Background/Aim: Diabetic retinopathy is a common ailment that causes visual impairment among adults, and evidence suggests that oxidative stress plays a significant role in its pathogenesis. The objective of this study was to examine the potential association between selenium deficiency and an increased risk of diabetic retinopathy among individuals with type 2 diabetes mellitus. Methods: This study was a prospective case-control study. 115 patients with a diagnosis of type 2 diabetes mellitus were included. The patients were divided into groups with and without retinopathy. No subgroups were made according to the level of retinopathy. The aim was to compare the serum selenium level of patients between groups. Therefore, other variables that may contribute to the development of retinopathy were also recorded. The duration of diabetes, medications used, and glycosylated hemoglobin levels were recorded. The retinopathy group included 47 patients, and the non-retinopathy group included 68 patients. Selenium levels were measured in plasma samples. Results: The mean selenium level of the retinopathy group (70.11 [17.28] μg/l) was significantly lower than that of the non-retinopathy group (80.20 [19.10] μg/l) (P=0.005). The median duration of diabetes mellitus was significantly higher in the retinopathy group than in the non-retinopathy group (10 [1-25] and 6 [1-21], respectively; P=0.002). Logistic regression analyses showed that higher levels of blood selenium were independent preventive factors against the occurrence of retinopathy (OR [95% CI]: 0.965 [0.939-0. 991]). The duration of diabetes mellitus was an independent risk factor for retinopathy occurrence [OR (95% CI): 1.131 (1.050-1.219)]. One unit increase in selenium level was associated with a unit decrease in diabetic retinopathy of 0.965 (0.939-0.991). Conclusion: Our research revealed a correlation between the duration of diabetes and the incidence of diabetic retinopathy. Furthermore, a notable difference was observed in blood selenium levels between patients with diabetic retinopathy and those without it. Specifically, patients with diabetic retinopathy had lower plasma selenium levels compared to the control group. These findings have potential implications for the treatment or prevention of diabetic retinopathy, but more research is needed to determine the efficacy of selenium supplementation for diabetic patients with or without microvascular complications. Future studies should investigate the effect of selenium deficiency on different subtypes of diabetic retinopathy and the impact of selenium supplementation in this patient population.
Aim: Chronic kidney disease creates a tendency to infections, and infections are the second most common reason for mortality following cardiovascular events in chronic kidney disease. Health authorities recommend vaccination against hepatitis B, annual influenza, pneumonia, zoster, tetanus, and new coronavirus disease for people with end-stage kidney disease. Vaccine-preventable diseases cause mortality in the adult population with chronic diseases. The primary purpose of this study is to investigate vaccination rates and awareness about vaccination among end-stage renal disease patients who were on renal replacement therapies in a single tertiary center in Turkey. Material and Method: 86 hemodialysis patients were included in this cross-sectional study. A questionnaire was used to investigate whether the patients were aware of the immunization schedule or not and whether they were vaccinated against hepatitis B virus, seasonal influenza virus, pneumonia, herpes zoster, tetanus, and SARS-CoV-2 or not. Results: Fifty-eight (67.4%) patients were vaccinated against SARS CoV2. 48(55.8%) patients were vaccinated against the Hepatitis B virus. 31 (36%) patients were vaccinated against Pneumococcus pneumonia. 48 (55.8%) patients have been vaccinated against the influenza virus annually. Only 14 (16.3%) patients were vaccinated against tetanus during the previous 10 years, and only 1 (1.2%) patient was vaccinated against Herpes zoster. Influenza vaccination rates were found to be higher in patients with a longer duration of hemodialysis when compared to the other group(p=0.03). SARS-CoV 2 vaccination rates were higher in patients who were older than 59 years of age when compared to the younger patients(p=0.03). Conclusion: Vaccination rates are far from the targets in patients with end-stage kidney disease. The most common reason to be unvaccinated is a lack of enough knowledge about the subject.
This study has investigated the vaccination rates against SARS-CoV-2 infection, antibody response to vaccine types, and factors affecting mortality in maintenance hemodialysis patients.98 of 143 patients undergoing hemodialysis in our clinic had 3 doses of BNT162b2 (Pfizer-BioNTechh) or CoronaVac (Sinovac Life Sciences) vaccine. Of these 98 patients, blood samples were obtained from 52 patients who agreed to obtain serum samples before and after vaccination. The serum samples were analyzed using the Abbott SARS-CoV-2 immunoassay designed to detect IgG antibodies against the receptor-binding domain of the S1 subunit of the spike protein of SARS-CoV-2. The rate of vaccination with at least one dose of vaccine was 85.3%, and the frequency of SARS-CoV-2 infection was 58.7%. The patients whose antibody titer was obtained after the third dose of vaccine (n=52) were divided into two groups according to the last vaccine type, as BioNTechh group of 16 patients and the Sinovac group of 36 patients. Considering all 52 patients with 3 doses of vaccine, the median antibody level was 397.3 (min-max) (4.5 - 40000) before the third vaccine dose, while 1325.3 (min-max) (10.5 - 40000) after the third vaccine dose (p < 0.001). In patients with the last vaccine dose of Sinovac (n=36), the median antibody titer was 168.2 (min-max) (4.5 - 40000) before the third vaccine dose, while 851.7 (min-max) (55.2 - 40.000) after the third vaccine dose (p < 0.01). In patients with the last vaccine dose of BioNTechh, the median antibody titer was 2738.6 (min-max) (9.4 - 37723.4) before the third vaccine dose, while 37575.8 (min-max) (10.5 - 40000) after the third vaccine dose (p = 0.002). The frequency of SARS-CoV-2 infection (p=0.001) and SARS-CoV-2 infection-related mortality rates were significantly lower in vaccinated patients than in unvaccinated patients (p
Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients. Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria). Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034). Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.
A 29-year-old man applied to the internal medicine outpatient clinic with fatigue and high plasma glucose levels. He had type 1 Diabetes Mellitus for 10 years and was using insulin glargine U300 and insulin glulisine for treatment. His glycosylated hemoglobin level was 16.7%, and he was hospitalized. Insulin doses were calculated as 1 unite/kg /day; glulisine 3x8 unit/day and glargine U300 1x18 unit/day were ordered. Although we increased the total insulin dosage to 1,5 units/kg/day, the plasma glucose measurements did not improve. The short-acting insulin analog was switched to insulin aspart based on the fact that insulin autoantibodies might cause this situation. On aspart treatment, the patient suffered from hypoglycemia with the same doses of glulisine. The occurrence of insulin autoantibodies against glulisine was confirmed clinically. Basal insulin dose was reduced to 20 units, and aspart 3x6 units/day was enough for plasma glucose control. Hyperglycemia due to autoantibodies against analog insulins is very rare. Here we report a type 1 Diabetes Mellitus patient who was on glulisine treatment for 10 years, and whose blood glucose measurements deteriorated recently. Hyperglycemia was regulated after the insulin switch from glulisine to aspart. This rare case report must be kept in mind in hyperglycemic patients with a history of long-time analog insulin treatment.
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