Vulvar edema: diagnostic clue to Crohn disease.

Vulvar lesions are clinically challenging for physicians because the differential diagnosis may include many entities. Vulvar edema is one of the most frequent symptoms and is normally attributed to a local cause. Herein, we present a case report of vulvar Crohn disease (VCD) in a 9-year-old girl, in which skin lesions preceded the systemic gastrointestinal symptoms. Both clinical features and histopathological findings guided us to an early Crohn disease (CD) diagnosis. Dermatologists often have the opportunity to detect systemic diseases at early stages. A good knowledge of the CD skin manifestations could lead to an early CD diagnosis, especially in children. The suspicion of CD in those cases in which cutaneous involvement precedes digestive symptoms is crucial to prevent future psychological and physical consequences.

Use of permethrin in the treatment of rosacea fulminans during pregnancy: One case report.

Rosacea fulminans (RF) is a rare dermatological condition which occurs exclusively in women and it is characterized by a sudden onset of painful papules, pustules, cysts, and nodules on the face. A 28-year-old woman was referred to our clinic due to a painful facial eruption within the 13th week of her second pregnancy. After physical examination, the diagnosis of RF during pregnancy was established. Several treatments were used: mupirocin ointment, topical zinc oxide, topical erythromycin, oral erythromycin, metronidazole gel, oral metronidazole, oral amoxiciline, and oral prednisone. Finally, the patient was started on 5% permethrin cream with complete clearing of the lesions. Nowadays, a wide range of treatments for rosacea is available: topical metronidazole, oral metronidazole, topical ivermectin, oral tetracyclines, oral isotretinoin, systemic steroids, photodynamic therapy, or pulsed dye laser. However, in pregnant patients, the treatment alternatives are limited. We consider that 5% permethrin cream could be an effective, cheap, and safe treatment not only in regular patients with rosacea but also in pregnant women, representing an important alternative in the context of pregnancy when therapeutic options are limited. To our knowledge, this is the first case of rosacea treated with 5% permethrin cream in monotherapy during pregnancy.

Rehydration during exercise prevents the increase of homocysteine concentrations.

This study aimed to assess the effect of rehydration during and after acute aerobic submaximal exercise on total homocysteine (tHcy) concentrations and related parameters in physically active adult males. Twenty trained males (29.4 ± 7.9 years old) completed four exercise tests: two without rehydration during exercise (NH1 and NH2), one with rehydration during exercise using water (H1) and one with rehydration during exercise using an isotonic sports drink (H2). After finishing the exercise tests, subjects followed a rehydration protocol for 2 h. Serum tHcy, vitamin B12, folate, creatine and creatinine were analysed before, after and at 2, 6 and 24 h after exercise. Data were analysed with and without correcting for haemoconcentration to assess the changes in tHcy related. The methylenetetrahydrofolate reductase (MTHFR) 677TT genotype was also analysed. THcy (uncorrected by haemoconcentration) increased significantly after exercise (P < 0.05) in the NH1 and NH2 tests [mean increase ± SD: 1.55 ± 0.33 (15.18%) and 1.76 ± 0.25 (17.69%) µmol/L, respectively], while no significant differences were found in the H1 and H2 tests [mean increase: 0.65 (6.29%) and 0.90 (8.69%) µmol/L, respectively]. The increase was partly due to haemoconcentration and partly due to the metabolism underlying acute exercise. THcy concentrations recovered to baseline after 24 h in all tests. In conclusion, adequate rehydration during acute aerobic exercise using either water or a sports drink maintains tHcy concentrations at baseline and for up to 2 h after exercise in physically active male adults and prevents further increases when compared to no rehydration.

Use of low-dose naltrexone in the treatment of severe Hailey-Hailey disease: One case report.

