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Natural antioxidants have an important role in the prevention of many age-related diseases and promotion of health. Among natural antioxidants from plants, flavonoids and other phenolic compounds are potent antioxidants and chelating agents. Panchavalkala the barks of five trees i.e. Nyagrodha (Ficus benghalensis L.), Udumbara (Ficus racemosa L.), Ashwatha (Ficus religiosa L.), Plaksha (Ficus virens Aiton) and Parisha (Thespesia populnea (L.)Sol.ex Correa) are also known as Pancha Ksheeri Vrikshas in use since Vedic period. Barks of these trees are dried in shade and are used for different formulations (Pancha Kashaya Kalpanas), in different pathological conditions, especially as wound healing, gynecological disorders and etc. The plant samples were extracted using ethanol and water, and subjected for the phytochemical analysis. It was confirmed that samples contain many biologically active compounds like flavonoids, polyphenols, tannins, alkaloids, glycosides and terpinoids etc. The marker compound of each trial drug and the quantitative analysis has been carried out by high performance liquid chromatography. The antioxidant study was done by using in vitro method 1, 1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The marker compounds caffeic acid and gallic acid were quantified in each extract for their quality and efficacy. PVK barks showed high free radical scavenging activity as evidenced by the low IC50 values in DPPH (EE PVK- 20.46µg/ml, AE PVK-37.79µg/ml, EE T.poulenea-22µg/ml, AE T. poulenia- 23.31µg/ml AE F. benghalensis- 25.53µg/ml, EE F. benghalensis- 26.23µg/ml, EE F. religiosa - 34µg/ml). Quercetin- IC50 value 4.026µg/ml is used as standard. The results of the study demonstrated that PVK barks possess phyto-constituent’s viz. tannins, flavonoids, polyphenols etc. and has potential antioxidant activity. Thus these barks have good therapeutic potential as natural antioxidant and might be used in life style related conditions like hyperlipidemia, diabetes, obesity, cardiovascular disorders and etc.
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Background: Dengue fever and scrub typhus are considered an endemic disease in the Indian subcontinent. The epidemiology and clinical presentations are complex and vary each year.? Objective: The objective of this study was to estimate the prevalence of coinfection with scrub typhus in children diagnosed with dengue fever. Methods: A retrospective hospital-based, cross-sectional study was done in the Department of Pediatrics of a teaching hospital in Puducherry. All children (0–14 years) who had enzyme?linked immunosorbent assay (ELISA) reported scrub typhus among those diagnosed with dengue fever (NS1Ag or immunoglobulin M ELISA positivity) during 2012–2016. Medical records with incomplete data were excluded from the study. Odds ratio was calculated to find out the association of coinfections. An independent t-test was used to find out the statistical significance. P < 0.05 was considered statistically significant. Results: Atypical features of dengue were present in 250/318 (78.6%) children. Coinfections were seen in 62/318 (19.4%) children. Scrub typhus was the most common (n = 51/62, 82.2%). The chance of scrub typhus in a dengue serology?positive child is significant when the symptoms are atypical or protracted (OR– 2.6, P = 0.033). Conclusion: High index of suspicion should be present in endemic dengue and scrub typhus coinfection.
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Objective: To describe the occurrence, microbiology, and risk factors of catheterassociated urinary tract infections (CA-UTI) in critically ill children. Methods: We conducted a review of hospital records for CA-UTI in the pediatric intensive care unit (PICU) over a 7- year period (2014-2020). Results: 62 CA-UTI cases (48% boys, median (IQR) age 36 (12,96 month) were identified during the study period with occurrence rate of 7.2/1000 catheter-days. The most common organisms were Escherichia coli (32.4%) and Enterococcus faecalis (30.6%). Using a multivariate logistic regression analysis, the significant associated variables for CA-UTI were duration of catheter drainage (a OR (95% CI) 1.14, (1.03,1.27), P=-0.009), PICU stay (aOR (95% CI) 1.13 (1.05,1.21) (P<0.001), and hospital stay (aOR (95% CI): 1.03 (1.01,1.06), P=0.015). Conclusion: CA-UTI is not an uncommon nosocomial infection in PICU. The risk increases with increasing duration of catheter drainage, and hospital or PICU stay.
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Introduction : We are moving towards a technically advanced Medical Education. However, effectiveness of online Teaching, Learning (T/L) remained unknown until COVID-19 pandemic.Aim : This study was planned to assess the perception of e-educators towards online T/L, the challenges and possible solutions during pandemic. Methodology : A mixed method cross-sectional study was conducted among 126 medical educators through online google survey from July to September, 2020 in a Tertiary Heath Care Institute & 2 neighbouring medical college. Result : Non response rate was 32%, 72.2% were males, 63.9% were between 31 to 50 years of age, 58% were having 10 or more years teaching experience. 36.2% were from basic sciences, 69.5% were holding higher academic post. 61% preferred combination of face to face and e-learning Although online classes were helpful in terms of 63.8% convenience, (54%) flexibility, 77.5% felt difficulties teaching and assessing skills domain. The major challenges encountered were technical glitches, no active participation and suggested solutions were technical assistance, formative assessments and use of new T/L, assessment tools. Conclusion : Although the change was negatively perceived, it’s inevitable. Training of faculties, sensitization of students and conducive environment is needed to combat the challenges, to improve the e-education system in health profession.
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The Rationale: Glanzmann thrombasthenia is a rare platelet disorder affecting 0.0001% of the population. Dentists may often be unaware of this condition, and manipulation of soft tissue can lead to grave consequences, which may even result in fatality. Patient Concerns: In this case report, a 4?year?old patient with Glanzmann thrombasthenia reported to the department with a chief complaint of a discoloured tooth. Clinical Findings: On examination, 51 was nonvital, and pulpectomy was the treatment planned. The non?vital anterior tooth was treated with a pulpectomy procedure. There was uncontrolled bleeding during the procedure. Treatment: A topical solution of BotroClot was used to arrest the bleeding, and obturation was completed following that. The post?operative period was uneventful. Take?away Lessons: Case report explored the use of a topical hemostatic agent to arrest bleeding from the canal. This case report warrants eliciting a thorough medical history before any dental procedure.
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Purpose: To describe the clinical profile and demographic distribution of band?shaped keratopathy (BSK) in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross?sectional hospital?based study included 2,664,906 new patients presenting between January 2011 and January 2021 (10?year period). Patients with a clinical diagnosis of BSK in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 8801 (0.33%) patients were diagnosed with BSK. The prevalence rates were 0.47% in children (age: <16 years) and 0.31% in adults. The majority of patients were males (62.87%) with unilateral affliction (85.21%). The mean age of the patients was 40.43 ± 23.14 years. The majority (16.93%) of the patients were in the age bracket of 11–20 years. A larger proportion of the patients were from higher socioeconomic status (60.46%) and the urban region (45.9%). Of the 10,103 eyes affected with BSK, the common ocular comorbidities were status post?vitreoretinal surgery (20.55%) and uveitis (12.7%) in children and corneal scar (41.23%) and spheroidal degeneration (13.7%) in adults. Most of the eyes had mild or no visual impairment (24.74%). Among the eyes that needed surgical intervention, chelation with ethylenediaminetetraacetic acid (EDTA) was the most performed surgical procedure (1.68%) along with phototherapeutic keratectomy (0.32%). Conclusion: BSK commonly affects adult males and is unilateral in nature. The majority of the patients in this cohort belonged to higher socioeconomic strata and urban geography. At initial presentation, visual impairment was mild to moderate in a vast majority of the patients, and the most common surgical intervention performed was chelation with EDTA during the study period.
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揋uitar pick sign,� also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19朼ssociated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.
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Objective: To describe the clinical profile and outcome of emergencies in children with chronic kidney disease (CKD). Methods: This retrospective analysis studied children with CKD presenting with acute emergencies. The clinical profile, renal and patient outcomes were compared between incidentally diagnosed - iCKD, previously diagnosed not on dialysis - pCKD and those on maintenance dialysis - dCKD groups. Results: 82 children (67 boys, median age – 8 years) with 99 visits were included. Uremic encephalopathy was the most common emergency in iCKD (64.7%) and pCKD (38.4 %), and access-related infections (32.1%) in dCKD group. Children with iCKD had higher Pediatric Risk of Mortality score (P<0.001), emergent initiation of dialysis (P=0.03) and discontinuation of treatment (P<0.001) when compared to the pCKD group. Conclusion: Uremic encephalopathy and access-related infections were the most common emergencies in children with CKD. Incidentally diagnosed CKD had a worse clinical profile and outcome.
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Background: Silver nanoparticles (AgNPs) show ample antibacterial activities when combining with honey. Aim and Objective: The study was designed to determine the antibacterial activity of different kinds of honey against the common wound pathogen Staphylococcus aureus. Materials and Methods: Bacterial strain was used to inoculate the wound. S. aureus ATCC-25923 was used in the study. Results: Wound infection examination was done by total count of bacterial load. In all three groups, better percentage of the wound closer, histological, blood, and tissue parameters identified in honey combine with AgNPs, showed a synergistic effect. Conclusion: Honey and AgNPs showed synergistic effect. It is recommended to apply both the products together.
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@#Introduction: Raised blood pressure is associated with diet high in sodium and low in potassium. According to the Malaysian Community Salt Survey (MyCoSS), Malaysian adults consume a high sodium diet, despite half claiming that they control their salt intake. The objective of this study was to investigate the association of sodium and potassium with salt-control claims among adults from the MyCoSS study based on 24-h urinary excretion. Methods: Data of 1,047 respondents aged 18 years and above who completed the knowledge, attitude, and practice (KAP) questionnaire were used in this study. Face-to-face interviews were conducted to acquire information on sociodemographic, medical reports and KAP on salt intake. Sodium and potassium level were assessed from 24-hr urine specimen, anthropometric measurements were done using WHO criteria, while blood pressure was measured using validated digital blood pressure monitor. Descriptive and analysis of variance (ANOVA) were used to determine the associations between urinary sodium and potassium with salt-control claims and practices. Results: The consumption of sodium was higher than recommended, while potassium was lower among respondents who claimed to control their salt intake. Significant associations were found between sodium intake with marital status, ethnicity, education level and employment status. Meanwhile, significant associations were found between potassium intake with ethnicity and employment status. Conclusion: Sodium intake was high, and potassium intake was low among respondents who claimed they control their salt intake. Further study with detailed intervention on specific target group is required to improve sodium and potassium intakes among Malaysian adults.
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BACKGROUND/OBJECTIVES@#Low early pregnancy serum 25-hydroxy vitamin D (25[OH]D) levels can increase gestational diabetes mellitus (GDM) risk, although inconsistent findings related to that association have been reported. This study examined the association of serum vitamin D with GDM and the possible influencers on this association. @*SUBJECTS/METHODS@#This study included 259 pregnant women within the Seremban Cohort Study (SECOST). Blood samples at < 14 weeks of gestation were drawn to determine serum 25(OH)D levels. GDM diagnosis was made at 24 to 32 weeks of gestation using a standard procedure. Association between serum vitamin D and GDM was tested using binary logistic regression. @*RESULTS@#Nearly all women (90%) had mild (68.3%) or severe (32.2%) vitamin D deficiency (VDD). Non-GDM women with mild VDD had a significantly higher mean vitamin D intake than GDM women with mild VDD (t = 2.04, p < 0.05). Women with higher early pregnancy serum vitamin D levels had a greater risk of GDM. However, this significant association was only identified among those with a family history of type 2 diabetes mellitus (T2DM) and in women with a body mass index indicating overweight or obese status. @*CONCLUSIONS@#The high prevalence of VDD in this sample of pregnant women underscores the need for effective preventive public health strategies. Further investigation of this unexpected association between serum vitamin D level and GDM risk in predominantly VDD pregnant women and the potential effects of adiposity and family history of T2DM on that association is warranted.
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Background/Aims@#To determine if patients with a positive intraoperative cholangiogram (IOC) who undergo a subsequent endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of post-ERCP pancreatitis (PEP) compared to those who undergo ERCP directly for suspected common bile duct stones. @*Methods@#A retrospective case-control study was performed from 2010 to 2016. Cases included inpatients with a positive IOC at cholecystectomy who underwent subsequent ERCP. The control group included age-sex matched cohorts who underwent ERCP for choledocholithiasis. Multivariate logistic regression was used to assess the association between PEP and positive IOC, adjusting for matching variables and additional potential confounders. @*Results@#Of the 116 patients that met the inclusion criteria, there were 91 women (78%) in each group. Nine patients (7.8%) developed PEP in the IOC group, compared to 3 patients in the control group (2.6%). The use of pancreatic duct stents and rectal indomethacin was similar in both groups. After adjusting for age, sex, total bilirubin levels, and any stent placement, patients with a positive IOC had a significantly increased risk of PEP (odds ratio, 4.79; 95% confidence interval, 1.05–21.89; p<0.05). @*Conclusions@#In this single-center case-control study, there was a five-fold increased risk of PEP following a positive IOC compared to an age-sex matched cohort.
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@#Introduction: Childhood obesity is a public health problem in Malaysia. Intake of sugar-sweetened beverages (SSB) is associated with obesity in children. There is a lack of studies on factors associated with SSB consumption in Malaysia. This study aimed to determine the sociodemographic factors associated with SSB consumption among Malaysian adolescents. Methods: Data of 2,021 students, aged 10-17 years on sociodemographic, SSB intake and anthropometrics were drawn from the school-based Adolescent Nutrition Survey 2017. A multistage stratified cluster sampling was used to obtain a nationally representative sample of primary and secondary school students. Body mass index (BMI)-for-age status was determined based on calculated z-score using the World Health Organization 2007 reference. SSB consumption was obtained from a food frequency questionnaire. Results: The prevalence of overweight and obesity among Malaysian adolescents were 16.6% and 14.7%, respectively. Malaysian adolescents consumed 1.4 cups of SSB per day. Rural children had a significantly higher SSB intake (1.5 cups) than urban (1.3 cups) children, while males (1.5 cups) had a significantly higher intake than females (1.3 cups). There were no significant differences in SSB consumption between thin, normal, overweight and obese adolescents. Conclusion: Almost all Malaysian adolescents consumed SSB during one month prior to the survey and the average amount consumed was 1.4 cups per day. Rural locality and male were associated with higher SSB consumption. There were differences in SSB consumption between Chinese and Malays, between Chinese and Indians, and between Chinese and Bumiputra Sarawak. There were no differences in consumption between the different BMI-for-age categories.
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ABSTRACT@#The oral microbiome comprises several hundreds of bacterial species that contribute to periodontitis, the most complex polymicrobial inflammatory disorder. Porphyromonas gingivalis is a prominent periodontitis pathogen that produces gingipains as a major virulent factor. Gingipain facilitates P. gingivalis survival, pathogenicity, and growth. Several genes were identified to have a role in the regulating of P. gingivalis pathogenesis. Studies suggest that gingipains inhibition is key for the successful treatment of periodontitis. As of now, several gingipain inhibitors have been developed, some exhibit high inhibition activity against gingipains. However, most inhibitors offer unknown toxicity and undesirable side effects. Hence, the development of highly potent and safe gingipain inhibitor is a major concern for periodontitis treatment. The present review highlights the connectivity between P. gingivalis, virulent factors, and its gene, periodontitis, and gingipain inhibitors. Development of gingipains inhibitors would not only treat periodontitis but would also assist in the treatment of other associated systemic diseases, for example: rheumatoid arthritis, cardiovascular diseases, diabetes, and Alzheimer's disease.
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Gingipain Cysteine EndopeptidasesABSTRACT
@#Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.
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@#Introduction: Adolescence is an important growth period for individuals. High prevalence of obesity among adolescents in Malaysia in recent years is worrying. This study aims to assess associations of gender and BMI-for-age status (BAZ) with nutrient intake of adolescents between 13-17 years old in Malaysia. Methods: Data of 999 respondents were drawn from Adolescent Nutrition Survey 2017; a cross-sectional school-based survey involving adolescents aged 10 to 17 years old. Respondents were selected using multistage stratified cluster sampling from 13 states and three federal territories in Malaysia to ensure nationally representative data. Data collection was undertaken from March until May 2017. Dietary intake was assessed using a single 24-hours dietary recall conducted via face-to-face interview by trained nutritionists. Nutritionist ProTM Diet Analysis Software was used to calculate nutritional intake values. Anthropometric measurements were measured using validated equipment. Nutritional status of the respondents was assessed using BMI-for-Age z-score and categorised based on WHO Growth Reference 2007. Results: The mean energy intake of the adolescents was 1972 kcal/day. Majority of the adolescents had normal BMI (74.6%) while overweight, obese and thinness were 12.0%, 7.2% and 6.2% respectively. Boys had significantly higher intakes of energy, carbohydrate, protein, fat, sugar, cholesterol, thiamin, Vitamin A, calcium, iron, sodium and potassium compared to the girls. Obese adolescents had significantly higher energy, carbohydrate, fat, sugar, Vitamin A and calcium intakes compared to other BMI groups. Conclusion: The findings highlighted the need for cultivating self-awareness on healthy eating among adolescents.
