Direct medical cost of nephropathy in patients with type 2 diabetes.

INTRODUCTION: Although it is known in the literature that the medical cost due to the complications of diabetes mellitus (DM) is high, data about the effect of diabetic kidney disease (DKD) on medical cost are limited. AIMS: The aim of this study is to investigate the cost of hospitalized patients with nephropathy due to type 2 DM, the parameters closely related to this cost and the effect of diabetic nephropathy stage on medical hospitalization costs. METHODS: The study group consisted of 141 patients with DKD, and the control group consisted of 111 patients with DM without chronic complications in this retrospective study. The demographic characteristics, duration of diabetes and HbA1c values of the patients were recorded at the time of their first hospitalization, medical hospitalization costs, and the length of stay in hospital were recorded for a year from the date of hospitalization. The total medical hospitalization costs of the patients were divided into two groups as cost of medications and supplies and service cost. Patients with DKD were compared according to their dialysis status and nephropathy stages. RESULTS: While the average cost of a patient with DKD was 603 (283-1267) United States Dollars (USD), the average cost of a DM patient without complications was 222 (141-292) USD (p < 0.05). It was observed that the patients with DKD had higher medical hospitalization costs and length of stay in hospital compared to patients with diabetes without complications. In addition, it was observed that the medical hospitalization costs and the length of stay in hospital were significantly higher in patients undergoing dialysis than patients who did not undergo dialysis (p < 0.05 for each). An independent relation was found between average cost and duration of diabetes in patients with DKD (p < 0.05). No relation was found between diabetic nephropathy stage and medical hospitalization costs (p > 0.05 for each). CONCLUSION: The estimated cost of treatment of DKD is higher than patients with uncomplicated diabetes. If preventive measures are not taken for DKD, it will continue to be a heavy economic burden.

Sexual dysfunction in female subjects with beta-thalassemia minor.

Beta thalassemia minor (BTM) is a hereditary disease caused by defective globin synthesis and it is frequently asymptomatic or only mildly anemic. Female sexual dysfunction affects 21-41% of women worldwide. In this study we aimed to investigate female sexual dysfunction in subjects with BTM. A total of 183 subjects who had regular sexual intercourse with marital partners were enrolled in this cross-sectional study. The study group was comprised of 87 subjects with BTM and the control group included 96 healthy subjects. Hemoglobin electrophoresis were performed in all subjects, and all participants were assessed by the Female Sexual Function Index (FSFI) questionnaire and the Arizona Sexual Experience Scale (ASEX). The FSFI scores of the study group were significantly lower than in the control group (19.1 ± 9.6 vs. 25.2 ± 6.6, p < 0.001). Conversely, the ASEX scores of the study group were higher than in the control group (15.2 ± 41 vs. 13.5 ± 6.1, p = 0.0085). Sexual functions were poor in subjects with BTM in this study and we conclude that certain metabolic diseases associated with BTM, such as insulin resistance, hyperglycemia and dyslipidemia, may be the main causes of sexual dysfunctions in these subjects.

Renal resistive index in patients with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The renal resistive index (RRI) is a measure of renal arterial resistance to blood flow. The aim of this study was to investigate the renal resistive index levels of patients with PCOS. SUBJECTS AND METHODS: A total of 216 women were included in this cross-sectional study. The study group consisted of 109 patients with PCOS, and the control group consisted of 107 healthy subjects. The RRI of all subjects was measured using renal Doppler ultrasonography. RESULTS: The patients with PCOS had higher RRI levels in comparison to the healthy subjects (0.64 ± 0.06 vs. 0.57 ± 0.06, p < 0.001). The RRI levels of the patients with PCOS were correlated with systolic blood pressure (p = 0.004, r = 0.268) and with homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.02, r = 0.216). CONCLUSION: In this study, we observed higher RRI levels in patients with PCOS. High RRI levels may be an indicator of cardiovascular and/or cardiovascular-associated diseases in patients with PCOS.

Renal resistive index in patients with polycystic ovary syndrome

ABSTRACT Objective: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The renal resistive index (RRI) is a measure of renal arterial resistance to blood flow. The aim of this study was to investigate the renal resistive index levels of patients with PCOS. Subjects and methods: A total of 216 women were included in this cross-sectional study. The study group consisted of 109 patients with PCOS, and the control group consisted of 107 healthy subjects. The RRI of all subjects was measured using renal Doppler ultrasonography. Results: The patients with PCOS had higher RRI levels in comparison to the healthy subjects (0.64 ± 0.06 vs. 0.57 ± 0.06, p < 0.001). The RRI levels of the patients with PCOS were correlated with systolic blood pressure (p = 0.004, r = 0.268) and with homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.02, r = 0.216). Conclusion: In this study, we observed higher RRI levels in patients with PCOS. High RRI levels may be an indicator of cardiovascular and/or cardiovascular-associated diseases in patients with PCOS.

Intraocular pressure in subjects with beta-thalassemia minor.

PURPOSE: Beta-thalassemia minor, a common hereditary blood disorder in Mediterranean countries such as Turkey, is associated with insulin resistance. Insulin resistance, in turn, can be associated with excessively high intraocular pressure and, therefore, intraocular pressure-induced blindness. This study aimed to investigate the intraocular pressure in subjects with beta-thalassemia minor. METHODS: We conducted a cross-sectional study comprising of 203 subjects divided into two groups: beta-thalassemia minor (103) and healthy (100).Hemoglobin electrophoresis was performed and complete blood count, blood pressures, serum fasting glucose and insulin levels were measured. All subjects underwent ophthalmological examinations including intraocular pressure measurements. RESULTS: Intraocular pressure in the subjects with beta-thalassemia minor was significantly lower than that in healthy subjects (p=0.007). Additionally, intraocular pressure was inversely correlated with hemoglobin A2 levels (p=0.001, r=-0.320). Serum insulin and systolic blood pressure were significantly higher in subjects with beta-thalassemia minor (p=0.03, p=0.009, respectively). CONCLUSION: Subjects with beta-thalassemia minor had lower intraocular pressure than healthy controls, suggesting beta-thalassemia minor may actually protect against high intraocular pressure.

Color Doppler ultrasonography is a reliable diagnostic tool in the diagnosis of extracranial vertebral artery dissections.

The purpose of this study was to evaluate the role of color Doppler sonography (CDS) in the diagnosis of extracranial vertebral artery dissections (EVADs). One hundred and fifty consecutive patients (age range 21-51 years, mean 44 years) with a clinical suspicion of vertebral artery dissection (VAD) were included in this study. All patients underwent CDS of vertebral arteries as the first-line imaging modality. Cervical T1-weighted fat-saturated axial MR images served as the gold standard. Of the 150 patients with a clinical suspicion of VAD, 27 patients were ultimately diagnosed with EVADs based on fat-saturated T1-weighted MR imaging. MR imaging was considered positive when crescentic hyperintensity (methemoglobin signal) was demonstrated at the wall of the vertebral artery. CDS was positive in 21 of these 27 patients and revealed either intramural hematoma or a dissecting membrane with two lumina. The most frequent site of involvement was the V1 to proximal V2 segment. The sensitivity, specificity, and positive and negative predictive values of CDS in the diagnosis of EVADs were 77.8, 98.4, 91.3, and 95.3%, respectively. CDS is a reliable diagnostic tool in the diagnosis of EVADs.

Better Renal Resistive Index Profile in Subjects with Beta Thalassemia Minor.

OBJECTIVE: Beta thalassaemia minor is a common genetic disorder without any characteristic symptoms except mild anemia. It is found to be associated with some cardiovascular risk factors such as insulin resistance and diabetes mellitus. The renal resistive index (RRI) is a measure of renal arterial resistance to blood flow. The aim of this study was to evaluate the RRI in subjects with beta thalassemia minor (BTM). SUBJECTS AND METHODS: A total of 253 subjects were included in this cross-sectional study. The study group consisted of 148 subjects with BTM and the control group consisted of 105 healthy subjects. BTM was diagnosed by a complete blood count and hemoglobin electrophoresis. Blood pressure measurement and biochemical tests were performed. The RRI of all subjects was measured using renal Doppler ultrasonography. RESULTS: Subjects with BTM had lower renal resistive indices compared to healthy subjects (0.58 ± 0.04 vs. 0.60 ± 0.06, p = 0.0016). Additionally, the RRI levels of subjects with BTM were correlated with systolic blood pressure (p = 0.017, r = 0.194). CONCLUSION: In this study, lower RRI were found in subjects with BTM. This may be associated with a decreased vascular resistance and blood viscosity in these subjects.

