Internal Medicine Outpatient Clinic Research Articles

Vogt-Koyanagi-Harada Disease Diagnosed in a Black-Skinned Woman in Internal Medicine

Introduction: Vogt-Koyanagi-Harada disease, initially described as an uveomeningoencephalitic syndrome, is a systemic granulomatous autoimmune disease that targets melanocyte-rich tissues, such as the eye, inner ear, meninges, skin and hair. It is one of the most prevalent causes of noninfectious uveitis affecting, more frequently, individuals of pigmented skin, such as Asians, Middle Easterners, Hispanics and Native Americans. However, it is very infrequent among persons of African descent. Here, we report on a case in a black-skinned woman in internal medicine. Clinical Observation: A 45-year-old Malian black-skinned woman with no history of ocular trauma or intraocular surgery presented at internal medicine outpatient clinic with 3-months history of achromic skin patches over the face and trunk, bilateral visual disturbance, bilateral hearing loss with tinnitus and headache. Dermatological examination revealed bilateral, symmetrical achromic lesions over the back, buttocks and eyelids, with scalp poliosis; and perioral pityriasis versicolor lesions. She had no alopecia or other dermatological lesions. Ophthalmological examination revealed a profound drop in visual acuity. Oto-rhino-laringologic examination revealed a discreet hearing loss. Ophthalmological investigations revealed bilateral posterior panuveitis on funduscopic examination, bilateral chronic iridocyclitis on slit- lamp examination, and bilateral choroidal thickening on ocular ultrasound. The diagnosis of Vogt-Koyanagi-Harada was retained, based on the diagnostic criteria established by the American Society for the Study of Uveitis (UAS) in 1978. Prednisone at a dose of 1.5 mg per kilogram tapering courses with adjuvant treatment was initiated. The ophthalmologist's prescription consisted of 1% atropine eye drops, 0.25% timoptol eye drops and dexamethasone eye drops which had been discontinued because of systemic cortitherapy; and that of the dermatologist, Hydrocortisone butyrate 0.1% cream, .......

Retrospective Investigation of Viral Hepatitis Seroprevalence in Patients Admitted at the Outpatient Clinics of Internal Medicine

ABSTRACT
 Aim: Viral hepatitis agents include Hepatitis B and Hepatitis C virus, which cause an important public health problem due to serious complications. Patients examined at the outpatient clinics of internal medicine are among main risk groups, as they have concomitant diseases and undergo various procedures. We aimed to investigate retrospectively the seroprevalence of viral hepatitis in outpatients in internal medicine in our region.
 Material and Methods: HBsAg and Anti-HCV parameters, and demographic data such as age and gender of patients admitted at the outpatient clinics of internal medicine at our hospital between January 2017 and July 2022 were retrospectively evaluated, with HBV-DNA and HCV-RNA levels of those who showed reactivity.
 Results: HBsAg test results of 2618 patients and Anti-HCV test results of 2943 patients were obtained in this study. The mean age of patients with HBsAg tests was 34.2±15.7, and mean age of patients with Anti-HCV test was 34.3±15.7 years. HBsAg reactivity rate was 0.9%; and the mean age of patients showing reactivity was 47.7±14.4 years. Anti-HCV reactivity rate was %0.1, with a mean age of 52.6±21.3 years. Both HBsAg and Anti-HCV reactivity was not present at the same patient in our study.
 Conclusion: Early diagnosis of Hepatitis B and Hepatitis C viruses decrease the risk of developing complications, easing treatment processes and decreasing the risk of contagion. Thus, increasing use of screening tests as part of preventive medicine is very important.

Clinical and laboratory factors associated with hospitalization and mortality in the COVID-19 pandemic

