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The concept of risk in the field of avitaminoses is very important and useful for the practitioner, who should consider two aspects: a) risk factors, which could be individual (physiological, pathological and psychological) and extra-individual (alimentary, environmental, etc.); b) subjects with an elevated risk of avitaminosis (childhood, old age, pregnancy, etc.). In these subjects the risk can be a generical one, when there is an elevated requirement for all vitamins (nursing women, sportmen, etc.) or a specific one, when there is a high requirement only for a single vitamin (osteomalacia, some professional diseases, use of oral contraceptives) or a vew of them (alcoholism, diabetes, etc.). On the basis of this kind of knowledge it is easy for the practitioner to estimate which vitamins are necessary for each subject or for a group of subjects in physiological or in pathological conditions. For example, there is an elevated risk of apyridoxinosis in old age (acalciferolosis in aged women), of athiaminosis and apyridoxinosis in diabetes, of apyridoxinosis in oral contraceptives users, of axeroftolosis in hyperthyroidism, of athiaminosis, apyridoxinosis, aniacinosis and anascorbosis in alcoholics. In the second chapter the concept of the latency period in avitaminosis is illustrated. This period corresponds to the interval between the moment when deficiency stimulus starts operating and the moment when its effect, that is the picture of avitaminosis, appears. The latency time is not measurable, on account of the difficulties in establishing the onset of the deficiency stimulus; generally it is very long and is followed by the period of biochemical symptomatology and subsequently by the one of clinical symptomatology. Each of these three phases can be further divided in several steps, which have summarized in a Table. The last chapter is dedicated to the classification of avitaminoses. From the etiopathogenetic point of view avitaminoses can be due to: a) deficiency of introduction (alimentary level)); b) deficiency of absorption (enteric level); c) deficiency of utilization (tissue level). From the clinical point of view avitaminoses can be distinguished in deficiency with: a) a complete clinical symptomatology (scurvy, beriberi, pellagra, rickets, osteomalacia, xerophthalmia, hemeralopia); b) an incomplete clinical symptomatology (mono- or oligo-symptomatic or partial clinical picture); c) a biochemical symptomatology only (subclinic or clinically asymptomatic picture).
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PMID:[Vitaminology for practitioners. II. Avitaminoses, risk, latency period, classification]. 58 76

Health is often seen in strip cartoons (SCs). However, its images convey their own properties. SCs are distributed globally. They are produced in Algiers, Dakar, and Bangui. The SC generally goes from humor to adventure stories. Health enters SCs in 3 ways: 1) the portrayal of life styles; 2) health as a suspenseful element; and 3) medical adventures emphasizing a doctor. Adventure stories with doctors for heroes are common. WHO is the basis for many SCs. Humor and adventure are the 2 basic themes in SCs; they are not mutually exclusive. 1 way that SCs portray health is the "stretched-out time of soap opera." These are stories of poor, talented doctors and devoted nurses. The SC is a graphic expression of world concerns. Healthy or unhealthy life styles may be seen in SCs. Food, tobacco, and alcohol are just parts of a story. Positive heroes are never alcoholics, because alcoholism is a potential vice. Habitual drinkers are usually secondary characters. Early in the 20th century, tobacco played a big role in developing SCs in Mexico. Breaking society's rules for a healthy life style leads to all kinds of consequences in SCs. There was no educational intent to having Popeye eat spinach. Spinach contains iron and is associated with strength. Scurvy is an enemy of many sailors, and this shows up in SCs on disease. It alternates with cholera as an element of adventure in sea stories. An imaginative story devoted to health education shows a medical and social confrontation with naval captains who are not too bright. SCs are neither good nor bad in themselves.
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PMID:Health in strip cartoons. 220 36

We report the case of a 82-year-old man, living in institution, hospitalized for a severe anaemia due to scurvy. Scurvy is rare in Occident. A multifactorial anaemia is usually associated with scurvy, but is rarely symptomatic. Alcoholism favours scurvy and anaemia. Treatment consisted of parenteral vitamin C supplementation associated with blood transfusion.
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PMID:[Vitamin C deficiency: a rare cause of poorly tolerated severe anemia]. 801 77

Mucocutaneous changes occur in vitamin deficiency states and may be helpful in clinical diagnosis of the underlying disease. Substitution and therapy with vitamins can also cause skin problems, which may be of allergic of nonallergic origin. The skin and mucosal changes in pellagra and scurvy can be diagnostic; however, in other vitamin deficiencies, skin signs are rather unspecific. In most cases combined vitamin deficiencies occur that result in polymorphic and nonspecific mucocutaneous signs. Vitamin deficiencies are due to malnutrition, malabsorption or genetic defects. In industrialized countries alcoholism and gastrointestinal disorders are the main cause of vitamin deficiencies. Alcoholics or patients with malabsorption syndrome suffering from seborrheic dermatitis-like or ichthyosiform-like eruptions should be investigated for vitamin deficiency. Laboratory analysis of blood and urine vitamin levels can be misleading because of the poor correlation with tissue vitamin concentrations. Rapid clinical improvement following vitamin substitution frequently confirms the clinical diagnosis. In this overview we describe mucocutaneous signs of vitamin deficiencies. Excellent reviews of this topic are recommended for further reading [1-5].
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PMID:[Vitamins and skin]. 807 86

