Slide Session : OS-END-12 ; Endocrinology : Is There a Correlation Between Paraoxanase-1 Activity, MPV and Other Atherosclerotic Risk Factors in Prediabetic and Diabetic Patients?

( Meral Mert ),( Yildiz Okuturlar ),( Pinar Karakaya ),( Asuman Gedikbasi ),( Filiz Islim ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It has been reported that MPV is increased in diabetes while the status of MPV in prediabetes is not well known. It has been reported that decreasing level of paraoxonase-1 is related to increased probability of development of atherosclerosis and cardiovascular disease (CVD). In this study we compared the mean platelet volume (MPV), paraoxonase-1 (PON) and arylesterase (ARE) levels in patients with the diagnosis of prediabetes and diabetes mellitus (DM). Methods: Forty five prediabetic patients and 135 type 2 diabetic patients were enrolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, family history of DM and CVD, childbirth, menopause status of all patients were recorded. Routine biochemical tests and A1c, lipid profiles, homocysteine, PON, ARE and MPV levels were performed. Results: Mean age of diabetics and prediabetic patients are 53.4 ±13.7 and 53.0±12.8 respectively. Age, weight, height, BMI and MPV levels were not significantly different in both groups but PON, ARE, A1c and HOMA levels were significantly different (p=0.0001). There were no significant differences in smoking, hypertension, hyperlipidaemia, exercise, coronary heart disease between the two groups. There was no significant correlation between MPV and PON, ARE but there was a negative correlation between Alc, glucose, WBC values and PON, ARE. We also found a negative correlation between triglyceride and PON levels and microalbuminuria and ARE levels. Conclusions: There was no difference in MPV level in both groups having different risk of atherosclerosis and probably because of the limited number of prediabetic patients in our study. However, lower levels of PON and ARE may have been caused by high risk of atherosclerosis in diabetic patients. It would be more reliable to analyse MPV, PON and ARE according to biochemical and clinical conditions.

Slide Session : OS-END-26 ; Endocrinology : Vitamin D Levels in Patients with Autoimmune Thyroid Disease

( Esref Erturk ),( Meral Mert ),( Yildiz Okuturlar ),( Ozlem Soyluk ),( Pinar Karakaya ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It is known that vitamin D has effects on the immune system. Vitamin D is an important immune system regulator. Several observational studies show that, vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. It has been suggested that vitamin D may play a role in the pathogenesis of several endocrine diseases, such as autoimmune thyroid diseases, hyperparathyroidism, diabetes mellitus, Addison`s disease. In this study it is aimed to find a correlation between autoimmune thyroid disease and vitamin D. Methods: Thyroid function test result, calcium, PTH and vitamin D levels were compared between a control group of 35 healthy people and 35 patients with a cross-sectional thyroid autoimmune disease. Results: Mean ages are found to be 41.8±14.08 years and 45.6±13.46 years in patients and controls respectively. Mean vitamin D, calcium and parathormone (PTH) levels in patients and control group are found to be 18.6±9.5 vs 39.13 ±14.6 ng/ml, 7.9±0.16 vs 8.67±0.80 mg/dl, 50.7±25.86 vs 56.21±18.17 pg/ml, respectively. Vitamin D levels were found to be significantly lower than the control group in patients with autoimmune thyroid disease. There was no difference between the levels of PTH. Conclusions: Analyzing of vitamin D, PTH and calcium parameters should be considered in patients with autoimmune thyroid diseases. Treatment of vitamin D deficiency may help increase the quality of life in tyroid patients.

Slide Session : OS-END-16 ; Endocrinology : Brachial intima-Media Thickness and Paraoxonase -1 Activity in Different Patients Group

( Yildiz Okuturlar ),( Meral Mert ),( Pinar Karakaya ),( Aysun Erbahceci Salik ),( Asuman Gedikbasi ),( Nilgul Akalin ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Atherosclerosis is one of the most important causes of death worldwide. Detection and prevention of the organ damage and determination of the risk due to atherosclerosis is getting more and more important in recent days. Brachial Intima-Media Thickness (B-IMT), mean platelet volume (MPV), paraoxonase (PON) and arylesterase (ARE) are accepted as markers of atherosclerosis. In this study we aimed to determine the importance of B-IMT, ARE, PON and MPV levels in four patient groups which are expected to have increased risk of atherosclerosis without vascular complications. Methods: A total of 100 patients (32 prediabetic patients = group 1, 13 subclinical hypothyroidism + prediabetic = group 2, 20 subclinical hypothyroidism = group 3, 35 diabetic patients = group 4) are enrolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, family history of diabetes mellitus and cerebrovasculer disease, childbirth, menopause status and HOMA levels of all patients were recorded. Routine biochemical tests and Alc, lipid profiles, homocysteine, PON, ARE were performed and brachial artery index was measured. Results: There were no significant differences in age, B-IMT, BMI, homocysteine, MPV, PON and LDL, HDL levels between the groups. We found a significant difference in A1c (p=0.001), glucose (p=0.0001), ARE (p=0.0001), triglyceride (p=0.005) and HOMA-R (p=0.0001) levels between groups. The significant correlations were shown in Table-1. Conclusions: The relationship between insulin resistance, lipid profile, TSH, B-IMT, PON, ARE and MPV are not similar in different patient groups. This is probably due to varying degrees of atherosclerosis in patients.

