Silent myocardial ischemia and related risk factors in patients with type 2 diabetes mellitus

Objectives: The aim of this study was to investigate the frequency of silent myocardial ischemia (SMI) in patients with Type 2 diabetes mellitus (DM) who do not have ischemiccardiac disease.Materials and Methods: To examine the relationship between ischemic cardiac disease and related factors such as blood pressure, lipid profile, smoking, gender, family history, body mass index (BMI), microalbuminuria, hsCRP, 150 diabetic patients who have never had any known coroner artery disease, exertional or rest dyspnea and labored breathing, aged between 35 and 70 years were included. Effort testing (treadmill) were performed to examine the existence of SMI.Results: Effort testing gave positive result for SMI in 20 patients and negative in 130 patients. Coronary angiographywas performed in 20 patients with positive effort testing results. The frequency of SMI was found as %13.3 by effort testing. The frequency of SMI (including non-criticalpatients) was %10.6 (16 patients) by using coronary angiography, which 13(8.6%) had critical and 3(2%) had non-critical coronary stenosis. No significant differences were found in age, gender, diabetic duration, trigliserid, HDL- cholesterol, blood pressure, BMI and hsCRP levels between positive and negative SMI patients with Type 2 DM.Conclusion: We determined that high LDL-Cholesterol and HbA1c and existence of microalbuminuria indicated significant SMI risk for patients with Type 2 DM

Comparison of QT dispersion between subclinical hypothyroid and euthyroid patients

Objectives: The aim of this study was to investigate the relationship between subclinical hypothyroid and QTc dispersionindicating local heterogeneity in repolarization of myocardium, which is well known as independent cardiac risk factor for sudden death and ventricular arrhythmia.Materials and Methods: We compared QTc dispersion of subclinical hypothyroid patients, after treatment and healthy control group. We included a total of 50 patients with 41 women and 9 men in the study group. Electrocardiographywith 12 derivations, thyroid hormones, serum electrolytes and basic biochemical parameters were measured.The control group consisted of 25 healthy individuals.QT distances were calculated by using Bazet formula. The difference between the longest QTc and the shortest QTc distance was accepted as QTc dispersion (QTcd).Results: Comparison of subclinical hypothyroid patients, their euthyroidic period after treatment and healthy controlgroup, gave no significant differences in age, body weight, body mass index and free thyroxin values. However,significant difference was found in durations of QTd and QTcd between the subclinical hypothyroid, the control and the euthyroidic groups (p<0.001). No significant differenceswere found in QTc and QTcd durations between euthyroidic period and healthy subjects (p>0.05).Conclusion: Our results suggested that subclinical hypothyroidpatients had longer QTc dispersion compared to euthyroidic period and healthy subjects. However there was no QTcd difference between the euthyroidic period and healthy control group

Evaluation of the relationship between vitamin D level and adropin, IL-1β, IL-6, and oxidative status in women

Background/aim: Vitamin D, adropin, proinflammatory cytokines, and oxidative stress closely related with metabolic homeostasis and endothelial dysfunction. The aim of the present study is to investigate how vitamin D levels affect serum adropin, IL-1ß, IL-6, and oxidative stress. Materials and methods: A total of 77 female subjects were divided into 3 groups according to vitamin D levels. Biochemical parameters, adropin, IL-1ß, IL-6, oxidative stress markers were studied in these groups, and the results were compared statistically. Results: Serum adropin, IL-1ß, IL-6, total oxidant status (TOS) and total antioxidant status (TAS) and oxidative stress index (OSI) levels differed significantly between the vitamin D groups (p < 0.05). A significant positive correlation was detected between vitamin D, and adropin and TAS (r = 0.807; p < 0.001, r = 0.814; p < 0.001, respectively). A significant negative correlation was detected between vitamin D, and IL-1ß, IL-6, TOS, OSI (r = –0.725; p < 0.001, r = –0.720; p < 0.001, r = –0.238; p = 0.037, r = –0.705; p < 0.001, respectively). Conclusions: Vitamin D could show its effects through vitamin D receptors on tissues or on the ENHO gene in adropin secreting tissues via direct or indirect mechanisms. Proinflammatory cytokines, oxidative stress, and adropin targeted studies could contribute to the prevention and treatment of diseases associated with vitamin D deficiency in future