Hailey-Hailey disease (HHD) or chronic benign familial pemphigus is an autosomal dominant genodermatosis with complete penetrance characterized by painful vesicles, erosions, and macerated intertriginous skin. We present a 66-year-old woman with a personal 35-year history of pruritic recurrent vesicles and erosions in both axillae and inguinal folds. HHD was confirmed by cutaneous biopsy. Past treatments had failed, including topical corticosteroids, antibiotics and oral doxycycline, minocycline, dapsone, and acitretin. Phototherapy and intralesional injection of toxin botulinum A was performed in the axillae. The patient was started on naltrexone 6.25 mg nightly. Six weeks later, complete clearing was observed. At typical doses, naltrexone blocks µ and δ opiod receptors, thereby blocking the union of ß-endorphins at those sites. Paradoxically, at low doses, the partial binding to those receptors leads to a homeostatic increase of opioid receptors and an upregulation of endogenous opioids. Low-dose naltrexone (LDN) may also exert an anti-inflammatory action through its antagonist effect on toll-like receptor 4 found on macrophages. We consider that LDN is an effective and safe alternative for the HHD, representing an important progress in the management of this disease with limited therapeutic options.

Regular breakfast consumption is associated with higher blood vitamin status in adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

OBJECTIVE: The present study aimed to examine the association between different breakfast consumption patterns and vitamin intakes and blood vitamin concentrations in European adolescents. DESIGN: Breakfast consumption was assessed by a questionnaire. Vitamin intake was calculated from two 24 h recalls. Blood vitamin and total homocysteine (tHcy) concentrations were analysed from fasting blood samples. SETTING: The European Commission-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. SUBJECTS: Participants were 1058 (52·8 % females) European adolescents (aged 12·5-17·5 years) from ten cities. RESULTS: Lower vitamin D and vitamin C concentrations were observed in male and female breakfast skippers than in consumers (P<0·05). Female breakfast consumers presented higher holo-transcobalamin and lower tHcy (P<0·05), while males had higher cobalamin concentrations, compared with skippers (P<0·05). Higher vitamin D and total folate intakes were observed in adolescents who consumed breakfast compared with skippers (P<0·05). Likewise, female consumers had higher intakes of vitamin B6 and vitamin E than occasional consumers (P<0·05). CONCLUSIONS: Regular breakfast consumption is associated with higher blood vitamin D and cobalamin concentrations in males and with higher vitamin D and holo-transcobalamin and lower tHcy concentrations in females. Moreover, breakfast consumption is associated with high intakes of vitamin D and total folate in both sexes, and with high intakes of vitamin B6 and vitamin E in females.

Dietary sources and sociodemographic and lifestyle factors affecting vitamin D and calcium intakes in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study.

OBJECTIVE: To investigate dietary sources of Ca and vitamin D (VitD) intakes, and the associated sociodemographic and lifestyle factors, among European adolescents. DESIGN: Linear regression mixed models were used to examine sex-specific associations of Ca and VitD intakes with parental education, family affluence (FAS), physical activity and television (TV) watching while controlling for age, Tanner stage, energy intake and diet quality. SETTING: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA)Cross-Sectional Study. SUBJECTS: Adolescents aged 12·5-17·5 years (n 1804). RESULTS: Milk and cheese were the main sources of Ca (23 and 19 % contribution to overall Ca intake, respectively). Fish products were the main VitD source (30 % contribution to overall VitD intake). Ca intake was positively associated with maternal education (ß=56·41; 95 % CI 1·98, 110·82) and negatively associated with TV viewing in boys (ß=-0·43; 95 % CI -0·79, -0·07); however, the significance of these associations disappeared when adjusting for diet quality. In girls, Ca intake was positively associated with mother's (ß=73·08; 95 % CI 34·41, 111·74) and father's education (ß=43·29; 95 % CI 5·44, 81·14) and FAS (ß=37·45; 95 % CI 2·25, 72·65). This association between Ca intake and mother's education remained significant after further adjustment for diet quality (ß=41·66; 95 % CI 0·94, 82·38). Girls with high-educated mothers had higher Ca intake. CONCLUSIONS: Low-educated families with poor diet quality may be targeted when strategizing health promotion programmes to enhance dietary Ca.

European adolescent ready-to-eat-cereal (RTEC) consumers have a healthier dietary intake and body composition compared with non-RTEC consumers.

