Non-invasive Screening of Metabolic Associated Fatty Liver Disease and Affecting Factors in Primary Care.

OBJECTIVE: To identify the presence of MAFLD (metabolic associated fatty liver disease) with some non-invasive screening methods and the factors affecting in patients with metabolic dysfunction. STUDY DESIGN: A cross-sectional study. Place and Duration of the Study: University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye, from March to June 2021. METHODOLOGY: This study included 233 participants with metabolic disease over the age of 18 who applied to family medicine clinics. The participants' sociodemographic data, chronic disease status, biochemical parameters, waist circumference, weight, height, body mass index, and presence of steatosis by ultrasonography were recorded. The risk of developing hepatic fibrosis and steatosis was calculated with the non-alcoholic fatty liver disease liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), fatty liver index (FLI), fibrosis-4 index (FIB-4), NAFLD fibrosis score (NAFLD-FS), and aspartate aminotransaminase to platelet ratio index (APRI). The conclusions were evaluated with SPSS. RESULTS: According to the diagnostic criteria, MAFLD was detected in 58.4% of the participants. Statistically significant difference was found between FLI, HSI, NAFLD-LFS and MAFLD (p<0.001). According to the steatosis index risk groups of the participants, 64.4% - 89.7% were found to be high-risk. Steatosis was confirmed by ultrasonography in 63.6% - 77.8% of those at high-risk for index steatosis. The statistically significant difference was found between hypertension, diabetes mellitus, hyperlipidemia, metabolic syndrome, obesity, and MAFLD (p=0.039, p<0.001, p<0.001, p<0.001, and p=0.011, respectively). CONCLUSION: Using non-invasive screening methods for steatosis can be clinically useful in detecting patients at risk for steatosis, and these methods are applicable in predicting MAFLD. KEY WORDS: NAFLD, Fatty liver index, Hepatic steatosis index, MAFLD, Steatosis.

Change of pulmonary function tests in hospitalized COVID-19 patients at third and sixth month follow-up.

BACKGROUND: The effect of COVID-19 infection on pulmonary function is unknown. OBJECTIVE: This study aimed to evaluate pulmonary function tests (PFTs) of patients hospitalized with the diagnosis of COVID-19 pneumonia at 3 and 6 months post-discharge. METHODS: Patients aged 18 years and over who had positive COVID-19 PCR test results and were hospitalized in the pandemic service between 1 May 2020 and 31 October 2020, were included in the study. All patients were evaluated with PFTs FVC, FEV1, FEV1/FVC, and FEF25-75 at 3 and 6 months after discharge. RESULTS: The mean age of 34 patients included in the study was 47.7 ± 12.7 years. The FVC, FEV1, FEV1/FVC, and FEF25-75 measurements at 3 and 6 months post-discharge showed no significant difference (P = 0.765, P = 0.907, P = 0.707, and P = 0.674, respectively). There was no significant difference in any PFT measurements at the third month follow-up, regardless of the pharmacological treatment protocols applied during hospitalization (P > 0.05). However, FEV1/FVC and FEF25-75 levels were 83.1 [3.4]% and 91.0 [10.0]%, respectively, in those who received systemic steroid treatment, and 78.3 ± 8.5% and 72.5 ± 25.7% in those who did not (P = 0.019 and P = 0.048, respectively). In addition, FVC and FEV1 levels increased significantly from the third to the sixth month follow-up in patients who received systemic steroid therapy (P = 0.035 and P = 0.018, respectively). CONCLUSION: Although there is no significant difference in PFT measurements from 3 to 6 months in COVID-19 patients, systemic steroid therapy may have a beneficial effect on respiratory function in COVID-19 patients.

Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication.

Objectives: Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series. Methods: This is a retrospective single-center study of 117 MHI patients admitted to emergency service. Results: The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male. Conclusion: Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Association between Sarcopenia and Cognitive Functions in Older Individuals: A Cross-Sectional Study.

