Oral health in young women having a low calcium and vitamin D nutritional status.

OBJECTIVE: Oral health plays an important role in an individual's eating choices, which in turn ensure good nutrition throughout life. The deterioration in diet quality may partially explain the association between tooth loss and several systemic diseases, including osteoporosis. The study evaluated the association between oral health and calcium (Ca) and vitamin D nutritional status. The effect of several dietary and lifestyle habits was also evaluated. MATERIAL AND METHODS: One hundred six women aged 23.7 ± 0.4 years were evaluated. Ca intake (CaI) and protein intake were recorded, and 25-hydroxyvitamin D (25OHD) was evaluated. Dental status and caries risk were assessed by determining the number of decayed (D), missing (M), and filled (F) teeth and DMFT index, Löe Silness plaque index (PI), and sugar intake (SI). RESULTS: Deficient CaI was observed in 59% of women; 71% had 25OHD <30 ng/mL and 72% consumed soft drinks daily. M/T score was 3%, D/T score was 28.4%, and F/T score was 0%. Thirty-nine percent of women were missing at least one tooth. PI and SI were 2.0 ± 0.1 and 5.2 ± 0, respectively, and DMFT score was 6.6 ± 0.4. CaI adjusted by other risk factors was associated with higher percentage of caries (p < 0.0001), DMFT (p < 0.001), and PI (p < 0.007). One hundred percent of women presented gingivitis. When considering the one third of the studied group with the highest caries scores, DMFT reached 10.6 ± 0.5. This group had significantly lower CaI and 25OHD levels (p < 0.05) and significantly higher protein intake, daily consumption of soft drinks, and PI and SI values compared to the rest of the women (p < 0.05). CONCLUSION: The results of this cross-sectional report evidenced an association between high cariogenic risk and great severity of oral disease in the studied group of young women and low CaI. CLINICAL RELEVANCE: Although caries progression is a complex process involving multiple factors, an adequate nutritional status of Ca and vitamin D could be an additional factor that may help preserve a good oral health.

[Health related quality of life assessment in patients with systemic sclerosis]. / La valutazione della qualità della vita nei pazienti con sclerodermia.

OBJECTIVE: Health-related quality of life (HRQoL) in patients with systemic sclerosis (SSc), a chronic disabling disease associated to physical and psychological impairment, is often left behind in clinical practice and research. This is due to the use of tools that are not complete or mainly designed for the physical condition only. We tested EQ-5D, a valid, simple and brief questionnaire for HRQoL that has never been validated in SSc. METHODS: Thirty-three consecutive SSc patients referring to our Rheumatology Department and undergoing treatment have been asked to fulfill EQ-5D together with HAQ. RESULTS: EQ-5D demonstrated good acceptability, feasibility and validity in patients affected by SSc. Conceptually equivalent domains of EQ-5D demonstrated a good correlation with HAQ correspondent domains. CONCLUSIONS: We suggest the use of EQ-5D in SSc patients as a HRQoL measure in clinical practice, as well as an out come parameter in randomized clinical trials and/or in pharmaco-economic evaluations.

[Influence of zinc administered by total parenteral nutrition on plasmatic zinc levels, on reactive C protein, on serum interleukin-6 and on serum interleukin-6 soluble receptor, in critical patients]. / Influencia del zinc administrado a pacientes críticos con nutrición parenteral sobre los niveles de zinc plasmático, proteína C reactiva, interleuquina-6 y receptor soluble de interleuquina-6.

