Clinical Impact of Insulin Resistance in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder characterized by multiple hormonal imbalances, reflecting on the clinical presentation. Among them, the insulin resistance (IR), defined as a metabolic state characterized by a decrease in cellular ability to respond to insulin signaling, is a key feature of PCOS independently of obesity. Thus, IR occurs in more than 70% of obese PCOS women and in 30–50% of lean ones. Compensatory high insulin levels are both a symptom and an underlying physiopathological driver of PCOS. Insulin appears to disrupt all components of the hypothalamic-pituitary-ovarian axis, and ovarian tissue IR results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia. The latter is the main culprit of the clinical picture in PCOS. Testing for IR can be helpful to rule out other conditions that are commonly misdiagnosed as PCOS and to recommend an appropriate treatment for the different PCOS phenotypes

Assessment of body composition of adult Bulgarian patients with type 1 diabetes mellitus by bioelectrical impedance analysis

Aim: The aim of this study was to investigate how type 1 diabetes mellitus affects adult Bulgarians’ body composition. Materials and methods: One hundred and twenty patients (60 men and 60 women) aged 20 to 40 years, as well as 80 healthy men and women, were enrolled in the study. Bioelectrical impedance indicators: body fat tissue percentage (%BFT), total body water percentage (%TBW), visceral fat tissue (VFT), muscle mass (MM), and bone mass (BM) and derived indicators: total fat mass (TFM), active body mass (ABM), active body mass percentage (%ABM), ABM index (ABMI), and BMI were defined. Results: The mean values of %BFT, VFT, TFM, and BMI were significantly higher in the female patients with type 1 diabetes mellitus while the mean values of %TBW, %ABM, and ABMI were significantly higher in healthy women. The mean values of VFM and ABMI were significantly higher in the male patients with type 1 diabetes mellitus while the mean values of MM and ABM were significantly higher in healthy men. Bioelectrical impedance analysis of the body composition in Bulgarian female patients exhibited an increase in the accumulation of adipose connective tissue both generally and viscerally. The total body water percentage in the female patients was significantly lower than in the healthy controls. The body composition of Bulgarian male patients exhibited an increase in the accumulation of visceral adipose tissue only. The skeletal muscle tissue in male patients exhibited a decrease in comparison to healthy men. Conclusion: We believe that these findings are consequence of the impact of type 1 diabetes mellitus on the body composition in Bulgarian patients

In search of dermatophytes – frequency and etiology of fungal infections in patients with and without diabetes mellitus

Introduction: Onychomycosis is a frequent nail disorder, accounting for up to 50% of all nail problems. Treatment of onychomycosis is expensive and requires a long time of antifungal medications. Consequently, a proper and faster diagnosis is necessary. Especially for those patients with diabetes mellitus, where onychomycosis is among the most significant predictors of foot ulcer and possible severe complications.Aim: To compare the sensitivity, specificity, and turnaround time between direct microscopy, culture, histology, and real-time PCR. In addition, to compare the frequency and etiology of onychomycosis in patients with and without DM.Materials and methods: This study included 102 patients, divided into two groups. One group consisted of patients with diabetes mellitus and the other – without diabetes. Nail samples were collected and examined by direct KOH microscopic examination, culture, histology, and real-time PCR.Results: From the 102 patients with clinical onychomycosis, positive KOH was found in 38 (37.3%). Culture – 82 out of 102 samples (80.4%) were positive for dermatophytes, yeasts, and/or NDM. Positive histology samples were 32 (41.6%). The PCR was positive in 57 (55.9%) out of the 102. We discovered that there is no significant statistical difference in the etiology of the fungal infections between the two groups.Conclusions: All mycological investigations have their place in the diagnosis of onychomycosis. Direct microscopy, culture, and histology are useful methods for clinicians to diagnose and follow up the post-treatment period. The advantages of RT-PCR include obtaining results faster and accurately identifying fungi, thus becoming more valued in the diagnosis of OM

Assessment of the impact of type 2 diabetes on the quality of life by Audit of Diabetes-Dependent Quality-of-Life (ADDQoL-19)

Together with the epidemic prevalence of diabetes mellitus (DM), the burden of this chronic metabolic disorder has serious impact on the quality of life of patients and reduces their life span. The objective of this study was to assess the impact of type 2 diabetes mellitus (T2DM) on the Quality of Life (QoL) by Audit of Diabetes-Dependent Quality-of-Life (ADDQoL-19). A cross-sectional study of 540 adults with T2DM was carried out. We collected socio-economic, demographic, health status, therapeutic and metabolic control data. The instrument used to measure the quality of life was the ADDQoL-19. The study included 411 adult patients [216 (52.6%) men; mean age 59.9. years]. T2DM had a negative impact on QoL in 36.7% of the participants, whereas 67.1% believed that their life would have been better without the presence of T2DM. The mean ‘present QoL’ score was: 0.6 (SD: 0.9) and the ‘diabetes-related’ QoL was: −1.8 (SD: 0.8). Diabetes had the most negative average weighted impact on ‘freedom to eat’ −4.0 (SD: 2.6), and ‘family life’ −3.9 (SD: 2.7). The results indicate that T2DM has a significant impact on QoL and its assessment is an important tool in the management of this disease. The negative values reflect the general negative impact of diabetes over all 19 examined aspects. These findings are of importance to health professionals and policy makers to identify and implement appropriate interventions in order to achieve better disease management and ultimately to increase the QoL of patients with T2DM

Vitamin D and Autoimmune Thyroid Diseases - a Review

The essential biological action of vitamin D is regulation of calcium and phosphorus metabolism and preserving bone health. In recent years there have been reports about the extraskeletal actions of vitamin D and its role in the regulation of immune system. Vitamin D supplementation appears to reduce the incidence of cardiovascular diseases, cancer, and infections and be able to reduce all-cause mortality. Deficiency of vitamin D has been found to correlate with the increased incidence of autoimmune diseases, including type 1 diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis. Autoimmune thyroid diseases (AITD), including Graves’ disease, Hashimoto’s thyroiditis are relatively common autoimmune disorders affecting more than 5% of general population. It has been shown that vitamin D receptors (VDR) and 1-alpha hydroxylase are expressed in papillary thyroid cancer and normal thyroid tissue, suggesting local synthesis of 1,25(OH)2D in the thyroid. While VDR gene polymorphism has been found in much research to be associated with AITDs, very few studies have examined the impact of vitamin D deficiency on the incidence of AITDs in humans with conflicting results. This review focuses on the association between vitamin D and autoimmune thyroid diseases and summarizes the results of vitamin D supplementation studies in patients with AITD

Pathophysiological Role of Adiponectin, Leptin and Asymmetric Dimethylarginine in the Process of Atherosclerosis

Adipose tissue is recognized as a rich source of proinflammatory mediators that may directly contribute to vascular injury, insulin resistance, and atherogenesis. Many studies have shown that adiponectin has antiatherogenic and anti-inflammatory properties. Adiponectin acts not only as a factor increasing insulin sensitivity, and the protective effect may result from its ability to suppress production of proinflammatory cytokines. It negatively regulates the expression of TNF-alpha and C-reactive protein (CRP) in adipose tissue; reduces expression of vascular and intracellular adhesion molecules (VCAM-1, ICAM-1), E-selectin, interleukin-8 (IL-8). Hyperleptinemia has been linked with the development of hypertension and endothelial dysfunction/atherosclerosis, two main pathophysiological conditions associated with cardiovascular disease development. Leptin-mediated increases in sympathetic nervous system activity may be among the principal mechanisms evoking obesity related hypertension. Leptin stimulates the secretion of proinflammatory cytokines, and increases the release of endothelin-1 (ET-1), which may promote hypertension. Increased serum levels of asymmetric dimethylarginine (ADMA), a physiological regulator of the biosynthesis of nitric oxide (NO), promote the process of atherosclerosis, leading to the occurrence of endothelial dysfunction and cardiovascular disease

Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy

Background: Thyroid dysfunction is common during the postpartum and the predisposing factors for its development are considered specific for the population studied. The aim of this study was to evaluate the risk factors for the occurrence of postpartum thyroid dysfunction (PPTD) in euthyroid women prior to pregnancy

Serum selenium concentration in patients with autoimmune thyroid disease

Abstract Introduction: Selenium (Se) is one of the environmental factors with an essential role in the pathogenesis of autoimmune thyroid disease (ATD). Scarce data is available for the selenium status of the Bulgarian population especially for patients with thyroid disorders. Aim: To compare the serum selenium (s-Se) concentrations in patients with ATD and healthy controls from Bulgarian population. Materials and methods: The s-Se concentrations were measured in 105 patients newly diagnosed or untreated for the previous 6 months with ATD (mean age 44±13 years). The patients were divided into three groups: euthyroid autoimmune thyroiditis (AIT) (n=31), hypothyroid AIT (n=33), and hyperthyroid patients with AIT or Graves’ disease (GD) (n=41). The results were compared to s-Se concentrations in 40 age- and sex-matched healthy controls. Determination of s-Se was carried out by inductively coupled plasma mass spectrometry (ICP-MS) after microwave-assisted acid mineralization of the serum samples. Results: The s-Se concentrations in patients with hyperthyroidism were significantly lower than those in the control group (hyperthyroidism: 69±15.0 µg/L vs. controls: 84±13 µg/L, p<0.001). There was no significant difference in the s-Se concentrations between euthyroid and hypothyroid participants with AIT and healthy controls. The s-Se concentrations in our control individuals were within the range of 53-137 µg/L, reported in literature data on mean serum and plasma levels of European healthy adults. Conclusions: The mean s-Se concentrations observed in all groups were below or close to the cutoff value of 80 µg/L, considered optimal for the activity of the Se-dependent antioxidant systems

Serum levels of leptin and adiponectin in patients with autoimmune Hashimoto’s thyroiditis

Introduction: Adipose tissue is immunologically and hormonally active, and these effects are mediated largely by adipocytokines. Thyroid hormones regulate metabolism and organ function, and Hashimoto’s thyroiditis (HT) is the most common autoimmune disease affecting thyroid function. Aim: To evaluate the levels of the adipocytokines leptin and adiponectin in patients with autoimmune HT, and to perform a comparative intragroup analysis in patients with different stages of gland functional activity, and in a control group. Materials and methods: Ninety-five patients with HT and 21 healthy controls were enrolled in the study. Venous blood was taken without anticoagulants after at least 12 hours of fasting, and serum samples were frozen at −70°C until analysis. Serum levels of leptin and adiponectin were determined by an enzyme-linked immunosorbent assay (ELISA). Results: Serum levels of leptin in HT patients were higher than those in the control group (4.5±5.2 ng/mL vs. 1.9±1.3 ng/mL). The hypothyroid patient’s group showed significantly higher levels of leptin than those of the healthy controls (5.1±5.2 ng/mL vs. 1.9±1.3 ng/mL), (p=0.031). Leptin levels correlated positively with body mass index (r=0.533, p<0.001), triglycerides (r=0.223, p=0.033), and immunoreactive insulin (r=0.488, p<0.001) levels. Serum adiponectin concentrations were higher in euthyroid HT patients than in the other groups, but the difference was not statistically significant (p=0.68). We found a positive correlation between adiponectin and HDL cholesterol levels (r=0.442, p<0.001), and negative with body mass index (r=−0.217, p=0.03), and immunoreactive insulin (r=−0.341, p=0.002). Conclusions: The results of this study suggest that leptin has a stronger effect than adiponectin in Hashimoto’s thyroiditis, which can be used to develop new therapeutic agents that modify its effect in the organism