Pinar Yildiz

Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients

Background: Studies have reported the presence of sleep disorders in approximately 50–70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels). Methods: We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. Results: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders. Conclusions: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.

Meckel's diverticulitis in Amyand's hernia

The presence of the appendix within an inguinal hernia has been referred to as ‘Amyand’s hernia’ to honour Cladius Amyand surgeon of King George II. Amyand was first to describe the presence of a perforated appendix within the inguinal hernial sac in 1735 [1]. Most cases are diagnosed intra-operatively rather than pre-operatively. Appendicular diverticulitis in an Amyand’s hernia was rare [2]. We present a case of an inguinal hernia containing both the Amyand’s hernia and a Meckel’s diverticulum. An 86-year-old man presented with a 20-year-old history of a bilateral inguinal mass. The mass in the right groin enlarged and became painful lately. The clinical examination of the abdomen was normal. There were swellingsin both groins, the right side being larger and tender, but the skin showed no signs of inflammation. The white blood cell count and the temperature were normal. Ultrasound examination described a hernia which contains mobile bowel segments inside, on the right side. The operation was performed by an anterior approach through an inguinal incision. A sliding hernia was found with the caecum comprising a hernial wall and the appendix protruding through the hernial sac being edematous and hyperemic (Fig. 1). An appendicectomy was done. Further exploration of the bowels revealed a Meckel’s diverticulitis which was managed by a wedge resection. We proceeded with the hernia repair and planted a mesh according to the Lichtenstein technique. Histopathologic examination showed a normal appendix vermiformix but revealed a Meckel’s diverticulitis. Post-operative recovery was uncomplicated; the patient was discharged 2 days after admission and had no complaints till now. The presence of the appendix within an inguinal sac is an uncommon condition and is referred to as ‘Amyand’s hernia’. The incidence of having a normal appendix within the hernial sac is 1 % [1, 3]. Most of the cases of Amyand’s hernia occur on the right side, probably as a consequence of the normal anatomical position of the appendix, and also because right-sided hernias are more Wiener klinische Wochenschrift The Central European Journal of Medicine Wien Klin Wochenschr (2012) 124:288–289 DOI 10.1007/s00508-012-0153-x

Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: Can they be components of a single disease process in elderly patients?

OBJECTIVE To report two patients with giant cell arteritis (GCA) who developed rheumatoid arthritis (RA) and to review the literature in terms of coexistence of RA, GCA, and polymyalgia rheumatica (PMR). METHODS We conducted a comprehensive review of the English literature from 1980 to 2015 to analyze data on the coexistence of GCA and RA. The PubMed, Web of Science, Proquest, and Ovid databases were searched for articles using the term RA combined with temporal arteritis, GCA, and PMR. RESULTS We identified 17 other cases of coexistent GCA and RA reported in the English literature, together with our 2 cases (19 cases). They included 14 females and 5 males, with a mean age of 74.3 years (range: 57-84) at the time of GCA. The mean age at the time of RA diagnosis was 69.6 years (range 24-83). The average time elapsed between the onset of GCA and the development of RA was 6.7 years (range: 3 month-34 years). RA and GCA were reported as the first disease in 10 cases and 4 cases, respectively. The development of these 2 diseases in a narrow period of time appeared in 4 cases (3 months-19 months). PMR was the first disease in 1 case. CONCLUSION RA, GCA, and PMR may appear simultaneously or consecutively; therefore, we suggest that physicians should be alert about such a fact so that a proper diagnosis and treatment could be tailored accordingly.

Mastalgia-Cancer Relationship: A Prospective Study

OBJECTIVE Mastalgia is an important symptom affecting approximately 70% of women and it disrupts the quality of life especially due to the worry of having cancer. In our study, the type and severity of mastalgia symptom of patients who presented to the outpatient clinic with mastalgia complaint were assessed along with their physical examination findings and radiology results. The purpose of the study is to demonstrate the relationship between mastalgia and malignity when assessed in combination with the risk factors of patients. MATERIALS AND METHODS The age, family history, menopausal status, age at the first childbirth, menarche, presence/absence of hormone replacement therapy, type of mastalgia, comorbidities and examination findings of 104 patients, who presented to the General Surgery outpatient clinic with mastalgia symptom, were recorded and assessed in the light of radiological study results. RESULTS With respect to the mastalgia types of the patients, 38.5% had cyclic pain, 57.7% non-cyclic pain and 3.8% other types of pain. Mild mastalgia was present in 46.2% of the patients, moderate mastalgia in 24% and severe mastalgia in 29.8% of them. According to the BIRADS category, 48.1% of the patients were identified to have BIRADS 1 mass lesions, 39.4% BIRADS 2, 9.6% BIRADS 3 and 2.9% BIRADS 5 mass lesions. The patients who were identified to have BIRADS 5 mass lesions described non-cyclic and severe pain in the post-menopausal period. They had palpable masses along with the pain symptom. CONCLUSION Our study suggests that mastalgia symptom does not per se result in suspicion of malignancy, but physical examination and radiological imaging should also be used as needed for confirmation. Studies with a larger patient population are needed to shed light on the mastalgia epidemiology and its relationship with cancer.