A Randomized Clinical Trial Comparing the Effects of Three Different Cholecalciferol Supplementation Protocols on Serum 25 Hydroxy Vitamin D Level in Asymptomatic Vitamin D Deficient Children

INTRODUCTION: Vitamin D is a secosteroid and its role in musculoskeletal health is known for almost a century. In the past two decades there have been a lot of research to explore the influence of vitamin D on skeletal and extraskeletal health and its action at molecular level. Vitamin D deficiency is pandemic(1) and vitamin D deficiency has been attributed to play a significant role in autoimmune diseases, malignancy, ischemic heart disease etc. METABOLISM: Cutaneous synthesis of cholecalciferol is the major source of vitamin D in humans. Vitamin D is obtained either from the diet (negligible in unfortified food) as vitamin D2 (ergocalciferol) or as vitamin D3(cholecalciferol). Ergocalciferol is vitamin D2 obtained from plant source by the influence of ultraviolet B radiation, while cholecalciferol is vitamin D3 obtained from animal source or from the human skin by the influence of ultraviolet B radiation on 7-dehydrocholesterol(2). Once vitamin D is absorbed, it get bound to Vitamin D- binding protein, an alpha globulin , and is then taken up by the liver. The absorbed vitamin D is biologically inactive requiring transformation in liver and kidney to become the active form. In the liver, vitamin D is converted to 25 hydroxy vitamin D3(25OHD) by 25 hydroxylase. This 25OHD is the predominant storage and circulating form of vitamin D. In the kidney, it gets converted to 1,25 dihydroxy vitamin D3 by 1 alpha hydroxylase. 1,25 dihydroxy vitamin D3 is the active form of vitamin D. The biologic effects of this active form is limited by 24 hydroxylase, which hydroxylates the active vitamin D3 into the inactive form. The major inducer of 24 hydroxylase is 1,25 dihydroxy vitamin D3, which promotes its own inactivation. AIMS AND OBJECTIVES: To analyze the effect of vitamin D (cholecalciferol) supplementation on serum 25OHD level in asymptomatic Vitamin D deficient children: Comparison of three different vitamin D supplementation protocols. PRIMARY OUTCOME: a. To compare the efficacy of three different vitamin D supplementation protocols in raising Se 25OHD levels. SECONDARY OUTCOMES: a. To analyse the side effects of cholecalciferol supplementation, if any, in children. b. To see whether Body Mass Index (BMI) has any effect on change in serum 25OHD levels after supplementation with cholecalciferol. DISCUSSION: We recruited 39 children with Se 25OHD less than 20ng/ml. They were evaluated for features of rickets clinically and for evidence of secondary causes that interfere with vitamin D absorption or metabolism. The predominant secondary causes that interefere with vitamin D absorption and metabolism in children are malabsorption syndrome, chronic renal disease and chronic liver disease. We screened all the participants for Se albumin and Se creatinine to rule out chronic renal disease and chronic liver disease. Se albumin and Se creatinine were normal for all the children and there were no features of rickets or malabsorption in any of the participants. Among the 39 children, 22 were females (56%) and 17 were males (44%). In groups B and C, the predominant population was females (73% and 67% respectively), while in group A, males(69%) were more (Fig 3). The mean age (Table 6) at recruitment was similar in all groups [Group A: 9.1 ± 4.5 (range: 2.5-15) yrs, Group B: 9.8 ± 3.0 (range: 3.5-12.5) yrs and Group C: 10.4 ± 4.2 (range: 2.0-15) yrs). Only five participants could be recruited who weighed less than 15 kg (Group A-n=2, Group B-n=1 and Group C-n=2). In view of the non-normal distribution for BMI centiles and Se PTH, we have analyzed the median (IQR) (and not mean, SD) for these parameters. The median BMI centile in group A (45.3 pg/ml) and Group C (47.2 pg/ml) were similar, and comparatively lower than Group B (81 pg/ml).. Most of the participants had BMI less than <85th centile. In Group A, one (7%) out of 13, in Group B, 5 (45%) participants out of 11 were above the 85th centile for BMI and in Group C, 4 participant out of 15 (26%) were above the 85th centile for BMI (Fig 4). The mean Se 25OHD at recruitment was 12-16 ng/ml (Group A: 15.6 ± 4.1ng/ml, Group B: 12.2 ± 3.9 ng/ml and group C 13.0 ± 4.3 ng/ml). The median Se PTH was similar in Group A (56.2 pg/ml) and Group B (54.0 pg/ml) and comparatively higher than Group C (34.6pg/ml). The mean Se Calcium and Se Phosphorous were similar in all the groups. The amount of UVB radiation available from sunlight depends on the angle at which the sun‟s rays strike the earth which in turn depends on the latitude of the place. We recruited participants from in and around Vellore (Latitude 12° 55' N), so that participants were limited to a similar latitudinal area. In our study, as our participants were recruited throughout the year based on block randomization serially, the influence of seasonal bias on the treatment groups results is possibly avoided . CONCLUSIONS: Oral cholecalciferol 6000 units daily; 10,000 units daily and 60,000 units weekly once; for 6 weeks) showed similar efficacy in raising Se 25OHD levels in asymptomatic children with hypovitaminosis D without any toxicity. BMI has a significant influence on the treatment response during the initial phase (i.e.) children with BMI > 85th centile require a higher dose of cholecalciferol for a similar rise in Se 25OHD as compared to children with BMI <85th centile

Media Sosial dan Dampak Positif Menurut Islam

Perkembangan teknologi pada masa kini menyumbang kemudahan dalam penggunaan saluran Internet dan menjurus dalam bidang komunikasi seharian. Antara contoh aplikasi yang melibatkan komunikasi secara talian adalah seperti Facebook, Blog, Twitter, dan Whatsapp. Secara umumnya, penglibatan penggunaan media sosial pada masa kini ingin melihat apakah implikasi yang berlaku terhadap proses komunikasi dan interaksi yang mampu mewujudkan kemudahan antara masyarakat. Tujuan kajian ini dijalankan untuk memantau peranan media sosial terhadap masyarakat yang sedang bergiat dalam menggunakan media sosial sebagai bahan berinteraksi dan komunikasi dalam seharian. Teori Penyelidikan ini juga penting untuk memberi panduan dalam menganalisis sejauh mana kepuasan masyarakat dalam penggunaan media sosial. Hasil kajian menunjukkan bahawa tujuan mereka menggunakan media sosial dalam bahagian interaksi untuk mengelakkan rasa kesunyian, mengeratkan hubungan antara sesama mereka, dan mencari hiburan dalam talian. Selain itu, terdapat implikasi yang baik dalam penggunaan media sosial terhadap masyarakat menurut Islam dan juga implikasi negatif yang mungkin membawa padah terhadap masyarakat kita pada masa kini