ACTA ENDOCRINOLOGICA (BUC)

Background. Insulin degludec/aspart (IDegAsp) is a co-formulation with IDeg and IAsp. Different insulin regimens may be switched to IDegAsp. In this study, we aimed to find out the effect of switch to IDegAsp on glycemic control and whether the basal characteristics and treatment modalities of the patients affect the change in glycemic control brought by switch to IDegAsp. Methods. We retrospectively analyzed the records of 78 patients whose insulin therapies (basal+bolus, premixed analogues or basal only) were switched on a 1:1 unit basis to IDegAsp±bolus insulin. Oral antidiabetic agents (OADs) given were recorded. At the end of 12th and 24th week, total insulin doses of patients and HbA1c were compared to the baseline. Results. There was a statistically significant decrease at HbA1c at 12 weeks (1.4%; p<0.001). There was not a significant difference in HbA1c between the OAD added group and the group with no new OADs(p=0.1). Basal insulin dose was not statistically different from baseline, whereas bolus insulin dose was significantly lower (p=0.007). At the end of 24 weeks the decrease in HbA1c level from baseline was preserved. Conclusion. Regardless of the baseline insulin regimen, diabetes type and oral antidiabetic drugs given, HbA1c is significantly lowered after switching to IDegAsp.

Background. There have been a number of reports on the relationship between the PPARγ2 Pro12Ala genotype and the development of obesity. Objective. A case-control survey was designed to investigate the potential association between a Pro12Ala polymorphism in the PPARγ2 gene and obesity and/or obesity-related phenotypes in a population from Turkey. Materials and methods. The polymerase chain reaction and restriction enzyme digestion were used to genotype the Pro12Ala polymorphism of the PPARγ2 gene in 149 unrelated obese and 105 non-obese control subjects from Turkey. The data were analyzed statistically. Results. We found that the overall minor allele frequency was 0.12 in cases and 0.095 in controls. In terms of genotype distribution and allele frequencies among the cases versus controls in the population studied, only the genderstratified analysis revealed a significantly higher frequency of Pro/Ala genotype within males. The polymorphism was associated with significantly higher weight, height, waist circumference, central adiposity (waist-to-hip ratio, WHR), lean body weight as well as dry body weight, but not overall adiposity (total body fat percentage, TBF) in cases carrying Ala allele (Pro/Ala or Ala/Ala). However, in the subjects carrying Ala allele of the control group, WHR values were found significantly lower. Conclusion. Our results showed that the Pro12Ala polymorphism in the PPARγ2 gene is associated with obesity in the studied adult population from Turkey. These data suggest that the Pro12Ala polymorphism in PPARγ2 may be a potential genetic risk factor for central obesity.

Background. The loss of reproductive function is one of the mostimportant adverse effects of chemotherapy. Folic acid deficiency may be harmful in pregnancy. Hence, it is imperative to investigate if leucovorin (LCN), a folinic\r\nacid supplementation and withdrawal of MTX treatment facilitate maintenance of pregnancy in albino rats.\r\nAim. The aim of this study was to examine the role of leucovorin (LCN) and withdrawal of MTX treatment in the\r\nprotection of pregnancy at very early stage of pregnancy in MTX treated rats.\r\nAnimals and Methods. Rats with regular oestrous cycle were randomly divided into five groups (n=6) as follows: Control,\r\nMTXLD (low dose), MTXHD (high dose), MTXHD + LCN (leucovorin), and MTXHD + WD (withdrawal). Animals were treated intramuscularly (im) on days 1-5 of pregnancy. MTXHD treatment was withdrawn and female rats showing regular cycle were caged with male rats. Laparotomy was performed on day 8 of pregnancy to note the number of implantation sites. Rats were sacrificed on day 20.\r\nResults. MTX significantly reduced maternal weights, number of corpora lutea, and implantation sites. 100% foetal\r\nresorption was prevalent in MTX treated groups. LCN supplementation did not help maintain pregnancy. While approximately 45% foetal resorption was observed in\r\nwithdrawal group.

Objective. To study papillary thyroid microcarcinomas (PTMCs) detected incidentally/non-incidentally, especially those with suggestive signs for progression into clinically overt forms.\r\nMaterial and methods. In the first part of study 102 microcarcinomas diagnosed between 1988-2008 were investigated. In the second part we included all the 311 patients thyroidectomized for different thyroid diseases in surgical clinics from T?rgu Mures in 2007.\r\nResults. During 1988-2008 the frequency of PTMCs increased progressively, achieving a peak in 2007 (46.5% of 58 PTCs). In 2007 from the 311 thyroidectomies 27 microcarcinomas were diagnosed, the majority (70.3%) being incidentalomas. In incidental and non-incidental PTMC groups the rate of microcarcinomas with potential progression into overt carcinomas was 21% and 50%, respectively. Only non-incidental forms with signs of progression were treated by total thyroidectomy in every case, while microincidentalomas\r\njust in about half of cases, although all must be treated the same way.\r\nConclusions. After the Chernobyl nuclear accident and use of modern diagnostic methods (ultrasound and FNA) the frequency of PTCs has increased progressively and\r\nsignificantly, including that of microcarcinomas diagnosed mostly incidentally. We must pay attention for PTMCs, because in our casuistry 29.6% harbored suggestive signs\r\n(multifocality, extrathyroidal extension, regional lymph node metastases) for progression.

