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Carotid Doppler ultrasonographic findings of dapagliflozin use in type 2 diabetic patients
(Taylor & Francis Ltd, 2021) Onmez, Attila; Gokosmanoglu, Feyzi; Baycelebi, Gulsah; Arikan, Ali Ahmet
Aim: Sodium-glucose cotransporter 2 inhibitors have been shown to reduce the risk of cardiovascular disease in type 2 diabetes (T2DM) patients. The purpose of this study was to evaluate cardiovascular disease risk indirectly through Doppler ultrasonography (USG) of carotid artery vascular markers in T2DM patients using dapagliflozin. Methods: One hundred forty-five patients presenting to our clinic between March 2016 and June 2018 and diagnosed with T2DM were included in the study. These were divided into two groups - a dapagliflozin group of 85 patients and a 60-member non-dapagliflozin control group. Common carotid artery end-diastolic velocity (EDV), peak systolic velocity (PSV), and resistive index (RI) parameters were evaluated using Doppler USG in both groups. Results: The mean duration of follow-up was 2.2 +/- 0.4 years. Mean ages were 45 +/- 14 years in the dapagliflozin group and 42 +/- 15 in the control group. Mean HbA1c was 7.4 +/- 1.6 in the dapagliflozin group and 7.3 +/- 2.1 in the control group. Common carotid artery, PSV, and EDV parameters were higher (p = .012/p = .036), while RI was lower (p < .001), in the dapagliflozin group than in the control group. Conclusion: Vascular resistance was lower in the group using dapagliflozin for diabetes management.
A Case of Pulmonary and Central Nervous System Invasive Aspergillosis with Characteristic Radiological Findings
(Soc Turkish Intensivists - Sti, 2024) Akbas, Turkay; Karahan, Fatih; Ogul, Hayri; Onec, Birgul; Onmez, Attila; Unlu, Nisa; Balbay, Ege Gulec
Central nervous system invasive aspergillosis is a rare fatal infection responsible for the majority of brain lesions in immunocompromised patients. A 56-year-old man with diabetes mellitus and non-Hodgkin's lymphoma was admitted to the emergency department with a diagnosis of pneumonia-related sepsis. At presentation, cranial computed tomography (CT) and magnetic resonance imaging were normal, but thoracic CT revealed right lung pneumonia, and antibiotic therapy was initiated. Control CT scans performed on the 13th day of admission because the patient had subsequently become hypotensive and somnolent revealed halo signs in the lungs and multiple hypodense lesions within the cerebrum, consistent with invasive aspergillosis. A post-contrast cranial CT scan also revealed vascular enhancement within the hypodense lesions, known as the central vascular sign. In conclusion, central nervous system aspergillosis can be diagnosed by means of tubular enhanced focuses in hypodense lesions on contrast-enhanced CT scans.
A Case of Pulmonary and Central Nervous System Invasive Aspergillosis With Characteristic Radiological Findings
(Soc Turkish Intensivists - Sti, 2024) Akbas, Turkay; Karahan, Fatih; Ogul, Hayri; Onec, Birgul; Onmez, Attila; Unlu, Nisa; Balbay, Ege Gulec
Central nervous system invasive aspergillosis is a rare and fatal infection that accounts for the majority of brain lesions in immunocompromised patients. A 56-year-old man with diabetes mellitus and non-Hodgkin's lymphoma was admitted to the emergency department with a diagnosis of pneumonia-related sepsis. At presentation, cranial computed tomography (CT) and magnetic resonance imaging were normal. However, thoracic CT revealed right lung pneumonia, and antibiotic therapy was initiated. Control CT scans performed on the 13(th) day of admission-because the patient had subsequently become hypotensive and somnolent- revealed halo signs in the lungs and multiple hypodense lesions within the cerebrum, consistent with invasive aspergillosis. A post-contrast cranial CT scan also revealed vascular enhancement within these hypodense lesions, known as the central vascular sign. In conclusion, central nervous system aspergillosis can be diagnosed by means of tubular enhanced foci in hypodense lesions on contrast-enhanced CT scans.
