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.

Is serum uric acid-to-HDL cholesterol ratio elevation associated with diabetic kidney injury?

OBJECTIVES: Diabetic kidney injury (DKI) is a serious microvascular complicationof type 2 diabetes mellitus (T2DM). Novel markers are being developedto make a timely diagnosis of this complication. Uric Acid to HDLratio (UHR) was reported to be associated with inflammatory andmetabolic diseases such as metabolic syndrome, type 2 diabetesmellitus, thyroiditis, and nonalcoholic hepatosteatosis, recently. Inthe present study, we aimed to show the diagnostic role of UHR indiabetic kidney injury (DKI), a condition characterized with chronicand low-grade inflammation. METHODS: We retrospectively analyzed data of 287 patients who already had T2D Min outpatient clinics of our institution. The study population was divided into two groups according to the presence of DKI. General characteristics and laboratory data, including UHR levels, of the diabetic subjects with DKI were compared to those of patients without DKI. RESULTS: The median UHR of the diabetic patients with DKI group (0,13 (0,06-0,33)) was significantly elevated compared to the UHR of diabetic patients without DKI (0,11 (0,04-0,34)) (p < 0.001). Median UHR was significantly and positively correlated with UACR (r=0.14, p=0.02), serum creatinine (r=0.18, p=0.002), and HbA1c (r=0.28, p<0.001) levels. There was also a significant inverse correlation between UHR and GFR (r=-0.19, p=0.001) values. Logistic regression analysis confirmed that a 0.1 point increase in UHR increases DKI odds by 2.3 times. UHR was also correlated with serum creatinine, GFR, and UACR, which are important signs for DKI. CONCLUSION: In conclusion, we think that UHR could be a diagnostic tool indiabetic kidney injury according to the preliminary results of the present study. UHR has an independent predictive role in DKI, and ithas significant correlation with other markers of kidney functions, therefore, we suggest routine evaluation of UHR in patients with DKIalong with other markers such as serum creatinine, GFR, and UACR.

A Novel Inflammatory Marker for the Diagnosis of Hashimoto's Thyroiditis: Platelet-Count-to-Lymphocyte-Count Ratio.

BACKGROUND: Hashimoto's thyroiditis (HT) is a chronic autoimmune thyroiditis that causes systemic inflammation in the body, leading to hypothyroidism and an enlargement of the thyroid gland. OBJECTIVES: This study aims to reveal whether there is a relationship between Hashimoto's thyroiditis and the platelet-count-to-lymphocyte-count ratio (PLR), which is used as a new inflammatory marker. METHODS: In this retrospective study, we compared the PLR of the euthyroid HT group and the hypothyroid-thyrotoxic HT group to the controls. We also evaluated the values of thyroid-stimulating hormone (TSH), free T4 (fT4), C-reactive protein (CRP), aspartate transaminase (AST), alanine transaminase (ALT), white blood cell count, lymphocyte count, hemoglobin, hematocrit, and platelet count in each group. RESULTS: The PLR of the subjects with Hashimoto's thyroiditis was found to be significantly different from the control group (p < 0.001), with the rankings as follows: hypothyroid-thyrotoxic HT 177% (72-417) > euthyroid HT 137% (69-272) > control group 103% (44-243). In addition to the increased PLR values, an increase in CRP values was also observed, revealing a strong positive correlation between the PLR and CRP in the HT patients. CONCLUSION: In this study, we found out that the PLR was higher in the hypothyroid-thyrotoxic HT and euthyroid HT patients than in a healthy control group.

A Case of Euglycemic Diabetic Ketoacidosis due to Empagliflozin Use in a Patient with Type 1 Diabetes Mellitus.

Euglycemic diabetic ketoacidosis is characterised by serum blood glucose <250 mg/dl, arterial blood pH <7.35, and the presence of ketones in urine or blood. Here, we present a 36-year female with type-1 diabetes mellitus, a case of euglycemic diabetic ketoacidosis, who was admitted to the emergency unit with nausea, vomiting, and confusion after using empagliflozin, which was added to her treatment one month ago. She was followed up in the intensive care unit for four days. Empagliflozin was discontinued. Intravenous fluids and insulin infusions were given. The patient, whose metabolic acidosis regressed, was discharged with the necessary recommendations and training. Euglycemic diabetic ketoacidosis should be kept in mind as a differential diagnosis in patients with type-1 diabetes and type-2 diabetes presenting with acidosis. Attention should be paid to the patients' medications and whether there are SGLT-2 inhibitors among these drugs. Key Words: Diabetes mellitus, Sodium-glucose co-transporter-2 inhibitors, Euglycemic diabetic ketoacidosis, Empagliflozin.

