The role of trimethylamine-N-oxide level in the diagnosis of diabetic retinopathy and the differential diagnosis of diabetic and nondiabetic retinopathy / Papel do nível de N-óxido de trimetilamina no diagnóstico da retinopatia diabética e no diagnóstico diferencial da retinopatia diabética e não-diabética

ABSTRACT Purpose: Trimethylamine N-oxide serum levels have been associated with type 2 diabetes mellitus and its complications. The current study aimed to find out if plasma trimethylamine N-oxide level may be a novel marker in the diagnosis of diabetic retinopathy and if it can be used in the differential diagnosis of diabetic and nondiabetic retinopathy. Methods: The study included 30 patients with diabetic retinopathy, 30 patients with nondiabetic retinopathy, 30 patients with type 2 diabetes mellitus without retinopathy, and 30 healthy control participants. Biochemical parameters, serum IL-6, TNF-α, and trimethylamine N-oxide levels were measured in all participants. Results: Trimethylamine N-oxide level was significantly higher in diabetic retinopathy than in the other groups (p<0.001). There was no significant difference in trimethylamine N-oxide levels between nondiabetic retinopathy and control or type 2 diabetes mellitus Groups. There was a significant positive correlation between trimethylamine N-oxide level and elevated FPG, BMI, HOMA-IR score, BUN, IL-6, and TNF-α levels. Conclusion: The current study showed that the trimethylamine N-oxide level is elevated in diabetic retinopathy. These findings suggest that serum trimethylamine N-oxide level might be a novel marker for diabetic retinopathy, and it might be used in the differential diagnosis of diabetic and nondiabetic retinopathy.

RESUMO Objetivo: Os níveis séricos de N-óxido de trimetilamina têm sido associados ao diabetes mellitus tipo 2 e suas complicações. O presente estudo tem como objetivo responder a duas questões, entre elas: O nível plasmático de N-óxido de trimetilamina poderia ser um novo marcador no diagnóstico de retinopatia diabética? e Ele poderia ser utilizado no diagnóstico diferencial de retinopatia diabética e não diabética? Métodos: Trinta pacientes com retinopatia diabética, 30 pacientes com retinopatia não diabética, 30 pacientes com diabetes mellitus tipo 2 sem retinopatia e 30 participantes saudáveis do grupo controle foram incluídos no estudo. Parâmetros bioquímicos, níveis séricos de IL-6, de TNF-α e de N-óxido de trimetilamina foram medidos em todos os participantes. Resultados: O nível de N-óxido de trimetilamina foi significativamente maior na retinopatia diabética do que nos outros grupos (p<0,001). Não houve diferença significativa no nível de N-óxido de trimetilamina entre o grupo de retinopatia não diabética, do grupo controle ou do grupo de diabetes mellitus tipo 2. Houve uma correlação positiva significativa entre o nível de N-óxido de trimetilamina e os níveis elevados de FPG, IMC, HOMA-IR, BUN, IL-6 e TNF-α. Conclusão: O estudo atual mostrou que o nível de N-óxido de trimetilamina encontra-se elevado na retinopatia diabética. Esses achados sugerem que o nível sérico de N-óxido de trimetilamina pode ser um novo marcador na retinopatia diabética, podendo ser usado no diagnóstico diferencial de retinopatia diabética e não diabética.

Effect of Biopsychosocial Factors on Glycemic Control in Type 2 Diabetes Mellitus.

