Incidence and Prevalence of Type 1 Diabetes in Children and Adolescents in Benghazi,Libya

The mean annual incidence rates of Type 1 diabetes mellitus in Arab children and adolescents in Benghazi, Libya were assessed as based on prospective registration of patients during the period 1981–1990. Results showed an annual incidence (per 100 000) of 7.0 (6.0–8.2) (males 6.3(5.0–7.9) females 7.8(6.3–9.7)) in 0–14 year olds and 8.8(7.8–10.0) (males 8.3(6.9–10.0), females 9.2(7.7–11.0)) in 0–19 year olds. There were no significant differences between males and females or between season of onset. The commonest age of onset was 15–19 years. Annual variations were significant in the 0–14 years age group (p < 0.001) and non-significant in the 0–19 years age group. In 1981 the age adjusted prevalence rates of Type 1 patients (per 100 000) were 23.5 (17.1–31.5) (males 21.2(13.1–32.3), females 25.9(16.8–38.3)) in 0–14 year olds and 36.2(29.1–45.1) (males 31.4(22.2–43.2), females 41.0(30.2–54.5)) in 0–19 year olds. In 1990 the prevalence rates had increased to 37.3(30.5–45.5) (males 40.7(30.8–53.3), females 33.8 (24.6–45.3)) in 0–14 year olds and 59.5(51.6–58.5) (males 60.3(49.3–73.6), females 58.6 (47.7–72.1)) in 0–19 year olds. Increase in prevalence rates was significant in both sexes and in both age groups (p < 0.001). Increase in prevalence rates in girls in 1981 and in boys in 1990 were not significant. It is concluded that Type 1 diabetes is a common chronic disease of children and adolescents in Benghazi, Libya.     

Increased Dietary Potassium and Magnesium Attenuate Experimental Volume Dependent Hypertension Possibly Through Endogenous Sodium‐Potassium Pump Inhibitor

We and others have shown that inhibition of cardiovascular muscle (CVM) cell Na⁺,K‐ATPase activity (NKPTA) due to increased level of endogenous sodium potassium pump inhibitor (SPI) is involved in the mechanism of volume expanded (VE) experimental and human essential hypertension (HT). Since diets fortified with very high potassium (K) or very high magnesium (Mg) decrease blood pressure (BP), we have examined the effect of a moderate increase in dietary K alone and a moderate increase in dietary K and Mg on plasma levels of SPI, CVM cell NKPTA, and BP in reduced renal mass (RRM)‐salt HT rats, a classical model of VE HT. Seventy Percent‐RRM rats were divided in four dietary groups, (1) Na free and normal K and Mg (0Na–K–Mg); (2) normal Na, K and Mg (Na–K–Mg); (3) normal Na and high K (2 ×normal), and normal Mg (Na–2K–Mg); and (4) normal Na and high K (2 ×normal), and high Mg (2 ×normal) (Na–2K–2Mg). As expected, compared to control 0Na–K–Mg rats, Na–K–Mg rats developed HT. Blood pressure increased significantly less in Na–2K–Mg rats whereas, BP did not increase in Na–2K–2Mg rats. Hypertension in NA–K–Mg rats was associated with an increase in plasma SPI and digitalis like factor (DIF) and a decrease in renal and myocardial NKPTA. However, doubling the Mg along with K in the diet (Na–2K–2Mg) normalized SPI and DIF and increased myocardial and renal NKPTA, compared to control 0Na–K–Mg rats. Also, compared to 0Na–K–Mg rats, water consumption, urine excretion, urinary sodium excretion urinary potassium excretion (U_NaV), and (U_KV) increased in the other three groups, more so in Na–2K–2Mg rats. These data show that K and Mg have additive effects in preventing an increase in SPI, thus probably preventing the BP increase in RRM rats.     

Rosiglitazone and pioglitazone similarly improve insulin sensitivity and secretion, glucose tolerance and adipocytokines in type 2 diabetic patients

Objective: We examined the effects of rosiglitazone treatment on profiles of adipocytokines levels, postprandial insulin and glucose excursion, lipids levels, comparing with those of pioglitazone treatment in patients with type 2 diabetes mellitus (T2DM). Methods: Changes in body weight, haemoglobin A_1c (HbA_1c), glucose/insulin/C‐peptide/free fatty acid (FFA) during 75 g oral glucose tolerance test (OGTT), HDL‐/LDL‐cholesterol, triglyceride (TG) and adipocytokines [tumour necrosis factor (TNF)‐α, leptin and adiponectin] were measured in T2DM patients treated with rosiglitazone, 8 mg/day (n = 35), or pioglitazone, 45 mg/day (n = 21), for 3 months. Results: After rosiglitazone or pioglitazone treatment, HbA_1c (8.6–7.2 vs. 8.3–6.9%, rosiglitazone vs. pioglitazone), fasting plasma glucose (190–144 vs. 178–140 mg/dl), fasting FFA (729–595 vs. 641–526 μEq/l), mean plasma glucose‐OGTT (292–229 vs. 285–233 mg/dl) and mean FFA‐OGTT (580–430 vs. 488–377 μEq/l) decreased similarly and all were statistically significant (p < 0.01). The insulinogenic index (ΔI_0–120/ΔG_0–120) (0.19–0.30 vs. 0.17–0.26) and Matsuda index of insulin sensitivity (2.0–3.1 and 2.7–4.3) increased (p < 0.01) similarly, despite increase in body weight (85–88 vs. 81–84 kg). TNF‐α (3.8–3.4 vs. 5.2–4.5 pg/ml) decreased (p < 0.05) and adiponectin (6.3–17.8 vs. 7.1–16.4 μg/ml) increased (p < 0.01), while leptin did not change following either treatment. After rosiglitazone treatment, plasma HDL‐cholesterol (34–38 mg/dl) and LDL‐cholesterol (103–120 mg/dl) increased (p < 0.01), while TGs (177–167 mg/dl) did not change significantly. After pioglitazone treatment, plasma HDL‐cholesterol (34–37 mg/dl) increased (p < 0.05), while LDL‐cholesterol (104–105 mg/dl) did not change and TGs (153–106 mg/dl) decreased (p < 0.01). Conclusions: Rosiglitazone and pioglitazone have similar beneficial effects on glycaemic control insulin sensitivity, insulin secretion and plasma adipocytokine levels. However, pioglitazone has a more beneficial effect on the plasma lipid profile than rosiglitazone.     

Successful surgical haemostasis in patients with von Willebrand disease with Koate®DVI

Summary. This report describes our experience with Koate^®DVI, a factor VIII (FVIII) concentrate containing von Willebrand factor (VWF) for surgery in patients with von Willebrand’s disease (VWD). Twenty‐one patients underwent 26 procedures, 10 of which were major and 16 were minor. The median age was 27 years (3–55) and the mean weight was 52 kg (16–88). Among the ten patients (type 2–5; type 3–5) who underwent major procedures, the pre‐operative dose was 35 IU kg^?1 of FVIII followed by 10–20 IU kg^?1 once daily depending on FVIII:C levels. The mean total dose of FVIII used per procedures was 106 IU kg^?1 (30–190) over a mean duration of 7 days (3–11). In this group, pre‐infusion FVIII:C, VWF:Ag and VWF: ristocetin cofactor (RCoF) level that were 19.5% (1–64), 20 U dL^?1 (0–96) and 12% (0–66) increased to 72% (54–198), 131 U dL^?1 (68–206) and 68% (27–108) postinfusion, respectively. Sixteen minor procedures were performed in 11 patients (type 1–3, type 2–6, type 3–2). The preparative dose of FVIII was 10–20 IU kg^?1. The average duration of factor support was 2 days (1–3) for a mean total dose of 23 IU kg^?1 (9–60). The pre‐infusion levels of FVIII:C, VWF:Ag and VWF:ristocetin cofactor (RCo) which were 31% (22–64), 25.5 U dL^?1 (0–63) and 21% (0–76), respectively, increased to 76% (27–111), 73 U dL^?1 (30–137) and 45% (2–106) postinfusion. Whereas surgical haemostasis was achieved in all patients, minor postoperative bleeding occurred after one procedure in each group. Both were controlled with additional doses of factor replacement. We conclude that Koate^®DVI in modest doses provide adequate haemostasis for surgery in patients with VWD.     

Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review

Controversial opinions exist concerning the effect of laparoscopic adjustable gastric banding on gastroesophageal reflux. MEDLINE and EMBASE databases were searched for relevant studies on patients undergoing adjustable gastric banding. Data are expressed in mean (range). Twenty studies were identified with a total of 3307 patients. The prevalence of reflux symptoms decreased postoperatively from 32.9% (16–57) to 7.7% (0–26.9) and medication use from 27.5% (16–38.5) to 9.5% (3.1–19.2). Newly developed reflux symptoms were found in 15% (6.1–20) of the patients. The percentage of esophagitis decreased postoperatively from 33.3% (19.4–61.6) to 27% (2.3–60.8). Newly developed esophagitis was observed in 22.9% (0–38.4). Pathological reflux was found in 55.8% (34.9–77.4) preoperatively and postoperatively in 29.4% (0–41.7) of the patients. Lower esophageal sphincter pressures increased from 12.9 to 16.9 mmHg (11.3–21.4). Lower esophageal sphincter relaxation decreased from 100% to 79.7% (58–86). The percentage of dysmotility increased from 3.5% (0–10) to 12.6% (0–25). Adjustable gastric banding has anti‐reflux properties resulting in resolution or improvement of reflux symptoms, normalized pH monitoring results and a decrease of esophagitis on short term. However, worsening or newly developed reflux symptoms and esophagitis are found in a subset of patients during longer follow‐up.     

Heart rate variability and vibration perception threshold in type 2 diabetes mellitus

The aim of the study was to compare heart rate variability (HRV) and vibration perception threshold (VPT) of patients with type 2 diabetes mellitus (T2DM) with control. The study was conducted on 60 patients with T2DM and 30 controls. The short term HRV and VPT were assessed in the both groups. All the time domain measures, SDNN [26 (15.5–35) vs 36 (30–40.25) ms, P?=?0.002], RMSSD [25.9 (11.95–40.45) vs 36.65 (27.05–44.13) ms, P?=?0.002], and pNN50 [3.5 (0.23–21.83) vs 16.4 (4.45–27.63) %, P?=?0.002] were less in T2DM. Similarly, in frequency domain, low frequency (LF) power [81 (32–148.75) vs 126 (85.25–237.75) ms², P?=?0.007], high frequency (HF) power [81 (16.75–187.75) vs 182.5 (121.50–281.75) ms², P?=?0.001] and HF nu [54.5 (33.2–63.83) vs 59.7 (50–75.05), P?=?0.03] were significantly less in T2DM. Whereas, LF nu [45.25 (35.28–63.93) vs 44.65 (33.7–65.35)] and LF/HF ratio [0.78 (0.54–1.13) vs 0.7 (0.4–1)] were comparable between the groups. In Poincare plot, SD1 [18.5 (8.73–28.98) vs 26.2 (19.33–31.65) ms, P?=?0.003] and SD2 [37 (26.13–51.18) vs 48.6 (39.63–56.15) ms, P?=?0.016] as well as the ratio of SD1/SD2 [0.18 (0.14–0.21) vs 0.29 (0.25–0.33) P?=?0.001] were less in T2DM. However, VPT was comparable between the groups. The patients with T2DM had reduced parasympathetic activity whereas sympathetic activity and vibration (somatic) sensation were similar. It indicates that cardiac parasympathetic activity in T2DM is affected before sympathetic and somatic activity.     

A comparison of a fluorescence enzyme immunoassay versus indirect immunofluorescence for initial screening of connective tissue diseases: Systematic literature review and meta-analysis of diagnostic test accuracy studies

The aim was to compare indirect immunofluorescence (IIF) and fluorescence enzyme immunoassay (FEIA) for initial screening of connective tissue diseases (CTDs) and to evaluate whether combining IIF with FEIA adds value.A comprehensive systematic literature review was conducted to identify fully paired, cross-sectional or case–control studies on ANA screening of CTD reporting results for IIF and FEIA. Study quality was assessed using the QUADAS-2 checklist. The reference standard was assessed against established classification criteria. The meta-analysis used hierarchical, bivariate and mixed-effects models to allow test results to vary within and across studies.Eighteen studies of good to fair quality were included in the review. IIF had a higher sensitivity than FEIA [cut-off 1:160, 7 studies, 3251 patients, 0.83 (95% CI 0.75–0.89) versus 0.73 (95% CI 0.64–0.80); cut-off 1:80, 7 studies, 12,311 patients, 0.89 (95% CI 0.84–0.93) versus 0.78 (95% CI 0.71–0.84)] but lower specificity [1:160, 0.81 (95% CI 0.73–0.87) versus 0.94 (95% CI 0.91–0.95); 1:80, 0.72 (95% CI 0.62–0.81) versus 0.94 (95% CI 0.90–0.96)]. A double-positive test had a higher likelihood ratio (LR) for CTD (26.2 (95% CI 23.0–29.9)) than a single positive test (14.4 (95% CI 13.1–15.9) FEIA+, 5.1 (95% CI 4.8–5.4) IIF+). A double-negative test result had more clinical value for ruling out CTD than a single negative test (LR 0.15 (95% CI 0.12–0.18) versus 0.21 (95% CI 0.18–0.25) IIF; 0.33 (95% CI 0.29–0.37) FEIA-). A FEIA+/IIF- discordant result had a higher LR than an IIF+/FEIA- discordant result (LR 2.4 (95% CI 1.7–3.4) versus 1.4 (95% CI 1.2–1.7)).Because of the comparatively higher specificity of FEIA and higher sensitivity of IIF, the combination of FEIA and IIF increases the diagnostic value. Clinicians should be acquainted with the clinical presentation of CTD and aware of the advantages and disadvantages of FEIA and IIF to avoid misinterpretation.     

Serum alkaline phosphatase,a risk factor for non-alcoholic fatty liver,but only for women in their 30s and 40s: evidence from a large cohort study

Background: Several risk factors are able to predict non-alcoholic fatty liver (NAFL) development, but the predictive value of serum alkaline phosphatase (ALP) remains uncertain. Our aim is to investigate the association between serum ALP levels and NAFL.

Methods: 21,331 NAFL-free subjects were included. Sex-specific ALP quartiles (Q1 to Q4) were defined. With Q1 used as reference, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated across each quartile.

Results: After adjusting for confounding variables, values in Q2, Q3 and Q4 had HRs (95%CIs) of 1.16 (0.94–1.43), 1.38 (1.13–1.69), 1.51 (1.24–1.83) in females and 0.99 (0.90–1.09), 1.04 (0.95–1.14), 0.96 (0.87–1.05) in males, respectively. A subgroup analysis of age factors in females, from Q2 to Q4, adjusted HRs (95%CIs) were 1.31 (0.81–1.99), 1.86 (1.23–2.81), 2.44 (1.60–3.71) in their 30 s, 1.13 (0.83–1.54), 1.17 (0.85–1.62), 1.65 (1.22–2.25) in their 40 s, and 0.95 (0.51–1.78), 0.91 (0.52–1.62), 0.89 (0.53–1.52) in their 50 s.

Conclusions: Higher serum ALP levels are considered a significant predictor for NAFL development in females aged 30 to 50.     

High prevalence of metabolic syndrome among urban subjects in India: A multisite study

ObjectiveMetabolic syndrome is an important cardiovascular risk factor. To determine its prevalence among urban subjects in India we performed a multisite study.MethodsThe study was performed at eleven cities using cluster sampling. 6198 subjects (men 3426, women 2772, response 62%, age 48 ± 10 years) were evaluated for socio-demographic, lifestyle, anthropometric and biochemical factors. Prevalence of metabolic syndrome was determined using harmonized Asian-specific criteria. Significant socioeconomic and lifestyle associations were determined.ResultsAge adjusted prevalence (%, 95% confidence intervals) of metabolic syndrome in men and women was 33.3 (31.7–34.9) and 40.4 (38.6–42.2) (harmonized criteria), 23.9 (22.4–26.4) and 34.5 (32.0–36.1) (modified Adult Treatment Panel-3, ATP-3) and 17.2 (15.3–19.1) and 22.8 (20.1–24.2) (ATP-3). Individual components of metabolic syndrome in men and women, respectively, were: high waist circumference 35.7 (34.1–37.3) and 57.5 (55.6–59.3), high blood pressure 50.6 (48.9–52.3) and 46.3 (44.4–48.1), impaired fasting glucose/diabetes 29.0 (27.5–30.5) and 28.0 (26.3–29.7), low HDL cholesterol 34.1 (32.5–35.7) and 52.8 (50.9–54.7) and high triglycerides 41.2 (39.5–42.8) and 31.5 (29.7–33.2) percent. Prevalence of metabolic syndrome was significantly greater in subjects with highest vs. lowest categories of education (45 vs. 26%), occupation (46 vs. 40%), fat intake (52 vs. 45%), sedentary lifestyle (47 vs. 38%) and body mass index (66 vs. 29%) (p < 0.05).ConclusionThere is high prevalence of metabolic syndrome in urban Indian subjects. Socioeconomic (high educational and occupational status) and lifestyle (high fat diet, low physical activity, overweight and obesity) factors are important.     

Changing patient population in Dhaka Hospital and Matlab Hospital of icddr,b

The Diarrhoeal Disease Surveillance System of icddr,b noted increasing number of patients ≥60 years at urban Dhaka and rural Matlab from 2001 to 2012. Shigella and Vibrio cholerae were more frequently isolated from elderly people than children under 5 years and adults aged 5–59 in both areas. The resistance observed to various drugs of Shigella in Dhaka and Matlab was trimethoprim–sulphamethoxazole (72–63%), ampicillin (43–55%), nalidixic acid (58–61%), mecillinam (12–9%), azithromycin (13–0%), ciprofloxacin (11–13%) and ceftriaxone (11–0%). Vibrio cholerae isolated in Dhaka and Matlab was resistant to trimethoprim–sulphamethoxazole (98–94%) , furazolidone (100%), erythromycin (71–53%), tetracycline (46–44%), ciprofloxacin (3–10%) and azithromycin (3–0%).     

Does my patient really need this at admission? Seven opportunities for improving value in patient care during their hospitalization

IntroductionBesides the main treatment for their disease, hospital patients receive multiple care measures which include venous lines (VL), urinary catheters (UC), dietary restrictions (DR), mandatory bed rest (BR), deep venous thrombosis prophylaxis (VTP), stress ulcer prophylaxis (SUP) and anticoagulation bridge therapy for atrial fibrillation (BAF). In many cases these practices are of low value.MethodsWe analysed patients admitted to Internal Medicine wards throughout 2018 (2714 inpatients). We used different methodologies to identify low-value clinical practices.ResultsBR or DR at admission were recommended in 37% (32–44) and 24% (19–30) of the patients respectively. In 81% (71–87) and 33% (21–45) of the cases this restriction was deemed unnecessary. Ninety-six percent (92–98) had VL and 25% (19–32) UC. VL were not used in 10% (6–12), UC had no indications for insertion in 21% (11–35) and for maintenance in 31% (12–46) patients. Fifty-seven percent (49–64) of the patients were administered VTP and 69% (62–76) were prescribed SUP. Twenty-two percent (15–31) of patients with VTP and 52% (43–60) with SUP had no indication. Chronic anticoagulation for AF was interrupted in 65% (53–75) with BAF was prescribed in 38% (25–52) of them.An intervention to reduce low-value care supporting clinical practices addressed only to the Internal Medicine Wards showed very poor results.ConclusionThese results demonstrate that there is ample room for reduction of low-value care. Interventions to implement clinical guidelines at admissions should be addressed to cover the entire admission process, from the emergency room to the ward. Partial approaches are discouraged.     

Impact of glucose tolerance status on the development of coronary artery disease among working-age men

AimsTo examine the impact of glucose tolerance status on the development of coronary artery disease (CAD) in working-age men in Japan.MethodsThis population-based retrospective cohort study included 111,621 men aged 31–60 years [63,558 with normal glucose tolerance (NGT); 37,126 with prediabetes; 10,937 with diabetes]. The Cox proportional-hazards regression model was used to identify variables related to the incidence of CAD.ResultsMultivariate analysis showed that, compared with NGT, diabetes increased the risk of CAD by 17.3 times (95% CI: 6.36–47.0) at ages 31–40 years, by 2.74 times (95% CI: 1.85–4.05) at ages 41–50 years and by 2.47 times (95% CI: 1.69–3.59) at ages 51–60 years. The HRs for CAD in men with diabetes aged 31–40 equaled that of men with NGT aged 51–60 [18.2 (7.15–46.4) and 19.4 (8.28–45.4), respectively].ConclusionThe impact of diabetes on CAD was markedly greater in men aged 31–40 years compared with those aged 41–60 years.     

A cross-sectional study assessing the pharyngeal carriage of Neisseria meningitidis in subjects aged 1–24 years in the city of Embu das Artes,São Paulo,Brazil

Meningococcal carriage is a prerequisite for invasive infection. This cross-sectional study assessed the pharyngeal carriage prevalence in healthy subjects aged 1–24 years in Embu das Artes city, São Paulo, Brazil. Pharyngeal swabs were examined for the presence of Neisseria meningitidis. The isolates were tested for different serogroups using agglutination and polymerase chain reaction. A logistic regression model assessed any independent association between Neisseria meningitidis carriage and various risk factors. A total of 87/967 subjects (9%, 95% Confidence Interval (CI): 7.3–11.0) tested positive for N. meningitidis: 6.2% (95% CI: 3.8–9.4) in 1–4 years, 8.5% (95% CI: 5.1–13.0) in 5–9 years, 12.5% (95% CI: 7.8–18.6) in 10–14 years, 12.6% (95% CI: 7.4–19.7) in 15–19 years and 9% (95% CI: 4.9–14.9) in 20–24 years age groups. Highest carriage prevalence was observed in adolescents 10–19 years old. Serogroup C was predominant (18.4%) followed by serogroup B (12.6%). The 15–19 years age group showed a significant association between number of household members and carriers of N. meningitidis. This cross-sectional study is the first in Brazil to evaluate meningococcal carriage prevalence and associated factors in a wide age range.     

Prevalence of QT Prolongation in a Type 1 Diabetic Population and Its Association with Autonomic Neuropathy

