Evaluation of near accommodation in type 1 diabetic patients

Aim: To evaluate accommodation in type 1 diabetic patients by PowerRef3 in our study. The PowerRef 3 can be used in studying the near triad of accommodation, vergence and pupil responses in healthy and clinical populations. Method: The accommodation of 14 patients (mean age: 33.14 ± 10.27) with type 1 diabetes and 16 control subjects (mean age: 35.81 ± 5.88) were measured by PowerRef3 at 30 cm with a standard accommodation target. The metabolic status of the diabetic patients and accommodation were compared with those of control subjects. Results: The mean accommodation, spherical equivalents and age was not significantly different between diabetic and control subjects.  The mean duration of diabetes was 13 ± 5.7 years (min: 7, max: 27). The mean accommodation was not significantly correlated with duration of diabetes and glycated hemoglobin levels, but it was significantly correlated with the spherical equivalents (p<0.05) and weakly correlated other metabolic parameters (fasting plasma glucose, cholesterol, low density lipoprotein, high density lipoprotein and triglyceride levels). Conclusion: The accommodation of type 1 diabetes patients at pre-presbyopic ages without diabetic retinopathy was similar to control subjects with PowerRef 3 measurements. This may reflect that good diabetes control, which will prevent retinopathy, may prevent the decrease in accommodation in type 1 diabetes patients

Cutaneous Findings in Patients with Acromegaly

Background: Acromegaly is a systemic syndrome caused by overproduction of growth hormone. The syndrome affects cutaneous, endocrine, cardiovascular, skeletal, and respiratory systems. Cutaneous manifestations of acromegaly are various, usually being the first presenting findings of the disease. Methods: Dermatological examinations of 49 patients of acromegaly who were followed-up at a tertiary referral hospital.Results: The study included 27 (55.1%) female and 22 (44.9%) male patients. The onset age of the disease was older in females than males (P =0.045). Most of the patients had acral enlargements, large triangular nose, coarse face, thickened lower lip, and prognathism. Fourteen patients (28.6%) had multiple cherry angiomas, 5 (10.2%) had varicose veins in lower limbs, and 2 (4.1%) had psoriasis.Conclusion: A wide spectrum of cutaneous symptoms and features may be associated with acromegaly. A detailed dermatological examination of patients with acromegaly should be an essential component of systemic evaluation. Future prospective studies investigating the relationships between changes in skin signs, hormone levels, and response to treatments may help to understand the details of skin involvement in acromegaly.</p

Evaluation of Postural Parathyroid Hormone Change in Patients with Primary Hyperparathyroidism

Purpose. In the present study, we aimed to investigate postural change of PTH in normal individuals and in patients with primary hyperparathyroidism (PHPT). Methods. Twenty-two patients with PHPT and nine healthy controls were enrolled. Following 12 h of fast, patients stayed in recumbent position for an hour and PTH and total Ca measurements were performed at the 45th and 60th minutes of resting. Afterwards, the patients resumed an upright posture for an hour and again blood samples were taken at the 45th and 60th minutes of standing. Results. In the PHPT group, mean PTH was calculated as 153.9 pg/mL in the recumbent position while it was 206.3 during upright position (Δ change was 47.7) (P<0.001). In the control group mean serum PTH was measured as 41.2 pg/mL in the recumbent position while it was 44.8 pg/mL in the upright position (Δ change was 1.7) (P=0.11). In both groups, serum Ca was higher in the upright position compared to the recumbent position (P<0.001). Conclusion. Postural change of serum PTH is significant only in PHPT group. Postural PTH test may give a clue to the clinician when the diagnosis of PHPT is equivocal

Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience

ABSTRACT Objective: Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence and importance is not known. The aim of this study was to evaluate ultrasonography (US) guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of ETT detected in the midline of the neck. Subjects and methods: Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic between September 2010 and April 2012 and underwent thyroid US, were retrospectively analyzed. Patients with ETT, detected in the midline of the neck in US were included in the study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated. Results: There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7. The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization) were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and all were histopathologically benign. In 7 (7.1%) patients, there was no history of thyroid operation. FNAB results of ETT were benign. Conclusion: This study evaluated the importance of ETT detected incidentally in the midline of the neck. Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of the neck can be found as incidental with imaging methods. Our results suggests that the incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they are often benign. Arch Endocrinol Metab. 2016;60(3):231-

Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults

There is concern about an emerging diabetes epidemic in Turkey. We aimed to determine the prevalence of diagnosed and undiagnosed diabetes, prediabetes and their 12-year trends and to identify risk factors for diabetes in the adult Turkish population. A cross-sectional, population-based survey, ‘TURDEP-II’ included 26,499 randomly sampled adults aged ≥ 20 years (response rate: 87 %). Fasting glucose and biochemical parameters were measured in all; then a OGTT was performed to identify diabetes and prediabetes in eligible participants. The prevalence of diabetes was 16.5 % (new 7.5 %), translating to 6.5 million adults with diabetes in Turkey. It was higher in women than men (p = 0.008). The age-standardized prevalence to the TURDEP-I population (performed in 1997–98) was 13.7 % (if same diagnostic definition was applied diabetes prevalence is calculated 11.4 %). The prevalence of isolated-IFG and impaired glucose tolerance (IGT), and combined prediabetes was 14.7, 7.9, and 8.2 %, respectively; and that of obesity 36 % and hypertension 31.4 %. Compared to TURDEP-I; the rate of increase for diabetes: 90 %, IGT: 106 %, obesity: 40 % and central obesity: 35 %, but hypertension decreased by 11 % during the last 12 years. In women age, waist, body mass index (BMI), hypertension, low education, and living environment; in men age, BMI, and hypertension were independently associated with an increased prevalence of diabetes. In women current smoking, and in men being single were associated with a reduced risk. These results from one of the largest nationally representative surveys carried out so far show that diabetes has rapidly become a major public health challenge in Turkey. The figures are alarming and underscore the urgent need for national programs to prevent diabetes, to manage the illness and thus prevent complications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10654-013-9771-5) contains supplementary material, which is available to authorized users

AN EVALUATION OF PATIENTS WITH TULAREMIA IN DUZCE PROVINCE IN THE WESTERN BLACK SEA REGION OF TURKEY

Tularemia is a zoonotic infectious disease caused by Francisella tularensis. The aim of our study was to examine the epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results of 68 tularaemia cases reported from Duzce, Western Black Sea region of Turkey, between 2016-2019. Clinical diagnosis was confirmed by micro-agglutination test (>= 1/160 titres). A total of 68 patients (35 females, 33 males) were diagnosed with tularemia. The most common symptoms among the patients in the study were swelling in the neck in 88.2% patients, sore throat in 73.5% patients and tonsillopharyngitis in 72.8% of the patients. Lymph node surgery was performed on 29.4% of patients despite receipt of antibiotherapy. The rate of ciprofloxacin use among patients not requiring lymph node surgery(46%) was significantly higher than that in patients requiring such surgery (20%) (p=0.046). No difference in lymph node surgery was observed among patients receiving combination antibiotherapy (p>0.05).WOS:00059603870005

TİROİDEKTOMİDEN YİRMİ YIL SONRA VERTEBRA VE AKCİĞER METASTAZI İLE ORTAYA ÇIKAN BİR TİROİD FOLLİKÜLER KARSİNOMU VAKASI

When the subjects are diagnosed with the follicular thyroid carcinoma, there are seen extra-thyroidal invasion in 25% of them, metastases in local lymph nodes in 5-10% of them and distant metastases in 10-20% of them. While 10-year survival rate is 8095% in the patients with differentiated thyroid carcinoma, this rate decreases to 40% in ones with distance metastases. Distance metastases are observed in 25% of the patients with follicular thyroid carcinoma over the age of 40. Follicular carcinoma frequently metastasizes to the lungs and bone. In this paper, a case is presented such that subtotal thyroidectomy was applied twenty years ago, the lung and bone metastases of follicular thyroid carcinoma were detected and any tumor tissue was not interestingly observed in complementary thyroidectomy in our cente

Gynecomastia: Clinical evaluation and management

Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. The main aim of any intervention is to relieve the symptoms and exclude other etiological factors

The effect of physicians' awareness on influenza and pneumococcal vaccination rates and correlates of vaccination in patients with diabetes in Turkey An epidemiological Study "diaVAX"

We aimed to examine the effect of increased physician awareness on the rate and determinants of influenza and pneumococcal vaccinations in diabetic patients. Diabetic patients (n = 5682, mean [SD] age: 57.3 [11.6] years, 57% female) were enrolled by 44 physicians between Sept 2010 and Jan 2011. The physicians were initially questioned regarding vaccination practices, and then, they attended a training program. During the last five years, the physicians recommended influenza and pneumococcal vaccinations to 87.9% and 83.4% of the patients, respectively; however; only 27% of the patients received the influenza and 9.8% received the pneumococcal vaccines. One year after the training, the vaccination rates increased to 63.3% and 40.7%, respectively. The logistic regression models revealed that variables which increased the likelihood of having been vaccinated against influenza were: longer duration of diabetes, presence of hyperlipidemia and more use of concomitant medications whereas more use of anti-hyperglycemic medications was associated with increased odds of vaccination. On the other hand, older age, longer duration of diabetes and presence of a cardiovascular disease were variables which decreased the likelihood of having been vaccinated against pneumococcal disease during the past five years. However, during the study period, variables which decreased the odds of having been vaccinated included: older age and anti-hyperglycemic medications for influenza, and presence of hyperlipidemia and a family history of hypertension for pneumococcal disease. While variables which increased the likelihood of vaccination in the same period were: increased number of co-morbidities for influenza, and family history of diabetes for pneumococcal disease. We conclude that increased awareness of physicians may help improve vaccination rates against influenza and pneumococcal disease. However, diabetic patients with more severe health conditions are less likely to having been vaccinated. More structural/systematic vaccination programs are needed to increase the vaccination rates in patients with diabetes