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Öğe Angiotensin-converting enzyme gene polymorphism and risk of insulin resistance in PCOS(Elsevier Sci Ltd, 2010) Celik, Onder; Yesilada, Elif; Hascalik, Seyma; Celik, Nilufer; Sahin, Ibrahim; Keskin, Lezzan; Ozerol, ElifThe aim of this study was to establish the frequency of angiotensin-converting enzyme (ACE) insertion (I) or deletion (D) gene polymorphism in women with polycystic ovary syndrome (PCOS) and to examine the association of this polymorphism with insulin resistance. A total of 32 women with PCOS and 31 healthy, age- and body mass index-matched controls were studied. Serum lipids, fasting glucose, insulin and other hormones concentrations were measured. Homeostasis model assessment was used to estimate insulin resistance (HOMA-IR). DNA was extracted from peripheral blood leukocytes and genotyping of ACE I/D polymorphism was carried out by polymerase chain reaction. ACE genotypes were distributed as follows: DD was present in 16 (50%), ID in 12 (37.5%) and II in four (12.5%) PCOS patients, and DD in seven (22.6%), ID in 20 (64.5%) and II in four (12.9%) of healthy subjects. The frequency of D and I alleles were found in 69% and 31% of the PCOS group and 55% and 45% in the control group, respectively. There were no significant differences regarding the genotypic distribution and allelic frequency between the groups. However the ACE DD genotype was significantly associated with serum insulin concentrations and HOMA-IR measurement (both P = 0.005). ACE DD genotype is associated with an increased insulin resistance in women with PCOS. (C) 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Comparison of thyroid fine needle aspiration biopsy and ultrasonography results(Lippincott Williams & Wilkins, 2023) Keskin, Lezzan; Karahan, Dogu; Yaprak, BuelentThyroid nodules are one of the most common health problems in the community. Although most of the nodules are benign, Fine needle aspiration biopsy (FNAB) is requested due to malignancy concerns. In this research, the aim was to make a comparison of the results of thyroid ultrasonography (USG) and FNAB for thyroid nodules. This study was conducted retrospectively on the data of 532 patients. Detail Edu ultrasonographic assessment was conducted before the FNAB procedure and FNAB was performed by an endocrinology specialist. FNAB results and Thyroid USG features were compared, and thyroid FNAB results were graded using the classification of World Health Organization Bethesda-2017. The average age of the individuals included in the research was 49.99 & PLUSMN; 13.65 (min = 18-max = 97). According to the 2017 Bethesda classification, 74.6% of FNAB results were benign, 16% follicular lesion of undated mined significance or A type of undated mined significance, 0.9% were malignant, and 1.1% were suspicious for malignancy. When USG findings were compared according to FNAB results, it was found that malignant lesions were significantly higher in single nodules (non- cystic and non- mixed lesions). Lesions with a single nodule on USG were found to be 3.6 times more likely to be malignant (OR 95% CI: 1.172-11.352). The gold standard method for the diagnosis the presence of thyroid nodules is thyroid fine needle aspiration biopsy with ultrasound guidance. Taking samples from the correct nodule and component increases its value. The presence of a single nodule from the thyroid USG features was found to be an important predictor of malignancy according to the biopsy results.Öğe Diagnostic potential of serum N-terminal pro-B-type brain natriuretic peptide level in detection of cardiac wall stress in women with polycystic ovary syndrome: a cross-sectional comparison study(Oxford Univ Press, 2007) Celik, Onder; Sahin, Ibrahim; Celik, Nilufer; Hascalik, Seyma; Keskin, Lezzan; Ozcan, Hamdi; Uckan, AhmetBACKGROUND: In addition to the negative effect on fertility, polycystic ovary syndrome (PCOS) has been associated with cardiac pathology. Brain natriuretic peptide (BNP) is a possible marker for cardiac risk, therefore we investigated whether N-terminal pro-B-type BNP (NT-proBNP) increases in women with PCOS compared with healthy women of comparable age and body mass index. METHODS: Thirty women with PCOS and 30 healthy women not suffering from overt cardiac disease were involved in the study. Fasting insulin and serum NT-proBNP levels were measured, and M-Mode echocardiography was performed. Insulin resistance was calculated using the homeostasis model assessment insulin resistance index (BOMA-IR). RESULTS: PCOS subjects had higher NT-proBNP levels than the control subjects (P < 0.001). Abnormal echocardiography indices were detected in 14 of the PCOS subjects (but none of the controls), including valvular heart disease in nine, diastolic dysfunction in two, right ventricular enlargement in one, right atrial enlargement in one and pulmonary hypertension in one. PCOS subjects (n = 30) showed an increased left ventricular mass (LVM) (P < 0.001) and left ventricular posterior wall thickness (LVPWT) (P = 0.006). In addition, NT-proBNP concentration was positively correlated with LVM (r = 0.587, P = 0.001) and negatively correlated with sex-hormone-binding globulin (r = -0.528, P = 0.003). There was a positive correlation between LVM and HOMA-IR (r = 0.295, P = 0.03) while LVPWT was positively correlated with fasting insulin and HOMA-IR (r = 0.335, P = 0.031 and r = 0.346, P = 0.045, respectively) in PCOS subjects (n = 30). CONCLUSION: The present study demonstrated that the level of NT-proBNP was increased in PCOS subjects with asymptomatic heart disease.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 Endothelial Dysfunction in Patients with Acromegaly(Galenos Yayincilik, 2005) Sahin, Ibrahim; Bentli, Recep; Topal, Ergun; Keskin, LezzanIt has been shown that Growth hormone (GH) and insulin like growth factor 1 (IGF-1) has important effects on heart and vascular system. However, little is known about endothelial function in acromegaly. The aim of this study was to determine endothelial function in patients with acromegaly. Endothelial function was evaluated in 10 patients with active acromegaly (eight men, two women) and in 11 age, sex and weight matched control (eight men, two women) using a flow mediated dilatation (FMD) technique in the brachial artery. In acromegalic patients mean FMD was 8.3 +/- 3.5 % and significantly lower than that of control group (p=.023). However, there were no significant correlations between GH, IGF-1 levels and percentage of FMD. These findings suggest that endothelial function impaired in patients with acromegaly.Öğe Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus(Elsevier Science Inc, 2008) Sahin, Ibrahim; Alkan, Alpay; Keskin, Lezzan; Cikim, Ayse; Karakas, Hakki M.; Firat, Ahmet K.; Sigirci, 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 (AlC>10%). AlC 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 AlC levels and, in some, extend with insulin resistance. (C) 2008 Elsevier Inc. All rights reserved.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 Febril nötropenik hastalarda piperasilin - tazobaktam-amikasin ve meropenem-amikasin etkinliklerinin karşılaştırılması(2002) Kuku, İrfan; Kaya, Emin; Arı, Fahri; Dikilitaş, Mustafa; Baydar, Mustafa; Keskin, Lezzan; Aydoğdu, İsmetFebril nötrepeni (FN) hastalarında ateşin varlığı aksi ispat edilinceye kadar enfeksiyon kaynaklı olduğu kabul edilip ampirik antibiyotik tedavisine hemen başlanılması gerekmektedir. Bu çalışma, FN hastalarında ampirik piperasilin-tazobaktam+amikasin ile meropenem+amikasin tedavisinin etkinliklerinin karşılaştırmak amacıyla planlanmıştır. Çalışmaya kliniğimizde takip edilen 51 hasta ve bu hastalarda gelişen 76 FN atağı değerlendirmeye alındı. FN atağı gelişen 40 hastaya ampirik meropenem+amikasin kombinasyonu, 36 hastaya tazobaktam+amikasin kombinasyonu verildi. Çalışma sonucunda her iki kombinasyon eşit etkinlikte bulunmuştur.