Diphtheria and Tetanus Immunity Status among Greek Adults: Results from a Nationwide Seroprevalence Study.

Diphtheria and tetanus could lead to serious morbidity. We aimed to evaluate immunity levels by measuring specific IgG antibodies for diphtheria and tetanus in serum samples from a nationally expanded sample of the Greek population. A geographically stratified sampling approach based on regional units (NUTS level 2) was applied by considering variables such as age group (30-80+) and sex. In total, 1201 persons (47.7% males and 52.3% females) participated in the survey. Bivariate analysis revealed a negative relationship between diphtheria and tetanus median antibody titers and age. The overall seropositivity rate for diphtheria IgG antibodies (≥0.10 IU/mL) was estimated at 31.5%. Regarding tetanus, the total seropositivity rate was estimated at 59.5% (tetanus IgG antibodies ≥0.10 IU/mL). Logistic regression analysis indicated that age groups <40 years and 40-59 years were independently associated with tetanus seropositivity. Logistic regression also revealed that male sex and being aged 60-69 years were independent risk factors for diphtheria-related seropositivity. Lastly, being resident of some regions was an independent risk factor for both diphtheria- and tetanus-related seropositivity. The present study shows that Greek adults are still not completely immune to diphtheria and tetanus. It is likely possible to achieve optimal immunization coverage by implementing serviceable public health initiatives after comprehending real community needs.

Pertussis Prevalence in Adult Population in Greece: A Seroprevalence Nationwide Study.

The reported cases of pertussis vary considerably globally. In the present nationwide study, we aimed to record the Bordetella pertussis prevalence in Greece by measuring serum IgG specific antibody levels to pertussis toxin (anti-PT IgG). General practitioners and laboratories participated in this study from 12 regions of Greece. A geographically stratified sampling plan based on regional units (NUTS level 2) was applied in order to produce a representative sample, taking into consideration age group (30−39, 40−49, 50−59, 60−69, 70−79 and 80+) and sex. In total, 1169 subjects participated in the study. The percentage of participants with anti-PT IgG antibodies higher than 50 IU/mL was 3.7%. The levels of anti-PT IgG antibodies of total sample ranged between 1.46 IU/mL to 126.60 IU/mL, with mean 17.74 IU/mL and standard deviation 14.03 U/mL (p-value < 0.001). The total seroprevalence of Greek regions for pertussis disease varied significantly among prefectures. The region with the highest seroprevalence was Peloponnese 21.3%, followed by the region of Central Greece 15.3%. The proportion of adults who have pertussis specific antibodies <50 IU/mL has been >90%, suggesting that a large number of adults may be vulnerable to infection of pertussis despite well-established vaccination programs in Greece. Despite the fact that vaccination reduced the number of reported pertussis cases in the last decades in Greece, our seroprevalence study may indicate that the herd immunity level among Greek adults is suboptimal.

Toxicity evaluation of an essential oil mixture from the Cretan herbs thyme, Greek sage and Cretan dittany.

The importance of herbal extracts on health, which was initially based on ethnopharmacological and traditional knowledge, becomes increasingly well documented by numerous experimental and intervention studies. The daily use of beverages from different aromatic plants which becomes more popular nowadays, has been a tradition in Crete, and a habit that has been linked to the longevity seen in the island. Additionally, a certain combination of aromatic plants has been used against common cold and influenza. Interestingly, when such a mixture of essential oils from Cretan herbs (Cretan Aromatic Plants essential oil, CAPeo, from thyme, Greek sage, and Cretan dittany) was formulated, significant antiviral properties were observed in vitro and a significant reduction in the duration and severity of symptoms of patients with upper respiratory tract infections was found in a clinical study. However, since many plants extracts can exert toxic effects, toxicity issues should be properly addressed. In the present work we present an acute and sub-chronic toxicity evaluation for this mixture of aromatic plants' essential oils in rats. In fact, it is the only toxicity study for Cretan dittany. We report absence of toxicity, rendering the use of the mixture of essential oils from Cretan dittany, Greek sage and thyme as safe.

