Vitamin D and respiratory disorder

The active form of vitamin D is synthesized in some body organs following sun exposure and dietary intake. Vitamin D exhibits its major and critical effects not only through regulation of calcium and phosphate metabolism but also by influencing on respiratory and immune system. Serum concentrations of 25-hydroxyvitamin D below the optimum limit lead to vitamin D insufficiency or maybe deficiency. These inappropriate concentrations of vitamin D lead to different types of pulmonary diseases such as viral and bacterial respiratory infection, asthma, chronic obstructive pulmonary disease, and cancer. In this review we described the association between vitamin D deficiency and severe therapy resistant asthma. We also reviewed the underlying molecular mechanism of vitamin D deficiency in children with severetherapy resistant asthma. Based on current information, future clinical trial are needed to study the role of vitamin D supplementation on different groups of patients with severe asthma including infants, children of school age, and ethnic minorities

Determine efficacy of a short course of montelukast in children with intermittent asthma and viral infection

Mild intermittent asthma is common in children and viral infections are responsible for the majority of exacerbations. As leukotrienes are potent inflammatory mediators, some studies have shown that Montelukast, a leukotriene receptor antagonist, may be effective on reduction of asthma symptom. To determine whether a short course of Montelukast in asthmatic children with common cold would modify the severity of an asthma episode. Children, aged 6-12 years with intermittent asthma participated in this randomized, double-blind, placebo-controlled clinical trial. Treatment with Montelukast or placebo was initiated at the onset of viral upper respiratory tract infection and continued for 7 days. Primary outcomes included the clinical manifestation: duration of episodes, daily symptom, nights symptoms and activity limitation. Secondary outcomes included the need for beta agonist usage, oral prednisolone, physician visit, hospital admission and school absence. A total of 187 children with intermittent asthma were randomized, 93 to Montelukast group and 94 to placebo group. Montelukast significantly decreased the cough by 17.3% [P<0.001], nighttime awakenings by 5.4% [P=0.01], interference with normal activity by 6% [P<0.01], time off from school by 6% [P<0.01], beta-agonist usage by 17.2% [P<0.001] and doctor visits by12.2% [P<0.01] compared to placebo. Whereas there was a non significant reduction in wheezing, tachypnea, respiratory distress, asthma exacerbation, oral prednisolone and hospitalization [P=0.8]. A short course of Montelukast, introduced at the first sign of a viral infection, results in a reduction in cough, beta-agonist use and nights awakened, time off from school and limitation of activity. More studies are needed to evaluate the optimal dose and duration of treatment

role of zinc sulfate in acute bronchiolitis in patients aged 2 to 23 months

Evaluating the effect of zinc sulfate in improving the clinical manifestations of acute bronchiolitis in children younger than 2 years. This was a double blind pilot trial on 50 patients aged 2 to 23 months at Ghaem and Dr. Sheikh Hospitals in Mashhad from January 2008 to March 2009. Patients were randomly divided into two groups: a case group received oral zinc sulfate and to the control group was given placebo. Mean age of case group was 168.0 +/- 108.6 days and control group 169.2 +/- 90.4 days [P=0.98] with male predominance in both groups. At first there was no statistically significant difference between the two groups in reducing the symptoms. But 24 hours after treating, improvement of some important manifestations including tachypnea, subcostal and intercostal retraction, wheezing and cyanosis revealed statistically significant difference in control group in comparison with case group [P=0.04]. Zinc sulfate has no benefit in improving clinical manifestations of acute bronchiolitis

[Leukocyte adhesion deficiency]

Leukocyte adhesion deficiency [LAD] is a rare functional leukocyte disorder, which is divided into two separate types: LAD-1 and LAD-2. LAD-1 results from lack of beta2 integrin molecules [CD 11 and CD 18] on the leukocyte cell surface. These molecules are essential for leukocyte adhesion to endothelial cells and chemotaxis. The present case report is about a 42-month-old girl with recurrent otitis, pneumonia and gingivitis. On physical examination, patient was pale and malnourished. Multiple desquamated erythematous plagues were found on her body and extremities. Blood investigations revealed persistent leukocytosis with normal serum Immunoglobulin profile and complement. The diagnosis of LAD1 was made based on Flow cytometry finding; showing decreased in GD11 and CD 18 markers of PMN-a. When a patient has persistent leukocytosis and recurrent infections, investigation for the primary immune deficiency, specially leukocyte adhesion deficiency must be considered

[Leukocyte adhesion deficiency; case report]

Leukocyte adhesion deficiency [LAD] disorders, LAD-1 and LAD-2 are rare disease of leukocyte function. LAD-1 results from a lock of leukocyte cell surface expression of beta 2 integrin molecules [CD11 and CD18] that are essential for leukocyte adhesion to endothelial cells and chemo taxis. Case Presentationt: Our patient a 23-month-old male infant was brought with recurrent skin infections. On examination, the infant was pale with multiple scars in his body. Investigations revealed persisting leukocytosis, serum Immunoglobulin profile and complement were normal. Flow cytometry showed decreased in CD11 and CD18 marker of PMN a diagnosis of LAD1 was made. The accompaniment of persistent leukocytosis and recurrent skin infections will guide us to the primary immune deficiency specially leukocyte adhesion deficiency