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-first dose supplement coverage evaluation amongst children aged 12–23 months residing in slums of Delhi, India.

Objective: To determine vitamin A-first dose supplement coverage in children aged 12–23 months and to find out its correlates with selected variables. Materials and Methods: The 30-cluster sampling technique based on probability proportional to size advocated by the World Health Organization was used to assess vitamin A-first dose supplement amongst 210 children in the age group of 12–23 months residing in slums of a randomly selected municipal zone of Delhi during October to November 2005. Results: Only 79 (37.6%) children out of 210 had received vitamin A-first dose supplement. Further analysis of 79 children was carried out with regard to selected variables like religion, gender, birth order, place of birth, immunization status and literacy of mother. These analyses showed that 71 (89.9%) were Hindu and eight (10.1%) were non-Hindu (P = 0.04). Nearly 44 (55.7%) males and 35 (44.3%) females had received vitamin A (P = 0.74). The proportion of children born in a health institution who received first dose (57%) of vitamin A supplementation was significantly higher than of those who were born at home (43%) (P < 0.001). Similarly, higher proportion of children with birth order-one (48.1%) in comparison to birth order-three or above (26.6%) received vitamin A (P < 0.001). Thirty children though fully immunized for vaccine-preventable disease up to the age-of-one year had not received vitamin A-first dose supplement, suggesting that an opportunity had been missed. The association between receipt of vitamin A by the child and literacy status of mother was found to be significant (P < 0.001). Conclusion: The study reflects low coverage of Vitamin A supplement.

Keratomalacia in a neonate secondary to maternal vitamin A deficiency.

A 40-day-old male child was admitted with complaints of not opening eyes from 2-3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neonates, although in children it is reported form developing countries.

Socioeconomic differentials in supplementation of vitamin A: evidence from the Philippines.

The efficacy of supplementation of vitamin A in child survival has been well-demonstrated. However, the effectiveness of a programme of vitamin A supplementation at the population level has been rarely examined. Understanding how programmes reach disadvantaged children can help improve the design of initiatives of vitamin A supplementation. The differentials in receipt of vitamin A by socioeconomic status were assessed using data from the Philippines. Factors associated with receipt of vitamin A during the last six months were examined using the Philippines Demographic and Health Surveys conducted in 1993 and 1998. In total, 6,970 and 6,118 children aged 12-59 months were included in 1993 and 1998 respectively. Logistic regression was used for identifying associations between the outcome and the household socioeconomic variables. The coverage of national-level vitamin A supplementation increased from 27% in 1993 to 79% in 1998. However, children whose mothers did not complete primary education and children living in poor households were less likely to receive supplementation. This disparity increased between the surveys: the adjusted odds of vitamin A intake by poor households compared to middle-class households declined from 0.73 [95% confidence interval (CI) 0.61-0.87) in 1993 to 0.52 (95% CI 0.42-0.63)] in 1998, resulting in an increased health inequity. The vitamin A programme in the Philippines was not uniformly successful in reaching the most vulnerable children. Approaches targeting vulnerable households or approaches not requiring mothers to travel to distribution centres may be more promising.

Effect of vitamin A supplementation on childhood morbidity and mortality.

In a double blind design, 1520 children aged < 10 years were individually randomised in vitamin A and placebo group in slums of Chandigarh. Children > 12, 6-12 and < 6 months of age received 200,000, 100,000, 500,000 I.U. of vitamin A respectively every 4 to 6 months during 15 months trial period. The prevalence of vitamin A deficiency was significantly reduced in vitamin A compared to placebo group during the follow-up period. In vitamin A group, incidence of diarrhoea and measles was significantly reduced but incidence of acute respiratory infections was not significantly different compared to control group. Risk of death was also significantly less in vitamin A group. Therefore, promotion of vitamin A rich diet or supplementation with synthetic vitamin A at 4-6 month interval should be a priority in populations where risk of vitamin A deficiency is high.

Effects of vitamin A supplementation during pregnancy and early lactation on body weight of South African HIV-infected women.

Effects of vitamin A supplementation during pregnancy and early lactation on maternal weight among HIV-1-seropositive South African women were examined. Three hundred twelve HIV-seropositive pregnant women between 28 and 32 weeks gestation were studied as part of a randomized, double-blind, placebo-controlled trial at the King Edward VIII Hospital in Durban, South Africa. Patients were randomized to receive placebo or 5,000 IU of retinyl palmitate and 30 mg of beta-carotene daily during pregnancy. At delivery, patients received placebo or 200,000 IU of retinyl palmitate. The main outcome measures were prenatal and postnatal maternal weight and weight loss at three months after delivery as measured in body mass index (BMI). Supplementation of vitamin A was not associated with improvements in prepartum weight gain but was significantly associated with improved weight retention three to six months after delivery (p = 0.02). The benefit of vitamin A supplementation appeared to be confined to subgroups with baseline CD4+ count < 200 cells/microL and serum retinol 0-20 micrograms/dL. Similar trends were observed in maintenance of postpartum BMI. However, no statistically significant associations were observed. Although there was no benefit of vitamin A supplementation on prepartum weight gain, a benefit on maintenance of postnatal weight was observed. The benefit was highest among those who were vitamin A-deficient or whose CD4+ count was < 200 cells/microL presupplementation. In populations for whom antiretroviral therapy is not readily available or accessible, the finding that vitamin A may improve postpartum weight lends some hope to a relatively inexpensive treatment which could be used for helping ameliorate some weight loss which is common during HIV infection.

Rapid assessment and delivery of Vitamin A to slum children by using National Immunization Day in Chandigarh.

This study was done with the objective to see the feasibility of using National Immunization Days (NIDs) for rapid assessment, and delivery of Vitamin A solution to about 27,600 children dwelling in 26 slums in Union Territory of Chandigarh. The assessment of Vitamin A deficiency (VAD) was done in a stratified random sample of 1304 children during third round of Intensified Pulse Polio Immunization (IPPI) and delivery of Vitamin A solution was done during fourth round of IPPI in 1999-2000 covering 27,642 children in the age group of 1-5 years. An additional team of two persons per centre delivered age specific doses of Vitamin A solution through 72 centres and operational problems were recorded. IPPI staff provided supervision and same tally sheets as of IPPI were used. The prevalence rate of VAD was 24.6%, with conjunctival xerosis, bitot's spot and corneal xerosis as 23.7%, 0.6% and 0.2% respectively. 27,275 (98.7%) children out of 27,642 were administered Vitamin A solution, with no major operational problem. Only five parents (0.01%) refused Vitamin A solution. No case of side effect or toxicity due to Vitamin-A was reported. The strategy to assess and deliver Vitamin A during NID's was found to be feasible and successful and could be a basis for launching similar initiatives in other areas of India and other countries where VAD is a public health problem.

Cost of vitamin A and iron supplementation to "at risk" population.

This is a cost descriptive study which estimates the cost of providing iron and vitamin A supplementation through the primary health care system in India. The norms for the primary health care workers were taken as per national norms. The costs included the proportionate cost of the building, workers' salary and the cost of the supplements. The total cost of providing iron supplementation through the PHC was estimated at Rs. 43,800. The cost per beneficiary for adult folifer was Rs. 3.60, for paediatric folifer was Rs. 2.90 and for syrup folifer, it was Rs. 15.50. The overall cost of providing iron and folic acid supplements to the "at risk" population was estimated as Rs 4.40 per beneficiary per year. The cost of vitamin A supplementation to under three through the PHC system was estimated at Rs. 3.20 per beneficiary per year. Both iron as well as vitamin A supplementation through the PHC system appear to be low cost interventions.

Nutrition education and mega-dose vitamin A supplementation in Nepal.

Two approaches to improve vitamin A nutriture are compared: nutrition education and mega-dose capsule distribution. The impact of these programmes on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality are compared for approximately 40,000 children who were assigned to either intervention cohorts or a control group from 75 sites within seven districts in two ecological settings (Terai, or lowland, and hills) of Nepal. Twenty-four months after the implementation of the project, the reduction of risk of xerophthalmia was greater among children of mothers who were able to identify vitamin A-rich foods [relative risk (RR) = 0.25; 95% CI = 0.10-0.62] than among children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at two years was reduced for both the nutrition education cohort (RR = 0.64; 95% CI = 0.48-0.86) and capsule distribution cohort (RR = 0.57; 95% CI = 0.42-0.77). The nutrition education program, however, was more expensive to deliver than the capsule distribution programme. High rates of participation in the supplementation programme were achieved within a short period. The nutrition education message spread rapidly throughout the study population, although practice was slower to change. Where maternal literacy was low and channels of communication were limited, the capsule programme appeared to be more cost-effective. However, economies of scale for nationwide programmes exist for nutrition education programmes that do not exist for capsule distribution programmes. A comprehensive national programme requires both dietary supplementation and nutrition education.

