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ORIGINAL ARTICLES
Study of serum apelin and its relation to obesity-associated hypertension
Samir N Assaad, Aliaa A El-Aghoury, Eman M El-Sharkawy, Eman Z Azzam, Marwa A Salah
January-April 2015, 1(1):28-35
DOI:10.4103/2356-8062.159990  
Introduction Over the past few decades obesity has become a major burden on health worldwide. The prevalence of hypertension has increased with a significant increase in the prevalence of overweight and obesity. Recent studies indicate an important role of adipose tissue hormones called adipokines in obesity-associated complications. Apelin has recently been added to the family of adipokines. One of the physiologic functions of the apelin/APJ system is regulation of the cardiovascular function. The aim of this study was to determine the relation of serum apelin to obesity-associated hypertension as well as to myocardial performance. Patients and methods The study included 30 obese hypertensive patients, 30 obese nonhypertensive patients, and 25 age-matched and sex-matched controls. In all studied participants we determined the lipid profile, serum insulin, fasting blood glucose level, HOMA-IR, serum apelin, and echocardiographic results of left ventricular systolic and diastolic function. Results Higher levels of fasting blood glucose, fasting serum insulin, HOMA-IR, triglycerides, total cholesterol, and low-density lipoprotein were detected in obese hypertensive and nonhypertensive patients. Left ventricular mass index (LVMI) was increased in both obese hypertensive and nonhypertensive patients in comparison with healthy individuals. Left ventricular ejection fraction and E/A ratio were significantly lower in hypertensive obese versus nonhypertensive obese individuals (P = 0.004 and <0.001, respectively), whereas LVMI was higher in hypertensive versus nonhypertensive patients (P < 0.001). Apelin levels were significantly equally higher in obese hypertensive and nonhypertensive patients (6.10 ± 1.88 and 6.40 ± 1.60 ng/ml) compared with controls (4.22 ± 0.86 ng/ml, P < 0.001). In hypertensive obese individuals, serum apelin correlated negatively with left ventricular ejection fraction (P = 0.02) and directly with E/A ratio (P = 0.03). Conclusion Apelin levels are significantly higher in obese hypertensive and nonhypertensive patients. This increase might be a compensatory mechanism against myocardial dysfunction with obesity.
  2,528 28 1
Influence of thyroid function on the outcome of percutaneous coronary intervention in euthyroid patients with coronary artery disease
Samir N Assaad, Mohamed A Sobhy, Tamer M Elsherbiny, Rania S Swelem, Magdy M Allam
September-December 2015, 1(3):97-108
DOI:10.4103/2356-8062.178289  
Background Thyroid hormonal disturbance plays an essential role in coronary artery disease (CAD) development and progress. Few studies have detected the relation between percutaneous coronary intervention (PCI), thyroid gland function, and morphology. We aimed to assess the influence of baseline thyroid function tests on the outcome of PCI in euthyroid patients with CAD, and to detect the effect of PCI on the thyroid function and ultrasound features. Patients and methods This study included 113 clinically euthyroid patients with stable CAD. Serum free T3, serum free T4, thyroid-stimulating hormone (TSH), thyroid-stimulating hormone index, free T3/T4 ratio, anti-thyroperoxidase (TPO), and high-sensitivity C-reactive protein had been measured before, and then 24 h and 3 months after PCI. The morphology of thyroid was evaluated through thyroid ultrasound before and 3 months after PCI. Results One day after PCI, there was a significant increase in serum FT3 and serum FT4 and no significant change in the serum TSH compared with just before PCI (P < 0.001, P = 0.04, P = 0.97, respectively). In addition, there was a significant increase in serum FT3/FT4 ratio compared with just before PCI (P = 0.007). Three months after PCI, there was a significant increase in serum FT4, decrease in serum FT3 returning to baseline, and a significant increase in serum TSH compared with just before PCI (P = 0.42, P < 0.001, P < 0.001, respectively). There was a significant decrease in the serum FT3/FT4 ratio and significant increase in serum thyroid-stimulating hormone index compared with just before PCI ( P ≤ 0.001, P < 0.001, respectively). Higher TSH and measured echogenicity index were independent pre-PCI predictors of unfavorable outcomes after 24 h with cutoff values greater than 0.95 mIU/ml and greater than 1.81, respectively. Lower FT3 and higher FT4 levels were independent pre-PCI predictors of unfavorable outcomes after 3 months with cutoff values less than or equal to 2.95 pg/ml and greater than 1.3 ng/dl, respectively. Conclusion A state of euthyroid hyperthyroxinemia was detected 24 h after PCI. A state of thyroid hormone resistance was detected 3 months after PCI. Higher TSH and measured echogenicity index independently predicted unfavorable outcome after 24 h. Lower FT3 and higher FT4 levels independently predicted unfavorable outcomes after 3 months.
  1,571 278 -
Autoimmune thyroid disorders in seropositive versus seronegative rheumatoid arthritis
Mohamed K Ghitany, Eiman A Soliman, Maha E Bondok, Shahinda A Elmaadawy
January-April 2015, 1(1):53-63
DOI:10.4103/2356-8062.159997  
Background Autoimmune diseases are chronic conditions initiated by the loss of immunological tolerance to self-antigens; they represent a heterogeneous group of disorders that afflict specific target organs or multiple organ systems. Autoimmune thyroid disease (AITD) is a common organ-specific autoimmune disorder affecting mostly middle-aged women. AITD is a term that includes various clinical forms of autoimmune thyroiditis; among these diseases, Hashimoto's thyroiditis and Graves' disease are the two most common types and share many features immunologically. Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to severe disability and premature mortality. Given the same pathogenic mechanisms, autoimmune diseases tend to cluster together, and hence this study was designed to investigate the relationship between AITD and RA, particularly seropositive versus seronegative subtypes. Patients and methods The study included 70 patients with evidence of RA. Their diagnosis was based on the 2010 American College of Rheumatology (ACR)-EULAR classification criteria, and they were subclassified into two groups: group I, comprising 35 patients with seropositive RA (positive to one or both seromarkers), and group II, comprising 35 patients with seronegative RA (negative to both seromarkers). Twenty healthy age-matched and sex-matched controls constituted group III. All of the studied participants underwent detailed history-taking and physical examination, focusing on RA duration of illness, clinical features suggestive of thyroid dysfunction, and disease activity score (DAS28). We determined the complete blood count, erythrocyte sedimentation rate, C-reactive protein, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, thyroid stimulating hormone (TSH), serum total T3 (TT3), serum total T4 (TT4), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), anti-thyroid peroxidase (anti-TPO), thyroglobulin Ab, and TSH receptor antibody (TRAb) levels, and also performed a neck ultrasound. Results It was found that erythrocyte sedimentation rate, C-reactive protein, RF, and anti-CCP were significantly higher in RA patients versus controls, particularly in seropositive versus seronegative patients. No significant difference was found between the studied groups as regards TSH, T3, and T4 levels; however, hypothyroidism was found to be more common than hyperthyroidism in RA patients (29 vs. 3% in group I and 9% in group II). Anti-TPO and antithyroglobulin were significantly higher in RA patients versus controls (P < 0.001) and specifically in seropositive (1301.9 ± 1716.0 and 1750.0 ± 1866.2, respectively) versus seronegative patients (799.4 ± 1597.7 and 898.1± 988.11, respectively). TRAbs were detectable in a small subset of RA patients (6% regardless of the serostatus) with significant difference between patients and controls (P = 0.006). Ultrasonographic features of thyroiditis were significantly evident in RA patients versus controls (P = 0.001). A positive correlation was found between RA autoantibodies (RF and anti-CCP) and thyroid autoantibodies (mainly anti-TPO and TRAbs) (P = 0.007, 0.012, 0.004, and 0.035, respectively). Conclusion Thyroid dysfunction and AITD are common in RA patients, with hypothyroidism being the most common disorder, which is prevalent in 29% of patients regardless of their serostatus. This association was independent of disease activity assessed by DAS28. Increased incidence of thyroid autoimmunity was seen in seropositive RA versus seronegative RA patients, as evidenced by higher levels of thyroid autoimmune markers in the former. TRAbs were detectable in a small subset of patients with RA.
