The Serum Level of Fibroblast Growth Factor-23 and Calcium-Phosphate Homeostasis in Obese Perimenopausal Women

Plasma FGF-23 concentrations and its relationship with calcium-phosphate homeostasis were evaluated in 48 perimenopausal obese women and in 29 nonobese controls. Serum parathyroid hormone, 25-hydroxyvitamin D3, CTX1, osteocalcin, total calcium, phosphorus, creatinine, and plasma intact FGF-23 concentrations were assessed. DXA of lumbar spine and femoral neck was performed to determine bone mineral density (BMD). Plasma iFGF-23 concentration was significantly higher in obese patients (by 42%) and correlated with age and BMD of proximal femur (R = −0.346; R = 0.285, resp.) but not with markers of bone turnover. However, serum phosphorus level in obese subjects was significantly lower. iFGF-23 concentration correlated significantly with body mass index (R = 0.292) and fat content (R = 0.259) in all study subjects. Moreover, a significant correlation between iFGF-23 and iPTH (R = 0.254) was found. No correlation between serum phosphorus or eGFR and plasma iFGF-23 and between eGFR and serum phosphorus was found. Elevated serum iFGF-23 concentration may partially explain lower phosphorus levels in the obese and seems not to reflect bone turnover

Serum ADMA concentration – an independent factor determining FMD impairment in cardiac syndrome X

Mechanisms of decreased endogenous vascular reactivity in individuals with cardiac syndrome X (CSX) are not fully understood

Regular consumption of vitamin D-fortified yogurt drink (Doogh) improved endothelial biomarkers in subjects with type 2 diabetes: a randomized double-blind clinical trial

<p>Abstract</p> <p>Background</p> <p>Endothelial dysfunction has been proposed as the underlying cause of diabetic angiopathy that eventually leads to cardiovascular disease, the major cause of death in diabetes. We recently demonstrated the ameliorating effect of regular vitamin D intake on the glycemic status of patients with type 2 diabetes (T2D). In this study, the effects of improvement of vitamin D status on glycemic status, lipid profile and endothelial biomarkers in T2D subjects were investigated.</p> <p>Methods</p> <p>Subjects with T2D were randomly allocated to one of the two groups to receive either plain yogurt drink (PYD; containing 170 mg calcium and no vitamin D/250 mL, n₁= 50) or vitamin D3-fortified yogurt drink (FYD; containing 170 mg calcium and 500 IU/250 mL, n₂= 50) twice a day for 12 weeks. Anthropometric measures, glycemic status, lipid profile, body fat mass (FM) and endothelial biomarkers including serum endothelin-1, E-selectin and matrix metalloproteinase (MMP)-9 were evaluated at the beginning and after the 12-week intervention period.</p> <p>Results</p> <p>The intervention resulted in a significant improvement in fasting glucose, the Quantitative Insulin Check Index (QUICKI), glycated hemoglobin (HbA1c), triacylglycerols, high-density lipoprotein cholesterol (HDL-C), endothelin-1, E-selectin and MMP-9 in FYD compared to PYD (<it>P </it>< 0.05, for all). Interestingly, difference in changes of endothelin-1, E-selectin and MMP-9 concentrations in FYD compared to PYD (-0.35 ± 0.63 versus -0.03 ± 0.55, <it>P </it>= 0.028; -3.8 ± 7.3 versus 0.95 ± 8.3, <it>P </it>= 0.003 and -2.3 ± 3.7 versus 0.44 ± 7.1 ng/mL, respectively, <it>P </it>< 0.05 for all), even after controlling for changes of QUICKI, FM and waist circumference, remained significant for endothelin-1 and MMP-9 (<it>P </it>= 0.009 and <it>P </it>= 0.005, respectively) but disappeared for E-selectin (<it>P </it>= 0.092). On the contrary, after controlling for serum 25(OH)D, the differences disappeared for endothelin-1(<it>P </it>= 0.066) and MMP-9 (<it>P </it>= 0.277) but still remained significant for E-selectin (<it>P </it>= 0.011).</p> <p>Conclusions</p> <p>Ameliorated vitamin D status was accompanied by improved glycemic status, lipid profile and endothelial biomarkers in T2D subjects. Our findings suggest both direct and indirect ameliorating effects of vitamin D on the endothelial biomarkers.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01236846">NCT01236846</a></p

Exclusion from service consumption in Polish health care system

Purpose: The scientific objective of this research was to determine social groups affected by exclusion in Polish health care. Materials and methods: Survey was carried out among local government units and nongovernmental organizations by using authorial questionnaire distributed towards representative research group selected. Results: This work depicts activities of social welfare centers in cooperation with non-profit sector entities, in the field of exclusion from the access to health care benefits in Poland, appointing circumstances, causes and the range of this exclusion. It presents the results of the countrywide research in the context of structure and tasks of the health care, but also two points of view (institutional and social one) for resolving the same population issues. Conclusions: On the basis of the conducted analyses it has been stated that social exclusion, in the field of health care, is a significant social problem, but the biggest difficulty is the access to the rehabilitation benefits and pharmacological therap

