25-hydroxyvitamin-d-2 and Pain

Four cases of hypovitaminosis D were seen in a general practitioner's population in the Netherlands: a Somalian veiled woman aged 53 and her 11-year-old daughter, a dark-skinned Surinam woman aged 31, and a veiled Moroccan woman aged 56 years. This cause of myopathy has only been recently recognised and is more prevalent than often thought, especially in high-risk groups such as veiled and dark-skinned immigrants who lack sunlight in the Netherlands. Symptoms are muscle pain and mainly proximal muscle weakness resulting in difficulties in ascending a staircase or getting up out of a chair. The diagnosis is made on the basis of a detailed history and measurement of serum 25-hydroxyvitamin D. Calcium and serum alkaline phosphatase activity may be normal. Treatment with ergocalciferol is effective and cheap. As diagnosis and treatment are relatively simple, finding and treating hypovitaminosis D is a rewarding challenge to primary health care practitioners in the Netherlands.

Topics: 25-Hydroxyvitamin D 2; Adult; Child; Cultural Characteristics; Ergocalciferols; Female; Humans; Life Style; Middle Aged; Morocco; Muscle Weakness; Muscular Diseases; Netherlands; Pain; Risk Factors; Skin Pigmentation; Somalia; Suriname; Vitamin D Deficiency

To assess the effect of vitamin D supplementation on neuropathy specific quality of life (NeuroQoL) in patients with painful diabetic neuropathy.. This prospective, open label study was conducted between June 2012 and April 2013. Patients with symptomatic diabetic neuropathy were given a single dose of 600,000 IU intramuscular vitamin D, and NeuroQol was assessed at baseline and at five follow-up visits every 4 weeks.. Of 143 participants, 41.3% were vitamin D deficient (vitamin D < 20 ng/ml). Treatment with vitamin D resulted in a significant increase in 25(OH)D (. Vitamin D is effective in improving quality of life in patients with painful diabetic neuropathy.

Topics: 25-Hydroxyvitamin D 2; Adult; Asymptomatic Diseases; Cost of Illness; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; Diabetic Neuropathies; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Middle Aged; Pain; Pakistan; Peripheral Nervous System Diseases; Psychiatric Status Rating Scales; Quality of Life; Severity of Illness Index; Stress, Psychological; Vitamin D; Vitamin D Deficiency

Topics: 25-Hydroxyvitamin D 2; Cystic Fibrosis; Humans; Pain; Vitamin D; Vitamin D Deficiency

Primary hyperparathyroidism is rare in children. Absence of specific symptoms and limited biochemical evaluation in children has led to lengthy delays in diagnosis with the potential for damage to the kidneys and skeleton.. The setting involved a private practice referral to a large tertiary care center.. Our patient is a 16-yr-old male presenting with gross hematuria, left flank pain, and right foot pain.. A biochemical evaluation revealed hypercalcemia and elevated parathyroid hormone levels. Renal ultrasonography demonstrated bilateral nephrolithiasis. Parathyroid ultrasonography and dual-phase technetium-99m sestamibi scintigraphy revealed a parathyroid adenoma in the left mid/lower anterior thyroid bed. A 4.5-g adenoma was removed at parathyroidectomy.. Bone mineral content and density performed by dual energy X-ray absorptiometry at the time of diagnosis and 1 yr after parathyroidectomy.. The main outcome measurement is a dramatic (24%-whole body and 49.9%-left hip) increase in bone mineral density during the 1-yr interval.. Delay in diagnosis of hyperparathyroidism is common in children, related to vague symptomatology and infrequent use of laboratory evaluations in children. Such delays lead to increased risk of osteoporotic fractures and kidney stones. This case illustrates the emergent need of diagnostic evaluation in children presenting with similar symptoms. We emphasize the importance of bone densitometry in children, which is not often considered as part of the standard evaluation in this age group. The remarkable increase in bone mineral density in the 1 yr after surgery attests to the plasticity of recovery of the growing skeleton.

