Clinical and epidemiologic observations have led to the concept of a procoagulant state in type 2 diabetes. This study aimed to determine the coagulation status in type 2 diabetic patients using rotation thromboelastography (ROTEM), which measures the interactive dynamic coagulation process. For this purpose, 51 (30 women, 21 men) type 2 diabetic patients (mean age, 56.1 years) and 40 age-matched, sex-matched and body-mass-index-matched healthy individuals were enrolled. Twenty-seven of the diabetic group had diabetic vascular complications. ROTEM using different activators for the intrinsic and extrinsic systems of coagulation cascade (intrinsic TEM-INTEM, extrinsic TEM-EXTEM, FIBTEM) was used to measure the coagulation time (CT), clot formation time (CFT), alpha angle (alpha) and maximum clot firmness (MCF). No significant difference was found in the prothrombin time, partial thromboplastin time, thrombin time, fibrinogen and platelet count between the two groups. INTEM-CT and INTEM-CFT and EXTEM-MCF were significantly higher in the diabetic group compared with controls (P = 0.012, P = 0.007 and P = 0.029, respectively). INTEM alpha in the diabetic group was significantly lower than the controls (P = 0.001). All other parameters, including INTEM-MCF, EXTEM-CT, EXTEM-CFT, EXTEM-alpha, FIBTEM-CT, FIBTEM-CFT, FIBTEM-MCF and FIBTEM-alpha, were similar between the two groups. Taking into account these data, we conclude that there is subtle activation of the extrinsic pathway with a concomitant decrement in the intrinsic pathway of the coagulation cascade in type 2 diabetes. The exact underlying mechanisms leading to these changes, and their consequences with regard to diabetic complications, remain to be determined.
Our results suggest that the prevalence GAD-Ab in Hashimoto's thyroiditis is around 5%. GAD-Ab antibody positivity per se does not appear to be associated with any disturbances in insulin sensitivity or insulin secretion in this specific population. The presence of islet-cell autoimmunity does not seem to influence insulin secretion or action in normal glucose tolerant subjects with Hashimoto's thyroiditis in this pilot study. Whether the presence of GAD-Ab per se or along with other antibodies impairs insulin dynamics or predicts the development of diabetes in autoimmune thyroiditis remains to be determined in future studies.
The clinical course of inflammatory bowel disease (IBD) is frequently associated with thromboembolic complications. The aim of this study was to investigate common thrombophilic markers in Turkish patients with active IBD. Twenty-seven consecutive patients with IBD who were followed-up at the Hacettepe University Hospital were recruited. All the patients were in the active disease state. International normalized ratio, activated partial thromboplastin time, lupus anticoagulant, anticardiolipin IgG, IgM antibodies, protein C, protein S, antithrombin-III, factor V, and factor II mutation of all the IBD patients and of a sex-matched and age-matched control group of non-IBD patients were measured. International normalized ratio, activated partial thromboplastin time, protein C, protein S, lupus anticoagulant, anticardiolipin IgG and IgM, and Proteins C and S mutations were comparable between the 2 groups, but antithrombin-III was significantly lower in the IBD group compared with healthy control group (P<0.0001). As a conclusion, it is reasonable to assume that there may be a subpopulation of the patients with IBD, in whom thrombophilic abnormalities might be important for either disease manifestation or for thrombotic complications. Those hemostatic abnormalities could be either inherited or secondary to the ongoing disease process. Routine screening for the common markers of thrombophilia does not seem to be warranted unless simultaneous arterial and venous thrombosis, major organ thrombosis, strong family history of thrombophilia, unusual and recurrent thrombosis resistant to standard anticoagulant therapy are present. Further studies are definitely required to clarify these complicated associations.
Objective: Bariatric surgery with multidisciplinary management is a more effective method to treat morbid obesity and obesity-related comorbidities compared with nonsurgical treatments. Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch in the super-obese population. In the past few years, however, LSG has been performed as a definitive procedure because of its promising early and midterm results. The aim of this study is to evaluate the efficacy of our initial LSG series of 73 patients on excess weight loss (EWL) and resolution of obesity-related comorbidities in short-term follow-up. Material and Methods:From March 2013 to May 2014, 78 morbid obese patients with an average body mass index (BMI) of 46.3 kg/m 2 underwent LSG. There is a 9-month follow-up period on average. Five patients were excluded from the study, because they could not be contacted. Comorbidities, preintervention BMI, glucose, HbA1c, and lipid profiles were recorded at 1, 6, and 12 months postintervention. Results:After the surgery, the percent EWL was 58%. The mean serum glucose level, HbA1c level, LDL-cholesterol level, triglyceride level, insulin, and insulin resistance decreased significantly and the mean HDL-cholesterol level increased. Conclusion:For the resolution of comorbidities, LSG may be used as an effective bariatric and metabolic surgery.
Kronik seyri ve hastalığın yönetimindeki zorluklar nedeniyle tip 2 diyabetli bireyler tamamlayıcı ve alternatif tedavi yöntemlerine sıklıkla başvurabilmektedir. Bu çalışmada, Tip 2 diyabetli bireylerde bitkisel destek kullanım sıklığı ve bitkisel destek kullanımı ile ilişkili etmenlerin ortaya konulması amaçlanmıştır. YöntemTanımlayıcı tipte planlanan araştırmaya, tip 2 diyabet tanısı almış toplam 193 yetişkin birey dahil edilmiştir. Veriler, yapılandırılmış bir anket kullanılarak yüz yüze görüşme yöntemi ile toplanmıştır. Görüşmede, bireylerin genel özellikleri, sağlık durumları, bitkisel destek kullanım durumları, kullandıkları ürünler, ürünleri hazırlama yöntemleri, kullanım sıklıkları, kullanım süreleri ve ürünü tavsiye eden kişiler sorgulanmıştır. Katılımcıların antropometrik ölçümleri araştırmacılar tarafından ölçülüp kaydedilmiştir. BulgularÇalışmaya katılan yaklaşık her üç kişiden birinin (%30,1) diyabetin yönetimi için bitkisel desteklere başvurduğu belirlenmiştir. Bitkisel destek kullanan bireylerin sırasıyla %25,9 ve %24,1'i tarafından kullanıldığı beyan edilen tarçın ve karışım ürünler en çok tercih edilen ürünler olmuştur. Ürünlerin temin edildiği yerlerin başında aktarlar (%50,7) gelmektedir. Bireylerin önemli bir kısmı kullandıkları bitkisel desteğe ilişkin araştırma yapmadığını (%82,8) ve kullandıkları ürün hakkında doktorlarına bilgi vermediğini (%81,0) bildirmiştir. Bitkisel destek kullanan bireylerin %67,3'ünün ürünleri komşu ya da tanıdık tavsiyesi üzerine kullanmaya başladığı kaydedilmiştir. Hem bitkisel destek kullanan (%79,3) hem de kullanmayanların (%67,4) büyük çoğunluğu bitkisel ürünlere yönelik sağlık çalışanlarından bilgi almak istediklerini bildirmişlerdir. SonuçBu çalışmada diyabetli bireyler arasında bitkisel destek kullanımının yaygın olduğu ortaya konmuştur. Ürünlerin bilinçsiz kullanımını önlemek için sağlık çalışanlarının konuya ilişkin farkındalığının yüksek olmasının gerekli olduğu düşünülmektedir.
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