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1.
Medicine (Baltimore) ; 99(2): e18338, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914014

RESUMO

BACKGROUND: This study aims to explore the effectiveness of vitamin D for the management of adult patients with gingivitis. METHODS: We will perform a comprehensive search from the following electronic databases: Cochrane Library, PUBMED, EMBASE, AMED, CINAHL, WANGFANG, VIP, CBM, and China National Knowledge Infrastructure. All databases will be searched from their inceptions to the present without language limitation. We will also search for unpublished data to avoid missing more potential studies. Two authors will carry out study selection, data extraction, and methodological quality evaluation, respectively. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: This study will summarize the up-to-date evidence about the anti-inflammatory effect of vitamin D for the management of adult patients with gingivitis through assessing modified gingival, gingival bleeding indices, inflammatory factors, plaque, quality of life, and any adverse events. CONCLUSION: This study may provide helpful evidence of vitamin D for the management of adult patients with gingivitis for clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019156561.


Assuntos
Gengivite/tratamento farmacológico , Gengivite/psicologia , Vitamina D/uso terapêutico , Adulto , China/epidemiologia , Gengivite/patologia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Vitamina D/efeitos adversos
2.
Medicine (Baltimore) ; 99(2): e18661, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914053

RESUMO

RATIONALE: Autism spectrum disorder (ASD) is a common neurodevelopmental disorder caused by complex interactions between genetic and environmental factors. Recent studies suggest that Vitamin D3 or bumetanide therapy may improve the core symptoms of ASD in some individuals. However, there are no guidelines that provide clinicians with evidence-based treatment regimens for the use of these therapies in ASD. PATIENT CONCERNS: A 30-month-old female was referred to our department because she did not respond when her name was called. DIAGNOSIS: The patient was diagnosed with ASD by a team of autism experts according to American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. INTERVENTIONS: The patient was administered Vitamin D3 150,000 IU intramuscularly once a month and Vitamin D3 800 IU orally each day. After 6 months, Vitamin D3 supplementation was discontinued because of lack of effectiveness. Subsequently, oral bumetanide 0.5 mg twice daily was initiated. OUTCOMES: The patient's symptoms remained unchanged after 6 months of Vitamin D3 supplementation, and her serum 25 (OH) D levels had reached 52.4 ng/mL. At the parent's request, Vitamin D3 supplementation was discontinued because of lack of effectiveness. Thereafter, bumetanide was initiated. After 1 month of bumetanide, the patient's Childhood Autism Rating Scale score was 26, which is below the cutoff score for ASD. This case report suggests that Vitamin D3 and bumetanide target different mechanisms in the pathogenesis of ASD. LESSONS: Based on these observations, we discuss three possible scenarios for Vitamin D3 supplementation and propose that bumetanide should be initiated if Vitamin D3 supplementation is ineffective (identifier ChiCTR-CCC-13004498).


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Bumetanida/uso terapêutico , Vitamina D/uso terapêutico , Pré-Escolar , Suplementos Nutricionais , Feminino , Humanos
3.
Rev Med Chil ; 147(5): 658-662, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31859899

RESUMO

Cerebrotendinous xanthomatosis (CTX) is an uncommon autosomal recessive disease caused by deficiency of 27-sterol-hydroxylase that results in an accumulation of cholestanol in the central nervous system, eyes, tendons, and blood vessels. We report a 22-year-old woman with a history of cataract surgery at the age of 14, cholecystectomy due to cholelithiasis at the age of 17 and chronic diarrhea, who presented with a six months period of gait instability and frequent falls. Physical examination revealed a bilateral pyramidal and cerebellar syndrome, with no visible tendon xanthomas. Cerebral magnetic resonance imaging showed an increase of the signal intensity on the T2-weighted images in periventricular cerebral white matter, dentate nuclei and spinal cord. With a high suspicion of CXT, a genetic study was conducted identifying a pathogenic variant in the CYP27A1 gene. There is considerable variation in clinical characteristics and age of onset of this disease, including absence of tendon xanthomas, delaying the diagnosis. Early recognition and chronic chenodeoxycholic acid therapy can improve outcome and quality of life.