PURPOSE: This study aims to analyse the association of European adolescents' ready-to-eat-cereal (RTEC) consumption frequency with their dietary intake by applying the concept of diet quality index and nutritional status. METHODS: From the multi-centre European HELENA study, relevant data were available in 1,215 adolescents (12.5-17.5 years). RTEC consumption was identified from a food frequency questionnaire. A diet quality index, daily nutrient intakes and daily milk/yoghurt and fruit intake were calculated from two 24-h dietary recalls. BMI, waist and hip circumference and body fat were measured for body composition. Cross-sectional regression analyses were adjusted for sex, age, socio-economic status, city and breakfast skipping. Differences in sub-regions within Europe were explored. RESULTS: RTEC consumers showed a more favourable daily micronutrient intake (vitamin B2, B5, B7, D, calcium, phosphorus and potassium), a better diet quality index, more frequent fruit (57 vs. 51%) and milk/yoghurt consumption (81.2 vs. 56%) and less breakfast skipping (25.1 vs. 36.7%). No differences in energy and macronutrient intake were observed. Daily RTEC consumers were 57% less likely to be overweight than RTEC non-consumers but did not differ in glucose and lipid status (N = 387). CONCLUSION: This is the first comprehensive pan-European survey elucidating socio-demographic determinants of European adolescents' RTEC consumption and indicating better dietary habits in RTEC consumers. The improved dietary profile was reflected in a more beneficial body composition. Our results have also shown the advantage of using an all-integrating diet quality index by capturing the diet complexity.

Dietary fiber intake and its association with indicators of adiposity and serum biomarkers in European adolescents: the HELENA study.

PURPOSE: To evaluate total, energy-adjusted dietary fiber (DF), water-soluble fiber (WSF), and water-insoluble fiber (WIF) intakes in European adolescents and to investigate their association with indicators of adiposity and serum biomarkers. METHODS: This study, conducted from 2006 to 2007, included 1804 adolescents aged 12.5-17.5 years (47% males) from eight European cities completing two non-consecutive computerized 24-h dietary recalls. GLM multivariate analysis was used to investigate associations. RESULTS: Mean DF intake (20 g/day) of the sample met the European Food Safety Authority recommendation, but was below those of the World Health Organization and of the Institute of Medicine. Total DF, WSF and WIF intakes were higher in males (P < 0.001), but following energy-adjustments significantly higher intakes were observed among females (P < 0.001). Bread and cereals contributed most to total DF, WSF and WIF intakes, followed by potatoes and grains, energy-dense but low-nutritious foods, fruits and vegetables. Moreover, energy-adjusted WSF and WIF were positively associated with body fat percentage (BF%), waist to height ratio and low-density lipoprotein cholesterol, while energy-adjusted WSF was inversely associated with serum fasting glucose (ß = -0. 010, P = 0.020). CONCLUSION: Total DF intakes are rather low in European adolescents. An inverse association with serum fasting glucose might indicate a possible beneficial role of DF in preventing insulin resistance and its concomitant diseases, even though DF intakes were positively associated with adolescents' BF%. Therefore, further longitudinal studies should elaborate on these potential beneficial effects of DF intake in the prevention of obesity and related chronic diseases.

Dietary animal and plant protein intakes and their associations with obesity and cardio-metabolic indicators in European adolescents: the HELENA cross-sectional study.

