Journal du syndrome métabolique

Purpose: To study the association of metabolic syndrome with severity of diabetic retinopathy.

Materials and method: Seventy-one consecutive cases of type 2 diabetes mellitus of more than 10 years duration aged 38 to 82 years were included. Metabolic syndrome was identified as per American Heart Association- National Cholesterol Education Programme Adult Treatment Panel III (AHA-NCEP ATP III) criteria. All the cases were assessed for log MAR visual acuity, intraocular pressure (IOP) and seven field fundus photography. The photographs were scored for 16 diabetic lesions. A single severity level (identical to the ETDRS Interim Scale) was calculated for each eye by using the Vanderbilt Classification System. Data was analysed using paired t-test.

Results: Of the 71 cases, 47 cases fulfilled at least 3 of the ATP III criteria for metabolic syndrome. Among the cases of metabolic syndrome, 18 cases fulfilled 3 criteria, 28 cases fulfilled 4 criteria and 1 case fulfilled all the 5 criteria. The analyses of the mean Vanderbilt score for severity of retinopathy showed significantly higher score (more severe retinopathy) in cases of metabolic syndrome (p<0.001). Higher IOP was observed in cases of metabolic syndrome (p<0.001). LogMAR visual acuity deteriorated (p<0.01), severity of retinopathy and intraocular pressure increased (p<0.001, p<0.001, respectively) with an increase in the number of components of metabolic syndrome. Triglyceride levels showed positive correlation with severity of retinopathy (p<0.001) and IOP (p<0.001). High density lipoprotein (HDL) levels also showed positive correlation with vision (p<0.001), severity of retinopathy (p<0.001) and IOP (p<0.001).

Conclusion: Metabolic syndrome is significantly associated with increased severity of diabetic retinopathy, decreased visual acuity and increased IOP.

Pubertal gynaecomastia is a common condition, usually disappearing within three years of onset. Enlargement of the breast rather than pain is the most common symptom. We report a case of painful severe persisting pubertal gynecomastia for more than four years in an adolescent boy requiring surgery; consider it’s the mechanism in puberty and the role of gonadotropin releasing hormone (GnRH) stimulation test in its management.

Metabolic syndrome (MS) represents a clustering of risk factors related to an elevated incidence of cardiovascular disease (CVD) and type 2 diabetes. Despite the possibility of multiple pharmacological interventions to treat metabolic changes related to MS, these therapeutic strategies often exhibit several side effects and inadequately prevents CVD. Among nutraceutical compounds presenting potential efficacy in this regard, bergamot polyphenols, via their multi-action properties, have been shown to positively modulate several mechanisms involved in MS suggesting their benefits as therapy. The purpose of this review is to discuss the beneficial effects of bergamot polyphenols providing a new therapeutic approach in the treatment of MS.

Over the past decade, metabolic syndrome has gained recognition as a significant contributor to cardiovascular mortality. Isolated metabolic syndrome, without diabetes mellitus, plays an increasingly essential role in the pathogenesis of Coronary Artery Disease (CAD). The risk factors for metabolic syndrome act synergistically to promote the development of Cardiovascular Disease (CVD); the more the risk factors, the higher the likelihood of developing CVD. Among these risk factors, obesity is the biggest culprit as it leads to an increase in the levels of free fatty acids (FFAs), thereby resulting in insulin resistance. This, in turn, causes impaired intracellular glucose metabolism and consequent production of free radicals that reduce nitrous oxide levels and cause endothelial dysfunction, leading to atherosclerosis. Also, visceral fat, being a source of C-reactive protein, indirectly promotes inflammation and atherosclerosis. However, in certain races, insulin resistance is fairly common, even in non-obese individuals. This implies the possibilities of multiple complex mechanisms at the microcellular level, causing insulin resistance over and above the aforementioned mechanisms occurring due to obesity. In spite of this fact, control of obesity still remains the first line of defense against metabolic syndrome and resulting cardiovascular mortality. Measures like proper diet and physical exercise, and medications such as statins, fibrates, niacin, and ACE inhibitors are the cornerstones of management of metabolic syndrome. Additionally, clinical trials using medications affecting peroxisome proliferator-activated receptors (PPARs) and intestinal enteropeptidases have shown promising results for treatment of metabolic syndrome. Moreover, current research is also focused on the role of adipokines, semicarbazide-sensitive amine oxidase/vascular adhesion protein-1 (SSAO/VAP-1), 5-HT2c receptors, and the LKB1/AMPK pathway in influencing the mechanisms of insulin resistance. In the near future, newly discovered mechanisms and highly potent novel drugs may reduce the prevalence of metabolic syndrome and subsequent cardiovascular mortality.

Objective: To know what is the degree of association between the presence of vascular complications in people with obesity, diabetes, hypertension and the different degree of consumption of tobacco or alcohol.

Methods: From March to December 2009 were 20,000 surveys to health workers and other occupational categories randomly selected in the 35 delegations of the IMSS, in each State. The study of variables included: affiliation, sex, age, job category, and registration of known diseases, smoking, nicotine addiction, and consumption of alcohol risk, addiction to alcohol, habits, physical exercise and eating habits. Analysis statistical, was held in the SPSS version 17 system, was obtained frequencies, point prevalence of the risk factors, smoking, prevalence of chronic diseases and Terminal vascular complications, chronic pulmonary damage, (COPD) liver cirrhosis and neoplasm’s (cancer unspecified organ. Analysis bivariate estimate of the relative risk of Association of risk factors and addictions with obesity, and with chronic diseases and complications terminals, by estimating the right odds to the prevalence, CI=confidence interval; Chi-square of Mantel-Haenszel (Xmh)

Results: The consumption of more than five cigarettes per day in women associated with obesity RMP 1.43 IC (1.03-1.98) Xmh 2.1 and abusive consumption of alcohol is associated with obesity in men with 1.81 RMP IC (1.57-2.10) Xmh 8.0

With respect to vascular complications in women who smoke at least one cigarette a day’s Association was found with cerebral vascular disease (EVC) 3.24 RMP IC (1.58-6.66) Xmh 3.38, with RMP cardiac infarct of 2.69 IC (1.66-4.38) Xmh 4.16; Women in large smokers for more than 5 cigarettes a day Association was found with EVC RMP 4.50 CI (1.37-14.8) Xmh 2.71; with infarct heart 3.07 IC (1.23-7.65) Xmh 2.53, diabetes, RMP 1.61 IC (1.05-2.46) Xmh 6.82 hypertension RMP 1.21 IC (1.00- 1.74) Xmh 3.05 and Dyslipidemia RMP 1.22 IC (1.00-2.04) Xmh 2.29

Men in heavy smokers Association was established as follows: EVC, RMP 2.69 IC (2.22-14.61) Xmh 4.08; Cardiac infarct, RMP 2.68 IC (1.51 - 4.76) Xmh 3.48; diabetes, RMP 1.63 IC (1.20-2.20) Xmh 7.13; Hypertension, RMP 1.30 CI (1.00 - 1.69) Xmh 4.31.

With regard to the abusive consumption of alcohol in women Association was found with EVC, RMP 2.40 IC (1.08 - 5.31) Xmh 2.22.

In men with alcohol addiction Association was found to EVC, RMP 7.15 IC (1.65 - 31.01) Xmh 3.07, cardiac infarction, RMP 3.21 IC (1.16-8.92) Xmh 2.36, diabetes, RMP 1.96 IC (1.11-3.46) Xmh 2.35; arterial hypertension, RMP 1.75 IC (1.07-2.87) Xmh 2.26

In women with alcohol addiction Association was found to RMP 25.82 IC (7.46-98.40) cardiac infarct Xmh 7.68, diabetes, RMP 4.69 IC (1.71-12.80) Xmh 3.31; arterial hypertension, RMP 2.99 IC (1.17-7.66) Xmh 2.40

In hypertensive patients with more than 5 cigarettes a day smoking Association was found with EVC, RMP 85.6 IC (40.1- 182.9) Xmh 12.6; Cardiac infarct, RMP 2.88 IC (2.50-3.33) Xmh 10.5. In hypertensive patients with alcohol addiction Association was found with EVC, RMP 45.9 IC (23.7-88.9) Xmh 9.13; Cardiac infarct, RMP 37.7 IC (22.5-62.1) Xmh 12.8. In large smoking diabetic patients Association was found with EVC, RMP 97.8 IC (36.4-262.5) Xmh 11.0, with RMP 50.8 IC (26.5-97.2) cardiac infarct Xmh 13.1. In diabetic patients with addiction alcohol Association was found with EVC, RMP 35.9 IC (15.1-85.4) Xmh 5.4, with cardiac infarct, RMP 26.9 IC (14.6-49.7) Xmh 8.1

Conclusions: The metabolic syndrome is identified clinically by obesity, associated with hypertension, diabetes mellitus and Dyslipidemia. This increases the risk of vascular complications even before having identified chronic diseases, diabetes and hypertension. In this study associated with vascular damage in women who smoke at least one cigarette in the day, both of EVC, and cardiac infarction. The increase of the Association is not much larger with more than 5 smoking a day, suggesting greater vascular lability in women who smoke without serious nicotine addiction. Analyze the Association of smoking of cigarettes more than 5 a day with other components of the metabolic syndrome is identified to increase the presence of diabetes 1.61 times higher in women and 1.63 in men, when compared with non-smokers, Increases 1.21-1.30 and women hypertension and 1.22 single dyslipidaemia in women. With respect to vascular complications, large men smoking their increase is one and a half times less than in women, but 2 and half times higher than in men non-smoking.

In hypertensive and diabetic heavy smokers compared patient’s non-smoking increases by 85 and 100 times the risk of EVC respectively: for myocardial infarction 3-50 times more respectively. This suggests a clear difference in the coronary vascular damage generated by diabetes to hypertension.

In men, the abusive consumption of alcohol was clearly associated to obesity. In women compared with abstemias women the EVC associated with 2 and a half times more.

Addiction to alcohol in men increased 7 times more the presence of EVC. In men and women cardiac infarct, 3 and 25 times more, diabetes mellitus 2 and 5 and arterial hypertension 2 and 3 respectively when compared with abstainers men and women.

In hypertensive and diabetic patients with alcohol addiction Association was found with EVC 46 and 36 times more risk, to cardiac infarct almost 40 and 27 times more risk when compared with hypertensive and diabetic abstainers.

Disseminated Tuberculosis (TB) is a potentially lethal disease if not diagnosed and treated early.It still remains if the presentation is non-specific, unusual and the relevant facts are overlooked. However, a high index of clinical suspicion and early diagnosis and timely institution of anti-tuberculosis treatment is life-saving. Here we did a case study of disseminated tuberculosis with unusual presentation.

Background: Insulin resistance, which precedes by many years the onset of and accompanies type II diabetes (T2D), is strongly associated with a clustering of cardiovascular risk factors, termed metabolic syndrome (MetS).

Objectives: The aim of this study was to investigate the extent of MetS risk in T2D Ethiopian patients.

Methods: A total of 72 T2D patients and 20 normal healthy controls without MetS were studied. Based on the world health organization criteria, 59.72% (43/72) of the patients had MetS.

Results: Type 2 diabetic patients with MetS (0.953 ± 0.007) were significantly (P<0.01) obese than those without (0.913 ± 0.012). Plasma total triglyceride (TG) (206.9 ± 16.91) and blood pressure (138.8 ± 3.247) were strongly significantly high (P<0.001) in patients with MetS as compared to those without MetS (104.4 ± 6.766 and 122.8 ± 2.725, respectively). On the other hand, plasma high density lipoprotein-cholesterol (40.91 ± 3.070) and total peroxide (0.055 ± 0.001) were found at a significantly (P<0.05) lower amounts in patients with MetS as compared to those without (50.90 ± 2.601 and 0.052 ± 0.001, respectively). In patients with MetS, the IR index showed a significant association (P<0.05) with the dyslipidemia markers: TG (r=0.254), low density lipoprotein-cholesterol (r=0.262), and total cholesterol (r=0.320). Waist-hip circumference ratio showed a positive significant correlation with blood pressure (r=0.330, P<0.05) and C-reactive protein was strongly associated with serum insulin concentration (r=0.382, P<0.01).

Conclusion: Ethiopian T2D patients with MetS are at a greater risk of hypertensive, dyslipidemia and oxidative stress states, and developing cardiovascular disorders. Interventions should be planned to help those patients avoid/delay onset of cardiovascular complications anticipated upon the accumulation of predisposing factors that are components of MetS.

Obesity, defined conventionally by Basal Mass Index (BMI), is associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death. However, not all obese people are affected by metabolic disturbances and a subset of normal BMI individuals suffer from metabolic syndrome (MetS). Although these phenotypes have been recognized by researchers, there is a paucity of data for obese people without MetS (MHO) (MetS+/Obe-). This study examined the prevalence of different definitions of obesity and their association with Coronary Artery Disease (CAD) in a Malay rural population.

Method: The group, an 18 month cross sectional, hospital based study, comprised 408 patients who were nonsmokers, age 20 and above, both gender and all races. We used differing definitions of obesity based on BMI, the consequences of obesity by these different definitions and ethnic associations.

Results: In patients with BMI ≥ 25, ≥ 27, and ≥ 30, the percentages of MHO were 15.4, 10.8 and 5.7% respectively. Obese, metabolic abnormal groups (MetS+/Obe+) (MOO) defined at BMI ≥ 25 (1.92, CI =1.16-3.17), ≥ 27 (1.94, CI=1.18-3.17) and non-obese, metabolic abnormal group with BMI<30 (MetS+/Obe-) (MONO) (1.71, CI=1.04-2.80) were significantly associated with CAD.

Conclusion: Obese, metabolic abnormal groups (MetS+/Obe+) (with obesity defined as BMI ≥ 25, ≥ 27) and metabolic abnormal group (MetS+/Obe-) with BMI <30 (with obesity defined as BMI ≥ 30) were significantly associated with CAD but obese metabolic normal subjects (Mets+/Obe-) (MHO) with BMI <27 were not significantly associated with CAD.