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Öğe Analysis of the factors related to the blood pressure control in hypertension(Coll Physicians & Surgeons Pakistan, 2018) Atik, Fatih; Aktaş, Gülali; Koçak, Mehmet Zahid; Erkuş, Edip; Şavlı, HalukObjective: To determine the factors associated with blood pressure control and comparing anthropometric and clinical parameters of subjects with well-controlled hypertension to those with poorly controlled blood pressure. Study Design: Observational cross-sectional study. Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from January to June 2016. Methodology: Medical data obtained and recorded from computerised database and case files of our clinic. Subjects with mean blood pressure above target levels were defined as poorly controlled and others were as well-controlled hypertension group according to JNC VIII. Results: Out of 342 subjects, only 116 (33.9%) were aware of normal blood pressure range. The number of patients who had a blood pressure on goal in the group and knew the normal range of blood pressure was significantly higher than the patients in group who did not know the normal range of blood pressure. Body mass index and waist circumference were both significantly higher in poorly controlled compared to well-controlled hypertensive subjects. Treatment compliance was significantly associated with better control of hypertension. Conclusion: Striking results of present study indicate that lower body mass index and lesser waist circumference along with treatment compliance and awareness of normal blood pressure ranges are important factors that affect reaching treatment targets in hypertensive subjects.Öğe Analysis of the type 2 diabetic patients followed in a university clinic(2018) Koçak, Mehmet Zahid; Aktaş, Gülali; Erkuş, Edip; Duman, Tuba Taslamacıoğlu; Atak, Burcin Meryem; Şavlı, HalukObjective: The aim of present study was to determine the effects of factors to diabetic regulation; such as, awareness of the disease, compliance with treatment, awareness of HbA1c target, in T2DM patients whom followed up in our clinic. Methods: Patients with T2DM were enrolled to this retrospective study. Patient‘s data were obtained and recorded from institutional database. As well as blood pressure, anthropometric measurements, physical examination signs, and laboratory parameters were recorded. Study population grouped into two according to HbA1c level; well-regulated T2DM group with a HbA1c lower than 8% and poorly-controlled T2DM group with a HbA1c 8% or greater. Results: A total of 150 patients with T2DM (72 men and 78 women) enrolled. Waist circumference, body mass index, duration of diabetes, LDL-cholesterol , total cholesterol, triglyceride and serum creatinine were significantly lower in well-controlled compared to poorly-controlled diabetic subjects (all p<0.05). Rate of well-regulated subjects was higher in patients living in urban compared to subjects living in rural area (p=0.01). Diabetic regulation rate was significantly higher in patients acknowledge the diabetic medications, in self-monitoring blood glucose, in subjects aware of HbA1c target, and free of diabetic complications; neuropathy, nephropathy, and diabetic foot (all p<0.05). Conclusions: Striking result of present study is that most important factors associated with better diabetic control were self monitoring of blood glucose, awareness of treatment target and acknowledgement of the diabetic medications; which all could be achieved by education and participation of the patient to the therapeutic process.Öğe Assessment of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in ulcerative colitis: a retrospective study(Kare Publ, 2017) Fidan, Kemal; Koçak, Mehmet ZahidObjectives: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are markers of subclinical inflammation already used to determine outcomes in coronary artery disease and some malignancies.The aim of this study was to investigate the NLR and the PLR as possible indicators of ulcerative colitis (UC) disease activity. Methods: Of a total of 67 patients included in the study, 36 had active UC and 31 were in a remission period. The NLR and the PLR were calculated using complete blood count parameters.The modified Truelove-Witts Severity Index was used to group the patients: remission (n=31), mild activation (n=21), moderate activation (n=6), and severe activation (n=9). Results: The mean NLR of the active and remission UC patients was 4.78 and 2.01, respectively (p<0.002). The cut-off value for NLR to discriminate an active phase in UC patients was calculated to be using receiver operating characteristic (ROC) analysis (sensitivity: 62%; specificity: 70%). The mean PLR of the active and remission UC patients was 209.52 and 131.27, respectively (p=0.005). The cut-off value for PLR to discriminate an active phase in UC patients was calculated to be >= 133.87 using ROC analysis (sensitivity: 63%; specificity: 68%). Conclusion: The NLR and the PLR of active UC patients were significantly higher than those of remission patients. The NLR and the PLR may be independent, noninvasive markers of disease activity in UC.