Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D

BACKGROUND: 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. METHODS: Design: A pre- and post-intervention observational study. Setting: A network comprising an academic primary care centre and nurse practitioners. Participants: 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. Main outcome measures: 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. Tests: Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0. RESULTS: 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). CONCLUSION: 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

Transport properties and ionic association in pure imidazolium-based ionic liquids as a function of temperature.

International audienceIn this work, three transport properties (viscosity, diffusion coefficient, and electrical conductivity) were experimentally determined from 298 K to 343 K in four pure imidazolium-based ionic liquids with two anions and different alkyl chain lengths on the cation: 1-ethyl-3-methylimidazolium methylsulfate, [C1C2Im][CH3SO4], 1-butyl-3-methylimidazolium methylsulfate, [C1C4Im][CH3SO4], 1-ethyl-3-methylimidazolium triflate, [C1C2Im][CF3SO3] and 1-butyl-3-methylimidazolium triflate, [C1C4Im][CF3SO3]. Higher viscosities, lower diffusion coefficients, and electrical conductivities were measured when the alkyl chain length was increased or a sulfate anion was present. From these experimental data, the ionic association was discussed using the qualitative approach of the Walden plots and the quantitative ionicity concept. An increased ionic association was observed when the alkyl chain length on the cation was increased, while comparable ionicities were measured for both anions. Finally, the applicability of the Stokes–Einstein equation (relation between the diffusion coefficient and the viscosity) was also discussed in these systems