Does mean platelet volume/lymphocyte count ratio associate with frailty in type 2 diabetes mellitus?

OBJECTIVES: Frailty is a common problem in patients with type 2 diabetes mellitus (T2DM). It is considered to be associated with inflammation. Novel markers derived from hemogram, such as neutrophil/lymphocyte ratio (NLR) and mean platelet volume/lymphocyte ratio (MPVLR), are proposed as inflammatory markers. In present study, we aimed to compare NLR and MPVLR levels of frail patients with T2DM to non­frail diabetic subjects. METHODS: Diabetic subjects were grouped in frail and non-frail groups according to the Edmonton Frail Scale. General characteristics and laboratory data of the frail and non-frail groups were compared. RESULTS: The MPVLR of the frail (3.9 [1.4-13.2] %) group was significantly higher than that of the non-frail (3.4 [1.5-6.9] %) group (p = 0.02). MPVLR was positively and significantly correlated with Edmonton Frail Scale score (r = 0.21, p = 0.03). A MPVLR level greater than 3.41 % has 71 % sensitivity and 51 % specifity in predicting frailty. CONCLUSION: We suggest that elevated MPVLR could be a finding that marks frailty in diabetic subjects. Inexpensive and easy­to­assess nature of the MPVLR may be useful in predicting frailty in type 2 diabetic population (Tab. 2, Fig. 1, Ref. 32).

THE ASSOCIATION BETWEEN VITAMIN D LEVELS AND HANDGRIP STRENGTH IN ELDERLY MEN.

CONTEXT: Vitamin D is a steroid hormone that acts by binding to the vitamin D receptor (VDR) found in many tissues. According to the long-term mechanism, vitamin D causes the proliferation and differentiation of muscle cells by gene transcription. OBJECTIVE: We aimed to evaluate the relationship between muscle strength and serum vitamin D levels in elderly men. DESIGN: Cross-sectional study. SUBJECTS AND METHODS: Male patients over age 50 were included in the study. Study population was divided into 2 groups with handgrip strength according to body mass index, either as subjects with weak or with normal handgrip strength test (HGST). Vitamin D levels and other variables compared between weak and normal groups. RESULTS: Vitamin D level of weak and normal groups were 7.5 (3-19.9) µg/L, and 11.6 (11.6-34.9) µg/L, which means significant reduced vitamin D levels in weakness group (p=0.01). Vitamin D levels were significantly correlated with HGST levels (r:0.362, p=0.001). Vitamin D levels were found to be an independent predictor of weakness according to HGST in logistic regression analysis (OR: 0.453, 95% Cl:0.138-0.769, p=0.05). CONCLUSIONS: Low vitamin D level is an independent risk factor for muscle weakness in men aged more than 50 years. Therefore, vitamin D levels should be screened and early replacement should be initiated for the sake of improvement of muscle strength in elderly subjects that vulnerable for frailty.

Effect of nursing care given at home on the quality of life of patients with stomach cancer and their family caregivers' nursing care.

In Turkey, the high incidences of stomach and oesophageal cancers in East and high incidence of stomach cancer in Northeast regions are remarkable. This study was conducted to identify homecare needs of patients with stomach cancer and their caregivers and the effect of family supportive nursing care on the quality of life of patients and families. The patient and his/her caregiver were assessed with respect to their daily life activities and NANDA was used for the identified nursing diagnoses, NIC for the appropriate interventions and NOC for assessment of the results. This study was conducted in a pre-test, post-test, controlled trial model to identify. The sample of the investigation consisted of 72 patients and 72 caregivers. As a data-collecting instrument, the Quality of Life Scale and Caregiver Quality of Life Index-Cancer were used. The overall quality of life, global health status and emotional and cognitive functions of the patients in the experimental group improved after the interventions. The overall quality of life and global health status was found to be poorer in the control group patients at post-test as compared to pre-test and their physical, role and social functions deteriorated. The caregivers' quality of life in the control group was affected more negatively with respect to the "Disruption in Daily Life" subscale as compared to pre-test values.

Effect of saliva decontamination procedures on shear bond strength of a one-step adhesive system.

