Influence of parity on bone mineral density and peripheral fracture risk in Moroccan postmenopausal women

The aims of the study were to determine: (1) the relationship between parity and bone mineral density (BMD); (2) the relationship between parity and osteoporotic peripheral fractures.

Material and methods

The group studied included 730 postmenopausal women. Patients were separated into four groups according to the number of fullterm pregnancies, group 1: nulliparae, group 2: one to three pregnancies, group 3: four to five pregnancies, and group 4: six and more pregnancies. Additionally, patients were separated into three groups according to their ages, as <50 years, 50–59 years and ≥60 years.

Results

The median parity was 4 [0–20]. All the patients with parity greater than six had spine and hip BMD values significantly lower than values in the other groups (p < 0.001). After adjustment for age and body mass index (BMI), decreased lumbar and total hip BMD were still associated to increased parity (analysis of covariance (ANCOVA), p = 0.04 and 0.023, respectively). The relation between parity and lumbar BMD was highly significant among women aged <50 years (age-adjusted p = 0.022), while there was no parity-spine BMD association in the other age groups. The relation between parity and hip BMD was seen only in the group 50–59 years (age-adjusted p = 0.042). A positive history for peripheral fractures was present in 170 (23%) patients. There was relationship between parity and peripheral fractures neither in the whole population nor in the sub-groups according to age.

Discussion

The present study suggests that the BMD of the spine and hip decreases with an increasing number of pregnancies, and this situation shows variations in different age groups. However, there was no correlation between parity level and peripheral fractures.     

Erythema elevatum diutinum. A clinicopathologic study of 5 cases

Erythema elevatum diutinum is a rare condition of unknown etiology listed with cutaneous vasculitis or neutrophilic diseases. Medical records and histopathologic slides of 5 patients with erythema elevatum diutinum were studied to better understand the disease. Lesions were clinically characteristic. All biopsy specimens showed leucocytoclastic vasculitis. The most significant finding is the association of erythema elevatum diutinum whith seronegative rheumatoid arthritis.     

Osteoporosis in patients with primary biliary cirrhosis

Metabolic bone disease has been recognized as an important complication of chronic liver disease particularly in cholestatic disorders [primary biliary cirrhosis (PBC) and primary sclerosing cholangitis] and after liver transplantation. It includes osteoporosis and more rarely osteomalacia, which is more frequent in severe malabsorption and advanced liver disease. The pathogenesis of this disorder is complex and is likely to be multifactorial. Regardless of the etiology of osteoporosis in PBC patients, they have an increased risk of spontaneous or low-trauma fracturing leading to significant patient morbidity, deterioration of quality of life, and even patient mortality. The development of bone densitometry has allowed assessment of bone mass and then contributed in estimating the fracture risk. The gold standard of bone mineral density measurement is currently the dual- energy X-ray absorptiometry. Recommendations formulated by the World Health Organization have reported the diagnostic ranges of osteoporosis based on the t-score: patient with osteoporosis has a t-score less than -2.5 SD, osteopenia has a t-score between -1.0 and -2.5 SD and a normal individual has a t-score more than -1.0 SD. The risk of fracture shows a correlation with bone mineral density but no fracture threshold was determined and the best site of characterizing the hip fracture risk is the measure of the bone mineral density of the proximal femur. The treatment of osteoporosis in patients with PBC is largely based on trials of patients with postmenopausal osteoporosis as there are a few and smaller studies of osteoporotic patients with PBC. Bisphosphonates seem to be effective in biliary disease and are more tolerated.     

Interference of tobacco smoke with immunochromatography assay for urinary drug detection

BackgroundThis study aimed to evaluate the interference of tobacco smoke on immunochromatography assay of urinary drug detection.MethodsOur study included 256 voluntary subjects (143 passive smokers and 113 current smokers). Cotinine was measured by immunoenzymatic method and thiocyanates (SCN^?) by selective electrode. Urinary drug was detected by immunochromatography assay. A positive result is completed by an analytical method with an immunometric assay.ResultsFalse positive results for benzodiazepines are significantly more frequent in smokers compared with passive smokers (90.2% Vs 22.4%; χ² = 116.62, p < 10^?3). For smokers, the number of cigarettes was significantly higher in subjects with falsely positive results for benzodiazepines compared with subjects with negative results (32 ± 11 Vs 20 ± 10; p = 0.04). Between these two groups, we established a significant difference for urinary cotinine (345 ± 211 Vs 117 ± 54 μg/μmol; p < 10^?3) and for plasma SCN^? (101.6 ± 3.4 Vs 98.8 ± 2.1 μmol/L; p = 10^?3). Urinary cotinine and consumption duration present the highest values of areas under curves (AUC) of the receiver-operating-characteristic (ROC) curves. The cut-off of 167.6 μg/μmol and 10.5 years were found as predictive factors of false positive results.ConclusionTobacco smoke interferes with immunochromatography assay of urinary drug detection; therefore, all subjects must be questioned about their smoking status to avoid such false results during results interpretation.     

An uncommon trichoepithelioma: the giant solitary trichoepithelioma

A case of giant solitary trichoepithelioma of the perianal region is described so to draw attention to this rare benign neoplasme and to discuss its clinical and histopathological chracteristics.     

Pseudoxanthoma elasticum: a report of 11 cases

INTRODUCTION: Pseudoxanthoma elasticum (PXE) is an inherited disorder of elastic tissue with many systemic manifestations PATIENTS AND METHODS: We performed a retrospective study from all the patients diagnosed with PXE at the department of dermatology of La Rabta hospital of Tunis, between 1986 and 2003. RESULTS: During the observation period, we identified 11 patients with PXE, 5 males and 6 females with a mean age of 28 years (10-47 years). Family history was found in 5 patients. Exhibit yellowish, pigskin, and popular lesions on the sides of the neck were observed in all cases. Systematic ophthalmologic examination revealed angio?d streaks in 4 patients. No abnormalities were found in cardiovascular and metabolic explorations. DISCUSSION: Diagnosis of PXE is based on clinical, histological and genetic criteria. Ocular and cardiovascular damage make all the gravity of the disease, from where interest of an ophthalmologic and cardiovascular examination systematic.