Causes of visual impairment in patients with ocular toxoplasmosis.

INTRODUCTION: The aim of this study was to report the causes of visual impairment in patients with the classic clinical presentation of ocular toxoplasmosis (OT). METHODOLOGY: Eight patients with OT underwent standardized ophthalmologic examination and fundus imaging. Macula and the lesions that could be visualized were evaluated by spectral domain optical coherence tomography (SOCT) at presentation. The scan acquisition protocols for SOCT included a radial line scan through the retinochoroiditis lesion, radial line macular scan, and horizontal volume scans at the macula. RESULTS: The mean age of the five (62.5%) women and three (37.5%) men was 25.7±7.6 years. The mean logMAR ETDRS best-corrected visual acuity was 0.45 (Snellen equivalent, 20/50). SOCT findings of macula were normal in seven patients, and one patient had decreased retinal thickness from a healed chorioretinitis at the fovea. Of eight patients, two had 3+ vitreous haze, four had 2+ vitreous haze, and two had 1+ vitreous haze at presentation. OCT scans revealed vitreous hyperreflective dots in all patients with different densities in different radial scans. Hyperreflective dots were denser in macular scans of eyes in which the active lesion was closer to the fovea. CONCLUSIONS: In this study, visual impairment in majority of the patients was found to be related to vitreous cells and flare. Dense vitritis on macula scans and visual impairment were seen in the patients who had an active lesion closer to the fovea. SOCT may provide objective data of the cellular load of the eyes with posterior segment inflammation.

High Levels of Circulating Endothelial Progenitor Cells Are Associated with Acrotism in Patients with Takayasu Arteritis.

OBJECTIVES: To investigate the association between endothelial progenitor cells (EPCs) and Takayasu arteritis (TA). Subjects andMethods: A total of 39 subjects were included in this study: 12 subjects had been diagnosed with active TA, 11 had active Behçet disease (BD), and 16 were healthy controls. The EPCs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels of all the subjects were measured. MedCalc 15.8 software (MedCalc, Belgium) was used for all statistical analyses. RESULTS: The level of EPCs was higher in TA patients (4.25 ± 2.56) than in the BD group (2.27 ± 2.0) and the healthy controls (2.12 ± 1.2) (p = 0.015). TA patients with acrotism (n = 4) had higher levels of EPCs compared to TA patients without acrotism (n = 8) (6.50 ± 1.73 vs. 3.12 ± 2.16, p = 0.02). A positive correlation was found between EPCs and the ESR (r = 0.723, p = 0.0079) and between EPCs and CRP in patients with TA (r = 0.769, p < 0.0034). CONCLUSION: High levels of circulating EPCs were correlated with the CRP level and the ESR in patients with TA. These cells could be a marker for acrotism and inflammation in patients with TA.

Retinal nerve fiber layer thickness in a healthy Turkish population measured by optical coherence tomography.

BACKGROUND: Normative optical coherence tomography (OCT) data is required for different subsets of the population as ethnic differences in retinal nerve fiber layer (RNFL) thickness have been reported. An OCT database for the normal Turkish population is not commercially available. OBJECTIVES: Quantify peripapillary RNFL thickness in a Turkish population. DESIGN: Cross-sectional, descriptive study. SETTING: Numune Training and Research Hospital, Adana, Turkey. SUBJECTS AND METHODS: RNFL measurements performed by Spectral OCT with a circular scan with 3.4 mm circle were centered around the optic disc of the right eye of each subject. Correlation of the effects of age and gender on RNFL thickness was analyzed. MAIN OUTCOME MEASURE(S): Correlation and measurements of RNFL. Retinal nerve fiber layer thick- ness measurements were obtained for the entire circumference of the optic nerve head. RESULTS: In 307 healthy subjects consisting of 135 (44%) males and 172 (56%) females, with a mean (SD) age of 35.1 (9.6) years (range, 20-50 years), RNFL was superior: 132.2 (16.63) micro m, inferior: 139.1 (14.53) micro m, nasal: 96.2 (14.23) micro m, temporal: 79.8 (10.7) micro m. The mean (SD) RNFL thickness for the group was 111.5 (9.3) micro m. There was no significant difference between the average RNFL thicknesses of age groups nor between males and females (P=.1, P=.42), and no significant correlation with respect to age (P=.430, r=-.04). There was a statistically significant difference between the inferior quadrants of the two genders (P=.04). CONCLUSIONS: RNFL thickness did not vary significantly with gender. A weak negative but statistically nonsignificant correlation between average RNFL thickness and age was found. LIMITATIONS: The participants were young adults or at early middle age so age effects on RNFL thickness may not be explained. The data does not reflect the entire Turkish population, which is not homogeneous.

