Noninvasive Liver Fibrosis Indices as Indicators of Microvascular and Macrovascular Complications in Type 2 Diabetes.

Objective: Nonalcoholic fatty liver disease (NAFLD) is more prevalent in patients with obesity, diabetes, and metabolic syndrome, which are risk factors for nonalcoholic steatohepatitis and liver fibrosis. NAFLD is related to cardiovascular outcomes in diabetes. We aimed to investigate the relationship between diabetic complications and NAFLD fibrosis score (NFS) and Fibrosis-4 score (FIB-4). Methods: Three hundred patients with type 2 diabetes mellitus (T2DM) were retrospectively evaluated according to NAFLD diagnosis on ultrasound in outpatient clinic. Risk of advanced fibrosis was estimated using FIB-4 and NFS. Diabetic complications of the patients were noted. Results: Presence of diabetic retinopathy is related to FIB-4 (P = 0.001) and NFS (P < 0.001) scores. NFS score (P = 0.037), not FIB-4 (P = 0.517), is related to diabetic nephropathy. Among macrovascular complications, only coronary artery disease is related to NFS and FIB-4 scores (P = 0.037 and P = 0.004, respectively). Although we cannot establish any association between fasting blood glucose, glycosylated hemoglobin (HbA1c) values and noninvasive liver fibrosis scores (P > 0.05), diabetes duration, and age positively correlated with the FIB-4 score (P = 0.033, P = 0.001). In logistic regression analysis, NFS > 0.676 values are associated with increased rates of diabetic retinopathy, independent of age, sex, HbA1c, and duration diabetes (odds ratio: 1.155, P = 0.030). FIB-4 has no relation with microvascular complications according to logistic regression analysis (P > 0.05 for all). Neither FIB-4 nor NFS has an effect on the presence of macrovascular complications (P > 0.05 for all). Conclusion: Our findings suggest that increase in NFS score is associated with the presence of diabetic retinopathy, independent of confounding factors. Further studies are needed on the applicability of noninvasive fibrosis scores in monitoring the presence of diabetic microvascular and macrovascular complications.

Factors related to the presence of nonalcoholic fatty liver disease in patients with type 2 diabetes: a single center study.

Aim of the study: There is a close relationship between the development of diabetes and nonalcoholic fatty liver disease (NAFLD). The aim of the study was to determine the frequency and associated factors of NAFLD in type 2 diabetes mellitus (T2DM) patients according to the ultrasound examination and noninvasive hepatic fibrosis indices. Material and methods: 316 patients who were followed up in the Internal Medicine Diabetes clinic, over the age of 18, diagnosed with T2DM were included retrospectively. NAFLD was noted using ultrasound. NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4) and AST to platelet ratio index (APRI) were used as non-invasive hepatic fibrosis indices. Results: The prevalence of NAFLD with hepatic ultrasound was 89.7% in T2DM patients. Among non-invasive fibrosis indices, NFS and FIB-4 were similar, but APRI was significantly higher in moderate-severe hepatosteatosis group (p values = 0.355, 0.246 and 0.003 respectively). In logistic regression analysis, while mild hepatosteatosis was associated with BMI and NFS (p = 0.004, p = 0.008), moderate to severe hepatosteatosis as associated with BMI and serum triglycerides (p < 0.001, p = 0.019). Conclusions: The prevalence of NAFLD is high in patients with T2DM. The frequency and degree of NAFLD is associated with the NFS, BMI and hypertriglyceridemia. While NFS is associated with mild hepatosteatosis; moderate to severe hepatosteatosis is associated with BMI and serum triglycerides.

COVID-19 pneumonia in patients with impaired fasting glucose, newly diagnosed diabetes and pre-existing diabetes: a tertiary center experience.

