Vitamin D deficiency in children and adults - causes, symptoms and procedures

The knowledge about the role of vitamin D in the human system so far has been limited only to its influence on the calcium-phosphate economy and the skeletal system. The last decade's research related to the discovery of the vitamin D receptor (VDR) made it possible to learn about the effect of vitamin D not only in bone metabolic processes, but also in immunological and anti-carcinogenic processes.

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The action of vitamin D

The effect of vitamin D on the human body is very broad. Calcitriol, i.e. the active form of vitamin D3, is similar in structure to steroid hormones and thus has a hormone-like effect. It acts on target cells through the nuclear VDR receptor (vitamin D receptor), which, according to recent studies, is present not only in bone cells, renal tubules and intestinal epithelium, but also in most cells of the human body: in the heart, blood vessel wall. , brain, prostate, mammary gland, adrenal glands, pancreatic β cells, small intestine, large intestine, parathyroid glands, lymphocytes, macrophages, keratinocytes and cancer cells.

Vitamin D sources

Vitamin D belongs to the group of fat-soluble vitamins. Two forms are essential for its action: vegetable D₂ (ergocalciferol) and derived from animal sources D₃ (cholecalciferol), which are produced from ergosterol and 7 - dehydrocholesterol (7-DHC), respectively.
The basic, evolutionarily developed and abundant source of vitamin D3 is its biosynthesis from 7-DHC in the skin under the influence of ultraviolet B (UVB) radiation contained in sunlight, which is able to cover as much as 90% of the daily requirement for this substance. Pro-vitamin D3 in the skin undergoes complex transformations under the influence of radiation and transforms into pre-vitamin D3, which then undergoes two-stage activation in the liver and kidneys, which ultimately leads to the formation of calcitriol.
The second, less important source of vitamin D in the body is food. Ergocalciferol (D2) from food is absorbed in the small intestine, but its natural resources are quite limited and in most cases rather poor in this vitamin. The largest food source is oily sea fish, such as eel or salmon, as well as eggs, cheese, liver and some mushrooms. However, to meet the daily requirement of vitamin D, you would need to eat about 20 eggs, over half a kilo of salmon, a few kilograms of cheese, or drink over 80 liters of milk.

Vitamin D biological activity

Effects on the skeletal system
The most important and best-known function of vitamin D is the regulation of calcium-phosphate metabolism, which creates optimal conditions in the body for proper bone mineralization. Vitamin D determines the development and maturation of the skeleton from fetal life to the end of growth, and its deficiency leads to bone mineralization disorders and is the cause of abnormal skeletal development and commonly known rickets in children. Later in life, vitamin D deficiency leads to disturbances in bone metabolism, i.e. osteomalacia and osteoporosis. Additionally, the anti-fracture effect of this vitamin has been demonstrated, especially in the elderly.

Immunomodulating effect of vitamin D.
The presence of the vitamin D receptor (VDR) was found on many immunologically competent cells. The high concentration of active metabolites of vitamin D in the blood increases the production of human cathelicidin, which is a natural broad-spectrum antibiotic.
The main effect of vitamin D is to reduce the inflammatory reaction, which is to protect the body against chronic inflammatory processes and autoimmune diseases, such as inflammatory bowel disease, rheumatoid arthritis, fibromyalgia, and diabetes. Vitamin D, by modulating the immune system, may also influence the course of cancer and infectious diseases. Scientific studies have described the beneficial effects of vitamin D in the treatment of psoriasis and in obstructive diseases such as asthma and COPD, where chronic progressive inflammation leads to disease progression
The nervous system
Vitamin D is one of the neurosteroids influencing the maturation and functioning of the brain, actively participating in its metabolism, regulating its local concentration. Vitamin D deficiency likely contributes to the higher incidence of mood disorders, including depression. Many scientific studies show a correlation between low vitamin D levels in the blood and the incidence of cognitive impairment and Alzheimer's disease. In addition, the incidence of multiple sclerosis (MS) is greater in areas of the globe with less exposure to sunlight, and among people who eat large amounts of vitamin D-rich fish, the incidence of MS is decreasing.

The effects of vitamin D deficiency in pregnancy

The supply of vitamin D in the mother's body during pregnancy and lactation affects the health of the baby immediately after birth and later in life. Severe vitamin D deficiency during pregnancy can cause neonatal hypocalcaemia and seizures, and maternal and neonatal secondary hyperparathyroidism.
Low birth weight is more common in newborns whose mothers did not have an adequate intake of calcium and vitamin D during pregnancy.
In addition, vitamin D deficiency during pregnancy causes reduced bone mineralization and lower bone mass in children, and in pregnant women it may be a risk factor for pre-eclampsia and gestational diabetes.
Metabolic diseases
Vitamin D receptors (VDR) have been found on pancreatic beta cells, adipocytes and skeletal muscle cells. Vitamin D, through VDR receptors, may reduce insulin resistance and increase glucose uptake in muscle tissue, therefore in people with vitamin D deficiency there is a greater risk of metabolic syndrome, insulin resistance and later development of type 2 diabetes.
Tumors
Vitamin D has antiproliferative properties and influences cell differentiation and apoptotic mechanisms. In vivo studies showed the effectiveness of cholecalciferol in inhibiting the progression of cancer and autoimmune diseases. Vitamin D derivatives are used in the treatment of prostate cancer and psoriasis.
The cardiovascular system
Hypovitaminosis D may cause more frequent occurrence of atherosclerosis, arterial hypertension or heart failure and additionally promotes left ventricular hypertrophy. Supplementation with vitamin D regulates the function of the vascular endothelium and improves its functioning.

