Diabetes mellitus (DM) is recognized as a major contributor to impaired testicular function and compromised male fertility. In the present study, the protective effects of the natural flavonoid diosmin (Dios) against diabetes-induced testicular injury were investigated using a rat model of streptozotocin (STZ)-induced diabetes. Diabetes was induced in rats via a single intraperitoneal injection of STZ at a dose of 50 mg/kg body weight. Dios was administered at doses of 25 and 50 mg/kg body weight for eight weeks. Diabetic rats displayed marked testicular dysfunction, evidenced by reduced serum testosterone levels, deteriorated sperm parameters, and pronounced histopathological alterations in testicular tissues. Biochemical analysis revealed elevated levels of oxidative stress markers, including malondialdehyde and protein carbonyls, along with decreased levels of reduced glutathione and diminished activities of catalase and superoxide dismutase in the testicular tissues. Furthermore, diabetes exacerbated testicular inflammation, as indicated by increased immunoexpression of NF-κB p65 and levels of pro-inflammatory cytokines. Likewise, diabetes induced testicular apoptosis, demonstrated by increased Bax and caspase-3 levels and decreased Bcl-2 levels. Treatment of diabetic rats with Dios significantly attenuated sperm parameters and testicular architecture and mitigated oxidative stress, inflammatory responses, and apoptotic cell death. Additionally, Dios enhanced antioxidant defense mechanisms and restored the Sirt1/Nrf2/HO-1 signaling pathway in the testicular tissues of diabetic rats. These results suggest that Dios may serve as an adjuvant therapeutic agent for diabetes-associated testicular dysfunction.

Aims: To assess perceptions and performance of 1st MBBS students in clinical examination skills after early clinical exposure (ECE) through clinical skills lab (CSL) using simulated patients. Methods: The research involved 150 first-year MBBS students, 50 students attended in two groups with 25 students each. A pre and post-test of awareness about ECE and CSL, a training session with one set of students receiving traditional lecture-based “see one do one” teaching methods, and the other group receiving training in small group teaching with simulated patients in CSL. Performance was assessed using a validated checklist. Feedback was taken from all participants. Results: The ECE group performed better in clinical skills. 38 students performed well and 11 performed excellently, compared to the traditional teaching group with only 11 performing good. ECE was perceived to be better by the majority of students (82.9%) than traditional teaching method. The majority of teachers (97.7%) agreed that early clinical exposure will help students prepare before encountering real patients and 90% of simulated patients agreed that students of ECE exposed group have examined better than the traditional teaching method (11%). The pre-and post-test scores showed an increase in awareness. Conclusion: Students in the first year of medical school perform better in examination skills if they have early clinical exposure and clinical skills lab with simulated patients are the best resources for achieving the primary goal of skill acquisition. Objetivos: Evaluar las percepciones y el desempeño de los estudiantes de primer año de MBBS en habilidades de examen clínico después de la exposición clínica temprana (ECE) a través del laboratorio de habilidades clínicas (CSL) utilizando pacientes simulados. Métodos: La investigación involucró a 150 estudiantes de primer año de MBBS, 50 estudiantes asistieron en dos grupos con 25 estudiantes cada uno. Una prueba previa y posterior de conocimiento sobre ECE y CSL, una sesión de capacitación con un grupo de estudiantes que recibieron métodos de enseñanza tradicionales basados ​​en conferencias de "ver uno hace uno" y el otro grupo recibió capacitación en enseñanza en grupos pequeños con pacientes simulados en CSL. El desempeño se evaluó utilizando una lista de verificación validada. Se tomó la retroalimentación de todos los participantes. Resultados: El grupo de ECE tuvo un mejor desempeño en habilidades clínicas. 38 estudiantes se desempeñaron bien y 11 se desempeñaron excelentemente, en comparación con el grupo de enseñanza tradicional con solo 11 que tuvieron un buen desempeño. La mayoría de los estudiantes (82.9%) percibieron que ECE era mejor que el método de enseñanza tradicional. La mayoría de los docentes (97,7 %) coincidió en que la exposición clínica temprana ayudará a los estudiantes a prepararse antes de enfrentarse a pacientes reales, y el 90 % de los pacientes simulados coincidió en que los estudiantes del grupo expuesto a ECE han realizado exámenes con mayor éxito que con el método de enseñanza tradicional (11 %). Las puntuaciones de las pruebas previas y posteriores mostraron un aumento en la concienciación. Conclusión: Los estudiantes de primer año de medicina obtienen mejores resultados en las habilidades de examen si tienen exposición clínica temprana, y el laboratorio de habilidades clínicas con pacientes simulados es el mejor recurso para lograr el objetivo principal de adquirir habilidades.

