Background: Polycystic ovary syndrome (PCOS) is a common reproductive endocrine co-morbidity of obesity. Ghrelin is a peptide which regulates food intake and body weight. The aim of this study was to measure ghrelin levels in obesity and PCOS and to evaluate the impact of weight loss on plasma ghrelin level, metabolic, and phenotypic features of PCOS. This prospective comparative study enrolled obese women without PCOS (N = 60) and obese PCOS women (n = 50) and 85 control groups. Body compositions including fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry (DEXA). Plasma ghrelin concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Results: Our results revealed that plasma ghrelin levels were lower in PCOS patients compared to obese (9.49 ± 5.59 ng/ml) and controls (48.21 ± 21.09 ng/ml). Moreover, it was negatively correlated to anthropometric measures, glycemic, lipid profile, and the phenotype characteristics of PCOS. Interestingly, after 12 weeks of following the Mediterranean diet (MD)-based weight loss program, ghrelin levels were increased in both obese groups.Conclusion: Successful weight loss leads to increase ghrelin levels in both obese and PCOS groups.

Background and study aim: Absence of adequate treatment for Helicobacter pylori (H. pylori) infection leads to prolonged life time colonization which is responsible for complications. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency and tolerability of standard triple therapy vs. quadruple regimen therapy in H. pylori eradication in Egypt. Subjects andMethods: Our study enrolled 140 patients (65 males,75 females) who attending to Gastroenterology clinic in Internal medicine & Tropical medicine departments, Zagazig University Hospitals from (June 2018 -June 2019), aged from 20 -60 years, complained of recurrent non-specific dyspepsia and epigastric pain & proved to be positive for H. pylori stool antigen test. The patients distributed into two groups: group (1), 70 patients given Clarithromycin triple therapy [Clarithromycin 500 mg + Amoxicillin 1gm + Pantoprazole 40 mg, each twice daily]. Group (2), 70 patients given quadruple therapy [Levofloxacin 500 mg once daily + Nitazoxanide 500mg (twice daily)+ Doxycycline 100 mg (twice daily)+ Pantoprazole 40 mg (twice daily)] for 14 days. Results: H. pylori eradication rate was statistically significant higher in patients who received quadruple therapy compared to those who received Clarithromycin-based triple therapy ( 85.7% vs. 67.1 % & P = 0.001 respectively).While, statistically insignificant regarding the treatment side effects in both groups ( 11.4 % vs. 14.3 %, P= 0.33 respectively). Conclusion: Quadruple therapy is preferable to Clarithromycin-contained triple therapy in tolerability and eradication of H. pylori in Egypt.

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Background: Cirrhotic patients have variable degrees of hepatic dysfunction. Impaired portal hemodynamics and hyponatremia occurs in the setting of end-stage liver disease. Aim: to uncover the role of portal hemodynamics in mortality and adverse outcome prediction of hyponatremic cirrhotic patients. Subjects and Methods: Eighty cirrhotic patients with hyponatremia (serum Na<130mmol/L) were included. diagnosis of hepatic encephalopathy using West Haven criteria, laboratory investigations, modified Child-Pugh and MELD scores were calculated, abdominal ultrasonography with Doppler study of portal circulation and upper GIT endoscopy were performed and the patients were followed up during their stay in hospital. Results: Serum sodium level has high statistically significant negative correlation with modified Child-Pugh score (P <0.001) and with MELD score (P <0.001). Most of the patients developed hepatic encephalopathy, spontaneous bacterial peritonitis, hepato-renal syndrome, and bleeding recorded in some patients; meanwhile mortality in 10% of the patients. In addition, apart from Hepatic Artery resistive Index, the difference in MELD score, MELD-Na score and Portal vein congestive Index between non-survived and survived patients was statistically insignificant, although all these indices were highly significant with hepatic encephalopathy, Portal vein congestive Index is highly significant in hepato-renal syndrome and bleeding esophageal varices, and Hepatic Artery resistive Index is highly significant in hepato-renal syndrome. Analysis of the receiver operating characteristic curve revealed that Portal vein CI was the most sensitive indicator (sensitivity 78.5%) and hepatic A resistive Index was the most specific indicator for prediction of mortality in hyponatremia cirrhotic patients. Conclusion: portal vein CI and hepatic A. RI can be used in the prediction of mortality in hyponatremia cirrhotic patients.

Background Chronic hepatitis C (CHC) is a silent viral infection; however, elevated mortality and morbidity rates are noted in Egypt due to its adverse effects. The augmented incidence of diabetes in patients with viral C infection may be owing to glucose intolerance, high BMI, senility, and inherited factors. Purpose of the study Little information is available about the connection between interleukin-28B (IL-28B) genotype in disease progression among CHC patients with diabetes. Thus, we aimed to assess the association between IL-28B genotype (rs12979860) in CHC with type 2 diabetes mellitus (T2DM) versus those without diabetes in disease progression among Egyptian patients. Results CC genotype was significantly lower in diabetics than in non-diabetics (13.7% vs. 36.3%). While (CT/TT) were significantly higher in diabetics than in non-diabetics (CT 58.8% vs. 43.7%), (TT 27.5% vs. 20%) (p = 0.03) and likewise alleles (p = 0.04). Multivariate logistic regression analysis was significant with viral load p < 0.001, alanine aminotransferase (ALT) p < 0.001, genotype CC versus TT p = 0.04 & T2DM p = 0.03. Conclusion CC genotype might be used as a protective factor and TT genotype as a risk factor in disease progression among CHC patients with T2DM. Additionally, viral load, ALT & T2DM might interplay as predictors of disease severity. Detecting the genetic factors can be helpful in predicting and preventing the complications of diabetes associated with the hepatitis C virus (HCV).

Background An epidemic of obesity has spread across the globe. Obesity has numerous comorbidities, including airway disease, insulin resistance, type 2 diabetes, cardiovascular disease, atherosclerosis, degenerative neurological disease, cognitive dysfunction, and cancer. Inflammatory cytokine is suggested to play a role in obesity and its complications. The current study aimed to estimate the expression and serum visfatin concentrations in obese Egyptian women. Moreover, we aimed to evaluate the possible association of visfatin gene expression and its serum levels with idiopathic intracranial hypertension (IIH) and cognitive dysfunction Participants and methods This cross-sectional study enrolled 60 obese women and 40 lean healthy women as controls. Obese women were classified according to grades of obesity into three groups. All participants underwent full clinical, neurological, and psychiatric examination. IIH group included patients with intracranial pressure greater than 25 cm H2O (opening pressure measured during lumber puncture in lateral decubitus position). Cognitive function was evaluated by using Montreal Cognitive Assessment scale (MoCA), Arabic version. Estimation of visfatin expression levels was determined by real-time PCR, and serum visfatin concentrations were measured using enzyme-linked immunosorbent assay. Results Our results revealed that obese women had higher values of visfatin expression (1.44±0.29) and serum levels (124.1±) compared with lean women (1.01±0.3 and 46.1±33.8, respectively). The visfatin expression and serum levels were significantly positively correlated with obesity indices, metabolic risks, MoCA, cerebrospinal fluid opening pressure, and cognitive dysfunction. Linear regression test showed that BMI, cerebrospinal fluid opening pressure, and MoCA were the main predictors of both serum and expression levels of visfatin in obese women. The receiver operating characteristic curve analysis revealed that the power of serum visfatin levels was higher than visfatin expression in differentiating obese women from lean ones. Conclusion There was a strong independent association between both higher visfatin expression and serum levels and obesity indices, metabolic risks, IIH, and cognitive dysfunction in obese Egyptian women.

Objective Ischemic stroke (IS) is one of the major causes of disability and death worldwide. Effective prevention remains the best approach to reduce the burden of stroke. Adipokines can serve as a key messenger to central energy homeostasis and metabolic homeostasis. Retinol-binding protein 4 (RBP4), a retinol transporter, is elevated in insulin resistance. Controversy exists regarding the role of RBP4 in thyroid diseases. The objective of this study was to evaluate serum RBP4 in patients with hypothyroidism and to assess the association of serum RBP4 with susceptibility of IS. Patients and methods This case–control study included 50 healthy individuals as a control group and 90 patients with hypothyroidism, who were stratified into two subgroups: patients with IS and patients without IS. All participants were subjected to history taking and clinical, laboratory, and radiological evaluation. Results Serum RBP4 levels were significantly higher in hypothyroid patient, especially patients with IS, compared with the nonstroke group. Interestingly, serum RBP4 level was positively correlated with vascular and metabolic risk factors. Moreover, diastolic and systolic blood pressures, triglyceride, free T3, as well as thyroid-stimulating hormone, were independently correlated with serum RBP4 by linear regression analysis test. The diagnostic power of serum RBP4 level in differentiating hypothyroidism from controls was revealed at the cutoff value of 12.25, with area under the curve of 0.909 (95% confidence interval: 0.861–0.957). However, the diagnostic power of serum RBP4 level in differentiating hypothyroid patient with IS from those without stroke was revealed at the cutoff values of 11.4, with area under the curve of 0.822 (95% confidence interval: 0.737–0.906). In conclusion, the higher levels of serum RBP4 in hypothyroidism, especially in patients with IS, were associated with metabolic and glucose abnormalities, and thus, it could be used as a promising predictive biomarker of IS in hypothyroidism.