Causes of Vitamin D Deficiency

According to the research of many European centers, vitamin D deficiency in adults and children is a common phenomenon. According to epidemiological data, the causes are both insufficient or no exposure to sunlight, and low vitamin D content in everyday food.
Providing the body with vitamin D through sun exposure is in many cases very difficult. In Poland, it is provided in summer, but it is disturbing that currently commonly used sunscreens inhibit as much as 90-95% of the natural production of vitamin D in the skin. In the autumn-winter period, that is from September to March, the synthesis of this vitamin ceases almost completely. Moreover, our daily diet satisfies the daily need for vitamin D only in 3-5%, therefore the majority of the population suffer from deficiencies, which seriously affects the physiological economy and increases the risk of many chronic diseases..

In addition to the above very important factors, there are groups of people more exposed to vitamin deficiencies. First of all, these are newborns whose skin is still immature and extremely sensitive to sun exposure. Additionally, milk - the only food in this period of life - is very poor in vitamin D.
The ability to naturally produce calcitriol also decreases with age, which is why the next group of people exposed to deficiencies are the elderly. With age, the synthesis of provitamin D3 (7-dehydrocholesterol) in the skin decreases, and thus, in a further stage, they have a reduced ability to synthesize cholecalciferol. Additionally, older people are more likely to have mobility problems and are less likely to stay in the sun.
The group of obese children and adults is particularly at risk, who, due to the excessive accumulation of adipose tissue in the body and the associated phenomenon of vitamin D storage (sequestration) in this tissue, have a lower concentration of vitamin D in the blood serum compared to people with a normal BMI.
Another group are people with darker complexions (especially African Americans) who have significant amounts of melanin in their skin, which reduces the synthesis of vitamin D by up to 99%.
Additionally, the medications that the patient is taking should be taken into account. Antiepileptic drugs, antiretrovirals, drugs used to prevent transplant rejection and glucocorticoids accelerate the conversion of active metabolites of vitamin D to inactive calcitric acid which is excreted from the body in the bile.

Symptoms and effects of vitamin D deficiency

The high percentage of vitamin D deficiency found in various age groups in the Polish population is worrying. It contributes not only to the development of rickets in children and osteomalacia and osteoporosis in adults, but also may significantly increase the risk of developing many other diseases, including type I diabetes, cancer (breast, prostate, colon), autoimmune diseases (sclerosis). disseminated, rheumatoid arthritis, systemic lupus erythematosus), cardiovascular and metabolic syndromes. Therefore, it is important to properly supply the entire human system with vitamin D, which takes into account its multidirectional action and impact on the body.
Indicator of the body's supply of vitamin D, which helps to determine whether its synthesis
and dietary intake is sufficient serum 25-hydroxyvitamin D (25 (OH) D) concentration is present. The optimal level in children is 20-60 ng / ml (50-150 nmol / l), and in adults 30-80 ng / ml (75-200 nmol / l).

In people suffering from vitamin D deficiency, we observe the following symptoms:
• muscle weakness - a reduction in the amount of muscle tissue is a very common consequence of vitamin D deficiency;
• bad mood, depression, apathy, and in extreme cases even depression;
• greater sensitivity to pain, frequent chronic musculoskeletal and even skin pain;
• increased risk of fractures, greater susceptibility to fatigue fractures;
• high blood pressure, dangerous pressure spikes;
• sleepiness, lack of energy and motivation to act;
• lower resistance to stress - vitamin D influences the level of serotonin in the brain;
• worse condition and loss of endurance;
• additionally, with low vitamin D levels in the body, symptoms such as loss of appetite, visual disturbances or even disgust and burning sensation in the mouth or throat may also appear.

Symptoms and effects of vitamin D deficiency - children

Vitamin D deficiency is dangerous for a child in the womb. This condition can lead to disorders of the child's brain development and be the cause of permanent damage to certain brain functions, and thus the development of various diseases, e.g. schizophrenia or autism.
In infants, the deficiency is manifested by an excessively flat head on the back as a result of softening of the cranial bones, as well as convex frontal tumors. Due to the lack of vitamin D, the fontanel overgrowth is delayed. In addition, vitamin D deficiency can lead to rickets of the ribs and weakness of the abdominal muscles, which may cause the infant to deal with the so-called "Frog's belly" (curving belly).

Treatment of vitamin D deficiency and its supplementation

Currently, due to the universally low concentration of vitamin D in the European population, prophylactic supplementation of this compound is recommended. Prophylactic dosage of vitamin D should be individualized depending on age, body weight, sun exposure (season), diet and lifestyle. It should also be remembered about groups particularly exposed to deficiencies, in which standard supplementation is sometimes insufficient and it is recommended to use maximum doses for a given age group of the population.
In both children and adults, in the case of laboratory-confirmed deficiency, it is advisable to use pharmacological treatment after prior consultation and under constant medical supervision, because treatment requires the use of doses depending on the concentration of 25 (OH) D and the patient's age, taking into account body weight and comorbidities and medications used. During the therapy, it is recommended to control the concentration of 25-hydroxyvitamin D every 1-3 months and to test the concentration of alkaline phosphatase, as well as the concentration of Ca and P in the serum.

