Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm.

PURPOSE OF REVIEW: The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine. RECENT FINDINGS: The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.

Dynapenic Abdominal Obesity and Metabolic Health in Non-Geriatric Patients with Obesity.

Background: Dynapenic abdominal obesity (DAO) is the combination of low muscle strength and high central adiposity, which can lead to functional and cardiometabolic impairments. Objective: The aim of this study was to examine the relationship between DAO and metabolic parameters in non-geriatric patients with obesity. Methods: All patients seen in the obesity outpatient clinic during a random month, along with 30 healthy individuals, were included in the study. Body mass index (BMI), waist circumference (WC), hip circumference (HC), serum fasting blood glucose, triglyceride, high-density lipoprotein, low-density lipoprotein (LDL), insulin, and glycated hemoglobin (HbA1c) levels were measured. Muscle function tests were conducted. Hypertension and diabetes mellitus diagnoses were recorded. DAO was determined using handgrip strength and WC. Metabolic syndrome was defined based on International Diabetes Federation (IDF) criteria. Data were analyzed using SPSS. Results: A total of 106 individuals participated in the study, including 76 individuals with obesity as the case group and 30 healthy individuals as the control group. In the case group, BMI, WC, HC, and chair stand test results were higher compared to the control group. There was no significant difference between the case and control groups in terms of gait speed or handgrip test results. In the case group, 30 people (39.5%) had dynapenic obesity (DO), and in the control group, 8 people (26.7%) had DO. There was no significant difference in DO rates between the case and control groups. In the case group, the HbA1c level was higher in DO (+) group than DO (-) group. In the control group, DO (+) group had higher LDL and HbA1c level than DO (-) group. No significant difference was observed in other search parameters between the DO (+) and DO (-) groups in both the case and control groups. Conclusion: DAO is common among people with obesity and contributes to a poor prognosis, increased morbidity, and mortality. Therefore, including its treatment in the management of obesity is crucial for individuals of all age ranges.

The effect of sarcopenia and sarcopenic obesity on survival in gastric cancer.

BACKGROUND: Sarcopenic obesity arises from increased muscle catabolism triggered by inflammation and inactivity. Its significance lies in its role in contributing to morbidity and mortality in gastric cancer. This study aims to explore the potential correlation between sarcopenia, sarcopenic obesity, and gastric cancer, as well as their effect on survival. MATERIALS AND METHODS: This retrospective study included 162 patients aged ≥ 18 years who were diagnosed with stomach cancer. Patient age, gender, diagnostic laboratory results, and cancer characteristics were documented. Sarcopenia was assessed using the skeletal muscle index (SMI) (cm2/m2), calculated by measuring muscle mass area from a cross-sectional image at the L3 vertebra level of computed tomography (CT). RESULTS: Among the 162 patients, 52.5% exhibited sarcopenia (with cut-off limits of 52.4 cm2/m2 for males and 38.5 cm2/m2 for females), and 4.9% showed sarcopenic obesity. Average skeletal muscle area (SMA) was 146.8 cm2; SMI was 50.6 cm2/m2 in men and 96.9 cm2 and 40.6 cm2/m2 in women, respectively. Sarcopenia significantly reduced mean survival (p = 0.033). There was no association between sarcopenic obesity and mortality (p > 0.05), but mortality was higher in sarcopenic obesity patients (p = 0.041). Patient weight acted as a protective factor against mortality, supporting the obesity paradox. Tumor characteristics, metabolic parameters, and concurrent comorbidities did not significantly impact sarcopenia or mortality. CONCLUSION: Sarcopenia is more prevalent in the elderly population and is linked to increased mortality in gastric cancer patients. Paradoxically, higher body mass index (BMI) was associated with improved survival. Computed tomography offers a practical and reliable method for measuring muscle mass and distinguishing these distinctions. TRIAL REGISTRATION: This study was approved by Istanbul Training and Research Hospital Clinical Research Ethics Committee of the University of Health Sciences (29.05.2020/2383).

