Comparing some of bone metabolism parameters between chronic hepatitis b patients and healty control

Genel bilgiler: lk defa 1940 yılında Amerikalı bir endokrinolog Fuller Albrightpostmenopozal osteoporozu tanımlamış ve sebebininde östrojen yetersizliğine bağlı kemikyapım yetersizliği olduğunu öne sürmüştür. Osteoporoz aşırı kemik rezorbsiyonu ilekarakterize, iskelet sistemi hastalığıdır. Osteoporozda düşük kemik kitlesi ve mikro mimaridebozulma ve mütakiben fraktür riskinde artış izlenir. Dünyada 200 milyondan fazla insandaosteoporoz olduğu tahmin edilmektedir. Kemik kuvvetinde azalma iskelet sistemi ile ilgilikırık riskinde artmaya yol açar ve bu da ağrı ve fonksiyon kaybı ile yaşam kalitesini bozar.skelet yapının asıl mimarları kıkırdak yapan kondrositler, kemik yapan osteoblastlar vekemiği rezorbe eden osteoklastlardır. Kemik devam eden bir süreç içinde kemik yapanosteoblastların ve kemik rezorbe eden osteoklastların koordine ettiği bir denge içinde yapılırve resorbe edilir. OPG, RANK ve RANKL osteoklast oluşumu, gelişimi, füzyonu, aktivasyonuve apopitozu için üç önemli sitokindir. OPG 380 aminoasitten oluşan salgısal bir proteindir.OPG osteoblastlardan salınmaktadır. OPG'nin biyolojik etkisi hem osteoklastogenezin sonbasamağının yani osteoklast öncülerinden dönüşümün engellenmesi, hem de erişkinosteoklastların aktivitesinin baskılanması şeklindedir. RANKL 317 aminoasitten oluşan tip 2transmembran bir protein formunda olduğu gibi, soluble formda da olan bir proteindir.RANKL, OPG gibi osteoblastlardan salınan diğer bir proteindir. RANKL osteoklastüzerindeki yüksek affinite reseptörü olan RANK'a bağlanarak differansiasyonu veaktivasyonunu sağlar. RANKL, kemik rezorbsiyonunu indükleyen ve hiperkalsemiye yol açanhemen hemen tüm faktörler tarafından indüklenir. Bu etki RANKL'a bağlanarak etkisini blokeeden OPG tarafından antagonize edilir. RANKL reseptörü olan RANK membrana bağlıosteoklast üzerinde yerleşmiş olan tümör nekrozis faktör süper ailesinin bir üyesidir.Osteoporozun son dönem karaciğer yetmezliğinin potansiyel bir komplikasyonu olduğubilinmektedir. Kronik hepatit B, C ve D virus enfeksiyonunun kemik döngüsü üzerine etkisiniirdeleyen çok az sayıda çalışma mevcuttur. Bazı çalışmalarda kronik hepatite bağlı sirozluhastalarda osteoporoz sıklığı % 53 olarak bildirilmiştir. Schiefke ve arkadaşları siroz olmayankronik B ve C hepatit tanılı hastalarda kemik mineral dansitesinde azalma izlemişlerdir.Sirozlu hastalarda osteoporoz, kemik metabolizması ve sitokinlerle ilişkisini irdeleyen çoksayıda çalışma olmasına karşın, siroz olmayan kronik hepatit B ve C tanılı hastalarda yeterlisayıda çalışma bulunmamaktadır. Biz bu nedenle siroz olmayan kronik hepatit B tanılı44hastalarda kemik mineral dansite, kemik yapım ve yıkım parametreleri ve serum RANKL veOPG düzeyleri arasındaki ilişkiyi irdeledik.Materyal ve metod: Çalışmaya. Gastroenteroloji Bilim Dalı ve Enfeksiyonhastalıkları Anabilim Dalı polikliniğine başvuran 16 kronik hepatit B tanılı hasta ve 31 sağlıklıkontrol vaka alındı. DXA, kemik dansite ölçümleri, Hologic QDR 4500W Elite serisi cihazlagerçekleştirildi. Kemik mineral dansite ölçümleri AP (anterior-posterior) pozisyonda L1, L2,L3, L4, L1-L4 lomber vertebralar, femur seviyesinde; femur boynu, büyük trokanter,intertrokanterik alan, ward's üçgeni ölçülerek gerçekleştirildi. Gece açlığından sonra hasta vekontrol grubundan alınan sabah açlık kanları santrifüj edidikten sonra serumlarından aspartatve alanin aminotransferaz, direk ve indirek bilirubin, gamma glutamil transpeptidaz ve alkalenfosfataz üre, kreatinin, kalsiyum, fosfor, osteokalsin, TSH, LH, FSH, östradiol, kortizol,prolaktin, anti-nükleer antikor düzeyleri ve hepatit B yüzey antijeni, hepatit B yüzey antijeninekarşı antikor, hepatit B kor antijenine karşı antikor, hepatit B early antijeni, hepatit B earlyantijenine karşı antikor, insan immun yetmezlik virüsüne karşı antikor değerleri ölçüldü.Gruplar arasındaki korrelasyon değerlendirilmesi Spearmen korrelasyon