Modulation of Interleukin-8 Production by Vitamin D Supplementation in Indonesian Patients with Diabetic Polyneuropathy: A Randomized Clinical Trial.

OBJECTIVES: We sought to assess the modulation of interleukin-8 (IL-8) production by vitamin D supplementation in Indonesian patients with diabetic polyneuropathy (DPN). METHODS: We conducted a cohort prospective, randomized, placebo-controlled, double-blind trial. This study was approved by the Local Ethical Committee and conducted from July 2018 to February 2019. We recruited 50 subjects with type 2 diabetes mellitus attending Haji Adam Malik General Hospital Medan, and divided them into two groups. The groups were treated for 10 weeks, either with placebo or vitamin D (D3) supplementation of 50 000 IU/week. They were evaluated by routine nerve conduction study (NCS) in the upper and lower limbs, and their serum vitamin 25-hydroxyvitamin D (25(OH)D) and IL-8 levels before and 10 weeks after placebo or vitamin D supplementation were measured. The role of IL-8 and vitamin D supplementation on the NCS was analyzed using linear regression. RESULTS: There was a significant difference between the mean vitamin 25(OH)D (p = 0.001) and IL-8 levels (p = 0.002) before and after vitamin D supplementation. There was no significant correlation between changes in vitamin 25(OH)D and IL-8 levels (p = 0.743). There was significant role of IL-8 on amplitude of the sensory sural nerve (p = 0.047; B = -0.009) and the nerve conduction velocity (NCV) of the motor tibial nerve (p = 0.007; B = -0.027). There was a significant role of vitamin D supplementation on NCSs. CONCLUSIONS: Higher IL-8 levels were correlated with poorer amplitude of the sensory sural nerve and the NCV of motor tibial nerves. Lower vitamin 25(OH)D levels were correlated with poorer distal latencies, amplitudes, and NCVs. There was no significant correlation between vitamin 25(OH)D and IL-8 levels. Thus, no sufficient evidence that vitamin D supplementation modulates IL-8 in Indonesian patients with DPN. Vitamin D3 improved NCSs in diabetic patients.

Predictive Model of Diabetic Polyneuropathy Severity Based on Vitamin D Level.

BACKGROUND: Type 2 Diabetes Mellitus is one of the most common metabolic diseases worldwide. The most common complication of DM is diabetic neuropathy (DN), especially diabetic polyneuropathy (DPN). Vitamin D plays an important role in the pathogenesis of DN, thus affecting its severity which can be assessed using nerve conduction study (NCS). AIM: This study aimed to develop a predictive model of DPN severity based on vitamin D level. METHODS: This was a prospective cohort study involving 50 subjects with DM which was conducted in Haji Adam Malik General Hospital Medan. All subjects were fulfilling inclusion criteria underwent laboratory examination to determine HbA1c and 25 (OH) D levels. Predictive variables were sex, age, duration of DM, smoking status, type and number of anti-diabetic drugs, the presence of metabolic syndrome, HbA1c and vitamin D levels. A scoring system was developed to determine a predictive model. The DPN severity was assessed using NCS and was re-evaluated after 3 months. RESULTS: Most of the subjects were female (60%), belonged to ≥ 50 years old age-group (88%), with DM duration < 5 years (56%), were non-smoker (90%), we're using one anti-diabetic drug (60%), were using insulin (50%), had metabolic syndrome (68%), had HbA1c level > 6.5% (94%), and had vitamin D level < 20 ng/ml (56%). A score of > 4 on this predictive model of DPN severity had a relative risk (RR) of 2.70. The predictive model had a sensitivity of 82.8% and specificity of 61.9%. CONCLUSION: A score of higher than 4 on this predictive model showed a 2.7 times higher risk of severe DPN. A predictive model of DPN severity based on vitamin D level had high sensitivity and specificity.

Correlation between Lymphocyte CD4 Count, Treatment Duration, Opportunistic Infection and Cognitive Function in Human Immunodeficiency Virus-Acquired Immunodeficiency Syndrome (HIV-AIDS) Patients.

BACKGROUND: Human immunodeficiency virus (HIV) infection is an epidemic worldwide, despite the marked benefits of antiretroviral therapy (ARV) in reducing severe HIV-associated dementia. A milder form of neurocognitive disorders are still prevalent and remain a challenge. AIM: This study aimed to determine the correlation between plasma cluster of differentiation 4 (CD4) lymphocyte, duration of ARV treatment, opportunistic infections, and cognitive function in HIV-AIDS patients. METHODS: A cross-sectional study involving 85 HIV-AIDS patients was conducted at Adam Malik General Hospital Medan, Indonesia. All subjects were subjected to physical, neurologic examination and Montreal Cognitive Assessment-Indonesian Version (MoCA-INA) to assess cognitive function and measurement of lymphocyte CD4 counts. RESULTS: Out of the 85 subjects evaluated, the proportion concerning sexes include 52 males (61.2 %) and 33 females (38.8%). The mean age was 38.53 ± 9.77 years old. There was a significant correlation between CD4 lymphocyte counts and MoCA-INA score (r = 0.271, p = 0.012), but there was no significant correlation between duration of ARV treatment and MoCA-INA score. There was also no difference in MoCA-INA score based on the presence of opportunistic infection. CONCLUSION: Lymphocyte CD4 count was independently correlated with cognitive function in HIV-AIDS patients.