Diyabetik Periferik Nöropatisi Olan Hastalarda Anjiogenez İle Endotel Disfonksiyonun; Endocan, Apelin Ve Endoglin Üzerinden Değerlendirilmesi

Günümüzde araştırmalar diabetik periferal nöropati patogenezini sorgularken hipoksik ve metabolik teoriler üzerine yoğunlaşmaya başlamıştır. Bu araştırmada tip-2 diabetes mellitusa bağlı en yaygın komplikasyon olan diabetik periferal nöropatide endotel disfonksiyonu ve angiogenesis basamaklarında; endocan, apelin ve endoglin proteinlerine ait konsantrasyonu değerlendirerek “yeni tedavi modalitelerine ışık tutabilir mi?”sorusuna cevap arandı.Periferal diyabetik nöropatisi olan ve olmayan; tip2 diyabetes mellitus tanılı olup, tedavisinde oral antidiyabetik veya insülin preparatları kullanan 99 olgudaendocan, apelin ve endoglin proteinlerinin konsantrasyonları, yaş, cinsiyet ve vücut kitle indeksi eşleşen sağlıklı gönüllülerden oluşturulan kontrol grubu karşılaştırmalı olarak değerlendirildi. Tüm gruplarda genel klinik ve laboratuvar incelemeleri kullanıldı.Sonuçlar:Diyabetik periferal nöropatisi olan olgularda ki endocan, apelin ve endoglin seviyeleri yüksek derecede farklı bulundu ve bu fark istatistiksel olarak anlamlı idi. Gluko-metabolik hastalıkların neden olduğu diyabete bağlı gelişen periferal nöropati patogenezinde üç proteinin de rol aldığı raporlandı. Bu araştırma sonucunda elde edilen verilerin; yeterince aydınlatılmayan diabetic periferal nöropati patogenezinin biraz daha anlaşılabilmesine ve yeni nesil reseptör hedefli gen tedavilerine ışık tutabileceği inancındayız.Diabetic peripheral neuropathy is a common complication of type- 2 diabetes mellitus. Endocan, apelin and endoglin are thought to be associated with endothelial dysfunction, angiogenesis and inflammation. In this study, we planned to evaluate these markers in diabetic peripheral neuropathy patients.This single-blind, controlled clinical study was conducted on 99 type 2 diabetic patients with or without diabetic peripheral neuropathy and 53 healthy volunteer controls. Physical and laboratory examinations were done in all groups. In these groups, Endoglin, apelin and endocan levels were measured with ELISA method.Endoglin, apelin and endocan concentrations in diabetic peripheral neuropathy patients were higher than other diabetes mellitus patients and healthy controls. Similarly, diabetes mellitus patient’s endoglin, apelin and endocan levels were higher than healthy controls. The differences were statistically significant. We detected a significant positive correlation between endoglin, apelin and endocan levels in all groups. Endoglin, apelin and endocan may reflect angiogenesis and endothelial dysfunction in diabetic peripheral neuropathy and they may be used as a marker in the future

The Relationship Between Diabetic Peripheral Neuropathy and (MPV) Mean Platelet Volume Values in Patients With Type 2 Diabetes Mellitus

Aim:We aimed to evaluate the relationship between diabetic peripheral neuropathy and MPV values in type 2 diabetes mellitus patients.Materials and Methods:We investigated type 2 diabetic patients’ data retrospectively. The data was divided as two groups (with and without diabetic peripheral neuropathy) according to their history, physical examination, laboratory results and electro-physiological study results. The patients with cardiovascular, hematological, oncological, hepatic, renal, infectious disease or a recent history of trauma and surgery were excluded. Statistical analysis was studied by SPSS 21 soft-ware statistics programme.Results:We included 83 diabetic patients (ages between 31 and 76) that 39 of them were patients with diabetic peripheral neuropathy (25 women, 14 men) and 44(27 women, 17 men) were without neuropathy. While the means of non-neuropathic group for the age was 57,89±8,8(31-75), A1c 7,3%(5,5-12,7), platelet counts 260.800±68,900/mm3, MPV value 8,96±0,67 fl(7,6-10,4); the means of neuropathic group were 56,54±8,4(37-76) years, 8,3 (5,6-14,4)%, 269.050±74.195/mm3 and 9,03 ± 0,75(7,4-10,5) fl respectively. There were no statistically significant differences in terms of age(p=0,482), platelet count(p=0,601), body mass index(p=0,299), MPV(p=0,596) and A1c(p=0,076). But statistically significant differences were found in terms of diabetes age(p=0,002) and fasting plasma glucose(p=0,04). A statistically significant correlation was not found between MPV and neuropathy existence by Spearman correlation analysis(p=0,599).Conclusion:We didn't find any correlation between MPV value and neuropathy development in our study. We suggest that to clarify this relationship certainly, we need a prospective, multi-centered study with a bigger cohort

