Use of home sphygmomanometers in Turkey: a nation-wide survey

The purposes of this study were to detect the prevalence of ownership of a home sphygmomanometer among hypertensive subjects through a nation-wide survey, to investigate parameters affecting ownership of a sphygmomanometer, to compare how home blood pressure monitoring (HBPM) was actually used in daily practice with some aspects of the current guidelines, and to discuss what we implemented to increase the reliability of HBPM in a developing country. A total of 2747 hypertensive patients from 34 cities, representative of the Turkish population, were enrolled in the study. A multiple-choice questionnaire was administered to each participant using the computer-assisted telephone interviewing method. Among 2747 hypertensive patients, 1281 of them (46.6%) had a home sphygmomanometer. Most of the patients were using wrist devices. The factors associated with ownership of a sphygmomanometer were female gender, older age, obesity, higher educational status, higher income level, living in urban areas, awareness of hypertension and anti-hypertensive drug usage. Only 16% of the devices were used on the advice of a physician. The patients learned usage of their device mainly from the sellers and their relatives. The ownership of a home sphygmomanometer is common among hypertensive patients in Turkey, but regular monitoring of blood pressure before physician visits is rare despite common ownership of these devices. Daily practice of HBPM in Turkey was far from the recommendations of the current guidelines. More effort is needed to improve the reliability of HBPM.     

Metal-ceramic screw-retained implant fixed partial denture with intraoral luted framework to improve passive fit

Passive fit of a long-span screw-retained implant prosthesis is an important criteria for the success of the restoration. This article describes a technique for fabricating a ceramometal implant fixed dental prosthesis (FDP) for a long-span partially edentulous situation by altering the conventional screw-retained design. The possibility of a passive fit is maximized by intraoral luting of the cast frame to milled abutments, and the potential framework distortion during fabrication is compensated to a major extent. Retrievability is ensured by screw retention of the prosthesis to the implants. Compared with conventional porcelain fused to metal screw-retained FDP, this prosthesis is relatively inexpensive to fabricate.     

Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition: population-based case-control study in Tirana, Albania

Aim

To assess the association between conventional risk factors and acute coronary syndrome in Albania, a transitional country in Southeast Europe.

Methods

A population-based case-control study was conducted in Tirana in 2003-2006. A total of 467 consecutive patients with nonfatal acute coronary syndrome were recruited. There were 370 men with mean ± standard deviation (SD) age of 59.1 ± 8.7 years and 97 women with mean±SD age of 63.3 ± 7.1 years. The control group comprised a population-representative sample of Tirana residents. In the control group, there were 469 men with mean±SD age of 53.1 ± 10.4 years and 268 women aged 54.0 ± 10.9 years. A structured questionnaire on demographic, socioeconomic, psychosocial factors, and health behaviors was administered. Physical measurements included anthropometrics and blood pressure. Venous blood and adipose tissue aspirations from the gluteal region were frozen-stored for future analysis. Multivariable-adjusted logistic regression was used to assess the independent associations of conventional risk factors with acute coronary syndrome.

Results

Upon adjustment for covariates, family history of coronary heart disease was found to be a strong predictor of acute coronary syndrome in both men (odds ratio [OR], 3.70; 95% confidence interval [CI], 2.58-5.30) and women (OR, 4.53; 2.40-8.57). Waist-to-hip ratio in men (OR, 4.03; 2.83-5.73) and obesity in women (OR, 3.31; 1.54-7.14) were strongly associated with acute coronary syndrome. In men, but not in women, there was a significant association with hypertension and current smoking (P = 0.011 and P<0.001, respectively). Diabetes was not significantly independently associated in either sex.

Conclusion

Classical risk factors predicted coronary heart disease in Albania, similarly as in the rest of the world, although associations with family history and anthropometric indices were stronger. These findings are resulting largely from the heterogeneous adoption of lifestyles conducive to increased coronary risk in transitional countries, and they point to the urgent need for targeted public health interventions.The relationship between coronary heart disease and risk factors such as smoking, high blood pressure, diabetes, obesity, and distribution of body fat is well established in developed countries (1-4). However, data on conventional risk factors, their patterns, determinants, and associations with coronary heart disease are scarce for the transitional countries of South East Europe. Unique among former communist countries in Southeast Europe, Albania was under Stalinist communist regime, and following the breakdown of this rigid government in 1990, it experienced a major social, cultural, and economic upheaval (5). Over the past 15 years changes in life-style (diet, tobacco, alcohol consumption, and physical exercise) have taken place, particularly in urban settings (6-8). The available evidence suggests an increase in alcohol intake, particularly among men (6). Smoking appears to have increased too, although smuggling makes it very difficult to validly estimate cigarette consumption in Albania (7). In 2001, the lifetime prevalence of smoking in Tirana was 61% in men and 24% in women (8). Furthermore, in 2001, 49% of men and 58% of women in Tirana reported largely sedentary leisure time activities such as reading and watching television (9). Although there is little information about cardiovascular disease occurrence in Albania, available data suggest that cardiovascular disease mortality may have increased over the past few years (10,11), and that cardiovascular disease morbidity (based on hospital admission counts) in both Tirana and the whole country has been increasing continually in the last decade (10).In this context, we undertook a population-based case-control study of coronary heart disease in Tirana between June 2003 and January 2006. Here, we report on the association of selected conventional risk factors such as smoking, anthropometric indices, hypertension, diabetes, and family history of coronary heart disease with acute coronary syndrome.     

Determination of ghrelin immunoreactivity in the rat stomach after fasting and refeeding

Ghrelin is a recently discovered hormone secreted by cells of the stomach. The aim of this study was to investigate fasting and refeeding induced alterations on ghrelin immunolabelling of cells of the stomach. Thirty-six adult male Wistar rats were used in this study. Rats were divided into six groups. Group I: control group; Group II: rats fasted for 7 days; Group III: rats fed for 1 day after 7 days of fasting; Group IV: rats fed for 3 days after 7 days of fasting; Group V: rats fed for 5 days after 7 days of fasting; Group VI: rats fed for 7 days after 7 days of fasting. At the end of the experiment, rats were sacrificed and stomach tissues were processed for imunohistochemistry to localize ghrelin. Ghrelin-immunopositive cells were detected only in the mucosal lining of the stomach. After fasting for 7 days, the number of ghrelin-immunopositive cells increased significantly compared to the control rats. Following refeeding, the number of ghrelin-immunoreactive cells was reduced to a level comparable to the controls. Therefore, fasting and refeeding after fasting were observed to result in changes in ghrelin immunoreactivity in the cells of the stomach. We conclude that ghrelin is highly expressed in the stomach and that fasting increases the expression of ghrelin in the stomach, but this expression decreases after refeeding. Our results indicate that regulation of ghrelin is a process probably involved in the long-term control of nutritional states.