Metabolic syndrome in a metapopulation of Croatian island isolates

Aim

To investigate the prevalence and factors associated with the metabolic syndrome in 9 isolated populations on Adriatic islands, Croatia, and in the group of immigrants to these islands.

Methods

Random samples of 100 inhabitants from each village and 101 immigrants were collected during 2002 and 2003. Bivariate and multivariate methods were used in data analysis. Age, gender, village, diet, smoking habits, physical activity, education, occupational class, and personal genetic history (a pedigree-based estimate of the individual genome-wide heterozygosity level) were used as independent variables in logistic regression.

Results

A total of 343 (34%) examinees met criteria of the metabolic syndrome diagnosis, with significant differences in the prevalence among villages (P = 0.002). Metabolic syndrome was most frequently detected on Mljet island (53%), where all examinees exhibited fasting plasma glucose over 6.1 mmol/L. Examinees with metabolic syndrome were significantly older than those without it (median age 60.0 vs 53.0; P<0.001). Women were more frequently diagnosed than men (39% vs 28%; P<0.001). The highest prevalence of the metabolic syndrome was found in the autochthonous group, whereas the lowest proportion was recorded in the admixed group (39% vs 21%, respectively, P = 0.017). However, only age (odds ratio [OR], 1.06; 95% confidence intervals [CI], 1.03-1.08) and having a university degree (OR, 0.18; 95% CI 0.04-0.92) were significantly associated with metabolic syndrome in the regression model.

Conclusion

Metabolic syndrome was not associated with pedigree-based individual genome-wide heterozygosity estimate, after controlling for a number of confounding factors. More precise marker based genomic measures are needed to provide a clear answer whether metabolic syndrome development is influenced by the population genetic structure.The metabolic syndrome refers to the clustering of cardiovascular risk factors that greatly increase an individual’s risk for developing diabetes, cardiovascular disease, and renal disease (1,2). It is defined as a concurrence of impaired glucose and insulin metabolism, overweight and abdominal fat excess, dyslipidemia, and hypertension, associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (3). Other frequently used terms for the metabolic syndrome are syndrome X and insulin resistance syndrome. Although insulin resistance is not a defining component of the metabolic syndrome in the definition proposed by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol Adult Treatment Panel III (4), it is considered to be its core feature (5,6).Metabolic syndrome is a substantial public health problem across the world (1,7). Its diagnosing criteria such as high blood pressure and obesity, are globally among the ten leading risk factors (7). Croatian population does not present an exception from this finding, with elevated blood pressure, smoking, physical inactivity, high alcohol intake, inadequate nutrition, and obesity being identified as the most prevalent cardiovascular risk factors in the general population (8).Beside widely investigated environmental and behavioral risk factors, a number of studies have identified a genetic contribution to the metabolic syndrome development. Metabolic abnormalities related to the metabolic syndrome aggregate in families, suggesting a common genetic component (9). Evidence for the genetic basis of type 2 diabetes and the metabolic syndrome has been derived from various family, twin, and population studies. Identification of genes associated with disease pathogenesis is currently under way, using techniques such as genome scanning by positional cloning and the candidate gene approach (10).Multitude of various risk factors renders epidemiological investigation of metabolic syndrome difficult. Reduced genetic and environmental heterogeneity of isolated human populations could theoretically be useful in the investigation of metabolic syndrome. Isolated populations residing in villages of Croatian islands were already proven to be good models for the investigation of common complex diseases of late onset (11-13). The aim of this study was to investigate the prevalence of metabolic syndrome and factors associated with it, namely personal genetic history in 9 isolated populations of Croatian Adriatic islands, as well as immigrants to the islands. These island populations exhibit a wide range of inbreeding and endogamy, reduced genetic variation at both individual and (sub)population levels, and a relative uniformity of environment (11).     

Comment on “A meta-analysis of fracture risk and bone mineral density in patients with systemic sclerosis”

Clinical Rheumatology -     

Benzodiazepine use among the elderly in the community.

Benzodiazepines are the most commonly prescribed psychotropic drug in the elderly. Benzodiazepines with a long duration of action can produce marked sedation and psychomotor impairment in older people, and are associated with an increased risk of hip fracture and of motor vehicle crash. One thousand seven hundred and one individuals of 65 years and over, identified from General Practitioner lists, were interviewed using the Geriatric Mental State-AGECAT package and current psychotropic drug use was recorded. Benzodiazepines were classified as having a short or long elimination half-life. Two hundred and ninety-five (17.3%) individuals were taking a benzodiazepine, with use in females being twice that in males. Of the 295, 152 (51.5%) were taking a long acting benzodiazepine and the use of long acting anxiolytic type benzodiazepines was particularly common. Fifty-two (17.6%) benzodiazepine users were taking one or more other psychotropic drugs. A benzodiazepine was used by eight of 18 (44.4%) subjects with an anxiety disorder, 62 of 180 (34.4%) individuals with depression, and seven of 71 (9.9%) people with dementia. Four-fifths of older people on a psychotropic drug were taking a benzodiazepine, highlighting the importance of this class of drug in the elderly population. The choice of a benzodiazepine with a long duration of action, which have been shown to be associated with serious adverse events in the elderly in over one half of benzodiazepine users, is of concern. The potential for adverse effects was further accentuated by polypharmacy practices. The choice of benzodiazepine for an older person has important consequences and should be addressed in greater detail with primary care.     

