Fatigue and Impact Properties of Kenaf/Glass-Reinforced Hybrid Pultruded Composites for Structural Applications.

To address the weight, cost, and sustainability associated with fibreglass application in structural composites, plant fibres serve as an alternative to reduce and replace the usage of glass fibres. However, there remains a gap in the comprehensive research on plant fibre composites, particularly in their durability for viable structural applications. This research investigates the fatigue and impact properties of pultruded kenaf/glass-reinforced hybrid polyester composites tailored for structural applications. Utilising kenaf fibres in mat form, unidirectional E-glass fibre direct roving yarns, and unsaturated polyester resin as key constituents, pultruded kenaf/glass hybrid profiles were fabricated. The study reveals that pultruded WK/UG alternate specimens exhibit commendable fatigue properties (18,630 cycles at 60% ultimate tensile strength, UTS) and fracture energy (261.3 kJ/m2), showcasing promise for moderate load structural applications. Notably, the pultruded 3 WK/UG/3WK variant emerges as a viable contender for low-load structural tasks recorded satisfactory fatigue properties (10,730 cycles at 60% UTS) and fracture energy (167.09 kJ/m2). Fatigue failure modes indicate that the stress applied is evenly distributed. Ductile failures and delaminations during impact test can be attributed to damping and energy absorbing properties of kenaf fibres. Moreover, incorporating kenaf as a hybrid alternative demonstrates substantial reductions in cost (35.7-50%) and weight (9.6-19.1%). This research establishes a foundation for advancing sustainable and efficient structural materials and highlights the significant role of materials design in shaping the future of engineering applications.

Glycemic responses to whole grain sourdough bread versus refined white bread in patients with gestational diabetes.

BACKGROUND: Nutritional therapy remains a key tool for prevention and management of gestational diabetes (GDM). Carbohydrate type and absorption rate rather than the carbohydrate amount have more impact on postprandial glucose (PPG) levels in GDM. The effect of refined white bread and whole grain sourdough bread on glycemic indexes were compared in GDM patients. METHODS: A total of 43 patients with GDM and 38 healthy pregnant women were included. A similar breakfast menu was given to both groups of patients at two different times in consecutive weeks; however, different types of bread with the same weight were used for both breakfasts; 1) white wheat (WW) bread, 2) sourdough whole grain wheat (SWGW) bread. Blood glucose, insulin and C­peptide levels were compared before and after breakfast. RESULTS: Fasting glucose, insulin and c­peptide levels were similar between groups (p > 0.05). While the second hour glucose levels were similar between the groups, the first hour results of glucose, insulin and C­peptide levels were lower in the SWGW group (p < 0.05). In the control patients, first hour glucose, insulin and C­peptide levels were also lower in the SWGW group (p < 0.05). CONCLUSION: The WW bread, which is more preferred in daily life routine, causes 45.5% more insulin secretion and 9.6% more first hour postprandial blood glucose compared to SWGW bread both in GDM patients and healthy pregnant women. According to the results of this study, we recommend that sourdough whole grain bread should be preferred in order to increase the success in the management of GDM.

Numerical Investigation into GFRP Composite Pipes under Hydrostatic Internal Pressure.

Glass-fiber-reinforced plastic (GFRP) composite pipes are used extensively in high-performance applications, due to their high stiffness and strength, corrosion resistance, and thermal and chemical stability. In piping, composites showed high performance due to their long service life. In this study, glass-fiber-reinforced plastic composite pipes with [±40]3, [±45]3, [±50]3, [±55]3, [±60]3, [±65]3, and [±70]3 fiber angles and varied pipe wall thicknesses (3.78-5.1 mm) and lengths (110-660 mm) were subjected to constant hydrostatic internal pressure to obtain the pressure resistance capacity of the glass-fiber-reinforced plastic composite pipe, hoop and axial stress, longitudinal and transverse stress, total deformation, and failure modes. For model validation, the simulation of internal pressure on a composite pipe installed on the seabed was investigated and compared with previously published data. Damage analysis based on progressive damage in the finite element model was built based on Hashin damage for the composite. Shell elements were used for internal hydrostatic pressure, due to their convenience for pressure type and property predictions. The finite element results observed that the winding angles from [±40]3 to [±55]3 and pipe thickness play a vital role in improving the pressure capacity of the composite pipe. The average total deformation of all designed composite pipes was 0.37 mm. The highest pressure capacity was observed at [±55°]3 due to the diameter-to-thickness ratio effect.

