Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age

Background: Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age.Methods: Children aged 2 to 60 months admitted for the first time were included in the study and divided into two groups i.e. with and without clinical signs of rickets. Disease profile was studied in both groups. Incidence of lower respiratory tract infection was compared between two groups.  Children with clinicoradiological signs of rickets were also investigated for biochemical abnormalities.Results: During the one year study period a total of 393 children were admitted, 65 were found to have rickets constituted as study group and 328 were without rickets were included the controls. Rickets incidence was 16.5% of which majority (74.6%) were males and most rachitic children (64.6%) were below six months of age. Acute lower respiratory tract infection (64.6%) was commonest in study group and acute gastroenteritis (24.4%) in the controls. The rate of ALRTI was nearly three times in study group.  Frontal bossing (67.7%) was most common sign of rickets and increased alkaline phosphatase (93.8%) was the commonest biochemical abnormality.Conclusions: Nutritional rickets, a multifactorial disease, is easily preventable. The present study has revealed the high incidence of rickets i. e., 16.5% and also show the strong statistically significant association of nutritional rickets with acute lower respiratory tract infections.

Evaluation of vitamin-D status in premenopausal and postmenopausal type-2 diabetic women and its relation to glycemic control

Background: Vitamin D deficiency is a public health problem around the world. In 2008, it was estimated that 1 billion persons present with vitamin D insufficiency or deficiency. Vitamin D is obtained through exposure to ultraviolet B (UVB) sunlight as well as nutritional sources. Despite the high UVB sunlight exposure in tropical countries, studies suggest Vitamin D deficiency is highly prevalent. Vitamin D is believed to help improve the body’s sensitivity to insulin, the hormone responsible for regulating blood sugar levels, thus reducing the risk of insulin resistance, which is often a precursor to Type-2 diabetes. Aim and objective of the study was to evaluate and compare the Vitamin-D levels in Premenopausal and Postmenopausal Type-2 Diabetic women and to evaluate if their Vitamin-D levels have any co-relation with their glycemic control.Methods: The study was conducted in Government Medical College Jammu and its associated hospital on 60 Type-2 Diabetic women, 30 premenopausal and 30 postmenopausal. Vitamin-D [25(OH) Vitamin D] levels were assessed by Chemiluminescence method in the Biochemistry Lab. of Govt. Medical College Jammu. Blood sugar levels, both fasting and postprandial, were assessed by Glucose oxidase-peroxidase method in the same Lab.HbA1C was assessed by HPLC [High Performance Liquid Chromatography] assay.Results: Vitamin-D deficiency [Vitamin-D levels <20 ng/ml] was seen in 16.67% of premenopausal type-2 diabetics and in 36.67% postmenopausal type-2 diabetics. This was not related to the glycemic control as HbA1C was increased in both the groups.Conclusions: Vitamin-D deficiency is more prevalent in postmenopausal Type-2 diabetics, as compared to premenopausal type-2 diabetics.

Study of correlation between maternal and cord blood vitamin D3 levels

Background: Vitamin D deficiency during pregnancy and in newborn period is common in this country. Vitamin D status of the mother is known to influence the vitamin D levels in the neonate, however how closely the maternal vitamin D level correlates with the cord blood Vitamin D is not clearly understood. To study the correlation between maternal and neonatal serum Vitamin D3 levels by as indicated by cord blood 25(OH)D levels and find out if there is a significant variation of cord blood 25(OH)D levels in Vitamin D sufficient and insufficient mothers.Methods: Healthy pregnant women between 18-45 years of age with no known history of chronic disease or long-term medication, consenting for the study were enrolled. Maternal blood sample was collected in peripartum period, cord blood sample was obtained after delivery from the umbilical cord after clamping. Vitamin D3 levels were measured by RIA and paired maternal and cord blood levels were statistically analyzed.Results: 569 paired samples of maternal and cord blood were analyzed. The mean maternal serum 25(OH)D level was 35.63ng/ml (sd 6.18, range 9.2-39.8) as compared to 13.52ng/ml (sd 3.79, range 7.9-27) for the neonates. 457 of the mothers were found to have sufficient, 101(18%) insufficient and 11(2%) deficient Vitamin D levels as per Endocrinological Society guidelines. In comparison, 535(94%) of the neonates had deficient levels, none of the neonates had sufficient Vitamin D levels, 34(5.99%) had insufficient levels. No significant correlation was found between maternal and neonatal serum vitamin 25(OH)D levels (r=0.007, P=0.85).Conclusions: Maternal and Cord blood serum Vitamin D3 levels were found to be poorly correlated in this study.