The prevalence of QT prolongation in a large random sample of Type 1 diabetic patients in Piemonte, Italy and its association with autonomic neuropathy were assessed. Three hundred and seventy-nine Type 1 diabetic patients (age 15–59) with (94, DAN+) and without (280, DAN-) autonomic neuropathy and 118 non-diabetic control subjects participated in the study. QT interval was measured on an ECG recorded at rest and QTc calculated according to Bazett's formula. QTc was greater than 0.440 s in 7.6% (95% CI 2.9–12.3) of control subjects, 25.6% (21.0–30.0) of diabetic patients, 30.8% (21.5–40.1) of DAN+, 23.9% (18.9–28.9) of DAN-. QTc was greater than 0.460 s (mean + 2SD of QTc in control subjects) in 11.7% (8.5–14.9) of diabetic patients, 18.1% (10.3–25.9) of DAN+, 9.6% (6.2–13.0) of DAN-. QT was above the 95% upper limit for the control subjects in the plot of measured QT against RR interval in 21.4% (17.3–25.5) of diabetic patients, 26.6% (17.7–35.5) of DAN+, 19.3% (14.7–23.9) of DAN-. No correlation was found between QT interval and age or disease duration. The prevalence of QT prolongation was higher in diabetic patients than in control subjects and in DAN+ than in DAN-.     

Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines

We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2–3.0), 55–64 years (AOR: 1.6, 95% CI: 1.4–1.9), and 45–54 years (AOR: 1.4, 95% CI: 1.3–1.6) age groups, females (AOR: 2.0, 95% CI: 1.7–2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0–2.8), diabetes (AOR: 1.4, 95% CI: 1.2–1.6), secondary (AOR: 1.2, 95% CI: 1.1–1.4), or college education level (AOR: 1.8, 95% CI: 1.4–2.3), middle (AOR: 1.3, 95% CI: 1.1–1.6), richer (AOR: 1.5, 95% CI: 1.2–1.8) or richest (AOR: 2.0, 95% CI: 1.6–2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2–1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3–2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.     

Associations of serum urea, creatinine and uric acid with clinical and laboratory features in patients with systemic lupus erythematosus

The aim of this study is to investigate the associations of serum urea, creatinine and uric acid levels with clinical and laboratory characteristics, independent of lupus renal involvement in SLE patients. A total of 191 SLE patients were included in the present study. Some clinical and laboratory characteristics of the patients were obtained by medical record review. The results showed that serum urea, creatinine and uric acid levels seemed to be associated with several clinical and laboratory characteristics of SLE. However, multivariate logistical regression analysis indicated that increasing serum urea levels were positively associated with disease duration and thrombocytopenia, but negatively with arthritis and skin rash. Compared with quartile 1 of urea, the ORs of quartile 2, quartile 3 and quartile 4 were, respectively, 1.008 (0.997–1.015, P?=?0.189), 1.010 (1.001–1.019, P?=?0.038) and 1.014 (1.004–1.024, P?=?0.008) with increasing disease duration; 1.912 (0.516–7.088, P?=?0.332), 10.126 (2.771–36.997, P?=?0.000) and 5.583 (1.285–24.266, P?=?0.022) with thrombocytopenia; 0.864 (0.331–2.254, P?=?0.765), 0.516 (0.18–1.475, P?=?0.217) and 0.162 (0.047–0.557, P?=?0.004) with arthritis; and 0.342 (0.135–0.868, P?=?0.024), 0.215 (0.074–0.622, P?=?0.005) and 0.332 (0.097–1.13, P?=?0.078) with skin rash. Increasing serum creatinine levels were positively associated with sex, disease duration and SLEDAI, but negatively with skin rash. Compared with quartile 1 of creatinine, the ORs of quartile 2, quartile 3 and quartile 4 were, respectively, 2.993 (0.282–31.74, P?=?0.363), 7.937 (0.861–73.18, P?=?0.068) and 13.411 (1.32–36.246, P?=?0.028) with male, 1.011 (1.002–1.02, P?=?0.017), 1.002 (0.991–1.013, P?=?0.684) and 1.018 (1.008–1.028, P?=?0.001) with increasing disease duration; 1.112 (1.006–1.228, P?=?0.038), 1.065 (0.959–1.183, P?=?0.239) and 1.140 (1.022–1.272, P?=?0.019) with increasing SLEDAI; and 0.303 (0.119–0.771, P?=?0.012), 0.282 (0.104–0.76, P?=?0.012) and 0.174 (0.052–0.584, P?=?0.005) with skin rash. Increasing serum uric acid levels were only positively associated with erythrocytopenia. Compared with quartile 1 of uric acid, the ORs of quartile 2, quartile 3 and quartile 4 were, respectively, 0.910 (0.37–2.239, P?=?0.837), 2.147 (0.901–5.116, P?=?0.085) and 3.079 (1.211–7.828, P?=?0.018) with erythrocytopenia. The present study demonstrated that, except for reflecting renal function, serum urea, creatinine and uric acid exert separate clinical significances in SLE.     

