Pshychological Resilience and Percieved Stress Level in Nurses: Experience of Nurses in Turkey.

OBJECTIVE: To determine the effect of psychological resilience levels of nurses on perceived stress levels in this study. METHODS: The research was carried out with 153 nurses. Socio-demographic Questionnaire, The Brief Resilience Scale, and Perceived Stress Scale were used as data collection tools. RESULTS: The nurses' total Brief Resilience Scale score average was 17.72 ± 4.48, and the total Perceived Stress Scale score average was 31.74 ± 7.18. There was a negative and moderately significant relationship between the resilience and stress level of the nurses. During the pandemic process, the level of stress that nurses perceive increases as their psychological resilience decreases. CONCLUSION: Psychological resilience and coping with stress are traits that can be improved. It is important to establish strategies to increase the resilience of nurses and improve their ability to cope effectively with stress.

The effect of photobiomodulation therapy on nonsurgical periodontal treatment in patients with type 2 diabetes mellitus: a randomized controlled, single-blind, split-mouth clinical trial.

Photobiomodulation therapy (PBMT) is a method currently used in the treatment of hard and soft tissue injuries due to its accelerating and enhancing effects on healing. In this study, we aimed to evaluate the possible additional benefits of applying PBMT with nonsurgical periodontal treatment in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Twenty-two type 2 DM patients with CP were enrolled in this clinical split-mouth study. Probing pocket depth (PPD), gingival index (GI), plaque index (PI), and clinical attachment level (CAL) were measured by intracaliber clinician (H.G.) at baseline and at 1 m, 3 m, and 6 m after treatment. Gingival crevicular fluid (GCF) samples were collected at baseline and at 1 week and 1 m, 3 m, and 6 m after treatment. According to split-mouth design, one randomly selected quadrant was treated with PBMT + nonsurgical periodontal treatment (NSPT) and the other quadrant was treated only non-surgical periodontal treatment. PBMT was applied the test quadrant on NSPT day and first, third, and seventh day after treatment at an energy density of 7.64 J/cm2. Repeated measures analysis of variance test was used for the intragroup comparison and a "paired t test" in the intergroup comparison of the clinical and laboratory findings. Comparing the test and control quadrant after treatment, the test quadrant showed significant decrease in PPD at 1 month, 3 months, and 6 months; in GI at 3 months and 6 months; in CAL at month 6; in GCF at 1 week, 1 month, 3 months, and 6 months; and in IL-1ß data at 3 months in comparison to the control quadrant. In contrast, there was no statistically significant difference in PI data at all times. Within the limitation of this study, adjunct use of PBMT on NSPT in patient with DM may positively affect the clinical and biochemical parameters.

Interferon alpha-induced non-immune thyrotoxicosis treated by plasmapheresis.

Interferon-alpha (IFN-α) is an effective drug used for the treatment of chronic hepatitis C. So far its numerous side effects have been reported in the literature. It may be difficult to always put IFN-induced thyroid diseases into a single classic thyroid disease table. There are numerous atypical thyroid diseases due to IFN usage for hepatitis C virus. Herein, we present a case with a rare clinical table such as thyrotoxicosis observed following IFN-α therapy in a patient with euthyroid nodular thyroid without autoimmune thyroiditis findings and the use of therapeutic apheresis method for the treatment of disease.

Hepatitis B and C seroprevalence in patients with diabetes mellitus and its relationship with microvascular complications.

