Serum uric acid in relation with the metabolic syndrome components and adiponectin levels in Lebanese University students.

BACKGROUND: The relation between serum uric acid (SUA) and metabolic syndrome (MetS) parameters has never been studied in a young Middle-Eastern population. In addition, the relation between SUA and adiponectin was poorly studied. METHODS: We looked at the relation between SUA, and both adiponectin and MetS components in 381 randomly selected Lebanese university students (201 males and 180 females). RESULTS: SUA was positively correlated with body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), fasting blood glucose (FPG), triglycerides, total and LDL-cholesterol, and homeostasis model assessment (HOMA) index (p<0.001 for all variables, p<0.01 for FPG) and inversely correlated with HDL-cholesterol and adiponectin (p<0.001 for both variables). In men, SUA was positively correlated with BMI, WC, SBP, DBP, FPG, triglycerides, total and LDL-cholesterol, and HOMA index and inversely correlated with adiponectin (p<0.001 for all variables, p<0.05 for adiponectin); these correlations persisted after BMI adjustment, for WC, FPG, triglycerides, total-cholesterol, LDL-cholesterol, and HOMA index. In women, SUA was positively correlated with total and LDL-cholesterol (p<0.001), independently of BMI. In a multiple regression analysis, SUA was independently associated with WC, triglycerides, total cholesterol, HDLcholesterol and adiponectin in the overall population while, in men, it was associated with triglycerides, total-cholesterol, and WC. CONCLUSION: Our results suggest, in young adults, a gender difference in the relation between SUA and both adiponectin and MetS parameters. In addition, we observed in both genders a strong relation of SUA with total cholesterol. Further studies are needed in larger populations in order to elucidate these findings.

Predictors of intra-operative parathyroid hormone decline in subjects operated for primary hyperparathyroidism by minimally invasive parathyroidectomy.

BACKGROUND: The predictors of intra-operative PTH (IOPTH) decline during minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism have been but poorly studied. MATERIALS AND METHODS: This retrospective study included 108 patients who underwent MIP for a single adenoma. Serum calcium and phosphorus were measured before surgery and 1 day post-operatively. IOPTH was measured before (intra-operative preincision or PTHt0) and 10 min after removal of the adenoma (PTHt10). The Modification of Diet in Renal Disease (MDRD) equation was used to estimate the glomerular filtration rate. The weight of the adenoma was assessed in all the subjects. RESULTS: The sex ratio female/male was 5.37 with a mean age of 57.3 yr. The mean pre- and postoperative values were for calcium 2.80 and 2.19 mmol/l, respectively (p<0.0001) and for phosphorus 0.90 and 1.16 mmol/l, respectively (p<0.0001). The PTH dropped from a mean value of 184.8 to 50.8 pg/ml 10 min after adenoma resection with a mean drop of 69.7%. Thirteen patients (12%) did not achieve a PTH fall of more than 50%. In a bivariate analysis, age, an MDRD<60 ml/min and weight of adenoma were inversely associated with IOPTH fall (p=0.009, p=0.004, and p<0.001, respectively) while gender, body mass index, hypertension, diabetes, pre-operative phosphorus and calcium had no significant effects. In the multivariate analysis, age, weight of adenoma, and MDRD were still independent negative predictors of the IOPTH fall (p=0.01, p=0.018, and p<0.001, respectively). CONCLUSION: Our results suggest that during MIP the presence of a parathyroid adenoma with a high weight, in an elderly subject or in a subject with altered renal function, will result in a lesser degree of IOPTH fall.

[Spasmodic laughter syncope. An unusual complication of pseudobulbar palsy]. / Syncope du rire spasmodique. Une complication inhabituelle du syndrome pseudobulbaire.