C-reactive protein to lymphocyte count ratio is a promising novel marker in hepatitis C infection: the clear hep-c study.

OBJECTIVE: Chronic hepatitis C (CHC) is one of the most important health problems affecting the significant rate of world population and it may lead to cirrhosis and hepatocellular carcinoma. C-reactive protein to lymphocyte count ratio (CLR) is used in estimating inflammatory burden. Therefore, this study aimed to compare CLR values between CHC patients and healthy controls and between CHC patients with and without fibrosis. METHODS: Patients with CHC infection who visited outpatient and inpatient internal medicine clinics of our institution between January 2021 and December 2021 were enrolled to this retrospective study. CLR of the patients with CHC and healthy controls were compared. We further compared CLR of CHC patients with and without fibrosis. RESULTS: Median CLR of CHC and control subjects was 2.61 (5.13%) and 0.31 (0.37%), respectively. CLR of the CHC group was significantly increased compared to the CLR of the controls (p<0.001). There was a significant positive correlation between CLR and APRI score (r=0.15, p=0.04). The sensitivity and specificity of CLR in determining CHC above 0.58% level were 84% and 82%, respectively (AUC: 0.884, p<0.001, 95%CI 0.84-0.93). In subgroup analysis, CLR was 3.97 (6.6%) for CHC patients with fibrosis and 1.7 (4.4%) for CHC subjects without fibrosis (p=0.001). CONCLUSION: Increased CLR in patients with CHC may be an alarming finding of liver fibrosis, as CLR is associated with both CHC and hepatic fibrosis.

C-reactive protein to lymphocyte count ratio is a promising novel marker in hepatitis C infection: the clear hep-c study

SUMMARY OBJECTIVE: Chronic hepatitis C (CHC) is one of the most important health problems affecting the significant rate of world population and it may lead to cirrhosis and hepatocellular carcinoma. C-reactive protein to lymphocyte count ratio (CLR) is used in estimating inflammatory burden. Therefore, this study aimed to compare CLR values between CHC patients and healthy controls and between CHC patients with and without fibrosis. METHODS: Patients with CHC infection who visited outpatient and inpatient internal medicine clinics of our institution between January 2021 and December 2021 were enrolled to this retrospective study. CLR of the patients with CHC and healthy controls were compared. We further compared CLR of CHC patients with and without fibrosis. RESULTS: Median CLR of CHC and control subjects was 2.61 (5.13%) and 0.31 (0.37%), respectively. CLR of the CHC group was significantly increased compared to the CLR of the controls (p<0.001). There was a significant positive correlation between CLR and APRI score (r=0.15, p=0.04). The sensitivity and specificity of CLR in determining CHC above 0.58% level were 84% and 82%, respectively (AUC: 0.884, p<0.001, 95%CI 0.84-0.93). In subgroup analysis, CLR was 3.97 (6.6%) for CHC patients with fibrosis and 1.7 (4.4%) for CHC subjects without fibrosis (p=0.001). CONCLUSION: Increased CLR in patients with CHC may be an alarming finding of liver fibrosis, as CLR is associated with both CHC and hepatic fibrosis.

Poorly controlled hypertension is associated with elevated serum uric acid to HDL-cholesterol ratio: a cross-sectional cohort study.