testi kullanılarakgerçekleştirildi. Idrar kalsiyum ve fosfor değerlendirilmesi için 24 saat idrar toplanarakgerçekleştirildi. Deoksipridinolin ölçümü spot idrarda gerçekleştirildi. Gruplar arasıosteoporoz risk faktörlerinin karşılaştırılması için ki-kare testi kullanıldı. P< 0.05 istatistikselolarak anlamlı kabul edildi.Bulgular: Çalışmaya toplam 47 vaka alındı. Olguların 16 adeti kronik hepatit B(37.56±10.26) ve 31 adeti sağlıklı kontrol (36.87±9.89) grubu idi. Kronik hepatit B tanılıolguların 13'ü erkek ve 3'ü kadından oluşmakta idi. Kontrol grubunun 18'i erkek ve 13'ükadın olarak dağılım gösterdi. Her iki grubun cinsiyet dağılımı (p=0.112) ve yaş dağılımı(p=0.824) arasında anlamlı bir fark izlenmedi. Gruplar arasında sigara (p=0.769), fizik aktivite(p=0.846), kahve tüketimi (p=0.89), ailede osteoporoz (p=0.06) ve vücut kitle indeksi(p=0.686) bakımından anlamlı fark izlenmedi. Hepatit B grubu ile sağlıklı kontrol grubukarşılaştırıldığında ortalama lomber ve femur boyun KMD değerleri, t ve z skorları arasındaanlamlı fark izlenmemiştir. OPG serum düzeyi hepatit grubunda kontrol grubuna göre yüksekizlenmiş iken (p=0.029), RANKL serum düzeyi hepatit grubunda kontrol grubuna göre düşükizlenmiştir (p=0.004). Spearman's korrelasyon testi ile lomber ve femur boyun t ve z-skorları,45KMD değerleri, idrar deoksipridinolin ve serum osteokalsin değerleri ile RANKL ve OPGarasında korrelasyon izlenmedi.Karar: Schiefke ve arkadaşlarının yaptıkları çalışmada, siroz olmayan viral hepatit Bve C'de osteopeni ve osteoporoz sıklığını yüksek saptamışlardır. Biz ise yaptığımız çalışmadaosteoporoz sıklığını sağlıklı kontrol grubundan farklı izlemedik. Hegedus ve arkadaşları,Wilson hastalarında OPG düzeyinin yüksek olmasını inflamatuvar olaya ve sürece bağlı olarakfibroblast ve immun kompetan hücrelerden artmış salınım şeklinde yorumlamışlardır. Diğerbir açıklama ise artmış kemik yıkımını kompanse etmek için osteoblastlardan OPG salımındaartma şeklindedir. Bu fikir bizim bulgularımızla uyuşmamaktadır. Çünkü çalışmamızda her ikigrubun ortalama KMD değerlerini normal sınırlar içinde bulduk. Sylvester ve arkadaşları, yenitanı crohn hastası çocuklarda gerçekleştirdikleri çalışmada OPG düzeylerini artmış, RANKLdüzeylerini azalmış saptamışlardır ve her iki grubun KMD değerlerini normal sınırlar içindebulmuşlardır. Bu durumu antijenik uyarıya sekonder gamma interferon artışına ve azalmışosteoblastik aktiviteye bağlamışlardır. Bizim çalışmamızda da gamma interferon azalmışolabilir. Hepatit B grubunda ortalama osteokalsin düzeylerini normal bulduk. Bu daosteoblastik aktivitenin OPG artışı ile uyumlu olarak artmadığını göstermektedir. nterlökin-13 RANKL serum düzeyini azaltan ve OPG düzeyini artıran ve osteoklastogenezi baskılayansitokin olarak bilinmektedir. nterlökin-13'ün STAT6 bağlı yolak ile osteoklast ve osteoblastüzerinde bulunan RANKL/RANK/OPG sistemini etkileyen reseptörleri aktif hale getirerek,osteoklast farklılaşmasını ve kemik rezorbsiyonunu baskıladığı gösterilmiştir. Bizimçalışmamızdaki bulgularımızla örtüşen bu durum hipotezimizi, yani: OPG ve RANKLdüzeyindeki değişikliklerin karaciğerdeki inflamatuvar yanıtın sonucu olduğunudesteklemektedir. Literatürde kronik hepatit B enfeksiyonunda transforming growth factorbeta 1 (TGF β1) düzeyinin arttığını gösteren çok sayıda çalışma vardır. TGF-β1'in RANKLdüzeyini azaltırken, OPG düzeyini artırdığı bilinmektedir. TGF-β1 osteoklastogenezibaskılamakta ve kemik döngüsünü azaltmaktadır. Bizim bulgularımız, tedavi almamış kronikhepatit B tanılı hastalarda bu sitokinin artmasından kaynaklanıyor olabilir. Ama bizçalışmamızda TGF-β1 düzeyini ölçmediğimiz için bu durum hakkında kesin bir şey söylemekmümkün değildir. TGF-β1'nın osteoklastogenezi baskılaması çalışmamızda kronik hepatit Btanılı hastalarda osteoporoz izlenmemesinin nedeni olabilir. OPG ve RANKL düzeyleri ileKMD, kemik yapım ve yıkım parametreleri arasında korrelasyon olmaması başka bir açıdan46bakıldığında kemik metabolizmasındaki değişiklikten