[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)
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. ]
LAM Extra for General Practicioners
[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. ]
LAM Extra for General Practicioners
[There have been attempts to treat obesity with medicines for nearly 100 years, since the discovery of ephedrine. For decades amphetamine derivates and agents stimulating or inhibiting the release of noradrenaline and dopamine have been applied. However, most of theses drugs had to be gradually withdrawn, due to their adverse effects on the cardiovascular and central nervous system or their sympaticotonic effect. Dexfenfluramine (Isolipan), which was introduced in the 90s, did not have such side effects, but it turned out to potentially cause valvular heart disease. Finally, sibutramin (Reductil) was introduced, which again had to be withdrawn in 2010 due to its hypertensive and cardiovascular side effects. After all, we were left without any appetite-suppressant drugs. Orlistat therapy, (Xenical 120 mg, alli 60 mg - OTC), which inhibits the absorption of fat, can eliminate only 30% of the consumed food's fat content, at the price of gastrointestinal side effects. The latest result of research carried out wordwide is that in 2012 the FDA approved commercial distribution of the selective 5HT2/c serotonin agonist lorcaserin (Belviq), which enhances satiety, in the USA. Unfortunately, in 2013 the EMEA temporarily postponed the lauch of this drug, until certain adverse effects are excluded. For diabetic patients, the GLP-1 agonist exenatid and the GLP-analog liraglutid, which can also reduce body weight, are available in the form of injections. ]
LAM Extra for General Practicioners
[Recognition of the characteristics of arthritis is crucial for making a correct diagnosis. Several aspects of the history and physical examination could help the diagnosis, such as the mode of onset (acute, insidious), duration of symptoms (self-limiting, chronic), number of affected joints (mono-, oligo-, polyarthritis), distribution of joint involvement (symmetrical, asymmetrical), localisation of affected joints (axial, peripherial) and sequence of involvement (additive, migratory, intermittent). Other important aspects for the correct diagnosis are the characteristics of the patient (gender, age, family history) and the presence or absence of extra-articular features of disease. The articular pattern may change with time in the course of a disease, and the single clinical pattern of joint disease may correspond to more than one diagnosis. Evidence of some distinct articular patterns may limit the spectrum of diagnostic options and reduces unnecessary diagnostic testing. The diagnostic process may require the addition of laboratory examination, imaging techniques, and other tests to refine the analysis. In this article, we report a case where joint punction and histological elucidation was necessary to make the correct diagnosis, because a syndrome of acute, destructive sterile arthritis mimicking articular infection might be present in a variety of joint disorders. In this paper, we highlight those characteristics that are distinctive for particular rheumatological disorders, in order to help starting treatment early.. In a substantial number of patients the cause of the diseases remains undetermined. However, a detailed anamnesis and physical examination remain the cornerstone of a diagnostic evaluation. ]
Journal of Nursing Theory and Practice
[On February 19, 2022 We celebrate the 205th anniversary of the birth of the first national matronage (head nurse), Zsuzsanna Kossuth. Zsuzsanna Kossuth was characterized by a high degree of empathy, self-sacrifice, exemplary behaviour, and professionalism. She laid the foundation for the processes of nursing and patient care and performed outstanding professional work throughout his life. She made no distinction between man and man, she only saw the suffering patient, in every soldier and injured. She sacrificed his life for his profession. The Hungarian Nursing Association founded the Zsuzsanna Kossuth commemorative medal in 1998, the year of the 150th anniversary of the War of Independence, which is donated every year on February 19.]
Journal of Nursing Theory and Practice
[Delirium is defined as a disturbance of consciousness and cognition that develops over a short period of time and fluctuates over time. During the last decade, the number of publications dealing with different aspects of delirium have been grown. The key points in most articles are pharmacological prevention and treatment, but because the rise of health care expenditures, all activities, which cost-effectively support the care process, is getting more and more important. The aim of the study: The aim of this research is to review the non-pharmacological prevention and treatment possibilities of delirium in elderly patients undergoing hip surgery. Systematic review, using articles published between 1999 and 2019 in PubMed and Wiley Online Libraries. Non-pharmacologic treatments significantly reduced the incidence (p=0.003–0.045) and duration (p=0.009–0.03) of delirium. The interventions also contributed to decrease the number of episodes (p=0.03), and to make the symptoms lighter. Early mobilisation and adequate fluid and electrolyte intake are key factors in reducing the incidence of delirium. Measuring oxygen saturation and support, appropriate nutrition, effective pain treatment, minimizing drug-interactions, maintaining good sleep and managing sensory dysfunctions have an effect on incidence, duration and severity of delirium.]
Clinical Neuroscience
[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]
Clinical Neuroscience
[Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.]
Lege Artis Medicinae
[There are confirmed COVID-19 infections in Hungary since March 2020. This disease caused by SARS-CoV-2 was initially known not to impose special risk on pregnant women, but probably due to the increasing number of cases and the latest mutations, this is no longer true nowadays. Recent outcomes suggest that pregnancy increases the risk of hospital admission, invasive ventilation and death with higher odds of preterm birth and caesarean section. Seemingly, vertical infection occurs only in a small percentage of all cases. To our best knowledge, 7 expectant mothers lost their life in Hungary thus far due to COVID-19. However, further rigorous studies are needed for a more accurate understanding of pregnancy complications.]
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