Comparison of triglyceride-glucose index and anthropometric obesity indices in predicting severe grades of hepatic steatosis in nonalcoholic fatty liver disease among non-diabetic obese individuals.

Background and Aim: The triglyceride glucose index (TyG) has been proposed as a promising indicator of both insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). However, the efficacy of the TyG index in predicting NAFLD has not been adequately studied, particularly in obese individuals. Materials and Methods: We analyzed 190 morbidly obese individuals. The TyG index, anthropometric obesity indices, homeostatic model assessment (HOMA-IR), and biochemical parameters were compared. NAFLD was diagnosed by hepatic ultrasonography and classified into four grades (0, 1, 2, and 3). Individuals in grades 2 and 3 are considered to have severe steatosis, while those in grades 0 and 1 do not. Results: The area under the curve (AUC) values of the TyG index, body mass index, neck circumferences, waist-to-hip ratio, and HOMA-IR did not differ significantly in predicting severe steatosis (0.640, 0.742, 0.725, 0.620, and 0.624 respectively). However, the AUC values of waist circumference and alanine aminotransferase provided better predictions than the TyG index (0.782, 0.744, and 0.640 respectively). Conclusion: The TyG index is highly effective in predicting both the presence and severity of NAFLD. However, it did not outperform simple obesity indices in predicting NAFLD and its severity in obese patients.

Prostate Cancer Awareness in the Middle East: A Cross-Sectional International Study.

PURPOSE: Prostate cancer has emerged as a significant public health challenge in the Middle East, characterized by rising incidence rates and a concerning mortality-to-incidence ratio. Yet, despite these alarming trends, data regarding prostate cancer awareness in the region remain limited. To address this critical knowledge gap, this study investigates prostate cancer awareness within the Middle East. MATERIALS AND METHODS: A cross-sectional survey was performed among 5,913 men age 40 years and older across 14 Middle Eastern countries between January 1, 2022, and July 31, 2023. Excluding those with a history of prostate cancer, a validated questionnaire assessed prostate cancer awareness. Data were analyzed using frequencies and percentages for categorical variables, medians and ranges for continuous variables, and Pearson chi-square analysis for relationships between education levels and awareness of prostate cancer. RESULTS: The survey achieved a 74.9% response rate, with 4,431 male participants. Regarding prostate cancer awareness, 83.8% of participants had heard of the disease. However, only 31.0% correctly identified it as the most common malignancy in men, and 21.8% believed it affects both sex. Awareness of screening was limited, with just 19.1% recognizing the prostate-specific antigen test's role. Additionally, participants had a pessimistic view, with a mean perception that 75% of patients with prostate cancer die from the disease, rather than from other causes. Higher education levels were associated with significantly increased awareness of prostate cancer (P < .001). CONCLUSION: This study reveals that while general awareness of the disease exists, crucial knowledge deficits regarding risk factors, screening, and prognosis are evident. Addressing these knowledge gaps through culturally tailored education may improve early detection rates, treatment outcomes, and ultimately reduce the burden of prostate cancer in the Middle East.

A rare complication of tension band fixation of olecranon osteotomy: Distal migration of K-wire.

Tension band wiring (TBW) is one of the most commonly used fixation techniques to fix olecranon osteotomies. Hardware prominence has been the most commonly reported complication of TBW. However, distal migration of Kirschner (K)-wire after TBW fixation for olecranon osteotomy has not been reported. In this case report, we presented distal migration of K-wire detected nine months after initial surgery in a 46-year-old male patient. The patient was operated on for an intraarticular distal humerus fracture using an olecranon osteotomy. The osteotomy was fixed with TBW fixation. The patient missed routine follow-ups and presented to the outpatient clinic with a complaint of skin irritation at the elbow nine months after the surgery. On radiological examination, distal migration of one K-wire was detected. The K-wire was surgically removed without any complication. Physicians should be aware of possible complications of TBW and remove fixation after fracture union to avoid unexpected complications.

