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    33 Questions about Triglycerides and Cardiovascular Effects: Expert Answers
    (Turkish Soc Cardiology, 2017) Cetinkalp, Sevki; Koylan, Nevrez; Ozer, Necla; Onat, Altan; Ozgen, A. Gokhan; Koldas, Z. Lale; Guven, Gulay Sain; Ozdogan, Oner; Karsidag, Kubilay; Yigit, Zerrin; Kayikcioglu, Meral; Tokgozoglu, Lale; Can, Levent H.; Tartan, Zeynep; Kultursay, Hakan; Karpuz, Baris; Kirilmaz, Bahadir; Ersanli, Murat; Ural, Dilek; Erbakan, Ayse Naciye; Oguz, Aytekin; Kayikcioglu, Ozcan R.; Temizhan, Ahmet; Sansoy, Vedat; Ceyhan, Ceyhun; Ongen, Zeki; Bayram, Fahri; Orem, Cihan; Sonmez, Alper; Beyaz, Sengul; Ukinc, Kubilay; Yurekli, Banu Sarer; Coker, Mahmut; Canda, Ebru; Simsir, Ilgin Yildirim
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    Assessment of pituitary function in patients with nasopharyngeal carcinoma: the effect of radiotherapy
    (2019) Akagunduz, Ozlem Ozkaya; Yurekli, Banu Sarer; Simsir, Ilgin Yildirim; Esassolak, Mustafa
    Radiotherapy (RT) plays a very important role in nasopharyngeal carcinoma (NPC). the pituitary gland can be affected by radiation due to its proximity to the nasopha-ryngeal cavity. Our aim is to demonstrate the effect of radiotherapy given for NPC on anterior pituitary function with basal pituitary hormones and provocative tests. Patients with NPC that were treated with definitive chemoradioherapy were reviewed retrospectively. Serum ACTH, GH, PRL, FSH, LH, TSH and cortisol, DHEAS, IGF-1, E2, testosterone, fT3, fT4 levels were recorded to evaluate pituitary function. Insulin tolerance test was performed to investigate hypothalamic-pituitary-adrenal axis and GH -IGF-1 axis. Comparison between early tumor stage and advanced tumor stage for pituitary dysfunction was done. the median time interval between the RT and endocrinologic evaluation was 4.0 (1-13) years. ACTH deficiency was found to be most common hormonal problem with a frequency of 73.7%. of these 71.4% were mild adrenal deficiencies. GH deficiency was seen in 60% of patients. fT3, TSH, GH and IGF-1 levels were significantly lower in patients with advanced tumor stage compared with early tumor stage (p = 0.033, p = 0.022, p = 0.043, p = 0.022, respectively). Growth hormone deficiency was found in all of advanced and in 43% of early tumor stage patients (p = 0.017). We found higher rates of ACTH and GH deficiencies followed by gonadotropin, corticotropin and thyrotropin deficiency. Basal pituitary hormones will not be sufficient to evaluate anterior pituitary failure. Annual and systematic dynamic tests together with basal anterior pituitary hormones would be needed
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    Can an oral antidiabetic (rosiglitazone) be of benefit in leukemia treatment?
    (Elsevier Science Bv, 2015) Cetinkalp, Sevki; Simsir, Ilgin Yildirim; Sahin, Fahri; Saydam, Güray; Ural, Ali Ugur; Yilmaz, Candeger
    PPARs are ligand-regulated transcription factors and regulate expression of several gene products. Therefore, PPARs are being studied for their possible contribution to the treatment of cancer, atherosclerosis, inflammation, infertility and demyelinating diseases. Primary AML patients were observed to have significantly elevated PPAR gamma mRNA expression compared to normal peripheral blood or bone marrow mononuclear cells. This study investigated the cytotoxic effects of rosiglitazone maleate, a pure PPAR gamma agonist, in vitro in HL-60 cell line. This study obtained results which can provide guidance for future studies. Whether the PPARy agonist rosiglitazone maleate may provide additive effects in refractory or relapsing cases of acute leukemia may be set as an objective for the future studies. (C) 2013 King Saud University. Production and hosting by Elsevier B.V. All rights reserved.
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    Cardiac phenotype in familial partial lipodystrophy
    (Wiley, 2021) Eldin, Abdelwahab Jalal; Akinci, Baris; da Rocha, Andre Monteiro; Meral, Rasimcan; Simsir, Ilgin Yildirim; Adiyaman, Suleyman Cem; Ozdemir Kutbay, Nilufer
    Objectives LMNA variants have been previously associated with cardiac abnormalities independent of lipodystrophy. We aimed to assess cardiac impact of familial partial lipodystrophy (FPLD) to understand the role of laminopathy in cardiac manifestations. Study design Retrospective cohort study. Methods Clinical data from 122 patients (age range: 13-77, 101 females) with FPLD were analysed. Mature human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from a patient with an LMNA variant were studied as proof-of-concept for future studies. Results Subjects with LMNA variants had a higher prevalence of overall cardiac events than others. The likelihood of having an arrhythmia was significantly higher in patients with LMNA variants (OR: 3.77, 95% CI: 1.45-9.83). These patients were at higher risk for atrial fibrillation or flutter (OR: 5.78, 95% CI: 1.04-32.16). The time to the first arrhythmia was significantly shorter in the LMNA group, with a higher HR of 3.52 (95% CI: 1.34-9.27). Non-codon 482 LMNA variants were more likely to be associated with cardiac events (vs. 482 LMNA: OR: 4.74, 95% CI: 1.41-15.98 for arrhythmia; OR: 17.67, 95% CI: 2.45-127.68 for atrial fibrillation or flutter; OR: 5.71, 95% CI: 1.37-23.76 for conduction disease). LMNA mutant hiPSC-CMs showed a higher frequency of spontaneous activity and shorter action potential duration. Functional syncytia of hiPSC-CMs displayed several rhythm alterations such as early afterdepolarizations, spontaneous quiescence and spontaneous tachyarrhythmia, and significantly slower recovery in chronotropic changes induced by isoproterenol exposure. Conclusions Our results highlight the need for vigilant cardiac monitoring in FPLD, especially in patients with LMNA variants who have an increased risk of developing cardiac arrhythmias. in addition, hiPSC-CMs can be studied to understand the basic mechanisms for the arrhythmias in patients with lipodystrophy to understand the impact of specific mutations.
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    A case of an ectopic prolactinoma
    (Informa Healthcare, 2012) Simsir, Ilgin Yildirim; Kocabas, Gokcen Unal; Sahin, Serap Baydur; Erdogan, Mehmet; Cetinkalp, Sevki; Saygili, Fusun; Yilmaz, Candeger; Ozgen, Ahmet Gokhan
    A 34-year-old female presented to our clinic with a 1.5 year history of secondary amenorrhea and galactorrhea. Prolactin (PRL) level was found to be 151.89 ng/ml. Pituitary imaging was reported to be normal. An examination of the patient revealed that PRL level was still high so the dose of cabergoline was further increased and subsequently, bromocriptine was added to the treatment. There was no reduction in PRL levels in controls. A scanning was performed to look for an ectopic focus. Abdominal computerized tomography revealed a heterogenous mass lesion originating from the uterus. Octreotide scintigraphy was performed and we observed an involvement consistent with the mass in the uterus. The patient underwent abdominal total hysterectomy. PRL dropped to 0.4 ng/ml the next day after the operation. The pathology result was a low-grade malignant mesenchymal tumor. Prolactin was found to be immunohistochemically negative. However, galactorrhea disappeared postoperative and PRL levels are still low. Elevated levels of PRL, resistant to bromocriptine and cabergoline, rapidly returned to normal after hysterectomy, which obviously indicates that hyperprolactinemia was associated with the myoma of the uterus.
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    Clinical performance evaluation of a newly developed sock for people with diabetes
    (Sage Publications Ltd, 2021) Cureklibatir Encan, Berna; Marmarali, Arzu; Bayraktar, Dilek; Cetinkalp, Sevki; Simsir, Ilgin Yildirim
    Diabetes mellitus (DM) is a chronic disease that has become a global health problem. As the population of people with diabetes is growing worldwide, the prevalence of complications associated with DM, such as diabetic foot, also increases. Neuropathy and high plantar pressure are the two most frequent causes of foot ulceration. Since diabetic wounds tend to heal slowly, it is crucial to prevent diabetic foot ulcers before they occur. in this study, the efficacy of a sock developed for diabetes in the previous research of the authors was investigated in a clinical study with the participation of patients with diabetes over a 6-month period. At the end of the study, it was observed that none of the participants had experienced any new ulcers, bacterial or fungal infections, or callus formation during this research. Moreover, a slight decrease in pressure was observed for the first, second, and third metatarsal bones when the socks were worn on day 1. on the other hand, pressure reduction was identified for the fourth and fifth metatarsal bones in all following measurements. However, analyses revealed that duration of usage did not have a statistically significant effect on overall plantar pressure. It was also found that pressure on the fourth and fifth metatarsal bones significantly decreased. Assessment of wearing comfort revealed the satisfaction of the patients, as well. Based on the promising outcomes of this clinical evaluation, these socks developed for people with diabetes can be strongly expected to help avoid diabetic foot ulcers.
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    Clinical presentations, metabolic abnormalities and end-organ complications in patients with familial partial lipodystrophy
    (W B Saunders Co-Elsevier Inc, 2017) Akinci, Baris; Onay, Huseyin; Demir, Tevfik; Savas-Erdeve, Senay; Gen, Ramazan; Simsir, Ilgin Yildirim; Keskin, Fatma Ela; Erturk, Mehmet Sercan; Uzum, Ayse Kubat; Yaylali, Guzin Fidan; Ozdemir, Nilufer Kutbay; Atik, Tahir; Ozen, Samim; Yurekli, Banu Sarer; Apaydin, Tugce; Altay, Canan; Akinci, Gulcin; Demir, Leyla; Comlekci, Abdurrahman; Secil, Mustafa; Oral, Elif Arioglu
    Objective. Familial partial lipodystrophy (FPLD) is a rare genetic disorder characterized by partial lack of subcutaneous fat. Methods. This multicenter prospective observational study included data from 56 subjects with FPLD (18 independent Turkish families). Thirty healthy controls were enrolled for comparison. Results. Pathogenic variants of the LMNA gene were determined in nine families. Of those, typical exon 8 codon 482 pathogenic variants were identified in four families. Analysis of the LMNA gene also revealed exon 1 codon 47, exon 5 codon 306, exon 6 codon 349, exon 9 codon 528, and exon 11 codon 582 pathogenic variants. Analysis of the PPARG gene revealed exon 3 p.Y151C pathogenic variant in two families and exon 7 p.H477L pathogenic variant in one family. A non-pathogenic exon 5 p.R215Qvariant of the LMNB2 gene was detected in another family. Five other families harbored no mutation in any of the genes sequenced. MRI studies showed slightly different fat distribution patterns among subjects with different point mutations, though it was strikingly different in subjects with LMNA p.R349W pathogenic variant. Subjects with pathogenic variants of the PPARG gene were associated with less prominent fat loss and relatively higher levels of leptin compared to those with pathogenic variants in the LMNA gene. Various metabolic abnormalities associated with insulin resistance were detected in all subjects. End-organ complications were observed. Conclusion. We have identified various pathogenic variants scattered throughout the LMNA and PPARG genes in Turkish patients with FPLD. Phenotypic heterogeneity is remarkable in patients with LMNA pathogenic variants related to the site of missense mutations. FPLD, caused by pathogenic variants either in LMNA or PPARG is associated with metabolic abnormalities associated with insulin resistance that lead to increased morbidity. (C) 2017 Elsevier Inc. All rights reserved.
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    Comparative Evaluation of Clinical Efficacy and Safety of Collagen Laminin-Based Dermal Matrix Combined With Resveratrol Microparticles (Dermalix) and Standard Wound Care for Diabetic Foot Ulcers
    (Sage Publications Inc, 2020) Cetinkalp, Sevki; Gokce, Evren Homan; Simsir, Ilgin Yildirim; Tanriverdi, Sakine Tuncay; Dogan, Fatma; Avci, Cigir; ozer, Ozgen
    This is an open, prospective, comparative parallel-arm medical device clinical study of Dermalix (Dx) in diabetic foot wounds. Dx is a 3-dimensional collagen-laminin porous-structured dermal matrix prepared and additionally impregnated with resveratrol-loaded hyaluronic acid and dipalmitoylphosphatidylcholine-based microparticles. the aim was to evaluate the efficacy and safety of Dx, an investigational medical device, in Wagner 1 and 2 wounds in comparison to a standard wound care (SWC) that consists of irrigation and cleaning with sterile saline solution. Forty-eight patients were randomized to receive either SWC or SWC + Dx. A 4-week treatment period was followed by a 2-month follow-up without treatment. the wound area measurement, total collagen, vascular epidermal growth factor, tumor necrosis factor, interleukin 1, caspase 3, glutathione, reduced/oxidized glutathione, and lipid peroxidation levels were evaluated. At the end of 4 weeks, the percentage closures of wounds were determined as 57.82% for Dx, and 26.63% for SWC groups. Dx had a significant effect on tumor necrosis factor, caspase 3, and reduced/oxidized glutathione levels. Dx provided 2 times faster wound healing and decreased oxidative stress. Application of Dx in the first phase of wound would help the wound area heal faster with a safe profile.
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    Comparison of Pheochromocytoma-Specific Morbidity and Mortality Among Adults With Bilateral Pheochromocytomas Undergoing Total Adrenalectomy vs Cortical-Sparing Adrenalectomy
    (Amer Medical Assoc, 2019) Neumann, Hartmut P. H.; Tsoy, Uliana; Bancos, Irina; Amodru, Vincent; Walz, Martin K.; Tirosh, Amit; Kaur, Ravinder Jeet; McKenzie, Travis; Qi, Xiaoping; Bandgar, Tushar; Petrov, Roman; Yukina, Marina Y.; Roslyakova, Anna; van der Horst-Schrivers, Anouk N. A.; Berends, Annika M. A.; Hoff, Ana O.; Castroneves, Luciana Audi; Ferrara, Alfonso Massimiliano; Rizzati, Silvia; Mian, Caterina; Dvorakova, Sarka; Hasse-Lazar, Kornelia; Kvachenyuk, Andrey; Peczkowska, Mariola; Loli, Paola; Erenler, Feyza; Krauss, Tobias; Almeida, Madson Q.; Liu, Longfei; Zhu, Feizhou; Recasens, Monica; Wohllk, Nelson; Corssmit, Eleonora P. M.; Shafigullina, Zulfiya; Calissendorff, Jan; Grozinsky-Glasberg, Simona; Kunavisarut, Tada; Schalin-Jantti, Camilla; Castinetti, Frederic; Vlcek, Petr; Beltsevich, Dmitry; Egorov, Viacheslav, I; Schiavi, Francesca; Links, Thera P.; Lechan, Ronald M.; Bausch, Birke; Young, William F., Jr.; Eng, Charis; Jaiswal, Sanjeet Kumar; Zschiedrich, Stefan; Fragoso, Maria C. B., V; Pereira, Maria A. A.; Li, Minghao; Biarnes Costa, Josefina; Juhlin, Carl Christofer; Gross, David; Violante, Alice H. D.; Kocjan, Tomaz; Ngeow, Joanne; Yoel, Uri; Fraenkel, Merav; Simsir, Ilgin Yildirim; Ugurlu, M. Umit; Ziagaki, Athanasia; Robles Diaz, Luis; Kudlai, Inna Stepanovna; Gimm, Oliver; Scherbaum, Christina Rebecca; Abebe-Campino, Gadi; Barbon, Giovanni; Taschin, Elisa; Malinoc, Angelica; Khudiakova, Natalia Valeryevna; Ivanov, Nikita, V; Pfeifer, Marija; Zovato, Stefania; Ploeckinger, Ursula; Makay, Ozer; Grineva, Elena; Jarzab, Barbara; Januszewicz, Andrzej; Shah, Nalini; Seufert, Jochen; Opocher, Giuseppe; Larsson, Catharina
    IMPORTANCE Large studies investigating long-term outcomes of patients with bilateral pheochromocytomas treated with either total or cortical-sparing adrenalectomies are needed to inform clinical management. OBJECTIVE To determine the association of total vs cortical-sparing adrenalectomy with pheochromocytoma-specific mortality, the burden of primary adrenal insufficiency after bilateral adrenalectomy, and the risk of pheochromocytoma recurrence. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from a multicenter consortium-based registry for 625 patients treated for bilateral pheochromocytomas between 1950 and 2018. Data were analyzed from September 1, 2018, to June 1, 2019. EXPOSURES Total or cortical-sparing adrenalectomy. MAIN OUTCOMES AND MEASURES Primary adrenal insufficiency, recurrent pheochromocytoma, and mortality. RESULTS Of 625 patients (300 [48%] female) with a median (interquartile range [IQR]) age of 30 (22-40) years at diagnosis, 401 (64%) were diagnosed with synchronous bilateral pheochromocytomas and 224 (36%) were diagnosed with metachronous pheochromocytomas (median [IQR] interval to second adrenalectomy, 6 [1-13] years). In 505 of 526 tested patients (96%), germline mutationswere detected in the genes RET (282 patients [54%]), VHL (184 patients [35%]), and other genes (39 patients [7%]). Of 849 adrenalectomies performed in 625 patients, 324 (52%) were planned as cortical sparing and were successful in 248 of 324 patients (76.5%). Primary adrenal insufficiency occurred in all patients treated with total adrenalectomy but only in 23.5% of patients treated with attempted cortical-sparing adrenalectomy. A third of patients with adrenal insufficiency developed complications, such as adrenal crisis or iatrogenic Cushing syndrome. Of 377 patients who became steroid dependent, 67 (18%) developed at least 1 adrenal crisis and 50 (13%) developed iatrogenic Cushing syndrome during median (IQR) follow-up of 8 (3-25) years. Two patients developed recurrent pheochromocytoma in the adrenal bed despite total adrenalectomy. In contrast, 33 patients (13%) treated with successful cortical-sparing adrenalectomy developed another pheochromocytoma within the remnant adrenal after a median (IQR) of 8 (4-13) years, all of which were successfully treated with another surgery. Cortical-sparing surgery was not associated with survival. Overall survivalwas associated with comorbidities unrelated to pheochromocytoma: of 63 patients who died, only 3 (5%) died of metastatic pheochromocytoma. CONCLUSIONS AND RELEVANCE Patients undergoing cortical-sparing adrenalectomy did not demonstrate decreased survival, despite development of recurrent pheochromocytoma in 13%. Cortical-sparing adrenalectomy should be considered in all patients with hereditary pheochromocytoma.
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    Continuation of evolution: Headliner glargine U300
    (Churchill Livingstone, 2018) Soyaltin, Utku Erdem; Simsir, Ilgin Yildirim; Cetinkalp, Sevki
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    Determining residual adipose tissue characteristics with MRI in patients with various subtypes of lipodystrophy
    (Aves, 2017) Altay, Canan; Secil, Mustafa; Demir, Tevfik; Atik, Tahir; Akinci, Gulcin; Kutbay, Nilufer Ozdemir; Temeloglu, Ela Keskin; Simsir, Ilgin Yildirim; Ozisik, Secil; Demir, Leyla; Eren, Erdal; Tuna, Emine Burcin; Aytac, Hasibe; Onay, Huseyin; Akinci, Baris
    PURPOSE We aimed to investigate residual adipose tissue with whole-body magnetic resonance imaging to differentiate between subtypes of lipodystrophy. METHODS A total of 32 patients 12 with congenital generalized lipodystrophy [CGL], 1 with acquired generalized lipodystrophy [AGL], 12 with familial partial lipodystrophy [FPLD], and 7 with acquired partial lipodystrophy [APL]) were included. RESULTS Despite generalized loss of metabolically active adipose tissue, patients with CGL1 caused by AGPAT2 mutations had a significant amount of residual adipose tissue in the scalp, earlobes, retro-orbital region, and palms and soles. No residual adipose tissue was noted particularly in the head and neck, palms and soles in CGL2 caused by BSCL2 mutations. CGL4 caused by mutations in the PTRF gene was characterized with well-preserved retro-orbital and bone marrow fat in the absence of any visible residual adipose tissue in other areas. No residual adipose tissue was observed in AGL. Despite loss of subcutaneous fat, periarticular adipose tissue was preserved in the lower limbs of patients with FPLD. Retro-orbital adipose tissue was surprisingly preserved in APL, although they lacked head and neck fat. CONCLUSION Lipodystrophies are a heterogeneous group of disorders characterized by generalized or partial loss of adipose tissue, which can be congenital or acquired. Our results suggest that residual adipose tissue characteristics can help distinguish different subtypes of lipodystrophy.
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    Effect of an Educational Intervention Based on Bandura's Theory on Foot Care Self-Efficacy in Diabetes: A Prospective Quasi-Experimental Study
    (Sage Publications Inc, 2020) Toygar, Ismail; Hancerlioglu, Sadik; Utku, Tulun; Simsir, Ilgin Yildirim; Cetinkalp, Sevki
    The purpose of this study is to evaluate the foot care self-efficacy of diabetic foot patients and the effect of an educational intervention for improving it. This study was of a semi-experimental design and was conducted between January and December 2019 in a diabetic foot council of a university hospital. After power analysis to determine sample size, 33 participants meeting the inclusion criteria were included in the study. A Patient Identification Form and Diabetic Foot Care Self-Efficacy Scale (DFCSES) were used to collect data. of the patients, 51.5% were male and the mean age was 54.91 +/- 16.61 years. the mean score of DFCSES was 50.18 +/- 20.88 before education and 72.67 +/- 20.74 after education. the educational intervention has large effects on self-efficacy (d= 1.233), perceived knowledge level on diabetic foot (d= 1.102), perceived health status (d= 0.859), and perceived quality of life (d= 0.807). Educational intervention was found to be an effective way to improve foot care self-efficacy, perceived knowledge level on diabetic foot, perceived health status, and perceived quality of life.
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    Effect of Dopamine Agonist Treatment on Glycemic Control in Patients with Lipodystrophy
    (Aves, 2024) Simsir, Ilgin Yildirim; Ozgur, Su; Soyaltin, Utku Erdem; Cetinkalp, Sevki
    Lipodystrophies involve the loss of subcutaneous adipose tissue, resulting in severe metabolic issues such as insulin resistance and challenging diabetes management. This case series aims to assess bromocriptine treatment response in lipodystrophy patients, offering insights into its antidiabetic effects. This retrospective analysis focused on four female lipodystrophy patients with poor glycemic control who were undergoing bromocriptine treatment. Statistical analysis used non- parametric tests. Metabolic parameters were assessed before and 3 months post-bromocriptine treatment, revealing a modest reduction in median daily insulin dose and decreased hemoglobin A1c and fasting glucose levels. Body weight remained constant, while triglyceride levels increased. Dopamine receptor expression in pancreatic beta-cells and adipocytes suggests a direct impact on glucose homeostasis. While this case series hints at bromocriptine's positive influence on glycemic control and insulin requirements in lipodystrophy patients, larger studies are essential for establishing efficacy and safety.
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    The effect of serum lipid levels on peripheral blood hematopoietic stem cell levels
    (Pergamon-Elsevier Science Ltd, 2021) Simsir, Ilgin Yildirim; Donmez, Ayhan; Kabaroglu, Ceyda; Yavasoglu, Irfan; Basol, Gunes; Gungor, Ayse; Ozkan, Melda Comert
    Introduction: There are limited numbers of available retrospective studies on various hematological diseases treated with stem cell mobilization therapy. In the present study, we aimed to demonstrate the effects of serum lipid levels on peripheral blood CD34+ (PBCD34+) cell counts as well as the changes in serum lipid levels during stem cell mobilization process. Method: PBCD34+ cell counts were compared between hypercholesterolemic patients and healthy individuals. Additionally, total cholesterol (TChol), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), and triglyceride (TG) levels were measured from healthy donors who underwent stem cell mobilization, at different time points (prior to filgrastim [phase 1], prior to apheresis [phase II], and the first week following apheresis [phase III]. Results: In the hypercholesterolemia group, the PBCD34+ cell count was found to be higher among patients with elevated LDL-C (2.6 +/- 0.35/mu L vs. 1.7 +/- 0.17/mu L, p = 0.003) and TChol (2.6 +/- 0.34/mu L vs. 1.7 +/- 0.14/mu L, p = 0.006) in comparison to the healthy controls. In the mobilization group, phase II HDL-C levels (35.3 +/- 2.8 mg/ dL) were found to be lower than both phase I (45.6 +/- 2.1 mg/dL) and phase III (44.5 +/- 2.6 mg/dL) (p = 0.007). Phase II TChol levels (183.5 +/- 10.0 mg/dL) were lower than both phase I (216.8 +/- 8.5 mg/dL) and phase III (212.2 +/- 8.4 mg/dL) (p = 0.02). At phase II, there was an inverse correlation between PBCD34+ cell count and HDL-C (r = - 0.57, p = 0.003). Discussion: Our results indicate that, while increased LDL-C level is the determinant of baseline PBCD34+ cell count, reduced HDL-C is the determinant of PBCD34+ cell count during mobilization process.
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    Effects of Dietary Carbohydrate Concentration and Glycemic Index on Blood Glucose Variability and Free Fatty Acids in Individuals with Type 1 Diabetes
    (Mdpi, 2024) Seckiner, Selda; Bas, Murat; Simsir, Ilgin Yildirim; Ozgur, Su; Akcay, Yasemin; Aslan, Cigdem Gozde; Kucukerdonmez, Ozge
    Monitoring glycemic control status is the cornerstone of diabetes management. This study aimed to reveal whether moderate-carbohydrate (CHO) diets increase the risk of free fatty acid (FFA) levels, and it presents the short-term effects of four different diet models on blood sugar, glycemic variability (GV), and FFA levels. This crossover study included 17 patients with type 1 diabetes mellitus to identify the effects of four diets with different CHO contents and glycemic index (GI) on GV and plasma FFA levels. Diet 1 (D1) contained 40% CHO with a low GI, diet 2 (D2) contained 40% CHO with a high GI, diet 3 (D3) contained 60% CHO with a low GI, and diet 4 (D4) contained 60% CHO with a high GI. Interventions were performed with sensor monitoring in four-day periods and completed in four weeks. No statistical difference was observed among the groups in terms of blood glucose area under the curve (p = 0.78), mean blood glucose levels (p = 0.28), GV (p = 0.59), and time in range (p = 0.567). FFA and total triglyceride levels were higher in the D1 group (p < 0.014 and p = 0.002, respectively). Different diets may increase the risk of cardiovascular diseases by affecting GI, FFA, and blood glucose levels.
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    Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates
    (Wiley, 2023) Demirkoparan, Mesut; Vahabi, Arman; Ozbek, Berker; Mert, Merve; Simsir, Ilgin Yildirim; Erdem, Hueseyin Aytac; Ozturk, Anil Murat
    Amputations related to diabetic foot ulcers (DFU) are associated with high morbidity and mortality rates. Glycaemic control and close follow-up protocols are essential to prevent such ulcers. Coronavirus disease (COVID) related restrictions and regulations might have a negative impact on patients who are with DFU or candidates for DFU. We retrospectively analysed 126 cases that had DFU underwent amputation surgery. Comparative analyses were done between cases that were admitted before COVID restrictions (Group A) and cases admitted after COVID restrictions (Group B). Two groups were homogenic demographically. There was no significant difference between groups in terms of mortality (p = 0.239) and amputation rates (p = 0.461). The number of emergent cases in the pandemic period doubled the number in pre-pandemic period even though this finding was not statistically significant (p = 0.112). Fastly adapted consulting practice and follow-up protocols to compensate for the problems created by COVID-related regulations seem to be effective in terms of mortality and amputation rates.
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    Enhancing Solubility and Bioavailability of Rosuvastatin into Self Nanoemulsifying Drug Delivery System
    (Bentham Science Publ Ltd, 2018) Karasulu, Hatice Yasim; Gundogdu, Evren; Turk, Ugur Onsel; Turgay, Tugce; Apaydin, Sebnem; Simsir, Ilgin Yildirim; Yilmaz, Condeger; Karasulu, Ercument
    Objective: The aim of this study was to develop new Rosuvastatin calcium (RCa) self nanoemulsifying drug delivery system (SNEDDS) and to evaluate the bioavailability and pharmacodynamic effect of RCa-SNEDDS in Yorkshire pigs. Methods: Firstly, SNEDDS was developed and prepared then RCa was incorporated into SNEDDS which was evaluated regarding their characterization, stability properties, drug release profiles, permeation and cytotoxicity studies. Finally, in vivo performance of RCa-SNEDDS (F1-RCa-SNEDDS) was examined by pharmacokinetic and pharmacodynamics studies. The average droplet size of RCa-SNEDDS ranged between 200 and 250 nm. RCa-SNEDDS that contained 12.8% Oleic acid, 11 % Labrafil M, 3.3 % Labrasol and 4.4 % Transcutol HP were found to be stable and exhibited approximately 4-fold higher permeation than commercial tablet (Crestor (R) 20 mg tablet). Results: In pharmacokinetic studies, when F1 -RCa-SNEDDS and commercial tablet were administered orally, F1-RCa-SNEDDS showed higher bioavailability of RCa than commercial tablet. Respectively, in pharmacodynamic studies, triglyceride and total cholesterol levels were significantly reduced with F1-RCa-SNEDDS formulation by 37% and 19% when compared to baseline values. Conclusion: However, these decreases with commercial formulation were only 6% and 2% respectively. According to these findings, development formulation could be potentially used to enhance the oral absorption of RCa.
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    Evaluation of bone mineral density and related parameters in patients with haemophilia: a single center cross-sectional study
    (E-Century Publishing Corp, 2017) Unal, Hatice Demet Kiper; Ozkan, Melda Comert; Atilla, Fatos Dilan; Demirci, Zuhal; Soyer, Nur; Simsir, Ilgin Yildirim; Omur, Ozgur; Capaci, Kazim; Saydam, Güray; Sahin, Fahri
    Haemophilia has been associated with low bone mineral density (BMD) probably due to some predisposing factors. The aim of this study was to evaluate the relationship between BMD and potential clinical predictors in adult haemophilic patients. Fortynine patients with moderate and severe haemophilia were enrolled. BMD was measured by Dual Energy X-Ray Absorptiometry (DXA) and blood tests were performed for vitamin D, calcium, phosphore, alkaline phosphatase and parathormone levels. Functional Independence Score in Haemophilia (FISH) and Haemophilia Joint Health Score (HJHS) were used to assess musculoskeletal functions. Body mass index (BMI), Hepatitis C virus (HCV)/Human immunodeficiency virus (HIV) seropositivity and smoking status were also recorded. BMD was found lower than expected for reference age in 34.8% of patients of less than 50 years old. In patients older than 50 years, 66.6% of them had osteoporosis and 33.3% of them had normal BMD. FISH score was statistically significant correlated with BMD of total hip (TH) and femur neck (FN) but not with lumbar spine (LS). In eligible patients, there was also a statistically significant correlation between BMD of TH and HJHS. Vitamine D deficiency was common and found in 77.5% of patients, although there was no significant correlation with BMD. Also no correlation was found between BMD and blood tests, HCV/HIV status, BMI and smoking. This study confirmed that patients with haemophilia have an increased prevelance of low BMD even in younger group. Our results showed that there are significant correlations between FISH score and BMD of TH and FN and also between HJHS score and BMD of TH. Thus, using scoring systems may be beneficial as a simple predictors of BMD to reflect the severity of haemophilic arthropathy.
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    Evaluation of Coronavirus Disease 2019-Related Morbidity and Mortality in Lipodystrophy Patients During the Pandemic Period
    (Aves, 2024) Semiz, Gokcen Gungor; Demir, Tevfik; Simsir, Ilgin Yildirim; Selimoglu, Ismail; Yilmaz, Muege; Ellidokuz, Huelya; Onay, Hueseyin
    Objective: Coronavirus Disease 2019's (COVID-19) impact on rare disease populations such as lipodystrophy syndromes is unknown. We assessed COVID-19 infection outcomes in lipodystrophy syndromes and aimed to investigate the effect of restricted access to the hospital during the pandemic on metabolic parameters. Methods: A survey form consisting of descriptive questions about the situation of the patients during the COVID-19 pandemic was created. The survey was performed by phone in February and March 2021; all patients gave verbal consent. Patients diagnosed with lipodystrophy syndromes participated in our study. Demographic parameters were recorded. They were asked if they were diagnosed with COVID-19; if so, the hospitalization, intensive care unit need, oxygen requirement, and COVID-19 treatment were questioned. Laboratory data were recorded from the hospital records. Results: Seventy-one patients were investigated. Lipodystrophy patients in our study had at least 1 comorbid disease. Diabetes mellitus was the most common (87.1%). Six patients stated they had a COVID-19 infection (6/71, 8.5%). Three cases (50.0%) were hospitalized, and 1 (16.6%) patient was followed up in the intensive care unit. There were no deaths in our cohort. When the laboratory parameters of the entire group were evaluated, spot urine microalbumin increased significantly compared to the prepandemic period (P P = .013). Conclusion: Lipodystrophy patients may experience COVID-19 more severely due to their numerous comorbidities. Further research should be conducted with larger patient cohorts to investigate this relationship.
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    Evaluation of Lower Urinary Tract Functions in Diabetic Patients
    (Galenos Yayincilik, 2019) Eskidemir, Umit; Simsir, Adnan; Simsir, Ilgin Yildirim; Kizilay, Fuat; Ozyurt, Ceyhun
    Objective: In this study, we aimed to investigate the effect of diabetes-related metabolic changes and chronic complications on lower urinary tract (LUT) functions. Materials and Methods: The study included 286 adult patients with type 1 and type 2 diabetes mellitus (DM). All patients' demographic data, diabetes-specific history, laboratory and physical examination findings were recorded. All the data were compared with uroflowmetric parameters and the scores of questionnaires used for evaluation of LUT symptoms and functions. Results: In the presence of diabetic peripheral neuropathy (DPN), average urinary flow rate (Q(ave)) International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score and the Overactive Bladder-questionnaire Short Form (OAB-q SF) score were significantly affected. In the presence of stage 3 or over diabetic nephropathy (DN), ICIQ-SF score was significantly higher. Also, in elderly group,Q(ave) and OAB-q SF score were significantly affected. The Q(ave) was lower both in patients who underwent any surgery due to diabetic complications and in patients with DM-related diseases. Q(ave), and OAB-q SF score were significantly lower in males. Type 2 DM was associated with postvoid residual (PVR) increase and Q(ave) decrease. Poor glycemic control was associated with lower OAB-q SF score. Finally, vitamin D deficiency was found to be associated with an increase in PVR volume. Conclusion: The present study showed that DPN, stage 3 or over DN, aging, DM-related diseases and surgeries, male gender, type 2 DM, poor glycemic control and vitamin D deficiency cause a tendency to develop any kind of LUT dysfunction.