COVID-19 infection is known to increase mortality in patients with diabetes. We aim to demonstrate the differences in disease course and clinical outcomes of patients with COVID-19 regarding the presence of impaired fasting glucose, pre-existing diabetes mellitus (DM) or new-onset DM. 236 patients with positive reverse transcription-PCR tests for SARS-CoV-2 were included in this single-center, retrospective observational study between March 2020 and May 2021. Laboratory results, comorbidities, medications and imaging findings were noted. Logistic regression was used to estimate associated factors for admission to the intensive care unit (ICU). 43 patients with normal glucose, 53 with impaired fasting glucose, 60 with newly diagnosed DM, and 80 with pre-existing DM were classified. Patients with pre-existing DM had higher fasting glucose and glycated hemoglobin than the other groups (p<0.001 for all). Patients with newly diagnosed DM were more likely to need dexamethasone 6 mg (p=0.001). In both newly diagnosed diabetes and impaired fasting glucose groups, 250 mg methylprednisolone was needed at higher rates (p=0.002). Newly diagnosed DM had higher rates of intubation (21.6%) and more mortality (20.0%) (p=0.045 and p=0.028, respectively). Mortality and hospitalization in the ICU were lower in the group receiving antidiabetic treatment. The risk of ICU attendance was higher in patients with impaired fasting glucose (HR=1.71, 95% CI: 0.48 to 6.08) and newly diagnosed DM (HR=1.88, 95% CI: 0.57 to 6.17), compared with pre-existing DM and non-diabetics. Newly diagnosed DM and impaired fasting glucose are associated with increased mortality and intubation in inpatients with COVID-19.

Uric acid albumin ratio as a predictive marker of short-term mortality in patients with acute kidney injury.

OBJECTIVE: We aimed to investigate uric acid and albumin ratio (UA/A) as a marker of short-term mortality in acute kidney injury (AKI). Both uric acid and albumin are strongly correlated with the development and mortality of AKI. METHODS: The patients hospitalized from May 2019 to September 2019 for AKI were included in this study. The diagnostic odds ratio (DOR), Youden index (J), and the area under a receiver operating characteristic curve (AUROC) determined a cut-off UA/A ratio for mortality. Cox-regression analysis was performed to identify UA/A as a prognostic marker of the 30-day mortality rate. RESULTS: A total of 171 patients with an average age of 69.20±13.0 (45.6% women) were included in the study. The average UA/A ratio was 3.3±1.5 mg/g and 2.5±1.0 mg/g in the non-survivor and survivor groups, respectively (P=0.001). The best cut-off UA/A ratio associated with mortality was determined as 2.4 mg/g with a specificity of 52% and a sensitivity of 77% (DOR, 3.6; J, 28.8; AUROC, 0.644). Thirty-day cumulative survival rates of the low and high UA/A ratio groups were 85.9±4.0% and 63.7±5.0%, respectively. The estimated survival times of the low and high UA/A ratio groups were 27.7 days (95% confidence interval [CI], 26.2-29.3) and 23.9 days (95% Cl, 22.0-25.9), respectively. CONCLUSION: We found a direct correlation between 30-day mortality and UA/A ratio at initial presentation in AKI patients regardless of age, comorbidities, and clinical and laboratory findings, including albuminuria.

The Effects of Fluid Balance Disorders on Mortality in Patients Hospitalized for Acute Disease in the Internal Medicine Clinic.

BACKGORUND: Previous studies conducted on critical patients in intensive care units have shown that fluid balance disorder (FBD) increases mortality. The purpose of this study is to investigate the effect of FBD on mortality of patients hospitalized in internal medicine ward. METHODS: The present study was designed as an observational study and follow-up period of the patients began in the first 8 hours of admission to the emergency room who had hypervolemia findings in physical examination were included in the fluid balance FB (+) group; those who had any of the dehydration findings were included in FB (-) group, those who had both hypervolemia and dehydration findings were included in FB (mix) group, and those with normal examination findings were included in FB (N) group. RESULTS: A total of 303 patients, mean age of 66.4 ± 15.9 years, 54.5% male, were included in the study, which covered the period between May 1, 2019 and September 30, 2019. In-hospital, monthly and quarterly cumulative survival rates of the patients were respectively; 91.7 ± 2.7%, 89.2 ± 2.8%, 81.7 ± 3.5% in FB (N) group; 86.3 ± 5.2%, 82.2 ± 5.7%, and 57.8 ± 7.4% in FB (-) group; 70.9 ± 4.4%, 68.1 ±4.4%, and 54.9 ± 4.7% in FB (+) group; 57.6 ± 10.2%, 56.0 ± 9.9%, 44.0 ± 9.9% in FB (mix) group. It was determined that there was an approximately 3-fold increase in both monthly and quarterly mortality risks in those who had FBD compared to those who were not (HR: 3.077 and 3.031, respectively). It was shown with the multivariate Cox regression analyses that this risk increases independently from both preliminary diagnosis, concomitant diseases, vital disorders (30-day and 90-day AHR 2.541 and 2.517, respectively), and from the biochemical disorders (30-day and 90-day AHR 2.132 and 2.124, respectively). CONCLUSIONS: Our study is important in terms of emphasizing the value of physical examination which lost its popularity with the development of technology and many medical instruments, but still simple and cheap.

Peripheral arterial disease diagnosed by ankle-brachial index: Predictor for early renal replacement therapy in chronic kidney disease.

Our study aimed to investigate the relationship between ankle-brachial index (ABI) and need for early renal replacement therapy (RRT) in predialysis patients with chronic kidney disease (CKD). A total of 112 patients (62% men) with pre-dialysis CKD, seen in the outpatient clinic, were included, and ABI was obtained as per standard protocol. Peripheral arterial disease (PAD) was defined as ABI <0.9 or >1.3 in either leg. The clinical data were analyzed, and the risk factors for early RRT were determined by multivariate logistic regression analysis. The prevalence of PAD was 44% in predialysis CKD patients. Over three years' follow- up, 14.2% required RRT; 11.3% developed major cardiovascular event (myocardial infarction, stroke, or death). A total of 26 events occurred. The incidence of all events was significantly higher in patients with abnormal ABI than in those with normal ABI (34.7% vs. 12.7%; log rank P = 0.02). PAD was associated with all events [hazard ratio (HR): 2.72; 95% CI: 1.04-7.17; P = 0.042] as also the need for RRT (HR 3.2; 95% Cl: 1.005-10.23; P = 0.049), on univariate cox proportional hazard analysis. Multivariate logistic regression analysis adjusted for other risk factors identified that PAD remained an independent predictor for the need for early RRT (HR: 12.2; 95%Cl: 2.2-66.5; P = 0.004) and all events (HR: 3.5; 95% Cl: 0.9-13.5; P = 0.032). PAD was an independent predictor for RRT requirement in predialysis CKD.

Prevalence of comorbidities in patients with type-2 diabetes mellitus.

AIMS: The prevalence of diabetes mellitus is gradually increasing in Turkey and it is becoming a serious public health problem. Other diseases which accompany diabetes becloud its treatment and bring additional problems. Until now, there have been no studies investigating the prevalence of co-morbidities in Turkish diabetic patients. With this study, we aimed to resolve the deficiency on this subject. METHODS: This cross-sectional descriptive epidemiological study was conducted between 2018 and 2019. Patients who had been regularly admitted to our diabetes center in the past 3 years were included in this study. Co-morbidities including hypertension, hyperlipidemia, obesity, coronary heart disease, cerebrovascular disease, diabetic retinopathy, and diabetic nephropathy were investigated. Factors relating to these co-morbidities were assessed. RESULTS: After exclusion from analysis, 1024 patients were included in the study. The female/male ratio was found to be 1.7. The mean age of these patients was 69.3 ± 9.8. The mean diabetes duration was 22.2 ± 7.0. The most common co-morbidities were hypertension and hyperlipidemia by the rate of 84.9% and 65.6%. Obesity prevalence was 54.4%, nephropathy was 36.6%, coronary heart disease 22.8%, retinopathy 18.5% and stroke prevalence was found to be 4.8%. Age, diabetes duration and insulin usage were found to be significantly related to all co-morbidities. CONCLUSIONS: This study is significant in that it is the widest Turkish diabetic co-morbidity analysis study to date. When compared to other worldwide studies, co-morbidities were seen to be a little bit higher in Turkish diabetic patients. Clinicians need to not only focus on anti-diabetic treatment but also on other co-morbidities in terms of decreasing mortality and morbidity.

