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  1. Book ; Online ; E-Book: Maternal-fetal and neonatal endocrinology

    Kovacs, Christopher S. / Deal, Cheri L.

    physiology, pathophsysiology, and clincal management

    2020  

    Title variant Maternal fetal and neonatal endocrinology
    Author's details edited by Christopher S. Kovacs, Cheri L. Deal
    Language English
    Size 1 Online-Ressource (xlvi, 993 Seiten), Illustrationen
    Publisher Elsevier AP Academic Press
    Publishing place London
    Publishing country Great Britain
    Document type Book ; Online ; E-Book
    Remark Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
    HBZ-ID HT020328965
    ISBN 978-0-12-814824-2 ; 9780128148235 ; 0-12-814824-1 ; 0128148233
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  2. Article ; Online: Complex clinical encounter series: osteoporosis presenting during pregnancy and lactation: wait and reassess.

    Kovacs, Christopher S

    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

    2024  Volume 39, Issue 3, Page(s) 197–201

    Abstract: Two months after her first pregnancy, a 35-yr-old exclusively breastfeeding woman bent to move her baby in the car seat and experienced sudden, severe pain from 5 spontaneous vertebral compression fractures. Genomic screen was negative but she had mild ... ...

    Abstract Two months after her first pregnancy, a 35-yr-old exclusively breastfeeding woman bent to move her baby in the car seat and experienced sudden, severe pain from 5 spontaneous vertebral compression fractures. Genomic screen was negative but she had mild ankylosing spondylitis previously well controlled on etanercept. She was vegetarian with a high phytate intake. A lactation consultant had advised her to pump and discard milk between feeds, leading her to believe she produced twice as much milk as her baby ingested. She presented with a LS Z score of -3.6 and a TH Z score of -1.6. After 6 mo postweaning, she was treated with teriparatide (14 mo intermittently over 18 mo) and ultimately achieved a 50% increase in LS bone density and an 8% increase in TH bone density. Her fragility is explained by normal lactational bone loss amplified by excessive milk production and phytate-induced impairment of intestinal calcium absorption, ankylosing spondylitis, and the bend-and-lift maneuver. The marked increase in bone density resulted from the combined effects of spontaneous recovery and pharmacotherapy. Spontaneous recovery of bone mass and strength should occur during 12 mo after weaning in all women, including those who have fractured.
    MeSH term(s) Humans ; Pregnancy ; Female ; Breast Feeding ; Fractures, Compression ; Phytic Acid/pharmacology ; Phytic Acid/therapeutic use ; Spondylitis, Ankylosing ; Spinal Fractures/drug therapy ; Osteoporosis/diagnostic imaging ; Osteoporosis/drug therapy ; Lactation ; Bone Density
    Chemical Substances Phytic Acid (7IGF0S7R8I)
    Language English
    Publishing date 2024-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 632783-7
    ISSN 1523-4681 ; 0884-0431
    ISSN (online) 1523-4681
    ISSN 0884-0431
    DOI 10.1093/jbmr/zjae038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Fraudulent, duplicate publication of pregnancy/lactation data in Osteoporosis International.

    Kovacs, Christopher S

    Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

    2023  Volume 34, Issue 12, Page(s) 2141–2142

    MeSH term(s) Pregnancy ; Female ; Humans ; Osteoporosis ; Lactation ; Breast Feeding ; Bone Density ; Pregnancy Complications
    Language English
    Publishing date 2023-10-19
    Publishing country England
    Document type Letter
    ZDB-ID 1064892-6
    ISSN 1433-2965 ; 0937-941X
    ISSN (online) 1433-2965
    ISSN 0937-941X
    DOI 10.1007/s00198-023-06939-9
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  4. Article ; Online: Scuba diving and the stress response: considerations and recommendations for professional and recreational divers.

    Kovacs, Christopher R

    International maritime health

    2023  Volume 74, Issue 3, Page(s) 186–191

    Abstract: Scuba diving is an activity that people engage in both for recreational purposes as well as having professional, commercial, and military applications. Scuba diving has often been considered a high-risk activity but, overall, scuba diving has been shown ... ...