BACKGROUND: Sarcopenia and cognitive disorders are frequently observed in older individuals. This study investigated the relationship between sarcopenia and cognitive function in this population. METHODS: This cross-sectional study included 201 participants aged >65 years in Istanbul between July 1, 2020 and January 31, 2021. We screened all participants using the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire to determine the risk of sarcopenia. Handgrip strength and skeletal muscle mass of participants at risk were measured to diagnose sarcopenia. Sarcopenia severity was evaluated using a 4-m walking speed test. We evaluated the cognitive status of participants using the Standardized Mini-Mental Test (SMMT) and the Standardized Mini-Mental Test for the Untrained (SMMT-E). RESULTS: It was found that 10.9% (n=22) of participants was risky for sarcopenia and 6.0% (n=12) and 33.3% (n=4) had definite and severe sarcopenia, respectively. Examination of the association between cognitive impairment and SARC-F showed that 8.6% (n=14) of participants with normal cognitive function were at risk of sarcopenia compared to 20.5% (n=8) of participants with cognitive impairment (p=0.045). Evaluation of the relationship between cognitive function and sarcopenia status showed that 3.7% (n=6) of participants with normal cognitive function had sarcopenia compared to 15.4% (n=6) among participants with cognitive impairment (p=0.006). CONCLUSION: The rate of sarcopenia was significantly higher in older individuals with cognitive than those with normal cognitive functions.

Body Shape Index and Cardiovascular Risk in Individuals With Obesity.

INTRODUCTION: Cardio-metabolic risks are tested to show various anthropometric measurements. This study aimed to evaluate a body shape index (ABSI) of individuals with obesity to determine the role of these measurements in cardiovascular risk prediction. METHODS: This cross-sectional study included 368 patients who were evaluated by the researcher in the polyclinic. Sociodemographic information was obtained, and anthropometric measurements were made. Body mass index (BMI), waist circumference, and ABSI were evaluated in all patients. The patient's risk of developing cardiovascular disease was calculated from the pooled cohort equations risk calculator (PRCAE), Framingham risk score, and systematic coronary risk evaluation (SCORE) risk calculation systems. RESULTS: Of the 368 patients in the study, 302 (82.1%) were females, and 66 (17.9%) were males. The average age of participants was 46.2 ± 12.0 years. The median BMI of participants was 37.5 (34.0-42.4) kg/m2. The median ABSI of participants was 0.0816 (0.0775-0.0849). A positive correlation was found between ABSI and Framingham risk score and PRCAE risk score (r = 0.297, p = 0.000 and r = 0.305, p = 0.000, respectively). A significant relationship was found between ABSI and Framingham, PRCAE, and SCORE risk groups (p = 0.000, p = 0.000, and p = 0.000, respectively). CONCLUSIONS: Our study results revealed a significant association of ABSI with Framingham, PRCAE, and SCORE risk calculation systems, which helps predict cardiovascular risk.

Predictive Value of Betatrophin for Determining the Cardiovascular Risks of Obese Individuals.

OBJECTIVE: To determine cardiovascular risk factors, calculate cardiovascular risk, and the value of betatrophin, a novel biomarker in predicting the risk of cardiovascular disease (CVD) in obese individuals. STUDY DESIGN: Cross-sectional and descriptive study. PLACE AND DURATION OF STUDY:  University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Turkey, from August to November 2019. METHODOLOGY:  Three hundred and sixty-three patients sociodemographic information was obtained, anthropometric measurements were made, and routine laboratory examinations were taken for obesity. In addition, betatrophin was studied from the samples collected and stored under appropriate conditions. The risk of CVD development in the patients was calculated using Framingham and PRCAE risk calculation systems. RESULTS: The median betatrophin level of the participants was 745.8 (636.3-935.7) ng/L. A significant relationship was found between Framingham sub-risk groups and betatrophin level (p=0.049). Moreover, a significant relationship was also found, especially between the medium-risk group and the high-risk group (p=0.029). A significant correlation was found between the triglyceride and the betatrophin levels (p=0.001, r=-0.166). No relation was found between betatrophin level and risk score in the PRCAE sub-risk groups. CONCLUSION: Its significant relationship with the risk groups determined by the Framingham scoring system and triglyceride level is promising for betatrophin to be used as a new biomarker in predicting the CVD risk. Key Words: Betatrophin, Framingham score, Cardiovascular disease, Obesity, Risk.

