Predictive power of different obesity measures for the presence of diastolic dysfunction

Objective: Body mass index (BMI) and waist circumference (WC) as measures of obesity have some limitations. The aim of this study was to evaluate whether one measure could predict the presence of diastolic dysfunction (DD) more accurately than the other measures. Methods: A total of 91 obese patients without any other risk factors for DD were prospectively enrolled. Echocardiographic examination was performed. DD was defined and categorized according to recent guidelines. The study participants were divided into 2 groups according to the presence of DD. Weight, height, and WC were measured; BMI and waist-to-hip ratio (WHR) were calculated; and a body shape index (ABSI) was calculated as WC/(BMI2/3height1/2). The associations between ABSI, BMI, WHR, and WC and the presence of DD were examined using logistic regression analyses. Analysis of covariance was used to examine the differences. Results: WC and BMI were significantly greater in subjects with DD (p=0.049 and 0.051, respectively). A greater BMI, WC, and WHR increased the risk of the presence of DD (BMI-DD: odds ratio [OR]=1.096, p=0.024; WC-DD: OR=1.059, p=0.007; WHR-DD: OR=2.363, p=0.007). After adjustment for age and sex, only BMI continued to be significantly associated with DD (p=0.031). ABSI was not associated with DD. Conclusion: After adjustment for age and sex, BMI was the only predictor of DD in obesity. Despite its limitations, BMI may still be a potentially more accurate measure of DD compared with other obesity measures. © 2018 Turkish Society of Cardiology

The use of lithium carbonate in the preparation for definitive therapy in hyperthyroid patients

Objective: The aim of this study was to elucidate the effectiveness of lithium carbonate prior to thyroidectomy or radioiodide therapy in patients with thyrotoxicosis. Subjects and Methods: Lithium carbonate was used as preoperative preparation or radioiodide therapy in 5 patients with Graves' disease and in 1 patient with toxic multinodular goiter because of side effects of thionamide in 5 patients and ineffectiveness of antithyroid medication in the remaining patient. Results: All 6 patients had a benign course following treatment without thyroid storm. No adverse effects or complications of lithium carbonate were observed. Conclusion: This report shows that lithium carbonate can be safely used preoperatively or prior to radioiodide therapy in circumstances where antithyroid medications are contraindicated and are ineffective in obtaining an euthyroid status. Copyright © 2008 S. Karger AG

Antidiabetic exendin-4 activates apoptotic pathway and inhibits growth of breast cancer cells

Exendin-4 is a GLP-1 analog used for the treatment of type 2 diabetes mellitus in its synthetic form. As women with diabetes have higher breast cancer incidence and mortality, we examined the effect of the incretin drug exendin-4 on breast cancer cells. The aim of the study is to investigate anticancer mechanism of exendin-4 in MCF-7 breast cancer cells. Cytotoxic effects of exendin-4 were determined by XTT assay. IC50 dose in MCF-7 cells were detected as 5 μM at 48th hour. Gene messenger RNA (mRNA) expressions were evaluated by real-time PCR. According to results, caspase-9, Akt, and MMP2 expression was reduced in dose group cells, compared with the control group cells. p53, caspase-3, caspase-8, caspase-10, BID, DR4, DR5, FADD, TRADD, PARP, PTEN, PUMA, NOXA, APAF, TIMP1, and TIMP2 expression was increased in dose group cells, compared with the control group cells. Effects of exendin-4 on cell invasion, colony formation, and cell migration were detected by Matrigel chamber, colony formation assay, and wound-healing assay, respectively. To conclude, it is thought that exendin-4 demonstrates anticarcinogenesis activity by effecting apoptosis, invasion, migration, and colony formation in MCF-7 cells. Exendin-4 may be a therapeutic agent for treatment of breast cancer as single or in combination with other agents. More detailed researches are required to define the pathways of GLP-1 effect on breast cancer cells because of the molecular biology of breast cancer that involves a complex network of interconnected signaling pathways that have role in cell growth, survival, and cell invasion. © 2015, International Society of Oncology and BioMarkers (ISOBM)