Type1 diabetes mellitus, also known as juvenile diabetes is an autoimmune disorder. It is a chronic condition in which there is a destruction of pancreatic beta cells by autoimmune response. Here, a case of a 13-year-old girl, weighing 32 kg and with a Body Mass index (BMI) of 13.9 kg/m2 was reported to the family medicine clinic with complaints of weakness, increased appetite and thirst, and increased frequency of micturition for the past two months. Personal history revealed a consistent weight loss over the past six months with the problem of lice in the hair from the past two months. A family history of diabetes, hypertension, and allergies was present. General physical examination reveals no abnormality and vitals were within normal limits. Blood investigations revealed increased levels of random blood sugar levels, glycated Haemoglobin (HbA1c) and Immunoglobulin (Ig)E. Hormonal assay was within normal limits, and skin prick test result revealed strong positive reactions to some allergens. The treatment included subcutaneous insulin, regular physical exercise and immunologic desensitisation of food allergens through Sublingual Immunotherapy (SLIT). The treatment resulted in controlled blood glucose levels with a reduction in insulin dose, a decrease in HbA1c levels, increased body weight and an improved BMI.

Background: Diabetes mellitus is frequently associated with complications and comorbidities that often require hospitalization and the use of multiple medications for effective management. However, the simultaneous use of these treatments significantly increases the risk of potential drug–drug interactions (pDDIs). Objectives: This study assessed the prevalence, levels, and associated predictors of pDDIs among hospitalized participants with type 2 diabetes mellitus (T2DM) and evaluated their clinical relevance and implications for monitoring and management. Methods: This retrospective cross-sectional study included 430 inpatients with T2DM at Universitas Indonesia Hospital, Indonesia. Lexicomp^® Lexi-Interact™ software Wolters Kluwer was used to analyze and classify pDDIs based on severity, risk rating, and documentation levels. Additionally, logistic regression analysis was conducted to identify the predictors of pDDIs, and the study assessed the clinical relevance of major pDDIs. Results: Of the total participants, 84.7% (n = 364) experienced pDDIs, with 1642 interactions identified. Moderate interactions accounted for 77.5% (n = 1273), whereas major interactions constituted 12.2% (n = 201). The most common risk rating was category C (77.5%, n = 1187), and the predominant evidence support level was ‘fair’ (64.8%, n = 1064). Multivariate logistic regression analysis showed a significant association between pDDIs and of 7–12 medications used (OR = 30.1; p < 0.001), and hospital stays ≥4 days (OR = 9.7; p = 0.001). Major pDDIs were significantly linked to ≥13 medications (OR = 5.5; p = 0.002), ≥4 days hospitalization (OR = 11.3; p < 0.001), and urinary tract infections (OR = 3.5; p = 0.02). Participants with major pDDIs exhibited hypoglycemia, hyperglycemia, electrolyte imbalances, and reduced therapeutic responses. Conclusions: The findings indicate a high prevalence of pDDIs among participants with T2DM, highlighting the impact of polypharmacy, prolonged hospitalization, and comorbidities. Implementing software-based screening, close monitoring, and targeted interventions are essential to reduce adverse clinical outcomes and enhance patient safety.