Penbe Cagatay

Effect of abdominal obesity on insulin resistance and the components of the metabolic syndrome: Evidence supporting obesity as the central feature

Background: Metabolic syndrome includes abdominal obesity, diabetes type 2, hypertension, dyslipidemia, derangements of fibrinolysis, and atherosclerosis. Since abdominal obesity is one of the major components of the insulin resistance syndrome (IRS), an attempt was made to evaluate the interrelationships between the magnitude of obesity and the components of the syndrome. Methods: A cross-sectional study of 123 subjects with type 2 diabetes, of whom 31 were normal body weight and 92 had varying degrees of obesity was conducted. The participants were investigated in terms of clinical and laboratory findings of IRS. Fasting and 30-min (early) plasma glucose and serum insulin excursions in response to oral glucose challenge (75 g) were determined. The peripheral and hepatic insulin resistance (insensitivity) was calculated by homeostasis model assessment (HOMA). Results: Clinical and biochemical findings were compared with the components of the IRS, and demonstrated that a rise in fasting as well as 30-min insulin secretion increases as abdominal body fat (obesity) increases. There was also a significant and proportional correlation between the magnitude of abdominal obesity and the components of metabolic syndrome. Conclusion: Abdominal adiposity appears to have a pivotal role in the development of IRS.

Expression of cytokeratin subtypes in intraepidermal malignancies: a guide for differentiation

Background:  Among intraepidermal malignancies of epithelial origin, Bowens disease, bowenoid actinic keratosis (BAK), intraepidermal malignant eccrine poroma (MEP), and Pagets disease may pose diagnostic difficulties.

Clinical Predictors of Obesity Hypoventilation Syndrome in Obese Subjects With Obstructive Sleep Apnea

BACKGROUND: Arterial blood gas (ABG) analysis is not a routine test in sleep laboratories due to its invasive nature. Therefore, the diagnosis of obesity hypoventilation syndrome (OHS) is underestimated. We aimed to evaluate the differences in subjects with OHS and pure obstructive sleep apnea (OSA) and to determine clinical predictors of OHS in obese subjects. METHODS: Demographics, body mass index (BMI), Epworth Sleepiness Scale score, polysomnographic data, ABG, spirometric measurements, and serum bicarbonate levels were recorded. RESULTS: Of 152 obese subjects with OSA (79 females/73 males, mean age of 50.3 ± 10.6 y, BMI of 40.1 ± 5.6 kg/m2, 51.9% with severe OSA), 42.1% (n = 64) had OHS. Subjects with OHS had higher BMI (P = .02), neck circumference (P < .001), waist circumference (P < .001), waist/hip ratio (P = .02), Epworth Sleepiness Scale scores (P = .036), ABG and serum bicarbonate levels (P < .001), apnea-hypopnea index (P = .01), oxygen desaturation index (P < .001), and total sleep time with SpO2 < 90% (P < .001) compared with subjects with pure OSA (n = 88). They also had lower daytime PaO2 (P < .001), sleep efficiency (P = .032), mean SpO2 (P < .001), and nadir SpO2 (P < .001). Serum bicarbonate levels and nadir SpO2 were the only independent predictive factors for OHS. A serum bicarbonate level of ≥ 27 mmol/L as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 76.6%, specificity of 74.6%, positive predictive value of 54.5%, negative predictive value of 88.9%). A nadir SpO2 of < 80% as the cutoff gives a satisfactory discrimination for the diagnosis of OHS (sensitivity of 82.8%, specificity of 54.5%, positive predictive value of 56.9%, negative predictive value of 81.4%). When we used a serum bicarbonate level of ≥ 27 mmol/L and/or a nadir SpO2 of < 80% as a screening measure, only 3 of 64 subjects with OHS were missed. CONCLUSIONS: Serum bicarbonate level and nadir saturation were independent predictive factors for the diagnosis of OHS.