Mortality and causes of death in patients with inflammatory bowel disease: A nationwide register study in Finland

Background and aimIncreased mortality has been reported in Crohn's disease (CD) but mostly not in ulcerative colitis (UC). We evaluated the overall and cause-specific mortality in a nationwide cohort of patients with inflammatory bowel disease (IBD) in Finland.MethodsA total of 21,964 patients with IBD (16,649 with UC and 5315 with CD) from the Special Reimbursement register were diagnosed 1987–1993 and 2000–2007 and followed up to the end of 2010 by collating these figures with the national computerized Cause-of-Death Register of Statistics Finland. In each cause-of-death category, the number of deaths reported was compared to that expected in general population, and expressed as a standardized mortality ratio (SMR).ResultsOverall mortality was increased among patients with CD (SMR 1.33, 95% confidence interval 1.21–1.46) and UC (1.10, 1.05–1.15). SMR was significantly increased for gastrointestinal causes in CD (6.53, 4.91–8.52) and UC (2.81, 2.32–3.34). Patients with UC were found also to have increased SMR from pulmonary (1.24, 1.02–1.46) and cardiovascular disease (1.14, 1.06–1.22) and cancers of the colon (1.90, 1.38–2.55), rectum (1.79, 1.14–2.69) and biliary tract (5.65, 3.54–8.54), whereas SMR from alcohol-related deaths was decreased (0.54, 0.39–0.71). Patients with CD had a significantly increased SMR for pulmonary diseases (2.01, 1.39–2.80), infections (4.27, 2.13–7.63) and cancers of the biliary tract (4.51, 1.23–11.5) and lymphoid and hematopoietic tissue (2.95, 1.85–4.45).ConclusionsIn this Finnish nationwide study increased overall mortality in both CD and UC was observed. The excess mortality of 14 % in IBD is mainly due to deaths related to inflammation in the gut.     

Antisense oligonucleotides,a novel tool for the control of cytokine effects on human cartilage. focus on interleukins 1 and 6 and proteoglycan synthesis

Objective. To prevent the negative effects of interleukin–1 (IL–1) and IL–1—induced IL–6 on cartilage proteoglycan (PG) synthesis, we used an antisense oligonucleotide (ASO) specific for IL–6 messenger RNA (mRNA) to inhibit IL–6 production. Methods. Explants of human articular cartilage were cultured in the presence or absence of IL–6—ASO, IL–1, and exogenous IL–6. As metabolic parameters, cartilage production of IL–6 was determined in the B9 bioassay and PG as incorporation of ³⁵SO₄. Results. The IL–6—ASO prevented IL–1—induced production of IL–6 in the cartilage explants, as well as IL–1—induced inhibition of PG synthesis. This inhibition was restored, despite the presence of IL–6—ASO, when exogenous IL–6 was added. A control ASO (not specific for IL–6 mRNA) was not effective. Conclusion. The IL–6—ASO used can penetrate the extracellular matrix of articular cartilage, enter the chondrocytes, and inhibit the IL–1—induced production of IL–6. Furthermore, IL–6—ASO can prevent the IL–1—induced inhibition of cartilage PG synthesis. The effect of exogenous IL–6 shows that IL–1 requires IL–6 for inhibition of PG synthesis.