Vitamin D status in patients with psoriasis

Introduction: Vitamin D may act as immune modulator in psoriasis and be related with disease characteristics. Our study aimed to evaluate the vitamin D status in patients admitted for diagnostics or exacerbation of psoriasis.Material and methods: 92 patients (50 male, 42 female, mean age 55 years) were included in analysis. Disease severity was assessed by Psoriasis Area and Severity Index (PASI). Type of disease was classified according to age at presentation as early (up to 40 years) and late (above 40 years). Serum levels of 25-hydroxyvitamin D, 25(OH)D, were tested with immune fluorescent method (ADVIA Centaur Vitamin D Total, Siemens).Results: The mean level of 25(OH)D in psoriatic patients was 12.07 ng/ml (30.18 nmol/l), found at low limit of insufficiency; related 95% CI range was 10.55 - 13.60 ng/ml (26.38 - 33.99 nmol/l). A total of 45 of 92 patients (48.9%) had vitamin D insufficiency (defined as 25 (OH) D level of 10 to 30 ng/ml), 44 patients (47.82%) had deficiency (< 10 ng/ml) and only in 3 patients 25(OH)D was assessed at level of sufficiency. Vitamin D level correlate with PASI (r=-0.508), but does not correlate with C-reactive protein. No significant difference in vitamin D status was observed in patients with obesity and early type 1 psoriasis.Conclusion: High prevalence (47.83%) of vitamin D deficiency in patients with moderate and severe psoriasis suspects the role of vitamin D in pathogenesis of disease exacerbation. Vitamin D therapeutic supplementation needs to be clarified by further studies

Saliva application in oral and systemic diseases

Saliva is a noninvasive and accessible biofluid that permits early detection of oral and systemic diseases. Changes in saliva reflect the alterations in the blood and thus making saliva a suitable diagnostic tool. The use of saliva has many advantages, including simple and non-invasive sampling and easy, low-cost storage.Today salivary diagnostics is a promising tool for diagnostic processes and clinical monitoring. Saliva is used to detect illicit drugs, alcohol, to measure hormone levels, and in the diagnosis of wide range systemic diseases such as cardiovascular, infectious, renal, endocrine diseases, some types of cancer as well as nonsystemic oral diseases.The current review presents a critical overview of saliva as a promising tool for the development of valuable salivary biomarkers, their relevance to the prognosis, diagnosis and management of systemic and oral diseases. Development of point-of-care testing based on saliva samples as a screening tool will also support the diagnostic process in near future

Markers of inflammation in patients with psoriasis vulgaris and psoriatic arthritis

Introduction: The pathogenesis of psoriasis is complex. Genetic factors have a basic role, followed by immunological disturbances, which have been found to provoke a chronic inflammatory process affecting the skin and joints. The study aimed to establish and analyze the relationship between the inflammatory manifestations and vitamin D status in the patients with psoriasis.Patients and methods: We investigated 113 patients with moderate or severe psoriasis, divided in two groups for analysis: presence of psoriasis without psoriatic arthritis (n=73) and with psoriatic arthritis (n=40). Clinical data for inflammation were assessed by Psoriasis Area and Severity Index (PASI). At hospital admission samples were collected for C-reactive protein (CRP) and blood count, as well as for 25-hydroxyvitamin D, 25(OH)D. The serum levels of 25(OH)D were tested with immune fluorescent method in 92 patients.Results: The patients with psoriatic arthritis compared to psoriatic patients without arthritis had higher C-reactive protein (31.77 30.61 mg/l vs. 4.13 4.19 mg/l, p<0.0001) and PASI (35.20 11.31 vs. 28.82 12.51, p=0.012) but lower 25(OH)D (10.66 8.73 ng/ml vs. 12.98 6.23 ng/ml, p=0.004). The significant correlation was found between the level of CRP and 25(OH)D, r= -0.2631 (p=0.012) and CRP and PASI, r=0.1993 (p=0.036).Conclusion: The serum level of CRP and 25(OH)D, the vitamin D deficiency respectively, could be accepted as markers for worse health condition according to the clinical manifestations of psoriasis, as well as the comorbid diseases

Basic methods for investigating and proving sickle-cell anemia

Въведение: Сърповидно-клетъчната анемия (СКА) е генетично детерминирано заболяване, представляващо сериозен обществен здравен проблем не само за страните с традиционно висока честота (Африка, Азия, Америка, Средиземноморие), но и за множество от европейските страни, където се наблюдава непрекъснато нарастване на честотата на това заболяване. Цел: Да представим методи, използвани за скриниране и диагноза на СКА. Дискусия: Методите, използвани при скриниране и диагностициране на СКА са два основни типа: рутинни и високо специализирани лабораторни методи. Рутинните тестове включват ПКК, биохимични показатели за доказване на хемолиза in vivo, изследване на урина, както и скриниращите тестове за доказване наличието на HbS - тестове за разтворимост, тестове, предизвикващи промяна във формата на еритроцитите и др. От изключително значение за потвърждаване на диагноза е използването на високо специализирани техники за разделяне на белтъци като електрофореза и високоефективна течна хроматография (HPLC), определящи абнормните хемоглобинови варианти. За нуждите на пренаталната диагностика се използва и ДНК анализ за доказване на точкова мутация в гена за бета веригата на глобиновата молекула. Заключение: Необходимо е да се познават различните видове методи за скриниране и диагноза на СКА, за да е максимално ефективен и бърз диагностичният процес при това разпространено и не рядко тежко протичащо наследствено заболяване.Introduction: The sickle-cell anaemia (SCA) is a genetically determined disease, that is a major public health issue amongst not only the countries where it is traditionally quite common (Africa, Asia, America and the Mediterranean), but also the majority of European countries, where a significant increase of the frequency of the disease is observed. Aim: To present methods used for screening and diagnose of SCA. Discussion: The methods used for screening and diagnose of SCA can be classified into two main categories - routine ones and highly specialised laboratory methods. The routine tests include complete blood count, biochemical parameters to prove in vivo haemolysis, urine tests and the screening tests for presence of HbS e.g. sickling tests and solubility tests. In order to confirm the diagnosis of SCA the usage of protein separation techniques such as electrophoresis and high-performance liquid chromatography (HPLC) for detection of abnormal hemoglobin variants is of high importance. Concerning prenatal diagnostics DNA analysis is also used for detection of point mutation in the fetus beta gene of globin molecule. Conclusion: In order to ensure with maximum of effectiveness the diagnostic process of this common hereditary disease, a good knowledge of all available screening and diagnostic methods is needed

Is vitamin D associated with testosterone in benign prostate hyperplasia?

Introduction. Benign prostate hyperplasia (BPH) affects about 50% of male population between 51-60 years and almost 90% of 81-90 aged males. It is considered that BPH pathogenesis involves epithelial cells and stromal tissue proliferation inside prostate gland and testosterone is one of the promoting factors of prostate cell growth. Evidences about the antiproliferative effects of vitamin D and the widespread vitamin D deficiency and insufficiency among Bulgarian population suggest a possible relation between vitamin D and testosterone in BPH patients.Aim. To evaluate the vitamin D status and total testosterone (TT) levels in BPH patients and their associations with laboratory parameters such as prostate specific antigen (PSA) for prostate growth.Materials and methods. A total of 37 male BPH patients (mean age 67,14±7,77 years) were enrolled in the study. In all patients, BPH was histologically proven. PSA and ТТ levels were analyzed immunochemically. The circulating form of vitamin D, 25-hydroxyvitamin D (25OHD) was assayed by liquid chromatography with mas-spectrometry detection (LC-MS/MS). Other covariates (BMI, age,) were collected by interview at the time of hospitalization. Classical biochemical parameters were assayed by routine spectrophotometric tests. Descriptive statistics, variation and non-parametric correlation analysis were used. The level of significance was set at p<0.05.Results. The mean level of 25OHD for BPH patients was close to the lower reference limit of 50nmol/L recommended by the US Endocrine Society Guideline. The majority of BPH patients (56.8%) display 25OHD levels above 50nmol/L, 43.2% of them were vitamin D deficient (25OHD < 50nmol/L), 8.1% - with severe vitamin D deficiency (25OHD <25nmol/L), and only 6 patients (16.2%) had optimal 25OHD levels above the limit of 75 nmol/L. The mean serum TT levels of BPH patients were 10.74 ± 4.026 nmol/L, close to the lower limit of 10.4 nmol/L for normal TT, according to the recommendations of the Endocrine Society. A significant seasonal variations were found for 25OHD levels (p<0.05) between the cold and warm season. Similar seasonality was not established for TT. Two-thirds of BPH patients (62.9%) were with PSA values below the upper limit of the reference interval of 4 ng/ml. Higher 25OHD levels (59.21 ± 3.756 nmol/l, p= 0.06) were established for the group with PSA below the threshold of 4ng/ml. A moderate negative correlation (Spearman r= -0.6707, p<0.01) was found only for the vitamin D deficient group. In case of vitamin D sufficiency, a weak positive trend was detected.Conclusion. Our study indicated vitamin D insufficiency in BPH patients according to the criteria of the Endocrine Society. Strong negative correlation between 25OHD and TT levels was found for vitamin D deficient BPH patients. Higher 25OHD were associated with lower PSA values indicating a potential favorable effect of 25OHD on slackening of BPH

Association between vitamin D status and obesity in Bulgarian pre-pubertal children: a pilot study

Background: It is considered that obesity and metabolic syndrome are accompanied with vitamin D deficiency. We aimed to examine the interrelations between vitamin D status and biomarkers for metabolic syndrome in Bulgarian pre-pubertal children.Methods: The study enrolled 51 pre-pubertal children (29 boys, 22 girls) examined for serum 25-xydroxyvitamin D, and routine parameters for metabolic syndrome. Obesity was evaluated by body mass index and waist circumference.Results: More than half (57.1%) of the studied children were vitamin D deficient, prevalent in girls than in boys (65.0% vs. 51.7% respectively). A tendency for worse metabolic status in the vitamin D-deficient group, expressed by higher fasting insulin, total cholesterol, total cholesterol/HDL-ratio and Homeostasis Model Assessment (HOMA)-index was observed. A trend for negative correlation was established between 25-xydroxyvitamin D and waist circumference, HOMA-index, and fasting insulin.Conclusions: Vitamin D deficiency and inverse relationships between 25-xydroxyvitamin D and waist circumference, HOMA-index, and insulin were found amongst studied children

Serum level of the human antimicrobial cathelicidin (hCAP18/LL-37) in patients with psoriasis vulgaris

Introduction: Psoriasis is a chronic immune-mediated inflammatory disease. Human cathelicidin (hCAP18/LL37) has been elucidated recently as a modulator of inflammation in the affected skin. Vitamin D may induce expression of this antimicrobial peptide. Our trial aimed to study the circulating level of hCAP18/LL-37 and to explore its relationship with the severity of psoriasis.Material and Methods: 79 patients with moderate to severe psoriasis (PASI >10) were included in a retrospective analysis. Stored serum samples were used for assessment of 25-hydroxyvitamin D - 25(OH)D and to measure the circulating human cathelicidin (LL-37).Results: In a study group of 79 patients we assessed mean level of 25(OH)D of 30.25 nmol/l (95% CI 25.87 - 34.62 nmol/l). Mean circulating cathelicidin was 27.17 ng/ml (95% CI 21.52 - 32.83 ng/ml). Only 8.9% of patients had LL-37 level > 54 ng/ml. Although circulating LL-37 was lower in severe psoriasis than in moderate psoriasis (24.33 ng/ml vs. 31.14 ng/ml), the variation is nonsignificant. We further evaluated the association of LL-37 with both PASI score and 25(OH)D concentration in the subgroup of patients with vitamin D deficiency (n=39). It was interesting to find a significant correlation between the level of LL-37 and 25(OH)D (r=0.38, p=0.017) and inverse association between the level of LL-37 and PASI (r= -0.30, p=0.06).Conclusion: In this pilot trial we assessed low serum levels of cathelicidin antimicrobial peptide in the patients with psoriasis. LL-37 may be discussed as related to PASI and 25(OH)D in a subgroup of psoriatic patients with vitamin D deficiency

Vitamin D deficiency during pregnancy

Vitamin D plays a crucual role during pregnancy. Its active form calcitriol is of utmost importance for placental physiology, for the synthesis of estradiol, progesterone, human chorionic gonadotropin, embryogenesis, and normal progression of pregnancy. Taking in mind the beneficial role of calcitriol on pregnancy, it could be supposed that its inadequacy may lead to deleterious consequences for the mother and fetus. Several studies reveal a correlation between low vitamin D levels during pregnancy and the development of unfavorable consequences for the mother as well as for the fetus: risk of preterm birth, preeclampsia, gestational diabetes mellitus, low birth weight, and postpartum complications.Evaluation of vitamin D status during pregnancy is of utmost importance to overcome the adverse outcomes for the mother and newborn. To achieve maximum protection from pregnancy complications, a serum levels of at least 40 ng/mL for the circulating 25-hydroxy vitamin D3 during the earliest time points of pregnancy are recommended.Control of vitamin D status during pregnancy would present an opportunity for initiating timely and thorough supplementation with harmless and inexpensive vitamin D pharmaceuticals, which in turn would decrease the risk of adverse pregnancy outcomes.

Determination of vitamin D status and significance of suboptimal levels of vitamin D for the course of some chronic diseases//Определяне на витамин D статус и значение на субоптималните нива на витамин D за хода на някои хронични заболявания

[EN] For decades, vitamin D has been associated mainly with bone diseases. As а prohormone of the steroid superfamily, vitamin D performed its effects through VDR (vitamin D receptor), found in many tissues. This has led to the understanding that vitamin D exerts the so-called "non calcemic" effects. There is scientific evidence linking inadequate vitamin D status to a variety of chronic diseases such as cancer, autoimmune and cardiovascular diseases, diabetes and others. The growing incidence of vitamin D insufficiency worldwide is now recognized as a pandemic.In recent years, there is a possibility for laboratory monitoring of vitamin D status in Bulgaria, predominantly by immunochemical methods. Our newly developed “in-house” HPLC-UV method for determination of 25-hydroxyvitamin D (25OHD), the best biomarker of vitamin D status, has shown a high analytical performance. It can be used in cases where there is doubt in the results obtained by immunochemical methods.There are still no ystematic studies in Bulgaria on the incidence of vitamin D insufficiency among healthy population as well as among specific risk groups of individuals with chronic diseases. In our study we have found high incidence of vitamin D insufficiency in two chronic and socially significant diseases (HCV-infection and prostate cancer) and proved correlation with informative clinical/laboratory parameters. This is a reason 25OHD to be included as a routine laboratory parameter in monitoring the course of the mentioned diseases. Public health could be improved by determining and monitoring vitamin D status of risk groups, and recommending a change in lifestyle and/or adequate supplementation with vitamin D preparations.[BG] Десетилетия наред витамин D се свързва предимно с костни заболявания. Като прохормон от стероидната суперфамилия, витамин D осъществява ефектите си чрез витамин D рецептора, разпространен в голям брой тъкани. Това доведе до разбирането, че витамин D упражнява и други, несвързани с костната обмяна ефекти, наречени още "некалциемични". Неадекватният витамин D статус се обвързва с разнообразни хронични заболявания като рак, автоимунни и сърдечно- съдови заболявания, диабет и др. Понастоящем все по-нарастващата в световен план честота на витамин D недостатъчността се определя като „пандемия“. В България отскоро съществува възможност за лабораторно мониториране на витамин D статуса най-често чрез имунохимични методи. Разработеният от нас „in house” HPLC-UV метод за определяне на 25(ОH)D като основен биомаркер за витамин D статуса, се отличава с висока аналитична надеждност. Това дава възможност да служи като арбитражен метод в случаите на съмнение в резултатите, получени с рутинните имунохимични методи. Все още липсват системни проучвания за честотата на витамин D недостатъчност, както сред здравото население, така и сред отделни групи индивиди с хронични заболявания. Доказаната от нас висока честота на витамин D недостатъчност при две хронични и социално значими заболявания като HСV-инфекция и простатен карцином и взаимовръзката с информативни клинико-лабораторни параметри дава основание за включването на този показател към рутинните лабораторни изследвания. Общественото здраве би могло да се подобри като се определя и мониторира витамин D статуса на рискови групи и при доказване на недостатъчност да се препоръчва промяна в стила на живот и/или адекватно суплементиране с витамин D препарати

Vitamin K: The New Faces of an Old Friend - a Role in Bone and Vascular Health

There is an exciting research expansion on the novel roles of vitamin K in the last decades. Subclinical deficiency in vitamin K is believed to be widely spread, possibly contributing to age-related diseases. The present review is focused on the effects of vitamin K on the skeleton and blood vessels, where it could be potentially useful in the prevention and treatment of osteoporosis and vascular calcification, both having a significant health impact in the society. The types (K1 and K2), nature and sources of vitamin K are reviewed as well as the mechanisms of action underlying their effects. Gamma-glutamic carboxylation of several vitamin K dependent proteins (VKDP), including clotting factors, is the primary mode of action of vitamin K, lead-ing to activation of proteins with specific functions. Priority was given to those VKDP that are involved in maintaining bone and vascular health. Other recently identified cellular transduction pathways through which vitamin K acts are also outlined. Experimental in vivo data confirming the expected beneficial effects of vitamin K on bones and blood vessels have paved the way for clinical studies. So far, the evidence from clinical experience with vitamin K supplementation is promising, but still insufficient to recommend routine use of vitamin K as a preventive agent. Several prospective randomized controlled clinical studies currently in progress are expected to give more clear-cut results allowing the routine use of vitamin K as a reliable, cheap and safe medication in the prevention of bone loss and vascular calcification. Biomed Rev 2017; 28: 70-90Keywords: vitamin K, osteocalcin, matrix Gla-protein, osteoporosis, vascular calcificatio