BACKGROUND: Previous studies suggest that dietary protein might play a beneficial role in combating obesity and its related chronic diseases. Total, animal and plant protein intakes and their associations with anthropometry and serum biomarkers in European adolescents using one standardised methodology across European countries are not well documented. OBJECTIVES: To evaluate total, animal and plant protein intakes in European adolescents stratified by gender and age, and to investigate their associations with cardio-metabolic indicators (anthropometry and biomarkers). METHODS: The current analysis included 1804 randomly selected adolescents participating in the HELENA study (conducted in 2006-2007) aged 12.5-17.5 y (47% males) who completed two non-consecutive computerised 24-h dietary recalls. Associations between animal and plant protein intakes, and anthropometry and serum biomarkers were examined with General linear Model multivariate analysis. RESULTS: Average total protein intake exceeded the recommendations of World Health Organization and European Food Safety Authority. Mean total protein intake was 96 g/d (59% derived from animal protein). Total, animal and plant protein intakes (g/d) were significantly lower in females than in males and total and plant protein intakes were lower in younger participants (12.5-14.9 y). Protein intake was significantly lower in underweight subjects and higher in obese ones; the direction of the relationship was reversed after adjustments for body weight (g/(kg.d)). The inverse association of plant protein intakes was stronger with BMI z-score and body fat percentage (BF%) compared to animal protein intakes. Additionally, BMI and BF% were positively associated with energy percentage of animal protein. CONCLUSIONS: This sample of European adolescents appeared to have adequate total protein intake. Our findings suggest that plant protein intakes may play a role in preventing obesity among European adolescents. Further longitudinal studies are needed to investigate the potential beneficial effects observed in this study in the prevention of obesity and related chronic diseases.

The influence of dairy consumption, sedentary behaviour and physical activity on bone mass in Flemish children: a cross-sectional study.

BACKGROUND: This cross-sectional study aimed to look for an association in young children between whole body bone mineral content (BMC) and areal bone mineral density (aBMD) and dairy consumption as well as sedentary behaviour (SB) and physical activity (PA). Moreover, we investigated whether there was an interaction effect between dairy consumption and SB or PA on BMC and aBMD. METHODS: Healthy children (6-12 years) were recruited from primary schools. Body composition and whole body bone mass were measured with dual-energy X-ray absorptiometry (DXA), dairy consumption was assessed with a food frequency questionnaire (FFQ) and PA and SB with an accelerometer. In total, 272 children underwent a DXA scan. Complete FFQ data were available for 264 children and 210 children had matching data from accelerometry recordings. Regression analyses were used to study the associations between (1) BMC and aBMD and (2) dairy consumption, SB and PA, adjusting for age, gender, pubertal stage, height and body composition. RESULTS: Dairy consumption was positively associated with whole body BMC and aBMD (absolute value as well as z-score), after correction for relevant confounders. SB was negatively associated with aBMD z-score and light PA was positively associated with both BMC and aBMD z-score. No gender differences were found. Moreover, an interaction effect between vigorous PA (VPA) and dairy consumption on aBMD (z-score) and BMC z-score was found, indicating that children with both high VPA and high dairy consumption had higher values for BMC and aBMD of the whole body minus the head. CONCLUSION: Already at young age, PA and dairy consumption positively influence whole body bone mass assessed by DXA. Moreover, this study indicates clearly that SB is negatively associated with whole body bone density. Promoting regular PA and sufficient dairy consumption in young children and limiting SB can be expected to positively influence their bone mass accumulation, which can help in the prevention of osteoporosis later in life.

Associations of dietary calcium, vitamin D, milk intakes, and 25-hydroxyvitamin D with bone mass in Spanish adolescents: the HELENA study.

Adequate nutrition is needed for the accrual of bone mass during the pre- and postpubertal growth periods. This study aimed to examine the associations between dietary calcium, vitamin D (calciferol), and milk intakes and 25-hydroxyvitamin D [25(OH)D] status and bone mineral content (BMC) and bone mineral density (BMD) in Spanish adolescents, aged 12.5-17.5 years, participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). Bone mass was measured with dual-energy X-ray absorptiometry and diet via 2 nonconsecutive 24-h dietary recalls (n=227; 48% males). A random subsample of 101 adolescents (46% males) had available measures of 25(OH)D. Multiple linear regression was applied. Significant adjusted associations were observed in males, among milk intakes and BMC and BMD. Also in males, whole-body, head, and right arm BMD were positively related to calcium intakes. In females, 25(OH)D was positively related among others to whole-body, subtotal, and left and right arm BMC and BMD. It could be speculated that diet is not a limiting factor of bone mass development in this group of healthy adolescents, and further research on the effect of other factors in addition to diet in a larger sample should be undertaken.

