Lege Artis Medicinae

[The Message of the Invisible Exhibition]

NAGY Zsuzsa

SEPTEMBER 21, 2009

Lege Artis Medicinae - 2009;19(08-09)

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Lege Artis Medicinae

[Do you have to die here?]

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[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.]

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[Up-to-date management of systemic sclerosis]

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[Systemic sclerosis is a chronic autoimmune disease characterized by three major features: widespread fibrosis in the skin and internal organs, a non-inflammatory small vessel obliterative vasculopathy and immunological activation with disease-specific autoantibodies. It is necessary to take a systematic approach to the diagnosis and evaluation of each case in order to provide appropriate treatment. Disease-modifying approaches can be classified according to the underlying pathogenic process. Thus vascular therapies include agents used for Raynaud’s phenomenon, critical digital ischaemia and organ-based vascular complications such as scleroderma renal crisis and pulmonary hypertension. Immunosuppressive drugs are used in lung involvement or rapid skin progression. The results of different anti-fibrotic therapies are controversial. Finally in managing organ-based manifestations and complications a multidisciplinary approach to the therapy is useful with patient education as an integral component of successful management.]

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[The effects of the chronic stress could not be avoided recently. The pathognomic regulation of the neurohormonal events is responsible for the manifestation of diseases such as obesity, cardiovascular diseases, diabetes mellitus type 2, depression, tumors, inflammations, allergy. Two major regulatory systems are involved in the neuroendocrine alterations caused by stress: the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous systems. The chronic activation of the adrenocortical system leads to insulin resistance and obesity associating with vascular, arteriosclerotic and inflammatory symptoms. The revealing of the pathognomic events on time and the enhanced physical activity may provide the effective prevention of these frequent diseases.]

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