The serum levels of angiopoietin-like protein 3 and 4 in type 2 diabetic patients with and without metabolic syndrome compared to the control group

INTRODUCTION

ANGPTLs (Angiopoietin-like proteins) 3 and 4 play an important role in the development of type 2 diabetes. These glycoproteins affect the modulation of glucose and lipid metabolism. They inhibit lipoprotein lipase (LPL) activity and provoke lipolysis. This study was aimed to investigate the protein levels of ANGPTL3 and 4 in the serum of type 2 diabetic patients with metabolic syndrome in comparison to the type 2 diabetic patients without metabolic syndrome and the control group.

METHODS

Three groups of individuals were included in this study; Group I: 47 patients with type 2 diabetes and metabolic syndrome; Group II: 25 patients with type 2 diabetes without metabolic syndrome; Group III: 40 non-diabetic healthy people without metabolic syndrome as a control group. After collection of 5 mL fasting blood samples, serum concentrations of fasting blood sugar (FBS), cholesterol (Chol), triglyceride (TG), HDL-C (High-density lipoprotein-Cholesterol) and LDL-C (Low-density lipoprotein-Cholesterol) were measured by the enzymatic method; blood pressure (BP), height and weight with stadiometers; and ANGPTL3 and 4 by the enzyme-linked immunosorbent assay (ELISA).

RESULTS

The serum levels of ANGPTL3 was significantly different among our three groups (p = .000). In patients with type 2 diabetes and metabolic syndrome (Group I), ANGPTL3 and 4 levels were lower than the control group. The serum levels of the parameters evaluated in this study (except HDL-C) was lower in the group II in comparison with the group I, and this difference was significant for TG, Chol, BP and BMI between these two groups. Also, our results revealed that there was a negative correlation between FBS, TG, Chol, LDL-C and BMI with ANGPTL3 and 4. While, there was a significant positive correlation between ANGPTL4 and ANGPTL3.

CONCLUSION

Altogether, our findings suggest that the decreased levels of ANGPTL3 and 4 may be a causative factor for type 2 diabetes.

Rheumatologic manifestations in Iranian patients with autoimmune thyroid diseases

BACKGROUND

Autoimmune thyroid diseases (ATDs) are the most common endocrine diseases which result in rheumatologic manifestations. Some studies have shown association between rheumatologic disorders and ATDs. Thus, the aim of this study was to assess the frequency of rheumatologic manifestations in patients with ATDs.

MATERIALS AND METHODS

In this cross-sectional descriptive study during 2010 to 2011, 65 patients with ATDs referred to the Rheumatology clinic of 5 Azar Hospital in Gorgan (North of Iran) were studied via systematic random sampling and patients with positive antithyroid peroxides (anti-TPO) were included in the study. These patients were examined by a rheumatologist for diagnosis of rheumatologic manifestations and tested for serum levels of TSH, Free T3 and T4, Anti-Nuclear Antibodies (ANAs) and Rheumatoid Factor (RF). SPSS software (version 16) and descriptive statistics were used for data analysis.

RESULTS

Nine males (14.8%) and 56 females (86.2%) with mean age of 38.81±1.44 years were studied. Overall, Rheumatologic manifestations were seen in 86.2 % (n=56). In this study, the most frequent rheumatologic manifestations were Carpal Tunnel Syndrome (36.1%) and Osteoarthritis (23%). Reynaud's phenomenon (RP) (10.7%), Discopathy (8.9%), Fibromyalgia (5.3%), Myopathy (3.6%), Rheumatoid arthritis (3.6%) and trigger finger (3.6%) were other manifestations, respectively.

CONCLUSION

In this region, there is a high frequency of rheumatologic manifestations in patients with ATDs. Thus, initial evaluation and regular checkings are recommended.

Change in Bone Mineral Density in Post Menopausal Women with Rheumatoid Arthritis

Introduction: Low bone mass is a serious complication of post menopausal women with rheumatoid arthritis. We determined the Change in Bone Mineral Density in postmenopausal women with rheumatoid arthritis. Methods: This retrospective cohort study was carried out on consecutive postmenopausal women with rheumatoid arthritis who were referred to the Azar 5th teaching hospital affiliated to Golestan University of Medical Sciences, North of Iran in 2009. The required data were gathered from the patients’ medical records. The data were analyzed using SPSS software and statistical tests. Results: We studied 98 postmenopausal women with rheumatoid arthritis. Mean number of years since menopause and mean duration of disease were 9.39 and 5.13 respectively. T Score mean in femoral neck and lumbar spines was -1.45±1.26 and -2.45±1.44 respectively. The overall prevalence of osteoporosis at both the lumbar spine and femoral neck was 13.3. We have found a significant correlation between age, duration of disease, duration of menopause and bone mineral density (P-Value<0.01). Conlusion: Our results indicate a negative effect of age, number of years since menopause and duration of disease on bone mineral density. So, BMD should be measured in high risk women prior to the implementation of any treatment or prevention program. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 Page 158-163 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14944

Age related metabolic syndrome among hemodialysis patients in gorgan, iran

People with metabolic syndrome are at high risk for developing cardiovascular disease. The present study aimed to determine the age related metabolic syndrome of hemodialysis patients. The biochemical parameters and demographic information were registered. The prevalence of metabolic syndrome was significantly high in ages 50-59 and 60-69 years in hemodialysis patients when compared with other age groups (P< 0.05). There was elevated frequency of metabolic syndrome from age 50-59 and 40-49 years in male and female hemodialysis patients, respectively. The frequency of metabolic syndrome in female subjects (65.27%) was higher than male (47.14%, P<0.05). The prevalence of metabolic syndrome was high in ages 50-59 years in males and females. There was a significant difference in hemodialysis patients with metabolic syndrome in ages 50-59 years in males and from ages 40-49, 50-59 and 60-69 years in females (P< 0.05). Our results show that 25.71%, 18.57% and 2.86% males and 36.11%, 20.83% and 8.33% females had three, four and five criteria for metabolic syndrome, respectively. The results of this study showed that females patients were more affected than males. This may depended on the specific lifestyle alterations among females and males patients in this area.

Comparison of Glycemic Excursion in Patients with New Onset Type 2 Diabetes Mellitus before and after Treatment with Repaglinide

Due to industrialization and sedentary life, incidence of type 2 diabetes (DM2) is increasing seriously. Repaglinide is a glucose reducing agent that predominantly reduces post-prandial glucose. Continuous glucose monitoring system (CGMS) monitors blood glucose excursions over a 3-day period. CGMS can be used as a therapeutic and diagnostic instrument in diabetics. There are not enough studies about using CGMS in DM2. The aim of this study was to determine the blood glucose excursions in patients with new onset of DM2. 10 patients with new onset of DM2 were entered to this study. As the first therapeutic management, patients received diabetic diet and moderate exercise for 3-weeks, if they did not achieve blood glucose goal (Fasting blood glucoser (FBG) <120mg/dl, 2-hour postprandial blood glucose (2hpp) <180mg/dl), were considered to undergo 3-days CGMS at baseline and after 4-weeks on Repaglinide (0.5mg three times before meals). Mean excursions of blood glucose were not different at the onset and at the end of treatment (6±4.05 VS 7.6±5.2 episodes, P=0.49). There were also no significant differences between mean duration of hypoglycemic episodes (zero VS 5.1±14.1 hours, P =0.28) and hyperglycemic episodes before and after therapy (7.6±5.2 VS 5.7±4.1, P=0.42), but mean hyperglycemia duration was significantly reduced at the end of therapy (21±26.17 VS 57.7±35.3, P=0.001). Patients experienced a mean of 0.3±0.67 episodes of hypoglycemia after therapy showed no significant difference before it (P =0.19). Mean FBG (with CGMS) was significantly lower after therapy than before it (142.9±54.31 VS 222.9±82.6, P <0.001).

This study showed the usefulness of CGMS not only as a diagnostic but also as an educational and therapeutic tool that in combination with Repaglinide (with the lowest effective dose and duration) can significantly reduce FBG and glycemic excursions in DM2 patients and hypoglycemic events are low.

A Rare Presentation of the Klinefelter's Syndrome

A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter's syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and siblings. His laboratory tests showed high levels of FSH and normal levels of LH and testosterone. With regards to all these findings, we suspected that there might be an occult Klinefelter's syndrome. So, we made his karyotype that showed a 47XXY pattern. Because there are only a few number of cases that have occult Klinefelter's syndrome in the basis of chronic renal failure, we decided to report this case.