Internal Medicine Outpatient Clinic Research Articles

The relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process in Turkey.

To determine the relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process. Individuals with chronic diseases are a sensitive group during the COVID-19 pandemic process; it is thought that self-care management may be adversely affected as a result of their more intense exposure to the psychological, physiological and economic effects of the pandemic. In the literature, there is no study examining the effect of perception of COVID-19 and fear of COVID-19 on self-care management in individuals with chronic diseases. Descriptive study. The study was conducted with 322 individuals who applied to the internal medicine outpatient clinics of a university's Health Practice and Research Center, met the inclusion criteria, agreed to participate in the study and had a chronic disease. Questionnaire form, Perception of COVID-19 Scale (P-COVID-19), The Fear of COVID-19 Scale (FCV-19S) and Self-Care Management Process in Chronic Illness Scale (SCMP-G) were used to collect data. STROBE checklist was used to report the present study. In the study, it can be stated that individuals with chronic diseases had a moderate to the high perception of contagiousness and dangerousness of COVID-19, they had a moderate-high level of fear of COVID-19 and their self-care care management was above moderate level. There was a significant positive correlation between P-COVID-19, FCV-19S and SCMP-G in the study. It was found that the perception of COVID-19 contagiousness and the fear of COVID-19 had a positive effect on the self-care management of individuals with chronic diseases. Determining the level of COVID-19 perception and fear of COVID-19 and their effects on the life of the individual, and evaluating self-care management during the difficult pandemic process will increase the success in the holistic nursing care and management of chronic diseases.

Application the Beck Depression Test to Screen for Depressive Findings Before and After Treatment in Patients with Iron Deficiency Anemia and/or Vitamin D Deficiency

Aim: Depression, vitamin D deficiency, and anemia are significant global public health issues. Depression, loss of interest, and a lack of enjoyment are the main warning indicators. In this study, we aimed to compare the results of the Beck depression test before and after replacement therapy in patients with iron deficiency anemia and vitamin D deficiency and to show the relationship between iron deficiency anemia (IDA), vitamin D deficiency anemia and depression in patients. Material and Methods: 139 patients with vitamin D deficiency and/or IDA who applied to the internal medicine outpatient clinics of Dışkapı Hospital between March 2017 and September 2017 participated in the study. Patients with vitamin D deficiency and/or IDA were included in the study, and the Beck depression test (BDI) questionnaire was applied to these patients before and after their treatment. Then, the scores on these two questionnaires were compared. Statistical analyzes were performed using SPSS version 20.0 (Armonk, NY: IBM Corp.). Results: All patients had Vitamin D deficiency, 59% (n=82) had both IDA and Vitamin D deficiency, and 41% had only Vitamin D deficiency. The mean follow-up time of the patients after treatment was 64.2±23.4 days. There was a significant decrease in BDI scores in both male patients (p=0.025) and female patients (p<0.001) after treatment compared to before. Conclusion: In our study, it was shown that the risk of depression is high in patients with vitamin D deficiency and/or IDA, and depressive symptoms decreased after short-term replacement therapy with vitamin D and iron.

Reasonable adjustments to the application of the comprehensive care standard within an Australian mainstream internal medicine outpatient clinic attended by adults with Down syndrome

ABSTRACT Background: The Australian Commission on Safety and Quality in Health Care recommends the development of reasonable adjustments to Comprehensive Care Standard to better suit the needs of people with intellectual disability. Method: An audit of adults with Down syndrome attending a mainstream internal medicine outpatient clinic was undertaken to describe their biopsychosocial profile, identify previously developed reasonable adjustments to clinical service and to consider their alignment with comprehensive care. Results: Of 54 adults, 31 (57%) male, average age 36 years (17.5–68 years), there were multiple syndromal and non-syndromal co-morbidities, 10 deaths (9 expected), from dementia. All had some degree of intellectual disability with all requiring disability supports to assist in their healthcare and an active health-disability interface in most cases. Conclusions: Reasonable adjustments to usual clinical content, process, knowledge, and organisation were identified, which appeared to facilitate application of comprehensive care. These were predominantly influenced by intellectual disability, disability supports, and the health-disability interface rather than the disease profile.

