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Effect of Life Style Modification with or Without Metformin on Monocyte
Chemoattractant Protein-1(MCP-1) Levels in Premenopausal Women with
Metabolic Syndrome
Background/Aim: MCP-1 is an inflammatory marker which can be considered one of the adipokines. MCP-1 has been studied in patients with obesity and insulin resistance with variable results. Insulin resistance and inflammation has been linked to metabolic syndrome. Our objective was to investigate the MCP-1 level in obese women with metabolic syndrome and study the effect of different strategies which modulates insulin resistance such as life style modification versus metformin on MCP-1 level. Patients &Methods: Body mass index (BMI), waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), lipid profile, Homeostasis model assessment of insulin resistance (HOMA-IR), plasma MCP-1, and C- reactive protein (CRP) were assessed in 40 obese premenopausal women. Subjects fulfilling the criteria of metabolic syndrome (20 women) were reassessed after 12 weeks of diet/exercise alone (10 women) versus diet/exercise in addition to2000 mg/day metformin (10 women). Results: Generally, plasma MCP-1 was significantly elevated in obese women compared with normal control and showed significant elevation in those with metabolic syndrome compared to obese without metabolic syndrome, MCP-1levels were significantly higher in patients with high waist circumference, insulin resistance (HOMA-IR) and high CRP . After 12 weeks of intervention, MCP-1 decreased in both groups ,but significantly lower in metformin-treated group (178.1 4.5 ﺁng/ml) than diet/exercise alone group, 7.8 ﺁng/ml) and showed significant correlation with WC, HOMA-IR and CRP. Conclusion: Plasma MCP-1 concentration is elevated in obese women with metabolic syndrome and correlated with BMI, insulin resistance and CRP. Plasma MCP-1 concentration is suppressed with metformin treatment more than life style modification alone, suggestive of the possible role of MCP-1 in insulin resistance and inflammatory state seen in obesity with metabolic syndrome and the possible anti-inflammatory effect of metformin in the management of metabolic syndrome beyond improving insulin resistance. Association of ghrelin and leptin with reproductive hormones in constitutional delay
of growth and puberty
Background: Constitutional delay of growth and puberty (CDGP) is a variation of the onset and timing of pubertal development without a defined endocrine abnormality. Recently published studies indicate that leptin and ghrelin play a role in puberty initiation and progress. They have been implicated in regulation of GnRH secretion, with ghrelin having inhibitory and leptin, facilitatory effects. We hypothesized that elevated ghrelin and reduced leptin concentrations could be implicated in altering the tempo of puberty in adolescents with CDGP. So in the current study we evaluate variations in leptin and ghrelin levels in adolescent boys with CDGP, the relationships between both hormones and reproductive hormones including LH, FSH and testosterone were also evaluated. Methods: The study enrolled 23 adolescent boys with CDGP and 20 healthy controls matched for age and sex. Weight, height, BMI, testicular volume, bone age, bone age delay, serum FSH, LH, testosterone, leptin and ghrelin were assessed. Results: Adolescent boys with CDGP had significantly lower leptin and higher ghrelin than normal controls. Leptin was positively correlated with BMI, bone age, testicular volume, FSH, LH and testosterone and negatively correlated with delayed bone age and ghrelin. Ghrelin was negatively correlated with BMI, bone age, testicular volume, FSH, LH and testosterone. With multiple regression analysis BMI, FSH, LH, testosterone and ghrelin remained independently correlated with leptin while BMI, LH and testosterone remained independently correlated with ghrelin. Conclusion: Elevated serum ghrelin and decreased leptin concentrations and their associations with reproductive hormones may explain the sexual immaturity in adolescent boys with CDGP. Elevated serum neutrophil elastase is related to prehypertension and airflow
limitation in obese women
Background: Neutrophil elastase level/activity is elevated in a variety of diseases such as atherosclerosis, systolic hypertension and obstructive pulmonary disease. It is unknown whether obese individuals with prehypertension also have elevated neutrophil elastase, and if so, whether it has a deleterious effect on pulmonary function. Objectives: To determine neutrophil elastase levels in obese prehypertensive women and investigate correlations with pulmonary function tests. Methods: Thirty obese prehypertensive women were compared with 30 obese normotensive subjects and 30 healthy controls. The study groups were matched for age. Measurements: The following were determined: body mass index, waist circumference, blood pressure, lipid profile, high sensitivity C-reactive protein, serum neutrophil elastase, and pulmonary function tests including forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. Results: Serum neutrophil elastase concentration was significantly higher in both prehypertensive (405.8 111.6 ﺁ ng/ml) and normotensive (336.5 women than in control non-obese women (243.9 significantly higher in the prehypertensive than the normotensive obese women. FEV1, FVC and FEV1/FVC ratio in both prehypertensive and normotensive obese women were significantly lower than in normal controls, but there was no statistically significant difference between the prehypertensive and normotensive obese women. In prehypertensive obese women, there were significant positive correlations between neutrophil elastase and body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, high sensitivity C-reactive protein and negative correlations with high density lipoprotein cholesterol, FEV1, FVC and FEV1/FVC. Conclusion: Neutrophil elastase concentration is elevated in obese prehypertensive women along with an increase in high sensitivity C-reactive protein which may account for dyslipidemia and airflow dysfunction in the present study population Elevated Serum Polymorphonuclear elastase is related to prehypertension and
airflow limitation in obese women
Background: Elevation of neutrophil elastase (NE) levels/activity has been demonstrated in a variety of diseases such as atherosclerosis, systolic hypertension and airway obstructive pulmonary diseases. It is unknown whether obese individuals with prehypertension also have elevated NE and if so it will have a deleterious effect on pulmonary function. Objectives: To investigate serum polymorphonuclear elastase level in obese prehypertensive women and correlate that level with pulmonary function tests. Patients&Methods: Thirty obese prehypertensive women were compared with 30 obese normotensive and 30 healthy controls. The 3 studied groups were matched for age. Measurements: Body mass index (BMI), waist circumference (WC), blood pressure, lipids profile, high sensitivity C- reactive protein (hs-CRP), serum polymorphonuclear elastase (PMNE), and pulmonary function tests including forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio were assessed. Results: Serum PMNE concentration was significantly elevated in both prehypertensive (405.8 111.6 ﺁ ng/ml) and normotensive obese women (336.5 23.9 ﺁ ng/ml), there was significant elevation of PMNE in prehypertensive than normotensive obese women. FEV1, FVC and FEV1/FVC ratio in both prehypertensive and normotensive obese women were significantly reduced in comparison to normal control, no statistically significant difference between prehypertensive and normotensive obese women. In obese prehypertensive women, there were significant positive correlations between PMNE and BMI, WC, systolic blood pressure, diastolic blood pressure, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c), hs-CRP and negatively correlated with high density lipoprotein cholesterol (HDL-c), FEV1, FVC and FEV1/FVC. Conclusion: Serum PMNE concentration is elevated in obese prehypertensive women and its level is correlated with inflammatory markers (CRP), dyslipidemia and air flow dysfunction. So it can be used as an early marker for the development of prehypertension and predict the possible occurrence of lung function impairment in obese women. Therefore inhibitors of serum NE may be of benefit in those patients. Effect of life style modification with or without metformin on Monocyte
chemoattractant protein-1(MCP-1) levels in premenopausal women with metabolic
syndrome
Background: MCP-1 is an inflammatory marker which can be considered one of the adipokines. MCP-1 has been studied in patients with obesity and insulin resistance with variable results. Insulin resistance and inflammation has been linked to metabolic syndrome. Our objective was to investigate the MCP-1 level in obese women with metabolic syndrome and study the effect of different strategies which modulates insulin resistance such as life style modification versus metformin on MCP-1 level. Methods: Body mass index (BMI), waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), lipid profile, Homeostasis model assessment of insulin resistance (HOMA-IR), plasma MCP-1, and C- reactive protein (CRP) were assessed in 40 obese premenopausal women. Subjects fulfilling the criteria of metabolic syndrome (20 women) were reassessed after 12 weeks of diet/exercise alone (10 women) versus diet/exercise in addition to2000 mg/day metformin (10 women). Results: Generally, plasma MCP-1 was significantly elevated in obese women compared with normal control and showed significant elevation in those with metabolic syndrome compared to obese without metabolic syndrome, MCP-1levels were significantly higher in patients with high waist circumference, insulin resistance (HOMA-IR) and high CRP . After 12 weeks of intervention, MCP-1 decreased in both groups ,but significantly lower in metformin-treated group (178.112.8±ﺁ vs.128.5 7.8 ﺁng/ml) and showed significant correlation with WC, HOMA-IR and CRP. Conclusion: Plasma MCP-1 concentration is elevated in obese women with metabolic syndrome and correlated with BMI, insulin resistance and CRP. Plasma MCP-1 concentration is suppressed with metformin treatment more than life style modification alone, suggestive of the possible role of MCP-1 in insulin resistance and inflammatory state seen in obesity with metabolic syndrome and the possible anti-inflammatory effect of metformin in the management of metabolic syndrome beyond improving insulin resistance. The high prevalence of Listeria monocytogenes peritonitis in cirrhotic patients of an
Egyptian Medical Center
Background: Spontaneous bacterial peritonitis (SBP) is a potentially lethal complication of cirrhosis. It is probably the most characteristic infectious complication of cirrhosis. Aim: The aim of this study was to evaluate the bacterial and fungal causes of SBP in Egyptian population. Furthermore to predict the occurrence of rare pathogen like Listeria monocytogenes in those patients. Materials and methods: The study included 100 patients with end stage liver disease associated with ascites. Patients were suspected to have SBP. The ascitic fluids were subjected to full cytological and microbiological study. Results: The peritoneal fluid cytological study revealed that 50 samples had cell counts >250 cells/mm3. 37 samples had growth and 13 samples had no growth (CNNA). The distribution of isolated pathogens was Gram positive cocci 48.8% followed by L. monocytogenes 24.4%, Gram negative bacilli 12.2% and Mycobacterium tuberculosis 7.3. The cells counts associated with listeria culture were 475 cells/mm3 with sensitivity 70% and specificity 68%. Conclusion: The study highlights the prevalence of microorganisms in Egyptian patients with liver cirrhosis associated with ascites. It reflects the occurrence of L. monocytogenes as an important pathogen of such clinical situation. Other rare pathogens like M. tuberculosis are not uncommon in those patients. Relationship between IGF-1 and cortisol/ DHEA-S ratio in adult men with diabetic
metabolic syndrome versus non-diabetic metabolic syndrome
Background: Metabolic syndrome (MS) is a strong risk factor for cardiovascular disease and type 2 diabetes mellitus. Previous studies have suggested that low insulin like growth factor-1 (IGF-I), low dehydroepiandrosterone sulfate (DHEA-S) and high cortisol are significant correlates of MS. The aim of the present study was to examine the relationships between serum IGF-1, cortisol, DHEA-S and cortisol/ DHEA-S ratio in adult men with MS either diabetic or non-diabetic. Methods: One hundred adult men were enrolled in this study, divided into three groups; group 1 included 30 patients with diabetic MS, group 2 included 30 patients with non-diabetic MS and group 3 included 40 age and sex-matched controls. Anthropometric measurements, Homeostasis model assessment of insulin resistance (HOMA), lipid profile, IGF-1, cortisol, DHEA-S and cortisol/ DHEA-S ratio were assessed. Results: IGF-1 and DHEA-S levels were significantly lower while serum cortisol and cortisol/ DHEA-S ratio were higher in both diabetic MS and non-diabetic MS adult men than healthy controls; they were also significantly different in the diabetic than in non-diabetic adult men with MS. IGF-1 was significantly and independently correlated with waist circumference, blood pressure, fasting blood glucose, HOMA, cortisol, DHEA-S and cortisol/ DHEA-S ratio. Cortisol/ DHEA-S ratio was significantly and independently correlated with blood pressure, fasting blood glucose, insulin, HOMA, triglyceride, high density lipoprotein cholesterol, cortisol and DHEA-S. Conclusion: IGF-1 concentration is reduced and cortisol/ DHEA-S ratio is increased along with insulin resistance in adult men with diabetic MS. IR may be responsible fore multiple multihormonal dysregulation in MS. Key words: Metabolic syndrome, IGF-1, cortisol/ DHEA-S ratio. Helicobacter pylori infection might be responsible for the interconnection between
type 1 diabetes and autoimmune thyroiditis
Background: Higher serological prevalence rates of helicobacter pylori (H. pylori) infection have been reported in patients with type 1 diabetes (T1DM) and autoimmune thyroiditis (AT). Patients with T1DM are at increased risk for developing other autoimmune diseases, most commonly AT. It is unknown whether H. pylori infection could explain the high prevalence of thyroid autoantibodies and AT in T1DM. The aim of the current study was to evaluate anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) autoantibodies in correlation with anti-H. pylori IgG and IgA in young patients with T1DM. Methods: Anti-H. Pylori IgG, IgA, anti–Tg and anti-TPO antibodies titers were measured in 162 euthyroid patients with T1DM and 80 healthy controls matched for age, sex and socioeconomic status. Results: Seroprevalence of H. pylori was significantly higher in patients with T1DM than in healthy controls; 79 % vs. 51.2%, p < 0.001. Anti H. pylori IgG was positive in 61.1% of patients with T1DM and 30% of controls, p < 0.001, anti H. pylori IgA was positive in 74% of patients with T1DM and 32.5% of controls, p < 0.001. Thyroid autoimmunity was also significantly higher in patients with T1DM than in controls; 56.7% vs. 6.2%, p < 0.001. Anti-TPO was positive in 25.3% of patients with T1DM and 3.7% of controls, p < 0.001, anti-Tg was positive in 47.5% of patients with T1DM and 6.2% of controls, p < 0.001. With simple and multiple regression analysis anti-H. pylori IgG and IgA titers were positively and significantly correlated with Anti-TPO and anti-Tg in patients with T1DM. Conclusion: our results support the idea of a connection between H. pylori infection and the occurrence of anti-TPO, anti-Tg autoantibodies and AT in young patients with T1DM. So, H. pylori infection could be considered as an environmental trigger for development of AT in T1DM. Young patients with T1DM should be screened for H. pylori infection. Keywords: Helicobacter pylori, type1 diabetes mellitus, autoimmune thyroiditis The high prevalence of Listeria monocytogenes peritonitis in cirrhotic patients of an
Egyptian medical center
Background: Spontaneous bacterial peritonitis (SBP) is a potentially lethal complication of cirrhosis. It is probably the most characteristic infectious complication of cirrhosis. The aim of this study was to evaluate the bacterial and fungal causes of SBP in Egyptian population. Furthermore to predict the occurrence of rare pathogen like Listeria monocytogenes in those patients. Methods: The study included 100 patients with end stage liver disease associated with ascites. Patients were suspected to have SBP. The ascitic fluids were subjected to full cytological and microbiological study. Results: The peritoneal fluid cytological study revealed that 50 samples had cell counts >250 cells/mm3. Thirty seven samples had growth and 13 samples had no growth (CNNA). The distribution of isolated pathogens was Gram positive cocci 48.8% followed by Listeria monocytogenes 24.4%, Gram negative bacilli 12.2% and Mycobacterium tuberculosis 7.3%. The cells counts associated with listeria culture were 475 cells/cmm3 with sensitivity 70% and specificity 68%. Conclusion: The study highlights the prevalence of microorganisms in Egyptian patients with liver cirrhosis associated with ascites. It reflects the occurrence of L. monocytogenes as an important pathogen of such clinical situation. Other rare pathogens like M. tuberculosis are not uncommon in those patients.

Source: http://www.mans.edu.eg/files/2013/staff-booklets/27101141201584.pdf