Stig Östlund

torsdag, januari 20, 2011

NEJM

--------------------Teaching Topics from the New England Journal of Medicine

---------------------------------Teaching Topics  January 20, 2011
Vitamin D: What vitamin D supplementation dose is recommended by the Institutes of Medicine report?
Coronary Atherosclerosis: How were subsequent cardiovascular events attributed between culprit and nonculprit lesions?
Vitamin D
Clinical Practice
Vitamin D Insufficiency
C.J. Rosen

Whereas frank vitamin D deficiency (serum level of 25-hydroxyvitamin D below 10 ng per milliliter) has long been recognized as a medical condition characterized by muscle weakness, bone pain, and fragility fractures, vitamin D “insufficiency,” defined as a serum level of 25-hydroxyvitamin D of 10 to 30 ng per milliliter, without overt clinical symptoms, has recently become a concern on the part of physicians and patients.

Clinical Pearls

*What is the best indicator of overall vitamin D status?
The serum 25-hydroxyvitamin D level is the best indicator of overall vitamin D status because this measurement reflects total vitamin D from dietary and sunlight exposure, as well as the conversion of vitamin D from adipose stores in the liver.
*What conditions and treatments cause very low serum levels of 25-hydroxyvitamin D?
Various medications, dietary habits, and medical conditions cause very low serum levels of 25-hydroxyvitamin D (i.e., below 10 ng per milliliter), including use of antiseizure medications (e.g., phenobarbital or phenytoin); long-term use of glucocorticoids; poor dietary intake of vitamin D coupled with negligible sun exposure; and malabsorption due to inflammatory bowel disease, gluten enteropathy, gastric surgery, biliary disease, or intestinal overgrowth.
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Morning Report
Questions
Q. What vitamin D supplementation dose is recommended by the Institutes of Medicine (IOM) report?
A. The recent IOM guidelines recommend 600 IU daily for a postmenopausal woman who is not at high risk for fractures or falls and 800 IU daily for persons who have a very high risk of osteoporosis or who are older than 70 years of age and have had previous fractures.
Q. What target level of 25-hydroxyvitamin D is suggested by the IOM?
A. The IOM report, based on evidence from observational studies and recent randomized trials, suggests that a serum level of 20 ng per milliliter of 25-hydroxyvitamin D would protect 97.5% of the population against adverse skeletal outcomes such as fractures and falls.
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IMAGE CHALLENGE

What is the diagnosis?



Question
Deficiency of which one of the following dietary components is most likely to have caused this rash
¤ Biotin
¤ Folate
¤ Niacin
¤ Riboflavin
¤ Vitamin C
See how others choose, and find the right answer (I was wrong... for the umpteenth time):
http://www.nejm.org/image-challenge?ci=01202011&showVotes=true
More image challenge: http://www.nejm.org/image-challenge?query=BUL

This Week at NEJM.org  January 20, 2011  >>  http://www.nejm.org/

Swedish:
Det finns  bra ordlistor, inklusive medicin-specialiserade sådana, på nätet med vilka man kan traggla sig igenom det mesta. Nästan.
Börja sökandet exempelvis här, och få adressen till bl.a. "guldgruvan"  MedlinePlus: http://www.2000taletsvetenskap.nu/medlex.htm

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