Association of endothelial nitric oxide synthase promoter region (T-786C) gene polymorphism with acute coronary syndrome and coronary heart disease

BackgroundNitric oxide (NO) is an endothelium derived relaxing factor (EDRF) which has an important role for regulating the heart-vessel physiology. The objective of this study was to evaluate the effects of the eNOS T-786C polymorphism on lipid parameters and the development of acute coronary syndrome (ACS) and coronary heart disease (CHD) for the first time in a Turkish study group. We have analyzed the genotype frequencies of the T-786C polymorphism of the eNOS gene in 10 ACS patients (5 men, 5 women), 20 CHD patients (14 men, 6 women), and 31 controls (10 men, 21 women), who were angiographically proven to have normal coronaries.ResultsThe demographic, biochemical and left ventricule systolic dysfunction data of the ACS, CHD patients and controls were analyzed as a function of eNOS T-786C genotypes. The eNOS gene T-786C polymorphism frequencies for T/T, C/T and C/C genotypes were respectively 10%, 40%, 50% in subjects with ACS; 75%, 20%, 5% in subjects with CHD and 67.7%, 25.8%, 6.5% in the control group. Significant difference was observed in genotype frequencies between the study groups for T-786C polymorphism (p = 0.001). The CC genotype frequency was found to be the most prevalent in ACS group in comparison to CHD and control groups (p = 0.001). TT was the most frequently observed genotype in both CHD patients and controls (p = 0.001). Left ventricule systolic dysfunction frequency was found to be highest in C/T genotype carriers (66.7%) in patients (ACS+CHD). None of the patients with LVSD were carrying the normal genotype (T/T). The eNOS T-786C polymorphism was not found to be effective over any analyzed lipid variable in patients (ACS+CHD). The HDL-cholesterol levels were found to be lower in CHD group were compared to controls (p < 0.01), whereas glucose and leucocyte levels of the ACS and CHD groups were both higher than controls (p < 0.001).ConclusionThe significantly high frequency of eNOS -786C/C genotype in ACS patients than in those of controls, indicate the genotype association with ACS. The finding of significantly high frequency of T/T genotype in the CHD group, may support the relationship of CC genotype with ACS without CHD. The high frequency of the mutant (C/C) and heterozygous (C/T) genotypes found may be linked to left ventricule remodeling after MI.

Lipoprotein Lipase Gene Polymorphism and Lipid Profile in Coronary Artery Disease

CONTEXT Lipoprotein lipase (LPL) plays a central role in lipid metabolism, hydrolyzing triglyceride in chylomicrons and very-low-density lipoproteins. The PvuII polymorphic variant of LPL gene is common and might affect risk of coronary artery disease (CAD). OBJECTIVE Our aim was to determine whether LPL- PvuII polymorphism can be considered to be an independent risk factor or a predictor for CAD in Turkish subjects. DESIGN We used polymerase chain reaction and restriction enzyme digestion to determine the distribution of the previously described C-->T transition that causes a PvuII polymorphism in intron 6 among healthy blood donors of Turkish origin and among angiographically confirmed CAD patients with comparable ethnic backgrounds. RESULTS For the PvuII genotypes, within the CAD group (n = 80), the +/- genotype was found in 39 individuals (48.8%), whereas 25 (31.3%) carried the +/+ genotype, and 14 (17.5%) carried the -/- genotype. Within the control group (n = 49), the -/- genotype was found in 19 individuals (38.8%), 16 (32.7%) carried the +/- genotype, and 14 (28.6%) carried the +/+ genotype. The genotype frequency distribution was significantly different (P =.049) in the CAD and control study groups. The most frequent genotype among CAD patients was +/-; this genotype was more frequent in patients than in control subjects. However, the -/- genotype was more prevalent in the control group. Lipoprotein lipase-PvuII polymorphism was found to be associated with fasting total cholesterol and low-density lipoprotein cholesterol levels. The +/+ genotype was found to have higher levels of total cholesterol and low-density lipoprotein cholesterol in both the CAD and control groups. CONCLUSION There was a difference in the distribution of LPL-PvuII genotypes between the healthy subjects and the patients with CAD. Lipoprotein lipase-PvuII polymorphisms were not detected as independent risk factors for CAD in this study group, but had associations with lipid levels.

