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Ertek S.,Sanliurfa Education and Research Hospital
Current Vascular Pharmacology | Year: 2014

Type 2 diabetes is characterized by insulin resistance together with progressive loss of beta-cell function. After recognition of gluco- and lipo-toxicity, attention was focused on the preservation and/or restoration of beta cell function, especially at the early stages of the diabetes, with better beta-cell reserve and in the absence of complications. Early treatment of glucotoxicity with insulin was searched by early insulin treatment studies, and these studies have some promising results, pointing the possibility of "remission" of diabetes in some patients. According to the results of these studies, patients with early diagnosis of diabetes, the ones with better beta cell reserve, patients with low tendency for "insulin-abuse" could make "U"-turn from insulin to pills or even drug-free life. Criteria to turn back to pills could be listed as disappearance of diabetic symptoms, daily insulin need < 0.25 unit/kg, euglycemia in both fasting and postprandial state, and better beta cell function. The main problems in early insulin treatment are the "insulin resistance" of both patients and doctors, hypoglycemia, weight gain and increased appetite. Meanwhile, hyperinsulinemia desensitizes receptors and causes worsening of situation in a vicious cycle of insulin resistance and hyperglycemia. Therefore, patients should be selected properly and U-turn could be performed in relevant conditions explained in the text. It could be possible to see early insulin treatment and U-turn strategies in future guidelines for type 2 diabetes. © 2014 Bentham Science Publishers.


Sivrikoz M.C.,Eskiehir Osmangazi University | Tulay C.M.,SanlIurfa Education and Research Hospital
Surgical and Radiologic Anatomy | Year: 2011

Purpose: Anatomical investigation is important for safer surgical procedures and to focus on aims. Pulmonary artery anatomy is very important point for thoracic surgery, especially in lobectomy procedure. Method: Between January 2005 and December 2008 at Eskişehir Osmangazi University Faculty of Medicine, Department of Thoracic Surgery, 85 right or left, upper, middle or lower lobectomy patients were included in this study who were operated because of various lung diseases which include bronchial carcinoma, inflammatory pseudotumor, bronchiectasis, carcinoid tumor of lung. Seventy-four male and 11 female patients were included in this study. Mean age of patients was 59 years. Results: Different types of variations were observed in 10 of 85 lobectomy cases; two types of variations could not be found in literature. Conclusion: The vascular anatomy of the lung and possible variations of the pulmonary artery should be well known by surgeon to prevent complications. The various branching pattern of the pulmonary arteries should be determined to prevent excessive and unnecessary resection with life-threatening bleeding. © 2011 Springer-Verlag.


Erten S.,Ataturk Education and Research Hospital | Kucuksahin O.,Ankara University | Sahin A.,Sanliurfa Education and Research Hospital | Altunoglu A.,Ataturk Education and Research Hospital | And 2 more authors.
Internal Medicine | Year: 2013

Objective The aim of the present study was to evaluate the plasma vitamin D (vit D) levels and their association with the disease activity in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) compared with healthy populations. Methods This study included 161 spondyloarthritis patients (113 uSpA patients and 48 AS patients) attending our rheumatology out-patient clinic, along with 92 controls. Results The plasma vit D levels were 18 μg/L (8-38) in the AS group, 20 μg/L (4-92.3) in the uSpA group and 24.3 μg/L (7.2-76.8) in the control group. The plasma vit D levels of the AS patients were significantly lower than those of the patients in the control group (p=0.004). The men in the AS group had significanly lower vit D levels than those in the control group (p=0.005). On the other hand, the women in the uSpA group had significanly lower vit D levels than those in the control group (p=0.011). The vit D levels were inversely related to both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the AS patients (p=0.002, R=-0.428; p<0.001, R=-0.592, respectively). This correlation was not demonstrated in the uSpA patients. The vit D levels were not found to correlate with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) levels in either the AS or uSpA patients. Conclusion 25-hydroxy-vit D deficiency is frequently observed in patients with SpAs. In this study, vit D deficiency was much more prominent in the male AS patients. On the other hand, among women, the uSpA patients exhibited much more prominent vit D deficiency than the control group subjects. The acute phase response may inversely affect the vit D levels in AS patients. © 2013 The Japanese Society of Internal Medicine.


