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Topal M, Erkus E. Improving sleep quality is essential for enhancing soluble Klotho levels in hemodialysis patients. Int Urol Nephrol 2023; 55:3275-3280. [PMID: 37382769 DOI: 10.1007/s11255-023-03693-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Sleep and Klotho seem to share common physiological pathways in aging. However, studies investigating this relationship are very few and none of them was done with a specific patient group. The aim of this study was to investigate the association of sleep quality and soluble Klotho levels in hemodialysis patients. METHODS 100 hemodialysis patients were included in this study. Soluble Klotho levels were obtained from each patient and Pittsburgh Sleep Quality Index was performed by all patients. Association of soluble Klotho with sleep quality was calculated. RESULTS Soluble Klotho levels were significantly inversely correlated with total sleep quality score (p < 0.001, r = - 0.444). Among the subscales, soluble Klotho levels were negatively correlated with subjective sleep quality (p < 0.001, r = - 0.365), sleep latency (p = 0.002, r = - 0.312), sleep disturbance (p = 0.002, r = - 0.303) and daytime dysfunction (p = 0.027, r = - 0.221). Patients who had good sleep quality scores were found to have higher soluble Klotho levels [4.15 (0.05-22.68) vs. 1.14 (0.32-17.63), p < 0.001]. In regression analysis, total sleep quality score, subjective sleep quality and age were found to be independent negative factors for soluble Klotho levels. CONCLUSION In this study, a significant association between sleep quality and soluble Klotho levels was revealed in hemodialysis patients. Improving sleep quality will lead to increased soluble Klotho levels, which may further slow down the aging process in hemodialysis patients.
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Affiliation(s)
- Mustafa Topal
- Clinic of Nephrology, Konya City Hospital, University of Health Sciences, Akabe Mahallesi Adana Çevreyolu Caddesi No: 135/1, 42020, Konya, Turkey.
| | - Edip Erkus
- Clinic of Nephrology, Konya City Hospital, University of Health Sciences, Akabe Mahallesi Adana Çevreyolu Caddesi No: 135/1, 42020, Konya, Turkey
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Ozkan Kurtgoz P, Karakose S, Cetinkaya CD, Erkus E, Guney I. Evaluation of sirtuin 1 (SIRT1) levels in autosomal dominant polycystic kidney disease. Int Urol Nephrol 2021; 54:131-135. [PMID: 33864594 DOI: 10.1007/s11255-021-02862-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/11/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and the majority of patients have a PKD-1 or PKD-2 mutation. Sirtuin 1 (SIRT1) has roles in cellular aging, antioxidant activity, cellular proliferation. In an experimental study, inhibition of SIRT1 was found to delay renal cyst development in ADPKD. The purpose of this study is to determine the SIRT1 levels in ADPKD patients. To our knowledge, this is the first study that investigating blood and urine SIRT1 levels in ADPKD patients. METHODS Sixty-seven patients with ADPKD and 34 control cases with normal renal functions and without renal cysts were included in this study. Serum and urine SIRT1 concentrations were determined by human enzyme-linked immunosorbent assay (ELISA) kit. 24-h urine samples were used for urine SIRT1 measurements. RESULTS The urine SIRT1 levels were statistically significantly lower in ADPKD patients group (p < 0.001). Although blood SIRT1 levels of ADPKD patients were higher than control cases but there were no statistically significant difference between the groups in terms of blood SIRT1 levels. Urine SIRT1 levels (β = 2.452, CI 95% 1.419-4.239, p = 0.001) were found an independent factor in multivariate regression analysis for ADPKD. CONCLUSIONS Urine SIRT1 levels were lower in ADPKD patients than control group. The low urinary SIRT1 levels despite the similar blood SIRT1 levels might be due to the impaired metabolism of SIRT1 in ADPKD patients; this state might has a role in cyst development.
