Objective: This study aims to investigate the relationship of monocyte to high-density lipoprotein cholesterol ratio (MHR) with diabetes mellitus (DM) and diabetic nephropathy. Methods: This study included 262 Type-2 diabetes mellitus patients, of which 60 had diabetic nephropathy and 202 did not have diabetic nephropathy who presented to the internal diseases polyclinic at Firat University Medical Faculty Hospital between May 2018 and October 2018 and 50 healthy control subjects. A retrospective scan of patient files was conducted and information relevant to nephropathy such as hemoglobin, glycated hemoglobin levels (HbA1c), hematocrit count (HCT), monocyte count, LDL, HDL, triglyceride levels, and microvascular complications were acquired. Results: We determined MHR values as 11.9±5.5 and 8.4±2.9 respectively for the diabetic and healthy groups. There was a statistically significant difference between the two groups in terms of MHR, with a positive correlation between diabetes and MHR (< 0.001; r: 0.241). Moreover, glucose, HDL, and triglyceride levels were different between the two groups with statistical significance (respectively, p< 0.001; p< 0.001; p< 0.001). Our study found higher MHR levels for patients with diabetic nephropathy compared to those without diabetic nephropathy (respectively, 17.1±7.9 and 10.3±3.3) and determined statistical significance and a negative correlation (p< 0.001; r: -0.512). Conclusion: Our results suggest that an elevated MHR can be a biomarker for diabetic nephropathy, allowing the detection of diabetic nephropathy with simple and inexpensive laboratory tests. doi: https://doi.org/10.12669/pjms.35.4.534 How to cite this:Onalan E. The relationship between monocyte to high-density lipoprotein cholesterol ratio and diabetic nephropathy. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.534 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction:The aim of this study was to assess the knowledge, attitude, and behavior of medical students about the COVID-19 and the effect of the outbreak on the students' anxiety levels. Methods:The cross-sectional study was carried out between 07-14 April, with the online questionnaire forms applied to the medical students. A questionnaire forms were sent to one of every two students in the faculty using the systematic sampling method. A total of 530 volunteers were included in the study. The data was collected through a self-administered questionnaire of the socio-demographic characteristics, opinions about the epidemic, knowledge, and attitude of medical students regarding COVID-19. Anxiety levels of the participants were measured with the State-Trait anxiety inventory.Results: A total of 530 medical students had a mean score of knowledge and attitude of 7.83±1.27 and 45.18±5.12, respectively. Participants demonstrated good knowledge and a positive attitude towards COVID-19. Clinical period students had a higher level of knowledge (p<0.001) and positive attitude (p=0.025) compared to preclinical students. While the knowledge score was higher in men (p = 0.033), the attitude score was higher in women (p <0.001). There was a negative correlation between attitude scores and state (p=0.003) and trait anxiety scores (p<0.001). Conclusion:Medical students had sufficient knowledge and attitude towards COVID-19. Anxiety caused by the outbreak may have negative effects on the positive attitudes of the participants.

Objectives: Vaccination to the population is the most effective way to get rid of the COVID-19 pandemic, which currently has no effective treatment. For the high vaccine acceptance rate, it is important to determine the vaccine willingness of individuals and the barriers to vaccination. We aimed to determine the acceptability of the COVID-19 vaccine and the effect of attitudes, perception and beliefs on vaccination willingness among medical students. Methods: In February 2020, a cross-sectional survey was conducted online among medical student. A total of 734 medical students out of 980 medical students answered the questionnaire forms (response rate: 75.4%). The online questionnaire collected socio-demographic characteristics, attitudes, risk perception and beliefs about the COVID-19 pandemic and vaccine. Vaccine hesitancy, rejection and acceptance were determined by self-report of medical students. Results: Total of 739 medical students included study. Students declared that 60.1% (n = 444) of them to be willing to vaccinated, 14.2% (n = 105) refused and 25.7% (n = 190) were not sure. Covid-19 willingness to be vaccinated was higher in female (p = 0.005), clinical students (p < 0.001), those who ever tested for COVID-19 (p = 0.002), those who had covid-19 infection history in the family (p = 0.043), those who had COVID-19 and COVID-19 vaccine education (p = 0.001). Positive attitudes skor and higher knowledge scores were related with highly willingness to be vaccinated. High beliefs score (positive beliefs) was found to be associated with a higher willingness to be vaccinated (p < 0.001). Conclusions: Although the majority of the study population willingness to be vaccinated, one-third of medical students are hesitant about vaccination. Education, positive attitude and beliefs are related to higher willingness to vaccination.The COVID-19 pandemic immunization programs should be designed to remove barriers to negative vaccine beliefs and perception.

