One hundred forty-one children with insulin-dependent diabetes mellitus were screened for serum immunoglobulin A (IgA) antigliadin antibodies by means of an enzyme-linked immunosorbent assay (ELISA) method. None of them had gastrointestinal symptoms, and no major nutritional disturbances were detected except for a girl with moderate growth delay. Twelve patients with positive IgA antigliadin antibodies on two or more consecutive measurements underwent a small intestinal biopsy; four of them had a subtotal villous atrophy, and celiac disease was diagnosed; in another patient, a partial villous atrophy was observed. Children suffering from both diabetes and celiac disease showed an onset of diabetes at a younger age than did nonceliac patients. Prevalence of celiac disease in the screened population is 2.85%, which is higher than in the general population of the Comunidad Valenciana (one in 2,500 live births).

Type II (non-insulin-dependent) diabetes mellitus is a clinical syndrome that is likely to result from a complex interaction between environmental and genetic factors. Recently, several monogenic forms of Type II diabetes have been identified [1±3]. Furthermore, genetic variation in the gene encoding calpain-10 is associated with late-onset Type II diabetes among Mexican-Americans [4] and altered glucose metabolism among Pima Indians [5]. Other genetic components of the more common form of late-onset Type II diabetes among Caucasian subjects are not known. The sulphonylurea receptor (SUR1) is a subunit of the pancreatic beta cell ATP-sensitive potassium channel (K ATP channel) [6,7]. This channel consists of two subunits: the sulphonylurea receptor (SUR1), which belongs to the ATP-binding cassette superfamily, and the inward rectifier K + channel member KIR6.2. Because this protein complex is a key com- Diabetologia (2001)

RESUMENLa crisis económica y financiera que envuelve al mundo, también afecta la salud, porque los servicios de salud, tal y como se practican hoy dependen cada día más del mercado. En estas circunstancias la salud es convertida en una mercancía que se encarece en la medida en que también lo hacen los productos dedicados al diagnóstico y tratamiento de las enfermedades. Ello genera, a su vez, desigualdad de acceso a la medicina entre grupos de países ricos y países pobres e igualmente entre los ciudadanos al interior de todos aquellos países sometidos a regímenes neoliberales, o constituyen una carga adicional para los países donde los servicios médicos son financiados por la sociedad. El reto de las enfermedades crónicas no transmisibles impone la necesidad de una estrategia proactiva y salutogénica, basada en el fortalecimiento de la salud a través de sus determinantes como contribución no solo a la sostenibilidad y racionalidad de los servicios médicos, sino también al acceso igualitario allí donde se requiera. Un proyecto denominado "Determinantes Individuales y Sociales de la Salud en la Medicina Familiar", se ha iniciado en La Habana Vieja aprovechando la vocación preventiva de la medicina cubana y la preparación de sus médicos en esta práctica y que pretende estudiar la factibilidad y los beneficios de esta estrategia médica.Palabras clave: Determinantes, salud, crisis económica. ABSTRACTThe global financial and economic crisis also affects health because the health services increasingly depend on the market nowadays. Health is considered a

Increased platelet aggregation contributes to vascular risk. D-003, a mixture of high molecular weight sugarcane wax acids, has shown antiplatelet effects in experimental models and healthy volunteers. This randomised, double-blinded, placebo-controlled study investigated the effects of titrated doses of D-003 (5-20 mg/d) on platelet aggregation in hypercholesterolemic patients. After a 4-week baseline phase, 56 patients were randomised to D-003 5 mg/d or placebo. The doses were doubled every 15 days if arachidonic acid (AA)-induced platelet aggregation was not inhibited at least by 15%.AA (0.75 and 1.5 mmol/L) and collagen (1 ?g/mL)-induced platelet aggregation, laboratory and physical safety indicators were assessed at baseline and every 15 days thereafter, when adverse events (AE) were also reported. No significant change of platelet aggregation was found in the placebo group. After 15, 30 and 45 on therapy, D-003 reduced platelet aggregation induced with both AA 0.75 mmol/L (18.1%, 19.0% and 30.3%, respectively) and AA 1.5 mmol/L (17.0%, 16.3% and 22.5%, respectively), and also collagen-induced platelet aggregation (26.6%, 20.8% and 29.4%) (p < 0.01 at days 15 and 30 versus placebo, p < 0.0001 at study completion). The mean inhibition of platelet aggregation with D-003 at day 15, at which all patients had received the lowest dose, was over 15%. Nineteen out of 28 D-003 randomised patients (67.9%) required dose titration to achieve such goal. At trial completion, the mean estimated dose was 11.6 mg/d. D-003 lowered low-density lipoprotein (22.0%), total cholesterol (14.7%) and raised high-density lipoprotein-cholesterol (10.9%) (p < 0.0001 versus placebo). Six patients (2 placebo, 4 D-003) withdrew from the trial, none due to AE. D-003 did not modify the safety indicators with respect to placebo. Four patients (2 placebo, 2 D-003-treated) reported AE: pruritus and increased blood pressure (2 placebo) and rash and polyphagia (2 D-003). In conclusion, D-003 (5-20 mg/d) given as doses titrated every 15 days (5-20 mg/d) inhibited AA- and collagen-induced platelet aggregation in hypercholesterolemic patients and was well tolerated.

D-003 5 and 10 mg/d administered to these older individuals (aged ≥60 years) for 8 weeks inhibited LP of LDL and increased TAS in a dose-dependent manner, while plasma MDA concentration decreased in the patients receiving D-003 10 mg/d only. D-003 was well tolerated at both doses.

No abstract

No abstract

Aim of the study:To investigate the efficacy and safety of Abexol and atorvastatin in patients with non-alcoholic fatty liver disease (NAFLD). Material and methods: The present study had a monocentric, randomized, double-blinded, comparative design with 4 parallel groups -group 1 (Abexol), group 2 (atorvastatin), group 3 (combined therapy) and group 4 (placebo) -to which dietary recommendations and physical activity practice were provided twice a day, for 24 weeks. Significant changes in the ultrasound analysis of the liver were considered a primary efficacy variable. Insulin resistance improvement (HOMA2-IR) was considered as a co-primary efficacy criterion. Significant changes in the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lipid profile variables and the anthropometric variables were evaluated as secondary variables of effectiveness. Statistical analysis of all data was according to the intention to treat method. Results: The groups were statistically homogeneous at baseline conditions. At the end of the 6 months of treatment about 50% of the patients in all groups showed a decrease of at least one degree in echogenicity, while the rest remained the same. There were no significant changes in the values of liver enzymes or anthropometric variables evaluated. Treatment with atorvastatin and combined therapy significantly reduced levels of low-density lipoprotein-cholesterol (LDL-C) and total cholesterol. The treatments were safe and well tolerated, although in the atorvastatin group the number of adverse events reported was greater than in the rest of the groups. Conclusions: Abexol and atorvastatin showed comparable efficacy and safety in patients with NAFLD, with advantages for treatment with atorvastatin with respect to its effects on the lipid profile of these patients.