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Doğan ME, Bilgin AB, Sari R, Bulut M, Akar Y, Aydemir M. Head to head comparison of diagnostic performance of three non-mydriatic cameras for diabetic retinopathy screening with artificial intelligence. Eye (Lond) 2024:10.1038/s41433-024-03000-9. [PMID: 38467864 DOI: 10.1038/s41433-024-03000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Diabetic Retinopathy (DR) is a leading cause of blindness worldwide, affecting people with diabetes. The timely diagnosis and treatment of DR are essential in preventing vision loss. Non-mydriatic fundus cameras and artificial intelligence (AI) software have been shown to improve DR screening efficiency. However, few studies have compared the diagnostic performance of different non-mydriatic cameras and AI software. METHODS This clinical study was conducted at the endocrinology clinic of Akdeniz University with 900 volunteer patients that were previously diagnosed with diabetes but not with diabetic retinopathy. Fundus images of each patient were taken using three non-mydriatic fundus cameras and EyeCheckup AI software was used to diagnose more than mild diabetic retinopathy, vision-threatening diabetic retinopathy, and clinically significant diabetic macular oedema using images from all three cameras. Then patients underwent dilation and 4 wide-field fundus photography. Three retina specialists graded the 4 wide-field fundus images according to the diabetic retinopathy treatment preferred practice patterns of the American Academy of Ophthalmology. The study was pre-registered on clinicaltrials.gov with the ClinicalTrials.gov Identifier: NCT04805541. RESULTS The Canon CR2 AF AF camera had a sensitivity and specificity of 95.65% / 95.92% for diagnosing more than mild DR, the Topcon TRC-NW400 had 95.19% / 96.46%, and the Optomed Aurora had 90.48% / 97.21%. For vision threatening diabetic retinopathy, the Canon CR2 AF had a sensitivity and specificity of 96.00% / 96.34%, the Topcon TRC-NW400 had 98.52% / 95.93%, and the Optomed Aurora had 95.12% / 98.82%. For clinically significant diabetic macular oedema, the Canon CR2 AF had a sensitivity and specificity of 95.83% / 96.83%, the Topcon TRC-NW400 had 98.50% / 96.52%, and the Optomed Aurora had 94.93% / 98.95%. CONCLUSION The study demonstrates the potential of using non-mydriatic fundus cameras combined with artificial intelligence software in detecting diabetic retinopathy. Several cameras were tested and, notably, each camera exhibited varying but adequate levels of sensitivity and specificity. The Canon CR2 AF emerged with the highest accuracy in identifying both more than mild diabetic retinopathy and vision-threatening cases, while the Topcon TRC-NW400 excelled in detecting clinically significant diabetic macular oedema. The findings from this study emphasize the importance of considering a non mydriatic camera and artificial intelligence software for diabetic retinopathy screening. However, further research is imperative to explore additional factors influencing the efficiency of diabetic retinopathy screening using AI and non mydriatic cameras such as costs involved and effects of screening using and on an ethnically diverse population.
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Affiliation(s)
- Mehmet Erkan Doğan
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
| | - Ahmet Burak Bilgin
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ramazan Sari
- Endocrinology and Metabolic Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mehmet Bulut
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yusuf Akar
- Endocrinology and Metabolic Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mustafa Aydemir
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Kargun S, Aydemir M, Yilmaz N, Ozdem S, Sari R. Diagnostic value of thyroglobulin washout in fine-needle aspiration samples for diagnosis and follow-up of differentiated thyroid cancer. Medicine (Baltimore) 2023; 102:e36426. [PMID: 38065908 PMCID: PMC10713132 DOI: 10.1097/md.0000000000036426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
Our goal was to assess the effectiveness of fine-needle aspiration thyroglobulin (FNA-Tg) in detecting malignant lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC). We also aimed to determine the factors that affect the accuracy of FNA-Tg. We conducted a retrospective cohort study using the laboratory, ultrasonographic, histopathological, FNA cytology (FNA-C), and FNA-Tg results of 176 DTC patients. We used receiver operating characteristic analysis to identify the cutoff value of FNA-Tg, and binary regression analysis to compare FNA-Tg with other diagnostic parameters. Spearman correlation was utilized to identify factors that influence FNA-Tg. Our study revealed that a cutoff value of 3.14 ng/mL for FNA-Tg had a sensitivity of 91.8% and a specificity of 96.6% in detecting malignant LNs in the entire group. In the subgroup with thyroid tissue, the optimal cutoff value for FNA-Tg was determined to be 15.5 ng/mL. Additionally, FNA-C had a sensitivity of 82.4% and a specificity of 99.4% for the entire group. The combined use of FNA-Tg and FNA-C yielded a sensitivity of 100% and a specificity of 96%, which was found to be more effective than using either test alone. Serum Tg positivity and serum thyroid-stimulating hormone were positively correlated with FNA-Tg levels in detecting malignant LNs. Our study demonstrated that FNA-Tg is a reliable method for detecting LN metastases in DTC patients, with a 3.14 ng/mL cutoff value. However, each center should take into account factors such as serum thyroid-stimulating hormone, serum Tg, and the presence of thyroid tissue when interpreting FNA-Tg results and determining the appropriate cutoff level.
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Affiliation(s)
- Sinem Kargun
- Department of Endocrinology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mustafa Aydemir
- Department of Endocrinology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nusret Yilmaz
- Department of Endocrinology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Sebahat Ozdem
- Department of Biochemistry, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ramazan Sari
- Department of Endocrinology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Foulds C, Royston S, Berker T, Nakopoulou E, Bharucha ZP, Robison R, Abram S, Ančić B, Arapostathis S, Badescu G, Bull R, Cohen J, Dunlop T, Dunphy N, Dupont C, Fischer C, Gram-Hanssen K, Grandclément C, Heiskanen E, Labanca N, Jeliazkova M, Jörgens H, Keller M, Kern F, Lombardi P, Mourik R, Ornetzeder M, Pearson PJG, Rohracher H, Sahakian M, Sari R, Standal K, Živčič L. An agenda for future Social Sciences and Humanities research on energy efficiency: 100 priority research questions. Humanit Soc Sci Commun 2022; 9:223. [PMID: 35791377 PMCID: PMC9245879 DOI: 10.1057/s41599-022-01243-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Decades of techno-economic energy policymaking and research have meant evidence from the Social Sciences and Humanities (SSH)-including critical reflections on what changing a society's relation to energy (efficiency) even means-have been underutilised. In particular, (i) the SSH have too often been sidelined and/or narrowly pigeonholed by policymakers, funders, and other decision-makers when driving research agendas, and (ii) the setting of SSH-focused research agendas has not historically embedded inclusive and deliberative processes. The aim of this paper is to address these gaps through the production of a research agenda outlining future SSH research priorities for energy efficiency. A Horizon Scanning exercise was run, which sought to identify 100 priority SSH questions for energy efficiency research. This exercise included 152 researchers with prior SSH expertise on energy efficiency, who together spanned 62 (sub-)disciplines of SSH, 23 countries, and a full range of career stages. The resultant questions were inductively clustered into seven themes as follows: (1) Citizenship, engagement and knowledge exchange in relation to energy efficiency; (2) Energy efficiency in relation to equity, justice, poverty and vulnerability; (3) Energy efficiency in relation to everyday life and practices of energy consumption and production; (4) Framing, defining and measuring energy efficiency; (5) Governance, policy and political issues around energy efficiency; (6) Roles of economic systems, supply chains and financial mechanisms in improving energy efficiency; and (7) The interactions, unintended consequences and rebound effects of energy efficiency interventions. Given the consistent centrality of energy efficiency in policy programmes, this paper highlights that well-developed SSH approaches are ready to be mobilised to contribute to the development, and/or to understand the implications, of energy efficiency measures and governance solutions. Implicitly, it also emphasises the heterogeneity of SSH policy evidence that can be produced. The agenda will be of use for both (1) those new to the energy-SSH field (including policyworkers), for learnings on the capabilities and capacities of energy-SSH, and (2) established energy-SSH researchers, for insights on the collectively held futures of energy-SSH research.
