Manifestations Of Vitamin Research Articles

Поздняя витамин-K-зависимая коагулопатия у пациента с гемофилией A: описание клинического наблюдения

Late-onset Vitamin K deficiency bleeding is a rare disease that develops as a manifestation of Vitamin K deficiency in children from 8 days to 6 months of age with an incidence of 4.4 to 72 cases per 100,000 newborns in countries where prophylaxis with Vitamin K1 preparations is not carried out and of 0 to 3 cases per 100,000 in countries where prophylaxis is carried out. In Russia the prophylaxis is carried out using menadione sodium bisulfite, a Vitamin K3 preparation, the effectiveness of which is questionable. One of the specific manifestations of the late-onset Vitamin K deficiency bleeding is intracranial hemorrhage (ICH), which occurs in more than half of all cases of the disease. This disease has not been described in patients with hemophilia A until now. Authors represent a clinical case report of the development of the late-onset Vitamin K deficiency bleeding by a massive ICH in a patient with hemophilia A.

Alternations in serum vitamin D, calcium, phosphorus and lipid profile levels in newly diagnosed type 2 diabetic patients of North-West India

Introduction and Aim: Thirty-two million Indians are suffering with diabetes mellitus worldwide and predicted that this number of diabetes to be increased to 80 million by 2030. Many reports revealed a positive relationship between diabetic patients suffering with 25 (OH) D deficiency. In developing nations like India 60% adults were found showing manifestations of vitamin D deficiency and dyslipidemia, a well-known risk factor for the development of diabetes mellitus. Therefore, we designed the study to evaluate alterations in vitamin D, calcium, and phosphorus along with complete lipid profile levels in newly diagnosed type 2 diabetic patients in North-West Indians.Materials and Methods: One hundred fifty newly diagnosed type 2 diabetic patients and equal number of healthy control subjects of both genders were recruited in the study. 5ml of blood was collected by venipuncture after 12-14 hours fasting in plain and potassium oxalate: sodium fluoride vial. Serum and plasma were separated and used for the determination of 25(OH) D levels, calcium, phosphorus and complete lipid profile levels.Results: A significantly (p < 0.001) high level of glucose was observed in newly diagnosed type 2 diabetics subjects while a significant fall (p < 0.001) was recorded in vitamin D levels in newly diagnosed type 2 diabetics in comparison to healthy control subjects. The nominal changes were seen in calcium and phosphorus levels in newly diagnosed type 2 diabetics with respect to healthy control subjects. Statistically significant increase was found in total cholesterol (p < 0.05), triglyceride (p < 0.001) and VLDL-cholesterol (p < 0.001) levels while no significant changes was observed in LDL- cholesterol and HDL- cholesterol levels in newly diagnosed type 2 diabetics with respect to healthy subjects.Conclusion: Aforementioned observations suggested that a significant decrease in vitamin D levels was associated with increased glucose and lipid levels like total cholesterol, triglycerides and VLDL-cholesterol levels could be responsible for the initiation of various diseases like diabetes mellitus, cardiovascular diseases, osteoporosis etc. Hence, new interventions should be included as a part of treatment to reduce the risk of type-2 diabetics and CVDs like atherosclerosis

Vitamin K deficiency-induced spontaneous haemopericardium and cardiac tamponade in an infant with alpha-1 antitrypsin deficiency: a case report.

