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Despite significant progress, deficiencies of iron and iodine remain major public health problems affecting > or =30% of the global population. These deficiencies often coexist in children. Recent studies have demonstrated that a high prevalence of iron deficiency among children in areas of endemic goiter may reduce the effectiveness of iodized salt programs. These findings argue strongly for improving iron status in areas of overlapping deficiency, not only to combat anemia but also to increase the efficacy of iodine prophylaxis. The dual fortification of salt with iodine and iron may prove to be an effective and sustainable method to accomplish these important goals.
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PMID:The influence of iron status on iodine utilization and thyroid function. 1660 28

In order to illustrate a particular circumstance of diagnosis of celiac disease, we report the case of 54-year-old women with a history of thyroid enlargement with normal thyroid function and positive anti-peroxidase antibodies. Immediately after total thyroidectomy with preservation of the parathyroid glands, she developed tetany with total serum calcium level at 50mg/l. Intravenous calcium infusion increased the calcium level and led to resolution of hypocalcemia-induced signs but there was no result when calcium and vitamin D were taken orally. The diagnosis of malabsorption was very probable in light of the family history of celiac disease, the anemia and the hypoalbuminemia. The diagnosis was confirmed by antibodies assay and endoscopy. The PTH level was less than 1 pg/l and radiography showed signs of hyperparathyroidism. Gluten-free diet, calcium and vitamin D led to an improvement of serum calcium.
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PMID:[Celiac disease revealed by hypocalcemia complicating total thyroidectomy: a case report]. 1707 43

A 52-year-old woman with diabetes mellitus (DM) complained of weakness of the arms and legs. She was referred to our hospital in November 2002 because of anemia, thyroid tumor and meningioma including DM. She was short in stature, juvenile bilateral cataract, intractable skin ulcers, clavus on the sole of her foot, a bird-like face and high-pitched voice. Typical physical features led to the final diagnosis of Werner's syndrome. Although the myelogram revealed no abnormal findings except erythroid hypoplasia, cytogenetic analysis of bone marrow cells showed deletion of chromosome 20 in 10% of the analyzed cells, which suggested the possibility of that myelodysplastic syndrome (MDS) or acute myeloblastic leukemia (AML) could occur. She had a thyroidectomy because both lobes of the thyroid gland were enlarged and caused hoarseness, In addition, it is common knowledge that the goiter could become malignant. We need to follow her carefully because she might be vulnerable to malignant disease, including leukemia and malignant meningioma.
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PMID:[A case of Werner syndrome with chromosomal abnormality]. 1707 96

Over a five-year period (September 1987 to August 1992), eight patients, one male and seven females, with a characteristics history of dysphagia due to cervical esophageal webs (Paterson-Brown Kelly syndrome) were encountered. The patients, all Arabs, comprised six Saudi females, one Yemeni female and an Eygptian male. All the patients, except two, were in middle age. The webs, single in five patients and multiple in three, and present at the levels of the 5th, 6th and 7th cervical vertebrae, were located in the anterior wall of the esophagus in four patients, circumferential-producing stenosis in three patients, while one patient with multiple webs had both types of location. Associated iron-deficiency anemia was present in all patients, three of them with evident koilonychia. One patient had associated nodular goiter and rheumatoid arthritis while another had a fatal complicating postcricoid carcinoma. The only male patient had associated ulcerative protocolitis. All seven patients without malignant complication of their webs had marked or total resolution of their dysphagia with iron therapy, pharyngoscopy/esophagoscopy, and dilatation. The Paterson-Brown Kelly syndrome of postcricoid dysphagia is discussed briefly.
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PMID:Paterson-Brown Kelly syndrome. 1737 8

