English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background: Since swine flu has been declared pandemic in 2009 it has become a major challenging publichealth problem associated with high morbidity and mortality. 25(OH)D deficiency is also pandemic and has been reported to be clinically correlated with decreased immunity and respiratory infections. The possible role of vitamin D in infections is implied from its impact on the innate and adaptive immune responses. This study is planned to evaluate clinical significance of 25(OH)D status on course and outcome in hospitalized cases of swine flu and to compare it with normal healthy subjects living in the same vicinity to evaluate if vitamin D is having any protective effect. Material & Methods: Present prospective cross-sectional study was conducted on 79 RT-PCR confirmed cases of swine flu admitted during recent epidemic. All patients were evaluated thoroughly by clinical history physical examination and laboratory investigations as per Performa and followed-up during hospital stay. 25hydroxyvitamin D (25(OH)D) estimation was done by electro-chemiluminescent Assay in all the cases and it was also done in 36 normal healthy family members of study patients living in the same vicinity (control group). Results: High prevalence (70.9%) of low (≤30ng/ml) status of 25(OH)D was observed in cases of swine flu as compared to control group. 25(OH)D status was associated with severity of illness. Mean value of 25(OH)D in mechanically ventilated patients was 9.81±6.43 while it was 22.76±11.35 ng/ml in patients who do not required ventilation (p<0.05). Mean 25(OH)D level in patients who stayed in hospital for <5 days was 28.60±8.79 ng/ml, 24.18±11.67 for 6-10 days and 8.23±2.12 for >10 days (p<0.01). Mean value of 25(OH)D in patients who died was 9.59±5.90 ng/ml as compared to 23.13±11.62 ng/ml who survived (p<0.01). Conclusion: Our study suggests that 25(OH)D may have preventive role for swine flu infection. Low level of 25 (OH)D is associated with high morbidity in terms of increase requirement for mechanical ventilation, multiorgan dysfunction and long duration of hospital stay. 25(OH)D deficiency is associated with high mortality in swine flu. 25(OH)D status should be given due consideration in high risk patients especially during winter season. DOI: 10.14302/issn.2379-7835.ijn-20-3369 Freely Available Online www.openaccesspub.org | IJN CC-license DOI: 10.14302/issn.2379-7835.ijn-20-3369 Vol-6 Issue 2 Pg. no.2 Introduction WHO declared swine flu (H1N1) pandemic on June 11, 2009 and since then it has become an important public health problem associated with repeated epidemics leading to high morbidity and mortality worldwide. Vitamin D deficiency is also pandemic. Vitamin D is best known for its influence on bone mineral density but now it is increasingly recognized for its extra-skeletal roles, including an effect on inflammation and the immune response to infection. Vitamin D generates many extra-skeletal effects due to the vitamin D receptor (VDR) which is present in most tissues throughout the body. Vitamin D receptor (VDR) is a nuclear receptor for 1,25-Dihydroxyvitamin D3. Cells involved in different biological processes such as immunity and inflammation have been found to possess VDR and are capable of metabolizing the active form of vitamin D suggesting that this nutrient may be an important factor in the immune response to infection. Recently anti‐viral effect of vitamin D has been described although underlying mechanism is poorly understood but finding suggestive of a complex interplay between viral infections and vitamin D, including the induction of anti‐viral state, functional immunoregulatory features, interaction with cellular and viral factors, induction of autophagy and apoptosis, and genetic and epigenetic alterations. Vitamin D has a modulatory and regulatory role in multiple processes, including host defence, inflammation, immunity, and epithelial repair. Patients with respiratory disease are frequently deficient in vitamin D. Respiratory viral infections are common and are the main trigger of acute exacerbations and hospitalization in children and adults with asthma and other airways diseases. Respiratory monocytes/macrophages and epithelial cells constitutively express the vitamin D receptor. Vitamin D, acting through this receptor, may be important in protection against respiratory infections. 1,25(OH)2D has been found to down-regulate pro-inflammatory cytokines such as IL-1, IL-6, IL-8, and TNFa. The anti-inflammatory effect of vitamin D is also carried by inhibition of NF-Kb. 1,25(OH)2D has been shown to promote the differentiation of monocytes into macrophages in mice and suppress the differentiation of human monocytes into dendritic cells. Because cathelicidin’s main mechanism of action is the destruction of envelope proteins of foreign agents, it may also be implicated in the destruction of influenza virus, which possesses an envelope. We do not find any study on vitamin D3 in swine flu patients therefore, this study was planned to evaluate 25(OH)D status and its clinical significance in cases of swine flu. Material and Methods Present prospective cross-sectional study was carried out on all the consecutive 79 confirmed cases of swine flu admitted in the dedicated swine flu ward, Department of Medicine, Sardar Patel Medical College & Associated Group of Hospitals, Bikaner during recent epidemic November 2018 to march 2019. Written informed consent was taken from all subjects or their legal guardians before enrolling for the study. Prior approval from Institutional Ethics Committee was taken. Inclusion criteria All patients of swine flu confirmed by positive RT-PCR admitted in the dedicated swine flu ward. Age >18 years. Patient or their legal guardian giving consent to Corresponding author: Bal Kishan Gupta, Prem Kutir, Opposite DRM Office, Hospital Road, Bikaner 334003 Rajasthan, India, Ph: +91 151 200218, +91 9829176143, Fax: +91 151 2226301, Email: bkgbkn@rediffmail.com

Clinical Evaluation of Significance of 25(Oh)D (Vitamin D) Status in Swine Flu (H1N1)