ziyade karaciğerde izlenenenflamasyonun OPG ve RANKL düzeyindeki değişiklikleri meydana getirmiş olabileceğidir.General information: In 1940, Fuller Albright described postmenapousalosteoporosis, and he claimed that the reason of bone loss was due to insufficient boneproduction as a result of estrogen insufficiency. Osteoporosis is a disorder of skeletal systemcharacterised by increased bone resorbtion. Low bone mass, defect in microarchitecture, andat the end of them increased risk of skeletal fracture was seen in osteoporosis. It is estimatedthat more than 200 million people living in the world have osteoporosis. Reduced bonestrength brings about increase in skeletal system related fracture risk which cause pain andloss of function and brings about loss of quality of life. The primary architects of skeletalsystem are cartilage making chondrocytes, bone making osteoblasts, and bone resorbingosteoclasts. Bone is resorbed and made continiously in a process coordinated by osteoclastsand osteoblasts respectively. OPG, RANK, RANKL are three important cytokines forosteoclast production, fusion, activation, and apopitosis. OPG is a secretory protein composedof 380 aminoacids. OPG is secreted from osteoblasts. The biologic effect of OPG is bothsupression of the last step in osteoclastogenesis that means prevention of conversion ofosteoclast progenitors and suppression of the activity of mature osteoclasts. RANKL is foundin either soluble form as 317 aminoacid type 2 transmembrane protein or soluble form. LikeOPG, RANKL is secreted from osteoblasts. RANKL differanciate and activate osteoclaststhrough with binding to RANK which is high affinity receptor located on the osteoclast.RANKL was induced by all factors inducing bone resorbtion and causing hypercalcemia. Thiseffect was blocked by OPG which binds to the receptor located on RANKL. RANK as aRANKL receptor is a tumor necrosis family member located on osteoclast membrane. It isknown that osteoporosis is the complication of end stage liver disease (74). There are a fewstudy that examine the relationship between bone metabolism and chronic hepatitits B,C andD infection. The incidence of osteoporosis was found 53 % in some studies performed inpatients with chronic hepatitis induced chirrosis. Schiefke et. al. was found reduced BMD innon chirrotic chronic hepatitis B and C patients. There is not enough study investigating therelation between osteoporosis, bone metabolism and cytokines in non chirrotic chronichepatitits B and C patients, although a there are a lot of related with chirrotic patients in theliterature. Because of that, we investigated the relation between BMD, bone turnoverparameters and OPG, RANKL serum levels in non chirrotic chronic hepatitis B patients.48Material and method: 16 patients admitted to the gastroenterology and infectiousdisease clinics with chronic hepatit B infection and 31 healthy control patient was includedinto the study. DXA, bone densitometry assesment was performed with Holologic QDR4500W Elite series apparatus. Bone densitometry measurement was performed at the level ofL1, L2, L3, L4, L4-5, lomber vertebrate, femur level; femur neck, great trockanter,intertrockanteric area and ward?s triangel. Serum aspartat and alanine aminotransferase, directand indirect bilirubin, gamma glutamyl transpeptidase and alkaline phosphatase, urea,creatinine, calcium, phosphor, osteocalcin, TSH, LH, FSH, estradiol, cortisol, prolactin,antinuclear antibody level and hepatit B surface antibody, antibody against to hepatitis Bsurface antigen, antibody against hepatit B core antigen, hepatitits B early antigen, antibodyagainst hepatitis B early antigen, antibody against human immuno deficiency virus wasevaluated in the centrifugated serum of both patients and control group following overnightfast. 24 hours of urine was collected for calcium and phosphor evaluation. Deoxypridinolinewas evaluated in random urine. Ki-kare test was used for comparison of osteoporosis riscfactors between control and patient group. P<0.05 was accepted statistically significant.Result: 47 person was included into the study. 