Olağandışı HbA1c düzeyi gözlenen tip 1 diyabetli bir olgunun değerlendirilmesi

The HbA1c test provides information about blood glucose levels of previous months depending on the erythrocyte lifetime when monitoring diabetic patients. However, various factors such as HbF and other hemoglobin variants can interfere with the measurement of HbA1c. In this study, an unexpectedly high HbA1c level was observed in a patient with type 1 diabetes. In the hemoglobin chain analysis, which explained the reason for the high value, high fetal hemoglobin levels were detected and interfered with HbA1c measurement with the HPLC method. This finding was in concordance with the literature. As a conclusion, it should be considered that hemoglobinopathy might be found in the patients who have higher levels of HbA1c which is not in agreement with the blood glucose. Thus, it can be said that HbA1c test is not a good marker for monitoring such diabetic patients. In such cases, fructosamine or other glycated end products may be a more reliable marker.HbA1c testi, diyabetik hastalarda eritrosit yaşam süresine bağlı olarak son birkaç aylık kan şekeri düzeyi hakkında bilgi veren bir testtir. Çeşitli yöntemlerle ölçülen HbF ya da diğer hemoglobin tipleri HbA1c ölçüm sonuçlarını etkileyebilir. Bu çalışmada tip 1 diyabetli bir hastada beklenmedik yüksek HbA1c düzeyi gözlendi. Nedenini açıklamak için gerçekleştirilen Hb zinciri analizinde, yüksek HbF düzeyinin HPLC metodu ile yapılan HbA1c ölçümünü etkilediği tespit edildi. Bu bulgu literatür ile de uyum göstermekteydi. Sonuç olarak, kan şekeri ile uyumu düşünüldüğünde yüksek bulunan HbA1c düzeyleri için hastalarda hemoglobinopati bulunabileceği göz önüne alınmalıdır. Bu durumda HbA1c testinin böyle diyabetik hastaların takibi için iyi bir rehber olmadığı söylenebilir. Bu gibi vakalarda, fruktozamin veya diğer glukozile son ürünler daha güvenilir izlem belirteci olabilir

Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS

Purpose This study is designed to explore the correlation between AMH levels and IR in normal weight PCOS women. Materials and methods This prospective study was conducted on 55 patients, who were admitted to obstetrics and gynecology department of a university clinic. Study group was consisted of 34 patients diagnosed as polycystic ovary syndrome (PCOS) according to the Rotterdam Criteria, whereas control group was consisted of 21 healthy volunteers without any features of clinical or biochemical hyperandrogenism, who had regular menstrual cycles. BMI C 25 kg/m2 were considered overweight and obese and excluded. Blood samples were obtained during days 2–3 after spontaneous menses or progesterone-induced withdrawal bleeding after overnight fasting for at least 12 h. The weight, height, hip and waist circumferences of the patients were measured. Fasting insulin and glucose (FPG) levels were used for calculating different insulin resistance indexes (Homeostatic Model Assessment (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI)). Results No significant difference was found between PCOS and control groups regarding the mean age, BMI, waist to hip ratio (WHR), mean values of FPG, FPG/insulin ratio and HOMA B (p[0.05). AMH values were significantly higher in PCOS cases when compared with controls (4.7 vs. 3.4 ng/mL) (p\0.05).The mean values of HOMAIR and QUICKI indexes were significantly higher among PCOS cases when compared with controls. E2 levels were significantly lower and Total-T were significantly higher in PCOS patients. When PCOS cases are categorized according to the existence of IR, no difference in Total-T and AMH levels between both groups. Although not statistically significant, a negative correlation of AMH with HOMA-IR and a positive correlation with QUICKI index were found. Among the hormone parameters, AMH was found to be positively correlated with Total-T (r = 0.332, p = 0.013). Conclusion Although the relation between AMH and androgen production is supported by current evidence, the mechanism underlying the relation between AMH and insulin resistance is not clear yet

PPI kullanımının clostridium difficile serum antijen değerlerine olan etkisi

Aim: To evaluate the effects of proton-pump inhibitor (PPI) use on distrubtion of intestinal flora by measuring serum Clostridium Difficile antigen levels before and at the end of a three- months treatment in patients with Laryngopharyngeal reflux (LFR) treatment. Material and Method: The study covers 32 patients with LFR, out of which 24 were female (75%) and 8 were male (25%). The mean age of the patients was 34.13 +/- 11.59. All patients included in the study were administered Lansoprazole 30 mg tablets perorally before meals and twice a day for treatment. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), white blood cell count, CRP and serum Clostridium Difficile toxin A, B measurement results were comparatively evaluated through the blood serum samples drawn from the patients before and at the end of the three- months treatment. Results: While the mean values of pre-treatment RSI and RFI were 20.81 +/- 4.05 and 13.31 +/- 3.30 respectively, the mean values were measured to be 3.41 +/- 2.37 and 1.50 +/- 1.88 respectively following the three- months treatment (p< 0.05). The pre-treatment mean value of serum Clostridium Difficile Ag was 140.56 +/- 11.74, while it was seen that the same value became 114.94 +/- 10.70 after the three- months treatment (p< 0.05). There was, however, no statistically significant change in the other parameters. Discussion: According to the results obtained, it was seen that the treatment with PPI was not cause to increase Clostridium difficile toxin A, B serum antigen levels. So these drugs could be used in long time therapies confidently.Amaç: Larengofarengeal Reflü (LFR) hastalığının tedavisi amacıyla Proton pompa inhibitörü (PPİ) kullanan hastalarda tedavi öncesi ve üç aylık tedavinin sonunda serum Clostridium Difficile antijen miktarı ölçülerek PPİ kullanımının serum Clostridium Difficile serum antijen miktarı üzerindeki etkisinin değerlendirilmesi. Gereç ve Yöntem: Çalışmaya LFR hatalığı tespit edilen 32 hasta ( 24 ( % 80)’ü kadın, 8 (% 20)’i erkek) dahil edildi. Hastaların yaş ortalaması 34.13 ± 11.59 idi. Çalışmaya dahil edilen tüm hastalara tedavi için günde iki kez yemeklerden önce alınacak şekilde lansoprazol 30 mg tablet peroral olarak başlandı. Tedavi öncesinde ve üç aylık tedavinin sonunda hastaların LFR şiddeti Reflü Semptom İndeksi ( RSI) ve RBS ( Reflü Bulgu Skoru) kullanılarak değerlendirildi. Ayrıca hastalardan tedavi öncesi ve üç aylık tedavinin sonunda alınan kan serum örneklerinde beyaz küre, CRP, sedimantasyon ve serum Clostridium Difficile toxin A, B ölçümleri yapılarak karşılaştırmalı olarak değerlendirildi. Bulgular: Tedavi öncesi RSI ve RBS ortalamaları sırasıyla 20.81±4.05 ve 13.31±3.30 iken, üç aylık tedavi sonrasında bu ortalamalar sırasıyla 3.41±2.37 ve 1.50±1.88 olarak tespit edildi ( p< 0,05). Tedavi öncesi serum Clostridium Difficilie Ag değerlerinin ortalaması 140.56±11.74 iken üç aylık tedavi sonrasında bu ortalamanın 114.56±10.70 olduğu görüldü ( p 0,05). Tartışma: Elde ettiğimiz sonuçlara göre, proton pompa inhibitörü kullanan hastaların Clostridium difficilie toxin A, B serum antijen düzeylerinde istatistiksel olarak anlamlı bir düşüş olduğunu görüldü

Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications

Aims: The aim of this study was to evaluate the predictive value of sex-hormone-binding globulin (SHBG) for the diagnosis of gestational diabetes mellitus (GDM), and to clarify the association between SHBG levels and GDM complications/medication requirements. Material and Methods: Among the participants (n = 93) who provided blood samples between 13 and 16 weeks’ gestation, 30 cases subsequently developed GDM. Complications and medical interventions were noted. The best cut-off point of SHBG and diagnostic performance were calculated. Results: The mean age was 28.45 - 5.0 years. SHBG levels were lower in the GDM group (n = 30) when compared with non-GDM (n = 63) cases (<0.01). Among the GDM women, SHBG was lower in the insulin therapy group (n = 15) compared with medical nutritional therapy alone (n = 15) (P < 0.01). A good predictive accuracy of SHBG was found for GDM requiring insulin therapy (area under the curve: 0.866, 95% confidence interval: 0.773–0.959). An SHBG threshold for 97.47 nmol/L had a sensitivity of 80.0%, specificity 84.6%, positive predictive value 50.0% and negative predictive value 95.7%. The calculated odds ratio for SHBG < 97.47 nmol/L was 12.346 (95% confidence interval: 1.786–83.33). Conclusions: SHBG is valuable for screening women early in pregnancy for GDM risk; however, a standard assay for analyses and a threshold level of serum SHBG for a constant gestational week has to be determined

A preliminary study: aspirin discontinuation before elective operations; when is the optimal timing?

Purpose: To evaluate the optimum timing of aspirin cessation before noncardiac surgeries. We have conducted a pilot study to minimize the aspirin cessation time before various surgeries. Methods: Eighty patients who were taking regular aspirin for secondary prevention undergoing elective surgical operations were enrolled in the study. We separated the patients into two groups. The control group had 35 patients who stopped aspirin intake 10 days before surgery. The study group had 45 patients who stopped their aspirin intake and underwent surgery one day after arachidonic acid aggregation tests were within normal limits. Bleeding, blood loss, and transfusion requirements were assessed perioperatively. Results: The mean time between aspirin cessation and aspirin nonresponsiveness were found to be 4.2 days with a median value of 4 days. In addition, the mean time between aspirin cessation and operation day were found to be 5.5 days with a median value of 5 days. No perioperative bleeding, thromboembolic or cardiovascular complications were encountered. Conclusion: Reducing time of aspirin cessation from 7-10 days to 4-5 days is a possibility for patients using aspirin for secondary prevention without increased perioperative complications

The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study

Objective: Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. Methods: Seventy two women with uncomplicated term pregnancies were randomized to spinal (n = 37) or general anesthesia (n = 35) groups. The blood pressure, oxygen saturation, and pulse rate of the patients were recorded during the procedure. Maternal blood samples of ischemia modified albumin (IMA) were taken 10 min from the start of the procedure. The fetal cord blood samples of IMA were taken immediately after birth. Results: Maternal (0.99 ± 0.19 vs. 0.80 ± 0.27) and fetal (1.00 ± 0.21 vs. 0.70 ± 0.26) IMA levels were significantly higher in the general anesthesia group. Fetal IMA levels were positively correlated with maternal gravidity (r = 0.31; P = 0.008), parity (r = 0.25; P = 0.028), and fetal birth weight (r = 0.23, P = 0.045). Also, as time from incision to delivery lengthens, fetal IMA levels increase (r = 0.29, P = 0.012). Conclusion: Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested

The association between ischemia modified albumin and placental histopathology in uncomplicated term deliveries

Ischemia modified albumin (IMA) is a marker of ischemia elevated in different clinical conditions and its use for hypoxia in perinatology is of current interest. We aimed to investigate the association between maternal and cord blood IMA levels and placental histopathological findings in uncomplicated term deliveries. In this study, placental histopathological evaluation in uncomplicated deliveries that ended with healthy newborns revealed 80.6% vasculopathy. The results support the hypothesis that hypoxia exceeding the placental reserve ends with fetal compromise. Moreover, the presence of maternal vasculopathy in placenta is not correlated with maternal and fetal IMA levels

Atherogenic dyslipidemia, subclinical atherosclerosis, non-alcoholic fatty liver disease and insulin resistance in polycystic ovarian syndrome

Objective: We aimed to explore the relationship between insulin resistance (IR) and small dense lipoprotein (sd-LDL) particles, carotid intima-media thickness (CIMT) and non-alcoholic fatty liver disease (NAFLD) in young normal weight PCOS cases. Methods: This prospective, case-control study was designed in a University Hospital and 34 women with PCOS and 21 healthy controls were enrolled. Fasting plasma glucose, insulin, lipid (including sd-LDL particles) and hormone profiles, abdominal ultrasound and CIMT were evaluated. Results: IR was present in 68% of PCOS group while in none of controls. High density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG), and sd-LDL were higher in patients with IR (p<0.05). A positive correlation of sd-LDL with IR, VLDL and TG was found. A significantly higher rate of NAFLD and CIMT was found in PCOS. Totaltestosterone levels were weakly and positively correlated with CIMT (r=0.277, p=0.041). Conclusion: Insulin resistance and NAFLD are highly prevalent among young normal weight PCOS patients. When compared to controls levels of sd-LDL and CIMT are increased in PCOS. Insulin resistance is the key parameter for NAFLD and atherogenic dyslipidemia in PCOS. Hence, screening for NAFLD may be valuable for detection and prevention of liver disease. Higher levels of sd-LDL in insülin resistant PCOS cases necessiates treating PCOS for I

CRP at early follicular phase of menstrual cycle can cause misinterpretation for cardiovascular risk assessment

Objective: C-reactive protein (CRP) is a well-known marker of infl ammation and infection in clinical practice. This study is designed to evaluate CRP levels in diff erent phases of menstrual cycle, which might end up with misleading conclusions especially when used for cardiovascular risk assessment. Methods: Twenty-seven women were eligible for the cross-sectional study. Venous blood samples from each participant were collected twice during the menstrual cycle. The fi rst sampling was held at 2nd to 5th days of the menstrual cycle for FSH, estradiol, CRP, and sedimentation, and the second was done at 21st to 24th days of the menstrual cycle for measurement of progesterone, CRP, and sedimentation values. Results: CRP values were signifi cantly higher in the early follicular phase compared to luteal phase (1.8 mg/L [0.3–7.67] vs. 0.7 mg/L [0.1–8.3], p < 0.001, respectively). In both phases of the menstrual cycle, sedimentation rate was similar (12.1 ± 6.7 vs. 12.3 ± 7.7; p = 0.717, respectively). Conclusions: CRP levels in early follicular phase of the menstrual cycle (menstruation) are signifi cantly higher than CRP levels in luteal phase of the same cycle. In reproductive age women, detection of CRP for cardiovascular risk assessment during menstruation might not be appropriate

Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study

[No Abstract Available