The association between central adiposity and autonomic dysfunction in obesity

Objective: To determine the relationship between central adiposity parameters and autonomic nervous system (ANS) dysfunction. Subjects and Methods: The study included 114 obese individuals without any cardiovascular risk factors. Weight (in kg), height (in m), and waist circumference (WC; in cm) were measured and body mass index was calculated. Echocardiographic examination was performed to measure left ventricular mass and epicardial fat thickness (EFT). All the participants underwent an exercise test and electrophysiological evaluation using electromyography. Heart rate recovery (HRR) at 1-5 min, R-R interval variation at rest and during hyperventilation, and sympathetic skin response were measured. Pearson's correlation analysis was used. Multiple linear regression analysis was used to identify the factors associated with autonomic dysfunction. Results: The HRR at 1-5 min was negatively correlated with WC and age (WC-HRR1: r = -0.32; WC-HRR2: r = -0.31; WC-HRR3: r = -0.26; WC-HRR4: r = -0.23; WC-HRR5: r = -0.21; age-HRR2: r = -0.32; age-HRR3: r = -0.28; age-HRR4: r = -0.41; age-HRR5: r = -0.42). Age was the only independent predictor of reduced HRR at 1-5 min. In addition, WC predicted a reduced HRR at 3 min. There were no significant associations between central obesity and electrophysiological parameters. EFT was not associated with ANS dysfunction. Conclusion: In this study, central adiposity and aging were associated with ANS dysfunction in obese individuals. The WC could be a marker of ANS dysfunction in obese individuals without any cardiovascular risk factors. The HRR assessment at a later decay phase could be more valuable for evaluating ANS function than during early recovery. © 2016 S. Karger AG, Basel

