Abstract:INTRODUCTION: The aim of this study was to compare the clinical, biochemical, and disease control characteristics of newly diagnosed Graves' disease (GD) before and during the coronavirus disease 2019 (COVID-19) era. Abstract:METHODS: In this retrospective, single-center observational study, 95 patients with newly diagnosed GD between January 2015 and November 2024 were evaluated for thyroid function, autoantibody levels, antithyroid drug (ATD) doses, and disease control status. Patients diagnosed before January 2019 were classified as the pre-COVID-19 group (n=46), whereas those diagnosed after March 2020 were classified as the COVID-19 era group (n=49); patients diagnosed between January 2019 and March 2020 were excluded due to potential classification ambiguity. Only patients treated with ATD for at least 12 months were included in the analysis. Abstract:RESULTS: Patients diagnosed during the COVID-19 era had higher thyroglobulin antibody (TgAb) titers at diagnosis (p=0.001) and higher free thyroxine levels at 12 months and at the final visit (p=0.001). Although the time to euthyroidism was lower in the COVID-19 era group, the difference was not statistically significant. End-of-treatment thyrotropin receptor antibody (TRAb) levels were similar between groups; however, fewer patients in the COVID-19 era group achieved TRAb normalization. Disease control rates and time to achieve disease control under ATD therapy were comparable between the two groups. Among patients diagnosed during the COVID-19 era, 89.8% received at least one messenger RNA vaccine dose, and 40.8% had a positive polymerase chain reaction test. Abstract:CONCLUSION: The COVID-19 era was not associated with a major change in the overall clinical course of GD . However, patients diagnosed during the COVID-19 era had higher TgAb levels at diagnosis and incomplete TRAb normalization in some cases, suggesting subtle differences in thyroid immuneactivity.

OBJECTIVE:This study aims to explore the predictive performance of machine learning-based radiomic features extracted from T2-weighted magnetic resonance imaging (MRI) in differentiating between women with polycystic ovary syndrome (PCOS) and healthy counterparts. METHODS:The study included patients diagnosed with PCOS who had undergone pelvic MRI in the endocrine department between 2014 and 2022, along with an age-matched control group. The ovaries were manually segmented from T2-weighted images using the 3D Slicer software. Both first- and second-order features, including wavelet filters, were extracted from the images. Utilizing the Python 2.3 programming language and the Pycaret library, various machine learning algorithms were employed to identify highly correlated features. The optimal model was selected from the 15 algorithms assessed. RESULTS:The study involved a total of 202 ovaries from 101 patients with PCOS (mean age 23±4 years) and 78 ovaries from the control group comprising 40 individuals (mean age 24±5 years). In the training set, the machine learning models displayed accuracy and area under the curve (AUC) values ranging from 72% to 83% and 0.50 to 0.81%, respectively. Notably, the Light Gradient Boosting Machine (LightGBM) model emerged as the most effective model among the various machine learning algorithms, exhibiting an AUC of 0.81 and an accuracy of 83%. When evaluated on the test set, the AUC, accuracy, recall, precision and F1 values of the LightGBM model were 0.80, 82%, 91%, 86%, 88%, respectively. CONCLUSION:Machine learning-based T2-weighted MRI radiomics seems viable in differentiating between individuals with and without PCOS.

Both diabetes mellitus (DM) and anemia are prevalent around the world. The possibility of these two diseases co-existing is also very high. Glycosylated hemoglobin (HbA1c) is used to diagnosed and monitor DM. Incorrect measurements of HBA1c will cause patients to be misdiagnosed as DM or to follow-up DM patients incorrectly. Conditions affecting the turnover of erythrocytes may cause inaccurate HBA1c measurement. In this study, a case of a 33-year-old patient diagnosed with Type 1 DM due to hemolytic anemia, which was misdiagnosed due to falsely low HBA1c value, and an 18-year-old patient misdiagnosed as DM due to falsely high HBA1c value stemming from iron deficiency anemia are presented. The reliability of HBA1c in the diagnosis and follow-up of DM is discussed.