Introduction: This study aimed to investigate the relationship between MPV and disease prognosis in patients with COVID-19, the chronic diseases that affect the prognosis of COVID-19, and the laboratory data that can help diagnose this disease and provide information about the course of the disease during the treatment process. Methods: The study was conducted in a cross-sectional format. All participants gave written, informed consent to participate. A questionnaire consisting of two parts, including categorical (socio-demographic) data and laboratory data, was applied to people who had COVID-19 who applied to the internal medicine outpatient clinic of the hospital. The Pearson chi-squared test and Fisher exact test were used for comparing categorical variables. The Mann-Whitney U test, or Kruskal-Wallis test with Bonferroni post hoc comparisons, was used to compare numerical variables between the groups. All analyses were performed using the SPSS 25.0 (SPSS Inc., Chicago, IL, ‎USA) software package. Results: The participants' mean (±SD) age was 40.8±13.7 years (median: 40, range: 18 – 72). Almost half of the participants (48.0%, n=98) were male, the majority (76.0%, n=155) were married, and 24.0% (n=49) were single. Of the 204 patients, 28 (13.7%) were hospitalized, and five died (2.5%). Of the five patients who died, three had chronic lung disease, one had diabetes and chronic lung disease, and one had no chronic disease. Conclusion: Older age and the presence of chronic diseases are important factors affecting hospitalization in patients with COVID-19. LDH, CRP, and ferritin levels were high, and the mean platelet volume levels were significantly higher in hospitalized patients. Keywords: COVID -19, pandemics, prognosis of COVID -19

The Effect of Language Concordance on Health Care Relationship Trust Score.

Various barriers exist for Limited English Proficient (LEP) patients in the United States healthcare system, including language barriers. To address language access, interpreters have been used as well as physicians who speak the same language (language concordance), with unknown effect. By studying the strength of patient-physician relationships under different communication parameters, such as the use of a variety of language services, we can better understand healthcare interactions and move toward optimizing patient care and health outcomes.This study investigates the importance of language-concordant care in LEP populations to build trusting patient-physician relationships. To determine whether Spanish-speaking patients who receive health care from language-concordant (in this study, Spanish-speaking) physicians have higher total trust scores on the Health Care Relationship (HCR) Trust scale than patients who useprofessional or ad hoc interpreters. This is a prospective survey conducted on Spanish-speaking adult patients coming to family and internal medicine outpatient clinics in the Phoenix, AZ, metro area. Of 214 recruited subjects, 176 completed the survey. Primary outcomes of the study: measured total mean Health Care Relationship (HCR) trust score among three groups (language concordant, professional interpreter, ad hoc interpreter). Secondary outcomes of the study: variance of trust scores among three groups for individual survey items. Results: The group with language concordant providers had a mean trust score of 48.73, significantly higher than the mean for the group with ad hoc interpreters with a mean of 45.53 (p = 0.0090). Patients with a professional interpreter also had a higher mean trust score of 48.27 than the ad hoc interpreters (p = 0.0119). There were several individual questions where the professional language groups had statistically significantly higher HCR trust scoresthan the ad hoc interpreter group in terms of their trust in specific instances, i.e., involving the patient in discussing treatment options, making the patient feel worthy of the doctor's time, and their doctor telling them the whole truth. There were no differences in overall mean scores or individual scores for the two professional language groups (language concordant providers and professional interpreters). The results reinforce the current understanding that professionally acknowledged and trained speakers of a second language in the medical setting allow for the formation of stronger patient-physician relationships, specifically in terms of a patient's trust in their physician. In addition to continuing to increase the availability of high-quality interpreters, the same effort should be placed on increasing the diversity of languages spoken by physicians to foster trusting patient-physician relationship formation.

A simple proof of vitamin D deficiency and inflammation relation: single center study, over two thousand patients

Aim: Vitamin D deficiency is a very common condition in the world. Although vitamin D appears to be effective mainly on calcium and bone metabolism, it is an important molecule that also affects immune functions and inflammation. In our study, we tried to evaluate the contribution of vitamin D deficiency to inflammation by examining the platelet indices of patients with low and normal vitamin D levels. Methods: Healthy patients who applied to internal medicine outpatient clinics of our hospital for routine control in 2017 were included in our study. Patients are included in the study by following needed criteria; creatinine <1.3 mg/dl, hemoglobine >12 gr/dl, vitamin B12 >150 pg/dl, red cell distribution width <14 fL, thyroid stimulating hormone (TSH) between 1-5 IU/L and C-reactive protein (CRP) <10 mg/dl. Patients were divided into two groups, those with vitamin D less than 10 ng/ml as the study group and those above 30 ng/ml as the control group. Results: A total of 2179 patients, 644 male and 1535 female, were included in the study. 797 patients constituted the study group (27.1% male), and 1382 patients constituted the control group (31% male). When the two groups were compared in terms of platelet indices, we found that mean platelet volume (MPV) and plateletcrit (PCT) were significantly higher in the study group (p<0.001, p<0.001). Conclusion: In our study, we found that MPV and PCT values increased significantly with vitamin D deficiency. We attributed this result to the absence of the anti-inflammatory activity of vitamin D. As a result, treating a patient’s vitamin D deficiency can also protect patients from cardiovascular or autoimmune diseases through the anti-inflammatory effect of vitamin D.

Evaluation of machine learning algorithms for renin-angiotensin-aldosterone system inhibitors associated renal adverse event prediction

BackgroundRenin-angiotensin-aldosterone system inhibitors (RAASi) are commonly used medications. Renal adverse events associated with RAASi are hyperkalemia and acute kidney injury. We aimed to evaluate the performance of machine learning (ML) algorithms in order to define event associated features and predict RAASi associated renal adverse events. Materials and MethodsData of patients recruited from five internal medicine and cardiology outpatient clinics were evaluated retrospectively. Clinical, laboratory, and medication data were acquired via electronic medical records. Dataset balancing and feature selection for machine learning algorithms were performed. Random forest (RF), k-nearest neighbor (kNN), naïve Bayes (NB), extreme gradient boosting (xGB), support vector machine (SVM), neural network (NN), and logistic regression (LR) were used to create a prediction model. Results409 patients were included, and 50 renal adverse events occurred. The most important features predicting the renal adverse events were the index K and glucose levels, as well as having uncontrolled diabetes mellitus. Thiazides reduced RAASi associated hyperkalemia. kNN, RF, xGB and NN algorithms have the highest and similar AUC (≥ 98%), recall (≥ 94%), specifity (≥ 97%), precision (≥ 92%), accuracy (≥ 96%) and F1 statistics (≥ 94%) performance metrics for prediction. ConclusionRAASi associated renal adverse events can be predicted prior to medication initiation by machine learning algorithms. Further prospective studies with large patient numbers are needed to create scoring systems as well as for their validation.

Severe depressive symptoms in patients with hypertension: Are antihypertensive medications implicated?

This study examined whether antihypertensive medications and other patient characteristics are associated with severe depressive symptoms in a patient with hypertension. Patients with a diagnosis of hypertension were recruited from the internal medicine outpatient clinics of a hospital in Amman, Jordan, into this cross-sectional study. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9); anxiety by the General Anxiety Disorder-7; sleep quality by the Insomnia Severity Index; and psychological stress by the Perceived Stress Scale. Multivariable binary logistic regression was used to examine the association between the different classes of antihypertensive medication and depressive symptoms. Of the 431 participants, 282 (65.4%) were men; 240 (55.7%) reported having type 2 diabetes; 359 (83.3%) had dyslipidemia; 142 (32.9%) were on beta-blockers; 197 (45.2%) were on ACE inhibitors or angiotensin receptor blockers; 203 (47.1%) were on metformin; and 133 (30.9%) were taking sulfonylurea. Severe depressive symptoms, indicated by scoring above the cut-off of 14 on the PHQ-9, was present in 165 (38.3%) patients. Severe depression was associated with younger age (<55years) (OR = 3.15, 95% CI = 1.829-5.41, P < 0.001), unemployment (OR = 2.15, 95% CI = 1.15-4.00, P = 0.01), diabetes (OR = 1.81, 95% CI = 1.09-3.02, P = 0.02), severe anxiety (OR = 6.40, 95% CI = 3.64-11.28, P < 0.001), and severe insomnia (OR = 4.73, 95% CI = 2.85-7.82, P < 0.001). Severe depressive symptoms were not associated with antihypertensive medications or other drugs used by hypertensive patients. Instead, age, diabetes, anxiety, and insomnia were the primary correlates of depression.

