Vitamin Supplementation Research Articles

Use of complementary and alternative medicine in vitiligo: a cross-sectional survey.

Vitiligo is characterized by skin depigmentation, which can lead to profound psychological effects and decreased quality of life, especially for those with skin of color. Individuals with vitiligo may utilize complementary and alternative medicine (CAM) due to limited treatment options with varying efficacy.An anonymous, multiple-choice, cross-sectional questionnaire was distributed to participants with vitiligo in the United States through online forums. Data on disease characteristics, use of prescription medications, use of topical therapies, supplements, and diets, and perceptions of CAM were collected.In total, 625 respondents completed the survey. Overall, 32.5% of participants (203/625) have tried CAM. Commonly reported CAM include supplements of vitamin D (57.7%, 116/203), vitamin B12 (46.3%, 93/203), vitamin C (27.4%, 55/203), topical Nigella sativa oil (26.4%, 53/203), oral omega-3 fatty acids (24.9%, 50/203), folic acid (22.9%, 46/203), and vitamin E (22.9%, 46/203). Frequently cited reasons for CAM use include desire to try "new" (40.4%, 82/203) or "more natural" (26.6%, 54/203) therapies, "frustration with conventional medicine" (24.6%, 50/203), and fear of "adverse side effects of conventional medicine" (23.6%, 48/203). Non-White participants were more likely than their White counterparts to report CAM use and have more positive perceptions of CAM therapies. Less than half (43.3%, 88/203) of CAM users reported that they disclosed their use of CAM with their physician.Dermatologists should be mindful of CAM and ask patients about their use. Further investigation of the role of CAM as adjuvant therapy for vitiligo is warranted to better advise patients.

Longitudinal change of energy expenditure, body composition and dietary habits in Progressive Supranuclear Palsy patients.

Alterations in metabolic status, body composition, and food intake are present in all neurodegenerative diseases. Aim of this study was to detect the progression of these changes in Progressive Supranuclear Palsy (PSP). We conducted a longitudinal study of 15 patients with PSP. The assessments were performed at baseline (T0) and after 7(IQR = 5) months of follow-up (T1). We collected anthropometric measures including body weight, height, body mass index and waist circumference, metabolic parameters through indirect calorimeters, body composition using bioimpedance analysis, and dietary habits with a validated questionnaire. PSP-rating scale (PSP-rs) was used to evaluate disease severity and dysphagia. The majority of patients (66.66%) presented PSP-Richardson Syndrome and 33.33% the other variant syndromes of the disease. At T1 there was a decrease in intake of total daily calories (p < 0.001), proteins (p < 0.001), fibers (p = 0.001), calcium (p = 0.008), iron (p < 0.001), zinc (0.034), vitamin E (p = 0.006) and folates (p = 0.038) compared to T0. No other changes were found. As for T1 data, no significant differences were shown according to disease phenotypes or the presence of clinically significant dysphagia for solids. Within a mid-term follow up, PSP patients presented reduced caloric and proteins intake regardless the presence of dysphagia. The PSP-rs is likely not adequate to assess dysphagia, which should be investigated by specific clinical scales or instrumental examinations. With the goal of maintaining adequate nutritional status, the administration of protein and vitamin supplements should be considered even in the absence of dysphagia evidenced by the rating scales.

Futuristic opportunities for pretreatment processes in biofuel production from microalgae

AbstractMicroalgal biofuel is a promising solution to replace fossil fuel as a renewable and environmental‐friendly energy source, thereby contributing to the United Nations (UN) Sustainable Development Goals (SDGs), in particular SDG‐7, or Affordable and Clean Energy. Unlike energy crops (like oil palm and sugar cane), microalgae benefit from faster growth rate, higher lipid content, smaller land area required, ability to flourish using waste or brackish water, and posing zero competition with food crops. Microalgae‐derived biofuels (like biodiesel, bioethanol, biomethane, and biohydrogen) are sustainable energy sources that can be produced using well‐developed techniques (e.g., transesterification, fermentation, anaerobic digestion, and Fisher–Tropsch process). To prevent dire climate conditions resulting from the global temperature rise of 1.5°C and resolve worldwide energy security issue, our generation will need to establish and implement renewables on a global scale. To improve the industrial production of microalgal biofuel, the efficiencies of biomass and metabolite production to post‐cultivation biofuel synthesis processes must be enhanced. For the cultivation step, there exist three key techniques that can directly change the traits, structure, and behavior of microalgal cells, and induce them to accumulate targeted metabolites rapidly and in large amounts. These techniques are genetic engineering, chemical modulation, and nanomaterial approach. Genetic engineering commonly alters the chloroplast DNA of microalgae to overexpress or down‐regulate key genes in various metabolic pathways so that the cells accumulate more lipids. Chemicals can also be used to modulate microalgal growth and lipid accumulation by inducing oxidative stress or prevent conversion of lipid molecules. Nanomaterials and nanoparticles can also enhance microalgal lipid production by microenvironmental stress induction, vitamin supplementation, and light backscattering. Therefore, in this review, the recent progress as well as the pros and cons of genetic engineering, chemical modulation, and nanomaterial approach in achieving greater biofuel production from microalgae are comprehensively examined.

