LAM Extra for General Practicioners

[The impact of vitamin D in infertility and the role in pregnancy and in nursing period]

SPEER Gábor

JUNE 10, 2014

LAM Extra for General Practicioners - 2014;6(03)

[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine, the target vitamin D level is 20 ng/ml, whereas the Endocrine Society recommends 30 ng/m as the minimum target value. These differences show that the two Society have different views on the risk of adverse effects. Screening, however, is not recommended by either society. In this review I summarize the role of the vitamin D supplementation in the prevention of infertility. Also, I suggest the protective effect of the vitamin D during the pregnancy. In my opinion screening program against D hypovitaminosis should be performed in case of infertility and in pregnancy, because data show a protective role of vitamin D against many disease of newborn. ]

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[The medical impact of hepatitis C (HCV) is significant worldwide. The main consequences are chronic hepatic injury, cirrhosis, and hepatocellular carcinoma formation. The estimated global prevalence is 3% with 180 million infected people worldwide. The prevalence <1% in Hungary. The prevalence increased between 1990 and 2005 in East Asia, Western Europe, and West sub-Saharan Africa. There is characteristic geographical distribution of the main HCV genotypes. The mode of transmission can not be identified of 40% of cases. The most frequent transmission is the intravénás drug injection in the developed countries, and unsafe health procedures in developing countries. The sensitive, nucleic acid amplification testing, identification of high-risk groups, development of vaccination would help the HCV prevalence in the future. ]

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LAM Extra for General Practicioners

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LAM Extra for General Practicioners

[VITAMIN D TREATMENT: HORMONE THERAPY FOR PATIENTS WHO NEED IT OR SIMPLY A SUPPLEMENTATION FOR EVERYONE?]

SPEER Gábor

[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]