INTRODUCTION: Diabetic patients are susceptible to bacterial, viral and fungal infections because of various deficiencies in the immune system. AIM: To investigate a possible link between hepatitis B/C prevalence and microvascular complications as well as duration of diabetes. MATERIAL AND METHODS: In total 1263 diabetic patients (1149 type 2, 114 type 1) were enrolled in the study. The control group consisted of 1482 healthy blood donors who were over 40 years old. All diabetic patients were tested for HBsAg, anti-HBs and anti-HCV beside routine laboratory tests. Diabetic patients were divided into three groups according to their diabetes duration, and all of the patients were scanned for microvascular complications. Demographic data of all patients were recorded. RESULTS: HBsAg seropositivity was 3.7% in diabetic patients and 1.08% in the control group; this difference was statistically significant (p < 0.001). HBsAg positivity rates in type 1 and type 2 diabetics were 0.8% and 4%, respectively (p = 0.09). HCV seropositivity was 2.2% for diabetics and 0.5% for the control group; this difference was statistically significant (p < 0.001). Anti-HCV seropositivity in type 1 and type 2 diabetics was 1.75% and 2.26%, respectively. There was no relationship between diabetes duration and hepatitis B-C prevalence (p > 0.05). Also, no relationship was found between microvascular complications of diabetes and hepatitis B/C seropositivity. CONCLUSIONS: Hepatitis B and C seroprevalence was found to be increased in diabetes mellitus; however, there was no relationship between hepatitis seroprevalence and the duration or microvascular complications of diabetes.

Evaluation of Serum S100A8/S100A9 Levels in Patients with Autoimmune Thyroid Diseases.

BACKGROUND: The correlation of S100A8/S100A9 with various inflammatory conditions, including autoimmune diseases have been reported. There is no study investigating the levels of S100A8/S100A9 in autoimmune thyroid diseases (AITD). AIMS: We aimed to evaluate the level of serum S100A8/S100A9 in AITD. STUDY DESIGN: Case control study. METHODS: Fifty patients with AITD (25 Hashimoto's thyroiditis (HT) and 25 Graves' disease (GD)) were included in the study. Twenty seven healthy subjects participated as a control group. Blood samples were obtained in the 3 months after the initiation of medical treatment. Serum levels of total antioxidant status (TAS), total oxidative status (TOS), total free sulfhydryl (SH), lipid hydroperoxide (LOOH) and S100A8/S100A9 were analyzed. RESULTS: The patients with AITD had significantly higher S100A8/S100A9, OSI, LOOH and TOS levels than the healthy control group. There was no significant difference between GD and HT patients in terms of S100A8/S100A9, TOS and OSI levels. S100A8/S100A9 level was positively correlated with LOOH, TOS and OSI levels but negatively correlated with -SH level in the patients with AITD. CONCLUSION: Serum S100A8/S100A9 levels were increased in patients with AITD and positively correlated with LOOH, TOS and OSI whereas negatively correlated with SH.

CYP gene expressions in obesity-associated metabolic syndrome.

PURPOSE: The contribution of cytochrome P450 (CYP) gene expressions in metabolic syndrome (MetS) has not been elucidated, and was the aim of this study. METHODS: A total of 51 MetS patients and 41 healthy controls with similar age and sex were included to this study. mRNA from blood samples was extracted, and real-time polymerase chain reaction was performed for gene expressions using a dynamic array system. RESULTS: We observed marked suppressions in CYP2A6 (p=0.0123), CYP4F2 (p=0.0005), CYP3A5 (p=0.0003), and CYP17A1 (p<0.0001) gene expressions in MetS patients. CONCLUSIONS: This is the first study to provide evidence that depressed expressions of CYP2A6, CYP4F2, CYP3A5, and CYP17A1 genes may play a role in MetS.

Evidence for elevated (LIMK2 and CFL1) and suppressed (ICAM1, EZR, MAP2K2, and NOS3) gene expressions in metabolic syndrome.

The metabolic syndrome (MetS) is a common multicomponent condition including abdominal obesity, dyslipidemia, hypertension, and hyperglycaemia. The aim of this study was to investigate the associations of the expression of a panel of signalling genes with the MetS in a Turkish population. A total of 54 MetS patients and 42 healthy controls with similar age and sex were included to this study. mRNA from blood samples was extracted, and real-time polymerase chain reaction was performed for gene expressions using a BioMark 96.96 dynamic array system. We observed marked increases in LIM kinase 2 (LIMK2) and cofilin 1 (CFL1) gene expressions in MetS patients. However, there were significant decreases in intercellular adhesion molecules 1 (ICAM1), ezrin (EZR), mitogen-activated protein kinase kinase 2 (MAP2K2), and nitric oxide synthase 3 (NOS3) gene expressions in MetS patients. Additionally, no marked changes were noted in other 15 genes studied. This is the first study to provide evidence that activation of LIMK2/CFL1 pathway may play an important role in MetS.

