Clinicopathologic study of endometrial and hormonal changes after metformin therapy in patients with polycystic ovary syndrome

Background: Polycystic ovary syndrome [PCOS] is a common complex genetic condition of women in the reproductive age. PCOS is a heterogeneous syndrome characterized by clinical/biochemical androgen excess, ovulatory dysfunction and polycystic ovaries. Metformin therapy has been proved to improve fertility in patients with PCOS, inducing not only high ovulation and pregnancy rates, but also reducing the incidence of miscarriages

Aim of the Work: This study was aimed to evaluate the effects of metformin therapy on hormonal profile and endometrial tissue, including pattern of immunohistochemical expression of androgen receptors [AR], in patients with PCOS

Patients and Methods: 100 patients with PCOS were included in this study. Each investigated case was submitted to detailed medical history, clinical examination that included body hair distribution, body weight, height and body mass index [BMI], transvaginal ultrasound, laboratory investigations [included fasting insulin, free testosterone, LH and FSH levels]. Endometrial pipelle samples were taken for histopathological evaluation and assessment of androgen receptor expression. These investigations were done before and after three months of metformin treatment

Results: A significant decrease of BMI of the investigated cases after metformin therapy was observed [P value <0.003]. There was a significant decrease of LH level after metformin therapy from 9.17 +/- 2.84 Miu/ml to 6.18 +/- 3.6 Miu/ml and of fasting insulin level from 14.3 +/- 4.3 to 8.2 +/- 5.9. Insignificant increase of FSH level from 3.87 +/- 1.8 to 4.85 +/- 2.6 and also insignificant decrease of free testosterone level from 1.58 +/- o.83 to 1.38 +/- 1.4 were also observed. Histopathological results of the endometrial specimens before metformin therapy revealed histologic features of early proliferative endometrium in 64 cases, 20 cases with a late proliferative endometrium and examination of the remaining 16 cases revealed features of simple endometrial hyperplasia. Among the 64 cases diagnosed as early proliferative endometrium before the therapy, 60 cases showed features of a late proliferative endometrium after treatment and the remaining 4 cases showed no histomorphologic changes. Among the 20 cases diagnosed as a late proliferative endometrium before therapy, 6 cases showed features of early secretory phase after therapy, 6 cases showed features of mid-secretory endometrium while the remaining 8 cases showed a late secretory endometrium that indicate successful ovulation after therapy. Regression of hyperplasia after therapy was noted in 6 of the 16 cases diagnosed as simple endometrial hyperplasia. Immunohistochemical [IHC] results revealed marked increase in endometrial AR expression in patients with PCOS compared to the normal fertile controls [p<0.004]. Also, a significant decrease of AR expression in endometrial epithelial and stromal cells after metformin administration in patients with PCOS was noted [p<0.003]

Conclusion: Metformin therapy restores normal menstrual cyclicity in patients with PCOS, induces ovulation and showing significant decrease in endometrial AR expression

Effect of curcumin administration against some biochemical alteration induced by acrylamide in adult male albino rats

Acrylamide is a chemical used in many industries, found in carbohydrate rich foods cooked at high temperature. Although it is found to be harmful, human are exposed to varying amounts of it in the diet, especially fried food. Curcumin is a herbal agent used in medicine and proved to be protective against many harmful agents. This study was undertaken to assess the protective effect of curcumin against some biochemical alteration induced by acrylamide in male albino rats. The experimental rats were divided into four groups included a control group, a group treated orally with curcumin by supercritical fluid extractor for 30 days, a group treated orally with acrylamide and a group treated orally with curcumin + acrylamide for 30 days. The results indicated that treatment with ACR alone resulted in a significant decrease in the haematological parameters, triglycerides, insulin, creatine kinase and choline esterase while the concentrations of urea, creatinine, ALT, AST and alkaline phosphatase were increased. Treatment with curcumin during ACR treatment reduced the effects induced by ACR, It could be concluded that curcumin exhibited a protective action against ACR-induced biochemical alterations in rats. For this reason, curcumin is recommended to be used in cooked food due to its palatable taste and prophylactic effect

Clinical characteristics of patients with atrial fibrillation at a tertiary care hospital in the central region of Saudi Arabia

To report on the clinical presentation, etiology, and laboratory features of acute and chronic atrial fibrillation [AF] in a tertiary hospital in Riyadh, Saudi Arabia. We retrospectively studied records of 720 patients with AF seen in outpatients and inpatients departments at King Abdulaziz Medical City, Riyadh, during the period of 1 January 2002 to 31 August 2008. Documented acute and chronic AF was present in 157 [21.8%] and 563 [78.1%] patients, respectively. Palpitations, dizziness and syncope were the most frequent symptoms in acute AF, while dyspnea and palpitations were the most common symptoms in the chronic type. Acute respiratory problems and acute myocardial infarction were significantly more common in acute AF, while congestive heart failure and acute respiratory problems [chest infection, bronchial asthma, and pulmonary embolism] were significantly more common in chronic AF. The most common causes of both types of AF were diabetes mellitus [DM] in 68.8%, hypertension [HTN] in 59.3%, chronic lung diseases [bronchial asthma, chronic obstructive pulmonary disease and interstitial lung disease] in 31.8%, valvular heart disease in 23.6%, and ischemic heart disease [IHD] in 23.1%. In 9 [1.3%] patients, no cause was detected. The echocardiographic findings of left ventricular hypertrophy, valve lesions, and depressed left ventricular function were significantly more common in chronic AF [P<0.01]. Nowadays, DM, HTN, and IHD are becoming the most common predisposing factors for AF in the central region of Saudi Arabia and require prevention and control

Diagnostic and prognostic value of CRP in post-ERCP pancreatitis

Acute pancreatitis [AP] is an inflammation of the pancreas secondary to a variety of causes. It is the most common serious complication of endoscopic retrograde cholangiopancreatography [ERCP]. As most ERCP is performed on an outpatient base, early evaluation can allow safe discharge of the majority of patients. The aim of this study was to identify the value of C-reactive protein [CRP] in the diagnosis and prognosis of post-ERCP pancreatitis [PEP]. One hundred patients who were candidate for ERCP examination either diagnostic or therapeutic included in the present study. All patients has been followed-up daily for at least 48 hours after ERCP for symptoms and signs suggestive of post-ERCP pancreatitis and follow-up of post ERCP pancreatitis patients has been done until pancreatic enzymes and CRP became normal. Serum amylase, lipase and CRP were done immediately after ERCP and on 2[nd] and 7[th] day after ERCP. CT abdomen was performed for patients who develop post-ERCP pancreatitis. Patients were divided into group A [GA] which developed post-ERCP pancreatitis [25 patients [25%]] and group B [GB] which had no pancreatitis [75 patients [75%]]. Serum amylase and lipase were significantly higher in GA relative to GB at T[0], T[2], T[7]. Additionally, at T[2] both serum amylase and lipase was more than 3 fold the upper limit of normal in GA. Also data concerned with CRP level at T[0], T[2], T7 revealed a significant increase in GA relative to GB. Data were highly significant at T[2] and T[7]. Out of the 25 cases of Post-ERCP pancreatitis, 17 cases showed CT findings consistent with acute pancreatitis, 13 of them had mild and moderate disease. The remaining 4 cases had severe acute pancreatitis. Since the mean value of CRP at T[7] in GA is still high above upper limit of normal, while serum amylase and lipase were not, and the significant rise in CRP level at T[0], T[2], T[7] in GA was directly correlated to the CT findings. Therefore, these data might suggest the importance of the CRP level as a diagnostic test and also in the assessment of the prognosis of Post-ERCP Pancreatitis, it is cheap, readily available but it is not an early marker

Hyperleptinemia and peripheral WBCs in nephropathy associated with type 2 diabetes

Peripheral white blood cell [WBC] count has been shown to be associated with insulin resistance, type 2 diabetes, coronary artery disease [CAD], stroke and diabetes micro-and macrovascular complication. Leptin's hematopoietic or proinflammatory role has been experimentally reported. We investigated whether serum leptin concentrations are associated with white blood cell [WBC] counts in diabetic nephropathy patients of type 2 diabetes mellitus. We studied three groups of patients according to albuminuria level: normal [18 patients], micrialbuminuria [17 patients] and third group with overt proteinuria [21 patients]. The total and differential leukocyte profiles of peripheral blood were measured and plasma leptin was examined by enzyme-linked immunosorbent assay. In our study, we showed a significant higher leptin level [p= 0.0 5] and neutrophilic counts [p= 0.017] in diabetic nephropathy patients but failed to show an association between leptin level and TLC or neutrophilia. Our study confirmed a significant hyperliptenemic state and higher neutrophilic counts in diabetic nephropathy patients of type 2 diabetes mellitus. These finding might be reinforcement of importance of inflammation in the pathogenesis of this microvascular complication of diabetes

Smoking as a risk factor for renal impairment and proteinuria: a case control study

In this study, the aim is to examine the association between current smoking status and indicators of kidney affection shown by reduced GFR and elevated urine protein/creatinine ratio in a population free of hypertension and diabetes mellitus, The study was carried out on 190 subjects [90 smokers and 100 non smokers]. Both smokers and non smokers were not diabetics nor hypertensives. For each subject serum creatinine [an indicator of GFR] and protein/creatinine ratio in urine [an indicator of proteinuria] were determined. Smokers were classified according to smoking index, which equals number of cigarettes smoked per day multiplied by the number of years of smoking, into: mild smokers [smoking index <200], moderate smokers [smoking index 200-600] and heavy smokers [smoking index >600]. In our study, the socio-demographic characteristic of the study population were matched and there was no statistically significant difference between smokers and non smokers as regards residence, education, occupation and marital status. Males represent 95.6% and females represent 4.4% of the smokers while males represent 97% and females represent 3% of the non smokers. Smokers were more likely to have higher diastolic blood pressure and serum creatinine and lower GFR. In spite of the limited number of the study sample results pointed to the negative effect of smoking on kidney. There was a relation between smoking and renal impairment. A dose-response effect on GFR was shown with lifetime exposure to smoking. The relation between smoking and proteitnuria was less significant. However, one of the few females, who shared our study and was mild smoker, had been with proteinuria. This gives some relation between smoking and proteinuria especially in females. However. longitudinal studies with clear identification of abnormal glucose metabolism and hypertension will be required to provide the missing evidence for causality. The fact that smoking is an important renal risk factor trust be taken into consideration in the management of patients with renal disease. A concerted effort to encourage renal patients to give up smoking. Effective programs aimed at stroking prevention and cessation are highly needed