Background Vitamin K deficiency bleeding is a life-threatening complication in early infancy. Exclusive breastfeeding and neonatal cholestasis syndromes, most notable α-1-antitrypsin deficiency, have been reported to be risk factors. Intracranial haemorrhage is most common. No association to haemopericardium has been reported before.Case summary We report on an 11 weeks old at term-born infant, who presented with severe anaemia and signs of cardiogenic shock. Immediately echocardiography was done and depicted cardiac tamponade. Pericardiocentesis was performed and a significant amount of haemorrhagic fluid was removed. Further workup revealed deranged coagulation parameters, cholestatic liver disease, and reduced α-1-antitrypsin levels. Despite normal brain sonography, a small cerebral haemorrhage was detected on magnetic resonance imaging. A genetic test finally proofed homozygotic mutation of the SERPINA1-gene and confirmed the diagnosis of α-1-antitrypsin deficiency as the underlaying cause. After initial replacement of coagulation factors, erythrocytes and vitamin K, the infant recovered. Eighteen weeks after discharge, the infant is still on vitamin K supplementation. She did not have any further bleedings and no neurologic or developmental impairment.Discussion Alpha-1-antitrypsin deficiency can lead to vitamin K deficiency in young infants even with adequate prophylaxis. Spontaneous haemorrhagic pericardial effusion was a new manifestation of vitamin K deficiency bleeding in our patient and should be considered and ruled out in young infants who present with acute anaemia and poor clinical condition.

Vitamin D3 metabolite ratio as an indicator of vitamin D status and its association with diabetes complications

BackgroundVitamin D deficiency is diagnosed by total serum 25-hydroxyvitamin D (25(OH)D) concentration and is associated with poor health and increased mortality; however, some populations have low 25(OH) D concentrations without manifestations of vitamin D deficiency. The Vitamin D Metabolite Ratio (VMR) has been suggested as a superior indicator of vitamin D status. Therefore, VMR was determined in a population with type 2 diabetes at high risk for vitamin D deficiency and correlated with diabetic complications.Research design and methodsFour hundred sisty patients with type 2 diabetes (T2D) were recruited, all were vitamin D3 supplement naive. Plasma concentration of 25-hydroxyvitamin D3 (25(OH)D3) and its metabolites 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3) and its epimer, 3-epi-25-hydroxyvitamin D3 (3-epi-25(OH)D3), were measured by LC-MS/MS analysis. VMR-1 was calculated as a ratio of 24,25(OH)2D3:25(OH)D3; VMR-2 as a ratio of 1,25(OH)2D3:25(OH)D3; VMR-3 was calculated as a ratio of 3-epi-25(OH)D3: 25(OH)D3.ResultsAn association means that there were significant differences between the ratios found for those with versus those without the various diabetic complications studied. VMR-1 was associated with diabetic retinopathy (p = 0.001) and peripheral artery disease (p = 0.012); VMR-2 associated with hypertension (p < 0.001), dyslipidemia (p < 0.001), diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.001), coronary artery disease (p = 0.001) and stroke (p < 0.05). VMR-3 associated with hypertension (p < 0.05), dyslipidemia (p < 0.001) and coronary artery disease (p < 0.05).ConclusionsIn this cross sectional study, whilst not causal, VMR-2 was shown to be the superior predictor of diabetic and cardiovascular complications though not demonstrative of causality in this cross-sectional study population over VMR-1, VMR-3 and the individual vitamin D concentration measurements; VMR-2 associated with both microvascular and cardiovascular indices and therefore may have utility in predicting the development of diabetic complications.

Temporal association between serious bleeding and immunization: vitamin K deficiency as main causative factor

BackgroundBleeding as an adverse event following immunization (AEFI) that is rarely reported in children, although it can be a parental concern. Bleeding episodes ranging in severity from mild to severe and defined as any external and/or internal bleeding can be caused by acquired or hereditary disorders. This study analyzes whether bleeding episodes in children that were recorded as AEFIs are causally associated with immunization and elaborates their etiology.MethodsA cross-sectional study of 388 AEFI cases in children from West Java Provincial Committee in Indonesia confirmed by case findings from 2000 until 2017.ResultsOf the total number of cases studied, 55 (14%) involved children aged 5 days to 12 years who presented with bleeding and were referred to a provincial hospital. Analysis revealed that 32 cases were most likely caused by acquired prothrombin complex deficiency (APCD) and 30 of these APCD cases were strongly suspected to be manifestations of vitamin K deficiency bleeding (VKDB). All VKDB subjects were aged 5 days to 3 months without a history of administration of prophylactic vitamin K. When a World Health Organization classification was used, most bleeding cases in this study became coincidental events with a temporal association with immunization. A causality assessment suggested that these cases were causally unrelated.ConclusionMost cases of bleeding reported as an AEFI were found to be VKDB, which is considered a coincidental event following immunization with a temporal association, and an unrelated category based on the results of a causality assessment. Vitamin K should be administered to all newborns as a prophylactic and AEFI surveillance should be improved based on the low numbers of AEFI reported in Indonesia.

