Vitamin D Deficiency in Medical Patients at a Teaching Hospital in North India.

BACKGROUND: While vitamin D is critical for calcium homeostasis, current literature also highlight role of vitamin D deficiency (VDD) in diseases other than the metabolic bone disorders. Only few studies on role of vitamin D in tuberculosis have been done in Asian populations. There is paucity of literature addressing this issue in Indian population as well. AIM: We planned to study prevalence of vitamin D deficiency in patients with tuberculosis and to compare it with patients who had non-tuberculosis medical illnesses and healthy individuals with the hypothesis that patients with tuberculosis might have higher prevalence of hypovitaminosis D. METHODS: In this descriptive cross-sectional study, there were three groups of study participants. Group 1 consisted of newly diagnosed sputum-positive pulmonary tuberculosis patients of either sex aged 18-60 years. Group 2 comprised of age and sex matched hospitalized patients of other medical illnesses. In group 3 healthy controls were recruited from the general population amongst patient's attendants and hospital staff with the same socio-economic status and ethnic background as that of the patients.Their routine hematological and biochemical parameters along with vitamin D status was assessed. RESULTS: Mean vitamin D levels were significantly low (11.2 ± 6.5 ng/ml) and prevalence of hypovitaminosis D was highest (92%) in patients with pulmonary tuberculosis than other groups. Sputum smear conversion time revealed a significant negative correlation with vitamin D levels (Spearman's p coefficient -0.24, P = 0.02). CONCLUSION: vitamin D deficiency is highly prevalent among hospitalized patients especially patients with pulmonary tuberculosis as compared to patients with other illnesses and healthy individuals. Hypovitaminosis D might be linked to severity of the tuberculosis and also response to treatment.

Study of Hepatic Osteodystrophy in Patients with Chronic Liver Disease.

INTRODUCTION: Chronic Liver Disease (CLD) is a major cause of morbidity and mortality worldwide. It involves haemodynamic and metabolic complications. Hepatic Osteodystrophy is a metabolic bone disease that may occur in individuals with chronic liver disease. It can significantly affect morbidity and quality of life of these patients. Fractures are also associated with an excess mortality. It has been an under recognized and inadequately studied complication among Indian population. An early diagnosis is essential to correct reversible risk factors which predispose to bone mass loss. AIM: To assess the prevalence of metabolic bone disease and identify the risk factors associated with hepatic osteodystrophy in patients with cirrhosis. MATERIALS AND METHODS: This was an observational, cross-sectional, hospital based study conducted at a medical college hospital. All patients more than 20-year-old, diagnosed with chronic liver disease/Cirrhosis were enrolled. They were subjected to haematological, biochemical investigations, evaluation of Vitamin D and other hormonal parameters. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DEXA). RESULTS: A total of 72 patients with mean age 50.04±11.24 years were included in the study. Amongst causes of chronic liver disease were alcoholic liver disease 22 (30.6%), CLD due to hepatitis B 24 (33.3%) and chronic hepatitis C 26 (36.1%). Twenty one (29.2%) patients had normal BMD while 51 (70.8%) had a low BMD. Out of these 51 patients, 36 (70.6%) were diagnosed of osteopenia and 15 (29.4%) others were found to have osteoporosis. Vitamin D levels and severity of liver disease had correlation with low BMD. CONCLUSION: Low BMD is highly prevalent in patients with chronic liver disease of variable aetiologies. We advocate more randomised and prospective studies to be conducted on homogeneous groups with chronic liver disease in its various stages. In view of numerous therapeutic options available both for liver disease and bone disease, it is prudent to characterize this condition in order to give these patients a better chance of survival with good quality of life.