OBJECTIVES: The diagnosis and follow-up of hypertension (HT) depend on the blood pressure measurements, which can be affected by several factors. In the present work, we aimed to explore the role of uric acid/HDL-cholesterol ratio (UHR) in HT and whether/or not it was associated with poor blood pressure control. METHODS: In this retrospective cross-sectional cohort study, all the participants treated for hypertension and then followed up in the internal medicine clinics of our institution were enrolled. Hypertensive patients were grouped as either poorly or well-controlled hypertension groups, according to the suggestions of Joint National Committee VIII criteria and healthy volunteers were enrolled as control group. UHR of the study groups was compared. RESULTS: Our study cohort consisted of 535 subjects; 258 in the well-controlled HT group, 186 in the poorly controlled HT group, and 91 in the control group. Median UHR levels of the poorly controlled HT group (13 (4-43) %) were significantly higher than well-controlled HT group 11 (4-22) %) and control group (8 (4-19) %) (p < 0.001). UHR was correlated with systolic (r = 0.33, p < 0.001) and diastolic (r = 0.28, p < 0.001) BP. UHR level greater than 11% has 70% sensitivity and 60% specificity in predicting poor BP control (AUC: 0.73, p < 0.001, 95%CI: 0.68-0.77). UHR was an independent risk factor for poor BP control in HT subjects and a unit elevation in UHR increased the risk of poorer BP control by 7.3 times (p < 0.001, 95%CI: 3.9-13.63). CONCLUSION: Assessment of UHR may be useful in HT patients since elevated UHR levels could be associated with poor blood pressure control in this population.

Sodium glucose co-transporter-2 inhibitor, Empagliflozin, is associated with significant reduction in weight, body mass index, fasting glucose, and A1c levels in Type 2 diabetic patients with established coronary heart disease: the SUPER GATE study.

BACKGROUND: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, yielded significant beneficiaries in the treatment of type 2 diabetes mellitus (T2DM). It is particularly benefited the diabetic subjects with heart conditions. AIMS: We aimed to obtain a real-world data about the effects of empagliflozin add-on treatment on metabolic parameters, cardiovascular risk factors, and anthropometric measures in patients with T2DM. METHODS: Type 2 diabetic patients with established coronary heart disease whom empagliflozin added to their treatment were enrolled in the study. Anthropometric measures, clinical and laboratory data, were obtained before and at the 6th month of the empagliflozin treatment. All data before and at the 6th month were compared. RESULTS: Body weight (p < 0.001), body mass index (p < 0.001), waist (p < 0.001) and hip (p < 0.001) circumferences, systolic blood pressure (p = 0.006), heart rate (p = 0.01), LDL cholesterol (p = 0.01), fasting plasma glucose (p < 0.001), and HbA1c (p < 0.001) levels were significantly reduced on 6th month of empagliflozin treatment compared to the baseline values. Estimated GFR (p = 0.66), serum creatinine (p = 0.8), uric acid (p = 0.40), total cholesterol (p = 0.053), triglyceride (p = 0.057), and HDL (p = 0.09) levels were not significantly changed. CONCLUSIONS: We suggest that empagliflozin treatment may improve anthropometric measures, metabolic parameters, and blood pressure and does not cause deterioration in kidney functions in type 2 diabetic patients with established coronary heart disease.

Does C-reactive protein to serum Albumin Ratio correlate with diabEtic nephropathy in patients with Type 2 dIabetes MEllitus? The CARE TIME study.

AIMS: Diabetic Nephropathy (DN) is a complication of Diabetes Mellitus and is associated with chronic and low-grade inflammatory burden. Novel inflammatory predictors, such as, C-reactive protein to serum albumin ratio (CAR) has been studied various inflammatory conditions, recently. Increased inflammatory burden accompany to both type 2 Diabetes Mellitus (T2DM) and DN, hence we aimed to compare CAR levels of the T2DM subjects with DN to those of without DN. METHODS: Patients with T2DM were enrolled to the study. Study population grouped into two according to the presence (group A) or absence (group B) of DN. Characteristics and laboratory data, as well as CAR levels; of the study groups were compared. RESULTS: Median CAR levels of the groups A and B were 2.17% (0.02-13.2) and 0.39% (0.02-4.39), respectively (p < 0.001). CAR was found to be an independent risk factor for diabetic nephropathy (adjusted to age, BMI, fasting glucose, HbA1c, and body weight). One unit (0.1%) elevation in CAR increased the risk of nephropathy by 3.5 folds (p < 0.001, 95%CI: 2.24-5.45). CAR levels greater than 0.82% have 79% sensitivity and 78% specificity in predicting DN (AUC: 0.86 [95% CI: 0.80-0.92]; p < 0.001). CONCLUSIONS: In conclusion, elevated CAR levels are higher in type 2 diabetic patients with diabetic nephropathy. According to the ROC curve, a level higher than 0.82% presents the best sensitivity and specificity in the association with the presence of DN.

