Role of secreted frizzled-related protein 4 in prediabetes and type 2 diabetes: a cross sectional study.

BACKGROUND: Type 2 diabetes (T2D) has become an epidemic. Delays in diagnosis and as a consequent late treatment has resulted in high prevalence of complications and mortality. Secreted frizzled-related protein 4 (SFRP4), has been recently identified as a potential early biomarker of T2D related to obesity, due to its association with low grade inflammation in adipose tissue and impaired glucose metabolism. We aimed to evaluate the role of SFRP4 in prediabetes and T2D in a Mexican population. METHODS: This was a cross-sectional study that included 80 subjects with T2D, 50 subjects with prediabetes and 50 healthy individuals. Fasting SFRP4 and insulin concentrations were measured by ELISA. Human serum IL-10, IL-6, IL-1ß and IL-8 levels were quantified by flow cytometry. Genotyping was performed by TaqMan® probes. RESULTS: Prediabetes and T2D patients had significantly higher SFRP4 levels than controls (P < 0.05). In turn, prediabetes subjects had higher SFRP4 concentrations than control subjects (P < 0.05). Additionally, the prediabetes and T2D groups had higher concentrations of proinflammatory molecules such as IL-6, IL-1ß and IL-8, and lower concentrations of IL-10, an anti-inflammatory cytokine, than controls (P < 0.001). The serum SFRP4 concentrations were positively correlated with parameters that are elevated in prediabetes and T2D states, such as, HbA1c and homeostasis model assessment insulin resistance (HOMA-IR), (r = 0.168 and 0.248, respectively, P < 0.05). Also, serum SFRP4 concentrations were positively correlated with concentrations of pro-inflammatory molecules (CRP, IL-6, IL-1ß and IL-8) and negatively correlated with the anti-inflammatory molecule IL-10, even after adjusting for body mass index and age (P < 0.001). The genetic variant rs4720265 was correlated with low HDL concentrations in T2D (P < 0.05). CONCLUSIONS: SFRP4 correlates positively with the stage of prediabetes, suggesting that it may be an early biomarker to predict the risk of developing diabetes in people with high serum concentrations of SFRP4, although further longitudinal studies are required.

[Cognitive deterioration following cerebral infarction: frequency and determining factors]. / Deterioro cognitivo después de un infarto cerebral: frecuencia y factores determinantes.

INTRODUCTION: Stroke is often associated with cognitive deterioration (CD) in varying degrees, and the risk factors associated to CD after a stroke vary from one study to another. AIMS: To determine the frequency of CD following cerebral infarction and to identify the factors that account for its presence. PATIENTS AND METHODS: A descriptive study was performed involving 126 stroke survivors who were hospitalised for rehabilitation. Patients were classified as having CD if they had scores below the cut-off point in one of the cognitive tests that were applied, i.e. the Folstein Minimental Test (< 24) or the Command-Condition Clock Test (< 7). The explanatory variables were: demographic variables (age, sex and years of schooling), comorbidity (arterial hypertension, diabetes mellitus and intelligence quotient), noxious habits (smoking and drinking), variables related to the lesion (extension, hemisphere and location), and others related to the consequences of the stroke (neurological status and depression). Bivariate and logistic regression analyses were performed to determine the role of these variables in CD. RESULTS: CD was observed in 51.6% of the patients. In the bivariate analysis, the extension of the infarction, age, years of schooling, degree of neurological compromise and depression were associated with the presence of CD. The logistic regression model showed that the factors explaining CD were severe neurological compromise (OR = 22.9; CI 95% = 4.2-125.2), having major depression (OR = 2.9; CI 95% = 1.14-7.8) and older age (OR = 0.94; CI 95% = 0.89-0.98). CONCLUSIONS: A little more than half of all stroke survivors, who are undergoing rehabilitation in hospital, have CD. The factors with the greatest explanatory power to account for CI were neurological status, depression and age.

Identification of a novel hypothalamic neuropeptide Y receptor associated with feeding behavior.

