Lege Artis Medicinae

[Investigation of vitamin D supply in hospitalized patients]

FATA Emőke1, ÁGOTA Katalin1, HORVÁTH Dóra Eszter1, VIRÁGH Éva1, KÁNYÁSI Mária2, KOVÁCS LÁSZLÓ1,3, BALOGH Dóra2, SCHAFFER Éva4, OLÁH András5, LŐCSEI Zoltán1, SALAMON Antal6, TOLDY Erzsébet2,7

NOVEMBER 20, 2014

Lege Artis Medicinae - 2014;24(10-11)

[Recent studies have shown that adequate vitamin D level is essential in the maintenance of normal immunological status and presumably, it has a remarkable role even in the healing of some diseases. Vitamin D deficiency is a common phenomenon worldwide. Presently, the accepted marker of vitamin-D status is the total-25-hydroxy- D-vitamin [t-25(OH)D], its level depends on the specific (DBP) and aspecific (albumin) binding proteins. As known, the level of binding proteins may change in the hospitalised patients therefore, the presently used marker could not be reliable for the vitamin status in these cases. Our aim was to measure the D-vitamin supply among hospitalized patients, taking into account the level of binding proteins. METHODS - 401 cases (average age 70±14 years) were sorted from Internal Medicine (IM; 68), Intensiv Care Unit (ICU; 58), Traumatology (203 patients suffered hip fracture) and Dialysis Center (72 patients with end stage renal disease). 127 age and sex matched persons with active lifestyle served as control group. We determined t-25(OH)D, DBP, parathormon (PTHi), albumin and the albumin corrected Ca level. The bioavailable and free vitamin fractions and the free index were calculated. RESULTS - Based on the measured t- 25(OH)D, patients have more frequently suboptimal D-vitamin levels, compared to the control group (66% vs. 97%). Severe Dvitamin deficiency occured nearly 8 times more likely (6% vs. 47%) in the hospitalized patients. Chronic renal failure and malignant diseases seem to be significantly negative influencing factors in the metabolism of the vitamin D. The level of DBP, albumin, t-25(OH)D, Bio-25(OH)D was significantly lower in the patients who died. CONCLUSION - In most cases, t-25(OH)D levels show similar results about the vitamin- D supply than other calculated 25(OH)D fraction ,except for the patients of ICU and IM . The t-25(OH)D, the Bio- 25(OH)D, the DBP and the albumin levels seem to be a good prognostic marker of the outcome.]

AFFILIATIONS

  1. Markusovszky Lajos Egyetemi Oktató Kórház, Általános Belgyógyászati Osztály
  2. Markusovszky Lajos, Egyetemi Oktatókórház, Központi Laboratórium
  3. B. Braun Avitum 6. sz. Dialízisközpont
  4. Markusovszky Lajos Egyetemi Oktató Kórház, Központi Aneszteziológiai és Intenzív Betegellátó Osztály
  5. Pécsi Tudományegyetem, Egészségtudományi Kar, Ápolástudományi Intézet
  6. Markusovszky Lajos Egyetemi Oktató Kórház, Baleseti Sebészeti Osztály
  7. Pécsi Tudományegyetem, Egészségtudományi Kar, Diagnosztikai Intézet

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[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]

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[BACKGROUND - The ambulance workers face a lot of mental stress and physical demands in their everyday life. The physical demands can be originated from caring heavy equipment and moving patients. The poor mental health can strengthen physical problems, too. In this study our aim was to detect and compare the musculoskeletal status of ambulance personnel in two regions of Hungary. SAMPLE AND METHODS - On a voluntary base a cross-sectional anonymous, standardized self-fill-in questionnaire (Nordic Musculoskeletal Questionnaire) was used with additional items. All ambulance personnel over 18 years old were involved in the study who worked in direct patient care either in the North-Hungarian or in the West-Hungarian Region of the country. RESULTS - In the regional representative sample N=810 workers answered our questions. Out of them 587 persons (72.5%) reported about some musculoskeletal problem during his lifespan. Most of them suffered from lower back pain (448 persons, 55%), back pain (318 persons, 39%), neck pain (250 persons, 30.9%). Parallel with the aging and with the time spent working for the ambulance service more and more overall discomfort can be detected (p=0.013; p=0.020). Having a second job affected the level and frequency of discomfort negatively (p=0.005). CONCLUSIONS - More than 70% of the ambulance workers experienced musculoskeletal problem during his emergency workers carrier which may worsen the quality of his work and his personal life. To handle the situation primary prevention, screening and possibilities for recreation should be forced among ambulance workers. ]

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[Investigation of vitamin D supply in hospitalized patients]

FATA Emőke, ÁGOTA Katalin, HORVÁTH Dóra Eszter, VIRÁGH Éva, KÁNYÁSI Mária, KOVÁCS LÁSZLÓ, BALOGH Dóra, SCHAFFER Éva, OLÁH András, LŐCSEI Zoltán, SALAMON Antal, TOLDY Erzsébet

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