Depression and diabetes

Introduction: Some researchers suggest that people with depression are more likely to develop diabetes. The AIM of this study is determinate the effects of SSRIs antidepressant in depressive patients with diabetes mellitus . Methods: The study was designed as observation cross-section including 80 depressive patients with diabetes, observed as two groups. The first group was presented patients without antidepressant medication in them (the patients who starting in the treatment), and the second group were patients with antidepressant therapy (sertraline). Depression status was assessed using BDI. Quantitative determination of glucose level in serum was performed with enzymatic reference method with hexokinase. Results : There was significant differences in distribution on according the level of blood glucose in observed groups. . In the first group 58% of patients have high level of blood glucose but in second group only 20% of them.. Data obtained in the first groups show significant positive correlation between score of BDI and blood glucose level. P=0,003. The results in examination groups show positive correlation between blood glucose level and socio-demographic and clinical parameters. Conclusion : The results obtained in our study showed high blood glucose levels in depressant patients but treatment with sertraline was diminished this level. So screening this condition is important, because that patients shoved be treated differently

Autoimune antibodies in thyroid diseases

Background: Irrespective of the recommendations to use the measurement of serum TSH as cornerstone of thyroid function testing, the laboratory diagnosis and monitoring of thyroid diseases are based on the thyroid panel including TSH, FT4, TT4, TT3, FT3, anti–TPO and anti-TG. Autoimmune thyroid diseases include Graves' disease, Hashimoto thyroiditis and these types of disorders are caused by immune system malfunction. In other words, instead of protecting the body's healthy tissues, malfunctioning immune cells actually attack them. Methods: Morning serum concentrations of anti-TPO and anti-TG were assessed in a prospective study in 50 subjects with Graves' disease, 50 subjects with Hashimoto thyroiditis and 40 healthy subjects as control 52 BALKAN JOURNAL OF CLINICAL LABORATORY - XXVI, 18, 1 th 26 BCLF 2018 Skopje l October 3 - 5, 2018 group. Serum concentration of anti–TPO and anti-TG were determined by chemiluminescence immunoassay using Immulite 2000 analyzer. Results: The following results were obtained: serum concentration of anti-TPO in the control group was 3.7 IU/mL ± 0.46, in Graves' disease 195 IU/mL ± 0.70 and in Hashimoto thyroiditis 238.5 IU/mL± 0.95. Serum concentration of anti-TG in Hashimoto thyroiditis was highest (333.3 IU/mL ± 0.55). Patients with Graves' disease and Hashimoto thyroiditis showed significantly higher concentrations of anti-TPO and anti-TG compared to healthy individuals (P<0.001). Conclusion: Serum concentrations of anti-TPO and anti-TG organ specific autoantibodies respectively are very precious parameters - markers for reliable diagnosis of autoimune thyroid diseases

Heroin dependents are insulin resistant

Background. Fasting insulin levels, HOMA-IR and HOMA-%B are precise methods for determining insulin resistance and can be used in assessing the insulin sensitivity in heroin dependents (HD). Heroin dependents are expected to be insulin resistant. To determine the heroin influence on insulin sensitivity in male heroin dependents compared to control healthy male (K). Materials. Fasting insulin levels (I), HOMA-IR, HOMA-%B, fasting glucose levels (gl) and C-peptide (C) were determined in both groups, group K with mean age (28.1±4.2 yr) and mean BMI (22.8±2.5 kg/m2), not different compared to group HD with mean age (27.9±5.4 yr) and BMI (22.3±3.1 kg/m2),which were HCV negative. Methods. I and C were determined with hemiluminiscentmethod on Immunology Analyzer Immulate2000, HOMA-IR was calculated [(FIxFgl)/22.5], as well as HOMA-%B [(20xFI)/(Fgl-3.5)]. Results. I values in HD group were 15.24±27.6 IU/L, significantly higher compared to K (4.58±3.23) (p0.05). HOMA-IR in HD (2.52±3.29) and HOMA-%B (111.56±58.14) were significantly higher compared to the correspondent values in K (1.02±0.8) (p<0.016) and (68.83±46.57) (p<0.05). I values correlated highly significantly positively with HOMA-IR, HOMA-%B and C-peptide (p<0.0001) in HD. Conclusions. HD were characterized with significantly higher I, HOMA-IR, HOMA-%B values, which correlated highly significantly between themselves, confirming insulin resistance in HD

Sexual Dysfunction as a Side Effect of Hyperprolactinemia in Methadone Maintenance Therapy

Although endocrine abnormalities are recognized in opiate users, very little is known about the range of hormones affected, their pathophysiology and their clinical relevance. Various endocrine abnormalities have been reported in these patients including, increased prolactin levels and abnormalities in sexual hormone. Path physiological mechanism postulated does explain these findings including direct action of heroin or methadone at the hypothalamic pituitary level. The aim of this study was to explore the effects of heroin and methadone maintenance treatment on the plasma prolactin levels and sexual function. Material and methods: We evaluated 20 male narcotic addicts maintained of methadone more than 3 years on oral high dose methadone 60-120 mgr/day. Patients taking neuroleptic therapy were excluded from the study because neuroleptic-included hyperprolactinemia. We also evaluated group of twenty male heroin addicts on the street heroin .The prolactin plasma levels were assayed using the chemiluminescent immunometric essay (CLIA) - high sensitive methods, The normal range of prolactin levels was 1,5-17 ng/ml(53-360 nmol/l) for men and 1,90-25,0 ng/ml for women. The sexual function was assessed using a Questionnaire: International Index of Erectile Function (IIEF) with 15 items in four levels of sexual function. The differences between two examination groups were determined by a student’s t test. The results show that street heroin addicts (55% of them have high level of prolactin) have significantly higher plasma prolactin levels (p=0,006) then the group of methadone maintenance patients (only 15% of them have high prolactin level). In our study, when we compared sexual dysfunction in examination groups in some domains, we did not find statistical significant results (sexual desire p=0,52 and overall satisfaction p=0,087). But in domains of erectile function p=0,011 and orgasm function p=0,033 we got statistical significant results. Key words: heroin addiction, methadone maintenance therapy, sexual dysfunction, prolactin plasma level

Determination of Hsp 70 as one of the important inputs in the detection and definition of the degree of myocardial ischemic events

Background: Atherosclerosis induced myocardial ischemia should be as soon as possible confirmed in aim of further protocols. Oxidative stress, through various inflammatory events induces processes involved in repairing the damage. Determination of Heat shock proteins(Hsp)70, involved in this issue give useful data since they induce mechanisms that take part in protein remodeling so can repair the impaired myocardium integrity. Hypoxia and re-oxygenation alter the distribution of cardiac proteins through changes in mRNA so, cardiac myocytes try to protect themselves by regulating antioxidant proteins and stress proteins. Therefore, the determinations of Hsp70 antibodies indicate necrosis, but also witness the initiation of the repair processes of damage. Methods: Study involves group (200) patients suspected for AMI. Standard laboratory protocol was carried out for confirming or dismiss the AMI diagnosis including, photometric determination of cardiac enzymes, (CK, CKMB), MEIA principle for estimation of cardiac markers. Determination of concentration of Hsp70Ab was performed with ELISA technique. Results: Standard statistical analysis showed a positive correlation of Hsp 70 level and CRP with increase cTnT and cTnI values at patients with confirmed AMI (67% of patients). Also, we found an elevated level of Hsp70 in the majority of patients with AP/NSAP (96.7%) and in patients with pulmonary disease (100%). Level of Hsp 70 vs control group shows 15 fold increases at the patients with AP/NSAP, but more important is even 26fold increase at the patients with AMI. Results are significant in aspect of estimation of level of damage, according to some previous data that which detected the path of activation and transduction of the signals through different protein kinase pathological processes. Conclusion: Our results and the prevalence of detected increased Hsp 70Ab at 67 % of patients with AMI testify of engagement of this proteins in cardiac proteins recovering processes. The higher prevalence in patients with AP speaks about the chronic condition at the patients and therefore our recommendation, supported by other data, is to monitor the level of these proteins in patients with AP in order to avoid unwanted, unfavorable outcomes for such patients

Основни познавања на лабораториската работа

Книгата на еден интересен начин го моделира наставниот процес поврзувајќи го начинот на работа (методот на лабораториска работа) со моделот на настава (проблемска настава). И едниот и другиот елемент се во функција на активност на студентот во наставата како и поврзување на теоријата со практиката, со што на овој начин студентите ќе се оспособат за успешно вклучување во животот и работата понатаму

Plasma cortisol levels in heroin addicts

Opioids can affect neuroendocrine functions, with the consequence that various endocrine abnormalitiesincluded the increased level of cortisol that can result from depression, may be acceptable in patients who use opioids. The pathophysiological mechanism that has been postulated does explain these findings, including the direct action of heroin along the hypothalamic-pituitary-adrenal axis. The AIM of this study is to examinations the correlation between duration of heroin addicts, plasma cortisol levels and depression in heroin addicts. Materials and Methods: The cross section present study included groups of n= 50 heroin addicts evaluation to the clinic for outpatients (ambulance) in medical institution- Psychiatric Hospital Skopje. All the patients followed criteria for opioid dependence. Criteria for elimination was: chronic liver or renal diseases, HIV diseases or active infection. The cortisol plasma levels were assayed using the chemiluminescent immunometric assay (CLIA) normal range of cortisol level was 55,0 – 690nmol/l. For in vitro diagnostic use with the Immulite 2000 Systems Analyzers –for the quantitative measurement of cortisol in serum, as an aid in the clinical assessment of adrenal status. To determinate exactly results of plasma cortisol levels we use QS of the Biorad. Depression was assays with Beck Depression Inventory (BDI) considerate with 21 items. The results were an analyzed statistically using; descriptive methods, t-test for independent simplex and the Pearson coefficient of linear correlation. The statistical test were considered significant at the level p ≤ 0,05. Results: The group consisted of n=50 heroin addicts evaluation to the clinic for outpatients (ambulance) in medical institution- Psychiatric Hospital Skopje. A higher percentage 54 % of heroin addicts have normal plasma cortisol level and 46 % have a higher plasma cortisol level. In our study we got positive correlation between duration of heroin addiction and plasma cortisol level but without statistically significant p > 0,05. A high number of heroin addicts 62% had higher score of BDI≥10 only 38% had score of BDI<10 (table 6). Between cortisol plasma level and score BDI (depression) we got statistically significant correlation p < 0,0001. Conclusion: In some heroin addicts we got higher plasma cortisol level and higher percent of score BDI≥10. Correlation between plasma cortisol level and score of BDI was significantly. So one of the endocrine abnormalities in opiate users is a higher cortisol plasma level who can correlate with depression. Maybe treatment heroin addicts will be normalization levels of ACTH and cortisol. Keywords: heroin addiction, cortisol plasma level, depression

Body fat distribution and lipid profile changes after weight loss – a case report

The aim of this study was to discover the relationship between body fat distribution and lipid profile changes after weight loss. In this case report following subject’s parameters were determined before and after weight loss of 12 kg: body mass index (BMI), body weight (BW), total, trunk and legs fat mass (FM) with dual energy x-ray absorptiometry (DXA) and their ratios legs/trunk and legs/total FM indexes of abdominal fat distribution. Lipid profile was also determined before and after weight loss: total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, LDL/HDL-C, TC/HDL-C. BW of 63 kg and BMI value of 28.74 kg/m2 before the weight loss lowered to 51kg and 22.55 kg/m2. The percentage difference between the change in BMI and BW was statistically not significant (p=0.782). Legs/total FM index value increase from 0.36 to 0.39 was significant (p0.05), but the percentage difference between their changes, during weight reduction was statistically significant (p=0.0001). TC, HDL-C, LDL-C, LDL/HDL-C, TC/HDL-C changes were also significant. The percentage difference between the change in BMI and BW to normal levels was statistically not significant, but the percentage difference between the changes in DXA indexes of visceral, abdominal obesity was significant and it was associated with significant reduction of atherogenic lipid profile indicating reduced atherogenic risk. These results confirmed that DXA measurements of abdominal fat distribution are very useful in studies related to obesity-associated disease risk

Immunological criteria for the differential diagnosis of thyroid disease

Background: Thyroid autoimmune disease is the major factor underlying hypothyroidism and hyperthyroidism and tends to occur in a genetically predisposed population. The major thyroid autoimmune diseases are: Hashimotoʼs diseases and Gravesʼ diseases. Methods: Quantitative measurement of antithyroid peroxidase (TPO) antibodies and autoantibodies to thyroglobulin (TG) in serum, EDTA, and heparinized plasma, as an aid in the clinical diagnosis of thyroid diseases. Serum concentration of Anti – TPO Ab and anti – TG Ab were determined by are a solid-phase, enzyme – labeled, chemiluminescent sequential immunometric assays using analyzer Immulite 2000. Results: 30% to 50% of individuals with autoimmune hypothyroidism, will have detectable anti-Tg autoantibodies, while 50% to 90% will have detectable anti – TPO autoantibodies. In Gravesʼ disease, both types of autoantibodies are observed at approximately half of these rates. 10 percent of healthy individuals have TG autoantibodies at low levels, higher concentracions are found in 30 and 85 percent of patients with Gravesʼ diseases and Hashimotoʼs thyroiditis, respectively. Patients with Graves disease and Hashimoto thyroiditis showed significantly higher concentrations of anti-TPO and anti-TG compared with healthy individuals. (P <0.001). Following results were obtained: values of anti-TPO in patients diagnosed with sc Groves disease compared to the control group were 3.7± 0.46, and in patients with Hashimoto thyroiditis 238,5 ± 0.95. Values of anti-TG in patients diagnosed with sc Groves disease compared to the control group were 333,3 ± 0.55, Hashimoto thyroiditis 500,5 ± 0.95. Conclusion: The consensus opinion today is that they are merely disease markers. It is felt that the presence of competent immune cells at the site of thyroid tissue destruction in autoimmune thyroiditis simply predisposes the patient to form autoantibodies to hidden thyroid antigens

Estimated central obesity index – worthwhile screening test procedure of abdominal obesity

Central obesity index (COI) is an indicator of central, abdominal obesity, which is the main characteristic of the metabolic syndrome. Dual-energy x-ray absorptiometric (DXA) assessment of the body fat distribution was performed through the COI values determined with a scan of the entire body in comparison to estimated COI values (eCOI) on spine and hip performed scans. COI was determined as a ratio of android (A) tissue percent fat (A-Tf%) and gynoid (G)-Tf% (COI=A/G-Tf%) as well as eCOI=eA/eG-Tf% in 3 groups of women: 1st group of women with Cushing’s syndrome (CS) (n=14), 2nd group of obese (O) women (n=21), 3rd group of non obese healthy women (C) (n=22). The examinees were not different according to their age, which was 44.32±13.83 years in the 1st group, 43.33±12.58 years in the 2nd group and 42.56±14.67 years in the 3rd group, as well as according to their BMI, which was 30.02±5.02 kg/m2 in CS, 29.66±4.88 kg/m2 in O, but it was in normal range 21.76±1.43 kg/m2 in non obese control group of healthy women. The values of eA, eG and eA/еG were not significantly different compared to the correspondent values A-Tf%, G-Tf% and A/G-Tf% in all examined groups (p>0.05). The values of eA and A-Tf% in CS were significantly higher compared to O (P0.05) in O confirming COI positive association with central, abdominal fat distribution. Conclusion: DXA indexes COI and eCOI discovered extreme central body fat distribution in CS women, differentiated them significantly and precisely from C and CO, and could be used as diagnostic DXA indexes of extreme central, abdominal obesity in CS and non CS abdominal obese women in DXA body composition and fat distribution assessment. Determination of eCOI is reliable, more practical and faster, with lower radiation and is more acceptable compared to COI, and it can be a routine screening procedure for body composition and body fat distribution assessment, during regular spine and hip scans for osteoporotic risk assessment instead of COI body fat distribution determination with total body composition measured scans which are used in scientific studies and are not necessary to be performed in clinical body fat distribution examinations