Primary Negative Prognostic Factors in Pediatric and Adult Patients Undergoing Trigger Finger Surgery.

Objectives This study aims to investigate the negative prognostic indicators of pediatric and adult trigger finger surgery patients concerning complications, recurrence, and satisfaction. Methods A retrospective study was conducted on 61 patients with a total of 91 trigger fingers, including 31 in children and 30 in adult patients, all of whom were treated using a standardized surgical technique. The study considered several demographic and clinical factors, including age, gender, dominant hand, body mass index, occupation, history of trauma, single or multiple finger involvement, staging according to Green classification, diabetes mellitus, comorbidities, recurrence, revision surgery, utilization of non-surgical treatment methods, need for rehabilitation after surgery, time to return to work, the time interval from clinic initiation to the surgery, satisfaction and the duration of the follow-up period. In addition, the quick version of the disabilities of the arm, shoulder, and hand (QDASH); and the visual analog scale (VAS) were used to assess patients' data. Results In adult patients, a statistically significant relationship was observed between the increasing grade of the Green stage and complication rate (p<0.001), recurrence (p<0.001), and lower satisfaction (p<0.001). No statistically significant relationship was identified between Green's classification and complications (p=0.129), recurrence (p=0.854), or satisfaction (p=0.143) in pediatric patients. While a statistically significant relationship existed between the time interval from clinic initiation to surgery and complications (p=0.033) in adult patients, no significant relationships were observed for recurrence or satisfaction. Conversely, there was no statistically significant relationship between the time interval from clinic initiation to surgery and complications, recurrence, or satisfaction in pediatric patients. Conclusion This study demonstrates that increasing the grade of the Green stage and duration of symptoms before surgery were the substantial factors contributing to prognosis in adult patients but not in pediatric patients. These findings can assist physicians during patients' treatment management. We suggest that physicians consider these factors for patients' satisfaction.

Investigation of Head Lice and Intestinal Parasites in Primary and Secondary School in Sivas.

Objective: The purpose of this study was to investigate the prevalence of intestinal parasites and head lice in primary school-aged children and to determine a possible relationship between the co-occurrence of ecto-endoparasites. Methods: The study were conducted in three schools in the center of Sivas: Sivas Karsiyaka Primary School, Kilavuz IMKB Primary School, and Karsiyaka 27 June Middle School. The presence of head lice and intestinal parasites was investigated in a total of 563 children aged 6 to 17, with 294 girls and 269 boys. Classroom teachers and students were provided with information about intestinal parasites, head lice, and methods of transmission and prevention, and a questionnaire was administered. During the head lice examination, students were inspected with a comb, and samples with nits were examined under a microscope in the laboratory. Cellophane tape and stool samples obtained from the participants were examined on the same day using the native-lugol, flotation, and trichrome staining methods under a light microscope (x10, x40, x100). Results: Five hundred sixty-three children were evaluated for head lice and 15 (2.6%) were found to be positive. During the examination, only nits were found in 11 students (1.9%), and both adult lice and nymphs were seen in 4 students (0.7%). Head lice were found positive in 2 out of 269 boys (0.7%), while 13 out of 294 girls (4.2%) positive (p<0.05). As a result of stool examination in children, Entamoeba coli was found in 11 (1.95%), Giardia intestinalis in 4 (0.71%), Blastocystis sp. in 14 (2.48%), Enterobius vermicularis in 8 (1.42%) and Taenia spp. in 2 (0.35%). Head lice infestation and Taenia spp. were found to coexist in 2 (0.35%) children. Conclusion: In conclusion, although there has been a noticeable decrease in head lice and intestinal parasites among primary school-aged children in Sivas province, these conditions are still present, as evidenced by previous studies conducted in our region.

Dynamic impact of demographic features, FDI, and technological innovations on ecological footprint: evidence from European emerging economies.