Assuntos
Ácido Quenodesoxicólico/uso terapêutico , Xantomatose Cerebrotendinosa/diagnóstico por imagem , Xantomatose Cerebrotendinosa/tratamento farmacológico , Colestanotriol 26-Mono-Oxigenase/genética , Colestanol/sangue , Diagnóstico Precoce , Feminino , Humanos , Imagem por Ressonância Magnética , Vitamina D/uso terapêutico , Xantomatose Cerebrotendinosa/genética , Adulto Jovem
4.
Methodist Debakey Cardiovasc J ; 15(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687100

RESUMO

Vitamin D has traditionally been known as the "bone vitamin". However, a large body of observational data has also linked low concentrations of serum 25-hydroxyvitamin D (25[OH]D), the primary storage form of vitamin D, to an increased risk of incident cardiovascular disease (CVD) and mortality, garnering public excitement about the purported nonskeletal benefits of vitamin D. Despite this, more recent meta-analyses and randomized clinical trials have failed to find a beneficial effect of vitamin D supplements on CVD and cancer outcomes. These findings, along with the lack of consensus on optimal serum 25(OH)D concentrations, have dampened some of the initial enthusiasm for vitamin D supplements. Residual confounding or reverse causation may explain some of the discrepancy between the observational and trial results. At this time, vitamin D supplements should not be prescribed for the primary purpose of CVD prevention. Adding to this complexity is the fact that many adults take vitamin D and calcium supplements together for bone health, and there is some concern (albeit inconclusive) related to calcium use and increased CVD risk. In this light, it may be best to achieve the recommended daily allowances of calcium intake through food and reserve calcium supplementation only for those at risk for calcium intake deficiency, with the smallest dosage needed after dietary modifications have been exhausted. In this review, we discuss vitamin D and calcium supplementation and how they may affect cardiovascular health.


Assuntos
Cálcio/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Suplementos Nutricionais , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Animais , Biomarcadores/sangue , Cálcio/efeitos adversos , Cálcio/deficiência , Cálcio na Dieta/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Suplementos Nutricionais/efeitos adversos , Humanos , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Vitamina D/efeitos adversos , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia
5.
Bone Joint J ; 101-B(11): 1402-1407, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674239

RESUMO

AIMS: Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. PATIENTS AND METHODS: The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants' discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. RESULTS: Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. CONCLUSION: These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402-1407.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/cirurgia , Idoso , Cálcio/uso terapêutico , Estudos de Coortes , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Adesão à Medicação , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Teriparatida/uso terapêutico , Reino Unido , Vitamina D/uso terapêutico
6.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770235

RESUMO

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/mortalidade , Desnutrição/mortalidade , Deficiência de Vitamina D/mortalidade , Deficiência de Vitamina D/terapia , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Fragilidade/sangue , Fragilidade/complicações , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Desnutrição/sangue , Desnutrição/complicações , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Vitaminas/uso terapêutico
7.
Pol Merkur Lekarski ; 47(279): 111-113, 2019 Sep 25.
Artigo em Polonês | MEDLINE | ID: mdl-31557141

RESUMO

It is probably that vitamin D may play an important role in the pathogenesis of Hashimoto's disease. Previous studies have shown a higher incidence of vitamin D deficiencies in patients with Hashimoto's disease compared to healthy subjects. Probably the severity of Hashimoto's disease may affect serum 25-hydroxycholecalciferol (25(OH)D) concentrations. In addition, a negative correlation between serum 25(OH)D concentrations and the level of antithyroid antibodies was observed. Moreover, vitamin D supplementation seems to be effective in reducing the levels of thyroid peroxidase (TPO) antibodies both in patients with deficiency and with normal concentrations of vitamin D. However, further studies are needed to more accurately determine the effect of vitamin D supplementation on the Hashimoto's disease.


