Effect of the DASH-diet and salt Kardisal® on blood pressure in adolescents with prehypertension (Cooperative multicentre interventional study).

BACKGROUND: In a cooperative multi-center interventional study of 60 probands with prehypertension and normal BMIs were followed for 3 months. DESIGN: The intervention included the DASH diet for 3 months in 30 probands plus sodium limited intake using the low sodium salt Kardisal® (60% NaCl, 40% KCl) (group A) and the DASH diet for 3 months in 30 probands without Kardisal® (group B). RESULTS: In group A (n=26 probands evaluated) the systolic blood pressure (median) decreased significantly from 138 to 129 mmHg (p<0.001), while the diastolic blood pressure had a statistically non-significant decrease. In group B (n=25 probands evaluated) the SBP decreased significantly from 135 to 132 mmHg (p<0.001), and the DBP decreased significantly from 85 to 69 mmHg (p<0.001). CONCLUSION: Despite a relatively short period on the DASH diet, the intervention produced a significant decrease in the blood pressure of prehypertensive adolescents. The additional use of a low sodium salt for home cooking was not found to have any advantages over the DASH diet alone.

The relationship between family socioeconomic condition and childhood injury frequency in selected locations in the Czech Republic.

BACKGROUND: Childhood injury rates are monitored worldwide because they markedly affect morbidity and mortality of children. There are numerous works that point out the relationship between family socioeconomic status and injuries, where lower socioeconomic levels are linked to higher numbers of injuries. MATERIAL/METHODS: The goal of this work was to evaluate the relationship between family socioeconomic status and childhood injuries in the Czech Republic. The research was carried out between 1/7/2009 and 31/12/2010. A 2-part questionnaire was used to gather information. The first part, "Injury/poisoning of children," included information on the injury itself; the second part, "Family functionality," concerned family socioeconomic situations. We collected a total of 874 questionnaires in the South-Bohemian region and 132 questionnaires from a selected county in the North-Bohemian region. A database identical with the questionnaire assignment was established, comprising all the data accumulated. RESULTS: The injury rate in families living in poor socioeconomic situations in locality 8 was statistically significantly higher compared to families in good socioeconomic situations. The number of home injuries was 205. Families with incomes that were twice the subsistence level had more child protective measures in their households. There was a statistically significant relationship between the number of child protective measures and injury frequency in families. Children in families having higher incomes (twice that of subsistence level) were more likely to suffer injuries related to organized sports as compared to those in families having lower incomes. CONCLUSIONS: The literature and research data show that preventive programs have the largest effect on reduction in childhood morbidity and mortality with respect to injuries.

Birth after cesarean section.

BACKGROUND: The number of incoming expectant women who have previously experienced cesarean section has increased. This work sought to find the frequency and connections between vaginal deliveries, cesarean sections, and iterative cesarean sections from 2004 to 2008. MATERIAL/METHODS: In all, 828 women with previous cesarean sections were included. From this group, 8282 vaginal deliveries were performed. During these years, 828 women had a history of the cesarean section; in these women, iterative cesarean sections were indicated. To evaluate knowledge of educational material designed for women being prepared for the iterative delivery, we used information compiled on experience from 2002 to 2003; the same approach was used to evaluate the nursing process on interventions and diagnoses of cesarean sections. RESULTS: From 2004 to 2008, 11 279 deliveries were performed in the Perinatological Center in Ceské Budejovice; this was significant (P<.001). The same result was obtained in the relation for the total number of deliveries and those performed by the iterative cesarean section. The number of iterative cesarean sections in women who had already experienced the cesarean section (828) and delivered by cesarean section again is 620. Other data were not significant. Only 2 to 3 pregnancies next to the first cesarean section were statistically significant in 2004 and 2005. CONCLUSIONS: If a trial of labor after cesarean does not proceed to vaginal birth, the woman will need support and encouragement to express feelings about another cesarean birth.

Aerobic exercise has beneficial impact on atherogenic index of plasma in sedentary overweigh and obese women.

OBJECTIVE: In obese patients, we hypothesized physical exercise (PE) to affect lipids through its intrahepatic fat accumulation-lowering effect, associated with a decrease of total body fat (Fat%) and even weight (Mass). DESIGN AND SETTING: Thirty seven sedentary, non-diabetic women (BMI median 34.8) from our out-patient department were tested. Elimination criteria: recent weight reduction, lipid-influencing or heart rate-modifying medication. PARTICIPANTS: 50 entering, 37 finishing, 7 excluded for processing failure, 6 did not fulfill the protocol. INTERVENTIONS: PE protocol: 60 min supervised trainings, intensity at 65% of VO2max, modified by the clamp heart rate test. Median of total training hours was 34 during 115 days (median). MAIN OUTCOME MEASUREMENTS: an effect of PE on total cholesterol (CH), triglycerides (TG), HDL-cholesterol (HDL_C), LDL-cholesterol (LDL_C), index of atherogenity (IA), atherogenic index of plasma (AIP), maximum peak oxygen consumption (VO2max), Mass, body mass index (BMI), waist circumference (Waist) and Fat%. RESULTS: Statistically significant differences at start (_s) and the end (_e) of PE (p<0.05): AIP -0.049, Mass -3.6 (kg), BMI -1.7 (kg/m2), Waist -2.5 (cm), Fat% -2.5, VO2max 2.92 (L.min-1kg-1). Correlation coefficients, Pearson's between Gaussian distributed (Gd-v) variables and Spearman´s (non Gd-v) statistically significant (p<0.05): IA and BMI, IA and Mass, IA and Waist, IA and Fat%, LDL and BMI, LDL and Mass, LDL and Fat%, LDL and Waist, IA and VO2max, LDL_C and VO2max. CONCLUSIONS: PE improves lipid profile towards production of antiatherogenic particles more likely due to changes in anthropometric parameters than in improvement of physical fitness.