Nutritional Status and Risk of Sarcopenia among Hospitalized Older Adults Residing in a Rural Region in Turkey.

This study aimed to determine the prevalence of sarcopenia and its associated factors in community-dwelling older adults at risk of malnutrition based on the Mini Nutritional Assessment (MNA), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI). The study participants were 345 adults aged >65 years who visited Geriatric Internal Medicine outpatient clinics. The study included people without acute illness for whom the risk of malnutrition could be assessed and appropriate measurements taken. At the baseline visit, participants' data and measurements were gathered. The primary data included sociodemographic details, anthropometric measurements, malnutrition screening tests, and functional assessments. The participants' mean age was 76.21±5.59 years, and 57.1% were men (n=97). The prevalence rate of sarcopenia was 45.5%. Compared to individuals without sarcopenia, those with it were older; had lower MNA, PNI, and GNRI scores; and had lower muscle mass, muscle strength, and lower leg circumferences (p<0.001). After adjusting for potential confounding factors, we found that sarcopenia, advanced age, male sex, high risk of malnutrition, calf circumference, and a low PNI score were all significantly associated with a low GNRI score (p<0.001). Sarcopenia was significantly associated with advanced age, male sex, and high risk of malnutrition. Patients' nutritional and functional status should always be assessed for therapeutic interventions and lifestyle changes.

Significance of pharmacist intervention to oral antithrombotic therapy in the pharmaceutical outpatient clinic of cardiovascular internal medicine: a retrospective cohort study

BackgroundOptimised antithrombotic therapy requires clinical experience and an understanding of the current guidelines. This retrospective study aimed to evaluate whether pharmacist interviews and interventions with patients taking oral antithrombotic drugs in the pharmaceutical outpatient cardiology clinic had favourable clinical outcomes including decreased bleeding.MethodsThe participants included patients visiting the outpatient clinic of cardiovascular internal medicine at the Kobe University Hospital from January–December 2017, and were taking oral antithrombotic medication. The observation period was from the first visit to the outpatient clinic to October 2021 or death. Patients who received pharmacist intervention more than twice were defined as the pharmacist intervention group. Two control patients per one pharmacist intervention group individual were selected from the non-intervention pool matched for age, gender and antithrombotic medication type.ResultsOf the 895 eligible patients, 132 were in the pharmacist intervention group and 264 were selected for the matched non-intervention group. Bleeding events according to the Bleeding Academic Research Consortium criteria over type 2 were significantly lower in the pharmacist intervention group compared with the non-intervention group (17.4% versus 28.4%, P = 0.019). There were no significant differences in mortality and heart failure hospitalisation frequency, stroke, or cardiovascular events between the groups. Multivariate analysis identified age (≥ 65 years) and pharmacist intervention as factors associated with bleeding (odds ratio = 2.29 and 0.51, respectively).ConclusionPharmacist intervention in the outpatient clinic of cardiovascular internal medicine was effective in reducing the risk of bleeding in patients undergoing antithrombotic therapy.

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. Within this research's scope, 411 patients over 16 years old who were evaluated in IzmirKatipCelebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between2018 and 2022and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed asbenign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa(κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. Although FNAB remains the most important diagnostic tool to identify benigncases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results andhelps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.

Effect of Fasting Ramadan on Different Laboratory Parameters on Type 2 Diabetic Mellitus Patients

