A case of mediastinitis accompanied with hyperosmolar nonketotic coma

AbstractMediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling

Importance and Risk Prediction of ABO Blood Group and Rh Factor in Papillary Thyroid Cancer

Objective: There are limited data in the literature regarding the potentialrelationship between thyroid cancer and ABO blood types and Rh factor.The aim of our study was to investigate whether papillary thyroid cancer(PTC) is associated with blood type.Materials and Methods: The present study included patients who presented to Dicle University Faculty of Medicine between June 2009 andDecember 2020 and were diagnosed with PTC as a result of postoperative(thyroidectomy) histopathological analysis. The control group consisted ofindividuals whose blood type was analyzed at a random blood center.Results: Of the 223 patients diagnosed with PTC, 163 (73.1%) were females and 60 (26.9%) were males. In the comparison of patients based onABO blood types and Rh factor, A Rh positive blood type was found 31%less frequently in the PTC group compared with the control group, and thusit was associated with a lower risk of PTC (OR:0.69; 95% Confidence Interval: 0.50–0.96, p=0.029).Conclusions: In our study, we found A Rh positive blood type to be significantly less frequent among patients with PTC. A Rh positive blood type canbe considered as a protective factor indicating a reduced risk of PTC

Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature

Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey

Summary Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and gener ally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D defciency can ensure safe and efective treatment. Purpose We observed a tendency to use high doses of cholecalciferol for vitamin D defciency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. Methods An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (>88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1,>150 ng/ mL; group 2, 149–100 ng/mL; and group 3, 99–88 ng/mL. Results A total of 253 patients were included in the fnal analysis (female/male: 215/38; mean age, 51.5±15.6 years). The average serum 25(OH)D level was 119.9±33 (range, 88–455) ng/mL, and the average serum calcium level was 9.8±0.7 (range, 8.1–13.1) mg/dL. Most (n=201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and cal cium levels. The serum 25(OH)D level was signifcantly higher in the symptomatic groups than in the asymptomatic groups (138.6±64 ng/mL vs. 117.7±31 ng/mL, p<0.05). The most common cause (73.5%) associated with high serum 25(OH) D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000–1.500.000 IU) for treating vitamin D defciency/insufciency in a short time (1–3 months). The cut-of value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89–216)]. Conclusions High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercal cemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and efective treatment of vitamin D defciency

Identifying clinical characteristics of hypoparathyroidism in Turkey: HIPOPARATURK‑NET study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients

Alternative methods for the diagnosis of macroprolactinemia: urine prolactin level and serum / urine prolactin ratio

Objective: The aim of this study was to investigate the urine prolactin and serum/urine prolactin ratio for accuracy diagnosis of macroprolactinemia. Methods: In the retrospective cross-sectional analysis, prolactin levels (high or normal) in the reproductive period of men and women were included in the study. Polyethylene glycol (PEG) precipitation method was used for the detection of macroprolactinemia. Then, patients were divided into three groups as macroprolactinemia, prolactinoma and healthy control group. In patients, prolactin values in spot urine with simultaneous serum prolactin values were calculated. The non-parametric Kruskal-Wallis test was used to compare the groups. The receiver-operating characteristic (ROC) curve was determined to evaluate the predictive power of serum/urine prolactin ratio. Results: A total of 41 patients were included in the study. Female/male:36 (87.8%)/ 5 (12.2%). Urinary prolactin median(minimum-maximum) values were macroprolactinemia, prolactinoma and control group, respectively; 0.06(0.05-0.10), 0.11(0.02-0.95), 0.08(0.05-0.25) ng/ml. Serum/urine ratio median (minium-maximum) values were macroprolactinemia, prolactinoma, and control group, respectively; 633(51-1032), 990(104-9635), 395.5(138-953). When the groups were compared, the patients with prolactinoma had higher urinary prolactin levels(p <0.01). Serum/urine prolactin ratio was found to be the highest in prolactinoma patients and the lowest in the control group and a significant difference was observed in groups (p <0.01). ROC analysis(control-macroprolactin) for serum/urine prolactin ratio (Sensitivity 84.6 specificity 93.7 cut off >549,5 AUC=0.83) p<0.01 Conclusion: Urinary prolactin level and serum/urine prolactin ratio may be used in diagnosis of macroprolactinemia

Does oxidative status affect serum sclerostin levels in patients with type 2 diabetes mellitus?

