Hypolipidemia and Sepsis: It is The Hypolipidemia Not The Statins

To The Editor: I read with great interest the correspondence written by Mathew and Daniel [1], who have the same concerns regarding the potential risks of hypolipidemia [2]. However, Mathew and Daniel referred to the recently published systemic review by Falagas and his colleagues [3], who analyzed twenty studies that examined the use of statins in patients with septicemia and other different bacterial and viral infections. They concluded that statins may have a positive role in treatment of patients with sepsis and infection

Hypolipidemia: A Word of Caution

INTRODUCTIONHypolipidemia is a decrease in plasma lipoprotein caused by primary (genetic) or secondary (acquired) factors. It is usually asymptomatic and diagnosed incidentally on routine lipid screening. The first report of hypocholesterolemia in the medical literature was in 1911 by Chauffard and coworkers, in patients with active tuberculosis [1]. Since then (about 95 years), only few dozens of studies were published in this regard. Unlike hyperlipidemia physicians are usually unaware of hypolipidemia, its causes and consequences. As the interest in aggressive management of hyperlipidemia increases, particularly with the available, relatively strong hypolipidemic drugs and the newer and probably stronger agents, the following question should be answered; how low can we go in serum levels. For the time being, it is difficult to give a certain limit for the safest and lowest level of serum cholesterol, but knowing the complications of hypolipidemia will raise awareness. What might appear as a simple mildly reduced serum lipid can be an indication of an underlying, serious problem. A systematic search of Pubmed for all the studies in the English language as well as the abstracts of publications in other languages related to hypolipidemia was undertaken. The following words were used in the search: hypolipidemia, hypocholesterolemia, hypobetalipoproteinemia, and statins. Search results were reviewed

An accidental liraglutide overdose: Case report

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Obesity in Libya: A review

Obesity is a global epidemic resulting in major morbidity and premature death. About 64% of Libyan adults are either overweight or obese, obesity progressively increasing with age, and two times more common among Libyan women than men. Cases of obesity and overweight are increasing in Libya as well as all over the world, with genetic and environmental factors playing a contributory role. With its known significant morbidity and mortality, obesity should draw the attention of the healthcare community, researchers, and policy makers in Libya.Keywords: obesity; overweight; diet; lactation; exercis

Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi-Libya: A pilot study

ABSTRACTBackground: Metabolic syndrome is a cluster of three out of five conditions that are due to hyperinsulinemia: abdominal obesity, atherogenic dyslipidemia (high triglycerides and/or low HDL),elevated blood pressure, and elevated plasma glucose. The syndrome is highly prevalent in patients with type-2 diabetes mellitus and often precedes the onset of hyperglycemia. It has been shown thatmetabolic syndrome is an independent clinical indicator of macro- and microvascular complications in diabetics. Aim and objectives: the aim of this pilot study was to estimate the frequency andcharacteristics of metabolic syndrome among type-2 diabetic patients in Benghazi. Patients and methods: This cross-sectional study involved 99 randomly selected adult patients with type-2diabetes mellitus. The patients were interviewed and examined, and their lipid profiles were checked 9-12 hours after overnight fasting. Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and of the International Diabetes Federation (IDF). Results: About 92% of the patients had the metabolicsyndrome according to ATP III criteria and 80.8% according to IDF criteria. Females were more affected, males with metabolic syndrome were significantly older, and females were significantly moreobese. No significant difference was observed between males and females regarding waistcircumference, HDL level and triglyceride level. The commonest and most important component ofmetabolic syndrome in the study group was low HDL. Conclusion: Metabolic syndrome is common among Libyans with type-2 diabetes mellitus, and it is significantly more common in females thanmales. The most significant predictor of metabolic syndrome in type-2 diabetic patients in Benghazi is low HDL

Clinical and Biochemical Characteristics of Polycystic Ovary Syndrome in Benghazi- Libya; A Retrospective study

Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting women of reproductive age and characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. There are no published data on this syndrome in Libyan patients. Aims and objectives: To assess the frequency of clinical and biochemical features of PCOS in our patient population, and to compare this with data collected in other parts of the world. Subjects and methods: A retrospective analysis of patient records at the endocrine clinic in Benghazi was undertaken. Patient inclusion was according to Rotterdam ESHRE/ASRM criteria. Clinical features, associated diseases, family history, hormone levels, and ultrasonography results were analyzed. Results: The mean age of the 318 PCOS patients at presentation was 25.8 years (range 15-44 years), and the majority (67%) were 20-29 years old at presentation. Of all patients, 57% were obese (BMI ≥ 30), 93% had oligo- / amenorrhea, 91% were hirsute, and 74% had ultrasound features of polycystic ovaries. Diabetes mellitus was diagnosed in 9% of all PCOS patients and hypertension in 4%. Total serum testosterone was elevated in 26% of the patients, and serum prolactin was elevated in 31%. Thyroid disease was noted among 5.3% of the patients, and a history of diabetes or hypertension among first-degree relatives was seen in (16%) and (8%) of the patients respectively. Conclusion: Chronic anovulation and hirsutism are the dominant features of PCOS in our patient population. More than half were obese, and the prevalence of diabetes, hypertension and thyroid disease in our patients seemed to be underestimated in comparison to other parts of the world

Fasting of Ramadan in peoples with diabetes in Benghazi, Libya: an exploratory study

Background: The epidemiology of diabetes and Ramadan fasting was reported from many Muslim countries, but not from Libya. Methodology: We interviewed 493 consecutive diabetic patients at Benghazi Diabetes and Endocrine Center for the potential complications of fasting during Ramadan. Results: We found 70% of diabetic patients completed the 30 days of Ramadan fasting. Hypo- and hyperglycemia was the most commonly reported complications especially during the first two weeks of Ramadan month. Conclusion: It seems majority of diabetic patients in Libya manage to fast during Ramadan month. Patient education and early planned adjustment of diabetic medication is needed to decrease the frequency of diabetic complication during Ramadan month.Keywords: diabetes; hypoglycemia; hyperglycemia; fasting; Ramada

Prevalence of Gall Bladder Stones among Type 2 Diabetic Patients in Benghazi Libya: A Case-control Study

Background: Diabetes mellitus and gall bladder stones are both common and costly diseases. Increasing age, female gender, overweight, familial history of the disease and type 2 diabetes mellitus is all associated with an increased risk of gallstones. Several studies from around the world reported an increased prevalence of gall bladder stones in patients with diabetes mellitus. Aims and objectives: The aim of this study was to define the frequency of gall bladder stones among Libyan diabetics and to evaluate the possible associated risk factors in these patients. Patients and methods: A case-control study was performed during 2007 at Benghazi Diabetes and endocrinology Center. The study involved 161 randomly selected type-2 diabetic patients under regular follow up at the center, and 166 age and sex matched non-diabetic outpatients at the 7th of October teaching hospital. Real-time abdominal ultrasound was performed by two radiologists to examine the abdomen after an overnight fast. Results: About 40% of the diabetic cohort had gall bladder stones as compared to 17.5% of non-diabetic patients. Females were significantly more affected than males. Patients with gall bladder stones were significantly older and had a significantly higher body mass index than those without stones. Conclusion: The prevalence of gallstones in Libyan diabetic patients is higher than the rates reported in other parts of the world. Libyan diabetic patients with gallstones tend to be older and more obese than those without gallstones. Duration of diabetes mellitus and type of treatment does not seem to influence the frequency of gall bladder stones among Libyan diabetics

Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study

BACKGROUND: There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries' cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women. METHODS: A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders. RESULTS: Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya's healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity. CONCLUSIONS: Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya