Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy.

INTRODUCTION: Orthostatic hypotension (OH) affects 5-20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients. METHOD: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria. RESULTS: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00-32.00] mm Hg vs. 24.00 [13.75-30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00-13.00] mm Hg vs. 6.00 [2.00-9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049). CONCLUSION: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.

The Effects of Coronavirus Disease 2019 Outbreak on Medical Students.

Introduction: The coronavirus disease 2019 (Covid-19) pandemic has influenced the whole world, where after the first case was diagnosed in Turkey, educational activities were suspended and partial curfews were implemented. This study was conducted to assess the concerns faced by the medical students about their professional life due to the disrupted educational activities and related psychological effects. Methods: This is a cross-sectional survey study, conducted with self-administered questionnaires on Bezmialem Vakif University medical students, during the pandemic. The questionnaire consists of queries about demographics, environmental factors, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scales. Results: A total of 178 students participated in the study, with a female-to-male ratio of 5:2. Of the total respondents, 19.7% were experiencing severe anxiety, 17.4% moderate anxiety, and 37.1% mild anxiety, according to the GAD-7; and 13.5% of the respondents were experiencing severe depression, 21.9% moderate-severe depression, and 23% mild depression according to the PHQ-9. There was no statistically significant difference between the grades in terms of GAD-7 or PHQ-9 scores. Male participants were more likely to have suicidal thoughts (p = 0.013). According to our study, the factors with the highest influence on students were as follows: "Major changes in personal life," "Disruption in educational activities," and "Covid-19 related anxiety of loss of relatives and contamination or infection." On average, women voted higher points for "Covid-19 related anxiety of loss of relatives and contamination." Conclusions: We found that a significant portion of students regardless of their year in medical school were profoundly affected by the pandemic process as is shown by their anxiety and depression scores. The disruption in educational activities is one of the main factors of these effects, and we believe that these should not be ignored, as they could in the future lead to a series of problems for medical education and students alike.