COVID-19 and the flu: data simulations and computational modelling to guide public health strategies.

BACKGROUND: Pandemics threaten lives and economies. This article addresses the global threat of the anticipated overlap of COVID-19 with seasonal-influenza. OBJECTIVES: Scientific evidence based on simulation methodology is presented to reveal the impact of a dual outbreak, with scenarios intended for propagation analysis. This article aims at researchers, clinicians of family medicine, general practice and policy-makers worldwide. The implications for the clinical practice of primary health care are discussed. Current research is an effort to explore new directions in epidemiology and health services delivery. METHODS: Projections consisted of machine learning, dynamic modelling algorithms and whole simulations. Input data consisted of global indicators of infectious diseases. Four simulations were run for '20% versus 60% flu-vaccinated populations' and '10 versus 20 personal contacts'. Outputs consisted of numerical values and mathematical graphs. Outputs consisted of numbers for 'never infected', 'vaccinated', 'infected/recovered', 'symptomatic/asymptomatic' and 'deceased' individuals. Peaks, percentages, R0, durations are reported. RESULTS: The best-case scenario was one with a higher flu-vaccination rate and fewer contacts. The reverse generated the worst outcomes, likely to disrupt the provision of vital community services. Both measures were proven effective; however, results demonstrated that 'increasing flu-vaccination rates' is a more powerful strategy than 'limiting social contacts'. CONCLUSIONS: Results support two affordable preventive measures: (i) to globally increase influenza-vaccination rates, (ii) to limit the number of personal contacts during outbreaks. The authors endorse changing practices and research incentives towards multidisciplinary collaborations. The urgency of the situation is a call for international health policy to promote interdisciplinary modern technologies in public health engineering.

New Anthropometric Measurements: Relationship to Thyroid Functions in Euthyroid Obese Subjects.

Introduction Body mass index (BMI) is unable to make a distinction between muscle mass and fat mass. Therefore, new anthropometric measurements, such as a body shape index (ABSI), body round index (BRI), and body adiposity index (BAI), have been formulated in recent years. Many studies have reported a correlation between BMI and thyroid function. In this study, we aimed to investigate the relationship between the above-mentioned new anthropometric measurements and thyroid functions in euthyroid obese subjects. Methods We included 675 euthyroid (TSH ≥ 0.4 and < 4.5 mIU/l) individuals from the obesity outpatient clinic, aged between 18 and 65 years old, with BMI ≥ 30. Thyroid-stimulating hormone (TSH), free T4 (fT4) and free T3 (fT3), anthropometric measurements (weight, height, and waist circumference), and bioelectric impedance analyses [percent body fat (PBF) and fat-free mass (FFM)] of individuals were measured and recorded. ABSI, BRI, and BAI were calculated with the data from these measurements. Anthropometric measurements were compared to thyroid function tests. Results Eighty percent of the subjects were female. The mean age and BMI were 38 ± 17 years and 38 ± 6 kg/m2, respectively. TSH was found to be negatively correlated with ABSI (p = 0.006) and positively correlated with BAI (p < 0.001), but a statistically significant relationship with BRI (p = 0.193) was not determined. Free T4 was not associated with any of the anthropometric measurements.While fT3 was determined to be positively correlated with ABSI (p = 0.008) and negatively correlated with PBF and BAI (p = 0.001, p = 0.002, respectively), no statistically significant relationship with fT3 and BRI was determined. Conclusion TSH is positively correlated with measurements of adiposity such as BMI, PBF, BAI while indexes in which abdominal obesity increases, such as waist circumference (WC), waist-hip ratio (WHR), and ABSI, are correlated with fT3 levels.

Evaluation of muscle mass in obesity, prediabetes and diabetes mellitus by different equations used for the measurement of muscle mass.

OBJECTIVE: Insulin resistance is one of risk factors for sarcopenia and there is no specific equation for the measurement of muscle mass. The present study aimed to evaluate muscle mass in the patients with obesity, prediabetes (PDM) and type 2 diabetes mellitus (DM) by different equations for the measurement of muscle mass. METHODS: Obese patients aged 18-65 years old, who presented between 2013 and 2015 were reviewed and they were separated into three groups as obese, prediabetes (PDM) and diabetes mellitus (DM). Height, body weight, body mass index (BMI), sum of the appendicular lean masses (ALM) were measured in all participants. Body muscle mass ratio was calculated as the total muscle mass divided by the body weight, and skeletal muscle index was calculated as the total muscle mass divided by the square of the height. In addition, ALM/weight, ALM/height2 and ALM/BMI ratios were also evaluated. RESULTS: A total of 1107 participants, of whom 666 (60.2%) were female, were enrolled into the study. Of the participants, 288 (%26.02) had obesity, 524 (%47.33) had PDM and 295 (26.65%) had DM. There was a significant difference in ALM/BMI ratio between the three groups for both genders (p = 0.003 for female and p = 0.003 for male). ALM/weight ratio and body muscle mass ratio were decreased between groups in female, whereas it was no difference in male (p = 0.003, p < 0.001 for females, respectively; p = 0.802, p = 0.840 for males, respectively). CONCLUSIONS: ALM/BMI may be more accurate for the evaluation of muscle mass in middle-aged obese, PDM and DM subjects.

Relationship between irritable bowel syndrome and plasma and tissue ghrelin levels.

BACKGROUND/AIMS: This study aimed to evaluate the relationship between irritable bowel syndrome (IBS) and plasma and tissue ghrelin levels. MATERIALS AND METHODS: Patients who had undergone gastroscopy procedure for any reason previously were enrolled in the study. Among these, patients with IBS symptoms were evaluated according to the Roma III criteria. The healthy control group comprised patients with no IBS symptom and had undergone gastroscopy procedure for another reason. The plasma ghrelin level and tissue ghrelin level obtained by immunohistochemical examination of biopsy specimens taken from the gastric antrum and corpus were evaluated in all participants. RESULTS: The mean age of 90 participants was 43.64}12.64 years. The median value of the plasma ghrelin level was 3.29 (1.2-12.7) in the diarrhea group (IBS-D), 1.49 (0.82-7.08) in the constipation group (IBS-C), and 1.5 (0.2-3.7) in the control group. The plasma ghrelin levels between the groups were found to be significantly higher in IBS-D than in IBS-C and the control groups (p=0.001 and p=0.001, respectively). On comparing antral mucosal gland biopsy outcomes among the groups, staining intensity score was found to be significantly high in IBS-C as compared with the control group, whereas no significant difference was observed between IBS-D and the control groups (p=0.020 and p=0.429, respectively). CONCLUSION: The plasma ghrelin level in IBS-D and the staining intensity in the antral mucosal gland in IBS-C were found to be significantly higher. In addition, there was no difference between the groups in terms of ghrelin staining intensity in the gastric corpus.

Determining depression level of caregivers providing home healthcare services.

OBJECTIVE: Due to increase in elderly population as result of longer life expectancy and the incidence of chronic disease, greater importance should be given to elderly care and the needs of primary caregivers. The purpose of this study was to determine depression status of caregivers who were providing in-home healthcare services. METHODS: This study was conducted with caregivers for 63 home-dependent patients who benefited from the services provided by Kartal Dr. Lutfi Kirdar Training and Research Hospital Family Practice Clinic between May 15, 2013 and July 1, 2013 using a socio-demographic variables questionnaire and the Beck Depression Inventory. Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney U test, Student's-t test and chi-square test. RESULTS: Of the total, 87.3% of survey participants were women. Average age was 52.47 years; 73% were married, 17.5% were single, and 9.5% were widows. Monthly income of 50.8% of participants was between TL 1000 and 3000. Of all the patients, 77.8% were totally, and 22.2% were semi-dependent. Depression was detected in 61.1% of patient relatives who were responsible for patient healthcare and in 22.2% of paid professional caregivers (p=0.052). Depression was detected at rate of 37% in caregivers who had been providing nursing care for less than 1 year, 63% for those who had been caregivers for 1 to 5 years, and for those providing care for more than 5 years, rate was 63 %. Rate of depression in study participants overall was 55.6%. CONCLUSION: Duration of providing care, dependency level of patient, and level of intimacy affect caregivers. They need psychological support.