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

The relationship between blood lactate levels and mortality in pediatric intensive care patients

Objective: To determine relationship between blood lactatelevel and mortality rate in children admitted to theintensive care unit.Methods: 298 critically ill patients aged between 28 daysand 16 years admitted to Dicle University Hospital, thethird step Pediatric Intensive Care Unit in between January2007 and December 2007 were included. Age, sex,diagnosis, Glasgow coma score points, the first measuredblood lactate levels (lactate 1) and the arithmeticaverage of all measured blood lactate levels during treatment(lactate 2) of cases were evaluated. Patients weredivided into group A (lactate < 20 mg/dl) and B (lactate ≥20 mg/dl). According to the results, patients were classifiedas survivors and non-survivors. Both lactate 1 andlactate 2 were compared with mortality rates.Results: In this study, a total of 298 patients were evaluated,158 of them were nonsurvivors and 140 were survivors.A significant correlation was found between lactatelevels and mortality rates. Lactate levels were higher innon-survivor cases (p<0.001). In group B, lactate 1 had68% (106/156) sensitivity and 75% (106/142) specificityfor determining the risk of mortality. Also in group B, lactate2 had 85% (134/158) sensitivity and 79% (134/169)specificity for determining the risk of mortality.Conclusion: There is a strong association between highblood lactate levels and mortality rates in the critically illpatients in pediatric intensive care unit. In these patientsblood lactate levels can be used for follow-up and evaluationof the effectiveness of treatment and determiningmortality. J Clin Exp Invest 2013; 4 (3): 269-273Key words: Pediatric intensive care unit, critically ill children,blood lactate levels, mortalit

Results of exchange transfusions in newborns without blood group incompatibility

Objective: Hyperbilirubinemia is a common problem ofneonatal period that has high morbidity and mortality.Blood exchange is the most effective and urgent treatmentmodality for very high bilirubin levels that can lead toneurotoxicity called as kernicterus. The aim of this studywas to compare 90 minutes exchange transfusion withthat of 120 minutes.Methods: This study was performed at Dicle UniversityMedical Faculty, Neonatal Unit between July 2007 andJune 2008. A total of 36 term newborn (38 - 42 gestationalweek) without blood group incompatibility and withtotal serum bilirubin levels over 25 mg/dl were included.Newborns were randomly assigned in two groups eachof them comprise 18 babies as Group 1 underwent 90minute-exchange and Group 2 120 minute. Effectivenessand complications of exchange transfusion were recorded.Newborns with Rh, ABO or subgroup incompatibilities,prematurity or small for gestational age, septicemia,hypothyroidism, G6PD enzyme deficiency, intrauterineinfections, diabetic mother’s baby, hemolytic disease ormetabolic diseases were excluded.Results: There were no significant differences in thebody weight, gestational age, postnatal age, age of mother,total bilirubin and albumin levels, the number of bloodexchange, hospital stay days and complications betweentwo groups (p>0.05). However, mean phototherapy durationwas significantly shorter in 120 minutes transfusiongroup compared with 90 minutes group (p<0.001).Conclusion: Our results indicated that 90 minutes wassufficient for an effective exchange transfusion in severehyperbilirubinemic newborn infants. However longer exchangetransfusion durations may shorten the duration ofphototherapy.Key words: Indirect hyperbilirubinemia, exchange transfusion,newborns, outcom

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

Clinical and demographic features of children diagnosed with cystic fibrosis after sweat test screening for failure to thrive, chronic diarrhea or recurrent pulmonary infections

