The Relationship Between Diabetic Peripheral Neuropathy and (Mpv) Mean Platelet Volume Values in Patients with Type 2 Diabetes Mellitus

Amaç: Çalışmamızda Tip 2 diyabetli hastalarda, MPV değeriyle, diyabetin mikrovasküler bir komplikasyonu olan nöropati arasındaki ilişkiyi araştırmayı hedefledik.Materyal ve Metot: Retrospektif çalışmamıza, iç hastalıkları polikliniklerimize başvuran tip 2 diyabetik hasta dosyaları değerlendirilerek, fizik muayene, elektrofizyolojik çalışma verileri, anamnez ve tetkik kayıtları incelenerek, diyabetik nöropatisi olan ve olmayan iki grup diyabetik hasta belirlendi. Bilinen kardiyovasküler, hematolojik, onkolojik hastalık, karaciğer ve böbrek hastalığı, akut veya kronik infeksiyon hastalığı, yakında geçirilmiş travma, cerrahiöyküsü olan vakalar çalışmaya dahil edilmedi. Vakaların istatistiksel değerlendirmesi SPSS 21 yazılım programı ile yapıldı.Bulgular: Yaşları 31-76 arasında değişen 39'u (25 kadın, 14 erkek) diyabetik periferik nöropatili, 44’ü (27 kadın, 17 erkek) ise nöropatisiz toplam 83 diyabetik vaka çalışmaya alındı. Nöropatisi olmayan vakaların ortalama yaşları 57,89±8,8 (31-75), A1c % 7,3 (5,5-12,7), açlık kan şekeri 144 mg/dl (80-326), trombosit sayısı 260.800±68,900/mm3, MPV değeri 8,96±0,67 fl (7,6-10,4) idi. Nöropatik vakaların ortalama yaşları 56,54±8,4 (37-76), A1c % 8,3 (5,6-14,4), açlık kan şekeri 184 (100-432) mg/dl, trombosit sayısı 269.050±74.195/mm3, MPV değeri 9,03 ± 0,75 (7,4-10,5) idi. Gruplar arasında yaş (p=0,482), trombosit sayısı (P=0,601), BKİ (p=0,299), MPV (p=0,596) ve A1c (p=0,076) değerleri açısından anlamlı fark yokken, diyabet yaşı (p=0,002) ve açlık kan şekeri (p=0,04) açısından istatistiksel anlamlı fark mevcuttu. Spearman korelasyon analizinde MPV düzeyi ile nöropati gelişimi arasında istatistiki anlamlılığa ulaşan bir ilişki bulunamadı (p=0,599).Sonuç: Tip 2 diyabetli 83 hasta ile yaptığımız çalışmamızda, MPV ile nöropati gelişimi arasında herhangi bir ilişki saptayamadık. Bu ilişkiyi daha iyi aydınlatabilmek için daha fazla vaka ile çok merkezli ve prospektif çalışmalara ihtiyaç vardır.Aim: We aimed to evaluate the relationship between diabetic peripheral neuropathy and MPV values in type 2 diabetes mellitus patients. Materials and Methods: We investigated type 2 diabetic patients’ data retrospectively. The data was divided as two groups (with and without diabetic peripheral neuropathy) according to their history, physical examination, laboratory results and electro-physiological study results. The patients with cardiovascular, hematological, oncological, hepatic, renal, infectious disease or a recent history of trauma and surgery were excluded. Statistical analysis was studied by SPSS 21 soft-ware statistics programme. Results: We included 83 diabetic patients (ages between 31 and 76) that 39 of them were patients with diabetic peripheral neuropathy (25 women, 14 men) and 44(27 women, 17 men) were without neuropathy. While the means of non-neuropathic group for the age was 57,89±8,8(31-75), A1c 7,3%(5,5-12,7), platelet counts 260.800±68,900/mm3, MPV value 8,96±0,67 fl(7,6-10,4); the means of neuropathic group were 56,54±8,4(37-76) years, 8,3 (5,6- 14,4)%, 269.050±74.195/mm3 and 9,03 ± 0,75(7,4-10,5) fl respectively. There were no statistically significant differences in terms of age(p=0,482), platelet count(p=0,601), body mass index(p=0,299), MPV(p=0,596) and A1c(p=0,076). But statistically significant differences were found in terms of diabetes age(p=0,002) and fasting plasma glucose(p=0,04). A statistically significant correlation was not found between MPV and neuropathy existence by Spearman correlation analysis(p=0,599). Conclusion: We didn't find any correlation between MPV value and neuropathy development in our study. We suggest that to clarify this relationship certainly, we need a prospective, multi-centered study with a bigger cohort

