Derun Taner Ertugrul’s research while affiliated with T.C. Sağlık Bakanlığı Ankara Eğitim ve Araştırma Hastanesi and other places

Aim: The risk of ischemic stroke is increased 5-fold in patients with atrial fibrillation (the most common reason for cardiac arrhythmia). The aim is to investigate whether insufficiency in anterior pituitary hormones develops in patients diagnosed with atrial fibrillation and no history of cerebrovascular accident. Method: A group of 65 patients with chronic /paroxysmal atrial fibrillation without a history of cerebrovascular accident and a group of 65 healthy controls without arrhythmia were included in this study. Atrial fibrillation was diagnosed by electrocardiography or 24-hour rhythm holter. Demographic data, biochemical tests, echocardiography findings were compared between the groups. P<0.05 was considered statistically significant. Results: There was no statistical difference in gender and age distribution between groups (p<0.05). (Patient group: Mean age 68 ± 7 years (16 (24.6%) male and 49 (75.4%) female) / Control group: Mean age 67 ± 6 years (18 (27.7%) male and 47 (72.3%) female). Serum insulin-like growth factor-1, adrenocorticotropic hormone and cortisol levels were significantly lower in the patient group compared to the control group (p=0.048, p=0.005, p=0.023). There was no significant difference in serum thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels between groups. Left atrial diameter and left ventricular end-diastolic diameter were higher in the patient group (p<0.0001). The left ventricular ejection fraction value was lower in the patient group (p<0.0001). Conclusion: It was thought that the reason for the low level of insulin-like growth factor-1 in the setting of normal liver and kidney functions and simultaneous cortisol and adrenocorticotropic hormone deficiency, in patients with atrial fibrillation with no history of cerebrovascular accident might be due to silent cerebral ischemia leading to pituitary dysfunction.

Diabetic ketoacidosis (DKA) is the most common emergency complication of diabetes. Euglycemic DKA (EDKA), on the other hand, has been known for many years but is a rare and under-recognized condition and constitutes a very small proportion of DKA cases. However, in recent years, an increase in the incidence of EDKA has been observed with the widespread use of sodium–glucose co-transporter 2 inhibitors, which have proven benefits in the treatment of diabetes mellitus and its cardiorenal complications, heart failure, and chronic kidney disease. Unlike classical DKA, these patients without significant hyperglycemia can easily be missed in emergency departments. EDKA should be kept in mind in patients with diabetes presenting with DKA but with a blood glucose level <250 mg/dL. The diagnostic and therapeutic approach after clinical suspicion in these patients is similar to classical DKA and is briefly summarized in this review. The most important point in treatment is that these patients are normoglycemic but have a significant insulin deficiency (relative or absolute). Therefore, insulin is the mainstay of the treatment and should be given together with dextrose solutions to avoid hypoglycemia.

Introduction: The effect of vitamin D status on steatosis has not been fully elucidated. In this study, we planned to investigate this interaction using a large-scale population-based cohort. Material and methods: Patients diagnosed with simple steatosis (K76.0) and non-alcoholic steatohepatitis (NASH) (K75.8) by using the International Classification of Diseases 10th Revision (ICD-10) coding system, and who had 25-hydroxyvitamin D (25OHD) measurements at the diagnosis, were included in the study. Control group comprised subjects without liver diseases. Age, gender, alanine aminotransferase (ALT) and 25OHD levels, and the date of the measurements were recorded. Results: We compared ALT and 25OHD measurements between the patient and control groups, and between the simple steatosis and NASH subgroups. 25OHD levels were lower and ALT levels were higher in the patient group (p < 0.001, effect size = 0.028, and p < 0.001, effect size = 0.442, respectively). Logistic regression analysis showed that when 25OHD levels decrease by 1 ng/dL, it increases the risk of being in the patient group by 3.7%. Conclusion: Our results suggest that vitamin D status may be related to the development of non-alcoholic fatty liver disease (NAFLD). Although this relationship is weak, it may be important in the pathogenesis of steatosis.

Objective: It was aimed to investigate irisin and chemerin levels in prediabetic individuals and their value in predicting prediabetes. Method: Thirty-eight prediabetic patients aged 18-65 years (22 impaired fasting glucose (IFG), 10 impaired glucose tolerance (IGT), 6 patients with coexisting IFG and IGT) and thirty-five healthy volunteers were included in which was designed as a cross-sectional study. The basic demographic characteristics of all participants in the case and control groups were compared with the serum chemerin, irisin, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), high-density lipoprotein (HDL-cholesterol), low-density lipoprotein (LDL-cholesterol), triglyceride (TG), free thyroxine (sT4), and thyroid-stimulating hormone (TSH) levels. Result: Serum chemerin level was found to be higher in the prediabetic group (p=0.03), while no significant difference was found for the irisin level between the two groups. In the multivariate logistic regression analysis, we showed that chemerin was an independent risk factor in predicting prediabetes. There was a positive correlation (p=0.01, r=0.279) between all participants' body mass index (BMI) and chemerin level and a negative correlation between irisin level and high-density lipoprotein cholesterol (HDL-C) level, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p=0.04 r=-0.295, p=0.01 r=-0.407, respectively). Conclusion: Chemerin is a new generation chemokine that predicts prediabetes. Studies aimed at irisin and chemerin may provide important role to prevent the prediabetes to Type 2 diabetes progression.

To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-confirmed COVID-19 infection (n=14,966) from March 11 to May 30, 2020 was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02–2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99–1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism.

INTRODUCTION: Obesity is one of the most important chronic metabolic diseases that includes many comorbidities. Lifestyle changes play the most important role in the treatment of obesity. Despite this, medical treatment and bariatric surgery procedures gain importance in patients whose weight control can not be achieved. In recent years, sleeve gastrectomy (SG) has become very popular. Nevertheless, its effects on gastrointestinal system physiology and bone metabolism are still not known properly. METHODS: Fifty-two patients who underwent SG between 2018 and 2019 were included in our observational study. Calcium, albumin, albumin-adjusted calcium (AAC), phosphorus (P), 25-hydroxyvitamin D [25(OH)D], alkaline phosphatase (ALP), parathyroid hormone (PTH), creatinine, glomerular filtration rate (GFR) and body mass index (BMI) of the patients were recorded both in the pre-operative period and three months postoperatively. Patients were grouped as patients with low calcium (10.2mg/dL) according to pre-operative and post-operative calcium levels. RESULTS: The mean age of the patients was 38.96+-8.93 years. 1 (8.33%) out of 12 patients with high serum calcium levels in the pre-operative period had low serum calcium levels in the post-operative period, eight patients (66.67%) had normal reference values, three patients (25%) had high serum calcium levels, the difference was significant. Based on ACC, eight patients (15.38%) had high calcium levels postoperatively. DISCUSSION AND CONCLUSION: Hypocalcemia, normocalcemia, and hypercalcemia may be observed during the follow-up after bariatric surgery. Although PTH and 25(OH)D play the most important roles in calcium metabolism, the interaction of bone- gut hormones is still unclear and complicated.

Introduction: COVID-19 disease has a worse prognosis in patients with diabetes, but comparative data about the course of COVID-19 in patients with type 1 (T1DM) and type 2 diabetes (T2DM) are lacking. The purpose of this study was to find out the relative clinical severity and mortality of COVID-19 patients with T1DM and T2DM. Material and methods: A nationwide retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n = 149,671) was investigated. After exclusion of individuals with unspecified diabetes status, the adverse outcomes between patients with T1DM (n = 163), T2DM (n = 33,478) and those without diabetes (n = 115,108) were compared by using the propensity score matching method. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation, and mortality. Results: The patients with T1DM had higher mortality than the age- and gender-matched patients with T2DM (n = 489) and those without diabetes (n = 489) (p < 0.001). After further adjustment for the HbA1c, and microvascular and macrovascular complications, the odds of mortality (OR: 3.35, 95% CI: 1.41-7.96, p = 0.006) and ICU admission and/or mechanical ventilation (OR: 2.95, 95% CI: 1.28-6.77, p = 0.011) were significantly higher in patients with T1DM compared to those with T2DM. Older age (OR: 1.06, 95% CI: 1.01-1.12, p = 0.028) and lymphopaenia (OR: 5.13, 95% CI: 1.04-25.5, p = 0.045) were independently associated with mortality in patients with T1DM. Conclusions: Patients with T1DM had worse prognosis of COVID-19 compared to T2DM patients or those without diabetes. These cases should be cared for diligently until more data become available about the causes of increased COVID-19 mortality in T1DM.

Background It is well documented that patients with chronic metabolic diseases such as diabetes and obesity are adversely affected by the Covid 19 pandemic. However, when the subject is rare metabolic diseases, there is not enough data in the literature. Aim To investigate course of COVID-19 among patients with Gaucher disease (GD), the most common lysosomal storage disease. Methods Based on the National Health System data, a retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n = 149 618) was investigated. The adverse outcomes between patients with GD (n = 39) and those without GD (n = 149 579) were compared in crude and propensity score matched (PSM) groups. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation and mortality. Results The patients with GD were significantly older and had a higher frequency of hypertension, T2DM, dyslipidemia, asthma or COPD, chronic kidney disease, coronary artery disease, heart failure, and cancer. Although hospitalization rates in Gaucher patients were found to be higher in crude analyzes, the PSM models (model 1, age- and gender-matched; model 2, matched for age, gender, hypertension, T2DM, and cancer) revealed no difference for the outcomes between patients with GD and the general population. According to multivariate regression analyses, having a diagnosis of GD was not a significant predictor for hospitalization (p = 0.241), ICU admission/mechanical ventilation (p = 0.403) or mortality (p = 0.231). Conclusion According to our national data, SARS-CoV-2 infection in patients with GD does not have a more severe course than the normal population. This article is protected by copyright. All rights reserved.

Background and aims: In this century, obesity is one of the most important health problems responsible for mortalities and morbidities worldwide. Bariatric surgery is an effective treatment modality used in the treatment of obesity. We aimed to elucidate the effect of bariatric surgery on hematological and nutritional parameters at post-operative 3rd, 6th, and 12th months after sleeve gastrectomy (SG). Subjects and methods: Totally 298 patients, who underwent SG in general surgery clinic between 2015 and 2017, were included in the study. We evaluated the levels of complete blood cell parameters [hemoglobin (Hb), hematocrit (Htc), white blood cell (WBC), lymphocyte (LYM), neutrophil (NTRL), mean corpuscular volume (MCV), platelet (PLT) counts], serum iron (SI), serum iron-binding capacity (SIBC), serum ferritin (FER), serum folate (FOL) and serum vitamin B12 (Vit B12)] at the pre-operative visit, and post-operative 3rd, 6th and 12th-month visits. Results: Hb, Htc, WBC and PLT levels decreased significantly at 12th-month after SG (p<0.001 for both comparisons). LYM and NTRL levels were found to be decreased in the post-operative period (p=0.006 and p<0.001, respectively). MCV levels were higher than pre-operative values (p<0.001). Vitamin B12 levels did not change after SG. Folate values were lower in post-operative visits than pre-operative visits (p<0.001). Serum iron and ferritin levels were increased after SG, whereas, serum iron-binding capacity levels were observed to be decreased (p<0.001). Conclusions: Long-term results of sleeve gastrectomy have not been elucidated adequately. Although this procedure has better outcomes on diabetes, hypertension, hyperlipidemia it can cause deleterious multisystemic consequences. Close follow-up of the patients in the post-operative period will prevent, unfavorable outcomes.