Giriş: Bu çalışmada, tekrarlayan akciğer enfeksiyonu, kronik ishal ve gelişme geriliği şikayetleri ile başvuran ve özgül tanı alamayan hastalarda kistik fibrozis (KF) sıklığını araştırarak bu hastaların demografik, klinik ve laboratuvar özelliklerinin araştırılması amaçlandı. Gereç ve Yöntem: Bu çalışmada, KF tanısı, KF için bir veya daha fazla karakteristik fenotopik özellik gösteren çocuklarda terde kondüktivite ölçümü yapılarak kondu. Değerlendirmede, terde klor konsantrasyonu 59 mmol/lt’nin altı negatif, 60-79 mmol/lt arası sınırda pozitif ve 80 mmol/lt’nin üzeri pozitif ter testi sonucu olarak kabul edildi. Atipik KF tanısı sınırda ter testi pozitifliğine ilave olarak genetik mutasyon, nazal potansiyel farkı ve elastaz aktivitesi gibi destekleyici faktörlerle birlikte kondu. Bulgular: Çalışmaya toplam 356 hasta dahil edildi. Yirmi hastaya (%5,6) KF tanısı kondu. Hastaların yaş ortalaması 19,3±18,1 ay idi ve 234 (%65,7)’ü erkekti. Tekrarlayan akciğer enfeksiyonu ile başvuran 90 hastanın 14’üne (%15,5), kronik ishal yakınması ile başvuran 99 hastanın 10’una (%10,1) ve belirgin büyüme ve gelişme geriliği olan 100 hastanın 7’sine (%7) KF tanısı kondu. Tanı konan hastaların temel başvuru yakınmaları ateş, solunum sistemi yakınmaları, gelişme geriliği ve kronik ishal idi. Toplam 356 hastaya 430 ter testi yapıldı ve ölçüm sonucu 60 mmol/lt üzerinde olan 33 hastadan 20 tanesine KF tanısı konuldu. Sonuç: Kronik ishal, tekrarlayan akciğer enfeksiyonu ve gelişme geriliği ile başvuran hastalarda KF ayırıcı tanılar arasında düşünülmelidir. Beyaz ırkta yaklaşık 3000’de 1 olan KF sıklığı hasta grubumuzda %5,6 oranıyla yüksek bulunmuştur.Introduction: The aim of this study was to investigate the incidence of cystic fibrosis (CF) in patients with recurrent pulmonary infection, chronic diarrhea and failure to thrive having no specific diagnosis and also to investigate the demographic features, and clinic and laboratory findings of such patients. Materials and Methods: The diagnosis of CF has been established through measuring the sweat conductivity in children presenting with one or more characteristic phenotypic features of CF. A chloride concentration lower than 59 mmol/l was interpreted as negative; 60-79 as borderline and over 80 as positive. A borderline sweat test result supported with genetic mutation, nasal potential difference or elastase activity was diagnosed as atypical CF. Results: A total of 356 patients fulfilled the study criteria. Twenty (5.6%) patients were diagnosed as CF. The mean age of the patients was 19.3±18.1 months and 234 (65.7%) of them were boys. Of the patients suffered from recurrent pulmonary infection, chronic diarrhea and failure to thrive; 15.5%, 10.1%, and 7% were diagnosed as CF, respectively. Major presenting complaints were fever, respiratory tract diseases, failure to thrive, and chronic diarrhea in patients with CF. A total of 430 sweat tests were applied to 356 patients and 20 of the 33 patients with a test resulting over 60 mmol/L were diagnosed as CF. Conclusions: CF should be considered for the differential diagnosis of the patients presented with chronic diarrhea, recurrent pulmonary infection, and failure to thrive. While the incidence of CF in white people is approximately 1 in 3000 individuals, we found a higher rate of 5.6% in our study group

Investigation of the association between Rho/Rho-kinase gene polymorphisms and systemic sclerosis.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Systemic sclerosis (SSc) is a disease characterized by inflammation, vascular abnormalities and fibrosis. The role of Rho/Rho-kinase pathway was demonstrated in the pathogenesis of fibrosis, inflammation and vascular abnormalities. This study was aimed to investigate the relation between SSc and Rho/Rho-kinase gene polymorphisms. The study included 339 patients with SSc and 302 healthy subjects who were apparently healthy and at similar age and gender. Genotype distributions and allele frequencies were detected by using Chi-square test or Fisher's exact Chi-square test between groups, and the haplotype analysis was applied using online program (SHEsis). Significant association was found in a polymorphism in the ROCK1 gene (rs35996865), a polymorphism in ROCK2 gene (rs10178332), a polymorphism in RhoA gene (rs2177268) and two polymorphisms in RhoC gene (rs11102522 and rs11538960) with SSc disease (p < 0.0022). In this study, association between SSc disease and Rho/Rho-kinase gene polymorphisms was investigated for the first time; significant associations between ROCK1, ROCK2, RhoA and RhoC gene polymorphisms and SSc disease were demonstrated. The results strongly suggest that this SNP may be an important risk factor for development of SSc. However, further validation of these findings in an independent cohort is necessary