Acoustic Voice Analysis in Subclinical Hyperthyroidism.

OBJECTIVE: To investigate the effect of subclinical hyperthyroidism on voice quality using acoustic analysis. STUDY DESIGN: Cross-sectional comparative study. Place and Duration of the Study: Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey, from January to June 2020. METHODOLOGY: A total of 115 participants, with 60 patients with subclinical hyperthyroidism and 55 healthy volunteers, were evaluated and compared. Healthy volunteers with similar age and gender distributions were also evaluated and compared. Acoustic variables including average fundamental frequency (F0), relative average perturbation (RAP), jitter, shimmer, noise-to-harmonic ratio (NHR), and voice turbulence index (VTI) were measured and recorded. RESULTS: In the patient group, acoustic voice analysis results were obtained for F0 224.97%, jitter 0.85%, RAP 0.51%, shimmer 3.16%, NHR 0.12 dB, and VTI 0.047, respectively. In the control group, these respective values were 219.60%; 0.74%; 0.46%; 3.11%; 0.12 dB; and 0.045, respectively. There was no statistically significant difference between the groups (p>0.05). CONCLUSION: Subclinical hyperthyroidism does not cause a significant change in voice quality. KEY WORDS: Acoustic analysis, Subclinical hyperthyroidism, Voice, Frequency.

Glycemic responses to whole grain sourdough bread versus refined white bread in patients with gestational diabetes.

BACKGROUND: Nutritional therapy remains a key tool for prevention and management of gestational diabetes (GDM). Carbohydrate type and absorption rate rather than the carbohydrate amount have more impact on postprandial glucose (PPG) levels in GDM. The effect of refined white bread and whole grain sourdough bread on glycemic indexes were compared in GDM patients. METHODS: A total of 43 patients with GDM and 38 healthy pregnant women were included. A similar breakfast menu was given to both groups of patients at two different times in consecutive weeks; however, different types of bread with the same weight were used for both breakfasts; 1) white wheat (WW) bread, 2) sourdough whole grain wheat (SWGW) bread. Blood glucose, insulin and C­peptide levels were compared before and after breakfast. RESULTS: Fasting glucose, insulin and c­peptide levels were similar between groups (p > 0.05). While the second hour glucose levels were similar between the groups, the first hour results of glucose, insulin and C­peptide levels were lower in the SWGW group (p < 0.05). In the control patients, first hour glucose, insulin and C­peptide levels were also lower in the SWGW group (p < 0.05). CONCLUSION: The WW bread, which is more preferred in daily life routine, causes 45.5% more insulin secretion and 9.6% more first hour postprandial blood glucose compared to SWGW bread both in GDM patients and healthy pregnant women. According to the results of this study, we recommend that sourdough whole grain bread should be preferred in order to increase the success in the management of GDM.

Evaluation of voice quality in primary hyperparathyroidism patients undergoing minimally invasive parathyroid surgery.

OBJECTIVE: Voice quality disorders remain a problem with classical surgical method which is expected to decrease with new minimally invasive methods. We aimed to examine whether there is an impairment in voice quality among our patients who have undergone open minimally invasive parathyroid surgery. METHODS: Forty-seven primer hyperparathyroidism patients included in the study. Their video laryngoscopic evaluations and voice analyses were done in pre-operative and post-operative 6th month, and changes in the voice quality were examined. RESULTS: Eighty-five (85.1%) of patients were female, with a mean age of 51.5 ± 9.4. According to the voice analysis in the preoperative-postoperative 6th months, F0 (%): 210.616-211.443, Jitt (%): 0.699-0.735, RAP (%): 0.420-0.444, Shim (%): 2.535-2.736, NHR (dB): 0.119-0.123, and VTI: 0.044-0.045, respectively. No significant differences were observed in any of the acoustic parameters between the pre- and post-operative periods. CONCLUSION: No deterioration in voice quality was observed in patients undergoing novel minimally invasive surgical technique. In this respect we think that this new method will be much more advantageous in terms of preserving the voice quality in eligible patients.

OBJECTIVO: Los trastornos de la calidad de la voz siguen siendo un problema con el método quirúrgico clásico y se espera que disminuyan con los nuevos métodos mínimamente invasivos. Nuestro objetivo fue examinar si existe un deterioro en la calidad de la voz entre nuestros pacientes que se han sometido a una cirugía abierta de paratiroides mínimamente invasiva. MÉTODOS: Se incluyeron en el estudio 47 pacientes con hiperparatiroidismo primario. Sus evaluaciones videolaringoscópicas y análisis de voz se realizaron en el sexto mes preoperatorio y posoperatorio, y se examinaron los cambios en la calidad de la voz. RESULTADOS: Ochenta y cinco (85,1%) de los pacientes eran mujeres, con una edad media de 51,5 ± 9,4. Según el análisis de voz en el sexto mes preoperatorio-posoperatorio, F0 (%): 210.616-211.443, Jitt (%): 0.699-0.735, RAP (%): 0.420-0.444, Shim (%): 2.535-2.736, NHR (dB): 0,119-0,123 y VTI: 0,044-0,045 respectivamente. No se observaron diferencias significativas en ninguno de los parámetros acústicos entre el pre y postoperatorio. CONCLUSIÓN: No se observó deterioro en la calidad de la voz en pacientes sometidos a una técnica quirúrgica mínimamente invasiva novedosa. Teniendo en cuenta que este método brindará la oportunidad de preservar la calidad de la voz en pacientes elegibles.

The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients.

OBJECTIVES: We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients. METHODS: In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23-73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued. RESULTS: There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG>13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy. CONCLUSION: These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control.

The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis.

BACKGROUND & OBJECTIVE: The relationship between thyroid disorders and dyslipidemia has now been clearly demonstrated, but the relationship between thyroid autoimmunity and dyslipidemia in euthyroid patients is still controversial. Our aim in this study was to determine whether there is a risk of dyslipidemia in our patients with euthyroid hashimoto thyroiditis. METHODS: Fifty-five autoantibody positive hashimoto patients and 55 antibody negative control groups who came to Sakarya University Medicine Faculty Endocrinology Outpatient Clinics between January 2018 and November 2019 were included in our case control study. The groups were similar in terms of age, cardiovascular risk factors and BMI. Both groups were compared according to the lipid profile results. RESULTS: All type of lipids; including LDL (p = 0.008), HDL (p = 0.041), triglyceride (p = 0.045) and total cholesterol (p = 0.002), were higher in the patient group, and these differences were statistically significant. Anti-TPO and Anti-TG antibody titers and lipid levels were evaluated by separate correlation analysis. There was a significant positive correlation between Anti-TPO and LDL (r = 0.331, p <0.001), triglyceride (r = 0.267, p = 0.005) and total cholesterol (r = 0.316, p = 0.001), however no significant correlation was observed between Anti-TPO and HDL. Similarly, there was a significant positive correlation between Anti-TG and LDL (r = 0.318, p = 0.001), triglyceride (r = 0.218, p = 0.022), and total cholesterol (r = 0.301, p = 0.001), but HDL correlation relationship was not detected. CONCLUSION: The relationship between thyroid autoimmunity and dyslipidemia has been demonstrated in our study even in the euthyroid phase. Whether antibody positive patients should be followed more closely for dyslipidemia and cardiovascular events is still controversial. This question will be answered with larger randomized controlled trials.

MYELOLIPOMA COEXISTENCE WITH GLUCOCORTICOID AND ANDROGEN SECRETING ADRENOCORTICAL CARCINOMA: SLOW AND BENIGN CLINICAL COURSE.

We present a case of androgen and glucocorticoid secreting adrenocortical carcinoma with concomitant myelolipoma. A giant adrenal tumor which was initially nonfunctional was reassessed four years later due to the patient's refusal to treat. The patient was a 48-year-old woman with hypertension and acne lesions on the face. Laboratory findings were consistent with glucocorticoid and androgen hypersecretion. Computed tomography revealed a heterogeneously contrasting mass of 145x118x100 mm with lobular contour and soft tissue areas. The patient underwent left laparoscopic transperitoneal adrenalectomy with three port technique. There were no complications in the perioperative period. The resected specimen weighed 850 grams. Pathological findings showed a combination of myelolipoma-adrenal cortical cancer. In the postoperative period, hypertension improved and the hormone panel was normalized. Postoperative computed tomography and PET-CT showed no residual mass and metastasis. Although imaging is compatible with benign masses such as myelolipoma, coexistence of ACC-myelolipoma should be kept in mind and functional evaluation should be performed.

Relationship between serum osteopontin levels and the severity of COVID-19 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an acute inflammatory respiratory disease. Osteopontin (OPN) is a glycoprotein expressed in various cell types, such as bone, immune, smooth muscle, epithelial and endothelial cells. It also acts as a regulator of immune response. The aim of the present study was to reveal the place of serum osteopontin levels in predicting severity among patients with COVID-19. METHODS: This study included 84 patients, 43 female and 45 male. Patients were divided into 2 groups, group 1 non-severe group (n: 48), group 2 severe (n: 40). Demographic data, neutrophil, lymphocyte, platelet, white blood cell counts, albumin, procalcitonin, C­reactive protein (CRP) and OPN levels were recorded. The OPN levels and these inflammatory parameters of the two groups were compared. RESULTS: There were no significant differences in terms of gender (female/male 25/23 vs. 18/22) and platelet count (178 K/µL vs. 191 K/µL) between the groups (p > 0.05). Ages (57.7 ± 17.0 years vs. 71.4 ± 12.8 years), procalcitonin (0.07 vs. 0.24 ng/mL), CRP (17 vs 158 mg/l), neutrophil count (3.7 vs 5.64 K/µL), WBC counts (5.38 vs 7.85 K/µL) and number of deaths (0 vs 26) (p < 0.001). The OPN levels (98.5 vs 13.75 ng/mL, p = 0.002) were found to be statistically higher, in group 2 than group 1. CONCLUSION: The present study showed that OPN can be used to predict the severity in patients with COVID-19.

The role and importance of auxiliary tests in differential diagnosis in patients with mildly high basal 17-OH-progesterone levels in the evaluation of hirsutism

Background/aim: In the differential diagnosis of hirsutism, early follicular basal 17-OH-progesterone levels sometimes overlap with the diagnosis of late onset congenital adrenal hyperplasia (LOCAH) and other causes of hyperandrogenism. This study aims to investigate the role of some common tests and clinical findings in differential diagnosis in such cases. Materials and methods: One hundred seventy-five female patients with hirsutism and mildly high initial 17-OH-progesterone levels (2-10 ng/mL) were included in the study. The cases were divided into three groups according to their diagnosis: LOCAH (n = 16, mean age = 26.1 ± 6.9), polycystic ovary syndrome (PCOS) (n = 122, mean age = 23.9 ± 5.1), and intracranial hypertension (IH) (n = 37, mean age = 25.2 ± 7.3). Clinical signs and symptoms, such as menstrual irregularity and hirsutism score, and hormone levels including total testosterone and dehydroepiandrosterone sulfate (DHEAS), were compared between the groups. Results: There was no difference between the groups with PCOS, LOCAH, and IH for total testosterone level results (P = 0.461). The DHEAS level was higher in the PCOS group than in the LOCAH group (449.6 ± 151.14 vs. 360.31 ± 152.40, P = 0.044). While there was no difference between the PCOS and LOCAH groups in terms of menstrual irregularity (P = 0.316), the hirsutism score for IH was significantly lower than those of PCOS and LOCAH (9.2 vs. 12.2 and 11.1, respectively; P < 0.001). Basal 17-OH-progesterone levels were higher in the LOCAH group than in the other groups (P = 0.016). Conclusion: While DHEAS level was lower in LOCAH than in PCOS, it was not different from that in IH. While the severity of hirsutism was higher in LOCAH than in IH, it was not different from that in PCOS. Menstrual irregularity was similar between PCOS and LOCAH. According to these results, although the auxiliary tests and clinical findings for the diagnosis of LOCAH contribute to the clinical interpretation, they are not superior to the 17-OH-progesterone level for diagnosis.

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection.

BACKGROUND: Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS: 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS: There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001). CONCLUSION: The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.

Hemogram parameters in the patients with subacute thyroiditis.

BACKGROUND &OBJECTIVE: Subacute Granulomatous Thyroiditis (De Quervain's Thyroiditis) is an acute painful inflammatory disease of the thyroid. We aimed to investigate easily accessible and cheap hemogram based parameters of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) in the follow up of inflammatory thyroid disease. METHODS: Patients admitted to Sakarya University Education and Research Hospital Endocrinology and Metabolism Outpatient Clinic and diagnosed as Subacute Granulomatous Thyroiditis between May 2017 and November 2018 were included in the study. Hemogram, thyroid function tests and acute phase values of these patients were recorded and compared with the values after treatment and disease recovery. On the sixth month, thyroid function tests were repeated and the rate of permanent hypothyroidism was screened. The relationships between initial hemogram parameters and acute phase reactants were evaluated. RESULTS: Total 71 patients were included in our study. 60 (84.5%) were female and 11 (15.5%) were male. The F/M ratio was found to be 6/1. Mean age was 43 ± 9.95 years. Receiver Operating Characteristics (ROC) Curve Analysis was performed and values for Area Under the Curve (AUC) for NLR and PLR, respectively, were 0.739 (95% CI 0.657-0.820 p<0.0001) and 0.772 (95% CI 0.694-0.850 p<0.0001), which are significant and associated with disease activity. However, the AUC for MPV parameter was: 0.578 (95% CI 0.484-0.672 P: 0.10) and was not significant. The cut off values defined as 2.4 (80% sensitivity and 51% specificity) for NLR and 146.84 (83% sensitivity and 54% specificity) for PLR for the acute phase of the disease. In the Correlation Analysis, NLR and PLR values were significantly correlated with ESR and CRP parameters, which are the most commonly used acute phase reactants. CONCLUSION: According to the present study, we believe that the NLR and PLR parameters will be of benefit in the follow-up the disease, accurately demonstrate the inflammatory load in the acute phase of the disease, and correlate with the common acute phase reactants.

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection

SUMMARY BACKGROUND Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001) CONCLUSION The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.

RESUMO ANTECEDENTES A doença de coronavírus 2019 é uma doença respiratória inflamatória aguda. Causa muitas alterações nos parâmetros do hemograma. Baixos níveis de albumina estão associados ao risco de mortalidade em pacientes hospitalizados. O objetivo do presente estudo é revelar o local da razão entre contagem de neutrófilos e albumina na predição de mortalidade em pacientes com COVID-19. MÉTODOS Cento e quarenta e quatro pacientes do sexo feminino e 79 do sexo masculino foram incluídos no estudo. Os pacientes foram divididos em dois grupos: Grupo 1 não grave (n: 85), Grupo 2 grave (n: 59). Dados demográficos, contagem de neutrófilos, linfócitos e plaquetas, níveis de albumina e proteína C reativa (PCR) foram registrados. A razão de contagem de neutrófilos para albumina (NAR) foi calculada dividindo-se as contagens absolutas de neutrófilos pelos níveis de albumina. O NAR e os níveis dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas no sexo e na contagem de plaquetas (201 vs 211 K/mL) entre os grupos (p>0,05). Idade (62,0±14,3 vs 68,6±12,2 anos), albumina (33,1 vs 29,9 gr/L), PCR (33 vs 113 mg/l), contagem de neutrófilos (4 vs 7,24 K/mL), contagem de leucócitos (6,70 vs 8,50 K/mL), valores de NAR (113,5 vs 267,2) e número de óbitos (5 vs 33) foram estatisticamente maiores (p<0,001) no Grupo 2 que no Grupo 1. O valor NAR de 201,5 mostrou mortalidade em todos os pacientes com COVID-19 com sensibilidade de 71,1% e especificidade de 71,7% (AUC: 0,736, IC 95%: 0,641-0,832, p<0,001). CONCLUSÃO O presente estudo mostrou que os níveis de NAR podem ser um marcador barato e simples para predizer mortalidade em pacientes com COVID-19.

BRAF V600E mutation in papillary thyroid cancer is correlated with adverse clinicopathological features but not with iodine exposure.

INTRODUCTION: BRAFV600E activating mutation is the most frequent genetic abnormality in the pathogenesis of papillary thyroid carcinoma. We aimed to evaluate the association between BRAFV600E mutation and well-established prognostic clinicopathological characteristics as well as iodine exposure. MATERIAL AND METHODS: From 2000 to 2012, the data of PTC patients admitted to Dr. Lutfi Kirdar Kartal Education and Research Hospital in Turkey were reviewed retrospectively. Clinicopathological parameters were collected. BRAFV600E mutation was analysed by DNA sequencing method in tumour specimens. We hypothesised thatBRAFV600E mutation prevalence is positively correlated with prolonged iodine exposure and expected to be higher in the second half of the recruitment period due to the increment in time spent from the iodisation process of the table salt in our country. Thus, iodine exposure was categorised as short-term (2000-2006) and long-term (2006-2012). RESULTS: A total of 197 patients were accrued. The study population predominantly consisted of conventional variant. A statistically significant relationship was observed betweenBRAFV600E mutation presence and age (p = 0.03), conventional variant PTC (p = 0.00002), T4 stage (p = 0.002), vascular invasion (p = 0.036), thyroid capsule invasion (p < 0.00001), extrathyroidal tissue invasion (p < 0.00001), and lymph node metastasis (p < 0.00001). When categorised as long-term and short-term, iodine exposure was not statistically significantly related withBRAFV600E mutation; however, there were far more PTC cases in the long-term group (86.3% vs. 13.7%). CONCLUSION: We revealed that BRAFV600E mutation is associated with adverse clinicopathological parameters. There appeared to be no relation between long-term iodine exposure and BRAFV600E.