Assessment of Oral Anticoagulation with Vitamin K Antagonists in Patients Living in a Low-Income Country of West Africa

Introduction: Despite the rise of direct oral anticoagulants (DOACs), vitamin K antagonists (VKA) remain the most widely used oral anticoagulants in developing countries. The aim of this study was to estimate the prevalence of good anticoagulation in patients treated with VKA in Lomé and describe associated factors. Methods: This was a cross-sectional study conducted from November 2019 to October 2020 in the cardiology departments of two University teaching hospitals in Lomé (CHU Sylvanus Olympio and CHU Campus), involving patients on VKA for ≥3 months, with a target international normalized ratio (INR) of 2.5 and a therapeutic margin between 2 and 3. The quality of anticoagulation was assessed by the time in therapeutic range (TTR) which was assessed by the Rosendaal method. Good anticoagulation was defined by a TTR > 70%. Results: A total of 344 patients were included (mean age = 58 ± 13.8 years, women = 56.1%). Indications for VKA treatment were represented by venous thromboembolic disease (43.3%), supraventricular arrhythmia (28.2%), severe left ventricular systolic dysfunction (19.8%) and pulmonary hypertension (8.7%). The average TTR was 47.6 ± 20.8%. The rate of good anticoagulation was 17.7%. Factors associated with good anticoagulation were the use of fluindione vs acenocoumarol (OR = 11.17;95% CI: 3.2 - 39.6;p = 0.0002), concomitant low-dose aspirin (OR 4.44;95% CI: 1.4 - 13.9;p = 0.01) and INR monitoring exclusively by the patient himself (OR = 4.92;95% CI: 1.5 - 16.3;p = 0.008). The rate of thromboembolic and hemorrhagic complications was each 2.6% and was not correlated with the quality of anticoagulation. Quality of anticoagulation by VKAs was poor in our practice. Factors associated with good anticoagulation were the use of fluindione vs acenocoumarol, concomitant low-dose aspirin and monitoring of INR exclusively by the patient himself. Conclusion: The quality of oral anticoagulation by VKAs could be improved in our practice by the creation of anticoagulation clinics for better therapeutic education of patients and efficient management of VKA dose, and the use of prescription assistance software.

Vitamin D, Parathyroid Hormone, Insulin Sensitivity and Islet β-Cell Secretory Function in Diabetic Patients from South Kivu in the Democratic Republic of Congo: Cross-Sectional Study

Background: The role of vitamin D and parathyroid hormone in the metabolic profile of type 2 diabetes mellitus in sub-Saharan Africa has not been adequately assessed. The aim of this study was to determine the prevalence of low vitamin D level and secondary hyperparathyroidism and their association with insulin sensitivity and β-cell secretory function among Congolese type 2 diabetics. Methodology: Fasting glycaemia, fasting insulin, 25OH D3 and human parathyroid hormone (hPTH) were measured in one hundred and eighty-four type 2 diabetic patients followed as outpatients in South Kivu. Levels of 25OH D3 65 pg/ml defined low vitamin D and elevated parathyroid hormone levels, respectively. The HOMA model was used to measure insulin sensitivity and β-cell secretory function. Results: Medians (IQR) were 25.3 (20.4 - 32.4) ng/ml for 25OH D3 and 53.7 (38.4 - 115.7) pg/ml for hPTH. 58.7% of diabetics had insulin resistance, 126 (68.5%) had low vitamin D and 80 (43.5%) had hyperparathyroidism. In multivariate analysis, hPTH (partial r = −0.28;p = 0.0002) and 25OH D3 (partial r = 0.16;p = 0.03) showed an independent association with insulin sensitivity after adjustment for body mass index and waist circumference. Finally, hPTH (partial r = 0.27;p = 0.0002) was the sole determinant of β-cell secretory function. Conclusions: This study confirms the high prevalence of low vitamin D level and secondary hyperparathyroidism and their association with insulin resistance and impaired islet β-cell secretory function among Congolese with type 2 diabetes mellitus. Vitamin D and calcium supplementation should be envisaged for cases of deficiency in this region.

Neurological Manifestations of Vitamin B12 Deficiency: About a Case

The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis was made possible by electroneuromyography which showed subclinical neurological damage associated with hematological damage (anemia). Through this observation, we recall the diagnostic criteria of the disease in a context of difficult medical practice. .

Carpel Tunnel Syndrome: A Link with Vitamin D, Body Mass Index and Hyperlipidemia

Introduction: Carbai tunnel syndrome [CTS] is compression of the median nerve at the wrist , this causes tingling in the hands, pain, numbness, tingling in the fingers particularly the thumb, index and middle fingers, loss of sensation in the hands and fingers, also weakness in the hands. The aim of the present study was to study a possible association which could be found between electrophysiological data in CTS, BMI, hyperlipidemia, and vitamin D [Vit D] levels. Methods: We used a sample of 40 females of the same age group, who were divided into Group 1 as a control consists of 18 healthy females and Group II consisted of 22 age matched females with clinical and electrophysiological evidence of CTS. We measured atherogenic index [AI] as a marker of hyperlipidemia, body mass index [BMI], Vit D status and electrophysiological tests of CTS. Results: Subjects with CTS had deficient Vit D status, they had significantly high atherogenic index (AI), and significant high BMI all compared to control Group I. Median sensory conduction velocity was significantly correlated negatively with BMI and atherogenic index, and positively correlated significantly with Vit D status. But median sensory and motor action potential latency were significantly correlated positively with BMI and atherogenic index, and negatively correlated significantly with Vit D status The analysis revealed BMI, atherogenic index and Vit D status as predictors of median nerve sensory and motor action potential latency and sensory nerve conduction velocity in CTS. Conclusion: The results of this study suggest that obesity and hyperlipidemia are potent CTS risk factors and declared the direct association between Vit D status and CTS occurrence. Our study supports the notion of the compensatory neuroprotective role of Vit D which could have a direct impact on the nerves integrity as it has an anti-inflammatory property which acts in relieving nervous insults and stress. .

社区H型高血压患者药物基因作用靶点多态性分布及叶酸联合维生素D干预效果研究

背景H型高血压严重影响着人们的健康及生活质量,目前临床上治疗高血压主要根据患者症状和临床经验选择药物,降压效果不理想,急需探寻降压药物基因分布的多态性,为高血压患者进行个体化用药指导。目的探讨济南市社区H型高血压药物作用靶点基因多态性分布及叶酸联合维生素D的干预作用,为该地区开展高血压医防融合精准医疗提供参考依据。方法2020年6月—2022年6月随机抽取山东省济南市槐荫区20家街道办事处社区卫生服务中心200例血压控制不佳的高血压患者为研究对象,治疗前首先进行5类常用抗高血压药物[利尿剂、β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)、钙离子通道抑制剂(CCB)、血管紧张素Ⅱ受体拮抗剂(ARB)]相关高血压个体化用药基因位点的基因多态性检测。将患者随机分为基因导向治疗组(基因组)与基因导向协同叶酸、维生素D治疗组(基因导向组),每组100例。基因组根据检测的高血压基因作用位点的特点调整用药;基因导向组在基因组治疗方案的基础上同时服用叶酸、维生素D。干预初始(M0)、干预3个月(M3)、干预6个月(M6)时采集患者晨间未服用降压药物情况下坐位收缩压和舒张压。记录患者患病情况、不良反应发生情况、脑卒中发生情况,进行基因测序,检测血清同型半胱氨酸(Hcy)浓度。采用Pearson相关性分析或Spearman秩相关分析探究性别、年龄、收缩压、舒张压与Hcy的相关性。结果研究对象性别(r_(s)=-0.463)、收缩压(r=0.181)、舒张压(r=0.188)与Hcy水平有相关性(P<0.05)。5类抗高血压药物基因作用靶点中,与药物代谢酶基因多态性位点相关的分别是CYP3A5(A6986G)、CYP2C9(c.1075A>C)、CYP2D6(c.100C>T),与药物作用靶点敏感性基因多态性位点相关的是ADRB1、ACEI(I/D)、AGTR1、NPPA。基因组A6986G:CYP3A5*1/*1(AA)、ACEI(I/D):D/D、c.100 C>T:CYP2D6*1/*1(CC)患者M3、M6舒张压低于M0,A6986G:CYP3A5a1/a3(AG)、ADRB1 c.1165 G>C:GG、c.1075 A>C:CYP2C9*1/*3(AC)、c.1075 A>C:CYP2C9*3/*3(CC)患者M6舒张压低于M0,A6986G:CYP3A5*3/*3(GG)、ADRB1 c.1165 G>C:CC、ACEI(I/D):I/I、c.1075 A>C:CYP2C9*1/*1(AA)、AGTR1 c.1166 A>C:AA、NPPA T2238C:TT、c.100 C>T:CYP2D6*10/*10(TT)患者M3、M6收缩压、舒张压低于M0,ADRB1 c.1165 G>C:GC、ACEI(I/D):I/D、c.100 C>T:CYP2D6*1/*10(CT)患者M6收缩压低于M0,M3、M6舒张压低于M0,差异有统计学意义(P<0.05)。Hcy水平组间比较结果显示,M3、M6基因导向组Hcy水平低于基因组,差异有统计学意义(P<0.05)。组内比较结果显示,基因组M6 Hcy水平低于M0,基因导向组M3、M6 Hcy水平低于M0,M6 Hcy水平低于M3,差异有统计学意义(P<0.05)。收缩压、舒张压组间比较结果显示,M3、M6基因导向组收缩压、舒张压低于基因组,差异有统计学意义(P<0.05)。组内比较结果显示,基因组、基因导向组M6收缩压、舒张压低于M0,M6收缩压低于M3,差异有统计学意义(P<0.05)。结论社区H型高血压患者中存在高血压药物相关基因多态性的表达差异,个体化用药效果显著;叶酸联合维生素D协同治疗更能显著降低H型高血压水平。

Identification and Evaluation of Vitamin D Levels in Urban Children & Adolescents in Dhaka City, Bangladesh through a Cross Sectional Study

Background: Vitamin D plays a pivotal role in supporting the immune system, helping to reduce the risk of infections and certain autoimmune diseases. Adequate vitamin D levels may be associated with a reduced risk of certain health conditions like pre-eclampsia, gestational diabetes, and postpartum depression. Brittle bones, osteoporosis in the elderly, and osteomalacia in young children are all symptoms of vitamin D insufficiency. Additionally, it contributes to problems linked to gum disease, including an increase in dental cavities, alveolar bone loss around the teeth, and other problems. It could lead to depression, tiredness, and a loss of appetite. In this study, urban children and adolescents in Dhaka city, Bangladesh are examined for vitamin D deficiency, insufficiency, and sufficiency. Methods: The Study was a cross-sectional study conducted under Dhaka National Medical College and Hospital, Dhaka and additionally included two other health centers Medinova Medical Services and Monoara General Hospital Service Golap bag, Dhaka from October 2020 to November 2021. The study location was at the 3 (Three) different hospitals which was located in Dhaka City. In this cross-sectional study, Participants will be selected purposively and conveniently based on the age categories from 0 - 19 years of age at the outdoor department of the hospital. The study included the secondary dataset of ambulatory individuals who came to the 3 (three) hospitals, randomly to evaluate serum vitamin D levels on referral from a general out-patient-department (OPD). They were examined for laboratory findings of serum 25 hydroxyvitamin D levels to determine vitamin D deficiency, insufficiency, and sufficiency among children and adolescent groups of both male and female Sex. Results: A total of 6394 individuals with a diverse age group were statistically examined for laboratory findings of serum vitamin D levels. Vitamin D deficiency was observed in 40.58% of individuals with a mean log of 1.01 ± 0.18 ng/ml serum vitamin D levels, vitamin D insufficiency in 30.93% of individuals with a mean log of 1.38 ± 0.05 ng/ml serum vitamin D levels and vitamin D sufficiency in 19.49% individuals with a mean log of 1.63 ± 0.12 ng/ml serum vitamin D levels. The highest percentage of individuals deficient in vitamin D were children and adolescents of age ranging between 15 to 19 years. Conclusion: The findings of vitamin D deficiency in children and adolescents direct higher authorities in the public health sector to take immediate steps to screen, intervene and educate high-risk populations incorporating vitamin D supplements to establish preventive and therapeutic measures.

The Association between Vitamin D Deficiency and Developing COVID-19 Related Serious Illnesses—A Systematic Review and Meta-Analysis

Background: Coronavirus is rapidly transmitted and highly infectious, and it is also associated with high morbidity and mortality but no drugs have been recognised as being effective;therefore, it is necessary to protect against serious illnesses with an intrinsic protection mechanism. In addition, Vitamin D enhances the intrinsic protection mechanism. Purpose: This study aims to systematically review and conduct a meta-analysis to determine if vitamin D deficiency is associated with the development of severe COVID-19 illness, providing crucial insights into the potential impact of vitamin D on disease outcomes. Methods: This study is conducted through systematic reviews and meta-analysis while following well-designed research questions. Literature searches are performed according to PRISMA guidelines with inclusion and exclusion criteria through the electronic database PubMed, CINAHL and Google Scholar. All data for meta-analysis were performed using RevMan 5.4. The software program was used for blending the statistical data and deriving the cumulative result of the intervention on concluding outcomes of interest. To analyze dichotomous data, the Mantel-Haenszel method was performed, and an odds ratio was conducted for outcome evaluation with 95% confidence interval. Results: The meta-analysis showed that there is statistically significant (P Conclusion: This study indicated that Vitamin D deficiency is associated with the development of COVID-19 related serious illnesses. Also, it is highly recommended to do more randomised control trials for the establishment of this topic strongly.

Content Determination of Vitamin C in Durian Endocarp and Optimization of Extraction Process

Purpose: To optimize the extraction process of vitamin C from durian endocarp, and to determine the content of vitamin C in durian endocarp with high performance liquid chromatography (HPLC). Method: Optimize ultrasonic extraction conditions by L9 (43) orthogonal experiment by using octadecylsilane chemically bonded silica as the stationary phase, using methanol (A): 0.1% oxalic acid (B) = 5:95 (V/V) as the mobile phase, setting the flow rate as 1.0 mL/min, and setting the wavelength as 254 nm for assay. Result: The optimal extraction process is as follows: the material-liquid ratio is 1:12, the extraction solvent is 2% oxalic acid aqueous solution, and the extraction time is 30 min;Vitamin C has a good linearity within the concentration range of 5.4 - 108.0 mg·mL-1, and the regression equation is y = 37698x - 61035 (R2 = 0.9996);the average recovery rate is 99.03%, the instruments are of high precision with good stability. Conclusion: This extraction process performs well in simplicity, costs and extraction efficiency, which may accelerate the development and utilization of vitamin C extraction from durian endocarp, and provide references to relevant studies and practices.

Vitamin D Levels in COVID-19 Patients Admitted to Intensive Care

Background: Vitamin D has garnered much attention for its role in immune function, more specifically, it’s conceivable link to the clinical severity of Covid-19 infections and therefore its potential application in prophylactic or therapeutic treatment. Vitamin D appears capable of inhibiting pulmonary inflammatory responses while enhancing innate defence mechanisms against respiratory pathogens with population-based studies showing an association between circulating vitamin D levels and lung function. We understand that infection with Sars-Cov-2 induces production of pro and anti-inflammatory cytokines, whilst Vitamin D downregulates production of pro-inflammatory Th1 cytokines including tumour necrosis factor and interferon Y, whilst increasing expression of anti-inflammatory cytokines by macrophages. Vitamin D is also involved in the renin-angiotensin system which is regulated by entry of the SARS-Cov-2 virus into cells via the ACE2 receptor, leading to cytokine storms, with subsequent fatal respiratory distress syndrome. The theoretical implications for Vitamin D status in the presentation of Covid-19 (the disease state of Sars-Cov-2) exist, yet data on its application is currently limited. Geographical variables depicting patterns between sun exposure, diet or Vit D status, and risk of death from Covid-19 have shown strong negative correlation. Aim: We aim to assess levels of Vitamin D deficiency in ICU patients who have tested positive for Sars-Cov-2 and who have exhibited respiratory symptoms. In this way, we hope to identify the possibility of Vitamin D as a significant contributing factor to disease progression in Covid patients. Sample: Male or Female patients of any age, who were admitted to the Intensive Care Unit exhibiting respiratory symptoms, with a positive Sars-Cov-2 PCR test, between 12/3/21 and 25/2/21. sample total: 79. Results: Testing was very inconsistent with only 67.1% having their Vitamin D levels checked. There was average delay in testing levels by 2 days. 64% of patients were found to be very deficient. Conclusion: This study highlights the strong correlation between Vitamin D status and severity of Covid-19 disease and thus demonstrates a potential huge shortfall in the testing and treatment of this immunodeficiency as it relates to Covid-19. Based on recommendations of Vitamin D levels required for protection of this viral syndrome, as much as 100% of patients sampled with severe disease could be deficient in Vitamin D.

Serum Vitamin E Reference Intervals in a Black Congolese Population of Kinshasa

Context: Vitamin E is a powerful antioxidant and plays an important role in human reproduction. However, micronutrient deficiency is a major public health problem, particularly in developing countries. This study aimed to establish reference intervals (RIs) for vitamin E in black Congolese people of childbearing age using an ELISA method to provide a reference for clinically assessing vitamin E status. Methods: A total of 127 healthy people between the ages of 20 and 42 who underwent check-ups were randomly selected for the study. ELISA method measured the level of vitamin E. The effect of gender on vitamin E level was assessed, and RI was established using a parametric approach. Results: Women showed significantly higher levels of vitamin E than men (p = 0.01). The RI of vitamin E in people of childbearing age was 3.71 to 13.72, 4.52 to 14.64, and 4.17 to 13.52 mg/L, respectively, for the whole population, women and men. Conclusion: Using an ELISA method, this study established RI for vitamin E in the black Congolese population of childbearing age. We also found that women had significantly higher vitamin E levels than men. The results could provide a scientific basis for interpreting vitamin status in people of childbearing age in our setting.

Dietary Vitamin K Restriction and Effectiveness of Vitamin K Antagonists Prescribed at the CNHU-HKM University Cardiology Clinic/BENIN

Introduction: Their efficacy in preventing thrombotic and embolic events has been proven in numerous studies, but their narrow therapeutic index requires particular vigilance, especially in terms of biology. In addition, treatment-related hemorrhagic complications are not uncommon. This study explores the influence of dietary vitamin K restriction on the efficacy of antivitamin K treatment at the University Cardiology Clinic of CNHU-HKM. Methods: Cross-sectional and descriptive study that took place from 25 April to 29 August 2019. Patients’ dietary behaviors and successive INR values were collected. Information on dietary intake was obtained by 2 non-consecutive 24-hour recalls. The effectiveness of VKA treatment was assessed by the “Time in Therapeutic Range” (TTR) of the INR. VKA treatment was considered effective for a TTR greater than 65%. Results: At the end of this study, 40 patients were surveyed. The mean age of the participants was 58.05 years ± 13.32 years, with a sex ratio of 1.35. Complete arrhythmia due to atrial fibrillation was the main indication for VKA treatment (37.50%) and fluindione was the most commonly prescribed drug (77.50%). The duration of treatment was less than or equal to 2 years in 47.5% of the subjects surveyed. Before starting treatment, 85% of patients received advice on restricting vitamin K-rich foods, and 45% of patients reported “food burnout” after a period of compliance with the restriction. The majority of respondents (97.50%) complied with the restriction on vitamin K-rich foods. All respondents had high energy intakes and a poor distribution of macronutrients, with a predominance of carbohydrates and proteins. 2.5% of respondents were on effective anti-vitamin K therapy with a TTR of over 65%. Conclusion: Restriction of vitamin K-rich foods is not conducive to effective treatment with vitamin K antagonists.

Iron versus Iron and Vitamin B6 Supplementation in Treatment of Iron Deficiency Anemia during Second Trimester of Pregnancy: Quasi Experimental Trial

Background: Anemia is one of the most prevalent complications during pregnancy. It is commonly considered a risk factor for poor pregnancy outcomes and can result in complications that threaten the life of both mother and fetus, such as preterm birth, and low birth weight. There is clear evidence to support prompt treatment in all patients with iron deficiency anemia because it is known that treatment improves quality of life and physical condition as well as alleviates fatigue and cognitive deficits. Objective: The aim of the study was to evaluate the value of addition of vitamin B6 to iron in treatment of iron deficiency anemia in pregnant women during the second trimester. Patients and Methods: The study was done by giving anemia pregnant women iron therapy and vitamin B6 which represent group A and iron therapy alone which represents group B. For each pregnant woman, age, parity and gestational history were taken before treatment. All pregnant women took their allocated treatment regularly for three weeks after diagnosis of iron deficiency anemia with complete blood picture and followed up after three weeks. Results: Results of the study revealed that there was no statistically significant difference between the two groups of therapy according to the hemoglobin level before treatment (p-value = 0.734), statistically significant higher mean value in after treatment than before treatment (p-value = 0.048), there was a significant difference in the rate of change of hemoglobin (p-value = 0.011) and body mass index (p-value 0.001). Conclusion: Iron and vitamin B6 seems to increase hemoglobin level more than iron only. Thus, in pregnant women with iron deficiency anemia iron plus vitamin B6 may be considered as a more effective alternative treatment than iron only.

维生素D3减轻高糖暴露诱导氧化应激促进人脐带间充质干细胞的成骨分化

背景:糖尿病骨质疏松症逐渐受到公众的关注,然而鲜有研究报道高糖环境对人脐带间充质干细胞成骨分化的影响和相应的治疗策略。目的:探讨维生素D3恢复高糖环境中人脐带间充质干细胞成骨分化的潜力。方法:通过CCK-8法检测人脐带间充质干细胞活力来筛选适宜的维生素D3干预浓度。在高葡萄糖条件下,通过RT-qPCR、蛋白质印迹、免疫荧光、JC-1线粒体膜电位、茜素红染色和β-半乳糖苷酶染色等实验评估维生素D3干预后人脐带间充质干细胞的成骨分化潜能、细胞内活性氧积累、线粒体膜电位改变和细胞衰老情况,并探讨了潜在的机制。结果与结论:①维生素D3在0.1μmol/L至1 mmol/L范围内均能显著促进人脐带间充质干细胞的增殖;②高糖环境下调了人脐带间充质干细胞中成骨相关基因α1-Ⅰ型胶原蛋白、碱性磷酸酶、Runt相关转录因子2、骨钙蛋白的mRNA和蛋白表达水平,诱发了氧化应激和细胞衰老;③维生素D3在10μmol/L的干预浓度下显著恢复了高糖条件下人脐带间充质干细胞的成骨表型,并通过激活Nrf2/HO-1信号通路减轻了细胞内的氧化应激和细胞衰老;④结果表明,高糖环境中人脐带间充质干细胞的成骨分化能力降低,维生素D3可以部分提高其成骨分化能力并减轻细胞损伤。

Maternal Vitamin D Deficiency and Risk of Development of Gestational Diabetes Mellitus: A Scoping Review

Background: Maternal vitamin D status is a critical determinant during pregnancy, because it plays an important role in the body not only in calcium homeostasis and bone remodeling, but also in the glucose metabolism. Vitamin D deficiency is associated with adverse pregnancy outcomes including gestational diabetes mellitus. Objective: To review evidence on the association between maternal vitamin D deficiency and incidence of gestational diabetes mellitus (GDM). Methods: PRISMA for scoping review guideline and scoping review guidelines of Arksey & O’Malley (2005) was followed in methodological process. A comprehensive search strategy was carried out across the Google Scholar and PubMed from January 2012 to December 2022, using the search terms of “gestational diabetes mellitus/pregnancy outcomes” combined with “vitamin D”, “cholecalciferol” or “25-hydroxyvitamin D” and/or “deficiency”. Articles were screened at the title and the abstract level and at full text by three co-investigators of the study independently with a fourth reviewer resolving discrepancies. Research studies published only in English language were selected. Research using pregnant mothers with multiple pregnancy and chronic diseases was excluded. Results: After screening 134 titles and abstracts, finally 55 original research articles were selected. It involved 48 observational studies and 7 Randomized Control Trials (RCT). Only 30 research articles had found an association between maternal vitamin D deficiency and GDM. Conclusion: As results of previous studies are mixed and inconclusive, further research including more RCTs is needed to clarify the exact mechanism of vitamin D on glucose metabolism during pregnancy.

Assessment of the Effects of Supplemental Rumen Protected B Vitamins and Choline for Periparturient Cows: A Meta-Analysis of 28 Feeding Studies

There are currently no prescribed requirements for B vitamins or choline for dairy cows during the transition period, but many recent studies have shown a variety of benefits from supplying these nutrients to periparturient cows. The purpose of this research effort was to determine the potential benefit of including a rumen protected blend composed of B vitamins (riboflavin, folic acid, vitamin B12) and choline (RPBlend, Jefo Nutrition Inc., St. Hyacinthe, QC, Canada) for dairy cows during the transition period, based on results from 28 on-farm feeding studies (USA-12, Mexico-7, Canada-4, Chile-3, Australia-1, Brazil-1) conducted between 2011 and 2018. All farms participated in monthly herd management record keeping systems and were selected to participate in studies due to their excellent management. Meta-analyses in which risk differences were determined were used to assess the effects of the supplemental RPBlend on health parameters and reproduction. The effect size was used as the determinant of the possible contribution of RPblend on the yields of milk, energy corrected milk (ECM), fat and protein yields during the first four weeks of lactation. Results showed that the inclusion of RPblend reduced (P < 0.05) involuntary culling and mastitis by cows during the first 30 days after calving. There was a tendency (P < 0.10) for reduced retained placenta and metritis. The meta-analyses revealed that the risk of the displaced abomasum and milk fever did not diminish (P > 0.10) with the inclusion of the BPBlend. The incidence rate of subclinical ketosis, determined as blood beta hydroxy butyric acid greater than 1.2 mM was lower (P (than those not supplemented. The proportion of cows confirmed pregnant by 100 days in milk was greater for cows given the BPBlend (P < 0.05). Milk yield and ECM were greater for cows receiving the RPBlend (1.13 and 0.93 kg/cow respectively, P < 0.05). There was no change in fat yield (P > 0.10) while the yield of milk protein was greater (P < 0.05) when the cows received the blend. These results suggest that the inclusion of rumen protected B vitamins and choline can assist cow health, reproduction and production at the start of lactation.

Investigating a Vitamin D Delivery Toothpaste Using a Penetration Enhancer Compound

Expanding in the oral care business, being passionately driven by innovative and scientific products, functional toothpaste has recently become more popular for functionality, variety, and efficacy. Many new types of toothpaste are commercially manufactured with diverse fragrances, colors, probiotics, and pharmaceutical ingredients to enhance the functionalities of toothpaste. Our study attempted to create a toothpaste formulation that might facilitate the intraoral delivery of vitamin D3 into the bloodstream. Simply brushing our teeth with toothpaste should be easy to take the essential vitamin regularly. In this study, an emulsion-based toothpaste mixed with an azone compound and sodium dodecyl sulfate as penetration enhancers blended thoroughly with other ingredients and then with vitamin D. Multiple toothpaste characteristic tests were performed, such as abrasiveness, scratchiness, spreadability, pH, foaming, cleaning, and antibacterial strength with our vitamin D toothpaste, and compared with those of other commercial brand toothpaste. To confirm the intraoral delivery of vitamin D through the oral cavity, an earthworm transport study and TEER value test were conducted using L. terrestris skin. Our data demonstrated the high feasibility of intraoral delivery of vitamin D based on those two skin studies with various experimental support;our vitamin D toothpaste had comparable characteristics with other commercial toothpaste for cleaning functionality.

The Deleterious Effect of Inappropriate Calcium and Vitamin D Supplementation during Pregnancy in Women Predisposed to Calcium Oxalate Urolithiasis

Background: Gestational formation of new urolithiasis is rare yet the impact of inappropriate gestational calcium and vitamin D supplementation (Ca/DS) is underestimated. Patients and Methods: we retrospectively evaluated 75 pregnant women with history of UL, yet were stable for >2 years on dietary restrictions, for new UL after Ca/DS. Results: During the past 5 years 21 (48%) of those who had received Ca/DS had developed UL and all had high Vitamin D with hypercalcemia while the remaining 31 patients, without Ca/DS, did not have UL and maintained normal vitamin D urinary calcium without need for supplementation. Overt UL was evident by 30th weeks of gestations and most were diagnosed by ultrasonography and managed by medical expulsive therapy. Conclusion: in patients with history of UL, prudent use of Ca/DS is indicated to avoid new UL.

Prevalence and Factors Associated with Vitamin D Deficiency in Patients with COVID-19 in Parakou in 2021

Introduction: Coronavirus 19 disease (COVID-19) often presents several serious complications in patients. 25-hydroxyvitamin D [25(OH)D] deficiency is considered a risk factor for severe forms of the disease. Objective: The objective of this work was to determine the prevalence and factors associated with vitamin D deficiency in patients with COVID-19 in Parakou in 2021. Methods: The method used was a descriptive and analytical cross-sectional study with prospective data collection that covered the period of August 1, 2021, to December 30, 2021. It concerned patients with COVID-19, symptomatic or not, in the commune of Parakou, selected by non-probability sampling. The 25(OH)D assay was performed by an enzyme immunoassay using the heterogeneous phase competition technique. Logistic regression was used to determine the factors associated with 25(OH)D deficiency at the 5% threshold. Results: A total of 197 patients with COVID-19 were included in the study with a mean age of 35.4 ± 15.2 years;with a female predominance (52.3%). The overall prevalence of 25(OH)D deficiency was 31.5% (95% CI [25.1 - 38.5]);it was 32.0% in females and 30.8% in males. 25(OH)D deficiency was more observed in patients ≥ 60 years than in patients < 60 years with no significant difference (p = 0.121), and in females (32.0%) than in males (30.8%) with no significant difference either (p = 0.857). Diabetes (p = 0.036), overweight or obesity (p = 0.032), severe disease forms (p = 0.003) and rhinitis (p = 0.009) were significantly associated with 25(OH)D deficiency. Conclusion: One-third of patients with COVID-19 in Parakou in 2021 were 25(OH)D deficient. 25(OH)D deficiency is associated with the severe form of the disease and with comorbidities justifying supplementation of this vitamin to patients with COVID-19.

Association of Vitamin D Deficiency with Diabetic Retinopathy in Young People with Type 1 Diabetes Mellitus

Background: Diabetic retinopathy is among the most common diabetic complications, and is one of the leading causes of blindness in the world. Recent studies have linked vitamin D to the pathogenesis of diabetes and there is growing evidence that vitamin D can interfere with the mechanisms involved in diabetes and its complications. Despite improvements in treatment, diabetic retinopathy remains a significant complication of type 1 diabetes mellitus. Identification of early treatable predictors of diabetic retinopathy such as vitamin D deficiency, may allow more aggressive management of those at high risk. Purpose: To assess the association of vitamin D deficiency with diabetic retinopathy in young people with type 1 diabetes mellitus. Design: Observational study with case control design. Method: 60 young people with type 1 diabetes aged between 11 to 24 years were included in this study. Among them, 30-young people have diabetic retinopathy and 30-young people do not have diabetic retinopathy. Purposive sampling technique was applied as per inclusion criteria. Statistical analysis of the results was done by using computer-based software, SPSS version 26. P value of less than 0.05 was considered as statistically significant. Results: Vitamin D deficiency was present in 83% of the young people with diabetic retinopathy and in 53% without diabetic retinopathy. The mean vitamin D level in young people with and without diabetic retinopathy was 17.38 ± 3.77 ng/ml and 20.15 ± 5.06 ng/ml respectively and the difference was statistically significant (p = 0.019). Vitamin D deficiency was increased with the severity of diabetic retinopathy. Univariate and multivariate logistic regression showed vitamin D deficiency was independently associated with diabetic retinopathy with a crude odds ratio of 5.69 with a p value of 0.008 and adjusted odds ratio of 16.08 with a p value of 0.002 respectively. Conclusion: Result of the study revealed that vitamin D deficiency was strongly associated with diabetic retinopathy in young people with type 1 diabetes mellitus.

良性阵发性位置性眩晕患者维生素D状态及影响因素研究

目的 了解北京地区良性阵发性位置性眩晕(BPPV)患者维生素D水平状况,探讨性别、年龄、季节对维生素D水平的影响。方法 将2018年10月—2021年9月就诊于首都医科大学附属北京朝阳医院耳鼻咽喉头颈外科的208例BPPV患者作为研究对象进行回顾性研究。结果 所有BPPV患者血清25-羟维生素D[25(OH)D]水平为15.31(10.68, 21.03)ng/mL。比较不同性别、年龄和各个季节血清25(OH)D水平,男性高于女性,61~70岁年龄组高于其他年龄组;夏季血清25(OH)D水平最高,夏秋季明显高于冬春季。所有纳入研究的BPPV患者维生素D缺乏146例(70.19%);维生素D不足41例(19.71%);维生素D充足21例(10.10%)。回归分析显示性别、年龄和季节均能影响维生素D水平。结论 北京地区BPPV患者维生素D缺乏较为普遍,性别、年龄和季节对维生素D水平有影响。