Physical and Mental Health Characteristics of Hospitalized COVID-19 Patients with and without Type 2 Diabetes Mellitus in Turkey.

The aim of this study was to assess the rates of depression, anxiety, and stress and quality of sleeping among COVID-19 patients with and without type 2 diabetes mellitus (T2DM). A case and control design has been employed, involving patients affected by COVID-19 infection (884 with T2DM vs. 884 controls without T2DM) and hospitalized in Istanbul (Turkey) from January to December 2021. A multivariate stepwise regression approach was used to test the associations between sociodemographic, metabolic, serum markers, mental health scores, and T2DM/COVID-19 patients' clinical presentation. A statistically significant difference between T2DM and non-T2DM was found with respect to age, gender, BMI (body mass index), smoking, physical exercise, and physical comorbidities as well as levels of depression, anxiety, stress, and sleeping disorders (0.0003 ≤ all p = 0.025). With regard to serum biomarkers, vitamin D and ferritin were identified as useful parameters of reduction of glycated hemoglobin as well as COVID-19 infection among T2DM patients. This study detected that 25% of patients with COVID-19 and T2DM experienced mental distress, with sleeping disturbances and lifestyle changes markedly impacting their clinical outcome alongside metabolic and serum parameters.

Sleep quality, quality of life, fatigue, and mental health in COVID-19 post-pandemic Türkiye: a cross-sectional study.

Aim: This study explores the predictors and associated risk factors of sleep quality, quality of life, fatigue, and mental health among the Turkish population during the COVID-19 post-pandemic period. Materials and methods: A cross-sectional survey using multi-stage, stratified random sampling was employed. In total, 3,200 persons were approached. Of these, 2,624 (82%) completed the questionnaire package consisting of socio-demographic information, Pittsburgh Sleep Quality Index (PSQI), the WHO Quality of Life Brief Version (WHOQOL-BREF), Fatigue Assessment Scale (FAS), Patients Health Questionnaire (PHQ-15), GAD-7 anxiety scale, and the 21-item Depression, Anxiety, Stress Scale (DASS-21). Results: Significant differences between genders were found regarding socio-demographic characteristics (p < 0.01). Using PHQ-15 for depressive disorders, significant differences were found between normal and high severity scores (≥ 10), regarding age group (p < 0.001), gender (p = 0.049), educational level (p < 0.001), occupational status (p = 0.019), cigarette smoking (p = 0.002), waterpipe-narghile smoking (p = 0.039), and co-morbidity (p = 0.003). The WHOQOL-BREF indicated strong correlations between public health, physical health, psychological status, social relationships, environmental conditions, and sleep disorders (p < 0.01). Furthermore, comparisons of the prevalence of mental health symptoms and sleeping with PHQ-15 scores ≥ 10 (p = 0.039), fatigue (p = 0.012), depression (p = 0.009), anxiety (p = 0.032), stress (p = 0.045), and GAD-7 (p < 0.001), were significantly higher among the mental health condition according to sleeping disorder status. Multiple regression analysis revealed that DASS21 stress (p < 0.001), DASS21 depression (p < 0.001), DASS21 anxiety (p = 0.002), physical health (WHOQOL-BREF) (p = 0.007), patient health depression-PHQ-15 (p = 0.011), psychological health (WHOQOL-BREF) (p = 0.012), fatigue (p = 0.017), and environmental factors (WHOQOL-BREF) (p = 0.041) were the main predictor risk factors associated with sleep when adjusted for gender and age. Conclusion: The current study has shown that sleep quality was associated with the mental health symptoms of depression, anxiety, stress, and fatigue. In addition, insufficient sleep duration and unsatisfactory sleep quality seemed to affect physical and mental health functioning.

The Impact of Cigarette Smoking, Water-Pipe Use on Hearing Loss/Hearing Impairment: A Cross-Sectional Study.

OBJECTIVE: The aim of the present study was to determine the association between cigarette smoking, waterpipe smoking, and co-morbidity diseases on hearing loss. METHODS: A cross-sectional study was conducted among 1015 patients [386 males (38%) and 629 females (62%)] who were aged are between 25 and 65 years. The study used clinical, physical examinations and Pure-Tone Audiometry (PTA) to assess hearing. Univariate and multivariate stepwise logistic regression analyses were used for the statistical analysis. RESULTS: Out of 1015 patients assessed, 199 were cigarette smokers with hearing loss (21.6%) and 111 waterpipe smokers with hearing loss (12%). There were statistically significant differences between cigarette smokers with hearing loss regarding (p<0.001), gender (p<0.001), BMI (p<0.001), hypertension (p<0.001), tinnitus (p<0.001), vertigo and/or dizziness (p<0.001), and migraine/headaches (p<0.001). Also there were statistically significant differences between waterpipe smokers with hearing loss, none smokers concerning age groups (p<0.001), BMI (p<0.001), using MP3 players (p=0.004), family history of hypertension (p=0.026), ATP III metabolic syndrome (p=0.010), IDF metabolic syndrome (p=0.012), tinnitus (p<0.001), vertigo/dizziness (p<0.001), and migraine/headaches (p=0.025). Multivariate stepwise logistic regression analysis indicated that tinnitus (p<0.001), dizziness (p<0.001), nausea (p=0.001), headaches and migraine (p<=0.003), fatigue (p=0.004), and vertigo (p=0.022) were considered as risk predictors risk hearing loss related cigarette smokers. Also, analysis revealed that tinnitus (p<0.001), nausea (p=0.001), headaches and migraines (p<0.001), Type 2 diabetes mellitus (p<0.001), and vertigo (p=0.021), were considered as risk predictors for hearing loss related waterpipe smokers. CONCLUSION: The present study suggests cigarette smoking and waterpipe smoking, life-style factors are possible risk factors for hearing loss among smoker participants.

Lessons to be Learned: The Knowledge, Attitudes, and Practices of Turkish People towards the COVID-19 Pandemic.

Background: The world experienced the greatest pandemic of the 21st century with the emergence of a new and readily transmissible the coronavirus disease. Understanding knowledge, attitudes, and practices (KAP) of the public towards the pandemic is an essential part of developing effective preventive strategies. Aim: The objective of this study was to investigate the knowledge, attitudes, and practices (KAP) concerning the coronavirus (COVID-19) among population in Istanbul. Methods: This is a cross-sectional and multi-stage, stratified random sampling based on multi-center population of Istanbul. A total of 5,414 persons were contacted and 4361 participants (80.5%) gave consent. The data were analyzed using descriptive and multiple regression analyses. Results: There were significant differences between low education and high educational level with respect to age groups, gender, occupation, income, residence, number of rooms and family members (P < 0.001). Responses concerning knowledge of COVID-19 indicated that subjects with high education level were significantly higher regarding knowledge of the signs and symptoms of COVID-19 and methods of detecting COVID-19 respectively. Majority of the participants consider COVID-19 risk is higher than AIDS or Cancer (75.8% of low education vs. 67.2% of high education level (P < 0.001). Multivariate stepwise regression analysis revealed that monthly income status (P < 0.001), appropriate method of detecting COVID-19 (P < 0.001), occupational status (P < 0.001), medical mask prevent against COVID-19 (P < 0.001), eating or contacting wild animals (P < 0.001), isolation and treatment of people reduce risk (P < 0.001), isolation 14 days (P < 0.001), avoid going to crowded places such as train-metro, bus, restaurants and shopping (P = 0.003), COVID-19 spreads via-respiratory droplets (P = 0.004), afraid of travel (P = 0.026) were significantly associated with COVID-19 knowledge. Conclusions: The current study results revealed that the educational level and occupation especially sedentary are correlated positively with knowledge, attitude and practices. This finding is not surprising since higher education levels and professional status are associated with good KAP in most epidemic diseases including COVID-19. Nevertheless, the recent experience with COVID-19 has provided lessons on strategy and policy making.

Assessment of the Role of Serum 25-Hydroxy Vitamin D Level on Coronary Heart Disease Risk With Stratification Among Patients With Type 2 Diabetes Mellitus.

We investigated the role of vitamin D on glycemic regulation and cardiac complications in patients with type 2 diabetes mellitus (T2DM). A total of 1139 patients (49.3% males vs 50.7% females) were included. Information on sociodemographic lifestyle, family history, blood pressure (BP), and coronary heart disease (CHD) complications was collected. Significant differences were found between males and females regarding age-groups (P = .002), body mass index (BMI; P = .008), physical activity (P = .010), sheesha smoking (P = .016), cigarette smoking (P = .002), hypertension (P = .050), metabolic syndrome (P = .026), and CHD (P = .020). There were significant differences between vitamin D deficiency, insufficiency, and sufficiency in relation to age-group (P = .002), income (P = .002), waist circumference (P = .002), hip circumference (P = .028), waist-hip ratio (P = .002), and BMI (P = .002). Further, mean values of hemoglobin, magnesium, creatinine, hemoglobin A1c (HbA1c), total cholesterol, uric acid, and diastolic BP were significantly higher among patients with vitamin D deficiency compared with those with insufficiency and sufficiency. Multiple logistic regression analysis revealed that 25-hydroxy vitamin D, 25(OH)D, HbA1c, waist circumference, uric acid, duration of T2DM, total cholesterol, systolic and diastolic BP, and BMI were strong predictor risk factors for CHD among patients with T2DM. The present study supports that 25(OH)D may have a direct effect on CHD and on its risk factors.

Does Ramadan fasting have effects on sleep, fatigue and blood pressure among patients with hypertension?

AIM: The aim of this study was to determine the effect of Ramadan fasting on blood pressure (BP), fatigue, sleeping and physical activity among hypertensive patients. SUBJECTS AND METHODS: A cross-sectional study was conducted from April 2019 to July 2019. Of the total 1500 hypertensive patients approached, 1118 (74.5%) gave their consent. Data analysis included sociodemographics, lifestyle habits, anthropometric measurements and clinical biochemistry parameters at baseline, and after 3 months. RESULTS: Out of 1118 subjects, 593(47.6%) were male and 653(52.4%) were female. There were statistically significant differences between males and females regarding age groups in years, educational level, occupational status, income, smoking habits, physical exercise, sports activities and fatigue. There were statistically significant differences for the biochemistry parameters regarding vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, HDL-C, LDL-C, uric acid and SBP for both males and females after the holy month of Ramadan as compared to before Ramadan. Also, BMI was significantly lower during the after month of Ramadan as compared to before Ramadan (P < 0.001). Multiple linear regression analysis results revealed that less hours of sleeping (P < 0.001), SBP (mmHg) (P < 0.001), DBP (mmHg) (P < 0.001), family size (P = 0.002), obesity BMI (kg/m2) (P = 0.013), fatigue (P = 0.022) and smoking cigarette (P = 0.029) were identified as statistically significant predictors of hypertensive patients with Ramadan fasting as contributing at higher risk factors. CONCLUSION: This study confirmed that fasting during Ramadan has no effect on the BP, blood glucose, HbA1C level, sleep quality, fatigue and BMI among hypertensive patients.

