Randomized clinical trial to comparing efficacy of daily, weekly and monthly administration of vitamin D3.

The comparative efficacy and safety profiles of selected daily 1000 IU, weekly 7000 IU and monthly 30,000 IU vitamin D 3-not previously investigated-will be evaluated. Here, a prospective, randomized clinical trial, comparing efficacy and safety of a daily single dose of 1000 IU (group A) to a once-weekly 7000 IU dose (group B), or monthly 30,000 IU dose (group C) of vitamin D3. The present study is a controlled, randomized, open-label, multicenter clinical trial, 3 months in duration. Sixty-four adult subjects with vitamin D deficiency (25OHD<20 ng/ml), were included according to the inclusion and exclusion criteria. Dose-responses for increases in serum vitamin 25OHD were statistically equivalent for each of the three groups: A, B and C. Outcomes were 13.0 ± 1.5; 12.6 ± 1.1 and 12.9 ± 0.9 ng/ml increases in serum 25OHD per 1000 IU, daily, weekly and monthly, respectively. The treatment of subjects with selected doses restored 25OHD values to levels above 20 ng/ml in all groups. Treatment with distinct administration frequency of vitamin D3 did not exhibit any differences in safety parameters. The daily, weekly and monthly administrations of daily equivalent of 1000 IU of vitamin D3 provide equal efficacy and safety profiles.

The role of serum total and free 25-hydroxyvitamin D and PTH values in defining vitamin D status at the end of winter: a representative survey.

We sought the lowest serum total 25-hydroxyvitamin D (t-25OHD) values in geographic areas with four seasons and investigated whether the calculation of serum free 25-hydroxyvitamin D (f-25OHD) could provide additional information on vitamin D status. This is a representative, cross-sectional study restricted to a sampling period at the end of winter, using a non-probability, stratified sample of the adult community-dwelling Hungarian population (n = 882). We measured t-25OHD, vitamin D binding protein (DBP), parathyroid hormone (PTH), and albumin levels. f-25OHD concentrations were calculated. We assessed environmental factors that could affect vitamin D levels and diseases possibly related to vitamin D deficiency. Mean t-25OHD values of the total population were 41.3 ± 20.6 nmol/L. t-25OHD levels were below 75, 50, and 30 nmol/L in 97, 77, and 34 % of participants not receiving vitamin D supplementation, respectively. t-25OHD values weakly positively correlated with DBP (r = 0.174; p = 0.000), strongly with f-25OHD (r = 0.70; p = 0.000). The association between t-25OHD and f-25OHD and between t-25OHD and PTH were non-linear (p squared term = 0.0004 and 0.004, respectively). t-25OHD levels were not affected by gender, age, place of residence; however, they were related to body mass index, sunbed sessions, and tropical travel. In contrast, f-25OHD levels were different in males and females but were not related to obesity. t- and f-25OHD were lower among people with cardiovascular diseases (p = 0.012). Nearly the entire Hungarian population is vitamin D insufficient at the end of winter. The use of t-25OHD could show a spurious association with obesity; however, it does not reflect the obvious sex difference.

[Survey of quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary]. / Hazai kórházakban rehabilitált rheumatoid arthritises betegek életminosége.

INTRODUCTION: There are limited data about the quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary. AIM: The aim of the authors was to assess demographic data, social status, health related quality of life, and needs for assistance and disease-related information of 239 rheumatoid arthritis patients (169 women and 7 men) admitted to four rehabilitation centres in Hungary. METHOD: For the assessment of demographic, social and other data the authors developed questionnaires. The health related quality of life was evaluated using the validated Short Form 36 questionnaire. RESULTS: The authors found that rheumatoid arthritis patients require in-patient rehabilitation relatively early in their disease course. 80.4% of the patients were over 50 years of age, and their social status was low as compared to the average of the Hungarian population. The health related quality of life of patients was significantly lower than that of the average population, but it was similar to the quality of life of patients with osteoarthritis, osteoporosis and low back pain. Among domains of the quality of life, the scores for physical function and pain were the lowest. The most common accompanying diseases included hypertension and osteoporosis. In case of knee and hip surgeries, postoperative rehabilitation was performed in due time. Patients were not satisfied with disease-related information and education given by health care providers. CONCLUSIONS: There is poor quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary. More efforts should be done to provide disease-related information and education for patients.

[Quality of life of osteoporotic patients treated in rheumatology rehabilitation in-patient units]. / Reumatológiai rehabilitációs osztályokon kezelt osteoporosisos betegek életminosége.

UNLABELLED: There has been no report on demographic, social and quality of life data of osteoporotic patients attending rheumatology rehabilitation in-patient units in Hungary. AIM: The authors analyzed the data of osteoporotic patients treated in rheumatology rehabilitation departments as in-patients in four hospitals in Hungary. METHODS: Demographic and social data were obtained by using a questionnaire developed by the authors, and quality of life was assessed with the use of the SF-36 questionnaire. The quality of life data of osteoporotic patients were compared to that obtained from patients with rheumatoid arthritis, osteoarthrosis and chronic low back pain who were treated in the same department at the same time. RESULTS: Of the 253 patients who were asked to participate in the study, 211 patients filled out the questionnaires. 25.6% of the patients were male. 58% of the patients were younger than 60 years of age, and 40% of them were heavy physical workers earlier. More than 50% of the patients did not complete secondary school education, and only 6.7% of the patients had a per capita monthly income higher than 100 000 HUF. The quality of life of the osteoporotic patients assessed by SF-36 scored 34.7, which was significantly lower than that of the mean of the Hungarian population scoring 70-90. The SF-36 scores of osteoporotic patients were lower in all domains compared to the scores of patients with rheumatoid arthritis, osteoarthritis and low back pain, although the difference was significant only in the domain of physical activity. The affective role of patients with osteoporosis was significantly lower than those with rheumatoid arthritis and osteoarthritis. CONCLUSIONS: Osteoporotic patients attending in-patient rheumatology in-patient rehabilitation units in Hungary have poor quality of life comparable, even worse than that found in patients with rheumatoid arthritis, osteoarthritis and chronic low back pain.

Effect of thermal water and adjunctive electrotherapy on chronic low back pain: a double-blind, randomized, follow-up study.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of thermal mineral water, compared with tap water in the treatment of low back pain. METHODS: This randomized, double-blind, controlled, follow-up study included 71 patients who underwent 20-minute daily treatment sessions with medicinal water or with tap water, both at a temperature of 34 degrees C, on 21 occasions. Both groups underwent additional adjunctive electrotherapy. Outcome measures were visual analogue scale scores, Schober's sign, Domján's signs, Oswestry disability and Short Form-36 questionnaire. The study parameters were administered at baseline, immediately after treatment, and after 15 weeks. RESULTS: After treatment, there was a significant improvement in all parameters in the thermal water group. This improvement was still evident after 15 weeks. The improvement in the control group was less substantial compared with baseline values. Comparison of the 2 treatments revealed a statistically significant difference in 3 outcome parameters (visual analogue scale scores III, IV and Schober's index). In the subset of patients who completed the study according to the protocol, the greater efficacy of treatment with thermal water was also confirmed by the other study parameters. CONCLUSION: In the group treated with thermal water, improvement occurred earlier, lasted longer and was statistically significant.

Drug-induced delayed cardiac protection against the effects of myocardial ischemia.

Drug-induced delayed cardiac protection (DCP) against the effects of acute myocardial ischemia was first described 22 years ago by the author and his coworkers. It can be initiated by noninjurious pharmacological doses of prostacyclin (PGI2), its stable analogues, and by catecholamines. DCP protects against many consequences of ischemia, attenuating early morphological changes, limiting infarct size and suppressing arrhythmias, and can also protect against ouabain intoxication. DCP operates under a variety of pathological conditions (atherosclerosis, hypercholesterolaemia, and diabetes). DCP can also be evoked by transient myocardial ischemia and by exercise and is known in this context as "ischemic preconditioning", specifically the "second window of protection"; transient ischemia also evokes an immediate but short-lived protection known as "classical preconditioning". DCP is fundamentally different in concept to conventional drug therapy because the process appears to depend on the duration of the trigger and be related in a bell-shaped manner to the strength of the trigger. The exact mechanism is uncertain. Prolongation of the effective refractory period (ERP) and of the action potential duration (APD) may contribute to DCP suppression of arrhythmias. The protection is time and dose dependent, with optimal effects 24 to 48 hr after treatment. It can be sustained by intermittent administration of low maintenance doses. Stimulation of the adenylate-cyclase/cyclic adenosine monophosphate (cAMP) system appears to be a common feature of DCP. Responses to beta-adrenergic stimuli are also diminished. Cardiac cAMP triggers the induction of phosphodiesterase (PDE) 1 and 4 isoforms and of Na/K-ATPase. Increased amount and activity of PDE isoforms subsequently reduces excess myocardial cAMP production. Changes in Na/K-ATPase moderate ischemic myocardial potassium loss, sodium, and calcium accumulation, as well as the toxicity of ouabain. The future therapeutic challenge is to identify new drugs that can mimic DCP.

Pharmacological induction of delayed and prolonged cardiac protection: The role of prostanoids.

In 1983, a delayed and prolonged cardioprotection induced by drugs was described. This pharmacologically induced adaptation to stress represents a new trend in cardioprotection as opposed to the classical drug treatment that was based on the presence of drug-receptor binding. Such a long-lasting, delayed adaptation can be induced by non-injurious pharmacological stimuli (eg, prostacyclin and its stable analogues, catecholamines and other substances) and manifests as a marked protection against the severe consequences of ischemia; attenuation of early morphological changes (limitation in infarct size) and reduction in ventricular arrhythmias as results of coronary artery occlusion and reperfusion or ouabain toxication. The protection is time- and dose-dependent; the maximum effects occur 24 h and 48 h after drug treatment. These effects can be prolonged for a longer period by the periodic administration of maintenance doses. Concerning the mechanism of this marked delayed protection, the findings show that these adaptive stresses stimulate the adenylate cyclase/cyclic AMP (cAMP) system and result in elevation in cardiac cAMP level. This triggers the induction of Na(+)/K(+)-ATPase and activates phosphodiesterase (PDE) isoforms, most likely PDE1 and PDE4. The increased amount of PDE isoforms and activated Na(+)/K(+)-ATPase moderates ischemic myocardial potassium loss, and reduces sodium and calcium accumulation during myocardial ischemia. This also attenuates ouabain toxicity. Induction of PDE isoforms may lead to a reduction in the accumulation of excess cAMP and contribute to a lessened response to beta-adrenergic stimuli. The antiarrhythmic effects can be explained by electrophysiological changes, such as prolongations of the effective refractory period and the action potential duration during ischemia and reperfusion. The advantages of pharmacologically induced adaptation to stress in preventive therapy are that an exact dosage can be applied, the risk of the harmful effects is minimal, the protection can be prolonged, and it can be induced under pathological conditions (eg, atherosclerosis, hypercholesterolemia). Pharmacologically induced long-term protection may represent a new approach in the therapy of cardiovascular diseases.

Efectos beneficiosos producidos por el aumento del tono parasimpático durante la oclusión coronaria aguda / Benefitial effects caused by increased parasympathetic tone during acute coronary occlusion

En perros mestizos, anestesiados y ventilados artificialmente, se realizaron oclusiones de la arteria coronaria descendente izquierda anterior, al aumentarse el tono vagal por medio de la estimulación eléctrica de lostroncos vagosimpáticos cervicales. Se permitió un intervalo de recuperación de 30 minutos entre las oclusiones. Se valoró el efecto de la hipertrofia parasimpática sobre el tamaño del área isquémica, la dispersión y la fragmentación de la actividad eléctrica epicárdica de la zona sin irrigación, el tiempo medio (50 por ciento) de repolarización del potencial de acción monofásico del tejido con irrigación normal, la latencia para la aparición de arritmias ventriculares y otras variables electrofisiológicas y hemodinámicas. El aumento del tono vagal provocó una disminución en el tamaño del área isquémica y en la heterogeneidad de la actividad eléctrica epicárdica, así como un aumento en la latencia para la aparición de arritmias ventriculares y en el tiempo medio de repolarización. Los resultados indican que las bajas frecuencias producidas por el aumento del tono vagal en la fase aguda del infarto del miocardio tienen un efecto beneficioso al proteger al corazón de la aparición de arritmias ventriculares graves, a pesar de la hipotensión arterial concominante (AU)