Kose S.,Tepecik Education and Research Hospital | Olmezoglu A.,Ataturk Education and Research Hospital | Gozaydin A.,Sanliurfa Education and Research Hospital | Ece G.,Tepecik Education and Research Hospital
Journal of Health, Population and Nutrition | Year: 2011

Hepatitis B virus (HBV) is one of the public-health issues worldwide. Approximately two billion people are infected with HBV, and about 350 million people are chronic carriers globally. About 3% of the world population is infected with hepatitis C virus (HCV). Oncology patients receiving packed red blood cell suspensions and other blood products usually are in the high-risk group for infections due to these viruses. The aim of the study was to detect the seroprevalence of hepatitis B and hepatitis C among chemotherapy patients at the Oncology Department of the Tepecik Education and Research Hospital. HBsAg, anti-HBs, anti-HBcIgM, anti-HBc total and anti-HCV assays were studied by enzyme immunoassay method (Diasorin, Italy) in serum samples of patients (n=448) referred to the Department of Oncology of the Tepecik Education and Research Hospital during 1 June 2006-1 January 2007. Of the 448 patients, 19 (4.2%) were HBsAg-positive, and three (0.7%) had anti-HCV positivity. In this study, the seroprevalence of HBV was similar to previous data in Turkey. This could be due to widespread vaccination programmes. The seroprevalence of low anti-HCV may be because of controlled blood transfusion. Oncology patients should be monitored for their protective antibody levels against HBV, and they must be included in the vaccination programme. Their anti-HCV status should also be checked as well. © International Centre for Diarrhoeal Disease Research, Bangladesh.


Erten S.,Ataturk Education and Research Hospital | Sahin A.,Sanliurfa Education and Research Hospital | Altunoglu A.,Ataturk Education and Research Hospital | Gemcioglu E.,Ataturk Education and Research Hospital | Koca C.,Ataturk Education and Research Hospital
International Journal of Rheumatic Diseases | Year: 2015

Aim: Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by chronic inflammation of the salivary and lacrimal glands. There is increasing evidence indicating that vitamin D is important in the initiation and propogation of a range of autoimmune diseases which may include SS. The aim of the present study was to evaluate plasma vitamin D (vit D) levels in patients with SS and to compare this with a control group. Method: One hundred and seven SS patients (97 [90.7%] female and 10 [9.3%] male) and 74 healthy controls (64 [86.5%] female and 10 [13.5%] male) were included into the study. Plasma baseline 25-hydroxy-vit D levels were measured by high-powered liquid chromatography method using an Agilent 1100 liquid chromatograph. Results: Plasma vit D levels in SS patients (20.5 ± 10.5 μg/L) were significantly lower than in the control group (28.4 ± 15.2 μg/L) (P < 0.001). Female SS patients had significanly lower vit D levels (19.3 ± 9.3 μg/L) than controls (28.3 ± 15.8 μg/L) (P < 0.001) but this difference was not present among the male patients and controls. There was no correlation between plasma vit D levels and erythrocyte sedimentation rate and C-reactive protein in SS patients. Conclusion: Vit D deficiency was frequent in patients with SS. In particular, female SS patients had the risk of vit D deficiency. It may be convenient to look for vit D deficiency and to correct vit D nutritional status in SS patients. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.


Uslu A.U.,Cumhuriyet University | Kucuk A.,University of Konya | Sahin A.,Cumhuriyet University | Ugan Y.,Sanliurfa Education and Research Hospital | And 4 more authors.
International Journal of Rheumatic Diseases | Year: 2015

Aim: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease with unknown etiology and systemic involvement. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are two new inflammatory markers used in the assessment of systemic inflammation. The aim here is to study NLR and PLR in patients with RA to investigate their relation with Disease Activity Score of 28 joints (DAS-28). Methods: The study included 104 patients with RA and a control group of 51 age- and gender-matched healthy subjects. We divided the patients into two groups according to the DAS-28 score. Group 1 included patients with a score of lower than 2.6 by the DAS-28 (patients in remission) and Group 2 included patients with a score of 2.6 and higher (patients with active disease). Results: NLR was 2.12 ± 0.83 in the patient group and 1.58 ± 0.57 in the control group. PLR was 136.50 ± 53.52 in the patient group and 114.84 ± 29.41 in the control group. There was a statistically significant difference in NLR and PLR between the patient and control groups (P ≤ 0.0001 and P = 0.001, respectively). Patients in Group 1 had an NLR of 1.84 ± 0.61 and a PLR of 119.25 ± 41.77. Patients in Group 2 had an NLR of 2.29 ± 0.90 and a PLR of 147.28 ± 56.96. There was a statistically significant difference in NLR and PLR between the two groups (P = 0.003 and P = 0.005 respectively). A correlation was observed between NLR and PLR by DAS-28 (r = 0.345, P ≤ 0.0001 and r = 0.352, P ≤ 0.0001, respectively). Conclusions: The present study showed us that NLR and PLR were two new inflammatory markers which could be used to assess disease activity in patients with RA. International Journal of Rheumatic Diseases © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.


