Olfa Berriche

Plasma Levels of Pentosidine, Carboxymethyl-Lysine, Soluble Receptor for Advanced Glycation End Products, and Metabolic Syndrome: The Metformin Effect

Metabolic syndrome (MetS) is considered one of the most important public health problems. Several and controversial studies showed that the role of advanced glycation end products (AGEs) and their receptor in the development of metabolic syndrome and therapeutic pathways is still unsolved. We have investigated whether plasma pentosidine, carboxymethyl-lysine (CML), and soluble receptor for advanced glycation end products (sRAGE) levels were increased in patients with MetS and the effect of metformin in plasma levels of pentosidine, CML, and sRAGE. 80 control subjects and 86 patients were included in this study. Pentosidine, CML, and sRAGE were measured in plasma by enzyme-linked immunosorbent assay (ELISA). Plasma pentosidine, CML, and sRAGE levels were significantly increased in patients compared to control subjects (P < 0.001, P < 0.001, and P = 0.014, resp.). Plasma levels of pentosidine were significantly decreased in patients who received metformin compared to untreated patients (P = 0.01). However, there was no significant difference between patients treated with metformin and untreated patients in plasma CML levels. Plasma levels of sRAGE were significantly increased in patients who received metformin and ACE inhibitors (P < 0.001 and P = 0.002, resp.). However, in a multiple stepwise regression analysis, pentosidine, sRAGE, and drugs treatments were not independently associated. Patients with metabolic syndrome showed increased levels of AGEs such as pentosidine and CML. Metformin treatment showed a decreased level of pentosidine but not of CML. Therapeutic pathways of AGEs development should be taken into account and further experimental and in vitro studies merit for advanced research.

Cerebral Aneurysms: A Rare Feature of Behçet's Disease—A Case Report and Review of the Literature

Behçets disease (BD) is a multisystem vascular inflammatory disease with several clinical manifestations. Intracranial aneurysms are an extremely rare but nevertheless severe complication of BD. We report a case of a 44-year-old man. The diagnosis of BD was made based on the presence of recurrent oral aphthous ulcers and positive human leukocyte antigen (HLA-) B51 in the absence of evidence of other diseases. MRI showed an ancient ischemic right capsulolenticular lesion, subacute white matter hypersignals of the left capsule lenticular region, and multiple arterial aneurysms. The patient underwent two-month systemic high-dose corticosteroids and immunosuppressive therapy associated with severe neurological deficiency upon admission and severe impairment upon discharge. A thorough review of the literature showed 20 case reports of intracranial aneurysms in BD.

Association lupus érythémateux systémique et polyendocrinopathie auto-immune de type II

Le lupus érythémateux systémique (LES) est une maladie autoimmune ayant un grand polymorphisme clinique. De nombreux facteurs génétiques, endocriniens, immunologiques et d’environnement contribuent au déclenchement puis à l’entretien de la maladie [1]. Le LES peut s’associer à des pathologies auto-immunes diverses. En revanche, son association à une polyendocrinopathie auto-immune (PEA) de type II est exceptionnelle [2]. Nous rapportons une observation particulière par l’association au LES d’une maladie d’Addison (MA) et d’une thyroïdite de Hashimoto (TH).

Le corticosurrénalome: une cause exceptionnelle d’hyperaldostéronisme primaire

Corticosurrenaloma is a rare malignant tumor of the adrenal gland that often secretes corticosteroids, sex steroids and precursors. Aldosterone-producing corticosurrenaloma is very rare, accounting for 1 case/10million inhabitants. We report the case of a 38-year old man presenting with severe arterial hypertension associated with deep hypokalaemia (2.2 mmol/L). Exploration showed primary hyperaldosteronism (aldosterone = 2645 pmol/l, aldosterone/renin ratio = 327 pmol/MUI), with hypersecretion of glucocorticoids. Abdominopelvic CT scan revealed left poorly differentiated and heterogeneous adrenal mass measuring 9cm, infiltrating into the surrounding adipose tissue and the diaphragm, extending into the left renal vein, with regional adenopathy and hepatic nodule measuring 4cm. The patient underwent radical nephrectomy followed by right hepatectomy two months after resulting in remission. A year after the patient developed lung metastases. This study highlights that corticosurrenaloma should be suspected in patients with primary aldosteronism despite its rarity.

0102: Atherogenic lipid profile and lipid peroxide products of patients with rheumatoid arthritis

