Frequency and the effects of spondyloarthritis-spectrum disorders on the clinical course and management of Takayasu arteritis: an observational retrospective study.

OBJECTIVES: Extravascular findings of Takayasu arteritis (TAK) often share features with the spondyloarthritis (SpA) spectrum of disorders. However, the characteristics of this overlap and its effect on the vascular manifestations of TAK are not fully known. Therefore, we aimed to investigate the frequency of SpA-related features in TAK patients. MATERIAL AND METHODS: In this observational retrospective study, 350 patients with TAK classified according to ACR 1990 criteria, from 12 tertiary rheumatology clinics, were included and evaluated for the presence of axSpA, IBD, or psoriasis. Demographic, clinical features, angiographic involvement patterns, disease activity, and treatments of TAK patients with or without SpA were analyzed. RESULTS: Mean age was 45.5 ± 13.6 years and mean follow-up period was 76.1 ± 65.9 months. Among 350 patients, 31 (8.8%) had at least one additional disease from the SpA spectrum, 8 had IBD, 8 had psoriasis, and 20 had features of axSpA. In the TAK-SpA group, TAK had significantly earlier disease onset, compared to TAK-without-SpA (p = 0.041). SpA-related symptoms generally preceded TAK symptoms. Biological treatments, mostly for active vasculitis, were higher in the TAK-SpA group (70.9%) compared to TAK-without-SpA (27.9%) (p < 0.001). Vascular involvements were similar in both. CONCLUSION: Our study confirmed that diseases in the SpA spectrum are not rare in TAK. Vascular symptoms appeared earlier in such patients, and more aggressive therapy with biological agents was required in the TAK-SpA group, suggesting an association between TAK and SpA spectrum. Key Points • The pathogenesis of Takayasu arteritis is mediated by an MHC class I alelle (HLA-B*52), similar to spondyloarthritis-disorders. • Extravascular findings of Takayasu arteritis are in the spectrum of spondyloarthritis disease. • This frequent coexistence between Takayasu arteritis and spondyloarthritic disorders suggests a relationship rather than a coincidence.

Unveiling cancer risk in ANCA-associated vasculitis: result from the Turkish Vasculitis Study Group (TRVaS).

To investigate cancer incidence in patients with ANCA-associated vasculitis (AAV), compare it with the age/sex-specific cancer risk of the Turkish population, and explore independent risk factors associated with cancer. This multicenter, incidence case-control study was conducted using the TRVaS registry. AAV patients without cancer history before AAV diagnosis were included. Demographic and AAV-related data of patients with and without an incident cancer were compared. Standardized cancer incidence rates were calculated using age-/sex-specific 2017 Turkish National Cancer Registry data for cancers (excluding non-melanoma skin cancers). Cox regression was performed to find factors related to incident cancers in AAV patients. Of 461 AAV patients (236 [51.2%] male), 19 had incident cancers after 2022.8 patient-years follow-up. Median (IQR) disease duration was 3.4 (5.5) years, and 58 (12.6%) patients died [7 with cancer and one without cancer (log-rank, p = 0.04)]. Cancer-diagnosed patients were older, mostly male, and more likely to have anti-PR3-ANCA positivity. The cumulative cyclophosphamide dose was similar in patients with and without cancer. Overall cancer risk in AAV was 2.1 (SIR) ((1.3-3.2), p = 0.004); lung and head-neck [primary target sites for AAV] cancers were the most common. In Cox regression, male sex and ≥ 60 years of age at AAV diagnosis were associated with increased cancer risk, while receiving rituximab was associated with decreased cancer risk. Cancer risk was 2.1 times higher in AAV patients than the age-/sex-specific cancer risk of the Turkish population population, despite a high rate of rituximab use and lower dose of cyclophosphamide doses. Vigilance in cancer screening for AAV patients covering lung, genitourinary, and head-neck regions, particularly in males and the elderly, is vital.

Evaluation of a Pressure Injury Prevention Care Bundle in an ICU in Turkey.

