Prophylactic Use Of Vitamin Research Articles

The association of vaccine hesitancy with other public health practices in well child care: a cross-sectional study

Vaccination is one of the most successful public health initiatives in human history. Despite all the benefits of vaccination, it is noteworthy that the number of vaccine hesitant parents has increased in recent years. Individuals with vaccine hesitancy are known to have similar attitudes towards other scientific initiatives. In this study, we investigated the relationship between the attitudes of vaccine hesitant parents and other practices and interventions in well child care. The “Parental Attitudes Towards Childhood Vaccinations (PACV) scale was applied to parents of children aged 2-6 without chronic diseases. A PACV score of 50 or above was considered as vaccine hesitancy. Sociodemographic characteristics, economic status and practices in well child care were questioned. Parents' vaccine hesitancy and their approaches to other practices in well child follow-up were compared. A total of 329 parents were included in the study. The rate of parents with vaccine hesitancy was 22.8% (n=75). In both groups, most participants had an undergraduate/graduate level of education. Those with vaccine hesitancy were less likely to have received vitamin K at birth (81.3% vs. 97.6%, p<0.01), and use of prophylactic vitamin D (72% vs. 88.2%, p<0.01) and iron supplements in the first year of life (66.7% vs 78.3%, p=0.038) were lower. No difference was found for developmental hip dysplasia and hearing screening. The current attitudes of vaccine hesitant parents are not limited to vaccination, but also affect other health initiatives. In our study, we have shown that vaccine hesitant individuals are also opposed and/or reluctant to child health initiatives. Taking this into account when developing strategies to overcome vaccine hesitancy may lead to more effective results.

Vitamin B-6 Prevents Heart Failure with Preserved Ejection Fraction Through Downstream of Kinase 3 in a Mouse Model

BackgroundThere is an urgent need to develop an efficient therapeutic strategy for heart failure with preserved ejection fraction (HFpEF), which is mediated by phenotypic changes in cardiac macrophages. We previously reported that vitamin B-6 inhibits macrophage-mediated inflammasome activation. ObjectivesWe sought to examine whether the prophylactic use of vitamin B-6 prevents HFpEF. MethodsHFpEF model was elicited by a combination of high-fat diet and Nω-nitro-l-arginine methyl ester supplement in mice. Cardiac function was assessed using conventional echocardiography and Doppler imaging. Immunohistochemistry and immunoblotting were used to detect changes in the macrophage phenotype and myocardial remodeling-related molecules. ResultsCo-administration of vitamin B-6 with HFpEF mice mitigated HFpEF phenotypes, including diastolic dysfunction, cardiac macrophage phenotypic shifts, fibrosis, and hypertrophy. Echocardiographic improvements were observed, with the E/E' ratio decreasing from 42.0 to 21.6 and the E/A ratio improving from 2.13 to 1.17. The exercise capacity also increased from 295.3 to 657.7 min. However, these beneficial effects were negated in downstream of kinase (DOK) 3-deficient mice. Mechanistically, vitamin B-6 increased DOK3 protein concentrations and inhibited macrophage phenotypic changes, which were abrogated by an AMP-activated protein kinase inhibitor. ConclusionsVitamin B-6 increases DOK3 signaling to lower risk of HFpEF by inhibiting phenotypic changes in cardiac macrophages.

Impact of the COVID-19 pandemic on the attitude of parents to the use of vitamin K in newborns for prevention of bleeding due to vitamin K deficiency

Introduction and objective: The COVID-19 pandemic has significantly impacted the global healthcare system and all aspects of medical education. In this study, the knowledge of parents about the prophylactic use of vitamin K in newborns and infants, and the method of prophylaxis of vitamin K deficiency bleeding was assessed. Materials and methods: Data for the study were collected by conducting an online survey of 232 parents. They were assigned to two groups: group 1, responding before the COVID-19 pandemic, and group 2, responding during the COVID-19 pandemic. Results: Vitamin K was administered intramuscularly in 99% of cases in group 1 and 57% in group 2 (significant relationship – p < 0.001). Half of group 2 mistakenly thought that vitamin K was given orally after childbirth. This answer was given by 20% of people from group 1 (p < 0.001). Conversely, the correct answer (intramuscular injection) was given by 52% of respondents in group 1 and 46% in group 2. More parents in the pre-pandemic group knew the symptoms of vitamin K deficiency in the body (54% vs. 25%; p = 0.006), when compared to the parents surveyed during the pandemic. Almost half of group 2 (46%) and 23% of group 1 also reported that oral vitamin K supplementation is recommended after childbirth (p = 0.001). Conclusions: Based on the study, it can be concluded that parents’ knowledge of the prevention of vitamin K deficiency is low. The COVID-19 pandemic has had an adverse effect on the public awareness and education regarding vitamin K deficiency bleeding prophylaxis commonly used in Poland. There is a link between the emergence of the COVID-19 pandemic and parents’ perspectives on the intramuscular administration of vitamin K for the purpose of preventing deficiency.

