Cardiac diastolic function is impaired at rest and worsens with exercise in otherwise healthy individuals with insulin resistance.

Insulin resistance (IR) is a pathophysiological condition and is associated with cardiovascular risk factors including heart failure. However, studies demonstrating myocardial abnormalities in the early phases of IR are limited. The aim of this study was to investigate myocardial function in otherwise healthy individuals with IR.Individuals with IR who were free of cardiovascular risk factors and healthy controls were included. Stress echocardiography with tissue Doppler imaging (TDI) was performed. Systolic and diastolic TDI waves were compared in both groups.A total of 77 individuals (51 with IR and 26 controls) were included in our study. The tissue early flow (e')/atrial contraction (a') ratio at rest was significantly lower in the IR group (P = 0.003). The annular early flow (E)/e' ratio, a predictor of left ventricular filling pressure, was similar in both groups at rest (P = 0.522). After exercise, e'/a' impairment became more prominent in the IR group (P < 0.001); whereas the E/e' ratio was also significantly lower (7.6 ± 1.8 versus 6.7 ± 0.9; P = 0.007) in the IR group.Myocardial involvement seems to occur in patients with IR, before the appearance of other cardiovascular risk factors. Exercise induced diastolic worsening may be a predictor of reduced compliance and increased ventricular stiffness. More detailed prospective studies are required for more precise results.

Left ventricle geometry affects coronary flow reserve in diabetic patients.

OBJECTIVES: The aim of this study was to investigate the association between coronary flow reserve (CFR) and left ventricle (LV) geometric patterns in patients with newly-diagnosed diabetes mellitus (DM). STUDY DESIGN: We studied 116 patients with newly-diagnosed DM and 31 healthy control subjects. Echocardiographic examination was performed on all subjects. Four different geometric patterns were identified in diabetic patients, according to LV mass index (LVMI) and relative wall thickness (RWT) [NG: Normal geometry; CR: Concentric remodeling; EH: Eccentric hypertrophy; CH: Concentric hypertrophy]. CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, CFR was decreased in diabetic patients (p<0.05). The lowest CFR values were observed in the CH group compared with control and other groups (p<0.05, for all). Also, CFR values of the CR and EH groups were lower than NG and the control group (p<0.05, for all). CFR was associated with LV geometry (r=-0.449, p=0.001), LVMI (r=-0.401, p<0.001), RWT (r=-0.247, p=0.008), HbA1c (r=-0.576, p<0.001) and mitral valve E/A ratio (r=0.239, p=0.01) in bivariate analysis. CFR was independently associated with LV geometry (ß=-0.449, p<0.001), LVMI (ß=-0.192, p=0.016), and HbA1c (ß=-0.576, p<0.001) in multivariate analysis. CONCLUSION: CFR was impaired in newly-diagnosed DM. The degree of this deformation increases from normal geometry towards to concentric hypertrophy. This condition suggests that myocardial structural remodeling due to diabetes might be effective on CFR.

High renal resistive index in hypertensive patients is also associated with serum homocysteine level.

BACKGROUND: Hypertension, homocysteine and renal resistive index are associated with atherosclerosis and lead to cardiovascular diseases. In this study, we aimed to investigate the association between homocysteine and renal resistive index in patients with newly diagnosed hypertension. METHODS: A total of 221 subjects were included in this case-control study. The study group consisted of 116 hypertensive patients and the control group consisted of 105 healthy subjects. Renal resistive index, homocysteine levels, insulin concentrations and blood pressures were measured. RESULTS: Renal resistive index, serum homocysteine levels and insulin concentrations were higher in hypertensive patients (p = 0.006, p < 0.001, respectively). Serum homocysteine levels were associated with hypertension (OR 9.5, Cl 95 % 4.86-18.7, p < 0.001). Homocysteine and insulin levels were positively correlated with renal resistive index (r = 0.372, p = 0.001; r = 0.392, p < 0.001, respectively). CONCLUSION: High renal resistive index in hypertensive patients is associated with homocysteine.

Low Serum Phosphorus Level in Massry's Phosphate Depletion Syndrome May Be One of the Causes of Acute Heart Failure.

