Therapy with vitamins

Glucocorticoid treatment for arthritis or other ailments can very quickly produce a form of osteoporosis caused by the inhibition of bone formation [334]. In such cases, the decrease in bone mass may be as much as 10-20%, but examination of trabecular bone reveals a much greater (30-40%) decrease in this component of bone [335]. Combination therapies with vitamin D and bisphosphonates, calcitonin or fluoride can be effective [336]. Therapy employing vitamin D or 1,25-(OH)2D3, the latter being highly calcaemic, should also include serum calcium monitoring and the use of thiazide diuretics as appropriate. 

Furthermore, Knapp and Gassmann (Gla, K3, K8) loaded normal subjects and patients having various cutaneous disorders with 10 g dl-tryptophan orally, and determined the 24-hour excretion of xanthurenic acid. Values indicating an abnormal excretion of xanthurenic acid were observed in 22 of 55 patients, predominantly those with cutaneous allergic or light sensitivity manifestations. In many instances these abnormal results were normalized following therapy with vitamin Bs. 

Long-term therapy with vitamin Bj must be evaluated at intervals of 6-12 months in patients who are otherwise well. If there is an additional illness or a condition that may increase the requirement for the vitamin e.g., pregnancy), reassessment should be performed more frequently. 

Supplement vitamin Be deficiency states, impaired absorption, therapy with vitamin Be antagonists, increased requirements (pregnancy, lactation), increased stimulation with exogenic estrogens. X-ray therapy... 

The mechanism whereby vitamin E controls the rate of DNA biosynthesis remains to be elucidated. The effect may be an indirect one related to the extent of repair processes in the dystrophic muscle and to infiltration with other cell types. Certain observations suggest that this is not the complete explanation. It has been found that in genetically dystrophic mice (Michelson et al., 1955), which exhibit muscle pathology similar to that observed in vitamin E-deficient rabbits, the rate of synthesis of skeletal muscle DNA is not increased (Girkin et al., 1962). The increased rate of DNA biosynthesis in bone marrow of vitamin E-deficient monkeys and the appearance of multinucleated cells which promptly disappear following therapy with vitamin E suggest that the vitamin exerts some more direct effect on DNA biosynthesis. These observations cannot be readily explained on the basis of an antioxidant effect of vitamin E. 

Clinicians are uncertain about what to do with asymptomatic patients with mild biochemical abnormalities and tend to treat patients with oral vitamin B12 without a specific diagnosis clear cobalamin deficiency, usually discovered shortly after birth as a failure to thrive, requires an aggressive therapy with vitamin B12 if long-term and irreversible neurologic damage is to be avoided (Carmel 2011). 

Vitamin A deficiency is characterized by squamous metaplasia of a variety of epithelia with increased cell proliferation and hyperkeratosis. These changes are also features of some benign dermatoses, for example, psoriasis. Once beneficial effects of oral vitamin A were observed, its use spread to the treatment of other diseases of the epidermis and epidermal appendages, including acne, psoriasis, and basal cell carcinoma. Since the hypervitaminosis A syndrome (see Chapter 13) interfered with long-term therapy with vitamin A, the need arose for synthetic derivatives that could be at least as efficacious as vitamin A and yet be less toxic. The use of isotretinoin and etretinate, as described above, represents the first development of this concept in clinical practice. 

Vitamin B12 has been used in the treatment of certain neurological conditions unrelated to pernicious anemia. Dramatic relief of pain in nutritional neuropathy was reported by Bean and associates. Marked improvement has followed administration of massive doses of vitamin B12, 1000 Mg. daily, in trigeminal neuralgia. The neurological manifestations of diabetes mellitus have also improved following therapy with vitamin Bi2. ... 

In Addisonian pernicious anemia the sole limiting factor seems to be vitamin Bis. Initially there may be some disturbance of folic add metabolism, but this becomes normal after therapy with vitamin Bis. Possible examples of dual deficiency, in which the response to one hemopoietic factor seemed to be inhibited by lack of another, have been described (Ungley, 1952). In these rare cases the dual deficiency was temporary, and after the initial stage vitamin Bis alone was the only therapy required (see page 187). 

Combined therapy with fluoride, vitamin D, and calcium—The supplementation of fluoride therapy with vitamin D and calcium apparently produced normal bone in patients with osteoporosis. ... 

Lactic acidosis (buildup of lactic acid in the blood) may also occur with die administration of metformin. Although lactic acidosis is a rare adverse reaction, its occurrence is serious and can be fatal. Lactic acidosis occurs mainly in patients with kidney dysfunction. Symptoms of lactic acidosis include malaise (vague feeling of bodily discomfort), abdominal pain, rapid respirations, shortness of breath, and muscular pain. In some patients vitamin B12 levels are decreased. This can be reversed with vitamin B12 supplements or with discontinuation of the drug therapy. Because... 

KOMULAINEN M, KROGER H, TUPPURAINEN M T, HEIKKINEN A M, ALHAVA E, HONKANEN R, lURVELIN I and SAARiKOSKi s (1999) Prevention of femoral and lumbar bone loss with hormone replacement therapy and vitamin D3 in early postmenopausal women a population-based 5-year randomized trial. J Clin Endocrinol Metab 84, 546-52. 

