Mehmet Uzunlulu

Effects of Telmisartan and Losartan on Insulin Resistance in Hypertensive Patients with Metabolic Syndrome

Partial peroxisome proliferator–activated receptor-γ (PPAR-γ) agonists are known to decrease insulin resistance. Experimental studies have shown that the angiotensin type 1 receptor blocker (ARB) telmisartan has a PPAR-γ−activating property, but there does not appear to be a class effect. To test telmisartans clinical importance, we here investigated its effect on insulin resistance in hypertensive patients with metabolic syndrome (MetS) in comparison with another ARB, losartan. A total of 42 hypertensive MetS patients (29 female, 13 male) were included (mean age: 50±9, range: 20–70 years). NCEP-ATP III criteria were used for the diagnosis of MetS. Patients were randomized to receive either telmisartan 80 mg/day (n=21) or losartan 50 mg/day (n=21) for 8 weeks. Biochemical assessments were made at baseline and at the end of the 8 weeks. Insulin resistance was evaluated by using homeostasis model assessment of insulin resistance (HOMA-IR). Both groups had similar reductions in systolic and diastolic pressures (p>0.05). HOMA-IR did not change significantly in either group throughout the study. In the telmisartan group, the mean HOMA-IR at baseline and at the end of the study were 1.9±07 and 1.9±0.5, respectively. The figures for the losartan group were 1.8±0.6 and 1.8±0.6, corresponding. In conclusion, in contrast with the reports that telmisartan may decrease insulin resistance by an effect associated with its molecular structure, 8 weeks of telmisartan treatment in the present study had a neutral effect on insulin resistance in hypertensive MetS patients, and similar results were obtained for losartan.

Evaluation of Skin and Subcutaneous Adipose Tissue Thickness for Optimal Insulin Injection

Patient’s skin and subcutaneous adipose tissue thicknesses are the primary criteria that determine the optimal insulin needle length in subcutaneous insulin treatment. The present study aims to measure skin thickness and subcutaneous adipose tissue thickness in patients with diabetes mellitus and to investigate the association of these measurements with waist circumference and body mass index. The study included 449 subjects (152 patients with DM and 297 healthy controls, mean age: 44.58 ± 14.25 year) aged 18 years or older. The primary endpoint was the time of comparison of skin thicknesses and subcutaneous adipose tissue thicknesses between patients with diabetes mellitus and healthy subjects and the secondary endpoint was the time of assessment of the relationship between skin and subcutaneous adipose tissue thicknesses and body mass index and waist circumference. Skin and subcutaneous adipose tissue thicknesses were measured by ultrasonography. Overall, average skin thickness values were 1.95 mm (1.05-3.92) for triceps, 2.35 mm (1.07-3.82) for anterior abdomen and 1.97 mm (1.12-3.12) for anterior thigh, while subcutaneous adipose tissue thicknesses were 6.42 mm (1.01-33.5) for triceps, 15.73 mm (1.04-39.3) for anterior abdomen and 7.92 mm (1.48-31.6) for anterior thigh. Triceps and anterior thigh skin thickness values were higher in the diabetes mellitus group compared to healthy controls (p<0.01 for both) while subcutaneous adipose tissue thicknesses were similar between the two groups. There was a positive correlation between body mass index and waist circumference and between skin and subcutaneous adipose tissue thicknesses (p<0.01 for both). The largest skin thickness measured in the present study was 3.92 mm, which supports the previous reports that short needle tips could be used safely in individuals with diabetes mellitus.

Dietary breads: Myth or reality?

AIMS To assess the differences in acute effects of whole wheat bread, wheat bran bread and rye bread--perceived as dietary (Low caloric!) breads--on glucose and insulin levels in patients with type 2 diabetes, as compared to white wheat bread. METHODS One hundred twenty one type 2 diabetic patients were randomized into three groups as whole wheat, wheat bran and rye bread groups. Each group ate 100 g of bread with water with in 10 min. Blood glucose measurements were made at every 30 min in 2 h. Insulin was measured at fasting and at the second hour in the patients who do not use insulin. The same processes were repeated on the following day, with white wheat bread for each group. RESULTS No significant difference was found in either glycemic or insulinemic effects between four types of breads when compared to each other (p=0.093 for glycemic effect and p=0.297 for insulinemic effect). CONCLUSION Three different bread types consumed as an alternative to white bread in Turkey, increase blood glucose levels of diabetic patients similar to white bread.