Prevalence and Risk Factors of Low Vitamin D Level in Adults with Epilepsy: A Cross-sectional Study at a Single Tertiary Neurological Center in Thailand

Background: Epilepsy has a wide-ranging impact on the quality of life in patients of all age groups. Reduced levels of active vitamin D contribute to various bone diseases and may influence seizure control. Nevertheless, the risk factors for low vitamin D levels in patients with epilepsy remain inconclusive and are not well-established. The limited number of studies in Thailand may not be sufficient to provide guideline recommendations for screening vitamin D levels in adults with epilepsy. Objective: To evaluate the prevalence and risk factors of low vitamin D levels in Thai adults with epilepsy taking long-term antiepileptic drugs. To provide supporting recommendations for screening vitamin D levels in patients with epilepsy for early diagnosis and appropriate vitamin supplementation. Materials and Methods: The present study was a cross-sectional study conducted on 87 adults with epilepsy aged 18 to 76 years who were followed up at the Neurological Institute of Thailand between March and October 2023. Patients with comorbidities affecting vitamin D metabolism were excluded from the study. Baseline demographic data, epilepsy-related information, and anti-seizure medication information were analyzed. Blood tests for vitamin D for 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, and albumin were performed. Results: The prevalence of low vitamin D levels was 85%, including deficiency at 37% and insufficiency at 48%, with the mean (±SD) of serum 25(OH)D being 21.9±7.60 ng/mL. Multivariate analyses revealed that female was significantly associated with low vitamin D levels, adjusted OR 4.97 (95% CI 1.23 to 20.05). There was no significant association among epilepsy-related information, anti-seizure medications, and low vitamin D levels. Conclusion: The prevalence of low vitamin D levels in the present study was significantly higher than that observed in the previous studies, which is consistent with the findings of the recent studies in many countries. The authors strongly recommend screening for vitamin D levels in Thai adults with epilepsy, particularly in females. Early diagnosis and management of this condition are beneficial for patients with epilepsy and can help mitigate the various complications resulting from low vitamin D levels. Keywords: Epilepsy; Low vitamin D level; Vitamin D deficiency; Vitamin D insufficiency; Antiseizure medications; Prevalence; Risk factors

The Role of Vitamins in Mitigating the Effects of Various Stress Factors in Pigs Breeding.

Good practices in farm animal care are crucial for upholding animal well-being, efficiency, and health. Pigs, like other farm animals, are exposed to various stressors, including environmental, nutritional, chemical, psychological, physiological, and metabolic stressors, which can disrupt their internal balance and compromise their well-being. Oxidative stress can adversely affect animal performance, fertility, and immunity, leading to economic losses for farmers. Dietary considerations are hugely important in attaining these objectives. This paper reviews studies investigating the impact of additional vitamin supplementation on stress reduction in pigs. Vitamin A can be beneficial in counteracting viral and parasitic threats. Vitamin B can be a potential solution for reproductive issues, but it might also be beneficial in reducing the effects of inappropriate nutrition. Vitamin C plays a vital role in reducing the effects of heat stress or exposure to toxins in pigs. Vitamin D proves to be beneficial in addressing stress induced mostly by infections and weaning, while vitamin E has been shown to mitigate the effects of toxins, heat stress, or transport stress. This review highlights the potential benefits of these dietary antioxidants in maintaining pig health, enhancing productivity, and counteracting the adverse effects of various stressors. Understanding the role of vitamins in pig nutrition and stress management is vital for optimising farm animal welfare and production efficiency.

