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Öğe Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men(Taylor & Francis Ltd, 2019) Bilgin, Satılmış; Aktaş, Gülali; Koçak, M. Zahid; Atak, Burçin M.; Kurtkulağı, Özge; Duman, Tuba T.; Şavlı, HalukAim: Hemogram indices were proposed as novel inflammatory markers in chronic conditions and inflammation has substantial role in the pathogenesis of type 2 diabetes mellitus (T2DM). We aimed to observe hemogram parameters of type 2 diabetic male subjects with various age groups in well and poorly controlled subsets. Methods: Data of type 2 diabetic men enrolled to the study were recorded from patient files of the institution. Study population were grouped into three according to the age. Group A was consisted of patients younger than 55 years, Group B was consisted of patients aged between 55 and 64 years, and Group C was consisted of patients aged 65 years or older. Data of the study groups were compared. Results: Study population was consisted of 130 subjects; 44 in Group A and 43 in each of Groups B and C. Median red cell distribution width (RDW) (p = .04), mean RDW to platelet ratio (RPR) (p = .006), median mean platelet volume to platelet ratio (MPR) (p = .02) levels of the study groups were statistically different. HbA1c level was significantly and positively correlated with RDW (r = 0.45, p < .001), neutrophil to lymphocyte ratio (NLR) (r = 0.47, p < .001), mean platelet volume to lymphocyte ratio (MLR) (r = 0.35, p < .001), MPR (r = 0.26, p = .003), and RPR (r = 0.37, p < .001) levels. Conclusion: Elevated RDW, NLR, MLR, MPR, and RPR levels in diabetic men should trigger the measurement of HbA1c since each were strongly correlated with HbA1c level. Moreover, elevated RDW, NLR, MLR, and RPR could be marker of worse diabetic control in men with T2DM.Öğe A case of sitagliptin-induced mild acute pancreatitis(Coll Physicians & Surgeons Pakistan, 2018) Koçak, Mehmet Zahid; Aktaş, Gülali; Erkuş, Edip; Duman, Tuba T.; Atak, Burçin M.; Şahin, Deniz; Şavlı, HalukAcute pancreatitis (AP) is characterised by inflammatory destruction of the gland due to early activation of the pancreatic proteolytic enzymes. Drug-induced AP accounts for only 0.1-2 % of AP.1 One of these drugs is dipeptidyl peptidase-4 inhibitor (DPP-4i). Association between AP and Sitagliptin, a DPP-4i, was initially described in a transgenic rat model.2 We aim to present a case of AP in a diabetic elderly, which was likely associated with Sitagliptin treatment.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 Millennium pandemic: A Review of coronavirus disease (COVID-19)(2020) Bilgin, Satılmış; Kurtkulağı, Özge; Kahveci, Gizem Bakir; Duman, Tuba T.; Tel, Burçin Meryem AtakCoronaviruses, a large family of single-stranded RNA viruses, can infect humans and animals, and can cause neurological, gastrointestinal and hepatic diseases as well as causing various lung diseases, including pneumonia, with shortness of breath, cough and fever. At the end of December 2019, a group of health authorities reported unidentified cases of pneumonia in a seafood market in Wuhan, China. The World Health Organization (WHO) used term 2019 novel coronavirus (COVID-19) to refer to a coronavirus that affected the lower respiratory tract of patients with pneumonia in Wuhan, China on 29 December and the WHO announced that the official name of the 2019 novel coronavirus was coronavirus disease (COVID-19). COVID-19 is seen in many countries around the World and has been accepted as a pandemic by WHO. It is defined as a suspicious case with fever, sore throat, cough, and people with a history of traveling to China or some parts of the country, or someone who contact with a patient who has a history of travel in China or contact with a confirmed COVID-19 infection patient. Currently, there is no proven vaccine or antiviral therapy that can be used against animal or human coronavirus. To control the outbreak, the drugs must be developed as soon as possible. Various drugs have been used in the treatment of COVID-19 and the main ones are chloroquine, remdesivir, lopinavir/ritonavir, oseltamivir, favipiravir. Since the virus affects the whole World, vaccines and/or new curative antiviral drugs are needed to end the pandemic. For this purpose, large-scale observational studies are needed.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.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 Role of N-terminal pro b-type natriuretic peptide (NT-pro-BNP) in compensated chronic kidney disease(2020) Duman, Tuba T.; Tekçe, Hikmet; Tekçe, Buket KinAim: To evaluate the role of N-terminal pro b-type natriuretic peptide (NT-pro-BNP) in the evaluation of hypervolemia in chronic kidney disease (CKD) and its relationship with CKD. Methods: Sixty compensated chronic kidney disease patients enrolled in this study. NT-pro BNP levels and other routine biochemical laboratory parameters are studied. The associations between results were analyzed. Results: NT-pro BNP levels were correlated with urea (r = 0.66, p <0.01), creatinine (r = 0.69, p <0.01) and phosphorus (r = 0.36, p <0.01) values and were negative correlated with hemoglobin (r = -0.32, p = 0.01), hematocrit (r = -0.36, p <0.01), albumin (r = -0.29, p = 0.02) and glomerular filtration rate (GFR) values (r = -0.35, p <0.01). Conclusion: The positive correlation between NT-pro BNP levels and urea and creatinine values in our study and the negative correlation with GFR support that the severity of hypervolemia increases as the CKD stage progresses. BNP and NT-pro BNP are strong predictors of all-cause cardiovascular mortality in asymptomatic CKD patients. In the light of all these data, it is possible to suggest that NT-pro BNP is associated with hypervolemia and therefore increased cardiovascular mortality in subjects with CKD.Öğe Type 2 diabetes mellitus is more commonly well controlled in younger men compared to older men(Taylor & Francis Ltd, 2019) Koçak, M. Zahid; Aktaş, Gülali; Duman, Tuba T.; Atak, Burçin M.; Bilgin, Satılmış; Kurtkulağı, Özge; Şavlı, HalukAims: Type 2 Diabetes Mellitus (T2DM) is nearly epidemic worldwide. Greater skeletal muscle mass in men is protective against the development of T2DM compared to women, however, nutritional diversity, stress levels and other factors also affects this situation. In present retrospective study, we aimed to observe diabetic control level, metabolic parameters and general characteristics of type 2 diabetic men and to compare these values in middle aged and elderly diabetic population. Methods: The male patients with T2DM that admitted to the outpatient internal medicine clinics of our institution between November 2018 and April 2019 were included to the study. According to the age, study population divided into two groups; either younger than 60 years (group I) and 60 years or older (group II). Study parameters were compared between study groups. Results: Fasting plasma glucose (FPG) and glycated Hb level (HbA1c) of group I were lower than those of the group II (p = 0.004 for FPG and p = 0.048 for HbA1c). Control level of T2DM was defined as well controlled in 20 (29%) patients in group I and 5 (10.9%) patients in group II (p = 0.02). Conclusion: Physicians should aware that well controlled T2DM is more common among younger diabetic men compared to older men and try to enhance diabetic regulation level in elderly men by interventions that aimed to improve skeletal muscle or by pharmacologic agents.
