Chinese expert consensus on metformin in clinical practice: 2023 update / 中华内科杂志

Metformin has robust glucose-lowering effects and multiple benefits beyond hypoglycemic effects. It can also be used in combination with various hypoglycemic drugs and is cost effective. In the absence of the strong indications of glucagon like peptide-1 receptor agonist (GLP-1RA) or sodium glucose cotransporter 2 inhibitor (SGLT2i) for cardiorenal protection, metformin should be used as the first-line pharmacological treatment for newly diagnosed type 2 diabetes and the basic drug for the combined treatment of hypoglycemic drugs. Metformin does not increase the risk of liver and kidney function damage, but patients with renal dysfunction should adjust the dosage of metformin based on estimated glomerular filtration rate (eGFR) levels. Moreover, the correct use of metformin does not increase the risk of lactic acidosis. Because long-term use of metformin is associated with a decrease in vitamin B12 levels, patients with insufficient intake or absorption of vitamin B12 should be regularly monitored and appropriately supplemented with vitamin B12. In view of the new progress made in the basic and clinical research related to metformin, the consensus updating expert group updated the consensus on the basis of the Expert Consensus on the Clinical Application of Metformin (2018 Edition).

Diferentes formas de presentación de la anemia megaloblástica en el lactante / Different forms of presentation of megaloblastic anemia in the infant

Introducción: La anemia megalobástica es un trastorno madurativo de los precursores eritroides y mieloides causado por déficit de vitamina B12, ácido fólico, o ambos. Es poco común en la infancia y su prevalencia se desconoce por ser una enfermedad poco frecuente. Objetivo: Describir diferentes formas de presentación de la anemia megaloblástica en el lactante. Presentación de casos: Se presentan dos casos de lactantes, en el caso 1 la madre tuvo una alimentación precaria durante el embarazo y la lactancia, prolongó la lactancia materna exclusiva más de 6 meses. La paciente comenzó a perder las habilidades ganadas en el desarrollo psicomotor y presentó trastornos neurológicos graves, por lo que se consideró que se trataba de una enfermedad progresiva del sistema nervioso central. En el caso 2, en el que se prolongó la lactancia materna exclusiva, apareció trombocitopenia, por lo que se sospechó una enfermedad hematológica maligna. Resultados: En ambos casos después de realizar diversas pruebas para descartar enfermedades neurológicas (caso 1) y enfermedades hematológicas (caso 2) se diagnosticó anemia megaloblástica por déficit de vitamina B12 por disminución en la ingesta y una reserva limítrofe en la madre que lacta. En ambos casos los síntomas desaparecieron con el tratamiento vitamínico sustitutivo. Conclusiones: En el lactante la anemia megaloblástica se puede presentar de diferentes formas clínicas a pesar de tener la misma causa, un déficit en la ingesta y una reserva escasa de la madre durante el embarazo y lactancia(AU)

Introduction: Megaloblastic anemia is a maturing disorder of the erythroid and myeloid precursors caused by deficiency of vitamin B12, folic acid, or both. It is uncommon in childhood and its prevalence is unknown because it is a rare disease. Objective: To describe different forms of presentation of megaloblastic anemia in infants. Presentation of cases: Two cases of infants are presented, in case 1 the mother had a precarious diet during pregnancy and lactation, and prolonged exclusive breastfeeding more than 6 months. The patient began to lose the skills gained in psychomotor development and presented severe neurological disorders, so it was considered that it was a progressive disease of the central nervous system. In case 2, in which exclusive breastfeeding was prolonged, thrombocytopenia appeared, so a malignant hematological disease was suspected. Results: In both cases, after performing various tests to rule out neurological diseases (case 1) and hematological diseases (case 2), megaloblastic anemia was diagnosed due to vitamin B12 deficiency due to a decrease in intake and a borderline reserve in the breastfeeding mother. In both cases the symptoms disappeared with vitamin replacement therapy. Conclusions: In the infant, megaloblastic anemia can occur in different clinical ways despite having the same cause, a deficit in intake and a low reserve of the mother during pregnancy and lactation(AU)

Association between vitamin D and cardioprotection in adult patients

SUMMARY OBJECTIVE: To conduct a review of articles which have evaluated the relationship between vitamin D and cardioprotection in adult. METHODS: A literature search was performed in the Pubmed and Scielo databases. The results were extracted from primary and secondary sources and will be presented in the form of a bibliographic review. RESULTS: Twenty-three articles were identified from the electronic search that reported on physiological mechanisms relating the vitamin D axis and the cardiovascular system through receptors. Of the ten studies that evaluated the therapeutic effect of vitamin D in cardiovascular diseases, none reported significant results. CONCLUSION: The articles assessed in this review did not demonstrate a cardioprotective effect of vitamin D, despite the epidemiological correlation of vitamin D deficiency with a higher prevalence of cardiovascular diseases.

