Background Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study. Methods We analyzed 82421 constipated patients and 82421 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilized to match age, gender, comorbidities, and medications at a ratio of 1:1. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were conducted. Results The incidence of asthma was 10.8 per 1,000 person-years in the constipation group, which was higher than the rate of 5.6 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, and medications, constipated patients had a 1.91-fold greater risk of asthma compared to those without constipation (adjusted hazard ratio [aHR]: 1.91 (95% C.I. 1.84-1.99). In subgroup analyses, patients aged 20-39 years had a 2.04-fold highest risk of asthma in the constipation cohort (aHR:2.04, 95% CI, 1.84-2.26). Besides, the severity of constipation is associated with an increased risk of asthma; the aHR was 1.76 (1.69-1.85), 2.15(2.03-2.27), and 2.29(2.10-2.49) for < 3 times, 3-12 times, and ≥12 times of laxatives prescription within one year, respectively. (p<0.001) Moreover, constipated patients had a higher likelihood of asthma, regardless of gender, comorbidities, and medications. Conclusion Constipation relates to a significantly increased risk of asthma. Physicians should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.
Background: Acute appendicitis (AA) is the most common cause of surgery performed for acute abdomen. The standard treatment for AA patients has been appendectomy for more than a century. use of broad-spectrum antibiotics, the medical treatment option has come to the fore in the treatment of uncomplicated AA. Aim: Evaluate whether WBC, platelet count, MPV, PDW, RDW, and C-reactive protein (CRP) values of patients diagnosed with uncomplicated AA clinically, with laboratory tests and radiologically with abdominal CT could be a marker for choosing medical or surgical treatment. Material and Method: 519 patients aged between 20 and 65 years who were diagnosed with uncomplicated AA by abdominal CT in our centre between January 2016 and January 2019 were retrospectively analysed. . The presence of at least one of the criteria of 7 mm or more appendix diameter and oedema or fluid accumulation around the appendix was accepted as uncomplicated AA. After the diagnosis of AA, 223 patients were treated medically, while 296 patients underwent laparoscopic appendectomy. The first group included patients who were treated medically and the second group included patients who underwent laparoscopic appendectomy. Results: Group 2 patients had higher mean platelet count (p <.005) and RDW (p = .003) values compared to Group 1 patients, while mean PDW (p <.001) values were lower compared to those of Group 1 patients. The differences between the mean WBC, CRP and MPV values of the groups were not statistically significant (p>0.05). Conclusions: The standard treatment for acute appendicitis is surgery. Recently, studies supporting antibiotic therapy have been conducted in patients diagnosed with AA. As a result, we think that PDW, RDW, and platelet values in patients diagnosed with uncomplicated AA may be a guide in choosing patients to be treated with surgery or antibiotics. Key Words: acute appendicitis, laparoscopic appendectomy, antibiotic therapy.
Background: Cystic echinococcosis (CE) is commonly located in the liver and lungs of affected hosts. Surgical management is one of the best choices for the treatment of hydatidosis and using effective scolicidal agents during hydatid surgery is essential to prevent secondary infection. The present study was designed to investigate the in vitro scolicidal activity of methanol extract of Sideritis perfoliata against the protoscoleces of hydatid cysts. Methods: The protoscoleces were collected from slaughtered livestock in Adiyaman and the effect of three concentrations of the aerial part extract of S. perfoliata (0.1mg/ml, 0.2mg/ml, and 0.4mg/ml) was assessed over three different exposure periods. All tests were carried in dublicate. Finally, the mortality of protoscoleces was assessed by the eosin exclusion test (0.1% eosin staining). Methanol extract of S. perfoliata was assessed by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS). Results: The results showed that the scolicidal effect of this extract at exposure periods of 10, 20, and 30 min was 29.6, 32.5, and 43.6% at concentrations of 0.1mg/ml, 37.8, 50, and 58.1% at concentration of 0.2mg/ml and finally 57.9, 71.8, and 79.1% at concentration of 0.4mg/ml, respectively; indicating that the extract requiring a further time to display a potent protoscolicidal effects. Some phenolic acids such as fumaric acid (260,13mg/L), syringic acid (27,92mg/L) and caffeic acid (26,84mg/L) and a flavonoid, luteolin (11,23 mg/L) were detected in high concentrations. Conclusions: The present study has demonstrated that the methanol extract of S. perfoliata has high scolicidal power in vitro, although the low concentration of plant extract may provide a base for future treatment of hydatid cysts. However, more research on the in vivo efficacy of S. perfoliata extract and its potential side effects is recommended.