16 patient with chronic hepatitis B(37.56±10.26) and 31 healthy person (36.87±9.89) was evaluated. Chronic hepatitis B patientsconsist of 13 men and 3 women. Healthy control group consist of 18 men and 13 women. Age(p=0.824) and sex (p=0.112) distribution of both group was not statistically significant. Therewas not statistically significant difference in between groups according to cigarette smoking(p=0.769), physicial activity (p=0.846), coffee consumption (p=0.89), osteoporosis in thefamily (p=0.06), and body mass index (p=0.686). According to mean lomber and femur neckbone mineral density values and t and z scores; there was not statistically significant differencein between chronic hepatitis B and healthy control groups. OPG serum level was statisticallysignificantly higher in the chronic hepatitis B group compared to healthy control (p=0.029).On the other side, RANKL serum level was found statistically significantly lower in chronichepatitis B group compared to healthy control (p=0.004). There is not statisticaly significantcorrelation between lomber and femur t and z scores, bone mineral density, urinedeoxypridinoline and serum osteocalcin values and RANKL and OPG.Conclusion: Schiefke et. all. found increased incidence of osteporosis and osteopeniain non-chirrotic viral hepatitis B and C patients. In our study, we have not found any49statistically significant different BMD values between groups. High OPG and low RANKLlevel was found in studies performed on the patients with Wilson?s disease and primary billierchirrosis. Hegedus et al. states in their study related with Wilson?s disease that high OPG levelwas due to increased secretion from immunocompetant cells as a result of inflamatory event.The other explanation was increased secretion from osteoblasts so as to compansate incresaedbone destruction. This idea was not applicable to our findings. Because, we found mean BMDvalues in normal range in both groups. In another study performed in pediatric age grouppatients with newly diagnosed crohn disease; Silvester at al. found higher OPG and lowRANKL levels in patient group like our results. They concluded that these findings are due toincreased gamma interferon secretion secondary to increased antigenic stimulus and reducedosteoblastic actvity. It is possible that gamma interferon may also be decreased in our study.We found normal mean osteocalcin levels in hepatitis B group. This means that osteoblasticactivity does not increase concordant with increase in the serum level of OPG. IL-13 is knownas a cytokine that reduce serum RANKL levels, increase serum OPG levels, and depressosteoclastogenesis. It has been shown that IL-13 suppres osteoclast differantiation and boneresorbtion via activating the receptors using STAT6 pathway which effectOPG/RANKL/RANK system located on osteoblasts and osteoclasts. This finding that iscompatible with our findings supports our hypothesis that; change in the serum levels of OPGand RANKL was due inflamation in the liver. There are many study in the literature thatdisclose incresed level of TGF-β1 in chronic hepatitis B patients. It is known that TGF- β1increase serum OPG level, while reduce serum RANKL level. It also depress bone turnoverand osteoclastogenesis. Our findings may probably results from the increased level of thiscytokine in newly diagnosed chronic hepatitis B infected patients. Unfortunatelly we have notmeasured serum levels of this cytokine in our study so we couldn?t able to talk about definitiveeffect of TGF- β1. The resason that we didn?t see osteoporosis in our hepatitis B patients maybe due to incresaed level of TGF-β1. We have not found any correlation between OPG andRANKL serum levels and BMD and bone metabolism parameters in our study which may bedue to secondary to inflamation of chronic hepatitis B instead of bone metabolism

