Vitamin D and thyrotropin in type 2 diabetic patients.

Vitamin D status and thyroid function may be related. Using our data from two previous studies in type 2 diabetic patients, we found slightly higher serum thyrotropin levels in patients with vitamin D deficiency (at the limit of statistical significance) and no effect of correction of vitamin D deficiency in serum thyrotropin levels.

Cáncer oculto en pacientes con tromboembolia pulmonar idiopática / Occult cancer in patients with idiopathic pulmonary embolism

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Metabolic effects of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency.

AIM: Epidemiological studies suggest that vitamin D status influences type 2 diabetes mellitus. We investigate the metabolic effects of vitamin D. MATERIAL AND METHODS: We studied consecutive type 2 diabetic patients without insulin therapy with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20ng/ml). They were treated with 16,000IU of calcifediol orally once a week for a minimum of 8 weeks. RESULTS: Twenty eight patients were treated for a mean time of 84.1 days (range 56 to 120 days). All patients achieved serum levels of 25(OH)D higher than 20ng/ml. There was a significant reduction in fasting glucose (145.6±35.5 vs. 131.7±30.4mg/dl, p<0.001). There were small non-significant reductions in HbA1c, fasting insulin and Homeostasis Model Assesment (HOMA)-insulin resistance (IR). There were small non-significant increases in HOMA-insulin sensitivity (S) and HOMA-beta cell function (B) and a small significant increase in Quantitative Insulin Sensitivity Check Index (QUICKI). CONCLUSIONS: Correction of vitamin D deficiency in type 2 diabetic patients decreases fasting glucose. Our results do not rule out improvements in metabolic control, insulin-resistance and function of the beta cell.

Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency.

BACKGROUND: Epidemiological studies suggest that vitamin D status may have an influence on lipid profile. PATIENTS AND METHODS: We studied consecutive type 2 diabetic patients with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20 ng/ml). They were treated with 16,000 IU of calcifediol orally once a week for a minimum of 8 weeks. RESULTS: A total of 28 patients were treated for a mean time of 84.1 days (range 56-120 days). All patients achieved serum levels of 25(OH)D higher than 20 ng/ml. There was significant reduction in total cholesterol (172.1 ± 32.4 versus 164.4 ± 27.3 mg/dl, p = 0.04). There were nonsignificant reductions in low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (non-HDL) cholesterol and triglycerides. There was no change in HDL cholesterol. CONCLUSIONS: Correction of vitamin D deficiency in type 2 diabetic patients decreases total cholesterol. Our results do not rule out reductions in LDL cholesterol, non-HDL cholesterol and triglycerides.

WITHDRAWN: Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency.

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Vitamin D Levels in Patients With Type 2 Diabetes Mellitus.

BACKGROUND: Vitamin D may influence many diseases, including type 2 diabetes mellitus. PATIENTS AND METHODS: We studied serum levels of 25-hydroxyvitamin D (25(OH)D) and associated characteristics in type 2 diabetic outpatients with pharmacologic treatment attended in internal medicine offices in a first-level hospital from Extremadura (Southern Spain). RESULTS: We included a total of 103 patients. Seventy-two patients (69.9%) had serum levels of 25(OH)D lower than 20 ng/mL. There was inverse correlation between serum levels of 25(OH)D and glycosylated hemoglobin (r = -0.74, P = 0.01). In 78 patients without insulin therapy, we found inverse correlation between serum levels of 25(OH)D and fasting serum insulin (r = -0.82, P = 0.001) and Homeostasis Model Assessment-Insulin Resistance (r = -0.51, P < 0.001). CONCLUSIONS: Vitamin D deficiency is common in type 2 diabetic patients. There are inverse correlations between vitamin D and metabolic control and insulin resistance.

Riesgo de recurrencia en la enfermedad tromboembólica venosa tras suspender la anticoagulación / Recurrence risk in venous thromboembolic disease after anticoagulation discontinuation

Determinar el riesgo de recurrencia de la enfermedad tromboembólica venosa tras suspender la anticoagulación es esencial para decidir la duración óptima del tratamiento. Factores de riesgo clínicos, un dímero-D elevado tras finalizar la anticoagulación y la presencia de trombosis venosa profunda residual deberían ser tenidos en cuenta. En este artículo se revisan estos factores de riesgo y los modelos de riesgo descritos (AU)

To determine the risk for recurrence of venous thromboembolic disease is essential to decide the optimum duration of treatment. Clinical risk factors, elevated D-dimer after anticoagulation withdrawal and the presence of residual deep vein thrombosis should be considered. In this article the risk factors and the reported risk models are reviewed (AU)

[Recurrence risk in venous thromboembolic disease after anticoagulation discontinuation]. / Riesgo de recurrencia en la enfermedad tromboembólica venosa tras suspender la anticoagulación.

To determine the risk for recurrence of venous thromboembolic disease is essential to decide the optimum duration of treatment. Clinical risk factors, elevated D-dimer after anticoagulation withdrawal and the presence of residual deep vein thrombosis should be considered. In this article the risk factors and the reported risk models are reviewed.

Vitamina B12 en pacientes diabéticos tipo 2 en tratamiento con metformina / Vitamin B12 in type 2 diabetic patients treated with metformin

Objetivo: Estudiar los niveles plasmáticos de vitamina B12 en pacientes diabéticos tipo 2 tratados con metformina en nuestro medio. Métodos Estudio observacional transversal de pacientes consecutivos con diabetes mellitus tipo 2 en tratamiento farmacológico atendidos en consulta de Medicina Interna. Resultados Se estudiaron 109 pacientes (81 en tratamiento con metformina). El tiempo medio en tratamiento con metformina fue 43,5 meses y la dosis media fue 1.779mg/día. Los pacientes tratados con metformina tuvieron unas concentraciones plasmáticas de vitamina B12 significativamente menores (393,5 frente a 509 pg/ml, p=0,0008). Siete (8,6%) de 81 pacientes tratados con metformina y ninguno de los 28 no tratados con metformina tuvieron unas concentraciones plasmáticas inferiores a 197 pg/ml. No hubo correlación entre las concentraciones de vitamina B12 y el tiempo en tratamiento con metformina o la dosis de metformina. Conclusiones En pacientes diabéticos tipo 2, el tratamiento con metformina se asocia a concentraciones plasmáticas de vitamina B12 más bajas. El déficit de vitamina B12 asociado a metformina es relativamente frecuente en nuestro medio (AU)

Objective: To test vitamin B12 plasma levels in type 2 diabetic patients treated with metforminin our area. Methods: A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic. Results: One hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was1,779 mg/day. Patients treated with metformin had significantly lower vitamin B12 plasma levels(393.5 vs. 509 pg/mL, P = .0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B12 plasma levels lower than197 pg/mL. No correlation was found between vitamin B12 plasma levles and metformin treatment time or dosage. Conclusions: In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B12 plasma levels. Vitamin B12 deficiency associated with metformin is relatively commonin our area (AU)

Vitamin B(12) in type 2 diabetic patients treated with metformin.

OBJECTIVE: To test vitamin B12 plasma levels in type 2 diabetic patients treated with metformin in our area. METHODS: A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic. RESULTS: One hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1,779 mg/day. Patients treated with metformin had significantly lower vitamin B(12) plasma levels (393.5 vs. 509 pg/mL, P = .0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B(12) plasma levels lower than 197 pg/mL. No correlation was found between vitamin B12 plasma levles and metformin treatment time or dosage. CONCLUSIONS: In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B12 plasma levels. Vitamin B12 deficiency associated with metformin is relatively common in our area.

Anticardiolipin antibodies in patients with type 2 diabetes mellitus.

BACKGROUND: There is controversy about an increased prevalence of antiphospholipid antibodies in diabetic patients. The possible implications are little known. METHODS: We prospectively studied all consecutive outpatients with type 2 diabetes mellitus (DM) attended to in an Internal Medicine office. IgM and IgG anticardiolipin antibodies (ACA) were determined by standardized enzyme-linked immunoassay. RESULTS: Fifty-six patients were included. Only one patient (1.8%) had a titer of IgM ACA higher than 15 MPL units and no patient had a titer of IgG ACA higher than 15 GPL units. Six patients (10.7%) had low IgM ACA titers (4-15 MPL units) and 18 patients (32.1%) had low IgG ACA titers (4-15 GPL units). There were no differences in the frequencies of a low IgM or IgG ACA titer or in the means of IgM and IgG ACA titers in patients with complicated and uncomplicated DM, with and without cardiovascular disease, with and without nephropathy, or with and without retinopathy. CONCLUSIONS: Moderate to high ACA titers must be exceptional in patients with type 2 DM. Low ACA titers may occur in patients with type 2 DM. These low titers do not seem to be associated with complicated DM, cardiovascular disease, nephropathy or retinopathy.

Adverse outcomes in patients with venous thromboembolic disease from a rural population.

OBJECTIVE: To study the adverse outcomes and its predictors during anticoagulant therapy in patients with venous thromboembolic disease (VTD) from a rural population. METHODS: This is a prospective observational study of 94 consecutive patients. The patients were diagnosed in a first-level hospital from a rural Spanish area using objective methods of VTD. RESULTS: The mean follow-up with anticoagulant therapy was 7.1 months (range: 0-29 months). Eighteen patients (19.1%) had an adverse outcome: 10 (10.6%) during the first month and 8 (8.5%) after the first month. Sixteen patients (17%) died, 6 (6.4%) had a major hemorrhage, and 4 (4.3%) had a thromboembolic recurrence. Comorbidity, cancer, nonidiopathic VTD, and pulmonary thromboembolism were significantly associated with adverse outcomes. CONCLUSIONS: Adverse outcomes during anticoagulant therapy are frequent in patients from a rural population with VTD. These adverse outcomes occur frequently during the first month of treatment and are associated with the patient's prior status and the presence of pulmonary thromboembolism.

Validación de un método de predicción del riesgo de evolución desfavorable en pacientes con tromboembolia pulmonar / Validation of a method for predicting risk of poor outcome in patients with pulmonary thromboembolism

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[C-reactive protein in the acute phase of ischemic stroke]. / Proteína C reactiva en la fase aguda del ictus.

BACKGROUND AND OBJECTIVE: We aimed to assess the prognostic importance of C-reactive protein (CRP) in the acute phase of ischemic stroke in-patients. PATIENTS AND METHOD: One hundred and seventeen patients within 48 h after index ischemic stroke were included. CRP levels and blood samples were obtained at this time, and a brain computerized tomography or magnetic resonance imaging were performed. Neurological and functional disability were evaluated and patients were divided according to the outcome into the following categories: transient ischemic attack, favorable stroke, and non-favorable stroke. RESULTS: 32 in-patients were classified as transient ischemic attack, 31 as favourable stroke, and 54 as non-favorable stroke. There was a worsening in neurological (p < 0.0001) and functional (p < 0.005) disabilities from the TIA group to non-favorable stroke. The CRP mean, by category, was 1.7, 1.07 and 3.6 mg/dl, respectively (p < 0.0001). CONCLUSIONS: We found increased levels of CRP in the non-favorable stroke category, that was related with neurological and functional disabilities, and with radiological findings, mainly when levels were greater than 3.6 (0.49) mg/dl.

Proteína C reactiva en la fase aguda del ictus / C-reactive protein in the acute phase of ischemic stroke

Fundamento y objetivo: Valorar si los valores de proteína C reactiva (PCR) son de utilidad para definir el pronóstico de los pacientes con enfermedad cerebrovascular en fase aguda. Pacientes y método: Se ha estudiado a 117 sujetos con enfermedad cerebrovascular en fase aguda, a los que se realizaron determinaciones de PCR en las primeras 48 h tras el episodio, así como perfil lipídico y otras determinaciones hematológicas, junto con tomografía computarizada o resonancia magnética craneales. Se valoró a los pacientes mediante escalas de capacidad funcional y deterioro neurológico y se les clasificó en 3 grupos atendiendo al pronóstico clínico y funcional durante el ingreso (ataque isquémico transitorio, ictus favorables e ictus desfavorables). Resultados: Un total de 32 pacientes se clasificó como ataque isquémico transitorio, 31 como ictus favorables y 54 como ictus desfavorables. Cada grupo mostró menor capacidad funcional (p < 0,005) y mayor deterioro neurológico (p < 0,0001) a medida que empeoraba el pronóstico. La media de la PCR en cada grupo fue de 1,7, 1,07 y 3,6 mg/dl, respectivamente (p < 0,0001). Conclusiones: En nuestra muestra existen diferencias significativas en los valores de PCR entre los grupos con mejor y peor pronóstico que se relacionan con el grado de deterioro neurológico, capacidad funcional y extensión radiológica de la lesión principalmente cuando dichos valores medios (desviación estándar) son superiores a 3,6 (0,49) mg/dl

Background and objective: We aimed to assess the prognostic importance of C-reactive protein (CRP) in the acute phase of ischemic stroke in-patients. Patients and method: One hundred and seventeen patients within 48 h after index ischemic stroke were included. CRP levels and blood samples were obtained at this time, and a brain computerized tomography or magnetic resonance imaging were performed. Neurological and functional disability were evaluated and patients were divided according to the outcome into the following categories: transient ischemic attack, favorable stroke, and non-favorable stroke. Results: 32 in-patients were classified as transient ischemic attack, 31 as favourable stroke, and 54 as non-favorable stroke. There was a worsening in neurological (p < 0.0001) and functional (p < 0.005) disabilities from the TIA group to non-favorable stroke. The CRP mean, by category, was 1.7, 1.07 and 3.6 mg/dl, respectively (p < 0.0001). Conclusions: We found increased levels of CRP in the non-favorable stroke category, that was related with neurological and functional disabilities, and with radiological findings, mainly when levels were greater than 3.6 (0.49) mg/dl