The effects of education on foot care behaviors and self-efficacy in type 2 diabetes patients.

Background: Diabetic foot significantly affects the quality of life of patients with diabetes. It leads to loss of labor force, psychosocial trauma, and high treatment costs due to serious morbidity and mortality. Nurses have an important responsibility to improve the metabolic status of individuals with diabetes, to protect them from foot complications, and to teach patients foot care skills. Aim: This study investigated the effects of education on type 2 diabetes patients regarding diabetic foot care and self-efficacy. Materials and Methods: This quasi-experimental study was conducted from February to July 2016 in hospitals located in the city of Balikesir in Turkey with type 2 diabetes patients who were admitted to the internal medicine clinic and monitored by the endocrinology and internal medicine outpatient clinics. G*power 3.1.9.2 software was used to calculate the sample size of 94 people with a 5% type 1 error, and 90% power. The study was carried out with stratified randomization, and a questionnaire was administered to the experimental and control groups. The experimental group received training, and both groups' scores on the Diabetic Foot Behavior Questionnaire [Appendix 1] and the Diabetic Foot Care Self-Efficacy Scale [Appendix 2] were compared after three months. The t-test, the paired t-test, and the Chi-square test were used. Results: While the self-efficacy and the foot care behavior scores of the control group did not show any differences (P > 0.05), the experimental group's scores were significantly higher (P < 0.05). The control group's self-efficacy and foot care behavior scores on the pre-test and final test were similar, while the experimental group's scores increased (P < 0.05). Conclusions: Starting from the diagnosis of diabetes, it is advisable to carry out foot assessments and to follow up with diabetics who received foot care education to increase their self-efficacy, to make foot care a habit, and to re-evaluate missing or incorrect practices during check-ups.

THE EFFECT OF DIABETES SYMPTOMS ON QUALITY OF LIFE IN INDIVIDUALS WITH TYPE 2 DIABETES.

OBJECTIVE: This study aimed to investigate the effect of symptoms of diabetes on the quality of life of individuals with Type 2 diabetes. METHOD: The study used a cross-sectional design. No sampling procedure was employed in the study; instead, 410 individuals presenting to the Balikesir Atatürk City Hospital Endocrinology and Internal Medicine Polyclinics between December 2016 and July 2017, diagnosed with Type 2 diabetes, and meeting the inclusion criteria were enrolled in the study sample. The study data were collected with a "Socio-demographic Characteristics Questionnaire", the "Diabetes Symptom Checklist", and the "SF-36 Quality of Life Questionnaire". RESULTS: The participants obtained the highest mean scores from the hyperglycemia subscale of the Diabetes Symptoms Checklist (3.35±0.60) and the mental health subscale of the SF-36 Quality of Life Questionnaire (50.65±8.10). The hypoglycemia, cardiology, psychology, and neurology variables included in the model were statistically significant and predicted 35% of the mental subscale score of the SF 36 questionnaire. SF 36 physical subscale score increased as the hypoglycemia, cardiology, psychology, and neurology scores decreased (p<0.05). CONCLUSION: The participants obtained high scores from the hyperglycemia subscale of the diabetes symptom checklist and mental health subscale of the quality of life questionnaire. Diabetes symptoms were found to affect the quality of life of individuals with diabetes.

The endothelial nitric oxide synthase (eNOS) polymorphism in otitis media with effusion (OME).

OBJECTIVES: Otitis media with effusion (OME) is the most common disease after viral infections of upper respiratory tract (URTI) in children. Studies indicate the important role of nitric oxide (NO) in the etiology of hearing loss. However, there is no study that focuses on the role of nitric oxide synthase (eNOS) polymorphisms in the cases with OME. The aim of the present study is to evaluate the eNOS polymorphisms in the pediatric patients with OME. MATERIALS AND METHODS: Eighty-nine patients who are diagnosed with otitis media with effusion and 85 healthy subjects who are compatible in terms of age and gender were included in the study. All patients in the study were subjected to complete ear, nose, throat (ENT) and audiological examinations. DNA analysis was performed with polymerase chain reaction (PCR) technique from the blood samples. The PCR product was cut by restriction fragment length polymorphism (RFLP) with BanII enzyme and checked by agarose gel electrophoresis. RESULTS: As a result of genetic analysis, there is no significant difference between patients and the controls in terms of eNOS Glu298Asp polymorphism (G/G, G/T, T/T). When these groups were compared in terms of allele distributions, a significant relationship was found between the patients and the controls (P=0.037). CONCLUSION: To the best of our knowledge, G allele was identified as predisposing to the development of OME and this is the first report indicates the correlation between the eNOS G894T polymorphism and OME in Turkey.

Electron microscopic examination of effects of bogma raki and walnut on cochlea: an experimental study.

Illegal alcohol beverages known as bogma raki in our country are consumed widely in our region. The studies investigating the relationship between alcohol consumption and hearing ability report different results. In this study, we aimed to investigate the toxic effects of bogma raki that contains neurotoxic substances on cochlea by electron microscopy. To the best of our knowledge, this study is the first in the literature. A total of 48 Wistar male albino rats (aged 12-16 weeks and weighing 200-240 g) were used in the study. The rats were divided into 4 groups with 12 animals in each group. The groups include control, bogma raki, walnut, and walnut + bogma raki groups. Bogma raki (30% v/v, 9.2 ml kg(-1) day(-1)) is added to drinking water of rats in bogma raki group (n = 12) for 4 weeks. Walnut group rats (n = 12) are fed with standard rat food and walnut without limitation (10 g kg(-1) day(-1)). Bogma raki + walnut group rats (n = 12) are fed with standard rat food and walnut and bogma raki is added to drinking water. The cochleas were dissected and removed en bloc and examined by electron microscopy. Perineuronal oedema around neurons of spiral ganglion and hairy cells of organ of Corti were present in the bogma raki group, walnut group and bogma raki + walnut group under electron microscopic examination. Comparing these three groups, there were no differences in the ultrastructural pathological changes. In the ultrastructural examination of the myelinated axons forming cochlear nerve, no ultrastructural pathology was detected in all the groups.

Investigation of demodex species frequency in patients with a persistent itchy ear canal treated with a local steroid.

OBJECTIVE: To investigate the frequency of demodex species in the external acoustic meatus in patients with an itchy ear canal. METHODS: Patients were assigned to one of three groups. Group one consisted of 54 patients with an itchy ear canal who were using a local agent, while group two was composed of 51 patients with an itchy ear canal who were not using a local agent. Group three consisted of 50 healthy individuals without an itchy ear canal. RESULTS: Demodex species test results were positive in nine (5.8 per cent) of the cases. Six of these positive cases were in group one, two in group two and one in group three. The frequency of demodex species in the external acoustic meatus was similar between those patients with an itchy ear canal who did not use a local agent and the healthy individuals (p = 0.571), but it was significantly higher in those using a local steroid compared with those not using a local agent (p = 0.046). CONCLUSION: Although demodex species was not significantly higher in patients with an itchy ear canal compared with the control group, use of a local steroid increased the parasite frequency in the external ear canal of affected patients.

Blood-pool SPECT in addition to bone SPECT in the viability assessment in mandibular reconstruction.

INTRODUCTION: The assessment of the postoperative viability of vascularized and non-vascularized grafts used in the reconstruction of mandibular defects due to trauma and surgical reasons is a major problem in maxillofacial surgery. AIM: In the present study, we evaluated the feasibility and image quality of blood-pool SPECT, which is used for the first time in the literature here in the assessment of mandibular reconstruction, in addition to non-invasive bone scintigraphy and bone SPECT. We also evaluated whether it would be useful in clinical prediction. PATIENTS AND METHODS: Micro-vascularized and non-vascularized bone grafts were used in 12 Syrian men with maxillofacial trauma. Between days 5-7 after surgery, three-phase bone scintigraphy, blood-pool SPECT and delayed bone SPECT scans were performed. After month 6, the patients were assessed by control CT scans. RESULTS: Of the non-vascularized grafts, one graft was reported as non-viable at week one. At month 6, graft resorption was demonstrated on the CT images. The remaining non-vascularized grafts and all of the micro-vascularized grafts were considered to be viable according to delayed bone SPECT and blood-pool SPECT images. However, only the anterior and posterior ends could be clearly assessed on delayed SPECT images, while blood-pool SPECT images allowed the clear assessment of the entire graft. CONCLUSIONS: The combined use of blood-pool and delayed SPECT scans could allow for better assessment of graft viability in the early period, and can provide more detailed information to clinicians about prognosis in the follow-up of patients undergoing mandibular graft reconstruction.

