Cause Of Vitamin Research Articles

Frequency of Vasocclusive Crises and the Relationship of Vitamin D Deficiency to the Frequency of Pain Crises in Children with Sickle Cell Disease in an Aboriginal Tribal Region in Gadchiroli, India

▪BackgroundRecent reports suggest that the clinical phenotype of sickle cell disease (SCD) in India may not be as mild compared to African haplotypes as previously believed (Jain et. al. 2016). There is however a paucity of data from India.There are some reports of association between Vitamin D deficiency and pain in SCD, but these associations have not been studied in pediatric SCD patients form India. The objective of this community-based study was to determine the frequency of vaso-occlusive episodes (VOE) in Indian pediatric SCD patients and to determine the relationship of Vitamin D deficiency to the frequencies of VOE and other SCD complications.MethodsWe conducted a community based study in aboriginal tribal area in Gadchiroli district in Maharashtra State, India. After providing informed consent, patients completed a health history interview and underwent blood testing for serum 25-Hydroxy Vitamin D by Radioimmunoassay. The number of times in the previous year that their child had severe pain, associated with cessation of activity including play and school attendance which required treatment, in the past year, was obtained by parent self-report, and was defined as a VOC. Hospitalizations for VOE treatment and number of blood transfusions in the past year were also obtained by parent self-report. No medical record review was done. Descriptive statistics and tests of hypothesis were performed using STATA Ver. 13.ResultsWe screened 91 children (50% male) with a median age of 14 years (range 5-16, IQR 10-16). They reported a median 3 episodes of VOC/Year (IQR 2-4) and a median 2 Hospitalizations (IQR 1-2) and a median of 1 blood transfusion/ year (IQR 1-2). Median Vitamin D level was 26.4 (IQR 22.6-29.9) with 15 patients (16.5%) being Vitamin D deficient (<20ng/ml). On Student t-test with equal variance, Vitamin D deficient patients vs. Vitamin D replete patients revealed 4±0 vs. 2.5± 0.97 VOCs/year (p=0.0000), 2.3± 0.7 vs.1.60±0.7 (p=0.0006). Hospitalizations for VOC/year(P=0.010) and 1.9±0.7 vs 1.4 ±0.6 blood transfusions/year(P=0.0064). In a linear regression model, after adjusting for age and sex, higher vitamin D levels were associated with lower VOCs (P=0.0000, Model F statistic= 53.8).ConclusionsChildren with SCD in an aboriginal tribal region in Gadchiroli, India have reported pain frequencies similar to that described in reports from other parts of the world. This suggests that the phenotype of SCD in India may not be as mild as previously thought. In this population, Vitamin D deficiency is associated with significantly increased VOE, hospitalizations for VOE and blood transfusions. These data provide the rationale for larger studies to further elucidate the association of Vitamin D with pain events in SCD, and to determine the causes of Vitamin D deficiency and its impact on severity of SCD, so as to inform the development of suitable preventive and therapeutic strategies [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The relevance of vitamin D in the oral health of HIV infected patients

HIV infection affects 36.9 million people globally, and vitamin D deficiency is a global public health concern for HIV patients. Approximately 70 %–80 % of HIV-infected patients have vitamin D deficiency. The deficiency is associated with many pathologies such as immune disorders, infectious diseases, chronic inflammation, oral diseases, as well as the fast progression of HIV. The causes of vitamin D deficiency in HIV infections include HIV itself, traditional factors such as less sun exposure, mal-absorption, hypercholesterolemia, seasonal variation, poor nutrition as well as some HAART drugs like efavirenz.Vitamin D has an immunomodulatory, anti-inflammatory, and anti-proliferative function. In the oral cavity, it plays a significant role in preventing oral infections such as periodontal and gum diseases, dental caries, and oral candidiasis. The consequences of vitamin D deficiency are bone resorption, increased productions of pro-inflammatory cytokines, T-lymphocytes, increased T-helper-1 functions, and decreased T-helper-2 functions. Consequently, this leads to increased infections, chronic inflammation, and the occurrence of oral diseases such as oral candidiasis, periodontal and gum diseases, and dental caries. The majority of these oral diseases are encountered in HIV patients. Vitamin D deficiency is significantly found in HIV patients. There is a lack of studies that directly link vitamin D to most oral diseases in HIV patients; however, the role of vitamin D in immunoregulation, prevention of oral diseases, and HIV infection is substantiated.