OBJECTIVE: To investigate the effect of diabetic patients' biopsychosocial factors on type 2 diabetes mellitus (T2DM) outcomes to contribute to diabetes mellitus management. STUDY DESIGN: Cross-sectional descriptive study. Place and Duration of the Study: Department of Family Medicine, School of Medicine, Firat University, Turkey, from October 2021 to March 2022. METHODOLOGY: A total of 210 type 2 diabetic patients were included. The sociodemographic form, Beck depression inventory (BDI), multidimensional perceived social support scale (MSPSS), general self-efficacy scale (GES), and Diabetes self-care activities scale (DSCA) were used to assess the biopsychosocial factors. Controlled diabetes and uncontrolled diabetes classification was made according to HbA1c level (HbA1c cut-off value: ≤7%). RESULTS: The median duration of T2DM (p=0.001), total cholesterol level (p=0.004) and fasting plasma glucose (p<0.001) were found to be higher in the uncontrolled diabetes group than in the controlled diabetes group. Spearman correlation test results showed a significant negative relationship between the scores of Beck depression and total cholesterol (r= -0.157, p = 0.023). There is a significant positive correlation between social support and total cholesterol (r=0.343, p<0.001), LDL (r=0.149, p= 0.031), triglyceride (r=0.165, p = 0.017), DSCA general diet score (r=0.367, p<0.001), DSCA physical activities (r=0.221, p = 0.001), DSCA glucose monitoring (r=0.302, p<0.001), DSCA foot care (r=0.311, p<0.001), and DSCA total scores (r=0.401, p<0.001). CONCLUSION: The present study showed that high BDI score was associated with low diabetes self-care score and presence of complications. Individuals' self-efficacy and high perception of social support were associated with increased diabetic self-care scores. KEY WORDS: Social support, Perception, Self care, Diabetes mellitus type 2, Diabetes complications, Depression.

Evaluation of Serum ANGPTL8/Betatrophin and Cartonectin/CTRP3 Levels in Diabetic and Non-Diabetic Retinopathy.

OBJECTIVE: To determine serum betatrophin and cartonectin levels and their relationship with biochemical parameters in diabetic and non-diabetic retinopathy. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Internal Medicine and Ophthalmology, School of Medicine, Firat University, Turkey, from April to November 2020. METHODOLOGY: Patients with diabetic retinopathy (DR), non-diabetic retinopathy (non-DR), type 2 diabetes mellitus without retinopathy, and healthy controls, were enrolled from April to November 2020. Demographic, metabolic, and biochemical parameters were evaluated. Serum betatrophin, cartonectin, IL-6, and TNFα levels were assayed by ELISA methods. One-Way Anova or Kruskal Wallis tests were applied to find out statistical significance among different variables between four groups. RESULTS: A total of 84 participants (DR= 21 patients; non-DR= 21 patients; 21 diabetic patients without retinopathy and 21 healthy controls) were enrolled in the study. TNF-α level was significantly higher in both DR and non-DR than in controls (p<0.001). IL-6 level was higher in DR group than T2DM and controls (p=0.013). Serum betatrophin level was significantly higher in DR group than in non-DR and T2DM groups (p=0.002). Cartonectin level was decreased in DR, non-DR, and T2DM groups compared to non-diabetic healthy controls (p=0.002). CONCLUSION: Serum betatrophin levels are higher in DR, whereas cartonectin levels are lower in both DR and non-DR groups. Serum betatrophins and cartonectin estimation may be helpful in early diagnosis and differential diagnosis in cases of diabetic and non-diabetic retinopathy. KEY WORDS: Angiopoietin-like protein 8, Cartonectin/CTRP3, Diabetic retinopathy, Diabetes mellitus, Type 2, Diagnosis, Differential, Betatrophin.

The role of trimethylamine-N-oxide level in the diagnosis of diabetic retinopathy and the differential diagnosis of diabetic and nondiabetic retinopathy.

PURPOSE: Trimethylamine N-oxide serum levels have been associated with type 2 diabetes mellitus and its complications. The current study aimed to find out if plasma trimethylamine N-oxide level may be a novel marker in the diagnosis of diabetic retinopathy and if it can be used in the differential diagnosis of diabetic and nondiabetic retinopathy. METHODS: The study included 30 patients with diabetic retinopathy, 30 patients with nondiabetic retinopathy, 30 patients with type 2 diabetes mellitus without retinopathy, and 30 healthy control participants. Biochemical parameters, serum IL-6, TNF-α, and trimethylamine N-oxide levels were measured in all participants. RESULTS: Trimethylamine N-oxide level was significantly higher in diabetic retinopathy than in the other groups (p<0.001). There was no significant difference in trimethylamine N-oxide levels between nondiabetic retinopathy and control or type 2 diabetes mellitus Groups. There was a significant positive correlation between trimethylamine N-oxide level and elevated FPG, BMI, HOMA-IR score, BUN, IL-6, and TNF-α levels. CONCLUSION: The current study showed that the trimethylamine N-oxide level is elevated in diabetic retinopathy. These findings suggest that serum trimethylamine N-oxide level might be a novel marker for diabetic retinopathy, and it might be used in the differential diagnosis of diabetic and nondiabetic retinopathy.

m6A RNA, FTO, ALKBH5 Expression in Type 2 Diabetic and Obesity Patients.

