Prevalence and management of arterial hypertension in the population aged 25-64 in the Czech Republic with a focus on diabetic patients.

OBJECTIVE: The aim of the study was to determine the prevalence of arterial hypertension and its awareness rate and control rate among diabetes mellitus (DM) patients in the Czech Republic between 25-64 years of age and to compare the results with those in age-matched non-diabetic patients. MATERIALS AND METHODS: Blood pressure measurement data of 1 170 respondents (467 men and 703 women) obtained during the EHES study in 2014 were analysed. DM was diagnosed in 95 (8.2%) respondents (44 men and 51 women). RESULTS: Mean systolic blood pressure in DM patients was 130.7 ± 18.3 vs. 123.2 ± 16.8 mmHg in non-DM subjects (p < 0.001). The difference in diastolic blood pressure was on the borderline of statistical significance (82.2 ± 9.4 mmHg in DM vs. 80.0 ± 10.6 mmHg in non-DM subjects, p = 0.051). Among the study population, 69.5% of DM and 34.2% of non-DM subjects suffered from arterial hypertension (p < 0.001). The hypertension awareness rates were 87.9% in the DM group and 66.8 % in the non-DM group. (p = 0.001). The percentage of treated arterial hypertension was 94.8% in DM patients vs. 80.5% in the non-DM group (p = 0.010). The blood pressure target of < 140/90 mmHg was achieved in 47.3% of DM patients vs. 60.6% in non-DM subjects (p = 0.077). Using a blood pressure target of < 130/80 mmHg, adequate arterial hypertension control was achieved in only 29.1% of DM patients. When comparing the achievement of the blood pressure targets recommended for diabetic patients (< 130/80 mmHg) and non-DM patients (< 140/90 mmHg), the difference between these groups was statistically significant (p < 0.001) in favour of the non-diabetic group. CONCLUSION: The study has shown the prevalence of arterial hypertension to be twice as high in DM patients aged 25-64 compared to the age-matched non-DM subjects in the Czech Republic. The adequate blood pressure control rate is significantly lower in DM patients than in the non-diabetic population. The study results indicate that the blood pressure targets recommended for diabetic patients (< 130/80 mmHg) are not always reached in clinical practice.

MODY diabetes and screening of gestational diabetes.

OBJECTIVE: The aim of this article is to present a summary of the actual diagnostic possibilities and differentiation of MODY (Maturity-Onset Diabetes of the Young) from gestational diabetes (GDM) found during routine screening, and specific aspects of care and treatment of MODY during pregnancy and early postpartum period. DESIGN: Rewiev. SETTINGS: Centre for Research of Diabetes, Metabolism and Nutrition; Second Department of Internal Medicine University Hospital Královské Vinohrady and Third Faculty of Medicine, Prague. Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague. METHODS: Recent publications selected in PubMed with the key words MODY, gestational diabetes. RESULTS: Many patients with MODY, especially the glucokinase MODY, can be first diagnosed during pregnancy. It is estimated that MODY patients account for up to 5% of GDM cases found in routine screening of GDM. MODY should be considered in lean women around 25 years of age, with a positive family history of diabetes in one of the parents. The differentiation of MODY from GDM is of particular importance not only for the different management and goals of antidiabetic therapy and planning ultrasound controls of fetal growth during pregnancy, but also because of the risk of hyperinsulinemic hypoglycemia in newborns. CONCLUSION: Recognition of MODY during pregnancy and adherence to existing recommendations concerning specific care of these patients is essential for the optimal course of their pregnancy and proper care of the newborn in the early postpartum period.

Positivity for islet cell autoantibodies in patients with monogenic diabetes is associated with later diabetes onset and higher HbA1c level.

