Níveis de Vitamina D e traumatismo encefálico – Vitamin D levels and traumatic brain injury

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by Brant Cebulla

A new randomized controlled trial from Iran suggests that vitaminD  could  play  an important role in the treatment of traumatic brain injury.

The study, led by Professor Bahram Aminmansour and colleagues from Isfahan University of Medical Sciences, investigated whether vitamin D in conjunction with progesterone could improve recovery rates in patients with traumatic brain injury.

Currently, physicians have few drugs that are effectively neuro-protective after a traumatic brain injury. Progesterone has been identified as safe and effective, protecting the blood-brain barrier, and helping prevent cerebral edema, excessive inflammatory response, and necrosis.  It  also helps stimulate myelin formation, reduces free radicals, and helps prevent neuronal loss.

Recent studies have suggested that vitamin D deficiency  may  worsen  traumatic brain injury and reduce the effects of current treatment. Like progesterone, activated vitamin D is a neurosteroid and has proven to be effective aiding recovery in animal models, perhaps by mechanisms similar to progesterone, which is also a steroid hormone.

The researchers enrolled patients admitted for traumatic brain injury, treating them in less than 8 hours of admission. They randomized 60 patients into three groups, with 20 patients in each of the following groups:

  1. Progesterone. These patients were injected with one mg/kg of progesterone intramuscularly every 12 hours for 5 days.
  2. Progesterone and vitamin D. These patients were injected with one mg/kg of progesterone intramuscularly every 12 hours for 5 days and also 200 IU/kg of vitamin D once-a-day for 5 days. For a 150 lb person, this would be 13,600 IU of vitamin D/day for five days.
  3. Placebo. These 20 patients were injected intramuscularly with placebo.

The researchers used the Glasgow Coma Scale to assess patients, which is a 15 point scale that monitors severity of coma via eye, verbal and motor responses; the higher the score, the better the consciousness. Prior to treatment, the three group had equivalent scores of around six.

Three months after intervention, patients in the progesterone + vitamin D group had the highest mean scale rating at 11.27, followed by progesterone alone at 10.25 and then placebo at 9.16 (p=.001).

Furthermore, after 3 months, 35% of patients in the progesterone + vitamin D group made “Good Recovery,” as assessed by the Glasgow Outcome Scale, while only 25% met this assessment in the progesterone group and only 15% in the placebo group (p=.03). Ten-percent died in the progesterone + vitamin D group, compared to 20% in the progesterone group and 40% in the placebo group (p=.03).

The authors note that the progesterone + vitamin D group showed the most favorable results likely because of a variety of complimentary mechanisms, including vitamin D’s beneficial role in the immune system, its anti-inflammatory action and reduction of TH1 cytokines. Furthermore, vitamin D prevents intracellular hypercalcemia (not promotes).

The researchers conclude:

“The use of combined progesterone and vitamin D is reasonable in that vitamin D in combination with progesterone improves repair mechanisms of the central nervous system considering their common pathways, and also compensates other mechanisms, which are not performed by progesterone. This reduces the . . . probable failure of a single treatment.”

Source:

Aminmansour B et al. Comparison of the administration of progesterone versus progesterone and vitamin D in improvement of outcomes in patients with traumatic brain injury: A randomized clinical trial with placebo group. Adv Biomed Res, 2012

 

Suplementos de vitamina D podem reduzir risco de Alzheimer – 10.000 UI, não menos

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Mulheres devem tomar suplementos de vitamina D, segundo dois novos estudos. É que as que não têm níveis suficientes da substância ao atingir a meia-idade apresentam maiores chances de desenvolver Alzheimer, segundo estudo publicado pelo jornal Daily Mail.

A associação que já foi feita em pesquisas anteriores foi confirmada em dois novos levantamentos distintos.

O cientista Cedric Annweiler, do Hospital da Universidade de Angers, na França, analisou dados de 500 voluntárias. Constatou que as que receberam o diagnóstico de Alzheimer ingeriam uma média de 50,3 microgramas de vitamina D por semana, em comparação com 59 microgramas das que não apresentaram sinais da demência.

