Vitamin D status and prevalence of hypovitaminosis D in different genders throughout life stages: A Brazilian cross-sectional study

OBJECTIVES: To evaluate the mean concentration of 25-hydroxivitamin D [25(OH) D] and prevalence of hypovitaminosis D in individuals residing in Rio de Janeiro, Brazil. METHODS: The data of 80,000 consecutive individuals who had 25(OH) D measurements performed by electrochemiluminescence between 1/2/2018 and 2/5/2018 were selected. Patients who reported the use of therapies/supplements were excluded. Levels of 25(OH) D ≥20 ng/mL (ages <60 years) and ≥30 ng/mL (ages ≥60 years) were considered adequate. RESULTS: We analyzed the data of 24,074 individuals (1-95 years old, 64.7% female). Descriptive curves showed that, in both sexes, the mean values of 25(OH) D decreased from the first years of life until adolescence, then slightly increased, and then tended to stabilize during adulthood. Levels of 25(OH) D <20 ng/mL were observed in 6% of girls versus 3.6% of boys and in 13.6% of adolescent girls versus 12.6% of adolescent boys and 11% of adults. The percentage of seniors with serum levels of 25(OH) D <20 ng/mL was 13.6% in women and 12.7% in men; 53.2% of women and 50.6% of men had levels <30 ng/mL. CONCLUSIONS: Mean 25(OH) D values were higher in children and lower in adolescents and women. Approximately 90% of non-seniors and presumably healthy residents of the urban metropolitan region of Rio de Janeiro presented satisfactory levels of 25(OH) D during the summer months; however, in over half of the elderly, the serum concentrations of 25(OH) D were inadequate. Therefore, strategies for the prevention of hypovitaminosis D should be considered in the senior population.

Tireoidite supurativa aguda com múltiplas complicações / Acute suppurative thyroiditis with multiple complications

A tireoidite supurativa aguda é uma desordem rara, mais frequentemente causada pelo Staphylococcus aureus ou Streptococcus pneumoniae, e atinge particularmente crianças com fístula do seio piriforme. Em adultos, a disseminação por via hematogênica a partir de foco infeccioso em orofaringe ou trato respiratório parece ser o principal mecanismo patogênico. Os sinais e sintomas iniciais da tireoidite aguda são semelhantes aos da faringite aguda e da tireoidite subaguda. Esse fato frequentemente retarda o diagnóstico dessa doença e aumenta o risco de complicações. Relatamos o caso de um paciente masculino de 28 anos, previamente saudável, que, após quadro de amigdalite, apresentou tireoidite aguda complicada por tireotoxicose, volumoso abscesso no lobo direito da tireoide, que se estendia à abertura superior do tórax com desvio da traqueia e compressão de grandes vasos, associado à trombose de veia jugular interna e sepse.

Acute suppurative thyroiditis is a rare disorder, most often caused by Staphylococcus aureus or Streptococcus pneumoniae, which affects particularly children with pyriform sinus fistula. In adults, the main pathogenic mechanism seems to be hematogenous dissemination from a focus of infection in the oropharynx or respiratory tract. The initial signs and symptoms of acute thyroiditis are similar to those of acute pharyngitis and subacute thyroiditis. This fact often delays diagnosis and increases the risk of complications. We report the case of a previously healthy, 28-year-old man who, after being affected by tonsillitis, developed suppurative thyroiditis complicated by thyrotoxicosis; a large abscess in the right lobe of the thyroid extending to the thorax introitus, which caused a trachea deviation and compressed large vessels; associated with internal jugular vein thrombosis, and sepsis.

Síndrome dos ovários policísticos e insulina: revisão do vínculo fisiopatológico e do tratamento com sensibilizadores de insulina / Polycistic ovary syndrome and insulin: revision of entail physiopathologic and insulin sensitizing agents treatment

A síndrome dos ovários policísticos (SOP) é uma desordem complexa que engloba um amplo espectro de sinais e sintomas, predominando aqueles de disfunção ovariana. Acomete cerca de 10 por cento das mulheres em idade reprodutiva. Resistência insulínica e hiperinsulinemia desempenham papel importante na patogênese da doença. Nesse contexto, a utilização de sensibilizadores de insulina (metformina e glitazonas) tem sido recentemente proposta como terapia de escolha para muitas mulheres com SOP. O uso desse agentes está associado a decréscimo nos níveis de androgênios e gonadotropinas, melhora na tolerência à glicose, perfil lipídico e função endotelial com redução dos marcadores de doença aterosclerótica subclínica. O tratamento é potencialmente útil no controle do hiperandrogenismo, das alterações metabólicas e particularmente da fertilidade.

Polycystic ovary syndrome is a complex disorder that encompasses a wide range of signs and symptoms, mainly those related with ovarian dysfunction, and affects about 10 per cent of women during their reproductive years. Insulin resistance and hyperinsulinemia play important role in the pathogenesis of the disease. So, insulin-sensitizing agents (metformin and glitazones) have been recently proposed as the therapy of choice for many women with polycystic ovary syndrome. Insulin sensitizer treatment has been associated with a reduction in serum androgen levels and gonadotropins, improvement in glucose tolerance, lipid profile and endothelial function with reduction in sub-clinica atherosclerotic markers. The treatment is potentially useful in the control of hyperandrogenism, metabolic changes and improvement of fertility.