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   2016| September-December  | Volume 2 | Issue 3  
    Online since February 27, 2017

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High-normal thyroid stimulating hormone is a predictor of metabolic syndrome among young polycystic ovary syndrome women
Ahmed Saad-Aldeen Salama, Ragaa Abed-Elshaheed Matta, Sahar H Elhini, Lamia Hamdi, Laila Adel, Hany Hassan
September-December 2016, 2(3):146-155
Background and objectives High-normal thyroid stimulating hormone (TSH) (2.6–4.5 μIU/ml) is associated with metabolic syndrome (MetS) in population studies. We hypothesized that euthyriod polycystic ovary syndrome (PCOS) with TSH of higher than 2.5 had altered anthropometric, metabolic, and endocrine parameters as well as higher percentage of MetS compared with those with lower TSH levels. Patients and methods The present study included 60 young euthyroid PCOS women without any thyroid risk factors and 60 age-matched and BMI-matched healthy, fertile women. Anthropometric measurements were obtained, biochemical and hormonal assay were evaluated, and the homeostatic model assessment-insulin resistance was calculated. PCOS women were divided into high-normal TSH (group 1) and low-normal TSH (group 2) groups. MetS was defined according to National Cholesterol Education Program/Adult Treatment Panel III. Results Group 1 had significantly higher waist circumference, systolic blood pressure and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting glucose, fasting insulin, homeostatic model assessment-insulin resistance, and free androgenic index and significantly lower high-density lipoprotein cholesterol, free thyroxin, and sex hormone binding globulin compared with both group 2 and healthy controls. In addition, group 1 (compared with group 2) had significantly higher percentage and higher risk of MetS [46.7 vs. 16.7%, P=0.01; odds ratio (OR)=4.4] and some of its components such as fasting glucose of at least 100 mg/dl (26.7 vs. 6.7%, P=0.03; OR=4.3), high-density lipoprotein cholesterol of less than 50 mg/dl (50 vs. 23.3%, P=0.03; OR=3.3), TG of at least 150 mg/dl (50 vs. 20%, P=0.01; OR=4), and near-significant higher percentage of both waist circumference of 88 cm or more and systolic blood pressure of at least 130 (P=0.06 for both, OR=3.25, 5, respectively). TSH level of 2.85 was the best threshold to indicate MetS risk (sensitivity=68%, specificity=88%, Youden index=0.56, area under the curve=0.81). Conclusion High-normal TSH PCOS women had increased risk of MetS. The optimal cut-off point for diagnosis of MetS was 2.85 µIU/ml.
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Iron metabolism in type 1 diabetes: relation to insulin resistance
Iman Z Ahmed, Yara M Eid, Rasha A El-Gamal
September-December 2016, 2(3):139-145
Background An evidence-based association was established between iron metabolism and insulin-resistant (IR) conditions, among which was type 2 diabetes. Previous studies have reported elevated hepcidin and ferritin levels in type 2 diabetics. Aim The aim of this study was to investigate the possible relationship between hepcidin or ferritin and the development of IR in type 1 diabetes mellitus (T1DM). Methodology The study included 60 male participants who were categorized as follows: 20 patients having T1DM with IR (group 1), 20 patients having TIDM without IR (group 2), and 20 age-matched and BMI-matched healthy individuals. IR was evaluated using estimated glucose disposal rate (eGDR) and insulin (U/day). All patients were tested for fasting blood sugar, postprandial blood sugar, hemoglobin A1c, lipid profile, high-sensitivity C-reactive protein, C-peptide, ferritin, and hepcidin. Results Serum hepcidin showed a nonsignificant difference between groups 1 and 2, and was not correlated to any IR-related variables. Serum ferritin was significantly higher in group 1, positively correlated to BMI, waist circumference, insulin (U/kg/day), and negatively correlated to eGDR. Out of all the significantly correlated variables, the hemoglobin A1c and waist/hip ratio were able to predict eGDR using the multivariate analysis. Conclusion Hepcidin plays no role in T1DM IR patients. Although ferritin was higher in T1DM patients and was negatively correlated to eGDR, it failed to demonstrate an independent influence on eGDR, hindering its potential use as a predictor of IR.
