PPARG genindeki Pro12Ala polimorfizmi, Türk populasyonunda insülin direnci ve tip 2 diyabet ile ilişkili değildir: Bir vaka-kontrol çalışması

Amaç: Tip 2 diyabet (T2D), diyabetin en sık görülen türüdür ve tüm dünyada olduğu gibi ülkemizde de ciddi bir halk sağlığı sorunu haline gelmiştir. İnsülin sekresyonunun azalması ve/veya insülin direnci (İR) gelişimi, T2D patogenezinde yer alan iki ana bozukluktur. Kromozom 3p25'te yer alan peroksizom proliferatör aktive reseptör gama (PPARG) geni tarafından kodlanan ve esas olarak adipositlerde eksprese edilen PPARG2, glikoz ve lipid metabolizmasının düzenlenmesinde yer alan çok sayıda anahtar geni düzenler. Fonksiyonel önemi dolayısıyla, T2D gelişimi ile ilişkisi ilk rapor edilen aday gen PPARG2 (Pro12Ala varyantı)’dir. Çalışmamızda, PPARG genindeki Pro12Ala'nın IR gelişimi ve T2D riski üzerine etkilerini Konya bölgesinde yaşayan 387 (181 non-obez/ 206 obez) T2D ve 264 (137 non-obez/127 obez) sağlıklı birey olmak üzere toplam 650 kişide değerlendirmeyi amaçladık. Yöntem: Bireylerden alınan kan örneklerinden, T2D ilişkili biyokimyasal parametreler analiz edildi ve sonrasında HOMA-IR (HOMA indeksi) hesaplandı. HOMAIR indeksi 2.5'ten yüksek olan kişiler insüline dirençli olarak kabul edildi. İzole edilen DNA örneklerinde, Pro12Ala genotiplendirmesi RT-PCR tekniği ile yapıldı. İstatistiksel analiz için SPSS18.0 programı kullanıldı. P<0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Obez hasta grubu dışında diğer hasta ve ve kontrol grupları Hardy-Weinberg dengesinde değildi (p<0.05). Dominant, resesif ve aditif modeller kurularak yapılan ilişkilendirme analizine göre Pro12Ala polimorfizminin T2D riski ve ilişkili biyokimyasal parametreler üzerine bir etkisi bulunmadı (p>0.05). Sonuç: Hastalığın poligenik doğası ve çevresel faktörlerin karmaşıklığı, genlerin T2D patogenezindeki etkisinin anlaşılmasını zorlaştırmaktadır. Bu nedenle, PPARG'nin hastalığın genetik zeminindeki olası rolünü ortaya çıkarmak için daha büyük popülasyonlarda daha fazla çalışmaya ihtiyaç vardır. Çalışma Türk toplumunda PPARG ve T2D ilişkisi bakımından sunulan ilk rapordur

An Atypical Presentation of Brucellosis in a Patient with Isolated Thrombocytopenia Complicated with Upper Gastrointestinal Tract Bleeding

A 59-year-old female patient was admitted to the emergency service with complaints of hematemesis and melena for the last few days. In laboratory tests, the platelet count was found to be /L. Intravenous or oral corticosteroid treatment was thought to be given for ITP but disclaimed due to upper GIS bleeding. On the 5th day of treatment, Brucella melitensis was isolated from blood culture before the results of Wright tube agglutination tests were reported positive as 1 : 80. On the second day of the anti-brucellosis treatment, the thrombocyte count was raised from 6000/mm3 to 110000/mm3, and on the 3rd day to 225000/mm3

Relationship Between Insulin Resistance and Mean Platelet Volume in Gestational Diabetes Mellitus

Objectives: A few studies have investigated the relationship between mean platelet volume (MPV) and gestational diabetes mellitus (GDM), and in these studies the relationship between MPV and insulin resistance has not been analyzed. Our aim in this study was to compare MPV values of the pregnant women with or without GDM and evaluate the relationship between MPV and homeostasis model assessment insulin resistance index (HOMA-IR) in pregnant women. Materials and Methods: One hundred and fourteen with GDM measurements being obtained before any dietary advice or therapy with insulin or hypoglycemic agents were given, and 76 with healthy pregnant women were included the study. Results: In the group with GDM, MPV value was found to be significantly higher than that of the control group (10.2 fl [8.0–12.2] vs. 9.9 fl [5.81–10.9], P = 0.004). HOMA-IR value was detected to be significantly higher in the group with GDM (2.46 [1.5–5.88] vs. 1.30 [0.17–2.92], P < 0.001). A positive correlation between MPV and HOMA-IR was found (r = 0.30, P = 0.002). Conclusion: We have shown that MPV was significantly elevated in GDM patients when compared to healthy pregnant women. Furthermore, we found that there was a positive correlation between MPV and HOMA-IR

Immunosuppressive treatment for immune thrombocytopenia which masked Graves′ disease

A 71-year-old female patient followed primary immune thrombocytopenia (ITP) was admitted to endocrinology unit with excessive sweating. We started methimazole for Graves′ disease. Without any additional immunosuppressive treatment, at week 12 of methimazole therapy, thyroid stimulating hormone (TSH) levels returned to normal, and platelet counts rose to tolerable levels. When her hospital records were analyzed, they revealed that a year ago, when she had been diagnosed with ITP, her TSH values had been suppressed. After immunosuppressive therapy, her platelet values were maintained at normal levels, and during her control visits, her TSH levels were measured twice and were within normal limits. We think that immunosuppressive therapy for ITP without considering thyroid function tests may result in a transient euthyroid state, which potentially masks Graves′ disease accompanying immunosuppressive therapy and associated recurrent ITP attacks

Assessment of serum galectin-3 levels in patients with gestational diabetes mellitus

Objective: This study was aimed to compare serum galectin-3 (Gal-3) levels in gestational diabetes mellitus (GDM) and healthy pregnant women and to evaluate the relationship between insulin resistance parameters and serum Gal-3 levels. Materials and Methods: Fifty-nine pregnant women who were screened for GDM with oral glucose tolerance tests (OGTT) at the 24th–28th gestational weeks were included in the study. According to the results of OGTT, 34 pregnant women were included in the GDM group and 25 pregnant women were included in the control group. Results: Serum Gal-3 value was found to be similar in the GDM and control group (P < 0.471). However, there was a significant positive association between Gal-3 and fasting insulin (r = 0.509, P < 0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.479, P < 0.001) in the whole pregnancies, and between Gal-3 levels and fasting insulin (r = 0.608, P < 0.001), HOMA-IR (r = 0.609, P < 0.001), and OGTT 60 min glucose (r = 0.444, P = 0.016) in the GDM patients. Conclusions: There was no difference in the last trimester serum Gal-3 levels between GDM and healthy pregnant women. However, a significant positive correlation was determined between Gal-3 and fasting insulin, HOMA-IR, and OGTT 60 min glucose values in the GDM group, and fasting insulin and HOMA-IR values in whole pregnancies. The results of our study support previous data reporting the relationship between Gal-3 and GDM through insulin resistance

Changes in Serum Levels of ADMA, SDMA and L-NMMA with Helicobacter Pylori Eradication

WOS: 000419258100007Objective: Increased asymmetric dimethylarginine (ADMA) levels are associated with reduced nitric oxide (NO) levels in many systems, particularly the cardiovascular system, and cause adverse effects. The objective of this study is to evaluate the effect of eradication therapy in patients infected with Helicobacter pylori (H. pylori) on the serum level of ADMA and other metabolic products of methylarginine. Methods: Patients who were found positive both in urea breath tests and stool antigen tests were considered to have H. pylori infection. These patients received eradication therapy for 14 days (twice daily pantoprazole 40 mg, twice daily amoxicillin 1000 mg, and twice daily clarithromycin 500 mg). Blood samples were taken to measure serum ADMA, symmetric dimethylarginine (SDMA), and N-monomethyl-Larginine (L-NMMA) levels before eradication therapy and 3 months after the therapy for patients for whom eradication was achieved. Results: A total of 23 of the 45 patients included in the study were female, whereas 22 were male. The mean age of the patients was 32.4 +/- 8 years. Significant reductions in the serum ADMA, SDMA, and L-NMMA levels of the patients were observed post-eradication therapy versus pre-eradication therapy. Conclusion: This study demonstrated significant reductions in serum ADMA, SDMA, and L-NMMA levels with H. pylori eradication. Further extensive long-term studies are needed to evaluate the positive effects that reduced serum ADMA, SDMA, and L-NMMA levels after H. pylori eradication can have on all systems, particularly the cardiovascular system

Letrozole Induced Hypercalcemia in a Patient with Breast Cancer

Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia. However, there is only one case report of letrozole induced hypercalcemia. A 52-year-old female patient was referred to our clinic because of the recent discovery of hypercalcemia (11.0 mg/dL). The patient had a history of left breast carcinoma. She had started a course of letrozole (aromatase inhibitor; 2.5 mg dose/day) ten months earlier. Patient’s parathyroid hormone-related protein levels were normal and a bone scintigram revealed no evidence of skeletal metastasis. Other potential causes of high calcium levels were ruled out. We recognized that, when letrozole was taken at one dose daily (2.5 mg), she had recurrent hypercalcemia. Our experience suggests that letrozole may precipitate hypercalcemia in a patient with breast cancer

Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma

A 42-year-old male patient was admitted to our hospital for planning autologous hematopoietic stem cell transplantation (auto-HSCT). He was diagnosed as multiple myeloma (IgG type Kappa) in 2003. His physical examination was normal with no important abnormality on laboratory evaluation. Chest radiography performed for routine evaluation prior to transplantation revealed a large, welldefined mass, that had obtuse angles with the chest wall consistent with extraparenchymal lesion superposed on second and third ribs. Also, there were multiple bony structures demonstrating changes of destructive effects of multiple myeloma. Computed tomography (CT)-guided biopsy was obtained from the mass by transthoracic fine-needle aspiration (FNAB) method. Biopsy was reported as extramedullary hematopoiesis (EMH) contrary to our expectation of multiple myeloma