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    Effect of sacubitril/valsartan combined with dapagliflozin on long-term cardiac mortality in heart failure with reduced ejection fraction
    (SAGE Publications Inc, 2022) Karabulut, Umut; Keskin, Kudret; Karabulut, Dilay; Yiğit, Ece; Yiğit, Zerrin
    The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II-IV symptoms and ejection fraction <= 40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16-3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) (P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10-.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85-.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.
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    Is there any association between rs1303 (Pi*M3) variant of alpha-1 antitrypsin gene and atrial septal aneurysm development?
    (Wiley, 2019) Turhan Çağlar, Fatma Nihan; Işıksaçan, Nilgün; Bıyık, İsmail; Oktay Türeli, Hande; Katkat, Fahrettin; Karabulut, Dilay; Öztaş, Didem Melis; Uğurlucan, Murat
    Aim Atrial septal aneurysm (ASA) is one of the congenital heart defects. The underlying pathophysiology of ASA has not been fully understood yet. Alpha-1 antitrypsin (A1AT) is a serine protease inhibitor glycoprotein, which is held responsible from tissue wall proteolysis if it is deficient in the body. The aim of this study was to investigate A1AT serum levels and the rs1303 (Pi*M3) variant in A1AT gene in patients with ASA. Material and Methods Thirty patients (7 male and 23 female) with isolated ASA and 33 patients (11 male and 22 female) with normal atrial septum on echocardiography were included in this study. A1AT serum levels of study patients were measured quantitatively by the enzyme-linked immune sorbent assay (ELISA) method. The A1AT gene mutation rs1303 was analyzed by genotyping, which is performed on genomic DNA extracted from circulating mononuclear blood cells. Single-nucleotide polymorphism was evaluated on polymerase chain reaction using commercial kits. Results A1AT serum levels were not statistically different among patients with and without ASA (9.52 +/- 4.33 mu g/mL vs 9.83 +/- 5.27 mu g/mL, respectively, P = .80). A1AT homozygote mutation (PiM3M3) was significantly higher in the ASA group than the control group (21 vs 11, OR (95% CI): 6.68 [2.09-21.40], P = .001). A1AT serum levels were similar among patients with normal A1AT allele (PiMM), homozygote variant (PiM3M3), and heterozygote variant (PiMM3) (P = .79). Conclusion This preliminary study revealed that homozygote A1AT rs1303 (PiM3M3) variant is significantly higher in patients with isolated ASA and may be associated with ASA development. Large scale comprehensive studies are needed to validate these results.
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    The relationship between orthostatic hypotension and vitamin D deficiency in patients with uncontrolled type 2 diabetes mellitus
    (Sakarya University, 2022) Yiğit, Ece; Sivritepe, Rıdvan; Karabulut, Dilay; Karabulut, Umut
    Objective: Vitamin D deficiency is common in diabetic patients, and studies showed that it could lead to neuropathy. Therefore, we aimed to determine relationship between 25-hydroxyvitamin D (25(OH)D) levels and orthostatic hypotension (OH) which is a component of autonomic neuropathy in diabetic patients.Materials and Methods: A total of 118 patients with Type 2 diabetes mellitus and aged 50-65 years were included. Patients were divided into two groups as OH present and OH not present. 25(OH)D and other variable parameters were evaluated between these two groups.Results: A total of 118 patients, 66 female and 52 male, were included in this cross-sectional study. The mean age of the patients was 56.2±3.2 years.25(OH)D levels were found to be significantly lower in the group with OH (p<0.026). Age and sex-adjusted regression analysis were performed to examine the relationship between 25(OH)D level and OH. It was found that 25(OH)D didn’t predict the presence of OH in the univariate and multivariate analyses (p >0.05).Conclusion: 25(OH)D levels are significantly lower in diabetic patients with OH. Although an independent relationship between them has not been demonstrated, it can be thought that correcting Vitamin D deficiency will be beneficial in the treatment of OH.