Вітамін D: нові аспекти застосування, ефективні дози. Сучасний стан проблеми

Крім класичної ролі вітаміну D в підтримці нормального стану скелетно-м’язової системи, в останнє десятиліття отримані докази того, що знижені концентрації в сироватці крові 25(OH)D асоційовані з низкою позаскелетних захворювань (цукровий діабет, артеріальна гіпертензія, захворювання щитоподібної залози, вікове зниження пізнавальної здатності, порушення функцій імунної та репродуктивної систем й ін.). Запобігання розвитку цих захворювань досягається при значно більш високих концентраціях 25(OH)D в сироватці крові, ніж це необхідно для підтримки нормального стану кісткової тканини, регуляції абсорбції й підтримки гомеостазу кальцію. Для забезпечення концентрації циркулюючої форми вітамінуD— 25(OH)D в сироватці крові на рівні, що забезпечує оптимальне функціонування, необхідне більш високе споживання цього вітаміну. Знижена концентрація вітаміну D в крові (&lt; 30 нг/мл) відзначається у 92% дорослого населення України незалежно від пори року. Причинами дефіциту вітаміну D є низька ефективність його ендогенного синтезу в шкірі через недостатню інсоляцію та неадекватне надходження цього вітаміну з їжею. Завдяки періоду напіввиведення вітаміну D близько двох місяців, періодичне щотижневе або щомісячне споживання сукупних доз холекальциферолу дає змогу досягти тих самих значень у сироватці крові, як і щоденне споживання. В огляді літератури розглядається значення дефіциту та недостатності вітамінуD у порушеннях регуляції багатьох систем організму людини та розвитку різних патологічних станів, що обґрунтовує доцільність ширшого використання методів корекції статусу вітаміну D. Попри необхідність проведення масштабних рандомізованих клінічних випробувань для визначення схем використання препаратів вітаміну D, уже зараз не викликає сумніву той факт, що нормалізація рівня 25(ОН)D у сироватці крові потрібна на всіх вікових етапах онтогенезу.

PREVALENCE OF VITAMIN D DEFICIENCY INPRE-DIALYTIC CHRONIC KIDNEY DISEASE PATIENTS ATTENDING A TERTIARY CENTRE IN NORTH-EAST INDIA

Introduction: Vitamin D deficiency has not only been associated with bone and muscular complications but also with cancer, cardiovascular diseases, infection, maternal and neonatal complications. There are many causes of vitamin D deficiency including socio-demographic factors, the timing of sun exposure, along with drugs, skin, liver, and kidney diseases. India is closer to the equator so is considered to have a lower risk of Vitamin D deficiency but it is not so, with many studies implicating deficiency even in the general population. There are no studies done on the north-eastern Indian population document on vitamin D levels in Chronic Kidney Disease (CKD) patients. Aim: To study the prevalence of Vitamin D deficiency in the pre-dialytic chronic kidney disease. Material and Methods:Observational study was done. 120 CKD patients were included in the study and staging was done according to the MDRD formula. Total 25-OH Vitamin D was measured by the Enzyme Immuno Assay method. Results: 43.33% of the patients in the group were found to have vitamin D deficiency and 26.66% of patients had vitamin D insufficiency. There was a significant association between vitamin D deficiency and stages 4 and 5 CKD. There was not any significant correlation between vitamin D levels with age, sex, body mass index, serum calcium, or albumin. Conclusion:High levels of vitamin D deficiency were seen in the CKD patients of the northeast Indian population. There were statistically significant changes in vitamin D levels and stages 4 and 5 of CKD.

