Susceptibility patterns in Neisseria gonorrhoeae in Nuuk, Greenland, 2015-2018: a short communication.

Antimicrobial resistance in Neisseria gonorrhoeae (GC) has made gonorrhoea control and treatment more complex globally. In Greenland, the incidence of gonorrhoea is high and there is a need for continued surveillance of antimicrobial susceptibility.This study investigated gonococcal isolates obtained in Greenland's capital Nuuk between January 2015 and June 2018. Subsequent to collection, isolates were tested for ciprofloxacin and ceftriaxone susceptibility in order to monitor the resistance pattern among GC strains. 150 GC strains were isolated in Nuuk during the observation period (139 males, 93%; 11 females, 7%). All strains were fully susceptible to ceftriaxone. 49% of the GC strains were susceptible to ciprofloxacin. The median minimal inhibitory concentration (MIC) for ceftriaxone among GC strains resistant to ciprofloxacin was higher than among GC strains susceptible to ciprofloxacin. No differences in ciprofloxacin susceptibility and median MICs for ceftriaxone were observed by collection year. In conclusion no ceftriaxone resistance has been found in Nuuk to date. Continued easy access to diagnostics and treatment combined with increased and more systematic surveillance of antimicrobial susceptibility in Nuuk is recommended. Further, it is advisable to investigate the possibilities for intermittent sampling in Greenland outside of Nuuk, if obstacles in relation to sending sampling material to Nuuk can be bypassed.

Iodine in Edible Seaweed, Its Absorption, Dietary Use, and Relation to Iodine Nutrition in Arctic People.

Dietary iodine is important to human health, and both low and high iodine intake levels increase the risk of disease. Seaweed is rich in iodine and it is a common component in both Asian and in Arctic cuisines. While the intake and impact are known for Asian people, data are lacking for Arctic people. We aimed to (1) measure iodine content of dietary seaweeds in Greenland, (2) estimate iodine absorption, and (3) assess the impact on iodine intake in Arctic people. A hunter in East Greenland donated household seaweed for (1) measurement of iodine content and (2) ingestion of 45 g by each of eight individuals with subsequent urine collections. (3) In Ammassalik, 96% of 50-69-year-old Inuit reported on the frequency of intake of seaweed and provided a spot urine sample for iodine measurement. Seaweed species provided were Chondrus crispus and Ascophyllum nodosum. (1) The iodine content was 47 and 102 mg/g, respectively. (2) An estimated 1.1 and 1.9 mg of the ingested 2.1 and 4.6 of iodine in seaweed were excreted in the urine within 2 days. (3) More than two in three Inuit reported some dietary use, and 41% (109 of 268) reported a weekly intake of dietary seaweed, which was associated with iodine excretion. In conclusion, the iodine content of edible seaweeds in the Arctic is very high and bioavailable. Dietary intake contributed to the recommended iodine intake level, but marked variation in iodine excretion calls for evaluation of the impact on thyroid function.

Rapid change in the ciprofloxacin resistance pattern among Neisseria gonorrhoeae strains in Nuuk, Greenland: time to reconsider preventive and treatment strategies.

OBJECTIVES: Sexually transmitted infections (STIs), including infections with Neisseria gonorrhoeae (GC), are highly incident in Greenland. Since January 2011, GC testing has been performed on urine with nucleic acid amplification tests (NAATs) by strand displacement amplification (Becton Dickinson ProbeTec). Monitoring of GC antibiotic susceptibility by culture was introduced in Nuuk in 2012. Until 2014, no cases of ciprofloxacin-resistant GC strains were reported. In this paper, we report the finding of ciprofloxacin-resistant GC and describe the most recent incidence of GC infections in Greenland. METHODS: The number of urine NAATs and culture-positive swabs from January to October 2014 were obtained from the Central Laboratory at Queens Ingrid's Hospital in Nuuk and stratified on gender, place and period of testing. Incidence rates were estimated as number of urine NAAT * (12/10) per 100,000 inhabitants. Men in Nuuk with a positive NAAT for GC were encouraged to provide a urethral swab for culture and susceptibility testing. RESULTS: From January to October 2014, a total of 5,436 urine GC NAATs were performed on patients from Nuuk and 9,031 from the rest of Greenland. Of these, 422 (8%) and 820 (9%) were positive, respectively. From January to August, 6 (15%) cultures from Nuuk were ciprofloxacin resistant while in September and October, 26 (59%) were ciprofloxacin resistant (p<0.01). In total, 35 (40%) of 88 culture-positive isolates showed ciprofloxacin resistance. GC incidence in Nuuk was 3,017 per 100,000 inhabitants per year, compared to 2,491 per 100,000 inhabitants per year in the rest of Greenland. CONCLUSION: Within a short period, a rapid and dramatic change in ciprofloxacin susceptibility among GC strains isolated in Nuuk was documented and recommendation for first line treatments has changed. Continued monitoring and rethinking of primary and secondary preventive initiatives is highly recommended in this high GC incidence setting.

