[Association of insulin resistance with alanine aminotransferase activity in patients with nonalcoholic fatty liver disease]

Background: Nonalcoholic fatty liver disease [NAFLD] is a term with a wide spectrum of disorders ranging from simple steatosis to progressive nonalcoholic steatohepatitis [NASH], cirrhosis and hepatocellular carcinoma. Serum alanine aminotransferase [ALT] level is a well-recognized clinical marker of liver injury and may represent a consequence of the proinflammatory process accused in the pathogenesis of NAFLD. Insulin resistance seems to predispose lipid accumulation within the liver and progress to fibrosis in NAFLD

Aim of the study: to investigate the association of insulin resistance with ALT activity in NAFLD patients

Patients and Methods: 50 patients with NAFLD, diagnosed by abdominal ultrasonography, were included in this study. Full history, clinical evaluation, body mass index [BMI], waist circumference and laboratory tests including liver function tests, lipid profile, random blood glucose [RBG] and glycated Hemoglobin [HBA1c] were done. Also, fasting blood glucose and fasting insulin levels were determined for calculation of Homeostasis Model Assessment-Insulin Resistance [HOMA-IR]

Results: Patients were divided into two groups; group I included 28 patients with elevated serum ALT level and group II included 22 patients with normal serum ALT level. There was significant difference between the two groups as regard to prevalence of type 2 diabetes mellitus, elevated RBG level, HbAlc, HOMA-IR and waist circumference but no significant difference between the two groups regarding age, sex, BMI, lipid profile and incidence of hypertension and ischemic heart disease

Conclusion: Our findings suggested that increased ALT activity was associated with insulin resistance in patients with NAFLD

Leptin, osteocalcin, and bone mineral density in post-hepatitic liver cirrhosis

The pathophysiology of osteoporosis complicating chronic liver disease is unknown. Some studies have found leptin to be a potent inhibitor of bone formation. The aim of this study is to investigate the relationship between leptin, osteocalcin and bone mineral density [BMD] in liver cirrhosis. Sixty patients with post-hepatitic liver cirrhosis were classified into three groups: group I, 20 pre-menopausal females; group II, 20 post-menopausal females; and group III, 20 males. In addition, 21 age- and sex-matched healthy subjects [seven for each group] were included as control subjects. Patients were classified according to Child-Pugh classification into grade A [n = 0], grade B [n = 38] and grade C [n = 22]. Serum osteocalcin, leptin and parathyroid hormone [PTH], in addition to liver functions test, hepatitis B surface antigen [HBsAg], anti-hepatitis C virus [HCV], serum phosphorus and calcium were measured. Bone mineral density [BMD] was measured by calcaneal ultrasound. Leptin was elevated in all groups [I, II and III] when compared with their control groups [p < 0.01, p < 0.001 and p < 0.01, respectively]. Further, it was high in female groups [I and II] compared to males [group III], [p < 0.01 each]. BMD and serum osteocalcin decreased in each group compared with the respective control [p < 0.001; p < 0.01 in group I, p < 0.05; p < 0.001 in group II and p < 0.001; p < 0.001 in group III, respectively]. In the Child-Pugh grade C group, BMD and osteocalcin were low [p < 0.001, p < 0.05, respectively], while serum leptin was elevated [p < 0.05], when compared with grade B group. Leptin correlated negatively with serum osteocalcin [r = -0.553; p < 0.001], BMD [r = -0.229; p < 0.05], albumin [r = -0.449; p < 0.001] and albumin/globulin [A/G] ratio [r = -0.661; p < 0.001], while positively correlated with both aspartate transaminase [AST] [r = 0.462; p < 0.001], and alanine transaminase [ALT] [r = 0.483; p < 0.001]. Osteocalcin negatively correlated with intact iPTH [r = -0.370, p < 0.001], while positively correlated with BMD [r = 0.418; p < 0.001], albumin [r = 0.659; p < 0.001] and A/G ratio [r = 0.444; p < 0.001]. Serum leptin was elevated in cirrhotic patients and may have a role in the pathogenesis of osteoporosis in liver cirrhosis

Complications of acute myocardial infarction in relation to the site of infarction

It has been suggested that infarction site may be significant determinant of clinical course and outcome after acute myocardial infarction [AMI].We aimed To assess the incidence of different sites of myocardial infarction [MI] and the different complications recorded according to the site of infarction, also to assess in-hospital mortality and its relation to age, sex, site of MI and other complications in patients with AMI. This study included all patients admitted to coronary care units of internal medicine and cardiology departments of Assiut university hospitals, Assiut government, Egypt, in the period from May 2007 to May 2008 with first AMI throughout one year [No=485 patients]. All patients were subjected to: careful history and clinical examination, electrocardiography [ECG], laboratory investigations, echocardiography and hemodynamic monitoring. In addition, 50 age and sex matched controls were included in this study. The incidence of AMI was higher in the old age group >/= 60 years [59.38%] with a higher percentage in men than women [71.75% vs 28.25%] in all age groups. Extensive anterior location of MI had the highest incidence among our patients [44.7%] while the inferopostenior location had the lowest incidence [4.1%] in both genders. Then the overall, inferior [26.2%], antroseptal [10.1%], extensive [9.3%] and lateral location [5.6%] came in between the two sites. Patients with extensive MI experienced the highest incidence of serious complications as cardiogenic shock [13.3%], left ventricular [LV] aneurysm [35.5%], LV thrombus [35.5%], stroke [2.2%], atrial fibrillation [AF] [13.3%], premature ventricular ectopics [PVCs] [100%] and they also had the highest incidence of in-hospital mortality [17.7%].The incidence of the various sites of MI as well as the complications recorded in these patients are near to that recorded in other studies all over the world. Patients with anterior and extensive infarction experienced the highest incidence of complications and mortality than those with inferior and inferoposterior locations

Thyroid disorders in systemic lupus erythematosus and rheumatoid arthritis

Aim: Thyroid disorders are not uncommon in systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA]. However, the association between SLE and RA with autoimmune thyroid diseases is conflicting. This study was designed to determine the patterns of thyroid dysfunction in SLE and RA in Assiut University Hospital. Subjects and Twenty patients with SLE and another twenty with RA were studied in addition to 20 healthy age- and sex-matched controls. All patients were subjected to complete history taking, thorough clinical examination and joint examination. All patients and controls were subjected to the following investigations: serum T3, T4, TSH, antithyroglobulin antibodies [ATGAb] and thyroid peroxidase antibodies [TPOAb]. Also, complete blood picture, ESR, RF, ANA, CRP and LE cells were determined. Fifty percent of SLE patients showed thyroid dysfunction compared to 15% of RA [P<0.05]. In SLE group, 20% had euthyroid sick syndrome, 20% had hypothyroidisrn [10% subclinical and 10% overt], and 10% had hyperthyroidism [5% subclinical and 5% overt]. However in RA, 10% had hypothyroidisrn [subclinical] and 5% had subclinical hyperthyroidism. TPOAb was found in 15% of SLE and 5% of RA patients and 10% of controls, but the titre was higher in SLE and RA patients. Also ATGAb was found in 5% of SLE and 30% of RA patients and 10% of controls, but the titre was higher in SLE and RA patients. Conclusions: Thyroid dysfunction was common in SLE [in particular] and RA. Euthyroid sick syndrome and hypothyroidism were the most common thyroid disorders in SLE. In RA hypothyroidism was more common than hyperthyroidism. SLE and RA were associated with antithyroid antibodies [TPOAb in SLE and ATGAb in RA]. We recommend the performance of thyroid function tests in patients with SLE [in particular] and RA as a part of biochemical and immunological profile