A frontal lobe meningioma in a child leading to visual loss.

Objective. Meningiomas are benign primary meningeal tumors and are seen rare in children and adolescents. Clinical Presentation and Intervention. A 15-year-old Turkish boy reported a 1-month history of headache and blurred vision in both eyes. His visual acuity was 0.3 in both eyes with papilledema. Magnetic resonance imaging showed a 77 × 97 × 77 mm intracranial-extra-axial frontal lesion which compresses the chiasm. He was diagnosed with intracranial meningioma and referred to neurosurgery clinic. Conclusion. Ophthalmologists should be aware of the fact that papilledema and low vision can be caused by an intracranial tumor which compresses optic chiasm.

High renal resistive index in hypertensive patients is also associated with serum homocysteine level.

BACKGROUND: Hypertension, homocysteine and renal resistive index are associated with atherosclerosis and lead to cardiovascular diseases. In this study, we aimed to investigate the association between homocysteine and renal resistive index in patients with newly diagnosed hypertension. METHODS: A total of 221 subjects were included in this case-control study. The study group consisted of 116 hypertensive patients and the control group consisted of 105 healthy subjects. Renal resistive index, homocysteine levels, insulin concentrations and blood pressures were measured. RESULTS: Renal resistive index, serum homocysteine levels and insulin concentrations were higher in hypertensive patients (p = 0.006, p < 0.001, respectively). Serum homocysteine levels were associated with hypertension (OR 9.5, Cl 95 % 4.86-18.7, p < 0.001). Homocysteine and insulin levels were positively correlated with renal resistive index (r = 0.372, p = 0.001; r = 0.392, p < 0.001, respectively). CONCLUSION: High renal resistive index in hypertensive patients is associated with homocysteine.

Low Serum Phosphorus Level in Massry's Phosphate Depletion Syndrome May Be One of the Causes of Acute Heart Failure.

Hypophosphatemia has been found to be associated with multiple organ dysfunction. In this study we aimed to investigate the association between low serum phosphorus and acute heart failure. A total of 213 subjects, 101 patients with acute heart failure and 112 healthy subjects were included in this case-control study. Serum phosphorus levels, calcium levels, and PTH concentrations were measured. Ejection fraction percentages, pulse rates, systolic and diastolic blood pressures were recorded. The groups were similar in terms of age and gender (p=0.067 and 0.995, respectively). The phosphorus levels and ejection fraction percentages of the patients with heart failure were lower than for the healthy subjects (p<0.001). Frequency of hypophosphatemia was higher in the heart failure group (p<0.001). There was a strong relationship between low serum phosphorus level and acute heart failure (OR 9.85, CI 95% 3.6-26.3, p<0.001). The phosphorus level of patients with acute heart failure was found to be low in this study. Therefore, the phosphorus level should be controlled in patients with acute heart failure and phosphorus supplementation can be a complimentary treatment for these patients.

Estimated costs of the treatment of diabetic foot ulcers in a tertiary hospital in Turkey.

