Internal Medicine

Association of serum Sestrin-2 level with insulin resistance, metabolic syndrome, and diabetic nephropathy in patients with type 2 diabetes Hazem M EL-Ashmawy, Azza M Ahmed The Egyptian Journal of Internal Medicine 2019 31(2):107-114 Background The aim of the study was to evaluate the relationship between serum Sestrin2, Insulin resistance (IR), metabolic syndrome (MetS), and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Patients and methods The study group consisted of 155 patients with T2DM who were recruited and evaluated for DN. IR was evaluated by the homeostasis model assessment-insulin resistance (HOMA-IR). Sestrin2 levels were determined by enzyme-linked immunosorbent assay. Results Serum Sestrin2 levels showed significant positive correlations with tumor necrosis factor-α (r=0.247, P=0.018), triglycerides (r=0.178, P=0.021), total cholesterol (r=0.33, P=0.007), fasting c-peptide (r=0.164, P=0.035), and systolic blood pressure (r=0.171, P=0.041). A significant negative correlation was found between Sestrin2 levels and serum adiponectin (r=0.247, P=0.018). Also, Sestrin2 levels were positively correlated HOMA-IR (r=0.188, P=0.026). There was a progressive significant increase of mean HOMA-IR through Sestrin2 tertiles (P=0.001). A significant increase of mean serum Sestrin2 levels was found in relation to the presence of DN or MetS. Conclusion Serum Sestrin2 levels are significantly associated with IR, MetS, and DN in patients with T2DM.

Assessment of some inflammatory markers and lipid profile as risk factors for atherosclerosis in subclinical hypothyroid patients Khaled A El-Hefnawy, Hanaa Hosni Elsaid The Egyptian Journal of Internal Medicine 2019 31(2):115-121 Background Subclinical hypothyroidism (SCH) is associated with dyslipidemia and low grade inflammation leading to atherosclerosis. Atherosclerosis shows an association with inflammatory markers, which with dyslipidemia may accelerate the atherogenesis, in SCH. Objective The objective of this study was to investigate some inflammatory markers and lipid profile as risk factors for atherosclerosis in SCH. Patients and methods An overall 100 participants were included and classified into two groups: control group I included 20 healthy volunteer, patient group II included 80 SCH patients and was subdivided into group ΙΙa (26 male patients) and group ΙΙb (54 female patients). All patients were submitted to the following investigations: complete blood picture, liver function tests, renal function tests, Lipid profile, calculated risk ratio I and II and specific laboratory Investigations [thyroid-stimulating hormone (TSH), free thyroxine, free tri-iodothyronine, C-reactive protein (CRP), serum interleukin (IL)-6 and serum IL-10 assays]. Results There were statistically high significant differences between the control group and the SCH group as regards serum triglycerides, cholesterol, low-density lipoprotein, risk ratio I and II, TSH, IL-6, IL-10 and CRP (P<0.001). Statistically significant higher levels of CRP, serum IL-6 and IL-10 were observed in SCH patients than in controls. TSH had a positive correlation in SCH patients with all studied parameters including all lipid parameters, CRP, IL-6 and IL-10 and was negative only to free tri-iodothyronine and free thyroxine, whereas IL-6 and IL-10 correlated also with all parameters except age. Conclusion SCH is associated with increased levels of inflammatory markers and dyslipidemia, which are indicators for atherosclerosis, and are good predictors of cardiovascular morbidity.

Evaluation of microRNA-192 in patients with diabetic nephropathy Gamal Saadi, Amr El Meligi, Mervat El-Ansary, Alkhateeb Alkemary, Ghada Ahmed The Egyptian Journal of Internal Medicine 2019 31(2):122-128 Background Diabetic nephropathy (DN) is the leading cause of kidney failure. The role of microRNAs (miRs) which are endogenous RNA oligonucleotides that regulate gene expression in DN is not yet clearly established. This study was designed to evaluate the blood level of miR-192 and its relation to disease severity in patients with type 2 diabetes mellitus with and without DN evidenced by the presence of albuminuria. Materials and methods The study included 60 patients (37 women and 23 men) with type 2 diabetes mellitus and 20 healthy control participants. All were subjected to thorough history taking, clinical evaluation and measurement of glycosylated hemoglobin, creatinine and urinary albumin/creatinine ratio. miR-192 was quantified in blood using reverse transcription TaqMan microRNA assay. Results The study showed that the miR-192 levels were significantly higher in patients with lower estimated glomerular filtration rate and higher albumin/creatinine ratio. Conclusion These findings may help to find a new marker for early detection of DN and this could be used in the future as a novel therapeutic target for the treatment of DN.

Maternal thyroid status and its relation to ferritin and vitamin B12 in Saudi pregnant women Mysara Mohamad Mogahed, Eman El Sayed Amer, Mona Ahmed El-Awady The Egyptian Journal of Internal Medicine 2019 31(2):129-135 Background Thyroid dysfunction is a worldwide phenomenon in women, and the prevalence increases during pregnancy, with hypothyroidism being the most common. In most developing countries, nutritional deficiencies of nearly all essential nutrients, including iron, vitamin B12, and folic acid, are common in pregnant women. Thyroid disorders and nutritional deficiencies especially of iron and vitamin B12 cause a number of maternofetal complications. Objectives To assess thyroid status in pregnant Saudi women and explore its relation to ferritin and vitamin B12. Patients and methods This was a cross-sectional study conducted at antenatal clinics of the Northern Area Armed Forces Hospital, KSA, enrolling 254 Saudi women: 180 pregnant [classified according to gestational age into group A (first trimester) and group B (second trimester)], and 74 age-matched healthy nonpregnant women, as control group (group C). After a detailed obstetrical and medical history, and clinical assessment, participants were subjected to laboratory investigations in the form of thyroid function by measuring thyroid-stimulating hormone (TSH) and free thyroxin, hemoglobin (HB), serum ferritin, and vitamin B12 levels. Results TSH level was lower in pregnant than nonpregnant women. Subclinical hypothyroidism (35.5%) was the most common thyroid disorder followed by overt hypothyroidism (10%) and hypothyroxinemia (2.2%) in pregnant women. HB and vitamin B12 levels were significantly lower in first and second trimesters of pregnancy when compared with controls (P=0.001). Serum free thyroxin correlated positively with HB and ferritin, whereas TSH correlated negatively with HB and ferritin. Conclusion High prevalence of hypothyroidism in pregnant females and its association with iron and vitamin B12 deficiencies highlight the urgent need for thyroid status to be detected and to evaluate nutritional deficiencies in such group, so as to start early treatment promptly and to prevent the adverse effects of the disorder to both mother and fetus to achieve normal pregnancy outcome.

Prolonged QTc interval in adults with diabetic ketoacidosis: is it only electrolyte disturbance? Osama A Khalil, Ghada M Samir, Ayman M.E.M Sadek The Egyptian Journal of Internal Medicine 2019 31(2):136-141 Context Cardiac arrhythmia in diabetic ketoacidosis (DKA) is a well-known complication that is usually a result of electrolyte imbalance. Another frequently missed cause of arrhythmia is the QT interval prolongation, which is not always attributed to electrolytes disturbance. Aim We aimed to explore the frequency of QTc interval prolongation among patients with DKA in the medical ICU, the association with serum electrolytes and pH, and the implication on the outcome. Patients and methods We carried out a cross-sectional cohort study on patients with DKA admitted to medical ICU. We had worked on 72 patients with DKA by performing the routine investigation including ECG follow-up during the hospital stay. Maximum QT interval in all measured leads (QTmax) and heart rate-corrected QTmax (QTmaxc) were calculated in milliseconds according to Bazett’s formula. We used SPSS, version 20.0, with the following statistical tests: Shapiro–Walk, Student’s t, Pearson’s correlation, logistic regression, receiver operating characteristic curve analysis, and relative risk. Results The frequency of QTmaxc interval prolongation without electrolyte imbalance was seen in 46 (63.9%) patients. pH revealed to be the most significant independent risk factor for QTmaxc interval prolongation (odds ratio=8.39, 95% confidence interval: 1.67–18.06) with a cutoff value less than 7.03, with sensitivity of 56% and specificity of 44%. QTmaxc prolongation carried a relative risk of ∼1.7-fold for mortality in patients with DKA. Conclusion Acidosis carries an independent risk for QTmaxc interval prolongation in the absence of electrolytes abnormalities, with related poor ICU outcome in patients with DKA.

Effect of walking and aerobic exercise on physical performance and depression in cases of type 2 diabetes mellitus Manal K Youssef The Egyptian Journal of Internal Medicine 2019 31(2):142-148 Aim Investigate the effect of walking and aerobic exercise on physical performance and depression symptoms in patient with type 2 diabetes mellitus (T2DM). Patients and methods Forty patients with T2DM were divided into two groups. Group 1 was treated by walking 30 min three times per week. Group 2 was treated by aerobic exercise for 30 min for 3 months. Physical performance and depression were measured pretreatment and posttreatment. Results Walking improved BMI by 4.2%, waist circumference by 1.22%, blood glucose by 6.82%, timed up and go test by 24.34%, static balance by 74.63%, 6 min walk by 14.91%, muscle power by 15.97%, muscle endurance by 71.42%, 2 min stair climbing by 52.63%, squat test by 73.63%, and hospital scale of anxiety and depression by 46.79%. Aerobic exercise improves by BMI 5.47%, waist circumference by 3.95%, blood glucose by 17.21%, time up and go test by 29.2%, static balance by 118.58%, 6 min walk 8.57%, muscle power by 31.93%, muscle endurance by 81.63%, 2 min stair climbing by 49.19%, squat test by 81.3%, and hospital scale of anxiety and depression by 50%. Conclusion Both walking and aerobic exercise improve physical performance and depression scale in T2DM.

Prevalence of diabetic kidney disease in patients with type 2 diabetes mellitus Khaled A Elhefnawy, Ahmed Maher Elsayed The Egyptian Journal of Internal Medicine 2019 31(2):149-154 Introduction The increased prevalence of diabetes has led to an increase in its vascular complications such as coronary heart disease, stroke, diabetic nephropathy (DN), and end-stage renal disease. The growing epidemic of type 2 diabetes led to increased incidence of DN. DN is characterized by proteinuria. Objective The aim of the study was to estimate the prevalence of diabetic kidney disease in patients with type 2 diabetes mellitus. Patients an methods This study included 151 patients with type 2 diabetes mellitus. After fulfilling the inclusion and exclusion criteria, all patients were submitted to these investigations: complete blood count, fasting blood glucose, and glycosylated hemoglobin, blood urea, serum creatinine, serum uric acid, calculation of estimated glomerular filtration rate using modification of diet in renal disease equation, lipid profile, serum albumin, urine analysis, and urinary albumin creatinine ratio. Results Of the patients, 60.3% have normoalbuminuria, 31.8% have microalbuminuria, and 7.9% have macroalbuminuria. Regarding glomerular filtration rate grades, 25.8% of the patients are of G1, 31.8% G2, 16.6% G3a, 16.6% G3b, 6.6% G4, and 2.6% are of G5. There is a significant increase in grading in patients with macroalbuminuria; also, most normoalbuminuric patients are G1 and G2. Of the studied patients, 53.6% are at low risk of chronic kidney disease progression, 9.9% are at moderate risk, and 36.4% are at high risk. Conclusion The prevalence of DN is increasing, partly due to the growing epidemic of type 2 diabetes so we have to detect it as early as possible to apply the proper measures to prevent or delay its progression.

Salivary α2-macroglobulin as a marker for glycemic control in patients with type 2 diabetes mellitus Ayman Abd-Elrahman Mohamed Nsr-Allah, Saad El-Osh, Azza M Ahmed, Sara Hazem The Egyptian Journal of Internal Medicine 2019 31(2):155-163 Introduction Panic from needle and the cost can discourage some diabetic patients from monitoring their blood glucose levels in a regular manner, so there is a critical need to find a new cost-effective, painless, and sensitive glucose-detection method. Many studies have found that α2-macroglobulin (A2MG) concentrations are increased in the blood of both type 1 and type 2 diabetic patients. Aim The aim of the article is to study the salivary A2MG value as a marker for glycemic control in patients with type 2 diabetes mellitus (DM). Patients and methods A total of 60 patients were included and divided into three groups. Group 1 included patients with type 2 DM with glycosylated hemoglobin (HbA1c) levels more than or equal to 7% (inadequate glycemic control). Group 2 included patients with type 2 DM with HbA1c levels less than 7% (adequate glycemic control). Group 3 included healthy persons (control group). All patients were subjected to the following: thorough history taking, full physical examination, and laboratory investigations, including fasting blood glucose, cholesterol, triglycerides, HbA1c, and salivary A2MG. Results There were statistical significant relations between salivary A2MG and both BMI and duration of diabetes (P<0.05) in type 2 uncontrolled diabetes group but not in controlled group (P>0.05). There were statistically significant positive correlations between levels of salivary A2MG and HbA1c, cholesterol, triglycerides, fasting blood sugar, duration of DM, BMI, and age. The best cutoff value of salivary A2MG as a predictor of bad glycemic control, in relation to HbA1c, was more than or equal to 645 ng/ml, with area under the receiver operating characteristic curve of 0.92, sensitivity of 91.7%, specificity of 90%, and P value of less than 0.001. Conclusion and recommendation With the advantages of rapid, accessible, sensitive, cost-effective, and noninvasive method, salivary A2MG is a promising biological marker for glycemic control in patients with type 2 DM.

The relationship between vitamin D level and thyroid antibodies in primary hypothyroidism Salwa S Hosny, Maram M.M Aboromia, Nesma A Ibrahim, Doaa K Abd El Halim The Egyptian Journal of Internal Medicine 2019 31(2):164-170 Background Vitamin D deficiency is a global health problem. Its deficiency has been reported to be associated with different autoimmune diseases. The aim of this study was to evaluate the relationship between vitamin D level and thyroid antibodies in primary hypothyroidism. Patients and methods A total number of 90 individuals were enrolled in this study. They were divided into the following groups: group I included 60 naïve patients with hypothyroidism representing the case group, and this group was further subdivided into 30 patients with autoimmune thyroid disease (AITD) and 30 patients without autoimmune thyroid disease. Group ІІ included 30 apparently healthy participants matched for age and sex representing a control group. All participants underwent a detailed clinical examination and laboratory tests including, 25 (OH) vitamin D, thyroid function tests (thyroid-stimulating hormone, free triiodothyronine, and free thyroxine), and thyroid autoantibodies assessment, including anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies. Results Serum levels of 25 (OH) vitamin D recorded a highly significant difference between the studied groups (13.08±3.58 ng/ml in group I vs. 20.67±13.33 ng/ml in group II; P<0.01). Moreover, there was a highly significant difference between patients with AITD and patients without AITD (12.6±5.5 ng/ml vs. 14.5±7.3 ng/ml, respectively; P<0.01), and vitamin D deficiency was more frequent in patients with AITD (43.3%), rather than 23.3% in patients without AITD. There was a significant negative correlation between serum 25 (OH) vitamin D and thyroid-stimulating hormone, anti-thyroid peroxidase antibodies, and anti-thyroglobulin (r=−0.459, −0.582, and −0.324, respectively; P<0.05), whereas a significant positive correlation between serum 25 (OH) vitamin D and both of free triiodothyronine and free thyroxine (r=0.368 and 0.598, respectively; P<0.05). Conclusion Vitamin D deficiency is associated with AITD, and further studies are needed to determine its role in management of primary hypothyroidism.

Risk factors of hematological malignancies in Upper Egypt: a case–control study Safinaz Hussein, Doaa Mohamed, Rania Hafez The Egyptian Journal of Internal Medicine 2019 31(2):171-177 Background The definite etiologies of hematological malignancies (HMs) are still unknown. Objective The aim of our study was to identify the distribution of HMs and its subtypes as well as to determine their risk factors in Assiut Governorate, Upper Egypt. Patients and methods This case–control study included 1137 patients diagnosed with different HMs (leukemia, lymphoma, myelodysplastic syndromes, and multiple myeloma) and normal healthy controls from January 2014 to December 2017. Data were collected using interviewed administered questionnaire, and clinical and biochemical assessment. Logistic regression analysis was conducted to identify the predictors of HMs and their subtypes. Results Leukemia was the most common presented HM (75%), nearly half of leukemic cases were acute myeloid leukemia, while non-Hodgkin’s represented the majority of patients with lymphoma. Increasing age and diabetes mellitus were significantly associated with all HMs. Except for multiple myeloma, hepatitis C virus and obesity had significantly higher odds ratio for HMs and their subtypes. Exposure to agricultural chemicals was a risk factor for lymphoma and myelodysplastic syndromes while exposure to electromagnetic field was a significant risk factor for leukemia. Conclusion and recommendations This is the first study evaluating the different risk factors and distribution of HMs in Upper Egypt. Studies with a more detailed evaluation of the role of the possible risk factors in the occurrence of blood cancers in Egypt are recommended.

Alexandros Sfakianakis
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