INTRODUCTIONIn 1973 SUBJECTS AND METHODSAfter we obtained informed consent, we consecutively studied 123 healthy subjects belonging to the following 6 distinct groups: physicians and nurses, who were studied both in the winter and in the summer (n = 11 men and 8 women); soldiers (n = 31 men); depigmented persons (n = 10 men and 5 women; 9 with vitiligo universalis and 6 with albinism); pregnant women belonging to a poor socioeconomic class (n = 29; annual income < 30 000 rupees/y); and the newborn children of the pregnant women (n = 29). Subjects were evaluated clinically to rule out metabolic bone disease, chronic hepatic and renal disorders, and other vitamin and mineral deficiencies. Subjects taking vitamin and mineral supplementation or any drugs or sunscreens were excluded.Three groups were studied in the winter: the soldier group, the depigmented group, and the physician and nurse group, and 3 groups were studied in the summer: the pregnant group, the newborn group, and the physician and nurse group. The physician and nurse group was studied in both winter and summer to evaluate the effect of seasonal variation on vitamin D status.
BackgroundStudies on the association between sitting time and low back pain (LBP) have found contrasting results. This may be due to the lack of objectively measured sitting time or because socioeconomic confounders were not considered in the analysis.ObjectivesTo investigate the association between objectively measured sitting time (daily total, and occupational and leisure-time periods) and LBP among blue-collar workers.MethodsTwo-hundred-and-one blue-collar workers wore two accelerometers (GT3X+ Actigraph) for up to four consecutive working days to obtain objective measures of sitting time, estimated via Acti4 software. Workers reported their LBP intensity the past month on a scale from 0 (no pain) to 9 (worst imaginable pain) and were categorized into either low (≤5) or high (>5) LBP intensity groups. In the multivariate-adjusted binary logistic regression analysis, total sitting time, and occupational and leisure-time sitting were both modeled as continuous (hours/day) and categorical variables (i.e. low, moderate and high sitting time).ResultsThe multivariate logistic regression analysis showed a significant positive association between total sitting time (per hour) and high LBP intensity (odds ratio; OR=1.43, 95%CI=1.15-1.77, P=0.01). Similar results were obtained for leisure-time sitting (OR=1.45, 95%CI=1.10-1.91, P=0.01), and a similar but non-significant trend was obtained for occupational sitting time (OR=1.34, 95%CI 0.99-1.82, P=0.06). In the analysis on categorized sitting time, high sitting time was positively associated with high LBP for total (OR=3.31, 95%CI=1.18-9.28, P=0.03), leisure (OR=5.31, 95%CI=1.57-17.90, P=0.01), and occupational (OR=3.26, 95%CI=0.89-11.98, P=0.08) periods, referencing those with low sitting time.ConclusionSitting time is positively associated with LBP intensity among blue-collar workers. Future studies using a prospective design with objective measures of sitting time are recommended.
Basal ganglia calcification occurs in 73·8% of patients with IH and correlates with the duration of hypocalcaemia, choroid plexus calcification, seizures and cataract. The progression of BGC is related to the calcium/phosphorus ratio during follow-up. This brings forth the importance of adequate phosphorus control in the management of hypoparathyroidism.
25-Hydroxy vitamin D (25(OH)D)deficiency is linked with predisposition to autoimmune type 1 diabetes and multiple sclerosis. Our objective was to assess the relationship between serum 25(OH)D levels and thyroid autoimmunity. Subjects included students, teachers and staff aged 16-60 years (total 642, 244 males, 398 females). Serum free thyroxine, thyroid-stimulating hormone (TSH), and thyroid peroxidase autoantibodies (TPOAb), intact parathyroid hormone and 25(OH)D were measured by electrochemiluminescence and RIA, respectively. Thyroid dysfunction was defined if (1) serum TSH $ 5 mU/ml and TPOAb . 34 IU/ml or (2) TSH $ 10 mU/ml but normal TPOAb. The mean serum 25(OH)D of the study subjects was 17·5 (SD 10·2) nmol/l with 87 % having values #25 nmol/l. TPOAb positivity was observed in 21 % of subjects. The relationship between 25(OH)D and TPOAb was assessed with and without controlling for age and showed significant inverse correlation (r 2 0·08, P¼ 0·04) when adjusted for age. The prevalence of TPOAb and thyroid dysfunction were comparable between subjects stratified according to serum 25(OH)D into two groups either at cut-off of #25 or . 25 nmol/l or first and second tertiles. Until recently, vitamin D deficiency was considered to be rare in India because of abundant sunshine (1,2) . However, a systematic study carried out in the year 2000 in Delhi showed the presence of low 25-hydroxy vitamin D (25(OH)D) in a majority of subjects including newborns, their mothers, healthy physicians, nurses, soldiers and those with vitiligo and albinism. Based on these study groups, subnormal serum 25(OH)D levels of Asian Indians could be linked to their skin pigmentation and poor sunshine exposure (1,3) . Subsequently, a series of studies have documented widespread hypovitaminosis D in north as well as south India (3 -5) . Besides bone mineral homeostasis, 25(OH)D deficiency has been associated with a wide range of non-skeletal effects including predisposition towards autoimmune disorders (6 -8) .The demonstration of vitamin D receptor in monocytes, dendritic cells and activated T cells indicates significant interaction between vitamin D and the immune system (6,7) . While the molecular mechanisms linking vitamin D with autoimmunity are under investigation, in vitro studies indicate an immunomodulatory effect of 1,25(OH)D on Th 1 , Th 2 , T regulator and dendritic cells leading to a shift towards activation of Th2 cells (6,7) . Clinical relevance of the mechanism is indicated by a number of studies showing increased prevalence of autoimmune disease such as multiple sclerosis in Canada and the northern part of the USA receiving less sunshine. Vitamin D supplementation resulted in decreased prevalence of autoimmune disorders such as type 1 diabetes and multiple sclerosis. A recent meta-analysis showed 29 % reduction in the risk of type 1 diabetes in children receiving vitamin D supplementation (9,10)
Patients with primary hyperparathyroidism in India presented with bone and renal diseases; half were normocalcaemic. All the patients had hypercalciuria despite the bone disease. The PTH-MM levels were increased and 25-OHD3 levels were low. The predominant bone disease is probably due to prolonged primary hyperparathyroidism coexisting with low calcium intake and/or 25-OHD3 deficiency. The mean weight of the adenoma was higher than that reported for patients in the Western literature.
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