Lu-177 labelled peptide treatment for radioiodine refractory differentiated thyroid carcinoma.

Differentiated thyroid carcinoma (DTC) has good prognosis but 5% of the patients already have distant metastasis at the diagnosis. Tumour cells can lose their iodine uptake ability and enter a state of dedifferentiation. Treatment for differentiated thyroid carcinoma that is not suitable for the local surgery and unresponsive to radioactive iodine uptake is not always easy for physicians. We present a case of a 64-year-old man who had total thyroidectomy surgery and central lymph node dissection with diagnosis of multinodular goitre disease. Histopathological evaluation was papillary thyroid cancer with tall cell variant. Treatment using 150 mCi radioiodine was administered to the patient three times but could not effect a cure. We performed Ga-68 labelled DOTATE (synthetic somatostatin analogue peptide). This provided a good outcome. As evident from our case, Lu-177 radionuclide labelled synthetic somatostatin analogue peptides have therapeutic effect on radioiodine refractory DTC, as an alternative treatment modality.

Paraoxonase and arylesterase levels in autoimmune thyroid diseases.

OBJECTIVE: The aim of this study was to evaluate serum paraoxonase-1 (PON1) activity and its association with oxidative stress in autoimmune thyroid disease (AITD). METHODS: A total of 50 patients with AITD, including 25 with Hashimoto's thyroiditis and 25 with Graves' disease were enrolled. The control group comprised 27 healthy subjects. Blood samples were obtained in the euthyroid period and 3 months after initiation of medical treatment. Serum samples from patients with AITD and the healthy control group were analyzed for basal PON1, salt-stimulated PON1, and arylesterase (ARE) activities, along with lipid hydroperoxide (LOOH) and total free sulfhydryl (-SH) levels. RESULTS: Serum PON1 activities and -SH levels were significantly lower (P < 0.001, for each), whereas LOOH levels were significantly higher (P < 0.001, for each) in patients with AITD, compared to the control group. We observed no significant differences in ARE levels between the patient and healthy control groups (P > 0.05). PON1 activity was positively correlated with -SH (r = 0.522, P < 0.001) and negatively correlated with LOOH (r = -0.487, P < 0.001). PON1 phenotype distribution of the subjects was not significantly different among the three groups (P = 0.961). CONCLUSIONS: Serum PON1 activity is decreased in patients with AITD, and correlated positively with -SH, a well-known antioxidant, and negatively with LOOH, an index of lipid oxidation.

TREATMENT INTENSIFICATION WITH INSULIN DEGLUDEC/INSULIN ASPART TWICE DAILY: RANDOMIZED STUDY TO COMPARE SIMPLE AND STEP-WISE TITRATION ALGORITHMS.

