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Prevalence of Vitamin D Deficiency in Exclusively Breastfed Infants at the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Said, Nusrat. A.

Department

Paediatrics and Child Health (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2015

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728063714

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Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk underlie the high risk of deficiency in exclusively breastfed infants. Data regarding the magnitude of vitamin D deficiency among exclusively breastfed infants in Kenya is needed to inform policies on supplementation of at risk groups. Objectives: The aim of this study was to determine the prevalence of vitamin D deficiency in exclusively breastfed infants using 25(OH)D and to evaluate the relationship between PTH and 25(OH)D in a population of exclusively breast fed infants. Study Design: This was a cross sectional survey carried out in three to six month old exclusively breastfed infants at the Aga Khan University Hospital, Nairobi. Methods: Ninety-eight infants were enrolled in the study and all had data on their demographics and anthropometric measures recorded. Self-reported data on maternal vitamin D supplementation and sunlight exposure was also collected. A brief physical examination to assess for skeletal signs of rickets was then performed. A blood sample was collected for measurement of serum 25(OH)D, calcium, phosphate and PTH . Prevalence of vitamin D deficiency was analyzed using proportions with 25(OH)D levels below 20ng/ml. PTH, calcium and phosphate levels in the vitamin D deficient and non-deficient groups were compared using analysis of variance(ANOVA). The level of 25(OH)D beyond which there was no PTH elevation was identified by drawing a scatter plot of PTH against vitamin D levels. Tests of association using odds ratio were used to determine the correlation between infant serum vitamin D levels and maternal vitamin D supplementation and sunlight exposure. Skeletal manifestations of vitamin D deficiency in this population were described using bar charts. Results: Prevalence of vitamin D deficiency among exclusively breastfed infants at Aga Khan University Hospital was 23.5% (95% CI 14.9%-32.0%). A further 31.6% were found to have insufficient levels of vitamin D leaving only 44.9% of the population classified as having sufficient levels.
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ذکر میرا وہ کریں منظور کیوں

ذکر میرا وہ کریں منظور کیوں
جانے وہ الفت سے ہیں معذور کیوں

پوچھتی ہے تم سے یہ میری وفا
جان کر مجھ سے ہوئے رنجور کیوں

آن بیٹھے وہ نظر کے سامنے
قبلہ و کعبہ ہو اب منظور کیوں

ہیں میسر ان کی مست آنکھیں جنھیں
وہ اٹھائیں بادہ و انگور کیوں

تم فضاؔ جب ہو مری محبوب تو
پھر میں دیکھوں حسن کیا اور حور کیوں

دور الشباب في رقي الأمم وازدهارها الحضاري على أساس الدين والعلم والأخلاق من منظور السيرة النبوية

Islam took great care of youth, because youth in Islamic nation are the shining stars, they are the backbone of nation and source of its survival and the pillars of advancement in the peace, and the soldier of victory in the war, and the hope of nation's present and future. Nations achieve greatness on the shoulders of their faithful and committed youth those who want progress, innovation and scientific competition in all sphere of the life, and serve great in uplifting of their Islamic nation. This article is an attempt to answer some questions, such as: possibility of the renewal of ideas of youth and concepts of the religious texts to work on drafting a practical approach for the advancement and prosperity based on the teachings of the religion that urges to wisdom with knowledge and ethics? This article deals with the Importance of youth’s role in progress of the nations and development of their civilizations in light of Holy Qur’an, Writing the idiomatic concept of the word "civilization, the impact of religion, science and ethics in advancement and property of nations, the causes and factors that led to the decline of the Islamic civilization, the foundations and pillars of western civilization, and the most important foundations on of the youth for advancement and prosperity of the nation. All these points are discussed in the article with a special reference an as taken is (صلى الله عليه وسلم) Prophet Holy of life the and Sunnah and Quran of excellent example for the development of nation with special reference to its youth.

Transfer of Rol Genes and Evaluation of Artemisinin Synthesis in Transgenic Artemisia Annua L. and Artemisia Dubia Wall.

