[Erythrocyte abnormalities in thyroid dysfunction]

Erythrocyte abnormalities are frequently associated with thyroid dysfunction. However, they are rarely investigated and related to the thyroid. This study was aimed to determine the nature and frequency of erythrocyte abnormalities in thyroid disease and look for their evolution after thyroid function restoration. This retrospective study included 412 patients with peripheral thyroid disease; hyperthyroidism [n=235] or hypothyroidism [n=177]. Hyperthyroidism was considered for TSH <0.10 IUI/ml and hypothyroidism for TSH> 5.01 IUI/ml. Anemia was defined by hemoglobin level <13 g/dl in men and <12 g/dl in women, microcytosis by mean corpuscular volume [MCV] <80 fl, macrocytosis by MCV> 98 fl, and hypchromia by mean corpuscular hemoglobin [MCH] <25 pg. Restoration of euthyroid state was considered in patients with normal TSH levels for at least 3 months. Anaemia was observed in 40.9% of patients with hyperthyroidism and 57.1% of patients with hypothyroidism. Among these, normocytic or macrocytic anaemia was present in 46.3% of cases. Whereas, microcytosis, with or without anaemia, was noted in 87.7% of patients with hyperthyroidism. FT4 was positively correlated with the number of red blood cells and haemoglobin, and inversely correlated with MCV and MCH. After restoration of euthyroid state, most erythrocyte abnormalities were corrected. Thyroid diseases are frequently associated with erythrocyte abnormalities, including normocytic anaemia in hypothyroidism and microcytosis in hyperthyroidism. These abnormalities should be investigated and corrected. Their presence could steer towards subclinical thyroid dysfunction, allowing its early management

[Ambulatory blood pressure measurement control in hypertensive treated diabetic patients]

Good blood pressure control is one of the recommended targets in diabetic patient's management.To evaluate blood pressure [BP] control in hypertensive treated diabetic patients using ambulatory blood pressure measurement [ABPM]. Two hundred and six hypertensive treated diabetic patients were enrolled in this study [83 men and 123 women]. Mean age were 60.3 +/- 9.6 years-old with mean diabetic duration of 9.1 +/- 8.2 years. All of them underwent 24 hours ABPM. Intervals between measurements were 20 minutes at diurnal period and 30 minutes at nocturnal period. 28 patients [13.6%] only were at recommended target levels of blood pressure control [mean diurnal BP < 130/80 mmHg and nocturnal BP < 115/65 mmHg] and 137 patients were at the most bed control levels [mean diurnal BP ? 140/90 mmHg or nocturnal BP ? 125/75 mmHg]. Bed controlled patients had mildly higher waist circumference [p=0.08]. Poor BP control was associated with non dipper character [p<0.001], diabetic nephropathy [p<0.01] and diabetic retinopathy [p<0.01]. Our hypertensive treated diabetic patients were far from good blood pressure control. ABPM showed that the loss of nocturnal blood pressure fall was the most associated abnormality with poor BP control. Diabetic microangiopathy were more frequent in poor controlled patients

Blood glucose control in the first year in diabetes type 1

The purpose of this study is to analyze the blood glucose control in the first year after the diagnosis of type 1 diabetes. This retrospective study included the data on 52 patients [age< 30 years] with type 1 diabetes who were admitted at the time of diagnosis, seen afterwards in our outpatient department and who had at least one HbAlc determination during follow-up. Our evaluation included 29 female and 23 male diabetic patients, with a mean age of 21.3 +/- 4.5 years and mean initial BMI of 20.0 +/- 4.6 kg/m2 at the time of diagnosis. In more than 75% of the cases, during the year following diagnosis, HbAlc was determined one to two times and the mean level was 8.41 +/- 2.76%. HbAlc level was less than 7% in 38.5% of cases, and this group, when compared to the other group [HbAlc >/= 7%] was characterized by a higher baseline BMI [21.4 +/- 3.4 vs 19.2 +/- 3.1 kg/m 2, p<0.02] and less insulin requirements. These results show that an optimal blood glucose control in type 1 diabetes is difficult to obtain even in the first year after the diagnosis

[Cardiovascular risk factors in adults with primary hypothyroidism]

The purpose of this study is to evaluate vascular risk factors in adults with primary hypothyroidism. This retrospective study included 80 adult [age >/= 30 years] patients [60 women and 20 men], with primary hypothyroidism. The mean age at diagnosis was 52.8 +/- 12.1 years, the mean BMI was 30.8 +/- 5.8 kg/m[2] and 46.3% of the patients were obese while 28.8% had overweight. Mean total cholesterol was 2. 74 +/- 0.83 g/l and 83.7% of patients had hyper-cholesterolemia. LDL cholesterol level was above 1.6 g/l in 65.2% of cases. Mean triglycerides was 2.01 +/- 1.14 g/l and 41.2% of patients had hypertriglyceridemia. 22.5% of patients had hypertension and 8.8% were diabetic. Coronary heart disease was diagnosed in 11 patients [13.8%] and was significantly associated with age and hypertension. These results underline the expected high frequency of overweight and dyslipidemia in adults with hypothyroidism, despite a low frequency of diabetes and hypertension

[Role of visceral obesity in metabolic disorders associated with hyperandrogenia in Hirsute women]

The aim of our study was to evaluate the relationship between the importance of visceral fat measured by tomodensitometry and the metabolic disturbances in hirsute women. It is a prospective study where 52 women were explored for hirsutism, They underwent a clinical and biological examination, as well as an abdominal tomodensitometry at the 4th and 5th lumbar spine level to measure the area of visceral fat [VF] and sub-cutaneous fat [ScF]. In the 25 patients with VF predominance [VF/ScF >/= 0.2] age, body mass index [BMI], fasting insulin, [12h] and the prevalence of dyslipidaemia were significantly higher compared with women with ScF predominance [VF/ScF<02] There was a positive correlation between VF and age, BMI, waist to hip ratio, I2h and triglyceridemia. In conclusion, hirsute women with visceral fat predominance are at higher risk to develop the insulin resistance syndrome, So, preventive measures against cardio-vascular risk factors, like overweight, must be a part of the treatment

[Risk factors of diabetic retinopathy proliferative: a literature review]

Diabetic retinopathy is the most frequent complication of diabetic microangiopathy. 2% of diabetic patients become blind and 10% have visual impairment. In fact, diabetic retinopathy represents the first cause of blindness in active population in developed countries. Identification of the risk factors, for the progression of retinopathy has a major role in its prevention. Other factors, such as individual susceptibility, duration of diabetes and the age of the patient when diabetes started cannot be acted upon. 0ther factors can modify. Some of the most important goals should be to control strictly diabetes, hypertension, and hyperlipidemia and to follow carefully eventual pregnancies. An early and global management of these factors may slow down the progression towards diabetic proliferative retinopathy and thus prevent blindness

[ silent myocardial ischemia of diabetics: screening and risk factors]

Silent myocardial ischemia [SMI] is a clinical form of coronary artery insufficiency. It is more frequent in diabetic subjects and has an unfavourable prognosis. The aim of our study is to evaluate the prevalence of SMI in diabetic subjects and to determine its risk factors. This is a prospective study of 114 diabetic outpatients free from known coronary artery disease and clinical and electric symptoms of coronary insufficiency. All subjects underwent an exercise electrocardiogram [EE]; a coronary angiography was indicated in the positive cases. The prevalence of SMI was 12.3%. The subjects with positive EE were older [58.0 +/- 7.8 vs 52.0 +/- 10.5 years, p<0.05], more frequently of male sex [M/W =7/7 vs 28/72, p<0.02], had a higher duration of diabetes [p<0.001], a higher body mass index [28.1 +/- 3.4 vs 26.2 +/- 2.8 Kg/m2, p<0.05] and were more frequently hypertensive [8/14 vs 24/100, p<0.05]. In conclusion, screening for SMI must primarily target elderly overweighted male subjects with a long duration of diabetes and at least one other vascular risk factor

[Glycemic control in patients with type 2 diabetes]

Long term blood glucose control is still difficult to obtain in type 2 diabetic patients. To evaluate quality of control, we analyzed data from 300 patients who attended our outpatient department in 2002 and performed at least one glycated hemoglobin measure. Mean age was 59.9 +/- 10.2 years; 58.7% were women and known duration of diabetes was 11.0 +/- 74; years. The glycated hemoglobin level was less than 7% in 21.3% of patients; those having lower duration of the disease, being more frequently treated with oral drugs, having a better control of other cardio vascular risk factors and having more frequent screening for complications. These results confirm the difficulty in obtaining optimal glucose control in patients with type 2 diabetes and the need for intensive anti-diabetic treatment