Browsing by Author "Ozmen, B"

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    Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus
    Unlu, Z; Ozmen, B; Tarhan, S; Boyvoda, S; Goktan, C
    Objective. To assess musculoskeletal ultrasonographic (US) findings in patients with type 2 diabetes mellitus (DM) with and without pes anserinus (PA) tendinitis or bursitis syndrome; and to determine possible etiologic factors such as systemic diabetic microvascular disease complications in these patients. Methods. The knee joints were examined with an ultrasound real-time scanner using a 10 MHz electronic linear transducer in 48 patients with type 2 DM and 25 controls. The presence of systemic diabetic microvascular disease complications was evaluated. Results. On examination 23 (23.9%) knees of the 14 (29.1%) patients with type 2 DM were found to have PA tendinitis or bursitis syndrome. US revealed that only 4 (8.3%) of the diabetic patients with PA tendinitis or bursitis syndrome had PA tendonitis findings. There were no significant differences in the thickness of PA tendons between the diabetic patients with bilateral knee PA tendinitis or bursitis syndrome (9 patients) and controls, or between the asymptomatic and symptomatic knees in patients with unilateral PA tendinitis or bursitis syndrome (5 patients). The prevalence of morphologic changes of the medial meniscus, effusion and synovitis in the suprapatellar recess, popliteal cyst, and radiographic osteoarthritis (OA) in the diabetic patients with PA tendinitis or bursitis syndrome was found to be increased. Conclusion. The prevalence of PA tendinitis or bursitis syndrome is not uncommon on examination in patients with type 2 DIM. However, patients with clinically diagnosed PA tendinitis or bursitis syndrome less frequently have morphologic US changes of the PA tendons. Our results also suggest that structural changes such as meniscus lesions that occur in consequence of OA might have a role in the etiology of medial knee pain in diabetic patients.
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    Depression and anxiety in hypothyroidism
    Demet, MM; Ozmen, B; Deveci, A; Boyvada, S; Adiguzel, H; Aydemir, O
    The aim of the study was to determine the prevalence and severity of depression and anxiety inpatients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, for psychiatric assessment, Hospital Anxiety and Depression Scale (HAD), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used There was no difference between the two groups in terms of demographic features. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyroidism. However depression was more significant in the hypothyroid than euthyroid group.
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    Down-regulation of the auto-aggressive processes in patients with hypothyroid Hashimoto's thyroiditis following substitutive treatment with L-thyroxine
    Guclu, F; Ozmen, B; Kirmaz, C; Kafesciler, SO; Degirmenci, PB; Taneli, F; Hekimsoy, Z
    Background. Hashimoto's thyroiditis is a chronic, organ-specific autoimmune disease. It is the most common cause of primary hypothyroidism during the adolescent period, via autoimmune thyroid tissue destruction, affecting 2% of the population. The pathogenesis of Hashimoto's thyroiditis involves a complex interaction between predisposing genetic and environmental factors. Objective. In this study, we wanted to investigate the role of cytokines such as IL-2, IL-4, IL-12 and IFN-gamma in the pathogenesis of the disease, and the changes to cytokine levels brought about by treatment with L-thyroxine. Methods. Sixty five female patients, aged 18-73 years with Hashimoto's thyroiditis, referred to the Celal Bayar University Medical Faculty Endocrinology out-patients clinic, were included in this study. After a 10-12 week period of L-thyroxine treatment, all patients were restored to the euthyroid state. At the beginning and end of the treatment period, serum-free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), autoantibodies against thyroid peroxidase (anti-TPO), autoantibodies against thyroglobulin (anti-Tg) levels were measured using a chemiluminecent, immunometric method, and cytokine levels were measured using ELISA. Results. There was a statistically significant decrease in the serum levels of TSH (p < 0.0001) and a concomitant increase in FT4 serum levels (p < 0.0001). Also, during the post-treatment period, serum levels of anti-Tg (p < 0.01) and anti-TPO (p < 0.001) were significantly lower than during the pre-treatment period. A statistically significant decrease was shown for interleukin (IL)-12 serum levels during the post-treatment period (p < 0.001). However, the decrease in interferon (IFN)-gamma serum levels was not statistically significant (p = 0.276). On the other hand, no change was demonstrated in serum IL-2 and IL-4 levels (p = 0.953 and p = 0.313, respectively) after treatment with L-thyroxine. Conclusion. Considering that our study involved a 10-12 week period of treatment, the statistically significant decrease in serum IL-12 levels, and the statistically non-significant decrease in IFN-gamma levels, might indicate that a T helper type 1 inflammatory process had been halted or slowed down.