Assuntos
Doença de Hashimoto , Deficiência de Vitamina D , Doença de Hashimoto/complicações , Humanos , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
8.
Vnitr Lek ; 65(7-8): 470-474, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487989

RESUMO

INTRODUCTION: Vitamin D (vitD) is a substance with an immunomodulatory effect. Its insufficiency has negative impact also on inflammatory bowel disease (IBD) where it is often present. The recommended daily intake for general population is 600 UI/day (units/day). What is the necessary dose for IBD patients remains unknown. The aim of the study was to verify whether the 2,000 IU/day of vitD is sufficient for maintaining sustained levels in these patients. METHODS: Patients with Crohns disease (CD) or ulcerative colitis (UC) were supplemented orally with 2,000 IU of cholecalciferol daily during winter time. The level of 25-hydroxyvitamin D (25OHD) was established at the beginning of substitution period (October to December) and in Month 4. Demographic data, Ca, P, parathormone levels, dose of vitD used, and patients compliance were observed. RESULTS: 108 patients with CD and UC (71/37) were analysed, out of them 51 females, average age 43.3 ± 16.2 years. The level of 25OHD increased from 60.2 ± 26.5 nmol/l to 68.1 ± 27.1 nmol/l (p < 0.001) during the period with the average substitution dose of vitD 1 858 ± 464 IU/day. 60.2 % of subjects complied with the recommended dosing of vitD. The dose of 1,820 IU vitD/day showed to be sufficient for maintaining sustained levels in the model. No changes of Ca, P serum levels occurred during observation period. CONCLUSIONS: Substitution doses of vitD recommended for general population are insufficient for IBD patients. A dose of up to 2,000/day, which is safe, is necessary to maintain normal levels of 25OHD. Noncompliance with the use of vitD is high.


Assuntos
Doenças Inflamatórias Intestinais , Deficiência de Vitamina D , Vitamina D , Vitaminas , Adulto , Suplementos Nutricionais , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Pessoa de Meia-Idade , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
9.
J Bone Joint Surg Am ; 101(15): 1413-1419, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393435

RESUMO

Worldwide, osteoporosis management is in crisis because of inadequate delivery of care, competing guidelines, and confusing recommendations. Additionally, patients are not readily accepting the diagnosis of poor bone health and often are noncompliant with treatment recommendations. Secondary fracture prevention, through a program such as Own the Bone, has improved the diagnosis and medical management after a fragility fracture. In patients who undergo elective orthopaedic procedures, osteoporosis is common and adversely affects outcomes. Bone health optimization is the process of bone status assessment, identification and correction of metabolic deficits, and initiation of treatment, when appropriate, for skeletal structural deficits. The principles of bone health optimization are similar to those of secondary fracture prevention and can be initiated by all orthopaedic surgeons. Patients who are ≥50 years of age should be assessed for osteoporosis risk and, if they are in a high-risk group, bone density should be measured. All patients should be counseled to consume adequate vitamin D and calcium and to discontinue use of any toxins (e.g., tobacco products and excessive alcohol consumption). Patients who meet the criteria for pharmaceutical therapy for osteoporosis should consider delaying surgery for a minimum of 3 months, if feasible, and begin medication treatment. Orthopaedic surgeons need to assume a greater role in the care of bone health for our patients.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Saúde Global , Programas de Rastreamento/organização & administração , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Absorciometria de Fóton/métodos , Idoso , Osso e Ossos/fisiologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Ortopedia/organização & administração , Osteoporose/epidemiologia , Prevenção Secundária/métodos , Sociedades Médicas/organização & administração , Vitamina D/uso terapêutico
10.
Cas Lek Cesk ; 158(3-4): 138-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31416321

RESUMO

Vitamin D is a lipophilic vitamin possessing a myriad of physiologic functions, including hormonal, in human body. It participates in calcium homeostasis and influences cells differentiation via genome. In the context of the broad research aimed at mapping its physiological effects in the human body it is obvious that it significantly interferes with the whole range of physiological and pathological conditions. This text briefly discusses its contribution to gynecology.


