Nutritional Deficiency Of Vitamin Research Articles

A case report on modern-day scurvy

Scurvy, from the Latin word scorbutus meaning to rupture or lacerate, refers to the clinical disease caused by nutritional deficiency of Vitamin C (Ascorbic acid), with characteristic mucocutaneous and mus- culoskeletal features. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Despite much decrease in prevalence, it still exists in developed countries. This case reports on an older male who presented with general lethargy, gum disease and easy bruising. His dietary history suggested global nutrient deficiency. Investigations excluded common causes of bleeding: trauma, coagulopathies, vasculitis, and malignancy. A low Vitamin C level confirmed the diagnosis of scurvy. This report serves to remind clinicians to consider scurvy as a possible working diagnosis in at-risk patients.

Антенатальна охорона плода (клінічна лекція)

The demographic situation in Ukraine indicates a deep demographic crisis. Although most couples want to have children, they often postpone this event to a later reproductive period. But no doubt every couple wants to have a healthy baby. An important measure to help women conceive and bear a healthy child is effective pre-pregnancy training to maintain and rehabilitate the reproductive health of the couple, with a special focus on preventing possible complications at the planning stage of pregnancy. Among the main factors influencing the health of the population, WHO identifies lifestyle. Therefore, already at the stage of planning a pregnancy, the important point is to give up bad habits, physical activity, nutrition and effective organization of sexual life. Nutritional deficiency of vitamins and traditional seasonality of nutrition in Ukraine often do not allow to ensure a full micronutrient status in the body of future parents, especially in the winter3spring period of the year. Therefore, the use of multivitamin complexes, including folic acid, is important for the people of Ukraine, both during pre-pregnancy preparation and during pregnancy, and then during lactation. In order to eliminate any pathology that may harm the expectant mother and her child, the couple must be rationally examined and rehabilitated during pre-pregnancy preparation. Also, expectant parents should avoid any harmful effects on their body, both at work and at home. Secondary prevention of morbidity and mortality of mother and child is early prenatal diagnosis, which is now actively developing in the world and in Ukraine. An equally important aspect of antenatal protection of the fetus is the formation of the psychological health of the future person. Therefore, the introduction of physiopsychoprophylactic training of each couple for the birth of a child with the involvement of perinatal psychologists is extremely important in modern conditions. No conflict of interest was declared by the authors. Key words: antenatal care of the fetus, pre-pregnancy training, primary and secondary prevention of congenital malformations, bad habits, pregnancy, fetal alcohol syndrome, nutrition during pregnancy, sex during pregnancy, perinatal fetal psychology.

The Association between Nutritional Alterations and Oral Lesions in a Pediatric Population: An Epidemiological Study.

The oral conditions of an individual are the result of different factors, including the subject's genotype, oral hygiene habits, the type of diet, and lifestyle, such as smoking. Nutrition in the first years of life can affect dental health for a long time. To prevent mouth diseases, it is also important to eliminate unfavorable eating behaviour and to amplify protective ones. Eating habits, especially in pediatric age, are an easily modifiable and controllable factor, and diet, in addition to influencing the health of the oral cavity, plays a fundamental role in systemic health. Indeed, a sugar-rich diet can lead to conditions, such as diabetes, being overweight, and obesity. The present research was an epidemiological study, with the aim of highlighting some of the associations between nutrition and oral health. In particular, we studied those lesions of hard and soft tissues that are diagnosed most frequently by dentists: caries, enamel hypoplasia, periodontal disease, and aphotoxic lesions and their associations with nutritional deficiencies and excesses including proteins, vitamin A, vitamin D, B vitamins, and iron and calcium minerals. To perform this study, we recruited 70 patients from the pediatric and orthodontic clinics, aged between 3 and 15 years (y), with mean age of 10.4 y.o. The study was conducted by providing a questionnaire to pediatric patients' (supported from their parents or guardians) on individual eating habits, followed by an accurate oral cavity specialistic examination. The nutritional data were processed by using Grana Padano Observatory (OGP) software, freely provided online by the OPG. The statistical tests performed were the chi-square (χ2) for independence, and Cramér's V test was used to evaluate the associations between eating habits and oral pathologies. The results showed that certain nutritional vitamin deficiencies and nutritional excesses were associated with definite oral pathologies.

SCURVY: A FORGOTTEN DISEASE LEADING TO WOUND INFECTION AND SEPTIC SHOCK

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Scurvy is a nutritional deficiency of Vitamin C, which is classically related to the ‘Age of Sail’ (1571-1862) and is considered a disease of developing countries. Here we report a patient admitted to intensive care unit (ICU) for wound infection leading to septic shock who was later diagnosed with scurvy. CASE PRESENTATION: A 63-year-old female, resident of a nursing home, having a past medical history significant for ischemic stroke with right sided residual weakness, non-verbal since her stroke for the past ten years, deep vein thrombosis on anticoagulation, was brought to the hospital for worsening encephalopathy. Her blood pressure on arrival was 80/50 mmHg, with rest of the vitals being normal. On examination, she was somnolent, having poor dental hygiene, widespread scattered petechiae on the skin, stage 3 wound on the lower back with foul smelly discharge, cold extremities with good capillary refill while having normal cardiopulmonary and abdominal examination. Lab work showed stage 2 acute kidney injury (Creatinine 1.5 mg/dl from baseline 0.7 mg/dl), sodium 154 mmol/L, INR 8.3, macrocytic anemia with hemoglobin 7.6 g/dl (baseline >10 g/dl), platelet count 37,000 K/uL (baseline >150 K/uL). CT scan of head was negative for any new or acute intracranial pathology. She was managed as per sepsis guidelines requiring blood cultures, appropriate fluid resuscitation, broad spectrum antibiotics with suspected source of sepsis being the wound infection. She required hemodynamic support with vasopressors for hypotension and was admitted to ICU. Vitamin C level was checked considering her poor dental hygiene, scattered petechiae, which came back as undetectable. She was started on optimal replacement of Vitamin C which resulted in gradual improvement of her petechiae, wound and notably her thrombocytopenia completely resolved within a week of initiation of Vitamin C. DISCUSSION: Vitamin C is essential in collagen synthesis, helping in keeping our gums, skin, bone and hair healthy. Moreover, it plays role in prostaglandin metabolism thus potentially decreasing the inflammation or even sepsis. Although considered rare nowadays, scurvy or other nutritional deficiencies can be seen in elderly population, especially people from nursing home or poor socioeconomic status. Such population is at higher risk of getting worse wounds which could result in fatal sepsis or septic shock. CONCLUSIONS: Though rare, scurvy must be kept in the differentials as it carries a higher risk of septic shock which can be fatal if not timely diagnosed and treated. Reference #1: Svirbely, J.L. and A. Szent-Gyorgyi, The chemical nature of vitamin C. Biochem J, 1933. 27(1): p. 279-85. Reference #2: Ma, N.S., C. Thompson, and S. Weston, Brief Report: Scurvy as a Manifestation of Food Selectivity in Children with Autism. J Autism Dev Disord, 2016. 46(4): p. 1464-70. DISCLOSURES: No relevant relationships by Yahya Ahmad, source=Web Response No relevant relationships by Shujaa Faryad, source=Web Response No relevant relationships by Usama Talib, source=Web Response

Circadian rhythms of locomotor activity and hippocampal clock genes expression are dampened in vitamin A–deficient rats

The main external time giver is the day-night cycle; however, signals from feeding and the activity/rest cycles can entrain peripheral clocks, such as the hippocampus, in the absence of light. Knowing that vitamin A and its derivatives, the retinoids, may act as regulators of the endogenous clock activity, we hypothesized that the nutritional deficiency of vitamin A may influence the locomotor activity rhythm as well as the endogenous circadian patterns of clock genes in the rat hippocampus. Locomotor activity was recorded during the last week of the treatment period. Circadian rhythms of clock genes expression were analyzed by reverse transcription–polymerase chain reaction in hippocampus samples that were isolated every 4 hours during a 24-hour period. Reduced glutathione (GSH) levels were also determined by a kinetic assay. Regulatory regions of clock PER2, CRY1, and CRY2 genes were scanned for RXRE, RARE, and RORE sites. As expected, the locomotor activity pattern of rats shifted rightward under constant dark conditions. Clock genes expression and GSH levels displayed robust circadian oscillations in the rat hippocampus. We found RXRE and RORE sites on regulatory regions of clock genes. Vitamin A deficiency dampened rhythms of locomotor activity as well as modified endogenous rhythms of clock genes expression and GSH levels. Thus, vitamin A may have a role in endogenous clock functioning and participate in the circadian regulation of the cellular redox state in the hippocampus, a peripheral clock with relevant function in memory and learning.