AIMS: Islet cell autoantibodies are associated with autoimmune insulitis and belong to the diagnostic criteria of type 1 diabetes mellitus. However, growing evidence suggests that autoantibodies are present in other types of diabetes. Here, we focus on the autoantibody incidence in Czech patients with maturity-onset diabetes of the young and analyse their functional relevance in terms of diabetes onset and control. METHODS: Autoantibodies against glutamic acid decarboxylase (GAD) 65 and protein tyrosine phosphatase islet antigen 2 (IA-2) were measured in a cohort of 28 Czech patients with maturity-onset diabetes of the young, all confirmed by genetic testing. Selected clinical data were correlated to the status and kinetics of autoantibodies. RESULTS: One quarter of patients with maturity-onset diabetes of the young examined (7/28; 25%) was positive for GAD or IA-2 autoantibodies. GAD autoantibodies were more prevalent (7/7) than IA-2 autoantibodies (1/7). The incidence of autoantibodies did not correlate with human leukocyte antigen status. The patients who were positive for the autoantibodies developed diabetes later than those who were autoantibody-negative, but had worse glycaemic control (increased HbA1c ). Expression of autoantibodies decreased with any improvement of diabetes compensation. Only one patient did not correspond to the above and displayed signs of combined signs of maturity-onset diabetes of the young and Type 1 diabetes. CONCLUSIONS: The data suggest transient but highly prevalent islet cell autoantibody expression in Czech patients with maturity-onset diabetes of the young. The autoantibodies were found in patients with delayed diabetes onset, and in times of insufficient diabetes control. As improvement of glycaemic control was associated with a decrease in levels of autoantibodies, their presence may reflect the kinetics of ß-cell destruction induced by causes other than autoimmune ones.

Investigation of sanguinarine and chelerythrine effects on LPS-induced inflammatory gene expression in THP-1 cell line.

Quaternary benzo[c]phenanthridine alkaloids sanguinarine and chelerythrine have been used in folk medicine for their wide range of useful properties. One of their major effect is also anti-inflammatory activity, that is not clarified in detail. This study focused on the ability of these alkaloids to modulate the gene expression of pro-inflammatory tumour necrosis factor α (TNF-α), monocyte chemoattractant protein 1 (MCP-1, also known as CCL-2), interleukin (IL)-6, IL-1ß and anti-inflammatory cytokines IL-1 receptor antagonist (IL-1RA) and IL-10. The effect of these alkaloids was compared with that of conventional drug prednisone. Human monocyte-derived macrophages were pre-treated with alkaloids or prednisone and inflammatory reaction was induced by lipopolysaccharide. Changes of gene expression at the transcriptional level of mentioned cytokines were measured. In our study mainly affected pro-inflammatory cytokines were CCL-2 and IL-6. Two hours after LPS stimulation, cells influenced by sanguinarine and chelerythrine significantly declined the CCL-2 expression by a factors of 3.5 (p<0.001) and 1.9 (p<0.01); for those treated with prednisone the factor was 5.3 (p<0.001). Eight hours after LPS induction, both alkaloids significantly diminished the CCL-2 expression. The lower expression was found for sanguinarine--lower by a factor of 4.3 than for cells treated with the vehicle (p<0.001). Two hours after LPS stimulation, cells treated with sanguinarine decreased the IL-6 mRNA level by a factor of 3.9 (p<0.001) compared with cells treated with the vehicle. Chelerythrine decreased the level of IL-6 mRNA by a factor of 1.6 (p<0.001). Sanguinarine decreased gene expression of CCL-2 and IL-6 more than chelerythrine and its effect was quite similar to prednisone. Four hours after LPS stimulation, cells pre-treated with sanguinarine exhibited significantly higher expression (a factor of 1.7, p<0.001) of IL-1RA than cells without sanguinarine treatment. Our results help to clarify possible mechanisms of action of these alkaloids in the course of inflammation.

Pulmonary function alterations after correction of mitral stenosis.

The aims of the study is to demonstrate the degree of pulmonary function reversibility after successful correction of mitral stenosis, transvenous as well as surgical. Before and in the short- and long-term follow-up after mitral stenosis correction (mitral valve replacement and percutaneous balloon mitral valvuloplasty) echocardiographic and pulmonary function studies were performed in 125 patients with pure or dominant mitral stenosis in order to investigate the influence of hemodynamic changes on pulmonary function. Immediately after procedure moderation of bronchial obstruction could be detected although only in balloon valvuloplasty group. In pts after surgery dramatic decline of pulmonary function due to thoracotomy was found. In the long-term follow-up substantial improvement of all ventilatory parameters in both groups was revealed, diffusing capacity remained unchanged. The favourable evolution was comparable in both groups. The explanation are time consuming beneficial peripheral metabolic, circulatory and organic pulmonary changes, what implies also irrelevant changes of PF in the early phase and unalterable diffusing capacity. (Tab. 1, Fig. 4, Ref. 15.)

[Air pollution and sperm quality]. / Znecistení ovzdusí a kvalita spermií.

BACKGROUND: It has been described that an exposition of males to chemical substances may significantly impoverish quality and quantity of produced spermatozoa. The aim of our study was to test whether the polluted air in the Teplice district has negative effects on the quality of sperm of males living in this district. METHODS AND RESULTS: 325 males 18-year-old living in the Teplice district and in the control district of Prachatice were tested. Samples were taken in 1992 and 1994, always at the end of winter and in autumn. According to WHO laboratory manual for investigation of the human sperm, basic parameters were determined: volume of the semen, pH, motility, number and morphology of spermatozoa. In selected groups of males the frequency of aneuploidia of spermatozoa was also examined. Examination of aneuploidia was done using three color fluorescence in situ hybridisation with satellite DNA proves specific for X, Z and 8 chromosomes. Logistic regression was used for the data analysis and Odd's Ratio was estimated (OR's). OR's was found for the morphology of spermatozoa (4.1 and 10.1 for medium and high exposition respectively), for the head morphology (6.1 and 4.1) and in the percentage of motile spermatozoa (9.8 and 3.5). More intensively exposed males had higher frequency of disomy in chromosomes X (p = 0.012), XY (p = 0.01), and Y (p < 0.001). CONCLUSIONS: Bio-indicators of toxic and genetic impairment have shown lower quality of sperm in males in Teplice district.

Dairy cattle as a bioindicator of exposure to genotoxic substances in a heavily polluted area in northern Bohemia.

The exposure of dairy cattle to genotoxic agents in two districts with different levels of environmental pollution was estimated using cytogenetic analysis of bovine peripheral lymphocytes. The Teplice district represented an industrialized area where the air pollution rate is extremely high mainly in the winter, and the Prachatice district--an agricultural area with a relatively low level of pollution. The Ames test was used to examine feed samples for the content of mutagenic substances. Cows in the Teplice district showed a significantly higher count of aberrant cells (4.83 +/- 2.36) than cows in the Prachatice district (3.63 +/- 2.12). The sum of revertants induced by rinsings or extracts of feeds in both of the two test strains (Salmonella typhimurium TA 98 and TA 100) was significantly higher in the district of Teplice than in the district of Prachatice. The percentages of findings with mutagenic responses were 56.3 and 34.8% for the districts of Teplice and Prachatice, respectively. No mutagenic activity was found in milk samples collected in any of the districts. Apparently, the cows kept in the Teplice district were more exposed to genotoxic substances than the cows in the Prachatice district. The major source of this exposure was probably fresh fodder contaminated by industrial emissions.

A new Robertsonian translocation in cattle, rob(16;20).

A new centric fusion translocation, rob(16;20), was discovered in a phenotypically normal bull. C-banding revealed the dicentric nature of this centric fusion. This bull is a descendant of a German red pied bull and a Czechoslovakian red pied cow. Its mother and 26 half-brothers had normal karyotypes, indicating that this translocation arose "de novo".

Cytogenetic monitoring of farm animals under conditions of environmental pollution.

Cytogenetic examinations were carried out in 13 cattle farms, two herds of horses, one stag farm and 13 pig farms in areas with different levels of environmental contamination. The frequency of aberrant cells per 100 mitoses was 3.67 +/- 1.89 in pigs (n = 260) and 4.16 +/- 2.4 in herbivores (n = 497). This is a significant difference (p < 0.01). Ten times higher frequencies of chromatid exchanges were found in pigs. The examined herds were classified into three groups by the level of environmental contamination (satisfactory, impaired and severely impaired environment). Significant differences in aberrant cell counts were recorded between the groups of herbivorous animals. Significant differences in pigs were recorded only between herds in satisfactory and severely impaired environments. Significantly higher frequencies of aberrant cells were found in farms of herbivorous animals in the industrial area of Pardubice compared with findings in the South Moravian agricultural area (4.7% and 3.1% respectively). The effect of local contamination sources on farm environment was also investigated. A cattle farm located in the vicinity of a large chemical plant was examined five times at 6-month intervals. An autumn examination revealed significantly higher frequencies of aberrant cells compared with the spring examination.

Somatic chromosome mutations and morphological abnormalities in sperms of boars.

Frequencies of chromosomally aberrant peripheral blood lymphocytes and morphologically abnormal spermatozoa were investigated in 10 boars from each of 11 A.I. centres. Highly significant differences were found between A.I. centres concerning both chromosomally aberrant cells and morphologically abnormal sperms. A significant correlation was found for the overall frequency of aberrant lymphocytes and morphologically abnormal sperms in A.I. centres. The coefficient of correlation was 0.675 (p = 0.022). No significant correlation was found when the 110 boars were evaluated regardless of the A.I. centre.

[Influence of the migration of Ascaris suum larvae on blood parameters in the pig]. / Einfluss der Wanderung von Ascaris suum-Larven auf die Blutmesswerte beim Schwein.

Biochemical and hematological blood parameters were investigated in pigs experimentally infected with Ascaris suum. The most marked changes were recorded on day 5-8 post inoculation, during fever. In this period there was a marked decrease of concentrations of albumin, iron, thyroxin, A and E vitamins in blood serum, while compared with the control group the contents of A vitamin in liver did not change. Further, the concentrations of nonesterified fatty acid increased, as well as those of inorganic phosphorus and 11-hydroxycorticosteroids. Till day 13 PI the decrease of albumin and iron concentrations intensified and a recession of cholesterol serum binding capacity for iron was also recorded. Our results suggest that the acute phase of pig ascariasis is accompanied by changes in the host metabolism, generally corresponding to findings in fever states of different aetiology.

[The effect of feeding corn silage juices on selected indicators of metabolism in dairy cows given feed containing various proportions of silage and hay]. / Vliv zkrmování kukuricných silázních stáv na vybrané ukazatele metabolismu dojnic pri ruzném zastoupení silází a senází v krmné dávce.

In farm production conditions two comparative trials lasting 58 and 128 days were carried out. Acidogenic exposure to acids of silage juices, silage and haylage (lactic acid, acetic and butyric acids) in feed ration ranged from 0.33 to 2.85 mol per 100 kg live weight. It was proved that it was possible to include 9 to 10 litres of silage juices in feed ration under the condition that the total daily intake would not exceed 1.94 mol of acids per 100 kg live weight. This supplement of silage juices increased milk production. Higher amount of acid (2.65 and 2.85 mol) resulted in acidogenic and ketogenic type of silage juice enriched feed ration, which caused a more rapid decrease of lactation curve in dairy cows fed this feed ration than in those in the control group.

Biochemical changes in sows after eleven or more farrowings.

The animals examined were 30 sows after eleven or more farrowings (pluriparous sows) and 26 primiparous sows. The pluriparous animals were 75.1 months old on the average and had farrowed an average of 13.23 litters. The mean age of the primiparous sows was 12.8 months. The blood sera of pluriparous sows had higher concentrations of total protein and urea and lower levels of 11-hydroxycorticosteroids (11-OHCS) and lower aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase activities than those of primiparous sows. The pluriparous sows showed mild hypoglycaemia and hypocholesterolaemia. When insulin was injected i.m. in the dose of 1 I.U. per kg body mass, a decrease in blood serum glucose, total protein and potassium levels was recorded 60 min later in both pluriparous and primiparous sows; a significant rise in 11-OHCS concentration occurred only in the primiparous sows. It was concluded that the response of the hypothalamo-pituitary-adrenal axis in pluriparous sows to an insulin load is reduced. Studies of pluriparous sows contribute to a better understanding of the ontogenetic development of pigs throughout their postnatal development.

[The effect of feeding silage juices on selected hematologic and biochemical parameters in the blood (serum) and urine of feedlot bulls]. / Vliv zkrmování silázních stáv na zmeny vybraných hematologických a biochemických ukazatelu v krvi (séru) a moci býcku ve výkrmu.

The influence of silage juice feeding on the changes in 24 haematological and biochemical parameters in blood (blood serum) and urine of feeder bulls was evaluated in two comparative experiments in which no silage was included in feed rations. The supplement of 2 or 4 litres of juice per 100 kg of live weight represented a daily acidogenous stress of 0.79 to 1.93 moles of organic acids. In the first experiment this supplement was not proved to evoke any significant changes in the evaluated parameters. In the second experiment, in which the silage juices were enriched with sodium chloride, aqueous ammonia solution (26%) and molasses, a statistically significant increase in the level of beta-hydroxybutyric acid in blood and in the corresponding sum of ketone bodies (P less than 0.05 to 0.01) was observed in the experimental group of animals. The levels of sodium in serum were also increased (P less than 0.05). The average weight gains of bulls belonging to the experimental group were higher than those in the control groups.