Enquanto isso, os pesquisadores liderados por Yelena Slinin, do Centro Médico VA, nos Estados Unidos, analisaram as taxas da vitamina de 6.257 pessoas do sexo feminino, que fizeram testes de habilidade mental. Baixos níveis de vitamina D (menos de 20 nanogramas por mililitro de sangue) foram associados com maiores probabilidades de deterioração cerebral.

Tabagismo aumenta em sete vezes o risco de periodontite

Universidade de São Paulo

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10/07/2012 – 08h42

Estudo realizado na USP comprova os malefícios do fumo para a saúde bucal.

O hábito de fumar pode elevar em até sete vezes o risco de periodontite. É o que revela a pesquisa recentemente publicada no Journal of Clinical Periodontology, que acompanhou 52 fumantes de São Paulo durante um tratamento periodontal e antitabágico.

Cláudio Mendes Pannuti, responsável pelo estudo e professor de Periodontia da USP, explica os danos que os pacientes sofrem. “Além da periodontite, os pacientes apresentam halitose, manchas dentais e maior chance de desenvolver câncer bucal. Após um ano, somente 17 participantes pararam de fumar. Apenas estes apresentaram melhora significativa na gengiva, comprovando que os riscos de doenças bucais diminuem quando não há o uso do tabaco”.

A pesquisa, além de comprovar que o tabagismo aumenta a possibilidade de doenças orais, enfatiza a importância da correta higiene bucal. “A prevenção é a maneira menos dolorida e mais econômica de cuidar da boca. Com três passos simples, escovação, uso do fio dental e do enxaguatório, é possível deixar a boca saudável”, completa Pannuti.

Uma informação interessante obtida a partir da pesquisa foi que 49% dos pacientes gostariam de receber auxílio para parar de fumar durante o tratamento dentário. “Cabe aos profissionais esclarecer dúvidas e orientar os pacientes quanto aos danos causados pelo tabaco. Muitas vezes, é mais fácil convencer o paciente a parar de fumar mostrando os efeitos que o fumo causa especificamente na boca, do que em outras partes do corpo”, ressalta Pannuti.

Fonte:  http://www.inpn.com.br/noticia.asp?id=199

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The near-death experience of the medical profession

Daily Mail, 11 September 2006

“Medical science, in other words, has been playing God. The Cambridge experiment has demonstrated just how horrifyingly wrong that was.”

The ghastly prospect that, as a result of catastrophic illness, doctors might write you off as dead even though you are well aware of what is going on but can’t communicate that you are still alive, is the stuff of nightmares.

 

Such concern is often expressed about patients in a persistent vegetative state (PVS), but until now this has been pooh-poohed by doctors as fanciful and alarmist.

 

They have asserted with unchallengeable confidence that the damage to these patients’ brains means that it is physically impossible for them ever again to be aware of anything.

 

As a result, ever since the landmark 1993 case of the Hillsborough disaster victim Tony Bland, the law has allowed doctors to stop giving such patients food and fluids on the grounds that this permits them finally to die and thus end a ‘living death’.

 

Actually, since they are not dying, it does nothing of the sort; it is more truthful to call it legalised killing. This objection, however, is brushed aside on the basis that, since they feel nothing, such patients are as good as dead, and protesters are dismissed as cranks or religious extremists.

 

But now, graphic evidence has been produced that such clinical arrogance is wholly misplaced. A team of Cambridge neuroscientists has reported that a woman who had suffered a severe head injury in a road accident, and seemed unable to communicate or respond to any stimulus, actually played tennis in her head and made a mental tour of her home when asked to do so by the research team.

 

Doctors said she retained the ability to understand spoken commands and to respond to them through activity in her brain which they were able to monitor and which was the same as the brain activity of a healthy person.

 

This revelation, which has astounded the medical profession, has the most profound ethical implications. It proves dramatically that even where a doctor pronounces that a patient will never recover consciousness, this certainly does not mean that the patient is dead. And it raises the horrifying possibility that PVS patients may have been starved or dehydrated to death even though they might have felt what was happening to them.

