Capillaroscopic appearance of nailfold vasculature of diabetic nephropathy patients

ABSTRACT Objectives: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Subjects and methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusions: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.

Capillaroscopic appearance of nailfold vasculature of diabetic nephropathy patients.

Objective: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusion: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.

Evaluation of Inappropriate Medication Use and Compliance in Elderly People.

OBJECTIVE: The aim of this study is to evaluate the potentially inappropriate medication use and medication compliance in elderly patients who buy prescribed drugs from a pharmacy in Ankara. METHODS: In this cross-sectional field study, 200 older people who bought prescribed drugs from a pharmacy which is close to several hospitals in Ankara in April 2016 were chosen as random sample. A questionnaire consisting of questions related to socio-demographic characteristics, health status, drug use of elderly and Morisky Green Levine Medication Adherence Scale (MGLS) was used to collect data. The appropriateness of the drugs prescribed for elderly was determined by the pharmacist according to Beers criteria. The data were evaluated by descriptive statistics and Chi-Square test. RESULTS: 57.4% of the 200 elderly patients in the study are women and the mean age is 72.55 ± 6.34 years; 72.6% of them are below high school. When the medication compliance was examined, 36.3% of them did not comply with the drug treatment according to MGLS. It was determined that having sufficient information about the drug, education level, occupation and polymorbidity affect medication adherence (p <0.05). When the appropriateness evaluated according to Beers Criteria, 41.7% of the subjects were prescribed potentially inappropriate medications (PIM). According to the analysis, the number of drugs prescribed and the type of the chronic disease have effects on the inappropriate prescription (p <0.05). CONCLUSION: According to the study, the prevalence of inappropriate medication use in the elderly is higher than the medication non-adherence.

Effects of early life factors on the health and quality of life of older adults.

BACKGROUND: Few studies on the effects of early life factors on the health and quality of life of adults have been conducted in Turkey. We aimed to investigate the effects of early life factors on the health and quality of life of older adults. METHODS: We administered a questionnaire to 350 adults, aged 50-89 years, living in Cankaya, Ankara. The questionnaire covered sociodemographic characteristics, early life characteristics, health status, and the World Health Organization Quality of Life-Ageing scale. Data were analyzed using χ 2 tests, independent samples t-tests, one-way anova, and binary logistic regression analysis. RESULTS: The analyses showed that the most important risk factors for chronic disease were being ≥65 years (odds ratio (OR) = 2.34), having a chronic health problem before 18 years of age (OR = 2.48), experiencing prolonged hospitalization or bed rest before 18 years of age (OR = 2.65), and experiencing parental unconcern during early life (OR = 2.13) (P < 0.05). In addition, having a high school education or less includes people who have primary or secondary or high school diploma (OR = 1.65), having lived in a village (OR = 1.65), having a low family economic status (OR = 2.40), and having experienced one negative event (OR = 1.41) or two or more negative events (OR = 1.39) during their early lives were identified as important risk factors for low quality of life (P < 0.05). CONCLUSION: Early life factors are among the important determinants of the health and quality of life of older adults in Turkey.

Contribution of auditory P300 test to the diagnosis of mild cognitive impairment in Parkinson's disease.

Abnormalities in auditory P300 test have been observed in patients with Parkinson's disease (PD). We aimed to investigate whether or not additional electrophysiological tests assist in making the clinical diagnosis of mild cognitive impairment in Parkinson's disease (PD-MCI), and we evaluated P300 changes in patients with non-demented PD and analyzed the correlation between the cognitive features and P300 changes. Twenty patients with PD who had been diagnosed with mild cognitive impairment (PD-MCI group) according to the Movement Disorder Society (MDS) 2012 PD-MCI level II criteria, 21 patients with PD without cognitive impairment (PD-Normal group), and 20 control subjects (control group) who were neurologically normal were examined by the standard auditory oddball paradigm. The N100, P200, N200, and P300 latencies and N100-P200, P200-N200, and N200-P300 amplitudes were measured and analyzed. P300 latencies recorded from Fz, Cz, and Pz and N200 latency recorded from Fz were significantly longer in the PD-MCI group than in the PD-Normal and the control group (respectively p < 0.001, p = 0.041). P300 amplitude recorded from Fz was significantly lower in PD-MCI group than those in the other groups (p = 0.038). While P300 was obtained in all patients in the PD-Normal and the control group, it was lost in 35% of PD-MCI patients. The results show that P300 provides a diagnostic tool for detecting PDMCI. We suggest that P300 prolongation and loss of P300 potential could be used as supportive parameter in the diagnosis of PD-MCI.

Utility of diffusion-weighted MRI in the diagnosis of bladder carcinoma.

