Insulin Resistance and Left Ventricular Mass in Non-Diabetic Hemodialysis Patients

AbstractBackgroundInsulin resistance (IR) is frequently recognized in patients with uremia, and it is thought that IR has a basic role in the pathogenesis of cardiovascular disease.ObjectiveTo evaluate the effect of IR on cardiovascular risk in non-diabetic patients receiving hemodialysis (HD).MethodsWe performed a cross-sectional observational study that comprised 186 non-diabetic patients receiving HD (95 men; mean [SD] age, 46.4 [10.8] years; age range, 35–60 years) who had been receiving HD for 7.3 (3.5) years. Demographic variables and laboratory values were recorded. Insulin resistance was determined using the Homeostatic Model Assessment (HOMA), and the left ventricular mass index (LVMI) was calculated via echocardiography.ResultsAccording to HOMA-IR levels, patients were categorized as having IR (HOMA-IR score ≥2.5; n = 53) or not having IR (HOMA-IR score <2.5; n = 133). Insulin resistance was determined in 28.4% of study patients. Compared with the non-IR group, the IR group had been receiving HD longer; had greater body mass index; and had higher serum creatinine, uric acid, triglyceride, insulin, and C-reactive protein concentrations, leukocyte count, and LVMI (P < 0.05). Patients with increased LVMI had significantly higher body mass index, systolic blood pressure, serum cholesterol and C-reactive protein concentrations, and HOMA score. At multivariate analysis, systolic blood pressure (β = 0.22; P = 0.03) and HOMA score (β = 0.26; P = 0.01) affected LVMI.ConclusionsInsulin resistance and hypertension are independent risk factors for left ventricular hypertrophy in non-diabetic patients with uremia who are receiving HD. Further studies are needed to indicate the benefits of improving IR for cardiovascular mortality in this subgroup of patients with uremia

Vitamin D Metabolism

Vitamin D plays an important role in bone metabolism. Vitamin D is a group of biologically inactive, fat-soluble prohormones that exist in two major forms: ergocalciferol (vitamin D2) produced by plants in response to ultraviolet irradiation and cholecalciferol (vitamin D3) derived from animal tissues or 7-dehydrocholesterol in human skin by the action of ultraviolet rays present in sunlight. Vitamin D, which is biologically inactive, needs two-step hydroxylation for activation. All of these steps are of crucial for Vitamin D to show its effect properly. In this section, we will present vitamin D synthesis and its action steps in detail

Antimicrobial activities, pollen diversity and physicochemical properties of natural honey from Southeastern Anatolia of Turkey

Background: Honey, a natural sweetener, is produced from the nectar of many plants. The pollen diversity, physicochemical properties, and antimicrobial activities were analyzed in honey samples from Mardin (Southeastern Anatolia). Methods: The melissopalynological method was used to identify and enumerate the pollen granules. Analytical methods and agar well diffusion assays were employed for the determination of some quality parameters and the antimicrobial potential of honey samples, respectively. Results: The pollen composition consisted of 27 taxa belonging to 13 families. The origins of all honey were determined as the multifloral sources. The most predominant taxa were mainly Hedysarum sp., Carduus sp., Melissa officinalis, Gossypium hirsitum, Paliurus spina-christi, Salix sp. and Pimpinella anisum. The secondary pollen taxa were Hedysarum sp., Trifolium sp., Astragalus sp., Salix sp., Paliurus spina-christi, Asphodeline sp., Centaurea sp., Carduus sp., Zea mays and Cistus sp., respectively. Asphodeline sp. as a secondary pollen taxon in a honey sample could be considered as the first report. The pH, total acidity, brix, refractive index, electrical conductivity, moisture and L, a, b values of the samples varied from 3.75 to 4.28, 30 to 42, 67.3 to 85.70, 1.45 to 1.50, 12.40 to 31.61, 0.24 to 0.90, 47.81 to 57.59, -0.94 to 4.31, 20.37 to 31.28, respectively. Antimicrobial activities of the honey specimens were also effective on five bacterial species and two yeast species. Conclusions: Honey samples from Southeastern Anatolia revealed a good diversity of pollen granules. The rich multiflora of honey increases not only its nutritional quality as well as antimicrobial potential on various clinically important microorganisms.

The Effect of Supplementary Feeding with Different Pollens in Autumn on Colony Development under Natural Environment and In Vitro Lifespan of Honey Bees

Simple Summary In the present study, the effect of feeding with pollen sources with different protein content on colony performance, wintering ability and in-vitro longevity of colonies that weakened after feeding with pine honey in autumn or that needed to enter the winter period were investigated. The experiment was carried out in 48 colonies divided into six groups as follows: control, syrup, mixed pollen, Cistus creticus pollen (Pink rock-rose), Papaver somniferum pollen (Opium poppy), and commercial bee cake group. The effect of nutritional differences on survival was found to be statistically significant in vitro and this supports the colony results in the natural environment. As a result, P. somniferum pollen is a good preference to be used in feeding colonies in beekeeping, due to its rich nutritional content. Honey bees need pollen and nectar sources to survive in nature. Particularly, having young bees in colonies is vital before wintering, and proper feeding is necessary to achieve this. In the present study, the effect of feeding with pollen sources of different protein content on colony performance, wintering ability and in-vitro longevity of colonies that weakened after feeding with pine honey in autumn, or that needed to enter the winter period, was investigated. The experiment was carried out in 48 colonies divided into six groups as follows: control, syrup, mixed pollen, Cistus creticus pollen (Pink rock-rose), Papaver somniferum pollen (Opium poppy), and commercial bee cake groups. In particular, the P. somniferum pollen group was different (p < 0.01) from the other experiment groups with the number of bee frames (3.44), the area with brood (1184.14 cm(2)) and the wintering ability of 92.19%. The effect of nutritional differences on survival was found to be statistically significant in vitro and this supports the colony results in the natural environment (p < 0.001). The P. somniferum group has the longest longevity with 23 days. Pollen preferences of honey bees were P. somniferum, C. creticus, and mixed pollen, respectively.Pollen Preferences of Honey bees [TAGEM/HAYSUD/B/20/A4/P5/1890]; Turkish Ministry of Agriculture and Forestry, General Directorate of Agricultural Research and Policies (TAGEM)This article was produced from the project The Pollen Preferences of Honey bees and the Effects of Pollen Use inWinter on Colony Dynamic (TAGEM/HAYSUD/B/20/A4/P5/1890) supported by The Turkish Ministry of Agriculture and Forestry, General Directorate of Agricultural Research and Policies (TAGEM)

A Novel De Novo Missense Mutation in HNF4A Resulting in Sulfonylurea-Responsive Maturity-onset Diabetes of the Young

Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes, with autosomal-dominant inheritance, which usually develops before 25 years of age. MODY is classically caused by a heterozygous mutation of genes known to affect insulin production or secretion. Heterozygous inactivating hepatocyte nuclear factor 4A (HNF4A) mutations, one of the rare subtypes of MODY, cause impaired insulin secretion and subsequent glucose intolerance especially in adolescence. Conversely, HNF4A mutations are also known to be associated with macrosomia and hyperinsulinemic hypoglycemia in newborns. Herein, we report a rare cause of diabetes resulting from a novel heterozygous mutation in the HNF4A gene. In conclusion, genetic testing should be considered in order to establish an accurate diagnosis and provide an opinion in determining the appropriate type of treatment

Does fetal MR alter the management of pregnancy in the diagnosis of isolated corpus callosum agenesis?

Objective To determine if fetal MR alters the management of pregnancy and family decisions in the isolated corpus callosum agenesis (CCA) cases or not. Methods Fetal MR was carried out in the cases diagnosed with CCA in the Perinatology Unit of our hospital between 2013 and 2019 after they were differentiated as complex and isolated CCA cases. The impact of MR results on the family decisions and their approaches towards termination were assessed. Results A total of 109 out 139 cases were evaluated as isolated CCA. While 93 (85.32%) of them were diagnosed with the complete CCA, 16 (14.68%) cases were diagnosed with the partial CCA. When the period after 2017 during which fetal MR was recommended to all patients was reviewed, it was seen that 7 (23.3%) of 30 cases who underwent fetal MR and 2 (20%) of 10 cases who did not undergo fetal MR terminated their pregnancies. There was no statistical difference between two groups in terms of the decisions of the patients for gestational termination who did and did not undergo fetal MR. Conclusion Fetal MR imaging in the isolated CCA does not change the decisions of the families for the gestational termination. In terms of the termination decision, week of gestation and socio-cultural factors may have more impacts

PD-L1 expression in immune cells is a favorable prognostic factor for nasopharyngeal carcinoma

Background: Programmed death-ligand 1 (PD-L1) has been determined as a reliable prognostic factor for various malignancies. In this study, we aimed to determine the prognostic effect of PD-L1 expression in tumor-infiltrating immune cells (TIICs) of nasopharyngeal carcinoma (NPC) patients.Methods: Seventy patients diagnosed with non-metastatic NPC were included in the study. PD-L1 expression on immune cells was analyzed by immunohistochemical method. Patients were categorized into two groups according to the PD-L1 expression level in TIICs (level of PD-L1 staining ≥5% positive vs <5% negative).Results: Median follow-up period was 34 months (range = 1 - 188). 1 and 2 years survival rate were found as 75% and 63% in PD-L1 negative TIICs group (47%), and 85% and 83% in PD-L1 positive TIICs group (53%), respectively. PD-L1 positivity in immune cells (ICs) was detected in 53% of the patients. The survival rate was found better in the PD- L1 positive group compared to the negative group (P = 0.049).Discussion: In conclusion, the survival rate was found significantly better in the PD-L1 positive TIICs group, compared to the negative group