Normocalcemic non-renal hyperparathyroidism

Parathyroid hormone (PTH) is produced by the parathyroid glands, which are the main regulators of calcium and phosphorus metabolism. Hyperparathyroidism is a clinical condition associated with an increase in serum PTH content. The state of parathyroid glands depends very much on the amount of vitaminD, magnesium and boron in the blood because, according to official data, substantiated by a number of scientific studies, the majority of the world population (80%) has a lack/deficiency of vitamin D. This fact explains the high prevalence of thyroid diseases (hyperplasia, adenoma, hyperparathyroidism) and associated pathology. Previous studies have shown that a deficiency/lack of vitaminD was found in 85–94% of Ukraine population. A deficiency/lack of vitamin D compensatorily stimulates an increase in PTH synthesis. Doctors very rarely determine the level of PTH, which prolongs the progression of hyperparathyroidism, and they detect it only with severe associated changes in other systems. Hyperparathyroidism occurs when one or more of the parathyroid glands become hyperactive, gradually leading to elevated serum parathyroid hormone levels and hypercalcemia. The diagnostic criteria for hyperparathyroid conditions are very vague, which is confusing and leads to unnecessary surgeries instead of simple vitamin D and boron therapy. Normocalcemic primary hyperparathyroidism is a diagnosis of exclusion, and it can be considered only after careful assessment of the causes of secondary hyperparathyroidism, including that associated with a lack of vitamin D. The most common form of hyperparathyroidism is normocalcemic non-renal hyperparathyroidism. Prophylactic use of vitamin D in the correct individualized doses (25(OH)D range of 100–150 nmol/l or 40–60 ng/ml) should reduce the risk of parathyroid pathology but only 10% of the population receives such therapy, others do not know that it is useful. The only way to eliminate the gradual progression of parathyroid disorders is to administer individual prophylactic or therapeutic doses of vitaminD.

Knowledge and Attitude among Doctors towards Use of Prophylactic Vitamin K in Neonatal Bleeding Disorders in Department of Obstetrics and Gynecology: Experience from Haj El-Safi Hospital, Sudan

Background: Vitamin K is crucial for neonates to prevent bleeding disorders. Raising awareness of vitamin K use would show positive outcomes. This study aimed to assess the knowledge and attitude of prophylactic use of vitamin K for bleeding disorders in neonates among doctors working in the Department of Obstetrics and Gynecology at Haj El-Safi Hospital, Sudan. Methods: A descriptive cross-sectional study was conducted in February 2019, involving 36 doctors selected by convenience sampling. Data were collected by an interview-based questionnaire designed to measure the knowledge level of doctors toward vitamin K deficiency classification and interactions, guidelines availability and adherence, and parents counseling. Data were analyzed and presented in tables. Results: The doctors involved in this study were 36, including 7 registrars, 6 medical officers, 23 house officers, mostly aged 20–25 years (n=29), and female (n=27). The level of knowledge about the classification of vitamin K deficiency and the interaction of vitamin K with other drugs among doctors was mostly good (n=14 and n=15, respectively). Registrars were the most in the good category (n=6, and n=7, respectively). Most doctors (n=23) were aware of vitamin K guidelines, while only 15 have continuous adherence, 16 of doctors counseled parents about the importance of prophylactic vitamin K. Conclusion: The level of knowledge towards prophylactic vitamin K use in neonatal bleeding disorders among doctors in the Department of Obstetrics and Gynecology at Haj El-Safi Hospital is good.

MORPHOMETRICAL CHANGES IN THE RATS UTERUS THICKNESS AFTER 30 DAYS OF HEAVY METAL SALTS EXPOSURE

Introduction. Much attention is paid to the global ecological problem of environmental pollution with heavy metals (HM), starting from their production and use and ending with the search for means of their degassing and bioremediation. Particular attention is drawn to the study of the influence of HM on the reproductive system, in particular, the uterus. This is due to the high risk of reproductive ability deterioration and the reflection of the consequences of HM exposure in future generations. Objective. The objective of our study was to perform morphometric measurement of the structural elements of the uterine wall in female rats under the conditions of 30-day exposure to HM salts, as well as to study the protective role of vitamin E. Materials and Methods. For the experimental study, 24 female rats were selected and randomly divided into three series (8 rats in each): series I included control rats that received ordinary drinking water; series II included rats that daily consumed water saturated with HM salts; and series III included rats that were administered vitamin E orally every day against the background of constant consumption of water enriched with a combination of HM. After 30 days of the experiment, the uteri were removed; the sections were stained with hematoxylin and eosin for microscopic examination, followed by morphometric measurement of the structural elements and their statistical analysis. Results. First, we measured the morphometric dimensions of the structural elements of the uterine wall in the control animals. At the same time, in the animals of the experimental series II and III, the morphometric indicators underwent significant changes. Thus, on the 30th day of the study, series II rats showed a significant thickening of the uterine wall by 31.03% (p < 0.001) vs. the indicators of the control series. A similar trend of morphometric changes in the thickness of the uterus was noted in series III animals, where the uterus thickened by 20.58% (p < 0.001). Moreover, a significant difference was also observed between experimental series II and III. The analysis of the organ structural components in the experimental series indicated the predominance of endometrium thickness over myometrium thickness. Сonclusions. The results showed that 30-day exposure to HM led to a statistically significant thickening of the uterine wall. At the same time, the most pronounced changes in morphometric indicators were observed in the endometrium (in comparison with the myometrium and perimetrium) of both experimental models, both under the conditions of HM combination exposure and during the prophylactic use of vitamin E against the background of the action of xenobiotics. It is important to note that with the use of vitamin E, the morphometric indicators of the uterine thickness were characterized by a less pronounced transformation of values, although they still significantly exceeded the values of the control series.

Динаміка сироваткового вмісту маркерів метаболізму кісткової тканини у дітей, хворих на бронхіальну астму, на фоні вживання вітаміну D3 та солей кальцію

Мета дослідження: оптимізація діагностики порушень стану кальцій-фосфорного обміну та контролю ефективності лікувально-профілактичного застосування вітаміну D та кальцію у дітей, хворих на бронхіальну астму. Матеріали та методи. Обстежено 120 дітей у 2 групах, по 60 осіб у кожній: 1-ша — діти, хворі на бронхіальну астму; 2-га — умовно здорові діти (контрольна група). Проведено 2 курси терапії розчином вітаміну D3 і карбонату/цитрату кальцію: 4 тижні — 2000 МО та 1000 мг на добу відповідно; 8 тижнів — 1000 МО та 500 мг на добу відповідно. Результати. Серед дітей з бронхіальною астмою зареєстроване зменшення кількості осіб з нормальним сироватковим вмістом загального кальцію (P < 0,05), остеокальцину (P < 0,05), паратгормону (P < 0,05), С-телопептидів колагену 1-го типу (P < 0,05), 25(ОН)D (P < 0,05), активності лужної фосфатази (P < 0,05). Через 1 місяць терапії збільшилася кількість дітей з нормальними показниками активності лужної фосфатази (P < 0,05), остеокальцину (P < 0,05), С-телопептидів колагену 1-го типу (P < 0,05); через 3 місяці — загального кальцію (P < 0,05), 25(ОН)D (P < 0,05). Висновки. Використання розчину вітаміну D3 та кальцію нормалізує показники метаболізму кісткової тканини у дітей з бронхіальною астмою. Оптимальний термін контролю ефективності медикаментозного відновлення кісткового метаболізму у дітей з бронхіальною астмою дорівнює 3 місяцям.

Vitamin E for the Prevention of Chemotherapy-Induced Peripheral Neuropathy: A meta-Analysis.

