ORAL MANIFESTATIONS of NURITIONAL DISEASES in CHILDREN Maria Bolat1, Madalina Ionela Chiriac2, Laura Trandafir3*, Anamaria Ciubara3, Smaranda Diaconescu3

Total Page:16

File Type:pdf, Size:1020Kb

ORAL MANIFESTATIONS of NURITIONAL DISEASES in CHILDREN Maria Bolat1, Madalina Ionela Chiriac2, Laura Trandafir3*, Anamaria Ciubara3, Smaranda Diaconescu3 Romanian Journal of Oral Rehabilitation Vol. 8, No. 2, April - June 2016 ORAL MANIFESTATIONS OF NURITIONAL DISEASES IN CHILDREN Maria Bolat1, Madalina Ionela Chiriac2, Laura Trandafir3*, Anamaria Ciubara3, Smaranda Diaconescu3 1. “Gr. T. Popa" University of Medicine and Pharmacy Iași, Romania, Faculty of Dentistry, Department of Dental Materials 2. MD, Endocrinology Department of Clinical County Emergency Hospital, 400349 Cluj-Napoca, Romania 3. “Gr. T. Popa" University of Medicine and Pharmacy Iași, Romania, Mother and Child Department of Psychiatry *Corresponding author; e-mail: [email protected] , tel. +40.232 ABSTRACT Examination of the oral cavity can reveal signs and symptoms of immunologic diseases, endocrinopathies, hematologic conditions, systemic infections, and nutritional disorders. Iron deficiency anemia is present particularly in developing countries and characteristic oral manifestations include mucosal pallor, atrophic glossitis, and candidiasis. Vitamin D deficiency rickets occur in children between 3 months and 2 years old, as well as in teenagers during growth spurts which require high levels of calcium and phosphorus. The occurrence of cavities is also enabled by enamel dysplasia caused by malnutrition in the first years of life, this being a location of choice for the occurrence of cavities. Oral manifestations of malnutrition include aphthous stomatitis and atrophic glossitis caused by anemia and avitaminoses. The oral cavity plays an important part in many physiological processes represented by digestion, respiration and phonation. Oral signs frequently precede general symptoms. Physicians should be familiar with the relationship between systemic and oral health. Key words: oral manifestation, nutritional, disease INTRODUCTION breastfeeding women. Iron deficiency anemia Examination of the oral cavity can reveal affects 43% of preschoolers worldwide, signs and symptoms of immunologic particularly in developing countries, where diseases, endocrinopathies, hematologic anemia rates are four times higher than in conditions, systemic infections, and developed countries. Prevalence rates vary nutritional disorders. Careful examination depending on the sanitary and socio- should include the assessment of mucosal economic conditions and the morbidity rate. changes, periodontal inflammation and [3] In Romania, iron deficiency anemia (one of bleeding, and general condition of the teeth. the most frequent types of anemia) occurs in Identifying these oral findings may enable approximately 40% of children up to the age early diagnosis and treatment. Physicians of 5 and in 30% of pregnant women. [2, 3] should be familiar with the relationship between systemic and oral health. General Clinical Manifestations: Anemia occurs most frequently during the Iron Deficiency Anemia first years of life. Clinical manifestations Iron deficiency anemia is a major public include pallor, asthenia, inappetence, health problem and the main deficiency cephalalgia, and tachycardia, paresthesias, disease affecting children’s growth, and attention deficit. [1, 6] Fingernails become development and infection resistance, and is more brittle, flattened, and sometimes associated with a high mortality rate in become concave (koilonychia). Dysphagia children below the age of 2. [1] Iron deficiency has an irregular rate of occurrence and is anemia affect approximately 25% of the caused by the atrophy of the pharyngeal world’s population, particularly children mucosa. [1, 6] between 4 and 24 months old, young teenagers, as well as pregnant and 56 Romanian Journal of Oral Rehabilitation Vol. 8, No. 2, April - June 2016 Oral manifestations of iron deficiency The Plummer-Vinson syndrome, also anemia (Fig. 1) include mucosal pallor, called sideropenic dysphagia or sideropenic atrophic glossitis, and candidiasis. Pallor of nasopharyngopathy, is a pathologic condition the buccal mucosa and gums occurs as a that occurs in long term iron deficiency result of decreased levels of hemoglobin and anemia. In this syndrome, iron deficiency oxygen in the tissues. [2, 4, 7, 8] The general anemia is associated with the existence of atrophy of the mucosa can also be noted, symptoms and features of dysphagia, atrophic including that of the dorsal surface of the glossitis and fingernail dystrophy tongue. The tongue develops characteristic (koilonychia). Dysphagia occurs due to features of atrophic glossitis with dark red muscle degeneration, as well as due to patches and depapillation. The filiform esophageal rings – thin, ring-shaped folds of papillae of the anterior two-thirds of the the mucosa, that partially block the transport lingual mucosa are the first to be affected by of foods through the esophagus. The common atrophy. [2, 5, 8] clinical features include sore and depapillated In severe cases, the fungiform papillae are red strawberry tongue, dry mouth, spoon- also affected, so that the tongue becomes shaped fingernails and angular cheilitis. completely smooth. This generalized atrophy Atrophy leads to changes in the oral, can lead to erosions and even ulcerations with pharyngeal and upper-esophageal mucosa. chronic persistent forms. [1, 2, 4] The general symptoms include pallor, Atrophic glossitis is a nonspecific finding palpitations, fatigue and shortness of breath that can occur in association with iron (dyspnea). Many of the patients with this deficiency anemia, pernicious anemia/vitamin syndrome are edented, having lost their teeth B complex deficiencies, and various other early on. Patients frequently report sensations conditions. Oral candidiasis is another major of “throat spasms”. [10] complication of iron deficiency anemia. Oral and periodontal surgical interventions These chronic lesions can be an important should be avoided on account of the risks of factor in the occurrence of oral mucosa bleeding and delayed healing. When carcinoma, particularly in older patients. [2] hemoglobin levels drop below 10 g/dl, Angular cheilitis occurs in the oral hypoxia impairs the interactions between the commissures, with the related ulcerative cellular components of blood, particularly patches extending beyond the mucosal- platelets and endothelial cells, reducing their cutaneous junction and thus being associated hemostatic capacity. [7] with the occurrence of bleeding and pain when opening the mouth. [2, 5, 8] Vitamin D Deficiency Rickets In less severe cases, the patient may Rickets is a general nutritional condition present with burning mouth syndrome affecting the organism during rapid growth, (glossodynia), while the occurrence of caused by vitamin D deficiency and leading erosions and ulcerations are associated with to impaired metabolism of phosphorus and burning and pain, which prevent the normal calcium with deficiencies in skeletal alimentation of the child and thus create a mineralization and excessive accumulation of vicious circle. [2] osteoid tissue during the growth process Iron deficiency may also lead to atrophy of which leads to bone deformities. [11, 12] oral mucosa, because iron is essential to the Vitamin D deficiency rickets occurs in normal functioning of oral epithelial cells, children between 3 months and 2 years old, as and in an iron deficiency state, oral epithelial well as in teenagers during growth spurts cells turn over more rapidly and produce an which require high levels of calcium and atrophic or immature mucosa. [9] phosphorus. In Europe, around 50–70% of young children show signs of rickets, while Plummer-Vinson (Paterson-Kelly) 40% of teenagers present with Syndrome hypovitaminosis D. In developing countries, the prevalence of hypovitaminosis D varies 57 Romanian Journal of Oral Rehabilitation Vol. 8, No. 2, April - June 2016 largely from one region to another (from 30 Subsequent manifestations includes growth to 90%). There is a high prevalence in retardation that is also known as rachitic children in China and Mongolia, but the dwarfism. Specific bone modifications highest can be found in Africa. Risk factors include the thickening of extremities, rachitic for hypovitaminosis D in developing rosary (thickening of the chondrocostal countries are the same as those reported in junctions), thoracic deformities (protrusion of western countries and include age extremes, the sternum and ribs – pectus carinatum), females, winter season, skin pigmentation Harrison’s groove, deformities of the limbs, (African population), malnutrition, lack of and bone fractures. Cranial deformities sun exposure, high coverage clothing style, as include the asymmetric prominence of the well as obesity. In Romania, 40% of children frontal and parietal bones, occipital flattening show signs of this disorder. [12] – plagiocephaly, craniotabes – softening of the occipital bone which has the consistency General Clinical Manifestations: of a "celluloid ball" upon palpation (this Clinical manifestations range from the feature has no clinical relevance until the age mild ones such as anxiety, nocturnal of 3 months), delayed fontanel closure hyperhidrosis, unprovoked irritability, beyond the age of 18 months or, in some difficult breathing (dyspnea), muscle cramps, cases, craniosynostosis. Distended abdomen paresthesias in the extremities, sensation of occurs as a result of low muscle tone. [11] lump in one’s throat associated with The oral manifestations of vitamin D palpitations, colic abdominal pain, abdominal deficiency rickets (Fig. 2) include delays in meteorism, inappetence, precocious satiety, dental development and eruption, as well
Recommended publications
  • Figuration. One Might Be Inclined to Explain This
    DR. E. HUGHES: CRANIOTABES OF THE FŒTUS AND INFANT. 1045 .experiments of Neuschlosz,40 who found that an emulsion of lecithin in water possesses a surface CRANIOTABES OF THE FŒTUS AND tension dependent on the amount of Ca present. INFANT. Too much or too little Ca had the same effect. In the therapeutic application of lime salts one also BY EDMUND HUGHES, M.R.C.S., L.R.C.P. LOND often notices opposite effects according to the amount used. IN a previous paper 1 I recorded some results of a To return for a moment t,o what Prof. Bayliss has clinical inquiry into this subject. The account then .called the " Clowes’s effect," it would seem that the given was composed under the combined disadvantages is view of the American author strongly supported of military service and paper shortage ; and this was by our experiments on the stereo-isomeric sugars. unfortunate, because the contentious nature of We have seen that pores are left between the oil- certain of the findings called for their rather full that ,drops, and it is obvious these pores, because presentment. I shall therefore make no apology they are subjected to the surface tension at the for re-stating these findings in somewhat more boundary, assume varying shapes. Now pores of a adequate form. could allow a con- definite shape sugars of definite Broadly, the position then reached was that the figuration-e.g., lævulose-to pass through, while recognised " craniotabes " arising during the first holding back sugars-e.g., glucose--of another con- few months of infancy is in many, and probably in be inclined figuration.
    [Show full text]
  • The Etiology and Significance of Fractures in Infants and Young Children: a Critical Multidisciplinary Review
    See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/294922302 The etiology and significance of fractures in infants and young children: a critical multidisciplinary review Article in Pediatric Radiology · February 2016 DOI: 10.1007/s00247-016-3546-6 CITATIONS READS 6 193 11 authors, including: Stephen D Brown Laura L Hayes Boston Children's Hospital The Children's Hospital at Sacred Heart, Pen… 53 PUBLICATIONS 493 CITATIONS 25 PUBLICATIONS 122 CITATIONS SEE PROFILE SEE PROFILE Michael Alan Levine The Children's Hospital of Philadelphia 486 PUBLICATIONS 14,224 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: ACR Appropriateness Criteria - Pediatric Panel View project The Program to Enhance Relational and Communication Skills (PERCS): A simulation-based, experiential approach for learning about challenging conversations in healthcare View project All content following this page was uploaded by Michael Alan Levine on 25 February 2016. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately. Pediatr Radiol DOI 10.1007/s00247-016-3546-6 REVIEW The etiology and significance of fractures in infants and young children: a critical multidisciplinary review Sabah Servaes1 & Stephen D. Brown 2 & Arabinda K. Choudhary3 & Cindy W. Christian 4 & Stephen L. Done5 & Laura L. Hayes6 & Michael A. Levine4 & Joëlle A. Moreno7 & Vincent J. Palusci 8 & Richard M. Shore 9 & Thomas L. Slovis10 Received: 21 December 2015 /Accepted: 13 January 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract This paper addresses significant misconceptions re- vitamin D in bone health and the relationship between garding the etiology of fractures in infants and young children vitamin D and fractures.
    [Show full text]
  • Brain Growth in Children with Marasmus
    Upsala J Med Sci 79: 116-128, 1974 Brain Growth in Children with Marasmus A Study Using Head Circumference Measurement, Transillumination and Ultrasonic Echo Ventriculography GUNNAR ENGSNER,2 SHOADAGNE BELETE,' IRENE SJOGREN2 and BO VAHLQUIST' From the Ethiopian Nutrition Institute, Addis Ababa, Ethiopia, I and the Department of Pediatrics, University Hospitals2Uppsala, Sweden ABSTRACT (I) To measure the brain size in marasmic in- Brain growth was studied by making simultaneous meas- fants and children by simultaneously recording the urements of head circumference, transillumination and head circumference and performing transillumina- lateral ventricle indices in 102 children aged 2-24 months tion and echo encephalography. suffering from marasmus. The head circumference was (2) To demonstrate whether or not, in infants significantly reduced, transillumination showed a slight- with marasmus aged less than six months, a re- to-moderate increase in the children 6-24 months of age, and echo encephalography showed a normal lateral ven- cordable improvement in brain size takes place tricle index. The results indicate a reduction of brain during nutrition rehabilitation. size which (particularly after the first 6 months of age) goes slightly beyond what may be inferred from the head circumference per se. The interpretation of the results, MATERIAL especially the relation between head circumference and brain size, is discused. Definition of marasmus The criteria used for including children in the study were as follows: In cases of severe protein-calorie malnutrition (a) Weight for age below 60% of the Boston standard (PCM) of the marasmus type, there is not only a (50% percentile) and no apparent oedema, i.e.
    [Show full text]
  • Pediatrics Curriculum 2017
    “As to diseases, make a habit of two things — to help, or at least, to do no harm.” ― Hippocrates . 1 TABLE OF CONTENTS 1. Table of Contents 2. Description 3. Requirements 4. Materials 5. Evaluation and Grading 6. History and Physical Template 7. Goals and Objectives i. Medical Knowledge: i. Week 1: Recommended Review Topic Objectives ii. Week 2: Recommended Review Topic Objectives iii. Week 3: Recommended Review Topic Objectives iv. Week 4: Recommended Review Topic Objectives ii. Patient Care: iii. Interpersonal and Communication Skills: iv. Practice-Based Learning and Improvement: v. Systems-Based Practice: vi. Professionalism vii. Osteopathic Philosophy and Osteopathic Manipulative Medicine 8. Required Reading 9. Supplemental Reading and Learning Resources 10. Pediatric Journals 11. Shelf and Board Exams 2 DESCRIPTION Pediatrics (Third Year): 1 block rotation (4 weeks): During your 4 week rotation Pediatrics rotation you are expected to meet and exceed the following requirements and challenge yourself, to be proactive learners and ask questions. The role of the pediatrician in prevention of disease and injury and the importance of collaboration between the pediatrician and other health professionals is stressed. Pediatrics involves recognition of normal and abnormal mental and physical development as well as the diagnosis and management of acute and chronic problems. As one of the core clerkships during the third year of medical school, pediatrics shares with family medicine, internal medicine, obstetrics/gynecology, psychiatry, and surgery the common responsibility to teach the knowledge, skills and attitudes basic to the development of a competent general physician. Most students will spend most of their time in the outpatient setting while others might take care of patients on the inpatient setting as well.
    [Show full text]
  • Benign Neonatal Shudders, Shivers, Jitteriness, Or Tremors
    Benign Neonatal Shudders, Shivers, Jitteriness,Millicent Collins, MD, Michal Young, or MD Tremors: Early Signs of Vitamin D Deficiencyabstract Jitteriness and tremors in the newborn period typically precipitate an extensive, invasive, and expensive search for the etiology. Vitamin D deficiency has not been historically included in the differential of tremors. We report a shivering, jittery newborn who was subjected to a battery of testing, with the only biochemical abnormality being vitamin D deficiency. A second case had chin tremors and vitamin D deficiency. Review of our patients suggests that shudders, shivers, jitteriness, or tremors may be the earliest sign of vitamin D deficiency in the newborn. Neonates who present with these signs should be investigated for vitamin D deficiency. Department of Pediatrics, Howard University College of Shudders, shivers, jitteriness, sepsis, seizure, or neurologic Medicine and Hospital, Washington, District of Columbia and tremors are terms used to disorder. Vitamin D deficiency has Dr Collins provided 1 case report, drafted the describe excessive movements in not been historically included in initial manuscript, and reviewed and revised the neonates. These terms, although the differential of such movements; manuscript: Dr Young conceptualized this case report, provided 1 case report, and reviewed used interchangeably, are defined however, vitamin D deficiency is the manuscript; and both authors approved the variably, depending on the author. common in pregnant women (5% to final manuscript as submitted and agree to be Jittery is a term used to describe 50%) and in breastfed infants (10% accountable for all aspects of the work. a series of recurrent tremors in to 56%), despite the widespread use DOI: https:// doi.
    [Show full text]
  • Nutritional Rickets
    J Clin Res Ped Endo 2010;2(4):137-143 DOI: 10.4274/jcrpe.v2i4.137 Review Nutritional Rickets Behzat Özkan Atatürk University, Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey Introduction Vitamin D deficiency (VDD) is known to be the leading cause of nutritional rickets (NR). Recent publications indicate that dietary calcium (Ca) deficiency before the occurrence of epiphyseal fusion can also have a primary role in the etiology of this metabolic bone disease (1,2). In Turkey, almost all NR cases result from VDD, whereas in Egypt and Nigeria, Ca insufficiency and/or VDD have been shown to have a role in ABSTRACT the etiology of the condition (3). Nutritional rickets (NR) is still the most common form of growing bone In a vitamin D sufficient state or when the serum disease despite the efforts of health care providers to reduce the 25-hydroxyvitamin D (25(OH)D) level is above 20 ng/mL incidence of the disease. Today, it is well known that the etiology of NR ranges from isolated vitamin D deficiency (VDD) to isolated calcium (50 nmol/L), intestinal Ca absorption can be as high as 80% of deficiency. In Turkey, almost all NR cases result from VDD. Recent the intake, especially during periods of active growth. On evidence suggests that in addition to its short- or long-term effects on the other hand, in a vitamin D deficient state, intestinal Ca skeletal development, VDD during infancy may predispose the patient to diseases such as diabetes mellitus, cancer and multiple sclerosis. absorption can decrease to as low as 10-15% and there is Among the factors responsible for the high prevalence of VDD in also a decrease in total maximal reabsorption of phosphate.
    [Show full text]
  • Nutritional Rickets a REVIEW of DISEASE BURDEN, CAUSES, DIAGNOSIS, PREVENTION and TREATMENT
    Nutritional rickets A REVIEW OF DISEASE BURDEN, CAUSES, DIAGNOSIS, PREVENTION AND TREATMENT Nutritional rickets A REVIEW OF DISEASE BURDEN, CAUSES, DIAGNOSIS, PREVENTION AND TREATMENT Nutritional rickets: a review of disease burden, causes, diagnosis, prevention and treatment ISBN 978–92–4-151658–7 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Nutritional rickets: a review of disease burden, causes, diagnosis, prevention and treatment. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
    [Show full text]
  • Incidence of Ricket Clinical Symptoms and Relation Between Clinical and Laboratory Findings in Infants
    PROFESSIONAL ARTICLES INCIDENCE OF RICKET CLINICAL SYMPTOMS AND RELATION BETWEEN CLINICAL AND LABORATORY FINDINGS IN INFANTS KORESPONDENT MIROSLAV POPOVIĆ AUTHORS Medicinski fakultet, Univerzitet u Prištini, Kosovska Mitrovica, Srbija [email protected] Čukalović M., Krdžić-Milovanović J., Odalović A., Jakšić D. Children’s clinic, Medical Faculty Pristina, Kosovska Mitrovica SUMMARY Rickets presents osteomalacia which is developed due to negative balance of calcium and / or phosphorus during growth and development. Therefore it appears only in children. The most common reason of insufficient mineraliza- tion is deficiency of vitamin D, which is necessary for inclusion of calcium in cartilage and bones. As result, prolifera- tion of cartilage and bone tissue appears, creating calluses on typical places. Bones become soft and curve, resulting in deformities. Our present study included 86 infants, in whom, besides other diseases, clinical and laboratory signs of rickets were identified. In our study, rickets is most common (82.5%) in infants older than 6 months. By clinical pic- ture, craniotabes is present in 46.5% of cases, Harisson groove in 26.7%, rachitic bracelets in 17.4%, rachitic rosary in 17.4% and carpopedal spasms in 2.3% of cases. Leading biochemical signs of vitamin D deficient rickets is hypophos- phatemia (in 87.3% of cases), normal calcemia (in 75.6% of cases) and increased values of alkaline phosphatase (in 93% of cases). It has been shown that rickets in infant age may later affect higher incidence of juvenile diabetes, infection of lower respiratory tract, osteoporosis, and so on. Keywords: rickets, children, vitamin D. INTRODUCTION calcium and phosphorus, pathogenesis of rickets is most often based on insufficient interstitial absorption of Rickets is bone disease which leads to improper these two elements as a result of deficit in vitamin D and its metabolites [4].
    [Show full text]
  • Resurrection of Vitamin D Deficiency and Rickets
    Resurrection of vitamin D deficiency and rickets Michael F. Holick J Clin Invest. 2006;116(8):2062-2072. https://doi.org/10.1172/JCI29449. Science in Medicine The epidemic scourge of rickets in the 19th century was caused by vitamin D deficiency due to inadequate sun exposure and resulted in growth retardation, muscle weakness, skeletal deformities, hypocalcemia, tetany, and seizures. The encouragement of sensible sun exposure and the fortification of milk with vitamin D resulted in almost complete eradication of the disease. Vitamin D (where D represents D2 or D3) is biologically inert and metabolized in the liver to 25- hydroxyvitamin D [25(OH)D], the major circulating form of vitamin D that is used to determine vitamin D status. 25(OH)D is activated in the kidneys to 1,25-dihydroxyvitamin D [1,25(OH)2D], which regulates calcium, phosphorus, and bone metabolism. Vitamin D deficiency has again become an epidemic in children, and rickets has become a global health issue. In addition to vitamin D deficiency, calcium deficiency and acquired and inherited disorders of vitamin D, calcium, and phosphorus metabolism cause rickets. This review summarizes the role of vitamin D in the prevention of rickets and its importance in the overall health and welfare of infants and children. Find the latest version: https://jci.me/29449/pdf Science in medicine Resurrection of vitamin D deficiency and rickets Michael F. Holick Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, and Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, Massachusetts, USA. The epidemic scourge of rickets in the 19th century was caused by vitamin D deficiency due to inadequate sun exposure and resulted in growth retardation, muscle weakness, skeletal deformi- ties, hypocalcemia, tetany, and seizures.
    [Show full text]
  • The Uses of Rickets: Race, Technology, and the Politics of Preventive Medicine in the Early Twentieth Century
    Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 2008 The sesU of Rickets: Race, Technology, and the Politics of Preventive Medicine in the Early Twentieth Century M. Allison Arwady Yale University Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Part of the Medicine and Health Sciences Commons Recommended Citation Arwady, M. Allison, "The sU es of Rickets: Race, Technology, and the Politics of Preventive Medicine in the Early Twentieth Century" (2008). Yale Medicine Thesis Digital Library. 390. http://elischolar.library.yale.edu/ymtdl/390 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. The Uses of Rickets: Race, Technology, and the Politics of Preventive Medicine in the Early Twentieth Century A Thesis Submitted to the Yale University School of Medicine In Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine by M. Allison Arwady 2008 THE USES OF RICKETS: RACE, TECHNOLOGY, AND THE POLITICS OF PREVENTIVE MEDICINE IN THE EARLY TWENTIETH CENTURY. M. Allison Arwady (Sponsored by John H. Warner). Department of the History of Medicine, Yale University, School of Medicine, New Haven, CT. Rickets, the bone disease classically caused by Vitamin D deficiency, was one of the most common diseases of children 100 years ago.
    [Show full text]
  • PEDIATRICS in Last Minutes
    Prelims_2.pdf Chapter-01_Pediatrics in Last Minutes.pdf Chapter-02_Pre Neet Pediatric Questions.pdf Chapter-03_Pre Neet Pediatric Answers.pdf Chapter-04_Previous Years Questions of DNB.pdf Pre NEET Pediatrics Taruna Mehra MBBS MD PEDIATRICS (MAMC) ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City • London • Dhaka • Kathmandu ® Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton SW1H 0HW (UK) Panama City, Panama Phone: +44-2031708910 Phone: +507-301-0496 Fax: +02-03-0086180 Fax: +507-301-0499 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Shorakhute, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author(s) specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work.
    [Show full text]
  • A Note on Theclinical Diagnosis of Rickets In
    Arch Dis Child: first published as 10.1136/adc.1.1.33 on 1 January 1926. Downloaded from A NOTE ON THE CLINICAL DIAGNOSIS OF RICKETS IN INFANCY. BY HELEN MACKAY, M.D., M.R.C.P. The (liagnosis of rickets may be base(d Otn anly one of the following: (1) Examinationi of the blood, i.e., estimation of the blood phosphorus and 1)l10(1 calciumn; (2) histological or (3) ra(liographic examination of the bones; (4) clinical examination of the patienit. It w6uld1 seem probable that (lefective laying (dOwn of calcium in tlle growing bones results from an upset in the balance an(l the absolute amounts of the calcium and phlosphlorus salts in the blood, so that presumably the earliest dliagnosis will in the future be base(d on blood examination and not on the secondary changes in the bones. Howlandl and Kramer claim that if the calcium concentration multiplied by the phosphorus concentration in milligrams per 100 cc. is less than 30, there is always rickets present, that if this figure is between 30 an(l 40 the rickets is slight or healing. In the present stage of our knowledlge, however, the generally accepted criterion of rickets is the histol)ogical one, i.e., the presenceeof excessive osteoi(d tissue, irregularity of the columns of cartilage cells, (lisorganisation at thle epiphysial line and( other pathological chatnges in the growing bones. As the bones, however, cannot be examined histologically (luring life, we are usually depen(lent on the evi(lence of changes reveale(d either by radiographic or by clinical examination-and these must of necessity be grosser and later manifestations of the (lisease than those revealed by microscopic examination.
    [Show full text]