Association of blood heavy metal levels with osteocalcin abnormality and incidence of osteoporosis in Saudi subjects / Associação de anormalidades de osteocalcina nos níveis de metais pesados no sangue e incidência de osteoporose em indivíduos sauditas

Serum toxic metals have been implicated in development of many diseases. This study investigated the association between blood levels of lead and cadmium with abnormal bone mineral density (BMD) and incidence of osteoporosis. Sixty Saudi male adults age matching were assigned into two groups: A healthy control group (n = 30) and osteoporosis patients diagnosed according to T-score (n = 30). Serum calcium, vitamin D, osteocalcin, lead, cadmium were measured. Osteoporotic group showed a highly significant elevation of blood lead and cadmium levels compared to the control group (p <0.001). BMD was negatively correlated with serum osteocalcin level compared with control. There was a significant negative correlation between the cadmium and lead levels (r=-0.465 and p-value = 0.01) and calcium (p < 0.004). Our findings suggested that high cadmium and lead were negative correlated to BMD and increased the risk factor for osteoporosis.

Os metais tóxicos do soro têm sido implicados no desenvolvimento de muitas doenças. Este estudo investigou a associação entre os níveis sanguíneos de chumbo e cádmio com densidade mineral óssea anormal (DMO) e incidência de osteoporose. Sessenta adultos sauditas do sexo masculino com idades iguais foram divididos em dois grupos: um grupo de controle saudável (n = 30) e pacientes com osteoporose diagnosticados de acordo com o T-score (n = 30). Cálcio sérico, vitamina D, osteocalcina, chumbo, cádmio foram medidos. O grupo osteoporótico apresentou elevação altamente significativa dos níveis de chumbo e cádmio no sangue em comparação ao grupo controle (p < 0,001). A DMO foi negativamente correlacionada com o nível de osteocalcina sérica em comparação com o controle. Houve correlação negativa significativa entre os níveis de cádmio e chumbo (r = -0,465 ep = 0,01) e cálcio (p < 0,004). Nossos achados sugeriram que cádmio e chumbo elevados foram correlacionados negativamente à DMO e aumentaram o fator de risco para osteoporose.

Evaluation of vitamin D and inflammatory markers in elderly

Abstract Vitamin D is an immune modulator, in addition to being interrelated with calcium homeostasis and bone metabolism. Recent studies have associated vitamin D with inflammatory processes. C-reactive protein (CRP), platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) have been used to determine inflammation. There is no consensus on the use of these markers to determine an association between inflammation and vitamin D levels. The objective of this study was to evaluate the association between inflammatory markers and vitamin D in the elderly. A cross-sectional, descriptive study was performed based on the analysis of vitamin D, CRP (quantitative determination of C-Reactive Protein by the ultra-sensitive method) and blood count of institutionalized elderly. In this study, 64% showed vitamin D deficiency, with mean value of 22 ng/mL. In the vitamin D deficient group, the mean values found were: CRP 4.5 mg/L; NLR 2.35 and PLR 119. In the group without vitamin D deficiency the mean values were: CRP 4 mg/L; NLR 1.87 and PLR 111 without statistical difference between the values of the analyzed parameters. The results point to a predominant profile of vitamin D deficiency in the evaluated individuals. No association was found between vitamin D values and the inflammatory markers analyzed.

Prevalencia de la deficiencia de vitamina D en niños de Costa Rica / Prevalence of vitamin D deficiency in Costa Rican children

Abstract Objective: To determine the prevalence of vitamin D deficiency in children in the South- Central Region of Costa Rica. Methods: A cross-sectional study was performed with Costa Rican children aged 1-7 years from the South-Central Region of the country belonging to the Nutrition and Education Centers and Children's Nutrition and Comprehensive Care Centers. Serum samples were collected from all participants between August 2014 and May 2016 and stored at -80 ° C. Vitamin D status was assessed by immunoassay on an ARCHITECT Plus i1000 instrument. Descriptive statistics were performed with the SPSS statistical software package (V20, IBM Corp). A value of p˂0.05 was considered significant. Spearman and Pearson correlation were also performed to study the association between vitamin D status, anthropometric and hematological variables. Results: Atotal of 428 sampleswere analyzed.According to the cut-off points establishedby the Endocrine Society, 4.9% of the children tested presented deficiency, 50.2% had insufficiency and 44.9% had vitamin D sufficiency. The mean concentration of 25-hydroxyvitamin D in the studied population was 29.7 ng/mL (SD 6.5) in boys and 29.8 ng/mL (SD 7.0) in girls. A high prevalence of hypovitaminosis D (55.1 %) was found, but only 7.9 % of the children presented 25-hydroxyvitamin D ≤ 20 ng/mL. No correlation was found between vitamin D status and any of the evaluated anthropometric or hematological variables. Conclusions: More than half of the young population presented hypovitaminosis-D. Therefore, in order to overcome this situation, the recommendation is to supplement the population with vitamin D and improve its fortification in widespread accessible food in Costa Rica.