Micronutrient malnutrition is a major health problem in China. According to a national nutritional survey, approximately 24% of all Chinese children suffer from a serious deficiency of iron (Fe) (anemia), while over 50% show a sub-clinical level of zinc (Zn) deficiency. More than 374 million people in China suffer from goiter disease, which is related to iodine (I) deficiency, and approximately 20% of the Chinese population are affected by selenium (Se) deficiency. Micronutrient malnutrition in humans is derived from deficiencies of these elements in soils and foods. In China, approximately 40% of the total land area is deficient in Fe and Zn. Keshan and Kaschin-Beck diseases always appear in regions where the soil content of Se in low. The soil-plant system is instrumental to human nutrition and forms the basis of the "food chain" in which there is micronutrient cycling, resulting in an ecologically sound and sustainable flow of micronutrients. Soil-plant system strategies that have been adopted to improve human micronutrient nutrition mainly include: (1) exploiting micronutrient-dense crop genotypes by studying the physiology and genetics of micronutrient flow from soils to the edible parts of crops; (2) improving micronutrient bioavailability through a better knowledge of the mechanisms of the enhancers' production and accumulation in edible parts and its regulation through soil-plant system; (3) improving our knowledge of the relationship between the content and bioavailability of micronutrients in soils and those in edible crop products for better human nutrition; (4) developing special micronutrient fertilizers and integrated nutrient management technologies for increasing both the density of the micronutrients in the edible parts of plants and their bioavailability to humans.
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PMID:Improving human micronutrient nutrition through biofortification in the soil-plant system: China as a case study. 1738 49

Micronutrient-deficiency control programs have been greatly extended at the national level in the last 10 to 15 years. However, rigorous evaluations of these are scarce, so that conclusions on impact are tentative and based mainly on indirect evidence. The coverage of vitamin A capsule distribution programs has exceeded 70% in most study countries. In countries implementing national iodized salt programs, the coverage reaches 60% to 90% of households with adequately iodized salt. Of the three micronutrients, coverage of iron tablet supplementation is the least well documented due to inadequate program monitoring systems and population survey data. Supplementation of preschool children 6 to 59 months of age with vitamin A capsules has plausibly contributed to the reduction in clinical vitamin A deficiency and its near-elimination in many countries. The impact of vitamin A capsule supplementation on children's biochemical vitamin A status (serum retinol) in national programs may be less. National data on salt iodization show a consistent relation to reduced prevalence of iodine-deficiency disorder symptoms (goiter); the rates of cretinism and other results of iodine deficiency are almost certainly falling too. The evaluation of the impact of salt iodization programs on biochemical iodine status is limited by a lack of data. Although trials have demonstrated the efficacy of iron supplementation in reducing the prevalence of anemia, the interpretation of national-level data is not so clear. Given the substantial financial and technical commitment required to implement national micronutrient-deficiency control programs, it is vital that investment enable the evaluation of the impact of these programs. It is becoming increasingly important to collect data on subclinical deficiency (e.g., biochemical data) to assess program impact.
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PMID:Lessons from successful micronutrient programs. Part III: program impact. 1801 68

We present a 10-year-old girl who presented to our emergency services with difficulty in breathing of 2-days duration and progressive weakness of a month's duration. In a previous admission elsewhere, she had not been detected to have hyperthyroidism or electrolyte abnormalities. On admission, the child was in hypercapnic respiratory failure with tachycardia and hepatomegaly. A small goiter as well as signs of thyrotoxicosis were present. Laboratory investigations showed anemia, mildly elevated liver enzymes and serum potassium of 4.8mEq/L. Despite intubation and ventilation and other supportive management including propranolol, the patient could not be saved. Post-mortem biopsy of the thyroid showed diffuse hyperplasia of the follicles and muscles showed evidence of thyroid myopathy.
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PMID:Fatal thyrotoxic periodic paralysis with normokalemia. 1805 90

