Menopause, lung function and obstructive lung disease outcomes: a systematic review.

BACKGROUND: The menopausal transition may have significant consequences for respiratory health, risk of chronic respiratory disease and management strategies. OBJECTIVE: To systematically summarize the literature regarding the impact of menopause status on respiratory health outcomes. METHODS: PubMed was searched systematically to identify population-based studies investigating the associations between menopause status and respiratory outcomes including asthma, chronic obstructive pulmonary disease (COPD), respiratory symptoms and lung function. RESULTS: Ten publications were identified for full review. Evidence on menopause and asthma was conflicting, while studies on COPD were scarce. The findings generally support an association between menopause and clinically significant reductions in lung function in a non-obstructive pattern. However, the effects of menopause are clouded by aging, menopausal hormone therapy use, and increased risk of metabolic syndrome during this period. CONCLUSIONS: As the global burden associated with respiratory conditions continues to rise, the need to understand the associations between menopause and respiratory health is essential to identify potentially modifiable risk factors for respiratory disease in adult women. More studies are needed to clarify the impact of menopause on obstructive lung disease.

Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults.

BACKGROUND AND OBJECTIVES: While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. METHODS: Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into "explained cough" if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or "unexplained cough" if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. RESULTS: The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being "unexplained". Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. CONCLUSIONS: Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.

The cosmetic use of skin-lightening products during pregnancy in Dakar, Senegal: a common and potentially hazardous practice.

Many women of childbearing age from sub-Saharan Africa use topical skin lighteners, some of which present a risk of toxic systemic effects. The goals of this study were to evaluate, in this environment, the frequency of this practice during pregnancy, as well as eventual consequences on pregnancy. Ninety-nine women from 6 to 9 months pregnant were randomly selected among those attending a standard maternal centre in Dakar for a prenatal visit. Investigations consisted of questions about the use of skin lighteners, a standard clinical examination, follow-up until delivery and a morning blood sample for plasma cortisol levels. Sixty-eight of the 99 selected women used skin lighteners during their current pregnancy, the main active ingredients being hydroquinone and highly potent steroids (used by 64 and 28 women, respectively). No difference in the main outcomes of pregnancy were found between skin-lightener users and the others; however, women using highly potent steroids, when compared with those who did not, had a statistically significant lower plasma cortisol level and a smaller placenta, and presented a higher rate of low-birth-weight infants. Skin lightening is a common practice during pregnancy in Dakar, and the use of steroids may result in consequences in the mother and her child.

[Ulcerating haemorrhagic colitis induced by celecoxib]. / Colite aiguë ulcéro-hémorragique induite par le célécoxib.

INTRODUCTION: Selectivity of cyclooxygenase-2 inhibitors (Cox2 inhibitors) decreased gastroduodenal toxicity of nonsteroidal anti-inflammatory drugs. Effects on colic mucosa are little known. OBSERVATION: A case history is described of a 38-year-old women, without digestive past, who presented with hemorrhagic ulcerated acute colitis beginning 2 days after starting celecoxib (200 mg/d) prescribed for sciatica. DISCUSSION: Intrinsic imputability of celecoxib is very probable in this case report by combination of chronological and semiological criteria. Extrinsic imputability is discussed, starting from the available bibliographical data which relate primarily to rofecoxib. CONCLUSION: This observation, which constitutes, as far as we know, the first case report of hemorrhagic ulcerated colitis related to celecoxib, confirms the colic toxicity of anti-Cox2 and identify a new cause of acute colitis. Report of colic side effects with Cox2 inhibitors is required because of their new marketing.

Presence of multiple non-B subtypes and divergent subtype B strains of HIV-1 in individuals infected after overseas deployment.