Restless legs syndrome in type 2 diabetes mellitus.

AIMS: This study aimed to investigate the prevalence of restless leg syndrome (RLS) in type-2 diabetes mellitus (DM) patients and to determine the risk factors. METHODS: Patients were recruited from the Dr. Lütfi Kirdar Kartal Training and Research Hospital Diabetes Center. Patients between 18-80 years of age and meeting a minimum 5 years diagnosis of type-2 DM were included. All patients were examined by the same neurologist in terms of having RLS. The diagnosis was made according to the updated International Restless Legs Syndrome Study Group consensus criteria. Mimicking conditions such as myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort and habitual foot tapping were carefully investigated and excluded. Laboratory data, insulin use, family history and other related co-morbidities connected to RLS patients were recorded. RLS severity assessment was scored and recorded. RESULTS: 318 patients were included in the study. The prevalence of RLS in type-2 DM patients was found to be 28.3%. RLS prevalence in females was 33.3% and 20.6% in males. 39 patients (43.3%) had a family history of RLS. 43 patients with RLS had a co-morbidity link with RLS. Any co-morbidity linked to RLS was not seen in 47 patients. The prevalence rate of RLS in patients without co-morbidities was 17.1%. Mean duration of DM in patients with RLS was 15.6±6.7years while in DM patients without RLS was 13.7±6.3years. The relationship between RLS and the duration of diabetes was found to be statically significant. (p=0.025). 68 (75.6%) of patients diagnosed with RLS were treated with insulin. A statistical significance was found in the development of RLS and insulin usage (p=0.035). CONCLUSIONS: This is the first study which shows the RLS prevalence and risk factors in Turkish type-2 diabetes mellitus patients. The results indicated that RLS is much more frequent in DM patients even after excluding polyneuropathy than in general Turkish population. The duration of diabetes and insulin use are related to RLS.

Stroke Prevalence in a Coastal Town on the Black Sea Coast in Turkey: Community Based Study.

BACKGROUND: This study aims to determine the stroke prevalence in Akçakoca which is a rural area in Turkey. METHODS: The study was designed as a cross-sectional, door-to-door survey. The stroke questionnaire was completed by a trained team in the presence of the participants according to their answers. Based on the screenings, patients who had been diagnosed with stroke previously were reexamined by a neurologist and determined the prevalence values, risk factors, and stroke types. RESULTS: A total of 3750 people over 44 years old were reached in the screenings. It was determined that 83 people had previously suffered a stroke. The prevalence rate of stroke in those above 44 years was found to be 2.2 (98% confidence level and ± 2% margin of error). 70 (84.3%) patients had suffered an ischemic stroke while 12 (14.5%) had suffered a hemorrhagic stroke. Male/female ratio was 1.1. CONCLUSION: The results of this study give the prevalence rate of stroke among the Turkish population living in a rural area. Due to a lack of other similar studies, it is impossible to make any data comparison. However, the results of this study help shed light on the stroke prevalence rate.

Assesment of the patients presenting with severe anemia to the emergency internal medicine clinic.

OBJECTIVE: Etiological evaluation of the patients who were hospitalized with the diagnosis of severe anemia (Hb<7 gr/dl) in the emergency internal medicine clinic between January and July, 2013. METHODS: In this study, 112 patients who were hospitalized in Dr. Lutfi Kirdar Kartal Education and Research Hospital emergency internal medicine clinic with severe anemia between January and July 2013 were retrospectively analyzed. Patients' initial complaints, underlying causes of their anemia and prognosis of the patients were evaluated. RESULTS: The etiology of anemia was iron deficiency in 60 (53.6%), chronic kidney failure in 16 (14.2%), hematologic malignancies in 12 (10.7%), liver cirrhosis in 12 (10.7%) and other non-malignant hematologic disorders in 4 (3.6%) patients. CONCLUSION: The most common cause of anemia in patients who apply to emergency internal medicine clinic with severe anemia is iron deficiency. The most common complaints on admission are subjective ones such as weakness, fatigue and lassitude. Chronic disease anemia does not cause severe anemia as much as iron deficiency.