OBJECTIVES: To study the interrelationship between serum Interleukin-6 (IL-6), serum Interleukin-6 soluble Receptor (IL-6 sR), C-Reactive Protein (C-RP), plasmatic Zinc levels (PlZn) and their response in relation to Zn administered by TPN, in critical patients. METHODS: 17 patients, receiving TPN as a consequence of acute pancreatitis (n = 4) or after a major abdominal surgery due to intestinal cancer (n = 7), intestinal fístula (n = 3), intestinal obstruction (n = 2) or intestinal íleus (n = 1) were studied. At the beginning (To) and at the end of the TPN administration (6-21 days) serum IL-6 and IL-6 sR were determined by ELISA; C-RP ultrasensitive (C-RP us) by inmunoturbidimetric method; Zn was determined in TPN and in plasma by Atomic Absorption Spectrometry. Characteristics of the patients were (mean +/- SD and ranges): age: 60.6 +/- 11.7 (37-77) years; BMI (kg/m(2)): 26.0 +/- 3.4 (19.9-34.0). RESULTS: The results (mean +/- standard deviation and ranges) were: Zn provided by TPN (mg/d): 6.1 +/- 2.0 (range 2.8 to 10.8). Biochemical levels were, at To and Tf, respectively: (mean+/-SD and ranges) were at To y Tf, respectively: Zn Pl (microg/dl): 104 +/- 46 (35-177); 120 +/- 55 (52-229); IL-6 (pg/mL) 93 +/- 74 (10-262); 117 +/- 180 (7-761); IL6sR (pg/mL): 1,012 +/- 322 (589-1855); 1,269 +/- 451 (631-2195); C-RP us (mg/L): 71 +/- 63 (2-196); 65 +/- 43 (0-137). There was no correlation between variations of IL6, IL6sR, C-RP, PlZn levels and the daily amount of Zn administered in the TPN mixtures. Two patients presented a bad evolution; they received 4.2 and 5.2 md/d of Zn and showed an increase of IL6 levels, maintained high levels of IL6sR but C-RP levels decreased. CONCLUSIONS: the range of 2.8 to 10.8 mg/d of Zn administered in TPN mixtures did not exacerbate the inflammatory response.

Body composition and bone metabolism in young Gaucher disease type I patients treated with imiglucerase.

UNLABELLED: Bone involvement is one of the most disabling complications in patients with type 1 Gaucher disease (GDI) and its pathophysiology is yet to be fully understood. It is well known that body composition is a determinant of bone mass. Previous reports indicating disturbance in glucose and lipid metabolism in GDI patients suggested a posible alteration in body composition in this group of patients. OBJECTIVE: To analyze body composition, bone mass and turnover in young adults with GDI receiving enzyme replacement therapy (ERT). POPULATION: 5 women and 4 men with GDI aged (X +/- SD) 26.9 +/- 6.9 years, receiving imiglucerase in a mean dose of 53 +/- 13 IU/kg/2weeks, during 4.9 +/- 3.9 years; and 145 sex and age matched healthy adults agreed to participate in the study. All control subjects had a body mass index (BMI) between 20 and 25 kg/m2. METHODS: Total body dual X-ray absorptiometry (DXA) was used to measure body composition and bone mass. Serum creatinine, calcium, osteocalcin (BGP), and type I collagen beta carboxy-terminal telopeptide (betaCTX) were determined in patients and controls. In addition, 25 hydroxyvitamin D (25OHD), and chitotriosidase activity were measured in patients. RESULTS: GDI patients presented statistically significant (p<0.01) lower BMI, bone mineral density (BMD), bone mineral content (BMC), lean mass (LM), and fat mass (FM), compared to controls. LM correlated positively with BMC and BMD in both groups (p<0.01). GDI patients receiving the lower dose of ERT (<60 IU/kg/2weeks) presented lower BMD values than those receiving the higher dose (> or =60 IU/kg/2weeks) (0.968 +/- 0.032 vs 1.088 +/- 0.061 g/m2, respectively, p<0.001). Mean BGP levels were similar in patients and controls, whereas betaCTX levels were higher in GDI patients (p<0.02). All patients presented deficiency levels (<30ng/ml) of 25OHD. CONCLUSIONS: Although the patients had been receiving ERT, they presented a significant diminution in all body composition parameters, the decrease was more evident in those receiving the lower dose. The reduction in bone mass was associated with an imbalance in bone turnover (increased bone resorption). The correlation between LM and bone mass, suggests that metabolic disturbance occurring in GDI patients may be indirectly responsible for bone mass reduction in GDI patients, by altering body composition.

[Nailfold capillaroscopic report: qualitative and quantitative methods]. / La refertazione dell'esame capillaroscopico: metodi di valutazione qualitativi e quantitativi.

Nailfold capillaroscopy (NVC) is a simple and non-invasive method used for the assessment of patients with Raynaud's phenomenon (RP) and in the differential diagnosis of various connective tissue diseases. The scleroderma pattern abnormalities (giant capillaries, haemorrages and/or avascular areas) have a positive predictive value for the development of scleroderma spectrum disorders. Thus, an analytical approach to nailfold capillaroscopy can be useful in quantitatively and reproducibly recording various parameters. We developed a new method to assess patients with RP that is capable of predicting the 5-year transition from isolated RP to RP secondary to scleroderma spectrum disorders. This model is a weighted combination of different capillaroscopic parameters (giant capillaries, microhaemorrages, number of capillaries) that allows physicians to stratify RP patients easily using a relatively simple diagram to deduce prognosis.