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Microalbuminuria and adiponectin in obese nondiabetic nonhypertensive people
Mohamed I Atta, Nilly H Abdalla, Ahmed A Ibrahim
September-December 2016, 2(3):156-162
Introduction The prevalence of obesity has increased dramatically over the last decade. The first sign of renal injury is microalbuminuria or frank proteinuria. The prevalence of microalbuminuria was positively increased with the increasing waist-to-hip ratio in nonhypertensive individuals. Adiponectin plays a role in the suppression of metabolic derangements that may result in diabetes, obesity, and nonalcoholic fatty liver disease and an independent risk factor for metabolic syndrome. Aim The aim of the study was to evaluate the relationship between obesity, adiponectin level, and microalbuminuria in obese nondiabetic nonhypertensive individuals. Patients and methods This study included 70 individuals who were divided into two groups according to their BMI: the obese group (group I), which included 50 people with BMI at least 30 kg/m2, and the control group (group II), which included 20 lean persons with BMI from 18.5 to 24.9 kg/m2. The study excluded patients with diabetes, hypertension, and chronic kidney disease. The following laboratory investigations were carried out on all subjects: serum glucose level, kidney function tests, and serum adiponectin level. Spot urine samples were collected for complete urinanalysis and tested for microalbuminuria and albumin/creatinine ratio (ACR). Results ACR showed significant increase in the obese group than in the nonobese group, but serum adiponectin showed significantly lower level in the obese group than in the nonobese group. Within the obese group a significant positive correlation was found between ACR and BMI and waist-to-hip ratio, whereas a significant negative correlation was found between ACR and serum adiponectin. Also, within the obese group a significant negative correlation was found between serum adiponectin level and ACR and BMI. Discussion and conclusion Through this study we have confirmed the association of microalbuminuria, obesity, and serum adiponectin. Our study supports the hypothesis that obesity is associated with microalbuminuria in obese people free from diabetes, hypertension, and chronic kidney disease.
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The potential of serum copeptin as a prognostic marker of mortality in patients with sepsis, severe sepsis, or septic shock
Samir N Assaad, Mohammed M Abd El Salam, Tamer M Elsherbiny, Neveen L Mikhael, Mohammad F Farghly
September-December 2016, 2(3):131-138
Background The present study sought to investigate the correlation of copeptin with the severity of septic status and to analyze the usefulness of copeptin as a predictor of mortality in patients with sepsis, severe sepsis, and septic shock. Patients and methods This prospective observational study was conducted in Alexandria Main University Hospital. The participants were 60 patients who had sepsis, severe sepsis, and septic shock consecutively admitted to the internal medicine ward and the ICU from October 2014 to August 2015. All patients were subjected to full history taking, clinical examination, as well as routine laboratory workup including serum Na+, serum K+, and serum lactate and imaging parameters. Serum copeptin was measured on the first or second day of admission. APACHE II scores were assigned on the basis of the most pessimistic clinical and laboratory data obtained during the first 24 h following admission. Patients were followed up for 10 days after admission, and the 10-day mortality rate was calculated. In addition, 20 age-matched and sex-matched healthy participants were enrolled as controls. Results Measured serum copeptin was significantly increased in groups I, II, and III in comparison with the control group (P<0.001). The value was increasing from sepsis to severe sepsis to septic shock. When patients were followed up for early mortality within 7–10 days, we found that the measured serum copeptin was higher in nonsurvivors than in survivors but without statistically significant difference. It was concluded according to the study of receiver operating characteristic curves that APACHE II score is more sensitive and specific than the serum copeptin when used as a prognostic tool to predict mortality in patients with severe sepsis and septic shock. Conclusion Our data demonstrate that serum copeptin levels increase progressively with the severity of sepsis and may be considered an independent predictor of mortality in severe sepsis and septic shock with superiority of APACHE II scoring.
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Study of the relation between the serum level of male sex hormone and peripheral vascular disease in elderly men
Doaa M Badreldin, Mohamed A Mehanna, Nany H Elgayar, Rania S Swelem
September-December 2016, 2(3):163-166
Introduction Testosterone hormone decreases consistently with advancing age. Many studies have shown a possible relationship between decreasing level of testosterone and atherosclerosis. Objective The objective of our study was to demonstrate the relationship between male sex hormone [testosterone and sex hormone-binding globulin (SHBG)] concentration and peripheral vascular disease in elderly men. Background Few studies have explored the relationship between serum sex hormones and lower-extremity peripheral arterial disease (PAD) in men. Patients and methods Our study was conducted on 20 elderly men older than 65 years with peripheral vascular disease and 10 healthy age-matched men as controls. Lower-extremity PAD was defined as ankle brachial index less than 0.90 and diagnosis was confirmed with Doppler ultrasound. Radioimmunoassay measured serum levels of total testosterone and SHBG, and we calculated free androgen index level from the mass action equations. Results The results show that serum level of total testosterone, SHBG, and free androgen index were lower in men with peripheral vascular disease than in those without. There is a positive correlation between total testosterone, SHBG, free androgen index, and ankle brachial index. Conclusion Low serum level of total testosterone, SHBG, and free androgen index are significantly and independently associated with the presence of PAD in elderly men.