Resumen Objetivo: Determinar la prevalencia de la deficiencia de vitamina D en niños de la Región Central Sur de Costa Rica. Métodos: Se realizó un estudio transversal con niños de 1-7 años de la Región Central Sur de Costa Rica pertenecientes a los Centros de Educación y Nutrición y Centros de Atención Integral y Nutrición Infantil. Se recolectaron muestras de suero de todos los participantes entre agosto de 2014 y mayo de 2016 y se almacenaron a -80 ° C hasta su uso. Se evaluó las concentraciones de vitamina D mediante un inmunoensayo con el instrumento ARCHITECT Plus i1000. Los análisis estadísticos descriptivos se realizaron con el paquete de software estadístico SPSS (V20, IBM Corp). Se consideró significativo un valor de p <0,05. También se realizó la correlación de Spearman y Pearson para estudiar la asociación entre el estatus de vitamina D con variables antropométricas y hematológicas. Resultados: Se analizaron un total de 428 muestras. Un 4,9% de los niños presentaban deficiencia, 50,2% insuficiencia y el 44,9% suficiencia de vitamina D, según los puntos de corte establecidos por Endocrine Society. La concentración media de 25-hidroxi vitamina D en la población estudiada fue de 29,7 ng/mL (DE 6,5) en niños y de 29,8 ng/ mL (DE 7,0) en niñas. Se encontró una alta prevalencia de hipovitaminosis D (55,1%), pero solo el 7,9% de los niños presentó 25- hidroxi vitamina D ≤ 20 ng/mL. No se encontró correlación del estatus de vitamina D con ninguna de las variables antropométricas o hematológicas evaluadas. Conclusiones: Más de lamitad de la población infantil evaluada presentó hipovitaminosis D. Por lo tanto, se recomienda suplementar y mejorar la fortificación con vitamina D en alimentos ampliamente accesibles en la población costarricense.

Associations between serum calcium, 25(OH)D level and bone mineral density in adolescents

Abstract Backgrounds: It is important to improve our understanding of the roles of calcium and vitamin D in bone health for preventing osteoporosis. We aimed at exploring the associations between serum calcium, vitamin D level, and bone mineral density (BMD) in adolescents included in the National Health and Nutrition Examination Survey (NHANES) 2001 - 2006. Methods: Weighted multivariate linear regression models were used to estimate the associations of serum calcium, 25(OH)D level with total BMD. Smooth curve fitting was used to explore the potential non-linear relationship. Results: A total of 5990 individuals aged between 12 and 19 years were included in this study. The fully-adjusted model showed serum calcium positively correlated with total BMD. However, an inverted U-shaped relationship was found when we performed the smooth curve fitting method, and the inflection point was calculated at 9.6 mg/dL using the two-piecewise linear regression model. In contrast, there was a positive correlation between serum 25(OH)D and total BMD after adjusting for potential confounders. Conclusions: The present study revealed a positive correlation between serum 25(OH)D level and total BMD, and an inverted U-shaped relationship between serum calcium and total BMD.(AU)

Relación entre niveles de vitamina D y perfil lipídico en embarazadas de alto riesgo / Relationship between level of vitamin D and lipid profile in high risk pregnant women

En la Argentina, las embarazadas presentan alta prevalencia (80%) de hipovitaminosis D y de sobrepeso u obesidad (27,4%). Ambas condiciones pueden aumentar la morbimortalidad materno-fetal. Bajos niveles de vitamina D se han relacionado con aumento del colesterol total, LDL, triglicéridos (Tg) y descenso de HDL. Objetivo: evaluar los niveles de 25-hidroxivitamina D (25OHD) y su relación con el perfil lipídico en pacientes embarazadas de alto riesgo. Materiales y métodos: estudio de corte transversal entre septiembre de 2016 y abril de 2017. Se excluyeron pacientes que recibieron suplementos de vitamina D, con disfunción tiroidea no compensada, malabsorción, insuficiencia cardíaca, renal o hepática y dislipidemia familiar. Niveles circulantes de 25OHD < 30 ng/ml se consideraron hipovitaminosis. Resultados: se evaluaron 86 embarazadas de 29,3 ± 7,1 años durante la semana 28 ± 6,5. El IMC pregestacional fue 28,3 ± 6,5 kg/m2 y la ganancia de peso 7 ± 4,3 kg. Perfil lipídico: colesterol total 240 ± 54 mg/dl; LDL 156 ± 54 mg/dl; HDL 66 ± 15 mg/dl; Tg 204 ± 80 mg/dl. La media de 25OHD fue de 23,8 ± 9 ng/ml, con una prevalencia de hipovitaminosis D de 77,9 %. Las pacientes con hipovitaminosis D presentaron mayores valores de colesterol total y LDL (p < 0,05), con tendencia no significativa a presentar mayores valores de Tg. Conclusión: en embarazadas de alto riesgo se observó una alta prevalencia de hipovitaminosis D, asociada con mayores concentraciones de colesterol total y LDL. (AU)

In Argentina, pregnant women have a high prevalence (80 %) of hypovitaminosis D and verweight/obesity (27.4%), conditions that can increase maternal-fetal morbidity and mortality. Low levels of 25-hydroxyvitamin D (25OHD) have been linked to an increase in total cholesterol, LDL cholesterol, triglycerides (TG) and a decrease in HDL cholesterol. Objective: to evaluate the levels of vitamin D and its relationship with the lipid profile in high risk pregnant patients. Materials and methods: cross-sectional study between September 2016 and April 2017. Patients who received vitamin D supplements or had non-compensated thyroid dysfunction, malabsorption, heart failure, renal or hepatic failure, or familial dyslipidemia were excluded. Hypovitaminosis D was defined as a circulating level of 25OHD < 30 ng/ml. Results: We assessed 86 women of 29.3 ± 7.1 years during pregnancy week 28 ± 6.5. Pre-gestational BMI was 28.3 ± 6.5 kg/m2. Their weight gain was 7 ± 4.3 kg. Lipid profile: total cholesterol 240 ± 54 mg/dl; LDL cholesterol 156 ± 54 mg/dl; HDL cholesterol 66 ± 15 mg/dL; TG 204 ± 80 mg/dl. The mean 25OHD level was 23.8 ± 9 ng/ml, with a 77.9 % prevalence of hypovitaminosis D. Patients with hypovitaminosis D had higher values of total cholesterol and LDL cholesterol (p<0.05), and a non-significant trend toward higher triglyceridemia. Conclusion: A high prevalence of hypovitaminosis D, associated with high total and LDL cholesterol was found in high risk pregnant women. (AU)

Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology

Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

Role of vitamin D in insulin resistance in obese individuals

BACKGROUND: Vitamin D is a fat-soluble compound responsible for promoting intestinal absorption of calcium, and this, in turn, acts as a signal transmitter or activator as protein in secretory processes and release of hormones. VitaminD receptors are distributed in various tissues of the body and involved in biochemical reactions in the pathogenesis of several diseases, such as obesity. OBJECTIVE: The aim of this article is to provide updated information on the role of vitamin D in insulin resistance inobese individuals. METHODS: It was conducted a search of articles published in PubMED, SciELO, and LILACS database, without limit forthe year of publication, using the keywords"vitamin D","insulin resistance",and "obesity". RESULTS: Excess adipose tissue seems to impair insulin signaling by inhibiting the phosphorylation of its receptor, resultingin insulin resistance. Studies have evidenced role of vitamin D in mechanisms involved in the pathogenesis of insulin resistance in obesity by acting in improving glycemic control both by increasing hepatic and peripheral glucoseup take and by promoting the secretion of this hormone. CONCLUSIONS: Vitamin D exerts a protective effect in the treatment and prevention of insulin resistance in patients with obesity and protects the body against oxidative stress and chronic inflammation, contributing to glycemic control. Unfortunately, current data related to the effects of vitamin D supplementation on insulin resistance are still inconclusive

Determinación de niveles de vitamina D en pacientes con fibromialgia: estudio de casos y controles / Vitamin D levels in patients with fibromyalgia: case control study

Introduction: fibromyalgia (FM) is characterized by diffuse chronic muscle pain, fatigue and disability, affecting quality of life. In recent years there are many reports that show a high prevalence of vitamin D deficiency in different populations. In patients with FM there are conflicting results about the associations with vitamin D deficiency. Method: Case control study matched controls by age and sex. A clinical interview, measurement of 25-OH vitamin D, calcium, phosphorus and intact PTH was measured. The definitions of the American Society of Endocrinology were used: Insufficient vitamin D levels of 21-29 ng/ml and deficiency when they are less than 20 ng/ml. Results: 39 female patients were included in each group. The average age was 46.33 years (SD 10.6) in patients with FM and 45.92 years (SD 11.9) in controls. VD average levels in women with FM was 26.13 ng/ml (SD 8.3) and the controls of 28.45 ng/ml (SD 8.7) p = 0.082. No group differences were found when using cutoffs of 30 ng/dl (OR 2.75 with p = 0.35 [95 percent CI 0.96 to 8.06]) or 20 ng/dl (OR 0,6 p = 0.38 [95 percent CI 0.15 to 2.18]). No VD patients with levels below 10 ng/dl were presented. Conclusions: We found no differences between groups in VD levels when considering the average levels of VD or using different cutoffs.

Women with recurrent spontaneous abortion have decreased 25(OH) vitamin D and VDR at the fetal-maternal interface

Immunological mechanisms have been proposed to underlie the pathogenesis of recurrent spontaneous abortion (RSA). Vitamin D has a potent immunomodulatory effect, which may affect pregnancy outcome. The objective of this study was to investigate 25-hydroxyvitamin D [25(OH) D] concentration and vitamin D receptor (VDR) expression in the decidual tissues of RSA patients. Thirty women with RSA (RSA group) and thirty women undergoing elective abortion (control group) were recruited during 2016 from gynecology outpatient clinics. We measured 25(OH) D, interleukin (IL)-17, IL-23, transforming growth factor β (TGF-β), VDR and 1-α-hydroxylase (CYP27B1) in decidual tissues collected during the abortion procedure. In the RSA group, 25(OH) D and TGF-β were significantly decreased while IL-17 and IL-23 were significantly increased compared with the control group. VDR expression was significantly decreased in the RSA group compared with the control group. Logistic regression analysis showed a significant negative correlation between 25(OH) D in decidual tissues and RSA. These results indicated that vitamin D concentrations in the decidua are associated with inflammatory cytokine production, suggesting that vitamin D and VDR may play a role in the etiology of RSA.

Vértigo posicional paroxístico benigno idiopático con recurrencias: vitamina D y calcemia / Idiopathic benign paroxysmal positional vertigo with recurrences: vitamin D and calcemia / Vertigem posicional paroxistica benigna idiopatica comrecorrências: vitamina D e calcemia

Introducción: la causa más frecuente de vértigo en los adultos es el Vértigo Posicional Paroxístico Benigno (VPPB). La vitamina D interviene en la correcta biomineralización de la otoconia; niveles bajos de la misma y la consiguiente alteración de la homeostasis del calcio pueden alterar la formación otoconial normal, e intervenir en la aparición de dicha patología. Objetivos: Analizar la distribución de pacientes con VPPB idiopático con recurrencias según edad, sexo, valores de vitamina D total y calcemia. Determinar la frecuencia de las alteraciones de estos valores en pacientes con dicha patología. Material y método: Estudio retrospectivo, descriptivo. Resultados: 30 pacientes, con edad media de 57 años (rango: 27-87 años), de los cuales 10 (33%) fueron hombres y 20 (67%) mujeres. Del total, 29 (97%) presentaron valores normales de calcemia; sólo uno (3%) presentó hipocalcemia; 9 (30%) pacientes presentaron valores normales de vitamina D y 21 (70%), valores alterados. Del total de pacientes con hipovitaminosis D (21), 6 (29%) fueron hombres y 15 (71%) mujeres, con edad media para dicha muestra de 52 años. De la misma, el mayor número de pacientes (9 = 43%) se encontraba entre el rango de edad 47-56 años. De la población con hipovitaminosis D (21), 10 (48%) correspondieron a valores insuficientes y 11 (52%), a valores deficientes. Conclusiones: En la muestra analizada, el 70% presentó hipovitaminosis D, deficiente o insuficiente en similar proporción. Esta alteración fue más prevalente en individuos de entre 47 y 56 años, con una edad media de 52, principalmente mujeres. No se objetivaron alteraciones significativas en los valores de calcemia analizados.