Öğe Association between hemogram parameters and coronary collateral development in subjects with non-ST-elevation myocardial infarction(Assoc Medica Brasileira, 2020) Sincer, İsa; Mansıroğlu, Aslı Kurtar; Aktaş, Gülali; Güneş, Yılmaz; Koçak, Mehmet ZahidOBJECTIVE: Coronary collateral development (CCD) predicts the severity of coronary heart disease. Hemogram parameters, such as mean platelet volume (MPV), eosinophil, red cell distribution width, and platelet distribution width (PDW), are supposed novel inflammatory markers. We aimed to compare hemogram parameter values in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) with adequate or inadequate CCD. METHODS: A total of 177 patients with NSTEMI undergoing coronary arteriography were enrolled and divided into two groups based on the development of CCD: one group with adequate CCD (n=88) and the other with impaired CCD (n=89). RESULTS: Baseline demographics and clinical risk factors were similar between the groups. Hemogram parameters were not significantly different between the two groups. However, compared to the inadequate CCD group, the median PDW was significantly higher in the adequate CCD group, 17.6 (1.4) vs. 17.8 (1.6) p=0.004. In a multivariate analysis, PDW (p=0.001, 95% CI for OR: 0.489(0,319-0,750) was found to be significantly different in the adequate CCD group compared to the inadequate CCD group. Pearson's correlation analysis revealed that PDW was significantly correlated with the Rentrop score (r=0.26, p<0.001). CONCLUSIONS: We suggest that since PDW is an index that is inexpensive and easy to assess, it could serve as a marker of CCD in patients with NSTEMI.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 A Case of Secondary Hypertension due to Giant Hydatid Cyst(2018) Atak, Burçin; Aktaş, Gülali; Koçak, Mehmet Zahid; Duman, Tuba; Erkuş, Edip; Gürel, Kamil; Şavlı, HalukHydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis.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 Clinical significance of mean platelet volume/lymphocyte ratio and mean platelet volume/platelet ratio in the exacerbation of chronic obstructive pulmonary disease(2019) Özsarı, Emine; Koçak, Mehmet ZahidObjectives: Studies showing the role of systemic inflammation in chronic obstructive pulmonary disease(COPD) are increasing. Particularly, importance of mean platelet volume (MPV) and neutrophil/lymphocyteratio (NLR) for acute exacerbation of COPD has been reported. The use of MPV/lymphocyte ratio (MLR) andMPV/platelet ratio(MPR) in acute exacerbation of COPD patients was investigated in our study, consideringthat MPV alone may be a more valuable marker of inflammation.Methods: Between March 2017 and March 2018, COPD patients who applied to Abant Izzet Baysal UniversitySchool of Medicine, Chest Diseases outpatient clinic were examined. Results were retrospectively scannedfrom patient files after institutional approval. Sixty-four (60.4%) stable COPD and 42 (39.6%) acuteexacerbation COPD patients were included in the study.Results: Seventy-one (67%) of patients were male and 35 (33%) were female. NLR was 2.26 (0.93-6.48) instable patients and 4 (1.18-36) in acute attack patients (p < 0.001); PLR was 137.44 (66.9-436.6) in patientswith stable disease and 162.8 (85-1056.6) in patients with attack (p = 0.068). MLR was 5 (2.92-25) in acuteattack patients and 4 (1.89-8.67) in stable patients; this difference was statistically significant (p = 0.003). MPVwas found to be 7 (5.5-9.1) fL in patients with stable disease and 8 (5-13.4) fL in acute patients. This differencewas statistically significant (p < 0.001). MPR was found to be statistically significantly higher in acute patientsthan in patients with stable disease (p = 0.04). WBC, neutrophil and CRP were found to be statisticallysignificantly higher in acute patients than in stable patients (p < 0.05). There was a statistically significantcorrelation between WBC and NLR (r = 0.269, p = 0.005) and between CRP and NLR (r = 0.379, p < 0.001).Conclusions: Hemogram parameters from routine laboratory tests in COPD patients are cheap and easilyaccessible. It is important to detect the presence of subclinical inflammation in the stable phase, as well as toidentify patients at risk of exacerbation. Prospective studies are needed to demonstrate correlations withinflammatory markers.Öğe Could red cell distribution width be a marker of thyroid cancer?(Coll Physicians & Surgeons Pakistan, 2017) Aktaş, Gülali; Şit, Mustafa; Karagöz, İbrahim; Erkuş, Edip; Özer, Bahri; Koçak, Mehmet Zahid; Yaman, Semih; Keyif, Fatih; Altınordu, Rabia; Erkol, Hayri; Şavlı, HalukObjective: To study red cell distribution width (RDW) values, a novel inflammatory marker in routine hemogram, of patients with benign or malignant thyroid nodules and to compare with healthy population. Study Design: Descriptive study. Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from November 2015 and February 2017. Methodology: The hemogram values of patients undergone thyroid surgery for thyroid nodule between November 2015 and February 2017 were retrospectively analyzed, and compared to those in healthy subjects. Subjects with infectious or inflammatory diseases were excluded. Patients' characteristics and laboratory data were obtained from institutional computerized database. Preoperative hemogram values of thyroid nodule patients were recorded. One-way ANOVA and Kruskal-Wallis tests were performed to compare variables with significance at p<0.05. Results: Median RDW of malignant nodule group was 15.8 (12.9-19.5) and was significantly higher than both of those in benign nodule (15) and control groups (14), (p<0.001). Conclusion: Elevated RDW in patients with thyroid nodules in preoperative period should alert the physician for possible malignancy and this cost-effective marker also can help support other modalities (ultrasound scan, and fine needle aspiration biopsy) to distinguish malignant from benign nodules.Öğe Diabetes control could through platelet-to-lymphocyte ratio in hemograms(Assoc Medica Brasileira, 2019) Atak, Burçin; Aktaş, Gülali; Duman, Tuba Taslamacıoğlu; Erkuş, Edip; Koçak, Mehmet Zahid; Şavlı, HalukOBJECTIVE: Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS: Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS: Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION: As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.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 General characteristics of anemia in postmenopausal women and elderly men(Taylor and Francis Ltd, 2019) Taslamancıoğlu Duman, Tuba; Aktaş, Gülali; Atak, Meryem Burçin; Koçak, Mehmet Zahid; Kurtkulagi, Özge; Bilgin, SatılmışIn present study, we aimed to investigate anemia etiologies, underlying causes, laboratory markers of anemia, required interventions in postmenopausal women and elderly men. The medical data of the anemic subjects were recorded from the patients' files and computerized database of the institution and retrospectively analyzed. Study population grouped into two according to the gender; men and women. Medical data of men and women were compared. A total of 113 subjects enrolled to the study; 78 women and 35 men. 51 (65%) of women and 21 (60%) of men had iron deficiency anemia, 5 (6.4%) of women and 1 (2.9%) of men had anemia of chronic disease, 2 (2.6%) of women and 10 (28.6%) of men had vitamin B12 deficiency anemia. Forty seven (60.3%) of the women and 30 (85.7%) of the men had comorbidities. 47% of colonoscopies were normal in study population (44% of women and 50% of men). Etiology and causes of anemia should be carefully investigated in subjects with advanced age. Physicians should kept in mind that B12 deficiency and comorbidities were more common in elderly men and about half of the colonoscopy procedures in this population is unnecessary. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.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 Is neuregulin-4 a predictive marker of microvascular complications in type 2 diabetes mellitus?