[Vitamin D treatment: hormone therapy for patients who need it or simply a supplementation for everyone?]


OCTOBER 04, 2013

LAM KID - 2013;3(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 (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.]



Further articles in this publication


[Parathyroid hormone changes following denosumab treatment in postmenopausal osteoporosis]

BALLA Bernadett


[Evidence-based hydro- and balneotherapy in Hungary - a systematic review and meta-analysis]

BALLA Bernadett


[A simple method to detect urate crystals in formalin-fixed tissue]

BÉLY Miklós, KRUTSAY Miklós

[In our previous study we refuted the thesis that sodium urate crystals are not, or only rarely detectable in formalin-fixed histological samples because they dissolve in the aqueous formalin solution. Our observations indicate that dissolution of urate crystals is primarily caused by haematoxylineosin staining. Undeniably, however, urate crystals are partially dissolved in the aqueous solution of formaldehyde, and thus a small amount of urate deposits may totally dissolve from tissue samples. The aim of the present study was to identify those steps of the staining procedure that are responsible for the dissolution of urate crystals. We found that the dissolution of urate crystals during the course of staining was caused by the combined effects of haematoxylin staining, treatment with 1% aqueous lithium carbonate solution and dehydration with acetone. As the simplest histological method for the detection of urate crystals, we recommend examining unstained sections (mounted with Canada balsam) of formalin-fixed, paraffin-embedded tissue samples in polarised light. According to our previous study, about two thirds of urate crystals remain detectable on unstaied sections, whereas haematoxylin-eosin stained sections of the same tissue samples (derived from patients with gout) did not contain urate crystals. In the samples where urate crystals could be detected in haematoxylin- eosin stained sections using polarised light, the unstained sections contained much more crystals, which shows that dissolution is greatly decreased on unstained sections.]


[A large prospective European cohort study of patients treated with strontium ranelate and followed up over 3 years]

BALLA Bernadett


[Infective sacroiliitis]


[INTRODUCTION - Pyogen infection of the sacroiliac joint occurs rarely in rheumatological practice. Its clinical symptoms are diverse, so the diagnosis is often made late. CASE REPORT - The author presents a case of a 67-year-old woman. The patient did not have any major diseases nor any predisposing factors for infection. Five days after doing hard physical work she felt strong pain irradiating from her lower back to the right lower limb. She was referred to the Department of Neurology with the diagnosis of right lumbar radiculopathy. She was primarily examined for tumours because of her high red blood cell sedimentation rate and CRP level and her inability to walk. The correct diagnosis was set up on the basis of MRI examination: infective sacroiliitis on the right side, which has spreaded to the adjacent tissues. USguided biopsy was unsuccesful, so empiric antibioitic treatment was started. The patient was discharged from hopsital after 35 days and continued clindamycin therapy at home. At control examination 6 month later she did not have any symptoms or complaints and laboratory examinations did not indicate inflammatory activity. MRI examination still showed an extensive oedema. CONCLUSION - Pyogen arthritis should be considered even in the absence of fever, leukocytosis and predisposing factors. By making the correct diagnosis and starting long-term antibiotic therapy in time, joint destruction is preventable and the patient is curable.]

All articles in the issue

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[Irritable bowel syndrome (IBS) is one of the most common gastrointestinal condition, which affects 10-15% of adults in developed countries. Recent observations have raised the possibility that disturbances in the gut microbiota and/or the accompanying low-grade inflammatory state might contribute to the etiology and symptomatology of irritable bowel syndrome. Some studies indicate that small intestinal bacterial overgrowth (SIBO), as confirmed by hydrogen breath tests (HBT), is more prevalent in patients with irritable bowel syndrome than in matched controls without IBS. Although the data are conflicting, this observation has led to the hypothesis that bacterial contamination was the primary cause of IBS. As a consequence of this hypothesis, a lot of therapeutic options have found their way into the armamentarium of those who treat patients with IBS. These agents include probiotics, prebiotics, antibiotics and anti-inflammatory agents. This paper describes the various mechanisms by which changes in the gut flora might contribute to IBS and also discusses the efficacy and safety of antibiotic therapies, especially rifaximin, for treating IBS/SIBO symptoms.]

