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    Antioxidant Effect of Thioredoxin and Vitamin D3 in Peritoneal Dialysis Patients
    (Hindawi Ltd, 2022) Ileri, Sara Yavuz; Batman, Adnan; Eraldemir, Ceyla; Bakirdogen, Serkan; Dervisoglu, Erkan
    Background. Among the chronic diseases, chronic kidney failure is one of diseases that have the most difficulty in coping with oxidative stress due to the deterioration of the antioxidant system balance in the body. Beyond being a vitamin, 1 alpha,25-dihydroxycholecalciferol (vitamin D3) is a molecule that positively or negatively affects many enzymes which are in protein structures. Thioredoxin (TRX), which has an important role in the antioxidant system, is one of these proteins. By conducting this study, we wanted to emphasize the role of vitamin D3 in reducing the oxidative stress load on patients undergoing peritoneal dialysis (PD) via serum TRX level measurement. Methods. In this study, we evaluated the medical treatments of 69 PD patients who were followed up routinely. The patients were divided into 2 groups according to whether they used vitamin D3 or not. 49 of our patients were using vitamin D3. While requesting routine laboratory tests, we reserved a separate serum sample to measure serum TRX levels by double-antibody sandwich enzyme-linked immunosorbent assay for all patients. Results. Only one parameter has a significant statistical relationship with serum TRX level and the treatment protocol. The serum TRX level was significantly higher (211,62 U/l +/- 314,46) in the group receiving vitamin D3 compared to the group which is not using Vitamin D3 (101,63 U/l +/- 215,03) (p < 0,006). Conclusion. This study highlights the importance of appropriate dose of vitamin D3 replacement especially in PD patients who are under intense oxidative stress compared to healthy individuals.
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    Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT?TOX survey
    (Springer, 2021) Pekkolay, Zafer; Gogas Yavuz, Dilek; Saygılı, Emre Sedar; Değertekin, Ceyla Konca; Topaloğlu, Ömercan; Önder, Çağatay Emir; Soylu, Hikmet; Taşkaldıran, Işılay; Pazır, Ayse Esen; Uğur, Kader; Tanrıkulu, Seher; Fırat, Sevde Nur; Atak, Burcu Meryem; Batman, Adnan; Omma, Tülay; Çağıltay, Eylem; Özdemir, Nilüfer; Çetinkaya Altuntaş, Seher; Nasıroğlu İmga, Narin; Karakılıç, Ersen; Hekimsoy, Zeliha; Kılınç, Faruk; Yay, Adnan; Eroğlu, Mustafa; Tuzcu, Alpaslan Kemal
    Summary Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D defciency can ensure safe and efective treatment. Purpose We observed a tendency to use high doses of cholecalciferol for vitamin D defciency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. Methods An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (>88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1,>150 ng/ mL; group 2, 149–100 ng/mL; and group 3, 99–88 ng/mL. Results A total of 253 patients were included in the fnal analysis (female/male: 215/38; mean age, 51.5±15.6 years). The average serum 25(OH)D level was 119.9±33 (range, 88–455) ng/mL, and the average serum calcium level was 9.8±0.7 (range, 8.1–13.1) mg/dL. Most (n=201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was signifcantly higher in the symptomatic groups than in the asymptomatic groups (138.6±64 ng/mL vs. 117.7±31 ng/mL, p<0.05). The most common cause (73.5%) associated with high serum 25(OH) D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000–1.500.000 IU) for treating vitamin D defciency/insufciency in a short time (1–3 months). The cut-of value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89–216)]. Conclusions High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and efective treatment of vitamin D defciency.
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    Choroidal Thickness in Mild Autonomous Cortisol Secretion
    (Kare Publ, 2024) Doğan Çakır, Sezin; Çakır, Akın; Yener Öztürk, Feyza; Basmaz, Seda Erem; Batman, Adnan; Saygılı, Emre Sedar; Selvinaz Erol, Rumeysa
    Objectives: To evaluate the patients with mild autonomous cortisol secretion (MACS) by means of choroidal thickness (CT) and also investigate whether CT may be a diagnostic tool in the management of MACS or not. Methods: Twenty-seven patients with MACS and 25 age -sex -matched healthy controls were enrolled in this cross-sectional comparative study. All the participants underwent CT measurement by using Spectralis optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) with enhanced deep imaging mode at the subfoveal, 500-1000-1500 mu m nasal and 500-10001500 mu m temporal to the foveola. Results: The groups were similar in terms of spherical equivalence, age and axial lengths. The mean CT was significantly thicker in patients with MACS than controls in all measurement quadrants (p<0.001). There was no significant correlation between CT, size of the adenoma, basal cortisol, 1mg dexamethasone suppression test, salivary cortisol, 24 -hour total urine -free cortisol, ACTH and DHEAS levels. However, 2 mg dexamethasone suppression test results were found to be significantly correlated with CT in temporal 500-1000 and 1500 m quadrants (r=0.436, p=0.023, r=0.443, p=0.021 and r=0.488, p=0.010, respectively). Five (18.5%) eyes had pachychoroid pigment epitheliopathy in the MACS group. Conclusion: CT increases in patients with MACS and those tend to have pachychoroid pigment epitheliopathy more frequent than healthy individuals. A thicker choroid in the patients with MACS may be a novel biomarker both as a diagnostic tool for the degree of hypercortisolemia and cortisol-related comorbidity.
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    Evalulation of Optical Coherence Tomography Measurements inPeritoneal Dialysis Patients
    (2021) Bek, Sibel; Batman, Adnan; Eren, Necmi; Tuğan, Büşra Yılmaz; Bakırdöğen, Serkan
    INTRODUCTION: Optical coherence tomography (OCT) is anon-invasive ocular imaging technique widely used nowadays.There are limited studies focusing on the OCT findings in PDpatients. Our aim is to compare retinal changes of peritonealdialysis (PD) patients with healthy control group by using OCT and investigate the effects of age, gender and duration of PDon these parameters. METHODS: In this cross-sectional study right and left eyes of32 patients and twenty right and left eyes of ten healthycontrols were included. Detailed ophthalmologicalexaminations with central macular thickness (CMT),peripapillary retinal nerve fiber layer (RNFL) thickness, andchoroidal thickness (using EDI-OCT) were measured. Macularthickness was measured at five different areas:central,superior, temporal, inferior and nasal. Theperipapillary RNFL thickness was analysed in six differentareas: temporal, inferotemporal, inferonasal, nasal,superonasal and superotemporal. RESULTS: Sixty-four eyes of 32 patients (18 males, 14females; aged 20 to 60 years, mean 48.67±12.25 years) with amean duration of PD of 46.80 months were included. Therewas a significant difference of macular thickness in the central,temporal, nasal, inferior and superior quadrants betweencontrols and PD patients (p < 0.05). Vitamin D3supplementation was linked to decreased macular thickness incentral, temporal, superior, nasal and inferior quadrants(p<0.05). There was a positive correlation between macularthickness in central and temporal quadrants with residualrenal function (p=0.006, p=0.019). DISCUSSION AND CONCLUSION: OCT revealed asignificant reduction of macular thickness in all quadrants inPD patients.
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    Predicting stimulated C-peptide in type 1 diabetes using machine learning: a web-based tool from the T1D exchange registry
    (Elsevier Ireland Ltd, 2025) Saygili, Emre Sedar; Batman, Adnan; Karakilic, Ersen
    Aims: The mixed-meal tolerance test (MMTT), though considered the gold standard for evaluating residual beta-cell function in type 1 diabetes mellitus (T1D), is impractical for routine use. We aimed to develop and validate a machine learning (ML) model to predict MMTT-stimulated C-peptide categories using routine clinical data. Methods: Data from 319 individuals in the T1D Exchange Registry with complete MMTT and clinical information were analyzed. The cohort was randomly split into training (70%) and test (30%) sets. Five clinical variables-age at diagnosis, diabetes duration, HbA1c, non-fasting glucose, and non-fasting C-peptide-were selected via recursive feature elimination. Four ML algorithms (random forest [RF], XGBoost, LightGBM, and ordinal logistic regression) were trained with 10-fold cross-validation. Results: The RF model showed the highest performance: AUC 0.94 (95% CI: 0.92-0.96), sensitivity 0.84 (95% CI: 0.80-0.89), and specificity 0.92 (95% CI: 0.90-0.94) in cross-validation. In the test set, AUC was 0.97, sensitivity 88%, and specificity 94%. Notably, 17.7% of individuals with undetectable non-fasting C-peptide had measurable levels after MMTT. Conclusions: This ML model provides a practical, non-invasive tool for estimating beta-cell function in T1D and is available online at https://cpeptide.streamlit.app.
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    Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study
    (NLM (Medline), 2023) Batman, Adnan; Yazıcı, Dilek; Dikbaş, Oğuz; Agbaht, Kemal; Saygılı, Emre Sedar; Demirci, İbrahim; Karakılıç, Ersen
    CONTEXT: The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. METHODS: This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19-related SAT (Cov-SAT), SARS-CoV-2 vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. RESULTS: Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. CONCLUSION: Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2 vaccine-related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.