D3 Deficiency Research Articles

Importance of Vitamin D3 in COVID-19 Patients.

Outbreaks of a respiratory ailment in Wuhan, China, known as the Corona virus Disease-2019 (COVID-19), began in late December 2019. Since then, several pieces of advice have been made to boost the immune system to fight more efficiently with this infection. Previously published studies showed that vitamin D3 (Vit D3) level was low in COVID-19 patients. One of the most important factors in COVID-19 severity would be the inflammatory response. It is well documented that the inflammatory cytokine storm increases the severity of COVID-19. Cytokine storm results from dysregulation of the innate immune system with an outpouring of proinflammatory cytokines and chemokines, leading to abnormal activation of the adaptive immune pathway. It has been approved that Vit D3 has immunomodulatory functions and plays an anti-inflammatory role, particularly in viral infections. Therefore, the current study was designed to investigate the possible role of Vit D3 deficiency in the COVID-19 patients' innate immunity. This study included 180 participants who were divided into group (A) consisted of 60 COVID-19 positive patients with normal level of Vit D3, group (B) consisted of 60 COVID-19 positive patients with Vit D3 deficiency, and group (C) consisted of 60 COVID-19 positive patients that had received Vit D3 therapy. The results showed that the rate of hospitalization in the group (B) (41.3%) was significantly increased, compared to group (A) (12.5%). In this regard, Vit D3 therapy led to a significant increase in the level of Vit D3, and the patients who received Vit D3 were recovered from hospital 5 days on average sooner than those in the group (B). Therefore, the consumption of Vit D3 as a daily supplement would be a reasonable suggestion for these days of the COVID-19 pandemic to increase the power of immunity of the body.

The study of the prevalence of vitamin D3 deficiency and its relationship with blood glucose level after coronary artery bypass graft operation among patients with diabetes

Objectives: Nowadays, vitamin D3 (VitD3) deficiency is among the most common dietary deficiencies around the world. Researchers have paid more attention to VitD3 because it is a vital element of the body and has a plausible relationship with various diseases such as diabetes mellitus type II. This study was conducted to examine the prevalence of vitamin D3 deficiency and its relationship with blood sugar levels in people with diabetes undergoing coronary artery bypass grafting (CABG). Methods: An observational study was conducted in 2017 in Shahid Madani Hospital, Tabriz, Iran, for 8 months. Due to the use of census sampling, only 115 patients with diabetes and open-heart surgery were enrolled in the study. A questionnaire collected information on the participants' demographics, medical history, VitD3 levels and blood glucose levels. Data were analyzed using SPSS ver. 25. Independent t-test was used to compare quantitative data, and chi-square test was used to compare categorical variables. Results: One hundred and fifteen out of 348 patients who had CABG surgery were diabetic. Moreover, 24.7% of patients with diabetes had VitD3 deficiency. The results of the coefficient-correlation test indicated that there was a significant relationship between the mean blood glucose level and VitD3 level (p < 0.05). Conclusions: The results of this study suggest that patients with diabetes can improve their blood glucose control after CABG surgery by taking sufficient VitD3. Therefore, it should be considered as a principle of the hospital operation to prescribe VitD3 prior to surgery for these patients.

Concerning effective and safe dosages of vitamin D3: mega-analysis of clinically effective studies as a basis for actual evidence

The negative effects of hypovitaminosis D3 and vitamin D3 deficiency in 80% of Russians make eliminating vitamin D deficiency an issue of state concern. Hundreds of effective clinical studies showed realistic opportunities of vitamin D3 to help patients with disorders of carbohydrate and lipid metabolism, high levels of nonspecific inflammation, tuberculosis, and women with a higher risk of complications and pregnancy losses. Vitamin D3 supplements are essential for the prevention and treatment of a wide range of “bone” and “extraosseous” diseases. One of the most important aspects of the clinical uses of vitamin D3 is the dosage and dosage regimen of the vitamin. This paper presents the results of a “mega-analysis” of 3965 clinical studies of vitamin D3 in terms of the effectiveness of different dosages in achieving different clinical outcomes. It was shown that dosages of 2000 IU/day and 4000 IU/day correspond to the peak values of the effectiveness index, regardless of the diagnoses studied (mega-analysis of 420 randomized trials). Some effectiveness in the treatment of rickets, gestational diabetes, calcium metabolism disorders, disorders of bone density and structure, diseases of the musculoskeletal system and connective tissue can be achieved using weekly dosages of 50,000 IU/week (mega-analysis of 196 studies). It has been shown that dosages of 100,000-1,000,000 IU, intended for a single dose once a month, are almost always found only among studies with a negative result (mega-analysis of 368 studies).

Vitamin D as Modulator of Drug Concentrations: A Study on Two Italian Cohorts of People Living with HIV Administered with Efavirenz.

To date, vitamin D seems to have a significant role in affecting the prevention and immunomodulation in COVID-19 disease. Nevertheless, it is important to highlight that this pro-hormone has other several activities, such as affecting drug concentrations, since it regulates the expression of cytochrome P450 (CYP) genes. Efavirenz (EFV) pharmacokinetics is influenced by CYPs, but no data are available in the literature concerning the association among vitamin D levels, seasonality (which affects vitamin D concentrations) and EFV plasma levels. For this reason, the aim of this study was to evaluate the effect of 25-hydroxy vitamin D (25(OH)D3) levels on EFV plasma concentrations in different seasons. We quantified 25(OH)D3 by using chemiluminescence immunoassay, whereas EFV plasma concentrations were quantified with the HPLC–PDA method. A total of 316 patients were enrolled in Turin and Rome. Overall, 25(OH)D3levels resulted in being inversely correlated with EFV concentrations. Some patients with EFV levels higher than 4000 ng/mL showed a deficient 25(OH)D3 concentration in Turin and Rome cohorts and together. EFV concentrations were different in patients without vitamin D supplementation, whereas, for vitamin D-administered individuals, no difference in EFV exposure was present. Concerning seasonality, EFV concentrations were associated with 25(OH)D3 deficiency only in winter and in spring, whereas a significant influence was highlighted for 25(OH)D3 stratification for deficient, insufficient and sufficient values in winter, spring and summer. A strong and inverse association between 25(OH)D3and EFV plasma concentrations was suggested. These data suggest that vitamin D is able to affect drug exposure in different seasons; thus, the achievement of the clinical outcome could be improved by also considering this pro-hormone.

Vitamin D3/VDR inhibits inflammation through NF-κB pathway accompanied by resisting apoptosis and inducing autophagy in abalone Haliotis discus hannai.

Vitamin D3 is believed to be a contributing factor to innate immunity. Vitamin D receptor (VDR) has a positive effect on inhibiting nuclear factor κB (NF-κB)-mediated inflammation. The underlying molecular mechanisms remain unclear, particularly in mollusks. Consequently, this study will investigate the process of vitamin D3/VDR regulating NF-κB pathway and further explore their functions on inflammation, autophagy, and apoptosis in abalone Haliotis discus hannai. Results showed that knockdown of VDR by using siRNA and dsRNA of VDR in vitro and in vivo led to more intense response of NF-κB signaling to lipopolysaccharide and higher level of apoptosis and autophagy. In addition, 1,25(OH)2D3 stimulation after VDR silencing could partially alleviate apoptosis and induce autophagy. Overexpression of VDR restricted the K48-polyubiquitin chain-dependent inhibitor of κB (IκB) ubiquitination and apoptosis-associated speck-like protein containing CARD (ASC) oligomerization. Besides, VDR silencing resulted in increase of ASC speck formation. In further mechanistic studies, we showed that VDR can directly bind to IκB and IKK1 in vitro and in vivo. In the feeding trial, H&E staining, TUNEL, and electron microscope results showed that vitamin D3 deficiency (0IU/kg) could recruit more basophilic cells and increase more TUNEL-positive apoptotic cells and lipid droplets (LDs) than vitamin D3 supplement (1000IU/kg and 5000IU/kg). In summary, abalone VDR plays a negative regulator role in NF-κB-mediated inflammation via interacting with IκB and inhibiting ubiquitin-dependent degradation of IκB. Vitamin D3 in combination with VDR is essential to establish a delicate balance between autophagy and apoptosis in response to inflammation.

Evaluation of High Dose Preoperative Activated Vitamin D to Prevent Post Total Thyroidectomy Hypocalcemia

Abstract Background With increase in the number of thyroidectomies, the incidence of postoperative hypocalcemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcemia may be (i) easy to estimate (ii) any deficiency can be easily corrected. Objective To determine the effectiveness of preoperative high dose calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Patients and Methods to assess the effect of preoperative vitamin D3 deficiency on post thyroidectomy hypocalcemia. For that purpose, 40 Egyptian patients for whom total thyroidectomy was performed in general surgery department at El-demerdash and Ain Shams University Specialized Hospital form March 2020 to September 2020. Patients were divided into 2 Groups; Group 1 included patients receiving preoperative single oral dose of active vit D(300000 IU) and Group 2 included patients receiving placebo instead of vit D. The incidence of postoperative hypocalcemia was investigated in all patients. Results Preoperative vitamin D measurements revealed a deficiency prevalence of 66.7% and a mean Vitamin D level of 17.09 ± 6.01. The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours and 72 hours. With respect to relation between calcium and preoperative vitamin D, the results showed that there is no big difference between two groups (hypocalcemia occurred in 30% from patients in vit D group and 35% in placebo group) and no patients with normal preoperative vitamin D had a postoperative hypocalcemia 24, 48 or 72 hours after the operation. Conclusion Giving of single preoperative high dose vitamin D doesn’t reduce the overall rate of hypocalcemia after total thyroidectomy. Postoperative hypocalcemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to develop hypocalcemia.

Comparative Study between Vitamin D and Placebo in Patients with Nasal Polyps

Background: Chronic rhino-sinusitis with nasal polyps [CRSwNP] is a prevalent disease that has an important influence on patient quality of life. Vitamin D3 [VD3] has been shown to suppress the proliferation of fibroblasts generated from nasal polyps.Aim of the work: The aim of this work is to evaluate the safety and efficacy of vitamin D3 in decreasing the severity and size of sino-nasal polyps in patients with vitamin D3 insufficiency.Methods: This study is a prospective cohort study conducted on 46 patients with chronic rhino-sinusitis with nasal polyps with vitamin D3 insufficiency [low levels of vitamin D3 < 30 ng/ml]. Included patients were divided into 2 groups, the first group were 22 patients given vitamin D3 [200,000 IU] intramuscular [IM], and the other control group included 20 patients were given placebo in the same manner as the first group. The two groups were assessed before vitamin D3 and placebo supplementation and after 3 months with endoscopic Meltzer grading score and CT scan.Results: Based on endoscopic Meltzer scores, there was improvement among 68.3% of vitamin D3 group vs. 20% of the placebo group; the severity of sino-nasal polyps was observed to be considerably reduced in vitamin D3 group in comparison to placebo group. CT finding reported 40.9% of vitamin D3 group improved vs. 10% of placebo group], the improvement of CT was changing of the affected sinuses from complete to partial opacification.Conclusion: Vitamin D3 has an effective way in lowering the severity of nasal polyps and alleviating their manifestations.

Frequency of Vitamin D deficiency in liver cirrhosis and its correlation with Child Pugh Score

Objective: To determine the frequency of vitamin D deficiency in patients with liver cirrhosis and the relationship of vitamin D deficiency with Child Pugh Class in patients with cirrhosis. Materials and Methods: Vitamin D and calcium levels were checked in patients with cirrhosis of liver aged 18 to 80 years admitted in Gastroenterology department of Lahore General Hospital. Investigations were also done to calculate Child Pugh (CTP) score and Child Class was assigned on the basis of score. Quantitative variables were expressed in terms of mean and standard deviation. Frequency and percentage were used for qualitative measures. The p-value was calculated by the contingency coefficient to find a relationship of vitamin D levels to CTP scores of liver cirrhosis. Data was analyzed using SPSS 24 Study Duration: The study was carried out from December 2019 to October 2020 Results: A total of 170 patients with mean age of 43.82 ± 9.72 (19-61) years were evaluated of which 144 (84.7%) were males, 26 (15.3%) were females. Vitamin D3 deficiency was found in 144/170 (84.7%) patients while insufficiency was found in 14/170(8.2 %). It was more common in male patients (86.1%) compared to female patients (76.9%). Mean vitamin D3 levels was 14.4 ± 9.4 ng/ ml. Patients with Child A cirrhosis 6/10 (60%) had deficiency, with child B 66/82 (80.5%) while with Child C 72/78 (92.3%) had deficiency of Vitamin D3. Conclusion: Vitamin D deficiency is common in patients with cirrhosis and level has decreased stepwise with higher Child Pugh Class. Keywords: Cirrhosis, Vitamin D, Child Pugh score

Low serum 1,25(OH)2D3 in end-stage renal disease: is reduced 1α-hydroxylase the only problem?

