Increased levels of C‐reactive protein and interleukin‐6 in hyperhomocysteinemic subjects

Objective. Elevated plasma homocysteine concentration is considered to be an independent risk factor for cardiovascular disease. However, the mechanisms by which hyperhomocysteinemia are related to vascular disease are unclear. High‐sensitivity C‐reactive protein (CRP), a marker of inflammation, has been reported to be an independent predictor of future myocardial infarction among clinically healthy individuals. Interleukin (IL)‐6 is a regulator of CRP and has a key role in initiation of inflammation. The aim of this study was to investigate whether individuals with increased plasma homocysteine concentrations have altered levels of serum CRP and IL‐6. Material and methods. Serum concentrations of CRP and IL‐6 were measured in 39 individuals with hyperhomocysteinemia and in 39 control subjects matched for gender, age and body mass index (BMI). In addition, the inflammatory effect of IL‐6 on peripheral blood mononuclear cells was measured. Results. Compared to controls, hyperhomocysteinemic subjects have elevated serum levels of CRP and IL‐6 (p?0.001 and p<0.005, respectively). Importantly, this raised level of IL‐6 was also seen in hyperhomocysteinemic individuals without accompanying hypercholesterolemia or cardiovascular disease. IL‐6 increased the release of monocyte chemoattractant protein‐1 from peripheral blood mononuclear cells, with particularly enhancing effects in cells from patients with hyperhomocysteinemia. Conclusions. These data suggest that enhanced inflammation may be associated with homocysteine‐related cardiovascular disease, possibly involving IL‐6‐related mechanisms.     

Are Antiepileptic Drugs Used in the Treatment of Migraine Associated with an Increased Risk of Suicidality?

Three antiepileptic drugs (AEDs), valproic acid, gabapentin, and topiramate (TPM), are used frequently in the prophylactic treatment of migraines. In December 2008, the US Food and Drug Administration issued a warning suggesting that the use of all AEDs is associated with an increased risk of suicidal ideation and behavior. This warning has been received by the medical community with great skepticism, and the validity of the findings of the meta-analysis that led to its publication has been questioned because of various methodological problems. Yet, migraine by itself is associated with an increased risk of suicidal ideation and behavior as well as with an increased risk of psychiatric disorders that facilitate the development of suicidal behavior. Furthermore, TPM has been associated with psychiatric adverse events that potentially could result in suicidal ideation and behavior. In this article, we review data to determine whether the AEDs used in the prevention of migraine are associated with an increased risk of suicidality.     

Tissue inhibitor of metalloproteinase‐1 levels in plasma from tumour arteries and veins of patients with rectal cancer

Objective. Tissue inhibitor of metalloproteinase‐1 (TIMP‐1) plays a major role in the regulation of tissue growth, including cancer growth. The TIMP‐1 protein can be determined in plasma, and increased plasma levels of TIMP‐1 are associated with a poor prognosis of colorectal cancer patients. The aim of the present study was to evaluate whether tumour tissue release of the TIMP‐1 protein contributes to the increased plasma levels of TIMP‐1 observed in patients with colorectal cancer. Material and methods. Preoperative blood samples from a peripheral vein and intraoperative blood samples from a tumour artery, a tumour vein and from a peripheral vein were drawn from 24 patients undergoing elective, intended curative surgery for primary rectal cancer. TIMP‐1 levels were determined concurrently in plasma from all samples using a validated ELISA method. Counts of white blood cells and platelets were also carried out. Results. No significant differences between plasma TIMP‐1 levels could be demonstrated in any compartment. In particular, there was no significant difference in TIMP‐1 levels in plasma from tumour arteries and tumour veins. However, there was a significant decrease in neutrophil cell counts from tumour arteries to tumour veins (p<0.001). Conclusions. The present results do not support the current hypothesis that tumour cells contribute substantially to increased plasma TIMP‐1 levels observed in patients with colorectal cancer.     

