Association of hyperleptinemia and insulin resistance with ischemic heart disease in type II diabetes

Insulin resistance and hyperinsulinemia often coexist with a cluster of metabolic factors including visceral obesity and referred to as the metabolic syndrome. These factors contribute to increased risk to type II diabetes and to ischemic heart disease. We investigated whether plasma leptin and insulin levels were linked with the coronary heart disease independent of the presence of diabetes mellitus. This study was conducted on 80 persons who were divided into 4 groups. Group I included 20 healthy volunteers Group II included 20 patients suffering from IHD without DM. Group III included 20 patients suffering from DM without IHD and Group IV included 20 patients suffering from both DM and IHD. Investigations were done including; FBS, PPS, urea, creatinine, cholesterol, TG, LDL-c, HDL-c, fasting serum insulin and leptin using RIA technique in addition to an EGG. Insulin resistance was calculated using HOMA test. Both mean leptin level and insulin resistance showed no statistical significant difference between ischemic heart disease group and the control group, but were significantly higher in diabetic groups [III, IV] than non-diabetic groups [I, II]. Within diabetic patients we found no significant difference in leptin and insulin resistance levels between those with IHD and those without IHD. In our study we found positive correlation between insulin resistance and BMI, cholesterol, LDL-c and leptin within ischemic heart disease group. Leptin and insulin resistance are associated with increased risk for atherosclerosis and ischemic heart disease in the presence of diabetes mellitus

Association of high serum ferritin concentration with metabolic syndrome

The metabolic syndrome affects 25% of western adults. It is closely linked to insulin resistance and implies an increased cardiovascular risk. Studies have shown an association between serum ferritin and one or more metabolic syndrome feature. The association between elevated iron stores and the metabolic syndrome, however, has been less well explored. We investigated the occurrence of iron overload in subjects selected for having metabolic syndrome, and investigated whether the association between elevated iron stores and the metabolic syndrome, if present will be related lo the sex or to the presence or absence of menstruation in females or not. The present study was done on 60 adult patients who have metabolic syndrome and divided into 3 groups; 20 premenopausal females, 20 postmenopausal females and 20 male patients. Age and sex matched 20 normal volunteers [7 premenopausal females, 7 postmenopausal females and 6 males] were taken as controls. Laboratory measurements included total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Serum ferritin, C-reactive protein, fasting serum insulin and plasma glucose. Homeostasis model assessment of insulin resistance [HOMA-IR] was calculated as fasting insulin [micro U/ml] x fasting glucose [mg/dl]/ 405. Mean levels of serum ferritin were significantly higher in metabolic syndrome patients as one group compared to control subjects [168.3 +/- 23 Vs 85.6 +/- 17 micro g/l, p<0.001], the elevation was significant in premenopausal women [112.4 +/- 11 Vs 85.6 +/- 17 micro g/l, p<0.05] and was highly significant in postmenopausal women and in men [145.1 +/- 16 and 199.6 +/- 21 micro g/l respectively Vs 85.6 +/- 17 micro g/l, p<0.001]. Mean levels of serum ferritin were significantly higher in postmenopausal women compared with premenopausal women [145.1 +/- 16 Vs 112.4 +/- 11 micro g/l, p<0.05] and higher in men compared with postmenopausal women but were statistically not significant [199.6 +/- 21 Vs 145.1 +/- 16 micro g/l, p>0.05]. The occurrence of body iron excess in metabolic syndrome patients was 15% in premenopausal women, 30% in postmenopausal women, and 40% in men. Mean values of fasting serum insulin were significantly higher in metabolic syndrome patients as one group compared to control subjects [14.78 +/- 4.3 Vs 12.34 +/- 4.2 micro U/ml, p<0.001]. Mean values of estimated insulin resistance using the homeostasis model assessment [HOMA-IR] were significantly higher in metabolic syndrome patients as one group compared to control subjects [4.13 +/- 1.2 Vs 2.87 +/- 0.09, p<0.001]. Ferritin was positively correlated with W/H ratio, BMI, elevated triglycerides, elevated glucose levels, Insulin and HOMA-IR in metabolic syndrome patients. Elevated iron stores were found in metabolic syndrome patients and it was positively associated with BMI, elevated triglycerides, glucose and insulin resistance

Plasma interleukin-8 level changes in acute renal failure patients treated with different therapeutic modalities

Acute renal failure is defined as rapid deterioration [hours to weeks] of kidney function. Introduction of continuous renal replacement therapy, with its advantages as regards hemodynamic stability, is expected to improve the outcome in patients with multi-organ failure MOF. It's also claimed to help in removal of IL-8, a pro-inflammatory chemokine that shares in leukocyte trafficking towards the kidney, where its removal could help in attenuating acute renal injury. The aim of our study was to test the effect of dialytic treatment opposed to non-dialytic treatment on the outcome of ARF. We also tested the difference between dialytic modalities on patients' outcome and on the ability to remove IL-8 from circulation. This study included 30 patients who suffered form acute renal failure [ARF] divided into two groups: Group A [15 patients] who received dialytic treatment and group B [15 patients] who did not receive dialysis. Group A was further subdivided into 3 groups according to the mode of dialysis used: Group A 1 [n=5]: Received continuous renal replacement therapies [CRRT], Group A 2 [n=5]: Received intermittent hemodialysis [IHD] and Group A 3 [n=5]: Received peritoneal dialysis [PD]. Plasma IL-8 level was determined pre and post dialysis. There is no significant difference in IL-8 pre in group A patients versus group B patients [p>0.05]. No significant difference was found between the outcome in group A versus group B [p>0.05]. There was no significant correlation between IL-8 pre and outcome in the whole population [p>0.05]. IL-8 is significantly higher in patients with septicemia [2233.5 +/- 1606.6] than that in patients without septicemia [202.4 +/- 256.7] [p<0.001]. Death was significantly higher in PD group compared with IHD [p<0.05], while there was no significant difference between IHD and CRRT, CRRT and IPD [p>0.05]. Death among patients with isolated ARF was significantly lower [16.6%] than death in patients with ARF as part of MOF [75%] [p<0.001]. Our results have shown that different dialytic modalities could remove the pro-inflammatory chemokine IL-8, from the plasma. Further studies aiming to evaluate the impact of variable dialytic modalities on ARF, need to be conducted using larger number of patients and more homogenous population as regard illness severity

