Efficacy and safety of liraglutide compared to sulphonylurea during Ramadan in patients with type 2 diabetes (LIRA-Ramadan): a randomized trial.

AIMS: Compare effects of liraglutide 1.8 mg and sulphonylurea, both combined with metformin, on glycaemic control in patients with type 2 diabetes (T2D) fasting during Ramadan. MATERIALS AND METHODS: In this up to 33-week, open-label, active-controlled, parallel-group trial, adults [glycated haemoglobin (HbA1c) 7%-10% (53-86 mmol/mol); body mass index ≥20 kg/m(2) ; intent to fast] were randomized (1:1) ≥10 weeks before Ramadan to either switch to once-daily liraglutide (final dose 1.8 mg) or continue pre-trial sulphonylurea at maximum tolerated dose, both with metformin. PRIMARY ENDPOINT: change in fructosamine, a validated marker of short-term glycaemic control, during Ramadan. RESULTS: Similar reductions in fructosamine levels were observed for both groups during Ramadan [liraglutide (-12.8 µmol/L); sulphonylurea (-16.4 µmol/L); estimated treatment difference (ETD) 3.51 µmol/L (95% CI: -5.26; 12.28); p = 0.43], despite lower fructosamine levels in the liraglutide group at start of Ramadan. Fewer documented symptomatic hypoglycaemic episodes were reported in liraglutide-treated (2%, three subjects) versus sulphonylurea-treated patients (11%, 18 subjects). No severe hypoglycaemic episodes were reported by either group. Body weight decreased more during Ramadan with liraglutide (ETD: -0.54 kg; 95% CI: -0.94;-0.14; p = 0.0091). The proportion of patients reporting adverse events was similar between groups. Liraglutide led to greater HbA1c reduction [ETD: -0.59% (-6.40 mmol/mol), 95% CI: -0.79; -0.38%; -8.63; -4.17 mmol/mol; p < 0.0001]. CONCLUSIONS: Despite lower fructosamine levels and body weight at the beginning of Ramadan, use of liraglutide showed similar glycaemic improvements, fewer hypoglycaemic episodes and greater body weight reduction compared with sulphonylurea. LIRA-Ramadan provides evidence for liraglutide being safe and efficacious for management of T2D during Ramadan fasting.

PO-08 - Venous thrombosis and cancer: about an Algerian series.

INTRODUCTION: Venous thromboembolism (VTE) and cancer is an association with increasing progression and poor prognosis. It always raises many issues including the question what is the exact incidence of occult cancer in a VTE? Is there a simple biological marker with a predictive value of this combination? Can we define a strategy thromboprophylaxis in cancer patients? AIM: To try to answer these questions we conducted a prospective study. MATERIALS AND METHODS: We collected 140 patients with VTE, 70 of neoplastic origin ( group A) and 70 of other etiologies (Group B). The clinical and laboratory features of VTE associated with cancers are described and compared to those of VTE without cancer. RESULTS: Among the results we can note that the average age of patients in group A is approximately 55 years; they are older than those of group B (55.6±14.5 vs 44.4±15.3, p<0.05), there are more unusual site vein thrombosis in group A than B (22.8 vs 10%, p<0.05), proximal venous lower extremities is predominant compared to a sural reached, in group A (84.8 vs 15.1%, p: 10(-6)), VTE discover neoplasia in 23% of cases, cancer is at the stage of recurrence in 14% of cases, the histological type was adenocarcinoma in 20% of cases; there are metastases at diagnosis in 53% of cases, LMWHs are prescribed in group A than B (55.7 vs 7.1%, p<0.05), mortality is higher in group A than B (91.4 vs 8.5%, p<0.05). Univariate statistical analysis allows to find discriminant variables between these two groups: female sex, age≥65 years, no thromboembolic personal history, thinness, surgery, unusual site deep venous thrombosis, bed rest, leukocytosis, anemia, hypoalbuminemia, hypocholesterolemia. Of these, five are identified by logistic regression. They are independent variables predictive of cancer before any VTE: absence of thromboembolic personal history, bed rest, unusual site vein thrombosis, anemia, leukocytosis. CONCLUSIONS: Based on these five risk factors, our patients are scored in three increasing levels of risk of morbid association.

[Association of celiac disease and cerebral venous thrombosis: report of two cases]. / Association maladie cœliaque et thrombose veineuse cérébrale. Revue de deux observations.

UNLABELLED: Thrombosis events may occur in celiac disease. Thrombophilic risk factors have been reported. INTRODUCTION: To report two cases of cerebral venous thrombosis in celiac disease patients and to determine associated thrombophilic factors. Case 1: a 63-year-old woman was admitted for cerebral venous thrombosis. Her past history included celiac disease which was untreated for the last 10 years. Biological data showed moderate hyperhomocysteinemia and positive reaction for antiphospholipid antibodies. Case 2: a 19-year-old girl was hospitalized for seizures and impaired consciousness. MRA demonstrated longitudinal sinus thrombosis with parietal infarction. Biological findings showed: protein S deficiency and positive reaction for antiendomysium and antigliadin antibodies. Gastroesophageal endoscopy with biopsy showed villous atrophy. Both patients improved under anticoagulant treatment. CONCLUSION: The sites of associated venous thrombosis are generally unusual in celiac disease, yet the cerebral localization is only exceptionally reported. It is essential to search for risk factors. Gluten-free diet remains the mainstay treatment for patients with celiac disease.

PP144. Profile of lupus pregnancy in internal medecine practice.

INTRODUCTION: The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome 'APLS' is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. OBJECTIVES: To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. METHODS: it's a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). RESULTS: On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21-41), SLE evolve with an average of 2.5years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient's. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive chronic renal Insufficiency (1). The specific events observed are a HELLP syndrome (1), pre-eclampsia (2), fetal losses (5), ischemic strokes (4) and post-partum cardiomyopathy (1). The pregnancies require caesarians (15) with ligature of trunks (2). We deplore fetal deaths (7) in tripled (1) and in twin (1) during the period of follow-up. We note a small birth weight (7), a preterm birth (5), a foetal distress (5) at the origin of a psychomotor disorders (1) and we observed a case of a transient skin lupus (1). CONCLUSION: The frequency of the maternal and fetal complications is partially understandable by the fact that the majority of the pregnancies neither are programmed, nor authorized by the treating physician. Indeed, between the denial of the disease and the desire of pregnancy in everything taken, the patients often take the risk and put the treating physician in front of pregnancies in top risks.

Cardiovascular risk and lupus disease.

AIM: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The aim of this study was to evaluate subclinical atherosclerosis and to determine the prevalence of risk factors for CVD in SLE patients. METHODS: One hundred fifty-three patients (149 women and 4 men), aged (37±11.6) years with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology (ACR), underwent physical examination, carotid and leg arteries B-mode ultrasound with a measure of ankle-brachial pressure index (ABPI); 94 patients had myocardial tomoscintigraphy. The laboratory check-up was: total cholesterol (TC), HDLc, LDLc, homocystein, glycemia, vascular cell adhesion molecules (VCAM-I). All patients had a normal renal function at the time of the study. RESULTS: The mean age is 37 years. Cardiovascular events were noticed in 15 patients (6 angina, 2 myocardial infarction and 7 strokes). Cardiovascular risk factors (CVRF) were: dyslipidemia (62.8%), moderate homocysteinemia (55%), BMI>25 (39%) and hypertension (35%) which is associated with a stroke (P<0.0006). The cumulative prednisone dose per patient was 45.5g. V.C.A.M-I level was high in 86.2 % of cases.95% of our patients had at least two CVRF. Myocardial perfusion stress scanning showed abnormalities in 21 patients (22.3%). Perfusion defects were linked with a stroke (P<0.01) and coronary events (P<0.02). Carotid atheroma was present in 32 patients (20.9%). Carotid plaques were associated with age (P<0.01), total cholesterol (TC)(P<0.05), and steroid dose (P<0.01). Intima-media-thickness was correlated with age (P<0.0003), TC (P<0.0007), LDLc (P<0.002), and homocysteine (P<0.03). 70% patients had a mediacalcinosis in femoral and popliteal arteries. The ABPI was correlated with V.C.A.M-I (P<0.0005). CONCLUSION: In Algeria, as elsewhere, young women with SLE have subclinical atherosclerosis which must be detected and they are at high risk of a vascular event.

[Hypoplasia of the hepatic segment of the inferior vena cava]. / Hypoplasie de la veine cave inférieure rétrohépatique.

Congenital anomalies of the inferior vena cava are not uncommon. In the past, the diagnosis was made by angiography and retrograde right heart studies which were being commonly performed for the assessment of congenital malformation of the heart. The advent of ultrasound and three-dimensional imaging such as computed tomography and magnetic resonance made it easier to obtain the diagnosis. We report here a case of inferior vena cava hypoplasia in a 19-year-old male, who presented with progressive ascitis and edema.

[Assessment of myocardial perfusion in systemic lupus erythematosus]. / Evaluation de la perfusion myocardique au cours du lupus érythémateux systémique.

INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Necropsy studies found a high incidence of myocardial and coronary injuries while clinical manifestations were observed in less than 10%. The purpose of this study was to evaluate myocardial perfusion in SLE patients. PATIENTS AND METHODS: The study was carried out in 153 patients with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology. Ninety-four (61.4%) underwent 99mTc-tétrofosmine SPECT analysis at rest and after stress. RESULTS: The average disease duration was 11 years. Ninety-four patients (93 women and one man) with a mean age 37 years were assessed. Twelve had a past history of vascular event: six stroke, four angina pectoris and two myocardial infarctions. Cardiovascular risk factor included: high blood pressure (35.2%), dyslipidemia (62.3%), moderate hyperhomocysteinemia (55%), BMI greater than 25 (40%).The cumulative prednisone dose per patient was 45.5g. Myocardial perfusion stress scanning showed abnormal perfusion in 21 patients (22.3%). Among these, eight underwent coronary angiography which was normal in seven cases. One patient had a right coronary stenosis. Perfusion abnormalities were correlated with stroke (p<0.01) and coronary events (p<0.02). CONCLUSION: Myocardial perfusion scintigraphy can be a useful noninvasive method to identify subclinical myocardial involvement in systemic lupus erythematosus and patients at risk of later events.

[Immunological abnormalities in myelodysplastic syndromes. Prospective study (series of 40 patients)]. / Manifestations immunes associées aux syndromes myélodysplasiques. Etude prospective de 40 patients.

UNLABELLED: The association of myelodysplastic syndromes (MDS) with auto-immune diseases and humoral disorders have already been reported. In this prospective study we tried to estimate type and the frequency of immunological associated diseases among patients affected by MDS. PATIENTS-METHODS: In this prospective study, auto-immune disease and humoral immunity disorders were systematically searched during MDS and conversely MDS searched during cytopenia. All MDS secondary to chemotherapy and the children's MDS were excluded. The MDS diagnosis was established according to FAB criteria and patients were classified in two groups A or B according to presence (group A) or not (group B) of dysimmune manifestations. RESULTS: Forty patients(19 males and 21 females, mean age of 56,6 years) with MDS have been enrolled during this period (group A: 20 patients). Associated diseases are following: systemic lupus erythematosus (three), lupus-like syndrome(one), sarcoidisis(one), Sjogrën syndrome(one), polyarthritis (two), chronic liver diseases (three), autoimmune thyroid diseases (two), pyoderma gangrenosum (one), Crohn's disease(one), haemolytic anaemia (one), and pericardial effusion(one). CONCLUSION: A wide spectrum of auto-immune manifestations is frequently reported in myelodysplastic syndromes. Further studies are necessary for discuss the current physiopathological hypothesis with their therapeutic relevance.

[Autoimmune chronic active hepatitis: anatomoclinic's study of 50 patients]. / Les Hépatites auto-immunes (HAI) chroniques de l'adulte: étude anatomoclinique d'une série de 50 patients.

PURPOSE: To analyse anatomoclinic and evolutive aspects of autoimmune hepatitis (AIH) through 50 observations collected in two Internal Medicine departments in Algiers from 1998 to 2002 and to make a review of the literature. METHODS: The study is prospective. The diagnosis of autoimmune hepatitis (AIH) is established according to the recommendations of the score of the International Autoimmune Hepatitis Group (1991) or/and hepatitic damage confirmed by histology. RESULTS: Fifty patients were studied: (32 women-18 men) and the mean age was 38 years (17 to 73). Autoimmune extra-hepatitic manifestations were associated in 26%. The AIH type 1 has been noted in 58%. AIH were type 2 in only 6%. In 22% of the cases AIH were sero-negative and the others AIH represented 14% were classed as overlap-syndrome (5 cases of primary biliary cirrhosis and 2 cases of primary sclerosing cholangitis hepatitis overlap syndrome). The first liver biopsy tissue showed strong necrotic-inflammatory activity in 56% and cirrhosis was identified in 19 patients (38%). The treatment (azathioprine and corticosteroid) was prescribed in 37 patients (74%) in active chronic hepatitis or in compensed cirrhosis. FOLLOW-UP: 28% of the patients died (9-36 months) because cirrhosis's complications or because complications of hepatocarcinoma (3 cases). CONCLUSION: The diagnosis of AIH must be established early for each patient with chronic liver disease particularly is those are supposed as a crypto genetic hepatitis. The prognosis is compromised by delayed diagnosis and the mortality in middle following up is high.