AIM: To evaluate the effect of different saliva decontamination procedures on the shear bond strength of a one-step universal adhesive system (Single Bond™ Universal Adhesive, 3M ESPE, St. Paul, MN, USA). MATERIALS AND METHODS: The occlusal surfaces of 75 human third molars were ground to expose dentin. The teeth were divided into the following groups: Group 1 (control group): Single Bond™ Universal Adhesive was applied to the prepared tooth according to the manufacturer's recommendations and light cured; no contamination procedure was performed. Group 2: Bonding, light curing, saliva contamination, and dry. Group 3: Bonding, light curing, saliva contamination, rinse, and dry. Group 4: After the procedure performed in Group 2, reapplication of bonding. Group 5: After the procedure performed in Group 3, reapplication of bonding. Then, composite resins were applied with cylindrical-shaped plastic matrixes and light cured. For shear bond testing, a notch-shaped force transducer apparatus was applied to each specimen at the interface between the tooth and composite until failure occurred. The data were statistically analyzed using one-way ANOVA. RESULTS: One-way ANOVA revealed significant differences in shear bond strength between the control group and experimental Groups 2 and 4 (P < 0.05). No significant difference was found for experimental Groups 3 and 5 when compared to the control group (P > 0.05). CONCLUSION: The present in vitro study showed that water rinsing is necessary if cured adhesive resin is contaminated with saliva to ensure adequate bond strength.

Role of inflammation in sensory neuropathy in prediabetes or diabetes.

OBJECTIVES: Prediabetes includes individuals with impaired glucose metabolism, and it has been associated with various complications of diabetes mellitus (DM), including peripheral neuropathy. We aimed to investigate the associations between pro-inflammatory (TNF-α) and anti-inflammatory (IL-10) cytokines and neuropathy of very distal sensory nerves in patients with prediabetes or type 2 DM. MATERIALS AND METHODS: We included 50 patients with prediabetes, 50 patients with type 2 DM, and 44 controls in the study. Plasma levels of HbA1c, TNF-α, and IL-10 were analyzed. Electrodiagnostic testing was performed on dorsal sural and medial plantar sensory nerves, which are the very distal sensory nerves of the feet. RESULTS: Abnormalities in nerve conduction studies (NCS) of the dorsal sural and medial plantar sensory nerves were substantially higher in patients with prediabetes or type 2 DM. In addition, plasma levels of TNF-α were significantly higher in patients with type 2 DM than in controls, whereas IL-10 levels were significantly lower in patients with both prediabetes and diabetes. However, we found no correlation between the levels of HbA1c, TNF-α, IL-10, and abnormalities in NCS of the dorsal sural or medial plantar sensory nerves in either patient group. CONCLUSIONS: To our knowledge, this is the first study to assess the relationships between TNF-α, IL-10, and NCS of the most distal sensory nerves in patients with prediabetes or type 2 DM. The mechanisms involved in the pathogenesis of DM and diabetic peripheral neuropathy are complex. The pro-inflammatory stage and the high incidence of neuropathy in patients with prediabetes may suggest a possible causative effect; however, the potential role of inflammation in the pathogenesis of peripheral neuropathy needs further clarification.

Association between frontal sinus development and persistent metopic suture.

BACKGROUND: Frontal sinuses are 2 irregular cavities, placed between 2 lamina of frontal bone. Expansion continues during childhood and reaches full size after puberty. Persistent metopic suture is one of the factors that are related to abnormal frontal sinus development. In this study, we want to discuss about the coexistence of persistent metopic suture and abnormal frontal sinus development using radiological techniques. MATERIALS AND METHODS: In this retrospectively planned study, images of 631 patients were examined, 217 (34.4%) of them were men and 414 (65.6%) of them were women. Brain computed tomography and magnetic resonance images were retrieved from the electronic archive for analysis. RESULTS: In this study, frontal sinus development is categorised as right side atrophy, left side atrophy, bilateral atrophy and bilaterally developed sinuses. The presence of metopic suture was accepted as persistent metopic suture. Frontal sinus atrophy was found in 22.7% and persistent metopic sutures were found in 9.7% of overall. CONCLUSIONS: In this study, no significant results were detected that were relatedto the frontal sinus agenesis or dismorphism associated with persistent metopicsuture. We conclude that, although publications propounding metopism thatleads to abnormal frontal sinus development are present in the literature, noreasonable explanation has been mentioned in these articles; and we believe thatthese findings are all incidental.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in the evaluation of the biliary obstruction.

PURPOSE: In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. MATERIALS AND METHODS: 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18-86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. RESULTS: MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. CONCLUSION: The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method.

A combined anatomical variation of inferior epigastric vessels.