Increased Chitotriosidase Activities in Patients with Rheumatoid Arthritis: A Possible Novel Marker?

Abstract Background: Chitotriosidase and YKL-40 are well-known in humans as Glyco_18 domain-containing proteins that are the common feature of mammalian chitinases and chitinaselike proteins. Previously, increased levels of YKL-40 were found correlated with the disease activity of rheumatoid arthritis. However, serum chitotriosidase activity in rheumatoid arthritis is not known yet. The aim of this study was to determine YKL-40 and chitotriosidase in patients with rheu - matoid arthritis and to compare these markers with traditi - onal ones such as C-reactive protein and erythrocyte sedimentation rate. Methods: Chitotriosidase, YKL-40 and C-reactive protein were measured in serum samples from 27 patients with rheumatoid arthritis and 27 healthy people. Chitotriosidase, YKL-40, C-reactive protein, and erythrocyte sedimentation rate were determined by a fluorometer, ELISA, nephelometer, and Western Green method, respectively. Results: Serum chitotriosidase activities and YKL-40 levels were higher in rheumatoid arthritis group than in control. A significant positive correlation was found between chitotriosidase and YKL-40. In ROC analysis, the areas under curves for chitotriosidase, C-reactive protein, erythrocyte sedimentation rate, and YKL-40 were 0.96, 0.84, 0.76, and 0.65, respectively. Area under the curve for chitotriosidase was significantly higher than the area for erythrocyte sedimentation rate (p=0.005) and for YKL-40 (p=0.0001), but not for Creactive protein (p=0.055). Conclusions: Serum chitotriosidase was significantly in creas - ed in patients with rheumatoid arthritis. Among all the param - eters evaluated, chitotriosidase was the most sensitive and specific one. Comprehensive studies covering larger populations are needed to elucidate the relationship bet ween chitinases, in particular chitotriosidase and rheumatoid arthritis. Kratak sadržaj Uvod: Hitotriazidaza i YKL-40 su dobro poznati kao proteini koji sadiže domen Gliko_18, koji je zajednička karakteristika hitinaze sisara i proteina sličnih hitinazi. Ranije se pokazalo da su povećani nivoi YKL-40 povezani sa delovanjem reuma- toidnog artritisa. Svrha ove studije je određivanje nivoa YKL- 40 i hitotriozidaza kod bolesnika sa reumatoidnim artritisom i upoređivanje sa uobičajenim indikatorima kao što su C- reaktivni protein i brzina sedimentacije eritrocita. Metode: Nivoi hitotriozidaza, YKL-40, C-reaktivni protein i brzina sedimentacije eritrocita u uzorcima seruma 27 boles- nika sa reumatoidnim artritisom i 27 zdravih osoba izmereni su redom fluorometrijskom, ELISA, nefelometrijskom i Western-Green metodom. Rezultati: U serumu grupe bolesnika sa reumatoidnim artritisom je zabeležena veća aktivnost hitotriozidaza i nivo YKL-40 u poređenju sa zdravim ispitanicima. Između hito- triozidaza i YKL-40 postoji statistički značajna pozitivna korelacija. U analizi ROC, za hitotriozidaze, C-reaktivni pro-tein, brzine sedimentacije eritrocita i YKL-40, područja ispod krive su redom zauzela 0,96, 0,84, 0,76 i 0,65. Vrednost područja ispod krive testa za hitotriozidaze je bila znatno veća od vrednosti područja ispod krive brzine sedimentacije eritrocita (p= 0,005) i YKL-40 (p=0,0001), ali identična sa područjem za C-reaktivni protein (p= 0,055). Zaključak: Aktivnost hitotriozidaze u serumu bolesnika sa reumatoidnim artritisom je u vidljivom porastu. Između svih procenjenih parametara utvrđeno je da je hitotriozidaza naj- osetljivija i najspecifičnija. Pbstoji potreba za opsežnim studi- jama na polju hitinaze, koje obuhvataju veće populacije i koje će istražiti odnos između hitotriozidaza i reumatoidnog artritisa.

Relationship between low levels of high-density lipoprotein cholesterol and metabolic syndrome in Turkish patients.

Objective — It is stated that high-density lipoprotein cholesterol (HDL-C) levels are low in Turkish people and that this may be related to genetic factors. Low HDL-C is a parameter of the metabolic syndrome (MetS). In this study, the relationship between low HDL-C levels and MetS has been investigated. Methods and results — A total of 720 successive patients, 20 years or older, were categorized into two groups, as those with low-HDL-C (in men < 40 mg/dl, in women < 50 mg/dl) and those without low-HDL-C levels (in men ≥ 40 mg/dl, in women ≥ 50 mg/dl).The groups were compared according to the frequency of the MetS and the averages of the MetS criteria other than HDL-C. Moreover, two groups were formed with normal (< 150 mg/dl) and high (≥ 150 mg/dl) triglyceride levels and they have been compared with the average HDL-C levels.The frequency of MetS was 70.8% in the group with low-HDL-C and 24.2% in the group without low HDL-C levels (p < 0.001).The averages of the MetS criteria other than the HDL-C were 2.17 ± 1.19 in the group with low-HDL-C levels and 1.59 ± 1.15 in the group without low-HDL-C levels (p < 0.001). Average HDL-C level was 48.90 ± 13.40 mg/dl in the group with normal triglyceride levels and 44.41 ± 10.26 mg/dl in the group with high triglyceride levels (p < 0.001). Conclusions — This study shows that low HDL-C is related to the MetS in our patients, a selected group of a population reported to have a low HDL-C average.

The effect of sociodemographic and clinical features on mortality in patients with diagnosis of aspiration pneumonia

OBJECTIVE: The aim of this study was to evaluate the sociodemographic and clinical chracteristics of patients hospitalized with aspiration pneumonia in internal medicine clinics, and to determine the incidence and parameters of mortality among these patients. METHODS: Patients over the age of 18 years who were hospitalized in clinics of internal medicine between January 1, 2010 and January 1, 2013 (115 male, 89 female; mean age: 77±13 years; patients aged 65 years and over, 88.2%; average duration of hospitalization, 11±9 days) were evaluated retrospectively and consecutively. The incidence of mortality, nutritional status at admission, comorbidity frequency, haematological and biochemical data and their relationship with mortality were evaluated. RESULTS: At admission, 85% of the patients were fed through oral route, while 15% of them were fed through PEG. There was no relation between nutritional status of the patients (oral, nasogastric tube or PEG) at admission, and development of aspiration pneumonia. Commonly seen comorbidities were dementia (49%), hypertension (43%), cerebrovascular accident (42%), and diabetes mellitus (31%) respectively. The mortality rate was 24.5% (in first three days, 56%). A correlation was found between mortality and increase in neutrophil/lymphocyte ratio (NLR) and increased uric acid rate (for both p<0.05). CONCLUSION: In this study, the mortality rates among patients diagnosed with aspiration pneumonia was found to be increased. The high number of geriatric patients and comorbidities might have played a role in this situation. Neutrophil/lymphocyte ratio (NLR) and uric acid levels in patients with aspiration pneumonia might be evaluated as factors related to mortality.

Triglyceride Response to Oral Glucose Load: Is it Exaggerated in Metabolic Syndrome?

Objective: Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors related to insulin resistance. Data show that triglyceride (TG) levels following an oral glucose tolerance test (OGTT) are higher among obese and insulin-resistant cases associated with metabolic risk factors. In this study, we aimed to assess whether an exaggerated TG response was present in cases with MetS who had undergone OGTT. Methods: In total, 88 cases (70 females, 18 males) without diabetes who were aged older than 18 years were recruited. All the cases underwent 75-gram OGTT. Fifty-one cases (42 females, 9 males; mean age: 48.69±10.13 years) with MetS according to the International Diabetes Foundation formed the MetS group, while 37 cases without MetS (28 females, 9 males; mean age: 48.78±9.18 years) formed the control group. Results: OGTT 0-, 1-, and 2-hour TG levels were 170.96±81.10 mg/dL, 166.94±72.82 mg/dL, and 157.76±74.29 mg/dL in the MetS group and 116.46±47.60 mg/dL, 115.35±46.01 mg/dL, and 108.51±49.33 mg/dL in the control group, respectively. The 2-hour TG levels were significantly decreased in both groups compared with the 0and 1-hour levels (p=0.001 for both). In both the groups, glucose and insulin levels significantly increased in the 1st hour compared with the 0th hour and significantly decreased in the 2nd hour compared with the 1st hour (p=0.001 for both). Conclusion: In this study, the presence of MetS did not have an effect on TG response to OGTT. The decrease in TG levels in both groups may be associated with the acute decreasing effect of early-phase insulin on TG.