Background Diabetes mellitus (DM) is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. It has been estimated that by the year 2030, there will be 8.6 million adult with diabetes in Egypt, making it the country with the tenth largest population of diabetic in the world. Diabetes is associated with reduced life expectancy, significant morbidity due to micro and macro vascular complications and diminished quality of life. Objective To study the impact of Ramadan fasting on metabolic parameters and anthropometry in type 2 DM in Egypt. Patients and Methods This study was conducted on 80 type 2 diabetic patients who were intending to fast Ramadan. During Ramadan (2014) the average fasting hours were 15 h. Patients were recruited from the internal medicine outpatient clinic at Ain Shams University hospitals and from the nutrition institute. 6 Patients were under insulin treatment (Biphasic human insulin) &amp; 74 patients were under oral hypoglycemic treatment {52 on combination treatment sulfonylurea + metformin &amp; 9 on metformin only &amp;13 of them were on sulfonylurea only}. Results We found that there was a statistically significant increase as regard lipid profile (serum triglycerides, serum total cholesterol, LDL-cholesterol and HDL-cholesterol) in after Ramadan measurement. Also CVD risk parameters have untimely increased after Ramadan this parameters including (10 years risk (Framingham score) systolic and diastolic blood pressure). In addition (Creatinine, HOMA IR and fasting insulin) showed increased level in after Ramadan measurement which indicate deterioration of blood glucose parameters. There was no statistical significant changes seen as regard anthropometric measures (BMI, WHR) in pre Ramadan and after Ramadan measurement. Also there was no statistical significant changes regarding fasting, 2 hours plasma glucose, A1c levels between pre-Ramadan fasting &amp; after-Ramadan. In addition CRP and ACR showed no significant changes as regard measurement between before and after Ramadan. Conclusion Ramadan fasting appears to have significant effect on lipid profiles that could adversely impact cardiovascular outcome. These effects are mostly due to quality and quantity of food intake during Ramadan and the negative impact of sedentary life style. In addition the number of fasting days and period of daily fasting could affect glycemic control and renal function tests. Bad dietary habits, lack of exercise and irregular drug intake during Ramadan has a negative impact on glycemic control.

Assessment of Carotid Atherosclerosis in Egyptian Chronic Hepatitis C Patients after Treatment by Direct Acting Antiviral Drugs

Abstract Background Recent studies suggested association between hepatitis C virus (HCV) infection cardiovascular disorders, including carotid atherosclerosis with evidence of an effect of HCV clearance on carotid atherosclerosis. Objectives We aimed to evaluate the impact of direct acting antiviral (DAA) therapy for chronic hepatitis c virus (HCV) infection on carotid atherosclerosis. Subjects and methods This is a prospective cohort study that was carried out in Internal Medicine and Hepatology Department and outpatient clinics of the Ain shams university hospitals included 80 Egyptian patients with chronic HCV infection who started treatment in form of IFN-free, DAA-based regimen and completed the course of treatment and six months follow up period. All patients were subjected to detailed history taking, full physical examination, full laboratory investigations. Radiological assessment by abdominal ultrasonography and high-resolution B mode ultrasonography of both the common carotid arteries. Results the mean age of cases 58.13± 7.56 years 49 (61.25%) males and 31 (38.75%) females. IMT was significantly decreased after treatment 1.24 vs. 1.57 mm p &amp;lt; 0.001. The number of patients with IMT ≥ 1 mm was significantly decreased after 6 months 45 (56.3%) vs 57 (71.3%). there was significant positive correlation between baseline carotid IMT and age, BMI, bilirubin, INR, CTP score, Carotid plaques, total cholesterol. Meanwhile, there was significant negative correlation between baseline carotid IMT and hemoglobin, platelets, albumin, HDL. In patients who achieved SVR, total cholesterol, triglycerides, LDL and HDL was significantly increased after treatment. IMT was significantly lower in SVR group compared to non- SVR (p = 0.016). Conclusion Hepatitis C virus eradication by DAAs improves carotid atherosclerosis in by decreasing intima media thickening.

Role of Circulating Ectodysplasin A as a Biomarker in Non-Alcoholic Fatty Liver Disease

Abstract Background The liver is a dynamic organ that plays critical roles in many physiological processes, including the regulation of systemic glucose and lipid metabolism. Dysfunctional hepatic lipid metabolism is a cause of nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disorder worldwide, and is closely associated with insulin resistance and type 2 diabetes. Objective To study serum level of Ectodysplasin A in patients with non-alcoholic Fatty Liver disease (NAFLD) to detect its relation to the incidence and severity of non-alcoholic Fatty Liver Disease (NAFLD). Patients and Methods Type of Study: Case-Control clinical study. Study Setting: Internal medicine and hepatology outpatient clinic at Ain Shams University Hospital Study period: this is a 6-month study period starting from July 2020 till January, 2021. Results There was a significant difference in between the two groups regarding to platelet, ALT, AST, GGT and albumin. The mean Ectodysplasin A was 337.54 ± 196.63 (pg/ml) in NAFLD group and 221.43 ± 115.89(pg/ml) in control group with high statistical significant difference in between. There was a significant positive correlation in between Ectodysplasin A and Weight, BMI, WC (cm), FPG, HbA1c and LDL-C in NAFLD group. Conclusion Ectodysplasin A level is elevated in NAFLD patients than in control. Ectodysplasin A level could be used as an inflammatory biomarker for the prognosis of patients NAFLD. Therefore, measurement of Ectodysplasin A level provides a new strategy to more aggressive treatments for high-risk groups.

