Postprandial phase fluctuations can trigger the coagulation cascade

Background and aims: Cardiovascular Diseases (CVD) are the most common causes of mortality and morbidity among patients with type 2 diabetes. Poorly controlled postprandial hyperglycemia contributes to the development of atherosclerosis. Fluctuations of the postprandial glucose levels bring changes in the coagulation system and propensity to thrombosis. Our aim was to determine the change of plasma coagulation parameters like D-Dimer, P-Selectin, Plasminogen activator inhibitor-1 (PAI-1), Prothrombin fragments 1-2 (PTF 1-2) in comparison to the fasting levels in 15 healthy controls and type 2 diabetic patients under treatment of various agents (metformin, insulin secretagog agents and insulin). Materials and methods: Blood samples were withdrawn after 12 h of fasting (min 0) and following breakfast composed of foods proper for each person, at 60th, 90th and 120th minutes. Fasting and 60th, 90th, and 120th minute measurements of glucose, insulin, triglyceride, D-Dimer, P-Selectin, PAI-1, PTF 1-2 had been performed. HA1C and fructosamine were measured also. Results: Some coagulation parameters tend to be changed at the postprandial phase in diabetics as well as in healthy controls. At the postprandial phase, PAI-1 increased significantly in both healthy controls and in all groups of diabetics. The fasting levels of fibrinogen, D-Dimer and P-Selectin were high in diabetics in comparison to healthy controls. An increase in the levels of P-Selectin, PAI-1 and PTF 1-2 at the postprandial phase was observed in healthy persons. Patients receiving insulin secretagog therapy showed an increase in the postprandial levels of PAI-1 like healthy controls. Patients receiving metformin showed an increase in the postprandial levels of PAI-1 and PTF 1-2. Postprandial phase changes in patients receiving metformin were similar to healthy controls. Poorly controlled, older patients with longer diabetes duration had been receiving insulin and these mentioned patients' levels of fibrinogen, D-Dimer and P-Selectin were high in the fasting state and showed an increase in PAI-1 at the postprandial phase. Postprandial levels of PTF 1-2 and D-Dimer were high in insulin treated patients. Levels of fibrinogen and D-Dimer were higher in patients with retinopathy. HA1C and fructosamine were correlated with the coagulation parameters like P-selectin, PAI-1 and PTF 1-2 levels. Correlations showed us that not only postprandial hyperglycemia but also accompanying diabetes, obesity, dyslipidemia and hypertension can aggravate this coagulation tendency at the postprandial phase. Conclusion: Postprandial phase changes can trigger postprandial coagulation cascade in diabetics as well as healthy persons

Rituximab Treatment in a Patient with Active Graves’ Orbitopathy and Psoriasis

Management of Graves’ orbitopathy remains an important therapeutic challenge. Current therapeutic modalities are unsatisfactory in about one third of patients. Rituximab is a monoclonal antibody against CD20 antigen that is expressed in mature and immature B cells. Early experience with rituximab suggests that it is a promising alternative therapy for Graves’ orbitopathy. Here we report a case of a 49-year-old woman with Graves’ orbitopathy and psoriasis. The patient received 2 infusions of 1 g rituximab 2 weeks apart. Although there was improvement in inflammatory signs of the disease, proptosis did not change after the treatment

Hypoglobulinemia and Nonsecretory Myeloma as a Rare Cause of Osteoporosis in a Young Man

A 27-year-old man was admitted to our hospital with the complaint of back pain. Bone mineral density evaluation revealed severe osteoporosis. The causes for secondary osteoporosis, such as thyrotoxicosis, glucocorticoid therapy, hypercortisolemia, hypercalciuria, and hyperparathyroidism were excluded. Laboratory examination revealed hypoglobulinemia. Further evaluation of the immunoglobulin levels was compatible with panhypoglobulinemia. The patient's vitamin D level was also low. The patient was first suspected of having a common variable immune deficiency, but he had not not experienced frequent infections. By carefully evaluating his chest x ray, a lytic lesion in his left humerus was observed. He did not have anemia and elevated sedimentation rate was not observed. Protein electrophoresis showed hypoglobulinemia. Haematology consultation was requested and a bone marrow aspiration was performed. Bone marrow examination revealed multiple myeloma with a myeloma cell increase of 70 to 80%. The patient was diagnosed as having nonsecretory myeloma which explained his hypoglobulinemia. Myeloma may cause severe osteoporosis, pain and hypercalcemia. A chemotherapy regimen (vincristine, adriablastina, dexamethasone) was initiated and further autologous stem cell transplantation was planned. The patient had also chromosome 13 abnormality. Osteoporosis at a young age especially in young men should always be extensively evaluated

Clinical Study Investigation on Carbohydrate Counting Method in Type 1 Diabetic Patients

Objective. The results from Diabetes Control and Complications Trial (DCCT) have propounded the importance of the approach of treatment by medical nutrition when treating diabetes mellitus (DM). During this study, we tried to inquire carbohydrate (Kh) count method's positive effects on the type 1 DM treatment's success as well as on the life quality of the patients. Methods. 22 of 37 type 1 DM patients who applied to Eskişehir Osmangazi University, Faculty of Medicine Hospital, Department of Endocrinology and Metabolism, had been treated by Kh count method and 15 of them are treated by multiple dosage intensive insulin treatment with applying standard diabetic diet as a control group and both of groups were under close follow-up for 6 months. Required approval was taken from the Ethical Committee of Eskişehir Osmangazi University, Medical Faculty, as well as informed consent from the patients. The body weight of patients who are treated by carbohydrate count method and multiple dosage intensive insulin treatment during the study beginning and after 6-month term, body mass index, and body compositions are analyzed. A short life quality and medical research survey applied. At statistical analysis, t-test, chi-squared test, and Mann-Whitney U test were used. Results. There had been no significant change determined at glycemic control indicators between the Kh counting group and the standard diabetic diet and multiple dosage insulin treatment group in our study. Conclusion. As a result, Kh counting method which offers a flexible nutrition plan to diabetic individuals is a functional method

Investigation on Carbohydrate Counting Method in Type 1 Diabetic Patients

Objective. The results from Diabetes Control and Complications Trial (DCCT) have propounded the importance of the approach of treatment by medical nutrition when treating diabetes mellitus (DM). During this study, we tried to inquire carbohydrate (Kh) count method’s positive effects on the type 1 DM treatment’s success as well as on the life quality of the patients. Methods. 22 of 37 type 1 DM patients who applied to Eskişehir Osmangazi University, Faculty of Medicine Hospital, Department of Endocrinology and Metabolism, had been treated by Kh count method and 15 of them are treated by multiple dosage intensive insulin treatment with applying standard diabetic diet as a control group and both of groups were under close follow-up for 6 months. Required approval was taken from the Ethical Committee of Eskişehir Osmangazi University, Medical Faculty, as well as informed consent from the patients. The body weight of patients who are treated by carbohydrate count method and multiple dosage intensive insulin treatment during the study beginning and after 6-month term, body mass index, and body compositions are analyzed. A short life quality and medical research survey applied. At statistical analysis, t-test, chi-squared test, and Mann-Whitney U test were used. Results. There had been no significant change determined at glycemic control indicators between the Kh counting group and the standard diabetic diet and multiple dosage insulin treatment group in our study. Conclusion. As a result, Kh counting method which offers a flexible nutrition plan to diabetic individuals is a functional method