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Affiliation(s)
- Chris Foulds
- Global Sustainability Institute, Anglia Ruskin University, Cambridge, UK
| | - Sarah Royston
- Global Sustainability Institute, Anglia Ruskin University, Cambridge, UK
| | - Thomas Berker
- Department of Interdisciplinary Studies of Culture, Centre for Technology and Society, Norwegian University of Science and Technology, Trondheim, Norway
| | - Efi Nakopoulou
- Department of History and Philosophy of Science, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Rosie Robison
- Global Sustainability Institute, Anglia Ruskin University, Cambridge, UK
| | - Simone Abram
- Department of Anthropology, and Durham Energy Institute, Durham University, Durham, UK
| | - Branko Ančić
- Institute for Social Research in Zagreb, Zagreb, Croatia
| | - Stathis Arapostathis
- Department of History and Philosophy of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel Badescu
- Department of Political Sciences, Babeş-Bolyai University of Cluj, Cluj-Napoca, Romania
| | - Richard Bull
- School of Architecture, Design and the Built Environment, Nottingham Trent University, Nottingham, UK
| | - Jed Cohen
- Salt River Project Integrated System Planning & Support, Tempe, AZ USA
| | - Tessa Dunlop
- Unit H1 Knowledge for Policy: Concepts and Methods, European Commission, Directorate-General Joint Research Centre, Ispra, Italy
| | - Niall Dunphy
- School of Engineering and Architecture, and Environmental Research Institute, University College Cork, Cork, Ireland
| | - Claire Dupont
- Department of Public Governance and Management, Ghent University, Ghent, Belgium
| | - Corinna Fischer
- Sustainable Products and Material Flows Division, Oeko-Institut e.V., Darmstadt, Germany
| | - Kirsten Gram-Hanssen
- Department of the Built Environment, Aalborg University Copenhagen, Copenhagen, Denmark
| | - Catherine Grandclément
- Research Group on Energy, Technology and Society, Électricité de France (EDF), Paris, France
| | - Eva Heiskanen
- Centre for Consumer Society Research, University of Helsinki, Helsinki, Finland
| | | | - Maria Jeliazkova
- Department of Public Policies and Social Changes, Institute of Philosophy and Sociology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Helge Jörgens
- Department of Political Science and Public Policy, Iscte—Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Margit Keller
- Institute of Social Studies, University of Tartu, Tartu, Estonia
| | - Florian Kern
- Ecological Economics and Environmental Policy, Institute for Ecological Economy Research, Berlin, Germany
| | - Patrizia Lombardi
- Urban & Regional Inter-university Department, Politecnico di Torino, Turin, Italy
| | | | - Michael Ornetzeder
- Institute of Technology Assessment, Austrian Academy of Sciences, Vienna, Austria
| | - Peter J. G. Pearson
- Centre for Environmental Policy, Imperial College London, London, UK
- School of Architecture, Cardiff University, Cardiff, UK
| | - Harald Rohracher
- Department of Thematic Studies—Technology and Social Change, Linköping University, Linköping, Sweden
| | - Marlyne Sahakian
- Department of Sociology, University of Geneva, Geneva, Switzerland
| | - Ramazan Sari
- Department of Technology, Management and Economics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Karina Standal
- CICERO—Center for International Climate Research, Oslo, Norway
| | - Lidija Živčič
- Focus Association for Sustainable Development, Ljubljana, Slovenia
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Altinoz MA, Sari R, Elmaci I. From Aspirin, via Gentisic Acid to Cancer Chemoprevention. Eur J Cancer Prev 2021; 31:S6. [PMID: 37657898 DOI: 10.1097/01.cej.0000816664.59224.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Meric A Altinoz
- Department of Medical Biochemistry, Acibadem M.A.A. University, Istanbul, Turkey
| | - Ramazan Sari
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ilhan Elmaci
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
- Department of Neurosurgery, Acibadem M.A.A. University, Istanbul, Turkey
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Yilmaz N, Tazegul G, Sari R, Avsar E, Altunbas H, Balci M. EFFECTIVENESS OF UNILATERAL ADRENALECTOMY IN BILATERAL ADRENAL INCIDENTALOMA PATIENTS WITH SUBCLINICAL HYPERCORTISOLEMIA. Acta Endocrinol (Buchar) 2021; 17:479-485. [PMID: 35747873 PMCID: PMC9206144 DOI: 10.4183/aeb.2021.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Unilateral adrenalectomy (UA) is an alternative for treatment in bilateral adrenal incidentaloma (AI) to avoid possible long-term risks of bilateral adrenalectomy. In this study, we aimed to evaluate the effectiveness of UA in bilateral AI patients with subclinical hypercortisolemia (SH). METHOD A total of 35 patients were included in this study. The patients were divided into two groups; those who underwent UA (n=27) and patients without adrenalectomy (PWA) (n=8). Hormone tests related to cortisol mechanism were reviewed to analyze results at the time of diagnosis compared to the latest available results to figure out any changes in cortisol mechanism and determine whether SH has recovered or not. RESULTS Median age of PWA group were higher compared to UA group (p=0.03). Median duration of follow-up in groups were similar (p=0.3). In the PWA group, none of the patients recovered from hypercortisolemia during their follow-up. In UA group 92.6% of the patients went into remission, whereas during follow-up 3.3% had recurred and another 3.3% were found to have post-adrenalectomy persistent SH. Patients in UA group had lower final cortisol level following dexamethasone suppression (p=0.003) and higher final adrenocorticotrophic hormone (ACTH) levels (p=0.001) than patients in PWA group. In UA group, final basal cortisol level (p=0.009) and final cortisol level after 1 mg dexamethasone suppression test (DST) (p=0.004) were lower than corresponding levels at the time of diagnosis. DISCUSSION Our study demonstrates unilateral adrenalectomy targeting the side with the larger lesion is an effective approach to reduce excess cortisol levels in bilateral AI patients with SH.
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Affiliation(s)
- N. Yilmaz
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - G. Tazegul
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkey
| | - R. Sari
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - E. Avsar
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkey
| | - H. Altunbas
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - M.K. Balci
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
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Sari R, Altinoz MA, Ozyar E, Danyeli AE, Elmaci I. A pediatric cerebral tumor with MN1 alteration and pathological features mimicking carcinoma metastasis: may the terminology "high grade neuroepithelial tumor with MN1 alteration" still be relevant? Childs Nerv Syst 2021; 37:2967-2974. [PMID: 34269865 DOI: 10.1007/s00381-021-05289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Astroblastoma, MN1-altered (old name: high-grade neuroepithelial tumor/HGNET with MN1 alteration) is a recently described central nervous system tumor mostly affecting pediatric patients and profoundly young girls. Differential pathological diagnoses of these tumors include ependymoma, pleomorphic xanthoastrocytoma, embryonal tumor with multilayered rosettes, meningioma, and even glioblastoma. As the treatment approaches to these tumors differ, it is essential to increase the awareness about these tumors in the neurosurgical community. CLINICAL PRESENTATION A 7-year-old female patient admitted with a 7-day history of headache, nausea, and vomiting. A contrasted MRI scan revealed a left parietal 4 × 4 × 5 cm mass with central necrosis and peripheral contrast enhancement. The tumor's histopathological findings were suggestive of a metastatic carcinoma with unknown primary, yet further genetic analysis revealed MN1 alteration. Peculiarly, the tumor pathomorphological features were not compatible with astroblastomas and exerted features strongly indicating a metastatic cancer; however, systemic PET and whole-body MRI failed to detect a primary malignancy. OUTCOME AND CONCLUSIONS Eighteen months after gross-total tumor resection, an in-field and out-field multifocal recurrence developed which required a second surgery and subsequent chemo-radiotherapy. The patient is doing well for 1 year after the second treatment regimen at the time of this report. Despite the final cIMPACT6 classification in 2020 advised to define all MN1 altered brain tumors as astroblastomas, there exist prognostic differences in MN1-altered tumors with and without morphological features of astroblastoma. Rare morphological variants of MN1-altered tumors shall be recognized for their future prognostic and clinical classification. HGNET with MN1 alteration seems still be a more proper definition of such malignancies as an umbrella term.
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Affiliation(s)
- Ramazan Sari
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Meric A Altinoz
- Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ayca Ersen Danyeli
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ilhan Elmaci
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey. .,Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
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Altin O, Kaya S, Sari R, Altuntas YE, Baris B, Kucuk HF. Surgical results of Hartmann procedure in emergency cases with left-sided colorectal cancer. CIR CIR 2021; 89:150-155. [PMID: 33784281 DOI: 10.24875/ciru.20000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to define indication of Hartmann procedure (HP) under emergency conditions, analyze, and present in which cases this procedure should be used. METHODS The patients who underwent emergency surgery for colorectal cancer were analyzed. Rates of mortality, overall, and disease-free survival of the patients were evaluated. The colostomy closure rate, operative mortality, and surgical complications of the secondary operation performed after the HP were also assessed. RESULTS Fifty-seven patients who underwent HP were included in the study. The indications were obstruction (n = 37) or perforation (n = 20). The post-operative mortality and morbidity rates were 21.1% and 63.2%, respectively. The 1-, 3-, and 5-year survival rates for all patients were 54%, 49%, and 45%. CONCLUSION HP can be a life-saving procedure in cases of high risk, emergency colorectal disease. Surgeons create a temporary stoma as a part of this procedure that is generally closed with a second operation. However, it is not possible to close the stoma in some cases, and the potential physical and emotional issues related to the stoma should be a part of the surgeon's considerations.
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Affiliation(s)
- Onder Altin
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Kaya
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Sari
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Yunus E Altuntas
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Baver Baris
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan F Kucuk
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Yilmaz N, Cansu GB, Toru S, Sari R, Ocak GG, Arici C, Altunbas HA, Balci MK. Cytopathology-histopathology correlation and the effect of nodule diameter on diagnostic performance in patients undergoing thyroid fine-needle aspiration biopsy. J Cancer Res Ther 2021; 16:S53-S58. [PMID: 33380652 DOI: 10.4103/jcrt.jcrt_219_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Although thyroid fine-needle aspiration biopsy (FNAB) is established to have a good overall sensitivity and specificity, various outcomes have been reported on its performance in large nodules. The aim of the study was to evaluate the diagnostic performance of FNAB and the effect of the nodule diameter on its diagnostic performance. Materials and Methods The outcomes of a total of 7319 patients who underwent FNAB over the course of 5 years were analyzed retrospectively and 648 patients who had undergone post-FNAB thyroidectomy or lobectomy were included in the study. FNAB results were classified according to the Bethesda system. After evaluating the compatibility between cytology and pathology results, all-nodules and diameter-based (<4 cm and ≥4 cm) sensitivity, specificity, false positivity, false negativity, and accuracy rates of FNAB were calculated. Results Sensitivity of FNAB was 85.4% for all nodules, 88.3% for nodules <4 cm, and 75.8% for nodules >4 cm (P < 0.001). Specificity was 58.4% for all nodules, 49.3% for nodules <4 cm, and 75.1% for nodules >4cm (P < 0.001). While false positivity was 41.6% for all nodules, it was 50.7% for nodules smaller than 4 cm and was 24.9% for nodules larger than 4 cm (P < 0.001). False negativity was 14.6% for all nodules and was 11.7% for nodules smaller than 4 cm and 24.2% for nodules larger than 4 cm (P < 0.001). Finally, among the entire set of nodules, the accuracy was 64.4%, which was 59.2% in nodules smaller than 4 cm, and 75.2% in nodules larger than 4 cm (P < 0.001). Conclusion Despite a higher rate of false negativity, FNAB has higher specificity and accuracy in large nodules than those in the small nodules. Nodule diameter should not be used alone as a criterion to recommend thyroidectomy to the patient.
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Affiliation(s)
- Nusret Yilmaz
- Division of Endocrinology and Metabolism, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Guven Baris Cansu
- Division of Endocrinology and Metabolism, Yunusemre State Hospital, Eskisehir, Turkey
| | - Serap Toru
- Department of Pathology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ramazan Sari
- Division of Endocrinology and Metabolism, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Guzide Gokhan Ocak
- Department of Pathology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Cumhur Arici
- Department of Surgery, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Hasan Ali Altunbas
- Division of Endocrinology and Metabolism, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Mustafa Kemal Balci
- Division of Endocrinology and Metabolism, School of Medicine, Akdeniz University, Antalya, Turkey
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Yabanoglu H, Sari R, Eksi Haydardedeoglu F, Kus M, Hargura AS, Arer IM. Preoperative Therapeutic Plasma Exchange and Surgical Treatment in Thyrotoxicosis Patients: A Single-Centre Retrospective Cohort Study. Acta Endocrinol (Buchar) 2021; 17:346-350. [PMID: 35342473 DOI: 10.4183/aeb.2021.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Context Therapeutic plasma exchange (TPE) provides time for thyroidectomy in thyrotoxic patients. Objective TPE is indicated in cases where antithyroid medications cannot be used due to the side effects or attain no adequate hormonal suppression response at the highest dosage and in cases of rapid onset of clinical symptoms. This study presents the treatment results of patients who underwent TPE and were subsequently operated for thyrotoxicosis. Design The patients who underwent thyroidectomy and TPE between January 1999 and February 2019 were retrospectively analyzed. Subjects and Methods The files of 27 patients with thyrotoxicosis who performed TPE prior to surgery were analyzed in relation to the demographic and clinical features. Results We included 15 (55.6%) females, 12 (44.4%) males with a mean age of 44 (23-82) years. The pre-TPE mean free thyroxine (fT4) level was 12 (5-46) pmol/L while free tri-iodothyronine (fT3) level was 34 (17-141) pmol/L. The post-TPE fT4 level was 6 (3-10) pmol/L while the fT3 level was 21 (12-41). There was one case of an allergic reaction during the procedure. In the postoperative follow-up, there was transient hypocalcemia in 8 (29%) patients, permanent hypocalcemia in 1 (3.7%) patient, and surgical site infection in 1 (3.7%) patient. Conclusion Preoperative TPE is an alternative treatment option for thyrotoxic patients. This is an especially effective treatment for patients with inadequate response or adverse reaction to antithyroid drugs or patients who need urgent surgery for thyroid storm.