Sleeping disturbances and predictor risk factors among type 2 diabetic mellitus patients.

Background: Sleep disturbance is a major health issue among people with type 2 diabetes mellitus (T2DM). The Pittsburgh Sleep Quality Index (PSQI) has been the most widely used instrument to measure subjective sleep disturbance. Aim: The aim of this study was to determine the impact of sleeping factor structure of the PSQI as potential predictor for glycosylated hemoglobin A1c (HbA1C) among people living with T2DM in the Turkish community to facilitate its use in the clinical practice and research. Subjects and Methods: This is a cross-sectional study and participants were between the age group of 25 and 65 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The PSQI was conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. Multivariate logistic regression analysis was used to estimate the associated risk factors for the T2DM. Results: The current study showed significant differences between male and female patients with respect to their age in years, body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, family history of metabolic syndrome, coronary heart disease (CHD), and PSQI. The results revealed significant differences between HbA1c ≤7 and females and HbA1c >7 T2DM patients with respect to gender, BMI (kg/m2), CHD, and PSQI. The study demonstrated significant differences between sleeping categories PSQI as good, average, and poor sleeping among T2DM patients with respect to age and gender. Meanwhile, significant differences were reported between sleeping categories among T2DM patients with respect to their: number of sleeping hours, wake-up time, sleeping time, HbA1c, fasting blood glucose, uric acid, and systolic and diastolic blood pressure. This study showed very strong statistically significant correlations between low HbA1c and poor sleep quality in patients with T2DM patients, including subjective sleep quality r = 0.763, sleep latency r = 0.327, sleep duration r = 0.472, habitual sleep efficiency r = 0.575, sleep disturbances r = 0.564, use of sleep medication r = 0.728, and daytime dysfunction r = 0.734. Multivariate stepwise logistic regression analysis revealed that Vitamin D (mmol/L) (P < 0.001), HbA1c (P < 0.001), duration of DM (P < 0.001), uric acid (mmol/L) (P < 0.001), systolic blood pressure mmHg (P = 0.006), diastolic blood pressure mmHg (P = 0.015), and BMI (P = 0.024) were considered at higher risk as the predictors for sleeping quality among T2DM patients. Conclusion: The results suggest a strong positive correlation between PSQI with HbA1c levels, systolic and diastolic blood pressure, age, BMI, among type 2 diabetic patients. This study ascertains that poor sleep quality may be due to elevated level of HbA1c, metabolic syndrome, diabetes, obesity, and/or hypertension.

RésuméObjectif: Le but de cette étude était de déterminer l'impact de la structure du facteur de sommeil du PSQI en tant que prédicteur potentiel de l'HbA1C chez les personnes vivant avec le DT2 dans la communauté turque afin de faciliter son utilisation dans la pratique clinique et la recherche. Méthodes: Il s'agit d'une étude transversale et les participants étaient âgés de 25 à 65 ans et ont visité le service de diabète et d'endocrinologie du Mega Medipol University Teaching Hospital d'Istanbul. Le PSQI a été mené sur 871 patients atteints de DT2. Une bonne qualité de sommeil a été définie comme un score PSQI <5. Une analyse de régression logistique multivariée a été utilisée pour estimer les facteurs de risque associés au T2DM. Résultats: la présente étude a montré des différences significatives entre les hommes et les femmes en ce qui concerne leur âge en années, l'IMC (kg / m2), l'activité physique, le tabagisme, le tabagisme, le revenu, les antécédents familiaux de syndrome métabolique, les maladies coronariennes ( CHD) et PSQI. Les résultats ont révélé des différences significatives entre l'HbA1C≤7 et les femmes et l'HbA1C> 7 patients T2DM en termes de sexe, d'IMC (kg/m2), de maladie coronarienne (CHD) et de PSQI. L'étude a démontré des différences significatives entre les catégories de sommeil PSQI comme bon, moyen et mauvais sommeil chez les patients T2DM en ce qui concerne l'âge et le sexe.. Une analyse de régression logistique par étapes multivariée a révélé que la vitamine D (mmol / L) (P <0,001), l'HbA1c (P <0,001), la durée de la DM (P <0,001), l'acide urique (mmol / L) (P <0,001), la systolique La pression artérielle mmHg (P = 0,006), la pression artérielle diastolique mmHg (P = 0,015) et l'IMC (P = 0,024) étaient considérées comme présentant un risque plus élevé comme prédicteurs de la qualité du sommeil chez les patients atteints de DT2.Conclusion: Les résultats suggèrent une forte corrélation positive entre le PSQI avec les niveaux d'HbA1C, la pression artérielle systolique et diastolique, l'âge, l'IMC, chez les patients diabétiques de type 2. Cette étude établit qu'une mauvaise qualité de sommeil peut être due à un niveau élevé d'HbA1C, au syndrome métabolique, au diabète, à l'obésité et / ou à l'hypertension.

Predictors risk factors for acute complex appendicitis pain in patients: Are there gender differences?