Hypophosphatemia has been found to be associated with multiple organ dysfunction. In this study we aimed to investigate the association between low serum phosphorus and acute heart failure. A total of 213 subjects, 101 patients with acute heart failure and 112 healthy subjects were included in this case-control study. Serum phosphorus levels, calcium levels, and PTH concentrations were measured. Ejection fraction percentages, pulse rates, systolic and diastolic blood pressures were recorded. The groups were similar in terms of age and gender (p=0.067 and 0.995, respectively). The phosphorus levels and ejection fraction percentages of the patients with heart failure were lower than for the healthy subjects (p<0.001). Frequency of hypophosphatemia was higher in the heart failure group (p<0.001). There was a strong relationship between low serum phosphorus level and acute heart failure (OR 9.85, CI 95% 3.6-26.3, p<0.001). The phosphorus level of patients with acute heart failure was found to be low in this study. Therefore, the phosphorus level should be controlled in patients with acute heart failure and phosphorus supplementation can be a complimentary treatment for these patients.

The association between aortic distensibility and coronary flow reserve in newly diagnosed diabetic patients.

INTRODUCTION: Aortic distensibility (AD) is an important parameter affecting coronary hemodynamics. Coronary flow velocity reserve (CFVR) is a reliable marker of coronary endothelial function in diabetic patients. The aim of this study was to investigate the association between AD and CFVR in newly diagnosed diabetic patients. METHOD: We studied 77 patients with newly diagnosed diabetes mellitus (DM) and 30 age- and sex-matched healthy control subjects. CFVR was calculated as the hyperemic to resting coronary diastolic velocities ratio by using transthoracic echocardiography. Pulse pressure (PP) and AD were calculated. RESULTS: Fasting blood glucose, HbA1c and PP were significantly higher in patients with diabetes (P < 0.001, P < 0.001 and P = 0.009, respectively). Other clinical and demographical characteristics, laboratory findings and echocardiographic findings were similar in both groups (P > 0.05, for all). The measurement of CFVR and AD in patients with diabetes were significantly lower compared with the controls (P < 0.001 and P = 0.001, respectively). CFVR was significantly negatively correlated with age, body mass index, HbA1c, systolic blood pressure, and PP, while significantly positively correlated with AD (P < 0.05, for all). Multivariate regression analysis showed that only AD (ß = 0.485, P < 0.0001) and HbA1c (ß = -0.362, P < 0.0001) were independently associated with CFVR. The cutoff value of AD obtained by the receiver operator characteristic (ROC) curve analysis was 2.44 for the prediction of impaired CFVR. CONCLUSION: Aortic distensibility and HbA1c were independently associated with CFVR. The decrease in AD may be used as a marker of impaired coronary microcirculation in asymptomatic diabetic patients.

Estimated costs of the treatment of diabetic foot ulcers in a tertiary hospital in Turkey.

OBJECTIVE: The prevalence of diabetes and its related complications are increasing, and a considerable portion of healthcare expenditures is spent worldwide on diabetes and its complications. In this study, we investigated the estimated treatment costs of diabetic foot ulcers in a tertiary hospital in Turkey. METHODS: A total of 203 patients with type 2 diabetes mellitus were included in this retrospective study. The study group comprised 91 patients with foot ulcers and the control group comprised 112 patients without any chronic complications. Their demographic characteristics, HbA1c levels and the length of hospital stay were recorded. The patients' bills, received from the hospital billing departments, were analysed. RESULTS: The average cost of diabetes patients with foot ulcers per person was calculated as 976.1±253.6 USD while it was 430.3±144.2 USD for diabetes patients without any chronic complications; thus, there was a significant difference between the average cost of these groups (p<0.001). Similarly, there were significant differences between the groups according to the costs of drugs, equipment and services (p<0.001). CONCLUSION: The estimated cost of treatment of diabetic foot ulcers is high in Turkey. It will continue to be a heavy economic burden if preventive measures are not taken.

Is ß-thalassaemia minor associated with metabolic disorder?

