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Hypopituitarism is a known cause of bone mineral loss. This study aimed to evaluate the frequency of osteopenia and osteoporosis in patients with Sheehan's syndrome (SS) and to determine the risk factors. This is a retrospective study of 60 cases of SS that have had a bone mineral density (BMD) measurement. Clinical, biological, and therapeutic data were collected. The parameters of osteodensitometry at the femoral neck and the lumbar spine of 60 patients with SS were compared with those of 60 age-, height-, and weight-matched control women. The mean age at BMD measurement was 49.4 ± 9.9 yr (range: 25–76 yr). The mean duration of SS was 19.3 ± 8.5 yr (range: 3–41 yr). All patients had corticotropin deficiency and were treated with hydrocortisone at a mean daily dose of 26.3 ± 4.1 mg. Fifty-seven patients (95%) had thyrotropin deficiency and were treated with thyroxine at a mean daily dose of 124.3 ± 47.4 µg. Thirty-five of the 49 patients, aged less than 50 yr at diagnosis and having gonadotropin deficiency (71.4%), had estrogen–progesterone substitution. Osteopenia was present in 25 patients (41.7%) and osteoporosis in 21 (35.0%). The BMD was significantly lower in the group with SS than in the control group ( p  < 0.001). The odds ratio of osteopenia–osteoporosis was 3.1 (95% confidence interval: 1.4–6.8) at the femoral neck and 3.7 (95% confidence interval: 1.7–7.8) at the lumbar spine. The lumbar spine was more frequently affected by low bone mineral mass ( p  < 0.05). The duration of the disease and the daily dose of hydrocortisone were independently and inversely associated with BMD at the femoral neck. The daily dose of thyroxine was independently and inversely associated with BMD at the lumbar spine. Estrogen–progesterone replacement therapy was not associated with BMD. Low bone mineral mass was very common in patients with SS. The lumbar spine was more frequently affected. The duration of the disease and the doses of hydrocortisone and thyroxine were involved in bone mineral loss. [ABSTRACT FROM AUTHOR]

Background and aims Peroxisome proliferator-activated receptor-γ co-activator-1α (PGC-1α) is a transcriptional co-activator involved in adaptive thermogenesis, skeletal muscle metabolism, fatty acid oxidation, and gluconeogenesis. Several studies have suggested that the common PGC-1α polymorphism Gly482Ser (rs8192678) may be associated with risk of type 2 diabetes (T2D), with conflicting results. The aim of this study was to analyze whether the Gly482Ser variant is a risk factor for development of T2D in Tunisian population. Methods In a case–control study 487 unrelated patients with type 2 diabetes and 402 apparently healthy controls were recruited from January 2008 to August 2010. The Gly482Ser polymorphism was determined by PCR-RFLP analysis. Results A significant difference in genotypes distribution was observed between patients (Gly/Gly: 34.1%; Gly/Ser: 47.1%; Ser/Ser: 18.5%) and controls (Gly/Gly: 43.8%; Gly/Ser: 42.3%; Ser/Ser: 13.9%) ( χ 2 = 9.44, p = 0.009). The T2D patient group showed a significant higher frequency of the Ser allele compared to the controls (43% vs. 34%; OR: 1.35, 95% [CI]: 1.11–1.65, p = 0.002). The association between the Gly482Ser polymorphism and T2D remained significant after adjustment for other well-established cardiovascular risk factors. Conclusions In the current study, a significant and independent association between the Gly482Ser polymorphism (rs8192678) of the PGC-1α gene and T2D in the Tunisian population was found. [ABSTRACT FROM AUTHOR]

