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Öğe Alterations of Thyroid Functions in Obesity: Is There any Impact of Co-Existence of Type 2 Diabetes Mellitus?(2018) Topaloğlu, Ömercan; Sümer, Fatih; Çetin, Sedat; Yoloğlu, Saim; Kayaalp, Cüneyt; İbrahim ŞahinAbstract: Aim: Little is known about the effect of coexistent type 2 diabetes mellitus (DM) on thyroid functions in obesity. We aimed to evaluate the thyroid function in the both diabetic and nondiabetic obese patients. Materials and Methods: 145 obese patients admitted to our department, between June 2014 and May 2016, were included in the study. The patients with known thyroid dysfunction were excluded from the study. The patients were grouped according to their BMI (body mass index), co-existence of type 2 DM, and TSH (thyroid stimulating hormone). Data were collected retrospectively and analyzed. Results: No difference was observed between diabetic and nondiabetic groups for the mean age, body weight, fT3 (free T3), fT4 (free T4), BMI, TSH. Primary hypothyroidism, subclinical hypothyroidism and hyperthyroidism were determined in 1.4, 0.7 and 2.8 % of the patients, respectively; no difference was found between diabetic and nondiabetic groups (p=0.588). There was no significant correlation between BMI and TSH (r=0.030, p=0.717).Distribution of patients in different TSH groups between diabetic and nondiabetic groups were similar (p=0.533). There were positive correlations between BMI and, fT4 or fT3 (r=0.274, p=0.001; r=0.280, p=0.002; respectively). Although 1.4% of all patients had isolated elevation of fT4, there was no difference between groups (p=0.178). 24.6% of diabetic, 28.4% of nondiabetic and 26.6% of all patients had isolated elevation of fT3; however, no difference was found (p=0.634). Conclusions: Our study suggested that obesity could be associated with elevated fT4 and fT3. Elevation of fT3 and fT4 with increasing BMI may be as response to increased metabolic rate. We found no difference between diabetic and nondiabetic groups concerning to fT4 and fT3 elevation. As a result, co–existence of type 2 DM seems to have no effect on thyroid functions.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 Hypertension in patients with sleep disordered breathing: cause or result? a cross-sectional analysis(2018) Kayabekir, Murat; Topaloğlu, ÖmercanAim: Sleep disordered breathing and its most frequent presentations, cardiovascular complications of OSAS, are important, frequent and not well known causes of mortality and morbidity. When considering physiological hemodynamic processes during sleep, togetherness of HT and OSAS become an important clinical picture. To investigate the frequency of hypertension in ‘Obstructive Sleep Apnea Syndrome’ (OSAS) patients applied to sleep laboratory. Study Design: Retrospective clinical study.Material and Methods: The test protocol consisted of the PSG recording and diagnosis. Sleep stages and respiratory events observed during sleep were evaluated according to “American Academy of Sleep Medicine” (AASM). The blood pressure measured manually by a sphygmomanometer and the measurements occur 3 times on the left arm. Data analysis was performed using IBM SPSS 23.0 statistical software package. Data were analyzed using descriptive statistical methods (frequency, percentage, mean, standard deviation, median, min-max).Results: Blood pressure measurements of 336 patients were evaluated. 98 (48 male, 50 female) of 336 OSAS patients were diagnosed as hypertension (29%). Hypertensive male patients had 3.3 times increased risk to be diagnosed as severe OSAS than female patients (OR=3,30; 95% CI=1,436-7,585). Together with this, hypertension frequency was found as 29% in patients with sleep disordered breathing.Conclusion: Finally; although hypertension and OSAS seem to be distinct clinical pictures, co-existence of these two disorders has been increased. Frequency of hypertension increases with increasing severity of OSAS. Hypertensive patients have increased risk for developing OSAS.Öğe Increase in C-peptide levels after resolution of hyperglycemia in patients with type 2 diabetes mellitus: Myths or facts?(2020) Topaloğlu, Ömercan; Evren, Bahri; Yoloğlu, Saim; Şahin, Şelale; Şahin, İbrahimAbstract: Aim: Long term control of glucotoxicity was shown to increase the secretion of insulin and C-peptide (Cp). We aimed to investigate the change in Cp levels after short term glycemic control in patients with uncontrolled type 2 diabetes mellitus (DM). Material and Methods: Patients with type 2 DM with uncontrolled hyperglycemia were included. Basal fasting Cp levels were measured both at admission (Cp-admission) and after control of hyperglycemia prior to discharge (Cp-discharge). Cp-difference was calculated as (Cp-discharge)-(Cp-admission). The patients were divided as group 1 (positive Cp-difference) and group 2 (negative Cp-difference), and group A (Cp-difference ?+0.5) and group B (Cp-difference ?-0.5). Results: Of the patients (n=123), 61.8% had positive Cp-difference, and mean Cp-differences were 0.16 (±1.59), 0.96 (±1.03), and -1.11 (±1.51) in all patients, group1 and 2; respectively (p=0.001). Mean body weight, creatinine and Cp-discharge were higher in group 1(p=0.045, p=0.013, p=0.001; respectively). Mean age, body mass index(BMI), diabetes duration, hospitalization, proteinuria, fasting and postprandial glucose, glucose-discharge, HbA1c, lipids, TSH, free T4, Cp-admission were similar in group 1 and 2.Cpdifference was correlated positively with Cp-discharge(p=0.001), negatively with Cp-admission (p=0.001). There were no significant differences between subgroups (age, BMI, diabetes duration, use of secretagogue, diabetic ketaoacidosis history, HbA1c (<10 or ?10%), hyperlipidemia, microvascular complication) regarding to Cp-difference. Positive predictors of positive Cp-difference were cardiovascular disease (p=0.004; Odds Ratio(OR)=3.006) and higher Cp-discharge(p=0.001; OR=6.420);positive predictors of Cpdifference ?+0.5 were male, lower Cp-admission and higher Cp-discharge. Conclusion: Our results indicate that short-term glycemic control has little but significant positive effect on basal Cp. Having cardiovascular disease was positive predictor for positive Cp-difference.Öğe Ischemia modified albumin levels and its association with clinical follow-up in acute renal failure(2017) Uzun, Mehmet; Topaloğlu, Ömercan; Kurtulmuş, Yusuf; Turkon, Hakan; Duman, Can; Karakas, Burak; Akar, HarunAim: In cases with acute ischemia, albumin’s binding capacity for transition metals decreases and the resulting albumin is defined as ischemia modified albumin (IMA). In this study, we aimed to investigate the relationship between IMA and clinical follow-up in patients with acute renal failure (ARF).Material and Methods: Levels of IMA were measured in 51(23 male, 28 female) patients with ARF. Venous blood samples were drawn from patients for biochemical tests and put in plain tubes containing the gel.Results: Mean age of male and female patients was 65.39±15.28 and 70.11±15.25, respectively. The IMA levels in 25.5% of the patients were within the normal range (<400 ABSU), while the IMA levels were higher (>400 ABSU) in 75.5% of the patients. The survival rates of patients in IMA <400 ABSU group for 12 and 24 months were 66.7% and for 30 and 32 months it was 33.3%; while the survival rates of patients in IMA ?400 ABSU group for 12 months were 85.8%, for 24 months were 61.3%, and for 30 and 32 months were 30.6%. No significant difference was determined among survival rates of IMA groups (p=0.719).Conclusion: The comparison between the groups having normal or higher IMA values did not show any significant differences in terms of survival. However, in our study the proportion of patients who needed dialysis during treatment were significantly higher in higher IMA group(IMA?400 ABSU). Therefore, we believe that higher IMA levels may indicate a necessity for dialysis in patients with ARF.Öğe May ischemia modified albumin be a predictor in diagnosis of contrast induced nephropathy?(2018) Topaloğlu, Ömercan; Demir, Bilgin; Ekinci, Ferhat; Uzun, Mehmet; Kurtulmuş, Yusuf; Turkon, Hakan; Duman, CanAim: “Ischemia modified albumin” (IMA) was investigated as a possible biomarker in several diseases such as vascular disorders. We aimed to reveal the possible value of IMA in predicting the development of contrast induced nephropathy (CIN) after coronary angiography in patients with stable angina pectoris.Material and Methods: 106 patients underwent coronary angiography with a diagnosis of stable angina pectoris were included in our study. Basic demographic and clinical findings and laboratory values were recorded and analyzed. Serum creatinine (SCre) levels were also measured 48 hours after coronary angiography and recorded. Amount of contrast agent (CA) given during coronary angiography was recorded. The patients were divided into 2 groups: CIN positive and CIN negative groups.Results: CIN was developed in 14 patients (13%); and IMA levels were similar in CIN positive and negative groups (p>0.05). SCre (both measurements before and after CA administration) was not correlated with IMA levels. There was no association between drug usage and development of CIN (p>0.05). Comorbidities were not associated with the development of CIN (p>0.05) with the exception of hypertension (HT). Presence of hypertension (p=0.0393) and female gender (p=0.0199) was associated with development of CIN. Mean age was 61.3 and 52.3 in CIN positive and negative groups, respectively (p>0.05).Conclusion: Any specific biomarker indicating CIN is not available yet. Most frequently used marker is the measurement of SCre 24- 48 hours after administration of CA. We found IMA levels not to be a predictor for the development of CIN. Further investigations will clearly determine the importance of IMA as a biomarker in renal failure developed after CA administration.Öğe Obezitenin Medikal Tedavisi(Fırat Tıp Dergisi, 2018) Evren, Bahri; Topaloğlu, ÖmercanÖz: Obezite kompleks ve multifaktöriyel bir hastalıktır. Obezite prevalansı dünya çapında çocuk ve ergenler arasında yükselirken, etkili ve sürdürülebilir tedavilere olan talep artmaktadır. Obezitenin önemli bir kısmı morbiditeyle ilişkilidir. Obezitenin tedavisinde temel olan tıbbi beslenme tedavisi, egzersiz gibi yaşam tarzı değişikliğidir. Yaşam tarzı değişikliği önerileri yetersiz kaldığında farmakolojik tedaviler kullanılabilir. Şu anki medikal tedavilerde Orlistat tümüyle yeterli değildir. Obezite tedavisinde, yeni ilaçların geliştirilmesi hem sistemik farmakoterapinin karmaşıklığı hem de etnik köken ve yaş gibi değişkenler nedeniyle zor olsada çalışması devam eden ilaçlar mevcuttur. Güvenlik ve uzun vadeli etkinlikleri ispat edilirse, obezite yönetiminde umut verici değişiklikler beklenmektedir. Başlık (İngilizce): Medical Treatment of Obesity Öz (İngilizce): Obesity is a complex and multifactorial disease. Together with the increasing prevalence of obesity worldwide among children and adolescents, the need for effective and sustainable treatment has been increasing. An important part of obesity is related to morbidity. Main part of the management of obesity is lifestyle change such as exercise and medical nutrition therapy. Pharmacological treatments can be used, if lifestyle modification recom-mendations are inadequate. Orlistat is not solely sufficient among the current medical treatments. Although the development of new drugs is difficult due to complexity of systemic pharmacotherapies and variables such as ethnicity and age, several drugs are still under development. If safety and long-term effectiveness of these drugs will be proven, promising changes in obesity management are expected.Öğe Palpable Purpura in a Patient with Uncontrolled Type 2 Diabetes Mellitus: Possible Side Effect of Linagliptin(İstanbul Medical Journal, 2019) Topaloğlu, Ömercan; Evren, Bahri; Şahin, İbrahimÖz: Linagliptin is a member of “Dipeptidyl Peptidase-4” (DPP-4) inhibitors and may be preferred for certain advantages. We present a type 2 diabetes case with developed skin findings after initiation of linagliptin. A 66-year-old type 2 diabetic woman with coronary heart disease for 10 years was admitted to our clinic with dry mouth, polydipsia and polyuria. She was on metformin, acetylsalicylic acid and nitrate treatment. The physical examination was unremarkable. On admission, blood glucose was 319 mg/dL, urine ketone was negative, serum biochemistry and arterial blood gas results were within normal limits. Linagliptin was added to treatment after glycemic regulation was achieved with intensive insulin regimen. On the second day of linagliptin treatment, palpable purpuralike lesions were seen in the lower and upper extremities. Linagliptin was considered as an etiological factor. After discontinuation of linagliptin, the lesions gradually regressed. DPP-4 inhibitors may lead to some dermatological side effects due to inhibition of other DPP enzymes. To the best of our knowledge, our case is the first case in the literature to develop palpable purpura after linagliptin treatment. Başlık (Türkçe): Kontrolsüz Tip 2 Diabetes Mellitus’lu Bir Hastada Palpabl Purpura: Linagliptinin Muhtemel Yan Etkisi Öz (Türkçe): Linagliptin, “Dipeptidil Peptidaz-4” (DPP-4) inhibitörlerinin bir üyesidir ve bazı avantajlarından dolayı tercih edilebilir. Linagliptin başlandıktan sonra deri bulguları gelişen tip 2 diyabetli bir olguyu sunuyoruz. On yıldır koroner kalp hastalığı olan 66 yaşında tip 2 diyabetli kadın hasta kliniğimize ağız kuruluğu, polidipsi ve poliüri ile başvurdu. Metformin, asetilsalisilik asit ve nitrat kullanan hastanın fizik bakısı normal sınırlardaydı. Başvuruda, kan glukozu 319 mg/dL, idrar ketonu negatif, serum biyokimya ve arteryel kan gazı normal sınırlarda saptandı. İntensif insülin rejimi ile glisemik regülasyon sağlandıktan sonra linagliptin eklendi. Linagliptin tedavisinin 2. gününde, hastanın alt ekstremitelerinde ve kollarında palpabl purpura benzeri lezyonlar ortaya çıktı. Etiyolojik faktör olarak linagliptin düşünüldü. Linagliptin kesildikten sonra lezyonlar kademeli olarak geriledi. DPP-4 inhibitörleri diğer DPP enzimlerinin inhibisyonu sebebiyle bazı dermatolojik yan etkilere yol açabilir. Bildiğimiz kadarıyla, bizim olgumuzda literatürde ilk defa linagliptin tedavisi sonrasında palpabl purpura gelişmiştir.Öğe The prevalence and predictors of prediabetes in the patients on liver transplant wait list(2018) Şahin, İbrahim; Kayaalp, Cüneyt; Sahin, Selale; Yoloğlu, Saim; Evren, Bahri; Topaloğlu, ÖmercanAbstract: Aim: Studies addressing the prevalence of prediabetes among liver transplantation (LT) candidates are limited. We aimed to investigate the prevalence and predictors of prediabetes in the patients on LT wait list. Material and Methods: One hundred one adult patients on LT wait list were included. Patients with known diabetes were excluded. Clinical, demographic and laboratory features were analyzed retrospectively. The patients were grouped by fasting blood glucose (FBG), age, gender, body mass index (BMI), and other clinical parameters. Results: Mean age of the patients was 47.98 ± 14.53; and 63.3% were males. Prediabetes and new-onset diabetes mellitus were diagnosed in 34(33.6%) and 6(5.9%) of the patients. Mean age was significantly higher in prediabetes group comparing to normal FBG. 52.47% (n = 53) of the patients was obese, 27.7% (n = 28) overweight, 19.8% in normal weight. The distribution of BMI subgroups was similar in FBG subgroups (p = 0.447). There were significant positive correlations between age, and BMI or FBG (p = 0.021 and p = 0.002, respectively). Being older (? 40 years-old) was found to be a predictor for prediabetes (p = 0.010, Odds Ratio = 4.986). BMI was not a predictor for prediabetes (p = 0.151). Conclusions: Our results suggested that the prevalence of prediabetes was increased in patients on LT wait list. Age but not BMI seems to be a significant predictor of prediabetes.