Efficacy of Vitamin D3 versus Vitamin D2 in deficient and insufficient patients: An open-label, randomized controlled trial

Background: Vitamin D deficiency is very common worldwide but highly prevalent in the Gulf region. The clinical manifestations of Vitamin D deficiency vary depending on the severity and duration of the deficiency. Effective treatment should correct the vitamin D levels and improve other metabolic markers. Objectives: We aimed to (1) compare the efficacy of Vitamin D3 and Vitamin D2 in terms of raising serum 25(OH) total Vitamin D levels, (2) evaluate the time of its attainment, and (3) demonstrate the effect of replacement with either preparation on serum markers of bone or calcium metabolism. Patients and Methods: We conducted a randomized controlled study involving 250 adults with Vitamin D deficiency or insufficiency, assigned into 1:1 ratio to receive weekly capsules of either 50,000 IU of D2 or 50,000 IU of D3 for up to 12 weeks. Serum total Vitamin D level, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels were measured at 0, 8, and 12 weeks. Analysis of variance and nonparametric test Kruskal–Wallis were used for the comparison of quantitative values and the Chi-square test for comparison of categorical variables. Results: After 8 weeks of treatment, the improvement in Vitamin D level was greater for patients in the D3 group (mean = 18.74, standard error [SE] = 1.08) than that for D2 group (mean = 5.88, SE = 0.65), F (1, 240) = 113.840; P &lt; 0.0005. Similarly after 12 weeks, the improvement in Vitamin D levels was greater for those in the D3 group (mean = 20.76, SE = 1.14) than that for the D2 group (mean = 7.93, SE = 0.79), F (1, 224) = 90.78; P &lt; 0.0005. At 12 weeks, serum calcium, phosphorus, alkaline phosphatase, and PTH levels were not significantly different between the D3 and D2 treatment groups. Conclusions: Vitamin D3 is more efficacious and faster in increasing the level of total Vitamin D than Vitamin D2. However, no significant differences were evident on calcium, phosphorus, alkaline phosphatase, or PTH levels between groups.

Immune Manifestations of Vitamin D Receptor Gene Polymorphism in Children with Allergic Diseases

Immune Manifestations of Vitamin D Receptor Gene Polymorphism in Children with Allergic Diseases

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 A deficiency in chronic kidney disease patients attending a tertiary care hospital

Background: Patients with Chronic kidney Disease are at the risk of developing a deficiency or excess of one or more micronutrients because of inadequate intake, interference of micronutrient absorption either by drug or uremic toxins, altered metabolism or loss or gain during dialysis. This aspect has been poorly explored as far as Vitamin A status is concerned. Objectives: · To find out the extent of Vitamin A deficiency in Chronic kidney Disease patients. · To pinpoint the role of diet in the occurrence of vitamin A deficiency in Chronic kidney Disease patients. Setting: A Tertiary Care Hospital setup in Northern India. Subjects: One hundred and seventy five incident cases of Chronic kidney Disease. Results: Fifty eight (33.14%) subjects had manifestations of vitamin A deficiency. Average vitamin A intake (IU/day) was 944.058±1824.7 which was 39.4% of recommended dietary allowance (RDA). Vitamin A intake of CKD subjects in stage III (1766.0±26.60) was significantly more than those with CKD stage IV (891.84±18.14) and stage V (491.70±860.47). All CKD patients with manifestations of vitamin A deficiency had vitamin A intake less than RDA. Extent of night blindness in subjects belonging to socioeconomic status (SES) very low plus low, lower middle, middle, upper middle and high were 30.30% 28.00%, 25.00%, 12.9% and 9.1%, respectively. Conclusion: Vitamin A deficiency is high in CKD patients primarily due to dietary inadequacy of vitamin A. The findings of the study calls for more in-depth multicentre research to have insight in management of patients of CKD with vitamin A deficiency. Keywords: Chronic kidney disease, Retinol binding protein, Socioeconomic status, Vit

