Assessment of Psoas Muscle Index in Middle-Aged Type 2 Diabetes Patients: Impact of Insulin Therapy on Sarcopenia.

OBJECTIVE: Sarcopenia, characterized by progressive skeletal muscle loss, poses significant health risks, including physical impairment and mortality. The relationship between sarcopenia and insulin resistance suggests insulin therapy's potential in preserving muscle mass, particularly in Type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate the Psoas Muscle Index (PMI) via computed tomography (CT) in middle-aged T2DM patients on insulin therapy versus oral antidiabetic drugs (OAD) and controls. METHODS: This retrospective study included 107 middle-aged T2DM patients undergoing non-contrast CT scans and 58 age-matched controls. CT images were analyzed to calculate PMI. Statistical analysis included Chi-square tests, independent samples t-tests, Mann-Whitney U tests, and correlation analyses. RESULTS: Insulin-treated patients exhibited higher PMI than OAD users (p < 0.001), while OAD users had lower PMI than controls (p < 0.001). No significant difference was found between insulin-treated patients and controls (p = 0.616). Negative correlations were observed between T2DM duration/age and PMI across all groups, with a positive correlation between T2DM duration and BMI observed in the OAD group. CONCLUSIONS: Insulin therapy in T2DM patients, regardless of age or disease duration, positively impacts muscle mass, highlighting its potential in preserving muscular health and advocating for tailored treatment strategies in T2DM management.

Acute ischemic events after COVID-19 infection in patients undergoing maintenance hemodialysis.

INTRODUCTION: Patients undergoing maintenance hemodialysis have unique risk factors that render them prone to ischemia. To what extent coronavirus infectious disease 2019 (COVID-19) increases this risk is unknown. METHODS: This retrospective cohort study included incident patients undergoing maintenance hemodialysis from one city in Turkey. A comparison was made between those who developed COVID-19 and those who did not for clinical variables. Independent predictors of acute ischemic complications in the total cohort were assessed using the logistic regression analysis. FINDINGS: By the start of the pandemic in Turkey, 33 of 154 (21.4%) patients developed COVID-19. During the 15 months of median follow-up after the start of the pandemic, 16 (10.4%) patients developed acute ischemic complications. These included acute myocardial infarction (n = 10), acute ischemic stroke (n = 4), acute peripheral artery thrombosis (n = 1), and pulmonary thromboembolism (n = 1). Overall, acute ischemic events occurred more commonly in those who experienced COVID-19 (24.2% vs. 6.6%, p = 0.007). Ischemia-free survival was significantly shorter in the COVID-19 group (p = 0.001). In the eight patients with COVID-19, ischemic complications emerged at a median 185 (range 21-306) days after the diagnosis of COVID-19. While age, dialysis vintage, and experience of COVID-19 were found as factors significantly associated with the development of acute ischemic events in univariate analysis, the association between COVID-19 and acute ischemia remained significant in the multivariate regression model (odds ratio 3.99, 95% CI [1.3, 12.13], p = 0.016). During the pandemic, 23 (14.9%) patients died. Overall survival was significantly shorter among those who developed acute ischemic event (p < 0.001). The hazard ratio of acute ischemic event for death was 6.76 (95% CI [2.92, 15.66], p < 0.001). DISCUSSION: A considerable number of patients undergoing maintenance hemodialysis developed acute ischemic complications weeks to months after the resolution of COVID-19. Hemodialysis patients appear to require specific interventions in order to prevent subsequent acute ischemic events after the resolution of COVID-19.

Insula Volume in Patients Diagnosed with Obsessive Compulsive Disorder and its Relation with Clinical Variables.