Capillaroscopic observations in childhood rheumatic diseases and healthy controls.

OBJECTIVE: To describe, by using video nailfold capillaroscopy (NFC), microvascular abnormalities in children with rheumatic diseases and to evaluate the capillary changes over a follow up period. METHODS: 118 children suffering from rheumatic diseases: 55 juvenile idiopathic arthritis (JIA), 7 mixed connective tissue disease (MCTD), 6 primary Raynaud's phenomenon (PRP), 34 systemic lupus erythematosus (SLE), 8 juvenile systemic sclerosis (JSSc) and 8 juvenile dermatomyositis (JDM) were included in the study. Patients with major capillaries abnormalities or scleroderma pattern were followed up for at least 12 months. 70 age- and sex-matched healthy controls (HC) were also examined. RESULTS: In HC there was a significant correlation between age and capillary length (p = 0.001). JIA patients showed capillary number, size, shape and arrangement similar to HC. Minor abnormalities were frequently observed. The percentage of major abnormalities were significantly increased compared to HC in MCTD (p = 0.008), SLE (p = 0.0002) and JDM patients (p < 0.0001). 5/8 of JSSc had a scleroderma pattern from the onset of the disease. The serial observations in connective tissue diseases also showed that the evolution of capillaroscopic pattern was not unidirectional. In fact, in some nailfolds there was an increase in capillary loss and in avascular areas, whereas sometimes it remained stable on repeated examination. CONCLUSION: NFC can be used as a simple, inexpensive, non-invasive method to evaluate the microvascular abnormalities in childhood rheumatic conditions, and it may be useful in early recognition and monitoring scleroderma spectrum disorders.

Changes in bone volume and bone resorption by olpadronate treatment in an experimental model of uremic bone disease.

Thirty male adult Wistar rats (300-/+10 g body weight) underwent either 5/6 nephrectomy (Nx, n=20) or sham operation (SHAM, n=10) to determine olpadronate effects in an experimental model of uremic bone disease. For a 38-day period, 10 rats received olpadronate (16microg/100g bw) once a week (Nx+OPD) and the other vehicle (Nx). SHAM received vehicle. At baseline, treatment onset (t=7 days) and end of study (t=45 days) calcium, phosphorus, creatinine, bone alkaline phosphatase (b-ALP) and deoxypyridinoline crosslinks (DPyr) were determined. At t=0 and t=45 bone mineral density (BMD) was measured by DXA. At t=45 the right tibia was removed for bone histology. There were no differences in serum calcium. Phosphorus increased in Nx and Nx+OPD compared to SHAM (p

The effect of olpadronate in ovariectomized thyroxine-treated rats.

Hyperthyroidism increases bone turnover and induces bone loss. This study examines the effect of thyroid hormone excess on two biochemical markers of bone turnover (hydroxyproline and bone alkaline phosphatase) as well as on bone mineral content (BMC) and bone mineral density (BMD). The possible protective role of dimethyl-APD (olpadronate, OLP), on both suppression of bone turnover and bone mineral loss in ovariectomized (ovx) rats, was also studied. Female Sprague-Dawley rats, were assigned to five groups of eight rats each: sham, ovx, ovx OLP treated (0.3 mg/kg per week), ovx T4 treated (250 micrograms/kg per day), and ovx T4-OLP rats. Rats were killed after 5 weeks of treatment. At the end of the study, blood samples were analyzed for serum calcium, phosphorus, T4, total and bone alkaline phosphatase (ALP and b-ALP), and urinary samples for hydroxyproline/creatinine ratio (HOProl/creat). Moreover, total BMC, BMD, and scanned area were determined by DXA. Ovx T4-OLP-treated rats presented higher values of b-ALP than ovx T4-treated, ovx, and sham rats (p < 0.05). Ovx increased HOProl/creat excretion compared with sham (p < 0.05), but it was similar compared with ovx T4-treated rats. OLP treatment reduced HOProl/creat excretion in both ovx T4-treated (p < 0.05) and ovx rats (p < 0.05). The final BMC in ovx was lower than in the sham group, but the difference was not statistically significant (p < 0.08). The lowest BMC was observed in ovx T4 rats (p < 0.05). When final BMC was expressed per body weight (BMC/W), ovx rats presented a significantly lower BMC/W than sham rats (p < 0.05). Ovx OLP rats had BMC/W levels higher than ovx (p < 0.005), ovx T4 (p < 0.01), and ovx T4-OLP rats (p < 0.01). The ovx group had a final BMD lower than sham animals (p < 0.05), but not significantly different than the ovx T4 rats. BMC and BMD of OLP ovx rats, whether they received T4 or not, was similar to the sham group. The highest final BMD was observed in the ovx T4-OLP group. In summary, the prevention of an increase in HOProl excretion accompanied by the fact that final BMD and BMC in OLP-treated animals were comparable to sham control rats may reflect that OLP administration could inhibit bone resorption in both T4-treated or -untreated rats. Although further studies are necessary, these findings may have clinical relevance in estrogen-depleted patients to whom medical management other than the reduction of T4 administration would be desirable.

