Sex hormone-binding globulin in obese type 2 diabetics

Background: Obesity is one of risk factors for type 2 diabetes because of its association with insulin resistance and poor glycemic control. Sex hormone-binding globulin [SHBG] and adipose tissue hormones have a role in development of insulin resistance, hyperlipidemia and type 2 diabetes. Serum SHBG has a role in glucose homeostasis and low levels are associated with development of diabetes, cardiovascular diseases, insulin resistance and hyperinsulinemia

Aim of work: To study the relationship between serum SHBG, obesity, and metabolic parameters in type 2 diabetes in both sex

Patients and Methods: forty obese type 2 diabetic patients and ten obese non-diabetic as controls were included in this study. Blood was taking from all subjects for estimation of glucose, Lipid profile, insulin and SHBG

Results: there was highly significant decrease in mean serum SHBG concentration in diabetic group compared with control non diabetic group. There were significant negative associations between serum SHBG and age, disease duration, BMI and glucose. On the other hand, there were non significant correlations between SHBG and waist circumference, fasting insulin, HOMA-IR, cholesterol and triglyceride levels

Conclusion: Low serum SHBG is associated with hyperglycemia in both sexes, independent of insulinemia

Serum antioxidant and pro-oxidant trace elements: relationship with oxidative stress in children with chronic renal failure on regular hemodialysis

There is a good evidence indicating that uremia, in general, is associated with enhanced oxidative stress and treatment of uremic patients with hemodialysis [HD] or peritoneal dialysis [PD] has been suggested to particularly contribute to oxidative stress and reduced antioxidant levels in those patients. Also uremic patients have abnormalities in trace elements which maybe caused by the uremia itself and/or enhanced or modified by the dialysis procedures. The aim of this study was to evaluate the oxidative stress imbalance and its relationship to the trace elements in children with chronic renal failure [CRF] on regular HD. This study was conducted on 36 children with CRF on regular HD and in 25 age and sex matched normal control children. Thiobarbituric acid [TBARS], total antioxidant [TAO], and hydrogen peroxide [H[2] O[2]] were measured by colorimetric assays. Trace elements [selenium [Se[+2]], zinc[zn[+2]], copper [Cu[+2]], manganese [Mn[+2]], lead [Pb[+2]] and cadmium [Cd[+2]] were measured by atom absorption/flame emission spectrophotometry. The results showed that the serum concentrations of TBARS, H[2]O[2], Cd and Pb were significantly higher in the studied cases [2.498 +/- 0.29, 2.967 +/- 0.414, 21.74 +/- 2.37 and 38.01 +/- 4.18 respectively] than in the controls [1.649 +/- 0.093, 0.311 +/- 0.032, 5.83 +/- 0.68 and 12.67 +/- 0.85 respectively] P<0.05 and P<0.001 for the others. The serum concentration of TAO, selenium, zinc and copper were significantly lower in the studied cases [1.379 +/- 0.017, 2.411 +/- 0.138, 91.07 +/- 2.979 and 84.89 +/- 3.145 respectively] than in the controls [2.049 +/- 0.014, 4.012 +/- 0.203, 128.7 +/- 4.924 and 128.7 +/- 3.904 respectively] [P<0.001 for each]. A significantly positive correlations were found between serum levels of cadmium and TBARS and between serum levels of selenium and TAO [r=0.359 P<0.05, and r=0.398, P<0.05 respectively]. Also a significant negative correlation was found between serum levels of zinc and serum level of TBARS [r=-0.392 P<0.05]. Our data suggest an enhanced oxidative stress and significant changes in trace elements in end stage renal disease [ESRD] patients undergoing HD. Also there is a significant relationship between the oxygen stress imbalance and the changes in the trace elements in these patients

influence of neonatal BCG vaccination on tuberculin skin test reactivity in primary school children

Tuberculosis prevalence remains high in spite of routine BCG [Bacillus Calmette Guerin] vaccination programme in Egypt. Tuberculin skin test [TST] is still a useful tool in diagnosis of TB and to find non-symptomatic infants with tuberculosis as well. BCG vaccination may cause problems in interpreting the TST. A limited number of studies have been undertaken to investigate how length of time after BCG vaccination affects TST results. To investigate the influence of high neonatal BCG vaccination coverage given within the first two months of life on TST reactivity in children from 6-10 years to assess the interpretation of this test. Four primary schools were randomly selected in Assiut city and 716 primary school children aged 6-10 years [336 females and 380 males] were skin tested with five units Mantoux tuberculin skin test [PPD RT-23] using the intradermal technique. All the children are BCG vaccinated once within the first two months of life and this was documented from their vaccination certificates and all were of the same socioeconomic level. Information on date of birth, weight, height, possible contacts with active TB and complete clinical examination was recorded. They were comparable regarding these parameters. BCG vaccination scar were checked and recorded. TST reaction induration size at 48 hours was retrieved. Children with cough, lymphadenopathy, chronic diarrhea or children who give false positive or false negative results were excluded from the study. Children mean age was 7.28 +/- 3.7 years; BCG vaccination was administered at mean age 35.9 +/- 15.85 days. Their mean weight was 26.58 +/- 8.74 Kg; mean height was 103.15 +/- 24.11 cm. Out of 716 children studied, 38.7% of them [277] had known BCG scar marking on their left shoulder that was significantly lower than those free from BCG scar [61.3%, 439/716] [p<0.05]. Eighty five percent of children [608/716] gave no indurations in TST that was significantly higher than those who gave TST in durations [15%, 108/716] [p<0.0 5]. The indurations diameters were 2-3mm in 64/108 children [9%], 4-5mm in 17/108 children [2.3%] and 6-7mm in 17/108 children [2.3%] and 12mm in 10/108 children [1.4%] with no significant difference in-between these values. Out of 608 children that gave no indurations in TST, 35% of them [214] had BCG scar that was significantly lower than those without scar [65%, 394/608] [p<0.05]. Out of 108 children that gave TST indurations, 56% of them [61/108] were with BCG scar and 44% of them [47/108] were without scar with no significant difference in-between. There were no correlations between age, sex, presence of BCG scar, age of BCG vaccination and the pattern of TST reaction and no correlation between presence and absence of BCG scar and TST diameter of indurations. In BCG vaccinated children, TST at age six to ten years gave variable reactions which ranged from no induration up to 12mm indurations diameters. The efficiency of BCG vaccination may not depend on the presence of the BCG scar. Therefore we recommend continuity of routine neonatal BCG vaccination, as it dose not affect TST reliability

Dyslipidemia, oxidative stress and cardiac dysfunction in children with chronic renal failure: effects of l-carnitine supplementation

Secondary carnitine deficiency may develop in chronic renal failure [CRF] patients undergoing long-term hemodialysis [HD], with a resulting higher incidence of cardiovascular diseases, dyslipidemia and oxidative stress. We studied the efficacy of 12 months of L-carnitine supplementation on the amelioration of dyslipidemia, oxidative stress and cardiac dysfunction in 24 CRF children undergoing long-term HD compared with 24 age- and sex-matched controls. Plasma samples were analyzed spectrophotometerically before and after dialysis sessions and after 2-month supplementation with oral L-carnitine [50 mg/kg/day] for free carnitine [FC], the lipid profile, and oxidative stress markers. Echocardiography the day following dialysis measured cardiac diameters, wall thicknesses, left ventricular mass index [MI], end diastole and systole volume indices and functions. The pre-dialysis FC concentration was substantially lower than controls and decreased significantly at the end of the dialysis session. Pre- and post-dialysis plasma levels of free fatty acids [FFAs], trigyleride [TG], total cholesterol [TC] and oxidative stress markers significantly increased while high-density lipoprotein cholesterol [HDL-C] and phospholipids significantly decreased compared to controls. Echocardiography detected a significant increase in cardiac diameters and thickness, and systolic and diastolic cardiac dysfunction. After L-carnitine supplementation, plasma levels of FC increased to normal levels. FFAs, TC and HDL-C returned to control levels while TG, phospholipids, and the oxidative stress markers decreased but remained significantly higher than controls. There was a significant decrease in cardiac diameters and an increase in left ventricular diastolic function [E/A ratio], but no correlation between FC levels and echocardiographic parameters. Pre-dialysis, post-dialysis and after treatment, plasma FC level showed a significant positive correlation with HDL-C and phospholipids and a significant negative correlation with each of oxidative stress markers, FFAs, TG and TC. On the other hand, FFAs showed a significant positive correlation with TG, TC, DC, NO and a significant negative correlation with HDL-C and phospholipids. This study demonstrates that CRF children under regular HD suffer from a decrease in the level of plasma FC, dyslipidemia, oxidative stress, and an increase in cardiac diameters and thickness with impairment of cardiac functions. Oral L-carnitine supplementation at a dose of 50 mg/kg for 2 months can increase plasma FC level, improve dyslipidemia, decrease oxidative stress with reduction of cardiac diameters and increase in diastolic function