Source

1) Agata Krasińska, Bogda Skowrońska, Znaczenie witaminy D u pacjentów z nadmierną masą ciała — nowe zasady suplementacji, Forum Zaburzeń Metabolicznych 2014, tom 5, nr 2, 63–70
2) Zasady suplementacji i leczenia witamina D – nowelizacja 2018 r., Postępy neonatologii 2018;24(1)
3) Zygmunt Zdrojewicz, Ewa Chruszczewska, Michał Miner, Wpływ witaminy D na organizm człowieka, Med Rodz 2015; 2(18): 61-66
4) Artur Gadomski, Skutki niedoboru witaminy D w organizmie człowieka, Nowa Pediatria 2017; 21(1): 34-37
5) Bogna Grygiel-Górniak, Mariusz Puszczewicz, Witamina D – nowe spojrzenie w medycynie i reumatologii, Postepy Hig Med Dosw (online), 2014; 68: 359-368 e-ISSN 1732-2693
6) Kurt A. Kennel, Matthew T. Drake, Daniel L. Hurley, Niedobór witaminy D u dorosłych:
kiedy badać i jak leczyć?, Vol 20/NR 5/MAJ 2011
7) Paweł Płudowski, Waldemar Misiorowski, Jerzy Konstantynowicz, Jacek Łukaszkiewicz,
Ewa Marcinowska-Suchowierska, Profilaktyka i leczenie niedoboru witaminy D – wybór właściwych rekomendacji, Post N Med 2016; XXIX(10): 738-746

FAQ

1. What might the effects of long-term vitamin D deficiency in adults be?
Long-term vitamin D deficiency in adults may be the primary cause of osteoporosis or osteomalacia. In addition, there may be problems with walking and balance, and painful contractions as a result of weakening muscle strength. Vitamin D deficiencies increase the risk of developing civilization diseases, e.g. obesity, diabetes, arterial hypertension, inflammatory and autoimmune diseases and cancer. In addition, long-term vitamin D deficiencies may accelerate the aging processes of the skin and the entire body, and additionally adversely affect the more frequent occurrence of mood disorders, including depression.

2. How to deal with insufficient vitamin D levels?

Insufficient vitamin D levels can adversely affect the human body. Exposure to UV radiation can cover the body's total daily requirements for this vitamin, but for most of the year we are unable to reap these benefits. Therefore, vitamin D deficiencies should be supplemented by consuming products that are its rich source, e.g. eggs, cheese, fish or mushrooms, and additionally supplemented with dietary supplements with the addition of vitamin D.
Taking higher doses of vitamin D is especially recommended for elderly people and women during menopause - this is due to the fact that with age they lose bone mass and weaken bones. However, as in cases of suspected vitamin D deficiency in children, adults are also advised to determine the necessary dose of this vitamin with their doctor to avoid the risk of overdosing.

Metabolic syndrome - symptoms and treatment
The metabolic syndrome (syndrome X, polymetabolic syndrome, insulin resistance syndrome) is considered a key risk factor for the development of cardiovascular diseases. Atherosclerosis, ischemic heart disease, and diabetes mellitus develop very easily in people with metabolic syndrome. The metabolic syndrome is a set of specific parameters, among which the main diagnostic criterion is abdominal obesity. The metabolic syndrome occurs in approximately 20% of the Polish population, more often in women. Syndrome X is typical of people who lead a sedentary lifestyle and consume meals based mainly on simple sugars and fats in excess. If you stay in these habits for many years, you may worsen metabolic disorders and develop complications that are dangerous to your health. The metabolic syndrome is often accompanied by hormonal disorders that require endocrinological consultation. How do you recognize yourself with metabolic syndrome? What can be done to avoid diseases caused by syndrome X?

Make an appointment now - to the doctor treating the metabolic syndrome at our hospital

What symptoms indicate metabolic syndrome?

The International Diabetes Federation (IDF) provides criteria that qualify for the diagnosis of metabolic syndrome. The condition for diagnosis is the presence of visceral (abdominal) obesity and the coexistence of at least two of the following disorders:
- triglyceride levels above 150 mg / dl or therapy of dyslipidemia,
- low levels of "healthy" HDL cholesterol (<40 mg / dl in men, <50 mg / dl in women),
- blood pressure above 130 / 85mmHg or therapy of arterial hypertension,
- blood glucose level above 100 mg / dl (fasting) or diagnosed type 2 diabetes.

Abdominal obesity (visceral)

Abdominal obesity is associated with the accumulation of fat around the waist. In fact, fat accumulates not only under the skin, but also inside the abdominal cavity. Visceral obesity is equated with a waist circumference exceeding 80 cm in women and 94 cm in men. You can also come across the WHR (waist to hip ratio) index, which is the ratio of the circumference of the waist to the circumference of the hips. If the WHR result is greater than or equal to 0.85 in women and 1.0 in men, abdominal obesity can be diagnosed.
Visceral distribution of adipose tissue is considered the most unfavorable due to the specific hormonal activity of abdominal fat. The production of proinflammatory cytokines (e.g. IL-6) is 2-3 times higher in abdominal adipose tissue than in subcutaneous adipose tissue. Abdominal fat is also a source of glucocorticosteroids (due to the increased expression of receptors for the enzyme converting inactive cortisone to cortisol). Hormones derived from visceral adipose tissue are secreted into the portal vein, which goes to the liver, affecting its function. In general, high levels of IL-6 and glucocorticosteroids promote the development of inflammatory and thrombotic processes and exacerbate metabolic disorders.

Carbohydrate metabolism disorders

Insulin is a hormone produced by the pancreas. Insulin stimulates the transport of glucose to the cells, lowering blood sugar levels. The body's cells contain receptors, the stimulation of which by insulin enables the transport of glucose inside the cell. The sensitivity of cells to insulin is in 50% genetically determined, and in the remaining 50% depends on environmental factors - mainly the type and degree of obesity and the level of physical activity. Some people require a lot more insulin to transport glucose into the cell. Why is this happening?