Relationship of IL-6, IL-8, TNF and sICAM-1 levels to PROM, pPROM, and the risk of early-onset neonatal sepsis.

BACKGROUND: Intraamniotic infections negatively affect the mortality and morbidity in parturients and newborns. The prognosis of the disease is associated with a timely diagnosis of these conditions. One of approaches to providing timely information on the risk of the initiation of intra-amniotic infection and early-onset neonatal sepsis is the examination of cytokine levels. OBJECTIVES: The purpose of the work was to evaluate the importance of the cytokines, IL-6, IL-8, and TNF-alpha, and the adhesive molecule, sICAM-1, as risk factors for early-onset neonatal sepsis and intra-amniotic infections. METHODS: In a group of 152 women we sampled the blood from the umbilical cord vein immediately after delivery for the determination of the cytokines IL-6, IL-8 and TNF-alpha, and the adhesive molecule, sICAM-1, in newborns. RESULTS: The sensitivity and specificity results are as follows, respectively: IL-6, 0.800 and 0.972; TNF-alpha, 0.364 and 0.943; IL-8, 0.875 and 0.965; and sICAM-1, 0.833 and 0.952. CONCLUSIONS: For screening purposes, it is suitable to determine levels of IL-8, IL-6, and sICAM-1. For the screening examination, one of the cytokines mentioned is sufficient, i.e., IL-8 or IL-6, or the level of the adhesive molecule, sICAM-1. It is unnecessary to combine these markers.

Optimization of therapeutic procedure during LDL-apheresis - verification of the computerized model in clinical practice.

UNLABELLED: LDL-apheresis is a very effective method in the treatment of resistant hypercholesterolemia when other therapies fail. To maximize the efficacy of the use of LDL-absorbers, we created a computerized model. The aim of this study is to verify it in clinical use. PATIENTS AND METHODS: A therapeutic technique of immunoadsorption was used, applying a pair of Lipopak columns (Pocard, Russia). Plasma was separated by a continuous-flow plasma separator (Cobe Spectra, USA); adsorption was controlled by adsorption-desorption equipment Adasorb (Medicap, Germany). 494 LDL-apheresis procedures had been performed in nine patients with primary hypercholesterolemia in the earlier, initial study; 47 other procedures (202 therapeutic cycles) were used in this verification study. The program for procedure planning uses Microsoft Excel for Windows. Complex metabolism of the LDL-cholesterol was neglected (owing to the short-time period of the procedure) and the procedure calculated as continuous filtration. The input enterer into the program includes basic patient data (mass, height, sex and initial plasma LDL level in mmol/L). RESULTS: The results show a very good match between calculated levels and the real laboratory results in most procedures, but in some procedures we observed minor differences (0.05 mmol/L), which was caused by procedure adjustments due to technical reasons. However, some methodological and medical details must be carefully observed (initial cholesterol level, correct calculation of plasma volume, and the precise capacity of adsorbers that must not be overshot); as they influence the correct match between calculated and real results significantly. CONCLUSIONS: Although our software uses a fairly simplified model of the LDL-cholesterol kinetics during the LDL-apheresis, it is providing a great aid in the procedure planning. It is also suitable for practical use because it only requires a few commonly used and readily available input values.

Optimization of the therapeutic procedure during LDL-apheresis--a computerized model.

UNLABELLED: LDL-apheresis is a very effective method for the treatment of resistant hypercholesterolemia when other therapy (dietary, or medication) fails. To maximize the efficacy of the LDL-absorbers we aimed to create a computerized model. PATIENTS AND METHODS: The therapeutic technique of immunoadsorption was used, applying a pair of columns, the Lipopak, Pocard, Russia. Plasma was separated by a continuous-flow plasma separator, the Cobe Spectra, USA; adsorption was controlled by adsorption-desorption equipment, ADA, Medicap, Germany. 494 LDL-apheresis procedures (treatment interval 17.5+/-1.6 days) were used to treat nine patients with primary hypercholesterolemia followed during the consecutive 3.6+/-0.5 years. Metabolism of LDL-cholesterol is known to be multicompartmental and dynamic, but for the short-time period of the procedure it can be simplified and one can calculate the procedure as a continuous filtration. We developed a program for procedure planning, using Microsoft Excel for Windows. Inputs inserted into the program include only basic patient data (mass, height, sex and initial plasma LDL level in mmol/l). RESULTS: The results show a very promising match between our planning of the procedures and the real laboratory results. The drop in calculated vs real plasma LDL-cholesterol level differ no more than +/-10%. CONCLUSIONS: Although our software does not take into account many well known details about the metabolism of cholesterol, in given conditions it can provide a fairly precise prediction of procedure parameters. It is also suitable for practical use, because it requires only a few commonly used and readily available input values. Immunoadsorption with Pocard absorbers is a potent and safe method of therapy in indicated patients.