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The current Coronavirus disease outbreak requires that physicians work in collaboration with other physicians especially in intensive care and emergency units. To fight against this new disease, whose pathogenesis, effects, and results have not been clearly demonstrated, especially in patients with the pre-existing chronic disease, requires special expertise and perspectives. Due to the need for dynamic glucocorticoid treatment at different stages of the disease in patients with adrenal insufficiency, the existence of reports indicating that "coronavirus disease 2019" also affects the adrenal reserve, and the use of glucocorticoids also in advanced stages in patients with Coronavirus disease require this issue to be emphasized with precision. Herein, treatment of the pre-existing adrenal insufficiency in patients with actual Coronavirus disease and the effects of the this critical disease on the adrenal gland have been reviewed.

Abstract Background We aimed to compare the morphological characteristics of corneal endothelial cells in type 2 diabetic patients and age-matched healthy subjects by specular microscopy. We also aimed to determine the association of corneal morphological features with the general characteristics and laboratory data of diabetic patients, including disease duration, haemoglobin A1c (HbA1c) levels and urine albumin creatinine ratio. Methods A total of 195 diabetic patients and 100 healthy controls were enrolled in the study. All participants underwent a complete ophthalmological examination. Corneal endothelial measurements were performed using a noncontact specular microscopy. Laboratory data including serum fasting glucose, haemoglobin A1c levels, creatinine levels, and the urinary albumin-to-creatinine ratio were recorded. Diabetic patients were further subdivided into 3 groups according to the presence and stage of diabetic retinopathy. Specular microscopy findings and central corneal thickness of all patients were compared. Results The ECD and hexagonal cell ratio were significantly lower, while the average cell size, CV%, and central corneal thickness were determined to be significantly higher in diabetic patients than in healthy controls (p = 0.001). With the presence and advancement of diabetic retinopathy, the ECD and hexagonal cell ratio decreased, while the average cell size, CV%, and central corneal thickness increased. When correlation analysis was performed between corneal morphological features and laboratory data of diabetic patients, ECD showed a significant negative correlation with diabetes duration (p = 0.028). HbA1c levels, urinary albumin-creatinine ratio (p = 0.041), average cell size and CV showed a positive correlation with these parameters. Conclusion In conclusion, keratopathy is an important complication of type 2 diabetes. With an increase in the stage of diabetic retinopathy, alterations in corneal findings also increased. In that respect, we can suggest that keratopathy should be evaluated more cautiously in diabetic patients.

Introduction : Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. Material and methods : Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. Results: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. Conclusions : Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5±9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7±23.6 vs. 113.1±21.3, p

Cardiovascular diseases are the most common cause of mortality and morbidity in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), receiving haemodialysis, peritoneal dialysis, and renal transplantation (Rtx). Estimated glomerular filtration rate (eGFR) places Rtx patients in one of the stages of CKD. Therefore, Rtx patients might be considered a subset of CKD patients. Besides the traditional risk factors of hypertension, diabetes, and dyslipidaemia, advanced-age novel risk factors such as endothelial dysfunction, vascular calcification, and increased chronic low-grade inflammation are highly prevalent and seem to play a more important role for vascular disease in CKD and Rtx patients compared to the general population. The role of Rtx in terms of atherogenesis and chronic ongoing low-grade inflammation is still unclear. To date, in the literature, the data are scant regarding the relationship between atherosclerosis, chronic inflammation, and cardiovascular events in Rtx patients with well-functioning kidneys. This review will discuss classical and recent epidemiological, pathophysiological, and clinical aspects of atherosclerosis and inflammation in Rtx patients.

Presented here is a case of long-term lithium use, with multiple emerging lithium-associated side effects. An 82-year-old woman was brought into the emergency department because of loss of consciousness. According to the physical examination and laboratory analyses, patient was diagnosed with lithium-associated hypercalcemia, hyperparathyroidism, nephrogenic diabetes insipidus (NDI), symptomatic sinus bradycardia, and thyroid dysfunction. In the literature, there is a limited number of case reports with lithium induced multiple clinical conditions. Multiple clinical manifestations due to the side effects of chronic lithium use might be seen. Health care professionals should keep in mind that lithium-related side effects might trigger or exacerbate each other. To avoid toxicity, close follow-up and clinical supervision are important for the early diagnosis and treatment of these side effects, due to the narrow therapeutic index and obscure clinical signs and symptoms of toxicity.

Aim: Diabetes mellitus (DM) is a common metabolic disease. Early diagnosis of diabetes prevents the increase in mortality and morbidity due to complications. The oral glucose tolerance test (OGTT) is a test used in the diagnosis of DM and in the determination of impaired glucose tolerance (IGT). In our study, it was aimed to evaluate the satisfaction of patients who underwent OGTT. Methods: A 25-question questionnaire was applied to 300 patients who underwent OGTT, aiming to evaluate their satisfaction. The physical and psychological status of the patients was examined before, during, and after the test. Results: Patients who were informed about the test before the test experienced less nausea during fluid intake (p=0.005). Approximately 58.7% of the participants agreed to repeat the test. Those who felt nauseous or hungry during the test were statistically less likely to accept retesting. The retest acceptance rates were statistically higher (p

Amaç: Bu çalışmada, obez hastalarda retinal mikrovasküler yapısında meydana gelen değişiklikleri değerlendirmeyi ve bu değişikliklerin klinik özelliklerle ilişkisini belirlemeyi amaçladık. Gereç ve Yöntemler: Tüm katılımcılarda kolesterol, açlık kan şekeri, açlık insülini,CRP ve HbA1C düzeylerini içeren biyokimyasal incelemeler yapıldı. Plazma aterojenik indeksi(AI) plazma trigliserid (TG) düzeyinin yüksek yoğunluklu lipoprotein (HDL) düzeyine oranının logaritması [log (TG/HDL-K)] olarak hesaplandı. Vücut Kitle İndeksi (VKİ) ≤25 kg/m2 olan hastalar kontrol grubuna dahil edildi. Obez hastalar VKİ'lerine göre üç gruba ayrıldı: grup 1 (VKİ: 30-34,99 kg/m2), grup 2 (VKİ: 35-39.99 kg/m2) ve grup 3 (VKİ ≥ 40 kg/m2) . Optik koherens tomografi anjiografi (OKT-A) ile foveal avasküler zon (FAZ), makulada yüzeyel ve derin kapiller pleksusun damar dansitesi (VD) ile radial peripapiller kapiller pleksus VD ölçüldü. Bulgular: Çalışmaya 27 kontrol ve 83 obez hasta olmak üzere toplam 110 hasta dahil edildi. Kontrol vakalarına kıyasla obez hastalarda HbA1C, açlık insülini, HOMA-IR, C-reaktif protein ve AI seviyeleri anlamlı derecede yüksekti. Obez hastalarda retinanın yüzeyel (p=0,003) ve derin (p=0,001)VD'leri anlamlı olarak azaldı ve FAZ anlamlı olarak arttı (p=0,032). Klinik özellikler ile OKT-A bulguları arasında yapılan korelasyon analizinde yüzeyel ve derin VD'ler yaş, VKİ, HbA1C ve AI ile ters orantılıydı. Sonuç: Obez hastalarda retina yüzeyel ve derin VD'leri azalmıştı ve retinal VD'ler ile yaş, VKI, HbA1C ve AI arasında ters bir ilişki vardı.