Translating vitamin D transcriptomics to clinical evidence: Analysis of data in asthma and chronic obstructive pulmonary disease, followed by clinical data meta-analysis.

Vitamin D (VitD) continues to trigger intense scientific controversy, regarding both its bi ological targets and its supplementation doses and regimens. In an effort to resolve this dispute, we mapped VitD transcriptome-wide events in humans, in order to unveil shared patterns or mechanisms with diverse pathologies/tissue profiles and reveal causal effects between VitD actions and specific human diseases, using a recently developed bioinformatics methodology. Using the similarities in analyzed transcriptome data (c-SKL method), we validated our methodology with osteoporosis as an example and further analyzed two other strong hits, specifically chronic obstructive pulmonary disease (COPD) and asthma. The latter revealed no impact of VitD on known molecular pathways. In accordance to this finding, review and meta-analysis of published data, based on an objective measure (Forced Expiratory Volume at one second, FEV1%) did not further reveal any significant effect of VitD on the objective amelioration of either condition. This study may, therefore, be regarded as the first one to explore, in an objective, unbiased and unsupervised manner, the impact of VitD levels and/or interventions in a number of human pathologies.

Significant metabolic improvement by a water extract of olives: animal and human evidence.

PURPOSE: Dyslipidemia and impaired glucose metabolism are the main health issues of growing prevalence and significant high healthcare cost, requiring novel prevention and/or therapeutic approaches. Epidemiological and animal studies revealed that olive oil is an important dietary constituent, inducing normolipidemia. However, no studies have specifically investigated the polyphenol-rich water extract of olives (OLWPE), generated during olive oil production. METHODS: In the present work, we initially examined the effect of OLPWE on animals' metabolic parameters. Rats fed with a high-fat diet were treated with three different doses of OLPWE for 4 months. Additionally, bioavailability was explored. Afterwards, OLWPE's metabolic effect was explored in humans. Healthy volunteers consumed microencapsulated OLWPE for 4 weeks, in a food matrix [one portion (30 g) of a meat product]. RESULTS: High-fat-fed rats developed a metabolic dysfunction, with increased LDL and insulin levels and decreased HDL; this syndrome was significantly impaired when treated with OLWPE. Treated rats had increased total plasma antioxidant capacity, while several phenolic compounds were detected in their blood. These findings were also verified in humans that consumed OLWPE, daily, for 4 weeks. Interestingly, in individuals with elements of cardio-metabolic risk, OLWPE consumption resulted in reduced glucose, insulin, total cholesterol, LDL and oxLDL levels. CONCLUSIONS: Our data clearly show that OLWPE can improve glucose and lipid profile, indicating its possible use in the design of functional food and/or therapeutic interventions.

Implementation of thyroid function tests algorithms by clinical laboratories: A four-year experience of good clinical and diagnostic practice in a tertiary hospital in Greece.

INTRODUCTION: Thyroid Function Tests (TFTs) are among the most commontly ordered tests. Significant overuse of TFTs can occur when instead of using a single TSH test to screen for thyroid disease a full panel (TSH plus FT4 and FT3) is ordered. The aim of our study was to evaluate the effectiveness of the application of a scientifically-established laboratory-controlled algorithm for TFTs to physician's orders for inpatients and to address potential pitfalls of such an approach. MATERIALS AND METHODS: We collected and analyzed Laboratory Information System data of the TFTs performed between April 2009 and March 2016 in a 739-bed tertiary teaching hospital. Between April 2013 and March 2016, we applied a laboratory controlled algorithm for inpatient TFT assays after TSH and did not perform further tests, unless a justified bypass was requested by the treating physician. RESULTS: Algorithm application led to significant reductions of TFTs executed per TSH ordered. Compared to the four years preceding the intervention, executed FT4/TSH tests decreased from 93 to 18%, FT3/TSH from 92 to 18%, anti-TG/TSH from 18 to 4% and anti-TPO/TSH from 11 to 3%. Simultaneously, FT4, FT3, anti-TG, and anti-TPO tests ordered in outpatients also displayed a significant gradual decrease. CONCLUSIONS: Hospital-based laboratories can safely apply a generally accepted TFTs algorithm on physician's orders without any compromise in diagnostic/therapeutic accuracy, thus achieving significant direct cost-reduction and increased physician awareness on current TFT ordering practices. Such an approach, combined with collaboration with ordering physicians, can safeguard patients from the consequences of low-value care practices.

Adiponectin levels may help assess the clinical repercussions of obesity irrespective of body mass index.

OBJECTIVE: Adiponectin is the major product of adipose tissue. The aim of this study was to associate adiponectin levels with adipose tissue and metabolic indices. DESIGN: Plasma samples of 274 non-diabetic volunteers were collected to evaluate for adiponectin, inflammatory markers, insulin and lipid parameters. Body fat composition was measured by DEXA. RESULTS: As expected, adiponectin levels correlated with body mass index (BMI) and gender but a wide scattering was evident. When the population was divided into two groups per median levels of adiponectin (11.94 µg/mL), adiponectin was correlated with various metabolic indices. Persons displaying relatively high adiponectin levels [17.7(CI:14.8-21.0]µg/mL; MEDIAN (25%-75%)] exhibited lower levels of inflammatory markers (hs-CRP, plasminogen, erythrocyte sedimentation rate), circulating lipids and markers of insulin sensitivity (fasting blood glucose, insulin, HbA1c and HOMA-IR) compared to those individuals displaying low-adiponectin levels [8.9(CI:6.9-10.6)µg/mL]. The percentage of high-adiponectin individuals decreased from 69.6% in the normal-BMI group to 36.5% in the obese-BMI group. Average adiponectin levels in the high-adiponectin normal-BMI group were significantly higher compared to the high-adiponectin obese-BMI group (p=0.014). Regarding body fat, only the individuals with high adiponectin levels in either the combined population or within the obese-BMI group displayed low levels of waist-to-hip ratio. Interestingly, high-adiponectin levels within the obese-BMI group were associated with higher legs fat than trunk fat as compared to the low-adiponectin obese-BMI group. CONCLUSIONS: Our data suggest that the distribution of adiponectin above or below a cutoff level may offer additional clinical information over and above that of BMI grouping regarding inflammatory profile, insulin-sensitivity and adiposity.

Vitamin D levels in a large Mediterranean cohort: reconsidering normal cut-off values.

OBJECTIVE: The determination of the normal range of 25-hydroxyvitamin D [25-(OH)D], though currently based on suppression of PTH levels, still remains a controversial issue. The 25-(OH)D levels exhibit gender and seasonal variability, the latter attributed in part to changes of insolation. DESIGN: The aim of this cross-sectional study was to estimate the levels of 25-(OH)D on the island of Crete and their correlation with metabolic, hormonal and bone turnover parameters. The study was performed over a period of five years and involved 8,183 male and female individuals (8,042 analyzed). RESULTS: Our results are as follows: (1) 25-(OH)D was significantly lower than expected (19.48±9.51 and 18.01±9.01 (ng/mL+SD) in males and females, respectively); (2) seasonal variation of 25-(OH)D was observed in both sexes (females < males), with values peaking in August; (3) a decline of 25-(OH)D was evident with advancing age, with lower levels in females compared to males up to menopause and no apparent difference between the genders thereafter; (4) levels of 25-(OH)D were lower in renal function impairment, diabetes/insulin resistance and inflammation, while no correlation was detectable in thyroid dysfunction; (5) normalization of PTH levels was observed at ~20 ng/mL 25-(OH)D. At the same cut-off level, a significant decrease of all measured bone turnover indices (b-ALP, osteocalcin and CTX) was evident. CONCLUSION: Based on the above data, it appears that a cut-off level of 25-(OH)D close to 20 ng/mL better reflects the physiology of our population.