INTRODUCTION: Spasmodic laughter is a classical sign of pseudobulbar palsy, but it has never been reported, to our knowledge, to provoke syncope. CASE REPORT: A 63-year-old hypertensive and diabetic man with peripheral neuropathy and lacunar pseudobulbar palsy presented with three episodes of spasmodic laughter which had induced syncope. No new episode was observed after the beginning of low dose bisoprolol. DISCUSSION: Sustained or spasmodic laughter is accompanied by repetitive bursts of forced expiration, corresponding to short repetitive Valsalva maneuvers. Laughter-induced syncope is considered as one of the many Valsalva-type/vagally mediated syncopal attacks leading to rapid fall in blood pressure without compensatory tachycardia. The presence of autonomic diabetic neuropathy may also contribute to these attacks.

Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers.

Hypovitaminosis D is associated with poor dietary intake and inadequate sunshine exposure. It is common worldwide, particularly in European elderly people. Information about vitamin D status in young adult populations from the Middle East is scarce. Furthermore, the relationship between hypovitaminosis D and some lifestyle factors such as style of clothing and dwelling location is not well defined. We assessed vitamin D intake and measured serum calcium, phosphorus, albumin, alkaline phosphatase, 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), osteocalcin, and urinary-free deoxypyridinoline (DPD) in 316 Lebanese volunteers (99 men and 217 women) aged 30-50 years; 156 were recruited from rural areas and 160 from urban areas. Fifty-one women from each area were veiled. The average daily vitamin D intake was 100.3 +/- 67.9 IU and was found to be higher in men compared with women, in urban subjects compared with rural ones and in nonveiled women compared with veiled ones. The mean level of 25(OH)D was 9.71 +/- 7.07 ng/ml. Hypovitaminosis D [25(OH)D < 12 ng/ml] affected 72.8% of our population. It was more common in women than in men (83.9% vs. 48.5%). Severe hypovitaminosis D [25(OH)D < 5 ng/ml] was observed in 30.7% of our subjects and was more prevalent in women (41.5%), particularly in the veiled ones (61.8%). 25(OH)D levels were the lowest in veiled women, and in women living in rural areas. Rural men had the highest 25(OH)D levels despite their very low vitamin D intake. In a multivariate model, inadequate vitamin D intake, urban dwelling, veil wearing, and high parity in women were independent predictors of hypovitaminosis D. 25(OH)D was related inversely to PTH and free DPD whereas osteocalcin achieved only a weak positive correlation with 25(OH)D. In the absence of information regarding time spent outdoors, our results show that hypovitaminosis D is common among young Lebanese people and is related mostly to low vitamin D intake. This should emphasize the need for more vitamin D in our population.

Type-2 diabetes family history delays the onset of type-1 diabetes.

Type-1 diabetes (T1D) is an autoimmune disease leading to insulin deficiency. Its occurrence is influenced by genetic and environmental factors. The human leukocyte antigen (HLA) region on chromosome 6 accounts for 45% of the genetic susceptibility for the disease, mainly the HLA-DQB1*0201 and HLA-DQB1*0302 alleles. Among the environmental factors involved, early exposure to cow's milk seems to be a trigger. In this study, we investigated the occurrence of T1D in 253 Lebanese Caucasian patients, in relation to HLA-DQB1*0201, HLA-DQB1*0302, HLA-DQB1*0602, gender, and early exposure to cow's milk, as well as to family history of T1D and type-2 diabetes (T2D). Our genetic analysis results show that in the patients studied, 77% and 40% were positive for BQ1*0201 and BQ1*0302, respectively. As for BQ1*0602, only 0.8% of patients were positive for this T1D protective allele, compared with 24% among the controls. Furthermore, our results did not show any gender preference of the disease or any effects of early intake of cow's milk on the age at onset of T1D. When family history of T2D or T1D was studied, our results show a novel finding whereby an immediate family history of T2D, but not T1D, delays the age at onset of T1D.

Diabetes mellitus and optic atrophy: a study of Wolfram syndrome in the Lebanese population.

Wolfram syndrome (WFS) is a rare hereditary neurodegenerative disorder also known as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness). WFS seems to be a heterogeneous disease that has not yet been fully characterized in terms of clinical features and pathophysiological mechanisms because the number of patients in most series was small. In this study we describe 31 Lebanese WFS patients belonging to 17 families; this, to our knowledge, is the largest number of patients reported in one series so far. Criteria for diagnosis of WFS were the presence of insulin-dependent diabetes mellitus and optic atrophy unexplained by any other disease. Central diabetes insipidus was found in 87% of the patients, and sensorineural deafness confirmed by audiograms was present in 64.5%. Other less frequent features included neurological and psychiatric abnormalities, urodynamic abnormalities, limited joint motility, cardiovascular and gastrointestinal autonomic neuropathy, hypergonadotropic hypogonadism in males, and diabetic microvascular disease. New features, not reported in previous descriptions, such as heart malformations and anterior pituitary dysfunction, were recognized in some of the patients and participated in the morbidity and mortality of the disease. Genetic analysis revealed WFS1 gene mutations in three families (23.5%), whereas no abnormalities were detected in mitochondrial DNA. In conclusion, WFS is a devastating disease for the patients and their families. More information about WFS will lead to a better understanding of this disease and hopefully to improvement in means of its prevention and treatment.

Heterogeneity in clinical manifestation of autosomal dominant neurohypophyseal diabetes insipidus caused by a mutation encoding Ala-1-->Val in the signal peptide of the arginine vasopressin/neurophysin II/copeptin precursor.

Autosomal dominant neurohypophyseal diabetes insipidus (ADNDI) is a familial form of diabetes insipidus due to progressive vasopressin deficiency with onset typically at 1-6 yr of age. Affected individuals demonstrate specific degeneration of the vasopressinergic magnocellular neurons in the hypothalamic supraoptic and paraventricular nuclei and loss of the posterior pituitary bright spot on magnetic resonance imaging. The genetic locus of ADNDI is the arginine vasopressin-neurophysin II (AVP-NPII) gene. Mutations that cause ADNDI have been found to occur both within the signal peptide of the prepro-AVP-NPII precursor and within the coding sequence for neurophysin II, but not within the coding sequence for AVP itself. We evaluated the AVP-NPII genes in two independent families with ADNDI and identified a mutation (C280-->T) in the coding sequence for the signal peptide of the prepro-AVP-NPII precursor in both families. This mutation encodes an Ala-->Val substitution at the C-terminus of the signal peptide (-1 amino acid). This mutation predicts the complete inability of signal peptidase to cleave the signal peptide from the preproprecursor and supports the hypothesis that the progressive neural degeneration that underlies ADNDI is caused by accumulation of malprocessed precursor. However, considerable heterogeneity in the age of onset (1-28 yr of age) and the severity of diabetes insipidus among affected members of these two families suggests that additional factors modulate the rate and extent of progression of the neurodegeneration that results from this one specific ADNDI mutation.

Physiological responses to glycerol ingestion during exercise.

To study selected cardiovascular, thermoregulatory, and hormonal responses to the consumption of glycerol solutions during exercise, nine subjects cycled for 90 min at 50% peak O2 uptake in a 30 degree C, 45% relative humidity environment. Beverages tested included a 10% glycerol solution (G), a 6% carbohydrate-electrolyte beverage (CE), the 6% carbohydrate-electrolyte beverage plus 4% glycerol (CEG), and a water placebo (WP) ingested at regular intervals during the first 60 min of exercise. The beverages were administered in counterbalanced order with subjects serving as their own controls. Ingestion of the glycerol solutions resulted in an increase in plasma osmolality and attenuation of the decrease in plasma volume associated with the WP treatment (P less than 0.05). Plasma renin activity was highest with WP (P less than 0.05), and G was associated with increased antidiuretic hormone levels (P less than 0.05). Ratings of perceived thirst were lowest for CEG and G, and the frequency of gastrointestinal distress was greatest for G (P less than 0.05). However, no differences among beverage treatments were observed for heart rate, esophageal temperature, sweat rate, ratings of perceived exertion, or changes in cortisol and aldosterone levels. These data indicate that there are no substantial metabolic, hormonal, cardiovascular, or thermoregulatory advantages to the consumption of solutions containing 4 or 10% glycerol during exercise.