A comparative analysis of the COVID-19 pandemic response: The case of Turkey.

OBJECTIVE: COVID-19 has spread worldwide and leads to an increased risk of mortality. We aimed to analyze what actions have been effective in fighting COVID-19 in Turkey with a comparison to pandemic-affected countries. METHODS: This was a retrospective observational cross-sectional study. The Republic of Turkey Ministry of Health official web page includes data reported daily from 11 March to 26 April. Global COVID-19 data were recorded daily from https://www.worldometers.info/coronavirus/country/. Data were analyzed for 31 days according to Intensive Care Unit (ICU) admission, intubation and mortality rates. Segmented regression analysis was used. The results from COVID-19-affected countries were compared with the results from Turkey for the first 65 days. RESULTS: In total, 889.742 tests were performed (positive=110.130 [12.37%]). The mortality rate was 2.55% (n=2805) on 27 April 2020. The annual percent change (APC) values of the cases showed 5 segments ([23.1], [14.7] [11.4], [3.7], [0.7]; each p=0.001). ICU admission showed 4 segments (APC: [3.1, p=0.001], [-2.2, p=0.10], [-7.6, p=0.001], [-4.5, p=0.001]). The decline of APC for intubation rates showed 5 segments (APC: [1.1, p=0.10], [-1.1,p=0.001], [-2.0, p=0.001], [-0.4, p=0.40], [-2.7, p=0.001]). The mortality rates showed 4 segments (APC: [-6.3, p=0.001], [8.4, p=0.001], [0.2, p=0.30], [1.4, p=0.001]). Deaths were reported per 1 million individuals for the first 65 days: Spain 11.6%, Italy 11.4%, UK 11.3%, France 11.1%, USA 10.3%, Germany 8.4%, Iran 8.2%, Turkey 7.5%, South Korea 4.1% and China 2.4%. CONCLUSION: Public health policies and protocols to combat COVID-19 helped control the spread and decrease positive cases and mortality rates in Turkey. Turkey managed COVID-19 better than Spain, Italy, UK, France, USA and Turkey managed COVID-19 similarly to Germany and Iran. China and South Korea were best at managing COVID-19.

The relationship between personality traits and BMI categories.

OBJECTIVE: To compare personality traits between average weight, overweight and obese people using Eysenck Personality Questionnaire Revised-Abbreviated Form (EPQR-A). Study design: Cross-sectional, descriptive study. Place and duration of study: S. B. U Kartal Dr. Lutfi Kirdar Training and Research Hospital Family Medicine Obesity Policlinic and Family Medicine Outpatient Clinics, from November 2018 to January 2019. METHODS: Participants aged between 18 and 65 years (279 female and 150 male) were layered according to Turkish Endocrinology and Metabolism Society (TEMD) Body Mass Index (BMI) categories to compare personality traits between normal weight, overweight and obese people. Each layer was compared to each other in this study. A questionnaire, including socio-demographic form, and EPQR-A Form were applied to the participants. RESULTS: Patients aged between 18 and 65 years (279 female and 150 male) were evaluated according to BMI categories. There was a significant difference in psychoticism score averages by BMI categories (p<0.001). The mean of psychoticism scores showed a V-shaped distribution according to the BMI categories. There were no significant differences between the average scores of neuroticism and extraversion according to BMI categories (p=0.094; p=0.157, respectively). CONCLUSION: There was a significant difference in psychoticism score averages by BMI categories. The mean of psychoticism scores showed a V-shaped distribution according to the BMI categories.

