Endocrinological Diseases Research Articles

Pneumococcal Disease in High-Risk Adults in Lebanon: Expert Opinion.

Pneumococcal disease affects people across all ages but is more prevalent in young children and the elderly. Despite the availability of the pneumococcal vaccine for adults, the disease burden and mortality associated with it remains a challenge. A few studies conducted in Lebanon have reported epidemiology of pneumococcal disease, concurring the high burden among adults and older adults in the region. The pneumococcal vaccine is a part of the routine immunization schedule for children, but there are no recommendations for adult vaccination. A medical advisory board was hence conducted in September 2020 to discuss the burden of pneumococcal disease (PD) among adults in Lebanon. The participants were experts from the fields of internal medicine, family medicine, hematology, cardiology, oncology, endocrinology, pulmonology, and infectious diseases. The experts reached a consensus that there is a need to take steps to increase the rate of adult vaccination uptake and create awareness among physicians, pharmacists, caregivers, and patients. The physicians should be trained on adult immunization and should actively discuss the importance of the pneumococcal vaccine, especially with high-risk adult patients. Implementing adult vaccination as a routine practice and involving various stakeholders to address the gaps can help in reducing the burden of pneumococcal disease in adults.

Associations between serum biomarkers and non-alcoholic liver disease: Results of a clinical study of Mediterranean patients with obesity.

BackgroundTransient elastography is an ultrasound-based method to detect non-alcoholic fatty liver disease (NAFLD). Despite the simultaneously rising prevalence of fatty liver and metabolic disease, further information about metabolic risk indicators of fatty liver is still necessary.MethodsA Southern Italian population sample with obesity (N = 87) was cross-sectionally explored for associations among the presence of NAFLD, assessed by FibroScan, and clinical, biochemical and anthropometric parameters. Inclusion criteria were age >18 years, BMI ≥ 25 kg/m2, no ongoing supplemental or drug therapy, including oral contraceptives or osteoporosis medications; exclusion criteria were pregnancy, endocrinological diseases, cardiovascular diseases, neoplasia, renal or hepatic failure, hereditary thrombocytopenia, hepatitis B (HBV) or hepatitis C virus (HCV) infection, and excess alcohol consumption.ResultsThe study sample featured a female predominance (67%, N = 60), age range 18–64 years, and 40% prevalence of NAFLD, in accordance with the fibroscan-measured controlled attenuation parameter (CAP) threshold value above 302 dB/m. Males were slightly more frequently affected by NAFLD (51.4% vs. 48.6%, p = 0.01). Insulin levels, insulin resistance (quantified by HOMA-IR), diastolic blood pressure, BMI, visceral adipose tissue (VAT), and waist circumference were significantly higher in the NAFLD subset compared to their counterparts (p < 0.01, p < 0.01, p = 0.05, p < 0.01, p < 0.01, p < 0.01, respectively). Uric acid (p < 0.01) also showed a positive trend in the NAFLD group. Other liver steatosis parameters, measured by stiffness (p < 0.01), fatty liver index (FLI) (p < 0.01) and FibroScan-AST (FAST) (p < 0.01), were also significantly greater in the NAFLD group. In three nested linear regression models built to assess associations between CAP values and serum uric acid levels, a single unit increase in uricemia indicated a CAP increase by 14 dB/m, after adjusting for confounders (coefficient: 14.07, 95% CI 0.6–27.54).ConclusionsClinical-metabolic screening for NAFLD cannot ignore uricemia, especially in patients with obesity.

Thyrotoxic periodic paralysis. A case report

In 19-26% of patients hospitalized with suspected stroke, the cause of neurological symptoms are not cerebrovascular diseases. In this case of newly diagnosed thyrotoxic periodic paralysis we presented the clinical, laboratory and instrumental features of the disease. The search for the cause of periodic paralysis allowed to identify an endocrinological disease - diffuse toxic goiter, prescribe antithyroid therapy. The data of prospective patient observation are presented. We discussed a differential diagnostic range of diseases with acute low paraparesis, including rupture of an aneurysm of the anterior communicating artery, bilateral infarction in territory of anterior cerebral arteries, thrombosis of upper sagittal sinus, acute spinal strokes and Guillain - Barre syndrome. The need to include thyrotoxic periodic paralysis in patients with acute lower paraparesis in the differential diagnostic series is substantiated.

Investigation of the relationship between the use of complementary alternative medicine and illness perception and illness cognition in patients with diabetic foot ulcer

Objective: to examine the relationship between illness perception, illness cognition, and other sociodemographic characteristics of individuals with diabetic foot ulcer (DFU) and their complementary alternative therapies (CAM) use within the framework of self-regulation model (SRM). Material and methodsThis cross-sectional descriptive study was carried out with 220 individuals with DFU in the Endocrinology and Metabolic Diseases outpatient clinic of two training and research hospitals between December 5, 2020, and June 5, 2021. Research data were collected by using the Patient Information Form, Brief Illness Perception Scale (BIPS), and Illness Cognition Questionnaire (ICQ). Descriptive statistical methods and the Mann-Whitney U test were used to were used in the evaluation of the data. The determinants of the CAM use status of the patients were evaluated by logistic regression analysis. ResultsIt was determined that 136 (61.81%) patients who used CAM mostly preferred herbal methods. Patients' mean scores were 42.23 ± 5.66 on the total BIPS, 39.65 ± 16.01 on the total ICQ. Increasing age, female gender, increased disease perception (BIPS) and disease cognition (ICQ) increased the use of CAM (Nagelkerke R2:0.552; Model: x2 = 168.579 p = 0.00) ConclusionsIt was determined that our patients frequently preferred CAM. Predictors of CAM use were identified as female gender, advanced age, illness perception, and illness cognition. Accordingly, for effective management of DFU, besides the comprehensive evaluation of individuals with DFU and the provision of wound care by health care professionals, illness perceptions, illness cognition, and CAM use should be considered carefully.

Relationship of thiol/disulphide homeostasis with oxidative stress parameters in non-diabetic, prediabetic and type 2 diabetic Turkish women

Background and Aims: Deterioration of thiol/disulphide homeostasis (TDH) is found in several diseases, including diabetes. This study aimed to examine the association between TDH and oxidative stress parameters in nondiabetics, prediabetics and newly diagnosed type 2 diabetics. Methods: A total of 26 non-diabetic, 24 prediabetic and 19 type 2 diabetic women were involved in our study. They all applied to Zonguldak Bulent Ecevit University, Health Practice and Research Center, Endocrinology and Metabolism Diseases, Diabetes Polyclinic to be tested for type 2 diabetes mellitus. The demographic and laboratory data were collected from the patient files. Oxidative stress parameters and dynamic TDH were investigated using ELISA kits. Results: Total oxidant status (TOS), total thiol and disulphide levels were significantly higher in type 2 diabetics than the non-diabetics (24.24±14.93 versus 14.14±12.19, 646.47±75.51 versus 470.88±180.85, and 179.32±51.24 versus 91.85±40.29, respectively). In type 2 diabetics, a positive correlation between TOS and native thiol, total thiol and disulphide levels was found (P=0.000). In prediabetics, a significant positive correlation was found between total antioxidant capacity and total thiol levels (P&lt;0.05), and also between arylesterase and native and total thiol levels (P&lt;0.05). Conclusion: The elevation of oxidative stress and the deterioration of TDH might cause the formation of symptoms related to high blood glucose levels in type 2 diabetics.

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany.

Introduction: Fracture-related infections (FRI) and periprosthetic joint infections (PJI) represent a major challenge in orthopedic surgery. Incidence of both entities is annually growing. Comorbidities play an important role as an influencing factor for infection and thus, for prevention and treatment strategies. The aims of this study were (1) to analyze the frequency of comorbidities in FRI and PJI patients and (2) to evaluate comorbidities as causative risk factor for PJI and FRI. Methods: This retrospective cohort study analysed all ICD-10 codes, which were coded as secondary diagnosis in all in hospital-treated FRI and PJI in the year 2019 in Germany provided by the Federal Statistical Office of Germany (Destatis). Prevalence of comorbidities was compared with the prevalence in the general population. Results: In the year 2019, 7158 FRIs and 16,174 PJIs were registered in Germany, with 68,304 comorbidities in FRI (mean: 9.5 per case) and 188,684 in PJI (mean: 11.7 per case). Major localization for FRI were infections in the lower leg (55.4%) and forearm (9.2%), while PJI were located mostly at hip (47.4%) and knee joints (45.5%). Mainly arterial hypertension (FRI: n = 3645; 50.9%—PJI: n = 11360; 70.2%), diabetes mellitus type II (FRI: n = 1483; 20.7%—PJI: n = 3999; 24.7%), obesity (FRI: n = 749; 10.5%—PJI: n = 3434; 21.2%) and chronic kidney failure (FRI: n = 877; 12.3%—PJI: n = 3341; 20.7%) were documented. Compared with the general population, an increased risk for PJI and FRI was reported in patients with diabetes mellitus (PJI: 2.988; FRI: 2.339), arterial hypertension (PJI: 5.059; FRI: 2.116) and heart failure (PJI: 6.513; FRI: 3.801). Conclusion: Patients with endocrinological and cardiovascular diseases, in particular associated with the metabolic syndrome, demonstrate an increased risk for orthopedic implant related infections. Based on the present results, further infection prevention and treatment strategies should be evaluated.

The utilization of BMI in patients with high WHtR as to cardiovascular risk

Introduction: A waist to height ratio (WHtR) greater than 0.5 may be a global screening tool for cardiovascular disease (CVD) and diabetes. However, it is unclear whether WHtR could be used instead of BMI. This study aimed to evaluate the role of BMI regarding CVD and diabetes in a subset of Turkish adults with WHtR greater than 0.5. Material and Method: The cross-sectional study involved 118 participants with WHtR&amp;gt;0.5, 18 years and older who applied to the endocrinology and metabolism disease outpatient clinic between September 2019 and February 2020. WHtR and BMI were calculated. Results: The prevalence of hypertension and hyperlipidemia increased with BMI. WHtR was correlated with FBG. BMI was significantly associated with TG, HDL-c, SBP, and DBP in linear regression analysis, but not with FBG. On the other hand, there was a significant association between WHtR and FBG. Conclusion: This study confirmed that the simple value of ‘0.5’ for WHtR was associated with diabetes risk. The cut-off value of 35 for BMI was effective categorizing participants with high blood pressure and lipid levels in paticipants with high WHtR. Further population-based studies in Turkish adults are needed to evaluate whether WHtR could be used independent from BMI as an early warning of cardiovascular risks for preventive interventions.

Viscoelastic and viscoplastic Glucose Theory (VGT #26): Investigation of the Relationships between an Overall Metabolism Index and type 2 Diabetes Utilizing HbA1C, Diabetic Nephropathy via Urinary Albumin-to-Creatinine Ratio, along with Diabetic Retinopathy with Hypothyroidism through Thyroid Stimulating Hormone using Statistical Correlation Coefficient and VGT of GH-Method: Math-Physical Medicine (No. 607)

Over the past two years, the author self-studied certain biomarkers and their relationships with certain diabetic complications, such as albumin-to-creatinine ratio (ACR) for diabetic nephropathy, thyroid stimulating hormone (TSH) for hypothyroidism and diabetic retinopathy (DR). The medical papers he reviewed utilized statistical tools, including regression analysis, with input data collected from hundreds of different patients in hospitals (References 1-14). In this article, he uses his own collected data from the past ~9 years, where he applies a combined math-physical medicine tools, such as correlations (a statistics tool), viscoelastic and viscoplastic glucose theory (VGT, a physics tool) from engineering, and perturbation theory from quantum mechanics to investigate certain hidden behaviors of selected biomarkers, such as MI, HbA1C, ACR, TSH, and their associated diseases. Initially, he attempts to find relationships between two biomarkers, ACR and TSH. Although these two biomarkers belong to output variables of the human body, he tries to alter their roles with the following two assumptions: TSH influences ACR and ACR influences TSH. He then selects the metabolism index (MI) as the sole input variable of all outputs for endocrinological diseases, including diabetes, chronic kidney disease (CKD), and diabetic retinopathy (DR). The MI is an integrated value from 10 selected categories: weight, glucose, blood pressure, blood lipid, diet, exercise, stress, sleep, water intake, and daily life routines. Next, he utilizes the general health status unit (GHSU), which is the 90-days moving average value of MI for this analysis. The logic behind this decision is that MI, chronic disease biomarkers and lifestyle details, influences type 2 diabetes (T2D) which in turn impacts various diabetic complications, including CKD (ACR as biomarker), DR and hypothyroidism (TSH as biomarker). In summary, the research path from GHSU (or MI) to T2D, then from GHSU to ACR or CKD, and GHSU to TSH or DR. Along this biomedical pathway, the following six key findings are observed: (1) The correlation between GHSU and Daily A1C is 82% within a period from 5/29/2018 to 2/15/2022. But, the correlation between Daily A1C and lab-tested A1C is 74% over 16 discrete dates. Both correlations are quite high which indicates that the overall metabolism is indeed strongly influencing T2D conditions.

