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Objective: Nonalcoholic fatty liver disease (NAFLD) is more prevalent in patients with obesity, diabetes, and metabolic syndrome, which are risk factors for nonalcoholic steatohepatitis and liver fibrosis. NAFLD is related to cardiovascular outcomes in diabetes. We aimed to investigate the relationship between diabetic complications and NAFLD fibrosis score (NFS) and Fibrosis-4 score (FIB-4). Methods: Three hundred patients with type 2 diabetes mellitus (T2DM) were retrospectively evaluated according to NAFLD diagnosis on ultrasound in outpatient clinic. Risk of advanced fibrosis was estimated using FIB-4 and NFS. Diabetic complications of the patients were noted. Results: Presence of diabetic retinopathy is related to FIB-4 (P = 0.001) and NFS (P < 0.001) scores. NFS score (P = 0.037), not FIB-4 (P = 0.517), is related to diabetic nephropathy. Among macrovascular complications, only coronary artery disease is related to NFS and FIB-4 scores (P = 0.037 and P = 0.004, respectively). Although we cannot establish any association between fasting blood glucose, glycosylated hemoglobin (HbA1c) values and noninvasive liver fibrosis scores (P > 0.05), diabetes duration, and age positively correlated with the FIB-4 score (P = 0.033, P = 0.001). In logistic regression analysis, NFS > 0.676 values are associated with increased rates of diabetic retinopathy, independent of age, sex, HbA1c, and duration diabetes (odds ratio: 1.155, P = 0.030). FIB-4 has no relation with microvascular complications according to logistic regression analysis (P > 0.05 for all). Neither FIB-4 nor NFS has an effect on the presence of macrovascular complications (P > 0.05 for all). Conclusion: Our findings suggest that increase in NFS score is associated with the presence of diabetic retinopathy, independent of confounding factors. Further studies are needed on the applicability of noninvasive fibrosis scores in monitoring the presence of diabetic microvascular and macrovascular complications. [ABSTRACT FROM AUTHOR]

Copyright of Kafkas Journal of Medical Sciences / Kafkas Tıp Bilimleri Dergisi is the property of Kafkas Journal of Medical Sciences, Kafkas Tip Bilimleri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim of the study: There is a close relationship between the development of diabetes and nonalcoholic fatty liver disease (NAFLD). The aim of the study was to determine the frequency and associated factors of NAFLD in type 2 diabetes mellitus (T2DM) patients according to the ultrasound examination and noninvasive hepatic fibrosis indices. Material and methods: 316 patients who were followed up in the Internal Medicine Diabetes clinic, over the age of 18, diagnosed with T2DM were included retrospectively. NAFLD was noted using ultrasound. NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4) and AST to platelet ratio index (APRI) were used as non-invasive hepatic fibrosis indices. Results: The prevalence of NAFLD with hepatic ultrasound was 89.7% in T2DM patients. Among non-invasive fibrosis indices, NFS and FIB-4 were similar, but APRI was significantly higher in moderate-severe hepatosteatosis group (p values = 0.355, 0.246 and 0.003 respectively). In logistic regression analysis, while mild hepatosteatosis was associated with BMI and NFS (p = 0.004, p = 0.008), moderate to severe hepatosteatosis as associated with BMI and serum triglycerides (p < 0.001, p = 0.019). Conclusions: The prevalence of NAFLD is high in patients with T2DM. The frequency and degree of NAFLD is associated with the NFS, BMI and hypertriglyceridemia. While NFS is associated with mild hepatosteatosis; moderate to severe hepatosteatosis is associated with BMI and serum triglycerides. [ABSTRACT FROM AUTHOR]

COVID-19 infection is known to increase mortality in patients with diabetes. We aim to demonstrate the differences in disease course and clinical outcomes of patients with COVID-19 regarding the presence of impaired fasting glucose, preexisting diabetes mellitus (DM) or new-onset DM. 236 patients with positive reverse transcriptionPCR tests for SARS-CoV-2 were included in this single-center, retrospective observational study between March 2020 and May 2021. Laboratory results, comorbidities, medications and imaging findings were noted. Logistic regression was used to estimate associated factors for admission to the intensive care unit (ICU). 43 patients with normal glucose, 53 with impaired fasting glucose, 60 with newly diagnosed DM, and 80 with pre-existing DM were classified. Patients with pre-existing DM had higher fasting glucose and glycated hemoglobin than the other groups (p<0.001 for all). Patients with newly diagnosed DM were more likely to need dexamethasone 6 mg (p=0.001). In both newly diagnosed diabetes and impaired fasting glucose groups, 250 mg methylprednisolone was needed at higher rates (p=0.002). Newly diagnosed DM had higher rates of intubation (21.6%) and more mortality (20.0%) (p=0.045 and p=0.028, respectively). Mortality and hospitalization in the ICU were lower in the group receiving antidiabetic treatment. The risk of ICU attendance was higher in patients with impaired fasting glucose (HR=1.71, 95% CI: 0.48 to 6.08) and newly diagnosed DM (HR=1.88, 95% CI: 0.57 to 6.17), compared with pre-existing DM and non-diabetics. Newly diagnosed DM and impaired fasting glucose are associated with increased mortality and intubation in inpatients with COVID-19. [ABSTRACT FROM AUTHOR]