Introduction Rheumatoid Arthritis (RA) is a chronic relapsing immune-inflammatory multisystem disease with predominant synovial proliferation and destruction of articular cartilage. Patients with RA have a higher riskof mortality related to increased risk of cardiovascular disease with atherogenic lipid profile. In recent years, oxidative stress in RA patients has received considerable attention and has been implicated as mediators of tissue damage and cardio-vascular disease in patients with RA. The aim of the present study was to assess the lipid profile and lipid peroxide products of patients with rheumatoid arthritis compared with healthy controls. Patients and Methods The study included 70 patients of rheumatoid arthritis who met the American College of Rheumatology (ACR) criteria were included in the study and were compared to 40 healthy volunteers subjects. Patients suffering from diabetes mellitus, hypothyroidism, liver or kidney disease, Cushing’s syndrome, obesity, familiar dyslipidemia and those receiving medications affecting lipid metabolism were excluded from the study. Blood samples of controls and patients were collected at the time of presentation and analyzed for lipid profile (total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol) and triglycerides (TG); malondialdehyde (MDA-marker of oxidative stress) and Conjugated Diene (CD) of RA versus healthy subjects. Results Patients exhibited higher serum levels of TC, LDL-C and TG, whereas their serum HDLC levels were significantly lower compared to controls. As a consequence, the atherogenic ratio of TC/HDL-C (3,67±0,83 vs 4,51±1,12; p Conclusion According to our results, patients with RA exhibited an atherogenic lipid profile with increased levels of oxidative stress markers. This situation accelerates vascular risk in RA. The results suggest the necessity for therapeutic co-administration of antioxidants along with conventional drugs to such patients. However, due to the limited number of cases included in this study, more studies may be required.

Primary Hyperparathyroidism and Hyperthyroidism in a Patient with Myotonic Dystrophy: A Case Report and Review of the Literature

Various endocrine manifestations are commonly described in myotonic dystrophy (MD), including primary hypogonadism, diabetes mellitus, and thyroid and parathyroid dysfunction. We describe a 46-year-old woman with a family history of MD with her son. She was diagnosed with cardiac arrhythmia and required the implantation of a pacemaker. She was noted to have a bilateral cataract. She complained of muscle weakness, diffuse myalgia, and palpitation. The electromyography (EMG) showed myotonic discharges. Laboratory tests showed high serum calcium 2.83 mmol/L, serum phosphate 1.2 mmol/L, parathormone 362.5 pg/mL, thyroid stimulating hormone TSH 0.02 mIU/L (normal range: 0.34–5.6 mIU/L), FT4 21.17 ng/mL, and negative anti-thyroperoxidase antibodies. Cervical ultrasound revealed a multinodular goiter. The 99mTc-MIBI scintigraphy localized a lower right parathyroid adenoma. The clinical data, the family history of MD, EMG data, and endocrine disturbances were strongly suggestive of MD associated with hyperthyroidism and primary hyperparathyroidism.

0424: Pericarditis in systemic lupus erythematosus

Pericarditis is a common manifestation in Systemic Lupus Erythematosus (SLE) that reveals the disease in 10-40% of the cases. This effusion is usually a small one, non-compressive. The aim of our study was to determine the incidence of pericarditis in SLE patients in our department and its characteristics. Patients and methods We retrospectively reviewed the records of sixty six patients (62 women and 4 men, 15 to 78 years of age) with a SLE followed at our department since 2003. The diagnosis of SLE was established according to criteria defined by the American Rheumatism Association Results All our patients with pericarditis were asymptomatic, except one who presented a tamponade requiring surgical drainage. We divided our patients in two groups: – G1: patients without pericarditis (16 patients) and G2: patients with pericarditis (50 patients). There is no differences in age (mean age 34±4 vs. 37±5 years, p Conclusion Pericarditis is the most studied cardiovascular manifestation of SLE. Echocardiography represents the standard method to investigate pericardial abnormalities and is able to demonstrate mild effusion or thickening of pericardial layers, therefore, should be performed periodically in SLE patients.

0405: Hypertension and disability in Tunisian’s elderly

Objective Hypertension is another common condition in older subjects, representing the most common morbid condition after osteoarthritis (Psaty et al., 2001). Hypertension represents a major risk factor for cardiovascular disease, the major source of morbidity among the over 65 population (ISTAT, 2005). In such a context, the aims of the present study were to investigate whether hypertension was associated independently with physical disability. Design and Methods A cross-sectional survey was conducted, covering a sample of 598 subjects (202 male, 396 female, mean aged 72,3 years) aged 65 years and over. The study approved by ethics Committee and supported by OMS and FNUAP. Information was gathered by home-based personal interview using a structured questionnaire. We assessed their disability status, sociodemographic informations and health behaviours. Disability was recorded on three levels scale: (intense, moderate and no disability) Statistical analysis was performed with SPSS and the significance was accepted at the p > 0.05 level. Multiple logistic regression models were used to obtain the independent variables associated with hypertension. Results The prevalence of hypertension was 52% (n=311), more frequent for female population (55% vs 45% for male). The prevalence of disability was 34.6%, only 10% have intense disability. Those with hypertension had higher Body Mass Index, waist circumference and diabetes. Regarding disability, the individuals who presented the highest prevalence of hypertension were more dependent. Multiple logistic regression revealed that the following were significantly independent factors of hypertension: Disability (OR = 1.6).Diabetes mellitus (OR = 2.36]).and a higher BMI (OR = 2.36). Conclusions We conclude that hypertension is associated not only to cardiovascular factors (Diabetes obesity) but also with higher functional disability. Older subjects are exposed at significantly higher likelihood of physical disability. Public health strategies to prevention hypertension in elderly may protect them also against disability.