The effect of growth hormone treatment on bone mineral density in prepubertal girls with Turner syndrome: a multicentre prospective clinical trial

Background Patients with Turner syndrome (TS) are treated with GH to increase adult height. Although it is well established that GH promotes longitudinal bone growth, the effects of GH treatment on bone density are less clear. Objective To determine how GH treatment affects trabecular bone mineral density (BMD) in girls with TS at prepubertal ages in a prospective multicentre study. Patients and method Twenty‐two patients with TS in the prepubertal period with a mean age of 9·8 ± 2·5 (range 3·6–12·8) years were included in the study. All girls with TS underwent measurement of areal BMD using dual‐energy X‐ray absorptiometry (DXA) to obtain pretreatment anteroposterior (AP) lumbar spine values at L1–L4. Patients received GH (Genotropin) subcutaneously for 1 year at a dose of 0·05 mg/kg/day. Height and weight were measured at 3‐monthly intervals. The AP lumbar spine areal BMD was remeasured using the same technique after 1 year of treatment. Lumbar spine BMD Z‐scores and volumetric BMD (vBMD) Z‐scores were calculated using national standards. Results The height SDS of our cases showed a significant increase with GH therapy. The pretreatment lumbar spine (L1–L4) BMD Z‐score was –1·2 ± 1·2 SD and the vBMD Z‐score was –0·8 ± 1·6 SD. There were no significant changes in these values after 1 year of GH treatment. Prepubertal TS girls more than 11 years of age had lower vBMD Z‐scores (–1·7 ± 1·7 SD) than the girls aged less than 11 (–0·1 ± 1·0 SD) (P < 0·05) at the onset of therapy. No significant changes were observed in these values after 1 year of GH therapy. Conclusions Osteopaenia becomes apparent in prepubertal TS patients as they reach pubertal age. BMD evaluation may be necessary in these prepubertal TS girls at diagnosis. Short‐term GH therapy in these TS patients does not have a significant effect on bone density when measured at a site with a predominance of trabecular bone.     

Adaptation of upper airway muscles to chronic endurance exercise

We tested the hypothesis that chronic endurance exercise is associated with the recruitment of four major upper airway muscles (genioglossus, digastric, sternohyoid, and omohyoid) and results in an increased oxidative capacity and a fast-toward-slow shift in myosin heavy chain (MHC) isoforms of these muscles. Female Sprague-Dawley rats (n = 8; 60 days old) performed treadmill exercises for 12 weeks (4 days/week; 90 minutes/day). Age-matched sedentary female rats (n = 10) served as control animals. Training was associated with an increase (p < 0.05) in the activities of both citrate synthase and superoxide dismutase in the digastric and sternohyoid muscles, as well as in the costal diaphragm. Compared with the control animals, Type I MHC content increased (p < 0.05) and Type IIb MHC content decreased (p < 0.05) in the digastric, sternohyoid, and diaphragm muscles of exercised animals. Training did not alter (p > 0.05) MHC phenotype, oxidative capacity, or antioxidant enzyme activity in the omohyoid or genioglossus muscle. These data indicate that endurance exercise training is associated with a fast-to-slow shift in MHC phenotype together with an increase in both oxidative and antioxidant capacity in selected upper airway muscles. It seems possible that this exercise-mediated adaptation is related to the recruitment of these muscles as stabilizers of the upper airway.     

Percutaneous transluminal angioplasty for total coronary occlusion: The effect of restenosis on left ventricular function

The study was undertaken to evaluate the effect of restenosis on global and regional left ventricular function after percutaneous transluminal coronary angioplasty (PTCA) for total coronary occlusion. Thirty-one consecutive patients with total coronary occlusion treated successfully with PTCA and had follow-up angiography at 3–6 months formed the study group. Nineteen patients had restenosis (16 males, mean age 48±10 years) and 12 had no restenosis (11 males, mean age 53±10 years). In the LAD group there were increases in anterobasal (35.9±8.5% vs 43.1±5.7%, p=0.05) and apical (24.1±6.8% vs 31.7±2.9%, p=0.03) segment motion scores in patients without restenosis after PTCA. Global ejection fractions (63.1±14.5% vs 68.9±12.4%, p=0.09) and anterolateral (28.7±11.3% vs 39.7±10.2%, p=0.09) segment scores increased, but did not reach statistical significance. In the LAD restenosis group anterobasal (41.5±14.3% vs 34.3±12.6%, p=0.001), apical (21.1±15.0% vs 17.8±10.9%, p=0.05) and anterolateral (32.7±19.6% vs 26.6±13.8%, p=0.03) segment motion scores decreased but the decrease in the global ejection fraction (60.3±18.5% vs 58.6±17.4, p=0.38) was not significant. In the RCA+LCX group there was a significant increases in global ejection fraction (69.0±7.5% vs 74.2±7.6%, p=0.03) and posterobasal (23.8±7.8 vs 34.4±8.0, p=0.04) segment motion scores in patients without restenosis. The wall motion scores were unchanged in patients with restenosis in the RCA+LCX group. It was concluded that restenosis after a successful PTCA for total coronary occlusion may deteriorate segmental wall motion and treatment modalities with increased patency rates should be used for total coronary occlusions.     

Helicobacter pylori seropositivity and atherosclerosis risk factors

Certain viral and bacterial infections may contribute to the initiation and progression of atherosclerosis. The aim of this study is to determine whether Helicobacter pylori (HP) seropositivity contributes to conventional atherosclerosis risk factors in the development of an early sign of atherosclerosis: intima-media thickness (IMT) of the carotid artery. Eighty-four patients who had at least two conventional atherosclerosis risk factors and a control group of 50 patients having no risk factors for atherosclerosis were enrolled in the study. None of the patients had ever received HP eradication treatment. HP IgG antibodies were determined by enzyme-linked immunosorbent assay. Carotid artery IMT was measured 1 cm before the carotid bifurcation. Seventy-five percent of the study group was HP seropositive. HP seropositive (n=64) and seronegative (n=21) groups were identical in terms of sex distribution, smoking pattern, mean age, hemoglobin, leukocyte, platelet, C-reactive protein, erythrocyte sedimentation rate, glucose, cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, systolic blood pressure and diastolic blood pressure levels. There was no significant difference between the mean carotid IMT of HP seropositive (0.8+/-0.3 mm) and negative (0.8+/-0.3 mm) patients in the study group. Similar to the study group, there was no statistically significant difference between mean carotid IMT of HP seropositive (0.56+/-0.19 mm) and negative patients (0.67+/-0.13 mm) in the control group (p=0.2). Future studies concerning virulent strains are needed to determine the probable role of HP in atherosclerosis.     

Immature Platelet Count Levels as a Novel Quality Marker in Plateletpheresis

The efficiency of plateletpheresis was improved owing to new developments in automated cell separators in the past decades. Nowadays multiple units of plateletpheresis products can be taken per collection from single donor and new parameters such as immature platelet fraction (IPF), immature platelet count (IPC) can be detected practically by automated hematology analyzers. Our aim is to find out a new quality parameter for evaluation of plateletpheresis by analyzing the platelet indices of donor and also to predict platelet recovery in recipients thereby preventing unnecessary platelet transfusion. In this study 104 platelet apheresis procedures were performed on the Trima Accel cell separator. Complete blood counts of donors and recipients were analyzed by Sysmex XN-1000 automated blood cell counter by means of quality parameters such as platelet count, IPF, IPC, mean platelet volume, platelet distribution width. We analyzed these parameters in the follow up after the transfusion of plateletpheresis and evaluated them as quality markers in the assessment of plateletpheresis effectiveness. For recipients of both single and double unit apheresis platelet transfusions, the pre-apheresis donor IPC correlated significantly with 1st and 24th hour recipient IPC values (p values?<?0.05 for all comparisons). A-IPC as well as % change in IPF can be used to determine the quality of plateletpheresis in conjunction with platelet number in terms of evaluation of donors and also in the follow up of recipients undergoing platelet transfusion.     

Unilateral renal agenesis and urethral atresia associated with ergotamine intake during pregnancy

Ergotamine, an ergot alkaloid, used for the treatment and prevention of migraine attacks, is considered as a teratogenic drug and, therefore, should be avoided in pregnancy. Here, we report a newborn infant with unilateral renal agenesis, urethral atresia, and pulmonary hypoplasia associated with the use of ergotamine for the treatment of migraine attacks at early pregnancy. Genitourinary anomalies in association with ergotamine usage were rarely reported and this was the third case of renal agenesia in association with ergotamine usage in literature. We suggest that ergotamine teratogenicity may be dose dependent and should be avoided in pregnancy for the possibility of genitourinary anomalies.     

Dermatologic comorbidities of the patients with severe COVID‐19: A case‐control study

The current studies focus on the association between COVID‐19 and certain comorbidities. To the best of our knowledge, the association between severe COVID‐19 and dermatologic comorbidities has not been reported yet. In this study, we aimed to describe the dermatologic comorbidities of patients with severe COVID‐19 and compare it with the control group. Patients who have died at U?ak Training and Research Hospital due to COVID‐19 and other diseases in the COVID‐19 Intensive Care Units and Internal Medicine Intensive Care Units were recruited into the study. Two groups were compared with each other regarding the most common dermatologic comorbidities. A total of 198 patients including 111 patients with COVID‐19 and 87 age and sex‐matched patients with other diseases were enrolled in the study. The most common dermatologic comorbidities were pruritus (8.1%), eczema (6.3%), skin infections (3.6%), leukocytoclastic vasculitis (1.8%), and urticaria (0.9%) in the COVID‐19 group while they were skin infections (9.2%), eczema (3.4%), pruritus (2.3%), and urticaria (1.1%) in the control group. None of patients in the control group had leukocytoclastic vasculitis. There were no significant differences between COVID‐19 and control groups in terms of pruritus, eczema, skin infections, and urticaria (P values were .117, .517, .181, .505, and 1.000, respectively). In conclusion, although it is not statistically significant, it appears that pruritus and leukocytoclastic vasculitis are more common in severe COVID‐19 patients. These cytokines‐related diseases in the immuno‐cutaneous systems may give some clues on the COVID‐19 severity. Further studies are required to elucidate the relationship between the immuno‐cutaneous system and COVID‐19 severity.     

Microvascular Complications in Adolescents with Type 1 Diabetes Mellitus

Objective: Screening of complications is an important part of diabetes care. The aim of this study was to investigate diabetic complications and related risk factors in adolescents with type 1 diabetes mellitus (T1DM).Methods: This cross-sectional study was conducted on type 1 diabetics who were over 11 years of age or had a diabetes duration of 2 years and included 155 adolescents with T1DM (67 male, 88 female). The mean age of the patients was 14.4±2.1 years. Mean diabetes duration was 6.3±2.9 years. The patients were screened for diabetic nephropathy, retinopathy and peripheral neuropathy.Results: Mean glycosylated hemoglobin (HbA1c) level of the study group was 8.4%. The frequency of microalbuminuria and peripheral neuropathy were 16.1% and 0.6%, respectively. None of the patients had diabetic retinopathy. Dyslipidemia and hypertension rates were 30.3% and 12.3%, respectively. Risk factors associated with microalbuminuria were hypertension, higher HbA1c levels, longer diabetes duration and dyslipidemia.Conclusion: Early diagnosis and treatment of hypertension and dyslipidemia as well as achieving a better metabolic control are important in prevention or postponement of complications in patients with T1DM. Yearly screening for diabetic nephropathy should be started 2 years after the onset of the diabetes. Conflict of interest:None declared.