Study of Bone Mineral Density, Vitamin-D and Body Mass Index in Asthmatic ACOS and COPD Cases: Those who are on Prolonged (more than 3 Years) use of Inhaled Corticosteroids

Introduction: Inhaled corticosteroids are the prime choice of treatment for Asthma, ACOS, and COPD cases, but using inhaled corticosteroids with the influencing factors for a longer duration may cause cachexia, skeletal muscle abnormalities, and metabolic syndromes. Objectives: To determine whether the use of inhaled corticosteroids has a harmful effect on bone, in case of Asthma, ACOS, and COPD. To assess the correlation between low bone mineral density with low vitamin D levels and low body mass index. To assess the fracture risk with the effect of inhaled corticosteroids in asthma, ACOS and COPD cases. Methods: A total of 260 subjects (123 males and 137 females) aged ≥ 25 years attended the routine check-up for NRI Institute of Medical Sciences, Visakhapatnam. The pulmonology department was grouped into 4. Data was collected and filed by using data collection sheet, measured bone mineral density with the ultra-sonogram machine, did investigative procedures to know the blood calcium and vitamin-D levels. Results: Our study revealed that all quantitative and qualitative parameters were measured and analyzed with the SPSS software version 18, (vitamin-D, bone mineral density, body mass index, allergies, family, smoking histories and others) obtained a statistically significant p-value. Conclusion: Effect of disease and inhaled corticosteroids use respiratory diseases for a longer duration or in high doses resulting in decreased bone mineral density along with the decreased body mass index.

Vitamin D Status in Patients with Pulmonary Tuberculosis: A Teaching Hospital Based Study

To evaluate the Vitamin D status in patients with pulmonary tuberculosis and normal healthy adults. Methods: Total of 48 subjects 24 (14 male and 10 female) newly diagnosed pulmonary tuberculosis and 24 (16 male and 8 female) healthy controls) was selected through non-probability purposive sampling according to inclusion and exclusion criteria. Result: Significant differences were observed for the obesity and smoking p-value 0.032 and 0.021 respectively. Chest x ray revealed cavitary in 9 (37.5%) of cases. Hemoglobin, RBC counts and Platelet counts revealed statistically significant difference between cases and controls. Conclusion: Patients with tuberculosis are significantly Vitamin D deficient as compared to normal individuals.

Linking of psoriasis with osteopenia and osteoporosis: A cross-sectional study

Background/Purpose: Psoriasis is a multisystem disease which has been related to vitamin-D deficiency through chronic inflammation. This psoriasis-related inflammatory state and vitamin-D deficiency may induce bone mineral density loss. The purpose of this study is to assess the relationship of psoriasis with bone mineral density, by comparing psoriatic patients with healthy controls and patients with osteopenia/osteoporosis. Methods: A total of 185 subjects were studied; 58 psoriatic patients who had not been under systemic or biological treatment were included. Age, gender, body mass index, phosphocalcic metabolic parameters and hip and lumbar (L4) bone mineral density data were collected. These variables were compared with those collected in 61 healthy controls and 67 patients with osteopenia/osteoporosis. Results: Psoriatic patients showed worse hip and lumbar spine bone mineral density levels than healthy controls (P = 0.001) and better levels than osteoporotic patients (P < 0.001). Multivariate analysis demonstrated a negative association of age and a positive association of body mass index in hip bone mineral density in psoriatic patients. Limitations: The main limitations are those of cross-sectional studies, such as a lack of follow up period, and a male predominance in the psoriatic group, which is corrected employing a multivariate analysis with an adjusted model for confounding factors. Conclusions: Bone mineral density levels in psoriatic patients are situated halfway between healthy controls and patients with osteopenia/osteoporosis. In addition, the higher body mass index in patients with psoriasis appears to confer a protective effect against further development of lower bone mineral density.

