Real-life use of vitamin D_3-fortified bread and milk during a winter season: the effects of CYP2R1 and GC genes on 25-hydroxyvitamin D concentrations in Danish families, the VitmaD study.

Common genetic variants rs10741657 and rs10766197 in CYP2R1 and rs4588 and rs842999 in GC and a combined genetic risk score (GRS) of these four variants influence late summer 25-hydroxyvitamin D (25(OH)D) concentrations. The objectives were to identify those who are most at risk of developing low vitamin D status during winter and to assess whether vitamin D(3)-fortified bread and milk will increase 25(OH)D concentrations in those with genetically determined low 25(OH)D concentrations at late summer. We used data from the VitmaD study. Participants were allocated to either vitamin D(3)-fortified bread and milk or non-fortified bread and milk during winter. In the fortification group, CYP2R1 (rs10741657) and GC (rs4588 and rs842999) were statistically significantly associated with winter 25(OH)D concentrations and CYP2R1 (rs10766197) was borderline significant. There was a negative linear trend between 25(OH)D concentrations and carriage of 0–8 risk alleles (p < 0.0001). No association was found for the control group (p = 0.1428). There was a significant positive linear relationship between different quintiles of total vitamin D intake and the increase in 25(OH)D concentrations among carriers of 0–2 (p = 0.0012), 3 (p = 0.0001), 4 (p = 0.0118) or 5 (p = 0.0029) risk alleles, but not among carriers of 6–8 risk alleles (p = 0.1051). Carriers of a high GRS were more prone to be vitamin D deficient compared to carriers of a low GRS. Furthermore, rs4588-AA carriers have a low but very stable 25(OH)D concentration, and interestingly, also low PTH level. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12263-014-0413-7) contains supplementary material, which is available to authorized users

Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay

OBJECTIVE: Hip fractures have been associated with increased mortality in the elderly. Several risk factors such as the time between the insult and the surgical repair have been associated with hip fracture mortality. Nevertheless, the risk of delayed surgical repair remains controversial. Few studies have examined this issue in Brazil. The aim of this study was to study the risk factors for death one year after hip fracture and in-hospital stay at a tertiary hospital in South Brazil. METHODS: A prospective cohort study was carried out from April 2005 to April 2011 at a tertiary university hospital at Santa Maria, Brazil. Subjects admitted for hip fracture who were 65 years of age or older were followed for one year. Information about fracture type, age, gender, clinical comorbidities, time to surgery, discharge, and American Society of Anesthesiologists score were recorded. Death was evaluated during the hospital stay and at one year. RESULTS: Four hundred and eighteen subjects were included in the final analysis. Of these, 4.3% died in-hospital and 15.3% were dead at one year. Time to surgery, American Society of Anesthesiologists score, Ischemic Heart Disease, and in-hospital stay were associated with death at one year in the univariate analysis. The American Society of Anesthesiologists score and time to surgery were one-year mortality predictors in the final regression model. In-hospital death was associated with American Society of Anesthesiologists score and age. CONCLUSION: Time to surgery is worryingly high at the South Brazil tertiary public health center studied here. Surgical delay is a risk factor that has the potential to be modified to improve mortality

Concomitance of IgM and IgG anti-dsDNA Antibodies Does Not Appear to Associate to Active Lupus Nephritis

Previous reports proposed that the IgM anti-dsDNA antibody is protective for lupus nephritis. In this cross-sectional study, we aimed to compare clinical features of systemic lupus erythematosus (SLE) patients positive for IgG anti-dsDNA alone with those presenting both IgG and IgM anti-dsDNA. Anti-dsDNA antibodies, urinary examination and complement levels were assessed in the day of appointment. IgG and IgM anti-dsDNA antibodies were detected by indirect immunofluorescence. Fifty-eight SLE patients (93.1% female, 81% European-derived, mean age 42.8±14.7 years, mean duration of disease 10.9±8 years) positive for IgG anti-dsDNA entered the study. Of those, 15 were also positive for the IgM anti-dsDNA isotype. The group with both isotypes showed significant less frequency of active nephritis (sediment changes and proteinuria) when compared to patients with IgG anti-dsDNA alone (6.7% versus 34.9%, p=0.046). These data suggest a nephroprotective role for IgM anti-dsDNA and a distinct biologic behavior for this isotype in SLE