Hypovitaminosis D is common in India. In the present prospective partially randomised study of vitamin D (D 3 ) supplementation during pregnancy, subjects were randomised in the second trimester to receive either one oral dose of 1500 mg vitamin D 3 (group 1, n 48) or two doses of 3000 mg vitamin D 3 each in the second and third trimesters (group 2, n 49). Maternal 25-hydroxyvitamin D (25(OH)D) at term, cord blood (CB) alkaline phosphatase (ALP), neonatal serum Ca and anthropometry were measured in these subjects and in forty-three non-supplemented mother -infant pairs (usual care). Median maternal 25(OH)D at term was higher in group 2 (58·7, interquartile range (IQR) 38·4 -89·4 nmol/l) v. group 1 (26·2, IQR 17·7-57·7 nmol/l) and usual-care group (39·2, IQR 21·2 -73·4 nmol/l) (P¼ 0·000). CB ALP was increased ( . 8.02 mkat/l or .480 IU/l) in 66·7 % of the usual-care group v. 41·9 % of group 1 and 38·9 % of group 2 (P¼0·03). Neonatal Ca and CB 25(OH)D did not differ significantly in the three groups. Birth weight, length and head circumference were greater and the anterior fontanelle was smaller in groups 1 and 2 (3·08 and 3·03 kg, 50·3 and 50·1 cm, 34·5 and 34·4 cm, 2·6 and 2·5 cm, respectively) v. usual care (2·77 kg, 49·4, 33·6, 3·3 cm; P¼0·000 for length, head circumference and fontanelle and P¼ 0·003 for weight). These differences were still evident at 9 months. We conclude that both 1500 mg and two doses of 3000 mg vitamin D 3 had a beneficial effect on infant anthropometry, the larger dose also improving CB ALP and maternal 25(OH)D.Key words: Vitamin D supplementation: Pregnancy: Infant anthropometry: Neonatal calcium Vitamin D deficiency has been reported to be frequent among adolescent girls and pregnant women in India, with approximately 80 % of both urban and rural subjects having serum 25-hydroxyvitamin D (25(OH)D) ,50 nmol/l (1,2) . Exposure to the abundant sunlight in India is poor in women because of the traditional modest style of dressing. The resulting consequences to the fetus and the newborn include low cord blood (CB) vitamin D and high alkaline phosphatase (ALP), neonatal hypocalcaemia and poor fetal growth, among others (2,3) . Thus, pharmacological supplementation may be necessary, especially in such vulnerable groups.Although several studies are available on vitamin D supplementation during pregnancy, its appropriate dose is not clear (4) . In a study by Datta et al. (5) , 160 pregnant Asian women in the UK were supplemented with a dose of 20 mg/d, which was later increased to 40 mg/d. However, the rise in maternal serum 25(OH)D was from 14·98 nmol/l to only 27·5 nmol/l. Similar results have been found in other studies that administered small daily doses of similar magnitude (6,7) , though one study (3) found significantly improved CB 25(OH)D in subjects receiving 25 mg/d when compared with controls. Studies that used larger (stoss) doses have done so only in the third trimester, whereas Ca transfer to the fetus has been shown to occur in the second trimester (8) . Marya et al. (...

We assessed the effect of vitamin D supplementation on related biochemistry, infection and dentition of the infant. In a double-blind, placebo-controlled trial conducted in Lucknow, India (latitude 26°N), 230 mother -newborn pairs were randomised to receive, for 9 months, 3000 µg/month oral vitamin D 3 by the mother (group A) or 10 µg/d by the infant (group B) or double placebo (group C). All babies received 15 min of sun exposure (unclothed) during massage. Infants' median 25-hydroxyvitamin D (25(OH)D) was lower in group C (median 45·3; interquartile range (IQR) 22-59·5 nmol/l) than in groups A (median 60·8; IQR 41·3-80·5 nmol/l (P < 0·01)) and B (median 61·3; IQR 41·3-75·3 nmol/l (P < 0·05)) at 3·5 months. Infant 25(OH)D correlated negatively with infant parathyroid hormone (r −0·46, P < 0·01). Elevated alkaline phosphatase (>7.5 µkat/l) was significantly more frequent in group C babies (16 %) than in group A (4 %) or group B (0 %) babies. The number of days with respiratory or diarrhoeal infection by 9 months of age was higher in group C (median 46·5; IQR 14·8-73·3 d) than in group A (median 18·5; IQR 8·8-31·0 d (P < 0·01)) or group B (median 13·0; IQR 7·0-28·5 (P < 0·05)). We conclude that monthly maternal or daily infant supplementation with vitamin D along with sun exposure is superior to sun exposure alone in maintaining normal infant 25(OH)D at 3·5 months, and provide protection from elevated alkaline phosphatase and infectious morbidity.Key words: Vitamin D: Lactation: Infants: Sunshine Hypovitaminosis D is highly prevalent in India despite adequate sunshine. Factors responsible for this include inadequate exposure to sunshine, atmospheric pollution and skin pigmentation. Serious consequences of vitamin D deficiency include cardiac failure and hypocalcaemic seizures (1) . Transplacental transfer and breast milk concentration of vitamin D are low in mothers with poor vitamin D status during pregnancy and lactation (2)(3)(4) . Studies from India have shown 84-96 % of mothers and infants at birth and at 3 months to have serum 25-hydroxyvitamin D (25(OH)D) < 20 ng/ml (50 nmol/l), with winter mean 25(OH)D in women being as low as 5·9 ng/ml (14·75 nmol/l) (2,5) . High-dose (160 µg or 6400 IU/d) vitamin D 3 administered to the lactating mother was found to safely and significantly improve maternal 25(OH)D and mean milk antirachitic activity (6) . Ala-Houhala et al. (7) showed that a regimen of 50 (but not 25) μg/d to the mother improved the nursing infant's serum 25(OH) D significantly. In the only study from India on postnatal supplementation of term infants, Kumar et al. (8) did not find any differences between the placebo and supplemented groups (receiving 35 µg vitamin D 3 /week) in mortality or hospital admissions (their primary outcomes) or referral to the outpatient clinic for moderate morbidity, although serum 25(OH)D was higher in the treated group. Current international recommendations mention 10 µg/d as routine supplementation for breastfeeding infants (3,4,9) . However, no study from tropic...