Pheochromocytoma-Induced Tako-Tsubo Syndrome: An Uncommon Presentation

BackgroundA pheochromocytoma-induced tako-tsubo syndrome is a life-threatening complication of the rare endocrinological disease. The association between the two syndromes is known, though seldom reported in literature, but the categorization is still debated. Case ReportIn this article, we provide two examples of clinical presentation of this rare condition, its diagnosis using point-of-care ultrasound, its management in the emergency department, and finally, a literature review. Why Should an Emergency Physician Be Aware of This?In case of a tako-tsubo syndrome-like myocardial dysfunction in a patient with unknown medical history, or recorded hypertensive or tachycardic peaks, a point-of-care ultrasound scan extended to the kidneys could help evaluate for a reversible underlying trigger cause such as pheochromocytoma.

Estradiol Valerate Affects Hematological and Hemorheological Parameters in Rats.

Polycystic ovary syndrome (PCOS) is one of the most common endocrinological diseases in women. Although the risk of cardiovascular diseases is high in PCOS, the number of scientific publications describing hemorheological changes is not significant. We aimed to perform a comprehensive hematological and micro-rheological study on experimentally induced PCOS in rats.Wistar rats were divided into control (n = 9) and PCOS groups (n = 9), in which animals received single-dose estradiol valerate. Measurements were carried out before treatment and monthly for four months. Bodyweight, blood glucose concentration, hematological parameters, red blood cell (RBC) deformability, and aggregation were measured. A histological examination of the ovary was performed at the end of the experiment. The blood glucose level and the bodyweight were significantly elevated vs. base in the PCOS group. A significant decrease was seen in RBC count, hemoglobin, and hematocrit. The maximal elongation index showed a significant increase. PCOS also resulted in a significant increase in RBC aggregation index parameters. The histological and hormone examinations confirmed developed PCOS. The administration of estradiol valerate caused significant changes during the examined period in hematological and hemorheological parameters. Our results draw attention to the possible usefulness of micro-rheological investigations in further studies on PCOS.

Mood disorders as a risk factor for family aggregation of somatic diseases

IntroductionMood disorders (MDs) are associated with somatic diseases and tend to aggregate in families. But there are limited studies on the risk of somatic diseases for relatives of patients with MDs.ObjectivesTo assess whether a patient’s mood disorder diagnosis is associated with a family history of somatic disorders.MethodsThis cross-sectional family study included 36 patients with MDs (66.7% women; age - 32 [11.2] years) and 68 of their relatives, and 23 healthy individuals (56,5% women; age - 30.5 [6.9] years) and 53 of their relatives. A Pearson’s χ2 test was used to compare the frequencies of family history of somatic disease. Logistic regression models were used to determine the independent association of MDs, after adjusting for the effects of sex, age, with binary characteristics.ResultsIndividuals with and without MDs had different frequencies of family history of cardiovascular (66,7% vs. 43,4%; p=0,03) and endocrinological diseases (47,2% vs. 39,1%; p=0,04). There were no statistically significant differences in the frequency of family history of gastrointestinal, pulmonary, urogenital and musculoskeletal diseases (p&gt;0,05). Logistic regression revealed that MDs diagnosis in patients was a risk factor for cardiovascular (p=0.03, OR=3.5) and endocrinological disease (p=0.04, OR=3.7) in their relatives.ConclusionsMDs are associated with the aggregation of somatic diseases in families. Future research is needed to clarify the biological reasons for this association.DisclosureNo significant relationships.