Scurvy has been known since ancient times, but the discovery of the link between the dietary deficiency of ascorbic acid and scurvy has dramatically reduced its incidence over the past half-century. Sporadic reports of scurvy still occur, primarily in elderly, isolated individuals with alcoholism. The incidence of scurvy in the pediatric population is very uncommon, and it is usually seen in children with severely restricted diets attributable to psychiatric or developmental problems. The condition is characterized by perifollicular petechiae and bruising, gingival inflammation and bleeding, and, in children, bone disease. We describe a case of scurvy in a 9-year-old developmentally delayed girl who had a diet markedly deficient in vitamin C resulting from extremely limited food preferences. She presented with debilitating bone pain, inflammatory gingival disease, perifollicular hyperkeratosis, and purpura. Severe hypertension without another apparent secondary cause was also present, which has been previously undescribed. The signs of scurvy and hypertension resolved after treatment with vitamin C. The diagnosis of scurvy is made on clinical and radiographic grounds, and may be supported by finding reduced levels of vitamin C in serum or buffy-coat leukocytes. The response to vitamin C is dramatic. Clinicians should be aware of this potentially fatal but easily curable condition that is still occasionally encountered among children.
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PMID:An orange a day keeps the doctor away: scurvy in the year 2000. 1153 73

Scurvy is a set of clinical manifestations characterized by general weakness, anemia, gingivitis and cutaneous bleeding, caused by a lack of ascorbic acid in the diet. This pathology is currently a clinical rarity, although it can still be seen in cases of malnutrition associated with alcoholism or with dietary deficiencies, especially in childhood and old age. We present the case of a 45-year-old male who consulted his physician because of lower limb edema with follicular purpura, accompanied by asthenia, polyarthralgia and bleeding gums. After treatment with 1 g/day of vitamin C was initiated, the patient's symptoms quickly improved. The diagnosis of scurvy was based on the patient's clinical symptoms, dietary history and the rapid resolution of the symptoms when vitamin C supplements were initiated.
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PMID:[Scurvy: follicular purpura as a diagnostic sign]. 1647 64

Scurvy is a dietary disease due to Vitamin C deficiency. Vitamin C is related to collagen synthesis and metabolism. Malnutrition, problems in bowel absorption, alcoholism and cerebral palsy are clearly often linked with scurvy, even it is no more common in the industrialized countries. Its clinical features are: asthenia, weight loss, appetite decrease, irritability, gingival or mucous lesions, porpora, follicular hyperkeratosis, musculoskeletal pain due to multiple fractures and subperiosteal bleedings, pseudoparalisis (frog-like position of legs) and refuse to walk. Authors report on a nine year-old girl with spastic quadriplegic cerebral palsy, who at the first examination showed deep anemia, fever and multiple epiphyseal separation of the right shoulder and the left knee. Diagnosis of scurvy was been made. The aim of this article was to underline the rarity and gravity of this disease, and its even more frequent appearance in children affected of cerebral palsy. Substitutive therapy consists on ascorbic acid supplementation. Complete restitutio ad integrum of skin-mucous injuries, such as gingival bleedings, was achieved within three months.
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PMID:[Multiple epiphyseal separations in a child with cerebral palsy and scurvy]. 1975 53

Scurvy, a severe form of vitamin C deficiency, killed scores of people until its cause and treatment were firmly established at the end of the eighteenth century. Since then, cases have surged periodically around the world, mostly in developing countries and during times of war and famine. In developed countries, scurvy is still endemic and evidence is growing that vitamin C deficiency might affect up to 30 percent of the population. Low socio-economic status, alcoholism, severe psychiatric illness leading to poor nutrition and critical illness are significant risk factors. We hereby report the case of a patient admitted in a Swiss intensive care unit of a tertiary teaching hospital and presenting with clinical signs and symptoms of severe vitamin C deficiency.
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PMID:Severe vitamin C deficiency in a critically ill adult: a case report. 2354 2

Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2-3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment.
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PMID:Scurvy in an alcoholic patient treated with intravenous vitamins. 2472 89

Scurvy in modern times may not be as rare as previously thought. The link between adequate intake of vitamin C and scurvy has been known since ancient times and is recorded in Ebers Papyrus. Recent reports indicate that, with restricted diets, vitamin C deficiency is being seen in infants exclusively fed plant-based formula and children with oral aversion, autism, restricted diets, and cerebral palsy. Additional at-risk groups include the older adults and patients having alcoholism. Often costly, emergency department visits and elaborate diagnostic studies lead to fruitless results when a simple diet history is often overlooked. Here, we report a case of pediatric scurvy in an 11-year-old autistic child with a restricted diet who presented with refusal to walk, fatigue, a purpuric rash, and gingival bleeding. The diagnosis was made based on diet history, physical examination findings, and symptom resolution with vitamin C supplementation. Our case report reaffirms that vitamin C deficiency still occurs and should be considered in children with restrictive diets. Early recognition of this disease by physicians provides early diagnosis, avoids costly diagnostic workup and hospitalization, and expedites effective treatment.
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PMID:Do You C What I C: Emergency Department Evaluation and Diagnosis of Pediatric Scurvy in an Autistic Child With a Restricted Diet. 2936 63


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