A genome-wide association study with tissue transcriptomics identifies genetic drivers for classic bladder exstrophy.

Classic bladder exstrophy represents the most severe end of all human congenital anomalies of the kidney and urinary tract and is associated with bladder cancer susceptibility. Previous genetic studies identified one locus to be involved in classic bladder exstrophy, but were limited to a restrict number of cohort. Here we show the largest classic bladder exstrophy genome-wide association analysis to date where we identify eight genome-wide significant loci, seven of which are novel. In these regions reside ten coding and four non-coding genes. Among the coding genes is EFNA1, strongly expressed in mouse embryonic genital tubercle, urethra, and primitive bladder. Re-sequence of EFNA1 in the investigated classic bladder exstrophy cohort of our study displays an enrichment of rare protein altering variants. We show that all coding genes are expressed and/or significantly regulated in both mouse and human embryonic developmental bladder stages. Furthermore, nine of the coding genes residing in the regions of genome-wide significance are differentially expressed in bladder cancers. Our data suggest genetic drivers for classic bladder exstrophy, as well as a possible role for these drivers to relevant bladder cancer susceptibility.

Association of C-reactive Protein/Albumin, Procalcitonin/Albumin, Platelet/Lymphocyte, and Lymphocyte/Monocyte Ratio with Mortality in Hospitalised COVID-19 Patients.

OBJECTIVE: To investigate and compare complete blood count and biochemistry parameters such as c-reactive protein/albumin (CRP/ALB) ratio, procalcitonin/albumin (PRO/ALB) ratio, lymphocyte/monocyte (LYM/MON) ratio, platelet/lymphocyte (PLT/LYM) ratio of the recovered/deceased, and ICU (intensive care unit) /ward patients with COVID-19. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Internal Medicine, Sakarya University Training and Research Hospital, Turkey, from April 2020 to January 2021. METHODOLOGY: The study was conducted with 590 diagnosed patients with COVID-19. The patients were divided into 2 groups as deceased (n = 294) /survivor (n = 296) and those in need of ICU (n= 418) /ward (n = 172). The information was obtained from the hospital information system and analysed retrospectively. The relationships of crp/alb, pro/alb, lym/mon, and PLT/LYM ratios with patient groups were investigated. RESULTS: Of the total 590 patients in the study, 358 (60.6%) were males. The total mean age was 65.63 ±14.9 years. The mean age of survivor and deceased groups was 71.32±10.9 and 59.97±16.2 years, respectively (p.

Selection of Natural Fibre for Pultruded Hybrid Synthetic/Natural Fibre Reinforced Polymer Composites Using Analytical Hierarchy Process for Structural Applications.

Application of synthetic fibres in composites has been raising environmental issues due to carbon emissions from the production site and reliability on non-renewable resources upon production. Hence, this research sets as a preliminary study to select suitable natural fibres to be hybridized with glass fibres for the development of sustainable and high-performance hybrid composites as potential alternative to conventional pultruded fibreglass composites in structural profile applications. In this study, analytical hierarchy process (AHP) was conducted to select the ideal natural fibre as reinforcement in the hybrid pultruded FRP composites suitable for structural applications. Hence, 13 natural fibre candidates were selected as alternatives and six criteria were chosen and analysed to select the best candidate for pultruded hybrid FRP. Criteria such as tensile strength, tensile modulus, density, cellulose content, elongation, and availability of fibres were assigned as the standard of selecting natural fibres for the application intended in this study. Among the 13 alternatives, kenaf was found to be the most suitable reinforcement for the application as it yielded the highest priority vector at 0.1. The results were then validated by carrying out sensitivity analysis to ensure kenaf is the most suitable material for the research.

