High prevalence of vitamin D deficiency in north Indian adults is exacerbated in those with chronic kidney disease

Aim:   Vitamin D is being increasingly recognized as an important player in disease. Hypovitaminosis D is widespread in chronic kidney disease (CKD) populations around the world. The vitamin D status of Indian CKD patients is not known.
Methods:   Levels of 25(OH) vitamin D and parathyroid hormone (PTH) were measured in adult north Indian male patients with newly diagnosed stage IV–V CKD and matched control subjects drawn from the same population. A total of 100 (34 stage IV and 66 stage V) patients with CKD and 72 controls were studied.
Results:   Only 4% control and 1% of CKD subjects had normal (>30 ng/mL) vitamin D levels. Approximately 68% of control and 77% of the CKD population had vitamin D deficiency (<15 ng/ml) whereas the remaining 38% control and 22% CKD patients had insufficient (15–30 ng/mL) vitamin D levels. Levels were lower in CKD subjects compared to their family members, and the CKD patients were significantly more likely to have severe vitamin D deficiency (<5 ng/mL). A strong negative correlation was noted between vitamin D and PTH. No significant correlation was found between vitamin D levels and body mass index, bodyfat percentage, serum albumin or calcium levels.
Conclusion:   Vitamin D deficiency is highly prevalent in north Indians, and this is more pronounced in CKD subjects. There is a significant inverse correlation between the vitamin D and PTH levels. The clinical significance of this deficiency and the potential benefits to be derived from vitamin D supplementation in this population merits further studies.     

Azathioprine in the treatment of muco-cutaneous pemphigoid

Four patients with muco-cutaneous pemphigoid were treated with azathioprine. Satisfactory control of the cutaneous lesions was maintained in two patients, in one of them with concomitant use of a corticesteroid. Oral ulceration was less frequent in three patients, and in two patients with ocular involvement visual impairment did not progress. Although the various complications of azathioprine therapy need to be considered, this drug may significantly improve the prognosis regarding vision in patients with ocular changes otherwise totally unresponsive to therapy.     

MUDI-CHOOD: AN UNUSUAL TROPICAL DERMATOSIS

Mudi-chood is an unusual dermatosis seen in India. It affects the nape of the neck and the exposed part of the upper back in girls and young women. It is characterized by mildly pruritic pigmented papular lesions. It probably represents the comedogenic activity of various oils applied to the hair, which is aggravated by the typical climatic conditions. We present three cases of mudi-chood.