Biomedical subjects

Tomris Erbas

Publications and source records attributed to Tomris Erbas.

5 recordsLinked to original sources

PubMed2006

Cardiovascular autonomic neuropathy: diagnosis and management.

Cardiovascular autonomic neuropathy increases morbidity and mortality, and reduces quality of life and activities of daily living of the patients with diabetes. The reduced cardiovascular autonomic function as measured by heart rate variability is strongly associated with an increased risk of silent myocardial ischemia and mortality. Currently, no specific therapeutic strategies can be recommended for cardiac autonomic neuropathy, but management of hyperglycemia and the use of angiotensin-converting enzyme inhibitors and beta blockers should be instituted.

Autonomic Nervous System Diseases↗

PubMed2006

Long-term outcome of Graves' disease patients treated in a region with iodine deficiency: relapse rate increases in years with thionamides.

BACKGROUND: Graves' disease (GD) is an autoimmune disease affecting the thyroid gland and eyes and is treated with three therapeutic modalities. This prospective study was designed to find out the outcome of patients with GD treated with thionamides, radioactive iodine (RAI) or surgery in an iodine deficient region. MATERIALS AND METHODS: Fifty-six nonsmoking patients (mean age 38.9 +/- 13.7 years) with GD were enrolled and followed for a mean period of four years. They were analyzed with respect to their treatment options and their outcome. RESULTS: Remission rate by thionamides was 74.4% in the first year but decreased to 65.1% in the following four years (p=0.0001). Remission rate achieved in the second year did not predict long-term remission with thionamides. Long-term remission rates for RAI and surgery were 100% during about seven years of follow-up. These remission rates for RAI and surgery were reached in the first year and did not reveal a statistically significant change in the following years. Thyroidectomy, both subtotal and total, was carried out without any complication. Graves' ophthalmopathy emergence and progression were not found to be correlated with the preferred therapeutic modality of thyrotoxicosis. CONCLUSION: Long-term thionamide therapy offered a relatively low rate of long-term remission in a region with iodine deficiency. Two years of remission achieved by thionamides did not predict long-term remission in patients living in iodine-deficient areas. RAI and thyroidectomy in experienced hands proved to be better therapeutic alternatives that can be carried out safely.

Adult↗

PubMed2006

Management and in-hospital outcome of patients with first episode of acute myocardial infarction: impact of diabetes mellitus.

The aim of this study is to compare clinical characteristics, management, complications, in-hospital outcome and mortality of diabetic and nondiabetic patients after the first episode of acute myocardial infarction (MI). This retrospective case-matched study included 60 diabetic and 55 non-diabetic patients. Medical information about patients was retrieved from the hospital recordings. Diabetic patients were older, were more hypertensive and had more coronary artery disease history than nondiabetic patients. The frequency of use of acute reperfusion therapy modalities was not statistically different between the two groups. Diabetes was a significant determinant against the use of beta blockers (OR=0.26; 95% CI 0.06-0.95) but in favor of angiotensin converting enzyme inhibitors (OR=3.3; 95% CI 1.17-9.36), whereas diabetes did not influence the use of other drugs. Diabetic patients had more complications than nondiabetic patients (40.0% and 16.3%, respectively, p=0.005). In-hospital mortality rate for diabetic patients was comparable to nondiabetic patients (16.7% and 10.9%, respectively, p=0.373). Pharmaceutical treatment regimens, particularly beta blockers, are underutilized after acute MI in diabetic patients. More frequent use of these regimens will improve the high complication and mortality rates in diabetic patients as well as in nondiabetic patients.

Adrenergic beta-Antagonists↗

PubMed2005

Melatonin levels decrease in type 2 diabetic patients with cardiac autonomic neuropathy.

The present study has been designed to determine melatonin levels in type 2 diabetic patients and test the relationship between the autonomic nervous system and melatonin dynamics. Thirty-six type 2 diabetic patients and 13 age-matched healthy subjects were recruited for the study. Circadian rhythm of melatonin secretion was assessed by measuring serum melatonin concentrations between 02:00-04:00 and 16:00-18:00 hr. Melatonin dynamics were re-evaluated with respect to autonomic nervous system in diabetic patients with autonomic neuropathy who were diagnosed by the cardiovascular reflex tests, heart rate variability (HRV), and 24-hr blood pressure monitoring. Nocturnal melatonin levels and the nocturnal melatonin surge were low in the diabetic group (P = 0.027 and 0.008 respectively). Patients with autonomic neuropathy revealed decreased melatonin levels both at night and during day when compared with healthy controls (P < 0.001 and 0.004 respectively) while the melatonin dynamics were similar to controls in patients without autonomic neuropathy. Nocturnal melatonin level was positively correlated with nocturnal high and low frequency components of HRV (P = 0.005 and 0.011 respectively) and systolic and diastolic blood pressures at night (P = 0.002 and 0.004 respectively) in patients with autonomic neuropathy. We found a negative correlation between nocturnal melatonin levels and the degree of systolic blood pressure decrease at night (r = -0.478, P = 0.045). As a conclusion this study has shown that circadian rhythm of melatonin secretion is blunted in type 2 diabetic patients and there is a complex relationship between various components of autonomic nervous system and melatonin secretion at night. Among the patients with autonomic neuropathy those with more preserved HRV and the systolic nondippers (<10% reduction in blood pressure during the night relative to daytime values) have more pronounced melatonin surge at night.

Autonomic Nervous System Diseases↗

PubMed2003

Diabetic autonomic neuropathy.

Diabetic autonomic neuropathy is the most common and troublesome complication of diabetes mellitus. Although involvement of the autonomic nervous system is generally diffuse, symptoms may be confined to a single target organ or organ system. Complications of diabetic autonomic neuropathy contribute greatly to the morbidity, mortality, and reduced quality of life of the person with diabetes and are the major source of increased costs of caring for the diabetic patient. Factors in the pathogenesis of these complications are altered metabolism, vascular insufficiency, loss of growth factor trophism, and autoimmune destruction of nerves in a visceral and cutaneous distribution. The clinical manifestations and the complications of diabetic autonomic neuropathy are reviewed. Future therapeutic strategies that are developed from a better understanding of the pathogenetic processes underlying this disorder can be directed at the cause rather than the manifestations. There are studies in progress that suggest that autonomic nerves can be induced to regenerate, and the future for patients with diabetic autonomic neuropathy is brighter.

Animals↗