OBJECTIVE: To identify the genetic subtypes and characteristics of HIV-1 strains from individuals infected after overseas deployment. PATIENTS AND METHODS: Sixty-one HIV-1-positive individuals detected between 1986 and 1995 in the French army were included in the study. For each patient, the year and country of HIV infection are known. Genetic subtypes of HIV-1 were determined using the heteroduplex mobility assay (HMA) using ED5/ED12 as outer and ES7/ES8 as inner primers. Strains were further characterized by sequencing and phylogenetic analysis of the C2-V3 region. The amino-acid sequences corresponding to the V3 region were aligned on the basis of the subtyping results and were then compared to the consensus V3 sequences of the corresponding subtypes. RESULTS: Among the 61 patients studied, nine became infected in France, and 52 were HIV-negative before overseas deployment but HIV-positive at their return. The majority (n = 43) deployed in Africa and a limited number of patients deployed in Asia (Cambodia, n = 5) or South America (guyana, n = 4). The nine individuals who were not deployed overseas were all infected with subtype B strains. The majority of the other patients were infected with non-B strains; eight subtype A, 20 subtype B, 16 subtype C, one subtype D, six subtype E and one subtype F. Five of the six subtype E strains were contracted in Cambodia and one in Djibouti, and all subtype C strains were from Djibouti. Phylogenetic analysis revealed a large diversity among the different strains introduced into France. Analysis of the amino-acid sequences of the V3 loop revealed the introduction of uncommon V3-loop patterns. CONCLUSION: In the group of HIV-1-infected individuals that we studied and who were deployed overseas, 63.4% were infected with non-B strains. In addition, the subtype A, B and C viruses in this population were very heterogeneous. Due to the routine occurrence of international travel and deployment, the predominance of subtype B HIV-1 viruses may change in European countries. However, the possible implications on the dynamics of the HIV-1 epidemic needs further follow-up.

Epidemiological and molecular characteristics of HIV infection in Gabon, 1986-1994.

OBJECTIVE: To describe trends in the prevalence of HIV-1 infection in different populations in Gabon, and the molecular characteristics of circulating HIV strains. METHODS: Data were collected on HIV prevalence through sentinel surveillance surveys in different populations in Libreville (the capital) and in Franceville. In Libreville, a total of 7082 individuals (hospitalized patients, tuberculosis patients, pregnant women, asymptomatic adults, prisoners) were recruited between 1986 and 1994. In Franceville, we tested 771 pregnant women and 886 healthy asymptomatic adults (1986-1988). Sera were screened for HIV antibodies by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot or line immunoassay (LIA). Reactive samples in ELISA were tested for the presence of antibodies to HIV-1 group O viruses by ELISA using V3 peptides from HIV-1 ANT-70 and HIV-1 MVP-5180 followed by confirmation by LIA and a specific Western blot. Seventeen HIV-1 strains were isolated (1988-1993) and a 900 base-pair fragment encoding the env region containing V3, V4, V5 and beginning of gp41 was sequenced and a phylogenetic tree was constructed. RESULTS: HIV prevalence was relatively low and remained stable (0.7-1.6% in pregnant women, 2.1-2.2% in the general population). The prevalence was also stable among prisoners (2.1-2.6%). Among hospitalized and tuberculosis patients prevalence was higher and increased (1.8-12.7% and 1.5-16.2%, respectively). Only three sera had antibodies to HIV-1 group O. The 17 HIV-1 strains represent six different genetic subtypes including type O. CONCLUSION: Our data from 1986 to 1994 show a stable and low HIV prevalence in Gabon, and a high genetic diversity of HIV-1 strains. This, also observed in Cameroon, is in contrast to that found elsewhere in Africa. Differences in rate of spread of HIV infection are probably explained by interplay between numerous factors. The role of different HIV subtypes in the dynamics of the HIV epidemic should be examined further.

Genetic characterization of the nef gene from human immunodeficiency virus type 1 group M strains representing genetic subtypes A, B, C, E, F, G, and H.

Most efforts to characterize sequence variation of HIV isolates has been directed toward the structural envelope gene. Few studies have evaluated the sequence variability of auxiliary genes such as nef. In this study 41 new HIV-1 strains, representing the majority of the described envelope subtypes of HIV-1 (A to H), were genetically characterized in the nef region. Phylogenetic analysis showed that 34 strains could be classified in the same subtype in nef and env, and 7 (19%) of the 41 new viruses were recombinants. For two of the seven strains, recombination occurred upstream of the nef gene, whereas for five of the seven strains recombination occurred within the nef gene with a crossover close to the 5' end of the LTR (long terminal repeat). The low intersubtype distance between subtype B and D in the nef gene confirms previous observations in the pol, env, and gag genes, which suggest a common ancestor for these subtypes. The majority of all the previously described functional domains in the nef gene were relatively conserved among the different subtypes, with only minor differences being observed. The myristoylation signal among the different subtypes, with only minor differences being observed. The myristoylation signal was less conserved for subtype C, with one or more amino acid changes being observed at positions 3, 4, and 5. The highly conserved acidic region (positions 62 to 65), critical for the enhancement of viral synthesis with an increased virus growth rate, was less conserved among the subtype G strains from our study. At least three epitopic regions of the nef gene have been defined and each can be recognized by CTLs under a variety of HLA restrictions; all were also relatively well conserved between the different genetic subtypes. Despite the relatively important genetic variation in nef sequences obtained among the different genetic subtypes, functional domains and CTL epitopes were relatively well conserved. In vitro and/or in vivo studies are necessary to study the relevance of the observed differences.

Short- and long-term action of multiple doses of ivermectin on loiasis microfilaremia.

One hundred nine Gabonese patients infected with Loa loa microfilariae were treated with ivermectin (200 microg/kg of body weight) at the Parasitology, Mycology and Tropical Medicine Department (Faculte de Medecine et des Sciences de la Sante, Libreville, Gabon). Each was given one dose per month for six consecutive months. The peripheral blood microfilaria (mf) count before and after each dose showed an average decrease in the microfilaremia of 87.3% (short-term-single dose). An annual single-dose mass treatment with 200 microg/kg of ivermectin was sufficient to control the parasite in populations with low (< 400/ml) L. loa mf counts. One month after the sixth dose (short-term-multiple doses), the average microfilaremia rate had decreased by 99.2% compared with the initial infection (35 patients). Samples were taken from 28 patients one month after the first dose and one month after the sixth dose. The average mf count decreased by 96.4% after the first dose and by 99.6% after the sixth dose (average residual mf counts = 13.7 and 1.5 mf/ml, respectively). The mf count after the sixth dose was only 11.2% of the count after the first dose. The low mf count persisted for more than six months after the sixth treatment (long-term-multiple doses). Thus, mass treatment with multiple doses is more appropriate for areas where the blood mf count is very high. These results show that the number of the annual treatments used in mass chemotherapy with ivermectin can be adapted to each population to provide efficient protection.

Prevalence and genetic variants of hepatitis GB-C/HG and TT viruses in Gabon, equatorial Africa.

The distribution of Hepatitis GB-C/HG (GB-C/HG) and TT viruses (TTV) infections was investigated in selected populations from Gabon using Polymerase Chain Reaction (PCR) and Enzyme Linked Immunosorbent Assay (ELISA) for anti-Envelop 2 (anti-E2) GBV-C/HGV antibodies. Among pregnant women, 29 of 229 (12.6%) were Hepatitis GB virus-C and Hepatitis G virus (GBV-C/HGV) RNA positive (+) and 32 of 81 (39.5%) anti-E2 + versus 8 of 39 (20.5%) TTV DNA +. Among sickle cell anemia patients, 9.7% (3/31) were GBV-C/HGV RNA + versus 22.5% (7/31) TTV DNA +. For tuberculosis patients, the figures were 11.5% (4/35) and 0%. A study of hepatocellular carcinoma cases (n = 27) versus controls (n = 66) did not show significant differences for GBV-C/HGV RNA (10.7% versus 12.1%) and TTV DNA (44.4% versus 30.3%). According to phylogenetic analysis, the 15 GBV-C/HGV strains investigated clustered in group 1, the most common in sub-Saharan Africa whereas TTV sequences (n = 4) mostly clustered in genotypes G1 and one close to genotype G3. In the Gabonese populations investigated, GBV-C/HGV and TTV infections were highly endemic. These data are consistent with the low pathogenicity of these agents.

[Hypothalamo-hypophyseal-adrenal hypofunction caused by the use of bleaching cosmetics in Senegal]. / Freinage hypothalamo-hypophyso-surrénalien lié à l'usage de cosmétiques dépigmentants au Sénégal.

Cosmetic use of bleaching agents to clear skin is widespread among black West African women. In Dakar, most products used for whole body applications contain highly potent corticosteroids. Whereas cutaneous adverse effects are well described, little is known about possible systemic consequences. In order to assess transcutaneous absorption of glucocorticoids, hypothalamo-pituitary-adrenal axis functionality can be tested. We measured plasma cortisol concentration at 8 h and 1 h after intramuscular injection of 250 micrograms of cosyntropin (Synacthen) in 12 women with a more than 10 years use of bleaching agents. Cortisol at 8 H was also measured in 9 non exposed women without disease or treatment able to disturb glucocorticoids metabolism. All controls had 8 H cortisol concentration (mean = 521 +/- 113 nmol/l) above the minimal normal level considered by our laboratory. The 8 H cortisol concentrations were under the minimal normal level in 9 exposed women and the overall mean value was significantly lower than the one observed in controls (264 +/- 81 nmol/l; p < 0.001). After cosyntropin, cortisol concentrations were elevated among all exposed women (469 +/- 196 nmol/l), and less so in 3 of them. Most of the bleaching agents users present a functional inertia of hypothalamo-pituitary adrenal axis. While there is no absolute evidence for risk of stress-induced adrenal insufficiency, our results show conclusively that an excessive corticosteroids charge among users who could be exposed to systemic adverse effects.

[Leptospirosis: a cause of pseudo-malarial fever in Gabon]. / Leptospirose: une cause de fièvre pseudo-palustre au Gabon.

A first case of leptospirosis has been recently described in Gabon where bioclimatological characteristics could favour the transmission of that disease. Therefore, a search for antibodies to leptospirae was conducted among 55 military Frenchmen with unexplained fever during a four-month stay in Gabon. Three (5.5%) were positive with IgM levels attesting for recent contamination. A screening antigenic battery identified L. bataviae in two cases and L. sejroe in one case. The three patients were employed outside in the precedent weeks. Travelers are exposed to leptospirosis in numerous Third-World countries. Clinical and biological similarities between leptospirosis and P. falciparum malaria could induce misdiagnosis. Co-infection could also be encountered. Doxycycline, whose activity against P. falciparum is well known, is also effective against leptospirae. Therefore, this drug seems valuable for prophylactic and therapeutic actions in areas exposed to the both diseases.

[Results of a systematic search for Plasmodium in internal medicine in Gabon]. / Résultats d'une recherche systématique d'hématozoaires en médecine interne au Gabon.

Among 158 adults hospitalized at the University Hospital of Libreville who did not receive any treatment against malaria before blood screening, 20 were carriers of malaria parasites. Plasmodium falciparum was seen in 19 cases with a parasitic density lower than 1,000 trophozoits/mm3 of blood in 18 cases. The most important prevalence was observed into the group of older people. In most cases symptoms related to malaria did not occur during the hospitalization. We conclude that, in such patients, a parasitic density lower than 1,000 trophozoits/mm3 is not sufficient to assess the diagnosis of malaria and does not deserve systematic treatment.

[First clinical and serological description of leptospirosis in Gabon]. / Première description clinique et sérologique de la leptospirose au Gabon.