Haemoglobin,C‐reactive protein and androgen levels in uncomplicated and complicated pregnancies of women with polycystic ovary syndrome

Objective. We studied a possible association between pregnancy complications and blood/serum levels of haemoglobin, C‐reactive protein, sex hormones and lipids in women with polycystic ovary syndrome. Material and methods. Twenty‐one women with polycystic ovary syndrome were followed prospectively from the first trimester to delivery. Women with pregnancy complications (n = 10) were compared to women without complications (n = 11). Outcome measures were blood/serum levels of haemoglobin, C‐reactive protein, dehydroepiandrosterone sulphate, androstenedione, testosterone, sex hormone binding globulin, free testosterone index, oestrogens and lipids. Results. Haemoglobin levels were higher in complicated pregnancies compared to uncomplicated pregnancies throughout the complete pregnancy, while C‐reactive protein levels were higher for complicated pregnancies at gestational weeks 19 and 32. Serum levels of lipids, androgens and oestrogens did not differ throughout pregnancy. Conclusion. In women suffering from polycystic ovary syndrome, pregnancy complications were associated with elevated blood/serum levels of haemoglobin and C‐reactive protein. Androgen, oestrogen and lipid levels did not differ between groups.     

Does initiation of an ambulance pre‐alert call reduce the door to needle time in acute myocardial infarct?

Objectives

To assess the effect an ambulance pre‐alert call for patients with suspected acute myocardial infarction (AMI) would have on door to needle (DTN) times.

Methods

We carried out back to back audits of DTN times following the initiation of the pre‐alert calls.

Participants

All patients thrombolysed within the emergency department between July 2003 and April 2004 (inclusive).

Statistical analysis

Mean DTN times and time to ECG pre‐change and post‐change were compared using the Two sample t test. The Fisher''s exact test was used to compare pre‐change and post‐change proportions of patients seen within guideline times.

Results

In total, 73 patients were thrombolysed with 40 of these arriving by ambulance. Eighteen of these 40 were pre‐change and 22 were post‐change. Four patients were excluded. Fifty per cent of the pre‐change group had a DTN time of <30 minutes compared with 91% of the post‐change group (p = 0.005, Fisher''s exact test). The phase one mean DTN time was found to be significantly greater than that for phase two (Two sample t test, p = 0.016; 95% CI 1.6 to 14.6).

Conclusions

There was a significant reduction in DTN times after the introduction of the pre‐alert call.     

High levels of education are associated with an increased risk of latent autoimmune diabetes in adults: results from the Nord-Trøndelag health study

OBJECTIVE

To investigate whether the risk for autoimmune diabetes in adults differs between socioeconomic groups and to compare such risk with that for type 2 diabetes.

RESEARCH DESIGN AND METHODS

The inhabitants of the Norwegian county of Nord-Trøndelag were investigated by questionnaires and clinical examinations on three occasions during 1984–2008. We used information from a subset consisting of 56,296 subjects (participating in at least two surveys), including 122 incident cases of autoimmune diabetes in adults (aged ≥35 and anti-GAD positive) and 1,555 cases of type 2 diabetes (aged ≥35 and anti-GAD negative). Hazard ratios (HRs) of diabetes associated with self-reported education and occupation were estimated by Cox proportional hazards models.

RESULTS

High levels of education (university versus primary school) were associated with an increased risk of autoimmune diabetes (HR 1.98 [95% CI 1.21–3.26]), after adjustment for BMI, lifestyle factors, and family history of diabetes. Case subjects with high levels of education had lower levels of C-peptide, tended to have higher levels of anti-GAD, and were more often treated with insulin. Conversely, these subjects had a reduced risk of type 2 diabetes (HR 0.69 [95% CI 0.57–0.82]), a risk that was partly explained by lower BMI and more physical activity (adjusted HR 0.89 [95% CI 0.74–1.06]).

CONCLUSIONS

High levels of education are associated with an increased risk of autoimmune diabetes in adults, a finding that may be mediated by effects on autoimmune activity. Because the association is not explained by traditional risk factors, other, currently unidentified, environmental factors are likely to be involved.There is some evidence indicating that socioeconomic conditions during early life can affect the incidence of autoimmune diabetes. Lower rates of childhood diabetes have been reported in more materially deprived areas, and children in families with a high socioeconomic position seem more prone to develop type 1 diabetes (1–3). It has been hypothesized that these associations result from differences in environmental factors, such as feeding patterns, hygiene standards, and lack of infections in early life, conditions that may affect the immune system and trigger an autoimmune reaction (4,5). Whether socioeconomic factors associate with autoimmune diabetes that develops at adult age is, however, not known. Contrasting with data on childhood type 1 diabetes, the risk of developing type 2 diabetes is more pronounced in lower socioeconomic groups (6–8). This association can be explained, at least in part, by traditional risk factors such as overweight and physical inactivity (9).Autoimmune diabetes in adults comprises latent autoimmune diabetes in adults (LADA) as well as “classical” type 1 diabetes. Autoimmunity is indicated by the presence of antibodies against β-cell–associated antigens, such as GAD (10). LADA is by far the most common form of adult-onset autoimmune diabetes and is estimated to account for 2–12% of all diabetes cases (11). As indicated by the name, onset of LADA is slower than type 1 diabetes, and insulin treatment is typically not required at the time of diagnoses. Even though it is characterized by autoimmunity, LADA patients also display features of type 2 diabetes with risk associations to being overweight and physical inactivity (12).The aim of this study was to investigate whether the risk of developing autoimmune diabetes in adults differs between socioeconomic groups and to compare such risk with that for type 2 diabetes. Furthermore, we aimed to analyze whether evidence could be found for a role of autoimmunity and whether associations found could be explained by traditional risk factors for type 2 diabetes, such as family history of diabetes, being overweight, physical inactivity, or smoking.     

Increased levels of BPI-ANCA in patients with primary Sjögren’s syndrome are associated with lung involvement

BackgroundThe goal of this study was to investigate the association between bactericidal permeability increasing (BPI)-antineutrophil cytoplasmic antibody (ANCA) protein levels and primary Sjogren's syndrome (pSS) with lung involvement, as well as the potential diagnostic performance of BPI-ANCA.MethodsThe levels of BPI-ANCA in pSS patients with (n = 36) and without (n = 85) lung involvement were measured using a commercial ELISA kit. Serological biomarkers and cytokines were measured in these patients as well. Lung involvement was determined by high-resolution computed tomography (HRCT) and/or clinical symptoms. The diagnostic performance of lung involvement was determined by receiver operating characteristic (ROC) curves.ResultsThe percentage of neutrophils (NEUT%), neutrophil–lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), and the levels of BPI-ANCA, C-reactive protein (CRP), interleukin-2 (IL-2) and IL-6 exhibited an upward trend, while the percentage of lymphocytes (LYMP%) and albumin (ALB) level exhibited a downward trend in the lung involvement group. The combination of BPI-ANCA, NEUT% and ALB significantly increased the area under the ROC curve (AUC) to 0.837 (95% confidence interval: 0.742–0.907, sensitivity: 82.14%, specificity: 81.36%, P < 0.001).ConclusionsIncreased BPI-ANCA was found in pSS patients with lung involvement and was associated with inflammation. A combination of BPI-ANCA, NEUT% and ALB had the best AUC, and may serve as an adjunct to distinguish between pSS patients with and without lung involvement.     

Seemingly healthy 71‐year‐old men with minor elevations of cardiac troponin I and at risk of premature death in CVD have elevated levels of NT‐proBNP: Report from the ULSAM study

Background. Hypersensitive cardiac troponin I (cTnI) assays detect even minor elevations of cTnI. Previous findings identifying a group of seemingly healthy elderly men with very minor elevations of cTnI have shown that these men were at risk of premature cardiovascular death. Objectives. To study the association between cTnI concentrations and cardiovascular risk factors and subclinical cardiac and renal target organ damage in a community‐based sample of elderly men. Methods. Biomarkers reflecting glucose and lipid metabolism, renal function, cardiac function and inflammation were measured in the ULSAM study (n = 1205, mean age 71 years). The participants were placed in three subgroups based on the cTnI concentrations: a low group with cTnI <0.02?µg/L, an intermediate group with cTnI between 0.02 and 0.039?µg/L and a high group with cTnI >0.039?µg/L. Results. In the entire cohort of 71‐year‐old men, most markers of glucose and lipid metabolism, renal function, inflammation and NT‐proBNP were significantly related to the concentrations of cTnI, and most obviously in the high‐cTnI group. In subjects with no signs of CVD (cardiovascular disease), only levels of NT‐proBNP related to cTnI, and with the highest NT‐proBNP levels in the high‐cTnI group (p<0.01). A multiple regression analysis showed that NT‐proBNP was independently related to cTnI (p<0.001). Conclusions. Measurement of cardiac troponins with highly sensitive assays identifies those at risk of premature CVD death who have hitherto remained unrecognized. The associated elevations of NT‐proBNP in these participants support the fact that these elevations reflect ongoing pathological processes in the myocardium.     

Sustained postprandial decrease in plasma levels of LDL cholesterol in patients with type‐2 diabetes mellitus

Objective. Low density lipoprotein cholesterol (LDL‐C) is an independent and modifiable risk factor for development of cardiovascular disease (CVD). Postprandial lipid metabolism has been linked to CVD, but little is known about the postprandial LDL‐C profile in patients with type‐2 diabetes (T2DM). We aimed to study the postprandial levels of LDL‐C in T2DM patients. Material and methods. After an overnight fast, 74 T2DM patients, mean age approximately 60 years, were served a standard fat‐rich meal of 3,515 kJ containing 54?% fat, 13?% protein and 33?% carbohydrates. Only drinking water was allowed postprandially. Blood samples were drawn at times 0 (fasting), 1.5, 3.0, 4.5 and 6.0?h (postprandial). In all samples, LDL‐C was measured with modified beta quantification (separation by ultracentrifugation followed by measurement of infranate high density lipoprotein cholesterol (HLD‐C) using a homogeneous assay). Results. At all postprandial times, levels of LDL‐C showed highly significant (p<0.005) decreases compared to time 0 (mean [95?% CI] maximum change in LDL‐C levels at 3.0?h: ?0.16?mmol/L [?0.12; ?0.20]; p<0.001). Independently of fasting LDL‐C levels and ongoing statin therapy, LDL‐C decreased significantly more in female compared to male patients postprandially (mean [95?% CI] maximum unadjusted change versus time 0 in LDL‐C for men [n = 56] at 3.0?h: ?0.14?mmol/L [?0.19; ?0.10], p<0.001; for women [n = 18] at 4.5?h: ?0.26?mmol/L [?0.35; ?0.18], p<0.001; ?0.14?mmol/L [?0.24; ?0.05], p = 0.005 between genders for the mean [95?% CI] fasting adjusted difference at 4.5?h in the change versus time 0 in LDL‐C; gender by time interaction: p = 0.007 (repeated measures mixed model)). Conclusions. In T2DM patients served a fat‐rich meal, levels of LDL‐C decreased significantly more in women compared to men postprandially, irrespective of fasting levels or ongoing statin therapy. This might have implications in the atherosclerotic process and on any difference in the risk of CVD between genders.     

Lowered levels of serum albumin and HDL‐cholesterol in children with a recent mild infection

BACKGROUND. Infections are associated with atherogenic changes in serum.

AIM. To elucidate effects of recent infections on risk factors for coronary heart disease in children.

SUBJECTS AND METHODS. In 1983 and again 3 years later, 2458 individuals aged 9, 12, 15, 18 and 21 years were investigated. In 1986, 106 subjects had symptoms of infection during the past 2 weeks before their follow‐up visit. Their serum albumin and lipid concentrations were compared to those in 1983 when these individuals probably were healthy. An age‐ and sex‐matched healthy control group from the cohort 1986 was chosen for comparison. For cholesterol age, sex and body mass index specific Z‐scores in addition to actual values were used in statistical comparisons.

RESULTS. Serum albumin was 42?g/L in subjects with positive history of infection and 46?g/L in healthy controls (P<0.0001). HDL‐cholesterol and the ratio of HDL‐ to total cholesterol were lower with increasing evidence of infection. Elevated serum C‐reactive protein (CRP) or orosomucoid grouped the subjects with high and low serum HDL‐cholesterol concentrations better than history of infection alone.

CONCLUSION. A mild infection lowers serum HDL‐cholesterol and serum albumin concentrations, which both favour atherogenesis.     

Evolution of an Innovative Approach to the Delivery of In‐Person Training in the Responsible Conduct of Research

The responsible conduct of research (RCR) Center is an innovative, workshop‐based approach to research ethics education at the University of Pittsburgh. A flexibly scheduled program of workshops combines the benefits of traditional case–based discussion and in‐person instruction with greater accessibility and a broader disciplinary reach. Essential features of the program include a rotating schedule of independent workshops with separate registration, expert speakers, and a dedicated program director position. At an institutional level, this novel response to National Institutes of Health‐mandated training requirements increases access to a wide range of interactive RCR training programs and promotes interdisciplinary conversations on research ethics that involves investigators, trainees, and the research community at large.     

Is eclampsia preventable? A case control review of consecutive cases from an urban underserved region

OBJECTIVES: The purpose of this study was to determine whether eclampsia is potentially preventable. METHODS: This was a retrospective case control study comparing 25 cases of eclampsia, 33 cases of preeclampsia and 50 pregnant controls. Eclampsia cases were classified as follows: group A was potentially preventable by patient education if there were preeclamptic symptoms before presenting to the hospital; group B was potentially preventable by health care provider if patient presented to health care with evidence of preeclampsia and was not appropriately treated; group C was not preventable if eclampsia developed without symptoms or preeclampsia. Statistical analysis was done as applicable. RESULTS: The mean gestational age at seizure was 34 weeks; 50% of seizures occurred outside a hospital and 44% had multiple seizures. Twenty were antepartum, three intrapartum, and two postpartum. Fourteen (56%) cases were classified as group A, 4 (16%) as group B and 7 (28%) as group C. Compared to controls, African-Americans, nulliparity, premature delivery, and increased neonatal morbidity were significantly associated with eclampsia. Compared with preeclamptics, eclamptic subjects had more symptomatology and more adverse maternal complications. CONCLUSIONS: In this underserved population, a significant percentage of eclampsia cases are potentially preventable by patient education or health care response. In a smaller percentage, eclampsia may develop without any symptomatology or preeclampsia.     

Increased serum levels of β₂-GPI-Lp(a) complexes and their association with premature atherosclerosis in patients with rheumatoid arthritis

BackgroundOur recent study found the existence of complexes of β₂-glycoprotein I (β₂-GPI) with lipoprotein(a)[Lp(a)] in circulation and the complex concentrations were increased in sera of systemic lupus erythematosus patients. The concentration of β₂-GPI-Lp(a) and its relationship with premature atherosclerosis were evaluated in rheumatoid arthritis (RA) patients.MethodsSerum concentrations of β₂-GPI-Lp(a) were measured in 53 active RA patients and 40 healthy controls by a “sandwich” ELISA. β₂-GPI-ox-LDL, ox-Lp(a), ox-LDL and anti-β₂-GPI were also measured by ELISAs. In addition, inflammatory markers were examined.ResultsSerum β₂-GPI-Lp(a) (1.12 ± 0.25 U/ml vs. 0.87 ± 0.19 U/ml, P < 0.0001) and β₂-GPI-ox-LDL (1.01 ± 0.20 U/ml vs. 0.80 ± 0.08 U/ml, P < 0.0001) concentrations in RA were both significantly higher than those of controls. Ox-Lp(a) (8.38 ± 6.69 mg/l vs. 5.49 ± 4.31 mg/l, P < 0.05) and ox-LDL (0.68 ± 0.65 mg/l vs. 0.37 ± 0.13 mg/l, P = 0.001) were also higher in RA than in controls. The area under the ROC curve (AUC) for β₂-GPI-Lp(a) (0.787) was larger than for ox-Lp(a) (0.731). AUC of β₂-GPI-ox-LDL (0.858) was also larger than for ox-LDL (0.785). β₂-GPI-Lp(a) and β₂-GPI-ox-LDL were positively correlated with ox-Lp(a), ox-LDL and CRP, respectively.Conclusionsβ₂-GPI-Lp(a) complex concentrations increased in active RA. Inflammation and oxidative stress in RA contribute to the increase of ox-Lp(a) and subsequently the formation of β₂-GPI-Lp(a).     

Circulating oxidized LDL is associated with the occurrence of echolucent plaques in the carotid artery in 61‐year‐old men

Objective. The aim of this study was to elucidate the relationship between the echogenicity of carotid artery plaques and the following risk factors: circulating oxLDL, hsCRP, the metabolic syndrome (MetS), and several of the traditional cardiovascular (CV) risk factors. Material and methods. A cross‐sectional population‐based study of 513 sixty‐one‐year‐old men. The levels of circulating oxLDL were determined in plasma samples by sandwich ELISA utilizing a specific murine monoclonal antibody (mAb‐4E6). High‐sensitivity CRP was measured in plasma by ELISA. Plaque occurrence, size and echogenicity were evaluated from B‐mode ultrasound registrations in the carotid arteries. Plaque echogenicity was assessed based on a four‐graded classification scale. Results. A higher frequency of echolucent carotid plaques was observed with increasing levels of oxLDL and systolic blood pressure (p = 0.008 and p = 0.041, respectively). Subjects with the MetS had a significantly higher frequency of echogenic plaques than subjects without the MetS (p = 0.009). In a multiple logistic regression analysis, oxLDL turned out to be independently associated with echolucent carotid plaques. Conclusions. The occurrence of echolucent carotid plaques was associated with oxLDL and systolic blood pressure, and oxLDL was associated with echolucent carotid plaques independently of systolic blood pressure.     

Quality of life in women with HIV/AIDS in a municipality in the state of São Paulo

High potency antiretroviral therapy brings benefits to people with HIV/AIDS, related to survival, chronicity and quality of life. The objective of this quantitative and cross-sectional study was to assess the quality of life of women with HIV/AIDS, using the WHOQOL--HIV bref and its association with sociodemographic variables. The study was performed in outpatient clinics specialized in care to HIV/AIDS patients. Of the 106 interviewed women, 99.1% were heterosexual and 92.4% were infected sexually. Among the domains of quality of life, spirituality had the highest score (65.7), followed by physical (64.7), psychological (60.6), social relationships (59.5). Level of independence (58.6) and environment (54.5) scored the lowest. The factors low socioeconomic and educational levels were associated with different domains of quality of life, showing the relationship between quality of life and living conditions. Challenges persist in the scope of social, affective and financial relations, which require effective interventions regarding empowerment of women with HIV/AIDS.     

Inequalities in the early treatment of women and men with acute chest pain?

Purpose

The aim of this study was to identify sex differences in the early chain of care for patients with chest pain.

Design

This is a retrospective study performed at 3 centers including all patients admitted to the emergency department because of chest pain, during a 3-month period in 2008, in the municipality of Göteborg. Chest pain or discomfort in the chest was the only inclusion criterion. There were no exclusion criteria.

Data Sources

Data were retrospectively collected from ambulance and medical records and electrocardiogram (ECG), echocardiography, and laboratory databases.

Main Findings

A total of 2588 visits (1248 women and 1340 men) made by 2393 patients were included.When adjusting for baseline variables, female sex was significantly associated with a prolonged delay time (defined as above median) between (a) admission to hospital and admission to a hospital ward (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.25-2.03), (b) first physical contact and first dose of aspirin (OR, 2.22; 95% CI, 1.30-3.82), and (c) admission to hospital and coronary angiography (OR, 2.50; 95% CI, 1.29-5.13).Delay time to the first ECG recording did not differ significantly between women and men.

Principal Conclusions

Among patients hospitalized due to chest pain, when adjusting for differences at baseline, female sex was associated with a prolonged delay time until admission to a hospital ward, to administration of aspirin, and to performing a coronary angiography. There was no difference in delay to the first ECG recording.     

Association of estrogen receptor α gene polymorphisms with BMD and their affect on estradiol levels in pre- and postmenopausal women in south Indian population from Andhra Pradesh

BackgroundOsteoporosis is a multifactorial disorder with a strong genetic component and ESR1 is suggested as a candidate gene for osteoporosis. Therefore the present study is aimed to investigate the role of ESR1 gene polymorphisms and its influence on estradiol levels and BMD in osteoporotic women of Indian ethnicity.MethodsFour-hundred twenty-seven osteoporotic women and 460 age matched controls were included in the study. ESR1 gene polymorphism was assessed by PCR-RFLP method. Serum estradiol was measured by ELISA.ResultsThe frequency of pp and xx genotypes as well as p and x alleles was significantly high in pre- and postmenopausal osteoporotics when compared to controls (p < 0.001). They had low BMD and estradiol levels in comparison with PP and XX genotype individuals (p < 0.05).ConclusionThe ESR1 gene is associated with low bone mass and low estradiol levels in all our study subjects. It is likely that the allele exerts its influence on the bone in early adulthood leading to an increased risk of osteoporosis later in life.     

IGF‐I concentrations are positively associated with carotid artery atherosclerosis in women

BACKGROUND. Alterations in the growth hormone (GH)/insulin‐like growth factor I (IGF‐I) axis are associated with increased cardiovascular morbidity and mortality, but previous studies have yielded conflicting results. In addition, the T1169A polymorphism in the GH1 gene has been associated with IGF‐I levels.

AIMS. To investigate whether IGF‐I concentrations and the T1169A polymorphism of the GH1 gene are associated with cardiovascular risk factors and the intima media thickness (IMT) of the carotid artery.

METHODS. Fasting plasma IGF‐I concentrations (n = 1008) were measured in a large population‐based OPERA (Oulu Project Elucidating Risk of Atherosclerosis) cohort. Genotype variants were determined by the restriction fragment length polymorphism method.

RESULTS. Low IGF‐I concentrations associated with several cardiovascular risk factors including age, adiposity, and high triglyceride, fasting insulin and C‐reactive protein concentrations in the analysis of all subjects. In the multivariate models, however, IGF‐I concentrations were positively associated with the mean IMT of women (ß = 0.127, P = 0.009) whereas the association in men was weaker and negative (ß = ?0.088, P = 0.034). The 1169A allele was associated with low low‐density lipoprotein cholesterol in both sexes and with low systolic blood pressure levels in women.

CONCLUSIONS. IGF‐I concentrations were associated with several traditional cardiovascular risk factors. The observed gender difference in the association between IGF‐I concentrations and carotid artery atherosclerosis warrants further study. The GH1 1169A allele may be associated with a favourable metabolic profile.     

Is Pelvic Ultrasound Associated with an Increased Time to Appendectomy in Pediatric Appendicitis?

Background

Appendicitis is a common pediatric condition requiring urgent surgical intervention to prevent complications. Pelvic ultrasound (US) as a diagnostic aid has become increasingly common. Despite its advantages, evidence suggests US can lead to delayed definitive management.

Objective

The objective was to test the hypothesis that US is associated with an increased time to appendectomy in children with acute appendicitis.

Methods

A chart review was conducted of all children aged 0−17 years who presented to the pediatric emergency department (ED) with a discharge diagnosis of appendicitis. The primary outcome variable was the interval between initial evaluation to appendectomy between patients who received an US and those who did not.

Results

Of 662 cases included, 424 patients (64%) underwent a pelvic US and 238 patients underwent an appendectomy without US. Median time interval from initial evaluation in the ED by a physician to appendectomy among patients who received an US was 9.7 h (interquartile range [IQR]: 6.8−15.0 h) compared with 5.5 h (IQR: 3.8−8.6 h) among patients who did not receive an US (Mann-Whitney, p < 0.001). The increased time to appendectomy in patients who received an US was dependent on the patient being female and presenting to the ED after hours (univariate analysis of variance test for interaction, p < 0.05).

Conclusions

Female pediatric patients and those presenting after hours that undergo an US have a significantly increased time to appendectomy compared with those who do not undergo diagnostic imaging.