Yazar "Guldiken, Sibel" seçeneğine göre listele

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    Arylsulfonamidothiazoles for the early stages of Alzheimer type dementia: A new potential for treatment
    (Churchill Livingstone, 2011) Guldiken, Sibel; Guldiken, Baburhan
    [Abstract Not Available]
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    The Association of Gene Polymorphisms of the Angiotensin-Converting Enzyme and Angiotensin II Receptor Type 1 with Ischemic Stroke in Turkish Subjects of Trakya Region
    (Aves Yayincilik, Ibrahim Kara, 2009) Sipahi, Tammam; Guldiken, Baburhan; Guldiken, Sibel; Ustundag, Sedat; Turgut, Nilda; Budak, Metin; Cakina, Suat
    Objectives: The aim of this study was to investigate the frequency of ACE insertion/deletion (I/D) and AT1R (A1166C) gene polymorphisms in ischemic stroke patients in Trakya region and the relation between these gene polymorphisms and stroke subtypes and vascular risk factors. Patients and Methods: The study involved 162 patients with ischemic stroke and 146 control subjects. Ischemic stroke patients were divided into large and small vessel disease subgroups according to ORG 10172 in Acute Stroke Treatment TOAST criteria. The ACE I/D polymorphism was investigated using polymerase chain reaction (PCR), and the AT1R (A1166C) polymorphism was identified using PCR and restriction fragment length polymorphism (RFLP) assay. Results: The ACE I/D genotype distribution in patients (DD=34.0%, ID=50.0%, II=16.0%) did not differ from those in controls (DD=34.3%, ID=49.7%, II=16.1%). The AT1R A1166C genotype distribution in patients (AA=58.0%, CA=34.6%, CC=7.4%) did not significantly differ from those in controls (AA=60.1%, CA=35.7%, CC=4.2%). There was also no difference among the stroke subgroups regarding the distribution of ACE I/D and AT1R (A1166C) polymorphisms. Conclusion: Our results show that ACE I/D and AT1R (A1166C) gene polymorphisms were not genetic risk factors for ischemic stroke in subjects in Trakya region.
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    A case of double parathyroid adenoma mimicing intrathoracic tumor
    (Lippincott Williams & Wilkins, 2008) Taskiran, Bengur; Altun, Betul Ugur; Usta, Ufuk; Guldiken, Sibel; Arikan, Ender; Van Tue-Rul, Arina
    Adenoma is the leading pathologic entity in primary hyperparathyroidism (85%-90%). Although brown tumors are rarely seen, they may be the initial presentation and confused with tumors of the contiguous structures. Bilateral neck exploration by an experienced surgeon is the preferred approach. However, computed tomography, magnetic resonance imaging, ultrasonography, and isotope scanning can delineate most cases (75%-85%). We present a man with 2 adenomas. The second tumor was not recognized until the first one was removed. Combined imaging modalities and the measurement of intraoperative parathormone did not help in identifying the second adenoma. We review the common problems associated with diagnosis and treatment of multiple parathyroid adenomas.
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    Comparative neurophysiological study for the diagnosis of mild polyneuropathy in patients with diabetes mellitus and glucose intolerance
    (Taylor & Francis Ltd, 2006) Turgut, Nilda; Guldiken, Sibel; Balci, Kemal; Tugrul, Armagan; Berberoglu, Ufuk; Altun, Betul Ugur
    This article evaluates diagnostic sensitivity of minimal F-wave latency, sural/radial amplitude ratio ( SRAR), dorsal sural/radial amplitude ratio ( DSRAR), sympathetic skin response ( SSR), and R-R interval variability ( RRIV) for detecting early polyneuropathy in patients with glucose intolerance and diabetic patients. F-wave latencies were more prolonged in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). SRAR was lower, SSR latency was more prolonged, and RRIV was lower in diabetic patients with abnormal nerve conduction studies than healty controls ( p < .001). SSR latency was more prolonged and RRIV was lower in diabetic patients with normal nerve conduction studies than healty controls ( p < .01, p < .05, respectively). DSRAR was lower in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). DSRAR was also lower in patients with glucose intolerance than control subjects ( p < .01). DSRAR was the most sensitive and specific test in either of diabetic patients with normal nerve conduction studies ( sensitivity 66%, specificity 90%) and diabetic patients with abnormal nerve conduction studies ( sensitivity 100%, specificity 90%). DSRAR is the most reliable method for detection of early nerve pathology. Patients with glucose intolerance might have subclinical neuropathy that can be demonstrated with DSRAR analysis.
