Vitamin-D receptor gene polymorphisms (TaqI and ApaI) and circulating osteocalcin in type 2 diabetic patients and healthy subjects.

INTRODUCTION: Vitamin D receptor (VDR) is encoded by the VDR gene. Several studies have supported that this gene is associated with diabetes. Heterodimer VDR/RXR functions as an enhancer of the BGLAP gene and increases the basal transcription rate of osteocalcin (OC) during osteoblast differentiation. OC is a regulator of glucose metabolism in mice. Moreover, OC level is decreased in patients with type 2 diabetes (T2D). Although inversely correlated with serum glucose insulin and glycated haemoglobin, it is unclear whether OC reduction is caused by diabetes or plays a role in the pathogenesis and/or progression of the disease. In this study we analysed the association between TaqI and ApaI VDR gene polymorphisms and OC serum concentration in T2D subjects. MATERIAL AND METHODS: Patients underwent clinical and nutritional assessment. Genomic DNA was extracted from leucocytes using a standard salting-out procedure. The polymorphisms were genotyped by PCR-RFLP method. ELISA was used to measure OC and insulin concentrations. RESULTS: Association between TT genotype of TaqI polymorphism and low levels of OC was observed only in the population with overweight and obesity. No association between TaqI and ApaI polymorphisms and T2D was observed (p > 0.05). Furthermore, in T2D subjects, no correlation between ApaI and TaqI genotypes and age, sex, Body Mass Index (BMI), glucose, or OC was observed. CONCLUSIONS: The TT genotype of TaqI VDR gene polymorphism was correlated with low levels of OC in overweight and obese subjects. However, TaqI and ApaI VDR gene polymorphisms were not associated with T2D.

[Palliative and support care at home in primary care]. / Atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio.

OBJECTIVES: To estimate the proportion of people requiring palliative and support care at home in primary care and to describe their characteristics. METHODS: A descriptive study was carried out by five Spanish sentinel networks between October 2007 and March 2008 in 282,216 people attended by 218 general practitioners and nurses. Patients receiving comprehensive, active and continued care at home were included if the aim was not to prolong life but to achieve the best quality of life for the patient, the family and the carers. A standard form was used to collect data on age, sex, type of patient, underlying diseases and other variables related to the process. Crude and age-adjusted rates were estimated. RESULTS: Of the 400 men and 792 women registered, 12% were strictly terminal. The mean age was 82.4 years and was higher in patients with functional disability (82.9 years) than in terminally-ill patients (78.9 years) (p<0.01). The estimated prevalence was 422.3 per 100,000 inhabitants aged 14 years or more (95% CI: 398.7-447.0) and was much higher in women than in men (553.9 versus 287.3, p<0.01). The estimate for the entire Spanish population was 309.0 per 100,000 inhabitants (95% CI: 286.0-332.0). CONCLUSIONS: The prevalence of palliative and support care in Spain is around three cases per 1,000 inhabitants and is higher in elderly populations. More than 85% of patients needing palliative or support care have a life expectancy of over 6 months and thus represent the majority of persons using this type of medical and social support. The most susceptible groups are women and the oldest-old.

La lipoproteína (a) es predictora de severidad angiográfica en varones menores de 50 años con inicio clínico de enfermedad coronaria / Lipoprotein (a) has predictor value of coronary artery stenosis severity documented by angiography in coronary male patientsless than 50 years old

Objetivo. Analizar la relación de las concentraciones séricas de lipoproteína (a) con la edad de presentación de la cardiopatía isquémica y la severidad angiográfica de la enfermedad coronaria en un grupo de varones menores de 50 años. Pacientes y métodos. Hemos estudiado a un grupo de 230 varones menores de 50 años, que fueron ingresados de forma consecutiva por un síndrome coronario agudo. Durante su ingreso, se determinaron las concentraciones de lipoproteína (a) a todos los pacientes, los cuales fueron distribuidos en dos grupos según la edad de aparición de enfermedad coronaria, con un punto de corte de 40 años. Se realizó un cateterismo cardíaco a 142 pacientes por mal control clínico o isquemia persistente. Resultados. Las concentraciones séricas de lipoproteína (a) se relacionaron con el número de vasos coronarios afectados; así, en la coronariografía normal los valores fueron de 12 mg/dl (1,5-75), en la enfermedad de un vaso de 27 mg/dl (2,5-96), en la enfermedad de dos vasos de 34 mg/dl (7-90) y en la enfermedad de tres vasos de 63 mg/dl (2-116), con significación estadística (p = 0,003).No encontramos diferencias significativas en las concentraciones de lipoproteína (a) al analizar la edad de presentación de las primeras manifestaciones clínicas, resultando de 31 mg/dl (2-97) en pacientes de 40 años o menos y de 33 mg/dl (2-94) en mayores de 40 años. Conclusiones. En nuestro grupo de varones con inicio clínico de enfermedad coronaria antes de los 50 años hemos encontrado una relación entre las concentraciones de lipoproteína (a) y la severidad angiográfica de la enfermedad coronaria. Sin embargo, no hemos encontrado relación entre las concentraciones de lipoproteína (a) y la edad de presentación de la enfermedad coronaria (AU)