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Effect of Low Dose Oral Vitamin-D and Calcium Replacement in HIV Patients.
Das, S, Bopitya, S, Chowdhury, AR, Das, A, Taha, H
Recent patents on anti-infective drug discovery. 2016;(1):59-67
Abstract
BACKGROUND There is high prevalence of vitamin-D deficiency and abnormal bone mineral density (BMD) in HIV patients. Our aim is to find out the effect of replacement of low dose oral vitamin-D (800 International unit) with calcium (500mg) as a once daily regimen along with antiretroviral (ARV) on serum vitamin-D and parathyroid hormone (PTH) level and bone mineral density (BMD) changes on patients with HIV infection who have vitamin- D deficiency. METHODS This is a non-randomised, open label study. We collected information about demography, viral load, CD-4 count, fracture risk factors. We measured serum 25(OH)D, parathyroid hormone (intact PTH), inorganic phosphate, corrected calcium, alkaline phosphatase (ALP) and BMD of hip and spine at baseline and after 12 months of routine follow up. Patients were treatment experienced and were divided into tenofovir containing, efavirenz containing, and protease Inhibitor (PI) containing regimens. RESULTS The study included 87 treatment experienced HIV patients with mean age 42.8 (+/-7.8) years, 55 (63%) females, 73 (84%) black African ethnicity, CD4 count 451.7 (+/-184.6) cells/dL, plasma VL 1.6 log (+/-0.03) copies/mL, exposure to antiretroviral therapy 43.2 (+/-30.2) months and duration of illness 58.4 (+/- 24.1) months. Forty four patients agreed to take vitamin-D with calcium replacement and 43 patients did not agree to take the replacement. After 12 months of follow up patients on vitamin D and calcium replacement (n=44) had significant increase in vitamin-D level (15.4+/-6.2 vs. 55.9+/-22.6, p=0.0001), reduction in PTH (8.04 +/-7.5, vs. 4.7 +/-1.8, p=0.005), alkaline phosphatase (111.1 +/-79.1 vs. 90.2+/-42.2, p=0.038) and increase in corrected calcium (2.18 +/-0.09 vs. 2.19 +/-0.09 p=0.001). In patients not on vitamin-D replacement (n=43), there was increase in vitamin-D (16.9 +/-12.1 vs. 49.4 +/-29.2, p=0.001) and corrected calcium (2.12 +/-0.09 vs. 2.16 +/-0.08 p=0.0001) level, but PTH and ALP did not change. BMD of hip and spine did not show any significant change in either of the two groups. In multivariate analysis that included all significant variables, vitamin-D and calcium replacement independently was associated with increase in vitamin-D level (OR 1.07, CI 1.02, 1.12, p=0.005), decrease in PTH level (OR 0.53, CI 0.35, 0.82, p=0.004), but not with change in corrected calcium, alkaline phosphatase, BMD of hip or spine. CONCLUSION After 12 months of follow up, replacement of low dose once daily oral vitamin-D with calcium in treatment experienced HIV patients with vitamin-D deficiency can increase vitamin-D level, reduce PTH level without any change in BMD of hip and spine.
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Effect of phytic acid, tannic acid and pectin on fasting iron bioavailability both in the presence and absence of calcium.
Jaramillo, Á, Briones, L, Andrews, M, Arredondo, M, Olivares, M, Brito, A, Pizarro, F
Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS). 2015;:112-7
Abstract
OBJECTIVE To determine the effect of phytic acid, tannic acid and pectin on fasting non-heme iron bioavailability in both the presence and absence of calcium. RESEARCH METHODS Twenty-eight apparently healthy adult females participated in two iron absorption studies using radioactive iron isotopes ((59)Fe and (55)Fe). One group received 5mg of iron (as FeSO4) alone (control), together with 10mg of phytic acid, 100mg of tannic acid and 250mg of pectin (study A), on different days. The second group received the same iron doses and compounds as the other group, plus 800mg of calcium (CaCl2) (study B). The compounds were administered after an overnight fast, and no food or beverages were consumed for the following 3h. Iron status and circulating radioactivity were measured in venous blood samples. RESULTS The geometric means of iron bioavailability (range±1SD) for iron alone, iron with phytic acid, iron with tannic acid, and iron with citrus pectin were 25.0% (11.9-52.0); 18.9% (9.9-35.8); 16.8% (8.7-32.3); and 21.1% (10.2-43.9), respectively (repeated-measures ANOVA, p<0.02 (Dunnett's post hoc: control vs tannic acid p<0.05). When 800mg of calcium was added (study B), iron bioavailability was 16.7% (10.1-27.5); 13.2% (7.1-24.6); 14.8% (8.8-25.1); and 12.6% (5.5-28.8), respectively (repeated-measures ANOVA, NS). CONCLUSIONS Tannic acid decreases the fasting bioavailability of non-heme iron, however this effect did not exist in the presence of calcium. No effect was observed by phytic acid or citrus pectin on fasting non-heme iron bioavailability in both the presence and absence of calcium.
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Concentration of 25(OH)D₃ and calcium and phosphorus metabolism in patients suffering from relapsing-remitting multiple sclerosis. A pilot study.
Kubicka, K, Pierzchała, K
Neurologia i neurochirurgia polska. 2013;(2):126-30
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate the concentration of 25(OH)D₃ and the indices of calcium and phosphorus metabolism at different times of relapsing-remitting multiple sclerosis (MS). The relationships between the concentrations of 25(OH)D₃ and the indices of calcium-phosphate metabolism were determined, depending on the duration of disease and vitamin and unsaturated fatty acids supplementation. MATERIAL AND METHODS Thirty patients (15 at the early stage and 15 at the advanced stage of MS) were enrolled. Each patient underwent neurological examination; neurological motor disability was defined according to the Expanded Disability Status Scale (EDSS). The results were compared to the values obtained in the control group (15 individuals) selected according to the age of subjects, their residence, ethnicity and gender. RESULTS Significantly lower serum concentrations of 25(OH)D₃ in MS patients compared to the control group were found. MS patients at the advanced stage of the disease (duration of 5-6 years) had lower 25(OH)D₃ concentrations than patients at the early stage of MS. Among patients in an advanced stage of MS, significantly lower levels of 25(OH)D₃ were found in women compared to men with a similar level of physical disability. CONCLUSIONS Lower serum concentrations of 25(OH)D₃ in MS patients compared to the control group were found. The lowest concentrations of 25(OH)D₃ were found in female patients aged 20-40 and in patients with a longer disease duration without substantial impairment of calcium-phosphate metabolism.
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Effects of 5-fluorouracil on oxidative stress and calcium levels in the blood of patients with newly diagnosed colorectal cancer.
Koçer, M, Nazıroğlu, M
Biological trace element research. 2013;(3):327-32
Abstract
The administration of chemotherapeutic agents for colorectal carcinoma is associated with an increase in oxidative stress and a concomitant decrease in antioxidant and element levels in the blood. This study investigated the effects of 5-fluorouracil (5-FU) chemotherapy on the levels of lipid peroxidation, reduced glutathione (GSH), glutathione peroxidase (GSH-Px), antioxidant vitamins, and elements in colorectal cancer patients. Twelve patients with newly diagnosed colorectal carcinoma and 12 healthy subjects were included in this study. Blood samples were collected from both the healthy controls and patients. 5-FU was intravenously administered to the patients for 6 weeks, and blood samples were collected again from the treatment group. In the patient group, lipid peroxidation levels were increased in both the plasma and erythrocyte samples, whereas GSH-Px activity and concentrations of GSH, vitamin E, and β-carotene in erythrocytes were decreased. The oxidant, antioxidant, and plasma calcium values were lower in 5-FU-treated patients than in the controls. Plasma vitamin A, chloride, sodium, and potassium concentrations did not change with 5-FU treatment. In conclusion, oxidative stress in patients with newly diagnosed colorectal cancer is attributable to the disease and not to 5-FU treatment. Blood vitamin E, β-carotene, GSH, and GSH-Px levels could be useful as early biomarkers of the prognosis of colorectal cancer patients.
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Simultaneous control of PTH and CaxP Is sustained over three years of treatment with cinacalcet HCl.
Sprague, SM, Evenepoel, P, Curzi, MP, González, MT, Husserl, FE, Kopyt, N, Sterling, LR, Mix, C, Wong, G
Clinical journal of the American Society of Nephrology : CJASN. 2009;(9):1465-76
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Abstract
BACKGROUND & OBJECTIVES Chronic kidney disease (CKD) is commonly complicated by secondary hyperparathyroidism (SHPT), leading to increased risk of morbidity and mortality. SHPT is a progressive disease often requiring long-term therapy to control parathyroid hormone (PTH) and mineral imbalances. Vitamin D sterols and phosphate binders, used as traditional therapies to lower PTH and phosphorus, may provide inadequate long-term control for many dialysis patients. Cinacalcet, by simultaneously lowering PTH, calcium, phosphorus, and calcium-phosphorus levels, may maintain PTH and mineral balance in these individuals. However, as with traditional therapies, long-term data are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENT Dialysis subjects from at least one of five lead-in studies (double-blind placebo-controlled, including one extension trial) completing up to 52 wk of either cinacalcet or placebo were eligible for this open-label extension study, including an 8-wk dose titration (initiated at 30 mg/d), followed by 24-wk maintenance and up to 132 wk of follow-up. Final efficacy analysis was at week 180. RESULTS Three hundred thirty-four of 589 enrolled subjects received cinacalcet from the beginning of the lead-in study. Weekly median PTH values were < or =300 pg/ml (weeks 16 through 180) and median CaxP values were < or =55 mg(2)/dl(2) (weeks 4 through 180). Similar results were exhibited in the 255 subjects who initially received placebo. Among the patients exposed to cinacalcet from the beginning of the lead-in study, 3% of subjects exhibited treatment-related serious adverse events. CONCLUSIONS Cinacalcet effectively maintained PTH, Ca and P reductions in dialysis subjects for up to 180 wk.
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Serotonin-induced platelet intracellular Ca2+ response in patients with anorexia nervosa.
Wöckel, L, Koch, S, Stadler, C, Meyer-Keitel, AE, Schmidt, MH
Pharmacopsychiatry. 2008;(1):10-6
Abstract
INTRODUCTION Serotonin (5-HT) is involved in the regulation of food intake. In anorexia nervosa there is a disturbance in 5-HT function. The stimulation of 5-HT(2)-receptors in platelets is a useful peripheral model to investigate the cascade of signal transduction and neuronal functioning. METHODS 25 anorexic female patients between the ages of 11 and 18 years with a mean body mass index (BMI) of 13.9+/-1.3 kg/m(2) participated in this study. The 21 healthy female controls revealed a mean BMI of 20.5+/-2.7 kg/m(2). 5-HT stimulated intracellular Ca(2+) response of the platelets was obtained using the Fura-2 method at the time of admission, during therapy and when the target BMI was reached. RESULTS We found a significant (p<0.01) decrease in 5-HT-induced Delta[Ca(2+)](i) at admission and a significant (p<0.05) increase of Delta[Ca(2+)](i) during treatment in patients with anorexia nervosa. Anorexic patients with and without comorbid depression had a comparable Ca(2+) release. However, low and high Ca(2+) responders showed a different course of Delta[Ca(2+)](i). The treatment with antidepressants led to a significant increase of Delta[Ca(2+)](i) in those patients with concomitant depression. DISCUSSION Since the course of Delta[Ca(2+)](i) is not related to BMI or the presence of comorbid depression, we conclude that serotonergic transmission or signaling pathways could be disturbed in patients suffering from anorexia nervosa. One inference of this preliminary study is that administration of antidepressants may be more effective in patients with concomitant depression.
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Ca pre-rinse greatly increases plaque and plaque fluid F.
Vogel, GL, Schumacher, GE, Chow, LC, Takagi, S, Carey, CM
Journal of dental research. 2008;(5):466-9
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Abstract
Previous studies demonstrated that a Ca pre-treatment greatly increases salivary F from a subsequent NaF rinse. This study examines if these increases are found in plaque and plaque fluid F. Thirteen individuals accumulated plaque before rinsing with: (1) 12 mmol/L NaF (228 microg/g F), (2) 150 mmol/L Ca rinse, or (3) the Ca rinse followed by the F rinse. One hr later, plaque samples were collected, the plaque fluid was recovered, and the plaque residues were extracted 5 times with pH 6.8 or pH 4.8 buffers, and then by acid. The F in each extract after the Ca rinse/F rinse greatly exceeded the corresponding F from the NaF rinse. Consequently, the Ca rinse/F rinse increased the total plaque F and the plaque fluid F by 12x and 5x, compared with the NaF rinse alone. These and the previous salivary results suggest that a Ca pre-treatment may increase the cariostatic effects of topical F agents.
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Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism.
Beyer, TD, Solorzano, CC, Prinz, RA, Babu, A, Nilubol, N, Patel, S
Surgery. 2007;(6):777-83
Abstract
BACKGROUND As many as 43% of patients will have normocalcemic intact parathyroid hormone (PTH) elevation after undergoing curative parathyroidectomy for primary hyperparathyroidism. This phenomenon may be due in part to an absolute or relative deficiency of vitamin D, which is under-recognized in patients with primary hyperparathyroidism. METHODS From September 1, 2004, to September 30, 2005, 86 consecutive patients underwent parathyroidectomy for primary sporadic hyperparathyroidism (psHPT). The patients were segregated into 2 groups based on postoperative management. Group 1 was composed of 26 patients who received routine oral calcitriol and calcium carbonate postoperatively. The 60 patients in the second group (group 2) received calcium carbonate postoperatively at the discretion of the primary surgeon. RESULTS A total of 85 patients (99%) achieved postoperative cure with sustained reduction in serum calcium. Within 30 days postoperatively, mean serum PTH levels normalized in both groups (41 +/- 31 vs 39 +/- 31 pg/ml; P = .91). However, at 1 to 3 months postoperatively, mean serum calcium levels remained similar (9.5 +/- 0.7 vs 9.3 +/- 0.5 mg/dl; P = .39) whereas mean serum PTH levels in groups 1 and 2 were 43 +/- 25 pg/ml and 67 +/- 45 pg/ml (P = .02), respectively. At 4 to 6 months postoperatively, mean PTH was again higher in group 2 (36 +/- 22 vs 67 +/- 35; P = .03), whereas mean serum calcium levels were normal (9.2 +/- 0.8 vs 9.6 +/- 0.4 mg/dl; P = .18). The incidence of postoperative normocalcemic PTH elevation was significantly higher in group 2 at 1 to 3 months (14% vs 39%; P = .04) and at 7 to 12 months (22% vs 83%; P = .04). CONCLUSIONS Vitamin D supplementation following parathyroidectomy for primary hyperparathyroidism reduces the incidence of postoperative eucalcemic PTH elevation.
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Cross-sectional analysis of abnormalities of mineral homeostasis, vitamin D and parathyroid hormone in a cohort of pre-dialysis patients. The chronic renal impairment in Birmingham (CRIB) study.
Zehnder, D, Landray, MJ, Wheeler, DC, Fraser, W, Blackwell, L, Nuttall, S, Hughes, SV, Townend, J, Ferro, C, Baigent, C, et al
Nephron. Clinical practice. 2007;(3):c109-16
Abstract
BACKGROUND Disturbances in mineral and vitamin D metabolism, which affect parathyroid hormone (PTH) synthesis, are well recognized in patients receiving dialysis. However, it is unclear at what stage of chronic kidney disease (CKD) these abnormalities develop. METHODS The associations between CKD stages 3 and 5, and alterations of calcium, phosphate, vitamin D and PTH concentrations were assessed in 249 patients (mean age 61 years, 66% male) and 79 age- and sex-matched healthy controls. RESULTS As compared to controls, serum phosphate concentrations were elevated among CKD patients (1.40 vs. 1.11 mmol/l; p < 0.0001). And levels of both 25-hydroxyvitamin D (42.1 vs. 60.4 nmol/l; p < 0.0001) and 1,25-dihydroxyvitamin D (58.2 vs. 119.5 pmol/l; p < 0.0001) were lower among patients with CKD, even among those with only stage 3 CKD and despite 73% of patients receiving vitamin D supplements. The ratio of 1,25-dihydroxy- to 25-hydroxyvitamin D was lower than controls, even among patients with stage 3 CKD (p = 0.0001), and this ratio diminished with advancing renal impairment. Concomitant elevations were observed in intact PTH (13.8 vs. 4.2 pmol/l; p < 0.0001) and whole PTH (7.9 vs. 2.7 pmol/l; p < 0.0001). CONCLUSION Impaired conversion of 25-hydroxy- to 1,25-dihydroxyvitamin D is an early feature of renal disease, and progresses as renal function deteriorates.
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Evaluation of a standardized short-time calcium suppression test in healthy subjects: interest for the diagnosis of primary hyperparathyroidism.
Titon, I, Cailleux-Bounacer, A, Basuyau, JP, Lefebvre, H, Savouré, A, Kuhn, JM
European journal of endocrinology. 2007;(3):351-7
Abstract
OBJECTIVE The diagnosis of primary hyperparathyroidism (PHP) can be difficult in patients with normal plasma calcium or parathyroid hormone (PTH) levels. We perfected a standardized short-time i.v. calcium loading test in healthy controls (HC) and compared the results with those of patients with PHP. METHODS Sixteen HC received 0.33 mmol/kg calcium gluconate intravenously for 3 h. Plasma calcium and serum PTH levels (assayed with immunoluminescent sandwich methods) were measured before, at the end of the infusion and 3 h later. Results were compared with those of 16 PHP patients. RESULTS In HC, basal total plasma calcium (mean +/- s.e.m.) was 2.33 +/- 0.02 mmol/l. At the end of calcium loading, calcemia reached 3.21 +/- 0.05 mmol/l and decreased to 2.94 +/- 0.08 mmol/l 3 h later. In PHP patients, basal plasma calcium was 2.54 +/- 0.03 mmol/l and reached similar values as in HC during the testing. Basal serum PTH levels were 32.5 +/- 3.3 ng/l in HC and 86.9 +/- 6.3 ng/l in PHP. At the end of calcium loading, they dropped to 8.8 +/- 0.6 ng/l (HC) and to 31.4 +/- 4.2 ng/l (PHP). Three hours later, they were 11.6 +/- 0.8 and 39.8 +/- 4.0 ng/l respectively. There was a cut-off in serum PTH values between the two groups at the end of calcium loading and 3 h later. CONCLUSION The standardized short-time PTH suppression test appears reliable to differentiate healthy subjects from PHP whose serum PTH levels remain >14 and >23 ng/ml respectively at the end of loading and 3 h later. This well-tolerated and easily performed test could be used for the diagnosis of PHP in patients suspected for the disease despite the normality of some basal biological markers.