Introduction: Meteorin-like (Metrnl), also known as subfatin, is a recently discovered adipokine with a favourable effect on insulin sensitivity. Studies have shown lower Metrnl levels in obese patients. However, data on its circulating levels in type 2 diabetes mellitus (T2DM) patients are contradictory. This study aims to evaluate serum Metrnl levels in T2DM patients and determine the relationship between serum Metrnl levels and insulin resistance in these patients. Material and methods: This cross-sectional study was conducted among 150 participants. The study was carried out between June 2019 and December 2019 at the internal medicine outpatient clinic of a tertiary university hospital. The participants were divided into three groups: group 1 (control group, n = 50), group 2 (newly diagnosed T2DM, n = 50), and group 3 (long-standing diagnosed T2DM, n = 50). An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of Subfatin (Metrnl), and the correlations of Metrnl level with anthropometric parameters, HOMA index, and biochemical measurements were assessed. Results: There was no statistically significant difference between the gender (p = 0.468) and age (p = 0.067) characteristics of the three groups. The Metrnl (subfatin) levels of the participants were as follows: control group-20.05 (1.56-103.78); newly diagnosed T2DM group-2.62 (1.25-103.78); and long-standing diagnosed T2DM group-2.01 (0.80-19.84) pg/mL. The Metrnl (subfatin) levels of the participants in the control group were higher than in the participants in the newly diagnosed T2DM and long-standing diagnosed T2DM groups (p < 0.001). Subfatin demonstrated a negative correlation with insulin and HOMA-IR in the control group and long-standing diagnosed T2DM group. Conclusions: The subfatin level was found to be higher in the healthy control group than in both diabetic patient groups. Subfatin level showed negative correlation with both insulin level and HOMA index. There was a relationship between subfatin and insulin resistance. Low levels of subfatin in the diabetic patient groups may play a role in the pathogenesis of T2DM by increasing insulin resistance.

Objective:To examine potential associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume (MPV), HbA1c and microvascular complications in diabetic patients from a cost-effectiveness perspective.Methods:One hundred patients with type 2 diabetes attending our outpatient unit between May 2018 and October 2018 were included, and 100 healthy individuals served as the control group. A retrospective file search was performed to collect information on hemoglobin, mean platelet volume (MPV), glycosylated haemoglobin (HbA1c), hematocrit (Hct), neutrophil and lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelets (Plt), platelet/lymphocyte ratio (PLR), and microvascular complications (neuropathy, retinopathy, nephropathy).Results:Demographic and laboratory data were retrospectively controlled between diabetes (n=100) and healthy control (n=100) groups. The mean age in diabetic patients and healthy controls was 56.34 and 36.68 years, respectively. The mean NLR in diabetics and healthy controls was 2.48 and 2.11, the difference in NLR being significant (p=0.002). MPV in diabetics and controls was 8.54 and 8.53, respectively, and the difference was not significant (p=0.93). PLR was also similar, i.e. 149.7 and 145.3 in diabetics and healthy controls (p=0.067). With respect to microvascular complications, retinopathy was found to be significantly associated with MPV and NLR (p=0.015, and p=0.051), and nephropathy showed a significant association with NLR (p=0.027) among diabetics. In contrast with the two other microvascular complications, no significant association between neuropathy and NLR could be detected, while PLR and neuropathy was significantly associated (p=0.003).Conclusion:Microvascular complications may be associated with certain hematologic parameters, as suggested by comparisons both between diabetics and healthy individuals and within the group of diabetic individuals. We believe that hematologic parameters such as hematocrit, MPV, NLR, and PLR, which can be obtained through a simple complete blood count, may be utilized as cost-effective predictors of diabetic microvascular complications. Further prospective studies with larger sample size are required to better delineate these associations.

Backround: Elabela (ELA) is a hormone that is secreted at high levels in the kidneys of a healthy adult. This study aims to investigate whether serum ELA levels of patients with Type 2 Diabetes vary with the severity of renal damage. Methods: Our study included 50 healthy control subjects and 100 diabetic patients, who were categorized into groups based on urine albumin/creatinine ratios (ACR). Patients included in the study were assigned to four groups: Group 1 (healthy control), Group 2 (ACR<29mg/g), Group 3 (ACR=30-299 mg/g), and Group 4 (ACR>300 mg/g normal or high serum creatinine). Physical examination findings, demographic characteristics of the study group were recorded, and serum ELA levels and other laboratory parameters were assessed using appropriate methods. Results: The results of the study indicated that ELA levels determined in healthy individuals gradually decreased through stages of normal albuminuria, microalbuminuria, and macroalbuminuria. Moreover, ELA had a significant negative corre- lation with LDL-C (r=-0.201, p=0.014), glucose (r=-0.437, P<0.001), retinopathy (r=-0.222, P=0.006), serum BUN (r=- 0.161, P=0.049), and a positive correlation with eGFR (r=0.250, P=0.002). Conclusions: The fact that ELA levels are higher in healthy individuals compared to diabetic patients without microalbu- minuria, and higher in diabetic patients without microalbuminuria compared to patients with advanced albuminuria and kidney damage, suggests that the ELA level can be an important clinical prognostic variable and even a promising agent for the treatment of diabetic nephropathy patients. Keywords: Elabela, diabetes, diabetic kidney disease, albuminuria.

Introduction: The aim of this study was to investigate serum apelin and resistin levels in patients with impaired fasting glucose, impaired glucose tolerance, type 2 diabetes and metabolic syndrome. Material and methods: The study comprised 18 patients with type 2 diabetes mellitus (T2DM) (nine females, nine males), 18 patients with impaired fasting glucose (IFG) (nine females, nine males), 18 patients with impaired glucose tolerance (IGT) (nine females, nine males), 18 patients with metabolic syndrome (MeS) (nine females, nine males), and 16 healthy individuals (eight females, eight males); serum adiponectin, apelin, resistin levels, fasting and postprandial blood glucose, insulin resistance markers, and lipid parameters were measured. Results: In the study, serum apelin levels were determined to be significantly lower in IGT, MeS, and T2DM groups compared with the control group (p = 0.002, p = 0.006, and p < 0.001, respectively). Serum resistin levels were determined to be significantly higher in IGT and T2DM groups compared with the control group (p < 0.001 and p < 0.001, respectively). Conclusions: Apelin and resistin are thought to affect glucose metabolism and insulin resistance. Apelin is an important indicator in individuals with IGT in the prediabetic period and may play a role in preventing diabetic complications and treatment of T2DM.

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