The impact of fasting during Ramadan on the glycemic control of patients with type 2 diabetes mellitus

WOS: 000325635000004PubMed: 23934679Background: Millions of Muslims fast from dawn until dusk during the annual Islamic holy month of Ramadan. Most of the studies evaluating biochemical changes in diabetic patients during Ramadan showed little changes in the glycemic control. in this study, our aim was to assess the impact of fasting during Ramadan on glycemic control in patients with type 2 diabetes. Methods and design: We examined 122 patients with type 2 diabetes (82 female, 40 male, age 56.93 +/- 9.57 years) before and after the Ramadan. 66.4% of the patients were treated with oral antidiabetic (OAD) alone, 6.5 % with a combination of insulin plus OAD and 19.7 % with insulin alone. 88 of 122 patients fasted during Ramadan (26.98 +/- 5.93 days). Weight, body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG), postprandial glucose (PPG), fructosamine, HbA1c, fasting insulin and lipid parameters were measured. Results: the frequencies of both severe hyperglycemia and hypoglycemia were higher in the fasting group, but the difference was not significant (p = 0.18). Weight, BMI, waist circumference, blood pressure, FPG (143.38 +/- 52.04 vs. 139.31 +/- 43.47 mg/dl) PPG (213.40 +/- 98.56 vs. 215.66 +/- 109.31 mg/dl), fructosamine (314.18 +/- 75.40 vs. 314.49 +/- 68.36 mu mol/l), HbA1c (6.33 +/- 0.98 vs. 6.22 +/- 0.92 %) and fasting insulin (12.61 +/- 8.94 vs. 10.51 +/- 6.26 mu U/ml) were unchanged in patients who fasted during Ramadan. Microalbuminuria significantly decreased during Ramadan (132.85 +/- 197.11 vs. 45.03 +/- 73.11 mg/dl). Conclusions: in this study, we concluded that fasting during Ramadan did not worsen the glycemic control of patients with type 2 diabetes

Alteration of maternal serum irisin levels in gestational diabetes mellitus

Objectives: The aim of our study was to compare serum irisin concentrations in pregnant women with and without ges­tational diabetes mellitus (GDM). Material and methods: This study was performed at the Tertiary Care Center, Department of Obstetrics and Gynecol­ogy, between January 2014 and April 2014. A total of 45 pregnant women with GDM (diabetes group) and 41 BMI- and age-matched healthy pregnant women (control group) were recruited. Maternal serum irisin levels were measured by enzyme-linked immunosorbent assay kit at 24–28 weeks of gestation. An association between maternal serum irisin lev­els and metabolic parameters was analyzed. Body mass index, serum levels of glucose, insulin and irisin were tested and analyzed in the study group and controls. Results: Pregnant women with GDM had significantly higher fasting plasma glucose (p = 0.001), first-hour OGTT glucose (p = 0.001), second-hour OGTT glucose (p = 0.001), and fasting insulin (p = 0.045) levels as compared to controls. Serum irisin levels were 1.04 ± 0.3 and 1.3 ± 0.2 in pregnant women with GDM and healthy pregnant controls, respectively (p = 0.001). Correlation analysis between irisin levels and anthropometric and biochemical parameters in patients with gestational diabetes revealed that none of the investigated parameters correlated with serum irisin level. Conclusions: Our results suggest that serum irisin levels might be introduced as a novel marker for GDM, with decreased levels of irisin being indicative of GDM