Seasonal variation in physical activity and sedentary time in different European regions. The HELENA study.

This report aims (1) to examine the association between seasonality and physical activity (PA) and sedentary time in European adolescents and (2) to investigate whether this association was influenced by geographical location (Central-North versus South of Europe), which implies more or less extreme weather and daylight hours. Valid data on PA, sedentary time and seasonality were obtained in 2173 adolescents (1175 females; 12.5-17.5 years) included in this study. Physical activity and sedentary time were measured by accelerometers. ANCOVA was conducted to analyse the differences in PA and sedentary time across seasons. Results showed that girls had lower levels of moderate to vigorous PA (MVPA) and average PA, and spent more time in sedentary activities in winter compared with spring (all P < 0.05). Stratified analyses showed differences in PA and sedentary time between winter and spring in European girls from Central-North of Europe (P < 0.05 for sedentary time). There were no differences between PA and sedentary time across seasonality in boys. In conclusion, winter is related with less time spent in MVPA, lower average PA and higher time spent in sedentary activities in European adolescent girls, compared with spring. These differences seem to mainly occur in Central-North Europe.

Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study.

An adequate vitamin D status is essential during childhood and adolescence, for its important role in cell growth, skeletal structure and development. It also reduces the risk of conditions such as CVD, osteoporosis, diabetes mellitus, infections and autoimmune disease. As comparable data on the European level are lacking, assessment of vitamin D concentrations was included in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Fasting blood samples were obtained from a subsample of 1006 adolescents (470 males; 46·8 %) with an age range of 12·5-17·5 years, selected in the ten HELENA cities in the nine European countries participating in this cross-sectional study, and analysed for 25-hydroxycholecalciferol (25(OH)D) by ELISA using EDTA plasma. As specific reference values for adolescents are missing, percentile distribution were computed by age and sex. Median 25(OH)D levels for the whole population were 57·1 nmol/l (5th percentile 24·3 nmol/l, 95th percentile 99·05 nmol/l). Vitamin D status was classified into four groups according to international guidelines (sufficiency/optimal levels ≥ 75 nmol/l; insufficiency 50-75 nmol/l; deficiency 27·5-49·99 nmol/l and severe deficiency < 27·5 nmol/l). About 80 % of the sample had suboptimal levels (39 % had insufficient, 27 % deficient and 15 % severely deficient levels). Vitamin D concentrations increased with age (P < 0·01) and tended to decrease according to BMI. Geographical differences were also identified. Our study results indicate that vitamin D deficiency is a highly prevalent condition in European adolescents and should be a matter of concern for public health authorities.

Can differences in physical activity by socio-economic status in European adolescents be explained by differences in psychosocial correlates? A mediation analysis within the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study.

OBJECTIVE: Socio-economic status (SES) has been positively associated with physical activity (PA) levels in adolescents. In order to tackle these social inequalities, information is needed about the underlying mechanisms of this association. The present study aimed to investigate the potential mediating role of psychosocial correlates of PA on the relationship between SES and PA in European adolescents. DESIGN: Cross-sectional study testing the mediating role of psychosocial correlates in the SES-PA association using the product-of-coefficients test of MacKinnon. SETTING: Ten European cities in nine different countries, the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. SUBJECTS: Adolescents (n 2780) aged 12·5-17·49 years self-reported on PA (moderate-to-vigorous intensity PA and total PA), SES indicators (education of the mother and Family Affluence Scale) and psychosocial correlates of PA (stage of change, attitudes, awareness, modelling, social support, self-efficacy, benefits, barriers and environmental correlates). RESULTS: SES (Family Affluence Scale) was significantly associated with moderate-to-vigorous intensity PA. According to single-mediator models, this association was significantly mediated by stage of change (t = 3·6, P ≤ 0·001), awareness (t = 2·7, 0·001 < P ≤ 0·01), modelling (t = 4·8, P ≤ 0·001), self-efficacy (t = 2·5, 0·01

Self-reported physical activity in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study.

