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    Acute pancreatitis and type 2 diabetes mellitus: who is guilty?
    (2015) Kucukler, Ferit Kerim
    Many factors play a role in the etiology of acute pancreatitis and its pathogenesis is not fully understood. Dipeptidyl peptidase 4 (DPP-4) inhibitors are a new group of agents for the treatment of Diabetes Mellitus (DM). There are some controversies about specific adverse events such as pancreatitis and hypersensitivity reactions. A 50-year-old morbid obese woman presented with upper abdomen pain after the eating food, nausea and vomiting. She was diagnosed with type 2 diabetes mellitus 7 years ago. Vildagliptin had been added to her treatment six months ago. Abdominal examination revealed epigastric tenderness with guarding. Laboratory data revealed elevated pancreatic enzymes. Abdominal computed tomography (CT) showed features of pancreatitis. Vildagliptin was stopped and patient's symptoms had diminished in parallel with normalization of pancreatic enzymes; and at the 5th day patient was discharged with healthy condition. She was free of symptoms and all laboratory data were normal at the 30th day after discharge. It is important to keep in mind that diabetic patients have an increased risk of pancreatitis which may be related to obesity, hyperlipidemia and/or drugs.
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    Langerhans cell histiocytosis: diagnosis on thyroid aspirate and effective treatment with systemic chemotherapy
    (Kuwait Medical Assoc, 2021) Koseoglu, Derya; Erenler, Behice Hande; Kucukler, Ferit Kerim
    Langerhans cell histiocytosis (LCH) is a disease with monoclonal proliferation and infiltration of organs by Langerhans cells. LCH is commonly seen in the skeletal system and skin, but it may also involve parenchymal organs. Thyroid involvement in LCH is an unusual presentation. The treatment of LCH of the thyroid remains unclear because of insufficient data. Here, we present a patient with LCH who had thyroid involvement. She had a lesion in the thyroid, which was detected coincidentally. The diagnosis was made by thyroid aspiration. The patient was treated with systemic chemotherapy and after therapy, the lesion disappeared completely and the patient became euthyroid.
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    Treatment Patterns and Associated Clinical Outcomes in Type 2 Diabetes Patients Initiating Second-Line Glucose-Lowering Therapy: Interim Analysis of Baseline Data from Turkey Arm of the Global DISCOVER Study
    (Turkiye Klinikleri, 2021) Bayram, Fahri; Sari, Ramazan; Kucukler, Ferit Kerim; Araz, Mustafa; Colak, Ramis; Baspinar, Osman; Tetiker, Tamer
    Objective: To evaluate the treatment patterns and associated clinical outcomes in Type 2 diabetes (T2D) patients initiating a second-line glucose-lowering therapy. Material and Methods: This paper presents a preliminary subgroup analysis of the baseline data collected from 536 patients [mean (standard deviation) age: 55.1 (10.0) years, 50.2% were males] in the Turkey arm of global observational DISCOVER study among T2D patients initiating second-line glucose-lowering therapy. Patient demographics, disease (duration, complications) and treatment (type of regimens, modifications) characteristics, hemoglobin A1c (HbA1c), low-density lipoprotein-cholesterol (LDL-C), and systolic blood pressure (BP) target achievement rates and the patient-reported outcomes were recorded at the initiation of second-line therapy. Results: Overall, 11.7% of patients were HbA1c target of <7% at baseline, 62.5% were systolic BP target of <140 mmHg and 21.2% were LDL-C target of <100 mg/dL. Major and minor hypoglycemic events were noted in 5.5% and 10.7% of patients, while macro and microvascular complications in 17.2% and 20.1% of patients, respectively. Metformin monot- herapy (47.9%) and metformin+sulfonylurea combination (22.6%) were the two most common first-line therapies. However, insulin (32.3%) was the most commonly prescribed second-line agent. Lifestyle assessment revealed a healthy lifestyle in 50.7% of patients. Conclusion: Our finding revealed a failure to achieve HbA1c, LDL-C, and systolic BP targets and a high rate of diabetes-related complications before initiation of second-line therapy in a significant proportion of Turkish T20 patients. Thus, emphasizing a need for more aggressive risk factor screening and modification at early disease stages and earlier treatment intensification among T2D patients.