Aim of the Study: Multiple sclerosis (MS) is an autoimmune disorder causing demyelination in axons. Available therapies target different molecules, but not all have therapeutic effects on disease progression, and this effect can only be seen after a long-time administration. Interferon beta (IFN-β), an MS therapy for many years, slows down the disease progression and reduces disease symptoms by targeting T cells. Yet, a considerable portion of the patient has experienced no therapeutic response to IFN-β. It is necessary to determine disease-specific biomarkers which allow early diagnosis or treatment of MS. Here, it was aimed to determine the effects of interleukin 10 (IL10) and 23 (IL23A) as well as forkhead box P3 (FOXP3) genes on MS after IFN-β therapy. Materials & Methods: Peripheral blood mononuclear cells (PBMCs) were extracted to isolate CD4+ and CD25+ T cells. Cytotoxicity assays were performed on each cell type for determining optimum drug concentration. Then, cells were cultured and determined drug concentration was administered to the cells to measure gene expressions with RT-PCR. Results: It was found that the cytotoxic effect of IFN-β was more efficient as the exposure time was expanded regardless of drug concentration. Moreover, CD25+ T lymphocytes were more resistant to IFN-β. IL23A was down-regulated, whereas FOXP3 was up-regulated at 48h in CD4+ T cells. For CD25+ T cells, the graded increase of FOXP3 was obtained while IL10 expression was gradually decreased throughout the drug intake, significantly. Conclusion: Although considerable change in expression was obtained, the long-term IFN-β effect on both genes and cells should be determined by follow-up at least a year. Keywords: MS, IFN-β, IL23A, FOXP3, IL10, T cells
Purpose: Recent studies have shown a relationship between cancer and inflammatory response. The aim of this study is to compare NLR and PLR values, which are inflammatory parameters, in precancerous and cancerous lesions and to determine whether there is a parameter that can be used in the early diagnosis of laryngeal squamous cell carcinoma. Methods:174 patients who were benign as a result of pathology, 122 patients who were malignant, 39 patients who were premalignant (335 patients in total) and 117 normal individuals were included in the study. Data groups were divided into 4 groups as Benign Laryngeal Lesion(BLL), Precancerous Laryngeal Lesion(PLL), Malignant Laryngeal Lesion(MLL) and Control Group(CG). In addition, the PLL group was subdivided into Mild Dysplasia(MiD), Moderate Dysplasia(MoD) and Severe dysplasia-carcinoma in situ (SeD/CIS). NLR, PLR and other parameters were calculated. Results: NLR and PLR values were significantly different between the groups. (p = 0.000, p = 0.002) The mean NLR was higher in the MLL and PLL groups, and was lower in the BLL and control groups. The mean PLR was also higher in the MLL and PLL groups. When the groups were compared in pairs, there was a significant difference between BLL and MLL (p = 0.001) and MLL and CG.(p = 0.006) The PLL group was subdivided into MiD, MoD and SeD / CIS. There was a significant difference in NLR when CG and other subgroups were compared.(p = 0.027) Significant differences were found between CG and SeD when the groups were compared in pairs.(p = 0.007) There was no significant difference between the groups in terms of PLR and dysplasia.(P = 0.516) Conclusion: As revealed in this study, these rates were low in the CG and BLL groups and high in the MLL group, so they could be used as markers to differentiate malignant lesions.
Purpose: The FDA-issued PLATO trial dataset revealed that some primary deaths causes (PDC) were inaccurately reported favoring ticagrelor. However, the PLATO Investigators operated the shorter death list of uncertain quality. We compared if PDC match when trial fatalities were reported to the FDA and by the PLATO investigators. Method: The FDA list contains precisely detailed 938 PLATO deaths, while shorter investigators dataset consists of 905 deaths. We matched 4 vascular (sudden, post-MI, heart failure and stroke), and 3 non-vascular (cancer, sepsis and suicide) PDC between death lists. Results: There were more sudden deaths in the shorter list than in the FDA dataset (161 vs.138; p<0.03), post-AMI (373 vs.178; p<0.001) but fewer heart failure deaths (73 vs.109; p=0.02). Stroke numbers match well (39 vs. 37; p=NS) with only 2 ticagrelor cases removed. Cancer matched well (32 vs.31; p=NS), and sepsis cases were identical (30 vs. 30; P=NS). However, 2 extra clopidogrel suicides in the shorter list are impossible to comprehend. Conclusions: The PLATO trial PDC were mismatched between FDA and Investigators sets. We are kindly asking the ticagrelor sponsor or/and concerned PLATO Investigators to clarify the PDC dataset match.
