Effect of silymarin and metformin on the sperm parameters and histopathological changes of testes in diabetic rats: An experimental study

Background: Oxidative stress is a major contributor to diabetes, which can lead to testicular damage and infertility. Objective: This study aimed to compare the effects of metformin as a chemical drug with silymarin as an herbal agent on the sperm parameters and histopathological changes of testes in diabetic rats. Materials and Methods: Thirty-two male Wistar rats (250-270 gr) were randomly divided into four groups: 1) control; 2) diabetic; 3) diabetic+metformin 200 mg/kg; and 4) diabetic+silymarin 100 mg/kg. Daily injections were administered intraperitoneally for 56 days. At the end of the treatment, blood sampling was performed for biochemical assessment. Then, the rats were sacrificed and their left testis and epididymis were cut for sperm analysis as well as histopathology and morphometric evaluation. Results: Diabetes was associated with a reduced sperm count, motility, viability, maturity, and chromatin quality of sperm (p ≤ 0.001). It was also associated with a higher malondialdehide level and lower total antioxidant capacity level of serum in comparison with the control group (p ≤ 0.001). There was a significant difference in the seminiferous tubule diameter, germinal epithelium height, and testicular histopathological alterations in the diabetic rats compared with the control rats (p ≤ 0.001). Treatment with metformin and silymarin improved the above-mentioned parameters and this improvement was more substantial in silymarin-treated animals (p ≤ 0.001). Conclusion: In diabetic rats, metformin and silymarin improved sperm parameters, sperm DNA integrity, seminiferous tubule diameter, germinal epithelium thickness, and testicular histopathological complications; this improvement was more substantial in the silymarin-treated group. So, the findings of this study suggest that silymarin is more effective than metformin in treating diabetic-induced infertility. Key words: Diabetes, DNA damage, Metformin, Silymarin, Sperm, Testis.

Duration of Type II DM, HbA1C Levels, TNF-α and IL-10 as Risk Factors for Level Charcot Joint Foot and Ankle in Type II DM Patients

Introduction: Type II Diabetes Mellitus has complications including disorders of the musculoskeletal system or what is often called diabetic charcot joint or charcot neuroarthropathy. Various risk factors are thought to increase the incidence of Charcot joint foot and ankle. Various studies have been made to assess these risk factors with the aim of reducing the occurrence of these complications. Material and Methods: The study used an analytical observational design with a case study and control approach to determine whether Type II DM II ≥ 10 years, HbA1c levels II ≥ 7%, TNF-α levels II ≥ 1.0 ng/L and IL-10 levels ≤ 255 pg/mL as factors. risk of Charcot joint foot and ankle in Type II DM patients. Where the sample involves 24 case groups and 24 control groups. Then a descriptive analysis was performed, bivariate inferential analysis using the chi-square test and an assessment of the risk factor odds ratio (OR). Then multivariate analysis was performed to assess the strength of the influence of risk factors using logistic regression test Results: There is a significant difference between Type II DM II ≥ 10 years, HbA1c levels II ≥ 7%, TNF-α levels II ≥ 1.0 ng/L, and IL-10 levels ≤ 255 pg/mL which are risk factors for the occurrence of charcot joint foot and ankle in Type II DM patients. The duration of type II DM II ≥ 10 years had the strongest relationship while IL-10 ≤ 255 pg/mL had the weakest relationship for the occurrence of Charcot joint foot and ankle in Type II DM patients. Conclusion: Increased duration of Type II DM, HbA1c level and TNF-α level above certain level and low IL-10 amount are risk factor for Charcot joint foot and ankle in Type II DM patients, with the duration of type II DM being the strongest risk factor. Key words: Diabetes mellitus type II, charcot joint foot and ankle, risk factors.