The association between serum uric acid to high density lipoprotein-cholesterol ratio and non-alcoholic fatty liver disease: the abund study.

OBJECTIVE: Non-alcoholic fatty liver disease, which is characterized by lipid being deposited into hepatocytes, affects nearly one in three adults globally. Inflammatory markers were suggested to be related with hepatic steatosis. Uric acid to HDL cholesterol ratio is proposed as a novel inflammatory and metabolic marker. We aimed to compare Uric acid to HDL cholesterol ratio levels of patients with Non-alcoholic fatty liver disease to those of healthy controls and find out potential correlations between Uric acid to HDL cholesterol ratio and other inflammatory and metabolic markers of Non-alcoholic fatty liver disease. METHODS: Patients with a diagnosis of Non-alcoholic fatty liver disease who were on clinical follow-up in our institution were enrolled in the study as the Non-alcoholic fatty liver disease group, while healthy volunteers were enrolled as the control group. The Uric acid to HDL cholesterol ratio of the groups was compared and potential correlations were studied between Uric acid to HDL cholesterol ratio and fasting blood glucose, transaminases, serum lipids (triglyceride, LDL-cholesterol), weight, and body mass index. RESULTS: The Uric acid to HDL cholesterol ratio of the Non-alcoholic fatty liver disease (13±5%) group was significantly higher compared to the Uric acid to HDL cholesterol ratio of the control (10±4%) group (p<0.001). Uric acid to HDL cholesterol ratio was significantly and positively correlated with fasting blood glucose, transaminases, triglyceride, body weight, waist circumference, hip circumference, and body mass index. A ROC analysis revealed that a Uric acid to HDL cholesterol ratio level greater than 9.6% has 73% sensitivity and 51% specificity in determining Non-alcoholic fatty liver disease. CONCLUSION: Due to the inexpensive and easy-to-assess nature of Uric acid to HDL cholesterol ratio, we suggest that elevated Uric acid to HDL cholesterol ratio levels be considered a useful tool in diagnosing hepatic steatosis.

Hashimoto's thyroiditis is associated with elevated serum uric acid to high density lipoprotein-cholesterol ratio.

Background. Hashimoto's thyroiditis (HT) is an auto-immune condition characterized with lymphocytic and fibroblastic infiltration of the thyroid gland. The rate of uric acid and HDL cholesterol - so called as uric acid to HDL ratio (UHR) has been shown to be elevated in inflammatory conditions diseases. We aimed to compare UHR and other laboratory parameters of the patients with HT to those values in healthy controls. Methods. The patients diagnosed with HT by medical history, physical examination, elevated thyroid autoantibodies in serum and characteristic sonographic findings in outpatient internal medicine clinics of our institution were enrolled to the present retrospective study. Age and sex matched healthy volunteers were enrolled as controls. UHR of the HT patients and control subjects were compared. Results. The mean UHR of the HT group was 11% ± 4 %, while UHR of the control group was 8% ± 2% (p<0.001). UHR was significantly and positively correlated with thyroid stimulating hormone (TSH) (r=0.26, p=0.01) and negatively correlated with free T4 (FT4) (r=-0.22, p=0.04) levels. The sensitivity and specificity of the UHR level were greater than 8.3%: were 74% and 52%, respectively (AUC: 0.74, p<0.001, 95% CI: 0.64-0.84). Conclusion. We suggest that UHR is a reliable and useful marker for HT. Therefore, it may be helpful in establishing the diagnosis of HT in addition to other diagnostic tools.