BACKGROUND: The purposes of our study were to investigate the feasibility of diffusion-weighted imaging in the detection of malignant bladder tumors, with comparison to the high-resolution thin-section fast spin-echo (FSE) T2-weighted MRI, and also to compare the apparent diffusion coefficient (ADC) values of the bladder tumors with the surrounding structures. MATERIAL AND METHODS: Fifty-three consecutive patients consisting of 44 males and 9 females who presented with a bladder mass were prospectively enrolled in this study. Mean age was 62.53 ± 12.03 (age range, 33-86 years). These patients were evaluated by high-resolution thin-section FSE T2-weighted and diffusion-weighted MRI for the detection of bladder masses. Following MRI, within 2 weeks, all patients were subjected to either surgery or cystoscopic biopsy, and the obtained histopathological proofs were used as the reference standard. Furthermore, ADC values of the bladder tumors, urine, the normal bladder wall, the central and peripheral zones of the prostate, the seminal vesicule, and the uterus outer myometrium were also calculated. ADC values of the bladder carcinomas and the related surrounding structures were compared as to whether a statistically significant difference was present or not. RESULTS: In a total of 47 patients, consisting of 39 males and 8 females, bladder carcinomas were clearly shown as having conspicuous high and intermediate signal intensity masses, relative to the surrounding structures on diffusion-weighted and T2-weighted images, respectively. An 89% sensitivity and a 100% positive predictive value were obtained for both FSE T2-weighted and diffusion-weighted MRI in the diagnosis of bladder carcinoma. Mean ADC values and standard deviations of the bladder tumors and the surrounding structures were as follows: bladder carcinomas (n=47): 1.28 ± 0.31, normal bladder wall (n=47): 1.98 ± 0.41, urine (n=47): 3.12 ± 0.24, seminal vesicle (n=39): 1.82 ± 0.33, peripheral zone of prostate (n=39): 1.80 ± 0.29, central zone of prostate (n=39): 1.55 ± 0.33, and uterus outer myometrium (n=8): 1.53 ± 0.19. It can be clearly seen that the mean ADC values of the bladder carcinomas were significantly lower than the surrounding structures (P<.05). CONCLUSION: High-resolution thin-section FSE T2 and diffusion-weighted MRI show high diagnostic performance and are comparable in the detection of bladder tumors. Diffusion-weighted MRI provides high quality images of the malignant bladder tumors against a suppressed background signal. Diffusion-weighted MRI using ADC measurements may be useful in the evaluation of tumor invasion to the adjacent organs.

Discrepant levels of vascular endothelial growth factor in psoriasis patients treated with PUVA, Re-PUVA and narrow-band UVB.

BACKGROUND: Previous reports showed that serum levels of vascular endothelial growth factor (VEGF) are increased in patients with psoriasis. However, to our knowledge, no studies have evaluated the effects of PUVA, Re-PUVA and narrow-band UVB (NB-UVB) treatments on serum levels of VEGF in patients with psoriasis. OBJECTIVE: The aim of the study was to evaluate the influence of PUVA, Re-PUVA and NB-UVB treatments on angiogenic activities in patients with psoriasis by comparing serum levels of VEGF. METHODS: Forty-six patients with psoriasis and 20 healthy subjects were included in the study. Peripheral blood samples were collected before, during and after the therapies. The efficacy of PUVA, Re-PUVA and NB-UVB was delineated by the psoriasis area and severity index. A repeated measure of ANOVA, Mann-Whitney U-test, chi(2) and Pearson's correlation coefficient were used for statistical analysis. RESULTS: The VEGF levels were significantly decreased in the PUVA group at the end of the follow-up period (P<0.001). However, the levels were significantly increased in the groups of NB-UVB and Re-PUVA (P<0.001). CONCLUSIONS: We found that there was a discrepancy during the PUVA, Re-PUVA and NB-UVB treatments. We believe that VEGF plasma levels could not be a useful monitor of psoriasis activity and/or treatment response.

Androgen receptor levels of oral and genital ulcers and skin pathergy test in patients with Behçet's disease.

BACKGROUND: Hormonal factors have long been proposed to play a role in Behçet's disease (BD). Male sex, systemic onset, HLA-B51 positivity and a younger age of onset in BD are associated with severer disease, and the disease generally runs a milder course in women. Vascular involvement is more common, and the skin pathergy test (SPT) is more strongly positive in men. BD rarely develops before puberty or after the age of 50 years. Clinical manifestations of the disease, with the exception of eye symptoms, tend to improve with time. Therefore, BD may be androgen driven to some degree. OBJECTIVES: We aimed to investigate androgen receptor (AR) levels of oral ulcers (OU), genital ulcers (GU) and SPT areas and compared them with those of adjacent normal-appearing skin/mucosa from patients with BD. METHODS: Thirty-eight patients with BD (16 female, 22 male; mean +/- SD age, 36.45 +/- 10.2 years), diagnosed according to the criteria of the International Study Group for Behçet's Disease, were included in the study with blind histological examination. Biopsies from OU of 10 patients, GU of 11 patients, SPT areas of 17 patients and adjacent (approximately 2 cm distant) normal-appearing skin/mucosa in patients with BD were performed. Nuclear AR levels were studied by an immunohistochemical technique, using monoclonal antibodies. The percentage of positively staining cells was recorded as the AR index (ARI). In addition, the prevalence and the positivity rate of SPT has also been evaluated. RESULTS: ARI values in the lesional and control (non-lesional adjacent) skin/mucosa were found to be 14.5 versus 18% for OU, 28.7 versus 25.5% for GU and 36.3 versus 21.8% (p = 0.068) for SPT areas. The positive SPT areas in male patients showed a higher ARI than those of female patients (43.36 and 23.33%; p = 0.078). The ARI values of SPT areas in male patients but not in female patients were found to be significantly higher as compared with non-lesional skin (21.63%; p = 0.039). The SPT positivity was also more common in male patients compared with female patients (86.4% and 62.5%), although the difference was not significant (p = 0.88). SPT have been found to be more strongly positive among the males (4.63 +/- 3.3) compared with female patients (3.18 +/- 1.9), and the difference was statistically significant (p = 0.022). CONCLUSIONS: Our findings indicate that androgens seem to play a role both in the formation and increased positivity of the SPT areas in male patients with BD.