Oral phytate supplementation on the progression of mild cognitive impairment, brain iron deposition and diabetic retinopathy in patients with type 2 diabetes: a concept paper for a randomized double blind placebo controlled trial (the PHYND trial).

Type 2 diabetes mellitus has a worldwide prevalence of 10.5% in the adult population (20-79 years), and by 2045, the prevalence is expected to keep rising to one in eight adults living with diabetes. Mild cognitive impairment has a global prevalence of 19.7% in adults aged 50 years. Both conditions have shown a concerning increase in prevalence rates over the past 10 years, highlighting a growing public health challenge. Future forecasts indicate that the prevalence of dementia (no estimations done for individuals with mild cognitive impairment) is expected to nearly triple by 2050. Type 2 diabetes mellitus is a risk factor for the development of cognitive impairment, and such impairment increase the likelihood of poor glycemic/metabolic control. High phytate intake has been shown to be a protective factor against the development of cognitive impairment in observational studies. Diary phytate intake might reduce the micro- and macrovascular complications of patients with type 2 diabetes mellitus through different mechanisms. We describe the protocol of the first trial (the PHYND trial) that evaluate the effect of daily phytate supplementation over 56 weeks with a two-arm double-blind placebo-controlled study on the progression of mild cognitive impairment, cerebral iron deposition, and retinal involvement in patients with type 2 diabetes mellitus. Our hypothesis proposes that phytate, by inhibiting advanced glycation end product formation and chelating transition metals, will improve cognitive function and attenuate the progression from Mild Cognitive Impairment to dementia in individuals with type 2 diabetes mellitus and mild cognitive impairment. Additionally, we predict that phytate will reduce iron accumulation in the central nervous system, mitigate neurodegenerative changes in both the central nervous system and retina, and induce alterations in biochemical markers associated with neurodegeneration.

Upper-extremity deep vein thrombosis in a patient on clozapine therapy carrying the prothrombin G20210A mutation.

Clozapine treatment for resistant schizophrenic disorders has been associated to venous thromboembolic events. We report the case of a patient who developed upper-extremity deep vein thrombosis just 2 months after starting on clozapine in whom the thrombophilia work-up revealed the presence of the prothrombin G20210A mutation.

[Neurophysiology and ageing. Definition and pathophysiological foundations of cognitive impairment]. / Neurofisiología y envejecimiento. Concepto y bases fisiopatológicas del deterioro cognitivo.

Brain ageing is produced by various morphological, biochemical, metabolic and circulatory changes, which are reflected in functional changes, whose impact depends on the presence or absence of cognitive impairment. Because of brain plasticity, together with redundancy of the distinct cerebral circuits, age- related deterioration of the brain at various levels does not always translate into loss of brain function. However, when the damage exceeds certain thresholds, there is age-related cognitive impairment, which increases the risk of developing various neurodegenerative diseases such as Alzheimer disease. Genetics, together with lifestyle, diet, and environmental factors, etc, can trigger the development of these diseases, which provoke cognitive impairment. This article discusses the most important age-related changes in the brain, as well as the pathophysiological foundations of cognitive impairment.

[Oxidative stress and longevity; a case-control study]. / El estrés oxidativo como predictor de longevidad; estudio de casos y controles.

INTRODUCTION: Human longevity is a complex issue influenced by genetic and environmental factors. Oxidative stress (OE) could play an important role in this process. Succesful aging could be related with the organism ability facing OE. In the present study we compared malondialdehyde (MDA) and oxidized proteins (OP) plasma levels, in elderly people older than 97 years and 70-80 years old, to better understand the effects of OE on human longevity. MATERIAL AND METHODS: Population-based case control study. We considered as cases patients who were born and live on la Ribera county in Valencia (Spain) older than 97 years old and who accepted to participate in the study. Controls were from the same poblational base, chosen randomly, and 70-80 years old. We made a descriptive analysis of sociodemographic, clinic and functional variables; an odds ratio (OR) estimation of being centenarian by OP and MDA quartiles; and a tendency analysis by Mantel-Haenszel test. RESULTS: Twenty eight cases and 31 controls were included. Functional state and robust percentage were worse in cases. MDA (1,44±0,45 vs 1,84±0,59, p=0,005), and OP (64,29±15,73 vs. 76,52±13,44, p=0,002) levels, were significantly lower in cases. The OR of being centenarian in lower/higher quartile were 3,8 for MDA and 5,7 for OP, with a Mantel-Haenszel signification of 0,029 and 0,044 respectively. CONCLUSIONS: In our study OE level were lower in centenarians than in younger elderly, and the lower the OE grade, the higher were the likelihood of being centenarian.

Early biomarkers of acute kidney failure after heart angiography or heart surgery in patients with acute coronary syndrome or acute heart failure.

BACKGROUND: Acute kidney injury (AKI) is a common complication in cardiac surgery and coronary angiography, which worsens patients' prognosis. The diagnosis is based on the increase in serum creatinine, which is delayed. It is necessary to identify and validate new biomarkers that allow for early and effective interventions. AIMS: To assess the sensitivity and specificity of neutrophil gelatinase-associated lipocalin in urine (uNGAL), interleukin-18 (IL-18) in urine and cystatin C in serum for the early detection of AKI in patients with acute coronary syndrome or heart failure, and who underwent cardiac surgery or catheterization. METHODS: The study included 135 patients admitted to the intensive care unit for acute coronary syndrome or heart failure due to coronary or valvular pathology and who underwent coronary angiography or cardiac bypass surgery or valvular replacement. The biomarkers were determined 12 hours after surgery and serum creatinine was monitored during the next six days for the diagnosis of AKI. RESULTS: The area under the ROC curve (AUC) for NGAL was 0.983, and for cystatin C and IL-18 the AUCs were 0.869 and 0.727, respectively. At a cut-off of 31.9 ng/ml for uNGAL the sensitivity was 100% and the specificity was 91%. CONCLUSIONS: uNGAL is an early marker of AKI in patients with acute coronary syndrome or heart failure and undergoing cardiac surgery and coronary angiography, with a higher predictive value than cystatin C or IL-18.