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Background: Vitamin D insufficiency is a widespread phenomenon, having an adverse effect on human health. This problem is also actual in Russia, which most part of the territory is located above the 42nd latitude and is at risk for vitamin D insufficiency. Objective: Our aim was to evaluate the vitamin D sufficiency of the child population of a junior age group and the adequacy of a drug treatment/prevention of vitamin D insufficiency in various regions of the Russian Federation. Methods: Children of the first 3 years of life, who received in-patient treatment in medical institutions of Russia, were examined. When they were involved in the study, they took a blood test to determine a plasma 25(OH)D concentration. The study period: November, 2013 – October, 2014. Results: 1,230 children aged from 1 month to 3 years were examined. Vitamin D insufficiency (25(OH)D concentration in the blood plasma 21–29 ng/ml) is found in 300 (24.4%), deficiency (25(OH)D ≤ 20 ng/ml) — in 513 (41.7%) children. The prevalence of vitamin D insufficiency and deficiency did not depend on a geographical location and level of insolation of regions, where the surveyed lived. Conclusion: In the studied selection more than 2/3 of children of a junior age group have a vitamin D insufficiency or deficiency. In this regard, it is expedient to revise the current guidelines taking into account modern approaches to the prevention and treatment of a vitamin D insufficiency, to make the appropriate changes and to implement them in a clinical practice.

The article analyzes "nursery English" in its substandard manifestations. It aims at classifying lexical units of the chosen colloquial area. Grouping the words is based on the comparison of neutral patterns and their specific ('nursery') counterparts. The results of the analysis demonstrate the two main tendencies of the language – redundancy and insufficiency – in their diverse expressions on the level of lexis of the researched field. The investigation discloses the basic models of "nursery English" (the English used by children) registered in fiction (A. Milne's prose and poetry have been chosen for the analysis). It points out the mechanisms, both, phonetic and morphological, used to create the specific nature of the language of the chosen area. The word reduction and extension is registered in the initial, medium, and final positions. Both linguistic phenomena may be caused by simplifying a complex sound structure, when a child is trying to overcome the difficulty of pronouncing the word; or they may arise in the event of eliminating or adding semantically insignificant word components, or be the consequence of insufficient knowledge of grammar. In most cases, the new formations of nursery English are quite clear to the speakers due to the context or speech situation. Yet, there appear structures which cause misunderstanding. The investigated stylistic area overlaps the specific scope of substandard English used by grown-up speakers; however, certain samples of the first one may be regarded as strictly "nursery". It is not unlikely that the expansion of the researched resource will reveal other transformations. The findings can benefit the studies of English stylistics and English Language System studies.

Background: Vitamin A deficiency is considered as one of the public health problems among pregnant women worldwide. Population representative data on vitamin A status in pregnancy have not previously been published from Iran. Objectives: The aim of this study was to publish data on vitamin A status in pregnant women in all the provinces of Iran in 2001, including urban and rural areas, and to describe the association of vitamin A status with maternal age, gestational age, and parity. Design: This descriptive cross-sectional study was conducted on 3,270 healthy pregnant women from the entire country, 2,631 with gestational age ≤36 weeks, and 639 with gestational age >36 weeks. Vitamin A status was determined in serum using high-performance liquid chromatography. Result: Retinol levels corresponding to deficiency were detected in 6.6% (1.4 µmol/L). The level of serum retinol was lower in older pregnant women (p=0.008), and at higher gestational age (p=0.009). High vitamin A levels were observed in pregnant women in the central areas of Iran and the lowest values in those in the southern areas of Iran. Conclusions: The vitamin A status was good in 2001 but should be closely monitored also in the future. About 25% of pregnant women had a vitamin A status diagnosed as insufficient or deficient (

У статті розглядається роль ферментів у процесі травлення, а також приділяється увага проблемі зовнішньосекреторної недостатності підшлункової залози. Дані характеристика ферментних препаратів, рекомендації щодо їх раціонального застосування.

With surgical palliation of hypoplastic left heart syndrome (HLHS), the tricuspid valve (TV) becomes the systemic atrioventricular valve and moderate/severe TV insufficiency (TVI), an adverse risk factor for survival to Fontan, has been reported in up to 35% of patients prior to stage I palliation. Precise echocardiographic identification of the mechanism of TVI cannot be determined by two-dimensional echocardiography. Three-dimensional echocardiography (3DE) can provide significant insight into the mechanisms of TVI. It is the intent of this report to propose a systematic method on how to evaluate and display 3DE images of the TV in HLHS which has not been done previously. TV anatomy, function, and the known mechanisms of insufficiency are reviewed. We defined three regions of the TV (anterior, posterior, septal) that can help define valve "leaflets" that incorporates the many variations of TV anatomy. To determine how the surgeon views the TV, a picture of a pathologic specimen of the TV was placed on a computer screen and rotated until it was oriented as it appears during surgery, the "surgeons view." We have proposed a systematic method for evaluating and displaying the TV using 3DE which can provide significant insight into the mechanisms causing TVI in HLHS. This has the potential to improve both the surgical approach to repairing the valve and, ultimately, patient outcomes.

A 64-year-old marathon runner presented to our clinic with a history of worsening pain in her left knee. Following magnetic resonance imaging, the diagnosis of subchondral insufficiency fracture of the knee (SIFK) was made. A course of conservative management via bisphosphonates was initiated. The patient successfully recovered and returned to full athletic function, having recently returned to competitive marathon running. This article aims to present this unusual case of lateral compartment SIFK and summarise the literature on this uncommon condition. [ABSTRACT FROM AUTHOR]

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Objectives: Vitamin D plays an important role in calcium homeostasis and is essential for normal bone growth and remodeling. Previous studies of acutely ill and institutionalized older women in Galway revealed that vitamin D insufficiency is extremely common. We aimed to evaluate age and gender-related rates of vitamin D insufficiency and deficiency in adult patients attending their General Practitioners in the same region. Design: A retrospective cohort study. Setting: General practices in Galway, a city located on the west coast of Ireland, latitude 53.17 North. Participants: A total of 15,708 consecutive blood samples from adults attending their General Practitioners between January 2013 and December 2014 were sent to the Clinical Biochemistry Laboratory in the University Hospital Galway for vitamin D level testing. 73% were from women. Intervention: Data were collected and grouped according to age, sex and season. Vitamin D levels (25OHD) were categorised into deficiency (<25nmol/L), insufficiency (25-50nmol/L) and sufficiency (>50nmol/L). Measurements: Median and interquartile range were reported as vitamin D levels were not normally distributed. Descriptive statistics were performed using STATA/MP 13.1 for Mac. Results: While vitamin D levels were sufficient in 56.4% (n=8,496), they were insufficient in 32.4% (n=4,891) and deficient in 11.2% (n=1,691). Of the deficient group, 19%(325) had levels <15nmol/L consistent with profound deficiency. Men were more likely than women to be deficient (12% (n=489) vs. 10.9% (n=1,202)) and insufficient (38.0% (n=1,550) vs. 30.4% (n=3,341)) (p<0.01). Highest rates of deficiency were seen in those 81-97 years (19.4% (n=136)) and 18-40 years (13.8% (n=543)), the former group showing less seasonal variation. Conclusion: Overall prevalence of insufficiency is similar to those in national and European studies published recently. However, there is a high possibility that those most vulnerable to vitamin D deficiency were underrepresented in this cohort, when results from previous studies in the same region are considered. Further prospective studies are needed to guide treatment with supplementation of vitamin D for appropriate subgroups. [ABSTRACT FROM AUTHOR]

Introduction: A significant correlation has been established between the pain and/or discomfort of Temporomandibular Joint (TMJ) and the various Activities of Daily Living (ADL). TMJ pain and/or discomfort have a significant negative impact on the daily activities and life of an individual. Although complex interplay of multifactorial causes accounts for temporomandibular disorders, bone markers like serum vitamin D are a reliable qualitative and quantitative tool to asses bone metabolism and health. Aim: To investigate the association between TMJ pain and discomfort in the ADL and to ascertain the relationship between serum vitamin D 25(OH)D levels and pain and discomfort with respect to TMJ during the ADL amongst controls and vitamin D deficiency patients in an Indian hospital based population in Mumbai, Maharashtra, India. Materials and Methods: The study included 100 adult patients reporting to the department of oral medicine and radiology on outpatient basis, who were divided into two groups (samples and controls) based on their serum 25(OH)D levels, the cut-off being 30 nmol/L. The effect of vitamin D levels on the activities of daily living were assessed using the scale by List and Helkimo. Variables were evaluated for statistical differences between male and female groups with AnOVA test. Significance of correlation was tested using Spearman rank correlation coefficient. A level of significance of 0.05 was considered to be significant. Results: In the study it was found that the serum vitamin D levels in female participants was lower than the male participants. The experience of TMJ pain and discomfort significantly impacts the activities of daily living in both sexes based on the rating scale elaborated in medical and behavioral science and modified by List and Helkimo. The study also shows that the pain/discomfort associated with TMJ has a significant negative influence on the social life, daily activities and also the psychological status of the individual. Conclusion: Vitamin D deficiency is significantly associated with tempormandibular pain, which can have adverse effects on the comfort and ADL of the patient. [ABSTRACT FROM AUTHOR]

Morbid obesity is a lifelong disease, and all patients require complementary follow-up including nutritional surveillance by a multidisciplinary team after bariatric procedures. Pancreatic exocrine insufficiency (PEI) refers to an insufficient secretion of pancreatic enzymes and/or sodium bicarbonate. PEI is a known multifactorial complication after upper gastrointestinal surgery, and might constitute an important clinical problem due to the large number of bariatric surgical procedures in the world. Symptoms of PEI often overlap with sequelae of gastric bypass, making the diagnosis difficult. Steatorrhea, weight loss, maldigestion and malabsorption are pathognomonic for both clinical conditions. Altered anatomy after bypass surgery can make the diagnostic process even more difficult. Fecal elastase-1 (FE1) is a useful diagnostic test. PEI should be considered in all patients after bariatric surgery with prolonged gastrointestinal complaints that are suggestive of maldigestion and/or malabsorption. Appropriate pancreatic enzyme replacement therapy should be part of the treatment algorithm in patients with confirmed PEI or symptoms suggestive of this complication. [ABSTRACT FROM AUTHOR]

Pelvic congestion syndrome is one of the many causes of chronic pelvic pain and is often diagnosed based on exclusion of other pathologies. Over the past decades, pelvic congestion syndrome was recognized to be a more common cause of chronic pelvic pain. Multiple diagnostic modalities including pelvic duplex ultrasonography, transvaginal ultrasonography, computed tomography, and magnetic resonance were studied. In the current literature, selective ovarian venography, an invasive imaging approach, is believed to be the gold standard for diagnosing pelvic congestion syndrome. [ABSTRACT FROM AUTHOR]

Background: Vitamin D inadequacy (deficiency and insufficiency) has become an epidemic with the assumption that women in Arab countries are at a higher risk due to their clothing style of wearing dark colored suits or a veil. Aim of the work: To determine the frequency of vitamin D inadequacy among young adult and early middle-aged males in Al-Qassim region and to study the effect of vitamin D supplementation. Patients and methods: Sixty Saudi males visiting Rheumatology Outpatient Clinic of a tertiary hospital in Al-Qassim region were enrolled and evaluated for musculoskeletal state including assessment of chronic diffuse musculoskeletal pains using Numeric Rating Pain Scale (NRPS) and functional evaluation of lower limb proximal muscle power using chair–rise performance test. Serum 25(OH)D was evaluated. Vitamin D supplementation was provided for symptomatic subjects. Follow-up clinical evaluation as well as serum 25(OH)D measurement after 12 weeks vitamin D3 supplementation was performed. Results: The mean age of the patients was 43.2 ± 6.4 years. 54 (90%) had vitamin D inadequacy; 42 (70%) deficiency and 12 (20%) had insufficiency. Significant increase in baseline serum 25(OH)D (13.92 ± 5.67 ng/ml) after 12 weeks of supplementation (35.94 ± 4.11 ng/ml) with significant decrease in NPRS (7.42 ± 2.12 vs 2.06 ± 2.04) (p < 0.001), as well as significant improvement of functional status scores of chair–rise performance test (93.95 ± 23.56 vs 203.1 ± 58.6 (p < 0.001). Conclusion: Vitamin D inadequacy is a major health problem not only in elderly people or women with in-door residency and dark-colored clothes, but also in Saudi male young adults in Al-Qassim region. [ABSTRACT FROM AUTHOR]

Background Relapses of immune-mediated hemolytic anemia ( IMHA), thrombocytopenia ( ITP), or polyarthropathy ( IMPA) occur despite normal hematologic and cytologic parameters. Thymidine kinase 1 ( TK1), canine C-reactive protein (c- CRP), haptoglobin ( HPT), and 25-Hydroxyvitamin- D (25( OH)D) might be adjunct to current monitoring strategies. Hypothesis/Objectives Compare serum concentrations of TK1, c- CRP, HPT, and 25( OH)D in dogs with well- and poorly controlled primary IMHA, ITP, or IMPA. Animals Thirty-eight client-owned dogs. Methods Prospective descriptive study. Dogs diagnosed with IMHA, ITP, or IMPA had serum biomarker concentrations measured commercially. Disease control was assessed by hematocrit/ PCV and reticulocyte count, platelet count, and synovial fluid cytology for IMHA, ITP, and IMPA, respectively. Statistical analysis performed by Mann-Whitney rank-sum tests and receiver operating characteristic curves. Results TK1 and c- CRP, but not HPT significantly decreased with well- versus poorly controlled IMHA ( P = 0.047, P = 0.028, P = 0.37). C- CRP, but not TK or HPT was significantly lower with well- versus poorly controlled IMPA ( P = 0.05, P = 0.28, P = 0.84). Sensitivity and specificity of TK and c- CRP (simultaneously) for detecting dogs with poorly controlled IMHA were 88 and 100%, respectively. Sensitivity and specificity of c- CRP for detecting poorly controlled dogs with IMPA were 13 and 100%, respectively. 92% of dogs were vitamin D insufficient (<100 ng/mL) regardless of disease control. Conclusions and Clinical Importance Combining TK1 and c- CRP might act markers of disease control in dogs with IMHA. Canine- CRP cannot be recommended as an independent marker of disease control in IMPA. 25( OH)D insufficiency in immune-mediated disorders might benefit from further study to determine if supplementation could improve therapeutic response or reduce disease risk. [ABSTRACT FROM AUTHOR]

A large number of evidence supports the role of vitamin D insufficiency in both women and men infertility. However, no studies have evaluated the rate of concordance of vitamin D status between the partners. This finding might open new scenarios in the interpretation of the available data linking vitamin D insufficiency and infertility. In the present cross-sectional study, 103 consecutive infertile couples were recruited between April and May 2014. Both partners concomitantly provided a serum sample for the assessment of 25-hydroxy-vitamin D [25-(OH)-D]. Vitamin D insufficiency was defined as serum 25-(OH)-D <20 ng/ml. One hundred-fifty subjects (73 women and 77 males) were 25-(OH)-D insufficient, corresponding to a rate of 73%. Overall, concordance was observed in 73 couples (71%), thus higher than the expected 61% (0.732 + 0.272) based on chance (p = 0.007). The Pearson coefficient of correlation R2 between the partners of the couples was 0.52 (p < 0.001). No statistically significant differences emerged when evaluating the rate of 25-(OH)-D insufficiency according to the causes of infertility. Serum 25-(OH)-D correlates within the partners of infertile couples. Further evidence is warranted to determine the clinical relevance and possible clinical applications of this finding. [ABSTRACT FROM AUTHOR]

Background. Vitamin D deficiency is prevalent in all the world countries. Recent studies show the correlation between vitamin D deficiency and musculoskeletal disorders. The purpose of this study is to examine vitamin D deficiency and insufficiency prevalence in patients of various ages, who have musculoskeletal disorders, and to reveal the influence of seasonal factors on these conditions. Materials and methods. 3460 patients of the Ukrainian scientific Medical Center of Osteoporosis Problems, aged 1 to 92 years, who were referred by other specialists to the center for bone state evaluation, were examined. A majority of the patients presented with osteoporosis and its complications, spinal osteochondrosis, knee and hip osteoarthritis (mean age — 52.90 ± 21.10 years). Most of the patients were women (83.5 %). 25(OH)D and parathyroid hormone analyses were performed by means of electrochemiluminescent method (Elecsys 2010 analyzer, Roche Diagnostics, Germany) and cobas test-systems. Statistics 6.0 software package (Copyright StatSoft, Inc., 1984-2001) was also used. Results. Among the patients with musculoskeletal pathology, the highest 25(OH)D level was noted in the age group of 1-9 years and the lowest — in the age group of 80 and over. Age negatively influenced 25(OH)D values. Prevalence of vitamin D deficiency among the patients with musculoskeletal pathology was 37.3 %, vitamin D insufficiency — 30.6 %; 32.1 % of patients had normal vitamin D status. Normal 25(OH)D level was found in 38.0 % of children, 33.2 % of adults and in 29.6 % of elderly patients. Month of blood sampling had a significant influence on 25(OH)D content (F = 7.49; p < 0.001). The highest significant differences in 25(OH)D levels during the summer vs. winter months were observed in the age groups of 10-19 (18.2 %), 40-49 (17.3 %), 30-39 (16.2 %) и 1-9 years (16.1 %). There were no significant seasonal differences observed in the elderly patients (60 years and older) with musculoskeletal pathology. Conclusions. Despite the combined calcium and vitamin D supplementation in most patients with musculoskeletal pathology, only 37.9 % of children, 33.2 % of adults and 29.6 % of the elderly people had normal 25(OH)D values and thus required screening examination of vitamin D level in patients with musculoskeletal disorders and additional vitamin D prescription (Guidelines for the Central and Eastern Europe). [ABSTRACT FROM AUTHOR]

Objective: To evaluate vitamin D deficiency prevalence and risk factors among pregnant Chinese women.Design: A descriptive cross-sectional analysis.Setting: China National Nutrition and Health Survey (CNNHS) 2010-2013.Subjects: A total of 1985 healthy pregnant women participated. Possible predictors of vitamin D deficiency were evaluated via multiple logistic regression analyses.Results: The median serum 25-hydroxyvitamin D level was 15·5 (interquartile range 11·9-20·0, range 3·0-51·5) ng/ml, with 74·9 (95 % CI 73·0, 76·7) % of participants being vitamin D deficient (25-hydroxyvitamin D <20 ng/ml). According to the multivariate logistic regression analyses, vitamin D deficiency was positively correlated with Hui ethnicity (P=0·016), lack of vitamin D supplement use (P=0·021) and low ambient UVB level (P<0·001). In the autumn months, vitamin D deficiency was related to Hui ethnicity (P=0·012) and low ambient UVB level (P<0·001). In the winter months, vitamin D deficiency was correlated with younger age (P=0·050), later gestational age (P=0·035), higher pre-pregnancy BMI (P=0·019), low ambient UVB level (P<0·001) and lack of vitamin D supplement use (P=0·007).Conclusions: Vitamin D deficiency is prevalent among pregnant Chinese women. Residing in areas with low ambient UVB levels increases the risk of vitamin D deficiency, especially for women experiencing advanced stages of gestation, for younger pregnant women and for women of Hui ethnicity; therefore, vitamin D supplementation and sensible sun exposure should be encouraged, especially in the winter months. Further studies must determine optimal vitamin D intake and sun exposure levels for maintaining sufficient vitamin D levels in pregnant Chinese women. [ABSTRACT FROM AUTHOR]

Objectives: Banxia Baizhu Tianma Decoction (BBTD) is widely used to treat vertebrobasilar insufficiency vertigo (VBIV) in China, but its efficacy remains largely unexplored. We systemically summarized relevant evidence from randomized controlled trials (RCTs) to assess the therapeutic effect of BBTD.Methods: Seven electronic databases were searched for relevant electronic studies published before July 2016. We evaluated RCTs that compared BBTD, anti-vertigo drugs and a combination of BBTD and anti-vertigo drugs. We performed a meta-analysis in accordance with the Cochrane Collaboration criteria. The outcomes were clinical efficacy (CE), blood flow velocity of the vertebrobasilar artery by transcranial Doppler (TCD), and adverse effects.Results: Twenty-seven studies with a total of 2796 patients were identified. Compared with anti-vertigo drugs, BBTD showed slight effects on CE (n=350; RR, 1.09; 95% CI, 1.01-1.18; p=0.03; I2=0%); however, BBTD plus anti-vertigo drugs (BPAD) significantly improved the clinical efficacy (n=2446; RR, 1.20; 95% CI, 1.16-1.24; p<0.00001; I2=0%) and accelerated the blood flow velocity of the left vertebral artery (LVA) (n=1444; WMD, 5.21cm/s; 95% CI, 3.72-6.70cm/s; p<0.00001; I2=91%), the blood flow velocity of the right vertebral artery (RVA) (n=1444; WMD, 5.45cm/s; 95% CI, 4.02-6.88cm/s; p<0.00001; I2=89%), and the blood flow velocity of the basilar artery (BA) (n=1872; WMD, 5.20cm/s; 95% CI, 3.86-6.54cm/s; p<0.00001; I2=90%). Adverse effects were mentioned in six studies.Conclusions: The current evidence indicates that BPAD is effective for the treatment of VBIV, but the efficacy and safety of BBTD is uncertain because of the limited number of trials and low methodological quality. Hence, high-quality and adequately powered RCTs are warranted. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is considered to be a public health problem. However, the nutrient status of vitamin D in Chinese children is unclear. The aim of this study was to describe the vitamin D status among children aged under 18 years in southeast China. Methods: Children who visited the Huzhou Maternal and Child Care Hospital from January 2012 to August 2015 were included in this large cross-sectional study. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by electrochemiluminescence immunoassay. Vitamin D status was defined as deficiency (25(OH)D < 20 ng/mL), insufficiency (25(OH)D: 20-29 ng/mL) and sufficiency (25(OH)D ≥ 30 ng/mL). The association between relevant variables and vitamin D status was analyzed by a using generalized estimated equation model and a multivariate regression model. Results: 13,997 children aged under 18 years were included. Of these, 23.3% children suffered from low vitamin D status (deficiency and insufficiency), while 76.7% had a sufficient vitamin D status. The prevalence of low vitamin D status was 29.7% in winter and 23.4% in spring, which was higher than that in summer (21.4%) and autumn (19.9%). Clinical visiting children (32.1%) suffered more from low vitamin D than health examination children (17.6%). Additionally, age and season were independently and significantly associated with 25(OH)D concentrations, respectively. Conclusions: The deficiency and insufficiency status of vitamin D was very common among newborns and children aged one to 17 years. This indicates that more sunshine and vitamin D--fortified foods are necessary among Chinese children. [ABSTRACT FROM AUTHOR]

Background: Vitamin D insufficiency (serum 25-OH vitamin D > 10 ng/ml and < 30 ng/ml) is prevalent in the obese (body mass index (BMI) > 30 kg/m²), yet relationships between the two are poorly understood. Objectives of this study include identification of the impact of obesity on reducing serum 25-OH vitamin D concentration, particularly in response to altered vitamin D3 supplementation, and to elucidate the longitudinal impact of serum 25-OH vitamin D on body mass index. Methods: Twenty four-week-old lean and obese male C57BL/6 J mice were fed low, standard, or high levels of cholecalciferol supplementation and followed for 24 weeks. Longitudinal measurements include serum 25-OH and 1,25-(OH)2 vitamin D, intact PTH, and calcium concentrations, as well as BMI, bone density and body fat/lean mass. Results: Baseline serum 25-OH concentrations were not different in lean and obese mice (lean 32.8 ± 4.4 ng/ml versus obese 30.9 ± 1.6 ng/ml p = 0.09). Lean mice receiving low supplementation exhibited rapid declines in serum 25-OH vitamin D concentrations, falling from 33.4 ± 5.4 ng/ml to 14.5 ± 3.4 ng/ml after 2 weeks, while obese mice declined at a lower rate, falling from 30.9 ± 1.5 to 19.0 ± 0.9 ng/ml within the same time period. Surprisingly, high vitamin D3 supplementation did not substantially increase serum vitamin D concentrations above standard supplementation, in either lean or obese mice. No differences in serum 1,25-(OH)2 vitamin D, intact parathyroid hormone (PTH) or serum calcium were observed between lean and obese mice within the same vitamin D supplementation group. Yet obese mice exhibited lower serum calcitriol, higher serum PTH, and lower bone mineral density (BMD) than did lean mice. Additionally, neither body mass index nor body fat % was significantly correlated with vitamin D concentrations. Interestingly, lean mice with high vitamin D supplementation consumed significantly more food than did lean mice with standard or low supplementation (14.6 ± 1.7 kcal/mouse/ day versus 11.8 ± 1.4 and 12.3 ± 1.7 respectively, p < 0.0001 for both). Conclusions: Low cholecalciferol supplementation in both lean and obese mice significantly and sustainably reduces serum 25-OH vitamin D concentrations. Interestingly, obesity slowed the rate of decline. Over the period of the study, vitamin D insufficiency was not subsequently correlated with greater BMI/body fat, although lean mice with high supplementation consumed greater calories with no apparent BMI increase. [ABSTRACT FROM AUTHOR]

Objectives: To determine and compare the prevalence of vitamin D insufficiency and deficiency in patients with systemic lupus erythematosus (SLE) with and without disease activity. Patients and methods: We made a comparative, observational, cross-sectional, prospective study of 137 women with SLE according to American College of Rheumatology criteria. Patients with chronic kidney disease, cancer, hyperparathyroidism, pregnancy, and lactation were excluded. Disease activity was assessed using the MEX-SLEDAI score: a score of ≥ 3 was considered as disease activity. Data were collected on diabetes mellitus, the use of corticosteroids, chloroquine, and immunosuppressants, photoprotection and vitamin D supplementation. Vitamin D levels were measured by chemiluminescent immunoassay: insufficiency was defined as serum 25-hydroxyvitamin D < 30 ng/ml and deficiency as < 10 ng/ml. Results: 137 women with SLE (mean age 45.9 ± 11.6 years, disease duration 7.7 ± 3.4 years) were evaluated. Mean disease activity was 2 (0-8): 106 patients had no disease activity and 31 had active disease (77.4% versus 22.6%). Vitamin D insufficiency and deficiency was found in 122(89.0%) and 4 (2.9%) patients, respectively. There was no significant difference in vitamin D levels between patients with and without active disease (19.3 ± 4.5 versus 19.7 ± 6.8; P = .75). No correlation between the MEX-SLEDAI score (P = .21), photosensitivity, photoprotection, prednisone or chloroquine use and vitamin D supplementation was found. Conclusions Women with SLE had a high prevalence of vitamin D insufficient. No association between vitamin D levels and disease activity was found. [ABSTRACT FROM AUTHOR]

Capacity building is a pervasive idea that has received little critical treatment from anthropology. In this introduction, we outline the growing use of the idea of 'capacity building' within and beyond development settings, and highlight mechanisms by which it gains footholds in both policy and practice. This special issue centres and questions its histories, assumptions, intentions and enactments in order to bring ethnographic attention to the promises it entails. By bringing together cases from different sectors and continents, the collection pursues capacity building's self-evident character, opening up what capacities themselves are thought to be. By not taking capacity building's promises for granted, the articles collected here have two aims: to interrogate the means of capacity building's ubiquity, and to develop critical purchase on its persuasive power. [ABSTRACT FROM AUTHOR]

Introduction: Criteria for starting weight-bearing on the heel with a symptomatic calcaneal insufficiency fracture have not yet been reported. Case Presentation: We describe a rare case of a 52-year-old woman with a calcaneal insufficiency fracture who sustained a second ipsilateral calcaneal insufficiency fracture within a short time span. The initial fracture was not evident radiographically, but was detected using magnetic resonance imaging (MRI). The patient rejected our advice to avoid weight-bearing on the heel, instead opting to use a silicone heel orthosis. Although there were no abnormal local findings, the stand on heel test was positive at each subsequent visit until 2 months after her first medical examination. At this time, radiographs showed a sclerotic line; however, a second round of MRI showed a new calcaneal insufficiency fracture anterior to the initial calcaneal insufficiency fracture. The patient then agreed to stop weight-bearing on the heel. Three months after the initial visit, radiographs showed two sclerotic lines, and the standon heel test became negative for the first time; hence, weight-bearing was permitted. There was radiographic evidence of fracture healing and complete resolution of symptoms 4 months after the initial visit. Conclusions: The callus formation seen on radiographs is helpful in determining when to start weight-bearing; however, fresh insufficiency fractures of the ipsilateral calcaneus may not be detected by radiography. Since local findings such as tenderness, swelling, and heat are subjective, the criteria for starting weight-bearing on the affected heel with an insufficiency fracture should be based on not only radiographs but also objective clinical findings such as the stand on heel test. [ABSTRACT FROM AUTHOR]

Takayasu arteritis is a rare pathology that usually has general and atypical signs that make its diagnosis difficult. These characteristics can delay diagnosis, thus leading to complications and death. We, herein, report an autopsy case of a 25-year-old female patient with a history of multiple consultations for dyspnea. During these consultations, no diagnosis was made. She was found unconscious near her home and shortly after, she was declared dead. Forensic autopsy revealed superficial traumatic lesions. Internal examination revealed complete situs inversus. Multiple bilateral pleural adhesions and bilateral moderate effusion were found. The heart was heavy with thickening of the aortic wall (1.1cm), carotid arteries, and pulmonary trunk, associated with a large aortic valve and evidence of leakage. Histological examination of the aorta and its major branches showed features of panarteritis with segmental involvement. The vascular wall was thick with lymphoplasmacytic infiltrate and giant cells involving mainly the medio-adventitial junction. Disruption of the elastic lamina and reactive fibrosis in the intima were also noted. Diagnosis of large vessel vasculitis and particularly Takayasu arteritis was made. Death was therefore attributed to heart failure due to aortic insufficiency as a complication of Takayasu arteritis. • Takayasu Arteritis is a rare disease that can lead to death. • Sudden death can be the only clinical manifestation of Takayasu Arteritis. • First-line doctor must take into consideration these types of complications. [ABSTRACT FROM AUTHOR]

Objective: Identify the incidence and risk factors of vitamin D deficiency/vitamin D insufficiency in children aged 1-5 years., Methods: A cross-sectional survey was conducted among children between the ages of 1 and 5 in the Bope-Poddala and Galle municipality areas. The sample was obtained by cluster sampling method. Data on socio-demography, pregnancy, sun exposure, and diet were obtained. Serum 25(OH)D concentrations were measured and the cutoff value was determined as per the global consensus in 2016., Results: Among 100 children, the mean serum 25(OH)D level was 86.4 nmol/L (24.06 ng/mL). The prevalence of vitamin D deficiency and vitamin D insufficiency was 7% and 28%, respectively. Birth weight and sunlight exposure were significantly different among vitamin D deficiency/vitamin D insufficiency and sufficient groups. Both were found to be risk factors for vitamin D deficiency/vitamin D insufficiency in logistic regression., Conclusion: Vitamin D deficiency/vitamin D insufficiency is significant among children aged 1-5 years and decreased sun exposure and low birth weight are the main risk factors., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Multiple myeloma (MM) is a hematological malignancy characterized by the exponential growth of malignant plasma cells. Individuals diagnosed with MM exhibit a deficiency in vitamin D and may suffer fatigue, a loss of muscular strength, persistent musculoskeletal aches, and pain. The objective of this systematic review and meta-analysis is to determine the prevalence of vitamin D insufficiency and deficiency in individuals diagnosed with MM., Methods: We searched five electronic databases using relevant keywords. The quality of the included studies was evaluated using the critical appraisal tool developed by the Joanna Briggs Institute. We employed a random-effects model and presented the findings in the form of percentages accompanied by 95% confidence intervals (CI). This protocol has been officially registered in PROSPERO under the registration number CRD42021248710., Results: The meta-analysis comprised a total of eighteen studies and found that, among patients with MM, the occurrence of serum vitamin D deficiency and insufficiency was 39.4% (95% CI: 25.8 to 52.9, n = 3746) and 34.1% (95% CI: 20.9 to 47.2, n = 3559), respectively. The findings indicate that a greater proportion of newly diagnosed patients exhibited vitamin D deficiency and insufficiency, with rates of 43.0% and 41.6%, respectively, compared to those receiving treatment (rates of 41.6% and 32.3%, respectively). The findings of the sensitivity analyses were consistent, and most of the studies (72.2%) were deemed to be of high quality. The results of Egger's test indicated the absence of publication bias., Conclusions: Patients diagnosed with MM have been found to exhibit significantly elevated levels of both vitamin D deficiency and insufficiency. Therefore, it is recommended to consider vitamin D testing as an additional parameter in the current criteria for the clinical evaluation of MM.

Despite being close to equator and receiving sufficient sun rays, evidences revealed that Indians have severe deficiency of vitamin D (vit D) ranging from 41 to 100% in different geographical locations. Therefore, in this study levels of 25(OH)D (physiologically measurable form) along with other bone metabolism associated biochemical markers were determined in serum sample of 300 apparently healthy study subjects (rural) from Doiwala block of Dehradun district in the state of Uttarakhand. Demographic data was also obtained based on a structured questionnaire to establish an association between 25(OH)D levels and various dietary and socio-cultural factors. Results demonstrated that of all study subjects, 197 (65%) had 25(OH)D levels below < 12 ng/mL (deficient) and 65 (21%) had 25(OH)D levels between 12 and 20 ng/mL (insufficient) with all other markers falling within respectively established reference ranges. Further, in univariate analysis, gender, occupation (indoor and outdoor), education were independently associated with vitamin D status. Additionally, parathyroid hormone associated significantly with gender and occupation, while calcium associated significantly with gender, occupation and education. Lastly, regression analysis revealed that gender and occupation independently associated with vitamin D status of subjects. In conclusion, apparently healthy subjects showed considerable vitamin D deficiency thereby generating an urgent need for formulating and implementing better government policies for enrichment of vitamin D levels among rural adults of Uttarakhand in future., Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01048-6., Competing Interests: Conflict of interestAuthors declare that they have no conflict of interest to disclose., (© The Author(s), under exclusive licence to Association of Clinical Biochemists of India 2022.)

Context: Vitamin D inadequacy is a global problem and it is one of the most common endocrine diseases world-wide. In this review article, we covered the important practical clinical issues for screening, prevention and treatment of vitamin D deficiency in adults as well as during pregnancy and lactation.

The problem of tragic cases on the lessons of physical education and ways of their avoidance is considered. The analysis of publications after all by such cases in Ukraine for the last 6 years is resulted. The results of researches of basic indexes of the cardiо-vascular system are rotined. 40 youths-students of basic medical group took part in researches. Research is conducted the teachers of department of physical education after the review of students by physicians and to dividing into medical groups. Biological age of heart is appraised, information of index of Robinson and indexes of heart-throbs is resulted. It is well-proven that in a basic medical group there are students which need enhanceable attention from the side of teacher.

Background : The prevalence of vitamin D deficiency has recently been recognized in different parts of the world, even affecting healthy populations. The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. Few studies have been done to evaluate the status of vitamin D in the medical community. The objective of this study was to evaluate the prevalence of low levels of vitamin D in healthy Saudi medical students. Materials and Methods: A cross-sectional study was carried out in November 2009 on male and female students in the preclerkship years of medical school at the King Faisal University, Dammam. Data on age, consumption of dairy products and seafood, and exposure to sunlight were collected. The body mass index was calculated. Approximately, 15 ml of blood was extracted for the measurement of serum calcium, serum albumin, serum phosphorus, alkaline phosphatase, fasting parathyroid hormone, and vitamin D levels. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D < 50 nmol/l. Comparison between groups was done for statistical significance using an unpaired t-test. Significance was set at P < 0.05 using 95% CI for all comparisons. Results: The data from 95 male and 103 female students were analyzed. The mean age for all students was 19.54 years. In 100% of the students, the vitamin D level was low. The prevalence of vitamin D deficiency in all students was 96.0% (92.64% in males and 99.03% in females), while the remaining 4% had vitamin D insufficiency. The mean 25-hydroxy vitamin D level was 26.83 ± 12.60 nmol/l in males and 16.03 ± 8.28 nmol/l in females (P-value = 0.0001). Males had a statistically significant higher body mass index as well as consumption of dairy products, while the consumption of seafood was significantly higher in females. There was no difference between the two groups in terms of exposure to the sun. Conclusion: Vitamin D deficiency was highly prevalent among medical students included in this study. An urgent action has to be taken in order to prevent adverse consequences of low vitamin D in the young, otherwise healthy populations.

PurposeTo evaluate the clinical characteristics of vitamin D deficiency and its association with iron deficiency anemia (IDA).MethodsA total of 171 children aged less than two years underwent 25-hydroxyvitamin D3 tests between January 2007 and July 2009. The study was classified into two groups: normal and vitamin D insufficiency, by their vitamin 25-hydroxyvitamin D3 levels.ResultsIn total, 120 children were in the normal group (mean age, body weight and heights 12.5±7.0, 9.3±0.9 kg and 76.8±1.1 cm), and 51 children in the vitamin D insufficiency group (9.9±5.4 months, 9.0±0.9 kg and 75.1±0.9 cm). Vitamin D insufficiency was most commonly diagnosed in the spring (44%). The proportion of complete breast-feeding was higher in the insufficiency (92%), and 25.5% of the children in the deficient group also experienced IDA compared that 12% of normal group. Ten children in the insufficiency group experienced bony changes. Six children received calcitriol medication in the normal group, in whom the mean vitamin 25-hydroxyvitamin D3 level increased from 39.6±14.6 ng/mL (pre-medication) to 41.8±17.2 ng/mL (post-medication), and 13 in the insufficiency group, in whom the mean vitamin 25-hydroxyvitamin D3 increased from 20.7±7.0 ng/mL to a mean post-treatment level of 43.7±23.8 ng/mL.ConclusionThis study demonstrated that approximately 30% of children aged ≤2 years experienced vitamin D insufficiency associated with subclinical rickets. Many children also experienced concurrent IDA. Guidelines for vitamin D supplement in such children must therefore be established.

La insuficiencia mitral isquémica es una complicación de la enfermedad coronaria que se asocia con resultados pobres. Su mecanismo básico es la remodelación del ventrículo izquierdo isquémico, que a su vez provoca desplazamiento de los músculos papilares, dilatación anular y tracción apical de las valvas. A pesar de que se ha comprobado que la reparación de la válvula mitral es superior al reemplazo de la válvula mitral para la corrección de la insuficiencia mitral severa orgánica, todavía hay un gran dilema en cuanto a qué procedimiento es el más adecuado para su tratamiento. Al parecer, en la actualidad la técnica de mayor uso para el tratamiento quirúrgico de pacientes con insuficiencia mitral isquémica severa, es la anuloplastia restrictiva de la válvula mitral; sin embargo, este procedimiento se asocia con 10% a 20% de persistencia post-operatoria temprana, y con 50% a 70% de tasas de recurrencia a cinco años. Además, la presencia de insuficiencia mitral isquémica severa persistente o recurrente, se asocia con mayor incidencia de eventos cardiacos y reducción de la supervivencia.Ischemic mitral valve insufficiency is a complication of coronary disease associated to poor results. Its basic mechanism is remodeling of ischemic left ventricle that causes the displacement of papillary muscles, annular dilation and valves apical traction. Although there is enough evidence that mitral valve repair is superior to mitral valve replacement for correction of severe organic mitral insufficiency, there is still a great dilemma as to which procedure is more suitable for its treatment. Apparently, now the most used technique for the surgical treatment of patients with severe ischemic mitral insufficiency is restrictive annuloplasty of the mitral valve; however, this procedure is associated to 10% to 20% of early post-operative persistence, and to 50% to 70% of recurrence rate at five years. Furthermore, the presence of persistent or recurrent severe ischemic mitral insufficiency is associated with increased incidence of cardiac events and reduced survival.

We present the case of a 37 year-old female who had disseminated tuberculosis (TB) with bilateral adrenal involvement resulting in primary adrenal failure (Addison’s disease) with refractory hyponatraemia and possible extrapontine ‘myelinolysis’. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB.