The high prevalence of vitamin D inadequacy and dress style of women in the sunny UAE

In the UAE, 255 women with different dressing styles (veiled and non-veiled) underwent assay for vitamin D(3). The vitamin level was suboptimal in all groups including those dressed in Western style. The contribution of hypovitaminosis D to osteoporosis was less impressive compared to that of age factor.

INTRODUCTION

Vitamin D deficiency is attributed to several causes including clothing styles that hinder exposure to sunlight. This work represents our experience of such issue and its relevance to osteoporosis.

METHODS

Two hundred and fifty-five women either fully covered (96, group G1), covered but face and hands exposed (104, group G2) or dressed in Western style (55, group G3) all underwent immunoassay of 25(OH)D; 78 % of them were Middle Easterners and North Africans. The mean age was 44.8 ± 14.6 years.

RESULTS

In the entire cohort, hypovitaminosis D prevalence was found to be 90.5 % (mean of 25(OH)D, 19.3 ± 9.35 ng/ml). The prevalence was 90.5, 94 and 83 % (all p = not significant (NS)), with a mean value of 17.6 ± 5.45, 16 ± 5.23 and 18.6 ± 6.18 ng/ml in the three groups, respectively. Significant differences in the mean value were observed between G1 vs. G2 (p = 0.04) and G2 vs. G3 (p = 0.01). Fifty-one women in G1 had longer adherence to their dressing habit than 68 in G2, yet the mean level of 25(OH)D was significantly lower in the latter (p = 0.008). Osteoporosis was found in 45/202 (22 %): 24.5, 22.5 and 14.5 % in the three groups, respectively (all p = NS). Patients with osteoporosis were significantly older than others with normal dual X-ray absorptiometry outcome. Values of serum calcium, phosphorus, alkaline phosphatase, mild to moderate secondary hyperparathyroidism and low 25(OH)D were comparable in the two groups.

CONCLUSIONS

The pattern and longevity of dressing style should not be used as pretext for the hypovitaminosis D before other factors are being examined or considered.

Lack of biochemical hypogonadism in elderly Arab males with low bone mineral density disease

The aim of the study is to study the relationship between androgen levels and bone mineral density (BMD) in elderly Arab males. Forty-five elderly Arab males underwent Dual X-ray absorptiometry for measurement of BMD. The outcomes were defined as per WHO description. Assays for testosterone (T), gonadotropins (LH and FSH) and estradiol (E2), in the serum were carried out. The ratio of T/LH was used as a surrogate for the cFT assay. We excluded patients receiving hormonal ablation for prostatic neoplasm and patients with chronic liver or renal disease and patients receiving corticosteroids. Twelve were osteoporotic (26.5%); 22 osteopenic (49%); and 11(24.5%) had normal outcome. Osteoporotic patients were significantly older (78.17 +/- 7.59 years) than the osteopenic (70.14 +/- 5.92, P <or= 0.01 and the normal subjects (71.20 +/- 4.17, P <or= 0.05). The means of total serum T, LH, FSH and E2 were all within the normal values and not significantly different between the three groups. Like wise were the means of the ratios of T/LH and E2/T too. A significant number of subjects in this cohort of elderly Arab males had reduced bone density that appears to be independent of androgen levels. Osteoporotics were significantly older than those with osteopenia or normal bone density. Aging seemed to have overridden the effect of normal sex hormones on bone density in these patients. Before considering these results as a possible exception to the widely established role of the hypoandrogenemia in male osteoporosis, other potential factors impacting on bone density need to be considered.

Borderline systemic lupus erythematosus (SLE): a separate entity or a forerunner to SLE?

AIM

To compare a subgroup of patients with borderline systemic lupus erythematosus (SLE) with those with classic lupus in order to determine whether the former subset is a separate entity or a forerunner to SLE.

METHODS

A retrospective survey was undertaken of a database containing the clinical information of a total of 71 patients in an Abu Dhabi hospital setting over a 12-year period. Data of interest were criterial and non-criterial features of SLE together with relevant laboratory tests.