People who lead a sedentary lifestyle and consume excess calories from meals rich in simple sugars are most likely to suffer from metabolic disorders. When carbohydrates are consumed in excess, their use by muscles and storage as glycogen in muscles and liver may not be sufficient. The excess glucose is then converted into fatty acids, which then form triglycerides and cholesterol. The excess of triglycerides builds adipose tissue, including visceral adipose tissue. Various compounds released from the abdominal fat reach the liver and inhibit the storage of glucose in the liver. Limiting the source of glucose disposal in the liver leaves its level high in the blood, additionally increasing the level of insulin released. Regularly repeated high levels of insulin in the blood result in the hiding of insulin receptors located on the surface of the cells. The above-described mechanism explains the potential mechanism of insulin resistance in overweight and abdominal obese people.
Insulin resistance may be accompanied by an increase in sodium ion retention and a decrease in uric acid filtration by the kidneys. This can result in high blood pressure and an increased level of uric acid in the blood (hyperuricaemia). There are also views that hyperuricemia can cause metabolic syndrome, as some studies have reported chronically elevated blood uric acid levels preceding hyperinsulinemia. It has been proposed that too much uric acid in the blood impairs the muscular blood flow and may thus reduce the transport of glucose to the muscles.

Dyslipidemia

Dyslipidemia means elevated levels of triglycerides and "bad" LDL cholesterol in the blood, with a lower level of "good" HDL cholesterol. Primary dyslipidaemia can be genetically determined, but it can also be associated with a poor diet, sedentary lifestyle, or smoking. Secondary dyslipidaemia develops from other conditions or is a consequence of taking certain medications.
HDL is actually a lipoprotein that transports cholesterol from tissues and plasma to the liver. The effect of HDL function is to lower the total level of cholesterol in the blood. Dyslipidemia (especially HDL reduction, even with relatively normalized LDL levels) leads to the development of atherosclerosis and thus increases the risk of coronary heart disease, heart attack and ischemic stroke.

Hypertension

Normal blood pressure in a healthy adult should be below 130 / 85mmHg. Hypertension is diagnosed with regular measurements of 140 / 90mmHg or more. The metabolic syndrome is more common in people with hypertension. The simultaneous presence of arterial hypertension and metabolic disorders significantly increases the risk of cardiovascular diseases. Hypertension accelerates the development of atherosclerosis - the walls of the arteries rebuild, lose their elasticity and are more prone to the formation of atherosclerotic plaques. The atherosclerotic plaque consists of, among others from cholesterol deposits - its high level in the course of metabolic syndrome contributes to faster progression of atherosclerosis.

Complications of the metabolic syndrome

Abdominal obesity, insulin resistance, dyslipidemia, hypertension, and increased activation of inflammatory and thrombotic processes are factors that lead to cardiovascular complications.
Atherosclerotic plaque may cause a narrowing of the vessel's lumen - for example, narrowing of the coronary arteries leads to the development of ischemic heart disease. The sharp closure of the coronary vessel results in a lack of blood supply to a specific part of the heart muscle - this is a heart attack.
Headaches and dizziness may occur when atherosclerotic lesions occur in the vessels that supply blood to the brain (carotid and head arteries). Acute closure of the vessel within the brain results in an ischemic stroke.
Atherosclerotic changes in the arteries of the lower limbs cause pain and fatigue in the limbs when walking (intermittent claudication). It is related to the insufficient supply of oxygen to the working muscles. Stopping in a place and resting will reduce the discomfort. The closure of the artery within the lower limb is associated with its acute ischemia and sometimes even threatens with the amputation of the leg.
Metabolic syndrome in women may be associated with polycystic ovary syndrome (PCOS). This disease is characterized by, inter alia, anovulation, making it much more difficult for women to get pregnant. Symptoms of PCOS are the features of androgenization, caused by elevated levels of male sex hormones (androgens): hirsutism, seborrhea, acne, alopecia in the front of the head, irregular menstruation.

Metabolic syndrome - treatment

Treatment of the metabolic syndrome includes measures to reduce overweight or obesity, mainly by reducing the percentage of visceral fat in the distribution of body weight. The aim of the procedure is also to improve the sensitivity of tissues to insulin, improve the lipid profile and normalize blood pressure.
The mainstay of treatment is lifestyle changes. It is advisable to increase physical activity, and preferably introduce training aimed at reducing body fat with the least possible loss of muscle mass. Such training should be safe for people with arterial hypertension, so in addition to cardiological consultation, in the initial period it is worth using the help of a professional trainer cooperating with a doctor.
Your diet should provide you with all the nutrients you need. Caloric content should be adjusted to the level of activity, thanks to which it will be possible to achieve a safe, gradual reduction of body weight. People with high blood pressure should also reduce the salt intake in the diet.
When carbohydrate metabolism disorders are significant, it is necessary to implement antidiabetic drugs. In case of high blood pressure, your doctor may decide to use antihypertensive drugs.
The metabolic syndrome may be accompanied by hormonal disorders, therefore a person with metabolic syndrome should be under the constant supervision of an endocrinologist. A diagnosis of PCOS may require the use of anti-androgen medications or medications to stimulate ovulation.
A comprehensive look at the processes taking place in the body undoubtedly allows you to take measures to comprehensively improve the health and quality of life of people with metabolic syndrome.
FAQs:
1. What is Metabolic Syndrome?
The metabolic syndrome is a set of symptoms that significantly increase the risk of developing atherosclerosis and its serious complications (stroke, heart attack, acute lower limb ischemia). The metabolic syndrome is characterized by the presence of visceral obesity, i.e. excess fat located inside the abdominal cavity. The following are also associated with the metabolic syndrome: increased blood triglycerides, abnormal HDL to LDL cholesterol ratio, arterial hypertension and type II diabetes. Women with metabolic syndrome are more frequently diagnosed with polycystic ovary syndrome (PCOS).
2. Metabolic syndrome - what are the risk factors?
The factors that increase the risk of metabolic syndrome include: a sedentary lifestyle, a high-calorie diet rich in simple sugars and saturated fats, smoking, stress and hormonal disorders (most often hyperandrogenism).
3. Metabolic syndrome - which doctor should you go to?
Due to the complexity of the disorders, treatment may require consultation with several specialists. The role of an endocrinologist is to recognize the symptoms typical of the metabolic syndrome and to recommend tests necessary for diagnosis. The endocrinologist may also prescribe drugs that improve carbohydrate metabolism and thus facilitate weight reduction. If hypertension is diagnosed, regular visits to a cardiologist and adherence to his recommendations are recommended. A dietitian helps you plan your meals, making losing weight and improving your health a lot easier.

Lipoliza to zabieg z zakresu medycyny estetycznej, polegający na niechirurgicznej liposukcji. Zabieg polega na wstrzykiwaniu preparatu zawierającego fosfatydylocholinę do tkanki tłuszczowej w określonej partii ciała. Substancja ta pozyskiwana z ziaren soi zawiera dezoksycholan, który powoduje rozbicie błon komórek tłuszczowych. Dzięki temu tkanka tłuszczowa w obrębie miejsca zabiegu zostaje zredukowana, co skutkuje korekcją kształtu oraz wygładzeniem danej partii ciała. Zabieg wykorzystywany jest coraz częściej w celu poprawy owalu twarzy i modelowaniu podbródka.

Szczegóły zabiegu

W obrębie podbródka wykonuje się kilkanaście wkłuć przy pomocy specjalnej, cienkiej igły. W ten sposób wprowadza się do tkanki tłuszczowej preparat, Celluform Plus. To środek, który został stworzony specjalnie na potrzeby lipolizy podbródka. W skład preparatu wchodzi roztwór kwasu deoksycholowego, który liftinguje skórę oraz rozpuszcza tłuszcz i wyciąg z arniki górskiej, który ma działanie antybakteryjne i łagodzące. Zabieg trwa około 30 minut.

Efekty

Po zabiegu może pojawić się tymczasowy obrzęk skóry, zaczerwienienie, uczucie ciepła czy świądu w okolicach miejsca zabiegu. Może także pojawić się ból i zasinienie. Jednak większość efektów niepożądanych utrzymuje się jedynie przez kilka dni po wykonaniu zabiegu (3-5 dni). Pacjentowi przez kilka następnych tygodni może towarzyszyć nadwrażliwość skóry w okolicy miejsca zabiegu, szczególnie przy ucisku i dotyku. Zaleca się, mimo to codzienny, kilkuminutowy masaż miejsca po zabiegu przez kolejne dwa tygodnie. Masowanie wrażliwej strefy ma zapewnić równomierny efekt. Dolegliwości pozabiegowe można zniwelować poprzez stosowanie leków przeciwbólowych lub antyhistaminowych.

Medycyna estetyczna

Nasza skóra w ciągu życia traci elastyczność. Poszczególne warstwy skóry stają się cieńsze i bardziej suche. Aktywność mięśni mimicznych sprawia, że pojawiają się widoczne zmarszczki i bruzdy. Zmniejsza się również objętość w dolnych warstwach skóry, zmieniając harmonijne proporcje twarzy. Zmiany w skórze zachodzące z wiekiem, a także wpływ środowiska, intensywne promieniowanie słoneczne, zanieczyszczenie powietrza i wolne rodniki powodują spadek poziomu kwasu hialuronowego w organizmie. Kwas hialuronowy to naturalny składnik naszego ciała, który pełni ważne funkcje, takie jak utrzymywanie nawilżenia, jędrności i elastyczności skóry. Zmniejszenie się jego poziomu w skórze sprawia, że dolne warstwy tkanki tracą swoją stabilność, siłę i objętość. Z czasem środkowa część twarzy opada na dolną, trzecią część twarzy. Zjawisko to ma decydujący wpływ na proporcje twarzy i powoduje odwrócenie tzw. „trójkąta młodości”.

Terapią procesów starzenia zajmuje się prężnie rozwijąca od kilkunatu lat medycyna estetyczna. W trakcie swojego rozwoju medycyna estetyczna przebyła długą drogę – stała się niemal bezbolesna i pozwala uzyskać naturalny efekt bez konieczności pozabiegowego wyłączenia pacjenta na jakiś czas z życia. W nowoczesnej medycynie estetycznej dla lekarzy i pacjentów ważne są współpraca i wzajemne zaufanie. Najważniejszy jest możliwie jak najbardziej naturalny i trwały efekt.

Zapraszamy na zabiegi z zakresu medycyny estetycznej, które w naszym gabinecie wykonywane są przez wykwalifikowanych lekarzy dermatologów i lekarzy medycyny estetycznej.

Konsultacje lekarskie z zakresu medycyny estetycznej

Jeżeli są Państwo zainteresowani zabiegami z zakresu medycyny estetycznej najlepiej poprzedzić zabieg konsultacją z lekarzem.
Lekarz wykluczy przeciwwskazania do zabiegu oraz szczegółowo opowie o przebiegu zabiegu oraz o ewentualnych reakcjach pozabiegowych. Dzięki konsultacji lekarskiej będą mieli Państwo czas na podjęcie decyzji oraz np. na zrobienie dodatkowych badań.

Peeling medyczny to procedura polegająca na nałożeniu na skórę odpowiednio dobranej mieszaniny związków chemicznych w określonym stężeniu, co w efekcie powoduje usunięcie defektów kosmetycznych i/lub zmian chorobowych w obrębie naskórka i skóry właściwej. Substancje te przenikają w głąb skóry i mają wpływ na przebudowę kolagenu i elastyny, które są czynnikami podporowymi w skórze. Tym samym seria peelingów wpływa na odnowę naskórka oraz skóry, a także działa odmładzająco likwidując oznaki starzenia się skóry: przebarwienia, drobne zmarszczki i inne niedoskonałości.

Wskazania do peelingów chemicznych

1. Zmiany barwnikowe: piegi, ostuda, przebarwienia pozapalne, plamy soczewicowate
   2. Uszkodzenia słoneczne: rogowacenie słoneczne
   3. Uszkodzenia związane z wiekiem: zmarszczki, utrata jędrności skóry
   4. Blizny
   5. Trądzik zaskórnikowy, grudkowo - krostkowy
   6. Rozstępy skórne
   7. Zaburzenia rogowacenia: suchość skóry, rogowacenie przymieszkowe

Przeciwwskazania

Ekspozycja skóry na słońce (bardzo słoneczne lato), alergie skórne, aktywna opryszczka, skłonność do powstawania bliznowców, stan po zabiegu chirurgicznym w obrębie twarzy (do 2 miesięcy), ciąża, karmienie piersią, liczne znamiona melanocytowe, liczne teleangiektazje, stan po krioterapii (do 6 miesięcy), choroby autoimmunologiczne (kolagenozy, pęcherzyce), skóra podrażniona, uszkodzona (nadżerki, przeczosy, otarcia), doustna terapia pochodnymi wit. A -wymagana co najmniej półroczna przerwa.

Enerpeel PA

Czas trwania - 30 min

Peeling silnie złuszczający oparty na kwasie pirogronowym 50%. Bardzo dobrze odblokowuje pory, wyraźnie redukuje łojotok i zapobiega tworzeniu się stanów zapalnych. Doskonale sprawdza się w terapii trądziku. Enerpeel PA ma również działanie antybakteryjne oraz stymuluje produkcję kolagenu na poziomie skóry właściwej. Peeling polecany jest zarówno dla osób z cerą tłustą, trądzikową jak i przesuszoną.

Enerpeel SA

Czas trwania - 30 min

Peeling oparty na działaniu kwasu salicylowego. Pobudza odnowę komórkową skóry, poprawia jej napięcie oraz usuwa małe zmarszczki. Ma silne właściwości złuszczające, odblokowuje ujścia gruczołów łojowych, działa przeciwzapalnie i antybakteryjnie. Usuwa również przerośniętą warstwę rogową. Zalecany przy terapii trądziku pospolitego, trądziku młodzieńczego oraz jako zabieg przygotowujący do mikrodermabrazji.

Enerpeel JR (Roztwór Jessnera)

czas trwania - 30 min

Peeling zawierający kwasy: 15% kwas salicylowy, 20% kwas mlekowy oraz 14% rezorcynę. Do efektów jego działania zalicza się przede wszystkim wygładzenie średniogłębokich i głębokich zmarszczek, wyrównanie kolorytu skóry, przeciwdziałanie lekkiemu i umiarkowanemu rogowaceniu słonecznemu. Zastosowanie znajduje również w terapii trądziku ze względu na silne działanie przeciwzapalne i ograniczające łojotok.

PQ AGE Evolution

czas trwania - 30 min

Innowacyjny peeling do liftingu i rewitalizacji. Przeznaczony jest dla osób, które w szybki i bezbolesny sposób chcą  pozbyć się drobnych zmarszczek oraz odmłodzić i ujędrnić skórę. Zabieg odpowiedni dla osób o skórze wrażliwej, które chciałyby ją zrewitalizować i zregenerować  bez inwazyjnych zabiegów o długim czasie rekonwalescencji.

Głównymi składnikami peelingu są od lat cenione w dermatologii substancje, które zostały połączone w jeden skuteczny i silny związek.

• TCA 34% – środek złuszczający, stymuluje skórę właściwą, głównie fibroblasty i kolagen
• Kwas kojowy – doskonały przy leczeniu plam pigmentacyjnych, posiada bardzo dobre właściwości antybakteryjne, przeciwgrzybiczne, przeciwutleniające
• Nadtlenek mocznika – posiada właściwości silnie rozjaśniające, dzięki utlenianiu związków organicznych
• Koenzym Q10 – to substancja niezbędna do funkcjonowania każdej komórki. Bierze udział w procesie wytwarzania energii w komórkach, poprawia ich dotlenienie, chroni przed wolnymi rodnikami.

Tak unikalne połączenie składników powoduje brak podrażnień, przy doskonałych efektach odmładzających.

Retises CT (Yellow Peel)

czas trwania - 20 min

Retises CT Yellow Peel to peeling złożony, który oddziaływuje na różne, nawet najgłębsze, warstwy skóry. Preparat oparty jest o dobroczynne działanie stężonego, czystego retinolu, retinylu oraz witaminy C. Peeling z retinolem przywraca twarzy młodzieńczy wygląd dzięki swojemu działaniu depigmentacyjnemu, złuszczającemu, odświeżającemu oraz regeneracyjnemu. Intensywność działania Retises CT można dostosować do indywidualnych potrzeb pacjenta oraz stanu jego skóry.

Retises CT Yellow Peel to unikalna kombinacja trzech składników aktywnych:

• retinol oraz retinyl (witamina A) – odżywiają skórę, działają przeciwzmarszczkowo oraz zmniejszają głębokość zmarszczek już istniejących, wpływają na poprawę kolorytu oraz niwelują efekty fotostarzenia skóry;
• witamina C – ma działanie antyoksydacyjne, przyspiesza syntezę kolagenu oraz elastyny, wpływa na wygładzenie skóry oraz rozświetla ją;
• witamina B3 – pobudza syntezę kolagenu i zwiększa produkcję ceramidów, wpływa również pozytywnie na nawilżenie skóry i poprawę jej elastyczności, a dodatkowo rozjaśnia przebarwienia posłoneczne.

Podczas zabiegu z peelingiem retinolowym złuszcza się martwy naskórek i pobudza skórę do regeneracji. W jego wyniku cera odzyskuje zdrowy wygląd, blask i jednolity koloryt. Dodatkowo zwiększa się jej grubość oraz staje się ona odżywiona i prawidłowo nawilżona.

Wskazania do zabiegu

• widoczne oznaki starzenia się oraz fotostarzenie,
• hiperpigmentacja,
• melasma,
• trądzik zaskórnikowy
• skóra pozbawiona blasku, szara, matowa, wiotka i przesuszona.

Przebieg zabiegu Retises CT

Retises CT to zabieg dwuetapowy. Najpierw na twarz pacjenta podaje się ampułkę z witaminą C, a następnie wmasowuje się preparat z retinolem, który powinien pozostać na skórze przez około 10 godzin, zgodnie z zaleceniami osoby przeprowadzającej zabieg. Po upływie tego czasu można go zmyć za pomocą przegotowanej wody. Po zabiegu peelingu z retinolem zalecane jest stosowanie preparatów łagodzących oraz natłuszczających. Złuszczanie rozpoczyna się zwykle dzień po zabiegu i trwa około czterech dni. Cała kuracja obejmuje zwykle serię 4 zabiegów, które w zależności od indywidualnych predyspozycji pacjenta są powtarzane w odstępach 2-4 tygodni.

Efekty zabiegu Retises CT

• rozświetlona, rozjaśniona i wolna od przebarwień skóra,
• zwężenie porów,
• wygładzenie skóry oraz jej zagęszczenie,
• głęboka regeneracja,
• spłycenie zmarszczek,
• poprawa owalu twarzy i lekkie uniesienie powiek,
• usunięcie zrogowaciałych komórek.

The heart is the most important organ in the human body, being its center and responsible for the most important functions of the body. However, even the heart is prone to many different diseases, collectively known as heart pathologies. Cardiomyopathies are a group of diseases of the heart muscle that are caused by a variety of factors but consistently lead to abnormalities in the structure and function of the heart. They may be accompanied by changes or dysfunctions in the pericardium, endocardium or other organs. As a result of cardiomyopathy, the body deprives the body of properly oxygenated blood, which can lead to death in the worst case. According to the WHO classification from 1995, five basic groups of cardiomyopathy are distinguished, each of which may take two forms of the disease - genetically determined (familial) or non-genetically determined (idiopathic - of unknown origin or acquired). In turn, the American Heart Association in 2006 created a more detailed classification, covering ten individual groups of cardiomyopathy.

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Symptoms

In many cases, cardiac pathologies do not guarantee visible symptoms at the beginning of development, and some types of cardiomyopathy may progress asymptomatically for a long time. However, as the disease progresses, there will be indications of heart failure. The patient will experience general body weakness and fatigue. Dizziness, shortness of breath and frequent fainting over time may occur. Swelling of the feet, exhausting cough and high blood pressure are also common symptoms. The patient also develops chest pain, arrhythmias and atrial fibrillation over time. However, the symptoms, depending on the type of pathology present, may be different and may not appear jointly at a similar time.

The causes of the disease

Heart pathologies can occur in people of all ages, but those in their forties are most at risk. The highest risk group includes people with family history of heart pathologies and genetic mutations, immune disorders, systemic diseases, heart ischemia, as well as alcoholism and blood pressure related diseases. The disease often affects people taking specific medications, which may result in heartbeat disorders, complications or even a heart attack. The risk factors also include diabetes, obesity, anyloidosis and sarcoidosis.

Diagnosis

Heart pathologies are usually difficult to diagnose, especially in these rare varieties. Numerous appropriate examinations are required in order to make a diagnosis. Diagnosis of cardiomyopathies is primarily based on an electrocardiogram
and cardiac echocardiography. An ECG test detects wave changes
T in leads above the right ventricle and widening of the QRS complex. A 24-hour ECG (Holter) recording is performed for reliable results read more, as well as an exercise test or perfusion scintigraphy of the heart muscle read more. Echocardiography, on the other hand, allows for the identification of the enlargement of the right ventricle, abnormal contractility of this ventricle and the condition of the heart muscle fibers. Additionally, MRI is performed for a more detailed picture of the fibers and the right ventricle as well
in some cases, a myocardial biopsy to confirm loss of normal heart muscle cells and an increase in fibrous and fatty tissue. However, a biopsy is performed extremely rarely due to the low sensitivity of the examination.

Classification of cardiomyopathy

• Dilated (congestive) cardiomyopathy

With congestive cardiomyopathy, one or both ventricles are dilated or dilated. Most often it is the left ventricle. This is accompanied by deterioration of contractile function and fibrosis of the striated muscle tissue that builds the heart. Additionally, there is interstitial and perivascular fibrosis and thinning of the walls of the heart cavities (especially the ventricles). The disease in most cases occurs when the heart muscle is weak enough that it cannot pump blood properly. The disease is extensive and is largely hereditary (about 25% of patients). It can also be caused by ischemic heart disease, and in the case of the form acquired by nutritional deficiencies, hormonal disorders or the use of drugs that damage the heart muscle (e.g. chemotherapy).

• Hypertrophic cardiomyopathy

This type of cardiomyopathy in more than half of the cases is due to genetics or mutations in the genes encoding the heavy chain of β-myosin (MYH7) and the type C myosin binding protein (MYBPC3). Hypertrophic cardiomyopathy most often develops as a result of diseases that cause hypertrophy of the heart muscle (e.g., amyloidosis, amyloidosis), long-term hypertension, diabetes, thyroid gland, or simply the aging process. This most common type of cardiomyopathy is characterized by asymmetric left ventricular hypertrophy due to the thickening of the left ventricular wall and a narrowing of the outflow tract. As a result, cardiac striated muscle fibers condense, preventing proper blood flow.

• Restrictive cardiomyopathy

The type of cardiomyopathy that is the least frequent of all five primary groups. The condition can develop as a result of a scar tissue from a heart transplant, or as a result of an illness such as mumps. Restrictive cardiomyopathy is characterized by stiffening of the chambers of the heart, causing the fibers to lose elasticity and unable to stretch properly to fill the heart cavities with blood.

• Arrhythmogenic right ventricular cardiomyopathy

Extremely rare group of ailments with genetic determinants. The disease most often runs in families and is inherited in an autosomal dominant manner. It consists in the progressive loss of heart muscle cells, which are replaced by connective tissue
and fat. Cardiomyocyte atrophy begins in the subendocardium of the right ventricle and then progresses towards the endocardium. It can lead to the involvement of the left ventricle (in about 50% of cases) and to the involvement of the interventricular septum (in about 20% of cases). The most common mutations responsible for the occurrence of ARVC relate to genes encoding proteins of intercellular junction (desmosomes). The disease in many cases leads to the occurrence of cardiac arrhythmias. Arrhythmogenic cardiomyopathy is known as a disease of young athletes because it causes sudden cardiac death in many of them and its symptoms can be triggered by exercise. Then they appear, among others shortness of breath, loss of consciousness, attacks of palpitations. However, ARVC can develop asymptomatically for a long time.

Cardiomyopathies unclassified:

• Postpartum (perinatal) cardiomyopathy
  It most often occurs at the end of pregnancy or shortly after the end of pregnancy. Postpartum cardiomyopathy is a rare type that occurs in the last month of pregnancy or within five months of pregnancy as a result of a weakened heart muscle. It is a type of dilated cardiomyopathy caused by factors of vascular and endocrine origin. The disease takes the form of left ventricular failure, which is a threat to the patient's life. Women suffering from the disease are advised against breastfeeding due to the presence of prolactin - they are given drugs that inhibit its secretion and limit lactation. This is to compensate for the damage to the heart muscle.

• Alcoholic cardiomyopathy
  It develops as a result of consuming a lot of alcohol over a long period of time - most often it is the consequence of an alcoholism disorder. As a result, the heart is weakened enough that it cannot pump blood properly. The heart muscle is enlarged. For this reason, alcoholic cadiomyopathy is a form of dilated cardiomyopathy.
  
  
• Metabolic cardiomyopathy
  It arises as a result of hormonal disorders, such as the thyroid gland, diabetes, acromegaly or adrenal insufficiency, as well as as a result of storage diseases. These types of ailments cause the retention of amyloid within the heart muscle - a type of pathological protein with a different structure.
  
  
• Stress-induced cardiomyopathy (takotsubo)
  Most often it occurs as a result of tragic experiences, such as the death of a partner or with increased mental stress (e.g. divorce). Its common name - broken heart syndrome - owes its occurrence often in people who have experienced heartbreak or unhappy love. It appears suddenly and disappears just as quickly, but it causes disturbances in the functioning of the left ventricle.

Treatment

Heart pathologies are a group of diseases that are not fully curable. Treatment is primarily aimed at reducing the symptoms and securing the patient's life.
First of all, the patient is recommended to make changes in lifestyle and to be active, although it should be remembered that people with heart disease must not overstrain themselves physically. Medicines used to treat cardiomyopathy include diuretics, β-blockers and supplements with a high potassium content. In many cases, the patient has a pacemaker implanted to improve its functioning,and in extreme cases performs heart transplant surgery. Treatment depends on the level of myocardial damage and the symptoms associated with the disease.

Sources:

• Bennett R.G., Haqqani H.M., Berruezo A. et al Arrhythmogenic cardiomyopathy in 2018-2019: ARVC/ALVC or Both? Heart Lung Circ. 2019; 28 (1): 164-177
• Beręsewicz A. (red.). Patofizjologia niewydolności serca. Warszawa 2010. Centrum Medyczne Kształcenia Podyplomowego.
• Brieler J. MD., Bredden M.A., Tucker J.  Cardiomyopathy: an overview. 96 (10). Am Fam Physician, 2017, s. 640-646.
• Cunningham F., Byrne J., Nelson D. Peripartum cardiomyopathy. 133 (1). Obstet Gynecol, 2019, s. 167–179.
• Douglas P., i in. Braunwald's Heart Disease. Elsevier Inc. ​
• Elliot PM, Poloniecki J, Dickie S. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. Journal of the American College of Cardiology. (36) 7, 2000, s. 2212-2218.
• Elliott P., Andersson B., Arbustini E. Klasyfikacja kardiomiopatii. 66. Stanowisko Grupy Roboczej Chorób Mięśnia Sercowego i Osierdzia Europejskiego Towarzystwa Kardiologicznego Kardiol Pol, 2008, s. 533-540.
• Gładysz J. Arytmogenna kardiomiopatia prawej komory - postępowanie diagnostyczne krok po kroku. (2). Państwowa Medyczna Wyższa Szkoła Zawodowa w Opolu Puls Uczelni, 2015, s. 12-17.
• Kwiatkowska J., Potaż P., Wałdoch A. Rodzinna kardiomiopatia rozstrzeniowa (DCM): problemy diagnostyczne, terapeutyczne i społeczne. 10 (33). suppl. 32. Standardy Med. 2008, s. 122-128.
• Lindley K.J., Verma A.K., Blauwet L.A. Peripartum cardiomyopathy: progress in understanding the etiology, management, and prognosis. 15 (1). Heart Fail Clin, 2019, s. 29-39.
• Maron B.J., i in. ACC/ESC clinical expert consensus document on hypertrophic cardiomyopathy: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Journal of the American College of Cardiology. 42, 2003, s. 1687-1713.
• Maron BJ, i in. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. „Circulation”. 113. 14, 2006, s. 1807-1816.
• Szczeklik A. (red.). Choroby wewnętrzne. Przyczyny, rozpoznanie i leczenie, tom I. Kraków: Wydawnictwo Medycyna Praktyczna, 2005, s. 288-296.
• Thiene G., Corrado D., Basso C. Arrhythmogenic right ventricular cardiomyopathy/dysplasia. „Orphanet J Rare Dis”. 2, 2008, s. 45.