Chronobiological evaluation and an intervention study on timing of food intake in the treatment of obesity
(Wiley, 2021) Gamsizkan, Zerrin; Onmez, Attila; Sahip Karakas, Tuba
Background The chronotype of patients who cannot reach their ideal weight despite diet and exercise may play a role in this resistance. In this study, the relationship between BMI and chronobiological preferences was examined and a weight loss programme was applied to refractory obese patients with evening type (ET). Method The study included 50 obese (BMI >= 30 kg/m(2)), 50 overweight (BMI = 25-29 kg/m(2)) and 50 normal weight (BMI < 25 kg/m(2)). The patients were asked to fill out a questionnaire including questions about sociodemographic characteristics, breakfast and night eating habits, as well as the morningness-eveningness quastionnaire (MEQ). In the second stage of the study, awareness interviews were held with ET obese patients in terms of eating time and habits. Results A statistically significant difference was observed between the BMI averages and the MEQ scores of ET, intermediate type (IT) and morning type (MT) groups (P = .0001). There was a statistically significant difference between the ET, IT and MT groups in terms of the distribution of late-night eating habits (P = .0001). The habit of skipping breakfast and taking more calories at dinner was found to be high in the ET patients (respectively; P = .021, P < .001). According to the results of the 3-month follow-up and intervention, the ET patients lost an average of 9.07 +/- 4.30 kg and a significant decrease was observed in the BMI scores (P < .001). Conclusions The study results support the idea that an individualised weight loss programme according to the patient's chronotype preferences may increase the success rate of obesity treatment. A weight loss programme that includes the timing of food intake and regulation of eating habits in evening-type obese patients can be used in the treatment of obesity.
Doppler ultrasonographic findings in cases with Hashimoto thyroiditis
(Kuwait Medical Assoc, 2020) Gokosmanoglu, Feyzi; Aksoy, Erkan; Onmez, Attila; Ergenc, Hasan
Objective: To investigate the effect of thyroid-stimulating hormone (TSH) levels on hemodynamic indexes in color doppler ultrasonography in patients with Hashimoto's disease Design: Prospective observational study Setting: Departmant of Endocrinology, Medical Park Hospital, Ordu, Turkey Subjects: One hundred and twelve patients Intervention: The patients were divided into two groups: Group 1, TSH: 0.35-4.94 mIU/L; and Group 2, TSH >4.94 mIU/L. The mean peak systolic velocity (mPSV), mean end diastolic velocity (EDV) and mean resistive index (RI) of the inferior thyroid artery were measured using doppler ultrasonography at the appropriate angle (45-60 degrees C). Main outcome measure: The mPSV, EDV and RI of the inferior thyroid artery Results: A total of 48.21% of the patients (n=54) were in Group 1 and 51.78% of them (n=58) were in Group 2. In our study, we found that as the TSH levels increased, the thyroid blood flow and RI decreased in patients with Hashimoto's disease and with clinical and subclinical hypothyroidism compared with normal ones. Conclusion: The TSH level in Hashimoto's disease and the vascular RI increases as the parenchymal damage increases.
Dynamic Changes in Perioperative Cellular Inflammation and Acute Kidney Injury after Coronary Artery Bypass Grafting
(Soc Brasil Cirurgia Cardiovasc, 2021) Parlar, Hakan; Arikan, Ali Ahmet; Onmez, Attila
Introduction: This study investigated the role of the neutrophillymphocyte ratio (NLR), the perioperative changes in NLR (deltaNLR), the platelet-lymphocyte ratio (PLR), and the platelet count in predicting acute kidney injury (AKI) following coronary artery bypass grafting (CABG) during hospital stay. Methods: The records of 396 patients with preoperative creatinine < 1.5 mg/dl undergoing isolated CABG between October 2015 and October 2019 were reviewed retrospectively. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes definition. Demographic data, operative data, inhospital mortality, preoperative NLR, PLR, and platelet counts were compared between patients with (AKI group) and without (nonAKI group) postoperative AKI. Additionally, NLR, delta-NLR, and PLR values were calculated daily for the first four postoperative days. A subsequent AKI group was formed for the first four postoperative days by excluding patients diagnosed with AKI. The daily and overall predictivity of the markers for AKI are investigated. Results: AKI was present in 86 patients during the postoperative period, while 310 patients had normal postoperative renal functions. NLR, delta-NLR, and PLR on the first four postoperative days (P<0.001 for all) were significantly associated with the development of AKI in subsequent days. Multivariate analysis identified postoperative NLR (odds ratio 1.17, 95% confidence interval 1.11-1.23; P<0.001) as an independent predictor of AKI. PLR lost its significant association with AKI at the values measured at discharge from hospital (P>0.05). Conclusion: NLR values measured on the first four days postoperatively are a useful tool in predicting AKI during hospital stay following CABG.