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The relationship between elevated ferritin levels and metabolic abnormalities in PCOS patients, and whether ferritin is a cause or a consequence, is still debated. This study aimed to evaluate the impacts of the fourth generation combined oral contraceptive containing ethinyl estradiol/drospirenone (EE 30 mcg/DRSP 3 mg), known for its favorable metabolic profile and lower side effect risk, on iron metabolism in PCOS patients, while also exploring the potential relationship between metabolic parameters and iron status. The retrospective analysis was conducted on 81 women aged 18–45, diagnosed with PCOS according to the Rotterdam criteria and treated with EE/DRSP for six months. Exclusion criteria were lack of data, secondary hyperandrogenemia, major medical conditions, or recent use of medications affecting hormone levels or iron metabolism. Pre- and post-treatment anthropometric measurements, hormonal and metabolic markers, and iron parameters were obtained from records. Post-treatment ferritin levels significantly increased (p = 0.001), while hemoglobin, hematocrit, and transferrin saturation decreased especially in overweight/obese patients (p = 0.012, p = 0.002, p = 0.017 respectively), suggesting a response to inflammation rather than iron storage disorders. Although overall CRP levels did not change significantly, post-treatment CRP levels were higher in overweight/obese patients compared to lean PCOS patients (p = 0.003). Ferritin levels were positively correlated with body mass index (p = 0.008, r = 0.310), insulin resistance indices (p = 0.027, r = 0.248), and the free androgen index (p = 0.001, r = 0.367) after treatment. Pre-treatment menstrual cycle length had no effect on ferritin. The study revealed a paradoxical increase in ferritin levels with EE/DRSP treatment, highlighting the complex role of ferritin as a metabolic marker in PCOS patients, particularly in relation to obesity, which is typically associated with low-grade chronic inflammation.

Introduction: Both diabetes mellitus (DM) and iron deficiency anemia (IDA) are prevalent in every area of the world, and so, the possibility of these two diseases co-existing is also very high. It is our belief that clinical results of any correlation between iron status of the body and glycosylated haemoglobin (HbA1c) would be beneficial to many patients, therefore in this study, the effect of IDA on HbA1c was investigated. Materials - methods: A total of 146 patients with DM and IDA were evaluated prospectively. While the patients were administered 270 mg/day of ferrous sulphate (80 mg elemental iron) orally for three months for the treatment of IDA, no interventions were made for the treatment of DM. Patient levels of hemoglobin (Hb), hematocrit, red blood cells (RBC), mean corpuscular volume (MCV), platelet, white blood cells (WBC), serum iron, serum iron binding capacity (SIBC), ferritin, fasting plasma glucose (FPG), HbA1c, body mass index (BMI), C-reactive protein (CRP) values were measured at baseline and at the third month of treatment with iron, and were compared. Results: The median age of our patients was 45 (40-50) and median duration of diabetes was 3 years (1,75-5). While the baseline median Hb was 10.4 (mg/dL) (9.5-11.1), MCV was 74 (fL) (70.8-77), ferritin was 4 (ug/L) (3-6) at three months, Hb was measured at 12.6 (mg/dL) (12.1-13.2), MCV was measured at 82 (fL) (80-86), ferritin was measured at 15 (ug/L) (9-21.2) and was significantly higher compared to baseline values (p < 0.001). The baseline median HBA1c of patients was 7.09 +/- 0.51 (%) and three month HBA1c was 6.69 +/- 0.53 (%), which was significantly lower than when comparing baseline values with values at third month (p < 0.001). Baseline and three month values for FPG were 118 (mg/dL) (108-132) and 116 (mg/dL) (106-125) respectively, and there was no significant difference (p:0.07). A 2.2 mg/dL (1.5-3.5) increase in median Hb level accompanied a 0.4 % (0.2-0.6) decrease in median HbA1c levels (Spearman rho = -0.362; p < 0.001). Conclusion: Our study has shown conclusivly that IDA is related to increased HbA1c concentrations and HbA1c decreases significantly following treatment with iron. IDA should be considered before making any decisions regarding diagnosis or treatment according to HbA1c. (C) 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Introduction Nivolumab is a human immunoglobulin G4 monoclonal antibody that inhibits programmed cell death-1 activity by binding to the programmed cell death-1 receptors. Cancer cells express increased number of programmed cell death-1 ligands and this allows them to escape the cytotoxic effects of the T cells. Therefore, the negative programmed cell death-1 receptor signal regulates T-cell proliferation and activation is disrupted. However, this change in the activity of the T cells can cause them to lose their ability to recognize host cells. The immune response enabled by these agents has led to side effects, commonly known as “immune-related adverse events.” Case report We report a case of a 66-year-old male patient who was treated with nivolumab for recurrent renal cell carcinoma presented with hepatitis and adrenalitis. Three weeks after starting nivolumab, the patient had abdominal pain and weakness, and then aspartate and alanine transaminase levels were found to be elevated. Management and outcome Hepatitis was predicted to be due to nivolumab, because other causes were excluded. He started using oral methylprednisolone and then, hepatitis improved. However, while receiving methylprednisolone treatment, fludrocortisone was started with the pre-diagnosis of adrenalitis due to the persistence of fatigue, weakness, and hyponatremia and hyperkalemia. With both treatments, the patient's symptoms and sodium and potassium level returned to normal. Discussion This case emphasizes the need for patient's education and awareness of immune-related adverse events, and the importance of understanding the management of life-threatening complications of the checkpoint inhibitors, because these side effects require prompt recognition and treatment.

OBJECTIVE To determine the relationship between the positivity of third-generation TSH receptor antibody (TRAb) at the time of diagnosis and the cumulative methimazole dose used until remission in patients with Graves' disease. STUDY DESIGN Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY Department of Endocrinology and Metabolic Diseases, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Turkey from 2016 to 2018. METHODOLOGY Newly diagnosed Graves' patients were included in the study. The patients were divided into two groups according to whether they entered remission (n: 21) or not (n: 20), in the 18th month of methimazole treatment. In addition, the patients were further divided into two categories, according to TRAb status at the time of diagnosis as negative (n: 17) or positive (n: 24). The TRAb positivity and the cumulative methimazole dose they used until the month of remission were compared in these groups. RESULTS The mean time to reach remission in 41 patients was 20.5 ± 3.1 months. TSH receptor antibody positivity rate was 58.5%. When the TRAb positivity of the groups was compared according to the state of having remission in the 18th month of the treatment, the positivity rate in the non-remission group was statistically significantly higher (p = 0.023).The time to go into remission was longer and the cumulative methimazole dose requirement was higher in the TRAb positive group (p <0.001). CONCLUSION Graves' disease patients with positive third-generation TRAb were found to have a lower rate of remission in the 18-month period compared to negative patients. Key Words: Graves' disease, TSH receptor antibody, Cumulative, Methimazole.

ABSTRACT Objective: We aimed to investigate the role of testosterone to estradiol ratio in predicting the effectiveness of human chorionic gonadotropin and testosterone treatments in male hypogonadism. Materials and methods: Thirty-six male patients with hypogonadotropic hypogonadism were included in the study. Seventeen (47.2%) patients received weekly recombinant human choriogonadotropin alpha (hCG) treatment (group-1) and 19 (52.8%) received testosterone replacement therapy (T treatment) every 21 days (group-2). Under these treatments, adequate frequency of morning erection (≥3/week), testosterone to estradiol ratio (T/E), and testicular volume changes were analyzed. Results: The mean age of the patients was 28.5 ± 8.7 years. When the frequency of morning erection (≥3/week) was specified as adequate, the cut-off value for effective T/E ratio was found to be 12.0 (sensitivity 93.8%, specificity 90.0%). There was no significant difference between the treatment groups in terms of total testosterone levels, T/E ratio, or frequency of morning erections (≥3/week) (p > 0.05). However, there was a statistically significant difference between the groups in terms of median left-right testicular volume in favor of group-1 (p < 0,05). Conclusion: In patients with hypogonadism who are under treatment, elevated estradiol-induced erectile dysfunction symptoms may persist even if serum testosterone levels are normal. Testosterone to estradiol ratio can be used as a predictive value in the effective treatment of hypogonadotropic hypogonadism with hCG and T.