Frequency, amount, and supplementation of vitamin A food sources to enhance vitamin A sufficiency status among toddlers aged 12-59 months

Vitamin A plays a crucial role as a micronutrient, particularly in relation to vision and growth. However, excessive intake of Vitamin A can lead to impaired vision and growth in toddlers. This study aimed to examine the impact of the frequency and amount of Vitamin A from food sources, as well as the intake of Vitamin A supplements, on the sufficiency status of Vitamin A in toddlers aged 12-59 months. The research design employed a quantitative approach using an analytical cross-sectional survey with a sample of mothers and toddlers aged 12-59 months, totaling 100 respondents. The relationship between the independent variables and the dependent variable was analyzed using the Chi-Square (α=0.05) statistical test with a 95% confidence interval. Quantitative results indicated a Vitamin A sufficiency status (71%), frequency of intake (56%), amount of intake (64%), and intake of Vitamin A supplements (60%) in the 'more' category. The results of the chi-square test showed the effect of Vitamin A food source intake on Vitamin A sufficiency status with a p-value of 0.002. Optimizing Vitamin A sufficiency among toddlers aged 12-59 months requires a multifaceted approach, focusing on frequency, amount, and appropriate food sources.

Nutrient removal and biomass production of marine microalgae cultured in recirculating aquaculture systems (RAS) water with low phosphate concentration

This study was conducted to investigate the feasibility of microalgal biomass production and nutrient removal from recirculating aquaculture systems (RAS) water (RASW) with low phosphate concentration. For this purpose, Nannochloropsis oculata, Pavlova gyrans, Tetraselmis suecica, Phaeodactylum tricornutum, and their consortium were cultivated in RASW and RASW supplemented with vitamins (+V). Among them, N. oculata showed the maximum biomass production of 0.4 g/L in RASW. Vitamins supplementation significantly increased the growth of T. suecica from 0.16 g/L in RASW to 0.33 g/L in RASW + V. Additionally, T. suecica showed the highest nitrate (NO3–N) removal efficiency of 80.88 ± 2.08 % in RASW and 83.82 ± 2.08 % in RASW + V. Accordingly, T. suecica was selected for scaling up study of microalgal cultivation in RASW and RASW supplemented with nitrate (RASW + N) in 4-L airlift photobioreactors. Nitrate supplementation enhanced the growth of T. suecica up to 2.2-fold (day 15). The fatty acid nutritional indices in T. suecica cultivated in RASW and RASW + N showed optimal polyunsaturated fatty acids (PUFAs)/saturated fatty acid (SFAs), omega-6 fatty acid (n-6)/omega-3 fatty acid (n-3), indices of atherogenicity (IA), and thrombogenicity (IT)). Overall, the findings of this study revealed that despite low phosphate concentration, marine microalgae can grow in RASW and relatively reduce the concentration of nitrate. Furthermore, the microalgal biomass cultivated in RASW consisting of pigments and optimal fatty acid nutritional profile can be used as fish feed, thus contributing to a circular bioeconomy.

Link Between Daily Sunlight Exposure and Dyslipidemia Patients – A Cross-Sectional Study

Background: Earlier studies have suggested that Sunlight and vitamin D are related to cardiovascular disease (CVD), but the link between sunlight exposure and risk factors for CVD has not been adequately investigated. Dyslipidaemia is a major risk factor for CVD we aim to investigate whether sunlight exposure has an effect on dyslipidemia patients’ serum lipid profile and vitamin D. Methods: This study was carried out in apparently healthy Indian adults of both sexes, aged above 18 years and dyslipidemia patients’ from Swamy Vivekananda Medical College Hospital (SVMCH). Normal control group (healthy subjects) (n30), Dull sunlight exposure group dyslipidemia patients N30, and bright sunlight exposure group dyslipidemia patients n30, Oral supplement of Vitamin D group (n30), Obese dyslipidemia patients group (n30) before and after sunlight exposure, after overnight fasting peripheral venous blood samples were collected, and the serum was stored in -80 oC fridge. Serum levels of 25(OH) D (25- hydroxy vitamin D3) and lipid levels were analyzed by routine lab method using an Autoanalyzer. Results: We compare the bright and dull sunlight exposure dyslipidemia patients and obese groups; a significant elevation was seen in 25-(OH) D concentrations in the bright sunlight exposure group (P &lt; 0.01), and the lipid profiles TGs, TCs, LDL-C, and VLDL-C were significantly decreased (P &lt; 0.05). The HDL-C level significantly increased when compared to the dull sunlight exposure group. There was no significant change in serum Vitamin D and lipid profile level of the oral supplement vitamin D group compared with the bright sunlight exposure group. Conclusion: Our study reveals that bright sunlight exposure is beneficial and linked with the improvement of Vitamin D and lipid profile of dyslipidemia. In comparison orally supplemented Vitamin D had an adverse effect on lipid profile.

