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The triglyceride-glucose (TyG) index is calculated from fasting triglycerides and fasting glucose levels and is an indicator of insulin resistance. The present study investigates whether the TyG index has a role in predicting clinical outcomes in cases of acute coronary syndrome (ACS). This retrospective study included 646 patients with ST-elevation myocardial infarction (STEMI) and 1048 patients with non–ST-elevation myocardial infarction (NSTEMI). The association between major adverse cardiac events (MACEs) that developed in-hospital and at 60 months of follow-up and TyG index values were compared. Patients were divided into 2 groups: TyG index values of ≥8.65 and

Aim:Despite advances in-stent technology, in-stent restenosis (ISR) is still a major problem following percutaneous coronary intervention (PCI) and its reasons have not been fully revealed. In the presented study, we investigated the effect of admission blood glucose (ABG), fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) levels on coronary ISR patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI in five-year follow-up.Methods:From 2.900 patients who underwent coronary stent implantation for STEMI from January 2008 through December 2012 were retrospectively analyzed through the hospital digital recording system. Of these, 264 patients who underwent control coronary angiography during the five-year follow-up were included in the study. Patients were divided into two main group ISR and non-ISR; were divided into two subgroups diabetic and non-diabetic groups were compared with HbA1c, ABG, FBG and angiographic parameters.Results:There were 127 patients in the ISR group (diabetic: 36 non-diabetic: 91) and 137 patients in the non-ISR group (diabetic: 43 non-diabetic: 94). Regardless of the patients diabetes status, no significant difference was found between the groups with and without ISR in terms of HbA1c, FBG and ABG. A significant relationship was found between the baseline HbA1c value and having ISR only in the diabetic subgroup (p=0.01).Conclusion:This study results showed that in diabetic STEMI patients who underwent primary PCI, higher HbA1c levels were associated with higher ISR rates, but not with FBG and ABG levels.

Devlet yapısı içerisinde Jandarma Genel Komutanlığı’nın ülke genelinde görevli üç genel kolluk kuvvetinden biri olarak teşkil edilmiş olması gereği öncelikle kolluk kavramı üzerinde genel bilgilendirme yapılacaktır. Bilahare yargısal içtihatlar ve öğretideki farklı görüşler kapsamında disiplin, disiplinin amacı, işlevi, türleri ile adli suç ve idari suç arasındaki benzerlik ve farklılıklar incelenecektir. 7068 Sayılı Genel Kolluk Disiplin Kanunu ise jandarma teşkilatı özelinde ele alınacak olması sebebiyle jandarma personelinin geçmişten günümüze tabi olduğu disiplin hükümlerinden de genel boyutta bahsedilecektir. Disiplin suçları, karşılığında öngörülen yaptırımların ‘cebir’ içermesi bakımından adli suç ve cezalara yakınlaşmaktadır. Nitekim çalışmamızı üzerine kurduğumuz temel felsefe de işte tam bu noktada adli suç ve cezalarına uygulanan ceza hukukunun genel ve usul ilkelerinin disiplin hukukunda geçerli olması gerektiği düşüncesine ilişkindir. Bu düşünceyle çalışmamızın son bölümünde, öğretideki görüşler ve yargısal kararlar ışığında ceza hukuku genel hükümlerinin, disiplin hukuk bakımından ne boyutta uygulanabilir olduğu değerlendirilecektir.

ÖzHızla gelişen dijital teknoloji ve ağ sistemleri sonucunda internet, “Vahşi Batı” misali siber suçların odak noktası haline gelmiştir. Mevcut durum, devletlerin egemenlik hakları kapsamında yargı yetkilerini paylaşmama eğilimi ile birlikte ele alındığında, bu suçlarla mücadele kapsamında uluslararası adli iş birliği, gerçekleşmesi zor bir ihtimal haline gelmektedir meğerki siber suçlarla mücadele özelinde bağlayıcı nitelikte uluslararası boyutu olan bir uzlaşı sağlanabilsin. Çalışmamız; konuya ilişkin literatür taraması, güncel yargı kararlarının incelenmesi ile uluslararası ve yerel mevzuat incelemelerinden edinilen bilgiler bağlamında şekillendirilmiştir. Öncelikle her devletin kendi sosyal, kültürel ve ekonomik değerleri özelinde farklılık gösteren siber suç terimi ile ilgili kavramsal bir incelemede bulunularak metnin devamında olması muhtemel anlam karmaşasının önüne geçilmek istenmiştir. Sonrasında ise Avrupa Konseyi Sanal Ortamda İşlenen Suçlar Sözleşme (Council of Europe Convention on Cybercrime, Budapeşte Sözleşmesi) dışında ulusal ve uluslararası alanda siber suçlarla mücadele amacıyla yapılan girişimler değerlendirilecektir.Sözleşme’nin getirdiği yükümlülükler açısından Türk Hukuku’ndaki etkileri ile Türkiye’de siber suçlarla mücadele amacıyla düzenlenen mevzuatın Sözleşme’yi karşılama durumu incelenecektir. Bu inceleme kapsamında ilk önce maddi ceza hukuku bağlamında siber suç tipleri belirlenecek, müteakiben suçla mücadele kapsamında uygulanacak koruma tedbirleri ve usul hükümleri ifade edilecektir. Son olarak da siber suçların sınır tanımaz yapısı gereği bu suçlarla mücadele açısından ülkeler arası sağlanacak adli yardımlaşma ilkelerinden bahsedilecektir., As a result of rapidly developing digital technology and network systems, the internet has become the focal point of cybercrime, like the "Wild West". When the current situation is considered together with the tendency of states not to share their jurisdiction within the scope of their sovereign rights, international judicial cooperation within the scope of combating these crimes becomes a difficult possibility, unless a binding international agreement with a binding international dimension can be achieved in the fight against cybercrime.Our study has been shaped in the context of the literature review on the subject, the examination of current judicial decisions and the information obtained from international and local legislation reviews. First of all, it is aimed to avoid possible confusion in the continuation of the text by making a conceptual analysis of the term cybercrime, which differs in each state's own social, cultural and economic values. Afterwards, attempts made to combat cybercrime in the national and international arena will be evaluated, apart from the Council of Europe Convention on Cybercrime (Budapest Convention).Within the scope of the obligations brought by the Convention, its effects on Turkish Law and the compliance of the legislation in Turkey with the aim of combating cybercrime will be examined. Within the scope of this review, firstly, the types of cybercrime in the context of substantive criminal law will be determined, then the protection measures and procedural provicions to be applied within the scope of combating crime will be expressed.Finally, due to the borderless nature of cybercrimes, the principles of judicial assistance to be provided between countries in terms of fighting these crimes will be mentioned

Aim: The conflicting relationships of serum omentin with inflammation markers and cardiometabolic disorders were investigated. Results & methods: Unselected 864 population-based middle-aged adults were cross-sectionally studied by sex-specific omentin tertiles. Men in the lowest omentin tertile (T1) had lower systolic blood pressure, HbA1c and glucose values and tended in T3 to higher lipoprotein(a) levels. Logistic regression analysis, adjusted for four covariates, revealed significant independent associations with the presence of hypertension and diabetes only in men. Sex- and age-adjusted odds ratio in gender combined for T2 & T3 versus T1 was 1.34 (95% CI: 1.00–1.79) for metabolic syndrome. Discussion & conclusion: The elicited adverse relationships of omentin-1 support the notion of oxidative stress-induced proinflammatory conversion of omentin, rendering loss of anti-inflammatory properties.

Objective The goal of this study was to determine variables preceding and predicting incident obstructive sleep apnea syndrome (OSAS) in the population at large. Methods Anthropometric, lipid, and non-lipid variables in participants with newly developing OSAS (n = 131) were compared with those of a cohort sample (n = 2615) of the Turkish Adult Risk Factor study. Available values preceding (by a median of 32 mo) the development of OSAS were used in multivariable Cox regression models. Results Significant determinants of OSAS assessed by group differences were waist/neck circumference and fibrinogen. Fasting triacylglycerols, systolic blood pressure, and C-reactive protein in men and low sex hormone–binding globulin and elevated homeostatic model assessment in women were further significant covariates. Cox regression analysis for the risk of incident OSAS confirmed the independent predictive value of central obesity measures, especially neck circumference (having a twofold hazard ratio) and younger age. Age-adjusted former smoking status and—compared with the lowest tertile—the upper two tertiles of fibrinogen (relative risk = 1.66, 95% confidence interval: 1.05–2.63) were significant predictors. Elevated triacylglycerols in males and high apolipoprotein B and lowest high-density lipoprotein cholesterol tertile in females also predicted subsequent OSAS. Systolic blood pressure and total cholesterol did not prove to be independent predictors in multivariable adjusted Cox models in which partial sex-dependent independence of obesity measures of the previously stated five variables was essentially retained. Conclusions An enhanced pro-inflammatory state appeared to be the underlying pathophysiologic mechanism for OSAS, whereas in men, the added factor of high-density lipoprotein dysfunction was suggested. Because it contributes to the pro-inflammatory state, discontinuance of smoking was another further significant predictor of OSAS.