A Review on the Effect of Fabric Reinforcement on Strength Enhancement of Natural Fiber Composites.

The main objective of this study is to examine the impact of reinforcements on the strength of natural fiber composites. Recent advancements in natural fiber composites have minimized the usage of man-made fibers, especially in the field of structural applications such as aircraft stiffeners and rotor blades. However, large variations in the strength and modulus of natural fiber degrade the properties of the composites and lower the safety level of the structures under dynamic load. Without compromising the safety of the composite structure, it is significant to enrich the strength and modulus of natural fiber reinforcement for real-time applications. The strength and durability of natural fiber can be enriched by reinforcing natural fiber. The reinforcement effect on natural fiber in their woven, braided, and knit forms enhances their structural properties. It improves the properties of natural fiber composites related to reinforcement with short and random-orientation fibers. The article also reviews the effect of the hybridization of natural fiber with cellulosic fiber, synthetic fiber, and intra-ply hybridization on its mechanical properties, dynamic mechanical properties, and free vibration characteristics, which are important for predicting the life and performance of natural fiber composites for weight-sensitive applications under dynamic load.

A Review on Reductions in the Stress-Intensity Factor of Cracked Plates Using Bonded Composite Patches.

In aerospace engineering applications, lightweight material structures are considered to perform difficult service conditions and afford energy efficiency. Therefore, composite materials have gained popularity due to their light weights and high performances in structural design. Mechanical loads and environmental conditions primarily create damage to structural materials, thus numerous studies have considered the repair of the damaged structure. Bonded composite repairs are generally chosen, as they provide enhanced stress-transfer mechanisms and joint efficiencies with the increased use of advanced composite materials in primary and secondary aircraft structural components. Thus, it is essential to have reliable and repeatable bonded repair procedures to restore damaged structural components. However, composite bonded repairs, especially with primary structures, present several scientific challenges in the current existing repair technologies. In this review, a study has been done on the bonded composite repair of damaged structures with the stress-intensity factor (SIF) as the parameter for defining the extent of failure by composite repair and unrepaired material structures. In this work, various types of repair methods and the techniques used by researchers are critically reviewed, and future opportunities are explored. The present study was limited to the composite and aluminium materials that are common in aerospace applications.

Use of nailfold video capillaroscopy in polycythemia vera.

Objectives: In this study, we aimed to investigate capillary vessel diameters and structural changes of capillaries by using nailfold video capillaroscopy (NVC) in patients with polycythemia vera (PV). Patients and methods: This cross-sectional study included a total of 24 patients (19 males, 5 females; mean age: 59.8±12.9 years; range, 50.2 to 68 years) who were diagnosed with PV and 15 healthy controls (11 males, 4 females; mean age: 40.7±5.1 years; range, 36 to 44 years) between June 2016 and February 2017. Nailfold video capillaroscopy was performed by an experienced rheumatologist who was blinded to clinical data. The apical, arterial, and venous limb diameters of capillaries were measured and microvascular changes of capillaries were scored. Results: When capillaries were evaluated in terms of morphological structures, giant capillary was detected in 67% of the patients with PV and 0% in the control group (p<0.05). The arterial, venous, and apical diameters of the capillaries were significantly higher in the patients with PV compared to the control group (p<0.001). Conclusion: The presence of giant capillaries and the marked increase of arterial, venous, and apical diameters of capillaries seem to be related to PV. As it additionally plays an important role in diagnosis, prognosis, and treatment monitoring of certain diseases, capillaroscopy can be considered to be a promising microcirculation biomarker.