 

It also calls sharply into question the practice of switching off the life-support machines of others who are in a deep coma. The fact is that these patients are alive, and the Cambridge experiment rubs the doctors’ noses in this most inconvenient fact — one that they have tried so hard to deny.

 

The case exposes the total absence of humility of a medical profession that pretends to know what it cannot possibly know. Much that goes on in the brain, especially around the issue of consciousness, remains utterly mysterious and unexplained.

 

Yet doctors arrogantly assume that they know enough about the brain not only to declare that their patients will never recover any sensation but, worse still, that in some cases they are actually dead.

 

This has implications even more sensitive than for sufferers from PVS. For the medical definition of ‘brain-stem death’ underpins organ donation, which gives people who would otherwise die of chronic disease the chance of gaining a healthy life through an organ transplant.

 

A new law that has just come into operation has deprived relatives of their power of automatic veto over the removal of organs from loved ones who carried donor cards. This is aimed to tackle the chronic shortage of organ donors, which means that every year some 500 people die waiting for a transplant.

 

Doctors will now be able to override relatives’ objections unless they feel that these are overwhelming. But relatives are often reluctant to give their consent for organs to be removed because they see that the body of their loved one remains healthily pink and with a heart that is still beating.

 

The philosopher Baroness Warnock, that self-appointed national arbiter of where life begins and ends, says such squeamishness is inevitably based on ‘irrational sentiment or irrational dogma’. But this is simply as ignorant as it is offensive.

 

For the fact is that the medical profession has redefined death purely for the benefit of the transplant programme. It has defined the point of death as the failure of the brain-stem to respond to certain tests, with the resulting additional diagnosis of the irreversible loss of the capacity for consciousness and the capacity to breathe.

 

But testing the brain-stem cannot exclude all possibility of recovery in every case — not least because it does not test the higher parts of the brain that may still be functioning. That is why, as a recent report from a German neurosurgical unit revealed, two of their patients diagnosed as brain-stem dead actually ‘recovered’. In other words, they were not dead at all.

 

Moreover, some anaesthetists who paralyse ‘brain-stem dead’ patients to enable their organs to be removed give them a general anaesthetic as well— just in case they may still have some feeling during the procedure.

 

Whoever heard of anaesthetising a corpse to avoid the slightest chance of causing it pain or distress? This in itself demonstrates that, even for doctors involved in organ removal for transplant purposes, the definition of death is wholly artificial and even meaningless.

 

Yet such is the pressure of the transplant programme, they insist on ignoring or even denying the considerable body of evidence giving rise to such doubts within the profession. The Royal College of Anaesthetists recently upheld the brain-stem death definition and repeated the claim that is frequently made in such circles that ‘death is a process rather than an event’.

 

But this is absurd. Dying is a process; death is indeed an event. The distinction has been blurred simply because death has become too inconvenient. Organs for transplant cannot usefully be extracted from the dead, so they are being taken instead on occasion from people who may at most be dying —at which point the ‘event’ of death certainly does take place.

 

Of course, it is a noble ideal to save the lives of those who are desperately ill. And some whose organs are harvested are undoubtedly dead. But what if the transplant programme does not always take organs from corpses but from living people who are actually killed by this process — and more horrifying still, may even have some awareness of their surroundings?

 

The uncomfortable fact is that we have redefined our understanding of death so that it no longer applies in circumstances where life has become too inconvenient. Our society no longer believes in absolutes — even those such as life or death — if they stop scientists from fulfilling their promise to deliver happiness to all.

Thus when the traditional understanding that human life begins at conception started getting in the way of embryo research, which was said to benefit infertile couples or help find a cure for genetic disease, Lady Warnock obligingly and arbitrarily shifted the start of life to 14 days’ gestation.

 

Thus, when the traditional understanding that death occurs when the heart stops beating started preventing organs being harvested for transplant purposes, doctors redefined the point of death as the failure of the brain stem instead.

 

Medical science, in other words, has been playing God. The Cambridge experiment has demonstrated just how horrifyingly wrong that was.

 
Fonte: http://www.melaniephillips.com/articles-new/?p=449

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