Artemisinin is an important secondary metabolite of Artemisia annua and Artemisia dubia. It is a major constituent of Artemisia species. Chemically it is an endoperoxide sesquiterpene lactone. It is a potent antimalarial drug that has also been proven very effective in treatment of cancer. The rol genes have been known to enhance production of secondary metabolites in plants, possibly through stimulation of defense pathway. This study examines the effect of transformation of A.annua and A.dubia with the rol genes through Agrobacterium tumefaciens and Agrobacterium rhizogenes. The artemisinin content, trichome density and expression of key genes in the biosynthetic pathway of artemisinin were measured. Anticancerous activity of extracts of transformed and untransformed A.annua and A.dubia was also observed against MCF-7 breast cancer cell lines. Transcriptomic study of transformed and control A.annua and A. dubia was carried out as well. A number of factors like type of explants, effect of sterilization and co- cultivation period have been reported to affect the efficiency of A.tumefacienes mediated transformation. LBA4404 strain of A.tumefacienes containing pRT99 plasmid harboring rol ABC genes were used for the A.tumefacienes mediated transformation. Mercuric chloride 0.1% for 2 minutes showed the best results for seed surface sterilization giving 95% germination. Leaf and stem were found best explants for transformation. Explants were infected with bacterial culture for 5 minutes and cultured on co-cultivation medium (MS medium with 200 μM acetosyringone) for 48 hours. Explants when cultured on selection medium (MS medium containing 0.1mg /L BAP supplemented with 50mg/ml kanamycin), resulted in the maximum number of transformants. Regeneration of transgenic shoots was obtained from both stem and leaf explants on regeneration medium (MS medium containing 0.1mg /L BAP supplemented with 20mg/ml kanamycin and 500mg/l cefotaxime). Eighty percent of the transgenic A.dubia shoots showed rooting response on half MS medium with 0.025mg/L NAA, while transgenic shoots of A.annua produced roots on half MS medium with 0.1mg/L NAA. Control and transgenic plants were transferred to small pots and acclimatized. Morphological differences like increased size and broad leaves were observed. Confirmation of transformation was made through PCR for rol A, B and C genes. Southern blot analysis was performed to check the copy number of inserted genes.A.rhizogenes strain LBA9402 and LBA 8196 carrying rol genes were used for the A.rhizogenes mediated transformation. Transformation with A.rhizogenes was carried out with the plants growing in green house through their in-vitro propagation. Hairy roots were produced from A. rhizogenes strain LBA9402 infected stem portions of A. annua and A.dubia after seven days of infection but no hairy roots were produced from strain LBA8196. Transformed and control roots were cultured on solid B5 medium for further roots proliferation. Transformed roots showed better proliferation than control roots. Artemisinin content was significantly increased in transformed material of both Artemisia species when compared to un-transformed plants. The artemisinin content increased mostly five to ten times within leaves of transformed lines, hairy roots and roots of transformed shoots. It indicated the plant capability of synthesizing much higher amounts than has been achieved so far through traditional breeding. Similarly, amount of different derivatives of artemisinin i.e. artemether, arteether, dihydroartemisinin and artesunate was also significantly increased in transformed material of both Artemisia species when compared to un-transformed plants. Expression of all the tested genes involved in artemisinin biosynthesis pathway was significantly increased, although variation amongst the genes was observed. Cytochrome P450 (CYP71AV1) and aldehyde dehydrogenase 1 (ALDH1) expression levels were higher than that of amorpha-4, 11 diene synthase (ADS). Levels of the trichome development and sesquiterpenoid biosynthetic gene (TFAR1) expression were also found increased in all transgenic lines. Trichome density significantly increased in the leaves of transformed plants, but no trichomes were seen in control or transformed roots. Crude hexane and aqueous extracts of rol genes transformed plants revealed higher anticancerous activities against MCF-7 breast cancer cell lines. Hexane extracts of transgenic plants revealed higher anticancerous activity against MCF-7 breast cancer cell lines compared to aqueous extracts. Transcriptomic study of A.annua and A.dubia allowed sequencing of the transcriptome of these species for the first time. 16400 Contigs were generated by aligning different transcriptome sequences. Up and down regulation and Putative gene functions were predicted. BLAST of 500 contigs was performed, out of which 264 contigs showed homology with genomes of different organisms. Blast results of somecontigs showed that some species have genes that are similar to those involved in artemisinin biosynthesis pathway. It would be interesting to know what are the pathways in which those genes are involved in these species. Furthermore, divergence of A. annua and A.dubia from the common ancestors can be found through phylogenetic tree construction.