Bothra, Meenakshi; Gupta, Nandita; Jain, Vandana
The treatment practices for vitamin D deficiency rickets are highly variable. Though a single intramuscular (IM) megadose of vitamin D is economical, and ensures good compliance, it poses the risk of hypervitaminosis D. This observational study was conducted to assess the duration of effect and safety of single IM megadose of cholecalciferol in the treatment of vitamin D deficiency rickets. Children younger than 14 years with rickets were enrolled. Baseline investigations included radiograph of wrists and estimation of serum calcium, phosphate, alkaline phosphatase (ALP), 25(OH) vitamin D and parathormone (PTH) levels. All children received a single IM megadose of vitamin D3. Biochemical parameters were re-evaluated at 1.5, 3 and 6 months after the megadose and the values were compared to the baseline. We enrolled 21 children, out of which nine remained under active follow-up till 6 months. Radiological evidence of rickets was present in all 21 children, 14 had hypocalcemia at the time of presentation. After IM cholecalciferol megadose, median 25 hydroxy vitamin D [25(OH)D] level remained significantly more than the baseline till 6 months after the megadose. At 1.5 months after the vitamin D megadose, three (30%) of the children were found to develop toxic levels of vitamin D (>150 ng/mL), although none had hypercalcemia or any clinical manifestation of vitamin D toxicity. At 3 months and 6 months after the megadose, 25(OH)D levels remained in the sufficient range (20-100 ng/mL) in seven out of the eight children who came for follow-up. A single IM megadose of vitamin D may be effective in significantly increasing the 25(OH)D levels for at least 6 months in children with rickets, but elevation of 25(OH)D to toxic range raises concern regarding its safety.
Full Text Available A female in the Netherlands with severe autoimmune hemolytic anemia (AIHA was treated with conventional corticosteroid (2 mg/kg/d in divided doses and blood transfusions for 18 months without improvement. The presented patient responded to megadose methylprednisolone (MDMP 30 mg/kg/d for 3 d, followed by 20 mg/kg for 4 d, and subsequently 10, 5, 2, and 1 mg/kg/d each for 1 week.
Full Text Available Although uncommon, traumatic optic neuropathy (TON is an important cause of visual loss. Different therapeutic approaches including different dosages of steroids, surgical decompression of optic canal and observation alone have been suggested but there has been no conclusive evidence to establish a standard approach to this devastating cause of visual loss. To determine the effectiveness of intravenous (IV steroids in the treatment of these patients, the medical records of patients with TON, including one bilateral case, treated with IV steroids were reviewed. Twenty-eight patients (22 males, 6 females with mean age of 24.1 (11 to 41 years were enrolled. All patients had received 30 mg/kg loading dose of methylprednisolone succinate followed by 5.4 mg/kg/ hour for 48 hours. Visual acuity (VA was improved by ≥ 1 line in 8 eyes (28.6% immediately after treatment and in 10 eyes (37% after 3 months; however, most of them (6 and 8, respectively were in the range of initial VA of no light perception to hand motion. After adjustment for the baseline VA, these improvements in visual acuities were not considered significant. Neither different orbital fractures, nor various extraocular muscle palsies had any significant effect on the prognosis of ultimate VA. Regarding the natural course of TON, this investigation showed that IV megadose steroids had no clear benefit on the visual outcome of patients with TON.
Accurate immunoassays measuring minute quantities of hormones are the cornerstone of the practice of endocrinology. Despite tremendous advances in this field, novel pitfalls in these tests emerge from time to time. Oral biotin can interfere with immunoassays of several hormones. The purpose of this report is to relate an extreme case of such interference. A patient with progressive multiple sclerosis was found to have extremely elevated free thyroxine, triiodothyronine, and suppressed thyrotropin (TSH) levels. His TSH receptor binding inhibiting antibody level was also elevated. This constellation of laboratory findings suggested a diagnosis of severe Graves' disease. All of the assays yielding abnormal results employed the biotin-streptavidin affinity in their design. The patient had no symptoms of hyperthyroidism, and detailed review of his medications revealed intake of megadoses of biotin. Temporary discontinuation of biotin treatment resulted in complete resolution of the biochemical abnormalities. Non-physiologic biotin supplementation may interfere with several immunoassays, including thyroid hormones, TSH, thyroglobulin, and TSH receptor binding inhibiting antibody, leading to erroneous diagnoses. Questioning for biotin intake should be part of the evaluation for patients undergoing endocrine tests. Interruption of biotin supplementation for at least two days prior to biotin-sensitive tests should be sufficient to avoid major misdiagnoses.
Byun, Jung-Ick; Chu, Kon; Sunwoo, Jun-Sang; Moon, Jangsup; Kim, Tae-Joon; Lim, Jung-Ah; Jun, Jin-Sun; Lee, Han Sang; Lee, Woo-Jin; Lee, Doo Young; Jeon, Daejong; Lee, Soon-Tae; Jung, Keun-Hwa; Jung, Ki-Young; Lee, Sang Kun
To evaluate the efficacy and safety of mega-dose phenobarbital (MDPB; enteral or parenteral phenobarbital >10 mg/kg/day) for treating super-refractory status epilepticus (SRSE; continuous or recurrent status epilepticus for ≥24 hours after the onset of continuous anaesthetic treatment) in adult patients. Adult patients with SRSE who were treated with MDPB in our institution from March 2005 to September 2014 were reviewed. We collected data on basic demographics, clinical features, functional status, anticonvulsant treatment, and possible adverse events. SRSE outcome was divided into six categories: successful therapy, initial failure, breakthrough seizures, withdrawal seizures, intolerable side effects, and death during treatment. Ten adult patients with SRSE received MDPB. Median age at seizure onset was 38 years (range: 18-59), and half were male. All patients had no history of seizures and had symptoms suggestive of viral encephalitis. Median duration of status epilepticus was 17.5 days (range: 6-60) and anaesthetics were used for a median of 14.0 days (range: 2-54) before MDPB. Successful control of SRSE was achieved in half of the patients, however, only one of ten patients was able to fully recover at discharge. Median duration of the MDPB was 45.5 days and the maximum serum phenobarbital level reached a median of 151.5 μg/ml. Patients with successful MDPB therapy had normal brain imaging (80% vs. 0%; p=0.048) and better functional outcome at discharge and after three months of follow-up. Infection was the most critical complication, along with cardiorespiratory depression. MDPB is a therapeutic option for control of SRSE when other choices are exhausted.
Hernández Pardines, F; Tapia-Quijada, H; Hueso-Abancens, J R
The case is described of a patient who had a sudden loss of vision in her right eye after glaucoma surgery. A diagnosis of retinal toxicity due to tobramycin (an aminoglycoside) was reached, which was characterised by retinal whitening with a red cherry stain, macular oedema, and vasculitis that progressed to papillary and macular atrophy with arteriolar sclerosis. Given the severity of symptoms an early attempt was made with megadoses of steroids and an intravitreal dexamethasone implant (Ozurdex®, Allergan S.A.), without response. Aminoglycoside toxicity is a rare, idiosyncratic, very serious complication for which there is no effective treatment. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Effect of vitamin D3 supplementation and influence of BsmI polymorphism of the VDR gene of the inflammatory profile and oxidative stress in elderly women with vitamin D insufficiency: Vitamin D3 megadose reduces inflammatory markers.
