A descriptive survey study in endocrinology clinic: evaluation of the use of natural products.

OBJECTIVE: The use of herbal products/dietary supplements (HP/DS) in endocrinal chronic diseases is growing. However, no studies have evaluated their use in patients who present to endocrinology and metabolic diseases clinics. This descriptive study aims to investigate the rate of HP/DS use and the factors affecting this in patients who presented to Karadeniz Technical University (KTU) Farabi Hospital Endocrinology and Metabolic Diseases Clinic, Türkiye between 01.11.2021 and 01.05.2022. METHODS: Five hundred six questionnaires with acceptable data quality were included this investigation. The data were analyzed on SPSS version 23.0 software. The factors with the greatest effect on the use of HP/DS were determined using binary logistic regression analysis. RESULTS: Analysis showed that 49.4% of the participants used HP/DS. The main factors affecting the use of herbal products were age, diagnosis of the disease, and treatment compliance problems. The most frequently used products were lemon, cinnamon, black cumin, ginger, turmeric, and dill. The participants main sources of information about HP/DS were friends/relatives, the internet/social media, and television, respectively. 74.8% of the participants using HP/DS did not inform their physcisian/pharmacist about such use, although 81.8% of these nevertheless wished to receive information from these occupational groups. CONCLUSION: Herbal product monitoring in patients should be performed in collaboration with pharmacists, herbal product use should be investigated, and counseling services should be made available in order to maintain and promote public health.

Comparison of orlistat and orlistat plus metformin therapy between diabetic and nondiabetic groups.

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.

Can signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) be used as an indicator of endothelial dysfunction in acromegaly patients?

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.

Comparison of orlistat and orlistat plus metformin therapy between diabetic and nondiabetic groups

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.

Clinical research of insulin glargine U300 in type 1 diabetes mellitus patients with frequent hypoglycaemia: real-world experience.

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.

Clinical research of insulin glargine U300 basal-bolus therapy and insulin degludec/aspart co-formulation in type 2 diabetes mellitus: A real world experience.

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.

Relationship between metabolic syndrome and nodular thyroid diseases.

Nodular thyroid diseases are common in Turkey. Insulin resistance (IR) is considered as the most important component of metabolic syndrome (MetS), and it is thought to directly affect thyroid diseases, together with other components of MetS. The aim of this study was to evaluate potential factors associated with thyroid nodularity. This study was part of the prospective MELEN study. In total, randomly selected 2233 subjects were evaluated. A euthyroid subgroup of participants (n = 1432) was selected and 421 of them had MetS. Both goitres and multinodular goitres (MNGs) were significantly more common in the MetS (+) group (p < .001). Older age was the only factor that significantly affected the presence of a nodular goitre (NG) (p < .001). The presence of a MNG was associated with older age (p < .001), systolic blood pressure level (p < .008) and MetS (p < .001). There was no difference in the thyroid volume or presence of nodular thyroid diseases between the IR (+) and (-) groups. Both the thyroid volume and the presence of MNGs were significantly associated with MetS, independent of thyroid-stimulating hormone (TSH) and IR. We suggest that the individual components of MetS may influence thyroid nodularity to some degree and that together they exert a cumulative effect on the thyroid gland. As a result, in the absence of MetS, we further suggest that IR alone does not explain the increase in thyroid volume and thyroid nodule formation.

The effect of L-thyroxine replacement therapy on ischemia-modified albümin and malondialdehyde levels in patients with overt and subclinical hypothyroidism.

BACKGROUND AND OBJECTIVES: The main objective of this study was to evaluate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in patients with subclinical (SHypo) and overt hypothyroidism (OHypo), and to assess the effects of levothyroxine (LT4) therapy on the oxidative stress (OS) parameters. We also investigated the relationships among serum thyroid hormones, lipid parameters, and IMA and MDA in these patients. DESIGN AND METHODS: Thirty untreated patients with OHypo, 25 untreated patients with Shypo, and 30 age- and sex-matched healthy controls were prospectively included in the study. Biochemical and hormonal parameters including IMA and MDA were evaluated in all patients just before and one month after the maintenance of euthyroidism. RESULTS: Compared with the control subjects, the levels of MDA and triglycerides (TG) significantly increased in patients with SHypo (p < 0.001 and p < 0.05, respectively), whereas high density lipoprotein cholesterol (HDL-C) levels significantly decreased (p = 0.01). Patients with OHypo showed significantly high MDA, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and TG levels (p = 0.001, p < 0.01, p = 0.01, and p < 0.01, respectively), and significantly low HDL-C levels compared with the controls (p < 0.05). MDA levels and lipid profile were not significantly different in the patients with OHypo when compared with the patients with SHypo. Serum IMA levels did not significantly change in patients with OHypo and SHypo compared with the controls. In the pre-treatment period, MDA levels were inversely correlated with HDL-C levels in patients with OHypo (r: -0.471, p = 0.009). Plasma MDA and LDL-C levels significantly decreased and HDL-C levels significantly increased in the groups of OHypo and SHypo after LT4 treatment. Serum IMA levels did not significantly change with the therapy in all patient groups. CONCLUSIONS: Increased MDA levels in both patient groups represent increased lipid peroxidation which might play an important role in the pathogenesis of the atherosclerosis seen in these patients. Increased OS in patients with SHypo and OHypo could be improved by LT4 treatment. Also, MDA can be used as a reliable marker of OS and oxidative damage, while IMA is considered to be inappropriate.

Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) levels in patients with overt and subclinical hyperthyroidism: effects of treatment.

BACKGROUND AND OBJECTIVES: Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) has been shown to increase in parallel with platelet activation in acute ischaemic and thrombotic diseases. There has been no study evaluating SCUBE1 levels in patients with overt hyperthyroidism (OHyper) and subclinical hyperthyroidism (SHyper), conditions which are known to show impairment of both endothelial and platelet function. This study sought to evaluate SCUBE1 concentrations in patients with SHyper and OHyper, and assessed the effects of antithyroid drug (ATD) therapy on circulating SCUBE1 levels. DESIGN AND METHODS: Forty-five untreated patients with OHyper, 20 untreated patients with SHyper and 30 age- and sex-matched healthy controls were prospectively included in the study. Biochemical and hormonal parameters were evaluated in all patients before and after treatment. RESULTS: Compared with the control subjects, SCUBE1 levels were significantly increased in patients with SHyper and OHyper (P < 0·0001 and P = 0·002, respectively). SCUBE1 levels were not significantly different in patients with OHyper compared with patients with SHyper. There was no significant correlation between serum thyroid hormones and SCUBE1 levels. Plasma SCUBE1 levels decreased significantly in both OHyper and SHyper after ATD treatment (P < 0·05). CONCLUSIONS: Increased SCUBE1 levels in both SHyper and OHyper patients may reflect increased platelet activation and possible endothelial dysfunction, which might augment the risk for atherosclerotic and atherothrombotic complications. SCUBE1 may be used as a reliable marker of endothelial damage in hyperthyroidism, especially in the subclinical period.

Spectrum and prevalence of nodular thyroid diseases detected by ultrasonography in the Western Black Sea region of Turkey.

OBJECTIVE: The aim of the study was to investigate thyroid diseases and the prevalence of goiter by ultrasonography (US) in a moderately iodine deficient area. MATERIAL-METHODS: The MELEN Study is a prospective cohort study on the prevalence of thyroid diseases in Turkish adults. A total of 2233 subjects with a mean age of 50 (age range 18 to 92) were submitted to study. Thyroid US was performed and interpreted by the same experienced physician. Goiter prevalence was defined according to Gutekunst's criteria. RESULTS: The most common thyroid disease was multinodular goiter (MNG) (42%), followed by nodular goiter (NG) (14.6%). The crude prevalence of nodular disease in the region was 56.6%. In the study cohort, thyrotoxicosis (TSH <0.35 µIU/ml) prevalence was 12 % and subclinical and overt hypothyroidism (TSH > 4.5 µIU/ml) prevalence was 6.5 %. CONCLUSION: We found that thyrotoxicosis and nodular thyroidal diseases are more important public health issues in moderate iodine deficient geographical areas. We recommend the increased rates of US screening especially in the endemic regions in order to detect thyroidal nodules earlier.

[Evaluation of carotis intima media thickness in chronic obstructive pulmonary disease patients]. / Kronik obstrüktif akciger hastaliginda karotis intima mediya kalinliginin degerlendirilmesi.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and atherosclerosis may occur due to similar risk factors and have a significant cause of morbidity and mortality. In this study to assess the relationship between COPD and atherosclerosis; carotid intima media thickness (CIMT) of COPD patients and adult healthy individuals with normal body mass index and metabolic parameters compared. MATERIALS AND METHODS: 2298 participants aged between 18-92; 46 patients diagnosed with COPD according to clinical features and pulmonary function tests the study, 47 healthy controls who do not have exclusion criteria were evaluated. Doppler ultrasound was performed for the assessment of CIMT to all participants. p values < 0.05 were considered to be significant. RESULTS: Mean CIMT in COPD group and control group were 0.79 ± 0.16 mm and 0.616 ± 0.1 mm, respectively (p< 0.001). In multiple linear regression analysis that made to determine the atherosclerotic risk parameters affecting CIMT; it was found that CIMT was related to age with direct proportion (p= 0.002) and to FEV(1)% with inversely proportion (p= 0.04). In multivariate logistic regression analysis that made to determine the parameters affecting atherosclerosis; we found that any parameters were related with atherosclerosis. CONCLUSION: Persistent low-grade systemic inflammation in COPD and atherosclerotic disease may possibly have been reported a factor in both pathologies. Early atherosclerosis and cardiovascular risks in adults with COPD increase independent of risk factors. CIMT which shows direct proportion with age and inverse proportion with FEV(1)% is a non-invasive, easily applicable and cheap method that can be used in determining the risk of atherosclerosis.

Rheumatoid arthritis masquerading as acromegaly recurrence: report of two cases.

Acromegaly is a chronic endocrinopathy characterized by hypersecretion of growth hormone (GH) and consequently of insulin-like growth factor-1 (IGF-1). The arthropathy in acromegaly is the most frequent and important cause of morbidity and functional disability in acromegaly. Rheumatoid arthritis (RA) is a rarely reported clinical situation in patients with acromegalic. We herein report 57- and 45-year-old two women, who complained bilateral, symmetric pain, swelling and morning stiffness in the joints of hands after optimal acromegaly treatment resembling acromegaly arthropathy. There was not arthralgia in other joints of the patients. Laboratory and radiological evaluations were carried out. After excluding the acromegaly activation and arthropathy by GH and IGF-1 measurement, according to clinical presentation, laboratory and radiological assessments, patients were diagnosed as RA.

Association of mean platelet volume with DSM-IV major depression in a large community-based population: the MELEN study.

The relationship between major depression and increased platelet activity has been previously stated by several studies. This study sought to test the relationship between mean platelet volume (MPV)--an indicator of platelet activity--and major depression, in an adult Turkish population sample. Respondents were 2286 participants interviewed in a regional survey. The diagnosis of current (one month) major depression was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. MPV was measured along with total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, BMI, and waist circumference. Two hundred eighty-nine participants (12.5%) were diagnosed as having major depression. Patients with major depression were found to have increased MPV levels in comparison with participants without depression (p = 0.001). After excluding the subjects with risk factors capable of influencing platelet activity, MPV was still found to be elevated in patients with major depression compared with non-depressed individuals (p < 0.01). Linear regression analysis revealed a significant independent association of major depression with MPV levels (r = 0.123; p = 0.001). According to the findings of this study, increased MPV (or platelet activation) is associated with current (one month) diagnosis of major depression. Future research should investigate the effect of depression treatment on MPV.