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Abstract INTRODUCTION: We compared the hepatitis C virus (HCV) core antigen test with the HCV RNA assay to confirm anti-HCV results to determine whether the HCV core antigen test could be used as an alternative confirmatory test to the HCV RNA test. METHODS: Sera from 156 patients were analyzed for anti-HCV and HCV core antigen using a chemiluminescent microparticle immunoassay (Architect i2000SR) and for HCV RNA using the artus HCV RG RT-PCR Kit (QIAGEN) in a Rotor-Gene Q instrument. RESULTS: The diagnostic sensitivity, specificity, and positive and negative predictive values of the HCV core antigen assay compared to the HCV RNA test were 77.35%, 100%, 100%, and 89.38%, respectively. HCV core antigen levels showed a good correlation with those from HCV RNA quantification (r =0.872). However, 13 samples with a viral load of less than 4000 IU/mL were negative in the HCV core antigen assay. All gray-zone reactive samples were also RNA positive and were positive on repeat testing. CONCLUSIONS: The Architect HCV core antigen assay is highly specific and has an excellent positive predictive value. At the present level of sensitivity (77%), the study is still relevant in a low-income setting in which most of the HCV-positive patients would go undiagnosed, since HCV RNA testing is not available and/or not affordable. HCV core antigen testing can also help determine the true burden of infection in a population, considering the fact that almost 50% of the anti-HCV positive cases are negative for HCV RNA.
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Humans , Hepatitis C/diagnosis , Hepacivirus/genetics , RNA, Viral , Sensitivity and Specificity , Hepatitis C Antigens , Hepatitis C AntibodiesABSTRACT
Mycoplasma is a frequent cause of community acquired pneumonia in children accounting for 20 percent of the cases. Though CNS complications are the most common extra pulmonary manifestations of M. pneumoniae stroke is a rare entity. Here we report a case of 7 years old male child with macrolide resistant M. pneumoniae complicated pneumonia that developed right hemiparesis and dysphasia. Brain magnetic resonance imaging and angiography showed left fronto parietal infarct and left carotid artery stenosis. He responed to non-macrolide antimicrobial regimen. This potential yet rare complication should be considered and closely monitored for in children presenting with complicated pneumonia.
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Introduction: The pulmonary veins play an important rolein the pulmonary circulation by receiving oxygenated bloodfrom the Lungs and delivering it to the left atrium. Pulmonaryvein anatomy piqued curiosity of researchers off late afterthe discovery of its role in genesis of atrial arrhythmias andincreased incidence of pulmonary hypertension in COPD.The congenital variations in number of pulmonary veinsand their drainage patterns, encompass a wide spectrum ofanomalies and are not uncommon in general population. Theaim of the study was to observe the variations in the numberof pulmonary veins and pulmonary ostia.Material and Methods: The present study was done on 25formalin fixed hearts aged 18-70 years, obtained from thedepartment of anatomy, Sri Padmavathi Medical college forwomen, Tirupathi. These hearts were observed for the numberof pulmonary veins, their drainage into left atrium, variationsin pulmonary ostia on right and left sides and were comparedwith previous studies.Results: Out of the 25 specimens studied, 23 hearts (92%)had normal pattern of four pulmonary veins, two from eachlung extending to the left atrium and opening into it via twoseparate pulmonary ostia, on either side. In 2 (8%) out of 25specimens, variations in the number of pulmonary veins andthe pulmonary ostia were observed.Conclusion: The awareness of the variant anatomy ofpulmonary veins and their drainage is of paramountimportance to Radiologists, Electrophysiologist and Cardiothoracic surgeons while performing surgical procedures onHeart.
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Background: Smoking is an essential determinant of various diseases. The study is aimed to understand the influence of smoking on serum vitamin D2/D3 levels and serum calcium levels in healthy young/middle-aged men.Methods: Prospective observational study was done among young and middle-aged healthy male smokers in a rural territory care center. Two hundred patients were studied and analyzed, who fulfill the inclusion and exclusion criteria.Results: The prevalence of vitamin D deficiency (25(OH)D <20 ng/ml) was 50.3%. Only 8.8% of the participants had vitamin D sufficiency (25 hydroxyvitamin D ?30 ng/ml). There is a strong correlation between 25(OH)D and smoking in the participants (p<0.001). 25 hydroxyvitamin D level was lower by approximately 4.3 ng/ml (p<0.001) in a smoker compared to a non-smoker among the total participants, this value increased to 9.2 ng/ml in the 40-50y subgroup (p=0.003). A multinomial logistic regression model demonstrated that a young smoker (20-29y) had a 58% increased likelihood of having vitamin D deficiency compared to a non-smoker of the same age group (p=0.041). Irrespective of age and chronicity of smoking, there was a significantly increased level of serum calcium and significant vitamin D2/D3 deficiency in smokers.Conclusion: A high prevalence of vitamin D deficiency was identified in young and middle-aged male smokers, which is not likely to be explained by other confounding lifestyle factors. The depression of the vitamin D-PTH system seen among smokers may represent another potential mechanism for the harmful effects of smoking on the skeleton