Tip 2 Diyabetli Bir Hastada Linagliptine Bağlı Lokalize Ağrılı Döküntü

The number of patients with type 2 diabetes using dipeptidylpeptidase-4 (DPP-4) inhibitors is increasing across the world.Although this class of antidiabetic medications is generallysafe and associated with less side effects compared to otheroral antidiabetic medications, they could also cause some sideeffects such as skin rashes. Herein we report a case of type 2diabetes patient who developed a painful maculopapular rashinduced by linagliptin, a widely used DPP-4 inhibitor.A localized painful maculopapular rash developed on thepalmar faces of the patient’s hands almost 1 day after theinitiation of the drug. The patient was using intensive insulintherapy before linagliptin was started. There was no eruptionon the other body parts except the palmar faces of the hands.Following the discontinuation of the drug, the rash disappearedin about four days. The patient had no history of urticaria anddid not use an ACE inhibitor. As far as we know, this is the firstcase report of a skin rash induced by linagliptin in the Turkishliterature. This case report highlights a rare and lesser knownside effect of linagliptin, a new member of DPP-4 inhibitors.Dipeptidil peptidaz-4 (DPP-4) inhibitörleri kullanan tip 2 diyabet hastalarının sayısı dünya genelinde artmaktadır. Bu antidiyabetik ilaç sınıfı genelde güvenli olmakla birlikte diğer oral antidiyabetik ilaçlarla karşılaştırıldığında daha az yan etki ile ilişkili olsa da, deri döküntüleri gibi bazı yan etkilerle ilişkili olabilirler. Burada yaygın olarak kullanılan bir DPP-4 inhibitörü olan linagliptin ile indüklenen ağrılı makülopapüler döküntü gelişen tip 2 diyabetli bir hastayı sunuyoruz. Linagliptin başlandıktan 1 gün sonra hastamızın ellerinin palmar yüzünde lokalize ağrılı makülopapüler bir döküntü gelişti. Linagliptin başlanmadan önce hasta intensif insülin tedavisi altındaydı. Vücudun diğer bölgelerinde herhangi bir döküntü yoktu. Linagliptin kesildikten sonra 4 gün içerisinde döküntü kayboldu. Hastanın ürtiker öyküsü yoktu ve Anjiyotensin dönüştürücü enzim inhibitörü kullanmıyordu. Bildiğimiz kadarıyla bu, Türk literatüründe Linagliptine bağlı deri döküntüsü geliştirdiği rapor edilen ilk olgudur. Bu olgu sunumu, DPP-4 inhibitörlerinin nadir görülen ve daha az bilinen bir yan etkisini vurgulamaktadır

Metastatic Papillary Thyroid Cancer Diagnosed and Treated during Pregnancy

Physiological changes of the thyroid gland encountered during pregnancy can cause previously diagnosed thyroid nodules to grow or new nodules to form. Surgery of the slowly growing, localized, non-metastatic, well-differentiated, thyroid cancers diagnosed during pregnancy can be delayed to after delivery, whereas rapidly growing and metastatic cancers with compressive symptoms may be a candidate for surgery during pregnancy. In this case report, we present a case of cervical metastatic papillary thyroid cancer diagnosed and treated by total thyroidectomy and right functional neck dissection during pregnancy in a 22-year-old pregnant woman at 23-week pregnancy. In this case report, the optimal treatment for papillary thyroid cancer diagnosed during pregnancy is discussed under the light of current endocrine guidelines and previous case reports and series

Renal complications of lipodystrophy: A closer look at the natural history of kidney disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/1/cen13732_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/2/cen13732.pd

Optimal trading strategies with limit orders

A model is proposed to study the risk management problem of designing optimal trading strategies in a limit order book. The execution of limit orders is uncertain, which leads to a stochastic control problem. In contrast to previous literature, we allow the agents to choose both the quotes and the sizes of their submitted orders. Attention is paid to how the trading strategy is affected by an order book\u2019s characteristics, market volatility and the trader\u2019s risk attitude. We prescribe an optimal splitting of the order size for the trades with limit orders, while the existing literature offers a solution to this problem with market orders, and, at the same time, we provide guidelines to optimally place 27 orders further behind the best price or to (re)position them more aggressively. Thus this 28 paper is an attempt towards a more realistic modeling of optimal liquidation throughout 29 limit orders

