Impact of three different daily doses of vitamin D3 supplementation in healthy schoolchildren and adolescents from North India: a single-blind prospective randomised clinical trial.

In India, there is a lack of information about the adequate daily dose of vitamin D3 supplementation in school children. Hence, we undertook this study to evaluate the adequacy and efficacy of different doses of vitamin D3 in schoolchildren. A total of 1008 vitamin D-deficient (VDD) children, aged 6-16 years with serum 25-hydroxyvitamin D (25(OH)D) levels <50nmol/l, were cluster randomised into three groups (A-344, B-341 and C-232) for supplementation (600, 1000 and 2000 IU daily) of vitamin D3 under supervision for 6 months. Of the 1008 subjects who completed the study, 938 (93 %) were compliant. Baseline and post-supplementation fasting blood and urine samples were evaluated for Ca, phosphates, alkaline phosphatase, 25(OH)D and parathormone and urine Ca:creatinine ratio. The mean age of the subjects was 11·7 (sd 2·4) years, and the overall mean baseline serum 25(OH)D level was 24·3 (SD 9·5)nmol/l. Post-supplementation rise in serum 25(OH)D in compliant group was maximum with 2000 IU (70·0 (SD 30·0)nmol/l), followed by 1000 IU (46·8 (SD 22·5)nmol/l) and 600 IU (36·5 (SD 18·5)nmol/l), and serum 25(OH)D levels of ≥50nmol/l were achieved in 71·5, 81·8 and 92·9 % by groups A, B and C, respectively. Secondary hyperparathyroidism decreased from 31·7 to 8·4 % post-supplementation. Two participants developed hypercalciuria, but none developed hypercalcaemia. Children with VDD benefit maximum with the daily supplementation of 2000 IU of vitamin D3. Whether recommendations of 400 IU/d by Indian Council of Medical Research or 600 IU by Indian Academy of Pediatrics or Institute of Medicine would suffice to achieve vitamin D sufficiency in children with VDD remains debatable.

Psychologist attitudes towards disclosure and believability of childhood sexual abuse: Can biases affect perception, judgement, and action?

BACKGROUND: The perception of CSA disclosure belief is critical to long-term outcomes for CSA survivors. Despite disclosures often occurring in clinical settings CSA survivors do not always report a sense of clinician belief in response to their disclosure. Ascertaining the factors that influence clinician belief is essential to improving outcomes. OBJECTIVE: This study examined whether language (i.e., word choice to describe abuse) and ongoing relationship status with a perpetrator impact perceptions of CSA belief amongst psychologists. METHODS: This 2 × 2 within subject's study examined relationship effects (ongoing verses estranged) and language effects (consensual verses abusive), embedded in fictitious vignettes, on believability. Seventy-five participants completed demographic surveys, rated and discussed belief in four vignettes, and completed validated scales capturing clinician trauma history and CSA myth endorsement. RESULTS: A significant main effect for relationship was found with ongoing victim-perpetrator relationships being less believed than depictions of estranged relationships (F(1,3) = 15.57, p = .001, h2 = 0.174). While no main effect for language was found (F(1,3) = 0.06, p = .801, h2 = 0.001) content analysis of the open-ended items revealed 80 % of psychologists reported being influenced by the language manipulations. Correlations revealed male psychologists were less likely to believe disclosures and more likely to endorse CSA myths than females, and psychologists who had engaged in trauma training appeared to have heightened disclosure belief and lower myth endorsement. CONCLUSIONS: While psychologists generally report belief in CSA disclosures they appear to evaluate specific disclosure aspects to inform this level of belief. Issues around social desirability, measure sensitivity, and learning effects are discussed alongside the importance of trauma training for psychologists.

Updates on the Role of Spinal Cord Stimulation in the Management of Non-Surgical Chronic Lower Back Pain.

Studies have shown that spinal cord stimulation (SCS) therapy is effective in the management of chronic low back pain. It plays a role by minimizing the intensity of chronic pain, improving the quality of life index, reducing the intake of narcotic analgesics, and increasing the functional improvement in the working environment. However, spinal cord stimulation therapy is not universal because of the complications in the procedure itself, the invasive nature of the treatment, and cost-effectiveness. Therefore, the proper selection of the patients is necessary to get the maximum benefit from the treatment. The study's main objective is to determine the role of spinal cord stimulation in treating non-surgical patients with chronic low back pain. The article will review the mechanism, outcomes, efficacy, predisposing factors in the success and failure of the treatment and indications, contraindications, and selection of patients undergoing spinal cord stimulation therapy. A manual search of the literature was done using databases like Google Scholar and PubMed using the keywords: spinal cord, stimulation, chronic, and low back pain. A total of 37 articles were included in the study after considering the inclusion and exclusion criteria. Spinal cord stimulation therapy effectively treats refractory lower back pain, considering the technology and mechanism of action. The authors conclude that spinal cord stimulation therapy can be used to manage chronic low back pain, other neuropathic pain, and ischemic pain when other standard treatment methods have failed and the pain persisted for more than six months.

Justice, equity and organ donation: A right or a wish?

We commend the article titled "Ethics of organ transplantation" by Sanjay Nagral for raising awareness about organ donation, especially kidney transplants, and shedding light on the Indian scenario. In this article, the author mentions that "If we wish to improve upon the current situation, the first step is total transparency on the part of the medical profession and open, public, debate on this and related issues."

Association of insulin-like growth factor-1 and IGF binding protein-3 with 25-hydroxy vitamin D in pre-pubertal and adolescent Indian girls.

BACKGROUND: There is a high prevalence of vitamin D deficiency (VDD) in India. Molecular mechanisms suggest a strong relationship between vitamin D and growth factors. However, there is a paucity of literature with regard to a relationship between insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3) and vitamin D particularly in subjects with VDD. The objective of the study was to assess the relationship between growth factors and serum vitamin D-parathormone (PTH) status in school girls and study the impact of vitamin D supplementation on growth factors in pre-pubertal girls with VDD. METHODS: Our study subjects were apparently healthy school girls aged 6-18 years. The baseline height, weight, body mass index (BMI), pubertal status, serum 25-hydroxy vitamin D (25OHD), PTH, IGF-1 and IGFBP-3 were assessed in 847 girls aged 6-18 years and in 190 pre-pubertal girls with VDD following supplementation. RESULTS: The mean age, BMI and serum 25OHD of girls were 11.5±3.2 years, 18.7±4.8 kg/m2 and 9.9±5.6 ng/mL, respectively. VDD was observed in 94.6% of girls. Unadjusted serum IGF-1 levels and IGF-1/IGFBP-3 molar ratio were significantly higher in girls with severe VDD as compared to girls with mild-to-moderate VDD. However, these differences disappeared when adjusted for age, height or sexual maturation. The serum IGF-1 and IGFBP-3 levels increased significantly post supplementation with vitamin D. CONCLUSIONS: There were no differences in serum IGF-1 levels and the IGF-1/IGFBP-3 molar ratio among VDD categories when adjusted for age, height and sexual maturation in girls. Vitamin D supplementation resulted in a significant increase in serum IGF-1 levels in VDD pre-pubertal girls.