We evaluated the chemopreventive effects of ethanolic neem leaf extract in the initiation and post-initiation phases of 7,12-dimethylbenz[a]anthracene (DMBA)-induced hamster buccal pouch (HBP) carcinogenesis. The frequency of bone marrow micronuclei as well as the concentrations of lipid peroxides, ratio of reduced to oxidized glutathione (GSH/GSSG), and the activities of the GSH-dependent enzymes glutathione peroxidase (GPx) and glutathione-S-transferase (GST) in the buccal pouch, liver and erythrocytes were used as biomarkers of chemoprevention. All the hamsters painted with DMBA alone for 14 weeks developed buccal pouch carcinomas that showed diminished lipid peroxidation and enhanced antioxidant status associated with increased frequencies of bone marrow micronuclei. In the liver and erythrocytes of tumour-bearing animals, enhanced lipid peroxidation was accompanied by compromised antioxidant defences. Administration of ethanolic neem leaf extract effectively suppressed DMBA-induced HBP carcinogenesis as revealed by the absence of tumours in the initiation phase and reduced tumour incidence in the post-initiation phase. In addition, ethanolic neem leaf extract modulated lipid peroxidation and enhanced antioxidant status in the pouch, liver and erythrocytes and reduced the incidence of bone marrow micronuclei. The results of the present study, demonstrate that ethanolic neem leaf extract inhibits the development of DMBA-induced HBP tumours by protecting against oxidative stress.

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Abstract

Based on the findings, we emphasize that there is a strong relationship between dyslipidemia and the progression of DED particularly in women. Ophthalmologists may increase their role to educate themselves to diagnose dyslipidemia and ensure comprehensive eye care to prevent blindness and cardiovascular disease. Recent treatment modalities could be aimed to improve the quality of life of women and elderly patients suffering from DED.

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Vitamin D deficiency is prevalent in chronic pancreatitis (CP), but the optimal route and dose of vitamin D supplementation are unknown. We evaluated the relative efficacy of two different doses of intramuscular (i.m.) vitamin D(3) in patients with CP and vitamin D insufficiency. In a double-blind randomized study, 40 patients with tropical calcific pancreatitis with serum 25-hydroxyvitamin D (25OHD) <75 nmol/L (mean 27.0 ± 14.5 nmol/L, <50 nmol/L in 90 %) were divided into three groups. Groups 1 and 2 received 600,000 IU (15,000 μg) and 300,000 IU (7,500 μg) i.m. cholecalciferol, respectively, while group 3 received i.m. saline. All groups received 1 g calcium and 500 IU (12.5 μg) vitamin D(3) orally daily and were studied for 9 months. The primary outcome was the proportion of patients with vitamin D sufficiency (25OHD >75 nmol/L) at 6 months. Vitamin D sufficiency was significantly different in the three groups (85, 29, and 0 % in groups 1, 2, and 3, respectively; p < 0.001). Mean 25OHD remained >75 nmol/L in months 1-6 in group 1 but reached a lower level (50-75 nmol/L) at these time points in group 2. At 6 months, serum alkaline phosphatase decreased significantly only in group 1 (230 ± 73 vs 165 ± 39 IU/L, p = 0.004). No patient in any group developed hypervitaminosis D or hypercalcemia. In conclusion, in patients with CP, a single i.m. injection of 600,000 IU was more effective at achieving vitamin D sufficiency over 6 months compared with 300,000 IU vitamin D(3). (Clinical Trials.gov number NCT00956839).