PECULIARITIES OF COVID-19 SUSCEPTIBILITY IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Polycystic ovary syndrome (PCOS) is the most common endocrinological disease among women of reproductive age, the prevalence of which reaches up to 15% in the world depending on the study population and the diagnostic criteria used. Purpose: analysis of existing medical research on the increased susceptibility to Covid-19, its form and features among women with PCOS, coverage of research on this topic to raise awareness of Ukrainian physicians in building proper prevention, modernizing approaches to diagnosis, treatment and avoidance of Covid-19 complications in women with PCOS and to disseminate material and further in form PCOS patients about possible risks of Covid-19. Results and discussion. Women with PCOS are characterized by a higher incidence of cardiovascular disease, kidney damade, non-fatty steatohepatitis, achieving a body mass index over 30 kg/m2 , diabetes and endometrial mucosal cancer. Metabolic syndrome characterized by hypertension, obesity, insulin resistance and dyslipidemia is found in 22.7% of women with PCOS. Given the high prevalence of various risk factors for PCOS, which coincide with the severity of Covid-19, it can be argued that women with PCOS are a critical group of patients with a potentially higher risk of adverse effects of Covid-19. Conclusions. Despite their young age and gender, women with PCOS are at increased risk for Covid-19. Women with cardiovascular and metabolic diseases in PCOS are a group of patients with a potentially higher risk of complications from Covid-19. Women with PCOS should first be informed about the need for vaccination and preventive measures during the Covid-19 pandemic, monitoring the treatment of existing pathologies and prompt medical attention for SARS-CoV-2 infection.

Association of Women Leaders with Women Program Director and Trainee Representation Across US Academic Internal Medicine.

BackgroundWomen are underrepresented within internal medicine (IM). Whether women leaders attract women trainees is not well explored.ObjectiveTo characterize leader and trainee gender across US academic IM and to investigate the association of leader gender with trainee gender.DesignCross-sectional study.ParticipantsLeaders (chairs, chiefs, program directors (PDs)) in 2018 and trainees (residents, fellows) in 2012–2016 at medical school-affiliated IM and seven IM fellowship programs.ExposureLeadership (chair/chief and program director; and, for resident analyses, fellow) gender.Main MeasuresOur primary outcome was percent women trainees (IM residents and, separately, subspecialty fellows). We used standard statistics to describe leadership and trainee gender. We created separate multivariable linear regressions to evaluate associations of leader gender and percent women fellows with percent women IM residents. We then created separate multivariable multilevel models (site as a random effect) to evaluate associations of leader gender with percent women subspecialty fellows.Key ResultsOur cohort consisted of 940 programs. Women were 13.4% of IM chairs and <25% of chiefs in each fellowship subspecialty (cardiology: 2.6%; gastroenterology: 6.6%; pulmonary and critical care: 10.7%; nephrology: 14.4%; endocrinology: 20.6%; hematology-oncology: 23.2%; infectious diseases: 24.3%). IM PDs were 39.7% women; fellowship PDs ranged from nearly 25% (cardiology and gastroenterology) to nearly 50% (endocrinology and infectious disease) women. Having more women fellows (but not chairs or PDs) was associated with having more women residents (0.3% (95% CI: 0.2–0.5%) increase per 1% fellow increase, p<0.001); this association remained after adjustment (0.3% (0.1%, 0.4%), p=0.001). In unadjusted analyses, having a woman PD (increase of 7.7% (4.7%, 10.6%), p<0.001) or chief (increase of 8.9% (4.6%, 13.1%), p<0.001) was associated with an increase in women fellows; after adjustment, these associations were lost.ConclusionsWomen held a minority of leadership positions in academic IM. Having women leaders was not independently associated with having more women trainees.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07635-w.

