Introduction An association between inflammatory bowel disease (IBD) and autoimmune thyroid disease (AITD) exists. The aim of the present study was to evaluate thyroid nodules, function, and antibodies in patients with IBD. Patients and materials The study included 50 patients with established diagnosis of IBD either ulcerative colitis (UC) or Crohn’s disease and 25 healthy controls. They were classified into two groups: group I included 25 patients with UC, and group II included 25 patients with Crohn’s disease; the control group included 25 healthy individuals. They were subjected to history taking, complete physical examination, and laboratory investigations that included evaluation of erythrocyte sedimentation rate (ESR), C-reactive protein, fecal calprotectin, free T3, free T4, thyroid-stimulating hormone, antithyroid peroxidase (TPO), antithyroglobulin (TG), and TSH receptor antibodies. Ileocolonoscopic and histopathological examination with assessment of IBD activity and thyroid ultrasonography were carried out. Results There were no statistically significant differences between the three groups as regards anti-TG antibodies (P=0.075), anti-TPO (P=0.190), AITD assessed serologically or by means of ultrasound (P=1.000), or as regards thyroid status (P=0.528). IBD patients had significantly more thyroid nodules compared with controls (P<0.001), and there was a positive correlation between IBD markers of activity (ESR and fecal calprotectin) and the presence of nodules. A significant negative correlation existed between free T3 and fecal calprotectin, ESR, and C-reactive protein, as well as between free T4 and ESR and fecal calprotectin. A significant positive correlation between anti-TG antibodies and fecal calprotectin as well as between anti-TPO antibodies and histological activity assessment of UC patients also existed. We found a significant negative correlation between free T3 and free T4 and several indices of IBD activity/severity. Conclusion AITD and altered thyroid function were the same among IBD patients and controls. However, IBD patients had significantly more nodules; indices of activity/severity of IBD correlated negatively with free T3 and T4, and positively with anti-TPO, anti-TG, and nodularity.

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Background Autoimmune diseases are chronic conditions initiated by the loss of immunological tolerance to self-antigens; they represent a heterogeneous group of disorders that afflict specific target organs or multiple organ systems. Autoimmune thyroid disease (AITD) is a common organ-specific autoimmune disorder affecting mostly middle-aged women. AITD is a term that includes various clinical forms of autoimmune thyroiditis; among these diseases, Hashimoto's thyroiditis and Graves' disease are the two most common types and share many features immunologically. Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to severe disability and premature mortality. Given the same pathogenic mechanisms, autoimmune diseases tend to cluster together, and hence this study was designed to investigate the relationship between AITD and RA, particularly seropositive versus seronegative subtypes. Patients and methods The study included 70 patients with evidence of RA. Their diagnosis was based on the 2010 American College of Rheumatology (ACR)-EULAR classification criteria, and they were subclassified into two groups: group I, comprising 35 patients with seropositive RA (positive to one or both seromarkers), and group II, comprising 35 patients with seronegative RA (negative to both seromarkers). Twenty healthy age-matched and sex-matched controls constituted group III. All of the studied participants underwent detailed history-taking and physical examination, focusing on RA duration of illness, clinical features suggestive of thyroid dysfunction, and disease activity score (DAS28). We determined the complete blood count, erythrocyte sedimentation rate, C-reactive protein, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, thyroid stimulating hormone (TSH), serum total T3 (TT3), serum total T4 (TT4), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), anti-thyroid peroxidase (anti-TPO), thyroglobulin Ab, and TSH receptor antibody (TRAb) levels, and also performed a neck ultrasound. Results It was found that erythrocyte sedimentation rate, C-reactive protein, RF, and anti-CCP were significantly higher in RA patients versus controls, particularly in seropositive versus seronegative patients. No significant difference was found between the studied groups as regards TSH, T3, and T4 levels; however, hypothyroidism was found to be more common than hyperthyroidism in RA patients (29 vs. 3% in group I and 9% in group II). Anti-TPO and antithyroglobulin were significantly higher in RA patients versus controls (P < 0.001) and specifically in seropositive (1301.9 ± 1716.0 and 1750.0 ± 1866.2, respectively) versus seronegative patients (799.4 ± 1597.7 and 898.1± 988.11, respectively). TRAbs were detectable in a small subset of RA patients (6% regardless of the serostatus) with significant difference between patients and controls (P = 0.006). Ultrasonographic features of thyroiditis were significantly evident in RA patients versus controls (P = 0.001). A positive correlation was found between RA autoantibodies (RF and anti-CCP) and thyroid autoantibodies (mainly anti-TPO and TRAbs) (P = 0.007, 0.012, 0.004, and 0.035, respectively). Conclusion Thyroid dysfunction and AITD are common in RA patients, with hypothyroidism being the most common disorder, which is prevalent in 29% of patients regardless of their serostatus. This association was independent of disease activity assessed by DAS28. Increased incidence of thyroid autoimmunity was seen in seropositive RA versus seronegative RA patients, as evidenced by higher levels of thyroid autoimmune markers in the former. TRAbs were detectable in a small subset of patients with RA.

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Introduction Hashimoto’s thyroiditis and Graves’ disease both constitute autoimmune thyroid diseases (AITD) that frequently coexist with other autoimmune disorders (AID). This study was conducted to evaluate the frequency of rheumatoid arthritis (RA) in patients diagnosed with AITD in relation to the general population. Patients and methods This was a cross-sectional case–control study, conducted on 103 patients with AITD of either Hashimoto’s thyroiditis or Graves’ disease with positive antithyroid peroxidase (TPOAb). A group 100 volunteers, matched for age and sex, with normal thyroid function and negative history of AID, were investigated for the prevalence of RA in the general population (control group). Participants in the study were tested for thyroid profile, rheumatoid factor (RF), erythrocyte sedimentation rate, and C-reactive protein. When appropriate, anticitrullinated peptide antibody was checked. Results Patients with AITD had a higher frequency of RA than the control (P=0.031). Thyroid profile showed no significant difference between patients with and without RA within the group of AITD. In that group, a positive correlation between titers of both RF and TPOAb was observed (r=0.474, P<0.001). The coexistence of RA with AITD was noticed to be associated with higher RF, C-reactive protein, and TPOAb titers as well as. the presence of type 2 diabetes mellitus, other AID and family history of RA. Conclusion RA is more prevalent in patients with AITD than the general population, and the underlying autoimmunity is likely to be the link. Our data highlight the importance of screening thyroid patients for RA especially if present with type 2 diabetes mellitus, another AID, or having a family history of RA.

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Objective The aim was to evaluate the effectiveness of an individualized educational program in improving patient’s awareness, knowledge, and attitude and to assess its role in reducing the burden of gestational diabetes mellitus (GDM). Patients and methods A prospective study was conducted on women diagnosed to have GDM at 24–28 weeks of gestation according to The Diabetes In Pregnancy Study group India criteria 2015 (2 h blood glucose ≥140 mg/dl) between December 2015 and December 2016 who were enrolled into an individualized GDM educational program. A modified and shortened version of a validated questionnaire developed by Carolan and colleagues was tested before and after education to evaluate the feedback of education. Follow-up was every 2 weeks till labor to assess awareness together with both maternal and fetal outcomes. Results A total of 60 pregnant women diagnosed to have GDM were included. The questions that were answered correctly in the post-test by more than 50% of the participants fell into these categories: definition of GDM (100%), associated risk factors (75%), way of diagnosis (83.3%), management of GDM (71.7%), and postpartum follow-up (56.7%). As regards fetal and maternal outcome it was observed that both weight gain and glycemic control were better in the well-educated group versus other groups (P=0.02, 0.01, respectively). Conclusion Health education plays an important role in increasing patients awareness regarding the GDM risk and its proper management in order to reduce its complications both for the mother and the fetus.

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Introduction Over the past few decades obesity has become a major burden on health worldwide. The prevalence of hypertension has increased with a significant increase in the prevalence of overweight and obesity. Recent studies indicate an important role of adipose tissue hormones called adipokines in obesity-associated complications. Apelin has recently been added to the family of adipokines. One of the physiologic functions of the apelin/APJ system is regulation of the cardiovascular function. The aim of this study was to determine the relation of serum apelin to obesity-associated hypertension as well as to myocardial performance. Patients and methods The study included 30 obese hypertensive patients, 30 obese nonhypertensive patients, and 25 age-matched and sex-matched controls. In all studied participants we determined the lipid profile, serum insulin, fasting blood glucose level, HOMA-IR, serum apelin, and echocardiographic results of left ventricular systolic and diastolic function. Results Higher levels of fasting blood glucose, fasting serum insulin, HOMA-IR, triglycerides, total cholesterol, and low-density lipoprotein were detected in obese hypertensive and nonhypertensive patients. Left ventricular mass index (LVMI) was increased in both obese hypertensive and nonhypertensive patients in comparison with healthy individuals. Left ventricular ejection fraction and E/A ratio were significantly lower in hypertensive obese versus nonhypertensive obese individuals (P = 0.004 and <0.001, respectively), whereas LVMI was higher in hypertensive versus nonhypertensive patients (P < 0.001). Apelin levels were significantly equally higher in obese hypertensive and nonhypertensive patients (6.10 ± 1.88 and 6.40 ± 1.60 ng/ml) compared with controls (4.22 ± 0.86 ng/ml, P < 0.001). In hypertensive obese individuals, serum apelin correlated negatively with left ventricular ejection fraction (P = 0.02) and directly with E/A ratio (P = 0.03). Conclusion Apelin levels are significantly higher in obese hypertensive and nonhypertensive patients. This increase might be a compensatory mechanism against myocardial dysfunction with obesity.

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Background Thyroid hormonal disturbance plays an essential role in coronary artery disease (CAD) development and progress. Few studies have detected the relation between percutaneous coronary intervention (PCI), thyroid gland function, and morphology. We aimed to assess the influence of baseline thyroid function tests on the outcome of PCI in euthyroid patients with CAD, and to detect the effect of PCI on the thyroid function and ultrasound features. Patients and methods This study included 113 clinically euthyroid patients with stable CAD. Serum free T3, serum free T4, thyroid-stimulating hormone (TSH), thyroid-stimulating hormone index, free T3/T4 ratio, anti-thyroperoxidase (TPO), and high-sensitivity C-reactive protein had been measured before, and then 24 h and 3 months after PCI. The morphology of thyroid was evaluated through thyroid ultrasound before and 3 months after PCI. Results One day after PCI, there was a significant increase in serum FT3 and serum FT4 and no significant change in the serum TSH compared with just before PCI (P < 0.001, P = 0.04, P = 0.97, respectively). In addition, there was a significant increase in serum FT3/FT4 ratio compared with just before PCI (P = 0.007). Three months after PCI, there was a significant increase in serum FT4, decrease in serum FT3 returning to baseline, and a significant increase in serum TSH compared with just before PCI (P = 0.42, P < 0.001, P < 0.001, respectively). There was a significant decrease in the serum FT3/FT4 ratio and significant increase in serum thyroid-stimulating hormone index compared with just before PCI ( P ≤ 0.001, P < 0.001, respectively). Higher TSH and measured echogenicity index were independent pre-PCI predictors of unfavorable outcomes after 24 h with cutoff values greater than 0.95 mIU/ml and greater than 1.81, respectively. Lower FT3 and higher FT4 levels were independent pre-PCI predictors of unfavorable outcomes after 3 months with cutoff values less than or equal to 2.95 pg/ml and greater than 1.3 ng/dl, respectively. Conclusion A state of euthyroid hyperthyroxinemia was detected 24 h after PCI. A state of thyroid hormone resistance was detected 3 months after PCI. Higher TSH and measured echogenicity index independently predicted unfavorable outcome after 24 h. Lower FT3 and higher FT4 levels independently predicted unfavorable outcomes after 3 months.

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Background Obesity is considered to be a worldwide health problem. Obese individuals are at a high risk of developing dyslipidemia, hypertension, impaired glucose tolerance, insulin resistance, and consequent increase of the risk of metabolic and cardiovascular diseases. In obesity, elevated insulin resistance is observed, which may be associated with disturbances in zinc status in the body. The few studies concerning the status of zinc and its relationship with insulin resistance in obese children and adolescents have brought inconclusive results. Aims The aims of this work were to study the level of serum zinc in obese children and adolescents and to evaluate its potential relation to obesity, insulin resistance, and lipid profile. Patients and methods Thirty obese children and adolescents and 30 healthy controls aged 5–19 years were recruited for the study. Lipid profile, serum zinc, fasting plasma glucose, and fasting insulin were measured. Insulin resistance was calculated according to the homeostatic model of assessment for insulin resistance and quantitative insulin-sensitivity check index. Results Obese individuals had significantly higher serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, fasting blood insulin, and homeostatic model of assessment for insulin resistance, whereas high-density lipoprotein cholesterol and quantitative insulin-sensitivity check index were significantly lower in obese children than in healthy controls (all P<0.05). The serum concentration of zinc was significantly lower in obese individuals compared with control. There was a positive significant correlation between serum zinc level and high-density lipoprotein (r=0.511, P<0.05). Conclusion Obese children and adolescents have a poorer zinc status than children and adolescents of normal weight, which may affect lipid profile.

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Introduction There is growing evidence that some cases of chronic idiopathic urticaria are associated with various autoimmune diseases such as thyroid autoimmunity. The association between chronic urticaria (CU) and thyroid disorders has been a subject of controversy. Some reports link CU with hyperthyroidism or hypothyroidism. The frequency of thyroid antibodies in patients with chronic idiopathic urticaria reported in 2009 was 30%, which is higher than that previously reported. Objective This is a case-control study that aimed to detect the presence of markers of thyroid autoimmunity (thyroid autoantibodies with or without underlying abnormal thyroid functions) among a cohort of autologous serum skin test (ASST)-positive patients with CU in comparison with ASST-negative CU patients as well as with healthy controls, and correlating it to the severity of urticaria symptoms. Patients and methods This study was carried out on 80 CU patients attending the Allergy and Immunology Clinic of Ain Shams University Hospitals. CU was diagnosed on the basis of the appearance of continuous recurrent hives for more than 6 weeks. The patients were subdivided into the following groups: group A - 40 CU patients with positive ASST; group B - 40 CU patients with negative ASST. In addition, 40 healthy individuals were included in this study as healthy controls. History and general examination were conducted to all study grouos. Assessment of the Urticaria Activity Score-7 and laboratory investigations including those for complete blood count, erythrocyte sedimentation rate, thyroid function, thyroid Abs, namelyantimicrosomal antibody and antithyroglobulin antibody and total immunoglobulin E (IgE), were done. Results Comparison between the three groups showed that antithyroglobulin antibody was highly statistically significant in group A than in both group B and healthy controls. Moreover, antimicrosomal antibody was also found to be of higher statistical significance in group A than in both group B and healthy controls. Although total IgE had no statistical significance between groups A and B, total IgE was found to be statistically significantly higher in group B than in healthy controls. Level of thyroid stimulating hormone was higher in group A than in controls, and free T3 was lower in group A than in group B. Conclusion We suggest that thyroid diseases have a role in CU, which was confirmed by a higher level of thyroid antibodies in the ASST-positive group than in ASST-negative patients and healthy controls.

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Background and objectives High-normal thyroid stimulating hormone (TSH) (2.6–4.5 μIU/ml) is associated with metabolic syndrome (MetS) in population studies. We hypothesized that euthyriod polycystic ovary syndrome (PCOS) with TSH of higher than 2.5 had altered anthropometric, metabolic, and endocrine parameters as well as higher percentage of MetS compared with those with lower TSH levels. Patients and methods The present study included 60 young euthyroid PCOS women without any thyroid risk factors and 60 age-matched and BMI-matched healthy, fertile women. Anthropometric measurements were obtained, biochemical and hormonal assay were evaluated, and the homeostatic model assessment-insulin resistance was calculated. PCOS women were divided into high-normal TSH (group 1) and low-normal TSH (group 2) groups. MetS was defined according to National Cholesterol Education Program/Adult Treatment Panel III. Results Group 1 had significantly higher waist circumference, systolic blood pressure and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting glucose, fasting insulin, homeostatic model assessment-insulin resistance, and free androgenic index and significantly lower high-density lipoprotein cholesterol, free thyroxin, and sex hormone binding globulin compared with both group 2 and healthy controls. In addition, group 1 (compared with group 2) had significantly higher percentage and higher risk of MetS [46.7 vs. 16.7%, P=0.01; odds ratio (OR)=4.4] and some of its components such as fasting glucose of at least 100 mg/dl (26.7 vs. 6.7%, P=0.03; OR=4.3), high-density lipoprotein cholesterol of less than 50 mg/dl (50 vs. 23.3%, P=0.03; OR=3.3), TG of at least 150 mg/dl (50 vs. 20%, P=0.01; OR=4), and near-significant higher percentage of both waist circumference of 88 cm or more and systolic blood pressure of at least 130 (P=0.06 for both, OR=3.25, 5, respectively). TSH level of 2.85 was the best threshold to indicate MetS risk (sensitivity=68%, specificity=88%, Youden index=0.56, area under the curve=0.81). Conclusion High-normal TSH PCOS women had increased risk of MetS. The optimal cut-off point for diagnosis of MetS was 2.85 µIU/ml.