OBJECTIVE: The purpose of this study is to determine the predictive risk factors for appendicitis and the cost-effectiveness of using abdominal helical computed tomography (CT) in comparison to abdominal ultrasonography (US) for the diagnosis of acute appendicitis in patients. SUBJECTS AND METHODS: The typical case was a patient with abdominal pain in the right lower quadrant and suspicion of appendicitis. A total of 643 patients who were consequently treated with appendectomy upon diagnosis of acute appendicitis between January 2015 and December 2018 were included in the study. The four diagnostic alternatives chosen were US, CT, biochemistry parameters, and physical examination in the hospital. RESULTS: There were statistically significant differences between male and female patients with regards to age, BMI, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of gastrointestinal discomfort (GI), anxiety (P < 0.001), red eye (P = 0.006), dizziness (P = 0.021), headache (P < 0.001), muscular symptoms, weakness and cramps (P < 0.001), bloating or swollen stomach (P < 0.001), UTI (P < 0.001), chest pain (P < 0.001), guarding (P < 0.001), loss of appetite (P = 0.004), nausea (P < 0.001) vomiting (P = 0.042), anorexia (P = 0.009), and constipation (P = 0.002). Moreover, there were statistically significant differences between male and female patients for pain (P < 0.001), pain right belly (P = 0.027), severe crumps (P = 0.007), high temperature and fever (P < 0.001), irritable bowel syndrome (P < 0.001), right iliac fossa (RIF) pain (P = 0.008), rebound tenderness (P = 0.024), positive bowel sounds (P = 0.029), and pointing tenderness (P < 0.001). Multivariate stepwise logistic regression showed nausea (P < 0.001), C-reactive protein (CRP) (P < 0.001), dizziness (P = 0.016), vomiting (P < 0.001), muscular symptoms (P = 0.007), irritable bowel syndrome (P = 0.034), guarding (P = 0.040), and loss appetite (P = 0.046) were considered at higher risk as predictors for appendicitis patients. CONCLUSIONS: CT is more cost-effective than the US and clinical examination for determining appendicitis. The current study suggested that nausea, C-reactive protein, dizziness, vomiting, muscular symptoms, irritable bowel syndrome, guarding, and loss appetite were considered as higher risk predictors for appendicitis patients.

Co-Morbidity between Major Depression and Schizophrenia: Prevalence and Clinical Characteristics.

BACKGROUND: The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence. SUBJECTS AND METHODS: A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons. RESULTS: A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69±14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59±13.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ. CONCLUSION: This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.

The prevalence of restless legs syndrome and comorbid condition among patient with type 2 diabetic mellitus visiting primary healthcare.

AIM: The aim of this study was to determine the prevalence of restless legs syndrome (RLS) and Pittsburgh Sleep Quality Index (PSQI) in patients with type 2 diabetes mellitus (T2DM) attending primary healthcare. SUBJECTS AND METHODS: This is a cross-sectional study and participants were between 25 and 70 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The diagnosis of RLS was performed according to the International Restless Legs Syndrome Study Group consensus criteria. The RLS and PSQI instruments were conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. RLS severity was assessed by the Restless Legs Syndrome-6 Scales (RLS-6). The scale development and validation was carried out using Rasch measurement model. RESULTS: The prevalence of RLS was 22.8% including 60.3% of females and 39.7% of males. This study showed significant differences between RLS and no RLS patients with respect to their age (years), body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, and sleeping quality with PSQI. Also, the analysis presented that statistically significant differences between both RLS and no RLS reported sleep complaints including difficulty falling asleep, inadequate sleep, anytime fatigue, and leg discomfort. There were statistically significant differences between RLS and no RLS patients regarding hypoglycemia, numbness in legs, retinopathy, neuropathy, nephropathy high blood pressure, depression, stroke, anemia, diabetic foot, ulcer, arthritis, respiratory disease, metabolic syndrome, and coronary heart disease. Furthermore, there were statistically significant differences between RLS and no RLS concerning the number of sleeping hours, wake-up time (AM), sleeping time (PM), BMI (kg/m2), HbA1c, vitamin D, calcium, creatinine, fasting blood glucose, low-density lipoprotein, triglyceride, uric acid, and systolic and diastolic blood pressure (mmHg). CONCLUSION: This study confirms positive relation and high prevalence of RLS among patients with T2DM visiting primary healthcare. The results suggest that physical activity is associated with a better perception of functional capacity and pain in diabetic patients with RLS, and thus a more active lifestyle should be encouraged.

Vitamin D and Elevated Serum Uric Acid as Novel Predictors and Prognostic Markers for Type 2 Diabetes Mellitus.

AIM: To ascertain the active role of uric acid and vitamin D as potential biomarkers for impaired glucose metabolism among people living with type 2 diabetes mellitus (T2DM) in Turkish community. SUBJECTS AND METHODS: This study was based on 680 patients with T2DM and 680 healthy subjects aged between 25 and 70 years, who visited the diabetes and endocrinology department of Istanbul Mega Medipol University Teaching Hospital, Istanbul, Turkey, during January 2016 to April 2018. The investigated biochemical indices included lipid profiles (low-density lipoprotein [LDL], high-density lipoprotein, total cholesterol, and triglyceride [TG]), uric acid, blood pressure (BP), serum creatinine, glycosylated hemoglobin (HbA1c), thyroid-stimulating hormone (TSH), postprandial glucose, and any related comorbidities. RESULTS: This study reported significant differences between family history duration of patients with T2DM of ≤5 and >5 years when compared to that of control subjects with respect to body mass index (BMI), smoking habit, sheesha smoking, income, family history of metabolic syndrome, hypertension, coronary heart disease, and nephropathy. Similarly, significant differences were found between patients with T2DM (with family history T2DM duration of less than 5 years and more than 5 years in contrast to healthy subjects' level of LDL, TG, fasting blood glucose, HbA1c, systolic BP (SBP), bilirubin, albumin, magnesium, potassium, calcium, number of sleeping hours, and TSH. We uncovered the correlation between serum uric acid level with the clinical biochemical indices related to T2DM: serum calcium (r = 0.336), magnesium (r = 0.272), potassium (r = 0.205), HbA1c (r = 0.638), fasting blood glucose (P = 0.486), bilirubin (r = 0.251), albumin (r = 0.285), LDL (r = 0.322), TG (r = 0.434), diastolic BP (DBP) (r = 0.392), SBP (r = 0.344), BMI (r = 0.482), waist circumference (WC) (r = 0.366), age (r = 0.217), number of sleeping hours (r = 0.275), and TSH (r = 0.445). Multivariate stepwise logistic regression showed that variables, such as serum vitamin D, uric acid, TSH, HbA1c, DBP, WC, BMI, and SBP, were considered at higher risk as significant (P < 0.001) predictors for T2DM. CONCLUSION: The results suggest strong positive correlation between serum uric acid level with BP (SBP and DBP), age, BMI, and WC among patients with T2DM. This study ascertains that an increase in uric acid level may be due to elevated level of HbA1c, metabolic syndrome, diabetes, obesity, and/or hypertension.

Assessment of the Gail Model in Estimating the Risk of Breast Cancer: Effect of Cancer Worry and Risk in Healthy Women.

Background: There has been substantial interest in developing methods to predict the risk of breast cancer. The Gail model is one the first model have been widely used to identify women at higher risk of breast cancer. Aim: This study aimed to determine the 5-year and the general life-time risk of breast cancer and also to determine breast cancer predictors in women using the Gail model. Methods: We used the Gail model to estimate the risk of breast cancer in female Turkish outpatients aged above 35 years in this cross-sectional study. Age, life-style habits, breast-feeding duration, family history of breast cancer, and body mass index were compared between high and low-risk subjects. We have performed the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) tools on patients regarding depression and anxiety. We also assessed the association of these covariates with the estimated risk of breast cancer in multivariate linear regression analysis. Results: We enrolled 1065 subjects with a mean age of 52.9 ± 8.4 years. The mean of the five-year risk for breast cancer was 1.33%±0.6. Meanwhile, the mean of lifetime risks for breast cancer was 10.15%±3.18, respectively. Nearly one-third of the participants had one child, 55.9% had breast-fed their children more than six months. Meanwhile, 18.5% of the subjects had a high depression score, 15.2% had a high anxiety score. Higher age, age at first birth, and parity; lower age at menarche; presence of menopause and family history of breast cancer were higher in the high-risk group. Higher age, and age at first birth; lower age at menarche; family history of breast cancer, presence of menopause, and parity were independently associated with higher breast cancer risk. Conclusion: We identified certain risk factors for breast cancer in our study population and Gail model is a reliable and useful breast cancer risk prediction model for clinical decision-making. This study contributes to the body of evidence in order to facilitate early detection and better plan for possible malignancies in Turkish population.

Health Services Management in Turkey: Failure or Success?

BACKGROUND: The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey. AIM: The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries. METHODS: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. RESULTS: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient's. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3-25 min). Consultation time has been affected by the patients' diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. CONCLUSIONS: The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.

Premarital Screening and Genetic Counseling Program: Studies from an Endogamous Population.

BACKGROUND: Studies in Arab countries have shown a significant lack of knowledge of Premarital Screening and Genetic Counseling (PMSGC) Program. PMSGC can identify and modify, through prevention and management, some behavioral, medical, and other health risk factors known to impact pregnancy outcomes. OBJECTIVE: The aim of this study was to explore the knowledge, attitudes, and practice of Qatari's toward the premarital screening program and shedding more light on a complex matter. MATERIALS AND METHODS: A cross-sectional study based on Hospitals and Primary Health Care Centers. A total sample of 1246 participants was surveyed, and 873 participants (70.0%) expressed their consent to participate in the study during January 2013-May 2014. The questionnaire based on sociodemographic data and for responses, on the PMSGC program knowledge, attitude, and practice statements. In addition, questions were asked regarding the services, activities, and how to attract and motivate the PMSGC program. RESULTS: The mean age and standard deviation (SD) of the males' age were 30.4 ± 6.50 and the mean and SD of females' age were 31.08 ± 5.98. There were statistically significant differences between males and females with regard to age, educational status, occupation status, household income, consanguinity, body mass index, cigarette smoking, and Shisha smoking. There were no any statistically significant differences between males and females regarding sickle cell anemia and thalassemia, glucose-6-phosphate dehydrogenase deficiency cystic fibrosis, homocystinuria, HIV, and hepatitis. The response to the ''Why proceeding through high-risk marriage?'' by gender, males and females responded statistically significant differences (P = 0.019). The step-wise multivariate regression analyses as predictors for knowledge of PMSGC program revealed that age, educational level, the lack knowledge of genetics counseling, parental interventions for cousin marriage decision, positive test results affect and change marriage decision, religious impact, household income, consanguinity, hereditary diseases knowledge, occupational status, and love factors were considered as the main factors associated with the premarriage screening and genetics counseling after adjusting for age, gender, and other variables. CONCLUSION: The current study revealed that knowledge and attitude regarding PMSGC program were low in population. Motivation, enforcement, and implementation of program at the school and university educational campaigns are vital. Improved counseling and adding new topics for counseling on genetic, chronic, and mental illness; building healthy families; and reproduction and fertility are considered to be top priorities in community.

Effect of ramadan fasting on glycemic control and other essential variables in diabetic patients.