During the routine gross anatomical dissection of the right inguinal region of a 45-year-old male cadaver, a variation was observed both in the inferior epigastric artery and the inferior epigastric vein. In this case, the right inferior epigastric artery originated from the femoral artery 13 mm inferior to the inguinal ligament. Additionally, in this cadaver, the single right inferior epigastric vein drained into femoral vein 8 mm inferior to the inguinal ligament. The distal origin of the inferior epigastric artery from the femoral artery and the lower drainage of the single inferior epigastric vein to the femoral vein must be taken into consideration by surgeons.

Cor triatriatum sinister: two cases diagnosed in adulthood and a review of literature.

Cor triatriatum sinister is a rare condition caused by a membrane within the left atrium that separates the pulmonary veins from the mitral valve. While the condition is usually diagnosed in childhood, a rare presentation during adulthood is observed when the membrane is incomplete. We report two cases of incomplete cor triatriatum sinister diagnosed during adulthood and review the literature for this rare anomaly.

The effect of vitamin D and melatonin on the ocular tissues in streptozotocin - Induced diabetes model in rats.

OBJECTIVE: The aim of the study was to investigate the effectiveness of vitamin D and melatonin on the ocular tissues in streptozotocin (STZ)-induced diabetes. MATERIALS AND METHODS: In this study, a total of 45 male Wistar rats were randomly divided into five groups as follows: 1) non-diabetic rats (control group); 2) untreated STZ-induced diabetic rats; 3) STZ-induced diabetic rats treated with vitamin D; 4) STZ-induced diabetic rats treated with melatonin; 5) STZ-induced diabetic rats treated with the combination of vitamin D and melatonin. After six weeks of treatment, all rats were sacrificed for post-mortem analyses. Retinal and corneal samples were obtained and analyzed for glial fibrillary acidic protein (GFAP) expression. Retinal and corneal thicknesses in addition to morphological changes were assessed via hematoxylin and eosin staining. RESULTS: Untreated diabetic rats revealed retinal disorganization, atrophy, increased vascularization along with more GFAP staining. However, all the treated groups exhibited more regular retinal layers and minimal GFAP staining. Additionally, treatment groups showed more uniform corneal layers with minimal GFAP staining. CONCLUSIONS: Melatonin and vitamin D could be used as an additional complementary treatment in diabetes. Developing treatment protocols involving supplementation, as well as informing patients about the potential benefits of vitamin D and melatonin could be impactful in the treatment process of diabetes.

Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole-of-population report.

OBJECTIVE: To review the clinical and demographic characteristics of pregnant and postpartum women who died as a consequence of influenza A H1N1 (2009) infection in Turkey. DESIGN: A review of the records for pregnant and postpartum women who died as a consequence of H1N1 influenza virus infection. SETTING: Nationwide in Turkey. POPULATION: Thirty-six pregnant or postpartum women who died as a result of confirmed pandemic H1N1 influenza virus infection. METHODS: Using the General Directorate of Mother and Child Health and Family Planning (MCHFP) Registry of the Ministry of Health of Turkey, we identified all pregnant and postpartum women who died as a result of confirmed influenza A H1N1 (2009) infection between 29 October and 31 December 2009. MAIN OUTCOME MEASURE: Maternal mortality as a result of H1N1 virus infection. RESULTS: The average time from symptom onset to initial presentation for health care was approximately 2.5 days, and the mean time from symptom onset to the receipt of antiviral medication was approximately 5.5 days. Only one-fifth of all women received early antiviral treatment (administered 2 days or less after symptom onset) and only one woman was vaccinated for H1N1 influenza 1 week before the onset of symptoms. The cause-specific maternal mortality ratio for H1N1 influenza infection in Turkey was estimated to be 3.01. The calculated risk of death associated with H1N1 influenza virus infection was approximately four times higher in pregnant and postpartum women than in the general population (relative risk, 3.88; 95% confidence interval, 2.77-5.43). CONCLUSIONS: Pregnant women are at increased risk for complications of, and death from, H1N1 influenza infection. Prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. Vaccination for H1N1 influenza may reduce the total number of deaths in pregnant and postpartum women. The high cause-specific maternal mortality rate suggests that H1N1 influenza virus infection may have increased the 2009 maternal mortality ratio in Turkey.

Combined antihypertensive treatment is better than mono-therapy in hypertensive patients.

BACKGROUND: Hypertension (HT) is a chronic condition associated with serious complications. In the present cross-sectional study, we aimed to analyse factors that contribute to blood pressure control in subjects with HT. METHODS: Subjects with HT admitted to outpatient internal medicine clinics of the institution were enrolled in the study. According to the Joint National Committee (JNC) VIII criteria, subjects with a mean blood pressure above target levels were defined as poorly-controlled hypertensive patients and others were grouped as well-controlled hypertensive patients. Clinical and laboratory parameters were compared between study groups. RESULTS: Smokers were more prevalent in the poorly-controlled HT group compared to the well-controlled HT group (p = 0.001). The number of patients who adhered to dietary and exercise recommendations were greater in well-controlled HT group than poorly-controlled HT group (p < 0.001 for both). The rate of combined therapy was greater in well-controlled HT group compared to poorly-controlled HT group (p = 0.04). CONCLUSIONS: We suggest that, in addition to dietary and exercise recommendations and smoking cessation, treatment with combination therapy could be better in reaching blood pressure targets in patients with HT.

Cervical stability training with and without core stability training for patients with cervical disc herniation: A randomized, single-blind study.

BACKGROUND: This study aims at evaluating and comparing the effects of cervical stability training to combined cervical and core stability training in patients with neck pain and cervical disc herniation. METHODS: Fifty patients with neck pain and cervical disc herniation were included in the study, randomly divided into two groups as cervical stability and cervical-core stability. Training was applied three times a week in three phases, and lasted for a total duration of 8 weeks. Pain, activation and static endurance of deep cervical flexor muscles, static endurance of neck muscles, cross-sectional diameter of M. Longus Colli, static endurance of trunk muscles, disability and kinesiophobia were assessed. RESULTS: Pain, activation and static endurance of deep cervical flexors, static endurance of neck muscles, cross-sectional diameter of M. Longus Colli, static endurance of trunk muscles, disability and kinesiophobia improved in both groups following the training sessions (p < 0.05). Comparison of the effectiveness of these two training methods revealed that the cervical stability group produced a greater increase in the right transverse diameter of M. Longus Colli (p < 0.05). However, static endurance of trunk muscles and kinesiophobia displayed better improvement in the cervical-core stability group (p < 0.05). CONCLUSIONS: Cervical stability training provided benefit to patients with cervical disc herniation. The addition of core stability training did not provide any additional significant benefit. Further research is required to investigate the efficacy of combining other techniques with cervical stability training in patients with cervical disc herniation. SIGNIFICANCE: Both cervical stability training and its combination with core stability training were significantly and similarly effective on neck pain and neck muscle endurance in patients with cervical disc herniation.

Chandelier retroillumination-assisted cataract surgery during vitrectomy.

PurposeTo present an alternative cataract surgical technique in patients with cataract and intravitreal hemorrhage.MethodsTwelve cases with poor fundus reflex caused by severe vitreus hemorrhage were included in the study. All patients underwent combined phaco surgery and 23-gauge vitrectomy. Chandelier retroillumination was inserted into the infusion trochar during the cataract operations and was used with low power (50-75%) in necessary steps.ResultsWe did not experience phaco complications or complications due to technique during surgery. Retroillumination assistance was especially useful during final stages of cataract surgery, particularly irrigation-aspiration of cortical material.ConclusionRetroillumination in absence of red fundus reflex may be helpful and can be practiced more often in cataract surgery combined with vitrectomy.

[Difficulties in the diagnosis of isolated radial artery injuries: a case report]. / Izole radial arter yaralanmasinda tani güçlükleri: Olgu sunumu.

Arterial injuries of the forearm account for an important fraction of peripheral vascular injuries. Early diagnosis and treatment are important for both function and viability of the extremity. Arterial injuries of the forearm mostly occur as a result of glass or knife cuts and gunshot wounds and the presence of accompanying injuries may facilitate the diagnosis. However, in this case (50-year-old male patient), a piece of nail behaved like a high-energy particle and injured the radial artery without any accompanying lesion. Detection of normal pulses in the radial and ulnar arteries delayed the diagnosis and treatment. This case report aimed to address difficulties in establishing the diagnosis of isolated radial artery injuries.

Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication.

Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications.

Alpha 2-adrenergic inhibition of pancreatic islet glucose utilization is mediated by an inhibitory guanine nucleotide regulatory protein.

The rate of glucose utilization in isolated pancreatic islets of the rat was inhibited by the alpha 2-adrenoceptor agonists clonidine and epinephrine. Yohimbine reversed the inhibition. alpha 1 or beta-adrenoceptor agonists had little or no effect on glucose utilization. Stimulation of muscarinic receptors by carbamylcholine reversed the effect of clonidine. Pertussis toxin blocked the effect of clonidine on glucose utilization, and potentiated the response to carbamylcholine. 8-Bromo-cAMP did not affect glucose utilization in the presence of clonidine. Thus, alpha 2-adrenoceptors negatively modulate glucose utilization, and the effect is mediated by an inhibitory guanine nucleotide regulatory protein, but not by cAMP.

Calcium mobilization, prostaglandin E2 and alpha 2-adrenoceptor modulation of glucose utilization and insulin secretion in pancreatic islets.

alpha 2-Adrenoceptor agonists inhibit glucose-stimulated insulin release and glucose utilization in pancreatic islets. In isolated pancreatic islets of the rat, the Ca2+ channel agonists CGP-28392 and BAY-K-8644 increased insulin release in the presence of clonidine. Neither CGP-28392 nor BAY-K-8644 antagonized the effect of clonidine on glucose utilization. The Ca2+ ionophore, ionomycin, also did not affect glucose utilization in the presence or absence of clonidine. Glucagon partly reversed the effects of clonidine on insulin release, and it potentiated glucose-stimulated insulin release in the absence of clonidine. Glucagon reversed the effects of clonidine on glucose utilization. Amiloride antagonized the effects of clonidine on insulin secretion but did not enhance markedly glucose utilization in the presence or absence of clonidine. Carbamylcholine and arecoline reversed the effects of clonidine on glucose utilization and partly reversed the effects on insulin release in the absence of extracellular Ca2+. Prostaglandin (PG) E2, but not PGF2 alpha, inhibited glucose utilization in a time- and concentration-dependent manner. PGE2 also inhibited glucose-stimulated insulin release. Pertussis toxin blocked both actions of PGE2. The cyclooxygenase inhibitor indomethacin did not affect insulin release or glucose utilization in the presence of clonidine. Thus, elevated intracellular Ca2+ levels antagonize the effects of clonidine on insulin release, whereas other mediators appear to be required to alter glucose utilization.

Pancreatic islet arachidonic acid turnover and metabolism and insulin release in response to delta-9-tetrahydrocannabinol.

Isolated pancreatic islets from the rat secrete insulin in response to glucose or delta-9-tetrahydrocannabinol (THC). THC stimulated the basal release of insulin and also potentiated the secretory response to glucose. The exposure of control or glucose-stimulated islets to THC inhibited the incorporation of [14C]arachidonic acid (AA) into phospholipids. However, in islets prelabeled with [14C]AA, THC enhanced the glucose-induced loss of AA from phospholipids. The enhanced AA release from islet phospholipids in response to glucose and THC was accompanied by increased synthesis of 12-L-[5,6,8,9,11,12,14,15-3H(N)]-hydroxy-5,8,10,14-eicosatetraenoic acid (12-HETE) and prostaglandin E2. The lipoxygenase inhibitor 3-amino-1-(3-trifluoromethylphenyl)-2-pyrazoline hydrochloride (BW755C) inhibited 12-HETE synthesis and insulin release in glucose and THC-challenged islets; nordihydroguaiaretic acid also inhibited insulin release in THC-treated islets. In contrast, the cyclooxygenase inhibitor, indomethacin, stimulated insulin release. In homogenized islet preparations, THC inhibited acyl-CoA acyltransferase, while it stimulated phospholipase A2 activity. The stimulatory effects of THC on islet cell AA hydrolysis from phospholipids, lipoxygenase product formation, and secretion suggests that these biochemical sequelae in cell activation are important modulators of insulin release.

Subtransverse process wiring: a new technique of segmental spinal fixation of the thoracic spine or in the treatment of adolescent idiopathic scoliosis.

STUDY DESIGN: Segmental fixation is the preferred technique for the surgical treatment of adolescent idiopathic scoliosis. Sublaminar wiring is a widely used, strong type of segmental fixation. The most common drawback of the sublaminar wiring is the risk of neurologic injury. The authors have applied subtransverse wiring for 3 years, and the technique seems promising. OBJECTIVES: To show that subtransverse wiring is a technique strong enough to correct scoliosis curves and does not carry neurologic injury risks. SUMMARY OF BACKGROUND DATA: Sublaminar wiring is a commonly used fixation method for posterior fusion in the treatment of scoliosis. Because of its associated risk of neurologic injury, it is mostly recommended for long neuromuscular curves. METHODS: The authors used the subtransverse wiring technique in 12 cases of adolescent idiopathic scoliosis and followed them for an average of 22 months. RESULTS: The average correction rate was 65%, and correction loss at the end of the follow-up period was 5 degrees. No neurologic complications were encountered. CONCLUSIONS: Subtransverse wiring is strong enough to correct scoliotic curves. It requires less operative time and skill and is neurologically safe.