Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography

PURPOSEWe aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM).METHODSWe prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients’ overall body composition.RESULTST1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05).CONCLUSIONSTCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis

Hospitalize Hastalarda Nutrisyonel Değerlendirme Testi NRS-2002'nin (Nutrıtıonal Rısk Screenıng -2002) Geçerlilik ve Güvenilirliğinin Değerlendirilmesi

Disease-related malnutrition is still an important problem in developed and developing countries. It is important to assess the patients’ nutritional status on hospital admission and plan a nutritional intervention. There is no international consensus on a single ‘’gold standart tool’’ for hospitalized patients. Thus various methods are used worldwide for screening disease related malnutrition. NRS-2002 (Nutritional Risk Screening-2002) is one of these tools and its use is recommended by ESPEN (European Society for Clinical Nutrition and Metabolism). In this study, it was intended to perform the validity and reliability study of NRS-2002 in our country.Two hundred and seventy one patients from surgical and medical wards were included in the study. Patients were evaluated within the first 48 hours after admission. Two clinicians blinded to NRS-2002 results, evaluated the nutritional status of patients by using six group of data (medical history, anthropometric measurements, oral intake, laboratory parameters, bioelectrical impedance analysis, geriatric assessment scales). The agreement between results of NRS-2002 and clinicians’ evaluation was observed. The prevelance of malnutrition was 39,1% according to NRS-2002. NRS-2002 showed a good kappa concordance agreement with clinicians’ evaluation (kappa:0,806). The sensitivity of NRS-2002 was 88% and spesivity was 92%. Positive and negative predictive values were 87 % and 92%, respectively. Test sensitivity was over 80% for both genders, geriatric population, surgical and medical wards. The intrarater reliability of NRS-2002 was also interpreted as almost perfect,being kappa=0,956. As a result, NRS-2002 is a valid and reliable tool for hospitalized patients.Hastalık ilişkili malnutrisyon gelişmiş ve gelişmekte olan ülkeler için önemli bir problem teşkil etmektedir. Hospitalize hastalarda hastaneye kabul anında nutrisyon durumunun değerlendirilmesi ve buna yönelik plan çizilmesi önemlidir. Hospitalize hastalarda kullanımı dünya genelinde kabul görmüş altın standart bir test olmaması nedeniyle malnutrisyon taramasında çeşitli araçlar kullanılmaktadır. NRS-2002 (Nutritional Risk Screening-2002) bu araçlardan biridir ve ESPEN (European Society for Clinical Nutrition and Metabolism) tarafından kullanımı önerilmektedir. Çalışmamızın amacı ülkemizde NRS-2002’nin geçerliliğini ve güvenilirliğini değerlendirmektir. Çalışmaya cerrahi ve dahiliye servislerine kabul edilen toplam 271 hasta dahil edilmiştir. Hastalar yatıştan itibaren ilk 48 saat içinde NRS-2002 ile değerlendirilmişlerdir. NRS-2002 sonucundan habersiz iki klinisyen hastalara ait verilerden (medikal öykü, diyet öyküsü, antropometrik ölçümler, biyokimyasal belirteçler, biyoimpedans analizi ve kapsamlı geriatrik değerlendirme) yola çıkarak hastaların beslenme durumlarını değerlendirmişlerdir. Klinisyen değerlendirmesi ile NRS-2002 sonuçları karşılaştırılmıştır. NRS-2002’ye göre malnutrisyon oranı %39,1 saptanmıştır. NRS-2002 ile klinisyen değerlendirmesi arası uyum iyi düzeyde (kappa:0,804) bulunmuştur. Testin sensitivitesi %88, spesivitesi %92 saptanmıştır. PPV ve NPV sırasıyla %87 ve %92 bulunmuştur. Testin sensitivitesi her iki cinsiyet grubu, geriatrik populasyon, dahiliye ve cerrahi hastaları için >%80 saptanmıştır. Test-tekrar test uyumunun çok iyi düzeyde (kappa:0,956) olduğu görülmüştür. Çalışmamızın sonucunda NRS-2002’nin hospitalize hastalarda kullanılabilecek geçerli ve güvenilir bir yöntem olduğu ortaya konmuştur