Vitamin D Deficiency – The Modern Epidemic

Researchers have analyzed data on vitamin D status on adult population in USA and found Vit D deficiency or insufficiency in 50-78%1. In United Kingdom 90% of adult population had low vitamin D2. It is extremely common in Sunny Middle East because people cover their body with clothes. The causes of vitamin D deficiency are – modern life style, Sun phobia because of skin cancer, wrinkles, aging spots; obesity, medical illness e.g. mal-absorption, liver &amp; kidney disease; medications e.g. phenytoin, phenobarbital, steroid. Natural vitamin has two forms, vitamin D3 (cholecaciferol) and vitamin D2 (ergocalciferol). Vitamin D3 is superior to vitamin D2.Vitamin D affects every system in human body. It plays a vital role in health of muscle and bones, normal functioning of immune system, controls growth of normal and cancerous cells, prevention &amp; treatment of type 2 diabetes, prevention of heart disease, kidney disease &amp; heart failure, prevention of coronary artery disease, treatment of psoriasis, prevention of dental problems and prevention &amp; treatment of depression3 In people with Vit D deficiency the parathyroid glands produce more than normal amount of PTH, which cause excessive dissolving of calcium from bone leading to bone aches and pain. Vitamin D deficiency is a major cause of osteoporosis. There is a direct correlation between Vit D level and bone mineral density. Post menopausal women with osteoporosis had low level of Vit D. Steroids antagonize effects of Vit D.

Variable Phenotypes Seen with a Homozygous CYP24A1 Mutation: Case Report

Vitamin D–mediated hypercalcemia may be due to benign or malignant conditions. Recently, loss-of-function mutations in the gene CYP24A1, which encodes 25-hydroxyvitamin D3-24-hydroxylase, have been described which result in reduced degradation of the active 1,25-(OH)2 D3, causing hypercalcemia and hypercalciuria. We describe four patients in whom we identified a novel CYP24A1 homozygous germline mutation (NM_000782.4: c.323A>G; p.(His108Arg). Three of the four patients had a long history of recurrent renal stones. One patient had nephrocalcinosis with significant renal impairment. The other three patients had intermittent hypercalcemia, which in two female patients predominantly occurred during pregnancy with severe gestational hypercalcemia. Germline CYP24A1 mutations are a rare but important cause of vitamin D–mediated hypercalcemia and demonstrate a core phenotype of renal stones, hypercalciuria, and PTH-independent hypercalcemia. However, even in the setting of a homozygous CYP24A1 germline mutation, hypercalcemia may be intermittent with a normal PTH level during the periods of normocalcemia resulting in the need for a high degree of clinical suspicion. Measurement of vitamin D metabolites, in particular the 25-(OH)D3/24,25-(OH)2D3 ratio which is elevated in patients with homozygous CYP24A1 germline mutations, may help provide a clue as to the underlying diagnosis. In women with a history of recurrent calcium-containing renal stones or nephrocalcinosis, we would recommend measurement of serum calcium levels prior to conception and each trimester due to the potential for severe adverse effects on mother and baby if an unidentified CYP24A1 mutation is present.

VITAMIN D INSUFFICIENCY IN FOUR MAJOR HOSPITALS OF PUNJAB

VITAMIN D INSUFFICIENCY IN FOUR MAJOR HOSPITALS OF PUNJAB

Vitamin D and Hemostasis Parameters in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients with Pulmonary Tuberculosis Coinfections

BACKGROUND: Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) remains one of the most common causes of Vitamin D deficiency and homeostasis disorders due to its progressiveness and complications.&#x0D; AIM: This study aims to determine the relationship of Vitamin D levels with hemostasis in HIV/AIDS patients with and without pulmonary tuberculosis (TB), who were consuming efavirenz (EFV)-based antiretroviral therapy (ART) for &lt;6 months, with or without rifampicin-based antituberculosis treatment.&#x0D; METHODS: 25(OH)D concentration, prothrombin time (PT), and platelet index were measured in HIV/AIDS patients with and without pulmonary TB, who were consuming EFV-based ART for &lt;6 months, with or without rifampicin-based antituberculosis treatment. This study was conducted in the Special Treatment Centers (Pusat Pelayanan Khusus, Pusyansus) Voluntary Counseling and Testing clinic at Rumah Sakit Umum Pusat (RSUP) Haji Adam Malik, Medan, Indonesia, between August and October 2019.&#x0D; RESULTS: We found no significant difference in terms of 25(OH)D concentration, PT, and platelet index between the two groups, except for platelet distribution width (PDW) differs significantly between HIV/AIDS-pulmonary TB group and HIV/AIDS only group (p = 0.026). We observed a significant difference in terms of mean platelet volume and PDW between baseline and after treatment for &lt;6 months (p ≤ 0.05) in the HIV/AIDS-pulmonary TB group and in the HIV/AIDS only group. A significant difference was also observed in terms of platelet count (p = 0.021) before and after EFV-based ART for &lt;6 months p ≤ 0.05) in the HIV/AIDS-pulmonary TB group.&#x0D; CONCLUSION: There is no correlation between 25(OH)D concentration and PT or platelet index in HIV/AIDS patients with and without pulmonary TB who were consuming EFV-based ART- and rifampicin-based antituberculosis for &lt;6 months.

Vitamin D levels in military personnel serving in the Far North of the Russian Federation

Relevance. Northern territories make up to 70 % of Russia. About 11.5 million people, mainly migrants, live in the Far North. Migration to the extreme conditions of the Far North facilitates adaptation, new pathways of protein, fat, carbohydrate, micro - and macronutrient metabolism. If the functional reserves decompensate, chronic diseases develop and life expectancy decreases. Intention. Evaluate the influence of extreme conditions of the Far North on the bone mineral density in male military personnel. Methodology. We examined 60 servicemen aged 25-45 who served &gt; 5 years in the Far North (Severomorsk). The control group included servicemen (n = 41) from the North-Western region (St. Petersburg). All the servicemen underwent dualenergy X-ray absorptiometry using a densitometer “Osteometer DTX 200” and vitamin D testing in the blood. Results and Discussion . The analysis of the obtained data showed a significant decrease in the level of vitamin D (29 ± 11.5) nmol/l and a significant decrease in the Z-criterion (0.1 ± 1.7) SD (p &lt; 0.05) in the servicemen from the Far North. Correlations between Z-criterion and vitamin D levels, body mass index and muscle strength were established. Correlations between Z- criterion and vitamin D levels, body mass index and dynamometry reflect the natural process of reducing bone mineral density due to the low insolation in all the subjects. Conclusion. A significant deviation of vitamin D and bone mineral density from normal values was found in military personnel serving in the Far North and North-West of Russia. The revealed decrease in endogenous synthesis in the skin due to insufficient insolation and inadequate intake of this vitamin from food are the causes of vitamin D deficiency.

Approach to the patient with vitamin D-deficient osteomalacia due to X-linked agammaglobulinemia

Osteomalacia is a metabolic bone disease characterized by impaired mineralization of bone matrix. VitaminD deficiency contributes to a decrease in the efficiency of intestinal calcium and phosphorus absorption, resulting in secondary hyperparathyroidism and an inadequate calcium-phosphorus product, thereby causing osteomalacia. We present a patient who was diagnosed as vitamin D-deficient osteomalacia due to X-linked agammaglobulinemia (XLA), and the genetic analysis of the BTK gene revealed a missense mutation (c.82C>T). It should be attached great importance to etiological analysis of osteomalacia, and XLA may also be a cause of vitamin D deficiency. Key words: Osteomalacia; Vitamin D deficiency; X-linked agammaglobulinemia

Osteoporosis - Is There An Indication For Vitamin D Supplementation?

Adequate intake of vitamin D and calcium are fundamental for the treatment of osteoporosis. A normal vitamin D status is required for optimal intestinal calcium absorption. However, general calcium and vitamin D supplementation is not sufficient for prevention of osteoporotic fractures in persons older than 50 years. Nevertheless, vitamin D deficiency should be avoided and corrected. In particular, parts of the population with increased risk for vitamin D deficiency (immobilized or older individuals, swarthy, migrants) should be tested. Secondary causes of vitamin D deficiency should be identified and treated.

A Case Report of Intraoperative Coagulopathy Secondary to Chronic Vitamin K Deficiency.

Dietary Vitamin K is a well-known anti-hemorrhagic agent that plays an integral role in the coagulation pathway. Vitamin K is involved in synthesis of coagulation factors; II, VII, IX and factor X. Vitamin K deficiency leads to bleeding diathesis. Hemorrhages usually present in deep soft tissue, rather than mucosal or epithelial membranes, bleeding that is generally caused by disorders of platelets. Major causes of vitamin K deficiency include; medications and diseases involving fat metabolism with a resultant fat malabsorption. Warfarin and Cephalosporins are one of the commonly prescribed medications that lead to vitamin K deficiency. Disease affecting fat metabolism pathway, such as; diseases of the pancreas (cystic fibrosis), short gut syndrome and certain pathologies of the biliary tree. Vitamin K deficiency is more common in newborns. In adults it is uncommon because of its ubiquitous nature and the abundance of its sources. Hemorrhagic disorders in adults due to Vitamin K deficiency are not commonly encountered in practice. We are presenting a case of an adult who presented with a compartment syndrome secondary to a traumatic intramuscular bleeding. Our case highlights the importance of considering vitamin K deficiency in the differential diagnosis of unexplained hemorrhages resulting from a coagulopathy.

Bioavailability of Different Vitamin D Oral Supplements in Laboratory Animal Model

Background and Objectives: The major cause of vitamin D deficiency is inadequate exposure to sunlight. It is difficult to supplement it with food because sufficient concentrations of vitamin D naturally occur only in a handful of food products. Thereby, deficiency of this vitamin is commonly corrected with oral supplements. Different supplement delivery systems for improved vitamin D stability and bioavailability are proposed. In this study, we compared efficiency of three vitamin D delivery systems: microencapsulated, micellized, and oil-based. Materials and Methods: As a model in this medical testing, laboratory rats were used for the evaluation of bioavailability of different vitamin D vehicles. Animals were divided into three groups: the first one was given microencapsulated vitamin D3, the second—oil-based vitamin D3, and the third—micellized vitamin D3. Test substances were given per os to each animal for 7 days, and vitamin D concentration in a form of 25-hydroxyvitamin D (25(OH)D) in the blood was checked both during the vitamin delivery period and later, up to the 24th day. Results: Comparison of all three tested products showed that the microencapsulated and oil-based vitamin D3 vehicles were the most bioavailable in comparison to micellized vitamin D3. Even more, the effect of the microencapsulated form of vitamin D3 remained constant for the longest period (up to 14 days). Conclusions: The results of this study suggest that the oral vitamin D supplement vehicle has an impact on its bioavailability, thus it is important to take into account how much of the suppled vitamin D will be absorbed. To maximize the full exploit of supplement, the best delivery strategy should be employed. In our study, the microencapsulated form of vitamin D was the most bioavailable.

Does Fresh Air make the Difference; a Comparative Study in Vitamin D Status among College Adolescent Females from Giza and Red Sea Governorates

The level of air pollution is negatively associated with the amount of solar ultra-violet ray B (UVB) that reaches earth surface. So, more pollutant areas lead to less UVB passage and consequently, 25 (OH) vitamin D cutaneous syntheses reduces. The research was carried out to study the effect of some biological, behavioral, and environmental factors on vitamin D level among college adolescent females from Red Sea and Giza governorates. A convenient sample consisted of 151 first grade university female youth was selected. Written consent was an initial basic step. Vitamin D intake was assessed and serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D [25(OH) D], and parathyroid hormone (PTH), were measured. Food intake was compared to the recommended dietary allowances. Results revealed that majority of respondents (92.0%) were veiled and exposed to sun at noon time and 61.0 % mentioned that sun- exposure took more than an hour. Waist circumference (WC) and waist to height ratio (WC to Ht) in Giza sample and increased fish consumption per week in Red Sea sample showed a positive effect on vitamin D status. Spring season had a negative influential effect on Giza participants. This study concluded that lack of sun exposure as the main cause of vitamin D deficiency in college female, there is also limited awareness of the association between sun exposure and vitamin D synthesis. Fresh air and good food practices could aid in solving health problems with such an influence as hypovitaminosis D. This study emphasized the need for further vitamin D assessment and intervention by supplementation or fortification of a staple food item. There is also an urgent need for public education to improve vitamin D- related practice and to minimize health hazards of improper exposure to UV B rays.

Vitamin D Deficiency in the Gulf Cooperation Council: Exploring the Triad of Genetic Predisposition, the Gut Microbiome and the Immune System.

Vitamin D is a fat soluble secosteroid that is primarily synthesized in the skin upon exposure to Ultraviolet B (UVB) sun rays. Vitamin D is essential for the growth and development of bones and helps in reducing inflammation by strengthening muscles and the immune system. Despite the endless supply of sunlight in the Gulf Cooperation Council (GCC) countries which includes United Arab Emirates, Qatar, Kuwait, Bahrain, Saudi Arabia, and Oman, Vitamin D deficiency in the (GCC) general population at various age groups remains alarmingly high. In parallel runs the increasing prevalence of acute and chronic illnesses including, autoimmune diseases, cancer, type 1 diabetes mellitus, cardiovascular disease and Inflammatory bowel disease in the adult as well as the pediatric population of these countries. The exact association between Vitamin D deficiency and chronic disease conditions remains unclear; however, studies have focused on the mechanism of Vitamin D regulation by assessing the role of the Vitamin D associated genes/proteins such as VDR (Vitamin D receptor), VDBP (Vitamin D Binding protein), CYP27B1 as these are integral parts of the Vitamin D signaling pathway. VDR is known to regulate the expression of more than 200 genes across a wide array of tissues in the human body and may play a role in controlling the Vitamin D levels. Moreover, reduced Vitamin D level and downregulation of VDR have been linked to gut dysbiosis, highlighting an intriguing role for the gut microbiome in the Vitamin D metabolism. However, this role is not fully described yet. In this review, we aim to expand our understanding of the causes of Vitamin D deficiency in the GCC countries and explore the potential relationship between the genetic predisposition, Vitamin D levels, immune system and the gut microbiome composition. Trying to unravel this complex interaction may aid in understanding the mechanism by which Vitamin D contributes to various disease conditions and will pave the way toward new therapeutics treatments for Vitamin D deficiency and its associated outcomes.

A study investigating the association between vitamin D and depression among university students in 39 countries

Objectives: The aim of this study was to explore the association between vitamin D deficiency and depression among university students and to identify the factors affecting this association. Methodology: A cross-sectional study was conducted between 1st January and end of March 2017 among university students from 39 different countries. Results: 699 students were participated in this study. The findings of this study found that 270 students (38.6%) had vitamin D deficiency with level less than 20. The findings of this study found that majority of students (99.9%) in this study had depression. The findings of this study found that there was no association between depression and vitamin D depression (p value=0.386). The findings of this study shows that there was a significant difference between the severe groups of depression and other classes in terms of prevalence of vitamin D deficiency (p value=0.000). Conclusion: The current study shows that there was no association between vitamin D deficiency and depression. On the other hand, there were significant associations between the severity of depression and vitamin D deficiency. Lack of sun exposure; diet and financial factors were the causes of vitamin D deficiency in this study. Further studies are highly recommended to investigate the causes of depression among students.

Vitamin Deficiency and HIV Infection, A Retrospective Study Looking at Possible Causal Factors in the Hispanic Population with HIV

Background: The cause of vitamin D deficiency in the Hispanic population with HIV has not been studied in great detail. This deficiency may be related to the underlying chronic disease or to the lack of sun exposure and other notable factors. The current standards that have been applied to non-HIV patients may in fact not be applicable to the HIV population. Objectives: This study attempted to evaluate the possible relationship between HIV and vitamin D deficiency in a Hispanic patient population residing in El Paso, Texas. Methods: 94 HIV-infected patients were surveyed over a period of 12 months. Data was collected from their records regarding CD4 count, HIV viral load, use of anti-retroviral drugs, vitamin D levels, and status of prescription for vitamin D. Results: We found no correlation between the highly active antiretroviral therapy (HAART) and vitamin D deficiency. We also did not find evidence that antiretroviral (ARV) therapy was correlated to lower vitamin D levels in these patients. Conclusions: Further studies are needed to examine the relationship between vitamin D deficiency and HAART.

DEFISIENSI VITAMIN D TERHADAP PENYAKIT (Vitamin D Deficiency and Diseases)

It has been estimated that deficiency and insufficiency of Vitamin D affect one bilion people worldwide. Vitamin D deficiency can befound not only in countries with four (4) seasons, but also in countries with sunlight exposure all year long The objective of this studywas to know whether vitamin D deficiency can occur in Indonesia as well and to explore the role of vitamin D in people‘s health, althoughIndonesia is a country in the equator region. To avoid long term negative health consequences 25 hydroxyvitamin D/25 (OH) D serumlevel should be between 30 and 100 ng/mL. The main source of vitamin D is by synthesis at the skin which is exposed to ultraviolet Bradiation. The other source of vitamin D is from food. There are a lot of causes of vitamin D deficiency, for example: decreased vitaminD synthesis, nutritional intake of vitamin D, maternal vitamin D stores and exclusive breastfeeding, mal absorption and decreasedsynthesis or increased degradation of 25 (OH) D. From the above factors, decreased vitamin D synthesis is the main cause of vitamin Ddeficiency. The vitamin D deficiency is estimated and plays an important role in multiple disorders, such as: osteoporosis, fracture, cancer,cardiovascular disease, diabetes mellitus, autoimmune disease and infectious disease. A good strategy in managing vitamin D deficiencyis needed in order to solve the related problems.

Difficulties in diagnosing secondary vitamin K-dependent coagulopathy in children as an example of a clinical case

A vitamin K deficiency is one of the most common causes of increased bleeding associated with disorders of coagulation path of hemostasis in newborns and children of first year of life. Coagulopathy is a manifestation of vitamin K deficiency by the time of birth or due to secondary causes. In the latter case, we should not forget about the more rare causes of vitamin K dependent coagulopathy in children. As an example, the article presents the case of a patient at 6 month of age with intracranial hemorrhage on the background of the secondary deficiency of vitamin K. The child had severe coagulopathy, recurrent course за the disease and resistance to oral therapy with menadione sodium bisulfite, which led to the idea of the presence of secondary coagulopathy. After carrying out the targeted sequencing the child was revealed with pathological changes in the gene ABCB11, which are described in the 2 nd type of familial syndrome of intrahepatic cholestasis, established the true reason for the deficiency of vitamin K was established. The girl’s therapy was optimized, by which clinical and laboratory manifestations of hemorrhagic disease of newborns were leveled. Thus, a comprehensive examination of children with recurrent bleeding associated with vitamin K deficiency due to unclear etiology can indicate the true cause of the disease.

Vitamin D deficiency associated with dilated cardiomyopathy in early infancy caused by maternal cholestasis.

.Breast feeding is known to be a major cause of vitamin D deficiency in infants because the content of vitamin D in breast milk is significantly lower than that in formula. We report a case of a 1-mo-old boy who developed hypocalcemic seizures and dilated cardiomyopathy caused by vitamin D deficiency despite being fed a sufficient amount of regular formula. The cause of vitamin D deficiency in this case was maternal vitamin deficiency due to severe hyperemesis and insufficient sunlight exposure, induced mainly by the malabsorption of fat-soluble vitamins caused by maternal cholestasis. We should carefully consider maternal conditions during pregnancy and the postpartum period to detect and prevent vitamin D deficiency in the fetus and infant.