Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute patients with polycystic ovary syndrome

PCOS is a heterogeneous clinical syndrome characterized by a spectrum of symptomatology, pathology and laboratory findings. It is now accepted that polycystic ovary syndrome has important long-term health implications, including metabolic disorders and increased risk factors for cardiovascular disease like insulin resistance, abdominal obesity, dyslipidemia, hypertension and markers of abnormal vascular function. The aim of this work was to study the effect of metformin on the clinical, metabolic and endocrine parameters in hirsute women secondary to polycystic ovary syndrome. The study was conducted on 30 Egyptian hirsute patients suffering from polycystic ovary syndrome. Clinical examination included anthropometric measurements [BMI and WHR] and Ferriman and Gallwey scoring for hirsutism. Fasting serum insulin and fasting blood glucose were measured from which insulin resistance [IR] was assessed by HOMA. The glucose to insulin ratio [GIR] was calculated. Lipid profile was estimated. Serum luteinizing hormone [LH] and follicle stimulating hormone [FSH] were estimated in the early follicular phase. Total serum testosterone and sex hormone-binding globulin [SHBG] were measured. Ultrasonographgy was done on the pelvis for examination of the ovaries. The patients were instructed to do diet and physical exercise. They received metformin 1500 mg/day for 6 successive months. Clinical, metabolic and endocrine parameters were reevaluated after the medication. A significant 31% improvement in the frequency of the menstrual cycle was observed. Hirsutism improved by 19%. BMI was reduced by 8%. WHR decreased by 2.3%. Insulin resistance decreased by 54%. Total serum cholesterol, LDL-cholesterol, serum triglyceride and total cholesterol/H DL-cholesterol ratio showed slight decrease [3%, 6%, 9% and 9%, respectively], while HDL-cholesterol showed a slight increase by 7%. Total serum testosterone decreased by 32% and LH/FSH ratio improved by 28%. SHBG levels increased by 9%. There was a positive correlation between BMI and HOMA-IR, serum cholesterol and serum TG. There was a highly significant positive correlation between BMI and FBG as well as fasting serum insulin and HOMA-IR. On the other hand, there was a significant negative correlation between BMI and GIR. A highly significant positive correlation was found between BMI and total cholesterol and TG. Also, there was a significant positive correlation between BMI and total cholesterol/HDL-cholesterol ratio. Again, BMI showed a highly significant positive correlation with LH/FSH ratio. There was a highly significant positive correlation between WHR and the frequency of the menstrual cycle and fasting serum insulin. There was a significant positive correlation between WHR and HOMA-IR, serum total cholesterol and TG. There was a significant negative correlation between WHR and SHBG. HOMA-IR showed a significant positive correlation with GIR. Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute women with polycystic ovary syndrome. This is associated with improvement in menstrual abnormalities. Metformin has additional benefit in reducing hair growth in Egyptian hirsute young women with polycystic ovary syndrome

Subclinical pulmonary involvement in children with juvenile rheumatoid arthritis and systemic lupus erythematosus: Clinical, functional, high-resolution computed tomographic and laboratory findings

Early detection of collagen-associated pulmonary disease could have an important effect on prognosis and therapeutic strategies to prevent irreversible pulmonary damage. The aim of this study was to determine the prevalence and characteristics of pulmonary involvement in children with juvenile rheumatoid arthritis [JRA] and systemic lupus erythematosus [SLE] of less than 2-year duration and without prior clinical evidence of lung disease. Twenty-eight patients with JRA [18M and 1OF, mean age 10.3 +/- 2.8 years] and twenty with SLE [6M and 14F, mean age 12.9 +/- 3.1 years] and twenty age- and gender-matched controls were studied. Patients were evaluated using the following measures: clinical, pulmonary function testing [PFT], chest radiography [CXR], high resolution computed tomogram [HRCT], induced sputum cells, phospholipids [PLs] and surfactant protein-A [SP-A] concentrations were also measured in 19 JRA and 12 SLE patients. Results: Measurements of PFT and sputum cellular and biochemical variable were significantly different in study patients as compared to controls. Abnormalities in PFTs, CXR, HRCT and sputum cells and SP-A/PL in JRA were 21.4%, 0.0%, 32.2%, 52.6% and 31.6%, respectively; and in SLE were 30%, 10%, 45%, 54.8% and 33.3%, respectively. Restrictive pattern was the commonest PFT abnormality. PFT results correlated significantly only with age in JRA and with hematological data in SLE. HRCT findings correlated significantly in JRA patients with seropositve disease, high activity grade, and diminished diffusion lung capacity [DLCO], and in SLE with PFTs: FVC, FEVI,FEF25-75% and DLco. Neutrophic alveolitis was closely associated with HRCT changes, low DLco and low sputum SP-A values. Pulmonary changes in children with recent onset JRA and SLE are frequent. The significance of these changes is being determined in a longitudinal study

Bone mineral density and biochemichal markers in children with chronic liver disease

Metabolic bone disease is known to complicate chronic liver disease. The aim of the present study was to determine bone mineral density [BMD] and bone turnover in children with chronic liver disease [CLD] and to assess the possible correlations with the severity of liver disease. Thirty hospitalized children with CLD,14 males and 16 females, aged 2-14 years and twenty age- and sex - matched healthy controls were enrolled. BMD was measured by dual energy X-ray absorptiometry at the lumber spines. Serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone [PTH], osteocalcin and carboxy- terminal telopeptide of type I collagen [ICTP] were measured. The severity of liver disease was assessed using Desmet's modification of Knodell's histological activity index. BMD was significantly lower in patients than in controls and osteoporosis was found in 8 [27%] of the patients. BMD was significantly correlated negatively with severity of liver disease and positively with serum osteocalcin level. No correlation was found between BMD and calcium, phosphorus? alkaline phosphatase, PTH, and ICTP serum levels. Serum osteocalcin level was significantly lower and serum ICTP was higher but not statistically significant in patients than in controls. Serum calcium, phosphorus, and PTH values in patients did not differ from those of controls. Levels of osteocalcin, but not PTH and ICTP9 were significantly correlated inversely with severity of liver disease. Ascitic patients had significantly lower BMD and serum osteocalcin values than non-ascitic patients, and also had significantly higher serum levels of ICTP than the controls. The results of this study indicate that BMD is decreased in children with CLD that is related to the severity of liver disease. The biomarkers of bone turnover reflect that decreased bone formation, rather than increased bone resorption, is the major contributor of bone loss in these patients

Kinetics of eliminations of some ethyl 2-cyano-5-oxopentanoates

The rates of elimination were determined for the reaction of ethyl 2-cyano-5-oxo-5-phenyl-3-[p-substituted phenyl] pentanoates Ia-f, and ethyl 2-cyano-5-oxo-3-phenyl-5-[p-substituted phenyl] pentanoates Ig- k, with sodium ethoxide in absolute ethanol. The products were found to be the corresponding substituted propenones IIa-k. Linear free energy correlation was found to give a positive reaction constant [rho]. A mechanistic E1cB mode was suggested and the reaction transition state is of the carbanion character

Cryosurgery [CS] vs infrared contact photocoaglulation [ICPC] in the treatment of some cutaneous haemagiomas

26 patients [22 females and 4 males] were studied. Their age ranged from 40 days to 6 years. 16 had superficial hemangioma, 6 had subcutaneous and 4 had mixed hemangiomas. Hemangiomas were located in the face in 7, scalp in 4, chest in 3, arms in 5, abdomen in 4 and back in 3. They divided into 2 groups group I [12 patients] was treated by cryosurgery m [CS] and group II [14 patients] was treated by infrared contact photocoagulation [ICPC]. The results were 69% reduction in size in group I after CS vs 65% in group II after ICPC. Surface elevalioll of the lesion was better in group I than group II. The scar after CS was well formed and acceptable rather than after ICPC. On conclusion, CS is convenient simple technique in the treatment of hemangiomas, also, ICPC is a successful tool in the treatment but inferior to CS

Histopathologic and immunohistopathologic evaluation of Pityriasis rosea

Biopsy specimens of secondary skin lesions of PR obtained from 20 patients were studied histopathologically and immunohistopathologically [using monoclonal antibodies directed against the dermal inflammatory infiltrate]. The tissue was paraffin embedded after fixation in BS and methanol 13 cases only gave positive results.Still the pattern of monoclonal expression in the stained cases varies. Our results suggest a possible role that may be mediated by the cellular immune reaction in the pathomechanism of such disease