Nutritional Supplements for Healthy Aging: A Critical Analysis Review

Background: Healthy aging is defined as survival to advanced age while retaining autonomy in activities of daily living, high societal participation, and good quality of life. Sarcopenia, insomnia, cognitive impairment, and changes in sensation can be key hinderances to healthy aging, but nutritional supplements may abate their impact. As research advances, an updated review on their efficacy on age-related conditions is warranted. Results: Sarcopenia can be mitigated through proper protein intake, supplements like creatine, and in certain situations Branched-Chain Amino Acids and Vitamin D, in adults over 65. Melatonin supplementation has moderate evidence for improving sleep, while valerian root lacks evidence. Magnesium, tart cherry, and kiwifruits have shown promising impacts on sleep in limited articles. Magnesium, Vitamin D, and B vitamin supplementation have been shown to improve cognition in those with mild cognitive impairment and Alzheimer’s disease but require further study prior to recommendation. The Age-Related Eye Disease Study supplement combination is routinely recommended to reduce risk of progression to advance stages of age-related macular degeneration. Alpha-Lipoic Acid and Folate have been investigated for their roles in mitigating age-related hearing losses. Conclusions: Nutritional supplements and lifestyle changes may mitigate disabilities across multiple domains of age-related illnesses and promote healthy aging.

Food Allergy Risk: A Comprehensive Review of Maternal Interventions for Food Allergy Prevention.

Food allergy represents a global health problem impacting patients' and caregivers' quality of life and contributing to increased healthcare costs. Efforts to identify preventive measures starting from pregnancy have recently intensified. This review aims to provide an overview of the role of maternal factors in food allergy prevention. Several studies indicate that avoiding food allergens during pregnancy does not reduce the risk of developing food allergies. International guidelines unanimously discourage avoidance diets due to potential adverse effects on essential nutrient intake and overall health for both women and children. Research on probiotics and prebiotics during pregnancy as preventive measures is promising, though evidence remains limited. Consequently, guidelines lack specific recommendations for their use in preventing food allergies. Similarly, given the absence of conclusive evidence, it is not possible to formulate definitive conclusions on the supplementation of vitamins, omega-3 fatty acids (n-3 PUFAs), and other antioxidant substances. A combination of maternal interventions, breastfeeding, and early introduction of foods to infants can reduce the risk of food allergies in the child. Further studies are needed to clarify the interaction between genetics, immunological pathways, and environmental factors.

Effectiveness of vitamin A supplementation among children under 5 years old in Kazakhstan

Micronutrient sufficiency leads to high rates of morbidity and mortality among children in Kazakhstan. Kazakhstan does not have a program for mandatory vitamin A supplementation of children under 5 years of age. Thus, the aim of this study was to assess the effectiveness of a pilot vitamin A supplementation program among children in Kazakhstan with the ultimate goal of informing future vitamin supplementation efforts. In Akmola and Kostanay regions of Kazakhstan, 529 children (aged 6-59 months) were randomly selected in each region through the local policlinics. In the first step of the study, mothers of the children were surveyed about the health status of their children using a standard data collection tool. Children were supplemented with Vitamin A using oral at a dose of 100,000 IU for children aged 6-11 months and 200,000 IU for children aged 12-59 months. Blood serum samples were collected for determining Vitamin A status. In the second step of the study, mothers were interviewed again about the health status of their children 6 months after the intervention and blood serum samples were collected to assess the efficacy of Vitamin A supplementation program. The number of self reported diarrhea cases and other intestinal infections significantly decreased after the vitamin A supplementation. The number of children with normal level of Vitamin A signficantly increased from before to after the intervention. Data from all participants (n = 529; pre VAS and 501 post VAS) showed that mean serum retinol levels increased significantly post VAS from 30.01 ±0.5 µg/dL to 61.06 ±1.2 µg/dL (p &lt;0.001) Likewise, a significant change was observed in the cases of reported diarrhea between pre-test and post-test assessments (30 vs. 95; p &lt;0.01). The health status of the examined children in the Akmola and Kostanay regions had significantly improved after the vitamin A supplementation and it points to the necessity of implementing Vitamin A supplementation program on the national level. This study has important policy implications for recommending the supplementation program on the national scale.

Fat-soluble Vitamins and Lung Cancer: Where We Are?

Fat-soluble vitamins (vitamins A, D, E, and K) are vital substances for maintaining normal physiological functions in the body. In recent years, scholars have explored the relationship between fat-soluble vitamins and the wasting disease - lung cancer. In this paper, we review recent studies on fat-soluble vitamins and lung cancer to clarify the relevance and molecular mechanisms of various vitamins in lung cancer, and whether the levels of fat-soluble vitamins in the body and vitamin supplementation affect the development of lung cancer. Our review could facilitate the discovery of biomarkers, potential therapeutic targets in lung cancer, and anti-tumor adjuvant drugs, in addition to highlighting other new ideas in the prevention and treatment of lung cancer.

Scurvy in Children: A Case Report

Scurvy is all the symptoms associated with a diet deficient in ascorbic acid or vitamin C, found in fresh fruit and vegetables. Scurvy is a pathology resulting from a deep and prolonged vitamin C deficiency, which can manifest itself as a bleeding syndrome, wound healing disorders, rheumatic signs, or gum damage. If left untreated (vitamin C supplementation), the disease can be fatal. This water-soluble vitamin is neither synthesized nor stored in the body. In recent years, there has been a resurgence of this pathology due to unbalanced nutrition. Clinical presentations are deceptive and variable, with orthopedic abnormalities and a diffuse hemorrhagic syndrome secondary to a defect in collagen fiber synthesis in children. The diagnosis of scurvy is confirmed by measuring ascorbemia, which is less than 2 mg/L (5-15 mg/L or 17-94 mmol/L), and treatment is based on vitamin C supplementation at 100 to 300 mg/day until complete recovery. We report the case of a 7-year-old patient with an autistic spectrum disorder associated with epilepsy, who presented with scurvy revealed by bone involvement consisting of bone pain, a bleeding syndrome and gingival hypertrophy in context of altered general condition. The diagnosis was confirmed by a collapsed ascorbic acid level (&amp;lt;3 mmol/l) and progressed favorably on vitamin supplementation.

A Prospective Observational Study on Neurotoxicity of Chemotherapy - A Critical Analysis

Background: Cancer treatment frequently depends on the intricate and potent effects that are acknowledged for their potential to save lives. Chemotherapy can have adverse effects on both the central and peripheral nervous systems, posing significant challenges. Objective: • To assess the causative agent, development, and timing of occurrence. • To improve management of neurological complications. • To discriminate the iatrogenic effects of cancer therapy and neurological progression. Method: A prospective observational study was conducted in a hospital setting, focusing on the neurotoxic effects of chemotherapy in cancer patients over a span of six months. The research involved participants from both the oncology in-patient and daycare departments. After obtaining informed consent, individuals in the study population were interviewed to gather information about any neurological symptoms they encountered following their chemotherapy sessions. Results and discussion: Within our study population, a predominant 67% comprised female patients, while male patients constituted 33%. Of the total participants, 66% reported experiencing neurological symptoms. Among these symptoms, the majority of patients encountered sensations such as tingling, numbness, and a burning sensation. Other reported symptoms included headaches, distal weakness, myalgia, seizures, and ataxia. Conclusion: In this current study, 66% of the study population encountered neurological side effects. Generally, the presence of comorbidities, vitamin deficiencies, and advanced age can significantly contribute to the development of peripheral neuropathy. Depending on the severity of neuropathy, recommendations for interventions include the prescription of vitamin supplements, calcium supplements, duloxetine, and pregabalin.

Unraveling the Enigma: Huntington’s Disease Masquerading as Treatment-Resistant Psychosis - A Case Study

IntroductionThis unusual case report unfolds a complex and emblematic scenario involving the diagnosis and management of a 46-year-old patient with treatment-resistant psychiatric symptoms, eventually revealing a significant association with Huntington’s Disease (HD). The initial presentation at Obregia Hospital featured early signs of psychosis, such as mood swings, social withdrawal, and mild cognitive impairment. Despite predominant treatment with atypical antipsychotics, significant improvements remained elusive.ObjectivesOur primary objectives were to document the intricate diagnostic journey, the challenges faced in managing the patient’s psychiatric symptoms, and the eventual revelation of an underlying neurological disorder, Huntington’s Disease. We aimed to emphasize the importance of a multidisciplinary approach to such complex cases.MethodsThe patient’s clinical course was closely monitored, and the Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of symptoms upon admission. The patient’s severe psychotic state led to involuntary hospitalization. Clinical observations pointing to an underlying neurological disorder prompted a neurology consultation and further investigations, including brain CT and MRI scans, but also genetic testing.ResultsThe CT scan revealed potential Huntington’s Disease evolution, while genetic testing confirmed the presence of the specific HTT mutation. Brain MRI with contrast substance highlighted characteristic Huntington’s Disease changes, such as cortical atrophy, necrosis, and substantial loss of brain tissue, particularly in the basal ganglia, cortical regions, and thalamic nuclei. The patient was hospitalized for nearly seven weeks, during which various psychiatric medications were trialed with limited success. However, a gradual increase of Trihexyphenidyl dosage, as well as a wash-up with saline solution and vitamin supplements (B1, B6, and C), was initiated. Subsequently, the introduction of oral haloperidol in gradually increasing doses led to significant improvements in psychiatric symptoms, dyskinesia, and overall functionality.ConclusionsThis complex case underscores the paramount importance of a multidisciplinary approach in diagnosing and managing patients with Huntington’s Disease and concurrent psychiatric symptoms. The revelation of a confirmed Huntington’s Disease diagnosis also necessitated genetic testing for the patient’s two adult children, with the son testing positive. This case illustrates the challenges of adapting treatment strategies continuously in such multifaceted scenarios and highlights the compelling need for a collaborative and integrative approach.Disclosure of InterestNone Declared

Serum vitamins and homocysteine levels in autoimmune liver disease: A systematic review and meta-analysis.

Vitamins and homocysteine (Hcy) are involved in liver metabolism and related to the pathogenesis of autoimmune liver disease (AILD), but consensus is lacking. This study aims to systematically summarize relevant evidence to clarify the association of serum vitamins and Hcy levels with AILD. The English and Chinese literature was searched until August 29, 2023. Studies were included if they were observational studies of investigating serum vitamins and Hcy levels in patients with AILD and their healthy comparisons. Quality assessment was performed by using the Newcastle-Ottawa Scale, and a meta-analysis was conducted using ReviewManager 5.3. The protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42023455367. A total of 25 case-control studies comprising 3487 patients (1673 patients and 1814 healthy controls) were included for analysis. There were 548 autoimmune hepatitis (AIH) cases, 1106 primary biliary cholangitis (PBC) cases, and 19 primary sclerosing cholangitis (PSC) cases. We found that serum A and E were decreased in both AIH and PBC/PSC; but vitamin C was reduced only in patients with PBC, not AIH. In addition, decreased content of 25(OH)D3 was found in both AIH and PBC. However, levels of 25(OH)D did not differ between the patients and controls, and were independent of disease types and the country. Only one study that met the inclusion criteria reported vitamin B6, B9, B12, and Hcy changes, and found that vitamin B6 and B9 were significantly decreased in patients with PBC, while serum vitamin B12 and Hcy levels were significantly elevated in them. One eligible study each confirmed a reduction in plasma vitamin K1 and 1,25(OH)2D3 in patients with PBC. Most vitamins are deficient in AILD, so appropriate vitamin supplementation should be necessary. Further studies with larger sample sizes are needed to validate these findings.

Rational use of prescribing power of a physician

Abstract Writing a prescription is a duty, responsibility and a power has to be used diligently. For various reasons, our prescription sometimes becomes longer than necessary. Multiple medications can be associated with adverse outcome. Co-prescription of proton pump inhibitors with analgesics and probiotics with antibiotics may not be required routinely. Human chorionic gonadotrophin for threatened abortion deserves a relook. Progesterone during pregnancy has been overstretched. Vitamins supplementation has its place only in specific situations but tends to be over-prescribed. A rational approach while prescribing would be scientific as well as pocket-friendly to the patient.

