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Öğe Alternative methods for the diagnosis of macroprolactinemia: urine prolactin level and serum / urine prolactin ratio(Dicle Üniversitesi Tıp Fakültesi, 2019) Pekkolay, Zafer; Tuna, Mazhar Müslüm; Güven, Mehmet; Tuzcu, Şadiye Altun; Kaplan, İbrahim; Akkuş, Zeki; Tuzcu, Alpaslan KemalObjective: The aim of this study was to investigate the urine prolactin and serum/urine prolactin ratio for accuracy diagnosis of macroprolactinemia. Methods: In the retrospective cross-sectional analysis, prolactin levels (high or normal) in the reproductive period of men and women were included in the study. Polyethylene glycol (PEG) precipitation method was used for the detection of macroprolactinemia. Then, patients were divided into three groups as macroprolactinemia, prolactinoma and healthy control group. In patients, prolactin values in spot urine with simultaneous serum prolactin values were calculated. The non-parametric Kruskal-Wallis test was used to compare the groups. The receiver-operating characteristic (ROC) curve was determined to evaluate the predictive power of serum/urine prolactin ratio Results: A total of 41 patients were included in the study. Female/male:36 (87.8%)/ 5 (12.2%). Urinary prolactin median(minimum-maximum) values were macroprolactinemia, prolactinoma and control group, respectively; 0.06(0.05-0.10), 0.11(0.02-0.95), 0.08(0.05-0.25) ng/ml. Serum/urine ratio median (minium-maximum) values were macroprolactinemia, prolactinoma, and control group, respectively; 633(51-1032), 990(104-9635), 395.5(138-953). When the groups were compared, the patients with prolactinoma had higher urinary prolactin levels(p <0.01). Serum/urine prolactin ratio was found to be the highest in prolactinoma patients and the lowest in the control group and a significant difference was observed in groups (p <0.01). ROC analysis(control-macroprolactin) for serum/urine prolactin ratio (Sensitivity 84.6 specificity 93.7 cut off >549,5 AUC=0.83) p<0.01 Conclusion: Urinary prolactin level and serum/urine prolactin ratio may be used in diagnosis of macroprolactinemia.Öğe Are there differences in the management of acute pancreatitis cases due to severe hypertriglyceridemia in pregnant women?(International Scientific Information, Inc., 2018) Kılınç, Faruk; Şenateş, Ebubekir; Demircan, Fatih; Pekkolay, Zafer; Gözel, Nevzat; Güven, Mehmet; Bahçecioǧlu, İbrahim Halil; Tuzcu, Alpaslan KemalBackground: The aim of this study was to determine the prognosis of severe disease and treatment approaches of both normal and pregnant, especially in patients with severe pancreatitis due to hypertriglyceridemia. Material/Methods: We included 30 patients (20 females and 10 males) in this study whose follow-ups and treatments were performed after a diagnosis of hypertriglyceridemia-induced acute pancreatitis between January 2011 and May 2017. Patient personal information, such as age, sex, pre-treatment and post-treatment triglyceride levels, receipt of anti-hyperlipidemic treatments or plasmapheresis, and family history, were collected from hospital records and patient files. Patients with severe pancreatitis history, score, and prognosis were included to increase the value of our study. Mild and moderate cases were excluded. Results: The mean age of the patients was 35±6 years. Twenty-four patients (80%) received an anti-hyperlipidemic treatment before their pancreatitis attacks. Plasmapheresis was performed on 8 patients before their pancreatitis attacks. Eighteen patients (60%) had a family history suggesting familial hypertriglyceridemia. Twelve patients (40%) were pregnant. Conclusions: The treatment of hypertriglyceridemia-induced acute pancreatitis was mostly confined to supportive, palliative treatments. However, plasmapheresis is a possible treatment option and should be used in the early stages of this disease. The response to medical treatment and support treatment was better in pregnant patients than in the other patient group, and pregnant patients did not require plasmapheresis.Öğe Glycogen Storage Disease Type IIIa Presenting with Hyperglycemia: A Novel Mutation(2020) Güneş, Müslüm; Tekeş, Selahaddin; Şimşek, Mehmet; Güven, MehmetGlycogen, the storage form of glucose in cells; plays a vital role in cellular function by providing the energy required for most metabolic processes. Defects in glycogen metabolism cause an accumulation of glycogen in the tissues.The glycogen storage diseases were categorized numerically in the order in which the enyzmatic defects were identified. Glycogen storage disease type IIIa is an inherited glyco-gen storage disease that is an autosomal recessive transition affecting liver and muscles. It occurs as a result of mutation in the gene of glyco-gen debranching enzyme (AGL gene). Hypoglycemia is a common condition. In this case, we presented a case of glycogen storage disease type IIIa with a new mutation in the AGL gene presenting with hyperglycemia.Öğe Hidroksi amit türevlerinin dinamik ve bazı amin tuzları ile kompleksleşmesinin 400 MHz 1H-NMR ile incelenmesi(2017) Güven, Mehmet; Köylü, M. ZaferBu çalışmada, bazı ?-hidroksi amit türevlerinin T_1 ve T_2 durulma zamanları 25 0C'de 400 MHz 1H-NMR spektrometresi ile ölçüldü. ( R_1)?(R_2= )((1?T_1 ))?(2(1?T_2 )) oranından ?_c korelasyon zamanı bulunarak moleküllerin hareketi incelendi. Ayrıca, 1H-NMR yöntemiyle ?-hidroksi amit türevlerinin bazı amin tuzları ile kompleksleşmesinden faydalanarak, bağlanma sabitleri (K_a) ve Gibbs serbest enerji değişimleri (?G0) hesaplandı. ?-hidroksi amit 1'deki Ar-OH, Amit –NH ve Alkolik –OH gruplarının T_1 sürelerinin, ?-hidroksi amit 2 ve 3'teki Ar-OH, Amit –NH ve Alkolik -OH gruplarının T_1 sürelerinden daha büyük olduğu görüldü. Bu sonuç, daha hacimli gruplar taşıyan ligand 2 ve 3'ün molekül içi non-kovalent etkileşimleri yanında, ?-? etkileşimlerinin de etkin olduğunu göstermektedir. Kompleksleşme çalışmalarında, ?-kiral hidroksi amit türevlerinin, D-, L-Triptofan ve D-, L-Fenilalanin Metil ester tuzlarıyla non-kovalent etkileşim (?-?, hidrojen bağı, katyon-? vb.) yaptığı ancak, bu etkileşimlerin ilgili amonyum tuzları arasında iyi bir enantiyoseçicilik yaratacak kadar güçlü olmadığı görüldü. Tüm moleküllerin ?_c değerleri ns mertebesinde bulundu. Bu durum, hareketi modüle eden ?_c ilgi zamanının dipolar etkileşmeye dayalı olduğunu göstermektedir. Anahtar Kelimeler: ?-Hidroksi Amit, T_1, T_2, Moleküler Dinamik, Kompleksleşme, Bağlanma Sabiti ve Korelasyon Zamanı.Öğe Obstrüktif uyku apne sendromlu hastalarda kortizol düzeylerinin değerlendirilmesi(Dicle Üniversitesi, Tıp Fakültesi, 2013) Güven, Mehmet; Tuzcu, Alpaslan KemalGiriş ve amaç : Obstrüktif uyku apne sendromu (OSAS) toplumda sık görülen bir durumdur. Uykuda meydana gelen solunum güçlüğü, apneler ,oksijen desatürasyonları kişide stres oluşturup hipofiz adrenal aksın aktivitesinin artmasına neden olmaktadır. Bu çalışmamızda OSAS ve sağlıklı bireylerdeki gece kortizol düzeyleri , sabah kortizol düzeyleri, 24 saatlik serbest kortizol atılımlarını karşılaştırmayı amaçladık. Materyal - metod : Çalışmada; Ocak 2012 ile Eylül 2013 tarihleri arasında Dicle Üniversitesi Endokrin Bölümünde yatan horlama, gündüz uyku hali, tanıklı apne gibi OSAS semptomları olan vücut kitle indeksi ? 30 olan 50 hasta ( 25 kişi kontrol, 25 kişi OSAS) çalışmaya alındı. Çalışmalar için kan örnekleri alındı. Klinikte yattığı süre içerisinde gece 23.00 , sabah 08.00 „ de kortizol seviyesi bakıldı. Sonraki günlerde 24 saatlik idrar toplatıldı ve serbest kortizol atılımı hesaplandı. Daha sonra gece 23.00 „ de hastalara 1 mg deksametazon supresyon testi uygulandı. Bulgular : Kontrol grubunun yaş ortalaması 43,76±8,36 ; OSAS grubunun ise 46,68±5,75 idi (p>0,05). Çalışmaya dahil edilen hastalardan kontrol grubunun sabah kortizolü 12,47± 6,25 ; OSAS grubunda 12,05 ±4,57 idi (p<0,05). Gece kortizolü kontrol grupta 3,82± 3,19; OSAS grubunda 6,18± 3,19 idi ( p<0,01) . 24 saatlik serbest idrar kortizolü kontrol grupta 44,33 ± 42,07 ; OSAS grubunda 81,96± 68,04 (p<0,05). 1 mg deksametazon testi kontrol grupta 0,87± 0,45 ; OSAS grubunda 1,53± 1,09 idi (p<0,01). Kontrol grubunda ,1 kişide baskılanma olmadı (%4). OSAS grubunda ise , 5 kişide baskılanma olmadı (%20). Baskılanma olmayanlara 2 mg dexametazon supresyon testi uygulanınca hepsinde baskılanma oldu. Sonuç: OSAS tanılı hastalarda gece kortizol seviyeleri ve 24 saatlik idrarda serbest kortizol düzeyi yüksek seyretmektedir.Öğe Psödohipoparatiroidi Tip 1A: Olgu sunumu(Dicle Üniversitesi Tıp Fakültesi, 2017) Güven, Mehmet; Pekkolay, Zafer; Soylu, Hikmet; Balsak, Belma Özlem Tural; Tuzcu, Alpaslan KemalPsödohipoparatiroidizm (PHPT); hedef organın parathormona (PTH) yanıt vermediği kalıtımsal bir bozukluktur. Biyokimyasal olarak; hipokalsemi, hiperfosfatemi ve PTH yüksekliği ile karakterizedir. PTH uygulamasına verilen yanıt belirgin derecede düşüktür. Tip 1A, biyokimyasal özelliklere ek olarak Albright herediter osteodistrofisi (AHO) olarak bilinen karakteristik somatik bir fenotipe de sahiptir. Bu fenotipin, kısa boy, yuvarlak yüz, frontal bombelik, brakidaktili, obezite özelikleri bulunmaktadır. Burada biz, hipokalsemi ve Albright herediter osteodistrofisi tanısı koyduğumuz; kalsiyum, aktif D vitamini ile tedavi ettiğimiz olgumuzu sunduk.Öğe Risk factors affecting ICU admission in COVID-19 patients; Could air temperature be an effective factor?(Wiley, 2021) Solmaz, İhsan; Özçaylak, Süleyman; Alakuş, Ömer Faruk; Kılıç, Jehat; Kalın, Burhan Sami; Güven, Mehmet; Araç, Songül; Akkoç, HasanAim As the COVID-19 pandemic has been spreading rapidly all over the world, there are plenty of ongoing works to shed on light to unknown factors related to disease. One of the factors questioned is also to be the factors affecting the disease course. In this study, our aim is to determine the factors that affect the course of the disease in the hospitalised patients because of COVID-19 infection and to reveal whether the seasonal change has an effect on the disease course. Methods Our study was conducted on 1950 PCR test positive patients who were hospitalised for COVID-19 disease between March 16 and July 15. Results As the seasonal temperature increases, decrease in WBC, PLT and albumin levels and increase in LDH and AST levels were observed. Risk of need for ICU has been found statistically significant (P < .05) with the increase in the age, LDH levels and CRP levels and with the decrease in the Ca and Albumin levels. Conclusions It is predicted with these results that, seasonal change might have affects on the clinical course of the disease, although it has no affect on the spread of the disease. And it might beneficial to check biochemical parameters such as LDH, CRP, Ca and Albumin to predict the course of the disease.Öğe Testicular adrenal rest tumor(Turkiye Klinikleri, 2018) Balsak, Belma Özlem Tural; Pekkolay, Zafer; Güven, Mehmet; Tuzcu, Alpaslan KemalPurpose: Testicular Adrenal Rest Tumor (TART) is a condition that is seen in men with congenital adrenal hyperplasia and particularly in uncontrolled cases. Its pathogenesis is not certain, but TART is believed to be derived from ectopic adrenal cortex remnants in the testis or from reprogrammed Leydig stem cells, that differentiate and grow under the effect of chronically elevated ACTH. Pressure in the testis increases due to the mass effect, and it prevents sperm exit, It presents with bilateral testicular mass and infertility. Case Report: Bilateral testicular mass was detected in a 28-year-old male patient on scrotal ultrasonography who had referred for infertility 1.5 months earlier. Bilateral orchiectomy was suggested to the patient with a presumed testicular tumor. There were hypervascularized solid lesions in right (18 mm), and left testes (15 mm) in his scrotal USG. In MRI, bilateral testicular masses were detected (25x33 mm in right testicle and 16x22mm in the left). The patient who did not accept the operation was directed to our endocrine polyclinic with the complaints of testicular mass and azoospermia. His laboratory test results were as following: LH: 0.1mIU/ml (1.7-8.6), FSH: 0.1 mIU/ml (1.5-12.4), T, Testesteron: 6.7 ng/ml (2.18-9), Prolaktin: 18 ng/ml (4.04-15.2), TSH: 3.19 (0.270-4.2), T4: 16.7 pmol/L (12-22), Kortizol: 3.5 µg/dL, ACTH:153 pg/mL, 17 Hidroksiprogesteron: 48 ng/mL, BHCG:0.1 mIU/ml (<5.3), AFP: 0.55 IU/ml (0.5-5.5), Synacten Test was conducted, Kortizol 30.dk was 4.9. 60.dk 4.9. 90.dk 4.9. 120.dk 5.4. 17-hydroxyprogesterone level at 30.dk was 39.7. 60.dk 36.5. 90.dk 28.8. 120.dk 25. No sperm cells were detected in the spermiyogram. Congenital Adrenal Hyperplasia and Testicular Adrenal Rest tumor were diagnosed in this patient. Prednisolone 5 mg started. Genetic analysis revealed mutation in 21 hydroxylase gene. In his follow-up, 7.5 million sperm were detected in the spermiogram and bilateral masses with slight shrinkage. Conclusions: Adults with congenital adrenal hyperplasia (CAH) may refer with infertility and bilateral testicular adrenal mass. The patient should be well assessed; surgery should not be performed if not necessary. Fertility is possible by starting corticosteroid therapy and adjusting the optimal dose.