Efficacy of public health surveillance systems

Public health surveillance system (PHSS) serves for continuous and systematic data collection, analysis and interpretation, in order to enable planning, implementation and evaluation of public health practice. PHSS should alert to events (usually unwanted), assist to create public health policy and strategies, document effects and achieving the goals as well as setting public health priorities. Surveillance systems monitor communicable and non-communicable diseases, health resources and public health programs and interventions. The main drawback of the existing PHSS is fragmentation and delay of information, usually not up-to-date. Modern information and communication technology enables getting data from hospitals and other health information systems directly, and use them for surveillance. Our model of surveillance system appeared as not standalone but an integrated system getting data that are by-product of frontline workers. Therefore, the electronic health records should be the source of data for disease surveillance. Medical, nurse and similar schools as well as the Ministry of Health and health institutions could be data sources for health personnel surveillance. Medical devices can be monitored by data coming from institutions and bodies dealing with such devices. Public health programs defined by institutions and bodies can be monitored by them and others taking part in implementation. Therefore, they all can be the source of data for surveillance of public health programs and interventions. Without such systems, any rationalization in health care and better quality is not possible. Therefore, the present public health surveillance system should be improved, as we have suggested, by using current information and communication technology and integrating the data that are by-product of the frontline worker, and by including the end users in system development at the very beginning.     

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently (“co-curing” method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.     

Stable Gastric Pentadecapeptide BPC 157 in Trials for Inflammatory Bowel Disease (PL-10, PLD-116, PL14736, Pliva, Croatia) Heals Ileoileal Anastomosis in the Rat

Purpose Gastric pentadecapeptide BPC 157 (BPC 157), which has been shown to be safe in clinical trials for inflammatory bowel disease (PL-10, PLD-116, PL14736, Pliva, Croatia), may be able to cure intestinal anastomosis dehiscence. This antiulcer peptide shows no toxicity, is limit test negative, and a lethal dose is not achieved. It is stable in human gastric juice. In comparison with other standard treatments it is more effective for ulcers and various wounds, and can be used without a carrier needed for other peptides, both locally and systemically (i.e., perorally, parenterally). We studied the effectiveness of BPC 157 for ileoileal anastomosis healing in rats. Methods We assessed ileoileal anastomosis dehiscence macroscopically, histologically, and biomechanically (volume [ml] infused through a syringe-perfusion pump system (1 ml/10 s), and pressure [mmHg] to leak induction [catheter connected to a chamber and a monitor, at 10 cm proximal to anastomosis]), at 1, 2, 3, 4, 5, 6, 7, and 14 days. BPC 157 (10 μg, 10 ng, 10 pg/kg i.p. (or saline [5 ml/kg]) was first administered after surgery, while it was last given 24 h before either assessment or sacrifice. Results Throughout the experiment, both higher doses of BPC 157 were shown to improve all parameters of anastomotic wound healing. The formation of adhesions remained slight, the blood vessels were filled with blood, and a mild intestinal passage obstruction was only temporarily observed. Anastomosis without leakage induces markedly higher volume and pressure values, with a continuous increase toward healthy values. From day 1, edema was markedly attenuated and the number of granulocytes decreased, while from days 4 or 5 necrosis decreased and granulation tissue, reticulin, and collagen formation substantially increased, thus resulting in increased epithelization. Conclusion This study showed BPC 157 to have a beneficial effect on ileoileal anastomosis healing in the rat.     

The cervical spine involvement in patients with psoriatic arthritis

Psoriatic arthritis (PsA) is a systemic disease and cervical spine can be affected. The data regarding cervical spondylitis are very rare and diverse in literarture. The aim of study was to assess the prevalence of cervical spine involvement in patients with PsA. Between totally 41 patients with PsA we confirmed the incidence of 68% (29 patients) with symptomatic cervical spine disease and 29% (12 patients) with radiological evidence of inflammatory involvement. The most frequent radiological findings were apophyseal joint changes, rarely ligamentous calcification and syndesmophytes. Only one patient had subaxial subluxation. The most common type of PsA was axial disease with or without peripheral arthritis (46%) and the least common was oligoarthritis (22%). There was no statistically significant difference between any type of PsA and cervical involvement. CONCLUSION: inflammatory cervical spine changes are not common radiographic finding in patients with PsA and apophyseal joint affection is the most common radiologic sign.