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Öğe Acute effects of thyroid gland palpation on parathyroid hormone and ionized calcium levels(Amer Assoc Clinical Chemistry, 2008) Serin, Erdinç; Eren, Nezaket; Ciğerli, Şebnem; Köybaşı, Serap; Kanat, Mustafa; Çağlayan, Mustafa[No Abstract Available]Öğe A case of hypothyroidism mimicking acute coronary syndrome(2006) Gündüz, Hüseyin; Arınç, Hüseyin; Yolcu, Mustafa; Akdemir, Ramazan; Kanat, Mustafa; Uyan, CihangirHypothyroid patients have increased concentrations of creatinine kinase that is mostly due to increased CK-MM. However, CK-MB has also been reported to increase above reference values in hypothyroid patients without apparent myocardial damage. This may create confusion during the evaluation of myocardial injury in a hypothyroid patient presenting with chest pain. Troponin I is considered as a superior marker for the diagnosis of myocardial infarction in hypothyroid patients. However, there are some reports showing an increase in the level of troponin I without any myocardial damage in hypothyroid patients as in our case. In this report, we present a 47 years old male hypothyroid patient who had chest pain, abnormal electrocardiographic findings and increased cardiac enzymes suggesting acute coronary syndrome although he had normal coronary arteriogram. © Springer 2005.Öğe A Case of Methimazole Induced Leukocytoclastic Vasculitis(Galenos Yayincilik, 2005) Kanat, Mustafa; Goksugur, Nadir; Parlak, Ali HaydarAntineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis has been described frequently in patients treated with propylthiouracil (PTU). However, other antithyroid drugs, carbimazole and methimazole (MMI), rarely cause vasculitis. We report a case of MMI induced ANCA negative leukocytoclastic vasculitis.Öğe Clinical implications of the DREAM study: Response to Davidson [14](2007) Kanat, MustafaThe following points should be taken into consideration when determining “what circumstances TZDs [thiazolidinediones] should be used in people without documented diabetes,” as questioned by the commentary published in the February issue of Diabetes Care (1). The DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) study (2) has limitations that prevent generalizations for individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). In this study, individuals with IFG (n = 739), IGT (n = 3,028), or both (n = 1,502) were included (3), and patient recruitment was completed between July 2001 and August 2003. Because these dates are earlier than November 2003 (4), when the American Diabetes Association accepted IFG as ≥100 mg/dl (5.6 mmol/l) and <126 mg/dl (7.0 mmol/l), individuals with glucose levels of ≥6.1 mmol/l (110 mg/dl) and <7.0 mmol/l (126 mg/dl) were included in the study. Since the inclusion criteria (3) for the DREAM study included a fasting plasma glucose concentration ≥6.1 mmol/l, this affects both the selection of glucose-loaded patients as well as the patients who were included in the study as IFG in terms of increased risk of development of diabetes, as there is an inverted U-shaped curve relationship between fasting blood glucose level and mean plasma insulin concentration, also called Starling's curve of the pancreas. Glucose-stimulated insulin response begins to decline at a fasting glucose concentration of ∼110–120 mg/dl as a sign of failing of compensatory insulin response (5). Subsequently, the effectiveness of rosiglitazone in this group (6.1 mmol/l ≤ IFG <7 mmol/l), which has already been approved for the treatment of diabetes, is an expected result. However, one cannot assume that rosiglitazone will be more affective than placebo in groups that have low risk of developing diabetes (5.6 mmol/l ≤ IFG <6.1 mmol/l).Öğe The effect of feto-maternal blood type incompatibility on development of gestational diabetes mellitus(Societa Editrice Universo, 2014) Kanat, Mustafa; Göksügür, Sevil Bilir; Özlü, Tülay; Tunçkale, Aydın; Öztürk, B.; Karagöz, YalçınObjective. To assess the relation between fetal and maternal blood type (ABO, Rh) incompatibility and development of gestational diabetes mellitus (GDM). Materials and Methods. A total of 500 pregnant women underwent diagnostic test for GDM by a 100-g oral glucose tolerance test (OGTT) after an 8 to 12-h overnight fast participated in this study. OGTT was performed between the 24-28 weeks of gestation, but participants who were at high risk for GDM were tested after the first prenatal visit. In the postpartum period, maternal and infant blood types were determined. Presence of GDM was evaluated in terms of matched and unmatched fetal and maternal ABO and Rh blood types separately. Results. GDM was detected in 235 participants. Unmatched ABO blood types between the mother-infant pairs were present in 44.7% (n=105) of GDM (+) and 35.8 % (n=95) of GDM (-) patients. Incompatible feto-maternal ABO blood type was positively correlated with development of GDM which was marginally significant. (p=0.045; R=1.2;95% CL; 1.004-1.48). However, Rh feto-maternal blood type incompatibility was not related with development of GDM. Conclusions. Feto-maternal ABO blood type incompatibility may be a weak risk factor for the development of GDM. © Società Editrice Universo (SEU).Öğe Evaluation of cardiac functions with tissue doppler imaging in prediabetic subjects(Korean Soc Cardiology, 2013) Kanat, Mustafa; Vardı, Şeref; Arınç, Hüseyin; Gündüz, Hüseyin; Erdem, Alim; Karagöz, YalçınBackground and Objectives: The aim of the present study was to evaluate left ventricle systolic and diastolic function, using tissue Doppler echocardiography (TDE), in relation to blood glucose status in prediabetic patients who had no evidence of heart disease by conventional echocardiography (CE). Subjects and Methods: We included 60 patients (30 female, 30 male) and 20 healthy controls (10 male, 10 female). All participants were randomised into four groups according to their oral glucose tolerance test. Group-I consisted of those patients who had only impaired fasting glucose (IFG). group-II consisted of patients who had only impaired glucose tolerance (IGT) and group-III consisted of patients who had both IFG and IGT, that is so-called combined glucose intolerance. Group-IV included the healthy controls. All subjects underwent both CE and TDE. Results: No significant differences were found among the four groups in terms of CE. There was no significant difference between group-IV and group-I with respect to the early peak diastolic velocity (Ea) of medial mitral annulus (11.65 +/- 0.66 vs. 9.72 +/- 1.58, p>0.05), whereas a statistically significant difference was found between group-IV and group-II (11.65 +/- 0.66 vs. 9.06 +/- 1.07, p<0.001) and between group-IV and group-III (11.65 +/- 0.66 vs. 9.74 +/- 1.09, p<0.05). Conclusion: Diastolic myocardial dysfunction in prediabetic patients may be identified by quantitative TDE before the appearance of CE indices of myocardial dysfunction.Öğe Evaluation of right ventricular function in patients with thyroid dysfunction(Karger, 2006) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Seyfeli, Ergün; Kanat, Mustafa; Özhan, Hakan; Akdemir, RamazanBackground: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. Patients and Methods: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. Results: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. Conclusions: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals.Öğe Heart rate variability and heart rate turbulence in patients with chronic obstructive pulmonary disease(Via Medica, 2009) Gündüz, Hüseyin; Talay, Fahrettin; Arınç, Hüseyin; Özyıldırım, Serhan; Akdemir, Ramazan; Yolcu, Mustafa; Kanat, MustafaBackground: In chronic obstructive pulmonary disease (COPD) patients, functional and structural changes of the respiratory system greatly influence cardiovascular autonomic functions. Determining autonomic balance may be important in understanding the pathophysiology of COPD and useful clinically in the treatment of COPD patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are useful tools in assessing the autonomic neurovegetative function. Our aim in this study was to evaluate the HRV and HRT variables in COPD patients. Twenty five moderate to severe COPD patients and 25 healthy subjects were included in this study. Methods: Pulmonary function tests and echocardiographic examination, arterial blood gases analysis were performed, HRV and HRT analysis were assessed from a 24-hour Holter recording. Results: When HRV and HRT parameters were compared, COPD patients had significantly decreased sNN50 total, pNN50, SDANN, SDNN, SDNNI, rMSDD in time domain HRV parameters, and the values of the HRT onset was significantly less negative in COPD patients. Although the values of the HRT slope were lower in COPD patients, there was no significant difference between the two groups. We also found a correlation between HRT and HRV parameters. Conclusions: In addition to HRV parameters, HRT onset was significantly different in COPD patients. In our opinion, the combination of HRV variables and HRT onset may be simple and elegant ways of evaluating cardiac autonomic functions. New investigations of HRT and HRV in COPD patients have a Potential importance for improving risk stratification and therapeutic approaches, and understanding the autonomic outcomes of the disease process. (Cardiol J 2009; 16, 6: 553-559)Öğe Intensive Lipid Reduction and Proinflammatory Markers in the MODEST Study(Galenos Yayincilik, 2010) Kanat, Mustafa; Yildiz, Ozcan; Tunckale, Ayd N.; Ceyhan, Banu Ozturk; Karagoz, Yalcin; Altuntas, Yuksel; Oguz, AytekinObjective: Statin therapy is well known to reduce inflammatory markers such as tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP). However, whether this relationship is maintained in the setting of targeting very low levels of LDL (<70 mg dl) in patients with type 2 diabetes has not been clearly established. Materials and Methods: We measured hsCRP, IL-6, and TNF-alpha in 43 subject enrolled into the multicenter, open-label, crossover prospective study evaluating the effects of lipid-lowering treatment on steroid synthesis in patients with type 2 diabetes (MODEST study). Subjects with diabetes and coronary artery disease were treated with 80 mg of atorvastatin for 12 weeks. The effect of treatment on pro-inflammatory markers was assessed after 12 weeks. Results: High-dose atorvastatin treatment significantly reduced the plasma levels of IL-6 and hsCRP (p<0.05, p<0.001, respectively), but not of TNF-alpha (p=0.051). Conclusion: Atorvastatin treatment targeting very low LDL-cholesterol level reduced the levels of several important inflammatory markers in patients with type 2 diabetes and coronary heart disease.Öğe Is daytime insulin more physiologic and less atherogenic than bedtime insulin?(Elsevier Ltd., 2007) Kanat, MustafaThe question is whether bedtime insulin, one of the standard therapy regimens of type 2 diabetes, can be more atherogenic than daytime insulin. There is no study to answer this question. However, pharmacokinetics of drugs and physiopathology of type 2 diabetes are considered, we can assume that daytime OAD plus bedtime insulin therapy might be more atherogenic than daytime insulin plus bedtime OAD therapy. The rationale for combination therapy is based on the assumption that, if evening insulin lowers the fasting glucose concentration to normal, then daytime oral agents wilt be more effective in controlling postprandial hyperglycemia. However, exogenous insulin administration is not a convenient way to inhibit hepatic glucose production which determines fasting plasma glucose because in post absorptive period, hepatic glucose production is determined by high glucagon and low insulin levels. In postprandial period, beta cell-originated insulin inhibits glucagon synthesis by paracrine effect and also inhibits hepatic glucose production by using half of its concentration that administered to portal system. Since half of insulin that found in portal system is exposed to hepatic clearance to inhibit hepatic glucose production, portal insulin concentration is 2-4-folds higher than peripheral insulin concentration. But, exogenous insulin neither inhibits glucagon synthesis via paracrine effect, nor reaches desired portal concentrations because it has a short half-life and in opposition to physiologic states it is not administered to the portal system. On the contrary, its peripheral concentration is higher than portal one. Thus, exogenous insulin that is used to inhibit hepatic glucose production requires higher concentrations than physiologic: values. Eventually, peripheral hyperinsulinemic state which is a risk factor of CVD is created iatrogenically. Bearing in mind that PI3K pathway, working synchronously with the diurnal rhythm of other metabolic hormones, is more active during daytime especially in postprandial period when aminoacids and glucose exist in the environment, and that decreased insulin response in PI3K pathway in diabetics, we may propose iatrogenically created hyperinsutinemia can cause more atherogenic effects via MAN pathway. For that reason, using OAD instead of bedtime insulin may be a more convenient way to inhibit hepatic glucose production. Thus, glucagon synthesis inhibition can be achieved via paracrine effect of OAD-induced insulin secretion, as well as required portal insulin concentration can be reached by the direct secretion of insulin to the portal system. Moreover, Lower peripheral hyperinsutinemia state can be provided. (C) 2006 Elsevier Ltd. All rights reserved.Öğe Is lipid lowering treatment aiming for very low LDL levels safe in terms of the synthesis of steroid hormones?(Elsevier Ltd., 2007) Kanat, Mustafa; Sipahioğlu, Murat; Arınç, Hüseyin; Serin, Erdinç; Yıldız, Özcan; Tunçkale, Aydın; Çelebi, HarikaToday atherosclerotic diseases are among the most important causes of death in the world. Epidemiological, clinical, genetic, experimental and pathological studies have clearly shown the role of lipoproteins in atherosclerosis. LDL is the major atherogenic lipoprotein and has been defined as the primary target of lipid lowering treatment by NCEP. Although the level of LDL, the primary target in the treatment of dyslipidemia, has been set as below 100 mg/dl in coronary heart diseases (CHD) and CHD risk equivalents, this level has been putted down to below 70 mg/dl for the group defined as very high risk group by the ATP (Adult Treatment Panel) guide that has been updated following the new clinical studies. As we already know, cholesterol is the precursor of glucocorticoids, mineralocorticoids and sex steroids, besides being a structural component of the cell membrane. Both adrenal and non-adrenal (ovarian + testicular) all steroid hormones are primarily synthesized using the LDL-cholesterol in the circulation. In addition to this, there is 'de novo' cholesterol synthesis in both the adrenals and gonads controlled by the HMG-CoA reductase enzyme. A third pathway, which under normal circumstances has little contribution as compared to the first two, is the use of circulatory HDL-cholesterol by the adrenal and gonadal tissues for the synthesis of steroids. Our knowledge on extremely towered LDL levels is quite limited. However, since statins both decrease circulatory LDL and inhibit de novo cholesterol synthesis, they are likely to affect the synthesis of steroid hormones. (c) 2006 Elsevier Ltd. All rights reserved.Öğe A multi-center, open label, crossover designed prospective study evaluating the effects of lipid lowering treatment on steroid synthesis in patients with Type 2 diabetes (MODEST Study)(Springer, 2009) Kanat, Mustafa; Serin, Erdinç; Tunçkale, Aydın; Yıldız, O.; Şahin, Sevgi; Arınç, Hüseyin; Karagöz, YalçınObjective: It has been suggested that lipid-lowering treatment with the use of statins adversely affects the steroid hormones. However, the safety of lipid lowering treatment targeting very low levels of LDL with respect to the steroid hormones has not been established. Research design and methods: A prospective, randomized, multicenter trial was conducted involving 98 patients. The patients were randomized into 2 groups: group-I received 10 mg of atorvastatin plus 10 mg of ezetimibe and group-II 80 mg of atorvastatin for the first 3 months. After crossover, the first group received 80 mg of atorvastatin and the second group 10 mg of atorvastatin plus 10 mg of ezetimibe for the following 3 months. Cortisol, DHEAS, testosterone, and estradiol levels were measured at the enrollment and at the end of the 1(st), 2(nd), 3(rd), and 6(th) months. Results: Along with a decrease in LDL level, the levels of DHEAS, testosterone, and estradiol decreased in both groups (p<0.001). While cortisol levels were maintained in the group given 10 mg of atarvastatin plus 10 mg of ezetimibe, it decreased significantly after the crossover to 80 mg of atorvastatin (p<0.001). The group initially given 80 mg of atorvastatin measured a lower level of cortisol for the first 3 months and it returned to normal levels after switching to 10 mg of atorvastatin plus 10 mg of ezetimibe. Conclusion: Eighty milligrams of atorvastatin decreased all adrenal and gonadal steroids, where,is 10 mg of ezetimibe combined with 10 mg of atorvastatin had at least no impact on cortisol levels. (J. Endocrinol. Invest. 32: 852-856, 2009) (C)2009, Editrice KurtisÖğe Oxygen-dependent bactericidal activity of leukocytes in patients with type 2 diabetes mellitus(Turkiye Klinikleri, 2009) Kanat, Mustafa; Donma, Orkide; Aygün, Cem; Sardoğan, Emine; Ekmekçi, Özlem BalcıObjective: In this study it is aimed to investigate the oxygen-dependent bactericidal activity of leukocytes in patients with diabetes mellitus type 2. Materials and Methods: All the data obtained from 28 patients with diabetes mellitus were compared with 31 demographically matched control individuals. Leukocytes of patients with diabetes mellitus and healthy control group were separated from blood samples for determination of oxygen-dependent antimicrobial activity enzymes including superoxide dismutase (SOD), glutathione reductase (GSH-R), gluthatione peroxidase (GSH-Px) and catalase. As lipid peroxidation products, thiobarbituric acid reactive substances (TBARS) were measured. Results: SOD, GSH-R, and catalase activities of patients with type 2 diabetes were not significantly different from control group (p>0.05). GSH-Px levels of patients with diabetes mellitus were significantly lower than control group (0.012±0.08 U/mg.pr versus 0.057±0.046 U/mg.pr, p<0.05). Measurements of TBARS were not different between patients with diabetes mellitus and control group (5.49±1.31 ?mol/l versus 5.53±1.45 ?mol/l, p=0.905). Conclusions: It is difficult to suggest that in patients with diabetes mellitus the tendency to some known infections is due to alteration in oxygen-dependent bactericidal activity of leukocytes.Öğe The prevalence of neuropathy and relationship with risk factors in diabetic patients: a single-center experience(Karger, 2006) Tamer, Ali; Yıldız, Serpil; Yıldız, Nebil; Kanat, Mustafa; Gündüz, Hüseyin; Tahtacı, Mustafa; Çelebi, HarikaObjective: To determine the rate of distal symmetrical polyneuropathy (DSP) in patients with type 2 diabetes mellitus, to evaluate the role of history, neurological examination and the electrodiagnostic methods in the diagnosis of DSP, and to determine the association between electromyography-supported neuropathy (ESN), neuropathic complaints (NCs) and risk factors. Subjects and Methods: A total of 191 type 2 DM patients (109 female, 82 male; mean age 58.7 +/- 10 years) were recruited. The NCs were recorded. All patients had electromyographic (EMG) examinations. The relationship between ESN, NCs and risk factors were evaluated. Results: Of the 191 patients, 83 (43.5%) had DSP on EMG examinations and 92 (48.2%) patients suffered from NCs. Among the ESN patients, a significant relationship existed with HbA1(c) level, illness duration, smoking, male gender or insulin usage (p < 0.05) but not with age, hypertension, hypercholesterolemia or hypertriglyceridemia. The frequency of NCs was higher in patients with ESN. There was also a significant association between NCs and ESN (p < 0.05). The presence of NCs was not related to age, gender, smoking, hypertension, hypercholesterolemia and hypertriglyceridemia (p > 0.05) but NCs were correlated to HbA1(c) level, illness duration and insulin usage (p < 0.05). Conclusion: Our data show that a strong association exists between the presence of DSP and illness duration, HbA1(c), smoking, thereby indicating that cessation of smoking and near normal glycemic control would be additional precautions to delay the beginning or progression of polyneuropathy.
