Nutritional screening of outpatient type 2 diabetes mellitus patients

Objective: To examine the parameters affecting the existence and prevalence of malnutrition in type 2 diabetic patients at initial presentation

Design: Cross-sectional study

Setting: Department of Internal Medicine, Sakarya University Research and Education Hospital, Turkey

Subjects: Nutritional screening of 580 outpatients with the diagnosis of type 2 diabetes who presented to an outpatient clinic

Intervention: Medical treatment of diabetic patients

Main outcome measure: The parameters affecting the existence and prevalence of malnutrition in type 2 diabetic patients

Results: Mean +/- standard deviation age of the patients was 54.6 +/- 10.7 years. Of the 580 patients, 327 were women [56.4%]. Malnutrition prevalence was 11.4% with Subjective Global Assessment and 9% with Mini Nutritional Assesment and Malnutrition Universal Screening Tool. Body mass index [BMI], albumin, fat%, mid-arm circumference and calf circumference were significantly lower and glycated hemoglobin [HbA1c] was significantly higher in patients with malnutrition, compared to patients without alnutrition. Malnutrition was significantly associated with weight loss, change in dietary intake and diminished physical activity [p = 0.005]. Logistic regression model, including BMI /= 8.69 mmol/mol, fat%

Conclusion: Type 2 diabetic patients are often obese and thus higher cut-off for BMI and fat% may be necessary to detect malnutrition. Poor glucose control, decreased fat%, change in dietary intake and especially diminished physical activity are independent predictors of malnurition in this population

Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis

Background and Objective: During the course of the autoimmune thyroid diseases, ultrasonography change parallel to histopathology. Vitamin D is associated with autoimmune diseases and thus can affect thyroid blood flow. Our aim was to investigate the relationship between vitamin D insufficiency/deficiency and thyroid hemodynamic indices in patients with Hashimoto thyroiditis

Methods: A total of 93 patients who presented to Sakarya University Endocrinology outpatient clinic from April to September 2016 and diagnosed with Hashimoto thyroiditis were included in this study. Clinical and serologic data, thyroid antibodies and 25[OH] D3 were evaluated. Mean peak systolic velocity [mPSV], mean end-diastolic velocity [EDV], mean resistive index [RI] flows of superior and inferior thyroid arteries were measured with B-mode Doppler ultrasonography

Results: Vitamin D insufficiency/deficiency was detected in 59 [63.4%]. TPO Ab and TgAb levels were found higher in patients with vitamin D insufficiency/deficiency. In the normal vitamin D group, superior thyroid artery mPSV [32.21+/-6.73cm/s] and EDV[13.27+/-2.80 cm/s] were higher than in the low vitamin D group [mPSV [28.32+/-8.99cm/s] and EDV[10.67+/-3.68 cm/s]] [P=0.034, P=0.001, respectively]. Inferior thyroid artery EDV value was higher in the normal compared to the low vitamin D group [0.032]. RI measured in all arteries were higher in the vitamin D insufficient/deficient group compared to the Vitamin D normal group [p=0.001]

Conclusion: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients

relation between serum vitamin D levels and hashimoto thyroiditis in women

Objective: Vitamin D has immunomodulatory effects which suggest a possible association between low serum 25-hydroxyvitamin D [25-OH D[3]] levels and autoimmune thyroid diseases. This study was conducted to investigate such a relation between low serum 25-OH D[3] levels and Hashimoto thyroiditis [HT]

Design: Prospective, case-control study

Setting: Internal Medicine Clinic of Sakarya University, Turkey

Subjects: Serum 25-OH D[3] levels were measured in 498 women presented to the outpatient clinic for routine history and physical examination. Thyroid hormones and antibodies were obtained in all patients. Thyroid ultrasonography was performed in antibody positive patients

Intervention: Blood tests and neck ultrasound

Main outcome measures: Vitamin D levels in Hashimoto Thyroiditis

Results: Serum 25-OH D[3] levels were significantly lower in patients with at least one thyroid antibody positive, compared to thyroid antibody negative patients [P = 0.013]. Serum 25-OH D[3] levels were also lower in antithyroglobine [TgAb] positive patients compared to antibody negative patients [P = 0.010]. There was a statistically significant negative correlation between anti-TgAb and serum 25-OH D[3] levels [P < 0.001]. There was no statistically significant difference in serum 25-OH D[3] levels between anti-thyroid peroxidase positive [TPOAb] patients and antibody negative patients [P = 0.643]