OBJECTIVE: To describe self-reported physical activity (PA) patterns in the various domains (school, home, transport, leisure time) and intensity categories (walking, moderate PA, vigorous PA) in European adolescents. Furthermore, self-reported PA patterns were evaluated in relation to gender, age category, weight status category and socio-economic status (SES). DESIGN: Cross-sectional study. SETTING: Ten European cities. SUBJECTS: In total, 3051 adolescents (47·6 % boys, mean age 14·8 (sd 1·2) years) completed an adolescent-adapted version of the validated International Physical Activity Questionnaire. RESULTS: The total sample reported most PA during leisure time (485 min/week) and least PA at home (140 min/week). Boys reported significantly more school-based PA (P < 0·001), leisure-time PA (P = 0·003), vigorous PA (P < 0·001) and total PA (P = 0·002) than girls, while girls reported more home-based PA (P < 0·001) and walking (P = 0·002) than boys. Self-reported PA at school (P < 0·001), moderate PA (P < 0·001), vigorous PA (P < 0·001) and total PA (P < 0·001) were significantly higher in younger age groups than in older groups. Groups based on weight status differed significantly only in leisure-time PA (P = 0·004) and total PA (P = 0·003), while groups based on SES differed in all PA domains and intensities except transport-related PA and total PA. CONCLUSIONS: The total sample of adolescents reported different scores for the different PA domains and intensity categories. Furthermore, patterns were different according the adolescents' gender, age, weight status and SES.

Health effects related to low vitamin D concentrations: beyond bone metabolism.

BACKGROUND: Vitamin D is essential for a vast number of physiologic processes, and thus adequate levels are necessary or advantageous for optimal health. During childhood and adolescence, an adequate vitamin D status is needed due to its important role in cell growth, skeletal structure, and development. AIMS: To review the extraskeletal effects of vitamin D, focusing especially on children. METHODS: Narrative review. RESULTS: Low vitamin D concentrations seem to be significantly associated with all-cause mortality. Regular sunlight exposure and vitamin D supplementation in early childhood may offer protection against the development of type 1 diabetes. Epidemiological evidence supports the importance of adequate vitamin D levels for the prevention of a number of cancers, mainly breast and colorectal ones. There seems to be an inverse relation between 25(OH)D serum concentrations and cardiovascular diseases, some components of the metabolic syndrome, and physical fitness. CONCLUSIONS: Lifestyle and appropriate nutrition may prevent the long-term effect of hypovitaminosis D beyond mineral and bone metabolism.

Contribution of bone turnover markers to bone mass in pubertal boys and girls.

BACKGROUND AND AIMS: The association between bone turnover markers and bone mass in adolescence is not clear. We aimed to evaluate the associations between bone turnover markers and bone mineral content (BMC), density (BMD) and area (BMA). SUBJECTS: A total of 56 adolescents (25 boys, 12.5-17.5 years) participated in the study. METHODS: Bone mass and physical activity (PA) were measured using dual energy X-ray absorptiometry and accelerometers. Osteocalcin and amino-terminal propeptide of type I procollagen (PINP), as markers of bone formation, and beta-isomer of the C-terminal telopeptide of type I collagen, as marker of bone resorption were also measured. Sexual maturation, weight, height and average PA were considered as confounders. RESULTS: Positive correlations (Pearson) were observed among the three bone turnover markers (r = 0.7-0.9). Stepwise multiple linear regression analyses showed that PINP was strong and negatively associated with BMC, BMD and BMA in girls, explaining 24.9% of the variance in BMC, 25.6% in BMD and 16.3% in BMA. CONCLUSION: PINP is a strong predictor of bone related variables in pubertal girls.

Antioxidant vitamin status (A, E, C, and beta-carotene) in European adolescents - the HELENA Study.

