Meta-analysis of MTHFR C677T polymorphism and type 2 diabetes mellitus in MENA region

BACKGROUND AND AIMS

The association of the C677T polymorphism of the Methylenetetrahydrofolate Reductase (MTHFR) gene with susceptibility to type 2 diabetes mellitus (T2DM) has been widely debated. Therefore, our aim is to conclusively resolve this controversy in the Middle East and North Africa region population through a meta-analysis.

MATERIEL AND METHODS

We identified relevant articles by searching literature databases, such as PubMed, Web of Science, and Science Direct, to retrieve studies that examined the association between the MTHFR C677T polymorphism and the risk of developing T2DM. Using meta-analysis, we calculated the odds ratio (OR) and confidence interval (CI) values of these studies to assess the susceptibility to T2DM related to the C677T polymorphism of MTHFR gene.

RESULTS

In this meta-analysis, we included a total of 13 publications comprising 2072 T2DM patients and 2164 control subjects. The results of the meta-analysis suggested that there is a significant association between the C677T polymorphism and T2DM risk in overall comparisons for allele contrasts (T vs C): OR = 1.25, 95% CI = 1.04-1.50, p = 0.015 and homozygous (TT vs CC): OR = 1.44, 95% CI = 1.01-2.05, p = 0.038). Subgroup analysis revealed that the C677T polymorphism is associated with a risk of T2DM in Asian populations, while there is no significant association between this polymorphism and T2DM in Caucasian and African populations. Furthermore, there was no evidence of publication bias.

CONCLUSION

Our study's results suggest that the allele contrast of the C677T polymorphism of the MTHFR gene is associated with an increased risk of T2DM in the overall population, particularly among Asians.

FTO gene variants (rs9939609, rs8050136 and rs17817449) and type 2 diabetes mellitus risk: A Meta-Analysis

BACKGROUND AND AIMS

There is tremendous increase in type 2 diabetes mellitus (T2DM) worldwide. The impact of FTO gene polymorphisms on the risk of T2DM is not yet clear because of the controversial results of studies. This meta-analysis aimed to better clarify the association between three FTO gene polymorphisms SNPs (rs9939609, rs8050136 and rs17817449) and T2DM in a larger combined population worldwide.

MATERIAL AND METHODS

A comprehensive search on the PubMed, Science Direct, and Web of Science databases was conducted to identify investigations in relationship between different FTO gene polymorphisms (rs9939609, rs8050136 and rs17817449) and T2DM globally. Published papers from January 2007 to May 2023 were collected. Inclusion criteria are limited to human case-control studies published in English and peer-reviewed, which provided data on the genotype distributions of FTO gene polymorphisms and T2DM risk. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to express the results of the meta-analysis. Potential sources of bias and heterogeneity using Egger's regression analysis were also assessed.

RESULTS

Of 234695 identified articles, forty-eight studies were selected including 36,051 patients with T2DM and 51,266 control subjects. Overall, we found a significant increased risk of T2DM susceptibility and rs9939609 FTO gene polymorphism in the Allele contrast (A vs. T: OR = 1,30, 95% CI = 1.14; 1.48, P < 0,05, I2 = 0,94), Recessive model (AA vs. AT + TT: OR = 1,54, 95% CI = 1.19; 2.00, P < 0,05, I2 = 0,94), Dominant model (AA + AT vs. TT: OR = 1,26, 95% CI = 1.10; 1.45, P < 0,05, I2 = 0,89), homozygote model (AA vs. TT: OR = 1,60, 95% CI = 1.26; 2.03, P < 0,05, I2 = 0,90), and heterozygote model (AA vs. AT: OR = 1,43, 95% CI = 1.09; 1.88, P = 0,008, I2 = 0,93). we also found a significantly increased risk of T2DM susceptibility and rs8050136 FTO gene polymorphism under all models. For rs17817449 we did not find any association between with T2DM.

CONCLUSION

The present meta-analysis confirms that rs9939609 and rs8050136 in the FTO gene are significantly associated with T2DM, while rs17817449 does not show any association.

Self-care intervention using mobile apps for sexual and reproductive health in the WHO Eastern Mediterranean Region

Sexual and reproductive health (SRH) concerns physical, mental, and social well-being as related to sexual and reproductive systems. Self-care, which is the ability to promote health without the support of a health-care provider, can advance SRH, especially for fragile populations. Mobile health (mHealth) solutions can be used to raise awareness about SRH. We performed a structured literature review and analysis of mHealth-based approaches for delivering self-SRH services and interventions in the WHO Eastern Mediterranean Region (EMR). A fuzzy-based framework for assessing those mHealth apps was proposed. We identified 6 out of 737 papers, and 23 (5.7%) out of 400 mHealth apps retrieved from app-stores, describing mHealth use for self SRH with only 10 apps developed in EMR countries, namely Morocco, Pakistan, Egypt, Iran, and Jordan. Our fuzzy-based framework proposes guidelines regarding the implementation of self-care interventions to help project leaders promote their adoption in the SRH systems.

Factors Associated With Mild Cognitive Impairment in Patients With Type 2 Diabetes: A Cohort Study

Background

Cognitive dysfunction is increasingly recognized as an important comorbidity of diabetes mellitus (DM).

Objective

The purpose of this study was to determine the prevalence and predictors of cognitive decline in individuals with type 2 diabetes mellitus (T2DM).

Methods

This cohort study included patients with type 2 diabetes mellitus aged between 40 and 75 years and with a duration of the evolution of diabetes that is greater than five years admitted in endocrinology consultation of the Sheikh Khalifa ibn Zaid Hospital in Casablanca, Morocco. For each patient, we collected clinical characteristics and biological assessments. All subjects provided screening test results as defined by the Mini-Mental State Examination (MMSE).

Results

We included a total of 100 patients with diabetes between May and September 2021. The median age of the patients was 65 years (interquartile range (IQR): 59-70 years), 65% were males, and the median duration of diabetes was 15 years (IQR: 9-20 years). The most common cardiovascular risk factors (CVRFs) were hypertension (72.7%) and dyslipidemia (53%). The most common complications of diabetes were peripheral neuropathy (50%), diabetic retinopathy (DR) (39%), peripheral artery disease (33%), and coronary artery disease (27%). Cognitive impairment was present in 47.5% of our patients. For the multivariate analysis, we found that the decrease in the MMSE score is associated with the increase in age (p-value = 0.004) and the occurrence of diabetic retinopathy (p-value < 0.001), dyslipidemia (p-value = 0.006), and elevated creatinine (p-value < 0.001).

Conclusion

It is necessary to consider the cognitive decline of patients with diabetes as one of the most important complications of this disease because of its impact on the evolution and compliance of these patients.

Modified Technique of Single-Bone Forearm in the Treatment of Deformities

The single-bone forearm is a salvage technique for massive loss of bone due to serious trauma, malignant tumors, infections or congenital deformity. It is also described to treat the sequelae of hereditary multiple exostoses disease that affects the distal end of the ulna. We present the case of a 29-year-old patient, operated for sequelae of hereditary multiple exostoses disease of the left forearm by a modified single-bone forearm technique. The patient, right-handed, operated on twice in childhood for a hereditary multiple exostoses disease of the left forearm: incomplete excision of the exostosis of the distal end of the ulna and lengthening of this last on external fixator, without improvement. The patient presented for a deformation of the left forearm with shortening compared to the right side‌. Significant limitation of prono-supination (pronation 15°, supination 20°). Elbow flexion at 110° and extension with deficit of 15°. Wrist flexion at 50° and extension at 50°, radial inclination at 25° and ulnar at 30°. The pain score was 3 according to the Visual Analogue Scale (VAS), especially on effort. Dash score was 31,82/100. We chose the forearm technique with a single bone. The immediate postoperative result found a realignment of the forearm, without neurological or vascular damages. Consolidation was obtained in four months. At five months, the patient recovered elbow flexion at 110° and full extension, wrist flexion at 45° and extension at 50°. Radial inclination at 20° and ulnar at 25°. The single-bone forearm technique has been described, not only for the treatment of hereditary multiple exostoses disease, but also for serious trauma or tumors with massive loss of bone. The technique generally consists of an osteotomy of the radius as well as the ulna, fixing the radius to the ulna creating a synostosis, with or without resection of part of one or both bones of the forearm. The most described complications of single-bone forearm procedure are pain, complications related to soft tissue secondary to the previous injury, and infections. The one-bone forearm remain a salvage technique for massive loss of bone of the forearm, or large deformities due to congenital malformations. This technique could allow the excision of massive bone and keep only a part of the ulna and the radius, with function maintenance and aesthetic forearm preservation.

[Squamous cell carcinoma in a patient with chronic osteomyelitic lesion: a case report]

L´association d´un carcinome épidermoïde et d´une ostéomyélite chronique est rare. Elle doit cependant être évoquée à chaque fois qu´il y a une modification de la symptomatologie locale usuelle. Le retard du diagnostic peut être fatal pour le patient. Les biopsies répétées peuvent être d´une aide précieuse pour le médecin traitant. Nous rapportons le cas d´un patient de 47 ans chez qui un diagnostic de dégénérescence carcinomateuse sur une ostéomyélite chronique fistulisée à la peau a été posé. Une amputation a été réalisée.