CORONARY HEART-DISEASE RISK-FACTORS IN HANSEN DISEASE SUFFERERS

In the frame of an epidemiologic study of Hansen’s disease (HD) sufferers, several risk factors have been investigated which might explain the high prevalence of coronary heart disease (CHD) among HD patients. The data analyzed in the present study are derived from 293 HD patients (157 men and 136 women). The patients, after having completed a WHO adopted questionnaire, were given a complete physical examination, a resting and an exercise electrocardiogram, and biochemical as well as hematological examinations. Coronary HD patients, when compared to noncoronary HD patients, showed statistically significant differences in the following parameters: (1) mean age, (2) mean concentration of the electrophoretic fraction of alpha-lipoproteins, (3) deviation from mean weight, (4) prevalence of hypertension, and (5) prevalence of the borderline lepromatous form of HD. However, the differences found when comparing other parameters, such as blood pressure, smoking, diabetes mellitus, total cholesterol, triglycerides, pre-beta and beta-lipoproteins, uric acid, erythrocyte sedimentation rate, ABO blood groups, etc., did not reach the level of significance. These findings suggest that HD sufferers are a special population subgroup with reference to CHD risk factors, differing in many ways from the general population

Impaired erythrocyte deformability precedes vascular changes in experimental diabetes mellitus

The effect of diabetes on the red blood cell (RBC) deformability and its association with histological vascular changes was investigated in 35 streptozotocin-induced diabetic Wistar rats in a 30-day experiment and compared to 10 controls. RBC deformability was significantly impaired in the diabetic rats on day 5 (p<0.001) and continued to deteriorate until day 20. On the 20(th) day, the diabetic rats were randomly divided into two groups (group A: insulin-treated; group B: non-insulin-treated). A slight, non-significant (p=0.20) improvement in RBC deformability was noticed in the insulin-treated group. In vitro incubation of RBCs with insulin did not improve the acquired RBC rigidity in either diabetic group. In contrast, it caused a significant reduction in RBC-deformability in the controls. On day 30, histological examination of arterial specimens from various sites revealed moderate to significant thickening in medium- and small-size artery and arteriole walls in both diabetic groups, with no evidence of diabetes-related changes in large, elastic-type arteries. No vascular changes were noticed in nine diabetic rats that succumbed between days 10 and 15. The results of this study indicate that reduced RBC deformability is an early manifestation of abnormal blood rheology in experimental diabetes, and precedes the evolution of vascular changes

Management and outcome of severe diabetic foot infections

We evaluated the bacteriological and clinical efficacy of the combination of ciprofloxacin /clindamycin in severe diabetic foot infections and we tried to elucidate the relationship between the vascular status of the lower limbs and the outcome of these infections. Initial empirical antibiotic therapy with ciprofloxacin (300 mg/ 12 hrs IV) and clindamycin (600 mg/8 hrs IV) was administered in 84 hospitalized diabetics with severe lower limb infections. This treatment was continued only in cases with primary clinical improvement. The major endpoints of treatment were: cure, improvement and failure. Evaluation of the vascular status of the lower extremities was performed by high resolution imaging coloured ultrasonography, US-Doppler and TcPO2 measurements. Polymicrobial flora was found in 83% of the cases with an average 2.8 species per specimen. Osteomyelitis was detected in 58% of the patients. After five days of IV administration of ciprofloxacin and clindamycin the response rate was 95.2%. After three weeks of therapy the clinical outcome was: cure 54.8%, improve ment 23.8%, and failure 21.4%. The long term follow up (mean duration 16 months) revealed complete healing of the skin lesions in 63 patients (75%). Unfavorable prognostic factors for these infections were: ankle systolic blood pressure <50 mmHg or toe systolic blood pressure <30 mmHg and TcPO2 < 20 mmHg. The side effects of the combination of ciprofloxacin/clindamycin were mild and there were no cases of pseudomembranous enterocolitis. The combination of ciprofloxacin/clindamycin was found to provide an excellent empirical as well as definitive treatment of severe diabetic foot infections. The evaluation of the vascular status and the severity of ischaemia of the lower limbs has a strong predictive value in the outcome of these infections

Prevalence, treatment and control of dyslipidaemia in Switzerland: still a long way to go.

BACKGROUND: There is little information regarding the prevalence and management of dyslipidaemia in Switzerland. DESIGN: Cross-sectional population-based study of 3238 women and 2846 men aged 35-75. METHODS: Dyslipidaemia prevalence, treatment and control were defined according to PROCAM guidelines adapted to Switzerland. RESULTS: About 29% of the overall sample presented with dyslipidaemia, of which 39% were treated and 58% of those treated were controlled. Among the 710 patients with personal history of cardiovascular disease (CVD) and/or diabetes, 632 (89%) presented with dyslipidaemia, of which 278 (44%) and 134 (21%) patients were treated and adequately controlled, respectively. On multivariate analysis, hypolipidaemic drug treatment was positively related with age and body mass index (P for trend <0.001), and negatively related with smoking status (P for trend <0.002), whereas personal history of CVD and/or diabetes had no effect [odds ratio (OR)=1.12, 95% confidence interval (CI): 0.90-1.38]. Adequate control of lipid levels was negatively related with female sex (OR=0.65, 95% CI: 0.45-0.94) and personal history of CVD and/or diabetes (OR=0.42, 95% CI: 0.30-0.59). When personal history of CVD and/or diabetes was replaced by PROCAM risk categories, patients in the highest risk were also less well controlled. CONCLUSION: In this population-based study, one-third of the participants was dyslipidaemic, but less than half was treated and only one-fifth was adequately controlled. The low treatment and control levels among individuals at high risk for CVD calls for a better application of recommendations regarding personal preventive measures