Résumé Objectifs de l'étude Évaluer les effets de la chirurgie bariatrique sur les paramètres anthropométriques et métaboliques chez des sujets tunisiens obèses morbides. Méthodes Il s'agit d'une étude rétrospective qui a inclus 47 sujets ayant une obésité morbide et qui ont bénéficié d'une chirurgie bariatrique entre 2004 et 2012. L'âge moyen était de 36,5 ± 8,9 ans et le sex-ratio de 0,08. Les données cliniques et paracliniques pré et post-opératoires ont été relevées à partir des dossiers médicaux des patients. Résultats La perte moyenne de l'excédent pondéral (PEP) était de 50,6 % [17,9–99,8]. Le taux d'échec (PEP < 25 %) était de 21,3 %. Le by-pass gastrique était l'intervention qui a permis d'obtenir les meilleurs résultats en termes de perte de poids (PEP de 63,4 %), suivi de la pose d'un anneau gastrique (PEP = 54,5 %) et de la sleeve gastrectomie (PEP = 40,8 %). Les taux de rémission de l'hypertension artérielle, du diabète de type 2, de l'hypercholestérolémie, de l'hypertriglycéridémie et de l'hyperuricémie étaient respectivement de 40 %, de 75 %, de 17 %, de 75 % et de 68 %. Conclusion Notre étude a prouvé l'efficacité de la chirurgie bariatrique chez nos patients obèses morbides dans l'obtention d'une PEP significative et dans la rémission des comorbidités. Abstract Aims of the study To investigate the effect of bariatric surgery on anthropometric and metabolic parameters in morbidly obese Tunisian subjects. Methods It is a retrospective study including 47 morbidly obese patients who have had a bariatric surgery between 2004 and 2012. The mean age was 36.5 ± 8.9 years and the sex ratio 0.08. Pre- and post-operative clinical and paraclinical parameters were collected from patients' medical records. Results Mean excess weight loss (EWL) was 50.6% [17.9–99.8]. Failure rate (EWL < 25%) was 21.3%. Gastric bypass surgery was the intervention which led to the best weight loss rate (EWL of 63.4%), followed by gastric banding (EWL = 54.5%) and sleeve gastrectomy (EWL = 40.8%). The remission rates from hypertension, type 2 diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and hyperuricemia were 40%, 75%, 17%, 75% and 68% respectively. Conclusion This study has proven the efficiency of bariatric surgery in morbidly obese Tunisian patients in achieving a significant EWL and in the remission of the comorbidities. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study was undertaken to investigate the impact of the Pro12Ala (rs1801282) polymorphism of the peroxisome proliferator-activated receptor γ-2 (PPARγ-2) gene on obesity or body mass index (BMI) and plasma leptin, insulin, adiponectin and lipid levels in a sample of the Tunisian population. Design and Methods: The study included 387 obese patients and 288 control subjects. The Pro12Ala genotype was determined by polymerase chain reaction followed by a digestion with the restriction of endonuclease BstUI. Results: In the whole population, there is no significant difference in genotype frequencies of the Pro12Ala polymorphism between obese patients and controls. However, separate analysis by gender revealed that obese men (but not women) had significantly higher frequency of Pro/Ala genotypes compared to controls (12.2% vs. 4.1%; χ 2 =6.76, p =0.009). In comparison to Pro/Pro homozygotes, Ala-allele bearers had a significantly higher risk of obesity [OR (95% CI)=3.26 (1.28–8.33)]. When obese subjects were stratified according to type 2 diabetes status, the association with obesity was only significant in obese non-diabetic patients [OR (95% CI)=3.74 (1.43–9.74), p = 0.007]. Additionally, obese male patients carrying the Ala-allele had significantly higher body mass index (p = 0.007) and plasma leptin levels (p = 0.023) compared to those homozygous for Pro-allele. The significant effect of Pro12Ala polymorphism on plasma leptin levels disappeared after adjustment for age and BMI. Conclusion: The present study provides evidence that the Pro12Ala polymorphism of the PPARγ-2 gene is associated with obesity in non-diabetic men from Tunisian origin. [Copyright &y& Elsevier]

Abstract: Objective: To determine the prevalence of thyroid disorders (TDs) and identify groups at risk for TDs in Tunisian pregnant women. Methods: Thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase antibodies (TPO-Ab) were determined in 1519 pregnant women. Thyroid disorder was defined as hyperthyroidism (TSH≤0.10 mIU/L) or hypothyroidism (TSH>4.5 mIU/L), and/or positive TPO-Ab (>12 IU/L). Results: TDs were observed in 147 women (9.7%). The prevalence was 6.5%, 3.2% and 1.3% for positive anti-TPO, hypothyroidism and hyperthyroidism, respectively. According to a trimester of gestation (first, second, and third, respectively), the prevalence decreases for positive TPO-Ab (7.7%, 7.5% and 4.7%) and for hyperthyroidism (2.7%, 0.7% and 0.5%), but increases for hypothyroidism (2.2%, 3.3% and 3.7%). TDs were more frequent in women with non-thyroid autoimmune disease [25% vs 9.6%; odds ratio (OR), 95% confidence interval (95% CI), 3.16 (1.01–11.8); p =0.05]. Women with positive TPO-Ab showed higher prevalence of non-thyroid autoimmune disease [25% vs 6.4%; OR (95% CI), 4.90 (1.31–18.4); p =0.04] and a trend toward increase of past gestational hypertension (p =0.09), late abortion (p =0.09), and fetal death (p =0.09). Hypothyroidism was more frequent in women with non-thyroid autoimmune disease and those with past pregnancy loss. Conclusions: TDs are common in Tunisian pregnant women and are associated with autoimmune diseases and poor gestational outcomes. These data support the benefit of thyroid testing in pregnant women, especially those with these conditions. [Copyright &y& Elsevier]

AIMS: Tumor necrosis factor [alpha] (TNF[alpha]) plays a key role in orchestrating the complex events involved in inflammation and immunity. Accordingly, TNF [alpha] has been implicated in a wide range of autoimmune and infectious diseases, but also in conditions such as obesity and insulin resistance. The aim of the present study was to investigate the association between the -863C/A polymorphism in the promoter of the TNF[alpha] gene and type 2 diabetes in the Tunisian population. METHODS: The polymorphism -863C/A in the TNF[alpha] gene was determined in 211 type 2 diabetes patients and 345 healthy controls using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analysis. RESULTS: A significant difference in genotype distribution and allele frequency was observed between patients and controls. Patients with type 2 diabetes had significantly higher frequency of the CA+AA genotypes compared to controls [35.5% vs. 22.3%; OR (95%CI), 1.91 (1.31-2.8); p=0.001]. The type 2 diabetes patient group showed a significant higher frequency of the A allele compared to the controls (0.19 vs. 0.11; p=0.001). After adjustment by a stepwise logistic regression method, hypertension, dyslipidemia, and CA+AA genotype were found to be significantly associated with T2D. CONCLUSION: The present study showed a significant and independent association between the -863C/A polymorphism of the TNF[alpha] gene and type 2 diabetes in the Tunisian population. [ABSTRACT FROM AUTHOR]