Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children

OBJECTIVE

To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022.

METHODS

A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM.

RESULTS

A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex.

CONCLUSION

Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.

Phase II study of capecitabine-based concomitant chemoradiation followed by durvalumab as a neoadjuvant strategy in locally advanced rectal cancer: the PANDORA trial

BACKGROUND

This study investigated the efficacy of chemoradiotherapy (CRT) followed by durvalumab as neoadjuvant therapy of locally advanced rectal cancer.

PATIENTS AND METHODS

The PANDORA trial is a prospective, phase II, open-label, single-arm, multicenter study aimed at evaluating the efficacy and safety of preoperative treatment with durvalumab (1500 mg every 4 weeks for three administrations) following long-course radiotherapy (RT) plus concomitant capecitabine (5040 cGy RT in 25-28 fractions over 5 weeks and capecitabine administered at 825 mg/m2 twice daily). The primary endpoint was the pathological complete response (pCR) rate; secondary endpoints were the proportion of clinical complete remissions and safety. The sample size was estimated assuming a null pCR proportion of 0.15 and an alternative pCR proportion of 0.30 (α = 0.05, power = 0.80). The proposed treatment could be considered promising if ≥13 pCRs were observed in 55 patients (EudraCT: 2018-004758-39; NCT04083365).

RESULTS

Between November 2019 and August 2021, 60 patients were accrued, of which 55 were assessable for the study's objectives. Two patients experienced disease progression during treatment. Nineteen out of 55 eligible patients achieved a pCR (34.5%, 95% confidence interval 22.2% to 48.6%). Regarding toxicity related to durvalumab, grade 3 adverse events (AEs) occurred in four patients (7.3%) (diarrhea, skin toxicity, transaminase increase, lipase increase, and pancolitis). Grade 4 toxicity was not observed. In 20 patients (36.4%), grade 1-2 AEs related to durvalumab were observed. The most common were endocrine toxicity (hyper/hypothyroidism), dermatologic toxicity (skin rash), and gastrointestinal toxicity (transaminase increase, nausea, diarrhea, constipation).

CONCLUSION

This study met its primary endpoint showing that CRT followed by durvalumab could increase pCR with a safe toxicity profile. This combination is a promising, feasible strategy worthy of further investigation.

Ability of TyG Index as a Marker of Insulin Resistance in Argentinean School Children

OBJECTIVE

To determine if the triglycerides and glucose index (TyG) can be used as a marker for insulin resistance (IR) in Argentinean schoolchildren according to age and sex.

METHODS

Anthropometric data, blood glucose levels, lipid profiles, and insulin levels were measured. The TyG index was defined by Ln [fasting triglyceride (mg/dL)* fasting glucose (mg/dL)/2]. A comparison of the ability of TyG to identify children with IR was performed using receiver operating characteristic (ROC) curves and the area under the ROC (AUROC) curve. IR was defined as HOMA-IR > III quartile.

RESULTS

A total of 915 (528, 57.7% males) apparently healthy schoolchildren, aged 9.3 ± 2.2, were evaluated. The AUROC using the HOMA-IR > III quartile as the dichotomous variable showed that TyG was a fair marker to identify IR (0.65, 95% CI, 0.61-0.69; p < 0.01). There was a significantly higher TyG AUROC in males (0.69, 95% CI, 0.63-0.75; p < 001) than in females (0.60, 95% CI, 0.54-0.66; p < 0.01). When children were divided according to age into two groups (5.0-9.9 and 10.0-14.9-year-olds); younger children (0.64, 95% CI, 0.58-0.69; p < 0.011) and older children (0.62, 95% CI, 0.55-0.68; p = 0.01) had a similar and fair AUROC. However, when children were divided by age and sex, females older than ten had a non-significant AUROC (0.53, 95% CI, 0.42-0.63; p = 0.61). The TyG index compared with HOMA-IR had low sensitivity and specificity, ranging from 0.62 to 0.56.

CONCLUSION

The TyG index had a fair AUROC with low sensitivity and specificity, indicating poor discrimination in identifying IR in apparently healthy Argentinean children. The ability to use TyG for screening purposes seems limited in Argentinean schoolchildren.

Influence of Telemedicine on the Number of Visits and HbA1c Determinations in Latin American Children with Type 1 Diabetes

Objective: To measure the changes in the number of medical visits and the number of hemoglobin A1c (HbA1c) determinations according to telemedicine access in children with type 1 diabetes (T1DM) during the pandemic 2020 compared with 2019 and 2018. Methods: This is a multinational study of children with T1DM from four Latin American countries. The number of medical visits, the number of HbA1c determinations, and access to telemedicine during 2020 were extracted from their records. Results: Two hundred twenty-seven children (59% females) aged 12.7 ± 3.2 years with a duration of 5.4 ± 2.7 years of T1DM in 2018 were evaluated. There was a higher prevalence of children with telemedicine access in the pandemic 2020 versus those without [145 (63.9%) vs. 82 (36.1%); P < 0.01]. There was a higher number of medical visits during 2020 in children with telemedicine access versus those without (6.9 vs. 2.6; P < 0.01). Children with telemedicine access had a higher number of visits in 2020 versus 2018 (6.87 vs. 5.04, P < 0.01), but similar to 2019. Children without access had a lower number of visits in 2020 versus 2019 (2.6 vs. 5.5; P < 0.01) and versus 2018 (2.6 vs. 5.1; P < 0.01). In 2020, the number of HbA1c determinations in children with telemedicine access was higher versus those without (1.8 vs. 0.9; P < 0.01). Children with telemedicine access had a lower number of HbA1c determinations in 2020 versus 2019 (1.8 vs. 2.4; P < 0.01), but similar to 2018. Furthermore, children without access had a lower number of HbA1c determinations in 2020 versus 2019 (0.9 vs. 1.9; P < 0.01) and versus 2018 (0.9 vs. 2.0; P < 0.01). Conclusions: We found that children with T1DM with telemedicine access had a significantly higher number of medical visits and HbA1c determinations during lockdown than those without access in different Latin American centers.

Cardiometabolic markers among Argentinean normal weight and overweight children with and without central obesity

BACKGROUND

The association between central obesity and cardiometabolic complications justifies exploring its association in normal-weight and overweight/obese (OW/OB) schoolchildren.

OBJECTIVE

To describe cardiometabolic markers in four groups according to BMI/WC categories: (i) normal weight with central OB; (ii) normal weight without central OB; (iii) OW/OB with central OB and (iv) OW/OB without central OB, in a sample of Argentinean schoolchildren.

METHODS

A cross-sectional study of 1264 Argentinean schoolchildren (624 F), aged 9.5 ± 2.2 years was performed between November 2013 and 2015. Children's anthropometric measures, blood pressure (BP), glucose, lipids, and insulin were measured. Children were divided into four groups: (i) normal weight with central OB; (ii) normal weight without central OB; (iii) OW/OB with central OB and (iv) OW/OB without central OB.

RESULTS

The prevalence of normal-weight children without central OB was 64.3% (796), normal weight with central OB 5% (66), OW/OB without central OB 11% (137), and OW/OB with central OB 21% (265). Normal weight with central OB had significantly higher triglycerides than normal-weight children without central OB (86 vs 70 mg/dL, respectively) and OW/OB children without central OB (81 vs 77 mg/dL). Multiple linear regression analyses showed that age, systolic BP, HDL-C, triglycerides, and maternal WC were significantly associated with children's WC; R2 = 0.50 as well as children's BMI; R2 = 0.37.

CONCLUSION

This study found that children with central OB might be at future higher cardiometabolic risk than those without central OB independently of the presence of OW/OB. However, future longitudinal studies should be performed to confirm these findings.

Influenza vaccination coverage in patients with diabetes mellitus afferent to an Italian hospital

Background

Patients with type 1 (T1DM) and type 2 (T2DM) diabetes are at increased risk of vaccine-preventable diseases and their complications. The National Vaccinal Prevention Plan 2017-2019 includes specific recommendations for patients with diabetes, which in 2018 have been included in the standards of care of the Italian Diabetes Society (SID) and Italian Association of Clinical Diabetologists (AMD).

Methods

Adult diabetic patients attending the Diabetes clinic at the San Raffaele Hospital, a large teaching hospital in Milan, Italy, were surveyed with a questionnaire to investigate self-reported vaccinal history, knowledge, attitudes and practice on the recommended vaccinations, vaccinal hesitancy and information sources on the topic.

Results

Between May 16 and November 11, 2019 N = 222 T1DM and N = 57 T2DM patients were enrolled. 25.2% of T1DM and 26.3% of T2DM patients did get vaccinated annually against the flu in the past 3 year. 85.0% of T2DM patients were vaccinated at the General Practitioner's (GP) clinic, while 54.9% of T1DM patients were vaccinated by their GP and 24.4% from territorial vaccinal clinics. 54.5% of T1DM and 50.0% of T2DM patients chose not to be vaccinated because they didn't consider the vaccine useful, while the second most common reason was that they have not been advised by healthcare personnel.

Conclusions

We documented a low coverage and knowledge about influenza vaccination. Patients with diabetes trusted information and advice of diabetologists and GPs about vaccination and claimed that they would be more likely to vaccinate if vaccination were offered in the diabetes clinic. Implementing training programs for professionals and educational campaigns for patients with diabetes may improve vaccinal coverage.

Key messages

Vaccination coverage in T1DM and T2DM patients is low due to vaccination hesitancy. A strong action from care givers, in order to raise vaccination awareness in this at-risk population, is needed.

Adiposity, lifestyle behaviors, and cardiometabolic markers in Argentinean schoolchildren

BACKGROUND

We determined the association between schoolchildren's OW/OB with age, sex, lifestyle behaviors, and cardiometabolic markers.

METHODS

Age, sex, anthropometric measures, and BP (blood pressure) were recorded in 1249 (554 M) schoolchildren. OW/OB was defined as BMI > 85%ile and BMI > 95%ile respectively. A validated questionnaire for lifestyle behaviors was performed. We offered free laboratory testing to a subgroup of 168 children.

RESULTS

Schoolchildren aged 8.8 ± 2.1 y from 9 elementary schools in 4 areas of Argentina were examined between April and September 2019. 265 (21.2%) of the children were OW, 265 (21.2%) were OB, and 425 (35%) had central OB. OW/OB was associated with low milk intake (OR = 1.92; 95% CI, 1.1-3.3), skipping breakfast (OR = 2.00; 95% CI, 1.2-3.4), a family history of hypertension (OR = 1.74; 95% CI, 1.1-2.9), and systolic BP (OR = 1.03; 95% CI, 1.01-1.05); adjusted for confounding variables. The subgroup analysis showed that OW/OB children had lower iron (83 vs. 94 ug/dl, respectively) and HDL-C (43 vs. 47 mg/dl) levels, but higher non-HDL-C (107 vs. 99 mg/dl) levels than normal-weight children. Multiple logistic regression analysis showed that OW/OB was inversely associated with iron (OR = 0.99; 95% CI, 0.98-0.998) and HDL-C (OR = 0.94; 95% CI, 0.91-0.97) levels; adjusted for confounding variables.

CONCLUSION

Adiposity in schoolchildren was associated with unhealthy lifestyle behaviors, higher atherogenic risk, and lower iron concentrations, suggesting that OW/OB children are at increased risk for anemia and cardiometabolic disease.

Blood pressure level increase with altitude in three argentinean indigenous communities

Objective

To compare blood pressure (BP) levels in three groups of Argentinean Indigenous schoolchildren from similar ethnic backgrounds but living at three different altitudes.

Methods

A cross-sectional study compared 185 (83 females) children aged 5–14 years from San Antonio de los Cobres (SAC), 3750 m above sea level; 46 (23 females) from Cobres, 3450 m; and 167 (83 females) from Chicoana (CH), 1400 m. Anthropometric and BP measurements were performed.

Results

The prevalence of overweight/obesity was lower in SAC (6.5% [12]) and Cobres (4.3% [2]) than in CH (24% [24]) (BMI > 85 percentile per CDC norms). Systolic BP increased significantly with altitude: (SAC 86 mm Hg, Cobres 77 mm Hg, and CH 69 mm Hg). Similar results were obtained with diastolic BP (SAC 57 mm Hg, Cobres 51 mm Hg, and CH 47 mm Hg) and with median arterial pressure (MAP) (SAC 67 mm Hg, Cobres 60 mm Hg, and CH 55 mm Hg). Multiple linear regression analyses showed that altitude was significantly and independently associated with children's systolic BP (beta 10.56; R² = 0.40), diastolic BP (beta 6.27; R² = 0.25) and MAP (beta 7.69; R² = 0.32); adjusted for age, sex, and BMI.

Conclusions

We found that as altitude increased, BP levels increased significantly in indigenous children from similar backgrounds living permanently at different altitudes.

Activity of Lipoprotein-Associated Enzymes in Indigenous Children Living at Different Altitudes

BACKGROUND

High altitude is associated with hypobaric hypoxia, and metabolic modifications. In particular, alterations to lipoprotein-associated enzymes have been reported under hypoxia.

OBJECTIVE

To determine the association between paraoxonase 1 (PON-1) and Cholesteryl-ester transfer protein (CETP) activities and altitude in two groups of Argentinean Indigenous schoolchildren living at different altitudes.

METHODS

A cross-sectional study compared 151 schoolchildren from San Antonio de los Cobres (SAC), 3,750 m, with 175 schoolchildren from Chicoana (CH), 1,400 m. Anthropometric data, lipids, apolipoprotein (apo) A-I, apo B, plus PON-1 and CETP activities were determined.

RESULTS

The prevalence of overweight/obesity was significantly lower in SAC than in CH. Z- BMI (0.3 vs 0.7), Apo A-I/Apo B (1.67 vs. 1.85) and PON-1 (170 vs. 243 nmol/mL.min) were significantly lower in SAC than in CH, respectively. Total cholesterol (156 vs 144 mg/dL), triglycerides (TG) (119 vs. 94 mg/dL), apo A-I (133 vs. 128 mg/dL), apo B (84 vs. 73 mg/dL), hematocrit (48 vs. 41%), transferrin (295 vs. 260 mg/dL) and CETP (181 vs. 150%/mL.h) were significantly higher in SAC than in CH. There was a significant univariate association between altitude and transferrin (r0.38), hematocrit (r0.75), TG (r0.24), apo B (r0.29), PON-1 (r-0.40), and CETP (r0.37). Multiple linear regression analyses showed that altitude was significantly associated with children's TG (β = 0.28, R² = 0.14), HDL-C (β = ‒0.27; R² = 0.23), apo B (β = 0.32; R² = 0.14), CETP (β = 0.38; R² = 0.15) and PON-1 (β = ‒0.36; R² = 0.16), adjusted for age, gender and BMI.

CONCLUSION

SAC children presented a more atherogenic lipid profile, plus lower PON1 and higher CETP activities, than CH children.