Journal of Nursing Theory and Practice

[Milestone in the Development of the Primary Health Care]

GUTÁSI Éva, TÓTH Baloghné Edit, LÁZÁR Marsiné Erika

[All health care systems in Europe face similar challenges. In Hungary the most important one is the emigration of health system workers and the increasing demand for care in ageing population. Key areas of the development of primary health care are prevention, public health and health promotion. In The Primary Care Development Model Program the single-handed general practices comprised of one GP, one nurse and one health visitor who were teamed up and formed the GP’s cluster employing various other health professionals (including community nurses). In the last 4 years the new primary care system became a reality for 40,000 inhabitants of four disadvantaged micro-regions of Hungary. The health status of more than 20.000 adults and 8000 children were assessed between 2013 and 2017 in the Modell Programme that uncovered a number of hidden diseases.]

Hypertension and nephrology

[Practical questions of early diagnosis and prevention of cerebrovascular disease are highly important for all internists]

NAGY Judit, SZAPÁRY László, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, VAS Tibor, KOLLER Ákos, WITTMANN István, KISS István, KOMOLY Sámuel

[Stroke is the third most frequent cause of death and the most important cause of disability and dependency worldwide. There are marked differences in the incidence, prevalence and mortality between the populations of Eastern and Western Europe. In Hungary, between 1998-2003, the incidence of stroke was 1,5-2 times higher than in the Western part of the continent. The early recognition of signs and symptoms of TIA and stroke and the urgent transportation of the patient to neurology, preferably to the nearest stroke-center are the key points of successful treatment, reduction of consequences and increased survival. The “time is brain” concept means that the management of TIA/stroke patients should be considered as emergency. This review briefly summarizes the epidemiology, key elements of the etiology, risk factors, up-to-dated diagnosis, primary and secondary prevention and treatment of TIA/stroke to provide information regarding the development of this field targeting the optimal management of TIA/stroke patients.]

Lege Artis Medicinae


RODÉ Magdolna

[Smoking causes a health catastrophy all over the world. Its importance is increasing in the less developed countries. More and more young people (especially women) have started smoking recently. Its devastating effect on women carries on to the next generations. Prevention should already begin in childhood. In Hungary, there is a wide network to assist for those who want to give up smoking - especially in the national network of lung health care clinics. Peer supporters have a prominent role in helping these patients. The market-strategy and publicity campaign of major tobacco producers also deserves intensive attention.]

Hypertension and nephrology

[Blood pressure management for stroke prevention and in the acute stroke. The new guideline of European Society of Hypertension (ESH, 2018), European Society of Cardiology and Hungarian Society of Hypertension (HSH, 2018)]

JENEI Zoltán

[Hypertension is the leading modifiable risk factor for stroke. Its prevalence amongst stroke patient is about 60-70% and the benefit of blood pressure (BP) lowering therapy on stroke risk reduction is well established. However the optimal BP targets for preventing stroke and reducing stroke consequences have been controversial. The new European (ESC/ESH) and Hungarian (HSH) hypertension guideline published in 2018 highlighted the primary and secondary prevention of stroke and the BP management in the acute stroke care as well. According results from ACCORD, SPRINT, HOPE-3, and other metaanalysis the systolic blood pressure (SBP) lowering < 120 mmHg has not favourable effect, thus in hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg. In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). In patients with acute intracerebral haemorrhage careful acute BP lowering with iv. therapy, to <180 mmHg should be considered only in case of SBP ≥ 220 mmHg (IIaB). In patients with acute ischaemic stroke who are eligible for iv. thrombolysis, BP should be carefully lowered and maintained to < 180/105 mmHg for at least the first 24 h after thrombolysis (IIaB). If the patient is not eli gible for lysis and BP ≤ 220/110 mmHg, routine BP lowering drug therapy is not recommended inside 48-72 h (IA). In patients with markedly elevated BP > 220/110 mmHg who do not receive fibrinolysis, drug therapy may be considered, based on clinical judgement, to reduce BP by 15% during the first 24 h after the stroke onset (IIbC). After 72 h of acute stroke in case of hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg (IIaB). In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). If BP < 140/90 mmHg after stroke, the BP lowering should be considered (IIbA). It is recommended to initiate an antihypertensive treatment with combination, preferably single pill combination of renin-angiotensin system blockers plus a calcium channel blocker and/or a thiazide like diuretics (IA). Lowering SBP < 120 mmHg is not recommended due to advers events regardless of age and type of stroke either in primary or secondary stroke prevention.]