OBJECTIVE: The prevalence of diabetes and its related complications are increasing, and a considerable portion of healthcare expenditures is spent worldwide on diabetes and its complications. In this study, we investigated the estimated treatment costs of diabetic foot ulcers in a tertiary hospital in Turkey. METHODS: A total of 203 patients with type 2 diabetes mellitus were included in this retrospective study. The study group comprised 91 patients with foot ulcers and the control group comprised 112 patients without any chronic complications. Their demographic characteristics, HbA1c levels and the length of hospital stay were recorded. The patients' bills, received from the hospital billing departments, were analysed. RESULTS: The average cost of diabetes patients with foot ulcers per person was calculated as 976.1±253.6 USD while it was 430.3±144.2 USD for diabetes patients without any chronic complications; thus, there was a significant difference between the average cost of these groups (p<0.001). Similarly, there were significant differences between the groups according to the costs of drugs, equipment and services (p<0.001). CONCLUSION: The estimated cost of treatment of diabetic foot ulcers is high in Turkey. It will continue to be a heavy economic burden if preventive measures are not taken.

Is ß-thalassaemia minor associated with metabolic disorder?

OBJECTIVE: To investigate the frequency of metabolic syndrome and its components in subjects with ß-thalassaemia minor. SUBJECTS AND METHODS: A total of 194 subjects, i.e. 92 subjects with ß-thalassaemia minor (study group) and 102 subjects without ß-thalassaemia minor (control group), were enrolled into this case-control study. Haemoglobin electrophoresis was performed on all patients. The waist circumference and systolic and diastolic blood pressure of the subjects were recorded. Fasting blood glucose and serum lipid levels were measured. RESULTS: Both groups were similar in terms of age and sex (p > 0.05 for each). The percentages of haemoglobin A2 (4.3 ± 0.4 vs. 2.0 ± 0.3) and haemoglobin F (3.38 ± 1.4 vs. 0.26 ± 0.4) and the mean corpuscular volumes (64 ± 4.7 vs. 81.5 ± 9.3) of the groups were statistically different (p < 0.001 for each). The frequency of metabolic syndrome and its components was similar in both groups (p > 0.05 for each). According to correlation analyses, the percentage of haemoglobin A2 correlated with fasting insulin, fasting glucose, systolic blood pressure, high-density lipoprotein, and low-density lipoprotein levels (p < 0.05). CONCLUSIONS: No association was found between ß-thalassaemia minor and metabolic syndrome despite insulin resistance, which was shown in subjects with ß-thalassaemia minor.

Metabolic syndrome as a risk factor for elevated intraocular pressure.

OBJECTIVE: The aim of this study was to investigate the association between intraocular pressure and metabolic syndrome by comparing central corneal thicknesses. METHODS: One hundred sixty-two subjects were enrolled in this cross-sectional study, with 89 subjects in a metabolic syndrome group and 73 subjects in a control group. Ophthalmological examinations, including intraocular pressure and central corneal thickness measurements, were performed on each subject. Serum fasting glucose, triglyceride and HDL cholesterol levels were measured, and waist circumference, systolic and diastolic blood pressure of all patients were recorded. RESULTS: Participants with metabolic syndrome had a significantly higher intraocular pressure than those without metabolic syndrome (p = 0.008), and there was no statistically significant difference between the central corneal thicknesses of the two groups (p = 0.553). Most of the metabolic syndrome components were associated with higher intraocular pressure (p < 0.05). CONCLUSIONS: There is a relationship between metabolic syndrome and intraocular pressure, but no association between metabolic syndrome and central corneal thicknesses. Intraocular pressure is affected by central corneal thicknesses, and intraocular pressure is used to correct according to the central corneal thicknesses measurement. To our knowledge, this is the first study that determines the positive relationship between metabolic syndrome and intraocular pressure by comparing the central corneal thicknesses of the groups.

High levels of endothelial progenitor cells can be associated with thrombosis in patients with Behçet's disease.

OBJECTIVES: Behçet's disease (BD) is a systemic disorder characterised by vasculitis. Endothelial progenitor cells are derived from the bone marrow and contribute to new vessel formation. The aim of this study was to investigate the level of endothelial progenitor cells in BD and BD-associated conditions. METHODS: A total of 74 subjects were included in this study, of whom 44 and 30 subjects were patients with BD or healthy subjects, respectively. Endothelial progenitor cells were defined and measured by flow cytometry according to the expression of CD146, CD31 and CD34. We separated BD patients according to the active disease, pathergy test results, thrombosis and gender. MedCalc 12.5 software programme was used for statistical analyses. RESULTS: The level of endothelial progenitor cells was comparable in patients with BD and healthy subjects (p=0.849). It was also comparable in patients with active or inactive BD (p=0.320). The level of endothelial progenitor cells was higher in patients with thrombosis (p=0.04). There was no statistical significant difference between pathergy positive and negative patients (p=0.969). The level of endothelial progenitor cells was not correlated with age, C-reactive protein, erythrocyte sedimentation rate, white blood cells and disease duration (p>0.05). CONCLUSIONS: The level of endothelial progenitor cells was significantly higher in BD patients with thrombosis. On the other hand, they were not associated with disease activity, pathergy test and other conditions. EPCs may be a useful marker for thrombosis in patients with BD. In our opinion, this is the most expected result in this study.

H. pylori May Not Be Associated with Iron Deficiency Anemia in Patients with Normal Gastrointestinal Tract Endoscopy Results.

Background. The aim of this study was to investigate the association between iron deficiency anemia and H. pylori in patients with normal gastrointestinal tract endoscopy results. Materials and Methods. A total of 117 male patients with normal gastrointestinal tract endoscopy results were included in this retrospective study. The study and control groups included 69 and 48 patients with and without iron deficiency anemia, respectively. The prevalence of H. pylori, the number of RBCs, and the levels of HGB, HTC, MCV, iron, and ferritin were calculated and compared. Results. There was no statistically significant difference found between the groups according to the prevalence of H. pylori (65.2% versus 64.6%, P = 0.896). Additionally, the levels of RBCs, HGB, HTC, MCV, iron, and ferritin in the patients in the study group were lower than those in the control group (P < 0.05). Finally, there was no association between iron deficiency anemia and H. pylori (OR 1.02, Cl 95% 0.47-2.22, and P = 0.943). Conclusion. H. pylori is not associated with iron deficiency anemia in male patients with normal gastrointestinal tract endoscopy results.

The effects of thyroid dysfunctions on insulin resistance in patients with hepatosteatosis.

BACKGROUND: Hepatosteatosis can develop due to insulin resistance. The effect of thyroid function status on insulin sensitivity and resistance is of great interest but the data is still conflicting. OBJECTIVES: The aim of this study was to evaluate the effects of thyroid dysfunctions on insulin resistance in patients with hepatosteatosis. MATERIAL AND METHODS: A total of 407 patients with hepatosteatosis were divided into three groups: 102 subjects with hypothyroidism, 103 with hyperthyroidism and 202 with normal thyroid function (control group). We measured serum thyroid stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) concentrations, blood glucose and insulin levels, serum lipid levels, hepatic transaminases and the homeostasis model assessment of insulin resistance (HOMA IR). RESULTS: Neither hypothyroidism patients nor hyperthyroidism patients showed significant differences in HOMA IR, glucose and insulin levels (p>0.05 for each). The frequency of insulin resistance was similar in all groups (p>0.05). CONCLUSIONS: Based on our findings, hypothyroidism and hyperthyroidism are not correlated to insulin resistance in patients with hepatosteatosis. Different causes which are associated with insulin resistance should be investigated in patients with thyroid dysfunction and hepatosteatosis.

Depression in subjects with beta-thalassemia minor.

Beta-thalassemia minor is a common genetic blood disorder in Mediterranean countries such as Turkey. Additionally, depression is one of the most widespread mental disorders that affect people worldwide, and its prevalence is increasing with co-occurring medical conditions. The aim of this study was to determine whether the frequency of depression is elevated in subjects with beta-thalassemia minor. A total of 106 subjects were included in this study, of which 53 participants were diagnosed with beta-thalassemia minor. The other 53 participants were otherwise healthy. Hemoglobin electrophoresis and a complete blood count were performed in all subjects, and all participants were evaluated using the Hamilton Depression Rating Scale (HDRS). The HDRS scores of the subjects with beta-thalassemia minor were higher than those in the healthy subjects (p < 0.001). Additionally, the hemoglobin A2 levels were positively associated with the HDRS scores (p < 0.0001, r = 0.482). This study suggests a possible association between depression and beta-thalassemia minor, in which the risk of depression may be increased in subjects with this condition.