EVALUATION OF CLINICAL AWARENESS OF DIABETIC MELLITUS AMONG RAKMHSU MEDICAL STUDENTS- A QUESTIONNAIRE SURVEY

Introduction: The number of patients with diabetes are increasing in rapid phase and the present medical students will encounter with such patients in the future very often. It was essential to understand and update their knowledge through education and awareness programs. Materials and methods: The cross-sectional questionnaire survey has been conducted in RAK Medical and Health Sciences University (RAKMHSU) with due approval from research ethics committee. After going through various indexed articles related to our topic, a pre designed pre validated questionnaire was prepared. The questionnaire assessed the knowledge about symptoms, investigations, treatment and complications. This was applied after validation to second, third, fourth and fifth year medical students. Results: The study showed the majority in both groups 93.5% and 89.2% agreed that they will be involved in taking care of diabetic patients in their future practice. The study also found that 65.2% group A agreed that excessive thirst and urination is a indicative of low blood sugar when compared with 31.7% from group B. With regard to symptoms majority in both groups agreed itchy skin is not a symptom of DM. When asked about insulin misuse, only 36.8% and 55.4% students agreed that blood glucose will go below 50mg/dl. Discussion and conclusion: Our study correlated with various studies which showed many students had problems in treatment aspects. But we also had positive results which correlated with other study showing they have good knowledge about symptoms. We also found our students had good knowledge about diabetic ketoacidosis. In conclusion, there is a need for conducting regular workshops, seminars, conferences in medical colleges to upgrade the knowledge of students and make them a competent general physician. Key words: Diabetes, Keto acidosis, Education, Knowledge, Risk factors

Progression of a 2nd type diabetes mellitus model on mice with usage of a calorie diet

Type 2 diabetes accounts for up to 90% of all diabetes cases. It is known that people with type 2 diabetes are often obese. Long-term complications also include problems with the cardiovascular, nervous and urinary systems. The model of type 2 diabetes mellitus based on a diet rich of fat and carbohydrates was used in the work. We observed a significant increase in the body weight of mice and sugar levels in their blood. Morphometric analysis of the pancreas showed an increase of its mass coefficient. Tactile sensitivity measurement showed an increase in its threshold. The developed model is quite suitable for analyzing the diabetes progression and its side effects on the body. Key words: diabetes mellitus type 2, obesity, pancreas, tactile sensitivity.

ДОСВІД ТА ПЕРСПЕКТИВИ ЗАСТОСУВАННЯ КАРБОКСІТЕРАПІЇ ПРИ ЦУКРОВОМУ ДІАБЕТІ

Цукровий діабет (ЦД) є глобальною актуальною соціальною проблемою XXI століття. Метою даного огляду літератури: є аналіз фізіологічних властивостей та фармакотерапевтичних можливостей карбоксітерапії, а також досвіду застосування даного методу для лікування ЦД. Матеріали і методи дослідження. Наукові публікації в зарубіжних та вітчизняних журналах переважно за останні 5 років, інтернет ресурси по карбоксітерапії як методу лікування ЦД. Результати досліджувати і їх обговорення. В результаті аналізу літератури були зіставленні механізми реалізації фармакологічних ефектів карбоксітерапії з окремими ланками патогенезу ЦД. Проаналізовані механізми і ефекти карбоксітерапії як ефективного альтернативного методу лікування ЦД та його ускладнень. Представлені дані свідчать про раціональність застосування карбоксітерапії як альтернативного методу лікування ЦД та його ускладнень. Висновки. З огляду на сучасні можливості фармакотерапії ЦД та більш ніж п’ятдесятирічний досвід застосування карбоксітерапії в практичній медицині дозволяє рекомендувати цей інноваційний метод як альтернативну off-label терапію ЦД. Ключові слова: цукровий діабет, лікування, карбоксітерапія. EXPERIENCE AND PROSPECTS OF CARBOXYTHERAPY IN DIABETES MELLITUS Drogovoz S. M.1, Belik G. V.1, Kalko К. О.1, Bondariev Ye. V.1, Derymedvid L. V.1, Orlenko І. V.1, Shtroblya А. L.2 National University of Pharmacy, Kharkiv, Ukraine Uzhgorod National University, Uzhgorod, Ukraine Diabetes mellitus (DM) is a global topical social problem of the XXI century. The aim of this literature review is to analyze the physiological properties and pharmacotherapeutic possibilities of carboxytherapy, as well as the experience of this method for the treatment of diabetes. Materials and methods. Scientific publications in foreign and domestic journals mainly for the last 5 years, online resources on carboxytherapy as a method of DM treating. Results and discussions. As a result of the literature analysis, the mechanisms of implementation of the pharmacological effects with separate links of the pathogenesis of diabetes were compared. The mechanisms and effects of carboxytherapy as an effective alternative method for treating diabetes mellitus and its complications have been analyzed. The presented data indicate the rational use of carboxytherapy as an alternative method for treating diabetes and its complications. Conclusions. Given the current possibilities of pharmacotherapy of diabetes and more than fifty years of experience in the use of carboxytherapy in practical medicine allows us to recommend this innovative method as an alternative to off-label therapy of diabetes. Key words: diabetes mellitus, treatment, carboxytherapy.

A Hospital-Based Study on Aetiology of Third, Fourth and Sixth Cranial Nerve Palsies

BACKGROUND Neuro-ophthalmology deals with complex systemic diseases that affect the visual system and pose a challenge for ophthalmologists. Here the focus is on the diseases of the nervous system that affect vision, ocular motility, or pupillary reflexes. Diplopia, a common symptom of cranial nerve palsy, may result from ophthalmic, orbital, or neurologic disorders. Our study intended to determine the aetiology of ocular motor nerve palsies. METHODS A cross-sectional study was conducted for two years at a tertiary care centre in South India. We evaluated 30 patients who came to the Ophthalmology OPD or were admitted, after obtaining the approval of the Ethics committee. RESULTS A total number of 30 patients who fulfilled the inclusion criteria were studied. There were 14 male and 16 female patients. The age range was 12 - 87 years with a mean age of 45 years. The highest incidence noticed was isolated sixth nerve palsy in 13 (43.3 %) patients. 11 patients had isolated third nerve palsy (36.7 %), while mixed ocular motor nerve palsies (third, fourth and sixth) were seen in 6 patients (20 %). None of them had isolated fourth nerve palsy. CONCLUSIONS  The sixth nerve continued to be the most common among the ocular motor nerve palsies. Meningitis was the major cause.  Diabetes and trauma, infections with CNS inflammation accounted for a majority of third nerve palsies.  Multiple cranial nerve palsies had varied aetiology like HIV Infection, Tolosa Hunt Syndrome, aneurysm of intracavernous part of ICA, cavernous sinus thrombosis and trauma.  The patient’s age, associated symptoms, clinical features and types of palsy are of great importance to choose appropriate radiological methods to study and treat these isolated cranial nerve palsies. KEY WORDS Diabetes, Meningitis, Oculomotor Nerve, Trochlear Nerve, Abducent Nerve, Trauma

Cardiovascular ultrasound implementation for a pragmatic approach to the diabetic patient

The tailoring of the management of diabetes is the fundamental task of the diabetologist who requires very different skills to guarantee the best diagnostic path and the best treatment for patients. To enrich the range of “measures” necessary for this customization process, it is now possible to use a tool that is now accessible to everyone: the ultrasound machine. Through some simple ultrasound scans, using a minimum amount of time, it is possible to acquire useful information for correct patient stratification and for a rational therapeutic approach, as recommended by the guidelines. The path for the certification of the skills of the diabetologist expert in the management of cardiovascular complications could be the natural context for the placement of these techniques. KEY WORDS diabetes mellitus; cardiovascular complications; tailoring of therapy; echocolordoppler; echocardiography.

Evaluation of Serum Gamma-Glutamyl Transferase Activity and Serum Uric Acid Level in Type II Diabetes Mellitus Patients

Studies in past few years have linked oxidative stress as a potential marker of diabetes mellitus. Thus, based on the previous literature this study was planned with the aim to evaluate serum GGT activity and serum uric acid level as potential indicators of oxidative stress in type-2 diabetes mellitus patients. A total of 68 participants were included following inclusion and exclusion criteria. After the statistical analysis, statistically significant differences were observed in the mean GGT activity between controls (30.19±7.639IU/L) and cases (59.386±22.215IU/L) (p=0.000). Similarly, mean serum uric acid level of controls (5.180±1.476mg/dl) and cases (3.510±0.792mg/dl) (p=0.000), were also statistically difference. Further, after applying Pearson’s correlation, positive correlation between GGT and HbA1C level (r=0.390) and with GGT and FPG level (r=0.375) were observed. However, correlation between HbA1c and uric acid (r=-0.372); FPG and uric acid (r=-0.374) level suggested serum uric acid concentration was inversely proportional to the degree of dysglycemia in diabetes mellitus patients of this study. Hence, results of this study suggested serum GGT activity and serum uric acid level were altered as compared to controls and cases. Thus, further study on these parameters may help to serve it as potential markers of oxidative stress in diabetes mellitus patients. Key words: Diabetes mellitus, HbA1C, GGT, Uric acid and Oxidative stress.