OBJECTIVE: To investigate whether m6A content changes in type 2 diabetes mellitus (T2DM) and obese individuals and whether the relationship of m6A content with the mRNA expression levels of FTO and ALKBH5 genes. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Internal Medicine, Firat University, Medical School, Elazig, Turkey, between January 2019 and January 2022. METHODOLOGY: The study included 34 newly diagnosed patients with type 2 diabetes mellitus, 34 obese individuals, and 33 healthy individuals without any chronic and metabolic disease matched for age and gender. The global m6A RNA methylation, FTO, and ALKBH5 gene analyses of all the participants were performed. Total cholesterol, triglyceride, LDL, HDL, HbA1c, and insulin and glucose levels were measured. RESULTS: The median percentages of m6A RNA methylation in the control group, obese, and T2DM participants were 5.62%, 4.20%, and 5.21% respectively (p=0.004). The m6A RNA methylation percentage of the obese participants was significantly lower than controls (p=0.021). The FTO and ALKBH5 mRNA levels were significantly lower in obese and T2DM participants than in controls. There was a negative significant correlation between m6A RNA level and FTO i.e. (r=-0.291, p=0.003) and ALKBH5 (r=-0.321. p=0.001) levels. CONCLUSION: m6A RNA expression levels of obese individuals were lower than healthy controls. The FTO and ALKBH5 mRNA expressions were lower in both obese and T2DM participants compared to the healthy controls. There was no significant difference between obese and T2DM individuals in terms of m6A RNA expression, FTO and ALKBH5 mRNA expression. m6A RNA expression, FTO, and ALKBH5 levels have a potential role in obesity and diabetes mellitus. KEY WORDS: m6A RNA methylation, Epigenesis, Genetic, FTO, ALKBH5.

Seasonal influenza vaccine awareness and factors affecting vaccination in Turkish Society.

Objective: Influenza vaccine reduces the burden of seasonal influenza and related complications. Potential vaccination barriers need to be identified to raise awareness and increase acceptance. We aimed to investigate the rates of seasonal influenza vaccination and the knowledge, opinions, and behaviours prevalent in Turkish society. Methods: The study among seven regions in Turkey was conducted from October-November 2018 in 28 family health centres, using a cross-sectional, descriptive design. The knowledge, opinions, and behaviours of participants regarding the influenza vaccine were obtained by family physicians through face-to-face interviews with participants. Results: A total of 3,492 people aged 10-97 years age range (median: 50 years) were included in the study. Over half of the participants (59.9%, n = 2093) were female. It was found that the percentage of participants who never received the influenza vaccine was 78.4%; only 13.4% were occasionally vaccinated, and 8.1% received regular annual vaccination. Influenza vaccination rates were higher in married people (p < 0.001), women (p = 0.005), patients with chronic lung and cardiovascular disease (p < 0.001), those over 65 years /nursing home residents (p < 0.001). Awareness of the vaccine's benefit was higher in the group at high risk of influenza (p < 0.001). Conclusion: The rate of regular vaccination against influenza every year was insufficient, at 8.1%. Individuals' insensitivity, insufficient knowledge, and attitudes toward influenza vaccination is a serious health problem for Turkish society. Barriers to influenza vaccination can be reduced by good communication between family physicians and their patients.

Role of Betatrophin and Inflammation Markers in Type 2 Diabetes Mellitus, Prediabetes and Metabolic Syndrome.

