The Role of Vitamin D in Children with

Recurrent Tonsillopharyngitis

Ismail Yildiz, Emin Unuvar,

Umit Zeybek, Bahar Toptas,
Canan Cacina, Sadık Toprak,
Ayse Kilic
and Salih Aydin

By : dr. Widyawati
Mentor
Dr. Lisa Apri Yanti, Sp.T.H.T.K.L
Dr. Erial Bahar M.Sc
 Background

Unreasonable
antibiotics use
Previous research
Leading causes of suggests that
hospital visits during vitamin D has an
childhood important role in
immune system

Determine the role of New ideas about the

vitamin D and VDR function of Vitamin D
in children with receptors (VDR)
tonsillopharyngitis
Methods

• Retrospective study, case

control

Istanbul University, Istanbul Medical

Faculty, Departement of Pediatrics,
Outpatient Clinic of General Pediatrics

Between April 2008 until April 2009

 Methods

Acute
2780 patients tonsillopharyngitis

Participant
115 patients 127 patients

Study group

Control group
 Methods
Inclusion criteria
• Tonsillopharyngitis > 7 times a year
• Symptoms of Tonsillopharyngitis ≤ 7 days
• No conditions requiring to be hospitalized
• Parental consent
• No known chronic diseases
• Not having any suplementation of vitamin
D during the last 3 month
 Variables
Dependent
Confounder 1. Recurrent
• Independent
1. Season Tonsillopharyngitis
2. Time of day
3. Fraction of body
Vitamin D exposed
4. Diet

VARIABLE STUDY
 Research Procedure
The study was in autumn
Study group : Patient with and winter season
acute tonsillopharyngitis who
met the inclusion criteria
Control group : Healthy
children from outpatient clinic

serum 25 (OH) and 1,25-

(OH) vitamin D levels were Bloods samples were
measured by ELISA collected from both group
Statistical Analysis
Qualitative
and
quantitative
parameter
SPSS 10.0 T- test

P<0.05 : The
level of
Logistic significance Chi-
regression
square
test

Pearson
Correlati Fisher’s
on Exact
analysis
• Interpretation of serum 25
(OH) vitamin D

insuffici sufficie excess intoxica

ent nt tion

50-80 80-250 250-325 > 325

nmol/L nmol/L nmol/L nmol/L
Normal serum 1,25 (OH)2
vitamin D :
16-65 pg/ml
 Result of serum 25 (OH) vitamin D level
79
80 70
70
60
50
case group
40
Control group
30
20
10 4
0 0 1 1 0
0
Insuffient sufficient excess intoxication
 Result of serum 1,25 (OH)2 Vitamin D
80 75
68
70
60
50
40 Case Group
Control Group
30
20
10
10 6
3 1
0
Below Normal Above
normal normal
 Table 1 Main characteristics of the Cases
GROUPS P Value

Study group Control group

(n:115) (n:127)

Gender Girl ; n (%) 45 (39.1) 57(44.9) 0.36

Age (years) 5.6±2.4 6.1±2.7 0.13

Weight (kg) 21.3±8.0 21.8±8.7 0.72

Height (cm) 113.8±16.2 112.8±19.3 0.74

Annual tonsillopharyngitis frequency 15.3±4.7 2.5±0.9 <0.01

Statistically Significant Differences

 Table 2 Serum Level of 25-OH Vitamin D levels

Study Group Control Group P Value

(84 Patients) (79 Patients)
Serum 25 (OH) vitamin D level 142.7±68.1 192.3±56.1 <0.01
(nmol/L)

Serum 1,25-(OH)2 vitamin D level 35.8±16.4 28.4±14.1 <0.01

(pg/mL)

Number of patients with serum 25- 4(4/84; 4,5%) 0 0.04

OH vitamin D level below < 50
nmol/L

Statistically Significant Differences

 Table 3 Vitamin D receptor gene polimorphism
VDR Gene Polimorphisms Study Group Control Group P Value
(n:100) (n;(%)) (n:104) (n;(%))
Taq TT 49 (49) 50 (48.5) 0.99
Tt 40 (40) 42 (40.8)
tt 11 (11) 11 (10.7)
Apa AA 39 (39) 43 (42.6) 0.14
Aa 53 (53) 58 (57.4)
aa 8 (8) 0 (0)
Fok I FF 46 (45.5) 54 (53.5) 0.55
Ff 52 (51.5) 41 (40.6)
ff 3 (3) 6 (5.9)

No Statistically significant difference

 Discussion

Serum 25-(OH) vitamin D

• Reid et al., lower in patient with recurrent

tonsillopharyngitis  normal serum in both group study.
 Discussion

VDR polimorfism

• Roth et al., No correlation between VDR ff allele

polimorfism and recurrent tonsillopharyngitis recurrent
tonsillpharyngitis increase in the patient with ‘Ff’
polymorphism, whereas decrease in the patient with ‘ff’
 Author’s Conclusion

Low Serum Vitamin

D level can be risk
factor for recurrent
tonsillopharyngitis
Serum 25 (OH)
Vitamin D in Children
with recurrent
Tonsillopharyngitis <
healthy children
 Critical
Appraisal
 The author does not
The author does not evaluating the
mention exclusion nutritional
criteria characteristics of the
children

Can’t determine the

serum 25-(OH) Serum samples
vitamin D level didn’t taking in both
because of the summer and winter
limited number cases
Did the study
address a
clearly
focused Yes
question / This study aimed to
issue? evaluate the association
between Serum vitamin
D and recurrent
tonsillopharyngitis on a
population
. Is the research
method (study
design)
appropriate for Yes
answering the
research Study design, a case
question? control study, compared
subject who have that
condition/disease (cases)
with subject who do not
have the condition/disease
(control)
 Can the
results be
applied to
your
organization?
Yes
This reseach recommend
 Were both
groups
comparable
at the start Yes
of the study? Both group, cases
and controls
compared at the
start study
 CONCLUSION

Valid Applicable
THANK YOU
 Isolation of DNA
• Blood Spesimens were collected in tube
containing EDTA and DNA was prepared from
leucocyte pellet by SDS lysis, ammonium
acetate and ethanol precipitation ( Miller et al.)
 Exclusion Criteria
• Having Tonsillectomy
• Presence of any known chronic systemic
disease
• Take Vitamin D supplementation
 Contoh kapsul Vitamin D

Farmakologi:
Calcitriol merupakan suatu metabolit aktif vitamin D3 yang
secara normal terbentuk di dalam ginjal dari zat prekursornya
25-hydroxycholecalciferol. Ada 2 tempat kerja utama Calcitriol
yaitu pada usus dan tulang. Calcitriol meningkatkan absorbsi
kalsium di usus dan mengatur mineral pada tulang.
• Absorpsi: Calcitriol segera diserap dari usus.
Konsentrasi puncak dalam plasma tercapai dalam waktu
3 sampai 6 jam setelah pemberian tunggal 0,25-1 mcg
peroral.
• Distribusi: Kira-kira 99,9% Calcitriol terikat dalam darah.
• Ekskresi: Calcitriol mengalami siklus enterohepatik dan
ekskresi bilier. Metabolit Calcitriol diekskresikan
terutama di feses. Waktu paruh eliminasi Calcitriol dalam
serum setelah pemberian oral dosis tunggal adalah 6-8
jam.
Grade 0: Tonsils absent
Grade 1: hidden behind
tonsillar pillars
Grade 2: Extend to
pillars
Grade 3: Visible beyond
pillars
Grade 4: Enlarged to
midline
 Relationship Between vitamin D and Immune
system

• Reid et al., Vitamin D is known to have an

important role in the production of both
cathelicidin and defensin Beta 2, as
antimicrobial peptides (AMPs), that
provide a natural defence against potential
pathogens, destroy invation of
microoganism
• Vitamin D reseptor ialah transkripsi ligan
yang di mediasi oleh efek genom 1,25
dihydroxyvitamin pada jaringan
• Penyebab mutasi VDR : codon prematur
yang berhenti, delesi gen secara parsial
• Polimorfisme ialah variasi urutan DNA
yang sering terjadi pada populasi