The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey
(Elsevier Sci Ltd, 2020) Onmez, Attila; Gamsizkan, Zerrin; Ozdemir, Seyma; Kesikbas, Enis; Gokosmanoglu, Feyzi; Torun, Serkan; Cinemre, Hakan
Background and aims: A national lockdown to prevent the spread of coronavirus disease (COVID-19) in Turkey was introduced in March 2020. We think that lockdowns may lead to weight gain and worsening of glycemic parameters in patients with type 2 diabetes mellitus (DM). The purpose of this study was to investigate how type 2 DM patients were affected by the lockdown. Method: Type 2 DM patients unable to attend regular follow-ups due to lockdown over a 75-day period between March and June 2020 and who again attended polyclinic follow-up when the lockdown was lifted were included in the study. These patients' glycemic control and weight status were compared with the pre-lockdown period. In addition, patients' general habits, and adherence to diet and exercise were evaluated, while their general health was assessed using the Short-Form 36-item survey. Result: The research involved 101 type 2 DM patients, 57 men (56.5%) and 44 women (44.5%), with a mean age of 55 +/- 13. Patients' mean pre-lockdown weight was 84.7 +/- 16.4 kg, rising to 85.5 +/- 16.8 kg post-lockdown, although the increase was not statistically significant (p = 0.781). In terms of glycemic parameters, Hba1c rose from 7.67 +/- 1.76 to 8.11 +/- 2.48, and fasting glucose from 157.9 (83-645) mg/dl to 163.2 (84-550) mg/dl, none of which were statistically significant (p = 0.253, p = 0.079, respectively). Conclusion: In addition to weight gain among type 2 DM patients during the Covid 19 lockdown, statistically insignificant increases were also observed in such glycemic parameters. This was a small sample and further studies with larger sample are needed. (C) 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Efficacy of Epinephrine Injection in Preventing Post-ERCP Pancreatitis
(Lippincott Williams & Wilkins, 2021) Torun, Serkan; Odemis, Bulent; Cetin, Mehmet F.; Onmez, Attila; Coskun, Orhan
Background: Rectal indomethacin or a topical spray of epinephrine to the papilla of Vater has each shown efficacy alone in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We supposed that a submucosal epinephrine injection would be more effective and longer acting than a topical epinephrine spray and therefore would further reduce the incidence of PEP. Patients and Methods: A retrospective analysis was conducted of 412 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2017 and December 2019. These patients were divided into 2 groups: the indomethacin group and the indomethacin plus the submucosal epinephrine injection group. The incidence rates and severity of PEP, post-ERCP hyperamylasemia, other outcomes, and any other adverse events were compared between the groups. Results: Baseline demographic and clinical characteristics and procedure-related parameters were similar between the 2 groups. The incidence of PEP was 0.4% in the epinephrine group compared with 5.1% in the indomethacin group (P <0.001). Post-ERCP hyperamylasemia occurred in 24.6% of patients in the indomethacin group, whereas 7.6% of patients in the epinephrine group developed this condition; the difference was significant (P <0.001). Postsphincterotomy bleeding occurred in 5 patients, all of whom were in the indomethacin group (P < 0.001). Other adverse events, including arrhythmias, acute coronary events, stroke, or hypertension were not significantly different between the 2 groups. Conclusion: Addition of a submucosal epinephrine injection in conjunction with rectal indomethacin significantly reduced the incidence of PEP, post-ERCP hyperamylasemia, and post-sphincterotomy bleeding.
The Relationship Between Hyperplastic Gastric Polyps And Helicobacter Pylori
(Duzce Univ, 2021) Erdal, Harun; Sakin, Yusuf Serdar; Cetin, Mehmet Fuat; Celik, Bulent; Onmez, Attila; Uygun, Ahmet; Gulsen, Mustafa
Objective: Helicobacter pylori (H. pylori) is a gram-negative bacterium. It is urease positive, mobile, microaerophilic, and spiral-shaped, and it settles in the stomach and the proximal duodenum. It is associated with chronic gastritis, stomach ulcers, duodenal ulcers, stomach cancer, and MALT lymphoma. It can also cause premalignant lesions, such as metaplasia and gastric atrophy. Although several studies are investigating the correlation between H. pylori and hyperplastic polyps (HPs) of the stomach, uncertainty in this regard continues. Methods: Data from 5378 patients who underwent esophagogastroduodenoscopy at the Department of Gastroenterology, Gulhane Training and Research Hospital, University Of Health Sciences between October 2016 and March 2019 were retrospectively analyzed, and patients with gastric polyps were evaluated for polyp pathologies and normal mucosa biopsies. Results: Sixty-one stomach polyps were detected in 49 patients after the retrospective analysis of the data between October 2016 and March 2019. Of the polyps found, 36 were hyperplastic (73%). There was no statistically significant difference between HPs and the presence of H. pylori, age, gender, anatomical location of polyps in the stomach, size, number, presence of metaplasia, or atrophy. The mean age was statistically lower in H. pylori-positive cases. Conclusions: No correlation was observed between HPs and the presence of H. pylori. There is a need for more extensive, multi-centered, and prospective studies evaluating the relationship between HPs and H. pylori.
The relationship between Vitamin D deficiency and polycystic ovary syndrome
(Makerere Univ, Fac Med, 2020) Gokosmanoglu, Feyzi; Onmez, Attila; Ergenc, Hasan
Background: Vitamin D deficiency is frequently seen in patients with polycystic ovary syndrome (PCOS) and has been shown to exhibit multiple effects on the disease process. The purpose of this study was to investigate the role of vitamin D deficiency in complex PCOS pathophysiological pathways. Methods: Two hundred sixty-seven patients with PCOS were divided into two groups Group 1 with 25(OH)D3 deficiency, and Group 2 with normal 25(OH)D3. Biochemical and hormonal parameters (androgen hormones, gonadotropins, and thyroid function tests) were compared between the two groups. Results: Eighty-six percent of the patients (n=231) were in Group 1 and 14% (n=36) in Group 2. Statistically significantly higher concentrations of serum testosterone, dehydroepiandrosterone-sulfate and LH were determined in Group 1 (p<0.05). 25(OH)D3 concentrations were negatively correlated with body mass index (r=-0.459), serum testosterone (r =-0.374) and dehydroepiandrosterone-sulfate levels (r=-0.418); (all; p< 0.05). Conclusion: The study findings show that low 25(OH)D3 levels are associated with high androgen levels in women with PCOS. Vitamin D deficiency should be considered as an additional risk factor in the development of PCOS. We think that providing vitamin D supplementation for women from identified deficiency areas can reduce the risk of PCOS development.
Residual Gastric Volume Relationship and Weight Loss After Laparoscopic Sleeve Gastrectomy
(Springer, 2020) Dogan, Sami; Onmez, Attila; Cetin, Mehmet Fuat; Ozaydin, Ismet; Pehlivan, Mevlut
Background Laparoscopic sleeve gastrectomy (LSG) has become a popular procedure for treating obesity. Excessive residual gastric volume (RGV) may be one cause of insufficient weight loss following this surgery. The purpose of this study was to investigate the relationship between weight loss and the RGV measured during surgery over a 2-year follow-up period. Methods All patients undergoing LSG at our university surgery department were included in this prospective observational study. During the operation, the pylorus was grasped with a laparoscopic clamp, and saline solution dyed with methylene blue was introduced using an intraluminal glass-tipped injector when the residual stomach became fully visible. The amount of fluid given when the remaining gastric tissue ceased expanding was noted. The patients were divided into three groups depending on the volume of the residual gastric tissue. Percentages of excess weight loss (EWL%) were also evaluated 6, 12, and 24 months after the LSG. Results Sixty-two patients (50 females and 12 males) with a mean age of 36 (17-56) years were included in the study. There was no significant difference between the preoperative and postoperative body mass index values (p = 0.407 and p = 0.337, respectively) or between the preoperative and postoperative weight (p = 0.081 and p = 0.517, respectively) among the groups. A comparison of the participants' weight losses and EWL% values after 6, 12, and 24 months of follow-up revealed no significant difference among the groups at any time point (p > 0.005). Conclusion Greater weight loss was observed as the RGV decreased over the 24-month follow-up period. However, that weight loss was not statistically significant.