The Relationship Between Diabetic Peripheral Neuropathy and (MPV) Mean Platelet Volume Values in Patients With Type 2 Diabetes Mellitus

Aim:We aimed to evaluate the relationship between diabetic peripheral neuropathy and MPV values in type 2 diabetes mellitus patients.Materials and Methods:We investigated type 2 diabetic patients’ data retrospectively. The data was divided as two groups (with and without diabetic peripheral neuropathy) according to their history, physical examination, laboratory results and electro-physiological study results. The patients with cardiovascular, hematological, oncological, hepatic, renal, infectious disease or a recent history of trauma and surgery were excluded. Statistical analysis was studied by SPSS 21 soft-ware statistics programme.Results:We included 83 diabetic patients (ages between 31 and 76) that 39 of them were patients with diabetic peripheral neuropathy (25 women, 14 men) and 44(27 women, 17 men) were without neuropathy. While the means of non-neuropathic group for the age was 57,89±8,8(31-75), A1c 7,3%(5,5-12,7), platelet counts 260.800±68,900/mm3, MPV value 8,96±0,67 fl(7,6-10,4); the means of neuropathic group were 56,54±8,4(37-76) years, 8,3 (5,6-14,4)%, 269.050±74.195/mm3 and 9,03 ± 0,75(7,4-10,5) fl respectively. There were no statistically significant differences in terms of age(p=0,482), platelet count(p=0,601), body mass index(p=0,299), MPV(p=0,596) and A1c(p=0,076). But statistically significant differences were found in terms of diabetes age(p=0,002) and fasting plasma glucose(p=0,04). A statistically significant correlation was not found between MPV and neuropathy existence by Spearman correlation analysis(p=0,599).Conclusion:We didn't find any correlation between MPV value and neuropathy development in our study. We suggest that to clarify this relationship certainly, we need a prospective, multi-centered study with a bigger cohort

Diyabetik Bir Olguda Orbital Sellülitin Nadir Bir Komplikasyonu: Kavernöz Sinüs Trombozu

Diyabetin çeşitli enfeksiyonlara ve tromboza eğilimi artırdığı iyi bilinmektedir. Diyabette doğal, hücresel ve humoral bağışıklık mekanizmalarının çeşitli basamaklarında bozukluklar beklenir. Trombosit fonksiyonlarındaki, koagülasyon faktörlerindeki ve damar yapısındaki bozukluklar da tromboza eğilimi artırır. Hem enfeksiyonların hem de trombotik olayların diyabetteki seyri diyabetik olmayan olgulara göre daha ciddidir. Bu yazıda orbital sellülit gelişip kavernöz sinüs trombozu ile komplike olan 94 yaşında diyabetik erkek olgu sunuldu. Olgu orbital sellülit, idrar yolu enfeksiyonu, hiperozmolar non ketotik durum, akut böbrek yetersizliği ve üremiye sekonder kompanse metabolik asidoz tanıları ile endokrinoloji servisine yatırıldı. Antibiyoterapisine ve hidrasyonuna vakit kaybetmeksizin başlanıp gerekli tedavisi yapılan olgu, mortalitesi yüksek kavernöz sinüs trombozu sonrası tedaviye cevap vermeyerek kaybedildi. Özellikle diyabetik olgularda orbital enfeksiyonların komşuluk yoluyla kavernöz sinüse yayılıp septik tromboza yol açarak ölümcül seyredebileceği göz önüne alınarak erken tanı ve tedavisi yapılmalıdırIt is that diabetes mellitus increases tendency to develop infections and thrombosis. Impairment of various mechanisms and agents of humoral and cellular immune systems can be expected. Disturbances of platelet function, coagulation factors, and vascular structure predispose diabetics to thrombotic events. The course of both infections and thrombotic events is often worse than in non-diabetic patients. Presently described is 94-year-old male patient with diabetes who had orbital cellulitis that became complicated with cavernous sinus thrombosis (CST). He was admitted to endocrinology clinic with diagnoses of orbital cellulitis, urinary tract infection, hyperosmolar non-ketotic state, acute renal failure, and compensated metabolic acidosis secondary to uremia. Despite immediate antibiotherapy, hydration, and additional required treatment, patient did not respond and died as a result of CST. There must be awareness, especially for diabetic patients, that orbital infections may spread to nearby cavernous sinuses and cause potentially lethal septic CST. Early diagnosis and immediate treatment are essentia

Effects of Bevacizumab, an Anti Vascular Endothelial Growth Factor Monoclonal Antibody, on Kidney Function and Morphology

AimTo constitute an experimental rat model by using human VEGF monoclonal antibody bevacizumab, for observation of renal side effects of this treatment.Materials and MethodsThirtysix adult female Wistar albino rats has been divided as two main groups: “3 days” and “21 days” . Each group has been divided in three; bevacizumab 10 mg/kg and 20 mg/kg were administered intravenously from the tail veins of the two subgroups and 1 mg/kg saline was administered to the third subgroup as control. Urine for 24 hours for detection of proteinuria and blood samples for detection of renal funtions were collected before, third day and 21st day of the drug administration and rats were sacrified at third and 21st days for pathological examination of kidneys.ResultsTwenty four hours urine protein excretion, creatinin excretion and urine protein/creatinin ratio were demonstrated as significantly increased on the third day of the rats administered 10 mg/kg bevacizumab; however, any significant increase of proteinuria couldn’t be shown on the 21 days group rats administered neither 10 mg/kg or 20 mg/kg. Pathological examination of rats sacrified on third day demonstrate the significant increase of bowman capsule gap and interstitial inflamation as correlated with the dosage of the drug. The thickness of vessel wall was observed on the pathological examination of rats sacrified on 21st day.ConclusionIt has been shown that bevacizumab administration of 10 mg/kg for three days is proper for constitution of an experimental rat model

The relationship between receptor of advanced glycosylation end products and oxidative stress markers in Type 1 diabetes

