Nur Kebapci

Higher Insulin Resistance Level is Associated with Worse Clinical Response in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis.

Insulin resistance is linked to atherosclerotic cardiovascular diseases and stroke. We investigated whether there is a relationship between insulin resistance and clinical findings and outcomes of acute ischemic stroke patients treated with intravenous thrombolysis. In our study, 180 acute ischemic stroke non-diabetic patients treated with intravenous recombinant tissue-type plasminogen activator (iv rt-PA) were evaluated for insulin resistance assessed by homeostasis model assessment insulin resistance (HOMA-IR). The threshold for HOMA-IR was determined as 2.7. Patients were grouped as HOMA-IR > 2.7 and HOMA-IR ≤ 2.7. Clinical features at baseline, 24th hour, and 3rd month were examined. Computed tomography (CT) findings for hemorrhagic transformation were also assessed. Patients with HOMA-IR > 2.7 had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores at 24th hour (p = 0.005) and higher modified Rankin Scale (mRS) scores at 3rd month (p = 0.011). Logistic regression analysis displayed that the presence of HOMA-IR > 2.7 increases the likelihood of poor outcome 2.93 times (confidence interval [CI] 1.001–1.079) (p = 0.003). There was no statistically significant difference between baseline clinical features, hemorrhagic transformation (p = 1.000), and mortality (p = 0.350) rates. Insulin resistance at higher levels seems to be associated with poor clinical courses and outcomes in patients who received iv rt-PA.

Investigation on Carbohydrate Counting Method in Type 1 Diabetic Patients

Objective. The results from Diabetes Control and Complications Trial (DCCT) have propounded the importance of the approach of treatment by medical nutrition when treating diabetes mellitus (DM). During this study, we tried to inquire carbohydrate (Kh) count methods positive effects on the type 1 DM treatments success as well as on the life quality of the patients. Methods. 22 of 37 type 1 DM patients who applied to Eskişehir Osmangazi University, Faculty of Medicine Hospital, Department of Endocrinology and Metabolism, had been treated by Kh count method and 15 of them are treated by multiple dosage intensive insulin treatment with applying standard diabetic diet as a control group and both of groups were under close follow-up for 6 months. Required approval was taken from the Ethical Committee of Eskişehir Osmangazi University, Medical Faculty, as well as informed consent from the patients. The body weight of patients who are treated by carbohydrate count method and multiple dosage intensive insulin treatment during the study beginning and after 6-month term, body mass index, and body compositions are analyzed. A short life quality and medical research survey applied. At statistical analysis, t-test, chi-squared test, and Mann-Whitney U test were used. Results. There had been no significant change determined at glycemic control indicators between the Kh counting group and the standard diabetic diet and multiple dosage insulin treatment group in our study. Conclusion. As a result, Kh counting method which offers a flexible nutrition plan to diabetic individuals is a functional method.

Metabolic syndrome is a risk factor for the development of chronic renal disease.

Metabolic syndrome (MetS) is characterized by the coexistence of multiple abnormalities: abdominal obesity, hypertension, dyslipidemia, and glucose intolerance in association with hyperinsulinemia and insulin resistance. The National Cholesterol Education Program Adult Treatment Panel (ATP III) criteria define MetS as having at least three of the following: abdominal obesity; high triglyceride and low high-density lipoprotein (HDL)-cholesterol levels; hyperglycemia, and hypertension. Insulin resistance, a key feature of theMetS and its components, is defined as a decreased sensitivity or responsiveness of peripheral tissues to the metabolic action of insulin. Abdominal fat, which is predictive of sensitivity to insulin, plays an important role in MetS. This syndrome confers a higher risk for diabetes mellitus (DM) and cardiovascular disease (CVD) risk, even with levels of glycemia below that used to define diabetes. Previous studies have shown that components and consequences of MetS, including DM and coronary heart disease, alter renal physiology and metabolism through a cascade of various reactions. For example, obesity-related early renal changes increase the glomerular filtration rate (GFR) because of increased salt reabsorption by the proximal tubule. Consequent tubuloglomerular feedback mediated reduction in afferent arteriolar resistance results in increased glomerular capillary pressure. The increased GFR is a compensatory response that restores salt balance despite continued increases in tubular reabsorption but contributes to renal injury, especially if it is combined with elevated blood pressure. In addition, obesity induced sleep apnea activates sympathetic nervous system increasing the tone of the glomerular efferent arterioles and the secretion of renin and angiotensin. In patients with MetS, mildly elevated blood pressure or mild hyperglycemia may portend an increased risk of chronic kidney disease (CKD) and microalbuminuria, while a high blood pressure was the most powerful predictor of renal dysfunction. In addition, dyslipidemia may affect the prognosis of CKD as low HDL cholesterol was shown to be a predictor of faster CKD progression. There are complex interactions among obesity, hypertension, and insulin resistance, which all together may contribute not only to cardiovascular damage but also to renal damage. Even mild to moderate CKD has been shown to be strongly associated with an increase in cardiovascular morbidity and mortality. Therefore, renal dysfunction is regarded as a coronary artery disease equivalently. Both MetS and CKD have been shown to be independently associated with increased cardiovascular events and mortality, and studies suggest a reciprocal relationship between MetS and CKD. Therefore, we performed the present study to investigate whether MetS is associated with renal dysfunction in the frame work of the possible role of CVD risk factors.