Assuntos
Deficiência de Vitamina D , Vitamina D , Vitaminas , Colecalciferol , Feminino , Ginecologia , Humanos , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
11.
Dtsch Med Wochenschr ; 144(16): 1120-1124, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416103

RESUMO

Adequate intake of vitamin D and calcium are fundamental for the treatment of osteoporosis. A normal vitamin D status is required for optimal intestinal calcium absorption. However, general calcium and vitamin D supplementation is not sufficient for prevention of osteoporotic fractures in persons older than 50 years. Nevertheless, vitamin D deficiency should be avoided and corrected. In particular, parts of the population with increased risk for vitamin D deficiency (immobilized or older individuals, swarthy, migrants) should be tested. Secondary causes of vitamin D deficiency should be identified and treated.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Vitamina D , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/administração & dosagem , Cálcio/uso terapêutico , Suplementos Nutricionais , Humanos , Osteoporose/tratamento farmacológico , Osteoporose/fisiopatologia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Deficiência de Vitamina D
12.
Folia Biol (Praha) ; 65(2): 70-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464183

RESUMO

We investigated the detrimental effects of diabetes on myocardium of pregestational streptozotocin (STZ)-diabetic mother rats and their neonates via evaluations of oxidative redox, inflammatory and apoptotic pathways, also aiming to characterize whether calcitriol and/or pomegranate peel extract confer myocardial protection in hyperglycaemic dams and their foetuses via modulation of the Raf/MEK/ERK cascade. Sixty Sprague-Dawley female rats were randomized into five groups (N = 12): control, diabetic, diabetic treated with calcitriol and/or pomegranate peel extract (PPE), and mated with non-diabetic healthy males. After confirmation of pregnancy, treatments were kept until gestational day (E-18). Serum and cardiac tissues of mothers and foetuses were collected and processed for biochemical, histopathological, and molecular assessments. We observed that, compared to the control, diabetic mothers showed dramatically increased hyperglycaemia and hyperlipidaemia associated with decreased myocardial functions and disrupted maternal performance. Also, diabetic mothers and their neonates exhibited elevated levels of myocardial injury (troponin I, endothelin 1, creatine kinase-MB, lactate dehydrogenase), with increased pro-inflammatory cytokines (interleukin 1, interleukin 1ß, transforming growth factor ß) and oxidative redox. Concurrently, the MAPK pathway was significantly down-regulated with increased myocardial apoptotic activity. Furthermore, mRNA expression of angiogenic and fibrotic markers was significantly increased. Paradoxically, calcitriol and/or pomegranate peel extract alleviated these diabetic myocardial insults and normalized the aforementioned assayed parameters. Our findings hypothesized that calcitriol and/or pomegranate peel extract exerted cardioameliorative impacts due to their unique anti-oxidative and anti-inflammatory properties, and thus may be a promising treatment that directly targets the secondary myocardial complications of diabetes in dams and their offspring.


Assuntos
Apoptose , Calcitriol/uso terapêutico , Cardiomiopatias/tratamento farmacológico , Diabetes Mellitus Experimental/tratamento farmacológico , Sistema de Sinalização das MAP Quinases , Extratos Vegetais/uso terapêutico , /química , Animais , Animais Recém-Nascidos , Apoptose/efeitos dos fármacos , Biomarcadores/metabolismo , Cardiomiopatias/complicações , Cardiomiopatias/patologia , Caspase 3/metabolismo , Citocinas/metabolismo , Dano ao DNA , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/patologia , Feminino , Feto/patologia , Fibrose , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , Miocárdio/patologia , Neovascularização Fisiológica/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Fosforilação/efeitos dos fármacos , Ratos Sprague-Dawley , Reprodução , Espectroscopia de Infravermelho com Transformada de Fourier , Estreptozocina , Regulação para Cima/efeitos dos fármacos , Vitamina D/farmacologia , Vitamina D/uso terapêutico , Quinases raf/metabolismo
13.
J Surg Res ; 243: 460-468, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377485