Kronik Hastalığı Olan Hastalarda Bağırsak Parazitlerinin Değerlendirilmesi

Objective: Parasitic diseases concern all segments of society, especially children in the growing age. Intestinal parasites not only cause mental and physical development retardation, but also cause loss of work force with the complaints they cause, negatively affecting both physical and mental health and the country's economy. In this study, we aimed to evaluate intestinal parasites in patients with chronic diseases. Methods: The files of patients who applied to the internal medicine outpatient clinic between 01.01.2022 and 31.12.2022 and underwent direct stool microscopy in the Parasitology Laboratory of Ordu University Medical Faculty were retrospectively scanned. The patients were divided into 2 groups as those with chronic disease and those without chronic disease. As a chronic disease; Diabetes Mellitus, hypertension, chronic heart disease, chronic heart failure, asthma, chronic obstructive pulmonary disease, other chronic lung diseases, chronic kidney failure, chronic liver failure, goiter diseases, rheumatic diseases were taken as. Socio-demographic characteristics of the patients such as age, gender, educational status, economic status and marital status, and stool microscopic examinations were recorded. Results: 385 patients were evaluated in the study. It consisted of 281 female and 104 male patients. 209 patients with chronic disease were identified. There is a significant relationship between age, marital and educational status and chronic diseases in the comparison of those with and without chronic disease according to their socio-demographic characteristics (P&amp;lt;0.005). Conclusion: There was no significant difference between those with and without chronic disease in terms of intestinal parasites. However, it has been suggested that controlled studies are needed by increasing the number of patients in the patient groups.

Reasons for requesting an interferon gamma release test from internal medicine and rheumatology clinics and evaluation of the results

Background/Aim: Tuberculosis is a disease involving many systems, such as the lung, gastrointestinal system, genitourinary system, etc. Detecting this disease in its latency significantly reduces the morbidity and mortality associated with tuberculosis. One of the tests used in latent TB screening is the interferon gamma release test. In rheumatology practices, it is routinely used to screen for latent tuberculosis infections before treatment with biological agents and Janus kinase (JAK) inhibitors, and it can also be used to exclude tuberculosis infection in clinical practice. In our study, we aimed to evaluate the reasons for requesting interferon gamma release tests and the results of this test in patients who requested it. Methods: Patients admitted to internal medicine and rheumatology outpatient clinics were retrospectively screened within the retrospective cohort study. In total, 364 patients who requested interferon gamma release testing were included in the study. Nine patients with unclear test results were excluded. Laboratory results, demographic data, reasons for requesting the interferon gamma release test, and results were evaluated. Results: The interferon gamma release test was requested by 355 patients. Of these, 266 patients (74.9%) asked for latent tuberculosis screening before treatment with biological agents and JAK inhibitors. This was followed by patients with peripheral lymphadenopathy-lung nodules, patients with unexplained elevated acute phase reactants, and patients with constitutional symptoms, respectively. Ten out of 107 patients (9.3%) had an active tuberculosis infection, while six out of ten patients (60%) had pulmonary tuberculosis, and four (40%) had extrapulmonary tuberculosis. Conclusion: The most common reason for requesting the interferon gamma release test in internal medicine and rheumatology clinics was screening for latent tuberculosis before treatment with biologic agents and JAK inhibitors. In internal medicine, it has been observed that this test can also be requested by patients with constitutional symptoms, unexplained elevated acute phase reactants, and a preliminary diagnosis of tuberculosis in order to rule out or strengthen the preliminary diagnosis.

Association between oral frailty and cystatin C-related indices-A questionnaire (OFI-8) study in general internal medicine practice.

