The treatment of hyperthyroidism with methimazole in a pregnant who developed agranulocytosis due to propylthiouracil

The most common cause of hyperthyroidism during pregnancy is Graves' disease. Anti-thyroid drugs are primarily used in the treatment of pregnant women with Graves’ disease. Anti-thyroid drugs’ side effects include itching, jaundice, skin rash, drug fever, arthralgia, lupus-like syndrome, toxic hepatitis, vasculitis, hypergammaglobulinemia, and lymphadenopathy.  Although agranulocytosis, a serious side effect of anti-thyroid drugs, is rare, it is difficult to treat when it occurs during pregnancy. In this article, we aimed to present a pregnant case with Graves' disease who developed agranulocytosis after the initiation of propylthiouracil, whose agranulocytosis was treated with granulocyte colony-stimulating factor, and subsequently, hyperthyroidism was treated with methimazole without any problem

Recurrent pregnancy loss and metabolic syndrome

Objectives: The aim of this study was to evaluate the frequency of metabolic syndrome (MetS) and its components inpatients with unexplained recurrent pregnancy loss (RPL).Material and methods: A cross-sectional study was held including 115 patients with unexplained RPL who were referredto a tertiary center between December 2018 and December 2019. In the study, MetS was classified according to TheNational Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria on the basis of metabolic riskfactors. Frequency of MetS in the patients with unexplained RPL was investigated. The relationship between miscarriagerate and metabolic risk factors was also evaluated.Results: According to our study the percentage of MetS in patients with unexplained RPL was 24.4%. When evaluated accordingto different age groups, it was 18.4% in patients aged 20–29 years, and it was 27.8% in patients aged 30–39 years. Atleast having one of its components were high (82.6%) in all patients with unexplained RPL.Conclusions: The percentage of MetS or of at least having one of its components were high in patients with unexplainedRPL. Increased number of having MetS components were associated with increased miscarriage rate

Effects of COVID-19 pandemic lockdown on the metabolic control of type 2 diabetes mellitus in patients

ABSTRACT Objective: The effects of the COVID-19 pandemic on the control of diabetes mellitus in patients are largely unknown. In this study we aimed to analyze the impact of the pandemic and the ensuing lockdown on the management of type 2 diabetes mellitus. Subjects and methods: A total of 7,321patients with type 2 diabetes mellitus (4,501 from the pre-pandemic period, 2,820 from the post-pandemic period) were studied retrospectively. Results: The admission of patients with diabetes melitus (DM) decreased significantly during the pandemic (4,501 pre-pandemic vs. 2,820 post-pandemic; p < 0.001). The mean age of patients was statistically lower (51.5 ± 14.0 vs. 49.7 ± 14.5 years; p < 0.001), and the mean glycated hemoglobin (A1c) level was significantly higher (7.9% ± 2.4% vs. 7.3% ± 1.7%; p < 0.001) in the post-pandemic period than in the pre-pandemic. The female/male ratio was similar in both periods (59.9%/40.1% for pre-pandemic, 58.6%/41.4% for post-pandemic; p = 0.304). As calculated by month the pre-pandemic rate of women was higher only in January (53.1% vs. 60.6%, p = 0.02). Mean A1c levels were higher in the postpandemic period than in the same month of the previous year, excluding July and October (p = 0.001 for November, p < 0.001 for others). Postpandemic patients admitted to the outpatient clinic were significantly younger than prepandemic visits for July (p = 0.001), August (p < 0.001) and December (p < 0.001). Conclusion: The lockdown had detrimental effects on blood sugar management in patients with DM. Hence, diet and exercise programs should be adapted to home conditions, and social and psychological support should be provided to patients with DM

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity

Measurement of the total antioxidant response using a novel automated method in subjects with nonalcoholic steatohepatitis

BACKGROUND: Oxidative stress, an increase in oxidants and/or a decrease in antioxidant capacity, is one of the potential biochemical mechanisms involved in the pathogenesis of nonalcoholic steatohepatitis. We aimed to investigate the total antioxidant response using a novel automated method in nonalcoholic steatohepatitis subjects. As a reciprocal measure, we also aimed to determine total peroxide level in the same plasma samples. METHODS: Twenty-two subjects with biopsy proven nonalcoholic steatohepatitis and 22 healthy controls were enrolled. Total antioxidant response and total peroxide level measurements were done in all participants. The ratio percentage of total peroxide level to total antioxidant response was regarded as oxidative stress index. RESULTS: Total antioxidant response of subjects with nonalcoholic steatohepatitis was significantly lower than controls (p < 0.05), while mean total peroxide level and mean oxidative stress index were higher (all p < 0.05). In subjects with nonalcoholic steatohepatitis, fibrosis score was significantly correlated with total peroxide level, total antioxidant response and oxidative stress index (p < 0.05, r = 0.607; p < 0.05, r = -0.506; p < 0.05, r = 0.728, respectively). However, no correlation was observed between necroimflamatory grade and those oxidative status parameters (all p > 0.05). CONCLUSION: Nonalcoholic steatohepatitis is associated with increased oxidant capacity, especially in the presence of liver fibrosis. The novel automated assay is a reliable and easily applicable method for total plasma antioxidant response measurement in nonalcoholic steatohepatitis

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Comparison of Body Compositions Evaluated with Bioelectrical Impedance Analysis (BIA) with Metabolic, Hormonal and Anthropometric Measurements in PCOS Patients

Aim: In this study, it was aimed to compare the body composition parameters measured by BIA(Bioelectrical Impedance Analysis) and the metabolic, anthropometric and hormonal parameters of the PCOS patients with the healthy control group and to examine the effect of PCOS on body composition parameters. It is aimed to give a better direction to PCOS follow-up and treatment. Material and Method: 23 non-obese PCOS patients were involved to this prospective study. PCOS diagnosis was made according to the Rotterdam Consensus. Antropometric, metabolic and hormonal parameters were measured. Body compositions were measured by BIA. Results: When the relationship between body composition parameters and metabolic and hormonal values were examined, significant correlations were found. There was a negative correlation between AUC-insulin levels and SHBG while a significant positive correlation between free testosterone in hirsute women with PCOS. There was a significant negative correlation between free testosterone level increase and body fat ratio while a significant positive correlation between SHBG and body fat ratio. There was a significant negative correlation between DHEAS and BMI and the hip circumference. When the relationship between body composition and antropometric parameters were examined, a significant positive correlation was found between BMI and body fat ratio, total body water and basal metabolic rate in women with PCOS. Conclusion: In this study, significant correlations were found between body compositions and hormonal, metabolic and anthropometric parameters in patients with PCOS. Based on these findings, we believe that BIA can play an important role in outpatient follow-up of patients with PCOS