Conclusion: Women with HT thyroiditis have lower vitamin D levels compared to women without HT thyroiditis. We determined that serum 25-OH D[3] insufficiency was 1.7 times more likely to be present in patients with HT. This insufficiency may increase the risk of HT disease

Association between the neutrophil-to-lymphocyte ratio, a new marker of systemic inflammation, and restless legs syndrome

<p><b>INTRODUCTION</b>Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is characterised by abnormal sensations in the legs as well as dysaesthesia. Although the aetiology of RLS has not yet been determined, it may be associated with systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a new and simple marker indicating systemic inflammation. The present study aimed to investigate the relationship between systemic inflammation and RLS through the use of the NLR.</p><p><b>METHODS</b>A total of 75 newly diagnosed patients with RLS and 56 healthy control subjects were included in the study. Baseline NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The NLRs of the two groups were compared.</p><p><b>RESULTS</b>There were no significant differences in gender and age between the two groups. The NLR was 1.96 ± 0.66 in the patient group and 1.67 ± 0.68 in the control group (p = 0.005). Receiver operating characteristic analysis was performed to determine the cut-off value of NLR to predict RLS. The NLR was predictive at 1.58 with a 64% sensitivity and 50% specificity (95% confidence interval 0.55-0.74, area under curve 0.648 ± 0.05). The NLR was found to be statistically higher in patients with RLS and may be used to predict RLS.</p><p><b>CONCLUSION</b>The aetiology of RLS remains undetermined. The present study showed that systemic inflammation may play a role in RLS. However, RLS could also be associated with systemic inflammatory diseases. This relationship is supported by high NLR values, which are related to chronic systemic inflammation.</p>

Neutrophil to lymphocyte ratio might help prediction of acute myocardial infarction in patients with elevated serum creatinine

Background and Objective: Diagnostic performance of troponin assays is affected by renal insufficiency. Neutrophil to lymphocyte ratio[NLR] is an independent predictor of acute coronary syndrome.Our objective was to evaluate performance of NLR in diagnosing acute myocardial infarction [AMI] among patients with elevated serum creatinine

Methods: Patients with elevated creatinine levels evaluated for coronary artery disease were included [n=284].Patients were divided into two groups according to having AMI or non-specific chest pain. AMI diagnosis was made based on clinical and laboratory data, including serial EKG and cardiac enzymes, ECHO and coronary angiography

Results: Troponin, neutrophil, and NLR were found to be higher in patients with AMI, compared to patients without AMI [P= 0.001, P= 0.001 and P=0.028, respectively]. ROC curve analysis for NLR in diagnosing AMI was significant[AUC:0.607; P=0.003]. Sensitivity, specificity, LR +, LR-, PPV and NPV for NLR>7.4 were found as 42.3%, 74.7%, 1.68%, 0.77%, 77% and 40%, respectively. Logistic regression analysis revealed that patients whose NLR>7.4 were 2.18 times as likely to have AMI

Conclusions: NLR can be used as an independent predictor of AMI in patients with renal insufficiency. This seems to get more important in the era of high sensitivity troponin assays. Our results might also help in early diagnosis of AMI in this high risk population while serial cardiac enzyme results are pending

Use of a portable monitoring device [Somnocheck Micro] for the investigation and diagnosis of obstructive sleep apnoea in comparison with polysomnography

Objective: Polysomnography [PSG] remains the gold standard for the diagnosis of obstructive sleep apnoea syndrome [OSAS]. While PSG is essential for OSAS, this technique is not suitable for epidemiological investigation due to its high cost. This study aimed to compare a portable monitoring device with PSG for the measurement of parameters related to the diagnosis of OSAS in rural areas

Methods: We conducted a descriptive study of 155 patients [30 women and 125 men; mean age, 52 +/- 12 years] who visited to the Hendek Government Hospital Sleep Laboratory between February 2011 and January 2013 Apnoea hypopnea index [AHI], mean levels of O[2] [meanO[2]], desaturation index [DI], and minimum oxygen saturation [minO[2]] variations as measured using both PSG and a portable Somnocheck Micro [SM] device were compared

Results: Differences were found between the meanO[2] and DI, but not between AHI and minO[2]. Differences between the methods were not desired, but the relationship between the methods was distinct and supported our hypothesis

Conclusions: The results of our study have shown that the SM portable device can be used as an alternative diagnostic tool in this population either at home or in sleep clinic