Tıpta Uzmanlık TeziDiyabetik komplikasyonların temelinde yatan ana mekanizma olan endotel hasarında oksidatif stresin rolü iyi bilinmektedir. Bu çalışma, Tip 1 diyabetik olgularda, ileri glikozillenme ürünlerinin oksidatif stres yolağındaki etkileri ile bu sistemlerin mikrovasküler komplikasyonların gelişimindeki rollerinin incelenmesi amacıyla planlandı. Çalışmaya 78 Tip 1 Diabetes Mellitus tanılı olgu ile yaş, cinsiyet ve vücut kitle indeksi uyumlu 72 sağlıklı kontrol olgusu alındı. Tip 1 Diabetes Mellitus hastaları mikrovasküler komplikasyonlar açısından tarandı. Çalışmamız sonucunda Tip 1 Diabetes Mellitus hastaları ile kontrol grupları arasında nitrik oksit ve ileri glikozillenme son ürünleri reseptörü düzeyleri açısından farklılık saptanmadı. Serum asymmetric-dimethyl-L-arginine ve total antioksidan kapasite düzeyleri Tip 1 Diabetes Mellitus grubunda daha düşük bulundu. ileri glikozillenme son ürünleri reseptörü ile oksidatif stres belirteçleri arasında anlamlı ilişki saptanmadı. Tip 1 Diabetes Mellitus hastaları mikrovasküler komplikasyonlar açısından değerlendirildiğinde ise, özellikle nefropati ve retinopatinin ileri evrelerinde hem ileri glikozillenme son ürünleri reseptörü hem nitrik oksit ve asymmetric-dimethyl-L-arginine düzeylerinin arttığı saptandı. Nitrik oksit damarlar için koruyucu bir moleküldür ama aynı zamanda serbest radikal üretimine katkısıyla oksidatif stres yaratır. asymmetric-dimethyl-L-arginine endotelyal nitrik oksit sentetazın kompetitif inhibitörüdür. Tip 1 Diabetes Mellitus hastalarındaki azalmış asymmetric-dimethyl-L-arginine düzeyi, endotelyal nitrik oksit sentetaz aşırı ekspresyonuna izin vererek vasküler yapıya zarar veriyor ve oksidatif stresi arttırarak endotel disfonksiyona yol açıyor olabilir. Tip 1 Diabetes Mellitus grubunda daha düşük total antioksidan kapasite saptanması, diyabet hastalarında antioksidan savunma mekanizmalarındaki hasara işaret etmektedir. Nitrik oksit düzeylerindeki artışın bir oksidatif stres ürünü olarak diyabete bağlı mikrovasküler komplikasyonların patogenezinde rol oynayabileceği düşünülmektedir. asymmetric-dimethyl-L-arginine düzeylerindeki artıştan ise nefropatinin ileri evrelerinde bozulan renal asymmetric-dimethyl-L-arginine eliminasyonunun sorumlu olduğu düşünülmektedir. ileri glikozillenme son ürünleri reseptörü ile oksidatif stres belirteçleri arasında anlamlı ilişki saptanmadı. Ancak nefropati ve retinopati gelişen hastalarda ileri glikozillenme son ürünleri reseptörü düzeylerinde artış gözlendi. Tip 1 Diabetes Mellitus'da komplikasyon gelişimiyle artan ileri glikozillenme son ürünleri reseptörü düzeylerinin oksidatif stres ve endotel hasarına karşı gelişen olası bir düzenleyici olabileceği düşünülmektedir.Anahtar kelimeler: Tip 1 Diabetes Mellitus, oksidatif stres, nitrik oksit, asymmetric-dimethyl-L-arginine, total antioksidan kapasite, ileri glikozillenme son ürünleri reseptörüAbstractOxidative stress plays a major role in the endothel dysfunction which is the main mechanism for the development of diabetic complications. This study was designed to evaluate the effects of advanced glycosylation end products on the oxidative stress pathway and their roles in the development of diabetic vascular complications. Seventy-eight cases with Type 1 Diabetes Mellitus and age, sex and body mass index-matched 72 healthy volunteers were enrolled in this study. Type 1 Diabetes Mellitus patients were assessed for the diabetic microvascular complications. Serum asymmetric-dimethyl-L-arginine and total antioxidant status levels were significantly lower in the people with diabetes compared to healthy controls. There was no significant difference in respect to nitric oxide and receptor for advanced glycosylation end products levels between two groups. There was no correlation between receptor for advanced glycosylation end products and oxidative stress markers. Type 1 Diabetes Mellitus patients were grouped according to microvascular complications. Significantly elevated receptor for advanced glycosylation end products, nitric oxide and asymmetric-dimethyl-L-arginine levels were detected in the progresive stages of nephropathy and retinopathy. Nitric oxide is a vasoprotective molecule but additionally it'a a part of oxidative stress via the production of free radicals. asymmetric-dimethyl-L-arginine is the competitive inhibitor of endothelial nitric oxide synthatase. Decreased asymmetric-dimethyl-L-arginine level in diabetic group may disturb vascular structure by letting over-expression of endothelial nitric oxide synthatase and may cause endothel dysfunction by increasing oxidative stress. Lower levels of total antioxidant status in Type 1 Diabetes Mellitus group indicates the defected antioxidant defence mechanism in diabetic patients. Elevated levels of nitric oxide in advanced stages of microvascular complications suggest its role in the pathogenesis of complications as a product of oxidative stress. Impaired renal asymmetric-dimethyl-L-arginine elimination is thought to be responsible from the increased asymmetric-dimethyl-L-arginine levels in the case of advanced nephropathy. No significant correlation between receptor for advanced glycosylation end products and oxidative stress markers. However, receptor for advanced glycosylation end products was elevated in the patients with nephropathy and retinopathy. The observed increase in receptor for advanced glycosylation end products in case of diabetic complications may be viewed as a protective reaction to counterbalance the oxidative stress and endothel damage caused by the increase in advanced glycosylation end products formation in these patients.Key words: Type 1 Diabetes Mellitus, oxidative stress, nitric oxide, asymmetric-dimethyl-L-arginine, total antioxidant status, receptor for advanced glycosylation end product