Introduction: The approach to thyroid hormone replacement varies across centres but the extent and determinants of variation is unclear. We evaluated geographical variation in levothyroxine (LT4) and liothyronine (LT3) prescribing across General Practices in England and analysed the relationship of prescribing patterns to clinical and socioeconomic factors. Methods: Data was downloaded from the NHS monthly General Practice Prescribing Data in England for the period 2011-2020. Results Overall, 0.5% of levothyroxine treated patients continue to receive liothyronine. All Clinical Commission Groups (CCGs) in England continue to have at least one liothyronine prescribing practice and 48.5% of English general practices prescribed liothyronine in 2019-20. Factors strongly influencing more levothyroxine prescribing (model accounted for 62% of variance) were the CCG to which the practice belonged and the proportion of people with diabetes registered on the practice list plus antidepressant prescribing, with socioeconomic disadvantage associated with less levothyroxine prescribing. For liothyronine prescribing (model accounted for 17% of variance), factors that were associated with increased levels of liothyronine prescribing were antidepressant prescribing and % of type 2 diabetes mellitus individuals achieving HbA1c control of 58mmol/mol or less. Factors that were associated with reduced levels of liothyronine prescribing included smoking and higher obesity rates. Conclusion: In spite of strenuous attempts to limit prescribing of liothyronine in general practice a significant number of patients continue to receive this therapy, although there is significant geographical variation in the prescribing of this as for levothyroxine, with specific general practice and CCG related factors influencing prescribing of both levothyroxine and liothyronine.
Aim: This study aimed to determine the approaches of family physicians in Turkey on the fasting of diabetic patients and whether they use international treatment guidelines when making recommendations. In addition, this study aimed to increase the awareness of family physicians on this issue before Ramadan, which is the fasting month. Material and Method: The study herein comprised cross-sectional observational research. Before Ramadan 2018, a structured questionnaire form, which was unique to this study, was prepared by considering the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), through platforms where family physicians gathered via social media and mail groups, and sent to the family physicians in Turkey via a link created using an electronic questionnaire preparation and application program. Moreover, the total knowledge level, attitude, and approach score were calculated through the questions prepared from the relevant guidelines. Results: Participating in the survey were 262 family physicians. Only 22% of family physicians said that they were aware that there were international guidelines for Ramadan and diabetes management, and only 10% said that they had read the relevant guidelines. The mean knowledge level, attitude, and approach scores were found to be lower than expected, and a significant difference was found between their scores and their academic titles. Conclusion: The lack of knowledge of international guidelines on the subject and lack of knowledge and experience about diabetes mellitus patient management in the fasting month stood out as the biggest problems. This study revealed that the awareness and competence of family physicians in disease management should be increased in addition to fasting before, during, and after Ramadan in diabetic patients.
Aims/Introduction: Insulin Degludec/Aspart (IDegAsp) and Insulin Glargine U300 (IGlarU300) have recently emerged as popular new-generation insulin analogs. The aim of this real-life study was to investigate the patient profiles in which IGlarU300 and IDegAsp were preferred and the insulin combinations after which each of them were mostly used, and also to analyze the effect of these two insulin analogs on blood glucose regulation and hypoglycemia. Materials and Methods: The retrospective study included 174 patients that were switched from basal insulin, basal+bolus insulin, or premixed insulin to IGlarU300 or IDegAsp due to uncontrolled blood glucose levels or history of hypoglycemia. Hypoglycemia, body weight, body mass index (BMI), fasting blood glucose (FBG), and HbA1c levels over three-month periods were evaluated for each patient. Results: There were 84 and 90 patients in the IGlarU300 and IDegAsp groups, respectively. Body weight was similar in both groups. Baseline FBG and HbA1c levels in the IGlarU300 and IDegAsp groups were 9.0%, 175.5 mg/dl and 9.4%, 193.5 mg/dl, respectively. A significant decrease was found in FBG and HbA1c levels in both groups (138.5, 7.8 vs. 141.5, 8.2; p<0.001 for all). Moreover, a significant weight gain was observed in both groups (p<0.05 for both). The prevalence of hypoglycemia in both groups decreased significantly and consistently between month 1 and 9 (p<0.001). At month 12, although this decrease continued in the IGlarU300 group (p=0.013), no significant decrease was observed in the IDegAsp group(p=0.057). Conclusion: Both twice-daily IDegAsp±bolus insulin and IGlarU300+bolus insulin therapies are effective and safe treatment modalities.
Aim: The aim of this study was to assess the efficacy of pre-operative axillary ultrasonography (AUS) and pre-operative axillary fine-needle aspiration biopsy (FNAB) from suspicious lymph nodes in clinically node-negative breast cancer to compare with radiologically positive and sentinel lymph node biopsy (SLNB) positive involvement. Method: Clinically node-negative early-stage breast cancer patients were included in the study. These patients under went pre-operative AUS examination, suspicious lymph nodes were evaluated with FNAB. AUS-FNAB results were compared with those of SLNB or of axillary dissection. Results: Of 181 patients undergoing AUS, 32 were reported to have axillary metastasis, 25 suspicious and 124 benign nodes. The suspicious group underwent FNAB examination and metastasis was found in 9 of them. The sensitivity of AUS-FNAB was found to be 64.06%, specificity 100%, positive predictive value 100% and negative predictive value (NPV) 83.5%. False negativity rate (FN) of this method was 16,4%. Lymphovascular invasion and tumor size were found statistically significant factors for false negativity. Conclusion:It was concluded that axillary AUS-FNAB with its high NPV, low FN rate, may be a clinical alternative to SLNB for early stage breast cancer patients.
Background: Arterial stiffness (AS) indicates the initial stage of cardiovascular disease (CVD), which associated with modifiable and lifestyle risk factors. We aimed to examine the association of AS with anthropometric indices, lipid profiles, and physical activity. Methods: 658 healthy middle-aged adults selected and anthropometric indices (body mass index (BMI), waist circumferences (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), neck circumferences (NC), a body shape index (ABSI), body roundness index (BRI), body-fat mass (BFM), visceral-fat, fat-free mass(FFM), lipid profiles, and PA were measured. Arterial Stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) and central augmentation index (cAIx). Results: Our results show, cf-PWV positively associated with TGs (β = 0.10, p = 0.01) and in anthropometric indices corelated with, WC (β = 0.11, p = 0.02), WHR (β = 0.09, p = 0.03), WHtR (β = 0.1, p = 0.02), and BRI (β = 0.09, p = 0.04). cAIx was independently positive association with cholesterol (β = 0.08, p = 0.03), WC (β = 0.1, p = 0.03), WHR (β = 0.09, p = 0.02), ABSI (β = 0.09, p = 0.01), BRI (β = 0.08, p = 0.05), visceral-fat area (β = 0.09, p = 0.03) and BFM (β = 0.08, p = 0.04) and negatively associated with PA (β = -0.08, p = 0.03). Conclusions: WC, WHR, and BRI were associated with both cf-PWV and cAIx. TGs and WHtR associated with cf-PWV, while cAIx was associated with ABSI, so improving these indices may be helpful to prevent CVD.
Our analysis as described in this research letter highlights the fact that age outweighs many other factors in people with T2DM in relation to mortality from SARS-CoV-2 virus, once infected. This fact should be taken into account in relation to the vaccination programme against coronavirus-19 in people with T2DM in the UK and elsewhere.
Background: Diabetes mellitus with coexisting hypertension contributes to increased morbidity and mortality. The study aimed to investigate the impact of the patients’ physical activity status and the type of cooking oil consumed by patients in their daily routine on glycemic profile, lipid profile, the hypertensive profile of the patients, and the length of stay, and overall cost of the treatment. Methods: A prospective observational study. All the patients referred to the medicine department of the three different hospitals located in Moga, City Punjab and those hospitalized due to diabetes mellitus (type-I and type-II) with coexisting hypertension were asked to participate in the study. Results: The patients’ mean age was found to be M= 53.85, SD= 11.54 years. Out of 1914 patients, 914 were male (47.8%); it was observed that the majority of the patients 525 (27.43%) in North India using butter or ghee- clarified butter as edible oil, followed by mustard oil 517 (27.01%) patients. About 345 (18.03%) of the patients consume soybean oil, whereas 226 (11.81%) of the patients like sunflower oil. Discussion: This study explored that cooking oil and physical activity are associated with length of stay in days & overall cost of the treatment, respectively. Our study results revealed that the type of oil compared with the treatment’s overall cost was significant for olive oil, soybean oil, and groundnut oil. Conclusion: The study revealed that moderate and low physical activity increases the length of stay compared to high physical activity. The consumption of olive oil as a regular food habit in daily routine decreases patients’ length of stay with diabetes with coexisting hypertension when doing the high physical activity but increases the overall cost of treatment.