IGF-1 gene polymorhism in obese patients with insulin resitance

AMAÇ: IGF`ler pankreatik ß hücre gelişimi, büyüme ve devamlılığı için önemli düzenleyicilerdir. IGF genindeki mutasyonlar tip 2 diabet, myokard enfarktüsü, doğum ağırlığı ve obezite ile ilişkili bulunmuştur. Bu ilişkinin temelinde insülin duyarlılığı yer alıyor olabilir. Biz bu çalışmada obez insülin direnci olan hastalarda IGF-1 gen polimorfizmini araştırdık. METOD:Araştırmaya Pamukkale Üniversitesi Endokrinoloji ve Metabolizma Hastalıkları Polikliniğinde tanı alan 101 obez insülin direnci olan hasta (77'si (% 76,2) kadın, 24'ü (% 23,8) erkek, yaş ortalamaları 42,8±11,8 yıl) ve 30 sağlıklı kişi (27'si (% 90,3) kadın, 3'ü (% 9,7) erkek ,yaş ortalamaları 40,8±9,8) dahil edildi. Vakalar Eylül 2007 ve Aralık 2007 tarihleri arasında toplandı. Antropometrik ölçümler, biyokimyasal ve hormonal değerlendirmeler yapıldı. DNA izolasyonu için kan örneği alındı ve DNA izolasyonu yapılarak PCR ile çalışıldı. BULGULAR: Hasta ve Kontrol Grupları'nın tiroid fonksiyonları ve IGFBP3 düzeyleri arasında bir farklılık gözlenmezken, obezlerde IGF, GH düzeyleri istatistiksel olarak anlamlı düşük bulunmuştur. IGF-I (CA)19 polimorfik bölgenin analizi değerlendirildikten sonra alleler 192-bp `den daha kısa (Grup 1), 192-194 bp(Grup 2) ve 194-bp'den daha uzun (Grup 3), olmak üzere değerlendirildi Hem Hasta hem de Kontrol Grubu'nda Grup 3 belirgin olarak daha sık gözlenmekteydi. Kontrol grubunda 1 hasta Grup 1, 1 hasta Grup 2 ve 28 hasta Grup 3`te yer almakta idi. Hasta (n:71) ve Kontrol Grubu'nda Grup 3'lerin (n:28) tüm verileri karşılaştırıldığında antropometrik, biyokimyasal ve hormonal değerler istatistiksel olarak anlamlı farklı bulunmuştur. IGF-1 düzeyleri de Hasta Grup 3'te (138,51 ±49,3) Kontrol Grup 3`e göre (218,14 ± 69,15) istatistiksel olarak anlamlı düşük tespit edilmiştir (p: 0,00 ). İki grup arasında tiroid fonksiyonları, GH, IGFBP3 ve kortizol düzeyleri açısından bir fark gözlenmemiştir. SONUÇ: Obez insülin direnci olanlarda IGF-1 ve GH düzeyleri normal kişilere göre daha düşüktür. Her iki grupta da en sık gözlenen IGF-1 gen polimorfizmi 194 bp den fazla olan gruptur. Farklı IGF1 genotipleri arasında IGF-1 düzeyleri, biyokimyasal ve hormonal değerler açısından fark bulunmamaktadır. Obezlerde IGF-1 düşüşüne sebep olan IGF-1 gen polimorfizmi dışında başka bir faktör gibi gözükmektedir ve bu IR olabilir.OBJECTIVE: IGFs (Insulin like growth factors) are important regulators of pancreatic ß cell devolopment, growth and maintanence. Mutations in the IGF genes have been found to be associated with type 2 diabetes, myocardial infarction, birth weight and obesity. These associations could result from changes in insulin secretion. We aimed to investigate IGF- 1 gen polymorphism in obese patients with insülin resistance. METHODS: We included 101 obese patients (women= 77, men=24?ü, mean age 42,8±11,8 year) with insülin resistance who applied to Endocrinology and Metabolism outpatient clinic and 30 healthy subjects ( women=28 , men= 3, mean age ) to study. All datas were colected between September 07 and December 07. At baseline physical examinations and antropometric measurements were done . Genomic DNA from the patients and controls were prepared. Investigated genomic areas were studied using specific primers by PCR methods. Amplified fragments were separated agarose gel electrophoresis and were identified the using the UV gel documentation system. RESULTS: Thyroid function tests and serum IGFBP3 levels were similar between patients and controls whereas IGF, GH and cortisol levels were significantly lower in obese insülin resistant patients. We categorized the IGF-1 (CA)19 polimorphisim area into 3 group as lower than192-bp( group 1) , 192-194 bp (group 2), ve higher than 194-bp (group 3). Group 3 was more frequent in both obese and control groups, When all parameters of group 3 were compared between obese(n: 71) and control groups(n: 28) ; weight, BMI, waist and hip circumfarence, fat distrubution, FBG, TG, HDL, LDL, AST, ALT, Uric acid, insülin levels were significantly different between two groups. IGF-1 levels were also significantly lower in obese group(138,51 ±49,3 ) in than controls(218,14 ± 69,15 ). CONCLUSIONS: IGF-1 levels were significantly lower in obese than normal people, The most frequent IGF-1 gen polymorphism allel is > 194 bp in both obese insülin resistant patients and controls, IGF-1 levels and the other biochemical and hormonal parameters were similar in different genotype groups, The cause of lower IGF-1 levels in obese patients might be different from IGF-1 gene polymorphism and it may be insülin resistance

Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation.