Role of Circulating Vascular Cell Adhesion Protein – 1 as a Biomarker in Non-alcoholic Fatty Liver Disease

Background As a result of the obesity pandemic, non-alcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease worldwide. NAFLD is the hepatic manifestation of obesity and a precursor of and independent risk factor for type 2 diabetes Aim of the Work To assess the level of vascular cell adhesion molecule 1 (VCAM-1) as noninvasive diagnostic tools for diagnosis of NAFLD degree of fibrosis. Patients and Methods A Case-Control clinical study in the Internal medicine and hepatology outpatient clinic at Ain Shams University Hospital for 6-month on 60 persons that were included in this study divided into 2 groups: Group A: 30 patient with NAFLD as a study group. Group B: 30 healthy subjects as a control group. Results In the present study, the mean VCAM-1 was 2.392 ± 0.3 in NAFLD group, 9.893 ± 2.3 in NASH group and 1.983 ± 0.3 in control group with high statistical significant increase in NASH followed by NAFLD than in control group. Regarding to ROC curve, VCAM-1 had excellent Diagnostic performance with an AUC of 0.994. A best cut-off criterion of VCAM-1 &amp;gt; 7.7 ng/mL could discriminate between patients with NASH from control group with a sensitivity of 95% and specificity of 100% In our study, there was no significant correlation in between VCAM-1 and age, AST, ALT In the present study, the significant predictors of bad outcome in patients with NAFLD and NASH were higher VCAM-1 level, GGT and higher AST levels Conclusion The significant predictors of bad outcome in patients with NAFLD and NASH were higher VCAM-1 level, GGT and higher AST levels.

Study of Neutrophil–Lymphocyte Ratio, Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-α) in Type 2 Diabetes with Diabetic Nephropathy

Abstract Background Diabetic kidney disease is defined by characteristic structural and functional changes. The predominant structural changes include mesangial expansion, glomerular basement membrane thickening, podocyte injury, and, ultimately, glomerular sclerosis. The major clinical manifestations of diabetic nephropathy are albuminuria, hematuria (less often), and, in many patients, progressive chronic kidney disease, which can be slowed with optimal therapy. Objective to assess the Neutrophil-lymphocyte Ratio, Interleukin- 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in Type 2 Diabetes with Diabetic Nephropathy. Patients and Methods In Our study We collect 90 subjects with their ages ranging from 35-70, selected from Internal Medicine and Endocrinology outpatient clinics and the inpatient department at Ain Shams University Hospitals. Results As regards NLR, there were statistically significant and direct correlations between NLR and IL6, TNF, serum BUN, serum creatinine and albumin to creatinine ratio, while significant and indirect correlation with EGFR. As regards IL6, there were statistically significant and direct correlations between IL6 and TNF, serum BUN, serum creatinine and albumin to creatinine ratio, while significant and indirect correlation with BMI and EGFR. As regards TNF, there were statistically significant and direct correlations between TNF and serum BUN and albumin to creatinine ratio. There is no statistical difference between the studied groups as regard sex, age, BMI, SBP, DBP. Conclusion The current study could find that NLR, IL-6 and TNF-α were significantly associated with albuminuria in Type 2 Diabetic patients with DN and that they can be used as evident biomarkers in assessing the progression of deteriorating renal function and different stages of renal disease in patients with DN.

