retinopathy (n = 70); group 2, diabetic patients with non-proliferative diabetic retinopathy (n = 64); group 3, diabetic patients with proliferative diabetic retinopathy (n = 58); and group 4, healthy controls (n = 100). RESULTS: A significant difference was found in MPV values between groups 2 and 4 (P = 0.001), between groups 3 and 4 (P = 0.001), and between groups 1 and 4 (P = 0.004). No significant difference was found in MPV values between groups 1 and 2 (P = 0.241) and between groups 2 and 3 (P = 0.460); whereas there was a statistically significant difference between groups 1 and 3 (P = 0.015). The three diabetic groups (groups 1, 2, and 3) were compared with each other. While there was a statistically significant difference between groups 1 and 3 (P = 0.015), there was no significance between groups 2 and 3 (P = 0.46), and between group 1 and 2 (P = 0.241). Logistic regression analysis found a 1.40-fold increase in the risk of retinopathy development (OR: 1.404; P = 0.002) and a 1.46-fold increase in the risk of proliferative diabetic retinopathy (OR: 1.466; P = 0.002) as the MPV value increased. CONCLUSIONS: In diabetic patients, the risk of retinopathy development increases with higher MPV values.

Gynecomastia: a rare complication of isoretinoin?

Isotretinoin is a retinoic acid derivative mostly used in the treatment of cystic acne vulgaris. The adverse effects of isotretinoin are well defined being the major limitation factor for its usage. The decrement of testosterone during isoretinoin treatment is defined in literature. We present a case with 20 years old man who developed gynecomastia after treatment with isotretinoin. To the best of our knowledge, this is the third report of the development of gynecomastia after isotretinoin treatment.

Pituitary apoplexy due to thyroxine therapy in a patient with congenital hypothyroidism.

A 24-year-old woman was admitted with general weakness, umbilical swelling, developmental delay, speech disorder, constipation, gait problem. Her findings were umbilical hernia, xerosis, dry hair, and short stature. After thyroxine treatment, she also had headache, vomiting, and palpitation, lack of appetite, and sleep disturbance. Pituitary magnetic resonance imaging revealed a heterogeneous mass at the central part of the gland on coronal section and it was interpreted as pituitary apoplexy. In the current case, the patient with congenital hypothyroidism (CH) developed pituitary apoplexy (PA) after thyroxine therapy. Therefore, it is suggested that the complaints were related to PA rather than adrenal insufficiency. Here we describe a case report evaluating PA in a patient with thyrotrophic pituitary adenoma due to CH. To the best of our knowledge, this is the first case in terms of PA associated with CH after thyroxine therapy in the literature.

Tissue Doppler imaging must be performed to detect early left ventricular dysfunction in patients with type 1 diabetes mellitus.

AIMS: We sought to compare diastolic parameters in patients having type 1 diabetes mellitus (DM) and healthy controls using both pulse-wave (PW) Doppler and relatively novel tissue-Doppler imaging (TDI) to evaluate the possible effect of diabetes on left ventricular dysfunction. METHODS AND RESULTS: One hundred and thirty-two patients were evaluated (81 type 1 diabetic patients and 51 healthy volunteers). The detailed M-mode, two-dimensional, colour Doppler; PW Doppler; and TDI analyses were performed on resting subjects in a regular setting. Posterior wall thickness, left atrial indexed diameter, and A velocity were significantly higher in the diabetics when compared with control group (P = 0.019, <0.001, 0.033, respectively). Rest of the M-mode and PW Doppler parameters of diabetics were comparable with those of control subjects (P > 0.05 for all). However, both septal E' and lateral E' velocities were significantly lower in diabetics than in the control subjects on TDI echocardiographic examination (P < 0.001 and 0.011, respectively). In addition, E'/septal E' and E/lateral E' ratios were significantly higher in the diabetic group (P < 0.001 and 0.008, respectively). CONCLUSION: TDI is a more accurate and powerful method than PW or M-mode in determination of early cardiac involvement related to type 1 DM even in the subclinical phase as well as hereditary cardiomyopathies.

The value of fine-needle aspiration biopsy in subcentimeter thyroid nodules.

BACKGROUND: The need to perform fine-needle aspiration biopsy (TFNAB) on subcentimeter thyroid nodules is less clear than for larger nodules. We compared the ultrasonographic features of thyroid nodules less than and greater than one centimeter and correlated this information with the cytological results for TFNAB and the final histopathological diagnosis in selected patients. METHODS: We evaluated 520 thyroid nodules (247 subcentimeter [group 1], 273 supracentimeter [group 2]) in 426 patients. Ultrasonography-guided fine-needle aspiration biopsy was performed on all nodules. Surgery was recommended for patients with TFNAB results that were read as malignant or suspicious. The results of ultrasonography, TFNAB, and histopathology were compared between the groups. RESULTS: Out of 426 patients, 337 had one nodule, 84 had two, and five had three. There was indeterminate cytology in 20 cases, 10 from each group. Inadequate cytology was obtained in 41/247 (16.6%) nodules in group 1 and 61/273 (22.3%) nodules in group 2, and the difference in rate was not significant (p = 0.067). The malignancy rate as determined by TFNAB was 4.9% in group 1 and 1.5% in group 2 (p < 0.025). In patients who underwent surgery for thyroid nodules the malignancy rate was 6% in group 1 and 2.9% in group 2 (p = 0.08). Hypoechoic pattern, microcalcification, and a long axis/short axis ratio (LA/SA) of < 1.5 were associated with malignancy in subcentimeter thyroid nodules (group 1), while only a hypoechoic pattern was associated with malignancy in supracentimeter thyroid nodules (group 2). CONCLUSIONS: The incidence of cancer in thyroid nodules < 1 cm does not appear to be lower than in larger nodules and may even be higher. Physicians should consider obtaining biopsy samples from subcentimeter hypoechoic nodules that contain microcalcification and have a relatively round shape (LA/SA < 1.5).

The relationship between phthalates and obesity: serum and urine concentrations of phthalates.

BACKGROUND: A limited number of human and animal studies suggest that a relationship exists between phthalates and obesity, although this is not supported by all research. The purpose of this study was to investigate the relationship between Body Mass Index (BMI) and the levels of phthalates in human blood and urine samples. METHODS: Sixty-four overweight or 132 obese individuals (total=196) of different ages (min-max, 17-62; mean ± SD, 42.07±11.3) and genders (F:M 97:99) enrolled in the study. BMI and waist circumference were measured to diagnose obesity. Venous blood samples were taken after overnight fasting. To compare the urine phthalates among participants, single spot urine (at least 10 mL) was collected from the subject after blood samples were taken. Urine and blood phthalate concentrations were measured using gas chromatography. RESULTS: Total blood/urinary phthalate levels significantly increased in proportion to the degree of obesity. There was a high correlation between the level of total phthalates in serum and BMI (ρ=0.697, P<0.001), and between total urinary phthalate levels and BMI (ρ=0.707, P<0.001). CONCLUSIONS: This is the first study to have shown that both blood and urinary phthalates increased in proportion to BMI. The results show a strong association between obesity and phthalates.

The Presence of Demodex Folliculorum in Various Obese Groups According to BMI Levels.

BACKGROUND: This study aimed to detect the presence of the parasite Demodex folliculorum (DF) in various obese groups according to BMI Levels. MATERIALS AND METHODS: A total of 182 patients (40.8 ± 14.8 years, min-max age 19 - 73 years) were enrolled in the study, of those 65 (35.7%) were female and 117 (64.3%) were male. They had previously applied to Mustafa Kemal University (Faculty of Medicine, Endocrine Outpatient Clinic) during 2012. A standardized skin surface biopsy method was used to research the existence of DF. Patients were classified into four main groups, including: obese (n = 89), overweight (n = 31), normal (n = 32), and underweight (n = 30). RESULTS: There was no significant difference between groups in terms of age and sex. The total DF positivity was 19 (21.3%) in obese patients. Among those with positive DF, the mean BMI was 35.7 ± 12.1 kg/m(2), while those with negative DF had a mean BMI of 29.2 ± 9.2 kg/m(2). There was a significant difference between two groups (P = 0.002). Also, the underweight group has significantly higher DF positivity in comparison to the normal weight group. CONCLUSION: The DF positivity was significantly higher in obese patients in accordance with the physiopathologic nature of the disease.

Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo.

OBJECTIVE: To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit. SUBJECTS AND METHODS: The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit. RESULTS: The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23-75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p < 0.05). CONCLUSION: A statistically significant association was determined between Vitamin D and calcium metabolism in patients with idiopathic BPPV. It can be considered that Vitamin D deficiency and decreased ionized Ca level may be a risk for BPPV, not only in patients with osteoporosis but also in all patients. Very low levels of 25(OH)-D seem to be associated with recurrence of BPPV. The recurrences might possibly be prevented with supplementary Vitamin D especially in those with recurrent idiopathic BPPV but further studies would be necessary to determine this.

Inverted T waves in patient with Addisonian crisis.

Addisonian crisis represents a state of acute adrenocortical insufficiency and occurs in patient with Addison's disease who are exposed to stress of infection, surgery, trauma, vomiting and diarrhea. We present a case with a 39-year-old female patient who admitted to the hospital with Addisonian crisis and, interestingly, her electrocardiograph showed ST depression and inverted T waves on inferior and V4-V6 leads. She did not have a history of angina pectoris and coronary artery disease, and her cardiac enzymes were normal. Exercise stress testing and echocardiographic assessment revealed normal findings. When faced with such a patient who has hypotension and ischemic ECG changes without having underlying angina, Addisonian crisis should be considered in differential diagnosis.

Herpes simplex type-2 encephalitis masked by diabetic ketoacidosis.

Diabetic ketoacidosis is a life-threatening acute complication of type-1 diabetes mellitus. Infection is the most common precipitating factor for diabetic ketoacidosis and is responsible for more than 50% of the cases. Here, we present a case study of a young man with herpes simplex virus type-2 encephalitis masked by diabetic ketoacidosis. We aim to orient clinicians towards being vigilant against such clinical scenarios.

Migrated phthalate levels into edible oils.

The determination of phthalates in edible oils (virgin olive oil, olive oil, canola oil, hazelnut oil, sunflower oil, corn oil) sold in Turkish markets was carried out using gas chromatography-mass spectrometry. Mean phthalate concentrations were between 0.102 and 3.863 mg L(-1) in virgin olive oil; 0.172 and 6.486 mg L(-1) in olive oil; 0.501 and 3.651 mg L(-1) in hazelnut oil; 0.457 and 3.415 mg L(-1) in canola oil; 2.227 and 6.673 mg L(-1) in sunflower oil; and 1.585 and 6.248 mg L(-1) in corn oil. Furthermore, the influence of the types of oil and container to the phthalate migration was investigated. The highest phthalate levels were measured in sunflower oil. The lowest phthalate levels were determined in virgin olive oil and hazelnut oil. The highest phthalate levels were determined in oil samples contained in polyethylene terephthalate.

Insulin resistance in patients with post-adolescent acne.

BACKGROUND: Post-adolescent acne has been defined as acne in a patient aged >25 years. Acne vulgaris first develops at the onset of puberty as a result of hormonal changes. During puberty, there is a transient decline in insulin sensitivity. We hypothesized that insulin resistance might persist after puberty in patients with post-adolescent acne. OBJECTIVES: This study was conducted in order to investigate the relationship between post-adolescent acne and insulin resistance. METHODS: The study population comprised 35 patients with post-adolescent acne and 35 healthy control subjects. The parameters measured were fasting blood glucose, insulin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). The homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated for each individual. RESULTS: No significant differences were observed between patients with post-adolescent acne and control subjects in fasting blood glucose, fasting insulin, AST, ALT, triglyceride and HDL-C levels, and HOMA-IR index. There were also no correlations between these parameters and the severity of acne. CONCLUSIONS: This study suggests that insulin resistance may not play a major role in the pathogenesis of post-adolescent acne. Hormonal changes, genetic susceptibility, stress, the use of cosmetics, drugs, and environmental factors should be considered in the development of post-adolescent acne.

Investigation of vitamin D levels in patients with vitiligo vulgaris.

The aim of the study was to investigate serum 25-hydroxyvitamin D (25(OH) D3) levels in patients with vitiligo vulgaris in terms of causal relation and extension of the disorder. This study is a clinical cross-sectional study carried out in order to determine 25-hydroxyvitamin D levels among 25 patients with vitiligo vulgaris and in 41 controls. Fitzpatrick skin phototypes, history of autoimmune disease, family history of vitiligo, and duration of the disease were also evaluated. The mean levels of vitamin D in patient and the control group were 15.2±5.2 ng/dL and 14.4±6.2 ng/dL respectively (P>0.05). In our study, 48% of the patients had insufficient (<30 ng/mL) and 52% had very low (<15 ng/mL) levels of vitamin D. There was no correlation between age, duration of the disease, and body surface area affected with vitamin D levels. There was no significant difference in vitamin D levels between patients who had family history of vitiligo (5 patients, 20%) and those that did not. Vitamin D levels were found to be insufficient (<30 ng/mL) or very low (<15 ng/mL) in most of the patients with vitiligo vulgaris, but not statistically significantly different as a group when compared to the controls. More studies are needed to differentiate between the effects of low vitamin D levels on pathogenesis of vitiligo vulgaris and lower vitamin D levels as a result of the disease.

Diabetic foot due to anaphylactic shock: a case report.

INTRODUCTION: Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite. CASE PRESENTATION: We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite. CONCLUSIONS: Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot.