VitD Levels Research Articles

The Role of Vitamin D in Autoimmune Thyroid Diseases: A Narrative Review.

Vitamin D (VitD) deficiency has garnered significant attention in contemporary medical research. Although the canonical biological activity of VitD manifests itself mainly in the regulation of calcium-phosphorus metabolism, recent studies show that, thanks to the presence of numerous receptors, VitD may also play an important role in regulating the immune system. VitD deficiency has been demonstrated to impact autoimmune disease, coeliac disease, infections (including respiratory/COVID-19), and patients with cancer. Recent studies also show that VitD plays a significant role in autoimmune thyroid diseases (AITDs). Many studies have shown a correlation between low VitD levels and chronic autoimmune thyroiditis - Hashimoto thyroiditis (HT), Graves' disease (GD), and postpartum thyroiditis (PPT). This review article, therefore, describes the current state of knowledge on the role of VitD in AITDs, including HT, GD, and PTT.

Evaluation of Vitamin D3 levels and dietary management in patients with papillary thyroid cancer.

Vitamin D (VitD) plays various roles, promotes musculoskeletal health, maintains parathyroid hormone levels and supports the immune processes. Vitamin D deficiency is common among cancer patients including thyroid cancer. Since some data indicate that preoperative VitD levels in cancer patients correlate with the further prognosis of the disease. Therefore, it is worthwhile to investigate this in the most common cancer of the thyroid gland, papillary thyroid cancer (PTC). The aim of this study was to evaluate serum VitD levels in patients with PTC concerning age, gender, body mass index (BMI), cancer stage, thyroid hormone levels, thyroglobulin concentration and the efficiency of VitD3 supplementation in these patients. Our cross-sectional study included 105 patients, and 34 healthy subjects in the control group. After 12 weeks of VitD3 supplementation (insufficient patients received1000IJ/day, deficient patients 2000IJ/day, severe deficient patient 5000IJ/day) along with the lifestyle and dietary management, the response was evaluated according to the personal characteristics, levels of VitD, free thyroxine (FT4), freetriiodothyronine (FT3) hormones and thyroglobulin (TG). The responders whose median age was 61-year-old, were mostly women (94%), with BMI below 23.7kg/m3, which indicates that most of the patients were normally nourished. 70% of patients were in the first stage of PTC, 76% had a vitamin D deficiency, while musculoskeletal disorders were present in 30% patients. VitD supplementation improved serum VitD status, FT3 discretely elevated and the TG levels significantly decreased in our PTC patients. It should be noted that VitD deficiency is presented in 70% of patients with PTC in our study sample. Dietary recommendation applied as lifestyle changes along with oral VitD3 supplementation, corrected VitD status to the recommended serum level. Although the data from our study is not sufficient to evaluate the VitD level as a prognostic factor for cancer, we have shown that it is necessary to examine its level along with an individual dietary approach for each patient with PTC.

Circulating miR-340-5p and miR-506-3p as Two Osteo-miRNAs for Predicting Osteoporosis in a Cohort of Postmenopausal Women.

An increasing risk of developing osteoporosis which is characterized by bone production weakness and microarchitectural deterioration is found among postmenopausal women. MicroRNAs (miRNAs) are secreted into the circulation from cells of various tissues in response to local disease severity including bone diseases. Herein, we set out to identify candidate miRNAs predictable for osteoporosis incidence in postmenopausal elderly women. The circulating miRNA expression profiles deposited in the dataset accessioned as GSE201543 were downloaded from the GEO database. The study included 176 postmenopausal women who underwent BMD testing, including 96 women reporting osteoporosis and 70 women reporting normal BMD. All subjects were submitted their serum samples for measurements of bone metabolism markers. The miRNA expression profiles of the GSE201543 dataset were differentially analyzed and found 97 miRNAs being upregulated concomitantly with 31 miRNAs being downregulated in the serum samples between osteoporotic postmenopausal women and postmenopausal women with normal BMD. Osteoporotic postmenopausal women were demonstrated with elevated serum levels of miR-340-5p and miR-506-3p when compared to normal postmenopausal women. Pearson correlation analysis demonstrated that circulating miR-340-5p and miR-506-3p expressions were increased as BAP, β-CTx, and PINP levels increased, but osteocalcin and 25-(OH)VitD levels are declined in osteoporotic postmenopausal women. Results of the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) showed circulating miR-340-5p and miR-506-3p expressions alone or combined together produced 0.843 AUC, 0.851 AUC, and 0.935 AUC, respectively, when used to predict the incidence of osteoporosis in postmenopausal women. Our work suggested that circulating miR-340-5p and miR-506-3p function as osteo-miRNAs in postmenopausal women and may serve as potential noninvasive biomarkers for the incidence of osteoporosis in postmenopausal women.

The Relation between Atrial Fibrillation Cardioversion Success Rate with Vitamin D Level in Patients Underwent Elective Cardioversion in King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guards, Riyadh Saudi Arabia.

To investigate the relation between serum Vitamin D (Vit-D) levels and the success rate of cardioversion for atrial fibrillation (AF). To examine the association between Vit-D level and successful cardioversion. This study also describes the general characteristics of patients with successful cardioversion. In this retrospective study, patients with AF who were treated using electrical cardioversion at King Abdulaziz Cardiovascular Center (KACC) between 2010 and 2021 were included. The information on demographic and clinical characteristics as well as outcome variables was collected. Of 100 patients who were admitted to KACC during the study period, 63% were females and 9% were diagnosed with Vit-D deficiency. Furthermore, 66% of patients had successful cardioversion. Moreover, no significant difference in Vit-D deficiency was observed between patients who had successful cardioversion and those with unsuccessful outcomes (P = 0.485). There is no association between serum Vit-D levels and the success rate of cardioversion in patients with AF. However, further studies are needed for more conclusive evidence.

The correlation between vitamin D levels and inflammation, as well as the Prognostic Nutritional Index (PNI), in people who are over the age of 60.

Aim: Elderly populations often have insufficient vitamin D (vit-D), which may contribute to autoimmune diseases and inflammation. Few studies have examined vit-D levels and immune function in humans. The study looked at vit-D levels and inflammatory markers in older adults. Material and Methods: Retrospective research was done. The hospital's records were searched for the study's data. Participants were 65-year-olds who applied to the internal medicine outpatient clinic between May 2020 and May 2022. Each person's vit-D, CRP, Lymphocyte/Monocyte, Neutrophil/Lymphocyte, Platelet/Lymphocyte, Ferritin, and Prognostic nutritional index (PNI) levels were measured. Results: The information from 2118 patients was analyzed as part of the study. Of those patients, 324 met the requirements for participation in the research, and the participants' average age was 73.21 years, with a standard deviation of 5.24 years. The average level of vit-D found in people was 14.18 nmol/L, with a standard deviation of 6.14 nmol/L. It was discovered that there was a negative correlation that was statistically significant between the individuals' levels of vit-D and the ratio of CRP to MPV (p less than 0.05). Vit-D and PNI were found to have a correlation of r=0.205, which was found to be positive and significant (p <0.05). Every 0.721-unit increase in PNI will result in an additional 1 unit of 25(OH) vit-D. It was found that the CRP (mg/L) variable contributed significantly to the model, and it was discovered that the presence of 1 unit of 25(OH) vit-D was increased for every 0.202 unit decrease (p <0.05). Conclusion: Insufficient vitamin 25(OH)D is found in the elderly population. 25(OH) vit-D has a negative relationship with CRP (mg/L) and MPV (fL), but a positive relationship with PNI, an indicator of nutritional status. The study suggests that if an elderly person is disabled, nutritional supplements should be provided.

Association of Long Non-Coding RNA Malat1 with Serum Levels of Interleukin-1 Beta and Vitamin D in Patients with Ischemic Stroke.

Previous studies have demonstrated the strong association of inflammatory cytokines and vitamin D (VitD) deficiency and ischemic stroke (IS) pathogenesis. Due to the negative correlation between long non-coding RNA (lncRNA) Malat1 and pro-inflammatory factors we decided to investigate the associations between Malat1 expression with serum interleukin-1β (IL-1β), and VitD levels in IS patients. In this cross-sectional study, 63 IS patients were included. We used enzyme-linked immunosorbent assays to evaluate the serum levels of VitD and IL-1β. Malat1 expression was evaluated by the real-time polymerase chain reaction test. The associations between Malat1expression with VitD and IL-1β were analysed with linear regression (Stepwise model) and Pearson's correlation analysis. The Malat1 expression was inversely correlated with stroke severity (r=-0.25, P=0.043). Stepwise regression analysis showed a significant positive relationship between VitD level and Malat1 expression (Beta=0.28, P=0.02), and also showed a non-significant negative relationship between IL-1β and stroke severity. VitD level showed a positive Pearson correlation with Malat1 (r=0.28, P=0.023) and a negative correlation with IL-1β (r=-0.29, P=0.018) while it could not detect a significantly negative correlation with stroke severity. For the first time the associations between Malat1 expression with IL-1β and VitD in IS patients was analyzed. We found a significant positive relationship between VitD and Malat1. This correlation needs to be investigated with a larger sample size to achieve a strong and reliable association between VitD and Malat1.

Vitamin D ameliorates liver pathology in mice caused by exposure to endocrine disruptor bisphenol A.

Increasing evidence suggests that bisphenol A (BPA) induces liver pathological changes. Further, an association between BPA and circulating vitamin D (VitD) levels were documented. The role of VitD in BPA-induced liver pathological changes was explored in this study. Healthy 4.5-week-old male (n = 35) and female (n = 35) Swiss albino mice were used in this study. The animals were randomly divided into control and treated groups. The control groups were further divided into sham (no treatment) and vehicle (corn oil), whereas the treated groups were also divided into VitD (2195 U/kg), BPA (50 μg/kg), and BPA + VitD (50 μg/kg + 2195 U/kg) groups. For 6 weeks (twice a week), the animals were dosed intraperitoneally. One week later (at 10.5-weeks-old), the animals were sacrificed for biochemical and histological analyses. BPA produced a considerable rise in the body and liver weights in both genders of mice when compared to control mice. BPA also caused significant increases in the liver damage markers alanine transaminase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). It also induced liver histopathological changes, including higher apoptotic indices in both genders. On the other hand, treatment with VitD considerably reduced liver damage and slightly decreased the apoptotic index rate. The ALP, ALT, and GGT levels were also markedly reduced. VitD has been proven to have a protective effect on both genders. According to our findings, VitD protects mice from BPA-induced liver damage, possibly via suppressing liver damage markers.

A case report of pseudohypoparathyroidism with bilateral fracture of neck of femur

A 19 year old female presented with a spontaneous onset of progressive non-traumatic b/l hip pain with inability to walk since 5 weeks. P/h/o pulmonary TB 2 years back present. 5 drug AKT taken for 9 months. Local tenderness was elicited and xray and MRI pelvis with both hips and LS spine was done which showed pathological fracture of basal neck of femur both side with severe listhesis of lumbosacral spine. Diagnosis of Pseudohypoparathyroidism was made on the basis of blood investigations which showed hypocalcaemia, hyper- phosphatemia, raised PTH, low Vit D3 level. Fixation of bilateral of neck femur with cancellus screw done to provide compression both side along with calcium and Activated Vitamin D3 supplimentation. Patient showed excellent response.

Effect of acute or subchronic stress on T cell response in peripheral blood: Regulatory role of vitamin D

The immune response, orchestrated by helper (Th1, Th2, and Th17) and regulatory (Treg) T cells, is modulated by stress and Vitamin D (Vit-D). Although the immunomodulatory functions of both are known, their specific roles on Th cells have not been fully clarified, yet. On this background, we aimed to investigate the effect of acute or subchronic stress on the distribution of peripheral T lymphocytes, as well as the immunomodulatory role of Vit-D. Young adult male, Swiss-albino mice (30–40g) were allocated to the control, acute stress (AS), subchronic stress (ChS), control+Vit-D, AS+Vit-D, and ChS+Vit-D groups (n=11/group). The combined cold (2-h at 4°C)-immobilization (2-h in a restrainer) stress protocol was employed as one day in AS groups and five consecutive days in ChS groups. Vit-D (2μg/kg ip) was applied every other day, until the end of the protocol. Serum cortisol, Vit-D and cytokine levels (IL-4, IFN-γ, and IL-17A) were measured, and lymphocytes from blood samples were subtyped by flow-cytometry. Stress exposure caused differential Th and Treg responses, acute stress shifting the response to Th1, and subchronic stress shifting the response to Th2. Th17 and Treg cells were lower in subchronic stress exposed mice. These changes became comparable to control values in Vit-D treated groups. The T cell response, crucial for immune system function, differs on the basis of stress exposure as such the Vit-D treatment. The tolerogenic profile created by Vit-D should be considered for management of stress-related diseases. Our results may help to provide a better understanding of disease pathogenesis.

Vitamin D3 and Lactobacillus rhamnosus GG/p40 Synergize to Protect Mice From Colitis by Promoting Vitamin D Receptor Expression and Epithelial Proliferation.

While vitamin D (VitD) levels are negatively correlated with inflammatory bowel disease (IBD) activity, VitD supplementation does not reduce IBD severity. The probiotic Lactobacillus rhamnosus GG (LGG), which secretes p40, can upregulate colonic VitD receptor (VDR) expression. We therefore evaluated synergy between VitD3 and LGG/p40 in the treatment of mouse colitis. A dextran sulfate sodium (DSS) colitis model was established in Vdr+/+ and Vdr-/- mice, and mice were treated with VitD3, LGG, or p40 alone or in combination for 7 to 14 days. Colitis severity was assessed by weight loss, disease activity index (DAI), colon length, histology, and inflammatory cytokine expression together with VDR expression, proliferation, and apoptosis. In vitro, VDR expression and cell viability were assessed in HCT116 cells after stimulation with p40. Total and nuclear VDR protein expression were lower in DSS-treated Vdr+/+ mice compared with control mice (P < .05). Compared with the DSS group, VitD3 + LGG alleviated colitis as assessed by significantly improved DAI and histological scores, increased colon length, decreased colonic Tnf, and increased Il10 expression together with increased colonic VDR gene and protein expression and increased Ki-67 proliferation index (P < .05). In Vdr-/- mice, VitD3 + LGG had no effect on DSS colitis. In Vdr+/+ mice, VitD3 + p40 also reduced colitis severity according to clinicopathological and immunological metrics and increased VDR expression and epithelial proliferation (P < .05). In HCT116 cells, p40 stimulation increased VDR protein expression and viability (P < .05). VitD3 and LGG/p40 synergistically improve the severity of colitis by increasing colonic VDR expression and promoting colonic epithelial proliferation.

Study on the relationship between vitamin D level and macrophage typing in patients with type 2 diabetes mellitus

ObjectivePopulation studies have shown that vitamin D (VitD) deficiency is associated with an increased incidence of type 2 diabetes mellitus (T2DM), VitD deficiency is a potential risk factor for T2DM, and the proportion of M1-type macrophages and M2-type macrophages in T2DM patients is imbalanced. Another study reported that VitD can affect the differentiation of macrophages into M1 and M2 types. However, there is no definitive result about the correlation between plasma VitD levels and macrophage typing in patients with T2DM. Whether VitD affects the progression of T2DM by regulating the polarization type of macrophages and the specific regulatory mechanism is not very clear. Therefore, we carried out the following research.MethodsWe first used flow cytometry to detect the proportions of M1 and M2 macrophages in peripheral blood of T2DM patients with different VitD levels. Furthermore, we used ELISA to detect the inflammatory factors affecting macrophage differentiation in patients’ plasma, including IL-6 secreted by M1-type macrophages and TGF-β secreted by M2-type macrophages. Mononuclear cells were separated from human peripheral blood with immunomagnetic beads, cultured in vitro, and treated with different concentrations of VitD, and the ratio of differentiation into M1 and M2 macrophages was detected by flow cytometry.ResultsWith the increase of serum 25(OH)D levels in patients with T2DM, the proportion of M1 and M2 macrophages in peripheral blood decreased, that is, the polarized phenotype of macrophages was more inclined to M2 type, while plasma IL-6 gradually decreased, and TGF-β gradually increased. In addition, VitD can promote the differentiation of CD14-positive monocytes cultured in vitro into M2 macrophages.ConclusionsWhen the level of VitD in T2DM patients is low, there are more M1-type macrophages in peripheral blood, and when the level of VitD is increased, M2-type macrophages are increased. Changes in related inflammatory factors were also consistent. In vitro culture of monocytes further confirmed that VitD can promote the differentiation of macrophages to M2 type in T2DM patients.

Vitamin D deficiency in relation with the systemic and central inflammation during multiple sclerosis.

During the last decade, vitamin D (VitD) has become a topic of interest in immune regulation, especially in multiple sclerosis (MS) disease. Amongst the wide range of effects reported for this vitamin on the immune system, a regulatory role on cytokines production has been described. Our aim is to analyze the status of VitD and its correlation with the circulating inflammation and the intrathecal humoral response during MS. We analyzed samples of 318 individuals: 108 MS patients and 210 controls. Determination of 25-(OH) VitD3 level in serum was made using electrochemiluminescence method. Circulating inflammatory cytokines (IL-6, IL-8, IL-10, TNF-a, IL12p70 and IL-1b) were investigated using Cytometer Bead Array Technology. The central humoral response was characterized using CSF isofocusing test and IgG Index calculation. As expected, mean value of VitD was significantly lower in MS group (26 nmol/L) than in control group (34.75 nmol/L) (p=0.002), with a severe deficiency in 67% of MS patients. Mean value of VitD was significantly lower in MS female patients. Regarding cytokines, mean value of TNFa was significantly higher in MS patients with oligoclonal bands of IgG in the CSF. IL6 was positively correlated with IgG level in serum of MS patients. Our results support the association of VitD deficiency with MS, especially in female patients of our region. However, the vitamin level seems to not correlate with inflammatory cytokines nor with disability. Interestingly, TNFa and IL6 levels were correlated with the intrathecal synthesis of IgG and the circulating IgG level, respectively.

The Role of Calcium, 25-Hydroxyvitamin D, and Parathyroid Hormone in Irritable Bowel Syndrome: A Bidirectional Two-Sample Mendelian Randomization Study

Several observational studies have indicated the potential associations among calcium, vitamin D (Vit-D), and irritable bowel syndrome (IBS). However, the causal relationship deduced from these studies is subject to residual confounding factors and reverse causation. Therefore, we aimed to explore the bidirectional causal effects among serum calcium, Vit-D, PTH, and IBS at the genetic level by a two-sample Mendelian randomization (MR) analysis of the datasets from IEU OpenGWAS database. Sensitivity analyses were performed to evaluate the robustness. The estimates were presented as odds ratios (ORs) with their 95% confidence intervals (CIs). The results of the inverse variance weighted method did not reveal any causal relationship between the genetically predisposed calcium (OR = 0.92, 95% CI: 0.80-1.06, p = 0.25) and Vit-D (OR = 0.99, 95% CI: 0.83-1.19, p = 0.94) level and the risk of IBS. The bidirectional analysis demonstrated that genetic predisposition to IBS was associated with a decreased level of PTH (beta: -0.19, 95%CI: -0.34 to -0.04, p = 0.01). In conclusion, the present study indicates no causal relationship between the serum calcium and Vit-D concentrations and the risk of IBS. The potential mechanisms via which IBS affects serum PTH need to be further investigated.

Trends in vitamin D level and risk of vitamin D deficiency after gastrectomy for gastric cancer: A retrospective study of a single high-volume center experience

Post-gastrectomy vitamin D deficiency can result in osteoporosis and fractures, which can decrease patient quality of life and increase their socioeconomic burden. However, because there is no consensus around preoperative measurement and regular postoperative monitoring of serum vitamin D [25(OH)vitD] level for gastric cancer patients, we performed a retrospective study with a single high-volume center experience. We reviewed a database of 614 gastric cancer patients who underwent curative gastrectomy between December 2015 and December 2019. Multivariate analyses were performed to identify risk factors for 25(OH)vitD deficiency after one year postoperative (n=546). A linear mixed model was used to evaluate changes between preoperative (n=585) and postoperative (6 [n=504] and 12 months [n=572]) 25(OH)vitD values. Preoperative 25(OH)vitD deficiency occurred in 67.7% of patients with gastric cancer. Patients who underwent postoperative chemotherapy for advanced pathologic disease were more likely to be 25(OH)vitD deficient at postoperative year one than those who did not receive chemotherapy (P=0.005). Postoperative chemotherapy was an independent risk factor along with preoperative 25(OH)vitD level for one year postoperative 25(OH)vitD deficiency (P=0.002). Meanwhile, there was significant change in 25(OH)vitD level after surgery according to reconstruction (increased in Billroth I group compared to gastrojejunostomy group, P=0.016), pathologic stage (increased in stage I group, decreased in stage II and III group, P=0.005), postoperative chemotherapy (increased in non-chemotherapy group, decreased in chemotherapy group, P=0.001), and season of surgery (increased when the blood tests were performed at summer, decreased when tested in non-summer season, P=0.009). More than half of gastric cancer patients had preoperative 25(OH)vitD deficiency, and those who had postoperative chemotherapy were at risk for 25(OH)vitD deficiency one year after surgery. There was a significant change in 25(OH)vitD level after surgery according to reconstruction method and postoperative chemotherapy. Preoperative measurement and regular postoperative monitoring should be considered for high-risk patients.

The Relationship of IL 17a, Vit-D Levels and some Biochemical Markers with Psoriasis and the Effect of Oral Vitamin D Supplementation on Clinical Amelioration of the Disease

The aim of the study was to measure vitamin D levels before and after giving specific doses of it. Patients with psoriasis have an imbalance in vitamin D levels, as vitamin D levels have been correlated with the level of disease progression. Psoriasis incidence rates after administration of vitamin D at a dose of 1 month every day 2000 IU, then the second and third month every week 10,000 IU for period a 3-month indicate that the size of the affected area did not expand or stopped expanding. Also in our study, interleukin-17 levels and lipid profile showed some changes, indicating that high levels of vitamin D may reduce inflammation or inflammatory diseases by contributing to immune system activation. There were notable changes in average lipids and the effect was likely caused by changes in vitamin D levels, which play an important role in lipid metabolism. There was also a decrease in calcium levels.

The efficacy of oral vitamin D supplements on fusion outcome in patients receiving elective lumbar spinal fusion—a randomized control trial

BackgroundPrevious studies have reported that vitamin D supplement could improve fracture healing, but evidence regarding the role of vitamin D supplements in spinal fusion was limited. Thus, this study aimed to evaluate the effectiveness of oral vitamin D supplements on fusion outcomes in patients undergoing lumbar spinal fusion.MethodsThis randomized, double-blind, parallel-designed, active-control trial included the patients who planned for elective lumbar spinal fusion. Eligible patients were randomly assigned to receive either daily vitamin D3 (cholecalciferol) 800 IU and daily calcium citrate 600 mg (experimental group) or only daily calcium citrate 600 mg (control group). All supplements were given from postoperative day 1 and lasted for 3 months. Primary outcome was postoperative 1-year fusion rate, and secondary outcomes included time to fusion, Oswestry Disability Index (ODI), and visual analogue scale (VAS) for pain.ResultsAmong the included 34 patients (21 in the experimental group and 13 in the control group), baseline 25-hydroxyvitamin D (25[OHVitD) level was 26.7 (10.4) ng/ml. Preoperative prevalence of vitamin D deficiency and insufficiency were 23.5% and 47.1%, respectively. Postoperative 1-year fusion rate was not significantly different between the two groups (95.2% vs. 84.6%, P = 0.544). The experimental group had significantly shorter time to fusion (Kaplan–Meier estimated: 169 days vs. 185 days [interquartile range: 88–182 days vs. 176–324 days], log-rank test: P = 0.028), lower postoperative 6-month ODI (P < 0.001), and lower postoperative 6-month VAS (P < 0.001) than the control group. Time to fusion was significantly and negatively correlated with preoperative, postoperative 3-month, and 6-month 25(OH)VitD levels (all P < 0.01).ConclusionThe patient with vitamin D supplements had shorter time to fusion, better spinal function and less pain after elective spinal fusion. Further research is warranted to identify the patients who can benefit the most from vitamin D supplements and the appropriate dose of vitamin D supplements.Trial registrationClinicalTrials.gov, NCT05023122. Registered 20 August 2021. Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT03793530.

Evaluation of interleukins 37 and 38 and vitamin D status in the serum of women with Graves' disease.

Graves' disease (GD) is an autoimmune thyroid disorder and recent studies have proposed a role for interleukin (IL)-37, IL-38, and vitamin D (VitD) in the pathophysiology of disease. Therefore, this study investigated the expression of IL-37, IL-38, and VitD in the serum of GD patients and correlations of their levels with some demographic and clinical characteristics. Serum IL-37, IL-38, and VitD levels were evaluated in 90 women with GD and 93 control women using enzyme-linked immunosorbent assay kits. Depending on therapy, six patients were newly diagnosed (ND; untreated), and 50 patients were receiving only carbimazole (CMZ), while 34 patients were also on CMZ but also received one (31 patients), two (one patient), or three (two patients) doses of radioactive iodine (RAI). IL-37 levels were significantly higher in GD patients than in controls, while IL-38 and VitD levels were significantly decreased. As indicated by the area under the curve (AUC), receiver operating characteristic curve analysis demonstrated the potential of IL-37, IL-38, and VitD as biomarkers to distinguish GD patients from controls (AUC=0.953, 0.959, and 0.793, respectively). Multinomial logistic regression analysis showed that altered levels of IL-37, IL-38, and VitD were most likely associated with the pathogenesis of GD. IL-37 was negatively correlated with IL-38 and VitD, while IL-38 and VitD were positively correlated. Serum Il-37 levels were upregulated in women with GD, while IL-38 and VitD levels showed downregulated levels. The latter two were positively correlated while they showed a negative correlation with IL-37.

Reduction in Opioid Use and Clinical Complications in Vitamin D Deficient Pediatric SCD Patients Following Vitamin D Replacement

Background: Hydroxyurea, the most common drug used to treat SCD patients, has several limitations: inadequate clinical benefit in 50% of adults, poor compliance, teratogenicity, marrow toxicity, and reduced fetal hemoglobin (HbF) induction over time. Thus, there is a need for additional treatment options. Vitamin D (vitD) could be a potential treatment option because it: 1) increases HbF and mean corpuscular volume, 2) reduces white cell (WBC) and platelet counts, and 3) is associated with increased morbidity in SCD patients. However, insufficient data demonstrating clinical benefits following vitD replacement prevents its routine use. To address this knowledge gap, we analyzed the change in emergency room visits/hospital admissions (admission rate), opioid use, clinical complications, HbF levels, and WBC count in pediatric SCD patients after vitD replacement. Methods: SCD patients 21 years and younger who received vitD at Texas Children's Hospital from 2007 to 2021 were included in this retrospective longitudinal study. Patients on chronic transfusions were excluded. Three-month data after an on-demand blood transfusion was also excluded from the analysis set as transfusion affects HbF levels temporarily. The study period included two years before vitD replacement (pre-vitD period, referent category ), vitD replacement period, and one year after cessation of vitD (post-vitD period). The patients with vitD levels < 30 ng/ml and ≥ 30 ng/ml were considered vitD deficient and not deficient, respectively. VitD levels or the vitD replacement status (pre-vitD, vitD, and post-vitD) were the exposure variables. Age and folic acid were considered potential confounders, and genotype and maximum tolerated dose of hydroxyurea (MTD) were effect modifiers. Hydroxyurea dose of ≥ 35 mg/kg/day or the dose that achieved absolute neutrophil count between 2000-4000/cmm was considered MTD. Statistical analyses: Two-level linear mixed model and Wilcoxon rank-sum tests were used. WBC, admission rate, and opioid use-related variables required log transformation to meet the model assumptions. A covariate was retained if its exclusion changed the beta coefficient of the exposure variable by over 10%. A backward selection method was used to derive a final model. P-values were adjusted for the multiple testing. Results: We analyzed 136 patients (male=68, average age=12.3 years, SCA=129) with a total of 534 clinic visits. The median follow-up was 3.5 years. 47.4% did not exhibit an elevation of vitD levels and 10.9% had a recurrence of deficiency despite an adequate replacement dose (median 2000 IU/day). Patients were on a stable dose of hydroxyurea (median: 19.9 mg/kg/day) during the study period. The reduction in hospital admissions, emergency room visits, infections, transfusions, and acute chest syndrome was higher during the vitD period than post-vitD period (Table1, Figure 1). The loss/reduction in benefits during the post-vitD period could be due to falling vitamin D levels and recurrence in 10.9% of patients. A comparable reduction in opioid use during the vitD and post-vitD replacement periods (81 vs.82%) suggests sustained benefit in pain reduction beyond the replacement period. (Table 1). Higher vitamin D levels were associated with higher HbF levels and lower WBC counts (Table1). There was a higher increase in HbF levels in patients at MTD (1.89% points) compared to the patients not at MTD (0.38% points) for each 10 ng/ml increase in vitD levels (p<0.01). Similarly, there was a higher reduction in WBC count in patients at MTD (15%) compared to the patients not at MTD (1%) (p<0.01). Conclusion: Our data show a statistically significant reduction in emergency visits/hospital admissions, opioid use, infections, transfusions, and acute chest syndrome following vitD replacement. The clinical improvement may be due to increased HbF levels and decreased WBC count observed with the increase in vitD levels. All subjects were on hydroxyurea; of note, subjects at MTD had a greater HbF response with vitD replacement than those not at MTD, suggesting an additive interaction between vitD and hydroxyurea. We, therefore, conclude that regular vitD screening followed by vitamin D replacement to achieve adequate vitamin D levels will likely reduce the public health burden of the SCD population significantly. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Study to assess Vitamin D deficiency and its association with sepsis in tertiary care centre

Introduction : Sepsis is a life threatening organ dysfunction generated due to the dysregulation of the immune response to infection. A high mortality rate in sepsis is the result of multiple organ failure which often follows sepsis. Recent studies have shown the correlation between vitamin D deficiency and severe infections and sepsis&#x0D; Aim and objective : To evaluate the correlation between serum levels of vitamin D and outcome of sepsis patients presenting to ED.&#x0D; Methodology : This cross sectional study was performed in the Saraswathi institute of medical sciences, Hapur from October 2021 to March 2022. For all the eligible patients, blood sample was drawn for measuring serum level of vitamin D and finally the correlation between the level of this vitamin and the studied outcomes was evaluated.&#x0D; Result : The mean vit d level of the study subjects who get cured were 23.09±11.20, whereas those patients who died had vit d level 16.12±10.60, on comparing there is significant association of vit d level with outcome of study subjects, with p value 0.02. On assessing vit D level with TLC of study subjects, on applying regression analysis we found no correlation between vitd level and TLC value of the study subjects with R square 0.&#x0D; &#x0D; Conclusion : On the basis of our study we can conclude that There is significant association of serum vit d level with outcome of sepsis in the study subjects. On comparing there is significant association of vit d level with outcome of study subjects, with p value 0.02, CRP increases generally in infections, it was associated with vit D level, however association was statistically non-significant.

Screening Questionnaire for Vitamin D Insufficiency in Children with Obesity.

Non-invasive screening tools to identify children at high risk of vitamin D (VitD) deficiency are proactive measures in preventive care. Recently, a validated questionnaire (Evaluation dEficieNCy Questionnaire, EVIDENCe-Q) for identifying newly diagnosed VitD-insufficient adults has been developed. We tested the EVIDENCe-Q modified for children with obesity and evaluated the correlation between VitD and questionnaire scores to adapt this tool to the pediatric population. We enrolled 120 children with obesity (BMI ≥ 2). Clinical evaluation and VitD levels were considered. The modified EVIDENCe-Q included information regarding factors affecting control of VitD, with scores ranging between 0 (best) and 36 (worst). VitD and adiposity indices were inversely correlated. The threshold values for identifying severe deficiency (&lt;10 mg/dL), deficiency (&lt;20 mg/dL) and insufficiency (&lt;30 mg/dL) were scores of 21, 19 and 23, respectively. According to those thresholds, the prevalence of severe deficiency, deficiency and insufficiency was 47.5%, 69.2% and 23.3%, respectively; the best accuracy was obtained with a questionnaire score cut-off of 19 for the VitD deficiency level. A novel simple screening tool such as the modified EVIDENCe-Q would be useful in clinical practice to identify potential cases of hypovitaminosis D and select at-risk patients. Considering the limited accuracy and specificity of our results, for the pediatric population a dedicated tool should be created. Phases of childhood and the role of adipose tissue could be considered in the definition of a questionnaire intended for pediatric patients with obesity.