Hypoadiponectinemia as a marker of increased cardiovascular risk in patients with non-alcoholic fatty liver disease: correlation with albumin/creatinine ratio

ABSTRACT Objective: We assessed plasma adiponectin and its correlation with carotid intima-media-thickness (CIMT), as a marker of atherosclerosis, and urine albumin/creatinine ratio (ACR) in patients with non-alcoholic fatty liver disease (NAFLD). Subjects and methods: The study included 100 Egyptian subjects (50 patients with NAFLD with no history of diabetes or hypertension and 50 age and sex-matched normal healthy control subjects). Urine albumin/creatinine ratio (ACR) was assessed in all participants and fasting plasma adiponectin was measured using ELISA technique. Ultrasonography was used to diagnose NAFLD. CIMT was assessed using high-resolution Doppler ultrasonography. Results: Mild albuminuria was detected in patients with NAFLD (mean urine ACR = 42 ± 30 mg/g). Plasma adiponectin was significantly lower and urine ACR and CIMT significantly higher in patients with NAFLD as compared with the control group (P < 0.001 for all). A significant negative correlation was found between plasma adiponectin and both urine ACR and CIMT in patients with NAFLD (P < 0.001 and < 0.05 respectively). A significant positive correlation was also found between CIMT and urine ACR in those patients (P < 0.05). Plasma adiponectin and urine ACR were independent determinants of CIMT in patients with NAFLD (P < 0.01 and < 0.05 respectively). Conclusion: Patients with NAFLD, without diabetes, have an increased risk of atherosclerosis and cardiovascular disease. Hypoadiponectinemia and low-grade albuminuria are important markers of that risk.

Effect of metformin on maternal and neonatal outcomes in pregnant obese non-diabetic women: a meta-analysis

Background: metformin reduces maternal and neonatal weight gain in gestational diabetes mellitus; however, this effect is poorly investigated in non-diabetic women

Objective: we performed this meta-analysis to investigate the effect of metformin intake during pregnancy on maternal and neonatal outcomes in obese non-diabetic women

Materials and Methods: we searched Medline, EMBASE, and Cochrane CENTRAL for eligible randomized controlled trials addressing the efficacy of metformin in pregnant obese non-diabetic women. Data were extracted and analyzed using RevMan software [Version 5.3]. Neonatal birth weight was the key outcome. Secondary outcomes included maternal weight gain, the incidence of preeclampsia, and neonatal adverse effects [miscarriage, stillbirth and congenital anomalies]

Results: pooled data from two RCTs [n=843] showed that metformin caused a significant reduction in maternal gestational weight gain [MD-1.35, 95% CI: [2.08, -0.630]], compared to placebo. The summary effect-estimate did not favor either of the two groups in terms of reduction of neonatal birth weight Z score [MD-0.09, 95% CI: [0.23, 0.06]]. Metformin was associated with 41% reduction in the risk of preeclampsia; however, this reduction was not statistically significant [RR 0.59, 95% CI: [0.03, 11.46]]. None of the neonatal adverse events including stillbirth [RR 1.14, 95% CI: 0.42, 3.10]] and congenital anomalies [RR= 1.36, 95% CI: [0.58, 3.21]] differed significantly between the two groups

Conclusion: for obese pregnant women, metformin could decrease gestational weight gain with no significant reduction in neonatal birth weight. In light of the current evidence, metformin should not be used to prevent poor pregnancy outcomes in obese non-diabetic women

Knee joint diseases diagnosed by ultrasound and magnetic resonance imaging

A great number of people all over the world suffer from knee joint problems. The benefits of ultrasound [US] when compared to magnetic resonance imaging [MRI] are that the US is noninvasive, freely available, well-accepted by patients, cheap and that it has the advantage of dynamic evaluation and real-time imaging. In this study, there is a comparison between uUS and MRI in characterization of knee joint diseases using. This is an observational cross-sectional study of 200 patients, who attended the Radiological Center, College of Applied Medical Sciences, King Khalid University, Saudi Arabia, from October 2011 to August 2013. The US technique has been carried out according to the protocol of American Institute of Ultrasound in Medicine, using a linear probe transducer with high frequency 7.5-12 MHz. The range of the patients' age was 12-80 years. The most common presenting symptoms were painful swelling of the knee joint and inability to move. In 125 of them US and MRI revealed variable diseases: Effusion [81], loose body [2], synovial cyst [4], quadriceps tendon rupture [1], meniscus tear [6], tumor [1] bursitis [8], arthritis [5], baker cyst [4] deep vein thrombosis [3] diagnosed with both US and MRI, and anterior cruciate ligament tear [6], posterior cruciate ligament tear [4] seen with MRI only The study suggested that US can evaluate cystic lesions, as well as menisci, ligaments, tendons, and muscles tear. Most of the knee joint disorders were degenerative in origin. Since MRI is not easily available in developing countries and rural areas. US can be used routinely for the diagnoses of most knee joint diseases, shortening the list of MRI indications

Role of multlidetector computed tomography in the diagnosis of small bowel neoplasms

Objective: to determine the role of Multidetector computed tomography [MDCT] in diagnosis of small bowel neoplasms

Methods: from September 2010 till March 2013, small bowel neoplasms evaluated by MDCT in 17 patients [14 males and 3 females]

Results: The small bowel neoplasms found and included in this study were lymphoma [12 patients], malignant gastrointestinal stromal stromal tumor [GIST] [3 patients], primary duodenal adenocarcinoma [1 patient] and jejunal metastasis [1 patient]

Conclusion: MDCT can he used as a front-line imaging modality for detection of small bowel neoplasms, regarding its ability, to show intraluminal, mural and extraintestinal lesions with their characteristic density and features to successfully differentiate between the different neoplasms and stage them