Decreased circulatory levels of Vitamin D in Vitiligo: a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Transplacental transport of fluoride, calcium and magnesium.

Background: In fluorosis endemic area, the amount of fluoride transferred to the fetus is significant in determining the early onset of fluorosis. The role played by placenta in transporting fluoride and other ions which are present in high concentrations in the local drinking water is studied. Aims & Objectives: The aim of the present study is to decipher the role of placenta in transport of fluoride to the fetus and to analyze the placental binding & distribution of fluoride, calcium and magnesium within the placenta. Materials & Methods: 200 healthy pregnant women aged between 17- 28 yrs were inducted in the study. All the women had a normal & uneventful delivery. The maternal blood, cord blood & placenta were collected immediately after delivery. The placenta was divided into 3 parts- the maternal side, fetal side & the peripheral. Separate tissue extracts were prepared from each site and analyzed. Fluoride, calcium and magnesium were quantified from the samples. Results: The average drinking water fluoride was 1.64±0.49ppm and ground water fluoride was 10.94±2.09ppm. Fluoride concentration of placenta on the maternal side was 1.62±0.787 ppm and in the periphery it was2.54±1.54 ppm (p<0.001) while that of the fetal side of placenta was1.41±0.776 ppm. Maternal and cord blood fluoride levels were1.21±0.79ppm and 0.45±0.304 ppm respectively (p<0.001). The concentrations of calcium in the maternal blood and cord blood were 9.67±1.53mg% and 9.89±1.89 mg% respectively (P<0. 5). The levels of calcium in the placenta were 8.79±1.36 mg%, 9.68±1.69 mg%, 13.87±3.32 mg% respectively on the maternal surface, fetal surface and periphery (p<0.001). The magnesium concentration on the peripheral part of placenta was twofold higher than that of the maternal serum and cord serum (p<0.001) indicating a significant accumulation of magnesium on the peripheral parts of the placenta. However, the differences in the magnesium concentrations of the placenta on the maternal and fetal surfaces with that of the maternal and cord blood sera were found to be insignificant. Conclusion: The results show that, Fluoride, Calcium and Magnesium accumulate in placenta, with the highest concentration being in the marginal part. The placenta therefore acts as a barrier to the transport of fluoride ions and protects against early fluorosis.

Serum - ascites albumin and cholesterol gradients in differential diagnosis of ascites.

Background: Differential diagnosis of ascites is a common clinical problem. Less expensive biochemical techniques are required to differentiate ascites with unknown etiology. Aim: To evaluate the diagnostic efficiency of ascitic fluid cholesterol, serum ascites albumin gradient (SAAG) and serum ascites cholesterol gradients (SACG) in differentiating cirrhotic, tuberculous and malignant ascites. Methods: 50 patients (25 with hepatic cirrhosis, 15 with tuberculosis and10 with malignancy) were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG. Results: The mean ascitic fluid cholesterol was significantly higher in malignant ascites when compared with cirrhosis and tuberculous ascites (p= 0.0001 each). The difference between tuberculous and cirrhotic ascites was also significant (p= 0.001). The mean value of SAAG was significantly higher in cirrhosis when compared with tuberculous and malignant ascites (p= 0.0001; p= 0.001 respectively) but the difference between tuberculous and malignant ascites was not significant The mean SACG was significantly lower in malignant compared to tuberculous and cirrhotic ascites (p= 0.0001; p= 0.001 respectively). The difference between tuberculous and cirrhotic ascites was not significant. Conclusion: SAAG is a better marker to differentiate cirrhotic ascites from tuberculous and malignant ascites. Ascitic fluid cholesterol and SACG are better markers to differentiate malignant ascites from cirrhotic and tuberculous ascites.