Comparison of the Impact of SGLT2-Inhibitors and Exenatide on Body Fat Composition.

OBJECTIVE: To investigate the effect of SGLT2-i and GLP-1RA as an add-on therapy to metformin on weight loss and body composition, and to compare their effects on glucose and lipid parameters. STUDY DESIGN: A descriptive study. Place and Duration of the Study: Goztepe Prof Dr Suleyman Yalcin City Hospital, from January 2016 to May 2021. METHODOLOGY:  The study included 50 patients with diabetes on metformin+SGLT2-i (dapagliflozin or empagliflozin, group 1) and 50 patients with diabetes on metformin+GLP-1 receptor agonist (RA, exenatide, group 2). RESULTS: The reduction in weight, BMI, total body, abdominal, leg, and arm fat percentage, and the improvement in body fat-free and muscle mass percentage were significantly higher in Group 2 (p<0.001, p<0.001, p=0.014; p=0.031, p<0.001; p=0.002 and p=0.014, p=0.014, respectively). The decline in abdominal fat mass in the GLP-1 RA group was also significant (p=0.031). There was a significant decrease in HbA1c, fasting glucose, and triglyceride levels (p<0.001, p<0.001, and p=0.036) with a significant increase in HDL-C (p=0.015). There was no significant difference between groups for glucose, HbA1c, and lipid parameters (p>0.05). CONCLUSION: Both SGLT2 inhibitors and exenatide, when added to metformin therapy, were effective in reducing weight and body fat, more by the GLP-agonist. SGLT2-i had no significant impact on decreasing abdominal fat depicting that these agents do not have any benefit in treating visceral adiposity. KEY WORDS: Type 2 diabetes mellitus, Obesity, GLP-1 receptor, SGLT2 inhibitor, Body fat distribution, Visceral adiposity.

Visceral Adiposity Index As a Practical Tool in Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis.

Aim: Our study aimed to examine the relationship of the visceral adiposity index (VAI) with clinical and histological parameters in biopsy-proven nonalcoholic fatty liver disease (NAFLD) cases and evaluate its place in clinical practice. Materials and Methods: The study included 57 biopsy-proven NAFLD cases and 57 healthy controls. The VAI values of the cases were calculated with the formula based on body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol levels. The relationships between VAI values and clinical and histological parameters were examined. Results: While the VAI was significantly higher in the NAFLD cases in comparison to the control group (3.5 ± 3.09 vs. 1.60 ± 0.98, respectively, P < 0.001), this difference was more noticeable in the nonalcoholic steatohepatitis (NASH) group (3.60 ± 3.35) (P < 0.001). In distinguishing the NAFLD group and the healthy group in VAI, it was determined that VAI had a sensitivity of 72%, specificity of 68%, and an area under the receiver operating characteristic curve value of 76.9%. No significant relationship was found between the histological parameters and VAI scores. Conclusions: Our study showed that VAI was increased in the NAFLD cases. This increase was observed to be more noticeable in especially the NASH cases. It is possible for this index to be a practical modality that could be used in clinical practice in prediction of especially NASH cases, which constitute the progressive form of the disease, but in this sense, there is a need for further studies.

Comparison of dermatologists and family physicians in terms of prescribing antibiotics for the treatment of acne vulgaris.

Acne vulgaris (AV) is a common skin disease that is treated both with dermatologists and family physicians (FPs) with different strategies. To assess the antibiotics that are frequently preferred in AV treatment, and the differences between the FPs and dermatologists in treatment were investigated. The physicians were informed about the study, and sent over the internet a multiple-choice questionnaire that consists of 29 questions in total. Afterwards, the answers provided were compared. 201 dermatologists and 147 FPs participated in the study. Dermatologists were found to have preferred topical erythromycin, nadifloxacin, clindamycin, and tetracycline, and systematically doxycycline and azithromycin in adult patients, whereas the FPs were found to have preferred mupirocin, fusidic acid (FA), and oxytetracycline, and systematically tetracycline. Dermatologists were found to have recommended topical clindamycin and erythromycin in pregnant/breastfeeding AV patients, whereas the FPs were found to have recommended FA. Dermatologists were found to have continued the antibiotics for 8 to 12 weeks, whereas the FPs were found to have continued for 1 to 4 weeks. The dermatologists preferred systemic antibiotics in cases with back involvement, moderate to severe AV, and that the FPs preferred them in severe AV. The dermatologists considered that the use of antibiotics alone or long-term were important factors causing antibiotic resistance. There were significant differences between the approaches of dermatologists and FPs to AV treatment. FPs were found to have insufficient information about prevention of antibiotic resistance. Therefore, we think that the continuous training of FPs on dermatology will be beneficial.

