IntroductionDiabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels (1). Diabetic foot ulcers are estimated to affect 15% of all patients with DM during their lifetime (2). Ulceration, infection, gangrene, and lower extremity amputation are complications often encountered in patients with DM. These complications frequently result in extensive morbidity, repeated hospitalizations, and high treatment costs. The etiology of diabetic foot ulcers is multifactorial. Risk factors identified include peripheral neuropathy, vascular disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. Despite considerable international efforts, DM continues to be the most common underlying cause of nontraumatic lower extremity amputations in the United States and Europe (3).Background/aim: To investigate serum ischemia-modified albumin (IMA), oxidized low-density lipoprotein (ox-LDL) levels, and paraoxonase 1 (PON1) activity in patients with diabetic foot. Materials and methods:Thirty patients with diabetes mellitus (DM), 30 patients with diabetic foot (29 and 27 of these patients had type 2 DM, respectively), and 30 healthy volunteers as the control group were included in the study. The patients with diabetic foot were divided into 2 groups, as those who had or had not undergone lower extremity amputation. Serum PON1 activity, ox-LDL, and IMA levels were measured.Results: Serum PON1 activity was lower (P < 0.05) and ox-LDL levels were higher (P < 0.05) in the diabetic foot group than in the control and diabetes groups. Albumin-adjusted IMA values were higher (P < 0.001) in the diabetic foot group compared to the diabetes group. The postamputation levels of IMA were decreased compared to the preamputation condition (P < 0.05). Conclusion:The low activity of PON1 and the high levels of ox-LDL and IMA may play an important role in the pathogenesis of diabetic foot. The use of these parameters in the follow-up of patients with DM may prevent the development of diabetic foot. In order to reach a definitive judgment, further studies with a larger number of subjects are necessary.

There are some studies regarding the presence/absence of oxidative stress in patients with hypogonadism with limited number of parameters. We aimed to investigate the effects of male hypogonadism and its treatment on oxidative stress parameters. Thirteen male patients with hypogonadotropic hypogonadism and 20 healthy subjects were involved in the study. Patients with hypogonadism were evaluated before and after six months of therapy. Markers indicating lipid and protein oxidation, total oxidant status (TOS) and total anti-oxidant capacity (TAC) were evaluated. Control subjects had significantly higher serum testosterone levels in comparison to hypogonadal patients before the treatment period. After the treatment of hypogonadism serum testosterone levels increased significantly. Myeloperoxidase (MPO) activity, levels of advanced oxidation protein products (AOPP), total lipid hydroperoxide and protein carbonyl compounds (PCC) were similar between the control subjects and the patient group before treatment. Pyrrolized protein and TOS were significantly lower and thiol levels and TAC were significantly higher in the control subjects than in patients with hypogonadism. Treatment of hypogonadism resulted in a significant decrease in AOPP levels while a significant increase was determined in TAC. No significant change was found in MPO activity. In conclusion, patients with hypogonadism have an increased status of oxidative stress which is at least partially improved after appropriate therapy.

Background Immunoassays show variability in the detection of macroprolactin. The aim of this study was to detect the frequency of macroprolactinemia in hyperprolactinemic patients and the problems encountered in routine clinical practice. Methods The screening of macroprolactinemia was performed by precipitation with polyethylene glycol (PEG) in 900 patient samples with hyperprolactinemia over a period of approximately 6 months. Recovery values of less than 40% and greater than 60% were considered as macroprolactinemia and predominantly monomeric prolactin (PRL), respectively. Results A total of 900 (17.9%) of the 5007 PRL results were out of reference range. Thirty-one (3.4%) of the patients had less than 40% recovery after screening of all patients with hyperprolactinemia. However, the macroprolactin test was requested by clinics from only 171 patients and seven of these patients had less than 40% recovery. We also detected predominantly macroprolactin in 24 samples, overlooked in routine practice. The patients with PRL above 100 ng/mL had no macroprolactinemia. Conclusions The screening for macroprolactinemia of hyperprolactinemic patients who have <100 ng/mL and also with unexplained hyperprolactinemia should be the first approach before any further research or treatment is initiated. Thus, unnecessary test repetition, investigation and inappropriate treatment can be avoided. Each laboratory should inform clinicians about the frequency of macroprolactinemia.

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