Rashmi Ranjan Das
1Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar 751019, India
Meenu Singh
2Department of Pediatrics, Post-Graduate Institute of Medical Education và Research (PGIMER), Chandigarh 160012, India
Inusha Panigrahi
2Department of Pediatrics, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
Sushree Samiksha Naik
3Department of Obstetrics & Gynecology, SCB Medical College, Cuttack 753007, India
1Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar 751019, India
2Department of Pediatrics, Post-Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India
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Background. Studies have found an increased incidence of vitamin D deficiency in children with pneumonia; however, there is no conclusive data regarding the direct effect of vi-ta-min D supplementation in acute pneumonia. Methods. A comprehensive search was performed of the major electronic databases till September 2013. Randomized controlled trials (RCTs) comparing treatment with vi-ta-min D3 versus placebo in children ≤5 years old with pneumonia were included. Results. Out of 32 full text articles, 2 RCTs including 653 children were eligible for inclusion. One trial used a single 100,000 unit of oral vi-ta-min D3 at the onset of pneumonia. There was no significant difference in the mean (±SD) number of days to lớn recovery between the vi-ta-min D3 & placebo arms (P = 0.17). Another trial used oral vi-ta-min D3 (1000 IU for <1 year & 2000 IU for >1 year) for 5 days in children with severe pneumonia. Median duration of resolution of severe pneumonia was similar in the two groups (intervention, 72 hours; placebo, 64 hours). Duration of hospitalization và time to lớn resolution of tachypnea, chest retractions, and inability khổng lồ feed were also comparable between the two groups. Conclusions. Oral vitamin D supplementation does not help children under-five with acute pneumonia.
1. Introduction
Worldwide, acute lower respiratory tract infection (ALRTI) is a leading cause of mortality in children less than 5 years old <1, 2>. More than 90% are in developing countries. The management of ALRTI includes intravenous antibiotics, oxygen, or assisted ventilation (in severe cases). Besides these, nutritional supplementations such as zinc & vitamin A supplementation have been tried, though the results have been unfavorable <3, 4>. Researchers have found that deficiency in vitamin D may predispose people khổng lồ infection, và thus vitamin D has been labeled as antibiotic vi-ta-min <5>. The immune enhancing actions of vitamin D include induction of monocyte differentiation, inhibition of lymphocyte proliferation, stimulation of phagocytosis dependent & antibody-dependent macrophages, & modulation of T và B lymphocytes that produce cytokines và antibodies <5–8>. Vi-ta-min D deficiency if severe leads lớn chest wall deformity, hypotonia, poor chest wall compliance, atelectasis, and fibrosis <9>. All these factors contribute to lớn a higher incidence of pneumonia in children with severe vitamin D deficiency.
A recent meta-analysis of randomized controlled trials (RCTs) showed that prophylactic vi-ta-min D supplementation in the pediatric age group reduced the rate of respiratory tract infections significantly (odds ratio (OR), 0.58; 95% CI, 0.41–0.8) <10>. Few studies have assessed the therapeutic efficacy of vi-ta-min D supplementation as an adjunctive lớn antibiotics và supportive measures in treating childhood pneumonia. Unlike the evidence favoring a prophylactic effect, there is no clear evidence to support or refute the therapeutic efficacy of vi-ta-min D in acute pneumonia. Hence the current meta-analysis was planned to lớn detect whether vi-ta-min D supplementation has any role in treatment of children <5 years old with acute pneumonia.
2. Methods
2.1. Criteria for considering Studies for This Review
2.1.1. Types of Studies
Studies are randomized double-blind placebo-controlled trials (RCTs).
2.1.2. Types of Participants
Participants are children of both sexes và >1 month lớn ≤5 years old, hospitalized with clinical diagnosis of acute pneumonia. Pneumonia was defined as age-specific tachypnea (>60/min if <2 months; >50/min if 2–11 months; >40 if 12–24 months) along with crepitations and absence of wheeze (with or without fever). Severe pneumonia was defined as age-specific tachypnea along with chest retractions or any of the danger signs (cyanosis, unable lớn feed, & lethargy). Studies including children suffering from other debilitating diseases, with severe wasting (weight for height <3SD), and known asthmatics were excluded.
2.1.3. Types of Interventions
The intervention commenced after the child is hospitalized, and it consisted of treatment with vi-ta-min D or placebo as an adjuvant to lớn standard hospital treatment (including antibiotics, oxygen, and other supportive measures). The trials had to compare vitamin D with placebo only. All formulations of vitamin D were considered.
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2.1.4. Types of Outcome Measures
Outcome measures frequently used to lớn determine the clinical efficacy of any acute pneumonia treatment are the duration of resolution illness, duration of hospitalization, treatment failure, adverse events, or death. Accordingly, trials measuring following outcomes were included in the review.
Vitamin D, also known as the sunshine vitamin, is a fat-soluble vitamin essential for optimal health. Helps your body toàn thân absorb calcium and maintain adequate levels of magnesium & phosphate - three important nutrients for teeth, muscles và bones. It also plays an important role in brain development, heart function, immune system and mental health.Human skin is capable of producing vi-ta-min D when exposed lớn ultraviolet B (UVB) rays. Most people get at least a certain amount of vi-ta-min D this way. According khổng lồ the National Institutes of Health (NIH), exposing your face, arms, and legs to lớn sunlight for 5 to lớn 30 minutes twice a week - without sunscreen - is usually enough khổng lồ produce vitamin D levels Optimal. However, depending on the geographical location or climate in which the individual lives, absorbing vi-ta-min D through sun exposure may not be as efficient. Other factors, such as changing seasons, time of day, pollution levels, smog, as well as age, skin màu sắc and sunscreen usage habits also affect production. Vi-ta-min D of the skin. For example, smog in the air can reduce the intensity of UV rays by up khổng lồ 60%. Furthermore, older adults and those with darker skin tones may need significantly longer sun exposure lớn produce the required levels of vitamin D. Besides, improper sun exposure can lead to lớn skin cancer. Therefore, the American Academy of Dermatology recommends that users should not take sunlight as the main source of vitamins for the body.
Certain fungi have the chất lượng ability khổng lồ produce vitamin D when exposed lớn UV light. For example, wild mushrooms & those that are artificially exposed to UV light can contain between 154 and 1,136 IU of vitamin D per 3.5-ounce serving. What"s more, their vi-ta-min D content remains high throughout the period of use và seems lớn be just as effective in increasing vi-ta-min D levels in the toàn thân as when taking a vitamin D supplement. That that said, most common mushrooms on the market if grown in the dark & not exposed to lớn UV rays contain very little vi-ta-min D content. Users should consider & choose the mushrooms that are suitable for needs by carefully reading the label as well as the nutrition facts sheet on the sản phẩm packaging before buying.
Egg yolks provide vi-ta-min D, although the specific amount depends greatly on the diet of the chickens & how they were raised. For example, eggs derived from chickens fed a vitamin-D-rich feed may contain up khổng lồ 6,000 IU (150 mcg) per yolk, while eggs from conventionally fed chickens only contain 18 to lớn 39 IU (0). ,4 lớn 1 mcg). Similarly, chickens that are free-range và exposed to lớn sunlight often produce eggs with three times more vi-ta-min D than chickens raised indoors. Natural eggs or organic chicken eggs tend lớn have a lot of vi-ta-min D. Users can choose the right control based on the information on the egg packaging.
Cheese is a natural source of vi-ta-min D, although in very small amounts. Most cheeses contain 8 to lớn 24 IU (0.2 to lớn 0.6 mcg) of vitamin D per 2-ounce (50-gram) serving. The vi-ta-min D nội dung between the varieties varies based on how the cheese is made. Fontina, Monterey & Cheddar cheeses usually contain more vitamin D, while mozzarella usually has less. Soft cheeses such as laughing cow, ricotta, or cream cheese have virtually no vi-ta-min D. Some cheeses may also be fortified with vi-ta-min D, and this will be indicated on the label or ingredient list.
Although some foods naturally contain small amounts of vitamin D, many products are fortified with this nutrient. Although standards for adding vitamin D to foods vary by country, a few of these foods include: Cow"s milk . Depending on the country in which you live, you can find milk fortified with vitamin D, & one cup (240ml) of milk can contain up to lớn 120 IU (3 mcg) of added vitamin D. Sugar-free drinks. Plant-based milks such as soy, rice, hemp, oat or almond milk or orange juice are often fortified with the same amount of vitamin D as cow"s milk. Up khổng lồ 100 IU (2.5 mcg) of vitamin D can be provided per 1 cup (240 ml). Yogurt . Some yogurts provide about 52 IU (1.3 mcg) of this vitamin per 3.5 ounces. Tofu. Not all legumes are fortified with vi-ta-min D, but some are fortified with about 100 IU (2.5 mcg) per 3.5 ounces (100 grams). Hot và cold cereal. Oatmeal and instant cereals are often fortified with vitamin D, with một nửa cup (120 grams) providing up khổng lồ 120 IU (3 mcg). Margarine. Unlike margarine which is not usually fortified with vitamin D, many margarine brands địa chỉ this nutrient. One tablespoon (14 grams) typically provides about 20 IU (0.5 mcg).
If users have concerns that the body toàn thân is not getting enough vitamin D from the diet, supplements can act as a reliable và consistent source. Vitamin D supplements generally come in two forms: vi-ta-min D2: typically harvested from yeast or fungi exposed to lớn UV light vi-ta-min D3: commonly derived from fish oil, with vegan forms available recently developed from lichen When taken in large doses of 50,000 IU (1,250 mcg) or more, vitamin D3 seems khổng lồ be more effective at increasing và maintaining blood levels of vitamin D than D2. However, when taken in smaller, daily doses, the advantage of D3 over D2 seems lớn be much smaller. Since vitamin D is fat soluble, taking it with fatty foods can help increase absorption. The recommended amount of vitamin D falls between 400 & 800 IU (10 to 20 mcg), depending on factors such as age & pregnancy. Long-term use of more than this dose is not recommended lớn avoid toxicity. Symptoms of vitamin D toxicity can include memory loss, difficulty concentrating, depression, abdominal pain, vomiting, high blood pressure, hearing loss, mental confusion, and other extremes like depression renal failure and coma. Periodic health check-ups help khổng lồ detect diseases early, so that there are treatment plans for optimal results. Currently, trunghocthuysan.edu.vn International General Hospital has general health checkup packages suitable for each age, gender và individual needs of customers with a reasonable price policy. Results of the patient"s examination will be returned to the home. After receiving the results of the general health examination, if you detect diseases that require intensive examination and treatment, you can use services from other specialties at the Hospital with unique treatment và services. Outstanding customer service.
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