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Background The habit of chewing Qat is one of Yemen’s social and cultural characteristics. Most Yemeni adults chew Qat regularly. The general belief among the Yemeni diabetics is that Qat chewing helps to lower their blood glucose. Objective In this study, we investigated the effect of Qat chewing on the level of blood glucose on patients with type 2 diabetes. Patients and methods The study included 260 patients with type 2 diabetes who were divided into two groups: Group 1 included 130 patients who were non-Qat chewers. Group 2 included 130 patients who were Qat chewers All patients underwent clinical examination; fasting, postprandial, and random blood glucose examination before and after Qat chewing; and glycated hemoglobin and lipid profile. Results The results of the study demonstrated that there was a significant increase in heart rate and arterial blood pressure after Qat chewing, whereas there were no significant changes in the level of blood glucose before and after Qat chewing. Moreover, we found that there were no effects in the levels of total cholesterol and triglyceride, whereas there was a nonsignificant decrease and a nonsignificant increase in the levels of low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol, respectively, among the Qat chewers. Conclusion We found that there was a significant effect of Qat on heart rate and hypertension. There was no significant effect of Qat on the blood glucose or lipids levels. The only effect, which leads to wrong belief, is that Qat chewing produces feeling of euphoria, stimulation, heightened awareness, increased confidence, alertness, and energy, resulting in temporary alleviation of fatigue which the diabetic patients experience. All these effects are because of the cathinone and moderate sympathetic effects.

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Background Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in adult women, and is emerging as a common cause of menstrual disturbance in the adolescent population. Insulin resistance, which is considered one of its underlying causes, has increased markedly in the past decade, placing more adolescent girls at risk for PCOS and its complications. Anti-Mullerian hormone (AMH) is secreted by the granulose cells of ovarian follicles and correlated with the count of small antral follicles and it is expressed throughout folliculogenesis. Objective This study aimed to evaluate AMH in Egyptian women with PCOS and to determine whether it might serve as a prognostic marker for treatment efficacy with metformin. Patients and methods This study included 30 women with PCOS (group 1) and 30 healthy women without PCOS (group 2). AMH was measured in both groups, and before and after treatment with metformin (2550 mg) for 3 months in group 1. Results AMH levels were higher in PCO groups before (3.54±0.58 ng/ml) and after treatment (2.79±0.39 ng/ml) than the control group (2.14±0.49 ng/ml), with P value less than 0.01. In the PCO group, it was higher before (3.54±0.58 ng/ml) than after treatment (2.79±0.39 ng/ml), with P value less than 0.01. Conclusion AMH is higher in PCO patients and its levels decrease significantly with the insulin sensitizer metformin, and it can be used as a marker for treatment efficacy with metformin.

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Introduction Vitamin D is one of the important hormones involved in Ca homeostasis. It is also essential for the prevention of osteoporosis and fractures. Vitamin D is important for maintaining many physiologic functions, such as optimal balance, muscle strength, and innate immunity. Vitamin D deficiency is associated with an increased risk for several types of cancer, as well as autoimmune and cardiovascular disorders. As the influence of diet on vitamin D status is minimal and most circulating vitamin D is derived from exposure to sunlight, elderly populations are greatly affected; they have marked limitations that hinder their exposure to sunlight as well as their feeding and nutritional habits. Objectives of the study The aim of this study was to assess vitamin D status in Egyptian geriatric, homebound, nursing home residents, and ambulatory elderly individuals. Patients and methods This study was carried out on 90 elderly male and female individuals divided into three groups: the first group included 30 homebound elderly individuals, the second group included 30 elderly individuals living in nursing homes, and the third group included 30 community-dwelling ambulatory elderly individuals. Results There were high statistically significant difference in the vitamin D levels between the groups studied, being the highest in group III, 158 (18–240) nmol/l, and the lowest in group II, 16 (4–194) nmol/l. Statistically significant differences were found in sun exposure, with good exposure in 60% of the individuals in group III. There were also statistically significant differences in the intake of vitamin D in diet, with good intake in 64.30% of the individuals in group III. Also, we found the highest waist circumference in group II (98.68±20.73 cm). Vitamin D showed a significant positive correlation with serum calcium in group II (ρ=0.199) and a positive correlation with aspartate transaminase (AST) in group III (ρ=0.418). Conclusion Elderly Egyptian individuals in nursing houses are at risk of developing vitamin D deficiency because of lack of exposure to sunlight, dietary problems, and or central obesity.

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Background Paralleling the increasing prevalence of obesity in the Egyptian population, metabolic syndrome and liver steatosis are also on the rise. Body composition measurement is used to describe the percentages of fat, bone, water, and muscle in human bodies. The available classic weight loss treatments such as low-calorie diet, exercise, behavioral modification, and pharmacotherapy usually achieve only limited weight loss. The BioEnterics Intragastric Balloon (BIB) is an endoscopic liquid-filled device for the treatment of obesity. Aim The aim of this study was to examine the safety of BIB insertion in a group of obese middle-aged Egyptian women treated with intragastric balloon to induce weight loss for 6 months and report its effect on their anthropometric measurements, body composition, fatty liver, and comorbidities. Patients and methods During the period from February 2012 until August 2013, 47 consecutive middle-aged female patients were enrolled for BIB insertion. Inclusion criteria were mainly based on the BMI (≥30.0 kg/m ² ) and on associated comorbidities. Apart from physical and anthropometric evaluation, body composition analysis was performed using a bioelectrical impedance analyzer to estimate fat mass, body fat percentage, and fat-free mass. The Adult Treatment Panel III criteria were used to diagnose metabolic syndrome, and ultrasound evaluation of the liver for the presence and grade of steatosis was performed. BIB placement was carried out after diagnostic endoscopy, under intravenous conscious or unconscious sedation. Results The total percentage of complications from BIB insertion was 12.8%, which were mostly mild and reversible. Three (6.4%) patients had their gastric balloon removed early (two voluntarily and one due to de-novo peptic ulcer) and were excluded from the study, whereas the remaining 44 patients continued their 6-month therapy duration. Overall, BIB insertion significantly reduced weight from a mean value of 96.82 ± 14.18 kg at baseline to 83.45 ± 12.03 kg after 6 months (P < 0.001). The mean value for the amount of weight lost at endpoint was 13.36 ± 3.29 kg, whereas the mean value for BMI lost at the time of BIB removal was 5.12 ± 1.20 kg/m ² , which was a significant reduction compared with baseline values (P < 0.001). No significant change occurred in the liver size over the 6-month study period (P = 0.12), whereas a significant decrease in the grade of steatosis was noted. Body fat mass and body fat percentage with bioelectrical impedance analyzer were significantly reduced (P < 0.001). However, there was also a significant decline in fat-free mass (P < 0.001). Significant favorable changes in the biochemical markers of metabolic syndrome, homeostasis model assessment of insulin resistance index, and liver profile also occurred. An overall 4.6% of patients showed resolution, whereas 31.8% showed improvement in the features of metabolic syndrome. Conclusion This study provides anthropometric, biochemical, and body composition evidence on significant improvement in metabolic syndrome, obesity-associated comorbidities, and fatty liver after weight loss induced by the minimally invasive and relatively safe technique. However, it is recommended to continue a weight-reducing diet after BIB removal for achieving long-term effectiveness and to add exercise programs to dietary restriction for promoting more favorable change in body composition.

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Background Diabetic nephropathy (DN) is the leading cause of renal failure. Diabetic patients with microalbuminuria typically progress to proteinuria and overt DN. Similar to other microvascular complications of diabetes, there are strong associations between glucose control (as measured using HbA1c) and the risk of developing DN. Apelin (APLN), a peptide first isolated from bovine stomach tissue extracts, is the endogenous ligand for the G-protein-coupled APJ receptor that is expressed at the surface of some cell types. APLN and APJ are widely expressed in homogenates from animal organs in a pattern shared with angiotensinogen and the angiotensin receptor. APLN is widely distributed in the central nervous system and periphery, especially in the heart, kidney, lung, and mammary glands. The APLN–APJ system may be involved in the pathogenesis of DN, which may play a renoprotective role partially by antagonizing the angiotensin II–ATIR pathway. Aim The aim of this study was to investigate the relation between serum APLN and different grades of DN in type 2 diabetic patients. Patients and methods This study was conducted on 150 diabetic patients and 20 controls selected from the inpatient department and outpatient clinics of the Internal Medicine Department in Menoufia University Hospital. The selected participants were divided into four groups: group 1 included 20 healthy controls; group 2 included 50 type 2 diabetes mellitus (T2DM) patients with normoalbuminuria; group 3 included 50 T2DM patients with microalbuminuria; and group 4 included 50 T2DM patients with macroalbuminuria. Members of the study groups were subjected to thorough history taking with special emphasis on age, sex, and duration of diabetes mellitus. Investigations included liver profile, complete blood count, fasting and 2 h postprandial plasma glucose, glycosylated hemoglobin (HbA1c), complete urine analysis, kidney function tests (blood urea nitrogen and serum creatinine), urine albumin/creatinine ratio, estimated glomerular filtration rate, and serum APLN. Results Serum APLN was significantly higher in group 4 compared with the other groups, in group 3 compared with groups 1 and 2, and in group 2 compared with group 1. There was a significant positive correlation between serum APLN and serum creatinine, urine albumin/creatinine ratio, and HbA1c. Further, there was a significant negative correlation between serum APLN and estimated glomerular filtration rate in the studied diabetic patients. There was no correlation between serum APLN and BMI in diabetic patients. Conclusion From this study, we can conclude that serum APLN is significantly higher in patients with DN compared with diabetic patients without nephropathy, and there is a positive correlation between serum apelin and the degree of DN. Thus, APLN may play an important role in the development of DN.

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Background An evidence-based association was established between iron metabolism and insulin-resistant (IR) conditions, among which was type 2 diabetes. Previous studies have reported elevated hepcidin and ferritin levels in type 2 diabetics. Aim The aim of this study was to investigate the possible relationship between hepcidin or ferritin and the development of IR in type 1 diabetes mellitus (T1DM). Methodology The study included 60 male participants who were categorized as follows: 20 patients having T1DM with IR (group 1), 20 patients having TIDM without IR (group 2), and 20 age-matched and BMI-matched healthy individuals. IR was evaluated using estimated glucose disposal rate (eGDR) and insulin (U/day). All patients were tested for fasting blood sugar, postprandial blood sugar, hemoglobin A1c, lipid profile, high-sensitivity C-reactive protein, C-peptide, ferritin, and hepcidin. Results Serum hepcidin showed a nonsignificant difference between groups 1 and 2, and was not correlated to any IR-related variables. Serum ferritin was significantly higher in group 1, positively correlated to BMI, waist circumference, insulin (U/kg/day), and negatively correlated to eGDR. Out of all the significantly correlated variables, the hemoglobin A1c and waist/hip ratio were able to predict eGDR using the multivariate analysis. Conclusion Hepcidin plays no role in T1DM IR patients. Although ferritin was higher in T1DM patients and was negatively correlated to eGDR, it failed to demonstrate an independent influence on eGDR, hindering its potential use as a predictor of IR.