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    A Cross-Sectional Study of the Prevalence of Cardiovascular Disease in Adults with Type 2 Diabetes in Turkiye: The CAPTURE Study
    (Aves, 2022) Bayram, Fahri; Bayraktaroglu, Taner; Sargin, Mehmet; Sahin, Ibrahim; Guldiken, Sibel; Dalbeler, Aysegul; Sonmez, Alper
    Objective: The primary objective of the CAPTURE study was to estimate the prevalence of cardiovascular disease (CVD) in adults with Type 2 diabetes mellitus (T2DM) across 13 countries from 5 continents. Here, we present the findings from Turkiye. Material and Methods: The non-interventional, cross-sectional CAPTURE study (NCT03811288; NCT03786406) was conducted across 15 centers in Turkiye. Standardized demographic and clinical data were collected from adults with T2DM who were treated by primary or specialist care physicians. The prevalences of CVD and its 7 subtypes were estimated. Descriptive statistics were used for data analysis. Results: Amongst the 801 participants (n=200 from primary care, n=601 from specialist care) with T2DM enrolled, 250 had established CVD, an estimated weighted prevalence of 31.2% (28.0-34.4) 95% confidence interval. Atherosclerotic CVD contributed to the majority (85.6%) of the CVD cases. An estimated 24.0% of the Turkiye sample had coronary heart disease (CHD). Heart failure was the second most predominant CVD subtype in Turkiye is correct sample (5.4%), followed by cardiac arrhythmia and conduction abnormalities (4.7%). Sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists with cardiovascular (CV) benefits were prescribed to 17.5% and 0.1% of the patients, respectively. Conclusion: Approximately 30% of participants with T2DM had established CVD in the CAPTURE Turkiye population, comparable to the global pooled prevalence. CHD was the major contributor and encompassed approximately 75% of the CVD cases. The use of glucose-lowering medication with CV benefits was low compared to the global pooled population, which may be due to the lack of reimbursement of these medications in Turkiye.
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    The Effect of Disease Duration on Foot Plantar Pressure Values in Patients with Type 2 Diabetes Mellitus
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Tuna, Hakan; Birtane, Murat; Guldiken, Sibel; Soysal, Neslihan Atile; Taspinar, Ozgur; Sut, Necdet; Tastekin, Nurettin
    Objective: Diabetic foot problems and consequent ulceration in older patients are a major cause of morbidity and permanent disability. One of the major risk factors for ulceration is foot pressure changes. We, in this study, aimed to identify any relation between disease duration and plantar pressure of patients with type 2 diabetes. Material and Methods: This study was done on 168 feet of 84 diabetic patients. Demographic parameters and body mass index were noted. The patients were allocated according to disease duration as being more (Group 1) or less than 10 years (Group 2). Static and dynamic pedographic evaluation was performed for each of the patients, and results were compared between the groups. Results: The static pedobarographic evaluation revealed significantly higher forefoot plantar force percentage values in the left feet of patients in group 1. We found that peak phalanx pressure was significantly higher in the left foot, while the contact area was lower in the right foot of group 1 patients, by dynamic pedobarographic evaluation. Conclusion: Contact area decreases and peak pressure increases during walking in forefoot after 10 years of disease duration in type 2 diabetic patients.
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    Effect of obesity on TAFI in postmenopausal period
    (Elsevier Sci Ltd, 2010) Taskiran, Bengur; Guldiken, Sibel; Demir, Ahmet M.; Okman, Tulay K.; Arikan, Ender; Turgut, Burhan; Tugrul, Ayse A.
    Aim: The aim of the study was to evaluate how obesity effects the coagulation and fibrinolytic system in the postmenopausal period. Method: Forty-eight obese (body mass index (BMI) >= 30 kg/m(2)) and 38 nonobese (BMI < 30 kg/m(2)) postmenopausal women were enrolled in the study. Fat mass and insulin resistance were calculated. Plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), D-dimer, thrombomodulin, and thrombin activatable fibrinolysis inhibitor (TAFI) antigen were determined by ELISA method. TAFI activity was measured using the chromogenic assay. Results: Obese subjects had higher PAI-1 (73.5 +/- 35.7 ng/mL vs. 57.1 +/- 34.2 ng/mL, p < 0.05) levels but lower tPA/PAI-1 ratio (0.59 +/- 0.50 vs. 38 +/- 0.21, p < 0.05) than their nonobese counterparts. Obesity was not statistically significant for other haemostatic variables. BMI and fat mass were positively correlated with PAI-1 (r = 0.312, p = 0.003; r = 0.381, p = 0.005, respectively) and negatively correlated with tPA/PAI-1 ratio (r = -0.273, p = 0.01; r = -0.545, p = 0.01, respectively). HOMA scores were also positively correlated with PAI-1 levels (r = 0.236, p = 0.04). Conclusion: We found that tendency to hypercoagulability in the postmenopausal women was due to increased PAI-1 rather than TAFI levels, which may contribute to adverse cardiovascular outcomes in this cohort. Further studies should be undertaken to evaluate effects of weight loss on the coagulation and fibrinolytic system. (C) 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
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    The effects of angiotensinogen M235T/T174M and angiotensin type 1 receptor A1166C gene polymorphisms on the development of diabetic nephropathy in type 2 diabetes mellitus patients
    (Aepress Sro, 2023) Yukcu, Fulya; Sipahi, Tammam; Guldiken, Sibel; Ustundag, Sedat; Sut, Necdet
    AIMS: Diabetic nephropathy is one of the major complications of Type 2 diabetes mellitus. In this study, we aimed to investigate the effects of angiotensinogen M235T/T174M and angiotensin type 1 receptor A1166C gene polymorphisms on the development of diabetic nephropathy in patients with type 2 diabetes mellitus. METHODS: This study included 100 type 2 diabetes mellitus patients with diabetic nephropathy patients (patient group) and 99 type 2 diabetes mellitus patients without diabetic nephropathy (control group). Polymerase chain reaction and restriction fragment length polymorphism methods were used to identify polymorphisms in the angiotensinogen M235T/T174M and angiotensin type 1 receptor A1166C genes.RESULTS: There was no significant difference in genotype frequencies of M235T gene polymorphism between patient and control groups (chi 2 = 4.01, df = 2, p = 0.13). There was no significant difference in genotype frequencies of T174M gene polymorphism between patient and control groups (X2 = 0.36, df = 2, p = 0.83). There was no significant difference in genotype frequencies of A1166C gene polymorphism between patient and control groups (chi 2 = 0.51, df = 2, p = 0.77).CONCLUSIONS: The results showed no significant difference in angiotensinogen M235T/T174M and angiotensin type 1 receptor A1166C gene polymorphisms between the patient and control groups. Future studies are needed to validate the results of this study and to explore underlying mechanisms (Tab. 3, Fig. 3, Ref. 35). Text in PDF www.elis.sk
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    The effects of fat distribution and some adipokines on insulin resistance in subjects with prediabetes
    (Via Medica, 2016) Bilir, Betul Ekiz; Guldiken, Sibel; Tuncbilek, Nermin; Demir, Ahmet Muzaffer; Polat, Ahmet; Bilir, Bulent
    Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p < 0.001) and visfatin (p < 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p < 0.01) and fat mass (p < 0.01) and low adiponectin (p < 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance.
