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  Citation statistics : Table of Contents
   2015| May-August  | Volume 1 | Issue 2  
    Online since November 23, 2015

 
 
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ORIGINAL ARTICLES
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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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.
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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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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.
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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.
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