Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study.

BACKGROUND/AIMS: Magnesium is an essential mineral for many metabolic functions. There is very little information on the effect of magnesium supplementation on metabolic profiles of chronic kidney disease (CKD) patients. The aim of this study was to assess the influence of magnesium supplementation on metabolic profiles of pre-diabetic, obese and mild-to-moderate CKD patients with hypomagnesemia. METHODS: A total of 128 hypomagnesemic, pre-diabetic and obese patients with an estimated glomerular filtration rate between 90 and 30 ml/min/1.73m2 were enrolled in a randomised, double-blind, placebo-controlled trial. Patients in the magnesium group received 365 mg of oral magnesium (n = 57) once daily for 3 months, while patients in the control group received a placebo (n = 61), also once daily for 3 months. Hypomagnesemia is defined by a serum magnesium level <1.8 mg/dl in males and <1.9 mg/dl in females; obesity is defined as a body mass index ≥30 kg/m2; and pre-diabetes is defined as fasting plasma glucose ≥100 but <126 mg/dl. The primary end point of the study was the change in insulin resistance measured by the homeostastic model assessment for insulin resistance (HOMA-IR). RESULTS: At the end of follow-up, insulin resistance (-24.5 vs. -8.2%, P = 0.007), HOMA-IR index (-31.9 vs. -3.3%, P < 0.001), hemoglobin A1c (-6.6 vs. -0.16%, P < 0.001), insulin (-29.6 vs. -2.66%, P < 0.001), waist circumference (-4.8 vs. 0.55%, P < 0.001) and uric acid (-0.8 vs. 2.2%, P = 0.004) were significantly decreased in terms of mean changes; albumin (0.91 vs. -2.91%, P = 0.007) and magnesium (0.21 ± 0.18 vs. -0.04 ± 0.05 mg/dl, P < 0.001) were significantly increased in those taking magnesium compared with a placebo. The decrease in metabolic syndrome (-10.5 vs. -4.9%, P = 0.183), obesity (-15.7 vs. -8.2%, P = 0.131), pre-diabetes (-17.5 vs. -9.8%, P = 0.140), and systolic (-5.0 ± 14.8 vs. 0.22 ± 14.9 mm Hg, P = 0.053) and diastolic (-3.07 ± 9.7 vs. 0.07 ± 9.6 mm Hg, P = 0.071) blood pressure did not achieve to a significant level after study. CONCLUSION: Our data support the argument that magnesium supplementation improves the metabolic status in hypomagnesemic CKD patients with pre-diabetes and obesity.

The prevalence of Helicobacter pylori infection in patients with gastric and duodenal ulcers - a 10-year, single-centre experience.

INTRODUCTION: Helicobacter pylori (H. pylori) occurs throughout the world and causes gastroduodenal diseases. There is data indicating a change in the prevalence of H. pylori infection worldwide. The prevalence of H. pylori is 80% in Turkey, while it is higher in many developing countries, and the rate of infection varies throughout the world. In many developing countries, the prevalence of infection exceeds 90% by adulthood. AIM: To determine the change in the rate of H. pylori infection in gastric ulcers and duodenal ulcers for a 10-year period in a single centre. MATERIAL AND METHODS: The study population included 550 patients (342 in 2004, 208 in 1994) with gastric and duodenal ulcers. RESULTS: In 2004 there were 125 (36.5%) patients with gastric ulcer and 217 patients with duodenal ulcer (64.5%). CLO test positivity was 39.2% in patients with gastric ulcers and 60% in patients with duodenal ulcers. In 1994 there were 208 patients (159 duodenal ulcers, 49 gastric ulcers). Urease test was positive in 74.2% of patients with duodenal ulcer and in 65.2% of patients with gastric ulcer. The decrease in the rate of urease positivity in patients with gastric ulcer was statistically significant (p = 0.01) during this 10-year period. CONCLUSIONS: In the present study we found that the urease positivity decreased significantly in patients with gastric ulcer between 1994 and 2004.

Nonalcoholic fatty liver disease and familial Mediterranean fever: are they related?

INTRODUCTION: Familial Mediterranean fever (FMF) is a periodic febrile disease characterized by acute recurrent episodes of serositis. Liver disease is not considered a part of the spectrum of clinical manifestations of FMF. OBJECTIVE: The purpose of this study was to characterize the nonalcoholic fatty liver disease (NAFLD) that could be associated with familial Mediterranean fever (FMF). METHODS: Clinical findings and treatment information of the patients with FMF were obtained from outpatient files. Weight, height, hip and waist circumference, blood pressure, blood C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), creatinine, alanine aminotransferase (ALT), and insulin levels were determined in all subjects, and additionally liver ultrasonography was performed for signs of hepatosteatosis. RESULTS: Fifty-two age and gender matched patients with FMF, and 30 healthy controls were included in the study. The prevalence of metabolic syndrome in the patient group was determined to be significantly higher in the patient group compared to the healthy group. When FMF patients with and without hepatosteatosis were compared, the prevalence of metabolic syndrome was determined to be 6 vs. 3, respectively (p < 0.001). Eleven patients with FMF were found to have grade 1-2 hepatosteatosis, and only 6 of healthy subjects had grade 1 hepatoseatosis (p = 0.901). CONCLUSION: When compared with healthy controls, we found the prevalence of NAFLD was not increased in patients with FMF.

Huge cystic lymphangioma mimicking ovarian malignancy: a case report.

Lymphangiomas are rare benign congenital malformations of the lymphatic system. Clinical presentation varies from asymptomatic masses to acute abdominal pain. A 25-year-old female who presented with acute onset of abdominal distension and severe pelvic pain is presented. As a palpable mass was found on the pelvic examination and ultrasonography demonstrated a hypoechoic cystic mass, an ovarian malignancy was suspected. Exploratory laparotomy was performed and revealed cystic lymphangioma of the sigmoid colon. The clinical, radiological and pathological findings of the patient are discussed with a brief review of the literature.

The relationships of leptin, adiponectin levels and paraoxonase activity with metabolic and cardiovascular risk factors in females treated with psychiatric drugs.

OBJECTIVES: The aim of this study was to investigate serum leptin, adiponectin and paraoxonase1 levels in adult females receiving pharmacotherapy for various psychiatric disorders. METHODS: The study group consisted of 32 obese females (mean age 40.53 +/- 11.00 years, mean body mass index 35.44 +/- 5.33 kg/m(2)) who were receiving treatment for psychiatric disorders, and the control group included 22 obese females (mean age 35.95 +/- 9.16 years, mean body mass index 30.78 +/- 3.33 kg/m(2)) who were free of psychiatric disorders. Analyses were performed using a bioelectrical impedance device. Fasting blood samples were obtained for complete blood count and various biochemical tests, including determination of leptin, adiponectin and paraoxonase1 activity. RESULTS: Body mass index, waist and hip circumference, body fat percentage, fasting blood glucose, insulin, glycosylated hemoglobin, homeostasis model assesement of insulin resistance, alanine transaminase, aspartate tarnsaminase, and leptin levels were significantly higher in the study group than in controls. Although body weight was positively correlated with leptin levels in both groups, body weight was negatively correlated with adiponectin levels in the control group and positively correlated with adiponectin levels in the study group. In the study group, body mass index and hip circumference correlated positively with leptin levels, hip circumference correlated positively with adiponectin levels, and waist to hip ratio correlated positively with paraoxonase levels. In the control group, body mass index as well as waist and hip circumferences were positively correlated with leptin levels. Weight, body mass index, and hip circumference were also negatively correlated with the adiponectin/leptin ratio in the control group. CONCLUSION: This study indicates a higher risk for obesity-related disorders, particularly metabolic syndrome, diabetes and cardiovascular disease, in patients treated with psychiatric drugs.

The relationships of leptin, adiponectin levels and paraoxonase activity with metabolic and cardiovascular risk factors in females treated with psychiatric drugs

OBJECTIVES: The aim of this study was to investigate serum leptin, adiponectin and paraoxonase1 levels in adult females receiving pharmacotherapy for various psychiatric disorders. METHODS: The study group consisted of 32 obese females (mean age 40.53 ± 11.00 years, mean body mass index 35.44 ± 5.33 kg/m2) who were receiving treatment for psychiatric disorders, and the control group included 22 obese females (mean age 35.95 ± 9.16 years, mean body mass index 30.78 ± 3.33 kg/m2) who were free of psychiatric disorders. Analyses were performed using a bioelectrical impedance device. Fasting blood samples were obtained for complete blood count and various biochemical tests, including determination of leptin, adiponectin and paraoxonase1 activity. RESULTS: Body mass index, waist and hip circumference, body fat percentage, fasting blood glucose, insulin, glycosylated hemoglobin, homeostasis model assesment of insulin resistance, alanine transaminase, aspartate tarnsaminase, and leptin levels were significantly higher in the study group than in controls. Although body weight was positively correlated with leptin levels in both groups, body weight was negatively correlated with adiponectin levels in the control group and positively correlated with adiponectin levels in the study group. In the study group, body mass index and hip circumference correlated positively with leptin levels, hip circumference correlated positively with adiponectin levels, and waist to hip ratio correlated positively with paraoxonase levels. In the control group, body mass index as well as waist and hip circumferences were positively correlated with leptin levels. Weight, body mass index, and hip circumference were also negatively correlated with the adiponectin/leptin ratio in the control group. CONCLUSION: This study indicates a higher risk for obesity-related disorders, particularly metabolic syndrome, diabetes and cardiovascular disease, in patients treated with psychiatric drugs.

Investigation of microalbuminuria in nondiabetic, normotensive obese women.

AIM: To investigate if obesity which is not accompanied by diabetes and/or hypertension is associated with microalbuminuria in female patients. MATERIALS AND METHODS: A total of 77 obese female patients from the Outpatient Clinic of Endocrinology of Istanbul University Cerrahpasa Medical Faculty and 30 age-matched, lean, healthy women were enrolled in the study. Patients with accompanying diabetes mellitus, hypertension, obesity associated with any endocrine abnormality, hepatic or renal disease, fever, infectious disease, malignancy were excluded. Weight, height, body-mass index (BMI), waist circumference, waist/hip ratio (WHR) and systolic and diastolic blood pressures were recorded. Albumin excretion in 24-hour urine samples (UAE) were measured using SYNCHRON LX System with MA Microalbumin kit in two separate 24-hour urine samples from every patient. Statistical analysis was performed using t-test and Pearson's correlation in SPSS 12.0 for Windows Program. RESULTS: The median albumin excretion in 24-hour urine sample was similar in obese and control groups (12.01 +/- 10.69 mg/day vs 9.35 +/- 4.09 mg/day; p= 0.211). There were no correlations between the albumin excretion in 24 hour urine samples and BMI, waist circumference, WHR, systolic or diastolic blood pressure. CONCLUSION: Diabetes mellitus and hypertension are known to be associated with microalbuminuria. In our study, microalbuminuria was not detected in obese women without diabetes and/or hypertension and UAE was similar in obese and lean women.

Comparison of invasive methods and two different stool antigen tests for diagnosis of H pylori infection in patients with gastric bleeding.

AIM: To compare two different H pylori stool antigen tests as noninvasive diagnostic methods. METHODS: The study population consisted of 22 upper gastrointestinal system bleeding patients. Urea breath test (UBT), rapid urease test (RUT) and histopathological examination were applied to all patients. Stool specimens from these patients were examined by rapid STRIP!HpSA and one step simple H pylori antigen cassette test for the detection of H pylori antigens. RESULTS: For these 22 patients, 15 (68.2%) were diagnosed as positive and seven (31.8%) were diagnosed negative for H pylori infection by the gold standard methods. Whereas 10 (45.5%) were positive and 12 (54.5%) were diagnosed negative by the rapid STRIP!HpSA test. The sensitivity, specificity, positive and negative predictive values were 60%, 86%, 90% and 50%, respectively. When compared to the gold standard methods, these differences were not significant. However, six patients (27.3%) were positive, and 16 (72.7%) were negative by the simple H pylori stool antigen cassette test. The sensitivity, specificity, positive and negative predictive values were 33%, 86%, 83% and 38%, respectively. Compared to the gold standard methods, the simple H pylori stool antigen cassette test results were significantly different (P = 0.012). CONCLUSION: Rapid STRIP!HpSA test could be used as a routine diagnostic tool in the microbiology laboratory for assessing clinical significance and eradication control of H pylori in upper gastrointestinal system bleeding patients.