Effect of empagliflozin use on monocyte high-density lipoprotein ratio and plasma atherogenic index in obese and non-obese type 2 diabetic patients.

OBJECTIVE: Diabetes mellitus (DM) is a metabolic disorder marked by hyperglycemia, caused by impaired insulin secretion and activity. Chronic inflammation holds a significant role in the development, progression, and complications of DM and obesity. There are publications reporting that the monocyte/ high-density lipoprotein (HDL)-C ratio (MHR) and plasma atherogenic index (PAI) could be used as indicators of systemic inflammation. In the present study, we aimed to explore the effect of empagliflozin, an inhibitor of sodium-glucose co-transporter 2 (SGLT2), on MHR and PAI in obese and non-obese type 2 diabetes mellitus (T2DM) patients. PATIENTS AND METHODS: A total of 125 patients who presented to the outpatient clinics of Tokat Gaziosmanpasa University Hospital between January 2019 and January 2023 with a diagnosis of T2DM and were started on 25 mg empagliflozin and used for a minimum of 24 weeks were included in the study. The patients' age varied between 18-75 years, were without chronic liver disease, chronic renal failure, infection, or inflammatory disease, and were not on drugs affecting bone marrow. The patients were categorized into two groups, obese and non-obese, according to their body mass index (BMI). The data obtained were statistically analyzed using the IBM SPSS Statistics 25 software package. RESULTS: The mean age of the patients was 57.5 ± 10.9 years. Of the patients, 59.2% (n = 74) were female, and 40.8% (n = 51) were male. The mean HbA1c percentage was 8.99 ± 2.18% prior to empagliflozin treatment and significantly decreased to 7.68 ± 1.80% after empagliflozin use (p < 0.05). The mean monocyte HDL-C ratio (MHR) pre- and post-empagliflozin treatment was 16.22 ± 6.31 and 13.77 ± 5.29, respectively, and these values significantly differed from each other (p < 0.05). The mean plasma atherogenic index (PAI) of the patients before empagliflozin treatment was 0.62 ± 0.28, whereas, after the treatment, it significantly reduced to 0.52 ± 0.27 (p < 0.05). While MHR and PAI statistically significantly decreased with the use of empagliflozin, there was no difference between the obese and non-obese patient groups in terms of MHR and PAI results. CONCLUSIONS: Studies in the literature show that the decrease in MHR and PAI leads to a decline in inflammation. MHR and PAI are inexpensive and practical markers to assess cardiovascular disease risk and inflammation in diabetic patients. This finding indicates that MHR and PAI can be used as inflammation markers in patients on empagliflozin treatment.

Erectile dysfunction in patients with psoriasis: potential impact of the metabolic syndrome.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease that affects up to 5.5% of world population and is associated with erectile dysfunction (ED). Aim of the present study was to investigate impact of metabolic syndrome (MetS) on association between psoriasis and ED as well as to improve our understanding of this association via studying other possible causes of ED such as psychological factors and disease effects. PATIENTS AND METHODS: The patient group included 37 male psoriasis patients and control group 28 healthy men. Severity of psoriasis was determined using Psoriasis Area and Severity Index (PASI), and ED was evaluated using International Index of Erectile Function (IIEF) Scale. Psychiatric state of the patients were determined using Beck Depression Inventory (BDI). MetS was diagnosed using the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: MetS, ED prevalence and BDI score were significantly higher in psoriasis patient group (p = 0.032, p = 0.018 and p < 0.001). Average IIEF score of psoriasis patients with and without MetS, on the other hand, was not different (p = 0.073). IIEF score had negative correlations with age, BDI and PASI scores. In multiple linear regression analysis, BDI score, old age and smoking (but not MetS) were found to be independent predictors of ED. CONCLUSIONS: ED, MetS and depression frequencies were significantly higher in psoriasis patient group. In addition, psoriasis severity and ED parameters were closely associated. Depression, old age and smoking were found to be independent risk factors for ED.

The impact of pretransplant hypoalbuminemia on survival in patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT): a nutritional problem?

OBJECTIVE: Serum albumin level is considered to be a marker reflecting the nutritional status in both healthy subjects and patients with malignancies. In this study we sought to investigate the association between pretransplantation serum albumin levels and prognosis among patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT). METHODS: We retrospectively analyzed the data of 102 patients who underwent alloHSCT from 2004 to 2010. Pretransplant serum albumin, D-dimer, creatinine, and fibrinogen levels drawn within 10 days before transplantation were obtained from patient files. All parameters were divided into 2 groups: normal levels (group 1) versus abnormal levels (group 2). Our normal range of serum albumin is 3.2-5.2 g/dL; patients with pretransplantation albumin level ≥3.2 g/dL were included in group 1 versus group 2 with <3.2 g/dL. RESULTS: The patients included 42 (41.1%) female and 60 (58.9%) male patients. The diagnoses were acute myeloblastic leukemia in 65 (63.7%) and acute lymphoblastic leukemia in 37 (36.3%). The median age was 26.0 years (range, 13-57). Univariate and multivariate analysis showed that patients with serum albumin levels <3.2 g/dL experienced significantly lower overall survival (OS) compared with ≥3.2 g/dL (hazard ratio [HR] 2.32 [range, 1.23-4.54] and HR 2.70 [range 1.38-5.26], respectively; P = .009). The median (range) OS in group 2 was 230.0 (184.0-544.0) days versus 570.5 (249.5-1,101.0) days in group 1 (P = .007). For disease free survival (DFS) evaluation, univariate and multivariate analysis showed that patients with serum albumin levels <3.2 g/dL had significantly lower values compared with patients with serum albumin ≥3.2 g/dL. (HR 2.17 [range 0.98-4.76] and HR 2.85 [range, 1.25-6.66], respectively; P = .046). The median (range) DFS in group 2 was 184.0 (61.0-524.0) days versus 445.0 (199.0-917.5) days in group 1 (P = .045). Among the patient characteristics the presence of infection was a significant independent variable for worse OS (HR 2.12 [range, 0.98-4.36], P = .036). The other parameters-age, sex, donor status, time to transplant interval, conditioning regimens, HLA status, and number of total infused CD34(+) cells-showed no significant effect on OS and DFS (P = .05). CONCLUSIONS: Pretransplantation decreased serum albumin levels were associated with poor survival in patients with leukemia who underwent alloHSCT.