Childhood obesity: causes, consequences, and prevention

As a result of the dramatic increase in the prevalence of overweight and obesity among children, childhood obesity is one of the most critical global public health challenges of the 21st century. Weight gain occurs when energy intake exceeds energy expenditure. Both genetic and environmental factors (such as a sedentary lifestyle) are implicated in its pathogenesis. Childhood obesity is associated with physical, psychological, and social consequences. Obese children are at higher risk of elevated fasting blood glucose, insulin resistance, impaired glucose tolerance, type 2 diabetes, hypertension, polycystic ovarian syndrome (PCOS), atherosclerosis and cardiovascular disease (CVD), sleep apnea, and asthma. Psychological and social consequences include low self-esteem, social discomfort and isolation, and depression. Since COVID-19 was declared a global pandemic, millions of children and adolescents worldwide have been affected drastically. While COVID-19 has increased the prevalence of weight gain and childhood obesity, obese children, on the other hand, have suffered excessively from COVID-19. Here, we provide details on the endocrine, metabolic, and epidemiological aspects of childhood obesity with a concise discussion of the relationship between COVID-19 and childhood obesity. The endocrine chapter is focused on childhood obesity pathophysiology and the role of adipocytes and insulin in the mechanism of obesity. The metabolic chapter covered metabolic diseases related to childhood obesity. In contrast, the epidemiological chapter covered the risk factors of childhood obesity and current approaches to the prevention of childhood obesity.

Peculiarities of Q fever and human cases reported so far in the Czech Republic

INTRODUCTION

Q fever is a zoonosis with a worldwide occurrence. Coxiella burnetii infection is most commonly transmitted by inhalation of air containing contaminated dust in cow, sheep and goat farming areas. The other modes of transmission are alimentary route (ingestion) and through sucking ticks. We set ourselves the goal of presenting a descriptive analysis of cases of Q fever in the Czech Republic (CZ) and former Czechoslovakia and draw attention to this often-overlooked issue.

METHODS

Summary of available information about Q fever was processed, and a narrative search of published cases of Q fever in the CZ and former Czechoslovakia, in Czech, Slovak and English, without time restrictions was performed. Furthermore, a descriptive analysis of Q fever cases reported to the Czech infectious diseases reporting system in 1982-2021 was done. After analysis, the available information system data were supplemented with data from a search of published scientific literature and weekly reports on the current epidemiological situation of the public health protection authorities of the CZ.

RESULTS

The disease has been reported in former Czechoslovakia and then in CZ since 1952. In 1952-1954, six outbreaks were reported with a total of 150 cases, mostly in connection with work with cattle. In 1980, a large-scale outbreak of Q fever affected 526 employees of the cotton production plant at Staré Město near Uherské Hradiště. Otherwise, units to dozens of cases were reported. From 1993 to 2021, 27 cases of the disease were detected in the CZ, of which 22 (81.5%) occurred in men. The age range was 0-60 years (mean 31, median 30 years). Seasonality by reporting month was highest in January and September.

CONCLUSION

There has been a decline in human cases of Q fever in the European Union (EU) in recent years, and only few cases of the disease occur in the CZ. Still, due to potential severity of the disease, the current climate change with the consequent increase in the spread of ticks as vectors of Coxiella, and animal movements associated with the global market, it is important to consider Q fever in the differential diagnosis. As part of the prevention, it is necessary to ensure compliance with basic hygiene rules, especially in at-risk occupations, and to consume only pasteurized dairy products. Vaccination of humans is not available in EU countries, although vaccination of livestock is possible.

Monitoring changes in invasive disease caused by Haemophilus influenzae in the Czech Republic between 1999 and 2020

AIM

To assess the trends and changes in the incidence of invasive disease caused by Haemophilus influenzae in the Czech Republic (CR) between 1999 and 2020 with regard to the introduction of childhood vaccination against H. influenzae serotype b (Hib) in 2001. Characterization of strains by multilocus sequence typing (MLST) and search for correlations between serotypes, sequence types, and patient groups or clinical manifestations of the disease.

MATERIAL AND METHODS

A total of 623 invasive H. influenzae strains from surveillance of invasive Haemophilus disease in the Czech Republic were analysed. All strains were biotyped based on phenotypic characteristics and serotyped using slide agglutination with specific a-f antisera. Three hundred and eighty-three strains from the collection of the National Reference Laboratory for Haemophilus Infections (NRL HEM) originating from surveillance in the CR were analysed by MLST and assigned to sequence types (ST). For analyses, the dataset was supplemented with five strains from the PubMLST database of serotypes rarely or not at all found in the CR. Similarity calculations based on MLST and strain (serotype, biotype, ST) and patient (diagnosis, sex, age) data were performed in BioNumerics 7.6.

RESULTS

After the introduction of Hib vaccination in 2001, a dramatic decline of more than 90% was observed in invasive Hib disease over the following years. Between 1999 and 2020, a total of 623 cases of invasive disease caused by H. influenzae were recorded in the CR, with about 20 cases reported annually in recent years. At present, the dominant agents causing Haemophilus invasive disease in the CR are non-enveloped strains (HiNT) followed by strains of Hif and Hie serotypes. The most common manifestation of Haemophilus invasive disease in the pre-vaccination era was meningitis, while now it is sepsis. Sequence types of 383 strains from the NRL HEM collection originating from surveillance in the CR were analysed. The results showed high clonality of the encapsulated strains and diversity of HiNT strains, which is consistent with the results of others. Strain similarity analysis showed no demonstrable relationships between patient age or clinical manifestation and serotype and ST.

CONCLUSION

In invasive Haemophilus disease, there has been a dramatic change as a result of Hib vaccination after 2001, with a reduction of cases caused by Hib from tens to units annually. In the last decade, the situation in the CR has been stable with no significant changes in the number of cases or in the representation of causative serotypes and is in line with the reports from other EU countries. In order to monitor further developments, it is desirable that the NRL HEM should continue the surveillance of invasive disease caused by H. influenzae, including molecular biological characteristics of strains. MLST allows the characterisation of strains based on allelic variants of selected housekeeping genes, but it does not allow the association of specific H. influenzae sequence types with patient age, sex or clinical manifestations. In the future, whole genome sequencing could be a useful tool for determining the correlation between the disease and specific strains.

Czech public health - past and present

The article deals with the concept, development, and current state of public health in the Czech lands as a theoretical and practical scientific discipline, as it has been formed and profiled during more than two hundred years of history. It identifies five developmental stages, which briefly characterizes and introduces important representatives of the field at the time. It describes the transformation of public health care after 1989 and points out some of the consequences of institutional reduction associated with the weakening of the field, which became fully apparent during the COVID-19 pandemic.

Acute and chronic Achilles tendon ruptures - current diagnostic and therapeutic options

This review presents information on the epidemiology and current trends in the diagnosis and therapy of acute and chronic Achilles tendon ruptures in middle-aged and elderly patients. Epidemiological data show an increasing incidence of ruptures among the entire population, especially in patients over 65 years of age. Dynamic sonography has become the gold standard diagnostic assessment, facilitating even therapeutic decision- making. The well established conservative-functional therapy can in indicated cases achieve results comparable to those of surgical treatment. Minimally invasive suture techniques using aiming devices reduce the risk of surgical damage and soft tissue complications, particularly in noncompliant patients and patients with restricted perfusion. Reconstruction of chronic tendon ruptures is mostly performed using static techniques, especially the combination of V-Y plasty and fascial flaps. In addition to reruptures and infections, the currently discussed complications also include deep vein thrombosis where a more generous indication scheme of thromboprophylaxis is under consideration.

Listeriosis - an analysis of human cases in the Czech Republic in 2008-2018

AIM

The aim of our work was to summarize the most important knowledge about listeriosis in humans and to analyse available epidemiological data on this disease in the Czech Republic in 2008-2018.

METHODS

We conducted a literature search and descriptive epidemiological analysis of all human Listeria cases reported to the national surveillance system of infectious diseases (EpiDat until 2017, ISIN for 2018) in the Czech Republic in 2008-2018. For data management and analysis, MS Excel 2010 was used. The incidence maps were created using the ECDC Map Maker tool (EMMa).

