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   Table of Contents - Current issue
January-March 2019
Volume 31 | Issue 1
Page Nos. 1-105

Online since Wednesday, April 24, 2019

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Is neutrophil-lymphocyte ratio a novel biomarker for macrovascular and microvascular complications of type 2 diabetes? p. 1
Walaa H Mohammad, Ahmad B Ahmad, Muhammad H Al-Maghraby, Mohamed Z Abdelrhman, Sanaa Ezzate
Background/aim The neutrophil-to-lymphocyte (N/L) ratio is a biomarker of inflammation. We aimed to test the hypothesis that macrovascular and microvascular complications of type 2 diabetes mellitus (DM) involve an inflammatory process. Patients and methods This is a cross-sectional study conducted on patients with type 2 DM. Demographic and clinical examination data of eligible patients were recorded. The blood samples for laboratory variables were collected and measured by the standard methods. A standard ultrasound examination was done to measure both carotid artery intima-media thickness (cIMT), and the averages of three results of each side were recorded. Results The current study showed that N/L ratio was an independent predictor of cIMT in patients with type 2 DM (B=0.003, t=8.325, P=0.000), in addition to other conventional cardiovascular risk factors including age, male sex, smoking index, duration of diabetes, estimated glomerular filtration rate, low-density lipoprotein-cholesterol, urinary albumin creatinine ratio, and HBA1c. Moreover, N/L ratio was an independent predictor of albuminuria in patients with type 2 DM (B=0.110, t=3.638, P=0.006), in addition to duration of diabetes, HBA1c, SBP, BMI, and estimated glomerular filtration rate. Conclusion N/L ratio was an independent predictor of cIMT and albuminuria. This supports the hypothesis that diabetic macrovascular and microvascular complications involve an inflammatory process. Therefore, NLR may serve as a cost-effective and readily accessible marker of diabetic vascular complications.
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Genetic variants of two-pore calcium channel 2 rs1551305 and its association with type 2 diabetes risk p. 8
Kareem Essam
Context The prevalence of diabetes is highest in the Eastern Mediterranean Region, with Egypt leading the region (11% for both sexes) and lowest in the European Region (7% for both sexes). Genome-wide association studies of single-nucleotide polymorphisms (SNPs) have identified a number of variants that are associated with β-cell function and insulin resistance. Two-pore calcium channel 2 (TPCN2) localizes to the lysosome and is a likely receptor for the calcium-mobilizing agent nicotinic acid adenine dinucleotide phosphate. Several studies have indicated that nicotinic acid adenine dinucleotide phosphate may play a role in the insulin signaling of β-cells. Aim of the study The aim of this study was to investigate the association between TPCN2 rs1551305 SNPs and the development of type 2 diabetes. Patients and methods A sample of 158 Egyptian participants was divided into two groups. Group one included 79 type 2 diabetic patients and group two included 79 healthy controls. TPCN2 rs1551305 SNPs were determined by the real-time PCR technique. Results A significant increase in the frequency of G/G genotype in diabetic patients was found. A/A genotype was significantly more frequent in the control group (P=0.001). G allele was also significantly higher in diabetic patients (P=0.008). The G/G genotype showed a 21.37-fold increase in the risk of developing diabetes mellitus. Conclusion The previous findings suggest that TPCN2 rs1551305 SNP is associated with the risk of type 2 diabetes development.
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The influence of single-nucleotide polymorphisms of interleukin-1β −511 and +3954 on the susceptibility to Hashimoto’s thyroiditis in Egyptian women: immune-endocrine interactions p. 14
Nearmeen M Rashad, Manar H Soliman, Mayada M Mousa, Azza H Abd El-Fatah
Background Hashimoto’s thyroiditis (HT) is a T-cell-mediated autoimmune disease. Cytokines play a crucial role in modulating immune responses that affect the balance between maintenance of self-tolerance and initiation of autoimmunity. Thus, we aimed to explore the possible associations of interleukin (IL-1β) −511C/T (rs16944) and IL-1β +3954C/T (rs1143634) gene polymorphisms with susceptibility of HT, and to clarify the impact of these polymorphisms on thyroid function of Egyptian women. Patients and methods Polymorphisms of the IL-1β −511 and IL-1β +3954 genes were assessed in a case–control study comprising 110 HT patients and 90 controls. Genetic variants were genotyped by multiplex PCR. Polymorphisms of the IL-1β were studied by PCR-restriction fragment length polymorphism analysis. Results Our results revealed that the IL-1β −511 CT genotype distribution was significantly higher in HT patients than in controls. With regard to IL-1β +3954 gene polymorphisms, our results showed that there was a nonsignificant difference between the control and HT groups. Women carrying TT and CT genotype of IL-1β −511 had significantly higher values of C-reactive protein, thyroid-stimulating hormone, anti-thyroid peroxidase, and anti-thyroglobulin. As regards the IL-1β serum level, women carrying TT and TC genotype of IL-1β −511 had significantly higher values compared with patients carrying the CC genotype. Moreover, anti-thyroglobulin and free thyroxine were the only independently correlated factors with IL-1β serum level by linear regression analysis. Conclusion CT genotype distribution was significantly higher in patients with HT than in controls with regard to IL-1β −511 (C>T) gene polymorphisms.
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The impact of stevioside supplementation on glycemic control and lipid profile in patients with type 2 diabetes: a controlled clinical trial p. 22
Nearmeen M Rashad, Mona A.E Abdelsamad, Atef M Amer, Mahmoud Z Sitohy, Mayada M Mousa
Background Stevia is a naturally occurring non-nutritive sweetener that has been reported as sugar substitutes for diabetic patients. We aimed to assess the impact of stevia supplementation on glycemic control in patients with type 2 diabetes mellitus (T2DM). Also, we aimed to examine the association between stevia supplementation and anthropometric measures as well as lipid profile in both obese and diabetic patients. Patients and methods The controlled clinical trial included unrelated 150 participants; 40 patients with T2DM and 60 obese patients and 50 healthy controls. Obese patients were then subdivided into two subgroups according to their fasting blood sugar: nondiabetic (n=30) and 30 patients with T2DM. The participants received stevia (4 mg/kg/body weight) as an alternative to artificial sweetener for 24 weeks. Results Our results found that stevioside supplementation for diabetic patients’ increased the total caloric intake and decreased BMI, waist circumference, waist–hip ratio, and fat mass index, in the obese group. Our results have shown a significant increase of BMI, waist circumference, waist–hip ratio, and fat mass index after 24 weeks of stevia supplementation. In the diabetic group, stevioside for 24 weeks improved the lipid profile and glycemic control, fasting plasma glucose, 2-h plasma glucose, fasting serum insulin, homeostasis model assessment of insulin resistance and hemoglobin A1c (HbA1c), as well as total cholesterol, triglycerides, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol in all studied intervention groups. Logistic regression test revealed that among clinical and laboratory waist circumference, fasting plasma glucose and HbA1c were independent predictors of response to stevioside. Conclusion Stevioside supplementations for 24 weeks improved cardiometabolic risk in diabetic patients. However, in the obese group, stevioside supplementations increased body weight.
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Serum macrophage migration inhibitory factor levels in Hashimoto’s thyroiditis p. 31
MN Ayman Abd Elrahman, Nagwa S Said, Azza Moustafa
Background Hashimoto’s thyroiditis (HT) is the most common autoimmune thyroid disease. The actual mechanism by which the immunological factors lead to HT has remained obscure. Macrophage migration inhibitory factor (MIF) is recently recognized as a cytokine that has a broad range of inflammatory and immune effects. The aim of this study is to assess the role of MIF in the pathogenesis of HT. Patients and methods One hundred and twenty-nine patients were classified into three groups: (a) overt hypothyroidism, (b) subclinical hypothyroidism, and (c) the control group. A complete history taking, clinical examination, and laboratory investigations were done. Laboratory investigations included thyroid function tests [thyroid-stimulating hormone (TSH), triiodothyronine, and thyroxine], antithyroid antibodies (antithyroid peroxidase antibodies and thyroglobulin antibodies), and MIF level. Results There is highly statistically significant difference between the three groups regarding MIF, the highest level being in group 1>group 2>group 3. In both hypothyroid groups (1 and 2), there are statistically significant positive correlations between MIF with TSH, thyroid peroxidase antibodies, and thyroglobulin antibodies, but there is no statistically significant correlation between MIF with thyroid functions tests and antithyroid antibodies in the control group. Conclusion Serum MIF levels increased in overt and subclinical hypothyroidism and its levels were positively correlated to TSH and thyroid-specific autoantibodies. Serum MIF levels play a role in the pathogenesis of thyroid autoimmune responses in patients with HT. We recommend further larger studies to assess the MIF role in the prognosis of the HT and its treatment by a new strategy.
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Salivary versus serum testosterone levels in boys with constitutional delay of growth and puberty p. 38
Eman H El-Adawy, Enas T El-Khamisy, Ghada El-Said, Amal Seleem
Background Salivary testosterone (Sal-T) has been established as a noninvasive biomarker in the diagnosis of androgen deficiency in men. However, available data on its utility in adolescent boys with constitutional delay of growth and puberty (CDGP) are not conclusive. Our study was designed to compare salivary versus serum measurements of free testosterone (FT) from the samples collected simultaneously and correlated them with the clinical parameters in boys with CDGP. Patients and methods The study enrolled 25 adolescent boys with CDGP and 20 healthy controls matched for age and sex. Weight, height, BMI, testicular volume, bone age, serum follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were assessed. Simultaneous morning saliva and serum samples were obtained for FT measurements by radioimmunoassay and Sal-T by the enzyme-linked immunosorbent assay technique. Results Adolescent boys with CDGP had significantly lower Sal-T and serum free-T than normal controls (P<0.001). Sal-T positively correlated with BMI, bone age, testicular volume, serum FSH, LH, and FT. With multiple regression analysis BMI, FSH, LH, and serum FT remained independently correlated with Sal-T. Using the receiver operating characteristic curve, Sal-T was found to be more sensitive than serum FT (76 vs. 69%) in the clinical assessment of boys with CDGP. Conclusion Our data shows that Sal-T strongly correlates with FT and provides a sensitive, simple, noninvasive, and diagnostic approach for androgen status in adolescent boys with CDGP.
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The relationship between the level of serum-free testosterone and depression in obese adolescent men in Sharkia Governorate p. 43
MN Ayman Abd-Elrahman, Amira A Fouad, Hossam E Salah
Background Obesity among children and adolescents is considered as one of the most serious public health concerns; low levels of testosterone have been associated with higher levels of morbidity and may have been associated with depression. Objective To assess the relationship between the level of serum-free testosterone and depression in obese adolescent men in Sharkia Governorate. Patients and methods The present study was conducted on 240 age-matched healthy Egyptian adolescent men, collected from the obesity clinic, Internal Medicine Department, Zagazig University Hospital and five high schools in Sharkia Governorate; all the included participants were subjected to: (a) history taking; (b) physical examination (weight, height, BMI, waist circumference, waist to hip ratio, and Tanner stage using Prader orchidometer); (c) hormonal investigations (free testosterone, estradiol, follicular-stimulating hormone, and luteinizing hormone); (d) psychological assessment for depression using: Mini International Neuropsychiatric Interview for Children and Adolescents and children’s depression inventory. Results There was a significant inverse correlation between free testosterone levels and waist circumference among both control and obese cases (r=−0.31, P=0.031 and r=−0.30, P=0.01, respectively). The free testosterone level was significantly lower in obese cases with depression (2.81±2.32 pg/ml) in comparison with obese cases without depression (3.63±2.65 pg/ml) (P=0.04) and testosterone levels was significantly lower in obese cases having some depressive symptoms (feeling depressed, feeling restless, feeling guilty, eating disorders, sleeping disorders, feeling restless, and suicidality). There were significant inverse correlations (P<0.05) between mean free testosterone level and both mild and moderate depression (r=−0.45, P=0.02 and r=−0.58, P=0.012, respectively), and with the following depressive symptoms; feeling depressed, feeling restless, feeling guilty, eating disorder, sleeping disorders, poor concentration, and suicidality. Conclusion Obese adolescent men in Sharkia Governorate are significantly associated with lower free testosterone levels. Most of the depression symptoms and their degree are inversely correlated with the levels of free testosterone, otherwise the levels of luteinizing hormone, follicular-stimulating hormone, and estradiol showed no correlation with the depression symptoms or their degree. We recommend further larger studies to prove the relationship between the level of serum-free testosterone and depression in obese adolescent men and try to put a management protocol.
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Serum β-CrossLaps as a predictor for osteoporosis in postmenopausal women with early diabetic nephropathy p. 52
Ashraf Mohamed
Background Osteoporosis is a progressive bone disease with an increased risk of fracture. Objective To estimate bone turnover through an early marker, β-CrossLaps (β-CTx), in postmenopausal women with type 2 diabetes mellitus (DM) and early diabetic nephropathy (DN). Patients and methods A case–control study comprised 80 Egyptian postmenopausal nonsmoker women: 26 women without DM (group 1) as a control group, 28 women had type 2 DM without DN (group 2), and 26 woman were type 2 DM with early DN (group 3). All demographic and clinical data were collected. Laboratory tests including serum calcium, phosphorus, alkaline phosphatase (ALP), bone ALP, β-CTx, glycated hemoglobin, microalbuminuria, serum creatinine, and blood sugar levels were estimated. Results Regarding bone minerals, there was a significant lower serum level of calcium and phosphorus in group 3 compared with groups 1 and 2 (P=0.029 and <0.0001, respectively). Groups 2 and 3 had significantly lower serum levels of total ALP (P=0.011 and 0.006, respectively) and bone ALP (with lowest level in group 3) (P<0.0001) compared with group 1. Groups 2 and 3 had significantly higher serum levels of β-CTx (with highest level in group 3) compared with group 1 (P=0.016 and 0.003, respectively). Dual-energy X-ray absorptiometry scan revealed a significant elevation in osteoporosis percent in group 3 (63.4%) in comparison with group 1 (26.9%) (P=0.001), whereas osteopenia percent was significantly higher in group 2 (P=0.004) compared with group 3. Conclusion In diabetic postmenopausal women, serum β-CTx and microalbuminuria are potentially useful tools for assessing bone resorption state.
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Association of serum growth differentiation factor 15 and hepatocellular carcinoma in Egyptian patients p. 57
Mohamed-Naguib Wifi, Rania A Zayed, Nevine Fouad, Ahmed Y Hassan, Maha A Hussien, Mohamed G Sokar
Background Liver cirrhosis and hepatocellular carcinoma (HCC) are consequences of chronic hepatitis C virus (HCV) infection. HCC is one of the fastest rising causes of cancer-related mortality. This dismal prognosis is related to late diagnosis with currently available screening methods. The aim of our study was to evaluate the diagnostic power of serum growth differentiation factor (GDF) 15 in HCC detection and its ability to distinct HCC from cirrhosis in chronic hepatitis C Egyptian patients. Patients and methods Ninety participants were included in the study; 30 patients with HCV-cirrhosis, 30 patients with HCV-Cirrhosis and HCC, and 30 gender and age-matched healthy subjects as the control group. The patients were subjected to history taking, clinical examinations, routine laboratory analysis, and α-fetoprotein (AFP) determination. Serum GDF15 was measured using an enzyme-linked immunosorbent assay kit. Results The mean level of GDF15 in HCV-cirrhosis patients was 140.28±128.66 pg/ml, in HCV-HCC patients 154.45±123.74 pg/ml, and in the control group it was 81.19±42.53 pg/ml. Statistically significant difference in GDF15 level was found between HCV-HCC patients and controls, P=0.012, while no statistically significant difference was found on comparing HCV-cirrhosis patients to controls or to HCV-HCC patients, P=0.064 and 0.473, respectively. The cut-off value of GDF15 to discriminate HCV-HCC patients from controls was 122.3 pg/ml with 53.3% sensitivity and 86.7% specificity and an area under the receiver operating characteristic (AUROC) of 0.692. AFP at a cut-off value of 20.85 ng/l was able to discriminate HCV-HCC patients from HCV-cirrhosis patients with 73.3% sensitivity and 73.3% specificity and an AUROC of 0.744. AUROC for combined AFP and GDF15 showed lower performance than AFP alone in discrimination of HCV-HCC from HCV-cirrhosis patients (AUROC=0.642). Conclusion GDF15 is not a potential diagnostic marker for the distinction of HCC from cirrhosis in chronic hepatitis C Egyptian patients.
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The role of hepatitis C virus and possible risk factors in development of hepatocellular carcinoma: 400 patients based study p. 64
Fatema Abu-bakr Abdelmoez, Hala Mostafa Imam, Naglaa kamal Idriss, Lobna Abdel Wahid, Wael Ahmed Abbas, Mohamed Abozaid Ali Abozaid, Hossam Mahmoud Abdelwahab
Background and aims Hepatocellular carcinoma (HCC) is one of the commonest tumors and considered the fifth most common malignant neoplasm and a major cause of death. Egypt has increased incidence of HCC cases, as Egypt has the highest prevalence of hepatitis C virus (HCV) infection. The aim was to study the epidemiological characteristics of HCC in Assiut, Egypt. Patients and methods A descriptive observational study design was applied for the present study. The studied population was 400 patients with HCC (288 of them were male and 112 were female) who fulfilled the diagnostic criteria for HCC. Data were analyzed for exploring the clinical, etiological, radiological, and tumor characteristics of the studied patients. Results The mean age of the patients was 59.85±9.1 years. Most cases (68%) were from rural areas, 38% of the patients were in agricultural occupation, and 32% of the patients were accidentally discovered to have HCC .The most frequent symptom was abdominal pain (15%). HCV antibody was present in 63% of the patients, HBV infection was recorded in 28%, coinfection was seen in 3%, and no viral infection was present in 6%. Diabetes mellitus was present in 37% and obesity in 24% of the patients. Right lobe of the liver was the most frequent affected lobe (61%), and 69% of the cases had a single lesion. Conclusion HCC incidence had been increasing in the past years in Egypt. The high prevalence of HCV infection in Egypt makes the surveillance strategies important for early detection of HCC in these patients to provide better curative treatment modalities in the early stages.
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Zinc deficiency correlates to spontaneous bacterial peritonitis in patients with cirrhotic ascites p. 73
Michel A Hanna, Mohamed H.A Fouad, Ahmed M ElGhandour, Heba H Ali
Background Zinc deficiency in patients with liver cirrhosis has been frequently studied. Although spontaneous bacterial peritonitis (SBP) is one of the most serious complications of liver cirrhosis, few studies addressed the relationship between zinc deficiency and SBP. Aim This study aims to detect the effect of zinc deficiency in the development of SBP in patients with liver cirrhosis. Patients and methods The current study included 306 patients with liver cirrhosis and ascites who underwent diagnostic paracentesis for exclusion of SBP during admission to the Gastroenterology and Hepatology Unit, Ain Shams University Hospital, Egypt. Of these, 79 patients diagnosed with SBP by means of ascitic fluid polymorph nuclear leukocytic count more than or equal to 250 cells/mm3 were assigned to group 1. The remaining 227 patients with cirrhotic ascites were assigned to group 2. Routine laboratory tests, in addition to, serum zinc concentrations were assessed in all patients. Results Patients with SBP showed lower serum zinc in comparison to patients with cirrhotic ascites (49.11±11.84 vs. 79.27±9.58 μg/dl) with a statistically significant difference between the two study groups (P<0.001). Conclusion Zinc deficiency might be related to the development of SBP in patients with cirrhotic ascites.
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Measurement of liver and spleen stiffness by acoustic radiation force impulse elastography for noninvasive detection of esophageal varices in Egyptian cirrhotic patients p. 78
Ossama A Ahmed, Yasser A Elhossary, Ramy S.A Hamid, Mohamed O Khalifa
Introduction and aim Screening for esophageal varices (EVs) is recommended in patients with cirrhosis. Recent studies have focused on noninvasive prediction of EVs. The aim of the study was to evaluate the accuracy of liver stiffness (LS) and spleen stiffness (SS) measured by acoustic radiation force impulse (ARFI) elastography for noninvasive detection of EVs in Egyptian cirrhotic patients. Patients and methods In this prospective study, we performed ARFI elastography to measure LS and SS on 30 patients with cirrhosis undergoing endoscopic screening for EVs and on 15 healthy volunteers (controls). The diagnostic utility of LS and SS for identifying the presence of EVs was compared. Results Patients with EVs showed higher LS and SS values than patients without varices. The diagnostic performance of LS for the detection of varices at a cutoff value of more than 2.47 showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 73.3, 66.7, 68.7, 71.4, and 71.3%, respectively. Regarding SS, at a cutoff value of more than 3.02, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 93.3, 73.3, 77.8, 91.7, and 87.6%, respectively. Conclusion SS measured using ARFI imaging is superior to LS with excellent diagnostic performance for predicting EVs and may be used as a noninvasive screening tool for the detection of EVs.
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Recent medical graduates’ knowledge and attitude toward obstructive sleep apnea in the Southern Region of Saudi Arabia: a cross-sectional study p. 86
Nasser M Marran, Ahmed A Bahri, Khalil I Kariri, Hasan M Daghriri, Jubran M Abiri, Abdulaziz M Kariri, Jnadi M Madkhali
Introduction Obstructive sleep apnea (OSA) is one of the most common sleep disorders and up to 80% of people with OSA remain undiagnosed and yet the present data suggest that medical graduates underreport OSA and is usually not given enough attention by medical colleges. We aimed to study recent graduated medical students’ knowledge and attitude toward OSA. Patients and methods An observational cross-sectional survey conducted in Jazan, Abha, Najran, and Albaha cities among the recently graduated medical students using OSA knowledge and attitude questionnaire containing 27 questions including sociodemographic, knowledge, and attitude. Results A total of 180 questionnaires were completed; the mean total knowledge score was 8.46±3.260, and the median score was equal to 9. The maximum knowledge score was 15 and the minimum score was 0. There was no significant association between knowledge score and other variables. Of these, 141 participants had positive attitude and they represent 78.3% while 39 of the participants had negative attitude and they represent 21.7%. Conclusion The level of knowledge regarding diagnosis and management of OSA in the southern region of Saudi Arabia is not optimal. This study suggests that medical colleges should improve the curriculum to focus on clinical application of OSA.
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Prevalence of asymptomatic nonalcoholic fatty liver disease in nondiabetic participants: a study from South India p. 92
VCS Srinivasarao Bandaru, Jaydip R Chaudhury, Palle Lalitha, Somala N Reddy, Pradeep K Misra, Banda Balaraju, Kandadai R Mridula
Background Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease that is rapidly increasing worldwide. Aim The aim of this study was to investigate the risk factors associated with NAFLD in nondiabetics from South India. Participants and methods We recruited 345 asymptomatic participants consecutively, and the study period was between January 2014 and December 2017. All participants underwent risk factor evaluation, fasting serum lipid profile, C-reactive protein (CRP), hemoglobin A1c, liver function test, and abdominal ultrasound. Results Of 345 participants, men represented 213 (71%). The mean age of the participants was 58.4±11.1 years, with age range from 24–68 years. Prevalence of NAFLD was seen in 22%. On risk factor evaluation, 107 (31%) were hypertensive, 89 (25.7%) smoked, 52 (15%) were overweight, 110 (24.9%) were obese, and 113 (32.7%) had dyslipidemia. The mean CRP was 12.7±9.5 mg/l. High γ-glutamyl transferase levels, elevated CRP levels, obesity (45, 59.2%), high total cholesterol (49, 64.4%), low levels of high-density lipoprotein (28, 36.8%), high levels of low-density lipoprotein (27, 35.5%), and high triglycerides (31, 40.7%) were significantly associated with NALFD compared with non-NAFLD. After adjustment using multiple regression analysis, obesity (odds ratio: 3.5; 95% CI: 2.18–6.16), high total cholesterol [odds ratio: 4.9; 95% confidence interval (CI): 2.91–9.43], low high-density lipoprotein (odds ratio: 2.3; 95% CI: 1.20–4.47), high low-density lipoprotein (odds ratio: 2.9; 95% CI: 1.58–6.17), high triglycerides (odds ratio: 2.4; 95% CI: 1.33–4.60), and elevated CRP levels (odds ratio: 2.0; 95% CI: 1.21–3.39) were significantly associated with NAFLD. Conclusion Our study established obesity, CRP positivity, and dyslipidemia as independently associated with NAFLD in South Indian patients.
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Adiponectin and ghrelin: nutritional regulatory role in chronic kidney disease patients p. 99
Sahier O El-Khashab, Mervat E Behiry
Background Adiponectin and ghrelin are orexigenic hormones involved in the regulation of appetite in kidney disease patients. The aim of the study is to investigate the plasma concentration of total adiponectin and ghrelin in hemodialysis (HD) patients, kidney transplant recipients (KTRs), and chronic kidney disease (CKD) patients not yet on regular dialysis. Patients and methods 2The study included 180 patients with a mean age of 34.6±9.53 who were enrolled from the Nephrology Department of Cairo Medical School. Group 1 included 60 HD patients; group 2 included 60 KTRs. Group 3 included 60 participants with CKD not yet on dialysis. Anthropometric measures of all patients were taken. All participants were investigated for adiponectin, ghrelin, lipid profile, albumin, and hemoglobin. Adiponectin and ghrelin were correlated with variable parameters. Results One hundred and eight patients (60%) were men. Adiponectin was significantly higher in HD patients than KTRs and CKD groups (17±3.5, 10.8±5.2, and 4.7±2.3, respectively). Ghrelin was lower in KTRs compared with HD and CKD groups (2.1±0.2, 2.8±0.25, 2.8±0.3, respectively, P<0.001). Adiponectin and ghrelin were inversely correlated with BMI in all studied groups. Conclusion Adiponectin and ghrelin levels were highest in HD patients. Adiponectin was superior to ghrelin as a positive predictor of nutritional status in CKD.
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