Effect of polyneuropathy on development of unilateral diabetic foot ulcer

Aim: This study investigates polyneuropathy in patients with unilateral diabetic foot ulcer by using electrophysiological methods and discusses whether electrophysiological parameters are predictive of diabetic foot ulcer development. Materials and methods: Fifty-two diabetic patients with unilateral diabetic foot ulcers (31 females, 21 males; mean age of 58.5 years) were included in the study. Results: In the upper extremities, motor fibers were affected in 82% and sensorial fibers were affected in 85% of the subjects. In the lower extremities, motor fibers were affected in 90% of the subjects in the injured site and in 79% of the patients in the intact site, and sensorial fibers were affected in 100% of the patients bilaterally. H-reflex was delayed in 93.2% of the patients at the injured site and in 86.4% of the patients at the intact site. Sensorial fibers were affected more than motor fibers and the condition was more pronounced in the lower extremities. Conclusion: The electrophysiological data were statistically different between injured and healthy extremities (P < 0.005). Our data revealed that nerve conduction studies have an important value in predicting diabetic foot ulcers and even showed that development of ulceration could be prevented in clinically and neurophysiologically documented diabetic neuropathy.Aim: This study investigates polyneuropathy in patients with unilateral diabetic foot ulcer by using electrophysiological methods and discusses whether electrophysiological parameters are predictive of diabetic foot ulcer development. Materials and methods: Fifty-two diabetic patients with unilateral diabetic foot ulcers (31 females, 21 males; mean age of 58.5 years) were included in the study. Results: In the upper extremities, motor fibers were affected in 82% and sensorial fibers were affected in 85% of the subjects. In the lower extremities, motor fibers were affected in 90% of the subjects in the injured site and in 79% of the patients in the intact site, and sensorial fibers were affected in 100% of the patients bilaterally. H-reflex was delayed in 93.2% of the patients at the injured site and in 86.4% of the patients at the intact site. Sensorial fibers were affected more than motor fibers and the condition was more pronounced in the lower extremities. Conclusion: The electrophysiological data were statistically different between injured and healthy extremities (P < 0.005). Our data revealed that nerve conduction studies have an important value in predicting diabetic foot ulcers and even showed that development of ulceration could be prevented in clinically and neurophysiologically documented diabetic neuropathy

Metabolic evaluation and measurement of ovarian volume in polycystic ovary sydrome: a cross-sectional observational study

