Serum α-Klotho and fibroblast growth factor 23 levels are not associated with non-proliferative diabetic retinopathy in type 1 diabetes mellitus.

Diabetic retinopathy is a commonly observed cause of blindness and is a common problem in individuals with diabetes. Recent investigations have showed the capability of serum α-Klotho and FGF 23 in mitigating the effects of diabetic retinopathy. This study aimed to discover the correlation between FGF 23, α-Klotho, and diabetic retinopathy in type 1 diabetics. This case-control study included 63 diabetic patients and 66 healthy controls. Following an overnight duration of fasting, morning blood samples were taken from both the patient and the control groups. The serum concentrations of α-Klotho and FGF 23 were quantified. An experienced ophthalmologist inspected the retinopathy. All participants in this study have moderate non-proliferative retinopathy. A p value under 0.05 was considered statistically significant. The mean α-Klotho level for retinopathic diabetic patients was 501.7 ± 172.2 pg/mL and 579.6 ± 312.1 pg/mL for non-retinopathic diabetic patients. In comparison, α-Klotho level of the control group was 523.2 ± 265.4 pg/mL (p = 0.531). The mean of FGF 23 level did not demonstrate a significant difference (p = 0.259). The mean FGF 23 level were 75.7 ± 14.0 pg/mL, 74.0 ± 14.8 pg/mL and 79.3 ± 14.4 pg/mL in groups, respectively. In conclusion, there was no significant difference in FGF 23 and α-Klotho levels between type 1 diabetics with and without retinopathy when compared to the control group.

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.

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.

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.

Psychiatric symptom rate of patients with Diabetes Mellitus: A case control study.

AIMS: The aim of the study is comparing the psychiatric symptom in Type1 DM, Type 2 DM and controls. METHODS: The study was designed as case control study and conducted between September 2011 and April 2012 to the Diabetes Clinic. Age, gender and education level matched 70 type 1 diabetics, 68 type 2 diabetics and 70 controls included to the study. SCL-90-R [Symptom Check List-90 (Revised)] test is used for determining the psychiatric symptom rates. RESULTS: It was found that the rate of somatization, interpersonal sensitivity, anger-hostility and additional scales were significantly different in type 1, type 2 diabetics and controls ((p = 0.023, p = 0.008, p = 0.018 and p = 0.039, respectively). Compared to control group, being a patient with type 1 or type 2 Diabetes found as a risk factor for somatization, depression, anger-hostility and additional scales. Moreover being a patient with type 1 DM was found as a risk factor for having OBS symptoms (p = 0.039) and type 1 DM was protective against having interpersonal sensitivity symptoms (p = 0.006). CONCLUSION: In diabetic patient groups, an increase in the rate of psychiatric symptoms was observed. Therefore a careful psychiatric examination is required in DM.

Vitamin D status of Turkish type 1 diabetic patients.

INTRODUCTION: Vitamin D was associated with the pathogenesis, treatment and prognosis of type 1 and type 2 diabetes mellitus. The aim of this study is to assess vitamin D status of Turkish adult type 1 DM patients and compare them with health controls and also to assess the relationship of vitamin D and glycemic control. METHOD: Study was designed as cross-sectional and conducted in a tertiary Hospital diabetes unit. 296 type diabetic patients and 151 healthy controls was included to the study. Venous samples were collected into plain tubes after overnight fasting. Serum 25-hydroxyvitamin D level was measured by radioimmunoassay technique. Statistical analysis was performed with SPSS 15.0. RESULTS: 25-Hydroxyvitamin D levels were similar between patients with type 1 diabetes (22, 9 ±â€¯17, 4 ng/ml) and controls (24, 5 ±â€¯19, 3 ng/ml) (p = 0,382). Most of the participants have 25-Hydroxyvitamin D deficiency. As shown in Table 2 serum 25-Hydroxyvitamin D level was not associated with most of the biochemical or anthropometric parameters. CONCLUSION: As a result there were no difference between type 1 diabetics and healthy controls according to their vitamin D levels. Further studies with a larger sample of patients will improve our understanding of the relation of vitamin D and diabetes.