Slide Session : OS-END-44 ; Endocrinology : The Relationship Between Vitamin D and Testosterone Levels in Overweight Patients

( Ozlem Soyluk ),( Meral Mert ),( Yildiz Okuturlar ),( Samet Sayilan ),( Pinar Karakaya ),( Farid Babashov ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: There are studies showing the relationship between vitamin D deficiency and obesity in the literature. Also it is known that testosterone levels decrese in obesity. So it is hypothesized that testosterone levels can increase with vitamin D replacement. We aimed to investigate this relationship between vitamin D and testosterone level in patients with BMI over 25 kg/m2. Methods: The data of 3110 patients with BMI > 25 kg /m2 are evaluated retrospectively. The relation between 25 OH vitamin D3, tetsoterone, parathormone (PTH), A1c, fasting insulin, fasting glucose, HOMA values, age, sex were examined. We compared the data of 265 women and 38 men whose records included all these parameters. Results: Mean ages are found to be 46,38±12,82 yeasr and 40,42±12,60 years in female and male patients respectively. There are no significant differences between vitamin D, PTH, B12 and HOMA levels in female and male patients. In the female group there was a negative correlation between age and 25 (OH)D3 level and in the male group there was a negative correlation between 25(OH)D3 and HOMA value. In both groups no correlation was found between 25(OH)D3 and total testosterone levels (Table-1). Conclusions: There are several studies with different results about the realtionship between vitamin D and parameters like obesity, testosterone level. In our study we could not find any relationship between Vitamin-D and testosterone levels.

Slide Session : OS-END-45 ; Endocrinology : Effect of Business Life on Obesity in Women

( Yildiz Okuturlar ),( Gulseren Gunduz ),( Nilgul Akalin ),( Meral Mert ),( Didem Acarer ),( Ozlem Soyluk ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The most important factor in the fight against obesity is thought to be change in lifestyle. Business life can effect weight and body fat distribution through its effects on levels of eating, sleeping, exercise and stress. In our study the relation between BMI, body fat distribution, 25-hydroxycholecalciferol (25-OH-D3), homeostasis model assessment (HOMA-R) and A1c levels were evaluated in working and non-working obese patients having a BMI of 30. Methods: Total number of 122 patients (62 of working and 60 of non-working) were enrolled in to the study. Medical history, weight-height-BMI- body fat ratio measurements and A1c- insulin- glucose- cortisol- 25-OH-D3- HOMA-R levels of all patients were recorded. Results: Between the working and non-working groups there were significant differences in average age (35.30±11.96 and 44.51±11.84 respectively, p=0.0001), weight (89.18±11.90 kg and 94.34±13.45 kg respectively, p=0.029), BMI (34.47±4.167 kg/ m2 and 37.39±5.65 kg/m2 respectively, p=0.002), body fat ratio (41.23±5.447% and 43.53±6.077% respectively, p= 0.029) and cortisol level (11.66±4.441 μg/dL and 14.12±5.402 μg/dL, respectively, p=0.029). Unlikely there were no significant differences in insulin, A1c, glucose, 25-OH-D3 and HOMA-R values. There were positive correlations between age and Alc and between BMI and age. Conclusions: Business life may lead to increase in weight and BMI. But in our study weight and BMI was significantly lower in the working group. This finding may be related to certain meal times, sleeping regime and physical activity of the working life which are effective on fat distribution and weight management.

Poster Session : PS 0446 ; Infectious Disease ; Fever of Unknown Cause Which is the Cause of Intestinal Tuberculosis

( Tugrul Burak Genc ),( Yildiz Okuturlar ),( Ozlem Harmankaya ),( Suut Gokturk ),( Bulent Durdu ),( Samet Sayilan ),( Selcuk Sezikli ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: In developing countries, tuberculosis (tbc) incidence is reduced; but immunocompromised patients still remain at high risk for the disease. Malignancy and Crohn`s disease should be considered in the differential diagnosis of gastrointestinal (GIS) tbc in immunocompromised patients. We present here the clinical course of a patient with fever of unknown origin and rectal bleeding. Methods: A 31-year-old male cachectic patient was admitted to hospital with abdominal pain, fever and diarrhea. The history of the patient revealed systemic lupus erythematosus, lupus nephritis and left middle cerebral artery infarction. Right hemiparesis was present. He was on warfarin 5mg/day, cilazapril 2,5mg/day, methylprednisolone 4mg/day, mycophenolate mofetil 2g/day, hydroxychloroquine 200mg/ day, levodopa+benserazide 375mg/day, levetiracetam 1 g/day. Creatinine was 2,79mg/dL, and C-reactive protein was 10 mg/dL. No pneumonic infi ltration was shown. Blood, urine and faeces cultures, Chlamydia IgM, mycoplasma IgM, toxoplasma IgM, EBV IgM, CMV IgM and PPD test were negative. Transesophageal echocardiography excluded infective endocarditis. Empiric antibiotic treatment with ceftriaxone, piperacillin-tazobactam and moxifi oxacin, and antifungal fi uconazole was started. On the 15th day hematochezia occured. Colonoscopy revealed three different massive lesions straightening the lumen in caecum, hepatic fi exure of colon and transverse colon (figure-1). Results: Pathologic examination demonstrated granulomatous lesion. Considering the positive results of Tbc-PCR treatment, the patient was diagnosed as GIS tbc and isoniazid, rifampicin, pyrazinamide and ethambutol were started. Conclusions: The ileocecal region is the most frequent localization of intestinal tbc. Colonic tbc is often localized in proximal colon and caecum, and usually associated with ileal tbc. It is rarely seen in transverse colon. Our patient is a rare case of gastrointestinal tbc presenting without pneumonic infi ltration and with an unusual localization in colon.

Slide Session : OS-NEP-06 ; Nephrology : Paraoxonase-1 Activity in Patients with Anemia with or Without Chronic Renal Failure

( Yildiz Okuturlar ),( Nilgul Akalin ),( Ozlem Harmankaya ),( Nurten Turan Guner ),( Deniz Yilmaz ),( Asuman Gedikbasi ),( Ozlem Soyluk ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Paraoxonase (PON)-1 is an antioxidant enzyme. It has three known activities, paraoxonase, arylesterase and diazoxonase. It has been reported that PON-1 defi ciency is related to increased susceptibility to development of atherosclerosis and cardiovascular disease. The aim of this study is to evaluate antioxidative status and carotid intima-media thickness (CIMT) in patients with anemia with/without chronic renal failure. Methods: 42 patients with anemia and a control group of 47 patients were enrolled in to the study. Patients were divided into two groups as Group 1 with iron defi ciency anemia and Group 2 with chronic renal failure and anemia of chronic disease and Group 3 as the healthy control group. In all three groups antioxidative status was evaluated by measuring free sulfhydryl groups (-SH = total thiol), paraoxonase and arylesterase levels. CIMT measurements were also performed at the same time. Results: In all three groups, age, weight, average height, gender, presence of diabetes and smoking habit were not signifi cantly different (p>0.05). Hemoglobin levels were 7.85 ± 1.25 in Group 1, 8.62 ± 1.09 in Group 2 and 13.45±1.63 in Group 3. We have found that Arylesterase and -SH levels were decreased both in Group 1 and 2 according to Group 3. Bilateral CIMT was increased only in Group 2. Between group 1 and group 2 the only difference was the the more signifi cant decrease in Arylesterase levels in group 2 (Table 1-2). Conclusion: PON-1 activity and -SH levels may be independently associated with the presence of atherosclerosis.

Slide Session : OS-END-37 ; Endocrinology : The Relationship Between Epicardial Adipose Tissue Thickness and Vitamin D in Patients with Metabolic Synrome

( Irem Kirac Utku ),( Yildiz Okuturlar ),( Esra Demir ),( Ozlem Harmankaya ),( Bulent Demir ),( Gonul Aciksari ),( Turgut Uygun ),( Alev Kural ),( Hanise Ozkan ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Metabolic syndrome is a systemic disorder and manifests a group of conditions such as abdominal obesity, dyslipidaemia, hypertension, coronary artery diseases. The importance of epicardial adipose tissue recognized its contribution to inflammation by pro-inflammatory cytokines discharge has been proved. Several investigations were performed on vitamin D receptor in different tissues except bone. In this study the epicardial adipose tissue thickness (EATT) and the levels of vitamin D were measured and compared with healthy control group. Methods: A total of 148 patients (84 patients who had metabolic syndrome without diabetes and 64 healthy individuals) were enrolled into the study. In all patients, the EATT was calculated by ecocardiography and the level of serum 25(OH) vitamin D was monitored. Results: It has been observed that the EATT in patients with metabolic syndrome increases significiantly compared with healthy control group (p<0.001). No significant difference between patients and control group was found on the levels of 25 (OH) vitamin D (p=0.507). There was no correlation between 25 (OH) vitamin D and the EATT (p=0.622). Conclusion: We observed that the EATT increased in patients with metabolic syndrome. In contradiction to the literature; the levels of 25(OH) vitamin D has not been found high in patients with metabolic syndrome. The reason of this can be small number of patients in our study. A significant correlation was not found between the EATT and the levels of 25 (OH) vitamin D. Further studies with a larger patient population are required assess the relationship.