Pseudotumor cerebral asociado a hipovitaminosis A, B6 y D: A propósito de dos casos / Pseudotumor cerebri associated with hypovitaminosis A, B6 and D: About two cases

La hipertensión endocraneana idiopàtica se asocia infrecuentemente con la hipovitaminosis A y D. Se presenta el caso de una paciente femenina de 8 años con visión borrosa de 24 horas y papiledema bilateral. Resonancia magnética nuclear normal. Presión de apertura de líquido cefalorraquídeo: 260 mm^O. Presentó déficit de vitamina A y D, e inició un tratamiento sustitutivo. El segundo caso corresponde a un paciente masculino de 12 años con fiebre y odinofagia de 3 días. Con antecedente de glomerulonefritis y sobrepeso. Presentaba edema bipalpebral y papiledema. Tomografia axial computada de la órbita: aumento de líquido en la vaina de ambos nervios ópticos. Resonancia magnética nuclear: aracnoidocele intraselar. Presión de apertura de líquido cefalorraquídeo: 400 mm^O. Presentó déficit de vitamina D y B6, e inició el tratamiento sustitutivo. La elevación de la presión intracraneal desencadena mecanismos de compensación que, al fallar, pueden comprometer la vida o provocar graves discapacidades neurológicas. Reconocer la causa para un enfoque terapéutico preciso es clave para disminuir la morbimortalidad asociada a esta patología.

Idiopathic endocranial hypertension is infrequently associated with hypovitaminosis A and D. The case of an 8-year-old female with 24-hour blurred vision and bilateral papilledema is presented. Nuclear magnetic resonance was normal. Opening pressure of cerebrospinal fluid: 260 mm^O. She presented vitamin A and D deficiency and started replacement therapy. The second case corresponds to a 12-year-old male with fever and odynophagia of 3 days. History of glomerulonephritis and overweight. He had bipalpebral edema and papilledema. Computed tomography scan of the orbit: increase of fluid in the sheath of both optic nerves. Nuclear magnetic resonance: intrasellar arachnoidocele. Opening pressure of cerebrospinal fluid: 400 mmH2O. He presented vitamin D and B6 deficiency and started replacement treatment. The elevation of intracranial pressure triggers compensation mechanisms that, when they fail, can compromise life or cause serious neurological disabilities. Recognizing the cause for an accurate therapeutic approach is key to reduce the morbidity and mortality associated with this pathology.

Vitamin A and the eye: an old tale for modern times / A vitamina A e o olho: uma velha história em tempos modernos

ABSTRACT Clinical presentations associated with vitamin A deficiency persist in poor regions globally with the same clinical features as those described centuries ago. However, new forms of vitamin A deficiency affecting the eyes, which have become widespread, as a result of modern societal habits are of increasing concern. Ophthalmic conditions related to vitamin A deficiency require the combined attention of ophthalmologists, pediatricians, internists, dermatologists, and nutritionists due to their potential severity and the diversity of causes. As the eyes and their adnexa are particularly sensitive to vitamin A deficiency and excess, ocular disturbances are often early indicators of vitamin A imbalance. The present review describes the clinical manifestations of hypovitaminosis A with an emphasis on so-called modern dietary disorders and multidisciplinary treatment approaches. The present review also discusses the relationship between retinoic acid therapy and dry eye disease.

RESUMO As apresentações clínicas associadas à deficiência de vitamina A persistem em regiões pobres ao redor do mundo com os mesmos achados clínicos descritos há séculos. No entanto, novas formas de problemas causados pela vitamina A afetam os olhos, estão associados com os hábitos da sociedade moderna e tem causado preocupação. Eles exigem a atenção dos oftalmologistas, pediatras, internistas, dermatologistas e nutricionistas, devido à sua gravidade e diversidade de causas. Uma vez que os olhos e seus anexos são órgãos muito sensíveis à deficiência e excesso de vitamina A, manifestações oculares podem ser indicadores precoces do desequilíbrio de vitamina A. Essa revisão traz as manifestações clínicas de hipovitaminose A enfatizando os chamados distúrbios dietéticos modernos e formas de abordagem multidisciplinar. E também traz evidências sobre a relação entre a terapia com ácido retinóico e doença do olho seco.

