Some clinicolaboratory predictors of nonalcoholic steatohepatitis

In nonalcoholic fatty liver disease [NAFLD], the high cost of undertaking histological assessment of all persons with asymptomatic elevations of liver enzymes cannot be justified in view of the risks and limited clinical benefits. As the clinicians cannot distinguish steatosis and nonalcoholic Steatohepatitis [NASH], the purpose of this work was to study some of the clinical and laboratory parameters that could be useful as noninvasive predictors of NASH in NAFLD patients. The demographics, clinical, radiological, laboratory, and histopathological features of 40 NAFLD patients with persistently elevated ALT were evaluated. Significant rise of serum glucose, ALT, AST, cholesterol, LDL and TG with significant decrease of HDL was found in NASH versus steatosis patients, and in patients with grade II NASH versus those with grade I. The number of NASH patients was higher among studied diabetic than non-diabetic group and in obese than non obese group. Grade II NASH was found only in diabetic and in obese patients. In NASH patients, the relative risk of hypertriglyceridemia was 17, of obesity 7.13, of diabetes 1.47, but with hypercholesterolemia it was only 1.1. In obese patients particularly those with diabetes, presence of hepatomegaly, sonographically bright liver, persistent rise of transaminases and hypertriglyceridemia are sufficient to diagnose Steatohepatitis and might prove useful in guiding selection of patients for liver biopsy and in targeting therapy

Effect of metformin therapy on menstrual pattern, ovulation, pregnancy rates, and insulin resistance in clomiphene citrate-resistant women with polycystic ovary syndrome

Background: insulin resistance and its compensatory hyperinsulinemia play a key pathogenic role in the infertility due to polycystic ovary syndrome [PCOS]. Metformin [MET] is an insulin-sensitizing drug that can be used to induce ovulation in PCOS with enhancement of pregnancy rate and regulation of menstryal of cycle

Objective: to evaluate the effect of metformin therapy on menstrual pattern, ovulation, pregnancy rates, and insulin resistance in clomiphene-citrate [CC] resistant women with polycystic ovary syndrome [PCOS]

Patients and method: two hundred women with CC-resistant PCOS were randomly allocated to metformin therapy or usual treatment. The other 100 patients were allocated to the study group. They received oral metformin therapy [500 mg, twice daily] over a period of two cycles and clomiphene citrate [150 mg/day] on cycle days 3-7 of the second cycle. 100 patients were allocated to the control group. They received clomiphene [50-100 mg daily for 5 days] for three cycles. The primary outcomes were restoration of spontaneous menses, ovulation induction [spontaneous or clomiphene induced] and pregnancy. Secondary endpoints were changes in biochemical parameters related to androgens and insulin

Results: there were no differences between the two groups in terms of age, BMI and duration of infertility. The endocrine profile of both groups at baseline was similar in terms of fasting glucose, insulin, gonadotrphins, and testosterone levels. However, after treatment, CC + MET group showed a significant decrease in LH [p <0.001], total testosterone [p <0.05], and fasting insulin levels [p <0.001]. There was a significant increase in ovulatory rate [p <0.001], pregnancy rate [p <0.001], and regularity of menstrual cycle [p <0.05] in the group of CC+MET when compared to the group of CC only

Conclusion: metformin therapy not only decreases hyperandrogenism and insulin resistance but also improves ovulation rates and pregnancy rates in clomiphene citrate-resistant women with PCOS