Psychiatric aspects of infertility

İnfertilite tıbbi, psikiyatrik, psikolojik ve sosyal sorunları beraberinde getiren kültürel, dinsel ve sınıfsal yönleri olan bir krizdir. Psikiyatrik ve psikolojik etkenlerle infertilite arasındaki ilişki karşılıklı bir etkileşimden kaynaklanmaktadır. Aile, insan neslinin devamının sağlanmasında ve toplumun beklentilerine uygun bireyler yetiştirilmesinde büyük önem taşıyan bir kurumdur. Üreme ve doğur- ganlık birey ve aileye özgü evrensel işlevler olarak görülmekte ve çocuk sahibi olma evlilik kurumu- nun beklenen sonucu olarak karşımıza çıkmaktadır. İnfertilitenin doğurduğu sonuçlar birey ve evlilik ilişkisi üzerinde kısa ve uzun dönemde ortaya çıkardığı yıkıcı etkilerinden kaynaklanır. Araştırmalar infertilitenin yol açtığı psikolojik ve psikiyatrik bozukluklara, cinsiyetler arası farklılıklara, infertilite tipiyle psikopatolojinin ilişkisine, psikiyatrik değerlendirme ve tedavinin gebelik oranı ve canlı doğum sayısı üzerindeki etkilerine odaklanmıştır. İnfertil kadınların yüksek düzeyde stres ve anksi- yete yaşamalarının altında yatan en önemli sebebin infertiliteye bağlı yaşanan annelik duygusunun kaybı, üretkenliğin kaybı, benlik saygısının kaybı, genetik devamlılığın kaybı olduğu bildirilmekte- dir. Bu gözden geçirme yazısında kadın infertilitesi ve psikiyatrik belirtiler arasındaki ilişkinin incelenmesi amaçlanmıştır.Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society’s expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression. Consequenc- es of infertility arise from short and long-term devastating effects on both individual’s physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders, gender differences, relation between the causes of infertility and psycho- pathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self and genetic continuity. The aim of this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms

Psychiatric Aspects of Infertility

Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict), gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000): 165-185

Prune-belly syndrome: A case report

Prune-belly (Eagle-Barret) sendromu, abdominal kas yokluğu, inmemiş testis ve üriner sistem anomalileri ile birlikte seyreden ve nadir görülen bir sendromdur. Burada yenidoğan yoğun bakım ünitemizde izlenen kriptorşidizm, hidroüreteronefroz ve atriyoventriküler septal defekti olan bir prune-belly sendromu olgusu sunulmuş ve literatür gözden geçirilerek etiyoloji ve tedavisi tartışılmıştır.Prune-belly (Eagle-Barret) syndrome is a rare condition with deficiency of abdominal musculature, cryptorchidism and urinary tract anomalies. We presented a prune-belly case with cryptorchidism, hydroureteronephrosis and atrioventricular septal defect and reviewed the literature about the etiology and treatment

Risk Factors That Increase Insulin Need in Patients with Gestational Diabetes Mellitus