Objectives: In Wilms Tumor (WT) secondary malignancies caused by the side effects of intensive treatments remain one of the important problems. Therefore, there is a need for new studies to identify low- and high-risk groups for WT and to improve the treatment regimens of children in the low-risk group. Therefore, in our study, we aimed to determine the prognostic significance of the cyclooxygenase-2 (COX-2) biomarker in WT. Materials and Methods: Our study included 24 patients diagnosed with WT between January 2010 and December 2019. The correlation between COX-2 expression and significant prognostic parameters was investigated by studying COX-2 antibody using the immunohistochemical method. Results: COX-2 expression was observed in 22 of the patients, and the expression was more evident especially in the epithelial component. There was no significant correlation between COX-2 positivity and prognostic parameters. Conclusions: In our study, no significant relationship was found between significant prognostic parameters and COX-2 expression. We think that the COX-2 pathway is effective during the development phase of WT, since COX-2 expression was observed in almost all patients, therefore it may be beneficial to add COX-2 inhibitors to the treatment, and that a sufficient number of studies should be conducted in this respect.
Aim: Dyspnea, a common symptom of novel coronavirus, can negatively affect sleep quality. The aim of this study was to evaluate the relationship between dyspnea severity and sleep quality in patients with COVID-19. Study Design: A cross-sectional design was used. Methods: Using the researcher’s mobile phone, data were collected via an online questionnaire from patients (n=100) who agreed to participate in the study. The data-collection form comprised three parts: a patient descriptive information form, the Dyspnea–12 Questionnaire, and the Richards–Campbell Sleep Questionnaire. Results: The mean age of patients was 46.39±12.61 years and 66.0% were male. Patients who were treated in the intensive care unit, had bachelor’s degree or more and patients with comorbid diseases had low mean scores from the RCSQ and high mean scores from the Dyspnea–12 Questionnaire (p<0.001, p<0.001; p=0.047, p<0.001;p<0.001, p<0.00,1,respectively).Patients who not receiving oxygen therapy had higher RCSQ mean scores and lower Dyspnea–12 Questionnaire scores (p<0.001, p<0.001; p<0.001, p<0.001, respectively). There was a strong negative relationship between the total scores obtained from the Richards–Campbell Sleep Questionnaire and the Dyspnea–12 Questionnaire(r= -701, p<.001). Conclusions: Sleep quality is affected by dyspnea severity in patients with COVID-19. Sleep quality and dyspnea severity are also influenced by quite different factors, and these should be addressed and eliminated by nurses as part of a holistic approach. The results of this study will help nurses, especially those providing treatment and care for patients with COVID-19, to identify the factors affecting dyspnea and sleep quality and to plan, implement, and evaluate nursing interventions that will reduce their workload.
Background：Depression is one of the most common and specific symptoms among postmenopausal women, leading to significant personal, family, and economic burdens. Some studies have shown that phytoestrogens can help relieve symptoms of depression. Objectives: This systematic review and meta-analysis aims to assess the efficacy and safety of phytoestrogens in treating depression among postmenopausal women. Methods: A comprehensive search for relevant studies published until November 25, 2020, was conducted in PubMed, the Cochrane Library, Chinese Biomedical Literature Database, Web of Science, and EMBASE. Statistical analyses were performed with Stata12.0, Comprehensive Meta-Analysis 3.0, and Review Manager 5.4. Results: 2,183 studies were identified and 10 studies were included, involving 1,248 participants. The quality of the four studies was assessed as high risk, six studies were assessed as unclear. The analyses conducted according random effects model indicated a positive effect on depressive symptoms for postmenopausal women compared to the placebo (SMD=-0.45; 95% [CI]= -0.60 to -0.29; Q=40.42, df=18, P=0.002; I2=55.5%). The high dose phytoestrogens (dose>100mg/day) have better effectiveness (SMD =-0.48; 95%[CI]= -0.76 to -0.20; I2=52.8%, P<0.05) than low dose (25mg/day≤dose≤100mg/day) (SMD=-0.45; 95%[CI]=-0.68 to-0.23; I2=66.7%; P>0.05) and ultralow dose (00.05). Isoflavones had better effectiveness (SMD=-0.52; 95% [CI]= -0.75 to 0.30; I2=65.8%, P<0.05) than lignans of phytoestrogens (SMD= -0.23; 95% [CI]= -0.05 to 0.01; I2=0%, P>0.05). The effectiveness varies in regions. The adverse reactions frequently reported were gastrointestinal symptoms and cold or upper respiratory tract infection. Conclusions: Phytoestrogen can relieve depression symptoms among postmenopausal women. High-dose isoflavones is the most effective. Although mild adverse reactions have been reported, phytoestrogen could be considered as a complementary treatment for postmenopausal depression.