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Affiliation(s)
- Pervin Ozkan Kurtgoz
- Division of Nephrology, Department of Internal Medicine, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey.
| | - Suleyman Karakose
- Division of Nephrology, Department of Internal Medicine, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Cigdem Damla Cetinkaya
- Department of Medical Biochemistry, Konya Training and Research Hospital, University of Health Sciences Turkey, Konya, Turkey
| | - Edip Erkus
- Division of Nephrology, Department of Internal Medicine, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
| | - Ibrahim Guney
- Division of Nephrology, Department of Internal Medicine, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
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Karakose S, Ozkan Kurtgoz P, Deniz CD, Erkus E, Guney I. Is There a Role of ADAMTS-1 in Cyst Development in Autosomal Dominant Polycystic Kidney Disease? Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Erkus E, Buyukterzı Z, Karakose S, Kurku H, Kurtgoz PO, Topal M, Guney I. The relationship of soluble klotho level with uremic cardiomyopathy and ecocardiographic parameters in hemodialysis patients. Semin Dial 2020; 34:157-162. [PMID: 33252840 DOI: 10.1111/sdi.12942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There are studies reporting that soluble kltho (sKlotho) deficiency plays a role in cardiovascular disease in addition to traditional risk factors such as diabetes, hypertension, anemia, smoking, and excessive volume burden. Our aim in this study was to investigate the relationship of sKlotho with uremic cardiomyopathy and echocardiographic parameters in patients receiving hemodialysis treatment. According to the median value, the sKlotho value was divided into two groups as ≥1.24 and <1.24 ng/ml. Ventricular wall thicknesses, ejection fractions, left atrium, M mode aorta systole, and diastole diameter measurements were taken. The left ventricular mass (LVM) was calculated using the Devereux formula. There were significant differences between the two groups in terms of age, number of patients with diabetes mellitus, comorbidity, dialysis time, sKlotho, phosphorus, parathormone, and albumin parameters. No significant difference was found between the two groups that were separated according to the median sKlotho value, when the echocardiographic parameters of interventricular septum thickness, left ventricular posterior wall thickness, left atrial diameter, left ventricular ejection fraction, and LVM index were compared. In conclusion, sKlotho is not a marker for showing and predicting uremic cardiomyopathy in hemodialysis patients.
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Affiliation(s)
- Edip Erkus
- Nephrology Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Zafer Buyukterzı
- Cardiology Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Suleyman Karakose
- Nephrology Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Huseyın Kurku
- Bıochemıstry Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Pervın O Kurtgoz
- Nephrology Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Mustafa Topal
- Nephrology Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
| | - Ibrahim Guney
- Nephrology Department, University of Health Sciences, Konya Research and Training Hospital, Konya, Turkey
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Kocak MZ, Aktas G, Atak BM, Duman TT, Yis OM, Erkus E, Savli H. Is Neuregulin-4 a predictive marker of microvascular complications in type 2 diabetes mellitus? Eur J Clin Invest 2020; 50:e13206. [PMID: 31999832 DOI: 10.1111/eci.13206] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/04/2019] [Accepted: 01/25/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Neuregulin-4 (Nrg-4) is a new adipokine released from brown adipose tissue. It plays pivotal role in regulating systemic energy balance, glucose and lipid metabolism and in reducing chronic inflammation. We aimed to investigate the relation between diabetic microvascular complications (DMC) and serum (Nrg-4) levels in patients with type 2 diabetes mellitus. METHODS Patients with type 2 diabetes mellitus were divided into DMC and diabetic patients without microvascular complications (non-DMC). Nrg-4 levels of the patients were compared. RESULTS Fifty and 29 patients enrolled to the DMC and non-DMC groups, respectively. Nrg-4 was 1.23 (0.02-5.1) ng/mL and 2.5 (0.21-6.01) ng/mL in DMC and in non-DMC groups, respectively (P < .001). In patients with DMC, FPG was 189.5 (89-446) mg/ dL, whereas it was 128 (95-278) mg/dL in non-DMC diabetic patients (P < .001). HbA1c was also significantly higher in the DMC group than in the non-DMC group (P < .001). Negative correlation was found between Nrg-4 and FPG (r = -0.231, P = .03), HBA1c (r = -0.312, P = .003) and microalbuminuria (r = -0.277, P = .009). Logistic regression analysis showed a 1-unit decrease in Nrg-4 to increase the presence of DMC by 1.9 times. The best cut-off value of Nrg-4 was 1.56 ng/mL with 82.1% sensitivity and 64% specificity, in predicting DMC. CONCLUSION In patients with diabetes, Nrg-4 levels may be a good predictor of early detection of one or more DMC, as microvascular dysfunction in an organ system is considered to be an initial onset of subclinical systemic damage.