Cystatin C-related indices such as the ratio of creatinine to cystatin C (Cr/CysC) and the ratio of estimated glomerular filtration rate by cystatin C (eGFRcys) to creatinine eGFRcre (eGFRcys/eGFRcre) levels have been shown to be associated with muscle mass and strength and can be markers of sarcopenia. Oral frailty is defined as an age-related gradual loss of oral functions, accompanied by a decline in cognitive and physical functions. It results in adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, poor quality of life, and increased hospitalization and falls. Therefore, poor oral health among the elderly is an important health concern due to its association with the pathogenesis of systemic frailty, suggesting it to be a multidimensional geriatric syndrome. The Oral Frailty Index-8 (OFI-8) is a questionnaire that can be used for easy screening of oral frailty. This study aimed to investigate whether cystatin C- related indices are different between patients with low to moderate risk of oral frailty and those at high risk of oral frailty, using the OFI-8 in attending a general internal medicine outpatient clinic. This is a cross-sectional study that included 251 patients with a mean age of 77.7±6.6 years and a median age of 77 years (128 men: mean age, 77.1±7.3 years; median age, 77 years and 123 women: mean age, 78.4±5.7 years; median age, 78 years) attending general internal medicine outpatient clinics. OFI-8 scores were tabulated by gender to determine whether there were differences between patients at low to moderate risk of oral frailty (OFI-8 score ≤3 points) and those at high risk (OFI-8 score ≥4 points) in Cr/CysC, eGFRcys/eGFRcre levels, height, weight, grip strength, etc. were examined. The OFI-8 score was higher in women than in men, suggesting that oral frailty is more common in women. Cr/CysC, eGFRcys/eGFRcre and grip strength were significantly lower in both men and women in the high-risk group for oral frailty (OFI-8 score ≥ 4). Height, hemoglobin level, red blood cell count, and serum albumin levels were significantly lower in men with an OFI-8 score ≥4. Receiver operating characteristic curve (ROC) analysis also showed that Cr/CysC and eGFRcys/eGFRcre were significantly associated with an OFI-8 score≥4 in both men and women. Cr/CysC and eGFRcys/eGFRcre were significantly lower in the high-risk group for oral frailty on the OFI-8in both men and women. A relationship exists among cystatin C-related indices, which can effectively screen systemic frailty. Similarly, the OFI-8 score can be used to effectively screen oral frailty. Thus, a collaboration that incorporates both systemic and oral frailty from medical and dental perspectives is required.

Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study.

Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles. We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed. Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels. Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.

Better renal replacement therapy to improve sexual function in female patients with end-stage renal disease: A cross-sectional study.

Sexual dysfunction is commonly observed in patients with end-stage renal disease (ESRD). Sexual dysfunction in correlation with ESRD is associated with physiological and psychological problems resulting in low sexual desire, arousal, difficulties in achieving orgasm, and pain during intercourse. Studies on female sexual dysfunction (FSD) in correlation with renal replacement therapy are limited, and previous studies reporting contradictive results have indicated that the best modality for providing better outcomes (especially on FSD) remains unclear. Thus, this study aimed to compare the sexual function between female patients with ESRD who were on continuous ambulatory peritoneal dialysis (CAPD) and those on hemodialysis (HD). This study enrolled female patients who were randomly selected from the urology and renal division of the Internal Medicine Outpatient Clinic of our hospital from January 2020 to August 2021 and divided into the following groups: predialysis, HD, CAPD, and control groups. The participants were asked to fill out the Female Sexual Function Index (FSFI) questionnaires, and their data were recorded and analyzed using GraphPad Prism 9.0.0. Of the 280 patients, 200 female patients were included in this study. The rate of FSD (cutoff: 26.55) was 42% in the control group, 72% in the predialysis group, 62% in the CAPD group, and 66% the in HD group. The control group had a higher mean score in all parameters (p < 0.05). The total FSFI mean score indicated no significant difference (p > 0.05) between the patients on HD and those on CAPD; the mean of each point was almost identical except for satisfaction, which was higher among patients on CAPD (p < 0.05). Significant differences in the components of desire, arousal, orgasm, and satisfaction were observed between the groups. Patients on CAPD had better FSFI scores than the female patients with ESRD who were on HD, and the scores of both groups of patients were better than those of the predialysis group.

Assessment of an integrated psychiatric pharmacy practice within a rural internal medicine clinic

<h2>Abstract</h2><h3>Background</h3> One-fifth of all adults in the United States have a mental health disorder. More than 60% of rural Americans live in a mental health provider shortage area. However, psychiatric pharmacist integration has not been widely used to full capacity at many rural, private institutions. <h3>Objective</h3> To assess the impact of psychiatric pharmacist integration into an outpatient, rural primary care office. <h3>Practice description</h3> A rural health institution that provides both inpatient and outpatient care. <h3>Practice innovation</h3> A psychiatric pharmacist was integrated within the outpatient internal medicine clinic. On referral from the primary care provider, the pharmacist, in consultation with the primary care provider, can make pharmacotherapy and monitoring recommendation and determine time to follow-up. <h3>Evaluation methods</h3> Single-center, retrospective cohort study from July 1, 2018, to May 23, 2022, with 3 main components: (1) patient outcomes using a within-subject comparison; (2) potential revenue from billable services and pharmacist interventions from all encounters September 12, 2019, to May 23, 2022; and (3) provider satisfaction using an adapted, anonymous survey. Descriptive statistics or percentages were used for both primary and secondary end points. A McNemar test was performed for repeated measures of nominal data, and a Wilcoxon matched-pairs signed rank test was used to analyze continuous data. A <i>P</i> value of < 0.05 was considered statistically significant. <h3>Results</h3> A statistically significant increase in guideline-driven treatments was seen after psychiatric pharmacist integration. A statistically significant improvement in Patient Health Questionnaire-9 scores was also seen after pharmacist integration in contrast to standard of care. Provider time and health care utilization also showed positive results after pharmacist integration. A total of $29,600 is estimated to have been billable for pharmacist services, and clinic staff perceptions of pharmacist integration proved positive. <h3>Conclusion</h3> Psychiatric pharmacist integration showed a statistically significant positive impact on patient care in a rural internal medicine outpatient clinic.