Fortification is defined as adding of one or more essential elements to food article, regardless of whether it has been already added to food or not, in order to prevent or correct deficiency of one or more nutrients in the general population or specific population group. Food fortification with minerals and vitamins helps eliminate diseases such as goiter, rickets, beriberi, and pellagra. Significant results have been also achieved in prevention of anemia and vitamin A deficiency. The aforementioned deficiencies can be prevented and eliminated by means of appropriate and diverse nutrition and supplementation of deficient micronutrients, but on the national level, food fortification is the best solution. Two basic conditions for the application of fortification are the following: that the food article is in wide use and that it is cheap (available). The purpose of our paper was to show the results achieved by means of fortification in various countries in order to build up the basis for similar propositions in our country (Serbia and Montenegro). Owing to fortification in Asia, the number of cretinism cases has been reduced by half while sugar fortification significantly reduced the number of children with vitamin A deficiency. For more than 50 years, flour fortification with iron in order to prevent its deficiency and anemia, has been successfully applied in the United States and Canada, and as of recently in some countries of Africa and South America. The analysis of the results leads to the conclusion that food fortification has had beneficial health effects in the communities where it has been applied.
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PMID:[Application and significance of fortification in prevention of micronutrient deficiency-induced diseases]. 1817 65

Primitive tribal groups (PTGs) are the most marginalised and vulnerable communities in India. Clinico-epidemiological studies on morbidity patterns among the elderly primitive tribe members are essential to recommend special intervention programmes to improve the health of the elderly in these communities. A community-based cross-sectional study was carried out among the elderly populations of four different PTGs, namely Langia Saora (LS), Paudi Bhuiyan (PB), Kutia Kondh (KK) and Dongria Kondh (DK) living in the forests of Orissa, India. Clinical and anthropometric data were collected using standard methods and haemoglobin was estimated by the cyanomethaemoglobin method. The average number of illnesses per person was 3.0. Common disabilities like vision and hearing impairment and mobility-related problems were found in considerable numbers. Gastrointestinal problems like acid peptic disease were found among 2.6% to 20% of cases. Non-specific fever was marked in 10.2% to 24.2% of individuals. The iodine deficiency disorder, namely goitre, was found among 4.2% to 6.0% of individuals. Diseases of the respiratory tract, like upper and lower respiratory tract infection, asthma, tuberculosis and leprosy, were found in small numbers. The prevalence of hypertension among males and females was 31.8% and 42.2%, respectively. The LS had the highest prevalence of hypertension (63% among men and 68% among women). With regard to anaemia status, severe anaemia was marked in 70% of males and 76.7% of females in the LS, while in other groups the prevalence of severe anaemia ranged from 15% to 33%. Although the prevalence of severe anaemia in other tribal communities is lower than in the LS, mild to moderate anaemia was found to range from 60% to 80%. The present study revealed a high prevalence of physical disabilities with both non-communicable as well as communicable diseases among the elderly primitive tribal members. This warrants the implementation of a special health care strategy to reduce suffering at this crucial age and improve quality of life.
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PMID:Health status of the elderly population among four primitive tribes of Orissa, India: a clinico-epidemiological study. 1839 31

Four methods are recommended for assessment of iodine nutrition: urinary iodine concentration, the goitre rate, and blood concentrations of thyroid stimulating hormone and thyroglobulin. These indicators are complementary, in that urinary iodine is a sensitive indicator of recent iodine intake (days) and thyroglobulin shows an intermediate response (weeks to months), whereas changes in the goitre rate reflect long-term iodine nutrition (months to years). Spot urinary iodine concentrations are highly variable from day-to-day and should not be used to classify iodine status of individuals. International reference criteria for thyroid volume in children have recently been published and can be used for identifying even small goitres using thyroid ultrasound. Recent development of a dried blood spot thyroglobulin assay makes sample collection practical even in remote areas. Thyroid stimulating hormone is a useful indicator of iodine nutrition in the newborn, but not in other age groups. For assessing iron status, haemoglobin measurement alone has low specificity and sensitivity. Serum ferritin remains the best indicator of iron stores in the absence of inflammation. Measures of iron-deficient erythropoiesis include transferrin iron saturation and erythrocyte zinc protoporphyrin, but these often do not distinguish anaemia due to iron deficiency from the anaemia of chronic disease. The serum transferrin receptor is useful in this setting, but the assay requires standardization. In the absence of inflammation, a sensitive method to assess iron status is to combine the use of serum ferritin as a measure of iron stores and the serum transferrin receptor as a measure of tissue iron deficiency.
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PMID:Methods to assess iron and iodine status. 1859 85


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