Efecto de la suplementación con vitamina D en dosis única sobre el estado nutricional de vitamina D / Effect of vitamin D supplementation as a single dose on the nutritional status of vitamin D

INTRODUCCIÓN: El primer año de vida es un periodo de riesgo de deficiencia de vitamina D (VD). La administración de 400 UI diarias de VD no tiene una adherencia del 100%, en cambio dosis únicas de 100.000 UI de VD oral son seguras en recién nacidos. OBJETIVO: Comparar el efecto de la suplementación oral de VD en dosis única de 100.000 UI al mes de edad vs dosis diarias de 400 UI sobre las concentraciones séricas de VD, a los 6 meses de vida. SUJETOS Y MÉTODOS: Ensayo clínico aleatorizado, sin enmascaramiento. Se incluyeron 84 lactantes sanos de 1 mes de vida, asignados al azar al grupo de estudio (GE) que recibió una dosis única de VD de 100.000 UI oral o al grupo control (GC), que recibió dosis diarias de VD de 400 UI oral del 1er al 6to mes de vida. A los 6 meses de edad se determinó la concentración sérica de VD. RESULTADOS: 65 lactantes terminaron el estudio, 36 en GE y 29 en GC. No se encontró deficiencia de VD. La insuficiencia de VD fue de 5,5% y 6,8% en el GE y GC, respectivamente. La concentración sérica de VD a los 6 meses de vida, fue de 38,8 ± 5,2 ng/ml y 39,7 ± 6,3 ng/ml para GE y GC, respectivamente (NS). CONCLUSIONES: La suplementación con 100.000 UI de VD única al mes de edad logra concentraciones séricas de VD a los 6 meses de vida, similares a dosis diarias de 400 UI de VD, del 1er al 6to mes.

INTRODUCTION: Infants are a group at risk of vitamin D (VD) deficiency. The administration of 400 IU of VD per day during the first year of life does not achieve 100% adherence. A single dose of 100,000 IU of oral VD is safe in newborns. OBJECTIVE: To compare the effect of oral administration of VD between a single dose of 100,000 IU at one month of age vs daily doses of 400 IU on serum concentrations of VD, at 6 months of age. SUBJECTS AND METHOD: Randomized clinical trial, without masking. 84 healthy infants were included at 1 month of age, randomized to the study group (SG) receiving a single oral dose of 100,000 IU or to the control group (CG), who received daily oral doses of VD of 400 IU from the 1st to the 6th month of life. At 6 months of life, the serum concentration of VD was determined. RESULTS: 65 infants completed the study, 36 in SG and 29 in CG. No VD deficiency was found. VD insufficient was 5.5% and 6.8% in the SG and CG, respectively. The serum concentration of VD at six months of age was 38.8 ± 5.2 ng/ml and 39.7 ± 6.3 ng/ml for the SG and CG, respectively (NS). CONCLUSIONS: Supplementation of 100,000 IU of VD at one month age achieves serum concentrations of VD at 6 months of life similar to the administration of daily doses of 400 IU of VD from the 1st to the 6th month.

Vitamin C for COVID-19: a living systematic review / Vitamina C para COVID-19: una revisión sistemática viva

OBJECTIVE: This living systematic review aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of vitamin C in treating patients with COVID-19. DATA SOURCES: We conducted searches in PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature, and in a centralized repository in L·OVE (Living OVerview of Evidence). In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it comprises and has been customized to group all COVID-19 evidence in one place. All the searches covered the period until April 29, 2020 (one day before submission). STUDY SELECTION AND METHODS: We adapted an already published standard protocol for multiple parallel systematic reviews. We searched for randomized trials evaluating the effect, in patients with COVID-19, of vitamin C versus placebo or no treatment. Anticipating the lack of randomized trials directly addressing this question, we also searched for trials evaluating MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19. Two reviewers independently screened each study for eligibility. A living, web-based version of this review will be openly available during the COVID-19 pandemic, and we will resubmit it to the journal whenever there are substantial updates. RESULTS: We screened 95 records, but no study was considered eligible. We identified 20 ongoing studies, including 13 randomized trials evaluating vitamin C in COVID-19. CONCLUSIONS: We did not find any studies that met our inclusion criteria, and hence there is no evidence to support or refute the use of vitamin C in the treatment of patients with COVID-19. A substantial number of ongoing studies should provide valuable evidence to inform researchers and decision-makers soon.

