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Öğe Characteristics of the type 2 diabetic patients with hypoglycemia in a tertiary referral hospital(Zaslavsky Publishing House, 2021) Bilgin, Satilmis; Aktas, Gulali; Kurtkulagi, Ozge; Atak, Burcin M.; Kahveci, Gizem; Demirkol, Muhammed E.; Duman, Tuba T.Background. Hypoglycemia is an important complication of the treatment of type 2 diabetes mellitus, which constitutes a barrier in stringent diabetic control. Beside it constitutes nearly 10 % of emergency department admissions that caused by adverse drug events, it may also increase morbidities and mortality by inducing, cardiac arrhythmias, neurological impairment and ischemic events. Hypoglycemia is the most common side effect of insulin treatment, however, oral antidiabetic agents may also induce hypoglycemic complications. In present retrospective study, we purposed to observe general characteristics and laboratory data of the type 2 diabetic patients whom presented with mild or moderate/severe hypoglycemia. Materials and methods. Patients with type 2 diabetes mellitus whom presented to our institution with hypoglycemia between January 2019 and January 2020 were retrospectively analyzed. General characteristics and laboratory data of the subjects recorded. Patients grouped into two groups, group I consisted of subjects with mild hypoglycemia and group II consisted of patients with moderate/severe hypoglycemia. Data of the subjects in groups I and II were compared. Results. There were 15 subjects in group I and 23 in group II. HbA1c and other laboratory markers were not significantly different in study groups. Similarly diabetes duration and anti-diabetic treatment were not significantly different in study groups. The rate of geriatric patients was significantly higher in group II compared to group I (p = 0.04). Conclusions. Subjects with moderate/severe hypoglycemia tend to be more frequently in geriatric age and HbA1c not correlates with the degree of the hypoglycemia. Since neither duration of diabetes, nor anti-diabetic treatment were associated with the severity of the hypoglycemia, each case should be evaluated individually to prevent further episodes which could increase morbidity and mortality in diabetic population. © 2021. The Authors.Öğe Compliance to levothyroxine treatment of the patients with hypothyroidism during SARS-CoV-2 pandemic era(Zaslavsky Publishing House, 2021) Bilgin, Satilmis; Meryem, Burcin; Tel, Atak; Duman, Tuba Taslamacioglu; Kurtkulagi, Ozge; Kahveci, Gizem Bakir; Sagdic, TugrulBackground. Hypothyroidism requires treatment with levothyroxine (L-T4) to keep patients euthyroid. The rate of hospital admissions for chronic conditions decreased during COVID-19 era. We aimed to observe whether hospital admissions of the patients with hypothyroidism decreased during COVID-19 compared to the same time period in 2019. We also aimed to find out the rate of treatment compliance in subjects with hypothyroidism during pandemic era. Materials and methods. This cross-sectional study was performed on patients who applied to Internal Medicine Department of Abant Izzet Baysal University Hospital, and who received L-T4 replacement therapy due to hypothyroidism. 108 hypothyroidism patients were included in the study with their consent forms. The patients were divided into 2 groups according to the treatment compliance; either as compliant or incompliant patients. Results. The last TSH level of compliant group was significantly lower than incompliant group (p < 0.001). The last fT4 level of the compliant group was significantly higher than that of the incompliant group (p = 0.04). The median of the LT-4 treatment used irregularly was 35 (10–90) days in incompliant group and was 0 (0–0) days in compliant group (p < 0.001). The number of irregularly L-T4 used days was significantly positively correlated with last TSH value (r = 0.564, p < 0.001), and negatively correlated with last FT4 value (r = –0.492, p < 0.001). Mean corpuscular volume (MCV) of the compliant and incompliant groups were 85 (69.1–97.5) fL and 89 (66–96.6) fL, respectively (p = 0.03). Retrospective nature and relatively small study population are two main limitations of our study. Conclusions. Compliance to treatment is very important to achieve euthyroid hormone levels in patients with hypothyroidism during COVID-19 pandemic. Elevated MCV levels could predict incompliance to treatment in hypothyroidism. © 2021. The Authors.Öğe Could triglyceride to high density lipoprotein-cholesterol ratio predict hepatosteatosis?