Investigação de surto de doença compatível com escorbuto em uma penitenciária masculina do Ceará, 2019-2020: um estudo de caso-controle / Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study / Investigación de un brote de enfermedad compatible con escorbuto en una penitenciaría masculina en el estado de Ceará, Brasil, 2019-2020: un estudio de casos y controlesInvestigação de surto

Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor< 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

Escorbuto / Scurvy

Apesar de considerado raro, o escorbuto, doença clínica causada pela deficiência de vitamina C, ainda ocorre nos dias de hoje, inclusive em países desenvolvidos. É caracterizada por acometer pacientes com história de alcoolismo, baixo nível socioeconômico, alergia alimentar e doenças psiquiátricas. A causa principal é a insuficiente ingestão de frutas e vegetais frescos. A apresentação clínica consiste de sinais e sintomas inespecíficos. Essas manifestações podem estar associadas ao acometimento de diversos órgãos, como a pele e os sistemas hematológico, articular e ósseo, pois o ácido ascórbico constitui elemento fundamental na formação do componente essencial desses tecidos: o colágeno. O diagnóstico é essencialmente clínico, baseando-se na sintomatologia e história dietética do paciente. O tratamento é feito com reposição de vitamina C em doses que variam de 500mg a 1g por dia, com resultados satisfatórios em curto espaço de tempo. Descrevemos o caso de uma paciente com 24 anos, com manifestações típicas de deficiência de vitamina C, retratando uma apresentação clássica de escorbuto nos dias atuais

Although considered rare, scurvy, a clinical disease caused by deficiency of vitamin C, still occurs today, even in developed countries. It usually affects patients with a history of alcohol abuse, low socio-economic status, food allergy and psychiatric disorders. The main cause is insufficient intake of fresh fruit and vegetables. The clinical presentation consists of nonspecific signs and symptoms. These symptoms may be associated with the involvement of various organs such as the skin and the hematological, joint and bone systems, because ascorbic acid is a crucial element in the formation of collagen, the essential component of these tissues. The diagnosis is essentially clinical, based on symptoms and dietary history of the patient. Treatment is with supplements of vitamin C in doses ranging from 500mg to 1g per day, with satisfactory results in a short time. We report the case of a 24-year female patient with typical manifestations of vitamin C deficiency, featuring a typical presentation of scurvy today

B vitamins, vitamin C and hematological measurements in overweight and obese Thais in Bangkok.

The dynamic changes of socio-economics leading to the industrialisation of countries are known to affect lifestyle and nutritional behaviours of the population. Review of the literature on the prevalence of obesity showed increasing numbers of the overweight and obese during the past decade. However, information on health and nutritional status of the obese in Thailand has not been widely publicized. This study reveals the vitamin status and hematological picture in 270 overweight and obese Thais in Bangkok, Thailand, compared with 175 normal subjects. No statistically significant differences in haemoglobin and hematocrit were observed in the overweight compared with the control subjects. The prevalence of anaemia was 9.8 per cent among male and 17.2 per cent among female overweight and obese subjects compared with 2.6 per cent and 21.2 per cent in male and female normal controls using the cut-off point of haemoglobin concentration as an indicator of anaemia. Prevalence of hypertension was exhibited in both male and female overweight and obese subjects. Even if there were no statistically significant differences in vitamin B1, B2 and B6 in overweight and obese subjects compared with the controls, high percentages of vitamin C and vitamin B2 deficiencies were observed. Vitamin B2 deficiency was detected in 19.7 per cent of overweight and obese males as well as in 28.7 per cent of overweight and obese females using glutathione reductase activity coefficient (alpha EGR) < 1.5 as the cut-off point. However, clinical signs of vitamin B2 deficiencies were rare. There was also a high percentage of vitamin C (antioxidant vitamin) deficiency in 51.5 per cent of the overweight and obese subjects and 41.7 per cent of the controls, respectively. The results suggest more attention should be paid to health study and nutritional problems for the overweight and obese population, especially concerning vitamins and oxidative stress. Further research is still needed in these aspects.

Dental chairside test for the diagnosis of ascorbic acid deficiency.

There is a strong correlation between gingival inflammation and clinical and sub-clinical ascorbic acid deficiency. This has created a demand for a handy diagnostic test to detect the ascorbic acid deficiency. The aim of this work was to find out the efficacy of one such test, i.e. the modified Lingual Ascorbic Acid Test (LAAT). To find out the significance of ths LAAT, it was compared with plasma ascorbic acid levels and then confirmed statistically. Our findings suggest that with this simple, reliable and inexpensive method, the dental practitioners can conveniently assess the ascorbic acid status of their patients.