Study of fasting plasma ghrelin hormone in obese non diabetic and obese type 2 diabetic patients

Obesity is a multifactorial syndrome characterized by an excessive adipose tissue accumulation. The aim of our work was to study the possible role of ghrelin hormone in the pathogenesis of obesity in obese non diabetic and obese type 2 diabetic patients. The study was conducted on 45 adult subjects. The studied subjects were subdivided into three groups: Group I includes 15 obese type 2 diabetic patients, Group II includes 15 simple obese non diabetic patients and Group III includes 15 normal subjects with normal BMI as a control group. All subjects were subjected to full history taking, clinical examination, routine investigations, fasting blood glucose, HbA 1c, fasting insulin, insulin resistance estimated by HOMA-IR and fasting plasma ghrelin. There was a significant decrease regarding fasting plasma ghrelin hormone in obese [either type 2 diabetic or non diabetic] than the control group p>0.05. However, ghrelin hormone was more decreased in obese type 2 diabetic than obese non diabetic. There was negative correlation between fasting plasma ghrelin hormone and both of fasting insulin hormone, fasting blood glucose and insulin resistance estimated by HOMA-IR. Also, there was negative correlation between fasting plasma ghrelin hormone and BMI, weight, waist circumference and waist hip ratio. Fasting plasma ghrelin was decreased in obese subjects and seemed to be a down-regulation in human obesity and this may be a consequence of elevated insulin

Bone mineral density in chronic hemodialysis patients and its correlation to biochemical markers

Renal osteodystrophy may result in considerabli morbidity for patients with end-stage renal disease. Secondary hyperparathyroidism, adynamic bone disease and osteomalacia, the main bony problems in chronic renal failure, may all be responsible for a reduction in bone mineral density [BMD]. The aim of this study is to investigate the biochemical parameters and bone mineral density in patients undergoing regular hemodialysis and to assess their possible correlation to different variables, Patients and Methods: thirty nine patients with end-stage renal disease maintained on regular hemodialysis for variable intervals were participated in the study. Osteocalcin, type1-C terminal collagen propeptide [CICP], Osteoprotegrin [OPG], receptor activator of nuclear factor kB ligand [RANKL], parathyroid hormone [PTh], serum total calcium, inorganic phosphorus and alkaline phosphatase were estimated to all patients. Bone mineral density[BMD] was measured by dual energy X ray absorptiometry [DEXA] in lumbar spine and femoral neck with estimation of BMD t-score. Body mass index [BMI] was calculated. Assessment of correlation between clinical, laboratory data and BMD was done. There was a positive correlation between age, BMD and CICP, between BMI and RANKL and also between BMD hip and spine. BMD in both sites correlated inversely, with PTH [P< 0.01], there was a significant correlation between duration of dialysis and PTH [P< 0.001], calcium level and hip t-score were the most important variable for prediction of reduced BMD. Osteopenia was frequent in patients on hemodialysis and those with hyperparathyroidism and longer duration of hemodialysis were more susceptible to reduced BMD developing osteoporosis

Antiphospholipid antibodies in Egyptian patients with chronic renal failure

The objectives of present research was to detect the incidence of antiphospholipid antibodies among Egyptian patients with chronic renal failure and its relation to their clinical manifestation and vascular access thrombosis. This study including 80 patients with chronic renal disease divided into two groups. Group A, forty patients with impaired renal function and group B, forty patients in chronic renal failure on hemodialysis. In addition to 10 age and sex matched subjects as a control group. All of them were subjected to clinical examination and laboratory investigation including antiphospholipid antibodies. Lupus anticoagulant was present in 21.25%, aCL IgM in 18.75% while aCL IgG in 11.25% of whole chronic renal disease patients. There was higher incidence of antiphospholipid antibodies in-group B end stage renal failure on hemodialysis [28/40[70%]] compared to group A of renal impairment [25/40[62.5%]]. Also there was insignificant relationship between antiphospholipid antibodies and age, kidney function or liver function tests. There is increase of antiphospholipid antibodies among patients with chronic renal failure with great liability for thrombosis of vascular access. Also patients with positive LA have a great possibility to be hypertensive. HCV infection in hemodialysis group may be the cause of increased incidence of antibodies. Antiphospholipid antibody profile should be done for patients with recurrent thrombosis of vascular shunt, as it is the main cause of hospitalization of dialysis patients

Independent, non-traditional risk factors for cardiovascular events and atherothrombosis in chronic kidney disease and in hemodialysis-dependent patients

This study aimed at evaluating the role of the emerging non-traditional risk factors, their impact on Cardiovascular Disease [CVD] prediction-together with traditional RFs-in Chronic Kidney Disease [CKD] and end-stage renal disease [ESRD] patients. Total homocysteine [tHcy], plasma fibrinogen [Fbg], plasma factor VII activity [FVIIc], anaemia [HCT] and C-reactive protein [CRP], were studied in 37 Egyptian patients classified into chronic kidney disease group [10 cases] and hemodialysis [HD] group [27 cases] in addition to 10 healthy age and sex-matched controls. This study showed that tHcy, fbg CRP and FVIIc demonstrated highly significant increase in the total patient group and in the HD group compared to the normal controls. These values showed a progressive increase with the disease approaching hemodialysis dependence. Among the 37 patients, 21 showed evidence of ischemic heart disease [IHD]. A statistically significant elevation of the previous factors was found in IHD when compared to non-ischemic group of patients. Multivariante analysis showed CRP as the most predictive risk factor for CVE in CKD and ESRD patients. Therefore, it was concluded that the emerging non-traditional factors studied could explain to a great extent-together with traditional RFs- the high rate of CVD in these patients and that CRP is the most fulfilling for being recommended in clinical practice. Alterations of these factors will aid prevention of coronary heart disease [CHD], thus benefiting the patient from risk factor modification