[The ankle brachial index in type 2 diabetes]. / Kotníko-pazni index u nemocných s diabetes mellitus 2. typu.

INTRODUCTION: The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI < 0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated. METHODS: We examined 253 T2DM subjects (135 males, 118 females, aged 66 +/- 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined as manifest CV diseases, elevated coronary calcium score (CAC) by Agatston (> 101) or according to the global CV Risk Score > or = 5% (SCORE). STATISTICAL METHOD: Wilcoxon's unpaired test, chi2 test, multiple logistic regression. RESULTS: The ABI < 0.9 was found unilateral in 23 T2DM (8%), bilateral in 24 (9%), in older males (71 +/- 8 years) with higher CAC (600 +/- 707) (p < 0.01), higher total cholesterol (5.4 +/- 1.3 mmol/L) and total homocystein (17.2 +/- 7.1 micromol/L) (p <0.05) in comparison to those with the ABI > or = 0.9 (age 66 +/- 9 years, CAC 234 +/- 458, total cholesterol 5.0 +/- 0.9, total homocystein 14.3 +/- 78). Many CV risk factors correlated positively with the low ABI < 0.9; it was significantly independently associated with age (p < 0.001), smoking (p < 0.01), LDL-cholesterol, total homocystein and CAC (p < 0.05). Low ABI < 0.9 predicted ischemic stroke in subjects with T2DM and manifest CV diseases in the further 3 years. There was no correlation between the ABI and the ultrasensitive C-reactive protein. CONCLUSION: Low ABI < 0.9 was in a strong association with the CV risk. The ABI measurement is a simple, noninvasive, time-nonconsuming and inexpensive method for subclinical atherosclerosis detection; the ABI can supply standard methods for the CV risk prediction.

[Monitoring of cardiovascular risk factors in patients with diabetes type 2]. / Kontrola kardiovaskulárních rizikových faktoru u diabetiku 2. typu.

The control of basic cardiovascular risk factors was examined in a sample of 415 diabetes type 2 patients, aged 66 +/- 10 years, with a 9.4 +/- 8 years long history of diabetes, both genders represented proportionally; 95% of the sample were hypertensive. The recommended blood pressure value was achieved by 13% males and 17% females. Antihypertensive monotherapy was indicated in 40% of the sample. Renin-angiotensin-aldosteron system inhibitors were prescibed to 90% of the sample. The fasting glycaemia < or = 6 mmol/L were achieved in 10% males and 11% females; glycosilated hemoglobin < 4.5% in 20% males and 24% females; 60% of the sample had antidiabetic pharmacotherapy--44% males and 48% females used metformin. Total fasting plasma cholesterol < 4.5 mmol/L was achieved in 31% males and 23% females; LDL-cholesterol < 2.5 mmol/L was achieved in 31% males and 41% females. The target values for diabetics in secondary prevention of cardiovascular diseases or with subclinical atherosclerosis was achieved in 13% of the sample. Statins were prescribed in 60% of the sample, fibrates in 4%. Only 2 females achieved all the target values. Hypolipidemic and antihypertensive drug therapy is unsatisfactory; there is certainly a big potential in life style changes among the diabetic patients.

[Macrovascular and microvascular complications in type 2 diabetes patients]. / Makrovaskulární a mikrovaskulární komplikace u diabetiku 2. typu.

The prevalence of chronic vascular complications is higher in patients with type 2 diabetes mellitus (DM2). The objective of our cross-sectional study was to assess the incidence and types of macrovascular (MVC) and microvascular (mvc) complications and to analyse their relation to the different risk factors and biomarkers in order to improve their prevention. SET OF PATIENTS AND METHODOLOGY: 415 patients (219 men and 196 women) with an average age of 66 +/- 9 years enrolled in the study. A total of 95% of patients with DM2 had a history of hypertension, 27% had MVC (of which 55% had ischaemic heart disease), and 54% had mvc (ofwhich 95% had diabetic nephropathy). RESULTS: The patients with vascular complications were significantly older and had a longer history of DM2; they did not differ for their systolic blood pressure, but had a higher pulse pressure and took more antihypertensives. They did not differ for their lipid levels or the respective therapy. Diabetic patients with MVC and mvc had higher insulin resistance, higher plasmatic levels of total homocysteine and a higher incidence ofalbuminuria or proteinuria. The factors which significantly and independently associated with MVC were male gender, age over 60 years, higher hs-C-reactive protein (hs-CRP) exceeding 1 mg/l, glycaemia over 5.6 mmol/l, lower diastolic blood pressure and lower HDL-cholesterol; mvc associated with higher age over 60 years, a history of DM2 exceeding 8 years, and hs-CRP above 1 mg/l. CONCLUSION: Our results show that patients with DM2 have a high incidence ofvascular complications significantly associated with age, DM2 history and higher hs-CRP, irrespective of the other monitored parametres.

[Epidemiologic monitoring of tick-borne encephalitis in Rimov in Southern Bohemia]. / Epidemiologické sledování klíst'ové encefalitidy v jizních Cechách. Lokalita Rímov. Pomer manifestních a inaparentních forem infekce, stanovenî proitilátkové odezvy ve sledovaném souborn. Snaha zvýsit intervencí stupen imunity mimorádným ockováním u osob s nízkými ci negativními titry v lokalite. Rímov v období prelomu roku 2001/2002.

Southern Bohemia is one of the extensive natural foci of tick-borne encephalitis (TE) in the Czech Republic. Some professionals hold the view that people living in the focus of infection acquire naturally herd immunity and are the protected against the infection and thus it is not necessary to vaccinate them against TE. Several serious cases of the disease in temporal sequence in Rímov in the district of Ceské Budejovice led the authors to examine more closely the problem of TE in this locality. Available epidemiological data were analyzed. A group of subjects with permanent residence in the community was assembled who were interested to participate in the trial. In these serological examinations were made to assess antibodies against TE. Analysis of the assembled data proved that during permanent residence in Rímov 6.07% of the investigated group during their life in Rímov developed the manifest form of TE, 9.64% developed the inapparent form and 15% subjects had antibodies after previous vaccination. The ratio of manifest and inapparent cases is 6.07:9.64, i.e. roughly 2:3. The total seroprevalence after the disease (manifest and inapparent) is 16%. Persons with a negative result of the examination were offered vaccination. The vaccination rate increased due to the authors' intervention from 15% to 65% in the given community.

The use of andriol in treatment of androgen deficiency in transsexual women.

In search of a non-invasive, long-term acting form of androgen to be used in female-to-male transsexuals, testosterone undecanoate (Andriol, Organon) was investigated from clinical and laboratory points of view. The therapy resulted in a significant elevation of androgens with a considerable increase of the free testosterone fraction, desired virilization and somatic changes to a masculine phenotype. Testosterone undecanoate provides sufficiently high androgen levels without significant influence on the hypothalamo-pituitary-gonadal axis. The treatment impaired neither liver function nor glucose tolerance. It is concluded that this drug is suitable for hormonal preparation before the reconstructive therapy to males.

Parental and interpersonal relationships of transsexual and masculine and feminine homosexual men.

A group of transsexual and homosexual men was examined using the Leary Test as a psycho-sociogram, and findings were compared to those from a group of heterosexual men. It was found that the fathers of homosexuals and transsexuals were more hostile and less dominant than the fathers of the control group and hence less desirable identification models. The average mothers of transsexuals were close to the ideal person in our culture, e.g., dominant, strong and kindly, and thus an imposing identification model. Heterosexual men and transsexuals, in their behavior towards their wives, on the average identified with the models set by their fathers. Effeminate homosexuals in relations towards their male partners on the average identified with their mothers. Non-effeminate homosexuals modeled their behavior somewhere between both parents. Heterosexual men tended to choose wives modelled on their mothers and modelled their behavior towards their wives on their fathers' behavior. Non-effeminate homosexuals tended to choose their male partners according to the model set by their mothers and behaved toward them in a more dominant manner than any of the other groups studied (effeminate homosexuals, non-effeminate homosexuals and transsexuals). Effeminate homosexuals on average chose the most dominant male partners and modelled their behavior toward them on that of their mothers. The wives of transsexuals were rated as the most hostile. The self-esteem of all the groups studied suffered from lack of dominance. On the average, non-effeminate homosexuals were found to be closest to the heterosexual norms, transsexuals the furthest.