Malignant struma ovarii: an unusual presentation.

Malignant struma ovarii is a rare disease; only a few cases are well documented in the literature. Thus, the overall prognosis and modalities of treatment are still somewhat controversial. In this article, the authors report a case of malignant struma ovarii discovered 4 years after ovariectomy after metastasis to the lungs and bones. Review of the pathology of the ovarian struma did not reveal the classic criteria of malignancy, there were, however, many features considered to be atypical and thus suspicious. The patient was treated by total thyroidectomy followed by repetitive doses of 131I. However, because of difficulties in increasing the level of endogenous thyrotropin (TSH) because of functional thyroid metastases in such an advanced disease, recombinant human thyrotropin (rhTSH; Thyrogen, thyrotropin alpha, Genzyme Corporation, Cambridge, MA) was used before administration of radioiodine. With this therapeutic protocol, the patient is still clinically stable 2 years after diagnosis.

The effects of glucose, fructose, and sucrose ingestion during exercise.

The purpose of this study was to compare the physiological, sensory, and exercise performance responses to ingestion of 6% glucose, 6% fructose, and 6% sucrose solutions during cycling exercise. Twelve subjects completed three sessions consisting of 115 min of intermittent cycle ergometer exercise at 65-80% of VO2max followed by a timed performance bout requiring the completion of 600 pedal revolutions. During each of five 4-min rest periods, subjects consumed 3 ml.kg LBM-1 of one of the beverages. Beverages were presented in counterbalanced, double-blind fashion. Heart rate, VO2, plasma urate, plasma lactate, respiratory exchange ratio, and carbohydrate combustion rates changed similarly among beverage treatment. However, fructose was associated with lower plasma glucose and serum insulin, a larger loss of plasma volume, greater gastrointestinal distress and relative perceived exertion ratings, and higher plasma or serum concentrations of free fatty acids, fructose, and cortisol values than sucrose or glucose (P less than 0.05). Compared to sucrose and glucose, fructose feeding also resulted in lower lactate and HR values during the performance bout (P less than 0.05). Mean +/- SE cycling performance times were faster with sucrose and glucose than with fructose: 419.4 +/- 21.0 s, 423.9 +/- 21.2 s, and 488.3 +/- 21.1 s, respectively (P less than 0.05). Relative to 6% solutions of sucrose and glucose, ingestion of a 6% fructose beverage is associated with gastrointestinal distress, compromised physiological response, and reduced exercise capacity.

The effect of fluid and carbohydrate feedings during intermittent cycling exercise.

The purpose of this study was to determine the effect of ingesting water or carbohydrates solutions on physiologic function and performance during 1.6 h of intermittent cycling exercise in the heat (dry bulb temperature = 33 degrees C). Thirteen male subjects (24 to 35 yr) completed four separate rides. Each ride consisted of intermittent steady-state cycling (at 55 and 65% VO2max) interspersed with five rest periods. A timed 480 revolution cycling task completed each experimental session. During each rest period, subjects consumed 2 ml.kg-1 body weight of water placebo or solutions of 5% glucose polymer, 6% sucrose/glucose, or 7% glucose polymer/fructose. Beverages were administered in double-blind, counter-balanced order. No differences were observed among subjects in response to beverage treatments for changes in plasma concentrations of total proteins, sodium, potassium, lactate, or in osmolality, percent change in plasma volume, heart rate, oxygen uptake, respiratory exchange ratio, rating of perceived exertion, sweat rate, rectal temperature, or mean skin temperature. Compared to water placebo, the carbohydrate treatments produced higher plasma glucose values following 1 h cycling (P less than 0.01). Mean (SD) times for the 480 revolution cycling task: water placebo = 432 (43) s; glucose polymer = 401 (52) s; *sucrose/glucose = 384 (39) s; and *glucose polymer/fructose = 375 (30) s, where = P less than 0.001 compared to water placebo. Physiologic function was similarly maintained during exercise by all beverage treatments, while ingestion of sucrose/glucose and glucose polymer/fructose resulted in improved end-exercise cycling performance.

Host and environmental factors defining the epidemiology of type 1 diabetes mellitus in a group of Lebanese children and young adults.

The effect of a number of host and environmental factors on the onset of type 1 diabetes mellitus (DM1) in a group of Lebanese children and young adults was studied. Results showed that DM1 in a group of 253 patients presented no gender preference and that the age of onset was similar in both genders. The overall body mass index reflected good metabolic control. HbA1c had a mean value of 8.98%, suggesting poor glucose control. Family history of DM1 and type 2 diabetes mellitus as well as consanguinity in patients' families were not different from those reported in the literature. Finally, onset of DM1 showed seasonal variation, peaking during winter months. DM1 showed a higher prevalence of onset among children born first and a decreased incidence as birth order increased. This study provides valuable data for the diagnosis, control and prevention of DM1 in children.

[Extrapontine myelinolysis: treatment with TRH]. / Myélinolyse extra-pontine: traitement par T.R.H.

Central pontine and extra-pontine myelinolysis are a well known complication of hyponatremia. Other causes may be present. We report a case of head injury in a 13 year-old girl, who recovered well after surgery for extra-dural hematoma, but presented endocrinological disorders with hyperglycemia followed by a severe hyponatremia. Despite the correction of these metabolic disorders, the patient became comatose, and MRI, on T2 weighted image, showed hyperintense signals in the basal ganglia consistent with extra-pontine myelinolysis. The patient's state remained unchanged for six weeks. Since S. Konno and H. Wakui published cases of myelinolysis who dramatically improved after TRH treatment, the patient was given 0.6 mg i.v daily of TRH for six weeks. Improvement began within a few days, and continued until complete recovery.

[Blood and leukocyte glutathione and glutathione S-transferase: relationship to cholesterolemia in healthy volunteers]. / Glutathion et glutathion S-transférase sanguins et leucocytaires: relation avec la cholestérolémie chez des volontaires sains.

Hypercholesterolemia increases the oxidation of low density lipoprotein (LDL) which subsequently leads to atherogenesis. The oxidized LDL are also known to increase in vitro macrophage synthesis of glutathione. The purpose of this study was to investigate the relationship between lipid parameters and the glutathione system (glutathione, glutathione S-transferase) in total blood and within leukocytes. The glutathione and glutathione S-transferase were evaluated by spectrophotometric methods in sixty-two healthy volunteers (32 women, 30 men, mean age 39.9 +/- 7.7). No correlation was found between the level of blood cholesterol and the values of the blood glutathione system. However, a positive correlation between the values of glutathione and glutathione S-transferase in leukocytes and the blood cholesterol level was only found in women (r = 0.55 and r = 0.50 respectively, p < 0.01). We also found in men a positive correlation between body mass index and glutathione S-transferase in total blood and within leukocytes (r = 0.38, p < 0.05, r = 0.5, p < 0.01 respectively). No correlation was found between age, smoking and the values of the glutathione system. Our results suggest that the glutathione system in leukocytes is related to blood cholesterol levels. The fact that this positive correlation was only observed in women points to a possible role of estrogens in the regulation of the glutathione system which merits to be further studied.

[Hypovitaminosis D: a major worldwide public health problem]. / L'hypovitaminose D, problème mondial majeur de santé publique.

PHYSIOLOGY: Vitamin D increases intestinal absorption of calcium favoring the microenvironment necessary for bone mineralization. In addition, vitamin D prevents hypocalcemia via its osteoclastic action. Severe hypovitaminosis leads to rickets in children and its equivalent in adults, osteomalacia. Mild to moderate hypovitaminosis D causes secondary hyperparathyroidism increasing the risk of fracture, particularly femoral neck fracture. Vitamin D would also have an antiinflammatory and anticancer effect. WORLDWIDE: Hypovitaminosis D is frequently observed in Europe in the elderly, particularly in the institutionalized population, but is also seen in otherwise healthy younger adults. An estimated 40% of the young European population has some degree of hypovitaminosis D. Surprisingly, it is more frequent in sunny Mediterranean countries than in certain northern countries such as Norway. The lower incidence observed in the United States is probably related to the vitamin D supplementation of the American diet. Hypovitaminosis D in Africa and the Middle-East is also an important problem, being considered to be one of the 5 most prevalent childhood diseases in developing countries. ENVIRONMENTAL FACTORS: The limited quantity of vitamin D in food and multiple environmental factors contribute to hypovitaminosis D. These factors include insufficient sun exposure and urban lifestyle with a high degree of pollution. In addition, cutaneous photosynthesis of vitamin D is limited by hyperpigmentation in black people, wearing traditional veils that limit sun exposure, and use of sun lotions, further contributing to vitamin D deficiency. CONCLUSIONS AND RECOMMENDATIONS: The very high prevalence of hypovitaminosis D in the world, and particularly in Europe, Africa and the Middle-East, points to the need for public health measures in these countries. While waiting for these measures to be implemented, vitamin D supplementation (for example in tablet form) should be encouraged in order to meet minimum requirements. Finally, the beneficial effect of moderate sun exposure on cutaneous vitamin D synthesis (and psychological well-being) must not be overlooked.

[Hypophyseal tuberculosis. A case report]. / Tuberculose hypophysaire. A propos d'un cas.

The authors present a case of hypophyseal tuberculosis. It is the case of a patient with abnormal sella turcica, erosion of sella and hypopituitarism. At intervention, they ascertain a lesion of sphenoïdal sinus with the lesion of hypophysis. The authors made the review of literature and ascertain the singularity of the both lesion. Generally, the tuberculosis of adenohypophysis is associated with tuberculosis meningitis. They think that it is an extension of sinusal lesion.

[Generalized amyloidosis associated with Hashimoto's thyroiditis and hypothyroidism]. / Amylose généralisée associée a une thyroïdite de Hashimoto avec hypothyroïdie.

Involvement of the thyroid gland in systemic amyloidosis is known since 1855, most frequently histologic than clinical. We report here a case of systemic amyloidosis associated with myxedema and Hashimoto's thyroiditis which has been rarely reported in the literature, and may represent a new example of auto-immune diseases associated with systemic amyloidosis.

[Laparoscopic adrenalectomy for pheochromocytoma. Case report and review of the literature]. / Surrénalectomie coelioscopique pour phéochromocytome. Rapport d'un cas et revue de la littérature.

Laparoscopic surgery has a wide application in general surgery. Since the first laparoscopic adrenalectomy, this approach has quickly been adopted, and increasing numbers are being reported. The small size of the adrenal gland, the benign nature of most adrenal tumors and the difficulty in reaching the organ via open means make resection of this gland particularly amenable to the laparoscopic approach. The potential benefits of this mini-invasive surgery include decreased operation blood loss, reduced narcotics requirements, shorter hospital stay and recovery time and minimize the parietal trauma. We report herein the first Lebanese case of laparoscopic adrenalectomy for pheochromocytoma with review of the literature.

[Thyroid-stimulating hormone hypophyseal adenoma. A case report]. / Adénome hypophysaire à TSH. A propos d'un cas.

TSH pituitary adenomas represent less than 1% of operated pituitary adenomas. More then 200 cases have been described till now and more patients are now identified since the widespread of ultrasensitive TSH assay which can detect paradoxical situations of elevated serum thyroxine levels with detectable TSH levels. Differential diagnosis must be done with pituitary resistance to thyroid hormones, disorder in which there is a state of "TSH mediated hyperthyroidism". Transsphenoidal surgery remains the treatment of choice of TSH secreting adenoma. A medical treatment with octreotide can improve biological findings and induce tumor shrinking. We report in this paper a TSH pituitary adenoma in a young girl of 15 years old.