The Frequency and Content of Prenatal Care Determine Birth Place: A Community Based Case-Control Study.

BACKGROUND: High-quality prenatal care services could decrease maternal-neonatal mortality and morbidities. The aim of this study was to compare institutional and unplanned home deliveries with regard to the use and content of prenatal care services. METHODS: The study was conducted in 2011 with two hundred and twenty-nine mothers with unplanned deliveries at home as study group and 458 mothers having institutional deliveries as controls living in Istanbul. The content of prenatal care was evaluated in accordance with the national ministry of health prenatal care management guidelines and the data was collected by a questionnaire with face to face interview. RESULTS: Women with unplanned deliveries at home use prenatal care services less frequently. Percentage of mothers that had home deliveries and did not use prenatal care services was 16.2% while this was only 3.4% in women having institutional deliveries (P=0.001). Moreover, all parameters of prenatal care were poor in content compared to women with institutional deliveries. CONCLUSION: Adequate prenatal care services in terms of quantity and quality can promote institutional deliveries.

Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers.

BACKGROUND: In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients. METHODS: In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1 month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10 IU/mL were identified as non-responders and with anti-HBs ≥ 10 IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%). RESULTS: Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5 g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability. CONCLUSION: We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.

Relation of Muscle Indices with Metabolic Parameters and C-Peptide in Type 2 Diabetes Mellitus.

OBJECTIVE: To assess the relation between bioimpedance measurements and metabolic parameters and C-peptide in patient with type 2 diabetes mellitus (DM). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Kartal Dr Lutfi Kirdar Training and Research Hospital, Pendik Kaynarca Diabetes Center, Exercise and Metabolism Unit, between January and March 2015. METHODOLOGY: Patients with DM, aged less than 65 years, were assessed for bioimpedance analysis, fasting plasma glucose (FPG), HbA1c, C-peptide levels, triglyceride levels, LDL-cholesterol, and HDL-cholesterol levels. Skeletal muscle index, total muscle index, skeletal muscle percentage, and total muscle percentage were used for muscle-related analyses. Mann-Whitney U-test or independent t-test were used to compare differences between two independent groups. Pearson correlation test or Spearman correlation test were used to find out correlation between variables. RESULTS: Atotal of 359 DM patients were enrolled in the study. Mean age was 51.6 ±8.0 years, and 278 (77.7%) of the participants were females. After adjusting age and gender variables, there was no relation between muscle-related measurements and FPG, triglyceride, LDL-cholesterol (p>0.05). However, there was muscle-related indexes (MRI) positively correlation with C-peptide and inversely associated with HDL-cholesterol (p<0.05). CONCLUSION: Muscle-related indices positively correlated with C-peptide, which showed endogenous insulin reserve.

Effect of socio-cultural factors on spontaneous abortion in Burdur, Turkey: A population based case-control study.

OBJECTIVE: To determine the sociocultural factors that have effect on spontaneous abortion in Burdur, Turkey. METHODS: Study was designed as case-control study. The case group consist of 257 women whose pregnancies ended with spontaneous abortion. The control group consisted of 514 women whose pregnancy continued since 22 weeks and more during the study. Chi-square, and backward LR logistic regression were utilized in analyses. RESULTS: In multifactorial-analyses it was determined that four factors (educational status of women, employment status of women, exposure to physical violence and non-receipt of ANC) created independent risk on spontaneous abortions. CONCLUSIONS: Pregnant women with these risk factors should be followed up more frequently and in a more qualified way in primary and secondary and tertiary health institutions.

Effect of Social Factors on Cesarean Birth in Primiparous Women: A Cross Sectional Study (Social Factors and Cesarean Birth).

BACKGROUND: P Cesarean delivery rates have been increasing throughout the world. Parallel to the developments in the world the cesarean rate in Turkey has risen to 48.1% in 2013. Some of the social factors were related with cesarean births. The purpose of this study was to determine cesarean birth rates and to find out social factors affecting the cesarean birth in primiparous women. METHODS: This study was conducted in Burdur Province, Turkey between the dates of 1 Jan 2012-31 Dec 2012 on 223 primiparous women. The data was collected with data collection form prepared by the researchers by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. RESULTS: In multivariate analyses, the place of delivery (OR: 11.2 [2.9-42.46] in private hospital and OR: 6.1 [2.6-14.1] in university hospital); time of the birth (OR: 7.1 [3.1-16.0]); doctor's effect (OR: 4.0 [1.8-8.95]) and husband's employment status (OR: 2.23 [1.0-4.7]) have been identified as factors affecting the caesarean delivery in primiparous women. CONCLUSION: Although the results do not show all of the factors affecting the caesarean delivery in primiparous women, they reveal that medical reasons are not the only reason in this increase trend. Health policy makers and health professionals are required to identify the causes of this increase and to take measures.

Single Gallstone Associated with High Fasting Insulin Level.

Gallstone (GS) formation is a multifactorial process and one of the associated factors is hyperinsulinemia. The aim of this cross-sectional study was to determine the association between size and count of gallstones, and insulin levels and resistance. The study group composed of 84 patients who have ultrasonographically confirmed gallstone(s). Insulin level of all participants were measured and insulin resistance was calculated with the homeostasis model assessment of insulin resistance (HOMA-IR) index. All p-values &lt; 0.05 were considered statistically significant. There were 28 patients with single stone and 56 with multiple stones. Mean insulin level was 12.54 &plusmn;11.66 ml/U (median 9.91 ml/U, IQR 6.33) and 56.3% of patients had insulin resistance. Mean stone size was 7.82 &plusmn;7.52 mm (median 6 mm and IQR 11.75). There was a non-significant association and correlation between insulin level and size of GS (p=0.129; r =0.16). There was significant difference between single stone group and multiple stones group, according to the insulin level.

Frequency of ABO/Rhesus Blood Groups in Patients with Diabetes Mellitus.

The correlation between ABO/Rh blood groups and diabetes mellitus is still controversial. The aim of this study was to determine the relationship between ABO/Rhesus blood groups and diabetes in Turkish population. This cross-sectional study was conducted in Istanbul Medeniyet University Göztepe Education and Training Hospital's Diabetes Units. The study group was composed of 421 patients with type-1 diabetes, 484 patients with type-2 diabetes and 432 controls. Blood samples were collected and tested for ABO/Rhesus blood groups. Data was analyzed by SPSS version 17.0. A significant association was found between blood groups and diabetes mellitus. The frequency of AB blood group was significantly higher in type-1 diabetics; and A blood group was significantly higher in type-2 diabetics. Furthermore, Rh negativity were significantly more frequent in type-2 diabetics.

Health-related quality of life assessed by LupusQoL questionnaire and SF-36 in Turkish patients with systemic lupus erythematosus.

The LupusQoL is a disease-specific health-related quality of life (HRQoL) measure for patients with lupus. We conducted this study to compare the efficiency of LupusQoL-TR (validated Turkish version of the LupusQoL questionnaire) with the 36-item Short-Form Health Survey (SF-36), a generic quality of life (QoL) scale, in Turkish patients with lupus. Both questionnaires were conducted at a single visit to the clinic. Disease activity was measured with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Associations between the LupusQoL-TR and SF-36 domains were examined while also examining age, disease duration, and disease activity for each questionnaire. Descriptive statistics, Spearman's correlation coefficients, and Students t test were performed to analyze the data. A total of 113 consecutive patients with lupus (F/M 108:5, mean age 40.6 ± 11.9 years, mean disease duration 8.5 ± 7.0 years) were included, and 69 % of these were active. The median SLEDAI score was 2 (0-24), the mean global LupusQoL-TR score was 60.9 ± 23.3, and the mean SF-36 score was 41.2 ± 9.0. There was a significant correlation between LupusQoL-TR and SF-36 mean scores (r = 0.83; p < 0.001). QoL assessed by LupusQoL-TR and SF-36 did not correlate with disease activity (r = -0.11; p = 0.244 and r = -0.03; p = 0.721, respectively). LupusQoL-TR and SF-36 questionnaires were beneficial instruments in evaluating HRQoL in Turkish lupus patients. However, LupusQoL-TR and SF-36 were not associated with SLEDAI scores, which suggested that QoL might be affected by other factors besides disease activity, especially in clinically inactive or mildly active patients.

Prevalence of celiac disease in adult type 1 patients with diabetes.

OBJECTIVES: Celiac disease, an autoimmune disease, is related to immune mediated intolerance to gluten. Some studies suggest that Celiac Disease was 20 times more frequent in type 1 patients with diabetes. The objective of our study was to evaluate the prevalence of celiac disease in hospital based type 1 diabetic adults. METHODS: Our study was carried out retrospectively in Medeniyet University Goztepe Training and Educational Hospital in Istanbul between 2012-2013. The cohort comprised 482 type 1 patients with diabetes attending the diabetes outpatient clinic. The data were analyzed by SPSS 10.5 package program. Student's t tests is used for comparative analyses. A p-value less than 0.05 was considered statistically significant. RESULTS: The cohort included 482 type 1 patients with diabetes. Fifty seven of them were not evaluated for Endomysium antibody positivity. Fifteen of the remaining 425 patients were positive for anti endomysial antibody (3.5%). The prevalence of biopsy proven celiac disease was 2.3% (10/425). There was no significant difference between Endomysial antibody positive and negative groups in regard of age, sex, or duration of the disease. CONCLUSION: This study confirms that the celiac disease is common in type 1 diabetic patients. Since a small proportion of celiac patients are symptomatic this disorder should be screened in all adult type 1 patients with diabetes by antiendomysium antibody.

Sociocultural Factors Affecting Unplanned Deliveries at Home: A Community-Based Case Control Study.

Unplanned home deliveries can vary with social and cultural factors. The aim of this study was to define the risk factors of unplanned home births. This case control study was conducted in Istanbul, Turkey. The study group was composed of 229 women who had unplanned home delivery. Six factors (presence of health insurance, duration of living in Istanbul, educational status of the woman, the number of individuals living in the household, the age of the woman at the time of current delivery, and the status of having received care prior to delivery) were determined as independent risk factors for unplanned deliveries at home.

Anxiety and depression predict quality of life in Turkish patients with systemic lupus erythematosus.

OBJECTIVES: The aim of our study was to evaluate quality of life (QoL) in patients with systemic lupus erythematosus (SLE) and assess the impact of disease activity and psychological distress on health-related quality of life (HRQoL) in Turkey. METHODS: The Medical Outcomes Study Short Form (SF) -36 was used in a cohort of 113 consecutive patients with SLE and 123 age- and gender-matched healthy subjects to measure HRQoL. Patients' disease activity was assessed with SLE disease activity index (SLEDAI) and psychological distress was evaluated by the Hospital Anxiety and Depression Scale (HADS) for all participants. Patients' demographic and clinical data were recorded at the time of HRQoL and HADS testing. Multiple logistic regression analysis was performed to explore the relationships between demographics, disease duration, disease activity as well as psychological (anxiety and depression) variables and the HRQoL. RESULTS: SLE patients have lower quality of life than healthy controls. No relationship between HRQoL and SLE activity or disease duration were observed. Patients with anxiety and/or depression reported worse SF-36 scores than those without psychological distress. The results of multivariate analysis suggested that HADS-A, HADS-D scores and working status were associated with the impairment of HRQoL. CONCLUSIONS: HRQoL is impaired in patients with SLE and is associated with mood disorders. Physicians should pay close attention to detect anxiety and depression and manage them in order to improve the quality of life in patients with SLE.