Introduction: the most common cause of vertigo in adults is Benign Paroxysmal Positional Vertigo (BPPV). Vitamin D is involved in the correct biomineralization of otoconia; low levels of calcium and the consequent alteration of calcium homeostasis can alter the normal otoconial formation and to intervene on the onset of this pathology. Objectives: To analyze the distribution of patients with Idiopathic BPPV with recurrence according to age, sex, total vitamin D and calcemia. To determine frequency of the alterations of these values in patients with this pathology. Material and method: Retrospective, descriptive study. Results: 30 patients, mean age 57 years (range: 27- 87 years), 10 (33%) men and 20 (67%) women. Of the total, 29 (97%) presented normal values of calcemia, only one (3%) presented hypocalcemia. 9 (30%) patients had normal values of vitamin D and 21 (70%), altered values. Of the total number of patients with hypovitaminosis D (21), 6 (29%) were men and 15 (71%) women, mean age of 52 years. In hypovitaminosis D group (21), the age of the largest number of patients (9 = 43%) ranged from 47 to 56 years. In this group, 10 (48%) patients corresponded to insufficient vitamin D values and 11 (52%) had vitamin D deficiency. Conclusions: In our sample, 70% of patients presented insufficiency or deficiency of vitamin D values in a similar proportion. These alterations were more prevalent in individuals with age ranged from 47 to 56 years, mean age of 52, mainly women. There were no significant alterations in the analized calcemia values.

Introdução: a causa mais comum de vertigem em adultos é a Vertigem posicional paroxística benigna (VPPB). A vitamina D está envolvida na biomineralização correta da otoconia; baixos níveis de cálcio e a consequente alteração da homeostase de cálcio podem alterar a formação normal de otoconia e intervir no início desta patologia. Objetivos: Analisar a distribuição de pacientes com VPPB idiopática com recorrência de acordo com a idade, sexo, vitamina D total e calcemia. Para determinar a freqüência de alterações desses valores em pacientes com esta patologia. Material e método: Estudo descritivo, retrospectivo. Resultados: 30 pacientes, idade média de 57 anos (faixa: 27-87 anos) dos quais 10 (33%) eram homens e 20 (67%) eram mulheres. Do total, 29 (97%) apresentaram valores normais de calcemia, apenas um (3%) apresentou hipocalcemia. 9 (30%) pacientes apresentaram valores normais de vitamina D e 21 (70%), valores alterados. Do total de pacientes com hipovitaminose D (21), 6 (29%) eram homens e 15 (71%) eram mulheres, com idade média de 52 anos. Do mesmo modo, o maior número de pacientes (9 = 43%) estava entre a faixa etária de 47-56 anos. Da população com hipovitaminose D (21), 10 (48%) pacientes corresponderam a valores insuficientes de vitamina D e 11 (52%) apresentaram deficiência de vitamina D. Conclusões: Em nossa amostra, 70% dos pacientes apresentaram insuficiência ou deficiência de valores de vitamina D em proporção similar. Estas alterações foram mais prevalentes em indivíduos entre 47 e 56 anos, idade média de 52, principalmente mulheres. Não houve alterações significativas nos valores de calcemia analizados.

Vitamin D role in smoking women and cardiac remodeling

Background: The objective of the study is to evaluate the influence of serum vitamin D concentrations and smoking status in cardiac structure and function. Methods: The participants of this study were healthy women smokers (n = 18, mean age 52.8 years), ex-smokers ( n = 18, mean age 51.7 years), and never smokers ( n = 19, mean age 44.4 years). All participants underwent assessment of body composition, dietary intake, sun exposure frequency, vitamin D serum determination, and echocardiographic assessment. All data underwent statistical analysis. Results: The three groups were classified as overweight. The group of ex-smokers showed significantly higher vitamin D serum concentrations. Smoker group showed a higher posterior wall thickness (PW), left ventricular mass, and left ventricular mass index (LVMI). We identified positive correlations between LVMI and smoking history, PW and vitamin D serum, and body mass index and time of smoking history. Multiple linear regressions showed positive association of smoking history and LVMI and PW, also that serum vitamin D has a positive association with PW. PW was associated with smoking history and serum vitamin D, showing a deleterious effect on the heart of both variables. Conclusions: Smoking habit in adult women was associated with cardiac remodeling, and excess of vitamin Dis associated with the action of smoking on cardiac variables. Thus, higher serum vitamin D values have a deleterious effect on the heart in this model.

Salud ósea en pacientes sometidos a trasplante de precursores hematopoyéticos: un nuevo problema a considerar / Vitamin D and parathyroid hormone levels and bone mineral density in patients undergoing hematopoietic cell transplantation

Background: Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk of developing osteoporosis. Aim: To determine the frequency and severity of Vitamin D deficiency, secondary hyperparathyroidism and low bone mass in patients undergoing HCT. Patients and Methods: Analysis of the database of patients undergoing HCT in our institution in the 2010-2015 period. We searched for patients with measurements of 25-OH vitamin D (25OHD), parathyroid hormone (PTH) and bone densitometry by double beam X ray absorptiometry (DXA) prior and up to one year after HCT. Results: Ninety patients were included, 53 were evaluated prior to HCT and 37 after HCT. They represent 73% of all patients undergoing HCT in the period. Median 25OHD was 12 ng/ml (range 4-41.4). Ninety seven percent of patients had levels considered insufficient and 85% compatible with deficiency. Median PTH was 60.5 pg/ml (range 21-186). Forty five percent of patients had secondary hyperparathyroidism. DXA was performed in 65 patients (prior to HCT in 54 and after HCT in 11). Of these, 11% had had a low bone mineral density. Conclusions: Patients undergoing HCT have a high risk of vitamin D deficiency, secondary hyperparathyroidism and low bone mineral density.

The Association of Vitamin D Levels with the Extent and Severity of Coronary Artery Disease.

Aims: Vitamin D is known for its primary role in calcium and bone homeostasis and regulation of parathyroid hormone (PTH) secretion. There is increasing evidence for health benefits accomplished by activated vitamin D, that go beyond these classical functions. Previous studies have suggested that lower Vitamin D levels are associated with increased cardiovascular disease (CVD) risk. Therefore, we aimed to evaluate relationship between vit D levels and extent and severity of coronary artery disease. Study Design: Cross-sectional. Place and Duration of Study: Sample: Department of Cardiology, Bagcilar Training and Research Hospital between November 2009 and march 2010. Methodology: We evaluated 135 patients who underwent elective coronary angiography between November 2009 and march 2010. Patients with renal failure(GFR less than 60ml/min per 1.73m2), history of malignancy within the past 5 years, any predominant non-cardiac disease, patients using any vitamin D supplement or with hyperparathyroidism or hypercalcemia were excluded. The severity and extent of CAD were determined using the Gensini score. And, patients were classified as having advanced (≥40) or mild (<40) CAD according to the Gensini scores. Results: The mean 25-OH D concentration was 18.7ng/mL. The overall prevalence of 25- OH D less then 15ng/mL was 34,8%(n=47), with 11% having 25-OH D less then 10ng/mL. Multivariate analysis revaeled that smoking, presence of hyperlipidemia, higher CRP levels, higher ALP levels and low levels of 25-OH D concentrations were significantly associated with higher Gensini Scores. Conclusion: In our study, we found significant correlation between low vitamin D levels and higher Gensini scores.

Mean Platelet Volume and Vitamin D Level

BACKGROUND: Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV. METHODS: This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent microparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MPV was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were divided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of 20 ng/mL, respectively. RESULTS: The vitamin D level in Group 1 (7.7+/-1.9 ng/mL) was lower than that in Group 2 (15.1+/-1.6 ng/mL, P<0.001) and Group 3 (25.6+/-6.3 ng/mL, P<0.001). The MPV in Group 3 (7.5+/-1.0 fL) was lower than that in Group 1 (8.1+/-1.1 fL, P<0.001) and Group 2 (7.9+/-1.0 fL, P=0.009). Linear regression analysis showed that low levels of vitamin D (beta=-0.109, P=0.019) was independently associated with increased MPV. CONCLUSIONS: There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV.

Vitamina D en pacientes con síndrome metabólico de la ciudad de valencia, venezuela / Vitamin D in patients with metabolic syndrome from valencia City, venezuela abstract

Entre los efectos no clásicos de la Vitamina D destaca su asociación con el sistema cardiovascular y su disminución, se relaciona con factores de riesgo que definen al Síndrome Metabólico (SM). Es por ello que el objetivo de este estudio fue evaluar los niveles de Vitamina D en pacientes con SM y relacionarlos con sus componentes. Fueron estudiados 31 individuos con SM que acudieron a consultas de medicina interna en el Instituto Venezolano de Seguro Social “Dr. Luis Guada Lacau” y el Ambulatorio Urbano “Dr. Miguel Franco” del Municipio Naguanagua, Edo. Carabobo durante el primer trimestre del año 2011. A los mismos les fueron medidos los niveles de 25-(OH)-Vitamina D, circunferencia abdominal, presión arterial, perfil lipídico y glicemia, así como los índices aterogénicos y la relación TG/HDL-c. 54% de los participantes presentó niveles insuficientes de Vitamina D, asociándose estadísticamente a LDL-c elevado (chi-cuadrado=3,77; p-valor=0,052), mostrando además una correlación media y positiva con los valores de esta lipoproteína (r=0.3813; p-valor=0.0350) y con la relación LDL-c/HDL-c (r=0.3820; p-valor=0,0340). No se encontraron diferencias estadísticamente significativas entre los parámetros evaluados al dividir la muestra según la presencia o no de insuficiencia de vitamina D (prueba t de Student y Prueba de Wilcoxon-U-Mann Whitney). Los resultados obtenidos confirman la hipótesis de que la hipovitaminosis D puede ser considerada como un factor de riesgo para desarrollar SM, sugiriendo la realización de futuras investigaciones que contribuyan a profundizar la participación de la insuficiencia de esta vitamina y su posible interacción con otros factores no clásicos de riesgo cardiovascular(AU)

Among the nonclassical effects of vitamin D highlights its association with cardiovascular system, strongly associating your decline to risk factors that define the metabolic syndrome (MS). That is why the aim of this study was to assess vitamin D levels in patients with MS and link components. Was study 31 subjects with MS attending internal medicine clinics at the Venezuelan Institute of Social Security, “Dr. Luis Guada Lacau” and the Ambulatory Urban “Dr. Miguel Franco” of Naguanagua, Edo. Carabobo during the first quarter of 2011. At the same they were measured the levels of 25 - (OH)-vitamin D, waist circumference, blood pressure, lipid profile and glucose, and the atherogenic index and the ratio TG/HDL-c. 54% of participants had insufficient levels of Vitamin D, associated statistically elevated LDL-c (chi-square=3.77, p-value=0.052), also showing average and positive correlation with the values of this lipoprotein (r=0.3813, p-value=0.0350) and LDL-C/HDL-C relationship (r=0.3820, p-value=0.0340). No statistically significant differences were found between the parameters evaluated by dividing the sample according to the presence or absence of vitamin D insufficiency (Student’s t and Wilcoxon- U Mann-Whitney test). The results confirm the hypothesis that vitamin D deficiency may be considered a risk factor for developing MS, suggesting future conducting research that contributes to deepen the involvement of the failure of this vitamin and its possible interaction with other factors nonclassical cardiovascular risk(AU)

Deficiência de vitamina D em pacientes com suspeita de insuficiência cardíaca e fração de ejeção normal / Vitamin D deficiency among pacients with suspected heart failure with normal ejection fraction

Fundamentos: Estudos têm demonstrado forte associação entre déficit de vitamina D (VitD) e risco de doença cardiovascular. Níveis reduzidos de VitD apresentam elevada prevalência, e são considerados fator de mau prognóstico na insuficiência cardíaca (IC). Objetivo: Avaliar a deficiência de VitD em pacientes com suspeita de IC e fração de ejeção normal e sua correlação com marcadores de função diastólica e sistólica. Métodos: Estudo transversal com 85 pacientes ambulatoriais (idade 70,8±11,5 anos, sexo feminino 72 % - Rio de Janeiro, latitude -22° Sul) com suspeita de IC e que apresentavam fração FEVE normal. Os pacientes foram submetidos à dosagem de vitamina D 25-hidroxi (25(OH)D) e BNP e realização de ecocardiograma, Doppler tecidual e eletrocardiograma para investigação de ICFEN, de acordo com os critérios da Sociedade Europeia de Cardiologia. Resultados: ICFEN foi confirmada em 32 pacientes (38 %) que tinham valores maiores de BNP (135,1 mediana 109 pg/mL vs. 23,4 mediana 16,4 pg/mL; p<0,0001) e dos índices de disfunção diastólica (volume AE-I 44,2±8,9 mL/m2 vs. 29,3±7,4 mL/m2; relação E/E’ 14,5±6,6 vs. 7,5±2,1; p<0,0001). Valores de VitD foram menores no grupo com ICFEN, com significado estatístico (34,9±14,9 mcg/L vs. 45,0±17,6 mcg/L; p=0,008). Regressão binária logística mostrou idade (p=0,001) e VitD (p=0,036) como fatores independentes significativos para ICFEN. Observou-se correlação negativa entre a relação E/E’ e valores de VitD (r=-0,300 p=0,005). Conclusão: Pacientes com ICFEN apresentavam menores níveis séricos de VitD e quase a metade apresentava deficiência de VitD. Observou-se correlação negativa entre VitD e relação E/E’ marcador da pressão de enchimento do VE.

Background: Studies have shown a strong association between vitamin D (VitD) deficiency and the risk of cardiovascular disease. Widely prevalent, VitD deficiency is considered as a poor prognosis factor for heart failure (HF).Objective: To assess VitD deficiency among patients with heart failure with normal ejection fraction (HFNEF) and correlations with systolic and diastolic function markers. Methods: A cross-section study with 85 outpatients (age 70.8±11.5 years, female 72 %, Rio de Janeiro, latitude -22°S) with suspected HF and normal EF, dosed with 25-hydroxy vitamin D (25(OH)D) and BNP measurements, with echocardiograms, tissue Doppler and electrocardiograms for investigating HFNEF, in compliance with the criteria established by the European Society of Cardiology. Results: HFNEF was confirmed in 32 patients (38 %) with higher BNP values (135.1 median 109 pg/mL vs. 23.4 median 16.4 pg/mL; p<0.0001) and diastolic dysfunction rates (volume AE-I 44.2±8.9 mL/m2 vs. 29.3±7.4 mL/m2, E/E’ 14.5±6.6 vs. 7.5±2.1; p<0.0001). The VitD values were lower in the HFNEF group, with statistical significance (34.9±14.9 mcg/L vs. 45.0±17.6 mcg/L; p=0.008). A binary logistic regression revealed age (p=0.001) and vitamin D (p=0.036) as independent factors significant for HFNEF. A negative correlation was noted between the E/E` ratio and the VitD values (r=-0.300 p=0.005). Conclusion: HFNEF patients had lower serum VitD levels and almost half were VitD deficient. A negative correlation was noted between VitD and the E/E’ ratio, an LV filling pressure marker.

Suplemento de 1, 25 dihidroxicolecalciferol e redução de cálcio e fósforo disponível para frangos de corte / Supplement of 1, 25-dihydroxycholecalciferol and reduction of calcium and available phosphorus in broiler chickens

Avaliaram-se o desempenho e o rendimento de carcaça e cortes nobres de frangos de corte machos com suplemento nas rações de 1,25 dihidroxicolecalciferol e redução de cálcio e fósforo disponível. Foi utilizado um delineamento em blocos ao acaso, com seis tratamentos: 0,0; 1,0; 2,0; 3,0; 4,0 e 5,0µg de vitamina D3 ativa/kg de ração, e seis repetições com 17 aves cada. Aos 8 e 42 dias de idade cada unidade experimental foi pesada para avaliação do desempenho. Posteriormente, quatro aves/repetição foram retiradas e abatidas para mensuração do rendimento de carcaça e de cortes nobres. A inclusão da vitamina D3 ativa influenciou positivamente (P<0,05) o ganho de peso e a conversão alimentar com as suplementações de 1,0 e 2,0µg/kg. O consumo de ração não apresentou diferença significativa para os níveis estudados. O rendimento de carcaça e de cortes nobres de frangos de corte machos aos 42 dias não foram influenciados pelo suplemento de 1,25 dihidroxicolecalciferol e redução de cálcio e fósforo disponível nas rações. Recomenda-se o fornecimento suplementar de 1,0 a 2,0µg/kg de vitamina D3 ativa nas rações para frangos de corte machos de 8 a 42 dias de idade.