OBJETIVO: Esta revisión sistemática viva tiene como objetivo proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de la vitamina C en el tratamiento de pacientes con COVID-19. FUENTES DE DATOS: Realizamos búsquedas en PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), literatura gris y en un repositorio centralizado en L·OVE (Living OVerview of Evidence). En respuesta a la emergencia de COVID-19, L·OVE se adaptó para ampliar el rango de evidencia que cubre y se personalizó para agrupar toda la evidencia de COVID-19 en un solo lugar. Todas las búsquedas abarcaron el período hasta el 29 de abril de 2020 (un día antes de su envío). SELECCIÓN DE ESTUDIOS Y MÉTODOS: Adaptamos un protocolo común publicado para múltiples revisiones sistemáticas paralelas. Se buscaron ensayos aleatorios que evaluaran el efecto de la vitamina C versus placebo o ningún tratamiento en pacientes con COVID-19. Anticipando la falta de ensayos aleatorios que aborden directamente esta cuestión, también buscamos ensayos que evaluaran MERS-CoV y SARS-CoV, y estudios no aleatorios en COVID-19. Dos revisores seleccionaron de forma independiente cada estudio para determinar su elegibilidad. Una versión viva y basada en la web de esta revisión estará abiertamente disponible durante la pandemia de COVID-19, y se volverá a enviar a publicación cuando haya actualizaciones sustanciales. RESULTADOS: Se examinaron 95 registros, pero ningún estudio se consideró elegible. Se identificaron 20 estudios en curso, incluidos 13 ensayos aleatorios que evalúan la vitamina C en COVID-19. CONCLUSIONES: No se encontró ningún estudio que cumpliera con los criterios de inclusión, por lo que no hay evidencia para apoyar o refutar el uso de vitamina C en el tratamiento de pacientes con COVID-19. Un número sustancial de estudios en curso debería proporcionar evidencia valiosa para informar a los investigadores y los tomadores de decisiones en un futuro próximo.

Suplementos vitamínicos para prevención o tratamiento de COVID-19 / Vitamin supplements to prevent the treatment of COVID-19

INTRODUCCIÓN: Las vitaminas son micronutrientes indispensables para el ser humano, ya que participan en diversas funcionas normales. Asimismo, su déficit puede causar serios problemas de salud. Con el abrupto advenimiento del COVID-19 y su rápido desarrollo hasta convertirse en pandemia, se han venido ofertando el uso sin prescripción médica de suplementos vitamínicos (compuestos únicos [como vitamina C] o en multivitamínicos) para prevenir o tratar el COVID-19, a pesar de que, a la fecha, no está aprobado su uso para la prevención o tratamiento del COVID-19 ni de ninguna outra infección del tracto respiratorio. Uno de los principales argumentos para la venta de estos suplementos se basa en que las vitaminas tienen un rol "fortalecedor" del sistema imnume por lo que tendrían efectos en la prevención o tratamiento de diversos problemas de salud, tales como las infecciones del tracto respiratorio. Sin embargo, la existencia de evidencia científica de un rol inmunomodulador de las vitaminas no implica necesariamente que estas deban ser eficaces o efectivas para prevenir o tratar el COVID19 o si quiera alguna otra infección del tracto respiratorio. Con la finalidad de brindar a las personas una información confiable acerca del uso de suplementos vitamínicos, la Seguridad Social, EsSalud, ha formado un Comité de Emergencias que tiene como evaluar la evidencia disponible acerca de la efectividad de los suplementos vitamínicos en la prevención o tratamiento de COVID-19. En tal sentido, el objetivo principal de esta revisión rápida es generar evidencia a partir de la literatura científica publicada que evalúe la efectividad de los suplementos vitamínicos en COVID-19. Previendo que la literatura directamente relacionada con COVID-19 sería escasa, ampliamos la pregunta de investigación para explorar la existencia de evidencia analógica, evaluando así también la eficacia/efectividad de los suplementos vitamínicos en la prevención o tratamiento de otras infecciones del tracto respiratorio (tales como , resfriado común, influenza, incluyendo neumonía). Así, esta revisón también nos permitió evaluar qué tan razonables son los argumentos utilizados para recomendar el uso de estos suplementos vitamínicos en infecciones del tracto respiratorio en general. MÉTODOS: Relacionados con el tema a tratar: uso de suplementos vitamínicos para la prevención o el tratamiento de COVID-19, infecciones por otros coronavirus o infecciones del tracto respiratorio (excluyendo tuberculosis). Para COVID-19 o infecciones por otros coronavirus: Umbrella reviews, revisiones sistemáticas, ECAs, estudios observacionales (cohortes, casocontrol o transversal). § Para infecciones del tracto respiratorio (excluyendo tuberculosis): Umbrella reviews, revisiones sistemáticas de ensayos clínicos aleatorizados controlados. RESULTADOS: De acuerdo con nuestra estrategia de búsqueda identificamos 650 estudios. Adicionalmente, hallamos 1 registros a través de otras fuentes. Un revisor (PSB) evaluó la elegibilidad de los estudios según títulos y resúmenes aplicando los objetivos de la presente revisión y la pregunta de investigación (PICO). Las referencias que cumplieron con los criterios de búsqueda fueron exportadas al software de manejo de referencias Zoter. Luego de la lectura por títulos y resúmenes se excluyeron 639 artículos por no abordar los criterios de nuestra pregunta PICO: población, tipo intervención, comparador, desenlace o tipo de estudio; quedando 12 artículos para lectura a texto completo. Luego de la lectura a texto completo llevada a cabo por PSB se incluyeron todos los artículos para la realización de este reporte de evidencia. De estos 12 artículos, nueve fueron revisiones sistemáticas y tres fueron revisiones umbrella que respondieran a la pregunta PICO. Todas las RS incluyeron ECA y todas las revisiones umbrela sincluyeron solamente revisiones de ECA . Ninguna RS o revisión umbrela evalúo la eficacia/efectividad de algún suplemento vitamínico para prevenir o tratar COVID-19 nin ninguna otra infección por coronavirus. Tres RS y dos revisiones umbrela evaluaron el efecto de la vitamina C para prevenir o tratar infecciones del tracto respiratoria, tales como resfrío común, influenza o neumonía; mientras que cinco RS y una revisión umbrela evaluaron el efecto de la vitamina D y solo una el efecto de la vitamina A. No encontramos ninguna RS ni revisión umbrela que evaluara la eficacia/efectivida de las vitaminas E, K, B6, B12, U, ácido fólico, complejo B, riboflvina o algún otor compuesto multivitamínico. CONCLUSIONES: Hasta la fecha de esta revisión, no existen estudios primarios que evalúen directamente la eficacia/efectividad de algún suplemento vitamínico (mono o multivitamínico) para la prevención o tratamiento de COVID-19. La abudante literatura existente acerca de los suplementos de vitamina C indica que su consumo de manera continua no previene el resfrío común y que su impacto sobre la duración de los síntomas es nulo o insignificante en niños y adultos. Es muy poco probable que estas conclusiones cambien si aparecen más estudios similares bien diseñados, por lo que tampoco se justifica su uso para prevenir o tratar infecciones del tracto respiratorio, tal y como viene siendo promocionado. La evidencia acerca de la vitamina D es limitada y no concluyente, existiendo evidencia contradictoria que sugiere la existencia de un pequeño efecto de esta en la prevención de infecciones del tracto respiratorio en algunso estudios, mientras que otros estudios fallan en corroborar estos hallazgos. La evidencia acerca de la vitamina A es muy limitada, existiendo incluso evidencia de un ligero incremento del riesgo de contraer infección respiratoria en quienes consumen vitamina A versus placebo.

Nutrientes y alimentos en la esclerosis múltiple / Nutrients and foods in multiple sclerosis. Abstract

La alimentación influye en la mejora de la sintomatología de cualquier enfermedad, incluida la esclerosis múltiple (EM),la cual, se caracteriza por un proceso inflamatorio crónico, autoinmune del sistema nervioso central generando situaciones como inflamación, alteraciones; digestivas y mentales, discapacidad, y fatiga. El propósito de la presente revisión fue identificar la evidencia científica sobre los aspectos nutricionales que mejoran la progresión de EM. La metodología consistió en la búsqueda de literatura, en bases de datos electrónicas, referente a nutrición y esclerosis múltiple, principalmente entre los años 2015-2020. Entre los resultados de los aspectos nutricionales que mostraron eficacia en mejorar la progresión de EM, se encuentran el zinc, vitamina D, fibra, probióticos, aceite de pescado y de oliva, cacao, cúrcuma, y salmón. Existen evidencias del papel inmunomodulador del Zn y de la vitamina D en la inhibición de la producción de citocinas proinflamatorias. Niveles bajos de ambos componentes se asocian con mayor riesgo de padecer EM. Otros componentes de interés nutricional son la fibra y probióticos; producen ácidos grasos de cadena corta, con propiedades antiinflamatorias. La primera se conoce por su papel en la motilidad gastrointestinal y los segundos por su acción celular y molecular en procesos inflamatorios, y modulación del microbioma, por mencionar algunos. Los aspectos nutricionales antes mencionados pueden contribuir a modular la inflamación y mejorar la fatiga. Finalmente, este documento genera un panorama importante para continuar con la investigación referente a la influencia de la alimentación en pacientes con EM(AU)

Diet influences the improvement of the symptoms of any disease, including multiple sclerosis (MS), which is characterized by a chronic, autoimmune inflammatory process of the central nervous system generating situations such as inflammation, mental and digestive alterations, disability and fatigue. The aim of this review was to identify the scientific evidence on the nutritional aspects that improve the progression of MS. The methodology consisted of searching literature, in electronic databases, referring to nutrition and multiple sclerosis, mainly between the years 2015-2020. The results of the nutritional aspects that showed effectiveness in improving the progression of MS, are zinc, vitamin D, fiber, probiotics, fish oil and olive oil, cocoa, turmeric and salmon. There is evidence of the immunomodulatory role of Zn and vitamin D in inhibiting the production of proinflammatory citokines. Low levels of both components are associated with an increased risk of MS. Other components of nutritional interest are fiber and probiotics; they produce short chain fatty acids, with anti-inflammatory properties. The first is known for its role in gastrointestinal motility and the second one for its cellular and molecular actions in inflammatory processes and the microbiome modulation, to name a few. The nutrition aspects mentioned above, can contribute to modulate inflammation and improve fatigue. Finally, this paper creates an important perspective to continue the investigation concerning the influence of diet in MS patients(AU)

