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Öğe Amenore ile seyreden De Morsier Sendromu: Olgu sunumu(2015) Kutlu, Orkide; Şahin, İbrahim; Sakin, Abdullah; Evren, BahriÖz: Septa Optik Displazi, De Morsier Sendromu olarak da bilinen nadir bir konjenital durumdur. Sendromun klasik triadındaki bulgular; beyin orta hat yapılarında anomaliler, optik sinir hipoplazisi ve hipofiz hormon disfonksiyonlarıdır. Triaddaki bulguların en az ikisinin bulunması ile tanı konulur. Burada primer amenore ile gelen ve de Morsier sendromu tanısı konulan bir olguyu sunduk. Optik sinir hipoplazisi, hipofizer yetmezlik veya beyin orta hat yapılarda anomali saptanması durumunda triada ait diğer bulguları araştırmalıdır ve gereğinde hormon replasman tedavileri başlanmalıdır.Öğe Bariatrik Cerrahi Adayı Morbid Obezite Hastalarının Yaşam Doyumunun Beden Algısı ve Benlik Saygısı ile İlişkisi(2018) Karlıdağ, Rifat; Kayaalp, Cüneyt; Evren, Bahri; Şahin, İbrahim; Akyüz, Mahmut; Gönenir Erbay, LaleÖz: Amaç: Obezitenin tıbbi sorunların yanı sıra psikososyal sorunlara da neden olduğu görülmektedir. Bu çalışmanın amacı bariatrik cerrahi adayı morbid obezite hastalarının yaşam doyumu, beden algısı ve benlik saygısı düzeylerini ve beden algısı ile benlik saygısının yaşam doyumu üzerine etkisini incelemektir. Gereç ve Yöntem: Çalışmaya Ocak-Aralık 2016 tarihleri arasında İnönü Üniversite Hastanesi Endokrinoloji Bilim Dalı’na başvuran ve vücut kitle indeksi (VKİ) en az 40 olan 136 morbid obezite hastası ve kontrol grubunu oluşturmak üzere VKİ 30’un altında olan 69 sağlıklı kişi dâhil edildi. Katılımcılar bir psikiyatri uzmanı tarafından değerlendirildi ve herhangi bir psikiyatrik hastalığı olanlar çalışma dışı bırakıldı. Hasta ve kontrol grubu-na sosyo-demografik veri formu, Coopersmith Benlik Saygısı Ölçeği, Beden Algısı Ölçeği ve Yaşam Doyumu Ölçeği uygulandı. Bulgular: Yapılan istatistiksel analizlerde morbid obezite hastalarında yaşam doyumu ve beden algısı ölçek puanları kontrol grubundan düşüktü. Benlik saygısı ölçek puanlarının ise hastalarda kontrol grubundan yüksek saptanması dikkat çekici idi. Yapılan korelasyon analizinde yaşam doyumu ve beden algısı arasında pozitif korelasyon saptandı. Sonuç: Çalışmanın bulgularına göre morbid obezite hastalarının kontrol grubuna göre yaşam doyumlarının daha düşük ve beden görünümlerinden memnuniyetsizliklerinin daha fazla olduğu, ancak benlik saygılarının yüksek olduğu görüldü. Ayrıca kişinin beden imajından memnuniyeti arttıkça yaşam doyumu da artmaktaydı. Beğeni kavramı ve güzellik anlayışı ve bunun kişi üzerinde etki derecesi toplumlar arasında farklılık göstermektedir. Benlik saygısının da kişiler arası ilişkilerden etkilendiği düşünülürse farklı toplumlarda yapılan diğer çalışmaların aksine çalışmamızda morbid obez hastalarda benlik saygısının yüksek oluşu toplumsal yapı ve/veya toplumsal kabul ve hasta sayısının değişkenliği ile ilişkili olabilir.Öğe Bulimia nervosa following bariatric surgery: a case report(2017) Erbay Gönenir, Lale; Şahin, İbrahim; Kayaalp, Cüneyt; Karlıdağ, RifatAbstract: Bariatric surgery is an obesity treatment method gaining popularity in recent years. Since it may cause rapid weight loss and improvement in comorbid conditions, it is a preferred modality in some of the obese patients. Both obesity and bariatric surgery interact with psychiatric disorders and require a thorough psychiatric evaluation. It has been shown that eating disorders diagnosed in the preoperative period may continue postoperatively as well. However, development of eating disorders in the postoperative periodfor the first time is quite rare. Here, we present a patient who was diagnosed with bulimia nervosa after she had bariatric surgery for obesity. After psychiatric evaluation, she was diagnosed with bulimia nervosa that developed after bariatric surgery. Medical and cognitive behavioral therapy programs were initiated. A partial improvement in her disturbed body perception was observed. She is still on medical and cognitive behavioral therapies. Eating disorder like bulimia nervosa may develop even in patients whose preoperative psychiatric evaluation is normal. Therefore, we suggest not only preoperative but also postoperative detailed psychiatric evaluation and follow up in obese patients who are candidate for bariatric surgeryÖğe A case of left atrial myxoma associated with atrial septal defect(Journal of Cardiac Surgery, 2005) Koşar, Feridun; Erdil, Nevzat; Güllü, Hakan; Şahin, İbrahim; Nisanoğlu, Vedat; Battaloğlu, BektaşCardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associ-ated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-oldwoman referred to the emergency department with loss of consciousness and finally diagnosed as a ped-inculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septaldefect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture.The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagno-sis when patients present with neurological consequences of systemic embolization.Öğe A case of left atrial myxoma associated with atrial septal defect(Journal of Cardiac Surgery, 2005) Koşar, Feridun; Erdil, Nevzat; Güllü, Hakan; Şahin, İbrahim; Nisanoğlu, Vedat; Battaloğlu, BektaşCardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associ-ated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-oldwoman referred to the emergency department with loss of consciousness and finally diagnosed as a ped-inculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septaldefect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture.The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagno-sis when patients present with neurological consequences of systemic embolization.Öğe A case of TSHoma mimicing Graves 'disease and makes GH cosecrete(2022) Aydin, Emine Sener; Evren, Bahri; Şahin, İbrahimThyrotropinomas (TSHoma) are rare pituitary adenomas. TSHomas can synthesize other hormones simultaneously. Co-secretion of TSH and GH is rarely reported in the literature. In these patients, signs of hyperthyroidism and acromegaly can be observed together. Its clinic is heterogeneous and in some cases, symptoms of thyrotoxicosis may mask the acromegaly symptoms. Some TSHoma patients may also be mistakenly diagnosed with Graves and experience a delay in diagnosis. We aimed to present a unique case with a diagnosis of TSHoma, who was referred to our center when Euthyroidism was not achieved and was followed up with a pre-diagnosis of Graves and also had GH co-secretion.Öğe A comparison of multivariate statistical methods to detect risk factors for type 2 diabetes mellitus(2023) Çiçek, İpek Balıkçı; Yoloğlu, Saim; Şahin, İbrahimAim: The goal of this study is to compare the performances of Logistic Regression (LR), Artificial Neural Networks (ANN) and Decision Tree models, which are machine learning classification methods, in the diagnosis of type 2 Diabetes Mellitus (DM) and to determine the most successful method. It is also the examination of risk factors affecting type 2 DM using these models. Materials and Methods: The study’s data was collected from patients who visited the Diabetes and Thyroid polyclinic at the Inonu University Faculty of Medicine Turgut Ozal Medical Center, Department of Internal Medicine. The k-Nearest Neighbor algorithm, which is one of the missing value assignment methods, was used to eliminate the prob- lems related to missing values. Sensitivity, accuracy, precision, specificity, AUC F1-score, and classification error were used as performance evaluation criteria. Evolutionary algo- rithm parameter optimization method was used to optimize the parameters of the ANN model. Missing value assignment, modeling and parameter optimization were done with Rapidminer Studio Free version 8.1. Results: Among the three methods applied in the diagnosis of type 2 DM, the ANN gave the best classification performance. The accuracy, sensitivity, selectivity, precision, F1-score, AUC and classification error values obtained from this method are respectively; 98.94%, 100%, 97.73%, 98.04%, 99.01%, 0.978 and 1.06. For the ANN method, the im- portance values of the gender, long-term drug use, family history, concomitant disease, cortisone use, stress factor, high blood pressure, smoking, high cholesterol, heart dis- ease, exercise status, carbohydrate use, alcohol consumption, vegetable use, meat use, age, weight, height, starting age, daily bread consumption, LDL, HDL, Total Cholesterol, Triglyceride, Fasting blood sugar the importance values of independent variables are re- spectively; 0.017, 0.009, 0.013, 0.017, 0.008, 0.016, 0.008, 0.006, 0.053, 0.024, 0.023, 0.040, 0.007, 0.020, 0.007, 0.046, 0.083, 0.049, 0.024, 0.066, 0.084, 0.083, 0.020, 0.031, 0.244. Conclusion: According to the performance criteria obtained from the three classifica- tion models used to predict type 2 DM; it has been found that the best classification performance belongs to the ANN model. According to the ANN method, the three most important risk factors that may cause type 2 DM were found to be fasting blood glucose, LDL, and HDL, respectively.Öğe A Cross-Sectional Study of the Prevalence of Cardiovascular Disease in Adults with Type 2 Diabetes in Türkiye: The CAPTURE Study(2022) Şahin, İbrahim; Bayram, Fahri; Bayraktaroğlu, Taner; Güldiken, Sibel; Dalbeler, Ayşegül; Sönmez, AlperObjective: The primary objective of the CAPTURE study was to estimate the prevalence of cardiovascular disease (CVD) in adults with Type 2 diabetes mellitus (T2DM) across 13 countries from 5 continents. Here, we present the findings from Türkiye. Material and Methods: The non-interventional, cross-sectional CAPTURE study (NCT03811288; NCT03786406) was conducted across 15 centers in Türkiye. Standardized demographic and clinical data were collected from adults with T2DM who were treated by primary or specialist care physicians. The prevalences of CVD and its 7 subtypes were estimated. Descriptive statistics were used for data analysis. Results: Amongst the 801 participants (n=200 from primary care, n=601 from specialist care) with T2DM enrolled, 250 had established CVD, an estimated weighted prevalence of 31.2% (28.0-34.4) 95% confidence interval. Atherosclerotic CVD contributed to the majority (85.6%) of the CVD cases. An estimated 24.0% of the Türkiye sample had coronary heart disease (CHD). Heart failure was the second most predominant CVD subtype in Türkiye is correct sample (5.4%), followed by cardiac arrhythmia and conduction abnormalities (4.7%). Sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists with cardiovascular (CV) benefits were prescribed to 17.5% and 0.1% of the patients, respectively. Conclusion: Approximately 30% of participants with T2DM had established CVD in the CAPTURE Türkiye population, comparable to the global pooled prevalence. CHD was the major contributor and encompassed approximately 75% of the CVD cases. The use of glucose-lowering medication with CV benefits was low compared to the global pooled population, which may be due to the lack of reimbursement of these medications in Türkiye.Öğe Ecotourısm in Büyükkonuk, North Cyprus(İnönü Üniversitesi, 2011) Kaynakçı Elinç, Zuhal; Cengiz, Ayşegül; Elinç, Hakan; Şahin, İbrahimEcotourism has become a significant notion for people and tourism sector after UNWTO announced year 2002 as “World Ecotourism Year.” Human being has been damaging nature and ecosystem since the very first day he discovered fire. With years passing by, advancing technology and using more chemicals than ever before have increased this destruction level. Mankind always used the nature as if it’s a never-ending source but people recently realized that even nature itself has a limited rejuvenation ability, which may need centuries, and some damages done may be almost irreversible. One of the ways for helping nature is ecotourism. This study contains examination and research of ecotourism attitude that brought into life in 2006 in Büyükkonuk, which is in Karpaz Peninsula of North Cyprus. Besides that, Ay Phodios (quest house), which is the best example of this ecotourism approach and guest house concept in Büyükkonuk, is examined in terms of using space and ecological materials used in it. One of the focus points of the study is how inhabitants of Büyükkonuk benefited from ecotourism, what did ecotourism contributed to the region and intended use of ecotourism-friendly buildings in Büyükkonuk. In the century we are living in, the countries which raised their awareness about sustainable tourism realized that; it may only be provided by being in step with a natural and fertile environment, while considering negative impacts of the possible developments on this environment, started to take precautions. Still, it’s questionable if these precautions are enough or not. Both in urbanization and structuring, preserving green spaces and keeping the balance of ecological balance has a lot of importance for our society and future generations.Öğe The effect of exercise induced weight loss on myokines and adipokines in overweight sedentary females steps aerobics vs jogging walking exercises(J Sports Med Phys Fitness, 2016) Düzova, Halil; Güllü, Esin; Çiçek, Güner; Köksal, Burcu; Kayhan, Başak; Güllü, Abdullah; Şahin, İbrahimThe objectives of this study were to verify effects of step-aerobic exercise (SAE) and jogging-walking exercise (JWE) program on myokines and adipokines levels in overweight sedentary females. METHODS:Volunteer subjects (n=25) were assigned to two exercise groups: steps aerobics and jogging-walking. The exercise program given to them was for five days a week and for twelve weeks period. Serum samples were collected from venous blood before and immediately after cardio-respiratory fitness test (CRF) by Bruce protocol and stored at -80 C until they were assayed before 12 weeks exercise program. After 12- weeks training program this procedure was repeated. Serum TNF-α, IL-6, IL-15, IL-17, IL- 18, leptin, resistin and adiponectin levels were assayed by ELISA. RESULTS: Leptin and IL-15 levels were increased whereas resistin levels were decreased after CRF test in JWE training group following 12-weeks exercise program. TNF-α, IL-15 and IL-18 levels were higher and leptin levels were lower in SAE group than JWE group after 12-weeks exercise period. However, both SAE and JWE did not lead to significant change in serum levels of IL-17, IL-6 and adiponectin levels. CONCLUSIONS: What this study has added to existing knowledge that both SAE and JWE may cause weight loss especially in fat mass. But, the effect of SAE and JWE on myokines and adipokines levels may be the different. Further studies are needed to find out clinical importance of these findings.Öğe End stage renal failure and radial artery tortusity: Two uncommon manifestations in Bardet-Biedl Syndrome(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2005) Serbest, Tekeş Selda; Şahin, İbrahim; Taşkapan, Hülya; Keskin, Lezzan; Kaya, EminÖz: Bardet-Biedl Sendromu (BBS) retinitis pigmentosa, obezite, polidaktili, brakidaktili, hipogonadizm ve mental retardasyon ile karakterize otozomal resesesif geçiş gösteren bir hastalıktır. Renal tutulum sık görülür ve daha çok hafif yapısal ve fonksiyonel bozukluklar şeklindedir. Ancak son dönem böbrek yetmezliği çok nadir görülür. Daha da önemlisi radial arter tortusitesi bildirilmemiştir. Yirmi yaşındaki BBS'li bayan hasta bulantı, kasılma ve kas krampları ile acil servise başvurdu. Hastanın ilk değerlendirilmesinde ciddi hipokalsemi (Ca: 3.6 mg/dl) ve üremi tespit edildi. Kalsiyum replasman tedavisi başlandı ve hasta Endokrinoloji bölümüne yatırıldı. Yapılan ileri tetkiklerinde retinopati, brakidaktili, konuşma bozukluğu ve glikoz tolerans bozukluğu gibi klasik bulgularının yanında son dönem böbrek yetmezliği ve radial arter tortusitesi mevcuttu. Hastanın sonuçları hipokalseminin böbrek yetmezliğine bağlı olarak geliştiğini işaret etmekte idi.Fistülizasyon operasyonu iki kez yapılmasına rağmen başarısız oldu. Yapılan Doppler ultrasonunda radial arterde yetmezlik ve tortusite saptandı. Bundan dolayı sürekli ambulatuar peritoneal dializ tedavisi başlandı ve hasta tedaviyi iyi tolere etti.Öğe Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus(J Diabetes Complications, 2008) Şahin, İbrahim; Alkan, Alpay; Keskin, Lezzan; Çıkım Sertkaya, Ayşe; Karakaş, Muammer Hakkı; Fırat, Ahmet Kemal; Sığırcı, AhmetThe aim of this study was to investigate possible metabolic alterations in cerebral tissues on magnetic resonance spectroscopy (MRS) in patients with impaired glucose tolerance (IGT) and with type 2 diabetes mellitus (T2-DM). Twenty-five patients with T2-DM, 13 patients with IGT, and 14 healthy volunteers were included. Single-voxel spectroscopy (TR: 2000 ms, TE: 31 ms) was performed in all subjects. Voxels were placed in the frontal cortex, thalamus, and parietal white matter. N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myo-inositol (MI)/Cr ratios were calculated. Frontal cortical Cho/Cr ratios were increased in patients with IGT compared to control subjects. Parietal white matter Cho/Cr ratios were significantly higher in patients with IGT when compared to patients with T2- DM. In the diabetic group, frontal cortical MI/Cr ratios were increased, and parietal white matter Cho/Cr ratios were decreased when compared to the control group. Frontal cortical NAA/Cr and Cho/Cr ratios and parietal white matter Cho/Cr ratios were decreased in diabetic patients with poor glycemic control (A1CN10%). A1C levels were inversely correlated with frontal cortical NAA/Cr and Cho/Cr ratios and with parietal white matter Cho/Cr ratios. T2-DM and IGT may cause subtle cerebral metabolic changes, and these changes may be shown with MRS. Increased Cho/Cr ratios may suggest dynamic change in membrane turnover in patients with IGT. Diabetic patients with poor glycemic control may be associated with neuronal dysfunction/damage in brain in accordance with A1C levels and, in some, extend with insulin resistance.Öğe Evaluation Of Morbid Obese Patients In Terms Of Sexual Dysfunctions: A Cross-Sectional Study(2022) Yaprak, Bülent; Şahin, İbrahim; Evren, Bahri; Keskin, Lezzan; Erbay, Lale GönenirAim: Obesity is a risk factor for sexual dysfunction. The aim of this study was to determine the frequency of sexual dysfunction in patients diagnosed with morbid obesity.Methods: The patient group included in the study consisted of 78 morbidly obese patients with BMI?40 kg/m2 and 68 healthy individuals with normal BMI. The data were obtained by using the sociodemographic information form filled by the participants, Beck anxiety scale, Beck depression scale and Golombok Rust Sexual Satisfaction Inventory.Results: Obese individuals were found to have sexual dysfunction compared to individuals with normal body BMI (p<0.05). When the Golombok Rust subscale scores of obese men were compared to those of normal-weight individuals, a significant deterioration was found in all subscale scores, including frequency, communication, satisfaction, avoidance, touch, impotence and premature ejaculation. In addition, the anxiety and depression scores of obese individuals were shown to be higher than those of normal-weight individuals (p<0.05).Conclusion: Morbidly obese individuals should be evaluated in terms of sexual functions. We believe that regulating obesity treatment, including possible treatment for sexual dysfunction, will increase the success rate and enhance the quality of life for patients.Öğe Evaluation of novel ventricular repolarization parameters in patients with acromegaly(2023) Eren, Hayati; Genc, Selin; Evren, Bahri; Şahin, İbrahimObjectives: T wave’s peak and end interval (Tp-e), Tp-e/QT ratio and Tp-e/QTc ratio are novel markers of ventricular repolarization and are associated with ventricular arrhythmias. Increased ventricular arrhythmia incidence is reported in patients with acromegaly. The purpose of this study is to evaluate ventricular repolarization using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with acromegaly. Methods: Thirty-five patients with acromegaly were included in the study. The control group was consisted of forty-one subjects without acromegaly that having similar age, sex ratio and comorbidities. The Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio, and other ventricular repolarization parameters of all patients were evaluated using electrocardiography. Results: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were significantly prolonged in patients with acromegaly compared to the control group. Furthermore, Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio showed a significant correlation with plasma GH levels and LVMI values. Conclusions: Our study revealed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with acromegaly. We believe that the Tp-e interval, Tp-e/QT ratio, and Tpe/QTc ratio can be used in the evaluation of increased cardiovascular risk in patients with acromegaly.