Aysen Helvaci

To evaluate factors affecting cognitive function in internal medicine outpatients. A total of 130 consecutive outpatients aged 50-80 years old were included in this cross-sectional study conducted at Okmeydani Training and Research Hospital, Istanbul, Turkey between March and May 2013. Cognitive function was evaluated via Standardized Mini-Mental State Examination (SMMSE) scores. Logistic regression analysis was performed to determine factors predicting poor cognitive function. Mild-to-moderate cognitive impairment was noted in 39.2% of the patients. Median (interquartile range) total SMMSE scores were significantly higher in patients aged 60 years (27.0 (2.0) vs. 25.0 (5.0), p=0.000). Multivariate linear regression analyses revealed female gender (B, -1.27; 95% CI, -2.36 to -0.18; p=0.023) and aging (B, -0.20; 95% CI, -0.26 to -0.14; p<0.001) to result in a significant decrease in the total SMMSE scores. Mild-to-moderate cognitive impairment was observed in 39.2% of internal medicine outpatients. Old age and female gender were significant predictors of lower total SMMSE scores. Furthermore, besides for high language scores in hypertensive patients on combined therapy, no significant impact of hypertension or obesity was observed on the SMMSE scores.

Objective: Hashimoto’s thyroiditis is a common autoimmune disorder. A few studies have analyzed the association between serum vitamin D levels and Hashimoto’s thyroiditis and available data remains inconclusive. The aim of this study was to evaluate the association between serum 25-Hydroxy vitamin D levels in pre- and postmenopausal woman with Hashimoto’s thyroiditis. Methods: We evaluated 120 premenopausal women with euthyroid Hashimoto’s thyroiditis (Group 1), 51 postmenopausal women with Hashimoto’s thyroiditis (Group 2), and the control groups consisted of 102 (74 premenauposal and 28 postmenauposal) age matched healthy subjects; who applied to our outpatient clinic of the internal medicine and endocrinology department. Anti-thyroid peroxidase (TPOAb) and anti- thyroglobuline (TGAb) antibody were positive in all patients. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), 25-Hydroxy vitamin D and parathyroid hormone (PTH) levels were measured. Results: In the group 1 the mean vitamin D level was 12.46 μg/L (SD±12.34), compared to 19.467 μg/L (S.D.±8.19) in the control group for premenopausal women, P=0.02 (Table 1). In the group 2 the mean vitamin D level was 18.46 (S.D.±10.97) μg/L, compared to 23.12 μg/L (S.D.±8.60) in the control group for postmenopausal women (Table 2). Table 1 Comparison of premenopausal women with euthyroid Hashimoto’s thyroiditis and control group Group 1 (n=120) Control (n=74) P Age 36.41±7.8 36.59±7.86 NS TSH (μIU/ml) 2.86±1.45 1.90±0.92 Group 2 (n=51) Control (n=28) P Age 54.2±5.65 53.28±5.31 NS TSH (μIU/ml) 2.74±2.05 2.47±1.11 NS Free T4 (ng/dl) 1.14±0.25 1.13±0.15 NS Free T3 (ng/dl) 2.99±0.46 3.01±0.39 NS TPOAb (IU/ml) 329.81±326.51 7.89±2.83 <0.001 TGAb (IU/ml) 381.32±721.65 20.50±17.11 <0.01 Vitamin D (μg/l) 18.46±10.97 23.12±8.60 NS PTH (ng/l) 52.16±23.25 51.18±18.34 NS (NS; Not Significant). Keywords: Hashimoto’s thyroiditis, 25-Hydroxy vitamin D, pre- and postmenopausal woman

Objective: Hashimoto’s thyroiditis (HT) is extremely common, particularly among women. Mean platelet volume (MPV) and platelet distribution width (PDW) are the measure of platelet size. We aimed to investigate MPV and PDW levels in euthyroid woman with HT. Methods: This was a retrospective study in which the data were obtained from a computerized patient registry database. We evaluated 145 women with HT and 60 matched healty controls, who applied to our outpatient clinic of the internal medicine and endocrinology department. Anti-thyroid peroxidase (anti-TPO) and anti-tiroglobulin (anti-TG) antibody were positive in all patients. Serum thyroid-stimulating hormone (TSH),free thyroxine, free triiodothyronine, platelet count (PC),platelet mass (PM), MPV, and PDW were measured. PM was calculated by multiplying MPV and PLT. All subjects iron, total iron binding capacity, ferritin, vitamin B12 and folic acid were evaluated. Results: There were no significant differences in age between the study and the control groups. Anti-TPO and anti-TG levels were significantly higher in the study group (PPPr=0.217, P=0.01). MPV was positive correlated with anti-TPO and anti-TG levels (r=0.175, P=0.03; r=0.407, Pr=0.168, P=0.04; r=0.250, P=0.006, respectively). Our results suggest that even if in euthyroid state, patients with HT have higher MPV, PDW,PC, and PM levels than the healthy controls. Even if in euthyroid state, HT patients with levothroxine replacement show higher MPV and PDW levels than those with no levothroxine replacement. MPV and PDW parameters are also positively correlated with serum TSH levels. Conclusions: Because of have a higher risk of thyroid malignancies in HT patients,higher MPV and PDW levels may be associated with inflammation and thyroid malignancies.

Objective: It is recognized that autoimmun thyroid dysfunction is associated with weight and metabolic changes, insulin resistance and type 1 diabetes. In this study, we aimed to investigate whether thyroid autoimmunity had an effect on insulin sensitivity in euthyroid woman with Hashimoto’s thyroiditis. Methods: Forty-seven newly diagnosed euthyroid woman with Hashimoto’ thyroiditis with a mean age of 43 years were included in the study. The control group consisted of 39 age and BMI matched healthy subjects. Thyroid hormones and antibodies, thyroid peroxidase antibody (TPOAb) and thyroglobuline antibody (TGAb), insulin, glucose, c-peptid, HbA1c and uric acid levels, and Homeostasis Model Assessment İnsulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) parameters were measured in all the subjects. Results: No significant correlation was observed between thyroid autoimmunity and HOMA-IR and between thyroid autoimmunity and QUICKI in both groups (Table 1). Table 1 Patient Control P Age 43.62±8.64 41.68±7.43 NS TSH (μIU/ml) 2.1±1.61 2.0±1.01 <0.001 Free T4 (ng/dl) 1.15±0.32 1.13±0.13 NS Free T3 (ng/dl) 2.97±0.49 3.0±0.39 NS TPOAb (IU/ml) 288.43±291.17 8.81±5.20 <0.001 TGAb (IU/ml) 323.17±651.96 16.98±12.36 <0.001 Uric acid (mg/dl) 4.09±1.09 3.94±0.93 NS Fasting glucose (mg/dl) 86.95±10.83 88.64±9.61 NS Fasting insülin (μg/dl) 11.28±6.68 11.31±13.30 NS C peptid (ng/ml) 2.38±1.05 2.44±1.36 NS HbA1c (%) 5.5±0.37 5.42±0.50 NS BMI 28.37±6.06 28.80±9.28 NS HOMA-IR 2.41±1.66 2.44±2.90 NS QUICKI index 0.34±0.03 0.35±0.03 NS NS: Not significant. Conclusion: Thyroid autoimmunity seem to not have a potential effect on insulin sensitivity in patients with newly diagnosed euthyroid Hashimoto’s.

Warfarin is an anticoagulant used in a variety of clinical indications and may rarely cause severe bleeding that can be life-threatening. Although intramuscular bleeding frequently occurs, secondary to trauma, it can be induced in cases with bleeding tendency. Hematoma is often treated with conventional methods. However, surgical decompression can also be applied. In this article, we report a case of gastrocnemius intramuscular hematoma, which was successfully treated with intracavitary tissue plasminogen activator that was recently used in the treatment of abdominal and pelvic abscess.

Background: Detection of early vascular changes prior to clinical manifestations of atherosclerosis, such as increased arterial carotid intima-media thickness (CIMT) and impaired endothelial function is of paramount importance for early identification of subjects at increased risk of accelerated atherosclerosis. The present study was designed to evaluate the relationship between early atherosclerosis and endothelial dysfunction in type 1 diabetic patients based on measurements of CIMT and soluble CD146 (sCD146) levels. Methods: Thirty-seven patients with type 1 diabetes, 14 males (37.8%) and 23 females (62.2%), of mean (SD) age 26.2 (4.1) years admitted to the outpatient diabetes clinic at Okmeydani Training and Research Hospital, Istanbul, between January 2008 and December 2012, and 37 healthy controls, 16 males (43.2%) and 21 females (56.8%), of mean (SD) age 25.8 (3.1) years, selected from relatives of patients, were included. Anthropometric measures; fasting plasma glucose; and serum HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and creatinine concentrations were compared, as were CIMT and serum sCD146. Results: Mean (SD) sCD146 levels were significantly higher in patients than in controls (314.6 (141.9) ng/ml vs. 207.8 (34.5) ng/ml, p = 0.001), but mean (SD) CIMT did not differ (0.5 (0.1) mm vs. 0.4 (0.1) mm). ROC curves for sCD146 significantly differed in differentiating type 1 diabetics from healthy controls (p = 0.0047) with a significantly higher percentage of patients than controls having sCD146 levels >260 ng/ml (21/37 (56.8%) vs. 2/37 (5.4%), p = 0.00011). Conclusion: Our findings emphasize that sCD146 levels may be a more sensitive marker than CIMT for earlier identification of type 1 diabetic patients at high risk for atherosclerosis.

We compared hemorheological parameters in 42 male patients with acute myocardial infarction (AMI), with (n = 22) or without (n = 20) ST-segment elevation and in 20 controls. Plasma and blood viscosity (cP), plasma protein (g/dL) and fibrinogen (mg/dL) concentrations, red (10⁶/µL) and white (10³/µL) blood cell counts, hemoglobin concentration (g/dL), and hematocrit (%) were compared. Plasma viscosity was significantly higher in patients with AMI with ( P = .012) and without ( P = .046) ST-segment elevation than in controls. Patients with AMI with and without ST-segment elevation had significantly lower albumin ( P = .002 and P = .009) and globulin ( P = .001 and P = .007) concentrations, red blood cell counts ( P = .0001 and P = .004), and hematocrit ( P = .014 and P = .040) and significantly higher fibrinogen concentrations ( P = .0001 and P = .001) than controls. These findings suggest that AMI in males is associated with increased plasma viscosity and fibrinogen concentrations and with decreased albumin and globulin concentrations, erythrocyte count, and hematocrit, regardless of ST-segment elevation.