Gas phase Elemental abundances in Molecular cloudS (GEMS) II. On the quest for the sulphur reservoir in molecular clouds: the H2S case.

CONTEXT: Sulphur is one of the most abundant elements in the Universe. Surprisingly, sulphuretted molecules are not as abundant as expected in the interstellar medium and the identity of the main sulphur reservoir is still an open question. AIMS: Our goal is to investigate the H2S chemistry in dark clouds, as this stable molecule is a potential sulphur reservoir. METHODS: Using millimeter observations of CS, SO, H2S, and their isotopologues, we determine the physical conditions and H2S abundances along the cores TMC 1-C, TMC 1-CP, and Barnard 1b. The gas-grain model Nautilus is used to model the sulphur chemistry and explore the impact of photo-desorption and chemical desorption on the H2S abundance. RESULTS: Our modeling shows that chemical desorption is the main source of gas-phase H2S in dark cores. The measured H2S abundance can only be fitted if we assume that the chemical desorption rate decreases by more than a factor of 10 when n H > 2 × 104. This change in the desorption rate is consistent with the formation of thick H2O and CO ice mantles on grain surfaces. The observed SO and H2S abundances are in good agreement with our predictions adopting an undepleted value of the sulphur abundance. However, the CS abundance is overestimated by a factor of 5 - 10. Along the three cores, atomic S is predicted to be the main sulphur reservoir. CONCLUSIONS: The gaseous H2S abundance is well reproduced, assuming undepleted sulphur abundance and chemical desorption as the main source of H2S. The behavior of the observed H2S abundance suggests a changing desorption efficiency, which would probe the snowline in these cold cores. Our model, however, highly overestimates the observed gas-phase CS abundance. Given the uncertainty in the sulphur chemistry, we can only conclude that our data are consistent with a cosmic elemental S abundance with an uncertainty of a factor of 10.

A sensitive λ 3 mm line survey of L483: A broad view of the chemical composition of a core around a Class 0 object.

An exhaustive chemical characterization of dense cores is mandatory to our understanding of chemical composition changes from a starless to a protostellar stage. However, only a few sources have had their molecular composition characterized in detail. Here we present a λ 3 mm line survey of L483, a dense core around a Class 0 protostar, which was observed with the IRAM 30m telescope in the 80-116 GHz frequency range. We detected 71 molecules (140 including different isotopologs), most of which are present in the cold and quiescent ambient cloud according to their narrow lines (FWHM ~0.5 km s-1) and low rotational temperatures (≲10 K). Of particular interest among the detected molecules are the cis isomer of HCOOH, the complex organic molecules HCOOCH3, CH3OCH3, and C2H5OH, a wide variety of carbon chains, nitrogen oxides like N2O, and saturated molecules like CH3SH, in addition to eight new interstellar molecules (HCCO, HCS, HSC, NCCNH+, CNCN, NCO, H2NCO+, and NS+) whose detection has already been reported. In general, fractional molecular abundances in L483 are systematically lower than in TMC-1 (especially for carbon chains), tend to be higher than in L1544 and B1-b, and are similar to those in L1527. Apart from the overabundance of carbon chains in TMC-1, we find that L483 does not have a marked chemical differentiation with respect to starless/prestellar cores like TMC-1 and L1544, although it does chemically differentiate from Class 0 hot corino sources like IRAS 16293-2422. This fact suggests that the chemical composition of the ambient cloud of some Class 0 sources could be largely inherited from the dark cloud starless/prestellar phase. We explore the use of potential chemical evolutionary indicators, such as the HNCO/C3S, SO2/C2S, and CH3SH/C2S ratios, to trace the prestellar/protostellar transition. We also derived isotopic ratios for a variety of molecules, many of which show isotopic ratios close to the values for the local interstellar medium (remarkably all those involving 34S and 33S), while there are also several isotopic anomalies like an extreme depletion in 13C for one of the two isotopologs of c-C3H2, a drastic enrichment in 18O for SO and HNCO (SO being also largely enriched in 17O), and different abundances for the two 13C substituted species of C2H and the two 15N substituted species of N2H+. We report the first detection in space of some minor isotopologs like c-C3D. The exhaustive chemical characterization of L483 presented here, together with similar studies of other prestellar and protostellar sources, should allow us to identify the main factors that regulate the chemical composition of cores along the process of formation of low-mass protostars.