We report the first case of leptospirosis describe in Gabon. Several environmental factors could favour the transmission of the disease in that country.

[Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon]. / Prévalences des virus des hépatites B et C, de l'HTLV-1 et du VIH dans les syndromes lymphoprolifératifs de type B au Gabon.

B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.

[A case of hepatic Loeffler's syndrome]. / Un cas de Loeffler hépatique.

INTRODUCTION: During nematode infection transit of the microorganism in the lung may be associated with transient infiltration lesions accompanied by marked eosinophilia. In the invasion stage of the disease maturation and sexual differentiation of schistosomules is restricted to portal vessels. Liver ultrasonography may show concomitant abnormalities. EXEGESIS: Eosinophilia was diagnosed in a 36-year-old man residing in Central Africa. Clinical examination, chest X-ray and biology were normal. Liver ultrasonography showed numerous hypoechoic lesions, up to 3 cm in diameter. Ultrasonography-directed biopsy demonstrated infiltration of both portal vessels and liver sinusoids, with sometimes microabcesses. No parasite was found in either blood, stool, or rectal biopsy. Immunoelectrophoresis and hemagglutination showed positive bilharziosis serology, whereas serology for other helminthiases was negative. Four months after treatment eosinophilia was still high, liver ultrasonography was normal, and hemagglutination was negative. CONCLUSION: The transient shistosomules maturation-related liver abnormalities detected by ultrasonography should be differentiated from the laying phase of the disease.

[Maternal and fetal prognosis of hypertension and pregnancy in Africa (Senegal)]. / Pronostic maternel et foetal de l'association hypertension et grossesse en Afrique sub-saharienne (Sénégal).

OBJECTIVES: The aims of this study were to record the different types of hypertension associated with pregnancy and to assess the incidence of hypertension and its gravity in Senegal. METHODS: Over a two-year period, a cohort of pregnant women with hypertension according to the American working group classification of hypertension and pregnancy, was studied. A group of 47 non hypertensive women were matched for age and parity. Modalities of delivery were studied: maternal death, type of delivery, birth weight. RESULTS: Among 2,400 deliveries, hypertension was observed in 94 women wih, mean age 33 years. The incidence of hypertension was 3.9% and the incidence of preeclampsia was 2.5%. The different types of hypertension were: Type I: 44 (47%), Type II: 16 (17%), Type III: 18 (19%), Type IV: 16 (17%). Echocardiography showed 30 cases of left ventricle hypertrophy with 3 cases of systolic dysfunction. Thirty-five patients had undergone a caesarean. Forty-seven infants had a birth weight below 2,000 g. Maternal mortality was 12.7%, fetal and neonatal mortality was 50%. There was a 21-fold higher chance of caesarean section in hypertensive women (p<4 x 10-4). Neonatal mortality was 36 times higher (p (4 x 10-6) than in the control group with a birth weight lower birth weight 975 g (p<10-6). Women suffering from toxemia gave birth to children having a lower birth weight (-543 g) (p<5.10-3), but, there was no significant difference concerning caesarean (p<7*10-1) maternal, fetal and neonatal mortality (p<9. 10-1) compared with other sub-groups. CONCLUSION: In developing countries, hypertension in pregnant women is a severe condition responsible for disease and handicaps which could be avoidable at little cost through a better policy of detection and good quality multidisciplinary management.

[Cardiac pacing in West Africa: feasibility, problems, and perspectives]. / La stimulation cardiaque définitive en Afrique de l'Ouest: faisabilité, problèmes et perspectives.

BACKGROUND: The frequency of conductive trouble is not know in West-Africa where the evacuation to Europe and the cardiology institute of Abidjan has been for long time the only possibility to implant stimulators. We analyse our experience, the problems ant the perspectives. METHODS: Over a three year period 92 patients (47 men, 45 women) were implanted using new (47%) or a recycled pacemaker. The technique used was essentially endoveinous (sub-clavicular puncture) except 2 children. The medium length of treatment was 24 months. RESULTS: Syncope was noticed at the entrance in most 50% of cases. The degenerative etiology was dominant in 85%. Most cases (87%) used the VVI mode. Complications comprised 3 leads deplacements, 5 infections, 1 pacemaker syndrome and 1 death by mesenteria ischemia. Seven patients died later without any relation of cardiac pacing. CONCLUSION: Despite an intrinsically high cost, pacemaker implantation is feasible and useful in selected indications in developing countries.

[Recurrent acute idiopathic pancreatitis. Look for a chronic inflammatory disease of the intestine]. / Pancréatite aiguë récidivante idiopathique. Chercher une maladie intestinale chronique inflammatoire.

INTRODUCTION: Among the new identified causes of so-called idiopathic acute pancreatitis are chronic inflammatory diseases of the intestine. OBSERVATION: A 21 year-old man was hospitalised for the third episode of unexplained acute pancreatitis. Digestive endoscopies revealed an ulcerated terminal ileitis compatible with Crohn's disease. DISCUSSION: The frequency of idiopathic pancreatitis in patients exhibiting a chronic inflammatory disease of the intestine is of around 1%. Pancreatic involvement may precede the digestive manifestations of Crohn's disease and its clinical expression varies. An auto-immune mechanism appears to be responsible.

[Malaria in expatriates in Africa. 154 cases. Clinical problems and therapeutic difficulties]. / Paludisme chez les expatriés en Afrique. 154 observations. Problèmes cliniques et difficultés thérapeutiques.

OBJECTIVES: Malaria is a major health priority. The aim of this study was to describe clinical expression, laboratory findings and therapeutic aspects of Plasmodium falciparum malaria observed in a French military population stationed in Gabon. PATIENTS AND METHODS: One hundred fifty-four cases of P. falciparum malaria were observed between July 1, 1994 and February 29, 1996. In 145 cases malarial fever predominated and in 9 others further complications occurred. Mean age of the patients was 23.7 years and mean delay to consultation was 30 hours. Seventy-two percent of the patients stated they took prophylaxis (chloroquine-proguanil) regularly. RESULTS: Pain generally accompanied the episodes of fever. There were 21 atypical cases. Parasitemia was < 25000 HPM in 70% of the cases. Blood counts showed leukopenia, lymphopenia, and thombopenia. Plasma cholesterol was low and lactic acid dehydrogenase levels were elevated. Halofantrine was used for curative treatment (2 doses with a 7 day interval) in 145 cases. Intravenous quinine was used in 9 cases. DISCUSSION: This series demonstrates the importance of malarial morbidity in French military men stationed in Africa and confirmed the performance of the acridine orange test. It also emphasized the importance of indirect laboratory findings for early diagnosis of malaria in foreigners living in Africa. A new dosage of halofantrine is proposed for the second injection due to cardiac toxicity.

[Scurvy in intensive care despite vitamin supplementation]. / Scorbut en soins intensifs malgré un apport vitaminique.

INTRODUCTION: Scurvy can occur in hospitalized patients despite vitamin supplementation. OBSERVATION: A 63 Year-old patient who had spent several weeks in intensive care developed an unexplained anemia and ecchymoses. Despite daily administration of 130 mg/day of vitamin C since his admission, his ascorbic acid blood levels had collapsed. Administration of 1g/day relieved the symptoms within four weeks. DISCUSSION: Whether a deficiency had existed prior to admission or not, scurvy developed during the week of intensive care despite parenteral nutrition supplying a daily dose of 130 mg of vitamin C. Such deficiencies decompensated in surgical situations remain a reality in developed countries. CONCLUSION: In certain pathological contexts and in all the growing number of cases in elderly patients and many surgical indications, the need for vitamin C supplementation has to be defined. The needs at that particular time must be taken into account and the prior nutritional status.