Browsing by Author "Bakiner, Okan Sefa"

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Assessment of Tear Meniscus with Optical Coherence Tomography in Thyroid-Associated Ophtalmopathy
(2014) Sizmaz, Selcuk; Altan-Yaycioglu, Rana; Bakiner, Okan Sefa; Bozkirli, Emre; Coban-Karatas, Muge; Ulas, Burak; https://orcid.org/0000-0002-9139-8848; 24215623; AAG-3306-2019; AAK-5525-2021; E-9887-2014; AEP-4897-2022
Purpose: To evaluate the tear-film meniscus with optical coherence tomography (OCT) in patients with Graves' disease (GD). Materials and methods: Patients with GD without clinical features of thyroid-associated ophthalmopathy (TAO) (Group 1, n = 35), patients with signs of TAO (Group 2, n = 31) and healthy participants (Group 3, n = 31) were enrolled. Palpebral fissure width, Schirmer test, tear break-up time (TBUT) test and tear-film meniscus height and area obtained with Fourier-domain-OCT were analyzed. Results: TBUT test scores were 8 s (2-25) in Group 1, 8 s (2-15) in Group 2 (p = 0.380); and10 s (5-17) in Group 3 (p = 0.000 Group 1 versus 3, and 0.000 for Group 2 versus 3). Tear-film meniscus height did not significantly differ between Groups 1 and 2 (257.5 mm (86-962) and 258 mm (99-1340), respectively, p = 0.980). In Group 3, tear-film meniscus height was 316 mm (122-720) (p = 0.005 Group 1 versus 3 and 0.004 for Group 2 versus 3). Tear-film meniscus area did not significantly differ between Groups 1 and 2 (0.025mm(2) (0.004-0.250) and 0.024mm(2) (0.003-0.316), respectively, p = 0.850). In Group 3, tear-film meniscus area was 0.048mm(2) (0.006-0.75) (p = 0.000 Group 1 versus 3 and 0.000 for Group 2 versus 3). Conclusion: Tear function is significantly disturbed in GD. OCT is an effective way to assess the tearing function also in patients with GD.
Association between Serum Osteopontin Levels and Cardiovascular Risk in Hypothyrodism
(2016) Duman, Gulhan; Ertorer, Eda Melek; Mete, Turkan; Bozkirli, Emre; Bakiner, Okan Sefa; Tutuncu, Neslihan Bascil
Purpose: Cardiovascular effects of hypothyroidism are well known. Osteopontin (OPN) is a new inflammatory marker which was first isolated from the bone. Flow-mediated dilatation (FMD), a noninvasive technique to measure this endothelium-dependent function, has been used in several clinical studies to show cardiovascular risks. The aim of our study was to assess FMD value in hypothyroidism patients and to investigate whether plasma OPN level is a parameter which can predict cardiovascular risks in this group of patients. Material and Method: This study included 39 patients who had high levels of thyroid-stimulating hormone (TSH) and 11 healthy euthyroid controls. Plasma TSH, free thyroxine, fibrinogen, high-sensitive C-reactive protein (hsCRP), fasting plasma glucose, total cholesterol (T-chol), low density lipoprotein (LDL), triglyceride and OPN levels were measured at the time hypothyroidism was first detected and after euthyroid state was achieved with levothyroxine treatment. In parallel with these assessments, brachial FMD measurements were also performed. Results: In hypothyroid patients cardiovascular risk factors such as T-chol, LDL and triglyceride levels were higher than in control group but fibrinogen and hsCRP levels were not different between the groups. OPN levels were similar in patient and control groups, but basal FMD levels were lower in patients with hypothyroidism. After euthyroidism was achieved, OPN levels significantly decreased and FMD levels significantly increased, but a correlation was not detected between these two parameters. Discussion: Our study did not show a significant correlation between OPN and cardiovascular risk parameters. Further studies are needed to use OPN as a cardiovascular risk marker in hypothyroid patients.
Continuous insulin therapy versus apheresis in patients with hypertriglyceridemia-associated pancreatitis
(2022) Araz, Filiz; Bakiner, Okan Sefa; Bagir, Gulay Simsek; Soydas, Baris; Ozer, Birol; Kozanoglu, Ilknur; 0000-0003-0780-5680; 0000-0002-5268-1210; 33323759; AAJ-9184-2021; AAE-1241-2021
Background The optimal treatment modality for lowering the triglyceride level in patients with hypertriglyceridemia (HTG)-associated acute pancreatitis is unknown. We evaluated the efficacy of continuous insulin infusion and apheresis procedures as triglyceride-lowering therapy. Materials and methods Clinical, demographic, and laboratory data were retrospectively evaluated for patients with HTG-associated pancreatitis who received continuous insulin infusion or apheresis in a single tertiary center. The endpoints were modality effectiveness and clinical outcomes. Results The study included 48 patients (mean age, 40.4 +/- 9.9 years). Apheresis and insulin infusion were performed in 19 and 29 patients, respectively, in the first 24 h of hospital admission. Apheresis procedures included therapeutic plasma exchange in 10 patients and double filtration plasmapheresis in nine patients. Baseline mean triglyceride level was higher in the apheresis group. The two groups were similar in terms of other baseline clinical and demographic characteristics. Seventeen patients (58.6%) in the insulin group and nine patients (47.4%) in the apheresis group exhibited Balthazar grades D-E. There was a rapid reduction (78.5%) in triglyceride level after the first session of apheresis. Insulin infusion resulted in a 44.4% reduction in mean triglyceride level in the first 24 h. The durations of fasting and hospital stay, and the rates of respiratory failure and hypotension, were similar between groups. More patients in the apheresis group experienced acute renal failure or altered mental status. Prognosis did not significantly differ between groups. Conclusion Although apheresis treatments are safe and effective, they provided no clear benefit over insulin infusion for HTG-associated pancreatitis.
Effect of type 2 diabetes mellitus on efficacy and safety of therapeutic apheresis for severe hypertriglyceridemia
(2020) Bagir, Gulay Simsek; Bakiner, Okan Sefa; Haydardedeoglu, Filiz Eksi; Araz, Filiz; Ertorer, Melek Eda; Kozanoglu, Ilknur; 0000-0001-7357-8709; 0000-0002-5268-1210; 0000-0003-0780-5680; 0000-0002-0179-9673; 33098371; AAK-5525-2021; ABI-3393-2020; ABI-3705-2020; AAE-1241-2021; AAJ-9184-2021; AAK-5003-2021
The efficacy and safety of triglyceride (TG) apheresis in patients with type 2 diabetes mellitus (DM) is unclear. Diabetic complications may predispose patients to adverse events (AEs) associated with the apheresis procedure, and diabetic dyslipidemia may negatively affect the efficacy of therapeutic apheresis (TA). We investigated the effect of DM on the efficacy and complications of TA. Patients with severe hypertriglyceridemia who underwent apheresis for treatment or for the prevention of acute pancreatitis were included in this retrospective study. Epidemiological data, lipid parameters, and AEs were recorded before and after each therapeutic session. A total of 166 procedures were performed in 27 patients. Group 1 included 17 patients with type 2 DM, and Group 2 included 10 patients without DM. The mean percentage decrease in TG levels (TG%) was higher in Group 1 (71.9% vs 60.6%, P < .001). The TG% was negatively correlated with the duration of DM in Group 1 (r = -.49, P < .001). The total number of TA sessions was 142 in patients who underwent double filtration plasmapheresis and 24 in patients who underwent therapeutic plasma exchange. We observed 9 (5.4%) mild-to-moderate AEs. No intergroup difference was observed in the total number of AEs (P = .06). TA is safe and effective in patients with type 2 DM with severe hypertriglyceridemia.
Glucagon-Like Polypeptide-1 and Brain
(2020) Bakiner, Okan Sefa; Ozsahin, Akadli Kursad
Glucagon-like polypeptide-1 has specific effects on the central nervous system, including regulation of glucose metabolism, positive cardiovascular effects, slowing intestinal motility, immune modulation, and regulation of appetite and energy expenditure. Recently, positive effects of GLP-1 on brain energy utilization, inhibition and restoration of neurodegeneration, response to stress, and protection against ischemic neuron damage have been demonstrated. Herein, the effects of glucagon-like polypeptide-1 on the central nervous system will be discussed.
Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization
(2020) Bagir, Gulay Simsek; Gunesli, Aylin; Haydardedeoglu, Filiz Eksi; Bakiner, Okan Sefa; Alkan, Ozlem; Ertorer, Melek Eda; 0000-0001-7357-8709; ABI-3705-2020
Objective: Despite serum prolactin normalization and tumor shrinkage being obtained using dopamine agonist treatment, hypogonadism may persist in several men with prolactinomas. In this study, we evaluated the effects of tumor magnetic resonance imaging features on the persistence of hypogonadism among normoprolactinemic men with prolactinomas objectively using Knosp and Hardy grading systems. Material and Methods: The patients with prolactinomas who achieved serum prolactin normalization using cabergoline therapy were evaluated, respectively. The extent of tumor growth was evaluated on the basis of Knosp and Hardy grading systems both at diagnosis and six months of medical therapy with serum prolactin normalization. Results: A total of 28 cases (18 macro- and 10 microprolactinomas) were included. After six months of treatment with cabergoline, all microprolactinoma patients with hypogonadism at baseline showed recovery (3, 100%). Moreover, nine of 14 macroprolactinoma patients with hypogonadism at inclusion recovered at the end (group 1), and five did not (group 2). Baseline Knosp grades and Hardy numbers did not differ between groups. However, higher Knosp grades and Hardy numbers were observed in patients who consistently had low serum testosterone in the sixth month (group 2) (p=0.01, p=0.02, respectively). All patients in group 2 had invasive tumors (Hardy number III-IV) both at inclusion and the sixth month according to this classification. Conclusion: We demonstrated that macroprolactinomas with persistent hypogonadism despite serum prolactin normalization more commonly showed cavernous sinus invasion and sellar destruction. We proposed that Knosp and Hardy grading systems are useful in predicting the persistence of male hypogonadism in prolactinomas following prolactin normalization.
Low Prevalence of Periodontitis and Preserved Vertebral Bone Density in Acromegaly: Excess GH May Not Impact Negatively on Trabecular Bone
(2014) Ertorer, Melek Eda; Serinsoz, Hulya Karaoglu; Bascil, Sibel; Bakiner, Okan Sefa; Bozkirli, Emre; Tutuncu, Neslihan Bascil; https://orcid.org/0000-0001-7357-8709; https://orcid.org/0000-0002-1644-6790; https://orcid.org/0000-0002-1816-3903; ABI-3705-2020; AAA-8309-2021; AAK-5525-2021; E-9887-2014; ABG-5027-2020
Mean platelet volume in Graves' disease: A sign of hypermetabolism rather than autoimmunity?
(2017) Bagir, Gulay Simsek; Haydardedeoglu, Filiz Eksi; Bakiner, Okan Sefa; Bozkirli, Emre; Ertorer, Melek Eda; 0000-0002-1644-6790; 0000-0002-0179-9673; 0000-0001-7357-8709; 29067056; AAK-5525-2021; E-9887-2014; AAK-5003-2021; ABI-3705-2020
Objective: To evaluate the impact of mean platelet volume (MPV) on predicting disease course among patients with Graves' disease (GD). Methods: This retrospective study was performed between 2013-2016 at the Outpatient Endocrinology Clinic of Baskent University Faculty of Medicine, Adana hospital on 65 patients with GD. Among participants, 30 cases experienced thyrotoxicosis again during the first six months after discontinuing anti-thyroid drug (ATD) sessions that had been carried out for at least 12 months prior to stopping (Relapse group). We also observed 35 patients who exhibited normal thyroid functions within six months following ATD withdrawal (Remission group). MPV levels and thyroid function tests were recorded and total duration of ATD therapy was calculated for all participants. Results: The mean MPV level that was measured at the time of drug withdrawal did not differ between groups, being 8.0 +/- 1.2 fL in the Relapse group vs. 8.0 +/- 1.0 fL in the Remission group (p=0.81). However, we found that the relapse MPV was higher than the withdrawal MPV in the Relapse group (9.2 +/- 1.3 fL) than it was in the Remission group (8.0 +/- 1.2 fL, p=0.00). Conclusions: Higher relapse MPV in Relapse group but similar MPV levels in both groups at ATD withdrawal may be attributed to hypermetabolism or hyperthyroidism rather than autoimmunity of GD.
Serum Immunoglobulin G4 Levels are Elevated in Patients with Graves' Ophthalmopathy
(2015) Bozkirli, Emre; Bakiner, Okan Sefa; Bozkirli, Emine Duygu Ersozlu; Haydardedeoglu, Filiz Eksi; Sizmaz, Selcuk; Torun, Aysenur Izol; Ertorer, Melek Eda; 0000-0002-1644-6790; 0000-0002-0179-9673; 0000-0001-7357-8709; 25400133; E-9887-2014; AAK-5525-2021; AAK-5003-2021; ABI-3705-2020
Objective Recent studies have shown close association between serum Immunoglobulin G4 (IgG4) levels and forms of autoimmune thyroiditis. However, there are limited data about the relationship between IgG4 and Graves' ophthalmopathy (GO). In the present study, we aimed to determine the possible association between IgG4 and GO. Design Cross-sectional study. Patients Sixty-five patients with Graves' disease (GD) and 25 healthy controls were recruited into the study. Thirty-two of these patients had GO. Measurements Serum IgG4 levels, thyroid functions and thyroid volumes were measured in all participants. Ophthalmological examination including Hertel's exophthalmometer readings (HER), Schirmer's test (ST), 'NO SPECS' classification and clinical activity score evaluation (CAS) were performed to all patients with GD. Results IgG4 levels were significantly elevated in patients with Graves' disease compared to controls (P = 0.0001). Also, IgG4 levels were significantly higher in patients with and without GO when compared to control subjects (P = 0.0001 and P = 0.002, respectively). Furthermore, IgG4 levels were significantly higher in the GO group compared with GD patients without GO (P = 0.024). IgG4 levels were observed to increase in parallel to CAS. Compared with other GD patients, 15 GD patients with serum IgG4 levels >= 135 mg/dl had higher CAS scores (P = 0.012). None of the factors including, TSH, T3, T4 levels, thyroid volume, HER and ST measurements, affect IgG4 levels as an independent factor. Conclusion IgG4 levels are evidently increased in patients with GD, and there is a possible relationship between IgG4 and GO. Our results suggest that IgG4 may be helpful in screening GD patients with high risk for GO and may well become a good indicator for the selection of right medication in the future.