To study the masking effect of folic acid on Vitamin B12deficiency anemia

Background and Aim: A deficiency of either Vitamin B 12 or folate can lead to megaloblastic anemia. Folate and Vitamin B 12 metabolism is linked in transfer of a methyl group from N5-methyltetrahydrofolate to cobalamin. Methods: This was an observational study carried out among healthy adults (students and staff) of a medical college in rural Northwest India. Results: Despite the occurrence of suboptimal serum Vitamin B 12 in more than half of our healthy study population on one hand, we observed normal hematological variables such as hemoglobin or lack red blood cell macrocytosis (mean corpuscular volume > 100 fL) among participants as a rule. Folic acid deficiency usually coexists with that of Vitamin B 12 , and this has been reported by many studies in past. Strikingly, our study population had 16.98 ± 5.44 ng/ml as mean serum folic acid which was toward higher side of normal range. This sufficiency of folic acid in the group having suboptimal Vitamin B 12 might have masked the manifestations of Vitamin B 12 deficiency. Conclusion: The sufficiency of folic acid in the study group might have masked the overt manifestations of Vitamin B 12 deficiency.

Promoting vitamin D uptake in infants and children

Despite it being thought of as a disease of the past, children in the UK, particularly those from high-risk groups, are at risk of rickets. The latest National Diet and Nutrition Survey estimated that 7.5% of 1½–3-year-olds were deficient in vitamin D ( Bates et al, 2014 ). Vitamin D deficiency presents with skeletal and non-skeletal manifestations. With the sun being the main source of vitamin D, there is a reliance on supplementation across most of the UK. This article looks at manifestations of vitamin D deficiency, the identification of at-risk groups and recommendations for supplementation.

24,25-Dihydroxyvitamin d3 and vitamin D status of community-dwelling black and white Americans.

24,25-Dihydroxyvitamin D [24,25(OH)2D] is a metabolite of 25-hydroxyvitamin D (25D). Blacks frequently have low total 25D without manifestations of vitamin D deficiency, suggesting that total serum 25D may incorrectly reflect vitamin D status in different racial groups. The ratio of serum 24,25(OH)2D to 25D [vitamin D metabolite ratio (VMR)] represents a new candidate biomarker for vitamin D status. We measured 24,25(OH)2D3 and 25D3 by mass spectrometry in a random community cohort of black (n = 212) and white (n = 164) Americans to evaluate VMR as a marker for vitamin D status. We measured parathyroid hormone concentrations by immunoassay to compare VMR and 25D3 against a physiological indicator of vitamin D deficiency. Serum 24,25(OH)2D3 strongly correlated with 25D3 in both black and white study participants (r = 0.90, P < 0.001 and r = 0.86, P < 0.001 respectively). Blacks had lower mean 25D3 than whites [17.0 (7.8) vs 27.5 (11.3) ng/mL; 42.4 (19.5) vs 68.6 (28.2) nmol/L, P < 0.001] and lower mean 24,25(OH)2D3 [2.1 (1.3) vs 3.6 (2.0) ng/mL; 5.1 (3.1) vs 8.7 (4.8) nmol/L, P < 0.001]. In contrast to total 25D3 concentrations, mean VMR values were similar in blacks and whites [11.9 (4.0) vs 12.5 (3.4), P = 0.16, respectively] and were negatively correlated with parathyroid hormone concentrations in both races (rs = -0.26, P < 0.001, and rs = -0.25, P < 0.001, respectively). Our results provide further evidence that measurement of total 25D for assessment of vitamin D status in patients of African descent deserves reevaluation and suggest that alternative measures such as VMR should be considered.