Öğe Febril Nötropenik Hastalarda Piperasilin-Tazobaktam-Amikasin Ve Meropenem-Amikasin Etkinliklerinin Karşılaştırılması(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2002) Kuku, İrfan; Kaya, Emin; Arı, Fahri; Dikilitaş, Mustafa; Baydar, Mustafa; Keskin, Lezzan; Aydoğdu, İsmetFebril nötrepeni (FN) hastalarında ateşin varlığı aksi ispat edilinceye kadar enfeksiyon kaynaklı olduğu kabul edilip ampirik antibiyotik tedavisine hemen başlanılması gerekmektedir. Bu çalışma, FN hastalarında ampirik piperasilintazobaktam+ amikasin ile meropenem+amikasin tedavisinin etkinliklerinin karşılaştırmak amacıyla planlanmıştır. Çalışmaya kliniğimizde takip edilen 51 hasta ve bu hastalarda gelişen 76 FN atağı değerlendirmeye alındı. FN atağı gelişen 40 hastaya ampirik meropenem+amikasin kombinasyonu, 36 hastaya tazobaktam+amikasin kombinasyonu verildi. Çalışma sonucunda her iki kombinasyon eşit etkinlikte bulunmuştur.Öğe Hipofiz Makroadenomu Olan 25 Hastanın Retrospektif Olarak Değerlendirilmesi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2004) Çıkım, Ayşe; Ateş, Özkan; Keskin, Lezzan; Çakır, Celal Özbek; Çıkım, Kerim; Tarım, ÖzcanBu çalışmanın amacı, 2000-2004 yılları arasında Nöroşirurji ve Endokrinoloji Kliniklerimizde tedavi edilen hipofizer makroadenomlu 25 hastanın (15 kadın, 10 erkek, yaş ortalaması 43.24 ± 15.44 yıl) retrospektif olarak incelenmesidir. Yöntem: Hastalar demografik ve endokrinolojik bulgulara, tümörün çapı, yayılımı ve operasyon şekline göre değerlendirilmiştir. Bulgular: Olguların 12’si klinik olarak non-fonksiyone adenom (CNFT), 6’sı prolaktinoma, 5’i akromegali ve 2’si kranyofarinjiomadır. CNFT’lü vakalarda erkekler (%58.3), akromegali (%80) ve prolaktinomalarda (%66.6) ise kadınlar çoğunluktaydı. Kranyofarinjiomalı iki olgu da kadındı. Baş ağrısı (%52) görme bozuklukları (%36) and hipogonadal semptomlar (%16) başvuru anında belirtilen en sık şikayetlerdi. Hipogonadotropik hipogonadizm ve hipopitüitarizm tedavi öncesi tespit edilen en sık endokrinolojik bozukluklardı. Hastaların 18’i tümör özelliğine göre transsfenoidal (n=10, %40) yada transkranyal yoldan (n=8, %32) opere edildi. Nüks oranı %22.2 bulundu. Operasyonlardan sonra hipopitüitarizmin %28’den %50’ye (n=9), ve kalıcı diabetes insipidusun %4’ten %27.8’e (n=5) yükseldiği görülürken, vizyon bozukluklarının % 48’den %20’ye, oftalmopleji oranının ise %20’den %4’e düştüğü görüldü. Sonuç: Her ne kadar hipofiz adenomlarında yeni tedavi yaklaşımları umut vaat ediyorsa da, makroadenomlar gerek kitle etkileri gerekse operasyona bağlı nedenlerle endokrinolojik ve cerrahi açıdan hala ciddi bir sorun olarak görünmektedir.Öğe Hodgkin lenfoma hastalarında serbest radikaller ve abvd tedavisi ile ilişkileri(İnönü Üniversitesi, 2004) Keskin, LezzanAtomunda bir veya daha fazla paylaşılmamış elektrona sahip moleküller olan serbest oksijen radikalleri oldukça reaktif maddelerdir. Bu moleküller normal hücre siklusları sırasında bol miktarda üretilir. Serbest oksijen radikallerinin etkisiyle DNA ve kromozomlarda kırılma ve onkogenlerde aktivasyon meydana gelmektedir. Antineoplastik ajanlar ( bleomisin, doxorubicin gibi), radyasyon, alışkanlık yapan maddeler, çevresel ajanlar (hava kirliliği yapan fotokimyasal maddeler) ve stres serbest oksijen radikallerinin biyolojik kaynakları içinde yer almaktadır.Bu çalışmada Hodgkin lenfoma hastalarının ABVD tedavi öncesi ve sonrasındaki seram oksidan (NO, MDA) ve antioksidan (SOD, CAT, GSH-Px) düzeyleri karşılaştırıldı. Çalışmaya toplam 34 Hodgkin lenfoma hastası dahil edildi.. Çalışma grubunun yaş ortalaması 30,41±12,08 ( 18-63) idi. Hastaların 19’u (%55,9 ) erkek, 15’i (%44,1) kadın idi. Olguların tümüne ABVD tedavi protokolü verildi. Hastalardan ABVD tedavisinden hemen önce ve tedavinin 1., 7., günlerinde kan örnekleri alındı. Tedavi sonrası 7. gün ölçülen serum NO, MDA düzeylerinde tedavi öncesine göre anlamlı artış tespit edildi. Bunu karşılık serum SOD, CAT ve GSH-Px düzeylerinde ise anlamlı azalma saptandı.Sonuç olarak çalışmamızda ABVD tedavi sonrası ortalama serum serbest radikal düzeylerinde artış, vücut savunma mekanizması olan antioksidan düzeylerinde ise anlamlı azalma olduğu tespit edildi. Bu bulgular, kemoterapilerin istenmeyen yan etkilerinden ve sekonder malignite oluşumundaki rolünden sorumlu olabilir.Öğe Out-of-Reference Range Thyroid-Stimulating Hormone Levels in Levothyroxine-Treated Primary Hypothyroid Patients: A Multicenter Observational Study(Frontiers Media Sa, 2017) Yavuz, Dilek Gogas; Yazici, Dilek; Keskin, Lezzan; Atmaca, Aysegul; Sancak, Seda; Sarac, Fulden; Sahin, IbrahimObjective: Although levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. Design: In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. Results: A total of 1,755 subjects (46 +/- 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 +/- 4.7 years and mean dose was 1.2 +/- 0.6 mu g/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 +/- 16 vs 3.8 +/- 0.9 mIU/L, P = 0.01) compared to compliant patients. Conclusion: The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.Öğe P-wave duration and dispersion in obese subjects(Blackwell Publishing, 2008) Kosar, Feridun; Aksoy, Yueksel; Ari, Fahri; Keskin, Lezzan; Sahin, IbrahimBackground: Although previous studies have documented a variety of electrocardiogram (ECG) abnormalities in obesity, P-wave alterations, which represent an increased risk for atrial arrhythmia, have not been studied very well in these patients. The aim of the present study was to evaluate P-wave duration and P dispersion (Pd) in obese subjects, and to investigate the relationship between P-wave measurements, and the clinical and echocardiographic variables. Methods: The study population consisted of 52 obese and 30 normal weight control subjects. P-wave duration and P-wave dispersion were calculated on the 12-lead ECG. As echocardiographic variables, left atrial diameter (LAD), left ventricular end-diastolic, and end-systolic diameters (LVDD and LVSD), left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass (LVM) of the obese and the control subjects were measured by means of transthoracic echocardiography. Results: There were statistically significant differences between obese and controls as regards to Pmax (maximum P-wave duration) and Pd (P dispersion) (P < 0.001 and P < 0.001, respectively). Pmin (minimum P wave duration) was similar in both groups. Correlation analysis showed that Pd in the obese patients was related to any the clinical and echocardiographic parameters including BMI, LAD, LVDD, IVST, LVPWT, and LVM. Conclusion: Our data suggest that obesity affects P-wave dispersion and duration, and changes in P dispersion may be closely related to the clinical and the echocardiographic parameters such as BMI, LAD, IVST, LVPWT, and LVM.Öğe THE RELATIONSHIP BETWEEN GLYCAEMIC INDEX, DAILY ENERGY INTAKE, METABOLIC PARAMETERS, AND BODY COMPOSITION IN THE ELDERLY: A CROSS-SECTIONAL STUDY(Gunes Kitabevi Ltd Sti, 2022) Mete, Burak; Keskin, LezzanIntroduction: This study aimed to evaluate the relationship between dietary glycaemic index, daily energy intake, metabolic parameters and body composition in elderly individuals.Materials and Methods: This is a cross-sectional study that included 198 elderly individuals who applied to the endocrinology outpatient clinic. Participants were asked to record the foods they consumed on three-day diet forms, which would be collected the following week at the time when also the metabolic parameters would be measured and body composition analyses performed at the polyclinic. Nutrient content was recorded with the BeBIS software. The body composition was analysed by using the bioelectrical impedance method.Results: The mean age of 198 people included in the study was 67.78 +/- 2.76 (65-78). HbA1c, insulin and HOMA-IR, visceral adiposity rates, body fat mass and metabolic age were found to be higher in participants with a dietary glycaemic index >= 70, and the effect of the glycaemic index on these parameters was statistically small. The daily energy intake showed a positive correlation with fasting blood glucose, triglyceride and triglyceride-glucose (TyG) index. Both the daily energy intake and glycaemic index showed a weakly positive correlation with visceral adiposity, metabolic age, body fat mass and body mass index. A dietary glycaemic index >= 70 was observed to increase the risk of obesity OR=3.7 times (95% CI=1.72 - 7.94), and the risk of HbA1C higher than 8 to increase OR=3.13 times (95% CI=1.0 - 9.74).Conclusion: An increase in the dietary glycaemic index and the daily energy intake in the elderly results in poor glycaemic control.Öğe Retrospective analyses of 25 patients with pituitary macroadenomas(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2004) Çıkım, Ayşe; Ateş, Özkan; Keskin, Lezzan; Çakır, Celal Özbek; Çıkım, Kerim; Tarım, ÖzcanÖz: Amaç: Bu çalışmanın amacı, 2000-2004 yılları arasında Nöroşirurji ve Endokrinoloji Kliniklerimizde tedavi edilen hipofizer makroadenomlu 25 hastanın (15 kadın, 10 erkek, yaş ortalaması 43.24 ± 15.44 yıl) retrospektif olarak incelenmesidir. Yöntem: Hastalar demografik ve endokrinolojik bulgulara, tümörün çapı, yayılımı ve operasyon şekline göre değerlendirilmiştir. Bulgular: Olguların 12'si klinik olarak non-fonksiyone adenom (CNFT), 6'sı prolaktinoma, 5'i akromegali ve 2'si kranyofarinjiomadır. CNFT'lü vakalarda erkekler (%58.3), akromegali (%80) ve prolaktinomalarda (%66.6) ise kadınlar çoğunluktaydı. Kranyofarinjiomalı iki olgu da kadındı. Baş ağrısı (%52) görme bozuklukları (%36) and hipogonadal semptomlar (%16) başvuru anında belirtilen en sık şikayetlerdi. Hipogonadotropik hipogonadizm ve hipopitüitarizm tedavi öncesi tespit edilen en sık endokrinolojik bozukluklardı. Hastaların 18’i tümör özelliğine göre transsfenoidal (n=10, %40) yada transkranyal yoldan (n=8, %32) opere edildi. Nüks oranı %22.2 bulundu. Operasyonlardan sonra hipopitüitarizmin %28'den %50'ye (n=9), ve kalıcı diabetes insipidusun %4'ten %27.8'e (n=5) yükseldiği görülürken, vizyon bozukluklarının % 48'den %20'ye, oftalmopleji oranının ise %20'den %4'e düştüğü görüldü. Sonuç: Her ne kadar hipofiz adenomlarında yeni tedavi yaklaşımları umut vaat ediyorsa da, makroadenomlar gerek kitle etkileri gerekse operasyona bağlı nedenlerle endokrinolojik ve cerrahi açıdan hala ciddi bir sorun olarak görünmektedir.Öğe Son Dönem Böbrek Yetmezliği ve Radial Arter Tortusitesi: Bardet-Biedl Sendromunun Nadir Görülen İki Bulgusu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2005) Serbest, Selda Tekeş; Şahin, İbrahim; Taşkapan, Hülya; Keskin, Lezzan; Kaya, EminBardet-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 Tip 2 diyabetli hastalarda artmış CRP düzeyi ve kronik komplikasyonlarla ilişkisi(Diabet Bilimi, 2006) Şahin, İbrahim; Zengin, S.; Keskin, Lezzan; Sığırcı, Ahmet; Taşkapan, Ç.