Status of Weight Change, Lifestyle Behaviors, Depression, Anxiety, and Diabetes Mellitus in a Cohort with Obesity during the COVID-19 Lockdown: Turk-Com Study Group.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to a lockdown period. Confinement periods have been related to unhealthy lifestyle behaviors. Our study aimed to determine weight change, changes in eating and exercise habits, the presence of depression and anxiety, and diabetes mellitus (DM) status in a cohort of patients with obesity. METHODS: The study was undertaken in nine centers of Collaborative Obesity Management (COM) of the European Association for the Study of Obesity (EASO) in Turkey. An e-survey about weight change, eating habits, physical activity status, DM status, depression, and anxiety was completed by patients. The International Physical Activity Questionnaire (IPAQ) score was used to determine physical activity in terms of metabolic equivalents (METs). A healthy nutrition coefficient was calculated from the different categories of food consumption. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) Questionnaire  were used for determining depression and anxiety, respectively. RESULTS: Four hundred twenty-two patients (age 45 ± 12.7 years, W/M = 350/72) were included. The healthy nutrition coefficient before the pandemic was 38.9 ± 6.2 and decreased to 38.1 ± 6.4 during the pandemic (p < 0.001). Two hundred twenty-nine (54.8%) patients gained weight, 54 (12.9%) were weight neutral, and 135 (32.3%) lost weight. Patients in the weight loss group had higher MET scores and higher healthy nutrition coefficients compared with the weight gain and weight-neutral groups (p < 0.001). The PHQ and GAD scores were not different between the groups. Percent weight loss was related to healthy nutrition coefficient (CI: 0.884 [0.821-0.951], p = 0.001) and MET categories (CI: 0.408 [0.222-0.748], p = 0.004). One hundred seventy patients had DM. Considering glycemic control, only 12 (8.4%) had fasting blood glucose <100 mg/dL and 36 (25.2%) had postprandial BG <160 mg/dL. When patients with and without DM were compared in terms of dietary compliance, MET category, weight loss status, PHQ-9 scores, and GAD-7 scores, only MET categories were different; 29 (11.7%) of patients in the nondiabetic group were in the highly active group compared with 5 (2.9%) in the diabetic group. CONCLUSION: The COVID-19 lockdown resulted in weight gain in about half of our patients, which was related to changes in physical activity and eating habits. Patients with DM who had moderate glycemic control were similar to the general population in terms of weight loss but were less active.

The Impact of Obesity on Sexual Functions and Dyadic Consensus in Patients with Obesity.

Background: Obesity is a chronic disease with several co-morbidities that increase morbidity and mortality and decrease quality of life. Psychopathologies are an important group of co-morbidities. In this study, it was aimed to search for the presence of depression and sexual dysfunction in patients with obesity, examine impact of obesity on marital adjustment, and highlight those important problems that are usually overlooked. Methods: Fifty patients who were seen in the obesity outpatient clinic in a random month as case group and gender-matched 50 healthy individuals as control group were included in the study. The inclusion criteria were body mass index (BMI) ≥30 kg/m2 and having a sexual partner. The exclusion criteria were having psychiatric/mental or any other chronic illness, using medication that would affect sexual functions, and alcohol/substance abuse. After recording the sociodemographic data, patients were asked to take three internationally validated questionnaires: The Arizona Sexual Experience Scale (ASEX), Dyadic Adjustment Scale (DAS), and Beck Depression Inventory (BDI). Results were analyzed using SPSS. Results: Fifty patients with obesity as case group and 50 normal weight healthy persons as control group were included in the study. BMI and BDI score were significantly higher in the case group than in the control group. DAS score was lower in the case group for consensus and affectional expression than the control group but there was no difference for satisfaction, cohesion, or total score between the groups. ASEX score was higher in the case group than in the control group. Conclusion: Patients with obesity have dyadic consensus problems with their partners. Their excessive weight causes distress and difficulty in expressing their feelings and usually results in marital problems and depression. Evaluation of the patient with a multidisciplinary approach in obesity centers will allow patients to be analyzed in every aspect of obesity including these issues and contribute to the success of the treatment.

Relationship between circulating microparticles and hypertension and other cardiac disease biomarkers in the elderly.

BACKGROUND: Microparticles are procoagulant membrane vesicles that play role in endothelium dysfunction pathogenesis and are increased in hypertension, acute/chronic vascular pathological events. Here; we aimed to compare MPs levels of hypertensive geriatric patients with healthy age-match-patients, discuss its availability as a cardiovascular biomarker and investigate its relationship with other inflammatory markers. METHODS: Forty seven hypertensive geriatric patients (M/F;15/32) and 47 healthy controls (M/F;19/28) were included in the study. MPs levels were examined functionally through thrombin generation test (TGT) parameters (MPS Lag time, MPS ETP, MPs Peak, MPS start Tail) and compared with CRP, N/L ratio, ALT, GGT, thrombocyte parameters. Decrease in MPS Lag time, increase in MPS ETS and MPs Peak elevation were accepted as tendency to coagulation which meant an increase in number and function of MPs. RESULTS: No significant difference was found between 2 groups for MPS tests (MPS Lag time, MPS ETP, MPs Peak, MPS start Tail). Platelet count was significantly higher in hypertensive patient group. There was a negative correlation between age and MPs Peak, MPS Lag time. There was a positive correlation between CRP and MPS ETP, MPs Peak values. CONCLUSIONS: Our present findings might help to understand the hemostasis via TGT parameters, in the elderly. Contribution of MPs to thrombosis tendency seen with aging and increased number of circulating MPs caused by hypertensive endothelial dysfunction must be taken into consideration. MPs might be accepted as vascular inflammation and damage markers and used as follow up tools of medical treatment of vascular inflammation-related diseases.

Porphyria cutanea tarda: a case report.

BACKGROUND: The porphyrias are a rare group of metabolic disorders that can either be inherited or acquired. Along the heme biosynthetic pathway, porphyrias can manifest with neurovisceral and/or cutaneous symptoms, depending on the defective enzyme. Porphyria cutanea tarda, the most common type of porphyria worldwide, is caused by a deficiency of uroporphyrinogen decarboxylase, a crucial enzyme in heme biosynthesis, which results in an accumulation of photosensitive byproducts, such as uroporphyrinogen, which leads to the fragility and blistering of sun-exposed skin. Porphyria cutanea tarda is a condition that affects the liver and skin by reduction and inhibition of uroporphyrinogen decarboxylase enzyme in erythrocytes. Areas of skin that are exposed to the sun can generate blisters, hyperpigmentation, and, sometimes, lesions that heal leaving a scar or keratosis. Liver damage might present in a wide range of ways from liver function test abnormalities to hepatocellular carcinoma. The toxic effect of iron plays a role in liver damage pathogenesis. CASE PRESENTATION: A 59-year-old Turkish man presented with hyperpigmented skin lesions, fatigue, and elevated ferritin level and liver function tests. He was diagnosed as having porphyria cutanea tarda after a clinical investigation and treated with phlebotomy. CONCLUSION: Porphyria cutanea tarda is a rare condition of the liver but it must be remembered in a differential diagnosis of liver disease with typical skin involvement to decrease morbidity and health costs with early treatment.

A Extensively drug-resistant Pseudomonas putida bacteremia that was resolved spontaneously.

Pseudomonas putida (P. putida) is a rare pathogen that causes various infections in newborns, neutropenic and cancer patients, or in patients with risk factors leading to immunosuppresion. Antibiotic resistance in P. putida is seen in growing numbers. Although it is less virulent compared to Pseudomonas aeruginosa, mortal infections are reported. Here, a P. putida case after an invasive procedure in a patient with gastrointestinal malignancy is reported. Although, it caused an antibiotic resistant bacteremia, it resolved spontaneously without any treatment. P. Putida might have lower virulence and a different antibiotic susceptibility when compared to Pseudomonas aeruginosa in different cases. More clinical information is needed for further evaluation.

Analysis of diabetes-related cerebellar changes in streptozotocin-induced diabetic rats.

BACKGROUND/AIM: Diabetic peripheral neuropathy has been extensively studied and reported, but the number of studies that have investigated diabetes-related changes in the central nervous system are limited, with even fewer studies on the cerebellum. The aim of this experimental study was to perform a histologic analysis of the diabetes-related changes in the cerebellums of diabetic rats. MATERIALS AND METHODS: Twenty Sprague Dawley rats weighing between 200 and 220 g were included in the study. Diabetes was induced in 14 of these rats by a single intraperitoneal injection of 65 mg/kg streptozotocin dissolved in saline, while 6 animals constituted the control group. The induction of diabetes was confirmed by measuring the blood glucose levels in the tail blood with a glucometer. Levels equal to or above 200 mg/dL were considered diabetic. Induction of diabetes failed in 3 animals, who were then excluded from the study. RESULTS: Light and electron microscopic studies revealed that the neurons and glial cells in the diabetic group had degenerative changes, irregularities and disruption in the myelin sheath, disintegration in the presynaptic vesicles, engorged axon terminals, perivascular and mitochondrial swelling, mitochondrial structural changes, and fragmentation of the neurofilaments. CONCLUSION: Ultrastructural alterations are observed in the diabetic rat cerebellum.

A rarely seen cause for empyema: Leuconostoc mesenteroides.

Leuconostoc species are Gram-positive, non-motile, vancomycin-resistant bacteria placed within the family of Streptococcaceae. They naturally exist in food and are important in the sauerkraut, milk and wine industries due to their role in fermentation. Infections caused by Leuconostocs are generally reported in immunosuppressed patients with an underlying disease, or in those who were previously treated with vancomycin. Central venous catheter insertion is also a risk factor for introducing bacteria into the body. Although they are resistant to vancomycin, leuconostocs are sensitive to erythromycin and clindamycin. Here, we report a case with pleural empyema due to Leuconostoc mesenteroides in an otherwise healthy person whose occupation is known to be selling pickles.

Osteoprotegerin as a marker of atherosclerosis in type 1 and type 2 diabetic patients.

BACKGROUND/AIM: The aim of this study was to investigate the availability of osteoprotegerin (OPG) as a marker of atherosclerosis and compare serum OPG levels with ankle-brachial index (ABI) in diabetic patients. MATERIALS AND METHODS: A total of 31 type 1 and 31 type 2 diabetic patients without macrovascular complications and 20 healthy volunteers were included. Serum OPG levels and ABI were measured. RESULTS: The duration of diabetes was significantly higher in type 1 diabetics than in type 2, although there was no significant difference between mean HbA1c levels. There was a weak and inverse correlation between OPG and atherosclerosis in type 1 diabetics only (P = 0.046, r = -0.360). There was a weak, positive correlation between ABI and HbA1c in all participant groups (P = 0.047, r = 0.220), and a weak-medium correlation in type 2 diabetics (P = 0.021, r = 0.414). After the adjustment of OPG levels to atherosclerosis risk factors, only the age factor was found to be effective on OPG. CONCLUSION: The inverse correlation of serum OPG with atherosclerosis in type 1 diabetics suggests that atherosclerosis may be related to increased duration of diabetes. Since the study participants did not show macrovascular complications, future prospective studies on the development of diabetic complications and correlation with OPG might give further information about the availability of OPG as a marker of atherosclerosis.