Night Eating Syndrome According to Obesity Groups and the Related Factors.

OBJECTIVE: To find the frequency of night eating syndrome (NES) in different obesity groups and to determine related factors. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Family Medicine, Outpatient Clinics, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital from December 2018 to January 2019. METHODOLOGY: Participants were divided into class I, class II, and class III obesity groups according to their BMI levels and administered a survey evaluating their sociodemographic features and a NES questionnaire. RESULTS: NES was detected in 92 (21.85%) of all participants; whereas, 28 participants (18.67%) of class I obesity group, 32 participants (22.70%) of class II obesity group and 32 participants (24.62%) of class III obesity group had NES (p=0.465). There was no significant difference between individuals with and without NES in terms of age, gender, marital status, income level, occupational status, presence of children, living-together subjects, cigarette consumption, BMI, waist-hip ratio, and waist-height ratio. However, within the class I obesity group, the likelihood of weight loss was significantly lower among participants with NES (p=0.026). There was no relationship between NES and the duration of obesity, dieting, and the number of main meals per day. However, the relationship between NES and the number of snacks per day was significant in class I and III obesity groups (p=0.040 and p=0.034, respectively).   Conclusion: The frequency of NES was found to be high in all obesity groups with no significant difference across groups. Therefore, all obese patients should be evaluated in terms of NES, and nutritional recommendations should be provided in the treatment of obesity. Key Words: Morbid obesity, Night eating syndrome, Obesity.

Can ocular OCT findings be as a predictor for end-organ damage in systemic hypertension?

PURPOSE: Detection of end-organ damage (EOD) in systemic hypertension is essential for the management of systemic hypertension. We aimed to evaluate subfoveal choroidal thickness (SFCT) and retinal layers' thicknesses by using spectral domain optical coherence tomography (SD­OCT) in patients with systemic hypertension and to assess the relationship between EOD and SD-OCT parameters. METHODS: A total of 189 consecutive patients with systemic hypertension and 100 controls were included. Patients were examined to detect EOD including hypertensive retinopathy (HTRP), left ventricular hypertrophy assessed by transthoracic echocardiography and microalbuminuria assessed by 24-h urine analysis. SFCT, inner plexiform-ganglion cell complex (IP-GCC), peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) were measured with SD-OCT. RESULTS: Patients with systemic hypertension had significantly lower SFCT and retinal layer thicknesses than controls (P˂0.001). In the dilated fundus photographic evaluation, 94 patients with systemic hypertension had HTRP and these patients had lower SFCT, CMT, IP-GCC and pRNFL thicknesses compared to hypertensive patients without HTRP and healthy controls. Patients with EOD had significantly lower SFCT, CMT, IP-GCC and pRNFL thicknesses and as the number of EOD increased, the SFCT decreased significantly. In the multivariate analysis, SFCT was found as an independent predictor of EOD (P˂0.001, odds ratio: 0.0605). CONCLUSION: Hypertensive patients, especially with EOD had significantly lower SD-OCT parameters compared to controls. It would be rational to add SD-OCT assessment to conventional hypertensive retinopathy evaluation in patients with systemic hypertension for early diagnosis of end-organ damage, burden of target organ involvement and monitoring anti-hypertensive treatment.

Investigation of the preventive effects of dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) on cisplatin-induced ovarian damage in rats.