Evaluation of endocan and endoglin levels in chronic kidney disease due to diabetes mellitus

Introduction: Endocan and endoglin have been shown to play a role in angiogenesis. Aberrant excessive angiogenesis is a main factor in the development of diabetic nephropathy. In this study we evaluated endocan and endoglin levels in diabetes patients with and without albuminuria and compared them with healthy subjects. Therefore we aimed at gaining a better understanding of the role of angiogenesis in diabetic nephropathy and to assess the predictive role of endocan and endoglin as markers of diabetic nephropathy progression. Material and methods: Ninety-six type 2 diabetes patients were classified according to their 24-hour urinary albumin excretion rate. Forty type 2 diabetes patients with normoalbuminuria (urinary albumin excretion = 30 mg/day) and 35 healthy non-diabetic control subjects were included. Their anthropometric features, arterial blood pressures, fasting glucose, glycated hemoglobin, urea, creatinine, lipids, endocan and endoglin levels were measured and compared to each other. Results: Endocan and endoglin levels of diabetics patients were higher than those of the controls. In comparison of endocan and endoglin levels of diabetic nephropathy patients with controls, p-values were < 0.001 and 0.002 respectively. In comparison of normoalbuminuric diabetic patients with controls, p-values were 0.001 and 0.017 respectively. Endocan levels of diabetic nephropathy cases were higher than those of normoalbuminuric patients (p = 0.011) but there was no statistically significant difference in endoglin levels between them (p = 0.822). Conclusions: Endocan might be a more reliable marker of diabetic nephropathy development than endoglin

Effects of Bevacizumab, an Anti Vascular Endothelial Growth Factor Monoclonal Antibody, on Kidney Function and Morphology