Escorbuto en el siglo XXI / Scurvy in XXI century

El escorbuto es una enfermedad causada por la deficiencia de vitamina C o ácido ascórbico. Sus manifestaciones clínicas son variadas debido a que esa vitamina es un cofactor de enzimas que intervienen en numerosos procesos, como la síntesis de colágeno y la absorción de diferentes nutrientes. La expresión cutánea característica son las petequias foliculares con pelos en cuello de cisne y en tirabuzón. El compromiso mucoso se manifiesta como hipertrofia y hemorragia gingival, gingivitis y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática o leucocitaria. El tratamiento se basa en el aporte suplementario de esa vitamina. Se presenta el caso de un paciente de 32 años con escorbuto debido a una dieta casi exclusivamente a base de harinas y carente de frutas y verduras. (AU)

Scurvy is a disease caused by vitamin C deficiency (also called ascorbic acid). Its clinical manifestations are varied because this vitamin is a cofactor of enzymes that take part in numerous processes, such as the synthesis of collagen and the absorption of different nutrients. Cutaneous expression of scurvy is follicular petechiae with corkscrew hairs. Mucous involvement manifests as gingival hypertrophy and bleeding, gingivitis and loss of teeth. The diagnosis of this entity is clinical and can be confirmed by plasma or leukocyte vitamin C dosing. The treatment consists of vitamin C supplementation. We present a 32-year-old male patient with scurvy secondary to a diet based almost exclusively on flour and lacking in fruits and vegetables. (AU)

Effect of vitamin D supplementation on 24-hour urine calcium in patients with calcium Urolithiasis and vitamin D deficiency

ABSTRACT Purpose: Hypercalciuria is one of the risk factors for calcium kidney stone formation (the most common type of urinary stones). Although vitamin D deficiency is prevalent among urolithiasis patients, the effect of vitamin D supplementation on urine calcium in these patients is still unclear. Materials and Methods: In this retrospective study, medical and laboratory tests records of 26 patients with recurrent calcium kidney stones and vitamin D deficiency treated with 50000IU vitamin D per week for 8-12 weeks were analyzed. The changes in 24-hour urine calcium (24-h Ca), serum 25-hydroxyvitamin D (25 (OH) D), serum parathormone (PTH), other 24-hour urine metabolites and calculated relative supersaturations of calcium oxalate (CaOxSS), calcium phosphate (CaPSS) and uric acid (UASS) were assessed. Moreover, correlations between changes in 24-h Ca and other aforementioned variables were assessed. Results: Serum 25 (OH) D and 24-h Ca increased after vitamin D supplementation, while serum PTH decreased (p < 0.001, for all analyses). The levels of 24-hour urine sodium and urea increased significantly (p = 0.005 and p = 0.031, respectively). The levels of CaOxSS and CaPSS increased, but the changes were not significant (p = 0.177, and p = 0.218, respectively). There were no correlations between the changes in 24-h Ca and serum 25 (OH) D or PTH. Conclusions: The result of current study suggests that although urine Ca increased in vitamin D supplemented patients, this increase was not associated with the increase in serum vitamin D and may be due to other factors such as dietary factors. Further randomized clinical trials considering other factors associated with urine Ca are warranted.

Vitamina D y enfermedades respiratorias pediátricas / Vitamin D and pediatrics respiratory diseases

Resumen: El mejor entendimiento sobre la actividad global de la vitamina D, ha llevado a una intensa búsque da de sus implicancias en enfermedades no esqueléticas. En este artículo se presenta una revisión actualizada de la relación entre la vitamina D y la patología respiratoria pediátrica. Se realizó una búsqueda bibliográfica en PUBMED utilizando términos libres y MESH: vitamina D, enfermedades del sistema respiratorio, asma, bronquiolitis. Se seleccionó estudios en humanos menores de 18 años y animales, publicados en inglés y español hasta el 2017. Se encontraron 507 artículos, de los cuales se incluyeron 43. Evidencia indirecta apunta hacia un rol de la vitamina D y la maduración pulmonar fetal. En relación a la patología pulmonar pediátrica, los estudios son escasos y poco concluyentes. Nuevos meta - análisis, con evaluación individualizada de los participantes, muestran un importante rol protector de la suplementación en la prevención de exacerbaciones asmáticas severas e infecciones virales agudas. En bronquiolitis los resultados son contradictorios, sin relación clara entre niveles plasmáticos y severidad. No existe suficiente evidencia que evalué los beneficios en fibrosis quística y tuberculosis. Recientemente se ha propuesto una relación directa entre la severidad de los trastornos respiratorios del sueño y los niveles plasmáticos de vitamina D, aunque se desconoce los mecanismos exactos involucrados a esta asociación. La información actual permite suponer que la suplementación de vitamina D puede representar una estrategia costo - efectiva en la reducción de importantes causas de morbimortalidad infantil.

