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2.
Medicina (B.Aires) ; 80(3): 289-291, jun. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1125082

ABSTRACT

El hipoparatiroidismo (hipoPTH) es una enfermedad infrecuente caracterizada por hipocalcemia y niveles inapropiadamente bajos o ausentes de parathormona. Presentamos el caso de un hombre de 25 años, deportista de alto rendimiento, con antecedente de hipoPTH secundario a tiroidectomía total dos años antes por cáncer papilar multifocal bilateral tiroideo, estadificado como T3 N1b M0, derivado por hipocalcemia sintomática. Presentaba calcemias promedio de 7mg%, síntomas de hipocalcemia en reposo y múltiples internaciones. Inicialmente, se optimizó tratamiento convencional con aporte de calcio vía oral hasta 12g/día, vitamina D y calcitriol, sin mejoría clínica ni bioquímica. Se descartaron malabsorción y complicaciones crónicas de hipoPTH. Se evidenció a través de cuestionario de salud SF-36 disminución de la calidad de vida. Se indicó sustitución con parathormona recombinante humana [rhPTH(1-84)] 50μg/día subcutánea con posterior ascenso a 75μg y reducción progresiva de la medicación por vía oral. Actualmente se encuentra asintomático, sin requerimiento de calcio ni vitamina D, mantiene calcemias de 9mg%, realiza actividad deportiva y demuestra marcada mejoría en la calidad de vida según cuestionario SF-36 (36-Item Short Form Health Survey).


Hypoparathyroidism (HypoPT) is a rare disease characterized by low calcium and inappropriately low circulating parathormone levels. We present the case of a 25-year-old high-performance athlete male, with history of HypoPT after total thyroidectomy for papillary thyroid carcinoma (T3 N1b M0) two years before, who was referred to our clinic for symptomatic hypocalcemia. The patient reported serum calcium average levels of 7mg%, presented symptoms of hypocalcemia at rest and had multiple hospital admissions. First, standard treatment was optimized by calcium supplementation up to 12g/d and active vitamin D, not showing clinical or biochemical improvement. Malabsorption and complications of chronic HypoPT were ruled out. The 36-Item Short Form Health Survey (SF-36) demonstrated an impaired quality of life (QoL). Full-length recombinant human parathyroid hormone [rhPTH(1-84)] therapy was started with 50μg/d subcutaneous, and later adjusted to 75μg/d and the oral treatment gradually decreased. Currently, he is asymptomatic, with serum calcium levels above 9mg%, without receiving oral medication. He performs sports activity and shows marked improvement in quality of life according to SF-36 questionnaire.


Subject(s)
Humans , Male , Adult , Parathyroid Hormone/therapeutic use , Hypoparathyroidism/drug therapy , Thyroidectomy/adverse effects , Vitamin D/therapeutic use , Calcitriol/therapeutic use , Thyroid Neoplasms/surgery , Thyroid Neoplasms/complications , Hormone Replacement Therapy/methods , Calcium-Regulating Hormones and Agents/therapeutic use , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/complications , Hypoparathyroidism/etiology
3.
Actual. osteol ; 16(1): 12-25, Ene - abr. 2020. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-1130045

ABSTRACT

La paratiroidectomía (PTX) es la terapia de elección en el hiperparatiroidismo secundario a enfermedad renal crónica (HPT-ERC) resistente al tratamiento médico. El objetivo del presente estudio fue evaluar el resultado de la PTX a largo plazo y sus factores predictores. Métodos: estudio unicéntrico retrospectivo observacional. Se incluyeron 92 pacientes con HPT-ERC en diálisis, en quienes se realizó la primera PTX en el Hospital Italiano de Buenos Aires entre 2006 y 2015 con seguimiento ≥ 6 meses. Se consideró persistencia del HPTERC con PTH > 300 pg/ml en el semestre posoperatorio, y recidiva con PTH > 500 pg/ml luego. Resultados: edad: 43,6±12,8 años, 50% mujeres, mediana 4,6 años de diálisis, PTH preoperatoria mediana 1639 pg/ml. A 39 se les realizó PTX subtotal (PTXS) y a 53 total con autoimplante (PTXT+AI). Se observó persistencia en 16 pacientes (17,4%). Presentaron recidiva 30 de 76 pacientes con adecuada respuesta inicial (39,5%; IC 95 28,5-50,5). La mediana de tiempo hasta la recidiva fue de 4,7 años (RIC 2,3-7,5). Los pacientes con recidiva presentaron mayor calcemia preoperatoria (mediana 9,9 vs. 9,3 mg/dl, p=0,035; OR ajustado 2,79) y menor elevación de fosfatasa alcalina en el posoperatorio (333 vs. 436 UI/l, p=0,031; OR ajustado 0,99). La recidiva se presentó más frecuentemente luego de la PTXT+AI (48,9%; OR ajustado 4,66), que en la PTXS (25,8%). Conclusiones: el tiempo en diálisis con inadecuado control metabólico constituye el principal factor para la recurrencia del HPT. Se postula que la mayor calcemia preoperatoria está relacionada con un HPT más severo y se asocia a recurrencia. Llamativamente, hallamos menores elevaciones de la fosfatasa alcalina durante el posoperatorio en pacientes con recurrencia. Hipotetizamos que esto pueda asociarse con menor mineralización en el posoperatorio e hiperfosfatemia sostenida, con consecuente estímulo paratiroideo. La menor recurrencia del HPT luego de la PTXS se vincula al sesgo generado en la selección del tipo de cirugía. (AU)


Parathyroidectomy is an effective therapy for refractory secondary hyperparathyroidism (sHPT). Continued dialysis represents risk for recurrent sHPT. The aim of this study was to estimate the proportion of recurrence and determine its predictors. Methods: We conducted a retrospective observational study of 92 adults in chronic dialysis, who underwent their first parathyroidectomy in this center between 2006 and 2015. We considered persistence of sHPT if PTH was > 300 pg/ml during the first postoperative semester, and recurrence if it was > 500 pg/ml afterwards. Results: Age 43.6+-12 y/o, 50% female, 4.6 years on dialysis, median preoperative PTH 1636 pg/ml (IQR 1226-2098). Subtotal parathyroidectomy (sPTX) was performed in 39, Total with autotransplantation (TA-PTX) in 53 patients. Persistence of sHPT occurred in 16 patients; relapse in 30 out of 76 with adequate initially response (39.5%; 95CI 28,5-50,5). Median time to recurrence: 4.7 y. Recurring patients had higher preoperative calcemia (9.9 vs 9.3 mg/dl; adj OR 2.79) and lower postoperative elevation of ALP (333 vs 436 UI/ml; adj OR 0.99). Recurrence presented more frequently in TA-PTX (48.9%; adj OR 4.66) than sPTX (25.8%). Conclusions: Time on dialysis with inadequate metabolic control remains the most important risk factor for sHPT recurrence. Higher preoperative levels of calcemia, related to sHPT severity, are associated with recurrence. Lower elevations of ALP during postoperative period in recurring patients are an interesting finding. We hypothesize that patients with less significant postoperative mineralization may have chronically higher levels of phosphatemia, stimulating parathyroid glands. Fewer recurrence in sPTX is associated to a bias in the procedure selection. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Parathyroidectomy/statistics & numerical data , Hyperparathyroidism, Secondary/complications , Recurrence , Vitamin D/therapeutic use , Calcitriol/analogs & derivatives , Calcitriol/therapeutic use , Calcium/blood , Retrospective Studies , Renal Dialysis , Alkaline Phosphatase/blood , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/therapy , Hyperparathyroidism, Secondary/surgery , Hyperparathyroidism, Secondary/diagnosis , Hyperparathyroidism, Secondary/therapy
4.
J. bras. nefrol ; 38(3): 313-319, July-Sept. 2016. tab, graf
Article in English | LILACS | ID: lil-796193

ABSTRACT

Abstract Introduction: Secondary hyperparathyroidism (SHPT) is a consequence of chronic kidney disease. The treatment at the Brazilian Unified Heath System (SUS) is performed with calcitriol, a drug which favors hypercalcemia and/or hyperphosphatemia, hindering the control of SHPT. Another option is paricalcitol, which causes parathormone (PTH) suppression faster than calcitriol, with minor changes in calcium-phosphorus product and calcium and phosphorus serum levels. Objective: This study aims to develop a cost-effectiveness analysis of paricalcitol versus calcitriol for patients in dialytic treatment with SHPT, from the SUS perspective. Methods: A Markov decision model was developed for patients ≥ 50 years old with end stage renal disease in dialytic treatment and SHPT. Quarterly cycles and a lifetime time horizon were considered. Life years (LY) gained were assessed as clinical outcome. Clinical and economic inputs were obtained from systematic literature review and official databases. Costs are presented in Brazilian real (BRL), for the year 2014. Results: In the base case: paricalcitol generated a clinical benefit of 16.28 LY gained versus 14.11 LY gained with calcitriol, total costs of BRL 131,064 and BRL 114,262, respectively, determining an incremental cost-effectiveness ratio of BRL 7,740 per LY gained. The data robustness was confirmed by the sensitivity analysis. Conclusions: According to cost-effectiveness threshold recommended by the World Health Organization for 2013, the treatment of SHPT in patients on dialysis with paricalcitol is cost-effective when compared to calcitriol, from the public healthcare system perspective, in Brazil.