Anti-IFI16 Antibodies in Inflammatory Bowel Disease and Their Variation with Infliximab Therapy in Comparison to Other Modalities of Treatment

Abstract Background Amatory bowel diseases (IBDs) are remittent or progressive conditions that may affect the entire gastrointestinal tract and the colonic mucosa and are associated with an increased risk for colon cancer. Patients with mucosal lesions may not have clinical symptoms, or only present with mild symptoms. Objective measurements are required to assess and monitor IBD disease activity. Moreover responses to treatments must be closely monitored to determine effectiveness and avoid disease complications. Aim of the Work The aim of this study is to assess the utility of IFI16 antibodies as a predictor of infliximab-induced remission in IBD patients in comparison to other modalities of treatment. Patients and Methods A Comparative cross sectional study in internal medicine and gastroenterology outpatient clinic at Ain Shams University Hospital. With 60 IBD patients are included in this study divided into three groups. Results Patients with low levels of IgG antibodies against IFI16 at baseline had a higher probability of a clinical response or remission at the end of induction therapy with IFX (OR 1/4 0.143; 95% CI 0.027–0.761). The only statistically significant association found in patients with UC was that between anti-IFI16 IgG and extensive colitis (E3) (OR 1/4 7.255; 95% CI 2.452–21.463; P 1/4 0.0001) (data not shown). Conclusion Overall, the findings presented in this study deserve more investigation to verify the possibility of exploiting a patient’s reac- tivity against the IFI16 autoantigen as a predictive marker of response to IFX therapy. Anti-IFI16 IgG titers may be of great clinical relevance and provide guidance when tailoring therapeutic choices to individual patients.

Study of the Relation between Serum Lipoprotein-Associated Phospholipase A2 (LP-PLA2) Level and Nonalcoholic Fatty Liver Disease (NAFLD)

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is one of the most common causes of chronic liver disease, worldwide. Lipoproteinassociated phospholipase A2 (Lp-PLA2) was recently characterized as a novel inflammatory biomarker that is correlated with several components constituting the metabolic syndrome. Aim and Objectives to study serum levels of Lp-PLA2 in patients with NAFLD to detect its relation to the incidence and severity of NAFLD. Subjects and Methods This is Case Control cross -sectional clinical Study, was carried out at Internal Medicine and Hepatology outpatient clinic at Ain Shams University Hospital on 80 persons were divided into 2 groups: (Group-I): 40 patient with NAFLD as a study group, (GroupII): Forty(40) healthy subjects as a control group. Result There was high statistically significant difference between the studied groups as regard LpPLA2. Conclusion The clinical use of Lp-PLA2, a biomarker for NAFLD, requires the standardization of analytical methods, characterization of analytical features, assessment of performance characteristics, incremental yield of different markers for given clinical indications, and demonstration of cost-effectiveness.

Colonoscopy versus Bowel Ultrasound in Assessment of Disease Activity and Severity in Patients with Ulcerative Colitis

Abstract Background Ulcerative colitis [UC] is a chronic inflammatory bowel disease characterized by relapsing and remitting episodes of inflammation usually limited to the mucosal layer of the colon. Treatment targets for UC patients nowadays include patient-reported as well as endoscopic remission. Recently, endoscopy is increasingly being used to guide treatment, because evidence suggests that mucosal healing is associated with improved long-term outcomes. However, it is challenging to repeatedly perform colonoscopies to assess mucosal disease activity due to the high cost and burden for the patient. Hence, alternative and reliable non-invasive methods to assess disease activity are needed. Aim of the Work The aim of this study is to to comparison colonoscopy versus bowel ultrasound in assessment of disease activity and severity in patients with Ulcerative Colitis. Patients and Methods This was a case control study, was conducted at Internal Medicine and Gastroenterology outpatient clinics in Ain Shams University over 90 patients suffering from morbid obesity and in whom surgical management is indicated. Participants were divided into two groups: Group (1): (n = 30) healthy individuals, matched for age and gender, group (2): (n = 60) Active and inactive (in remission) ulcerative colitis patients. Results The main findings of the study revealed that: There was no statistically significant difference between the studied groups as regard Demographic data. The mean age at diagnosis was 36.11 (±10.42 SD) with range (20-53), the mean duration of disease was 1.95 (±0.83 SD) and according to Disease extent there were 48 (80%) left-sided, 11 (18.3%) extensive and 1 (1.7%) pancolitis. There was high statistically significant difference between the studied groups as regard Laboratory investigations. There was high statistically significant difference between the studied groups as regard Radiological Examination. According to Endoscopic Findings there were 21 (35%) 0 or 1 (remission) and 39 (65%) 2 or 3 (active). There was high statistically significant relation between Endoscopic Findings and Laboratory investigations. There was high statistically significant relation between Endoscopic Findings and Radiological Examination. Conclusion BUS may represent a useful first-line, non-invasive tool for assessing endoscopic activity, severity, and extent, and may be helpful to determine in a rapid manner whether a significant flare has occurred and to guide the management of UC patients, delaying or avoiding colonoscopy when it is not needed. In addition, BUS may be preferred in clinical practice for monitoring disease course and for assessing short-term treatment response, reducing the necessity of repeated CS, although specific data on monitoring will be needed.