(2021) Kurtkulaği, Özge; Bilgin, Satilmis; Kahveci, Gizem; Tel, Burçin Meryem Atak; Kösekli, Mehmet AliAim: The triglyceride / HDL cholesterol (TG/HDL-c) ratio is increased in a variety of diseases including, coronary heart disease and type 2 diabetes mellitus. However, its role in non-alcoholic hepatosteatosis is not well understood. In present study, we aimed to compare the TG/HDL-c levels of the patients with non-alcoholic hepatosteatosis to those of the healthy subjects. Methods: Medical data of the patients with non-alcoholic hepatosteatosis whom presented to the outpatient internal medicine clinics of our institution were retrospectively analyzed. Healthy subjects whom admissions to our clinics were due to check up were enrolled to the study as control group. TG/HDL-c of the groups compared. Results: TG/HDL-c level of the liver steatosis group (5 (2-22) %) was higher than the control group (2.7 (1-8) %), (p<0.001). TG/HDL-c was significantly and positively correlated with fasting blood glucose (r=0.31, p<0.001), C - reactive protein (r=0.25, p<0.001) and LDL-cholesterol (r=0.3, p<0.001) levels. A TG/HDL-c value greater than 3.1% has 91% sensitivity and 77% specificity in detecting hepatosteatosis. Conclusions: We suggest that TG/HDL-c ratio could be a useful marker of non-alcoholic hepatosteatosis due to its inexpensive and easy to assess nature.Öğe Diagnostic Value of HALP Score in Detecting Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus(Thieme Medical Publ Inc, 2024) Tel, Burcin Meryem Atak; Tel, Mustafa Ramiz; Bilgin, Satilmis; Duman, Tuba Taslamacioglu; Aktas, GulaliIntroduction Hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been used to predict the prognosis in several types of cancers for the last few years. We aimed to reveal whether HALP score has high sensitivity and specificity in the detection of diabetic nephropathy. Methods A cross-sectional study developed in Abant Izzet Baysal University Hospital in Bolu, Turkiye. Patients with type 2 diabetesmellitus (DM) were enrolled in the study. Study cohort included patients with diabetic nephropathy and patients without diabetic nephropathy. Pregnant women, subjects with malignancy, active infections conditions, and rheumatologic or hematologic diseases were excluded. We retrospectively analyzed and compared the HALP scores of the type 2 DM patients with and without diabetic nephropathy. Moreover, we sought correlation between HALP score and fasting glucose, glycated hemoglobin (HbA1c), and estimated glomerular filtration rate (eGFR). Results A total of 356 DM patients, 162 with nephropathy and 194 without nephropathy were included in the study. The HALP score was 44.86 (4.5-119.9) in the nephropathic group, while it was 55.14 (13.2-173.7) in the nonnephropathic group (p < 0.001). HALP score was negatively correlated with HbA1c (r = -0.66, p - 0.003) and fasting glucose (r = -0.65, p = 0.002), while positive correlation was found between HALP score and eGFR (r = 0.13, p = 0.02). HALP score lower than 45.9% have 73% sensitivity and 52% specificity in detecting diabetic nephropathy (area under the curve: 0.64, p<0.001, 95% confidence interval: 0.59-0.70). Conclusion We suggest that HALP score can become a simple and easy to assess marker for diabetic nephropathy in addition to standard tests.Öğe Evaluation of the relationship between the prealbumin/fibrinogen ratio and diabetic nephropathy in patients with type 2 diabetes mellitus(Amer Inst Mathematical Sciences-Aims, 2024) Tel, Burcin Meryem Atak; Tel, Ramiz; Duman, Tuba; Bilgin, Satilmis; Kaya, Hamza; Bardak, Halil; Aktas, GulaliIntroduction: Our aim was to compare the prealbumin/fibrinogen ratio (PFR) of diabetic patient populations with or without diabetic nephropathy. Materials and methods: People with type 2 diabetes who attended the internal medicine outpatient clinic were enrolled in the study. Two groups were formed according to the proteinuria of the patients: Diabetic nephropathy and non-nephropathy group. Diabetic nephropathy was calculated using the mathematical formula of spot urine albumin/spot urine creatinine x100. Patients with proteinuria above 200 mg/g were considered to have nephropathy. PFR was simply calculated by dividing prealbumin by fibrinogen. Results: A total of 152 patients who attended our outpatient clinic were enrolled in the study. There were 68 patients in the diabetic nephropathy group and 84 in the non-nephropathy group. The prealbumin/fibrinogen ratios (PFR) were significantly lower in the nephropathic group [0.061 (0.02-0.16)] than the non-nephropathic group [0.0779 (0.01-0.75)] (p = 0.002). Conclusions: We suggest that decreased levels of PFR can indicate diabetic nephropathy in subjects with type 2 diabetes mellitus.Öğe Platelet to lymphocyte ratio in differentiation of benign and malignant thyroid nodules(2021) Bilgin, Satilmis; Kahveci, Gizem; Tel, Burçin Meryem Atak; Kurtkulaği, Özge; Kösekli, Mehmet AliAim: Differentiation of thyroid nodules, either as benign or malignant, is a real diagnostic challenge.Inflammation has an important role in development of the malignancy. Therefore, inflammatory markers areassociated with malignant thyroid nodules. Platelet /lymphocyte ratio (PLR) is also one of the novelinflammatory indices derived from hemogram tests. We hypothesized whether PLR was associated withmalignant thyroid nodules. For this purpose, we compared PLR levels of the patients with benign thyroidnodules to the PLR of the subjects with malignant nodules.Methods: The subjects who visited outpatient internal medicine clinics of our institution with a diagnosis ofthyroid nodule were enrolled to the present retrospective study. According to the examination of the fine needleaspiration cytology (FNAC) specimen of the nodules, patients grouped into benign or malignant nodule groups.PLR of groups were compared.Results: Median PLR values of the benign and malignant thyroid nodule groups were 106 (48-432) % and 119(48-365) %, respectively (p=0.001). PLR value higher than 106% has 69% sensitivity and 51% specificity indetecting malignant nodules (AUC: 0.59, p=0.001, 95% CI: 0.54-0.65). PLR was positively correlated withTSH level (r=0.10, p=0.34).Conclusion: We suggest that elevated PLR could be an additional tool to differentiate malignant thyroidnodules from benign ones in supportive of sonography, scintigraphy and cytology.Öğe Primary hyperaldosteronism as a rare cause of hypokalemia(National Academy of Medical Science and Ministry of Health of Ukraine, 2020) Kurtkulagi, Ozge; Aktas, Gulali; Kocak, M. Zahid; Atak, Burcin M.; Duman, Tuba T.; Bilgin, Satilmis; Savli, HalukPrimary hyperaldosteronism (PHA) is a syndrome characterized by increased aldosterone release and suppressed renin-angiotensin cascade. Hypertension, alteration in potassium homeostasis, and target tissue damage are characteristic features of the disease. The importance of recognizing PHA is due to the fact that it has a very negative cardiovascular and renal effect which can result in death. In this case report, we present a patient with resistant hypokalemia whom consequently diagnosed with PHA. A 54-year-old female patient who was scheduled for operation due to congenital hip dislocation was found to have decreased serum potassium in her preoperative laboratory tests. Therefore, the patient was referred to the internal medicine outpatient clinic with a serum potassium value of 2.1 mmol/L. Her systolic and diastolic blood pressures were 150 and 90 mmHg, respectively. On electrocardiogram, prominent U waves were noted. Therefore, potassium replacement was initiated at once by intravenous route. The potassium value in spot urine was 12.4 mmol/L. A 24 hour urine collected and urinary potassium excretion in 24 hours of urine was detected as 15 mmol/L, which means transtubular potassium gradient was greater than 4 mmol/L. Since she was hypertensive during clinical follow up in the ward, hypertension along with hypokalemia raised the clinical suspicion of hyperaldosteronism. Serum aldosterone renin ratio was measured as 155 %. A computerized tomography scan revealed (22 × 16 mm) neoplasm which was suggestive of adrenal adenoma in the right adrenal gland. Cushing Syndrome was ruled out with a normal cortisol level and pheochromocytoma was ruled out by normal levels of metanephrine in the 24 hours of urine. Spironolactone 50 mg was initiated and serum potassium was raised to normal range. She scheduled for unilateral adrenalectomy and discharged with full recovery of hypokalemia. Since PHA has undesired cardiovascular and renal effects which may increase mortality and morbidity, establishing the diagnosis as soon as possible is crucial. Hypertensive patients with hypokalemia or adrenal incidentaloma or obstructive sleep apnea syndrome, resistant hypertensive subjects, patients with moderate or severe hypertension, and hypertensive patients with a family history of PHA should undergo screening for PHA. In conclusion, we suggest that PHA should be kept in mind in differential diagnosis of the patients with hypertension and hypokalemia. © 2020 National Academy of Medical Science and Ministry of Health of Ukraine. All rights reserved.