Vitamin D Levels and Cardiometabolic Markers in Indigenous Argentinean Children Living at Different Altitudes

The objective of this study was to assess the association between vitamin D and cardiometabolic markers in 2 indigenous communities from similar ethnic backgrounds, but living at different altitudes. A cross-sectional study compared 152 (72 females) indigenous schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 175 (86 females) from Chicoana (CH), 1400 m above sea level, mean age 9 years. Anthropometry, blood pressure, lipids, glucose, insulin, and vitamin D were assessed in spring season. The prevalence of children’s overweight/obesity was significantly lower in SAC, 9.2% (13), than in CH, 41.5% (71). There was a significantly higher prevalence of vitamin D deficiency (<20 ng/mL) in SAC (n = 103, 67.7%) than in CH (n = 62, 36.3%). SAC showed an inverse correlation between vitamin D and insulinemia (r = −0.17, P < .05), whereas CH showed an inverse correlation between vitamin D and systolic blood pressure (r = −0.19, P < .05), z-BMI (body mass index; r = −0.25, P < .01), triglycerides (r = −0.15, P < .05), glucose (r = −0.35, P < .05), and insulinemia (r = −0.24, P < .01). Multiple linear regression analysis showed that vitamin D (β = −.47; R² = .21) was significantly associated with SAC location, adjusted for confounding variables. Vitamin D levels were significantly and directly associated with altitude and inversely with metabolic markers, suggesting that populations living at high altitudes are at higher risk for future cardiovascular diseases.

Blood pressure levels among Indigenous children living at different altitudes

The objective was to compare blood pressure (BP) levels in 2 groups of Indigenous Argentine school children from similar ethnic backgrounds but living at different altitudes. One hundred and fifty-two (46.3%) children (age, 4-14 years) from San Antonio de los Cobres (SAC), at 3750 m above sea level, and 176 children (53.7%) from Chicoana (CH), at 1400 m above sea level, participated in this cross-sectional study. Data for children's anthropometry, BP, glucose, lipids, vitamin D, and insulin, as well as mothers' height and weight were assessed. Hypertension was defined as BP ≥ 95th percentile. The prevalence of overweight/obesity among children was significantly lower in SAC (n = 17, 11.2%) than in CH (n = 74, 42%) (body mass index (BMI) > 85th percentile per US Centers for Disease Control and Prevention norms). However, the prevalence of hypertension was significantly higher among children in SAC (n = 15, 9.9%) than among those in CH (n = 2, 1.1%). Children were divided into 4 groups by mean arterial BP quartiles for comparison by ANOVA. As mean arterial BP increased, age, BMI, glucose, triglycerides, triglycerides/high-density lipoprotein cholesterol, and insulin levels increased significantly. Multiple linear regression analyses showed that children's mean arterial BP was significantly associated with altitude adjusted for confounding variables (R² = 0.42). Furthermore, when mean arterial BP was replaced by systolic BP (R² = 0.51) or diastolic BP (R² = 0.33), similar results were obtained. Our results suggest that Indigenous children who live permanently at high altitude have higher levels of BP, adjusted for confounding variables. Routine BP measurements conducted in the SAC community could be essential for the prevention of cardiovascular disease.

Type 2 diabetes markers in indigenous Argentinean children living at different altitudes

Background

Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for metabolic diseases.

Objective

To determine the association between Type 2 diabetes (T2D) risk factors and altitude in two groups of Argentinean indigenous schoolchildren who live permanently at different altitudes.

Methods

This cross-sectional study compared 142 schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 171 from Chicoana (CH), 1400 m. Data for children's anthropometry, blood pressure and lipids, as well as mothers' height and weight were assessed.

Results

There was not a significant difference in age between SAC (9.0 + 2y) and CH (9.4 + 2y) children. However, mean children's weight (29 vs. 38 kg), height (130 vs. 138 cm), BMI (17 vs. 19 kg/m²), and HDL-C (46 vs. 48 mg/dL) were significantly lower in SAC than in CH, respectively. In contrast, systolic blood pressure (87 vs. 70 mmHg), cholesterol (157 vs. 148 mg/dL), and triglycerides (104 vs. 88 mg/dL) were significantly higher in SAC than in CH, respectively. There was not a significant difference in age (33.2 + 7y vs. 34.4 + 8y) and BMI (26.2 + 4y vs. 28 + 5y) between SAC and CH mothers. Multiple linear regression analyses showed that children's blood pressure (R² = 0.38), triglycerides (R² = 0.21), and HDL-C (R² = 0.16) were significantly associated with altitude, adjusted for confounding variables.

Conclusion

This study shows that indigenous Argentinean children living at 3750 meters have higher T2D risk compared with those living at 1400 meters above sea level.

Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

BACKGROUND AND AIM

The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII).

METHODS AND RESULTS

Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA_1c) level was 60 mmol/mol (7.6%). The HbA_1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA_1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis.

CONCLUSIONS

Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia.

CLINICAL TRIAL REGISTRATION NUMBER

NCT 02620917 (ClinicalTrials.gov).

Association between Apo B Levels in Mothers and in their Pre-school Age Offspring

OBJECTIVE

The study aims to determine the association between apo B levels in mothers and their pre-school offspring.

METHODS

Anthropometric measurement (e.g. BMI), lipids, lipoproteins, and apolipoproteins (e.g. apo B) levels in mothers and their children were obtained in November 2015 in Buenos Aires.

RESULTS

Eighty-four children (42M) aged 5.3±1.6 years and their mothers aged 33.8±7.2 years were examined. The prevalence of overweight was 39.2 % (33) in mothers and 22.6 % (19) in children, and the prevalence of obesity was 38.1% (32) in mothers and 10.7% (9) in children. Multiple linear regression analysis showed that maternal apo B levels were associated with apo B levels in their offspring, adjusted for confounding variables (Beta=0.29; p=0.03; R2=0.25). Furthermore, offspring born to mothers with high apo B levels were six times likelier to have high apo B levels (OR), 5.7; (95% CI 1.3-25.5).

CONCLUSION

This study suggests that maternal apo B levels were significantly associated with apo B concentration in their pre-school age children.

Activity of the antioxidant enzyme paraoxonase in Argentinean children living at high altitude

Background: Children living at high altitude in San Antonio de los Cobres (SAC), Argentina, were shown to have lower high-density lipoprotein cholesterol (HDL-C) levels than Buenos Aires (BA) children. HDL antioxidant capacity is mainly attributed to paraoxonase1 (PON1).

Objective: To compare PON1 activity in indigenous SAC vs. BA children.

Methods: A cross-sectional study compared 158 SAC vs. 97 BA children (6–16 years). Anthropometric data and lipoprotein profile were measured. PON1 was evaluated employing paraoxon (PON) and phenylacetate (ARE) activity.

Results: The prevalence of overweight/obesity was lower in SAC than in BA children (18.3 vs. 30.9%). Triglycerides (1.34 vs. 0.90 mmol/l), apo B (0.84 vs.0.72 g/l), apo A-I (1.33 vs. 1.27 g/l), and ARE activity (100 vs. 90 µmol/ml/min) were higher, while HDL-C (1.16 vs. 1.32 mmol/l) and PON activity (170 vs. 203 nmol/ml/min) were lower in SAC than in BA. Separate multiple linear regression analyses showed that SAC children had significantly higher triglyceride (Beta −0.38), apo B (Beta −0.34), and ARE (Beta −0.36) plus lower HDL-C (Beta 0.33) and PON (Beta 0.25) compared with BA; adjusted for age, gender, and BMI.

Conclusion: SAC showed an unfavorable lipoprotein profile, lower PON and higher ARE activities compared with BA children, suggesting the presence of altered HDL metabolism and antioxidant capacity.

