Calcium intake: good for the bones but bad for the heart? An analysis of clinical studies

ABSTRACT The proper dietary calcium intake and calcium supplementation, when indicated, are important factors in the acquisition of peak bone mass during youth and in the prevention of fractures in old age. In addition to its deposition in bone, calcium confers an increase in its resistance and exhibits important activities in different enzymatic pathways in the body (e.g., neural, hormonal, muscle-related and blood clotting pathways). Thus, calcium supplementation can directly or indirectly affect important functions in the body, such as the control of blood pressure, plasma glucose, body weight, lipid profile and endothelial function. Since one publication reported increased cardiovascular risk due to calcium supplementation, many researchers have studied whether this risk actually exists; the results are conflicting, and the involved mechanisms are uncertain. However, studies that have evaluated the influence of the consumption of foods rich in calcium have reported no increase in the cardiovascular risk, which suggests that nutritional intake should be prioritized as a method for supplementation and that the use of calcium supplements should be reserved for patients who truly need supplementation and are unable to achieve the recommended daily nutritional intake of calcium.

Split-hand/foot malformation (SHFM) e manifestações atípicas: desafio diagnóstico / Split-hand/foot malformation (SHFM) and atypical manifestations: diagnostic challenge

A Split-hand/foot Malformation, muitas vezes aceita como sinônimo de ectrodactilia, é uma malformação com diferentes padrões de hereditariedade que pode se apresentar isoladamente ou como parte de síndromes de maior expressão clínica. Discutimos as peculiaridades do seu diagnóstico e das manifestações associadas ao quadro. Descrevemos o caso esporádico de um paciente com ectrodactilia que desenvolveu uma Síndrome Mielodisplásica associada a manifestações reumatológicas e a Trombose Venosa Profunda. Consideramos o paciente como portador da forma isolada da Split-hand/foot Malformation e as suas outras manifestações como consequências atípicas da Síndrome Mielodisplásica.

The Split-hand/foot Malformation often accepted as a synonym for ectrodactyly is a malformation with different patterns of heredity that can present it individually or as part of syndromes with most clinical significance. We discussed the peculiarities of their diagnosis and clinical manifestations associated with the condition presented. We describe a sporadic case of a patient with ectrodactyly who developed a myelodysplastic syndrome associated with rheumatic manifestations and Deep VeinThrombosis. We considered the patient as suffering from an isolated form of Split-hand/foot Malformation and its other manifestations as atypical consequences of myelodysplastic syndrome.

Doença de Mucha-Habermann / Mucha-Habermann disease

Os autores descrevem um caso de doença de Mucha-Habermann (DMH), que cursou com quadro sugestivo de síndrome de ativação macrofágica (SAM). O objetivo do trabalho foi descrever um caso de rara vasculite de Mucha-Habermann (pitiríase liquenoide e varioliforme aguda - PLEVA) em paciente de 28 anos que apresentou lesões ulceronecróticas generalizadas em pele e mucosas, acometimento gastrointestinal, cardíaco e hepático, associados a febre alta contínua, com provável evolução para SAM e posterior óbito. Trata-se de doença rara, potencialmente fatal, com graves complicações sistêmicas. Os autores ressaltam a importância de seu diagnóstico e de tratamento agressivo.

A case of Mucha-Habermann disease (MHD), possibly associated with macrophage activation syndrome (MAS), is reported. The purpose of this paper was to describe the rare MHD (also known as pityriasis lichenoides et varioliformis acuta - PLEVA) in a 28-year-old male, who presented with generalized ulceronecrotic lesions on the skin and mucosae, gastrointestinal involvement, and heart andliver failure, associated with continuous high fever.The patient might have progressed to MAS and eventually died. The MHD is rare, potentially fatal and has severe systemic complications.The importance of early diagnosis and aggressive treatment is emphasized.