Hypocalcemic rachitic cardiomyopathy in infants

Hypocalcemic cardiomyopathy in infants is characterized by heart failure in a previously normal infant with hypocalcemia without organic cardiac lesion. Vitamin D deficiency rickets is increasing in Middle East. In a six month study 136 cases of rickets were diagnosed in the main Children's Hospital in Almadinah but none of them showed evidence of cardiomyopathy. Concerned of missing this serious complication of rickets we searched pub med and present this review article. 61 cases of hypocalcemic cardiomyopathy were reported as case reports with two series of 16 and 15 cases from London and Delhi, respectively. The major features of these cases: the age ranged from one month to 15 months with a mean age of 5 months. All presented with heart failure and hypocalcemia. There was a minor feature of rickets in a few of the cases. All had high alkaline phosphatase. Echocardiology evidence of cardiomyopathy was found in all. Most of them responded to calcium, vitamin D and cardiotonic and diuretics. We concentrated on pathogenesis of this hypocalcemic cardiomyopathy and reviewed the literature. The evidence available supports that the most likely cause of cardiomyopathy is hypocalcemia. Hypovitamin D also contributes but hyperparathyroidism might have a protective role as we did not detect any evidence of cardiomyopathy with hyperparathyroidism and florid features of rickets. We need to look out for cardiomyopathy among infants with hypocalcemia. For prevention maternal supplementation during pregnancy and lactation with up to 2000 units of vitamin D and 400 units for their infants

Perception and knowledge of mothers on causes and treatment of rickets associated knee deformity in Ile-Ife, Osun State, Nigeria

This descriptive cross-sectional community-based study was carried out in Ile-Ife; Nigeria to assess the knowledge of mother's on the aetiology of rickets associated knee deformities and the cultural perception of its treatment. Data collection was done using interviewer based semi structured questionnaires. A total of 464 questionnaires were administered with a response rate of 86.9. Over half (59.8; N=241) and 36.5(147) of the mothers were aware of children with knee deformity and rickets; respectively. Ninety-one (22.6) mothers had the correct knowledge and perception of the true meaning of rickets. Rickets associated knee deformity aetiology was wrongly perceived to be mainly hereditary (53.8); cancer (50.9) and bone infection (48.1). Very low proportions of mothers had correct knowledge on the causes of rickets such as inadequate exposure to sunshine (21.3) or inadequate intake of calcium (21.1). The knowledge of aetiology of rickets was influenced by education (P0.02); skilled occupation (P0.0001) and the previous birth of a child with knee deformity from rickets (P0.001). The mother's cultural perceptions of treatment for childhood rickets associated knee deformities was significantly affected by age (P0.001); education; (P0.001); skilled occupation (P0.000); history of knee deformity (P0.04) and mothers with children diagnosed to have knee deformity (P0.004). Lack of finance; poor compliance to treatment; too long treatment periods; lack of information on where to seek for treatment and unaffordable treatment were among the important factors affecting completeness of treatment of knee deformity due to rickets. In conclusion; the awareness of mothers about rickets in Nigeria is still very low. It is a major reason for late presentation or complete failure to seek for adequate treatment of the knee deformity due to rickets. Increase and sustain public health enlightenment programmes are necessary for prevention. Health policy should incorporate free surgical fees for the established knee deformity to encourage community participation in the management of the condition

Raquitismo e osteomalacia / Rickets and osteomalacia

Raquitismo e osteomalacia são defeitos da mineralização óssea. O raquitismo é caracterizado por anormalidades na formação na placa epifisária de crescimento, com áreas não mineralizados, desorganização da arquitetura celular e retardo na maturação óssea. A osteomalacia é caracterizada pela deficiente mineralização da matriz osteóide do osso cortical e trabecular com acúmulo do tecido osteóide pouco mineralizado. São processos que, em geral, ocorrem associados. Após o final do crescimento, com o fechamento da cartilagem epifisária, apenas a osteomalacia permanece. A folha do processo de mineralização tem como uma das principais causas a inadequada concentração extracelular de cálcio e fósforo, os dois principais componentes minerais do osso, e a falta ou comprometimento da ação dos elementos responsáveis pela sua absorção, principalmente a vitamina D. As principais manifestações clínicas como as deformidades ósseas e o atraso no crescimento, são semelhantes nos diferentes tipos de raquitismo e osteomalacia existem características que são específicas. As causas são adquiridas ou hereditárias e os recentes avanços em biologia molecular permitem a identificação dos genes envolvidos e das mutações. Essa discussão inclui os principais tipos da patologia.

Raquitismo: revisäo de literatura e relato de um caso clínico / Rickets: a review of the literature and report of a clinical case

O presente trabalho relata e discute um caso clínico de raquitismo. Descreve suas manifestaçöes sistêmicas e bucais, as formas de tratamento e a importância do diagnóstico precoce da doença através dos sinais clínicos e radiográficos na cavidade oral

Prevención del déficit de vitamina D en Ushuaia, Argentina / Prevention of vitamin D deficiency in Ushuaia, Argentina

La deficiencia de vitamina D aumenta el riesgo de raquitismo carencial en los niños.Estudios previos en Ushuaia(55ºS)demostraron que el 47 por ciento de la población infantil tiene niveles disminuidos de 25-hidroxi-vitamina D(250HD) (menor a 8ng/ml) a final del invierno siendo adecuados al final del verano.Para prevenir la deficiencia de vitamina D se estudió el efecto de administrar una dosis única de 150.000 UIde vitamina D2 al comienzo del otoño a un grupo de 79 niños residentes en Ushuaia(Argentina)de 8,6 ñ 1,4(Xñ 1DS)años de edad.Se evaluaron basalmente,a las 6 semanas y a los 5 meses posdosis(fines de invierno)los niveles,séricos de calcio,fósforo,fosfatasa alcalina,250HD y parathormona(PTH)y el cociente calciuria/creatinuria en orina de 2 hs.En síntesis la administración de una dosis única de 150.000 UI de vitamina D2 al comienzo del otoño mantuvo durante el invierno los niveles séricos adecuados de 250HD sin provocar hipercalcemia ni hipercalciuria

Raquiotismo: uma visäo ortopédica / Richets: the orthopaedic vision

Os autores fazem um estudo retrospectivo de 81 pacientes que apresentaram quadro clínico de raquitismo atendidos no Serviço de Ortopedia e Traumatologia do Hospital Municipal Menino Jesus, no período de 1982 a 1992. Este trabalho tem por finalidade chamar a atençäo do cirurgiäo ortopédico para esta entidade, que se encontra ainda hoje presente entre nós. Os autores fazem uma revisäo bibliográfica e discutem as indicaçöes do tratamento cirúrgico ortopédico, mostrando sua importância, assim como a do tratamento medicamentoso, e a necessidade de sermos intervencionistas em determinados casos, principalmente nas deformidades dos membros inferiores.

Problemas frecuentes del aparato locomotor / Frequent problems of locomotive system

El objetivo de la presente publicacion es presentar modulos de atencion primaria de salud, relacionados con el diagnostico y terapeutica de las enfermedades del sistema locomotor, para ser utilizados por los estudiantes de medicina a un nivel primario de salud. Presenta casos tomados de la vida real que permiten introducir al alumno en un proceso de analisis de la situacion de salud. Incluye guias para ser utilizadas por el estudiante para educar a la familia y la comunidad en espectos relacionados con prevencion de salud a un nivel primario de salud