Change in Circulating Levels of Endothelial Progenitor Cells and Sexual Function in Women With Type 1 Diabetes.

ContextEndothelial progenitor cells (EPCs), which are involved in the mechanisms of vascular repair and sexual function, are decreased in diabetic women compared with general population.ObjectiveThis work aimed to investigate the circulating levels of EPCs and the change in sexual function during the menstrual cycle in women with type 1 diabetes (T1DM) compared with healthy women.MethodsThis case-control observational study was conducted at the Unit of Endocrinology and Metabolic Diseases at University Hospital “Luigi Vanvitelli’’ of Naples. Participants included 36 women with T1DM and 64 age-matched healthy controls. EPCs were quantified by flow cytometry and sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale. All assessments were made at the follicular, ovulatory, and luteal phases of the same menstrual cycle. Main outcome measures included differences in EPCs levels and sexual function between patients and controls.ResultsCompared with controls, women with T1DM showed significantly lower levels of both CD34 + (P < .001) and CD34 + CD133 + cells (P < .001) in the ovulatory phase, and CD34 + KDR + cells both in the ovulatory phase and in the luteal phase (P < .001 for both). Diabetic women showed significantly lower total FSFI scores and higher FSDS score than control women in all phases of the menstrual cycle. FSFI total score was predicted by both CD34 + CD133 + and CD34 + KDR + cells in the follicular phase, CD34 + and CD34 + KDR + CD133 + cells in the ovulatory phase, and CD34 + KDR + and CD34 + KDR + CD133 + cells in the luteal phase.ConclusionWomen with T1DM show lower levels of EPCs during the menstrual cycle compared with controls. EPCs count predicts sexual function in this selected population.

Graves' Disease after Administration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine in a Type 1 Diabetes Patient.

Although there is a great demand for increased coronavirus disease 2019 (COVID-19) vaccination worldwide, rare side effects of the vaccine in susceptible individuals are attracting attention. We recently treated a patient with type 1 diabetes who had HLA-A*240201/A*020101, B*5401/B*5601, DRB1*0405/DRB1*0405, DPB1*0501/DPB1*0501 and DQB1*0401/DQB1*040 and developed Graves' disease soon after the administration of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. While causal relationships between vaccinations and adverse events are difficult to discern due to both confounding and masking factors, our findings suggest that attention to possible adjuvant-related endocrinological diseases in certain individuals receiving SARS-CoV-2 vaccines is appropriate.

Evaluation of Insulinoma Cases Presented with Hyperinsulinemic Hypoglycemia: A single-centre Experience

Introduction&#x0D; Insulinomas constituting the most common cause of endogenous hyperinsulinism-related hypoglycemia are neuroendocrine tumors originating from pancreatic beta cells. They are generally benign and solitary lesions. Although most cases are sporadic, multiple endocrine neoplasia (MEN) 1-related patients are also present. &#x0D; Material and Method&#x0D; Thirteen patients followed up in Bursa Uludağ University Medical Faculty Endocrinology and Metabolic diseases clinic between the years 2012 and 2021 were retrospectively evaluated. Demographical, clinical, biochemical, radiological and histopathological data of the patients were assessed. &#x0D; Results&#x0D; Eight of the patients were females, and five were males with an average age of 43±14.9 years. Ten of the patients had sporadic, and three had MEN1 syndrome-related insulinoma. During the prolonged fasting test, the patients had a mean lowest plasma glucose level of 36.4 ± 6.2 mg/dl with a simultaneous mean insulin level of 11.3 (4.4 - 214.1) mIU/L and c-peptide level of 2.8 (0.46-12.8) mcg/L. In preoperative localization studies, a lesion was detected in 11 out of 13 (84.6%) patients with upper abdominal computed tomography (CT) and 6 out of 10 patients (60%) with magnetic resonance imaging (MRI). Six patients had grade 1, and 7 patients had grade 2 neuroendocrine tumor. The whole group's mean lesion diameter was 15 (11-48) mm. The mean patient follow-up duration was 30.5 ± 23 months. Hypoglycemia recurred in none of the patients in the postoperative period, and only two patients (15.4%) developed postoperative diabetes mellitus (DM). &#x0D; Conclusion&#x0D; Preoperative localization rates in insulinomas increased due to non-invasive imaging methods and technological developments in recent years. This will probably cause earlier diagnosis and treatment, and pancreas preserving surgery option will be more available in most insulinoma cases.

