Life-Threatening Hypercalcemia due to Graves' Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

A 47-year-old woman presented with the complaints of nausea, vomiting, and weight loss. She had a history of bilateral surrenalectomy due to Cushing's syndrome. On examination she had tachycardia and orthostatic hypotension. Laboratory examinations revealed hypercalcemia and suppressed parathyroid hormone levels. She also had thyrotoxicosis due to Graves' disease. The investigations to rule out a malignancy were negative. With steroid, zoledronic acid, and antithyroid drug treatment her symptoms were resolved and calcium level was normalized. This case highlights the importance of recognizing thyrotoxicosis and concomitant adrenal failure as a possible cause of severe hypercalcemia

Identification of Ligand Binding Sites of Proteins Using the Gaussian Network Model

The nonlocal nature of the protein-ligand binding problem is investigated via the Gaussian Network Model with which the residues lying along interaction pathways in a protein and the residues at the binding site are predicted. The predictions of the binding site residues are verified by using several benchmark systems where the topology of the unbound protein and the bound protein-ligand complex are known. Predictions are made on the unbound protein. Agreement of results with the bound complexes indicates that the information for binding resides in the unbound protein. Cliques that consist of three or more residues that are far apart along the primary structure but are in contact in the folded structure are shown to be important determinants of the binding problem. Comparison with known structures shows that the predictive capability of the method is significant

Vitamin D level is associated with mortality predictors in ventilator-associated pneumonia caused by Acinetobacter baumannii

Introduction: Vitamin D plays a role in host defense and is known to be associated with mortality in patients in the intensive care unit (ICU). We aimed to evaluate the relationships between vitamin D levels and predictors of mortality in patients with ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumanii (XDR A. baumanii)

Multifocal Mesenchymal Hamartoma Of The Chest Wall In A Newborn

Mesenchymal hamartoma of the chest wall is an extremely rare, benign chondro-osseous chest wall tumor which originates from one or more ribs, in newborns or infants. It usually appears as a solitary lesion but more rarely can be multifocal and bilateral. Sometimes it may mimic chest wall malignant tumors because of its destructive radiological nature. Herein, we aim to present the imaging characteristics of a 4-day-old boy with multifocal mesenchymal hamartoma of the chest wall.WoSScopu

Life-Threatening Hypercalcemia due to Graves' Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

A 47-year-old woman presented with the complaints of nausea, vomiting, and weight loss. She had a history of bilateral surrenalectomy due to Cushing's syndrome. On examination she had tachycardia and orthostatic hypotension. Laboratory examinations revealed hypercalcemia and suppressed parathyroid hormone levels. She also had thyrotoxicosis due to Graves' disease. The investigations to rule out a malignancy were negative. With steroid, zoledronic acid, and antithyroid drug treatment her symptoms were resolved and calcium level was normalized. This case highlights the importance of recognizing thyrotoxicosis and concomitant adrenal failure as a possible cause of severe hypercalcemia

The Effects of Psychological Focus Group Therapy on the Quality of Life of Female Patients with Acromegaly

Objective: Chronic diseases such as acromegaly affect psychological health. This study aimed to evaluate the effects of a 1-year-long psychological focus group therapy on the quality of life of patients with acromegaly. Material and Methods: Seven female patients with acromegaly, followed-up at the endocrinology outpatient clinic of Cerrahpasa Medical Faculty, were evaluated. The weekly group psychotherapy sessions were conducted by a psychoanalyst and a clinical psychologist between May 2018 and May 2019. Beck Depression Inventory (BDI) and Acromegaly Quality of Life (AcroQoL) scales were assessed at baseline, 3-months, 6-months, and 1-year of group therapy. Results: The mean age of the patients was 43.7 +/- 6.2years, and the median duration of disease was 8 [3-10] years. Six patients were in disease remission. There was a significant improvement in the BDI (p=0.008) and AcroQoL-total scores (p=0.04) from the beginning till the end of the study. A strong negative correlation was observed between BDI and AcroQoL-2 (p=0.003; r=-0.91 vs. p=0.04; r=-0.77) and AcroQoL-t(o)tal (p=0.03; r=-0.78 vs. p=0.01; r=-0.85) scores at baseline and the 3-months of therapy, respectively. Moreover, the psychoanalyst reported that the patients showed an improved ability to face difficulties caused by their illnesses, expressed their emotional reactions more freely, and were more capable of enduring the disease. Conclusion: Patients with acromegaly benefited from the 1-year psychological focus group therapy in terms of psychological well-being, along with improved AcroQoL and BDI scores. Psychotherapeutic approaches, starting with the diagnosis of the disease, might be a significant intervention that improves the quality of life of patients with acromegaly

Fatigue is Related to Insulin Use by Acting Via Depressive Mood in Patients with Diabetes Mellitus

Objective: Fatigue is a common symptom in diabetes mellitus. The aim of this study was to determine the factors leading to fatigue and to investigate the effect of insulin use on fatigue among the diabetic population. Material and Methods: One-hundred diabetic patients attending the diabetes clinic of Cerrahpasa Medical Faculty between October 2017-January 2018 and 42 healthy controls were evaluated in this cross-sectional study. Questionnaires including demographic and disease characteristics, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), quality of life scale (SF-36), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Ages (47.6 +/- 14.8 and 45.7 +/- 14.1 years; p=0.47) and body mass indices (26.6 +/- 4.1 and 25.3 +/- 3.5 kg/m(2); p=0.08) of 100 patients with diabetes (Type 1 Diabetes/Type 2 Diabetes=29/71) and 42 healthy volunteers were similar. The diabetic group had worse FIS total (p=0.05), FIS psychological (p=0.04) scores and SF-36 scores compared to the healthy controls. When the patients with diabetes were divided into two groups according to insulin use and compared with healthy controls, the ESS and PSQI were similar but all FIS parameters (total p=0.005, cognitive p=0.007, physical p=0.01, psychological p=0.009) and BDI (p=0.05) were significantly worse in patients with insulin use than non-insulin and control groups. The relationship between fatigue and insulin use was independent of glycemic control and duration of diabetes but was affected by the BDI (p=0.001). Conclusion: Insulin use leads to fatigue in patients with diabetes, regardless of diabetes type, and this effect is influenced by depressive mood. Psychotherapeutic approaches prior to insulin treatment might yield fruitful results

The Role of Different Molecular Markers in Papillary Thyroid Cancer Patients with Acromegaly

Purpose Prevalence of papillary thyroid cancer (PTC) is increased in patients with acromegaly. We aimed to determine the protein expression of BRAF, RAS, RET, insulin like growth factor 1(IGF1), Galectine 3, CD56 in patients with PTC related acromegaly and to compare the extensity of these expressions with normal PTC patients and benign thyroid nodules