Serum leptin in end-stage renal disease patients on hemodialysis: its value as a malnutrition marker

Leptin is a protein hormone secreted by adipocytes in proportion to the amount of body fat and exerts sustained inhibitory effects on food intake while increasing energy expenditure. It has been reported that serum leptin levels are high in patients with chronic renal failure and may have a potential impact on the development of uremic cachexia. The present study aimed to evaluate serum leptin level and its relation to markers of malnutrition in non diabetic patients with end-stage renal disease [ESRD] treated with hemodialysis. Serum leptin level was measured in 48 ESRD patients [30 males and 18 females] on regular hemodialysis, and in 20 healthy control subjects. The nutritional status was checked by anthropometric measurements [body mass index [BMI] and triceps skin fold thickness [TSFT]] and laboratory data [hemoglobin, hematocrite, serum albumin, pre-albumin, total protein, and blood urea nitrogen]. Patients were included if they were on hemodialysis for more than one year, anuric, had normal C reactive protein values and had no history of diabetes mellitus, liver disease or chronic pulmonary disorders. The mean serum leptin level was higher in ESRD patients [28.5 +/- 15.3ng/ml] compared to the control [5.2 +/- 3.8ng/ml; P<0.001]. The indices of hematological and protein-energy malnutrition were evident in hemodialysed patients compared to controls. The mean serum leptin was significantly higher in male patients compared to the male control group [11.5 +/- 4.7 vs 3.2 +/- 2.1ng/ml, P<0.01]. Also, serum leptin was significantly higher in the female patients compared to the female control group [35.8 +/- 12.1 vs 12.7 +/- 4.5ng/ml, P<0.001]. The mean BMI for female patients was significantly higher than male patients [24.4 +/- 4.1 vs 21.1 +/- 5.6kg/m2, P<0.04]. The mean TSFT for female patients was significantly higher than male patients [13.8 +/- 3.2 vs 10.7 +/- 2.2mm, P<0.05]. A positive correlation was found between the TSFT and leptin, both in male [r=0.44, P<0.03] and female patients [r=0.71, P<0.01]. Also, there was a positive correlation between the BMI and leptin both in male [r=0.41, P<0.02] and female patients [r=0.67, P<0.01]. No correlation was observed between serum leptin with the length of time on dialysis, total protein, serum albumin, pre-albumin, hemoglobin, hematocrite, creatinine and blood urea levels. Serum leptin is markedly elevated in patients with ESRD on hemodialysis. It is significantly correlated with the BMI and TSFT and could be utilized as a potential indicator of malnutrition in these patients. Further studies may provide a therapeutical approach aiming to neutralize serum leptin levels or blocking its effect on the hypothalamus to prevent uremia-associated malnutrition

Value of screening colonoscopy in the diagnosis of Egyptian patients with lower gastrointestinal symptoms

Colorectal cancer is a major cause of mortality allover the world. Fecal occult blood testing, flexible sigmoidoscopy and total colonoscopy are the most commonly recommended screening tests for colorectal cancer, yet screening rates are still below target levels. To fully realize the benefits of early detection of colorectal cancer, screening rates must be improved. The current study has been conducted to study the current pattern of colorectal lesions from endoscopic and histopathologic perspectives in relation to clinical and laboratory aspects in Egyptian patients with different lower gastrointestinal symptoms. 165 cases with different lower gastrointestinal symptoms presented to Gastroenterology and Endoscopy Unit, Specialized Medical Hospital, Mansoura University. Clinical, laboratory, colonoscopic and histopathological examination of colonoscopic samples were done during the period from October 2005 to July 2006. The main lower gastrointestinal symptoms were abdominal pain, distension, altered bowel habits, dysentery and rectal bleeding. Ulcerative colitis represented 9.1% while colorectal carcinoma represented 4.1% of cases. The commonest symptoms and laboratory findings associated with colorectal carcinoma group were constitutional symptoms, constipation, rectal bleeding, fecal occult blood and iron-deficiency anemia. The colonoscopic examination is safe, accurate and cost-effective means of the screening for colorectal carcinoma

Impact of chronic hepatitis c virusinfection on bone marrow statusinpatients with liver cirrhosis

Background: Viral infection has been implicated in the pathogenesis of bone marrow failure. We designed this study to explore the influence of chronic HCV infection on the bone marrow status in patients withliver cirrhosis presenting with peripheral blood cytopenias

Patients and Methods: The present study was conducted on 70 patients with different grades of liver cirrhosis based on Child-Pugh scoringsystem . They were categorized into those positive for HCV infection [50patients] and those without [20 patients]based on assay of anti-HCV anti-bodies and qualitative PCR for HCV-RNA. Complete blood count and bonemarrow examination have been performed to all studied patients

Results: Normal bone marrow cellularity was more evident in pa-tients without HCV infection. However, hypercellular bone marrow wasmore evident in patients with positive HCV infection .Furthermore, no significant changes in different bone marrow elements in patients with posi-tive HCV infection were demonstrated when compared to patients withnegative HCV infection [P<0.05]

Conclusion: HCV infection has no evident direct suppressive effecton bone marrow elements in cirrhotic patients presenting with mono, biorpancytopenia. Understanding the pathogenetic mechanism of cytopeniasin cirrhotic patients is important to improve the management strategy andoutcome

Serum leptin level in chronic hepatitis

This study was planned to evaluate serum leptin levels in patients with chronic viral hepatitis or liver cirrhosis. The study included 80 patients with chronic viral hepatitis [chronic hepatitis C positive group [41 patients]. 23 non-cirrhotic and 18 patients post HCV cirrhosis. Chronic hepatitis B patient [25 patients] 10 patients non-cirrhotic and 15 post HBV cirrhosis. Chronic hepatitis B and C virus positive group. [14 patients] 6 non-cirrhotic and 8 patients post HBV and HCV cirrhosis. 10 healthy subjects of matched age and sex as a control group. The study showed that serum leptin levels was significantly elevated with non-cirrhotic and cirrhotic cases [chronic hepatitis] than the control while the highest concentration being seen in cirrhotic patients. There was a non significant difference in serum leptin levels with the different etiology of non-cirrhotic chronic viral hepatitis. Serum leptin levels showed a non significant difference between different Child classes. Serum leptin levels are sex dependent, higher in females than males. Serum leptin levels correlated positively with [BMI], this correlation was significant in females while not significant in males. Serum leptin was correlated positively with serum bilirubin, on the other hand serum leptin levels was inversely correlated significantly with serum albumin but no correlation with SGPT or SGOT. It can be concluded that in the course of chronic viral liver disease, serum leptin levels may reflect the extent of liver dysfunction Serum leptin levels is higher in patients with chronic hepatitis and is significantly increased in cirrhotic than non-cirrhotic and there is no correlation between BMI and its level