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Affiliation(s)
- Mehmet Zahid Kocak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Burcin M Atak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Tuba T Duman
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Ozgur Mehmet Yis
- Department of Medical Biochemistry, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Kocak MZ, Aktas G, Erkus E, Yis OM, Duman TT, Atak BM, Savli H. Neuregulin-4 is associated with plasma glucose and increased risk of type 2 diabetes mellitus. Swiss Med Wkly 2019; 149:w20139. [PMID: 31656034 DOI: 10.4414/smw.2019.20139] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neuregulin-4 is a cytokine with many functions and is primarily produced by fat tissue. AIM OF THE STUDY The aim of the study was to observe the relationship between serum neuregulin-4 levels and diabetes regulation in type 2 diabetes mellitus (T2DM), and to compare neuregulin-4 levels of diabetic subjects with those in healthy controls. METHODS Patients with T2DM were included to the study. Healthy subjects were enrolled as controls. Subjects with T2DM with glycated haemoglobin (HbA1c) <7% were classed as well controlled and those with HbA1c >7% were classed as poorly controlled. Neuregulin-4 levels of the study and control groups were compared. RESULTS The neuregulin-4 levels of the poorly controlled T2DM, well-controlled T2DM and control groups were significantly different (p = 0.005). Neuregulin-4 was significantly correlated with fasting plasma glucose (r = 0.247, p = 0.002) but not with HbA1c. In a regression analysis model, 0.1 point elevation in neuregulin-4 levels increased the rate of existence of T2DM 4.4-fold (odds ratio 4.4, 95% confidence interval 1.26-15.1; p = 0.02). CONCLUSION Neuregulin-4 is significantly increased in patients with T2DM compared with control subjects, which means that it could be a marker of T2DM. Since neuregulin-4 was correlated with fasting glucose, we suggest that elevated neuregulin-4 could predict poor control in T2DM for short periods when HbA1c is not useful. Moreover, one unit elevation in neuregulin-4 (0.1 ng/ml) increases the rate of existence of T2DM 4.4-fold, independently from other variables.
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Affiliation(s)
- Mehmet Z Kocak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Ozgur M Yis
- Department of Medical Biochemistry, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Tuba T Duman
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Burcin M Atak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Abstract
BACKGROUND Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. METHODS We studied a peripheral blood smear and repeated the hemogram test at 37°C to establish the diagnosis of cold agglutinin disease. RESULTS Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/µL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37°C and the test results showed RBC: 3.4 M/µL, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. CONCLUSIONS Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.
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Abstract
Physicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.
