Side Effects of Glucocorticoids

Glucocorticoids represent the most important and frequently used class of drugs in the management of many inflammatory and immunologic conditions. Beside these beneficial effects, glucocorticoids are also associated with serious side effects. Cushing’s syndrome, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, osteoporosis, psychiatric disturbances, and immunosuppression are among the most important side effects of systemic glucocorticoids. These side effects are especially noticeable at high doses for prolonged periods. Even in low-dose therapy, glucocorticoids could lead to serious side effects. The underlying molecular mechanisms of side effects of glucocorticoids are complex, distinct, and frequently only partly understood. This comprehensive article reviews the current knowledge of the most important side effects of glucocorticoids from a clinical perspective

Effects of glomerular filtration rate on the severity of coronary heart disease

Objective: Chronic kidney disease (CKD) is considered to beone of the most common risk factors for cardiovascular diseases.Glomerular filtration rate (GFR) is the best method oftesting level of kidney function and determining stage of kidneydisease. The aim of this study was to examine the impactof renal function on severity of coronary heart disease (CHD).Methods: The present study included 918 patients undergoingelective coronary angiography. GFR was evaluated bysimplified Modification of Diet in Renal Disease (MDRD) formula(mL/min/1.73 m2). The extent and severity of CHD wereevaluated according to SYNTAX score.Results: According to SYNTAX score, 416 patients had normalcoronary arteries or nonsignificant CHD (control group),267 had mild CHD (SYNTAX score: 1–22), 129 had moderateCHD (SYNTAX score: 23–32), and 106 had severe CHD(SYNTAX score: ?33). Estimated GFR values (median [25th–75th percentiles]) were 99.00 (83.00–116.00) in the controlgroup, 85.00 (73.00–101.00) in the mild CHD group, 87.00(73.25–101.75) in the moderate CHD group, and 81.00(65.00–101.00) in the severe CHD group. According to Spearman’srank correlation analysis, a negative correlation foundbetween MDRD and SYNTAX score was statistically significant(p<0.001, r=-0.268).Conclusion: Renal function is an important predictor of presenceand severity of angiographic CHD in patients without severerenal impairment. Negative correlation between MDRDand SYNTAX score was determined. This simple biochemicaltest can be used in determining risk of cardiovascular diseaseaside from other risk factors during routine clinical practice

Thyrotoxic Hypokalemic Periodic Paralysis

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but life-threatening complication of hyperthyroidism characterized by recurrent episodes of muscle weakness due to intracellular potassium shifting in the presence of high levels of thyroid hormone. Attacks can be triggered by many factors. Its differential diagnosis from the other common causes of hypokalemic paralysis is necessary to maintain targeted therapy. Outcome was right away positive under potassium replacement therapy. Hyperthyroidism should be treated to prevent attacks

Hyponatremia in the outpatient setting: clinical characteristics, risk factors, and outcome

Purpose Hyponatremia is a common disorder and hyponatremia in the outpatient setting is not extensively studied. Our aim was to investigate the characteristics of hyponatremia in ambulatory patients. Methods Seventy-six adult outpatients with hyponatremia were enrolled in this prospective study. Demographic features, presenting symptoms and signs, associating morbidities, medications, laboratory findings, mortalities, and length of hospital stay, were recorded. Results Mean age was 74.7 ± 12.7 years, and 52 (68.4 %) were female whereas 24 (31.6 %) were male. Mean sodium concentration was 123.6 ± 6.6 mEq/L. Leading cause was thiazide diuretic use (n = 37, 48.7 %) and approximately half of the patients (n = 40, 52.6 %) had a multifactorial etiology. Severe hyponatremia (sodium < 125 mEq/L) was identified in 37 (48.7 %). Thiazide diuretic use, vomiting, and apathy were independent predictors of severe hyponatremia. Eight (10.5 %) patients had a mortal course. A relatively younger age, male gender, presenting sign of lethargy, associating morbidities of malignancy, chronic liver disease, and hypoalbuminemia were risk factors for mortality. Conclusions Hyponatremia is prevalent among elderly, especially in women and with thiazide diuretics. Apart from the trend toward sodium depletion observed in healthy elderly which occurs due to changes in the tubular handling of sodium, a multifactorial etiology including thiazides seems to predict the occurrence and the severity of hyponatremia. Hyponatremia may be a significant cause of mortality in seniors. A relatively younger age, male gender, association of cirrhosis, malignancy, and hypoalbuminemia predict mortality. In elderly outpatients, identification of the risk factors for hyponatremia and close monitoring are imperative to reduce the related mortality and morbidity

