Examination of quality of life in patients using exenatide with different dimensions.

OBJECTIVE: To investigate the effects of exenatide treatment on type-2 diabetes mellitus patients' quality of life. METHODS: The cross-sectional study was conducted from March 1 to June 30, 2019, after approval from Suleyman Demirel University, Isparta, Turkey, and comprised type 2 diabetes mellitus patients of either gender under exenatide treatment. Data was collected using a questionnaire during face-to-face interview and included sociodemographic and clinical information along with the World Health Organisation-5 well-being index, the obesity awareness and insight scale, the obesity-specific quality of life scale and the coping orientation to problems experienced-brief inventory. Data was analysed using SPSS 22. RESULTS: Of the 146 patients, 82(56.2%) were female. The overall mean age was 50.6±11.5 years, mean duration of diabetes was 7.4±4.3 years, and mean exenatide use was 9.1±6.6 months. The most common reason cited in favour of exenatide was related to weight-loss 121(82.9%). The patients scored the highest score on the 'Awareness' subscale of the obesity awareness scale 29.54±5.42. RESULTS: Exenatide use was effective in improving quality of life, and weight-loss was considered a secondary gain by the diabetics. Keywords: Diabetes mellitus, Exenatide, Quality of life, Patients.

Low high-density lipoprotein cholesterol is characterized by elevated oxidative stress.

High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for premature atherosclerosis and cardiovascular disease. Plasma HDL exerts potent antioxidant activity. We evaluated parameters associated with oxidative stress in participants with low HDL-C. This study included 32 patients with low HDL-C (≤35 mg/dL) and 33 age- and sex-matched control patients with normal HDL-C (>35 mg/dL). We evaluated clinical and laboratory parameters that are associated with oxidative stress. The oxidative stress index (OSI) levels were significantly higher in the low HDL-C group (3.32 [0.01-13.3] vs 0.74 [0.17-3.55] AU; P<.01) and negatively correlated with HDL-C levels. We suggest that change in OSI and uric acid levels in the study group might indicate increased oxidative status in patients with low HDL-C. This may be associated with increased cardiovascular risk.

Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions.

BACKGROUND: Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography. METHODS AND RESULTS: We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (ß=-0.31, P<0.01) and presence of the diabetes (ß=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR. CONCLUSION: CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.

Evaluation of total oxidative status and total antioxidant capacity in patients with endemic fluorosis.

The objective of the present study was to determine the plasma total oxidative status (TOS) and total antioxidant capacity (TAC) in patients with endemic fluorosis. A total of 79 (35 males and 44 females; mean age 44.0 ± 11.9 years) patients with endemic fluorosis and 55 (23 males and 32 females; mean age 48.3 ± 8.5 years) age-, sex- and body mass index-matched healthy controls were included in this study. The urine fluoride levels and plasma TOS and TAC levels were measured. The urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (1.91 ± 0.15 vs. 0.49 ± 0.13 mg/L, respectively; p < 0.001). TOS was significantly higher in fluorosis group than in control group (17.55 ± 3.82 vs. 15.06 ± 4.31 µmol H(2)O(2) Eq/L, respectively; p = 0.001). TAC was significantly lower in fluorosis group than in control group (1.60 ± 0.36 vs. 1.82 ± 0.51 mmol Trolox Eq/L, respectively; p = 0.004). Oxidative stress index (OSI) was significantly higher in fluorosis group than in control group (11.5 ± 3.8 vs. 8.8 ± 3.7, respectively; p < 0.001). Correlation analysis in all the groups indicated that TAC was negatively correlated with urine fluoride (r = -0.25, p = 0.003), TOS was positively correlated with urine fluoride (r = 0.34, p < 0.001) and OSI was positively correlated with urine fluoride (r = 0.36, p < 0.001). The results of our study demonstrate that oxidative stress plays an important role in the pathogenesis of the endemic fluorosis.

Aspirin increases NMDA receptor subunit 2A concentrations in rat hippocampus.