Association of Sweet Taste Receptor Gene Polymorphisms with Dental Caries Experience in School Children

Sweet taste is a powerful factor influencing food acceptance. The peripheral taste response to sugar is mediated by the TAS1R2/TAS1R3 taste receptors. The aim of the study was to determine the relationship between TAS1R2 (rs35874116 or rs9701796) and/or TAS1R3 (rs307355) single nucleotide polymorphisms with dental caries experience in schoolchildren. A total of 184 schoolchildren aged between 7 and 12 years (101 girls, 83 boys) were included in the study. Genomic DNA was extracted from saliva samples and the genotypes were identified by qPCR. The genotype frequencies were as follows: 6.6% for homozygous wild type, 41.8% for heterozygous and 51.6% for homozygous polymorphic genotype carriers of TAS1R2 gene rs35874116; 27.8% for heterozygous and 72.2% for homozygous polymorphic genotype carriers of TAS1R2 gene rs9701796, and 83.1% for homozygous wild type and 16.9% for heterozygous genotype carriers of TAS1R3 gene rs307355 polymorphism. A significant association was observed between total caries experience (dft + DMFT - decayed filled primary teeth + decayed, missing and filled permanent teeth) and TAS1R2 rs35874116 (p = 0.008) and TAS1R3 rs307355 (p = 0.04) gene polymorphisms but not for TAS1R2 gene rs9701796 polymorphism. TAS1R3 gene rs307355 polymorphism has been found to be an independent risk factor for dental caries experience by logistic regression analysis and to have increased the risk of caries. Moderate caries experience (4-7 caries) was found to be associated with TAS1R3 rs307355 heterozygous genotype, whereas high-risk caries experience (>8 caries) was found to be associated with TAS1R2 rs35874116 homozygous polymorphic genotype.

Lipoprotein lipase gene PvuII polymorphism serum lipids and risk for coronary artery disease: Meta-analysis

Our aim was to determine whether lipoprotein lipase gene PvuII polymorphism can be considered as an independent risk factor for coronary artery disease (CAD) by conducting a meta-analysis of all available published trials, including our own study. In 7 seperate studies, 3289 subjects were screened for this substitution; meta-analysis included only some of these individuals. Among the 7 studies, 6 were performed on white subjects, whereas 1 was on patients with Saudi Arabic descent.Subgroup analysis indicated that individuals with PvuII substitution does not have an increased risk for CAD. The LPL-PvuII genotype and allele frequency distributions did not differ significantly between CAD patients and healthy controls. There was no difference in the distribution of LPL-PvuII genotypes between the healthy subjects and the patients with CAD. However, no significant differences in lipid variables (triglyceride and HDL-cholesterol) were determined for the PvuII polymorphisms in the patients with CAD. No significant differences were found in serum triglyceride and HDL-cholesterol levels for LPL-PvuII genotypes when the control and CAD groups were pooled. In conclusion, LPL-Pvu II polymorphism cannot be used as independent genetic risk factor for CAD.

Levels of tumour necrosis factor-alpha and IL-1alpha in newly diagnosed and multidrug resistant tuberculosis.

Background:  The pro‐inflammatory cytokines tumour necrosis factor (TNF)‐α and IL‐1α play key roles in host defence against tuberculosis (TB) but there is little knowledge of their levels in multidrug resistant TB (MDR‐TB). The aim of the present study was to investigate the levels of TNF‐α and IL‐1α and their relationship with the levels of T helper (CD4+), T suppressor (CD8+) and total lymphocytes (CD45+) in newly diagnosed TB (N‐TB) and MDR‐TB.

Genetic variations of the apolipoprotein B gene in Turkish patients with coronary artery disease

