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Familial Pellagra-Like Skin Rash with Neurological Manifestations
Arch Dis Child: first published as 10.1136/adc.56.2.146 on 1 February 1981. Downloaded from 146 Freundlich, Statter, and Yatziv Familial pellagra-like skin rash with neurological manifestations E FREUNDLICH, M STATTER, AND S YATZIV Department ofPaediatrics, Government Hospital, Nahariya, Israel, and Paediatric Research Unit and Department ofPaediatrics, Hadassah University Hospital, Jerusalem, Israel development was normal, although the skin rash SUMMARY A 14-year-old boy of Arabic origin was noted several times. On one occasion a skin presented with a pellagra-like rash and neurological biopsy was performed and reported to be compatible manifestations including ataxia, dysarthria, nystag- with pellagra. A striking improvement was again mus, and coma. There was a striking response to oral noticed after nicotinamide administration. nicotinamide. The laboratory findings were not The last admission was at age 14 years in late typical of Hartnup disease: aminoaciduria and November (as were all previous admissions). At indicanuria were absent and there was no evidence this time, he presented with mild confusion, diplopia, of tryptophan malabsorption. Tryptophan loading dysarthria, ataxia, and a pellagroid skin rash. His did not induce tryptophanuria nor did it increase general condition deteriorated during the next few excretion of xanthurenic or kynurenic acids. These days; he became unable to walk or stand, and both findings support the possibility of a block in trypto- horizontal and vertical nystagmus were observed. phan degradation. The family history suggests a He became apathetic and entered into deep coma genetically-determined disorder. 4 days after admission. The electroencephalogram showed a markedly abnormal tracing with short We report a patient with familial pellagra-like skin bursts of high voltage 2 5 per second activity with manifestations and laboratory rash, with neurological superimposed sharp waves, mainly over the posterior copyright. -
THE PATHOLOGIC PHYSIOLOGY of PELLAGRA: V. the Circulating Blood Volume
THE PATHOLOGIC PHYSIOLOGY OF PELLAGRA: V. The Circulating Blood Volume Roy H. Turner J Clin Invest. 1931;10(1):111-120. https://doi.org/10.1172/JCI100332. Find the latest version: https://jci.me/100332/pdf THE PATHOLOGIC PHYSIOLOGY OF PELLAGRA V. THE CIRCULATING BLOOD VOLUME By ROY H. TURNER (From the Department of Medicine, Tulane University of Louisiana School of Medicine, and the Medical Services of the Charity Hospital, New Orleans) (Received for publication October 27, 1930) Determination of circulating blood volume was undertaken as a part of a study of the disturbed physiology in pellagra, chiefly for the purpose of finding out whether shrinkage of plasma volume existed in patients who were suffering from a disease frequently characterized by severe diarrhea. Such a shrinkage would be of great importance of itself, and would obviously have a bearing upon the interpretation of the composition of the plasma determined at the same time. The existence of anemia can hardly be established nor its severity estimated -so long as we are in ignorance- of the plasma volume. It was also considered possible that the magnitude of the circulating blood volume might be correlated with certain of the features of the skin lesions, such as the degree of exudation of serum. I have used the dye method of Keith, Rowntree and Geraghty (1) modified as follows: A 3 per cent aqueous solution of brilliant vital red (National Analine Company) was made up 'the afternoon before use, and sterilized at 100°C. for 8 minutes. With a sterile calibrated pipette the quantity of this solution for each patient was placed in a sterile 50 cc. -
Malnutrition Characteristics: Application in Practice
1 2 Objectives 1. Describe the practical steps for determining a patient’s/resident’s malnutrition etiology. 2. List the six malnutrition criteria and outline processes for their identification in specific patients/residents. 3. Discuss inclusion of the malnutrition criteria in the nutrition care process and medical record documentation. 3 Malnutrition – Not a New Issue PERCENTAGE OF WEIGHT LOSS: BASIC INDICATOR OF SURGICAL RISK IN PATIENTS WITH CHRONIC PEPTIC ULCER HIRAM O. STUDLEY (Studley, JAMA, 1936) Malnutrition Is Common in 4 US Hospitalized Patients % Malnutrition* in Hospital-Admitted Patients Hospital Specialty # Pts Malnourished Pts Boston, MA1 General 251 44% Birmingham, AL2 General 134 48% Multiple V.A. sites3 General 2,448 39% Boston, MA4 Pediatric 224 25% Syracuse, NY5 ICU 129 43% Chicago, IL6 General 404 54% Chicago, IL7 ICU 57 50% Chicago, IL8 ICU >65 260 34% General Pennsylvania 9 and ICU 274 32%/44% * (1. Blackburn et al, 1977; 2. Weinsier et al, 1979; 3. VA Study 1991; 4. Hendricks et al, 1995; 5. Giner et al, 1996; 6. Braunschweig et al, 2000; 7. Sheehan et al, 2010; 8. Sheehan et al, 2013.; 9. Nicolo et al, 2014) 5 Malnutrition Prevalence • General patient population – Braunschweig, et al, 2000 – Observational/retrospective • Patients with LOS > 7 days (n=404) • Nutrition assessment via SGA – Within 72 hrs of admission and at discharge Normally Nourished Moderately Severely (SGA-A) Malnourished (SGA-B) Malnourished SGA-C 46% (n=185) 31% (n=125) 23% (n=94 ) (Braunschweig et al, J Am Diet Assoc, 2000) 6 Nutritional Change -
Reference Charts for Nutrition Diagnosis and Protocol
Nutrition Care Process NUTRITION CARE AND TREATMENT Nutrition Care Components Key Information Process Nutritional Medical, nutrition and social Information about current/recent illnesses and medications, past medical and Integrating Nutrition Interventions in Care and Treatment: The Screening and history surgical interventions and dietary intakes in last 1 month. Probe for recent roles of the Comprehensive Care Team Assessment unexplained weight loss (3 months), food insecurity2 and barriers to food intake such as illnesses of the digestive system and psychosocial factors, and food allergies. Anthropometric and Accurately measure the client’s weight in kg (use a regularly calibrated scale) and functional impairment height in cm. Mid upper circumference measurement is used for screening those at assessment risk in community settings and in assessment of maternal nutrition in pregnant women. Waist and hip measurements are also necessary in assessing changes in body shape and over nutrition. Muscle strength using the grip strength tester and level of functional impairment eg Clinical Staff 3 Hand grip test, Karnofsky Performance status scale . (Doc tors, Laboratory assessment Laboratory based testing target s biochemical markers and haematology. Anaemia , nurses, etc) vitamins and minerals correlate with nutrition status and disease progression 4 Spouse / (deficiency, normal, overload). Social worker Partner Nutritional Protein energy malnutrition Severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) with 5 Diagnosis1 (Under nutrition/wasting) medical complications and or not able to feed orally, refer for inpatient care . Severe acute malnutrition and moderate acute malnutrition without medical complications. (Other forms include stunting and underweight in children5) Over nutrition Over weight and obese. Micronutrient deficiency Vitamin and mineral deficiency diseases and disorders e.g. -
Definition and Comparability
2.5. ADULT MALNUTRITION (UNDERWEIGHT AND OVERWEIGHT) Poor nutrition intake among adults, leading to either face a double burden of under- and overnutrition occurring underweight or overweight, is closely associated with ill simultaneously among different population groups. health. More than one-third of all deaths worldwide are due The prevalence of overweight is growing rapidly in the to ten main risk factors, and seven of these are related to Asia/Pacific region (Figure 2.5.2). Since 1990, the share of nutrition (WHO, 2002b). overweight people has increased by about 5% for both male In developing countries, underweight is the risk factor and female populations on average in Asian countries. The most closely associated with early death. Undernutrition in speed was much slower but the share has also grown at 3% pregnant women also leads to low birthweight babies (see for men and 4% for women in OECD countries during the Indicator 2.2 “Preterm birth and low birthweight”). Social same period. determinants of health such as poverty, inadequate water However, up to now, obesity is still more prevalent in and sanitation, and inequitable access to education and OECD countries than in countries in Asia, but a sizeable health services underlie malnutrition. A key driver of the share of overweight adults is obese in the several countries increasing obesity epidemic is a changing food environ- of the Pacific (Figure 2.5.3). In developing countries obesity ment, in which nutrient poor and energy dense processed is more common among people with a higher socioeco- foods are readily available and often cheaper than healthier nomic status, those living in urban regions and middle- alternatives. -
Malnutrition by Litsa Georgakilas, RD LDN CNSC Overview
Malnutrition By Litsa Georgakilas, RD LDN CNSC Overview How is malnutrition defined? Malnutrition diagnosis ASPEN guidelines Contacting a dietitian Malnutrition: Did you know... • 1 in 3 patients are malnourished on admission • Patients diagnosed with malnutrition have a 3 times longer LOS • Surgical patients with malnutrition have a 4 times higher risk of pressure ulcer development • The annual burden of disease-associated malnutrition across 8 diseases in the U.S. is $156.7 billion What is malnutrition? “An acute, subacute or chronic state of nutrition in which a combination of varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function.” – American Society of Parenteral Enteral Nutrition Who is at risk? Adults should be considered at risk if they have any of the following: • Involuntary loss or gain within 6 months • Body mass index less than 18.5 kg/m2 or greater than 25 kg/m2 • Chronic disease • Increased metabolic requirements • Modified Diet • Inadequate nutrition intake, including not receiving food or nutrition products for greater than 7 days Malnutrition Diagnoses ● Involves: ○ Knowledge about the needs of the population and individual patient ○ Clinical judgement ○ Evidence-based practice ○ Nutrition standards Malnutrition Etiologies • Social/ Environmental Circumstances – Chronic starvation without inflammation (access to food is limited, ex. Anorexia nervosa, physical conditions) • Chronic Illness – mild- moderate inflammation -
Malnutrition Rates in Children Under 5 Years NUTRITION Malnutrition Rates in Children Under 5 Years
MALnutRitiON rates in children under 5 years NUTRITION Malnutrition rates in children under 5 years In Nigeria, 37 per cent of children, or 6 million children, are stunted (chronically malnourished or low height for age), more than half of them severely. In addition, 18 per cent of children suffer from wasting (acutely malnourished or low weight for height), half of them severely. Twenty-nine per cent of children are underweight (both acutely and chronically malnourished or low weight for age), almost half of them severely. Stunting prevalence remained relatively stable between 2007 and Trends in wasting (low weight for height) prevalence 2013, whereas wasting has increased significantly, from 10 per cent (MICS 2007, MICS 2011 and DHS 2013) in 2011 to 18 per cent in 2013. Although underweight rates were stable between 2007 and 2011 at around 25 per cent, the rate increased slightly to 29 per cent in 2013. Trends in malnutrition rates Nigeria West and World1 Central Africa Stunting 37% 36% 25% Underweight 29% 23% 15% Wasting 18% 11% 8% Disparities in malnutrition related to various background Source: UNICEF State of the World’s Children Report 2015 characteristics are significant in Nigeria, but are often more pronounced for stunting. Children from rural areas are almost twice as likely to be stunted than children from urban areas. Trends in stunting (low height for age) prevalence A child whose mother has no education is four times more likely (MICS 2007, MICS 2011 and DHS 2013) to be stunted than a child whose mother has secondary or higher education. Children from the poorest 20 per cent of households are also four times more likely to be stunted than children from the wealthiest 20 per cent of households. -
Nutritional Dermatoses in the Hospitalized Patient
HOSPITAL CONSULT IN PARTNERSHIP WITH THE SOCIETY FOR DERMATOLOGY HOSPITALISTS Nutritional Dermatoses in the Hospitalized Patient Melissa Hoffman, MS; Robert G. Micheletti, MD; Bridget E. Shields, MD Nutritional deficiencies may arise from inadequate nutrient intake, abnormal nutrient absorption, or improper nutrient PRACTICE POINTS utilization.4 Unfortunately, no standardized algorithm for • Nutritional deficiencies are common in hospitalized screening and diagnosing patients with malnutrition exists, patients and often go unrecognized. making early physical examination findings of utmost • Awareness of the risk factors predisposing patients importance. Herein, we present a review of acquired nutri- to nutritional deficiencies and the cutaneous manifes- tional deficiency dermatoses in the inpatient setting. tations associated with undernutrition can promote copy early diagnosis. Protein-Energy Malnutrition • When investigating cutaneous findings, undernutri- tion should be considered in patients with chronic Protein-energy malnutrition (PEM) refers to a set of infections, malabsorptive states, psychiatric illness, related disorders that include marasmus, kwashiorkor and strict dietary practices, as well as in those using (KW), and marasmic KW. These conditions frequently are certain medications. seen in developing countries but also have been reported 5 • Prompt nutritional supplementation can prevent patient in developed nations. Marasmus occurs from a chronic morbidity and mortality and reverse skin disease. deficiencynot of protein and calories. Decreased insulin pro- duction and unopposed catabolism result in sarcopenia and loss of bone and subcutaneous fat.6 Affected patients include children who are less than 60% ideal body weight Cutaneous disease may be the first manifestation of an underlying nutri- 7 tional deficiency, highlighting the importance of early recognition by der- (IBW) without edema or hypoproteinemia. -
Choice of Foods and Ingredients for Moderately Malnourished Children 6 Months to 5 Years of Age
Choice of foods and ingredients for moderately malnourished children 6 months to 5 years of age Kim F. Michaelsen, Camilla Hoppe, Nanna Roos, Pernille Kaestel, Maria Stougaard, Lotte Lauritzen, Christian Mølgaard, Tsinuel Girma, and Henrik Friis Abstract quality, especially PUFA content and ratios, in children with moderate malnutrition. There is consensus on how to treat severe malnutrition, but there is no agreement on the most cost-effective way to treat infants and young children with moderate mal- Introduction nutrition who consume cereal-dominated diets. The aim of this review is to give an overview of the nutritional Child malnutrition is a major global health problem, qualities of relevant foods and ingredients in relation leading to morbidity and mortality, impaired intellec- to the nutritional needs of children with moderate mal- tual development and working capacity, and increased nutrition and to identify research needs. The following risk of adult disease. This review will deal with the general aspects are covered: energy density, macronutri- needs of children between the ages of 6 months and ent content and quality, minerals and vitamins, bioactive 5 years with moderate malnutrition. Infants below 6 substances, antinutritional factors, and food processing. months of age should (ideally) be exclusively breastfed, The nutritional values of the main food groups—cereals, and if malnourished, will have special needs, which will legumes, pulses, roots, vegetables, fruits, and animal not be covered here. Moderate malnutrition includes all foods—are discussed. The special beneficial qualities children with moderate wasting, defined as a weight- of animal-source foods, which contain high levels of for-height between –3 and –2 z-scores of the median minerals important for growth, high-quality protein, of the new World Health Organization (WHO) child and no antinutrients or fibers, are emphasized. -
Nutritional Deficiency and Imbalances - Ricardo Uauy and Eva Hertrampf
THE ROLE OF FOOD, AGRICULTURE, FORESTRY AND FISHERIES IN HUMAN NUTRITION – Vol. IV - Nutritional Deficiency and Imbalances - Ricardo Uauy and Eva Hertrampf NUTRITIONAL DEFICIENCY AND IMBALANCES Ricardo Uauy London School of Hygiene & Tropical Medicine, UK Eva Hertrampf Instituto de Nutrición y Tecnología de los Alimentos (INTA), University of Chile, Santiago, Chile Keywords: Malnutrition, children, somatic growth, infection, food security, diagnosis, treatment, micronutrients, bioavailability, nutrition and AIDS, Keshan disease, spina bifida, biomarkers, marasmus, UNICEF, children, women, kwashiorkor, adult slimness, growth indicators, starvation Contents 1. Introduction 2. Protein-Energy Malnutrition (PEM) 2.1. Malnutrition and Growth of Children and their Survival Around the World 2.2. Activity Level and Somatic Growth in Children 2.3. Adult Slimness—A New Form of Malnutrition 2.4. The Interaction between Infection and Nutrition 3. Conditioning Factors 3.1. Household Food Security 3.2. Care 4. Malnutrition Secondary to Chronic Disease 4.1. Diagnosis 4.2. Treatment of Secondary Malnutrition 4.3. Nutrition and AIDS 5. Spectrum of Micronutrient Deficit and Excess 5.1. Examination of the Risk from Micronutrient Deficit and Excess 5.2. Dietary Basis for Micronutrient Deficit (Bioavailability) 6. Conclusions Glossary Bibliography Biographical Sketches UNESCO – EOLSS Summary SAMPLE CHAPTERS Nutrition has been clearly identified as a key factor in human development, not only as a conditioning factor for health but also as a determinant of quality of life throughout the life cycle and of overall development. Starvation, total or partial, affects the function of key organ systems such as respiratory, locomotor, muscular/skeletal, gastrointestinal, immune system, and related inflammatory response. Malnutrition affects not only mortality and morbidity figures but also physical growth and intellectual development, school performance, effectiveness of education, productivity of labor, and virtually all aspects of human and social development. -
How to Spot and Talk About Symptoms That Could Mean You're
A Guide for Adults How to Spot and Talk About Symptoms That Could Mean You’re Malnourished Poor nutrition and eating What You Need to Watch For problems can put you at risk of Since malnutrition may not be immediately apparent, you need to watch for, being malnourished. Malnutrition write down, and talk about any changes you notice in: threatens your health and your • Your appetite • Your weight ability to recover from injuries • How much food you eat • Your daily activity levels or illnesses. That’s why it is • Your bowel habits • Swelling in your belly, legs, ankles, important for you to know what and feet symptoms to look for and when you need to address them. You’re doing OK if you can say: “I feel good. I eat three meals a day and have the energy to do what I want.” If you were recently hospitalized, been given directions regarding your diet, or been told you need When You Need to Be Concerned a bit more nourishment, it is If you notice any of the following warning signs, you need to discuss them particularly important that you with your healthcare provider: keep, follow, and share this • Sudden loss or decrease in • Episodes of nausea, vomiting, or information with those who care appetite diarrhea for more than three days for you. • Eating less than 75% of a normal • Unplanned weight loss greater than meal for more than a week 10 pounds • Decrease in activity level Schedule an appointment if you find yourself saying: “I haven’t wanted to eat anything since I started this new medication…” “I’m not finishing my meals like I used to…” -
The Clinical Importance of Vitamin B12
Open Access Austin Journal of Nutrition & Metabolism Mini Review The Clinical Importance of Vitamin B12 Pereira DSR1* and Monteiro MN2 1Department of Nutrition and Metabolism, Universidade Abstract Federal do Amapá, Colegiado de Farmácia, Campus Vitamin B12 is co-factor of enzymes (for example, methionine synthase Universitário Marco Zero do Equador, Brazil and methylmalonyl-CoA mutase) which are responsible for catalyzing important 2Department of Nutrition and Metabolism, Universidad biochemical reactions in the human organism. Very high doses of vitamin B12 Politécnica y Artística del Paraguay (UPAP), Paraguay (milligrams or grams) have medical applications such as cyanide poisoning *Corresponding author: Ricardo de Souza Pereira, antidote, gastrointestinal disorders, asthma, migraine, stroke prevention and Universidade Federal do Amapá, Colegiado de Farmácia, neurological disorders (Alzheimer’s and Parkinson’s disease). Campus Universitário Marco Zero do Equador, Rod. Keywords: Vitamin B12; Cyanocobalamin; Gastritis; Pernicious Anemia; Juscelino Kubitschek, KM-02, Jardim Marco Zero, GERD; Gastroesophageal Reflux Disease; Cerebrovascular Accident; Beriberi; CEP68.902-280, Macapá, AP, Brazil Scurvy; Pellagra; Pernicious Anemia; Cyanide Intoxication; Hydroxocobalamin; Received: September 09, 2019; Accepted: October 15, Methylcobalamin; Hydroxycobalamin; Pain; Chronic Pain; Neuropathy; Low 2019; Published: October 22, 2019 Back Pain; Parkinson Disease; Alzheimer Disease Introduction • Loss of appetite. What are vitamins? • Pale skin. Vitamins are organic chemical compounds, ie compounds • Concentration problems. containing carbon. Such substances are necessary for metabolism • Shortness of breath, especially during exercise. and therefore are essential nutrients to sustain life. Most vitamins are obtained from food. Vitamins are water-soluble (vitamins B, C) or • Red and swollen tongue or bleeding gums. fat-soluble (vitamins K, E, D and A).