The requested URL /scielo.php?script=sci_arttext&pid=S0021-75572014000100028 was not found on this server.Introduction: Patients with chronic kidney disease (CKD) commonly experience 25-hydroxyvitamin D3 (25-OH-D3) deficiency, and these patients have a higher incidence of cardiovascular diseases (CVDs) due to endothelial dysfunction (ED). The aim of our study was to investigate the effect of 25-OH-D3 deficiency and its supplementation on ED in patients with CKD. Methods: Twenty-nine uremic patients on dialysis and 20 healthy controls were evaluated for ED by high-resolution Doppler ultrasonography of the brachial artery. In addition, 25-OH-D3-deficient patients (25-OH-D3 < 30 nmol/L) with CKD and healthy controls were evaluated for ED before and after 8 weeks of oral vitamin D (cholecalciferol, 50,000 units) treatment. All subjects were evaluated for percent flow-mediated dilatation (%FMD), percent endothelium-independent nitroglycerin-induced vasodilatation (%NID), and bilateral carotid intima-media thickness (CIMT).
Findings: Patients on dialysis had lower %FMD and %NID 6.11 [2.27–12.74] and 10.96 [5.43–16.4], respectively, than controls 15.84 [8.19–22.49] and 21.74 [12.49–29.4], respectively (P < 0.05). Patients on dialysis had higher left and right CIMT (0.79 ± 0.15 and 0.78 ± 0.14, respectively) than controls (0.60 ± 0.09 and 0.59 ± 0.09, respectively; In 25-OH-D3-deficient patients with CKD, after vitamin D treatment, %FMD was significantly increased in dialysis patients (10.25 [7.8–12.8]) compared to before supplementation (5.4 [2.77–6.15]; Discussion: These results indicated that dialysis patients had significantly lower blood 25-OH-D3 levels and higher CIMT than healthy subjects. In addition, vitamin D supplementation improved ED and increased %FMD in dialysis patients. Our findings suggest that vitamin D supplementation in dialysis patients might prevent CVD. Continue reading full articleIndiana University School of Medicine provides evidence based screening tools and guidelines for health care providers to evaluate a range of pediatric diseases and conditions.
Click on the document name below to open it for printing. ADHD Screening - ADHD is the most common behavioral disorder in children. Our guideline summarizes current recommendations from AAP and AACAP and outlines a practical algorithm for diagnosis and treatment of ADHD in children 5 – 18 years old. Also attached are management tools for physicians and patient handouts. Asthma Assessment Ages 0-4 - Asthma is a chronic airway disease that affects over 9 million children in the U.S. Because of the high prevalence of asthma, diagnosis and management belongs in primary care. This guideline combines the most current practice guidelines for asthma management from AAAAI, reviewed and approved by our faculty, with practical tools for asthma management. There are two separate guidelines which adjust medication management based on the age of the patient. - Asthma is a chronic airway disease that affects over 9 million children in the U.S. - Depression affects up to 5% of children and 15% of adolescents.
It is important for PCPs to be comfortable with screening, initial diagnosis and treatment of depression. This guideline is based on AAP recommended GLAD-PC and AAACP practice algorithms and provides the most up-to-date reference tool with guidelines for depression screening. It was created in collaboration with our colleagues from the division of adolescent medicine and child psychology. Developmental Screening - Based on the AAP Developmental Policy Screening (2006), this guideline is practical and easily implemented for the primary care pediatrician and includes an algorithm to guide decision making. The AAP statement recommends developmental surveillance at every well-child visit and developmental screening using formal, validated tools at 9, 18, and 30 months of age or whenever a parent or provider expresses concern. - Information for providing immunizations as part of comprehensive child health care according to standards for Pediatric Immunization Practices. Vitamin D Supplementation - To prevent rickets and vitamin D deficiency in healthy infants, children, and adolescents, a daily vitamin D intake is recommended.
This guideline reviews and summarizes in a very usable algorithm all current recommendations and available Vit D preparations. Weight Management - Current research on weight-management interventions for obese children and adolescents suggests that behavioral interventions are probably safe in children aged 4 to 18 years and can be effective particularly in moderate to high intensity comprehensive programs. Our guideline outlines the consensus management statement for children with BMI over 85%ile. Included is an algorithm and references. The ASQ Learning Collaborative at Indiana University School of Medicine provides information and support for clinicians using the Ages and Stages Questionnaire (ASQ). The ASQ Learning Collaborative meets every month on the third Wednesday of the month from 8:00am-9:00am (EST) via conference call. During these calls, sites give reports on their successes and challenges in using ASQ and local experts and colleagues give technical assistance for implementation.
Continuing Medical Education (CME) credit is available for those who participate in the calls. Ages and Stages Questionnaire (ASQ) is a reliable and validated developmental screening tool for children from birth to 5 years. The ASQ helps determine a child’s strengths as well as potential developmental problems and educates parents about developmental milestones. It provides a framework for monitoring signs that a young child may be delayed in one or more areas of development. For more information about ASQ and the Learning Collaborative MOC see ASQ Practical Pearls General and Community Pediatrics is a regularly scheduled lecture series for pediatricians, family practice physicians and other primary health care providers. Current scientific advances as they apply to daily practice are discussed to help participants advance their diagnostic and therapeutic skills through this highly practical evidence based review. CMEs are given for attendance. For upcoming events see the General and Community Pediatrics calendar.