RESULTS

Fifty-six patients had SLE and 15 were considered to have borderline SLE as they satisfied less than four criteria of classification. Age and female sex distribution were no different in the two subgroups, but the disease duration was shorter in patients with borderline lupus. The occurrence of arthropathy (non-erosive), serositis, thrombocytopenia, hemolytic anemia, and malar eruption was common to both subgroups. Patients with borderline SLE lacked other mucocutaneous manifestations of lupus and major organ disease involvement. A number of other clinical features were also observed in the latter subgroup, including antiphospholipid (APL) syndrome. In addition, patients with borderline SLE expressed a multiple autoantibody profile, but had lower titers of antinuclear factor (ANF) and anti-double-stranded DNA (anti-dsDNA) antibodies than those with classic SLE. None progressed to full-blown SLE after a mean period of follow-up of 21.2 months.

CONCLUSIONS

In our patients, borderline SLE was milder than classic lupus, yet shared a wide spectrum of non-criterial features and also produced clinical subsets. The clinical heterogeneity and multiple antibody profile may suggest that borderline SLE is a forerunner to SLE rather than a separate entity. A regular and longer period of follow-up is required, however, to ultimately determine the fate of these patients.

A patient with extensive blue rubber bleb nevi associated with multiple congenital anomalies: an overlap or a new syndrome?

We report a case of a 13 year old boy with non-familial, multiple blue rubber bleb nevi (BRBN). He also had additional dysmorphic anomalies including a low hairline, low set ears, narrow nares, ptosis, hypotelorism, a high arched palate and downward slanting of the outer canthi. Skeletal deformities included a short, slightly webbed neck, kyphosis, cubitus valgus, non-traumatic luxation of the head of the right radius and a short left little and index fingers. He had no evidence of gastrointestinal lesions or bleeding, congenital heart or renal disease or enchondromata. The boy was mentally slow compared to his peers. He had normal chromosomes. The absence of gastrointestinal bleeding or iron deficiency anaemia is inconsistent with Bean's syndrome and the lack of enchondromata in this patient militates against the diagnosis of classical Maffucci syndrome. Some of his physical features are obviously similar to those observed in a Noonan's syndrome yet the presence of extensive BRBN would be an extremely unusual finding. Since the overall picture does not fit into any of the classical categories mentioned above, the constellation of his features has yet to find a specific syndrome. It may, however, represent an overlap between them or, possibly, a new syndrome.

False positive VDRL (BFP-STS) and systemic lupus erythematosus; new data in clinico-laboratory associations

AIM

To investigate the relationships between clinical features and serological parameters in systemic lupus erythematosus (SLE) patients with false positive venereal disease research laboratory (VDRL) test (BFP-STS) and those without.

METHODS

The records of 74 patients with SLE were reviewed. These were divided on the basis of the presence of a biologically false positive serological test (BFP-STS) (n = 18) or its absence (n = 56). The clinical features and serological parameters were subsequently evaluated in each group.

RESULTS

A biologically false positive serological test was found in 18 patients (24.5%). Clinically, they had a significantly higher frequency of malar rash (P < 0.02), hemolytic anaemia (P < 0.02) and SLE-related antiphospholipid (APL) syndrome (P < 0.02). Neuropsychiatric lupus was more frequent in the group without BFP-STS. Moreover, subacute cutaneous LE (SCLE), Raynaud's phenomenon, livedo reticularis (LR) and cardiopulmonary complications were present only in the latter group. There was no significant association between BFP-STS and other autoantibodies including Extractable nuclear antigen (ENAs), however, there was a significant association with C3 hypocomplementemia (P < 0.05). Half of the patients with BFP-STS were positive for anticardiolipin antibodies (aCL Abs) vs. 28% in the negative group (P = NS).

CONCLUSIONS

The study suggests that the clinical and serological relevance of BFP-STS in lupus patients may vary from those described in relation to other antiphospholipid determinants. Our patients appeared to have sparing of certain major organ systems, yet there was a greater tendency to developing Antiphospholipid (APL) syndrome and hemolytic anaemia.