Faculty Bibliography

BACKGROUND/AIMS/OBJECTIVE:We studied the effect of the combined treatment with an angiotensin-converting enzyme (ACE) inhibitor (ramipril) and eplerenone compared with ramipril alone in streptozocin-induced diabetic rats. METHODS:Wistar rats were divided into 4 groups: nondiabetic controls, streptozocin-treated diabetic rats (50 mg/kg), diabetic rats receiving ramipril (1 mg/kg) and diabetic rats treated with the combination of ramipril (1 mg/kg) and eplerenone (100 mg/kg) for 8 weeks. Our model produced early-stage diabetic nephropathy. RESULTS:The diabetic rats developed polyuria, proteinuria, hyperfiltration (assessed by creatinine clearance) and histopathological evidence of renal injury including glomerular hypertrophy and mesangial expansion. Ramipril reduced proteinuria but its combination with eplerenone did not produce any greater benefit. Both treatment approaches prevented glomerular hypertrophy. Addition of eplerenone to ramipril prevented glomerular hyperfiltration. CONCLUSION/CONCLUSIONS:Whether eplerenone should be used in addition to an ACE inhibitor or an angiotensin receptor blocker at an early stage of diabetic nephropathy remains questionable.

OBJECTIVES/OBJECTIVE:Acute poisoning is one of the most common situations managed in the emergency department. Significant differences have been reported concerning the prevalence and etiology of poisoning. This study aims to present the epidemiologic and clinical characteristics of poisonings in the region of Thrace in Northern Greece, where no similar studies have been performed. METHODS:A prospective study was carried out in our hospital's emergency department during 4 years (1999-2003). Atotal of 223 adult patients were admitted with acute poisoning, 87 males (39%) and 136 females (61%). RESULTS:Mean age of male and female patients was 37.1 years (standard deviation 16.1) and 33.4 years (standard deviation 14.5), respectively. Intoxications were more common in summer (34.1%). The median time between poisoning and presentation was 4 hours. Poisonings were more common in the urban population (64.1%). Psychotropes were the leading cause of poisoning in patients with a psychiatric disease (74.1%) and analgesics in all the other patients groups (34.8%). The clinical status on admission was: conscious (45.7%), confused (35.4%), precoma/coma (18.9%). Haemodialysis was performed only in one patient and respiratory support was necessary in 10 patients. An antidote was administrated in 73 patients. Median hospital stay was 1 day. Two patients died (0.9%). CONCLUSIONS:Poisoning's aetiology varies significantly in different countries. Previous suicide attempts are common in these patients. Precipitating factors can be major depressive, or dysthymic disorders. The mortality rate is low.

INTRODUCTION/BACKGROUND:The objective of this study was to determine the prevalence of childhood obesity and elevated blood pressure (BP) in a rural population of northern Greece. METHODS:In total, 572 schoolchildren between the age of 4 and 10 years were examined. Obesity was defined using three different standards: (1) body mass index (BMI) charts of the French society of Paediatrics (FR), selected because of the low cardiovascular risk profile and low prevalence of obesity in France; (2) United States BMI CDC charts (US), selected because of the high prevalence of childhood obesity in the USA; and the reference curves of the International Obesity Task Force (IOTF). Children with elevated BP were defined as BP > or = 95th percentile for age, gender and height, according to the Greek national charts. RESULTS:The prevalence of obesity for boys was 13.6% (IOTF), 23.7% (US) and 31.7% (FR); for girls 14.4% (IOTF), 21.1% (US) and 35.1% (FR). The prevalence of elevated BP was 7.9% (45 children). It was 5 to 6 times more common for obese than non-obese children to have elevated BP (relative risk of 5.2 to 6.2 and odds ratio 6.3 to 7.7). CONCLUSIONS:The results confirm the high prevalence of childhood obesity in Greece, in this study found to be more prevalent in rural than urban Greece. The IOTF criteria tend to underestimate obesity and may not be optimal for use in a primary clinical care setting where the approach is for health education and patient treatment, rather than purely epidemiological. The study also confirms a strong relationship between high BP and increased BMI.

INTRODUCTION/BACKGROUND:We investigated the relation between C-peptide levels and the prevalence of diabetic complications in patients with type 2 diabetes and the metabolic syndrome. METHODS:This study includes all patients with diabetes and treated only with oral hypoglycemic agents who were admitted to our department in 2006. The chronic complications of diabetes (vascular disease, retinopathy, nephropathy, neuropathy) were evaluated. RESULTS:The 77 patients with type 2 diabetes and treated only with oral hypoglycemic agents were divided in two groups, with and without the metabolic syndrome. The two groups did not differ in glycemic control, blood pressure levels, or duration of diabetes. CRP levels were higher in patients with the metabolic syndrome (p=0.03), and nephropathy was more common (70%, compared with 33%). Similar, C-peptide levels were higher in patients with the metabolic syndrome: 3.12+/-1.36 compared with 1.82+/-1.25 (p<0.001). In patients with the metabolic syndrome, C-peptide levels did not differ in patients with or without diabetic complications (3.01+/-1.16, compared with 3.96+/-2.55; p=0.51). Similarly, C-peptide levels in patients without the metabolic syndrome did not differ according to the presence of complications of diabetes (2.25+/-1.21 versus 1.36+/-1.16; p=0.07). However, C-peptide levels were higher in patients with diabetes and the metabolic syndrome who had either nephropathy or vascular disease, compared with those with those complications but without the metabolic syndrome (p=0.01). CRP levels did not correlate with C-peptide levels in any patient group. DISCUSSION/CONCLUSIONS:Higher C-peptide levels were associated with metabolic syndrome in patients with type 2 diabetes and in diabetes patients who also had nephropathy and vascular disease.