BACKGROUND: An adequate nutritional status of antioxidant vitamins (vitamins A, C, E) and b-carotene is essential especially during childhood and adolescence, because of their important roles in cell growth and development. Currently, there are no physiological reference values for blood concentration of these vitamins and b-carotene in apparently healthy European adolescents. The aim of the current study was to obtain reliable and comparable data of antioxidant vitamins and b-carotene in a cross-sectional study, within HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence), which was conducted in a representative sample of adolescents from ten European cities. MATERIAL AND METHODS: From a subsample of 1,054 adolescents (males= 501) of the HELENA Cross Sectional Study with an age range of 12.5 to 17.49 years, fasting blood samples were taken and analyzed for vitamins A, E, C, and b-carotene status. As specific reference values for adolescents are missing, percentile distribution by age and sex is given. RESULTS: Mean concentrations were the following: Retinol: 356.4 ± 107.9 cm/mL; alpha-tocopherol: 9.9 ± 2.1 microg/mL; vitamin C: 10.3 ± 3.3 mg/L; and b-carotene: 245.6 ± 169.6 cm/mL. Females showed higher alpha-tocopherol and vitamin C values compared with males and 17-year-old boys had higher retinol levels than the same-aged girls (p = 0.018). Retinol serum concentrations increased significantly according to age in both gender, but girls had also significantly increasing b-carotene levels by age. CONCLUSIONS: For the first time, concentrations of antioxidant vitamins and pro-vitamin beta-carotene have been obtained in a representative sample of apparently healthy European adolescents. These data can contribute to the establishment of reference ranges in adolescents.

Vitamin D Status in Spanish Elite Team Sport Players.

Low vitamin D is usual; however, data are limited for elite team players. The aim was to investigate the vitamin D levels in Football Club Barcelona (FCB) first division players of six sport modalities. Ninety-five elite male players (27.3 ± 4.6 y) belonging to FCB provided data for vitamin D throughout a season. In this study, 25(OH)D was measured in serum by chemiluminescent immunoassay. Outdoor/indoor training and supplementation were also considered. Total mean 25(OH)D concentrations were 91.9 ± 23.1 nmol/L in all players, with higher mean levels among supplemented players (94.7 ± 24.3 nmol/L). Around 25% of the team players were below optimal levels (<75 nmol/L), but none were below 50 nmol/L. Caucasian, supplemented football and handball players had the highest mean vitamin D concentrations over the whole year, whereas basketball players (indoor training) had the lowest ones. The highest rate of vitamin D insufficiency was found in spring (40%). A positive significant effect was observed for the interaction between indoor/outdoor training and supplementation with 25(OH)D concentrations (p < 0.05). Those team players training outdoors with supplementation had higher total vitamin D concentrations than those with indoors training and/or supplementation. A positive interaction of outdoor training with supplementation exists to determine 25(OH)D concentrations in team players.

Vascular obliteration because of endothelial and myointimal growth in COVID-19 patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic multi-organ viral illness. Previous studies have found that many patients had a procoagulant state and/or severe hypoxemia with relatively well-preserved lung mechanics. Mechanisms underlying the damage to vascular tissues are not well-elucidated yet. Histological data in COVID-19 patients are still limited and are mainly focused on post-mortem analysis. Given that the skin is affected by COVID-19 and the relative ease of its histological examination, we aimed to examine the histology of skin lesions in COVID-19 patients to better understand the disease's pathology. METHODS: Five skin lesions from COVID-19 adult patients were selected for a deep histological tissue examination. RESULTS: A strong vasculopathic reaction pattern based on prominent vascular endothelial and myointimal cell growth was identified. Endothelial cell distortion generated vascular lumen obliteration and striking erythrocyte and serum extravasation. Significant deposition of C4d and C3 throughout the vascular cell wall was also identified. A regenerative epidermal hyperplasia with tissue structure preservation was also observed. CONCLUSIONS: COVID-19 could comprise an obliterative microangiopathy consisting on endothelial and myointimal growth with complement activation. This mechanism, together with the increased vascular permeability identified, could contribute to obliteration of the vascular lumen and hemorrhage in COVID-19. Thus, anticoagulation by itself could not completely reverse vascular lumen obliteration, with consequent increased risk of hemorrhage. Findings of this study could contribute to a better understanding of physiopathological mechanisms underlying COVID-19 on living patients and could help further studies find potential targets for specific therapeutic interventions in severe cases.