Pott's disease and hypercalcemia in a patient with rheumatoid arthritis receiving methotrexate monotherapy

WOS: 000328585100020PubMed: 24347778Methotrexate (MTX) may have adverse effects on multiple organs and system. A few cases of pulmonary tuberculosis in-patients with rheumatoid arthritis (RA) while receiving MTX monotherapy has been reported in the literature. We submit a case of vertebral tuberculosis with hypercalcemia in a patient receiving MTX monotherapy. Patient with RA taking MTX for 15 years developed pancytopenia, skin necrosis, tuberculous spondylodiscitis and hypercalcemia. the present case showed adverse effects of MTX therapy may occur even after years of continuous treatment. Due to pancytopenia in older patients, life-threatening tuberculosis at unusual sites may develop

Tip 2 diyabet hastalarında vildagliptin tedavisinin portal ven basıncı ve hepatosteatoz üzerine etkisi

Objective: ftis study investigated how vildagliptin (a di-pepti- dyl peptidase 4 inhibitor) affects portal vein pressure and hepat- osteatosis in patients with type 2 diabetes mellitus. Methods: ftis cross-sectional study evaluated the use of specific drugs for at least 3 months on two groups of type 2 diabetes mellitus cases. Group 1 used metformin and gliclazide, Group 2 used the same amounts of metformin and gliclazide, with the addition of vildagliptin. Using Doppler ultrasound, all cases were measured for portal vein flow velocity, portal vein flow and portal vein diameter. Degree of hepatosteatosis was also recorded. Results: A total of 97 patients completed the study. fte study finished with 49 type 2 DM patients in Group1 (20 men, 29 women) and 48 patients in Group2 (20 men, 28 women. No significant difference was found in term of age, gender, BMI, HbA1c, mean arterial pressure, LDL-C, HDL-C or triglyceride levels in two groups.Portal vein flow velocity, portal vein flow volume, and portal vein diameter of all cases were measured by Doppler ultrasound in both groups. No significant difference was found between the groups (respectively p=0.92, p=0.60, p=0.92). ftere was no significant difference between groups re- garding to ultrasonographic grading of hepatosteatosis Conclusion: Treating type 2 diabetes mellitus patients with vildagliptin for had no effect on portal vein hemodynamics and hepatosteatosis as assessed with Doppler ultrasound. Further long-term studies with better evaluation methods are needed to demonstrate any expected beneficial effect of vildagliptin on por- tal hemodynamics and hepatosteatosis.Amaç: Bu çalışmanın amacı tip 2 diyabeti olan ve tedavide bir di-peptidyl peptidase 4 (dpp-4) inhibitörü olan vildagliptin kul- lanan hastalarda ilacın portal ven basınc parametreleri ve hepa- tosteatoz üzerine etkilerini araştırmaktır. Yöntemler: Bu çalışma gözlemsel bir çalışmadır. Tip 2 diyabeti olan hastalarda en az üç aydır metformin ve gliclazide kullananlar (Grup 1) ile benzer özellikleri olan ve aynı tedaviye ek olarak vildagliptine alanlar (Grup 2) karşılaştırılmıştır. Çalışmada katı- lımcıların portal ven çapı, portal ven akım hızı, portal ven debisi ve hepatosteatoz derecesi non invaziv bir yöntem olan doppler ultrason (US) ile ölçülerek kaydedilmiştir. Bulgular: Çalışmaya toplam 97 hasta alınmıştır. Çalışmada 1. gruba 49 hasta alınırken 2. gruba 48 hasta alınmıştır. Katılım- cıların yaş ortalaması, cinsiyet, vucut kitle indeksi, HbA1c, or- talama kan basıncı, LDL-C, HDL-C ve trigliserit düzeyleri kar- şılaştırıldığında 2 grup arasında anlamlı bir fark bulunmamıştır. Çalışmaya katılanlarda doppler US ile yapılan ölçümlerde her iki grup portal ven akım hızı, debisi ve çapında anlamlı değişiklik saptanmamıştır (sırayla p=0,92, p=0,60, p=0,92). Sonuç: Vildagliptin kullanan hastalarda tedavinin portal ven ba- sıncı değişkenleri ve hepatosteatoz üzerine etkisi saptanamamış- tır. Ancak çalışma da hasta sayısının azlığı ve altın standart bir yöntem olmayan doppler US kullanıldığından kesin bir yargıya varmak için daha büyük çaplı çalışmalara ihtiyaç vardır

