Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy.

Diabetes mellitus (DM) is currently considered a modern global epidemic, and diabetic nephropathy (DN) is the most common cause of chronic kidney disease (CKD). Anemia is one of the most significant complications of CKD, and it is mainly attributed to insufficient erythropoietin (EPO) production. However, anemia develops earlier in the course of CKD among patients with DM, and the severity of anemia tends to be more marked in these patients compared to nondiabetic subjects, regardless of the stage of CKD. In this review, we focus on the "less known" complex interacting mechanisms which are involved in the pathophysiology of anemia associated with DN. Although the major cause of anemia in DN is considered to be an inappropriate response of the plasma EPO concentration to anemia, several other possible mechanisms have been suggested. Glomerular hyperfiltration, proteinuria, renal tubular dysfunction and interstitial fibrosis are among the main culprits. On the other hand, systemic effects such as chronic inflammation, autonomic neuropathy and the renin-angiotensin system are also involved. Finally, several medications are considered to aggravate anemia associated with DN. Since anemia is an important predictor of quality of life and is implicated in the increased burden of cardiovascular morbidity and mortality, further research is required to elucidate its pathogenesis in diabetic patients.

Effects of Selective Serotonin Reuptake Inhibitors (SSRIs) therapy on the female sexual response cycle of women with major depression.

OBJECTIVE: Depression and its treatment may influence all aspects of the female sexual function from desire to sexual satisfaction. This study aimed to examine the components of the female sexual response cycle (SRC) of women with major depression treated with Selective Serotonin Reuptake Inhibitors. MATERIALS AND METHODS: The correlations structure of the items of the SRC's phases (i.e. desire, arousal, orgasm, satisfaction and pain) in a validated Malay version of Female Sexual Function Index (FSFI) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria. Factor loadings using PCA with varimax rotation divided the sexual domains into three components based on Kaiser's criteria. RESULTS: Sexual desire, sexual arousal, lubrication and orgasm were highly correlated, to form a "sexual drive" construct. Sexual satisfaction and pain made up the second and third components, respectively. SSRIs may affect the components of the SRC causing highly overlapping constructs of sexual drive including orgasm. Recognizing this helps strategizing the treatment approach of female sexual dysfunction in depression particularly in relation to the role of SSRIs.