Climate change effect mitigation is a critical priority for top leaders and communities around the globe. Human-induced environmental issues are affecting humankind's standard of living and development potential and the planetary boundaries. Sustainability objectives aim to enhance environmental quality and ensure sustainable development for all by eliminating social inequalities. This study examines the complex relationships between demographic features, foreign direct investment, technological innovation, and ecological footprint, emphasizing the relevance of population aging, population density, and urbanization in this context. The research uses a selection of emerging European economies during 1995-2018. The reasons for countries' selection are related to the increasing rate of population aging in European countries, the attractiveness for foreign direct investment, the economic growth, and the technological advancement potential these emerging countries possess. In order to investigate the long-run relationship between the selected variables, the study tests the cross-section dependence, homogeneity, and cointegration and uses Konya tests to determine panel causality. Based on Konya methodology, differences between countries in the panel are evidenced and discussed accordingly. Our findings confirm the long-run relationship between environment, technological innovation, population aging, and FDI. The results of this research are highly relevant for policymakers in selected countries for identifying the set of correlations and the relevance of various variables in such national economies. Demographic features such as population aging and population density are critical for Europe, and the results show the impact on the ecological footprint.

Prostate cancer presentation and management in the Middle East.

BACKGROUND: Although prostate cancer is a prevalent malignancy worldwide, its clinical presentation and management in the Middle East are not well-documented. This study aims to provide insights into the initial clinical presentation and management of prostate cancer in this region. METHODS: A retrospective review was conducted on seven institutional databases from six Middle Eastern countries, including Türkiye, Lebanon, Iraq, Syria, Bahrain, and Jordan, to identify patients diagnosed with prostate cancer in 2021. Descriptive analysis was performed on the collected data to provide an overview of the demographic, clinical, and treatment variables. RESULTS: A total of 1,136 patients were identified with a median age of 70 (range, 50-84). Most patients (78%) received their prostate cancer diagnosis after presenting with symptoms, as opposed to routine PSA screening. At the time of diagnosis, 35% of men had clinical T3 or T4 disease, 54% with Stage IV disease and 50% with Gleason score ≥ 8. Regarding treatment, 20% of non-metastatic and 22% of metastatic patients received no treatment. CONCLUSION: Most men in this study sought prostate cancer evaluation due to symptoms and were subsequently diagnosed with advanced-stage disease, providing a foundation for future research aimed at understanding the underlying factors behind the observed trends and enabling informed interventions.

Burden of prostate cancer in the Middle East: A comparative analysis based on global cancer observatory data.

BACKGROUND: Prostate cancer represents a significant global health issue, yet our understanding of its impact in the Middle East remains limited. This study aimed to assess the incidence and mortality of prostate cancer in the Middle East, and compare these rates to those in Europe and North America. MATERIALS AND METHODS: We utilized the 2020 Global Cancer Observatory data, compiling incidence and mortality rates of prostate cancer in 20 Middle Eastern countries. We calculated mortality-to-incidence ratios (MIR) and compared the age-standardized incidence rate (ASIR) and MIR between the Middle East and the combined regions of North America and Europe. The countries were further stratified based on the Human Development Index (HDI) and income level for additional analysis. RESULTS: In 2020, the Middle East documented an estimated 51,649 new prostate cancer diagnoses, accounting for 3.7% of global cases. Despite a significantly lower ASIR in the Middle East compared with Europe and North America (10.50 vs. 21.50, p = 0.0087), the region had a higher MIR (12.35 vs. 3.00, p = 0.0476). When stratified based on HDI or income levels, there was no significant difference in MIRs; however, a significant trend of increasing MIR with decreasing HDI (p = 0.028) and income levels (p = 0.016) was observed. CONCLUSIONS: Despite a lower incidence, our analysis showed a significantly higher MIR for prostate cancer in the Middle East compared with Europe and North America. These findings underscore the unique challenges posed by prostate cancer in the Middle East and emphasize the necessity of tailored strategies to address this pressing public health issue.