Low serum 1,25-dihydroxyvitamin D (1,25(OH)2D) in end-stage renal disease (ESRD) is considered a consequence of elevated fibroblast growth factor 23 (FGF23) and concomitant reduced activity of renal 1α-hydroxylase (CYP27B1). Current ESRD treatment strategies to increase serum calcium and suppress secondary hyperparathyroidism involve supplementation with vitamin D analogues that circumvent 1α-hydroxylase. This overlooks the potential importance of 25-hydroxyvitamin D (25(OH)D) deficiency as a contributor to low serum 1,25(OH)2D. We investigated the effects of vitamin D (cholecalciferol) supplementation (40,000 IU for 12 weeks and maintenance dose of 20,000 IU fortnightly), on multiple serum vitamin D metabolites (25(OH)D, 1,25(OH)2D3 and 24,25(OH)2D3) in 55 haemodialysis patients. Baseline and 12 month data were compared using related-samples Wilcoxon signed rank test. All patients remained on active vitamin D analogues as part of routine ESRD care. 1,25(OH)2D3 levels were low at baseline (normal range: 60–120 pmol/L). Cholecalciferol supplementation normalised both serum 25(OH)D and 1,25(OH)2D3. Median serum 25(OH)D increased from 35.1 nmol/L (IQR: 23.0–47.5 nmol/L) to 119.9 nmol/L (IQR: 99.5–143.3 nmol/L) (P < 0.001). Median serum 1,25(OH)2D3 and 24,25(OH)2D3 increased from 48.3 pmol/L (IQR: 35.9–57.9 pmol/L) and 3.8 nmol/L (IQR: 2.3–6.0 nmol/L) to 96.2 pmol/L (IQR: 77.1–130.6 pmol/L) and 12.3 nmol/L (IQR: 9–16.4 nmol/L), respectively (P < 0.001). A non-significant reduction in daily active vitamin D analogue dose occurred, 0.94 µmcg at baseline to 0.77 µmcg at 12 months (P = 0.73). The ability to synthesise 1,25(OH)2D3 in ESRD is maintained but is substrate dependent, and serum 25(OH)D was a limiting factor at baseline. Therefore, 1,25(OH)2D3 deficiency in ESRD is partly a consequence of 25(OH)D deficiency, rather than solely due to reduced 1α-hydroxylase activity as suggested by current treatment strategies.

Effect of obesity on immune response against covid-19

Background and Aim: In Wuhan, Hubei Province, China, a new coronavirus, now known as SARS-CoV-2, produced a series of acute atypical respiratory diseases in December 2019. A number of studies have investigated for risk factors in attempt to provide prevention and treatmentoptions for the general public. Obesity, along with other comorbidities such diabetes, hypertension, coronary artery disease, and heart failure, has been recognized as a risk factor for catastrophic outcomes in patients with COVID-19 infection. Thus, the present study aimed to determine the association between the incidence of COVID-19 infection and BMI according to the demographic data. Materials and Methods: This cross-sectional was conducted in the Iraq-Erbil city between 15th October 2020 to 5th of February 2021. Inclusion criteria were participants that tested positive for SARS-COVID-2. The patients classified according to their weight into 6 classes. The semi‐quantitative analysis of IgG and IgM anti‐SARS‐CoV‐2 antibodies was carried out for 200 enrolled participants by ELISA and also vitamin and ferritin level measured for the patients. Results: The incidence of COVID-19 infection was higher among male by 4% than female. The highest percentage of COVID19 infection reported among the age group of (30-39) years old. The prevalence of the mentioned infection was higher among class 1 obesity group. A total of 200 IgG and IgM tests revealed that the underweight and class 3 obese patients had the highest percentage of positive cases in IgG testing by (100 %) while the obese patient class 1 reported highest percentage of positive IgM cases (47.36 percent). Furthermore, the highest number of underweight people (100%) had vitamin D3 deficiency among patients and the highest percentage of iron deficiency anemia was among class 3 obese patients (25%). Conclusions: The present study concluded gender balance in COVID19 incidence. The infection of COVID-19 was found in all age groups. However, middle age group appears to be more susceptible. The highest IgG and IgM reported among obese patients. The highest number of underweight people had vitamin D3 deficiency. In contrast, the highest percentage of iron deficiency anemia was reported in class 3 obese patients Keywords: Age, Body Mass Index, COVID-19, Gender, Vitamin D.

Application of Ultraviolet Light for Poultry Production: A Review of Impacts on Behavior, Physiology, and Production

The application of ultraviolet (UV) light in poultry production is garnering increased interest with the drive toward improved poultry welfare and optimized production. Poultry can see in the UV spectrum (UVA wavelengths: 320–400 nm) thus inclusion of these shorter wavelengths may be viewed as more natural but are typically excluded in conventional artificial lights. Furthermore, UVB wavelengths (280–315) have physiological impact through stimulation of vitamin D pathways that can then improve skeletal health. However, better understanding of the effects of UV supplementation must occur before implementation practically. This non-systematic literature review aimed to summarize the impacts of UV supplementation on the behavior, welfare, and production of laying hens, meat chickens (breeders and growers), and other domestic poultry species including directions for future research. The literature demonstrated that UVA light has positive impacts on reducing fear and stress responses but in some research, it significantly increases feather pecking over age during the production phase. UVB light will significantly improve skeletal health, but an optimum duration of exposure is necessary to get this benefit. Supplementation with UVB light may have more distinct impacts on egg production and eggshell quality when hens are experiencing a dietary vitamin D3deficiency, or if they are at the terminal end of production. The relative benefits of UVB supplementation across different ages needs to be further verified along with commercial trials to confirm beneficial or detrimental impacts of adding UVA wavelengths. Further research is warranted to determine whether adding natural light wavelengths to indoor poultry production is indeed a positive step toward optimizing commercial housing systems.

Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis

BackgroundNo publications have reported on osteomalacia in patients receiving intermittent cyclical therapy with etidronate (a bisphosphonate) and undergoing long-term hemodialysis (HD).Case presentationWe report on a 46-year-old Japanese man admitted to our hospital for further examination of left forearm pain. Maintenance HD was started at age 24 years, and the man had been on HD since then. At age 38 years, surgical parathyroidectomy was performed for secondary hyperparathyroidism; iliac crest bone biopsy performed at the same time showed osteitis fibrosa. The active vitamin D3 preparation calcitriol was started, and intermittent cyclical etidronate therapy was introduced 2 years later for osteoporosis. At age 45 years, the patient stopped taking calcitriol because of hypercalcemia but continued with etidronate. At age 46 years, a pseudofracture with a Looser zone occurred in the left ulna, and left femur bone biopsy revealed osteomalacia. Etidronate was discontinued, and calcitriol was restarted; open reduction and internal fixation with an angular stability plate were performed. Union of the bone was achieved 10 months after the operation. At age 49 years, a lumber bone biopsy confirmed improved bone morphometry.ConclusionsWe believe that intermittent cyclical etidronate therapy without administration of active vitamin D3 during long-term HD might have induced osteomalacia, resulting in the ulna insufficiency fracture. Therefore, we propose that administration of active vitamin D3 is essential to prevent osteomalacia in patients on long-term HD who are receiving bisphosphonates and have potential vitamin D3 deficiency.

Delayed fracture union in a case of vitamin D dependent rickets associated with pulmonary tuberculosis - a case report

&lt;p&gt;Rickets is a defect of bone mineralization caused by vitamin D deficiency, seen most significantly at growth plates that result in radiological bony abnormalities like metaphyseal flaring and cupping, physeal widening with focal and generalised osteomalacia.&lt;strong&gt; &lt;/strong&gt;Here we present a rare case of 7 years old male, a case of vitamin D3 deficiency rickets in a known case of multi drug resistant pulmonary tuberculosis. The patient had suffered left proximal fibular fracture following trivial fall 1.5 month back and had delayed bony union leading to difficulty in walking and pain. The patient was treated with oral vitamin D supplementation. In vitamin D deficiency rickets, there is decreased bone mineralization leading to weak bones and delayed fracture healing in children. Low serum vitamin D levels also caused decreased immunity with increased susceptibility to respiratory infections like pulmonary tuberculosis. Appropriate treatment with injectable or oral vitamin D3 with adequate exposure of sunlight and proper nutrition is the best modality of treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Risk factors of osteoporosis in soldiers of the Armed Forces: A cross-sectional study from Western India

BackgroundOsteoporosis may result from risk factors such as smoking, alcohol, low body mass index, less physical exercise, and dietary calcium deficiency. The risk of osteoporosis fractures can be reduced with lifestyle changes, which include diet, exercise, and preventing falls. The present study is an effort to measure the burden of risk factors of osteoporosis in adult male soldiers in the Armed Forces. MethodsThe present study was a cross-sectional study among serving soldiers in South-Western part of India, and 400 participants consented to be included in the study. After obtaining informed consent, the questionnaire was distributed. Venous blood samples were collected to measure serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH). ResultsThe prevalence of vitamin D3 severe deficiency (<10 ng/mL) was 38.5%, and the prevalence of vitamin D3 deficiency (10–19 ng/mL) was 33%. Low serum calcium (<8.4 mg/dL) and serum phosphorus (<2.5 mg/dL) were found among 19.5% and 11.5%, respectively, whereas a raised serum PTH level (>66.5 pg/mL) was seen in 5.5% of the participants. A statistically significant association was found between consumption of milk and milk products and levels of calcium. With a cutoff value of 20 ng/mL for vitamin D3 deficiency, a statistically significant association was found for consumption of fish, physical activity, and sun exposure. ConclusionA remarkably large percentage of otherwise normal healthy soldiers have deficiency or insufficiency of vitamin D and might be prone to osteoporosis. Despite significant advances in our understanding and management options for male osteoporosis, there still remain important gaps in knowledge which needs to be looked into.

Relative contribution of vitamin D deficiency to subclinical atherosclerosis in Indian context: Preliminary findings.

Asian Indians have a genetic predisposition to atherothrombotic risk. common carotid intima-media thickness (CCIMT) measured by ultrasound is a quantitative marker for atherosclerotic burden and a derived variable, that is, “CCIMT statistical Z-score (Z-score)” is useful for better quantification. The association between vitamin D deficiency and atherosclerosis is inconclusive. Since, vitamin D deficiency is highly prevalent in India, there is a need to study its relative contribution to subclinical atherosclerotic burden.This prospective cross-sectional study (n = 117) in apparently healthy individuals aged 20 to 60 years sought to identify the determinants of CCIMT Z score with CCIMT measured by “echo-tracking” method. A multivariable linear regression analysis was done with CCIMT Z score as dependent variable and the following as independent variables: age, body mass index, waist-to-height ratio, total cholesterol to HDL ratio (TC-HDL ratio), serum vitamin D3 levels (ng/mL), sex, diabetes mellitus, current cigarette smoking status. A diagnostic prediction model was also developed with a threshold value of 1.96 for CCIMT Z score.The mean (SD) for calendar age (y) was 40 (8). There were 26 (22.22%) individuals in sample with CCIMT Z score ≥1.96 (advanced stage) of whom 14 (23.33%) were <40 y (n = 60). The mean score was 1.28 (90th percentile) in the entire sample. Vitamin D3 deficiency with a mean (SD) blood level (ng/mL) of 14.3 (6.4) was noted and prevalence of deficiency was 81%. The final model wasCCIMT Z-score = 0.80 + (0.841 × current smoking = 1) + (0.156 × TC-HDL ratio) – (0.0263 × vitamin D3 blood level in ng/mL).The decreasing order of association is smoking, TC-HDL ratio, and vitamin D3. With the model, likelihood ratio (95% CIs) was better for positive test 3.5 (1.23–9.94) than that for a negative test 0.83 (0.66–1.02).Internal validation with Bootstrap resampling revealed stability of baseline diagnostic variables.There is substantial subclinical atherosclerotic burden in Indian setting with independent contribution by vitamin D deficiency. The model is valuable in “ruling-in” of the underlying advanced atherosclerosis. The study is limited by convenient sampling and lack of external validation of the model.

Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study.

Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion, and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure undergoing CRRT, by performing periodic PTH measurements in the acute phase of critical illness. This was a single-centre, prospective, observational study conducted in an mixed, university-affiliated intensive care unit. Critically ill patients who fulfilled all of the following criteria were included: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; and sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dL; total ionized calcium plasma level > 1.35 mmol/L); parathyroid gland disease; end-stage renal disease; patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures; aged under 18 years; pregnant; and life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator. Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p = 0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5-8 relative to measurement 1, and measurements 4-8 relative to measurement 2 (p < 0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score, and PTH levels were observed. A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p < 0.05). The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. A probable reason for this is the existence of the inflammatory state triggered by sepsis.

O-151 Detailed characterization of infertile men with idiopathic versus unexplained infertility: a single-center experience

Abstract Study question We aimed to investigate the rate of and the clinical characteristics of men with idiopathic versus unexplained infertility from a cohort of white-European men. Summary answer Approximately 20% and 5% of men evaluated for primary couple’s infertility depicted characteristics suggestive for idiopathic and unexplained infertility, respectively. What is known already Male factor infertility (MFI) can be associated with clinical, hormonal and genetic diseases, but MFI is idiopathic in almost 30% of cases. Study design, size, duration Data from 3098 infertile men (according to WHO definition) consecutively evaluated between 2003-2020 at a single academic centre were analysed and compared with those of 103 fertile controls. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Idiopathic infertility was defined for pathological semen analysis but normal physical examination and endocrine, genetic and biochemical laboratory testing. Unexplained infertility is defined as infertility of unknown origin with normal sperm parameters. Participants/materials, setting, methods Testicular volume (TV) was assessed with a Prader’s orchidometer. Serum hormones and sperm DNA fragmentation index (SDF) were measured in every patient. Vitamin D3 (VitD) deficiency was considered for vitD levels &amp;lt;20 ng/mL. Semen analyses were based on the 2010 WHO reference criteria. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Main results and the role of chance Overall, 570 (18.5%) and 154 (5.0%) patients depicted criteria suggestive for either idiopathic or unexplained primary infertility, respectively. Groups were similar in terms of age, BMI, CCI, recreational habits, circulating serum hormones and SDF. Testicular volume was lower in men with idiopathic vs. unexplained infertility [median (IQR) 20 (15-25) vs. 20 (17-25); p &amp;lt; 0.001]; more idiopathic than unexplained infertile men depicted TV &amp;lt; 15ml (23.4% vs. 12%; p &amp;lt; 0.01). Similarly, vitD levels were lower [22 (17-28) vs. 27 (21-42) ng/mL; p &amp;lt; 0.001] in idiopathic vs. unexplained infertile men, with a higher rate of pathologic VitD levels in the same group (42.1% vs. 10%; p = 0.04). When compared to fertile controls, groups were similar in terms of age, BMI, CCI and serum hormones values. TV was larger in fertile controls than idiopathic and unexplained infertile men (all p &amp;lt; 0.01). At multivariable logistic regression analysis only vitD deficiency (OR 8.1, p = 0.03) was found to be associated with idiopathic infertility after accounting for age, BMI, testosterone values and TV. Limitations, reasons for caution The small number of fertile controls may raise the possibility of biases. Wider implications of the findings Idiopathic and unexplained infertility were identified in approximately 20% and 5% of men evaluated, respectively. Idiopathic infertile men showed lower TV and lower vitD values compared to men with unexplained infertility. Future studies are needed to develop a more tailored management to these difficult MFI cases. Trial registration number .

Relationship of vitamin D3 deficiency and chronic rhinosinusitis with nasal and sinus polyposis in patients referring to the Department of Ear, Nose, and Throat Diseases Department of Vali-asr Hospital in Brigand, Iran

Introduction: Chronic rhinosinusitis may require referral to an ear, nose, and throat specialist for possible endoscopic sinus surgery if medical management fails. Vitamin D is one of the essential vitamins for the body that is effective in inflammatory processes. Therefore, it seems necessary to confirm the association between the deficiency of this vitamin and the occurrence of chronic rhinosinusitis with nasal polyposis. This study aimed to determine the relationship of vitamin D3 deficiency and chronic rhinosinusitis with nasal and sinus polyposis in patients referring to the Otorhinolaryngology Department of Valiasr Hospital, Birjand, Iran, in 2017. Methods: A case-control study was performed on individuals, including a group of patients with rhinosinusitis and a control group (n=20 each), referring to the Department of Ear, Nose, and Throat Diseases Department of Vali-asr Hospital. Among patients diagnosed with chronic rhinosinusitis, the cases that had polyps on endoscopic examination were included in the study. After completing the consent form, venous blood samples (10cc) were collected from the patients in fasting conditions. The electrochemical luminescence method was used for measuring the level of serum vitamin D. A questionnaire containing demographic information and clinical findings was completed by reviewing the patients' records. Data analysis was performed in SPSS software (Version. 22)using Chi-square and Mann-Whitney U-tests. Results: The mean and median scores of vitamin D level were obtained at14.13±12.99 and 10.25 in the case group, and 18.72±9.29 and 18.77 in the control group, respectively. The level of vitamin D was significantly higher in the control group than in the chronic group (P=0.04). In the case group, 16 (80%) patients lacked vitamin D and 3 patients had an insufficient level of vitamin D. In the control group, 13 (65%) patients lacked vitamin D and 4 cases had an insufficient level of vitamin D. There was no significant difference in vitamin D levels between the two groups (P=0.61). No significant difference was observed between the two clinical symptoms. Conclusion: It was revealed that the lack of vitamin D was likely to be an effective factor in the rhinosinusitis disease; therefore, proceedings need to be taken to cure the deficiency of this vitamin.

Serum vitamin D3 levels in pregnant women with preeclampsia at third trimester of pregnancy

Background: Preeclampsia (PE) is a pregnancy-specific condition, characterized by high blood pressure and proteinuria after 20 weeks of gestation. One of the hypotheses concerning the etiology of PE is vitamin D3 deficiency during pregnancy. Vitamin D3 is especially important during pregnancy as low maternal vitamin D3 stores may contribute to problems like low birth weight as well as an increased risk of maternal comorbidities. Objectives: To evaluate serum vitamin D3 levels and how they can be affected by the severity of PE at the third trimester of pregnancy. Methods: This case-control study included a total of 71 pregnant women at the third trimester of pregnancy (41 with PE and 30 without PE as controls). Vitamin D3 serum level was measured by enzyme-linked immune-sorbent assay (ELISA). Results: The study’s findings showed no significant difference in serum vitamin D3 level (p&gt;0.05) between controls (14.41±1.41ng/ml) and PE patients (14.32±1.00). As well, subgroup analysis revealed non-considerable changes between mild PE cases (15.92±1.73 ng/ml) and severe ones (13.07±1.09 ng/ml). Conclusions: PE and its severity may have no significant effect on serum vitamin D3 levels of pregnant women at the third trimester of pregnancy.

Pleiotropic effects of vitamin D3

Introduction: Vitamin D belongs to the group of fat-soluble vitamins. cholecalciferol (D3) and ergocalciferol (D2) are the most important forms. Vitamin D is associated with a regulatory role in calcium and phosphate metabolism. In recent years, there has been attention to its pleiotropic action. Aim: The aim of the study was to present the general characteristics of vitamin D and explore its relation with polycystic ovary syndrome (PCOS), endometriosis, pain management, insulin resistance, influenza and chronic kidney disease (CKD).Description: VDR receptor has been detected in the cells of the intestines, bones, kidneys, heart, brain, prostate, breast, ovaries, skin. In the ovaries, vit. D3 affects the production of progesterone, estradiol or estrone which suggest its important role in the folliculogenesis and ovulation. Women with PCOS have significantly lower levels of vitamin D3 compared to healthy women. It has been suggested that the deficiency of this vitamin may be related to infertility. Research show that vit. D3 may affect the mechanisms of the inflammatory and nocyceptive pain perception. A significant connection has also been found between vit. D3 and the metabolism of the adipose tissue and insulin secretion. Vitamin D3 deficiency may increase the risk of development of obesity and insulin resistance as well as CKD.Summary: The observation of statistically significant correlation between the reduced level of vit. D3 and occurrence of numerous diseases indicates the need for further research to explain the mechanisms in which D3 deficiency may contribute to development of these diseases. This knowledge is important for the development of new prevention and treatment methods of the diseases mentioned in this article.