Distinctively Different Phenotypes of Two Cases with a Rare Karyotype of 45,X/47,XYY Mosaicism: Case Report and Literature Review

The 45,X/47,XYY mosaicism is an extremely rare genetic disorder with highly phenotypic manifestations such as ovotesticular disorders of sexual development, mixed gonadal dysgenesis and Turner syndrome. Herein, we report two cases with very distinctive phenotypes despite having the same sex chromosome mosaicism of 45,X/47,XYY. It should be kept in mind that the rare type of sex chromosome mosaicism of 45,X/47,XYY may present with genital phenotypes ranging from normal female to male characteristics

Loss of MANF Causes Childhood-Onset Syndromic Diabetes Due to Increased Endoplasmic Reticulum Stress

Mesencephalic astrocyte-derived neurotrophic factor (MANF) is an endoplasmic reticulum (ER)-resident protein that plays a crucial role in attenuating ER stress responses. Although MANF is indispensable for the survival and function of mouse beta-cells, its precise role in human beta-cell development and function is unknown. In this study, we show that lack of MANF in humans results in diabetes due to increased ER stress, leading to impaired beta-cell function. We identified two patients from different families with childhood diabetes and a neurodevelopmental disorder associated with homozygous loss-of-function mutations in the MANF gene. To study the role of MANF in human beta-cell development and function, we knocked out the MANF gene in human embryonic stem cells and differentiated them into pancreatic endocrine cells. Loss of MANF induced mild ER stress and impaired insulin-processing capacity of beta-cells in vitro. Upon implantation to immunocompromised mice, the MANF knockout grafts presented elevated ER stress and functional failure, particularly in recipients with diabetes. By describing a new form of monogenic neurodevelopmental diabetes syndrome caused by disturbed ER function, we highlight the importance of adequate ER stress regulation for proper human beta-cell function and demonstrate the crucial role of MANF in this process.Peer reviewe

Naiv hepatit C enfeksiyonlu hastaların on-altı yıllık prognozu

Objectives: In this study, we aimed to evaluate the clinical course of treatment-naive patients infected with hepatitis C virus (HCV) who were followed up in various centers in Turkey. Materials and Methods: This was a retrospective study performed with the participation of 15 centers. Patients aged 18 years and older with HCV infection were included. Results: A total of 391 treatment-naive patients infected with HCV were included in this study. During the follow-up period, the final values of alanine aminotransferase, aspartate transaminase, and total protein were significantly decreased when compared to the initial values (p<0.001, p<0.001, and p=0.005, respectively). In the study group, 19.2% of the patients underwent liver biopsy and 4.1% underwent transient elastography (FibroScan). An increased histological activity index (HAI) score and fibrosis in the second biopsy were observed in one patient, only increased HAI in two patients and increased fibrosis in one patient, as shown on the FibroScan. In the 16 years of the study period, cirrhosis was radiologically detected in only one patient. Conclusion: Even if rapid progression is not observed, close monitoring of the clinical findings related to liver failure and fibrosis with invasive or non-invasive methods may be useful.Amaç: Bu çalışmada ülkemizin çeşitli merkezlerinde takip edilen naiv hepatit C virüs (HCV) ile enfekte hastaların klinik seyrini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma retrospektif olarak 15 merkezin katılımıyla gerçekleştirilmiştir. Çalışmaya 18 yaş üstü, HCV enfeksiyonu olan hastalar dahil edilmiştir. Bulgular: Çalışmada 391 tedavi-naiv HCV enfeksiyonlu hasta yer almıştır. Hastaların takip süresinde son alanine aminotransferase, aspartate transaminase ve total protein değerleri ilk düzeyine göre önemli düzeyde azalmıştır (sırasıyla p<0,001, p<0,001, p=0,005). Çalışma grubunda hastaların %19,2’sine karaciğer biyopsisi, %4,1’ine elastografi (FibroScan) uygulanmıştır. Takip esnasında bir hastada ikinci biyopside histolojik aktivite indeksi (HAI) ve fibroziste artma, iki hastada sadece HAI’da artma, birinde FibroScan ile fibrozis değerinde artma olduğu gözlenmiştir. Bir hastada 16 yıl içinde radyolojik olarak siroz saptanmıştır. Sonuç: Hızlı progresyon gözlenmemekle birlikte hastaların izleminde karaciğer yetmezliği ile ilgili klinik bulguların ve invaziv veya noninvaziv yöntemlerle fibrozisin yakın takibi yararlı olabilir