A case of malignant melanoma presented with lombar vertebra fracture

Aims: Malignant melanoma is a type of skin cancer with a very poor prognosis. It is the most common skin cancer. Metastases are frequently observed in malignant melanoma, which can have a very aggressive course, even without skin findings. Here, we aimed to report a malignant melanoma case presenting with lumbar vertebra fracture, which is a unique form of presentation. Case description: A 31-year-old male patient was admitted to the internal medicine outpatient clinic with complaints of low back pain and inability to walk 15 days ago. After the first hour sedimentation value was found to be 101 in the examinations of the patient who came with the complaint of low back pain, he was referred to the hematology department with the preliminary diagnosis of multiple myeloma. Bone marrow aspiration and biopsy was performed. Non-hematopoietic cells were observed in bone marrow aspiration. L2 vertebra fracture was detected in lumbar MRI of the patient with bilateral limitation of movement in the lower extremities. The patient with L2 vertebral fracture was transferred to the neurosurgery service for operation. The patient was diagnosed with malignant melanoma after the frozen biopsy sent after the operation and the previous bone marrow biopsy. Conclusions: Bone marrow infiltration can be seen in malignant melanoma patients. However, a malignant melanoma patient presented with lombar vertebra fracture has not been reported before in the literature.

An Investigation of Diabetes Mellitus and Vitamin D Deficiency in Patients Presented to Internal Medicine Outpatient Clinic

Introduction: Vitamin D deficiency plays a role also in the occurrence of autoimmune diseases, including heart disease, cancer, inflammatory bowel diseases, diabetes, and rheumatological diseases. In addition, vitamin B12 deficiency, one of the autoimmune diseases, can also be seen in cases of Vitamin D deficiency. Furthermore, Vitamin D is also associated with insulin secretion and increased insulin sensitivity in target cells, and relevant studies reported Vitamin D deficiency at the initial stage of diabetes mellitus (DM). Accordingly, the present study aimed to investigate the relationship between Vitamin D, DM, Vitamin B12, and ferritin in patients presented to the internal medicine outpatient clinic. Materials and Methods: The data from adults aged 18 years and over, who presented to the Internal Medicine Outpatient Clinic of the Mersin City Training and Research Hospital between 01 June 2021 and 31 December 2021 were retrospectively investigated. Results: 476 (95.2%) patients had vitamin D levels below 30 ng/ml, 20 (4.0%) had vitamin B12 levels below 200 pg/ml, and 319 (63.8%) patients had ferritin levels below 20 ng/ml. There was a significant decrease in ferritin in female gender (p

The effects of education on foot care behaviors and self-efficacy in type 2 diabetes patients.

Diabetic foot significantly affects the quality of life of patients with diabetes. It leads to loss of labor force, psychosocial trauma, and high treatment costs due to serious morbidity and mortality. Nurses have an important responsibility to improve the metabolic status of individuals with diabetes, to protect them from foot complications, and to teach patients foot care skills. This study investigated the effects of education on type 2 diabetes patients regarding diabetic foot care and self-efficacy. This quasi-experimental study was conducted from February to July 2016 in hospitals located in the city of Balıkesir in Turkey with type 2 diabetes patients who were admitted to the internal medicine clinic and monitored by the endocrinology and internal medicine outpatient clinics. G*power 3.1.9.2 software was used to calculate the sample size of 94 people with a 5% type 1 error, and 90% power. The study was carried out with stratified randomization, and a questionnaire was administered to the experimental and control groups. The experimental group received training, and both groups' scores on the Diabetic Foot Behavior Questionnaire [Appendix 1] and the Diabetic Foot Care Self-Efficacy Scale [Appendix 2] were compared after three months. The t-test, the paired t-test, and the Chi-square test were used. While the self-efficacy and the foot care behavior scores of the control group did not show any differences (P > 0.05), the experimental group's scores were significantly higher (P < 0.05). The control group's self-efficacy and foot care behavior scores on the pre-test and final test were similar, while the experimental group's scores increased (P < 0.05). Starting from the diagnosis of diabetes, it is advisable to carry out foot assessments and to follow up with diabetics who received foot care education to increase their self-efficacy, to make foot care a habit, and to re-evaluate missing or incorrect practices during check-ups.