Is mean platelet volume associated with the angiographic severity of coronary artery disease?

Background: Platelet activation and aggregation play key roles both in the pathogenesis of atherosclerosis and in the developmentof acute thrombotic events. Platelet volume is a marker of platelet activation and function, and is measured usingmean platelet volume (MPV).Aim: To determine the relationship between MPV and angiographic Gensini and SYNTAX scores, which give informationabout the severity and complexity of coronary artery disease (CAD).Methods: This study included 435 consecutive patients undergoing elective coronary angiography. The complete blood countand biochemical examination of blood were obtained after 12 h of fasting. The independent association between MPV andthe severity of CAD was statistically evaluated using PASW Statistics 18 for Windows.Results: Mean age of the study population was 58.4 ± 9.3 years, of whom 196 were female (45.1%) and 239 male (54.9%).Of the patients, 63.2% had CAD, 31.7% had diabetes mellitus, 61.8% had hypertension, 56.6% had hyperlipidaemia, and38.6% were smokers. Mean Gensini score was 20.7 ± 31.1. According to Gensini scores, 160 of the patients (36.8%) hadnormal coronary arteries (Gensini score: 0), 134 of the patients (30.8%) had minimal CAD (Gensini score: 1–19), and 141 ofthem (32.4%) had severe CAD (Gensini score ? 20). Mean MPV values were 8.4 ± 1.0 fL in the group that had no CAD,8.7 ± 1.0 fL in the group with minimal CAD, and 9.3 ± 1.5 fL in the group with severe CAD. According to Spearman correlationanalysis, the positive relationship found between MPV and Gensini score was statistically significant (p < 0.001,r = 0.290). Likewise, SYNTAX score was also associated with MPV (p < 0.001, r = 0.504).Conclusions: We determined a positive correlation between MPV and Gensini and SYNTAX scores. Therefore, this simplehaematology test can be used in determining cardiovascular disease burden besides other risk factors during routine clinicalpractice. For further information about this topic, large-scale studies are needed

The relationship between insulin resistance, metabolic syndrome and nonalcoholic fatty liver disease in non-obese non-diabetic Turkish individuals: a pilot study

Background/Aims: Nonalcoholic fatty liver disease is related to obesity, metabolic syndrome, and insulin resistance. Nonalcoholic fatty liver disease and metabolic syndrome may also be encountered in non-obese, non-diabetic individuals, and there are no published data about the prevalence of these conditions in non-obese, non-diabetic Turkish subjects. We aimed to determine the difference between non-obese, non-diabetic nonalcoholic fatty liver disease patients and healthy controls in terms of insulin resistance and metabolic syndrome in Turkish subjects. Materials and Methods: Non-obese, non-diabetic individuals (n=219) were enrolled. The cohort was divided into two groups according to presence of steatosis in ultrasonography: nonalcoholic fatty liver disease group (n=143) and healthy control group (n=76). Insulin resistance and metabolic syndrome were analyzed and compared between the two groups. Results: The prevalences of metabolic syndrome (32.2% vs. 5.3%, respectively; p<0.001) and insulin resistance (46.2% vs. 9.2%, respectively; p<0.001) were significantly higher in the nonalcoholic fatty liver disease group. According to multiple logistic regression analysis, age (odds ratio 1.534; p=0.0032), insulin resistance (odds ratio 1.074; p<0.001), and serum ALT levels (odds ratio 1.102; p<0.001) were independently associated with nonalcoholic fatty liver disease. Conclusion: Insulin resistance and metabolic syndrome are not rare in non-obese, non-diabetic Turkish subjects with nonalcoholic fatty liver disease. Ultrasonographically detected fatty liver was independently associated with insulin resistance, irrespective of the presence of metabolic syndrome