Gas phase Elemental abundances in Molecular cloudS (GEMS): I. The prototypical dark cloud TMC 1.

GEMS is an IRAM 30m Large Program whose aim is determining the elemental depletions and the ionization fraction in a set of prototypical star-forming regions. This paper presents the first results from the prototypical dark cloud TMC 1. Extensive millimeter observations have been carried out with the IRAM 30m telescope (3 mm and 2 mm) and the 40m Yebes telescope (1.3 cm and 7 mm) to determine the fractional abundances of CO, HCO+, HCN, CS, SO, HCS+, and N2H+ in three cuts which intersect the dense filament at the well-known positions TMC 1-CP, TMC 1-NH3, and TMC 1-C, covering a visual extinction range from A V ~ 3 to ~20 mag. Two phases with differentiated chemistry can be distinguished: i) the translucent envelope with molecular hydrogen densities of 1-5×103 cm-3; and ii) the dense phase, located at A V > 10 mag, with molecular hydrogen densities >104 cm-3. Observations and modeling show that the gas phase abundances of C and O progressively decrease along the C+/C/CO transition zone (A V ~ 3 mag) where C/H ~ 8×10-5 and C/O~0.8-1, until the beginning of the dense phase at A V ~ 10 mag. This is consistent with the grain temperatures being below the CO evaporation temperature in this region. In the case of sulfur, a strong depletion should occur before the translucent phase where we estimate a S/H ~ (0.4 - 2.2) ×10-6, an abundance ~7-40 times lower than the solar value. A second strong depletion must be present during the formation of the thick icy mantles to achieve the values of S/H measured in the dense cold cores (S/H ~8×10-8). Based on our chemical modeling, we constrain the value of ζ H2 to ~ (0.5 - 1.8) ×10-16 s-1 in the translucent cloud.

Astrochemical evolution along star formation: Overview of the IRAM Large Program ASAI.

Evidence is mounting that the small bodies of our Solar System, such as comets and asteroids, have at least partially inherited their chemical composition from the first phases of the Solar System formation. It then appears that the molecular complexity of these small bodies is most likely related to the earliest stages of star formation. It is therefore important to characterize and to understand how the chemical evolution changes with solar-type protostellar evolution. We present here the Large Program "Astrochemical Surveys At IRAM" (ASAI). Its goal is to carry out unbiased millimeter line surveys between 80 and 272 GHz of a sample of ten template sources, which fully cover the first stages of the formation process of solar-type stars, from prestellar cores to the late protostellar phase. In this article, we present an overview of the surveys and results obtained from the analysis of the 3 mm band observations. The number of detected main isotopic species barely varies with the evolutionary stage and is found to be very similar to that of massive star-forming regions. The molecular content in O- and C- bearing species allows us to define two chemical classes of envelopes, whose composition is dominated by either a) a rich content in O-rich complex organic molecules, associated with hot corino sources, or b) a rich content in hydrocarbons, typical of Warm Carbon Chain Chemistry sources. Overall, a high chemical richness is found to be present already in the initial phases of solar-type star formation.

Detection of interstellar HCS and its metastable isomer HSC: new pieces in the puzzle of sulfur chemistry.

We present the first identification in interstellar space of the thioformyl radical (HCS) and its metastable isomer HSC. These species were detected toward the molecular cloud L483 thanks to observations carried out with the IRAM 30m telescope in the λ 3 mm band. We derive beam-averaged column densities of 7 × 1012 cm-2 for HCS and 1.8 × 1011 cm-2 for HSC, which translate to fractional abundances relative to H2 of 2 × 10-10 and 6 × 10-12, respectively. Although the amount of sulfur locked by these radicals is low, their detection allows to put interesting constraints on the chemistry of sulfur in dark clouds. Interestingly, the H2CS/HCS abundance ratio is found to be quite low, ~ 1, in contrast with the oxygen analogue case, in which the H2CO/HCO abundance ratio is around 10 in dark clouds. Moreover, the radical HCS is found to be more abundant than its oxygen analogue, HCO. The metastable species HOC, the oxygen analogue of HSC, has not been yet observed in space. These observational constraints are confronted with the outcome of a recent model of the chemistry of sulfur in dark clouds. The model underestimates the fractional abundance of HCS by at least one order of magnitude, overestimates the H2CS/HCS abundance ratio, and does not provide an abundance prediction for the metastable isomer HSC. These observations should prompt a revision of the chemistry of sulfur in interstellar clouds.

