Comparison of the efficiency of anti-androgenic regimens consisting of spironolactone, Diane 35, and cyproterone acetate in hirsutism.

The aim of the present study was to evaluate the effects of three different anti-androgenic drug-therapy regimens, Diane 35 (cyproterone acetate (CPA) [2 mg] and ethinyl estradiol [35 microg]) plus CPA, Diane 35 plus spironolactone, and spironolactone alone, in patients with hirsutism. In this prospective, randomized clinical study, 79 subjects with idiopathic hirsutismus were studied. The patients were divided into 3 groups. Group I patients (n=32) were treated with Diane 35 plus CPA, group II patients (n=25) with Diane 35 plus spironolactone [100 mg], and group III patients (n=22) with spironolactone [100 mg] alone. Serum FSH, LH, testosterone (T), and DHEAS levels were analyzed before and after treatment at 6 and 12 months. Hirsutism scores were graded according to the Ferriman-Gallwey scoring system, and side effects were monitored. All treatment regimens were found to be efficient and well-tolerated, and none of the patients stopped therapy due to any adverse event. However, in hormone screening, only patients on the Diane 35 plus CPA regimen revealed a decrease in serum T levels after therapy. As such, treatment of each hirsute patient should be planned individually, but with regard to both cost-efficiency and potential side effects, we recommend spironolactone alone in the treatment of hirsutismus.</p

Approaches to the low grade metamorphic history of the karakaya complex by chlorite mineralogy and geochemistry

In this study, chlorite is used to investigate the diagenetic-metamorphic evolution and accurate geological history of the different units belonging to the Karakaya complex, Turkey. Primary and secondary chlorite minerals in the very low-grade metamorphic rocks display interference colors of blue and brown and an appearance of optical isotropy. Chlorites are present in the matrix, pores, and/or rocks units as platy/flaky and partly radial forms. X-ray diffraction (XRD) data indicate that Mg-Fe chlorites with entirely IIb polytype (trioctahedral) exhibit a variety of compositions, such as brunsvigite-diabantite-chamosite. The major element contents and structural formulas of chlorite also suggest these were derived from both felsic and metabasic source rocks. Trace and rare earth element (REE) concentrations of chlorites increase with increasing grade of metamorphism, and these geochemical changes can be related to the tectonic structures, formational mechanics, and environments present during their generation. © 2015 by the authors; licensee MDPI, Basel, Switzerland

Review of Two Siblings with Werner's Syndrome: A Case Report

We report the clinical course of two siblings with Werner's syndrome (WS) who were diagnosed and followed at our clinics for 12 years. Initial diagnosis of the first sibling (sister) was at age 20, the second (brother) at 16. At the initial diagnosis, the sister had amenorrhea, muscle atrophy at arms and legs, diabetes mellitus (DM), short stature, bilateral cataracts, genital hypoplasia, osteoporosis, and gray hair. During 12 years follow-up period, high-pitched voice, hepatosteatosis, renal parenchymal disease, and urethral obstruction developed. Regarding the brother, DM, cataracts and genital hypoplasia were observed at the initial diagnosis. During the 12 years follow-up period, gray hair, high-pitched voice, steatohepatosis, and osteoporosis developed

Central region morphometry in a child brain; Age and gender differences

Background: Data on central region morphometry of a child brain is  important not only in terms of providing us with information about central region anatomy of the brain but also in terms of the help of this  information for the plans to be applied in neurosurgery.Objective: In the present study, central region morphometry of a child  brain in mid.sagittal MR images was analyzed in age and gender groups.Materials and Methods: Different points determined previously,  commissura posterior (PC) and the distances between cerebral cortex point (VCS) vertical to commissura anterior. commissura posterior line, sulcus centralis (CS), sulcus marginalis (MS), and the angle (α) between   CS-PC-MS were determined and measured together with difference of gender in three different age groups (aged 6.9, 10.13, and 14.17).Results: Central region measures of the brains of boys aged 6.17 are  higher than girls except for MS.PC distance. While VCS.PC, CS.PC, and MS-PC measures display a significant difference in the girls aged 14.17  when compared to the other age groups of 6.9 and 10.13 (P &lt; 0.05), angle α is not significantly different in age and gender groups (P &gt; 0.05). However, while VCS-PC, CS-PC and MS-PC distances show a significant  increase in girls beginning from the age of 14, this increase is limited in boys.Conclusion: Morphometric differences observed in different age groups in boys and girls shall contribute our evaluation of the alterations in brain development in both of genders and shall be useful in preparation of  surgical operation plans to be applied to the central region.Key words: Brain, central region, child, morphometry, magnetic resonance Imagin

