A novel marker for prediabetic conditions: Uric acid-to-HDL cholesterol ratio.

OBJECTIVES: The objective of this study was to identify a parameter that can facilitate the diagnosis of prediabetes and predict the likelihood of its development in individuals at high risk. METHODS: In this retrospective study, the study population was selected from Bolu Abant Izzet Baysal University Hospital's patients. Participants were divided into two groups, prediabetes and healthy group. We excluded individuals with certain conditions or taking certain medications. The study compared the ratios of uric acid to high-density lipoprotein (HDL) between the two groups and identified the optimal point of differentiation. RESULTS: The study analyzed data from 228 individuals, including 125 with prediabetes and 103 healthy controls. Those with prediabetes had a significantly higher median UHR (0.13 (0.07-0.24) %) compared to healthy individuals (0.09 (0.05-0.16) %) (p < 0.001). Higher UHR values were associated with a greater risk of prediabetes. A UHR cut-off points greater than 0.11 % had a sensitivity of 74 % and specificity of 69 % in detecting prediabetes. CONCLUSION: The study provides evidence that UHR can serve as a practical and valuable diagnostic and screening tool for prediabetes (Tab. 2, Fig. 1, Ref. 23). Text in PDF www.elis.sk Keywords: serum uric acid, HDL cholesterol, UHR, prediabetes.

SERUM URIC ACID TO HDL CHOLESTEROL RATIO IS ASSOCIATED WITH DIABETIC CONTROL IN NEW ONSET TYPE 2 DIABETIC POPULATION.

Since uric acid to HDL cholesterol ratio (UHR) is proposed as a novel predictor of metabolic and inflammatory disorders, we aimed to study UHR levels in patients with new onset type 2 diabetes mellitus (T2DM) and compare them to those in healthy controls. Patients with new onset T2DM were enrolled and control subjects were volunteers to participate without any established diseases. Laboratory data including UHR, fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were compared. The mean UHR of the T2DM and control groups was 16±8% and 10±3%, respectively (p<0.001). Moreover, UHR was significantly and positively correlated with HbA1c (r=0.75, p<0.001), FBG (r=0.64, p<0.001), waist circumference (r=0.35, p<0.001), body mass index (r=0.20, p=0.002) and inversely correlated with glomerular filtration rate (r=-0.24, p<0.001). High levels of UHR might be associated with increased mean blood glucose levels for a long time, since UHR was correlated with both FBG and HbA1c in patients with new onset T2DM.

Is Neuregulin-4 a predictive marker of microvascular complications in type 2 diabetes mellitus?

BACKGROUND AND AIMS: Neuregulin-4 (Nrg-4) is a new adipokine released from brown adipose tissue. It plays pivotal role in regulating systemic energy balance, glucose and lipid metabolism and in reducing chronic inflammation. We aimed to investigate the relation between diabetic microvascular complications (DMC) and serum (Nrg-4) levels in patients with type 2 diabetes mellitus. METHODS: Patients with type 2 diabetes mellitus were divided into DMC and diabetic patients without microvascular complications (non-DMC). Nrg-4 levels of the patients were compared. RESULTS: Fifty and 29 patients enrolled to the DMC and non-DMC groups, respectively. Nrg-4 was 1.23 (0.02-5.1) ng/mL and 2.5 (0.21-6.01) ng/mL in DMC and in non-DMC groups, respectively (P < .001). In patients with DMC, FPG was 189.5 (89-446) mg/ dL, whereas it was 128 (95-278) mg/dL in non-DMC diabetic patients (P < .001). HbA1c was also significantly higher in the DMC group than in the non-DMC group (P < .001). Negative correlation was found between Nrg-4 and FPG (r = -0.231, P = .03), HBA1c (r = -0.312, P = .003) and microalbuminuria (r = -0.277, P = .009). Logistic regression analysis showed a 1-unit decrease in Nrg-4 to increase the presence of DMC by 1.9 times. The best cut-off value of Nrg-4 was 1.56 ng/mL with 82.1% sensitivity and 64% specificity, in predicting DMC. CONCLUSION: In patients with diabetes, Nrg-4 levels may be a good predictor of early detection of one or more DMC, as microvascular dysfunction in an organ system is considered to be an initial onset of subclinical systemic damage.

Differential value of eosinophil count in acute coronary syndrome among elderly patients.

We aimed to search eosinophil (EOS) counts in elderly acute coronary syndrome (ACS) subjects and to investigate its value for discrimation between unstable angina pectoris (UAP) and myocardial infarction (MI) [non-ST elevation MI (NSTEMI) or ST elevation MI (STEMI)]. The patients were divided into three groups regarding the diagnosis: patients with UAP (63), with NSTEMI (154), and with STEMI (73). General characteristics such as gender, age, systolic and diastolic blood pressure were obtained from patients' files. Complete blood count and biochemical parameters were measured before coronary angiography. EOS was found significantly higher in UAP (0.134 (0.002-0.746) u/mm3) compared to NSTEMI (0.085(0.001-0.601) u/mm3) and STEMI (0.020(0.001-0.479) u/mm3) groups. Kruskal-Wallis test with Bonferroni-corrected Mann-Whitney U-test revealed that EOS count was significantly different between UAP and NSTEMI (p < .001), UAP and STEMI (p < .001) and NSTEMI and STEMI (p < .001) groups. A receiver operating curve (ROC) analysis revealed that a cut-off >0.083 u/mm3 EOS value had a sensitivity of 79% and specificity of 57% for determination of ACS as UAP (AUC = 0.686, 95% CI, 0.617-0.755). In the present study, we detected an inverse relationship between the number of blood eosinophil count and the severity of ACS subgroups in elderly patients with higher counts in UAP than MI groups.

General characteristics of anemia in postmenopausal women and elderly men.

In present study, we aimed to investigate anemia etiologies, underlying causes, laboratory markers of anemia, required interventions in postmenopausal women and elderly men. The medical data of the anemic subjects were recorded from the patients' files and computerized database of the institution and retrospectively analyzed. Study population grouped into two according to the gender; men and women. Medical data of men and women were compared. A total of 113 subjects enrolled to the study; 78 women and 35 men. 51 (65%) of women and 21 (60%) of men had iron deficiency anemia, 5 (6.4%) of women and 1 (2.9%) of men had anemia of chronic disease, 2 (2.6%) of women and 10 (28.6%) of men had vitamin B12 deficiency anemia. Forty seven (60.3%) of the women and 30 (85.7%) of the men had comorbidities. 47% of colonoscopies were normal in study population (44% of women and 50% of men). Etiology and causes of anemia should be carefully investigated in subjects with advanced age. Physicians should kept in mind that B12 deficiency and comorbidities were more common in elderly men and about half of the colonoscopy procedures in this population is unnecessary.

Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus.

AIM: Despite it has some disadvantages, the most important marker of diabetic control is glycated hemoglobin (HbA1c). Uric acid to HDL cholesterol ratio (UHR) is a promising marker in metabolic syndrome. We aimed to compare UHR levels of well and poorly controlled type 2 diabetic male subjects, as well as healthy men, and to observe its correlation with other metabolic parameters. METHODS: Male patients with T2DM that showed up in outpatient internal medicine clinics of our hospital were enrolled to the study. Diabetic subjects divided into two groups according to the level of HbA1c: well-controlled T2DM group (HbA1c < 7%) and poorly controlled T2DM group (HbA1c ≥ 7%). Third group was consisted of healthy subjects without any chronic diseases. UHR levels of the groups were compared. RESULTS: The UHR levels of well and poorly controlled diabetics and control subjects were 12%±5%, 17%±6% and 9%±3%, respectively (p<.001). The UHR was significantly and inversely correlated with GFR and was significantly and positively correlated with waist circumference, body weight, body mass index, serum creatinine, fasting plasma glucose (FPG) and HbA1c levels. CONCLUSION: UHR could serve as a promising predictor of diabetic control in men with T2DM, since it has significant association with HbA1c and FPG levels.

Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men.

AIM: Hemogram indices were proposed as novel inflammatory markers in chronic conditions and inflammation has substantial role in the pathogenesis of type 2 diabetes mellitus (T2DM). We aimed to observe hemogram parameters of type 2 diabetic male subjects with various age groups in well and poorly controlled subsets. METHODS: Data of type 2 diabetic men enrolled to the study were recorded from patient files of the institution. Study population were grouped into three according to the age. Group A was consisted of patients younger than 55 years, Group B was consisted of patients aged between 55 and 64 years, and Group C was consisted of patients aged 65 years or older. Data of the study groups were compared. RESULTS: Study population was consisted of 130 subjects; 44 in Group A and 43 in each of Groups B and C. Median red cell distribution width (RDW) (p = .04), mean RDW to platelet ratio (RPR) (p = .006), median mean platelet volume to platelet ratio (MPR) (p = .02) levels of the study groups were statistically different. HbA1c level was significantly and positively correlated with RDW (r = 0.45, p < .001), neutrophil to lymphocyte ratio (NLR) (r = 0.47, p < .001), mean platelet volume to lymphocyte ratio (MLR) (r = 0.35, p < .001), MPR (r = 0.26, p = .003), and RPR (r = 0.37, p < .001) levels. CONCLUSION: Elevated RDW, NLR, MLR, MPR, and RPR levels in diabetic men should trigger the measurement of HbA1c since each were strongly correlated with HbA1c level. Moreover, elevated RDW, NLR, MLR, and RPR could be marker of worse diabetic control in men with T2DM.

Type 2 diabetes mellitus is more commonly well controlled in younger men compared to older men.

METHODS: The male patients with T2DM that admitted to the outpatient internal medicine clinics of our institution between November 2018 and April 2019 were included to the study. According to the age, study population divided into two groups; either younger than 60 years (group I) and 60 years or older (group II). Study parameters were compared between study groups. RESULTS: Fasting plasma glucose (FPG) and glycated Hb level (HbA1c) of group I were lower than those of the group II (p = 0.004 for FPG and p = 0.048 for HbA1c). Control level of T2DM was defined as well controlled in 20 (29%) patients in group I and 5 (10.9%) patients in group II (p = 0.02). CONCLUSION: Physicians should aware that well controlled T2DM is more common among younger diabetic men compared to older men and try to enhance diabetic regulation level in elderly men by interventions that aimed to improve skeletal muscle or by pharmacologic agents.

Association Between Hemogram Parameters and Survival of Critically Ill Patients.

AIM: Recently, hemogram parameters, such as mean platelet volume (MPV), had been proposed as novel inflammatory and prognostic factors. In present retrospective analysis, we aimed to determine and compare MPV of survived and dead patients whom admitted to intensive care unit (ICU) of our institution. METHODS: We recorded hemogram parameters and other laboratory data and demographic characteristics of patients treated in ICU. Patients are divided into 2 groups-dead patients and survived patients. Laboratory data of survived patients compared to those of dead patients. RESULTS: Age, gender, and other laboratory variables were not significantly different between dead and survived patients. On the other hand, MPV of survived patients was significantly higher than that of the dead patients ( P = .001). CONCLUSION: We think that elevated MPV levels in an ICU patient should alert clinicians for worse outcome. Physicians should be more careful in the management of these patients.

MEAN PLATELET VOLUME: AN OVERLOOKED HERALD OF MALIGNANT THYROID NODULES.

Physicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.

A Rare Non-Hemolytic Case of Idiopathic Cold Agglutinin Disease.

BACKGROUND: Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. METHODS: We studied a peripheral blood smear and repeated the hemogram test at 37°C to establish the diagnosis of cold agglutinin disease. RESULTS: Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/µL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37°C and the test results showed RBC: 3.4 M/µL, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. CONCLUSIONS: Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.

The role of the uncertainty of measurement of serum creatinine concentrations in the diagnosis of acute kidney injury.

Uncertainty of measurement is the numeric expression of the errors associated with all measurements taken in clinical laboratories. Serum creatinine concentration is the most common diagnostic marker for acute kidney injury. The goal of this study was to determine the effect of the uncertainty of measurement of serum creatinine concentrations on the diagnosis of acute kidney injury. We calculated the uncertainty of measurement of serum creatinine according to the Nordtest Guide. Retrospectively, we identified 289 patients who were evaluated for acute kidney injury. Of the total patient pool, 233 were diagnosed with acute kidney injury using the AKIN classification scheme and then were compared using statistical analysis. We determined nine probabilities of the uncertainty of measurement of serum creatinine concentrations. There was a statistically significant difference in the number of patients diagnosed with acute kidney injury when uncertainty of measurement was taken into consideration (first probability compared to the fifth p = 0.023 and first probability compared to the ninth p = 0.012). We found that the uncertainty of measurement for serum creatinine concentrations was an important factor for correctly diagnosing acute kidney injury. In addition, based on the AKIN classification scheme, minimizing the total allowable error levels for serum creatinine concentrations is necessary for the accurate diagnosis of acute kidney injury by clinicians.

Evaluation of the urinary kidney injury molecule-1 levels in patients with diabetic nephropathy.

PURPOSE: Kidney Injury Molecule-1 is a protein that increases in urine following tubular damage. Kidney Injury Molecule-1 levels were correlated with the level of chronic kidney disease secondary to diabetic nephropathy in patients with type 2 Diabetes Mellitus. METHODS: Clinical and laboratory findings of 142 patients with diabetic nephropathy and 34 control subjects were analysed. Creatinine and HbA1c levels in blood samples and albumin, creatinine and Kidney Injury Molecule-1 levels in urine samples were assessed. RESULTS: Urinary Kidney Injury Molecule-1 levels were significantly increased both in subgroups of diabetic nephropathy (normo-/micro-/macro-albuminuria) and in chronic kidney disease (stage 2-4) compared with controls. Urinary Kidney Injury Molecule-1 levels in stage 2 chronic kidney disease patients were significantly higher than those of the patients with stage 3-4 chronic kidney disease. Urinary Kidney Injury Molecule-1 levels, along with urinary albumin excretion and the duration of diabetes, were found to be independent risk factors associated with low glomerular filtration rates. CONCLUSION: Urinary Kidney Injury Molecule-1 levels seems to predict renal injury secondary to diabetic nephropathy in early period independent of albuminuria, because urinary Kidney Injury Molecule-1 was elevated despite normal urinary albumin excretion in the normoalbuminuric subgroup. Urinary Kidney Injury Molecule-1 levels, which are elevated in primarily in stage 2, shows a gradual decrease in patients with chronic kidney disease stages 3 and 4; thus, urinary Kidney Injury Molecule-1 levels may be useful in tracking the progression of kidney disease.

Post-treatment plasma omentin levels in patients with stage III colon carcinoma.

PURPOSE: Gastrointestinal carcinomas are ~1.5-2-fold more prevalent in obese populations compared to nonobese ones. Possible factors playing an important role in the association between obesity and cancer include insulin, insulin like growth factor-I, sex steroids and adipocytokines. This study investigated the omentin levels, a novel adipocytokine, in patients with stage III colon carcinomas (CC). METHODS: The study investigated 45 patients with stage III CC who had been treated with surgery and adjuvant oxaliplatin, leucovorin and 5-fluorouracil chemotherapy. The study control group was composed of 35 healthy individuals. RESULTS: The median age of the CC and control groups was 62 (range 32-74) and 56 (range 43-71) years, respectively (p=0.206). There were no significant differences between the CC and control groups in terms of gender (p=0.218), body mass index (BMI) (p=0.218), fasting blood glucose (p=0.487), total cholesterol (TC) (p=0.521), low-density lipoprotein (LDL) (p=0.722), high-density lipoprotein (HDL) (p=0.078), triglycerides (TC) (p=0.698), hemoglobin (p=0.096) and creatinine levels (p=0.130). The median plasma omentin concentration was 618 pg/mL (range 151-758) in the CC group and 376 pg/mL (155-662) in the control group (p<0.001). No significant correlation was found between omentin and the other parameters examined in the CC group. CONCLUSION: Omentin levels are significantly elevated in stage III CC patients treated with surgery and chemotherapy. This elevation was independent of the basic risk factors associated with elevated omentin levels. Future studies of the pathophysiological causes of omentin elevation may facilitate the evaluation of the interactions between CC and adipose tissue.

Determination of Anti-nuclear Antibody Pattern Distribution and Clinical Relationship.

BACKGROUND AND OBJECTIVES: Autoantibodies are immunglobulins occurred directly against autoantigens that are known as endogen antigens. Autoimmune disease is an occasion that the body begins a fight against its own cells and tissues. The antibodies that are created by the body against its own cell nuclei are called as anti-nuclear antibodies (ANA), and one of the methods used for detection and pattern of ANA is indirect immunofluorescence test (IIF). In the present study, it was aimed to determine the rate of ANA positivity and patterns of the positive specimens, and to investigate the relationship between ANA positivity and diseases in patients. METHODS: ANA test results of a total of 3127 patients admitted during March 2010 to December 2012 were evaluated retrospectively. ANA test (HEp 20-10, EUROIMMUN, Germany) was used in dilution of 1:100 in IIF test. RESULTS: A total of 494 (15.8%) resulted as ANA positive. ANA positivity rate was significantly higher in female patients than the male ones (p<0.001). The most frequent ANA patterns were coarse speckled pattern (154 patients, 31.2%), nucleolar pattern (89 patients, 18.0%), fine speckled pattern (57 patients, 11.5%), and speckled pattern (48 patients, 9.7%). ANA positivity was most commonly determined in rheumatoid arthritis (RA) (42 patients, 8.5%), systemic lupus erythematosus (SLE) (29 patients, 5.9%), and rheumatoid vasculitis (RV) (28 patients, 5.7%). The most frequent symptoms or findings were joint pain (127 patients, 26.0%) and anemia (28 patients, 5.7%). ANA positivity rates were found to be significantly higher in patients with RA (p<0.001), with SLE (p<0.001), and with Raynaud phenomenon (p=0.001) in comparison to the controls. Amongst the most frequent diseases evaluated, no significant differences were found between the control groups and the groups of RV (p=0.089), multiple sclerosis (p=0.374), and Sjögren syndrome (p=0.311) in terms of ANA positivity rates. CONCLUSIONS: The present study is the first study reporting the positivity rate and distribution of ANA in Bolu located in northwestern Turkey. Information about the pattern types and the distribution of the patterns according to the diseases and symptoms contribute in diagnosis of autoimmune diseases. It is observed that clinical diagnosis has been supported significantly by ANA test according to data of our study.

Serum C-reactive protein to albumin ratio as a reliable marker of diabetic neuropathy in type 2 diabetes mellitus.

In various diseases characterized by inflammation, the C-reactive protein to albumin ratio (CAR) serves as a marker of inflammation. Type 2 diabetes mellitus (T2DM) is frequently complicated by diabetic neuropathy (DN) and timely diagnosis is crucial for treatment and potential reversal of this complication. Since both DN and T2DM are associated with chronic, low-grade inflammation, our study aimed to evaluate CAR levels in type 2 diabetic subjects with DN and compare them to those in subjects without DN. Patients presenting to our institutional outpatient clinics were divided into two groups based on the presence of DN. Data on characteristics and laboratory measures, including CAR, were compared between the DN and non-DN groups. The median CAR in the DN and non-DN group was 2.19% (range 0.2 - 49%) and 0.56% (range 0.02 - 5.8%), respectively (P < 0.001). CAR showed significant positive correlations with weight (r = 0.19, P = 0.01), body mass index (BMI) (r = 0.11, P = 0.03), waist circumference (r = 0.10, P = 0.046), fasting glucose (r = 0.14, P = 0.004), serum creatinine (r = 0.25, P < 0.001), triglyceride (r = 0.17, P < 0.001), and low density lipoprotein (LDL)-cholesterol (r = 0.13, P = 0.001) levels, and an inverse correlation with estimated glomerular filtration rate (eGFR) (r = -0.16, P <0.001). Additionally, CAR demonstrated a sensitivity of 78% and specificity of 73% for predicting DN at a threshold of 1.02% (area under curve [AUC] 0.84, 95% confidence interval [CI] 0.82 - 0.87, P < 0.001). High CAR levels were independently associated with an increased risk of DN (odds ratio [OR] 1.34, 95% CI 1.08 - 1.62, P < 0.001). Elevated CAR levels may thus be considered a potential marker for DN in T2DM patients.

Current usage of long-acting insulin analogs in patients with type 2 diabetes mellitus.

INTRODUCTION: Insulin treatment is fundamental to diabetes management. Basal insulin therapy reduces intraday glycemic fluctuations upon reaching a steady state. Besides better blood glucose regulation and achieving target HbA1c values in patients, it also offers protection from diabetes complications. In this review, we aimed to compare basal-acting insulins in light of the literature. AREAS COVERED: We reviewed current evidence related to diabetes treatment with basal insulins. This includes discussions on clinical trials and meta-analyses concerning first and second-generation ultra-long-acting basal insulins. Treatment indications for long-acting basal insulins, which have shown benefits and are considered superior or comparable to others in the literature, are derived from current clinical studies and meta-analyses, which form the basis of the recommendations in this review. EXPERT OPINION: First and second-generation basal insulins do not show much superiority over each other in terms of blood glucose regulation and reaching the target HbA1c. However, second-generation basal insulins cause fewer hypoglycemic events. We recommend using the appropriate basal insulin in patient-based, individualized treatments. Basal insulin Icodec may become more widely used over time, owing to its association with less hypoglycemia and a reduction in the number of injections.

Controlling Nutritional Status (CONUT) score is a novel marker of type 2 diabetes mellitus and diabetic microvascular complications.

OBJECTIVES: Type 2 diabetes mellitus (T2DM) and its microvascular complications are characterized by chronic inflammation. The Controlling Nutritional Status (CONUT) score is a tool used to assess nutritional status and is often associated indirectly with inflammatory processes. We aimed to compare the CONUT scores of T2DM patients with those of healthy volunteers and to compare T2DM patients with and without microvascular complications. METHODS: Patients diagnosed with T2DM and healthy volunteers (as controls) were included in the study. The CONUT score is calculated using the following formula: serum albumin score + total cholesterol score + total lymphocyte count score. CONUT scores of T2DM patients and healthy controls, as well as those of diabetics with and without microvascular complications, were compared. RESULTS: The CONUT scores of the T2DM and control groups were (1 [0-7]) and (0 [0-2]), respectively (p < 0.001). The sensitivity and specificity of the CONUT score (<1.5 threshold) in detecting T2DM were 43% and 90%, respectively (AUC: 0.67, p < 0.001, 95% CI: 0.64-0.71). Moreover, the CONUT score was an independent risk factor for T2DM (OR: 0.34, p < 0.001, 95% CI: 0.22-0.52). The CONUT score of T2DM patients with microvascular complications (2 [0-7]) was significantly higher than that of T2DM patients without microvascular complications (0 [0-4]) and control subjects (0 [0-2]) (p < 0.001). A CONUT score higher than 1.5 had 83% sensitivity and 92% specificity in detecting T2DM with microvascular complications (AUC: 0.91, p < 0.001, 95% CI: 0.89-0.93). CONCLUSION: The CONUT score could be useful in detecting diabetic microvascular complications in clinical practice, as it is an inexpensive and easy-to-assess marker.

Insulin Abuse: A Case Report of Munchausen Syndrome.

Hypoglycaemia in individuals with diabetes is defined as the presence of signs or symptoms in addition to potentially occurring abnormal plasma glucose levels in the patient. Munchausen Syndrome (MS) is characterized by the deliberate induction of physical or psychological symptoms or the act of pretending to have symptoms. Patient reports of this factitious disease pattern are limited in the literature. The diagnosis and treatment of this syndrome, which is among factitious disorders, is very difficult. Endocrinological complaints are very common among those admitted to the hospitals. BACKGROUND: Unnecessary and numerous examinations cause financial losses and loss of time for both the individual and the healthcare system. In this case report, we aimed to discuss the management of a patient who tried to gain secondary gain by creating artificial hypoglycemia attacks. CASE REPORT: In this case report, the diagnosis of Munchausen syndrome given to a 28-year-old female patient who was diagnosed with type I diabetes and repeatedly admitted to the hospital due to hypoglycemia attacks is discussed. CONCLUSION: Munchausen syndrome is an important and often overlooked diagnosis that should be kept in mind due to the possibility of individuals harming themselves unpredictably, as well as causing disruptions in the healthcare system and wasting time due to numerous and unnecessary examinations and evaluations. For this reason, it is a diagnosis that should be kept in mind in cases of unexplained hypoglycemia attacks.

Could a reduced hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict autoimmune hepatitis and degree of liver fibrosis?

OBJECTIVE: Autoimmune hepatitis is a rare inflammatory disease of the liver that is characterized by elevated liver enzymes. The hemoglobin, albumin, lymphocyte, and platelet score, which is derived from hemoglobin, serum albumin, circulating lymphocyte count, and platelet count, is also associated with inflammatory conditions. The aim was to examine the hemoglobin, albumin, lymphocyte, and platelet score of patients with autoimmune hepatitis and to compare it to that of healthy individuals in this retrospective analysis. METHODS: Subjects diagnosed with autoimmune hepatitis were enrolled in the study, and healthy individuals were enrolled as controls. Moreover, autoimmune hepatitis subjects were grouped into mild or moderate/advanced fibrosis. Furthermore, aspartate to platelet ratio index, Fibrosis-4, and hemoglobin, albumin, lymphocyte, and platelet scores of the autoimmune hepatitis patients and controls were compared. In addition, the hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients with mild fibrosis is compared to that of those with moderate/advanced fibrosis. RESULTS: The mean hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients was 44.2±14.5 while this value was 76.8±15.5 in control subjects. The hemoglobin, albumin, lymphocyte, and platelet score was significantly reduced in autoimmune hepatitis patients than healthy controls (p<0.001). The hemoglobin, albumin, lymphocyte, and platelet score was significantly and negatively correlated with C-reactive protein, aspartate, alanine transaminase, gamma glutamyl transferase, aspartate to platelet ratio index, and Fibrosis-4 values. A hemoglobin, albumin, lymphocyte, and platelet score that was lower than 52.3 had 83% sensitivity and 73% specificity in predicting autoimmune hepatitis. The sensitivity and specificity of the hemoglobin, albumin, lymphocyte, and platelet score were higher than the Fibrosis-4 score in predicting moderate/advanced fibrosis in autoimmune hepatitis. CONCLUSION: We suggest that the hemoglobin, albumin, lymphocyte, and platelet score be used as an additional noninvasive diagnostic tool for autoimmune hepatitis and to predict moderate/advanced liver fibrosis in patients with autoimmune hepatitis.