Do We Care Enough About the Presence of Sexual Problems in Diabetic Patients?

Purpose: Sexual health is not only the absence of sexual dysfunction or disability, but also the presence of physical, emotional, mental, and social well-being related to sexuality. The current study aims to determine whether all adult patients who have applied for their regular health check-ups due to diabetes mellitus had ever voluntarily expressed their sexual problems to a specialist and whether they were asked about the presence of sexual dysfunction. It also aims to determine how the physicians attach importance to the issue. Patients and Methods: All patients aged 18-65 years with type 1 and type 2 diabetes mellitus, who applied to our hospital between the years of January 2021 and 2022, were questioned by filling out a questionnaire for the presence of sexual problems in addition to screening for chronic complications of diabetes mellitus (retinopathy, nephropathy, and neuropathy) and routine history and physical examination. Results: The association between the presence of sexual problems and whether patients were questioned about the relevant issue in their previous controls and gender and age factors, educational background, presence of comorbidities, duration of marriage, and microvascular complications of diabetes mellitus were examined. In a population of 595 patients, 53.78% of the patients stated that they had sexual problems; however, 9.91% had been questioned about this issue by the physician. It was observed that 6.3% of female and 15.3% of male patients had previously consulted a doctor voluntarily due to their sexual problems. Conclusion: This study presents empirical findings that shed light on the inadequacies in healthcare providers' approach to addressing sexual health concerns among individuals diagnosed with diabetes, as well as the shortcomings in patients' effective communication of these concerns.

Retinal Nerve Fiber Layer Thickness in Prediabetic Patients.

OBJECTIVE: Diabetic retinopathy is a leading cause of blindness. Diabetic retinopathy is not only seen in diabetic patients with the clinical diagnosis but also in prediabetic patients. The aim of this study is to evaluate the RNFL thickness in prediabetic patients. MATERIALS AND METHODS: In this study, 50 prediabetic patients and 50 healthy individuals were included. RNFL measurements were performed with SD-OCT in patients with prediabetes and healthy controls. RESULTS: The mean RNFL thickness for the prediabetic group was 94.7 ± 6.3 µm, inferior quadrant (120 ± 11.6), superior quadrant (112.3 ± 14.13), nasal quadrant (71 ± 12.9), and temporal quadrant (65.3 ± 9.2 µm). The mean RNFL thickness for the control group was 98.9 ± 7.5 µm, inferior quadrant (128 ± 14.7), superior quadrant (116.3 ± 15.12), nasal quadrant (77 ± 15.8), and temporal quadrant (71.2 ± 10.3 µm). Variance analysis demonstrated that the RNFL thickness difference between the groups was significant in all quadrants (P < .001). CONCLUSION: RNLF thinning can be seen in prediabetic patients before obvious vascular damage has occurred, and it may present in prediabetic patients not only in the temporal quadrant but also in all quadrants. The early retinal neural changes shown in this study in prediabetic patients may help to better understand the process leading to diabetic overt retinopathy.

The preventive role of levosimendan against bleomycin-induced pulmonary fibrosis in rats.

BACKGROUND: In this study, the effects of levosimendan used in the treatment of acute congestive heart failure upon pulmonary fibrosis in rats induced with bleomycin (BL) were analyzed. METHODS: A total of 33 male Sprague-Dawley type rats were categorized into five groups randomly. About 2.5U/kg BL was intratracheally administered to the rats in the BL, BL+L1, BL+L2, and BL+L3 groups, and 0.9% saline was intratracheally administered at the same rate to the control group. 0.3, 1, and 3mg/kg levosimendan was intraperitoneally administered to the BL+L1, BL+L2, and BL+L3 groups, respectively. Blood and tissue samples were taken from the rats euthanized to determine the changes in erythrocyte enzyme activities and to conduct histopathological evaluations after 14 days. With values between 0 and 3, histopathological scoring damage was assessed by the presence of inflammation and fibrosis in a semiquantitative manner. RESULTS: Compared with those in the C group, glutathione reductase (GR) and Catalase (CAT) enzymes decreased in the BL group; compared with that in the BL group, GR increased in the BL+L1 and BL+L3 groups, 6-phosphogluconate dehydrogenase (6PGD) increased in the BL+L3 group, and CAT increased in the BL+L2 and BL+L3 groups (p<0.05). In the histopathological evaluation, fibrosis occurred in all rats in the BL group, and tissue damage was noticed to be generally less in the BL+L1, BL+L2, and BL+L3 groups (p<0.001). CONCLUSIONS: The results obtained from biochemical and histopathological evaluations indicate that levosimendan had an anti-fibrotic effect without a dose-dependent response on pulmonary fibrosis.

Genotoxic evaluation of two oral antidiabetic agents in the Drosophila wing spot test.

In this study, two sulfonylureas--glimepiride and glipizide--commonly used in type 2 diabetes mellitus were investigated for genotoxicity in the Drosophila wing spot test. For this purpose, three-day-old transheterozygous larvae were treated with three mutagenic compounds, and the results obtained were compared with the control group. Mutational or recombinogenic changes were recorded in two recessive genes--multiple wing hairs (mwh) and flare (flr (3)). Two recessive markers were located on the left arm of chromosome 3, mwh in map position 0.3, and flare-3 (flr3) at 38.8, while the centromere was located in position 47.7. Wing spot tests are targeted on the loss of heterozygosity, which may be grounded in different genetic mechanisms such as mutation, mitotic recombination, deletion, half-translocation, chromosome loss, or nondisjunction. Genetic changes formatting in somatic cells of the imaginal discs cause nascence different mutant cloning in different body parts of adult flies. Our in vivo experiments demonstrated that glimepiride and glipizide show the genotoxicity, which is especially dependent on homologous somatic recombination.

Determination of insulin in humans with insulin-dependent diabetes mellitus patients by HPLC with diode array detection.

A simple and reliable high-performance liquid chromatographic method with diode array detection has been developed and validated for the determination of insulin in human plasma. A good chromatographic separation was achieved on a C18 column with a mobile phase consisting of acetonitrile and 0.2M sodium sulfate (pH 2.4), 25:75 (v/v). Its flow rate was 1.2 mL/min. Calibration curve was linear within the concentration range of 0.15-25 µg/mL. Intra-day and inter-day relative standard deviations for insulin in human plasma were less than 6.3 and 8.5%, respectively. The limits of detection and quantification of insulin were 0.10 and 0.15 µg/mL, respectively. Also, this assay was applied to determine the pharmacokinetic parameters of insulin in eight insulin-dependent diabetes mellitus patients after subcutaneous injection of 25 IU of Actrapid HM.

Bone mineral density in patients with familial Mediterranean fever.

This study was carried out to determine lumbar and femoral bone mineral density (BMD) in patients with familial Mediterranean fever (FMF), an autosomal-recessive disease characterized by recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. In patients with FMF and control subjects, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. BMD was determined at the lumbar spine (L1-4) and the femoral regions (neck and total) using dual energy X-ray absorptiometry. Twenty-eight FMF patients and 30 control subjects without a history of inflammatory disease participated in our study. The demographic variables, such as age, sex and body mass index were similar between patients and controls (P > 0.05). We found statistically significant difference in ESR and CRP between FMF patients and controls (P < 0.01, P < 0.05 respectively). There was statistically significant difference in lumbar spine, femoral neck, and total femur BMD between FMF patients and control groups (P < 0.001, P < 0.01, P < 0.01 respectively).Our study indicates that lumbar spine and femoral neck and total femur BMD in patients with FMF may be lower than in healthy subjects.

Thyroid dysfunction in patients treated with radiotherapy for neck.

PURPOSE: The aim of the present study was to retrospectively evaluate the early and late changes in thyroid dysfunction after radiation therapy for head and neck cancer either with or without surgery. PATIENTS AND METHODS: Sixty-three patients receiving neck irradiation including the thyroid gland were recruited in the study. Thirty-six patients had undergone either a functional or radical neck dissection, and radiotherapy was the primary treatment in 27 patients. RESULTS: Of 63 patients, 24 (38%) were diagnosed with hypothyroidism (HT), 8 (12.7%) with clinical HT, and 16 (25.4%) with subclinical HT. The median time to the development of clinical HT was 15 months (range, 0-36 months) and subclinical HT was 3 months (range, 0-24 months). Eleven (17.5%) of the patients were diagnosed with subclinical hyperthyroidism. The median time to the development of the subclinical hyperthyroidism was 0 months (completion of radiation therapy) (range, 0-3 months). Univariate analyses of age, smoking history, neck RT dose, clinical stage, concurrent chemotherapy, and surgery failed to identify a clinically relevant risk factor for HT. Univariate analysis of clinical HT revealed that the elevated pre-radiation therapy thyroid-stimulating hormone level was significant factor (P = 0.021). CONCLUSION: HT associated with head and neck irradiation. We recommend that thyroid function should be evaluated periodically in patients who have undergone neck radiation.

The Diagnostic Value of Tc-99m MIBI Gated Myocardial Perfusion SPECT in Detection of Silent Myocardial Ischemia in Asymptomatic Patients with Type 2 Diabetes Mellitus.

OBJECTIVE: In this study, we aimed to evaluate the diagnostic value of Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated myocardial perfusion SPECT (MPS) in the detection of coronary artery disease (CAD) and silent myocardial ischemia (SMI) in patients with asymptomatic type 2 diabetes mellitus (DM). MATERIALS AND METHODS: For this purpose, 35 patients with type 2 DM and 15 volunteers with no cardiac symptoms (control group) were included in this study. Exercise tolerance tests (ETT), echocardiography and Tc-99m MIBI gated MPS were performed in patients and volunteers. Computed tomography coronary angiography (CTCA) was performed in patients with coronary ischemia or infarct detected by Tc-99m MIBI gated MPS. The results were analyzed and compared visually and statistically. RESULTS: The present study revealed a high rate of silent myocardial ischemia (25.71%, N=9) in 35 patients with type 2 DM. Severe CAD in CTCA was detected in four of nine patients with ischemia or infarct by Tc-99m MIBI gated MPS (44.4%). Left ventricular diastolic dysfunction, ischemic pattern and high risk of CAD were detected in the same four patients by echocardiography, ETT and biochemical analysis, respectively. At the end of the statistical evaluation, we found that Tc-99m MIBI gated MPS showed significant correlations with CTCA, echocardiography, ETT, Hba1c level, risk of CAD and diabetic age in diabetic patients with CAD. CONCLUSION: We propose that Tc-99m MIBI gated MPS is a reliable and non-invasive method that can be used to detect silent myocardial ischemia and CAD in patients with type 2 DM.

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.

The possible factors affecting suicide attempts in the different phases of the menstrual cycle.

This study was designed to investigate whether there is a relationship between the menstrual cycle and suicide attempts, and to determine the factors affecting suicide attempts in different phases of the menstrual cycle. The study sample included 52 women who were admitted to the emergency room because of a suicide attempt. The incidence of suicide attempts in menstrual follicular phase (MFP) was significantly higher than in other phases. No significant difference of socio-demographic and clinical characteristics was observed between MFP and the other phases. Also, hormone levels of patients who attempted suicide were not different from those of healthy control subjects. In spite of the fact that suicide attempts were often made in MFP, there was substantial difficulty in explaining why this frequency was different than other phases. Furthermore, the event may be linked to low estrogen and progesterone levels in this phase. It has, however, been thought that hormonal effects cannot be responsible alone for suicide attempts.

Antioxidant status and lipid peroxidation in type II diabetes mellitus.

Diabetes Mellitus (DM), a state of chronic hyperglycaemia, is a common disease affecting over 124 million individuals worldwide. In this study, erythrocyte glutathione levels, lipid peroxidation, superoxide dismutase, catalase, and glutathione peroxidase and some extracellular antioxidant protein levels of patients with type II diabetes mellitus and healthy controls were investigated. Thirty-eight patients (21 males; with age of mean +/- SD, 53.1+/-9.7 years) and 18 clinically healthy subjects (10 males; with age of mean +/- SD, 49.3+/-15.2 years) were included in the study. Levels of erythrocyte lipid peroxidation, serum ceruloplasmin and glucose levels, HbA1C levels, and erythrocyte catalase activity were significantly increased, whereas serum albumin and transferrin levels, erythrocyte glutathione levels, and glutathione peroxidase activity were significantly decreased compared to those of controls. There was no significant difference in superoxide dismutase activity compared to controls. The results suggest that the antioxidant deficiency and excessive peroxide-mediated damage may appear in non-insulin dependent diabetes mellitus.

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.

Investigation of red blood cell carbonic anhydrase, glucose 6-phosphate dehydrogenase, hexokinase enzyme activities, and zinc concentration in patients with hyperthyroid diseases.

We have recently reported on the activities of glucose-6-phosphate dehydrogenase (G6PD), hexokinase (HK) and carbonic anhydrase I (CA-I) and II (CA-II) isoenzymes obtained from erythrocytes of healthy subjects and untreated patients with hyperthyroid diseases. Also, erythrocyte zinc concentrations were measured. Red blood cell (RBC) zinc (Zn) concentration was measured by atomic absorption spectrophotometry. Activities of carbonic anhydrase II and I isoenzymes were determined with CO2-hydratase activity method by using selective inactivation with bromopyruvate. G6PD and HK enzyme activities were measured spectrophotometrically via absorbance change (at 340 nm) in NADPH formed as a result of the reactions catalysed by these enzymes. In statistical analysis of all these parameters, activity of CA-I was 4388 +/- 207 (EU/gHb) and 2881 +/- 869 (EU/gHb) in healthy and untreated hyperthyroid subjects, respectively. The activity values for CA-II were 5391 +/- 257 (EU/gHb) and 4688 +/- 12.6 (EU/gHb) in healthy and untreated hyperthyroid subjects. Glucose 6-phosphate dehydrogenase (G6PD) activity was 10.19 +/- 1.87 (EU/gHb) in healthy group and 4.92 +/- 2.49 (EU/gHb) in patient group. While hexokinase enzyme activity was 1.575 +/- 0.898 in healthy subjects, it was 0.651 +/- 0.418 (EU/gHb) in the patient group. While erythrocyte zinc concentration in the healthy subjects was 49.32 +/- 23.5 (mg/gHb), this concentration for patients with uncontrolled hyperthyroid diseases was significantly decreased to 29.62 +/- 4.26 (mg/gHb). As a conclusion, CA-I isoenzyme, G6PD, hexokinase activities and erythrocyte zinc concentration had decreased in untreated patients carrying hyperthyroid diseases as compared to those of the healthy subjects.