Background: The results of studies that clarify the association of genetic markers at the apolipoprotein B (apo B) gene (EcoRI and XbaI polymorphisms) with coronary artery disease (CAD) are not consistent and suggest that the effect is context dependent (dependent on ethnicity and sex). The present study represents the first investigation of the apo B gene polymorphisms in Turkish patients with CAD and their influence on lipid levels. Aim: The study investigated the association of apo B gene EcoRI and XbaI polymorphisms with CAD and with variation in lipid levels (total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), and triacylglycerol (TAG)). Subjects and methods: The study group was composed of 150 individuals with angiographically documented CAD and 100 angiographically proven to be healthy controls. PCR-RFLP was used to determine the DNA polymorphisms of the apo B gene. Results: The frequencies of apo B genotypes detected with EcoRI (AA, AG, GG) and XbaI (CC, CT, TT) did not differ significantly between case and control subjects. A significant association between EcoRI genotypes and T-Chol (p ≤ 0.05), and LDL-Chol (p ≤ 0.001) was observed only in CAD patients. Patients with the AA genotype had higher levels of serum T-Chol and LDL-Chol compared with AG. With logistic regression analysis the XbaI TT genotype was found to be associated with CAD prevention. However, no significant differences in lipid variables were determined for the XbaI polymorphisms in the patients with CAD. Conclusions: Apo B EcoRI genotypes were not found as risk factors for CAD, whereas XbaI TT genotype was detected to prevent against CAD in our study group. Résumé. Arrière plan: Les résultats des études qui clarifient l’association des marqueurs génétiques du gène B (apo B) de l’alipoprotéine (polymorphismes EcoRI et XbaI) avec la maladie coronarienne (MC), ne sont pas satisfaisants et suggèrent que l’effet est dépendant du contexte (dépendance par rapport au sexe et à l’ethnicité). Cette étude est la première recherche sur les polymorphismes EcoRI et XbaI du gène apo B chez des patients turcs souffrant de MC et sur leur influence sur les niveaux lipidiques. But: L’étude explore l’association des polymorphismes EcoRI et XbaI du gène apo B avec la MC et avec la variation des niveaux lipidiques : cholestérol total (Chol-T), cholestérol de lipoprotéines de haute densité (Chol-LHD), cholestérol de lipoprotéines de basse densité (Chol-LBD) et glycéroltriacyl (GTA) Sujets et méthodes. Le groupe étudié est composé de 150 individus présentant une angiographie de MC et de 100 individus a angiographie saine. La technique de RFLP-PCR a été utilisée pour déterminer les polymorphismes d’ADN du gène apo B. Résultats: Les fréquences des génotypes de apo B détectées avec EcoRI (AA, AG, GG) et XbaI (CC, CT, TT) ne diffèrent pas significativement entre patients et contrôles. Une association significative entre génotypes EcoRI et Chol-T (p ≤ 0,05) ainsi qu’avec Chol-LBD (p ≤ 0,001) n’a été observée que chez les patients à MC. Les patients de génotype AA ont un niveau plus élevé que ceux de génotype AG pour les niveaux de Chol-T et de Chol-LBD dans le sérum. Par analyse de régression logistique, on trouve que le génotype XbaI TT est associé à la prévention de la MC. On n’a cependant pas trouvé de différence significative des variables lipidiques qui serait déterminée par les polymorphismes XbaI chez les patients MC. Conclusion: Les génotypes apo B EcoRI n’apparaissent pas être des facteurs de risque pour la MC, tandis qu’il apparaît que le génotype XbaI TT protège de la MC dans le groupe étudié. Zusammenfassung. Hintergrund: Die Ergebnisse von Studien, die die Beziehung zwischen genetischen Markern auf dem Apolipoprotein B (Apo B)-Gen und koronarer Herzkrankheit (coronary artery disease, CAD) klären, sind nicht vereinbar und legen nahe, dass der Einfluss vom Zusammenhang abhängt (je nach ethnischer Zugehörigkeit und Geschlecht). Die vorliegende Studie ist die erste Untersuchung von Apo B-Gen-Polymorphismen und ihrem Einfluss auf Lipidspiegel bei Türkischen Patienten mit CAD. Ziel: Die Studie untersuchte die Beziehung von Apo B-Gen EcoRI- und XbaI-Polymorphismen mit CAD und mit der Schwankung der Lipidspiegel (Gesamtcholesterin (total cholesterol, T-Chol), High-density lipoprotein Cholesterin (HDL-Chol), Low-density lipoprotein Cholesterin (LDL-Chol) und Triacylglycerol (TAG)). Probanden und Methoden: Die Studiengruppe bestand aus 150 Personen mit angiographisch dokumentierter CAD und 100 angiographisch gesicherten gesunden Kontrollen. PCR-RFLP wurden benutzt um DNS-Polymorphismen des Apo B-Gens zu bestimmen. Ergebnisse: Die Häufigkeiten der Apo B-Genotypen, die mit EcoRI (AA, AG, GG) und XbaI (CC, CT, TT) bestimmt wurden, unterschieden nicht signifikant zwischen Patienten und Kontrollpersonen. Eine signifikante Beziehung zwischen EcoRI-Genotypen und T-Chol (p ≤ 0,05) und LDL-Chol (p ≤ 0,001) wurde nur bei CAD-Patienten beobachtet. Patienten mit dem Genotyp AA hatten höhere Serumspiegel von T-Chol und LDL-Chol, verglichen mit AG. Unter Verwendung einer logistischen Regressionsanalyse fand sich, dass der XbaI TT-Genotyp vor CAD schützt. Allerdings wurden keine signifikanten Unterschiede bei den Lipidvariablen hinsichtlich von XbaI-Polymorphismen bei Patienten mit CAD gefunden. Zusammenfassung: Es wurde nicht gefunden, dass Apo B EcoRI-Genotypen Risikofaktoren für das Auftreten einer CAD darstellen, allerdings zeigte sich in unserer Studiengruppe, dass der XbaI TT-Genotyp gegen CAD schützt. Resumen. Antecedentes: Los resultados de los estudios que tratan de aclarar la asociación de los marcadores genéticos en el gen de la apolipoproteína B (apo B) (polimorfismos EcoRI y XbaI) con la enfermedad arterial coronaria (EAC), no son consistentes y sugieren que el efecto depende del contexto (es dependiente de la etnicidad y del sexo). El presente estudio constituye la primera investigación sobre los polimorfismos del gen apo B en pacientes turcos con EAC y su influencia sobre los niveles lipídicos. Objetivo: El estudio investigó la asociación de los polimorfismos EcoRI y XbaI del gen apo B con la EAC y con la variación en los niveles lipídicos (colesterol total (Col-T), colesterol asociado a lipoproteínas de alta densidad (Col-HDL), colesterol asociado a lipoproteínas de baja densidad (Col-LDL) y triacilglicerol (TAG)). Sujetos y Métodos: El grupo estudiado estaba compuesto por 150 individuos con EAC documentada angiográficamente y 100 controles sanos, comprobados mediante un angiograma. Se utilizó la PCR-RFLP para determinar los polimorfismos del ADN del gen apo B. Resultados: Las frecuencias de los genotipos apo B detectados con EcoRI (AA, AG, GG) y XbaI (CC, CT, TT) no diferían significativamente entre los casos y los controles. Se observó una asociación significativa entre los genotipos EcoRI y los niveles de Col-T (p ≤ 0,05) y Col-LDL (p ≤ 0,001), sólo en pacientes con EAC. Los pacientes con el genotipo AA tenían niveles más altos de Col-T y de Col-LDL séricos comparados con los de genotipo AG. Mediante un análisis de regresión logística se encontró que el genotipo XbaI TT estaba asociado con la prevención de la EAC. Sin embargo, en los pacientes con EAC no se encontraron diferencias significativas en las variables lipídicas para los polimorfismos XbaI. Conclusiones: No se ha encontrado que los genotipos apo B EcoRI sean factores de riesgo para la EAC, mientras que se detectó que el genotipo XbaI TT prevenía contra la EAC en el grupo estudiado.