de Medeiros Cavalcante, Isa Gabriela; Silva, Alexandre Sérgio; Costa, Maria José Carvalho; Persuhn, Darlene Camati; Issa, Chahira Taha Mahd Ibrahim; Issa, ChariraTahaMad Ibraim; de Luna Freire, Tiago Lima; da Conceição Rodrigues Gonçalves, Maria
This study aimed to evaluate the effect of vitamin D3 megadose supplementation and influence of BsmI polymorphism in the VDR gene on the inflammatory profile and oxidative stress in elderly women with vitamin D deficiency. A double blind, randomized, placebo-controlled trial was conducted with 40 elderly women (aged 68±6 years) diagnosed with vitamin D insufficiency (24.7±3.1 ng/mL). Participants were distributed into a supplementation group that received 200,000 IU of vitamin D3 (SG; n=20) and a placebo group (PG; n=20). Blood samples were collected at baseline and after intervention to analyse the 25(OH)D, parathyroid hormone, serum calcium, ultra-sensitive C-reactive protein (us-CRP), alpha 1-acid glycoprotein (AGP-A), total antioxidant capacity (TAC), and malondialdehyde (MDA) levels, as well as the renal and hepatic function, and genotyping was performed for BsmI polymorphism. Four weeks after supplementation, elderly women in the SG group showed a significant increase in the serum concentration of 25(OH)D (25.29±2.8 to 31.48±6.0; p=0.0001), which was followed by increased TAC (65.25±15.66 to 71.83±10.71; p=0.03) and decreased serum PTH (46.32±13.2 to 35.45±11.0; p=0.009), us-CRP (0.38±0.3 to 0.19±0.1; p=0.007) and AGP-A levels (75.3±15.4 to 61.1±5.9; p=0.005). Changes in BP, ANAC and MDA were not observed. The 25(OH)D and PTH, us-CRP and AGP-A levels of participants with the BB/Bb genotype were more responsive to supplementation, but their other markers did not change. Supplementation with a vitamin D3 megadose reduced inflammatory markers and increased the total antioxidant capacity in elderly women with vitamin D insufficiency. The 25(OH)D, PTH, us-CRP and AGP-A levels of elderly patients with the BB/Bb genotype were more responsive to supplementation compared with those with the bb genotype. Copyright © 2015 Elsevier Inc. All rights reserved.
Assis Ana Marlúcia Oliveira
Full Text Available Um estudo de seguimento foi desenvolvido em duas localidades do semi-árido do estado da Bahia, Nordeste do Brasil, com o objetivo de identificar a ocorrência e a natureza de possíveis efeitos adversos agudos em conseqüência da suplementação com megadoses de vitamina A (100.000 e 200.000 UI oferecida junto com imunização em massa, a crianças de seis a 59 meses de idade. A amostra do estudo foi composta por 852 crianças; 416 do município de Teofilândia integraram o grupo que recebeu a vitamina A com as vacinas e 436 crianças de Santa Bárbara foram incluídas no grupo que recebeu somente a vacina. Nas 24 horas que antecederam a vacinação, as crianças dos dois grupos referiram similar freqüência de diarréia, febre e vômito; a anorexia foi mais prevalente em Teofilândia e persistiu durante todo o período de seguimento. Os resultados sugerem que nenhum efeito adverso agudo, em especial diarréia, vômito, febre ou anorexia, esteve associado à ingestão da vitamina A combinada à vacinação em massa, particularmente à Sabin, DPT e anti-sarampo.
Tolerância à aplicação de megadoses de vitamina A associada à vacinação em crianças no Nordeste do Brasil Tolerance of vitamin A application associated with mass immunization of children in Northeast Brazil
Ana Marlúcia Oliveira Assis
Full Text Available Um estudo de seguimento foi desenvolvido em duas localidades do semi-árido do estado da Bahia, Nordeste do Brasil, com o objetivo de identificar a ocorrência e a natureza de possíveis efeitos adversos agudos em conseqüência da suplementação com megadoses de vitamina A (100.000 e 200.000 UI oferecida junto com imunização em massa, a crianças de seis a 59 meses de idade. A amostra do estudo foi composta por 852 crianças; 416 do município de Teofilândia integraram o grupo que recebeu a vitamina A com as vacinas e 436 crianças de Santa Bárbara foram incluídas no grupo que recebeu somente a vacina. Nas 24 horas que antecederam a vacinação, as crianças dos dois grupos referiram similar freqüência de diarréia, febre e vômito; a anorexia foi mais prevalente em Teofilândia e persistiu durante todo o período de seguimento. Os resultados sugerem que nenhum efeito adverso agudo, em especial diarréia, vômito, febre ou anorexia, esteve associado à ingestão da vitamina A combinada à vacinação em massa, particularmente à Sabin, DPT e anti-sarampo.A follow-up study was carried out in two localities in the semi-arid region of the State of Bahia, Northeast Brazil, with the aim of identifying the occurrence and nature of possible acute side effects subsequent to vitamin A megadose supplement given together with mass immunization in children 6-59 months old. The sample consisted of 852 children, 416 from the county of Teofilandia who received vitamin A together with vaccines and 436 from Santa Barbara, who received only vaccine. In the 24 hours before immunization, children from both groups had similar incidences of diarrhea, fever, and vomiting. Anorexia was more prevalent in Teofilandia and remained so throughout the study period. The results suggest that acute side effects like diarrhea, vomiting, fever, or anorexia were not associated with the vitamin A dosage given with mass OPV, DPT, and measles immunization.
Full Text Available Aim: To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone on visual recovery and evaluate their side-effects for the treatment of optic neuritis. Materials and Methods: Prospective, randomized case-controlled study including 21 patients of acute optic neuritis presenting within eight days of onset and with visual acuity less then 20/60 in the affected eye who were randomly divided into two groups. Group I received intravenous dexamethasone 200 mg once daily for three days and Group II received intravenous methylprednisolone 250 mg/six-hourly for three days followed by oral prednisolone for 11 days. Parameters tested were pupillary reactions, visual acuity, fundus findings, color vision, contrast sensitivity, Goldmann visual fields and biochemical investigations for all patients at presentation and follow-up. Results: Both groups were age and sex-matched. LOGMAR visual acuity at presentation was 1.10 ± 0.52 in Group I and 1.52 ± 0.43 in Group II. On day 90 of steroid therapy, visual acuity improved to 0.28 ± 0.33 in Group I and 0.36 ± 0.41 in Group II ( P =0.59. At three months there was no statistically significant difference in the color vision, contrast sensitivity, stereoacuity, Goldman fields and the amplitude and latency of visually evoked response between the two groups. The concentration of vitamin C, glucose, sodium, potassium, urea and creatinine were within the reported normal limits. Conclusion: Intravenous dexamethasone is an effective treatment for optic neuritis. However, larger studies are required to establish it as a safe, inexpensive and effective modality for the treatment of optic neuritis.
Knudsen, Mikkel Malham; Jørgensen, S. P.; Lauridsen, A. L.
Objective: The goal of this study was to examine the effects of a single oral dose of 300 000 international units of either ergocalciferol (D2) or cholecalciferol (D3) on the plasma levels of 25-hydroxyvitamin D in patients with alcoholic liver cirrhosis. Methods: Inclusion criteria for this stud...
Hansen, Phyllis, Comp.
Vitamin C is an important vitamin. Since its discovery in 1937, it has been acclaimed as a possible preventive or cure for the common cold, the flu, and even cancer. Others believe vitamin C is harmful if taken in megadoses. As the controversy continues, facts and research results become increasingly important. This bibliography, which provides…
Grady, Denise; Siwolop, Sana
Presents seven dietary guidelines on ways to reduce the risk of contracting cancer, discussing scientific evidence supporting the guidelines. Includes a list of foods indicating possible role in cancer, sources, recommendations related to amount/frequency of intake, and hazards of megadoses. Foods cited include fats, vitamins, alcohol, caffeine,…
Smedslund, Geir; Berg, Rigmor C.
ENGLISH: There is considerable scientific disagreement about the possible effects of dietary supplements on mental health and illness. Do dietary supplements (possibly in megadoses) have an effect on symptoms and consequences of schizophrenia? We critically appraised randomized controlled trials about supplemental vitamins, fatty acids and other dietary supplements given to people diagnosed with schizophrenia. The primary outcome was symptoms of schizophrenia. We evaluated the evidence to be ...
Niemiec, T.; Sawosz, E.; Chwalibog, André
Four grups of twenty growing Wistar rats were irradiated with either UV, IR, UV+IR light or were not irradiated (control). Ten rats from each group received a diet supplemented with 0.6% of L-ascorbic acid. The effects of the mega-dose of vitamin C were evaluated by changes in the antioxidative....../oxidative status. UV and IR radiation promoted oxidative DNA degradation in rat livers and supplementation with ascorbic acid strengthened the prooxidative effects on DNA oxidation in rats irradiated with UV or IR light. Vitamin C also increased the tiobarbituric acid reactive substances (TBARS) concentration...
Atalay, Mustafa; Lappalainen, Jani; Sen, Chandan K
Physical exercise induces oxidative stress and tissue damage. Although a basal level of reactive oxygen species (ROS) is required to drive redox signaling and numerous physiologic processes, excess ROS during exercise may have adverse implications on health and performance. Antioxidant nutrients may be helpful in that regard. Caution should be exercised against excess antioxidant supplements, however. This article presents a digest for sports practitioners. The following three recommendations are made: 1) it is important to determine the individual antioxidant need of each athlete performing a specific sport; 2) multinutrient preparations, as opposed to megadoses of any single form of nutrient, seem to be a more prudent path to choose; and 3) for outcomes of antioxidant supplementation, performance should not be the only criteria. Overall well being of the athlete, faster recovery, and minimization of injury time could all be affected by antioxidant therapy.
Niemiec, T.; Sawosz, E.; Chwalibog, André
The objective of this study was to determine the effects of mega-doses of vitamin C (0.3, 0.6 and 0.9% of diet) as a dietary supplement for rats on selected indices of the antioxidative/oxidative state in 40 growing Wistar rats (4x10). It was found that L-ascorbic acid and Total Antioxidative State...... (TAS) in plasma did not increase with increasing vitamin C supply. The results indicate that high doses of L-ascorbic acid (0.3 and 0.9 but not 0.6%) increased the concentration of this antioxidant in plasma. Supplementation of vitamin C above 0.3% to the diets had pro-oxidative effects on lipid...... structures, while application of 0.9% promoted oxidative degradation of rat livers....
Full Text Available Interest in mismatched transplantation arises from the fact that a suitable one-haplotype mismatched donor is immediately available for virtually all patients, particularly for those who urgently need an allogenic transplant. Work on one haplotype-mismatched transplants has been proceeding for over 20 years all over the world and novel transplant techniques have been developed. Some centres have focused on the conditioning regimens and post transplant immune suppression; others have concentrated on manipulating the graft which may be a megadose of extensively T celldepleted or unmanipulated progenitor cells. Excellent engraftment rates are associated with a very low incidence of acute and chronic GVHD and regimen-related mortality even in patients who are over 50 years old. Overall, event-free survival and transplant-related mortality compare favourably with reports on transplants from sources of stem cells other than the matched sibling.
Kozlowski, B W
ABSTRACT Many forms of vitamin supplementation have been proposed for the treatment of behavioral and cognitive disorders in children with mental retardation. Except for nutrient deficiencies and selected inborn errors of metabolism, the efficacy of these treatments has not been established. Therapeutic supplementation with vitamin B(6) in Down syndrome and folie acid in fragile X syndrome was attempted following the identification of apparent biochemical aberrations involving the nutrients. Double-blind controlled trials have revealed no evidence that B(6) treatment was effective in Down syndrome. Very limited evidence, only among prepubertal subjects, suggested that behaviors improved with folie acid treatment in fragile X syndrome. There is less clarity of the scientific rationales for various combinations of vitamins (or vitamins and minerals) that have been promoted according to the concept of orthomolecular medicine. Well-designed controlled studies, with data presented in conformity with generally accepted scientific standards, have not supported the efficacy of megadose supplementation with 1) multivitamins in cognitive disabilities or attention deficit disorders, or 2) multivitamins and minerals in Down syndrome or other forms of mental retardation. Insufficient data are available to support claims made for vitamin B(6) and magnesium supplementation in autism. Research in the larger field of nutrient-behavior research has reinforced the need for studies to be more rigorously designed and to draw on the expertise of multiple disciplines. Evidence of toxic effects of nutrients continues to accrue, reinforcing the fact that megadoses should not be used indiscriminately or without physician monitoring. For children with mental retardation generally, assuring that established nutritional needs are met warrants primary consideration.
