Vitamin D deficiency in the intensive care unit: an invisible accomplice to morbidity and mortality?

The association between vitamin D deficiency and chronic illness is well-known. Vitamin D deficiency has been associated with increased mortality in the general population. Despite this knowledge, vitamin D insufficiency is seldom considered and rarely replaced adequately, if at all, in critically ill patients in intensive care. We present a hypothetic model demonstrating how vitamin D deficiency may be an unrecognized contributor to adverse outcome in intensive care patients.     

Drugs or no drugs?

Guidelines for the treatment and management of depression in primary and secondary care have been available for more than a year. Yet anecdotal evidence suggests their implementation is patchy. Treatment should be tailored to the severity of the depression. Psychological treatments can be used alone or in combination with antidepressants, depending on the illness severity. Prescribers and patients should be aware of the side effects of the drugs.     

Vitamin D deficiency,insulin resistance and thyroid dysfunction in obese patients: is inflammation the common link?

Abstract

The aim of this article is to study the possible relation of serum vitamin D concentrations to body mass index (BMI), visceral fat thickness (VFT), insulin resistance (IR), inflammation (serum monocyte chemoattractant protein-1 – MCP-1) and thyroid parameters in obese patients. A total of 158 non-diabetic, obese patients aged 19–68 without a history of thyroid pathology were recruited. Biochemical markers, insulin, 25-OH vitamin D, thyroid parameters (TSH, FT3, FT4, TPO antibodies, TG antibodies) and VFT were measured. Serum MCP-1 evaluated the inflammation. A HOMA-IR cut-off value of 2.5 defined IR. Most patients had severe (70.3%) or moderate (25.3%) vitamin D deficiency. Vitamin D level was negatively associated with BMI (p?=?.043) and during the cold season with VFT (p?=?.009). Vitamin D deficiency correlated with Hashimoto’s thyroiditis prevalence during the warm season (p?=?.047) and was a risk factor for its occurrence (p?=?.021). At 15?ng/mL cut-off value, vitamin D was negatively correlated with MCP-1 (p?=?.0006). Also, MCP-1 was positive correlated with HOMA- IR (p?=?.042), TPO-Ab levels (p?=?.011) and with Hashimoto’s thyroiditis (p?=?.027). MCP-1 was a risk factor for vitamin D deficiency (p?相似文献   

Chronic Tension‐Type Headache With Vitamin D Deficiency: Casual or Causal Association?

The prevalence of tension-type headache and vitamin D deficiency are both very high in the general population. The inter-relations between the two have not been explored in the literature. We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.     

PSA-screening for prostate cancer--yes or no?

Prostate cancer is a mayor health care problem, especially in the industrialised countries of the Western world. At this time it is the second most common cancer reason for death (CH: 1500 men/year) which will even get more importance in the future by demographic developments. While there is no doubt that in individuals early detection of organ confined disease with localised treatment the prostate cancer can be eradicated and individual men be cured there are uncertainties whether mass screening a population will contribute to reducing prostate cancer related mortality. Its value has not been proved definitively by prospective randomised controlled studies. Most of Medical Societies recommend a "well informed" decision by family physicians, where the men between 50-70 years know about the benefits and harms including: risk of cancer, diagnostic procedures, therapeutic consequences and possible side effects. After agreement of early detection a biopsy has to be done directly above a PSA level of 4.0 ng/ml or a suspicious digital rectal examination. A PSA "grey zone" 4-10 ng/ml can not further be postulated. The ratio of free/total PSA gives no support to prolong biopsy in this moment, because an elevated benign prostate with a higher production of free PSA can mask the tumor in the peripheral zone. Results of the ERSPC and the PLCO trials are expected to give information about the benefits and harms of mass screening in 2006/8.     

Vitamin?D status in critically ill children

Background

Hypovitaminosis?D is an independent risk factor for cardiovascular disease, muscle weakness, impaired metabolism, immune dysfunction, and compromised lung function. Hypovitaminosis?D is common in critically ill adults and has been associated with adverse outcomes. The prevalence of hypovitaminosis?D and its significance in critically ill children are unclear.

Methods

We performed a prospective study to determine the prevalence of hypovitaminosis?D in 316 critically ill children, and examined its association with physiological and biochemical variables, length of pediatric intensive care unit (PICU) stay, and hospital mortality.

Results

The prevalence of hypovitaminosis?D [25(OH)D₃ <50?nmol/L] was 34.5?%. Hypovitaminosis?D was more common in postoperative cardiac patients than in general medical ICU patients (40.5 versus 22.6?%, p?=?0.002), and the cardiac patients had a higher inotrope score [2.5 (1.9–3.3) versus 1.4 (1.1–1.9), p?=?0.006]. Additionally, ionized calcium within the first 24?h was lower in patients with 25(OH)D₃ <50?nmol/L [1.07 (0.99–1.14)?mmol/L] compared with patients with normal vitamin?D₃ [1.17 (1.14–1.19)?mmol/L, p?=?0.02]. Hypovitaminosis?D was not associated with longer PICU stay or increased hospital mortality.

Conclusions

Hypovitaminosis?D is common in critically ill children, and is associated with higher inotropes in the postoperative cardiac population, but not with PICU length of stay or hospital survival.