OBJECTIVE: To determine the association of betatrophin and inflammation factors in metabolic diseases such as diabetes, impaired fasting glucose, impaired glucose tolerance and metabolic syndrome. STUDY DESIGN: A cross-sectional, analytical study. PLACE AND DURATION OF STUDY: Firat University Medical School between April 2017 and December 2020. METHODOLOGY: The study included 20 patients with type 2 diabetes mellitus, 20 patients with impaired fasting glucose (IFG), 20 patients with impaired glucose tolerance (IGT), 20 patients with metabolic syndrome (MetS), and a control group consisting of 20 healthy individuals. Anthropometric, fasting serum biochemical data were collected. Circulating betatrophin, and inflammation markers were measured by enzyme-linked immunosorbent assay (ELISA). The association of betatrophin, TNF-alpha, and IL-6 levels between groups were performed with One-way ANOVA and post-hoc Tukey HSD test. RESULTS: Significantly higher levels of circulating betatrophin were observed in IFG, IGT, And MetS groups compared to healthy controls (p=0.017). There were significantly difference TNF-α levels in IFG, IGT, and MetS groups compared to healthy controls (p<0.001). The levels of IL-6 were significantly higher in MetS group than healthy controls (p=0.007). CONCLUSION: The circulating betatrophin and TNF-α levels were increased in MetS, IFG and IGT. IL-6 was decreased in MetS compared to the healty controls. Further studies are needed to elucidate the role of betatrophin and inflammatory parameters in the development of T2DM and prediabetic syndromes, whether betatrophin could have clinical applications in the development of new antidiabetic agents. Key Words: Betatrophin, IL-6, TNF-alpha, Metabolic syndrome, Insulin resistance, Diabetes mellitus type 2.

Relationship between Serum Elabela Level and Hypertensive Nephropathy.

OBJECTIVE: To determine the difference in serum Elabela level in hypertensive patients with and without nephropathy compared to the healthy control group. Study Desing:  Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Firat University Medical School, Elazig, Turkey between December 2018 and November 2020. METHODOLOGY: The cross-sectional descriptive study consisted of 37 patients with hypertensive nephropathy (group 3), 50 hypertensive patients without nephropathy (group 2), and 50 healthy controls (group 1). Hypertensive nephropathy was defined as serum creatinine ≥1.8 mg / dl or  GFR <40 ml / minute. Biochemical parameters (Glucose, AST, ALT, urea, creatinine, lipid levels, hemogram, calcium, phosphorus, parathormone) and the levels of serum Elabela were evaluated and compared. RESULTS: There was no significant difference in age (0.270) and gender (0.951) between groups. The median Elabela levels of the three groups were 40.3 ng/mL (22.5-54.6), 5.1 ng/mL (3.7-8.3), 9.2 ng/mL (6.1-23.1), respectively with a significant difference (p<0.001). CONCLUSION: The plasma levels of Elabela were lower in the case of hypertension, independent of nephropathy. However, this decrease is not specific for nephropathy and may be due to other accompanying chronic diseases. Key Words: Hypertension, Hypertensive nephropathy, Elabela.

The Effects of Secondary Hyperparathyroidism on Circadian Blood Pressure in Hemodialysis Patients.

OBJECTIVE: To determine the relationship between secondary hyperparathyroidism (sHPT) and circadian blood pressure (BP) rthym among patients undergoing hemodialysis treatment. STUDY DESIGN: A descriptive and prospective cohort study. PLACE AND DURATION OF STUDY:   Department of Nephrology, Firat University Hospital, Turkey, between June and December 2019. METHODOLOGY: Eighty-five patients, undergoing hemodialysis three times a week, were included. The BP parameters and circadian blood pressure rhythm were measured by the mobil-o-graph sphygmomanometer. Non-dipper blood pressure phenomenon was defined as a night-time mean artery pressure (MAP)  decrease of <10% from the daytime MAP; sHPT was defined as parathormone >300 pg/ml. RESULTS: Of the 85 participants, mean age was 57.07 ± 14.46 years. In cohort, sHPT rate 58.8% (n =50) and non-dipper blood pressure pattern rate was 64.7% (n = 55). Systolic blood pressure (p=0.001), diastolic blood pressure (p=0.001), and mean arterial blood pressure (p<0.001) were higher in participants with sHPT. sHPT (p = 0.003) was an independent risk factor for non-dipper blood pressure pattern (odds ratio [OR] 0.065, 95% CI: 0.11-0.390). A negative correlation was identified between parathormone and the reduction in night blood pressure (r = -0.346, p=0.001). CONCLUSION: Secondary hyperparathyroidism can cause non-dipper blood pressure pattern by reducing the reduction in night blood pressure. Treatment of sHPT is important in the control of blood pressure and normal circadian blood pressure rhythm in tertiary protection in hemodialysis patients. Key Words: Blood pressure, Circadian rhythm, Hyperparathyroidism secondary, Hemodialysis, Chronic kidney diseases.

Prevalence of Anemia and Associated Risk Factors among Pregnant Women, What is the Role of Antenatal Care in Prevention? A Cross-sectional Study.

OBJECTIVE: To determine the prevalence of anemia with the associated factors in pregnant women and the effect of family medicine practice and antenatal care services provided by family physicians on the prevention of anemia during pregnancy. STUDY DESIGN: Community-based cross-sectional study. PLACE AND DURATION OF STUDY: Family Health Centres in the Elazig region, Turkey from January to June 2019. METHODOLOGY: A total of 495 pregnant women, attending the family health centres, were included. Women were administered a questionnaire related with the anemia and related factors; and hemoglobin values were drawn. Hemoglobin concentration <11 g/dl was classified as anaemic. Sociodemographic, individual dietary diversity and obstetric characteristics of the participants were obtained from structured questionnaire form. Binary logistic regression model was employed to determine the effect of explanatory variables on dependent variable anemia.   Results: The prevalence of anemia during pregnancy was 27.9% (Hb<11.0 gr/dl). Prevalence of anemia was found lower in participants with higher education levels (p=0.005) and having nutrition education (p=0.004). Income status (OR=0.017 [95%Cl:0.002-0.15, p<0.001]), dark tea preference (OR=87.127 [95%Cl:17.68-429.36, p<0.001]), and iron supplementation time (OR=0.945 [95%Cl: 0.91-0.98, p=0.002]) were determined as the independent predictors of anemia in pregnancy. CONCLUSION: Low income, insufficient iron supplementation treatment and dark tea preference were the main predictors of anemia. Most of the factors that cause anemia during pregnancy can be prevented with patient education and supportive treatments. Therefore, the authors recommend applying effective and quality prenatal care and patient education programs to reduce anemia during pregnancy. Key Words: Pregnant women, Anemia, Prenatal care, Family practice, Turkey.

The role of vitamin D deficiency on COVID-19: a systematic review and meta-analysis of observational studies.

OBJECTIVES: Although vaccination has started, coronavirus disease 2019 (COVID-19) poses a continuing threat to public health. Therefore, in addition to vaccination, the use of supplements to support the immune system may be important. The purpose of this study was to synthesize evidence on the possible effect of low serum vitamin D levels (25[OH]D<20 ng/mL or 50 nmol/L) on COVID-19 infection and outcomes. METHODS: We searched Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect without any language restrictions for articles published between January 1 and December 15, 2020. We performed 3 meta-analyses (called vitamin D and COVID-19 infection meta-analysis [D-CIMA], vitamin D and COVID-19 severity meta-analysis [D-CSMA], and vitamin D and COV ID-19 mortality meta-analysis [D-CMMA] for COVID-19 infection, severity, and mortality, respectively) to combine odds ratio values according to laboratory measurement units for vitamin D and the measured serum 25(OH)D level. RESULTS: Twenty-one eligible studies were found to be relevant to the relationship between vitamin D and COVID-19 infection/outcomes (n=205,869). The D-CIMA meta-analysis showed that individuals with low serum vitamin D levels were 1.64 times (95% confidence interval [CI], 1.32 to 2.04; p<0.001) more likely to contract COVID-19. The D-CSMA meta-analysis showed that people with serum 25(OH)D levels below 20 ng/mL or 50 nmol/L were 2.42 times (95% CI, 1.13 to 5.18; p=0.022) more likely to have severe COVID-19. The D-CMMA meta-analysis showed that low vitamin D levels had no effect on COVID-19 mortality (OR, 1.64; 95% CI, 0.53 to 5.06, p=0.390). CONCLUSIONS: According to our results, vitamin D deficiency may increase the risk of COVID-19 infection and the likelihood of severe disease. Therefore, we recommend vitamin D supplementation to prevent COVID-19 and its negative outcomes.

Knowledge, behaviours and anxiety of eastern part of Turkey residents about the current COVID-19 outbreak.

INTRODUCTION: The aim of this study was to assess the knowledge, attitude, and behavior of Eastern part of Turkey residents about the COVID-19 and the relationship between the pandemic and the anxiety levels. METHODS: Cross-sectional study was carried out between 07-21 April 2020 through online questionnaires. The study included 897 people who filled out the form and met the study criteria. The data was collected through a self-administered questionnaire of the socio-demographic characteristics, generalized anxiety disorder scale, opinions about the epidemic, knowledge, and attitude of individuals regarding COVID-19. RESULTS: A total of 897 participants had a mean score of knowledge and attitude of 5.11±1.63 and 46.81±5.65, respectively. Knowledge and attitude score was higher in males (p<0.001) and participants with high education level (p=0.003). Anxiety level was negatively correlated with knowledge (r=-0.156, p<0.001) and attitude scores (r=-0.288, p<0.001). There was a positive significant correlation between knowledge level and attitude score (r=0.194, p<0.001). CONCLUSION: Gender and education levels had a statistical effect on individuals' COVID-19 knowledge and attitude scores. COVID-19 outbreak was associated with high anxiety levels in individuals and it was determined that the anxiety caused by the epidemic negatively affected the knowledge and attitudes of the individuals.

Arterial Stiffness and its Related Factors in Patients on Hemodialysis.

OBJECTIVE: To evaluate the prevalence of arterial stiffness in patients on hemodialysis and related factors that aggravate the condition. STUDY DESIGN: Prospective-cohort study. PLACE AND DURATION OF STUDY:   Department of Nephrology, Firat University Hospital, Turkey, from August to October 2019. METHODOLOGY: Central blood pressure (BP), augmentation index (AIx) and aortic pulse wave velocity score (PWVs) were assessed using the mobil-o-graph pulse wave velocity system.  Increased arterial stiffness (AS) wgnas defined by the aortic PWV of  >10 m/s. RESULTS: The mean PVWs were 8.14 ± 2.39 m/s the mean AIx was 21.23 ± 11.58 m/s, and AS was 33.7% in hemodialysis patients. Systolic blood pressure, pulse rate, pulse pressure, central systolic blood pressure, older age, HD vintage, HT vintage, creatinine, CRP and neutrophil leukocyte ratio (NLR), were related factors with AS. Multivariate linear regression analysis showed that systolic blood pressure (ß=0.322; 95% CI: 0.007-0.042; p = 0.006), and age of patients (ß=0.787; 95% CI: 0.095-0.127; p<0.001) were independent determinants of PWVs. CONCLUSION: The frequency of AS was 33.7% in hemodialysis patients without a history of cardiovascular disease. Increased age and systolic blood pressure were independent factors affecting PWV. Effective blood pressure control therapy can reduce AS in hemodialysis patients. Key Words: Pulse wave velocity, Arterial stiffness, Cardiovasculer disease, Systolic blood pressure, Hemodialysis.

Serum apelin and resistin levels in patients with impaired fasting glucose, impaired glucose tolerance, type 2 diabetes, and metabolic syndrome.

INTRODUCTION: The aim of this study was to investigate serum apelin and resistin levels in patients with impaired fasting glucose, impaired glucose tolerance, type 2 diabetes and metabolic syndrome. MATERIAL AND METHODS: The study comprised 18 patients with type 2 diabetes mellitus (T2DM) (nine females, nine males), 18 patients with impaired fasting glucose (IFG) (nine females, nine males), 18 patients with impaired glucose tolerance (IGT) (nine females, nine males), 18 patients with metabolic syndrome (MeS) (nine females, nine males), and 16 healthy individuals (eight females, eight males); serum adiponectin, apelin, resistin levels, fasting and postprandial blood glucose, insulin resistance markers, and lipid parameters were measured. RESULTS: In the study, serum apelin levels were determined to be significantly lower in IGT, MeS, and T2DM groups compared with the control group (p = 0.002, p = 0.006, and p < 0.001, respectively). Serum resistin levels were determined to be significantly higher in IGT and T2DM groups compared with the control group (p < 0.001 and p < 0.001, respectively). CONCLUSIONS: Apelin and resistin are thought to affect glucose metabolism and insulin resistance. Apelin is an important indicator in individuals with IGT in the prediabetic period and may play a role in preventing diabetic complications and treatment of T2DM.

Low serum levels of meteorin-like/subfatin: an indicator of diabetes mellitus and insulin resistance?

INTRODUCTION: Meteorin-like (Metrnl), also known as subfatin, is a recently discovered adipokine with a favourable effect on insulin sensitivity. Studies have shown lower Metrnl levels in obese patients. However, data on its circulating levels in type 2 diabetes mellitus (T2DM) patients are contradictory. This study aims to evaluate serum Metrnl levels in T2DM patients and determine the relationship between serum Metrnl levels and insulin resistance in these patients. MATERIAL AND METHODS: This cross-sectional study was conducted among 150 participants. The study was carried out between June 2019 and December 2019 at the internal medicine outpatient clinic of a tertiary university hospital. The participants were divided into three groups: group 1 (control group, n = 50), group 2 (newly diagnosed T2DM, n = 50), and group 3 (long-standing diagnosed T2DM, n = 50). An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of Subfatin (Metrnl), and the correlations of Metrnl level with anthropometric parameters, HOMA index, and biochemical measurements were assessed. RESULTS: There was no statistically significant difference between the gender (p = 0.468) and age (p = 0.067) characteristics of the three groups. The Metrnl (subfatin) levels of the participants were as follows: control group - 20.05 (1.56-103.78); newly diagnosed T2DM group - 2.62 (1.25-103.78); and long-standing diagnosed T2DM group - 2.01 (0.80-19.84) pg/mL. The Metrnl (subfatin) levels of the participants in the control group were higher than in the participants in the newly diagnosed T2DM and long-standing diagnosed T2DM groups (p < 0.001). Subfatin demonstrated a negative correlation with insulin and HOMA-IR in the control group and long-standing diagnosed T2DM group. CONCLUSIONS: The subfatin level was found to be higher in the healthy control group than in both diabetic patient groups. Subfatin level showed negative correlation with both insulin level and HOMA index. There was a relationship between subfatin and insulin resistance. Low levels of subfatin in the diabetic patient groups may play a role in the pathogenesis of T2DM by increasing insulin resistance.

Investigation of the Effect of Written and Visual Information on Anxiety Measured Before Magnetic Resonance Imaging: Which Method is Most Effective?

Background and objective: Magnetic resonance imaging (MRI) causes severe anxiety in some patients. Anxiety during MRI leads to prolongation of the procedure and deterioration of image quality, resulting in loss of labor and cost increase. The aim of this study was to investigate the effect of written and visual information on state anxiety in patients undergoing MRI. Material and Methods: A cross-sectional prospective study was conducted with 294 participants. The study was carried out between January 2019 and March 2019 at the Radiology Clinic of the tertiary university hospital. The participants were divided into 3 groups as group 1 (control group), group 2 (written information) and group 3 (visual information). The trait anxiety and state anxiety of the participants were measured by State-Trait Anxiety Inventory (STAI) inventory, which can measure both anxiety status. Results: There was no statistically significant difference between demographic characteristics and trait anxiety scores (p = 0.20) of all three groups. The state anxiety scores of group 3 were statistically lower than the group 2 (p < 0.001) and control group (p < 0.001). The state anxiety scores of group 2 were statistically lower than control group (p < 0.001). Conclusion: MRI anxiety can be reduced by visual and written information. Visual information may be more effective in reducing MRI anxiety than written information.

Evaluation of Dental Anxiety and Fear in Patients who Admitted to the Faculty of Dentistry: Which Patients are More Risky in terms of Dental Anxiety.

BACKGROUND: Dental anxiety and fear make the dental operation and the treatment difficult. Beside that it causes the delays or absence in the dental appointments so it leads to problems for oral and dental health. The aim of this study was to investigate the frequency of dental anxiety, the factors affecting dental anxiety and the effects of dental anxiety on oral dental health of the participants. METHODOLOGY: We conducted a hospital-based, cross-sectional study among 342 patients attending the outpatient clinic of a tertiary dentistry hospital. Dental anxiety and trait anxiety levels of the participants measured using MDAS and STAI scales. We conducted the student t-test, One-way Anova and Tukey's post hoc for the analysis of our data. The Pearson's correlation analysis has been used for the analysis of two different quantitative data obtain from MDAS and STAI scales. RESULTS: The age average of 342 participant of our research was 34,41±11,78. 59,1% of our participants was women. (n=202) Dental anxiety was existing in the 42,1% of the participants (n=144). 56,4% of the participants have had a hard and painful dental treatment experiences. 15,2% of our participants (n=52) had MDAS 19 point or more. CONCLUSIONS: High and statistically significant dental anxiety scores have been detected for the patients who are women, housewives, who had uneasy and painful dental treatment stories, who have personel inclinations to the anxiety. Examinations directed to the factors which would increase the dental anxiety, may prevent possible complications and also the risk carried by the patients related to the dental health may be estimated with the help of this kind of examinations.

Screening Cardiovascular Risk in Patients with High Depression Scores.

OBJECTIVE: Protection against cardiovascular diseases is provided by the dynamics of risk screening and counseling of primary health care services. Depression is known to pose a risk for cardiovascular diseases. The aim of our study was to determine which specific features of well-known depressed people who had not yet experienced a cardiovascular event were associated with cardiovascular risk. METHODS: This study was conducted in patients at the Corum Gulabibey Family Health Center between June 2016 and June 2017. Patients without a known cardiovascular disease were subjected to Beck Depression Inventory (BDI) and Framingham risk scale. Framingham risk scores were compared by dividing the participants into two groups according to having Beck depression scores of equal/above 10 points (high BDI = HBDI) and below 10 points (low BDI = LBDI). RESULTS: Age, LDL, total cholesterol, triglyceride, and blood pressure were all correlated with risk scores. In contrast, HDL and body mass index were only correlated with the risk scores in HBDI participants. From the HBDI patients, those who were obese had higher risk scores than those without obesity. CONCLUSION: Obesity is a high cardiovascular risk predictor that can be screened at one site in depression. While the body mass index of depressed individuals was correlated with the cardiovascular risk, this index being above 30 was indicative of high cardiovascular risk.

Diclofenac- and Pantoprazole-Induced Rhabdomyolysis: A Potential Drug Interaction.

BACKGROUND: Drugs represent one of the etiologic causes of acute rhabdomyolysis (AR) with drug-induced rhabdomyolysis most commonly associated with HMG-CoA reductase inhibitors. AR etiology can also result from the use of diclofenac, a non-steroidal anti-inflammatory drug, and omeprazole, a proton pump inhibitor. Cases of AR triggered by pantoprazole have never before been reported, although it has been observed that its inclusion in multiple drug therapies can result in muscle events. CASE PRESENTATION: A 45-year-old man presenting with complaints of fatigue and extensive body pain was diagnosed with acute rhabdomyolysis. His symptoms started on the fourth day of the concomitant use of diclofenac and pantoprazole. The patient was using diclofenac 50-mg tablets once daily for 1 month and pantoprazole 40-mg tablets once daily during the previous week for headaches and pyrosis, resulting in an increase in his creatinine kinase levels to 3114 IU/L (reference range 24-190 IU/L) on the fifth day of concomitant use. His creatinine kinase levels returned to normal and his complaints disappeared after the seventh day of discontinuation of both treatments. DISCUSSION: A third case of diclofenac-induced rhabdomyolysis was defined in which, different from previous cases, AR was detected during the concomitant use of diclofenac and pantoprazole. The timing of the symptom development and the limited number of AR cases induced by diclofenac and pantoprazole suggested a drug interaction. CONCLUSION: The close relationship between diclofenac and pantoprazole, and the cytochrome P450 and P-glycoprotein systems offers a strong indication that a drug interaction may be occurring. While evaluating the side effects of drugs in patients undergoing monotherapy, clinicians should also consider the mechanisms that play a part in drug absorption and distribution.