The Role of NF-κB, PPAR-α, and PPAR-γ in Older Adults with Metabolic Syndrome.

The etiopathogenesis of metabolic syndrome (MetS) has not been fully understood yet, and chronic low-grade inflammation is thought to be associated with the development of complications related to MetS. We aimed to investigate the role of Nuclear factor Kappa B ( NF-κB ), Peroxisome Proliferator-Activated Receptor- α and γ (PPAR-α, and PPAR-γ) which are the main markers of inflammation in older adults with MetS. A total of 269 patients aged≥18, 188 patients with MetS who met the diagnostic criteria of the International Diabetes Federation, and 81 controls who applied to geriatrics and general internal medicine outpatient clinics for various reasons were included in the study. Patients were separated into four groups: young with MetS (< 60, n=76), elderly with MetS (≥60, n=96), young control (< 60, n=31), elderly controls (≥60, n=38). Carotid intima-media thickness (CIMT) and NF-κB , PPAR-α, and PPAR-γ plasma levels were measured in all of the participants. Age and sex distribution were similar between MetS and control groups. C-reactive protein (CRP), NF-κB levels (p=0.001) and CIMT (p<0,001) of MetS group were significantly higher than in the control groups. On the other hand, the PPAR-γ (p=0.008) and PPAR-α (p=0.003) levels were significantly lower in MetS. ROC analysis revealed that the NF-κB, PPAR-α, and PPAR-γ could be used to indicate MetS in younger adults (AUC: 0.735, p<0.000; AUC: 0.653, p=0.003), whereas it could not be an indicator in older adults (AUC: 0.617, p=0.079; AUC:0.530, p=0.613). It seems that these markers have important roles in MetS-related inflammation. In our results, suggest that the indicator feature of NF-κB , PPAR-α and PPAR-γ in recognizing MetS in young individuals is lost in older adults with Mets.

Retrospective analysis of the relationship between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and glycemic regulation in patients with type 2 diabetes mellitus followed up at an internal medicine outpatient clinic

Background/Aim: Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increasing incidence worldwide and its effects are being seen in many countries. Insulin resistance is the main factor in the pathophysiology. T2DM leads to an increase in mortality and morbidity due to macrovascular and microvascular complications. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are effective parameters in monitoring the inflammatory response. The primary aim of this study was to investigate glycemic control in patients with type 2 diabetes by focusing on their correlation with inflammatory markers, such as NLR and PLR, glycated hemoglobin (HbA1c), and fasting blood glucose levels. Methods: The present study was carried out in 2022 within the purview of the Internal Medicine Clinic at Balikesir İvrindi State Hospital. Data from the initial annual consultations of patients with T2DM, either newly diagnosed or previously diagnosed and visiting for follow-up, were utilized. Our study excluded patients under the age of 18 and those diagnosed with cirrhosis, heart failure, type 1 diabetes mellitus, malignancy, epilepsy, acute infection, pregnancy, or chronic inflammatory disease. We further excluded those on medications including steroids, antivirals, anticonvulsants, antipsychotics, antithyroids, and chemotherapeutic drugs that impact the leukocyte count. Based on their HbA1c levels, patients were systematically categorized into two distinct cohorts: those with controlled blood sugar (HbA1c ≤7%) and those with uncontrolled blood sugar (HbA1c &gt;7%). In the ambit of this study, we incorporated data from 205 patients. We employed a cross-sectional study that retrospectively examined the correlation between NLR, PLR, and glycemic regulation in T2DM patients. SPSS 22.0 software was used to perform statistical calculations. Results: It was observed that patients with poor glycemic control had longer disease durations and this disparity bore statistical significance (P=0.005). Patients exhibiting poor glycemic control demonstrated elevated levels of CRP (C-reactive protein), a difference that reached statistical significance (P=0.003). The group exhibiting poor glycemic control demonstrated a notable elevation in NLR, indicating statistical significance (P=0.001). Although it was not statistically significant, PLR was found to be higher in patients with uncontrolled T2DM (P=0.441). Conclusion: This research investigates the correlation between HbA1c levels and inflammatory markers, specifically NLR and TLR, in T2DM patients who exhibit poor control of glycemia. Our findings highlight the potential of these markers as indicators of glycemic control, thus emphasizing the need for integrated strategies for managing inflammation and improving glycemic control in T2DM patients. The novelty of this area of research contributes to the scarcity of available literature, underlining the importance and timeliness of this study. Based on our findings, we suggest an increased focus on regular monitoring of inflammatory markers, for instance NLR and PLR, to assess the glycemic control in T2DM patients. The significant correlation of these markers with HbA1c levels implies that they could potentially serve as useful tools in personalizing diabetes management strategies, leading to improved patient outcomes. Not only does our research contribute to filling this knowledge gap, but it also underscores the potential for utilizing inflammatory markers in tracking disease progression and optimizing treatment efficacy in T2DM.