Aim: Detailed evaluation of patients in preoperative stage is an important factor that reduces morbidity and mortality as well as the operation itself. In our study, we aimed to examine clinically, pathologically and endocrinologically, the patients who were decided to undergo transsphenoidal surgery, in light of the literature.Materials and Methods: In this retrospective observational study, preoperative and pathological data of consecutive pituitary adenoma patients who applied to our department from January 2019 to June 2020 and underwent transsphenoidal surgery with microscopic methods, were examined.Results: The study included a total of 31 patients. Distribution of patients in relation to pathological diagnoses was as follows: Functional pituitary adenoma (n: 15), non-functional adenoma (n: 11), apoplexy (n: 2), carcinoma metastasis (n: 2) and craniopharyngioma (n: 1). No statistically significant difference was found between functional and non-functional adenomas, in terms of tumor size, cavernous sinus invasion, Ki-67 index and p53 staining pattern (p> 0.05) whereas presence of suprasellar extension and visual field defect were significantly more in non-functional adenomas (p = 0.015, p = 0.045, respectively).Conclusion: Highly invasive character was detected in both functional and non-functional pituitary Ki-67 indexes were low in the study population, increased p53 expression was noticeable. We can state that the Ki-67 index may not be directly proportional to the invasive behavior of the disease.

Bilgiye erişimin kolaylaştığı günümüzde, maalesef her birimiz zaman zaman; pratik, ayrıntıdan uzak ve hedefe yönelik bilgiye ulaşmakta zorlanmışızdır. Elinizdeki bu eser, sahada birebir vaka görüp aktif çalışan hekimlerimiz tarafından kaleme alınmış olup kolay, anlaşılır, ayrıntıdan uzak ve hedefe yönelik bilgileri vakalar üzerinden okuyucuya ulaştırmayı hedeflemektedir. Aile hekimleri, iç hastalıkları hekimleri, endokrinoloji alanında çalışan ya da tiroid hastalıkları ile ilgilenen tüm meslektaşlarımızın ilgiile okuyup faydalanabileceği bir kaynak oluşturulduğu kanaatindeyiz. Siz değerli meslektaşlarımızın geri bildirimleri ile bir sonraki baskı ve eserde huzurlarınıza daha öz güvenli çıkmayı umuyoruz

It aimed to evaluate the renal functions according to the accumulation site of amyloid in patients diagnosed with secondary amyloidosis by renal biopsy. Fifty patients diagnosed with secondary amyloidosis, who referred to the nephrotic syndrome outpatient clinic included in the study. According to the findings of renal biopsy, only-glomerular amyloid deposition (group- 1) detected in 9 patients and glomerular+ tubulointerstitial deposition (group- 2) identified in 41 patients. Serum creatinine, creatinine clearance, and total proteinuria levels compared between groups at the time of presentation and on 3rd, 6th, 12th, and 24th months. Initial and subsequent serum creatinine, creatinine clearance, and total proteinuria levels not found to be significantly different between groups (p>0,05 for all). Among subjects with only-glomerular deposition, statistically significant descents in total proteinuria, when compared to initial levels, were observed from the beginning of the 6th month to the end of the 24th month (p

Mehmet Celik1*, Serhat Ozcelik2, Ece Celik3 and Melike Ozcelik4 1Department of Endocrinology and Metabolism, Faculty Medicine, Trakya University, Edirne, Turkey 2Department of Endocrinology and Metabolism, Kartal Lütfü Kırdar Training and Research Hospital, Istanbul, Turkey 3Division of Allergy and Clinical Immunology, Medical Faculty, Antalya University, Antalya, Turkey 4Department of Medical Oncology, Umraniye Training and Research Hospital, Istanbul, Turkey

Introduction To evaluate the efficacy and safety of transition from premixed and intensive insulin to twice-daily insulin degludec/aspart (IDegAsp) co-formulation in patients with type 2 diabetes mellitus. Material and methods In this 12-week study, patients receiving twice-daily premixed insulin therapy in group 1 (n = 55) were switched to twice-daily IDegAsp. In group 2 (n = 60), patients on intensive insulin therapy were switched to IDegAsp injected twice a day. Inter- and intragroup comparisons were made. Results A total of 115 patients were included in the study. There was a significant improvement in glycaemic control, median daily total insulin dose, body mass, body mass index, and hypoglycaemic events in group 1 and group 2 with the switch to IDegAsp (p < 0.05). The decrease in median daily total insulin dose requirement in group 2 was higher than that of group 1 (p = 0.001). There was no difference between groups in terms of other parameters (p > 0.05). Conclusions The current analysis indicates that IDegAsp treatment improves outcomes, with the most notable differences observed in daily total insulin requirement, body mass, and hypoglycaemia.

Aim: Systemic inflammatory response has been shown to play a critical role in all stages of tumor development, progression and metastasis. High neutrophil lymphocyte ratio (NLR) is thought to be an indicator of poor prognosis of tumors. In this study, we investigated the relationship between preoperative NLR and lymph node metastasis of differentiated thyroid carcinoma (DTC). Methods: The study included a total of 74 patients diagnosed with DTC according to pathology results after thyroid surgery. The NLR was determined by dividing the absolute neutrophil count in the whole blood count by the lymphocyte count. Optimal cut-off value was estimated by means of ROC curve. The study was designed a cross-sectional study.Results: With a 95% confidence interval, the area under the curve of 0.620 and the likelihood ratio of 3.2, the cut-off value for NLR was found to be 2.59 with 44.4% sensitivity and 86.2% specificity, respectively. There was a significant relationship between the current cut off value and the lymph node metastasis of DTC (P=0.03). Conclusion: NLR was found to be significantly increased in lymph node-positive differentiated thyroid cancers. The neutrophil to lymphocyte ratio as an inflammation index is inexpensive for patients with differentiated thyroid carcinoma, easily available and easy to obtain from routine blood tests.

OBJECTIVE: This study aims to evaluate the efficacy and safety of the addition of 10 or 25 mg of empagliflozin to patients with type 2 diabetes mellitus using a maximum tolerable dose of metformin and gliclazide. METHODS: A total of 60 patients who had been receiving a maximum tolerable dose of metformin plus gliclazide. was divided into two groups in this study. In the first group (Group 1, n=32), 10 mg empagliflozin was added to the current treatment once a day, and in the second group (Group 2, n=28) 25 mg empagliflozin was added to the same treatment once a day. Biochemical results, weight and blood pressure changes of the patients in both groups were evaluated before and after 12 weeks of empagliflozin addition. Patients who developed urinary tract and genital infections after treatment were recorded. RESULTS: There was a statistically significant decrease in HbA1c in both groups after empagliflozin treatment (Group 1, p<0.001 and Group2, p=0.001). When the lipid profile was evaluated, no significant difference was found between basal and post-treatment parameters (p>0.05). Patients in Group 1 and Group 2 lost 2.6 +/- 1.2 and 3.8 +/- 2.0 kg of body weight, respectively (p<0.0001 for each). There were also significant reductions in systolic and diastolic blood pressure for groups 1 and 2 (p<0.0001 for each). Although there was a numerical increase in the urinary tract and genital infections in both groups after empagliflozin treatment, there was no statistically significant difference compared to the pre-treatment period (p>0.05). CONCLUSIONS: Two doses of empagliflozin added to the present treatments showed a dose-independent improvement in glycemic control and a neutral effect on lipid metabolism.

Background: Protein tyrosine kinase-7, a regulatory protein in the Wnt signaling pathway, was highly overexpressed in various cancer types and assumed to be related to prognosis. Aims: The purpose of this study is to assess whether protein tyrosine kinase-7 expression status in curatively resected gastric carcinoma would independently identify patients with a high risk of recurrence and death. Study Design: Retrospective cohort study. Methods: We included patients who were at least 18 years of age and diagnosed with gastric cancer. The exclusion criterion was a metastatic disease at the time of diagnosis or operation. Data on clinicopathological prognostic determinants and clinical courses, including the date of disease relapse and survival status, were collected with the use of medical records. Surgically removed tumor tissue specimens were examined by two independent pathologists at the pathology department of our institution. Protein tyrosine kinase-7 expression status was assessed with immunohistochemical processing and stratified on a scale ranging from 0 to +3 according to the extent of stained tumor cells. It was then further categorized into two groups, one being + (positive), including +1, +2, and +3 scores, another was- (negative), including-and +/- scores. Results: A total of 114 patients were analyzed. Protein tyrosine kinase-7 expression was present in 66.7% of the surgical tumor specimens. There was no statistically significant difference in almost all relevant parameters between the protein tyrosine kinase-7 positive and negative groups. The estimated median survival in the protein tyrosine kinase-7 positive group was significantly better than the protein tyrosine kinase-7 negative group (60 vs 22 months, p<0.001). Disease-free survival was found to be 55 months in the protein tyrosine kinase-7 positive group, whereas it was 21 months in the negative group (p=0.015). In the multivariate analysis, along with negative protein tyrosine kinase-7 expression, poor performance status, and advanced stage were significantly associated with the risk of death (p<0.001 for each). Conclusion: Compared to patients with negative PTK-7 expression, patients with positive PTK-7 expression have better disease-free survival and overall survival rates. Efforts should be made to enhance this finding and translate it into clinical practice.

Context Severe hypertriglyceridemia (SH), which calls for a triglyceride (TG) level above 1000 mg/dL, remains an important health issue. While some data exist to offer combination of heparin, insulin and fenofibrate as a reasonable treatment option, safety and benefits of this therapy have not been accurately weighted, largely due to the limited sample size of the relevant studies. Aim Assess the efficacy and safety of the heparin, insulin and fenofibrate combination in the treatment of patients with SH. Patients - Methods Patients aged ≥18 years with TG level above 1000 mg/dL and adequate organ function were included. Triglyceride levels were measured immediately before the treatment and on the 3rd and 6th days of the treatment. Treatment dosage, duration, response and side effects were assessed. Patients with hypertriglyceridemia presenting with acute pancreatitis were treated additionally with lipid apheresis. Results A total of 42 patients were included. Of these, 85.8% came to medical attention with some kind of secondary hypertriglyceridemia causes. The baseline median TG value of the cases was 2141.0 mg/ dL (1026-12250). There were 6 patients (14.3%) with acute pancreatitis at presentation. In patients without pancreatitis, with administration of insulin infusion, unfractionated heparin infusion and fenofibrate capsule, median TG values decreased to 921 mg/ dL (190-6400) on the 3rd day and to 437 mg/ dL (112-1950) on the 6th day of the treatment (p<0.0001, Friedman test). Potential toxicities related to insulin, heparin and fenofibrate combination treatment including hypoglycemia, hemorrhage, rise in creatine kinase levels, hepato - and nephrotoxicity were not observed. Conclusion In this trial involving patients with SH, our data suggest that insulin, heparin and fenofibrate combination therapy was safe and effective.

Serhat Ozcelik*1 and Mehmet Celik2 Author Affiliations 1Department of Internal Medicine, Division of Endocrinology and Metabolism, Kartal Training and Research Hospital, Turkey 2Department of Internal Medicine, Division of Endocrinology and Metabolism, Antalya Kepez State Hospital, Turkey Received: May 06, 2019 | Published: May 14, 2019 Corresponding author: Serhat Ozcelik, Department of Internal Medicine, Division of Endocrinology and Metabolism, Kartal Training and Research Hospital, Istanbul, Turkey DOI: 10.26717/BJSTR.2019.18.003090