Discovery of the elusive radical NCO and confirmation of H2NCO+ in space.

The isocyanate radical (NCO) is the simplest molecule containing the backbone of the peptide bond, C(=O)-N. This bond has a prebiotic interest since is the one linking two amino acids to form large chains of proteins. It is also present in some organic molecules observed in space such as HNCO, NH2CHO and CH3NCO. In this letter we report the first detection in space of NCO towards the dense core L483. We also report the identification of the ion H2NCO+, definitively confirming its presence in space, and observations of HNCO, HOCN, and HCNO in the same source. For NCO, we derive a column density of 2.2×1012 cm-2, which means that it is only ~5 times less abundant than HNCO. We find that H2NCO+, HOCN and HCNO have abundances relative to HNCO of 1/400, 1/80, and 1/160, respectively. Both NCO and H2NCO+ are involved in the production of HNCO and several of its isomers. We have updated our previous chemical models involving NCO and the production of the CHNO isomers. Taking into account the uncertainties in the model, the observed abundances are reproduced relatively well. Indeed, the detection of NCO and H2NCO+ in L483 supports the chemical pathways to the formation of the detected CHNO isomers. Sensitive observations of NCO in sources where other molecules containing the C(=O)-N subunit have been detected could help in elucidating its role in prebiotic chemistry in space.

Obesity, endothelial function and inflammation: the effects of weight loss after bariatric surgery.

OBJECTIVE: Obesity is associated with a high risk for atherosclerotic cardiovascular disease. There is a causal association between obesity, inflammation, insulin resistance (IR) and endothelial dysfunction. The aim of this study was to evaluate changes in IR, proinflammatory state and markers of endothelial dysfunction in morbidly obese patients after weight loss following bariatric surgery. METHODS: In this study, we measured the levels of soluble intracellular adhesion molecule-1 (sICAM1), plasminogen activator inhibitor 1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) in 79 morbidly obese patients at baseline and 3, 6 and 12 months after gastric bypass. Also, we evaluated changes in IR. RESULTS: Twelve months after surgery, there was a significant decrease in plasma levels of sICAM1 (p < 0.001), PAI-1 (p < 0.05), hs-CRP (p < 0.001), IL-6 (p < 0.001) and homeostasis model assessment (HOMA) (p < 0.001) and a significant increase of McAuley index (McAuley) (p < 0.001). Baseline levels of hs-PCR were positively correlated with sICAM-1 (r = 0.450, p < 0.01) and IL-6 (r = 0.451, p < 0.01). Significant correlations were also found between the decrease of PAI-1 and the decrease of hs-PCR (r = 0.425, p < 0.01) and tryglicerides (r = 0.351, p < 0.01). CONCLUSIONS: In patients with morbid obesity, substantial surgically induced weight loss is followed by a significant improvement in the endothelial function, inflammatory state and insulin sensitivity, that may reduce their cardiovascular risk. A relationship exists between improved inflammatory profile and endothelial function.

Structured management strategy based on the Gastro-oesophageal Reflux Disease (GERD) Questionnaire (GerdQ) vs. usual primary care for GERD: pooled analysis of five cluster-randomised European studies.

BACKGROUND: Response to treatment among primary care patients with gastro-oesophageal disease (GERD) is variable. AIM: The GERD Management Project (GMP) evaluated the effectiveness of a structured management approach to GERD vs. standard treatment (usual care). METHODS: Data from five cluster-randomised clinical trials in adult primary care patients with symptoms of GERD were pooled. The structured pathway was based on the self-administered GERD Questionnaire (GerdQ) and was compared with standard treatment. RESULTS: 1734 patients were enrolled (structured treatment, n=834; standard treatment, n=900). The difference in the mean GerdQ score change from baseline favoured the structured pathway (-0.61; 95% CI: -0.88, -0.34; p<0.001). The odds ratio for an indication for treatment revision at the end of follow-up (structured vs. standard treatment) was 0.39 (95% CI: 0.29, 0.52; p=0.001). CONCLUSIONS: Management of primary care patients with GERD can be improved by systematic stratification of patients using a patient management tool such as the GerdQ.

Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe.

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with substantial morbidity and mortality. Despite advances in endoscopic and pharmacological treatment during the past two decades, the incidence of mortality associated with NVUGIB has remained relatively constant. AIM: To report outcomes and predictive factors for bleeding continuation/re-bleeding and mortality of NVUGIB in clinical practice in different European countries. METHODS: This observational, retrospective cohort study (NCT00797641; ENERGIB) was conducted in Belgium, Greece, Italy, Norway, Portugal, Spain and Turkey. Eligible patients were hospitalised (new admissions or inpatients), presenting with overt NVUGIB with endoscopy from 1 October to 30 November, 2008. Patients were managed according to routine care, and data regarding bleeding continuation/re-bleeding, pharmacological treatment, surgery and mortality during 30-days after the initial bleed were collected. A multivariate analysis of clinical factors predictive of poor outcomes was conducted. RESULTS: Overall, 2660 patients (64.7% men; mean age 67.7 years) were evaluable. Significant differences across countries in bleeding continuation/re-bleeding (range: 9-15.8%) or death (2.5-8%) at 30 days were explained by clinical factors (number of comorbidities, age > 65 years, history of bleeding ulcers, in-hospital bleeding, type of lesion or type of concomitant medication). Other factors (country, size of hospital, profile of team managing the event, or endoscopic/pharmacological therapy received) did not affect these outcomes. Similar predictors were observed in patients with high-risk stigmata. CONCLUSION: Differences in the outcomes of nonvariceal upper gastrointestinal bleeding in clinical practice across some European countries are explained mainly by patient-related factors, and not by management factors.

[Soluble intercellular adhesion molecule-1 and C reactive protein after bariatric surgery]. / Moléculas solubles de adhesión intercelular tipo 1 y proteína C reactiva tras cirugía bariátrica.

BACKGROUND AND OBJECTIVES: Obesity is associated with a state of chronic low-grade inflammation. A causal association between inflammatory processes and atherogenesis has been proposed. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients who underwent bariatric surgery. Serum C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations were measured before and after massive weight loss due to gastric bypass. METHODS: In this prospective study we measured CRP and sICAM-1 concentrations in 50 morbidly obese patients (19 men and 31 women) at baseline and 3, 6 and 12 months after gastric bypass. RESULTS: Body mass index (BMI), CRP, and sICAM-1 decreased significantly. BMI correlated with CRP but not with sICAM-1. CONCLUSIONS: The improvement in vascular risk profile after weight loss in morbidly obese patients could be partially explained by changes in inflammatory status.

Moléculas solubles de adhesión intercelular tipo 1 y proteína C reactiva tras cirugía bariátrica / Soluble intercellular adhesion molecule-1 and C reactive protein after bariatric surgery

Background and objectives Obesity is associated with a state of chronic low-grade inflammation. A causal association between inflammatory processes and atherogenesis has been proposed. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients who underwent bariatric surgery. Serum C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations were measured before and after massive weight loss due to gastric bypass. Methods In this prospective study we measured CRP and sICAM-1 concentrations in 50 morbidly obese patients (19 men and 31women) at baseline and 3, 6 and 12 months after gastric bypass. Results Body mass index (BMI), CRP, and sICAM-1 decreased significantly. BMI correlated with CRP but not with sICAM-1.ConclusionsThe improvement in vascular risk profile after weight loss in morbidly obese patients could be partially explained by changes in inflammatory status (AU)

Antecedentes y objetivos La obesidad se asocia a un desorden inflamatorio de bajo grado. Se ha propuesto una asociación causal entre inflamación y arteriosclerosis. El objetivo de este trabajo fue valorar el perfil inflamatorio en pacientes obesos mórbidos determinando las concentraciones de proteína C reactiva (PCR) y de moléculas solubles de adhesión intercelular tipo 1 (sICAM-1) antes y después de la pérdida de peso por cirugía bariátrica. Método Se realizó un estudio prospectivo en el que se midieron las concentraciones séricas de PCR y de sICAM-1 en 50 pacientes con obesidad mórbida (19 hombres y 31 mujeres) antes y a los 3, 6 y 12 meses de la realización de un by-pass gástrico. Resultados Se observó una disminución significativa de índice de masa corporal (IMC), PCR y sICAM-1. Se encontró correlación entre IMC y PCR, pero no entre IMC y sICAM-1.ConclusiónLa mejora del perfil de riesgo vascular en pacientes obesos tras la pérdida de peso podría atribuirse, en parte, a la mejora del estado inflamatorio (AU)

Screening for bipolar disorder in a Spanish sample of outpatients with current major depressive episode.

OBJECTIVE: Bipolar spectrum disorders often go unrecognised and undiagnosed or misdiagnosed. One of the underlying reasons is the poor recognition of bipolar disorder among patients presenting depressive episodes. The specific aim of this study was to estimate the Mood Disorder Questionnaire (MDQ) rate of positive screens for bipolar disorder in a Spanish sample of outpatients with a current major depressive episode and compare it with their current psychiatric diagnosis. The study was designed to address this specific question. METHOD: 971 consecutively outpatients with a current DSM-IV TR diagnosis of a major depressive episode entered this cross-sectional study. Study measures included sociodemographic and clinical data, Clinical Global Impression of Severity of Illness Scale (CGI-S), Hamilton Depression Scale (HAMD) and MDQ. RESULTS: 905 patients fulfilled criteria to be included in the analysis. All of them presented with a current major depressive episode. 74.3% (n=671) of the patients had received a diagnosis of unipolar depression and 25.7% (n=232) of bipolar disorder by a psychiatrist. Using a MDQ of 7-or-more-item threshold, the global positive screen rate for bipolar disorder was 41.3% (n=373). From the 671 patients with previous unipolar depression diagnosis, 161 (24%) screened positive for bipolar disorder with MDQ, whereas in 232 patients diagnosed of bipolar disorder, 212 (91.4%) screened positive for bipolar disorder. CONCLUSIONS: The MDQ showed a positive screen rate for bipolar disorder in 24% of patients with a previous diagnosis of unipolar disorder and a current major depressive episode. Screening tools like MDQ could contribute to increase detection of bipolar disorder in patients with depression. Early diagnosis of bipolar disorder may have important clinical and therapeutic implications in order to improve the illness course and the long-term functional outcome.

Tratamiento a largo plazo de un adenoma secretor de tirotropina con análogos de somatostatina / Long term treatment of a thyrotropin secreting adenoma with somatostatin analogues

Los tumores hipofisarios secretores de tirotropina (tirotropinomas) son menos del 1% de los adenomas hipofisarios y una causa rara de hipertiroidismo. La mayoría se diagnostica como macroadenoma, y los microadenomas son excepcionales. Debe hacerse el diagnóstico diferencial con la resistencia a las hormonas tiroideas. El tratamiento de elección es la adenomectomía transesfenoidal. Si fracasa, los análogos de somatostatina son una alternativa terapéutica. Presentamos a una paciente con un microadenoma productor de tirotropina en quien se practicó una adenomectomía transesfenoidal. Tras el fracaso de la cirugía, se inició tratamiento con un análogo de somatostatina. En laactualidad, después de 9 años, la paciente continúa el tratamiento y el hipertiroidismo y el crecimiento tumoral están controlados (AU)

Thyrotropin secreting adenomas (TSHomas)account for less than 1% of all pituitary adenomas and are a rare cause of hyperthyroidism. Most cases correspond to macroadenomas, microadenomas beingexceptional. Differential diagnosis should be made with resistance to thyroid hormones. The first line treatment is transphenoidal surgery. When surgery is unsuccessful, somatostatin analogues are a therapeutic alternative. We report a patient with a TSH-secreting microadenoma. The microadenoma was resected through the transsphenoidal route. Because surgery was unsuccessful, medical therapy with somatostatin analogue was initiated. Currently, 9 years later, the patient continues to be under treatment with somatostatin analogue therapy, which has controlled the hyperthyroidism and tumoral growth. We describe successful long-term treatment of a TSH-oma with somatostatin analogue therapy when surgery is unsuccessful (AU)

Long term treatment of a thyrotropin secreting adenoma with somatostatin analogues.

Thyrotropin secreting adenomas (TSH-omas) account for less than 1% of all pituitary adenomas and are a rare cause of hyperthyroidism. Most cases correspond to macroadenomas, microadenomas being exceptional. Differential diagnosis should be made with resistance to thyroid hormones. The first line treatment is transphenoidal surgery. When surgery is unsuccessful, somatostatin analogues are a therapeutic alternative. We report a patient with a TSH-secreting microadenoma. The microadenoma was resected through the transsphenoidal route. Because surgery was unsuccessful, medical therapy with somatostatin analogue was initiated. Currently, 9 years later, the patient continues to be under treatment with somatostatin analogue therapy, which has controlled the hyperthyroidism and tumoral growth. We describe successful long-term treatment of a TSH-oma with somatostatin analogue therapy when surgery is unsuccessful.

A 6-month prospective observational study on the effects of quetiapine on sexual functioning.

OBJECTIVE: The aim of this study was to assess the long-term impact of quetiapine on sexual functioning of patients with schizophrenia treated in a real practice setting. METHODS: This was a multicenter, noncomparative, open-label, and naturalistic study conducted in outpatients with a diagnosis of schizophrenia or schizophreniform disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were evaluated at baseline, day 15, and at the end of months 1, 3, and 6 using the Brief Psychiatry Rating Scale, the Clinical Global Impression Severity and Improvement Scales, and the Psychotropic-Related Sexual Dysfunction Questionnaire. All primary effectiveness analyses were based on the intent-to-treat sample and consisted primarily of last-observation-carried-forward analysis of Psychotropic-Related Sexual Dysfunction Questionnaire, Brief Psychiatry Rating Scale, and Clinical Global Impression Improvement of Illness Scale. RESULTS: Eighty-six patients were recruited by 19 investigators, and 82 patients were included in the intent-to-treat sample. Psychotropic-Related Sexual Dysfunction Questionnaire total scores for the patients decreased progressively and significantly from baseline to the study end point. When only patients who initiated quetiapine treatment without being switched from another antipsychotic (n = 28) were included in the intent-to-treat analysis, Psychotropic-Related Sexual Dysfunction Questionnaire scores remained almost unchanged throughout the study. Sexual dysfunction rates, defined as a change in the score of any item greater than 0, were 3.7%, 2.4%, 2.4%, and 4.9% for decreased libido, delayed ejaculation/orgasm, lack of ejaculation/orgasm, and difficulties with erection/lubrication, respectively. Overall, quetiapine was efficacious and well tolerated. CONCLUSION: Despite the limitations of the design, our results suggest that quetiapine shows a low frequency of sexual dysfunction during long-term treatment of patients with schizophrenia or schizophreniform disorder in the clinical practice setting.

[Atorvastatin lowers C-reactive protein in dislipemic patients with type 2 diabetes mellitus]. / Descenso de proteína C reactiva tras tratamiento con atorvastatina en diabéticos tipo 2 con dislipemia.

BACKGROUND AND OBJECTIVE: Type 2 diabetes mellitus is associated with an augmented risk for cardiovascular disease. The levels of C-reactive protein (CRP), the prototypic marker of inflammation, are associated with an increased risk for cardiovascular events. The statins have direct anti-inflammatory effects. Thus, we tested the effects of atorvastatin on levels of CRP on patients with type 2 diabetes. PATIENTS AND METHOD: We evaluated CRP in baseline and 6 months after onset of 20 mg daily atorvastatin therapy of 30 patients with type 2 diabetes with hyperlipidemia. Clinical and biochemical data were obtained. RESULTS: CRP-levels were significantly decreased after treatment with atorvastatin compared with baseline (median change: -4,99 mg/l; p < 0.001). We observed an correlation between CRP baseline with body mass index (r = 0.429; p = 0.018), serum fibrinogen (r = 0.607; p = 0.001) and microalbuminuria (r = 0.470; p = 0.01). Conversely, there was no significant correlation between CRP baseline with LDL cholesterol. The CRP reduction was significantly correlated with fasting glucose (r = -0.457; p = 0.019) and glycosylated hemoglobin at 6 months (r = -0.421; p = 0.03). CONCLUSIONS: These results confirm findings from previous studies that atorvastatin reduce CRP levels in a largely LDL cholesterol independent manner.

[The cost of type 2 diabetes in Spain: the CODE-2 study]. / El coste de la diabetes tipo 2 en España. El estudio CODE-2.

OBJECTIVE: To estimate the cost of providing health care to patients with type 2 diabetes, by differentiating costs of the disease, costs of complications, and other unrelated health costs. METHODS: Data on resource use were retrospectively collected from medical records and personal interviews in 29 primary health care centers in Spain. Patients were randomly selected from each center's diabetes registry. RESULTS: We evaluated 1004 patients (561 women) with a mean age of 67.42 years and a mean disease duration of 10.07 years. A total of 50.9% had no complications, 17.7% had macrovascular complications only, 19.5% had microvascular complications only and 11.9% presented both types of complication. The annual health cost per patient was 1305.15 euros. Of this cost, 28.6% (373.27 euros) was directly related to diabetes control, 30.51% (398.20 euros) was related to complications of the disease, and 40.89% (533.68 euros) was unrelated. The mean cost of patients with no complications was 883 euros compared with 1403 euros for those with microvascular complications, 2022 euros for those with macrovascular complications and 2133 euros for patients with both types of complication. CONCLUSIONS: Because of the high cost of treating type 2 diabetes and its complications, preventive measures should be implemented and control of the disease should be improved to reduce the costs associated with chronic complications.

El coste de la diabetes tipo 2 en España. El estudio CODE-2 / The cost of type 2 diabetes in Spain: the CODE-2 study

Objetivo: Estimar el coste de la atención sanitaria al paciente diabético tipo 2, diferenciando el gasto derivado del control de la enfermedad, de la atención de sus complicaciones y de otros costes directos asociados. Métodos: Recogida retrospectiva del consumo de recursos a partir de la historia clínica y la entrevista personal en 29 centros de atención primaria de todo el territorio nacional de una muestra de pacientes seleccionados de forma aleatoria a partir del registro de diabéticos de cada centro. Resultados: Se evaluó a 1.004 pacientes (561 mujeres) con una media de edad de 67,42 años y una media de evolución de la enfermedad de 10,07 años. El 50,9 por ciento no presentaba complicaciones, el 17,7 por ciento sólo macrovasculares, el 19,5 por ciento sólo microvasculares y el 11,9 por ciento ambas. El coste anual sanitario por paciente fue de 1.305,15 euros. De este coste el 28,6 por ciento (373,27 euros) estaba relacionado directamente con el control de la diabetes, el 30,51 por ciento (398,20 euros) con sus complicaciones y el 40,89 por ciento (533,68 euros) no estaba relacionado. El coste medio de un paciente sin complicaciones fue de 883 euros frente a 1.403 de un paciente con complicaciones microvasculares, 2.022 cuando existían complicaciones macrovasculares y 2.133 cuando coexistían ambos tipos de complicaciones. Conclusiones: El elevado coste del tratamiento de la diabetes tipo 2 y sus complicaciones, sugiere la posibilidad de que la mejora del control de la enfermedad pueda no sólo mejorar la supervivencia y la calidad de vida, sino reducir los costes asociados con las complicaciones crónicas (AU)

Objective: To estimate the cost of providing health care to patients with type 2 diabetes, by differentiating costs of the disease, costs of complications, and other unrelated health costs. Methods: Data on resource use were retrospectively collected from medical records and personal interviews in 29 primary health care centers in Spain. Patients were randomly selected from each center's diabetes registry. Results: We evaluated 1004 patients (561 women) with a mean age of 67.42 years and a mean disease duration of 10.07 years. A total of 50.9% had no complications, 17.7% had macrovascular complications only, 19.5% had microvascular complications only and 11.9% presented both types of complication. The annual health cost per patient was 1305.15 euros. Of this cost, 28.6% (373.27 euros) was directly related to diabetes control, 30.51% (398.20 euros) was related to complications of the disease, and 40.89% (533.68 euros) was unrelated. The mean cost of patients with no complications was 883 euros compared with 1403 euros for those with microvascular complications, 2022 euros for those with macrovascular complications and 2133 euros for patients with both types of complication. Conclusions: Because of the high cost of treating type 2 diabetes and its complications, preventive measures should be implemented and control of the disease should be improved to reduce the costs associated with chronic complications (AU)