OBJECTIVE: This 26-week, multicenter, randomized, open-label, parallel-group, treat-to-target trial in adults with type 2 diabetes compared the efficacy and safety of treatment intensification algorithms with twice-daily (BID) insulin degludec/insulin aspart (IDegAsp). METHODS: Patients randomized 1:1 to IDegAsp BID used either a 'Simple' algorithm (twice-weekly dose adjustments based on a single prebreakfast and pre-evening meal self-monitored plasma glucose [SMPG] measurement; IDegAsp[BIDSimple], n = 136) or a 'Stepwise' algorithm (once-weekly dose adjustments based on the lowest of 3 pre-breakfast and 3 pre-evening meal SMPG values; IDegAsp[BIDStep-wise], n = 136). RESULTS: After 26 weeks, mean change from baseline in glycated hemoglobin (HbA1c) with IDegAsp[BIDSimple] was noninferior to IDegAsp[BIDStep-wise] (-15 mmol/mol versus -14 mmol/mol; 95% confidence interval [CI] upper limit, <4 mmol/mol) (baseline HbA1c: 66.3 mmol/mol IDegAsp[BIDSimple] and 66.6 mmol/mol IDegAsp[BIDStep-wise]). The proportion of patients who achieved HbA1c <7.0% (<53 mmol/mol) at the end of the trial was 66.9% with IDegAsp[BIDSimple] and 62.5% with IDegAsp[BIDStep-wise]. Fasting plasma glucose levels were reduced with each titration algorithm (-1.51 mmol/L IDegAsp[BIDSimple] versus -1.95 mmol/L IDegAsp[BIDStep-wise]). Weight gain was 3.8 kg IDegAsp[BIDSimple] versus 2.6 kg IDegAsp[BIDStep-wise], and rates of overall confirmed hypoglycemia (5.16 episodes per patient-year of exposure [PYE] versus 8.93 PYE) and nocturnal confirmed hypoglycemia (0.78 PYE versus 1.33 PYE) were significantly lower with IDegAsp[BIDStep-wise] versus IDegAsp[BIDSimple]. There were no significant differences in insulin dose increments between groups. CONCLUSION: Treatment intensification with IDegAsp[BIDSimple] was noninferior to IDegAsp[BIDStep-wise]. Both titration algorithms were well tolerated; however, the more conservative step-wise algorithm led to less weight gain and fewer hypoglycemic episodes. Clinicaltrials.gov: NCT01680341.

The Challenge of Diabetes in the Elderly and Affecting Factors: A Turkish Study.

This study was conducted with the goal of evaluating the challenge of diabetes in elderly individuals and affecting factors. This descriptive study was conducted with 88 diabetic patients 65 years of age or older who were admitted to the endocrinology and metabolism disorders outpatient clinic data of the study collected by using a questionnaire prepared by the researchers and the Elderly Diabetes Burden Scale. Total score of the scale varies between 19 and 92 points. While a higher score indicates a higher burden a lower score indicates a lower burden, data were analyzed by using Student t test, 1-way analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test. Subscale and total mean scores of patients were as follows: 9.4 ± 3.2 for symptom burden; 12.4 ± 3.4 for social burden; 11.4 ± 3.3 for burden by dietary restrictions; 11.9 ± 3.7 for burden of worry about diabetes; 4.3 ± 1.3 for burden from treatment dissatisfaction; 9.4 ± 4.6 for burden by oral antidiabetic drugs or insulin; and 58.5 ± 9.6 for total diabetes burden score. Diabetes burden was found to be higher for patients who were at an advanced age, single, female, had a lower income, receiving oral antidiabetic or insulin treatment, and had diabetes duration of 6 to 11 years, a concomitant chronic condition or a diabetic person among first-degree relatives and who did not come for regular follow-up visits, had no assistance for their care, and who stated a poor quality of life and treatment compliance. Elderly diabetic patients were found to have a high total Elderly Diabetes Burden Scale score, and the highest scores were observed for the subscales of burden by dietary restrictions, social burden, and burden of worry about diabetes. Thus, it could be recommended to perform appropriate nursing interventions in order to assess and reduce diabetes challenge during planning of necessary treatment and care in elderly diabetic patients.

Expression Levels of miR-30a-5p in Papillary Thyroid Carcinoma: A Comparison Between Serum and Fine Needle Aspiration Biopsy Samples.

