Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function

The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged >/= 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group

[Molecular mechanism of action of ezetimibe and recent therapeutics]

High blood Low density lipoprotein cholesterol is a major cardiovascular risk factor and must be the primary target of primary and secondary heart protection. Statines, 3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] reductase inhibitors, are the cornerstone of lipid-lowering therapy for reducing LDLc levels. However, some patients at high risk fail to achieve LDLc target despite high-dose statin therapy. Statins may also induce adverse effects. Ezetimibe is the first potent cholesterol absorption inhibitor. Several ongoing clinical interventional trials will shed more light on the association statin plus ezetimibe in high risk patients. A better understanding of intestinal cholesterol absorption will lead to novel approaches for the prevention and treatment of hyperlipidemia

[ quality of ambulatory care provided to non-insulin treated diabetic patients]

We assessed the quality of care provided to non-insulin treated diabetic patients by examining the medical records of 248 such patients attending our outpatient department in 2002. The mean age was 59.5 [SD 10.1] years, 62.1% were women and known duration of diabetes was 8.6 [SD 5.9] years. The majority of patients were treated with a combination of sulfonylurea and metformin. Glycaemic control was assessed using fasting blood glucose in 96.8% of patients, post-prandial blood glucose in 31.9% and glycated haemoglobin in 52.4%. Weight was measured at least once for 88.7% of patients, blood pressure for 91.1% of patients and lipid levels for 64.9%. Body mass index was less than 25 kg/m2 in 12.3% of patients and blood pressure less than 140/90 mmHg in 40.3%. Foot examination was noted in only 2% of records, electrocardiography was performed for 25% of patients and fundoscopy for 21%. Proteinuria was documented in 19.8% of patients and plasma urea and/or creatinine in 57.3%

[Microangiopathte among the patients type 2 diabetes at diagnosis]

Chronic complications may he preset at the moment of diagnosis in type 2 diabetes. To study the retinopathy and the nephropathy among recently diagnosed patients, we analyzed data of 194 patients admitted in our department and who underwent screening for these two complications. The mean age was 56.0 +/- 12.9 years and 52.6% of patients were female. Retinopathy was diagnosed in 7.2% of patients and was associated with lower BMI compared to patients without retinopathy. Nephropathy was identified in 7.7% of patients, who had higher systolic and diastolic blood pressure and higher serum cholesterol levels than patients without nephropathy. These results confirm the high, frequency of retinopathy and nephropathy at the time of diagnosis in type 2 diabetes in adulthood and the lack of link between these complications. They underline the importance of their independent detection at the initial investigation

Probleme poses par la prise en charge des complications oculaires du diabete

In volument of ocular complication of diabetes constitutes an inevitable consequence of long standing diabetes. This a precocious diagnosis and an appropriate therapy seem the best way for preventing or at less stabilizing the complications. This study, shows the numerous aspects of an insufficient follow up and therapy in one HUC of Tunis. The solution to propose is evident

congenital suprarenal hyperplasia by 11 beta hydroxylase

The congenital adrenal hyperplasia by 11 beta hydroxylase deficiency is responsible for hypertention and hyper androgeny with sexual ambiguity or precocious pseudo puberity. This data reports the difficulties with early diagnosis and management of these rare affections