Aim: The need for bodily energy in the elderly may decrease due to physical activity limitations, while it may increase with the effects of the disease. The most common screening tool developed for the geriatric population is the Mini Nutritional Assessment, and lower scores are associated with higher mortality predictions. We aimed to correlate the nutritional status of patients admitted to the emergency department with mortality. Materials and Method: Among the geriatric patients admitted to our emergency internal medicine unit between October 1, 2019, and March 1, 2020, 289 patients were included in this cross-sectional study. The Nutritional Risk Screening-2002 and Mini Nutritional Assessment tests were administered to all patients. Results: The number of patients at risk of malnutrition was 49.4% (n=143). The median follow-up was 312 days for all patients, and the mortality rate was 42.5% (n=123) for all our patients, and 50.4% (n=72) of the patients who died were male. Diabetes was high in our geriatric patients, as in all age groups, and its effect on mortality was observed, and cancer patients had an almost three-fold higher malnutrition rate. Seventy patients were transferred from the internal medicine service to the intensive care unit, and 61 of these patients (87.14%) died. Conclusion: The Mini Nutritional Assessment is a non-complex and sensitive method that can be used to predict early and mid-term mortality in geriatric patients admitted to the emergency department. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the vaccination rates and the levels of awareness on pneumococcal, influenza, tetanus and hepatitis B vaccination among patients with Type 2 diabetes mellitus (DM). Material and Methods: The study was performed on patients with DM who presented to the outpatient Clinic of Internal Disease at Kartal Dr. Lütfi Kırdar City Hospital. Patients were asked to fill out a questionnaire regarding their vaccination status, attitude, and awareness about vaccines. Results: A total of 293 patients [121 (41.3%) males and 172 (58.7%) females] with a mean age of 65 years were included in the study. The mean duration of diabetes was 15 years. Overall, 47.8% of patients reported awareness about the need for vaccination while the rate of being unvaccinated was 52.2%. Reasons for the lack of vaccination were as follows: 67.3% of patients were unaware of the reason for not receiving vaccines; 17.5% patients did not want to be vaccinated; 13.3% patients reported that their physicians did not recommend vaccination; 1.5% reported unavailability of vaccines, and 0.4% reported negligence. Among vaccinated cases, 34.1% were vaccinated against flu; 20.8% against tetanus; 9.9% against pneumonia; 7.8% against hepatitis; and 5.1% received vaccination for other diseases. Conclusion: The levels of vaccine awareness and vaccination rates are low among diabetic patients. It is essential to raise vaccination awareness among this patient population. The health authorities and departments need to develop effective strategies to increase vaccination rates across the country. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to retrospectively evaluate geriatric oncology cases hospitalized in the clinic. Methods: Files of oncology patients hospitalized between May 2012 and March 2013 were analyzed. Demographic data was recorded, including the 5 most common types of cancer according to gender, duration of hospitalization, and prognosis of patients diagnosed at 65 years of age or older. Results: The 5 most common types of cancer in male patients (28.3%, n=17) were hematological malignancies (21.7%, n=13), lung cancer (13.3%, n=8), colon cancer (10%, n=6), bladder cancer (8.3%, n=12) and prostate cancer. The 5 most common types of cancer in female patients (26.7%, n=12), were hematological malignancies, colon cancer (24.4%, n=11), breast cancer (13.3%, n=6), lung cancer (11.1%, n=5), and bladder cancer (4.4%, n=2). Conclusion: In cases of geriatric oncology, incidence of cancer types may also vary. The most common cancer type in both men and women in the present study was hematologic malignancy. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to retrospectively evaluate geriatric type 2 diabetic patients admitted to emergency services as a result of diabetes. Methods: All files of geriatric patients admitted to emergency services between January and August 2013 were analyzed. Patients admitted as a result of diabetes and related acute complications were included in the study. Results: Hypoglycemia was diagnosed in 28.2% (n=42) of patients, and hyperglycemic hyperosmolar state was found in 26.9% (n=40). Hyperglycemia, diabetic ketoacidosis, diabetic foot infection, and lactic acidosis were diagnosed in 20.1% (n=30), 16.1% (n=24), 6.7% (n=10), and 2% (n=3) of patients, respectively. Conclusion: Difficulties can occur in follow-up and treatment of diabetes mellitus in geriatric patients. Further comprehensive studies are needed on the topic. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to investigate the relationship between disease duration and emergency hospitalization rates in type 2 diabetes. Methods: 197 patients (93 women, 104 men) with type 2 diabetes admitted to emergency services between February and July 2013 were evaluated retrospectively. Results: Hospitalization rate was 30.4% in patients with disease duration ≥10 years and 18.1% in patients with disease duration <10 years. Conclusion: Prolongation of disease duration in type 2 diabetes increases emergency hospitalization rates due to diabetic complications. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Kartal Training & Research Hospital / Kartal Egitim ve Arastirma Hastanesi Tip Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Neuroleptic malignant syndrome is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It is characterized by central neurotransmitter imbalance. The syndrome is thought to be caused by Dopaminergic block. Pooled data suggests the incidence of NMS is between 0.2%-3.20%. The mortality rate is very high at 55%, but may be reduced significantly by early recognition and improved management. We present this case as an example of the difficulty in diagnosing NMS. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Kartal Training & Research Hospital / Kartal Egitim ve Arastirma Hastanesi Tip Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Kartal Training & Research Hospital / Kartal Egitim ve Arastirma Hastanesi Tip Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adult-onset Still's disease is a rare inflammatory disorder of unknown etiology. Its main features are high fever, rash, polyarthralgia, lymphadenopathy, hepatosplenomegaly, leukocytosis and elevated liver enzymes, high erythrocyte sedimentation rate, and ferritin. High levels of ferritin are commonly observed in Adult onset Still's Disease, but ferritin levels were found to be normal in our patient. We diagnosed iron deficiency anemia as a result of further evaluation. For this reason, we thought ferritin levels were normal. We presented this case because of its rarity in the literature. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to evaluate the compliance to treatment and quality of life of the diabetic patients admitted to our hospital using SF-36 health survey. Methods: We evaluated the compliance to therapy and sociocultural factors of a total of 133 type 2 diabetic patients whom were admitted and treated in our internal medicine department. Of 133 patients, 41.4% of them were male (n=55) and 58.6% of them were female (n=78). Classification regarding age showed that 29% of patients were between 46-55 years of age, whereas 53.4% of them were over 56. Results: Our records indicate that 38.2% (n=50) of the patients were illiterate. Patients that graduated from primary school or from the university were 49.6% (n=65) and 3.6% (n=5); respectively. Of the patients that participated in our study, 48.8% (n=65) were diagnosed with diabetes 5 years ago and 24% (n=36) of them were diagnosed 11 or more years ago. Treatment modalities included oral diabetics (OADs) alone (48%; n=65), insulin alone (27%; n=36) or insulin and OAD both (25%; n=23). Patients with a diabetic age younger than 5 years had better quality of life scores when compared to patients with 6 years or older diabetes (p=0.001). Similarly, patients with graduated from primary school or higher education had better quality of life score than illiterate patients (p=0.02). The same association was not observed in comparison of patients graduated from primary school or lower and the patients with high school graduation or higher (p=0.98). Treatment modalities had similar effect on quality of life (p=0.13). There were no association between quality of life and the institution treating the patients (p>0.05). Conclusion: As the diabetic patient gets older, quality of life deteriorates. Moreover, illiterate diabetic patients have worse quality of life scores than literate patients. However, there is no statistically significant difference between patients that graduated from primary school and patients with higher education in terms of health survey scores. Treatment modality was not found associated with quality of life. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence of diabetes and hypertension in patients in the preoperative preparation polyclinic and to evaluate reasons for delays to surgery. Methods: Patients admitted to internal medicine preoperative preparation polyclinic between January and June 2008 were retrospectively and randomly reviewed. The frequency of diabetes, hypertension and availability for operation were checked and the number of delayed operations were evaluated. Results: A total of 930 patients (492 female and 438 male) were included in the study. Of these, 401 patients (43%) had hypertension, 142 patients (15%) were unaware that they were hypertensive, 158 patients who received treatment (total: 259; 61%) were not the target patients, 60 women and 42 men were diabetic, 99 patients (10%) had uncontrolled hypertension, and 24 patients (2%) had delayed surgery due to uncontrolled diabetes. Conclusion: Diabetes and hypertension are common reasons for delays in surgical procedures. In the patient group, hypertension was the most prevalent in patients whose surgeries were delayed. We also found that 25% of diabetics in the study could not undergo surgery due to poor glycemic control. The results indicated that diabetes and hypertension are frequentlydetected causes for delays in surgical procedures. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the rate of reaching glycemic goals in patients with type-2 diabetes admitted to outpatient clinic of our internal medicine department and their medication profile. Methods: A total of 375 diabetic patients visited the outpatient clinic of Internal Medicine Department within 3 months between March 2011 and May 2011. HbA1c levels, age of the patients, and medication were investigated. Medication profiles of the patients with HbA1c levels of ⩽7% (good glycemic control group) were evaluated. Results: Regardless of age, 66% of all patients (n=248) were in good glycemic control group. In patients that reached glycemic goal, 81% of them were using oral antidiabetics (OADs) (n=203); 15% of them (n=36) were using OADs and insulin; and only 4% of them (n=9) were using insulin. There were 169 patients who had diabetes 5 years or longer; in these patients, good glycemic control was seen in 36% of them (n=36). In these patients, 98% of them (n=61) were using OADs, and only 1 patient (2%) was using insulin and OADs. Conclusion: In the diabetic population, increased disease duration is correlated with decreased glycemic control. In good glycemic control group, we unexpectedly observed that there were more patients under OAD medication than patients under insulin therapy. [ABSTRACT FROM AUTHOR]

Background: Trials including diabetic and pre-diabetic patients have shown that the risk of cardiovascular event is increased in patients in whom blood glucose levels are high. In this study, we analyzed the achieval rate of target cholesterol levels in patients with diabetes mellitus. Methods: 344 diabetic patients admitted to our hospital between March and May 2012 were randomly included. Low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG) were measured in our hospital biochemistry laboratory. Patients' treatments were recorded. Results: Although all 135 male and 209 female diabetic patients were undergoing treatment for diabetes, 83% (n=286) had LDL cholesterol levels greater than 100mg/dl. Despite this, only 47.3% (n=163) were taking lipid-lowering medications. The mean level of LDL-cholesterol was: 126.4±33.5 mg/ dl, TG: 179.2±6.53 mg/dl; HDL-cholesterol: 45.9±10.8 mg/dl. In 16.8% of the patients (n=58) target LDL cholesterol was achieved. In addition, all lipid targets (LDL <100 mg/dl, triglyceride <150 mg/dl and HDL >40 mg/dl in men and >50 mg/dl in women) were achieved in nearly 5% (n=17) of the patients. Conclusion: This study, which was done in a randomly selected group of follow-up diabetic patients, showed that we are far away from lipid targets. We must approach more aggressive for treatment of hyperlipidemia. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein (M protein). In the presence of obvious clinical findings (e.g., lytic bone lesions, hypercalcemia, elevated sedimentation rate, hyperglobulinemia), diagnosis is easy; however, in the case of atypical findings, with high clinical suspicion, further testing is required for the diagnosis. As in light chain disease, the paraproteins that cannot be detected in standard electrophoresis can be determined easily in immunofixation electrophoresis. Through this case report, the clinical findings of light chain myeloma and the clinical use of immunofixation electrophoresis are reviewed. [ABSTRACT FROM AUTHOR]

Background: Hyponatremia is a serious clinical condition characterized by a high morbidity and mortality that shows an increasing incidence in presentation to the emergency department. We aimed to evaluate the etiology and prognosis of patients with hyponatremia hospitalized to the emergency internal medicine service. Methods: 118 consecutive patients with hyponatremia hospitalized to emergency internal medicine service from February 2012 to July 2013 were included in our study. We recorded demographic data, serum Na+ levels, volume status, factors that led to hyponatremia and prognosis of all patients. Results: 57 (48.3%) men and 61 (51.7%) women were included in our study. Median age was 68 years. The mean level of Na+ was 114.6±8.4 mEq/l. We detected normovolemic hyponatremia in 51 patients (43.2%), hypervolemic hyponatremia in 37 patients (31.4%) and hypovolemic hyponatremia in 30 patients (25.4%). Syndrome of inappropriate ADH was the leading cause of hyponatremia. Normovolemic patients had the highest mortality rate. Conclusion: The results of our study suggest that the most common cause of hyponatremia in tertiary health care units is not hypotonic solutions, but rather syndrome of inappropriate ADH. [ABSTRACT FROM AUTHOR]