Cord blood leptin levels in relation to child growth trajectories.

OBJECTIVE: Leptin represents a potential modulator of developmental programming of childhood obesity. We investigated the association of cord blood leptin with growth trajectories from birth to early childhood. MATERIALS/METHODS: We used data from the prospective mother-child cohort "Rhea", Crete, Greece. Cord blood samples from 642 neonates were collected. 578 (90%) children had complete follow up data from birth to 4years. We measured child weight, height, waist circumference, skinfold thicknesses, blood pressure, and serum lipids, leptin, adiponectin and C-reactive protein in early childhood (median 4.2years). We estimated growth trajectories from 3months up to 4years using random-effects linear-spline models. Multivariable logistic and linear regression models were used adjusting for confounders. RESULTS: Mean cord blood leptin levels were 7.3ng/mL (standard deviation: 6.3). Children with high cord blood leptin (>90th percentile) exhibited lower weight, height and body mass index from 6months to early childhood. Each SD increase in cord blood leptin was associated with lower weight at the age of 4 by 242g (95% CI: -416, -69). In a stratified analysis, the reverse association was observed in children born small for gestational age (p for interaction=0.001), and in those exhibiting rapid infant growth during the first 3months of life (p for interaction=0.002). Cord blood leptin levels were not associated with cardiometabolic risk factors at 4years. CONCLUSIONS: Long term programming effects of in utero exposure to leptin extends beyond infancy into early childhood. Further studies are needed to explore potential effect modification by intrauterine and early infancy growth patterns.

Chemerin, visfatin, and vaspin serum levels in relation to bone mineral density in patients with inflammatory bowel disease.

BACKGROUND: There is evidence that fat mass is correlated with bone mineral density (BMD) in inflammatory bowel disease (IBD), but data on the role of adipokines on this association are limited. The aim of this study was to investigate the serum levels of chemerin, visfatin, and vaspin, hormones that act as adipokines, in relation to BMD in patients with ulcerative colitis (UC) and Crohn's disease (CD). PATIENTS AND METHODS: Serum from 120 IBD patients (68 CD, 52 UC) and 98 matched healthy controls (HC) was collected. Chemerin, visfatin, and vaspin levels were assessed using an enzyme-linked immunosorbent assay. BMD was determined for the lumbar spine and the proximal femur using dual-energy X-ray absorptiometry. Full-body composition scans were analyzed using enCORE software based on the absorptiometry system. RESULTS: Serum chemerin was higher in IBD patients than HC [CD 13.67.1±5.8, UC 13.9±4.3 vs. HC 7.8±2.6 ng/ml, odds ratio (OR): 0.95, 95% confidence interval (CI) 0.93-0.98, P<0.0001]. Serum visfatin levels in CD patients were significantly higher than those in UC patients (9.3±14.01 vs. 6.5±7.2 ng/ml, OR: 0.86, 95% CI 0.80-0.92, P=0.039). In multivariate logistic regression analysis, a significant independent association of osteoporosis (T-score ≤2.5 SD) with age (OR: 1.04, 95% CI 1.01-1.08, P=0.02), visfatin (OR: 0.78, 95% CI 0.63-0.97, P=0.02), and chemerin levels (OR: 0.83, 95% CI 0.70-0.98, P=0.03), but not with BMI or body composition, was found. CONCLUSION: Serum visfatin and chemerin levels are associated with the development of osteoporosis in IBD. These results suggest a role of visfatin and chemerin in the pathophysiology of osteoporosis in IBD.

Muscular effects of vitamin D in young athletes and non-athletes and in the elderly.