Evaluation of the potential implications of following a vegan diet on bone health

Cow’s milk is the primary source of calcium in the NZ diet(1). The absence of dietary planning in a vegan diet can result in the individual unknowingly obtaining low intakes of calcium. Prolonged low calcium intakes can result in negative implications on bone mineral density by increasing the risk of osteoporosis later in life. The measurement of bone health parameters in NZ vegan adults have not been investigated. Therefore, we measured bone mineral density, markers of calcium homeostasis and assessed intake of essential nutrients for optimal bone health in vegans. This cross-sectional study included adults (&gt;18yrs), who followed a vegan diet for 2 years minimum. Demographic and lifestyle information was obtained from questionnaires including previous history of bone fractures and background of familial osteoporosis. A 4-day food record was completed for analysis of calcium, zinc, protein, magnesium, phosphorus and vitamin C intake and compared to the Estimated Average Requirement (EAR)(2). Weight, height and BMI were obtained, bone mineral density was measured at the hip and spine via dual x-ray absorptiometry (DXA) and reported as Z and T scores. Plasma calcium concentrations were corrected for albumin. All values are presented as mean and standard deviation. The study included 212 participants, aged 39 ± 12.38 years, 71% female. T scores at the lumbar spine and femoral neck were −0.63 ± 1.22 (Z score: −0.29 ± 1.12) and −0.66 ± 1.00 (Z score: −0.24 ± 0.89), respectively. Nine participants had a Z-score of &lt;-2.0 at the lumbar spine, and three at the femoral neck. Corrected calcium concentrations were 2.21 ± 0.33 mmol/L. Calcium intake was 917 ± 347.23 (range 195 to 2,429 mg/day) in all participants, which exceeded the EAR of 840 mg/day for adults aged 19-50 years. Men had higher intakes of calcium than women, 1,051 ± 363.7 mg/day (range 382 to 2,267 mg/day) vs. 867 ± 328.04 mg/day (range 194 to 2,428 mg/day), P-value &lt;0.001. The main source of calcium in the vegan diet was tofu. The intake of protein (77 ± 27.80) g/day, magnesium (569 ± 181.05) mg/day, and vitamin C (145 ± 96.94) mg/day met the EAR, excluding vitamin and mineral supplements. However, the intake of phosphorus (1,472 ± 459.98) mg/day and zinc (10.6 ± 4.01) mg/day were below the EAR. The findings of this study suggest that bone health of vegans are not negatively affected by the exclusion of dairy in the diet, provided that appropriate dietary planning is included to avoid nutrient deficiencies associated with poor bone health. Despite mean intake of calcium exceeding the EAR, very low intakes demonstrated significant variations between participants.

Pre-pregnancy preparation of women with hypoandrogenism and female sexual dysfunction