Appropriateness of thyroid function test requesting to the foreseen algorithm in Giresun province center

Amaç: Amerikan Tiroid Derneği (ATA), Amerikan Klinik Endokrinologlar Birliği (AACE) ve Türkiye Endokrinoloji ve Metabolizma Derneği gibi organizasyonların kılavuzlarında tiroid fonksiyonlarını değerlendirmede ilk yapılacak testlerin tiroid stimulan hormon (TSH) ve serbest T4 (fT4) olması gerektiği bildirilmektedir. Bu çalışmada Giresun İli Merkez'de tiroid fonksiyon test istemlerinin klinikte öngörülen algoritmaya uygunluğunun incelenmesi amaçlanmıştır. Gereç ve Yöntem: S.B. Giresun Prof. Dr. A. İlhan Özdemir Devlet Hastanesi Tıbbi Biyokimya Laboratuvarı'nda 01.01.2016-31.12.2016 tarihleri arasında çalışılıp raporlanmış TSH, serbest T3 (fT3) ve fT4 test sonuçları Laboratuvar Bilgi Sistemi kayıtlarından elde edildi. Tiroid fonksiyon testlerinin istemleri 4 grupta (yalnız TSH istemi, TSHfT4 istemi, TSHfT3 istemi, TSHfT3fT4 istemi) incelendi. Her bir grubun istem sonuçları Roche Immunoassay ölçüm sistemleri için bildirilen TSH referans aralığına göre (0,27-4,2 mIU/L) hipotiroidik, normotiroidik ve hipertiroidik olmak üzere 3 alt gruba ayrıldı. Bulgular: İçinde TSH'ın olduğu tiroid fonksiyon test paneli istemlerinin (n65.533) %47,8'ini TSHfT4 istemi,%34,3'nü yalnız TSH istemi, %17,8'ini TSHfT3fT4 istemi, %0,05'ini ise TSHfT3 istemi oluşturmakta idi. TSH referans aralığına göre (0,27-4,2 mIU/L) belirlenen normotiroidik gruplarda istenen toplam test sayısı (n120.308) içerisinde fazladan istenmiş fT3 ve fT4 test sayılarının (n44.025) yüzdesi %36,6 olarak hesaplandı. Sonuç: Tiroid fonksiyon test istemlerinde klinikte öngörülen algoritmaya göre yalnız TSH isteminin yapılması gereken vakalarda, TSH ile beraber fT3 ve fT4 test istemlerinin yaygın olmamakla beraber kullanıldığı saptandı. Ek olarak daha önce farklı merkezlerde yapılan sonuçlara kıyasla Giresun ili Merkez'de tiroid fonksiyon test istemlerinin klinikte öngörülen algoritmaya uygunluğunun daha kabul edilebilir düzeylerde olduğu görüldü.Objective: It is reported that the first tests to evaluate thyroid functions in the guidelines of American Thyroid Association (ATA), American Association of Clinic Endocrinologs (AACE) and Turkey Endocrinology and Metabolism Association are thyroid stimulated hormone (TSH) and free T4 (fT4). In this study, it was aimed to investigate the appropriateness of thyroid function test requests to the clinically foreseen algorithm in Giresun Province Center. Materials and Methods: TSH, fT3 and fT4 test results, which were worked and reported between 01.01.2016 and 31.12.2016 in the Ministry of Health Prof.Dr.A.İlhan özdemir State Hospital Medical Biochemistry Laboratory, were obtained from the Laboratory Information System records. Thyroid function tests were evaluated in 4 groups (Only TSH; TSH fT4; TSH fT3; TSH fT3 fT4). The results of each group were divided into three subgroups: hypothyroidism, normothyroidism and hyperthyroidism according to the reported TSH reference range (0.27-4.2 mIU / L). Results: Thyroid function test panel requests (n 65,533), TSH fT4 is the cause of 47.8%, TSH is the only cause of 34.3%, TSH fT3 fT4 is the 17.8% whereas TSH fT3 was the cause. The percentage of additional fT3 and fT4 test numbers (n 44,025) was calculated as 36.6% within the total number of tests (n 120,308) required in the normothyroidic groups determined according to the TSH reference range (0.27-4.2 mIU / L). Conclusion: According to the clinically foreseen algorithm for thyroid function tests, it was determined that fT3 and fT4 test requests together with TSH were used together with not being widespread when only TSH should be done. In addition, compared to the results obtained in different centers, it has been observed that the demand for thyroid function test in Giresun province center is more acceptable than that of the clinically prescribed algorithm

Evaluating of atherosclerosis in rheumatoid arthritis patients with carotid intima media thickness and lipoprotein phospholipase A2 activity

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Thyroid autoimmunity in patients with Familial Mediterranean Fever: preliminary results

Ankarali, Handan Camdeviren/0000-0002-3613-0523; Bugdayci, Guler/0000-0002-4060-3354; SOY, MEHMET/0000-0003-1710-7018WOS: 000328085300008PubMed: 24302182AIM: We investigated whether there was a significant increase in thyroid autoimmunity in patients with Familial Mediterranean fever (FMF). PATIENTS AND METHODS: In total, 220 patients, consisting of 42 with FMF, 75 with rheumatoid arthritis (RA), and 103 healthy controls, were enrolled. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid autoantibodies (anti-thyroid peroxidase and anti-thyroglobulin) were measured in all participants. RESULTS: After adjustment for age, gender, and smoking status, statistically significant differences between serum levels of anti-thyroglobulin antibody, anti-thyroid peroxidase antibody, and fT3 were found between the groups (all p 0.05). The frequency of autoimmune thyroiditis in FMF group is higher than control group. However, this difference did not reached the level of statistical significance (p > 0.05). CONCLUSIONS: Although statistically not significant, thyroid autoimmunity was observed more frequently in patients with FMF than in healthy controls. Thyroid autoantibodies were significantly higher in patients with FMF. Studies with greater number of patients are required for evaluating the frequency of the autoimmune thyroiditis in patients with FMF

Serum levels of visfatin, resistin and adiponectin in patients with psoriatic arthritis and associations with disease severity

