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Öğe Circulating leptin and osteoprotegerin levels affect insulin resistance in healthy premenopausal obese women(Elsevier Science Inc, 2007) Ugur-Altun, Betul; Altun, ArmaganWe investigated the relationship between circulating leptin and osteoprotegerin (OPG) levels and insulin resistance assessed by HOMA-IR in premenopausal obese and normal weight women. Thirty four obese women (age 31 +/- 8 years) (BMI 35 +/- 4 kg/ m(2)) with 19 healthy controls (age 31 +/- 7 years) (BMI < 25 kg/m(2)) (BMI 21 +/- 2 kg/ m(2)) were included in the study. Women were healthy and had no osteoporosis. Circulating leptin levels were significantly higher in obese women (17.11 +/- 2.05 ng/ mL vs. 8.38 +/- 4.71 ng/mL, p < 0.0001) and decreased OPG levels were found (14.7 +/- 7.15 pg/mL vs. 19.17 +/- 6.37 pg/mL, p = 0.03). Leptin showed a positive correlation with BMI (r = 0.851, p < 0.0001), waist-to-hip ratio (r = 0.692, p < 0.0001), fasting insulin (r = 0.441, p < 0.001), HOMA-IR (r = 0.412, p = 0.002), fibrinogen (r = 0.387, p = 0.004), uric acid (r = 0.293, p = 0.033), hematocrit (r = 0.394, p = 0.003), systolic (r = 0.504, p < 0.0001), and diastolic blood pressure (r = 0.363, p = 0.008). OPG showed a negative correlation with insulin (r = -0.341, p = 0.013) and HOMA-IR (r = -0.324, p = 0.018). In obese women group, the regression equation of HOMA-IR was (HOMA-IR = [0.095 x leptin]-[0.051 x OPG] + 1.71). However, there was no relation between leptin and OPG levels. In conclusion, circulating leptin and OPG levels were related to insulin resistance in premenopausal obese women. However, leptin had no interference in OPG in premenopausal women. (c) 2007 IMSS. Published by Elsevier Inc.Öğe An Evaluation of Glucose Tolerance in Essential Hypertension(Yonsei Univ Coll Medicine, 2009) Tugrul, Armagan; Guldiken, Sibel; Ugur-Altun, Betul; Arikan, EnderPurpose: 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.Öğe Impact of osteoprotegerin and leptin on amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in healthy young adults(Elsevier Ireland Ltd, 2007) Altun, Armagan; Ugur-Altun, Betul; Arkan, Ender; Kunduracilar, Hakan; Guldiken, Sibel; Kara, Mujdat; Tugrul, Armagan[Abstract Not Available]Öğe Obese Subjects Have Low Global Fibrinolytic Capacity Associated with Insulin Resistance(Galenos Yayincilik, 2006) Turgut, Burhan; Guldiken, Sibel; Demir, Muzaffer; Ugur-Altun, Betul; Gerenli, Murat; Vural, Ozden; Tugrul, ArmaganObese subjects frequently have insulin resistance and they are at particularly risk of cardiovascular complications, possibly related to haemostatic and fibrinolytic system dysfunction. The aim of this study was to determine the effects of obesity on global fibrinolytic capacity (GFC) which is a new test used to assess fibrinolytic activity, and to evaluate the relationship of GFC with cardiovascular risk (CVR) factors. Fifty obese subjects, with a body mass index (BMI)> 30 kg/m(2) (36 women, 14 men; mean age, 30 +/- 7 years; mean BMI, 34 +/- 3 kg/m(2)); and 30 non-obese subjects, with a BMI< 25 kg/m(2) (19 women, 11 men; mean age, 30 +/- 6 years; mean BMI, 22 +/- 2kg/m(2)) were enrolled the study. Anthropometric measurements (weight, height, hip and waist circumferences) were recorded down. Plasma fasting glucose, insulin, lipid profiles, fibrinogen levels, Ddimer and GFC were determined. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). The gender and age were well matched in the two groups. Mean GFC was significantly lower in obese subjects than non- obese ones (7.6 +/- 7.5 mu g/ml, 16.3 +/- 11.9 mu g/ml, P< 0.001). However, there was no difference between mean D-dimer levels of the two groups. Mean plasma levels of fasting glucose (P< 0.05), insulin (P< 0.001), HOMA- IR (P< 0.01), fibrinogen (P<0.001) in the obese group were higher than in the non- obese group. GFC showed inverse correlations with HOMA- IR (r=- 0,41, P< 0,001) and fasting insulin (r=- 0,30, P<0,05). These data showed that obese subjects have a net hypofibrinolytic state which is associated insulin resistance.Öğe Phrenic neuropathy in diabetic and prediabetic patients without neuromuscular complaint(Springer-Verlag Italia Srl, 2013) Yesil, Yusuf; Ugur-Altun, Betul; Turgut, Nilda; Ozturk, Zeynel Abidin; Kuyumcu, Mehmet Emin; Yesil, Nesibe Karahan; Caner, SedatNeuropathy, one of the major reasons of morbidity in diabetes mellitus (DM), is associated with prediabetic conditions as well as DM. The present study aims to compare phrenic and peripheral nerves in prediabetic, diabetic patients and healthy controls. A total of 37 diabetic, 40 prediabetic patients and 18 healthy controls were enrolled in the study. All subjects underwent conventional sensory and motor nerve conduction studies. Bilateral phrenic and peripheric nerve conduction studies were performed. In both right and left phrenic nerves, the amplitudes were lower in prediabetic and diabetic patients than control subjects, respectively (p: 0.005 and p: 0.001). Both of the phrenic nerve conductions were altered similarly. The results of our study demonstrate that phrenic nerves are affected like peripheric nerves in prediabetic and diabetic patients. We suggest reminding phrenic neuropathy in newly onset respiratory failure in diabetic and prediabetic patients.Öğe Silent myocardial ischemia in middle-aged asymptomatic patients with type 2 diabetes in Turkish population(Sage Publications Inc, 2007) Ugur-Altun, Betul; Altun, Armagan; Guldiken, Sibel; Tatli, Ersan; Kara, Mujdat; Tugrul, ArmaganThe authors investigated silent myocardial ischemia in unselected consecutive middle-aged asymptomatic patients with type 2 diabetes without any evidence of coronary heart disease documented by treadmill exercise test. Ninety asymptomatic patients with type 2 diabetes (48 men; mean age; 49 +/- 6 years) were included in the study. Mean duration of diabetes in the study group was 4 +/- 4.2 years (range 1 to 21 years); 38% of the study population, diabetes duration was only 1 year). All patients were subjected to treadmill exercise test with Bruce protocol. A positive test was noted in 4 of 90 (4%) study patients. Two male patients (4%) and 2 (4%) women patients developed exercise-induced ST-segment depression, but none had concomitant chest pain. Diabetics with silent myocardial ischemia were older (55 +/- 3 years vs 49 +/- 6 years, p = 0.04) than those without silent myocardial ischemia. Also, diabetics with silent myocardial ischemia had higher fibrinogen level (372 +/- 51 vs 307 +/- 71 mg/dL, p = 0.04) than diabetics without silent myocardial ischemia. In treadmill exercise test, diabetics with silent myocardial ischemia had lower total exercise time and peak workload (375 +/- 30 vs 474 +/- 115 seconds, p = 0.04; 7.3 +/- 0.5 vs 8.9 +/- 1.9, p = 0.04, respectively) than without silent myocardial ischemia. Insulin resistance is associated with a variety of atherosclerosis risk factors. Exercise test findings show increased cardiac sympathetic activity and parasympathetic withdrawal in increased insulin resistance.Öğe Sympathetic skin response and RR interval variation in patients with cardiac syndrome X(Sage Publications Inc, 2007) Altun, Armagan; Turgut, Nilda; Tatli, Ersan; Ugur-Altun, Betul; Balci, KemalSympathetic skin response (SSR) and R-R interval variation (RRIV) are noninvasive electrophysiological tests used in the assessment of sympathetic and parasympathetic nervous system function, respectively. Cardiac syndrome X (CSX) is usually diagnosed in the presence of typical angina pectoris, a positive response to exercise testing, and normal-appearing coronary angiograms without spasm induced by hyperventilation or ergonovine. Alterations of autonomic nervous system control of cardiac function have been described in CSX. The aim of the study was to investigate autonomic nervous system function in patients with CSX. Nine patients with CSX (2 men, 7 women) and healthy controls (11 men, 19 women) were included in the study. SSRs were recorded from palm of hands by stimulation of the median nerve. RRIV recordings were taken from precordium during both rest position (R%) and deep inspiration of 6 times per minute (D%). In addition D%-R% and D%/R% values were calculated. SSR amplitude of CSX was lower than in controls (3.64 +/- 4.78 vs 6.36 +/- 3.4 mV, p = 0.017). There was no difference between groups for SSR latency values (CSX: 1,366 99; controls: 1,383 85 msec). Also, R% (CSX: 13.04 +/- 63; controls: 12.92 +/- 3.91) and D% (CSX: 16.63 +/- 8.88; controls: 21.43 +/- 73) values were similar in the 2 groups. However, D%-R% (CSX: 3.59 +/- 10.11; controls: 8.51 +/- 7.01) and D%/R% (CSX: 1.45 +/- 0.93; controls: 1,78 +/- 0.69) values were slightly lower in patients with CSX but were not statistically significant. A linear correlation was found between SSR amplitude and D%/R% (r = 0.336, p = 0.036). The authors conclude that, among patients with CSX, there are alterations of autonomic nervous control of skin as well as of other organs ie, heart). SSR and RRIV testing can be done easily in the neurophysiology laboratory to assess the sympathetic and parasympathetic system, respectively.Öğe Transient pituitary insufficiency in the acute postpartum state mimicking Sheehan syndrome(Lippincott Williams & Wilkins, 2006) Sayin, N. Cenk; Canda, M. Tunc; Ugur-Altun, Betul; Ozden, Gulsah; Yarol, Fusun G.A 34-year-old woman was referred to our obstetrics department because of severe postpartum hemorrhage. She had undergone a cesarean delivery in another hospital earlier in the day. The patient's hemoglobin (Hb) level was 7 g/dL. Blood transfusions were begun, but the bleeding continued and an emergent total abdominal hysterectomy was performed. Postoperatively, the Hb level returned to normal by 3 days with ongoing transfusion. Her lactation could not be induced. To assess the level of pituitary damage, an insulin tolerance test was performed. Growth hormone and cortisol levels were measured. These tests revealed attenuated responses for both cortisol and growth hormone. Three months later, thyroid function tests revealed secondary hypothyroidism. However, these findings were transient. By 15 months, however, all hormonal levels were normal. We report the case as an example of spontaneous recovery from hypopituitarism caused by obstetric hemorrhage.