Can immune parameters be used as predictors to distinguish between pulmonary multidrug-resistant and drug-sensitive tuberculosis?

Introduction Despite the development and wide implementation of Directly Observed Therapy Strategies (DOTS), multidrug-resistant tuberculosis (MDR-TB) remains a serious global health threat. In this study, the role of host immune response in patients with MDR-TB is investigated and compared with that of patients with smear-positive drug-sensitive tuberculosis (SP-TB). Material and methods 27 patients with SP-TB, 20 patients with MDR-TB, and 20 healthy controls were included in the study. Immune parameters were determined by flow cytometry using monoclonal antibodies in order to compare the percentage values of these markers in the two study groups and the control group. Results The levels of lymphocyte subgroups in the gate of CD45(+)/CD14(–) lymphocyte: CD45(+), CD3(+), CD4(+), NK, CD3/HLA-DR, CD 95(+) cells were significantly lower; by contrast CD23(+), CD25(+), CD19(+), CD4(+)/CD8(+), HLA-DR cells were found to be lower, but not significantly so in patients with MDR-TB, compared to levels in patients in the SP-TB and control groups. Besides these findings, the levels of NKT cells and γδ TCR(+) cells were significantly higher in the MDR-TB than in the healthy control and SP-TB group. Conclusions The lower levels of CD3/ HLA-DR, CD4 (+), Fas (+), and NK, and the higher level of NKT together with γδ T cells in patients with MDR-TB compared to those in SP-TB may indicate a profound immune suppression in MDR-TB patients and thereby may denote an accumulation in the bacterial load. Our findings may shed light on the pathogenesis and prognosis of MDR tuberculosis, and may point towards the use of flow cytometry findings as an aid to early diagnosis in MDR-TB patients.