  1,368 19 -
Effect of intragastric balloon-induced weight loss on body composition, fatty liver, and comorbidities in Egyptian middle-aged obese women: a 6-month follow-up study
Mohammed M Shamseya, Marwa A Madkour
May-August 2015, 1(2):90-96
DOI:10.4103/2356-8062.170207  
Background Paralleling the increasing prevalence of obesity in the Egyptian population, metabolic syndrome and liver steatosis are also on the rise. Body composition measurement is used to describe the percentages of fat, bone, water, and muscle in human bodies. The available classic weight loss treatments such as low-calorie diet, exercise, behavioral modification, and pharmacotherapy usually achieve only limited weight loss. The BioEnterics Intragastric Balloon (BIB) is an endoscopic liquid-filled device for the treatment of obesity. Aim The aim of this study was to examine the safety of BIB insertion in a group of obese middle-aged Egyptian women treated with intragastric balloon to induce weight loss for 6 months and report its effect on their anthropometric measurements, body composition, fatty liver, and comorbidities. Patients and methods During the period from February 2012 until August 2013, 47 consecutive middle-aged female patients were enrolled for BIB insertion. Inclusion criteria were mainly based on the BMI (≥30.0 kg/m 2 ) and on associated comorbidities. Apart from physical and anthropometric evaluation, body composition analysis was performed using a bioelectrical impedance analyzer to estimate fat mass, body fat percentage, and fat-free mass. The Adult Treatment Panel III criteria were used to diagnose metabolic syndrome, and ultrasound evaluation of the liver for the presence and grade of steatosis was performed. BIB placement was carried out after diagnostic endoscopy, under intravenous conscious or unconscious sedation. Results The total percentage of complications from BIB insertion was 12.8%, which were mostly mild and reversible. Three (6.4%) patients had their gastric balloon removed early (two voluntarily and one due to de-novo peptic ulcer) and were excluded from the study, whereas the remaining 44 patients continued their 6-month therapy duration. Overall, BIB insertion significantly reduced weight from a mean value of 96.82 ± 14.18 kg at baseline to 83.45 ± 12.03 kg after 6 months (P < 0.001). The mean value for the amount of weight lost at endpoint was 13.36 ± 3.29 kg, whereas the mean value for BMI lost at the time of BIB removal was 5.12 ± 1.20 kg/m 2 , which was a significant reduction compared with baseline values (P < 0.001). No significant change occurred in the liver size over the 6-month study period (P = 0.12), whereas a significant decrease in the grade of steatosis was noted. Body fat mass and body fat percentage with bioelectrical impedance analyzer were significantly reduced (P < 0.001). However, there was also a significant decline in fat-free mass (P < 0.001). Significant favorable changes in the biochemical markers of metabolic syndrome, homeostasis model assessment of insulin resistance index, and liver profile also occurred. An overall 4.6% of patients showed resolution, whereas 31.8% showed improvement in the features of metabolic syndrome. Conclusion This study provides anthropometric, biochemical, and body composition evidence on significant improvement in metabolic syndrome, obesity-associated comorbidities, and fatty liver after weight loss induced by the minimally invasive and relatively safe technique. However, it is recommended to continue a weight-reducing diet after BIB removal for achieving long-term effectiveness and to add exercise programs to dietary restriction for promoting more favorable change in body composition.
  1,022 8 -
Study of vitamin D level in type 2 diabetic patients before and after treatment with pioglitazone
MR Halaw, MM Abu Shady, YM Eid, AA EL Sherbeney, WW Mohamed
January-April 2015, 1(1):43-48
DOI:10.4103/2356-8062.159994  
Objective The aim of this study was to evaluate vitamin D level in type 2 diabetic patients before and after treatment with pioglitazone and assess any possible relationship with type 2 diabetic patients who are pioglitazone naive. Participants and Methods The study included 50 female participants; of them, 20 were healthy female participants who served as controls and 30 were pioglitazone-naive diabetic patients. All individuals were subjected to history taking and clinical examination, including fasting blood sugar, 2 h postprandial, glycosylated hemoglobin (HbA1c), lipid profile test (total cholesterol, HDL, LDL, triglycerides), kidney function tests (serum creatinine and calculated glomerular filtration rate), and evaluation of serum calcium, phosphorus, and alkaline phosphatase and serum 25-hydroxy vitamin D (by enzyme linked immunosorbant assay) before (basal) and after 3 months of treatment with pioglitazone. Results There was an nonsignificant elevation of vitamin D in group 2b (diabetic patients after using pioglitazone for 3 months), in comparison with vitamin D level in group 2a (diabetic patients before using pioglitazone) (P = 0.117). Vitamin D levels were found to be inversely associated with HbA1c levels in type 2 diabetic patients (P = 0.000 linear regression analysis); it was also found to be inversely associated with fasting and 2 h postprandial blood sugar levels (P < 0.000). Conclusion Vitamin D could impact glycemic control in terms of the inverse relation of vitamin D with HbA1c%, and at the same time poor glycemic control could impact vitamin D status in uncontrolled diabetic patients. Thiazolidinediones do not have significant effect on vitamin D level in female diabetic patients.
