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Öğe The association between vitamin d levels and handgrip strength in elderly men(Editura Acad Romane, 2020) Koçak, Mehmet Zahid; Aktaş, Gülali; Atak, Burçin Meryem; Bilgin, Satılmış; Kurtkulağı, Özge; Duman, Tuba Taslamacıoğlu; Özçil, İrem EmirContext. Vitamin D is a steroid hormone that acts by binding to the vitamin D receptor (VDR) found in many tissues. According to the long-term mechanism, vitamin D causes the proliferation and differentiation of muscle cells by gene transcription. Objective. We aimed to evaluate the relationship between muscle strength and serum vitamin D levels in elderly men. Design. Cross-sectional study. Subjects and Methods. Male patients over age 50 were included in the study. Study population was divided into 2 groups with handgrip strength according to body mass index, either as subjects with weak or with normal handgrip strength test (HGST). Vitamin D levels and other variables compared between weak and normal groups. Results. Vitamin D level of weak and normal groups were 75 (3-19.9) mu g/L, and 11.6 (11.6-34.9) mu g/L, which means significant reduced vitamin D levels in weakness group (p=0.01). Vitamin D levels were significantly correlated with HGST levels (r:0.362, p=0.001). Vitamin D levels were found to be an independent predictor of weakness according to HGST in logistic regression analysis (OR: 0.453, 95% CI:0.138-0.769, p=0.05). Conclusions. Low vitamin D level is an independent risk factor for muscle weakness in men aged more than 50 years. Therefore, vitamin D levels should be screened and early replacement should be initiated for the sake of improvement of muscle strength in elderly subjects that vulnerable for frailty.Öğe Combined antihypertensive treatment is better than mono-therapy in hypertensive patients(Van Zuiden Communications, 2020) Kurtkulağı, Özge; Aktaş, Gülali; Bilgin, Satılmış; Atak, Burçin Meryem; Duman, Tuba Taslamacıoğlu; Demirkol, Muhammed EminBackground: Hypertension (HT) is a chronic condition associated with serious complications. In the present cross-sectional study, we aimed to analyse factors that contribute to blood pressure control in subjects with HT. Methods: Subjects with HT admitted to outpatient internal medicine clinics of the institution were enrolled in the study. According to the Joint National Committee (JNC) VIII criteria, subjects with a mean blood pressure above target levels were defined as poorly-controlled hypertensive patients and others were grouped as well-controlled hypertensive patients. Clinical and laboratory parameters were compared between study groups. Results: Smokers were more prevalent in the poorly-controlled HT group compared to the well-controlled HT group (p = 0.001). The number of patients who adhered to dietary and exercise recommendations were greater in well-controlled HT group than poorly-controlled HT group (p < 0.001 for both). The rate of combined therapy was greater in well-controlled HT group compared to poorly-controlled HT group (p = 0.04). Conclusions: We suggest that, in addition to dietary and exercise recommendations and smoking cessation, treatment with combination therapy could be better in reaching blood pressure targets in patients with HT.Öğe Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels(Assoc Medica Brasileira, 2019) Erkuş, Edip; Aktaş, Gülali; Koçak, Mehmet Zahid; Duman, Tuba Taslamacıoğlu; Atak, Burçin Meryem; Şavlı, HalukOBJECTIVE: Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS: Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS: Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION: Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.Öğe Edmonton frail score is associated with diabetic control in elderly type 2 diabetic subjects(Springer International Publishing Ag, 2020) Bilgin, Satılmış; Aktaş, Gülali; Kurtkulağı, Özge; Atak, Burçin Meryem; Duman, Tuba TaslamacıoğluPurpose We aimed to observe clinical and laboratory indices of the diabetic subjects who were either frail or not according to Edmonton frail score. We also aimed to study whether Edmonton frail score was correlated with metabolic and other parameters of the diabetic subjects. Methods Patients with T2DM visited our clinic were enrolled to the study and grouped as either frail or not frail according to the Edmonton score. Clinical and laboratory parameters of the groups were compared. Results Serum triglyceride (p = 0.04), serum albumin (p = 0.006) and Glomerular Filtration Rate (GFR) (p = 0.01) were significantly lower, while fasting blood glucose (FBG) (p = 0.02), HDL cholesterol (p = 0.005) and glycated hemoglobin (HbA1c) (p = 0.04) were significantly higher in frail group compared to the not frail patients. Edmonton frail score was positively correlated with HbA1c, age, duration of T2DM, FBG, and negatively correlated with serum albumin and GFR levels. Conclusions We think that frailty is associated with poor glucose control in subjects with T2DM and better control of the disease may prevent or slow down the development of frailty, as well as microvascular complications in subjects with type 2 diabetes mellitus.