Background:Vitamin D is believed to have an immunomodulatory and anti-inflammatory action, and its deficiency has been linked with several autoimmune disorders, including rheumatoid arthritis (RA). The relationship between the severity of RA and serum levels of Vitamin D is a subject of immense interest and therapeutic implications.Materials and Methods:This was a prospective, comparative study conducted on 100 participants, 50 cases of RA and 50 healthy controls, all in the age group of 18–75 years. Serum Vitamin D levels were measured and compared in cases and controls. Vitamin D levels in RA patients were also assessed in different stages of disease activity to assess the correlation between the two.ResultsEighty-four percent patients of RA were Vitamin D deficient versus only 34% of controls. The serum Vitamin D levels were also significantly lower in the RA patients (mean value of 21.05 ± 10.02 ng/ml), as compared to the controls (mean value of 32.87 ± 14.16 ng/ml). There was a significant inverse correlation between serum Vitamin D levels and RA disease activity. The mean serum Vitamin D levels were 35.28 ± 9.0 ng/ml, 33.80 ± 4.1 ng/ml, 22.47 ± 6.18 ng/ml, and 14.21 ± 6.97 ng/ml in the remission, low disease activity, moderate disease activity, and high disease activity groups, respectively.ConclusionsVitamin D deficiency is more common in RA patients and may be one of the causes leading to development or worsening of the disease.

Introduction: Diabetic nephropathy is one of the most common and serious complications of long standing type 2 diabetes mellitus. Microalbuminuria is a strong predictor of diabetic nephropathy. Homocysteine level plays an important role in pathogenesis of diabetic microvascular complications, particularly diabetic nephropathy. Vitamin B 12 , Folic acid and Vitamin B 6 facilitate homocysteine metabolism. Methods: This case-control study was carried out at a tertiary care centre. Total 150 subjects were enrolled, which included 60 cases of type 2 diabetes with microalbuminuria, 60 cases of type 2 diabetes without microalbuminuria and 30 healthy controls. Besides routine investigations, fasting blood glucose, glycated haemoglobin, and homocysteine levels in serum were measured. All subjects were screened for microalbuminuria. Statistical analysis was done. Results: Homocysteine levels, fasting blood glucose and glycated haemoglobin were significantly higher in patients of type 2 diabetes with microalbuminuria as compared to those without microalbuminuria (p = 0.00, p = 0.01, p = 0.01). Strong positive correlation was observed between the homocysteine levels and degree of microalbuminuria(r = +0.758, p = 0.00), and also between the fasting blood glucose levels and degree of microalbuminuria (r = +0.259, p = 0.02). Conclusions: It would be useful to perform an early screening for raised homocysteine levels and for low vitamin levels in the patients of uncontrolled diabetics. This would help to evaluate the need of folic acid, Vitamin B 12 and Vitamin B 6 supplements since these supplements can be beneficial for delaying the progress of diabetic nephropathy in these patients.

Bilirubin is more than just the final product of heme catabolism. Today it is considered to be a fundamental substance which acts as an antioxidant and anti-inflammatory agent in the serum. It can neutralize free radicals and prevent peroxidation of lipids. In addition there is evidence that it protects the cardiovascular system, neuronal systems, the hepatobiliary system, the pulmonary system and the immune system. Recently the use of pharmacological agents which augment expression of Heme oxigenase 1 (HO-1) has been investigated. Consequently its metabolites such as carbon monoxide (CO), biliverdin (BV) and bilirubin (BR) could become parts of a therapeutic strategy for treatment of various inflammatory illnesses. Reactive oxygen species (ROS) and signaling events are involved in the pathogenesis of endothelial dysfunction and represent a major contribution to vascular regulation. But depending on the amount of ROS production it might have toxic or protective effects. Despite a large number of negative outcomes in large clinical trials (e.g., HOPE, HOPE-TOO), antioxidant molecules and agents are important players to influence the critical balance between production and elimination of reactive oxygen and nitrogen species. With the present review we would like to highlight the important antioxidant role of the HO system and especially discuss the contribution of the biliverdin, bilirubin, and biliverdin reductase (BVR) to these beneficial effects.

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