Serum seladin-1 levels in diabetes mellitus and Alzheimer's disease patients
(Springer Heidelberg, 2020) Onmez, Attila; Alpay, Merve; Torun, Serkan; Sahin, I. Ethem; Onec, Kursad; Degirmenci, Yildiz
Background Diabetes mellitus (DM) has been shown to increase the risk of Alzheimer's disease (AD). Downregulation of selective Alzheimer's disease indicator-1 (seladin-1) occurs in the cerebral regions affected by AD. However, inconsistent results have been reported for the relationship between seladin-1 levels and AD. The effect of DM on serum seladin-1 levels in AD is unknown. The present study is aimed to investigate serum seladin-1 levels in diabetic and non-diabetic patients with AD. Methods Forty-six patients with AD and 25 healthy volunteers over 65 years of age were included in this study. The patients were divided into three groups-those with AD only, those with DM and AD, and control groups. Demographic characteristics and serum seladin-1 levels were compared among the groups. Results There was no statistically significant difference in seladin-1 levels in the AD only group compared to the control group (p = 0.376). However, seladin-1 levels were significantly lower in the DM and AD group compared to the AD only and control groups (p = 0.002, p = 0.001; respectively). Negative correlations were present between seladin-1 and fasting glucose, postprandial glucose, HbA1c, and insulin (p < 0.05; all). Conclusion Decreased serum seladin-1 values in the presence of DM and inverse correlations with diabetic parameters in patients with AD, together with a non-significant difference from the control group, suggests that seladin-1 may be altered only in the presence of DM in patients with AD. Lower serum seladin-1 levels may also play a role in the pathogenesis of AD in patients with DM.
Thyroid Homeostasis After Bariatric Surgery in Obese Cases
(Springer, 2020) Gokosmanoglu, Feyzi; Aksoy, Erkan; Onmez, Attila; Ergenc, Hasan; Topkaya, Sibel
Background The aim of this study was to determine changes in thyroid hormones and morphology with weight loss after bariatric surgery in obese patients. Methods This prospective study was performed in our endocrinology and surgery clinic. Pre- and post-bariatric surgery thyroid function tests and thyroid ultrasonography parameters were compared. Results Four hundred seventy-two patients were included in the study. Mean weight loss after surgery was 30.7 +/- 5.1 kg. TSH levels decreased statistically significantly parallel with weight loss and decreased BMI (p = 0.025) after bariatric surgery. However, no statistically significant change was observed in fT4 or fT3 levels (p > 0.05). A significant increase in thyroid parenchyma echogenicity, correlated with weight loss and time elapsed since surgery, was detected at ultrasonography (US) grayscale histogram analysis compared with muscle echogenicity (p = 0.032). An increase in echogenicity was even detected in patients with isoechoic thyroid parenchyma before surgery. Fasting insulin and HOMA-IR levels decreased after surgery (p = 0.010 and p = 0.001, respectively). Patients were divided into three groups based on weight loss. In group 3, preoperative TSH of 4.1 +/- 0.7 decreased to 1.6 +/- 0.7 postoperatively (p = 0.001), while preoperative HOMA-IR of 4.9 +/- 1.9 decreased to 2.4 +/- 0.8 postoperatively (p = 0.001). Conclusions Obesity causes thyroid hormone resistance through a mechanism similar to insulin resistance and leads to an increase in TSH similar to hyperinsulinemia. Our findings show that echogenicity at thyroid US increases in line with weight loss following bariatric surgery.

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