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DR. PRADEEP DUBEY MD(PED). DCH. CONSULTANT PEDITRICIAN. DR. PRADEEP DUBEY MD(PED). DCH. CONSULTANT PEDITRICIAN. VITAMIN D DIFICIENCY IN CHILDREN AADIGURU NEURO PEDITRIC CENTRE PREM MANDIR CHOWK, WRIGHT TOWN, JABALPUR.

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20 th century witnessed - Discovery of Vit D Nutrition Research, Vol. 19, No. 11, pp. 1683-1718, 1999

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The Evolution of Vit D Bone health Vitamin Miracle Drug For strong bones

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Vitamin D & Cancer J. Nutr. 135: 2739S2748S, 2005.

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First evidence for anticancer effects of Vit D Biochem Biophys Res Commun. 1981 Oct 15;102(3):937-43.

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Clinical trials - Vit D & Cancer Ann Epidemiol 2009;19:468483.

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Infections TB Epidemic influenza HIV Vaginal infections

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Nobel Prize in Physiology or Medicine, 1903 Dr.Niels Ryberg Finsen

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Finsen extended his work to all forms of internal TB

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Sputum Conversion Rate RCT Sputum conversion rates from AFB positive to negative- Vit D 0.25 mg/day supplemented patients -100% Non-supplemented patients- 77% South Med J. Author manuscript; available in PMC 2010 November 1.

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Refractory case of PTB- Improvement with Vit D

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Vitamin D & Autoimmune diseases Who are you? Where am I? You look delicious!

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N Engl J Med 2007;357:266-81. J. Nutr. 135: 2739S2748S, 2005. Multiple sclerosis IBDT1DM RA

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Vit D deficiency- An Important, Common, & Easily Treatable Cardiovascular Risk Factor?

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PTH Diabetes & Metabolic Syndrome Hypertension & Hypertrophy IR & Pancreatic cell dysfunction Inflammation RAAS Atherosclerosis Adverse CV events J Am Coll Cardiol 2008;52:194956

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Vitamin D deficiency in healthy South Indians Am J Clin Nutr 2007; 85: 1062-7 Deficient (

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Vitamin D deficiency in healthy South Indians Am J Clin Nutr 2007; 85: 1062-7 Deficient (

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Groups at Risk of Vitamin D Inadequacy Breastfed infants AAP recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day Older adults Older adults are at increased risk of developing vitamin D insufficiency People with limited sun exposure Homebound individuals, people who wear long robes and head coverings, & people with occupations that limit sun exposure People with dark skin People with fat malabsorption People who are obese or who have undergone gastric bypass surgery

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Cause of Rickets The First Insight

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Vit D physiology N Engl J Med 2007;357:266-81.

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RICKETS ROSARY

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SKELETAL CHANGES

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HEALING RICKETS

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LINE OF CALCIFICATION

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NORMAL PELVIS

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DEFORMED PELVIS

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Loading dose 60,000 IU/Week for 8 weeks 60,000 IU/Week for 8 weeks Blood test Maintenance dose 60,000 IU/ 60,000 IU/ Mont h Dose of Vitamin D For treatment of Vitamin D Deficiency

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Recommended Vitamin D Intake by Endo. Society Guidelines, 2011 Reasonable daily allowance (IU/ day) Reasonable allowance (IU/ month) 0-6 months400-100012000-30000 6-12 months400-100012000-30000 Children (1-18 yrs)1000-200030,000-60,000 Adults (19-50 yrs)1500-200045,000-60,000 Elderly (51-70 yrs)1500-200045,000-60,000 Elderly (71 yrs)1500-200045,000-60,000 Pregnancy1500-200045,000-60,000 Lactation1500-200045,000-60,000

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