Revista de síndrome metabólico

Background: Childhood and adolescent obesity is a global public health concern because of associated increased risk of cardiovascular diseases later in life. Although there are several studies on childhood obesity in Nigeria, few have assessed it in adolescents.

Objectives: This study intends to assess the prevalence of overweight and obesity in adolescents in urban northern Nigeria.

Method: A cross sectional school based survey was conducted to determine the prevalence of overweight and obesity. Stratified sampling was used to select 718 students. Their weight and height were measured and used to compute the Body Mass Index (BMI). Overweight and obesity were defined using the International Obesity Task Force (IOTF).

Results: The prevalence of obesity and overweight were 0.84% and 1.98% respectively; with advancing age as a risk factor for both overweight and obesity. Multivariate logistic regression showed that the risk of overweight was almost two times higher with advancing age adjusted odds ratio of {1.79} with a p-value of { 0.03} and C.I. { 1.05 - 3.09}, adjusted for gender and school type.

Conclusion: The data suggest the prevalence of overweight and obesity are low, and that advancing age is a risk factor for obesity.

This paper assesses whether there is a significant difference in socioeconomic condition (income), insurance status, and Length of Stay (LOS) of inpatients diagnosed with diabetic myocardial infarction in teaching vs nonteaching hospitals. A retrospective data analysis of discharges was conducted from the 2008 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Sample selection was based on the International Classification of Diseases, Ninth Revision, codes with LOS as the outcome variable. Teaching hospitals have longer LOS compared to nonteaching hospitals for patients with incomes below $48,000 (χ2=16.185, df=6, P < 0.013). The duration of hospital LOS is higher in teaching than in nonteaching hospitals for patient insurance (χ2=24.975, df=6, P=0.0001). For patients with Medicare, the hospital stay of 1 day and less is lower in nonteaching hospitals. Teaching hospitals have higher rates of LOS than nonteaching hospitals for the age group, 65-74 (χ2=37.294, df=6, P=0.0001). Especially for hospital stays of more than 6 days, the LOS is higher in teaching hospitals. The difference in LOS in teaching and nonteaching hospitals is statistically significant for males (P=0.009) vs. females (P=0.003). The results of this study indicate that the difference in LOS between teaching and nonteaching hospitals based on patient age, income, and insurance is statistically significant. When one controls for the independent variables in this study, the difference presented is large enough to affect clinical policy. These findings highlight the need for interventions to increase awareness of health care disparities that exist among inpatients with diabetic myocardial infarction, especially for low-income and older patients who do not qualify for Medicare.

Introduction: The development of rapid, non-invasive and inexpensive tools to screen individuals at risk of developing metabolic syndrome and its consequences of type 2 diabetes and coronary artery disease is important from an epidemiologic and public health view.

Method: A cross sectional analysis was performed with 398 patients from January to November 2011 from records of an outpatient department of a district hospital in rural Malaysia, comprising all races, for prevalence of Metabolic Syndrome (MetS) according to different published criteria.

Result: The prevalence of MetS by different criteria was 49.0% by Hypertensive-Waist (HW), 32.7% Hyper triglyceridaemic-Waist (HTGW), 55.3% by International Diabetes Federation (IDF), 55.3% by Harmonized NCEPATP111 (HNCEPATP111), and 61% by Modified WHO (MWHO). Prevalence of type 2 Diabetes Mellitus (DM) by different criteria was 53.3, 55.4, 55.5, 56.3, 70.3 % respectively and that of Coronary Artery Disease (CAD) was: 21.0, 23.1, 22.7, 23.3 and 23.3% respectively. The agreement of IDF with HW, HTGW, Harmonized NCEPATP111, MWHO using Kappa index was 0.744, 0.560, 0.870 and 0.494 respectively.

Conclusion: HW is able to screen MetS better than HTGW and has better concordance with IDF, although its ability to screen for DM and CAD is somewhat less than HTGW. HW is therefore an excellent screening test for MetS as it is immediately available, non-invasive, requires no laboratory tests, has no appreciable cost, has better concordance with IDF than HTGW and is comparable to IDF and HNCEP for screening DM and CAD.

Coronary Artery Disease (CAD) incidence varies according to certain risks; patients with pre-existing cardiovascular heart disease who later develop diabetes mellitus (DM) have the greatest risk, and non-diabetic patients with CAD, diabetic patients without CAD, and patients with metabolic syndrome (MetS) the next three high risk categories. Insulin resistance, a major feature in both DM and MetS probably causes atherogenic dyslipidaemia.

Objectives: (1) to determine the prevalence of MetS and DM in the study population, (2) to determine the prevalence of Coronary Artery Disease (CAD) in DM with MetS (DM+/MetS+), in DM alone (DM+/MetS-), MetS alone (Mets+/DM-) and in ‘normal’ group (DM-/MetS-), and (3) to determine the prevalence of MetS in DM patients.

Results: 62.1% of the study population had MetS, 44.7% had DM, 83.6% had both MetS and DM. 18.6% had CAD. CAD was seen in 25.2% of DM+/MetS+, 19.1% of MetS+/DM-, 14.3% of DM+/MetS-, and 11.6% of MetS-/DMpatients. DM+/MetS+ group had the highest association with CAD OR= 2.19, CI (1.43-3.35), DM-/MetS- group the lowest association OR=0.45, CI (0.27-0.73), and DM+/MetS- (OR=0.69, CI (0.28-1.73) and MetS+/DM- (OR=0.94, CI (0.57- 1.58) had no significant association with CAD.

Conclusion: Only DM+/MetS+ patients had a high risk of developing CAD. Risk of CAD in patients with MetS+/ DM- and DM+/MetS- was not statistically significant in multivariate analysis, while the group with neither, MS-/DM-, had the lowest risk of developing CAD.

Background: Gene Therapy (GT) aims to fix a disease linked with genetic abnormality. Gene Therapy (GT) is currently receiving an attention from scientists, clinicians and the general public in an attempt to correct genetic defects. It including with congenital abnormalities, craniosynostosis (syndromic and nonsyndromic), craniofacial deformity, and neurodevelopmental disorders. However, its application is beset with complications partly because of lack of advanced knowledge, research and partly because of vested interest by the society.

Objective: This study is an attempt to highlight some of the major benefits of gene therapy which leads to define the role played by medical informatics in facilitating rational use of gene therapy.

Materials and methods: An attempt was made to review major studies in the international literature to synthesize the potential risks, benefits of gene therapy. We also reviewed the tools and techniques in this field of medical informatics. W hich can be employed for spreading awareness about gene therapy among common people? We developed a conceptual model of matching the key concepts with the current protocols used in the field of medical informatics.

Results: GT offers a new hope for the treatment of birth defects, neurodegenerative disorders like Huntingtons disease. Its application in Parkinsons disease has moved a step closer to acceptance in the wake of its successful double blind clinical trial. The educational media, fall under four categories, viz., audio media, the visual media, the audio-visual and the virtual-media in vitro and vivo. The simulation and animation capabilities of the media are quite helpful in the conceptualization of gene therapy. The audio-visual media are useful for counseling in matter of genetic disorders the public.

Conclusion: Our study suggests that an integrated and holistic approach of medical informatics. It can be highly beneficial for the advanced application of gene therapy in the years to come. G T has become debatable and often controversial because of tendency to use for manipulating the desirable attributes. Moreover, its rational use is likely to benefit the mankind.

Aims: Metabolic Syndrome (MS) is a heterogenic entity and its major limitation was the use of binary components and the dependence of some criteria to ethnic origin and/or gender. We seek to remodel MS criteria to adapt them to the Tunisian context and to determine a sole quantitative MS parameter.

Materials and methods: 592 subjects who underwent routine control were investigated for biochemical, anthropometric and clinical examination. The diagnosis of MS was based on the IDF and AHA/NHLBI definition.The computer model HOMA 2 was used to determine HOMA-β, HOMA-S and HOMA-IR. Triglycerides (TG), High Density Lipoprotein cholesterol (cHDL), Systolic Blood Pressure (SBP), HOMA-IR and Waist Circumference Stature (WCS) were used to calculate the different MS markers. The area under curve of ROC curves were used to compare the powers of these MS parameters.

Results: HOMA-IR was more informative about glycaemia abnormality, WCS express better android obesity, and TG/cHDL ratio characterizes dyslipidemia. (TG x WCS x HOMA-IR x SBP) / cHDL parameter was more accurate to estimate MS occurrence; its cut-off point is 106.75

Conclusion: This marker, with sensitivity and specificity of 94.4 and 85.1 per cent, can be used either to diagnose or to predict MS occurrence.

Background: The atrial fibrillation (AF) is the iperkinetic arhytmia most frequently encountered in the general population. Metabolic Syndrome (MS) is a condition characterized by a set of cardiovascular risk factors that include: abdominal obesity, hypertension, impaired fast glucose, elevated tryglicerides and low HDL-C. We set out to analyze the impact of the MS has on our population looking to explain the reasons for the possible correlation with AF.

Methods: MS was defined according to the definition of the guidelines of NCEP-ATP III. 350 patients were enrolled in the Department of Cardiology of our University Polyclinic of Palermo. Among these patients, 149 (42.57%) had Paroxysmal Atrial Fibrillation (PAF) and 201 (57.42%) had Chronic Atrial Fibrillation (CAF). We had two groups, the first 170 patients (48.57%) with AF and MS, and the second 180 patients (51.42%) with AF but without MS.

Results: In our population, there is not a significant difference in the prevalence of hypertension between group with MS and group without MS (p=0.52), while there is a significant difference in prevalence between the two groups in relation to other variables as overweight/obesity, hyperglycemia, hypertryglicerydemia and low HDL-C (p<0.0001).

Conclusions: Our results lead us to think that metabolic and hormonal disorder may be important in the pathogenesis of the CAF and in the maintenance of the arythimia, although by mechanisms not yet completely known. Inflammation and oxidative stress important for the MS have been proposed as etiologic factors also implicated in the pathogenesis of AF or at least maintaining.

Aims: We have investigated to what extent Metabolic Syndrome (MS) is related to Coronary Artery Disease (CAD) incidence and we tried to determine a metric parameter combining MS quantitative components to be used as a screening tool to diagnose CAD.

Materials and methods: 239 patients and 244 control subjects were investigated for clinical, biochemical, anthropometric and angiographic information. CAD is defined as 50% stenosis on the left main coronary artery or multiple significant (≥ 70% stenosis) in more than one coronary artery. The diagnosis of MS was based on the IDF and AHA/NHLBI definition. The computer model HOMA 2 was used to determine HOMA-β, HOMA-S and HOMA-IR. Triglycerides (TG), High Density Lipoprotein cholesterol (cHDL), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), HOMA-IR and Waist Circumference (WC) were used to calculate the different MS markers. The area under curve of ROC curves were used to compare the powers of these MS markers.

Results: MS was significantly related to the CAD. Each MS quantitative component was a significant discriminating factor for CAD. FPG followed by SBP were the principal predictive factors of CAD. A metric parameter combing MS qualitative components [(TG/cHDL) × (HOMA-IR × WC)] + SBP was more accurate to estimate CAD risk. Its cut-off point was 247.1

Conclusion: MS was associated with CAD. This marker, with sensitivity and specificity of 86.2 and 73.0 per cent can be used either to diagnose or to predict CAD incidence.