INTRODUCTION: Neuroimaging studies performed in recent years on patients with obsessive compulsive disorder have determined anomalies that are possibly associated with the determinant signs and symptoms of the disease. The purpose of this study is to investigate the morphometric changes in insula volume and related parameters in order to understand the etiopathogenesis of obsessive compulsive disorder better. METHOD: Throughout the study, 20 patients eligible for the study criteria, who were diagnosed with OCD according to DSM-5 diagnostic criteria and receiving inpatient or outpatient treatment after applying to Firat University Hospital Psychiatry Department, and 13 healthy subjects in the control group have been included in the study. Sociodemographic and Clinical Data Form, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Yale-Brown Obsession Compulsive Scale (Y-BOCS) and SCID-I have been applied to the patients. Volumetric measurements were performed on the insula by using magnetic resonance imaging (MRI) in patient and control groups. RESULTS: No significant difference was observed between patients with Obsessive Compulsive Disorder and healthy controls with regard to insula volume. DISCUSSION: It may be stated that insula may be associated with both the pathophysiology and clinical course of the disease. It is suggested that studies considering the imaging methods examining the functional characteristics of this area and tests on cognitive functions together may lead to significant and efficient results.

Gastric wall fat halo sign in patients without intestinal disease.

PURPOSE: To investigate the relationship between gastric wall fat halo sign and visceral obesity with potentially associated diseases. MATERIALS AND METHODS: Between September 2015 and April 2017, 90 patients with gastric wall fat halo signs and 130 controls were prospectively evaluated. Patient height, weight, body mass index (BMI), sex, age, subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), percentage of visceral fat (VF%) and the presence of colic or ileal fat halo signs, hepatic steatosis and aortic calcified plaques were recorded for the two groups. Cut-off values for the VFA, TFA, and VF% were determined and the diagnostic efficacy was calculated using receiver operating characteristic (ROC) curve analysis. RESULTS: No significant differences were found in age, BMI and SFA, but the VFA, VF%, TFA and frequencies of colic or ileal fat halo signs, hepatic steatosis and aortic calcified plaques were significantly higher in the patient group. The areas under the ROC curve (AUCs) were 0.803, 0.770 and 0.596 for VFA, VF% and TFA, respectively. The diagnostic efficacies of VFA and VF% were significantly higher than those of the TFA. CONCLUSION: Gastric wall fat halo signs may be observed in overweight people, especially those with increased VFA and VF%. Additionally, these signs are usually observed along with fat halo signs of the colon or terminal ileum. However, extensive studies are needed to clarify the relationship between gastric wall fat halo signs and type 2 diabetes, cardiovascular diseases and metabolic syndrome.

Evaluation of Apparent Diffusion Coefficients in the Cerebellar Tonsils and Bulbus in Chiari Type I Malformations: Comparison Before and After Surgery.

AIM: To evaluate the preoperative and postoperative 6th month mean apparent diffusion coefficient (ADC) values of the cerebellar tonsils and bulbus in patients with Chiari Malformation Type I (CMI), and to compare the results with healthy controls. MATERIAL AND METHODS: We included 15 patients with CMI who underwent suboccipital decompression, upper cervical laminectomy, and duraplasty surgery, and compared them with 10 healthy individuals. Three regions of interest were placed, one each in the cerebellar tonsils and one in the bulbus. The mean ADC values were measured separately in each region. RESULTS: Among the patients, mean ADC values were significantly decreased after surgery compared with before surgery. The mean ADC values before surgery were significantly higher for patients than for controls; however, although mean ADC values were slightly higher after surgery for patients than for controls, the differences were not significant. Thus, after surgical intervention, ADC values in patients with CMI became close to those of normal individuals. CONCLUSION: The increased ADC values in patients with CMI before surgery implied that not only morphologic changes but also increased diffusivity may play a key role in the pathophysiology and clinical presentation of the disease. We conclude that decompression surgery can produce favorable diffusional alterations.

Evidence for the changes of pituitary volumes in patients with post-traumatic stress disorder.

In pubertal and postpubertal patients with post-traumatic stress disorder (PTSD), significantly greater pituitary gland volumes have been reported. Moving from this point, in the present study, we aimed to investigate pituitary gland volumes in patients with PTSD and hypothesized that volumes of the gland would be structurally changed. Volumetric magnetic resonance imaging of the pituitary gland was performed among sixteen patients with PTSD and fifteen healthy control subjects. We found that the mean volume of the pituitary gland was statistically significant and smaller than that of healthy subjects (0.69±0.08cm3 for patient group and 0.83±0.21 for control subjects). Consequently, in the present study, we found that patients with PTSD had smaller pituitary gland volumes than those of healthy controls like other anxiety disorders. It is important to provide support for this finding in future longitudinal investigations.