Abdul Majeed Chowdry
Full Text Available Vitamin D deficiency state is endemic in the Kashmir valley of the Indian subcontinent. Clinicians frequently treat patients with Vitamin D for diverse clinical symptoms to improve the general health and to reduce the frailty of elderly and these doses may at times be inappropriately high. Vitamin D toxicity-induced acute kidney injury (AKI, often considered rare, can be life-threatening and associated with substantial morbidity if not identified promptly. We aimed to describe clinical and biochemical features, risk factors, and management of AKI patients with Vitamin D toxicity seen at a single tertiary care centre in Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India, between January 2014 and January 2016. Evaluation included detailed clinical history and biochemical tests including serum calcium, phosphorus, creatinine, intact parathyroid hormone, and 25-hydroxyvitamin D [25(OHD]. Nineteen patients with Vitamin D toxicity-induced AKI could be identified. Clinical manifestations included nausea, vomiting, altered sensorium, constipation, pancreatitis, AKI, acute on chronic kidney disease, and weight loss. Median (range age was 64 (45–89 years. Median (range serum 25(OHD level and median (range total serum calcium level were 99 (190–988 ng/mL and 139 (119–152 mg/dL, respectively. Overdose of Vitamin D caused by prescription of megadoses of Vitamin D was the cause of AKI in all cases. Median (range cumulative Vitamin D dose was 6,000,000 (3,600,000–9,000,000 IU. On three- and six-month follow-up, the creatinine and estimated glomerular filtration rate normalized and returned to baseline in all patients except three cases who had underlying chronic kidney disease. Three patients needed rehospitalization for another episode of AKI. Our data demonstrate an emergence of Vitamin D toxicity as a cause of AKI in this part of the world. Irrational use of Vitamin D in megadoses resulted in AKI in all cases. Persistence of Vitamin D in
Maria de Fátima Costa Caminha
Full Text Available Realizou-se revisão sistemática de estudos avaliativos da aplicação de megadoses de vitamina A nas concentrações de retinol no sangue e no leite maternos como medida de curto prazo para a prevenção de hipovitaminose A. Com base na estratégia do Centro Cochrane do Brasil para ensaios clínicos aleatórios foram identificadas 115 publicações no PubMed, entre as quais, por um conjunto de critérios de inclusão/exclusão, foram selecionados 14 artigos publicados entre 1993 a 2007. O efeito das intervenções com três esquemas posológicos (200.000, 300.000 e 400.000 UI de vitamina A foram analisados. Dos 11 experimentos realizados em leite materno, nove apresentaram elevação dos níveis de retinol em comparação com o grupo controle; dos nove que avaliaram sangue materno, quatro mostraram elevação após tempos variados de aplicação de megadoses de vitamina A. Conclui-se que a administração de vitamina A em elevadas doses foi positiva em 82% dos ensaios com leite materno, mas menos notáveis em comparação ao sangue materno. Não foram observadas diferenças significativas quanto à posologia aplicada.Se realizó revisión sistemática de estudios evaluativos de la aplicación de megadosis de vitamina A en las concentraciones de retinol en la sangre y en la leche maternos como medida de corto plazo para la prevención de hipovitaminosis A. Con base en la estratégia del Centro Cochrane de Brasil para ensayos clínicos aleatorios fueron identificadas 115 publicaciones en el PubMed, entre las cuales, por un conjunto de criterios de inclusión/exclusión, fueron seleccionados 14 artículos publicados entre 1993 a 2007. El efecto de las intervenciones con tres esquemas posológicos (200.000. 300.000 y 400.000 UI de vitamina A fueron analizados. De los 11 experimentos realizados en leche materna, nueve presentaron elevación de los niveles de retinol en comparación con el grupo control; de los nueve que evaluaron sangre materna
Fahey, P J; Boltri, J M; Monk, J S
Certain dietary practices are valid methods of lowering the risk of disease. Others, while popular, have unproven benefits or may even be associated with risks of their own. Careful evaluation of hypercholesterolemia is necessary. Persons with a high level of low-density lipoprotein (LDL) cholesterol and a low level of high-density lipoprotein (HDL) cholesterol need diet therapy, because they are at increased risk of cardiovascular disease. Weight reduction and fat restriction can lower blood pressure, help control hyperglycemia, and improve the LDL cholesterol-HDL cholesterol ratio. Some evidence indicates a protective role of beta carotene against cancer in animals. However, hypervitaminosis A is dangerous and relatively easy to accomplish, so supplementation beyond a multivitamin tablet is discouraged. Data about inhibition of cancer in humans through use of high doses of vitamin E or C or selenium are inconclusive, and studies of effects of long-term ingestion are not available. In general, megadoses of even healthy substances are thought to be dangerous. Decreased consumption of fat, increased consumption of foods high in fiber, and elimination of alcohol and tobacco are sensible recommendations. Consumption of cruciferous vegetables has not been proven to reduce the incidence of cancer, but a moderate amount of them in the diet would seem reasonable.