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    Vitamin D Levels in Overweight/Obese Adults With and Without Metabolic Syndrome
    Karatas, S; Hekimsoy, Z; Dinc, G; Onur, E; Ozmen, B
    Background: Vitamin D role is not only associated with mineral metabolism and bone health but also in globally important diseases such as obesity and metabolic syndrome. The aims of this observational study were to investigate: 1) 25(OH) vitamin D levels in overweight/obese persons with and without metabolic syndrome and compare these with levels in healthy subjects, 2) the relationship between serum 25(OH) vitamin D levels and metabolic syndrome components such as body mass index, waist circumference, blood pressure, fasting blood glucose, lipid parameters and insulin resistance: Homeostasis Model Assesment of Insulin Resistance (HOMA-IR). Methods: Participants (n = 287) were 94 overweight/obese adults with metabolic syndrome, 120 overweight/obese adults without metabolic syndrome, and 73 non-obese healthy subjects (controls). Overweight/obese subjects were classified as metabolic syndrome (MetS) positive according to the recent International Diabetes Federation criteria. HOMA-IR was calculated as serum glucose (mg/dL) x insulin level (mu U/mL)/405. Vitamin D nutritional status was assessed as deficient if 25(OH) vitamin D levels were < 20 ng/mL, insufficient if = 20 - < 30 ng/mL, and sufficient if = 30 ng/mL. Results: Serum 25(OH) vitamin D deficiency, defined as a level < 20 ng/mL, was more common in overweight/obese adults with (72%) and without (69%) metabolic syndrome than in controls (49%) (P = 0.006). Serum 25(OH) vitamin D levels were significantly lower in overweight/obese metabolic syndrome adults (16.8 +/- 7.3 ng/mL) and overweight/obese non-metabolic syndrome adults (18.3 +/- 8.6 ng/mL) than healthy subjects (21.2 +/- 8.9 ng/mL, P = 0.001). A negative relationship was found between serum 25(OH) vitamin D levels and body mass index (r = -0.159, P = 0.007) and serum triglyceride levels (r = -0.149, P = 0.012). Serum 25(OH) vitamin D levels correlated inversely (not statistically significant) to waist circumference, fasting blood glucose, HOMA-IR, and blood pressure, but positively (not statistically significant) to HDL cholesterol levels. Conclusions: Vitamin D deficiency is very common in overweight/obese adults, more so than in healthy controls. Vitamin D deficiency is not more common in those with metabolic syndrome than in those without. Reduced 25(OH) vitamin D levels are associated with an increased risk of overweight/obesity and metabolic syndrome.
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    Association between homocysteinemia and renal function in patients with type 2 diabetes mellitus
    Ozmen, B; Ozmen, D; Turgan, N; Habif, S; Mutaf, I; Bayindir, O
    Homocysteinemia is an independent risk factor for cardiovascular disease, but information on its association with type 2 diabetes and mild renal dysfunction is limited. Plasma total homocysteine (tHcy) concentration is partly determined by renal plasma clearance. Serum cystatin C (Cys C) concentration has been introduced as a marker of renal function, specifically as an indicator of glomerular filtration rate (GFR). The aim of this study was to explore the relationships among tHcy, creatinine clearance (Ccr), serum Cys C, and microalbuminuria in a population with type 2 diabetes. Fasting plasma tHcy, serum homocysteine-related vitamins (folate and vitamin B 12), serum Cys C, serum creatinine, urine microalbumin, and creatinine clearance were determined in 75 type 2 diabetic patients and 40 healthy control subjects. The patients were assigned to two groups based on urinary albumin excretion (UAE): normoalbuminuric (NAU, UAE <30 mg/24 hr, n = 35) and microalbuminuric (MAU, UAE 30-300 mg/24 hr, n = 40). Ccr was calculated using the Cockroft-Gault formula. Plasma Hcy levels were determined by HPLC with fluorescence detection and serum Cys C by automated particle enhanced immunoturbidimetry. Plasma tHcy levels were significantly higher in normoalbuminuric and microalbuminuric patients than in controls (10.64+/-0.53, 13.29+/-0.78, 6.91+/-0.37 mmol/L, respectively). Serum Cys C levels in microalbuminuric diabetics were higher than in normoalbuminurics and controls (1.36+/-0.06, 1.12+/-0.04, 1.10+/-0.06 mg/L, respectively). Positive correlations were noted between tHcy and Cys C levels in normoalbuminuric and microalbuminuric diabetics (r = 0.72, r = 0.64, respectively). Homocysteine and creatinine concentrations were correlated in both diabetic groups (r = 0.89, r = 0.93, NAU and MAU, respectively). Elevated plasma total homocysteine concentrations in type 2 diabetics suggest an association between homocysteinemia and deterioration of renal function, evidenced by increased serum creatinine and Cys C, Ccr, and microalbuminuria. These findings implicate homocysteinemia in the relationship between diabetic nephropathy and cardiovascular complications of diabetes.
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    Atherosclerosis risk factors in children of parents with the metabolic syndrome
    Akinci, G; Coskun, S; Akinci, B; Hekimsoy, Z; Bayindir, P; Onur, E; Ozmen, B
    Background: Metabolic syndrome is a constellation of disorders that produces a high risk of atherosclerosis. Endothelial dysfunction is the key event in atherosclerosis and already present even in the childhood. The aim of the present study is to investigate inflammatory and radiological signs of atherosclerosis in children who have parents with the metabolic syndrome. Design and methods: Fifty children of parents with the metabolic syndrome and 38 age- and sex-matched controls were studied. Anthropometric measurements, blood pressure assessment, echocardiography, flow-mediated vasodilatation (FMD) which is a non-invasive test for the evaluation of endothelial function and fasting blood measurements including blood glucose, insulin, total cholesterol, HDL cholesterol, triglyceride, hsCRP and soluble CD40 ligand were performed. Results: Serum sCD40L and hsCRP levels were significantly higher in the study group compared to the controls. FMD values did not differ between the study and control groups. Increased serum sCD40L levels were positively correlated with body mass index, waist hip ratio, LDL/HDL cholesterol ratio, and the number of metabolic syndrome components in parents, whereas showed negative correlation with the serum HDL cholesterol levels. High hsCRP levels were positively correlated with body mass index and the number of metabolic syndrome components. Multiple regression analysis demonstrated that the number of metabolic syndrome components in parents presented as being a significant predictor of the serum sCD40L and hsCRP levels of their children. Conclusion: Our results suggest that children of patients with metabolic syndrome have higher values of the serum markers of inflammation, which may be associated with increased risk for development of cardiovascular disease. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    Allergic rhinitis and its relationship with autoimmune thyroid diseases
    Degirmenci, PB; Kirmaz, C; Oz, D; Bilgir, F; Ozmen, B; Degirmenci, M; Colak, H; Yilmaz, H; Ozyurt, B
    Background: Autoimmune thyroid diseases are the most common of all autoimmune diseases. In the literature, Hashimoto thyroiditis (HT) is considered to be a T-helper (Th) type 1 dominant condition, and Graves disease is considered a Th2-dominant condition. Objective: The aim of this study was to highlight a new aspect of the relationships among Th cell subgroups by determining the incidence of autoimmune thyroid disease in patients with allergic rhinitis (AR). Methods: Patients were diagnosed with AR based on their medical histories, physical examinations, and skin-prick test results in an outpatient clinic. The levels of free triiodothyronine, free thyroxine, thyroid-stimulating hormone, thyroid peroxidase antibodies, and thyroglobulin antibodies were measured in peripheral blood samples from all study subjects. Results: A total of 1239 patients with AR and 700 consecutive, age- and sex-matched healthy subjects were included in the study. Thyroid function tests showed that 1037 patients with AR (83.7%) had normal thyroid function, 171 (13.8%) had euthyroid HT, and 31 (2.5%) had hypothyroid HT. Among the control subjects, thyroid function test results showed that 688 subjects (98.2%) had normal thyroid function, 10 subjects (1.4%) had euthyroid HT, and 2 subjects(0.4%) had hypothyroid HT. Conclusion: The incidence of HT in the general population is 1.5%; in contrast, it was observed in 16.3% of our patients with AR, which represented a much higher rate than that in the overall population. Graves disease was not detected in our study subjects. A high incidence of HT in patients with AR, in which Th2 responses are dominant, indicates that further studies of the relationships among atopy, autoimmune diseases, and Th cell subgroups are needed.
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    Does thyroid replacement therapy affect pulmonary function tests in patients with subclinical hypothyroidism?
    Koral, L; Hekimsoy, Z; Yidirim, C; Ozmen, B; Yorgancioglu, A; Girgin, A
    Objective: Subclinical hypothyroidism is an elevation in serum thyroid-stimulating hormone (TSH) while having normal serum free thyroxine (FT4) and triiodothyronine (FT3) levels. The purpose of this prospective observational study was to evaluate the pulmonary function of patients diagnosed with subclinical hypothyroidism, both before and after treatment with thyroid hormone. Methods: This study took place at the Medical Faculty, Celal Bayar University, Manisa, Turkey between February 2003 and June 2004. Thirty-eight patients (37 females, one male) with subclinical hypothyroidism between 20 and 65 years of age were included in the study. Most were mildly obese. Arterial blood gases and pulmonary function tests were performed before treatment with thyroid hormone, and afterwards, the TSH value reached the normal range (indicating euthyroidism). Results: Oxygen saturation, but not partial oxygen pressure or partial carbon dioxide pressure, was statistically, but not clinically significantly higher after treatment with thyroid hormone (p=0.01). Pulmonary function tests were not significantly different before and after treatment with thyroid hormone. Conclusion: In our subclinical hypothyroidism patients, pulmonary function tests were normal and did not significantly change with thyroid hormone replacement. The advantages of thyroid hormone replacement therapy, at least regarding respiratory function, seem to be clearly present in patients with overt, clinical hypothyroidism but not in patients with subclinical hypothyroidism.