RESUMO

INTRODUCTION: Neointimal hyperplasia (NIH) and restenosis after percutaneous transluminal coronary angioplasty (PTCA) and intravascular stenting remain a problem on a long-term basis by causing endothelial denudation and damage to the intima and media. Vascular sterile inflammation has been attributed to the formation of NIH. Cathepsin L (CTSL), a lysosome protease, is associated with diet-induced atherogenesis. Vitamin D regulates the actions and regulatory effects of proteases and protease inhibitors in different cell types. Objectives of this study are to evaluate the modulatory effect of vitamin D on CTSL activity in post-PTCA coronary arteries of atherosclerotic swine. METHODS: Yucatan microswine were fed with high-cholesterol atherosclerotic diets. The swine were stratified to receive three diets: (1) vitamin D-deficient diet, (2) vitamin D-sufficient diet, and (3) vitamin D-supplement diet. After 6 mo, PTCA was performed in the left circumflex coronary artery (LCx). After 1 y, angiography and optical coherence tomography imaging were performed, and swine was euthanized. Coronary arteries were embedded in paraffin. Tissue sections were stained with hematoxylin and eosin. Expression of Ki67 and CTSL were evaluated by immunofluorescence. RESULTS: Increased number of Ki67 + cells were observed in the postangioplasty LCx in vitamin D-deficient compared with vitamin D-sufficient or vitamin D-supplemented swine. Notably, the expression of CTSL was significantly increased in postangioplasty LCx of vitamin D-deficient swine compared with the vitamin D-sufficient or vitamin D-supplemented animal groups. CONCLUSIONS: Increased expression of CTSL correlates with the formation of NIH in the PTCA-injured coronary arteries. However, in the presence of sufficient or supplemented levels of vitamin D in the blood, CTSL expression was significantly reduced.


Assuntos
Catepsina L/metabolismo , Vasos Coronários/efeitos dos fármacos , Neointima/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/uso terapêutico , Angioplastia Coronária com Balão/efeitos adversos , Animais , Aterosclerose/terapia , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Vasos Coronários/metabolismo , Suplementos Nutricionais , Feminino , Fator de Crescimento Insulin-Like I , Miócitos de Músculo Liso/metabolismo , Neointima/metabolismo , Neointima/prevenção & controle , Suínos , Tomografia de Coerência Óptica , Fator de Necrose Tumoral alfa/metabolismo , Vitamina D/farmacologia , Deficiência de Vitamina D/metabolismo , Deficiência de Vitamina D/prevenção & controle
15.
Actual. osteol ; 15(2): 94-102, mayo - ago. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048478

RESUMO

El propósito de la terapia en el desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica (IRC) consiste en restaurar el balance mineral, y, en la osteoporosis, mantener o aumentar la masa ósea. Ambas terapias tratan de evitar la fractura ósea. La mayoría de los osteoactivos están contraindicados en la insuficiencia renal crónica avanzada (estadios 4 y 5), y las terapias son empíricas. Algunos autores opinan que sin anomalías bioquímicas del desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica avanzada se podría intentar el tratamiento estándar para la osteoporosis. Antes de intentar la terapia osteoactiva se debe corregir el desorden mineral óseo que pudiera presentarse asociado a la IRC, y en la indicación del tipo de osteoactivo se sugiere seleccionar al paciente según su estado óseo. Se aconseja que la administración de los antirresortivos se realice a dosis menores con respecto a los que tienen mejor función renal junto con aportes adecuados de calcio y vitamina D, antes y durante el tratamiento para prevenir el riesgo de severas hipocalcemias y un efecto óseo excesivo. Se presenta el caso clínico de una mujer de 65 años, con diagnóstico de osteoporosis de etiología multifactorial, fractura de pelvis, múltiples fracturas vertebrales e insuficiencia renal crónica avanzada, entre otras comorbilidades, y probable enfermedad ósea adinámica. Recibió inicialmente terapia con teriparatide y luego con denosumab, complicándose con hipocalcemia asintomática. (AU)