The Relationship Between Sociodemogaphic Characteristics of Patients Appliying to an Internal Medicine Outpatient Clinic and Sources of Information about the COVİD-19 Pandemic

The Relationship Between Sociodemogaphic Characteristics of Patients Appliying to an Internal Medicine Outpatient Clinic and Sources of Information about the COVİD-19 Pandemic

The relationship between renal renal resistive index and hypertensive end-organ damage

Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients. Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria). Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034). Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.

Relationship between vitamin D levels and hematological parameters

Objective: This study aims to examine the relationship between serum vitamin D levels and hematological parameters, and body mass index. Material and Methods: It was carried out in the internal medicine outpatient clinic of Ayancık State Hospital between April 2017 and November 2020. Information about the sociodemographic and laboratory values of the patients was obtained from the hospital information system. The patients were divided into two groups as those with vitamin D levels below 20 ng/ml and those with over 30 ng/ml. Vitamin D levels and hematological parameters of all patients were examined. Results: Of the 343 patients included in the study, 277 were women. When vitamin D levels were evaluated, vitamin D levels were significantly lower in women (82.7%; n:244) according to gender (p=0.023). When vitamin D levels are assessed according to age, It was observed that the vitamin D level of the patients included in the study, especially in the advanced age group, was low. There was no significant difference between vitamin D levels and body mass index (p=0.138). Age, MCV, MPV, HDL, Calcium (Ca), Phosphorus, Vitamin B-12, Vitamin D levels were found to be significantly higher in female patients with adequate vitamin D levels (p&lt;0.05). Conclusion: In our study, it was observed that there was a significant relationship between vitamin D levels, age, gender, platelet level, monocyte, MCV, neutrophil, protein, HDL, calcium, and vitamin B12 levels. Beside the treatment and clinical examinations, it is necessary to monitor and evaluate the vitamin D levels of the patients, as well as hematological, biochemical and endocrinological parameter changes.

Clinical Investigation of Leukocyte DNA Damage in COVID-19 Patients

This prospective cross-sectional study aimed to evaluate leukocyte DNA damage in coronavirus disease (COVID-19) patients. In this study, 50 COVID-19-positive patients attending the Erzurum City Hospital Internal Medicine Outpatient Clinic and 42 control group patients were included. DNA damage was detected in living cells through leukocyte isolation in 50 COVID-19-positive patients using the comet assay method. DNA tail/head (olive) moments were evaluated and compared. White blood cells (WBC), red blood cells (RBC), hemoglobin (HGB), neutrophils (NEU), lymphocytes (LYM), eosinophils (EO), monocytes (MONO), basophils (BASO), platelets (PLT), and the neutrophil/lymphocyte ratio (NLR) were analyzed. The RBC, lymphocyte, eosinophil, and monocyte means were significantly higher in the control group (p < 0.05), whereas the HGB and neutrophile means were significantly higher in the study group (p < 0.05). There were significant negative correlations between COVID-19 and RBC (r = -0.863), LYM (r = -0.542), EO (r = -0.686), and MONO (r = -0.385). Meanwhile, there were significant positive correlations between COVID-19 and HGB (r = 0.863), NEU (r = 0.307), tail moment (r = 0.598), and olive moment (r = 0.582). Both the tail and olive moment mean differences were significantly higher in the study group, with higher ranges (p < 0.05). COVID-19 infection caused statistically significant increases in both the tail and olive damage percentage in patients, causing DNA damage. Lastly, the NLR rate was associated with the presence and progression of COVID-19.