The Validity and Reliability of the Turkish Version of Jefferson Scale of Physician Lifelong Learning for Medical Students.

OBJECTIVE: Lifelong Learning is a voluntary and self-motivated form of learning that lasts from birth to death for personal and professional reasons. As medical science has a dynamic nature, the knowledge gained in the faculty of medicine mostly will not be enough in the later professional life. The aim of this study is to determine the validity and reliability of the JeffSPLL-MS© in Turkish. METHOD: Linguistic equivalence analysis was applied first, and confirmatory factor analysis (CFA) was utilized in order to test the construct validity. Concurrent validity was tested by simultaneous administration of Lifelong Learning Trends Scale (LLTS) and JeffSPLL-MS©. Finally, internal consistency and test-retest reliability of the scores gathered from the scales in the study were calculated. RESULTS: Linguistic equivalence study supplied that there is a strong relationship (r=.873, p=.001) between Turkish and English forms of the scale. For CFA, Kaiser Meyer Olkin (KMO) value was .863 and the results of Bartlett Sphericity Test were appropriate (X2 = 1173,6; p=.001, df=91); model-data fit indices for JeffSPLL-MS© with 14 items in three factors were also satisfactory ((X2/df =1,51); RMSEA=0,046; NFI=0,918; RFI=0,902; CFI=0,971) and factor loadings of items were ranging between.522 and.764. The Pearson correlation coefficient as the indicator of concurrent validity of the scales LLTS and JeffSPLL-MS© was calculated as .624 (p=.001). The internal consistency (Cronbach alpha) of the total scores gathered from JeffSPLL-MS© is .843 and stratified alpha coefficient is .892. Cronbach alpha values for the subscales are as follows: .830 (F1=Learning beliefs and motivation), .719 (F2=Skills in seeking information), .721 (F3=Attention to learning opportunities). The test-retest reliability values for the scale, and its subscales were ranged between.709 and.812 within a four-week period. CONCLUSION: It is concluded that JeffSPLL-MS© can be used as a valid and reliable measurement instrument for medical education studies in Turkey.

A comparison of metacognitive factors among patients with cancer and the control group.

OBJECTIVE: Research examining the relationship between metacognitions and cancer has only recently begun to emerge. This study attempted to compare the metacognitions of the patients with and without cancer. The effects of stage of cancer, type of cancer, and treatment modality (chemotherapy, radiotherapy, operation) on metacognitions were investigated. Patients with cancer were hypothesized to have higher levels of negative metacognitions. METHODS: Participants were patients with cancer (N = 279) and patients without cancer (control group, N = 212). The Metacognition Questionnaire-30 was administered to all participants. Results were analyzed according to demographic and histopathological characteristics of the patients. RESULTS: The results showed that patients with different cancer diagnoses scored higher than the controls on all subscales of the MCQ-30. Those who received chemotherapy scored the highest on the MCQ-30. The patients who were in early stages of cancer had higher levels of negative metacognitions. Patients who did not have operation but had chemotherapy had the highest levels of negative metacognitions. Patients who were in locally advanced stage, did not have operation but had received or was receiving chemotherapy had the highest levels of negative metacognitions. CONCLUSIONS: Patients who were in early stages of cancer appeared to be in greater need for psychological help and access to services. Findings indicated a need for psychological support for patients who undergo chemotherapy.