OBJECTIVE: To investigate the frequency of metabolic syndrome and its components in subjects with ß-thalassaemia minor. SUBJECTS AND METHODS: A total of 194 subjects, i.e. 92 subjects with ß-thalassaemia minor (study group) and 102 subjects without ß-thalassaemia minor (control group), were enrolled into this case-control study. Haemoglobin electrophoresis was performed on all patients. The waist circumference and systolic and diastolic blood pressure of the subjects were recorded. Fasting blood glucose and serum lipid levels were measured. RESULTS: Both groups were similar in terms of age and sex (p > 0.05 for each). The percentages of haemoglobin A2 (4.3 ± 0.4 vs. 2.0 ± 0.3) and haemoglobin F (3.38 ± 1.4 vs. 0.26 ± 0.4) and the mean corpuscular volumes (64 ± 4.7 vs. 81.5 ± 9.3) of the groups were statistically different (p < 0.001 for each). The frequency of metabolic syndrome and its components was similar in both groups (p > 0.05 for each). According to correlation analyses, the percentage of haemoglobin A2 correlated with fasting insulin, fasting glucose, systolic blood pressure, high-density lipoprotein, and low-density lipoprotein levels (p < 0.05). CONCLUSIONS: No association was found between ß-thalassaemia minor and metabolic syndrome despite insulin resistance, which was shown in subjects with ß-thalassaemia minor.

Metabolic syndrome as a risk factor for elevated intraocular pressure.

OBJECTIVE: The aim of this study was to investigate the association between intraocular pressure and metabolic syndrome by comparing central corneal thicknesses. METHODS: One hundred sixty-two subjects were enrolled in this cross-sectional study, with 89 subjects in a metabolic syndrome group and 73 subjects in a control group. Ophthalmological examinations, including intraocular pressure and central corneal thickness measurements, were performed on each subject. Serum fasting glucose, triglyceride and HDL cholesterol levels were measured, and waist circumference, systolic and diastolic blood pressure of all patients were recorded. RESULTS: Participants with metabolic syndrome had a significantly higher intraocular pressure than those without metabolic syndrome (p = 0.008), and there was no statistically significant difference between the central corneal thicknesses of the two groups (p = 0.553). Most of the metabolic syndrome components were associated with higher intraocular pressure (p < 0.05). CONCLUSIONS: There is a relationship between metabolic syndrome and intraocular pressure, but no association between metabolic syndrome and central corneal thicknesses. Intraocular pressure is affected by central corneal thicknesses, and intraocular pressure is used to correct according to the central corneal thicknesses measurement. To our knowledge, this is the first study that determines the positive relationship between metabolic syndrome and intraocular pressure by comparing the central corneal thicknesses of the groups.

N-terminal pro-brain natriuretic peptide levels and abnormal geometric patterns of left ventricle in untreated hypertensive patients.

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age = 51.7 ± 5.8 years) and 44 healthy control subjects (mean age; 51.3 ± 4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p < 0.05). NT-proBNP levels of all geometric patterns were higher than the control group (p < 0.05, for all). NT-proBNP levels were similar between CR and NG groups (p > 0.05). NT-proBNP was independently associated with LV geometry (ß = 0.304, p = 0.003) and LVMI (ß = 0.266, p = 0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.

NT-proBNP predicts impaired myocardial function in newly diagnosed hypertensive patients with preserved ejection fraction.

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9 ± 5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group <114 pg/ml and NT-proBNPhigh group ≥114 pg/ml). Patients with NT-proBNPhigh were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNPlow. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.

The effects of thyroid dysfunctions on insulin resistance in patients with hepatosteatosis.

BACKGROUND: Hepatosteatosis can develop due to insulin resistance. The effect of thyroid function status on insulin sensitivity and resistance is of great interest but the data is still conflicting. OBJECTIVES: The aim of this study was to evaluate the effects of thyroid dysfunctions on insulin resistance in patients with hepatosteatosis. MATERIAL AND METHODS: A total of 407 patients with hepatosteatosis were divided into three groups: 102 subjects with hypothyroidism, 103 with hyperthyroidism and 202 with normal thyroid function (control group). We measured serum thyroid stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) concentrations, blood glucose and insulin levels, serum lipid levels, hepatic transaminases and the homeostasis model assessment of insulin resistance (HOMA IR). RESULTS: Neither hypothyroidism patients nor hyperthyroidism patients showed significant differences in HOMA IR, glucose and insulin levels (p>0.05 for each). The frequency of insulin resistance was similar in all groups (p>0.05). CONCLUSIONS: Based on our findings, hypothyroidism and hyperthyroidism are not correlated to insulin resistance in patients with hepatosteatosis. Different causes which are associated with insulin resistance should be investigated in patients with thyroid dysfunction and hepatosteatosis.

Depression in subjects with beta-thalassemia minor.

Beta-thalassemia minor is a common genetic blood disorder in Mediterranean countries such as Turkey. Additionally, depression is one of the most widespread mental disorders that affect people worldwide, and its prevalence is increasing with co-occurring medical conditions. The aim of this study was to determine whether the frequency of depression is elevated in subjects with beta-thalassemia minor. A total of 106 subjects were included in this study, of which 53 participants were diagnosed with beta-thalassemia minor. The other 53 participants were otherwise healthy. Hemoglobin electrophoresis and a complete blood count were performed in all subjects, and all participants were evaluated using the Hamilton Depression Rating Scale (HDRS). The HDRS scores of the subjects with beta-thalassemia minor were higher than those in the healthy subjects (p < 0.001). Additionally, the hemoglobin A2 levels were positively associated with the HDRS scores (p < 0.0001, r = 0.482). This study suggests a possible association between depression and beta-thalassemia minor, in which the risk of depression may be increased in subjects with this condition.

Serum 25-hydroxyvitamin D level is associated with aortic distensibility and left ventricle hypertrophy in newly diagnosed type 2 diabetes mellitus.

We aimed to evaluate the association between serum vitamin D status and elastic properties of aorta in patients with diabetes mellitus (DM). We studied 136 patients with newly diagnosed DM (mean age: 62.9 ± 10.6 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. Aortic distensibility was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Left ventricle mass index (LVMI) was determined according to the Devereux formula. Multiple linear regression analysis showed that vitamin D level is independently associated with LVMI (ß = -0.259, p = 0.001), aortic distensibility (ß = 0.369, p < 0.001), high-sensitive C-reactive protein (hs-CRP) (ß = -0.220, p = 0.002) and body mass index (ß = -0.167, p = 0.015) in patients with DM. In diabetic patients, serum 25-hydroxyvitamin D level is independently associated with aortic distensibility. Vitamin D may play a role on pathogenesis of impaired elastic properties of aorta in type 2 DM.

SYNTAX score is a predictor of angiographic no-reflow in patients with ST-elevation myocardial infarction treated with a primary percutaneous coronary intervention.

OBJECTIVES: The no-reflow phenomenon has a negative prognostic value in patients with acute ST-elevation myocardial infarction (STEMI). The SYNTAX score (SS) quantifies the extent and complexity of angiographic disease and predicts long-term mortality and morbidity in STEMI. We aimed to assess the no-reflow and its possible relationships with SS and clinical characteristics in patients with STEMI treated with a primary percutaneous coronary intervention (PPCI). MATERIALS AND METHODS: In this study, 880 patients with STEMI treated with PPCI were included prospectively (646 men and 234 women, mean age 58.5±12.4 years). The SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score were determined in all patients. No-reflow was defined as TIMI grade 0, 1 and 2 flows or TIMI grade 3 with myocardial blush grade 0 and 1. The patients were divided into two groups: a normal flow group and a no-reflow group. RESULTS: No-reflow was observed in 32.8% of patients. The mean SS of the no-reflow group was higher than that of the normal flow group (19.2±6.8/12.9±6.1, P<0.001). On multivariate logistic regression analysis, SS [ß=0.872, 95% confidence interval (CI)=0.845-0.899, P<0.001], diabetes (ß=0.767, 95% CI=0.128-4.597, P=0.004), anterior myocardial infarction (ß=5.421, 95% CI=1.369-21.469, P=0.025), and thrombus grade after wiring (ß=2.537, 95% CI=1.506-4.273, P<0.001) were found to be independent predictors of no-reflow. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 19.75 for the prediction of no-reflow (sensitivity: 70.6%, specificity: 69.4%). CONCLUSION: The SS is a predictor of no-reflow in patients with STEMI treated with PPCI.

Low serum magnesium levels and diabetic foot ulcers.