Bone mass changes during pregnancy and lactation in the rat.

We examined bone mass changes in the total, axial, and appendicular skeleton as well as in the different subareas of femur and tibia in rats fed on a normal calcium diet. A total of 16 virgin Wistar rats, approximately 5 months of age (270+/-30 g), were assigned to two groups of eight rats each. One group was mated and, for each pregnant rat, a nonpregnant control rat was studied simultaneously. Weaning was performed when the pups reached 38+/-3 g body weight. At the beginning (t = 0), on the first day postpartum (t = 22 days), and at weaning (t = 45 days), total skeleton bone mineral content (BMC), area, and bone mineral density (BMD) were determined by dual-energy X-ray absorptiometry (DXA) in vivo under anesthesia. Body weight increased significantly during pregnancy (p < 0.05) and decreased at weaning, whereas control rats showed a slow, gradual increment without reaching a significant difference. During pregnancy, BMC and area of the total skeleton increased significantly in pregnant rats, but the changes in BMD were not different compared with the control group. A completely different pattern was observed between groups during the 23 days of lactation. While the skeleton continued to grow in the control group (BMC and area increased), the total skeleton of lactating rats showed no change in area (size), small decreases in BMC, and a significant decrease in BMD (p < 0.05). Consequently, although BMC and BMD of both groups were similar at the time of delivery, BMC was 12.0% lower and BMD 4.9% lower at the end of lactation in the lactating rats compared with the control group. The contribution of the maternal skeleton to the lactation period was not similar; that is, the areas with the highest trabecular component showed the greater average differences in BMD at the time of weaning (proximal tibia -19.9%, distal femur -12.6%, spine -10.9%) (p < 0.05), compared with relatively minor, nonsignificant losses in areas where cortical bone predominates (distal tibia -5%, middle tibia -5.2%). Our experimental results demonstrated the usefulness of DXA in vivo to visualize changes in BMD during the reproductive cycle of the rat. Moreover, the data confirm that normal pregnancy in the rat appears to exert little influence on bone, whereas lactation induces significant bone loss, mainly in the areas of predominant trabecular bone.

The effect of tiaprofenic acid on uric acid excretion in man.

The uricosuric effect of tiaprofenic acid was evaluated in a group of normouricaemic inpatients with various rheumatic disorders. Six patients aged 26 to 60 years were maintained on a standardised low-purine diet and, after a washout period of 72 hours, tiaprofenic acid was administered in 3 oral doses of 300 mg 12-hourly. A normal renal function, as assessed by serum creatinine and creatinine clearance determinations, was considered mandatory for entry into the study. The following parameters were evaluated before and after treatment: haematological values, blood urea nitrogen (BUN), serum and urinary creatine concentrations, serum uric acid concentration and the fractional excretion rate of uric acid. Our preliminary results showed a substantial increase of urinary uric acid excretion in the samples collected after treatment, especially in the first 4 hours.

Effect of one year residence in Antarctica on bone mineral metabolism and body composition.

