Hypovitaminosis D in long-stay hospitalized patients in Songklanagarind Hospital.

The major source of vitamin D is endogenous synthesis under sunlight exposure, thus, vitamin D deficiency is uncommon in healthy people living in a tropical area where sunshine is plentiful. However, long-stay hospitalized patients who do not get direct sunlight may become vitamin D deficient. The authors studied the prevalence of vitamin D deficiency in patients without other risk factors for vitamin D deficiency who had been admitted to Songklanagarind Hospital for longer than 27 days. The second objective was to identify predictive factors for vitamin D deficiency. Considered variables were clinical character, basic laboratory results, and intact parathyroid hormone level (iPTH). Among 60 patients studied, there were 12 patients who were vitamin D deficient and only one had a level lower than 8 ng/ml. Despite vitamin D deficiency, average serum calcium was normal. Patients in the vitamin D deficient group had lower serum corrected calcium and higher iPTH level than patients in the vitamin D sufficient group. No other clinical or laboratory data could predict a vitamin D deficiency state. In summary, the present tropical area study showed that 20 per cent of long-stay hospitalized patients who had a mild degree of vitamin D deficiency and 1.7 per cent had severe vitamin D deficit. Vitamin D supplementation is unnecessary in this group of patients.

Screening for microalbuminuria in type 2 diabetes: a reconsideration.

To study the effect of timing of urine collection in determination of microalbuminuria in type 2 diabetic patients, timed urine (night time and daytime) as well as spot urine (first morning and random morning) samples were collected from 44 type 2 diabetic patients, 21 with normoalbuminuria and 23 with microalbuminuria. The methods of spot urine albumin expression for microalbuminuria were also compared between albumin concentration (AC) and albumin to creatinine ratio (ACR). Night time albumin excretion rate (AER) was 16 per cent lower and daytime AER was 13 per cent higher than 24-h AER (p<0.001). Forty-one (93%) of both night time and daytime urine samples had results corresponding with 24-h AER. For the spot urine, expression as AC showed a slightly stronger correlation with 24-h AER than expression as ACR. The levels of albumin in random morning urine samples were 50 and 35 per cent significantly higher than those in first morning urine samples when expressed as AC and ACR, respectively. In conclusion, because of low diurnal variation of AER, either daytime or night time urine could be used for screening of microalbuminuria in type 2 diabetes. Since mean albumin levels obtained from random morning urine were higher than those obtained from first morning urine, the cut-off level should be set higher in random morning urine in order to give comparable sensitivity in predicting microalbuminuria. The spot urine, either first morning or random morning urine, had a good correlation with the 24-h AER whether expressed as AC or ACR. Given the cost of the latter, the authors suggested measuring spot urine AC instead of ACR for screening of microalbuminuria in type 2 diabetes.