The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients.

OBJECTIVES: We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients. METHODS: In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23-73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued. RESULTS: There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG>13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy. CONCLUSION: These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control.

The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis.

BACKGROUND & OBJECTIVE: The relationship between thyroid disorders and dyslipidemia has now been clearly demonstrated, but the relationship between thyroid autoimmunity and dyslipidemia in euthyroid patients is still controversial. Our aim in this study was to determine whether there is a risk of dyslipidemia in our patients with euthyroid hashimoto thyroiditis. METHODS: Fifty-five autoantibody positive hashimoto patients and 55 antibody negative control groups who came to Sakarya University Medicine Faculty Endocrinology Outpatient Clinics between January 2018 and November 2019 were included in our case control study. The groups were similar in terms of age, cardiovascular risk factors and BMI. Both groups were compared according to the lipid profile results. RESULTS: All type of lipids; including LDL (p = 0.008), HDL (p = 0.041), triglyceride (p = 0.045) and total cholesterol (p = 0.002), were higher in the patient group, and these differences were statistically significant. Anti-TPO and Anti-TG antibody titers and lipid levels were evaluated by separate correlation analysis. There was a significant positive correlation between Anti-TPO and LDL (r = 0.331, p <0.001), triglyceride (r = 0.267, p = 0.005) and total cholesterol (r = 0.316, p = 0.001), however no significant correlation was observed between Anti-TPO and HDL. Similarly, there was a significant positive correlation between Anti-TG and LDL (r = 0.318, p = 0.001), triglyceride (r = 0.218, p = 0.022), and total cholesterol (r = 0.301, p = 0.001), but HDL correlation relationship was not detected. CONCLUSION: The relationship between thyroid autoimmunity and dyslipidemia has been demonstrated in our study even in the euthyroid phase. Whether antibody positive patients should be followed more closely for dyslipidemia and cardiovascular events is still controversial. This question will be answered with larger randomized controlled trials.

Erectile dysfunction pattern in patients with end stage renal disease on regular dialysis.

INTRODUCTIONS: Evaluating the epidemiology, pattern, and contributing factors of sexual dysfunction in end-stage renal disease (ESRD) patients is the cornerstone in understanding and enhancing these patients' quality of life. In this study, we aimed to identify the different patterns of erectile dysfunction (ED) among 100 patients undergoing hemodialysis. MATERIALS AND METHODS: A single-center, cross-sectional, study was conducted on 100 patients with ESRD on hemodialysis. Patients were assessed using the International index of erectile dysfunction (IIEF) and Doppler assessment of the penis. RESULTS: A total of 100 patients were included in this study with a mean age of 48.77 ± 9.66 years old. The mean erectile index was 7.10 ± 4.62; while the mean free and total testosterone were 10.07 ± 7.69 and 2.93 ± 1.4 ng/dL, respectively. Overall, 67% of the patients had abnormal hormonal levels. Concerning the penile vasculature, 71% of the patients had arterogenic importance and 19% had venous impotence. The comparative analysis demonstrated that hypertensive patients had lower erectile index (p = 0.002). In addition, smokers had lower erectile index (p < 0.001). There was statistical significance between normal hormonal and abnormal hormone level according to erectile index, with lower index in patients with abnormal hormonal level (p = 0.03). CONCLUSION: In conclusion, our findings indicate that the most common causes of ED with renal failure were hormonal disturbance, including testosterone, and prolactin. Hypertension and smoking are major contributing factors that should be managed carefully to reduce the risk of ED and improve the quality of life.

Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?