BACKGROUND/OBJECTIVES: To investigate effects of microalbuminuria (MA), diabetes duration, glycosylated haemoglobin (HbA1c) level, hypertension (HT) and/or hyperlipidaemia (HL) coexistence on retinal layers in diabetic patients without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS: This cross-sectional study involved 95 (45 had MA and 50 had no MA) patients with type 2 diabetes mellitus (DM) without DR and 91 age- and gender-matched non-diabetic controls. Macular and peripapillary SD-OCT measurements (Heidelberg Engineering GmbH, Heidelberg, Germany), DM duration, HbA1c levels and presence of HT and/or HL were used for statistical analyses. RESULTS: The MA (+), MA (-) and control groups had similar age and gender distribution (p > 0.05). The differences in SD-OCT measurements among the MA (+), MA (-) and control groups were insignificant (p > 0.05). However, diabetic patients (n = 95) had significantly thinner inferior-temporal peripapillary retinal nerve fibre layer (RNFL) (p = 0.042) than in the controls (n = 91). Superior peripapillary RNFL was significantly thinner in patients with an HbA1c level > 7% (p = 0.049). However, 3 mm-nasal, temporal and superior perifoveal thicknesses were significantly lower in patients with DM duration over 10 years (p < 0.05). HT and/or HL coexistence did not lead a significant difference in SD-OCT parameters among the groups. CONCLUSIONS: In diabetic patients without DR, peripapillary inferior-temporal RNFL thinning might be an early sign of neuroretinal degeneration and it seems to be independent from vascular endothelial damage (MA). Poor metabolic control appears to lead superior peripapillary RNFL thinning, while perifoveal thicknesses tend to decrease with longer DM duration

Phaeochromocytoma combined with subclinical Cushing's syndrome and pituitary microadenoma

Objectives: Phaeochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report a case of PHEO and PCS originating from the same adrenal gland and discuss the peculiar diagnostic aspects of this entity. Clinical Presentation: A 64 yr old man was hospitalized to evaluate the right adrenal mass which was discovered incidentally by ultrasonography. He had a history of type 2 diabetes mellitus and hyperlipidemia. Blood pressure measurements were all normal during his hospital stay. Laboratory examination showed: urinary catecholamines were markedly increased. HbA1C of 14.3 %, midnight cortisol of 11(μg/dL), cortisol was not suppressed after the overnight 1 mg oral dexamethasone suppression test (DST): 3.42(μg/dL), 24 hr free cortisol in the urine : 213 g/day (10-100), cortisol levels were suppressed more than 50% with 8 mg of dexamethasone. CT scan of the adrenal glands showed a 6 cm well encapsulated right adrenal mass together with a clearly normal left adrenal gland. MRI investigation of the sella turcica revealed a pituitary microadenoma on the right side of the adenohypophysis He was treated with α and subsequent β blockers after the diagnosis of PHEO and PCS was made. Right adrenalectomy was performed. The pathology showed typical PHEO with adrenocortical hyperplasia. VMA, metanefrin and free cortisol levels were normalized one month after surgery. Conclusion: The present report is a rare case of PHEO combined with PCS in the same adrenal gland. © 2008 CIM

Effects of substitutive therapy on right ventricular systolic and diastolic functions in patients with idiopathic hypogonadotropic hypogonadism.

There have been controversial studies evaluating ventricular functions in patients with idiopathic hypogonadotropic hypogonadism (IHH). A recent study has demonstrated that low serum testosterone levels are associated with increased cardiovascular mortality. We aimed to investigate ventricular functions by standard echocardiography and examine the effects of substitutive therapy on right ventricular (RV) functions in patients with IHH by means of pulsed wave tissue Doppler imaging (PWTDI). Twenty-three patients with IHH and 31 controls were evaluated by standard echocardiography and PWTDI. Isovolumic acceleration (IVA), myocardial systolic wave (Sm) velocity, myocardial precontraction time (PCTm), and PCTm to contraction time (CTm) ratio were determined as systolic indices. Myocardial relaxation time (RTm), early (Em) velocity, late (Am) velocity, and Em to Am ratio were determined as diastolic indices. Peak pulmonary artery pressure (PAP) was significantly higher in control subjects (p=0.008). IVA and Sm values were similar in patients and controls. Em, Am velocities, and their ratios did not differ. PCTm was significantly longer (p=0.001) and PCTm to CTm ratio was significantly higher in patients (p=0.001). These parameters also decreased after replacement therapy, albeit not statistically significantly (p>0.05). PAP was significantly higher after substitutive therapy (p=0.009). Ventricular functions are normal in patients with IHH. Substitutive therapy has no effects on RV functions. However, substitutive therapy may increase PAP in small amounts, which has no immediate clinical implication with short-term use