Wpływ dystrybucji tkanki tłuszczowej oraz wybranych adipokin na insulinooporność w stanie przedcukrzycowym

  Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p < 0.001) and visfatin (p < 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p < 0.01) and fat mass (p < 0.01) and low adiponectin (p < 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance. (Endokrynol Pol 2016; 67 (3): 277–282)    Wstęp: Ryzyko rozwoju insulinooporności i zespołu metabolicznego zwiększa się zwłaszcza u osób z otyłością centralną. W niniejszym badaniu oceniono wpływ dystrybucji tkanki tłuszczowej i wybranych adipokin na insulinooporność u osób ze stanem przedcukrzycowym. Materiał i metody: Osiemdziesięciu siedmiu chorych dobranych pod względem wieku I płci podzielono na 3 grupy w zależności od wyniku testu doustnego obciążenia 75 g glukozy: osoby z nieprawidłową glikemią na czczo, osoby z nieprawidłową tolerancją glukozy i osoby z prawidłową tolerancją glukozy. Zmierzono stężenie insulin na czczo. Do oszacowania insulinooporności zastosowano model homeostazy. Masę tkanki tłuszczowej oceniono za pomocą analizatora bioimpedancji elektrycznej, a grubość brzusznej tkanki tłuszczowej (podskórnej, trzewnej i przedotrzewnowej) zmierzono metodą ultrasonograficzną. Stężenie na czczo w surowicy kilku adipokin (adiponektyna, leptyna, rezystyna, waspina, wisfatyna, białko wiążące retinol-4 [RBP-4], czynnik martwicy nowotworów alfa [TNF-alfa]) zmierzono, stosując metodę ELISA. Wyniki: Średni wskaźnik masy ciała, masa tkanki tłuszczowej I grubość brzusznej tkanki tłuszczowej były podobne we wszystkich grupach. Nie stwierdzono różnic między grupami pod względem średniego stężenia insuliny na czczo ani stężeń waspiny, RBP-4, leptyny, rezystyny i TNF-alfa. W porównaniu grup ze stanem cukrzycowym i grupy z prawidłową tolerancją glukozy wykazano, że stężenia adiponektyny (p < 0,001) i wisfatyny (p < 0,001) były niższe u osób ze stanem przedcukrzycowym. Ponadto stwierdzono, że wysoki wskaźnik masy ciała (p < 0,01) i duża masa tkanki tłuszczowej (p < 0,01) oraz niskie stężenie adiponektyny (p < 0,05) przyczyniają się do rozwoju insulinooporności u osób ze stanem przedcukrzycowym. Wnioski: Autorzy sugerują, że nie tylko otyłość, ale również obniżenie stężenia adiponektyny odgrywają pewną rolę w patogenezie insulinooporności w okresie przedcukrzycowym. (Endokrynol Pol 2016; 67 (3): 277–282)

Diyabetik Bir Olguda Orbital Sellülitin Nadir Bir Komplikasyonu: Kavernöz Sinüs Trombozu

Diyabetin çeşitli enfeksiyonlara ve tromboza eğilimi artırdığı iyi bilinmektedir. Diyabette doğal, hücresel ve humoral bağışıklık mekanizmalarının çeşitli basamaklarında bozukluklar beklenir. Trombosit fonksiyonlarındaki, koagülasyon faktörlerindeki ve damar yapısındaki bozukluklar da tromboza eğilimi artırır. Hem enfeksiyonların hem de trombotik olayların diyabetteki seyri diyabetik olmayan olgulara göre daha ciddidir. Bu yazıda orbital sellülit gelişip kavernöz sinüs trombozu ile komplike olan 94 yaşında diyabetik erkek olgu sunuldu. Olgu orbital sellülit, idrar yolu enfeksiyonu, hiperozmolar non ketotik durum, akut böbrek yetersizliği ve üremiye sekonder kompanse metabolik asidoz tanıları ile endokrinoloji servisine yatırıldı. Antibiyoterapisine ve hidrasyonuna vakit kaybetmeksizin başlanıp gerekli tedavisi yapılan olgu, mortalitesi yüksek kavernöz sinüs trombozu sonrası tedaviye cevap vermeyerek kaybedildi. Özellikle diyabetik olgularda orbital enfeksiyonların komşuluk yoluyla kavernöz sinüse yayılıp septik tromboza yol açarak ölümcül seyredebileceği göz önüne alınarak erken tanı ve tedavisi yapılmalıdırIt is that diabetes mellitus increases tendency to develop infections and thrombosis. Impairment of various mechanisms and agents of humoral and cellular immune systems can be expected. Disturbances of platelet function, coagulation factors, and vascular structure predispose diabetics to thrombotic events. The course of both infections and thrombotic events is often worse than in non-diabetic patients. Presently described is 94-year-old male patient with diabetes who had orbital cellulitis that became complicated with cavernous sinus thrombosis (CST). He was admitted to endocrinology clinic with diagnoses of orbital cellulitis, urinary tract infection, hyperosmolar non-ketotic state, acute renal failure, and compensated metabolic acidosis secondary to uremia. Despite immediate antibiotherapy, hydration, and additional required treatment, patient did not respond and died as a result of CST. There must be awareness, especially for diabetic patients, that orbital infections may spread to nearby cavernous sinuses and cause potentially lethal septic CST. Early diagnosis and immediate treatment are essentia

The Relationship Between Diabetic Peripheral Neuropathy and (Mpv) Mean Platelet Volume Values in Patients with Type 2 Diabetes Mellitus

Amaç: Çalışmamızda Tip 2 diyabetli hastalarda, MPV değeriyle, diyabetin mikrovasküler bir komplikasyonu olan nöropati arasındaki ilişkiyi araştırmayı hedefledik.Materyal ve Metot: Retrospektif çalışmamıza, iç hastalıkları polikliniklerimize başvuran tip 2 diyabetik hasta dosyaları değerlendirilerek, fizik muayene, elektrofizyolojik çalışma verileri, anamnez ve tetkik kayıtları incelenerek, diyabetik nöropatisi olan ve olmayan iki grup diyabetik hasta belirlendi. Bilinen kardiyovasküler, hematolojik, onkolojik hastalık, karaciğer ve böbrek hastalığı, akut veya kronik infeksiyon hastalığı, yakında geçirilmiş travma, cerrahiöyküsü olan vakalar çalışmaya dahil edilmedi. Vakaların istatistiksel değerlendirmesi SPSS 21 yazılım programı ile yapıldı.Bulgular: Yaşları 31-76 arasında değişen 39'u (25 kadın, 14 erkek) diyabetik periferik nöropatili, 44’ü (27 kadın, 17 erkek) ise nöropatisiz toplam 83 diyabetik vaka çalışmaya alındı. Nöropatisi olmayan vakaların ortalama yaşları 57,89±8,8 (31-75), A1c % 7,3 (5,5-12,7), açlık kan şekeri 144 mg/dl (80-326), trombosit sayısı 260.800±68,900/mm3, MPV değeri 8,96±0,67 fl (7,6-10,4) idi. Nöropatik vakaların ortalama yaşları 56,54±8,4 (37-76), A1c % 8,3 (5,6-14,4), açlık kan şekeri 184 (100-432) mg/dl, trombosit sayısı 269.050±74.195/mm3, MPV değeri 9,03 ± 0,75 (7,4-10,5) idi. Gruplar arasında yaş (p=0,482), trombosit sayısı (P=0,601), BKİ (p=0,299), MPV (p=0,596) ve A1c (p=0,076) değerleri açısından anlamlı fark yokken, diyabet yaşı (p=0,002) ve açlık kan şekeri (p=0,04) açısından istatistiksel anlamlı fark mevcuttu. Spearman korelasyon analizinde MPV düzeyi ile nöropati gelişimi arasında istatistiki anlamlılığa ulaşan bir ilişki bulunamadı (p=0,599).Sonuç: Tip 2 diyabetli 83 hasta ile yaptığımız çalışmamızda, MPV ile nöropati gelişimi arasında herhangi bir ilişki saptayamadık. Bu ilişkiyi daha iyi aydınlatabilmek için daha fazla vaka ile çok merkezli ve prospektif çalışmalara ihtiyaç vardır.Aim: We aimed to evaluate the relationship between diabetic peripheral neuropathy and MPV values in type 2 diabetes mellitus patients. Materials and Methods: We investigated type 2 diabetic patients’ data retrospectively. The data was divided as two groups (with and without diabetic peripheral neuropathy) according to their history, physical examination, laboratory results and electro-physiological study results. The patients with cardiovascular, hematological, oncological, hepatic, renal, infectious disease or a recent history of trauma and surgery were excluded. Statistical analysis was studied by SPSS 21 soft-ware statistics programme. Results: We included 83 diabetic patients (ages between 31 and 76) that 39 of them were patients with diabetic peripheral neuropathy (25 women, 14 men) and 44(27 women, 17 men) were without neuropathy. While the means of non-neuropathic group for the age was 57,89±8,8(31-75), A1c 7,3%(5,5-12,7), platelet counts 260.800±68,900/mm3, MPV value 8,96±0,67 fl(7,6-10,4); the means of neuropathic group were 56,54±8,4(37-76) years, 8,3 (5,6- 14,4)%, 269.050±74.195/mm3 and 9,03 ± 0,75(7,4-10,5) fl respectively. There were no statistically significant differences in terms of age(p=0,482), platelet count(p=0,601), body mass index(p=0,299), MPV(p=0,596) and A1c(p=0,076). But statistically significant differences were found in terms of diabetes age(p=0,002) and fasting plasma glucose(p=0,04). A statistically significant correlation was not found between MPV and neuropathy existence by Spearman correlation analysis(p=0,599). Conclusion: We didn't find any correlation between MPV value and neuropathy development in our study. We suggest that to clarify this relationship certainly, we need a prospective, multi-centered study with a bigger cohort

Kronik obstrüktif akciğer hastalığında nötrofil-lenfosit oranının öngörücü rolü]

Objective: Recently neutrophil-to-lymphocyte ratio (NLR) -the level of neutrophil reflecting the severity of inflammation and lymphocyte occurring after physiological stress has been gaining popularity, which was, along with other inflammatory markers, commonly accepted as an accurate marker of the inflammatory status. In this multi-centered study, an early, rapid, and low-cost diagnosis method was investigated. To this end, the correlation between chronic obstructive pulmonary disease and inflammation was planned to be utilized and whether neutrophil-to-lymphocyte ratio can be used as a valid tool in the diagnosis of acute exacerbations of chronic obstructive pulmonary disease was investigated. Method: We retrospectively enrolled the 467 patients. Control group included sex and age-matched healthy people. C-Reactive protein, forced expiratory volume-1, forced vital capacity, complete blood count and clinical data A receiver-operating characteristic curve analysis was performed to determine the best cut-off value of N/L ratio and C-Reaktif protein to predict the exacerbation. Two-sided p values <0.05 were considered statistically significant. Results: By spearman analysis, there was a strong correlation between. C-Reactive protein and N/L ratio in both stable group (r=0.436, p<0.001) and exacerbation group (r=0.534, p=0.001). Conclusion: Neutrophil/lymphocyte ratio may be a useful predictor of inflammation in chronic obstructive pulmonary disease and acute exacarbation of chronic obstructive pulmonary disease patients

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Effect of CPAP on New Endothelial Dysfunction Marker, Endocan, in People With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) morbidity and mortality. Endocan is a surrogate endothelial dysfunction marker that may be associated with CV risk factors. In this study, we tested whether serum endocan is a biomarker for OSA. Serum endocan levels were measured at baseline in 40 patients with OSA and 40 healthy controls and after 3 months of continuous positive airway pressure (CPAP) treatment in the patients with OSA. All participants were evaluated by full polysomnography. Flow-mediated dilatation (FMD) and carotid intima media thickness (cIMT) were measured in all participants. Endocan levels were significantly higher in patients with OSA than in healthy controls. After adjusting confounders, endocan was a good predictor of OSA. Endocan levels correlated with OSA severity (measured by the apnea-hypopnea index [AHI]). After 3 months of CPAP treatment, endocan levels significantly decreased. Endocan levels were significantly and independently correlated with cIMT and FMD after multiple adjustments. The cIMT and FMD also had significant and independent correlation with AHI. Endocan might be a useful marker for the predisposition of patients with OSA to premature vascular disease.NHLBI NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01 HL085188, K24 HL093218, T32 HL134632, K24 HL132105] Funding Source: Medline; NATIONAL HEART, LUNG, AND BLOOD INSTITUTEUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01HL085188, K24HL093218, T32HL134632, K24HL132105] Funding Source: NIH RePORTE

An Acute Renal Failure Case Due To Overdose Use Of Perindopril/Amlodipin

Fixed -dose combination therapies are important alternative of hypertension treatment. The management of suicidal intoxication with these conbination preparations which might have different and sometimes interactive mechanisms is still unclear. In this case-report a 51 -yearold male patient who had taken 26 pills of perindopril 5 mg and amlodipine 10 mg combination drug. He admitted to the emergency department with the complications of dizziness and fatigue. He was followed in intensive care unit after his first medical care unitafter his first medical emergency intervensions. After development of hypotensionand acute renal failure, he improved with fluid resussitation and symtomatic treatment and he was discharged

Case Report: Two Patients with Partial DiGeorge Syndrome Presenting with Attention Disorder and Learning Difficulties

DiGeorge syndrome (DGS) has classically been characterized by the triad of clinical features including congenital cardiac defects, immune deficiencies secondary to aplasia or hypoplasia of the thymus, and hypocalcaemia due to small or absent parathyroid glands. The phenotypic features of these patients are much more variable and extensive than previously ecognized. The acknowledgement of similarities and phenotypic overlap of DGS with other disorders associated with genetic defects in 22q11 has led to an expanded description of the phenotypic features of DGS including palatal/speech abnormalities, as well as cognitive, neurological and psychiatric disorders. Here, we report the cases of two DGS patients with dysmorphic facial features who were initially admitted to the Psychiatry Department for attention disorder and learning difficulties