There were evaluated the performance, the carcass yield and noble cuts yield of broilers with supplement of 1,25-dihydroxycholecalciferol and reduction of calcium and available phosphorus. It was used a randomized block design, with six treatments: 0.0; 1.0; 2.0; 3.0; 4.0 and 5.0µg of active vitamin D3/kg of ration, and six repetitions with 17 birds each. At 8 and 42 days of age each experimental unit was weighted in order to evaluated the performance. Later, four broilers/repetition were removed and slaughtered in order to measure the carcass and noble cuts yield. The inclusion of active vitamin D3 influenced positively (P<0.05) the weight gain and the feed conversion at the supplementations of 1.0 and 2.0µg/kg. The feed intake wasn't significative among the studied levels. The carcass and noble cuts of male broilers at 42 days were not influenced by supplement of 1,25-dihydroxycholecalciferol and reduction of calcium and available phosphorus in rations. It is recommended to provide additional of 1.0 up to 2.0µg/kg of active vitamin D3 in rations for male broilers from 8 to 42 days of age.

Determinação de 25-hidroxivitamina D2 e D3 em plasma por CLAE-DAD / Determination of 25-hidroxy-vitamin D2 and D3 in plasma by HPLC-DAD

INTRODUÇÃO: O interesse pela vitamina D nos últimos anos teve aumento significativo. Estudos epidemiológicos realizados têm demonstrado um crescente aumento da deficiência de vitamina D entre a população. O marcador diagnóstico de escolha para determinar os níveis de vitamina D é a concentração de 25-hidroxivitamina D (25(OH)D), com suas frações D2 (25(OH)D2) e D3 (25(OH)D3). OBJETIVO: Desenvolver uma metodologia analítica empregando cromatografia líquida de alta eficiência com detector de arranjo de diodos (CLAE-DAD) para a determinação de 25(OH)D3 e 25(OH)D2 em plasma. MATERIAIS E MÉTODOS: 25(OH)D3 e 25(OH)D2 foram extraídos das amostras de plasma com hexano, utilizando-se dodecafenona como padrão interno (PI). Utilizou-se coluna analítica ACE 5 C18 com partículas de 5 µm e dimensões de 150 × 4,6 mm, fase móvel metanol-água (80:20; v/v) e quantificação em 265 nm. RESULTADOS: A exatidão foi entre 98,4 e 107,5%. A precisão intraensaios esteve entre 6,5% e 9,2% para 25(OH)D3 e entre 3,7% e 8,7% para 25(OH)D2. A precisão interensaios esteve entre 2,9% e 6% para 25(OH)D3 e entre 4% e 4,5% para 25(OH)D2. O limite inferior de quantificação foi 10 ng/ml. As concentrações encontradas em amostras de 32 pacientes idosos estiveram entre 10,1 e 32,4 ng/ml, caracterizando deficiência de vitamina D nesse grupo. DISCUSSÃO O método foi capaz de quantificar 25(OH)D2 e 25(OH)D3 com uma preparação de amostra relativamente simples e rápida. O método foi seletivo, com separação adequada dos metabólitos e do padrão interno e sem presença de interferentes. CONCLUSÃO: O método desenvolvido apresenta desempenho analítico adequado e pode ser aplicado em condições clínicas.

INTRODUCTION: The interest in vitamin D has increased significantly in recent years. Epidemiological studies conducted over the past 25 years have shown a steady increase in vitamin D deficiency. The diagnostic marker of choice to determine vitamin D levels is the concentration of 25-hidroxy-vitamin D (25(OH)D) in the fractions D2 (25(OH)D2) and D3 (25(OH)D3). OBJECTIVE: To develop an analytical method using high-performance liquid chromatography with diode-array detection (HPLC-DAD) for the determination of 25(OH)D2 and 25(OH)D3 in plasma. MATERIALS AND METHODS: 25(OH)D3 and 25(OH)D2 were extracted from plasma samples with hexane and dodecaphenone was used as internal standard. The separation was performed in an ACE 5 C18 column, with particle size of 5 µm (4,6 × 150 mm), mobile phase methanol-water (80:20, v/v) and quantification at 265 nm. RESULTS: Accuracy was in the range of 98.4 to 107.5%. Intra-assay precision was between 6.5 and 9.2% for 25(OH)D3 and 3.7 and 8.7 for 25(OH)D2. Inter-assay precision was between 2.9 and 6% for 25(OH)D3 and 4 and 4.5 for 25(OH)D2. The limit of quantification was 10 ng/l. Concentrations of 25(OH)D3 in samples from 32 elderly patients were between 10.1 and 32.4 ng/ml, characterizing vitamin D deficiency in this group. DISCUSSION: The method allowed the quantification of 25(OH)D2 and 25(OH)D3. Furthermore, the sample preparation was relatively simple and fast. The method was selective with an adequate separation of metabolites and internal standard with no interfering substances. CONCLUSION: Not only did the developed method show suitable analytical performance, but it may also be applied in clinical conditions.