Objective. In our study, we aimed to evaluate thyroid nodule ultrasound findings, nodule frequency and malignancy risk according to the ultrasonographic classification systems [(American Thyroid Association-2015 (ATA) and American College of Radiology - Thyroid Imaging Reporting and Data System (ACR-TIRADS)] in obese and non-obese subjects. Materials and methods. 111 obese subjects and 111 non-obese age- and sex-matched control subjects were included in the study. The malignancy risk of the identified nodules was evaluated using ultrasonographic classification systems. Fine needle aspiration biopsy (FNAB) was performed on the nodules according to ultrasonographic malignancy risk, and cytopathological evaluation was performed according to the Bethesda system. Results. We did not find any difference between the groups in terms of age, sex, thyroid stimulating hormone (TSH) levels and thyroid volumes. We detected thyroid nodules in 36 (32.4%) of 111 subjects in the obese group and 22 (19.8%) of 111 subjects in the control group. Compared with controls, the prevalence of nodules was higher in obese subjects (p=0.046). There was no difference in the malignancy risk of nodules in obese subjects compared to non-obese subjects according to both ultrasonographic classification systems. Conclusion. We have determined that the frequency of thyroid nodules is higher in obese patients than in nonobese subjects. However, we did not find any difference between the two groups in terms of malignancy risk of thyroid nodules according to ultrasonographic classification systems.

Context. We report the use of subcutaneous somatostatin injection three times a day to decrease hypercortisolism in a patient who had Cushing’s syndrome induced by bronchial carcinoid tumour progressive pneumonia due to immune suppression. Subject and Method. A 46-yearold man with 7-month history of DM type-2, hypertension and cerebrovasculardisease, vertebral compression-fracture was admitted to our clinic. Physical examination was consistent with Cushing’s syndrome. Laboratory results revealed hyperglycemia (143 mg/dL; reference range, <100 mg/dL) and hypokalemia (2.29 mEq/L; reference range, 3.5-5.1 mEq/L). His morning serum cortisol was 40 μg/dL (reference range 6.7- 22.6 μg/dL), urine cortisol-excretion was 2245 μg/24 hours (reference range 58-403 μg/24 hours), after 1 mg dexamethasonesuppression test serum cortisol was 28 μg/dL (6.7-22.6 μg/dL) and ACTH 354 pg/mL (reference range 7.9-66 pg/mL). Adrenal CT and hypophyseal MRI were normal. An ectopic source was searched for Cushing’s syndrome. Chest CT scan of the right lung showed 12x9 mm nodule. High fever cough occurred on the followp. Chest radiograph revealed diffuse pneumonic infiltration. Despite 3-drug antibiotic combination therapy, infection did not improve. Subcutaneous injection of octreotide 3x100 μ/g was initiated to decrease hypercortisolism. The infection improved rapidly after the therapy. The morning serum cortisol, urine cortisol-excretion, ACTH was at the upper normal range (77.1 pg/mL, reference range 7.9-66 pg/mL) on 10th day of treatment. The patient was a consulted for surgery and the nodule was excised. The pathology was consistent carcinoid tumor. Conclusion. Subcutaneous octreotide treatment may be helpful to gain time for exploring the focus in ectopic cushing’s syndrome and to control the serious infections due to hypercortisolism.

Aim. We aimed to determine styles of coping with stress, emotion regulation skills, eating attitudes and quality of life in children with DM type-1 and comparison of findings with healthy children. In addition, it was aimed to investigate the relationship between these findings and the presence of psychopathology, emotion regulation skills and styles of coping with stress in their mothers. Method. The study included 70 diabetic,70 healthy children and their mothers. During the evaluation, the Children’s Depression Inventory, the Screen for Children Anxiety Related Disorders (SCARED), the Difficulties in Emotion Regulation Scale (DERS), the Eating Attitudes Test (EAT), the Pediatric Quality of Life Inventory (PedsQL) and Ways of Coping Inventory (COPE) were applied to all children. In addition, DERS, COPE, Beck depression and Beck anxiety scales were applied to all mothers. Results. It was found significantly more problems in diabetic group in the DERS-impulse subscale, COPEhelplessness, PedsQL-physical subgroup, EAT, SCARED scores experienced than the control group. In the scales applied to mothers of diabetic children, significantly higher scores were found in the DERS-nonacceptance subscale, deficits in emotional clarity subscale and impulse subscale, COPE-helplessness subgroup, and Beck Depression Scale. Conclusions. DM creates problems in patients' and mothers' emotional regulation skills and coping styles with stress; it also negatively affects the quality of life and eating attitudes of children.

Streptococcus pneumoniae generally causes pneumonia or meningitis. The psoas abscess and osteomyelitis is mainly caused by Staphylococcus aureus. We report here on a patient with type 2 diabetes mellitus who had a psoas abscess and foot ulcer caused by Streptococcus pneumoniae after acupuncture\r\nand moxibustion.

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Background. Thyroid nodules are a common pathology worldwide. Fine needle aspiration biopsy (FNAB) is an important diagnostic method for the investigation of malignancy in thyroid nodules. However, according to the Bethesda System used to classify the results, patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS / FLUS) may not be classified as benign or malignant. Therefore, it may be necessary to determine some clinical risk factors to apply the best treatment in these patients. Aim. To determine the factors that increase the risk of malignancy in this patient group. Methods. A retrospective study including 138 patients with an FNAB categorized as AUS/FLUS and operated between June 2015–September 2018. Demographical, Laboratory (TSH) and Ultrasound variables (number, size and characteristics of nodules) of the patients were compared among postoperative histopathological results. Results. Hypo-echoic structure, microcalcification and irregular margin of the nodules were detected to be associated with malignancy in patients with FNAB results of AUS/FLUS (p <0.001). Conclusion. We suggest that surgical treatment should be considered if the patients have nodules with the hypo-echoic structure, microcalcification and irregular margin with an FNAB histopathological result of AUS / FLUS.