Vitamin D and type 2 diabetes mellitus

WHAT IS KNOWN AND OBJECTIVE

The deleterious effect of vitamin D deficiency on bone health has long been known. More recent studies suggest a deleterious effect of low vitamin D (hypovitaminosis D) on general health. And specific studies propose an association between hypovitaminosis D and the aetiology and progression of type 2 diabetes (T2DM). Given a commonly assumed lack of toxicity of vitamin D, routine measurement of plasma vitamin D and supplementation is rapidly becoming accepted general practice.

COMMENT

Authoritative practice guidelines have raised the level of vitamin D that is to be considered minimal for optimum health. This recommendation was based on a wealth of information and definitive evidence for skeletal benefits of vitamin D, but there was a lack of compelling evidence that hypovitaminosis D is causally related to extra-skeletal health outcomes such as diabetes. Hence, vitamin D supplementation for the purpose of achieving a level consistent with good health is evidence based, but measurement and supplementation for the purpose of preventing or treating T2DM is not.

WHAT IS NEW AND CONCLUSION

Although the maintenance of adequate vitamin D levels is desirable for all patients, we conclude that routine measurement of vitamin D level in every patient or initiating high-dose supplementation for the purpose of preventing or treating T2DM is not evidence based.

Septic arthritis in the geriatric population

Septic arthritis has emerged as an important infection in geriatric patients. Between 25% and 50% of all cases of nongonococcal bacterial arthritis in nonprosthetic joints occur in patients over the age of sixty years. Thirty-three percent of nongonococcal septic arthritis occurs in the geriatric population. In this retrospective study of geriatric septic arthritis, 22 patients were reviewed. The major predisposing factor was prior history of arthritis, with the knee being the most commonly affected joint. Staphylococcus aureus was the major pathogen, with gram-negative organisms accounting for a significant number of infections. We think that empiric antibiotic coverage for gram-negative organisms should be initiated at the time of treatment only in patients with multiple predisposing factors for septic arthritis. The disease also may be more indolent than previously reported, leading to delayed diagnosis, treatment, and increased morbidity and mortality.

Usher's syndrome. Ophthalmic and neuro-otologic findings suggesting genetic heterogeneity

The conditions of 70 patients with Usher's syndrome were studied by ophthalmic and neuro-otologic examinations. Two distinct clinical and presumed genetic types were discernible on the basis of differences in hearing impairment, vestibular sensitivity, and, to a lesser extent, deterioration in retinal photoreceptor function. Distinguishing these two types has relevance for both diagnosis and genetic counseling of patients with Usher's syndrome.

Problems in identifying an acoustically evoked potential to a single stimulus

The identification of evoked scalp potentials in man to a single acoustic stimulus such as a word becomes possible by combining several techniques. Either multiple EEG derivations from one subject or single derivations from several subjects, can be summed algebraically to yield a tracing with a significant increase (by a factor of 2 or more) in the size of the response relative to the background. A specific template has been found which, when cross correlated with the EEG, yields 2 dimensional (correlation and time) description of when the response occurs.