RESUMEN
Vitamin C (ascorbic acid) is an essential water-soluble antioxidant, and deficiency (ie, plasma level <11 µmol/L) can result in scurvy. People at the highest risk for vitamin C deficiency (ie, scurvy) are those with inadequate intake, such as patients with alcohol abuse disorder, malnutrition, psychiatric disorders, restrictive eating habits, and food insecurity, as well as those with malabsorptive syndromes. We present a case of a 26-year-old woman with Crohn's colitis, myasthenia gravis, and juvenile rheumatoid arthritis who presented with frequent bruising, epistaxis, and excessive bleeding from small cuts and who was found to be deficient in vitamin C. Plasma levels initially normalized with oral vitamin C supplementation, but bleeding symptoms eventually returned despite high-dose oral supplementation with 2000 mg daily. She ultimately required routine intravenous supplementation in the home setting for the normalization of levels and the resolution of symptoms. Case reports of vitamin C deficiency typically involve patients with an inadequate intake of vitamin C-containing foods or inadequate absorption. In contrast, our patient reported a regular intake of vitamin C-containing foods, in addition to oral supplementation, but continued to have difficulty maintaining normal vitamin C levels. Scurvy should be considered for any patient with symptoms of bleeding, petechiae, or ecchymosis and, although it can typically be treated with oral vitamin C, intravenous repletion may be necessary in some cases.
Asunto(s)
Deficiencia de Ácido Ascórbico , Enfermedad de Crohn , Miastenia Gravis , Escorbuto , Adulto , Ácido Ascórbico/uso terapéutico , Deficiencia de Ácido Ascórbico/complicaciones , Deficiencia de Ácido Ascórbico/tratamiento farmacológico , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Miastenia Gravis/complicaciones , Miastenia Gravis/tratamiento farmacológico , Escorbuto/diagnóstico , Escorbuto/tratamiento farmacológico , Escorbuto/etiología , Vitaminas/uso terapéuticoRESUMEN
OBJECTIVE: To identify the optimal intensity and duration of cupping that would minimize mechanical skin deformation. METHODS: We developed an optical measurement probe and system for measuring skin color values in real time. We applied cupping at the following five Bladder Meridian acupoints. To investigate optimal intensity, negative pressure intensity was increased every 2 min up to 80 kPa. To investigate optimal time, 10 measurement sites were selected and negative pressure intensities of 30, 60, and 80 kPa were applied for 5 min each. Skin color information was analyzed by the following skin color values: red color saturation, erythema index, and melanin index. RESULTS: The red color saturation and erythema index increased steadily up to 60 kpa negative pressure intensity, then decreased between 60 and 80 kPa. Therefore, maximal values were observed at 60 kPa. The melanin index consistently increased with increasing negative pressure intensity. The red color saturation and erythema index did not change after 20 s at 60 kPa negative pressure intensity. For negative pressure intensities below 80 kPa, significant changes in melanin index were not observed after 20 s. At 80 kPa negative pressure intensity, the melanin index exhibited an increasing pattern for 200 s, then showed no changes. CONCLUSIONS: To minimize skin deformation, 60 kPa and 20 s were the appropriate intensity and duration when using red color saturation and erythema index as diagnostic indexes. Because of the increasing pattern up to 80 kPa negative pressure intensity, the optimal intensity of melanin index could not be determined. When applying 80 kPa negative pressure intensity and using melanin index as the diagnostic index, we recommend a duration of 200 s.
Asunto(s)
Pigmentación de la Piel , Piel , Eritema/diagnóstico , Humanos , MelaninasRESUMEN
This case report presents the case of a 28-year-old man who developed scurvy during the coronavirus disease 2019 (COVID-19) pandemic. Scurvy is a disease resulting from a nutritional deficiency of vitamin C (ascorbic acid). It is a rare condition, whose signs and symptoms can vary from patient to patient. The treatment is vitamin C supplementation, which is often followed by a swift recovery. To our knowledge, this is the first reported case of scurvy during the COVID-19 pandemic. This article highlights a rare acquired bleeding disorder, which may manifest more commonly during a pandemic due to food scarcity or stay-at-home mandates in those already at risk.
RESUMEN
El escorbuto es una enfermedad causada por la deficiencia de vitamina C o ácido ascórbico. Sus manifestaciones clínicas son variadas debido a que esa vitamina es un cofactor de enzimas que intervienen en numerosos procesos, como la síntesis de colágeno y la absorción de diferentes nutrientes. La expresión cutánea característica son las petequias foliculares con pelos en cuello de cisne y en tirabuzón. El compromiso mucoso se manifiesta como hipertrofia y hemorragia gingival, gingivitis y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática o leucocitaria. El tratamiento se basa en el aporte suplementario de esa vitamina. Se presenta el caso de un paciente de 32 años con escorbuto debido a una dieta casi exclusivamente a base de harinas y carente de frutas y verduras. (AU)
Scurvy is a disease caused by vitamin C deficiency (also called ascorbic acid). Its clinical manifestations are varied because this vitamin is a cofactor of enzymes that take part in numerous processes, such as the synthesis of collagen and the absorption of different nutrients. Cutaneous expression of scurvy is follicular petechiae with corkscrew hairs. Mucous involvement manifests as gingival hypertrophy and bleeding, gingivitis and loss of teeth. The diagnosis of this entity is clinical and can be confirmed by plasma or leukocyte vitamin C dosing. The treatment consists of vitamin C supplementation. We present a 32-year-old male patient with scurvy secondary to a diet based almost exclusively on flour and lacking in fruits and vegetables. (AU)
Asunto(s)
Humanos , Masculino , Adulto , Adulto Joven , Escorbuto/diagnóstico , Ácido Ascórbico/uso terapéutico , Escorbuto/terapia , Vitaminas/uso terapéuticoRESUMEN
Cupping is one of the various treatment methods used in traditional oriental medicine. Cupping is also used as a diagnostic method and it may cause skin hyperpigmentation. Quantitative measurements and analysis of changes in skin color due to cupping are critical. The purpose of this study is to suggest an optical technique to visualize and identify changes in skin color due to cupping. We suggest the following analysis methods: digital color spaces [red, green, and blue (RGB) and L∗a∗b], the Erythema Index (E.I.), and the Melanin Index (M.I.). For experiments, we selected and stimulated 10 acupoints at 80 kilopascals (kPa) per minute. The RGB and L∗a∗b color spaces were observed to be decreased (p < 0.05) after cupping. The E.I. and M.I. were observed to be increased significantly (p < 0.05) after cupping. To assess various changes in skin color, we observed the changes for 72 hours. We also obtained the color changes by using the recovery pattern during the recovery period (p < 0.01). We propose that this method can be useful for visual identification and as a way to improve the identification of skin color changes.