Rituximab Treatment in a Patient with Active Graves’ Orbitopathy and Psoriasis

Management of Graves’ orbitopathy remains an important therapeutic challenge. Current therapeutic modalities are unsatisfactory in about one third of patients. Rituximab is a monoclonal antibody against CD20 antigen that is expressed in mature and immature B cells. Early experience with rituximab suggests that it is a promising alternative therapy for Graves’ orbitopathy. Here we report a case of a 49-year-old woman with Graves’ orbitopathy and psoriasis. The patient received 2 infusions of 1 g rituximab 2 weeks apart. Although there was improvement in inflammatory signs of the disease, proptosis did not change after the treatment.

Effects of serum uric acid levels on the arginase pathway in women with metabolic syndrome

BackgroundElevated serum uric acid levels and increased arginase activity are risk factors for cardiovascular diseases (CVD). The aim of the present study was to investigate effects of serum uric acid levels on the arginase pathway in women with metabolic syndrome (MetS).MethodsSerum arginase activity, and nitrite and uric acid levels were measured in 48 women with MetS and in 20 healthy controls. The correlation of these parameters with components of MetS was also evaluated.ResultsOur data show statistically higher arginase activity and uric acid levels but lower nitrite levels in women with MetS compared to controls. Serum uric acid levels were negatively correlated with HDL cholesterol, nitrite levels and positively with Body Mass Index, waist to hip ratio, triglyceride and total cholesterol levels, systolic blood pressure, Homeostasis Model Assessment-Insulin Resistance-Index, serum arginase activity, and LDL-cholesterol levels in women with MetS.ConclusionResults of the present study suggest that serum uric acid levels may contribute to the pathogenesis of MetS through a process mediated by arginase pathway, and serum arginase activity and nitrite and uric acid levels can be used as indicators of CVD in women with MetS.

Low perfusion index affects the difference in glucose level between capillary and venous blood

Aim In emergency cases, finger stick testing is primarily used to check the blood glucose value of patients since it takes longer to obtain the venous value. In critical patients, under conditions that cause an increase in metabolic state and level of stress, there occurs considerable difference in glucose levels between capillary and venous measurements. This study aimed to investigate the comparability of capillary and venous glucose values, according to the perfusion index level obtained with the Masimo Radical-7® device, in critical patients aged 18 years and over. Method We conducted this prospective and observational study in the emergency department of the Eskisehir Osmangazi University hospital between November 3, 2008 and February 2, 2009. Results The blood glucose of 300 critical patients was checked by finger stick in the emergency unit. The participants with normal vital signs had perfusion index between 0 and 5; the results obtained by the two methods were more consistent for perfusion index values of 6 and over. The results were most consistent in aged participants with normal vital sign findings and low perfusion index and in young patients with high perfusion index. In the cases where at least one of the vital signs was abnormal, the glucose values obtained by the two methods were more consistent when the perfusion index was 6 or over. In this group, independently from the perfusion index value, the consistency was higher in younger patients compared with aged patients. Conclusion In the emergency department, perfusion index value measured by Masimo Radical-7 and capillary blood glucose levels can serve in blood sugar management in critically ill patients.

Factors Affecting Swallowing During Thyroid Fine-Needle Aspiration Biopsy

Objective. This prospective study was conducted to examine the factors that affect swallowing during thyroid fine‐needle aspiration biopsy (FNAB). Methods. Consecutive patients who were to undergo FNAB were approached for inclusion in the study. The depth and size of the nodule were measured in all patients. In a random fashion, patients were told not to swallow during the procedure, or they were not given any instructions regarding swallowing. Results. Regarding the 143 participants in the study, no significant differences in age (P = .07), diameter and depth of the thyroid nodules (P = .14; P = .46, respectively), or cytologic diagnosis of thyroid aspirates (P > .20) were found between the swallowing (n = 50) and nonswallowing (n = 93) patient groups. Swallowing was observed in 29 patients who were instructed not to swallow (36%) and in 21 patients who were not given any instructions regarding swallowing (34%; P = .95). The mean duration of the procedure for swallowing patients was 19.8 seconds, and it was 15.7 seconds for nonswallowing patients. The duration of the procedure was significantly shorter in patients who did not swallow (P = .001). More male patients swallowed than female patients (P = .003). Conclusions. Giving specific instructions about not swallowing did not make a difference regarding swallowing by patients during the FNAB procedure. More male patients swallowed than female patients. A longer duration of the FNAB procedure meant that the operator was more likely to encounter swallowing (and thus displacement of the thyroid) while doing the procedure. Completing the procedure quickly is the surest method to avoid a moving thyroid while performing FNAB.