The Relationship Between Atherosclerotic Risk Factors and Female Gender

Introduction: Identification and control of cardiovascular risk factors form the basis of strategies for protecting cardiovascular health. However, according to the results of many studies, women are less aware of their own risk factors and participate less in screening programs than men. This study was conducted to determine the risk of experiencing atherosclerotic events and risk-related factors in women aged 40-79 years. Patients and Methods: This retrospective, cross-sectional analysis was conducted by the primary physician of the laboratory values used in atherosclerotic cardiovascular disease (ASCVD) risk assessment, who applied to the consultant outpatient clinics (pulmonary diseases, infectious diseases, nephrology, internal medicine outpatient clinics) in a training and research hospital between September and November 2021. The data of 131 female patients between the ages of 40-79 were analyzed. Results: The average age of the 131 women included in the study was 51.6 years. It was observed that women predominantly had three or four risk factors. The five most common risk factors identified were as follows: a total cholesterol level above 170 mg/dL (86.3%), menopause (65.6%), HDL cholesterol below 50 mg/dL (64.1%), systolic blood pressure above 130 mmHg (56.4%), and smoking (32.1%). In the study, when investigating the relationship between the ASVCD risk calculator, atherosclerosis risk factors, and the menopausal period, statistically significant associations were observed between age, systolic blood pressure, total cholesterol, HDL, LDL, 10-year risk ratio, optimal risk ratio, and lifetime risk ratio. Conclusion: The study determined that the average lifelong expected ASCVD risk among the women participating in the study, in terms of cardiovascular diseases, was 39.87 ± 8.81%. This finding highlights the significance of cardiovascular diseases and underscores the importance of conducting comprehensive risk assessments at the individual level to prevent them.

Evaluation of serum iron status indicators in patients with primary open angle glaucoma.

To investigate the relationship between serum iron status indicators (ferritin) levels and POAG. The files of all glaucoma patients who applied to the ophthalmology clinic between January 2018 and January 2022 were reviewed retrospectively. Laboratory data from fasting blood tests, internal medicine outpatient clinic reports, and extensive ophthalmologic examination data, including fundus photographs showing the optic disc, were collected from the files. A control group was formed from individuals with adequate general and eye health, age- and gender-matched individuals who had undergone examination in the ophthalmology clinic within the same date range. Serum iron status indicators and some laboratory data of POAG patients and healthy controls were compared. Of our participants, consisting of 65 patients with POAG and 72 healthy controls, 84 (61.32%) were female and 53 (38.68%) were male. It was observed that serum ferritin level was significantly higher in POAG patients compared to healthy controls, and the total iron binding capacity was significantly lower (respectively (p = 0.022), (p = 0.002). In logistic regression analysis, it was found that the risk of POAG increased in cases with high serum ferritin levels (OR = 0.982; p = 0.012). In addition, the risk of POAG was found to increase in cases where MCV was lower (OR = 1.121; p = 0.039). This study shows that higher serum ferritin levels are associated with a higher risk of POAG.

The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia.