(Wiley, 2020) Koçak, Mehmet Zahid; Aktaş, Gülali; Tel, Meryem Burçin Atak; Duman, Tuba Taslamacıoğlu; Yis, Özgür Mehmet; Erkuş, Edip; Şavlı, HalukBackground and Aims Neuregulin-4 (Nrg-4) is a new adipokine released from brown adipose tissue. It plays pivotal role in regulating systemic energy balance, glucose and lipid metabolism and in reducing chronic inflammation. We aimed to investigate the relation between diabetic microvascular complications (DMC) and serum (Nrg-4) levels in patients with type 2 diabetes mellitus. Methods Patients with type 2 diabetes mellitus were divided into DMC and diabetic patients without microvascular complications (non-DMC). Nrg-4 levels of the patients were compared. Results Fifty and 29 patients enrolled to the DMC and non-DMC groups, respectively. Nrg-4 was 1.23 (0.02-5.1) ng/mL and 2.5 (0.21-6.01) ng/mL in DMC and in non-DMC groups, respectively (P < .001). In patients with DMC, FPG was 189.5 (89-446) mg/ dL, whereas it was 128 (95-278) mg/dL in non-DMC diabetic patients (P < .001). HbA1c was also significantly higher in the DMC group than in the non-DMC group (P < .001). Negative correlation was found between Nrg-4 and FPG (r = -0.231, P = .03), HBA1c (r = -0.312, P = .003) and microalbuminuria (r = -0.277, P = .009). Logistic regression analysis showed a 1-unit decrease in Nrg-4 to increase the presence of DMC by 1.9 times. The best cut-off value of Nrg-4 was 1.56 ng/mL with 82.1% sensitivity and 64% specificity, in predicting DMC. Conclusion In patients with diabetes, Nrg-4 levels may be a good predictor of early detection of one or more DMC, as microvascular dysfunction in an organ system is considered to be an initial onset of subclinical systemic damage.Öğe Is uric acid elevation a random finding or a causative agent of diabetic nephropathy?(Assoc Medica Brasileira, 2019) Koçak, Mehmet Zahid; Aktaş, Gülali; Duman, Tuba Taslamacıoğlu; Tel, Burçin Meryem Atak; Şavlı, HalukOBJECTIVE: In this study, we aimed to analyze the relationship between serum uric acid (UA) and microalbuminuria as a marker of renal injury in type 2 diabetes mellitus. METHODS: A total of 100 patients with type 2 diabetes mellitus were enrolled in the study. Participants were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. UA and microalbuminuria were compared between the study groups. RESULTS: Serum UA levels of diabetic nephropathy patients were significantly higher than those in the non-nephropathy group (UA in patients with diabetic nephropathy groups: 6.3 (1.82) mg/dl, UA in patients of the non-nephropathic group: 4.85(1.92) mg/dl)(p<0.001). There was a correlation between microalbuminuria and UA (r=0.238). This correlation was statistically significant (p=0.017). CONCLUSION: UA levels may be an important predictor of nephropathy in diabetic patients.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 Mean platelet volume: An overlooked herald of malignant thyroid nodules(Sestre Milosrdnice Univ Hospital, 2019) Şit, Mustafa; Aktaş, Gülali; Özer, Bahri; Koçak, Mehmet Zahid; Erkuş, Edip; Erkol, Mehmet Hayri; Yaman, SemihPhysicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1 +/- 1 fL vs. 7.8 +/- 0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.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 Neuregulin-4 is associated with plasma glucose and increased risk of type 2 diabetes mellitus(E M H Swiss Medical Publishers Ltd, 2019) Koçak, Mehmet Zahid; Aktaş, Gülali; Erkuş, Edip; Yis, Özgür Mehmet; Duman, Tuba Taslamacıoğlu; Atak Tel, Burçin Meryem; Haluk, ŞavlıBACKGROUND: Neuregulin-4 is a cytokine with many functions and is primarily produced by fat tissue. AIM OF THE STUDY: The aim of the study was to observe the relationship between serum neuregulin-4 levels and diabetes regulation in type 2 diabetes mellitus (T2DM), and to compare neuregulin-4 levels of diabetic subjects with those in healthy controls. METHODS: Patients with T2DM were included to the study. Healthy subjects were enrolled as controls. Subjects with T2DM with glycated haemoglobin (HbA1c) <7% were classed as well controlled and those with HbA1c >= 7% were classed as poorly controlled. Neuregulin-4 levels of the study and control groups were compared. RESULTS: The neuregulin-4 levels of the poorly controlled T2DM, well-controlled T2DM and control groups were significantly different (p = 0.005). Neuregulin-4 was significantly correlated with fasting plasma glucose (r = 0.247, p = 0.002) but not with HbA1c. In a regression analysis model, 0.1 point elevation in neuregulin-4 levels increased the rate of existence of T2DM 4.4-fold (odds ratio 4.4, 95% confidence interval 1.26-15.1; p = 0.02). CONCLUSION: Neuregulin-4 is significantly increased in patients with T2DM compared with control subjects, which means that it could be a marker of T2DM. Since neuregulin-4 was correlated with fasting glucose, we suggest that elevated neuregulin-4 could predict poor control in T2DM for short periods when HbA1c is not useful. Moreover, one unit elevation in neuregulin-4 (0.1 ng/ml) increases the rate of existence of T2DM 4.4-fold, independently from other variables.