SOY, MEHMET/0000-0003-1710-7018; Tonuk, Sukru Burak/0000-0003-0290-9341WOS: 000383531000007PubMed: 25196858Aim: Psoriatic arthritis (PsA) is an inflammatory form of arthritis typically associated with psoriasis and/or psoriatic nail disease. Adipocytokines were once thought to influence development of (only) insulin resistance and diabetes mellitus. However, it is now clear that adipocytokines play important roles in development of the inflammation associated with either autoimmune or auto-inflammatory disorders. In the present study, we measured changes in the serum levels of adiponectin, resistin and visfatin, and the associations of such changes with the extent of disease activity and insulin resistance in PsA patients. Material and methods: A total of 67 subjects (28 with PsA and 39 healthy controls) without hypertension or diabetes mellitus were enrolled. Adiponectin, resistin and visfatin levels, and the extent of insulin resistance (assayed using the homeostasis model [HOMA-IR]), were measured in all subjects. Assessment of PsA disease activity was done with the Disease Activity Index for Psoriatic Arthritis (DAPSA). Results: Psoriatic arthritis patients had considerably higher serum levels of adiponectin, resistin and visfatin than did healthy controls (all P 0.05). Conclusion: There is no correlation between adipocytokines and disease activity. Although serum adiponectin, resistin and visfatin levels are higher in patients with PsA, pathophysiological significance of the result has to be evaluated with more extensive studies.Scientific Research Project Unit of Abant Izzet Baysal UniversityAbant Izzet Baysal University [2012.08.03.566]The technical assistance of Sengul Gunduz is greatly appreciated. This research has been supported by Scientific Research Project Unit of Abant Izzet Baysal University (Project Number: 2012.08.03.566). The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/PhFsI7

Sinus node dysfunction requiring permanent pacemaker implantation in a young adult with klinefelter syndrome

WOS: 000374330000030PubMed: 25744562Patient: Male, 22 Final Diagnosis: Sinus node dysfunction Symptoms: Bradycardia . lassitude Medication: - Clinical Procedure: Pacemaker implantation Specialty: Cardiology Objective: Unusual clinical course Background: Klinefelter syndrome is the most common genetic cause of male infertility and affects approximately 1 in 500 live births. Although accompanying cardiac disorder is not a specific feature of Klinefelter syndrome, rarely associated anomalies such as mitral valve prolapse, atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus, and hypertrophic obstructive cardiomyopathy have been reported. A clear association between Klinefelter syndrome and arrhythmic disorders has not yet been demonstrated. Case Report: We report a case of a sinus node dysfunction that required permanent pacemaker implantation in a young adult with Klinefelter syndrome. The patient was consulted to cardiology clinic due to bradycardia. On physical examination, no cardiac abnormality was detected except for bradycardia. Holter results showed sinus arrhythmia with a minimum heart rate of 33 bpm and maximum of 154 Bpm. There were 3612 ventricular premature beats, 30 ventricular pairs, 804 supraventricular premature beats, 7 supraventricular pairs, and 4 supraventricular runs, the longest of which was 5 beats. The patient had defined dizziness and nausea during Holter monitoring. Electrophysiological study (EPS) was planned because existing findings indicated risk of cardiac syncope. Findings of EPS were interpreted as sinus node dysfunction. A permanent pacemaker implantation was performed and the patient has been free of symptoms since. Conclusions: This concomitance should be kept in mind when examining patients with Klinefelter syndrome with bradycardia and/or syncope. It is easily mistaken for epilepsy, which is a commonly encountered abnormality in Klinefelter syndrome

Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism

Alcelik, Aytekin/0000-0002-3156-1076WOS: 000309036000007PubMed: 22825898Background: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients. (Cardiol J 2012; 19, 4: 374-380

Evaluation of left atrial mechanical functions and atrial conduction abnormalities in patients with clinical hypothyroid

Alcelik, Aytekin/0000-0002-3156-1076WOS: 000307428200010PubMed: 22641548Background: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. Methods: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. Results: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Infra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 +/- 6.1 vs 18.0 +/- 2.7, p < 0.001; and 10.6 +/- 3.4 vs 6.9 +/- 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 +/- 6.2 vs 44.3 +/- 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. Conclusions: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction. (Cardiol J 2012; 19, 3: 287-294