Wiedza chorych hemodializowanych na temat metod zapobiegania hiperfosfatemii

INTRODUCTION: The beginning of renal replacement therapy is generally connected with changing dietary habits. A positive phosphate balance is a major clinical problem, often observed in haemodialysis patients. The treatment of hyperphosphataemia is based primarily on dietary intervention and the use of phosphate binders – medications which bind phosphorus in the gastrointestinal tract. Properly conducted education of patients with CKD helps to perceive the risks resulting from an improper diet. MATERIAL AND METHODS: The diagnostic survey method with author's own survey questionnaire was used in the study. The survey contained closed questions concerning the knowledge of dietary recommendations for haemodialysis patients enabling the maintenance of the recommended phosphatemia. Statistical analysis was performed with SAS 9.4 software (SAS Institute Inc., Cary, North Carolina, USA), assuming the statistical significance level p < 0.05. The following tests were applied: chi-squared test/Fisher's exact test, due to the small size of subgroups – the Kruskal-Wallis test for comparison of three groups, and the Mann-Whitney U test to compare the two groups. RESULTS: Haemodialysis patients were aware of the need for restrictions on the consumption of products with a high phosphorus content, but had problems choosing those recommended when composing meals. The right set of meats was chosen by 44 patients (36%). Dairy consumption in a moderate amount was declared by 74 people (61%). 46 respon-dents (38%) reduced their egg yolk consumption. Out of the range of available cheeses, 92 respondents (76%) declared the consumption of mainly curd cheese. The right set of bakery products was indicated by 31 patients (26%), and 73 patients (60%) avoided carbonated beverages. CONCLUSIONS: Patients' knowledge concerning the possibilities of preventing hyperphosphataemia was far from insufficient.WSTĘP: Rozpoczęcie leczenia nerkozastępczego wiąże się zasadniczo ze zmianą stylu odżywiania. Istotnym problemem klinicznym, często obserwowanym u chorych hemodializowanych, jest dodatni bilans fosforanowy. Postępowanie w przypadku hiperfosfatemii opiera się przede wszystkim na interwencji dietetycznej i stosowaniu leków wiążących fosfor w przewodzie pokarmowym. Właściwie przeprowadzona edukacja chorych na PCHN ułatwia postrzeganie zagrożeń, jakie wynikają z niewłaściwej diety. MATERIAŁ I METODY: W badaniu zastosowano metodę sondażu diagnostycznego z wykorzystaniem kwestionariusza ankiety własnego autorstwa. Sondaż zawierał pytania zamknięte dotyczące znajomości wskazówek dietetycznych zalecanych chorym hemodializowanym, pozwalających na utrzymanie zalecanej fosfatemii. Analizę statystyczną wykonano w programie SAS wersja 9.4 (SAS Institute Inc., Cary, North Carolina, USA), przyjmując poziom istotności statystycznej p < 0,05. Wykorzystano testy: Chi2/Fishera z uwagi na małą liczebność w podgrupach, test Kruskala-Wallisa dla porównania trzech grup oraz test U Manna-Whitneya dla porównania dwóch grup. WYNIKI: Chorzy hemodializowani byli świadomi konieczności stosowania ograniczeń w spożywaniu produktów z wysoką zawartością fosforu, lecz mieli problemy z wybraniem tych, które są zalecane przy komponowaniu posiłków. Właściwy zestaw mięs wybrało 44 chorych (36%). Spożycie nabiału w umiarkowanej ilości deklarowały 74 osoby (61%). Spożycie żółtka jaja kurzego ograniczyło 46 respondentów (38%). Z puli dostępnych serów spożycie głównie twarogu deklarowało 92 badanych (76%). Właściwy zestaw pieczywa wskazało 31 pacjentów (26%), a napojów gazowanych unikało 73 chorych (60%). WNIOSKI: Stan wiedzy chorych na temat możliwości zapobiegania hiperfosfatemii był dalece niewystarczający

Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper

Patients with multimorbidity increasingly impact healthcare systems, both in primary care and in hospitals. This is particularly true in Internal Medicine. This population associates with higher mortality rates, polypharmacy, hospital readmissions, post-discharge syndrome, anxiety, depression, accelerated age-related functional decline, and development of geriatric syndromes, amongst others. Internists and Hospitalists, in one of their roles as Generalists, are increasingly asked to attend to these patients, both in their own Departments as well as in surgical areas. The management of polypathology and multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience. In addition, patients' needs, health-care environment, and routines have changed, so emerging and re-emerging specific competences and approaches are required to offer the best coordinated, continuous, and comprehensive integrated care to these populations, to achieve optimal health outcomes and satisfaction of patients, their relatives, and staff. This position paper proposes a set of emerging and re-emerging competences for internal medicine specialists, which are needed to optimally address multimorbidity now and in the future