Optimal concentration of 1, 25-vitamin-D3 to induce the differentiation of bone marrow mesenchymal stem cells into cardiomyocyte-like cells in vitro / 解剖学报

Objective To explore the optimal concentration of 1, 25-vitamin-D3 for inducing the differentiation of bone marrow mesenchymal stem cells (BMSCs) into cardiomyocyte-like cells in vitro. Methods BMSCs of SD rats were isolated and cultured by whole bone marrow adherent method combined with density gradient centrifugations. Depending on the final concentration of 1, 25-vitamin-D3, the 2nd-generation BMSCs were divided into five groups: 3 nmol/L group, 6 nmol/L group, 12 nmol/L group, 24 nmol/L group and the control group. The adherent cells were observed dynamically under the inverted phase contrast microscope, including their morphology and growth status. The surface antigens, morphological characteristics, protein expression and mRNA expression of the cells in each group were assessed. Results 1. Under the inverted phase contrast microscope, most of the primary cells showed a short spindle shape after 72 hours of culture. After 1 week of culture, the cells showed diversified morphology. The adjacent cells of BMSCs, induced after 4 weeks, were closely connected with each other, and the arrangement had obvious directivity. There were differences in the number and morphology of BMSCs, induced by 1, 25-vitamin-D3 at different concentrations. 2. The result of flow cytometry showed that the positive expression rates of CD29, CD45 and CD90 were 97. 4%, 3. 3% and 91. 4%, respectively, 3. The results of immunofluorescence, immunocytochemistry and Western blotting revealed that the expressions of tropomyosin (TPM), connexin43 (Cx43) and cardiac troponin T(cTnT) in 6 nmol/L group were significantly higher than that of the other groups, while that in control group were weak or negative (P<0. 05). 4. Transmission electron microscope(TEM) observation showed that the induced cells had a cardiomyocyte-like ultrastructure: there were many parallel arranged myofilaments, mitochondria, ribosomes, rough endoplasmic reticulum and other organelles in the cytoplasm. 5. The result of Real-time PCR showed that the induced cells could express GATA binding protein 4(GATA 4) and Nkx2. 5 at the 1st week, and then the expression of them decreased at the 2nd week, but then increased at the 4th week. The 6 nmol/L group was superior to the other three groups in gene expression (P<0. 05). Conclusion 1, 25-vitamin-D3 can induce BMSCs to obtain myocardial differentiation phenotype, and the optimum concentration of inducing differentiation is 6 nmol/L.

Vitamin D down-regulates microRNA-21 expression to promote human placental trophoblast cell migration and invasion / 南方医科大学学报

OBJECTIVE@#To investigate the effect of vitamin D on microRNA-21(miR-21) expression and migration and invasion of human placental trophoblast cells.@*METHODS@#The changes in the expression of miR-21 were detected using RT-qPCR in HTR-8/SVneo cells following stimulation by vitamin D at different doses for 24, 48 and 72 h.HTR-8/SVneo cells transfected with miR-21 mimic or inhibitor with or without vitamin D treatment were examined for changes in cell migration and invasion abilities using Transwell assay, and Western blotting was used to detect protein expressions of E-cadherin, fibronectin, and MMP9.@*RESULTS@#Vitamin D obviously inhibited the expression of micoRNA-21 in HTR-8/SVneo cells in a concentration-and time-dependent manner.Transfection with the miR-21 mimic significantly inhibited the migration and invasion of HTR-8/SVneo cells, and this inhibitory effect was abolished by treatment with vitamin D; transfection with miR-21 inhibitor obviously promoted the migration and invasion of HTR-8/SVneo cells, and these effects were not significantly affected by vitamin D treatment.@*CONCLUSIONS@#Vitamin D may promote trophoblast cell migration and invasion to accelerate the development of preeclampsia by down-regulating the expression of miR-21.

Supplementation with Three Different Daily Doses of Vitamin D3 in Healthy Pre-pubertal School Girls: A Cluster Randomized Trial

Objective: To compare the adequacy and efficacy of differentdoses of vitamin D3 in pre-pubertal girls.Design: Cluster Randomized controlled trial.Setting: Public school in Delhi, India, between August 2015 andFebruary 2016.Participants: 216 healthy pre-pubertal girls, aged 6.1-11.8 years.Intervention: Daily supplementation with 600 IU (n=74), 1000 IU(n=67) or 2000 IU (n=75) of vitamin D3 under supervision for 6months.Outcome measures: Primary: Rise in serum 25 hydroxy VitaminD (25(OH)D); Secondary: Change in bone formation andresorption markers.Results: Following 6 months of supplementation, the mean (SD)rise in serum 25(OH)D was maximum with 2000 IU (24.09 (8.28)ng/mL), followed by with 1000 IU (17.96 (6.55) ng/mL) and 600 IU(15.48 (7.00) ng/mL). Serum 25(OH)D levels of ?20 ng/mL wereseen in 91% in 600 IU group , 97% in 1000 IU group and 100% in2000 IU group. The overall mean (SD) rise in urinary calciumcreatinine ratio (0.05 (0.28) to 0.13 (0.12) mg/mg), and serumprocollagen type I N-terminal propeptide (538.9 (199.78) to 655.5(218.24) ng/mL), and reduction in serum carboxy-terminaltelopeptide (0.745 (0.23) to 0.382 (0.23) ng/mL) was significant(P<0.01). The change in the above parameters was comparableamong the three groups after adjustment for age.Conclusion: Daily vitamin D supplementation with 600 IU to 2000IU for 6 months results in Vitamin D sufficiency in >90% of pre-pubertal girls

Comparative Study of Vitamin D Deficiency between PCOD and Normal Women: A Prospective Hospital Based Study

Background: - Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with a prevalence of 6–10% in the general population. PCOS is characterized by the following: ovulatory dysfunction resulting in oligo-amenorrhea and/or anovulation, hyperandrogenism and/or hirsutism and the presence of polycystic ovarian morphology by ultrasound. Vitamin D also plays a physiologic role in reproduction including ovarian follicular development and luteinization via altering anti- Müllerian hormone (AMH), signaling, follicle- stimulating hormone sensitivity and progesterone production in human granulosa cells. The aim of this study aimed to compare levels of vitamin D in women with PCOS and normal women. Methodology: - Total fifty women were included in this study. Among the fifty cases 50% were from PCOD group and 50% were normal. This study were conducted in the Dept. of Obs/Gynae, Madhubani Medical College, Bihar. Blood sample was taken and serum vitamin D concentration was measured. Result: - Mean serum 25(OH) vitamin-D level in PCOD group and in control group is clinically significant. Conclusion: - This study concludes that 25(OH) vitamin-D was clinically significant, but not sufficient to be a diagnostic tool for PCOS.

Efectividad en la suplementación con omega 3 (Pescado) y vitamina D durante el periodo gestacional para la prevención de diversas alergias en el lactante de 0-1 año de edad / Effectiveness in the omega 3 (Fish) and vitamin D supplementation during the gestational period for the prevention of various allergies in the 0-1 year old infant / Eficácia na suplementação de ômega 3 (peixe) e vitamina D durante o período gestacional para a prevenção de várias alergias na criança de 0 a 1 ano

Resumen El objetivo de esta investigación fue describir la efectividad de la suplementación con omega 3 (pescado) y vitamina D durante la etapa gestacional para la prevención de diversas alergias en el lactante de 0 a 1 año. Se presenta los resultados de una compilación y categorización de la mejor evidencia científica disponible. Se aplicó la metodología sugerida para la práctica clínica basada en la evidencia, la cual inició con el establecimiento de una pregunta clínica seguido por la búsqueda de la información en las bases de datos Medline, Science Direct y Cochrane Library, obteniendo 334 artículos de los cuales al aplicar los criterios de selección se conservan 9. Luego se llevó a cabo un análisis crítico utilizando la plataforma FLC 2.0 y clasificando la evidencia por su calidad y grados de recomendación según Canadian TaskForce on Preventive Health Care.Se concluye que a pesar de que los beneficios de la vitamina D y el omega 3 son múltiples, y que el uso en conjunto de ambos en el embarazo, podría significar una mejora no solo sobre la salud materna sino también sobre el feto y lactante; al no contar con estudios con resultados contundentes, no se puede generalizar o recomendar en la práctica clínica.

Abstract The objective of this research was to describe the effectiveness of omega 3 (fish) and vitamin D supplementation during the gestational stage for the prevention of various allergies in infants aged 0 to 1 year. The results of a compilation and categorization of the best available scientific evidence are presented. The methodology suggested for the clinical practice based on the evidence was applied, which began with the establishment of a clinical question followed by the search of the information in the Medline, Science Direct and Cochrane Library databases, obtaining 334 articles of which when the selection criteria are applied, they are kept 9. Then, a critical analysis was carried out using the FLC 2.0 platform and the evidence was classified by its quality and degrees of recommendation according to the Canadian Task Force on Preventive Health Care. It is concluded that although the benefits of vitamin D and omega 3 are multiple, and that the joint use of both in pregnancy, could mean an improvement not only on maternal health but also on the fetus and infant; By not having studies with conclusive results, it can not be generalized or recommended in clinical practice.

Resumo O objetivo desta pesquisa foi descrever a eficácia da suplementação de ômega 3 (peixe) e vitamina D durante o estágio gestacional para a prevenção de várias alergias em lactentes de 0 a 1 ano de idade. Os resultados de uma compilação e categorização das melhores evidências científicas disponíveis são apresentados. Foi aplicada a metodologia sugerida para a prática clínica baseada na evidência, que começou com o estabelecimento de uma questão clínica seguida pela busca da informação nos bancos de dados da Medline, Science Direct e Cochrane Library, obtendo 334 artigos dos quais quando os critérios de seleção são aplicados, eles são mantidos 9. Então, uma análise crítica foi realizada usando a plataforma FLC 2.0 e a evidência foi classificada por sua qualidade e graus de recomendação de acordo com a Canadian Task Force on Preventive Health Care. Conclui-se que, embora os benefícios da vitamina D e omega 3 sejam múltiplos e que o uso conjunto de ambos na gravidez, pode significar uma melhora não só na saúde materna, mas também no feto e no bebê; Ao não ter estudos com resultados conclusivos, não pode ser generalizada ou recomendada na prática clínica.

Vitamin D Estimation: A New Biomarker for Cardiovascular Disease

Background: Vitamin D deficiency is prevalent in the majority parts of the world. The prevalence of vitamin D deficiency in India in urban area 9-11% and in rural area 3-6%. Coronary artery disease is worldwide health problem and consists of variety of heart illness. Vitamin D deficiency may cause cardiovascular events by a variety of potential biological mechanism. Aims & Objectives: To evaluate the role of vitamin D as a rising risk factor for coronary artery disease.  Materials & Methods: The study was carried out in department of Cardiology, S.P. Medical College included 50 patients of coronary artery disease admitted in H.R.M. Center Bikaner. The control population comprise of age and sex matched 50 healthy persons. Vitamin D was done on ELISA reader and lipid profile assessment was done on fully automated analyzer. The statistical analysis was done by using SPSS software. The results were articulated as Mean ± SD. The Student t-test was carried out for relationship of the data & P value <0.05 was considered statistically significant. Results: The study discovered that vitamin D level was established to be significantly lower in cases as compared to controls. We also noticed significant difference in mean to total cholesterol, HDL cholesterol and LDL cholesterol in between cases and control. Conclusion: This study concluded that continue follow up of vitamin D will be helpful for measurement of increased risk of coronary artery disease episode beyond the traditional risk factors.

Vitamin-D-deficiency rickets even with abundant sunlight -A case to highlight emerging problem

We describe a case of vitamin-D-deficiency rickets in a young child to highlight its existence in Malaysia where sunlight is abundant throughout the year. The child presented with deformity of both legs. He came from an educated urban family but remained indoors most of the time. Radiographs of knees and wrists showed changes of florid rickets. Low serum 25-hydoxyvitamin-D, high parathyroid hormone, normal serum phosphate and calcium levels, and normal renal function clinched the diagnosis of vitamin-D-deficiency rickets. He improved remarkably after treatment with oral Vitamin-D. We emphasise the importance of exposure to sunlight to prevent rickets.

Association of vitamin D receptor gene polymorphisms with polycystic ovary syndrome among Indian women.

Background & objectives: The Vitamin-D receptor (VDR) regulates vitamin D levels and calcium metabolism in the body and these are known to be associated with endocrine dysfunctions, insulin resistance and type-2 diabetes in polycystic ovarian syndrome (PCOS). Studies on VDR polymorphisms among PCOS women are sparse. We undertook this study to investigate the association pattern of VDR polymorphisms (Cdx2, Fok1, Apa1 and Taq1) with PCOS among Indian women. Methods: For the present study, 250 women with PCOS and 250 normal healthy control women were selected from Hyderabad city, Telangana, India. The four VDR polymorphisms were genotyped and analysed using ASM-PCR (allele specific multiple PCR) and PCR-RFLP (restriction fragment length polymorphism). Results: The genotype and allele frequency distributions of only Cdx2 showed significant difference between the PCOS cases and control women, indicating protective role of this SNP against PCOS phenotype. However, significant association was observed between VDR genotypes and some of the PCOS specific clinical/biochemical traits. For example, Fok1 showed a significant genotypic difference for the presence of infertility and Cdx2 genotpes showed association with testosterone levels. Further, the two haplotypes, ACCA and ACTA, were found to be significantly associated with PCOS indicating haplotype specific risk. Interpretation & conclusions: Although VDR polymorphisms have not shown significant association with PCOS, in view of functional significance of the SNPs considered, one cannot yet rule out the possibility of their association with PCOS. Further, specifically designed studies on large cohorts are required to conclusively establish the role of VDR polymorphisms in PCOS, particularly including data on vitamin D levels.

Evaluación del metabolismo fosfo-cálcico en el síndrome nefrófico córtico-sensible primario en pediatría / Evaluation of bone and mineral metabolism in primary corticosteroid-sensitive pediatric nephrotic syndrome

Introducción: el tratamiento esteroide del síndrome nefrótico cortico sensible (SNCS) puede causar alteraciones del metabolismo mineral, prevenibles con calcio y vitamina D. Se llevó a cabo un estudio de cohortes de tipo retrospectivo longitudinal a lo largo de 36 meses. Objetivos: 1) evaluar la relación entre la Dosis Acumulativa de corticoides (DAC) con la concentración sérica de 25-OH Vitamina D y con el Contenido Mineral Ëseo (CMO); 2) evaluar la relación entre la DAC y el CMO en la Densitometría Mineral Ësea (DMO). Material y métodos: Incluimos a pacientes entre 2 años y 12 años con síndrome nefrótico primario cortico-sensible (SNCS) (primer episodio o síndrome nefrótico recaedor o síndrome nefrótico cortico-dependiente), normotensos, eutróficos y con FG>90ml/min/1.73m2, los cuales se separaron en 3 grupos: GRUPO A: 3 o 6 años (puntaje Z y CMO), edad ósea, PTHi. Resultados: Evaluamos a 29 pacientes, con una edad media de 4,4 años. La DMO se realizó en 11 pacientes y no hubo diferencias significativas entre los grupos (p=0,08). Tampoco hubo diferencias significativas entre la media de la edad cronológica y la edad ósea media media (p 0,3). La prueba T para evaluar la dosis de 25-OH colecalciferol al aumentar la dosis de Ergocalciferol fue significativa (T:32.4 Q: <0.001). Hubo una correlación significativa entre los tres grupos: entre la dosis de Vitamina D y el dosaje sérico de Vitamina D de 0,9; entre el DAC y la dosis de 25 OH colecalciferol de 0,62 y entre el DAC y el CMO de 0.44. Por último, el aumento promedio en los tres grupos de dosis de vitamina D fue de 1833UI. Conclusiones: Observamos una relación entre la DAC e hipovitaminosis D, corregible al aumentar la dosis de Vitamina D.

Introduction: steroid treatment for corticosteroid-sensitive nephrotic syndrome (CSNS) could cause bone and mineral metabolism alterations, preventable with calcium and Vitamin D. Objectives: We carried out a preliminary retrospective study along 36 months with the following objectives. 1) To evaluate the relationship between Cumulative Corticosteroid Doses (CCD) and 25-0 Vitamin D serum concentration and with Bone Mineral Content (BMC); 2) To evaluate the relationship between CCD and Bone Mineral Densitomety (BMD). Methods: We included patients between 2 and 12 years of age with corticosteroid sensitive primary nephrotic syndrome (CSNS) (first episode, relapsing nephrotic syndrome, corticosteroid dependent nephrotic syndrome) normotensive, eutrophic and FG>:90ml/min/1.73 m2, who were divided into three groups: GROUP A: =3 or 4 relapses/year, GROUP C: CSNS, we measured: a) Quarterly: calcemia, phosphatemia, alkaline phosphatase; b) half-yearly: 25-OH cholecalcipherol levels, CCD; c) annually BMD in children >6 years (score Z and BMC), bone age, PTHi. Results: We evaluated 29 patients, average age: 4.4 years. The BMD was performed on 11 patients and there were no significant differences among the groups (p=0.08). No significant differences were seen between chronologic age and average bone age (p=0.3). Change in 25-OH cholecalcipherol levels due to the increase of ergocalcipherol dose was significant (T:32.4 Q:<0.001). There were significant correlation in the three groups, between Vitamin D dose and Vitamin D serum levels (Pearson correlation R=0.9), between CCD and 25 OH cholecalcipherol dose: (Pearson correlation R=0.62) and between CCD and BMC (Pearson correlation R=0.44). Finally, in these three groups the average increase of vitamin D was: 1833IU. Conclusions: We found a relationship between CCD and hypovitaminosis D, which could be corrected increasing Vitamin D dose.

Changes and clinical of serum 25-hydroxy vitamin D levels in rheumatoid arthritis / 国际检验医学杂志

Objective To observe the changes of serum 25‐hydroxy vitamin D[25‐(OH)D] level of patients with rheumatoid ar‐thritis(RA) and study its clinical significance .Methods The method of chemiluminescence was adopted to detect peripheral blood serum 25‐(OH) D of 60 cases of RA patients(RA group) and 60 cases of healthy people(control group) .Results The serum 25‐(OH) D level of patients in RA group was(34 .37 ± 8 .87) nmol/L ,while that of the control group was(61 .33 ± 7 .74) nmol/L ;after comparison ,the differences were statistically significant (t= -6 .892 ,P 0 .05) . Conclusion The serum 25‐(OH) D level of RA patients is significantly low ,which might be associated with the RA disease activi‐ty .

Efficacy and Safety of Weekly Alendronate Plus Vitamin D3 5600 IU versus Weekly Alendronate Alone in Korean Osteoporotic Women: 16-Week Randomized Trial

Vitamin D (vit-D) is essential for bone health, although many osteoporosis patients have low levels of 25-hydroxy-vit-D [25(OH)D]. This randomized, open-label study compared the effects of once weekly alendronate 70 mg containing 5600 IU vit-D3 (ALN/D5600) to alendronate 70 mg without additional vit-D (ALN) on the percent of patients with vit-D insufficiency [25(OH)D <15 ng/mL, primary endpoint] and serum parathyroid hormone (PTH, secondary endpoint) levels in postmenopausal, osteoporotic Korean women. Neuromuscular function was also measured. A total of 268 subjects were randomized. Overall, 35% of patients had vit-D insufficiency at baseline. After 16-weeks, there were fewer patients with vit-D insufficiency in the ALN/D5600 group (1.47%) than in the ALN group (41.67%) (p<0.001). Patients receiving ALN/D5600 compared with ALN were at a significantly decreased risk of vit-D insufficiency [odds ratio=0.02, 95% confidence interval (CI) 0.00-0.08]. In the ALN/D5600 group, significant increases in serum 25(OH)D were observed at weeks 8 (9.60 ng/mL) and 16 (11.41 ng/mL), where as a significant decrease was recorded in the ALN group at week 16 (-1.61 ng/mL). By multiple regression analysis, major determinants of increases in serum 25(OH)D were ALN/D5600 administration, seasonal variation, and baseline 25(OH)D. The least squares mean percent change from baseline in serum PTH in the ALN/D5600 group (8.17%) was lower than that in the ALN group (29.98%) (p=0.0091). There was no significant difference between treatment groups in neuromuscular function. Overall safety was similar between groups. In conclusion, the administration of 5600 IU vit-D in the ALN/D5600 group improved vit-D status and reduced the magnitude of PTH increase without significant side-effects after 16 weeks in Korean osteoporotic patients.

Serum vitamin-D predicts insulin resistance in individuals with prediabetes.

Background & objectives: Patients with diabetes and vitamin-D insufficiency have increased insulin resistance. Similar observations among individuals with prediabetes are not well documented. The aim of this study was to find the occurrence of vitamin-D insufficiency/deficiency among individuals with prediabetes and to evaluate the relationship between vitamin-D status and insulin resistance. Methods: One hundred fifty seven individuals with prediabetes who fulfilled all the inclusion and exclusion criteria underwent clinical examination, anthropometric measurements (waist circumference, waist-hip ratio, waist-height ratio) and blood sampling after overnight fast for estimation of fasting blood glucose, fasting insulin, 25(OH)vitamin-D, intact parathyroid hormone (iPTH) and lipid profile. One hour post 75 g glucose (1hPG) blood glucose during oral glucose tolerance test was measured. Results: Vitamin-D deficiency/insufficiency was found in 115 (73.25%) individuals with prediabetes. Severe vitamin-D deficiency (<10 ng/ml) was seen in 14.65 per cent individuals. Individuals with the lowest vitamin-D levels (<10 ng/ml) had the highest insulin resistance (HOMA2-IR: 2.04 ± 0.67). Serum 25(OH)D had a statistically significant inverse correlation with insulin resistance (HOMA2-IR; r=-0.33; P=0.008), and positive correlation with insulin sensitivity (QUICKI; r=0.39; P=0.002), after adjusting for BMI and HbA1c. There was no correlation between vitamin-D status and estimated beta cell mass (HOMA-β). The mean waist-height ratio among individuals with prediabetes was 0.57 (normal<0.5) indicating a high risk of cardiovascular morbidity. Individuals with elevated 1hPG>155 mg/dl had significantly higher BMI and worse insulin resistance, and 1hPG correlated well with 2 hour post glucose blood glucose (r=0.57; P<0.001). Interpretations & conclusions: Vitamin-D deficiency/insufficiency may have some role in the development/worsening of insulin resistance in individuals with prediabetes in our country who have a high cardiovascular risk. Prospective studies on a large group of individuals need to be done to confirm the findings.

Vitamina D e análogos para o controle do hiperparatireodismo secundário / Vitamin D and analogues in the aontrol of secondary hyperparathyroidism

A vitamina D participa (d)o metabolismo mineral e sua deficiência está associada com doenças extra-ósseas Estudos têm evidenciado hipovitaminose Dna população geral e em renais crônicos. Na progressão da doença renal crônica (DRC), a redução dos níveis de calcitriol, hipocalcemia e hiperfosfatemiasão fatores causais do hiperparatireoidismo secundário (HPTS). Utilizamos o calcitriol para o manejo do HPTS e da hipovitaminose D per se também devemser enfatizadas. Novos análogos da vitamina D, desenvolvidos para substituírem o calcitriol devido à hipercalcemia e hiperfosfatemia associadas ao seuuso, não se mostraram superiores no controle do HPTS. O estado de conhecimento atual sugere a realização de estudos randomizados, controlados ecom amostragem maior para comparar efetividade e segurança entre estes análogos e o calcitriol. Assim, estes estudos poderiam sinalizar para um melhor controle mineral e da doença óssea e resultar em um impacto favorável na morbi-mortalidade na DRC.

Vitamin D has been reported as pivotal for mineral metabolism and bone health, and its deficiency has also been associated with non-skeletal diseases.Many studies have shown high prevalence of vitamin D deficiency in general population as well as in chronic kidney disease (CKD) patients. In CKD progression, low calcitriol levels, hypocalcemia and hyperphosphatemia have all been implicated in the genesis of the secondary hyperparathyroidism (SHPT).In addition to calcitriol supplementation for SHPT management, emphasis should be given to the diagnosis and treatment of vitamin deficiency itself. Newvitamin D analogs were developed in an attempt to overcome the hypercalcemia and hyperphosphatemia that can follow calcitriol treatment but currentknowledge does not allow any conclusion about superiority of new analogs. Large randomized controlled trials studies are needed to compare efficacy and safety of these analogs and calcitriol. These studies could promote a better understanding of mineral metabolism and bone disease control, and result in a favorable impact on morbidity and mortality of CKD patients.