Öğe Haemogram parameters in vitamin D deficiency(Coll Physicians & Surgeons Pakistan, 2018) Erkuş, Edip; Aktaş, Gülali; Atak, Burçin Meryem; Koçak, Mehmet Zahid; Duman, Tuba TaslamacıoğluObjective: To study haemogram derived inflammatory indices, mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) in vitamin D deficient patients and to compare to those subjects with normal vitamin D levels. Study Design: Descriptive study. Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from March to May 2017. Methodology: Patients' data visiting the outpatient clinics of the institution was retrospectively obtained from patients' files and computerised database. Subjects were grouped into normal vitamin D and vitamin D deficiency groups, according to the serum Vitamin D levels. Seasonal threshold value for vitamin D in Bolu region was set as 10 ng/ml. General characteristics and laboratory data of the study population were recorded and compared. Results: Vitamin D deficiency was more common in subjects working inside as compared to those working outside (p=0.02), and in subjects with comorbidities compared to those without comorbidities (p= 0.31). Body mass index (BMI), MPV, NLR were significantly higher in vitamin D deficient group as compared to subjects with normal vitamin D levels. A MPV greater than 6.22 has 89% sensitivity and 55% specifity for vitamin D deficiency, and NLR greater than 1.69 has 76% sensitivity and 55% specifity for vitamin D deficiency. Conclusion: Elevated MPV and NLR may be the indicator of underlying serious vitamin D deficiency. Physicians should be alert and order a vitamin D assay in patients with elevated MPV or NLR, especially in endemic areas for vitamin D deficiency.Öğe Mean Platelet Volume (MPV) as an inflammatory marker in type 2 diabetes mellitus and obesity(Univ Udayana, 2018) Aktaş, Gülali; Koçak, Mehmet Zahid; Duman, Tuba Taslamacıoğlu; Erkuş, Edip; Atak, Burçin MeryemBackground: Type 2 diabetes mellitus and obesity are two important disorders which are associated with the enormous amount of morbidity and mortality. Inflammation plays a crucial role in development and complications of these diseases. Aim: We aimed to compare mean platelet volume (MPV) as an inflammatory marker in well and poorly controlled type 2 diabetic subjects and to observe its association with obesity indices, body mass index (BMI) and waist circumference. Method: Data of type 2 diabetic patients obtained from institutional database retrospectively analyzed. Patients were divided into two groups according to the HbA1c level as follows: HbA1c lower than 7% were classified as well-controlled, and HbA1c equal to or greater than 7% were classified as poorly controlled diabetics. Result: Both MPV, body mass index (BMI) and waist circumference were significantly higher in poorly controlled diabetics compared to patients with well-controlled type 2 DM. Conclusion: MPV could be considered as a marker of inflammatory burden in type 2 DM and obesity. Due to its cost-effective and easy to assess nature, MPV may be screened periodically in these patients, along with HbA1c and other measures to keep both physicians and patients aware of the inflammatory load of these diseases.Öğe Mean platelet volume to lymphocyte ratio as a novel marker for diabetic nephropathy(Coll Physicians & Surgeons Pakistan, 2018) Koçak, Mehmet Zahid; Aktaş, Gülali; Erkuş, Edip; Duman, Tuba Taslamacıoğlu; Atak, Burçin MeryemObjective: To compare mean platelet volume to lymphocyte ratio (MPVLR) of diabetic nephropathy subjects to those diabetics without diabetic nephropathy. Study Design: Observational, cross-sectional study. Place and Duration of Study: Tertiary referral hospital, in Bolu, Turkey, from July to December 2017. Methodology: Patients with type 2 diabetes mellitus admitted to the Internal Medicine Clinic, were included. Patients were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. MPVLR was calculated mathematically by division of MPV by lymphocyte count. Results: There were 162 subjects (79 females, 83 males). The MPVLR in patients with diabetic nephropathy and non-nephropathic diabetic groups were 4.1 (2.09-11.84) and 3.4 (1.37-25.56), respectively. The difference was reached statistically significant level (p<0.001). The best cut-off value for MPVLR was 3.66 (AUC=0.733, p<0.001); MPVLR predicted diabetic nephropathy with 71.1% sensitivity and 67.4% specificity, at this level. Conclusion: The MPVLR is an easily calculated and efficient index that can be considered a powerful and independent predictor of diabetic nephropathy in diabetic patients. We suggest that, it can be useful adjunct to standard tests in the diagnosis of diabetic nephropathy.