Avaliação do desenvolvimento da discondroplasia tibial em frangos de corte submetidos à dieta com 25 hidroxicolecalciferol / Evaluation of tibial dyschondroplasia development in broiler chickens fed diets containing 25 hydroxicolecalciferol

Este trabalho teve como objetivo avaliar o desenvolvimento da discondroplasia tibial (DT) em frangos de corte de 1 ae fontes de vitamina D (1250UI D3/kg sem 25-(OH)D3; 1250UI D3/kg com 69mg 25-(OH)D3/ton e 3000UI D3/kg com 69mg 25-(OH)D3/ton) e dois tratamentos controles com níveis de cálcio e fósforo com 3000UI D3/kg sem 25-(OH)D3 e 3000UI D3/kg com 69mg 25-(OH)D3/ton de ração. Foram avaliadas características ósseas. No período de 1 a 21 dias, os resultados indicaram que as concentrações de cálcio e fósforo nas tíbias não foram influenciadas pelos tratamentos e que o consumo de ração foi superior para os tratamentos que compõem o fatorial. A resistência óssea também não foi influenciada pelos tratamentos e a análise histológica não evidenciou lesões características de DT. Conclui-se que, nas condições experimentais da presente pesquisa, o desenvolvimento de DT não foi observado.

This research was carried out to evaluate the development of tibial dyschondroplasia (TD) in broilers from 1 to 21 days. Four hundred forty day-old male chickens, from broiler breeders aged 60-62 weeks, were randomly distributed in a 3x3+2 factorial arrangement, resulting in 11 treatments with four replicates of 10 birds each. The factors evaluated were: bird strains (Ross 308, Cobb 500, and Hybro), levels and sources of vitamin D (1250UI D3/kg without 25-(OH)D3; 1250UI D3/kg with 69mg 25-(OH)D3/ton, and 3000UI D3/kg with 69mg 25-(OH)D3/ton), and two control treatments containing calcium and phosphorus levels with 3000UI D3/kg without 25-(OH)D3 and 3000UI D3/kg with 69mg 25- (OH)D3/ton of feed. Bone characteristics were evaluated. From 1 to 21 days, the results showed that bone calcium and phosphorus concentrations were not influenced by the treatments, however, feed intake was higher for factorial than control treatments. Bone breaking resistance was not influenced by the treatments and there were no typical lesions of TD. In conclusion, it was not observed TD development in broilers from 1 to 21 days according to experimental procedures of this research.

Medición de 25-hidroxivitamina D sérica: comparación de dos inmunoensayos / Measurement of 25-hydroxyvitamin D in serum: comparison of two immunoassays

La concentración sérica de 25-hidroxivitamina D (25-OHD) es utilizada como indicador del estado nutricional de Vitamina D (VD). El método más utilizado para medirla es el RIA. El desarrollo reciente de métodos automatizados no radiactivos facilitaría la práctica diaria de laboratorio y el diagnóstico de necesidad de suplementación. Objetivos: Comparar los datos de 25-OHD obtenidos usando un RIA y un método de quimioluminiscencia (QLIA) automatizado disponible en nuestro medio. Materiales y métodos: Concentraciones de 25-OHD se midieron en suero de 45 pacientes: 8 hombres y 37 mujeres; 18 no suplementados y 27 suplementados con VD (n=5 con VD2 y n=22 con VD3). Las mediciones de 25-OHD se realizaron con un RIA y un QLIA automatizado (LIAISON), ambos DiaSorin. Se calcularon los coeficientes de variación intraensayo (CV intra) e interensayo (CV inter) para ambos métodos. Análisis estadístico: la comparación entre métodos se realizó con los programas Analyse-it y Med Calc Se consideró significativa una p<0.05. Resultados: Los CV% intra e inter fueron: para RIA menores de 10,6 y 19,9 vs QLIA menores de 8,0 y 13.2, respectivamente. En la población total y en el subgrupo no suplementado con VD los datos de RIA vs QLIA fueron: coeficiente de correlación de Pearson (0,9259 vs 0,9412), Bias%: (6.1 vs 2.7), coeficiente de concordancia (0,9244 vs 0,9329). Conclusiones: 1) Ambas metodologías son adecuadas para mediciones de 25OHD, especialmente en casos no medicados con VD, 2) La tendencia hacia un mayor bias% observado en pacientes suplementados con VD no parecería ser atribuible a variabilidad metodológica, y sugeriría que la VD exógena o alguno de sus metabolitos interactuaría en forma diferente en la medición de 25-OHD por cada una de las metodologías utilizadas. Mayor número de casos es necesario a fin de confirmar esta hipótesis.

Serum concentration of 25-hydroxyvitamin D (25OHD) is used as an indicator of nutritional status of Vitamin D (VD). The methodolgy more frequently used for its measurement is RIA. The recent development of automated non-radioactive methodologies would help the laboratory daily practice to diagnose the need for supplementation. Objectives: To compare the data of 25-OHD obtained using a RIA and an automated chemiluminescence method (CLIA) automated available in our country. Materials and methods: Concentrations of 25-OHD were measured in serum of 45 patients: 8 men and 37 women, 18 unsupplemented and 27 supplemented with VD (n=5 with VD2 and n=22 with VD3). For 25-OHD measurements we used a RIA and a QLIA under an automated platform (LIAISON), both DiaSorin. We calculated intra-assay (intra) and interassay (inter) coefficients of variation (CV%) for both methods. Statistical analysis: comparison between methods was conducted with Analyse-it and Med Calc softwares; p <0.05 was considered significant. Results: The intra and inter CV% were below 19.9 and 10.6 for RIA vs 8.0 and 13.2 for CLIA, respectively. In the overall population and in the subgroup never supplemented with VD, data for RIA vs CLIA were: Pearson correlation coefficient (0.9259 vs 0.9412), Bias% (6.1 vs. 2.7), concordance coefficient (0.9244 vs 0.9329). Conclusions: 1) Both methods are suitable for measurements of 25OHD, particularly in cases not medicated with VD, 2) The trend toward greater bias% observed in patients supplemented with VD does not appear to be attributable to methodological variability, and suggests that exogenous VD or its metabolites interact differently in the measurement of 25-OHD by each of the methodologies used. A higher number of cases is needed to confirm this hypothesis.