Factors associated with gallstones in patients with chronic renal failure treated by haemodialysis in upper Egypt

Studies performed to date on the prevalence of gallstones in chronic renal failure [CRF] on haemodialysis [HD] have given contradictory results. to evaluate the frequency and percentage of gallstones and its main associated risk factors in a group of Egyptian haemodialysis patients. The study included 147 patients with CRF on HD randomly selected from Assiut and Sohag University renal dialysis units in Upper Egypt [102 males, 45 females]. The screening protocol included complete medical history, female parity, as well as, use of estrogen therapy by females. History of diabetes mellitus and duration of haemodialysis were also recorded. Body mass index [BMI] was calculated and a number of biochemical parameters [total cholesterol and triglycerides, serum calcium, phosphorus and uric acid] were estimated in fasting serum. An ultrasound scan of the gall bladder and biliary tract was performed with a 3.5 MHz linear probe after at least 12 h fasting. In addition, the prevalence of gallstones in the general population of the same geographical region was calculated after revising available data in ultrasonography reports. The mean age of CRF patients was 43 +/- 14.2 years and mean duration of dialysis was 30 +/- 30.5 months. Gallstones were diagnosed in 22.4% of HD patients and this was mildly significantly higher in women than men [31.1% in women vs 18.6% in men, P=0.05] and this percentage was significantly higher than that of the general population in the same geograbical region [1.6% of the total examined] [P=0.001]. The percentage of gallstones didnt increase significantly with increasing age or duration of dialysis. We noticed an insignificantly raised risk for gallstones with use of estrogen by females, diabetes mellitus and smoking in males [OR=3.2, 1.6, 1.2 respectively; P >0.05 for all of them]. No significant difference was noted between CRF patients with and without gallstones in the studied biochemical parameters except for mean serum calcium that was significantly higher in patients with gallstones [9.8 +/- 1.3 vs 8.1 +/- 1.1; P=0.04]. The percentage of gallstones in a group of Egyptian patients on HD is higher than that of the general population of the same area. Apart from female sex, the traditional risk factors associated with gallstones in the non-uraemic general population appear not to play a significant role in gallstone formation in HD patients. Estrogen use in females, presence of diabetes mellitus and smoking in males, have insignificantly raised the risk for gallstones in these patients. Changes in serum calcium appear to play a role. Our results suggest that other factors inherent to kidney pathology may contribute to this high percentage of gallstones in CRF patients on haemodialysis

Relation of leptin and proinflammatory cytokines to anorexia and wasting in pulmonary and extrapulmonary tuberculosis

Tuberculosis is the classic cause of "consumption," but the exact pathogenesis of such wasting is largely unknown. Animal studies in other conditions suggest that leptin may be a mediator between pro inflammatory cytokine activity and wasting. Because leptin is involved in weight regulation and cellular immunity, it may have a role in tuberculosis-associated wasting. Qims: 1] To estimate leptin concentration in a group of active pulmonary or extra pulmonary tuberculosis as compared to healthy control subjects. 2] To study the relationship between serum leptin, anorexia and wasting. 3] To study the correlation between serum leptin and proinflammatory cytokines [TNF-d, IL-1,IL-6] Patients and Non-diabetic Egyptian adults with pulmonary [n=26] and extrapulmonary tuberculosis [n=19] as well as 20 healthy controls were recruited into a case-control study. Body mass index [BMI], C- reactive protein, serum leptin, TNF-a, interleukin-1 and 6 were measured. According to the calculated BMI, eighteen patients were wasted [40%] and 27 [60%] were not wasted. Mean serum leptin was significantly lower in tuberculous patients than controls and in wasted than non-wasted patients. TNF-a, IL-l.IL-6 were significantly higher in patients than controls. Only IL-6 was significantly higher in wasted than non-wasted patients Serum leptin showed a significant positive correlation with BMI. While, IL-6 had a significant negative correlation with BMI Moreover, stepwise linear regression analyses showed that IL-6 was the only factor significantly contributing to loss of appetite [anorexia] in tuberculous patients. leptin does not appear to be part of the proinflammatory cytokine response in human tuberculosis. Changes in leptin are entirely appropriate for the changes in body mass index. Altered leptin activity cannot, therefore, be held responsible for the weight loss and anorexia so often associated with tuberculosis infection. Anorexia and wasting seem primarily determined by the level of inflammatory cytokine [IL-6]

Leptin in patients with thyroid disorder

Leptin is an adipocyte-secreted protein, which functions as a metabolic, neuroendocrine hormone beside its role in regulation of food intake and energy balance. The aim of this study was to assess the influence of hypo and hyperthyroidism on plasma leptin levels. Also, we studied some biochemical changes and its relation to serum leptin. This study was done on patients with newly discovered thyroid disorders [17 cases with hypothyroidism and 19 cases with hyperthyroidism] and 19 lean euthyroid subjects as a control group. We measured the plasma leptin levels, thyroid hormones, and different biochemical variables "serum calcium [Ca], phosphorus [P], alkaline phosphatase [ALP], uric acid, serum urea, creatinine, and complete lipogram and their relation to plasma leptin. The mean leptin levels were higher in hypothyroid patients [9.5 ng/ml in males and 11.9 ng/ml in females] and lower in hyperthyroid patients [1.2 ng/ml in males and 2.8 ng/ml in females] compared with controls [2.4 ng/ml in male and 6.6 ng/ml in female]. Leptin was significantly negatively correlated with thyroxine [T[4]] [r = -0.74 P < 0.0001], triiodothyronine [T[3]] [r = -0.57,]P <0.005] and positively correlated with thyroid stimulating hormone [TSH] [r = 0.78 P <0.0001] after adjusting for body mass index [BMI] and Lipids, Also, plasma leptin significantly positively correlated with BMI = [r = 0.45, P < 0.005]. No significant correlation was observed between plasma leptin and lipids after adjusting for BM1 and thyroid hormones. Their was no significant correlation between leptin and Ca,k ALP, P, uric acid or creatinine. Plasma leptin was significantly elevated in hypothyroidism and decreased in hyperthyroidism, compared with controls. T[4], T[3] and TSH area potent regulator of plasma leptin independent of BMI