Resumo Introdução: O hiperparatireoidismo secundário (HPTS) é uma consequência da doença renal crônica. O tratamento no SUS é realizado com calcitriol, que favorece a hipercalcemia e/ou hiperfosfatemia, dificultando o controle do HPTS. Uma opção clinicamente relevante é o paricalcitol, que ocasiona a supressão do paratormônio (PTH) de forma mais rápida que o calcitriol e com menores alterações nas taxas séricas de cálcio, fósforo e do produto cálcio-fósforo. Objetivo: Este trabalho tem como objetivo desenvolver uma análise de custo-efetividade de paricalcitol versus calcitriol para pacientes em diálise com HPTS, perspectiva do SUS. Métodos: Foi desenvolvido um modelo de decisão de Markov para a população ≥ 50 anos, com DRC em diálise e HPTS. Foram considerados ciclos trimestrais e um horizonte temporal lifetime. O desfecho clínico avaliado foram os anos de vida ganhos. Dados foram obtidos a partir de revisão sistemática da literatura e bases de dados oficiais. Custos em reais (R$), ano de 2014. Resultados: No caso base: paricalcitol gerou benefício clínico de 16,28 anos de vida ganhos versus 14,11 anos de vida ganhos com calcitriol, custos totais de R$ 131.064 e R$ 114.262, respectivamente. A razão de custo-efetividade incremental de R$ 7.740 por ano de vida salvo. Dados robustos confirmados pela análise de sensibilidade. Conclusão: De acordo com o limiar de custo-efetividade recomendado pela Organização Mundial de Saúde para o ano de 2013, o tratamento de pacientes com HPTS em diálise com paricalcitol é custo-efetivo, comparado ao calcitriol, perspectiva SUS.


Subject(s)
Humans , Male , Female , Middle Aged , Calcitriol/economics , Calcitriol/therapeutic use , Cost-Benefit Analysis , Bone Density Conservation Agents/economics , Bone Density Conservation Agents/therapeutic use , Brazil , Ergocalciferols/economics , Ergocalciferols/therapeutic use , Renal Dialysis , Delivery of Health Care , Hyperparathyroidism, Secondary/economics , Hyperparathyroidism, Secondary/drug therapy
5.
An. bras. dermatol ; 91(2): 160-166, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-781364

ABSTRACT

Abstract BACKGROUND: Psoriasis is a common, chronic, recurrent, immune-mediated disorder of the skin and joints. It can have a significant negative impact on the physical, emotional and psychosocial wellbeing of affected patients. OBJECTIVES: To measure improvement in health-related QoL (HRQoL) in Greek patients with psoriasis vulgaris after a month of treatment with calcipotriol-betamethasone dipropionate gel; and evaluate adherence to treatment parameters. METHODS: The study included 394 psoriasis vulgaris patients from 16 private dermatological practices in Greece, all treated with calcipotriol-betamethasone dipropionate gel. They were evaluated at the first visit and after 4 weeks. Moreover, they completed the Dermatology Life Quality Index (DLQI), while other data such as disease severity, subjective symptoms and adherence, were collected. RESULTS: At week 4, the DLQI median was reduced by 3.5 points from the baseline (p<0.001; baseline and week 4 median: 4.5 and 1.0 respectively). Pruritus and sleep disorders also improved (p<0.001). Furthermore, 90.1% of the subjects fully adhered to treatment, with a 97.1% mean level of compliance. CONCLUSIONS: The convincing clinical results, with a distinct improvement in HRQoL, plus the high level of adherence due to its advantageous physical properties, make the calcipotriol-betamethasone dipropionate gel formulation an important, effective and well-tolerated topical therapy to treat psoriasis.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Psoriasis/drug therapy , Quality of Life , Calcitriol/analogs & derivatives , Betamethasone/analogs & derivatives , Dermatologic Agents/therapeutic use , Medication Adherence/statistics & numerical data , Psoriasis/pathology , Time Factors , Severity of Illness Index , Calcitriol/therapeutic use , Betamethasone/therapeutic use , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Statistics, Nonparametric , Drug Combinations , Medication Adherence/psychology , Gels , Greece
7.
Braz. j. med. biol. res ; 48(7): 654-664, 07/2015. graf
Article in English | LILACS | ID: lil-751344

