A preliminary investigation into the unsaponifiable fraction of donkey milk: Sterols of animal origin, phytosterols, and tocopherols

We investigated the main sterols, phytosterols, and the α- and γ-tocopherol content in donkey milk during the first 2 mo of lactation. Cholesterol was the main sterol in milk (mean ± standard deviation = 0.97 ± 0.443 g/100 g of fat). Lanosterol was the main minor sterol of animal origin, followed by desmosterol (0.003 ± 0.001 and 0.001 ± 0.001 g/100 g of fat, respectively). Of the phytosterols, β-sitosterol was the main sterol of vegetal origin in donkey milk (0.005 ± 0.002 g/100 g of fat), but lower levels of campesterol, brassicasterol, and stigmasterol were also recorded. Mean levels of α- and γ-tocopherol were 0.01 ± 0.007 and 0.003 ± 0.001 g/100 g of fat, respectively. We observed no significant changes in sterol or tocopherol content during the first 2 mo of lactation. The presence of lanosterol in donkey milk is of particular interest, because lanosterol is a potential drug and has important physiological effects. The presence of phytosterols, which are considered nutraceutical molecules, enhances the nutritional quality of donkey milk fat for consumers

Secondary prevention of coronary heart disease. A survey in an Italian primary care practice

AIM: Management of patients with pre-existing coronary heart disease (CHD) relies for the most part on primary care physicians, an endeavour whose success is dependent upon acceptance and day-to-day application of guideline recommendations for secondary CHD prevention. The aim of this study is to analyze the status of secondary CHD prevention in an Italian primary care practice consisting of five partnered general practitioners attending 7006 subjects aged 15 years or more (3137 males, 3869 females) in Pontedera, Tuscany. METHODS: Retrieval of patients with history of CHD (previous myocardial infarction, [MI], and stable angina) from computerized records of the 5987 (2735 men, 3252 women) subjects aged 35-85 years enlisted in the practice. Patients with myocardial infarction <3 months at the time of the query were excluded. RESULTS: Search retrieved 153 (2.6%) subjects with history of CHD, 93 (3.4%) males and 60 (1.8%) females. Females were older and smoked more frequently than men. Antiplatelet drugs, beta-blockers, renin-angiotensin system blockers and statins were prescribed in 84%, 56%, 66% and 68% of the ischemic patients. LDL cholesterol targets of 100 and 70 mg/dL were achieved in only 60 (45%) and 11 (9%) respectively. Systolic blood pressure was above 140 mmHg in 25 out of 146 patients with available data. CONCLUSION: The surveys shows satisfactory uptake of guideline recommendations but also pitfalls in the implementation of secondary CHD prevention requirements. Targeted interventions on primary care physicians are critically needed to enhance further provider adherence to consensus guidelines for CHD risk reduction

Health care delivery in type 2 diabetes. A survey in an Italian primary care practice

tAims: Evidence-based guidelines provide targets and performance measures for thetreatment of type 2 diabetic patients but a wide gap separates guidelines-driven recom-mendations from their clinical application, a phenomenon hindering the transfer of provenbenefits to affected populations.Methods: We analyzed the quality of diabetic care delivered by 8 general practitioners jointin a group practice attending 571 diabetic patients (5.6% of the total enlisted subjects) byassessing process (% of HbA1c, SBP and LDL-C determinations) and intermediate outcome (%of patients with HbA1c8%, systolic BP 140 mmHg, LDL-cholesterol130 mg/dL) indicators.Results: HbA1cwas at target in 49% of patients and >8% in 22%; SBP and LDL-C determinationwas available in about two-thirds of patients, only a minority at target for SBP and LDL-C.Antihyperglycemic and antihypertensive treatment was prescribed in most patients butonly a third was on statins. During the post-evaluation phase, percentages of patients withHbA1c>8%, SBP < 130 mmHg and LDL-C < 100 mg/dL and the drug prescription pattern didnot change.Conclusions: Several weaknesses affect primary care delivery to type 2 diabetic patients andefforts are needed to improve the management of this high-risk group