The N-methyl-d-aspartate receptor (NMDAR), a heteromeric protein, is a glutamate receptor that has three classes of subunits: NR1, NR2, and NR3. It has been reported that these receptors are involved in synaptogenesis, synaptic plasticity, and many other processes in the central nervous system. The aim of this study is to investigate the efficacy of aspirin on hippocampal NMDARs. Sixteen rats were studied in two groups, with eight animals in each group. The first group was the control group, and the second one was the aspirin-given group. Aspirin (acetylsalicylic acid) was administered orally to the rats (200 mg/kg). Tissue samples were obtained after 3 h. The brain was removed, and both hippocampi were dissected out for evaluation. It was found that acute doses of aspirin caused increases on the levels of NMDAR 2A (NR2A) receptors and malondialdehyde (MDA), the end product of lipid peroxidation. Production was significantly increased in the aspirin-given group. We know that MDA is a marker for free radical-mediated tissue damage. In conclusion, lipid peroxidation, caused by acute doses of aspirin may lead to excitotoxicity effects by a hippocampal NR2A-mediated mechanism.

Relation of leptin, adiponectin and insulin resistance to bone mineral density in type 2 diabetic postmenopausal women.

BACKGROUND: Our aim is to identify the relation of leptin, adiponectin and insulin resistance to bone mineral density (BMD) in type 2 diabetic postmenopausal women and compare it with that experienced by nondiabetics. MATERIAL AND METHODS: Seventy six postmenopausal female patients were included in the study. Postmenopausal type 2 diabetic (n = 19) and nondiabetic patients (n = 19) with spine and/or hip BMD T score lower than -2 were included in the study, and postmenopausal type 2 diabetic (n = 20) and nondiabetic women (n = 18) with normal BMD (T score > -1) were selected as control groups. Those receiving therapy for osteoporosis, over the age of 65, those who had a disease and were taking a medication that could affect bone metabolism were excluded. Biochemical tests, as well as leptin, adiponectin and insulin levels, were measured and insulin resistance was calculated using the HOMA test. RESULTS: There was no correlation between low BMD and leptin, adiponectin and insulin resistance. There was only a negative correlation between leptin and femur Ward's triangle BMD. CONCLUSION: Further large-scale studies must to be performed in order to analyse the effects of leptin, adiponectin and insulin resistance on bone metabolism in type 2 diabetic patients.

Serum copper, zinc, and magnesium levels in patients with chronic fluorosis.

Although there are many studies on effect of fluoride on trace elements in experimental animals, few studies exist on serum trace elements levels in patients with endemic fluorosis. We aimed to determine the serum levels of trace elements including serum copper (Cu), zinc (Zn), and serum levels of minerals including calcium (Ca), phosphorus (P), magnesium (Mg), sodium (Na), potassium (K) in patients with endemic fluorosis. The study group consisted of 30 patients with endemic fluorosis (17 females, 13 males, mean age 33.53±9.85 years). An age, gender, and body mass index matched 30 healthy volunteers comprised control group (21 females, ten males with a mean age 33.93±7.39 years). Urine fluoride levels of chronic fluorosis patients were significantly higher than that of control subjects as expected (1.92±0.10 mg/l vs. 0.41±0.09 mg/l, respectively; P<0.001). Serum Cu levels (89.14±16.77 µg/dL vs. 102.69±25.04 µg/dL, respectively, P=0.017), serum Zn levels (77.98±20.58 µg/dL vs. 94.57±35.87µg/dL, respectively, P=0.032), and serum Mg levels (1.92±0.18 mg/dL vs. 2.07±0.31 mg/dL, respectively, p=0.022) was significantly lower in chronic fluorosis patients than in controls. There were no statistically significant differences between the fluorosis group and control group with respect to serum levels of Na, K, Ca, and P. We concluded that chronic fluorosis is associated with reduced serum levels of Cu, Zn, and Mg.

Predictors of clock drawing test (CDT) performance in elderly patients attending an internal medicine outpatient clinic: a pilot study on sun exposure and physical activity.

Influence of sun exposure and physical activity on cognition has not been evaluated simultaneously. We aimed to evaluate predictors of clock drawing test (CDT) performance on n=125 patients attending an internal medicine outpatient clinic. Interview data was gathered on sociodemographic, health-related and lifestyle factors referring to the last year. Factors associated with obtaining a score >0 and a full score (10/10) were analyzed by univariate (UVA) and multivariate (MVA) logistic regression analyses. Mean age of the participants was 72 ± 5, 58% were women and 17% were illiterate. Mean CDT score was 4.70 ± 2.27, 61.6% scored >0 and 21.6% scored 10/10. Both duration of walking and summer sun exposure predicted a CDT score >0 in UVA. However only summer sun exposure was an independent predictor (odds ratio=OR=1.73, 95% confidence interval=CI=1.16-2.57). Other factors independently associated with obtaining a score >0 were education level (OR=2.70, 95%CI=1.77-4.12) and cerebrovascular disease (CVD) history (OR=0.08, 95%CI=0.008-0.78). Factors independently associated with obtaining a full score were weight (OR=1.05, 95%CI=1.00-1.10), education level (OR=2.04, 95%CI=1.38-3.00) and visiting the clinic alone (OR=3.92, 95%CI=1.354-11.39). Our study shows that CDT can be utilized to unravel the lifestyle factors associated with cognitive function. To our knowledge, this is the first study to suggest an association between sun exposure and cognition.