Keskin, Muhammed/0000-0002-4938-0097; WOS: 000411505100002 PubMed: 28694392 Objective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey. Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age >= 40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed. Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status. Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures. Turkish Society of Cardiology; TOFAS, Istanbul We are indebted to the Turkish Society of Cardiology, and particularly to the firm TOFAS, Istanbul, for their partial support for the TARF survey, and to the Turkish Institute of Public Health for logistical support.

Aim The aim of the study was to evaluate the predictive value of HbA1c for risk of overall mortality or a composite endpoint of death and nonfatal events. Methods Logistic regression retrospectively assessed the longitudinal association of measured HbA1c with outcome in 746 middle-aged adults, recruited from a tertiary health center and stratified to absence or presence of type 2 diabetes, using the recent American Diabetes Association criteria. Results A total of 70 deaths and additional incident nonfatal events in 82 cases were recorded at a median of 3.1-year follow-up. Multivariable linear regression revealed among nondiabetic individuals HbA1c to be significantly associated—independent of fasted glucose—inversely with triglycerides and high-density lipoprotein cholesterol, distinct from the diabetic sample. Sex and diabetes status differed in baseline HbA1c values with respect to the development of outcome. Nondiabetic men who subsequently died exhibited significantly lower HbA1c, as did men and women with incident coronary heart disease. Similar difference was observed for incident hypothyroidism and nondiabetic subjects developing malignancy. In logistic regression analysis, adjusted for sex, age, and fasting glucose, each 0.7% (SD, 1) decrement of baseline HbA1c predicted the composite endpoint in the nondiabetic sample (risk estimates, 1.49%; 95% confidence interval, 1.07–2.04), but not in the diabetic sample, whereas overall mortality in the whole sample was increased (risk estimates, 1.51%; 95% confidence interval, 1.05–2.17). Conclusions Inverse association of HbA1c with adverse outcomes in men and nondiabetic people indicates the involvement of HbA1c levels in autoimmune activation. The weaker inverse association with prevalent diabetes and in women is consistent with the operation of more pronounced confounding autoimmune processes.

Primary Hyperparathyroidism (PHP) in pregnancy constitutes a serious danger to mother and fetus. The diagnosis of PHP in pregnancy presents a challenge, and PHP commonly goes unidentified and untreated in pregnancy. We present four case reports about patients having PHP, which is very rare condition in pregnancy and their treatment modalities. Three patients, not to be controlled biochemically, denied the parathyroidectomy operation although they are informed about the details of their disease. They are followed up with medical therapy. The first one had no maternal or fetal complications, the second one acquired nephrolithiasis crisis in the last trimester and the third one gave birth to a premature baby who succumbed to tetany. The fourth patient who underwent parathyroidectomy operation in the second trimester had no maternal or fetal complications. PHP in pregnancy is a preventable cause of fetal and maternal mortality and morbidity. Thus, suspecting from PHP during the pregnancy and early diagnosis is critically important in terms of maternal and fetal wellness.

The population-based CANHEART (Cardiovascular Health in Ambulatory Care Research Team) “big data” cohort examining the relationship between high-density lipoprotein cholesterol (HDL-C) and cause-specific mortality rates was of interest in several aspects [(1)][1]. These investigators found that

Objective: We investigated the possible association of serum acylation stimulating protein (ASP) with cardiometabolic disorders and the evidence of autoimmune activation. Methods: Population-based randomly selected 1024 participants were cross-sectionally and prospectively analyzed. ASP concentrations were measured with a validated ELISA kit. Correlations were sought separately in subjects with no cardiometabolic disorders (n=427) designated as “healthy.” Results: ASP was positively correlated with total testosterone and inversely correlated with platelet activating factor (PAF), PAF-acetylhydrolase (AH), in each gender, and positively correlated in “healthy” men with lipoprotein [Lp](a) and apolipoprotein B. Correlations of ASP with PAF values ≥22 nmol/L were abolished, contrasted to a strongly inverse one in subjects with PAF

OBJECTIVE This study aimed to examine the overall and coronary mortality in the 2014 Turkish Adult Risk Factor Study survey, and the distribution of cumulative mortality and incident coronary heart disease (CHD) across 7 geographic regions. METHODS Information on mode of death was appropriately obtained. Information collected from survivors was based on history, examination of the cardiovascular system and the Minnesota coding of electrocardiograms. Cox regression analyses were performed. RESULTS Of the 1.323 participants to be surveyed, 87 were lost to follow-up, 753 examined, and 35 ascertained as deceased. In 448 subjects, verbal information alone was obtained regarding health status. Nineteen deaths were of coronary and cerebrovascular origin. Cumulative 24-year assessment of the entire cohort in the age bracket 45-74 years disclosed high coronary mortality, at 7.3 per 1000 person-years in men and 3.8 in women, and recorded a limited decline of 18% since the year 2000. Age-adjusted Cox regression analysis, comprising 614 deaths and 482 incident CHD over a follow-up of 9.6 years, revealed higher mortality rates in the Mediterranean region and in men in the Black Sea and Marmara regions. The age-adjusted CHD incidence was significantly higher in males of the Mediterranean and females of the Southeast regions. An estimated 400-420.000 incident CHD cases develop currently each year in Turkey. CONCLUSION The generally high age-adjusted overall mortality in Turkey displays significant differences across geographic regions. Age-adjusted CHD incidence is not regressing sufficiently, and is especially high among men of the Mediterranean and women of the Southeast regions.

To what extent is the metabolic syndrome (MetS) determined beyond its recognized components? In 1702, middle-aged men and women without MetS at baseline, MetS development was identified in 546 participants at a mean of 10.1-year follow-up. Participants subsequently developing MetS had, beyond higher values of MetS traits, significantly higher total and low-density lipoprotein cholesterol, apolipoprotein B, C-reactive protein (CRP), γ-glutamyl transferase (GGT), and lower high-density lipoprotein cholesterol. Females were significantly more frequent never smokers and males had lower values of total testosterone. In logistic regression analyses, adjusted for sex, age, and smoking status, MetS was predicted disparately in the sexes, whereas males exhibited, beyond abdominal obesity, CRP, GGT, and sex hormone-binding globulin (SHBG) as independent predictors, abdominal obesity was not an independent predictor in females in whom other than age, CRP conferred MetS risk, whereas SHBG was and current smoking tended to be protective. A surrogate of hepatic steatosis proved a major mediator of abdominal obesity in determining incident MetS (relative risk, 5.6 [95% confidence interval, 3.4-9.3]) in each sex. We confirm that GGT and SHBG are novel independent MetS determinants. Hepatic steatosis is the major predictor of MetS mediating adiposity in each sex. Abdominal obesity is not an independent determinant in Turkish women in whom autoimmune activation seems to prevail before MetS development.

The recent paper by Wilkins et al. [(1)][1] was highly interesting. They examined nearly 2,800 young participants (mean age, 25 years) of a multicenter cohort, aiming to quantify the association of concordance and discordance between apolipoprotein (apo) B and low-density lipoprotein-cholesterol (

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

PubMed: 25362940 Objectives: To analyze (1) the sex-specific and age-brack- Et defined all-cause and coronary mortality in the 23-years' follow-up of the Turkish Adult Risk Factor Study, and (2) to determine the nation-wide prevalence of Type-2 diabetes and its recent trend. Study design: Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath office. Information collected in survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. Diabetes was defined by criteria of the American Diabetes Association without the use of glycated hemoglobin. Results: Of the 1370 participants to be surveyed, 768 were examined, in 452 subjects information was gathered, and 29 men, 18 women were ascertained to have died. Cumulative assessment of the entire cohort in the age bracket 45-74 years disclosed coronary mortality to be 7.5/1000 person- years in men and 3.74 in women, persisting to be high among the European countries. The recent decline observed in overall mortality seemed to halt as well. Of greatest concern was the finding in the past 12 years that the rate of rise in the age-controlled prevalence of Type-2 diabetes was as high as 5% annually. Conclusion: Overall and coronary mortality in Turkish adults continue to be high, while an elicited annual increase of 5% in the age-controlled prevalence of diabetes is virtually alarming and requires new public health policies. © 2014 Turkish Society of Cardiology.

Background The definition of glomerular hyperfiltration has not been agreed upon and the pathophysiological mechanisms have not been well explored. Low serum creatinine concentrations may be associated with increased risk of coronary heart disease (CHD) or cardiopulmonary events the impact of which needs further study. Methods Consecutive applicants to a cardiovascular hospital free of moderate/severe chronic kidney disease (age 55.6 ± 8.2 years) were grouped into those without (“healthy”, n = 469) and with CHD (320 stable and acute coronary syndrome cases) at baseline and into sex-specific quartiles of CKD-EPI equation-estimated glomerular filtration rate (eGFR). New or recurrent cardiovascular (myocardial infarction, stroke, heart failure [HF]) events, obstructive pulmonary disease (COPD) and death were determined during 3-years’ follow-up. Results Among 25 deaths and 75 cardiopulmonary events, HF was the leading nonfatal event. Age, serum uric acid and left ventricular ejection fraction proved the best independent inverse covariates of eGFR in the “healthy” sample. The highest eGFR quartile (“hyperfiltrators”), exhibiting significantly lower serum LDL-cholesterol levels, significantly predicted the combined outcome (at a RR of 6) in “healthy” subjects, after adjustment for sex, age, body mass index, smoking status and presence of hypertension. This finding was paralleled by the highest eGFR quartile calculated also by the MDRD equation, replicating this also in the CHD group. Conclusion Renal “hyperfiltrators” represent individuals with autoimmune activation (involving serum creatinine, partly escaping assay), are misclassified into optimal renal function and actually are at significantly higher risk of death, HF or cardiopulmonary events. Low serum creatinine levels may represent a clue to the existence of autoimmune activation.

Two highly prevalent diseases, Type-2 diabetes mellitus and coronary heart disease (CHD), share risk factors. Excess levels of LDL-cholesterol have been overemphasized to uniformly encompass the development of CHD, and the origin of insulin resistance underlying Type-2 diabetes has not been fully elucidated. Autoimmune response has been recognized to be responsible only of a small minority of diabetes. The increasing trend in the worldwide prevalence of diabetes and the risk factors for both diseases are reviewed, the independent mediation for CHD of (central) adiposity in both diseases and the 'hypertriglyceridemic waist' phenotype are outlined. Evidence is described that serum lipoprotein (Lp)(a) concentrations, not only in excess, but also in apparently 'reduced' levels, as a result of autoimmune response, underlie both disorders and are closely related to insulin resistance.

Background We determined the proportion of the effects of body mass index (BMI) or its categories on cardiometabolic outcomes mediated through systolic blood pressure (SBP), total cholesterol and fasting glucose. Methods Cox regression analyses were performed for incident outcomes among Turkish Adult Risk Factor study participants in whom the three mediators had been determined (n = 2158, age 48.5 ± 11 years). Over a mean 10.2-years’ follow-up, new coronary heart disease (CHD) developed in 406, diabetes in 284 individuals, and 149 CHD deaths occurred. Results Hazard ratios (HR) of BMI for incident diabetes were no more than marginally attenuated by the 3 mediators including glucose, irrespective of gender. Compared to “normal-weight”, sex- and age-adjusted RRs for incident CHD of overweight and obesity were 1.40 and 2.24 (95 % CI 1.68; 2.99), respectively, in gender combined. Only three-tenths of the excess risk was retained by BMI in men, six-tenths in women. No mediation of glycemia was discerned in males, in contrast to greatest mediation in females. HR of age-adjusted continuous BMI was a significant but modest contributor to CHD mortality in each gender. While the BMI risk of CHD death was abolished by mediation of SBP in men, HR strengthened to over two-fold in women through mediation of fasting glucose. Conclusions Mediation of adiposity by 3 traditional factors exhibited among Turkish adults strong gender dependence regarding its magnitude for CHD risk and the mediation by individual risk factors. Retention of the large part of risk for diabetes in each sex and for CHD in women likely reflects underlying autoimmune activation. Electronic supplementary material The online version of this article (doi:10.1186/s12902-016-0134-6) contains supplementary material, which is available to authorized users.