ÖZET Amaç: Çalışmanın amacı gestasyonel diyabetes mellitus (GDM) olgularında insülin tedavisi gereksinimini artıran risk faktörlerini incelemekti. Gereç ve Yöntem: Çalışmaya gebeliğin 24-28. haftalarında 75 gr oral glukoz tolerans testi (OGTT) ile GDM tanısı konulan 128 gebe alındı. Hastaların demografik özellikleri, tanı anındaki açlık insülin ve HbA1c düzeyleri değerlendirildi. Hastaların gebelik süresince %35,2’sinde insulin gereksinimi oldu. Araştırmaya alınan olgular gebelik izleminde insülin tedavisi gereken olgular (insulin grubu) (n=45) ile sadece diyet ile izlenen olgular (diyet grubu) (n=83) şeklinde iki gruba ayrıldı. Bulgular: İnsülin grubunun yaş ortalaması diyet grubununkine göre anlamlı olarak daha yüksekti (32±0,6’ya karşın 34,7± 0,6; p=0.004). Gebelik öncesi vücut kitle indeksi (VKİ) değerleri insulin grubunda anlamlı olarak daha yüksekti (29±0,6’ya karşın 32± 0,8 kg/m2; p=0.004). OGTT esnasındaki açlık kan şekeri (AKŞ) insulin grubunda 101,6± 2,1 mg/dl iken, diyet grubunda 92,7± 1,1 mg/dl idi (p<0.001). OGTT 1.saat plazma glukozu düzeylerinde iki grup arasında anlamlı fark yok iken (p=0.069), 2.saat plazma glukozu insulin grubunda 159,1± 6,8 mg/dl, diyet grubunda 143,1± 3,7 mg/dl idi (p= 0.027). Tanı anındaki HbA1c değerleri insulin grubunda anlamlı olarak daha yüksek bulundu (4,9± 0,1’e karşın 5,3± 0,1; p= 0.001). İki grubun açlık insulin düzeyleri ve HOMA-IR değerleri arasında anlamlı fark bulunmadı (p=0.908, p=0.073). Sonuç: GDM’li hastalarda yaş, ailede diyabet öyküsü, gebelik öncesi vücut kitle indeksi, açlık kan şekeri ve HbA1c izlemde insülin tedavisi gereksinimi açısından önemli risk faktörleri olarak bulunmuştur.Objective: Our aim was to determine the risk factors associated with the need for insulin therapy in patients with gestational diabetes mellitus (GDM). Material and Method: We enrolled 128 pregnant women who were diagnosed GDM by 75 gr oral glucose tolerance test (OGTT) at 24-28 week gestational weeks. The demographic features, insulin and HbA1c levels were evaluated. 35,2% of the patients needed insulin therapy during pregnancy. We compared patients with GDM who needed insulin therapy during pregnancy (insulin group) and women treated with diet alone (diet group). Results: The patients treated with insulin were older than the patients in diet group (32,0±0,6 vs, 34,7± 0,6; p=0.004). Prenatal body mass index (BMI) was significantly higher in the insulin group compared to the diet group (29±0,6 vs, 32± 0,8 kg/m2; p=0.004).While the mean fasting plasma glucose (FPG) levels was 101,6± 2,1 mg/dl in the insulin group, it was 92,7± 1,1 mg/dl in the diet group (p<0.001). While there was not a difference in OGTT 1 hour- plasma glucose levels between the two groups (p=0.069), 2 hour- plasma glucose levels were 159,1± 6,8 mg/dl in the insulin group and 143,1± 3,7 mg/dl in the diet group (p= 0.027). HbA1c level was significantly higher in the insulin group compared to the diet group (4,9± 0,1 vs, 5,3± 0,1; p= 0.001). There was not a difference in fasting insulin levels and HOMA-IR between the two groups (p=0.908, p=0.073). Conclusion: Age, family history of diabetes, prenatal BMI, FPG and HbA1c were found to be risk factors associated with insulin need in patients with GDM

Alteration of maternal serum irisin levels in gestational diabetes mellitus

Cure, Medine Cumhur/0000-0001-9253-6459WOS: 000378215000014PubMed: 27304658Objectives: the aim of our study was to compare serum irisin concentrations in pregnant women with and without gestational diabetes mellitus (GDM). Material and methods: This study was performed at the Tertiary Care Center, Department of Obstetrics and Gynecology, between January 2014 and April 2014. A total of 45 pregnant women with GDM (diabetes group) and 41 BMI-and age-matched healthy pregnant women (control group) were recruited. Maternal serum irisin levels were measured by enzyme-linked immunosorbent assay kit at 24-28 weeks of gestation. An association between maternal serum irisin levels and metabolic parameters was analyzed. Body mass index, serum levels of glucose, insulin and irisin were tested and analyzed in the study group and controls. Results: Pregnant women with GDM had significantly higher fasting plasma glucose (p = 0.001), first-hour OGTT glucose (p = 0.001), second-hour OGTT glucose (p = 0.001), and fasting insulin (p = 0.045) levels as compared to controls. Serum irisin levels were 1.04 +/- 0.3 and 1.3 +/- 0.2 in pregnant women with GDM and healthy pregnant controls, respectively (p = 0.001). Correlation analysis between irisin levels and anthropometric and biochemical parameters in patients with gestational diabetes revealed that none of the investigated parameters correlated with serum irisin level. Conclusions: Our results suggest that serum irisin levels might be introduced as a novel marker for GDM, with decreased levels of irisin being indicative of GDM