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    The Effects of Pulsed Electromagnetic Field Treatment in Pain Due to Diabetic Polyneuropathy
    (Aves Yayincilik, Ibrahim Kara, 2010) Fezyioglu, Pervin; Ozdemir, Ferda; Guldiken, Sibel; Balci, Kemal; Sut, Necdet
    Objectives: Diabetic polyneuropathy is the most common and disabled complication of diabetes mellitus. Pharmacological treatment of diabetic neuropathy is limited because of the side efects of the drugs, used in the treatment of diabetic neuropthy. Alternative treatments are also used in diabetic neuropathy. Systemic side effects of non-pharmacological treatment modalities are rare. We evaluated the value of pulsed electromagnetic field treatment in patients with pain due to diabetic polyneuropathy. Patients and Methods: Symptomatic 95 patients were included in the study, and from these patients, 25 patients were randomized in pulsed electromagnetic field treatment group and 25 patients were randomized in placebo group. Pulsed electromagnetic field device was applied over both feet of the patients for one hour a day (during 10 days). Visual analog scale and neuropathic pain scale of all patients were performed before and after treatment and 6th week. Electroneuromyography was also performed before treatment and 6th week. Results: Improvement of pain determined by visual analog scale was 53% after treatment and 67% six weeks later. The improvement of visual analog scale scores were statistically significant in study group when compared with control subjects. Conclusion: The pulsed electromagnetic field may be an alternative treatment modality in diabetic patients with neuropathic pain.
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    Epilepsy and Thyroid Hormones
    (Kare Publ, 2018) Guldiken, Sibel
    The nervous and endocrine systems are 2 important related systems. Thyroid hormones, in particular, bind to the nuclear receptors of neuronal and glial cells, which affects migration, myelination, and synaptogenesis, and contributes to the development and differentiation of the nervous system. Changes in thyroid hormone levels during the early periods of life can cause serious and permanent damage to the nervous system. Although the exact mechanism is unknown, thyroid hormones interfere with the excitatory and inhibitory neurons and are thought to alter the cerebral epileptogenic threshold. Therefore, thyroid hormones may play a role in the pathogenesis of epilepsy.
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    An Evaluation of Glucose Tolerance in Essential Hypertension
    (Yonsei Univ Coll Medicine, 2009) Tugrul, Armagan; Guldiken, Sibel; Ugur-Altun, Betul; Arikan, Ender
    Purpose: This study aimed to detemine the impaired glucose tolerance and diabetes prevalence in patients with essential hypertension (HT) and to compare the developed microvascular complications of these groups. Materials and Methods: An oral glucose tolerance test (OGTT) was performed on 338 essential hypertensive cases and glucose tolerances were classified according to ADA-2002 criteria. Results: Of the 338 cases, 32 people had diabetes (DM, 9.460/6), 78 people had glucose intolerance (IGT, 23.1%), and 228 people had only hypertension but not IGT and DM (67.4%). Both the mean ages of the DM group (56.9 +/- 6.7 years, p = 0.002) and IGT group (56.3 +/- 8.4 years, p = 0.003) were older than the mean age of the control group (51.1 +/- 6.4 years). The risk of IGT development was found to be four times greater in male cases than female cases when compared to the control group (p = 0.004, add ratio = 4.194). There were no significant differences in the body mass indexes (BMI's), hypertension durations, and microvascular complications between the groups. Conclusion: In conclusion, the risk of IGT and DM development in hypertensive cases increases with aging and longer hypertension duration. The risk of IGT development in hypertensive cases is four times more in males.
