Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics

Background  

For the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage. A screening method for depression is the patient health questionnaire (PHQ-9). The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression in diabetes patients in outpatient clinics.     

Impact of luteal phase hysteroscopy and concurrent endometrial biopsy on subsequent IVF cycle outcome

Purpose

Endometrial biopsy preceding implantation in in vitro fertilization (IVF) treatment causes a type of injury which facilitates implantation. Pre-treatment hysteroscopic evaluation of uterine cavity also raises the success in IVF. This study investigates whether office hysteroscopy and concurrent endometrial biopsy performed in the luteal phase, on the day of GnRH agonist initiation for long protocol, improves subsequent IVF outcome.

Methods

A prospective, nonrandomized, controlled study of 128 normoresponder women was performed: In 70 women (study group), office hysteroscopy and concurrent endometrial biopsy were performed on the day of GnRH agonist initiation preceding ET cycle and in 58 women (control group), GnRH agonist was initiated without any intervention. However, uterine cavity was shown to be normal with hysteroscopy within the previous 6 months in those women. Implantation and pregnancy rates were compared between the groups.

Results

Intrauterine pathologies were observed in 28 % of women in the study group. Implantation rate (38 vs. 25 %; p = 0.04) and pregnancy rate per ET (67 vs. 45 %; p = 0.01) were found to be significantly higher in the study group compared to the control group.

Conclusion

Office hysteroscopy and concurrent endometrial biopsy performed in the luteal phase, on the day of GnRH agonist initiation for long protocol, provide direct evaluation of the uterine cavity immediately before ET cycle and also significantly improve the implantation and IVF outcome.     

Omentin and chemerin and their association with obesity in women with polycystic ovary syndrome

We aimed to investigate whether overweight/obesity is associated with omentin and chemerin. The study group consisted of 81 women with Polycystic ovarian syndrome (PCOS) (41 lean, BMI?2 and 40 overweight or obese, BMI?>?25?kg/m²) and 61 healthy subjects (31 lean, BMI?2 and 30 overweight or obese, BMI?>?25?kg/m²; control group). The clinical, endocrine, metabolic parameters, plasma omentin and chemerin levels were measured in patients and compared to control. In all subjects with PCOS (n?=?80), serum chemerin levels were higher compared with those of the controls (n?=?58) (7.71?±?1.78?ng/mL versus 6.94?±?0.82?ng/mL, p?=?0.003). However, serum omentin levels were not significantly different between the PCOS subjects and the controls (1.55?±?0.43?ng/mL versus 1.69?±?0.37?ng/mL, p?=?0.056). The mean chemerin concentrations were significantly elevated in the obese PCOS group compared with the obese control subjects (8.98?±?1.45?ng/mL versus 7.02?±?0.67?ng/mL, p?=?0.000) and the nonobese PCOS group compared with the obese control subjects (6.57?±?1.17?ng/mL versus 7.02?±?0.67?ng/mL, p?=?0.000). In conclusion, fat mass seems to be the main determinant factor of increased chemerin and decreased omentin in women with PCOS.     

Fuchs' heterochromic uveitis associated with retinal break or dialysis

BACKGROUND: Three cases of Fuchs' heterochromic uveitis (FHU) are described, 2 with peripheral retinal breaks and 1 with retinal dialysis. METHODS: Argon laser photocoagulation was applied around the breaks and the dialysis. RESULTS: The retinal breaks and dialysis were successfully photocoagulated. INTERPRETATION: Thorough inspection of the fundus, including the peripheral retina, is important in patients with FHU to exclude a retinal break or a dialysis.     

Diode laser-assisted endoscopic dacryocystorhinostomy: a comparison of three different combinations of adjunctive procedures

Chronic dacryocystitis is a frequently encountered condition which can be corrected by dacryocystorhinostomy. Today, the diode laser is increasingly put to use in such corrective operations. This study aims to answer the questions of which adjunctive procedures and which combinations of such procedures are necessary and effective in securing more successful outcomes in diode laser dacryocystorhinostomy. This prospective randomized study included eighty patients (13 male, 67 female) who underwent dacryocystorhinostomy in our hospital during the 2 year period of January 2009–January 2011. The patients were selected consecutively and were randomly allocated to three groups. Group 1 (30): diode laser + mitomycin C + silicone intubation; Group 2 (27): diode laser + silicone intubation; Group 3 (23): diode laser + mitomycin C. All patients were evaluated postoperatively on day 1, week 1, and on the 1st, 3rd, 6th, 12th, 18th, and 24th months. The postoperative evaluation consisted of preoperative and postoperative ostium measurements, recording postoperative complications, and calculating and comparing success rates and operative times. The mean ages of the patients were 63.4 for Group 1, 60.7 for Group 2, and 61.8 for Group 3. No statistically significant difference was found among the groups regarding pre- and postoperative ostium measurements. The success rates were 84.3, 80, and 76.9 % for Groups 1, 2, and 3, respectively. Complications noted in Group 1 were restenosis (3), premature silicone tube loss (1), development of granulation tissue (3), synechia (2), infection (2), and hemorrhage (3). Those for Group 2 were restenosis (5), premature tube loss (2), granulation (8), synechia (6), infection (3), and hemorrhage (4). Group 3 had 6 cases with stenosis, 5 with granulation, 3 with infection, 6 with synechia, and 5 with hemorrhage. The operative times of the groups were 25.5, 15.3, and 18.1 min, respectively, for Group 1, 2, and 3. All three groups had statistically significant differences regarding the duration of surgery, with p < 0.001, p < 0.001, and p = 0.002 for Group 1 and 2, Group 1 and 3, and Group 2 and 3, respectively. Our study showed that when diode laser DCR was combined with bicanalicular silicone intubation and intraoperative mitomycin C application, those adjunctive procedures, while increasing operative time, enhanced the success rate and diminished complications as compared to diode laser plus intubation and/or diode laser plus mitomycin C.     

Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis

Background Osteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis （AS）.The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS.Methods Fifty-nine AS patients and 40 healthy controls were enrolled.Bone mineral density （BMD） was measured using dual-energy X-ray absorptiometry （DEXA） at posterior-anterior （PA） lumbar,lateral lumbar and hip regions.Thoracic and lumbar X-rays were obtained for morphometric measurements.Clinical,biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index （BASDAI）,Bath Ankylosing Spondylitis Metrology Index （BASMI）,Bath Ankylosing Spondylitis Functional Index （BASFI）,Bath Ankylosing Spondylitis Radiology Index-total （BASRI-t）,erythrocyte sedimentation rate （ESR） and the C-reactive protein levels.Results Osteoporosis was present in 32% of patients and 5% of controls according to lateral vertebral BMD measurements.Fracture was present in 31% of patients.The effect of some clinical and laboratory parameters on BMD status and vertebral fractures was analyzed in the patient group.Osteoporosis in lateral lumbar DEXA was associated with higher BASMI,BASFI,BASRI-t scores and ESR level.Low hip BMD was associated with low BMI and high BASFI and BASRI-t scores.Vertebral fractures were associated with advanced age,longer disease duration,longer duration since diagnosis,higher BASMI and BASRI-t scores,higher ESR level,reduced femoral and lateral lumbar BMD.Logistic regression analysis revealed that only BASRI-t score was significantly associated with low lateral spinal BMD and BMI and BASFI score were independently associated with low hip BMD.The presence of compression fractures was independently associated with BASRI-t score and low lateral lumbar BMD.Conclusions Osteoporosis and vertebral fractures in AS seem to be related to the extent of radiological involvement.A low lateral lumbar BMD     

Utility and limitations of 3-Tesla diffusion-weighted magnetic resonance imaging for differentiation of renal tumors

Objective

To investigate utility and limitations of 3-Tesla diffusion-weighted (DW) magnetic resonance imaging (MRI) for differentiation of benign versus malignant renal lesions and renal cell carcinoma (RCC) subtypes.

Materials and methods

Sixty patients with 71 renal lesions underwent 3 Tesla DW-MRI of the kidney before diagnostic tissue confirmation. The images were retrospectively evaluated blinded to histology. Single-shot echo-planar imaging was used as the DW imaging technique. Apparent diffusion coefficient (ADC) values were measured and compared with histopathological characteristics.

Results

There were 54 malignant and 17 benign lesions, 46 lesions being small renal masses ≤4 cm. Papillary RCC lesions had lower ADC values (p = 0.029) than other RCC subtypes (clear cell or chromophobe). Diagnostic accuracy of DW-MRI for differentiation of papillary from non-papillary RCC was 70.3% resulting in a sensitivity and specificity of 64.3% (95% CI, 35.1–87.2) and 77.1 (95% CI, 59.9–89.6%). Accuracy increased to 83.7% in small renal masses (≤4 cm diameter) and sensitivity and specificity were 75.0% and 88.5%, respectively. The ADC values did not differ significantly between benign and malignant renal lesions (p = 0.45).

Conclusions

DW-MRI seems to distinguish between papillary and other subtypes of RCCs especially in small renal masses but could not differentiate between benign and malignant renal lesions. Therefore, the use of DW-MRI for preoperative differentiation of renal lesions is limited.