Incidence and characteristics of vitamin D deficiency rickets in New Zealand children: a prospective New Zealand paediatric surveillance unit study

Vitamin D deficiency rickets is the most significant manifestation of vitamin D deficiency in growing children. Concerns have been raised in New Zealand (NZ), and worldwide, that cases continue to present, and may be possibly increasing. We undertook a prospective study to investigate the incidence and characteristics of vitamin D deficiency rickets in NZ children. Prospective surveillance of Vitamin D Deficiency Rickets was conducted by the NZ Paediatric Surveillance Unit (NZPSU), for 36 months, from July 2010 – June 2013 inclusive. Inclusion criteria were: children aged <15 years with vitamin D deficiency rickets (defined by low 25-hydroxyvitamin D and elevated alkaline phosphatase levels, and/or radiological rickets). 58 children with confirmed vitamin D deficiency rickets were identified. Median age was 1.4 years (range 0.3 – 11), male gender 47%, 95% of children were born in NZ, as opposed to 22% of mothers. Overall annual incidence in those aged <15 years was 2.2/100,000, while incidence in the south of NZ peaked at 6.8/100,000. Overall NZ incidence in children aged <5 years was higher at 6.6/100,000. Skeletal abnormalities, poor growth and developmental delay were the most common presenting features, with hypocalcaemic convulsion in 16%. Key risk factors identified were: dark skin pigment, Indian/South Asian and African ethnicity, age ≤2 years, exclusive breast feeding, and southern latitude, particularly when combined with season (winter/spring). Vitamin D deficiency rickets remains a health problem for New Zealand children, with significant associated morbidity. Public health policy, utilising infant supplementation, for at minimum the above identified risk factors, should be considered to reduce the incidence of this disease among those at high risk.

Neurological manifestations of vitamin D deficiency, is there any significant clinical correlation?

Neurological manifestations of vitamin D deficiency, is there any significant clinical correlation?

The Prevalence of Vitamin D Deficiency in Ancient Egyptian Population from Baharia Oasis ,the Greco Roman Period

Background: Vitamin D deficiency is considered to be the most common nutritional deficiency and also one of the most common undiagnosed medical conditions in the world. Vitamin D is naturally present only in minor amounts in most foods; the great majority is synthesized by the action of ultraviolet light on chemical precursors in the skin. The manifestation of vitamin D deficiency in sub adults is referred to as rickets, and in adults, osteomalacia . Rickets and osteomalacia are the sub adult and adult expressions of a disease in which the underlying problem is a failure to mineralize bone protein (osteoid). The most common cause of this disease is a physiological deficiency in vitamin D. The associated problems include deformed bones. Material and Methods: This study aimed to investigate the skeletal remains of ancient Egyptians from Baharia Oasis population for lesions indicative of vitamin D deficiency (rickets and osteomalacia). The material consisted of 1075 commingled bones (38 sub adults and1037 adults). They were recovered from Baharia oasis. Results: The results showed that, there was no evidence of rickets in sub adult group. The prevalence of osteomalacia in adult Baharia populations was 7.4% ; all were adult males. This result could indicate that this population was subjected to sunlight all over the year and their diet was rich of calcium and phosphorus. Conclusion: These few cases that were found may be due to mechanical stress during wine and textile production.

Extraskeletal effects and manifestations of Vitamin D deficiency.

The actions of vitamin D are not confined to bone. Vitamin D receptors are present in nearly all the nuclei and its actions are manifold. Populations deficient in vitamin D are at higher risk of developing autoimmune diseases, diabetes, cancer, infections, allergies and other chronic illnesses.

