Tip 2 Diyabetli Bir Hastada Linagliptine Bağlı Lokalize Ağrılı Döküntü

The number of patients with type 2 diabetes using dipeptidylpeptidase-4 (DPP-4) inhibitors is increasing across the world.Although this class of antidiabetic medications is generallysafe and associated with less side effects compared to otheroral antidiabetic medications, they could also cause some sideeffects such as skin rashes. Herein we report a case of type 2diabetes patient who developed a painful maculopapular rashinduced by linagliptin, a widely used DPP-4 inhibitor.A localized painful maculopapular rash developed on thepalmar faces of the patient’s hands almost 1 day after theinitiation of the drug. The patient was using intensive insulintherapy before linagliptin was started. There was no eruptionon the other body parts except the palmar faces of the hands.Following the discontinuation of the drug, the rash disappearedin about four days. The patient had no history of urticaria anddid not use an ACE inhibitor. As far as we know, this is the firstcase report of a skin rash induced by linagliptin in the Turkishliterature. This case report highlights a rare and lesser knownside effect of linagliptin, a new member of DPP-4 inhibitors.Dipeptidil peptidaz-4 (DPP-4) inhibitörleri kullanan tip 2 diyabet hastalarının sayısı dünya genelinde artmaktadır. Bu antidiyabetik ilaç sınıfı genelde güvenli olmakla birlikte diğer oral antidiyabetik ilaçlarla karşılaştırıldığında daha az yan etki ile ilişkili olsa da, deri döküntüleri gibi bazı yan etkilerle ilişkili olabilirler. Burada yaygın olarak kullanılan bir DPP-4 inhibitörü olan linagliptin ile indüklenen ağrılı makülopapüler döküntü gelişen tip 2 diyabetli bir hastayı sunuyoruz. Linagliptin başlandıktan 1 gün sonra hastamızın ellerinin palmar yüzünde lokalize ağrılı makülopapüler bir döküntü gelişti. Linagliptin başlanmadan önce hasta intensif insülin tedavisi altındaydı. Vücudun diğer bölgelerinde herhangi bir döküntü yoktu. Linagliptin kesildikten sonra 4 gün içerisinde döküntü kayboldu. Hastanın ürtiker öyküsü yoktu ve Anjiyotensin dönüştürücü enzim inhibitörü kullanmıyordu. Bildiğimiz kadarıyla bu, Türk literatüründe Linagliptine bağlı deri döküntüsü geliştirdiği rapor edilen ilk olgudur. Bu olgu sunumu, DPP-4 inhibitörlerinin nadir görülen ve daha az bilinen bir yan etkisini vurgulamaktadır

Türk populasyonununda tip 2 diabet hastalarında insülin substrat-2 geni g1057d polimorfizmi

Amaç: İnsülin reseptör substratı (IRS) proteini, hedef dokulara insülin sinyalinin iletilmesinde kritik bir öneme sahiptir. IRS-2 knockout farelerin insanlardaki tip 2 diabete benzer bir klinik fenotip gösterdiği tespit edilmiştir. IRS2 geninde çok sayıda polimorfizm belirlenmiş olmakla birlikte farklı populasyonlarda tip 2 diabet ile IRS-2 Gly1057Asp polimorfizmi arasındaki ilişki araştırılmış olup elde edilen sonuçlar oldukça çelişkilidir. Bu çalışmada Türk populasyonunda Diabetes mellitus ile IRS-2 G1057D polimorfizmi arasındaki ilişkiyi araştırmak amaçlanmıştır. Materyal ve Metot: Çalışma populasyonu 328 kişiden oluşmakta olup 138 kişi DM hastası ve 190 kişide kontroldür. DNA periferik kandan izole edilmiş olup IRS2 G1057D polimorfizmi PCR-RFLP yöntemi kullanılarak belirlenmiştir. Bulgular: IRS2 G1057D polimorfizmi genotip dağılımlarının gruplar arasında istatistiksel olarak anlamlı bir farklılık göstermediği tespit edilmiştir. Sonuçlar: Elde edilen bulgular IRS2 G1057D polimorfizminin tip 2 diabetin patogenezinde rolü olmadığını göstermektedir.Background: Insulin receptor substrate (IRS) proteins are critical to signal transduction in insulin target tissues. IRS-2 knockout mice exhibit a phenotype similar to human type 2 diabetes, characterized by insulin resistance with abnormal glucose tolerance at birth culminating in the development of fasting hyperglycemia in later age. While several polymorphisms have been identified in the IRS-2 gene, the association of the Gly1057Asp polymorphism with type 2 diabetes has been studied in different populations, but the results have been inconsistent. The present study was undertaken to determine IRS-2 G1057D polymorphism association with Diabetes mellitus in Turkish subjects. Material and Methods: The study population consisted of 328 subjects 138 patients with DM and 190 controls. DNA was extracted from peripheral blood. Genetic polymorphism of IRS-2 G1057D was detected by using PCR-based restriction fragment-length polymorphism. Results: The genotype distribution of the IRS2 G1057D polymorphism was not statistically significant between groups. Conclusions: These results strongly argue against a major role of the G1057D IRS-2 polymorphism in the pathogenesis of type 2 diabetes in Turkish subjects

Association of Insulin Receptor Substrate-2 Gene Polymorphism with Ovarian Cancer

Objective: The insulin receptor substrate (IRS) proteins have been implicated in contributing to all stages of tumorigenesis in many cancers, from initiating events to metastatic progression. In this study, we aimed to evaluate the association of IRS-2 gene polymorphism with ovarian cancer. Material and Methods: The study group consisted of 185 women: 45 women with ovarian cancer and 140 control subjects. All the patients with ovarian cancer were primarily treated by surgical intervention. Genetic polymorphism of IRS-2 G1057D was detected by using polymerase chain reaction (PCR)-based restriction fragment-length polymorphism (RFLP).Results: For IRS-2 G1057D polymorphism, the frequencies of GG, GD and DD genotypes were 60%, 33.3%, and 6.7%, respectively in the ovarian cancer cases and 53.6%, 38.6% and 7.9 % in controls. The risk for ovarian cancer was not significantlydifferent in the individuals with the IRS-2 DD genotype compared to the GG genotype (95% CI: 0.203-3.04, P: 0.787). Also, there was no association between carriage of the D allele and ovarian cancer risk. We found no significant difference between the genotypes in the ovarian cancer group and control group (P:0.545).Conclusion: These results do not support an association between carriage of the G1057D variant of IRS-2 gene and ovarian cancer

Fractional Exhaled Nitric Oxide Measurement in Pulmonary Hypertension: A Follow-Up Study

Pulmonary hypertension (PH) is a fatal disease although significant improvements in treatment are achieved. Easily implemented and noninvasive prognostic techniques are needed while following-up these patients. The aim was to investigate the role of fractional exhaled nitric oxide (FeNO) in follow-up for patients with PH. In this longitudinal study, patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who were seen in PH Outpatient Clinic, Istanbul Faculty of Medicine, Istanbul University, were enrolled in the study. Echocardiography, 6-minute walking test, brain natriuretic peptide, and FeNO measurements were performed, and World Health Organization functional class was evaluated to all patients at baseline, and third, and sixth months. Right-heart catheterization and pulmonary function tests at the time of diagnosis were recorded. The study comprised 31 patients (23 women, 8 men; mean age: 53.4 +/- 17.1 years) with PAH (n = 19) and CTEPH (n = 12) and 80 healthy controls. Patients with PH had lower FeNO values than the control group (16.5 ppb vs 19.8 ppb; P < .05). Fractional exhaled nitric oxide values did not change during follow-up and did not correlate with other follow-up measures except tricuspid annular plane systolic excursion values. Fractional exhaled nitric oxide was higher in the idiopathic PAH subgroup at baseline and at third month than patients with PAH associated with other diseases. Fractional exhaled nitric oxide did not change in patients who had clinical deterioration. As a conclusion; Patients with PH had lower FeNO values than healthy controls, but FeNO did not change significantly during follow-up. Large-scale studies with prolonged follow-up periods are needed to understand the role of FeNO in the follow-up of the patients with PH

Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)

Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Base