ABSTRACT

Recent evidence indicates that a deficiency of 1,25-dihydroxyvitamin D3 (1,25[OH]2D3) may influence asthma pathogenesis; however, its roles in regulating specific molecular transcription mechanisms remain unclear. We aimed to investigate the effect of 1,25(OH)2D3 on the expression and enzyme activity of histone deacetylase 2 (HDAC2) and its synergistic effects with dexamethasone (Dx) in the inhibition of inflammatory cytokine secretion in a rat asthma model. Healthy Wistar rats were randomly divided into 6 groups: control, asthma, 1,25(OH)2D3 pretreatment, 1,25(OH)2D3 treatment, Dx treatment, and Dx and 1,25(OH)2D3 treatment. Pulmonary inflammation was induced by ovalbumin (OVA) sensitization and challenge (OVA/OVA). Inflammatory cells and cytokines in the bronchoalveolar lavage (BAL) fluid and histological changes in lung tissue were examined. Nuclear factor kappa B (NF-κB) p65 and HDAC2 expression levels were assessed with Western blot analyses and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR). Enzyme activity measurements and immunohistochemical detection of HDAC2 were also performed. Our data demonstrated that 1,25(OH)2D3 reduced the airway inflammatory response and the level of inflammatory cytokines in BAL. Although NF-κB p65 expression was attenuated in the pretreatment and treatment groups, the expression and enzyme activity of HDAC2 were increased. In addition, 1,25(OH)2D3 and Dx had synergistic effects on the suppression of total cell infusion, cytokine release, and NF-κB p65 expression, and they also increased HDAC2 expression and activity in OVA/OVA rats. Collectively, our results indicated that 1,25(OH)2D3 might be useful as a novel HDAC2 activator in the treatment of asthma.


Subject(s)
Animals , Male , Asthma/drug therapy , Calcitriol/pharmacology , /drug effects , NF-kappa B/drug effects , Vitamins/pharmacology , Asthma/chemically induced , Blotting, Western , Bronchoalveolar Lavage Fluid/chemistry , Cell Count , Calcitriol/therapeutic use , Cytokines/analysis , Cytokines/drug effects , Disease Models, Animal , Enzyme-Linked Immunosorbent Assay , Gene Expression Regulation, Enzymologic/drug effects , /metabolism , Immunohistochemistry , Lung/chemistry , Lung/drug effects , NF-kappa B/analysis , Ovalbumin , Rats, Wistar , Real-Time Polymerase Chain Reaction , Reproducibility of Results , Treatment Outcome , Vitamins/therapeutic use
8.
An. bras. dermatol ; 89(5): 803-805, Sep-Oct/2014. graf
Article in English | LILACS | ID: lil-720802

ABSTRACT

Although uncommonly diagnosed, clear cell acanthoma represents an original source of speculative interest for dermatologists. Due to its clinical variability, it is often only recognized accidentally after histology. Dermoscopy has improved the reliability of clinical diagnosis of typical clear cell acanthoma thanks to the vascular pinpoint pattern and desquamative, peripheral collarette. Generally, therapy of clear cell acanthoma is oriented towards ablative solutions, such as surgery or cryotherapy. We propose a conservative therapy, based on the application of topical calcipotriol, which has produced complete regression after 2 months and no relapse one year after the end of treatment. A dermatoscope monitored all changes of clear cell acanthoma, showing its utility not only in diagnosis but also in therapeutic follow-up. This new therapeutic approach should support an inflammatory etiology of clear cell acanthoma, although further observations are needed to confirm this.


