Screening of diabetic retinopathy and macu-lopathy in Lebanese population using retinography and SD-OCT: the role of telemedicine

Diabetes and diabetic retinopathy [DR] are nowadays a major public health threat. The aim of this study is the screening of DR and diabetic maculopathy [DM] in a primary medical care center in Lebanon. We study also the interest of retinography and of SD-OCT in a tele-medicine screening program. This is a transversal study of patients with type 2 diabetes and with a regular follow-up in a primary medical care center in Beirut. For every patient, a retinography and an SD-OCT of the macula were obtained. Photos were sent by Internet to the Ophthalmology Department of Hotel-Dieu de France to be evaluated by a retina specialist. Visual acuity and DR risk factors were assessed. 119 patients were included in this study. Mean age was 51.7 +/- 10.2 years [54 females and 65 males]. Mean diabetes duration was 12.15 years [SD 6.2]. Mean of last three measurements of glycated hemoglobin was 8.1 +/- 1.34%. Diabetic retinopathy was detected in 36 patients by retinography [30.3%]. Diabetic maculopathy was confirmed by SD-OCT in 13 patients. Visual acuity was significantly correlated with central macular thickness. Mean diabetes duration, mean of last three measurements of glycated hemoglobin, peripheral neuropathy, positive macroalbuminuria and treatment with insulin were independently associated to diabetic retinopathy. Teleophthalmology is an efficient way for screening diabetic retinopathy in the Lebanese population. National screening program should be undertaken to adapt teleophthalmology on a larger scale

Vitamin D status in lebanese university students

Vitamin D inadequacy is highly prevalent in Lebanon in young adults, school children and postmenopausal osteoporotic women. However, this prevalence has not been previously studied in university students. Three hundred and eighty-one students [mean age 23.9 +/- 3.9 years], randomly recruited from Saint- Joseph University, were included in this cross-sectional study [201 males and 180 females]. Recruitment was performed across all seasons. The mean 25 hydroxyvitamin D [25[OH]D] was 31 +/- 12.4 ng/ml. 25[OH]D was inversely correlated with BMI and waist circumference [r = - 0.18 and r = - 0.19, p < 0.001 for both variables]. 25[OH]D was significantly different between the winter season and the other seasons [p = 0.023, p = 0.001 and p < 0.0001 for spring, summer and fall respectively]. 25[OH]D was lower in men compared to women [29.01 +/- 11.23 versus 33.2 +/- 13.4, p < 0.01]. This gender difference disappears after adjustment for both season and BMI. In addition, the inverse relation between 25[OH]D and BMI was non significant in the female population. In a stepwise multilinear regression analysis using 25[OH]D as a dependent variable, season and BMI were the independent predictors of vitamin D levels [p < 0.0001 and p = 0.001 respectively]. Our results suggest that, in a population of high educational level, vitamin D status is better compared to other subgroups of the Lebanese population. In addition, we found, after adjustment for BMI and season, no gender difference in 25[OH]D levels while the winter season and a high BMI negatively affect vitamin D status

[Autoimmune thyroid disease. Clinical and biological correlations]

In this article, we analyze the clinical and biological data concerning the autoimmune thyroid diseases in patients recruited in an endocrinology clinic at the university hospital center of Hotel-Dieu de France between March 2005 and November 2005. We studied 121 patients [51 with Basedow disease and 70 with Hashimoto thyroiditis], between 13 and 68 years old, with a BMI of 24.68 kg/m[2] and with a female predominance [105 women]. Symptoms of hyperthyroidism represented the most frequent cause of consultation. The distribution of patients regarding their thyroid disease showed that 42.1% of patients had hyperthyroidism [only one patient had subclinical hyperthyroidism], 21.5% had a subclinical hypothy-roidism, 28.1% had clinical hypothyroidism and 83% had euthyroid goiter. Half of the patients had at least a member of their family whith a thyroid disease. The autoimmune thyroid diseases are strongly associated to other autoimmune diseases and to repetitive spontaneous abortion. Thus, 39% of the married women had had at least one spontaneous abortion and 26.4% of the patients had one or more autoimmune disease associated to their thyroid disease; diabetes mellitus type 1 representing the most frequent one. Concerning the treatment, we remarked a remission of 30 patients [66.7%] with Basedow disease after 18 months of anti-thyroid drug treatment of 45 patients. In Hashimoto thyroiditis, we remarked a frequent evolution of patients with subciinical hypothyroidism to overt hypothyroidism when medical treatment was not initiated