Topics: 25-Hydroxyvitamin D 2; Absorptiometry, Photon; Adenoma; Adolescent; Bone and Bones; Bone Density; Humans; Hydronephrosis; Hyperparathyroidism, Primary; Kidney; Kidney Calculi; Lithotripsy; Male; Pain; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Spine; Technetium Tc 99m Sestamibi; Trabecular Meshwork; Ultrasonography

Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. We aim to determine the first diagnosis considered, the duration and resolution of symptoms, and the predictors of response to treatment in female asylum seekers suffering from hypovitaminosis D.. A pre- and post-intervention observational study.. A network comprising an academic primary care centre and nurse practitioners.. Consecutive records of 33 female asylum seekers with complaints compatible with osteomalacia and with hypovitaminosis D (serum 25-(OH) vitamin D < 21 nmol/l). Treatment intervention: The patients received either two doses of 300,000 IU intramuscular cholecalciferol as well as 800 IU of cholecalciferol with 1000 mg of calcium orally, or the oral treatment only.. We recorded the first diagnosis made by the physicians before the correct diagnosis of hypovitaminosis D, the duration of symptoms before diagnosis, the responders and non-responders to treatment, the duration of symptoms after treatment, and the number of medical visits and analgesic drugs prescribed 6 months before and 6 months after diagnosis.. Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0.. Prior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%). The mean duration of symptoms before diagnosis was 2.53 years (SD 3.20). Twenty-two patients (66.7%) responded completely to treatment; the remaining patients were considered to be non-responders. After treatment was initiated, the responders' symptoms disappeared completely after 2.84 months. The mean number of emergency medical visits fell from 0.88 (SD 1.08) six months before diagnosis to 0.39 (SD 0.83) after (P = 0.027). The mean number of analgesic drugs that were prescribed also decreased from 1.67 (SD 1.5) to 0.85 (SD 1) (P = 0.001).. Hypovitaminosis D in female asylum seekers may remain undiagnosed, with a prolonged duration of chronic symptoms. The potential pitfall is a diagnosis of somatisation. Treatment leads to a rapid resolution of symptoms, a reduction in the use of medical services, and the prescription of analgesic drugs in this vulnerable population.

Topics: 25-Hydroxyvitamin D 2; Administration, Oral; Adult; Analgesics; Calcium; Chi-Square Distribution; Cholecalciferol; Drug Prescriptions; Emergencies; Female; Humans; Injections, Intramuscular; Logistic Models; Osteomalacia; Pain; Primary Health Care; Prospective Studies; Radioimmunoassay; Spectrophotometry; Time Factors; Vitamin D Deficiency

To describe 21 cases of symptomatic rickets in adolescents.. The setting was a primary and secondary care hospital in Saudi Arabia providing medical care to Saudi Arab company employees and their families. Cases of symptomatic rickets diagnosed between January 1996 and December 1997 in adolescents aged 10 to 15 years were assessed with respect to clinical presentation, biochemical and radiological evaluation, dietary assessment, and estimation of sun exposure.. Symptomatic rickets developed in 21 adolescents (20 females), with a prevalence rate of 68 per 100 000 children years. Presentation included carpopedal spasms (n = 12), diffuse limb pains (n = 6), lower limbs deformities (n = 2), and generalised weakness (n = 1). Biochemical findings included hypocalcaemia (n = 19), hypophosphoraemia (n = 9), raised serum alkaline phosphatase (n = 21) and parathormone (n = 7), and reduced 25-hydroxyvitamin D concentrations (n = 7). Radiological studies were suggestive of rickets in only eight children. All children had an inadequate dietary calcium and vitamin D intake. All but one had less than 60 minutes sun exposure per day.. Even in sunny climates, adolescents, especially females, can be at risk of rickets. Hypocalcaemic tetany and limb pains were the most common presenting symptoms. Radiological evidence was not present in every case.

Topics: 25-Hydroxyvitamin D 2; Adolescent; Alkaline Phosphatase; Calcium, Dietary; Child; Diet Records; Female; Growth; Humans; Hypocalcemia; Male; Nutrition Policy; Pain; Phosphorus; Rickets; Saudi Arabia; Sunlight; Tetany; Vitamin D