Galectin-3 levels and inflammatory response in patients undergoing bariatric surgery.

PURPOSE: Obesity, a low-grade systemic inflammatory disease, causes inflammation in metabolic tissues. Galectin-3(Gal-3) is one of the lectin molecules involved in inflammatory processes. We evaluated the possible relationship between Gal-3 level and the metabolic inflammatory process before and after obesity surgery. METHODS: One hundred participants were included in the study and classified as normal weight, overweight, Class I, II, and III obese. Class III obese group underwent bariatric surgery and evaluated in the 3rd and 6th months after surgery. Glucose, insulin, glycated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hsCRP), Gal-3, interleukin (IL)-6, IL-10, adiponectin, and leptin levels were determined. RESULTS: Gal-3 levels were higher in Class III obese compared to the normal weight group. Postoperative leptin and hsCRP levels were decreased significantly, but the decrease in IL-6 and Gal-3 levels were not significant. Postoperative increased adiponectin and IL-10 levels were significant. Gal-3 was found significantly higher in insulin resistant group. The correlation between Gal-3 with BMI, adiponectin, leptin, hsCRP levels, and HOMA-IR was found weak. CONCLUSION: These findings might support the fact that Gal-3 is one of the molecules involved in the linkage between insulin resistance and meta-inflammation in morbid obese.

Are patients with obesity "scapegoats"? The obesity prejudice levels of health care workers in Turkey.

OBJECTIVE: This study assessed obesity prejudice levels, attitudes, and perceptions of health care workers toward individuals with obesity and the relationship between health care workers' perceptions of own and society's weight bias, healthy lifestyle preferences, body mass index, and other factors with obesity prejudice levels. METHODS: This cross-sectional and descriptive study was conducted with 700 health care workers in Turkey via an online survey addressing characteristics, perceptions, and attitudes toward obesity including an obesity prejudice scale. Categorical variables were expressed as frequencies and percentages. The χ² test was applied to compare categorical variables. The distribution of the data was evaluated by the Kolmogorov-Smirnov test. Normally distributed data were compared by an independent sample t-test, while the Mann-Whitney U and Kruskal-Wallis tests were used for comparing non-normally distributed data. RESULTS: Participants' mean age was 40.2±11.3 years and 67.9% were women. Notably, 57.9% worked at tertiary health care centers, 85.9% were physicians, and 64.8% were family physicians; 25% were prejudicial, while 58.1% tended to have prejudice toward individuals with obesity. Obesity prejudice scores were significantly higher among those who were in close contact with and who stated their preference for patients with obesity. CONCLUSIONS: Half of the participants tended to have prejudice, and one-fourth were prejudicial toward individuals with obesity. These results highlight the necessity of raising awareness of health care workers to reduce prejudicial attitudes that may negatively impact patients with obesity. Stigmatizing experiences might be detrimental, reducing the quality of life with long-term consequences for emotional and physical health.

The willingness to accept the COVID-19 vaccine and affecting factors among healthcare professionals: A cross-sectional study in Turkey.

INTRODUCTION: While discussions on the effectiveness of COVID-19 vaccines continue, healthcare professionals' attitudes and their growing fear and anxiety during the pandemic process are not yet fully known. In this study, we aimed to investigate the COVID-19 vaccine acceptance and affecting factors in healthcare professionals. METHODS: This was a cross-sectional online survey conducted in 1574 healthcare professionals consisting of physicians, nurses, dentists, pharmacists, and healthcare personnel in Turkey in December 2020. Demographic, attitudinal, and Fear of COVID-19 Scale scores of healthcare professionals were investigated in this survey. RESULTS: About 84.6% of healthcare professionals declared willingness to accept the COVID-19 vaccine whenever possible. Most physicians (90.4%) stated to receive the COVID-19 vaccine, while 66.5% of nurses, 73.9% of healthcare personnel, also preferred to have it as soon as the vaccine was available. Factors affecting the willingness to accept the COVID-19 vaccine were found to be advanced age, male gender, working in a primary health care center, living with family, having a child, having a chronic disease, having high Fear of COVID-19 Scale (FC-19S) scores. While the group with the highest vaccine rejection rate was nurses with 33.5%, FC-19S scores were significantly higher in nurses who wanted to be vaccinated. In multivariate regression analyses, factors related to the acceptance of the COVID-19 vaccine were identified as advanced age, routine adult vaccination, no history of COVID-19, and recommendation of the COVID-19 vaccine. CONCLUSION: A high proportion of healthcare professionals declared their willingness to accept the COVID-19 vaccine, and hence, this will play a leading role in optimizing the vaccination rate of the entire population while combating the pandemic.

