Use Of Cholecalciferol Research Articles

Hemodialysis Patients May Benefit from Cholecalciferol Treatment Targeting High Level of 25(OH)D.

(1) Background and Objectives: Vitamin D is implicated in the pathogenesis of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) in hemodialysis (HD) patients, including the development of secondary hyperparathyroidism (SHP). While cholecalciferol supplementation is recommended for vitamin D deficiency correction, its impact on CKD-MBD remains inconsistent. The aim of this observational prospective study was to assess the effect of cholecalciferol in achieving high-normal serum 25-hydroxycholecalciferol (25(OH)D > 75 ng/mL) levels and its impact on CKD-MBD biochemical markers, including 1,25-dihydroxycholecalciferol (1,25(OH)2D) and parathormone (PTH) in HD patients. The study also evaluated the maintenance dosage required to sustain 25(OH)D levels within the 50-75 ng/mL range. (2) Materials and Methods: A total of 22 HD patients with baseline 25(OH)D levels 30-50 ng/mL received cholecalciferol (70,000 IU/week) to achieve the target serum 25(OH)D > 75 ng/mL. Baseline data on calcium, phosphate, 1-84 PTH, 25(OH)D, and 1,25(OH)2D serum levels were compared with the data when 25(OH)D > 75 ng/mL was targeted or when the highest 25(OH)D levels were noted. (3) Results: Cholecalciferol significantly improved vitamin D status in HD patients, with 73% reaching the target 25(OH)D level >75 ng/mL in a median time of 7.5 weeks, with a median total dose of 525,000 IU. This was associated with a significant rise in 1,25(OH)2D, decrease in 1-84 PTH, and no significant effect on calcium and phosphate levels. The median maintenance dose of cholecalciferol was established at 30,000 IU/week. (4) Conclusions: The findings support the use of cholecalciferol targeting high normal 25(OH)D levels to improve biochemical markers of CKD-MBD in HD patients.

D-hypovitaminosis in menopausal disorders clinic: Correction possibilities

Introduction. The postmenopausal period being a significant part of a modern woman’s life. The persistence of menopausal disorders clinic can be combined with the hypovitaminosis D state, which, in turn, can further aggravate the existing symptoms. Vitamin D supplementation may be one of the pharmacological approaches to correct menopausal disorders.Aim. To evaluate the contribution of hypovitaminosis D to the clinic of menopausal disorders; to determine the clinical efficacy of using cholecalciferol in late postmenopausal residents of Yekaterinburg.Materials and methods. During the period from 2018 to 2021, 144 late postmenopausal patients from 56 to 79 years old living in Yekaterinburg and do not need outside help in everyday life took part. The following parameters of anthropometry, the severity of modified menopausal index (MMI), hospital anxiety and depression scales (HADS), Mini-Mental State Examination (MMSE), an assessment of serum 25(OH)D level (chemiluminescent immunoassay; Access 2, Beckman Coulter, USA) were studied. Clinical efficacy of cholecalciferol was evaluated in 68 patients in the prospective cohort study design. Micellated water-soluble form of cholecalciferol in standard doses recommended by the Russian Association of Endocrinologists (RAE) was used.Results. Vitamin D deficiency and insufficiency are associated with increased parameters of body weight (p = 0.048), waist circumference (p = 0.018) and hips (p = 0.016), increased cases of decreased performance (p = 0.046) and subclinical symptoms anxiety (p = 0.033). Supplementation of standard therapeutic and maintenance doses of cholecalciferol for 6 months contributed to a significant reduction in neurovegetative component of modified menopausal index in 54.4% of cases (p = 0.035) and improvement in cognitive function parameters in 50.0% of cases (p = 0.023) in late postmenopausal patients.Conclusions. The use of cholecalciferol in adequate doses can be considered as an important component of complex therapy for women in late postmenopausal period.