RESULTS

In total, 380 cases of human listeriosis (mean annual incidence of 0.33/100 000 inhabitants) were reported in the Czech Republic in 2008-2018. The highest age specific incidence was detected in 0-year-olds (1.85/100 000) and then in persons over 60 years (mean incidence of 0.95/100 000). Altogether 222 cases were detected in men (mean incidence of 0.39/100 000) and 158 in women (mean incidence of 0.27/100 000). Geographically, the highest mean annual incidence was reported in the Moravian-Silesian Region (0.6/100 000) and Pilsen Region (0.57/100 000). As many as 96.3% of the reported cases required hospital admission. Of 81 deaths related to listeriosis, 50 were directly caused by listeriosis. The highest monthly incidence was observed in June through October and then in January.  The incidence of listeriosis in the CZ shows an oscillating trend over the last 11 years. Neither epidemics nor imported cases were reported to the national surveillance system during the study period.

CONCLUSIONS

Listeriosis cases have been on the rise in the European Union (EU) over the last years, while in the CZ, an oscillating and slightly increasing trend has been observed. Generally, cases are reported mostly in the population aged over 64 years (and especially after the age of 84). As there is no vaccine available yet against this disease, the only option is the prevention, i.e., health education of consumers in general and of the risk groups in particular, and compliance with food safety and hygiene standards in food production and handling.

Mumps and its occurrence in the Czech Republic and Slovakia

Mumps is an infectious viral disease transmitted by droplets. It is vaccine preventable and thanks to the start of compulsory vaccination in 1987, there has been a significant reduction in cases. Nevertheless, over the years, occasional local outbreaks have occurred in the Czech Republic, especially in adolescents, while in Slovakia, since the beginning of vaccination, the situation has been kept under somewhat better control. This may be explained by the differences in the vaccination schedules between the countries and the consequent secondary vaccine failure, the so-called waning of immunity in Czech older children, adolescents, and young adults. The article summarizes current knowledge about mumps and data on its incidence in the Czech Republic and Slovakia.

Atherosclerosis in patients with type 1 diabetes

Type 1 diabetes is often associated with the early manifestation of atherosclerosis, which represents the morphological basis for macrovascular complications of diabetics. Atherosclerosis in patients with type 1 diabetes shows certain specific features that result from different proportions of risk factors, the presence of diabetes and its complications. The paper deals with the possibilities of influencing and detecting the atherosclerotic process in these risk patients.

A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus

Hypoglycemia particularly severe one is important side effect of diabetes therapy with impact on patient´s quality of life and mortality. The highest risk of hypoglycemia is connected with insulin therapy followed by derivates of sulfonylurea (SU) and glinides. The risk of hypoglycemia found in observational studies were 2-3 times higher in patients treated with SU and 3-4 higher when treated with insulin compared with other types of antidiabetics. The risk of hypoglycemia is increased in patients over 75 years of age, with longer period of treatment with insulin and in those treated with several types of antidiabetics.

Current view of treatment of hypoglycemia

Hypoglycemia is a side effect of the therapy primarily with insulin, sulphonylurea derivates and glinides. Its therapy is based on the immediate ingestion of sacharides, preferably glucose. Amount of 15-20 g is recommended as its optimal dose, although several recent studies are suggesting amount related to the patient´s weight. The therapy of severe hypoglycemia in the non-professional settings is based on glucagon injection, in the professional ones intravenous administration of glucose is preferable option.

How well we treat with insulin in the Czech Republic and in the Slovak Republic A summary of results and comments on the original Czech-Slovak DIAINFORM study

Despite the continuously improving treatment options, many patients with type 1 (T1DM) and type 2 diabetes (T2DM) still do not achieve the recommended treatment goals. The article provides summary and commentary of the results of DIAINFORM study focused on the level of metabolic control in T1DM and T2DM patients treated with insulin in the Czech and Slovak Republics. The overall percentage of patients with HbA1c 3 mmol/mol in the T1DM group was 29.9 % and in the T2DM group was 33.4 %.