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Affiliation(s)
- H Yabanoglu
- Baskent University, "Dr. Turgut Noyan" Teaching and Research Center, Department of General Surgery, Adana, Turkey
| | - R Sari
- Baskent University, "Dr. Turgut Noyan" Teaching and Research Center, Department of General Surgery, Adana, Turkey
| | | | - M Kus
- Baskent University, "Dr. Turgut Noyan" Teaching and Research Center, Department of General Surgery, Adana, Turkey
| | - A S Hargura
- Baskent University, "Dr. Turgut Noyan" Teaching and Research Center, Department of General Surgery, Adana, Turkey
| | - I M Arer
- Baskent University, "Dr. Turgut Noyan" Teaching and Research Center, Department of General Surgery, Adana, Turkey
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Sari R, Altinoz MA, Ozlu EBK, Sav A, Danyeli AE, Baskan O, Er O, Elmaci I. Treatment Strategies for Dopamine Agonist-Resistant and Aggressive Prolactinomas: A Comprehensive Analysis of the Literature. Horm Metab Res 2021; 53:413-424. [PMID: 34282593 DOI: 10.1055/a-1525-2131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite most of the prolactinomas can be treated with endocrine therapy and/or surgery, a significant percentage of these tumors can be resistant to endocrine treatments and/or recur with prominent invasion into the surrounding anatomical structures. Hence, clinical, pathological, and molecular definitions of aggressive prolactinomas are important to guide for classical and novel treatment modalities. In this review, we aimed to define molecular endocrinological features of dopamine agonist-resistant and aggressive prolactinomas for designing future multimodality treatments. Besides surgery, temozolomide chemotherapy and radiotherapy, peptide receptor radionuclide therapy, estrogen pathway modulators, progesterone antagonists or agonists, mTOR/akt inhibitors, pasireotide, gefitinib/lapatinib, everolimus, and metformin are tested in preclinical models, anecdotal cases, and in small case series. Moreover, chorionic gonadotropin, gonadotropin releasing hormone, TGFβ and PRDM2 may seem like possible future targets for managing aggressive prolactinomas. Lastly, we discussed our management of a unique prolactinoma case by asking which tumors' proliferative index (Ki67) increased from 5-6% to 26% in two subsequent surgeries performed in a 2-year period, exerted massive invasive growth, and secreted huge levels of prolactin leading up to levels of 1 605 671 ng/dl in blood.
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Affiliation(s)
- Ramazan Sari
- Department of Neurosurgery, Acibadem Hospital, Maslak, Istanbul, Turkey
- Avrasya University, Health Sciences Faculty, Trabzon, Turkey
| | - Meric A Altinoz
- Department of Biochemistry, Acibadem University, Istanbul, Turkey
| | | | - Aydin Sav
- Department of Pathology, Yeditepe University, Istanbul, Turkey
| | - Ayca Ersen Danyeli
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ozdil Baskan
- Department of Radiology, Memorial Hospital, Istanbul, Turkey
| | - Ozlem Er
- Department of Medical Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ilhan Elmaci
- Department of Neurosurgery, Acibadem Hospital, Maslak, Istanbul, Turkey
- Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
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Ertugrul DT, Kan E, Tura CB, Tugtekin HB, Ayakta H, Celebioglu M, Yılmaz C, Utebay O, Yetkin I, Gurkan E, Sezer K, Gen R, Ozcaylak S, Okuturlar Y, Coskun M, Giynas NG, Aysal H, Erdem AS, Aydemir M, Bakiner O, Cicekli E, Gezer D, Kaya R, Kebapcilar L, Cinkir U, Ulu MS, Ersoy C, Kagan MT, Ekiz BD, Kilinc F, Onbasi K, Cengiz M, Celik M, Guclu M, Sarıkaya M, Ozbag O, Sari R, Ucler R, Sezikli S, Araz M, Gundogan E, Bozkurt E, Akbas M, Bozkus R, Akinci B, Karakilic E, Medeni M, Keskek O, Goncuoglu ES, Zuhur SS, Sahin AZ, Dal K, Eren MA, Arkan T, Taskiran B, Kilinc G, Bozkirli E, Kafesciler SO, Kafesciler N, Sen EC, Doganay S, Koseoglu C, Tetiker T, Bayraktaroglu T, Oguz A, Ataoglu E, Demirpence MM, Tursun S, Anaforoglu I, Tabak O, Emral R, Karsidag K, Dizdar OS, Tuzcu AK, Caliskan M, Sirmatel P, Kocaoz Y, Dogan H, Fenkci SM, Sahin I, Karaca Z. Add-on therapy with dapagliflozin in routine outpatient care of type 2 diabetes patients from Turkey: a retrospective cohort study on HbA1c, body weight, and blood pressure outcomes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Elmaci I, Altinoz MA, Sari R, Syed HR, Aydinlar EI, Kahraman S, Jean WC. Shall elective neurosurgical patients be postponed during a pandemic? Lessons from the peak period of COVID-19 pandemic. J Neurosurg Sci 2020; 65:460-461. [PMID: 33320470 DOI: 10.23736/s0390-5616.20.05230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ilhan Elmaci
- Department of Neurosurgery, Acibadem M.A.A. University, Acibadem Maslak Hospital, Istanbul, Turkey -
| | - Meric A Altinoz
- Department of Biochemistry, Acibadem M.A.A. University, Istanbul, Turkey
| | - Ramazan Sari
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Hasan R Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.,Global Brainsurgery Initiative, Washington DC, USA
| | - Elif I Aydinlar
- Department of Neurology, Acibadem M.A.A. University, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Sibel Kahraman
- Department of Anesthesiology, Acibadem M.A.A. University, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Walter C Jean
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.,Department of Neurological Surgery, George Washington University, Washington DC, USA
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Elmaci I, Altinoz MA, Akdemir G, Sari R, Baskan O, Ozpinar A, Hacker E, Sav A. Neurosurgical and neuro-immunological management of IgG4-related hypertrophic sclerosing pachymeningitis. A literature survey and discussion of a unique index case. Clin Neurol Neurosurg 2020; 200:106342. [PMID: 33158629 DOI: 10.1016/j.clineuro.2020.106342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Dural thickening is observed in lymphoma, dural carcinomatosis, meningioma, tuberculosis, and autoimmune diseases. We encountered a patient with dural thickening and complaints of neck and back pain, numbness and loss of strength in the hands. The patient also suffered from polychondritis and had previously received steroid and methotrexate treatment for this indication. The patients' serum was also positive for ANA, yet she did not have any other findings suggesting lupus. Our radiological and pathological analysis revealed IHSP (IgG4-related hypertrophic sclerosing pachymeningitis). In this review study, we provided a detailed literature survey to increase the awareness about IHSP in the neurosurgical community. METHODS MRI (magnetic resonance imaging)-based radiological analyses revealed a posterior extramedullary spinal mass extending from C2 to T2-T3 level. The dural mass was surgically excised and a broad panel of immunohistochemical markers including S100, EMA, CD246/ALK-1, CD45, CD20, CD79a, CD138, CD68, CD1a and CD34 was studied. Immunoglobulin heavy chain/kappa chain gene rearrangement analysis was performed which ruled out a lymphoproliferative disorder. RESULTS MRI and pathological findings suggested IHSP. As the disease relapsed with a new anterior extramedullary multilobulated lesion extending from C5 to T1 level, the patient is now closely monitored for further medical and surgical treatment. CONCLUSIONS IHSP is a relatively novel entity of hypertrophic pachymeningitis and should be included in the differential diagnosis of dural thickening. The fibrosis accompanying IHSP may not respond to medical treatment, which includes steroids and immunosuppressive agents. Additionally, neurological deficits, seizures, spinal decompression, hydrocephalus, or brainstem compression necessitate early surgical intervention. A continued vigilance is also necessary as the disease may relapse long-term following surgical treatment.
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Affiliation(s)
- Ilhan Elmaci
- Department of Neurosurgery, M.A.A. Acibadem University, Maslak Hospital, Istanbul, Turkey
| | - Meric A Altinoz
- Department of Medical Biochemistry, M.A.A. Acibadem University, Istanbul, Turkey.
| | | | - Ramazan Sari
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ozdil Baskan
- Department of Radiology, Memorial Hospital, Istanbul, Turkey
| | - Alp Ozpinar
- Department of Neurosurgery, University of Pittsburgh, United States
| | - Emily Hacker
- Department of Neurosurgery, University of Pittsburgh, United States
| | - Aydin Sav
- Department of Pathology, Yeditepe University, Istanbul, Turkey
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Affiliation(s)
- Ramazan Sari
- Department of General Surgery, 147015Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Kaya
- Department of General Surgery, 147015Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Abdirahman S Hargura
- Department of General Surgery, 107864Kenyatta University Teaching, Referral and, Research Hospital, Nairobi, Kenya
| | - Onder Altin
- Department of General Surgery, 147015Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan F Kucuk
- Department of General Surgery, 147015Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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15
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Kaya S, Yuksek MO, Sari R, Altin O, Sikar H, Kucuk H. Is hemithyroidectomy sufficient in unilateral benign nodular goitre? Minerva Endocrinol (Torino) 2020; 46:406-412. [PMID: 32969625 DOI: 10.23736/s2724-6507.20.03203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. METHODS Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. RESULTS A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. CONCLUSIONS Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.
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Affiliation(s)
- Selcuk Kaya
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Mustafa O Yuksek
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Sari
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey -
| | - Onder Altin
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan Sikar
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan Kucuk
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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16
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Kaya S, Yuksek MO, Sari R, Altin O, Sikar HE, Kucuk HF. Is hemithyroidectomy sufficient in unilateral benign nodular goitre? MINERVA ENDOCRINOL 2020. [PMID: 32969625 DOI: 10.23736/s0391-1977.20.03203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multinodular goiter is a common disease in population. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. MATERIALS AND METHODS The patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analysed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. RESULTS A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. CONCLUSIONS Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.
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Affiliation(s)
- Selcuk Kaya
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Mustafa O Yuksek
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Sari
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey -
| | - Onder Altin
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan E Sikar
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan F Kucuk
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Abstract
Actinomycosis is a rare bacterial disease characterized by chronic or subacute suppurative inflammation. Abdominal actinomycosis is rarer and accounts for approximately 20% of all actinomycosis cases. In the literature, patients who underwent surgery for actinomycosis mimicking malignant tumors have been reported. Most of these patients had mucosal trauma and inflammation signs. It is often difficult to diagnose abdominal actinomycosis preoperatively and often impossible to distinguish it from a malignant tumor. We present a case that preoperatively was diagnosed as a malignant tumor but pathological evaluation reported to be diverticulitis and actinomycosis. This case can increase the awareness about this disease, which is possible to be treated non-surgically.
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Affiliation(s)
- Ramazan Sari
- Department of General Surgery, Baskent University, Adana, Turkey
| | - Murat Kuş
- Department of General Surgery, Baskent University, Adana, Turkey
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Abstract
BACKGROUND Immunosuppressive drugs used in transplantation patients, may contribute to the development of post-transplant diabetes mellitus through their possible adverse effects on incretins. We aimed to compare the effects of different immunosuppressive drugs used in renal transplantation patients on glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) levels. PATIENTS AND METHODS Forty five subjects were enrolled in the study (cyclosporine-treated 15 and tacrolimus-treated renal transplant patients 15, and healthy volunteers as a control group 15). Oral glucose tolerance test with 75 gr glucose was performed. GLP-1 and GIP levels were measured at 0 (baseline), 30, 60, 90, 120 min using ELISA method. RESULTS A statistically significant level of difference was detected in GLP-1 levels at the baseline, 30th and 120th minutes among all three groups (p < 0,001, p = 0,026 and p = 0,022, respectively). Baseline GLP-1 levels in cyclosporine-treated renal transplant patients were higher than in both tacrolimus-treated renal transplant patients (p = 0,016) and control groups (p < 0,001). GLP-1 levels at the 30th minute were higher in tacrolimus-treated renal transplant patients when compared to the cyclosporine-treated renal transplant patients (p = 0,024). GLP-1 levels at the 120th minute were higher in tacrolimus-treated renal transplant patients than the control group (p = 0,024). The areas under the curve of GLP-1 was higher in tacrolimus-treated renal transplant patients when compared to the control group (p = 0,018). GIP levels at 120th was lower in cyclosporine-treated renal transplant patients when compared to control group (p = 0,003). CONCLUSION These findings showed a temporally affected incretin hormones in renal transplant patients, a preserved GLP-1 response to an oral glucose load in renal transplant patients on cyclosporine and increased GLP -1 response to an oral glucose load in those on tacrolimus.
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Affiliation(s)
- Nusret Yilmaz
- Akdeniz University, School of Medicine, Division of Endocrinology, Antalya, Turkey
| | - Ramazan Sari
- Akdeniz University, School of Medicine, Division of Endocrinology, Antalya, Turkey.
| | | | - Sebahat Ozdem
- Akdeniz University, School of Medicine, Department of Biochemistry, Antalya, Turkey
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Yilmaz N, Avsar E, Tazegul G, Sari R, Altunbas H, Balci MK. Clinical Characteristics and Follow-Up Results of Adrenal Incidentaloma. Exp Clin Endocrinol Diabetes 2020; 129:349-356. [PMID: 31958848 DOI: 10.1055/a-1079-4915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
It is recommended that adrenal incidentaloma patients should be monitored for radiological changes, increase in size and new functionality that may occur in the future, even if they are benign and nonfunctional at the initial evaluation. Our aim is to evaluate the key clinical characteristics of adrenal incidentaloma patients focusing on changes during follow-up and associated clinical outcomes. A total of 755 patients (median age: 56 years), with an adrenal incidentaloma > 1 cm and underwent functionality tests, were included in the study. Clinical characteristics, functionality status and follow-up durations were recorded. During the course of follow-up, any changes in size and development of new functionality, and clinical consequences thereof were evaluated. In 71.8% of patients, incidentalomas were non-functional. Most frequent functionality (15.8%, n=119) was subclinical hypercortisolemia (SH) [10.9% (n=82) possible autonomous cortisol secretion (PACS) and 4.9% (n=37) autonomous cortisol secretion (ACS)] of all incidentalomas. Frequencies of Cushing's syndrome (CS), pheochromacytoma and primary hyperaldosteronism were 4.9% (n=37), 3.8% (n=29) and 3.7% (n=28), respectively. Adrenocortical carcinoma frequency was 1.5% (n=11). Of 755 patients, 43% (n=325) were followed up regularly more than 6 months. Median follow-up duration was 24 months (6-120). A total of 17 (5.2%) patients, which had non-functional incidentalomas at baseline had developed new functionality during follow-up, of which 15 (4.6%) were SH [13 patients (4%) PACS and 2 patients (0.6%) ACS] and 2 (0.6%) were CS. During follow-up, 24% (n=78) of the patients had an increase in mass size between 5-9 mm, while 11.7% (n=38) of the patients had an increase of ≥10 mm. During follow-up, 4% (n=13) of the patients developed a new lesion with a diameter ≥10 mm on the opposite side. In patients with a follow-up duration of more than 2 years, frequencies of size increase and new lesion emerging at the opposite adrenal gland were higher. 14 patients (4.3% of the patients with regular follow-up) underwent surgery due to increase in size or development of new functionality during follow-up. Our study demonstrated that a necessity for surgery may arise due to increase in size and development of functionality during follow-up period in adrenal incidentaloma patients, and thus continuing patient follow-up, even with wider intervals, will be appropriate.
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Affiliation(s)
- Nusret Yilmaz
- Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey
| | - Esin Avsar
- Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey
| | - Gokhan Tazegul
- Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey
| | - Ramazan Sari
- Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey
| | - Hasan Altunbas
- Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey
| | - Mustafa Kemal Balci
- Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey
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Sari R, Yabanoglu H, Hargura AS, Kus M, Arer IM. Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure. J Coll Physicians Surg Pak 2020; 30:18-22. [PMID: 31931926 DOI: 10.29271/jcpsp.2020.01.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the safety and the effectiveness of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for refractory secondary hyperparathyroidism in patients with chronic kidney disease. STUDY DESIGN A comparative study. PLACE AND DURATION OF STUDY Baskent University, Adana Medical and Research Center, Adana, Turkey, from January 2012 to November 2018. METHODOLOGY Patients operated upon for refractory secondary hyperparathyroidism by the general surgery team were inducted. Overall, 25 (40%) patients underwent total parathyroidectomy with autotransplantation (Group 1), whereas 37 (60%) patients underwent subtotal parathyroidectomy (Group 2). Patient files were retrospectively analysed for recurrence or persistence of hyperparathyroidism. RESULTS A total of 62 patients, 32 (52%) of whom were females, with a mean age of 41.4 ±15.8 years for group 1; and 30 patients were males with a mean age of 43.1 ±16.7 years for group 2 were assessed in this study. The presenting complaints were bone pains and malaise supported by laboratory values that showed consistently elevated parathyroid hormone levels (>200 pg/ml). In the postoperative follow-up, 29 patients (46.8%) had transient hypocalcemia, while 3 (5%) had persistent hypoparathyroidism. In Group 1, one (4%) patient had a recurrence, while 4 (16%) patients had persistent hyperparathyroidism. In contrast, two (5.6%) patients in Group 2 had recurrence, whereas 8 (22%) patients had persistent hyperparathyroidism. CONCLUSION Both surgical options can be safely utilised in the management of refarctory secondary hyperparathyroidism. Moreover, regardless of the procedure used, all the parathyroid glands must be explored. However, due to high morbidity and failure rates of subsequent surgeries, the surgeon should be keen and thorough in the initial procedure.
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Affiliation(s)
- Ramazan Sari
- Department of General Surgery, Baskent University, Adana Medical and Research Center, Adana, Turkey
| | - Hakan Yabanoglu
- Department of General Surgery, Baskent University, Adana Medical and Research Center, Adana, Turkey
| | | | - Murat Kus
- Department of General Surgery, Baskent University, Adana Medical and Research Center, Adana, Turkey
| | - Ilker Murat Arer
- Department of General Surgery, Baskent University, Adana Medical and Research Center, Adana, Turkey
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Alemdar S, Yilmaz N, Ozdem S, Sari R. Incretin levels in patients with hypothyroidism and the evaluation of incretin levels alterations with treatment. ASIAN BIOMED 2019. [DOI: 10.1515/abm-2019-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Incretin hormones may influence the effects of thyroid hormones on insulin secretion, insulin resistance, and glucose metabolism. Thyroid hormones regulate insulin secretion, and the risk of diabetes was found to be associated with thyroid hormones.
Objectives
To determine whether incretin hormones influence the effects of thyroid hormones on insulin resistance and glucose metabolism.
Methods
A total of 26 patients were included in 2 groups consisting of 13 patients with hypothyroidism and 13 healthy controls. Levels of glucose, insulin, glucagon-like peptide 1 (GLP-1), and gastric inhibitory polypeptide (GIP) levels were measured in 0, 30, 60, 90, and 120th min during the oral glucose tolerance test in the control group and before and after thyroxine treatment in the hypothyroid group.
Results
In the hypothyroid group, waist circumference decreased after the euthyroid state was achieved (P = 0.026). No statistically significant differences were detected in the GLP-1 and GIP levels at baseline and 30, 60, 90, and 120 min between the hypothyroidism and control groups or after ensuring the euthyroid state in patients with hypothyroidism. Peak GLP-1 levels were observed at 30 min in the control group, whereas peak GLP-1 and GIP levels were detected at 90 min in the hypothyroidism group. After achieving the euthyroid state, peak GLP-1 and GIP levels were detected at 30 min as well.
Conclusion
In patients with hypothyroidism, the incretin hormones, especially the peak response of the incretin system, are significantly affected. Significant changes were observed in the incretin system by correcting hypothyroidism.
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Affiliation(s)
- Serkan Alemdar
- Department of Internal Medicine, School of Medicine, Akdeniz University , Antalya 07070 , Turkey
| | - Nusret Yilmaz
- Department of Internal Medicine, School of Medicine, Akdeniz University , Antalya 07070 , Turkey
| | - Sebahat Ozdem
- Department of Biochemistry, Akdeniz University, School of Medicine , Antalya 07070 , Turkey
| | - Ramazan Sari
- Department of Internal Medicine, School of Medicine, Akdeniz University , Antalya 07070 , Turkey
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Tazegul G, Bozoğlan H, Doğan Ö, Sari R, Altunbaş HA, Balci MK. Cystic lateral neck mass: Thyroid carcinoma metastasis to branchial cleft cyst. J Cancer Res Ther 2019; 14:1437-1438. [PMID: 30488872 DOI: 10.4103/0973-1482.188440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Etiologies of lateral cervical masses are complex, most commonly these masses are branchial cleft cysts; however, metastatic thyroid carcinoma should be included in the differential. We report a case of lateral cystic neck mass in a 22-year-old female patient diagnosed as metastatic papillary thyroid carcinoma. The patient was diagnosed after she underwent surgery for branchial cleft cyst. The patient underwent thyroidectomy which revealed multifocal micropapillary thyroid carcinoma with capsular invasion and lymph node metastases. Radioactive iodine treatment was planned. Congenital malformations of the lateral neck may present themselves in the second and third decades of life. Ectopic thyroid tissue within a branchial cleft cyst may give rise to primary papillary carcinoma, as well as branchial cleft cyst may harbor metastases of primary thyroid papillary carcinoma. We classified our patient as a metastasis to the branchial cleft cyst rather than primary papillary carcinoma of the branchial cleft cyst.
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Affiliation(s)
- Gokhan Tazegul
- Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hümeyra Bozoğlan
- Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya, Turkey
| | - Özlem Doğan
- Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ramazan Sari
- Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hasan Ali Altunbaş
- Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Kemal Balci
- Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya, Turkey
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Boz A, Tazegul G, Bozoglan H, Dogan O, Sari R, Altunbas HA, Arici C, Ocak GA, Balci MK. Bone metastases without primary tumor: A well-differentiated follicular thyroid carcinoma case. J Cancer Res Ther 2018. [PMID: 29516937 DOI: 10.4103/0973-1482.199391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Metastases to the bone are the most common malignant bone tumors. Prostate, breast, and lung carcinomas are the most common primaries of bone metastases. Bone metastases show poor prognosis in means of median survival; however, some patients with highly curable tumors such as thyroid carcinoma may benefit from treatment. We report and discuss a unique case of a 70-year-old female patient presenting with arm pain, diagnosed with metastatic well-differentiated follicular carcinoma without a primary tumor in the thyroid.
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Affiliation(s)
- Adil Boz
- Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Gokhan Tazegul
- Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Humeyra Bozoglan
- Department of Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ozlem Dogan
- Department of Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ramazan Sari
- Department of Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Hasan Ali Altunbas
- Department of Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Cumhur Arici
- Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Guzide Ayse Ocak
- Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mustafa Kemal Balci
- Department of Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Koyuncu BU, Karaca M, Sari F, Sari R. Is Skin Tag Associated with Diabetic Macro and Microangiopathy? J Natl Med Assoc 2018; 110:574-578. [PMID: 30129497 DOI: 10.1016/j.jnma.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 01/23/2018] [Accepted: 03/14/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Although skin tag is associated with diabetes mellitus, no data in the literature show that the presence of skin tag is associated with diabetic macro and microangiopathy. The purpose of this study was to investigate the frequency of hypertension, dyslipidemia, obesity, macro and micro angiopathy in type 2 diabetic patients with and without skin tag. MATERIAL AND METHODS We evaluated 99 (40 female and 59 male) type 2 diabetic patients. All patients were evaluated for blood pressure, body mass index, lipids, HbA1c, macroangiopathy (peripheral vascular disease, cerebrovascular disease and coronary heart disease), microangiopathy (neuropathy, nephropathy, retinopathy) and skin tag. RESULTS Age, HbA1c and body mass index were 65.0 ± 14.2 years, 8.1 ± 2.0% and 30.5 ± 6.4 kg/m2, respectively. The frequency of skin tags 53.5%, dyslipidemia 68.7%, hypertension 69.7%, obesity 39.4%, macroangiopathy 61.6% (peripheral vascular disease 12.1%, cerebrovascular disease 16.2%, and coronary heart disease 49.5%), microangiopathy 63.6% (neuropathy 21.2%, nephropathy 38.4%, retinopathy 38.4%) were detected. Higher body mass index (p = 0.04) and frequency of obesity (p = 0.03) were detected in patients with skin tag than without skin tag. Age (p = 0.8), gender (p = 0.6), HbA1c (p = 0.4) and the presence of dyslipidemia (p = 0.4), hypertension (p = 0.6), macroangiopathy (p = 0.2), and microangiopathy (p = 0.9) were not different in patients with and without skin tag. CONCLUSION We conclude that presence of skin tag is merely related to obesity and may not be strongly associated with macro- and microangiopathy in type 2 diabetic individuals. Further studies with large patient population are required to elucidate the association between the presence of skin tag and diabetic angiopathy.
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Affiliation(s)
- Birsen Unsal Koyuncu
- Akdeniz University, School of Medicine, Division of Endocrinology and Metabolism, Antalya, Turkey
| | - Mustafa Karaca
- Akdeniz University, School of Medicine, Division of Endocrinology and Metabolism, Antalya, Turkey
| | - Funda Sari
- Antalya Research and Education Hospital, Division of Nephrology, Antalya, Turkey
| | - Ramazan Sari
- Akdeniz University, School of Medicine, Division of Endocrinology and Metabolism, Antalya, Turkey.
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Yilmaz N, Tazegul G, Bozoglan H, Sari R, Ozdem S, Altunbas HA, Balci MK. Diagnostic value of the late-night salivary cortisol in the diagnosis of clinical and subclinical Cushing’s syndrome: results of a single-center 7-year experience. J Investig Med 2018; 67:28-33. [DOI: 10.1136/jim-2018-000752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Abstract
Late-night salivary cortisol (LNSaC) is an easy-to-use test reflecting the free cortisol level in the serum and does not require hospitalization. Controlled studies reported that LNSaC has a high sensitivity and specificity, but have not set a clearly defined cut-off value to be used in the diagnosis of Cushing’s syndrome. In this study, we aimed to evaluate the diagnostic performance of LNSaC in patients with clinical Cushing’s syndrome (CCS) and subclinical Cushing’s syndrome (SCS). The data of 543 patients, whose LNSaC levels were assessed using electrochemiluminescence immunoassay method, were retrospectively evaluated. The study included a total of 324 patients: 58 patients with CCS, 53 patients with SCS, and 213 patients without Cushing’s syndrome (NoCS). The cause of the Cushing’s syndrome was hypophyseal in 26 patients (45%), adrenal in 24 patients (41%), and ectopic in 8 patients (14%) in the CCS group. Median LNSaC levels were 0.724 (0.107–33) µg/dL in CCS group, 0.398 (0.16–1.02) µg/dL in SCS group, and 0.18 (0.043–0.481) µg/dL in NoCS group (p=0.001). Accordingly, LNSaC had 89.6% sensitivity and 81.6% specificity at a cut-off value of 0.288 µg/dL in the diagnosis of CCS; and had 80.7% sensitivity and 85.1% specificity at a cut-off value of 0.273 µg/dL in the diagnosis of SCS. In the present study, a lower sensitivity and specificity than previously reported was found for LNSaC in the diagnosis of CCS. Moreover, the diagnostic performance of LNSaC in patients with SCS was close to its diagnostic performance in patients with CCS. Each center should determine its own cut-off value based on the method adopted for LNSaC measurement, and apply that cut-off value in the diagnosis of Cushing’s syndrome.
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Emral R, Tetiker T, Sahin I, Sari R, Kaya A, Yetkin İ, Cil SU, Tütüncü NB. An international survey on hypoglycemia among insulin-treated type I and type II diabetes patients: Turkey cohort of the non-interventional IO HAT study. BMC Endocr Disord 2018; 18:9. [PMID: 29433560 PMCID: PMC5809967 DOI: 10.1186/s12902-018-0238-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/01/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Limited real-world data are currently available on hypoglycemia in diabetes patients. The International Operations Hypoglycemia Assessment Tool (IO HAT) study was designed to estimate hypoglycemia in insulin-treated type I (T1DM) and type II (T2DM) diabetes mellitus patients from 9 countries. The data from Turkey cohort are presented here. METHODS A non-interventional study to determine the hypoglycemia incidence, retrospectively and prospectively, in Turkish T1DM and T2DM patients using a 2-part self-assessment questionnaire. RESULTS Overall, 2348 patients were enrolled in the Turkey cohort (T1DM = 306 patients, T2DM = 2042 patients). In T1DM patients, 96.8% patients reported hypoglycemic events (Incidence rate [IR]: 68.6 events per patient-year [ppy]), prospectively, while 74.0% patients reported hypoglycemic events (IR: 51.7 events ppy), retrospectively. In T2DM patients, 95.9% patients (IR: 28.3 events ppy) reported hypoglycemic events, prospectively, while 53.6% patients (IR: 23.0 events ppy) reported hypoglycemic events, retrospectively. Nearly all patients reported hypoglycemia during the prospective period. CONCLUSIONS This is a first patient-reported dataset on hypoglycemia in Turkish, insulin-treated diabetes patients. A high incidence of patient-reported hypoglycemia confirms that hypoglycemia remains under-estimated. Hypoglycemia increased healthcare utilization impacting patients' quality of life. Hypoglycemia remains a common side effect with insulin-treatment and strategies to optimize therapy and reduce hypoglycemia occurrence in diabetes patients are required. TRIAL REGISTRATION Clinicaltrials.gov, NCT02306681 (Date of registration: 12 Nov 2014; retrospectively registered).
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Affiliation(s)
- Rıfat Emral
- Department of Endocrinology and Metabolic Diseases, Ankara University, Faculty of Medicine, İbn-i Sina Hospital, Academic Region M1/09, Samanpazarı, 06100 Ankara, Turkey
| | - Tamer Tetiker
- Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Çukurova University, Adana, Turkey
| | - Ibrahim Sahin
- Endocrinology and Metabolism Department, Inonu University School of Medicine, Malatya, Turkey
| | - Ramazan Sari
- Division of Endocrinology and Metabolism, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ahmet Kaya
- Division of Endocrinology and Metabolism, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İlhan Yetkin
- Division of Endocrinology and Metabolism, School of Medicine, Gazi University, Ankara, Turkey
| | | | - Neslihan Başcıl Tütüncü
- Division of Endocrinology and Metabolism, School of Medicine, Baskent University, Ankara, Turkey
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Abstract
Schwannomas are benign tumors treatable with neurosurgery or radiosurgery, yet a small subset may exhibit aggressive growth. Hence illuminating their immune features can help develop better treatments. A tumor-promoting inflammation exists in schwannomas. Transcription factor NF-κB triggers synthesis of inflammatory cytokines and chemokines. NF-κB is suppressed by NF2/merlin, yet it is mutated or repressed in schwannomas, and therefore MCP-1/CCL2, MIP-1α/CCL3, CXCL16, and CXCR6/Bonzo are likely expressed in these tumors. CD68+ and CD163+ macrophages may infiltrate schwannomas and promote their growth. Anti-inflammatory salicylates inhibit schwannomas in cell culture and clinically. Schwannomas that cannot be completely removed by neurosurgery or controlled by radiosurgery may be suitable targets of pharmacologic interventions focusing on immune mechanisms.
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Affiliation(s)
| | - Meric A Altinoz
- Neuroacademy Group, Sisli, Istanbul, Turkey.,Department of Neurosurgery, Memorial Health Group, Istanbul, Turkey
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Elmaci İ, Altinoz MA, Sav A, Bolükbaşı FH, Önöz M, Başkan Ö, Sari R. Whorling-sclerosing meningioma. A review on the histological features of a rare tumor including an illustrative case. Clin Neurol Neurosurg 2017; 162:85-90. [DOI: 10.1016/j.clineuro.2017.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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Tazegul G, Ogut TS, Bozoglan H, Dogan O, Yilmaz N, Ulas T, Salim O, Sari R, Altunbas HA, Balci MK. Using plasma exchange to successfully manage thyrotoxicosis in a patient with possible antithyroid drug-related thrombotic thrombocytopenic purpura. Endocr Regul 2017; 51:153-156. [PMID: 28858843 DOI: 10.1515/enr-2017-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities, fever, and renal insufficiency. The association or co-existence of thyrotoxicosis or antithyroid drugs with TTP has not been previously reported. Subject and Results. Herein, we present a 54-year-old female patient newly diagnosed with toxic multinodular goiter accompanying with TTP, possibly triggered by either thyrotoxicosis or antithyroid drugs. CONCLUSIONS The present report is the first in the literature to demonstrate the co-existence of these two diseases and the use of plasma exchange as a modality to treat both conditions.
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Cira DK, Sari R, Ozdem S, Yilmaz N, Bozkurt S. GLP-1 and GIP Levels in Patients With Hyperthyroidism: The Effect of Antithyroid Treatment. Ann Pharmacother 2017; 51:663-668. [DOI: 10.1177/1060028017707221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background:Incretin hormones (glucagon-like peptide-1 [GLP-1] and gastric inhibitory polypeptide [GIP]) may play a role in the development of glucose intolerance and hyperglycemia in patients with hyperthyroidism. Objective: We aimed to assess both incretin levels and treatment-induced changes in incretin levels in those with hyperthyroidism. Methods: A total of 24 subjects (12 with hyperthyroidism and 12 healthy) were enrolled in the study. Oral glucose tolerance test was performed and serum glucose, insulin GLP1, and GIP levels were evaluated at 0 (baseline), 30, 60, 90, and 120 minutes using ELISA. Measurements were repeated after euthyroidism was reached in subjects with hyperthyroidism. Results: The baseline glucose level was higher in those with hyperthyroidism compared with controls ( P = 0.03). GLP-1 and GIP responses to oral glucose load did not differ significantly between those with hyperthyroidism and controls. Peak GLP-1 and GIP levels were reached in both groups at 60 and 90 minutes, respectively. Areas under the curve (AUCs) for GLP1 and GIP were similar in those with hyperthyroidism and controls. Although GLP-1 and GIP levels did not change before and after antithyroid treatment in subjects with hyperthyroidism, time to peak GLP-1 and GIP levels were reached at 30 minutes after euthyroid state was achieved. Reversal of hyperthyroid to euthyroid status did not induce significant changes in AUCs for incretins. Conclusion: The findings of the present study suggest that the total incretin response to oral glucose load is preserved in patients with hypertyhroidism, but peak incretin responses may change after achieving euthyroid state.
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Affiliation(s)
| | - Ramazan Sari
- Akdeniz University, School of Medicine, Antalya, Turkey
| | - Sebahat Ozdem
- Akdeniz University, School of Medicine, Antalya, Turkey
| | - Nusret Yilmaz
- Akdeniz University, School of Medicine, Antalya, Turkey
| | - Selen Bozkurt
- Akdeniz University, School of Medicine, Antalya, Turkey
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Abstract
AIM Failed cranioplasty attempts may lead to numerous complications in a broad spectrum including cosmetic problems, infection, neurological deterioration and even death. Selection of the most appropriate surgical technique for second and further surgical attempts for these patients still remains a debate. We aimed to share our experience and technical pitfalls on management of failed cranioplasty, particularly for patients with large cranial defects. MATERIAL AND METHODS A retrospective data analysis of cranioplasty cases in our series was performed including the time period between 2002 and 2012. Patients required recurrent cranioplasty were analyzed in detail. RESULTS Totally, 101 patients underwent cranioplasty for bony defect. Of 101 patients, eleven required a revision surgery due to infection or spontaneous resorption of the bone flap. All patients underwent revision cranioplasty with pre-surgical plaster cast mold technique modified from previous studies and/or tissue expansion technique. Polymethyl-metacrylate (PMMA) was used as substitute for reconstructions. Mean follow-up was 36 months. Two out of eleven cases (18.1%) developed major complications, which led to further revision. At the end, a satisfactory reconstruction was achieved for all patients. CONCLUSION Our modified molded plaster cast technique is a safe and cost-effective approach for the revision of failed cranioplasty. We believe that the tissue expanding techniques have also great contribution to achieve successful results.
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Affiliation(s)
- Ramazan Sari
- Memorial Health Group, Department of Neurosurgery, Istanbul, Turkey
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Altinoz MA, Elmaci I, Bolukbasi FH, Ekmekci CG, Yenmis G, Sari R, Sav A. MGMT gene variants, temozolomide myelotoxicity and glioma risk. A concise literature survey including an illustrative case. J Chemother 2017; 29:238-244. [PMID: 28436299 DOI: 10.1080/1120009x.2017.1312752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Temozolomide may cause thrombocytopenia or neutropenia in 3-4% of glioblastoma patients, respectively. However, pancytopenia is rarely reported. MGMT (O6-methylguanine-DNA-methyltransferase) enzyme repairs temozolomide-induced DNA mutations and associates both with antitumour efficacy and myelosuppression. Many studies on the effects of MGMT gene-methylation on temozolomide's effects exist, but much fewer publications concerning MGMT variants were documented. A full sequencing of the MGMT gene was performed in a female glioblastoma patient, who developed pancytopenia following temozolomide treatment. Results indicated the presence of all the rs2308321 (I143 V), rs2308327 (K178R) and rs12917 (L84F) MGMT-variants, which were previously associated with temozolomide myelotoxicity. rs12917 (L84F) variant was reported as associating with lesser risk of gallbladder tumours, yet with higher risk of non-Hodgkin lymphomas related with exposure to chlorinated solvents or hair dyes. DNA repair proteins may exert diverging effects on DNA injuries caused by different chemicals and therefore exerting complex effects on myelotoxicity, antitumour activity and carcinogenesis.
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Affiliation(s)
| | - Ilhan Elmaci
- a Neuroacademy Group , Istanbul , Turkey.,b Department of Neurosurgery , Memorial Hospital , Istanbul , Turkey
| | - Fatih Han Bolukbasi
- a Neuroacademy Group , Istanbul , Turkey.,b Department of Neurosurgery , Memorial Hospital , Istanbul , Turkey
| | | | - Guven Yenmis
- c Department of Genetics , Acibadem University , Istanbul , Turkey
| | - Ramazan Sari
- d Department of Neurosurgery , Hizmet Hastanesi , Istanbul , Turkey
| | - Aydin Sav
- e Nisantasi Pathology Group , Istanbul , Turkey
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Brandmeier S, Taskiran E, Bolukbasi F, Sari R, Elmaci I. Multimodal intraoperative neurophysiologic monitoring in the neurosurgical oncology. Turk Neurosurg 2017; 28:204-210. [DOI: 10.5137/1019-5149.jtn.19177-16.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ozmen I, Karakurt Z, Salturk C, Kargin F, Takir HB, Aksoy E, Sari R, Celik E, Tuncay EA, Yildirim E, Mocin OY, Adiguzel N, Oztas S, Gungor S, Gungor G. Can N-terminal pro B-type natriuretic peptide, neutrophil-to-lymphocyte ratio, C-reactive protein help to predict short and long term mortality? ACTA ACUST UNITED AC 2016; 117:587-594. [PMID: 27826974 DOI: 10.4149/bll_2016_114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is limited data about ICU, short and long-term mortality prediction of severe CAP with neutrophil-to-lymphocyte ratio (NLR): N-terminal proB- type natriuretic peptide (NT-proBNP): C-reactive protein (CRP). AIM Besides the known severity indexes of ICU, can NLR, NT-proBNP, CRP predict ICU, short and long term mortality? METHODS A retrospective cohort study was carried out in a level III ICU of a tertiary training hospital for chest diseases and thoracic surgery. RESULTS Over the study period, a total of 143 patients were enrolled in the study. The APACHE II scoring showed a significantly higher predicting performance for ICU mortality (p = 0.002). The performance for predicting short term mortality NLR (p = 0.039) and long term mortality NTproBNP (p = 0.002) had a significantly higher performance. The survival analysis revealed that mortality was significantly higher in patients with CURB65 score ≥ 4 (p = 0.047). CONCLUSION NLR, NTproBNP > 2000pg/mL can be used to predict pneumonia severity in ICU alike CURB65 and PSI. Higher NLR, APACHE II and atrial fibrillation can cause an important mortality factor in long term. Consequently, clinicians should take an attention for good cardiac evaluation and cardiac follow-up of patients with CAP (Tab. 4, Fig. 3, Ref. 36).
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Sari R, Bolukbasi FH, Onoz M, Baskan O, Altinoz MA, Sav A, Elmaci I. P11.05 Whorling-sclerosing type of meningioma. CD34 and P53 IHC-positivity with lack of malignant features in a rare meningioma type. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Ozek E, Altinoz MA, Bolukbasi FH, Sari R, Elmaci I. P11.04 Matrix Metalloprotease-9 Expresssion
in Meningioma: Correlation With Growth
Fraction and Role of Gender. A Pilot Immunohistochemical Study. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Altinoz MA, Bilir A, Bolukbasi FH, Sari R, Yazici Z, Elmaci I. P08.03 Erucic acid, a component of Lorenzo’s oil used in treatment of adrenoleukodystrophy, acts antineoplastic in C6 glioma cell culture. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Taskiran E, Brandmeier S, Ozek E, Sari R, Bolukbasi F, Elmaci I. Multimodal Intraoperative Neurophysiological Monitoring in Spinal Cord Surgery. Turk Neurosurg 2016; 27:436-440. [PMID: 27593793 DOI: 10.5137/1019-5149.jtn.16414-15.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Intraoperative neurophysiological monitoring (IONM) monitors the functional integrity of critical neural structures by electrophysiological methods during surgery. Multimodality combines different neurophysiological methods to maximize diagnostic efficacy and provide a safety margin to improve the outcomes of spinal surgery. Our aim was to share our intraoperative monitoring experiences with patients who underwent surgery because of spinal cord pathologies between September 2013 and January 2015. MATERIAL AND METHODS We had twenty-six cases. Location of the lesions, surgery, neurological findings, and electrophysiological findings intraoperatively and postoperatively were documented. RESULTS The combination of motor evoked potential (MEP), somatosensorial evoked potential (SSEP), free-run and trigger electromyography (EMG) were performed according to lesion localization. MEPs plus SSEPs were run in 23 patients and MEPs with triggered EMG were performed in 4 patients. In only one patient, optimal recording could not be elicited because of technical problems. MEP and SSEP changes were recorded in 12 and 3 patients respectively. Postoperative neurological deficits were observed in 2 patients. Deficits were transient in one case and permanent in the other. While baseline MEP responses were either absent or low amplitude ( < 50 microvolt) in 7 patients, following resection they were either visible or increased in amplitude. Surgery was ended in one patient with C7-T2 intramedullary tumour after the right distal MEP response disappeared. CONCLUSION Multimodal IONM is an important method to monitor the neural structures under risk in spine surgery and to keep the surgery within safety limits, especially for intramedullary spinal cord lesion surgery.
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Affiliation(s)
- Emine Taskiran
- Istanbul University, Cerrahpasa Medical Faculty, Department of Neurosurgery, Intraoperative Neurophysiology, Istanbul, Turkey
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Sari F, Ozdem S, Sari R. SERUM 25-HYDROXYVITAMIN D(3) LEVELS IN TYPE 2 DIABETIC PATIENTS WITH NORMO-, MICRO-, AND MACROALBUMINURIA. Acta Endocrinol (Buchar) 2016; 12:303-308. [PMID: 31149105 DOI: 10.4183/aeb.2016.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The aim of this study was to observe the differences in serum 25-hydroxyvitamin D(3) levels in nondiabetic healthy control subject and type 2 diabetic patients, and to investigate the differences in serum 25-hydroxyvitamin D(3) levels in type 2 diabetic patients with normo-, micro- and macroalbuminuria. Patients and Methods Total 140 nondiabetic healthy controls and 384 type 2 diabetic patients (156 normoalbuminuric, 152 microalbuminuric and 76 macroalbuminuric) were included in the study. 25-hydroxyvitamin D(3) levels were measured in sera with the method of electrochemiluminescence using modular immunoassay analyzer. Results Vitamin D deficiency was detected in 70.85% and 22.9% of type 2 diabetic patients and nondiabetic healthy controls, respectively. Serum 25-hydroxyvitamin D(3) levels were significantly lower in type 2 diabetic patients compared to nondiabetic healthy controls (16.4 ± 9.5 ng/mL vs. 28.2 ± 11.6 ng/mL, p=0.0001). Serum 25-hydroxyvitamin D(3) levels were lower in albuminuric and nonalbuminuric diabetic patients (14.3 ± 7.9 ng/mL vs. 19.6±10.9 ng/mL, respectively, p=0.013). Serum 25-hydroxyvitamin D(3) levels were 19.6 ± 10.9 ng/mL in normoalbuminuric, 14.9 ± 8.8 ng/mL in microalbuminuric and 12.9 ± 5.8 ng/mL in macroalbuminuric diabetic patients. While lower serum 25-hydroxyvitamin D(3) levels were detected both in microalbuminuric (p=0.028) and macroalbuminuric diabetic patients (p=0.014) compared to normoalbuminuric diabetic patients, 25-hydroxyvitamin D(3) levels did not change significantly between microalbuminuric and macroalbuminuric diabetic patients (p=0.67). Serum 25-hydroxyvitamin D(3) levels correlated negatively with urinary albumin excretion (r=-0.24, p=0.016) in patients with diabetes mellitus. Conclusion Findings of the present study demonstrated reduced serum 25-hydroxyvitamin D(3) levels which were significantly related with albuminuria in type 2 diabetic patients.
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Affiliation(s)
- F Sari
- Antalya Research and Training Hospital, Department of Internal Medicine, Division of Nephrology, Antalya, Turkey
| | - S Ozdem
- Akdeniz University, School of Medicine, Department of Internal Medicine, Department of Clinical Biochemistry, Antalya, Turkey
| | - R Sari
- Akdeniz University, School of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Antalya, Turkey
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Linjawi S, Sothiratnam R, Sari R, Andersen H, Hiort LC, Rao P. The study of once- and twice-daily biphasic insulin aspart 30 (BIAsp 30) with sitagliptin, and twice-daily BIAsp 30 without sitagliptin, in patients with type 2 diabetes uncontrolled on sitagliptin and metformin-The Sit2Mix trial. Prim Care Diabetes 2015; 9:370-376. [PMID: 25488587 DOI: 10.1016/j.pcd.2014.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/04/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022]
Abstract
AIMS Investigate efficacy and tolerability of intensifying diabetes treatment with once- or twice-daily biphasic insulin aspart 30 (BIAsp 30) added to sitagliptin, and twice-daily BIAsp 30 without sitagliptin in patients with type 2 diabetes (T2D) inadequately controlled on sitagliptin. METHODS Open-label, three-arm, 24-week trial; 582 insulin-naïve patients were randomized to twice-daily BIAsp 30+sitagliptin (BIAsp BID+Sit), once-daily BIAsp 30+sitagliptin (BIAsp QD+Sit) or twice-daily BIAsp 30 without sitagliptin (BIAsp BID), all with metformin. RESULTS After 24 weeks, HbA1c reduction (%) was superior with BIAsp BID+Sit vs. BIAsp QD+Sit (BIAsp BID+Sit minus BIAsp QD+Sit difference: -0.36 [95% CI -0.54; -0.17], P<0.001) and BIAsp BID (BIAsp BID minus BIAsp BID+Sit difference: 0.24 [0.06; 0.43], P=0.01). Observed final HbA1c values were 6.9%, 7.2% and 7.1% (baseline 8.4%), and 59.8%, 46.5% and 49.7% of patients achieved HbA1c <7.0%, respectively. Confirmed hypoglycaemia was lower with BIAsp QD+Sit vs. BIAsp BID (P=0.015); rate: 1.17 (BIAsp QD+Sit), 1.50 (BIAsp BID+Sit) and 2.24 (BIAsp BID) episodes/patient-year. Difference in bodyweight change favoured BIAsp QD+Sit vs. both BID groups (P<0.001). CONCLUSIONS Adding BIAsp 30 to patients with T2D poorly controlled with sitagliptin and metformin is efficacious and well tolerated; however, while BIAsp BID+Sit showed superior glycaemic control, BIAsp QD+Sit had a lower rate of hypoglycaemia and showed no weight gain.
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Affiliation(s)
- Sultan Linjawi
- Coffs Endocrine and Diabetes Services, Coffs Harbour, New South Wales, Australia.
| | | | - Ramazan Sari
- Akdeniz University, School of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Antalya, Turkey
| | | | | | - Paturi Rao
- Nizam's Institute of Medical Sciences, Hyderabad, India
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Jacobs C, Simon N, Patte R, Dupuy CA, Sari R. Control of blood pressure in patients treated by maintenance hemodialysis. Efficacy of dialysis and contribution of antihypertensive drugs. Contrib Nephrol 2015; 41:128-36. [PMID: 6525834 DOI: 10.1159/000429275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Donmez BO, Ozturk N, Sarikanat M, Oguz N, Sari R, Ozdemir S. Sodium tungstate alleviates biomechanical properties of diabetic rat femur via modulation of oxidative stress. Gen Physiol Biophys 2014; 33:443-52. [PMID: 25032510 DOI: 10.4149/gpb_2014020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022]
Abstract
Diabetes mellitus leads to bone disorders such as osteopenia and osteoporosis that can increase fracture risk. On the other hand, sodium tungstate is an inorganic compound which exerts anti-diabetic activity in experimental studies due to its suggested insulin-mimetic or antioxidant activity. Therefore this study was designed to investigate the effect of tungstate on bone quality in diabetic rat femurs. The rats were divided into four groups: Control (C), tungstate-treated control (C+Tung), diabetes (STZ-D) and tungstate-treated diabetes (STZ-D+Tung). Diabetes mellitus was induced by single injection of streptozotocin (50 mg/kg). The treated rats received 150 mg/kg/day of sodium tungstate for 12 weeks. Sodium tungstate achieved a little (17%) but significant reduction on blood glucose levels, while it didn't recover the reduced body weights of diabetic rats. In addition, impaired bone mechanical quality was reversed, despite the unchanged mineral density. Sodium tungstate administration significantly lowered the 2-thiobarbituric acid reactive substances and restored the activity of tissue antioxidant enzymes such as glutathione peroxidase, catalase and superoxide dismutase in diabetic rats. On the other hand, glutathione levels didn't change in either case. These findings indicate that tungstate can improve the reduced mechanical quality of diabetic rat femurs due probably to reduction of reactive oxygen species and modulation of antioxidant enzymes as well as reduction in blood glucose levels.