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Objective This study aimed to evaluate the effectiveness and safety of insulin glargine in combination with glimepiride treatment in daily practice in patients who failed premixed insulin with or without oral antidiabetic (OAD) regimen. Patients and methods This 6-month, prospective, multicenter, observational study conducted in Egypt included adult patients with type 2 diabetes mellitus on premix with or without OAD (glimepiride plus metformin), with glycated hemoglobin (HbA1c) greater than 8.5% and for whom the investigator decided to switch to insulin glargine in addition to glimepiride. Overall, three mandatory visits (baseline, 3 months, and 6 months) and seven phone calls were performed by the investigator for each eligible patient. Patients were assessed according to the value of HbA1c and fasting blood glucose (FBG). Results At the end of this study, the results showed effectiveness of combining insulin glargine plus glimepiride in reducing the mean baseline level of HbA1c% by 1.79 and 2.5% at visit 2 (week 12) and visit 3 (week 24), respectively (P<0.001). The percentage of patients reaching target HbA1c less than 7% in visit 2 (week 12) and visit 3 (week 24) was 5 and 24.3%, respectively. They also showed a significant reduction (P<0.001) in the mean FBG at visit 2 (week 12) and visit 3 (week 24) of 97.44 and 104.4 mg/dl, respectively, whereas the mean percent reductions were 44.37 and 47.54%, respectively. The percentage of patients who reaching FBG less than or equal to 100 mg/dl was 26.7 and 32.2%, in visit 2 (week 12) and visit 3 (week 24), respectively. There was no significant change in mean body weight between baseline and visit 3 (P>0.05). The mean 2-h postprandial blood glucose level was decreased significantly (P<0.001) at visit 2 to 171.93±68.2 mg/dl and at visit 3 to 155.88±56.61 mg/dl. The mean reductions of 2-h postprandial blood glucose at weeks 12 and 24 were 140.8 and 156.8 mg/dl, respectively, and the mean percentage reductions were 45 and 50.1%, respectively. A total of 50 adverse events were reported by 41 patients during the study. The most frequently reported adverse event was hypoglycemia, which included 37 episodes reported by 31 patients, where nocturnal hypoglycemia was represented in 12 episodes, with percentage of 32.4%. Conclusion The results showed that a combination therapy of insulin glargine and glimepiride improved glycemic control in patients with type 2 diabetes mellitus, who failed premixed with or without OAD (glimepiride plus metformin). In addition, safety analysis showed high patient tolerability to glargine and glimepiride regimen.

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Background and aim The prevalence of hepatitis C virus (HCV) infection among dialysis patients is higher than in the general population. The prevalence of cognitive impairment (CI) is common among hemodialysis (HD) patients. Also patients with end-stage liver disease are vulnerable to cognitive dysfunction. Malnutrition and inflammation are common occurrences in maintenance HD patients. About 40–78% of individuals on HD suffer from hypozincemia. Zinc deficiency has been observed with high prevalence in liver cirrhosis. This study was carried out to assess the effect of chronic HCV on serum zinc level and its relation as a cofactor to CI and nutritional status in HD patients. Patients and methods The study involved 80 HD participants who were enrolled into two groups: group I: 40 HCV-positive HD patients (20 without liver cirrhosis and 20 with liver cirrhosis) and group II: 40 HCV-negative HD patients without liver cirrhosis. All participants were evaluated as regards detailed history and clinical examination, standardized mini-mental state examination (MMSE), malnutrition inflammation score (MIS), Child–Pugh classification, complete blood picture (CBP), prothrombin time, international normalized ratio, alanine aminotransferase, aspartate aminotransferase, serum albumin, bilirubin, blood urea, serum creatinine, Na, K, Ca, P, transferrin, ammonia, serum zinc level (predialysis and postdialysis session), virology including anti-HCV Ab, quantitative HCV PCR and hepatitis B surface antigen, Kt/V, fibrosis-4 score (FIB-4 score), and abdominal ultrasonography. Results We found that MMSE and zinc level were significantly lower and MIS was significantly higher in HCV HD patients with liver cirrhosis when compared with HCV HD patients without liver cirrhosis and HCV-negative HD patients. A positive significant correlation was found between zinc level and MMSE while there was a negative significant correlation between zinc level and MIS. Conclusion There may be an association between hypozincemia, CI, and malnutrition in HD patients especially those with chronic hepatitis C associated with liver cirrhosis.

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Background Nesfatin-1 is a newly found anorectic neuropeptide with potent metabolic regulatory effects, whose peripheral levels are shown to be elevated in diabetes. It is a newly discovered hypothalamic neuropeptide that regulates appetite. Its discovery has generated great interest in the scientific community because of its implication in energy and glucose homeostasis. Nesfatin-1 is an amino-acid peptide originating from the cleavage of nucleobindin2. It has a molecular weight of 9.8 kDa and the half-life of nucleobindin2 mRNA is ∼6 h. Interestingly, nesfatin-1 is also expressed in pancreatic β-cells, where it is localized with insulin in secretion vesicles. The structure of nesfatin-1 is also tripartite; the segment starting from the N-terminal end and going up to 23 amino acids is called N23, the middle segment covering the amino acids from 23 to 53 is called M30, and the segment from the 53rd to 82nd amino acids toward the carboxyl terminus is called C29. Objective We compared serum nesfatin-1 in patients with type 2 diabetes with evidence of diabetic kidney disease (DKD) [urinary albumin–creatinine ratio (UACR) >300 mg/day or reduced estimated glomerular filtration rate (eGFR) <60 ml/min] with patients newly diagnosed with type 2 diabetes and who had no evidence of DKD (UACR<30 mg/day) and a control group of healthy nondiabetic individuals. Patients and methods Ninety patients attending the outpatient clinics at Alexandria Main University Hospital and Alexandria Police Hospital, Egypt, were enrolled in this cross-sectional study to determine the association of serum level of nesfatin-1 and DKD in patients with type 2 diabetes. They were divided into three groups: group I included 30 type 2 diabetic patients with DKD. Group II included 30 type 2 diabetic patients without DKD. Group III included 30 nondiabetic healthy controls matched for age and sex with group I. Assessment included a thorough assessment of history, complete clinical examination, neurological examination, fundus examination, and laboratory investigations including metabolic profile and plasma nesfatin-1 by enzyme-linked immunosorbent assay. Results The study showed a statistically significant difference between the three studied groups in terms of age (P<0.001), HbA1c and fetal bovine serum (P≤0.001), fasting insulin level (P=0.022), blood urea (P<0.001), serum creatinine (P<0.001), eGFR (P<0.001), and UACR (P<0.001). The difference between the three groups studied was not significant in serum nesfatin-1 (P<0.564). The mean peripheral concentrations of nesfatin-1 were not significantly higher in patients with diabetes who had evidence of DKD compared with newly diagnosed type 2 diabetic patients who had no evidence of DKD (P<0.001). Conclusion Serum nesfatin-1 was not significantly higher in albuminuric type 2 diabetic patients compared with normoalbuminuric patients. Serum nesfatin also did not correlate with eGFR and creatinine in the different groups studied. Serum nesfatin-1 may not be useful as an early marker of DKD instead of albuminuria. More studies are needed to identify the role and the significance of nesfatin in diabetic patients.

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Background Diabetes mellitus is a major contributor to morbidity and mortality worldwide. A marked variability in the application of preventive and therapeutic strategies was documented. Good quality of care is associated with lower burden of complications. Study objectives The present study was conducted to assess the quality of medical care provided to type 2 diabetic patients attending the internal medicine outpatient clinic in Alexandria Main University Hospital. Patients and methods A cross-sectional survey was conducted on 490 type 2 diabetic patients. Patients were interviewed using a structured questionnaire containing data on personal and sociodemographic characteristics as well as their self-care practices. Records of interviewed patients for a set of performance measures for diabetes care during the last year were reviewed. Weight, height, and blood pressure were measured and a series of laboratory investigations were carried out in order to assess the outcome of diabetes care. Results The study included 490 diabetic patients, of whom 281 (57.3%) were male patients. Their mean age was 53.62 ± 10.72 years. The duration of diabetes among the studied patients ranged from 1 to 22 years, with a mean of 9.54 ± 4.78 years. Nearly one-third of them were not compliant with antidiabetic treatment; 44.1% were current smokers and 82% of them had never practiced physical exercise before. In the previous 3 months, glycosylated hemoglobin was ordered for only 60.8% of the studied patients. In the last year, foot and fundus examinations were carried out for nearly two-third of the studied patients (68.2 and 64.5%, respectively). Moreover, only 12.5, 26.1, and 38.5% of patients were investigated for microalbuminuria, serum creatinine, and blood lipids, respectively. Uncontrolled hyperglycemic state was diagnosed in a vast majority of cases (99.2%). Moreover, 78.6% were obese and 82% had hypertriglyceredemia. Conclusion Intermediate outcome measures – namely, poor glycemic control and high prevalence of obesity and hypercholesterolemia – denote suboptimal medical care and/or poor compliance of patients with self-care management practices. In order to improve quality of care of type 2 diabetes aiming at reducing the incidence of complications, improving outcome, and improving the quality of life of patients, multilevel intervention plan should be carried out.

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Introduction Type 2 diabetes mellitus (T2DM) is a group of pandemic debilitating metabolic diseases featuring chronic hyperglycemia that results from defective insulin secretion and/or insulin actions. Dame and Sutor reported that diabetic patients are prone to thrombocytosis through a complex interplay of mechanisms. Therefore, the aim of our work is to evaluate serum sclerostin levels in patients with T2DM and to analyze the relationships among sclerostin, bone mineral density (BMD), bone metabolism, and thrombocytosis. Objective This study aimed to evaluate serum sclerostin in T2DM and its correlations with bone metabolism and thrombocytosis. Patients and methods Fifty male T2DM patients were enrolled; they were divided into two groups according to existing thrombocytosis. Forty age-matched men were included as controls. Clinical tests of physical mobility, fasting blood glucose, glycated hemoglobin, calcium, creatinine, parathormone (PTH), 25-hydroxyvitamin D, bone-specific alkaline phosphatase (BALP), serum carboxy-terminal cross-linked telopeptide of type I collagen (sCTX-I), serum sclerostin, and BMD were performed. Results There were insignificant increases in BMD in diabetic patients versus controls. There were significantly lower levels of PTH, BALP, and sCTX-I in the diabetes mellitus (DM) patient groups compared with the controls (P < 0.001). Serum sclerostin levels were significantly higher in DM patients than the controls, with insignificantly higher sclerostin levels in group II. Serum sclerostin was correlated positively with disease duration and correlated negatively with PTH, BALP, and sCTX-I (P < 0.001). Conclusion Sclerostin plays a role in the pathogenesis of bone changes in T2DM. The interplay between vitamin D, PTH, and blood glucose highlights the possibility of an existing endocrine axis. Finally, the role of osteocytes in regulating hematopoiesis and association with DM and osteoporosis should be investigated further.

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Introduction Chronic kidney disease (CKD) is a worldwide disease that is classified into five stages according to the glomerular filtration rate and presents through a variety of symptoms and signs. Anemia is one of the first signs of kidney dysfunction. The most common causes of anemia in CKD are erythropoietin (EPO) hormone deficiency and iron deficiency. Anemia and hyporesponsiveness to erythropoietin-stimulating agents (ESAs) are commonly observed in CKD patients and are associated with increased morbidity, mortality, and a significant healthcare economic burden. Although testosterone deficiency is a prevalent condition in men with CKD, it has so far received relatively little attention in practice. Testosterone stimulates erythropoiesis through the production of hematopoietic growth factors and possible improvement of iron bioavailability. Aim The aim of this study was to evaluate serum testosterone levels in patients on maintenance hemodialysis (MHD) and correlate its level with anemia and response to ESAs therapy. Patients and methods This study included 40 male patients from dialysis units, where they were divided equally into group A, group taking ESAs, and group B, group not taking ESAs (EPO-naive group). Another 20 men were included in group C (control group). All groups were subjected to a full assessment of history, full clinical examination, and laboratory investigations to exclude all possible causes of anemia. Results This study showed that in group A, 75% of the participants were anemic, whereas in group B, 100% of the participants were anemic, with a higher degree of anemia. The testosterone level was slightly higher in group B than group A; despite being within the normal range, it was relatively deficient on the basis of the age of the participants in the control group. Conclusion Testosterone deficiency is a prevalent condition in CKD that starts at an earlier age than the normal population. It is an evident independent cause of anemia in EPO-naive CKD patients and is a possible cause of resistance of ESAs in CKD patients; still, the most important causes of anemia in CKD are EPO and iron deficiency.

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Introduction Fibroblast growth factor-21 (FGF21) regulates glucose and lipid metabolism and protects against atherosclerosis. Serum FGF21 levels were assessed in newly diagnosed, drug-naive patients with prediabetes (group 1, n=60) and diabetes mellitus type 2 (group 2, n=60), in addition to 40 healthy individuals (group 3, n=40). Results Serum FGF21 levels were significantly increased in groups 1 and 2 compared with group 3 (231.7±59.3 and 260.4±82.5 vs. 22.6±5.31 pg/dl, respectively; P<0.001 for both). Moreover, group 2 had statistically significantly higher FGF21 levels compared with group 1 (P=0.03). Receiver operating characteristic curve analysis identified FGF21 cutoff value of greater than 204 and 30 pg/ml for the diagnosis of diabetes mellitus type 2 and prediabetes, with an area under the curve 0.72 and 1, sensitivity of 82.5 and 100%, and specificity of 60 and 100%, respectively. Using univariate analysis, FGF21 was positively correlated with blood pressure, obesity (BMI and waist–hip ratio), glycemic (glucose and glycosylated hemoglobin) and insulin resistance (fasting insulin and homeostasis model assessment-insulin resistance) parameters, atherogenic lipid profile, liver enzymes, and cardiovascular disease risk score in group 1 and group 2. FGF21 correlated with albumin–creatinine ratio negatively in group 1 and positively in group 2. Independent predictors of FGF21 level were fasting glucose, insulin, and triglyceride in both patient groups. The independent predictors of FGF21 were obesity parameters in group 1 and albumin–creatinine ratio, age, and systolic blood pressure in group 2. Conclusion Among prediabetic patients, FGF21 is an excellent predictor and a novel linkage between metabolic parameters, circulatory system, and nephropathy.

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Objective Thyroid dysfunction (TD) is a risk factor for coronary heart disease (CHD) events. We study the prevalence and predictors of TD and its impact on characteristics, cardiac function, and ischemic severity of patients with manifest CHD. Patients and methods A total of 200 patients 6–12 months after acute coronary syndrome had at least one vessel − significant stenotic coronary artery lesion. Before elective angiography, patients underwent anthropometric measurement, routine biochemical assay, thyroid hormones, and thyroid peroxidase antibody. Results The prevalence of TD was 17.5%: 12% for hypothyroidism (9.5% subclinical, 2.5% overt) and 5.5% for hyperthyroidism (2.5% subclinical, 3% overt). Compared with the euthyroid group, the hypothyroid group had a significantly higher age, BMI, diastolic blood pressure (BP), atherogic lipid profile, and impaired cardiac functions and higher pulmonary artery systolic pressure (PASP), and the hyperthyroid group had significantly higher systolic BP, ejection fraction (EF), and PASP and significantly lower diastolic BP and lipid profile. Independent predictors for hypothyroidism were age, bradycardia, increased BMI, lower EF, diastolic dysfunction, and atherogenic lipid profile, whereas increased PASP was an independent predictor for hyperthyroidism. Thyroid-stimulating hormone (TSH) was positively correlated and both free triiodothyronine and free thyroxine were negatively correlated to BP, BMI, lipid profile, impaired EF, and coronary atherosclerosis severity. TSH and free thyroxine were positively correlated to PASP, which increased significantly through hypothyroidism to hyperthyroidism. TSH and free triiodothyronine were independent predictors of severity of CHD. Conclusion Age, obesity, impaired cardiac function, and atherogenic lipid profile are predictors of hypothyroidism, and PASP is the predictor of hyperthyroidism among manifest CHD. Thyroid hormones are predictors of severity of coronary atherosclerosis and correlated to cardiac functions and PASP.

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Background The β3-adrenergic receptor (β3-AR) is mainly expressed in adipose tissue and plays an important role in lipid metabolism and metabolic rate by mediating lipolysis and thermogenesis. It has been suggested that the Trp64Arg (T→C) polymorphism in the β₃-AR gene affects fat accumulation and/or impairment of lipid and carbohydrate metabolism. Objective The aim of this study was to investigate whether common polymorphism (Trp64Arg) of β₃-AR gene has a role in the apparent susceptibility to type 2 diabetes mellitus (DM) and its related disorders in the Egyptian population. Patients and methods One hundred and thirty five healthy controls and 123 individuals with type 2 DM were enrolled in the study. The β₃-AR Trp64Arg polymorphism was identified using restriction fragment length polymorphism PCR of peripheral blood DNA samples. Analysis of data was performed using SPSS program 11. Results Allele frequency for C was 23.2% in the diabetic group compared with 12.2% in the control group. The carriers of XC genotype (TC and CC) were at high risk of developing type 2 DM (odds ratio=2.8; 95% confidence interval=1.6–4.9) when compared with the carrier of TT genotype. Furthermore, they were at much higher risk of developing its related disorders such as central obesity, dyslipidemia, and hypertension (odds ratio=2.8; 1.8, 1.5, 2.2, and 2.7 for BMI, waist–hip ratio, triglycerides, high-density lipoprotein, and hypertension, respectively). Conclusion The prevalence of Arg64 allele of the Trp64Arg polymorphism in the β₃-AR gene is a risk factor for type 2 DM and its related disorders in the Egyptian population.

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Introduction Hepatitis C virus (HCV) infection is known to be associated with insulin resistance (IR). The latter occurs early in the course of the disease and adversely affect it. The mechanism of this association seems to be different from that occurring in the metabolic syndrome. The aim of the study was to test this relationship in non-diabetic patients with early cirrhosis who are not fulfilling the criteria of metabolic syndrome. Patients and methods This cross-sectional study, included 100 patients with Child A cirrhosis induced by HCV. The patients were subjected to clinical, laboratory, ultrasonographic, and endoscopic evaluation. On the basis of homeostasis model assessment for insulin resistance (HOMA-IR) categorization, the patients were divided into two groups, with and without IR. Results A total of 63 patients had a higher HOMA-IR score, hence assigned as group 1, with significant elevation of liver enzymes, less albumin levels and more esophageal varices than in group 2. In a cohort of patients previously eradicated from the virus, HOMA-IR is lower than the non-treated patients. Conclusion Even in the absence of diabetes and metabolic syndrome, IR is evident in nearly two-thirds of patients having early HCV-induced cirrhosis. This link is associated with more inflammation of the liver and more drawbacks on the portal circulation. Sustained clearance of the virus improves insulin sensitivity.

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