Polycystic Ovary Syndrome in Adolescent Period: Physical, Metabolic, and Hormonal Features

Aim: The Rotterdam criteria are used in the diagnosis of polycystic ovary syndrome (PCOS). However, since menstrual irregularities and acne are seen more frequently in adolescents, it is theoretically difficult to use the Rotterdam criteria. The aim of this study was to investigate whether the Rotterdam criteria are sufficient for the diagnosis of PCOS in adolescence. Material and Methods: Thirty patients and thirty healthy individuals between the ages of 16 and 18 years were included in the study. Anthropometric measurements, Ferriman Gallwey score (FGS), ultrasonographic ovarian volumes, androgens, and other hormone levels of the participants were recorded. Results: There was a statistically significant positive correlation between the homeostatic model assessment of insulin resistance (HOMA-IR) and waist circumference/hip circumference ratio in the patient group (r=0.656, p<0.001). The mean luteinizing hormone (LH) levels of the patient group were found to be statistically significantly higher than the control group (p=0.048). The median FGS of the patient group was statistically significantly higher than the control group (p<0.001). Serum total testosterone levels of adolescent girls who have polycystic ovaries were statistically significantly higher than the ones who have not (p=0.001). The median FGS of those with polycystic ovarian appearance on ultrasonography was found to be statistically significantly higher than those without (p=0.034). Conclusion: Among the Rotterdam diagnostic criteria, oligoanovulation, acne, and polycystic ovarian appearance on ultrasonography can be seen in healthy adolescents without PCOS. In this study, the most supportive finding for the diagnosis of PCOS was the appearance of polycystic ovaries accompanying moderate hirsutism

Association of Insulin Receptor Substrate-2 Gene Polymorphism with Ovarian Cancer

Objective: The insulin receptor substrate (IRS) proteins have been implicated in contributing to all stages of tumorigenesis in many cancers, from initiating events to metastatic progression. In this study, we aimed to evaluate the association of IRS-2 gene polymorphism with ovarian cancer. Material and Methods: The study group consisted of 185 women: 45 women with ovarian cancer and 140 control subjects. All the patients with ovarian cancer were primarily treated by surgical intervention. Genetic polymorphism of IRS-2 G1057D was detected by using polymerase chain reaction (PCR)-based restriction fragment-length polymorphism (RFLP).Results: For IRS-2 G1057D polymorphism, the frequencies of GG, GD and DD genotypes were 60%, 33.3%, and 6.7%, respectively in the ovarian cancer cases and 53.6%, 38.6% and 7.9 % in controls. The risk for ovarian cancer was not significantlydifferent in the individuals with the IRS-2 DD genotype compared to the GG genotype (95% CI: 0.203-3.04, P: 0.787). Also, there was no association between carriage of the D allele and ovarian cancer risk. We found no significant difference between the genotypes in the ovarian cancer group and control group (P:0.545).Conclusion: These results do not support an association between carriage of the G1057D variant of IRS-2 gene and ovarian cancer

Technical Analysis with a Long-Term Perspective: Trading Strategies and Market Timing Ability

This paper extends the literature on the profitability of technical analysis in three directions. First, we investigate the performance of complex trading rules based on moving averages computed over longer periods than those usually considered. Different trading rules are simulated on daily prices of the Standard & Poor’s 500 index and we find that trading rules are more profitable when signals are generated over long horizons. Second, we analyse whether financial leverage can improve the profitability of different strategies, which appears to be the case when leverage is achieved with debt. Third, we propose a new market timing test that assesses whether a trading strategy can generate signals corresponding to bull and bear markets. The results of this test show that complex rules produce high proportions of accurate signals