Lipohypertrophy in Individuals with Type 2 Diabetes: Prevalence and Risk Factors

Introduction: As well as its negative effect on the subcutaneous tissues, lipohypertrophy has negative effects on clinical data. The purpose of this study was to examine the frequency of lipohypertrophy, risk factors and perceived barriers preventing rotation in individuals with type 2 diabetes. Methods: This descriptive cross-sectional study was conducted at Diabetes Education Center and Endocrine and Metabolism Clinic of a university hospital and Diabetes Education and Monitoring Center in a private hospital in Turkey between June 2016- April 2017. The inclusion criteria were as follows; undergoing at least one year of insulin therapy, injecting insulin pens or syringes themselves, being over 18 years of age, making regular injection of insulin and being a patient with type 2 diabetes. Introductory information form was used to collect the data. The data were analyzed using descriptive statistics and chi-square analysis with SPSS version 16.0. Results: Factors influencing lipohypertrophy development were determined as follows; healthcare personnel who provide insulin education, duration of diabetes, the number of injection administered daily, needle length, the number of injection sites, insulin types, injection site rotation and intra-site rotation and needle exchange frequency. In addition, the prevalence of lipohypertrophy was found to be higher in patients with hypoglycemia, unexplained hypoglycemia, and those with high BMI and A1C. Conclusion: It is recommended that diabetes education should be provided by the diabetes specialist nurses who have diabetes-specific certifications and / or education and who can provide full-time education. Randomized controlled interventional studies investigating how to prevent the lipohypertrophy development are also needed

Evaluation of Agreement Between Sweep Visual Evoked Potential Testing and Subjective Visual Acuity

Objectives:The primary objective of this study was to evaluate the agreement of visual acuity (VA) obtained with the sweep visual evoked potential (sVEP) method with the VA obtained with the Snellen chart. The secondary objective was to examine the effect of age and gender on agreement.Materials and Methods:Best corrected VAs of subjects were recorded with the Snellen chart, and sVEP testing was performed according to the recommendations of the International Society for Clinical Electrophysiology of Vision (ISCEV). Snellen VAs and sVEP measurements were analyzed using logMAR conversion for statistical analysis. Agreement was evaluated with Bland-Altman analysis.Results:The study included 49 subjects with a mean age of 53.5±17.3 years (range: 19-75 years) and mean Snellen VA of 0.31±0.32 logMAR (range: 1.3-0.0 logMAR). In the Bland-Altman analysis, the mean differences between the VA and sVEP measurements (VA-sVEP) were significantly different and outside the limits of agreement (p=0.035). A significant proportional bias (p=0.0007) was found in the regression analysis performed between VA-sVEP and the mean VA. According to the Bland-Altman analysis of sex subgroups, there was a significant difference between VA and sVEP measurements in female subjects (p=0.006). The difference between VA and sVEP measurement increased significantly with older age (R2: 0.306, p<0.001, β: 0.05 [0.03, 0.08]).Conclusion:In conclusion, sVEP measurements and VAs did not show statistical agreement. Cranial anatomy and endocrine differences of the subjects may affect their sVEP measurements. The difference between the methods varies according to VA level. Directly using sVEP results instead of VA would not be appropriate

Histološka i imunohistokemijska svojstva metastatskog karcinosarkoma mliječne žlijezde u kuje - prikaz slučaja

A carcinosarcoma is a tumor composed of cells morphologically resembling both malignant epithelial and mesenchymal components. An 11-year-old, female, mixed-breed terrier was referred to the clinic with complaints of anorexia, vomiting and exercise intolerance. Clinically, tumoral masses were seen in the mammary glands. During necropsy, multilobulated calcified masses were observed in several visceral organs (the liver, kidneys, lungs, small intestines, lymph nodes and thyroid) and both right and left (3rd and 4th) mammary glands. Immunohistochemically, Thyroglobulin, SMA, TTF-1, S100, CD34, and p53 were negative in both epithelial and mesenchymal areas, however, Ki-67 showed high proliferation, especially in the mesenchymal areas. While the positivity of vimentin expression was high in the mesenchymal component of the tumor, the positivity of cytokeratin (CK7 and CK19) expressions was high in the epithelial component of the tumor. In the case of a carcinosarcoma, there is a probability that not only the carcinomatous part, but also the sarcomatous part will metastasize. Despite being uncommon, canine carcinosarcomas should always be considered in the differential diagnosis of mixed mammary tumors, if they include both components. There have not been many previous studies dealing with the metastasis of a mammary carcinosarcoma in dogs as an aggressive tumor. Therefore, we consider this report a worthy contribution and have defined the multiple organ metastasis of a mammary carcinosarcoma.Karcinosarkom je tumor sastavljen od stanica koje morfološki nalikuju i na maligne epitelne i na mezenhimne komponente. Ženka stara 11 godina, mješanka u tipu terijera, primljena je na pregled zbog anoreksije, povraćanja i nepodnošenja tjelesnog napora. Klinički, uočena je tumorska masa u mliječnim žlijezdama. Pri obdukciji su uočene multilobulirane kalcificirane tvrobe u nekoliko visceralnih organa (jetra, bubreg, pluća, tanko crijevo, limfni čvorovi, štitnjača) te u desnoj i lijevoj (trećoj i četvrtoj) mliječnoj žlijezdi. Imunohistokemijski su tireoglobulin, SMA, TTF-1, S100, CD34 i p53 bili negativni i u epitelnim i mezenhimnim tkivima, međutim Ki-67 pokazao je visoku proliferaciju, osobito u mezenhimnom području. Dok je pozitivnost ekspresije vimentina bila visoka u mezenhimnoj komponenti tumora, pozitivnost ekspresije citokeratina (CK7 i CK19) bila je visoka u epitelnoj komponenti tumora. U slučaju karcinosarkoma moguće je da ne metastaziraju samo karcinomatozni dijelovi nego također i sarkomatozni. Premda je neuobičajen, pseći karcinosarkom trebalo bi uzeti u obzir kao diferencijalnu dijagnozu kod miješanih tumora mliječne žlijezde, ako sadržavaju obje komponente. U dosadašnjim istraživanjima nema mnogo radova o metastazama karcinosarkoma mliječne žlijezde kuja, posebno u slučajevima gdje je to agresivan tumor. Stoga smatramo da je ovaj prikaz slučaja vrijedan doprinos kojim su utvrđene višestruke metastaze karcinosarkoma mliječne žlijezde na različitim organima

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe

Two and three dimensional bearing capacity solutions for shallow foundations

Yüzeysel temellerde nihai (uç) tasıma gücü Geotekniğin en önemli konularından birini olusturmaktadır. Terzaghi’nin limit denge kuramı (1943) ile gelismeye baslayan analitik çalısmalar, limit analiz (alt ve üst limit kuramı) ile gelismeye devam etmistir. Çalısmalardaki en önemli basamak, sonlu elemanlar gibi bilgisayar teknolojisinin ürünü olan metodların kullanılması ve nümerik çalısmaların artısında gözlenmektedir. Bu çalısmada, sonlu elemanlar yönteminden yararlanarak temellerin tasıma gücü üzerinde, kohezyon (c), içsel sürtünme açısı (? ) ve temel boyutu (B) ile sürsajla birlikte temel derinliğinin etkisi de arastırılmıstır. Bu çalısmayla elde edilen bulgular, Terzaghi ve Meyerhof tarafından ortaya konulan ve günümüzde halen geçerliliğini koruyan formüllerden yapılan hesaplamalar ile karsılastırmaları yapılmıstır.Bearing capacity of shallow foundations has always been one of the most interesting areas in geotechnical engineering because it is a function of a lot of parameters ( such as cohesion and unit weight of soil, depth and shape of foundation ) related to soil and footing. Bearing capacity estimation is generally based on the theories developed by Terzaghi, Meyerhof, Brinch Hansen and Vesic. In recent years, the finite element method has been used for computing the bearing capacities of shallow foundations. This method has the advantage of combining all the parameters into a single problem

Evaluation of Optic Disc Perfusion with Optical Coherence Tomography Angiography in Acute Non-arteritic Anterior Ischemic Optic Neuropathy

Objectives: This study aimed to evaluate superficial peripapillary vascularization qualitatively and quantitatively in patients with acute non-arteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCT-A)

Augmented surgical amounts for intermittent exotropia to prevent recurrence

Purpose: The purpose was to evaluate the results of bilateral lateral rectus (BLR) recession which is based on augmented surgical amounts of classical surgical table of Parks′ for basic and pseudo-divergence excess type intermittent exotropia [X(T)]. Materials and Methods: Patients with X(T) operated by the same surgeon and followed-up for at least 6 months were included. Patients with prior surgery, neurobehavioral and musculoskeletal conditions, strabismus different from that mentioned above X(T) were excluded. All the patients received BLR only. The amount of the recession was increased by the amount needed to correct 5 prism diopters (PD) more X(T) than what was measured. After the operation, 1 st week, 2 nd and 6 months measurements were recorded. The patients were grouped according to their 1 st week (3-7 days) postoperative examination as: >10 PD esotropia (Group 1), ≤10 PD esotropia (Group 2), exotropia (Group 3), and orthotropic (Group 4), respectively. Final surgical outcomes were classified as "good" (≤10 PD exotropia and ≤5 PD esotropia), "recurrence" (>10 PD exotropia) and "overcorrected" (>5 esotropia). Results: Thirty-seven patients were included. The mean age was 6.78 ± 2.87 years (range: 2-12 years). Mean preoperative deviation was 29.72 ± 8.07 PD (range: 15-45 PD) at distance and 20.94 ± 11.65 PD (range: 10-45 PD) at near (P < 0.0001). There were 21 (56.8%) patients in Group 1, 9 (24.3%) patients in Group 2, 1 (2.7%) patient in Group 3 and 6 (16.2%) patients in Group 4. Initial esotropia was achieved in 30 (30/37) of the patients. Twenty-eight of them had good results at the end of the 6 months. Overall "motor surgical" success rate was found to be 89.2% (33/37 patients), with 1 (2.7%) overcorrection and 3 (8.1%) recurrences at the end of the 6 months. Conclusion: This study demonstrated that early overcorrection of 10-20 PD after X(T) surgery can achieve acceptable motor outcomes in the first 6 months postoperative period