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Affiliation(s)
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
| | - Bahri Ozer
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
| | - Mehmet Zahid Kocak
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
| | - Edip Erkus
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
| | - Hayri Erkol
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
| | - Semih Yaman
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
| | - Haluk Savli
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Golkoy, Bolu, Turkey
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Kocak MZ, Aktas G, Erkus E, Sincer I, Atak B, Duman T. Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus. ACTA ACUST UNITED AC 2019; 65:9-15. [PMID: 30758414 DOI: 10.1590/1806-9282.65.1.9] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/20/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Metabolic syndrome (MS) is a clinical entity that associated with increased risk of type 2 Diabetes Mellitus (DM) and cardiovascular diseases. Serum uric acid levels are correlated MS criteria. We hypothesized whether a uric acid to HDL-cholesterol ratio (UHR) could predict diabetic regulation and presence of MS in type 2 diabetic subjects. METHODS Admissions of the subjects with type 2 DM to outpatient clinics of our institution were retrospectively analyzed. Study population grouped into well-controlled and poorly controlled diabetics according to the HbA1c level (cut off 7%) and further grouped into type 2 DM with and without MS according to the presence of MS. UHR of study groups compared. RESULTS A hundred diabetic subjects enrolled. Mean UHR was significantly lower in well-controlled diabetics (9.7 ± 3.7%) compared to poorly controlled subjects (14 ± 5.4%) (p<0.001). Median UHR of diabetics with MS (13 (6-29) %) was greater than that of the diabetics without MS (9 (3-16) %) (p<0.001). UHR greater than 11% has 77% sensitivity and 60% specifity in predicting worse diabetic control (AUC: 0.752, p<0.001) and a UHR greater than 10.6% has 83% sensitivity and 71% specifity in predicting MS (AUC: 0.839, p<0.001). Sensitivity and specifity of UHR in predicting MS were better than most of the sensitivities and specifities of the five criteria of MS. CONCLUSION We suggest utilization of UHR in diagnosis of MS as a novel criteria. Nevertheless, prospective studies with larger population may make a better scientific evidence in that issue.
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Affiliation(s)
- M Zahid Kocak
- Abant Izzet Baysal University, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Gulali Aktas
- Abant Izzet Baysal University, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Edip Erkus
- Abant Izzet Baysal University, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Isa Sincer
- Abant Izzet Baysal University, Faculty of Medicine, Department of Cardiology, Bolu, Turkey
| | - Burcin Atak
- Abant Izzet Baysal University, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Tuba Duman
- Abant Izzet Baysal University, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
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Atak B, Aktas G, Duman TT, Erkus E, Kocak MZ, Savli H. Diabetes control could through platelet-to-lymphocyte ratio in hemograms. ACTA ACUST UNITED AC 2019; 65:38-42. [PMID: 30758418 DOI: 10.1590/1806-9282.65.1.38] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.
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Affiliation(s)
- Burcin Atak
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Tuba T Duman
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Edip Erkus
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - M Zahid Kocak
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Haluk Savli
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
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Erkus E, Aktas G, Kocak MZ, Duman TT, Atak BM, Savli H. Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels. ACTA ACUST UNITED AC 2019; 65:51-55. [PMID: 30758420 DOI: 10.1590/1806-9282.65.1.51] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.
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Affiliation(s)
- Edip Erkus
- Abant Izzet Baysal University Hospital, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - M Zahid Kocak
- Abant Izzet Baysal University Hospital, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Tuba T Duman
- Abant Izzet Baysal University Hospital, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Burcin M Atak
- Abant Izzet Baysal University Hospital, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
| | - Haluk Savli
- Abant Izzet Baysal University Hospital, Faculty of Medicine, Department of Internal Medicine, Bolu, Turkey
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Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, Savli H. Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci 2019; 19:1602-1606. [PMID: 31148989 PMCID: PMC6531946 DOI: 10.4314/ahs.v19i1.35] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Type 2 diabetes mellitus is associated with chronic low grade inflammation. One of the novel inflammatory markers is hemogram derived neutrophil to lymphocyte ratio (NLR). Objective We aimed to compare NLR levels of diabetic subjects and healthy controls and to observe possible correlation between NLR and HbA1c. Methods Medical data of type 2 diabetic subjects admitted to out-patient clinics of our institution between April to July in 2017 were obtained from database and retrospectively analyzed. Control group was chosen from healthy subjects who visited our institution for a routine check-up. Anthropometric measures, laboratory data, including, HbA1c, NLR were recorded. Results Median NLR of the type 2 DM group 2.44 (1.9) was significantly elevated when compared to healthy controls (1.5 (0.9), (p<0.001). In addition, a Pearson's correlation test revealed that NLR was strongly correlated with age (r=0.26, p=0.008), fasting plasma glucose (r=0.38, p<0.001), and HbA1c (r=0.49, p<0.001). Conclusion Elevated NLR in otherwise healthy subjects may be indicative of underlying impaired glucose metabolism and moreover, NLR should be used as a marker of diabetic control level in addition to HbA1c in type 2 diabetic subjects.
