LAM KID

[About vitamin D - let’s combine!]

HONTVÁRI Lívia

DECEMBER 20, 2013

LAM KID - 2013;3(04)

[Vitamin D deficiency is a worldwide health problem. On the basis of the recommendations of the latest vitamin D consensus conference, we would like to draw attention to the significance of prevention as well as the recognition and treatment of vitamin D deficiency. We mention that some antiporotics designated “prefix” or “combi” are available that may ensure adequate calcium and vitamin D intake, thus improving patient’s adherence.]

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Further articles in this publication

LAM KID

[Once again on adherence - Is it just fashionable or indeed a timely issue?]

VALKUSZ Zsuzsanna

[Nonadherence to pharmacological treat-ment in osteoporosis is a well-recognised problem not only in Hungary but all over the world. As in other chronic diseases, adherence to osteoporosis treatment is poor, which results in serious problems affecting patients as well as health care resources. Low adherence rates consistent-ly result in increased rates of fractures. Some approaches aimed to improve com-plience and persistence, such as extension of dosing intervals, might improve patients’ adherence to therapy. International clinical studies have demonstrated that the number of fractures cannot be reduced without suf-ficient adherence. Improving patient edu-cation, enhancing interactions between health care providers and patients, taking into account patients’ preferences and involving them in treatment decisions may all improve adherence.]

LAM KID

[Our predecessors were right - Closing remarks on the solubility of urate crystals in microscopic specimens]

BÉLY Miklós, KRUTSAY Miklós

[The authors studied the solubility of urate crystals in alcohol, in an 8% aqueous solution of formaldehyde and in acetone, respectively. The urate crystals were least soluble in alcohol. In comparison, the amount of urate crystals decreased in the aqueous solution of formaldehyde, which confirmed the suggestion of our predecessors that tissues suspected to contain urate crystals should be fixed in alcohol. Urate crystals dissolved in greatest amounts in acetone. Acetone is widely used by histological laboratories for dehydration of tissue blocks before embedding them in paraffin, which, in case of fixation in aqueous formaldehyde, contributes to the dissolution of urate crystals. In our earlier studies, we found that dissolution of urate crystals from haematoxylineosin stained sections is caused by the staining of nuclei in haematoxylin, therefore urate crystals are preferably demonstrated in unstained tissue sections.]

LAM KID

[Femoral neck fractures treated with DHLS screws - early results]

KOCSIS András, KÁDAS István, KÁDAS Dániel, HANGODY László

[In Hungary, the treatment approach for medial femoral neck fractures depends on the type of fracture and the overall condition of the patient. An obvious goal is to minimise the most common complications of the applied method, namely avascular necrosis of the head and redisplacement, while maintaining a low-risk and minimally invasive technique. Following the surgical method most commonly used in our country, we combined the double cannullated screws technique with the compressing HeadLess Screw System. This way we succeeded to achieve intraoperative compression, which provides intensified stability while retaining the principles of minimally invasive techniques.]

LAM KID

[MicroRNAs as a new family of hormones]

BOJCSUK Dóra, SIPOS Lilla, BÁLINT Bálint László

[MicroRNA molecules regulate the translation of mRNAs to proteins. In a study published by Maria A. Cortez and her colleagues in Nature in 2011, the authors suggest that miRNAs, known as biomarkers and translation regulators, could be considered as nucleic acid hormones. In this paper we introduce the characteristics of microRNAs that support their function as hormones.]

LAM KID

[Quality of life of patients with osteoporosis in Hungary]

VOKÓ Zoltán, INOTAI András, HORVÁTH CSABA, BORS Katalin, SPEER Gábor, KALÓ Zoltán

[AIM - The aim of our study was to estimate the loss of quality of life due to osteoporotic fractures. We performed a cross-sectional study including 840 patients in 21 centers that specialise in the care of patients with osteoporosis and in acute care of fractures. METHODS - Patients were selected randomly and stratified for the location of and time elapsed since the fracture. Quality of life (QoL) was assessed by the Qualeffo-41 and the EuroQol-5D questionnaires. RESULTS - Patients with morphometric fractures of more than one vertebra had the lowest median EQ-5D index value (0.59). Symptomatic vertebral, hip and arm fractures also considerably decreased QoL. Patients with morphometric fractures of more than one vertebra had the lowest total Qualeffo-41 score. When controlled for age and gender, patients with hip fracture or morphometric vertebral fracture had at least 0.2 less mean utility values than had osteoporotic patients without history of fracture. Patients with more than a oneyear history of hip fracture had QoL scores as low as had patients with an acute fracture. In case of wrist and arm fractures, the acute loss of QoL somewhat decreased with time. CONCLUSION - In conclusion, osteoporotic fractures, especially hip and vertebral fractures result in a significant loss of patients’ quality of life. Our results show that physicians need to pay a close attention to morphometric vertebral fractures, which contribute to a great loss of human capital.]