Neuropeptide Y (NPY) plays important roles in the central control of appetite and energy balance, but the receptor subtype responsible for this function has not been cloned. Here we report the cloning by expression of a novel NPY receptor subtype from a rat hypothalamus cDNA library. The novel receptor, referred to as the NPY Y5 receptor, has a transcript of approximately 2.6 kilobases with an open reading frame of 1335 base pairs that encodes a 445-amino acid protein. The amino acid sequence deduced from the rat Y5 cDNA clone shows only 30-33% identity to other NPY receptors, including Y1, Y2, and Y4/PP1. Using the rat Y5 receptor cDNA probe, the human homologue was obtained by low stringency hybridization. The human Y5 amino acid sequence has 88% identity to the rat Y5 receptor. Importantly, pharmacological analysis shows that the rat and human Y5 receptors have high affinity for the peptides that elicit feeding (e.g. NPY, PYY, (2-36)NPY, and (LP)NPY) and low affinity for nonstimulating peptides (e.g. (13-36)NPY and rat PP), suggesting that it is the NPY feeding receptor subtype.

[Financing regional health services. Problems and possible solutions]. / La finaciación de los servicios regionales de salud. Problemas y posibles soluciones.

The purpose of this paper is to highlight the fact that the present financial system of the Health Regional Services is constraining their management and development possibilities and thus, the System designed in the General Law of Health (Ley General de Salud); moreover, it is, hindering the development of the Autonomous Communities themselves, as the financing of these services is a hard weight to carry, within the own financing process of the Autonomous Communities. We just try to demonstrate there is no reason whatsoever that may justify the present financing procedure of the Health Services already Transferred to Government of the Autonomous Communities. We deem it is necessary to change such model, in order that principles of sufficiency, autonomy and interterritorial solidarity become effective. We are also of the opinion that we are now living the adequate moment to overcome these problems, as it is our must to renegotiate the application, for the five-year period 1992-1995, of the principles under the Organic Law for the financing of the Autonomous Communities. (Spanish, LOFCA).

Nutrition-induced variations in responsiveness to insulin effects on lipoprotein lipase activity in isolated rat fat cells.

The effect of insulin on the regulation of lipoprotein lipase (LPL) activity in isolated adipocytes from rats in various nutritional states was studied. Because LPL is secreted from adipocytes, possible insulin effects on LPL activity were assessed as 1) total cellular LPL activity, 2) LPL activity spontaneously secreted during incubations and 3) LPL secretion during perifusion of adipocytes preincubated with or without insulin. Incubation with insulin for 2 h produced no increase in LPL activity associated with adipocytes isolated from 5- to 6-wk-old fasted rats but increased by 83% the activity of LPL secreted into the incubation medium. Insulin pretreatment increased by 230% the capacity of the cells to secrete LPL activity when perifused in the presence of 5% fasted human serum. In adipocytes from young rats killed in the fed state, preincubation with insulin caused a small increase in cell-associated LPL activity (+21%) but no increase in LPL activity spontaneously secreted into the incubation medium. Similar to results in fasted rats, insulin-pretreated cells showed a 101% increase in their ability to secrete LPL activity during a perifusion. In contrast, larger adipocytes from 3-mo-old rats were totally unresponsive to insulin effects on both cellular and secreted LPL. However, 3 d of fasting followed by 9 d of refeeding restored responsiveness to insulin effects on both cellular and secreted LPL activity. Thus, variations in cellular responsiveness to insulin effects on LPL activity may play an important role in regulating nutrition-induced changes in LPL activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Serologic tests in the diagnosis of presumed toxoplasmic retinochoroiditis.

We treated three patients who had documented Toxoplasma retinochoroiditis and negative immunofluorescent antibody toxoplasmosis titers (titer less than 1:16), positive Sabin-Feldman dye titers of 1:64, 1:16, and 1:64 in the three patients, respectively, and a positive enzyme-linked immunoassay titer of 1:256 in the one patient tested. In patients with negative immunofluorescent antibody toxoplasmosis titers, we recommend obtaining Sabin-Feldman or enzyme-linked immunoassay titers, or both, before excluding the diagnosis of ocular toxoplasmosis.

Ocular and oculodermal melanocytosis associated with uveal melanoma.