OBJECTIVE The present study aimed to investigate the role of neutrophil/lymphocyte ratio (NLR), an inflammation marker, complete blood count, and biochemical parameters in the diagnosis of COVID-19. METHODS A total of 80 patients who had been hospitalized in the internal medicine clinic were enrolled in the study. The cases were allocated into two groups, i.e., COVID (+) and (-), based on real-time reverse transcription-polymerase chain reaction. The demographic, clinical, and laboratory [NLR, platelet/lymphocyte ratio (PLR), complete blood count, biochemistry, and serology] data of the patients were retrospectively obtained from the hospital data management system. RESULTS NLR and fever levels were found to be higher in COVID-19 (+) cases (P=0.021, P=0.001, respectively). There was no difference between males and females with regard to COVID-19 positivity (P=0.527). Total bilirubin levels were found to be lower in COVID-19 (+) cases (P=0.040). When the ROC analysis was carried out for NLR in COVID-19 (+) cases, the AUC value was found to be 0.660 (P=0.021), sensitivity as 69.01 %, specificity as 65.40 %, LR+: 1.98 and LR- : 0.48, PPV: 80.43, and NPV: 50.00, when the NLR was ≥2.4. The risk of COVID-19 was found to be 20.3-fold greater when NLR was ≥ 2.4 in the logistic regression (P=0.007). CONCLUSION NLR is an independent predictor for the diagnosis of COVID-19. We also found that fever and total bilirubin measurements could be useful for the diagnosis of COVID-19 in this population.

Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?

SUMMARY OBJECTIVE The present study aimed to investigate the role of neutrophil/lymphocyte ratio (NLR), an inflammation marker, complete blood count, and biochemical parameters in the diagnosis of COVID-19. METHODS A total of 80 patients who had been hospitalized in the internal medicine clinic were enrolled in the study. The cases were allocated into two groups, i.e., COVID (+) and (-), based on real-time reverse transcription-polymerase chain reaction. The demographic, clinical, and laboratory [NLR, platelet/lymphocyte ratio (PLR), complete blood count, biochemistry, and serology] data of the patients were retrospectively obtained from the hospital data management system. RESULTS NLR and fever levels were found to be higher in COVID-19 (+) cases (P=0.021, P=0.001, respectively). There was no difference between males and females with regard to COVID-19 positivity (P=0.527). Total bilirubin levels were found to be lower in COVID-19 (+) cases (P=0.040). When the ROC analysis was carried out for NLR in COVID-19 (+) cases, the AUC value was found to be 0.660 (P=0.021), sensitivity as 69.01 %, specificity as 65.40 %, LR+: 1.98 and LR- : 0.48, PPV: 80.43, and NPV: 50.00, when the NLR was ≥2.4. The risk of COVID-19 was found to be 20.3-fold greater when NLR was ≥ 2.4 in the logistic regression (P=0.007). CONCLUSION NLR is an independent predictor for the diagnosis of COVID-19. We also found that fever and total bilirubin measurements could be useful for the diagnosis of COVID-19 in this population.

RESUMO OBJETIVO O objetivo do presente estudo foi investigar o papel da razão neutrófilos/linfócitos (RNL), um marcador de inflamação, hemograma completo e parâmetros bioquímicos no diagnóstico de COVID-19. MÉTODOS Um total de 80 pacientes internados na clínica médica foram incluídos no estudo. Os casos foram alocados em dois grupos, COVID (+) e (-), de acordo com a reação em cadeia da polimerase com transcrição reversa em tempo real. Os dados demográficos, clínicos e laboratoriais [NLR, relação plaquetas / linfócitos (PLR), hemograma completo, bioquímica e sorologia]) dos pacientes foram obtidos retrospectivamente no sistema de gerenciamento de dados hospitalares. RESULTADOS Os níveis de NLR e febre foram maiores nos casos de COVID-19 (+) (P = 0,021, P = 0,001,respectivamente). Não houve diferença entre homens e mulheres em relação à positividade para COVID-19 (P = 0,527). Os níveis totais de bilirrubina foram menores nos casos de COVID-19 (+) (P = 0,040). Quando a análise ROC foi realizada para NLR nos casos COVID-19 (+), o valor da AUC foi de 0,660 (P = 0,021), sensibilidade 69,01%, especificidade 65,40%, LR +: 1,98 e LR-: 0,48 , PPV: 80,43 e NPV: 50,00 quando o NLR era> 2,4. The risk of COVID-19 was found to be 20.3-fold greater when NLR was ≥ 2.4 in the logistic regression (P=0.007). CONCLUSÃO NLR é um preditor independente para o diagnóstico de COVID-19. Também concluímos que aferições de febre e bilirrubina total podem ser úteis para o diagnóstico de COVID-19 nesta população.