Thickening of the epicardial adipose tissue can be alleviated by thyroid hormone replacement therapy in patients with subclinical hypothyroidism

Background: Subclinical hypothyroidism (SCH) is a common disorder which has adverse cardiovascular effects. Epicardial adipose tissue (EAT), a novel marker of cardiovascular risk, is increased in SCH. Aim: We aimed to investigate whether L-thyroxine treatment can reverse the thickening of EAT in SCH. Methods: Forty-four patients with SCH and 42 euthyroid control subjects were included. EAT thickness was measured using transthoracic echocardiography at baseline and after restoration of the euthyroid status with 3 months of L-thyroxine treatment. Results: At baseline, mean EAT thickness was significantly greater in the SCH group when compared to the control group (6.3 ± 1.7 mm vs. 4.1 ± 0.9 mm, respectively, p < 0.001). There was a significant positive correlation between baseline serum thyroid stimulating hormone (TSH) level and EAT thickness in the SCH group. There was a significant reduction in mean EAT thickness in response to L-thyroxine treatment (6.3 ± 1.7 mm vs. 5.1 ± 1.4 mm, p < 0.001). The decrease in EAT thickness after L-thyroxine treatment when compared to baseline (DEAT) significantly correlated to the difference in TSH levels before and after treatment (DTSH; r = 0.323; p = 0.032). Conclusions: Epicardial adipose tissue thickness is increased in patients with SCH. This thickening was alleviated with restoration of the euthyroid status with L-thyroxine treatment in our study population of predominantly male, relatively old subjects with greater baseline EAT thickness

Distance Education in Medical Schools: the Experience and Opinions of Academicians and Students

DergiPark: 819194tmsjAims: This study aims to identify the thoughts and opinions of medical schools’ students and academicians about the distance medical education and examination system that has been rapidly applied during the COVID-19 pandemic Methods: A ques- tionnaire was prepared via Google Forms which consisted of a total of 3 sections. Informed consent was obtained in the first section and participants were directed to “student” or “academician” section. There were 28 questions for the students and 24 questions for the academicians. Categorical variables were demonstrated as numbers and percentages, whereas continuous variables were presented as minimum, maximum, and mean values. Chi-squared test was used to compare preclinic and clinic year students, and the academicians in preclinic, medical, and surgical fields. Results: A total of 321 participants completed the questionnaire. The mean participant ages were 21.4 years and 41.68 years for the students and the academicians, respectively. Only 30% of the students thought the distance education lessons were beneficial while it was 35.5% for the academicians. 25.8% of the academicians and 29.6% of the students were indecisive on the matter. When the examination process was taken into account 67.7% of the academicians and 56.9% of the students thought the online examinations were not reliable. Conclusion: It is predicted that the pandemic process will continue in the next academic years. Considering the current situation, distance education seems to be the best option to ensure that the learning process can continue while protecting the health of students and academicians. Although distance education is not sufficient by itself in medical education during and after the COVID-19 pandemic, it is a method that should be used in almost every field of medical education, especially in the preclinical phase. Both the distance education, and online examination process require improvements and they are needed to be supported with face to face lectures and practices

Matches between the loci identified in the genome-wide association and the genome-wide linkage studies of Behçet’s disease and the loci of the differentially expressed genes documented in the present study.^a

<p>Matches between the loci identified in the genome-wide association and the genome-wide linkage studies of Behçet’s disease and the loci of the differentially expressed genes documented in the present study.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149052#t005fn002" target="_blank">^a</a></p

The top 20 most differentially expressed genes in the class comparison analysis.^a

<p>The top 20 most differentially expressed genes in the class comparison analysis.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149052#t003fn001" target="_blank">^a</a></p