Individualized significance of the -251 A/T single nucleotide polymorphism of interleukin-8 in severe infections.

Based on the concept of the individualized nature of sepsis, we investigated the significance of the -251 A/T (rs4073) single nucleotide polymorphism (SNP) of interleukin (IL)-8 in relation to the underlying infection. Genotyping was performed in 479 patients with severe acute pyelonephritis (UTI, n = 146), community-acquired pneumonia (CAP, n = 109), intra-abdominal infections (IAI, n = 119), and primary bacteremia (BSI, n = 105) by restriction fragment length polymorphism of the polymerase chain reaction (PCR) product and compared with 104 healthy volunteers. Circulating IL-8 was measured within the first 24 h of diagnosis by an immunosorbent assay. Carriage of the AA genotype was protective from the development of UTI (odds ratio 0.38, p: 0.007) and CAP (odds ratio 0.30, p: 0.004), but not from IAI and BSI. Protection from the development of severe sepsis/septic shock was provided for carriers of the AA genotype among patients with UTI (odds ratio 0.15, p: 0.015). This was accompanied by greater concentrations of circulating IL-8 among patients with the AA genotype. It is concluded that carriage of rs4073 modifies susceptibility for severe infection in an individualized way. This is associated with a modulation of circulating IL-8.

Risk factors for lower extremity arterial disease in non-insulin-dependent diabetic persons.

The relationship of lower extremity arterial disease to the different risk factors for atherosclerosis in non-insulin-dependent (Type 2) diabetes mellitus is a matter of continuing investigation. The present study was conducted on a random sample of 193 non-insulin-dependent diabetic patients in order to compare the frequency and severity of some known risk factors for atherosclerosis among such persons with and without indications of lower extremity arterial disease. Conventional risk factors for atherosclerosis (smoking, existence of hypertension, total plasma cholesterol, HDL-cholesterol, and triglycerides) were assessed. In addition body mass index, waist-to-hip ratio, body fat mass, and albumin excretion were determined. Criteria for the presence of lower extremity arterial disease were an ankle brachial pressure index < 0.89 and/or the existence of intermittent claudication. Age, length of diabetes, and waist-to-hip ratio appeared to be factors significantly related to lower extremity arterial disease in most cases. Blood lipids, body mass index, HbA1 (except in males), smoking, and type of antidiabetic treatment were not significantly related to disease. The multivariate analysis confirmed the significant contribution of the duration of diabetes (p = 0.002), and waist-to-hip ratio (p = 0.024) and further showed a significant relation with triglycerides (p = 0.020). Thus, lower extremity arterial disease in non-insulin-dependent diabetes mellitus is significantly related to a long duration of diabetes and to central body fat distribution (but not to body mass index), as well as to triglyceride levels.

Evidence for an increase in the prevalence of known diabetes in a sample of an urban population in Greece.

It is accepted that the prevalence of known diabetes mellitus has increased in some countries, although the available data are incomplete and sometimes anecdotal. In 1974 a sample of the urban population (n = 21,410) in a suburb of Athens (Greece) was evaluated for the prevalence of known diabetes mellitus. The study was repeated 17 years later in the same area under the same conditions and methodology on 12,836 randomly selected inhabitants (both sexes, all ages). Visiting nurses contacted the inhabitants at home and filled in a questionnaire. The results show a clear increase in diabetes prevalence of the population as a whole (standardized rates: 1974: 2.4% (95% confidence intervals 2.2-2.6%) 1990: 3.1 (2.8-3.4%)). Standardization was done on the basis of data obtained from the same census. The changes were statistically significant in the 50-59, 60-69, and 70-79 age groups (1974: 5.87, 10.98, and 11.41%; 1990: 7.70, 13.68, and 19.52%, respectively). Thus, the prevalence of known diabetes mellitus has considerably increased during the last 17 years in a sample of urban Greek population.

Pattern of treatment among diabetic patients in a sample of urban Greek population.

It is well known that therapeutic habits and diabetic patient's compliance differ substantially between different populations. It is also accepted that if patients are recruited in specialized diabetes centers some important bias is likely to occur, e.g. an excess of insulin-treated subjects. Therefore, population studies are very helpful in order to establish treatment patterns in different populations. A descriptive study was performed during an epidemiological survey conducted on 12,842 randomly selected inhabitants of a suburb of Athens (both sexes, all ages). 509 persons were recorded as known diabetics. Information concerning the type of treatment was collected. Reliable data were available on 490 diabetic individuals. 145 (29.6%) of them were following diet alone, while 270 (55.1%) were receiving antidiabetic tablets and only 75 (15.1%) injected insulin. In patients 40 years old or more (n = 471), the corresponding numbers were 30.1, 56.5 and 13.4% respectively. Thus, it is obvious that insulin-treated patients represent a small percentage of the total diabetic population. It seems that these differences are caused by genetic as well as other factors.