Amaç İnsan VEGF monoklonal antikoru bevasizumab kullanarak, bu tedavinin böbrek üzerine olan yan etkilerini gözlemleyebileceğimiz deneysel bir sıçan modeli oluşturmak ve bevasizumab’ın sıçan böbreği üzerine olan etkilerini değerlendirmektir. Materyal ve Metot Otuzaltı adet erişkin dişi Wistar albino sıçan “üç günlük” ve “21 günlük” iki ana gruba ayrıldı. Her grup üçe bölündü; iki gruba kuyruk venlerinden intravenöz olarak bevasizumab 10 mg/kg ve 20 mg/kg dozlarında uygulandı, üçüncü gruba kontrol grubu olarak 1 ml/kg serum fizyolojik uygulandı. İlaç verilmesi öncesi, ilaç verilmesinin üçüncü günü ve ilaç verilmesinin 21. günü proteinüriyi saptamak amacıyla 24 saatlik idrarları ve böbrek fonksiyon testleri çalışılmak üzere serumları toplandı. Üçüncü ve 21. gün sıçanlar sakrifiye edilerek böbrekleri patolojik olarak incelendi. Bulgular 10 mg/kg dozunda bevasizumab uygulanan sıçanlarda üçüncü gün 24 saatlik idrar protein atılımı, kreatinin atılımı ve idrar protein/kreatinin oranlarında anlamlı bir artış olmuş; 21 gün grubunda ise ne 10 mg/kg ne de 20 mg/kg ilaç verilen grupta anlamlı proteinüri artışı gösterilememiştir. Üçüncü gün sakrifiye edilen sıçanlarda bowman kapsül aralığı ve interstisyel inflamasyonun ilaç dozuyla orantılı olarak anlamlı artışı saptanmıştır. 21. gün sakrifiye edilen grubun patolojik değerlendirmesinde ise doz artışıyla korele olarak damar duvarında kalınlaşma gözlenmiştir. Sonuç İnsan VEGF monoklonal antikoru bevasizumab kullanarak, bu tedavinin böbrek üzerine olan yan etkilerini gözlemleyebileceğimiz deneysel bir sıçan modeli oluşturmak için 10 mg/kg dozunda üç günlük bevasizumab uygulanmasının uygun olduğu gösterilmiştir.Aim To constitute an experimental rat model by using human VEGF monoclonal antibody bevacizumab, for observation of renal side effects of this treatment. Materials and Methods Thirtysix adult female Wistar albino rats has been divided as two main groups: “3 days” and “21 days” . Each group has been divided in three; bevacizumab 10 mg/kg and 20 mg/kg were administered intravenously from the tail veins of the two subgroups and 1 mg/kg saline was administered to the third subgroup as control. Urine for 24 hours for detection of proteinuria and blood samples for detection of renal funtions were collected before, third day and 21st day of the drug administration and rats were sacrified at third and 21st days for pathological examination of kidneys. Results Twenty four hours urine protein excretion, creatinin excretion and urine protein/creatinin ratio were demonstrated as significantly increased on the third day of the rats administered 10 mg/kg bevacizumab; however, any significant increase of proteinuria couldn’t be shown on the 21 days group rats administered neither 10 mg/kg or 20 mg/kg. Pathological examination of rats sacrified on third day demonstrate the significant increase of bowman capsule gap and interstitial inflamation as correlated with the dosage of the drug. The thickness of vessel wall was observed on the pathological examination of rats sacrified on 21st day. Conclusion It has been shown that bevacizumab administration of 10 mg/kg for three days is proper for constitution of an experimental rat model

Prevalence of Metabolic Syndrome in Primary Hyperparathyroidism

Aim: In this study, we aimed to evaluate the prevalence of metabolic syndrome (MetS), metabolic abnormalities and independent predictors of MetS in primary hyperparathyroidism and to contribute to long-term follow-up and management of these patients. Methods: Seventy-eight non-pregnant patients aged 18 years and over without renal or hepatic failure and other systemic diseases, who were diagnosed with primary hyperparathyroidism, between January 2005 and December 2014 were included in the study. Results: Sixty-two (79.5%) subjects were female and 16 (20.5%) were male. The mean age of the patients was 55.3±12.6 years. Fifty eight patients were classified as symptomatic and 20 as asymptomatic. Thirty-two patients (41%) were found to have primary hyperparathyroidism in accordance with the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. The frequency of urinary tract stone disease was significantly higher in patients with hyperparathyroidism with MetS than in those with primary hyperparathyroidism without MetS (p=0.018). Conclusion: In our study, the prevalence of MetS in patients with primary hyperparathyroidism was found to be similar to that demonstrated in epidemiological studies performed in the general population of the same age. However, in these patients higher prevalence of hypertension, increased waist circumference, lipid disorders such as some syndrome abnormalities that may lead to the increased cardiovascular morbidity and mortality were observed

Investigation of VEGF and IL-8 Gene Polymorphisms in Patients with Differentiated Thyroid Cancer

Background: Differentiated thyroid carcinomas (DTC) account for most of the thyroid cancers. The emergence of DTC may be affected by various predisposing genetic alterations and environmental factors The aim of this study was to investigate the role of VEGF C936T and IL-8 A251T gene polymorphisms in the pathogenesis and metastasis of differentiated thyroid cancer