Subject(s)
Aged , Humans , Male , Acanthoma/drug therapy , Calcitriol/analogs & derivatives , Dermatologic Agents/therapeutic use , Skin Neoplasms/drug therapy , Administration, Cutaneous , Antineoplastic Agents/therapeutic use , Calcitriol/therapeutic use , Dermoscopy , Time Factors , Treatment Outcome
9.
Indian J Dermatol Venereol Leprol ; 2013 July; 79 Suppl(): S47-52
Article in English | IMSEAR | ID: sea-147531

ABSTRACT

Psoriasis is a common, chronic, inflammatory skin disease that can have a significant impact on the quality of life of those who are afflicted due to chronicity of the disease and frequent remissions and relapses. Many available systemic therapies, however, are unsuitable for chronic administration due to the risk of cumulative toxicity. Recent advances in the understanding of the pathophysiology of psoriasis have led to the development of new, genetically engineered, targeted therapies for this disease. These include approaches targeting antigen presentation and co-stimulation, T-cell activation and leukocyte adhesion, action on pro-inflammatory mediators, and modulating the cytokine balance. Although only preliminary data are available so far and there is limited data supporting their use, these trials contribute to a further understanding of the disease and will eventually lead to new therapeutic options for psoriasis.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antigen-Presenting Cells/immunology , Calcitriol/therapeutic use , Cytokines/antagonists & inhibitors , Humans , Molecular Targeted Therapy , Psoriasis/drug therapy , Receptors, Chemokine/antagonists & inhibitors , Recombinant Fusion Proteins/therapeutic use , Signal Transduction/drug effects
10.
Indian J Dermatol Venereol Leprol ; 2013 Jul; 79(Suppl_7):s47-s52
Article in English | IMSEAR | ID: sea-154746

ABSTRACT

Psoriasis is a common, chronic, inflammatory skin disease that can have a significant impact on the quality of life of those who are afflicted due to chronicity of the disease and frequent remissions and relapses. Many available systemic therapies, however, are unsuitable for chronic administration due to the risk of cumulative toxicity. Recent advances in the understanding of the pathophysiology of psoriasis have led to the development of new, genetically engineered, targeted therapies for this disease. These include approaches targeting antigen presentation and co-stimulation, T-cell activation and leukocyte adhesion, action on pro-inflammatory mediators, and modulating the cytokine balance. Although only preliminary data are available so far and there is limited data supporting their use, these trials contribute to a further understanding of the disease and will eventually lead to new therapeutic options for psoriasis.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antigen-Presenting Cells/immunology , Calcitriol/therapeutic use , Cytokines/antagonists & inhibitors , Humans , Molecular Targeted Therapy , Psoriasis/drug therapy , Receptors, Chemokine/antagonists & inhibitors , Recombinant Fusion Proteins/therapeutic use , Signal Transduction/drug effects
11.
Article in Korean | WPRIM | ID: wpr-46502

ABSTRACT

The metastatic calcification is defined as the deposition of calcium salt in normal tissue with an abnormal serum biochemical environment, such as chronic kidney disease, hyperparathyroidism, and hypercalcemia related with malignancy. Although the metastatic calcification can develop in any organs and tissues, presenting its symptoms and complications are rare. Thus a few cases have been reported. This case shows the metastatic calcification of the small intestine without any peritoneal and mesenteric vascular calcification which was early diagnosed by computed tomography and mesenteric angiography in a patient with abdominal pain, receiving continuous ambulatory peritoneal dialysis due to end stage renal disease. The clinician should early consider the metastatic calcification as differential diagnosis when unidentified calcifications are noted in simple abdominal X-ray such as in the present case, and promptly confirm it by using appropriate diagnostic tests in order to prevent its complications and progression.


Subject(s)
Calcinosis/diagnosis , Calcitriol/therapeutic use , Calcium/blood , Calcium Carbonate/therapeutic use , Calcium Channel Agonists/therapeutic use , Humans , Intestine, Small/diagnostic imaging , Kidney Failure, Chronic/therapy , Male , Mesenteric Artery, Superior/diagnostic imaging , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Tomography, X-Ray Computed
12.
Brasília; CONITEC; out. 2012. tab, graf.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-836739