OBJECTIVE: To evaluate the changes of the biochemical parameters of mineral metabolism and to assess the effect of these changes on the bone mass of young healthy men who voluntarily lived in the Antarctic Continent for one year. DESIGN: Lumbar spine and whole body bone mineral density (BMD) were measured pre- and post-campaign (14 months later). Serum and urinary biochemical parameters were measured every two months. Serum levels of calcium, phosphate, total alkaline phosphatase, parathormone (PTH) and 25-hydroxyvitamin D (250HD) were determined in blood fasting samples; and hydroxyproline, calcium and creatinine in 2 h fasting urine. The subjects received a dose of 100 i.u./d of vitamin D during May after obtaining the samples and then an average of 125 i.u./d from July to January. SUBJECTS: Seventeen healthy volunteers, who left Buenos Aires during the 1992 summer: ten arrived in the Belgrano II Base at the end of January and the other seven arrived in San Martín in March and stayed there up to summer 1993. RESULTS: BMD increased in lumbar spine (L2-L4), total body and the subarea of the legs but there were no differences between the pre- and post-campaign values in arms and pelvis. The percentage of fat mass decreased significantly after 1 y of residence in Antarctica, in comparison to the basal values. Most biochemical parameters remained unaltered and within the normal range during the whole study. PTH showed a nadir in March (end of the summer) when compared to initial levels (73.0 +/- 28.2 vs 39.9 +/- 32.7 pg/ml, P < 0.05), and recovered its initial value in spring. Calcium levels showed a significant decrease in March (9.5 +/- 0.4 vs 8.5 +/- 1.0 mg%, P < 0.01). 25OHD levels began to decrease in March (24.7 +/- 6.4 vs 18.7 +/- 5.3 ng/ml), reaching a minimum value whose difference approached statistical significance during the winter period (July: 16.4 +/- 8.2 ml, 0.05 < P < 0.06). No significant changes in serum phosphate, total alkaline phosphatase, urinary hydroxyproline/creatinine and calcium/creatinine ratios were found through the year. CONCLUSIONS: 25OHD levels decreased in autumn and winter (nadir in July) and recovered the initial levels by the end of the campaign. An unexplained marked diminution in PTH and serum calcium was found at the beginning of the campaign. In spite of the low vitamin D levels, bone mass in this group of young healthy men increased, probably because of their intense physical activity.

High prevalence of vitamin D insufficiency in healthy elderly people living at home in Argentina.

OBJECTIVE: To evaluate the nutritional status of vitamin D in urban populations of healthy elderly people living at home, in different regions of Argentina. DESIGN: Cross-sectional study. SUBJECTS: In total, 386 ambulatory subjects over 65 y of age from seven cities (between latitude 26 degrees S and 55 degrees S) were asked to participate between the end of winter and the beginning of spring. Of these, 369 accepted, 30 were excluded because of medical history or abnormal biochemical determinations. Finally, 339 subjects (226 women and 113 men) (X+/-s.d.) (71.3+/- 5.2 y) were included. RESULTS: Serum 25OHD levels were lowest in the South (latitude range: 41 degrees S-55 degrees S): 14.2+/-5.6 ng/ml (P<0.0001vs North and Mid regions); highest in the North (26 degrees S-27 degrees S): 20.7+/-7.4 ng/ml (P<0.03 vs Mid, P<0.0001vs South); and intermediate in the Mid region (33 degrees S-34 degrees S) 17.9+/-8.2 ng/ml. Serum mid-molecule PTH (mmPTH) and 25OHD were inversely related: (r=-0.24, P<0.001). A cutoff level of 25OHD at which serum mmPTH levels began to increase was established at 27 ng/ml. A high prevalence (87-52%) of subjects with 25OHD levels in the deficiency-insufficiency range (25OHD levels <20 ng/ml) was detected. CONCLUSION: This study shows that vitamin D deficiency/insufficiency in the elderly is a worldwide problem. Correction of this deficit would have a positive impact on bone health of elderly people.

Theory about interrelationships between macromineral nutrients and growth rate during recovery from undernutrition.

Previous papers of our group have reported that, in the first stages of nutritional recovery, the needs of undernourished infants, in terms of Protein Calories percentage (P%) were higher than normal, and similar to those of other mammals which double their birth weight faster than man. During this period, a high dietary P% produces an accelerated catch-up growth. Therefore, Calcium and Phosphorus balances increase proportionally to weight gain rate (WGR), and Calcium retention per gram of new tissue is dependent on dietary Calcium/Protein ratio. On the other hand, Bernhart demonstrated that there was a direct correlation between the growth rate of the sucklings of several species, including humans, and the percentage of protein and ash in the fluid milk. As a consequence of these facts, we assume that during catch-up growth, in order to attain a normal body composition, dietary level of essential minerals must be related to factors affecting weight gain. These relationships suggest the hypothesis that, during the recovery from undernutrition, in order to meet the needs of the catch-up growth allowed by the Protein/Calories ratio, Calcium and Phosphorus milk concentrations would be in relation to the Protein/Calorie concentration. In this way, Calcium and Phosphorus concentrations might be the limiting factors for attaining a normal body composition. This hypothesis might also be generalized to other minerals in order to prevent them from becoming the limiting factors for attaining a normal body composition.