Abstract: The better understanding of the global activity of vitamin D has led to an intense search for its involvement in non-skeletal diseases. This article presents an updated review of the relationship between vitamin D and pediatric respiratory pathology. A literature search was performed in PUBMED using free terms and MESH terms: vitamin D, asthma, respiratory system diseases, and bronchiolitis. Stu dies in human patients younger than 18 years and animals, published in English and Spanish until 2017 were included. 507 articles were found, of which 43 were included. Indirect evidence suggests a role of vitamin D and fetal lung maturation. In relation to pediatric pulmonary pathology, studies are scarce and inconclusive. Recent meta-analyses performed with individualized evaluation of the participants shows an important protective role of vitamin D supplementation in the prevention of severe asthma exacerbations and acute viral infections. In bronchiolitis, the results are contradictory, with no clear relationship between plasma levels and severity. There is not enough evidence to assess the benefits of vitamin D supplementation in cystic fibrosis and tuberculosis. A direct relationship between the severity of sleep-related breathing disorders and vitamin D plasma levels has recently been proposed, although the exact mechanisms involved in this association are unknown. Current information suggests that vitamin D supplementation may represent a cost-effective strategy in redu cing important causes of infant morbidity and mortality.

Use of active metabolites of vitamin D orally for the treatment of psoriasis

SUMMARY Objective: The objective of this study was to analyse the existing bibliographic production on clinical trials related to the use of vitamin D for oral treatment of psoriasis. Method: A literature review of clinical trials related to the use of vitamin D for oral treatment of psoriasis, published in the LILACS, Scielo, Medline, PubMed and Cochrane Library from 1986 to 2013. The search included the following terms: "Psoriasis and oral Vitamin D"; "psoríase e vitamina D oral". Results: After analysing the titles and summaries, 10 articles met the eligibility criteria. Discussion: According to the literature, most tests were made in moderate psoriasis with doses ranging from 0.25 to 2μg, demonstrating improvement with this treatment modality. Some studies suggest the use of high doses, but the biggest concern is hypercalciuria as a side effect. Conclusion: The use of active metabolites of vitamin D orally for the treatment of psoriasis showed efficacy and safety.

RESUMO OBJETIVO: O objetivo deste estudo foi analisar a produção bibliográfica existente sobre os ensaios clínicos relacionados ao uso da vitamina D para tratamento por via oral da psoríase. MÉTODOS: Revisão de literatura de ensaios clínicos relacionados ao uso de vitamina D para tratamento por via oral da psoríase publicados no Lilacs, SciELO, MedLine, PubMed e Biblioteca Cochrane no período de 1986 a 2013. A pesquisa incluiu os seguintes termos: "Psoriasis and oral Vitamin D"; "psoríase e vitamina D oral". RESULTADOS: Depois de analisar os títulos e resumos, dez artigos preencheram os critérios de elegibilidade. DISCUSSÃO: Segundo a literatura, a maioria dos ensaios foi realizada na psoríase moderada, com dose que varia de 0,25 a 2 μg, demonstrando melhora com esta modalidade terapêutica. Alguns estudos sugerem o uso de doses elevadas, porém a maior preocupação é a hipercalciúria como efeito colateral. CONCLUSÃO: O uso de metabólitos ativos de vitamina D por via oral para o tratamento da psoríase demonstrou eficácia e segurança com relação aos efeitos colaterais.

Effect of vitamin D supplementation on patients with systemic lupus erythematosus: a systematic review / Efeito da suplementação com vitamina D em pacientes com lúpus eritematoso sistêmico: uma revisão sistemática

Abstract The objective of this systematic review was to analyze clinical trials carried out for the investigation of the effect of vitamin D supplementation on systemic lupus erythematosus. The research was performed from August to September 2016, without limits regarding year of publication, restriction of gender, age, and ethnicity. For the guiding question, the PICO strategy was employed. To evaluate the quality of the publications the PRISMA protocol and Jadad scale were used. The risk of bias analysis of the clinical trials was performed using the Cochrane collaboration tool. After the process of article selection and removal of duplicates, four articles were identified as eligible. The results of three studies showed a positive effect of supplementation on disease activity reduction and significant improvement in levels of inflammatory markers, fatigue, and endothelial function. Only one study showed no improvement in disease activity after supplementation. Moreover, all studies showed an increase in serum vitamin D levels. The data from this review provide evidence on the benefits of vitamin D supplementation in patients with lupus and vitamin D insufficiency/deficiency. However, it is still necessary to elucidate whether vitamin D acts in the protection against this metabolic disorder, as well as the standardization of the type, dose and time of vitamin D supplementation.

Resumo O objetivo desta revisão sistemática foi analisar ensaios clínicos feitos na investigação do efeito da suplementação com vitamina D sobre o lúpus eritematoso sistêmico. A pesquisa foi feita nas bases de dados Scopus, PubMed e Biblioteca Cochrane, de agosto a setembro de 2016, sem limite de ano de publicação, restrição de gênero, idade e etnicidade. Para a questão norteadora foi empregada a estratégia Pico. Para avaliar a qualidade das publicações usaram-se o protocolo Prisma e a escala de Jadad. A análise do risco de viés dos ensaios clínicos ocorreu pela ferramenta de colaboração Cochrane. Após o processo de seleção e remoção de artigos duplicados, quatro artigos foram identificados como elegíveis. Os resultados de três estudos mostraram efeito positivo da suplementação na redução da atividade da doença e melhoria significativa nos níveis de marcadores inflamatórios, fadiga e função endotelial. Em apenas um estudo não houve melhoria na atividade da doença após a suplementação. Ademais, todos os estudos apresentaram aumento dos níveis séricos de vitamina D. Os dados desta revisão fornecem evidências dos benefícios da suplementação com vitamina D sobre o lúpus em pacientes com insuficiência/deficiência. Contudo, ainda é necessário elucidar a atuação do nutriente na proteção contra esse distúrbio metabólico, bem como a padronização do tipo, da dose e do tempo de suplementação com vitamina D.

O papel da dieta na etiologia da endometriose / The role of diet in the etiology of endometriosis

Introdução: A endometriose é uma condição inflamatória crônica e hormônio-dependente. Fatores genéticos, imunológicos e ambientais podem estar implicados na patogênese da endometriose. Nesse sentido, esse estudo tem por objetivo descrever o papel da dieta na etiologia da endometriose. Método: Foi realizada uma busca eletrônica no PubMed, no período entre 1 de janeiro de 2012 e 31 de dezembro de 2016, empregando os termos "endometriosis and diet" e "endometriosis and food". Os critérios de inclusão foram: relação direta com o tema, publicação no idioma inglês, disponibilidade da versão completa do artigo e artigo original/pesquisa. Foram selecionadas 12 publicações que cumpriram os critérios previamente estabelecidos. Resultados: Houve predomínio de estudos que avaliaram a contribuição de ácidos graxos poli-insaturados para o desenvolvimento da endometriose (6/12), seguido pelas vitaminas B, C, D, E, cálcio e magnésio (4/12) e apenas dois artigos investigaram xantohumol e café/cafeína, sendo um artigo cada. A maioria desses compostos atuou na redução das lesões endometriais, uma vez que exibiram efeitos anti-inflamatório e antiangiogênico e são antioxidantes. No entanto, as pesquisas foram conduzidas em modelos animais e, apesar dos achados promissores, é necessário cautela ao extrapolar os resultados para o estudo da endometriose em humanos. Conclusões: Foi demonstrado um papel significativo da dieta no desenvolvimento e progressão da endometriose, sendo que a maioria exibe efeito protetor. Nesse sentido, é pertinente, adequado e justificável o acompanhamento nutricional às pacientes portadoras de endometriose.

Introduction: Endometriosis is a chronic inflammatory condition and hormone dependent. Genetic, immunological, and environmental factors may be implicated in the pathogenesis of endometriosis. Thus, this study aims to describe the role of diet in the etiology of endometriosis. Methods: An electronic search was conducted in PubMed in the period from January 1, 2012 to December 31, 2016, using the terms "endometriosis and diet" and "endometriosis and food." Inclusion criteria were directly related to the subject, published in English, availability of the full version of the article and original/research article. We selected 12 publications that met the criteria previously established. Results: There was a predominance of studies have evaluated the contribution of polyunsaturated fatty acids for the development of endometriosis (6/12) followed by vitamins B, C, D, E, calcium, and magnesium (4/12) and only two articles investigated xantohumol and coffee/caffeine, one article each. Most of these compounds reduced endometrial lesions once they exhibit effects anti-inflammatory, anti-angiogenic and are antioxidants. However, studies were conducted in animal models and despite the promising findings, it is necessary to exercise caution when extrapolating the results for the study of endometriosis in humans. Conclusions: A significant role of diet in the development and progression of endometriosis was demonstrated, most of which exhibits a protective effect. In this sense, it is relevant, appropriate, and justifiable nutritional monitoring of patients with endometriosis.

Automedicação em estudantes de enfermagem do Estado do Amazonas - Brasil / La automedicación por los estudiantes de enfermería del Estado de Amazonas - Brasil / Self-medication Among Nursing Students in the State of Amazonas - Brazil

RESUMO Objetivo Determinar a prevalência e os fatores associados à automedicação entre estudantes de enfermagem. Método Estudo transversal realizado com 116 estudantes de enfermagem de uma universidade pública do Estado do Amazonas – Brasil, no período de março a abril de 2014. Utilizou-se questionário constituído por variáveis socioeconômicas e de consumo de medicamentos. Foi realizada a análise bivariada e a regressão logística – nível de significância de 5%. Resultados A prevalência de automedicação foi de 76,0%, motivada especialmente pela percepção de que o problema de saúde não requeria visita ao médico (46,6%). Metade dos estudantes relataram queixas álgicas. Os grupos farmacológicos mais consumidos foram anti-inflamatórios não esteroides (63,2%) e antibióticos (11,1%). O desconhecimento das implicações negativas da prática da automedicação foi associado à automedicação (OR=6,0). Conclusão A alta prevalência de automedicação, além de poder levar a reações adversas retrata também o uso irracional de medicamentos pelos estudantes, especialmente, quando considerado o papel destes futuros profissionais na segurança do paciente.

RESUMEN Objetivo Determinar la prevalencia y los factores asociados con la automedicación entre estudiantes de enfermería. Métodos Estudio transversal con 116 estudiantes de enfermería de una universidad pública en Amazonas - Brasil, en el período de marzo y abril del 2014. Se utilizó un cuestionario que consta de los niveles socioeconómicos y el consumo de drogas. Se realizó un análisis bivariante y regresión logística -nivel de significación del 5%. Resultados La prevalencia de la automedicación fue de un 76,0%, motivada especialmente por la constatación de que el problema de salud requiere no visitar al médico (46,6%). La mitad de los estudiantes reportaron quejas de dolor. Los grupos de fármacos más consumidos fueron los antiinflamatorios no esteroide (63,2%) y antibióticos (11,1%). Ignorar las implicaciones negativas de la práctica de la automedicación se asoció con la automedicación (OR = 6,0). Conclusión La alta prevalencia de la automedicación, pueden dar lugar a reacciones adversas, retrata el uso irracional de los medicamentos por los estudiantes, especialmente teniendo en cuenta el papel de estos futuros profesionales de la seguridad del paciente.

ABSTRACT Objective To determine the prevalence of self-medication and associated factors among nursing students. Method This is a cross-sectional study with 116 nursing students from the public university in the state of Amazonas, Brazil, from March to April 2014. Data were collected using a questionnaire with socioeconomic and medicine use variables. The data were subjected to bivariate analysis and logistic regression at a significance level of 5%. Results The prevalence of self-medication was 76.0%, chiefly motivated by the belief that the health condition did not require a medical appointment (46.6%). Half of the students reported pain-related complaints. The most commonly used pharmacological groups were non-steroidal anti-inflammatory drugs (63.2%) and antibiotics (11.1%). Lack of awareness of the negative implications of self-medication was associated with self-medication (OR = 6.0). Conclusion The high prevalence of self-medication that may lead to adverse reactions reveals the students’ irrational use of medicines, especially considering the role of these future professionals in patient safety.

Differences in the prevalence of vitamin D deficiency and hip fractures in nursing home residents and independently living elderly

ABSTRACT Objective To compare the prevalence of vitamin D deficiency and fracture history in nursing home residents and community-dwelling elderly subjects and to explore the association of vitamin D levels with various characteristics. Materials and methods Sixty-six nursing home residents and 139 community-dwelling elderly subjects participated. Marital status, medical history, medication including vitamin D supplements, smoking, past fractures were assessed. Weight and height were measured and body mass index calculated. Serum 25-hydroxyvitamin D (25-OHD), PTH, Ca, phosphate, creatinine and eGFR were determined. Results In the nursing home residents 25-OHD was lower (17.8 nmol/l, [9.4-28.6] vs. 36.7 nmol/l, [26.9-50], p < 0.001), PTH was higher (5.6 pmol/l, [3.9-8.9] vs. 4.7 pmol/l [3.6-5.8], P = 0.003) and 25-OHD deficiency was more prevalent (65.2% [53.7-76.7] vs. 22.3% [15.4-29.2], p < 0.001) as was elevated PTH (23% [12.8-33] vs. 5.8% [2-10], p = 0.001). 25-OHD correlated negatively with PTH (institutionalized r = -0.28, p = 0.025 and community-dwelling r = -0.36, p < 0.001). Hip fractures were reported by 8% of the residents and 2% of the independent elderly. The only predictor for hip fracture was elevated PTH (OR = 7.6 (1.5-36.9), p = 0.013). Conclusion The prevalence of vitamin D deficiency and secondary hyperparathyroidism was high in the institutionalized subjects. Hip fracture risk was associated with elevated PTH and not directly with vitamin D levels or the residency status.

Vitamin A supplementation reduces the Th17-Treg – Related cytokines in obese and non-obese women

ABSTRACT Objective The objective of the present study was to investigate the effect of vitamin A supplementation on serum Th17 (IL-6, IL-17, IFNγ) and Treg (TGF-β, IL-10) related cytokines in obese and non-obese women. Subjects and methods In a randomized double blind placebo controlled design, 56 obese women were randomly assigned to receive either an oral dose of 25,000 IU retinyl palmitate or placebo per day for 4 months. Twenty eight ages matched non-obese women were also received vitamin A. At the study entry, anthropometric variables were measured and serum Th17 and Treg related cytokine profile were determined at baseline and 4 months after intervention. Results Significantly higher baseline concentrations of IL-6 were observed in obese compared with non-obese women (P < 0.05). However, the initial concentrations of other cytokines were not significantly different between groups. The mean concentrations of IL-17 and TGF-β were significantly decreased after vitamin A supplementation in non-obese and obese women respectively. Positive relationships between IL-17 and IL-10 (r = 0.42, P < 0.001), TGF-β and IL-17 (r = 0.35, P < 0.001) and between IL-10 and IFN-γ (r = 0.41, P = 0.002) in total participants were also observed. Conclusions The results of the present study showed for the first time that vitamin A supplementation reduces serum concentrations of IL-17 and TGF-β in reproductive age women. Further studies are needed to explore the possible underlying mechanisms.