Effect of Biopsychosocial Factors on Glycemic Control in Type 2 Diabetes Mellitus.

OBJECTIVE: To investigate the effect of diabetic patients' biopsychosocial factors on type 2 diabetes mellitus (T2DM) outcomes to contribute to diabetes mellitus management. STUDY DESIGN: Cross-sectional descriptive study. Place and Duration of the Study: Department of Family Medicine, School of Medicine, Firat University, Turkey, from October 2021 to March 2022. METHODOLOGY: A total of 210 type 2 diabetic patients were included. The sociodemographic form, Beck depression inventory (BDI), multidimensional perceived social support scale (MSPSS), general self-efficacy scale (GES), and Diabetes self-care activities scale (DSCA) were used to assess the biopsychosocial factors. Controlled diabetes and uncontrolled diabetes classification was made according to HbA1c level (HbA1c cut-off value: ≤7%). RESULTS: The median duration of T2DM (p=0.001), total cholesterol level (p=0.004) and fasting plasma glucose (p<0.001) were found to be higher in the uncontrolled diabetes group than in the controlled diabetes group. Spearman correlation test results showed a significant negative relationship between the scores of Beck depression and total cholesterol (r= -0.157, p = 0.023). There is a significant positive correlation between social support and total cholesterol (r=0.343, p<0.001), LDL (r=0.149, p= 0.031), triglyceride (r=0.165, p = 0.017), DSCA general diet score (r=0.367, p<0.001), DSCA physical activities (r=0.221, p = 0.001), DSCA glucose monitoring (r=0.302, p<0.001), DSCA foot care (r=0.311, p<0.001), and DSCA total scores (r=0.401, p<0.001). CONCLUSION: The present study showed that high BDI score was associated with low diabetes self-care score and presence of complications. Individuals' self-efficacy and high perception of social support were associated with increased diabetic self-care scores. KEY WORDS: Social support, Perception, Self care, Diabetes mellitus type 2, Diabetes complications, Depression.

Comparing Perfusion Data of CE-MRI, SWI, and CTA with MR Perfusion in Stroke.

BACKGROUND: To evaluate the perfusion status of patients with acute stroke, different imaging tools are used depending on the condition. CT-CT Angiography and MRI are indispensable imaging tools to diagnose and manage stroke patients. Susceptibility-weighted imaging (SWI) also has been used lately to evaluate vascular structures and consequences of stroke in the brain. We aimed to compare CE-MRI, SWI, and CTA with DSC-MRP in terms of perfusion. METHODS: Stroke cases of CE-MRI, SWI, CTA and DSC-MRP of 44 patients were included. Collateralization was assessed on CTA; leptomeningeal-pial collateralization (LPC) and parenchymal enhancement (PE) on CE-MRI; prominent vessel sign (PVS) and hemorrhagic transformation on SWI. Results were compared with MRP maps and the ratio of penumbra/infarct core. RESULTS: LPC was correlated with increased CBV (p<0,001), decreased CBF (p=0,026), and prolonged MTT and TTP (p=0,001 and p=0,003). LPC was observed more often in cases with infarct zones with penumbra compared to those without penumbra (p=0,024). PE was positively correlated with prolonged MTT and TTP (p=0,015 and p=0,031). Moreover, there was a positive relationship between PE and increased penumbra ratio over the infarct core (p=0,037). Ipsilateral PVS was associated with increased CBV (p=0,004) and decreased CBF (p=0,002). No relationship was found between collateralization grading on CTA and perfusion metrics or penumbra ratio. CONCLUSION: In conclusion; ipsilateral PVS can be a measure of CBV and CBF. LPC on CE-MRI can be a sign of an increase in CBV. PE can show larger penumbra. CE-MRI with SWI can be used to evaluate perfusion status.

The role of vitamin D deficiency on COVID-19: a systematic review and meta-analysis of observational studies.

OBJECTIVES: Although vaccination has started, coronavirus disease 2019 (COVID-19) poses a continuing threat to public health. Therefore, in addition to vaccination, the use of supplements to support the immune system may be important. The purpose of this study was to synthesize evidence on the possible effect of low serum vitamin D levels (25[OH]D<20 ng/mL or 50 nmol/L) on COVID-19 infection and outcomes. METHODS: We searched Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect without any language restrictions for articles published between January 1 and December 15, 2020. We performed 3 meta-analyses (called vitamin D and COVID-19 infection meta-analysis [D-CIMA], vitamin D and COVID-19 severity meta-analysis [D-CSMA], and vitamin D and COV ID-19 mortality meta-analysis [D-CMMA] for COVID-19 infection, severity, and mortality, respectively) to combine odds ratio values according to laboratory measurement units for vitamin D and the measured serum 25(OH)D level. RESULTS: Twenty-one eligible studies were found to be relevant to the relationship between vitamin D and COVID-19 infection/outcomes (n=205,869). The D-CIMA meta-analysis showed that individuals with low serum vitamin D levels were 1.64 times (95% confidence interval [CI], 1.32 to 2.04; p<0.001) more likely to contract COVID-19. The D-CSMA meta-analysis showed that people with serum 25(OH)D levels below 20 ng/mL or 50 nmol/L were 2.42 times (95% CI, 1.13 to 5.18; p=0.022) more likely to have severe COVID-19. The D-CMMA meta-analysis showed that low vitamin D levels had no effect on COVID-19 mortality (OR, 1.64; 95% CI, 0.53 to 5.06, p=0.390). CONCLUSIONS: According to our results, vitamin D deficiency may increase the risk of COVID-19 infection and the likelihood of severe disease. Therefore, we recommend vitamin D supplementation to prevent COVID-19 and its negative outcomes.

The Effects of Secondary Hyperparathyroidism on Circadian Blood Pressure in Hemodialysis Patients.

OBJECTIVE: To determine the relationship between secondary hyperparathyroidism (sHPT) and circadian blood pressure (BP) rthym among patients undergoing hemodialysis treatment. STUDY DESIGN: A descriptive and prospective cohort study. PLACE AND DURATION OF STUDY:   Department of Nephrology, Firat University Hospital, Turkey, between June and December 2019. METHODOLOGY: Eighty-five patients, undergoing hemodialysis three times a week, were included. The BP parameters and circadian blood pressure rhythm were measured by the mobil-o-graph sphygmomanometer. Non-dipper blood pressure phenomenon was defined as a night-time mean artery pressure (MAP)  decrease of <10% from the daytime MAP; sHPT was defined as parathormone >300 pg/ml. RESULTS: Of the 85 participants, mean age was 57.07 ± 14.46 years. In cohort, sHPT rate 58.8% (n =50) and non-dipper blood pressure pattern rate was 64.7% (n = 55). Systolic blood pressure (p=0.001), diastolic blood pressure (p=0.001), and mean arterial blood pressure (p<0.001) were higher in participants with sHPT. sHPT (p = 0.003) was an independent risk factor for non-dipper blood pressure pattern (odds ratio [OR] 0.065, 95% CI: 0.11-0.390). A negative correlation was identified between parathormone and the reduction in night blood pressure (r = -0.346, p=0.001). CONCLUSION: Secondary hyperparathyroidism can cause non-dipper blood pressure pattern by reducing the reduction in night blood pressure. Treatment of sHPT is important in the control of blood pressure and normal circadian blood pressure rhythm in tertiary protection in hemodialysis patients. Key Words: Blood pressure, Circadian rhythm, Hyperparathyroidism secondary, Hemodialysis, Chronic kidney diseases.

Prevalence of Anemia and Associated Risk Factors among Pregnant Women, What is the Role of Antenatal Care in Prevention? A Cross-sectional Study.

OBJECTIVE: To determine the prevalence of anemia with the associated factors in pregnant women and the effect of family medicine practice and antenatal care services provided by family physicians on the prevention of anemia during pregnancy. STUDY DESIGN: Community-based cross-sectional study. PLACE AND DURATION OF STUDY: Family Health Centres in the Elazig region, Turkey from January to June 2019. METHODOLOGY: A total of 495 pregnant women, attending the family health centres, were included. Women were administered a questionnaire related with the anemia and related factors; and hemoglobin values were drawn. Hemoglobin concentration <11 g/dl was classified as anaemic. Sociodemographic, individual dietary diversity and obstetric characteristics of the participants were obtained from structured questionnaire form. Binary logistic regression model was employed to determine the effect of explanatory variables on dependent variable anemia.   Results: The prevalence of anemia during pregnancy was 27.9% (Hb<11.0 gr/dl). Prevalence of anemia was found lower in participants with higher education levels (p=0.005) and having nutrition education (p=0.004). Income status (OR=0.017 [95%Cl:0.002-0.15, p<0.001]), dark tea preference (OR=87.127 [95%Cl:17.68-429.36, p<0.001]), and iron supplementation time (OR=0.945 [95%Cl: 0.91-0.98, p=0.002]) were determined as the independent predictors of anemia in pregnancy. CONCLUSION: Low income, insufficient iron supplementation treatment and dark tea preference were the main predictors of anemia. Most of the factors that cause anemia during pregnancy can be prevented with patient education and supportive treatments. Therefore, the authors recommend applying effective and quality prenatal care and patient education programs to reduce anemia during pregnancy. Key Words: Pregnant women, Anemia, Prenatal care, Family practice, Turkey.

Evaluation of serum/salivary levels of carnosine and cotinine in recurrent wheezing of young children with passive smoking.

BACKGROUND: Recurrent wheezing is common in young children, with a cumulative prevalence of up to 40 % in the first 6 years of life. In this study, we aimed to evaluate the relationship between the number of wheezing episodes and the number of cigarettes smoked at home and serum / saliva cotinine and carnosine levels in children with recurrent wheezing. METHODS: This study was conducted with 80 young children with recurrent wheezing, aged between 1-4 years and 50 healthy control groups. Patient population was divided into three groups depending on the number of their exposure to cigarette smoke and wheezing attacks. Serum cotinine, saliva cotinine, serum carnosine, saliva carnosine, vitamin D levels were measured by using the ELISA method. RESULTS: A significant relationship for serum cotinine and saliva cotinine levels was found between groups (p < 0.05). It was determined that as the number of exposure to cigarette smoke and number of wheezing episodes in young children with recurrent wheezing increased, the level of serum/saliva cotinine levels increased significantly, compared to the control group. In contrast, it was determined that as the number of exposure to cigarette smoke and number of wheezing episodes in young children with recurrent wheezing increased, serum/saliva carnosine levels decreased significantly, compared to the control group. In addition, a significant difference in serum vitamin D levels was found between healthy young children and young children with recurrent wheezing (p < 0.05). CONCLUSIONS: We think that the measurement of salivary cotinine is a useful and noninvasive marker to evaluate passive smoking exposure in the etiology of recurrent wheezing in young children.

Arterial Stiffness and its Related Factors in Patients on Hemodialysis.

OBJECTIVE: To evaluate the prevalence of arterial stiffness in patients on hemodialysis and related factors that aggravate the condition. STUDY DESIGN: Prospective-cohort study. PLACE AND DURATION OF STUDY:   Department of Nephrology, Firat University Hospital, Turkey, from August to October 2019. METHODOLOGY: Central blood pressure (BP), augmentation index (AIx) and aortic pulse wave velocity score (PWVs) were assessed using the mobil-o-graph pulse wave velocity system.  Increased arterial stiffness (AS) wgnas defined by the aortic PWV of  >10 m/s. RESULTS: The mean PVWs were 8.14 ± 2.39 m/s the mean AIx was 21.23 ± 11.58 m/s, and AS was 33.7% in hemodialysis patients. Systolic blood pressure, pulse rate, pulse pressure, central systolic blood pressure, older age, HD vintage, HT vintage, creatinine, CRP and neutrophil leukocyte ratio (NLR), were related factors with AS. Multivariate linear regression analysis showed that systolic blood pressure (ß=0.322; 95% CI: 0.007-0.042; p = 0.006), and age of patients (ß=0.787; 95% CI: 0.095-0.127; p<0.001) were independent determinants of PWVs. CONCLUSION: The frequency of AS was 33.7% in hemodialysis patients without a history of cardiovascular disease. Increased age and systolic blood pressure were independent factors affecting PWV. Effective blood pressure control therapy can reduce AS in hemodialysis patients. Key Words: Pulse wave velocity, Arterial stiffness, Cardiovasculer disease, Systolic blood pressure, Hemodialysis.

Statistical Shape Analysis of Subthalamic Nucleus in Patients with Parkinson Disease.

OBJECTIVE: Subthalamic nucleus (STN) is the most targeted localization in the treatment of Parkinson disease (PD) with deep brain stimulation. However, no studies have been found in the literature about possible shape changes of STN in the literature. We aimed to investigate possible shape changes in the STN and the relationship between shape changes and disease duration in PD patients by using statistical analysis. METHODS: Patients who were diagnosed with idiopathic PD and controls were enrolled in this study. Age, sex, and disease duration of all cases were recorded. Turbo-spin-echo T2-weighted axial series parallel to the skull base in each case containing midbrain images were obtained, including the whole STN. Standard anatomic landmarks were selected and marked on each digital image using a special software in all cases. Statistical geometric shape and deformation analysis of STN was performed in 2 groups. RESULTS: Forty-three patients with PD and 50 age/sex-matched controls were enrolled in this study. There were statistically significant left and right STN shape differences between the groups. Maximum deformation was seen in the dorsolateral parts of both STNs. General shape variability of the STNs was found on the left (0.096) and right (0.049). CONCLUSIONS: Significant shape differences and remarkable deformation of STN are seen in patients with PD compared with controls. Maximum deformation was observed in the dorsolateral part of the STN, and with the increase in the duration of the PD, shape differences and deformations became more prominent.

Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension.

PURPOSE: To search for CSF dynamics of idiopathic intracranial hypertension (IIH) and communicating hydrocephalus and any correlation between MRI findings, CSF metrics and CSF opening pressure in IIH. MATERIALS AND METHODS: Healthy subjects (30) and subjects with IIH (29) and high-pressure communicating hydrocephalus (43) were enrolled. Nonparametric Kruskal-Wallis test (p = 0.05) was used to compare three groups, Mann-Whitney U test with Bonferroni correction to compare two groups (p = 0.016). Correlation of MRI findings of IIH with CSF metrics and CSF opening pressure was analyzed by Spearman's Rank correlation coefficient (p = 0.05). RESULTS: In IIH, no correlation between MRI findings and aqueductal stroke volume (ASV) but statistically significantly CSF opening pressure in the presence of transverse sinus compression was noted. Comparing with healthy subjects, ASV was nonsignificantly lower and standardized diastolic and sum and difference of systolic and diastolic flow durations were statistically significantly lower. Comparing with hydrocephalus, the width of prepontine cistern (PPC)/the width of aqueductus sylvii (AS) was significantly higher and other CSF metrics with standardized systolic and sum of systolic and diastolic flow durations were significantly lower. In hydrocephalus, ASV and peak velocities were significantly higher. Compared with normal group, PPC/AS and reverse/forward flow duration were significantly lower and other CSF metrics were significantly higher. CONCLUSION: In hydrocephalus, significant increase in ASV and peak velocities were noted. In IIH, CSF opening pressure was statistically significantly high in the presence of transverse sinus compression and standardized diastolic flow durations were statistically significantly short that are probably effects of increased impedance of CSF flow against increased intracranial pressure and unchanged or even decreased intraventricular CSF volume.

Evaluation of mean platelet volume in localized scleroderma.

BACKGROUND: Localized scleroderma is a chronic inflammatory skin disease characterized by sclerosis of the dermis and subcutaneous tissue. Platelets play an important role in inflammation. Following activation, platelets rapidly release numerous mediators and cytokines, which contribute to inflammation. OBJECTIVES: To evaluate whether there was any relation between localized scleroderma and platelet parameters. METHODS: Forty-one patients with localized scleroderma were enrolled in the study. The control group consisted of 30 healthy subjects. RESULTS: The mean platelet volume level in the patient group was 9.9 ± 1.3 fl and in the control group was 7.6 ± 1.1 fl. This difference was statistically significant (p< 0.001). The plateletcrit values are minimally higher in the patient group as compared to the control group. It was statistically significant (p<0.001). There was no significant difference in the platelet counts between the two groups (p= 0.560) In the patient group, there was no significant relation between the mean platelet volume levels and clinical signs of disease (p=0.09). However, plateletcrit values are higher in generalized than localized forms of disease (p=0.01). STUDY LIMITATIONS: The limited number of patients and the retrospective nature of the study were our limitations. CONCLUSIONS: This study suggests that platelets might play a role in the pathogenesis of scleroderma. Platelet parameters may be used as markers for evaluating disease severity and inflammatory processes. Thus, there is a need for more detailed and prospective studies.

Evaluation of mean platelet volume in localized scleroderma

Abstract: Background: Localized scleroderma is a chronic inflammatory skin disease characterized by sclerosis of the dermis and subcutaneous tissue. Platelets play an important role in inflammation. Following activation, platelets rapidly release numerous mediators and cytokines, which contribute to inflammation. Objectives: To evaluate whether there was any relation between localized scleroderma and platelet parameters. Methods: Forty-one patients with localized scleroderma were enrolled in the study. The control group consisted of 30 healthy subjects. Results: The mean platelet volume level in the patient group was 9.9 ± 1.3 fl and in the control group was 7.6 ± 1.1 fl. This difference was statistically significant (p< 0.001). The plateletcrit values are minimally higher in the patient group as compared to the control group. It was statistically significant (p<0.001). There was no significant difference in the platelet counts between the two groups (p= 0.560) In the patient group, there was no significant relation between the mean platelet volume levels and clinical signs of disease (p=0.09). However, plateletcrit values are higher in generalized than localized forms of disease (p=0.01). Study Limitations: The limited number of patients and the retrospective nature of the study were our limitations. Conclusions: This study suggests that platelets might play a role in the pathogenesis of scleroderma. Platelet parameters may be used as markers for evaluating disease severity and inflammatory processes. Thus, there is a need for more detailed and prospective studies.

Vitamin D status in the first-trimester: effects of Vitamin D deficiency on pregnancy outcomes.

OBJECTIVE: To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes. METHODS: Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry. RESULTS: The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01). CONCLUSION: A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally.

Association of serum YKL-40 level with tumor burden and metastatic stage of prostate cancer.

PURPOSE: To investigate the relationship between serum level of YKL-40 and Gleason score, grade and stage of the disease, and for the first time, with tumor burden in patients with prostate cancer (PCa). MATERIALS AND METHODS: Serum levels of YKL-40 and prostate-specific antigen were measured in 34 men (mean age: 66 years) with newly diagnosed and untreated PCa, in 34 men (mean age: 65 years) with biopsy proven benign prostatic hyperplasia, and in 29 healthy young men (mean age: 24 years). RESULTS: Serum YKL-40 concentration in men with PCa and benign prostatic hyperplasia, and in controls were 165.67 ± 107.84 ng/mL, 137.38 ± 82.04 ng/mL, and 69.69 ± 18.46 ng/mL, respectively. Serum level of YKL-40 was correlated with tumor burden in 30.4% of the patients with PCa (P = .04). A cut-off serum YKL-40 value of 92.696 ng/mL produced 70.6% sensitivity and 93.1% specificity. Elevated serum level of YKL-40 was strongly associated only with metastatic stage of the PCa. No association was observed between elevated level of YKL-40 and Gleason score groups or Gleason grade. CONCLUSION: Our results suggest that elevated serum level of YKL-40 may be a useful indicator of tumor burden and metastatic stage of PCa. Further studies are warranted to better elucidate the meaning of YKL-40 in tumor burden and invasiveness.