Use and safety of conducted electronic devices: what is known?

Conductive electronic devices (CED), such as Taser and stun guns, are sold worldwide for use by security services, although they have also been used for self-defence and even for torture. CED are promoted as non-lethal weapons which can potentially save lives. However, there are multiple reports of deaths temporally associated with CED use. These weapons have definite physiological effects in normal volunteers, especially when accompanied by exertion. Medical examiners often report that deaths followed physical encounters which included the use of CED were due to natural causes, excited delirium and/or drug intoxication. These cases present complex situations in which multiple factors potentially contribute to the death, including electric shocks which cause neuromuscular incapacitation, severe pain and anxiety. Public health officials, physicians and hospital personnel need to be aware that individuals controlled with CED are at increased risk of death. We need better recording of incidents worldwide to understand the extent and outcomes of CED use.

Hepatocyte growth factor: molecular biomarker and player in cardioprotection and cardiovascular regeneration.

The liver possesses impressive regenerative capacities. Grafts of embryonic liver explants and liver explant-conditioned media have been shown to enhance the mitotic activity of hepatocytes. Hepatocyte growth factor (HGF), also named scatter factor (SF), has been identified as a primary candidate in promoting and regulating liver regeneration. Although initially thought to be a liver-specific mitogen, HGF was later reported to have mitogenic, motogenic, morphogenic, and anti-apoptotic activities in various cell types. By promoting angiogenesis and inhibiting apoptosis, endogenous HGF may play an important role in cardioprotection as well as in the regeneration of endothelial cells and cardiomyocytes after myocardial infarction. Since serum concentration of HGF increases in the early phase of myocardial infarction and in heart failure, HGF may also play a key role as a prognostic and diagnostic biomarker of cardiovascular disease. Here we discuss the role of HGF as a biomarker and mediator in cardioprotection and cardiovascular regeneration.

The effects of propofol or halothane on free radical production after tourniquet induced ischaemia-reperfusion injury during knee arthroplasty.

BACKGROUND: Ischaemia-reperfusion injury following tourniquet release is a good in vivo model for evaluating acute conditions. The aim of the study was to investigate the effects of propofol or halothane anaesthesia on oxidative stress by determining malondialdehyde (MDA) levels during knee arthroplasty. METHODS: Thirty patients undergoing orthopaedic surgery were divided into two groups. Anaesthesia was induced with either fentanyl 100 microg and propofol 2 mg kg(-1) (Group 1) or fentanyl 100 microg and thiopentone 5 mg kg(-1) (Group 2) and maintained with infusion of propofol in Group 1 or inhalation of halothane in Group 2. ECG, SpO2, EtCO2, and mean arterial pressure (MAP) were monitored. Venous and arterial blood samples were obtained at different measurement times for MDA and blood gas analyses. RESULTS: There was a significant decrease in MAP in the 1st and 5th minutes after tourniquet release (ATR) when compared with the 5th minute before tourniquet release (BTR) in both groups. Heart rate (HR) increased significantly in the 1st minute ATR in Group 1 only. EtCO2 increased significantly in the 1st and 5th minutes ATR, SpO2 decreased in the 1st minute ATR in both groups. There was a significant decrease in pH and increase in pCO2 at 1, 5 and 30 min ATR in both groups. pO2 values decreased in the 1st minute ATR in Group 1 only and returned to control values at 5 min ATR and decreased at 30 min ATR in the recovery room in both groups. The differences in SaO2 were similar to SpO2. MDA levels decreased before and after release of tourniquet when compared to baseline in both groups. However, there was a statistically significant decrease only in Group 1. CONCLUSION: Propofol may be a good choice of anaesthetic when an ischaemia-reperfusion injury is anticipated as in orthopaedic surgery requiring a tourniquet, due to its antioxidant properties, but halothane needs further study.

Hepatoprotective effects of Turkish folk remedies on experimental liver injury.

Seven plants which are used in Turkish folk medicine were studied for possible hepatoprotective effects. These plants are Carduus acanthoides and C. nutans (Asteraceae), Cichorium intybus (Asteraceae), Fumaria asepalae and F. vailantii (Fumariaceae), Gentiana olivieri (Gentianaceae) and Plantago lanceolata (Plantaginaceae). Stems, bracts and receptaculum of Cynara scolymus were used as natural reference drugs. Effects of the ethanolic extracts were studied using the carbon tetrachloride-induced hepatotoxicity model in rats. The extracts of F. vailantii and G. olivieri significantly prevented the elevation of plasma and hepatic malondialdehyde formation (evidence of lipid peroxidation) as well as enzyme levels (AST and ALT) in acute liver injury, which might be ascribed to their potent hepatoprotective activity. Liver sections were also studied histopathologically to confirm the biochemical results.

Does remote organ ischaemia trigger cardiac preconditioning during coronary artery surgery?

The aim of this study is to provide biochemical evidence of the occurrence of cardiac preconditioning via remote organ ischaemia on the patients undergoing coronary artery surgery. Eight male patients were randomly allocated into two groups. Blood samples were collected via coronary perfusion catheter immediately before cardiopulmonary bypass (point 0), prior to declamping aorta (point 1) and 5 min after declamping the aorta (point 2) to determine creatinine phosphokinase (CPK), CPK-MB and lactate dehydrogenase (LDH) levels in the control group. A tourniquet wrapped around the right upper extremity of the patient was inflated and deflated twice to perform 3 min of ischaemia separated with 2 min of reperfusion in the preconditioning group. Blood samples were withdrawn as described for the control group. Only LDH levels at point 2 were found to be significantly higher than the control group's. These data implied that preconditioning appeared to protect myocardium by enhancing anaerobic glycolysis.

Selenium levels and glutathione peroxidase activities in patients with acute myocardial infarction.

OBJECTIVE: Selenium (Se) is part of the enzyme glutathione peroxidase (GSH-Px) that plays an important role in the antioxidant defence of the body, including the myocardium, against the deleterious actions of free radicals and lipid peroxides. In order to evaluate the Se status and the GSH-Px activity in ischaemic heart disease, plasma, erythrocyte and urinary Se concentrations together with plasma and erythrocyte GSH-Px activities were determined in 27 patients diagnosed as acute myocardial infarction (AMI). The control group consisted of 24 age-matched healthy individuals. METHODS AND RESULTS: Fasting blood and urine samples were collected within 24 hours after the onset of chest pain. Mean plasma, erythrocyte and urine Se concentrations were significantly lower in the patient groups (63.7 +/- 12 micrograms/l, 0.48 +/- 0.04 microgram/g Hb and 49.6 +/- 27.7 micrograms/g creatinine, respectively), compared to controls (82.2 +/- 14.6 micrograms/l, 0.51 +/- 0.03 microgram/g Hb and 93.4 +/- 62.6 micrograms/g creatinine, p < 0.001, p < 0.02 and p < 0.003, respectively). No statistically significant difference was found between mean plasma GSH-Px activity in patients (0.36 +/- 0.1 U/ml) and controls (0.35 +/- 0.09 U/ml), whereas erythrocyte GSH-Px activity was higher in patients (48.1 +/- 10.2 U/g Hb) than in the controls (35.3 +/- 9.1 U/g Hb, p < 0.001). CONCLUSION: Our findings confirm the previous studies and demonstrate that patients suffering from AMI exhibit lower plasma, erythrocyte and urinary Se than the controls. Since the erythrocyte Se level represents a measure of the Se status over a period of several weeks due to its long biological half-life, low Se levels observed in the patient group might have been present before the acute event, thereby suggesting an aetiologic relevance. The presence of increased erythrocyte GSH-Px activity in these patients may be interpreted as an antioxidant defence against the chronic oxidant stress present before the AMI, presumably due to the process of coronary atherosclerosis.

The beneficial effect of 2'-deoxycoformycin in renal ischemia-reperfusion is mediated both by preservation of tissue ATP and inhibition of lipid peroxidation.

Renal ischemia injures the renal tubular cell by disrupting the vital cellular metabolic machinery. Further cell damage is caused when the blood flow is restored by oxygen free radicals that are generated from xanthine oxidase. Oxygen radicals cause lipid peroxidation of cell and organelle membranes, disrupting the structural integrity and capacity for cell transport and energy metabolism. In the present study, the possible therapeutic usefulness of the adenosine deaminase inhibitor, 2'-deoxycoformycin (DCF), during renal ischemia and reperfusion injury was investigated. The effects of DCF on renal malondialdehyde (MDA) and ATP levels were studied after 45 min ischemia and 15 min subsequent reperfusion in rat kidneys. MDA levels remained unchanged during ischemia, but increased after the subsequent reperfusion. DCF pretreatment (2.0 mg/kg i.m.) decreased MDA and increased ATP levels during the ischemia-reperfusion period. DCF exerts a dual protective action by facilitating purine salvage for ATP synthesis and inhibiting oxygen radical-induced lipid peroxidation. These results suggest that DCF therapy could be beneficial in the treatment of ischemia-reperfusion renal injuries.

The relation of optical density of seminal plasma with serum FSH and LH levels in azoospermic patients.

The aim was to investigate the relation between optical density of seminal plasma, serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in azoospermic patients and to establish criteria depending on optical density measurements in order to estimate serum FSH and LH levels. Optical density of seminal plasma and serum FSH and LH levels were measured in 45 azoospermic patients. The semen samples with an optical density (OD) of more than 0.5 showed normal levels of FSH and LH, while those with less than 0.5 were observed to have high levels of FSH and LH. The optical density of seminal plasma can be used in the prediction of serum FSH and LH levels in azoospermic patients.

Serum fructosamine and fructosamine-albumin ratio as screening tests for gestational diabetes mellitus.

To evaluate the role of fructosamine/albumin ratio as an alternative screening parameter for gestational diabetes mellitus (GDM), serum fructosamine, albumin, protein, fructosamine/albumin ratio, and oral glucose tolerance were measured in 56 non-pregnant control healthy subjects, and in 96 pregnant women who screened positive after a 50 g glucose challenge-test. Oral glucose tolerance test (OGTT) identified 12 of 96 pregnant women as having GDM. Fructosamine concentration of 1.98 +/- 0.32 mmol/L (mean +/- SD) and fructosamine/albumin ratio of 47 +/- 10 mumol/g (mean +/- SD) has been obtained in nonpregnant control subjects. During the second trimester a lower fructosamine level (1.84 +/- 0.29 mmol/L, p < 0.05) and a higher fructosamine/albumin ratio (62 +/- 15 mumol/g, p < 0.001) occurs in pregnant women, when compared to non-pregnant healthy control subjects, most likely due to the low serum albumin concentration (30 +/- 6 g/L). The serum fructosamine levels and fructosamine/albumin ratio were only slightly higher in the pregnant women with GDM than in normal pregnant women (2.05 +/- 0.47 mmol/L versus 1.84 +/- 0.29 mmol/L, 67 +/- 16 mumol/g versus 62 +/- 15 mumol/g, respectively) but the differences were not statistically significant. The fructosamine and fructosamine/albumin ratio values for normal and GDM groups overlapped considerably. Sensitivity, specificity, positive predictive and negative predictive values for fructosamine were 41.7%, 85.7%, 29.4% and 91%, and for fructosamine/albumin ratio 25%, 79.8%, 15% and 88% respectively. This suggests that both fructosamine and fructosamine/albumin ratio have low sensitivity as predictors of GDM and can therefore not be used as screening tests.