Evaulation of atrial conduction abnormalities and left atrial mechanical functions in patients with subclinical thyroid disorders

Alcelik, Aytekin/0000-0002-3156-1076WOS: 000310110900006PubMed: 22933164Introduction: Changes of thyroid hormones levels may lead to effects, not only in ventricular function, but also atrial function. The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical coupling and P wave dispersion in patients with subclinical thyroid disorders. Material and methods: Eighty patients with subclinical thyroid disorders and forty controls were included. A diagnosis of subclinical thyroid disorders were reached with increased or decreased serum TSH and normal free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay were measured by tissue Doppler imaging (TDI). Results: All groups had similar demographic findings. LA mechanical functions significantly impaired in subclinical thyroid disorders than control group. Intra- and Interatrial delay, were measured significantly higher in patients with subclinical thyroid disorders than control group. PA lateral and interatrial delay were positively correlated with TSH (r = 0.507, p = 0.006 and r = 0.455, p = 0.015, respectively) in subclinical hypothyroid patients. There was negative correlation between TSH and interatrial delay (r = -0.492,p = 0.006) in subclinical hyperthyroid patients. Linear multivariate regression analysis demonstrated that, TSH was the only an independent factor of interatrial delay in patients with subclinical thyroid disorders. Conclusions: This study showed that impaired LA mechanical and electromechanical function in subclinical thyroid disorders. TSH was an independent determinant of interatrial delay. Prolonged atrial electromechanical coupling time and impaired mechanical atrial functions may be related to the increased incidence of arrhythmias. (Endokrynol Pol 2012; 63 (4): 286-293

Detection of subclinical atrial dysfunction by two-dimensional echocardiography in patients with overt hyperthyroidism

Alcelik, Aytekin/0000-0002-3156-1076WOS: 000312513100003PubMed: 23199618Background. - Hyperthyroidism is an important cardiovascular risk factor in the development of atrial fibrillation and heart failure. Increased atrial electromechanical intervals are used to predict atrial fibrillation, measured by tissue Doppler imaging (TDI). Aims. - To evaluate atrial electromechanical delay (EMD) and left atrial (LA) mechanical function in patients with overt hyperthyroidism. Methods. - Thirty-four patients with overt hyperthyroidism and 34 controls were included. A diagnosis of overt hyperthyroidism was reached with decreased serum thyroid-stimulating hormone (TSH) and increased free T4 (fT4) concentrations. Using TDI, atrial electromechanical coupling (PA) was obtained from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). LA volumes (maximum, minimum and presystolic) were measured by the disks method in apical four-chamber view and indexed to body surface area. LA active and passive emptying volumes and fractions were calculated. Results. - LA diameter was significantly higher in hyperthyroid patients (P = 0.001). LA passive emptying volume and fraction were significantly decreased in hyperthyroid patients (P = 0.038 and P < 0.001). LA active emptying volume and fraction were significantly increased in hyperthyroid patients (P < 0.001 and P < 0.001). Left and right intra-atrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMDs were significantly higher in hyperthyroid patients (29.2 +/- 4.4 vs 18.1 +/- 2.6, P < 0.001; 18.7 +/- 4.3 vs 10.6 +/- 2.0, P < 0.001; and 10.5 +/- 2.9 vs 7.1 +/- 1.2, P < 0.001, respectively). Stepwise linear regression analysis demonstrated that fT4 and TSH concentrations were independent predictors of interatrial EMD (beta = 0.436, P < 0.001 and beta = -0.310, P = 0.005, respectively). Conclusion. - This study showed prolonged atrial electromechanical intervals and impaired LA mechanical function in patients with overt hyperthyroidism, which may be an early sign of subclinical cardiac involvement and dysrhythmias in overt hyperthyroidism. (c) 2012 Elsevier Masson SAS. All rights reserved