Obesity and metabolic state are associated with increased healthcare resource and medication use and costs: a Finnish population-based study

The European Journal of Health Economics - To characterize healthcare resource (HCRU) and medication use and associated costs in individuals with obesity compared with individuals with normal...     

Coeliac Disease: Frequent Occurrence After Clinical Onset of Insulin-dependent Diabetes Mellitus

Coeliac disease was searched for in a series of 776 children with newly diagnosed IDDM. During the follow-up of 2 to 3 years from diagnosis, reticulin and gliadin antibodies were measured, and a jejunal biopsy was performed in those cases with high levels of antibodies; 19 children were identified with coeliac disease, giving the prevalence of 2.4 %. In only one case had coeliac disease been diagnosed before IDDM. Nine patients with proven coeliac disease were negative for antibodies when IDDM was diagnosed, but became positive within 24 months. All patients found to have coeliac disease were positive for IgA reticulin antibodies, but only 12 of 18 (67 %) showed a high level of IgA gliadin antibodies. Of the 18 patients genotyped for HLA DR locus, 14 (78 %) were positive for DR3 and 10 (56 %) were positive for DR4. DQB1*0201 allele was present in 17 of 18 patients (94 %). Coeliac disease in children with IDDM tends to develop soon after diabetes is diagnosed. Routine screening for coeliac disease is recommended repeatedly during the first years after the diagnosis of IDDM.     

Prevalence of metabolic syndrome components among the elderly using three different definitions: a cohort study in Finland

Objective

Limited data are available on the metabolic syndrome (MetS) and its components in elderly people (aged 70 years and over) at population level in Northern Europe. A study was undertaken to investigate the prevalence of MetS and its components in an aging population by using different definitions.

Design, setting, and subjects

A cross-sectional study of 539 inhabitants from Northern Finland (mean age 71.9 years) was conducted to investigate the prevalence of MetS, by using the definitions of MetS by the National Cholesterol Education Panel (NCEP), the modified NCEP (NCEPm), and the International Diabetes Federation (IDF).

Main outcome measures

Prevalence of MetS by the NCEP, NCEP modified, and IDF criteria.

Results

Overall, the prevalence of MetS was 24.7%, 35.2%, and 37.2% in men, by NCEP, modified NCEP, and IDF-definitions, respectively. In women the corresponding figures were 20.9%, 33.1%, and 47.8%. Hypertension was the most common component in both men (91.8%) and women (89.0%) by the IDF criteria. Glucose abnormalities were particularly prevalent in men (53.2% by NCEP and 78.4% by IDF criteria).

Conclusions

The most common component was hypertension in both genders. Lower waist-circumference cut-off points of the IDF criteria led to a higher prevalence of MetS particularly in women. Prevalence of MetS varied significantly when measured by different definitions. Nearly half of older women met the IDF definition of MetS, which was more than twofold when compared with NCEP. Clinical practitioners should be aware of the limitations when using set criteria of MetS, in contrast to identifying the individual cardiovascular risk factors and the accumulation of these.Key Words: Elderly population, definitions, IDF, metabolic syndrome, prevalenceData on the prevalence of components of the metabolic syndrome (MetS) among elderly Northern Europeans, particularly as compared by the three currently used different definitions, are limited. The authors observed significant variation in the prevalence of MetS and associated components among an ageing Finnish population, when measured with the different criteria. Furthermore, different definitions identified different individuals as having MetS. Clinical practitioners should therefore be aware of the limitations using set criteria of MetS, in contrast to identifying the individual cardiovascular risk factors and the accumulation of these.     

Decreased Thromboxane Production in Migraine Patients During Headache-Free Period

SYNOPSIS
To study the role of the proaggregatory, vasoconstrictory thromboxane A ₂ (TxA ₂ ) in migraine, the plasma levels of Thromboxane B ₂ (TxB ₂ ), the stabile metabolite of TxA ₂ , were measured from 14 adults and 8 children with migraine during the attack-free interval. In addition, the platelets' capacity to generate TxB ₂ during spontaneous clotting was studied. The plasma TxB ₂ concentrations were lowered in the adult migraine patients. Also the platelets' capacity to produce TxB ₂ was reduced in migraine children and in adults with classic migraine. The decreased platelet TxA ₂ synthesis in the attack-free period of migraine patients may reflect a deficient pool of platelet arachidonic acid, the precursor of TxA ₂ , perhaps as a result of increased consumption during migraine attacks.     

The incidence and management of the slit ventricle syndrome

Summary The incidence of slit ventricles of shunt treated hydrocephalic children was evaluated in a follow up study of 141 patients. Slit like ventricles on computer tomography was seen in 75 patients (53%). 52 patients (37%) suffered from clinical symptoms corresponding with overdrainage of cerebrospinal fluid.Those 52 patients with the Slit Ventricle Syndrome (SLVS) were treated by changing the valve to one with a higher opening pressure and/or adding an antisiphon device (ASD) to the shunt. 22 patients, initially treated by changing the opening pressure of the valve, needed the ASD later. Altogether 74 episodes of the SLVS were treated. The ASD proved reliable for the management of the SLVS. Normalization of ventricular size occurred in 54% of patients, whereas only in 15% treated without the ASD. Reduction of paroxysmal activity on EEG was seen in 70% of patients treated with the ASD, whereas only in 23% of patients treated without the ASD. Clinical relief of symptoms occurred in every patient, and ventricular catheter obstructions could be avoided, even if the ventricular size remained slit-like on CT.     

Classification and management of the slit ventricle syndrome

A total of 32 patients with overdrainage of CSF, fulfilling the radiological and clinical criteria for collapsed ventricles (slit ventricles), were classified into acute, subacute and chronic forms. The basis of classification into these categories was neurologic symptomatology. The majority (29 patients) originally had a ventriculoatrial shunt and 3 had ventriculoperitoneal shunts. Operative correction was performed in 23 patients (insertion of a high pressure valve in 18 and an antisiphon device in 5). Of these, 5 had acute, 10 subacute, and 6 chronic symptoms. Two patients without symptoms were operated on also. During the follow-up period, which varied from 2 to 11 months, no patient has shown recurrence of the original symptoms of the slit ventricle syndrome; two patients developed subacute signs and an antisiphon device was inserted in addition to the high-resistance valve. On the basis of this series, it is concluded that the slit ventricle syndrome can also develop in patients with an atrioventricular shunt and can be treated by preventing further overdrainage of CSF. Though the results are acceptable by present methods, the need for a servo-regulated shunt persists. The surgical correction should preferably be performed before the acute phase. A flowchart is presented for management of a child with suspected slit ventricles.     

Intestinal permeability to mannitol and lactulose in children with type 1 diabetes with the HLA-DQB1*02 allele

Food antigens and enteroviruses are possible triggers of type 1 diabetes. Because permeability of the intestinal epithelium may facilitate contact of these antigens with the mucosal immune system, we set out to study intestinal permeability in patients with type 1 diabetes. Children with type 1 diabetes (n = 26, mean age 12 years, mean duration of disease 4 years) and 24 healthy age-matched control children were given mannitol and lactulose orally, and their intestinal permeability was measured as a percentage of this dose recovered in urine. Patients with type 1 diabetes did not differ in their permeability to lactulose, nor was their lactulose/mannitol ratio any different from that of controls. However, patients with type 1 diabetes who had the HLA-DQB 1*02 allele and, therefore, a higher risk for celiac disease (CD) absorbed significantly more mannitol (mean + 95% CI): 17.7% (15.2-20.2) than did those negative for this allele: 12.3% (8.2-16.4), p = 0.04. Their lactulose permeability was also higher: 0.30 (0.16-0.44) and 0.09% (0-0.18), respectively, p = 0.02. Although the differences in permeability reach statistical significance, there was still much overlap between the two groups in terms of actual laboratory values. The higher permeability of patients with the HLA-DQB1*02 allele suggests that these patients may be more prone to develop abnormal immune responses to food antigens.     

Importance of aliphatic amines in uremia.

Five main aspects were addressed: 1)The demonstration that creatinine is an endogenous precursor of dimethylamine (DMA) in chronic renal failure. 2) The size of the body amine pool measured in transplant patients suggests sequestration in some intracellular compartment. This illustrates the possible error in directly relating serum concentrations to neurological toxicity. 3) Bacterial overgrowth and increased generation of duodenal DMA in the small intestine becomes apparent at a serum creatinine above 8 mg/dl. Two cases show that bacterial overgrowth preceded the increased duodenal DMA. 4)Clinical toxicity is demonstrated by i) correlation of abnormal neurobehavioral parameters with serum amine levels, and ii) by improvement with administration of nonabsorbable broad spectrum antibiotics. Results with adsorption agents are inconclusive. 5) Preliminary tests of behavior modification in a rat model by direct instillation of amines into the brain are positive for TMA but negative for DMA, but no DMA entry into brain cells is demonstrated in the latter. The generation of aliphatic amines represents only one part of a spectrum of alteration induced by proximal intestinal bacterial enzyme action that occurs in renal failure. It is possible that some bacterial activity is beneficial and that the net clinical result is a balance between the "good" and the "evil" bacterial effects.