Parathyroidectomy is a treatment of last resort for sHPT, but should be considered in patients with persistently elevated iPTH levels above 800 pg/mL (800 ng/L) that is refractory to medical therapy to lower serum calcium and/or phosphorus levels.39 A portion or all of the parathyroid tissue may be removed, and in some cases a portion of the parathyroid tissue may be transplanted into another site, usually the forearm. Bone turnover can be disrupted in patients undergoing parathyroidectomy whereby bone production outweighs bone resorption. The syndrome, known as hungry bone syndrome, is characterized by excessive uptake of calcium, phosphorus, and magnesium for bone production, leading to hypocalcemia, hypophosphatemia, and hypomagnesemia. Serum ionized calcium levels should be monitored frequently (every 4 to 6 hours for the first 48 to 72 hours) in patients receiving a parathyroidectomy. Calcium supplementation is usually necessary, administered IV initially, then orally (with vitamin D supplementation) once normal calcium levels are attained for several weeks to months after the procedure. 

We see some similarities between the major life processes in plants (growth and differentiation) and the major life processes in animals and humans (proliferation and differentiation). We expect in future to relate this concept to animal production and to human health, to be able to cross the bridge from soil to plant to animal and finally human health. For example, the development in medicine of differentiation therapy in which vitamin A-derivates are used to treat human cancer cells in vitro (De Luca el al., 1995). Cancer is defined by too much uncontrolled growth of cells without enough differentiation. Using treatment with vitamin A-derivatives - a product of differentiation processes in the plant - undifferentiated cancer cells change into differentiated more healthy ones. 

The answer is c. (Hardman, p 15230 Administration of intravenous CaG would immediately correct the tetany that might occur in a patient in whom a thyroidectomy was recently performed. Parathyroid hormone would act more slowly but could be given for its future stabilizing effect. Long-term control of a patient after a thyroidectomy can be obtained with vitamin D and dietary therapy Calcitonin is a hypocalcemic antagonist of parathyroid hormone. Plicamycin (mithramycin) is used to treat Paget s disease and hypercalcemia. The dose employed is about one-tenth the amount used for plicamycin s cytotoxic action. 

Adverse events are rare with vitamin B12 therapy. 

Other patients with vitamin 8 2 deficiency - In seriously ill patients, administer both vitamin B-12 and folic acid. It is not necessary to withhold therapy until the precise cause of B-12 deficiency is established. For hematologic signs, children may be given 10 to 50 meg/day for 5 to 10 days followed by 100 to 250 meg/dose every 2 to 4 weeks for neurologic signs, 100 meg/day for 10 to 15 days, then once or twice weekly for several months, possibly tapering to 250 to 1,000 meg/month by 1 year. 

Parenteral Anticoagulant-induced prothrombin deficiency hypoprothrombinemia secondary to conditions limiting absorption or synthesis of vitamin K (eg, obstructive jaundice, biliary fistula, sprue, ulcerative colitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas, regional enteritis) drug-induced hypoprothrombinemias due to interference with vitamin K metabolism (eg, antibiotics, salicylates) prophylaxis and therapy of hemorrhagic disease of the newborn. 

Anemia Administration has been associated in a few cases with vitamin B-12 or folic acid deficiency, megaloblastic anemia, and sideroblastic anemia. If evidence of anemia develops, institute appropriate studies and therapy. 

We found that supplementation of vitamin A in the form of an aerosol is an effective, safe, and routinely manageable method to enhance vitamin A and RBP concentrations. Consequently, this modality of treatment may serve as an alternative vitamin A therapy during chronic or acute episodes of malnutrition, malabsorption, or in case of insufficient compliance to other therapies and might be useful in respiratory diseases associated with vitamin A deficiency. 

IM therapy should be reserved for patients with GI, liver, or biliary disease associated with vitamin D malabsorption... 

CAM. Data about 145 boys and 35 girls, with a mean age of 10 years, were obtained. The most popular form of alternative therapy was vitamins, minerals, and antioxidants (51%), followed by nutritional supplements (14%), herbs and botanical medicines (11%), massage (9%), chiropractic (4%), homeopathy (4%), and acupuncture (2%). (Horrigan et ah, 1998). An anecdotal report described the use of St. John s wort by four teenagers who were under psychiatric care (Walter and Rey, 1999). Three of the patients had been reluctant to reveal this to their psychiatrist, believing the doctor had no interest in alternative medicine or would disapprove of it. 

Vitamin K antagonists, such as dicoumarol (8.61, a natural product) and warfarin (8.62), are used as anticoagulants in human therapy (thrombosis, atherosclerosis) and as rat poisons that lead to internal bleeding and death in rodents. Heparin, a polysaccharide consisting of 2-0-sulfonated glucuronic acid and 2-N,6-0-disulfonated glucosamine, is also a widely used anticoagulant, but its effect is connected not with Vitamin K but with enzyme inhibition. 

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