Background: Fasting during the holy month of Ramadan is a religious obligation for all Muslims who represent 1.8 billion of the world population (24%). This study explores the effect of Ramadan fasting on the blood glucose, glycated hemoglobin (HbA1c), lipid profile, sleeping quality, and essential lifestyle parameters and also explores the safety of fasting for a whole month among diabetic patients. Aim: The aim of the present study was to assess the impact of Ramadan fasting on the blood glucose, HbA1c, lipid profile, sleeping quality, and lifestyle parameters among patients with type 2 diabetes mellitus (T2DM) in Turkey. Subjects and Methods: A total of 1780 diabetic patients were approached, and 1246 (70%) participated in this cross-sectional study carried out during the period from May 27, 2017, to June 24, 2017. Data analysis comprised sociodemographic features, lifestyle habits, blood pressure measurements, serum lipid profiles, serum calcium, Vitamin D 25-hydroxy, uric acid, and HbA1c at before 4 weeks and after 12 weeks from Ramadan. Results: Out of 1246 patients, 593 (47.6%) were male and 653 (52.4%) were female. The mean ± standard deviation age of the patients was 50.39 ± 15.3 years. Males were significantly older than females (51.53 ± 12.56 vs. 49.26 ± 14.4; P = 0.003, respectively). Significant differences were found in Vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (female), low-density lipoprotein-cholesterol (male), uric acid, and systolic and diastolic blood pressure after and before the holy month of Ramadan (P < 0.05 for each). HbA1c (P < 0.001), physical activity (P < 0.001), hours of sleeping (P < 0.001), systolic blood pressure (BP) (mmHg) (P = 0.007), BMI (P = 0.016), diastolic BP (mmHg) (P = 0.018), family history (P = 0.021), and smoking (P = 0.045) were identified as significantly associated with Ramadan fasting as contributing factors. Conclusion: In one of the largest studies of its kind, we show that Ramadan fasting has positive effects on T2DM patients as it reduces their blood pressure, blood glucose, HbA1C, and BMI. Furthermore, there are improvements in the duration of sleep and physical activity, the role of Ramadan fasting in diabetes therapy has been confirmed.

RésuméContexte: Le jeûne pendant le mois sacré du Ramadan est une obligation religieuse pour tous les musulmans qui représentent 1,8 milliard de personnes dans le monde population (24%). Cette étude explore l'effet du jeûne du Ramadan sur la glycémie, l'hémoglobine glyquée (HbA1c), le profil lipidique, qualité de sommeil, et les paramètres essentiels de style de vie et explore également la sécurité du jeûne pour un mois entier chez les patients diabétiques. But: Le but de la présente étude était d'évaluer l'impact du jeûne du Ramadan sur la glycémie, l'HbA1c, le profil lipidique, le sommeil paramètres de qualité et de style de vie chez les patients atteints de diabète sucré de type 2 (DT2) en Turquie. Sujets et méthodes: Un total de 1780 patients diabétiques ont été approchés, et 1246 (70%) ont participé à cette étude transversale réalisée au cours de la période Du 27 mai 2017 au 24 juin 2017. L'analyse des données comprenait des caractéristiques sociodémographiques, des habitudes de vie, des mesures de la tension artérielle, les profils sériques des lipides, le calcium sérique, la vitamine D 25-hydroxy, l'acide urique et l'HbA1c avant 4 semaines et après 12 semaines de Ramadan. Résultats: Sur 1246 patients, 593 (47,6%) étaient des hommes et 653 (52,4%) étaient des femmes. L'âge moyen ± écart-type des patients était de 50,39 ± 15,3 ans. Les mâles étaient significativement plus âgés que les femelles (51,53 ± 12,56 contre 49,26 ± 14,4, P = 0,003, respectivement). Important différences ont été trouvées dans la vitamine D, la glycémie, le taux d'HbA1c, la créatinine, la bilirubine, l'albumine, le cholestérol total, les triglycérides, la densité lipoprotéine-cholestérol (femelle), lipoprotéine-cholestérol de basse densité (mâle), acide urique et tension artérielle systolique et diastolique après et avant le mois sacré du Ramadan (P <0,05 pour chacun). HbA1c (P < 0,001), activité physique (P <0,001), heures de sommeil (P <0,001), tension artérielle systolique (TA) (mmHg) (P = 0,007), IMC (P = 0,016), TA diastolique (mmHg) (P = 0,018), antécédents familiaux (P = 0,021), et le tabagisme (P = 0,045) a été identifié comme étant significativement associé au jeûne du Ramadan en tant que facteurs contributifs. Conclusion: Dans l'un des les plus grandes études de son genre, nous montrons que le jeûne du Ramadan a des effets positifs sur les patients atteints de DT2 car il réduit leur tension artérielle, le sang glucose, HbA1C et BMI. En outre, il y a des améliorations dans la durée du sommeil et de l'activité physique, le rôle du jeûne du Ramadan dans la thérapie du diabète a été confi rmée. Mots-clés: Indice de masse corporelle, diabète sucré, hémoglobine glyquée, jeûne du Ramadan, qualité de sommeil.

Schizophrenia and co-morbid obsessive - compulsive disorder: Clinical characteristics.

BACKGROUND: Psychiatric co-morbidity is a common condition, partly due to the overlap of symptoms in the categorical diagnosis of mental disorders. The co-occurrence of schizophrenia (SZ) and obsessive compulsive disorder (OCD) is a common and challenging co-morbid condition. Also, the relationship between SZ and OCD remains unclear. AIM: The aim of this study was to describe the co-morbidity of obsessive-compulsive disorder (OCD) among schizophrenia (SZ) patients and compare clinical characteristics of schizophrenia patients with versus without comorbid OCD. SUBJECTS AND METHODS: A cohort-study was carried out on 396 patients enrolled between November 2011 to June 2014 at the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI), and Structured clinical interview for DSM-5 (SCID-5) for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in SZ patients with and without comorbid OCD (SZ-OCD vs SZ). RESULTS: 396 subjects were interviewed. Age of SZ-OCD patients was 42.69 ± 14.33 (years old) whereas SZ patients without OCD ranged 41.59 ± 13.59 years old. There were statistically significant differences in clinical characteristics between SZ with and without OCD : age (p = 0.010), BMI (body mass index; p = 0.011), education (p = 0.033), employment (p = 0.019), cigarette smoking (p = 0.039), sheesha smoking (p = 0.008), and prevalence of consanguinity (p = 0.043). In particular, the rate of consanguinity in the current generation was 31.8% [95% CI = 29.1-34.7]. Also, there were statistically significant differences at Hamilton Depression score, General Health Score, Clinical Global Impression- Score, duration of illnesses, and Global Assessment of Functioning (p < 0.001). The results show that anxious, mood and psychotic dimensions rated higher among SZ - OCD ones than SZ only patients. CONCLUSION: This study confirms that SZ-OCD is a common co-morbidity and prevalence of SZ OCD is higher among patients reporting a degree of consanguinity. Even if this condition is under-recognized in clinical practice, it may significantly change SZ presentation and outcome since psychopathological dimensions report higher scores in the co-morbidity sample.

Low Vitamin D Deficiency Associated With Thyroid Disease Among Type 2 Diabetic Mellitus Patients.

BACKGROUND: The aim of this study was to investigate the relationship between vitamin D deficiency and thyroid diseases among type 2 diabetes mellitus (T2DM) patients. METHODS: This was a cohort case and control study, 546 T2DM patients and 546 control study participants were enrolled, aged between 25 and 65 years. The subjects were also investigated for fasting blood glucose levels (FBG), post prandial glucose (PPG,) glycosylated hemoglobin (HbA1c), thyroid stimulating hormone (TSH), T3, T4, and presence of other comorbid conditions. Thyroid fine needle aspiration biopsy was suggested to patients whose thyroid nodules were greater than 1.00 cm. RESULTS: There were significant differences between T2DM patients and control subjects regarding BMI (kg/m2), physical activity, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of thyroid nodules. The clinical biochemistry values among T2DM for vitamin D, calcium, magnesium, potassium, phosphorous, fasting blood glucose, cholesterol, HbA1c, HLDL, LDL, triglyceride, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower than control subjects, but higher in creatinine, albumin, TSH, T3, and T4 which appeared statistically significant differences (P < 0.001). Also, the study revealed statistically significant differences between subjects vitamin D deficiency and with thyroid nodules for calcium, magnesium, phosphorous, HbA1c, high density lipoprotein (HDL), SBP and DBP, TSH, T3, and T4 among T2DM patients and control subjects (P < 0.001). Multivariable stepwise logistic regression analysis showed that TSH, HbA1c, vitamin D deficiency, SBP (mm Hg), BMI, family history of DM, serum calcium level and family history of thyroid were considered at higher risk as predictors of thyroid among T2DM patients. CONCLUSIONS: This study suggests that obesity, HbA1c, the environment, and genetic susceptibility among T2DM, may increase the risk of thyroid disease and cancer. Although evidence has shown that thyroid cancer incidence has been rising more rapidly over time than the occurrence of cancers of other sites, due to an increase of obesity, diabetes and lack of physical activity, this study lacks of direct evidence supporting this conclusion.

The Impact of Vitamin D Deficiency on Retinopathy and Hearing Loss among Type 2 Diabetic Patients.

AIM: The current study was aiming to investigate the relation between vitamin D, retinopathy, and hearing loss among type 2 diabetes mellitus (T2DM) patients. METHODS: Cross-sectional study carried on 638 subjects aged between 20 and 60 years who visited the Endocrinology, Ophthalmology, and ENT Outpatient Clinics of the Medipol Hospital during the period from March 2016 to May 2017. Two audiometers Grason Stadler GSI 61 and Interacoustics AC40 Clinical audiometer were used to evaluate the hearing loss. Risk factors for diabetic retinopathy were evaluated, including age, sex, diabetes duration, glycated hemoglobin (HbA1c), hypertension, and lipid profiles. RESULTS: The mean age (± SD, in years) for retinopathy with hearing loss versus normal subjects was 47.7 ±10.2 versus 48.5±9.1. The associated risk factors were significantly higher in T2DM with hearing loss, hypertension (32.6% versus 15.7%), tinnitus (40.0% versus 18.0%), vertigo (59.7% versus 26.8%), and headache (54.9% versus 45.3%), than in normal hearing diabetes. There were statistically significant differences between hearing impairment versus normal hearing for vitamin D [19.40±9.71 ng/ml versus 22.67±9.28 ng/ml; p<0.001], calcium, magnesium, phosphorous, cholesterol, HDL-C, LDL-C, albumin, systolic blood pressure [131.70±9.25 Hg versus 127.73±11.98 Hg], diastolic blood pressure [82.20±8.60 mm Hg versus 79.80±8.20 mm Hg], and microalbuminuria. Multivariate logistic regression analysis revealed that variables such as vertigo, duration of DM, mobile/I pad phone, vitamin D deficiency, sleeping disturbance, headache, frequently TV watching, tinnitus, cigarette smokers, and hypertension were considered at higher risk as a predictors of retinopathy with hearing loss among diabetic patients. CONCLUSION: Vitamin D deficiency is considered as a risk factor for diabetic retinopathy and hearing loss among diabetic patients. Meanwhile, hyperglycemia could be considered as a modifiable risk factor for diabetic retinopathy; tight glycemic control may be the most effective and important therapy for improving quality of life and substantially reducing the incidence of retinopathy and in T2DM patients.

Exploring the effectiveness of crisis counseling and psychoeducation in relation to improving mental well-being, quality of life and treatment compliance of breast cancer patients in Qatar.

BACKGROUND: An insufficient number of studies have been carried out in the Middle East to evaluate the role of structured psychotherapeutic interventions in enhancing breast cancer patients' psychological well-being, quality of life and treatment compliance. This study has been designed to address this limitation by exploring the benefit of two structured psychotherapeutic interventions, crisis counseling and psychoeducation, in enhancing breast cancer patients' psychological well-being, quality of life and treatment compliance in Qatar. METHODS: A total of 201 women with early-stage breast cancer from the state of Qatar were recruited and randomized into either the control group or one of the treatment groups (crisis counseling or psychoeducation). Each of the two treatment interventions consisted of a total of six 60- to 90-minute sessions, which were provided over a period of 12 weeks. The short- and long-term benefits of the crisis counseling and psychoeducation interventions were evaluated in terms of improving patients' psychological well-being, quality of life and treatment compliance by asking all the patients to complete the Depression, Anxiety and Stress Scale, 21 item version (DASS-21) and European Organization for Research and Treatment of Cancer Quality of Life scale (QLQ-C30) instruments at different points in time and by monitoring their compliance to chemotherapy and radiotherapy treatment. RESULTS: This study revealed that both of the study interventions, crisis counseling and psychoeducation, were effective in improving women's psychological well-being and quality of life over time in comparison to the control group, but had no significant impact on patients' compliance with treatment. In addition, the study showed that psychoeducation conferred a greater advantage than did the crisis counseling model, especially in improving women's psychological well-being over time. CONCLUSION: This study is considered the first of its kind in Qatar to provide evidence on the benefit of crisis counseling and psychoeducation interventions in improving the psychological well-being and quality of life of women with early-stage breast cancer in Qatar. In addition, this study has provided innovative research that can be used as evidence to propose changes to the psychotherapy services for breast cancer patients in Qatar. This research study aims to provide a first step toward further research in the future, which will hopefully lead to a better health care system for cancer patients in Qatar.

The Impact of Metabolic Syndrome on Increased Risk of Thyroid Nodules and Size.

AIM: The present research aimed to determine the relation between metabolic syndrome (MetS) and thyroid volume and nodule prevalence among Turkish population patients. METHODS: This retrospective cohort study was carried on 850 patients between the ages of 20 and 65 who visited the diabetic, endocrinology, and general surgery outpatient clinics in the Mega Medipol and Medipol Hospital between January 2014 and December 2017. This study included sociodemographic information, body mass index (BMI), diabetes mellitus (DM), systolic (SBP) and diastolic (DBP) blood pressures, and clinical biochemistry results such as serum triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL) cholesterol, hemoglobin A1c (HbA1c), fasting blood glucose levels, thyroid-stimulating hormone (TSH), T3, T4, and other MetS parameters. Thyroid fine needle aspiration biopsy was suggested to patients whose thyroid nodules were greater than 1.00 cm. The definition and diagnostic of MetS used as proposed by the National Cholesterol Education Program-Third Adult Treatment Panel. RESULTS: There were statistically significant differences between patients with thyroid nodules and those without regarding age, gender, BMI, physical activity, cigarette smoking, shisha smoking, family history of diabetes, hypertension, and thyroid. Meanwhile, statistically significant differences were found between with and without MetS for calcium (P = .028), magnesium (P < .001), potassium (P < .001), fasting blood glucose (P = .047), HbA1c (P < .001), HDL (P < .001), LDL (P < .001), albumin (P = .008), bilirubin (P = .002), triglyceride (P = .011), SBP (P = .001) and DBP (P = .011), TSH (P = .005), T3 (P < .001), and T4 (P < .001). Furthermore, there were statistically significant differences between participants with and without thyroid nodules for calcium (P < .001), magnesium (P < .001), potassium (P < .001), fasting blood glucose (P = .010), HbA1c (P = .019), HDL (P < .001), LDL (P = .012), albumin (P = .002), bilirubin (P < .001), triglyceride (P < .001), SBP (P < .001) and DBP (P = .004), TSH (P = .015), T3 (P < .001), and T4 (P < .001). Multivariate stepwise logistic regression analysis used for independent predictors for the presence of thyroid nodules which TSH (P < .001), family history of thyroid and DM (P < .001), age in years (P = .025), DBP and SBP (P < .001), BMI (P = .014), HDL-C (P = .034), and waist circumference (in cm; P = .044) were considered at higher risk as a predictors of thyroid with patients with MetS. CONCLUSION: The results of the current study confirm a strong positive association between MetS and thyroid nodules risk among patients with MetS. This study suggest that the patients with MetS can be considered as a marker to have moderately increased risk of future thyroid nodules and cancer. Meanwhile, MetS, obesity, and hyperglycemia could be a qualifiable and modifiable risk factor for thyroid nodules. The regularly glycemic control may be the most important treatment for the reduction of incidence or the prevention of thyroid.