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  • ISSN: 2333-6692
    Volume 6, Issue 1
    Research Article
    Rajalingam Ramalingam* and Min Moon Tang
    Introduction: Vitiligo is an acquired depigmenting disorder with significant impact on quality of life. There is a high prevalence of vitamin D deficiency among vitiligo patients worldwide. However, the status of vitamin D among vitiligo patients in Malaysia is unknown.
    Objectives: To compare the level of serum 25-hydroxyvitamin D between vitiligo patients and healthy controls, to determine the relationship between vitamin D level and vitiligo severity, and to identify variables affecting vitamin D level.
    Method: A single-center, cross-sectional, case-control study assessed anthropometry, serum 25-hydroxyvitamin D level, auto antibodies, sun exposure, and dietary vitamin D intake in patients with vitiligo and in matched controls.
    Results: Among 180 subjects, 93 (51.7%) had vitiligo, and 87 (48.3%) were controls. Twice as many vitiligo patients had antithyroperoxidase autoantibody compared to controls, although this was not significant. There was no difference in the mean vitamin D level between both groups. Two-thirds of subjects in both cohorts had vitamin D deficiency or insufficiency. The independent variables affecting vitamin D level were sun exposure index and dietary vitamin D intake, the latter being extremely low in both groups. While vitamin D level was associated with obesity, there was no correlation with Fitzpatrick skin phototype or severity of vitiligo.
    Conclusions: Serum vitamin D level is universally low in this study population, with no significant difference between vitiligo and healthy subjects, and this is due to low dietary intake. Since there is no correlation between vitamin D level and severity of vitiligo, vitamin D supplementation may not be justified.
    Saty Sara, Wehbe Tarek*, and Abou Jaoude Elizabeth
    Introduction and Objectives: Prediabetes (PD) is a state that precedes type 2 diabetes mellitus (T2D). As the obesity epidemic explodes, and T2D incidence is on the rise, an early intervention during PD would be the optimal approach to prevent the onset of T2D. The purpose of this study is to investigate the effects of the glucagon-like peptide-1 (GLP-1) agonist liraglutide in combination with metformin in eliminating the PD state.
    Material and methods: This retrospective study was conducted in two health care centers on 79 overweight/obese prediabetic subjects aged 18 to 65 years. Fifty five subjects were treated with metformin, and 24 with metformin and liraglutide, in addition to lifestyle modifications. Data collected included: body weight, waist circumference, fasting plasma glucose (FPG), Glycated Hemoglobin (HbA1c), glucose tolerance test (GTT), fasting insulin level (FIL), blood pressure (BP), serum lipids and any side effects. The changes of these parameters were compared between groups at three time points: first visit, and 3 and 6 months later.
    Results: The liraglutide/metformin group displayed significant weight loss, loss of the abdominal fat, improvements in FPG, HbA1c levels, systolic and diastolic BP and rise of High Density Lipoprotein (HDL). More importantly, 91.6% of the evaluable prediabetics treated with liraglutide/ metformin returned to normal glucose tolerance state during the six months period. No major side effects were observed, except for mild transient nausea.
    Conclusion: These findings suggest that the liraglutide, combined with metformin and lifestyle intervention, could be a promising intervention to reverse PD and stop its progression. Validation of our data in a prospective, randomized design would be greatly anticipated.
    Derick Adams*, Linda Gotthelf, and Carol Addy
    Background: Lifestyle modification and weight loss are the best ways to prevent type 2 diabetes. The Centers for Disease Control (CDC) has established criteria for Diabetes Prevention Programs (DPP) to help identify programs that have efficacy in diabetes prevention.
    Methods: This is a retrospective study that investigated 400 patients (200 patients with pre-diabetes and 200 patients at-risk for type 2 diabetes) who met CDC criteria for entry into a DPP and participated in the Health Management Resources (HMR) clinic-based program for a minimum of 1 year. Changes in body weight, BMI, total cholesterol/HDL ratio, triglycerides, systolic blood pressure, diastolic blood pressure, fasting blood glucose, dietary intake, and average physical activity per week were reported.