[Raynaud's phenomenon]. / Il fenomeno di Raynaud.

Raynaud's phenomenon (RP) is a vasospastic disorder characterized by episodic color changes of blanching, cyanosis, and hyperemia in response to cold and/or emotional stress. Although most typically noted in the fingers, the circulation of the toes, ears, nose and tongue is also frequently affected. Population studies have shown that RP in adults is more common in women than men, with prevalence estimates ranging from 4% to 30%. Geographic variations in the prevalence reflect differences in climate. RP may be a primary or a secondary process. LeRoy and Medsger suggested criteria for primary RP: symmetric attacks, the absence of tissue necrosis, ulceration or gangrene, the absence of a secondary cause, negative antinuclear antibodies, normal nailfold capillaroscopy and a normal erythrocyte sedimentation rate. Secondary RP is characterized by an age of onset of more than 30 years, painful and asymmetric attacks, ischemic skin lesions, positive autoantibodies, capillaroscopic abnormalities and/or clinical features suggestive of connective tissue diseases (CTDs). Among the CTDs, systemic sclerosis has the highest frequency of RP. Finding a cause for RP requires a knowledge of the patient's occupational, smoking, drug history, physical examination, nailfold capillaroscopy, routine laboratory tests and autoantibodies. Furthermore, RP should be distinguished from acrocyanosis, a condition characterized by continuous cyanosis of the hands or feet that is aggravated by cold temperature. The most important instruction to the patient is abstinence from any smoking, offending drugs should be discontinued, and abrupt changes in temperature. If these measures are inadequate, calcium-channel blockers are the most widely used (nifedipine 30 mg up to 90 mg daily). Alternatively, sympatholytic agent (prazosin), angiotensin II -receptor type I antagonist (losartan), selective sertonin-reuptake inhibitor (fluoxetine) may be useful. In the severe cases the role of prostaglandins is well established, but standard therapeutic protocols are not jet available.

[HLA typing in systemic sclerosis] / Tipizzazione del sistema HLA nella sclerosi sistemica.

OBJECTIVE: The aim of the study was to investigate the relationship between Systemic Sclerosis (SSc) and HLA antigens, and to correlate these antigens with the clinical manifestations of the disease. MATERIALS AND METHODS: 55 patients were stratified according a) to the cutaneous involvement b) to the positivity of Scl-70 and anticentromere antibody and c) to the internal organ involvement, in particular we used HRCT to demonstrate lung fibrosis, echocardiography for the diagnosis of pulmonary hypertension, blood creatinine, urinalysis and arterial hypertension to demonstrate renal failure, and esophagus double-contrast barium swallow for the diagnosis of esophagopathy. The control group consisting of 2000 healthy Caucasian subjects was recruited from the same population. RESULTS: The frequency of the antigens A23 (p=0.003, RR=3.69), B18 (p<0.0001, RR=3.57), and DR11 (p<0.0001, RR=6.18) was statistically increased in the patients population compared with the healthy controls. Although there is no any significant correlation between HLA antigens and different clinical subsets of scleroderma, antigens B18 and DR11 could be associated with more severe clinical features. CONCLUSIONS: The presence of a significant association between SSc and specific HLA antigens (A23, B18, and DR11) could link the HLA system with SSc.

[Cost-of-illness in systemic sclerosis: a retrospective study of an Italian cohort of 106 patients]. / Analisi dei costi nella sclerosi sistemica. Studio retrospettivo in una casistica di 106 pazienti.

