Ozge Telci Caklili

Endocan: A Novel Predıctor of Endothelıal Dysfunctıon ın Obstructıve Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSA) is an independent risk factor for endothelial dysfunction and cardiometabolic diseases. Plasma endocan levels are elevated in a large number of diseases, and is a novel surrogate endothelial cell dysfunction marker. We aimed to assess the role of serum endocan level as a potential mechanism of endothelial dysfunction in OSA patients.

Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease.

Background/Aims Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. Methods An observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. Results Fasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. Conclusions Gallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD.

Abdominal lipohypertrophy without insulin injection

A 44-year-old woman was referred to the endocrinology clinic of our hospital with lipohypertrophy on her abdomen. She had been diagnosed with type 2 diabetes mellitus 1 year previously and been using metformin treatment since the diagnosis. Otherwise, she was a healthy patient who had never used any kind of insulin or other injectable drug. Other than two subcutaneous masses (fi gure A), her physical examination was normal. Her BMI was 29 kg/m2 and her waist circumference was 104 cm. Her HbA1c was 6%, her fasting glucose concentration was 6·77 mmol/L, her fasting insulin concentration was 34·38 mU/mL (246·68 pmol/L), and her insulin resistance assessed by homeostatic model assessment was 10. Cushing’s syndrome was excluded after doing a 1 mg dexamethasone suppression test. Contrast-enhanced MRI showed that the breast-like masses were adipose tissue (fi gure B), and her lipohypertrophy was attributed to her insulin resistance. Lipohypertrophy is not rare in patients on insulin treatment. Although she had never used insulin or any kind of injectable drug, her presentation resembled lipodystrophy caused by many insulin injections. Our attempt to fi nd a similar case in the scientifi c literature was unsuccessful, leading us to conclude that the patient’s unique presentation might be a result of genetic factors that have resulted in dysmorphic fat accumulation due to insulin resistance.

Differences in leptin, ghrelin, and glucagon-like peptide-1 levelsbetween religious fasting and normal fasting

Background/aim: Leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) affect hunger, satiety feelings, and food intake. We hypothesized that during Ramadan, if the brain knows that the body will be hungry until sunset, there may be differences between leptin, ghrelin, and GLP-1 levels in Ramadan and non-Ramadan fasting. Materials and methods: This study had two phases. In the first phase, the participants were asked to skip the dawn meal of Ramadan (suhur), so that 12 h of fasting could be achieved. Participants ceased food intake at midnight, and at noon blood was drawn. Eight participants were selected as a subgroup. These participants gave blood three times a day to detect hormonal changes during Ramadan. Six months later, in the second phase, blood samples were obtained at noon from participants after 12 h of fasting. Results: Analysis was conducted on 30 patients [19 males (63.3%) and 11 females (36.7%)]. There was a significant difference in leptin, ghrelin, and GLP-1 levels between Ramadan fasting and non-Ramadan fasting (P = 0.04, P = 0.02, and P < 0.001, respectively). In the subgroup analysis, there was no statistically significant difference in leptin, ghrelin, and GLP-1 levels over time. Conclusion: The results of this study suggest that the nervous and gastrointestinal systems may behave differently in religious fasting than in nonreligious fasting.

Increased fasting and stimulated c- peptide levels after the diagnosis of type 1 diabetes: a case report

Context: Recently a few studies showing α-cell ability to differentiate into insulin–producing β-cells after prolonged duration of diabetes and reconstruction of new insulin–producing cells in the absence of autoimmunity in mice with completely ablated β-cells were reported. Here, we present a patient with type 1 diabetes and increased fasting and mixed-meal stimulated C-peptide levels 10 years after the diagnosis. Case description: A female patient with type 1 diabetes for 10 years was referred to our endocrinology clinic for hypoglycemia attacks. Her fasting glucose, HbA1C, fasting and mixed-meal stimulated C-peptide levels were measured three years ago and recently. Fasting and mixed-meal stimulated C-peptide levels were found to be increased compared to the levels of three years ago (<0.01 ng/mL vs. 0.06 ng/mL and <0.01 ng/mL vs 0.28 ng/mL respectively). Conclusion: It is possible that β-cell function may increase in type 1 diabetes, a decade after the diagnosis as observed in our patient. . Germany). We performed a mixed-meal tolerance test (MMTT) to the patient after an overnight fasting of ≥ 12 hours without administering her usual morning insulin treatment. After fasting blood glucose, C-peptide, and HbA1c levels were measured, a mixed meal containing 33 g of carbohydrate, 15 g of protein, and 6 g of fat (240 kcal total) [2] was eaten in less than 10 minutes, and C-peptide level was measured 90 minutes after the mixed-meal. Parameters were confirmed with repetitive measurements. Total daily insulin dose, fasting glucose and HbA1c level of the patient was decreased and her fasting and mixed-meal stimulated C-peptide levels were increased compared to her levels 3 years ago. Her current laboratory parameters and those in 2012 are shown in Table 1. Discussion It is accepted that T1D is a disease with absolute insulin deficiency. However recent studies have shown endogen insulin secretion is still present in some patients with T1D even in patients with long disease duration [2-4]. In these studies, it was not clear whether β-cell function was ongoing since the disease begun, or if it has increased or decreased. To our knowledge this case may be the first case in literature with fasting and mixed-meal stimulated C-peptide levels increased compared to the levels three years ago. Correspondence to: Gonca Incemehmet Tamer, Istanbul Medeniyet University Goztepe Training and Research Hospital, Endocrinology and Metabolism, Fahrettin Kerim Gokay Street, Kadikoy, Turkey, Tel: +90 (216) 5709195; Fax: +90 (216) 5709191; E-mail: hgtamer@yahoo.com

Effect of vitamin D status on lipid profile in premenopausal women: a cross-sectional study

Objective High lipid levels play important roles in the pathogenesis of atherosclerosis and some authors suggest vitamin D deficiency as a risk factor for atherosclerosis. The aim of this study was to evaluate the effect of vitamin D status on lipid profile in premenopausal women. Patients and methods A total of 315 nonsmoking premenopausal female volunteers without diabetes mellitus were included in the study. Patients were divided into four subgroups. The groups were as follows: patients with less than or equal to 12 ng/ml (group 1, n=126) vitamin D levels, between 20 and 12 ng/ml (group 2, n=48), between 30 and 20 ng/ml (group 3, n=21), and at least 30 ng/ml (group 4, n=120) vitamin D levels. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and non-HDL-C levels of the four groups were compared. Results HDL-C levels of group 4 were the highest (P=0.03), and TG and non-HDL-C levels of group 1 were the highest (P=0.04, 0.016, respectively) in all groups. There was no significant difference between serum parathormone, calcium, and phosphorus levels of the four groups (P=0.778, 0.121, 0.184, respectively). In unadjusted analysis, 25-hydroxy vitamin D levels were found to be correlated negatively with BMI (P=0.0005), LDL-C (P=0.01), and non-HDL-C (P=0.003) and correlated positively with HDL-C levels (P=0.006). After adjustments for age, sex, BMI, and log parathormone levels were made, no correlation was found between 25-hydroxy vitamin D and lipid (TC, LDL-C, HDL-C, and TG) levels (P=0.91, 0.06, 0.95, 0.79, respectively). Conclusion There may be an association between vitamin D insufficiency and dyslipidemia. However, this association may depend on obesity.

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.

The Influence of On-pump Versus Off-pump Surgery on Short- and Medium-term Postoperative Coronary Flow Reserve After Coronary Artery Bypass Grafting.

BACKGROUND Although several clinical trials have compared surgical outcomes between off-pump and on-pump coronary artery bypass grafting (CABG), whether there is a difference in the early- and medium-term postoperative coronary microvascular functions is not fully understood. We compared short- and medium-term coronary microvascular function after off-pump and on-pump CABG. METHODS A prospective study of patients undergoing off-pump and on-pump CABG. Eighty-two patients scheduled for CABG were recruited: 38 underwent off-pump surgery and 44 on-pump surgery. Each participants coronary flow reserve (CFR) and diastolic function were measured with transthoracic Doppler echocardiography six and 12 months after surgery. RESULTS Baseline and hyperaemic diastolic peak flow velocity in the left anterior descending artery were similar in both groups, as was CFR (2.22±0.66) in the off-pump group compared with (2.13±0.61) in the on-pump group, (P=0.54). Coronary flow reserve was significantly and inversely correlated with high sensitivity C-reactive protein concentration (r=-0.416; P<0.001) and positively correlated with mitral E/A-wave velocity ratio (r=0.247; P=0.02). Stepwise linear regression analysis revealed that only high sensitivity C-reactive protein concentration was independently correlated with CFR (β=-0.272, P=0.02). CONCLUSIONS Heart-lung bypass technique had no medium-term influence on the coronary microcirculation, despite a possible initial unfavourable effect. Serum hs-CRP concentration was an independent predictor of medium-term coronary microvascular dysfunction.