Roman Junik

Correlation between Body Mass Index and Waist Circumference in Patients with Metabolic Syndrome.

Metabolic syndrome is defined as a group of coexisting metabolic risk factors, such as central obesity, lipid disorders, carbohydrate disorders, and arterial hypertension. According to the 2005 IDF criteria, subsequently revised in 2009, abdominal obesity is identified as the waist circumference of ≥80 cm in women and ≥94 cm in men. It is responsible for the development of insulin resistance. The aim of our study was to demonstrate a correlation between waist circumference (WC) and body mass index (BMI) in patients with metabolic syndrome in relation with hypertension, lipid disorders, and carbohydrate disorders. A cross-sectional two-site study was conducted in the Kuyavian-Pomeranian Voivodeship for 24 months. The study group consisted of 839 patients with diagnosed metabolic syndrome: 345 men (41.1%) and 494 women (58.9%) aged 32–80. In the study group, WC was found to be significantly correlated with BMI (R = 0.78, P < 0.01). The presence of overweight in men (BMI 25, 84 kg/m2) and even normal body weight in women (BMI 21,62 kg/m2) corresponds to an increased volume of visceral tissue in the abdomen. Introduction of primary prophylaxis in those people to limit the development of diabetes mellitus type 2 and cardiovascular diseases should be considered.

Thyroid ultrasound in diabetic patients without overt thyroid disease

Purpose: To assess thyroid volume and to evaluate possible lesions in the gland structure using thyroid ultrasound in patients with diabetes mellitus type 1 (DM1) and 2 (DM2) without overt thyroid disease. Material and Methods: Consecutive adult patients with DM2 (n = 98) and DM1 (n = 30) without overt thyroid disease referred to our department because of poorly controlled disease and/or diabetic complications were prospectively analyzed. Thyroid volumes, gland echogenicity, thyroid nodules incidence, and TSH levels were compared with control groups (n = 50 and 38) and matched according to sex and age. Results: Significant increases in median thyroid volume were observed in both subjects with DM1 (17.3 cm3, interquartile range (IR) 13.9–21.6 cm3 versus 14.4 cm3, IR 11.3–18.3 cm3; P<0.05) and DM2 (20.5 cm3, IR 14.9–27.1 cm3 versus 14.1 cm3, IR 11.3–18.3 cm3; P<0.001) in comparison to their control groups. Moreover, in the population of type 2 diabetics, thyroid nodules (OR 2.37, 95% CI 1.14–4.93), parenchymatous goiter (OR 5.40, 95% CI 1.20–24.30), and all kinds of thyroid goiter according to the WHO definition (OR 4.18, 95% CI 2.02–8.66) were remarkably more frequent. In our patients, reduced (but within normal range) TSH level occurred in DM1 (median 0.97 mIU/l, IR 0.61–1.58 mIU/l versus median 1.66 mIU/l, IR 0.76–2.09 mIU/l; P<0.05). The presence of a negative linear correlation between thyroid volume and TSH concentration was noticed in patients with DM2 (R S = −0.38, P<0.01). Conclusion: In individuals with DM1 and DM2 treated for poorly controlled disease and/or diabetic complications, thyroid volumes were significantly higher than in the normal population. Moreover, nodular thyroid structure and parenchymatous goiter occurred more frequently in these type 2 diabetic patients.

The comparison of serum vascular endothelial growth factor levels between patients with metastatic and non-metastatic thyroid cancer, and patients with nontoxic multinodular goiter

BACKGROUND One of the important proangiogenic factors involved in the growth of normal and neoplastic tissues is vascular endothelial growth factor (VEGF). AIM We hypothesized that serum VEGF concentration would differ between patients with metastatic and non-metastatic thyroid cancer, multinodular goiter, and healthy subjects. We also hypothesized that endogenous TSH stimulation would affect serum VEGF level. SUBJECTS AND METHODS The study group consisted of 71 patients (62 females and 9 males), aged 44.9 +/- 12.3 years, with differentiated thyroid cancer (50 papillary, 17 follicular, and 4 oxyphilic), treated in our department during the years 2003-2006. All patients had undergone total or near-total thyroidectomy and radioactive iodine treatment, that had resulted in remission in 59 patients and persistent/recurrent disease in 12 patients. The study included two control groups: 30 patients with nontoxic multinodular goiter and 30 healthy subjects. RESULTS Serum VEGF concentrations were significantly higher in patients with distant metastases than those in remission or healthy patients. (423.4 vs 217.6 vs 235.55 pg/ml respectively, P < 0.05). This was not observed in patients with locoregional metastases. During endogenous TSH stimulation, VEGF decreased significantly (215.3 vs 169.6 pg/ml, P < 0.05). Patients with multinodular goiter showed significantly lower VEGF concentrations than the remaining study groups. CONCLUSIONS Serum VEGF concentration might be used as an additional marker of thyroid cancer with distant metastases, but its interpretation should be undertaken very cautiously. Endogenous TSH stimulation decreases VEGF levels in patients either with or without thyroid tissue, suggesting that its regulatory effects are through receptors located outside the thyrocytes.

Stress hyperglycaemia in patients with first myocardial infarction

Objective:  To investigate the incidence of stress hyperglycaemia at first acute myocardial infarction (MI) with ST‐segment elevation, occurrence of stress hyperglycaemia as a manifestation of previously undiagnosed abnormal glucose tolerance (AGT), and its relation to stress hormone levels.

Value of oral glucose tolerance test in the acute phase of myocardial infarction

BackgroundAlthough European guidelines advise oral glucose tolerance test (OGTT) in patients with acute myocardial infarction (AMI) before or shortly after hospital discharge, data supporting this recommendation are inconclusive. We aimed to analyze whether disturbances in glucose metabolism diagnosed before hospital discharge in AMI patients represents a latent pre-existing condition or rather temporary finding. Additionally, we planned to investigate the value of pre-selected glycemic control parameters as predictors of long-term glucometabolic state.MethodsWe assessed admission glycemia, glycated hemoglobin, mean blood glucose concentration on days 1 and 2 in 200 patients with a first AMI but without overt disturbances of glucose metabolism. We also performed OGTT at discharge and 3 months after discharge.ResultsThe prevalence of disturbances in glucose metabolism (as assessed by OGTT) at 3 months was significantly lower than at discharge (29% vs. 48%, p = 0.0001). Disturbances in glucose metabolism were not confirmed in 63% of patients with impaired glucose tolerance and in 36% of patients with diabetes mellitus diagnosed during the acute phase of AMI. Age >77 years, glucose ≥12.06 mmol/l at 120 minutes during OGTT before discharge and mean blood glucose level on day 2 >7.5 mmol/l were identified as independent predictors of disturbances in glucose metabolism at the 3-month follow-up.ConclusionsDisturbances in glucose metabolism observed in patients with a first AMI are predominantly transient. Elderly age, high plasma glucose concentration at 120 minutes during OGTT at discharge and elevated mean blood glucose level on day 2 were associated with sustained disturbances in glucose metabolism.

Effect of the 5-HTTLPR polymorphism on affective temperament, depression and body mass index in obesity

BACKGROUND AND AIM Many studies show high prevalence of affective disorders in obese patients. Affective temperament is a subclinical manifestation of such conditions. The 5-HTT gene encoding the serotonin transporter may be involved in both mood and eating dysregulation. The aim of this study was to investigate the influence of a polymorphism in the 5-HTT gene on affective temperament types, depressive symptoms and Body Mass Index (BMI) in obese patients. METHODS This study involved 390 patients (237 females, and 153 males) with obesity. The TEMPS-A questionnaire, Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were used to evaluate affective temperaments and prevalence of depression. DNA was obtained for serotonin transporter gene-linked polymorphism (5-HTTLPR) genotyping. RESULTS In obese patients S/S genotype was associated with depressive and L/L with cyclothymic temperament. Subjects with L/L genotype presented significantly higher BMI and greater intensity of depressive symptoms in BDI and HDRS. Females scored higher in anxious and depressive, while males in hyperthymic, cyclothymic and irritable temperaments. Females scored higher in BDI (subjective depression) while males in HDRS (objective depression). LIMITATIONS TEMPS-A, BDI and HDRS are frequently used in studies on affective disorders. However, these methods do not examine all dimensions of mood and personality. CONCLUSIONS In obese patients S allele of 5-HTTLPR was associated with development of depressive temperament while L allele corresponded with greater obesity and prevalence of depression. Different mechanisms may be involved in manifestation of depression in males and females with obesity.

Visfatin concentrations in obese patients in relation to the presence of newly diagnosed glucose metabolism disorders.

INTRODUCTION Visfatin, protein secreted by visceral adipose tissue, exerts insulin-mimetic actions. Visfatin concentration increases in patients with longer-standing diabetes type 2 with progressive b-cell dysfunction. Data about the role of visfatin in newly diagnosed glucose metabolism abnormalities are limited. Evaluation of visfatin concentration in patients with obesity, in relation to the presence of newly diagnosed glucose metabolism disorders. MATERIAL AND METHODS The study included 68 subjects with obesity, without a previous diagnosis of abnormal glucose metabolism. In all subjects we performed an oral glucose tolerance test, and according to the results the group was divided into the subgroups: A (n = 31), with glucose metabolism disorders (impaired fasting glucose, impaired glucose tolerance and type 2 diabetes); and B (n = 37), without abnormalities. In all subjects serum lipids, uric acid, C-peptide, glycated haemoglobin (HbA1c), creatinine, and serum visfatin concentrations were measured. The control group comprised 30 lean, healthy individuals with normal glucose tolerance. RESULTS We found elevated visfatin levels in obese individuals versus the control group (50.0 ± 48 vs. 26.7 ± 22.1 ng/mL; p = 0.01). Visfatin concentrations in both subgroups, A and B, did not differ (40.86 ± 27.84 vs. 57.7 ± 59.79 ng/mL; p = 0.19). In subgroup A visfatin concentration correlated significantly with triglycerides (r = 0.37, p = 0.038), HbA1c (r = -0.43, p = 0.02), C-peptide (r = -0.38,p = 0.048), and waist-hip ratio (r = -0.41, p = 0.036). CONCLUSIONS The presence of newly diagnosed glucose metabolism abnormalities in obese subjects had no influence on the visfatin level, probably due to preserved endogenous insulin secretion and relatively short exposure to hyperglycaemia in patients with prediabetes or at early stage of type 2 diabetes.

The effect of hypothyroidism occurring in patients with metabolic syndrome.

INTRODUCTION Metabolic syndrome involves abdominal obesity, arterial hypertension, type 2 diabetes and lipid disorders manifested as atherogenic dyslipidaemia. Abnormal thyroid function affects the severity of MetS components, since regulating metabolism is one of the most important functions of thyroid hormones. In this study, we present the influence of hypothyroidism on lipid and carbohydrate disorders in patients with MetS. MATERIAL AND METHODS The described study was a prospective, two-centre screening study of 24-month duration. The study participants were 441 patients (350 women, 91 men, aged 28-82) with metabolic syndrome diagnosed according to the 2005 IDF. RESULTS By comparing the study and the control group, statistically significant differences were observed in the mean triglyceride levels (respectively 161,5 vs. 134,8 mg/dL, p = 0.047), mean fasting glycaemia (respectively 111,8 vs. 126,1 mg/dL, p = 0.044) and TG/HDL ratio (4,74 vs. 3,71, p = 0.043). Hypothyroidism shows a positive correlation with the TG levels and TG/HDL-C ratio and a negative correlation with the mean fasting glycaemia in people with MetS. A significantly higher TG/HDL-C ratio and lower mean insulin sensitivity ratio observed in men with hypothyroidism, indicated higher insulin resistance in men. CONCLUSIONS In view of the above, it may be hypothesized that in patients with both MetS and hypothyroidism, especially of male gender, the risk of death of cardiovascular causes is greater due to the severity of MetS components. Moreover, we suggest that in patients recently diagnosed with MetS, active detection of hypothyroidism should be performed by determining the TSH levels, while patients diagnosed with hypothyroidism (apart from replacement therapy) should be monitored for the possible occurrence of MetS in the future.

Zalecenia ogólne dotyczące postępowania diagnostyczno-terapeutycznego w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Progress in the diagnostics and therapy of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN), the published results of new randomised clinical trials, and the new guidelines issued by the European Neuroendocrine Tumour Society (ENETS) have led the Polish Network of Neuroendocrine Tumours to update the 2013 guidelines regarding management of these neoplasms. We present the general recommendations for the management of NENs, developed by experts during the Third Round Table Conference - Diagnostics and therapy of gastro-entero-pancreatic neuroendocrine neoplasms: Polish recommendations in view of current European recommenda-tions, which took place in December 2016 in Żelechów near Warsaw. Drawing from the extensive experience of centres dealing with this type of neoplasms, we hope that we have managed to develop the optimal management system, applying the most recent achievements in the field of medicine, for these patients, and that it can be implemented effectively in Poland. These management guidelines have been arranged in the following order: gastric and duodenal NENs (including gastrinoma); pancreatic NENs; NENs of the small intestine and appendix, and colorectal NENs.

The polymorphisms in serotonin-related genes (5-HT2A and SERT) and the prevalence of depressive symptoms in obese patients

As overweight and obesity are a growing problem in industrialized societies, they become a main focus of many studies. The aim of this study was to determine whether there is an association between the occurrence of polymorphisms in serotonin-related genes and the prevalence of depressive symptoms in obese patients. Two polymorphisms were tested: a 44-bp insertion/deletion in the serotonin transporter (SERT) gene and a single-nucleotide variation (1438G/A) in the serotonin 2A receptor (5-HT2A) gene. The study involved 180 patients (41 men; 139 women) previously diagnosed as obese. All patients were subjected to clinical, biochemical, and neuropsychological evaluation and genotyping. Amplification of the gene fragments was obtained by the polymerase chain reaction (PCR) method. Products of the genotyping were separated via electrophoresis. The intensity of depressive symptoms was measured using the Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAM-D). Clinically relevant depressive symptoms were diagnosed in 39% of subjects. The lowest intensities of depressive symptoms were ascertained in the group with the least advanced obesity, but this trend was statistically insignificant. Small differences were observed in obesity indicators among three groups of patients with various genotypes of the SERT gene, but these differences were also statistically insignificant. Furthermore, in the context of the intensity of depressive symptoms, no significant associations were observed in these two groups. Furthermore, no statistically significant differences were observed among specific obesity parameters and intensity of depressive symptoms as a function of the 5-HT2A gene polymorphism. To conclude, depressive symptoms were prevalent in obese participants: 39% of subjects experienced symptoms of clinical relevance. However, no significant associations were observed between 5-HT2A and SERT gene polymorphisms and depressive symptoms in this study group.