AIMS: It is increasingly important to determine the economic consequences of diseases considering the policy of limited health-care budgets. In this study we evaluated the annual direct and indirect costs of Systemic Sclerosis (SSc) and we tried also to identify any cost predictors. METHODS: We studied 106 patients (103 female, 3 male), 57 affected by Limited Systemic Sclerosis (LSSc) and 49 affected by Diffuse Systemic Sclerosis (DSSc). Mean age was 57 years (SD +/- 13.8) and mean disease duration was 8,9 years (SD +/- 7.2). Direct Costs: data were calculated referring to DRG (Disease Related Group) expenses for the in-patients. We referred to national pharmacopoeia to calculate the pharmaceutical cost for the out-patients. Indirect costs: we estimated the expense comparing our cases to literature data. Intangible costs: these are attributable to pain and psychological suffering. It is very difficult to express the intangible costs in monetary terms and they are often conveyed as disability and poorer quality-of-life. We used the Health Assessment Questionnaire "HAQ" and the Short Form-36 "SF-36" to evaluate this issues. RESULTS: Our study confirms, the extremely high costs caused by Systemic Sclerosis (total cost's 2001 year is 1,173,842.93 Euro, and average yearly patient cost is 11,073.99 Euro). Considering an estimated prevalence of 375 cases/106, the total yearly economic impact of SSc in Italy should be 249 million euro. Intangible costs were calculated as modifications of the health status. Average value of the HAQ was significantly higher than the control population (0.94 +/- 0.72), average values in the SF-36 were significantly lower than the control population (49.99 +/- 19.16 for physical dimension and 58.42 +/- 27.71 for mental dimension). The diffuse form of SSc, anti-Scl 70 antibodies, high skin score and a poor health status (HAQ and SF-36) were found to be cost predictors. CONCLUSIONS: As reported in the literature, our study confirms, the extremely high costs for total and single patients caused by Systemic Sclerosis. The DSSc are more expensive than the LSSc approximately 11% (p=0.0067). The direct costs are 30% higher in the DSSc than the LSSc (p < 0.001). The indirect and intangible costs are not significantly different. Moreover, our study shows also the possibility of identifying different cost predictors.

[Evaluation of quality of life in patients with systemic sclerosis by administering the SF-36 questionnaire]. / Valutazione della qualità della vita in pazienti affetti da sclerosi sistemica mediante somministrazione del questionario SF-36.

AIMS: To evaluate the quality of life of patients affected by systemic sclerosis (SSc) through the application of the Medical Outcome Survey Short-Form 36 (SF-36) questionnaire and to correlate the results with the disability index of the health assessment questionnaire (HAQ-DI) and the systemic involvement. METHODS: We studied 95 (3 M, 91 F) patients affected by SSc (mean age 60 years, range 39-83, mean duration of disease 6 years, range 1-34). The organ system involvement was evaluated by skin score, chest High Resolution Computed Tomography (HRCT), electrocardiography according to Holter, Doppler-echocardiography and esophagogram. RESULTS: Considering the values of the 8 question groups of the SF-36 the most different between the patients and the control population are the values relevant to the physical dimension. The general health values estimating the physical and social dimension are significantly lower in the patients than in the control population (t=9,324; p<0,0001). A very good correlation was found between the DI (r = -0,7903; p <0.0001) and all the scores of SF-36. The skin involvement showed a statistically significant correlation with the DI (r=0.3709; p=0.0002) and the PA score of the SF- 36 (r =0.2853; p=0.0051). No other statistically significant correlation was found between any of the SF-36 dimensions and involvement of a specific organ. CONCLUSION: SF-36 showed to be a valid instrument to evaluate the quality of life and the disability of patients with SSc and it seems to correlate with extent of skin involvement.

[Olpadronate prevents cortical and trabecular bone loss induced by supraphysiological dosis of thyroxine in ovariectomized rats]. / El olpadronato previene la pérdida de hueso cortical y trabecular inducida por dosis suprafisiológicas de tiroxina en ratas ovariectomizadas.

