Athrogenic indexes: Useful markers for predicting metabolic syndrome in axial spondyloarthritis / Índices aterogénicos: marcadores útiles para predecir el síndrome metabólico en la espondiloartritis axial

Introduction: Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce. We aim: to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome. Methods: We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDLc), low-density lipoprotein cholesterol (LDLc), and total cholesterol (TC). We calculated TC/HDLc, TG/HDLc, LDLc/HDLc ratios, and atherogenic index of plasma (LogTG/HDLc). Results: Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89±5.88 versus 23.63±4.47kg/m2, p=0.03), higher TG (1.41±0.64 versus 0.89±0.5mmol/L, p=0.05) and a lower HDLc level (1±0.28 versus 1.31±0.22mmol/L, p=0.01). However, the LogTG/HDLc and TG/HDLc were higher in patients under TNFα inhibitors. The ability of the TG/HDLc ratio and LogTG/HDLc to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios). Conclusion: Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.(AU)

Introducción: El síndrome metabólico es una entidad patológica asociada a un alto riesgo de enfermedad cardiovascular. Los datos sobre la frecuencia de este síndrome, el perfil lipídico y el índice aterogénico del plasma en pacientes con espondiloartritis axial radiográfica son escasos. Nuestro objetivo es determinar la prevalencia del síndrome metabólico en pacientes con espondiloartritis. También pretendemos determinar valores discriminativos de índices aterogénicos entre pacientes con y sin síndrome metabólico. Métodos: Realizamos un estudio transversal que incluyó a 51 pacientes que cumplían los criterios ASAS 2009 para espondiloartritis axial radiográfica. Medimos los siguientes parámetros: triglicéridos (TG), lipoproteínas de alta densidad (HDLc), colesterol de lipoproteínas de baja densidad (LDLc) y colesterol total (CT). Calculamos las relaciones CT/HDLc, TG/HDLc, LDLc/HDLc y el índice aterogénico del plasma (LogTG/HDLc). Resultados: El síndrome metabólico se observó en el 33% de los casos. Los pacientes con enfermedad activa tenían un índice de masa corporal más alto (26,89±5,88 versus 23,63±4,47kg/m2; p=0,03), TG más altos (1,41±0,64 versus 0,89±0,5 mmol/L; p=0,05) y un nivel de HDLc más bajo (1±0,28 versus 1,31±0,22mmol/L; p=0,01). Sin embargo, el LogTG/HDLc y TG/HDLc fueron mayores en pacientes bajo inhibidores del TNFα. La capacidad de la relación TG/HDLc y LogTG/HDLc para distinguir pacientes con o sin síndrome metabólico fue buena en puntos de corte de 1,33 y 0,22, respectivamente (especificidad: 91,2% y sensibilidad: 70,6% para ambas relaciones). Conclusión: Nuestro estudio mostró que el síndrome metabólico es frecuente en pacientes con espondiloartritis axial. Los índices aterogénicos se pueden utilizar para predecir el síndrome metabólico en estos pacientes.(AU)

Athrogenic indexes: Useful markers for predicting metabolic syndrome in axial spondyloarthritis.

INTRODUCTION: Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce. We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome. METHODS: We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDLc), low-density lipoprotein cholesterol (LDLc), and total cholesterol (TC). We calculated TC/HDLc, TG/HDLc, LDLc/HDLc ratios, and atherogenic index of plasma (LogTG/HDLc). RESULTS: Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89±5.88 versus 23.63±4.47kg/m2, p=0.03), higher TG (1.41±0.64 versus 0.89±0.5mmol/L, p=0.05) and a lower HDLc level (1±0.28 versus 1.31±0.22mmol/L, p=0.01). However, the LogTG/HDLc and TG/HDLc were higher in patients under TNFα inhibitors. The ability of the TG/HDLc ratio and LogTG/HDLc to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios). CONCLUSION: Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.

[Role and effectiveness of radioactive-iodine therapy for the treatment of Grave's disease]. / Irathérapie dans la maladie de Basedow: place et efficacité.

The treatment of Graves' disease is based on three therapies: medical treatment with synthetic antithyroid agents, surgery and radioactive-iodine therapy. The purpose of our study was to study the role and effectiveness of radioactive-iodine therapy for the treatment of Graves' disease. We conducted a retrospective, descriptive study of the epidemiological, clinical, paralclinical and therapeutic features of 54 patients with Graves' disease managed and treated with iodine-131 as well as of their short- and medium-term remission rate. The sex ratio was 0.45. The average age of patients was 38,33 ± 12.7 years. The most common functional signs were weight loss, tremors and palpitations. Mean FT4 was 54,51 ± 19,56 ng/dl (ranging from 8,90 and 100). Mean TSHus was 0,074 ± 0,29 µIU/ml. Synthetic antithyroid drugs were used in 49 patients; 83,67% of cases had persistent hyperthyroidism. Radioactive-iodine therapy was used as first-line therapy in 9,3% of cases and as second-line therapy in 90,7% of cases. Mean activity was 13,29 mCi ± 1,46 ranging from 10 to 15 mCi. The first assessment of hormonal status was performed after an average post-treatment period of 1,91 months; 29 patients (53,7%) achieved remission (eu- or hypo-thyroidism). After a 12 month-follow-up, patients' course was marked by remission in 88,88% of cases (euthyroidism in 14,8% and hypothyroidism in 74% of cases). Radioactive-iodine therapy is an effective treatment for Graves' disease. High radioactive iodine dose provides high remission rate.

Delay of insulin therapy in type 2 diabetics.

Type 2 diabetes (T2DM) is a progressive disease. Insulin appears early in the therapeutic intensification algorithm, but is still a last resort. This delay is frequent but its duration has been little studied in the Tunisian population. The main objective of this study was to identify and evaluate, in a specialized center, the delay in insulin therapy in type 2 diabetics. This was a retrospective, cross-sectional study of 140 patients. DT2 were included as oral antidiabetic agents, including at least one optimal dose sulfonamide, hospitalized for insulin therapy between January 1, 2014 and December 31, 2015. The delay in insulin therapy was defined by the succession of two HbA1c values ≥8% at least 3 months apart. Its duration, in months, calculated in 90 patients, corresponds to that passed between T0 where HbA1c ≥8% and T1 at the insulin initiation. Our population was 74 women and 66 men, mean age 58.2 ± 11.7 years. The average duration of diabetes was 10.3 ± 6.1 years; mean fasting glucose and HbA1c were 11.9 ± 3.6 mmol / l and 11.3 ± 2%, respectively. The delay in insulin therapy concerned all patients. Its average duration was 39 ± 29 months with extremes of 6 months to 10 years. Mean HbA1c increased significantly from 10 ± 1.5% to 11.2 ± 2% between T0 and T1 (p <10-3). A shift to insulin beyond three years was associated with the duration of diabetes (p = 0.03) and dyslipidemia (p = 0.04). Insulin therapy is late even in a specialized center. This therapeutic inertia is universal. Its causes should be better studied to be better mastered.

Impact of sertraline on weight, waist circumference and glycemic control: A prospective clinical trial on depressive diabetic type 2 patients.

AIM: Depression is prevalent in patients with type 2 diabetes. It may have a negative impact on the management of diabetes mellitus and could affect weight. The main aim of the investigation was to evaluate the effect of antidepressant treatment (sertraline) on anthropometric variables and glycemic control in depressed type 2 diabetic patients. METHODS: Thirty three type 2 diabetic outpatients depressed received open-label sertraline therapy for up to 12 weeks. Clinical outcome measures included the 17-item Hamilton depression rating. Changes in the anthropometrics variables were evaluated by measuring weight, waist circumference and by calculating body mass index at three, six and 12 weeks of treatment. In addition, fasting, postprandial plasma glucose level, glycosylated hemoglobin-A 1C measures, lipid and renal profile were obtained before and during sertraline therapy. RESULTS: Weight decreased significantly (-2kg; p=0.000) and body mass index decreased from 30.41kg/m2 to 29.6kg/m2 (p=0.000). Patients lost on average seven centimeters in waist circumference (p=0.000). We also observed a modest, non-significant reduction in fasting, postprandial and glycosylated hemoglobin. We observed a significant reduction in mean score according to the Hamilton depression scale (p=0.000) CONCLUSION: Our study results suggested that sertraline produced a benefic effect on weight, body mass index and waist circumference at 12-week follow up.

Methylenetetrahydrofolate Reductase (MTHFR) (C677T and A1298C) Polymorphisms and Vascular Complications in Patients with Type 2 Diabetes.

OBJECTIVES: To assess whether 2 polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene, C677T and A1298C, are risk factors for vascular complications in Tunisian patients with type 2 diabetes mellitus. METHODS: The MTHFR polymorphisms were genotyped, and plasma homocysteine levels were evaluated in 160 Tunisian patients with type 2 diabetes mellitus. RESULTS: Prevalence of the 2 heterozygous polymorphisms of the thermolabile MTHFR gene (CT and AC) was encountered more commonly in patients with diabetes mellitus than in the healthy controls (p<10-3). Subjects with diabetes had significantly higher homocysteine (Hcy) levels than the control subjects; however, there was no statistical difference in plasma Hcy values between carriers of mutant genotypes (CT/TT for C677T and AC/CC for A1298C) and wild types (CC and AA) in patients with diabetes. Retinopathy was found to be a vascular complication in patients with either the 677CT or the 1298(AC+CC) genotype more commonly than in those with the wild-type genotypes (p=0.003; OR=3.2, 95% CI, 1.4 to 7.4; p<10-3; OR=5.9, 95% CI, 2.7 to 13). Only patients who carry the A1298C mutation (AC+CC) are at risk for at least 1 complication (p=0.002). Double heterozygous mutants were at the greatest risk for retinopathy and for suffering at least 1 complication (p<10-3). CONCLUSIONS: Studies involving a larger study population and various ethnic groups are required before ruling out the role of MTHFR gene in type 2 diabetes mellitus and in vascular complications.

Association of HLA-DR-DQ polymorphisms with diabetes in Tunisian patients.

OBJECTIVE: Type 1 diabetes (T1D) is a polygenic disease whose principal locus is the human leukocytes antigen (HLA) region. The aim of this study was to evaluate HLA DR-DQ alleles and to asses them as risk factors for type 1 diabetes in the Tunisian population. MATERIALS AND METHODS: A total of 119 subjects with diabetes were tested for HLA class II alleles and compared with 292 healthy controls. HLA DRB1 and DQB1 alleles were genotyped using polymerase chain reaction sequence-specific primers (PCR-SSPs). RESULTS: The results revealed that the most susceptible haplotypes are the DRB1(*)03-DQB1(*)02 (pc<10(-3)) and DRB1(*)0401-DQB1(*)0302 (pc=0.001). (pc denotes Bonferroni corrected probability values.) The most protective haplotypes are DRB1(*)11-DQB1(*)03, DRB1(*)07-DQB1(*)02, and DRB1(*)13-DQB1(*)06 (pc=0.0026, pc=0.0065, and pc=0.02 respectively). Our results showed some particularities unique to Tunisians, there was a lack of a significant protective effect of the DRB1(*)15-DQB1(*)06 haplotype that usually is the dominant combination associated with protection in most other populations. CONCLUSION: Tunisian diabetic patients share the most susceptible and protective HLA haplotypes with Caucasians and those in neighbor Mediterranean countries. This is most likely explained by the history and admixture events of Tunisia and North Africa.

Effect of lipopenic and hypotensive treatment on homocysteine levels in type 2 diabetics.

AIM: Evaluate the effect of lipopenic and hypotensive treatment on homocysteine levels. METHODS: We recruited 145 type 2 diabetics and 130 control subjects. Thirty-seven diabetics had no complications, 54 had microvascular complications and 54 had macrovascular complications. We determined the parameters homocysteine of lipid, vitamin B12, triglycerides, and folates for all subjects. Associated treatments used one or more of the following drugs, statin, fibrate, angiotensin-converting enzyme inhibitor and beta-blockers. RESULTS: Hyperhomocysteinemia was present in 35.6% of patients. Diabetics had elevated serum levels of triglycerides (P < 0.001), homocysteine (P < 0.01), folates (P < 0.01) and vitamin B12 (P < 0.001). A strong association was found between type 2 diabetes and hyperhomocysteinemia (P < 0.001). Diabetics with associated treatment had elevated homocysteine, vitamin B12 and folate levels when compared to diabetes-free controls. For diabetics with macrovascular complications, we found significant differences in homocysteine (P = 0.010) and folate (P = 0.014) between those taking associated drugs and those who did not. For diabetics with microvascular complications, a significant difference was found in folate only (P = 0.012). CONCLUSION: Drugs used for hypertension and hyperlipidemia may have an effect on homocysteine levels, for this reason the interaction between drug action and homocysteine levels should be taken into consideration.

[Hypothalamic-pituitary Langerhans cell histiocytosis in adults]. / Atteinte hypothalamo-hypophysaire dans l'histiocytose de l'adulte.

INTRODUCTION: Langerhans cell histiocytosis is a rare entity. Involvement of the pituitary region is frequently delayed and rarely studied. CASES: We report some clinical and paraclinical particularities of the disease in four women. Diabetes insipidus was the initial symptom in all cases, accompanied by panhypopituitarism at initial presentation in one woman. Hypopituitarism was diagnosed from 6 months to 4 years after the diabetes insipidus in the other cases, and systemic lesions appeared 3 to 6 years thereafter. Magnetic resonance imaging of the hypothalamic-pituitary axis found tumors in two patients and infundibular thickening in the other two. One patient also had a partially empty sella. DISCUSSION: In adults, pituitary involvement seems to occur predominantly in women, and panhypopituitarism is possible at initial presentation. The clinical polymorphism of Langerhans cell histiocytosis makes this disease difficult and often slow to diagnose.

[Factors influencing homocysteineamia in type 2 diabetic patients]. / Facteurs modifiant l'homocysteinemie chez un groupe de diabetiques de type 2.

Previous studies have suggested that hyperhomocysteinaemia (Hcy) could be a strong and independent cardiovascular risk factor. Many factors could influence the serum concentration of Hcy such as vitamin B 12, folic acid, renal failure, hypothyroid status, ovarian failure and cancers. So the aim of our study was to evaluate the prevalence of hyperhomocysteinaemia among 54 type 2 diabetic patients and to study, its relationship with vitamin B12, folic acid and Metformin. Were excluded all patients with an evident cause of hyperhomocysteinaemia. Mean age of patients was 52.8 years. Mean Hcy was 11.7 + 6.9 micromol/l. The prevalence of hyperhomocysteinaemia was 27.8% in our group. There were eight (14%) patients with vitamin B12 deficiency and three among them had hyperhomocysteinaemia. There was no folic acid deficiency and no relationship with Metformin treatment. We suggest a wide screening of hyperhomocysteinaemia in type 2 diabetic patients and folic acid or vitamin B12 supplements if necessary.