Human accumulation of mercury in Greenland.

In the Arctic, the traditional diet exposes its people to a high intake of mercury especially from marine mammals. To determine whether the mercury is accumulated in humans, we analyzed autopsy samples of liver, kidney and spleen from adult ethnic Greenlanders who died between 1990 and 1994 from a wide range of causes, natural and violent. Liver, kidney and spleen samples from between 33 and 71 case subjects were analyzed for total mercury and methylmercury, and liver samples also for selenium. Metal levels in men and women did not differ and were not related to age except in one case, i.e. for total mercury in liver, where a significant declining concentration with age was observed. The highest total mercury levels were found in kidney followed by liver and spleen. Methylmercury followed the same pattern, but levels were much lower, constituting only 19% of the total mercury concentration in liver and spleen and as little as 3% in kidney. In liver selenium was found in surplus to mercury on a molar basis. Mercury concentrations in the liver and kidneys of Greenlanders were elevated compared to levels in the general population in Japan, Korea and several European countries, except in the Faroe Islands where mercury levels were 2-3 times higher. This is in accordance with the expected exposure of mercury in the diet.

Inuit are protected against prostate cancer.

Incidence and mortality rates for prostate cancer are reported to be low among Inuit, but this finding must be additionally supported given the difficulty of obtaining a precise medical diagnosis in the Arctic. We conducted an autopsy study in 1990-1994 among 61 deceased males representative of all deaths occurring in Greenland and found only one invasive prostate cancer. Histological data were available for 27 autopsies and revealed no latent carcinoma. Our results suggest that in situ carcinoma is rare among Inuit and that their traditional diet, which is rich in omega-3 polyunsaturated fatty acids and selenium, may be an important protective factor.

Fatty acid compositions of serum phospholipids of postmenopausal women: a comparison between Greenland Inuit and Canadians before and after supplementation with fish oil.

OBJECTIVES: We compared serum phospholipid fatty acid compositions, in particular the status of omega-3 polyunsaturated fatty acid (PUFA), of postmenopausal Greenland Inuit women and postmenopausal Canadian women at baseline and after supplementing the Canadian women with a fish-oil product. METHODS: Fasting serum samples were collected from 15 Inuit subjects from Greenland and 16 non-Inuit subjects from Canada. In addition, eight Canadian subjects provided fasting serum samples after completing a long-chain omega-3 PUFA intervention (2.4 g of eicosapentaenoic acid [EPA] plus 1.6 g of docosahexaenoic acid [DHA] per day) for 28 d. Fatty acid compositions of serum phospholipids of the samples were determined and compared by one-way analysis of variance. RESULTS: In comparison with the Greenlanders, baseline Canadian women had 73% and 46% less EPA (20:5omega-3) and DHA (22:6omega-3), respectively, and 32% and 91% more linoleic acid (LA; 18:2omega-6) and arachidonic acid (AA; 20:4omega-6), respectively. The omega-3 supplementation in Canadian women increased DHA and decreased LA levels to approach those in Greenland Inuit and raised EPA levels to surpass (45% higher) those in Greenland women (P < 0.0001). In contrast, AA was only moderately lowered (by 16% overall) such that AA levels remained 62% higher in the supplemented Canadians than in the Greenlanders (P < 0.0001). CONCLUSIONS: Short-term EPA plus DHA supplementation of postmenopausal North American women can mimic the high EPA and DHA levels and lower LA levels in corresponding Inuit women but not the markedly lower levels of AA. The present findings also support the hypothesis of genetically decreased Delta5-desaturase potential in the Greenland Inuit compared with Canadian postmenopausal women.