Vitamin A deficiency: An eye sore

Vitamin A deficiency is a major cause of childhood mortality and morbidity in India and other developing countries. The ocular manifestations of vitamin A are collectively called xerophthalmia and range from conjunctival xerosis to severe blinding complications such as keratomalacia. Vitamin A deficiency exists as a major public health nutrition problem among preschool-aged children, especially in the South East Asian region, as well as among the pregnant and lactating women. Deficiency can be diagnosed by the ocular manifestations such as Bitot's spots, serum retinol levels, and conjunctival impression cytology (CIC). Improving vitamin A status in the diet or by periodic administration of vitamin A to children can reduce both mortality and blindness. This review is an attempt to highlight the ocular manifestations of vitamin A deficiency, its prevalence, treatment, and preventive strategies.

Hemothorax and Hematocele: Unusual Presentations of Vitamin K Deficiency Bleeding Disorder

Sir, Hemothorax and hematocele are rare manifestations of Vitamin K deficiency bleeding disorder in newborns; hematocele being hitherto unreported in English literature. An exclusively breastfed, 1-mo-old male infant presented with sudden onset respiratory distress associated with swelling of left scrotum. Examination revealed that the infant was in shock with severe pallor, tachycardia, tachypnea, reduced air entry and vocal resonance over right hemithorax with dull percussion note on the same side. Heart sounds were normal with no organomegaly. The left scrotal sac was enlarged with a mild bluish hue (Fig. 1); the swelling being irreducible. Investigations showed a negative septic screen with hemoglobin 5 g/dl and platelets 200,000/cumm. Chest radiograph showed homogenous opacity involving right hemithorax with mediastinal shift to the left. Needle thoracentesis revealed a bloody tap and 100 ml of blood was drained by a water-seal drainage tube. Ultrasonography of the scrotum confirmed the presence of hematocele in left testis. Prothrombin Time (PT) and activated Partial Thromboplastin time (aPTT) were markedly deranged. Fibrinogen levels were normal. A review of history revealed no history of maternal intake of any drugs antenatally and no bleeding diathesis in the family. The patient had not received vitamin K at birth. He was managed with oxygen, intravenous fluids, red cell transfusion and intravenous vitamin K. Symptoms resolved within hours. A repeat PT and aPTT after 8 h showed normalization of values. Considering the clinical picture of hemothorax and hematocele in an exclusively breast fed baby with normal septic screen, in the context of deranged aPTT and PT which normalized after administration of vitamin K, a diagnosis of Late onset Vitamin K Deficiency Bleeding (VKDB) of the newborn was made. VKDB is characterized by hemorrhagic manifestations with INR≥4 with normal platelet and fibrinogen level. Diagnosis is confirmed by rapid (within 2 h) normalization of coagulation V. Aggarwal :K. Mishra : B. Rath : S. Chaudhary : P. Kumar Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children’s Hospital, New Delhi, India

Protean Manifestations of Vitamin D Deficiency, Part 1

Just when vitamin deficiencies were thought to be a "thing of the past" a new vitamin deficiency-that of vitamin D has developed over the past 20 years. Vitamin D works like a hormone being produced primarily in one organ (the kidney) before circulating through the bloodstream to multiple organs where it has multiple effects. The increased prevalence of vitamin D deficiency is due to changes in modern lifestyle-mainly lack of exposure to sunlight and the increased prevalence of obesity that, results in sequestration of this fat-soluble vitamin in adipose tissue. Distance from the Equator and increasing age and skin pigmentation are additional risk factors. In pregnancy vitamin D deficiency can result in low birth weight, pre-term labor, pre-term birth, infections, and pre-eclamptic toxemia. While vitamin D deficiency is classically associated with rickets and osteomalacia, its effects are much more protean.

Chronic musculoskeletal pain in females as a manifestation of Vitamin D deficiency in Saudi Arabia

Chronic musculoskeletal pain in females as a manifestation of Vitamin D deficiency in Saudi Arabia