Do initial hematologic indices predict the severity of COVID-19 patients?

Background/aim: In this study, we aimed to evaluate the initial hematological findings analyzed on admission in confirmed COVID-19 patients who were transferred to the intensive care unit (ICU), to predict possible hematological indices. Materials and methods: Initial neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), red cell distribution width to platelet ratio (RPR), mean platelet volume to platelet ratio, and lymphocyte multiplied by platelet count (LYM × PLT), of 695 patients with laboratory-confirmed COVID-19 were investigated and comparisons were made between the mild/moderate and severe groups. Results: The proportion of COVID-19 cases admitted to the ICU was 3.9%. The median age of patients admitted to the ICU was significantly higher than those who were not; [68.5 (interquartile range (IQR); 21.5] years vs. 41.0 (IQR; 15.7) years; P < 0.001. Severe cases had higher NLR (6.6 vs. 2.4; P < 0.001), and MLR (0.40 vs. 0.28; P = 0.004) and lower PLR (180.0 vs. 129.0; P < 0.001) compared to that of mild or moderate patients. Among all of the parameters, the ROC curve of NLR gave us the best ability to distinguish serious patients at an early stage (AUC = 0. 819, 95% confidence interval 0.729­0.910; P < 0.001). Conclusion: These data showed that age, initial NLR, PLR, and LYM × PLT were associated with the severity of COVID-19 disease and patients' need for the ICU. Therefore, initial hemogram parameters may be essential to predict the prognosis of COVID-19 patients.

Assessment of left atrial function in patients with type 2 diabetes mellitus with a disease duration of six months.

INTRODUCTION: Changes in left atrial (LA) size and function are associated with adverse clinical events. Recently, duration of diabetes mellitus (DM2) has been found to be positively associated with increased LA volume and impaired LA function. This study was performed, using two-dimensional echocardiograpy, to evaluate the changes in LA volume and function in patients with DM2 with a disease duration of six months, and to assess the parameters that affect LA volume and function. METHODS: Fifty-six patients (28 male, age: 52.6 ± 6.5 years) with DM2 and 56 controls (24 male; age: 50.1 ± 7.0 years) were enrolled in the study. Each subject underwent conventional two-dimensional echocardiography to assess LA volume (indexed maximal LA volume: Vmax, pre-atrial contraction volume: Volp, minimal LA volume: Vmin) and LA function [passive emptying volume - passive emptying fraction (PEV - PEF), active emptying volume - active emptying fraction (AEV - AEF), total emptying volume - total emptying fraction (TEV - TEF) ]. RESULTS: LA diameter, indexed Vmax, Volp, Vmin, AEV and TEV were found to be significantly higher in the DM2 group compared with the controls (p < 0.05). Indexed Vmax, Volp and Vmin were significantly correlated with HbA1c level, body mass index (BMI), high-sensitivity C-reactive protein and uric acid levels, mitral A wave, E/E' ratio and A' wave. According to multivariate analysis, age and BMI had a statistically significant effect on LA volume. CONCLUSION: Impaired LA function may be present in patients with newly diagnosed DM2. BMI and increasing age caused LA enlargement and LA volumes that were independent of the effects of hypertension and DM2.

Better knowledge and regular vaccination practices correlate well with higher seasonal influenza vaccine uptake in people at risk: Promising survey results from a university outpatient clinic.

BACKGROUND: The knowledge, beliefs, opinions, and attitudes of patients and their relatives regarding seasonal influenza vaccination were evaluated. METHODS: This descriptive study was undertaken in the outpatient clinics of Baskent University Hospital. There were 566 responders who completed a self-administered questionnaire. RESULTS: The mean age of participants was 48.35 years, and 16.8% were ≥65 years. Of the responders, 21.7% were vaccinated this year, whereas 57.8% did not desire to get it. Vaccination rates were significantly higher among responders ≥65 years of age (56.4%), those having at least 1 chronic illness (46.5%), and those who were vaccinated regularly every year (22.2%). Half of the responders did not know that the vaccine was reimbursed for people at risk. The most common reason for refusing the influenza vaccine was not getting the flu frequently (51.2%). Fear of side effects, concerns about vaccine's effectiveness, and belief that vaccine causes the flu were other common reasons for not being vaccinated. Of the responders, 77% believed that getting official information or a recommendation from a physician would influence their decision about seasonal influenza vaccination. CONCLUSIONS: People who are at risk or vaccinated regularly display a higher vaccine uptake and better knowledge of influenza and vaccination. The opinions and attitudes of this study population may assist in developing strategies for changing attitudes of the public toward influenza vaccination.

Depression, Coping Strategies, Glycemic Control and Patient Compliance in Type 2 Diabetic Patients in an endocrine Outpatient Clinic.

OBJECTIVE: Diabetes is a multifactorial disorder posing a great challenge to public health. In this study, we aimed to evaluate the relationship between depression, coping strategies, glycemic control and patient compliance in type 2 diabetic patients. METHODS: Total 110 outpatients (mean (SD) age: 57.9 years (10.5), 56.4% were females) with type 2 diabetes mellitus were included in this descriptive and cross-sectional study. They were followed-up in the endocrinology outpatient clinic at Baskent University Istanbul Hospital Turkey. A questionnaire including items on sociodemographics, patient compliance, Beck Depression Inventory (BDI) and Ways of Coping Questionnaire (WCQ) were used. Glycemic control was measured by HbA1c levels. RESULTS: Mean depression score was 12.6(9.2) with moderate to severe depression in 30.9% of study participants. Overall scores for BDI, fatalism and helplessness approaches were significantly higher among females compared with male patients. Depression scores were correlated positively to duration of disease (r=0.190, p=0.047), fatalistic (r=0.247, p=0.009), helplessness (r=0.543, p=0.000) and avoidance (r=0.261, p=0.006) approaches, and negatively to educational status (r=-0.311, p=0.001) and problem solving-optimistic approach (r=-0.381, p=0.000). CONCLUSIONS: Likelihood of depression was frequent, consistent with literature and was associated with gender, educational status, coping strategies, duration of diabetes and patient compliance with treatment in our study. Screening for depression and patient education may improve the quality of life in diabetic patients.

Amyloid goiter due to familial mediterranean Fever in a patient with byler syndrome: a case report.

BACKGROUND: Familial Mediterranean Fever (FMF), also inherited with autosomal recessive trait, is characterized by recurrent episodes of fever, arthritis, and serositis. Congenital Byler Syndrome (Progressive Familial Intrahepatic Cholestasis) inherited with autosomal recessive trait and characterized by defective secretion of bile acids. FMF associated Amyloid A deposition occurs in many tissues and organs, but amyloid goiter is a rare entity that leads to enlargement and dysfunction of the thyroid. CASE REPORT: We present a rare case of 24 year old male patient who had liver and kidney transplantation due to Byler Syndrome and secondary amyloidosis related to FMF, diagnosed as rapidly growing large amyloid goiter. Deposits of extracellular amyloid and dense adipose metaplasia diagnostic for amyloid goiter are determined upon histopathological examination of thyroidectomy material. CONCLUSION: When goiter was detected in cases with history of systemic amyloidosis and rapidly growing goitre, amyloid goiter should be remembered at first. This case is unique since two autosomal genetic disorders are together in the same patient and important as it emphasizes the consequences of consanguineous marriage, early diagnosis and treatment compliance of FMF and the awareness of amyloid goiter in patients followed by primary care physicians and healthcare professionals.