Introduction: Sclerostin is a glycoprotein known as a negative regulator of bone formation, predominantly expressed by mature osteocytes. There is no causative evidence information on the role of sclerostin in the pathogenesis of type 2 diabetes mellitus (T2DM) in humans. Aim: This study aimed to investigate the relationship between serum sclerostin levels and oxidative status and biochemical parameters in T2DM patients and healthy people. Materials and methods: This cross-sectional study, conducted in a clinical trial center, included 45 subjects with T2DM and 45 subjects as controls. Results: Serum sclerostin, total oxidative status (TOS), albumin, and ferritin levels were significantly higher in T2DM patients than in the control group (p<0.05). Total antioxidant status (TAS) was significantly higher in the control group (p<0.05). There was a weak positive correlation between sclerostin and TOS (r=0.23, p=0.03) and a weak negative correlation between sclerostin and TAS (r=-0.28, p=0.03). Conclusions: We have demonstrated that serum sclerostin levels increase in patients with T2DM and that the increased sclerostin levels are associated with oxidative stress

Erkek hipogonadotropik hipogonadizm tanılı hastaların fertilizasyon oranlarının belirlenmesi ve fertilizasyonu etkileyen faktörlerin değerlendirilmesi

Amaç: Hipogonadotropik hipogonadizm tanısıyla takip edilen hastaları retrospektif olarak tarayıp, bu hastalardaki fertilizasyon oranlarını, hormonal profili ve fertilizasyon düzeyini etkileyen faktörleri araştırmayı amaçladık.Gereç ve Yöntem: 2009-2015 yılları arasında Endokrinoloji polikliniğine başvurmuş olan erkek hipogonadizmi tanılı hastalar retrospektif olarak incelendi. 18 yaşından büyük 55 erkek hasta çalışmaya alındı.Hasta dosyalarından hastaların yaşı, boyu, ağırlığı ve testosteron düzeyleri incelendi. Tedavi öncesi TÖ ve tedavi sonrası TS testosteron,spermiogram parametreleri ve skrotal ultrasonografideki testis volümleri karşılaştırıldı.Bulgular: Ortalama testosteron seviyesiTÖ: 0.88±1,3 ng/ml , TS: 5.98±2.96 ng/ml olup, artış istatistiksel olarak anlamlıydı

Does oxidative status affect serum sclerostin levels in patients with type 2 diabetes mellitus?

Introduction: Sclerostin is a glycoprotein known as a negative regulator of bone formation, predominantly expressed by mature osteocytes. There is no causative evidence information on the role of sclerostin in the pathogenesis of type 2 diabetes mellitus (T2DM) in humans. Aim: This study aimed to investigate the relationship between serum sclerostin levels and oxidative status and biochemical parameters in T2DM patients and healthy people. Materials and methods: This cross-sectional study, conducted in a clinical trial center, included 45 subjects with T2DM and 45 subjects as controls. Results: Serum sclerostin, total oxidative status (TOS), albumin, and ferritin levels were significantly higher in T2DM patients than in the control group (p<0.05). Total antioxidant status (TAS) was significantly higher in the control group (p<0.05). There was a weak positive correlation between sclerostin and TOS (r=0.23, p=0.03) and a weak negative correlation between sclerostin and TAS (r=−0.28, p=0.03). Conclusions: We have demonstrated that serum sclerostin levels increase in patients with T2DM and that the increased sclerostin levels are associated with oxidative stress