Muscles are major targets of vitamin D. Exposure of skeletal muscles to vitamin D induces the expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation. At the same time vitamin D suppresses the expression of myostatin, a negative regulator of muscle mass. Moreover, vitamin D increases the number of type II or fast twitch muscle cells and in particular that of type IIA cells, while its deficiency causes type IIA cell atrophy. Furthermore, vitamin D supplementation in young males with low vitamin D levels increases the percentage of type IIA fibers in muscles, causing an increase in muscular high power output. Vitamin D levels are strongly associated with exercise performance in athletes and physically active individuals. In the elderly and in adults below the age of 65, several studies have established a close association between vitamin D levels and neuromuscular coordination. The aim of this review is to appraise our current understanding of the significance of vitamin D on muscular performance in both older and frail individuals as well as in younger adults, athletes or non-athletes with regard to both ordinary everyday musculoskeletal tasks and peak athletic performance.

Electrophysiological and Electroanatomical Mapping of the Right Atrium in Persistent Atrial Fibrillation: Relation to Collagen Turnover.

BACKGROUND: Atrial fibrillation (AF) is associated with abnormal atrial substrate. We investigated whether patients with persistent lone AF and patients with persistent AF and nonischemic dilated cardiomyopathy (NIDCM) exhibit any differences in electrophysiological and electroanatomical properties of right atrium (RA) and collagen turnover. We also investigated the relationship between mean RA bipolar voltage and collagen turnover. METHODS: Ten patients with a history of persistent lone AF and eight patients with a history of persistent AF and NIDCM were studied. Sinus node recovery times (SNRTs) and effective refractory periods (ERPs) at 600 ms, 500 ms, and 400 ms from the high (HLRA) and low (LLRA) lateral RA, proximal coronary sinus (pCS), and right atrial appendage (RAA) were evaluated, and RA electroanatomic mapping was created. Serum N-terminal propeptide of collagen type I (PINP), cross-linked C-terminal telopeptide of collagen type I (CTx), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of matrix metalloproteinases (TIMP-1) were measured as markers of collagen synthesis and degradation. RESULTS: No differences were found in SNRTs, ERPs from the HLRA, LLRA at 600 ms, pCS and RAA, mean RA bipolar voltage, serum PINP, CTx, MMP-1, and TIMP-1 between the two groups. In persistent lone AF, serum levels of TIMP-1 were related with mean HLRA and HPRA bipolar voltage. CONCLUSIONS: Persistent AF patients with or without NIDCM, demonstrate similar changes in electrophysiological and electroanatomical properties of the RA, as well as similar structural changes. Moreover, serum markers of collagen synthesis are correlated with bipolar voltage in specific regions of RA in persistent lone AF.

The impact of adipose tissue-derived factors on the hypothalamic-pituitary-gonadal (HPG) axis.

Adipose tissue produces factors, including adipokines, cytokines and chemokines which, when released, systemically exert endocrine effects on multiple tissues thereby affecting their physiology. Adipokines also affect the hypothalamic-pituitary-gonadal (HPG) axis both centrally, at the hypothalamic-pituitary level, and peripherally acting on the gonads themselves. Among the adipokines, leptin, adiponectin, resistin, chemerin and the peptide kisspeptin have pleiotropic actions on the HPG axis affecting male and female fertility. Furthermore, adipokines and adipose tissue-produced factors readily affect the immune system resulting in inflammation, which in turn impact the HPG axis, thus evidencing a link between metabolic inflammation and fertility. In this review we provide an overview of the existing extensive bibliography on the crosstalk between adipose tissue-derived factors and the HPG axis, with particular focus on the impact of obesity and the metabolic syndrome on gonadal function and fertility.

Vitamin D and exercise performance in professional soccer players.