Polikistik over sendromu tanılı hastaların cushing sendromu açısından taranması

Amaç : Polikistik over sendromu (PKOS) ve Cushing sendromu hirsutizm, menstrual düzensizlik, obezite, glukoz intoleransı, dislipidemi gibi birçok ortak klinik bulguya sahiptir. Bu çalışmanın amacı hirsutizm ve/veya menstrual düzensizlik nedeniyle başvuran ve PKOS tanısı koyduğumuz hastaları Cushing sendromu açısından taramaktır. Gereç ve Yöntemler: Çalışmaya PKOS tanısı koyduğumuz, yaşları 14-35 arasında değişen 109 hasta dahil edildi. Tüm hastalarda antropometrik, hormonal ve metabolik ölçümler yapıldı. Cushing sendromu açısından tüm hastalara 1 mg- deksametazon supresyon testi (DST) uygulandı. Bulgular : Hastaların ortalama beden kitle indeksi ölçümleri 35.6± 9.5 kg/m 2 olup, hastaların %75.2’sini obez grup oluşturuyordu. Hastaların ortalama Ferriman- Gallwey skoru 12.6 ± 3.7 olup, %61.1’inde menstrual düzensizlik mevcuttu. Hastaların ortalama açlık plazma glukoz düzeyleri 96.5 ± 12.8 mg/dl iken, ortalama HOMA-IR değerleri 3.2± 1.9 olarak saptandı. Hastaların %52.3’ünde HOMA-IR>2.7 olarak bulundu. Hastalar 1 mg DST ile tarandığında; sadece 3 hastada kortizol düzeylerinde supresyon olmadı. Daha sonra üç hastaya da 2 gün 2 mg DST uygulandı ve her üç hastada da kortizol düzeylerinin 1.8 ?g/dl’nin altına indiği görüldü. Ciddi hirsutizmi olan hastalarda (n=34) ortalama1-mg DST değeri 0.73 ± 0.7 mg/dL idi; fakat hafif ya da orta düzeyde hirsutizmi olan hastalarda bu değer 0.64 ± 0.4 mg/dL olarak saptandı (p=0.427). Sonuç: Polikistik over sendromu tanısı koyduğumuz genç kadınların hiçbirinde Cushing sendromu saptanmadı.Objective: Polycystic ovary syndrome (PCOS) and Cushing’s syndrome share several clinical features such as hirsutism, irregular menses, obesity, glucose intolerance and dyslipidemia. The aim of this study was to investigate the presence of Cushing’s syndrome in patients who were admitted with the complaints of hirsutism and/or irregular menses and were diagnosed with PCOS. Material and Methods: One hundred nine patients with PCOS (aged 14-35 years) were included in the study. We evaluated anthropometric, hormonal, and metabolic parameters. All the patients were evaluated with 1-mg dexamethasone suppression test (DST) for Cushing’s syndrome. Results: The mean body mass index of the patients was 35.6 ± 9.5 kg/m 2 and 75.2% of the patients were obese. The mean Ferriman- Gallwey score of the patients was 12.6 ± 3.7 and 61.1% of them had menstural irregularities. While the mean fasting plasma glucose level of the patients was 96.5 ± 12.8 mg/dl, mean value of HOMA-IR was 3.2 ± 1.9. We observed HOMA-IR>2.7 in 52.3% of the patients. Three patients failed to suppress plasma cortisol following1 mg- dexamethasone administration. Then, we performed 2-day 2 mg DST and observed that all the three patients suppressed cortisol levels to less than 1.8 µg/dl. In patients with severe hirsutism (n=34) the average 1- mg DST result was 0.73 ± 0.7 mg/dL in patients with mild and moderate hirsutism (n=75), however, this value was 0.64 ± 0.4 mg/dL (p=0.427). Conclusion: We did not observe Cushing’s syndrome in the young women who were diagnosed with PCOS