    Abstract Scuba diving is an activity that people engage in both for recreational purposes as well as having professional, commercial, and military applications. Scuba diving has often been considered a high-risk activity but, overall, scuba diving has been shown to be a safe activity when divers participate within their experiential, physical, and psychological limits. However, increased physical and psychological stress can quickly arise during diving activities due to unexpected events and situations and may lead to the onset of panic in an unprepared diver. Dive safety is dependent on the ability of a diver to understand the primary signs of stress and panic and attempt to minimise their potential impacts on the immediate situation. The purpose of this review is to examine the stress response in divers, illustrate the role that panic plays in potential diving accidents and fatalities, and provide recommendations to both help understand and manage stress and panic in the diving community in an effort to further increase the overall safety of scuba diving across all applications.
    MeSH term(s) Humans ; Diving/physiology ; Diving/psychology ; Stress, Physiological ; Stress, Psychological
    Language English
    Publishing date 2023-09-30
    Publishing country Poland
    Document type Review ; Journal Article
    ZDB-ID 2032821-7
    ISSN 2081-3252 ; 1641-9251
    ISSN (online) 2081-3252
    ISSN 1641-9251
    DOI 10.5603/imh.91707
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Does fetal exposure to vitamin D programme childhood bone mass?

    Kovacs, Christopher S

    The lancet. Diabetes & endocrinology

    2017  Volume 5, Issue 5, Page(s) 317–319

    Language English
    Publishing date 2017-05
    Publishing country England
    Document type Journal Article
    ISSN 2213-8595
    ISSN (online) 2213-8595
    DOI 10.1016/S2213-8587(17)30067-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Analysis of the MAVIDOS trial.

    Kovacs, Christopher S

    The lancet. Diabetes & endocrinology

    2017  Volume 5, Issue 5, Page(s) 328

    Language English
    Publishing date 2017-05
    Publishing country England
    Document type Letter
    ISSN 2213-8595
    ISSN (online) 2213-8595
    DOI 10.1016/S2213-8587(17)30114-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The Skeleton Is a Storehouse of Mineral That Is Plundered During Lactation and (Fully?) Replenished Afterwards.

    Kovacs, Christopher S

    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

    2017  Volume 32, Issue 4, Page(s) 676–680

    Abstract: During lactation, mammals resorb mineral from the maternal skeleton to provide calcium to milk. Rodents lose 25% to 35% of skeletal ash weight, ash calcium content, and bone mineral content as measured by dual-energy X-ray absorptiometry (DXA), and have ... ...

    Abstract During lactation, mammals resorb mineral from the maternal skeleton to provide calcium to milk. Rodents lose 25% to 35% of skeletal ash weight, ash calcium content, and bone mineral content as measured by dual-energy X-ray absorptiometry (DXA), and have compromised material properties of bone as assessed by crushing vertebrae and 3-point bend tests of femora or tibias. The strength, stiffness, and toughness of vertebrae, femora, and tibias are reduced by as much as 60%. The effects of lactation are not uniform throughout the skeleton, but instead resorption is much more marked in the trabecular-rich spine than in the appendicular skeleton or whole body. Women who breastfeed exclusively lose an average of 210 mg calcium in milk each day, whereas nursing of twins or triplets can double and triple the output of calcium. Clinical data are also consistent with skeletal calcium being released during lactation to provide much of the calcium needed for milk production. Lumbar spine bone mineral density (BMD), as assessed by DXA, declines by a mean of 5% to 10% among numerous studies during 3 to 6 months of exclusive lactation, whereas largely cortical sites (hip, forearm, whole body) show half that loss or no significant changes. Micro-CT of rodents and high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging of women confirm that lactation causes microarchitectural deterioration of bone. These skeletal losses occur through two pathways: upregulated osteoclast-mediated bone resorption and osteocytic osteolysis, in which osteocytes remove mineral from their lacunae and pericanalicular spaces. After weaning, the skeleton is fully restored to its prior mineral content and strength in both animal models and humans, despite persistent microarchitectural changes observed in high-resolution imaging. Osteoblasts upregulate to lay down new osteoid, while osteocytes remineralize their surroundings. The factors that stimulate this post-weaning skeletal recovery remain unclear. In most studies, a history of lactation does not increase the risk, but may protect against, low BMD and fragility fractures. © 2017 American Society for Bone and Mineral Research.
    MeSH term(s) Animals ; Bone Density/physiology ; Bone Resorption/metabolism ; Breast Feeding ; Female ; Femur/metabolism ; Humans ; Infant, Newborn ; Lactation/physiology ; Spine/metabolism ; Tibia/metabolism
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 632783-7
    ISSN 1523-4681 ; 0884-0431
    ISSN (online) 1523-4681
    ISSN 0884-0431
    DOI 10.1002/jbmr.3090
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  8. Article ; Online: Community-acquired pneumonia: Strategies for triage and treatment.

    Modi, Anita R / Kovacs, Christopher S

    Cleveland Clinic journal of medicine

    2020  Volume 87, Issue 3, Page(s) 145–151

    Abstract: Community-acquired pneumonia significantly contributes to patient morbidity and healthcare costs. As our understanding of this common infection grows, collaborative efforts among researchers and clinical societies provide new literature and updated ... ...

    Abstract Community-acquired pneumonia significantly contributes to patient morbidity and healthcare costs. As our understanding of this common infection grows, collaborative efforts among researchers and clinical societies provide new literature and updated guidelines informing its management. This review discusses diagnostic methods, empiric treatment, and infection prevention strategies for patients with suspected community-acquired pneumonia.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/therapy ; Diagnosis, Differential ; Disease Management ; Humans ; Pneumonia/diagnosis ; Pneumonia/therapy ; Practice Guidelines as Topic ; Risk Assessment ; Severity of Illness Index ; Triage/standards
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2020-02-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639116-3
    ISSN 1939-2869 ; 0891-1150
    ISSN (online) 1939-2869
    ISSN 0891-1150
    DOI 10.3949/ccjm.87a.19067
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  9. Article ; Online: Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention.

    Modi, Anita Rae / Kovacs, Christopher S

    Cleveland Clinic journal of medicine

    2020  Volume 87, Issue 10, Page(s) 633–639

    Abstract: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) cause significant inpatient morbidity and mortality. They are especially challenging to diagnose promptly in the intensive care unit because a plethora of other causes can ... ...

    Abstract Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) cause significant inpatient morbidity and mortality. They are especially challenging to diagnose promptly in the intensive care unit because a plethora of other causes can contribute to clinical decline in complex, critically ill patients. The authors describe the diagnosis, management, and prevention of these diseases based on current guidelines and recent evidence.
    MeSH term(s) Critical Care/methods ; Critical Care/standards ; Critical Illness/therapy ; Diagnosis, Differential ; Disease Management ; Healthcare-Associated Pneumonia/diagnosis ; Healthcare-Associated Pneumonia/prevention & control ; Healthcare-Associated Pneumonia/therapy ; Humans ; Intensive Care Units ; Pneumonia, Ventilator-Associated/diagnosis ; Pneumonia, Ventilator-Associated/prevention & control ; Pneumonia, Ventilator-Associated/therapy ; Practice Guidelines as Topic
    Keywords covid19
    Language English
    Publishing date 2020-10-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639116-3
    ISSN 1939-2869 ; 0891-1150
    ISSN (online) 1939-2869
    ISSN 0891-1150
    DOI 10.3949/ccjm.87a.19117
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  10. Article ; Online: Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery.

    Kovacs, Christopher S

    Physiological reviews

    2016  Volume 96, Issue 2, Page(s) 449–547

    Abstract: During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the ... ...

    Abstract During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.
    MeSH term(s) Animals ; Bone Diseases, Metabolic/metabolism ; Bone and Bones/metabolism ; Calcium/metabolism ; Female ; Humans ; Lactation/metabolism ; Maternal Nutritional Physiological Phenomena ; Phosphorus Compounds/metabolism ; Pregnancy ; Pregnancy Complications/metabolism ; Weaning
    Chemical Substances Phosphorus Compounds ; Calcium (SY7Q814VUP)
    Language English
    Publishing date 2016-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 209902-0
    ISSN 1522-1210 ; 0031-9333
    ISSN (online) 1522-1210
    ISSN 0031-9333
    DOI 10.1152/physrev.00027.2015
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