Serum parathyroid hormone levels in chronic endemic fluorosis.

Endemic waterborne fluorosis is a public health problem in Isparta, a city located in southern Turkey. Fluoride is a cumulative element that increases metabolic turnover of the bone and also affects the homeostasis of bone mineral metabolism. There are number of similarities between the effects of excess parathyroid hormone (PTH) and fluorosis on bone. So fluoride might show its effect via PTH. We aimed to determine PTH levels in patients with endemic fluorosis to estimate the possible toxic effects of chronic fluoride intake. Fifty-six patients with endemic fluorosis and 28 age-, sex-, and body-mass-index-matched healthy controls were included in this study. Endemic fluorosis was diagnosed according to the clinical diagnosis criteria of Wang. The urine fluoride levels of fluorosis patients were significantly higher than those of control subjects as expected (1.9 ± 0.1 vs. 0.4 ± 0.1 mg/L, respectively; P < 0.001). PTH levels in fluorosis group were significantly higher than control group (65.09 ± 32.91 versus 47.40 ± 20.37, respectively; P = 0.01). The results of our study demonstrate that serum PTH levels are increased in patients with endemic fluorosis. Fluoride, by interfering calcium balance, may be the cause of secondary hyperparathyroidism.

Effect of endemic fluorosis on hematological parameters.

Although so many studies exist on effect of fluoride on hematological parameters in experimental animals, a few studies have been conducted to investigate the effects of chronic fluorosis on hematological parameters in humans' subjects with endemic fluorosis. So we aimed to determine the hematological parameters in patients with endemic fluorosis. The study group consisted of 60 patients with endemic fluorosis (27 females, 33 males, and mean age 33.4 ± 9.6 years). An age-, gender-, and body mass index-matched control group was composed of 34 healthy volunteers (11 females, 23 males with a mean age 32.6 ± 5.6 years). Urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (0.42 ± 0.09 vs 1.92 ± 0.14 mg/l, respectively; P < 0.001). There were no statistically significant differences between the fluorosis group and control group with respect to hematological parameters (complete blood count and ferritin). We concluded that chronic fluorosis has no effect on hematological parameters in patients with endemic fluorosis.

Altered cyclin D1 genotype distribution in human sporadic pituitary adenomas.

BACKGROUND: The cyclin D1 gene (CCND1) is a proto-oncogene playing a critical role in the transition through the G1 to the S phase of the cell cycle and is overexpressed in many tumors. G870A polymorphism at the exon4/intron4 splicing region of the CCND1 gene may play a role in pituitary tumorigenesis and invasiveness. The objective of this study was to examine CCND1 polymorphism in patients with different types of sporadic pituitary adenomas. MATERIAL/METHODS: One hundred thirty patients (38 male, 92 female, mean age: 45.37+/-13.55 SD years) with sporadic pituitary adenomas (PA group) and 129 healthy controls (HC group) were included in the study. The CCND1 G870A polymorphism in PA and HC were genotyped by PCR-RFLP using peripheral blood samples. CCND1 expression was also evaluated with an immunohistochemical method in tumor tissues of 39 patients of the PA group. RESULTS: The genotype distribution in the PA [AA: 30 (23.1%), AG: 90 (69.2%), GG: 10 (7.7%)] was statistically different from the HC group [AA: 36 (27.9%), AG: 64 (49.6%), GG: 29 (22.5%), p=0.001]. Patients carrying the AG genotype were more frequent compared with the control group. Tumor type, volume, and invasion were not related to the genotype. Immunohistochemically, 21 of the 39 tumors showed nuclear positivity for CCND1, varying between 1 and 40% of tumor cells. Positive staining was observed more intense in patients carrying the AG genotype. CONCLUSIONS: CCND1 polymorphism may be an early event in tumorigenesis, but it is not a reliable prognostic criterion.