RESUMO
Justification: The emerging literature on prevalence of vitamin D deficiency in India, prevention and treatment strategies of rickets, and extra-skeletal benefits of vitamin D suggest the need for revising the existing guidelines for prevention and treatment of vitamin D deficiency in India. Objectives: To review the emerging literature on vitamin D prevalence and need for universal vitamin D supplementation. To suggest optimum vitamin D therapy for treatment of asymptomatic and symptomatic vitamin D deficiency, and rickets. To evaluate the extra-skeletal health benefits of vitamin D in children. Process: A National consultative committee was formed that comprised of clinicians, epidemiologists, endocrinologists, and nutritionists. The Committee conducted deliberations on different aspects of vitamin D deficiency and rickets through ten online meetings between March and September, 2021. A draft guideline was formulated, which was reviewed and approved by all Committee members. Recommendations: The group reiterates the serum 25- hydroxy vitamin D cutoffs proposed for vitamin D deficiency, insufficiency, and sufficiency as <12 ng/mL, 12-20 ng/mL and >20 ng/mL, respectively. Vitamin D toxicity is defined as serum 25OHD >100 ng/mL with hypercalcemia and/or hypercalciuria. Vitamin D supplementation in doses of 400 IU/day is recommended during infancy; however, the estimated average requirement in older children and adolescents (400-600 IU/day) should be met from diet and natural sources like sunlight. Rickets and vitamin D deficiency should be treated with oral cholecalciferol, preferably in a daily dosing schedule (2000 IU below 1 year of age and 3000 IU in older children) for 12 weeks. If compliance to daily dosing cannot be ensured, intermittent regimens may be prescribed for children above 6 months of age. Universal vitamin D supplementation is not recommended in childhood pneumonia, diarrhea, tuberculosis, HIV and non-infectious conditions like asthma, atopic dermatitis, and developmental disorders. Serum 25-hydroxy vitamin D level of >20 ng/mL should be maintained in children with conditions at high-risk for vitamin deficiency, like nephrotic syndrome, chronic liver disease, chronic renal failure, and intake of anticonvulsants or glucocorticoids.
RESUMO
Background: The two most common vector borne diseases in the world are malaria and dengue. Co-infection infection is not unusual in a geographical region such as India, wherein both the vectors coexist. This study aimed to determine whether simultaneous malaria and dengue infection is serious in children than mono infection alone.Methods: In this study all children with fever of less than 7 days duration were included in the study. Clinical inspection and laboratory analysis were performed in all instances, following a detailed history. Children were categorized under 3 categories, malaria (M), dengue (D) and coinfection (DM). For any statistical difference between groups, their clinical as well as hematological parameters were analyzed. SPSS software was used for the statistical studies.Results: Malarial chills fever was also found in a substantial percentage of children with dengue. Superficial as well as profound bleeding were seen more often in the coinfected DM groups than D or M alone. In M group alone, jaundice and diarrhea were noted. In the segregated M and DM groups, the neurological indication, neurological involvement such as altered sensorium and seizure was noted at the same rate, whereas, there had been no occurrence in D group. Anemia was reported in all children, but M group showed the highest drop.Conclusions: Severity criteria, neurological involvement such as altered sensorium and seizures were reported at same rate both in malaria and coinfection, whereas, none of the patients with dengue showed signs of seizure. Anemia relative to hematologic parameters, was considerably more prevalent in the malaria patients. Presence of bleeding in malaria and jaundice in dengue patients, should be considerably investigated for a coinfection.
RESUMO
The present study was carried out to compare the safety and efficacy of Misoprostol with Surgical Evacuation in the management of abortion. 100 women as specified by the inclusion and exclusion criteria were recruited for this prospective observational study. 50 subjects (Group A) were managed medically by Misoprostol and 50 subjects (Group B) underwent Surgical Evacuation. Clinical outcome, time taken for expulsion, number of doses required, mean duration of hospital stay, mean analgesic requirement, mean blood loss and side effects were compared between the two groups. It was concluded that vaginal administration of Misoprostol is a safe, effective and cheap alternative to surgical evacuation. No serious adverse effects were observed with Misoprostol.