AIM: The current study had two aims. The primary purpose was to examine the association between serum vitamin D levels and the ergometric evaluation of muscle strength, aerobic capacity, and speed in professional soccer players. The secondary aim was to evaluate the effects of the soccer off-season period on serum vitamin D levels. METHODS: Sixty-seven Caucasian male soccer players (age 25.6 ± 6.2 and height 1.81 ± 0.08 m), members of two Greek Superleague Soccer teams and one Football-league championship team participated in this study. Exercise performance testing for the determination of squat jump (SJ), countermovement jump (CMJ), 10 (10 m) and 20 meters (20 m) sprint performance, maximal oxygen consumption (VO2max), anthropometry, and blood sampling were performed before (pre) and after (post) the six-week off-season period. RESULTS: Analysis of our results showed the following: (a) a significant correlations between serum vitamin D levels and performance parameters in both pre (SJ; P < 0.001, CMJ; P < 0.001, VO2max; P < 0.001, 10 m; P < 0.001, and 20 m; P < 0.001) and post (SJ; P < 0.001, CMJ; P<0.001, VO2max; P = 0.006, 10 m; P < 0.001, and 20 m; P < 0.001) experimental sessions. (b) Vitamin D concentration increased significantly (P < 0.001) following the six-week off-season period compared to baseline, while at the same time all measured performance parameters decreased (SJ; P < 0.001, CMJ; P < 0.001, 10 m; P < 0.001, 20 m; P < 0.001, VO2max; P<0.001). DISCUSSION: Our findings suggest that vitamin D levels are associated with the ergometric evaluation of muscle strength, as expressed by SJ and CMJ, sprinting capacity, and VO2max in professional soccer players, irrespective the levels of performance. Furthermore, our data reaffirm the importance of UVB on serum vitamin D levels. Moreover, reductions in exercise training stress may also have beneficial effects on vitamin D levels, suggesting a possible association of its levels and the training-induced stress. Our results indicate a possibly bidirectional interaction between soccer performance indices and vitamin D levels.

Effect of different seasonal strength training protocols on circulating androgen levels and performance parameters in professional soccer players.

OBJECTIVE: To examine the effects of three seasonal training programs, largely different in strength volume, on androgen levels and performance parameters in soccer players. DESIGN: Sixty-seven soccer players, members of three different professional teams, participated in the study. Strength intensity of the training programs were assessed as high (for Team-A, n=23), moderate (for Team-B, n=22), and low (for Team-C, n=22). Blood samples were analyzed for total-testosterone, free-testosterone, and the metabolic product of activate testosterone 3a-androstendiol glucuronade (3a-Diol-G). Players were tested for maximal oxygen consumption (VO2max), squad-jump (SJ), countermovement-jump (CMJ), 10 m and 20 m sprint performance prior at the beginning of the pre-season period, at the middle (mid-point), and at the end of the competition period (end-point). RESULTS: All performance parameters increased significantly until mid-point in all teams (p<0.001). However, performance was further increased only in Team-A only for jumping and sprinting ability between end-point vs mid-point (p<0.001). An effect of the training program of Team-A on TT levels was evident exhibiting significant differences between at all point-measurements (baseline/mid-point:p=0.024, baseline/end-point:p<0.001, mid/end-point:p=0.008), while a marginally significant effect (p=0.051) was detected within Team-B and a non-significant effect in Team-C. Similar results were obtained for 3a-Diol-G in Team-A (p=0.001) where significant differences were found between end-point to both baseline (p=0.001) and mid-point (p=0.038). No differences were detectable for FT. A borderline significant negative correlation was observed between 3a-Diol-G and VO2max in Team-B at mid-point. No other correlations were evident between performance and hormonal parameters. CONCLUSION: Our findings suggest that the volume of strength training combined with intensive soccer training caused an elevation of circulating TT and 3a-Diol-G levels in parallel to the induction of performance capacity. It is our opinion that the elevation of endogenous androgens as a result of the volume of strength training indicates that the only method to improve athletic performance is hard training. There are no substitutes or shortcuts. If the organism needs more androgens it will produce them endogenously.

Discrepancy between exercise performance, body composition, and sex steroid response after a six-week detraining period in professional soccer players.