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Surrogate markers for diagnosis of vitamin D deficiency
Raef M Boutros, Rania S Abd El-Baky, Laila M Ali Hendawy, Dina A Marawan
September-December 2016, 2(3):172-176
Background/objectives Vitamin D deficiency is becoming a pandemic problem. Hypovitaminosis-D is diagnosed by measuring 25-hydroxyvitamin D in blood. In Egypt this costs 500 EGP, whereas one ampoule containing 200 000 units of vitamin D costs 5 EGP. Therefore, we need markers for vitamin D deficiency that are affordable. Materials and methods We conducted a cross-sectional study on 90 healthy patients aged 20–60 years during spring and summer. Participants underwent history taking, clinical examination, and measurements of hemoglobin, creatinine, calcium (Ca) (total and ionized), phosphorus, magnesium, parathyroid hormone (PTH), and 25-hydroxyvitamin D. Results The prevalence of vitamin D deficiency (<20 ng/ml) was 73.33%, that of insufficiency (21–30 ng/ml) was 25.56%, and that of vitamin D sufficiency (>30 ng/ml) was only 1.11% in the samples tested. PTH had a significant inverse correlation with vitamin D level (r=−0.2), whereas serum Ca (total and ionized) and phosphorus had a positive correlation. By receiver operating characteristic curve the predictive accuracy of PTH was 70%, whereas that of total Ca was 38%, ionized Ca was 43%, and phosphorous was 60.7%. Conclusion Measurements of PTH, Ca, and phosphorus can be used as markers for vitamin D deficiency; these tests cost less than 200 EGP, resulting in 60% savings in the cost of diagnosis of this widely prevalent condition.
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Study of serum adiponectin level as an atherosclerotic index in the elderly and its relationship to carotid intima–media thickness
Noha Mohammed Elsabbagh, Sekina Ismail Ahmed, Fouad Serag Eldin Mohammed, Noha Said Kandil, Hoda Abdelaziz Hassan
September-December 2016, 2(3):167-171
Background It is well known that aging is associated with several hormonal alterations. However, the consequence of aging on the endocrine function of adipose tissue is not fully elucidated. Adiponectin is a new anti-inflammatory protein secreted exclusively by adipocytes and plays a protective role against insulin resistance and atherosclerosis. Aim of the work The aim of the work was to assess serum adiponectin as a biomarker for atherosclerosis and its relation to the carotid intima–media thickness (CIMT) as a clinical surrogate marker of atherosclerosis in elderly patients. Patients and methods The study was conducted on 80 participants aged 20–85 years who were subdivided into four groups. The first group was the control group (GI), which included 20 healthy young volunteers aged 20–40 years. The other three groups each included 20 elderly participants aged above 65 years who were classified according to arterial blood pressure and serum blood glucose levels into elderly healthy (GII), elderly hypertensives (GIII), and elderly diabetics (GIV). Results The mean adiponectin level (control, 12.48±3.95; GII, 9±3.25; GIII, 8.49±2.40; and GIV, 7.16±3.23) was significantly lower in individuals with high CIMT than in those with low CIMT (GI, 0.64±0.05; GII, 0.75±0.06; GIII, 0.72±0.08; GIV, 1.03±0.15). Adiponectin level was negatively correlated with age, BMI, systolic blood pressure, diastolic blood pressure, triglyceride, low-density lipoprotein cholesterol, and blood glucose, and positively correlated with high-density lipoprotein cholesterol. Conclusion Adiponectin was significantly negatively correlated with CIMT independently of age, sex, and all metabolic risk factors. The present study found that serum adiponectin level in humans is lower in elderly individuals and in patients with diabetes mellitus and essential hypertension than in healthy participants, and is negatively affected by the duration of these diseases.
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