The effect of EGb 761 on the doxorubicin cardiomyopathy.

Doxorubicin (Dx) is used to treat a number of types of cancer. The drug produces many toxic reactions and cardiomyopathy. Many drugs have been used to prevent this myocardial damage caused by peroxidative alterations. EGb 761 is being used to prevent arrhythmias in ischemic myocardium. We decided to establish the tissue protective effect of EGb 761 against myocardial toxic effects of Dx in three groups of rats. Cardiotoxicity signs of Dx were found to be dose-related, beginning at 30 mg/kg dose and being apparent at 45 mg/kg dose. 48 hr after a single i.v. injection, myocardial tissues showed a marked edema, vacuolization and fragmentation. We compared the changes in heart tissue biochemically and histopathologically among the control, Dx treated and EGb 761 (100 mg/kg/d.x 4, i.p.) + Dx treated groups. Biochemical results of CK-MB and MDA values showed a significant decrease in Dx + EGb 761 group when compared with Dx treated group. Histopathologically, myocardial tissues of Dx + EGb 761 treated group were found to have diminished vacuolization and fragmentation. These results suggest that EGb 761 might have the same therapeutic potential in Dx related cardiomyopathy.

The effect of high-dose inhaled budesonide on lipid profile in asthmatic patients.

1. We determined the effect of high doses of inhaled corticosteroid (budesonide, BUD, 1600 micrograms/day for 4 weeks) on fasting triglyceride, cholesterol and high-density lipoprotein (HDL)-cholesterol concentration in 11 asthmatic patients. 2. No significant change of serum fasting triglyceride concentrations was found before and after BUD therapy (p > 0.05). However, serum fasting cholesterol concentration decreased slightly (p = 0.03) and HDL-cholesterol concentrations increased after BUD therapy for four weeks (p = 0.01). 3. These results suggest that high-dose BUD therapy does have minor effects on lipid metabolism after long periods of use in asthmatic patients.

Findings of an external quality assessment scheme for determining aluminum in dialysis fluids and water.

The analytical performance of laboratories participating in the dialysis fluids and water aluminum program of the Guildford External Quality Assessment Scheme over the period 1986-1993 has been reviewed. For aluminum concentrations > 3.33 mumol/L in dialysis fluids, the between-laboratory CV has fallen from approximately 36% to 23%, whereas for specimens of water the reduction was from 36% to approximately 18%. Improvements at lower concentrations were less impressive. Performance of individual participants varied; only a few consistently provided accurate results. Many of the participants are able to measure serum aluminum well, so lack of expertise is not responsible for poor results. We suggest that matrix effects associated with different specimen types have a significant influence on performance and that due account is not always taken of these factors. Resolution of these problems would be aided by appropriate reference materials.

The effect of deferoxamine on brain lipid peroxide levels and Na-K ATPase activity following experimental subarachnoid hemorrhage.

1. In the present study we have studied the effects of deferoxamine treatment on lipid peroxidation and Na-K ATPase activity after experimental induction of subarachnoid haemorrhage (SAH) in guinea pigs. 2. We assessed the extent of lipid peroxidation by measuring the level of malondialdehyde and Na-K ATPase activity in 3 different groups (sham-operated, SAH, SAH + deferoxamine). 3. There was no significant difference in lipid peroxide content between sham-operated and haemorrhagic animals, but Na-K ATPase activity decreased after SAH. 4. Deferoxamine treatment reduced the malondialdehyde content and induced the recovery of Na-K ATPase activity, exerting a brain protective role against the detrimental effects of the haemorrhage.

The effect of short term lithium treatment on the leukocyte, liver and muscle carbohydrate metabolism of guinea-pigs.

1. The effect of lithium treatment on the leukocyte, liver and muscle glycogen levels of guinea-pigs has been studied. 2. A 4-week treatment with lithium chloride (5 mmol/l i.p. in saline) increased leukocyte, liver and muscle glycogen and decreased blood glucose levels. 3. These results strongly suggest that a lithium-induced insulin-like effect may be related to the long term effect.