Öğe Evaluation of Oxidative Stress Status and Adenosine Deaminase Activity in Hyperthyroid and Hypothyroid Patients(2014) Kıran, Tuğba Raika; Bay Karabulut, Aysun; Şahin, İbrahim; Çolak, CemilAbstract: A few prospective studies evaluated the oxidative stress variables and adenosine deaminase activity in patients with hyperthyroidism and hypothyroidism. Thus; we aimed to investigate oxidative stress variables and adenosine deaminase activity in patients with hyperthyroidism and hypothyroidism. Study populations consisted of 20 patients with hyperthyroidism, 20 patients with hypothyroidism and 20 age matched healthy volunteers as control group. Plasma nitric oxide, malondialdehyde levels and glutathione, adenosine deaminase activities were measured in all subjects. plasma nitric oxide and adenosine deaminase levels were higher in patients with hyperthyroidism, but lower in patients with hypothyroidism compared to those of controls (P<0.05). Plasma nitric oxide levels were higher in patients hypothyroidism compared to the control group (P<0.05). Glutathione levels were lower in both patients with hypo and hyperthyroidism compared to the control group (P<0.05). Our results suggest that both patients with hyperthyroidism and hypothyroidism may have effect on oxidative stress status and adenosine deaminase activity.Öğe Evaluation of the effect of metformin treatment on markers of bone formation and resorption in patients newly diagnosed with Type 2 diabetes(2022) Karagöz, Zuhal Karaca; Şahin, İbrahim; Kurt, Feyzi; Cil, Burcu OzgurType 2 Diabetes Mellitus can affect bone metabolism by many mechanisms and increase the risk of osteoporosis. It has been reported that glucose-lowering treatments, in- cluding metformin also have an effect on bone turnover. The aim of this study is to evaluate the effect of metformin treatment on bone formation and resorption in patients with newly diagnosed type 2 Diabetes Mellitus. There were 37 patients in the study population who were newly diagnosed with type 2 Diabetes Mellitus. Fasting plasma glucose level and postprandial plasma glucose level as well as plasma Hemoglobin A1C, calcium, phosphorus, parathyroid hormone, osteocalcin and C-Telopeptide levels were measured before initiation of metformin treatment. The tests were repeated 3 months after the treatment. The levels of fasting plasma glucose and postprandial plasma glucose decreased after 3 months of metformin treatment as expected and the difference was statistically significant. However there was no significant change incalcium, phosphorus and parathyroid hormone levels. There was also a sig-nificant decrease due to Metformin treatment in osteocalcin levels, which is a bone formation mar-ker. Metformin treatment has decreased C-Telopeptide levels as well which is also a bone formation marker. Our results have shown that 3 months of metformin treatment may suppress the bone turno-ver. Another important finding of our study was the reduction in levels of bone formation markers in female patients. Controlledlong-term studies are needed to be conducted in order to manifest the clinical implications of these findings.Öğe The Frequency of Vitamin D Deficiency in Obese Patients on Bariatric Surgery Wait List: Is there any Association with Co-existence of Prediabetes or Diabetes?(2019) Topaloğlu, Ömercan; Evren, Bahri; Yoloğlu, Saim; Sahin, Selale; Şahin, İbrahimAbstract: Objective: The impact of co-existence of prediabetes on 25 (OH)D3 deficiency is less known. We investigated the prevalence and predictors of 25(OH)D3 deficiency in obese adults on the bariatric surgery waitlist. Material and Methods: One hundred ninety-nine patients without known chronic diseases including diabetesmellitus (DM) and hypertension were included. Anthropometric, biochemical, and hormonal [fasting insulin, C-peptide, 25(OH)D3] parameters were analyzed. Insulin resistance (IR) was calculated using the homeostasis model assessment of IR (HOMA-IR). Patients having HOMA-IR of ?2.5 were considered insulin resistant. Patients were divided into subgroups according to body mass index (BMI), fasting blood glucose, HOMA-IR, glycated hemoglobin A1c (HbA1c), and 25(OH)D3 levels. Results: According to HbA1c levels, prediabetes and DM were diagnosed in 39.6% (n=79) and 27.1% (n=54) of patients. The 25(OH)D3 levels were severely deficient, deficient, and insufficient in 47.2%, 36.7%, and 10.6%of patients; however, the levels were sufficient (?30 ng/mL) only in 5.5%. The mean 25(OH)D3 level was 9.59, 9.76, and 12.08 ng/mL in nondiabetic, prediabetic, and diabetic patients (p>0.05). BMI and 25(OH)D3 levels were negatively correlated (p=0.045, r=-0.142). HOMA-IR was not correlated with 25(OH)D3 levels (p=0.98); it was similar in patients with different 25(OH)D3 levels. Age ?40 years andmale gender were significant predictors for severe 25(OH)D3 deficiency, but IR, prediabetes, and DM were not significant predictors. Conclusion: Increased BMI was associated with decreased 25(OH)D3 levels. The co-existence of prediabetes does not seem to affect 25(OH)D3 levels. Age ?40 years and male gender were significant predictors for severe 25(OH)D3 deficiency. Severe 25(OH)D3 deficiency was frequent in obese patients on the bariatric surgery waitlist. Vitamin D deficiency was also shown in other studies on obesity. 25(OH)D3 levels should be measured in all patients undergoing bariatric surgery and managed accordingly. The effect of preoperative vitamin D replacement on postoperative weight loss will clarify the association between vitamin D levels and obesity.Öğe Gebelikte ve Laktasyonda Mineral Metabolizması ve Hipoparatiroidizm(2021) Topaloglu, Omercan; Şahin, Bayram; Şahin, İbrahimGebelikte kalsiyum, fosfor ve magnezyum ihtiyacı artar, ancak düzeltilmiş kalsiyum, iyonize kalsiyum, fosfor ve magnezyum seviyeleri değişmez. Gebelikte maternal PTHrP artarak böbrek ve plasentada 1-alfa hidroksilaz aktivitesini ve kalsitriol sentezini arttırır. Gebeliğin ilk trimesterinde PTH normalin altına düşebilir, sonraki haftalarda orta-normal aralığa yükselir. Laktasyonda düzeltilmiş kalsiyum ve iyonize kalsiyum seviyesi normal sınırlardadır. Laktasyonda PTHrP seviyesi artarak maternal iskeletten kalsiyum rezorpsiyonunu ve böbreklerden kalsiyum abzorpsiyonunu uyarır, PTH alt sınırda ölçülür. Maternal iskelet yıkımı pahasına, transplasental kalsiyum geçişi devam ettiğinden, ciddi maternal hipokalsemi gelişmedikçe fetal hipokalsemi beklenmez. Bazı gebeler erken dönemde kalsiyum replasmanına daha az ihtiyaç duyarlar. Hipoparatiroidizm tanısı olan kadınlar gebe kaldığında yakın takip gereklidir. Gebelikte maternal hipokalsemiden ve hiperkalsemiden kaçınılmalıdır. Maternal hipoparatiroidizm tedavisinde günlük 1-1,5 gram kalsiyum ve 0,5-3 ?g kalsitriol (bölünmüş dozlarda) veya haftalık 50000-150000 IU 25(OH)D vitamini verilmesi önerilir. Gebelikte hipoparatiroidi izleminde obstetrik, endokrinoloji ve pediatri doktorları iş birliği içinde olmalıdır. Düzeltilmiş serum kalsiyum veya iyonize kalsiyum düzeyi gebelik boyunca 3-4 haftada bir, laktasyonda ilk ay haftalık sonra ayda bir ölçülmelidir; gebelikte ve laktasyonda alt-normal referans aralığında tutulmalıdır.Öğe How effective is the obesity treatment on improving oxidative stress? Is there any difference between drugs?(2022) Keskin, Lezan; Şahin, İbrahim; Yavuz, Dilek Gogas; Yüksel, Meral; Taşkapan, Mehmet ÇağatayIntroduction: Obesity shortens the life period and decreases its quality, causing several complications. Recently, oxidative stress produced by lipid peroxydation is considered a cardiovascular risk factor. In this study, we aimed to investigate the relationship between weight loss with lipid profile, insulin resistance, and lipid peroxidation products malondialdehyde (MDA, oxidant) and paraoxonase-1 (PON1, antioxidant) levels which is protective in atherosclerosis, and to evaluate alteration on oxidative stress. Methods: Patients diagnosed as obese at the Endocrinology and Metabolic Diseases Outpatient Clinics of Inonu University Faculty of Medicine between December 2005 and February 2008 were studied. 103 patients were included in the study. Study population was divided into two treatment groups. In the first group, 120 mg of orlistat, three times daily, and in the second group, sibutramine 15 mg per day were given in addition to appropriate diet therapy. The patients were evaluated at the end of three months treatment period. Results: Dramatic changes in body weight, Body Mass Index (BMI), and waist and hip circumference were observed during the three-month evaluation in patients receiving orlistat or sibutramine. Additionally, significant improvements were measured in systolic- diastolic blood pressure levels, lipid levels, and insulin resistance. The decrease in the MDA level and the increase in the PON level were similar and significant in both patient groups. Discussion and Conclusion: The treatment of obesity, aimed at reducing body weight, acts to reduce oxidative stress by increasing paraoxonase-1 activity (antioxidant) and reducing the amount of the peroxidation product malondialdehyde (oxidant), regardless of the type of medication administered.Öğe Identifying the determinants of microalbuminuria in obese patients in primary care units the effects of blood pressure random plasma glucose and other risk factors(Journal of Endocrinological Investigation, 2016) Pehlivan, Erkan; Özen, G.; Taşkapan, Hülya; Güneş, Gülsen; Şahin, İbrahim; Çolak, CemilObjective The objective of this study is to evaluate the demographic characteristics, blood pressure and blood glucose and the other related factors that affect the microalbuminuria levels in the obese patients aged 40 and above who applied to the primary care for medical evaluation. Materials and methods The population of the research, which was a cross-sectional type, comprised obese patients aged 40 and above who had applied to the community health centers in the center of Malatya. A total of 422 obese patients consisting of 116 males and 306 females were included in the research. The anthropometric measurements of the participants were determined, their blood pressures and their random blood glucoses were evaluated, as well. A microalbuminuria measurement was performed in the urine samples taken from the patients using “Nycocard Reader II” device. Findings The incidence of microalbuminuria in patients was found as 31.5 %, whereas the incidence of macroalbuminuria was 6.6 %. The incidence of microalbuminuria in female patients was 32.7 %, while it was 28.4 % in male patients; on the other hand, the incidence of macroalbuminuria in female patients was found as 6.8 %, whereas this percentage was determined as 7.8 in male patients (p > 0.05). The probability of the incidence of microalbuminuria increased 2.8 times more in those with the diastolic blood pressure of 90 mmHg and above when compared to those without it (GA: 1.79–4.56), whereas the incidence increased 3.2 times more in those with the random blood glucose of 200 mg/l and above (GA: 1.32– 7.84) (p < 0.001). In our study, among the variables predicting the microalbuminuria in obese patients; the cutoff values of the diastolic and systolic blood pressures, the waist circumference were found as >85 mmHg; >130 mmHg; >141 mg/ dl, respectively, in male patients and found as >85 mmHg, >114 cm, and 109 cm, respectively, in female patients. The sensitivity and specificity of the tests indicating the cutoff values showed significance (p < 0.05). There was no statistically significant relevance between the microalbumin levels of the obese patients via the anthropometric criteria, except for their waist circumference (p > 0.05). Result In this study, the blood pressure and blood glucose levels of the patients along with their waist circumference that indicated a central obesity were specified as the determinants of microalbuminuria. While the obese patients are being evaluated in terms of proteinuria, the cutoff values of these variables can be taken into consideration.