6539 Hungry Bone Syndrome & Osteoblastic Metastasis In The Setting Of Prostate Cancer : A Rare Cause Of Hypocalcemia

Abstract Disclosure: B. Sharma: None. M. Khan: None. A. Rao: None. P. Guido: None. Background: Hungry bone syndrome (HBS) is due to excessive calcium and phosphorus sequestration in the bone, manifesting as hypocalcemia and hypophosphatemia.It is most commonly seen as a postoperative complication of parathyroidectomy.Advanced prostate cancer with osseous metastasis has been previously described as is a rare cause of HBS. Clinical Case: A 65 year old male was admitted to the hospital with acute congestive heart failure and severe hypocalcemia.He exhibited symptoms of muscle spasms and perioral paraesthesias. Physical exam was positive for Trousseau's sign.Initial tests were consistent with severe hypocalcemia (corrected non-ionized calcium 6.8 [8.8-10.2] mg/dL), low ionized calcium (0.58 [1.10-1.30] mmol/L). Three weeks prior to admission, corrected non-ionized calcium was 9.8 mg/mL. Other labs showed normal magnesium, normal phosphorus, elevated alkaline phosphatase (1044 [45-117] U/L), low Vitamin D (12 [>30] ng/mL ), elevated iPTH (567 [19-88] pg/mL) and low PTH-rp (9 [11-20] pg/mL]. His electrocardiogram showed regular rate and rhythm with Qtc prolongation (497 ms).He had a significant oncological history of prostate cancer and multiple myeloma in remission.He was previously treated with zoledronic acid, discontinued 1 year prior to admission, for reducing skeletal complications while being treated for multiple myeloma. He had a recent workup with medical oncology for recurrence of prostate cancer due to elevated Prostate-specific antigen (380 [<4.00] ng/mL).Computed tomography imaging showed diffuse osteoblastic metastatic disease in the axial skeleton, pelvis and proximal femur. During hospital admission hypocalcemia was persistent, likely also due to concurrent furosemide use, necessitating the administration of intravenous calcium infusion and use of cholecalciferol and calcitriol.He was discharged on calcium carbonate 4500 mg twice a day, cholecalciferol 50 000 units weekly for 12 weeks and calcitriol 2 mcg twice a day. Conclusion: Hypocalcemia in the setting of prostate cancer is most commonly due to the use of bisphosphonates or Receptor activator of nuclear factor kappa-B ligand (RANK-L) inhibitors. Hypocalcemia in this case was due to sequestration of calcium in the bone by osteoblastic metastasis. This case illustrates the importance of recognising osteoblastic metastasis as a differential in protracted and severe hypocalcemia in malignancy.High doses of calcium, vitamin D, and calcitriol replacement are often needed as the hypocalcemia is usually severe and refractory with some cases requiring prolonged IV calcium infusion.Treatment of the underlying cancer and bone metastases with chemotherapy has been shown to improve hypocalcemia and reduce the requirement of calcium and vitamin D supplementation.There is limited data to suggest if bisphosphonates can be safely used in these cases for prevention of skeletal related events. Presentation: 6/1/2024

The morphological structure of prostate gland under the condition of experimental prostatopathy and after using of cholecalciferol in the different schemes of hypofertility correction

The impact of negative factors, stress, and modern living conditions damages men's health and leads to infertility. Prostatitis is often a cause of hypofertility. It is now shown that vitamin D may play a role in regulating the functioning of reproductive system organs. The aim of the study was to determine the effect of cholecalciferol on the histological structure of the prostate gland in rats with experimental prostatitis and after its application alone or in combination with a prostate protector. Experimental prostatitis was induced by cold intraoperative damage to the prostate gland. To correct prostatitis, vitamin D3 (cholecalciferol) was administered orally at a dose of 4000 IU. The prostate protector (Prostatilen, Pr) and its pharmaceutical composition, as well as vitamin D3, were administered rectally. Rats with modeled prostatitis were divided into groups: EP (cold experimental prostatitis without treatment); EP + seed oil (on the background of experimental prostatitis, animals received a solvent – apricot kernel oil); EP + vit D3 (per os) (on the background of experimental prostatitis, animals received vitamin D3); EP + Pr (rec) (on the background of experimental prostatitis, males were administered Prostatilen per rectum); EP + vit. D3 (per os) + Pr (rec) (on the background of experimental prostatitis, animals received vitamin D3 (per os) and Prostatilen gel (per rectum)); EP + (vit. D3 + Pr) (rec) (on the background of experimental prostatitis, rats were administered Prostatilen gel with vitamin D3 per rectum). Intact animals (Intact group) and sham-operated rats (Control group) were used as controls. Paraffin sections of the prostate gland were stained with hematoxylin, eosin, and Van Gieson's method. In addition to the review microscopy of the ventral lobes of the prostate gland and the isthmus between them, the power of histochemical reactions was measured, the severity of inflammation and fibrosis was assessed, the number of terminal sections of the prostatic glands with a visually unchanged state, with lumen expansion, and with wall destruction was counted, the longitudinal diameter of the acini and the height of the epithelial cells of the prostatic glands were measured. Statistical analysis of the results was performed using the standard software package "Statistica 6.0" with the use of Student's t-test and nonparametric analog of one-way analysis of variance – Kruskal-Wallis test, as well as Mann-Whitney test. It was found that rats with experimental prostatitis exhibit pronounced changes in the morphological structure of the prostate gland. The prostate-protective effect of vitamin D per os at a dose of 4000 IU was established, which reduced the manifestations of atrophic and destructive processes, signs of tissue inflammation, and coarsening of the prostate gland stroma. Signs of fibrosis development in the prostate gland in males of this group were reduced, and the number of destructive changes and the longitudinal diameter of the terminal sections of the prostatic glands of prostate ventral lobe in rats with experimental prostatitis were decreased. Thus, the addition of cholecalciferol to the basic therapy for infertility has a more pronounced corrective effect on the morphological structure of the prostate than the separate use of cholecalciferol and the prostate protector. Combining basic therapy with vitamin D enhances the prostate-protective properties of the latter and is promising for restoring reproductive function overall.

Features of supply and approaches to the use of vitamin D in children in the post-COVID period

Vitamin D is an important component of immune function, and deficiency in childhood is associated with an increased risk of acute respiratory viral infections. Purpose. To assess the dynamics of vitamin D supply in children after a new coronavirus infection with the use of cholecalciferol. Material and methods. We examined 55 children aged 0–17 years (10.0 [9.2; 10.6] years), 52.7 % boys with COVID-19, who received cholecalciferol in a dose of 1000 to 3000 IU for 30 days in depending on the concentration of 25(OH)D. After 30 days of taking vitamin D3, the levels of total vitamin D in the blood serum were re-determined. Results. The median 25(OH)D level in children with COVID-19 was 24.5 [23.9; 26.7] ng/ml. 34.5 % of children had vitamin D deficiency status (≤ 20 ng/ml), 32.7 % had insufficiency (21–30 ng/ml), a third of patients had normal vitamin D status (≥ 30 ng/ml). As a result of treatment with cholecalciferol, the number of children with hypovitaminosis D decreased by 2 times (35.4 %, p < 0.05), with an adequate level — doubled (65.5 %, p < 0.05). Depending on the level of 25(OH)D, no statistically significant differences were found in the severity of coronavirus infection (χ² = 0.872, p = 0.929). Conclusion. In 2/3 of cases, children infected with SARS-CoV-2 had hypovitaminosis D. Children under 6 years of age were more likely to have vitamin D insufficiency, while patients 7–17 years of age had a deficiency. The distribution of vitamin D levels did not differ depending on the severity of coronavirus infection. Doses of cholecalciferol taken for 30 days were sufficient to increase the concentration of vitamin D in the blood serum of children with deficiency but did not reach standard values in patients with vitamin D deficiency.

МАТЕМАТИЧЕСКАЯ МОДЕЛЬ ДЛЯ ПРОГНОЗИРОВАНИЯ СНИЖЕНИЯ РАСЧЕТНОЙ СКОРОСТИ КЛУБОЧКОВОЙ ФИЛЬТРАЦИИ ЧЕРЕЗ 12 МЕСЯЦЕВ ПОСЛЕ ПАРАТИРЕОИДЭКТОМИИ У ПАЦИЕНТОВ С ПЕРВИЧНЫМ ГИПЕРПАРАТИРЕОЗОМ

Background. Primary hyperparathyroidism (PHPT) is an endocrine disease characterized by excessive production of parathyroid hormone (PTH) and elevated or high-normal blood calcium levels caused by primary pathology of the parathyroid glands. The "classic" complication of PHPT is a decrease in the kidneys filtration function. Parathyroidectomy (PTE) reduces the risks of further deterioration in filtration function; however, in some cases, this is not achieved. Aim. To develop a mathematical model to predict the decline in estimated glomerular filtration rate (eGFR) 12 months after PTE in patients with PHPT, and implement it as a software. Methods. Retrospective study included 140 patients with PHPT who underwent PTE in 1993–2010 and 2018–2020 at the National Medical Research Center of Endocrinology. Analyzed variables included sex, age, indicators of calciumphosphorus, purine, lipid, and carbohydrate metabolism, presence of PHPT complications, treatment for PHPT, histological examination of removed parathyroid tissue, development of postoperative hypocalcemia and transient hypoparathyroidism, therapy for postoperative hypocalcemia. The random forest method was used to build the mathematical model. Results. To predict the decline in eGFR, a model using 24 predictors was built: sex, age, body mass index, PTH, ionized calcium, alkaline phosphatase, phosphorus, urea, eGFR, total cholesterol, diastolic blood pressure, SD(T-score)<-2.5/ SD(Z-score)<-2.0, CKD, duration of nephrolithiasis, use of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors, preoperative use of cholecalciferol and cinacalcet, parathyroid hyperplasia/adenoma, postoperative hypocalcemia, dose of alfacalcidol and calcium supplements, postoperative use of cholecalciferol. The resulting model (http://194.87.111.169/cfr) predicts a decline in eGFR in patients with PHPT after PTE with a probability of 56.8–86.3% and excludes – with a probability of 85.6–97.7%. Conclusion. A mathematical model to predict the decline in eGFR 12 months after PTE in patients with PHPT was developed, with an overall accuracy of 88%, 95% CI (79%; 93%). The model was implemented as a calculator that can be used in routine clinical practice.

Vitamin D supplementation in children with urinary tract infection

Urinary tract infections (UTIs) are one of the most common bacterial infections in the global population. Vitamin D deficiency is also an urgent and common problem, and the high incidence of hypovitaminosis does not depend on age, sex, nationality, and geographical location. Along with the so-called "classical" effects of cholecalciferol, no less significant non-calcemic functions of cholecalciferol have been actively studied over the past two decades, particularly its effect on inflammation and its role in anti-infectious immunity. More and more data on the relationship between UTIs and vitamin D deficiency supports the possible use of cholecalciferol as an adjuvant to basic UTI therapy.
 Aim. To analyze the vitamin D status in children with UTI compared to healthy ones.
 Materials and methods. The study included 75 children from 1 month to 18 years with UTIs of various localization treated in a healthcare institution in Stavropol. The mean age of the study patients was 6.0±0.3 years. Vitamin D status was based on serum calcidiol [25(OH)D3] level.
 Results. The vitamin D level is statistically significantly higher in children of the control group than in patients with UTI: 36.42 ng/mL [24.92–46.37] vs 24.13 ng/mL [13.75–36.42], respectively (p=0.003). There were no patients with severe vitamin deficiency in the control group, while in the UTI group, it occurred in 20.0% of patients. The vitamin D level was less than 20 ng/mL in 31 (41.3%) children with UTI and only 2 (6.6%) in the control group (p=0.001). Normal vitamin status was found in only 38.7% of patients with UTI compared to 66.7% of healthy children (p0.01). The lowest level was found in patients with acute cystitis – 19.7 ng/mL [9.8–19.7], and the highest in patients with acute pyelonephritis – 31.9 ng/mL [14.3–36.4].
 Conclusion. Based on the study results, it can be concluded that vitamin D deficiency may be one of the risk factors for developing UTIs in children. Further studies involving more patients are needed.

A pill full of sunshine. Vitamin D supplementation among polish students

Introduction and purpose of work:
 Vitamin D has a significant impact on the functioning of the human body. Vitamin D deficiency is a public health problem worldwide in all age groups including Poland. Supplementation is recommended in the general population with the use of cholecalciferol and should be individualized depending on age, body weight, the sun exposure, diet, and lifestyle.
 The aim of study was to analyze vitamin D supplementation habits among polish students in two divided groups: medical students and non-medical students.
 Methods: 
 The tool used to carry out the research was a specially constructed, online questionnaire. The survey was completed by 244 students, 126 of whom supplement vitamin D. Pearson’s χ2 test was used to analyze the survey’s results. The processing of the obtained data, statistical calculation and graphs were made using the R program.
 Results and conclusions: 
 Students of medical faculties are more likely to take vitamin D supplements than students of other faculties. They are significantly more likely to adjust the dose of supplementation to the current guidelines. In 87% of students who tested the level of vitamin D in the blood serum and remember their result, the level of the parameter is ≥30 ng/ml (75 nmol/L), which is below the optimal level for this particular age group. Supplementation improves the quality of life, the benefits of supplementation were noticed by 71.4% of all students. It is necessary to promote the prophylactic habit of vitamin D supplementation.

The problem of vitamin D deficiency among the population and the efficacy of drugs in increasing its level

A review of the literature shows that cholecalciferol, ergocalciferol and calcifediol are currently used in foreign and domestic practice to increase vitamin D levels, while there is no consensus on the effectiveness, necessity and possibility of using one or another type of vitamin D supplements. In this regard, we conducted statistical studies of the effectiveness of increasing the level of vitamin D in the patient's blood serum, and also made an analysis of literary sources on the biological activity and safety of the use of cholecalciferol, ergocalciferol and calcifediol. Research has shown that cholecalciferol is currently the most commonly used vitamin D supplement, with calcifediol gaining popularity, which is an order of magnitude superior to cholecalciferol in terms of dose-time-effectiveness. Clinical studies by foreign authors have shown that the use of calcifediol in some cases is accompanied by an improvement in muscle function, a decrease in systolic blood pressure, restoration of acceptable levels of parathyroid hormone and other positive biological effects. Also, there is no doubt about the safety and absence of toxic effects of calcifediol as a therapeutic agent. Most foreign experts studying the applicability of calcifediol for the treatment of patients indicate its increased hydrophilicity, which provides it with the greatest advantages in the treatment of diseases associated with a decrease in absorption in the intestine. It is clear that large-scale laboratory and clinical studies are needed to obtain final conclusions about the therapeutic usefulness, scope, dosage and duration of use of calcifediol, however, the prospect of widespread use of this drug as a therapeutic agent is also beyond doubt.

Efficacy of cholecalciferol rodenticide to control wood rat, Rattus tiomanicus and its secondary poisoning impact towards barn owl, Tyto javanica javanica

Studies were conducted on the potential use of cholecalciferol as an alternative to anticoagulant rodenticides to control common rat pest in oil palm plantations, i.e., wood rats, Rattus tiomanicus, and the secondary poisoning impact of cholecalciferol on barn owls, Tyto javanica javanica. The laboratory efficacy of cholecalciferol (0.075% a.i.) was compared with commonly used first-generation anticoagulant rodenticides (FGARs): chlorophacinone (0.005% a.i) and warfarin (0.05% a.i). The 6-day wild wood rat laboratory feeding trial showed cholecalciferol baits had the highest mortality rate at 71.39%. Similarly, the FGAR chlorophacinone recorded a mortality rate of 74.20%, while warfarin baits recorded the lowest mortality rate at 46.07%. The days-to-death of rat samples was in range of 6–8 days. The highest daily consumption of bait by rat samples was recorded for warfarin at 5.85 ± 1.34 g per day while the lowest was recorded in rat samples fed cholecalciferol, i.e., 3.03 ± 0.17 g per day. Chlorophacinone-treated and control rat samples recorded consumption of about 5 g per day. A secondary poisoning assessment on barn owls in captivity fed with cholecalciferol-poisoned rats showed after 7 days of alternate feeding, the barn owls appeared to remain healthy. All the barn owls fed with cholecalciferol-poisoned rats survived the 7-day alternate feeding test and throughout the study, up to 6 months after exposure. All the barn owls did not show any abnormal behavior or physical change. The barn owls were observed to be as healthy as the barn owls from the control group throughout the study.

Issues of diagnostics and treatment of vitamin D deficiency in older patients

Vitamin D is a fat-soluble compound that a person obtains from food or synthesizes independently when the skin is exposed to sunlight.
 Vitamin D metabolism is modulated by various intrinsic and extrinsic factors, including genetic polymorphism, skin type (pigmentation), age, health, season, latitude, clothing, and diet. Some of them are modifiable, i.e., they can be controlled by humans.
 To assess the vitamin D level in the body, the recommendation was to determine the concentration of total 25(OH)D in the blood serum, the main circulating form, which reflects both the intake of vitamin D from food and native preparations and the synthesized vitamin D in the skin under the influence of ultraviolet irradiation. This study focused on the diagnosis and treatment of vitamin D deficiency in older patients.
 The age-related problem is associated with a more frequent history of surgery and chronic diseases requiring drug therapy, which in turn can affect the metabolism of this vitamin. Vitamin D deficiency in older people requires constant and long-term use of cholecalciferol; however, the risks of drug interactions and polypharmacy should not be overlooked.
 The diagnosis and treatment of vitamin D deficiency in older people should consider all the characteristics of this group. Moreover, this study presents the features of vitamin D metabolism in older people, nosologies predisposing to the development of vitamin D deficiency, methods for diagnosing and correcting vitamin D deficiency, and relationship between severe COVID-19 and vitamin D levels.
 Further study of possible drug interactions, additional effects of vitamin D, and its contribution to comorbidities is warranted.

The use of cholecalciferol in the treatment of bronchial asthma in children

The results of evaluation of the clinical efficacy of cholecalciferol in the complex treatment of bronchial asthma in children are presented. 60 children with bronchial asthma were examined. All patients were prescribed cholecal ciferol in addition to basic therapy. In all children, the level of the 25(OH)D metabolite was determined in the blood serum. The study of clinical efficacy after treatment showed an increase in the content of vitamin D, in children there was an improvement in the course of the disease: the number of exacerbations per year, the number of night attacks decreased, the length of stay in the hospital was reduced, attacks stopped in a shorter time, the duration of dry and wet cough significantly decreased, it was noted reduction in the duration of shortness of breath, cyanosis of the nasolabial triangle, oral wheezing.

Effect of different doses of cholecalciferol and calcidiol on meat quality parameters and skeletal muscle transcriptome profiles in swine

Skeletal muscle tissue is one of the potential targets for vitamin D actions. There are indications that vitamin D supplementation to swine has a positive effect on meat quality. However, these issues need further study, especially in terms of response to the use of different forms of vitamin D. We carried out a multi-purpose study to compare the effects of cholecalciferol and calcidiol on meat quality and muscle tissue transcriptome. Meat quality assessment and gene expression analysis were performed on longissimus dorsi samples collected from swine fed grower/finisher diets containing 2000 IU cholecalciferol/1500 IU cholecalciferol per kg (n = 8), 3000 IU cholecalciferol/2500 IU cholecalciferol per kg (n = 10), 2000 IU cholecalciferol +1000 IU calcidiol/1500 IU cholecaliferol +1000 IU calcidiol per kg (n = 8), and 2000 IU calcidiol/1500 IU calcidiol per kg (n = 8). The results suggest that increasing the dose of cholecalciferol and using calcidiol in the diet of finishers may improve meat texture parameters (shear force P = 0,014, toughness P = 0,048, cohesiveness P = 0,017, resilience P = 0,002). Shear force (68.46 N–51.42 N) and toughness (145.85 N–114.52 N) decreased the most under the effect of increasing cholecalciferol dosage. In turn, cohesiveness (0.60 N–0.65 N) and resilience (0.23 N–0.28 N) increased most strongly under the use of cholecalciferol+calcidiol. Moreover, the results indicate no significant effect of increasing cholecalciferol dose and use calcidiol in the swine diet on muscle tissue transcriptome.

Vitamin D and its Possible Relationship to Neuroprotection in COVID-19: Evidence in the Literature.

Vitamin D is a hormone involved in the regulation of important biological processes such as signal transduction, immune response, metabolic regulation and also in the nervous and vascular systems. To date, coronavirus disease 2019 (COVID-19) infection does not have a specific treatment. However, various drugs have been proposed, including those that attenuate the intense inflammatory response, and recently, the use of vitamin D, in clinical trials, as part of the treatment of COVID-19 has provided promising results. It has been observed in some clinical studies that the use of cholecalciferol (vitamin D3) and its two metabolites the circulating form, calcidiol or calcifediol (25-hydroxycalciferol, 25-(OH)-D), and the active form, calcitriol (1,25-(OH)2-D), in different doses, improve the clinical manifestations, prognosis, and survival of patients infected with COVID-19 probably because of its anti-inflammatory, antiviral and lung-protective action. In relation to the central nervous system (CNS) it has been shown, in clinical studies, that vitamin D is beneficial in some neurological and psychiatric conditions because of its anti-inflammatory and antioxidant properties, modulation of neurotransmitters actions, and regulation of calcium homeostasis between other mechanisms. It has been shown that COVID-19 infection induces CNS complications such as headache, anosmia, ageusia, neuropathy, encephalitis, stroke, thrombosis, cerebral hemorrhages, cytotoxic lesions, and psychiatric conditions and it has been proposed that the use of dietary supplements, as vitamin and minerals, can be adjuvants in this disease. In this review, the evidence of the possible role of vitamin D, and its metabolites, as a protector against the neurological manifestations of COVID-19 was summarized.

Assessment of 25(OH)D status in patients with genital endometriosis and clinical efficacy of cholecalciferol in the treatment of the disease

AIM: The aim of this study was to determine the 25(OH)D status in patients with genital endometriosis compared to the control group and to analyze the clinical efficacy of cholecalciferol implication as a combined targeted therapy of the disease.
 MATERIALS AND METHODS: The main group included 440 patients with genital endometriosis (mean age 33.75.8 years) with various degrees of disease prevalence. The control group consisted of 30 women with the normal ovulatory menstrual cycle (mean age 26.33.1 years) in whom gynecological pathology was not revealed. Peripheral blood (PB) 25(OH)D level was assessed in all the participants included into the study. In 49 women from the main group, the level of 25(OH)D in the peritoneal fluid (PF) was determined. Comparative evaluation of the clinical efficacy of cholecalciferol intake in combination with gonadotropin-releasing hormone agonist (aGnRH) 3.75 mg injections or with dienogest 2 mg oral administration, as well as monotherapy in comparison with standard hormone-modulating treatment was carried out. Prior to the start of treatment, the patients had pain syndrome of varying severity, which was evaluated using the McGill Pain Questionnaire with the Visual Analogue Scale for pain. The psycho-emotional status was assessed using the Hospital Anxiety and Depression Scale. The Excel, Statistica 10, and Jamovi software programs were used to process the obtained data.
 RESULTS: The level of 25(OH)D in PB of patients with endometriosis was significantly lower compared to the control group (p 0.001). Women with Grades III and IV genital endometriosis were characterized by lower PB 25(OH)D levels compared to the patients with Grades I and II of the disease, but the difference was not statistically significant. Relationships were revealed between 25(OH)D levels in the PB and PF (p 0.001), as well as PF 25(OH)D level and the disease prevalence (p = 0.004). Significantly more pronounced pain reduction and stabilization of the psycho-emotional status were observed in patients receiving combined therapy with cholecalciferol.
 CONCLUSIONS: Insufficient level of vitamin D and vitamin D deficiency can be considered as factors that play a role in the progression of genital endometriosis. The use of cholecalciferol in combination with aGnRH 3.75 mg or dienogest 2 mg may more effectively reduce the severity of pain and stabilize the psycho-emotional status in patients with genital endometriosis compared to standard hormone-modulating therapy.

Оценка сочетанного применения холекальциферола и антигипертензивной терапии у лиц с артериальной гипертензией

Актуальность.Целью исследования стала оценка влияния применения холекальциферола в дозе 2000 МЕ в сутки на уровень 25(ОН)D в сыворотке и артериальное давление на фоне антигипертензивной терапии у больных с артериальной гипертензией II стадии. Материалы и методы. Мы провели проспективное одноцентровое исследование у 115 больных со II стадией АГ (91 женщина и 24 мужчины), средний возраст 50,7 ± 7,1 года. Продолжительность периода наблюдения составила в среднем 15,8 ± 1,8 мес. (от 12 до 18 мес.). Пациенты получали антигипертензивную терапию в соответствии с европейскими рекомендациями: ингибиторы ангиотензинпревращающего фермента или антагонисты рецепторов ангиотензина — лозартан, или диуретики (гидрохлортиазид или индапамид) в составе комбинированной терапии, или антагонисты кальция — амлодипин, или бета-адреноблокаторы, или их сочетание. Каждому второму пациенту было рекомендовано принимать витамин D в виде холекальциферола в дозе 2000 МЕ/день ежедневно. Всем пациентам проводили общий анализ крови, общий анализ мочи, определение сахара в крови натощак, мочевины в сыворотке крови, креатинина в сыворотке крови, систолического и диастолического артериального давления, антропометрических данных, электрокардиографию. Уровень общего витамина D в сыворотке крови определяли с помощью иммуноферментного анализа. Статистический анализ выполняли, используя программный пакет «STATISTICA 10.0» (SN AXAR207F394425FA-Q). Результаты. Было выявлено, что прием диуретиков (гидрохлортиазида в дозе 12,5–25 мг или индапамида в дозе 1,5 мг) в составе комбинированной антигипертензивной терапии оказывает влияние на изменения 25(ОН)D в сыворотке (F = 5,35; p = 0,02) и его уровень (F = 11,8; p = 0,0009). Изменения систолического артериального давления были более выражены (–27,4 ± 17,9) в группе пациентов, получавших диуретик и холекальциферол, по сравнению с группой сравнения, что соответствовало уровню достоверности p < 0,001. В той же группе была выявлена взаимосвязь между динамикой систолического артериального давления и длительностью приема холекальциферола (R = 0,42; p = 0,023). Было обнаружено достоверное влияние как холекальциферола (F = 4,1; p = 0,046), так и диуретиков (F = 14,3; p = 0,0003). Выводы. Тиазидные или тиазидоподобные диуретики оказывают отрицательное влияние на уровень 25(OH)D в сыворотке. Сочетанное применение холекальциферола и диуретика в дозе 2000 МЕ в сутки для лечения пациентов с АГ II стадии позволяет достичь наибольшего антигипертензивного эффекта в отношении систолического артериального давления без риска избыточной концентрации витамина D в организме.

Preventive use of Calcitriol versus cholecalciferol on biochemical markers of Metabolic Bone Disease (MBD) in very low birth weight infants: a pilot randomized clinical trial

About 55% of extremely-low-birth-weight (birth weight < 1000 g) and 23% of very-low-birth-weight infants (birth weight < 1500 g) suffer from metabolic bone disease (MBD). There are limited data on the use of calcitriol (1, 25-dihydroxycholecalciferol) to prevent or treat MBD in preterm infants. Therefore, this study aimed to compare the preventive effect of calcitriol and cholecalciferol on the biochemical markers of MBD in preterm infants. This study was a pilot randomized controlled trial conducted in the Alzahra teaching hospital of Tabriz University of Medical Sciences. we randomized 72 very-low-birth-weight infants in two groups of calcitriol 0.25 µg/day and cholecalciferol 400 IU/day. Biochemical markers, including serum 25-hydroxyvitamin D, Alkaline phosphatase (ALP), Phosphorus (P), calcium (Ca), Parathyroid hormone (PTH), and tubular reabsorption of phosphate (TRP) levels were checked at baseline, three, and five weeks after medication, consecutively. After three weeks of supplementation, infants in the cholecalciferol group had higher levels of serum 25-hydroxyvitamin D (P=0.001) and lower levels of urine phosphate (P=0.009); There were no significant differences in other biochemical markers. At the end of the fifth week, there was no significant difference between the two groups in terms of biochemical markers. Conclusion: The study indicated that the use of cholecalciferol caused a lower urinary loss of phosphate in very-low-birth-weight infants at a short time; however, these findings were not sustained during the study period.