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Lege Artis Medicinae

[The importance of vitamin D deficiency in practice]

TAKÁCS István

[The effects of vitamin D in bone health have been known since the 1920s. Recently, it has been proven that its role in the body is much more complex. Activated vitamin D is a steroid hormone that regulates transcription of more than 200 human genes through its receptor that is detectable in almost all types of cells. In contrast to the former conceptions, it can be activated not only in the kidneys; moreover, local 1-α-hydroxylation plays a greater role in its extraskeletal effects. Vitamin D deficiency, currently defined as serum levels of <30 ng/ml, is caused by the lack of ‘effective’ sunlight exposition. Thus, vitamin D deficiency is one of the most frequent deficiencies in the developed world that plays a role not only in the development of skeletal conditions but many other diseases, as well. A low vitamin D level causes a reduced calcium absorption, a higher bone remodelling rate and increased bone loss. It also reduces muscle strength and increases the risk of falling. Normal vitamin D status is required for the effectiveness of drugs for osteoporosis treatment; however vitamin D treatment in itself is not effective in osteoporosis. An increasing number of studies show the benefits of vitamin D supplementation and treatment in extraskeletal conditions. Vitamin D plays an important role in the prevention of several auto-immune diseases, infections, cardiovascular diseases, and cancers. Therefore, all UV-B radiation-deprived adults require an intake of vitamin D to maintain a level of >30 ng/ml. Vitamin D3 treatment is safe. The necessary dose can be reliably approximated by the calculation that an incremental consumption of 100 IU/day raises serum vitamin levels by 1,0 ng/ml. Clinical trials suggest that for the vast majority of individuals, a prolonged intake of 10,000 IU/day does not pose any risk.]

Ca&Bone

[Serum 25(OH)-Vitamin D levels and bone metabolism in patients on maintenance hemodialysis]

ALMÁSI Csilla, AMBRUS Csaba, DEÁK György, MARTON Adrienn, BERTA Klára, LAKATOS Péter, SZABÓ András, HORVÁTH CSABA, MUCSI István

[INTRODUCTION - Increasing evidence suggests that 25- hydroxy vitamin D3 (25(OH)D3) may contribute to the bone health of patients with chronic kidney disease.However, there is very little information available on the vitamin D3 status of patients with chronic renal failure. In a cross-sectional study we assessed the association between vitamin D3 status and parathyroid function, bone turnover, bone mass and structure in patients on maintenance haemodialysis. PATIENTS AND METHODS - Sixty-nine patients on maintenance haemodialysis were assessed by bone densitometry (DEXA) and quantitative bone ultrasound. Serum 25-hydroxy vitamin D3 levels and serum markers of bone turnover were simultaneously measured. RESULTS - A high prevalence of potentially significant vitamin D3 deficiency was found in this patient group; 59% of the patients had their 25(OH)D3 vitamin level below 20 nmol/l.There was a significant negative correlation between serum 25(OH)D3 and serum intact parathormone (iPTH) levels (r=-0.231, p<0.05) and this association remained significant after controlling for potential co-variables. Furthermore, a positive correlation was observed between serum 25(OH)D3 concentration and bone mineral density measured at the radius (r=0.424, p<0.01). Finally,we show for the first time that 25(OH)D3 levels are significantly and independently associated with broad band ultrasound attenuation (β =0.237, p<0.05) measured with calcaneal quantitative bone ultrasound in patients with chronic renal failure. CONCLUSION - Vitamin D3 deficiency may contribute to the impaired bone health of patients on maintenance dialysis, therefore, it seems to be warranted regularly monitoring and carefully controlling the D3-vitamin level of these patients.The results also suggest that quantitative bone ultrasound is useful in assessing bone health of patients with chronic renal failure.]

LAM KID

[Comparison of different schemes of vitamin D3 therapy]

SZILI Balázs, BAKOS Bence, KATÓ Karina, KIRSCHNER Gyöngyi, TOBIÁS Bálint, BALLA Bernadett, HORVÁTH Péter

[Vitamin D plays an important role in several pathways in humans. Its relation with several diseases has been previously de­scribed. Vitamin D deficiency affects al­most the full population on temperate zone at the end of the winter. Recommendations on vitamin D supplementation are inconsistent and there are only a few data about the efficacy of cholecalcipherol given not in daily manner. In the present paper, we examine the different administration mo­dalities, and their efficacy in increasing serum vitamin D levels. High doses administered rarely appear to be equally efficient and safe compared to low doses provided frequently.]

LAM Extra for General Practicioners

[About vitamin D - let’s combine!]

HONTVÁRI Lívia

[Vitamin D deficiency is a worldwide health problem. On the basis of the recommendations of the latest vitamin D consensus conference, we would like to draw attention to the significance of prevention as well as the recognition and treatment of vitamin D deficiency. We mention that some antipo-rotics designated “prefix” or “combi” are available that may ensure adequate calcium and vitamin D intake, thus improving patient’s adherence.]

Clinical Neuroscience

Correlation of vitamin D levels with electrophysiological findings and pain in the patients with Carpal Tunnel Syndrome

DEMIRYÜREK Enes Bekir, SENTÜRK Asli

Objective - This study aimed to assess the correlation between vitamin D deficiency and electrophysiological findings and pain level in patients with symptoms of carpal tunnel syndrome (CTS). Patients and method - A total of 131 patients with symptoms of CTS, 70 with vitamin D deficiency and 61 without vitamin D deficiency, were included in the study. Using demographic data and findings from electrophysiological examinations, the patients were divided into two groups based on their vitamin D level (Group 1: <20 ng/ml; Group 2: ≥20 ng/ml). The Boston Carpal Tunnel Syndrome Questionnaire was used to assess their CTS- related pain level. Results - Although the rate of CTS in the patients with a low vitamin D level was found to be high, no statistically significant correlation was observed between low vitamin D level and the frequency and severity of CTS. Additionally, the pain and functional loss ratio induced by CTS was found to be higher in the group with a lower vitamin D level than in the group with normal levels. Conclusion - Low vitamin D levels may increase the severity of CTS symptoms. Treatment of vitamin D deficiency in patients with CTS can play a role in reducing pain and disability.