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    Fatal Lactic Acidosis Due to Metformin
    (Aves, 2010) Kavalci, Cemil; Guldiken, Sibel; Taskiran, Bengur; Kavalci, Gulsum
    [Abstract Not Available]
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    Frequency of rheumatic diseases in patients with autoimmune thyroid disease
    (Springer, 2007) Soy, Mehmet; Guldiken, Sibel; Arikan, Ender; Altun, Betul Ugur; Tugrul, Armagan
    We aimed to investigate the frequency of rheumatic diseases in patients suffering from autoimmune thyroid diseases (ATD). Sixty-five patients (56 F, 9 M), who were followed by diagnosis of ATD, were questioned and examined for the presence of rheumatic disease. Basic laboratory tests and antithyroid antibodies, antinuclear antibody and rheumatoid factor (RF) levels were also measured by appropriate methods. Various rheumatic diseases were detected in 40 (62%) of patients with ATD. The most frequent rheumatic conditions were fibromyalgia, recurrent aphthous stomatitis, osteoarthritis, keratoconjunctivitis sicca and xerostomia and carpal tunnel syndrome which were detected in 20 (31%), 13 (20%), 10 (15%), 9 (14%) and 8 (12%) of patients, respectively. Autoimmune diseases, except Sjogren's syndrome, which were detected in ten patients with ATD, are as follows-vitiligo: two; autoimmune hepatitis: two; oral lichen planus: one, ulcerative colitis: one, inflammatory arthritis in four patients (two of them had rheumatoid arthritis, one had psoriasis and psoriatic arthritis and one had mixed collagen tissue disease). RF was positive in two patients, one of them had rheumatoid arthritis and FANA was positive in six (9%) patients; all of them had hypothyroidism. The frequency of rheumatic diseases seems to be higher in patients suffering from ATD. Initial evaluation and a regular checking for rheumatic diseases in patients suffering from ATD were recommended.
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    Frequency Of Thyroid Diseases in Type 2 Diabetic Patients
    (Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2009) Taskiran, Benguer; Guldiken, Sibel; Peynirci, Hande; Altun, Betuel Ugur; Tugrul, Armagan
    Objectives: Thyroid diseases and type 2 diabetes mellitus are two abundant diseases in general population. In this study, we evaluated the frequency of thyroid diseases in type 2 diabetic patients. Patients and Methods: The study included 306 type 2 diabetic patients, who were followed up in Trakya University Department of Endocrinology and Metabolism Disorders. All patients had thyroid function tests, antithyroglobulin antibody values, antithyroid peroxidase values, and thyroid imaging (scintigraphy and/or ultrasonography). Results: A total of 38 (12.4%) patients had thyroid diseases with the following distribution: 29 (9.5%) Hashimoto thyroiditis, five (1.7%) multinodular goitre, three (%1) Graves' disease, and one toxic solitary adenoma (0.3%). Conclusion: We found that thyroid diseases in type 2 diabetics were seen as frequent as in general population. We suggest that there is no need to screen type 2 diabetics for thyroid diseases, hypothyroid in particular, that increase the risk for cardiovascular diseases, in addition to the recommended screening of the general population in guidelines.
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    Glu298Asp polymorphism of the endothelial nitric oxide synthase gene in Turkish patients with ischemic stroke
    (Springer, 2009) Guldiken, Baburhan; Sipahi, Tammam; Guldiken, Sibel; Ustundag, Sedat; Budak, Metin; Turgut, Nilda; Ozkan, Hulya
    The low plasma nitric oxide concentrations and reduced vascular reactivity are considered major proatherogenic mechanisms in cardiovascular diseases. The present study aimed to assess the allelic frequency and the genotypic distribution of the Glu298Asp gene polymorphism at exon 7 of endothelial nitric oxide synthase (eNOS) gene in Turkish ischemic stroke patients compared to appropriate healthy controls, and to correlate the genetic findings with stroke subtypes. The study population included 146 (75 males, 71 females) patients with ischemic stroke which were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and 133 (34 males, 99 females) healthy subjects. The eNOS polymorphism was identified with a PCR followed by RFLP with the restriction enzyme BanII. Genotypes were defined as GG, GT, and TT according to the presence of the G and T alleles. In this case-control study, we did not find any significant difference in either the genotypic distribution or allelic frequency of Glu298Asp gene polymorphism between the patients and the controls. In addition, there was also no significant difference for the genotype distribution and the allelic frequency among the stroke subtypes. The results suggested the lack of the association between the Glu298Asp gene polymorphism and ischemic stroke or subtypes of ischemic stroke in the Turkish population.