Cândido, Flávia Galvão; Bressan, Josefina
Vitamin D (1,25(OH)2D3) is a steroid hormone that has a range of physiological functions in skeletal and nonskeletal tissues, and can contribute to prevent and/or treat osteoporosis, obesity, and Type 2 diabetes mellitus (T2DM). In bone metabolism, vitamin D increases the plasma levels of calcium and phosphorus, regulates osteoblast and osteoclast the activity, and combats PTH hypersecretion, promoting bone formation and preventing/treating osteoporosis. This evidence is supported by most clinical studies, especially those that have included calcium and assessed the effects of vitamin D doses (≥800 IU/day) on bone mineral density. However, annual megadoses should be avoided as they impair bone health. Recent findings suggest that low serum vitamin D is the consequence (not the cause) of obesity and the results from randomized double-blind clinical trials are still scarce and inconclusive to establish the relationship between vitamin D, obesity, and T2DM. Nevertheless, there is evidence that vitamin D inhibits fat accumulation, increases insulin synthesis and preserves pancreatic islet cells, decreases insulin resistance and reduces hunger, favoring obesity and T2DM control. To date, there is not enough scientific evidence to support the use of vitamin D as a pathway to prevent and/or treat obesity and T2DM.
Psatha, Nikoletta; Karponi, Garyfalia; Yannaki, Evangelia
Over the past decade, stem cell gene therapy has achieved unprecedented curative outcomes for several genetic disorders. Despite the unequivocal success, clinical gene therapy still faces challenges. Genetically engineered hematopoietic stem cells are particularly vulnerable to attenuation of their repopulating capacity once exposed to culture conditions, ultimately leading to low engraftment levels posttransplant. This becomes of particular importance when transduction rates are low or/and competitive transplant conditions are generated by reduced-intensity conditioning in the absence of a selective advantage of the transduced over the unmodified cells. These limitations could partially be overcome by introducing megadoses of genetically modified CD34(+) cells into conditioned patients or by transplanting hematopoietic stem cells hematopoietic stem cells with high engrafting and repopulating potential. On the basis of the lessons gained from cord blood transplantation, we summarize the most promising approaches to date of increasing either the numbers of hematopoietic stem cells for transplantation or/and their engraftability, as a platform toward the optimization of engineered stem cell grafts. Copyright © 2016 ISEH - International Society for Experimental Hematology. Published by Elsevier Inc. All rights reserved.
Good nutrition is essential to good health during all phases of living with HIV. Good nutrition helps the body fight infections, enables HIV-fighting drugs to work properly, and in some cases may ease drug-related side effects. The author suggests fifteen things people should know to get the most out of their daily diet. These include: eat foods from the five basic food groups; increase calorie intake; eat a combination of foods rich in protein, carbohydrates, and moderate amounts of fat; consume small frequent meals; avoid junk foods; drink plenty of liquids; maintain usual body weight; take a multi-vitamin and mineral supplement, but beware of megadosing; take charge when dining out; have regular dental checkups; establish a regular exercise program; and consult a registered dietitian specializing in HIV. Weight loss is of special concern for those living with HIV. The author suggests taking a short walk before eating and exploring the variety of nutritional supplements to increase calorie intake.