Radiological evaluation of the styloid process length in the normal population

Background: The aim of this study was to evaluate the styloid process (SP) length in the normal population using multidetector computed tomography (MDCT).Materials and methods: In this study, 160 patients who underwent paranasal MDCT between January 2012 and December 2012 were retrospectively evaluated. The patients were divided into groups according to their age and gender: Group 1 age 31–40 years old, 111 subjects; Group 2 age 41–50 years old, 49 subjects; Group A 98 males; Group B 62 females. The mean SP length was calculated from the mean of 2 measurements. SPs were assessed for their average lengths in different gender and age groups. Student’s t-test was used for the comparison of the mean SP lengths between the groups. Differences were considered to be statistically significant at p &lt; 0.05.Results: The mean SP length on both sides varied from 18 to 51 mm (28.4 ± 5.5) in all the patients. The mean SP length was 27.2 ± 5.2 mm in females and 29.2 ± 5.6 mm in males. There was a statistically significant difference between the mean SP lengths in terms of gender (p &lt; 0.028). The mean SP length was 28.5 ± 5.7 mm in Group 1 and 28.2 ± 5.1 mm in Group 2. There was no statistically significant difference between the mean SP lengths in terms of age (p &gt; 0.718).Conclusions: In conclusion, there is still no consensus on the normal values of SP length. Normal values should be determined according to the geographical regions and ethnic groups for the diagnosis of Eagle’s syndrome.

The incidence of pneumatised inferior turbinate and relation to close anatomic structures

Background: Pneumatisation of the inferior turbinate (PIT) is a rare abnormality of the paranasal sinus. It is very difficult to differentiate from the hypertrophia of the inferior turbinate clinically. Thus, it is important to be considered, especially in cases with no response to medical treatments. We aimed to investigate the presence and the frequency of PIT by computed tomography (CT). Materials and methods: A total of 2905 cases (1381 female, 1524 male) with an age range between 16 and 84 were included. Results: The pneumatisation of the inferior turbinate was observed in 1.72% of the cases with a percentage of 1.88% in women and 1.57% in men. In PIT (+) cases the bilaterality was found in 54% of them. According to the subtypes, 70% was lamellar, 28% was bullous and 2% was extensive. No statistically significant difference was found for age distribution. The most commonly associated variations were the pneumatisation of the middle and upper turbinate and the septal deviation. Conclusions: The pneumatisation of the inferior turbinate is a rare variation with a similar frequency among men and women. It is diagnosed by CT and when symptomatic, the optimal treatment is surgery

Evaluation of the length and angulation of the styloid process in the patient with pre-diagnosis of Eagle syndrome

Clinical symptoms caused by the elongated styloid process (SP) or calcified stylohyoid ligament were first described by W. Eagle and they are now known as Eagle syndrome (ES). Normal length of SP was stated by Eagle as 2.5 cm. The objective of this study was to determine and discuss the length of SP and medial angulation degree with computed tomography (CT), which is an affective modality in the identification of ES, and a comparison with related studies. Three-dimensional (3D) images obtained from the axial CT scans of 22 cases (11 males and 11 females) aged between 24 and 80 years, who referred to Cumhuriyet University Hospital, Department of Radiology for multi slice CT with the pre-diagnosis of ES, were used. Lengths of the SP and medial angulations were measured on the obtained images. Inter- and intra-group comparisons were carried out using Wilcoxan and Mann-Whitney U tests. The mean length of the SP was found as 4.1 &#177; 1.1 cm. When inter- and intra-group lengths of the right and left SP were compared, the difference was not significant (p > 0.05). The mean medial angulation of the SP was found as 67.5 &#177; 5.1°. There was a significant difference found between the right side medial angulation and left side medial angulation in all persons (p < 0.05). Lengths of the right and left SP of the patients with pre-diagnosis of ES were close to each other. However, the right-side angulation was observed to be smaller than the left medial angulation in all the patients. Similarly, right side medial angulation of the females was smaller than the left side medial angulation, but this difference was absent in the males. Eagle syndrome should be kept in mind in patients with a sore throat radiating to the ears with swallowing and an observed non-compliance between the complaints such as feeling a foreign body in the throat and facial pain, and physical examination of those who do not have a response to long-term medical therapy should be performed. (Folia Morphol 2011; 70, 4: 295&#8211;299