Evaluation of the Paraoxonase-1 Level in Patients with Acute Pancreatitis.

BACKGROUND: This study, aimed to evaluate the role of paraoxonase-1 (PON-1), in the pathogenesis of acute pancreatitis (AP). PON-1 plays a significant role in antioxidant, anti-inflammatory and antiatherogenic responses and may help predict the severity of AP. METHODS: A total of 50 patients with AP and 45 healthy volunteers were included in the study. AP was diagnosed when serum amylase and/or lipase values increased threefold and/or more than the upper limit of normal, together with a complaint of abdominal pain. Modified Atlanta and Ranson scoring were used for AP severity. RESULTS: AP causes were biliary for 35 (70%) patients and idiopathic for 8 (16%) patients, AP developed in 6 (12%) patients after endoscopic retrograde pancreatography, and AP in 1 (2%) patient was a consequence hypertriglyceridemia. No difference in PON-1 level was found between the groups (PON-1=197.06±164.6 and 192.1±111.78, respectively, p=0.86). On the other hand, patients were stratified according to the modified Atlanta (177.5±166.8 for mild to moderate vs. 268.5±64.2 for severe, p<0.018) or Ranson (163.2±133.06 for mild vs. 208.8±158.0 for severe, p<0.016). PON-1 level was significantly higher in patients with severe AP compared to patients with mild and/or moderate disease. CONCLUSION: Although PON-1 level did not differ in patients with and without AP, PON-1 level increased significantly in parallel with the severity of AP. Thus, PON-1 can be a potential marker for the severity of the disease and can predict prognosis.

Analysis of Interleukin-17, Interleukin-23, neopterin and Nesfatin-1 levels in the sera of Hashimoto patients.

Background: Hashimoto's thyroiditis (HT) is an autoimmune disorder affecting the thyroid gland and may present as goiter or atrophic thyroiditis that may result in various metabolic and inflammatory disorders. The aim of this study is to determine the changes in serum levels of interleukin-17 (IL-17), IL-23, neopterin, and nesfatin-1 parameters in HT patients and to evaluate the possible relationship among these parameters. Methods: 90 HT patients and 30 healthy individuals were included in this study. Demographic data of the patients included in the study were recorded and detailed physical examinations were performed. IL-17, IL-23, neopterin, and nesfatin-1 levels were measured in the serum samples of the participants by the ELISA method.

Comparing the outcomes of tripod technique and locked plate fixation for the treatment of Mason type 3 radial head fractures.

OBJECTIVES: In this study, we aimed to compare functional outcomes and complication rates of tripod technique and locked plate fixation used in Mason type 3 radial head fractures. PATIENTS AND METHODS: Between January 2012 and December 2019, a total of 27 patients (16 males, 11 females; median age: 43.2 years; range, 20 to 68 years) with Mason type 3 radial head fractures were retrospectively analyzed. The patients were divided into two groups according to fixation method used. Group 1 consisted of 12 patients who were treated with tripod technique, and Group 2 consisted of 15 patients who were treated with locked plate fixation. Operation time, follow-up period, length of hospital stay, union time, Disabilities of Arm, Shoulder and Hand (DASH) scores, range of motions and complications were recorded. RESULTS: The median time to bone union was 46.7 days in Group 1, which was significantly shorter than Group 2 (p<0.001). The median forearm pronation-supination arc was 123.75° (range, 30° to 180°) in Group 1 and was 94° (range, 45° to 180°) in Group 2. There was no significant difference in the forearm rotation between the groups. The median elbow flexion-extension arc was 99.17° (range, 65° to 130°) in Group 1 and was 80.33° (range, 30° to 130°) in Group 2. No statistically significant difference was found in the flexion-extension and pronation-supination arc degrees. There was no significant difference in the postoperative DASH scores between the groups (p=0.464). CONCLUSION: Our study results demonstrate that comparable results can be achieved in both techniques regarding functional outcome and range of motion. With a shorter union time and less complication rates, the tripod technique should be considered as the primary treatment method for the comminuted radial head fractures without a metaphyseal defect.