Full Text Available The advantage of using a Human Leukocyte Antigen (HLA-mismatched related donor is that almost every patient who does not have a HLA-identical donor or who urgently needs hematopoietic stem cell transplantation (HSCT has at least one family member with whom shares one haplotype (haploidentical and who is promptly available as a donor. The major challenge of haplo-HSCT is intense bi-directional alloreactivity leading to high incidences of graft rejection and graft-versus-host disease (GVHD. Advances in graft processing and in pharmacologic prophylaxis of GVHD have reduced these risks and have made haplo-HSCT a viable alternative for patients lacking a matched donor. Indeed, the haplo-HSCT has spread to centers worldwide even though some centers have preferred an approach based on T cell depletion of G-CSF-mobilized peripheral blood progenitor cells (PBPCs, others have focused on new strategies for GvHD prevention, such as G-CSF priming of bone marrow and robust post-transplant immune suppression or post-transplant cyclophosphamide (PTCY. Today, the graft can be a megadose of T-cell depleted PBPCs or standard dose of unmanipulated bone marrow and/or PBPCs. Although haplo-HSCT modalities are based mainly on high intensity conditioning regimens, recently introduced reduced intensity regimens (RIC showed promise in decreasing early transplant-related mortality (TRM, and extending the opportunity of HSCT to an elderly population with more comorbidities. Infections are still mostly responsible for toxicity and non-relapse mortality due to prolonged immunosuppression related, or not, to GVHD. Future challenges lie in determining the safest preparative conditioning regimen, minimizing GvHD and promoting rapid and more robust immune reconstitution.
Arnold, L E
A previous review of alternative treatments (Tx) of ADHD--those other than psychoactive medication and behavioral/psychosocial Tx--was supplemented with an additional literature search focused on adults with ADHD. Twenty-four alternative Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. Enzyme-potentiated desensitization, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, massage, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data, many of these tests reasonably controlled. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data, but no systematic clinical trial. Laser acupuncture has promising unpublished pilot data and may be more applicable to adults than children. Essential fatty acid supplementation has promising systematic case-control data, but clinical trials are equivocal. RDA vitamin supplementation, non-Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and are possibly dangerous. Simple sugar restriction seems ineffective. Amino acid supplementation is mildly effective in the short term, but not beyond 2-3 months. Thyroid treatment is effective in the presence of documented thyroid abnormality. Some alternative Tx of ADHD are effective or probably effective, but mainly for certain patients. In some
Sakalli, Hakan; Arslan, Didem; Yucel, Ahmet Eftal
.048) increased significantly. In group two, the VAS (P = 0.001) decreased, the role physical (P = 0.009), and role emotional (P = 0.034) increased significantly; In group three, the TUG (P = 0.0001) and the VAS (P = 0.002) decreased, whereas the physical function (P = 0.0001) and role physical (0.001) increased significantly; In group four, the VAS (P = 0.007) decreased significantly. The megadose vitamin D administration increases quality of life, decreases pain, and improves functional mobility via po or im route in the elderly.
Full Text Available OBJETIVO: Descrever as novas recomendações da American Heart Association (AHA, baseado em evidências científicas organizadas pelo Comitê Internacional de Reanimação, endossado e disseminado por entidades norte-americanas e européias. FONTES DOS DADOS: Os guias para suporte básico e avançado de vida em pediatria publicados nas revistas Circulation em novembro de 2005 foram revisados, bem como as subseqüentes publicações sobre o mesmo tópico usando as palavras-chave cardiac arrest, basic life support, advanced life support, cardiopulmonary resuscitation e pediatric resuscitation, através dos métodos de busca PubMed e MEDLINE. SÍNTESE DOS DADOS: As maiores alterações foram na área de suporte básico de vida. O novo guia enfatiza a relação compressão torácica/ventilação para os profissionais da saúde treinados, que passa a ser 15:2 em todas as idades, exceto neonatos. É ressaltada a importância das compressões torácicas fortes e rápidas e a necessidade de se evitar a hiperventilação durante e após a parada cardiorrespiratória. O uso de megadoses de adrenalina foi retirado, bem como outras orientações. CONCLUSÃO: O guia mais recente de reanimação em pediatria da AHA tem como foco principal o atendimento básico pré-hospitalar. Está baseado na melhor evidência científica disponível, porém futuras pesquisas são necessárias para corroborar essas mudanças e trazer novas evidências para os futuros protocolos.OBJECTIVE: To describe the new American Heart Association (AHA guidelines for pediatric life support, based on the scientific evidence evaluated by the International Liaison Committee on Resuscitation, and endorsed and disseminated by North American resuscitation councils. SOURCES: The guidelines for basic and advanced life support published in Circulation in November 2005 were reviewed together with subsequent publications on the same topics, identified in PubMed and MEDLINE using the keywords