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Affiliation(s)
- Baris O Donmez
- Department of Nutrition and Dietetics, School of Health, Akdeniz University, 07070, Antalya, Turkey
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Giugliano D, Tracz M, Shah S, Calle-Pascual A, Mistodie C, Duarte R, Sari R, Woo V, Jiletcovici AO, Deinhard J, Wille SA, Kiljanski J. Initiation and gradual intensification of premixed insulin lispro therapy versus Basal {+/-} mealtime insulin in patients with type 2 diabetes eating light breakfasts. Diabetes Care 2014; 37:372-80. [PMID: 24170763 DOI: 10.2337/dc12-2704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We compared two strategies initiating and intensifying insulin treatment and tested for noninferiority of premixed insulin to basal ± mealtime insulin analog in patients eating light breakfasts. RESEARCH DESIGN AND METHODS This randomized, open-label, 48-week study compared two algorithms. Up to three injections of insulin lispro mix 25 and/or insulin lispro mix 50 (premix; premixed insulin lispro) or basal insulin glargine plus up to three injections of insulin lispro (basal+; glargine + insulin lispro) were used in type 2 diabetic patients uncontrolled with oral antihyperglycemic medication and consuming <15% daily calories at breakfast. The hypothesis was to test noninferiority of premix to basal+ for glycemic control measured by HbA1c after 48 weeks, assessed using ANCOVA with a 0.4% margin. RESULTS Patients (n = 344; 176 [51%] females; mean [SD] age 54.3 [8.8] years; BMI 29.4 [4.6] kg/m(2); baseline HbA1c 9.02 [0.97]%) were randomized to premix (n = 171) or basal+ (n = 173). In the per-protocol analysis (n = 230), least squares means (95% CI) end point HbA1c were 7.40% (7.15-7.65) and 7.55% (7.27-7.82) in respective arms. Between-treatment difference was -0.14% (-0.42 to 0.13), with noninferiority met. Significantly more patients in premix achieved HbA1c targets of <7.0% compared with basal+ (48.2 vs. 36.2%; P = 0.024). Self-monitored blood glucose profiles, body weight changes, total insulin doses, and overall hypoglycemia (65 vs. 60%) were similar in premix and basal+ (P = 0.494), except nocturnal episodes (34.3 vs. 23.7%; P = 0.018) were more common in premix. CONCLUSIONS Both intensive insulin strategies improved glycemic control; however, final HbA1c levels were seen above those achieved in previous treat-to-target trials, likely due to the inadequate insulin titrations and probably due to the complexity of tested insulin regimens. A higher percentage of patients achieved target HbA1c <7% with multiple premixed insulins, but this treatment resulted in more nocturnal hypoglycemia than a basal-bolus regimen.
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Altaş M, Cerçi A, Silav G, Sari R, Coşkun K, Balak N, Işik N, Elmaci I. Microsurgical management of non-neurofibromatosis spinal schwannoma. Neurocirugia (Astur) 2012; 24:244-9. [PMID: 23102980 DOI: 10.1016/j.neucir.2012.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/17/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this study is to assess the clinical properties and surgical results of patients diagnosed with spinal schwannomas without neurofibromatosis (NF) properties. PATIENTS AND METHODS The data obtained from 35 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. 35 patients underwent surgery for spinal schwannoma at our institution between January 1997 and 2010. The data were gathered retrospectively from medical records and included clinical presentation, tumor location and post-operative complications. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists with histopathological sections in paraffin stained with hematoxylin-eosin. RESULT We treated 35 (20 males and 15 females) patients with spinal schwannomas. The mean age of the patients was 47.2 (between 13 and 76) years. Of the cases, six schwannomas were located in the cervical spine, four in the thoracic spine, two in cervico-thoracic area, 10 in the thoraco-lumbar area and 13 in the lumbar spine. Two patients had malignant schwannomas that were recurrent. Of the 35 cases, the schwannomas were intradural-extramedullary in 30 cases (86%), intradural-intramedullar in 2 cases (6%), and extradural in 3 cases (9%). CONCLUSION Spinal schwannomas may occur at any level of the spinal axis and are most frequently intradural-extramedullary. The most common clinical presentation is pain. Most of the spinal schwannomas in non-NF patients can be resected completely without or with minor post-operative deficits. This knowledge may help us to create a strategy for total resection of a spinal schwannomas.
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Affiliation(s)
- Murat Altaş
- Department of Neurosurgery, Tayfur Ata Sokmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
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Sari F, Eray E, Sari R. The Effect of Quinapril Treatment on Insulin Resistance, Leptin and High Sensitive C-Reactive Protein in Hypertensive Patients. Clin Exp Hypertens 2011; 33:548-51. [DOI: 10.3109/10641963.2011.577481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
AIM In traumatic brain injury (TBI) patients, it is desired to monitor the intracranial pressure (ICP) to assess the cerebral haemodynamics and guide the therapy. The study was designed to see if the pulsatility index (PI) measured by transcranial Doppler ultrasonography (TCD) predicts information about ICP values. MATERIAL AND METHODS In 52 TBI patients with Glasgow Coma Scale (GCS) score < 9, invasive intracranial monitoring and TCD ultrasonography for PI were performed through five days. ICP, cerebral perfusion pressure (CPP), PI values were recorded and calculated. The correlation and regression analysis between ICP, PI and CPP were investigated in the whole group and in patients with a Glasgow Outcome Score (GOS) of 3-5. RESULTS The decline in ICP and PI values was significant through five days. The correlation between ICP and PI was strongly significant (p < 0.0001) on days 1, 3 and 5. In patients with a GOS of 3-5, correlation of ICP and PI was also observed. The only significant correlation observed between CPP and PI was on day 5. CONCLUSION The strong correlation observed between ICP and PI through the management period of TBI patients can lead us to use TCD ultrasonography-derived PI as a guide if invasive monitoring is not available.
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Affiliation(s)
- Melek Gura
- Goztepe Training Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
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Eray E, Sari F, Ozdem S, Sari R. Relationship between thyroid volume and iodine, leptin, and adiponectin in obese women before and after weight loss. Med Princ Pract 2011; 20:43-6. [PMID: 21160213 DOI: 10.1159/000322075] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 12/30/2009] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate whether or not reduction of thyroid volume during weight loss is related to adipocytokines and urinary iodine excretion in obese women. SUBJECTS AND METHODS 98 obese and 31 non-obese women consecutively admitted to the endocrinology and metabolism outpatient clinic of the School of Medicine, Akdeniz University were included in the study. Thyroid volume, thyroid function tests, leptin and adiponectin levels, and urinary iodine excretion were measured at baseline and six months after treatment for obesity. RESULTS Thyroid volume increased in obese women (p = 0.048). After adjustment for body mass index, there were no significant differences in plasma leptin and serum adiponectin levels between obese and non-obese women (p > 0.05). Thyroid volume correlated positively with body mass index (r = 0.48, p = 0.04), leptin (r = 0.1, p = 0.03), and thyroid-stimulating hormone (r = 0.43, p = 0.001) levels, while there was a negative correlation between thyroid volume and urinary iodine (r = -0.38, p = 0.04) and urinary iodine/creatinine ratio (r = -0.25, p = 0.045) in obese women. Changes in body mass index (p = 0.022) and leptin levels (p = 0.039) were the only factors that significantly affected the change of thyroid volume during weight loss. CONCLUSION Iodine status may play an important role in increased thyroid volume in obese women; however, iodine status did not seem to exert a significant influence on the changes in thyroid volume. On the other hand, changes in both body mass index and plasma leptin levels seemed to be important for changes in thyroid volume.
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Affiliation(s)
- Esin Eray
- Division of Endocrinology and Metabolism, School of Medicine, Akdeniz University, Antalya, Turkey
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Sari R, Balci MK, Apaydin C. The Relationship Between Plasma Leptin Levels and Chronic Complication in Patients with Type 2 Diabetes Mellitus. Metab Syndr Relat Disord 2010; 8:499-503. [DOI: 10.1089/met.2009.0127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ramazan Sari
- Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Mustafa Kemal Balci
- Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Cemil Apaydin
- Division of Ophthalmology, Akdeniz University, School of Medicine, Antalya, Turkey
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Schlichting HE, Ofek EO, Wenz M, Sari R, Gal-Yam A, Livio M, Nelan E, Zucker S. A single sub-kilometre Kuiper belt object from a stellar occultation in archival data. Nature 2009; 462:895-7. [PMID: 20016596 DOI: 10.1038/nature08608] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 10/21/2009] [Indexed: 11/09/2022]
Abstract
The Kuiper belt is a remnant of the primordial Solar System. Measurements of its size distribution constrain its accretion and collisional history, and the importance of material strength of Kuiper belt objects. Small, sub-kilometre-sized, Kuiper belt objects elude direct detection, but the signature of their occultations of background stars should be detectable. Observations at both optical and X-ray wavelengths claim to have detected such occultations, but their implied abundances are inconsistent with each other and far exceed theoretical expectations. Here we report an analysis of archival data that reveals an occultation by a body with an approximately 500-metre radius at a distance of 45 astronomical units. The probability of this event arising from random statistical fluctuations within our data set is about two per cent. Our survey yields a surface density of Kuiper belt objects with radii exceeding 250 metres of 2.1(-1.7)(+4.8) x 10(7) deg(-2), ruling out inferred surface densities from previous claimed detections by more than 5sigma. The detection of only one event reveals a deficit of sub-kilometre-sized Kuiper belt objects compared to a population extrapolated from objects with radii exceeding 50 kilometres. This implies that sub-kilometre-sized objects are undergoing collisional erosion, just like debris disks observed around other stars.
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Affiliation(s)
- H E Schlichting
- Department of Astronomy, 249-17, California Institute of Technology, Pasadena, California 91125, USA.
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Abstract
Obesity is a chronic metabolic disorder associated with cardiovascular disease and atherosclerosis. Platelet activation and aggregation are central processes in the pathophysiology of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk marker for atherothrombosis. Our objective was to evaluate the effect of weight loss on the MPV in obese patients. We selected 30 obese women patients and 30 non-obese healthy women subjects. All obese patients took the same content and caloric diet treatment for 3 months. Body mass index (BMI), metabolic parameters and MPV were measured at baseline and after 3 months diet treatment. Before diet treatment, obese group had significantly higher MPV levels than in the non-obese control group (8.18 +/- 1.09 fl vs. 8.01 +/- 0.95 fl, p = 0.004). MPV showed positive correlations with BMI level in the obese group (r = 0.43, p = 0.017). BMI significantly decreased after diet treatment (36.2 +/- 3.2 kg/m(2) vs. 34.7 +/- 3.6 kg/m(2), p < 0.001), in the obese group. MPV significantly decreased after diet treatment in the obese group (8.18 +/- 1.09 fl vs. 8.08 +/- 1.02 fl, p = 0.013). There was a positive correlation between weight loss and reduction in MPV (r = 0.41, p = 0.024). In addition to its well-known positive effects on cardiovascular disease risk, weight loss may also possess significant anti-platelet activation properties that can contribute its antiatherogenic effects in obese patients.
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Affiliation(s)
- Erkan Coban
- Department of Internal Medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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