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Affiliation(s)
- Tuba T Duman
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Burcin M Atak
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Mehmet Z Kocak
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Edip Erkus
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Haluk Savli
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
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Kocak MZ, Aktas G, Erkus E, Duman TT, Atak BM, Savli H. Mean Platelet Volume to Lymphocyte Ratio as a Novel Marker for Diabetic Nephropathy. J Coll Physicians Surg Pak 2019; 28:844-847. [PMID: 30369376 DOI: 10.29271/jcpsp.2018.11.844] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/18/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare mean platelet volume to lymphocyte ratio (MPVLR) of diabetic nephropathy subjects to those diabetics without diabetic nephropathy. STUDY DESIGN Observational, cross-sectional study. PLACE AND DURATION OF STUDY Tertiary referral hospital, in Bolu, Turkey, from July to December 2017. METHODOLOGY Patients with type 2 diabetes mellitus admitted to the Internal Medicine Clinic, were included. Patients were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. MPVLR was calculated mathematically by division of MPV by lymphocyte count. RESULTS There were 162 subjects (79 females, 83 males). The MPVLR in patients with diabetic nephropathy and non- nephropathic diabetic groups were 4.1 (2.09-11.84) and 3.4 (1.37-25.56), respectively. The difference was reached statistically significant level (p <0.001). The best cut-off value for MPVLR was 3.66 (AUC=0.733, p <0.001); MPVLR predicted diabetic nephropathy with 71.1% sensitivity and 67.4% specificity, at this level. CONCLUSION The MPVLR is an easily calculated and efficient index that can be considered a powerful and independent predictor of diabetic nephropathy in diabetic patients. We suggest that, it can be useful adjunct to standard tests in the diagnosis of diabetic nephropathy.
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Affiliation(s)
- Mehmet Zahid Kocak
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Tuba T Duman
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Burcin M Atak
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
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Atik F, Aktas G, Kocak MZ, Erkus E, Savli H. Analysis of the Factors Related to the Blood Pressure Control in Hypertension. J Coll Physicians Surg Pak 2018; 28:423-426. [PMID: 29848415 DOI: 10.29271/jcpsp.2018.06.423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/09/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the factors associated with blood pressure control and comparing anthropometric and clinical parameters of subjects with well-controlled hypertension to those with poorly controlled blood pressure. STUDY DESIGN Observational cross-sectional study. PLACE AND DURATION OF STUDY Abant Izzet Baysal University Hospital, Bolu, Turkey, from January to June 2016. METHODOLOGY Medical data obtained and recorded from computerised database and case files of our clinic. Subjects with mean blood pressure above target levels were defined as poorly controlled and others were as well-controlled hypertension group according to JNC VIII. RESULTS Out of 342 subjects, only 116 (33.9%) were aware of normal blood pressure range. The number of patients who had a blood pressure on goal in the group and knew the normal range of blood pressure was significantly higher than the patients in group who did not know the normal range of blood pressure. Body mass index and waist circumference were both significantly higher in poorly controlled compared to well-controlled hypertensive subjects. Treatment compliance was significantly associated with better control of hypertension. CONCLUSION Striking results of present study indicate that lower body mass index and lesser waist circumference along with treatment compliance and awareness of normal blood pressure ranges are important factors that affect reaching treatment targets in hypertensive subjects.
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Affiliation(s)
- Fatih Atik
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Mehmet Zahid Kocak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Aktas G, Kocak MZ, Taslamacioglu Duman T, Erkus E, Atak BM, Sit M, Savli H. Mean Platelet Volume (MPV) as an inflammatory marker in type 2 diabetes mellitus and obesity. Bali Med J 2018. [DOI: 10.15562/bmj.v7i3.806] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Erkus E, Aktas G, Atak BM, Kocak MZ, Duman TT, Savli H. Haemogram Parameters in Vitamin D Deficiency. J Coll Physicians Surg Pak 2018; 28:779-782. [PMID: 30266124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study haemogram derived inflammatory indices, mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) in vitamin D deficient patients and to compare to those subjects with normal vitamin D levels. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Abant Izzet Baysal University Hospital, Bolu, Turkey, from March to May 2017. METHODOLOGY Patients' data visiting the outpatient clinics of the institution was retrospectively obtained from patients' files and computerised database. Subjects were grouped into normal vitamin D and vitamin D deficiency groups, according to the serum Vitamin D levels. Seasonal threshold value for vitamin D in Bolu region was set as 10 ng/ml. General characteristics and laboratory data of the study population were recorded and compared. RESULTS Vitamin D deficiency was more common in subjects working inside as compared to those working outside (p=0.02), and in subjects with comorbidities compared to those without comorbidities (p=0.31). Body mass index (BMI), MPV, NLR were significantly higher in vitamin D deficient group as compared to subjects with normal vitamin D levels. A MPV greater than 6.22 has 89% sensitivity and 55% specifity for vitamin D deficiency, and NLR greater than 1.69 has 76% sensitivity and 55% specifity for vitamin D deficiency. CONCLUSION Elevated MPV and NLR may be the indicator of underlying serious vitamin D deficiency. Physicians should be alert and order a vitamin D assay in patients with elevated MPV or NLR, especially in endemic areas for vitamin D deficiency.
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Affiliation(s)
- Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Burcin Meryem Atak
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Mehmet Zahid Kocak
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Tuba T Duman
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal (AIB) University Hospital, Bolu, Turkey
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Atak B, Aktas G, Kocak MZ, Duman T, Erkus E, Gurel K, Savli H. A Case of Secondary Hypertension due to Giant Hydatid Cyst. J Coll Physicians Surg Pak 2018; 28:801-803. [PMID: 30266129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
Hydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis.
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Affiliation(s)
- Burcin Atak
- Department of Internal Medicine, Abant Izzet Baysal University (AIB), Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal University (AIB), Bolu, Turkey
| | - M Zahid Kocak
- Department of Internal Medicine, Abant Izzet Baysal University (AIB), Bolu, Turkey
| | - Tuba Duman
- Department of Internal Medicine, Abant Izzet Baysal University (AIB), Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal University (AIB), Bolu, Turkey
| | - Kamil Gurel
- Department of Radiology, Abant Izzet Baysal University (AIB), Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal University (AIB), Bolu, Turkey
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Kocak MZ, Aktas G, Erkus E, Taslamacioglu Duman T, Atak BM, Savli H. ANALYSIS OF THE TYPE 2 DIABETIC PATIENTS FOLLOWED IN A UNIVERSITY CLINIC. Konuralp Tıp Dergisi 2018. [DOI: 10.18521/ktd.345149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Atak BM, Erkus E, Duman TT, Kocak MZ, Kosekli MA. Mean Platelet volume to platelet and red cell distribution width to platelet ratios in Irritable Bowel Syndrome. ACTA ACUST UNITED AC 2018. [DOI: 10.30714/j-ebr.2018237498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kocak MZ, Aktas G, Erkus E, Duman TT, Atak BM, Sahin D, Savli H. A Case of Sitagliptin-Induced Mild Acute Pancreatitis. J Coll Physicians Surg Pak 2018; 28:334. [PMID: 29615184 DOI: 10.29271/jcpsp.2018.04.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Mehmet Zahid Kocak
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
| | - Tuba T Duman
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
| | - Burcin M Atak
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
| | - Deniz Sahin
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal (AIB) Universty, Bolu, Turkey
