Estimation of anti-diabetes drug metformin in Turkiye using wastewater-based epidemiology.

Metformin is the most commonly used drug for the treatment of type 2 diabetes (T2D), which is dramatically increasing due to factors such as increasing obesity, physical inactivity, and aging of the population. Metformin analysis was carried out in composite wastewater samples seasonally collected from wastewater treatment plants in 10 cities in 2019 and 2020 30 cities in 2021 in Turkiye. Metformin was measured in all wastewater samples, with an average concentration of 97.81 µg/l in 2019, 75.19 µg/l in 2020, and 69.13 µg/l in 2021. This study was utilized to predict metformin usage in different sociodemographic regions in Turkiye using a wastewater-based epidemiology (WBE) approach. As a result of the analysis, the average metformin consumption in Turkiye was estimated to be 22.2 ± 9.6 [1.9-63.8] g/d/1,000 persons (mean ± SD [range]). Furthermore, these estimates were compared with data for time, sociodemographic characteristics, and patient numbers. Assessing the correlation with estimates and the socioeconomic classes of the cities in question revealed that cities with high-income levels had the lowest metformin use rate. Finally, the study provides supporting data aiding the development of public health strategies for decreasing the overall load of T2D across Turkiye.

Multisectoral action on drug dependence in Turkey: applying a whole-of-government approach

The use of substances that produce dependence has become a severe and worldwide health problem. Substancedependence is not only a health issue; it also has public, social, legal and governmental aspects. For this reason, antidrugefforts need to be multidirectional. Protection of people who has not yet met with drugs (particularly teenagers)and people with drug use but not yet dependence can be ensured by developing effective policies. For that purpose,under the leadership of Deputy Prime Minister and under the coordination of Ministry of Health, and with the highlevel participation of other 7 related Ministries a holistic and high level multidisciplinary approach is adopted withinthe scope of Anti-Drug Emergency Action Plan in Turkey. Priority objective of all these efforts is to ensure effectiveimplementation, sustainability of prevention and protection activities. This study summarizes strategies and supply,demand and communication policies developed with high level determination and institutional cooperation within thescope of Anti-Drug Emergency Action Plan.

Iodine deficiency and goiter prevalence of the adult population in Erzurum.

It is believed that total goiter prevalence in Turkey is as high as 30.5%. The iodine deficiency is the distinct etiologic factor in the development of goiter. The aim of this study was to determine goiter prevalence and iodine deficiency in adults living in Erzurum (1659 m above sea level) for at least 10 year. The study involved 340 people (192 females, 148 males). The median age was 38.5 year (ranging from 20 to 76 years). Ultrasound-measured thyroid volume (TV) for men (TV>25 ml) and for women (TV>18 ml) was considered goiter indicator. By this evaluation, goiter was diagnosed in 94 (27.6 %) cases, whereas the goiter prevalence, based on the palpation method, was 5.6%. Urinary iodine concentration (UIC) was measured by ammonium persulfate method. UIC in subjects with goiter was significantly lower than that of the others (median values 5.0 vs 7.8 microg/dl, p<0.0001). While the value of UIC > or = 10 microg/dl (no. 121, 36.6%) was accepted normal, the extent of iodine deficiency in other subjects was classified as severe (UIC<2.0 microg/dl, no.53, 15.6%), moderate (UIC=2.0-4.9 microg/dl, no.75, 22%) and mild (UIC=5.0-9.9 microg/dl, no.91, 26.8%). TV values were found to be significantly different among the four groups (p<0.05). TV values were significantly correlated with body surface area and UIC (r=0.15 and r=-0.16, respectively, p<0.005). Also, the prevalence of thyroid nodules was estimated as 2.1% by palpation and 18% by ultrasonography. We conclude that goiter originating from iodine deficiency has been an important health problem in Erzurum. Besides taking measures at national level, local factors and risks which interfere with the nationwide efforts should also be dealt with for the eradication of the iodine deficiency problem. In the region, periodical evaluation of iodine level and iodine related disorders will guide the measures to be taken for the well being of people's general health.

A prospective evaluation of early thyroid dysfunction on completion of neck radiotherapy.

The purpose of this study was to examine thyroid dysfunction in the early phase of radiotherapy to the head and neck region. Forty-seven patients receiving neck irradiation including the thyroid gland were included. Twenty-eight patients had undergone either a functional or radical neck dissection and in 19 patients radiotherapy was the primary treatment. Compared to the pre-treatment values, there was a significant fall in the TSH level at completion of radiotherapy in the non-operated patients and a non-significant fall in the operated patients. The TSH was also significantly lower in the non-operated group at the end of treatment compared to the operated group. There was a significant fall in the FT3 and significant higher in the FT4 at the end of radiotherapy for both groups. This study shows that even during completion of radiotherapy to the head and neck region changes in thyroid function were observed for both previously operated and non-operated patients.