The evaluation of nailfold videocapillaroscopy findings in patients with type 2 diabetes with and without diabetic retinopathy.

OBJECTIVE: Diabetes mellitus (DM) is a chronic hyperglycemic state and is associated with microvascular structural alterations. This study aimed to investigate the diameters of capillary loops and morphostructural changes using nailfold video capillaroscopy (NVC) in patients with type 2 DM with and without diabetic retinopathy (DR). METHODS: This cross-sectional, single-center study was conducted in patients with type 2 DM who were followed in outpatient clinics of ophthalmology and internal medicine. General demographic data were collected from patients. An ophthalmologist examined all patients in terms of DR. A rheumatologist blinded to the clinical data performed NVC. The diameters of apical, arterial, and venous loop of capillaries were measured, and the microvascular changes of capillaries were scored. RESULTS: In this study, 44 patients with type 2 DM with DR (47.7% males) and 20 patients with type 2 DM without DR (55% males) were included. In our study, patients with type 2 DM with DR had more frequent capillary hemorrhage, more frequent ectasia, more frequent giant capillary, and more frequent neo-angiogenesis than patients with type 2 DM without DR. However, these findings were not statistically significant. CONCLUSION: Further controlled studies with large sample size are needed to determine the characteristic NVC findings of DR in patients with type 2 DM.

Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children.

PURPOSE: Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution. METHODS: A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not. RESULTS: Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003). CONCLUSION: This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.

Arterial Blood Supply of the Nose: An Angiographic Study.

OBJECTIVE: To define anatomical variations associated with arterial blood supply of the nose which has clinical implications on the management of different disorders, especially intractable posterior epistaxis. STUDY DESIGN: Case series. METHODS: Selective angiography of external and internal carotid arteries of 100 patients scheduled for routine angiography was done. RESULTS: Different anatomical variations were documented. The ophthalmic artery can arise from the middle meningeal artery in 1% while ethmoidal arteries can be absent in 5%. The maxillary artery courses as 2 loops in the pterygopalatine fossa in 64% of cases where the descending palatine artery originates before the first loop or on its top so that caution is needed in controlling epistaxis. The sphenopalatine artery has different patterns of branching and may have more than 2 branches in 18% of cases. In 19% of cases, there is cross-circulation between both sides through the nasal blood supply. CONCLUSION: Angiographic study of the nose is a very helpful tool for accurate knowledge of anatomical variations of the arteries with a tremendous effect on our surgical approaches and techniques for the management of different diseases in the nasal region, especially intractable posterior epistaxis.

The relationship between vitamin D deficiency and erythrocyte sedimentation rate in patients with diabetes

Background/aim: Vitamin D deficiency in diabetic patients has been shown to be associated with some inflammatory markers. However, its relationship with erythrocyte sedimentation rate (ESR) is still unknown. The aim of this study was to investigate the relationship between vitamin D deficiency and ESR in patients with type 2 diabetes mellitus (T2DM). Materials and methods: This cross-sectional study was conducted with 294 consecutive patients with T2DM. Serum levels of 25-hydroxyvitamin D, glycemic parameters, lipids, ESR, and C-reactive protein were measured. Patients were evaluated according to 25-hydroxyvitamin D levels as having vitamin D deficiency, vitamin D insufficiency, and vitamin D sufficiency. Results: ESR was found to be higher in patients with vitamin D deficiency than in patients who were vitamin D-sufficient (P < 0.001), and ESR was negatively correlated with 25-hydroxyvitamin D level (r = ­0.265, P < 0.001). HbA1c and postprandial glucose levels were higher in patients with vitamin D deficiency than vitamin D-sufficient patients (P = 0.005 and P = 0.019, respectively). In receiver operating curve analysis, an ESR value of 14.5 mm/h had 70.1% sensitivity and 50.3% specificity for the prediction of vitamin D deficiency. Conclusion: The present study revealed that ESR is higher in T2DM patients with vitamin D deficiency than patients with sufficient vitamin D. There was an inverse association between ESR and vitamin D levels. Furthermore, vitamin D deficiency was related to poor glycemic control.

Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum.

Objective: Higher subclinical enthesitis on US has been reported in IBD and celiac disease, separately. The objective of this study was to compare IBD and celiac disease for enthesitis on US. Higher enthesitis scores in IBD compared with celiac disease would support a shared pathogenic mechanism between IBD and spondyloarthritis, whereas similar scores may suggest a general impact of gut inflammation on the enthesis. Methods: Patients with IBD, celiac disease and healthy controls (HCs) were recruited and 12 entheses were scanned by US, blind to the diagnosis and clinical assessment. Elementary lesions for enthesitis were scored on a scale between 0 and 3, for inflammation, damage and total US scores. Results: A total of 1260 entheses were scanned in 44 patients with celiac disease, 43 patients with IBD and 18 HCs. The three groups were matched for age and BMI. Patients with celiac disease and IBD had higher inflammation scores than HCs [10.4 (6.5), 9.6 (5.4) and 5.6 (5.2), respectively, P = 0.007) whereas damage scores were similar. Both age and BMI had significant effects on the entheseal scores, mostly for inflammation scores but when controlling for these the US enthesopathy scores were still higher in celiac disease and IBD. Conclusion: The magnitude of subclinical enthesopathy scores is similar between celiac disease and IBD in comparison with HCs. These findings suggest that the common factor between both diseases and enthesopathy is abnormal gut permeability, which may be modified by the genetic architecture of IBD leading to clinical arthropathy.

Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review.

The objective of this article is to evaluate the appropriate timing of tracheostomy in patients with prolonged intubationregarding the incidence of hospital-acquired pneumonia, mortality, length of stay in intensive care unit (ICU) and duration of artificial ventilation. The study included published articles yielded by a search concerning timing of tracheostomy in adult and pediatric patients with prolonged intubation. The search was limited to articles published in English language in the last 30 years (between 1987 and 2017). For the 690 relevant articles, we applied our inclusion and exclusion criteria and only 43 articles were included. 41 studies in the adult age group including 222,501 patients and 2 studies in pediatric age group including 140 patients met our criteria. Studies in adult age group were divided into three groups according to the methodology of determining the cut off timing for early tracheostomy, they were divided into studies that considered early tracheostomy within the first 7, 14 or 21 days of endotracheal intubation, while in pediatric age group the cut off timing for early tracheostomy was within the first 7 days of endotracheal intubation. There was a significant difference in favor of early tracheostomy in adults' three groups and pediatric age group as early tracheostomy was superior regarding reduced duration of mechanical ventilation, with less mortality rates and less duration of stay in ICU. Regarding hospital-acquired pneumonia, it was significantly less in adult groups but with no significant difference in pediatric age group (3 patients out of 72 pediatric patient with early tracheostomy had pneumonia compared to 11 patients out of 68 with late tracheostomy). Studies defining early tracheostomy as that done within 7 days of intubation had better results than those defining early tracheostomy as that done within 14 or 21 days of intubation. In conclusion, early tracheostomy within 7 days of intubation should be done for both adults and pediatric patients with prolonged intubation.