    Results: Following the HMR program the average FBG was reduced from 107.3 to 95.6 mg/dL in patients with prediabetes. Mean weight loss was 56.1 pounds or 22.2% ideal body weight (IBW) in those with pre-diabetes and 48 pounds or 20.0% of IBW in those at risk for diabetes. Patients at risk for diabetes increased physical activity by a mean of 276 min/wk. 47.3% of all study patients reported eating higher fat foods at baseline compared to only 4.3% of patients at the end of the program.
    Conclusions: The HMR program is effective in preventing type 2 diabetes mellitus and fulfills criteria of a CDC DPP.
    Hawa Juma El-Shareif*
    Background: Graves' disease (GD) is an autoimmune disease characterized by goiter hyperthyroidism and ophthalmopathy. Treatment options include anti-thyroid drugs (ATD), radioactive iodine (RAI), and surgery.
    Objective: To determine the clinical features at presentation, mode of treatment, and long-term outcome of GD in our region and to determine the whether the duration of ATD treatment, patient gender, and age at presentation can predict the long-term response rate.
    Methods: Retrospective review of medical records of 145 consecutive Libyan patients with GD who were treated at the endocrine clinic of the Tripoli Medical Center (TMC) during the period between June 2005 and April 2007. Demographic data, presenting clinical features, and the results of thyroid function test at the time of the first presentation were obtained. Mode of treatment and the long-term outcome were recorded
    Results: A total of 145 patients were reviewed, 71.7% were female and 28.3% were males. Mean age was 36.7±11.8 years (Range 16-70) and mean duration of follow up was 5.7±3.9 years (Range 1-12) years. Tremor (64.8%), weight loss (54.5%), and palpitation (53.1%) were the most common clinical manifestations. 76.6% were treated only with antithyroid drugs (ATD), 16.6% received radioactive iodine (RAI), and 6.9% underwent surgery. Long-term remission rates for ATD, surgery, and RAI were 59.1%, 88.9%, and 87% respectively.
    Conclusion: Clinical manifestations of GD in our patients were comparable with those reported in the literature. There was an underuse of second-line treatment, namely surgery, and RAI therapy.
    Review Article
    Donovan A. McGrowder*
    Childhood obesity is a global health problem with short- and long-term health consequences. There is increasing prevalence of obesity among children and there is increased risk for coronary heart disease. A number of clinical and biochemical parameter becomes abnormal in children and adults with obesity. Preventative measures involving family and community-based intervention as well as clinical measures from early childhood should assist in decreasing the prevalence rates. This review focus on current knowledge on the prevalence of overweight and obesity in children and adults, and the biochemical parameters that are abnormal.
    Case Report
    Provatas Ioannis*, PandelakosStavros, Koufopoulos Nektarios, Stamou Chrysa, PavlouKalliopi, and Helen Trihia
    Primary Water-Clear Cell Adenoma (WCCA) of the parathyroid glands are extremely rare neoplasm, consisting of cells with clear, foamy cytoplasm filled with glycogen, lacking an infiltrative growth pattern and metastases. We report the case of a 58-year-old woman with primary hyperparathyroidism, without a known history of MEN-1 or NF-1, with a tumour posterior to the right thyroid lobe. No evidence of metastasis was reported. The clinical diagnosis was parathyroid adenoma. Following the surgical procedure, we received an encapsulated tumor measuring 4,5 cm in diameter and weighting 12 gr, consisting of water-clear cell cells, without mitoses, atypical features or capsular invasion, at the rim of which normal residual parathyroid tissue was included. The differential diagnosis included a variety of primary and secondary clear-cell tumors of head and neck region, however the morphological and immunohistochemical (strong positivity only for PTH, p27 and bcl-2) assessment drove to the diagnosis of WCCA of the parathyroid gland. After the operation, the levels of PTH in patient’s serum dropped to normal and the post-operative course remained free of symptoms or abnormal laboratory findings. In conclusion, all the clinical and laboratory findings strongly suggested the diagnosis of WCCA of the parathyroid gland, however because of the rarity of this type of tumours, we had to examine this partiular tumour in detail, in order to exclude all the other clear-cell tumours that can appear in this region.
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