A cross-sectional study to evaluate metabolic and demographic factors affecting cognitive function among low educated internal medicine outpatients.

OBJECTIVE: To evaluate factors affecting cognitive function in internal medicine outpatients. METHODS: A total of 130 consecutive outpatients aged 50-80 years old were included in this cross-sectional study conducted at Okmeydani Training and Research Hospital, Istanbul, Turkey between March and May 2013. Cognitive function was evaluated via Standardized Mini-Mental State Examination (SMMSE) scores. Logistic regression analysis was performed to determine factors predicting poor cognitive function. RESULTS: Mild-to-moderate cognitive impairment was noted in 39.2% of the patients. Median (interquartile range) total SMMSE scores were significantly higher in patients aged 60 years (27.0 (2.0) vs. 25.0 (5.0), p=0.000). Multivariate linear regression analyses revealed female gender (B, -1.27; 95% CI, -2.36 to -0.18; p=0.023) and aging (B, -0.20; 95% CI, -0.26 to -0.14; p<0.001) to result in a significant decrease in the total SMMSE scores. CONCLUSION: Mild-to-moderate cognitive impairment was observed in 39.2% of internal medicine outpatients. Old age and female gender were significant predictors of lower total SMMSE scores. Furthermore, besides for high language scores in hypertensive patients on combined therapy, no significant impact of hypertension or obesity was observed on the SMMSE scores.

The effect of autoimmunity on the development time of microvascular complications in patients with type 1 diabetes mellitus.

BACKGROUND: Type 1 diabetes mellitus (DM) is an autoimmune disease with chronic complications that is becoming more frequent as life expectancy of diabetics has increased owing to improved methods of detection and better management. In this study, we investigated whether the presence of autoimmunity can be used in predicting the development time of microvascular complications. MATERIAL AND METHODS: Our study included 52 patients with type 1 diabetes mellitus (DM). The subjects had developed microvascular complications and they had been tested for anti-GAD (glutamic acid decarboxylase) antibodies and/or islet-cell antibodies (ICA). In the assessment of microvascular complications, we used ocular fundus examination, electromyography (EMG), and 24-h urine microalbuminuria tests. RESULTS: Of the patients included in the study, 30 were female and 22 were male. Of all patients characterized for the existence of diabetic complications, 36 of 52 had both diabetic retinopathy and diabetic nephropathy, 5 patients had diabetic neuropathy, and 11 patients had diabetic retinopathy only. At the diagnosis of diabetes, 20 in 52 patients tested negative for autoantibodies (anti-GAD and anti-ICA), while 32 of 52 tested positive for anti-GAD and/or anti-ICA. The mean HbA1C level of autoantibody-negative patients was 7.7%, while antibody-positive patients had slightly higher HbA1c levels (7.9%). However, this difference was not statistically significant (p>0.05). The mean development time of microvascular complications in autoantibody-positive patients was calculated as 11: 40±6.46 years, and in patients with negative autoimmunity results it was 10.91±6.70 years. CONCLUSIONS: The presence of diabetes-related autoantibodies (DRAs) in patients with type 1 diabetes mellitus does not have a significant effect on the development time of diabetic microvascular complications.

Serum resistin and insulin-like growth factor-1 levels in patients with hypothyroidism and hyperthyroidism.

Introduction. The aim of this study was to evaluate the serum levels of resistin and insulin-like growth factor-1 (IGF-1) and and also the potential relationship between thyroid function and levels of resistin and IGF-1 in hypothyroid and hyperthyroid patients. Methods. Fifteen cases of hypothyroid (HT), 16 of subclinically hypothyroid (SCHT), 15 of hyperthyroid (HrT), 15 of subclinically hyperthyroid (SCHrT), and 17 healthy individuals have been included in the study. Serum resistin levels were measured using enzyme-linked immunosorbent assay and IGF-1 and thyroid stimulating hormone (TSH) levels by chemiluminescence method. Results. Resistin levels in total HT group were significantly higher than in controls (12.66 ± 6.04 and 8.45 ± 2.90 ng/mL, resp.). In SCHrT subgroup resistin levels were significantly higher than those of controls (14.88 ± 7.73 and 8.45 ± 2.90 ng/mL, resp.). IGF-1 levels were significantly lower in total HT than in total HrT and control groups (117.22 ± 52.03, 155.17 ± 51.67, and 184.00 ± 49.73 ng/mL, resp.). Furthermore IGF-1 levels in HT subgroup were significantly lower compared to controls (123.70 ± 44.03 and 184 ± 49.73 ng/mL, resp.). In SCHT subgroup IGF-1 levels were significantly lower than those of control and SCHrT groups (111.11 ± 59.35, 184.00 ± 49.73, and 166.60 ± 47.87 ng/mL, resp.). There were significant correlations between IGF-1 and TSH in HT subgroup and between resistin and TSH in total HrT group. Conclusion. It was concluded that increased resistin levels are directly related to thyroid dysfunction, and GH/IGF-1 axis is influenced in clinically or subclinically hypothyroidism patients.