Sustainable pathways for attaining net-zero emissions in European emerging countries - the nexus between renewable energy sources and ecological footprint.

This study aims to investigate the relationship between renewable energy and ecological footprint during the period of 1994-2018 from selected developing countries in Europe (Czechia, Croatia, Poland, Romania, Romania, and Turkey). In this context, the ecological footprint (EF), which has recently been the most widely used environmental indicator in the literature and is known as the most comprehensive because it includes many environmental factors, has been determined as the dependent variable. As independent variables, renewable energy consumption (REC), energy-related tax revenue (ETR), and energy productivity (EP) are included in the model. GDP and development of environment-related technologies (DET), which affect the ecological footprint in the model, are determined as control variables. As a result of the panel data analysis, according to the Durbin-Hausman cointegration test result, a long-term relationship between the variables was determined. According to the CCE estimator analysis, it can be said that there is a positive relationship between ETR and GDP variables and EF. For the AMG estimator analysis, it can be said that there is a positive relationship between GDP and EP variables and EF. Finally, according to the results of the Konya Causality test, a unidirectional causality relationship is detected from environmental technologies to the ecological footprint in Turkey, and a unidirectional causality relationship from the ecological footprint to GDP in Czechia, Romania, and Turkey. Furthermore, no causality relationship is detected between other variables. Based on the results, several policy implications are suggested.

Effectiveness of a telehealth patient education intervention for breast cancer awareness and screening uptake among Afghan refugee women: a cross-sectional survey and feasibility study.

Background: Refugee populations have low levels of cancer awareness, low cancer screening rates, and a high rate of advanced or metastatic cancer at diagnosis. Educational interventions to improve cancer awareness and screening have been successful in other nationality refugee populations but have never been implemented in Afghan refugee populations. We aimed to estimate the level of breast cancer awareness among Afghan refugee women and test the feasibility of a telehealth breast cancer educational intervention to increase breast cancer awareness in this population. Methods: A cross-sectional survey of Afghan refugee women residing in Istanbul, Türkiye who had no personal history of breast cancer and who presented to outpatient primary clinics for care between August 1, 2022, and February 10, 2023 was performed. Participant awareness of breast cancer (BC) was assessed using the validated BC awareness tool, Breast Cancer Awareness Measure (BCAM), during a telehealth encounter. After this baseline assessment, a BC educational intervention was administered to each participant during the telehealth encounter. Six months after the initial assessment and education, a follow-up BCAM was administered via telehealth in order to determine the effectiveness of the education intervention. Findings: One hundred participants were accrued to the study. Median age was 49 years (range: 40-64). All participants had no formal education, were married, and were not employed. Prior to the educational intervention, BC awareness was low; none of the participants were able to identify some common signs/symptoms and risk factors for BC. Prior to the educational intervention, zero participants had ever had a mammogram or seen a physician for a breast-related concern. Six months after the educational intervention, up to 99 percent of participants (99 of 100 participants) were able to correctly identify common signs or symptoms and risk factors for BC. Six months after the educational intervention, all one hundred participants had accepted the offer of a screening mammogram. Interpretation: A telehealth BC education intervention meaningfully increased BC awareness in Afghan refugee women. This increase in BC awareness was associated with a strong increase in completion of BC screening. Further implementation of educational interventions is warranted in order to increase participant awareness and improve screening rates. Funding: Dana Farber Cancer Institute Jay Harris Junior Faculty Research Grant.

Relationship between systemic immune inflammation index and amputation in patients with diabetic foot ulcer.

AIM: The systemic immune inflammation index (SII) is a cost-effective biomarker calculated by lymphocyte, neutrophil and platelet counts and is currently being studied in various diseases. Since there is no study examining the relationship between SII and diabetic foot ulcers (DFU) in the literature, our aim was to investigate the relationship between SII and amputation rate in DFU. METHODS: Type 2 DM 511 patients with DFU were screened from 2017 to 2021. Laboratory data obtained on the first day of hospitalization were considered. Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and SII were calculated from routine blood count. Participants were divided into two groups as amputation (Group 1) and non-amputation (Group 2). RESULTS: Amputation rate was 18.8%. The A1c (8.80 (3.26) % vs. 9.52 (3.10) %, p = 0.007) and HGB (10.17 ± 2.16 g/dL vs. 12.05 ± 2.20 g/dL, p < 0.001) levels, and lymphocyte count (1.81 (1.16) vs. 2.05 (1.11), p = 0.015) were significantly lower in Group 1 than Group 2. The counts of WBC (14.01 (9.16) × 109/L vs. 10.41 (5.82) × 109/L), PLT (393.35 (196.98) × 109/L vs. 312.05 (141.33) × 109/L), neutrophil (11.52 (8.75) × 109/L vs. 6.93 (5.96) × 109/L), PLR (226.04 (159.24) × 109/L vs. 153.12 (101.91) × 109/L), NLR (6.64 (6.93) vs. 3.34 (3.99)) and SII (2505.86 (3957.47) × 109/L vs. 1092.50 (1476.08) × 109/L), and the levels of CRP (14.12 (12.66) mg/dL vs. 3.86 (12.63) mg/dL) and ESR (87.50 (50.50) mm/h vs. 63.00 (57.25) mm/h) were significantly higher in Group 1 than Group 2 (all p < 0.001). AUC of ROC analysis of PLR was 0.666 (95% CI, 0.604-0.728), NLR was 0.695 (95% CI, 0.638-0.752) and SII was 0.716 (95% CI, 0.661-0.772) for the predicting of amputation and the SII had the best AUC with 67.4% sensitivity and 63.3%specificty. CONCLUSION: SII is a cost-effective and readily available marker, but alone may not be sufficient to predict the risk of amputation in DFU. In our results, the predictive role of SII alone or with other markers for future DFU and its role in predicting other chronic diabetic complications will be evaluated in extensive studies.

Does rotational deformity cause poor outcomes after pediatric supracondylar humerus fractures?

BACKGROUND: We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) com-plication after supracondylar humerus fracture surgery. METHODS: Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria. RESULTS: Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational deformity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001). CONCLUSION: In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

Radiation therapy for prostate cancer in Syrian refugees: facing the need for change.

Purpose: To report the utilization of radiation therapy in Syrian refugee patients with prostate cancer residing in Turkey. Methods and materials: A multi-institutional retrospective review including 14 cancer centers in Turkey was conducted to include 137 Syrian refugee patients with prostate cancer treated with radiation therapy (RT). Toxicity data was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Noncompliance was defined as a patient missing two or more scheduled RT appointments. Results: Advanced disease, defined as stage III or IV, was reported in 64.2% of patients while androgen deprivation therapy (ADT) was only administrated to 20% of patients. Conventionally fractionated RT with a median number of 44 fractions was delivered to all patients with curative intent (n = 61) while palliative RT (n = 76) was delivered with a median number of 10 fractions. The acute grade 3-4 toxicity rate for the entire cohort was 16%. Noncompliance rate was 42%. Conclusion: Most Syrian refugee prostate cancer patients presented with advanced disease however ADT was seldom used. Despite the low treatment compliance rate, conventional fractionation was used in all patients. Interventions are critically needed to improve screening and increase the use of standard-of-care treatment paradigms, including hypofractionated RT and ADT.

Effects of COVID-19 pandemic lockdown on the metabolic control of type 2 diabetes mellitus in patients.

Objective: The effects of the COVID-19 pandemic on the control of diabetes mellitus in patients are largely unknown. In this study we aimed to analyze the impact of the pandemic and the ensuing lockdown on the management of type 2 diabetes mellitus. Subjects and methods: A total of 7,321patients with type 2 diabetes mellitus (4,501 from the pre-pandemic period, 2,820 from the post-pandemic period) were studied retrospectively. Results: The admission of patients with diabetes melitus (DM) decreased significantly during the pandemic (4,501 pre-pandemic vs. 2,820 post-pandemic; p < 0.001). The mean age of patients was statistically lower (51.5 ± 14.0 vs. 49.7 ± 14.5 years; p < 0.001), and the mean glycated hemoglobin (A1c) level was significantly higher (7.9% ± 2.4% vs. 7.3% ± 1.7%; p < 0.001) in the post-pandemic period than in the pre-pandemic. The female/male ratio was similar in both periods (59.9%/40.1% for pre-pandemic, 58.6%/41.4% for post-pandemic; p = 0.304). As calculated by month the pre-pandemic rate of women was higher only in January (53.1% vs. 60.6%, p = 0.02). Mean A1c levels were higher in the postpandemic period than in the same month of the previous year, excluding July and October (p = 0.001 for November, p < 0.001 for others). Postpandemic patients admitted to the outpatient clinic were significantly younger than prepandemic visits for July (p = 0.001), August (p < 0.001) and December (p < 0.001). Conclusion: The lockdown had detrimental effects on blood sugar management in patients with DM. Hence, diet and exercise programs should be adapted to home conditions, and social and psychological support should be provided to patients with DM.

Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold.

Purpose: This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Methods: Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. Results: The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9 months (range 12-24). Lesion size was 3 cm2 in group I and 2.9 cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. Conclusion: No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4 cm2. Level of Evidence: Level III: retrospective comparative study.

Evaluation of Nrg4 and thiol/disulfide homeostasis in patients with GDM.

BACKGROUND: In this study, we aimed to evaluate the role of neuregulin4 (Nrg4) in the etiopathogenesis of gestational diabetes mellitus (GDM) and thiol/disulfide homeostasis as an indicator of oxidative stress. METHODS: This prospective, case-control study included 34 women with diabetes and 34 healthy pregnant women who applied between January 2017 and January 2020. Levels of native and total thiol, disulfide and Nrg4 were measured in both diabetes mellitus and healthy pregnant groups. RESULTS: When compared to the control group, the serum neuregulin4 levels in the diabetes group were considerably lower (3.22 ± 2.16 vs. 4.55 ± 0.96, p < 0.001). Native thiol (292.67 ± 43.65 vs. 366.40 ± 51.28; p < 0.001), total thiol (388.60 ± 46.60 vs. 414.52 ± 54.19; p < 0.001) levels and native thiol/total thiol ratio (75.51 ± 8.95 vs. 88.35 ± 3.54; p < 0.001) were lower in diabetes group compared to control group. Disulfide level (47.96 ± 19.52 vs. 24.06 ± 7.69) and disulfide/native thiol (17.13 ± 8.03, vs. 6.67 ± 2.30) and disulfide/total thiol (12.24 ± 4.47 vs. 5.82 ± 1.77) ratios were higher in diabetes group (all p < 0.001). CONCLUSIONS: We suggested that decreased Nrg4 level and impaired oxidative stress parameters may be related with the increased risk of diabetes. However, we did not found a correlation between the Nrg4 and oxidative stress parameters.

Clinical features of generalized lipodystrophy in Turkey: A cohort analysis.

AIM: To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow-up. METHODS: This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean ± SD follow-up was 86 ± 78 months. RESULTS: The Kaplan-Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan-Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (≥ 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan-Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan-Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow-up period. Causes of death were end-stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. CONCLUSIONS: Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL.