Background and objectives Nesfatin-1 as a potent anorexigenic peptide is secreted by pancreatic β cells. Conflicting data are available about its level among diabetic patients. Our study aimed to assess nesfatin-1 levels in newly diagnosed drug-naïve diabetic and pre-diabetic patients and its association with cardio-metabolic risk and insulin resistance (IR). This case-control study included drug-naive patients with DMT2 (group 1, n = 30) and pre-diabetes (group 2, n = 30) in addition to healthy subjects (group 3, n = 28). Anthropometric and routine biochemical assessments were performed. Serum nesfatin-1and plasma insulin levels were assessed by ELISA methods. Homeostatic model for assessment of IR (HOMA-IR) was calculated. Results Serum nesfatin-1 was significantly lower in diabetic and pre-diabetic compared to healthy subjects (3.89 ± 1.1 ng/dl and 7.47 ± 1.22 ng/dl versus 15.39 ± 3.53 respectively, p < 0.001). Also diabetic patients had statistically significant lower nesfatin-1 levels than pre-diabetic patients (p < 0.001) Roc curve analysis identified cut-off values of ≤ 9 ng/dl and ≤ 5.5 ng/dl with an AUC of 0.94 and 0.97, sensitivity of 96.7 and 100%, and specificity of 93.3% and 96.7% for diagnosis of pre-diabetes and diabetes respectively. Using bivariate analysis, nesfatin-1 was negatively correlated with glycemic parameters (fasting and 2 h postprandial blood sugar, HBA1c), IR parameters (fasting insulin and HOMA-IR) and atherogenic lipid profile (triglyceride, cholesterol, and LDL-c); and positively correlated to HDL-c in both diabetic and pre-diabetic but not in healthy. Conclusion Nesfatin-1 is an excellent predictor for pre-diabetes and DMT2. It is associated with favorable glucose and lipid metabolism probably via insulin signaling pathway.

Background and Aims Vascular calcification contributes to morbidity and mortality in patients with ESRD on maintenance hemodialysis. to study the relationship between osteocalcin and vascular calcification. Method 160 patients with ESRD on maintenance hemodialysis and 60 age-and sex-matched healthy controls were recruited. Serum vitamin K2 and osteocalcin both intact and undercarboxylated were measured. Transthoracic echocardiography was done for valvular calcification and thickening, and carotid duplex was done for carotid intimal medial calcification and thickening. Results Hemodialysis patients have higher median serum vitamin K2 (p&lt;0.001), higher undercarboxylated osteocalcin (p&lt;0.001). Only older age, duration of hypertension, and duration of established cardiovascular disease are associated with carotid media-intimal calcification. Old age is a strong predictor of carotid media intimal thickening. Female sex is associated with valvular thickening. Conclusion Functional vitamin K deficiency is present in maintenance hemodialysis patients and serum osteocalcin is not associated with cardiovascular calcification.

Introduction Chronic kidney disease (CKD) is associated with increased morbidity and mortality. Cardiovascular disease (CVD) is the most common complication and a chief cause of death in patients with end stage renal disease (ESRD) accounting for 45% to 50% of causes of death in ESRD patient. Pulmonary hypertension (PH) occurs frequently in patients with CKD. The role of hemodialysis in reducing pulmonary artery pressure (PAP) and improving RV systolic function in not properly studied. Purpose To evaluate the effect of hemodialysis on Right ventricular (RV) systolic function and Pulmonary artery pressures using echocardiography in newly diagnosed end stage renal disease patients and after three months of regular hemodialysis. Patients and Methods 30 patients recently diagnosed to have ESRD were enrolled and were followed up after three months. Trans-thoracic echocardiography was done prior to the first dialysis session and after three months of regular hemodialysis to asses RV systolic function and PAP. Results There was a significant improvement of RV systolic function assessed by trans-annular plane systolic excursion (TAPSE)(mm)(pre dialysis 18.9 ± 3.76, post 21.56 ±3.51, p &lt;0.01), fractional area change (FAC)(%)(pre dialysis 41.27 ± 8.9, post 47.5 ± 6.1, p &lt; 0.01),tricuspid lateral annular systolic velocity (S’)(cm/s) (pre dialysis 12.3 ± 2.79, post 14.16 ± 2.3, p &lt; 0.01),myocardial performance index (MPI)(pre dialysis 0.2 ± 0.1, post 0.1 ± 0.1, p &lt; 0.01)and right ventricular outflow tract fractional shortening (RVOT-FS)(%)(pre dialysis 36.5 ± 9.5, post 39.3 ± 8.6, p &lt; 0.01)post dialysis (P value &lt;0.01). All parameters of assessing pulmonary artery pressures; systolic pulmonary artery pressure (PASP)(mmHg)(pre dialysis 48.03 ± 17.16, post 35.12 ± 14.73, p &lt; 0.01), pulmonary diastolic artery pressure (PADP)(mmHg)(pre dialysis 24.05 ± 9.7, post 18.12 ± 9.64, p &lt; 0.01), mean pulmonary artery pressure (MPAP)(mmHg) (pre dialysis 35.61 ± 15.07, post 25.8 ± 12.06, p &lt; 0.01), pulmonary capillary wedge pressure (PCWP)((pre dialysis 23.28 ± 8.74, post 17.39 ± 5.87, p &lt; 0.01) and pulmonary vascular resistance (PVR)(Wood unit)(pre dialysis 1.89 ± 0.57, post 1.43 ± 0.46, p &lt; 0.01) improved significantly post dialysis (P value &lt;0.01).There was a significant inverse correlation between the duration of renal impairment and the improvement in SPAP and PCWP after the initiation of dialysis (P values are 0.021 and 0.015, Correlation co-efficient -0.421, -0.441 respectively). The best cut-off value for weight reductionduring dialysis for prediction of improvement of SPAP is 2.75 Kg (AUC = 0.950, CI = 0.881-1.000, P value &lt; 0.01). Conclusions The present study shows that significant improvement occurred in all RV systolic function parameters and all parameters of assessing pulmonary artery pressures post dialysis in patients recently diagnosed to have ESRD. RVOT FS is a reliable method for assessing RV function and it is significantly correlated only with TAPSE and FAC at the baseline before dialysis.

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Introduction: Diabetes mellitus type 2 (formerly non insulin-dependent diabetes mellitus (NIDDM) is a metabolic disorder that is characterized by hyperglycemia in the context of insulin resistance and relative lack of insulin. Aims of the Work: The aim of the present study is assessment of plasma level of nesfatin-1 and its association with various metabolic parameters in newly diagnosed type 2 diabetic patients. Subjects and Methods: This study included 90 Patients were selected from those coming to Minia University hospital diabetes and outpatient clinics known to have newly diagnosed Diabetes Mellitus, diagnosed according to 2017 American Diabetes association (ADA) criteria. Results: This study was conducted on 90 persons our selected from our diabetic outpatient clinic and outpatient clinic of internal medicine .All subjected were divided into three groups. Discussion: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. (ADA 2013). Conclusion and recommendations:The novelty of our study is that we showed, for the first time, significantly lower nesfatin-1 levels in diabetic patients (Type 2 DM) but less lower in prediabetic patients (IGT). Nesfatin-1 is a newly identified polypeptide probably involved, in the regulation of food intake. It is important to clarify the relationships between nesfatin-1 and insulin resistance with regard to diabetes. To elucidate its physiological role further studies are required.