Volume 54 (2016): Edition 4 (December 2016)

Hyponatremia is defined by a level of Na in serum below or equal to 136 mEq/L while in hepatic cirrhosis it is classically considered as relevant only at a level of Na below 130 mEq/L.

Hyponatremia frequently occurs in patients with end-stage hepatic disease. The frequency and severity are variable but it has been estimated that it occurs with a frequency of 57% in hospitalized patients with cirrhosis and in those on waiting lists for hepatic transplants. Signs and symptoms of hyponatremia are related to dysfunctions of the central nervous system, due to migration of the water from intravascular space to the brain cells, resulting in the occurrence of cerebral edema. Therapeutic options in hyponatremia are limited and are based on restriction of water consumption, exclusion of diuretics and vaptans. Hepatic transplant remains the only definitive treatment for end-stage hepatic diseases in which hyponatremia has occurred.

Introduction. The role of progranulin in individuals with metabolic syndrome is not exactly clear.We aimed to assess the serum level of progranulin in type 2 diabetic patients with and without metabolic syndrome and compare them with healthy controls.

Methods. The study included 60 patients with type 2 diabetes and 30 healthy individuals as control groups. Biochemical parameters and progranulin levels were determined.

Results. Subjects with metabolic syndrome showed significantly higher levels of triglyceride, waist circumference, BMI, systolic and diastolic blood pressure than subjects without metabolic syndrome and the control groups, while HDL-cholesterol level was significantly lower in subjects with metabolic syndrome. Fasting blood sugar was significantly higher in type 2 diabetic patients than in the control groups. Serum level of progranulin was slightly increased in subjects with metabolic syndrome. Serum progranulin level had no significant relationship with metabolic syndrome components.

Conclusions. Serum progranulin was also not dependent on cardiometabolic risk factors for subjects with metabolic syndrome, but it could be considered for the management of type 2 diabetes mellitus. Further studies are recommended to explain the effect of progranulin on the pathogenesis of metabolic risk factors.

Background. Recent biochemical and physiological investigations have focused on the fundament of mood disorders in thyroid dysfunction. The present study aimed to address depressive disorder in a sample of Iranian hypothyroid women compared to euthyroid individuals.

Methods. Thirty consecutive hypothyroid female patients aged 25 to 40 years who referred to the Endocrinology and Metabolism Clinic at Rasoul-e-Akram Hospital in Tehran within a four-month period in 2015 were assessed. Thirty healthy euthyroid subjects matched for sex, age, and educational level were selected as the control. For assessment of depression status, Depression Anxiety Stress Scale-21 (DASS-21) was employed.

Results. The study showed higher mean depression score in hypothyroid patients when compared to euthyroid ones (13.8 ± 9.5 versus 5.8 ± 5.2, p = 0.010). No significant association was revealed between mean depression score and patients’ education level (p = 0.627), age (p = 0.967), occupation status (p = 0.211), and marital status (p = 0.556).

Conclusion. Hypothyroid women are predisposed to depressive symptoms independent of their baseline demographic and socioeconomic characteristics.

Background. Some recent suggestions could show omega-3 condition deficiency following prolonged hemodialysis; however, these claims and speculations have not been well demonstrated with sufficient evidences. Hence, we attempted to assess the beneficial effects of omega-3 on lipid profile in patients with end-stage renal disease (ESRD) undergoing hemodialysis.

Methods. One hundred and seventeen ESRD patients who were on maintenance dialysis in Rasoul-e-Akram and Madaen Hospitals were enrolled in this randomized clinical trial. These patients were divided into two groups randomly using block randomization method (57 patients as the case group receiving omega-3 for 12 weeks and 60 as the control group). Blood sample was taken from all patients for measurement of lipid profile, serum hemoglobin, and C-reactive protein at baseline as well as after the completion of interventions (after 12 weeks).

Results. The average change in the value of HDL-C was significantly more in the patients who received omega-3 than in the control group (MD, -7 mg/dL; 95% CI, -11 to 0 p = 0.000). Also, the reduction in serum creatinine level was more in the omega-3 group than in the control group (MD, 0.7 mg/dL; 95% CI, -0.4 to 2.1 p = 0.023). The change in other indices including serum triglyceride, total cholesterol, and serum hemoglobin levels was not different between the two groups. The multivariable linear regression analysis showed no difference in serum HDL level between the two groups adjusted for sex, age, and time of dialysis, while the level of serum HDL-C could be adversely predicted by duration time. Similar regression model showed a between-group difference in serum creatinine in the presence of potential confounders.

Conclusion. The change in serum HDL level following use of omega-3 supplement is influenced by time of dialysis, not by drug effect. However, consumption of omega-3 can significantly reduce serum creatinine.

Introduction. Oxidative stress is one of the key mechanisms responsible for disease progression in non-alcoholic fatty liver disease. The aim of this study was to evaluate the serum levels of oxidative stress markers in patients with type 2 diabetes mellitus (DMT2) and non-alcoholic steatohepatitis (NASH) and test their relationships with clinical and biochemical patient characteristics, compared to patients with DMT2 without non-alcoholic fatty liver disease (NAFLD), and controls.

Materials and methods. In all, 60 consecutive patients with DMT2 and NASH, 55 with DMT2 without NAFLD, and 50 age-and-gender-matched healthy subjects participated in the study. The serum levels of protein carbonyls and 8-isoprostane were determined by ELISA methods, while the serum levels of malondialdehyde (MDA) were detected by means of the spectrophotometric method. Clinical, demographic, and laboratory parameters were examined for all the subjects included in the study. Multivariate logistic regression was used to test the independent predictive factors in the relationships investigated here.

Results. Patients with DMT2 and NASH displayed significantly higher serum levels of protein carbonyls (1.112 ± 0.42 nmol/dL), MDA (6.181 ± 1.81 ng/mL), and 8-isoprostane (338.6 ± 98.5 pg/mL) compared to patients with DMT2 without NAFLD, and controls. Results of multivariate logistic regression analyses indicate that in patients with DMT2 and NASH, the serum levels of oxidative stress markers were independently and positively associated with: HbA1c, duration of diabetes, the UKPDS cardiovascular risk score (for protein carbonyls); age, LDL-cholesterol (for 8-isoprostane); and triglycerides serum levels (for MDA).

Conclusions. Our findings indicate that the process of oxidative stress tends to increase in patients with DMT2 and NASH, compared to patients with DMT2 without NAFLD, and controls. This evidence suggests that an antioxidant therapy might prove useful in the treatment of patients with DMT2 and NASH.

Background. The prevalence of End Stage Renal Disease (ESRD) is increasing in different parts of the Kingdom of Saudi Arabia (KSA), particularly Hail Region. Therefore, the aim of this study was to assess the respiratory complications that associated with ESRD.

Methods. In the present study, clinical, imaging and laboratory parameters were identified for 100 ESRD patients with ESRD who were referred to the Pulmonary Medicine Department at King Khalid Hospital.

Results. Pulmonary Edema, Pneumonia, and Pleural effusion were identified in 22%, 14%, and 16% of the referred ESRD patients, respectively.

Conclusion. Respiratory complications are common among ESRD patients in Hail Region.

Proliferative myositis (PM) is a rare inflammatory disease. Most commonly, the lesion occurs in the extremities. Regarding its fast growth and bizarre shape of the cellular components this entity commonly misdiagnosed and the patients undergo improper therapeutic approaches. In other words, it is often misdiagnosed as sarcoma. The diagnosis can only be made by the microscopic examination, so biopsy is mandatory. Here the authors report a patient with PM who was initially misdiagnosed as pleomorphic sarcoma of the lower extremity and explain this rare entity.

Proliferative myositis should be taken into account if a fast growing, intramuscular mass occurs in the extremities.

73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention.

Taking advantage of an interesting clinical scenario, we want to introduce a discussion about fatality in our daily practice and the need to accept that. An 80 year-old man with non-traumatic spontaneous bleeding tendency came to the clinics. Although being on warfarin as a consequence of primary thrombotic prophylaxis due to an atrial fibrillation, full assessment was performed. Not only the rare entity found on him, but also the severe complication that happened afterwards challenged clinicians and led them to risky treatment options.