Adnan Gokcel

Evaluation of the safety and efficacy of sibutramine, orlistat and metformin in the treatment of obesity

Aim: Some of our obese patients who were receiving 10 mg/day sibutramine reported feeling hunger at night. To address this, we designed a randomized, prospective clinical trial to study the efficacy and safety of 10 mg sibutramine twice daily (bid), and compare this treatment with 120 mg orlistat three times daily (tid) and 850 mg metformin (bid).

Age as a predictor of hyperphosphatemia after oral phosphosoda administration for colon preparation

Background and Aim:  It has been reported that oral phosphosoda (OPS), commonly used in bowel cleansing, may cause complications such as hyperphosphatemia and hypocalcemia. This has been observed in patients with normal kidney function and in those with renal insufficiency. Few controlled studies have been performed with respect to age on healthy subjects after OPS administration.

Silent coronary artery disease in patients with type 2 diabetes mellitus.

Abstract.The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of ≥70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187–13.659), hypertension (OR=5.564; 95% CI, 1.446–21.400) and retinopathy (OR=3.766; 95% CI, 1.096–12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.

Detection of insulin resistance in Turkish adults: a hospital‐based study

Aim: The aim of the present study was to investigate the usefulness of insulin sensitivity check indices in our hospital population.

Intima-media thickness of the carotid arteries is related to serum osteoprotegerin levels in healthy postmenopausal women

Abstract Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and also plays a role in vascular calcification. The objective of this study was to evaluate the relationship between serum OPG levels, and carotid artery intima-media thickness (IMT) and carotid plaque formation in healthy postmenopausal women. We recruited 68 healthy postmenopausal women for the study. Carotid plaque presence and IMT were evaluated by high resolution B-mode ultrasound. IMT was positively correlated with presence of plaque, age, menopause age and OPG, and inversely correlated with Apolipoprotein A1 (Apo A1). Serum OPG level was positively correlated with IMT (r = 0.366; p < 0.003) and age (r = 0.324; p < 0.008), and negatively correlated with Apo A1 (r = –0.481; p < 0.0001). We did not observe any significant relation between plaque occurrence and levels of serum OPG. In regression analysis OPG (p < 0.02) and menopause age (p < 0.05) were independent risk factors for IMT, and age (p < 0.05) and IMT (p < 0.05) were independent risk factors for plaque formation. Although the role of OPG in the vascular biology is poorly understood, our results suggest that elevated levels of serum OPG is associated with IMT and may play a role in the pathogenesis of atherosclerotic disease.

Comparison of the criteria for gestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy

This is a retrospective study to compare the criteria for diagnosis of gestational diabetes mellitus (GDM) by the National Diabetes Data Group (NDDG), and Carpenter and Coustan criteria, and to study the outcome of GDM when diagnosed by the more sensitive criteria. Six hundred and sixty-two pregnant women were included in this study from the medical records between September 1998 and April 2001. GDM was positive in 6.50% of patients according to Carpenter and Coustan and in 4.08% of patients according to NDDG criteria. Women with GDM were older, had higher fasting and glucose challenge test (GCT) glucose levels, and fetal weight than the normal women. Hypoglycemia was observed only in one infant. Regarding pre-term delivery and preeclampsia, there was no significant difference between the groups. Age, delivery week and fetal weight of patients who had caesarian delivery were significantly higher than spontaneous vaginal delivery. Prevalence of macrosomia in GDM group was higher than in the normal group. There was a significant correlation between the macrosomia and number of positive blood glucose values during OGTT. In multivariate analyses, fasting, GCT and second hour OGTT blood glucose levels, mean parity, and delivery week were independent risk factors for fetal weight. Carpenter and Coustan criteria is more sensitive than the NDDG criteria and women with GDM had a higher frequency of macrosomia and the frequency of macrosomia increases by the number of positive blood glucose levels during OGTT. Tight glycemic control might decrease the prevalence of caesarian delivery, pre-eclampsia, pre-term delivery and hypoglycemia of the infant.

Effects of sibutramine in non-dieting obese women

The aim of this study was to evaluate the effects of sibutramine on plasma leptin levels, body weight and glucose metabolism in nondieting women. Fourteen healthy, non-diabetic, obese women were studied before treatment, after 1 week of placebo administration, and after a 2-week course of sibutramine (10 mg/day). At each of these stages, we assessed body composition, measured the levels of plasma leptin, Cpeptide and various biochemical parameters, and also recorded plasma insulin and glucose levels during oral glucose tolerance tests. After 1 week of placebo treatment, there were no significant changes in any of the parameters. However, two weeks of 10 mg/day sibutramine dropped plasma leptin levels from a mean (±SE) of 48.84±4.54 to 42.84±4.74 ng/ml (p<0.04), reduced BMI from 39.36±2.01 to 38.57±1.93 kg/m2 (p<0.002), and decreased insulin resistance (IR, as measured using the homeostasis model assessment of insulin resistance) from 5.59±0.85 to 3.66±0.43 (p<0.02). There was no correlation between the reduction in leptin concentration and the decrease in BMI, fat mass, percent body fat, IR, C-peptide, or the area under curve for glucose or insulin. There was also no correlation between the decrease in leptin levels and the increases that occurred in the insulin sensitivity index or the hepatic sensitivity index. The results showed that treatment with 10 mg/day sibutramine significantly reduces BMI, IR and leptin levels in non-dieting obese women.

The relation between serum levels of osteoprotegerin and postoperative epidural fibrosis in patients who underwent surgery for lumbar disc herniation.

Abstract Objectives: Epidural fibrosis (EF) is a part of the normal physiological tissue response to laminectomy and it is an important cause of failed back surgery syndrome (FBSS). Osteoprotegerin (OPG) is a soluble member of the tumor necrosis factor receptor family, and is expressed in high concentrations by a variety of tissues and cell types. The objective of this study was to evaluate the relationship between serum OPG levels, and the existence of postoperative EF in patients with lumbar disc herniation. It has been suggested that cytokines and growth factors, which play a role in the wound healing, may enhance the expression of OPG. Methods: Forty women who underwent surgery for lumbar disc herniation were included in this study. Postoperative MRI was performed to assess EF in all patients. Results: The serum OPG levels of subjects with postoperative EF were significantly higher than those of subjects without postoperative EF (4.72 ± 0.27 versus 3.25 ±0.41 pmol/l; p=0.005). Discussion: Although the role of OPG in the development of EF is poorly understood, our results suggest that elevated levels of serum OPG are associated with and may play a role in the pathogenesis of fibrotic process.