Assessment of indicators of vitamin A status in non-cirrhotic chronic hepatitis C patients

Subjects with chronic liver disease are susceptible to hypovitaminosis A due to several factors. Therefore, identifying patients with vitamin deficiency and a requirement for vitamin supplementation is important. Most studies assessing vitamin A in the context of hepatic disorders are conducted using cirrhotic patients. A cross-sectional study was conducted in 43 non-cirrhotic patients with chronic hepatitis C to evaluate markers of vitamin A status represented by serum retinol, liver retinol, and serum retinol-binding protein levels. We also performed the relative dose-response test, which provides an indirect estimate of hepatic vitamin A reserves. These vitamin A indicators were assessed according to the stage of liver fibrosis using the METAVIR score and the body mass index. The sample study was predominantly composed of male subjects (63%) with mild liver fibrosis (F1). The relative dose-response test was <20% in all subjects, indicating vitamin A sufficiency. Overweight or obese patients had higher serum retinol levels than those with a normal body mass index (2.6 and 1.9 µmol/L, respectively; P<0.01). Subjects with moderate liver fibrosis (F2) showed lower levels of serum retinol (1.9 vs 2.5 µmol/L, P=0.01) and retinol-binding protein levels compared with those with mild fibrosis (F1) (46.3 vs 67.7 µg/mL, P<0.01). These results suggested an effect of being overweight on serum retinol levels. Furthermore, more advanced stages of liver fibrosis were related to a decrease in serum vitamin A levels.

Deficiencia de vitamina A en niños con fibrosis quística / Vitamin A deficiency in children with cystic fibrosis

INTRODUCCIÓN: la carencia subclínica de vitamina A es frecuente en niños y adolescentes con fibrosis quística, y tiene un origen multifactorial; contribuye al deterioro pulmonar y ensombrece el pronóstico de la enfermedad. OBJETIVO: caracterizar el estado de esta vitamina en niños y adolescentes fibroquísticos y su relación con el estado nutricional y algunas variables clínicas. MÉTODOS: se realizó un estudio descriptivo, transversal (año 2014), de los 11 pacientes menores de 18 años atendidos en consulta multidisciplinaria del Hospital Pediátrico Centro Habana, que recibían suplementos diarios de vitamina A, como parte de la recomendación dietética y que se encontraban estables de su enfermedad, sin síntomas carenciales. Se evaluó el nivel de retinol sérico por cromatografía de alta resolución y se consideraron valores normales, según la OMS, entre 30 y 79 µg/dL, marginales entre 20 y < 30 µg/dL y deficiencia subclínica entre 10 y < 20 µg/dL. El estado nutricional se evaluó según percentil de índice de masa corporal, correspondiente a la población cubana según edad decimal y sexo. Se clasificó, además, a los enfermos, según mutación reportada, presencia de insuficiencia pancreática y enfermedad pulmonar típica, de acuerdo con registros clínicos. RESULTADOS: en la muestra predominó la mutación del 508F (2 homocigotos y 6 heterocigotos) y la enfermedad típica con insuficiencia pancreática (10 de 11). En 7 niños (63,6 %) se detectaron niveles bajos de vitamina A (4 marginales y 3 deficientes), con predominio en niños con bajo peso (80 vs. 50 % en los eutróficos), prescolares (2 de 2) y adolescentes (3 de 5). CONCLUSIONES: es importante el monitoreo de esta vitamina en el seguimiento de los enfermos de fibrosis quística.

INTRODUCTION: subclinical Vitamin A deficiency is common in children and adolescents with cystic fibrosis of multifactoral origin; it influences the pulmonary deterioration and casts a shadow over the disease prognosis. OBJECTIVE: to characterize the state of this vitamin in children and adolescents with cystic fibrosis and its association with the nutritional status and with some clinical variables. METHODS: a cross-sectional and descriptive study was conducted in younger than 18 years-old children. They were seen at the multidisciplinary service of Centro Habana pediatric hospital, and received daily Vitamin A supplements as part of dietary recommendations; they were stable with no symptoms of shortage at the time of study. A high resolution chromatography evaluated the level of serum retinol, whose values, according to WHO standards, were considered normal when yielding 30-79 µg/dL, marginal from 20 to less than 30 µg/dL and subclinical deficiency ranging from 10 to lower than 20 µg/dL. The nutritional status was measured as body mass index percentiles of the Cuban population by decimal age and sex. Additionally, the patients were classified on the basis of reported mutation, pancreatic deficiency and typical pulmonary disease pursuant to the medical histories. RESULTS: in the sample, the 508F mutation (2 homozygotic and 6 heterozygotic) and typical disease with pancreatic disease (10) prevailed. Seven children (63.2 %) had low Vitamin A levels (4 marginal and 3 deficient), being low weighed children (80 vs. 50 % in the eutrophic ones), preschool children (2 out of 2) and adolescents (3 out of 5) predominant. CONCLUSIONS: it is important to monitor Vitamin A in the follow-up of patients with cystic fibrosis.

Survival and mortality among users and non-users of hydroxyurea with sickle cell disease / Sobrevida e mortalidade em usuários e não usuários de hidroxiureia com doença falciforme / Sobrevida y mortalidad en usuarios y no usuarios de hidroxiurea con enfermedad falciforme

OBJECTIVE: to estimate survival, mortality and cause of death among users or not of hydroxyurea with sickle cell disease. METHOD: cohort study with retrospective data collection, from 1980 to 2010 of patients receiving inpatient treatment in two Brazilian public hospitals. The survival probability was determined using the Kaplan-Meier estimator, survival calculations (SPSS version 10.0), comparison between survival curves, using the log rank method. The level of significance was p=0.05. RESULTS: of 63 patients, 87% had sickle cell anemia, with 39 using hydroxyurea, with a mean time of use of the drug of 20.0±10.0 years and a mean dose of 17.37±5.4 to 20.94±7.2 mg/kg/day, raising the fetal hemoglobin. In the comparison between those using hydroxyurea and those not, the survival curve was greater among the users (p=0.014). A total of 10 deaths occurred, with a mean age of 28.1 years old, and with Acute Respiratory Failure as the main cause. CONCLUSION: the survival curve is greater among the users of hydroxyurea. The results indicate the importance of the nurse incorporating therapeutic advances of hydroxyurea in her care actions. .

OBJETIVO: estimar a sobrevida, mortalidade e causa de morte em usuários ou não de hidroxiureia com doença falciforme. MÉTODO: coorte retrospectiva de 1980 a 2010, de pacientes internados em dois hospitais públicos brasileiros. Determinou-se a probabilidade de sobrevida com Kaplan-Meier, cálculos de sobrevida (SPSS versão 10.0), comparação entre curvas de sobrevida e método Log Rank. Nível de significância p=0,05. RESULTADOS: de 63 pacientes, 87% estavam com anemia falciforme, sendo 39 em uso de hidroxiureia, com média de idade na instituição do fármaco de 20,0±10,0 anos e dosagem média de 17,37±5,4 a 20,94±7,2mg/kg/dia, elevando a hemoglobina fetal. Na comparação de usuários e não usuários de hidroxiureia, a curva de sobrevida foi maior nos usuários (p=0,014). Ocorreram 10 óbitos, com idade média de 28,1 anos, tendo como causa principal a Insuficiência Respiratória Aguda. CONCLUSÃO: a curva de sobrevida é maior nos usuários de hidroxiureia. Os resultados apontam a importância do enfermeiro incorporar avanços terapêuticos da hidroxiureia em suas ações assistenciais. .

OBJETIVO: estimar la sobrevida, la mortalidad y la causa de muerte de usuarios y no usuarios de hidroxiurea con enfermedad falciforme. MÉTODO: cohorte retrospectiva de 1980 a 2010 de pacientes internados en dos hospitales públicos brasileños. Se determinó la probabilidad de sobrevida con Kaplan-Meier, cálculos de sobrevida (SPSS versión 10.0), comparación entre curvas de sobrevida, método Log Rank. Nivel de significado p=0,05. RESULTADOS: de 63 pacientes, 87% estaban con anemia falciforme, siendo que 39 usaban hidroxiurea, promedio de edad en la institución del fármaco de 20,0±10,0 años y dosificación promedio de 17,37±5,4 a 20,94±7,2mg/kg/día, elevando la hemoglobina fetal. En la comparación de usuarios y no usuarios de hidroxiurea, la curva de sobrevida fue mayor en los usuarios (p=0,014). Ocurrieron 10 muertes, edad promedio de 28,1 años, siendo la Insuficiencia Respiratoria Aguda la causa principal. CONCLUSIÓN: la curva de sobrevida es mayor en los usuarios de hidroxiurea. Los resultados apuntan la importancia de que el enfermero incorpore los avances terapéuticos de la hidroxiurea en sus acciones asistenciales. .

Iron deficiency and anemia are associated with low retinol levels in children aged 1 to 5 years / Deficiência de ferro e anemia estão associadas com baixos níveis de retinol em crianças de 1 a 5 anos

OBJECTIVE: To analyze the occurrence of anemia and iron deficiency in children aged 1 to 5 years and the association of these events and retinol deficiency. METHODS: This was an observational analytic cross-sectional study conducted in Vitoria, ES, Brazil, between April and August of 2008, with healthy children aged 1 to 5 years (n = 692) that lived in areas covered by primary healthcare services. Sociodemographic and economic conditions, dietary intake (energy, protein, iron, and vitamin A ingestion), anthropometric data (body mass index-for-age and height-for-age), and biochemical parameters (ferritin, hemoglobin, and retinol serum) were collected. RESULTS: The prevalence of anemia, iron deficiency, and retinol deficiency was 15.7%, 28.1%, and 24.7%, respectively. Univariate analysis showed a higher prevalence of anemia (PR: 4.62, 95% CI: 3.36, 6.34, p < 0.001) and iron deficiency (PR: 4.51, 95% CI: 3.30, 6.17, p < 0.001) among children with retinol deficiency. The same results were obtained after adjusting for socioeconomic and demographic conditions, dietary intake, and anthropometric variables. There was a positive association between ferritin vs. retinol serum (r = 0.597; p < 0.001) and hemoglobin vs. retinol serum (r = 0.770; p < 0.001). CONCLUSIONS: Anemia and iron deficiency were associated with low levels of serum retinol in children aged 1 to 5 years, and a positive correlation was verified between serum retinol and serum ferritin and hemoglobin levels. These results indicate the importance of initiatives encouraging the development of new treatments and further research regarding retinol deficiency. .

OBJETIVO: Analisar a ocorrência de anemia e de deficiência de ferro em crianças de 1 a 5 anos e a associação destes desfechos com a deficiência de retinol. MÉTODOS: Trata-se de um estudo observacional analítico do tipo transversal, realizado no município de Vitória - ES, entre abril e agosto de 2008, com crianças (n = 692) saudáveis de 1 a 5 anos, residentes em áreas de abrangência de Unidades Básicas de Saúde. Foram avaliados dados sociodemográficos, econômicos, dietéticos (ingestão de energia, proteína, ferro e vitamina A), antropométricos (índice de massa corporal-por-idade e estatura-por-idade) e bioquímicos (níveis séricos de ferritina, hemoglobina e retinol). RESULTADOS: Detectou-se anemia, deficiência de ferro e deficiência de retinol em 15,7%, 28,1% e 24,7% das crianças, respectivamente. A análise univariada evidenciou maior ocorrência de anemia (RP: 4,62; IC 95%: 3,36; 6,34, p < 0.001) e de deficiência de ferro (RP: 4,51; IC 95%: 3,30; 6,17, p < 0.001) entre crianças que apresentavam deficiência de retinol. As mesmas relações se mantiveram após o ajuste pelas variáveis socioeconômicas, demográficas, dietéticas e antropométricas. Houve relação positiva entre os valores de ferritina sérica vs. retinol (r = 0,597; p < 0,001) e hemoglobina vs. retinol (r = 0,770; p < 0,001). CONCLUSÕES: A anemia e a deficiência de ferro mostraram-se associadas com baixos níveis de retinol em crianças de 1 a 5 anos, e houve correlação positiva dos níveis de retinol com os de ferritina sérica e hemoglobina. Isto torna importante iniciativas que estimulem o desenvolvimento de novos tratamentos e a ampliação de pesquisas em relação à deficiência ...

Modifiable environmental factors in multiple sclerosis / Fatores ambientais modificáveis na esclerose múltipla

Potential environmental modifiable factors involved in multiple sclerosis (MS) include low adherence to treatment, smoking, obesity, low levels of liposoluble vitamins A and D, high consumption of salt, and a sedentary lifestyle. Chronic tobacco use, obesity, sedentarism and insufficient levels of these vitamins all contribute to maintenance of a proinflammatory state. It is unlikely that there will be noticeable improvement in the inflammatory condition of MS if stopping smoking, reducing weight, exercising, increasing vitamin levels are done in an isolated and erratic manner. Modification of each and every one of these environmental risk factors is likely to be an important approach in the management of MS. The present review presents the arguments for an association between these hazardous modifiable factors and the chronic inflammatory state observed in MS.

Potenciais fatores ambientais modificáveis envolvidos na esclerose múltipla (EM) incluem baixa adesão ao tratamento, tabagismo, obesidade, baixos níveis das vitaminas lipossolúveis A e D, e um estilo de vida sedentário. O uso crônico de tabaco, obesidade, sedentarismo e níveis insuficientes destas vitaminas podem todos contribuir para a manutenção de um estado pró-inflamatório. É pouco provável que haja melhora notável na condição inflamatória da EM se a cessação do tabagismo, a redução de peso, exercícios e maiores níveis de vitaminas forem obtidos isoladamente e de maneira errática. A modificação de cada um destes fatores de risco ambientais poderá ser importante parte do manejo eficaz da EM. A presente revisão apresenta argumentos para uma associação entre os fatores modificáveis nocivos e o estado inflamatório crônico observado na EM.

Pityriasis Rubra Pilar and hypothyroidism

Pityriasis Rubra Pilaris (PRP) is a chronic and rare papulosquamous disorder. Treatment of Pityriasis Rubra Pilaris is based on empiric evidence because of several doubts regarding its etiology and also because of its relative rarity, making randomized studies difficult to perform. Some factors suggest that the metabolism of vitamin A is involved in pathogenesis. We report a case of Pityriasis Rubra Pilaris associated with autoimmune hypothyroidism which presented rapid and complete response after thyroid hormone replacement, without any association with other systemic treatment. In literature there are only three other reports of significant improvement of the lesions after hormonal correction. Deficiency of thyroid hormone inhibits the conversion of carotene into vitamin A, which would be responsible for the occurrence of Pityriasis Rubra Pilaris in this patient.

Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais / Micronutrient deficiencies and linear growth: a systematic review of observational studies

O objetivo do artigo é avaliar a associação das deficiências de ferro, vitamina A e zinco com o déficit de crescimento linear. Revisão sistemática nas bases de dados eletrônicas PubMed, LILACS e SciELO. Foram selecionados artigos publicados entre janeiro de 1995 e março de 2010, considerando os descritores: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Foram revisados 14 estudos de delineamento observacional. Dos estudos tipo coorte (dois), um indicou associação estatística entre o estado nutricional de ferro e o déficit de estatura; o outro apontou associação estatística entre as concentrações de ferritina sérica e o ganho de estatura. Dez estudos transversais investigaram a associação estatística entre as deficiências de micronutrientes e o déficit de estatura, resultando três deles na associação para o ferro, dois para a vitamina A e nenhum para o zinco. O esclarecimento sobre a associação entre o déficit de estatura e as deficiências de ferro, vitamina A e zinco dificulta-se por fatores de caráter biológico e relacionados à magnitude das deficiências, o que sugere a importância da padronização metodológica dos estudos.

This article seeks to evaluate the association of iron, vitamin A and zinc deficiencies with linear growth retardation. A systematic review of electronic databases in PubMed, LILACS and SciELO was conducted. Scientific papers published between January 1995 and March 2010 were selected, inserting the key words: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Fourteen observational design studies were reviewed. In the cohort studies (two), one indicated a statistical association between iron levels and stunting; and the other revealed a statistical association between serum ferritin concentrations and an increase in height. Ten cross-sectional studies investigated the statistical association between micronutrient deficiencies and stunting, three of which resulted in an association with iron, two with vitamin A and none with zinc. Elucidation of the association between stunting and iron, vitamin A and zinc deficiencies involves difficulties of a biological nature and also related to the magnitude of these deficiencies, indicating the importance of a methodological standardization of the studies.

Crescimento e deficiências de micronutrientes: perfil das crianças assistidas no núcleo de creches do governo da Paraíba, Brasil / Growth and micronutrient deficiencies: profile of children attendied at the day care center for the government of Paraiba, Brazil

O objetivo deste artigo é avaliar o perfil de crescimento das crianças assistidas no Núcleo de Creches do Governo da Paraíba e a contribuição relativa das deficiências de vitamina A, ferro e zinco. Estudo transversal em 240 crianças pré-escolares. Foram consideradas as categorias de diagnóstico nutricional: déficit ponderal, déficit de estatura e sobrepeso. As concentrações séricas de retinol, zinco e de hemoglobina foram determinadas para avaliar a deficiência de vitamina A (< 0,70 µmol/L), deficiência de zinco (< 65 Μmol/L) e anemia (< 110 g/L), respectivamente. A prevalência de déficit de estatura foi de 5,8%, a de sobrepeso de 3,8%, e a de déficit de peso de 0,4%. A média de Escore-Z para o índice P/E foi menor e estatisticamente significante quando a mãe da criança foi diagnosticada com baixa estatura ou com baixo peso e nas crianças de 12-36 meses de idade. Para o índice E/I, a média de Escore-Z foi menor e estatisticamente significante quando a criança nasceu com baixo peso e quando a mãe da criança apresentou baixa estatura. Crianças de 12-36 meses e sem o beneficio do Programa Bolsa Família tiveram média de hemoglobina menor. Verificou-se ausência de associação significante entre as deficiências de vitamina A, ferro e zinco e os índices antropométricos estudados.

This article seeks to evaluate the growth of children attending public day care centers of the Government of the State of Paraiba and the relative significance of vitamin A, iron and zinc deficiencies. It involved a cross-sectional study of 240 preschool children. The following categories of nutritional status were considered: underweight (W/H < -2 z-scores), stunting (H/A < -2 z-scores) and overweight (W/H > +2 z-scores). Serum concentrations of retinol, zinc and hemoglobin were established to assess vitamin A deficiency (< 0.70 mmol/L), zinc deficiency (< 65 mmol/L) and anemia (< 110 g/L), respectively. The prevalence of stunting was 5.8%, that of overweight 3.8%, and that of underweight 0.4%. W/H z-scores were lower and statistically significant in children aged 12-36 months. An association was also found between W/H z-scores and maternal height. This association was also observed regarding body mass index. H/A z-scores were lower and statistically significant in low birth weight children. Lower hemoglobin concentrations were detected in children aged 12-36 months who were not receiving the financial support of the Bolsa Familia (Family Allowance) program. There was no significant association between vitamin A, iron and zinc deficiencies and the anthropometric indices studied.

Persistent diarrhea: Risk factors and outcome.

Objective. To identify risk factors associated with Persistent diarrhea (PD) and deaths due to PD. Methods. This prospective case control study included 60 children with PD (cases) and 60 children (controls) with acute diarrhoea (AD). Detailed history, examination and appropriate investigations were done for all children. Crude Odds ratio was calculated for each risk factor by univariate analysis and adjusted odds ratio was calculated by multivariate logistic regression. Results. Prior antibiotic use, steroid use, anemia, vitamin A deficiency, malnutrition, LRI, UTI, oral candidiasis, and hyponatremia, were statistically significant risk factors by univariate analysis. Prior antibiotic use, vitamin A deficiency, malnutrition and LRI were independently associated with PD by multivariate logistic regression analysis. The risk factors for mortality were stool frequency more than 10 times per day, severe malnutrition, oral candidiasis, hypoalbuminemia and HIV positivity. Conclusions. The presence of these risk factors should alert the clinician to take appropriate measures, to decrease the mortality.

Vitamina A e diabetes gestacional: [revisão] / Vitamin A and gestational diabetes: [review]

O diabetes mellitus (DM), patologia de caráter crônico e evolutivo, atualmente apresenta configuração de epidemia mundial. O diabetes gestacional, condição associada tanto à resistência à insulina quanto à diminuição da função das células-β, também caracteriza-se pela elevada incidência em diversas populações e grupos étnicos. Recentemente têm sido constatadas fortes evidências para o comprometimento dos níveis de retinol de gestantes com DM em resposta à evolução dessa patologia. Essa condição torna as gestantes diabéticas mais propensas a apresentar estado bioquímico marginal ou deficiente em vitamina A quando comparadas com as de gestação saudável. Dessa maneira, tendo conhecimento sobre o papel fisiológico da vitamina A e as consequências do DM na gestação, esta revisão visa esclarecer o impacto da instalação do DM sobre os níveis de retinol dessas gestantes, bem como, as consequências que o estado de deficiência em vitamina A poderá causar para essas mulheres e para seus lactantes.

Diabetes mellitus (DM) a pathology with chronic evolution, has now acquired a connotation of global epidemic. Gestational diabetes, a condition associated with insulin resistance and decreased β-cells function is also characterized by a high incidence in different populations and ethnic groups. Recently strong evidence has been found for involvement of retinol levels of pregnant women with DM due to the pathology’s evolution. This condition makes these diabetics prone to have a marginal biochemical profile or a vitamin A deficiency when compared to those of healthy pregnant women. Therefore, with an awareness of the physiological role of vitamin A and consequences of diabetes during pregnancy, this review intends to clarify the impact of DM on retinol levels of these pregnant women and the consequences that vitamin A deficiency may cause to these women and their infants.

Evaluation of serum vitamin a levels in patients with Rhinitis

The aim of this study is to evaluate serum vitamin A levels in patients with rhinitis. A case control study concerned with 48 patients with rhinitis who underwent serum vitamin A evaluation and compared with the corresponding results of 100 apparently healthy persons as a control group. The study was carried out in Department of ENT in Al-Salam Teaching Hospital in Mosul, from April 2001 to June 2004. Vitamin A evaluation was performed in Department of Biochemistry in Mosul Medical College. The parameters analyzed included age, sex, clinical diagnosis and vitamin A measurement. The average age was 25 years with a range of 3-52 years. It was found that patients with rhinitis had significantly lower serum vitamin A levels than the control subjects. The levels were 0.292 +/- 0.099 [SD] micro mol/liter versus 0.886 +/- 0.199 [SD] micro mol/ liter, respectively. These findings prompted us to suggest a hypothesis that in rhinitis and possibly in other respiratory tract infections, a general derangement in vitamin A handling exists

Avaliação bioquímica de vitamina A em escolares de uma comunidade rural / Biochemical assessment of vitamin A in schoolchildren from a rural community

OBJETIVO: Investigar a prevalência de deficiência de vitamina A em escolares de área rural do Distrito Federal e correlacionar com índices de anemia e desnutrição. MÉTODOS: Do total de 179 alunos, o estudo incluiu 155 escolares (5 a 18 anos), cujos pais autorizaram a participação na coleta de sangue. A concentração de retinol plasmático foi determinada por cromatografia líquida de alta resolução, e os níveis plasmáticos de vitamina A inferior a 20 µg/dL foram considerados como inadequação ou deficiência de vitamina A. A hemoglobina foi dosada em contador de células automatizado, e a anemia foi caracterizada para crianças e adolescentes com valor sérico menor que 11,5 e 12,0 g/dL, respectivamente. O estado nutricional foi avaliado com o índice escore z para peso/altura, altura/idade e percentil do índice de massa corporal. RESULTADOS: Os resultados mostraram que 33,55 por cento dos escolares pesquisados apresentavam deficiência de vitamina A, com prevalência de 35,44 por cento entre crianças (5-9 anos) e de 31,58 por cento entre adolescentes (10-18 anos). Não foi encontrada correlação entre a prevalência de deficiência de vitamina A e prevalência de anemia ou desnutrição. A deficiência de vitamina A foi homogênea entre as idades e gêneros. CONCLUSÕES: A elevada prevalência de deficiência de vitamina A em crianças e adolescentes desta escola rural estudada identifica um problema de saúde pública na região. Esses resultados apontam para a necessidade de inclusão de faixas etárias maiores de 5 anos no grupo de risco de hipovitaminose A e sua inserção nas políticas públicas de combate à hipovitaminose A.

OBJECTIVE: To investigate the prevalence of vitamin A deficiency among schoolchildren from a rural area in the Distrito Federal, Brazil, and to correlate this with rates of anemia and malnutrition. METHODS: From a total of 179 students, the study recruited 155 schoolchildren (5 to 18 years), whose parents gave permission for blood tests. Plasma retinol concentration was assayed by high resolution liquid chromatography, and levels of plasma vitamin A lower than 20 µg/dL were defined as abnormal or deficient in vitamin A. Hemoglobin was measured by an automated cell counter, and anemia was defined as serum concentrations of less than 11.5 and 12.0 g/dL for children and adolescents, respectively. Nutritional status was assessed using z scores for weight/height, height/age and body mass index percentiles. RESULTS: The results indicated that 33.55 percent of the schoolchildren tested had a vitamin A deficiency, with a prevalence of 35.44 percent among children (5-9 years) and 31.58 percent among adolescents (10-18 years). No correlation was observed between the prevalence of vitamin A deficiency and prevalence rates of anemia or malnutrition. Both sexes and all ages were homogeneous for vitamin A deficiency. CONCLUSIONS: The elevated prevalence of vitamin A deficiency among the children and adolescents attending this rural school identify a public health problem in the region. These results indicate that age groups from 5 years onwards should be included in those at risk of hypovitaminosis A and that they should be included in public policies aimed at combating hypovitaminosis A.

Prevalência da carência de ferro e sua associação com a deficiência de vitamina A em pré-escolares / Prevalence of iron deficiency and its association with vitamin A deficiency in preschool children

OBJETIVO: Estimar a carência de ferro na população estudada e verificar se isso se associa à falta de vitamina A. MÉTODOS: Foram estudadas 179 crianças com idade > 24 meses e < 72 meses, sem diarréia e/ou febre no momento da coleta. A identificação da deficiência de vitamina A foi realizada através do teste de resposta sérica de 30 dias. Foram obtidas amostras de sangue periférico em jejum para dosagem dos níveis de hemoglobina, ferro sérico e capacidade latente de fixação de ferro, além de informação sobre a presença de diarréia ou febre nos 15 dias precedentes à pesquisa. RESULTADOS: 35,8 por cento (64/179) das crianças apresentaram carência de ferro; 75,4 por cento (135/179), deficiência de vitamina A; e 29,1 por cento (52/179) apresentaram carência de ferro e deficiência de vitamina A, concomitantemente. A carência de ferro não apresentou associação com a deficiência de vitamina A, nem tampouco com cada índice hematimétrico analisado separadamente. As crianças entre 24 e 36 meses de idade apresentaram significativamente maior prevalência da carência de ferro (p = 0,0005), como também as crianças com episódios febris ou diarréicos nos 15 dias precedentes à entrada no estudo (p = 0,003). CONCLUSÕES: Apesar de a carência de ferro não apresentar associação à deficiência de vitamina A, ambas as carências apresentaram prevalências elevadas em uma população saudável e com baixo índice de desnutrição. Tal situação é conhecida como fome oculta. As crianças mais jovens apresentaram maior risco de portar carência de ferro, como também as crianças com episódios febris ou diarréicos nos 15 dias precedentes à entrada no estudo.

Classification of 154 clinical cases of vitamin A deficiency in children [0-15 years] in a tertiary hospital in North West Frontier province Pakistan

To share our experience of 154 cases of clinical vitamin A deficiency in Pakistani children. Methods and The data on age, sex, date of presentation and clinical stage of vitamin A deficiency was recorded. A total of 154 children aged 0-15 years suffering from clinical vitamin A deficiency [xerophthalmia] were recorded. One hundred and twenty three [79.9%] children were 0-6 years with 99 [64.3%] male children. Blinding xerophthalmia [corneal xerosis, corneal ulcers ad keratomalacia] was present in 94 [61%] children. Thirty nine% children presented in summer, 28% in autumn, 20% in winter and 13% in spring respectively. This report indicates that clinical cases of vitamin A deficiency in children do occur in Pakistan. Children under 6 years of age are the most vulnerable age group and there is a seasonal variation in presentation. Both life and sight of these children are at risk. Community based studies may be helpful to identify the magnitude of the problem and possible risk factors at national, provincial and district levels

Gestational nightblindness among women attending a public maternity hospital in Rio de Janeiro, Brazil.

This study evaluated the prevalence of gestational nightblindness among postpartum women seen at the University Maternal Hospital of the Federal University in Rio de Janeiro, Brazil and the association of this symptom with a biochemical indicator (serum retinol levels) and sociodemographic, anthropometric and antenatal care variables. In total, 262 postpartum women, who did not receive vitamin A supplementation during pregnancy, were interviewed. Gestational nightblindness was diagnosed through the standardized interview as proposed by WHO. Serum retinol levels were evaluated by spectrophotometry. Gestational nightblindness relating to low levels of serum retinol (<1.05 micromol/L, p = 0.000) was diagnosed in 17.9% of subjects interviewed. Less than five antenatal care appointments (odds ratio [OR] = 2.179; confidence interval [CI] 95% = 1.078 - 4.402) and a history of one or more miscarriage(s) (OR = 2.306; CI 95% = 1.185 - 4.491) were predictors for gestational nightblindness. These findings justify the need for nutritional counselling, aimed at improving the vitamin A nutritional status, especially among pregnant women with a history of previous miscarriages and poor antenatal care.