ABSTRACT
Hypovitaminosis D is now considered a pandemic, especially among more vulnerable populations and in HIV-infected subjects, with 80% presenting levels below 30 ng/mL. As there is no consensus on the more adequate dosage needed to correct such deficiency, the objective of this study was to evaluate 25 (OH) vitamin D supplementation in HIV-1 patients deficient of vitamin D. A total of 73 HIV-1-infected patients were included, drawn from a cohort of 435 patients; 37 patients were randomized to the active group, supplemented once a week with 50,000 UI vitamin D by mouth (group 1) and 36 to the placebo group (group 2). The study period ranged from June 2016 to September 2017. Variables involved in vitamin D metabolism and risk factors associated with hypovitaminosis were evaluated. The mean age was 45 years and 31.5 % were women. Vitamin D supplementation was effective in normalizing serum levels after six months in group 1 (mean 35 ng/mL compared to 21 ng/mL for the placebo group; p = 0.04). No patient reached blood levels considered toxic (>100 UI). Efavirenz use can negatively influence vitamin D levels and supplementation is necessary as a likely adjunct to improving CD4+ T cells, resulting in greater effectiveness of the treatment. A weekly oral dose of 50,000 IU of vitamin D was sufficient to normalize the vitamin deficiency, safely and with good adherence among persons living with HIV/AIDS in Brazil.
Subject(s)
Acquired Immunodeficiency Syndrome , Vitamin D Deficiency , Acquired Immunodeficiency Syndrome/drug therapy , Brazil , Dietary Supplements , Female , Humans , Middle Aged , Vitamin D , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiologyABSTRACT
ABSTRACT Hypovitaminosis D is now considered a pandemic, especially among more vulnerable populations and in HIV-infected subjects, with 80% presenting levels below 30 ng/mL. As there is no consensus on the more adequate dosage needed to correct such deficiency, the objective of this study was to evaluate 25 (OH) vitamin D supplementation in HIV-1 patients deficient of vitamin D. A total of 73 HIV-1-infected patients were included, drawn from a cohort of 435 patients; 37 patients were randomized to the active group, supplemented once a week with 50,000 UI vitamin D by mouth (group 1) and 36 to the placebo group (group 2). The study period ranged from June 2016 to September 2017. Variables involved in vitamin D metabolism and risk factors associated with hypovitaminosis were evaluated. The mean age was 45 years and 31.5 % were women. Vitamin D supplementation was effective in normalizing serum levels after six months in group 1 (mean 35 ng/mL compared to 21 ng/mL for the placebo group; p= 0.04). No patient reached blood levels considered toxic (>100 UI). Efavirenz use can negatively influence vitamin D levels and supplementation is necessary as a likely adjunct to improving CD4+ T cells, resulting in greater effectiveness of the treatment. A weekly oral dose of 50,000 IU of vitamin D was sufficient to normalize the vitamin deficiency, safely and with good adherence among persons living with HIV/AIDS in Brazil.
Subject(s)
Humans , Female , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiology , Acquired Immunodeficiency Syndrome/drug therapy , Vitamin D , Brazil , Dietary Supplements , Middle AgedABSTRACT
Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described in affected patients. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. This study aimed to assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya "milk") and hydration (minimum 2.5 L daily). All psoriasis patients were scored according to "Psoriasis Area and Severity Index" (PASI) at baseline and after treatment. Evaluation of clinical response of vitiligo patients required a quartile grading scale. All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from 14.9 ± 7.4 to 106.3 ± 31.9 ng/mL and from 18.4 ± 8.9 to 132.5 ± 37.0 ng/mL) and PTH levels significantly decreased (from 57.8 ± 16.7 to 28.9 ± 8.2 pg/mL and from 55.3 ± 25.0 to 25.4 ± 10.7 pg/mL) in patients with psoriasis and vitiligo respectively. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25-75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.
ABSTRACT
Nevos pigmentares constituem-se de células névicas que se definem como melanócitos com dendritos rudimentares e de maior tamanho que se originam dos melanoblastos da crista neural. A retirada cirúrgica de nevos pigmentares é indicação freqüente na práticaMédica. A recidiva destas lesões geralmente está relacionada à insuficiência de margens, podendo levar à recorrência da lesão com reaparecimento na área. É controverso na literatura a respeito de qual seriam as margens ideais, profunda e laterais, para evitar recidivas
Subject(s)
Humans , Dysplastic Nevus Syndrome , Nevus, Pigmented , Surgery, PlasticABSTRACT
Nevos pigmentares constituem-se de células névicas que se definem como melanócitos com dendritos rudimentares e de maior tamanho que se originam dos melanoblastos da crista neural. A retirada cirúrgica de nevos pigmentares é indicação freqüente na práticaMédica. A recidiva destas lesões geralmente está relacionada à insuficiência de margens, podendo levar à recorrência da lesão com reaparecimento na área. É controverso na literatura a respeito de qual seriam as margens ideais, profunda e laterais, para evitar recidivas
Subject(s)
Humans , Dysplastic Nevus Syndrome , Nevus, Pigmented , Surgery, PlasticABSTRACT
O emprego da terapia com anticoagulantes orais para prevenção de fenômenos tromboembólicos tem apresentado interesse clínico crescente e amplamente utilizado na cardiologia. Nas últimas décadas resultados de diversos ensaios clínicos randomizados vem definindo as indicações apropriadas para utilização dessa terapia, mostrando os seus benefícios, normatizando formatos para otimização terapêutica visando maximizar sua eficácia e segurança e diminuir o risco de complicações hemorrágicas e não hemorrágicas. Pela importância do benefício que o resultado desses grande trials mostraram em reduzir o fenômenos tromboembóticos, chegando à 60-70% de redução de risco desses eventos; pela necessidade de monitorização freqüente destes pacientes e ao mesmo tempo a dificuldade de marcação de consultas no ambulatório geral de cardiologia do HSPM devido à grande quantidade de pacientes; pela dificuldade de se atingir e manter uma faixa terapêutica adequada uma vez que vários fatores fisiológicos e farmacológicos como a interação com outras drogas ou doenças que afetam a farmacocinética dos anticoagulantes orais, além da dieta e fatores gastrointestinais que afetam a biodisponibilidade da vitamina K1; é que motivaram a implantação do ambulatório de anticoagulação em cardiologia do HSPM
Subject(s)
Humans , Patients , Myocardial Ischemia , HypertensionABSTRACT
O emprego da terapia com anticoagulantes orais para prevenção de fenômenos tromboembólicos tem apresentado interesse clínico crescente e amplamente utilizado na cardiologia. Nas últimas décadas resultados de diversos ensaios clínicos randomizados vem definindo as indicações apropriadas para utilização dessa terapia, mostrando os seus benefícios, normatizando formatos para otimização terapêutica visando maximizar sua eficácia e segurança e diminuir o risco de complicações hemorrágicas e não hemorrágicas. Pela importância do benefício que o resultado desses grande trials mostraram em reduzir o fenômenos tromboembóticos, chegando à 60-70% de redução de risco desses eventos; pela necessidade de monitorização freqüente destes pacientes e ao mesmo tempo a dificuldade de marcação de consultas no ambulatório geral de cardiologia do HSPM devido à grande quantidade de pacientes; pela dificuldade de se atingir e manter uma faixa terapêutica adequada uma vez que vários fatores fisiológicos e farmacológicos como a interação com outras drogas ou doenças que afetam a farmacocinética dos anticoagulantes orais, além da dieta e fatores gastrointestinais que afetam a biodisponibilidade da vitamina K1; é que motivaram a implantação do ambulatório de anticoagulação em cardiologia do HSPM