Background: Vitamin E has been increasingly used to prevent chemotherapy-induced peripheral neuropathy (CIPN) in recent years. However, it is still unclear whether vitamin E can effectively prevent CIPN. Methods: We searched all clinical studies in the Embase, Cochrane Library, Clinicaltrials.gov, and PubMed databases from inception to December 2020. We performed a meta-analysis of 9 randomized controlled trials (RCTs) with 486 patients that compared the vitamin E group with the control group. Outcomes of the study were incidence of all-grade CIPN, incidence of severe CIPN, and the total neuropathy scores (TNS). Random effect models were used to make the meta-analysis results more cautious. Results: Notably, vitamin E significantly reduced the incidence of all-grade CIPN (overall risk ratio (RR) = 0.55, 95% CI: 0.36, 0.85, I2 = 77.3%, p = 0.007), and TNS (overall standard mean difference (SMD) = −0.64, 95% CI: −1.03, −0.25, I2 = 42.7%, p = 0.001). However, the results of the subgroup analysis, which included only double-blind RCTs, suggested that vitamin E did not significantly reduce the incidence of all-grade CIPN (overall RR = 0.52, 95% CI: 0.07, 4.06, I2 = 77.5%, p = 0.531). Moreover, there was no significant difference in the incidence of severe CIPN between these two arms (p = 0.440). Conclusion: The results of our meta-analysis suggests that vitamin E has a beneficial effect on the incidence and symptoms of CIPN. However, routine prophylactic use of vitamin E is still not recommended. Moreover, more high-quality double-blind RCTs are needed to further validate the effects of vitamin E in prevention of CIPN.

Profilaxia pré e pós exposição ao Covid-19: Uma revisão sistemática

Introdução: Covid-19 é definida como a infecção respiratória causada pelo coronavírus SARS-CoV-2. A ausência de tratamentos específicos, a alta incidência da doença e a preocupação global com os efeitos socioeconômicos suscitam a necessidade de determinar medidas profiláticas para o combate a esta pandemia. Metodologia: Trata-se de uma revisão sistemática, realizada a partir de pesquisa nas bases Pubmed e DOAJ de trabalhos com os descritores “profilaxia” e “prevenção” em Covid-19. Os dados foram extraídos em planilha de Excel, organizados por nível de evidência e dispostos na classificação “profilaxia não medicamentosa” e “profilaxia medicamentosa”. O desfecho considerado foi Covid-19 confirmado laboratorialmente. A pesquisa forneceu 63 artigos da base PubMed e 388 resultados da base DOAJ, sendo selecionados 19 trabalhos. Das intervenções não farmacológicas, fechamento de escolas, quarentena obrigatória da comunidade, testagem em massa com isolamento de casos, isolamento obrigatória de imigrantes, distanciamento social superior a 1 metro, uso de máscaras descartáveis e higiene das mãos impactam significativamente no pico, quantidade total de casos e duração do surto, bem como no número de mortes. Triagem de sintomáticos em portos e aeroportos apresentou limitada efetividade. Das intervenções farmacológicas, apesar de ensaios pré-clínicos promissores, evidências atuais não apoiam uso profilático de vitamina D, zinco, cloroquina/hidroxicloroquina, ivermectina ou colchicina na prevenção do Covid-19. Conclusão: A pandemia atual é uma crise de saúde pública e econômica sem precedentes e as únicas formas de profilaxia eficazes foram as não medicamentosas.

PREVENTION OF BLEEDING ASSOCIATED WITH LATE VITAMIN K DEFICIENCY IN INFANTS OF THE FIRST THREE MONTHS OF LIFE - TACTICS OF REDUCTION OF DEATHS AND DISABILITY

The article, intended for neonatologists, general practitioners, family medicine, pediatricians, presents the main causes of disorders in the hemostasis system, which lead to the development of hemorrhagic syndrome in newborns and infants. Emphasis is placed on various forms of neonatal hemorrhagic disease (NHD), which is based on a deficiency of fat-soluble vitamin K. The main risk group for bleeding associated with late vitamin K deficiency is formed by children who are exclusively breastfed. The article presents modern approaches to the prevention of late bleeding associated with vitamin K deficiency, which is based on chronic problems of the digestive system – chronic cholestasis, cystic fibrosis and others. Describes and interprets current guidelines for the prophylactic use of vitamin K in infants in the first three months of life in European countries of high economic development, the United States, which reflects various effective schemes for the prevention of bleeding associated with vitamin K deficiency in infants, differing in single dose application of a preventive course and a way of administration of vitamin K (phytomenadione). The role of parents in the prevention of vitamin K deficiency in infants who are breastfed is emphasized.

Vitamin D intake is associated with decreased risk of immune checkpoint inhibitor-induced colitis.

There is a lack of predictive markers informing on the risk of colitis in patients treated with immune checkpoint inhibitors (ICIs). The aim of this study was to identify potential factors associated with development of ICI colitis. We performed a retrospective analysis of melanoma patients at Dana-Farber Cancer Institute who received PD-1, CTLA-4, or combination ICIs between May 2011 to October 2017. Clinical and laboratory characteristics associated with pathologically confirmed ICI colitis were evaluated using multivariable logistic regression analyses. External confirmation was performed on an independent cohort from Massachusetts General Hospital. The discovery cohort included 213 patients of whom 37 developed ICI colitis (17%). Vitamin D use was recorded in 66/213 patients (31%) before starting ICIs. In multivariable regression analysis, vitamin D use conferred significantly reduced odds of developing ICI colitis (OR 0.35, 95% CI 0.1-0.9). These results were also demonstrated in the confirmatory cohort (OR 0.46, 95% CI 0.2-0.9) of 169 patients of whom 49 developed ICI colitis (29%). Pre-treatment neutrophil-to-lymphocyte ratio (NLR) ≥5 predicted reduced odds of colitis (OR 0.34, 95% CI 0.1-0.9) only in the discovery cohort. This is the first study to report that among patients treated with ICIs, vitamin D intake is associated with reduced risk for ICI colitis. This finding is consistent with prior reports of prophylactic use of vitamin D in ulcerative colitis and graft-versus-host-disease. This observation should be validated prospectively in future studies.

Association of vitamin D intake with decreased risk of immune checkpoint inhibitor-induced colitis.

89 Background: There is a lack of predictive markers informing on the risk of colitis in patients treated with immune checkpoint inhibitors (ICIs). The aim of this study was to identify potential factors associated with development of ICI colitis. Methods: We performed a retrospective analysis of melanoma patients at Dana-Farber Cancer Institute who received PD-1, CTLA-4, or combination blockade between May 2011 to October 2017. Clinical and laboratory characteristics associated with pathologically confirmed ICI colitis were evaluated using multivariate logistic regression analyses. External validation was performed on an independent cohort from Massachusetts General Hospital. Results: The discovery cohort included 213 patients of whom 37 developed ICI colitis (17%). The odds of colitis were higher in patients treated with ipilimumab either as monotherapy or in combination with nivolumab compared to those treated with pembrolizumab. Vitamin D use was recorded in 66/213 patients (31%) before starting ICIs. In multivariable regression analysis, vitamin D use conferred significantly reduced odds of developing ICI colitis (OR 0.35, 95% CI 0.1–0.9). These results were confirmed in the validation cohort of 169 patients of whom 49 developed ICI colitis (29%). Pretreatment neutrophil/lymphocyte ratio (NLR) ≥5 predicted reduced odds of colitis (OR 0.34, 95% CI 0.1–0.9) only in the discovery cohort. Conclusions: This is the first study to report that among patients treated with ICIs, vitamin D intake is associated with reduced risk for ICI colitis. This finding is consistent with prior reports of prophylactic use of vitamin D in ulcerative colitis and GVHD. This observation should be validated prospectively in future studies. [Table: see text]

Preventive Use of Ascorbic Acid For Atrial Fibrillation After Coronary Artery Bypass Graft Surgery.

Atrial fibrillation is one of the most frequent complications and a major risk of morbidity and mortality after cardiac surgery. Antioxidants such as vitamin C are used for prevention of this arrhythmia. Different results of studies have been reported, but most of them have shown efficiency of vitamin C in prophylaxis of postoperative AF. We tried to examine this efficacy with larger sample size. Three hundred and fourteen on pump coronary artery bypass graft surgery alone. Patients were divided into two groups: The intervention group received vitamin C (N = 160) and the control group did not receive any (N = 154). Intervention group was administered two grams of vitamin C intravenously (IV) 24 hours preoperatively, 500 mg every 12 hours IV for 48 hours in ICU, and 500 mg every 12 hours PO for 48 hours in ward. Continuous monitoring in ICU and three times a day ECG was used for AF detection. The two groups were compared. The two groups were matched in terms of age, sex, LA size, ejection fraction, functional class, and TSH level. Of the patients, 244 were male. Mean age was 62 years (40-84 years) in both groups. M/F ratio was four in both groups. Functional class and ejection fraction were the same in both groups. There was no mean TSH level difference. AF occurrence in vitamin C group was 7.6 % and in control group was 7.8 %. There was no difference in ICU or hospital stay. Prophylactic use of vitamin C does not further reduce postoperative atrial fibrillation in on pump CABG patients.

Is Vitamin C Beneficial to Patients with CAP?

Community-acquired pneumonia (CAP) is one of the most common causes of morbidity and mortality in elderly and children. Vitamin C is known as a physiological antioxidant, regulating innate immune system in the lung. Vitamin C has been used to prevent and treat CAP. However, the use of vitamin C for preventing and treating CAP has been a subject of controversy. We aim to review the most significant findings about vitamin C supplementation in patients with pneumonia based on literature from the PubMed. First, we reviewed recent advances about the role of oxidative stress in CAP. Oxidative stress is a crucial component of the host defense system and inflammatory response. However, excessive oxidative stress can cause a systemic inflammatory response leading to tissue damage. The degree of oxidative stress has been associated with the severity of CAP. Vitamin C is beneficial to the host defense system by regulating the innate immunity in the lungs. We also discuss the prophylactic use of vitamin C for pneumonia. Vitamin C supplementation decreased the pneumonia risk in patients with vitamin C deficiency. However, it is not beneficial for prophylactic use of vitamin C to prevent pneumonia in the well-nourished population. Finally, we summarize the effect of vitamin C on mechanical ventilation used during respiratory failure. Administration of vitamin C decreases the duration of mechanical ventilation by decreasing oxidative stress.

DI-009 Health literacy to prevent adverse drug events: cetuximab dermatological toxicity

BackgroundAnti-EGFR chemotherapy drugs cause skin toxicity due to high numbers of receptors in keratinocytes of the epidermis, sebaceous glands, epithelial hair follicles. Cetuximab treatment for metastatic colorectal cancer causes rash...

Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease

Background:Few previous studies proved that complications related to sickle cell disease (SCD) were common with regional anesthesia compared with general anesthesia while others reported no differences. This study was carried out to evaluate the role of prophylactic vitamin D on anesthetic outcome among male children with SCD undergoing circumcision.Materials and Methods:A comparative study was carried out on 58 children undergoing circumcision with the regional block under light general anesthesia. The study sample was classified into two groups: one group received daily 400 IU vitamin D for 6 months before surgery while the other group without vitamin D. All patients were followed regarding the post-operative analgesia and the incidence of post-operative SCD related complications (acute chest syndrome, painful crisis and cerebrovascular accident). Data were analyzed with Statistical Package for Social Sciences version 13, produced by IBM SPSS, Inc. in Chicago, Illinois, USA.Results:There was a highly significant difference between the two groups (P < 0.001) regarding first analgesic request and total analgesic consumption per day: there was delayed analgesic request and less total analgesic consumption per day in vitamin D group. Comparison of post-operative sedation scores showed highly significant difference (P < 0.001) between the two groups, Sedation scores was increased significantly in vitamin D group. This study also reported that the administration of vitamin D was associated with less noticeable post-operative SCD complications.Conclusion:The use of prophylactic vitamin D in SCD will result in delayed post-operative analgesic request and less total analgesic requirement. Administration of vitamin D was also associated with less post-operative complications.

Vitamin C for preventing and treating pneumonia

Pneumonia is one of the most common serious infections, causing two million deaths annually among young children in low-income countries. In high-income countries pneumonia is most significantly a problem of the elderly. To assess the prophylactic and therapeutic effects of vitamin C on pneumonia. We searched CENTRAL 2013, Issue 3, MEDLINE (1950 to March week 4, 2013), EMBASE (1974 to April 2013) and Web of Science (1955 to April 2013). To assess the therapeutic effects of vitamin C, we selected placebo-controlled trials. To assess prophylactic effects, we selected controlled trials with or without a placebo. Two review authors independently read the trial reports and extracted data. We identified three prophylactic trials which recorded 37 cases of community-acquired pneumonia in 2335 people. Only one was satisfactorily randomised, double-blind and placebo-controlled. Two trials examined military recruits and the third studied boys from "lower wage-earning classes" attending a boarding school in the UK during World War II. Each of these three trials found a statistically significant (80% or greater) reduction in pneumonia incidence in the vitamin C group. We identified two therapeutic trials involving 197 community-acquired pneumonia patients. Only one was satisfactorily randomised, double-blind and placebo-controlled. That trial studied elderly patients in the UK and found lower mortality and reduced severity in the vitamin C group; however, the benefit was restricted to the most ill patients. The other therapeutic trial studied adults with a wide age range in the former Soviet Union and found a dose-dependent reduction in the duration of pneumonia with two vitamin C doses. We identified one prophylactic trial recording 13 cases of hospital-acquired pneumonia in 37 severely burned patients; one-day administration of vitamin C had no effect on pneumonia incidence. The identified studies are clinically heterogeneous which limits their comparability. The included studies did not find adverse effects of vitamin C. The prophylactic use of vitamin C to prevent pneumonia should be further investigated in populations who have a high incidence of pneumonia, especially if dietary vitamin C intake is low. Similarly, the therapeutic effects of vitamin C should be studied, especially in patients with low plasma vitamin C levels. The current evidence is too weak to advocate prophylactic use of vitamin C to prevent pneumonia in the general population. Nevertheless, therapeutic vitamin C supplementation may be reasonable for pneumonia patients who have low vitamin C plasma levels because its cost and risks are low.

Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia. This guideline follows methods described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B) and suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B). For acutely ill hospitalized medical patients at low risk of thrombosis, we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B). For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C). For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis (Grade 2C). For critically ill patients who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 2C). In outpatients with cancer who have no additional risk factors for VTE we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of vitamin K antagonists (Grade 1B). Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.

Examining the evidence: complementary adjunctive therapies for multiple sclerosis

Objective: The purpose of this article is to provide a comprehensive overview of the most frequently encountered non-conventional approaches trialed for use in multiple sclerosis (MS). The efficacy and safety of non-conventional approaches ranging from bee venom therapy (BVT) to an array of vitamins and herbal products were discussed and evaluated.Methods: Relevant English-language articles were identified through searches of MEDLINE (1990–2006), PubMed (1999–2006), Cochrane (1995–2006) and Toxnet (2000–2006). Classification of available literature was conducted according to the evidence based guidelines established by the American Academy of Neurology (AAN). However, due to the non-conventional nature of these treatment approaches, most available literature was derived from anecdotal reports and suboptimal clinical studies, lacking the rigor of evidence-based practice.Results: There is presently only marginal supportive evidence for BVT in MS treatment. The inability to identify and quantify the active component of BVT combined with the associated risk of anaphylaxis has deterred its widespread use. The most promising evidence comes from prophylactic daily supplementation with vitamin D. Despite beneficial reports regarding non-herbal supplements such as alpha-lipoic acid (ALA), luteolin, evening primrose oil and vitamins such as B12, the lack of evidence does not support their prophylactic use.Discussion: Based on available evidence, the prophylactic use of vitamin D is a viable option as an adjunct to conventional medicine. Although there is a lack of conclusive evidence to support the use of other non-conventional treatments, patients are still opting to trial and bare the risks of these products which are accessible without the intervention of a healthcare professional. Controlled, evidence-based trials are essential for healthcare professionals to competently intervene and recommend these products.

Effect of dietary vitamin C supplement on reproductive performance of aviary pheasants

The effects of three doses of vitamin C (100, 200 and 300 mg/kg) added to the feed of reproductive pheasants on egg production, egg fertility and parameters of hatchability were investigated. In experiments I (1999) and II (2000) birds were kept in outdoor aviaries. In 2000, air temperatures recorded on the farm during the experiment were high (25&amp;ndash;30&lt;sup&gt;o&lt;/sup&gt;C), differing considerably from those recorded in the preceding years. In experiment I no statistically significant differences were shown between the control pheasants and those supplemented with 100 and 200 mg/kg vitamin C in terms of egg production, egg fertility and parameters of hatchability. The poorest results were found in the group of birds receiving a feed supplemented with 300 mg/kg vitamin C. In experiment II, statistically higher egg production and egg fertility were noted, compared to the control group, in the groups supplemented with 100 and 200 mg/kg vitamin C. Compared to the control group, pheasants from these groups were also characterized by higher hatchability from set eggs (by approx. 15 percentage units) and fertilized eggs (by approx. 9 percentage units) and smaller number of unhatched chicks and dead embryos after day 10 of incubation. In experiment II, the beneficial effect of 100 and 200 mg supplements of vitamin C on the studied parameters could result from the soothing action of the vitamin on the effects of heat stress. The present results justify the prophylactic use of vitamin C supplement at 100 mg/kg feed in the nutrition of reproductive pheasants reared in aviaries. Under heat stress (high air temperatures) increasing the dose of this vitamin to 200&amp;nbsp;mg/kg feed seems beneficial. &amp;nbsp; &amp;nbsp;