Fifteen patients with ocular or oculodermal melanocytosis were found after reviewing 1210 cases of histologically proven uveal melanomas. The melanoma in each of these patients developed in the eye affected with ocular or oculodermal melanocytosis and not in the unaffected eye. In the one case of bilateral involvement with oculodermal melanocytosis, the patient developed the melanoma in the eye more affected with melanocytosis. In the only case of partial ocular melanocytosis, the melanoma developed in a sector of the eye affected with melanocytosis. A comparison of the prevalence of ocular or oculodermal melanocytosis in patients with uveal melanoma with the prevalence of ocular or oculodermal melanocytosis in the general population, implies that there is an increased incidence of uveal melanomas in patients with ocular or oculodermal melanocytosis.

[Evaluation of pulmonary valve stenosis by means of phonomechanocardiography]. / Valoración de la estenosis pulmonar valvular por fonomecanocardiografía.

At the DIF Children's Hospital, 12 patients with pulmonary stenosis (PS) were studied. The values of the systolic pressure of right ventricle (SPRV) varied between 69 to 300 mmHg, showing a direct relationship with age. Weight and height were not related to the degree of PS. Five patients presented dyspnea and 3 of them also presented cyanosis, but seven were asymptomatic. Symptoms appeared in those patients with higher systolic and end diastolic pressure of RV, although the correlation was not significant. The phonocardiogram (PCG) showed a correlation between the duration of the systolic ejective murmur (SEM) and the degree of increase SPRV. The presence of an ejection click did not show a significant correlation with the severity of PS. Furuta's index, the IIA-IIP interval and the IIP/IIA index indicated a substantial corresponding between the SPRV and the transpulmonary gradient, both measured by catheterization. The "a" wave of phlebogram was giant in patients with high SPRV. The calculation of the SPRV by PCG showed a strong correlation with the determination made by catheterization. After surgery the duration of the SEM and Furuta's index decreased in all patients. The ejection click disappeared in 3 patients, becoming apparent in one. The IIA-IIP interval was shorter than before the operation and the phlebogram "a" wave of was reduced, except in one patient. The PCG is a reliable method of great utility for the evaluation of PS.

Assessment of the therapeutic effect of epimestrol and epimestrol associated with clomiphene in female sterility.

In 24 women with disturbances of ovulation treated for sterility with Epimestrol, ovulation was achieved in 3 patients but none of these became pregnant after therapy. Since it has been suggested that the association of Clomiphene with a weak estrogen might improve the pregnancy rate, we decided to administer Clomiphene associated with Epimestrol. Using this combined therapy in 58 patients, 32 out of the 58 women ovulated and 17 conceived. The overall rate of pregnancy using the combined therapy was no better than that obtained when Clomiphene alone is administered. From this study it is concluded that: (1) Epimestrol is not an effective method for the induction of ovulation, and (2) addition of Epimestrol to Clomiphene is of no clinical benefit.

Nutritional anaemia during pregnancy. A comparative study of two socio-economic classes.

PIP: Hematological status of pregnant women from low and middle economic classes before and after similar hematinic therapy were compared. Subjects were 88 economically indigent and 88 middle-class women. Both groups came from the same ethnic background. Before treatment mean values for hemoglobin and nutrients were significantly lower in the poor pregnant women, except for serum folate which was similar. The only parasitic infestations found were whipworm (Trichuris trichiura) in 10% of the poor group and 2% of the middle-class group. Treatment of 40 poor and 33 middle-class patients was with oral doses of 130 mg of ferrous fumarate. The other 48 poor and 55 middle-class patients also received 2.5 mg of folic acid orally daily. At term, after treatment, there was still a statistically but lesser difference between the 2 groups, with the exception of serum iron. Total iron binding capacity was similar in both groups. The frequency of preeclampsia was 4% in the middle-class and 5% in the poor patients. At term, despite the iron dosage, anemia frequency and iron deficiency remained the same in both groups. Those taking folic acid improved so that the 2 classes were equal. Low serum folate levels for those of the middle class not taking folic acid were 25%. It is concluded that all pregnant women in this population should receive both iron and folic acid supplementation throughout pregnancy. For women with an iron deficiency at the beginning of pregnancy, 120 mg/day was not enough. There was the possibility of impaired iron absorption in these patients.^ieng