Low serm Fibroblast Growth Factor-21 levels is not associated with Carotid intima-media thickness in acromegaly patients.

Elevated fibroblast growth factor-21 (FGF-21) levels are related to carotid intima-media thickness (CIMT), a well-established marker of atherosclerosis. Acromegaly has also been linked to increased CIMT. There has been no data considering the association between FGF-21 levels and atherosclerosis in acromegaly patients. This study aimed to evaluate FGF-21 levels and CIMT in acromegalic patients in relation to atherosclerotic complications. Case-control study. The study group included 70 acromegaly patients and 72 healthy volunteers from the Department of Endocrinology and Metabolism Disease, Marmara University Medical School. FGF-21, growth hormone, insulin-like growth factor I, lipids, glucose, insulin levels were assessed. CIMT was measured from the common carotid artery wall on B-mode ultrasound. Median FGF-21 levels were significantly lower in the acromegaly group than in the control group. CIMT was higher in acromegaly patients compared to controls. Although there was no correlation between FGF-21 levels and CIMT in patients with acromegaly, a positive correlation was found between high-density lipoprotein-cholesterol and FGF-21 levels. Glucose metabolic markers were the determining factors of the FGF-21 levels in acromegaly patients. Our study is the first to examine the relationship between serum FGF-21 levels and atherosclerosis in acromegaly patients. The lower serum FGF-21 levels in acromegaly subjects might be associated with the improving effects of growth hormone on liver fat. Acromegaly was linked to higher CIMT, but there was no correlation between FGF-21 levels and CIMT. The role of FGF-21 in acromegaly as a marker of atherosclerosis requires additional research.

ÇOCUK YOĞUN BAKIM ÜNİTESİNE YATAN HASTALARIN KLİNİK VE DEMOGRAFİK DEĞERLENDİRİLMESİ

Purpose: This study aimed to evaluate the patients who received health services in the pediatric intensive care unit (PICU) of Ankara City Hospital’s Pediatrics Department in a 2-year period and the outcomes of these cases by examining their clinical and demographic characteristics.&#x0D; Materials and Methods: This retrospective study was carried out in the 32-bed tertiary PICU of Ankara City Hospital. The records of 2280 patients between the ages of 1 month and 18 years who were hospitalized in the PICU between September 1, 2019, and September 1, 2021, were retrospectively analyzed. Age, sex, presence of chronic disease, reason for hospitalization in the intensive care unit, length of stay, status and duration of respiratory support, and mortality rates were evaluated.&#x0D; Results: The mean age of the patients was 5.16±5.12 years and the mean PICU stay was 12.47±20.16 days. Bronchiolitis, sepsis, pneumonia, trauma, congenital heart disease, status epilepticus, hematological diseases, oncological diseases, diabetic ketoacidosis, and metabolic diseases were found to be the most common reasons for hospitalization in the PICU. The most frequent underlying diseases were neurological, respiratory, hematological, cardiological, endocrinological, nephrological, gastrointestinal system, oncological, and metabolic diseases. The mortality rate of these patients was 10.8%. Underlying oncological or hematological diseases and immunodeficiency, higher susceptibility to infection, longer hospital stay, and longer duration of mechanical ventilation were found to be statistically significantly higher in deceased patients compared to survivors.&#x0D; Conclusion: The profile of patients admitted to PICUs is expanding day by day. A significant decrease in mortality was observed in all patient groups as a multidisciplinary approach was implemented. It was also observed that most of the patients had an underlying chronic disease and this condition was associated with mortality.

An Abnormal Psychology Study Using Stressors and Symptoms for a Hypothetical Individual with Borderline Personality Disorder and a Comparison with the Physio-Pathology Study Using Lifestyle Details and Glucoses from an Individual with Type 2 Diabetes by Applying the Concepts from Viscoelastic and Viscoplastic Glucose Theory (VGT #12) Based on GH-Method: Math-Physical Medicine (No. 591)

The majority of this article focuses on stressors and symptoms of a hypothetical patient with borderline personality disorder (BPD) during the period from Y2010 to Y2022. The example cited is a purely hypothetical patient with BPD conditions. The author has accumulated knowledge on abnormal psychology since 2002 and augment it from his established five psychotherapy centers to care for approximately 200 abused women and abandoned children from 2006 to 2010. Due to confidentiality, he cannot reveal any of their identities, but their general stories or commonly observed behaviors have been included into this hypothetical BPD case. Psychology is an empirical science and, at times, it is easier to describe in words about stressors (root causes), symptoms, behaviors, reactions, and/or treatments; however, it is more difficult to describe them in numbers, using a quantitative manner. That is why most psychological research work are based on statistics tools only, and not based on branches of natural science, such as physics and mathematics. The author self-studied, observed, and managed abnormal psychology therapy for 9-years, from 2002 to 2010. During that period, he has read approximately 100 textbooks and 500+ clinical reports. Based on his findings, he tried to develop some “scientific formula” based equations with a quantitation and precision approach to study and research abnormal psychology. Here, the word “scientific” means that observing physical phenomena, applying physics principles, deriving mathematical equations, building engineering modeling, and utilizing computer and artificial intelligence tools - not relying statistics tools alone. However, it was very difficult for him to collect and utilize data from patients with Personality Disorder (PD) without breaching professional ethics and patient confidentiality. The author has then given up his original idea of using his developed math-physical medicine research approach (MPM) for the psychology field. In the summer of 2010, when his health conditions became life-threatening due to severe type 2 diabetes (T2D) complications, he launched his GH-Method: math-Physical medicine (MPM) research approach on metabolism, endocrinology, food nutrition, and chronic diseases to save his own life. To date, he has written and published nearly 600 medical papers using the MPM method. This particular paper is one of his few attempts to apply his developed MPM methodology on the abnormal psychology field of BPD. The author hopes to continue his psychological research by using more of MPM approach. He appreciates the invaluable inputs, comments, criticisms, and suggestions from his colleagues regarding the area of abnormal psychology.

Remote management of osteoporosis in the first wave of the COVID-19 pandemic

SummaryWe conducted a survey during the first pandemic wave of coronavirus disease 2019 (COVID-19) on a large group of osteoporotic patients to evaluate the general conditions of osteoporotic patients and the impact of the pandemic on the management of osteoporosis, finding high compliance to treatments and low COVID-19 lethality.IntroductionDuring the first pandemic wave of coronavirus disease 2019 (COVID-19), 209,254 cases were diagnosed in Italy; fatalities were 26,892 and were overwhelmingly older patients. The high prevalence of osteoporosis in this age group suggests a potential relationship between SARS-CoV-2 infection and bone metabolism.MethodsIn a telephone survey conducted from April to May 2020, patients from the Osteoporosis Center, Clinic of Endocrinology and Metabolic Diseases of Umberto I Hospital (Ancona, Italy), were interviewed to evaluate the general clinical conditions of osteoporotic patients, compliance with osteoporosis medications, COVID-19 prevalence, hospitalization rate, COVID-19 mortality, and lethality.ResultsAmong the 892 patients interviewed, 77.9% were taking osteoporosis treatment and 94.6% vitamin D supplementation as prescribed at the last visit. COVID-19-like symptoms were reported by 5.1%, whereas confirmed cases were 1.2%. A total number of 33 patients had been in hospital and the hospitalization rate of those who had not discontinued vitamin D supplementation was less than 4%. There were eight deaths, two with a concomitant COVID-19 diagnosis. The prevalence of severe osteoporosis was 50% in total COVID-19 patients and 87.5% in deceased COVID-19 patients. The overall COVID-19 mortality was 0.2%; lethality was 20%, lower than the national rate of the same age group.ConclusionsThis large group of osteoporotic patients showed high compliance and lower COVID-19 lethality compared to patients of the same age. Novel approaches such as telemedicine can provide critical support for the remote follow-up of patients with chronic diseases also in the setting of routine care.