Vitamin D Deficiency Patients Research Articles

A perilous and complicated situation in hospitals: Vitamin D deficiency in multiple myeloma patients—A nationwide cross-sectional study.

e20010 Background: For the year 2019, the United States age-adjusted rate of new Multiple Myeloma (MM) cases was 6.8 per 100,000 people and the age-adjusted death rate was 3 per 100,000 people. Vitamin D Deficiency (VDD) and associated complications are very common in MM patients. Aim of our study was to evaluate the prevalence and risk of VDD in patients with MM and VDD associated disability and mortality in the VDD patients. Methods: We performed a cross-sectional retrospective analysis of Nationwide Inpatient Sample data 2016-2018. Adults hospitalizations with MM were identified using ICD 10 code. Hospitalized patients were grouped into patients with VDD and without VDD. We ran chi square, unpaired-t test and mixed-effect survey logistic regression analysis to find out odds ratio and 95%CI showing outcomes of VDD in MM patients. Results: We found 330,175 hospitalizations with MM. Of these 11,480 were noted to be patients with VDD with higher prevalence (0.64% vs 0.37%) of and strong association (aOR:1.41, 95%CI:1.35-1.47) with MM in comparison without MM. Amongst MM, females [1.50, 1.49-1.51], black race [1.23, 1.22-1.24], urban teaching hospitals [1.22, 1.22-1.23], and hospitals in mid-west region [1.30, 1.29- 1.32] had higher prevalence odds of VDD compared with males, white race population, rural hospitals and hospitals in northeast region. (p<0.0001) Patients with VDD had higher prevalence and strong association with higher morbidity [5.1% vs 3.9%, 1.24,1.14-1.36; c-value=0.67], severe/extreme disability [77.2% vs 73.3%, 1.26, 1.20-1.33; c-value=0.73], and discharge to locations other than home [51.15% vs 45.69%, 1.29, 1.23-1.34; c-value=0.69] in comparison without VDD. (p<0.0001) [Table]. Conclusions: Significant poor outcomes warrant early identification of VDD and role of same hospitalization vitamin D replacement amongst MM patients with higher risk. [Table: see text]

Pre-transplantation vitamin D deficiency increases acute graft-versus-host disease after hematopoietic stem cell transplantation in thalassemia major patients.

Although there are many studies on the role of vitamin D deficiency (VDD) in hematopoetic stem cell transplantation (HSCT), outcomes have often reported conflicting results because of the heterogeneity of the patients in the studies. We investigated the association between VDD prior to HSCT and outcomes after HSCT in a relatively homogenous group of patients with thalassemia major (TM) who received identical treatment for TM before transplantation, and the same conditioning regimen and GVHD prophylaxis during and after transplantation. All patients, including the patients with normal vitamin D3 levels received 400 to 800 IU per day of vitamin D for the first 6 months after HSCT. Pre-HSCT VDD increased the frequency of aGVHD after transplantation, particularly in HSCTs performed with PBSC for the stem cell source. Pre-transplant low vitamin D3 levels had no association with transplant outcomes such as engraftment, viral infections, alloimmunization, chronic GvHD, total days of hospitalization, and success in terms of transfusion independence. Low vitamin D3 levels before HSCT carry a significant risk for aGVHD. All patients with TM should be screened for VDD before HSCT, and every effort should be made to supplement vitamin D before the transplant in VDD patients.

Abstract 14211: In-Hospital Mortality and Length of Stay Among Patients Hospitalized With Acute Heart Failure and Vitamin D Deficiency: A Study From National Inpatient Sample 2016-2017

Introduction: Vitamin D deficiency (VDD) is highly prevalent in patients with Congestive Heart Failure (CHF) and associated with adverse clinical outcomes. VDD is thought to over-activate neurohormonal and inflammatory responses leading to left ventricular dysfunction. Hypothesis: VDD status is associated with increased in-hospital mortality rate and length of stay (LOS) in patients with acute heart failure. Methods: We used the National Inpatient Sample (NIS) data from 2016-2017 to examine a possible association between VDD and in-hospital mortality or LOS among patients hospitalized with acute heart failure (AHF). We included patients 18 years or older with a primary diagnosis of AHF. Other covariates of interest included sex, age, race, insurance, income quartile by zip code, comorbidities, hospital location, and size. We used the Charlson Comorbidity Index (CCI) categories to account for comorbidities. Bivariate analyses included Chi-square and Fisher's exact test with categorical variables and mean and median test for LOS to examine possible group differences among patients with AHF. We ran unadjusted and adjusted regression models to test the study hypothesis. Results: We identified a total of 177,811 acute heart failure discharges. Two percent (n= 3542) had VDD. The mean age in a VDD group was 72.8 ±14.06 years while in a non-VDD group was 71.5 years±14.49 (p < 0.001). Among VDD patients, 56.06% were females (p < 0.001); 66.70% were White, 21.70% were black, 6.61% were Hispanic (p < 0.001); 18.66% were in Northeast, 30% in Mid-west, 33.8% in South and 17.5% in West hospital region (p < 0.001). There was a higher proportion of Charlson Comorbidity index of three or more in VDD compared to non-VDD (80.12% vs. 69.41%; p < 0.001) group. VDD status was associated with 31.5% decrease in odds of in-hospital mortality compared to non-VDD status (Adjusted Odds Ratio 0.68, 95% C.I. 0.54- 0.87, p = 0.002). However, there was a small but statistically significant increase in length of stay (β = 0.95, linearized S.E. ± 0.18, 95% C.I. 0.06-0.13, p-value < 0.001) in patients with VDD compared to non-VDD. Conclusions: VDD status is associated with statistically significant increased LOS, but lower in-hospital mortality in patients hospitalized with AHF.

Lack of association of baseline 25-hydroxyvitamin D levels with disease severity and mortality in Indian patients hospitalized for COVID-19

Vitamin D deficiency (VDD) owing to its immunomodulatory effects is believed to influence outcomes in COVID-19. We conducted a prospective, observational study of patients, hospitalized with COVID-19. Serum 25-OHD level < 20 ng/mL was considered VDD. Patients were classified as having mild and severe disease on basis of the WHO ordinal scale for clinical improvement (OSCI). Of the 410 patients recruited, patients with VDD (197,48.2%) were significantly younger and had lesser comorbidities. The levels of PTH were significantly higher in the VDD group (63.5 ± 54.4 vs. 47.5 ± 42.9 pg/mL). The proportion of severe cases (13.2% vs.14.6%), mortality (2% vs. 5.2%), oxygen requirement (34.5% vs.43.4%), ICU admission (14.7% vs.19.8%) was not significantly different between patients with or without VDD. There was no significant correlation between serum 25-OHD levels and inflammatory markers studied. Serum parathormone levels correlated with D-dimer (r 0.117, p- 0.019), ferritin (r 0.132, p-0.010), and LDH (r 0.124, p-0.018). Amongst VDD patients, 128(64.9%) were treated with oral cholecalciferol (median dose of 60,000 IU). The proportion of severe cases, oxygen, or ICU admission was not significantly different in the treated vs. untreated group. In conclusion, serum 25-OHD levels at admission did not correlate with inflammatory markers, clinical outcomes, or mortality in hospitalized COVID-19 patients. Treatment of VDD with cholecalciferol did not make any difference to the outcomes.

Association of serum vitamin D status with development of type 2 diabetes: A retrospective cross-sectional study

Background and aimsVitamin D deficiency (VDD) has become a growing global public health issue, which is placing increasing burdens on healthcare systems worldwide due to its multifactorial clinical manifestations. However, epidemiological findings pertaining to VDD's link with various disease pathologies, especially type 2 diabetes mellitus (T2DM), remain contradictory. Through a retrospective cross-sectional analysis, this study aimed to contribute towards the construction of a novel framework for understanding the relationship between VDD and T2DM to subsequently inform relevant public health policy.MethodsA retrospective cross-sectional analysis of the prevalence of diabetes in both VDD and non-VDD groups was conducted. Data pertaining to various biochemical parameters was obtained from the Kasturba hospital database for 500 patients tested for both serum 25(OH)D and blood glucose levels [i.e. random, fasting, post-prandial, and/or hemoglobin A1c (HbA1C)] between 1st January and 30th April 2018.ResultsWithin the study sample, 117 (41.1%) of patients with VDD had T2DM, whereas 72 (33.5%) of patients without VDD had T2DM. This indicates no association between VDD and T2DM (χ2 = 2.98; p = 0.084). Still, an OR value of 1.4, despite statistical insignificance (95%CI:0.96–2.0, p = 0.084) indicates that there is an approximately 40% greater odds of developing T2DM in VDD patients relative to non-VDD patients. Moreover, the likelihood ratio (LR) is 2.99, which indicates an approximately 3-fold chance of having T2DM as a VDD patient, relative to a non-VDD patient.ConclusionsDespite the lack of statistical significance, the findings of this study make important contributions to the existing literature and must be considered in light of their inherent limitations. Taking these into account, it becomes clear that these results should not be extrapolated nor assumed to entirely invalidate the hypothesized link between VDD and T2DM. Rather, such gaps warrant need for further research and more robust study designs to draw sufficiently significant conclusions to justify reforms in clinical practice. Vitamin D deficiency (VDD) has become a growing global public health issue, which is placing increasing burdens on healthcare systems worldwide due to its multifactorial clinical manifestations. However, epidemiological findings pertaining to VDD's link with various disease pathologies, especially type 2 diabetes mellitus (T2DM), remain contradictory. Through a retrospective cross-sectional analysis, this study aimed to contribute towards the construction of a novel framework for understanding the relationship between VDD and T2DM to subsequently inform relevant public health policy. A retrospective cross-sectional analysis of the prevalence of diabetes in both VDD and non-VDD groups was conducted. Data pertaining to various biochemical parameters was obtained from the Kasturba hospital database for 500 patients tested for both serum 25(OH)D and blood glucose levels [i.e. random, fasting, post-prandial, and/or hemoglobin A1c (HbA1C)] between 1st January and 30th April 2018. Within the study sample, 117 (41.1%) of patients with VDD had T2DM, whereas 72 (33.5%) of patients without VDD had T2DM. This indicates no association between VDD and T2DM (χ2 = 2.98; p = 0.084). Still, an OR value of 1.4, despite statistical insignificance (95%CI:0.96–2.0, p = 0.084) indicates that there is an approximately 40% greater odds of developing T2DM in VDD patients relative to non-VDD patients. Moreover, the likelihood ratio (LR) is 2.99, which indicates an approximately 3-fold chance of having T2DM as a VDD patient, relative to a non-VDD patient. Despite the lack of statistical significance, the findings of this study make important contributions to the existing literature and must be considered in light of their inherent limitations. Taking these into account, it becomes clear that these results should not be extrapolated nor assumed to entirely invalidate the hypothesized link between VDD and T2DM. Rather, such gaps warrant need for further research and more robust study designs to draw sufficiently significant conclusions to justify reforms in clinical practice.

Correlation of Vitamin D Deficiency with Predictors of Mortality in Critically Ill Children at a Tertiary Care Centre in North India-A Prospective, Observational Study.

This study was conducted to assess the relationship of vitamin D deficiency (VDD) with various demographic characteristics, laboratory parameters, and predictors of mortality. This prospective observational study was performed at pediatric intensive care unit (PICU) of a tertiary care hospital situated in north India. A total of 125 children admitted in PICU with age from 2 months to 14 years were analyzed. The subjects were classified as Vitamin D deficient (≤20 ng/mL) and nondeficient (>20 ng/mL). The relationship between VDD and predictors of mortality were analyzed using correlation and multivariate analysis. Respiratory system (40%) was most commonly involved. VDD was seen in 72% of the patients. There was statistically significant correlation of VDD with age ( p = 0.019), season ( p = 0.018), height ( p = 0.005), and weight ( p = 0.003). On multivariate analysis factors associated with VDD were age (odds ratio [OR] = 1.01, 95% confidence interval [CI] 1.00-1.03, p = 0.006), season (OR = 3.98, 95% CI 1.09-14.50, p = 0.036). VDD was also correlated to bacteriuria ( p = 0.033), cardiovascular sequential sepsis-related organ failure assessment score (CV-SOFA score) ( p = 0.001), and mechanical ventilation ( p = 0.043). On multivariate analysis, factors associated with VDD were bacteriuria (OR = 4.88, 95% CI 1.04-22.89, p = 0.04), mechanical ventilation requirement (OR = 2.95, 95% CI 1.12-7.85, p = 0.029), and CV-SOFA score (OR = 2.33, 95% CI 1.14-4.76, p = 0.021). Median (interquartile range) duration of PICU stay in VDD patients was (3-7) days while in nondeficient patients it was (2-6) days ( p = 0.107). VDD was a significant risk factor for the need of mechanical ventilation, bacteriuria, and mortality among patients in our cohort.

Prevalence and Outcomes Associated with Vitamin D Deficiency among Indexed Hospitalizations with Cardiovascular Disease and Cerebrovascular Disorder-A Nationwide Study.

Background: According to past studies, recovery and survival following severe vascular events such as acute myocardial infarction and stroke are negatively impacted by vitamin D deficiency. However, the national estimate on disability-related burden is unclear. We intend to evaluate the prevalence and outcomes of vitamin D deficiency (VDD) among patients with cardiovascular disease (CVD) and cerebrovascular disorder (CeVD). Methods: We performed a cross-sectional study on the Nationwide Inpatient Sample data (2016–2017) of adult (≥18 years) hospitalizations. We identified patients with a secondary diagnosis of VDD and a primary diagnosis of CVD and CeVD using the 9th revision of the International Classification of Diseases, clinical modification code (ICD-10-CM) codes. A univariate and mixed-effect multivariable survey logistic regression analysis was performed to evaluate the prevalence, disability, and discharge disposition of patients with CVD and CeVD in the presence of VDD. Results: Among 58,259,589 USA hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23%, and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH, and SAH, respectively and 1.82% had VDD. The prevalence of hospitalizations due to CHF (14.66% vs. 11.43%), AIS (1.87% vs. 1.71%), and TIA (0.4% vs. 0.38%) was higher among VDD patients as compared with non-VDD patients (p < 0.0001). In a regression analysis, as compare with non-VDD patients, the VDD patients were associated with higher odds of discharge to non-home facilities with an admission diagnosis of CHF (aOR 1.08, 95% CI 1.07–1.09), IHD (aOR 1.24, 95% CI 1.21–1.28), acute MI (aOR 1.23, 95% CI 1.19–1.28), AFib (aOR 1.21, 95% CI 1.16–1.27), and TIA (aOR 1.19, 95% CI 1.11–1.28). VDD was associated with higher odds of severe or extreme disability among patients hospitalized with AIS (aOR 1.1, 95% CI 1.06–1.14), ICeH (aOR 1.22, 95% CI 1.08–1.38), TIA (aOR 1.36, 95% CI 1.25–1.47), IHD (aOR 1.37, 95% CI 1.33–1.41), acute MI (aOR 1.44, 95% CI 1.38–1.49), AFib (aOR 1.10, 95% CI 1.06–1.15), and CHF (aOR 1.03, 95% CI 1.02–1.05) as compared with non-VDD. Conclusions: CVD and CeVD in the presence of VDD increase the disability and discharge to non-home facilities among USA hospitalizations. Future studies should be planned to evaluate the effect of VDD replacement for improving outcomes.