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    High-intensity interval training acutely alters plasma adipokine levels in young overweight/obese women
    (Taylor & Francis Ltd, 2018) Vardar, Selma Arzu; Karaca, Aziz; Guldiken, Sibel; Palabiyik, Orkide; Sut, Necdet; Demir, Ahmet Muzaffer
    The aim of this study was to investigate the plasma adipokine responses to high-intensity interval training (HIT) in overweight/obese women. Twelve women (age 21.7 +/- 3.8 years) completed a 19 days of HIT comprising six session of 4-6 repeats of a Wingate test (0.065 kg load/kg). Plasma adipokine levels were measured before exercise, and at 5 and 90 min after exercise on the first and the last training days. Adiponectin was higher at 5 min than 90 min post-exercise (11.7 +/- 7.3 and 10.5 +/- 5.8 ng/ml; p = .01) in the first exercise day. Leptin decreased 5 min after exercise (23.6 +/- 13.2 vs. baseline 27.8 +/- 14.4 ng/ml; p < .01) and remained depressed following 90 min (p < .01). The changes in adiponectin and leptin concentrations were similar on the first and last exercise days. No consistent effect was found on resistin concentration. Future studies are required to disclose the functional consequences of these alterations in plasma adipokine levels.
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    Histopathological Evidence of Lymph Node Metastasis in Papillary Thyroid Carcinoma
    (Humana Press Inc, 2015) Can, Nuray; Tastekin, Ebru; Ozyilmaz, Filiz; Sezer, Yavuz Atakan; Guldiken, Sibel; Sut, Necdet; Sarikas, Nurtac
    Prophylactic lymph node dissection is still controversial due to the potentially surgery-related morbidity in management of papillary thyroid carcinomas. So, some histopathological predictors for lymph node metastasis in thyroidectomy specimens may reveal importance. The objective of this study was to define histomorphological indicators of lymph node metastasis in the patients who had been performed thyroidectomy without lymph node dissection. Clinicopathological features of patients archived in Department of Pathology at Trakya University Medical Faculty were reviewed. A total of 211 patients who had been diagnosed as papillary carcinoma and had been performed total thyroidectomy/lobectomy with central/cervical lymph node dissection were included in the study. Clinical features (age, gender, preoperative/postoperative clinical, and laboratory findings) and histopathological features (histological variant, tumor size, focality, extrathyroidal extension, tumor border, lateral tubular growth, intraglandular dissemination, stromal and lymphocytic tumor response, lymphocytic thyroiditis, lymphovascular invasion, lymph node metastasis, number of metastatic lymph nodes, extranodal extension, size of the metastatic foci) were evaluated. Male gender, conventional variant, tumor size greater than 10 mm, multifocality, extrathyroidal extension, lateral tubular growth, intraglandular dissemination, lymphocytic and stromal tumor response, and absence of lymphocytic thyroiditis were predictive, and older age (>= 45 years) and follicular variant PTC were protective for lymph node metastasis. In order to optimize the management of papillary thyroid carcinomas, pathologists should search for the clues of lymph node metastasis particularly intraglandular dissemination, lateral tubular growth, tumor border and lymphocytic/stromal tumor response, multifocality, concomitant lymphocytic thyroiditis besides the actual prognostic criteria especially in younger aged male patients.
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    Iatrogenic Cushing's Syndrome After Topical Steroid Therapy for Psoriasis
    (Medknow Publications & Media Pvt Ltd, 2016) Sahip, Birsen; Celik, Mehmet; Ayturk, Semra; Kucukarda, Ahmet; Mert, Onur; Dincer, Nejla; Guldiken, Sibel
    Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis. In the context of such treatment, the glucocorticoid withdrawal problem has to be overcome. At present there is no consensus on steroid withdrawal. Patients on long-term glucocorticoid treatment must be evaluated for potential adverse effects and withdrawal symptoms by their physician and their endocrinologist.
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    Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)
    (Karger, 2019) Sonmez, Alper; Yumuk, Volkan; Haymana, Cem; Demirci, Ibrahim; Barcin, Cem; Kiyici, Sinem; Guldiken, Sibel
    Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Basel