Publications by authors named "Gunay Can"

165 Publications

Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women.

Neurourol Urodyn 2021 May 18. Epub 2021 May 18.

Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.

Aim: To investigate the relationship between handgrip strength with types of urinary incontinence (UI) and pelvic floor muscle strength (PFMS) in women.

Methods: Ninety-two women, who presented to the geriatric and urology outpatient clinics complaining of UI between July 2019 and February 2020 and had indicated to undergo urodynamic assessment after basic neurourological evaluation, were included in this cross-sectional study. The presence and types of UI were identified by clinical examination and urodynamic studies. Demographic parameters, anthropometric data, comorbidities and medications were recorded. The International Consultation on Incontinence Questionnaire-Short Form was applied. Handgrip strength (HGS) was measured by a hand dynamometer. The PFMS was subjectively assessed via vaginal digital palpation and measured quantitatively by the vaginal probe of the perineometer.

Results: Thirty-eight urodynamic stress, 28 detrusor overactivity, 26 urodynamic mixed UI patients were reported. Perineometer measurements were significantly lower in the urodynamic stress UI group compared to the other two groups (p = 0.020). There was no relationship between the types of urinary incontinence and HGS. However, a positive correlation was found between PFMS and HGS (p = 0.045, r = 0.298).

Conclusion: The positive correlation between HGS and PFMS indicates that low HGS may be a marker for PFMS weakness. Furthermore, the association between sarcopenia and UI may be explained by this condition.
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http://dx.doi.org/10.1002/nau.24699DOI Listing
May 2021

Low Serum Uric Acid Predicts Risk of a Composite Disease Endpoint.

Medicina (Kaunas) 2021 Apr 8;57(4). Epub 2021 Apr 8.

Departments of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, 34098 Istanbul, Turkey.

Mortality may increase in hypouricemia as well as inhyperuricemia. We assessed the predictive value of low serum uric acid (SUA) levels on the risk of overall mortality or a composite endpoint of death and nonfatal events. In 1013 community-based middle-aged adults, free of uncontrolled diabetes and coronary heart disease at baseline, the association of sex-specific SUA tertiles with defined outcomes was evaluated prospectively by logistic regression, stratified to gender and presence of type-2 diabetes, using recent criteria. : Totally, 43 deaths and additional incident nonfatal events in 157 cases were recorded at a median 3.4 years' follow-up. Multivariable linear regression disclosed SUA to be significantly associated among non-diabetic individuals positively with creatinine, triglycerides, and body mass index in women further with fasted glucose. In multivariable-adjusted logistic regression analysis, sex-specifically dichotomized baseline uric acid (<5.1 and <4.1 mg/dL vs. higher values) significantly predicted the non-fatal events in the whole sample (relative risk (RR) 1.51 [95% confidence interval (CI) 1.02; 2.26]), as well as in men, while composite endpoint in the whole sample tended to rise (RR 1.38). Compared with the intermediate one, the top and bottom SUA tertiles combined tended to confer mortality risk (RR 2.40 [95% CI 0.89; 6.51]). Adverse outcomes in diabetic women were predicted by tertiles 2 and 3. : Inverse association of SUA with adverse outcomes, especially in men, is consistent with the involvement of uric acid mass in autoimmune activation. The positive association of uric acid with adverse outcomes in diabetic women is likely mediated by concomitant high-density lipoprotein dysfunction.
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http://dx.doi.org/10.3390/medicina57040361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068308PMC
April 2021

An easy-to-use nomogram for predicting in-hospital mortality risk in COVID-19: a retrospective cohort study in a university hospital.

BMC Infect Dis 2021 Feb 5;21(1):148. Epub 2021 Feb 5.

Department of Infectious Diseases, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey.

Background: One-fifth of COVID-19 patients are seriously and critically ill cases and have a worse prognosis than non-severe cases. Although there is no specific treatment available for COVID-19, early recognition and supportive treatment may reduce the mortality. The aim of this study is to develop a functional nomogram that can be used by clinicians to estimate the risk of in-hospital mortality in patients hospitalized and treated for COVID-19 disease, and to compare the accuracy of model predictions with previous nomograms.

Methods: This retrospective study enrolled 709 patients who were over 18 years old and received inpatient treatment for COVID-19 disease. Multivariable Logistic Regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed with the possible predictors and total point were calculated.

Results: Of the 709 patients treated for COVID-19, 75 (11%) died and 634 survived. The elder age, certain comorbidities (cancer, heart failure, chronic renal failure), dyspnea, lower levels of oxygen saturation and hematocrit, higher levels of C-reactive protein, aspartate aminotransferase and ferritin were independent risk factors for mortality. The prediction ability of total points was excellent (Area Under Curve = 0.922).

Conclusions: The nomogram developed in this study can be used by clinicians as a practical and effective tool in mortality risk estimation. So that with early diagnosis and intervention mortality in COVID-19 patients may be reduced.
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http://dx.doi.org/10.1186/s12879-021-05845-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862983PMC
February 2021

The Impact of Stone Density on Operative Complications of Retrograde Intrarenal Surgery: A Multicenter Study with Propensity Score Matching Analysis.

J Laparoendosc Adv Surg Tech A 2021 Jan 20. Epub 2021 Jan 20.

Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey.

The aim of the study was to evaluate the impact of stone density on operative complication rates in retrograde intrarenal surgery (RIRS). A total of 473 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were included. To adjust for baseline confounders, one-to-one propensity score matching was performed. After matching, the patients were divided into two groups according to stone density (low density [LD] group, ≤970 Hounsfield unit [HU]; high density [HD] group, >970 HU). The patients' demographics, stone-related features, stone-free rates, and intraoperative and postoperative complication rates were compared between the groups. The primary objective was to evaluate whether the intraoperative and postoperative complication rates were higher in patients whose stone density was greater than 970 HU. After propensity score matching, 170 of 210 LD and 170 of 263 HD patients undergoing RIRS were included. The baseline characteristics did not differ significantly between the groups. There were no significant differences between LD and HD patients with respect to intraoperative (5.9% and 8.8%, respectively;  = .29), postoperative (10.6% and 15.3%, respectively;  = .14), and overall complication rates (15.2% and 21.1%, respectively;  = .16). Stone-free status was achieved in 143 patients (84.1%) in the LD group and 148 patients (87%) in the HD group; the difference was not statistically significant ( = .27). Our results show that RIRS is a safe and effective minimally invasive procedure for the treatment of upper urinary tract stones, even in HD stones.
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http://dx.doi.org/10.1089/lap.2020.0936DOI Listing
January 2021

Optimal anthropometric measures to predict incidence of coronary heart disease in adults in Turkey.

Natl Med J India 2019 Nov-Dec;32(6):334-341

Department of Public Health, Cerrahpasa Medical Faculty, Istanbul University-cerrahpasa, Istanbul, Turkey.

Background: We aimed to identify the most suited anthropometric measure for the prediction of risk for incident coronary heart disease (CHD) among the Turkish population.

Methods: We collected data on body mass index, waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index. We analysed these using both C-statistics and Cox regression models adjusted for age, systolic blood pressure, glucose and high-density lipoprotein (HDL)-cholesterol for assessing risk of incident CHD among 3203 Turkish Adult Risk Factor (TARF) study participants (mean [SD] age 48.5 [11] years).

Results: Over a mean follow-up of 9.93 years, new CHD developed in 573 individuals. Multi-adjusted C-statistics were highest for WHtR followed by WC, in both sexes. Except WHR, all measures were significantly associated with incident CHD in combined sexes in the full model. There was a sex difference, however, in the mediation of the three risk factors for adiposity; these attenuated hazard ratios (HRs) in males, whereas in females, significant prediction of incident CHD persisted for each measure. WC (HR 1.36 [95% CI 1.13; 1.64]), followed by WHtR (HR 1.24 [95% CI 1.10; 1.40]), were in combined sex, as in females, the most informative surrogates of adiposity. Hip circumference did not protect, but rather conferred modest CHD risk, especially in females, rendering a low utility of predictive value for WHR. The CHD risk curve did not have a J shape.

Conclusions: WC is the most suitable of five adiposity surrogates for CHD risk among Turkish adults, while in males, unmediated adiposity risk was similarly identified by WHtR. Retention of the large part of CHD risk in females perhaps reflects the underlying autoimmune activation.
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http://dx.doi.org/10.4103/0970-258X.303619DOI Listing
December 2020

Factors affecting mortality in geriatric patients hospitalized with COVID-19

Turk J Med Sci 2021 04 30;51(2):454-463. Epub 2021 Apr 30.

Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19).

Materials And Methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death.

Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107–20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473–14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012–1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000–1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001–1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126–1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811–0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065–0.874, P: 0.031).

Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.
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http://dx.doi.org/10.3906/sag-2008-91DOI Listing
April 2021

Interobserver agreement between interpretations of acute changes after lung stereotactic body radiotherapy.

Strahlenther Onkol 2021 May 24;197(5):423-428. Epub 2020 Nov 24.

Department of Radiation Oncology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Cerrahpaşa Ave. Kocamustafapaşa St. No:34/E Fatih, Istanbul, Turkey.

Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment modality for inoperable early-stage lung cancer or metastatic lung lesions. Post-SBRT, acute radiological lung changes sometimes mimic tumor progression, so over-investigation may be applied. We aimed to reveal the interobserver agreement among physicians regarding acute radiographic changes on CT of the thorax obtained shortly after SBRT MATERIALS AND METHODS: Radiologic images of 20 lesions treated with SBRT were evaluated for acute lung changes. Two physicians, one senior and one junior, from diagnostic radiology, radiation oncology, nuclear medicine, and chest disease departments reviewed these images. The final interpretations were categorized as stable, regression/consolidation, progressive disease, and SBRT-related changes. The evaluations of the physicians were compared with the experienced reference radiation oncologist. The gold standard was accepted as the reference physician's final score. Unweighted Cohen's kappa (κ) coefficient was used for assessing interobserver agreement between physicians.

Results: The evaluations of the physicians were compared with the reference radiation oncologist. The strongest coherence coefficient was found with the senior radiation oncologist (κ: 0.72). The kappa coefficients between the junior radiation oncologist, junior nuclear medicine physician, and the reference physician were 0.61 and 0.55, respectively. The disciplines with the lowest kappa coefficients were junior chest disease and senior radiologist, and the kappa values were 0.37 and 0.44, respectively.

Conclusion: Disciplines dealing with lung cancer treatment may not be aware of the various radiologic changes after SBRT or inexperienced in interpreting them from recurrence. Therefore, physicians must have detailed radiotherapy information such as planning target volume (PTV), dose/fractionation, etc. In addition, final evaluations should be performed in the multidisciplinary team dealing with the treatment of the patient.
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http://dx.doi.org/10.1007/s00066-020-01711-yDOI Listing
May 2021

Risk factors predicting upper urinary tract deterioration in children with spinal cord injury.

Neurourol Urodyn 2021 01 18;40(1):435-442. Epub 2020 Nov 18.

Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Aim: The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI).

Methods: The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration.

Results: Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI.

Conclusion: Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.
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http://dx.doi.org/10.1002/nau.24580DOI Listing
January 2021

Sex-specific associations of TCF7L2 variants with fasting glucose, type 2 diabetes and coronary heart disease among Turkish adults.

Anatol J Cardiol 2020 11;24(5):326-333

Department of Genetics, Aziz Sancar Institute for Experimental Medicine, İstanbul University; İstanbul-Turkey.

Objective: TCF7L2 is a repressor and transactivator of genes, and its variants are strongly associated with diabetes. This study aimed to evaluate the sex-specific relationship between the most common TCF7L2 gene variants (-98368G>T, rs12255372 and -47833C>T, rs7903146) with diabetes and coronary heart disease in Turkish Adult Risk Factor (TARF) Study.

Methods: Single nucleotide variants (SNVs) have been genotyped using the TaqMan allelic discrimination assays in 2,024 (51.3% in women, age: 55±11.8) Turkish adults participating in the TARF study. Statistical analyses were used to investigate the association of genotypes with clinical and biochemical measurements.

Results: Among the TARF study participants, 11.7%, 24.3%, 14.1%, and 38.3% had diabetes, hypertension, coronary heart disease (CHD), and obesity, respectively. The frequencies of T allele for -47833C>T and -98368G>T in Turkish adults were determined to be 0.35 and 0.33, respectively. -47833C>T was significantly associated with higher fasting glucose concentrations in all participants, especially in men. Both SNVs were significantly associated with diabetes and CHD in all participants (p<0.05). When study population was stratified according to sex, -98368G>T was associated with diabetes in women (p=0.041) and -47833C>T was associated with diabetes and CHD in men (p=0.018 and p=0.032, respectively). Also, both SNVs and the diplotypes of common haplotype (H1) remained strongly associated with type 2 diabetes after risk factors were adjusted (p<0.05).

Conclusion: T allele homozygosity of two SNVs as well as the diplotype H1-/H1- reflects risk of diabetes primarily in men. Enhanced CHD risk is determined by the presence of diplotype H1-/H1- among nondiabetic participants.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.57736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724383PMC
November 2020

Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience).

Eur J Clin Microbiol Infect Dis 2021 Feb 15;40(2):325-333. Epub 2020 Sep 15.

Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey.

Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution.
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http://dx.doi.org/10.1007/s10096-020-03994-6DOI Listing
February 2021

The rs2175898 Polymorphism in the ESR1 Gene has a Significant Sex-Specific Effect on Obesity.

Biochem Genet 2020 Dec 10;58(6):935-952. Epub 2020 Jul 10.

Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Vakif Gureba Cad. 34080 Sehremini, Istanbul, Turkey.

Polymorphisms in the ESR1 gene have been associated with obesity and lipid metabolism. There are also important sex-related differences in the prevalence of obesity and related phenotypes. Therefore, we aimed to interrogate the association of the ESR1 rs2175898 gene polymorphism with obesity, obesity-related variables, and lipid levels in men and women as separate groups. Two thousand twenty-two randomly selected middle-aged and elderly Turks were genotyped for ESR1 rs2175898 polymorphism using real-time polymerase chain reaction with hybridization probes. We found sex-related differences of the ESR1 rs2175898 polymorphism in obesity. Logistic regression analysis after adjustment for age, smoking status, physical activity, diabetes mellitus, and the presence of menopause status in women demonstrated significantly decreased risk for obesity in female AG genotype carriers (OR 0.69; 95% CI 0.52-0.91; p = 0.010), and in male GG genotype carriers (OR 0.49; 95% CI 0.25-0.96; p = 0.039), Furthermore, carriers of the rs2175898 G allele exhibited a lower body mass index in both sexes and decreased waist circumference in women but not in men. Our findings also showed significantly higher serum total-C levels (p = 0.007) in the carriers of the AG+GG/AG genotype compared with the AA genotype in men. The AG genotype of the ESR1 rs2175898 polymorphism in women and GG genotype in men were found to have a decreased likelihood for obesity compared with the other rs2175898 genotypes.
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http://dx.doi.org/10.1007/s10528-020-09987-6DOI Listing
December 2020

An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality.

Ann Hematol 2020 Aug 20;99(8):1925-1932. Epub 2020 Jun 20.

Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098, Istanbul, Turkey.

Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum β-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.
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http://dx.doi.org/10.1007/s00277-020-04144-wDOI Listing
August 2020

Excess Mortality in Istanbul during Extreme Heat Waves between 2013 and 2017.

Int J Environ Res Public Health 2019 11 7;16(22). Epub 2019 Nov 7.

Institut national de santé publique du Québec and Université Laval, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada.

Heat waves are one of the most common direct impacts of anthropogenic climate change and excess mortality their most apparent impact. While Turkey has experienced an increase in heat wave episodes between 1971 and 2016, no epidemiological studies have examined their potential impacts on public health so far. In this study excess mortality in Istanbul attributable to extreme heat wave episodes between 2013 and 2017 is presented. Total excess deaths were calculated using mortality rates across different categories, including age, sex, and cause of death. The analysis shows that three extreme heat waves in the summer months of 2015, 2016, and 2017, which covered 14 days in total, significantly increased the mortality rate and caused 419 excess deaths in 23 days of exposure. As climate simulations show that Turkey is one of the most vulnerable countries in the Europe region to the increased intensity of heat waves until the end of the 21st century, further studies about increased mortality and morbidity risks due to heat waves in Istanbul and other cities, as well as intervention studies, are necessary.
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http://dx.doi.org/10.3390/ijerph16224348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887774PMC
November 2019

Mapping of carbon monoxide related death risk in Turkey: a ten-year analysis based on news agency records.

BMC Public Health 2019 Jan 3;19(1). Epub 2019 Jan 3.

Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Koca Mustafa Paşa Mahallesi, Cerrahpaşa Caddesi No:53, 34096 Fatih, Istanbul, Turkey.

Background: Carbon-monoxide (CO) poisoning is a substantial cause of preventable mortality. In Turkey, no nationwide data are being collected nowadays. In our study, we aimed to assess the trend in deaths related to CO exposure in all provinces of Turkey in a 10-year period by using the records of a news agency which collects the news from the majority of the national newspapers, local newspapers and television channels.

Methods: In this study, 27,881 news items that were released between January 2008 to December 2017 which included keywords of "poisoning" and "death" or "carbon monoxide" and "death" were evaluated. 2667 non-fire related deaths were used in the final analyses.

Results: In a 10-year period, the risk of CO-related death in Turkey was 0.35/100000. 1371 (51.4%) of the victims were male and the median age of the patients was 45 years (range, 15 days-108 years). Most of the deaths occurred ≥50 years of age. Stoves were the predominant source [n = 2096 (78.6%)]. There was a stagnating trend of CO-related deaths. Most of the incidents occurred in winter. The Middle Anatolian region was of the highest risk in CO-related mortality.

Conclusions: In conclusion, CO poisoning is still a considerable public health concern in Turkey. Results of our study showed that stoves are still frequently being used and are the cause of death especially in rural areas with lower socioeconomic status. A better organized, nationwide surveillance and management approaches are needed to demonstrate the true burden CO related morbidity and mortality as well as its prevention in Turkey.
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http://dx.doi.org/10.1186/s12889-018-6342-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318903PMC
January 2019

High-normal thyroid-stimulating hormone in euthyroid subjects is associated with risk of mortality and composite disease endpoint only in women.

Arch Med Sci 2018 Oct 26;14(6):1394-1403. Epub 2016 Oct 26.

Department of Cardiology, Suruç State Hospital, Şanliurfa, Turkey.

Introduction: The aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events.

Material And Methods: In 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender.

Results: In total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years' follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age ( = 0.006), but in women inversely with fT3 and fT4 ( < 0.001, and = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07-3.82) and, much more strongly, the mortality risk, independently of fT4 increments.

Conclusions: The significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.
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http://dx.doi.org/10.5114/aoms.2016.63264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209708PMC
October 2018

Higher follicular fluid glycodelin levels are negatively correlated with embryonic development in assisted reproduction.

JBRA Assist Reprod 2018 11 1;22(4):346-351. Epub 2018 Nov 1.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: To investigate the possible effect of follicular fluid glycodelin levels on the quality of developing oocytes and subsequent embryo development.

Methods: Follicular fluid glycodelin levels of 145 patients undergoing assisted reproductive treatment were analyzed and the correlation between glycodelin levels and ART outcomes were evaluated.

Results: We found that glycodelin levels were negatively correlated with the number of high quality embryos on day 3 (r=-0.20, =0.05). Additionally, higher glycodelin levels were correlated with higher FSH levels (r=0.18, p=0.04). However, glycodelin levels were not predictive for implantation (=0.67) or ongoing pregnancy rates (=0.99).

Conclusion: Glycodelin in the follicular environment might be one of the factors that influence the competence of growing oocytes and affect the quality of subsequent in vitro embryo development.
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http://dx.doi.org/10.5935/1518-0557.20180069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210615PMC
November 2018

Population-based serum omentin-1 levels: paradoxical association with cardiometabolic disorders primarily in men.

Biomark Med 2018 02 12;12(2):141-149. Epub 2018 Jan 12.

Biochemistry Laboratory, Institute of Cardiology, Istanbul University, Istanbul, Turkey.

Aim: The conflicting relationships of serum omentin with inflammation markers and cardiometabolic disorders were investigated. Results & methods: Unselected 864 population-based middle-aged adults were cross-sectionally studied by sex-specific omentin tertiles. Men in the lowest omentin tertile (T1) had lower systolic blood pressure, HbA1c and glucose values and tended in T3 to higher lipoprotein(a) levels. Logistic regression analysis, adjusted for four covariates, revealed significant independent associations with the presence of hypertension and diabetes only in men. Sex- and age-adjusted odds ratio in gender combined for T2 & T3 versus T1 was 1.34 (95% CI: 1.00-1.79) for metabolic syndrome.

Discussion & Conclusion: The elicited adverse relationships of omentin-1 support the notion of oxidative stress-induced proinflammatory conversion of omentin, rendering loss of anti-inflammatory properties.
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http://dx.doi.org/10.2217/bmm-2017-0197DOI Listing
February 2018

Tenth categories of total and HDL cholesterol fail to independently predict death risk in middle-aged Turkish adults.

Turk Kardiyol Dern Ars 2017 Oct;45(7):590-598

Department of Cardiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Objective: The aim of this study was to delineate in detail the longitudinal association of total cholesterol (TC) and highdensity lipoprotein cholesterol (HDL-C) levels with overall mortality in middle-aged participants of the biennial Turkish Adult Risk Factor study.

Methods: Baseline lipid variables were analyzed in sex-specific deciles. A baseline age of 45 to 84 years as an inclusion criterion led to the enrollment of 2121 men and women. Cox regression analyses were performed.

Results: Deaths were recorded in 237 and 306 women and men, respectively, during a mean 8.85±4.4 years of follow-up. After adjustment for age, smoking status, lipid-lowering and antihypertensive drug usage, prevalent diabetes, and coronary heart disease, and using the lowest decile as referent, neither TC (p trend=0.94 and 0.96, respectively), nor HDL-C categories (p trend=0.20 and 0.31, respectively) were significantly predictive of mortality in either gender. TC deciles exhibited a gender difference insofar as hazard ratios in females tended to be reciprocal to those in males in deciles 2 through 5.

Conclusion: The findings on TC deciles may be attributed to a comparatively higher death rate in the female (compared with male) bottom decile, reflecting the autoimmune process-induced elevated risk in the lowest decile. Observations on HDLC confirmed presumed pro-inflammatory conversion in levels >50 mg/dL. These results have important clinical implications.
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http://dx.doi.org/10.5543/tkda.2017.38085DOI Listing
October 2017

Determinants of obstructive sleep apnea syndrome: Pro-inflammatory state and dysfunction of high-density lipoprotein.

Nutrition 2017 Nov - Dec;43-44:54-60. Epub 2017 Jul 6.

Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: The goal of this study was to determine variables preceding and predicting incident obstructive sleep apnea syndrome (OSAS) in the population at large.

Methods: Anthropometric, lipid, and non-lipid variables in participants with newly developing OSAS (n = 131) were compared with those of a cohort sample (n = 2615) of the Turkish Adult Risk Factor study. Available values preceding (by a median of 32 mo) the development of OSAS were used in multivariable Cox regression models.

Results: Significant determinants of OSAS assessed by group differences were waist/neck circumference and fibrinogen. Fasting triacylglycerols, systolic blood pressure, and C-reactive protein in men and low sex hormone-binding globulin and elevated homeostatic model assessment in women were further significant covariates. Cox regression analysis for the risk of incident OSAS confirmed the independent predictive value of central obesity measures, especially neck circumference (having a twofold hazard ratio) and younger age. Age-adjusted former smoking status and-compared with the lowest tertile-the upper two tertiles of fibrinogen (relative risk = 1.66, 95% confidence interval: 1.05-2.63) were significant predictors. Elevated triacylglycerols in males and high apolipoprotein B and lowest high-density lipoprotein cholesterol tertile in females also predicted subsequent OSAS. Systolic blood pressure and total cholesterol did not prove to be independent predictors in multivariable adjusted Cox models in which partial sex-dependent independence of obesity measures of the previously stated five variables was essentially retained.

Conclusions: An enhanced pro-inflammatory state appeared to be the underlying pathophysiologic mechanism for OSAS, whereas in men, the added factor of high-density lipoprotein dysfunction was suggested. Because it contributes to the pro-inflammatory state, discontinuance of smoking was another further significant predictor of OSAS.
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http://dx.doi.org/10.1016/j.nut.2017.06.021DOI Listing
May 2018

Comparison of Different Iron Preparations in the Prophylaxis of Iron-deficiency Anemia.

J Pediatr Hematol Oncol 2017 10;39(7):495-499

Departments of *Pediatrics †Social Pediatrics §Public Health, Istanbul University Cerrahpasa Medical Faculty ‡Department of Neonatology, Maltepe University, Medical Faculty, Istanbul, Turkey.

We compared the efficacy of ferrous sulfate (divalent) and ferric polymaltose (trivalent) compounds for the prophylaxis of iron-deficiency anemia (IDA). Study infants included exclusively breast milk-fed term infants. Subjects were divided randomly into 2 groups at 4 months of age and group 1 (n=56) received divalent and group 2 (n=56) received trivalent iron (Fe) preparation at a dose of 2 mg/kg/d for 5 months. At 9 months of age, after a 5-month prophylaxis, a significant increase was observed in hemoglobin (Hb), hematocrit, serum Fe levels, and transferrin saturation in both groups. However, group 1 had significantly higher Hb, hematocrit, mean corpuscular volume, Fe, and transferrin saturation than group 2 (11.7±0.6 g/dL, 34.6%±1.7%, 76.2±2.9 fL, 55.5±1.8 mcg, 20.8±3.9 g/L, respectively in group 1 vs. 11.3±0.5 g/dL, 33.5%±1.5%, 74.7±3.2 fL, 42.5±1.8 mcg, 14.1±7.5 g/L, respectively in group 2). No significant difference was found in ferritin values between the groups. Fe deficiency was found in 17 (30.3%) of the subjects in group 1, and 23 (41%) of subjects in group 2 whereas 5 (8.9%) subjects had IDA in group 1 and 12 (12%) in group 2 which were insignificant between groups. No significant difference was found with regard to side effects between 2 Fe preparations. Although divalent Fe therapy led to a higher Hb and serum Fe level, both ferrous and ferric Fe preparations were effective for prophylactic use in the prevention of Fe deficiency and IDA with comparable side effects.
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http://dx.doi.org/10.1097/MPH.0000000000000967DOI Listing
October 2017

Lower circulating migration inhibitory factor protein is associated with metabolic syndrome and diabetes.

Biomark Med 2017 Jul 13;11(7):557-568. Epub 2017 Jul 13.

Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Aim: The controversial relationship between macrophage migration inhibitory factor (MIF) and the likelihood of cardiometabolic diseases was investigated. Results/methodology: Assayed MIF protein from 1225 adults was cross-sectionally analyzed. MIF was independently inversely associated with age, total testosterone and positively with high-density lipoprotein-cholesterol. In men MIF correlation with age, testosterone and waist circumference converted from inverse in the upper to positive in the bottom MIF third. Both metabolic syndrome and diabetes were significantly associated, in combined gender, with the intermediate (vs the highest) MIF tertile at an odds ratio 1.6. Coronary heart disease was not significantly related with MIF in either gender.

Discussion/conclusion: Findings are consistent with oxidative damage to MIF protein and its involvement in autoimmune activation, likely more extensive in women.
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http://dx.doi.org/10.2217/bmm-2016-0359DOI Listing
July 2017

Female and urban participants demonstrate an adverse trend in overall mortality in Turkey - and a report on the TARF survey 2016.

Turk Kardiyol Dern Ars 2017 Jul;45(5):391-397

Department of Cardiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Objective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey.

Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age ≥40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed.

Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status.

Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures.
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http://dx.doi.org/10.5543/tkda.2017.76746DOI Listing
July 2017

Relation of Biochemical Parameters with Flow-mediated Dilatation in Patients with Metabolic Syndrome.

Chin Med J (Engl) 2017 Jul;130(13):1564-1569

Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey.

Background: Metabolic syndrome (MetS) is one of the high cardiovascular (CV) situations. Endothelial dysfunction, which is a common finding in patients with MetS, is related with increased CV risk. In patients with MetS, the effect of the major CV risk factors, not included in the MetS definition, on endothelial dysfunction is not well known. The aim of this study was to determine the effect of major CV risk factors such as gender, smoking, family history, and biochemical parameters on endothelial dysfunction in patients with MetS.

Methods: The study was performed between December 2010 and August 2014. A total of 55 patients (15 females and 40 males) with MetS and 81 healthy controls (37 females and 44 males) with a body mass index <25 kg/m2 were enrolled in the study. Endothelial dysfunction was measured by flow-mediated dilatation (FMD), oxidative stress parameters; high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (ox-LDL), endothelial nitric oxide synthase (e-NOS), nitric oxide, and cell adhesion markers; von Willebrand factor, and e-selectin. Platelet aggregation (endothelial adenosine diphosphate), total platelet count, and mean platelet volume were additionally analyzed and demographic parameters were explored. Student's t- test, Mann-Whitney U-test, and Chi-square test were used to analyze the results.

Results: The fasting blood glucose (z= 3.52, P= 0.001), hs-CRP (z = 3.23, P= 0.004), ox-LDL (z = 2.62, P= 0.013), and e-NOS (z = 2.22, P= 0.026) levels and cardiac risk score (z = 5.23, P< 0.001) were significantly higher in patients with MetS compared with the control group. Smoking was correlated with decreased FMD (χ2 = 9.26, P= 0.002) in MetS patients but not in the control group.

Conclusions: Increased ox-LDL, hs-CRP, and e-NOS are likely to be a result of oxidative stress, a condition in which an imbalance occurs between the production and inactivation of reactive nitrogen and oxygen species. In addition, in patients with MetS, smoking is independently related to endothelial dysfunction.
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http://dx.doi.org/10.4103/0366-6999.208231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494920PMC
July 2017

Lipoprotein(a)-activated immunity, insulin resistance and new-onset diabetes.

Postgrad Med 2017 Aug 22;129(6):611-618. Epub 2017 Jun 22.

e Department of Biochemistry, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey.

Objectives: Some evidence suggests that serum lipoprotein[Lp](a) may be inversely linked to type-2 diabetes. We aimed to determine in nondiabetic people the relationship of serum [Lp](a) with insulin resistance and new-onset diabetes (NOD).

Materials And Methods: Population-based middle-aged adults (n = 1685) were categorized by fasting glucose and stratified to gender, having excluded prevalent diabetic subjects. NOD (n = 90) occurred over a median 5 years' follow-up.

Results: Subjects that subsequently developed NOD, derived both from the normoglycemia and impaired fasting glucose (IFG) groups,were distinguished, among others, primarily by significantly elevated serum gamma glutamyltransferase, reduced Lp(a) (by 31%) and, compared to IFG, by low total cholesterol levels. Partial correlation of Lp(a) with homeostatic model assessment (HOMA) was inverse in normoglycemic men; such correlation, neutral in normoglycemic women, proved inverse in IFG (r = -0.17). Circulating Lp(a) in individuals with paired measures increased significantly (1.55-fold) in the period from baseline up to NOD. Multivariable-adjusted logistic regression analysis for NOD in combined sexes indicated independent and additive prediction by serum Lp(a), albeit inverse in direction (RR 0.84, [95%CI 0.72; 0.97]).

Conclusion: Lp(a) is significantly reduced in the period preceding NOD and is inversely associated with HOMA index, observations consistent with underlying autoimmune activation.
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http://dx.doi.org/10.1080/00325481.2017.1342508DOI Listing
August 2017

Algorithm for predicting CHD death risk in Turkish adults: conventional factors contribute only moderately in women.

Anatol J Cardiol 2017 Jun 9;17(6):436-444. Epub 2017 Mar 9.

Department of Cardiology, Cerrahpaşa Medical Faculty, İstanbul University; İstanbul-Turkey.

Objective: To assist the management strategy of individuals, we determined an algorithm for predicting the risk of coronary heart disease (CHD) death in Turkish adults with a high prevalence of metabolic syndrome (MetS).

Methods: The risk of CHD death was estimated in 3054 middle-aged adults, followed over 9.08±4.2 years. Cox proportional hazard regression was used to predict risk. Discrimination was assessed using C-statistics.

Results: CHD death was identified in 233 subjects. In multivariable analysis, the serum high-density lipoprotein-cholesterol (HDL-C) level was not predictive in men and the non-HDL-C level was not predictive in women. Age, presence of diabetes, systolic blood pressure ≥160 mm Hg, smoking habit, and low physical activity were predictors in both sexes. The exclusion of coronary disease at baseline did not change the risk estimates materially. Using an algorithm of the 7 stated variables, individuals in the highest category of risk score showed a 19- to 50-fold higher spread in the absolute risk of death from CHD than those in the second lowest category. C-index of the model using age alone was as high as 0.774 in men and 0.836 in women (p<0.001 each), while the incorporation of 6 conventional risk factors contributed to a C-index of 0.058 in males and 0.042 in females.

Conclusion: In a middle-aged population with prevalent MetS, men disclosed anticipated risk parameters (except for high HDL-C levels) as determinants of the risk of CHD death. On the other hand, serum non-HDL-C levels and moderate systolic hypertension were not relevant in women. The moderate contribution of conventional risk factors (beyond age) to the estimation of the risk of CHD death in women is consistent with the operation of autoimmune activation.
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http://dx.doi.org/10.14744/AnatolJCardiol.2017.7580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477072PMC
June 2017

The relationship of Chlamydophila pneumoniae with schizophrenia: The role of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) in this relationship.

Rev Argent Microbiol 2017 Jan - Mar;49(1):39-49. Epub 2017 Feb 28.

Istanbul University, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey. Electronic address:

Several pathogens have been suspected of playing a role in the pathogenesis of schizophrenia. Chronic inflammation has been proposed to occur as a result of persistent infection caused by Chlamydophila pneumoniae cells that reside in brain endothelial cells for many years. It was recently hypothesized that brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) may play prominent roles in the development of schizophrenia. NT-3 and BDNF levels have been suggested to change in response to various manifestations of infection. Therefore, we aimed to elucidate the roles of BDNF and NT3 in the schizophrenia-C. pneumoniae infection relationship. RT-PCR, immunofluorescence and ELISA methods were used. Fifty patients suffering from schizophrenia and 35 healthy individuals were included as the patient group (PG) and the healthy control group (HCG), respectively. We detected persistent infection in 14 of the 50 individuals in the PG and in 1 of the 35 individuals in the HCG. A significant difference was found between the two groups (p<0.05). Twenty-two individuals in the PG and 13 in the HCG showed seropositivity for past C. pneumoniae infection, and no difference was observed between the groups (p>0.05). C. pneumoniae DNA was not detected in any group. A significant difference in NT-3 levels was observed between the groups, with very low levels in the PG (p<0.001). A significant difference in BDNF levels was also found, with lower levels in the PG (p<0.05). The mean serum NT-3 level was higher in the PG cases with C. pneumoniae seropositivity than in seronegative cases; however, this difference was not statistically significant (p>0.05). In conclusion, we suggest that NT-3 levels during persistent C. pneumoniae infection may play a role in this relationship.
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http://dx.doi.org/10.1016/j.ram.2016.09.009DOI Listing
February 2019

Little contribution of conventional factors in an algorithm to predicting death risk in Turkish adults.

Int J Cardiol 2017 Mar 21;230:542-548. Epub 2016 Dec 21.

Department of Cardiology, Şanlıurfa Educational Hospital, Şanlıurfa, Turkey; Koç University Medical Faculty, Istanbul, Turkey.

Objective: Determinants of risk of death are highly relevant for the management strategy of individuals. We aimed to determine an algorithm for predicting risk of death in Turkish adults who have a high prevalence of metabolic syndrome (MetS).

Methods: Nine-year risk of death was estimated in 3348 middle-aged adults, followed over 8.81±4.2years. Cox proportional hazard regression was used to predict risk of death. Discrimination was assessed using C-statistics.

Results: Death occurred in 565 subjects. In multivariable analysis, high-density lipoprotein (HDL) and non-HDL cholesterol levels were not predictive in either sex; in women, current smoking was also not predictive. Age, presence of diabetes, systolic blood pressure ≥160mmHg and low physical activity were predictors in both sexes, beyond smoking status in men. Exclusion of coronary disease at baseline did not change risk estimates materially. Using an algorithm of the stated 7 variables showed an 11- to 18-fold spread in the absolute risk of dying among individuals in the highest than in the lowest of 4 risk score categories. C-statistics of the model using age alone was 0.790 in men, 0.808 in women (p<0.001 each), while the incorporation of 6 conventional risk factors contributed to C-index was >0.020 in males and 0.009 in females.

Conclusions: In a middle-aged population with prevalent MetS, serum lipoproteins and, in women, smoking status, were not relevant for the risk of death. The contribution of conventional risk factors beyond age to estimating risk of death was modest among Turkish men, and little in women in whom autoimmune activation is operative.
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http://dx.doi.org/10.1016/j.ijcard.2016.12.061DOI Listing
March 2017

Sex-dependent independent prediction of incident diabetes by depressive symptoms.

Int J Geriatr Psychiatry 2017 12 28;32(12):1425-1432. Epub 2016 Nov 28.

Department of Cardiology and Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: To study the predictive value of depressive symptoms (DeprSs) in a general population of Turkey for type 2 diabetes.

Methods: Responses to three questions served to assess the sense of depression. Cox regression analyses were used regarding risk estimates for incident diabetes, after exclusion of prevalent cases of diabetes. Mean follow-up consisted of 5.15 (±1.4) years.

Results: Depressive symptoms were present at baseline in 16.2% of the whole study sample, threefold in women than men. Reduced physical activity grade was the only significant covariate at baseline in men, while younger age and lower blood pressure were significantly different in women compared with those without DeprS. In men, presence of DeprS predicted incident diabetes at a significant 2.58-fold relative risk (95% confidence interval 1.03; 6.44), after adjustment for age, systolic blood pressure, and antidepressant drug usage. When further covariates were added, waist circumference remained the only significant predictor, while DepS was attenuated to a relative risk of 2.12 (95% confidence interval 0.83; 5.40). DeprS was not associated with diabetes in women, whereas antidepressant drug usage only tended to be positively associated.

Conclusion: Gender difference existed in the relationship between DeprS and incident diabetes. DeprS predicted subsequent development of diabetes in men alone, not in women. Copyright © 2016 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/gps.4630DOI Listing
December 2017

Fasting glycemia and glycated hemoglobin categories: Relationship to serum lipoprotein(a) level and disparity in 2 geographic regional groups of Turkey.

Anatol J Cardiol 2017 Mar 10;17(3):191-199. Epub 2016 Nov 10.

Department of Cardiology, Cerrahpaşa Faculty of Medicine, İstanbul University; İstanbul-Turkey.

Objective: The goal of the present study was to determine covariates of serum lipoprotein (Lp) (a) within fasting glucose and glycated hemoglobin (HbA1c) categories, and to detect features that were different among covariates based on residence in Marmara and Central Anatolia (Marm-CA) regions or remaining 5 geographic regions of Turkey.

Methods: Data of randomly-selected group of 1167 men and women (mean age 61 years) who participated in biennial surveys of 2013 and 2015 were cross-sectionally analyzed in 6 categories.

Results: In multiple linear regression analysis of nondiabetic women, homeostatic model assessment (HOMA) index score was inversely associated with Lp(a) (ß coefficient 0.49; p=0.001); this was not true for men. In the whole sample, Lp(a) was significantly positively associated with female sex and with serum creatinine, and inversely in each sex with HOMA index (ß coefficient 0.63; p<0.001). Linear models within separate categories showed significant associations of Lp(a) only in individuals with no evidence of diabetes other than HbA1c >6.5%: in women, positive association with total cholesterol and inverse relationship with creatinine were found, and in men, positive association with apolipoprotein (apo) B was determined. Similar age, diastolic blood pressure, fasting glucose, triglyceride, uric acid, and C-reactive protein values were obtained from participants of 2 regional groups. Residents of the Marm-CA region who were nondiabetic exhibited significantly (by 23%) lower serum Lp(a) among individuals with HbA1c ≥5.7%, significantly higher HOMA index score, concentrations of apoB, and low-density lipoprotein cholesterol.

Conclusion: Hallmark of prediabetic and diabetic glycemia/HbA1c categories seems to be an independent inverse association between Lp(a) protein (yet not of apoB) and HOMA score, this being primarily so in residents of Marm-CA region.
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http://dx.doi.org/10.14744/AnatolJCardiol.2016.7190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864978PMC
March 2017

Distinction of hypertriglyceridemic waist phenotype from simple abdominal obesity: interaction with sex hormone-binding globulin levels to confer high coronary risk.

Postgrad Med 2017 Mar 28;129(2):288-295. Epub 2016 Nov 28.

c Cardiology Department , Dicle Univ ., Diyarbakir , Turkey.

Objective: The associations of total testosterone (TT) and sex hormone-binding globulin (SHBG) with the hypertriglyceridemic waist (HtgW) phenotype and coronary heart disease (CHD) risk have scarcely been examined. We explored such cardiometabolic risk mediations in middle-aged adults.

Methods: Participants (n = 1924) in a population-based study were studied by forming categories consisting of abdominal obesity, hypertriglyceridemia, both (HtgW), or none ('healthy'). Cardiometabolic risk was prospectively analyzed (mean follow-up 5.7 years).

Results: With reference to the healthy group, SHBG values in HtgW were significantly lower, alike serum HDL-cholesterol. ApolipoproteinB-containing lipoproteins, fasting glucose and complement C3 levels, inverse to lipoprotein[Lp](a) especially in female participants with HtgW phenotype compared with those in the 'healthy' category, suggested the operation of aggregation to Lp(a). Multivariable Cox regression analysis in a model comprising age, waist circumference and systolic blood pressure showed significant protection by SHBG against incident diabetes which tended to be so with TT in men. Sex hormones were not associated with risk of incident CHD or MetS. In another multivariable model, compared to the 'healthy' and the hypertriglyceridemia categories, dichotomized high and, in females, low SHBG values within the HtgW category, positively predicted CHD at significant over 2-fold relative risks.

Conclusion: HtgW phenotype distinguishes itself from the (virtually neutral) simple abdominal obesity in independently conferring high CHD risk when elevated or reduced SHBG levels interact. Underlying operation of Lp(a) aggregation is suggested.
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http://dx.doi.org/10.1080/00325481.2017.1261608DOI Listing
March 2017