Liver abscess due to Yersinia bacteremia in a well-controlled type I diabetic patient.

Yersiniae enterocolitica, a gram negative rod-like organism, causes terminal ileitis and mesenteric adenitis in adolescents and adults. Some forms present with liver and spleen abscesses and have worse prognosis. We report a type 1 diabetic patient with a liver abscess mimicking metastatic liver disease who was successfully treated with percutaneous drainage and antibiotic administration; culture from blood was positive for Yersinia enterocolitica, but drainage material from the liver abscess did not yield a positive result for Yersinia enterocolitica. Although the prognosis is not good in such cases, with high mortality rates, our patient recovered from the disease with appropriate treatment.

Serum visfatin and fetuin-a levels and glycemic control in patients with obese type 2 diabetes mellitus.

BACKGROUND: Visfatin is an adipokine produced by visceral adipose tissue and has insulin-mimicking effects. Fetuin-A is a hepatic secretory protein that binds the insulin receptor and inhibits insulin action both in vivo and in vitro. The authors of the present study aimed to investigate the levels of serum visfatin and fetuin-A and their correlation with hemoglobin A1c (HbA1c) and urine albumin levels in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 40 obese patients with T2DM (11 males and 29 females; age, 54.47±10.83 years and 23 obese nondiabetic controls (8 males and 15 females; age, 53.04±11.33 years) were included in the study. Age, sex, and body mass index were similar in the 2 groups. Serum visfatin and fetuin-A levels were measured by enzyme-linked immunosorbent assay. HbA1c and urine albumin levels were measured by high performance liquid chromatography and nephelometric method, respectively. RESULTS: Serum levels of visfatin in patients with T2DM (4.03±2.44 ng/mL) were similar to the control group (3.65±3.02 ng/mL). Serum fetuin-A levels were significantly lower in patients with T2DM than the controls (298.75±78.86 and 430.73±94.46 µg/mL, respectively). HbA1c levels were significantly higher in the T2DM group compared with controls (7.33±1.32 and 5.44±0.84%, respectively). Correlations between visfatin, fetuin-A and HbA1c levels were not observed. CONCLUSION: The present study suggests fetuin-A may play a role in the pathogenesis of T2DM.

Evaluation of the weight-increasing effects of biphasic analog and regular NPH insulin mixtures in patients with Type 2 diabetes mellitus.

BACKGROUND: Weight gain is a significant problem in diabetic patients in terms of worsening glycemic control, increasing diabetic and cardiovascular morbidity and mortality, and contributing to social and psychological problems. In the present study, we evaluated the effects of a biphasic analog and regular NPH insulin mixtures on weight gain in patients with Type 2 diabetes mellitus (T2DM) over 1 year. METHODS: Group I consisted of 71 patients (29 men and 42 women) being treated with analog mixtures (insulin lispro 75/25 mix and biphasic insulin aspart 70/30 mix) twice daily; Group II consisted of 69 patients (23 men and 46 women) being treated with a regular insulin mixture (70/30) twice daily. Starting weight, body mass index, HbA1c, and hypoglycemic episodes were evaluated after 6 and 12 months. RESULTS: Weight gain in Group I at 6 and 12 months was 1.41 ± 2.70 and 2.08 ± 3.74 kg, respectively. In Group II, weight gain at 6 and 12 months was 1.5 ± 3.0 and 2.29 ± 3.85 kg, respectively. Intragroup comparisons indicated that, for both groups, weight gain at 6 and 12 months differed significantly from the starting weight. However, no significant differences in weight gain were found between the two groups (P > 0.05). CONCLUSIONS: The weight-increasing effects of an analog mixture of insulin and the NPH regular mixture of insulin appear to be similar. This should be taken into account when determining the type of insulin to use in treating T2DM patients.