Worldwide Interest in Vitamin D, Negative Effects on Kidneys, and Bone Density: Analysis of Google Trends Data

Background: Besides its role in calcium homeostasis and bone mineralization, vitamin D may also reduce the risk of cancer, cardiovascular and autoimmune diseases. Excessive vitamin D intake can lead to life-threatening hypercalcemia and toxicity, however. Here, we wanted to determine the relative search volume (RSV) of interest in vitamin D and its adverse biological effects (hypercalcemia, renal failure, kidney stones, bone density).Methods: We used data from Google Trends to assess changes in RSV trends across the world's regions. Data were extracted via the search terms "cholecalciferol", "ergocalciferol, "hypercalcemia", "acute renal failure", "kidney stones", and "bone density" from queries in English from 1 January 2004 to 1 October 2018 in the tool's related query database. Statistical analysis was performed using SPSS (R) 22.0 for Windows (IBM Inc., Armonk, NY, USA, 10504-1722).Results: There was a correlation between the RSV of cholecalciferol and ergocalciferol (Spearman's correlation) and the RSV of hypercalcemia, renal failure, kidney stones, and bone density. As measured by the change in RSV score, the trend for interest in kidney stones increased more rapidly than that for the other search terms. There was a positive correlation between the RSV score for cholecalciferol (or ergocalciferol) and renal failure and between the RSV score for cholecalciferol (or ergocalciferol) and kidney stones, whereas there was a negative correlation between cholecalciferol and hypercalcemia. The interest of ergocalciferol increased in parallel with the interest in bone density. The highest concentration of interest in cholecalciferol occurred in North America, Europe, India and Australia, whereas interest in ergocalciferol was greater in Central and South America, Spain, and Thailand. Interest in kidney stones was greater than cholecalciferol in North America, Brazil, India, and Australia, while interest in bone density was greater than cholecalciferol in North America, Brazil, Italy, Spain, South Africa, and Australia.Conclusions: In the pre-pandemic COVID-19 (COronaVIrus Disease 19) era, our preliminary results showed a positive correla-tion between global interest in cholecalciferol and kidney stones and renal failure, respectively. However, we found an unexpected negative correlation between global interest in cholecalciferol and hypercalcemia. Additionally, we found a positive correlation between global interest in ergocalciferol and bone density. These correlations can inform health interventions and education.

Decreased vitamin D Levels in the pediatric population after COVID-19 lockdown

Background. SarsCov2 infection began to spread worldwide since December 2019 and, on March 2020, the World Health Organization characterized its related disease, named COVID-19, as a pandemic. In Italy, to contain the spread of infection a severe lockdown from March 10th, 2020 to May 4th, 2020 was instituted. Other less severe restrictions were imposed in the winter 2020- 2021 and in the spring 2021. The containment measures caused a series of consequences for the population and, in particular, for children and adolescents that presented several psychophysical problems. Aim(s): This study aims to investigate the serum levels of vitamin D in children and adolescent before, during and after the lockdown consequent to COVID-19 pandemic. Material(s) and Method(s): This is a retrospective cross-sectional study, including all children and adolescents between 1 to 18 years referring to the Pediatric Endocrinology Service of the University Hospital of Verona, Italy, between January 2019 and December 2021. All patients affected by clinical conditions that involve vitamin D metabolism or assuming vitamin D supplementation were excluded. Result(s): In total, 490 children (36.7% males and 63.3% females) were enrolled in this study. The vitamin D levels decreased over time: 28.2 +/- 10.2 ng/mL in 2019;28.2 +/- 11.4 ng/mL in 2020 and 24.9 +/- 10.1 ng/mL in 2021 (p<0.05). The vitamin D levels are significant higher in summer and in autumn in comparison with the levels of winter and spring, regardless of the examined years. Conclusion(s): Our data showed that the measures adopted to contain the covid-19 pandemic led to a reduction of serum levels of vitamin D in pediatric population, probably due to the reduced solar exposure. This may have severe consequences on the bone metabolism of those children who did not present optimal vitamin D levels even before the lockdown. Therefore, an adequate supplementation of vitamin D is necessary at least during the winter period in children living in Northern Italy.

Have we changed our work during Covid19 pandemic

Background: Pain is one of the most debilitating symptoms in oncological diagnosis, and is present in most cancer patient (in the literature range 20 to 95%). Cancer pain is a chronic pain with multifactorial pathogenesis with which intense episodic transient acute pain can coexist (Btcp). Hence the need to assess / correctly measure pain to set an appropriate drug therapy (treatment based on the 'three steps of pain' -OMS 1986-) and it is possible to have a more objective evaluation of the results of the established analgesic therapy. During the emergency period, outpatient visits were reduced both in terms of organization and frequency and the reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection led to a new approach to taking load. Material (patients) and methods: Experience of our center, from 1 March 2020 to 31 May 2020, during the covid 19 emergency compared with the pre-covid period from 1 November 2019 to 31 January 2020 regarding the evaluation of pain, the need to set specific analgesic therapy, the need to modify this therapy in the course of time (switching between opioids or association between opioids of two different classes) and the need to add adjuvant drugs. Results: During this time we followed 15 patients versus 17 patients in pre-covid period. Pain was measured in all the first evaluation (using one-dimensional measurement scales-numerical scale -), in 90% of cases this was done by telephone (versus 0% pre covid). Furthermore, the cargiver's telephone involvement was necessary, especially in monitoring over time to evaluate pain control, Btcp episodes and side effects (in the pre-covid period it was the patient who exposed these data during the visit). On the other hand, as regards the specific analgesic therapy set, the need to rotate the opioids or to associate two opioids of different classes, the prescription of the rescue dose and the adjuvant drugs, there were no differences compared to the pre-emergency period. Conclusions: During the emergency period, in consideration of the high frequency of pain and the impact on the patient's quality of life, it was necessary to modify our approach to manage the patient with cancer, make a correct assessment (repeated over time) and set up an effective analgesic therapy.

Penalty for simultaneous care during the emergency covid-19

Background: Simultaneous care represents an organizational model based on the global care of the cancer patient through continuous assistance and a progressive integration between cancer therapies and palliative care. The model responds to global needs (physical, psychological, social) of the patient and his family managed by a multidisciplinary team made up of oncologists, palliativists, radiotherapists, psychologists. As compared with cancer patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life and longer survival. In the province of Sondrio ASST Valtellina and Alto Lario has activated simultaneous care for cancer patients for about a year. Material (patients) and methods: The simultaneous care clinics are structured on defined days and times, managed by a multidisciplinary team which always involve family members. During the emergency period the surgeries underwent changes in terms of organization and frequency. The reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection have led to a significant reduction in the numbers of cancer patients treated early in simultaneous treatment. The analysis of the data defines a number of 12 cancer patients followed simultaneously in a pre-covid period from 1 November 2019 to 31 January 2020. During the covid-19 emergency, in the period from 1 March 2020 to 31 May 2020, they were followed 5 patients. On average 3 patients versus 1 in the emergency period. Results: During the covid-19 emergency, the results show a significant reduction in simultaneous care paths. In this phase, the simultaneous care clinic was managed as needed by a single professional with telephone consultations and few home visits without the direct involvement of family members. Conclusions: The reduction in simulataneous care during the emergency period penalized cancer patients who, in a moment of clinical fragility, experienced a lived experience of abandonment that affected their quality of life. In memory of dr. Fabio Rubino, Responsible for the Palliative Care Service.