Clinical efficacy and safety of use of alfacalcidol and calcitriol in daily endocrinological practice

This paper aims to discuss and compare 2 vitamin D derivatives available on the Polish market, alfacalcidol and calcitriol, in the context of their effectiveness and safety in endocrine patients. Both above-mentioned substances find a number of applications, including in hypoparathyroidism, which is one of the most common indications for their use. We would also like to draw the reader’s attention to the fact that there are quite a lot of reports in the literature on the positive effect of alfacalcidol and calcitriol on maintaining bone mass and the risk of fractures, which may bring additional potential benefits to our patients

Wpływ aktywności fizycznej na stężenia sklerostyny

Osteoporosis is a serious medical and socioeconomic problem of the 21st century. Mechanical load is a key regulator which controls bone formation and remodelling, with participation of osteocytes. Sclerostin is produced and released by mature osteocytes into bone surface, where it inhibits the conveyance of osteoblast proliferation and differentiation activating signals from mesenchymal cells, thus suppressing new bone formation. The goal of the study was an evaluation of the effects of a 12-week physical training programme on the levels of bone turnover markers [Sclerostin, Osteocalcin (OC), C-terminal telopeptide of type I collagen (β-CTX)] in blood serum of women with osteopenia. Materials & Methods: The study included 50 women of the Regional Menopause and Osteoporosis Centre of the WAM Teaching Hospital, at the age of 50-75 years with the diagnosis of osteopenia, obtained on the basis of hip and/or lumbar spine densitometry (T-score from -1.0 to -2.5 SD). During the initial 12 weeks (between point 1 and 2), the patients maintained their previous, normal level of physical activity. During subsequent 12 weeks (between point 2 and 3), a programme of exercise was implemented. The programme included the interval training on a bicycle ergometer, three times a week for 36 minutes. During the entire study duration, all the patients received a supplementation of calcium (500 mg) and vit. D3 (1800 IU) once daily. Serum levels of OC, alkaline phosphatase (ALP), β-CTX and sclerostin were assayed at 3 time points. Results: After the course of the exercise cycle, the OC concentration was increased, sclerostin levels decreased, while no statistical differences were observed in β-CTX levels vs. the period of physical inactivity. No correlations were found between sclerostin level changes and osteocalcin level changes during the training time, because of too small groups. Neither statistically significant were the differences in alkaline phosphatase, calcium and phosphorus levels. Conclusions: The obtained results emphasise the role of physical training as an effective stimulation method of bone formation processes in women with osteopenia. Sclerostin can be a marker of physical activity. Celem pracy była ocena wpływu 12-tygodniowego treningu ruchowego na stężenie markerów obrotu kostnego [Sklerostyny, Osteokal­cyny (OC), C-końcowego telopeptydu kolagenu typu I (β-CTX)] w surowicy krwi pacjentek z osteopenią. Materiał i metody: Do badania zostało włączonych 50 pacjentek, w wieku 50–75 lat z rozpoznaniem osteopenii. Przez pierwsze 12 tygodni (punkt 1 i 2) pacjentki prowadziły dotychczasowy poziom aktywności fizycznej. Przez kolejne 12 tygodni (między punktem 2 i 3) został włączony program ćwiczeń fizycznych. Program obejmował trening interwałowy, przeprowadzony na cykloergometrze rowerowym 3 razy w tygodniu, po 36 minut. Wszystkie pacjentki przez cały okres trwania badania pozostawały na suplementacji 500 mg wapnia i 1800 j.m. witaminy D3 dziennie. W surowicy krwi w 3 punktach czasowych oznaczano OC, fosfatazę zasadową (ALP), β-CTX oraz sklerostynę. Wyniki: Po cyklu treningu fizycznego uzyskano wzrost stężenia OC, spadek sklerostyny, natomiast nie odnotowano istotnych statystycz­nie różnic w poziomie markera β-CTX w porównaniu do okresu bez ćwiczeń. Nie wykazano korelacji pomiędzy zmianami sklerostyny a zmianami osteokalcyny w czasie treningu, prawdopodobnie ze względu na liczebność grup. Różnice w poziomach fosfatazy zasadowej, wapnia i fosforu również nie były istotne statystycznie. Wnioski: Wyniki badania podkreślają rolę treningu fizycznego, jako skutecznej metody pobudzania procesów kościotworzenia u pacjentek z osteopenią. Sklerostyna może być markerem aktywności ruchowej

The Multi-Biomarker Approach for Heart Failure in Patients with Hypertension

We assessed the predictive ability of selected biomarkers using N-terminal pro-brain natriuretic peptide (NT-proBNP) as the benchmark and tried to establish a multi-biomarker approach to heart failure (HF) in hypertensive patients. In 120 hypertensive patients with or without overt heart failure, the incremental predictive value of the following biomarkers was investigated: Collagen III N-terminal propeptide (PIIINP), cystatin C (CysC), lipocalin-2/NGAL, syndecan-4, tumor necrosis factor-α (TNF-α), interleukin 1 receptor type I (IL1R1), galectin-3, cardiotrophin-1 (CT-1), transforming growth factor β (TGF-β) and N-terminal pro-brain natriuretic peptide (NT-proBNP). The highest discriminative value for HF was observed for NT-proBNP (area under the receiver operating characteristic curve (AUC) = 0.873) and TGF-β (AUC = 0.878). On the basis of ROC curve analysis we found that CT-1 > 152 pg/mL, TGF-β 2.3 ng/mL, NT-proBNP > 332.5 pg/mL, CysC > 1 mg/L and NGAL > 39.9 ng/mL were significant predictors of overt HF. There was only a small improvement in predictive ability of the multi-biomarker panel including the four biomarkers with the best performance in the detection of HF—NT-proBNP, TGF-β, CT-1, CysC—compared to the panel with NT-proBNP, TGF-β and CT-1 only. Biomarkers with different pathophysiological backgrounds (NT-proBNP, TGF-β, CT-1, CysC) give additive prognostic value for incident HF in hypertensive patients compared to NT-proBNP alone.The study was financed by JUVENTUS PLUS grant 2012 (No. IP2011003271) of the Polish Ministry of Science and Higher Education (MNiSW) and research grant of Medical University in Lodz and MNiSW No. 502-03/5-139-02/502-54-008

Rola selenu w patofizjologii gruczołu tarczowego

It is now assumed that proper functioning of the thyroid gland (TG), beside iodine, requires also a number of elements, including selenium, iron, zinc, copper, and calcium. In many cases, only an adequate supply of one of these microelements (e.g. iodine) may reveal symptoms resulting from deficits of other microelements (e.g. iron or selenium). Selenium is accounted to the trace elements of key importance for homeostasis of the human system, in particular, for the proper functioning of the immune system and the TG. Results of epidemiological studies have demonstrated that selenium deficit may affect as many as one billion people in many countries all over the world. A proper sequence of particular supplementations is also worth emphasising for the significant correlations among the supplemented microelements. For example, it has been demonstrated that an excessive supplementation of selenium may enhance the effects of iodine deficit in endemic regions, while proper supplementation of selenium in studied animals may alleviate the consequences of iodine excess, preventing destructive-inflammatory lesions in the TG. This paper is a summary of the current knowledge on the role of selenium in the functionality of the TG.Obecnie uważa się, że dla właściwego funkcjonowania gruczołu tarczowego (GT), oprócz jodu niezbędne są również: selen, żelazo, cynk, miedź oraz wapń. Niejednokrotnie dopiero adekwatna podaż jednego z tych mikroelementów (na przykład jodu), może ujawnić objawy wynikające z niedoboru pozostałych (na przykład żelaza lub selenu). Selen jest zaliczany do pierwiastków śladowych mających kluczowe znaczenie dla utrzymania homeostazy organizmu ludzkiego, szcze­gólnie dla prawidłowego funkcjonowania układu odpornościowego i tarczycy. Wyniki badań epidemiologicznych wykazały, że niedobór selenu może dotyczyć aż 1 miliarda ludzi na całym świecie i wielu krajów. Warto również podkreślić istotne zależności, które narzucają odpowiednią kolejność suplementacji. Wykazano bowiem, że nadmierna podaż dużych dawek selenu może w rejonach endemicznych nasilać skutki niedoboru jodu, podczas gdy odpowiednia podaż selenu u badanych zwierząt może łagodzić konsekwencje nadmiaru jodu, zapobiegając zmianom destrukcyjno-zapalnym tarczycy

Biomarkers and echocardiographic predictors of myocardial dysfunction in patients with hypertension

The study aimed to identify early echocardiographic and circulating biomarkers of heart failure (HF) in hypertensive patients with normal resting echocardiography. Echocardiography at rest and during exercise, and selected biomarkers were assessed in control group, dyspnea group, and HF group. On exercise dyspnea patients had lower early diastolic (E') and systolic (S') mitral annular velocity (12.8 ± 1.0 vs 14.9 ± 3.0 cm/sec and 9.3 ± 2.0 vs 10.9 ± 2.0 cm/sec, respectively), and higher E/E' ratio compared to control group (6.7 ± 1.0 vs 5.9 ± 1.0) (p < 0.05 for all comparisons). The level of N-terminal propeptide of procollagen type III (PIIINP) was significantly higher in dyspnea group than in controls (p = 0.01). Control and dyspnea patients had lower levels of cardiotrophin-1, cystatin C, syndecan-4, and N terminal–probrain natriuretic peptide than HF patients (all p ≤ 0.01). In multivariate analysis PIIINP (unadjusted odds ratio [OR] = 8.2, 95% confidence interval [Cl] 1.7–40.6; p = 0.001; adjusted OR = 8.7; 95%CI: 1.5–48.3; p = 0.001) and E/E' ratio on exercise (unadjusted OR = 1.8, 95%CI: 0.8–4.0; p = 0.033; adjusted OR = 2.0; 95%CI: 0.8–4.8; p = 0.012) were the only factors significantly associated with the presence of dyspnea. PIIINP is the first early biomarker for the HF development in patients with HA and normal resting echocardiography. Exertional echocardiography may indicate patients with incipient HF with preserved ejection fraction

Analysis of vitamin D levels in patients with and without statin-associated myalgia - a systematic review and meta-analysis of 7 studies with 2420 patients

Vitamin D (vit D) deficiency may be associated with an increased risk of statin-related symptomatic myalgia in statin-treated patients. The aim of this meta-analysis was to substantiate the role of serum vitamin D levels in statin-associated myalgia. The search included PUBMED, Cochrane Library, Scopus, and EMBASE from January 1, 1987 to April 1, 2014 to identify studies that investigated the impact of vit D levels in statin-treated subjects with and without myalgia. Two independent reviewers extracted data on study characteristics, methods and outcomes. Quantitative data synthesis was performed using a fixed-effect model. The electronic search yielded 437 articles; of those 20 were scrutinized as full texts and 13 studies were considered unsuitable. The final analysis included 7 studies with 2420 statin-treated patients divided into subgroups of patients with (n=666 [27.5%]) or without (n=1754) myalgia. Plasma vit D concentrations in the symptomatic and asymptomatic subgroups were 28.4±13.80ng/mL and 34.86±11.63ng/mL, respectively. The combination of data from individual observational studies showed that vit D plasma concentrations were significantly lower in patients with statin-associated myalgia compared with patients not manifesting this side effect (weighted mean difference -9.41ng/mL; 95% confidence interval: -10.17 to -8.64; p <0.00001). This meta-analysis provides evidence that low vit D levels are associated with myalgia in patients on statin therapy. Randomized controlled trials are necessary to establish whether vitamin D supplementation reduces the risk for statin-associated myalgi