Abstract 13697: Prevalence and Disability Associated With Vitamin D Deficiency Amongst Patients With Cardiovascular and Cerebrovascular Disorders

Introduction: Previous studies had provided evidence that vitamin D deficiency is a strong negative predictor for survival and recovery after severe vascular events but national estimate on disability related burden is not clear. Hypothesis: We evaluate the prevalence of vitamin D deficiency (VDD) amongst patients with cardiovascular disease (CVD) and cerebrovascular disorders (CeVD) and to find out whether or not CVD and CeVD in the presence of VDD increases the disability. Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample data (years 2016-2017) in adults (≥18 years) hospitalizations. We identified patients with secondary diagnosis of VDD and primary diagnosis of CVD (AFib, CHF, IHD, acute MI, and angina) and CeVD (AIS, TIA, ICeH and SAH) using ICD-10-CM codes. We performed a chi-square test and multivariable survey logistic regression to analyze disability of patients with CVD and CeVD in presence of VDD. Disability/loss of function was investigated by APRDRGs severity using 3M Health Information Systems software. (Score 1-4 indicates minor to extreme loss of function) Results: Among 58,259,589 US hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23% and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH and SAH, respectively and 1.82% had VDD. Prevalence of hospitalizations due to CHF (14.66% vs 11.43%), AIS (1.87% vs 1.71%) and TIA (0.4% vs 0.38%) was higher; and IHD (2.62% vs 3.45%), acute MI (1.58% vs 2.16), angina (0.05% vs 0.06%), AFib (1.14% vs 1.28%), ICeH (0.17% vs 0.23%) and SAH (0.05% vs 0.08%) was lower among VDD patients in compare to non-VDD. (p&lt;0.0001) In regression analysis, VDD was associated with higher odds of severe or extreme disability amongst patients hospitalized with AIS (OR:1.1; 95%CI:1.06-1.14), ICeH (1.22; 1.08-1.39), TIA (1.36; 1.25-1.47), IHD (1.37; 1.33-1.41), acute MI (1.44; 1.38-1.49), Afib (1.10; 1.06-1.15), and CHF (1.03; 1.02-1.05) in comparison to without VDD. Conclusions: CVD and CeVD in presence of VDD increase the disability amongst US hospitalizations. Future studies should be planned to evaluate the discharge outcomes as well as the effect of identification and in-hospital management of VDD on improvement of the outcomes.

Vitamin D Deficiency and Oral Health: A Comprehensive Review.

Vitamin D (VD) levels have been gaining growing attention in Oral Health. During growth and adulthood, VD deficiency (VDD) is associated with a wide variety of oral health disorders, and impaired VD synthesis may expedite some of these conditions. In children, severe VDD can induce defective tooth mineralization, resulting in dentin and enamel defects. As a consequence, these defects may increase the risk of the onset and progression of dental caries. Further, VDD has been associated with higher prevalence of periodontitis and gingival inflammation, and several recent preclinical and clinical studies have unveiled potential pathways through which Vitamin D may interact with the periodontium. VDD correction through supplementation may contribute to a successful treatment of periodontitis; however, alveolar bone regeneration procedures performed in baseline VDD patients seem more prone to failure. Vitamin D may also be linked with some oral pathology entities such as certain oral cancers and events of osteonecrosis of the jaw. This review aims to provide comprehensive evidence of how VD levels should be considered to promote good oral health, and to summarize how VDD may hamper oral development and its role in certain oral conditions.

MON-178 Vitamin D Treatment of Patients with Type 1 Diabetes Reduces RORy, FoxP3 and CD4 Gene Expression in T Helper Cells

Background: Vitamin D (VD) deficiency and the dysregulation of T helper (Th) cells contribute to the pathogenesis of type 1 diabetes (T1D). Based on the modulatory effects of VD on immune cells, we investigated the gene expression of transcription factors (TFs) regulating the Th cell differentiation before and after VD treatment in a pilot trial. Materials and methods: Nineteen patients with T1D (11 females and 8 males) were randomized and treated for three months with 4000 IU/day cholecalciferol. The gene expression of four Th cell specific TFs (Th1/T-bet, Th2/GATA3, Th1/RORy and Treg/FoxP3) as well as the Th cell surface molecule CD4 was measured before (V1) and after three months (V3) of VD treatment. Th cells were isolated by density gradient centrifugation from venous blood samples and subsequently enriched by magnetic sorting with antibodies. Total RNA from the selected cells was extracted, transcribed and analyzed by RT-qPCR. Transcription levels were calculated using the comparative cycle threshold (CT) method (values presented as 2-[CTtarget -CT18S]= 2-[∆CT]). VD-therapy effects on the gene expression were evaluated by the differences between V1 and V3 using the Wilcoxon matched-pairs test. The median differences are given with Hodges-Lehmann estimator (HLS) and 95% confidence interval (CI). Results: The 25(OH)D3 levels increased to 39.1 ng/ml (HLS: 17.22 ng/ml; 95% CI 9.3 to 23.9, p=8 x10-4) after three months cholecalciferol treatment. In response to this the gene expression of the two TFs FoxP3 (HLS: -12.68; 95% CI -21.47 to -3.36, p=0.01) and RORy (HLS: -1.85; 95% CI -4.68 to 0.02,ptrend=0.07) were downregulated. Additionally, a reduced gene expression of CD4 (HLS: -128; 95% CI -452.36 to -15.46, p=0.009) was detected. Notably, all these gene expression changes occurred in women (FoxP3 HLS: -17.30, p=0.02; RORy HLS: -3.96, p=0.01 and CD4 HLS: -146, p=0.007) but not in men. Furthermore, the downregulation of FoxP3 gene expression after VD supplementation was found in patients who had a 25(OH)D3 level below 20 ng/ml (n=9) at study entry (HLS: -17.36;p=0.03). Changes in the gene expressions of T-bet and GATA3 were not significant. Conclusion: Elevated 25(OH)D3 levels after high dose VD therapy result in downregulated genes (FoxP3, RORy and CD4) which are involved in the differentiation of effector Th cells (Treg and Th17). These VD effects occur predominantly in female patients, highlighting a gender specificity of the Th cell response. The downregulation of FoxP3 gene in VD deficiency patients may reflect other Th cell phenotypes. Our results support a targeted approach for anti-inflammatory VD treatment based on the measurement of peripheral 25(OH)D3 levels and Th cell related TFs. To corroborate our observations, further mechanistic studies and larger groups of patients are necessary.

SAT-274 The Optimal Dosage of Vitamin D Supplement for Vitamin D Deficiency in Korean Children and Adolescents

Purpose: Vitamin D deficiency (VDD) is very common nowadays in children as well as in adults, probably due to decreased exposure to sunlight. In Korea, the prevalence of VDD was 47% in teenage boys and 65% in teenage girls. However, the optimal dosage regimen for correcting deficiency is unknown. We investigate the change of serum 25(OH) vitamin D concentration according to the treatment dosage and duration in VDD. Methods: Data was collected from 1797 children and adolescents aged 0 to 16 year between August in 2017 and July in 2018, retrospectively. They were divided to 3 groups (deficiency, insufficiency, sufficiency) according to their serum 25(OH) vitamin D concentrations (less than 20, between 20 and 30, more than 30 ng/mL, respectively). There were 3 subgroups (poor, moderate, good) according the daily increase (DI) of the serum 25(OH) vitamin D concentration (less than 0.3, between 0.3 and 0.6, more than 0.6 ng/mL/day, respectively) after 4 to 6 week oral administration of 25(OH) vitamin D in children and adolescents with vitamin D deficiency. Results: The serum 25(OH) vitamin D concentration showed the correlation with age (p=0.000), gender (p=0.000), weight standard deviation score (SDS) (p=0.008) and body mass index (BMI) SDS (p=0.000). And the serum 25(OH) vitamin D concentration showed seasonal variation in children over 2 years of age and adolescents (p=0.000). There was a significant correlation between serum 25(OH) vitamin D concentration and DI (p=0.021). In VDD patients treated with vitamin D, DI were not correlated with age, sex, weight SDS and BMI SDS. Conclusions: The prevalence of VDD increased in female, older age, overweight and winter in Korea and the response to treatment was higher in patient with lower serum 25(OH) D concentration. It may be appropriate to take an oral 25(OH) Vitamin D with 2000 IU/day for 6 weeks in Korean children and adolescents with VDD.

Does Vitamin D Deficiency Affect the Immunogenic Responses to Influenza Vaccination? A Systematic Review and Meta-Analysis.

Influenza virus infection is a major global public health problem, and the efficacy of influenza vaccination is not satisfactory. Vitamin D is involved in many immune-mediated inflammatory processes. The impact of vitamin D levels on the immunogenic response to influenza vaccination is not clear. We performed a comprehensive literature search and systematic review of studies that investigated vitamin D and influenza vaccination. Data pertaining to study population, vaccine components, vitamin D levels, and immunogenic response were analyzed. Nine studies, with a combined study population of 2367 patients, were included in the systematic review. Four studies were included in the meta-analysis to investigate the influence of vitamin D deficiency (VDD) on the seroprotection (SP) rates and seroconversion (SC) rates following influenza vaccination. We found no significant association between vitamin D level and the immunogenic response to influenza vaccination. However, strain-specific differences may exist. We observed lower SP rates of influenza A virus subtype H3N2 (A/H3N2) and B strain in VDD patients than patients with normal vitamin D levels (A/H3N2: 71.8% vs. 80.1%, odds ratio (OR): 0.63, 95% confidence interval (CI): 0.43–0.91, p = 0.01; B strain: 69.6% vs. 76.4%, OR: 0.68, 95% CI: 0.5–0.93, p = 0.01). However, the SP rates of A/H1N1 and SC rates of all three strains were not significantly different in VDD and control groups. In conclusion, no association was observed between VDD and immunogenic response to influenza vaccination.

Coagulation and fibrinolysis in hyperparathyroidism secondary to vitamin D deficiency.

IntroductionAbnormal coagulation tests have been observed in patients with primary hyperparathyroidism (HPT) suggesting a prothrombotic effect of parathyroid hormone (PTH). Vitamin D deficiency (VIDD) is the most frequent cause of secondary HPT. Aim of our study was to investigate the influence of HPT secondary to moderate-to-severe VIDD and vitamin D replacement on the coagulation and fibrinolysis system.Subjects and methodsProspective cohort study of patients with vitamin D <25 nmol/L with and without HPT, and a control group of patients on vitamin D suppletion. At baseline and after 2 months of vitamin D suppletion (900,000 IU in 2 months), endocrine and coagulation markers were measured.Results59 patients with VIDD of which 34 had secondary HPT and 36 controls were included. After 2 months of suppletion, vitamin D increased by 399% (VIDD with HPT), 442% (all patients with VIDD) and 6% (controls). PTH decreased by 34% (VIDD with HPT, P < 0.01 for decrease), 32% (all VIDD, P < 0.01) and increased by 8% in the controls (P-values: <0.01 for relative changes between VIDD with HPT or all VIDD patients vs controls). Relative changes in PT, aPTT, fibrinogen, Von Willebrand factor, factors VII, VIII and X, thrombin generation, TAFI, clot-lysis time and d-dimer were not different between patients with VIDD with HPT or all VIDD vs controls.DiscussionSecondary HPT due to VIDD does not have a prothrombotic effect. In contrast with previous reports, PTH does not seem to influence coagulation or fibrinolysis, which is relevant because of the high prevalence of VIDD.

Profile of vitamin-D deficiency patients in a tertiary care centre, Bhopal: causes and its implications in health

Introduction: Vitamin D deficiency is widespread in individuals irrespective of their age, gender, race and geography. The aim of this study was to assess the status of Vitamin D deficiency in various age group in the people visiting Chirayu Medical College and Hospital, Bhopal for their routine health check-up. Material and Methods: This study was done in the department of Orthopaedics and department of Biochemistry, Chirayu Medical College and Hospital Bhopal. The study comprised of the total of 100 subjects. Five millilitre of venous blood was collected from subjects in plain vials (red top tube) and the serum Vitamin D level was assessed by ELFA method using Biomeriuxminividas. Results: Among the 100 individuals studied in this study there was 66 Females and 34 Males. Among the study group studied it was found that approx. 25% of the total individuals studied are Vitamin D deficient i.e. having serum vitamin D level &lt;20 ng/ml. 20% of the individuals in study group have insufficient vitamin D level i.e. between 20-29 ng/ml. 44% of the total individuals studied have sufficient Vitamin D level (between 30-100 ng/ml) in their sera but in this 44% individuals approx. 11% individuals have their serum vitamin D level in the borderline normal range i.e. between 30-40ng/ml. Conclusion: As Vitamin D deficiency affects all age groups, therefore, strategies such as increasing awareness among masses about adequate exposure to sunlight, rich dietary sources of vitamin D and fortification of foods with Vitamin D which are consumed by majority of Indian population irrespective of the socio-economic status can be adopted and implemented for prevention and control of Vitamin D deficiency throughout the nation.

