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 Materials and methods: Blood samples were withdrawn after 12 h of fasting (min 0) and following breakfast composed of foods proper for each person, at 60th, 90th and 120th minutes.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

THE INVESTIGATION OF THE FREQUENCY OF RESTLESS LEG SYNDROME AND RELATED FACTORS IN DIABETIC PATIENTS

Objective: Restless legs syndrome (RLS) is a neurological disorder characterized by sensory and motor symptoms especially in legs that often occur during rest. Although etiology is not known precisely, it can also occur secondary to diabetes mellitus. The aim of this study is to determine the frequency of RLS in diabetic patients and to investigate related factors

Assessment of Osteoporosis Awareness and Osteoporosis Risk Level of Patients Admitted to a University Hospital

© 2022 The International Society for Clinical DensitometryIntroduction: We aimed to evaluate osteoporosis awareness and risk of osteoporosis in individuals by using the One-Minute Osteoporosis Risk Test and Osteoporosis Self-Assessment Tool for Asians score. Methodology: This descriptive cross-sectional study included 591 volunteers who were admitted to the Internal Medicine outpatient clinic of the University Hospital. The One-Minute Osteoporosis Risk Test was applied through face-to-face interviews. Participants were classified as low, medium, and high osteoporosis risk groups in terms of the Osteoporosis Self-Assessment Tool for Asians scores. Results: Median score of the One-Minute Osteoporosis Risk Test was 1 (0–2) and the mean score of the Osteoporosis Self-Assessment Tool for Asians was 4.61 ± 3.80. In terms of the Osteoporosis Self-Assessment Tool for Asians score, 0.7% (n = 4) of the participants have a high risk of osteoporosis, 5.4% (n = 32) have a medium risk of osteoporosis and 93.9% (n = 555) have a low risk of osteoporosis. One-Minute Osteoporosis Risk Test scores of participants in terms of the osteoporosis risk levels were not significantly different (p = 0.432). The proportion of having information about osteoporosis in men was significantly lower than in women (21.0% vs. 33.4%, p = 0.004). The proportion of obtained information from medical staff was significantly higher in women than men (86.9% vs. 66.7%, p = 0.005). Informed participants have a significantly higher One-Minute Osteoporosis Risk Test score than non-informed participants (p = 0.004). Results: The risk of osteoporosis was found to be low in individuals admitted to the university hospital. The Osteoporosis Self-Assessment Tool for Asians score was more effective in determining the osteoporosis risk level compared to the One-Minute Osteoporosis Risk Test. Men should be given as much importance as women in informing about osteoporosis. Media tools should be used more effectively for this purpose

Acute Ischaemic Hepatitis Secondary to Acute Portal System Thrombosis Triggered by Diabetic Ketoacidosis: Rare Presentation of Acute Ischaemic Hepatitis

Hypotension, hypoxia or hypotension and hypoxia together may lead to ischaemic hepatitis; hypotension is often as a result of cardiovascular diseases. Ischaemic hepatitis not due to the cirrhotic process or malignancy but due to acute thrombosis of the portal venous system is rare. In this article, we present a case of acute ischaemic hepatitis due to an acute thrombus developing after a ketoacidosis coma which was thought to have triggered this event. Other reasons which could have triggered this event, such as a thrombophilia and cirrhosis or malignancy, were excluded

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

Raynaud's phenomenon in a healthy Turkish population

Raynaud's phenomenon (RP) is a vasospastic disease and is characterized by ischemia of the digits, nose, and ears. The vasospasm can be triggered by cold weather, cold water, or emotional stress and is followed by triphasic color changes. First white color (ischemia), then blue color (congestion and cyanosis), and finally red color change (reactive hyperemia) can be observed. The prevalence is reported to be between 0.5 and 20% in different studies and is dependent on genetic, occupational, and environmental factors. The purpose of our study was to determine the prevalence of RP in an eastern part of Turkey among healthy subjects. A total of 768 people were included in the study. This cross-sectional study was conducted between April 2003 and October 2003 at the University Hospital and at the State Hospital in Van, Turkey. The participants were interviewed and examined to diagnose RP and a questionnaire and color charts were used. Of these 768 patients, 25 women and 20 men were diagnosed to have RP. A female predominance (25/20) was observed. Their mean age was 24.78 +/- 5.71 years. The prevalence of RP was 5.9% in our study population