The onset of pregnancy in the natural cycle is a task that requires the coordinated work of both central and peripheral levels of regulation of hypothalamic‑pituitary hormones. An analysis of the reproductive health of women with a menstrual cycle disorder against the background of hypoandrogenism indicates an unsatisfactory course of the early stages of the pregnancy process with the subsequent formation of infertility against the background of a reduced ovarian reserve. Hypolubrication is considered a clinical marker of hypoandrogenism in women of reproductive age.&#x0D; Objective — Optimization of pre‑pregnancy training in women with hypoandrogenism, menstrual cycle disorders and early pregnancy losses in the anamnesis.&#x0D; Materials and methods. A comprehensive clinical, laboratory and instrumental examination involved 90 women with menstrual cycle disorders and hypoandrogenism, from them 45 women received the proposed therapy (group Ia), and 45 patients traditional therapy (group IIa). The control group consisted of 30 healthy women at the stage of pre‑gravid examination. The age of women was 18 to 35 years. Hormonal reproductive background was determined on the 5 ‑ 7th day of the menstrual cycle in all examined women, as well as levels of thyroid‑stimulating hormone (TSH), thyroid peroxidase antibody, vitamin D, homocysteine. The proposed algorithm of pre‑gravid measures included: 1) optimization of thyroid gland function (after consultation with an endocrinologist); 2) restoration of pituitary‑ovarian relationships in case of functional central hypogonadism; 3) therapy aimed at optimizing the prolactin level (target value 12.5ng/ml); 4) reduction of homocysteine level (target level 5.6 mmol/l); 5) normalization of vitamin D level (norm is 75—125 nM/l, insufficiency defined as 50—75 nM/l, and deficiency &lt;50 nM/l). The target control parameters included restoration of lubrication, ovulatory menstrual cycle, onset and progression of pregnancy. IBM SPSS Statistics version 25.0 software was used for statistical processing of the obtained data. The control periods of therapy were 3, 6 and 9 months.&#x0D; Results. In women with proposed treatment algorithm, therapy resulted in the recovery of vitamin D levels, starting from the 6th month of therapy, and complete normalization was recorded at the 9th month of treatment. This indicates the need for long‑term supplementation of vitamin D in women with hypoandrogenism. A decrease in the homocysteine levels was also noted on the 6th month of treatment, and its normalization after 9 months of treatment. Elevated homocysteine levels and vitamin D insufficiency/deficiency were observed throughout the follow‑up period in the conventional therapy group. In women with the proposed therapy, the levels of follicle‑stimulating hormone (FSH), TSH, luteinizing hormone (LH) and prolactin tend to normalize already from the 3rd month of therapy, while the highest positive increase was noted in the LH indicator on the 3rd‑6th month of treatment. Ovarian steroidogenesis approached the indicators of the control group after 6—9 months of therapy. Proandrogenic steroidogenesis began to increase on the 3rd month of therapy, reaching maximum on the 9th month. Unsatisfactory indicators of changes in free testosterone and dehydroepiandrosterone sulfate (DHEA‑C) were noted in women from the group of the traditional pre‑pregnancy preparation even after 9 months.&#x0D; The specified features of steroid support of the hormonal background of women’s reproductive health demonstrated the following: signs of female sexual dysfunction in the group with the proposed therapy completely disappeared after the 9th month of treatment, and in the group of traditional therapy they continued to bother 91.1% of women. At the end of the observation period, the regular menstrual cycle was gained in 40.0% of women with the proposed therapy and in 6.7% with the traditional one. Progressive pregnancies in the group with the proposed algorithm were achieved in 37.5% of women (successfully overcame the luteoplacental barrier), and in 8.8% in the group of the traditional approach (ended by early termination of pregnancy).&#x0D; Conclusions. The period of formation of the luteal phase insufficiency is the specific feature of the restoration of menstrual cycle fullness in women with hypoandrogenism, which requires additional therapy to ensure the conditions for a full‑fledged secretory endometrium transformation. The pregnancy process takes place in unfavorable conditions, which can lead to early pregnancy losses. The period of pre‑pregnancy measures in this group of patients should last at least 6—9 months. Traditional pre‑pregnancy preparation does not contribute to the restoration of the central mechanisms of menstrual cycle regulation in women with hypoandrogenism, nor does it contribute to the restoration of full‑fledged ovarian steroidogenesis, it is accompanied by anovulation and insufficiency of the luteal phase, early pregnancy losses. Symptoms of female sexual dysfunction do not disappear under the influence of traditional treatment.

Autoimmune Atrophic Gastritis: A Clinical Review.

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa due to anti-parietal cell antibodies. This review provides a comprehensive and up-to-date overview of autoimmune atrophic gastritis, reporting recent evidence on epidemiology, pathogenesis, diagnosis, clinical presentation, risk of malignancies, and management. The prevalence of AAG has been estimated at between 0.3% and 2.7% in the general population. The diagnosis of AAG is based on a combination of the serologic profile and the histological examination of gastric biopsies. Patients with AAG are often asymptomatic but can also have dyspeptic or reflux symptoms. The atrophy of the oxyntic mucosa leads to iron and vitamin B12 malabsorption, which may result in anemia and neurological affections. Autoimmune atrophic gastritis is associated with an increased risk of type I neuroendocrine tumors (NETs) and gastric cancer, with an incidence rate of 2.8% and 0.5% per person/year, respectively. Management is directed to reinstate vitamins and iron and to prevent malignancies with endoscopic surveillance. In conclusion, atrophic autoimmune gastritis is an infrequent condition, often asymptomatic and misdiagnosed, that requires an early diagnosis for appropriate vitamin supplementation and endoscopic follow-up for the early diagnosis of NETs and gastric cancer.