Uncomplicated urinary tract infection (uUTI) is one of the most prevalent bacterial infections in clinical practice. Empirical treatment is used commonly; thus, knowledge of the local antimicrobial susceptibility pattern is crucial to avoid the growing antibiotic resistance. The aim of this study is to evaluate the effectiveness of the empirical treatment of uUTI and determine the susceptibility pattern for common uUTI causative microorganisms at outpatient clinics in hospitals in the Jazan region. This is a prospective observational study of 120 patients with uncomplicated urinary tract infections attending internal medicine outpatient clinics in Al-Hayat Jazan hospital, Saudi Arabia, from September 2021 to January 2023. In total, 120 patients were included in the study. The mean age of the participants was 48.53 ± 9.29. Risk factors for UTI were found in 57.5%, and type 2 diabetes mellitus (DM) was the major risk factor (27.5%). The most common causative microorganism was Escherichia coli (E. coli) (87.5%), followed by Klebsiella pneumoniae (5%), Staphylococcus aureus, Enterobacter spp., and Enterococcus spp. (2.5%). Nitrofurantoin was the most effective antimicrobial agent (sensitivity rate of 91.7%) against all microorganisms, followed by Ciprofloxacin (75%). This study concluded that nitrofurantoin and Ciprofloxacin are suitable empirical treatments for uncomplicated urinary tract infection in the Jazan region, and increased resistance against trimethoprim/sulphamethoxazole (TMPSMX) and cefaclor was observed; thus, empirical therapy with these agents should be reconsidered in local guidelines. Wide surveillance research is necessary to monitor effective empirical therapies and to evaluate the regional antimicrobial susceptibility pattern.

Is The Glycerol, Petroleum Jelly and Liquid Paraffin Mixture (Dexeryl®) an Adjunctive Therapy for Vitiligo of Autoimmune Origin? Toward a Novel Therapeutic Indication. About a Case

Introduction: Vitiligo, considered to have an autoimmune basis, is an acquired, non-contagious disorder characterized by progressive, patchy loss of pigmentation from skin, overlying hair, and oral mucosa. The treatment of vitiligo includes medicines or medicated skin creams, such as corticosteroids or a calcineurin inhibitor, phototherapy, Depigmentation, or removing color from dark areas, surgical techniques. The results from treatments can vary from one part of the body to another, and new patches may appear in the meantime Here, we report a case with complete remission of vitiligo of autoimmune origin under DMARDs and the glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®), of which we hypothesize that the glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®) would have played a role in rapid and complete vitiligo lesion regression. Clinical Observation: An 18-year-old Malian female presented to the internal medicine outpatient clinic with 3-months history of pruritic achromic skin patches. Concomitantly, this was associated with Gottron's papules, polyarthralgia with arthritis and exertional dyspnea for which the diagnosis of mixed connective tissue disease (MTCD) based on the EULAR/ACR 2019 criteria for systemic lupus erythematosus, EULAR/ACR 2010 criteria for rheumatoid arthritis with subcutaneous rheumatoid nodule, EULAR/ ACR 2013 criteria for systemic scleroderma, Bohan and Peter 1975 criteria for probable dermato-polymyositis and Kasukawa’s criteria 1988 for MTCD itself; and autoimmune hemolytic anemia (AHA) with positivity of the direct coombs test and the context of hemolysis were made. Vitiligo of autoimmune origin was considered because of the clinical context and the immunological disorder in this case. She was treated only with Disease-Modifying Anti-rheumatic Drugs (DMARDs) and glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®). The vitiligo lesion had completely resolved on 1-year follow-up visit in our case without specific vitiligo treatment. Discussion: The glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®) in our case was indicated for dry skin presentation. But we observed a rapid and complete vitiligo regression under this mixture associated with DMARDs. This is why, beside a controlled inflammation process by DMARDs, we suspected a role of glycerol, petroleum jelly and liquid paraffin mixture (dexeryl®) in melanocyte regeneration. Conclusion: This case would highlight a potential novel indication of glycerol, petroleum jelly and liquid paraffin mixtures (dexeryl®) in vitiligo of autoimmune origin. A clinical trial will be necessary to deeply appreciation this novel therapeutic property of glycerol, petroleum jelly and liquid paraffin mixtures (dexeryl®).