Relationship between MPV and paraoxonase-1 activity, brachial artery diameter and IMT in patients with diabetes mellitus

Aims: Higher mean platelet volume (MPV) in diabetic patients has been considered as an emerging risk factor for diabetes related micro- and macrovascular complications. Human paraoxonase 1/arylesterase (PON1), which has antioxidant and antiatherogenic properties, is documented in high oxidative stress conditions like uncontrolled diabetes. The present study aimed to evaluate the relationship between mean platelet volume (MPV) and paraoxonase-1 (PON-1) activity, brachial artery diameter (BAd) and intima media thickness (BA-IMT), in diabetic patients with regard to obesity and diabetic complications.Methods: Two-hundred and one diabetic patients (mean age: 52.4 ± 13.4 years, 73.6% females) were grouped according to obesity and diabetic complications (microvascular and macrovascular). Data on demographics, anthropometrics, diabetic complications, MPV levels, BAd and BA-IMT, and serum paraoxonase and arylesterase activities were recorded. The correlation of MPV values to paraoxonase and arylesterase activities, BAd and BA-IMT was evaluated.Results: Paraoxonase and arylesterase values were 119.8 ± 37.5 U/L and 149.0 ± 39.9 U/L, respectively, with no significant difference in respect of obesity and macrovascular complications. Significantly lower values for paraoxonase (107.5 ± 30.7 vs. 123.9 ± 38.8 U/L, p = 0.007) and arylesterase (132.1 ± 30.2 vs. 154.7 ± 41.2, U/L, p = 0.001) were noted in patients with microvascular complications. MPV values were 9.10 ± 0.87 fL, with no significant difference across the groups and no significant correlation with other parameters.Conclusion: In conclusion, PON-1 activity is more significantly decreased in diabetic patients with microvascular than macrovascular complications with no effects on MPV values. On the other hand, no relationship was found between thrombogenic activity and PON-1 activity, BAd and BA-IMT regardless of obesity and diabetic complications.Keywords: cardiovascular, diabetes, insulin resistance, obesity, vasculatur

Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer

Purpose. In this study we tried to determine the association between body-mass index (BMI), survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients’ hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p=0.230). The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.). Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with “obesity paradox” in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Hastanede yatırılarak tedavi edilmiş ve plevral effüzyon nedeniyle plevral drenaj uygulanmış hastaların retrospektif olarak değerlendirilmesi

Objective: Pleural effusion (PE) is a common pathological condition that can occur during the clinical course of many diseases. This study aimed to retrospectively evaluate the clinical features and treatment results of patients with pleural fluid drainage due to PE. Methods: A retrospective analysis was performed in the study with 103 patients between January 2020 and March 2021, who had pleural drainage due to PE. The posteroanterior and lateral chest radiographs were evaluated. Results: A total of 103 patients were included in the study, with an overall mean age of 62.5 years minimum: 24, maximum: 91 years. Most patients had three or more comorbid diseases (n=53, 51.5%). The majority of patients had drainage using a pleural catheter (n=97, 94.2%). Cytological examination of the pleural fluid revealed malignancy in 5 (4.9%) patients, whereas 89 (86.4%) were discharged during follow-up, and 14 (13.6%) had mortality. In the patients who died, more fluid with exudate characteristics at a level close to statistical significance was detected. Malignant cells were detected in the pleural fluid in 10% of patients with primary malignant cases (n=50), whereas no malignant cell was found in the pleural fluid of patients without malignancy diagnosis (n=53), with a statistically significant difference between patients with and without malignancy. The total length of hospital stay was significantly higher in patients undergoing a second surgical procedure. Conclusion: Patients undergoing pleural fluid drainage had at least one systemic disease. The most common systemic disease in patients was a cardiac disease, followed by malignant disease. "No malignant cells were detected in the fluids of patients without primary malignancy," in the cytology. In addition, the rate of second pleural surgery is high in PE cases, which further prolongs the length of hospitalization of these patients.Amaç: Plevral efüzyon (PE) birçok hastalığın klinik seyri sırasında ortaya çıkabilen ve sık görülebilen bir patolojik durumdur. Bu çalışmada, iç hastalıkları kliniğinde yatırılarak tedavi edilmiş ve PE nedeniyle plevral sıvı drenaj uygulanmış hastaların klinik özelliklerini ve tedavi sonuçlarını retrospektif olarak değerlendirmeyi amaçlanmıştır. Gereç ve Yöntem: Çalışmada Ocak 2020 ile Mart 2021 tarihleri arasında iç hastalıkları kliniğinde yatırılarak tedavi edilmiş ve PE nedeniyle plevral drenaj uygulanmış 103 hasta geriye dönük olarak incelenmiştir. Bu hastalardaki mevcut komorbit hastalıklar kayıt edilmiştir. Bütün hastaların çekilmiş olan posteroanterior ve lateral akciğer grafileri incelenerek sıvı miktarları değerlendirildi. Olguların demografik özellikleri, sıvı analizinde dikkat çeken özellikleri, torasentez dışında kullanılan tanı yöntemleri, drenaj için kullanılan cerrahi yöntemler, işleme ait komplikasyonlar, hastaların yatış süresi ve sağkalım durumları değerlendirildi. Bulgular: Hastaların yaş ortalaması 62,5 yıl minimum: 24, maksimum: 91 yıl idi. Yüz üç hastanın 58’i kadın (%56,3) ve 45’i erkekti (%43,7). Hastaların çoğunluğunda üç ve üzeri komorbidit hastalık mevcuttu (n=53, %51,5). Hastaların çoğunluğuna plevral katater ile drenaj uygulanmıştı (n=97, %94,2). Drenaj sonrasında hastaların %10,7’sinde (n=11) cerrahi girişime ait komplikasyon izlendi. Plevral sıvının sitolojik incelenmesinde hastaların beşinde (%4,9) plevral sıvıda maligniteye rastlandı. Toplam drenaj süresi ortalama 8,8 gün iken (min: 1 gün, maks: 68 gün, IQR=7) toplam hastanede kalış süresi 23,6 gün (min: 3, maks: 103, IQR=19) olarak hesaplandı. Takipte hastaların 89’u taburcu edilirken (%86,4), 14’ü eks olmuştu (%13,6). Eksitus olan hastalarda istatistiksel anlamlılığa yakın düzeyde daha fazla eksüda vasfında sıvı saptandı. Primer malignitesi mevcut olan hastaların (n=50) %10’unda plevral sıvıda malign hücre saptanırken malignite tanısı olmayan hastaların (n=53) hiçbirinde plevral sıvıda malign hücre saptanmamıştı ve bu aradaki fark istatistiksel olarak anlamlıydı (p=0,02). İkinci kez cerrahi girişim gerektiren hastalarda hastanede kalış süresi anlamlı olarak yüksek bulundu. Sonuç: Pleral sıvı drenajı uygulanmış hastalarda en az bir sistemik hastalık mevcuttu. Hastalarda en sık görülen sistemik hastalık kardiyak hastalıklarken ikinci sırada ise malignansiler yer almaktadır. Drenaj sonrası komplikasyon görülebilmekte ancak majör komplikasyon gelişmemektedir. Mortaliteyi etkileyen faktörler sıklıkla hastaya ait olan primer sistemik hastalığa bağlıydı. Primer maligniteye sahip olmayan hastalarda plevral sıvının sitolojik incelemesinde malign hücreye rastlanmadı. Ayrıca PE’lerde ikinci plevral cerrahi işlem oranı yüksektir bu durum hastaların yatış süresini daha da uzatmaktadır