Sunlight Exposure vs Oral Vitamin D Supplementation for Prevention of Vitamin D Deficiency in Infancy: ARandomized Controlled Trial

Objective: To compare the efficacy of sunlight exposure and oral vitamin D3 supplementation to achieve vitamin D sufficiency in infants at 6 months of age. Design: Open-label randomized controlled trial. Setting: Public hospital in Northern India (28.7°N). Participant: Breastfed infants at 6-8 weeks of age. Intervention: Randomized to receive sunlight exposure (40% body surface area for a minimum of 30 minutes/week) or oral vitamin D3 supplementation (400 IU/day) till 6 months of age. Outcome: Primary - proportion of infants having vitamin D sufficiency (>20 ng/mL). Secondary - proportion of infants developing vitamin D deficiency (<12ng/mL) and rickets in both the groups at 6 months of age. Results: Eighty (40 in each group) infants with mean (SD) age 47.8 (4.5) days were enrolled. The proportion of infants with vitamin D sufficiency increased after intervention in the vitamin D group from 10.8% to 35.1% (P=0.01) but remained the same in sunlight group (13.9%) and was significant on comparison between both groups (P=0.037). The mean (SD) compliance rate was 72.9 (3.4)% and 59.7 (23.6)% in the vitamin D and sunlight group, respectively (P=0.01). The geometric mean (95% CI) serum 25(OH) D levels in the vitamin D and sunlight group were 16.23 (13.58-19.40) and 11.89 (9.93-14.23) ng/mL, respectively; (P=0.02), after adjusting baseline serum 25(OH)D with a geometric mean ratio of 1.36 (1.06-1.76). Two infants in sunlight group developed rickets. Conclusion: Oral vitamin D3 supplementation is more efficacious than sunlight in achieving vitamin D sufficiency in breastfed infants during the first 6 months of life due to better compliance.

Effects of Supplementation of Calcium and Sunshine During Pregnancy on Serum Level of Total 25-OH-D / 沈阳医学院学报

Objective:To study the effect of supplementation of calcium and sunshine during pregnancy on serum level of total 25-hydroxyvitamin vitamin D (25-OH-D) . Methods: A total of 151 cases of normal pregnant women were divided into four groups:without calcium and sunshine, without calcium and with sunshine, with calcium and without sunshine, with calcium and sunshine. LIAISON XL chemiluminescence analyzer was used to detect the serum level of 25-OH-D. Results:Compared with the group of without calcium and sunshine, the serum level of 25-OH-D in other groups increased significantly.The calcium deficiency rate of puerpera and neonatal decreased significantly.The reference range was 13.96 ng/ml (2.5%percentile), 39.54 ng/ml (50%percentile) and 73.90 ng/ml (92.5%percentile) .The mean value of 25-OH-D was (41.67 ± 14.72) ng/ml.Conclusion:Proper supplementation of calcium and adequate sunshine during pregnancy can prevent calcium deficiency of puerpera and neonate.The reference range of serum 25-OH-D is slightly lower than that in general population.

Laryngeal Spasm Mimicking Asthma and Vitamin D Deficiency

We present a woman with heterozygous carnitine palmitoyl transferase 2 (CPT-2) deficiency who in the last 6 months suffered from episodic dyspnea and choking. Symptoms could not be attributed to her muscular energy defect, since heterozygous CPT-2 deficiency is usually asymptomatic or causes only mild muscle fatigability. Myopathy is usually triggered by concurrent factors, either genetic (additional muscle enzymes defects) or acquired (metabolic stress). The patient was referred to our respiratory clinic for suspect bronchial asthma. Spirometry showed mild decrease in inspiratory flows. Methacholine challenge was negative. Dyspnea was triggered by hyperventilation-induced hypocapnia, which produced marked decrease in airflow rates, particularly in inspiratory flows, consistent with laryngospasm. Nutritional assessment of the patient showed low serum level of calcium and vitamin D, attributable to avoidance of milk and dairy products for lactose intolerance and to insufficient sunlight exposure. After calcium and vitamin D supplementation episodic laryngospasm disappeared and hypocapnic hyperventilation test induced very mild change in airflow rates. Calcium and vitamin D deficiency may favour laryngeal spasm mimicking asthma, particularly in subjects with underlying myopathy.

Métodos para predição de bitter pit em maçãs 'Fuji' e 'Braeburn' / Methods for bitter pit prediction in Fuji and Braeburn apples

Experimentos foram conduzidos com objetivo de avaliar a eficiência de métodos para predição da ocorrênciade bitter pit em maçãs ‘Fuji’ e ‘Braeburn’ em duas épocas de amostragem. Os frutos, provenientes de seis pomares distintos, três para cada cultivar, foram coletados antecipadamente (20 dias em relação à colheita) e na data prevista para a colheita comercial. Os métodos de predição utilizados foram: a) infiltração dos frutos com solução 0,10M MgCl2 mais 0,01% Tween-20 e 0,4M de sorbitol; b) imersão dos frutos em solução com 2500nL L-1 de ethephon mais 0,01% Tween-20. Os frutos foram armazenados em atmosfera controlada (AC) por cinco meses mais 12 dias, a 20°C, simulando a incidência real debitter pit em armazenamento comercial. Cada tratamento foi constituído por quatro repetições de 25 frutos. A incidência e severidade de bitter pit, prevista por ambos os métodos foisemelhante à ocorrência real de bitter pit após o armazenamento em atmosfera controlada para cada uma das cultivares utilizadas, quando os frutos foram amostrados antecipadamente em relação à colheita comercial. Na avaliação realizada com frutos amostrados na colheita comercial, nenhum dos métodos foi capaz de prever a incidência de bitter pit após o armazenamento de maneira confiável. Para ambas as cultivares, a infiltração com magnésio e a imersão dos frutos em ethephon só são eficientes na prediçãoda incidência de bitter pit em frutos coletados 20 dias antes da colheita comercial.

Experiments were carried out with objective to evaluate the efficiency of methods for bitter pit prediction in ‘Fuji’ and ‘Braeburn’ apples sampled at two harvest dates. Fruits from 6 orchards, three for each cultivar, were sampledearlier (20 days before harvest) and at commercial harvest date. The prediction methods assessed were: infiltration ofapples with 0.10M MgCl2 solution containing 0.01% Tween-20 and 0.4M sorbitol; and immersion of fruits in 2.500nL L-1 ethephon solution plus 0.01% Tween-20. Four replications of25 fruits of each orchard were stored on controlled atmosphere (CA) during five months plus 12 days at 20°C in order to assess the real bitter pit occurrence. Both methods showed incidence and severity similar to real bitter pit occurrence after storage for both cultivars sampled 20 days before harvest. On the other hand, none method was able to predict the incidence of bitter pit after CA storage for fruits sampled at commercial harvest.The magnesium infiltration and immersion of fruits on ethephon only are efficient to predict bitter pit incidence on fruits when sampled 20 days before commercial harvest.