Critical analysis on the use of cholecalciferol as a COVID-19 intervention: a narrative review.

The World Health Organization has declared that a pandemic situation exists in relation to the disease caused by the new coronavirus, COVID-19. So far, the absence of a vaccine against the new coronavirus has led people worldwide to seek various therapeutic alternatives, including use of cholecalciferol. Narrative review developed by a research group at a public university in Recife (PE), Brazil. We searched the literature on the use of cholecalciferol for prevention or treatment of COVID-19, using the MEDLINE and LILACS databases, with the keywords "vitamin D", "cholecalciferol", "SARS-CoV-2", "COVID-19" and "coronavirus", from January 1, 2020, to June 10, 2020. Narrative reviews, cohort studies and ecological studies were selected. We retrieved 32 references, of which 8 were considered eligible for intensive review and critical analysis. These comprised five narrative reviews, two observational studies and one protocol proposal. Most of the studies selected reported positive effects from use of vitamin D for prevention or treatment of COVID-19. However, there was little quantitative data to assess the real impact of using this vitamin as an intervention against this disease. Current studies on vitamin D used for purposes other than bone health promotion cannot be taken as support to justify its use in a disease as recent as COVID-19. Studies of greater robustness, with higher levels of clinical evidence, need to be conducted. Rational use of this vitamin needs to be ensured, thereby minimizing the impacts on the patient and the public healthcare system.

Is cholecalciferol a potential disease-modifying anti-rheumatic drug for the management of rheumatoid arthritis?

Vitamin D is a pleiotropic molecule with a well-characterised immunomodulatory activity in vitro; however, its potential clinical application in autoimmune conditions has yet to be clarified. Several authors have investigated the use of vitamin D as a disease-modifying anti-rheumatic drug (DMARD) in rheumatoid arthritis (RA), obtaining divergent conclusions. This systematic review summarises and critically analyses the findings of papers assessing the impact of vitamin D supplementation on pain relief, disease activity, functional status and flare rate. We conclude that the correction of hypovitaminosis D may have a beneficial effect on pain perception; moreover, the achievement of an adequate plasma vitamin D concentration obtained with high-dose regimens might evoke immunomodulatory activities of vitamin D and favourably impact on disease control. Nevertheless, the current evidence is still not strong enough to support the use of cholecalciferol as a DMARD in RA, and further studies are required to clarify this issue.

Colecalciferol: Uma análise crítica de produtos manipulados e industrializados

Profissionais de saúde tem prescrito cada vez mais vitamina D, visto que sua deficiência representa um problema de saúde coletiva mundial. Adicionalmente, indivíduos têm utilizado esta substância para outros fins além daqueles ligados ao metabolismo mineral, apesar da escassez de dados científicos sobre seu papel na prevenção de outras doenças. Este trabalho analisou a prescrição, manipulação e uso do colecalciferol em apresentações magistrais e comerciais nacionais. Farmácias magistrais de Recife, PE informaram as formas farmacêuticas manipuladas contendo colecalciferol para administração oral; consultas eletrônicas ao site da Anvisa e ao software INTUITIVE®, utilizado pela Farmácia Escola Carlos Drummond de Andrade (FECDA), permitiram que as apresentações comerciais/manipuladas, no período do estudo, fossem elencadas e analisadas. Foram realizadas consultas a bases de dados visando estabelecer uma análise crítica e atual diante dos achados. Foi verificada uma ampla preocupação no estabelecimento dos níveis sanguíneos adequados desta vitamina na população por parte dos profissionais de saúde habilitados, visto que 29 diferentes especialistas prescreveram colecalciferol manipulado. Também foi constatada uma maior quantidade de dosagens e formas farmacêuticas magistrais quando comparadas com as apresentações comerciais do mercado nacional. No mais, garantir que estas prescrições estejam embasadas nas necessidades de cada paciente, requer exames sanguíneos e utilização de guias reconhecidos, o que, associado ao acompanhamento farmacoterapêutico, poderá contribuir para o sucesso terapêutico.