Decreasing soluble intercellular adhesion molecule-1 serum level, has a predictive value for the response to interferon therapy in patients with chronic hepatitis C virus

Intercellular adhesion molecule-1 [ICAM-1] plays a fundamental role during liver inflammation. In fact, weak ICAM-1 expression is physiologically restricted to the endothelium of portal vessels and to sinusoidal lining cells, but it becomes markedly evident on sinusoidal lining cells and at the surface of hepatocytes during inflammatory liver diseases. The aim of this study was to evaluate the level of soluble ICAM-1 [sICAM-1] in chronic hepatitis C [CHC] patients and its changes during interferon [IFN] therapy. Sixty subjects were divided into 2 groups: group A included 40 patients with CHC [subdivided according to their response to treatment into responders and non-responders] and group B included 20 healthy subjects representing the control group. Levels of sICAM-1 were measured in 40 patients with CHC treated with IFN and ribavarin, at baseline and after 3 months of therapy, and in 20 normal control subjects. All the patients were negative for HBV surface antigen. All the controls were negative for HBV surface antigen, and HCV antibody. The levels of sICAM-1 were significantly higher in the patient than in the control subject group [3.40 +/- 1.44 micro g/Lvs. 1.91 +/- 0.34/ micro g/L; p<.001]. Baseline sICAM-1 levels were similar in responders and non-responders [3.58 +/- 1.8 micro g/L vs. 3.24 +/- 1.04 micro g/L; P. NS]. By contrast, the concentration of sICAM-1 decreased significantly only in responders after 3 months of therapy [3.58 +/- 1.87 micro g/L vs.2.50 +/- 0.59 micro g/L; P<.001] and not in non-responders [3.24 +/- 1.04 micro g/L vs. 3.12 +/- 1.02 Pg/L; P. NS]. The probability of response to treatment, analyzed by Kaplan-Meier analysis, was much higher in the group showing a decrease of sICAM-1 than in the patients who did not show such a decrease. In conclusion, a longitudinal evaluation of serum levels of sICAM-1 in the first period of treatment is particularly useful in the identification of patients with high significant probability of response to treatment

Elevated high-sensitive C-reactive protein associates with early-stage carotid atherosclerosis in patients with type II diabetes

To evaluate whether low-grade inflammation contributes to early-stage advanced carotid atherosclerosis in patients with type II diabetes. The mean and maximum [max] intima-media thicknesses [IMT] of the carotid artery were assessed using ultrasound B-mode imaging in 75 patients with type II diabetes [32 men and 43 women, aged 52.1 +/- 3.6 years [ +/- SD], duration of diabetes 9.2 +/- 3.7 years] and 75 age-matched healthy nondiabetic subjects [28 men and 47 women]. High-sensitive C-reactive protein [hs-CRP] levels were measured with a latex-enhanced immunonephelometer. Patients with type II diabetes had significantly higher hs-CRP levels [median 0.35, range 0.05-1.47mg/l vs. median 0.14, range 0.05-1.44mg/l; p=0.001] as well as significantly higher mean IMT and max IMT than the nondiabetic subjects [mean IMT 0.76 +/- 0.09 vs 0.72 +/- 0.04mm p = 0.003; max IMT 0.84 +/- 0.11 vs. 0.77 +/- 0.06mm, p<0.0001]. Hs-CRP levels were significantly correlated with the mean and max IMT of patients with type II diabetes and with the max IMT of nondiabetic subjects. Multivariate regression analyses for both diabetic and nondiabetic subjects as a single group showed that hs-CRP levels are independently correlated with the mean IMT and max IMT levels [p=0.002 and p=0.023, respectively] as well as with diastolic blood pressure, sex and duration of diabetes. Our data indicate that hs-CRP levels are elevated in patients with type II diabetes possibly corresponding with early-stage advanced carotid atherosclerosis

Effect of recombinant erythropoietin therapy on some nutritional markers in patients on regular haemodialysis

Several factors in changes renal disease [esrd] enhance protein catabolism and increase protein requirements. The relative important of nutritional markers in relation to haemodialysis process in patients with chronic renal failure [crf] is still under investigation. This study was designed to evaluate the effect of recombinant human erythropoietin [r-huepo] therapy on hemoglobin [Hb] level and some nutritional markers [serum albumin, insulin like growth factor-1 [IGF-1] and serum leptin] in patientys on regular haemodialysis. Patients were subdivided into 2 group, the first group receiving r-huepo and the second group not receiving r-huepo. All parameters were studied at the start of study after 3 months. Recombinant human erythropoietin therapy combined with haemodialysis caused significant increase in h[b], albumin and igf-1 level after 3 months, while regular haemodialysis caused significant increase in h[b] and albumin only. The increases were more marked in the group receiving r-huepo. A significant positive correlation was found between both body mass index [bmi] and triceps skin fold [tsf] and lepton. In conclusion, r-huepo therapy can accelerate improvements in nutritional status and the h[b] level in patients on regular haemodiaysis