  756 10 -
Association of plasma omentin-1 level with insulin resistance in chronic kidney disease patients
Anass Qasem, Salama Farage, Fawzy A Elmesallamy, Hanaa H Elsaid
May-August 2015, 1(2):72-76
DOI:10.4103/2356-8062.170204  
Introduction The early prediction and prevention of cardiovascular disease risk factors is highly important in chronic kidney disease (CKD) patients. The plasma level of omentin was found to be associated with different disorders such as insulin resistance, diabetes mellitus, obesity, endothelial dysfunction, and atherosclerosis. The aim of the study was to clarify the influence of changes in levels of circulating omentin-1 on insulin resistance in CKD patients with and without type 2 diabetes mellitus. Participants and methods Seventy-eight patients were enrolled in this cross-sectional study: 23 patients with CKD on conservative treatment, 35 patients on maintenance hemodialysis, and 20 healthy volunteers. Serum concentrations of omentin-1 were determined with an enzyme-linked immunosorbent assay kit. Results Significant difference in plasma omentin-1 level was noticed between diabetic patients and nondiabetic patients in both the predialysis group and the hemodialysis (HD) group. There was also a significant difference in plasma omentin-1 level between nondiabetic patients in the predialysis group and the HD group and between diabetic patients in the predialysis group and hemodialysis group. There were significant negative correlation between plasma Omentin-1 level (ng/ml), fasting insulin level (mIU/ml), HOMA-IR and eGFR (ml/min/1.73m 2 ) while significant positive correlation with IL-6 (pg/ml) and hsCRP (mg/l). Conclusion Plasma omentin-1 concentration was higher in CKD patients. In addition, there was an association between omentin-1 and insulin resistance in hemodialysis patients, which may be considered a cardiovascular risk factor in CKD patients.
  714 18 -
Impact and predictors of thyroid dysfunction among patients with stenotic coronary artery lesion during late postacute coronary syndrome
Sahar H Elhini, Ragaa A Matta, Nossa N Eledawi, Lamia Hamdi
January-April 2017, 3(1):1-9
DOI:10.4103/ejode.ejode_28_16  
Objective Thyroid dysfunction (TD) is a risk factor for coronary heart disease (CHD) events. We study the prevalence and predictors of TD and its impact on characteristics, cardiac function, and ischemic severity of patients with manifest CHD. Patients and methods A total of 200 patients 6–12 months after acute coronary syndrome had at least one vessel − significant stenotic coronary artery lesion. Before elective angiography, patients underwent anthropometric measurement, routine biochemical assay, thyroid hormones, and thyroid peroxidase antibody. Results The prevalence of TD was 17.5%: 12% for hypothyroidism (9.5% subclinical, 2.5% overt) and 5.5% for hyperthyroidism (2.5% subclinical, 3% overt). Compared with the euthyroid group, the hypothyroid group had a significantly higher age, BMI, diastolic blood pressure (BP), atherogic lipid profile, and impaired cardiac functions and higher pulmonary artery systolic pressure (PASP), and the hyperthyroid group had significantly higher systolic BP, ejection fraction (EF), and PASP and significantly lower diastolic BP and lipid profile. Independent predictors for hypothyroidism were age, bradycardia, increased BMI, lower EF, diastolic dysfunction, and atherogenic lipid profile, whereas increased PASP was an independent predictor for hyperthyroidism. Thyroid-stimulating hormone (TSH) was positively correlated and both free triiodothyronine and free thyroxine were negatively correlated to BP, BMI, lipid profile, impaired EF, and coronary atherosclerosis severity. TSH and free thyroxine were positively correlated to PASP, which increased significantly through hypothyroidism to hyperthyroidism. TSH and free triiodothyronine were independent predictors of severity of CHD. Conclusion Age, obesity, impaired cardiac function, and atherogenic lipid profile are predictors of hypothyroidism, and PASP is the predictor of hyperthyroidism among manifest CHD. Thyroid hormones are predictors of severity of coronary atherosclerosis and correlated to cardiac functions and PASP.
  710 12 -
Study of the relation between serum testosterone level and carotid atherosclerosis in elderly men
Nany H El Gayar, Marwa H Mahmoud, Amro M Elabd
September-December 2015, 1(3):128-136
DOI:10.4103/2356-8062.178324  
Objective The aim of the present study was to evaluate the relationship between serum testosterone concentration and carotid atherosclerosis in elderly men. Participants and methods The current study included 40 participants who were classified into two groups; the first group comprised 30 elderly healthy men (the case group) and the second group comprised 10 young males (the control group). Serum level of total testosterone was measured using a commercial immunoassay kit cobas testosterone II; sex hormone binding globulin (SHBG) was measured using a commercial immunoassay kit cobas. SHBG and free androgen index (FAI) were calculated by dividing the total testosterone value by SHBG value and then multiplying it by 100 [total testosterone (nmol/l)/SHBG (nmol/l)Χ100%]. Ultrasonographic measurement of carotid intima-media thickness (IMT) was also carried out. Results Total testosterone level was significantly lower in the case group than in the control group (t = 5.354, P < 0.001). SHBG was significantly higher in the case group than in the control group (t = 4.796, P < 0.001). FAI was significantly lower in the case group than in the control group (z = 4.686, P < 0.001). IMT was significantly higher in the case group than in the control group (t = 3.513, P = 0.001). As regards the number of plaques, 10 men participants (33.3%) from the case group did not have any plaques, 13 (43.3%) had one plaque, and seven (23.3%) had two plaques; however, in the control group, nine participants (90%) did not have any plaques and only one (10%) had one plaque; therefore, the case group had significantly higher number of plaques than did the control group (z = 3.007, P = 0.003). There was a significant negative correlation between total testosterone and SHBG (R = −0.856, P < 0.001), a significant positive correlation between total testosterone and FAI (R = 0.957, P < 0.001), and a significant negative correlation between testosterone and both IMT (R = −0.501, P = 0.005) and number of plaques (R = −0.358, P = 0.52). SHBG was negatively correlated with FAI (R = −0.845, P < 0.001) but positively correlated with both IMT (R = 0.392, P = 0353) and the number of plaques (R = 0.032, P = 0.056). There were significant negative correlations between FAI and both IMT (R = −0.601, P < 0.001) and the number of plaques (R = −0.461, P = 0.010). IMT was positively correlated with the number of plaques (R = 0.760, P < 0.001). Conclusion These findings suggest that normal physiologic testosterone levels may help to protect men from atherosclerosis. In elderly men, low plasma testosterone is associated with elevated carotid IMT. A negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries. These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk for developing atherosclerosis.
  706 13 -
The relationship between serum apelin level and different grades of diabetic nephropathy in type 2 diabetic patients
Alaa Dawood, Mohamed Abdelraof, Yasser El Ghobashy
January-April 2017, 3(1):32-37
DOI:10.4103/2356-8062.205205  
Background Diabetic nephropathy (DN) is the leading cause of renal failure. Diabetic patients with microalbuminuria typically progress to proteinuria and overt DN. Similar to other microvascular complications of diabetes, there are strong associations between glucose control (as measured using HbA1c) and the risk of developing DN. Apelin (APLN), a peptide first isolated from bovine stomach tissue extracts, is the endogenous ligand for the G-protein-coupled APJ receptor that is expressed at the surface of some cell types. APLN and APJ are widely expressed in homogenates from animal organs in a pattern shared with angiotensinogen and the angiotensin receptor. APLN is widely distributed in the central nervous system and periphery, especially in the heart, kidney, lung, and mammary glands. The APLN–APJ system may be involved in the pathogenesis of DN, which may play a renoprotective role partially by antagonizing the angiotensin II–ATIR pathway. Aim The aim of this study was to investigate the relation between serum APLN and different grades of DN in type 2 diabetic patients. Patients and methods This study was conducted on 150 diabetic patients and 20 controls selected from the inpatient department and outpatient clinics of the Internal Medicine Department in Menoufia University Hospital. The selected participants were divided into four groups: group 1 included 20 healthy controls; group 2 included 50 type 2 diabetes mellitus (T2DM) patients with normoalbuminuria; group 3 included 50 T2DM patients with microalbuminuria; and group 4 included 50 T2DM patients with macroalbuminuria. Members of the study groups were subjected to thorough history taking with special emphasis on age, sex, and duration of diabetes mellitus. Investigations included liver profile, complete blood count, fasting and 2 h postprandial plasma glucose, glycosylated hemoglobin (HbA1c), complete urine analysis, kidney function tests (blood urea nitrogen and serum creatinine), urine albumin/creatinine ratio, estimated glomerular filtration rate, and serum APLN. Results Serum APLN was significantly higher in group 4 compared with the other groups, in group 3 compared with groups 1 and 2, and in group 2 compared with group 1. There was a significant positive correlation between serum APLN and serum creatinine, urine albumin/creatinine ratio, and HbA1c. Further, there was a significant negative correlation between serum APLN and estimated glomerular filtration rate in the studied diabetic patients. There was no correlation between serum APLN and BMI in diabetic patients. Conclusion From this study, we can conclude that serum APLN is significantly higher in patients with DN compared with diabetic patients without nephropathy, and there is a positive correlation between serum apelin and the degree of DN. Thus, APLN may play an important role in the development of DN.
  666 21 -
Development and validation of an IGF-1-modified Child-Pugh score to risk-stratify hepatocellular carcinoma patients
Ahmed O Kaseb, Lianchun Xiao, Rania Naguib, Wafaa El-Shikh, Manal Hassan, Hesham Hassabo, Jeong-Hoon Lee, Jung-Hwan Yoon, Hyo-Suk Lee, Young Kwang Chae, James L Abbruzzese, Jeffrey Morris
January-April 2015, 1(1):14-20
DOI:10.4103/2356-8062.159986  
Background The Child-Turcotte-Pugh (CTP) score inaccurately predicts survival in patients with chronic liver disease, including hepatocellular carcinoma (HCC), yet remains the standard tool for assessing hepatic reserve and guiding therapeutic decisions. CTP scoring relies on objective laboratory values for albumin, bilirubin, and prothrombin time and subjective clinical grading of hepatic encephalopathy and ascites. As liver production of insulin-like growth factor-1 (IGF-1) is significantly reduced in patients with cirrhosis, we hypothesized that IGF-1 could be a valid surrogate for hepatic reserve to replace the subjective parameters in CTP scores. Materials and methods We prospectively enrolled patients and collected data and retrospectively tested plasma IGF-1 levels in four independent cohorts: two HCC cohorts from the USA [n = 310 (training set) and n = 99 (validation set 1)]; one HCC cohort from Korea [n = 188 (validation set 2)]; and one cirrhosis cohort from Egypt [n = 71 (validation set 3)]. Recursive partitioning identified within the training set three optimal IGF-1 ranges that correlated with survival: >50 ng/ml = 1 point; 26-50 ng/ml = 2 points; and <26 ng/ml = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with IGF-1 values, subjected both the resulting IGF score and the CTP score to log-rank analysis, and quantified the prognostic values with C-statistics to compare the scores' performance in all cohorts. Results The IGF score was significantly more accurate in predicting survival and improved the stratification of all CTP classes in the training and validation cohorts. Conclusion The new IGF score is simple and blood-based, and validated well on multiple independent HCC cohorts. It could identify a subpopulation of patients who may benefit from active therapy because of their preserved hepatic reserve, as distinct from patients for whom therapy can be deferred or avoided.
  664 19 -
Study evaluating testosterone deficiency as a cause of anemia and reduced responsiveness to erythropoiesis-stimulating agents in men on maintenance hemodialysis
Mohamed Magdy Abd El-Kader, Eman Ezat Al-Gohary, Mohamed Momtaz El-Sawy, Ammar Yasser Neanaa
January-April 2015, 1(1):1-6
DOI:10.4103/2356-8062.159981  
Introduction Chronic kidney disease (CKD) is a worldwide disease that is classified into five stages according to the glomerular filtration rate and presents through a variety of symptoms and signs. Anemia is one of the first signs of kidney dysfunction. The most common causes of anemia in CKD are erythropoietin (EPO) hormone deficiency and iron deficiency. Anemia and hyporesponsiveness to erythropoietin-stimulating agents (ESAs) are commonly observed in CKD patients and are associated with increased morbidity, mortality, and a significant healthcare economic burden. Although testosterone deficiency is a prevalent condition in men with CKD, it has so far received relatively little attention in practice. Testosterone stimulates erythropoiesis through the production of hematopoietic growth factors and possible improvement of iron bioavailability. Aim The aim of this study was to evaluate serum testosterone levels in patients on maintenance hemodialysis (MHD) and correlate its level with anemia and response to ESAs therapy. Patients and methods This study included 40 male patients from dialysis units, where they were divided equally into group A, group taking ESAs, and group B, group not taking ESAs (EPO-naive group). Another 20 men were included in group C (control group). All groups were subjected to a full assessment of history, full clinical examination, and laboratory investigations to exclude all possible causes of anemia. Results This study showed that in group A, 75% of the participants were anemic, whereas in group B, 100% of the participants were anemic, with a higher degree of anemia. The testosterone level was slightly higher in group B than group A; despite being within the normal range, it was relatively deficient on the basis of the age of the participants in the control group. Conclusion Testosterone deficiency is a prevalent condition in CKD that starts at an earlier age than the normal population. It is an evident independent cause of anemia in EPO-naive CKD patients and is a possible cause of resistance of ESAs in CKD patients; still, the most important causes of anemia in CKD are EPO and iron deficiency.
  658 15 -
Association between thyroid autoimmunity and chronic urticaria in patients versus healthy controls
Ashraf M Okba, Dina S Sheha, Asmaa S Moustafa, Alyaa A El-Sherbeny, Nesrine A Mohamed, Manar F Aglan
May-August 2015, 1(2):84-89
DOI:10.4103/2356-8062.170206  
Introduction There is growing evidence that some cases of chronic idiopathic urticaria are associated with various autoimmune diseases such as thyroid autoimmunity. The association between chronic urticaria (CU) and thyroid disorders has been a subject of controversy. Some reports link CU with hyperthyroidism or hypothyroidism. The frequency of thyroid antibodies in patients with chronic idiopathic urticaria reported in 2009 was 30%, which is higher than that previously reported. Objective This is a case-control study that aimed to detect the presence of markers of thyroid autoimmunity (thyroid autoantibodies with or without underlying abnormal thyroid functions) among a cohort of autologous serum skin test (ASST)-positive patients with CU in comparison with ASST-negative CU patients as well as with healthy controls, and correlating it to the severity of urticaria symptoms. Patients and methods This study was carried out on 80 CU patients attending the Allergy and Immunology Clinic of Ain Shams University Hospitals. CU was diagnosed on the basis of the appearance of continuous recurrent hives for more than 6 weeks. The patients were subdivided into the following groups: group A - 40 CU patients with positive ASST; group B - 40 CU patients with negative ASST. In addition, 40 healthy individuals were included in this study as healthy controls. History and general examination were conducted to all study grouos. Assessment of the Urticaria Activity Score-7 and laboratory investigations including those for complete blood count, erythrocyte sedimentation rate, thyroid function, thyroid Abs, namelyantimicrosomal antibody and antithyroglobulin antibody and total immunoglobulin E (IgE), were done. Results Comparison between the three groups showed that antithyroglobulin antibody was highly statistically significant in group A than in both group B and healthy controls. Moreover, antimicrosomal antibody was also found to be of higher statistical significance in group A than in both group B and healthy controls. Although total IgE had no statistical significance between groups A and B, total IgE was found to be statistically significantly higher in group B than in healthy controls. Level of thyroid stimulating hormone was higher in group A than in controls, and free T3 was lower in group A than in group B. Conclusion We suggest that thyroid diseases have a role in CU, which was confirmed by a higher level of thyroid antibodies in the ASST-positive group than in ASST-negative patients and healthy controls.
  656 7 1
Study of frailty index in elderly men with type 2 diabetes mellitus
Marwa AM Saad, Samar M Abd El-Fattah, Mohamed S Gad, Akram M Deghady
September-December 2015, 1(3):115-120
DOI:10.4103/2356-8062.178291  
Introduction Frailty is a common and growing multidimensional health and social care challenge across the world. Diabetes mellitus (DM) is one of the most important causes of morbidity and mortality in Egypt. Frailty and diabetes are inter-related. In addition, diabetes causes early-onset frailty. In this study we aimed to determine the frailty index in elderly men with type 2 DM and compare it with that in pre-elderly diabetic patients and age-matched healthy controls. Materials and methods Seventy male participants were included in the present study and were divided into three groups. Group I comprised 20 healthy men aged 65-75 years who were considered the control group; group II comprised 25 patients aged 50-64 years with type 2 DM; and group III comprised 25 patients aged 65-75 years with type 2 DM. Patients on insulin therapy and those with hypogonadism or hypothyroidism were excluded from the study. Frailty index was determined for all participants using Fried's five phenotypic parameters. Patients were considered frail if they fulfilled more than or equal to three parameters, prefrail if they fulfilled one to two parameters, and nonfrail if they fulfilled none of the parameters. Data were collected, analyzed, and compared between groups I and III and between groups II and III. Further, frailty index was correlated with the duration of DM and the degree of glycemic control. Results Seventy patients were divided into three groups. The mean age in group I was 68.50 ± 1.90 years, that in group II was 58.24 ± 4.34 years, and that in group III was 68.60 ± 2.43 years. Regarding the frailty index, in group I 17 patients (85%) were nonfrail, three (15%) were prefrail, and none were frail; in group II, four patients (16%) were prefrail, 21 (84%) were frail, and none were nonfrail; and in group III, three patients (12%) were prefrail, 22 (88%) were frail, and none were nonfrail. A statistically significant difference was noted between groups I and III, whereas no significant difference was noted between groups II and III. A significant positive correlation was found between the frailty index score and duration of diabetes and degree of glycemic control in groups II and III. Conclusion Diabetes and frailty are causally related. Diabetes is associated with frailty at earlier age. The duration of diabetes and degree of glycemic control correlate with the severity of frailty in both elderly and pre-elderly diabetic patients.
  624 15 -
Plasma visfatin level in adult Egyptians with android obesity
Alaa M Wafa, Ataa M Bakr, Ibrahim Abd El Aal, Amira M Nagi
January-April 2017, 3(1):10-14
DOI:10.4103/2356-8062.205207  
Context Android obesity is considered an important predictor of increased mortality and morbidity from diabetes mellitus and cardiovascular disorders. Aim Our research was conducted to assess the level of serum visfatin in android obesity and its relation to anthropometric and biochemical parameters in adults with android obesity. Patients and methods This study was conducted on 136 patients recruited from the outpatient obesity clinic of Specialized Medical Hospital, Mansoura University. The patients were divided into two groups: group I consisted of 65 control nonobese individuals, and group II consisted of 71 obese individuals with android obesity. The obese patients were subdivided into obese diabetic patients (35 patients) and obese nondiabetic patients (36 patients). All participants were subjected to thorough history taking, full clinical examination, and anthropometric measurements to assess body mass index and waist circumference. The changes that appeared in the carbohydrate metabolism were interpreted according to the criteria from the glycometabolic classification of WHO. Plasma glucose levels, lipid profile, and serum visfatin were measured. Results Our study demonstrated a significant elevation of visfatin (P≤0.001) in obese individuals (37.6; 20.7–65.9) compared with that in lean patients (15.3; 7.5–20). Additionally,visfatin levels were higher in the diabetic obese subgroup (45.5; 33.7–65.9) than in the nondiabetic obese subgroup (32; 20.7–46.5). Furthermore, visfatin was positively correlated to blood glucose in the obese group, which suggests a role of visfatin in glycemic control. A significant correlation between visfatin and lipid profile was demonstrated, which may suggest a role for visfatin in lipid homeostasis. Conclusion Serum visfatin was elevated in patients with android obesity, with more significant elevation in patients with android obesity with type 2 diabetes mellitus. It showed potential to be used as a marker of metabolic syndrome as it had a strong relation to android obesity.
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Quality of medical care provided to type 2 diabetic patients attending Alexandria Main University Hospital, Egypt
Azza A Esmail, Heba M.T. Elweshahi, Dalia Abd Elmotey
January-April 2016, 2(1):1-6
DOI:10.4103/2356-8062.184397  
Background Diabetes mellitus is a major contributor to morbidity and mortality worldwide. A marked variability in the application of preventive and therapeutic strategies was documented. Good quality of care is associated with lower burden of complications. Study objectives The present study was conducted to assess the quality of medical care provided to type 2 diabetic patients attending the internal medicine outpatient clinic in Alexandria Main University Hospital. Patients and methods A cross-sectional survey was conducted on 490 type 2 diabetic patients. Patients were interviewed using a structured questionnaire containing data on personal and sociodemographic characteristics as well as their self-care practices. Records of interviewed patients for a set of performance measures for diabetes care during the last year were reviewed. Weight, height, and blood pressure were measured and a series of laboratory investigations were carried out in order to assess the outcome of diabetes care. Results The study included 490 diabetic patients, of whom 281 (57.3%) were male patients. Their mean age was 53.62 ± 10.72 years. The duration of diabetes among the studied patients ranged from 1 to 22 years, with a mean of 9.54 ± 4.78 years. Nearly one-third of them were not compliant with antidiabetic treatment; 44.1% were current smokers and 82% of them had never practiced physical exercise before. In the previous 3 months, glycosylated hemoglobin was ordered for only 60.8% of the studied patients. In the last year, foot and fundus examinations were carried out for nearly two-third of the studied patients (68.2 and 64.5%, respectively). Moreover, only 12.5, 26.1, and 38.5% of patients were investigated for microalbuminuria, serum creatinine, and blood lipids, respectively. Uncontrolled hyperglycemic state was diagnosed in a vast majority of cases (99.2%). Moreover, 78.6% were obese and 82% had hypertriglyceredemia. Conclusion Intermediate outcome measures – namely, poor glycemic control and high prevalence of obesity and hypercholesterolemia – denote suboptimal medical care and/or poor compliance of patients with self-care management practices. In order to improve quality of care of type 2 diabetes aiming at reducing the incidence of complications, improving outcome, and improving the quality of life of patients, multilevel intervention plan should be carried out.
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Study of the C-reactive protein and tumor necrosis factor-α levels in the elderly before and after resistance exercise training
Noha M El-Sabbagh, Enas M Shahin, Nany H Abo El Makarem, Rania S Swelem, Shaymaa AIM AbdElMoneim
January-April 2015, 1(1):7-13
DOI:10.4103/2356-8062.159984  
Introduction Aging results in chronic low-grade inflammation that is associated with an increased risk for disease, poor physical functioning, and mortality. The biomarkers that are mostly related to inflammation such as tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) are created to stimulate and activate the immune system in response to inflammation. Strategies that reduce age-related inflammation may improve the quality of life in older adults. The benefits of regular exercise for the elderly are well established, whereas less is known on the impact of low-intensity resistance exercise on this chronic low-grade inflammation in the elderly. Aim of the study To study the level of TNF-α and CRP before and after programmed resistance exercise in Egyptian elderly individuals. Patients and methods Thirty healthy elderly individuals aged 60 years or older, of both sexes, participated in 4 weeks of resistance exercise training (RET). Circulating levels of TNF-α and CRP were measured before and after the exercise training. Results This study found that both inflammatory markers, TNF-α and CRP, were statistically significantly decreased (P = 0.036, 0.009), respectively, in comparison with the previous starting level measured before the exercise in the same individuals. Conclusion There was a negative correlation between TNF-α and CRP levels and the RET, which indicated that RET represents a low-cost strategy that may reduce age-related inflammation and may thus improve the quality of life in older adults.
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Serum sclerostin levels in type 2 diabetes mellitus patients: possible correlations with bone metabolism parameters and thrombocytosis
Manal Ali Abdel Khalek, Amal Mohamad El-Barbary, Alyaa Ahmed Elsherbeny, Emad Abdel Mohsen Abdel Hadi, Mona Gameel Balata, Manal Shawky Hussein, Rasha Ahmad Gaber, Sonya Ahmed El-Gaaly
January-April 2015, 1(1):21-27
DOI:10.4103/2356-8062.159989  
Introduction Type 2 diabetes mellitus (T2DM) is a group of pandemic debilitating metabolic diseases featuring chronic hyperglycemia that results from defective insulin secretion and/or insulin actions. Dame and Sutor reported that diabetic patients are prone to thrombocytosis through a complex interplay of mechanisms. Therefore, the aim of our work is to evaluate serum sclerostin levels in patients with T2DM and to analyze the relationships among sclerostin, bone mineral density (BMD), bone metabolism, and thrombocytosis. Objective This study aimed to evaluate serum sclerostin in T2DM and its correlations with bone metabolism and thrombocytosis. Patients and methods Fifty male T2DM patients were enrolled; they were divided into two groups according to existing thrombocytosis. Forty age-matched men were included as controls. Clinical tests of physical mobility, fasting blood glucose, glycated hemoglobin, calcium, creatinine, parathormone (PTH), 25-hydroxyvitamin D, bone-specific alkaline phosphatase (BALP), serum carboxy-terminal cross-linked telopeptide of type I collagen (sCTX-I), serum sclerostin, and BMD were performed. Results There were insignificant increases in BMD in diabetic patients versus controls. There were significantly lower levels of PTH, BALP, and sCTX-I in the diabetes mellitus (DM) patient groups compared with the controls (P < 0.001). Serum sclerostin levels were significantly higher in DM patients than the controls, with insignificantly higher sclerostin levels in group II. Serum sclerostin was correlated positively with disease duration and correlated negatively with PTH, BALP, and sCTX-I (P < 0.001). Conclusion Sclerostin plays a role in the pathogenesis of bone changes in T2DM. The interplay between vitamin D, PTH, and blood glucose highlights the possibility of an existing endocrine axis. Finally, the role of osteocytes in regulating hematopoiesis and association with DM and osteoporosis should be investigated further.
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Fibroblast growth factor-21 is a novel linkage between metabolic parameters, cardiovascular risk, and nephropathy in prediabetes
Sahar H Elhini, Ragaa A Matta, Mahmood Saad, Hanan Mostafa, Ahmed AbedelfadeeL
January-April 2017, 3(1):22-31
DOI:10.4103/ejode.ejode_30_16  
Introduction Fibroblast growth factor-21 (FGF21) regulates glucose and lipid metabolism and protects against atherosclerosis. Serum FGF21 levels were assessed in newly diagnosed, drug-naive patients with prediabetes (group 1, n=60) and diabetes mellitus type 2 (group 2, n=60), in addition to 40 healthy individuals (group 3, n=40). Results Serum FGF21 levels were significantly increased in groups 1 and 2 compared with group 3 (231.7±59.3 and 260.4±82.5 vs. 22.6±5.31 pg/dl, respectively; P<0.001 for both). Moreover, group 2 had statistically significantly higher FGF21 levels compared with group 1 (P=0.03). Receiver operating characteristic curve analysis identified FGF21 cutoff value of greater than 204 and 30 pg/ml for the diagnosis of diabetes mellitus type 2 and prediabetes, with an area under the curve 0.72 and 1, sensitivity of 82.5 and 100%, and specificity of 60 and 100%, respectively. Using univariate analysis, FGF21 was positively correlated with blood pressure, obesity (BMI and waist–hip ratio), glycemic (glucose and glycosylated hemoglobin) and insulin resistance (fasting insulin and homeostasis model assessment-insulin resistance) parameters, atherogenic lipid profile, liver enzymes, and cardiovascular disease risk score in group 1 and group 2. FGF21 correlated with albumin–creatinine ratio negatively in group 1 and positively in group 2. Independent predictors of FGF21 level were fasting glucose, insulin, and triglyceride in both patient groups. The independent predictors of FGF21 were obesity parameters in group 1 and albumin–creatinine ratio, age, and systolic blood pressure in group 2. Conclusion Among prediabetic patients, FGF21 is an excellent predictor and a novel linkage between metabolic parameters, circulatory system, and nephropathy.
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Study of advanced glycation endproducts and their receptors in Egyptian type 2 diabetic individuals with peripheral neuropathy
Alaa M Wafa, Mamdoh R EL-Nahas, Azza A Al Biaumy, Yara M Mansour
January-April 2017, 3(1):15-21
DOI:10.4103/2356-8062.205209  
Context Diabetic neuropathy is one of the commonest long-term complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy in developed world. Aim The aim of our work was to measure advanced glycation endproducts (AGEs) and their receptors (RAGEs) in diabetic peripheral neuropathy (DPN), both painful and painless DPN. Patients and methods Our study was conducted on 50 type 2 diabetes mellitus patients with peripheral neuropathy, divided into two subgroups: the first group included 25 patients with painful DPN and the second group included 25 patients with painless DPN. Moreover, a third group included 20 diabetic patients without peripheral neuropathy, and a fourth group that included 20 healthy participants. All groups were subjected to full history taking and clinical examination, anthropometric parameters, the calculation of neuropathy disability score, and nerve conduction studies (peroneal, sural, and tibial nerves). Laboratory investigations included serum AGEs and RAGEs. Results Our study demonstrated that hemoglobin A1c, AGE, and RAGE showed statistically significant difference between the studied groups. Hemoglobin A1c was significantly high in both neuropathic and diabetic groups in comparison with control. Regarding AGE, it was statistically higher in neuropathic group than in control (P<0.011). On the contrary, RAGE was significantly higher in both neuropathic and diabetic groups rather than control (P<0.02). Although the neuropathic group has higher levels of AGE and RAGE than diabetic group, the difference was statistically nonsignificant. Significant difference was found between studied groups regarding nerve conduction studies of sural and tibial nerves. Statistically significant difference was found in the parameters of nerve conduction studies between neuropathic group and both non-neuropathic diabetic and control groups. Conclusion Our study concluded that AGE and RAGE are significantly higher in diabetic patients with neuropathy versus control, with more elevation in neuropathic group than in diabetic without neuropathy.
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Serum total osteocalcin level as a vascular marker in elderly patients with metabolic syndrome
Marwa A Saad, Nany H Al-Gaiar, Marwa H Mahmood, Amr M Al-Abd
September-December 2015, 1(3):109-114
DOI:10.4103/2356-8062.178290  
Metabolic syndrome (MetS) is a major public health problem and a clinical challenge worldwide. Several epidemiological studies have confirmed the increased risk for cardiovascular diseases (CVD) in individuals with MetS. Total osteocalcin (TOC) is a bone-derived, noncollagenous protein that was recently recognized as a hormone-regulating energy metabolism factor. Importantly, osteocalcin expression has been described as having a role in calcifying vascular smooth muscle cells. We aimed in the present study to analyze the correlation between serum levels of TOC and vascular calcification in elderly persons with MetS. Seventy-four elderly men aged 65 years or older were included in the present study and divided into two groups. Group I comprised 40 patients who satisfied at least three criteria for MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) definition, and group II comprised 34 age-matched healthy men who served as the control group. BMI was calculated, blood samples were taken for lipid profile analysis, and total osteocalcin (OCN) levels were evaluated using enzyme-linked immunosorbent assay kits. Carotid Doppler B mode ultrasonography was performed for all participants. Patients with MetS exhibited significantly higher BMIs, waist circumference, fasting blood sugar, triglycerides, blood pressure, total cholesterol, and lower high-density lipoprotein-cholesterol compared with controls. Patients with MetS had significantly lower levels of TOC compared with controls. Also, patients with MetS had significantly higher intima-media thickness and a higher number of carotid plaques compared with controls. TOC was significantly negatively correlated with parameters of carotid atherosclerosis. It is also negatively correlated with dyslipidemic parameters. Its correlation with components of MetS did not reach statistical significance. We concluded that serum osteocalcin levels were negatively correlated with carotid atherosclerosis in patients with MetS. This may reflect the role of osteocalcin as a circulating endocrine factor that regulates glucose metabolism and thereby cardiovascular risk in patients with MetS. Prospective studies are needed to assess the time course and relevance of serum osteocalcin in the development of atherosclerosis in patients with MetS.
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Study of copeptin and brain natriuretic peptide in patients with thyroid dysfunction: relation to cardiovascular performance
Samir Naim Assaad, Mohamed Kamal Ghitany, Salah Ahmed Marzouk, Mohamed Ibrahim Lotfy, Ahmed Kamal Swidan, Hanaa Tarek El-Zawawy
May-August 2015, 1(2):65-71
DOI:10.4103/2356-8062.170200  
Background Thyroid disorders are the second most common endocrine disorders after type 2 diabetes mellitus. Copeptin, the C-terminal part of pre-pro arginine vasopressin, and brain natriuretic peptide (BNP) are new markers of cardiac and endothelial diseases. The relationship between thyroid status and copeptin has not been studied yet. Serum BNP levels are also affected by thyroid function status; however, its value in the presence of thyroid dysfunction has been recently questioned. Aim of the work The aim of this work was to assess the alteration of serum copeptin and BNP in patients with thyroid dysfunction and the relationship between this alteration and cardiovascular performance in patients with thyroid dysfunction. Materials and methods This study included 60 patients who were divided into two groups: group 1 included 30 patients with hyperthyroidism and group 2 included 30 patients with primary hypothyroidism. A total of 20 healthy euthyroid individuals served as the control group (group 3). All patients and controls were subjected to estimation of serum and urine osmolarity and electrolyte study and evaluation of T3, T4, thyroid-stimulating hormone, serum copeptin, and serum BNP using enzyme-linked immunosorbent assay. Echocardiographic study was conducted to assess left ventricle (LV) systolic and diastolic functions. In addition, endothelial function was assessed by measuring flow-mediated dilatation of the brachial artery. Results In patients with hyperthyroidism, serum copeptin was significantly lower than that in controls (mean = 2.24 ± 1.68 vs. 3.34 ± 2.93 pmol/l, P = 0.03). However, it was significantly higher in hypothyroid patients in comparison with controls (mean = 18.78 ± 11.29 vs. 3.34 ± 2.93 pmol/l, P = 0.0001). Serum BNP in the hypothyroid group was significantly higher than that in the control group (mean = 15.02 ± 6.9 vs. 3.60 ± 1.38 ng/l, P = 0.028). E′/ A′ was significantly lower in hypothyroid patients in comparison with the control group (mean = 1.15 ± 0.72 vs. 1.48 ± 0.48, P = 0.03), and more than half of the patients (53%) had E′/ A′ less than 1, suggesting the presence of diastolic dysfunction in hypothyroid patients. There was a significant negative correlation between ejection fraction (P = 0.002), fractional shortening (P = 0.01), and copeptin in the hypothyroid group. There was a significant positive correlation between copeptin and flow-mediated dilatation (P = 0.01) in the hyperthyroid group. Conclusion Serum copeptin and BNP were significantly increased in hypothyroid patients, whereas serum copeptin was significantly decreased in hyperthyroid patients. In hyperthyroid patients, LV systolic function was increased. More than half of the hypothyroid patients with high serum copeptin levels had impaired LV filling.
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The prognostic value of serum 25-hydroxyvitamin D level in patients with ST-segment elevation myocardial infarction
Hegazy S Mohammed, Hisham M El-Ashmawy, El-Sawy M Mohamed, Alkomy Mostafa
January-April 2015, 1(1):49-52
DOI:10.4103/2356-8062.159996  
Background Low serum level of vitamin D has been shown to be associated with cardiovascular diseases as well as the presence of diabetes, dyslipidemia, and hypertension. Vitamin D deficiency is prevalent in Egypt as well as worldwide. We aimed to assess vitamin D status in patients with acute ST-segment elevation myocardial infarction (STEMI) and its correlation with hospital length of stay, in-hospital complication, in-hospital mortality, and 6-month mortality. Patients and methods In a prospective study, 53 patients with acute STEMI were included. The patients' 25-hydroxyvitamin D levels (ng/ml) were determined and the associations with clinical characteristics, laboratory data, in-hospital outcomes, and 6-month mortality were investigated. The study also included 20 healthy adult volunteers. Results Almost 70% of the patients in the STEMI group were vitamin D deficient (<30 ng/ml). Patients with a history of hypertension had significantly lower vitamin D levels (P < 0.001). Moreover, there was a significant positive relationship between hospital length of stay and levels of vitamin D (P < 0.003). Also, hospital length of stay was significantly shorter in patients who had undergone a primary percutaneous intervention (P < 0.008). Conclusion Vitamin D deficiency is highly prevalent in patients with acute STEMI. Vitamin D deficiency is highly prevalent in patients with a history of hypertension. Vitamin D deficiency is associated with longer length of hospital stay.
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Study of possible relation between maternal serum resistin and insulin resistance in patients with preeclampsia
Manal Mohsen, Eman A Algohary, Saefya H Hassan, Alyaa A El-Sherbeny, Emad A Abd El-Hadi, Abdel Latif G El-Kholy
May-August 2015, 1(2):77-83
DOI:10.4103/2356-8062.170205  
Introduction In humans, resistin antagonizes the effects of insulin on glucose metabolism in the liver and skeletal muscle, interacts with and reinforces inflammatory pathways, and may promote endothelial cell activation. Increased resistin levels have been associated with obesity, insulin resistance, metabolic syndrome, type 2 diabetes, and increased cardiovascular risk. Objectives Our study aimed to investigate the utility of maternal serum resistin in women with preeclampsia compared with normal pregnant women and its relation to insulin resistance. Patients and methods This study was carried out on 90 women who were divided into two groups: group I: preeclampsia (n = 60) and group II: healthy pregnant controls (n = 30). All individuals were subjected to the following after an informed oral and written consent was obtained: full assessment of history, clinical examination with a special focus on edema, blood pressure measurement, and maternal BMI [weight (kg)/height 2 (m 2 )]. Gestational age was determined according to the date of the last menstrual period and confirmed by first-trimester ultrasound. Laboratory investigations including complete blood count, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, homeostasis model assessment-insulin resistance (HOMA-IR), and serum resistin were performed. Results Statistical comparison between preeclamptic patients (group I) and the healthy control group (group II) in terms of the different parameters studied showed a highly statistically significant increase in the patient group compared with the control group in systolic blood pressure, diastolic blood pressure, BMI, creatinine (CRE), aspartate aminotransferase, alanine aminotransferase, 50 g oral glucose challenge test, fasting blood glucose, fasting insulin, HOMA-IR, and resistin. In contrast, there was a highly statistically significant decrease in the patient group than the control group in haemoglobin (HB). Conclusion In this study, it was found that elevated serum resistin levels could be associated with exaggerated insulin resistance in patients with preeclampsia. Further studies are needed to clarify the role of resistin in the pathophysiology of preeclampsia and insulin resistance.
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Clinical significance of serum adipokine visfatin/eNampt in relation to prostate cancer detection and aggressiveness
Salwa H Gomaa, Tamer M Abou Youssif, Mostafa Elmissery, Saba Elgendy
January-April 2015, 1(1):36-42
DOI:10.4103/2356-8062.159992  
Background Prostate cancer is a common malignancy ranked as the second most common cause of cancer and the fifth cause of cancer-related mortality worldwide. The association between obesity and prostate cancer remains poorly understood, but evidence suggests that obesity may adversely affect the risk of developing high-grade disease. Adipokines may contribute toward the molecular basis for a link between obesity and prostate cancer. Several studies have shown the role of visfatin in different cancers including astrocytomas, myeloma, and male oral squamous cell; gastric, endometrial, hepatocellular, and colorectal carcinomas; and invasive breast cancer. Objective In the present study, we attempted to investigate whether a high serum level of visfatin is a good biomarker associated with prostate cancer, especially high-grade cancer, and in obese patients; then, it could be used as a biomarker for the detection of prostate cancer and to determine its aggressiveness. Participants and method The present study included 89 individuals divided as follows: 15 age-matched volunteers, control group (group I), 36 patients diagnosed with benign prostatic hyperplasia (BPH group) (group II), and 38 patients diagnosed with prostate cancer (PC group) (group III). Results There was a statistically significant increase in serum visfatin level in PC patients (group III) compared with both the controls (group I) and patients with BPH (group II) (P < 0.001, P < 0.001, respectively). In PC patients, the median value of serum visfatin was 55.36 ng/ml (44.32-94.02), whereas it was 12.06 ng/ml (10.36-17.74) in the BPH group and 14.89 ng/ml (10.68-18.62) in the control group. BMI, visfatin, and prostatic-specific antigen were found to be the major significant determinants of the tumor grade (Gleason score) of PC (with a 95% confidence interval 0.096-0.233, P < 0.001; 0.083-0.016, P = 0.005; and 0.001-0.019, P = 0.033, respectively). Conclusion In this study, we found a significant positive association between serum visfatin and PC, especially in obese individuals, and we suggest that visfatin could be used as a new promising biomarker for PC; further investigations are warranted to confirm its role in the diagnosis of PC and to assess its aggressiveness.
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Assessment of the association of the adiponectin gene single-nucleotide polymorphism 45T/G with type 2 diabetes mellitus in Egyptian diabetic patients
Said A Ooda, Mervat F El-Belbesy, Nargues M Hassanein, Ola H Elgaddar, Hassan M Bachlah
January-April 2016, 2(1):23-30
DOI:10.4103/2356-8062.184402  
Background Type 2 diabetes mellitus (T2DM) is a common multifactorial genetic disease. Adiponectin is a hormone produced solely by adipocytes and is a regulator of glucose and energy homeostasis. A number of genes and polymorphisms have been reproducibly associated with T2DM in a variety of studies. The gene ADIPOQ, encoding adiponectin, was found to be the main locus contributing to variations in adiponectin serum levels. Objective The aim of the work was to investigate the association between single-nucleotide polymorphism in exon 2 (45T/G) of the adiponectin gene with serum adiponectin level, and the occurrence of T2DM, which could allow proper management and genetic counseling for the high-risk carrier. Patients and methods The study included 40 patients with T2DM and 40 normal individuals with no family history of diabetes mellitus. BMI, serum fasting and postprandial glucose, lipid profile, fasting insulin, and adiponectin were measured. Molecular study for adiponectin 45T/G gene polymorphism was carried out. Results There was no statistically significant difference found when either genotype or allele frequencies were compared between the two groups. Conclusion Single-nucleotide polymorphism 45T/G of adiponectin gene was not associated with T2DM.
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