The association between serum uric acid to high density lipoprotein-cholesterol ratio and non-alcoholic fatty liver disease: the abund study

SUMMARY OBJECTIVE: Non-alcoholic fatty liver disease, which is characterized by lipid being deposited into hepatocytes, affects nearly one in three adults globally. Inflammatory markers were suggested to be related with hepatic steatosis. Uric acid to HDL cholesterol ratio is proposed as a novel inflammatory and metabolic marker. We aimed to compare Uric acid to HDL cholesterol ratio levels of patients with Non-alcoholic fatty liver disease to those of healthy controls and find out potential correlations between Uric acid to HDL cholesterol ratio and other inflammatory and metabolic markers of Non-alcoholic fatty liver disease. METHODS: Patients with a diagnosis of Non-alcoholic fatty liver disease who were on clinical follow-up in our institution were enrolled in the study as the Non-alcoholic fatty liver disease group, while healthy volunteers were enrolled as the control group. The Uric acid to HDL cholesterol ratio of the groups was compared and potential correlations were studied between Uric acid to HDL cholesterol ratio and fasting blood glucose, transaminases, serum lipids (triglyceride, LDL-cholesterol), weight, and body mass index. RESULTS: The Uric acid to HDL cholesterol ratio of the Non-alcoholic fatty liver disease (13±5%) group was significantly higher compared to the Uric acid to HDL cholesterol ratio of the control (10±4%) group (p<0.001). Uric acid to HDL cholesterol ratio was significantly and positively correlated with fasting blood glucose, transaminases, triglyceride, body weight, waist circumference, hip circumference, and body mass index. A ROC analysis revealed that a Uric acid to HDL cholesterol ratio level greater than 9.6% has 73% sensitivity and 51% specificity in determining Non-alcoholic fatty liver disease. CONCLUSION: Due to the inexpensive and easy-to-assess nature of Uric acid to HDL cholesterol ratio, we suggest that elevated Uric acid to HDL cholesterol ratio levels be considered a useful tool in diagnosing hepatic steatosis.

Monocyte lymphocyte ratio As a predictor of Diabetic Kidney Injury in type 2 Diabetes mellitus; The MADKID Study.

AIMS: Inflammation is a cardinal pathogenetic mechanism in diabetic kidney injury (DKI). The detection of microalbuminuria (MA) is very important in preventing end-stage renal failure in diabetic subjects. A combination of high monocyte and low lymphocyte counts are used as a marker of inflammation. Monocyte to lymphocyte ratio (MLR) is considered as a marker in inflammatory diseases. We aimed to evaluate the MLR levels in diabetic subjects as a predictive marker in detecting MA. METHODS: A total of 212 patients with type 2 diabetes mellitus (T2DM) were included in the study. Patients with T2DM were divided into two groups as MA and normoalbuminuria (NA). MLR of the groups were compared. RESULTS: There were 72 patients in MA and 140 patients in NA group. MLR of the MA and NA groups were 0.247 (0.131-0.540) and 0.211 (0.052-0.390), respectively (p < 0.001). There was a statistically significant correlation between MLR and MA (r = 0.228, p = 0.001). In multivariate backward logistic regression analysis, MLR, fasting blood glucose, HbA1c and presence of comorbid clinical diseases were determined as independent predictors of DKI. CONCLUSIONS: We suggest that MLR could serve as a predictive and effective marker for DKI in diabetic subjects due to its strong correlation with MA and inexpensive and readily available nature.

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.

The effects of a single dialysis session on atrial electromechanical conduction times and functions.

BACKGROUND/AIMS: Abnormalities in atrial electromechanical delay (EMD) times and mechanical functions are considered as independent predictors of atrial fibrillation. However, to date, effects of a single hemodialysis (HD) session and acute volume-preload changes on atrial-EMD functions have not been investigated by Tissue Doppler Echocardiography (TDE). The aim of the present study was to evaluate atrial-EMD times and mechanical functions in HD patients. METHODS: Thirty-five non-diabetic, normotensive HD patients and 35 healthy control subjects were enrolled in the study. Standard and TDE performed before mid-week dialysis session for hemodialysis group and on admission for control group. RESULTS: Interatrial and left-right intraatrial-EMD intervals and left atrial mechanical volumes were significantly longer in hemodialysis group compared to controls (all p<0.01) and were reduced after HD session. Furthermore, removed ultrafiltration volume was associated with reduction in atrial-EMD intervals and functional volumes. LA-passive emptying volume, ultrafiltration volume, LV-E/E' ratio, and Vp were independent predictors of interatrial-EMD. CONCLUSIONS: The present study confirms negative effects in HD patients of structural remodeling and reveals negative effects of electrical remodeling. Prolonged inter and intraatrial-EMD intervals should be the underlying pathophysiological factors of increased rate of atrial fibrillation in the HD population.