Efficacy of low-dose oral sulodexide in the management of diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) is the single greatest cause of end-stage renal disease (ESRD). Without specific interventions, microalbuminuria (incipient nephropathy) gradually progresses to macroalbuminuria (overt nephropathy) within 10-15 years in about 80% of type 1 and 30% of type 2 diabetic patients, and to ESRD within further 20 years in about 75% and 20%, respectively. A primary alteration in DN consists of decreased concentration of glycosaminoglycans (GAGs) in the glomerular extracellular matrix. This evidence has prompted interest in using exogenous GAGs and specifically sulodexide in DN treatment. PATIENTS AND METHODS: In this uncontrolled multicenter study, diabetic patients with albumin excretion rate (AER) >or=30 mg/24 hours were treated with oral sulodexide 50 mg/day for 6 months, while receiving concomitant medication as required. Two hundred thirty-seven patients (54% males and 46% females, mean age 55 years, mean diabetes duration 11 years) were evaluated; 89% had type 2 and 11% type 1 diabetes mellitus, 67% microalbuminuria and 33% macroalbuminuria. RESULTS: AER was significantly and progressively reduced during sulodexide treatment (p<0.0001): geometric mean after 3 and 6 months was 63.7% (95% confidence interval [95% CI], 59.3%-68.4%) and 42.7% (95% CI, 37.8%-48.2%) of baseline, respectively. The reduction was similar in type 1 and type 2 diabetes and was slightly greater in macroalbuminuric than in microalbuminuric patients. Blood pressure was slightly lowered, while fasting glucose and glycosylated hemoglobin were moderately reduced. Adverse effects were observed in 5.5% of patients, including gastrointestinal in 3.8%. CONCLUSIONS: Sulodexide therapy was shown to reduce AER in patients with DN.

Dietary intakes of essential nutrients among Arab and Berber ethnic groups on rural Tunisian island.

OBJECTIVE: The dietary intake was investigated and food sources were identified among Tunisian ethnic groups from Jerba Island in the south of Tunisia. METHODS: Ninety-four subjects of moderate socioeconomic status (47 Berbers and 47 Arabs) aged 32 to 64 y completed a 1-mo qualitative food-frequency questionnaire and a single 24-h dietary recall, and dietary intakes and demographic status were observed from 2006 to 2007. RESULTS: The prevalence of overweight and obesity was not significantly associated with Arab men compared with Berber men. Therefore, obesity was significantly associated with Berber women (P<0.001). Height was significantly different between Arab and Berber women (P<0.001). There were no significant differences in energy intake between men and women. Protein intake was not significantly different between ethnic groups. Milk and dairy products in the Berber group were significantly different from the Arab group. Intakes of calcium, zinc, iron, and folate were below recommended nutrient intakes in men and women in the two ethnic groups. Vitamin E intake was greater in Berbers than in Arabs (P<0.01). CONCLUSION: Ethnicity was significantly associated with dietary intakes in the two ethnic groups of Jerba Island.

The G1057D polymorphism of IRS-2 gene is not associated with type 2 diabetes and obese patients among ethnic groups in Tunisian population.

BACKGROUND: Type 2 of diabetes is the most common metabolic disorder and results from the interaction between genetic and environmental factors. Insulin receptor substrate-2 (IRS-2), one of the major substrates of the insulin receptor, has a crucial role in insulin signalling and in beta cell development and survival. While several polymorphisms have been identified in the IRS-2 gene, the association of the Gly1057Asp polymorphism with type 2 diabetes has been studied in European and Chinese populations, but the results have been inconsistent. OBJECTIVES: The aim of this study was to investigate the association of Gly1057Asp polymorphism in insulin receptor substrate-2 (IRS-2) gene among patients with type 2 diabetes in well defined ethnic groups from Djerba Island in Southeastern Tunisia. METHODS: The studied population (172 Arabs and 100 Berbers) includes 162 patients with type 2 diabetes and 110 healthy controls. BMI was calculated for each subject. The subjects were unrelated and randomly selected Arabs and Berbers were equally distributed between controls and diabetics. The G1057D polymorphism of the IRS-2 gene was genotyped using PCR-RFLP assay. RESULTS: This case/control study indicated that frequency of the IRS-2 Gly1057Asp polymorphism was not significantly different between the healthy controls and type 2 diabetic groups, neither between healthy nor obese subjects, in both ethnic groups. Moreover, this polymorphism is present at a lower frequency in Djerbian than in neighbouring European populations. CONCLUSION: These results strongly argue against a major role of the Gly1057Asp IRS-2 polymorphism in the pathogenesis of type 2 diabetes in Djerbian subjects.

Association of the insertion/deletion polymorphism of the angiotensin-converting enzyme gene with type 2 diabetes in two ethnic groups of Jerba Island in Tunisia.

INTRODUCTION: The aim of the current study was to evaluate the role of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism on the prediction of type 2 diabetes in two ethnic populations from Jerba Island,Tunisia. METHODS: In this study, we analysed the genotypic and the allelic distributions of the ACE I/D polymorphism and conducted a case/control association study between healthy normoglycaemic controls and diabetic patients in the two studied groups.ACE gene polymorphism was analysed by polymerase chain reaction in 272 individuals consisting of 172 diabetic subjects and 100 controls. RESULTS: The genotype frequencies for DD, ID and II were 75.50%, 19.60% and 4.89% inArabs and 76.66%, 16.66% and 6.67% in Berbers, respectively, in the case group, and 42.85%, 35.71% and 21.43% inArabs and 57.50%, 22.50% and 20.00% in Berbers, respectively, in the control group.The DD frequency was significantly higher in the case group than in the control group (p<0.001), suggesting that the DD genotype is associated with an increased susceptibility to type 2 diabetes in our study populations. CONCLUSIONS: The current investigation provides new evidence regarding the role of the ACE I/D polymorphism in the pathogenesis of type 2 diabetes in Jerbian populations. Furthermore, it underlines the importance of ethnicity, which should be considered in all studies aiming to test the genetic effects on the susceptibility to type 2 diabetes.

[Graves' ophthalmopathy: diagnosis and highlights on etiopathogenesis and treatment]. / L'exophtalmie basedowienne: diagnostic et mise au point etiopathogeniques et therapeutiques.

It's due to extraocular tissues enlargement: extraocular muscles. Thyroid stimulating receptor antibodies were first incriminated. However, Graves' proptosis can appear several months or years before development of goiter or thyrotoxicosis. Different treatment are possible: glucocorticoids, radiotherapy, surgical orbitary decompression, classical surgery. Treatment of hyperthyroidism has to be undertaken similarly. Classically, surgical or medical treatment with antithyroid drugs were indicated.

[Therapeutic specifics in atrial fibrillation in hyperthyroidism. Study of 14 cases]. / Particularités thérapeutiques de la fibrillation auriculaire au cours de l'hyperthyroïdie. Etude à propos de 14 cas.

The aim of this study is to clarify the specificities of atrial fibrillation in hyperthyroidism. It's a retrospective study of 6 years, about 14 patients hospitalized for hyperthyroidism with atrial fibrillation. There were 9 Women and 5 men, 55.7 +/- 11.5 years old. Arryhthmia was discovered especially with palpitation and dyspnea. Cardiac echography diagnosed valvular disease in 83.3% of cases. Cardiovascular complications concerned 5 patients and consisted in cardiac insufficiency and cardiomyopathy in one case. Treatment of hyperthyroid consisted in radio-iodine administered to 7 patients at the dose of 9.8 +/- 3.9 mCi. Two patients had total thyroidectomy. Arryhthmia was treated with propranolol, 98.3 +/- 70 mg daily and anticoagulant treatment was given. From the group of nine hyperthyroid recovered patients, arryhthmia was reduced in 3 cases. In this group, age was higher and arryhthmia history was longer. We conclude that chances to treat arryhthmia associated to hyperthyroid are higher when euthyroidism or even hypothyroidism is rapidly obtained, during of atrial evolution is short and some factors aren't present, like aging, existence of valvular disease or left auricular dilatation.

[Predictive elements of malignancy of isolated thyroid nodules]. / Elements predictifs de malignite d'un nodule isole de la thyroïde.

The clinically revealed thyroid nodules are very frequent (3 to 5% of the general population), among them, fewer than 10% are malignant. The objective of this retrospective study type witness-case is to determinate the malignity predictive clinical and paraclinical elements for 45 patients presenting a thyroid malignant nodule and 45 others matched by age and sex presenting a thyroid isolated nodule. These patients were treated at the ORL ward of Charles Nicolle Hospital over a period of 10 years from 1989 to 1999. The average age of advent of malignant nodule is 43.2 + 14.4 years old with a clear female predominance (sex ratio = 4). The elements clearly linked to the hazard of thyroid cancer are loss of weight (p = 0.05; OR = 8.11), hard consistency of nodule (p = 0.002), the presence of cervical adenopathies (p = 0.05; OR = 4.22), vocal cords paralysis (p = 0.04), the presence of anemia (p = 0.01; OR = 5.7), a solid structure at sonography (p = 0.05) and the presence of a flux at doppler-sonography (p = 0.02). Personal antecedents of non malignant thyroid pathology, the nodule location and size and hypoechogenic features have not been clearly associated with the hazards of thyroid cancer.

[Value of ambulatory blood pressure monitoring in blood pressure profile determination in type 2 diabetes]. / Apport de la MAPA dans l'étude du profil tensionnel du diabétique type 2.

Risk assessment in the type 2 diabetic patients must take into account the major risk factors, particularly arterial hypertension which is commonly associated, increasing the risk for macrovascular and microvascular complications. The aim of this study is to determine whether ambulatory blood pressure monitoring provides additional information to clinical (office) blood pressure measurement for the detection and control of hypertension in type 2 diabetic patients. Ambulatory blood pressure monitoring is more helpful than office blood pressure measurement for the evaluation of blood pressure levels. It is very valuable in type 2 diabetic patients for detecting autonomic dysfunction and elevated blood pressure load, which are associated with cardiovascular complications.