Öğe Monocyte lymphocyte ratio as a predictor of diabetic kidney injury in type 2 diabetes mellitus; The MADKID Study(Springer International Publishing Ag, 2020) Koçak, Mehmet Zahid; Aktaş, Gülali; Duman, Tuba Taslamacıoğlu; Atak, Burçin Meryem; Kurtkulağı, Özge; Tekçe, Hikmet; Bilgin, SatılmışAims Inflammation is a cardinal pathogenetic mechanism in diabetic kidney injury (DKI). The detection of microalbuminuria (MA) is very important in preventing end-stage renal failure in diabetic subjects. A combination of high monocyte and low lymphocyte counts are used as a marker of inflammation. Monocyte to lymphocyte ratio (MLR) is considered as a marker in inflammatory diseases. We aimed to evaluate the MLR levels in diabetic subjects as a predictive marker in detecting MA. Methods A total of 212 patients with type 2 diabetes mellitus (T2DM) were included in the study. Patients with T2DM were divided into two groups as MA and normoalbuminuria (NA). MLR of the groups were compared. Results There were 72 patients in MA and 140 patients in NA group. MLR of the MA and NA groups were 0.247 (0.131-0.540) and 0.211 (0.052-0.390), respectively (p < 0.001). There was a statistically significant correlation between MLR and MA (r = 0.228, p = 0.001). In multivariate backward logistic regression analysis, MLR, fasting blood glucose, HbA1c and presence of comorbid clinical diseases were determined as independent predictors of DKI. Conclusions We suggest that MLR could serve as a predictive and effective marker for DKI in diabetic subjects due to its strong correlation with MA and inexpensive and readily available nature.Öğe Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus(Makerere Univ, Fac Med, 2019) Duman, Tuba Taslamacıoğlu; Aktaş, Gülali; Atak, Burçin Meryem; Koçak, Mehmet Zahid; Erkuş, Edip; Şavlı, HalukBackground: Type 2 diabetes mellitus is associated with chronic low grade inflammation. One of the novel inflammatory markers is hemogram derived neutrophil to lymphocyte ratio (NLR). Objective: We aimed to compare NLR levels of diabetic subjects and healthy controls and to observe possible correlation between NLR and HbA1c. Methods: Medical data of type 2 diabetic subjects admitted to out-patient clinics of our institution between April to July in 2017 were obtained from database and retrospectively analyzed. Control group was chosen from healthy subjects who visited our institution for a routine check-up. Anthropometric measures, laboratory data, including, HbA1c, NLR were recorded. Results: Median NLR of the type 2 DM group 2.44 (1.9) was significantly elevated when compared to healthy controls (1.5 (0.9), (p<0.001). In addition, a Pearson's correlation test revealed that NLR was strongly correlated with age (r=0.26, p=0.008), fasting plasma glucose (r=0.38, p<0.001), and HbA1c (r=0.49, p<0.001). Conclusion: Elevated NLR in otherwise healthy subjects may be indicative of underlying impaired glucose metabolism and moreover, NLR should be used as a marker of diabetic control level in addition to HbA1c in type 2 diabetic subjects.Öğe A rare non-hemolytic case of idiopathic cold agglutinin disease(Clin Lab Publ, 2018) Erkuş, Edip; Koçak, Mehmet Zahid; Aktaş, Gülali; Özen, Mehmet; Atak, Burçin Meryem; Duman, Tuba T.; Tekçe, Buket Kın; Şavlı, HalukBackground: Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. Methods: We studied a peripheral blood smear and repeated the hemogram test at 37 degrees C to establish the diagnosis of cold agglutinin disease. Results: Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/jiL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37 degrees C and the test results showed RBC: 3.4 M/mu L, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. Conclusions: Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.Öğe Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus(Taylor & Francis Ltd, 2019) Aktaş, Gülali; Koçak, Mehmet Zahid; Bilgin, Satılmış; Atak, Burçin Meryem; Duman, Tuba Taslamacıoğlu; Kurtkulağı, ÖzgeAim: Despite it has some disadvantages, the most important marker of diabetic control is glycated hemoglobin (HbA1c). Uric acid to HDL cholesterol ratio (UHR) is a promising marker in metabolic syndrome. We aimed to compare UHR levels of well and poorly controlled type 2 diabetic male subjects, as well as healthy men, and to observe its correlation with other metabolic parameters. Methods: Male patients with T2DM that showed up in outpatient internal medicine clinics of our hospital were enrolled to the study. Diabetic subjects divided into two groups according to the level of HbA1c: well-controlled T2DM group (HbA1c?
