[Serum level of retinol-binding protein 4 in obese patients with insulin resistance and in patients with type 2 diabetes treated with metformin]. / Sérová hladina retinol-binding proteinu 4 u obéznytch s inzulínovou rezistenciou a jedincov s diabetom 2. typu liecených metformínom.

OBJECTIVE: Is there a difference between the retinol-binding protein 4 (RBP4) levels in obese patients with insulin resistance (IR) without diabetes, in obese patients with type 2 diabetes mellitus (DM2T) treated with metformin and in nonobese healthy individuals? METHOD: 28 obese individuals with insulin resistance, 11 type 2 diabetes patients treated with metformin and 17 control individuals were examined for serum level of retinol-binding protein 4 using the RIA method. The results were compared within the groups and RBP4 was correlated with insulin in the IR group and the control group. OUTCOME: The highest and the lowest RBP4 levels (561.6 +/- 209 ng/ml) were recorded, respectively, for obese individuals with IR (IR HOMA 3.9) and for obese type 2 diabetics treated with metformin (391.1 +/- 133,5 ng/ml) (P < 0.01). The RBP4 level of the control group was significantly lower as compared with the obese individuals with IR (452.8 +/- 104.6 ng/ml) (P < 0.05), but insignificantly higher as compared with the obese individuals with DM2T treated with metformin (391,1 +/- 133.5 ng/ml). RBP4 in the monitored group correlated with insulin r = 0.46 (p < 0.03). CONCLUSION: The increase in RBP4 in obese individuals by GLUT4 regulation in adipocytes contributes to the development and aggravation of systemic IR. Through its effect on RBP4 expression in adipocytes, metformin may improve total insulin sensitivity in obese individuals including those with MS and delay the onset of manifest DM. RBP4 could by used as a marker of deteriorating glucose tolerance in obese individuals.

[Nitrate contaminated drinking water from private wells has an impact on the size and functional state of the thyroid gland in schoolchildren]. / Nitrátmi kontaminovaná pitná voda z domácich studní ovplyvnuje vel'kost' a funkcný stav stítnej zl'azy u skolopovinných detí.

UNLABELLED: The authors compared the size of the thyroid gland, assessed by ultrasonographic examination of its volume and the functional state of the thyroid by examination of the serum level of TSH and anti-TPO antibodies in 492 pupils aged 10 and 13 years in two close agricultural areas. The areas differed above all as to the nitrate content of drinking water. In communities where the source of drinking water were private wells (nitrate area), as much as 68.1% of the water samples had a nitrate content > 50 mg/l and 46.4% samples > 100 mg/l. In communities where the source of drinking water was a water main with a known source (control area) the water samples did not exceed 50 mg/l (73.7% > 15 mg/l and 26.3% > 50 mg/l. RESULTS: Pupils from the nitrate area had a larger thyroid gland similarly as older pupils from the control area. A volume above 7 ml/m2 in the nitrate area was recorded in the group of 10-year olds in 25/99 (27.7%) and in the group of 13-year-old ones in 33/154 (21.4%), while in the control area it was in the 10-year-old ones 11/92 (11.9%) and in the 13-year-old ones 16/156 (10.2%, P < or = 0.01). In the nitrate area TSH > 5 mIU/l was recorded in 5.6% and higher anti-TPO antibodies in 2.6% pupils. In the control area the corresponding figure was 1.1% pupils, P < or = 0.01.

Contribution of thyroid gland ultrasound for screening of patients with suspected subclinical thyroid gland disorders.

Thyroid gland ultrasonography is recommended in patients with nonspecific clinical symptoms such as fatigue, weight gain, dry skin, amnesic symptoms, depression, bradycardia, abnormal myocardial contractility, increased diastolic pressure, hypercholesterolemia, menstrual abnormalities, infertility, fibrocystic breast disease, anxiety, insomnia, tachycardia, paroxysmal atrial fibrillation and osteoporosis. Subclinical hypothyroidism or hyperthyroidism can cause any of the above mentioned symptoms. Diffusely decreased, decreased and inhomogenous thyroid gland echogenicity requires laboratory examination. Thyroid gland ultrasonography is recommended also in patients with type I. diabetes mellitus and vitiligo because of increased incidence of thyroid disorders in these patients. Clinical observation of patients treated with Lithium, Amiodaron or Interferon is also recommended. (Tab. 2, Fig. 6, Ref. 18.)