Cicero A.F.,University of Bologna | Tartagni E.,University of Bologna | Ertek S.,Sanliurfa Education and Research Hospital
Current Vascular Pharmacology | Year: 2014

Metabolic syndrome (MetS) is a world-wide epidemic disease associated with increased morbidity and mortality. Treatment strategies include pharmacologic and non-pharmacologic methods, with varying degrees of success rate all over the world. Pharmaceutical interest in this field is growing, together with patients' requests for supplementary (or "alternative") treatments. The knowledge of nutraceuticals beneficial effects in subjects with the MetS could help us to better define the appropriate treatment for these subjects, in particular those with contraindications for commonly used drugs, or to achieve guidelines suggested targets. On the other side, it could be not convenient to use a nutraceutical to treat each metabolic syndrome component (i.e. from 3 to 5) in each affected subjects. Thus, this review tries to focus on widely marketed nutraceuticals with clinically demonstrated effects on more than one component of the MetS, namely omega-3 fatty acids, berberine, psyllium and other soluble fibers, cinnamon, chromium picolinate, banaba, and bitter gourd. © 2014 Bentham Science Publishers.


Kose S.,Tepecik Education and Research Hospital | Ece G.,Tepecik Education and Research Hospital | Gozaydin A.,Sanliurfa Education and Research Hospital | Turken M.,Tepecik Education and Research Hospital
Journal of Infection in Developing Countries | Year: 2012

Introduction: Hepatitis delta virus (HDV) is an incomplete virus dependent on hepatitis B virus (HBV) for its multiplication. It can infect individuals with active HBV infection and cause severe liver disease. It is less prevalent than hepatitis B virus, but it causes more serious clinical pictures. In this study we investigated anti-HDV seroprevalance and epidemiological features among HBsAg seropositive outclinic patients at Izmir Tepecik Educational and Research Hospital. Methodology: Serum samples collected from outpatients at Izmir Tepecik Educational and Research Hospital between 1 September 2007 and 30 August 2009 were evaluated. Anti-HDV assay was performed by enzyme immunoassay (EIA). Patients over the age of fourteen who were referred to our hospital were taken into the study. Results: Out of 3,094 HBsAg positive patients, 79 (2.5%) had anti-HDV IgG seroprevalance. Of these 79 patients, 42 were hepatitis B carriers, 34 had chronic hepatitis B, two had liver cirrhosis, and one had hepatocellular carcinoma. Conclusion: Although superinfection and co-infection of HDV are less prevalent than hepatitis B infection, the prognosis is worse as the response to therapy is poor; therefore, patients with hepatitis B should be evaluated further for HDV infection. © 2012 Kose et al.


Kose S.,Tepecik Education and Research Hospital | Gozaydin A.,Sanliurfa Education and Research Hospital | Akkoclu G.,Tepecik Education and Research Hospital | Ece G.,Tepecik Education and Research Hospital
Journal of Infection in Developing Countries | Year: 2012

Interferon alpha is a molecule frequently used in the treatment of chronic hepatitis B, C, and D, with immunomodulatory and antiviral activity. It is also used in some cancer types. It has been widely claimed that interferon alpha triggers autoimmunity, with its broad adverse effect profile. Here we present the case of a 29-year-old male patient with chronic hepatitis B diagnosis who developed type 1 diabetes mellitus and autoimmune thyroiditis during treatment with interferon alfa-2b. Within four months of initiation of treatment with interferon alfa-2b, the patient presented to our clinic with dry mouth, urinary frequency (8 to 10 times per day), drinking plenty of water, night time urination, and tiredness. He was admitted to the clinic when his fasting blood glucose level was detected to be high. After examinations, the patient was diagnosed with type 1 diabetes and autoimmune thyroiditis and began to receive treatment with insulin and propranolol. Fasting blood glucose levels were controlled and thyroid hormones decreased to normal levels within one month after the treatments began. For patients who will receive treatment with interferon alpha, especially those individuals with chronic hepatitis, pancreatic autoantibodies should be checked and close monitoring should be performed as there may be glucose tolerance impairment in patients with high titers. In addition, follow-up with thyroid function tests should be performed prior to and during the treatment. © 2012 Kose et al.


Tulay C.M.,Sanliurfa Education and Research Hospital
Annals of Thoracic and Cardiovascular Surgery | Year: 2014

Purpose: Hydatid disease is endemic in many parts of the world. Mediastinal hydatidosis is seen less than 0.1% of all hydatid diseases. We want to report our primary mediastinal hydatid cysts. Materials and Methods: In this retrospective study, from January 2010 to December 2012, 158 patients with intrathoracic hydatid cysts were operated in our thoracic surgery clinic. Nine of 158 (5.69%) patients had mediastinal hydatid cyst. Chest X-ray and computed tomography (CT) were used as diagnostic tools. Results: Hydatid cyst was confrmed surgically and pathologically in all the patients. Anterior mediastinal hydatid cysts and one cardiac involvement were determined in our study. While total cyst excision was performed in seven patients, partial pericystectomy could be done in two patients. In one patient, left ventricle invasion was seen and it was totally excised. Postoperative albendazole was applied to patients and there was no recurrence of disease till now. Conclusions: Mediastinal hydatid cysts are uncommon and should be kept in mind in differential diagnosis of mediastinal cystic lesions especially in endemic regions. Surgical resection must be done and then medical therapy is needed to prevent recurrence. ©2014 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.

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