الفهرس 
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Abstract
Rheumatic fever and associated with valvular disease of the heart; rheumatic heart disease (RHD) is a serious disease with many complications and high mortality rates all over the world especially in developed countries. Its link with poverty and malnutrition states is well established. Although vitamin D intake influences cardiac diseases the link between vitamin D and RHD has not been examined (Enquselassie, 1993).
The aim of this study is to assess the effect of introduction of vitamin D supplements for children with RHD and to see its effect on the clinical course and laboratory findings over a period of 3 months.
This is an experimental case control prospective follow-up study that was conducted for 60 children diagnosed as RHD, whose ages ranged from between 6 to 15 years. They were divided into two groups: Group I: The intervention group: This comprised 30 patients with RHD, confirmed by ECHO studies. They were subjected to vitamin D administration together with their regular prophylaxis with 3 weekly LAP. Group II: The non-intervention (control) group: This comprised 30 patients with RHD, confirmed by echo studies. This group did not receive any other medication apart from their regular prophylaxis with 3 weekly LAP.
All subjects were exposed to a thorough clinical evaluation and echocardiographic assessment. Blood samples were drawn for measurement of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-streptolysin titre (ASOT) in serum before and after 3 months of vitamin D administration. The intervention group received of vitamin D at the dose of 200,000 IU by IM injection provided by the researcher and followed up every month to ensure compliance.
The findings were as follows:
1- Residence: 60% of Group I resided compared to 80% of Group II patients resided in rural areas (X2 = 12.77, P = 3.84).
2- History: There were no significant difference between cases and controls as regards history of tonsillitis, presence of rheumatic fever, presence of rickets and features of anemia (X2 = 2.01, P = 3.84).
3- The Weight of the cases was ranged between 19-46 Kgm with a mean of 32.78.11 Kg while weight of subjects of the control group was ranged between 20-48 Kg with a mean of 33.678.5 Kg. There was no statistical significance difference between the weight of the subjects of the case and control groups (P = 0.654).
4- The length of subjects of the cases group was ranged between 112-146 Cm with a mean of 130.39.8 Cm while it was it ranged in the control group between 111-147 Cm with a mean of 130.210.8 Cm. There was no statistical significance difference between the length of the subjects of the case and control groups (P = 0.970).
5- The maximum arm circumference (MAC) ranged between 13-15 cm with a mean of 14.50.6 cm for group I and 13.5-15.5 cm with a mean of 14.50.5 cm for group II. There was no statistical significance difference between the groups (P = 0.346).
6- Anti-streptolysin O Titre (ASOT) ranged between 370-910 IU with a mean of 530.03149.8 IU for group I and decreased after three months to a mean of 422.6204.03. ASOT in group II ranged between 340 and 900 with a mean of 574.1155.5 and decreased after three months of vitamin-D administration to a mean of 233.670.15. There was a significant and marked decrease in the mean value of ASOT after three months in group I (P = 1.386) compared to no significant decrease in the mean value of ASOT in the control group II cases (P = 0.286).
7- ESR of the first hour in group I ranged between 15-56 mm with a mean of 38.910.33 mm while after three months of taking vitamin D supplements ESR ranged between 6-30 mm with a mean of 13.534.64 mm with a statistical significant difference between the mean values of ESR before and after three months of vitamin D intake (P = 0.470).
8- ESR of the second hour in group I ranged between 23-92 mm with a mean of 68.818.2 mm while after three months of taking vitamin D supplements the ESR of the second hour decreased significantly and ranged between 6-50 mm with a mean of 23.077.95 mm remaining still above the normal cut off level (P = 0.0218).
9- ESR of the first hour in group II ranged between 16-61 mm with a mean of 32.0312.13 mm while after three months of taking placebo ESR ranged between 9-63 mm with a mean of 29.5714.09 mm. with no statistical significant difference between the mean value of ESR in the first hour in control group whether at diagnosis or after three months of administration of placebo (P = 0.470).
10- ESR of the second hour in group II ranged between 32-92 mm with a mean of 62.6718.75 mm while after three months of taking placebo ESR of the second hour decreased slightly but insignificantly and ranged between 16-95 mm with a mean of 55.9323.09 mm remaining still above the normal cut off level (P = 0.220).
11- CRP values in group I was positive in intervention group, at diagnosis, twenty-six cases showed positive CRP values (26/30, 86.7%) while four cases showed negative CRP values (4/30, 13.3%). While after three months of vitamin-D supplementation, no case showed positive CRP values (0/30, 0.0%) and all cases showed negative CRP values (30/30, 100%), with a high statistical significance conversion of cases of positive CRP values to negative CRP values in the intervention group (X2 = 153.05, P = 3.84).
12- CRP values in group II was positive in (20/30, 66.7%) while ten subjects showed negative CRP values (10/30, 33.3%). After three months of giving placebo, 17 subjects out of the thirty subjects of the control group showed positive CRP values (17/30, 56.7%) while 13 subjects showed negative CRP values (13/30, 43.3%).
13- Echocardiographic examination findings did not reveal any statistically different changes in morphological or functional parameters of the heart before or after vitamin D intake.
It is concluded that vitamin D intake to children affected by recent RHD could have some beneficial effect on speeding up their recovery. However such findings require more extensive studies.