Amaç: Polikistik over sendromu (PKOS), hirsutizm veya laboratuvar değerlendirmesinde hiperandrojenemi bulguları, adet düzensizliği ve anovulasyona bağlı infertiliteye yol açabilen ve üreme çağındaki kadınları etkileyen önemli bir hastalıktır. Beraberinde yer alan insülin direnci ve adipozite artışı kardiyometabolik risk artışına da neden olabilmektedir. Biz çalışmamızda PKOS düşünülen hastaların muayene ve laboratuar bulguları ile overlerin abdominal ultrasonografi ile değerlendirme sonuçlarını sunmayı planladık. Gereç ve Yöntem: Çalışmaya endokrinoloji polikliniğine hirsutizm, adet düzensizliği gibi semptomlarla başvuran ve PKOS tanısı düşünülen 22 kadın hasta alındı. Hastaların yaşı, aile öyküsü, PKOS fenotipleri, ilk adet yaşı, siklus uzunluğu ve fizik muayene bulguları kaydedildi. Hirsutizm için Ferriman&Gallwey skoru kullanıldı. Biyokimyasal ve hormonal tetkikleri yapılarak HOMA-IR yöntemi ile insülin direnci hesaplandı. Abdominal ultrasonografi ile over volümleri ölçüldü. Verilerin istatistiksel analizi için SPSS-16 kullanıldı. Bulgular: Yaş ortalaması 21.41±0.88 yıl olan hastaların %40.9'u B, %31.8'i C ve %27.3'ü A PKOS fenotipik özelliklerini gösteriyordu. Siklus uzunluğu değerlendirildiğinde hastaların %31.8'inde siklus normal (27-34 gün) bulundu. Hastaların hepsinde Ferriman&Gallwey skoru >=7 idi. Hirsutizm oranı yüksek olmasına rağmen androjen düzeyleri genellikle normal bulundu (testosteron %72 normal, DHEAS %82 normal). Hastaların 8'i (% 36) obez ve 3'ü (%13.6) fazla kilolu idi. Hastaların %40.9'unun birinci derece yakınında tip 2 diyabetes mellitus mevcuttu. Tüm hastaların açlık glukoz ve 75 gr OGTT sonrası glukoz düzeyleri normaldi. HOMA-IR yöntemi ile hastaların %41'inde insülin direnci saptandı. Hastaların LDL kolesterol ve trigliserid düzeyleri ile AST, ALT ve GGT düzeyleri normal bulunurken, 15 (%68) hastada HDL kolesterol 50 mg/dl altındaydı. Abdominal ultrasonografide over volümleri ortalama sağda 11.6±1.12ml, solda 11.5±1.01ml ölçüldü ve 13 hastada (%59.1) polikistik over görünümü mevcuttu. Sonuç: Hastalarımızın tamamında hirsutizm saptanırken, büyük kısmında siklus düzensizliği, ultrasonografide over volümü artışı ve PKO görünümü ile PKOS tanısı desteklenmiştir. Ancak PKOS hastalarımızda laboratuar olarak hiperandrojenizm bulguları, insülin direnci ve obezite daha az oranda görülmüştür.Purpose: Polycystic ovary sydrome is a disease of women in reproductive period, with hirsutism or hyperandrogenic signs in laboratory evaluation, causing infertility due to dysmenorrhea and unovulation. Accompanying insulin resistance and adiposity may increase cardiometabolic risk. In our study, we planned to represent the physical examination and laboratory findings of the patients diagnosed as polycystic ovary sydrome, together with andominal ultrasonographic evaluation of the ovaries. Material and Methods: Twenty-two patients who admitted the endocrinology department with the complaints of hirsutism and dysmenorrhea were included in the study. Their ages, family histories, polycystic ovary sydrome phenotypes, first menstrual age, length of cyclus and physical examination findings were recorded. Ferriman&amp;Gallwey score was used for hirsutism. Insulin resistance was calculated via HOMA-IR method by making the biochemical and hormonal tests. Ovarian volumes were measured by abdominal ultrasonography. SPSS-16 was used for the statistical analysis of the findings. Results: Mean age was 21.41±0.88. Polycystic ovary sydrome phenotypes were B in 40.9%, C in 31.8% and A in 27.3%. Cyclus length was normal in 31.8% (27-34 days). Ferriman&amp;Gallwey score was >=7 in all of the patients. Although hirsutism rates were high, androgen levels were generally normal (testosterone 72% normal, DHEAS 82% normal). Eight (36%) patients was obese and 3 (%13.6) was overweight. Forty percent of the patients had type 2 diabetes mellitus in a first degree relative. Fasting glucose levels and glucose levels after 75 gr OGTT were normal in all patients. Insulin resistance was detected in 41% of the patients via HOMA-IR method. LDL cholesterol, trigliceryde, AST, ALT and levels were normal. HDL cholesterol level was below 50 mg/dl in 15 (68%) patients. In abdominal ultrasonography, mean ovarian volumes were 11.6±1.12ml on right, 11.5±1.01ml on left. 13 (59.1%) patients had polycystic ovary appearance. Conclusion: Hirsutism was detected in all of our patients. In most of them, polycystic ovary sydrome diagnosis was supported by cycle irregularity, increased ovarian volume and polycystic ovary appearance in ultrasonagraphy. In our polycystic ovary sydrome patients, hyperandrogenism laboratory findings, insulin resistance and obesity were seen in lower ratios

Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)

Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Base