Unbalanced bone remodeling in Tunisian patients with inflammatory bowel diseases

Bone loss is an ignored complication in inflammatory bowel diseases. Its underling mechanisms are not fully elucidated. To investigate bone turnover in patients with inflammatory bowel diseases.The study included 67 patients with inflammatory bowel diseases and 54 age- and sex-matched healthy subjects. Urinary degradation products of C-terminal telopeptide of type I collagen, serum osteocalcin, parathyroid hormone, 25 hydroxy vitamin D and interleukin-6 were assessed. Bone mineral density was measured by dual energy-X-ray absorptiometry and osteoporosis was defined as T score < -2.5 SD. Patients showed significantly higher levels of C-terminal telopeptide of type I collagen and interleukin-6 and lower levels of 25 hydroxy vitamin D. Serum osteocalcin and parathyroid hormone were in normal range. In multivariate analysis, urinary degradation products of C-terminal telopeptide of type I collagen were associated with disease activity [p=0.04] and osteocalcin was associated with parathyroid hormone [p=0.04]. Urinary degradation products of Cterminal telopeptide of type I collagen and interleukin-6 were significantly increased in inflammatory bowel disease patients with osteoporosis. No association was found between osteoporosis and serum osteocalcin, parathyroid hormone and 25 hydroxy vitamin D. Bone resorption rate is increased and is associated with osteoporosis in inflammatory bowel disease patients. Inflammation, malnutrition, and hypovitaminosis D may contribute to the bone loss

Aminoacidopathies and organic acidurias in Tunisia: a retrospective survey over 23 years

Inborn errors of metabolism are neglected in developing countries because they are not as common as infectious and nutritional disorders. In Tunisia, no information is available on the incidence and epidemiological features of these inherited metabolic diseases. To precise the profile of aminoacidopathies other than phenylketonuria and organic acidurias and to estimate their incidences in Tunisia. Between 1987 and 2009, our laboratory received 13171 requests for analysis of patients with symptoms suggestive of inborn errors of metabolism. For these cases, ion exchange chromatography of free amino acids was performed on amino acids analyser. Urinary organic acids profiles were determined by gas chromatography-mass spectrometry. Abnormal cases were 370 [2.8%], divided into 212 cases of aminoacidopathies [57.3%] and 158 cases of organic acidurias [42.7%]. The most frequent aminoacidopathies, were maple syrup disease [32.5%], tyrosinemia type I [28.8%] and nonketotic hyperglycinemia [16%]. Methylmalonic aciduria [33.5%], propionic aciduria [18.4%] and 2-hyrdoxy glutaric aciduria [10.8%] were the most frequent organic acidurias. The incidences were calculated using the Hardy-Weinberg formula and were estimated at 1/13716 for maple syrup disease, 1/14804 for tyrosinemia type I, 1/16144 for methylmalonic aciduria and 1/23176 for propionic aciduria. Aminoacidopathies and organic acidurias turned out to be highly frequent in Tunisia, mainly because of a high rate of consanguinity. We believe that they are underestimated. To improve their diagnosis, it is necessary to have available sophisticated equipment which would allow early treatment of patients

[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