[The effect of the light schedule on biochemical indicators in the blood, serum and urine of heifers during their estrus cycle]. / Vliv svetelného rezimu na biochemické ukazatele krve, séra a moce jalovic v prubehu ríjového cyklu.

The dynamics of 38 biochemical parameters of blood, serum and urine was studied in ten heifers during their oestrous cycle in a light house (80-340 lux) and a dark small house (10-40 lux). In the light stable a significant influence (P less than 0.05) was found to be exerted on five parameters and in the dark stable nine parameters, four being influenced in the same way in both houses: haematocrit value and haemoglobin in blood and cholesterol and progesterone in serum; the relationship of progesterone content in serum to the days of oestrous cycle was particularly high in the light house. The comparison of the parameters between the groups demonstrated a significant (P less than 0.05) influence of light regime, exerted on some days of the oestrous cycle upon the levels of inorganic phosphorus, total protein and aspartate aminotransferase activity (AST) in serum and upon haematocrit, haemoglobin and ketone bodies in the blood of heifers. However, the light regime did not influence the levels of progesterone which were somewhat higher in the light house but with no statistically significant difference from the dark house. A significant difference between the groups was obtained in the levels of sodium and phosphorus in urine (P less than 0.05) between the first and tenth days of the oestrous cycle. No differences in the oestrous cycle between the heifers in the light and dark stables were recorded. Neither was the duration of heat influenced significantly; it was only less manifest in the dark stable.

[The effect of a light regimen on the dynamics of biochemical indicators in the blood, serum and urine of heifers during 1 day]. / Vliv svetelného rezimu na dynamiku biochemických ukazatelu krve, séra a moce jalovic v prubehu jednoho dne.

Circadian dynamics of 38 biochemical parameters of the blood, serum and urine of heifers was studied under the natural light conditions of a light (160-180 lux) and dark (10-40 lux) small cow house. In each house, eight parameters were subject to a significant influence during the day, six of them being the same in both houses: calcium, chlorides, urea and thyroxine of blood serum, glucose and haematocrit in the blood of heifers. The comparison of parameters in different groups showed that different light regimes exerted a significant influence on calcium, chlorides, total protein, cholesterol, vitamin A and thyroxine in serum, haematocrit and leucocyte count in blood, and sodium and urea in the urine of heifers. The effect of feeding regime on the dynamics of parameters was tested by the calculation of the percentual fluctuation of their average values in heifer blood and serum before feeding (samples taken at 6.30 hrs) and after feeding (sampled at 10 hrs). In the light house, six parameters were judged to be less stable and one unstable (urea in serum). In the dark house six parameters were less stable and four unstable (calcium, urea, copper and thyroxine in serum).

[Development of aspartate aminotransferase, alanine and gamma-glutamyltransferase in the blood serum of dairy cows during the last month of pregnancy and the puerperium in relation to liver function]. / Vývoj aktivit aminotransferáz asparátu AST), alaninu (ALT) a gamaglutamyltransferázy (GMT) v krevním séru dojnic v posledním mesíci brezosti a v puerperiu ve vztahu k jaterním funkcím.

Over the period of two years, the blood serum of dairy cows from three localities was examined repeatedly for the activities of aspartate aminotransferase (EC 2.6.1.1) (AST), alanine aminotransferase (EC 2.6.1.2) (ALT) and gammaglutamyltransferase (EC 2.3.2.1) (GMT). First examinations were performed two to four weeks before the expected term of delivery, the repeated examinations between the sixth and eighth week after delivery. The results obtained were used to calculate AST/ALT and GMT/ALT indexes in the studied group of animals (n = 12). As found out, the decrease in these indexes or the equality of values from the sixth to the eighth week after delivery, as compared with the period of two to four weeks prior to delivery, were connected with the clinically detectable disturbances of puerperium, i. e. inflammable discharge from the reproductive organs of dairy cows; this was observed even in the cases when the enzymatic activity was within the references standards.