Estimation of magnesium in patients with functional hypoparathyroidism.

Context:It is evident that about 30-50% of patients with Vitamin D deficiency (VDD) do not manifest develop secondary hyperparathyroidism (SHPT). A number of theories have been proposed to explain this lack of SHPT, including hypomagnesemia.Settings and Design:Retrospective review of laboratory database.Materials and Methods:We evaluated the differences in serum magnesium (Mg) levels among those with VDD with or without SHPT. A retrospective review of 6255 laboratory data of bone mineral profiles performed in the period of 2007–2013. After excluding patients with hypercalcemia, renal dysfunction/unknown kidney function and primary hypothyroidism, the remaining 1323 patient data were analyzed. SHPT was defined as serum parathyroid hormone >65 in those with VDD.Statistical Analysis Used:ANOVA and Wilcoxon tests as appropriate to compare means. Multivariate logistic regression to analyze relation between variables and outcome of SHPT.Results:We noted that 55% patients (n = 727) had VDD, and among those who had VDD, 23% (n = 170) were hypocalcemic (corrected serum calcium <8.5). Patients with VDD who did not exhibit SHPT were 56% (n = 407). The mean (±standard deviation) serum Mg levels in the entire cohort (n = 1323) was 1.94 ± 0.26 mg/dl and 1.95 ± 0.26 mg/dl in VDD cohort and 2 ± 0.31 mg/dl in the VDD-hypocalcemic cohort. There was no statistical difference in the Mg levels among those with SHPT compared to those without SHPT (P = 0.14). Serum calcium and phosphorus were lower in those with SHPT (P = 0.06 and P < 0.001, respectively). In multivariate logistic regression, serum calcium (P = 0.043), phosphorus (P < 0.001) and severe VDD (P < 0.001) independently correlated with occurrence of SHPT in VDD.Conclusions:Serum Mg levels did not explain the functional hypoparathyroidism seen in about half of the patients with VDD. A low normal serum calcium and phosphorus levels are more likely to be associated with VDD patients who develop SHPT.

Tenofovir-Linked Hyperparathyroidism Is Independently Associated With the Presence of Vitamin D Deficiency

To determine patient and treatment characteristics associated with vitamin D deficiency (VDD) in an UK inner city HIV-1-positive adult cohort. Two hundred twenty-seven HIV-positive patients attending prospectively for routine blood tests in winter had serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations and other routine chemistry measured. Those with and without VDD were defined as having serum 25-hydroxyvitamin D concentrations <50 nmol/L and >75 nmol/L, respectively. Characteristics were compared between patients with and without VDD. The effects of VDD, tenofovir use, and their interaction on chemical measures were investigated. VDD was found in 57% (131 of 227) of patients. Independent associations included nonwhite ethnicity [adjusted odds ratio (95% confidence interval): 7.40 (2.52 to 21.7)], higher random blood glucose [2.38 (1.24 to 4.57) per mmol/L], higher estimated glomerular filtration rate [eGFR: 1.04 (1.01 to 1.06)], and higher PTH [1.19 (1.00 to 1.42)]. PTH was higher in those receiving tenofovir (median 7.2 pmol/L) than other patients (4.3; P < 0.001) overall, but high PTH with tenofovir occurred only in the context of VDD. Tenofovir use was not associated with serum creatinine or eGFR overall but interacted with vitamin D status (P = 0.05 and P = 0.08, respectively), being linked to somewhat higher creatinine and lower eGFR among patients without VDD but higher eGFR in VDD patients. 25(OH) VDD is associated with tenofovir-linked hyperparathyroidism and also with higher eGFR.