OBJECTIVE: To evaluate a pressure injury (PI) prevention care bundle in ICU patients diagnosed with internal diseases. METHODS: The study had a quasi-experimental design and included 98 patients who were diagnosed with internal diseases and hospitalized in the ICU. Patients in the control group (n = 49) received routine clinical care, whereas those in the intervention group (n = 49) received the PI prevention care bundle. Data were collected using a patient information form and the Braden Scale. RESULTS: All patients in the control group and 61.2% of the patients in the intervention group developed PIs. Those in the intervention group who developed PIs did so later on average in comparison with the control group. Patient risk of PI development increased with advanced age, low oxygen saturation, low prealbumin values, and low Braden Scale scores. Fewer PIs developed in the patients in the intervention group despite their longer duration of hospitalization and high glucose levels. CONCLUSIONS: The PI prevention care bundle may help prevent the development of PI.

Effect of perfluoropropane (C3F8) versus sulfurhexafluoride (SF6) tamponades on the retinal microvasculature after macular hole surgery.

PURPOSE: To determine the effects of C3F8 and SF6 gasses by using optical coherence tomography angiography (OCTA) in patients with surgically closed idiopathic full-thickness macular holes (FTMH). METHODS: A prospective, comparative study, in which 38 eyes of 38 patients with an idiopathic FTMH were studied. Twenty patients were randomized to the C3F8 group and 18 patients to the SF6 group. All patients underwent pars plana vitrectomy, internal limiting membrane peeling with 14 % C3F8 or 20 % SF6 gasses. The superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities (VD), foveal avascular zone (FAZ) area in SCP, the choriocapillaris flow area; and subfoveal choroidal thickness (SFCT) were examined at preoperative and postoperative first- and third-month controls using OCTA. RESULTS: When the changes in the FAZ, SFCT, SCP and DCP VDs were compared, no significant differences were found between the groups (p>0.05 for all). It was determined that the 1-mm radius flow area increases in the C3F8 group at the first and third months after the surgery were significantly higher than in the SF6 group (p<0.05). A significant gain was observed in the BCVA values compared to their preoperative values for both groups; however any differences between the C3F8 and SF6 groups in terms of BCVA were not detected in this study. CONCLUSION: This is the first report to compare the effects of C3F8 and SF6 gasses on idiopathic FTMH surgery by using OCTA. C3F8 and SF6 gasses may have similar effect on the remodeling process of vascular tissues.

Electrochemical skin conductances values and clinical factors affecting sudomotor dysfunction in patients with prediabetes, type 1 diabetes, and type 2 diabetes: A single center experience.

BACKGROUND AND AIM: Sudomotor dysfunction is linked to small fibers damage. We investigated sudomotor dysfunction in a large group of participants with diabetes, prediabetes, and nondiabetic healthy subjects. This study aimed to complete knowledge on sudomotor dysfunction in this population, especially regarding the threshold values for the electrochemical skin conductance (ESC) and factors affecting it. MATERIALS AND METHODS: A total of 690 volunteers in four groups were included in the study (type 1 [T1DG]: n = 80, 61.3% women; type 2 diabetes [T2DG]: n = 438, 63.5% women; prediabetes [Pre-DG]: n = 88, 80.7% women; healthy control [HC-G]: n = 84, 67.5% women). All subjects were investigated for clinical diabetic peripheral polyneuropathy and sudomotor dysfunction. The characteristics of participants obtained from outpatient records were evaluated. We used the Sudoscan device to measure ESC which was normalized for BMI, to improve the discriminative capability of the method. RESULTS: Diabetic polyneuropathy was found in 17.5% of T1DG, 27.4% of T1DG, and 10.2% of Pre-DG. The mean ESC/BMI was lower in subgroups with diabetic polyneuropathy than those without. Mean ESC/BMI was lowest in T2DG and highest in HC-G but comparable in T1DG and Pre-DG. We accepted the "mean ESC/BMI-1 SD" in the HC-G as the threshold for sudomotor dysfunction. Accordingly, the prevalence of sudomotor dysfunction was 18.8%, 44.3%, 59.1%, and 15% in T1DG, T2DG, Pre-DG, and HC-G, respectively. In T2DG, sudomotor dysfunction was found in 66.7% of persons with retinopathy, of which 56.3% had clinical diabetic polyneuropathy. The prevalence of sudomotor dysfunction in subjects with peripheral artery disease, chronic kidney disease, cardiovascular disease, and hypertension was 46.7%, 47.4%, 43.4%, and 50%, respectively, and 42.9%, 38.9%, 45.5%, and 37.3% of whom in the same order detected with clinical diabetic polyneuropathy. Considering the entire group, a logistic regression model demonstrated that the variables associated with SMD were: retinopathy (OR: 2.969; 95% CI: 1.723, 5.114), female gender (OR: 1.952; 95% CI: 1.287, 2.962), and e-GFR (OR: 0.989; 95% CI: 0.981, 0.998). Since the rate of complications was very low in T1DG, excluding this group, a new model similarly revealed that retinopathy and female gender were associated with SMD, however, the association with e-GFR was disappeared. CONCLUSION: The prevalence of sudomotor dysfunction is high when established peripheral polyneuropathy was present in diabetes. Even though, sudomotor dysfunction can also occur before clinical polyneuropathy in both types of diabetes (T1DG: 18.8%, T2DG 44.3%), prediabetes (59.1%), and nondiabetic healthy subjects (15%). The variables associated with sudomotor dysfunction were retinopathy and female sex. Normalization of ESC for BMI would be a beneficial approach. However, before this method is included in the routine screening programs for diabetic polyneuropathy, large-scale and prospective studies are required to reach a consensus on the pathological threshold values.

The relationship between health literacy and successful aging in elderly individuals with type 2 diabetes.

OBJECTIVE: In the study, it was aimed to evaluate the relationship between health literacy and successful aging in elderly individuals with type 2 diabetes. METHODS: This descriptive study was conducted with the participation of 415 elderly patients with type 2 diabetes who presented to the diabetics outpatient clinic between April-September 2021. The study data were collected through Identifying Information Form, Health Literacy Scale, and Successful Aging Scale. In the analysis of the data, descriptive statistics, Pearson correlation analysis, One-Way ANOVA, and student's t test were used. RESULTS: Health Literacy Scale total mean score of the elderly individuals was found as 55.50 ± 6.08, and their Successful Aging Scale total mean score was determined to be 38.91 ± 2.05. A positive correlation was found between Health Literacy Scale total mean score and Successful Aging Scale total mean score, while a negative relationship was determined between Successful Aging Scale mean score and HbA1c values (p < 0.001). CONCLUSION: As a result of the study, it was concluded that elderly patients with type 2 diabetes who had high levels of health literacy had high levels of successful aging as well.

Pulmonary involvement in antineutrophil cytoplasmic antibody-associated vasculitides: A single center experience from Turkey.

OBJECTIVE: Pulmonary involvement is an important cause of mortality and morbidity in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). In this study, we aimed to evaluate the type and frequency of pulmonary involvement and investigate the potential relationship between thorax computed tomography (CT) signs and other systemic clinical findings in AAV. METHODS: A total of 63 patients over the age of 18 and diagnosed with AAV were included in this study. Thoracic CT imaging findings and clinical features of the patients at the time of diagnosis were retrospectively evaluated. The frequency and distribution of detected pathological findings on imaging according to disease types, in addition to the relationship of these findings with other systemic findings and disease severity, were analyzed. RESULTS: Of 63 patients, 50 (79.4%) had pulmonary symptoms at the time of presentation. Most frequently observed pulmonary finding of thorax CT was nodular opacity. Consolidation, cavitary nodules, bronchiectasis, emphysema and fibrotic sequelae change were more common in the patients with diagnosis of granulomatosis with polyangiitis. Honeycomb, atelectasis, interstitial pneumonia, pulmonary venous congestion and pleural effusion were more common in the patients with diagnosis of microscopic polyangiitis. Ground-glass appearance, central airway disease, peribronchovascular nodules, pericardial effusion and lymphatic adenomegaly (>10 mm) were more common in the patients with diagnosis of eosinophilic granulomatosis with polyangiitis. Interstitial lung disease, pulmonary hemorrhage and severe lung involvement were found significantly increased in patients with myeloperoxidase antibody (MPO)-ANCA positivity (P < 0.05). CONCLUSION: Lung involvement was detected in almost all of the patients with AAV. Both interstitial lung disease and severe lung involvement were more frequently found in patients with MPO-ANCA positivity compared to other patients. Pulmonary examination by an imaging technique in all patients with AAV may be useful to determine the vasculitis subtype and to determine the extent of the disease. PRACTITIONER POINTS: Pulmonary involvement is quite common in AAV. Every patient with suspected AAV should be examined with imaging for lung involvement, even in the absence of respiratory symptoms. Severe pulmonary involvement is associated with the presence of severe disease and MPO-ANCA positivity.

Associations of Nonmotor Symptom Burden, Activities of Daily Living, and Fear of Falling in Parkinson Disease.

ABSTRACT: BACKGROUND: Parkinson disease (PD), a neurodegenerative disease characterized by motor and nonmotor symptoms, can affect the daily activities of individuals. This study was conducted to determine nonmotor symptom burden in patients with PD and to reveal the relationship of nonmotor symptom burden with activities of daily living and fear of falling. METHODS: This cross-sectional and correlational study was carried out with 309 patients given a diagnosis of PD. The data were collected using a personal information form, the Non-Motor Symptoms Scale, the Katz Activities of Daily Living Scale, and the Fear of Falling Questionnaire. RESULTS: Whereas 70.2% of the patients had very high nonmotor symptom severity levels, 33.7% were semidependent or dependent in terms of performing their activities of daily living. The fear of falling was experienced by 32.7% of the patients. A statistically significant inverse relationship was found between the mean Non-Motor Symptoms Scale scores of the patients and their mean Katz Activities of Daily Living Scale and Fear of Falling Questionnaire scores ( P < .05). Nonmotor symptom burden independently explained 66% of the total variance in the performance of activities of daily living and 69% of the total variance in fear of falling ( P < .01). CONCLUSION: Nonmotor symptom burden in PD patients is a significant determinant for participation in activities of daily living and fear of falling. Nurses should approach patients with PD with a focus not only on assessing motor symptoms but also on assessing nonmotor symptoms.

The relationship between diabetes burden and successful ageing in diabetic elderly patients.

OBJECTIVE: The aim of this study was to determine the diabetes burden in elderly individuals along with successful ageing, which defines how well individual ages contribute to coping with the disease and diabetes management. This study also aimed to evaluate the relationship between diabetes burden and successful ageing in elderly individuals with type 2 diabetes. METHODS: The data for this descriptive study were collected from 526 individuals who were 65 years old patients diagnosed with type 2 diabetes in the diabetes polyclinic of a research and training hospital between January and June 2021. RESULTS: It was found that the Successful Ageing Scale score was higher in women, those who had regular diabetes control, and those who had easy access to health services. Elderly Diabetes Burden Scale scores were found to be higher in men, those whose diabetes treatment was insulin, and those with poor perceived health status. No statistically significant relationship was determined between the Elderly Diabetes Burden Scale total score and the Successful Ageing Scale total score (p>0.05). CONCLUSION: Accordingly, by enabling the elderly to have easy access to healthcare services, preventing complications, and providing elderly healthcare services, it will be possible to reduce the diabetes burden in the elderly and enable them to age successfully.

Spiritual Well-being, Diabetes Burden, Self-management, and Glycemic Control Among Patients with Type 2 Diabetes in Turkey: A Descriptive and Correlational Study.

Spiritual well-being is considered a significant factor in helping to manage chronic diseases and cope with the disease process. This descriptive-correlational study aimed to investigate the relationship between spiritual well-being, diabetes burden, self-management, and among 300 outpatients with type 2 diabetes in Turkey. A significant relationship was found between the diabetes burden and self-management levels and the spiritual well-being of patients with diabetes (p < 0.005). Multiple linear regression analyses found that a high diabetes burden (ß = -0.106) decreased well-being, and high self-management increased well-being (ß = 0.415). Additionally, the results revealed that marital status, household members, performing daily life activities alone, hospitalization due to complications, diabetes burden, self-management, glycemic control, and blood lipid parameters explained 29% of the total variance in the spiritual well-being level. Accordingly, the present study recommended that health professionals should consider spiritual well-being to support disease management with a holistic approach to diabetes patients.

Comparison of sexual functions in women with and without type 1 diabetes.

OBJECTIVE: This study aimed to investigate female sexual function in patients with type 1 diabetes by comparing female sexual function index scores between women with and without type 1 diabetes. METHODS: A total of 62 women with type 1 diabetes and 69 age-matched women without diabetes but with similar backgrounds were enrolled in the patient and control groups, respectively. All participants were sexually active and had no systemic diseases other than diabetes in the patient group. RESULTS: The frequency of female sexual dysfunction was significantly higher, and the mean female sexual function index score was significantly lower in women with diabetes compared to the control group (p=0.01). There was a significant relationship between sexual dysfunction and duration of diabetes, glycosylated hemoglobin test, and body mass index (p<0.05). CONCLUSION: This study demonstrates that female sexual dysfunction is more common among women with type 1 diabetes than among women without type 1 diabetes. Patients with type 1 diabetes should be evaluated in terms of sexual health. Health professionals should give more attention to and provide guidance regarding sexual function in women with type 1 diabetes.

Comparison of sexual functions in women with and without type 1 diabetes

SUMMARY OBJECTIVE: This study aimed to investigate female sexual function in patients with type 1 diabetes by comparing female sexual function index scores between women with and without type 1 diabetes. METHODS: A total of 62 women with type 1 diabetes and 69 age-matched women without diabetes but with similar backgrounds were enrolled in the patient and control groups, respectively. All participants were sexually active and had no systemic diseases other than diabetes in the patient group. RESULTS: The frequency of female sexual dysfunction was significantly higher, and the mean female sexual function index score was significantly lower in women with diabetes compared to the control group (p=0.01). There was a significant relationship between sexual dysfunction and duration of diabetes, glycosylated hemoglobin test, and body mass index (p<0.05). CONCLUSION: This study demonstrates that female sexual dysfunction is more common among women with type 1 diabetes than among women without type 1 diabetes. Patients with type 1 diabetes should be evaluated in terms of sexual health. Health professionals should give more attention to and provide guidance regarding sexual function in women with type 1 diabetes.

Medical Device-Related Pressure injuries in adult intensive care units.

AIM AND OBJECTIVE: This study was conducted to examine the development, characteristics, and risk factors of medical device-related pressure injury (MDRPI) in intensive care units (ICU). BACKGROUND: The number of individuals admitted to ICU increased in the last years all over the world. In parallel with this need, the frequency of the use of life-support and therapeutic medical devices in the ICU also increases. This situation may lead to the development of MDRPI in the ICU and an increase in its prevalence. METHOD: The study, which was conducted observationally, prospectively and descriptively, included 302 patients who were hospitalised in an ICU within a year. The study was reported according to the STROBE Declaration. RESULTS: It was observed that MDRPI developed in 27.2% of the patients. It was found that MDRPI developed the most in the nose (26.8%) and mouth (15.9%) regions of the patients. It was determined that MDRPI was diagnosed in 28% of the patients within 3-5 days. It was determined that mostly orthopaedic devices (plaster, cervical collar, splint) (62.5%), fasteners (57.1%), non-invasive ventilation/oxygen masks (51.2%) caused the development of MDRPI. It was found that the number of medical devices used was higher, and the number of hospitalisation days in the ICU was also higher, and these factors explained 28.3% of the total variance in the development of MDRPI. CONCLUSION: It was determined that MDRPI developed in approximately one of four patients in the ICU and that the numbers of medical devices and hospitalisation days were important determinant risk factors. RELEVANCE TO CLINICAL PRACTICE: The high rate of development of MDRPI is worrying in terms of nursing care quality. It is recommended that nurses recognise risk factors in order to prevent the development of MDRPI, evaluate the suitability, necessity, and safety of the devices to be used is located.

Telemedicine as a Motivational Tool to Optimize Metabolic Control in Patients with Diabetes in Turkey: A Prospective, Randomized, Controlled TeleDiab Trial.

Introduction: Telemedicine is a follow-up system that can improve the quality of management and cost-effectiveness of rapidly increasing diabetes patients. Methods: Two hundred adult patients with diabetes were enrolled in this prospective, randomized study. Consecutive patients were divided equally into two groups. Both groups received routine care visits quarterly. TeleDiab group also sent self-monitoring of blood glucose data and received short message service over the transmission system for 12 months. After the study was completed, all patients continued their routine care visits, and their data were evaluated for another 12 months. Six years after the initial study, patients were contacted by phone during the Covid-19 lockdown, and their status was assessed. Results: At the end of the study, glycemic control, kidney function, and lipid parameters of the TeleDiab group were statistically significantly better than the Usual Care group. There was no significant change in the weights of the patients. It was observed that this state of wellbeing continued both at the end of the second year and during the Covid-19 lockdown. Individuals with type 2 diabetes were found to benefit more from telemedicine. Discussion: It has been beneficial to guide patients with applications such as TeleDiab in diseases such as diabetes that require lifelong follow-up. On the other hand, the importance of telemedicine programs in the management of chronic diseases in the current pandemic conditions has come to the fore even more. Telemedicine is an effective motivational tool to ensure optimal control not only of glycemic but also of kidney and lipid parameters.

Could systemic immune inflammation index be a new parameter for diagnosis and disease activity assessment in systemic lupus erythematosus?

PURPOSE: Systemic immune inflammation index (SII) has been used as a marker of inflammatory status in various diseases, but its role in systemic lupus erythematosus (SLE) is unknown. We aimed to investigate the role of SII in SLE and its association with disease activity and renal involvement. METHODS: In this retrospective study, 76 patients with SLE were compared with 76 age- and gender-matched healthy control group in terms of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). SLE Disease Activity Index 2000 system (SLEDAI-2 K) was used to divide the SLE patients into an inactive group (SLEDAI-2 K < 9) and an active group (SLEDAI-2 K ≥ 9). Correlations between the ratios and both disease activity and renal involvement were analyzed. RESULTS: SLE patients had a higher level of SII compared with controls. The ability of SII in predicting SLE (AUC = 0.626) was lower than NLR (AUC = 0.723) and PLR (AUC = 0.666). SII was positively correlated with C-reactive protein (r = 0.288. p = 0.01), but no association between SII and SLEDAI-2 K scores was found. Significantly higher values of NLR, but not SII, were detected in patients with nephritis (p = 0.04). The best NLR cut-off value to predict SLE patients with nephritis was 2.32, with 78.5% sensitivity and 56.2% specificity. CONCLUSION: For the first, we demonstrated that SII level was elevated in patients with SLE. However, NLR is a better marker than SII in predicting SLE and could serve as an indicator of nephritis. Larger-scale studies should be carried out to confirm our results.

The relationship between diabetes burden and successful ageing in diabetic elderly patients

SUMMARY OBJECTIVE: The aim of this study was to determine the diabetes burden in elderly individuals along with successful ageing, which defines how well individual ages contribute to coping with the disease and diabetes management. This study also aimed to evaluate the relationship between diabetes burden and successful ageing in elderly individuals with type 2 diabetes. METHODS: The data for this descriptive study were collected from 526 individuals who were 65 years old patients diagnosed with type 2 diabetes in the diabetes polyclinic of a research and training hospital between January and June 2021. RESULTS: It was found that the Successful Ageing Scale score was higher in women, those who had regular diabetes control, and those who had easy access to health services. Elderly Diabetes Burden Scale scores were found to be higher in men, those whose diabetes treatment was insulin, and those with poor perceived health status. No statistically significant relationship was determined between the Elderly Diabetes Burden Scale total score and the Successful Ageing Scale total score (p>0.05). CONCLUSION: Accordingly, by enabling the elderly to have easy access to healthcare services, preventing complications, and providing elderly healthcare services, it will be possible to reduce the diabetes burden in the elderly and enable them to age successfully.