Efficacy and safety of oral semaglutide with flexible dose adjustment versus sitagliptin in type 2 diabetes (PIONEER 7): a multicentre, open-label, randomised, phase 3a trial

Background: Oral semaglutide is the first oral formulation of a glucagon-like peptide-1 (GLP-1) receptor agonist developed for the treatment of type 2 diabetes. We aimed to compare the efficacy and safety of flexible dose adjustments of oral semaglutide with sitagliptin 100 mg. Methods: In this 52-week, multicentre, randomised, open-label, phase 3a trial, we recruited patients with type 2 diabetes from 81 sites in ten countries. Patients were eligible if they were aged 18 years or older (19 years or older in South Korea), had type 2 diabetes (diagnosed ≥90 days before screening), HbA1c of 7·5–9·5% (58–80 mmol/mol), and were inadequately controlled on stable daily doses of one or two oral glucose-lowering drugs (for 90 days or more before screening). Participants were randomly assigned (1:1) by use of an interactive web-response system, stratified by background glucose-lowering medication at screening, to oral semaglutide with flexible dose adjustments to 3, 7, or 14 mg once daily or sitagliptin 100 mg once daily. To approximate treatment individualisation in clinical practice, oral semaglutide dose could be adjusted on the basis of prespecified HbA1c and tolerability criteria. Two efficacy-related estimands were prespecified: treatment policy (regardless of treatment discontinuation or use of rescue medication) and trial product (on treatment and without use of rescue medication) for participants randomly assigned to treatment. The primary endpoint was achievement of HbA1c of less than 7% (53 mmol/mol) at week 52 and the confirmatory secondary efficacy endpoint was change in bodyweight from baseline to week 52. Safety was assessed in all participants who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT02849080, and European Clinical Trials Database, EudraCT number 2015-005593-38, and an open-label extension is ongoing. Findings: Between Sept 20, 2016, and Feb 7, 2017, of 804 patients assessed for eligibility, 504 were eligible and randomly assigned to oral semaglutide (n=253) or sitagliptin (n=251). Most participants were male (285 [57%] of 504) with a mean age of 57·4 years (SD 9·9). All participants were given at least one dose of their allocated study drug except for one participant in the sitagliptin group. From a mean baseline HbA1c of 8·3% (SD 0·6%; 67 mmol/mol [SD 6·4]), a greater proportion of participants achieved an HbA1c of less than 7% with oral semaglutide than did with sitagliptin (treatment policy estimand: 58% [134 of 230] vs 25% [60 of 238]; and trial product estimand: 63% [123 of 196] vs 28% [52 of 184]). The odds of achieving an HbA1c of less than 7% was significantly better with oral semaglutide than sitagliptin (treatment policy estimand: odds ratio [OR] 4·40, 95% CI 2·89–6·70, p&lt;0·0001; and trial product estimand: 5·54, 3·54–8·68, p&lt;0·0001). The odds of decreasing mean bodyweight from baseline to week 52 were higher with oral semaglutide than with sitagliptin (estimated mean change in bodyweight, treatment policy estimand: −2·6 kg [SE 0·3] vs −0·7 kg [SE 0·2], estimated treatment difference [ETD] −1·9 kg, 95% CI −2·6 to −1·2; p&lt;0·0001; and trial product estimand: −2·9 kg [SE 0·3] vs −0·8 kg [SE 0·3], ETD −2·2 kg, −2·9 to −1·5; p&lt;0·0001). Adverse events occurred in 197 (78%) of 253 participants in the oral semaglutide group versus 172 (69%) of 250 in the sitagliptin group, and nausea was the most common adverse event with oral semaglutide (53 [21%]). Two deaths occurred in the sitagliptin group during the trial. Interpretation: Oral semaglutide, with flexible dose adjustment, based on efficacy and tolerability, provided superior glycaemic control and weight loss compared with sitagliptin, and with a safety profile consistent with subcutaneous GLP-1 receptor agonists. Funding: Novo Nordisk A/S