The aim of the present report was to clarify the effect of excess T4 on axial and peripheral bone mineral density (BMD) in estrogen-depleted rats. The protective effect of olpadronate (Olpa) on axial and peripheral bone mass in thyroxine-treated rats was also investigated. Female Sprague-Dawley rats were used: SHAM, OVX + Vh, OVX + Olpa (0.3 mg/kg/week), OVX + T4 (250 micrograms/kg/day) and OVX + T4 + Olpa rats. OVX + Vh group presented a BMD lower than SHAM in the tibia (p < 0.01) but not in femur or lumbar spine; the middle tibia BMD did not change but it was lower at the distal (pns.) and proximal levels (p < 0.003) in OVX + Vh. OVX + T4 rats presented a BMD significantly lower than OVX + Vh rats in total tibia (p < 0.02), femur (p < 0.006) and lumbar spine (p < 0.006). Moreover the BMD was lower in all studied areas of the tibia, but it was statistically significant only at the middle level (p < 0.004). OVX + Olpa rats had a BMD higher than OVX + Vh rats in femur (p < 0.002), lumbar spine (p < 0.0001), total (p < 0.001) and proximal tibia (p < 0.001). Surprisingly, total and proximal tibia BMD values in OVX + Olpa rats presented a BMD significantly higher than OVX + T4 rats in femur (p < 0.001), lumbar spine (p < 0.001), tibia (p < 0.001) and proximal tibia (p < 0.0001). It is important to point out that OVX + T4 + Olpa BMD was significantly higher than in SHAM rats at the lumbar spine, total and proximal tibia (p < 0.01). The present study suggests that although supraphysiological thyroid hormone affected both cortical and trabecular bone, under estrogen-depleted conditions, the cortical bone appears to be more sensitive than the trabecular bone to T4 treatment. We also found that Olpa could prevent the peripheral and axial bone loss induced by thyroid hormone excess.

[Interrelationship between vitamin D intake and absorption and retention of calcium during nutritional recovery]. / Interrelaciones entre ingesta de vitamina D y absorción y retención de calcio durante la recuperación nutricional.

We have previously reported that, in the first stages of nutritional recovery, the needs of undernourished infants, in terms of protein-calories percentage (P%) are higher than normal, producing an accelerated catch-up. Consequently, calcium (Ca) and phosphorus (P) balances increase proportionally to weight gain rate (WGR) in order to attain a normal body composition. As for the control of Ca metabolism by vitamin D, the question is whether vitamin D intake must also be increased during this accelerated catch-up growth period. In this report we have analysed retrospectively previous results in order to clarify the interrelationship between Ca absorption, Ca retention and vitamin D intake. A total of 29 undernourished infants, from 2 to 18 months of age, were fed Ad libitum with one of two proprietary milk formulas containing, per 100 g.: Ca, 0.50 and 1.17 g.; P, 0.37 and 0.50 g.; vitamin D, 350 and 400 UI (8.7 and 10 micrograms); proteins, 11.34 and 17.00 kcal/100 kcal of total diet, respectively. Recommended Dietary Allowances (RDA) of Ca and vitamin D, according to FAO/OMS and NRC, were calculated with reference to normal infants body weight and to 1000 kcal of recommended dietary energy intake. Ca intake was higher than the RDA and ranged between 60 and 413 mg/kg/day; intake of vitamin D increased proportionally to food intake; calcium absorption ranged between 40.0 and 92.0% (mean = 69.8 +/- 14.6) and CaB correlated with Ca intake (r = 0.97), being higher than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

[Free erythrocyte protoporphyrin as a function of age in growing rats]. / Protoporfirina libre eritrocitaria en función de la edad en ratas en crecimiento.

The assessment of the iron (Fe) status is very important because its deficiency is one of the most common in both developing and industrialized countries, being particularly prevalent among infants and young children. Diagnosis is difficult in the presence of other conditions which interfere with the interpretation of laboratory tests, such as hemoglobin (Hb), hematocrit (Hct), serum iron, transferrin saturation percentage and serum ferritin. Free erythrocyte protoporphyrin (FEP) is a precursor of Heme and normally occurs in very low concentration in red blood cells (RBC); elevated values indicate early impaired iron nutritional status, providing information about gradual changes in the iron supply to the marrow. This laboratory test is a practical and convenient method because it needs a small blood sample easily preserved. Although the Second National Health and Nutritional Examination Survey (NHANES II) of USA has provided a good opportunity to define more precisely the cut-off points, it is doubtful whether the age-related differences in children represent normal development or the effects of iron deficiency. In order to provide information about these aspects the present experimental model was performed: weanling Wistar rats were fed until 95 days of age (t 95) with an isocaloric diet containing 20 or 30 g/100 g. of protein (casein) (N 20 and N 30, respectively), allowing the highest growth and erythropoiesis rates and covering the requirements of all the nutrients (Table 1). Body weight and food intake were recorded three times/week.(ABSTRACT TRUNCATED AT 250 WORDS)