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Kocak MZ, Aktas G, Erkus E, Atak B, Duman T, Savli H. Superior Vena Cava Syndrome and Multiple Venous Thrombosis in a Patient with B Cell Lymphoma. amj 2018. [DOI: 10.15850/amj.v5n1.1202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E, Savli H. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis. Rev Assoc Med Bras (1992) 2017; 63:1065-1068. [PMID: 29489971 DOI: 10.1590/1806-9282.63.12.1065] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Mustafa Sit
- Abant Izzet Baysal University Hospital, Turkey
| | | | - Hayri Erkol
- Abant Izzet Baysal University Hospital, Turkey
| | | | - Edip Erkus
- Abant Izzet Baysal University Hospital, Turkey
| | - Haluk Savli
- Abant Izzet Baysal University Hospital, Turkey
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Aktas G, Sit M, Karagoz I, Erkus E, Ozer B, Kocak MZ, Yaman S, Keyif F, Altinordu R, Erkol H, Savli H. Could Red Cell Distribution Width be a Marker of Thyroid Cancer? J Coll Physicians Surg Pak 2017; 27:556-558. [PMID: 29017671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study red cell distribution width (RDW) values, a novel inflammatory marker in routine hemogram, of patients with benign or malignant thyroid nodules and to compare with healthy population. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Abant Izzet Baysal University Hospital, Bolu, Turkey, from November 2015 and February 2017. METHODOLOGY The hemogram values of patients undergone thyroid surgery for thyroid nodule between November 2015 and February 2017 were retrospectively analyzed, and compared to those in healthy subjects. Subjects with infectious or inflammatory diseases were excluded. Patients' characteristics and laboratory data were obtained from institutional computerized database. Preoperative hemogram values of thyroid nodule patients were recorded. One-way ANOVAand Kruskal-Wallis tests were performed to compare variables with significance at p<0.05. RESULTS Median RDW of malignant nodule group was 15.8 (12.9-19.5) and was significantly higher than both of those in benign nodule (15) and control groups (14), (p<0.001). CONCLUSION Elevated RDW in patients with thyroid nodules in preoperative period should alert the physician for possible malignancy and this cost-effective marker also can help support other modalities (ultrasound scan, and fine needle aspiration biopsy) to distinguish malignant from benign nodules.
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Affiliation(s)
- Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Mustafa Sit
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Ibrahim Karagoz
- Department of Anesthesiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Edip Erkus
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Bahri Ozer
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Mehmet Zahid Kocak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Semih Yaman
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Fatih Keyif
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Rabia Altinordu
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Hayri Erkol
- Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Haluk Savli
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Acar Z, Aga MT, Kiris A, Korkmaz L, Erkan H, Erkus E, Akyz AR, Celik S. Mean platelet volume on admission is associated with further left ventricular functions in primary PTCA patients. Eur Rev Med Pharmacol Sci 2012; 16:1567-1569. [PMID: 23111972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM In ST elevation myocardial infarction (STEMI) patients, mean platelet volume (MPV) is associated with infarct related artery patency both before and after reperfusion. In anterior STEMI patients successfully treated with primary percutaneous coronary intervention (PCI), the relationship between left ventricular (LV) function and MPV on admission is unknown. METHODS 97 anterior STEMI patients successfully revascularizated with PCI between January 2010 and February 2011 are included. MPV on admission is recorded. All patients underwent transthoracic echocardiography within 3 days or before discharge. Patients were divided into two groups according to left ventricular ejection fraction (LVEF), as systolic dysfunction (LVEF < 50%, 1st group) and normal systolic functions (LVEF > 50%, 2nd group). The 1st group included 61 (47 males) patients and the 2nd group included 36 (35 males) patients. RESULTS MPV was; 9.5+/-1.1 femtoliter (fL) in the 1st and 8.8+/-0.8 fL in the second group. The difference between the groups was significant (p = 0.001). There was a significant difference in the Troponin I levels and white blood cell (WBC) counts on admission between two groups (30+/-29 vs 12.2+/-15.1 ng/mL, p = 0.001 and 12.3+/-3.8 vs 10.6+/-3.4 counts ×109/L, p = 0.027, respectively). CONCLUSIONS In anterior STEMI patients treated with percutaneous coronary intervention, increased MPV on admission is associated with impairment in left ventricular systolic function.
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Affiliation(s)
- Z Acar
- Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey.
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