ABSTRACT

A psoríase é uma das doenças inflamatórias da pele mais frequentes do mundo. Caracteriza-se por lesões eritêmato-descamativas com padrões e distribuição corpórea variáveis, podendo ser classificada fenotipicamente em formas vulgar, gutata, eritrodérmica e pustulosa. A forma mais frequente da psoríase é a psoríase em placas ou vulgar. O número, dimensão e extensão das lesões são variáveis entre os pacientes e conforme a evolução da doença. As lesões surgem sobretudo nos cotovelos, joelhos, região lombar e couro cabeludo, embora possam afetar qualquer área do corpo, cobrindo, nos casos mais graves, extensas áreas do tronco e membros. O Daivobet® é uma combinação de duas substâncias com diferentes mecanismos de ação: hidrato de calcipotriol, um análogo da vitamina D3, com ação anti-proliferativa; e dipropionato de betametasona, um corticosteroide tópico, com potente ação anti-inflamatória. Como existe uma incompatibilidade química entre o calcipotriol e os corticóides de alta potência, não é recomendado que se misture os dois produtos finais. A incompatibilidade se deve ao fato de que o calcipotriol necessita de um alto pH para ter estabilidade e o dipropionato de betametasona só é estável em meio ácido (pH em torno de 3,5). Um veículo inovador permite a combinação dos dois princípios ativos na mesma formulação com garantia da estabilidade dos dois componentes. A evidência atualmente disponível sobre a eficácia do Daivobet® individualmente é limitada, mas como grupo farmacológico (análogo de vitamina D + corticosteróide) fica demonstrado sua eficácia clínica para tratamento tópico da psoríase vulgar, apesar de que esta eficácia é, em algumas circunstâncias, de pouco impacto clínico dependendo do desfecho analisado e do tipo de comparador avaliado. Também temos que ter em consideração a gravidade e o grau de comprometimento do paciente, que como foi observado em outros estudos, os melhores resultados foram obtidos em pacientes com Psoríase Leve, indicação que também é recomendada pelo Consenso Brasileiro de Psoríase. Os membros da CONITEC presentes na reunião ordinária do dia 02/08/2012, por unanimidade, deliberaram por recomendar a não incorporação do medicamento Daivobet® (calcipotriol + dipropionato de betametasona) para o tratamento da psoríase. Foi assinado o Registro de Deliberação nº 15/2012 na 7ª reunião ordinária de 02/08/2012.


Subject(s)
Humans , Calcitriol/analogs & derivatives , Calcitriol/therapeutic use , Dermatologic Agents/therapeutic use , Psoriasis/therapy , Brazil , Cost-Benefit Analysis/economics , Technology Assessment, Biomedical , Unified Health System
13.
Rev. salud pública ; 13(5): 804-813, oct. 2011. ilus, tab
Article in English | LILACS | ID: lil-625646

ABSTRACT

Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.


Objetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce la incidencia de hipocalcémia sintomática. Se evalúa su costo-efectividad en Colombia. Materiales y métodos Utilizamos la información de un meta-análisis que comparó la administración de vitamina D o metabolitos contra calcio no tratamiento en pacientes llevados a tiroidectomía total y diseñamos un análisis de costo-efectividad basados en un modelos de decisiones con costos locales. Resultados El valor del OR para la comparación entre calcitriol y calcio comparado con no tratamiento o calcio exclusivo fue de 0.32 (95 % IC, 0.13- 0.79) y 0.31 (95 % IC, 0.14-0.70), respectivamente. La estrategia más costo-efectiva fue la administración de vitamina D o metabolitos y calcio, con una relación de costo-efectividad incremental de US $0.05. Conclusiones El tratamiento profiláctico de la hipo calcemia con vitamina D o metabolitos y calcio o calcio exclusivo después de tiroidectomía total es una estrategia costo-efectiva.


Subject(s)
Humans , Calcitriol/therapeutic use , Calcium Carbonate/therapeutic use , Calcium Gluconate/therapeutic use , Hypocalcemia/prevention & control , Postoperative Care/economics , Postoperative Complications/prevention & control , Thyroidectomy , Colombia , Cost-Benefit Analysis , Calcitriol/administration & dosage , Calcitriol/economics , Calcium Carbonate/administration & dosage , Calcium Carbonate/economics , Calcium Gluconate/administration & dosage , Calcium Gluconate/economics , Calcium/blood , Decision Trees , Drug Costs , Emergencies/economics , Hypocalcemia/economics , Hypocalcemia/epidemiology , Hypocalcemia/etiology , Length of Stay/economics , Length of Stay/statistics & numerical data , Probability , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Tetany/epidemiology , Tetany/etiology , Tetany/prevention & control
16.
Actual. osteol ; 4(3): 121-127, sept.-dic. 2008.
Article in Spanish | LILACS | ID: lil-614286

ABSTRACT

El cáncer es una de las mayores causas de muerte en el mundo. Si bien la vitamina D (colecalciferol) ha sido asociada a la regulación de la homeostasis de calcio, muchos son los datos epidemiológicos, bioquímicos y genéticos sobre otros efectos importantes de la vitamina D, como el desarrollo y la progresión de diferentes cánceres. El objetivo del presente artículo es revisar distintos aspectos acerca de los mecanismos de acción y efectos moleculares de la vitamina D o sus metabolitos y de los indicadores epidemiológicos que los correlacionan con el cáncer, su prevención y tratamiento. El estudio de los efectos de la vitamina D se ha vuelto muy amplio: nuevos genes, nuevos blancos, mecanismos diferentes. Niveles adecuados de vitamina D son necesarios para una gran cantidad de procesos fisiológicos y no solamente para el mantenimiento de la homeostasis del calcio. Los estudios clínicos podrían revisar las recomendaciones sobre las dosis de vitamina D que puedan proteger también contra el desarrollo del cáncer.


Subject(s)
Humans , Male , Female , Calcitriol/metabolism , Calcitriol/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology , Neoplasms/prevention & control , Vitamin D , Vitamin D/metabolism , Vitamin D/chemistry , Cell Differentiation , Nutritional Status
17.
Arq. bras. endocrinol. metab ; 52(8): 1244-1251, Nov. 2008. ilus, graf, tab
Article in English | LILACS | ID: lil-503289

ABSTRACT

Mutations in the vitamin D receptor (VDR) are associated to the hereditary 1,25-dihydroxivitamin D-resistant rickets. The objectives of this work are: search for mutations in the VDR and analyze their functional consequences in four Brazilian children presented with rickets and alopecia. The coding region of the VDR was amplified by PCR e direct sequenced. We identified three mutations: two patients had the same mutation in exon 7 at aminoacid position 259 (p.Q259E); one patient had a mutation in exon 8 at codon 319 (p.G319V) and another one had a mutation in exon 3 leading to a truncated protein at position 73 (p.R73X). Functional studies of the mutant receptors of fibroblast primary culture, from patients' skin biopsy treated with increasing doses of 1,25(OH)2 vitamin D showed that VDR mutants were unable to be properly activated and presented a reduction in 24-hydroxylase expression level.


Mutações no receptor de vitamina D (VDR) são associadas a raquitismo hereditário resistente a 1,25-dihidroxivitamina D. Os objetivos deste trabalho foram procurar mutações no VDR e analisar suas conseqüências funcionais em quatro pacientes com raquitismo e alopécia. A região codificadora do VDR foi amplificada por PCR e seqüenciada diretamente. Identificamos três mutações: dois pacientes apresentavam a mesma mutação no éxon 7 na posição protéica 259 (p.Q259E); um paciente apresentava uma mutação no éxon 8 no códon 319 (p.G319V) e o outro apresentava uma mutação no exon 3 resultando em uma proteína truncada na posição 73 (p.R73X). O estudo funcional dos receptores mutados nos extratos de culturas de fibroblasto primárias obtidas de biópsia de pele dos pacientes, tratados com doses crescentes de 1,25(OH)2 vitamina D demonstraram que os receptores mutantes não apresentam ativação adequada apresentando expressão reduzida de 24-hidroxilase.


Subject(s)
Child , Female , Humans , Male , Young Adult , Alopecia/genetics , Familial Hypophosphatemic Rickets/genetics , Mutation , Receptors, Calcitriol/genetics , Alopecia/drug therapy , Base Sequence , Calcitriol/therapeutic use , Fibroblasts/drug effects , Fibroblasts/enzymology , Familial Hypophosphatemic Rickets/drug therapy , RNA, Messenger/genetics , RNA, Messenger/metabolism , Receptors, Calcitriol/metabolism , Sequence Analysis, DNA , Steroid Hydroxylases/genetics , Steroid Hydroxylases/metabolism , Vitamins/therapeutic use , Young Adult
18.
Rev. chil. endocrinol. diabetes ; 1(4): 257-262, oct. 2008. tab, graf, ilus
Article in Spanish | LILACS | ID: lil-612486

ABSTRACT

We report a 77 years old woman with osteoporosis in whom a hyperparathyroidism secondary vitaminD deficiency and renal hypercalciuria was diagnosed. Serum calcium was normal. During the diagnostic work up, a parathyroid nodule was discovered and subjected to a fine needle aspiration biopsy, that showed normal parathyroid cells. The patient was treated with calcitriol, cholecalciferol, hydrochlorothiazide and intravenous zolendronic acid. There was a reduction in urinary calcium and serum PTH levels and improvement of serum 25 hydroxy vitamin D levels.


Subject(s)
Humans , Female , Aged , Vitamin D Deficiency/complications , Kidney Diseases/complications , Hypercalciuria/complications , Hyperparathyroidism/etiology , Bone Density , Calcitriol/therapeutic use , Cholecalciferol/therapeutic use , Vitamin D Deficiency/drug therapy , Kidney Diseases/drug therapy , Hypercalciuria/drug therapy , Thyroid Nodule/diagnosis , Osteoporosis/etiology
19.
Med. infant ; 15(3): 233-239, sept. 2008. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: lil-544699

ABSTRACT

El estudio del crecimiento a largo plazo de niños con raquitismo hipofosfatémico familiar, demostró que 18 de los 30 pacientes estudiados no crecían adecuadamente, y que a su vez este pobre crecimiento estaba asociado a una falta de cumplimiento de la ingesta de fósforo indicada por el médico tratante, medicación que forma parte esencial de la terapia. Entre las principales causas identificadas de falta de cumplimiento se encontró la incapacidad de muchas farmacias del país de preparar la solución de sales de fósforo, las dificultades de transporte y conservación de dichas sales, la inestabilidad de la solución, la falta de recursos de los pacientes sin cobertura, la dificultad de las obras sociales en financiar las sales en los pacientes con cobertura. Luego de reuniones mantenidas entre miembros de un equipo multidiciplinarios formado ad hoc, la farmacia del hospital logró preparar una cápsula con sales de fósforo para ser disuelta en agua en el hogar, se estableció un circuito de entrega gratuita del medicamento al paciente aprobado por las autoridades del Hospital, y un sistema de cobro a los organismos pagadores en los casos que correspondiera. La autorización de la Dirección fue tomada en base a la necesidad de mejorar la calidad de atención en estos pacientes, al relativo bajo costo del medicamento (1180 pesos por pacientes por año), y el escaso número de pacientes bajo tratamiento. La vigilancia del crecimiento en pacientes crónicos probó en este caso ser una herramienta confiable y sencilla para detectar un problema generalizado en el tratamiento de una enfermedad y mejorar la calidad de la atención.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Calcitriol/therapeutic use , Pharmaceutical Trade , Growth and Development , Phosphorus/therapeutic use , Hypophosphatemia, Familial , Failure to Thrive/prevention & control
20.
Actual. osteol ; 4(1): 14-21, ene.-abr. 2008. ilus
Article in Spanish | LILACS | ID: lil-614270

ABSTRACT

La osteomalacia tumoral (OT) u osteomalacia oncogénica es un síndrome paraneoplásico producido por una pérdida renal de fosfato. Es una enfermedad rara, con aproximadamente 130 casos publicados. Recientemente, se han descrito varios factores de origen óseo que participarían en el mantenimiento de la homeostasis del fósforo; en conjunto se los denomina ?fosfatoninas?, y el más conocido es el Factor de Crecimiento Fibroblástico 23 (FGF-23). Ésta es una hormona proteica detectable en el suero de sujetos sanos y ha sido relacionado con la fisiopatología de tres tipos de raquitismo/osteomalacia con hipofosfatemia: dos enfermedades hereditarias (raquitismo u osteomalacia hipofosfatémicos asociado/a al cromosoma X [XLH], y raquitismo u osteomalacia autosómicos dominantes [ADHR]), y la OT. Los tumores asociados a la OT son de origen mesenquimático, de crecimiento lento, complejos y polimórficos. En general estos tumores son benignos, de tamaño pequeño, asintomáticos y de localización incierta; también se ha descrito el cuadro en asociación con neoplasias malignas. El diagnóstico presuntivo requiere la documentación de hipofosfatemia y de una disminución marcada en la reabsorción tubular de fósforo. Deben registrarse los antecedentes familiares, y proceder a estudios de localización del tumor: la TC y la RNM son de poca utilidad, y recientemente se ha visto la sensibilidad de centellogramas con análogos de somatostatina y del PET scan con fluorodesoxiglucosa. El diagnóstico de certeza se obtiene si se logra la reversión de la hipofosfatemia con la extracción del tumor. El tratamiento médico requiere dosis altas de fosfatos y calcitriol por vía oral, no siempre bien tolerados. Se han usado también el octreotide y el calcimimético cinacalcet. El tratamiento curativo es la remoción quirúrgica del tumor causante.


Subject(s)
Humans , Male , Female , Calcitriol/therapeutic use , Diagnosis, Differential , Phosphates/therapeutic use , Hypophosphatemia , Neoplasms , Osteomalacia/diagnosis , Osteomalacia/therapy , Phosphorus Metabolism Disorders , Familial Hypophosphatemic Rickets , Vitamin D/metabolism , Bone Density Conservation Agents/administration & dosage , Paraneoplastic Syndromes
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