OBJECTIVE: Magnesium plays an important role in glucose homeostasis and insulin sensitivity. The aim of this study was to investigate the association between serum magnesium levels and diabetic foot ulcers. METHODS: A total of 147 subjects were included in this study. The participants were divided into three groups, including a study group of 49 patients with diabetes and foot ulcers, a control group of patients with diabetes without foot ulcers and a control group of 49 healthy subjects. Measurements and comparisons were made of the participants' magnesium levels, HBA1C percentages, serum fasting glucose levels, creatinine levels and serum lipid levels for all groups. MedCalc version 12.0 (MedCalc, Turkey) was used for the statistical analysis. RESULTS: The groups were similar in terms of age and sex (p=0.116 and 0.897, respectively). The magnesium levels of the patients with diabetes and foot ulcers were lower than those in the patients with diabetes without foot ulcers and the healthy subjects (p<0.001). There was a strong relationship between the serum magnesium levels and the incidence of diabetic foot ulcers (OR 5.9, Cl 95% 2.7-12.6, p<0.001). CONCLUSIONS: A low serum magnesium level is associated with diabetic foot ulcers. Therefore, the magnesium levels should be controlled in patients with diabetes (with or without foot ulcers) and magnesium supplementation can be a complimentary treatment in such cases.

Depression in patients with euthyroid chronic autoimmune thyroiditis.

Depression and chronic autoimmune thyroiditis are common diseases. The aim of this study was to determine whether the frequency of depression is elevated in patients with chronic autoimmune thyroiditis and normal thyroid function. A total of 201 subjects were included, of whom 107 and 94 participants were healthy or had euthyroid chronic autoimmune thyroiditis, respectively. Serum thyroid hormone levels and thyroid auto-antibodies were measured in all subjects. All participants were evaluated with Hamilton Depression Rating Scale (HDRS). HDRS scores of patients with euthyroid chronic autoimmune thyroiditis were higher than in healthy participants. This study suggests a possible association between depression and chronic autoimmune thyroiditis. The depression risk may be increased in patients with chronic autoimmune thyroiditis and normal thyroid function.

Effects of acute organophosphate poisoning on thyroid hormones in rats.

The aim of this study was to investigate the effects of organophosphate poisoning on thyroid hormones. In this study, male Wistar albino rats weighing 200-225 g were used. The rats were divided into 4 groups. Group 1 (n = 10) was administered 30 mg/kg lethal dose of methamidophos, whereas group 2 (n = 7) was treated with physiologic NaCl (SP). Group 3 (n = 10) was treated with 30 mg/kg of methamidophos. When cholinergic symptoms developed among the rats in group 3, they were treated with 40 mg/kg pralidoxime intraperitoneally (IP) and administered atropine IP until the cholinergic symptoms disappeared. Group 4 (n = 7) was treated with SP. After the cholinergic symptoms appeared among the rats in group 1, intracardiac blood samples were taken. In group 3, blood samples were taken after the cholinergic symptoms had disappeared. Then triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and plasma choline esterase (PCE) levels were studied by RIA. The Kruskal-Wallis test and Mann-Whitney U test were used for comparison between groups. Bonferroni correction was applied when multiple comparisons were made. T3, T4, and TSH levels decreased in group 1 compared with group 2 (P < 0.01). When the results between groups 3 and 4 were compared, it was found that the T3 and T4 levels in group 3 decreased while the decreases in T3 levels were statistically significant (P < 0.01). When comparing the results of groups 1 and 3, the T4 level was lower in group 1 and the T3 level was higher in group 3 (P < 0.01). The TSH level increased in group 3 after treatment (P < 0.01). Thyroid hormones were affected after acute organophosphate poisoning. Hypothyroidism and sick euthyroid syndrome was observed during poisoning and after treatment. In serious poisoning, there may be a poor prognosis, but more extensive studies will illuminate the issue in depth.

Apoptosis and proliferating cell nuclear antigen in lupus nephritis (class IV) and membranoproliferative glomerulonephritis.

BACKGROUND: The role of apoptosis in the pathogenesis of renal diseases has not been clearly established. Proliferating cell nuclear antigen (PCNA) is also a proliferation marker. In this study, we investigated the relationship between clinical course and PCNA apoptosis on baseline renal biopsy in patients with Lupus nephritis (LN) and membranoproliferative glomerulonephritis (MPGN). METHODS: Thirty-nine patients with proliferative glomerulonephritis [lupus nephritis (LN)[21] and MPGN[18]] were included in this study. PCNA and apoptosis on renal biopsies were detected by immunohistochemical and terminal deoxynucleotidyl transferase mediated dUTP nick end labelling (TUNEL) methods, respectively. We calculated the ratios of intraglomerular apoptotic cells and PCNA positive cells per glomeruli, and total numbers of apoptotic tubular cells and PCNA positive tubular cells among the 100 tubular cells, and PCNA positive cell and apoptotic cell on two different tubulointerstitial areas (40 x 10). RESULTS: In LN: Apoptotic indexes of glomerulus and tubulus were 1.08+/-0.49 and 3.71+/-1.38, respectively. PCNA positivities were found at 16.76+/-11.34%, 46.57+/-22.54%, and 40.28+/-23.14% on glomerulus, tubulus, and interstitium, respectively. The activity index was 11.23+/-3.41, and the chronicity index was 3.81+/-1.99. In MPGN: Apoptotic indexes were found at 0.83+/-0.25 and 3.55+/-1.75 on glomerulus and tubulus, respectively. PCNA positivities were found at 21.33+/-18.42%, 35.5+/-25.99%, and 34.66+/-26.84% on glomerulus, tubulus, and interstitium, respectively. In controls, apoptosis was not found. In LN: PCNA positivity on tubulus and interstitium were correlated with the activity index (r = 0.768, p < 0.001, r = 0.721, and p < 0.001, respectively). Glomerular PCNA and apoptosis on interstitium and glomerulus were not correlated with the activity index. The activity index also was not correlated with creatinine clearance and daily proteinuria (p = 0.35 for both). At the end of the first year, patients with recovered or stabilized renal function had higher interstitial and tubular PCNA than others in G1 and G2. CONCLUSION: It can be said that expression of PCNA on renal biopsy was correlated with activity indexes in LN. PCNA may be a prognostic indicator in MPGN and LN. However, apoptosis does not have a predictive value for MPGN and LN.

Clinical report of 28 patients with Sheehan's syndrome.

The aim of the present study was to determine the clinical and hormonal characteristics with Sheehan's syndrome in 28 cases that we had diagnosed and followed in the last 20 years. Twenty-eight patients with Sheehan's syndrome, diagnosed and followed at our University Endocrinology Clinic in the last 20 years were reported in the study. Medical history, physical examination, routine laboratory examinations, pituitary hormone analysis, CT and/or MRI scan of the sella of the patients were reviewed. All patients had a history of massive hemorrhage at delivery and physical signs of Sheehan's syndrome. Twenty-six of them lacked postpartum milk production, followed by failure of resumption of menses. There were 9 subjects with disturbances in consciousness associated with hyponatremia on admittance. All 28 patients had secondary hypothyroidism, adrenal cortex failure, hypogonadotrophic hypogonadism and growth hormone deficiency. Diabetes insipidus has not been found in any patient. Empty sellae were revealed in 8 patients by CT and/or MRI scan. Sheehan's syndrome is still encountered in clinical practice occasionally. If not diagnosed early, it could cause increased morbidity and mortality. The most important clues for diagnosis of Sheehan's syndrome are lack of lactation and failure of menstrual resumption after a delivery complicated with severe hemorrhage.

Comparison of the efficiency of anti-androgenic regimens consisting of spironolactone, Diane 35, and cyproterone acetate in hirsutism.

The aim of the present study was to evaluate the effects of three different anti-androgenic drug-therapy regimens, Diane 35 (cyproterone acetate (CPA) [2 mg] and ethinyl estradiol [35 microg]) plus CPA, Diane 35 plus spironolactone, and spironolactone alone, in patients with hirsutism. In this prospective, randomized clinical study, 79 subjects with idiopathic hirsutismus were studied. The patients were divided into 3 groups. Group I patients (n=32) were treated with Diane 35 plus CPA, group II patients (n=25) with Diane 35 plus spironolactone [100 mg], and group III patients (n=22) with spironolactone [100 mg] alone. Serum FSH, LH, testosterone (T), and DHEAS levels were analyzed before and after treatment at 6 and 12 months. Hirsutism scores were graded according to the Ferriman-Gallwey scoring system, and side effects were monitored. All treatment regimens were found to be efficient and well-tolerated, and none of the patients stopped therapy due to any adverse event. However, in hormone screening, only patients on the Diane 35 plus CPA regimen revealed a decrease in serum T levels after therapy. As such, treatment of each hirsute patient should be planned individually, but with regard to both cost-efficiency and potential side effects, we recommend spironolactone alone in the treatment of hirsutismus.