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    Current Position of Gliclazide and Sulfonylureas in the Contemporary Treatment Paradigm for Type 2 Diabetes: A Scoping Review
    (Springer Heidelberg, 2024) Sahin, Ibrahim; Bakiner, Okan; Demir, Tevfik; Sari, Ramazan; Atmaca, Aysegul
    The increasing burden of type 2 diabetes (T2D), in relation to alarming rise in the prevalence; challenges in the diagnosis, prevention, and treatment; as well as the substantial impact of disease on longevity and quality of life, is a major concern in healthcare worldwide. Sulfonylureas (SUs) have been a cornerstone of T2D pharmacotherapy for over 60 years as oral antidiabetic drugs (OADs), while the newer generation SUs, such as gliclazide modified release (MR), are known to be associated with low risk of hypoglycemia in addition to the cardiovascular neutrality. This scoping review aimed to specifically address the current position of gliclazide MR among other SUs in the contemporary treatment paradigm for T2D and to provide a practical guidance document to assist clinicians in using gliclazide MR in real-life clinical practice. The main topics addressed in this paper include the role of early and sustained glycemic control and use of SUs in T2D management, the properties of gliclazide MR in relation to its effectiveness and safety, the use of gliclazide therapy in special populations, and the place of SUs as a class and gliclazide MR specifically in the current T2D treatment algorithm.
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    Endocrine and metabolic disorders in adult patients with thalassemia major
    (2020) Yilmaz, Nusret; Tazegul, Gokhan; Avsar, Esin; Kupesiz, Alphan; Sari, Ramazan; Altunbas, Hasan Ali; Balci, Mustafa Kemal
    Aim: Iron overload in tissues, despite current chelation therapies, is a major cause of organ dysfunction and serious complications in thalassemia major. Similarly, iron accumulation in endocrine tissues pave the way for various endocrinopathies. Previous reports regarding prevalence of endocrinopathies in thalassemia major varies significantly based on study population. In this study, we aimed to investigate the metabolic and endocrine disorders among the transfusion-dependent adult thalassemia major patients.Materials and Methods: Data from transfusion-dependent adult thalassemia major patients with regular follow-up were retrospectively evaluated. Former records of the patients were examined to evaluate endocrine disorders, on the basis of laboratory test results. Results: A total of 76 patients with a median age of 28 years, composed of 39 (51.3%) female and 37 (48.7%) male patients were included. Out of the entire cohort, 36.8% (n=28) had hypogonadism, 30.3% (n=23) had thyroid dysfunction, 28.9% (n=22) had a glucose metabolism disorder and 7.9% (n=6) had hypoparathyroidism. Hypogonadism was encountered in 38.5% (n=15) of females and in 35.1% (n=13) of males. Only one patient from each gender had hypergonadotropic hypogonadism, possibly related to iron overload, while the rest had hypogonadotropic hypogonadism. A positive history of delayed puberty was noted in 30.8% (n=12) of females and 24.3% (n=9) of males. Of the patients, 30.3% (n=23) had one, 18.4% (n=14) had 2, 10.5% (n=8) had 3, and 1.3% (n=1) had 4 different endocrine dysfunctions. Accordingly, 61.5% of the patients had at least one endocrine dysfunction while only 39.5% (n=30) had no endocrine dysfunction at all. Conclusion: Survival time has been prolonged in patients with thalassemia major by virtue of effective transfusion and chelation therapies. As a consequence of prolonged survival, endocrine dysfunctions commonly strike adult thalassemia major patients, therefore, endocrine functions need to be evaluated at regular intervals during follow-up.
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    An international survey on hypoglycemia among insulin-treated type I and type II diabetes patients: Turkey cohort of the non-interventional IO HAT study
    (Bmc, 2018) Emral, Rifat; Tetiker, Tamer; Sahin, Ibrahim; Sari, Ramazan; Kaya, Ahmet; Yetkin, Ilhan; Cil, Sefika Uslu
    Background: Limited real-world data are currently available on hypoglycemia in diabetes patients. The International Operations Hypoglycemia Assessment Tool (IO HAT) study was designed to estimate hypoglycemia in insulin-treated type I (T1DM) and type II (T2DM) diabetes mellitus patients from 9 countries. The data from Turkey cohort are presented here. Methods: A non-interventional study to determine the hypoglycemia incidence, retrospectively and prospectively, in Turkish T1DM and T2DM patients using a 2-part self-assessment questionnaire. Results: Overall, 2348 patients were enrolled in the Turkey cohort (T1DM = 306 patients, T2DM = 2042 patients). In T1DM patients, 96.8% patients reported hypoglycemic events (Incidence rate [IR]: 68.6 events per patient-year [ppy]), prospectively, while 74.0% patients reported hypoglycemic events (IR: 51.7 events ppy), retrospectively. In T2DM patients, 95.9% patients (IR: 28.3 events ppy) reported hypoglycemic events, prospectively, while 53.6% patients (IR: 23.0 events ppy) reported hypoglycemic events, retrospectively. Nearly all patients reported hypoglycemia during the prospective period. Conclusions: This is a first patient-reported dataset on hypoglycemia in Turkish, insulin-treated diabetes patients. A high incidence of patient-reported hypoglycemia confirms that hypoglycemia remains under-estimated. Hypoglycemia increased healthcare utilization impacting patients' quality of life. Hypoglycemia remains a common side effect with insulin-treatment and strategies to optimize therapy and reduce hypoglycemia occurrence in diabetes patients are required.
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    Myelodysplastic Syndrome in an Acromegaly Patient: A Case Report
    (Galenos Yayincilik, 2005) Sari, Ramazan; Demirel, Ulvi; Sahin, Ibrahim; Aydogdu, Ismet; Mizrak, Bulent; Taskapan, Hulya
    Acromegaly patients have higher incidence of neoplasia than the general population, especially for colonic carcinoma. Recently, various hematological malignancies have been reported in patients with acromegaly. However, myelodysplastic syndrome has not been reported in acromegaly previously. In this paper, we reported a unique patient with acromegaly and concomitant pancytopenia and myelodysplastic syndrome.
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    Prognostic significance of systemic inflammatory markers in rectal cancer
    (2021) Sari, Ramazan; Kaya, Selcuk; Tuzun, Sabah; Altuntas, Yunus Emre; Kucuk, Hasan Fehmi
    Aim: The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR), which is indicators of systemic inflammatory response, have been demonstrated to be prognostic factors in many types of cancer. The aim of this study was to investigate importance of NLR and PLR in rectal cancer.Materials and Methods: The data of 114 patients who underwent curative resection after neoadjuvant chemoradiotherapy (NACRT) for rectal cancer (RC) between January 2012 to June 2017 and 113 healthy subjects were retrospectively analyzed. Blood samples obtained prior to NACRT were examined. The NLR and PLR in RC patients were compared with the results of healthy individuals.Results: The distribution of NLR and PLR results was significantly different between the RC patients and the control group (p0.001 for both). According to the ROC curve, the cut-off value for NLR was 2.70 and for PLR it was 151.18 in estimating the survival of the patients. NLR and PLR only correlated significantly with tumor wall involvement (T stage). The Kaplan-Meier method of predicting survival revealed no significant difference between groups with increased or decreased NLR and PLR in terms of overall survival (OS) and disease-free survival (DFS).Conclusion: The NLR and PLR of the study group treated with NACRT and those of the control group were significantly different. However, elevated NLR and PLR before NACRT were not found to be significant prognostic biomarkers for OS and DFS in surgically treated RC patients.