The purpose of therapy for the bone mineral metabolism disorder associated with chronic kidney disease is to restore the mineral balance; and to maintain or increase bone mass in osteoporosis. The goal of both types of therapy is to avoid bone fractures. Most antiosteoporotic drugs are contraindicated in advanced chronic renal failure (CRF) stages 4 and 5, and the therapies are empirical. Some authors believe that without biochemical abnormalities of the mineral bone metabolism disorder associated with advanced chronic kidney disease, standard treatment for osteoporosis could be attempted. Before attempting antiosteoporotic therapy, the bone mineral disorder that may be associated with CRF must be corrected, and in the indication of the type drug it is suggested that the patient be selected according to their bone status. It is advised that the administration of anti-resorptives be performed at lower doses in individuals with poor renal function compared to those with better renal function together with adequate calcium and vitamin D, before and during treatment to prevent the risk of severe hypocalcemia, and an excessive bone effect. We present the clinical case of a 65-year-old woman with a diagnosis of osteoporosis of multifactorial etiology, pelvic fracture, multiple vertebral fractures and advanced chronic renal failure, among other comorbidities and probable adynamic bone disease. The patient received initial therapy with teriparatide and followed by denosumab administration and exhibited asymptomatic hypocalcemia. (AU)


Assuntos
Humanos , Feminino , Idoso , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Fraturas Ósseas/prevenção & controle , Osteoporose/terapia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/complicações , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Cálcio/administração & dosagem , Cálcio/uso terapêutico , Alendronato/uso terapêutico , Teriparatida/administração & dosagem , Teriparatida/efeitos adversos , Teriparatida/uso terapêutico , Difosfonatos/administração & dosagem , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Cinacalcete/uso terapêutico , Ácido Risedrônico/uso terapêutico , Denosumab/administração & dosagem , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Hipocalcemia/prevenção & controle
16.
N Z Med J ; 132(1499): 72-75, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31352477

RESUMO

Iron-induced hypophosphatemia represents an increasingly recognised complication of iron infusion. A 34-year-old woman presented for surgical management of her colorectal cancer. Post-operative blood tests revealed severe hypophosphatemia, resistant to oral phosphate supplementation and large volumes of intravenous phosphate replacement. Further questioning and biochemical investigation led to the recognition of iron-induced hypophosphatemia as a contributory cause, secondary to iron infusion administered as part of pre-operative optimisation. Early consideration, diagnosis and management of this complication has the potential to reduce fluid burden associated with intravenous phosphate supplementation and optimise post-operative care.


Assuntos
Cirurgia Colorretal , Hipofosfatemia/induzido quimicamente , Ferro/efeitos adversos , Adulto , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/etiologia , Calcitriol/uso terapêutico , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Feminino , Humanos , Hipofosfatemia/tratamento farmacológico , Ferro/uso terapêutico , Vitamina D/análogos & derivados , Vitamina D/uso terapêutico
17.
Medicina (Kaunas) ; 55(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31336940

RESUMO

Background and Objectives: The controversy about the impact of vitamin D supplementation on weight loss treatment was observed in several randomized controlled trials (RCTs). This meta-analysis investigates the effects of vitamin D supplementation (cholecalciferol or ergocalciferol) on weight loss through holistic measurements of Body Mass Index (BMI), weight and waist circumference. Materials and Methods: Google Scholar, WOS, PubMed and Scopus were explored to collect relevant studies. The selected articles focused on vitamin D supplementation in overweight and obese individuals with different conditions. Eleven RCTs were included into this meta-analysis with a total of 947 subjects, with a mean of the follow-up from 1 to 12 months and different vitamin D interventions (from 25,000 to 600,000 IU/monthly of cholecalciferol). Results: The meta-analyzed mean differences for random effects showed that cholecalciferol supplementation deceases the BMI by -0.32 kg/m2 (CI95% -0.52, -0.12 kg/m2, p = 0.002) and the waist circumference by -1.42 cm (CI95% -2.41, -0.42 cm, p = 0.005), but does not statistically affect weight loss -0.43 kg (CI95% -1.05, +0.19 kg, p = 0.17). Conclusions: This meta-analysis lays the foundation for defining the potential clinical efficacy of vitamin D supplementation as a potential therapeutic option for weight loss programs, but further studies are needed to confirm the validity of these findings and delineate potential underlying mechanisms.


Assuntos
Vitamina D/farmacologia , Perda de Peso/efeitos dos fármacos , Índice de Massa Corporal , Suplementos Nutricionais , Humanos , Obesidade/psicologia , Obesidade/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/psicologia , Programas de Redução de Peso/métodos , Programas de Redução de Peso/normas
18.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296627

RESUMO

We present a case of transient osteoporosis of the hip in a 38-year-old recreational trail runner. Shortly after a trail running competition, he developed acute hip pain, functional disability and an antalgic gait. Diagnosis was made with MRI showing bone marrow oedema, plain radiographs demonstrating osseous demineralisation and bone scintigraphy showing uniform radioactive uptake. Treatment included off-loading of the anatomical site for 6 months until symptom resolution, analgaesia, Vitamin D, bisphosphonates and pulsed electromagnetic field therapy. He recovered fully and returned to running activities 8 months after initial presentation. Transient osteoporosis of the hip is rare but benign, self-limiting condition; however, awareness and exact diagnosis are important as runners often present with hip pain and other more serious pathologies such as avascular necrosis or stress fractures need to be excluded.


Assuntos
Dor Aguda/complicações , Artralgia/complicações , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Corrida , Dor Aguda/terapia , Adulto , Analgesia , Artralgia/terapia , Conservadores da Densidade Óssea/uso terapêutico , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/terapia , Ácido Clodrônico/uso terapêutico , Edema/complicações , Edema/diagnóstico por imagem , Edema/terapia , Radiação Eletromagnética , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoporose/terapia , Radiografia , Cintilografia , Vitamina D/uso terapêutico
19.
Autoimmun Rev ; 18(9): 102350, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323357

RESUMO

Vitamin D plays a key role in in calcium homeostasis and, thus, provides an important support in bone growth by aiding in the mineralization of the collagen matrix. However, vitamin D performs various immunomodulatory, anti-inflammatory, antioxidant and anti-fibrotic actions. Autoimmune diseases result from an aberrant activation of the immune system, whereby the immune response is directed against harmless self-antigens. Does vitamin D play a role in the pathophysiology of autoimmune diseases? And, if so, what is its role? In the last decade, researchers' interest in vitamin D and its correlations with autoimmune diseases has considerably increased. We conducted a literature review, covering the period January 1, 2009 through March 30, 2019, in PubMed. We analyzed more than 130 studies in order to find a correlation between vitamin D levels and its effect upon several autoimmune diseases. The analysis demonstrated an inverse association between vitamin D and the development of several autoimmune diseases, such as SLE, thyrotoxicosis, type 1 DM, MS, iridocyclitis, Crohn's disease, ulcerative colitis, psoriasis vulgaris, seropositive RA, polymyalgia rheumatica. International multicenter study could allow us to confirm the data already present in the literature in the single clinical studies and to evaluate when to effectively supplement vitamin D in patients who do not take corticosteroids.


Assuntos
Doenças Autoimunes/etiologia , Doenças Autoimunes/terapia , Vitamina D/fisiologia , Doenças Autoimunes/sangue , Doenças Autoimunes/epidemiologia , Comorbidade , Suplementos Nutricionais , Prática Clínica Baseada em Evidências/tendências , Humanos , Sistema Imunitário/efeitos dos fármacos , Vitamina D/farmacologia , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/imunologia
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