Relevance to nursing care The evidence available regarding vitamin D on mortality has been inconclusive. Vitamin D can be obtained from sun exposure on skin, dietary intake, or supplementation as vitamin D3 or D2. Proper balance of vitamin D and calcium levels are important for healthy bones. Past studies have indicated that vitamin D supplementation prevents osteoporosis, osteomalacia, and fractures. Contradictory studies suggest that vitamin D may prevent cancer, cardiovascular disease, and affect mortality; and observational research has indicated a relationship of low vitamin D levels and risk of mortality. Evidence related to vitamin D is important for nurses working with patients with and without vitamin D insufficiency. The value of vitamin D needs clarification, and health information about risk factors, common problems with deficiency, as well as the benefits and proper use of vitamin D supplementation are needed by patients and caregivers. The purpose of this systematic review was to assess the beneficial and harmful effects of vitamin D supplementation on the prevention of mortality in healthy adults and in adults with a stable form of disease.

Vitamin D supplementation for prevention of mortality in adults

Despite the rapid accumulation of advanced information governing iron nutrition, the diversity of dietary practices and economic circumstances have resulted in iron deficiency in developing as well as in affluent countries.

Iron Deficiency in Infancy and Childhood

Although both SLC30A8 rs13266634 single nucleotide polymorphism and plasma zinc concentrations have been associated with impaired glucose regulation (IGR) and type 2 diabetes (T2D), their interactions for IGR and T2D remain unclear. Therefore, to assess zinc-SLC30A8 interactions, we performed a case-control study in 1,796 participants: 218 newly diagnosed IGR patients, 785 newly diagnosed T2D patients, and 793 individuals with normal glucose tolerance. After adjustment for age, sex, BMI, family history of diabetes, and hypertension, the multivariable odds ratio (OR) of T2D associated with a 10 µg/dL higher plasma zinc level was 0.87 (95% CI 0.85-0.90). Meanwhile, the OR of SLC30A8 rs13266634 homozygous genotypes CC compared with TT was 1.53 (1.11-2.09) for T2D. Similar associations were found in IGR and IGR&T2D groups. Each 10 µg/dL increment of plasma zinc was associated with 22% (OR 0.78 [0.72-0.85]) lower odds of T2D in TT genotype carriers, 17% (0.83 [0.80-0.87]) lower odds in CT genotype carriers, and 7% (0.93 [0.90-0.97]) lower odds in CC genotype carriers (P for interaction = 0.01). Our study suggested that the C allele of rs13266634 was associated with higher odds of T2D, and higher plasma zinc was associated with lower odds. The inverse association of plasma zinc concentrations with T2D was modified by SLC30A8 rs13266634. Further studies are warranted to confirm our findings and clarify the mechanisms underlying the interaction between plasma zinc and the SLC30A8 gene in relation to T2D.

https://diabetes.diabetesjournals.org/content/diabetes/63/5/1796.full.pdf

Interactions Between Zinc Transporter-8 Gene (SLC30A8) and Plasma Zinc Concentrations for Impaired Glucose Regulation and Type 2 Diabetes

Background and Aim
Celiac disease (CD) is emerging in Asia. While a few population-based studies from Asia have reported a prevalence of CD from 0.1% to 1.3%, the exact prevalence of CD in Asia is not known. We conducted a systematic review and meta-analysis to estimate the prevalence of CD in Asia.

Methods
On search of literature, we found 1213 articles, of which 18 articles were included. Diagnosis of CD was based on European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines.

Results
Pooled sero-prevalence of CD in Asia was 1.6% in 47 873 individuals based on positive anti-tissue transglutaminase and/or anti-endomysial antibodies. Pooled prevalence of biopsy proven CD in Asia was 0.5% in 43 955 individuals. The prevalence of CD among women was higher than in men (0.5% vs 0.4%, P = 0.04). The pooled prevalence of CD was 0.3% in Iran, 0.5% in Turkey, 0.6% in India, and 0.7% in Israel. The pooled prevalence of CD was significantly higher in Israel and India as compared with that in Iran.

Conclusions
Celiac disease is not uncommon in Asia, and the sero-prevalence and prevalence of CD in Asia are 1.6% and 0.5%, respectively. The prevalence of CD varies with gender and geographic location. There is a need for population-based prevalence studies in many Asian countries to properly estimate the burden of CD in Asia.

Prevalence of celiac disease in Asia: A systematic review and meta-analysis.

Levin and O’Neal’s The Diabetic Foot

Objective: To assess serum zinc and magnesium level in type-2 diabetic patients and the effect of age, gender, glycemic control and duration of diabetes on these trace elements in comparison with those of control subjects. Study Design: Non-interventional case control study. Place and Duration of Study: Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, from October 2007 to March 2008. Methodology: There were 42 diabetic patients and 42 age matched non-diabetic (control) subjects included in this study. Serum zinc, serum magnesium and fasting blood sugar measured among the diabetic and control groups and association of both trace elements were assessed with glycemic status, age, gender and duration of diabetes using SPSS version 16.0 for analysis. Results: Serum zinc level was significantly lower (mean 2.03+0.39 mg/dL) in diabetic patients as compared to control subjects (4.84+4.217 mg/dL, p = < 0.001). No significant difference was found in serum magnesium level with mean of 22.67+24.5 mg/dL in diabetic patients as compared to controls (18.3+3.4 mg/dL, p = 0.26). Conclusion: Serum zinc level was significantly lower in type-2 diabetics, whereas no significant difference was found in serum magnesium level when compared with control subjects. There was no association of age, gender, glycemic status and duration of diabetes on the serum concentration of these trace elements in type-2 diabetic patients.

/pdf/serum-zinc-and-magnesium-in-type-2-diabetic-patients-5fln1fbyhz.pdf

Serum zinc and magnesium in type-2 diabetic patients.

Objective: The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C (CHC) patients and HCV outcome. Study Design: Descriptive study.

/pdf/frequency-of-thyroid-disorders-during-interferon-and-4yoe5qhfka.pdf

Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection.

Introduction Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycemia due to absolute or relative insulin deficiency. Cardiovascular autonomic neuropathy invokes potentially life threatening outcomes especially in poorly controlled diabetic patients. However, there is scarcity of epidemiological data for CAN in poorly controlled type 2 diabetic patients in Pakistan. Objective The objective of this study is to assess the frequency of cardiovascular autonomic n europathy (CAN) in patients with poorly controlled type 2 d iabetes mellitus in Pakistan. Study design Descriptive cross-sectional. Setting Department of Medicine, Liquate University Hospital, Hyderabad/Jamshoro, Sindh, Pakistan. Duration February to November 2012. Sampling technique Non-probability purposive. Material and method This study included 207 patients, who all met the inclusion criteria and gave an informed consent for inclusion in the study. All the patients in the study were evaluated for CAN using four different clinical tests- Resting heart rate, test for orthostatic hypotension, hand gripping test and QTc interval on ECG. Resting Heart Rate of more than 100 beats per minute was taken as abnormal. Orthostatic hypotension was defined as a fall of systolic blood pressure >20 mmHg and/or diastolic blood pressure >10 mmHg on change of posture. The patients were asked to squeeze a small ball in hand gripping test and an increase in diastolic blood pressure 440 ms was considered abnormal or prolonged. Patients were labeled as CAN +ve if any two or more than two of the above listed tests were found positive/abnormal. Results In our study, 76 out of 207 (36.7%) of the patients with poorly controlled type 2 diabetes mellitus were found to have cardiovascular autonomic neuropathy (CAN). Conclusion Cardiac autonomic dysfunctions are common in poorly controlled type 2 diabetes.

Cardiovascular autonomic neuropathy (CAN) in patients of type 2 diabetes mellitus: a tertiary care hospital based study.

OBJECTIVE To see the various clinical presentations and biochemical profile in adult celiac disease patients of Hyderabad Sindh. METHODS A total 60 suspected cases of adult celiac disease, both males and females were screened out from Liaquat University of Medical and Health Sciences hospital and private clinics at Sadar Hyderabad Sind by non probability purposive sampling during a period from July 2011 to December 2012.Age ranged between 18 to 55 Years. A detailed history and clinical examination was done. Patients already on gluten free diet, age 15 iu/ml detected by ELISA) were included. The biochemical profile including serum albumin, calcium ,ferritin, SGPT, Alkaline phosphatase and Haemoglobin were estimated in central Diagnostic laboratory LUMHS by taking 10 cc centrifuged blood sample. The data was plotted on SPSS 16, mean and percentages were calculated. RESULTS All patients were divided in to three groups according to age. The most common group was 18-30 years; (mean, 23.5±5.6) comprised 56.6%. The commonest clinical presentation was diarrhoea in 50%, menstrual irregularity in 21%, walking problems 21%, undue fatigue in 15% and edema in 15%. P values calculated in quantitative variable of males and females. The p value was significant in between serum calcium (p 0.004), haemoglobin (p 0,004), serum ferritin (<0.005) and alkaline phosphatise (<0.005). CONCLUSION This study showed that Adult celiac disease was present with entirely different clinical and biochemical profile in patients in this region.

Clinical presentations and biochemical profile in adult celiac disease patients in Hyderabad: Pakistan.

.. Objectives: To know the correlation of foot ulcers to the nutritional status of type 2 Diabetic patients of Hyderabad. Study Design: Cross sectional study. Place of Study: Private clinics of consultants of Hyderabad, Sindh, Pakistan. Duration of study: February 2015 to June 2016. Methodology: 387 diabetic type 2 patients were selected from different clinics of physicians, orthopedics and diabetic consultants of sadder Hyderabad Sindh Pakistan. The mean age was 40±11.5 years. All patients were enrolled on prescribed proforma. Thorough clinical examination was done. Wagner’s classification was used to categorize diabetic foot ulcers. Nutritional status was classified on Mini Nutritional Assessment score and patients were divided into three groups according to Mini nutritional score. Blood samples were obtained for Hemoglobin%, blood sugar, serum calcium and serum albumin estimation. All patients were assessed radiologically by x-rays of involved foot. ANOVA test was used and p value <0.05 was considered statically significant. Results: There was linear correlation in between Mini nutritional assessment and severity of diabetic foot ulcer (p <0.03). Biochemical parameter were also significantly associated with the severity of ulcers. Serum albumin was decreased in grade 4 ulcer significantly (p value <0.04), while hemoglobin was also decreased in grade 4 ulcer, p value (<0.05). There was no association of serum calcium to severity of foot ulcer, (p value >0.07). Conclusion: Diabetic foot ulcers are common in type 2 diabetic patients and nutritional status is strongly associated with grade of severity. It is important to assess nutritional status of all diabetic patients.

/pdf/diabetic-foot-ulcers-correlation-of-nutritional-status-of-3jhm3j5h3f.pdf

Naila Masood

Papers

Serum zinc and magnesium in type-2 diabetic patients.

Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection.

Cardiovascular autonomic neuropathy (CAN) in patients of type 2 diabetes mellitus: a tertiary care hospital based study.

Clinical presentations and biochemical profile in adult celiac disease patients in Hyderabad: Pakistan.

Diabetic foot ulcers; correlation of nutritional status of type 2 diabetic patients of hyderabad sindh pakistan