Healthier Lipid Profiles with Vitamin D Supplementation in a Pilot Study in Argentinean Children of Two Ethnicities

OBJECTIVE

to explore changes in lipid levels in two groups of children of different ethnicities who were able to access vitamin D supplementation versus those who were not.

METHODS

A prospective one-year study evaluated 87 San Antonio de los Cobres (SAC) Indigenous and 36 Buenos Aires (BA) urban schoolchildren aged 9.7 + 2.1 years between October 2013 and October 2014. SAC children included 70 (80.5%) treated with 100,000 IU/year of vitamin D and 17 (19.5%) untreated; and BA children included 25 (69,5%) treated and 11(30.5%) untreated. BMI, lipids, and 25-hydroxyvitamin D (25(OH)D) concentrations were measured at baseline and after one year.

RESULTS

There was a significantly lower prevalence of overweight/obesity in SAC (n = 7; 8%) versus BA (n = 7; 36.4%) children. There was a significant association between changes in (25(OH)D) and changes in HDL-C levels in SAC (r0.44;p < 0.01) and in BA (r0.34;p < 0.05). Multiple linear regression analyses showed that changes in (25(OH)D ) were significantly associated with changes in HDL-C in SAC (Beta = 0.55, p = 0.02; R20.11) and BA children (Beta = 0.42, p = 0.04; R2 0.21) adjusted for age, gender, and BMI. Furthermore, multiple logistic regression analysis showed that children in the treated group had a likelihood six times greater of having HDL-C >40 mg/dL than the untreated group, adjusted for age, gender, and BMI (OR 6.3: CI 2.0 - 19.8; p < 0.01).

CONCLUSION

These results suggest that children who had received vitamin D supplementation had significantly higher vitamin D status and HDL-C, as compared with non-supplemented children in both communities.

Association between blood pressure and magnesium and uric acid levels in indigenous Argentinean children at high altitude

OBJECTIVE

To determine the association between nontraditional risk factors such as magnesium and uric acid with blood pressure (BP) in Indigenous children.

METHODS

A total of 263 school-aged indigenous children living at high altitude were enrolled in a cross-sectional study in November 2011. Prehypertension (preHTN) and hypertension (HTN) were defined by systolic and/or diastolic BP ≥ 90th to <95th percentile or ≥95th percentile respectively, according to age, sex, and height.

RESULTS

The prevalence of preHTN and HTN was 13.7 and 8.3%, respectively. Low magnesium levels were identified in 21.7% (57/263): 28.1% (16/57) of the children with low magnesium levels had preHTN versus 9.7% (20/206) with normal magnesium values. Furthermore, 21.8% (12/57) of the children with low magnesium levels had HTN versus 4.5% (20/206) with normal magnesium values. There was a significant association between mean arterial pressure and magnesium (r = -026), uric acid (r = 0.20), phosphorus (r = -0.17), z-BMI (r = 0.22), potassium (r = -0.10), HOMA-IR (r = 0.17), calcium (r = -0.10), and sodium (r = -0.13). Multiple linear regression analysis showed that mean arterial pressure was associated significantly and directly with BMI, age, gender, and uric acid; and inversely with magnesium, adjusted for sodium, calcium, phosphorus, potassium, and HOMA-IR (R²  = 0.43). Furthermore, multiple logistic regression analyses showed that magnesium (OR = 0.015) and uric acid (OR = 2.95) were significantly associated with preHTN. Similar results were obtained when preHTN was replaced by HTN.

CONCLUSION

Our results indicate that HTN was associated inversely with magnesium and positively with uric acid in indigenous school children.

Association between waist circumference and magnesium and uric acid in indigenous Argentinean children living at high altitude

BACKGROUND

Studies in adults show that central obesity increases the likelihood of Type 2 diabetes (T2DM).

OBJECTIVE

To determine the association between waist circumference (WC) and non-traditional risk factors such as magnesium (Mg), phosphorus, and uric acid in indigenous children living at high altitudes.

METHODS

A total of 354 (166 M) indigenous school children, aged 9.6 + 2.3 years, were enrolled in a cross-sectional study in November 2011. Central obesity was defined as WC > 90th percentile according to age and sex. Low Mg and phosphorus levels were defined as serum Mg <1.8 mg/dL and phosphorus <2.4 mg/dL . Hyperuricemia was defined as serum uric acid > 7 mg/dL.

RESULTS

The prevalence of central obesity was 6.8% (24/354). None of the children had hyperuricemia or low P levels. HypoMg was identified in 21.7% (57/263). There was a significant association between WC (z-score) and Mg (r-015), uric acid (r0.28), phosphorus (r-0.30), HOMA-IR (r0.49), Triglycerides (r0.24), and HDL-C (r0.24). However, calcium, sodium, and potassium were not significantly associated with WC. As z-WC quartiles increased Mg and phosphorus levels significantly decreased, whereas uric acid levels increased. Multiple linear regression analysis showed that z-WC was associated significantly and directly with uric acid (B0.31), triglycerides (B0.004), and HOMA-IR (B0.35); and inversely with Mg (B-0.83) and phosphorus (B-0.25), adjusted for confounding variables (R2 0.34).

CONCLUSION

Our results indicate that central obesity was significantly and inversely associated with Mg and phosphorus and directly with uric acid in indigenous school children. Supplementation with Mg and/or phosphorus could prevent future cardiovascular disease. Prospective and randomized studies should be performed to confirm these findings.

Comparison Between HDL-C Levels in Argentine Indigenous Children Living at High Altitudes and U.S. Children

BACKGROUND

Studies have shown low levels of high-density lipoprotein cholesterol (HDL-C) in indigenous children versus urban children from Argentina. We hypothesized that indigenous children living at high altitudes might have lower HDL-C levels compared with U.S. children, probably due to ambient hypoxia, lifestyle conditions, or ethnicity. This study was designed (1) to compare HDL-C levels in Argentinean indigenous children with those reported in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) for U.S. children and (2) to determine the association between HDL-C and adiposity in both groups.

SUBJECTS AND METHODS

A cross-sectional study of 1,232 (631 females) Argentinean indigenous schoolchildren (4-14 years old) from San Antonio de los Cobres (SAC) was performed between November 2011 and November 2014. Anthropometric measures were performed in the whole group and compared with those of 2,151 U.S. children (1,034 females). However, HDL-C concentrations were measured in 905 SAC children and compared with those of 1,451 U.S. children. Analyses were done incorporating sampling weights for age in both samples to obtain unbiased estimates. In the case of NHANES the weights provided by each individual in the 2011-2012 NHANES demographic file were used, whereas in the SAC sample the weights were obtained using the census data provided by the 2010 National Statistics and Censuses Institute of Argentina.

RESULTS

The prevalence of overweight/obesity was significantly lower in SAC (135/1,232; 11%) than in the United States (759/2,151; 35%). However, the prevalence of low levels of HDL-C was significantly higher in SAC (298/905; 33%) than in the United States (142/1,451; 10%). The prevalence of low levels of HDL-C increased significantly in both groups as body mass index categories increased. Multiple logistic regression analysis showed that SAC children had nine and a half times the odds of having low levels of HDL-C compared with U.S. children, adjusted for confounding variables (odds ratio = 9.55; 95% confidence interval, 7.18-12.71).

CONCLUSIONS

This study shows a high prevalence of low levels of HDL-C in indigenous Argentinean children 4-14 years of age living at high altitudes compared with U.S. children.

Waist Circumference Percentiles in Indigenous Argentinean School Children Living at High Altitudes

BACKGROUND

Central obesity is associated with increased risk of type 2 diabetes.

OBJECTIVES

The study objectives were to develop waist circumference (WC) percentiles, to determine if WC is associated with metabolic risk, and to compare our WC percentiles with those reported in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

METHODS

A cross-sectional study of 1232 children (606 boys ) 5-14 years was performed from 2011 to 2014 in indigenous Koya children from northwestern Argentina. Anthropometric characteristics, glucose, lipids, and insulin levels were measured. Sex-specific reference percentiles were computed using the Lambda-Mu-Sigma (LMS) method. We obtained 2007-2010 NHANES data for comparison with our results.

RESULTS

Compared with the NHANES 90th percentile, WC values for children in this study were lower by an average of 11.05 cm for girls and 12.66 cm for boys. The prevalence of low high-density lipoprotein cholesterol (HDL-C) was 11.8% in children with WC ≤50th percentile, 10.3% in children with WC >50th-70th percentile, 17.5% in children with WC >70th-90th percentile, and 21.3% in children with WC >90th percentile. The prevalence of high triglycerides (TG) was 19.5% in children with WC ≤50th percentile, 19.9% in children with WC >50th-70th percentile, 28.8% in children with WC >70th-90th percentile, and 39.7% in children with WC >90th percentile. Multiple logistic regression analyses showed that high TG values (>150 mg/dL) were significantly associated with WC [odds ratio (OR)] 1.05; 95% confidence interval (CI) 1.03-1.08; and low HDL-C values (<35 mg/dL) were significantly associated with WC (OR 1.04; 95% CI 1.01-1.06), adjusted for age and gender.

CONCLUSION

We present for the first time WC reference data for indigenous Koya children ages 5-14 years. There was a significant association between WC and dyslipidemia in this community. Compared with the NHANES WC percentiles, our WC values were lower. These differences possibly reflect ethnicity or the lower prevalence of obesity.

Novel thiotolerant catalysts for the on-board partial dehydrogenation of jet fuels

The possibility of producing on-board H₂ by dehydrogenation of petrol derivates is interesting for transport applications.

Diginyc partial hydatidiform mole with increased fetal nuchal translucency and ovarian hyperstimulation syndrome

PURPOSE OF INVESTIGATION

Hydatidiform mole (HM) is an abnormal pregnancy characterized by proliferation of cytotrophoblast and syncytiotrophoblast and vesicular swelling of placental villi. The fetus or embryo can be absent or abnormal. HMs can be complete or partial.

CASE REPORT

A case of diginyc partial HM at 12 weeks of gestational age was referred to the present center of prenatal diagnosis. The patient showed ovarian hyperstimulation syndrome. At ultrasonography, increased fetal nuchal translucency (NT) with fetal anomaly was evident, without sonographic signs of placental mole. Pregnancy was terminated with legal abortion.

RESULTS

Partial HM (PHM) was suspected by ultrasonographic fetal markers with ovarian hyperstimulation syndrome, but the diagnosis was performed only with fluorescent in situ hybridization. In particular fetal NT appeared increased also in diginyc mole.

CONCLUSION

In order to improve the detection rate of PHM, routine histological examinations may be associated to fluorescent in situ hybridization in all cases of fetal anomalies.

Status of Dyslipidemia in Vitamin D Supplemented Argentinean Indigenous Children Versus A Non-supplemented Mixed Population Group

BACKGROUND

Epidemiological studies have suggested an inverse association between circulating levels of vitamin D and cardiovascular disease risk biomarkers, including an atherogenic lipid profile.

OBJECTIVE

To compare the prevalence and the distribution of lipid levels among vitamin D supplemented Argentinean indigenous San Antonio de los Cobres (SAC) children with a nonsupplemented Buenos Aires (BA) mixed population group.

METHODS

A group of indigenous children from SAC with hypovitaminosis D supplemented with vitamin D; and a nonsupplemented group from a BA mixed population were compared via a cross sectional study. Anthropometric measures, glucose, lipids, vitamin D, and insulin were measured.

RESULTS

The mean ages were 10.3 + 2.3 in SAC and 8.7 ± 1.8 years in BA children. There was a lower prevalence of overweight 7.9%(15/192) vs 17.8% (23/129); and of obesity 1.6% (3/192) vs 30.2% (39/129) in SAC vs. BA respectively. Approximately half of the SAC children versus 30% from BA had optimal vitamin D levels (≥30ng/mL). There was a significantly higher prevalence of high triglycerides (TG) (27.6%vs 4.6%) and low HDL-C (21.3% vs 5.4%) in SAC vs BA children, respectively. In separate linear regression models, we found that despite effective vitamin D repletion, SAC children had higher TG and TG/HDL-C values, whereas HDL-C levels were lower than those of BA children adjusted for age, gender, BMI, and insulin levels.

CONCLUSION

Indigenous Argentinean children have a higher risk for dyslipidemia in comparison with BA children, even after vitamin D treatment, suggesting that dyslipidemia could be related to diet or ethnic backgrounds.

Association between triglyceride to HDL-C ratio and insulin resistance in indigenous Argentinean children

BACKGROUND

Insulin resistance is considered one of the major risk factors for the development of type 2 diabetes mellitus (T2DM). Thus, early identification, preferably by using simple and inexpensive diagnostic tools, is essential for preventing T2DM. Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been proposed as an inexpensive tool to identify individuals at high risk of T2DM. The objective of this study was to determine the relationship between insulin resistance and TG/HDL-C in indigenous Argentinean children.

METHODS

A cross-sectional study of 501 (243 boys) indigenous school children aged 10.0 ± 2.4 yr were assessed for anthropometry, lipids, glucose, and insulin levels from November 2011 to November 2013. Insulin resistance was defined as the upper third quartile of homeostasis model assessment (HOMA-IR).

RESULTS

The prevalence of overweight/obesity was 11.4% per Centers for Disease Control. Mean levels of various characteristics were: body mass index (BMI) 17.2 ± 2.6, HDL-C 39 ± 9 mg/dL, TGs 121 ± 58 mg/dL, TG/HDL-C 2.9 ± 1.8, glucose 77 ± 8 mg/dL, HOMA-IR 1.0 ± 0.8, and insulin 44 ± 9 mUI/L. Children in the higher quartiles of TG/HDL-C had significantly higher HOMA-IR values than children in the lower quartiles. Multiple linear regression analysis showed that TG/HDL-C was significantly associated with HOMA-IR (r² = 0.19) adjusted for age, gender, and BMI. Furthermore, for a 1-unit increase in log TG/HDL-C, the odds of being insulin resistant (HOMA-IR>III quartile) increased by 2.58 times [odds ratio (OR), 2.58 (1.63-4.05); p < 0.01], adjusted for age, gender, and BMI.

CONCLUSION

This study suggests that TG/HDL-C may be a good marker to identify insulin resistant indigenous Argentinean children.

[Preliminary data on the effectiveness of resveratrol in a new formulation in treatment of hot flushes]

AIM

We conducted a pilot study to evaluate the effectiveness of resveratrol absorbed orally, conveyed through a new patented technology that increases the absorption through the oral mucosa in treatment of hot flushes (HF) during menopause.

METHODS

This is a randomized controlled double-blind study with crossover design. From October 2012 to July 2014 we considered the first 50 patients enrolled at the Center for Menopause Maggiore Hospital of Charity of Novara, with diagnosis of physiological or surgical menopause. Each woman received a diary in which she indicated the weekly number of HF and the perceived intensity, in a 0-10 Scale (Visual Analogue Scale, VAS).

RESULTS

Reduction of the monthly number of vasomotor episodes. Resveratrol 16/28 (57.1%); P2/22 placebo (9.1%) <0.001. The resveratrol group gets a positive result 6.28 times more compared to the placebo arm (95% CI: 1.61-24.49). Improvement of the intensity of symptoms and improving quality of life: resveratrol 22/28 (78.6%); placebo 4/22 P (18.2%) <0.001. Resveratrol group obtained a positive result 4:32 times more than the placebo arm (95% CI: 1.74-10.71).

CONCLUSION

Resveratrol is effective in reducing the number of episodes vasomotor and the intensity of HF, with the transition from moderate/severe to mild symptoms in 78.6% of patients. Resveratrol has the characteristics to be an alternative therapy in the treatment of HF in menopause.

Heart Rate Variability (HRV) modifications in adult hemiplegic patients after botulinum toxin type A (nt-201) injection

BACKGROUND

The most important adverse effect of BoNT-A is the systemic diffusion of the toxin. There is some evidence that the administration of high doses can increase the risk of systemic diffusion and the development of clinically evident adverse effects, however an international consensus does not exist about its maximum dose.

AIM

The aim of this study was to evaluate changes in autonomic heart drive induced by high doses (higher than 600 units) of incobotulinumtoxinA injection in spastic stroke patients. Moreover, the treatment safety by monitoring adverse events occurrence was assessed.

DESIGN

Case control study.

POPULATION

Eleven stroke survivors with spastic hemiplegia.

METHODS

Patients were treated with intramuscular focal injections of IncobotulinumtoxinA (NT 201; Xeomin®, Merz Pharmaceuticals GmbH, Frankfurt, Germany). Doses were below 12 units/Kg. Each patient underwent an ECG recording before injection and 10 days after treatment. Linear and non-linear Heart Rate variability (HRV) measures were derived from ECGs with a dedicated software.

RESULTS

None of the variable considered showed statistically significant changes after BoNT-A injection.

CONCLUSION

The use of incobotulinumtoxinA in adult patients at doses up to 12 units/kg seems to be safe regarding autonomic heart drive.

CLINICAL REHABILITATION IMPACT

The use of IncobotulinumtoxinA up to 600 units could be a safe therapeutic option in spastic hemiplegic stroke survivors.

Maternal misperceptions of children's overweight in an indigenous Argentinean community

OBJECTIVE

To compare the prevalence of misperception between 2 groups of mothers towards their children's weight status from an indigenous population in San Antonio de los Cobres (SAC) and a Buenos Aires (BA) mixed population.

METHODS

Questionnaires regarding mothers' perceptions about their children's shape were performed during 2014.

RESULTS

Overall, 152 SAC children (80 males) aged 9.0+2.1 years and 119 BA children (59 males) aged 8.1+1.7 years were evaluated. There was a significant difference in the prevalence of maternal misperception of normal weight vs overweight children in both ethnicities: SAC (38.8% vs 66.7%) and BA (33.3% vs 62.9%).

CONCLUSION

These results suggest that maternal misperception of children's overweight was poor in both communities despite having different socio-economic and ethnic backgrounds.

Improvement of Apolipoprotein B in Argentine Indigenous School Children after Vitamin D Supplementation

OBJECTIVE

To determine whether vitamin D supplementation improves non-traditional cardiovascular risk factors such as Apo B levels among indigenous children.

METHODS

A prospective two-year study evaluated a treated cohort of 190 children (104 males) aged 9.4+ 2.2 years. Children were divided into group A (n=104; 54.7%) and group B (n=86; 45.3%). Both groups received vitamin D supplementation with 100,000 u/year; group B was treated in 2013 and group A in 2014. All subjects were evaluated at the end of each treatment and anthropometric measures, lipids and vitamin D levels between the two groups were compared.

RESULTS

Changes in vitamin D levels were significantly higher in Group A, which was supplied in 2014, than in group B, which was not supplied in 2014 (6.8 vs 0.96 ng/dL; respectively). Levels of LDL-C and Apo B were improved in group A versus B: LDL-C (-5.7 vs 6.9 mg/dL respectively) and Apo B (-0.9 vs 11. mg/dL respectively). Several multiple regression linear analyses showed that changes in vitamin D were significantly associated with lower LDL-C levels (Beta- 0.41, p<0.01; R2 0.07); and with lower Apo B levels (Beta-0.37, p<0.01; R2 0.17).

CONCLUSION

Vitamin D supplementation among indigenous children could improve Apo B levels.

Screening for gestational diabetes in the Lombardy region: A population-based study

AIM

As the treatment of hyperglycaemia during pregnancy with diet or insulin reduces the risk of adverse maternal outcomes and perinatal complications, screening for gestational diabetes mellitus (GDM) is included, albeit to variable extents, in all guidelines of care for pregnant women. The aim of the present investigation was to estimate the proportion of pregnancies screened for GDM in Lombardy between 2007 and 2010, and to identify predictors of screening.

METHODS

A retrospective cross-sectional study using regional healthcare utilization databases of Lombardy was conducted. The study included all residents of Lombardy without pregestational diabetes who delivered between 1 January 2007 and 31 December 2010. The proportion of pregnancies with at least one screening test for GDM was calculated, along with the odds ratios and 95% confidence intervals associated with selected covariates for GDM screening.

RESULTS

Of the 362,818 pregnancies included in the sample, 30% were screened for GDM. The proportion of pregnancies screened increased slightly from 2007 (27%) to 2010 (33%) and with maternal age (from 28% among women<25 years to 32% among those ≥35 years), and varied widely across local health management organizations (HMOs) of residence (range: 20% to 68%). Socioeconomic indicators (education, immigrant status), obstetric history and prepregnancy hypertension were independent predictors of GDM screening.

CONCLUSION

The study finding of a low rate of pregnant women screened for GDM among residents of Lombardy supports the need for programmes to improve training of healthcare professionals, to raise women's awareness of GDM and to eliminate barriers to GDM screening.

Posterior reconstruction and outcomes of laparoscopic radical prostatectomy in a high-risk setting

Posterior reconstruction was found to be associated with lower degree of anastomotic leakage and enhanced urinary continence at one and three months after extrafascial laparoscopic radical prostatectomy.

Background and Objectives:

To detail the technique and evaluate the impact of a personal modified posterior reconstruction technique (PDR) on the outcomes of extrafascial laparoscopic radical prostatectomy (eLRP) in a consecutive series of 52 patients affected by high-risk prostate cancer (HRPCa).

Methods:

From October 2007 to March 2012, 52 patients underwent PDR during eLRP for HRPCa. Fifty-four patients who underwent eLRP for HRPCa with no PDR were considered as historical controls. Mean operative time (MOT), mean catheterization time (MCT), % continence and quality of life (QoL) at a scheduled follow-up, % anastomotic leakage, % adjuvant therapy were compared between the groups. Percentage of continence and QoL were prospectively assessed by self-administered validated questionnaires (ICI-Q-SF; SF-36) at 1, 3, 6, and12 months.

Results:

PDR was associated wither higher continence rates at 1 and 3 mo (P = .028, P = .006), a lower incidence of cystographic leakage (P = .002), and an increased adjuvant radiotherapy rate (P = .008). At 1- and 3-mo interval, in the PDR group, we found a higher number of patients reporting better general health, (P = .01, P = .03) reduced role limitations due to physical health, (P = .02, P = .001), and emotional problems (P = .001, P = .02).

Conclusions:

PDR is associated with a lower degree of anastomotic leakage, and it significantly enhances urinary continence at 1 and 3 mo. The increased adjuvant radiotherapy rate and quality of life after surgery observed with our technique suggest that in the high-risk setting an early functional recovery may substantially influence the oncologic outcome of eLRP.

Improvement in high-density lipoprotein cholesterol levels in argentine Indian school children after vitamin D supplementation

BACKGROUND/AIMS

Low vitamin D levels correlate with dyslipidemia, but limited data exist on indigenous children. The objective was to determine whether vitamin D supplementation improves high-density lipoprotein cholesterol (HDL-C) levels among Koya children.

METHODS

A prospective 1-year study evaluated a treated cohort of 70 (38 males) children aged 10.3 ± 2.1 years who received 5,000 U of vitamin D weekly during 8 weeks, and a control group of 20 (8 males) children aged 9.2 ± 1.1 years who did not receive vitamin D.

RESULTS/CONCLUSIONS

At baseline, 18 (20%) had severe vitamin D deficiency (<10 ng/ml), 66 (73.3%) had deficiency (10 to <20 ng/ml), and 6 (6.6%) had insufficiency (20 to <30 ng/ml). At baseline, there was no significant difference in the prevalence of hypovitaminosis D between groups. After 1 year, the prevalence of severe vitamin D deficiency decreased from 20 to 0%, and that of insufficiency increased from 6 to 19% (p < 0.001) only in the treated group. The prevalence of low HDL-C also decreased in the treated group only (35.7-5.7%; p < 0.01). Multiple linear regression analysis showed that treated children improved HDL-C levels by 4 mg/dl (R(2): 0.13) adjusted for confounding factors, suggesting that vitamin D supplementation among Indian children improved HDL-C levels.

Orthofile®: a new approach for mechanical interproximal reduction : a scanning electron microscopic enamel evaluation

PURPOSE

The aim of this in vitro study was to evaluate the stripping achieved on different teeth (incisors, canines, and premolars) by two grades of abrasive strips used for the first and tenth time. Our second aim was to test the efficacy of these strips by calculating the time necessary to perform interproximal reductions of 0.10, 0.20, and 0.30 mm.

METHODS

Four models were constructed using extracted teeth affixed in wax. The upper and lower arches were set on plaster bases and fixed in wax, carefully creating contact points. All model mouths were treated with artificial saliva (Oral Balance®) in order to simulate the biological conditions in the oral cavity. We then tested specific air-rotor strips of different grades and degrees of wear (15-µm-grain and 25-µm-grain Orthofile® strips). Afterwards the teeth from all samples were cut lengthwise in half, and each mesial and distal portion was gold-plated and observed under SEM at incremental magnification (30, 60, and 100 µm).

RESULTS

The 25-µm-grain strip was more effective than the 15-µm-grain strip, irrespective of the tooth involved. Second, the finishing phase with specific polishing strips after interproximal reduction was fundamental in reducing the number of abrasions and irregularities created by stripping, in particular after using the 25-µm-grain strip. To achieve the best result, the entire abraded area must be polished.

CONCLUSION

This system permits a rapid and effective stripping procedure in direct proportion to the strip's grain and in inverse proportion to the wear from its use. Further research will enable us to compare this system with similar procedures.

Vitamin D protects human endothelial cells from oxidative stress through the autophagic and survival pathways

CONTEXT

Recently, vitamin D (VitD) has been recognized as increasingly importance in many cellular functions of several tissues and organs other than bone. In particular, VitD showed important beneficial effects in the cardiovascular system. Although the relationship among VitD, endothelium, and cardiovascular disease is well established, little is known about the antioxidant effect of VitD.

OBJECTIVE

Our objective was to study the intracellular pathways activated by VitD in cultured human umbilical vein endothelial cells undergoing oxidative stress.

DESIGN

Nitric oxide production, cell viability, reactive oxygen species, the mitochondrial permeability transition pore, membrane potential, and caspase-3 activity were measured during oxidative stress induced by administration of 200 μM hydrogen peroxide for 20 minutes. Experiments were repeated in the presence of specific vitamin D receptor ligand ZK191784.

RESULTS

Pretreatment with VitD alone or in combination with ZK191784 is able to reduce the apoptosis-related gene expression, involving both intrinsic and extrinsic pathways. At the same time, it has been shown the activation of pro-autophagic beclin 1 and the phosphorylation of ERK1/2 and Akt, indicating a modulation between apoptosis and autophagy. Moreover, VitD alone or in combination with ZK191784 is able to prevent the loss of mitochondrial potential and the consequent cytochrome C release and caspase activation.

CONCLUSIONS

The present study shows that VitD may prevent endothelial cell death through modulation of the interplay between apoptosis and autophagy. This effect is obtained by inhibiting superoxide anion generation, maintaining mitochondria function and cell viability, activating survival kinases, and inducing NO production.

Association between nontraditional risk factors and metabolic syndrome in indigenous Argentinean schoolchildren

BACKGROUND

Whether apolipoproteins (Apos) are better cardiovascular disease (CVD) markers than metabolic syndrome (MS) is widely debated. Measurement of Apo B is standardized, simple, and inexpensive and does not require fasting. The aim of this study was to compare the ability of nontraditional CVD markers such as Apo B, Apo B/Apo A, non-high-density lipoprotein cholesterol (HDL-C), vitamin D, and homeostasis model assessment of insulin resistance (HOMA-IR) to identify children with MS.

SUBJECTS AND METHODS

A cross-sectional study of 355 Argentinean Koya schoolchildren (166 boys) 9.6±2.3 years old was performed in November 2011. Anthropometric measures, blood pressure, Tanner stages, and serum levels of glucose, lipids, insulin, Apo A, Apo B, and vitamin D were measured.

RESULTS

The prevalence of overweight/obesity was 10.7% (n=38), and that of underweight was 14.6% (n=52) using Centers for Disease Control and Prevention criteria. The prevalence of central obesity was 10.9% (38/355), high triglycerides was 11.1% (39/355), low HDL-C was 44.9% (158/355), hypertension was 12.8% (45/355), hyperglycemia was 0.3% (1/355), and MS was 4.2% (15/355). Several multiple logistic regression analyses showed that MS was significantly associated with HOMA-IR (odds ratio [OR], 3.6 [95% confidence interval (CI) 1.51-8.52]), non-HDL-C (OR, 1.03 [95% CI 1.007-1.049]), Apo B (OR, 1.06 [95% CI 1.03-1.09]), and Apo B/Apo A (OR, 78.3 [95% CI 3.67-1,674.4]) adjusted for age and gender. Furthermore, the areas under the receiver operator characteristic curves were as follows: Apo B, 0.77 (95% CI 0.63-0.90); Apo B/Apo A, 0.76 (95% CI 0.63-0.88); non-HDL-C, 0.72 (95% CI 0.57-0.85); and HOMA-IR, 0.69 (95% CI 0.49-0.90). These values indicate that these variables were acceptable predictors for MS.

CONCLUSIONS

This is the first study of nontraditional markers in South American Indian children. MS was associated with multiple nontraditional markers of future CVD risk such as non-HDL-C, Apo B, and Apo B/Apo A. However, Apo B was the best predictor for MS, suggesting that it could be used as a risk marker of future CVD in this community.

Improvement in lipid profile after vitamin D supplementation in indigenous argentine school children

OBJECTIVE

To determine whether vitamin D supplementation of indigenous school children living at high altitude who are vitamin D insufficient improves lipid profile.

METHODS

A prospective two-year study evaluated 60 children (29 males) from Hogar School who received 100,000 units of vitamin D and 36 children (16 males) from Sosa School who received 50,000 units. Anthropometric measures, Triglycerides (TG), HDL-C, TG/HDL-C, and vitamin D levels were measured in November 2011 and in November 2013.

RESULTS

Children aged 8.8 ± 2 years with mean z-BMI (-0.43) were evaluated. After vitamin D supplementation, mean vitamin D levels increased from 14.7 to 32.1 ng/mL (p < 0.01) in Hogar and from 14.6 to 25.1 ng/mL (p < 0.01) in Sosa School. Furthermore, mean HDL-C increased significantly in Hogar (39.8 to 43.9 mg/dL); while no significant changes were found in Sosa School (44.4 to 45.1 mg/dL). Though no significant changes were found in median TG (117 to 111 mg/dL) and TG/HDL (3.0 to 2.7 mg/dL) in Hogar; TG (95 to 111 mg/dL) and TG/HDL-C (2.2 to 2.4 mg/dL) increased significantly in Sosa School. Several multiple linear regression analyses showed that children from Hogar School decreased TG/HDL-C by 1.3 mg/dL (R(2): 0.14), HDL-c by 3.6 mg/dL (R(2): 0.13), and TG by 31 mg/dL (R(2): 0.11), adjusted for confounding factors.

CONCLUSIONS

Indigenous children who received 100,000 U of vitamin D significantly improved vitamin D and lipid levels compared to children who received 50,000 U, suggesting that optimal vitamin D levels are associated with a healthier lipid profile.

Low vitamin D concentrations among indigenous Argentinean children living at high altitudes

BACKGROUND

Hypovitaminosis D is an international problem; however, there is little information about its prevalence in apparently healthy Indian children living at high altitudes.

OBJECTIVES

To determine (i) the prevalence of hypovitaminosis D and (ii) the association of serum vitamin D with the risk factors for diabetes among Indian Koya children.

METHODS

A cross-sectional study of 290 (129 males) school children aged 10.7 ± 2.9 yr was performed. Anthropometric measures, blood pressure (BP), Tanner stages and serum levels of glucose, lipids, and insulin were measured. 25-hydroxyvitamin D [25(OH)D] was measured by radioimmunoassay (Dia Sorin).

RESULTS

The prevalence of obesity was 3.4% (10), overweight 3.4% (10), normal weight 79.0% (229), and underweight 14.1 % (41) per CDC reference standards. Concentrations of [25(OH)D] were median 10 (range 8-13 ng/mL); 10 (3.4%) had insufficient vitamin D levels (20 to <30 ng/mL), 136 (46.9%) had deficient levels (10 to <20 ng/mL), 144 (49.7%) had severe deficiency (<10 ng/mL) and none had optimal levels (≥30 ng/mL). There was an inverse significant correlation between [25(OH)D] and age (r = 0.14), body mass index (BMI) (r = 0.16), waist circumference (r = 0.15), systolic BP (r = 0.19), hemoglobin (r = 0.19), glucose (r = 0.22), insulin (r = 0.13), and homeostasis model of assessment-insulin resistance (r = 0.16). Multiple linear regression analysis showed that 25(OH)D concentrations were significantly and inversely associated with glucose concentrations (β = -0.28; p = 0.02) adjusted for age, BMI, systolic BP, hemoglobin, and insulin.

CONCLUSIONS

This study demonstrated a high prevalence of both 25(OH)D deficiency and insufficiency and an inverse association between 25(OH)D and glucose concentration in apparently healthy Koya Indian children. Further research is needed to confirm these findings.

Calcium handling in porcine coronary endothelial cells by gastrin-17

In porcine coronary artery endothelial cells (PCAEC), gastrin-17 has recently been found to increase nitric oxide (NO) production by the endothelial NO synthase (eNOS) isoform through cholecystokinin 1/2 (CCK1/2) receptors and the involvement of protein kinase A (PKA), PKC and the β2-adrenoreceptor-related pathway. As eNOS is the Ca(2)(+)-dependent isoform of the enzyme, we aimed to examine the effects of gastrin-17 on Ca(2)(+) movements. Thus, experiments were performed in Fura-2-acetoxymethyl-ester-loaded PCAEC, where changes of cytosolic Ca(2)(+) ([Ca(2)(+)]c) caused by gastrin-17 were analysed and compared with those of CCK receptors and β2-adrenoreceptors agonists/antagonists. In addition, some experiments were performed by stimulating cells with gastrin-17 in the presence or absence of cAMP/PKA activator/inhibitor and of phospholipase C (PLC) and Ca(2)(+)-calmodulin dependent protein kinase II (CaMKII) blockers. The results have shown that gastrin-17 can promote a transient increase in [Ca(2)(+)]c mainly originating from an intracellular pool sensitive to thapsigargin and from the extracellular space. In addition, the response of cells to gastrin-17 was increased by the adenylyl cyclase activator and the β2-adrenoreceptor agonists and affected mainly by the CCK2 receptor agonists/antagonists. Moreover, the effects of gastrin-17 were prevented by β2-adrenoreceptors and CaMKII blockers and the adenylyl cyclase/PKA and PLC inhibitors. Finally, in PCAEC cultured in Na(+)-free medium or loaded with the plasma membrane Ca(2)(+) pump inhibitor, the gastrin-17-evoked Ca(2)(+) transient was long lasting. In conclusion, this study shows that gastrin-17 affected intracellular Ca(2)(+) homeostasis in PCAEC by both promoting a discharge of an intracellular pool and by interfering with the operation of store-dependent channels through mainly CCK2 receptors and PKA/PLC- and CaMKII-related signalling downstream of β2-adrenoreceptor stimulation.

Association of vitamin D with glucose levels in indigenous and mixed population Argentinean boys

INTRODUCTION

There is little information about low vitamin D concentrations in apparently healthy indigenous children in South America.

OBJECTIVES

(a) To compare the prevalence of hypovitaminosis D in SAC (San Antonio de los Cobres) versus BA (Buenos Aires) boys and (b) to determine the association of serum vitamin D concentration with age, gender, and risk factors for diabetes.

METHODS

This cross-sectional study compares 129 boys from SAC with a 98% indigenous population, versus 116 boys from BA with a mixed population. Anthropometric measures and serum levels of glucose, lipids, insulin, and 25-hydroxyvitamin D [25(OH)D] were measured in May 2011 and May 2010 (fall season). Optimal, insufficiency, deficiency, and severe deficiency of vitamin D were defined as [25(OH)D[levels ≥75 nmol/L, 50 to <75 nmol/L, 25 to <50 nmol/L, and <25 nmol/L respectively.

RESULTS

The mean age was 9.7±2.7 in SAC and 11.3±2.51 years in BA children. Seventeen (13.2%) SAC and 2 (1.7%) BA children were underweight; 99 (76.7%) SAC and 58 (50.0%) BA children were normal weight; 5 (3.9%) SAC and 15 (12.9%) BA children were overweight; and 8 (6.2%) SAC and 41 (35.3%) BA children were obese (p<0.001). Sixty-six (51.2%) SAC and 1 (0.9%) BA children had vitamin D severe deficiency; 58 (45.0%) SAC and 53 (45.7%) BA children had deficiency; 5 (3.9%) SAC and 61 (52.6%) BA had insufficiency; and 0 (0%) SAC and 1 (0.9%) BA children had optimal vitamin D (p<0.001). Therefore, there was a lower prevalence of overweight/obesity and a higher prevalence of vitamin D deficiency in SAC than in BA children. Separate linear regression models showed an inverse association between glucose levels (beta=-0.22; p=0.01) and HOMA=IR (beta=-0.21; p=0.02) with vitamin D levels adjusted for age, z-BMI and community.

CONCLUSIONS

There was a higher prevalence of 25(OH)D deficiency in SAC versus BA boys, suggesting that dark skin, high altitudes, or genetic backgrounds could contribute to this problem. In addition, we found an inverse association between [25(OH)D] and glucose concentration in apparently healthy children. Additional longitudinal studies should be done to confirm these findings.