Vitamin D deficiency is related to thyroid antibodies in autoimmune thyroiditis.

INTRODUCTION: It has been known that vitamin D has some immunomodulatory effects and in autoimmune thyroid diseases, vitamin D deficiency was more prevalent. In this study, our aim was to investigate the relationship between thyroid autoantibodies and vitamin D. MATERIAL AND METHODS: Group 1 and 2 consisted of 254 and 27 newly diagnosed Hashimoto's thyroiditis (HT) and Graves' disease (GD) cases, respectively; age-matched 124 healthy subjects were enrolled as controls (group 3). All subjects (n = 405) were evaluated for 25OHD and thyroid autoantibody [anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-tg)] levels. RESULTS: Group 2 and group 1 patients had lower 25OHD levels than group 3 subjects 14.9 ±8.6 ng/ml, 19.4 ±10.1 ng/ml and 22.5 ±15.4 ng/ml, respectively (p < 0.001). Serum 25OHD levels inversely correlated with anti-tg (r = -0.136, p = 0.025), anti-TPO (r = -0.176, p = 0.003) and parathormone (PTH) (r = -0.240, p < 0.001). Group 2 patients had higher anti-tg and anti-TPO levels than group 1 and 3 (p < 0.001). CONCLUSIONS: In this study, we found that patients with autoimmune thyroid disease (AITD) present with lower vitamin D levels and GD patients have higher prevalence. Since we found an inverse correlation between vitamin D levels and thyroid antibody levels, we may suggest that vitamin D deficiency is one of the potential factors in pathogenesis of autoimmune thyroid disorders.

Frequency of Vitamin D deficiency in pregnant diabetics at Baskent University Hospital, Istanbul.

OBJECTIVE: To find out the frequency of vitamin D deficiency and its relation with glucose parameters and the incidence of gestational diabetes (GDM). METHODOLOGY: Gestational diabetes was diagnosed with 75 gram oral glucose tolerance test. Forty-four pregnant women diagnosed with GDM and 78 non-GDM pregnant women were enrolled as case and control group, respectively in this descriptive study. Vitamin D status was classified as deficiency at ≤20 ng/ml for serum 25(OH)D concentrations. RESULTS: The mean ages were 33.4±5.2 (18-44) years and 29.7±4.1 (21-39) years, mean BMI was 30.6±5.9 kg/m² (19.5-46.1) and 25.9±4.4 kg/m2 (16.5-38) in case and control groups, respectively. The frequency of GDM was found 9.38%. The mean serum vitamin D levels in GDM group were significantly lower than in non-GDM subjects (p=0.07). A total of 56.8% of GDM patients were compared with 35.8% of control group which had Vitamin D deficiency and the difference was significant (p= 0.02). There was no significant association between vitamin D levels and fasting glucose, insulin and HbA1c. Vitamin D levels were inversely correlated with clothing style, parathyroid hormone levels, dental problems and muscle cramps. CONCLUSIONS: The association of maternal Vitamin D status with the markers of glucose metabolism in pregnancy needs prospective studies.

Carotid Artery Intima Media Thickness and HsCRP; Predictors for Atherosclerosis in Prediabetic Patients?

OBJECTIVE: We aimed to assess carotid intima media thickness (CIMT) and serum high-sensitivity C-reactive protein (hs-CRP) levels as estimated markers of subclinical atherosclerosis and inflammation in prediabetic patients. METHODOLOGY: One hundred and ten patients were defined as prediabetic and seventy-six subjects (age and sex matched) were assigned as control group in our cross sectional study. Bilateral CIMT measurements and hs-CRP levels were evaluated. RESULTS: The prevalance of hypertension, hyperlipidemia, angiotensin receptor blockers and antihyperlipidemic medication use were statistically higher in the prediabetic group. Serum hs-CRP levels, left, right and maximum CIMT were statistically higher among prediabetics compared to control group. There was a positive, significant correlation between left, right, maximum CIMT and fasting blood glucose, HbA1c, hs-CRP levels and BMI. CONCLUSION: Recognising and focusing on the intervention of prediabetic state as early as possible and identifying the susceptible patients who may benefit from more aggressive preventive therapy is an important issue of primary prevention of diabetes and cardiovascular diseases.

Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey.

OBJECTIVE: To investigate the frequency of vitamin D deficiency in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters in adult out-patients. DESIGN: Descriptive, retrospective study concerning evaluation of the initial 25-hydroxyvitamin D (25(OH)D) levels determined at admission in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters. 25(OH)D levels ,20 ng/ml were classified as deficiency, 20­30 ng/ml as insufficiency and .30 ng/ml as sufficiency. SETTING: Out-patient clinics at a tertiary care centre. SUBJECTS: A total of 2488 adult patients (mean age: 53?3 (SD 15?2) years; 85?2% were females) admitted to out-patient clinics at Baskent University Istanbul Hospital were included. RESULTS: Mean level of 25(OH)D in the overall population was 17?4 (SD 11?5) ng/ml while insufficiency and deficiency were evident in 24% and 66% of patients, respectively. Mean 25(OH)D levels in males .45 years old were higher than in their female counterparts (19?4 (SD 11?3) ng/ml v. 17?8 (SD 12?2) ng/ml; P,0?05). Mean 25(OH)D levels obtained in summer (18?6 (SD 11?1) ng/ml) and autumn (23?3 (SD 13?6) ng/ml) were significantly higher than levels in spring (16?1 (SD 10?3) ng/ml) and winter (14?6 (SD 10?2) ng/ml; P,0?01). Mean 25(OH)D levels were determined to be significantly lower in obese patients compared with non-obese patients (15?6 (SD 10?4) ng/ml v. 17?6 (SD 11?6) ng/ml; P,0?05). Levels of 25(OH)D were significantly negatively correlated with serum parathyroid hormone levels (r520?194; P,0?001) while significantly positively correlated with phosphorus (r50?059; P,0?01) and HDL cholesterol (r50?070; P,0?01) levels. CONCLUSIONS: Our findings indicate that vitamin D deficiency is very common among out-patients in Turkey, regardless of gender and age, especially among obese people and during winter and spring.

Diabetes mellitus and phytotherapy in Turkey.

This study reports a literature review aimed to analyse various studies related to the use of phytotherapy in diabetes mellitus in Turkey in order to provide additional information for healthcare professionals. The incidence of Diabetes Mellitus is rising and many of the diabetics frequently use herbal treatments along with modern medical treatment for glycaemic control and/or improve their well-being. Several electronic databases (such as Medline and Pubmed) were searched for 1990-2010 period (till May, 2010) and 33 related articles were analysed. Many studies--mostly animal trials- have been conducted in this field. Among the herbs most-commonly used along with modern medical therapies and also in folkloric medicine, we searched for bitter melon, cinnamon, fenugreek, olive leaf, black seed and white mulberry. Studies conducted in this field have produced conflicting results and, the necessity to conduct randomized, placebo-controlled clinical human studies to develop new drugs from herbs, as in the case of metformin, still remains important. Besides, further studies are required to address the issues of standardization and quality control of existing preparations. More importantly, healthcare professionals caring for diabetic patients need to be aware of phytotherapy to incorporate phytomedicine into their practices and should undertake more responsibility in relation to these kind of therapies that are commonly-used throughout the world.