GAS6 intron 8 c.834+7G > A gene polymorphism in diabetic nephropathy

WOS: 000361338400021PubMed ID: 25869052Background - Aim: In animal experiments, growth arrest-specific 6 (Gas6) protein plays a key role in the development of mesangial cell and glomerular hypertrophy in the early phase of diabetic nephropathy, and diabetic nephropathy is prevented by warfarin-induced inhibition of GAS6 protein. It was shown that GAS6 intron 8 c.834+7G>A polymorphism is protective against type 2 diabetes mellitus, and AA genotype is associated with higher blood levels of GAS6 protein. Our aim is to investigate whether this polymorphism is a risk factor for diabetic nephropathy in type 2 diabetes mellitus. Method: Eighty-seven patients with diabetic nephropathy were compared with 66 non-diabetic controls in terms of GAS6 intron 8 c.834+7G>A polymorphism. Patients with history of stroke, ischemic heart disease were excluded. Each patient was examined by the ophthalmologist to determine diabetic retinopathy. Results: Frequency of GG, GA and AA genotypes are similar in diabetic nephropathy and control groups according to GAS6 intron 8 c.834+7G>A polymorphism (p = 0.837). Rate of diabetic retinopathy was 54.02%. In the subgroup analysis, GA genotype was significantly more frequent than GG genotype in patients with diabetic retinopathy when compared to without diabetic retinopathy (p = 0.010). Conclusion: In our study, GAS6 intron 8 c.834+7G>A polymorphism was not associated with diabetic nephropathy in type 2 diabetes mellitus. However, heterozygous state of this polymorphism may be a risk factor for diabetic retinopathy in patients with diabetic nephropathy

Effect of vildagliptin add-on treatment to metformin on plasma asymmetric dimethylarginine in type 2 diabetes mellitus patients

WOS: 000331555100001PubMed ID: 24627624Aims: A close association has been demonstrated between increased cardiovascular risk and high asymmetric dimethylarginine (ADMA) levels in type 2 diabetes mellitus (DM) patients. We planned to measure serum ADMA levels in type 2 DM patients using vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor. Materials and methods: A total of 68 type 2 DM patients who were on metformin were enrolled in the study. Based on the glycemic levels of patients, vildagliptin was added on to treatment in 33 patients. Patients were followed for 6 months. Serum ADMA, C-reactive protein, and fibrinogen levels were compared in groups of patients using metformin or metformin + vildagliptin, after 6 months. Results: Serum ADMA levels were found to be significantly lower in the group using vildagliptin compared to the group using metformin + vildagliptin (P<0.001). However, serum C-reactive protein and fibrinogen levels were statistically similar in the two study groups (P=0.34 and P=0.23, respectively). Conclusion: Metformin + vildagliptin treatment was observed to lower serum ADMA levels in type 2 DM patients. Our findings notwithstanding, large-scale prospective randomized controlled studies are warranted to conclude that vildagliptin provides cardiovascular protection along with diabetes regulation