PURPOSE: The aim of this study was to examine the effects of a six-week off-season detraining period on exercise performance, body composition, and on circulating sex steroid levels in soccer players. METHODS: Fifty-five professional male soccer players, members of two Greek Superleague Teams (Team A, n = 23; Team B, n = 22), participated in the study. The first two weeks of the detraining period the players abstained from any physical activity. The following four weeks, players performed low-intensity (50%-60% of VO2max) aerobic running of 20 to 30 minutes duration three times per week. Exercise performance testing, anthropometry, and blood sampling were performed before and after the six-week experimental period. RESULTS: Our data showed that in both teams A and B the six-week detraining period resulted in significant reductions in maximal oxygen consumption (60,31±2,52 vs 57,67±2,54; p<0.001, and 60,47±4,13 vs 58,30±3,88; p<0.001 respectively), squat-jump (39,70±3,32 vs 37,30±3,08; p<0.001, and 41,05±3,34 vs 38,18±3,03; p<0.001 respectively), and countermovement-jump (41,04±3,99 vs 39,13±3,26; p<0.001 and 42,82±3,60 vs 40,09±2,79; p<0.001 respectively), and significant increases in 10-meters sprint (1,74±0,063 vs 1,79±0,064; p<0.001, and 1,73±0,065 vs 1,78±0,072; p<0.001 respectively), 20-meters sprint (3,02±0,05 vs 3,06±0,06; p<0.001, and 3,01±0,066 vs 3,06±0,063; p<0.001 respectively), body fat percentage (Team A; p<0.001, Team B; p<0.001), and body weight (Team A; p<0.001, Team B; p<0.001). Neither team displayed any significant changes in the resting concentrations of total-testosterone, free-testosterone, dehydroepiandrosterone-sulfate, Δ4-androstenedione, estradiol, luteinizing hormone, follicle-stimulating hormone, and prolactin. Furthermore, sex steroids levels did not correlate with exercise performance parameters. CONCLUSION: Our results suggest that the six-week detraining period resulted in a rapid loss of exercise performance adaptations and optimal body composition status, but did not affect sex steroid resting levels. The insignificant changes in sex steroid concentration indicate that these hormones were a non-contributing parameter for the observed negative effects of detraining on exercise performance and body composition.

Serum hepcidin and prohepcidin concentrations in inflammatory bowel disease.

BACKGROUND: Anemia is an important complication of inflammatory bowel disease (IBD). Recent data suggest that hepcidin is a major mediator of anemia with a central role in iron homeostasis and metabolism. The aim of this study was to evaluate the serum levels of hepcidin and its prohormone, prohepcidin, in patients with IBD in comparison with healthy controls. METHODS: One hundred patients with IBD [49 ulcerative colitis (UC), 51 Crohn's disease (CD)] and 102 healthy controls were enrolled. Serum hepcidin and prohepcidin levels were measured by commercially available enzyme-linked immunosorbent assays kits. Their relationship with clinical and laboratory parameters of UC and CD was assessed. RESULTS: Median hepcidin levels were significantly higher in both patients with UC and patients with CD compared with healthy controls (P<0.0001). Median prohepcidin levels were significantly lower in patients with IBD compared with healthy controls (P = 0.03). In the univariate analysis, serum hepcidin was significantly negatively correlated (r = -0.36, P = 0.0003), whereas serum prohepcidin was positively correlated (r = 0.65, P<0.0001) with the hemoglobin levels. Significant correlations of both hepcidin (r = 0.34, P = 0.0007) and prohepcidin (r = -0.21, P = 0.04) with ferritin levels were found in patients with IBD. Serum hepcidin was also correlated with disease activity (for UC, r = 0.36, P = 0.009) and C-reactive protein (r = 0.29, P = 0.004). After multivariate analysis serum hepcidin levels remained significantly correlated with ferritin (P = 0.0008) and disease activity (for UC, P = 0.004). CONCLUSION: Serum hepcidin and prohepcidin levels are significantly altered in patients with IBD compared with healthy controls. This finding suggests a substantial role of these two hormones in the development of anemia in IBD.

Elderly patients with trochanteric hip fracture have lower serum Vitamin D levels compared to patients with cervical hip fracture.

Hip fracture patients have lower serum 25-hydroxyvitamin D (25(OH)D) levels, at the time of their fracture, compared to age-matched controls. Aim of this work was to examine if the admission levels of serum 25(OH)D in patients with hip fracture are associated not only to hip fracture in general but also to the type of hip fracture, i.e., trochanteric vs. cervical. Our hypothesis was based on the fact that in Mediterranean countries trochanteric hip fractures are more common than cervical while the contrary is true for northern European countries. Fifty-three community free elderly Cretan women with an acute low energy hip fracture (29 with trochanteric and 24 with cervical fracture) and 70 community free elderly women without hip fracture were included in this study. Serum PTH, Ca, P and Cre showed no significant difference between the two fracture groups. Women with trochanteric fractures had significantly lower serum 25(OH)D levels compared to those with cervical hip fracture (i.e., 35.9 nmol/l vs 55.2 nmol/l (p=0.015) while the group of those with cervical hip fracture do not appear to differ from the controls.

Atorvastatin for diabetic macular edema in patients with diabetes mellitus and elevated serum cholesterol.

BACKGROUND AND OBJECTIVE: To determine the efficacy of atorvastatin in reducing hard exudates and diabetic macular edema. PATIENTS AND METHODS: An uncontrolled clinical case series included 18 eyes with diabetic maculopathy and an elevated baseline lipid profile. All patients were treated with atorvastatin. Ophthalmologic evaluation, including fundus photography and fluorescein angiography, was performed at presentation and repeated at 3, 6, and 12 months. Hard exudates, hemorrhages, and fluorescein leakage at 12 months were evaluated and compared with baseline findings. RESULTS: Eighteen subjects with diabetic maculopathy received atorvastatin, and a significant decrease in total cholesterol and low-density lipoprotein cholesterol was seen (P < .05). Hard exudates and fluorescein leakage were decreased. No evidence of an association between change in hemorrhage status and treatment was found. CONCLUSION: Oral atorvastatin therapy in patients with diabetes mellitus and dyslipidemia seems to reduce the severity of hard exudates and fluorescein leakage in diabetic maculopathy and could be useful as an adjuvant therapy in the management of diabetic macular edema.

Effects of tumor necrosis factor alpha inhibition with infliximab on lipid levels and insulin resistance in patients with inflammatory bowel disease.

INTRODUCTION: TNF-alpha is a critical mediator of inflammation with an important role in metabolic profile and insulin resistance. The regulation of these parameters by TNF-alpha in inflammatory bowel disease (IBD) is, however, poorly understood. The aim of this study was to assess the in-vivo TNF-alpha-mediated regulation of insulin resistance and of lipid levels in patients with IBD. METHODS: Twenty-two patients with IBD (eight females; 19 Crohn's disease) received infliximab according to treating physician's assessment at weeks 0, 2 and 6 from baseline and subsequently every 8 weeks and were prospectively followed for 14 weeks. Fasting insulin, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A1 (apo-A1), apolipoprotein B100 and lipoprotein a were measured in serum at baseline and at week 14. Insulin resistance was calculated with the use of the Homeostasis Model Assessment index. RESULTS: Infliximab therapy induced clinical response or remission in 19 of the 22 patients. C-reactive protein levels were significantly decreased by week 14. Body mass index was increased in all patients. No difference was observed in insulin levels, Homeostasis Model Assessment index, triglycerides, LDL cholesterol, apolipoprotein B100 and lipoprotein a. In contrast, total cholesterol, HDL cholesterol and apo-A1 levels were significantly increased from baseline. CONCLUSION: TNF-alpha inhibition does not alter insulin resistance in IBD patients. In contrast, total cholesterol, HDL cholesterol and apo-A1 levels are significantly increased after infliximab treatment compared with baseline. The importance of these alterations needs to be clarified in future studies.