The effects of gallic acid and metformin on male reproductive dysfunction in diabetic mice induced by methylglyoxal: An experimental study

Background: Diabetes mellitus is a disease that has reached a dangerous point. Today, nearly 500 million men and women around the world live with diabetes. Gallic acid (Gal) affects diabetes. Objective: To evaluate the effects of Gal and metformin (met) on the levels of glucose, insulin, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), sperm count, antioxidant status, and histological changes in the testes of diabetic mice induced by methylglyoxal (MGO). Materials and Methods: In this experimental study, 50 male adult NMRI mice, weighting 25-30 gr, aged 3-4 months were randomly divided into five equal groups (n = 10/each). (i) Control (vehicle, normal saline), (ii) MGO (600 mg/kg/d) orally for 28 days, (iii) Gal (50 mg/kg/d), (iv) MGO+Gal, and (v) MGO+met (200 mg/kg/d). Gal and met were administered orally for 21 consecutive days after the induction of diabetes. Blood samples were taken at 24 hr after the latest doses of treatment. Histological assessment of the testis was done, and the epididymis sperm count was obtained. Antioxidant indices, glucose, insulin, LH, FSH, and testosterone levels were measured. Results: In the MGO group compared to the control group, insulin, glucose (p = 0.001), LH (p = 0.04) and malondialdehyde (p = 0.001) were increased. However, the level of testosterone (p = 0.001), seminiferous tubule diameters, epithelial height, sperm count, superoxide dismutase activity (p = 0.02), and testis volume (p = 0.01) were decreased. The results indicated that Gal and met ameliorated the MGO effects. Conclusion: These findings suggested that the animals receiving MGO became diabetic. According to the results, Gal and met can effectively prevent MGO-induced diabetes. The effect of Gal was equivalent and sometimes better than metformin. Key words: Diabetes mellitus, Gallic acid, Male reproductive system, Metformin, Mice.

Study of Retinal Nerve Fibre Layer Thickness in Diabetics - with and without Diabetic Retinopathy

BACKGROUND Diabetes mellitus is a heterogeneous group of diseases, characterized by a state of chronic hyperglycemia, resulting from varied aetiologies. Diabetic retinopathy (DR) is the most common ocular complication of diabetes with 5 % of diabetics, progressing to severe visual loss of 5/200 or less. 3 Very few studies have been conducted on optical coherence tomography (OCT) changes in diabetic retinopathy in Indian scenario. We wanted to evaluate the association of retinal nerve fibre layer (RNFL) thickness with diabetic retinopathy and assess the possibility of RNFL thickness changes being a precursor to diabetic retinal changes. METHODS A cross sectional study was conducted at the Department of Ophthalmology, Acharya Vinobha Bhave Rural Hospital. A total of 120 patients were enrolled for the study and divided into four groups of equal population as controls / non-diabetics (NDM), diabetics without retinopathy (NDR), diabetics with non-proliferative diabetic retinopathy (NPDR) and diabetics with proliferative retinopathy (PDR). Patients were evaluated for visual acuity, RNFL thickness, intraocular pressure(IOP), cup disc ratio in each case and data was statistically analysed. RESULTS Mean temporal RNFL thickness in PDR group was 73.72 ± 15.22 and was statistically significant (P = 0.0001) than temporal RNFL thickness in controls (60.41 ± 7.56), NDR (61.06 ± 6.51) and NPDR (59.01 ± 5.51). Mean cup-disc disc ratio was 0.26 ± 0.08 in controls, was 0.28 ± 0.11 in NDR group, 0.32 ± 0.08 in NPDR group and 0.36 ± 0.11 in PDR group and was statistically significant (P = 0.026). However no statistically significant difference was seen in global average RNFL thickness across groups though it was more in NPDR and PDR when compared to NDM group, and was least in NDR group. CONCLUSIONS There was statistically significant increase in temporal RNFL thickness in diabetic group which worsens with the disease. Hence temporal RNFL thickness may be estimated in diabetic patients to predict transformation to diabetic retinopathy and intervene at an early stage. KEY WORDS Diabetes Mellitus, Retinal Nerve Fibre Layer, Proliferative Diabetic Retinopathy, Non Proliferative Diabetic Retinopathy