Rickets: Part I

Rickets is characterized by impaired mineralization and ossification of the growth plates of growing children caused by a variety of disorders, the most frequent of which is nutritional deficiency of vitamin D. Despite ample knowledge of its etiology and the availability of cost-effective methods of preventing it, vitamin D deficiency rickets remains a significant problem in developing and developed countries. This two-part review covers the history, etiology, pathophysiology and clinical and radiographical findings of vitamin D deficiency rickets. Other less frequent causes of rickets and some of the disorders entering into the differential diagnoses of rickets are also considered. Controversial issues surrounding vitamin D deficiency include determination of what constitutes vitamin D sufficiency and the potential relationship between low levels of vitamin D metabolites in many individuals and unexplained fractures in infants.

Early Animal Models of Rickets and Proof of a Nutritional Deficiency Hypothesis

In the period between 1880 and 1930, the role of nutrition and nutritional deficiency as a cause of rickets was established based upon the results from 6 animal models of rickets. This greatly prevalent condition (60%-90% in some locales) in children of the industrialized world was an important clinical research topic. What had to be reconciled was that rickets was associated with infections, crowding, and living in northern latitudes, and cod liver oil was observed to prevent or cure the disease. Several brilliant insights opened up a new pathway to discovery using animal models of rickets. Studies in lion cubs, dogs, and rats showed the importance of cod liver oil and an antirachitic substance later termed vitamin D. They showed that fats in the diet were required, that vitamin D had a secosteroid structure and was different from vitamin A, and that ultraviolet irradiation could prevent or cure rickets. Several of these experiments had elements of serendipity in that certain dietary components and the presence or absence of sunshine or ultraviolet irradiation could critically change the course of rickets. Nonetheless, at the end of these studies, a nutritional deficiency of vitamin D resulting from a poor diet or lack of adequate sunshine was firmly established as a cause of rickets.

Bariatric surgery: a cost-effective intervention for morbid obesity; functional and nutritional outcomes

Obesity has been described as the health crisis of the 21st century. It is a chronic lifelong medical condition, whose pattern often starts in childhood, and is demographically worsening in every developed country. The cost of treating the many medical conditions associated with obesity threatens to overwhelm healthcare resources. Medical treatments produce at most no more than 10% weight loss in the severely obese, with high failure rates. In this article, we review the available evidence regarding long-term reduction in weight, reduced mortality and improvement in most, if not all, obesity-related comorbidities. There is a need for daily multivitamins and extra minerals, especially with gastric bypass, and nutritional deficiencies of vitamins D and B12, Ca, Fe and folate need monitoring and prevention. Currently there is no medical therapy on the near horizon that will match the effect of surgery, which, if done safely, remains the only effective therapy. Bariatric surgery is cost effective, and health providers should embrace the development and rapid expansion of services.

Nutritional Deficiency of Selenium Secondary to Weight Loss (Bariatric) Surgery Associated with Life-Threatening Cardiomyopathy

Nutritional deficiencies of vitamins and minerals have been associated with reversible and irreversible cardiomyopathic processes. Selenium deficient dilated cardiomyopathy, first described in 1935 in the Keshan Province of China, was sometimes reversed with selenium supplementation. In the past three decades, selenium deficient cardiomyopathy has re-emerged in western medicine secondary to gastrointestinal disorders, long-term total parenteral nutrition (TPN) and gastrointestinal surgery. This report describes a case of selenium deficient cardiomyopathy secondary to the bariatric (weight loss) surgical operation bilio-pancreatic diversion (Scopinaro procedure). This patient presented with life-threatening heart failure nine months after this surgery, having lost 100 kg of body weight. Multiple nutritional deficiencies were detected and corrected including severely depleted selenium levels. Cardiac function and the clinical scenario improved dramatically over three weeks. Screening patients at risk of malnourishment for selenium deficiency as a potential cause of cardiomyopathy is indicated.

Role of the vitamin D-endocrine system in the pathophysiology of postmenopausal osteoporosis.

Impaired calcium absorption and impaired adaptation to a low calcium diet are common features of aging in women and these processes are even more severely impaired in patients with osteoporotic fractures. The calcium absorption defects are associated with several abnormalities of the vitamin D-endocrine system including secondary hyperparathyroidism, intestinal resistance to 1,25-dihydroxyvitamin D (1,25(OH)(2)D) action, decreased 1,25(OH)(2)D production due to impaired 25(OH)D 1alpha-hydroxylase activity, and, in some elderly persons, nutritional deficiency of vitamin D. However, in postmenopausal women, most of these abnormalities are normalized by administration of physiologic replacement dosages of estrogen and, thus, appear to be secondary consequences of estrogen deficiency. Nonetheless, a minority of them, especially nutritional vitamin D deficiency and impaired 25(OH)D 1alpha-hydroxylase activity late in life, appear to be primary and are independent of estrogen deficiency.

Retinol status of newborn infants with congenital diaphragmatic hernia.

The etiology of congenital diaphragmatic hernia (CDH) is not yet known. Studies in the literature from 1941 have reported that nutritional deficiency of vitamin A during pregnancy could lead to CDH, associated or not with other malformations in young rats. More recently, possible correlations between expression patterns of cellular retinoid-binding protein and retinoic-acid receptors and morphologic effects of vitamin A deficiency have been suggested. The purpose of this study was to verify in human newborns the possible link between vitamin A deficiency and CDH previously observed in experimental animals. Blood samples were obtained during the first hours after birth from 11 term CDH newborns and 11 healthy controls matched for gestational age, and also from 7 mothers in each group, for a total of 7 newborn-mother pairs of matched CDH-controls. Plasma retinol was measured by high-performance liquid chromatography and retinol-binding protein (RBP) by nephelometry. In the 11 matched CDH-control newborns, plasma retinol and RBP levels in CDH newborns were 50% less than control values (P< 0.0002 and <0.006, respectively); in contrast, retinol levels in CDH mothers were significantly higher than those of control mothers (P < 0.005). The observation that the plasma concentrations of retinol and RBP are low in infants with CDH relative to controls may be clinically very relevant and may help to elucidate the mechanism of development of this congenital anomaly.

Retinal degeneration associated with vitamin E deficiency in hunting dogs

Nutritional deficiency of vitamin E in dogs can lead to oxidative damage and degeneration of the photoreceptors of the retina. Clinical and pathologic changes associated with vitamin E deficiency in dogs are similar to those described for central progressive retinal atrophy and equine lower motor neuron disease, which suggests that these diseases share a common pathogenesis.

Homocysteine as a risk factor for cardiovascular disease

Homocysteine is an amino acid that appears to damage the vascular endothelium and promote thrombosis. The most frequent causes of hyperhomocyst(e)inemia are the inherited defect of the enzyme cystathinonine B-synthase and nutritional deficiency of vitamin B 12 or folate. Hyperhomocyst(e)inemia is associated, perhaps causally, with atherosclerotic vascular disease. Interactions with risk factors such as cigarette smoking, hyperlipidemia, and hypertension are possible, but not yet defined. Dietary supplementation with vitamin B 12, folate, and other substances can reduce homocysteine levels. Such simple measures may reduce the risk of vascular disease in hyperhomocyst(e)inemic subjects.

Some aspects of thymine biosynthesis in Ochromonas malhamensis

The donor of the 5-methyl group of thymine in the protozoan, Ochromonas malhamensis, was found to be N 5,N 10-methylene-tetrahydrofolate. N 5-methyl-tetrahydrofolate was not a methyl donor for this reaction. The incorporation of label from N 5,N 10-methylene-C 14-tetrahydrofolate into thymine derivatives was found to proceed in a nutritional deficiency of vitamin B 12, but was greatly decreased in the presence of B 12-anilide, a vitamin B 12 antagonist. Dimethylbenzimidazolylcobamide coenzyme prevented a large part of the decrease in incorporation of label due to the anilide, and cyanocobalamin was slightly effective. Adenylcobamide coenzyme decreased thymine synthesis further. Evidence was obtained for an alternate pathway of thymine biosynthesis operating through a compound tentatively identified as a 5-methyl-cytosine derivative. This pathway was not inhibited by B 12-anilide, but extracts from B 12-deficient cells caused marked increases in incorporation of label on addition of dimethylbenzimidazolylcobamide coenzyme.