BACKGROUND: Fine needle aspiration biopsy (FNAB) is a useful tool in the diagnosis of thyroid nodules. However, some limitations exist as approximately 25% of the cases cannot be distinguished with this method. Therefore, identification of novel diagnostic markers is very important in improving the papillary thyroid carcinoma (PTC) diagnosis. microRNAs (miRNAs) are small regulatory RNA molecules that have been involved in a variety of biological processes, including tumorigenesis. Moreover, determination of miRNAs with prognostic, diagnostic, and therapeutic potential is of a great interest today. AIMS: In the present study, we evaluated the expression level of miR-30a-5p in serum and FNAB samples of PTC patients. METHODS: A total of 60 cases were included in the study, with the patients subdivided into four groups; benign, atypical cells of undetermined significance (ACUS), malignant group, including Hurthle cell PTC (HC-PTC), and malignant without Hurthle cell PTC (non-HC-PTC). Peripheral blood and FNAB samples of the cases were collected. The serum and FNAB expression levels of miR-30a-5p among the groups were compared. The miR-30a-5p expression level was determined using real-time polymerase chain reaction (RT-PCR). RESULTS: According to both pre- and postoperative pathological diagnosis, miR-30a-5p levels were significantly increased in both serum and FNAB samples of HC-PTC and non-HC-PTC groups compared to other groups. This increase was more evident in the non-HC-PTC group (p=0.0245 for FNAB, p=0.0166 for serum). CONCLUSIONS: The results of this study suggest that miR-30a-5p might be a novel diagnostic marker candidate in PTC. Further studies are required to investigate this possibility.

Is calprotectin a novel biomarker of neuroinflammation in diabetic periferal neuropathy?

BACKGROUND: In the present study, we aimed to investigate serum calprotectin levels in patients with diabetic peripheral neuropathy, and possible role of this molecule in the disease pathogenesis. METHOD: Twenty nine patients with diabetic peripheral neuropathy, 30 type 2 diabetic patients without neuropathy, and 40 healthy controls were enrolled in the study. Fasting plasma glucose (FPG), high-density lipoprotein- cholesterol (HDL-C), low-density lipoprotein- cholesterol (LDL-C), total cholesterol, triglyceride, HbA1c, calprotectin and hsCRP levels were measured in diabetic and healthy control groups. RESULTS: Serum calprotectin and hsCRP levels were significantly higher in patients with and without neuropathy than healthy controls (p < 0.001, p = 0.017, p < 0.001 and p = 0.001, respectively). Serum calprotectin and hsCRP levels were higher in diabetics with neuropathy than the ones without (p = 0.021 and p < 0.001, respectively). The positive correlation was detected between calprotectin levels and hsCRP and HbA1c in Spearman correlation analysis (r = 0.510, p < 0.001; r = 0.437, p < 0.001 respectively). The results of multiple logistic regression analysis demonstrated the important association between neuropathy development and hsCRP and serum calprotectin levels in diabetic individuals. CONCLUSION: Seum calprotectin levels were increased in diabetic peripheral neuropathy. It may have a role in the pathogenesis of the disease.

Ectopic acromegaly due to a growth hormone-secreting neuroendocrine-differentiated tumor developed from ovarian mature cystic teratoma.

Acromegaly is a clinical syndrome caused by the overproduction of growth hormone (GH) and also known as a rare disease. Clinical, biochemical, and radiological features are often indistinguishable between GH-producing hypophysis adenomas and ectopic GH-releasing hormone (GHRH)-producing tumors. A 40-year-old woman presented to us with her growing feet, hands especially fingers, and enlarging nose. Biochemical diagnosis of acromegaly was made by measuring insulin-like growth factor-1 (IGF-1) level and glucose-suppressed GH estimation. Her spot IGF-1 level was 1300 ng/ml (90-226 ng/ml). The basal GH was 30 ng/l, and 60- and 120-min GH levels after 75-g oral glucose load were 29 and 40 ng/l, respectively. Magnetic resonance imaging (MRI) of pituitary was normal. There was no pituitary adenoma or pituitary hyperplasia. Extrapituitary ectopic hypersecretion of GH or GHRH-secreting tumor search was done by high-resolution computed tomography (CT) of chest and whole abdomen. Abdomen CT revealed 9.5 × 8 cm pelvic mass, which included calcific regions and solid component. The specimen's immunohistochemical staining with GH was positive but interestingly GHRH was negative. According to immunohistochemical staining, the patient's diagnosis was ectopic acromegaly due to a GH-secreting neuroendocrine-differentiated tumor developed from an ovarian mature cystic teratoma. Herein, we present excellent illustration of an unusual and confusing clinical scenario of ectopic acromegaly.

Evaluation of conventional imaging techniques on preoperative localization in primary hyperparathyroidism.

We aimed to evaluate the diagnostic and preoperative localization capacity of 99mTc methoxyisobutylnitrile (MIBI) parathyroid scintigraphy and ultrasonography (USG) in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT) as well as the relationship between the success rate of these techniques and biochemical values. In this study, we retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and 5 patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV) were 89.7%, 85.2% and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitancy of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.

Paraoxonase and arylesterase activities in patients with papillary thyroid cancer.

OBJECTIVE: The aim of this study was to evaluate paraoxonase-1 (PON1) activities and oxidative stress status, and the changes in their levels after total thyroidectomy in patients with papillary thyroid cancer (PTC). MATERIALS AND METHODS: Twenty-five patients with PTC and 27 healthy controls were enrolled in the study. Blood samples were obtained from the PTC patients before and 3 months after the operation. Preoperative and postoperative serum samples from PTC patients and healthy controls were analyzed for paraoxonase (PON), arylesterase (ARE) activities, and lipid hydroperoxide (LOOH) and -SH (total free sulfhydryl) levels. RESULTS: The preoperative PON, ARE and -SH levels of the patients with PTC were significantly lower compared to those of the control group (p = 0.033, p < 0.001, p = 0.002, respectively), while LOOH levels were significantly higher (p < 0.001). The levels of PON and ARE decreased significantly in patients with PTC after the operation (p = 0.038, p = 0.023, respectively), while LOOH and -SH levels remained unchanged (p = 0.117, p = 0.487, respectively). PON and ARE levels showed a positive correlation with -SH (r = 0.211, p = 0.065; r = 0.471, p < 0.001, respectively) and a negative correlation with LOOH (r = - 0.391, p < 0.001, r = - 0.486, p < 0.001, respectively). CONCLUSION: Serum PON1 activity is decreased in patients with PTC, and serum PON1 is positively correlated with -SH, a well-known antioxidant, and negatively correlated with LOOH, an oxidant. PON1 activity is significantly decreased after total thyroidectomy.

Investigation of the role of 8-OHdG and oxidative stress in papillary thyroid carcinoma.

The aim of this study was to determine levels of serum 8-hydroxy-2'-deoxyguanosine (8-OHdG) as an indicator of oxidant-induced DNA damage and oxidant status in patients with papillary thyroid carcinoma before and after surgery. This study included 25 patients with papillary thyroid carcinoma and age-matched 27 healthy controls. Total antioxidant status (TAS), total oxidant status (TOS), lipid hydroperoxide (LOOH), and 8-OHdG levels were measured. 8-OHdG levels were significantly higher in the preoperative papillary thyroid carcinoma (PTC) group compared with the healthy control group (p < 0.001) and were significantly lower after operation in patients with papillary thyroid carcinoma (p = 0.004). Oxidative stress index (OSI) levels were significantly higher in both preoperative and postoperative PTC patients compared with the healthy control group (p < 0.001 and p < 0.001, respectively). TOS levels were higher in the preoperative and postoperative PTC groups compared to the healthy control group (p < 0.001 and p < 0.001, respectively). TAS levels was lower in the preoperative PTC groups compared to the healthy control group (p = 0.011). Serum LOOH levels were higher in both preoperative and postoperative PTC groups compared to the healthy control group (p < 0.001 and p < 0.001, respectively). Correlation analysis yielded that serum 8-OHdG levels were positively correlated with OSI and LOOH levels in patients with PTC before surgery (r = 0.668, p < 0.001; r = 0.446, p = 0.025, respectively) and had a negative correlation with TAS levels (r = -0.616, p = 0.001). We have shown severe oxidative DNA damage and impaired antioxidant status in papillary thyroid carcinoma.

Evaluation of epicardial fat tissue thickness in patients with primary hyperparathyroidism.

OBJECTIVE: Primary hyperparathyroidism (pHPT) affects the cardiovascular system, and epicardial fat tissue (EFT) thickness is closely associated with cardiovascular diseases and atherosclerosis. Despite this, the association between EFT thickness and pHPT has not been studied in a clinical setting. This study aimed to assess EFT thickness in patients with pHPT. METHODS: The study included 38 patients with pHPT and 40 healthy controls. EFT thickness, carotid intima-media thickness (CIMT), serum levels of parathormone (PTH) and calcium, and blood chemistry profiles were determined in all subjects. Correlation and regression analyses were performed with EFT thickness and CIMT as dependent variables and age; systolic and diastolic blood pressure; body mass index (BMI); presence of diabetes mellitus; and free plasma glucose (FPG), PTH, and serum calcium (Ca) levels as independent variables. RESULTS: Both the mean EFT thickness and the mean CIMT were significantly greater in the pHPT group than the control group (P < .001 for both). Correlation analysis showed that EFT thickness was significantly correlated with CIMT, age, systolic blood pressure, and PTH and serum Ca levels. Furthermore, the regression analysis revealed that EFT thickness retained its independent and positive association with FPG and serum Ca levels. CONCLUSIONS: The results of this study indicate that EFT thickness may be a useful marker of early atherosclerosis in patients with pHPT. Furthermore, the increase in EFT thickness appears to be due to hypercalcemia.

Evaluation of atrial electromechanical delay and diastolic functions in patients with hyperthyroidism.

AIM: Hyperthyroidism is a well-known cause of atrial fibrillation (AF) which is associated with increased morbidity and mortality. Atrial electromechanical delay (EMD) is a significant predictor of AF. The aim of this study was to assess the atrial EMD and diastolic functions in subclinical and overt hyperthyroidism by using tissue Doppler imaging (TDI). METHODS AND RESULTS: The study population consisted of 3 groups: group I (30 healthy subjects), group II (38 patients with subclinical hyperthyroidism), and group III (25 patients with overt hyperthyroidism). Atrial electromechanical coupling was measured with TDI. Standard echocardiographic measurements and parameters of diastolic function were obtained by conventional echocardiography and TDI. Intra- and inter-atrial EMD were significantly prolonged in subclinical and overt hyperthyroidism compared with control group (P = 0.03 and P < 0.001 for intra-atrial EMD; P < 0.001 for inter-atrial EMD). In groups II and III, mitral A velocity (P = 0.005 and P = 0.001) and mitral E-wave deceleration time (P < 0.001 and P = 0.02) were significantly increased, and mitral E/A ratio (P = 0.005 and P = 0.001) was significantly decreased compared with the control group. The lateral mitral Em /Am ratio in group II and group III was significantly lower than controls (P = 0.001). Mitral Em /Am ratio (ß = -0.32, P = 0.002) and thyroid stimulating hormone (TSH) level (ß = -0.27, P = 0.009) were negatively and independently correlated with inter-atrial EMD. CONCLUSION: This study showed that intra- and inter-atrial electromechanical intervals were prolonged and diastolic function was impaired in both overt and subclinical hyperthyroidism. TSH level and mitral Em /Am ratio were found as independent predictors of atrial EMD.

Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people.

Osteoporosis is, an age related disorder, influencing elderly people worldwide. The latest data suggests that inflammation plays a critical role in bone remodeling and in pathogenesis of osteoporosis. NLR is a simple, non-invasive and cost-effective marker of inflammation in various malignancies and inflammatory diseases. The objective of the present study was to compare NLR levels in osteopenic, osteoporotic and control subjects and to assess the correlation between NLR levels and BMD. A total of 1635 patients aged 65 years or more were included in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)), glucose/lipid metabolism and established risk factors were determined. In osteoporosis group, NLR levels were found to be elevated as compared to osteopenic and control group (2.54±1.45, 2.37±1.00 and 2.18±0.85, respectively). At multivariate analysis NLR emerged as independent predictor of osteoporosis (OR=1.122; 95%=1.020-1.235, p=0.018) and there was a significant negative correlation between lumbar spine (L2-L4), femoral neck scores and NLR (r=0.348, p<0.001; r=0.264, p=0.004, respectively). Elderly people with osteoporosis have elevated NLR levels, suggesting that inflammation may play an important role in bone remodeling.