To investigate whether Dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) had any preventive effect against the ovarian damage caused by cisplatin (CP) (cis-diamminedichloroplatinum) in rats. On the first day ovaries were removed, Anti-Müllerian hormone (AMH) was measured (Group1, n:6), in the other groups 7.5 mg/kg cisplatin was administered intraperitoneally. In Group 2 (n = 6), 0.1 ml saline, in Group 3 (n = 5), 20 umol/kg CAPE, in Group 4 (n = 7), DHEA 6 mg/kg were administered every day. On the 10th day, ovaries were removed, AMH was measured. Ovary reserve (primordial/primary/secondary/tertiary/atretic follicles, AMH), ovarian damage scores (follicular degeneration, congestion, hemorrhage, edema, inflammation) were compared. The number of tertiary follicles were statistically high in the CAPE group (p = .015), the inflammation score in the DHEA group (p = .012), AMH level (p = .009) in the control group. The lowest number of atretic follicles (AF) was in the control group, while the highest number of AF was in the DHEA group (p = .002). Significant decreases in AF were the case in the cisplatin and DHEA groups compared to the control group (p < .008). The AMH values had the highest positive correlation with the number of primordial follicles and the highest negative correlation with the number of AF. The cut off point for AMH was 1.57 ng/ml as an indicator of low ovarian reserve. Cisplatin causes total damage and increased numbers of AF on the ovary. Depending on this, AMH levels fall. These negative effects of cisplatin are not obstructed by CAPE or DHEA, and may even be increased by DHEA.

Lipid profile and plasma atherogenic index in postmenopausal osteoporosis.

OBJECTIVE: The goal of this study was to investigate the relationship between the lipid profile, plasma atherogenic index (PAI), and osteoporosis in postmenopausal women. METHODS: The data of age, duration of menopause, height, weight, lipid profile, bone mineral density (BMD) value, and history of oral contraceptive use of 407 postmenopausal women who had not been menstruating for at least 12 months, were between the ages 45 and 80, and presented at the obstetrics and gynecology polyclinic of Kartal Dr. Lutfi Kirdar Tr aining and Research Hospital were reviewed. The patients were divided into 2 groups according to the presence of osteoporosis, and the data compared. The level of significance was accepted as p<0.05. RESULTS: A total of 142 postmenopausal patients with osteoporosis were included in the study. The mean age was 61.7±6.9 years. In the control group, there were 263 postmenopausal women without osteoporosis, with a mean age of 58.3±4.5 years. There was no statistically significant difference with respect to triglyceride level; however, in the osteoporosis group, the level of total cholesterol and low-density lipoprotein (LDL) were lower, and the level of high-density lipoprotein (HDL) was higher (p=0.762, p=0.002, p=0.01, p<0.001, respectively). CONCLUSION: A high level of HDL, and low LDL and PAI values, which are important for the prevention of cardiovascular disease, were found to be negative factors for BMD.

WISP1 is a novel adipokine linked to metabolic parameters in gestational diabetes mellitus.

OBJECTIVE: To investigate Wnt1-inducible signaling pathway protein-1 (WISP1) levels and their correlation with metabolic parameters in pregnant women with gestational diabetes mellitus (GDM) and non-GDM healthy pregnant women. MATERIALS AND METHODS: In this prospective cross-sectional study, the study group was composed of 62 women with GDM and 73 healthy pregnant women matched for age, body mass index (BMI) and gestational age. Blood samples were collected at 25-29th gestational week. Serum WISP1, betatrophin, glucose, fasting insulin, glycosylated hemoglobin A1c, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, C reactive protein, alanine aminotransferase and creatinine levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) values was calculated. The level of significance was accepted as p < 0.05. RESULTS: Circulating WISP1 in the GDM group was significantly higher than the control group (p <0.001). Further, WISP1 was positively correlated with BMI, HOMA-IR values and fasting glucose, fasting insulin, triglyceride, betatrophin levels. BMI, HOMA-IR and betatrophin independently and positively predicted WISP1 levels. CONCLUSION: These results demonstrate a relationship between WISP1 and the metabolic parameters of GDM. And, WISP1 might be involved in the pathophysiology of GDM. As a part of this pathophysiological mechanism, the activation of WISP1 and betatrophin might take place through several ways; WISP1 and betatrophin might either use same signaling pathways and potentiate each other or they might also constitute the sequential steps of a common pathway.