Situaçäo nutricional e alimentar de pré-escolares no semi-árido da BAhia (Brasil): II - Hipovitaminose A / Nutritional status of pre-school children of the semi-arid region of Bahia (Brazil): II - Vitamin A deficiency

Foram estudados 754 pré-escolares de áreas urbanas de sete municípios do semi-árido do Estado Bahia, Brasil, com o objetivo de determinar a prevalência da hipovitaminose A e sua associaçäo com a idade, sexo, renda em salário-mínimo, escolaridade materna e adequaçäo dietética em vitamina A. Na amostra estudada näo se registrou nenhum caso de sinais e/ou sintomas de xeroftalmia durante o exame clínico-oftalmológico. Em 563 crianças, foi possível a coleta de sangue para determinaçäo de retinol sérico; encontrou-se um valor médio de 20,3µg/dl (DP=10,8µg/dl) e uma prevalência de 15,3 por cento de níveis deficientes (abaixo de 10,0µg/dl). Em todos os sete municípios estudados a prevalência de retinol sérico deficiente foi superior a 5,0 por cento que é nível crítico proposto pela OMS para considerar a hipovitaminose A como problema de saúde pública. A distribuiçäo de retinol sérico encontrada näo teve relaçäo com o sexo das crianças, mas com a idade, diminuindo a prevalência de níveis deficientes e baixos na medida em que a idade aumenta. Näo se encontrou associaçäo familiar per capita ou escolaridade materna e a prevalência de níveis de retinol deficiente. Os resultados de consumo alimentar provenientes do inquérito recordatório de 24h mostraram que apenas 8//das crianças consumiram quantidades adequadas de retinol ou de seus precursores; 66 por cento ingeriam abaixo da metade e quase 35 por cento delas näo chegaram a ingerir nem um quarto da quantidade recomendada para sua faixa etária. A carência de vitamina A deve ser considerada como problema de saúde pública severo, tanto pela alta prevalência de níveis deficientes de retinol em todos os municípios como também pela dimensäo da inadequaçäo dietética

O estado nutricional da vitamina A em pacientes portadores de de doença pulmonar obstrutiva / Vitamin A status of patients with chronic obstructive pulmonary disease

Um conjunto de dados epidemiológicos, clínicos e experimentais permitiram levantar a hipótese de que pacientes com DPOC apresentam deficiência de vitamin A. Nesta linha, o objetivo principal deste trabalho consistiu na avaliaçäo do estado nutricional da vitamina A em pacientes em DPOC. Para a avaliaçäo, analisamos as várias fases do metabolismo da vitamina A, desde a ingestäo até os órgäos alvo: ingestäo alimentar, digestäo, captaçäo hepática de quilomícrons, transporte de ésteres retilínicos e de retinol no soro e a captaçäo celular da vitamina. Os seguintes métodos foram utilizados para o estudo das fases descritas: inquérito alimentar pela técnica do questionário de freqüência; determinaçäo, no soro, de ésteres retilínicos e retinol (antes e após dose teste com vitamina A), a-caroteno, ß-caroteno, u-tocoferol, RBP e TTR; e os índices de obstruçäo pulmonar, antes e após suplementaçäo com vitamina A. Com objetivos secundários, analisou-se o estado da vitamina A em fumantes habituais, em fumantes com doença pulmonar obstrutiva leve e em pacientes com DPOC com exacerbaçäo do quadro respiratório. Procurou-se verificar a existência de associaçäo entre o estado da vitamina A e o grau de obstruçäo pulmonar e a atividade inflamatória. Por último, analisou-se a resposta das provas de funçäo pulmonar, nos pacientes com DPOC leve, à suplementaçäo de vitamina A. Para este objetivos, foram empregados os seguintes métodos, alé dos citados acima: questionário relacionado com o fumo e as provas laboratoriais relacionadas com a fase aguda. Para satisfazer os objetivos do trabalho, foram estudados na avaliaçäo transversal: um grupo de doentes com DPOC clínica e estável (GIV) (sexo masculino, n=7, idade 63,6 ñ 5,9 anos);...

Estratégia alternativa de doses periódicas de vitamina A no Estado da Paraíba / Alternative strategics of periodical dose of vitamin A in state of Paraiba

O Programa de dose periodica de vitamina A na Paraiba e parte do programa governamental de combate as carencias nutricionais especificas(PCCNE) ocorrido em areas onde alta prevalencia desta deficiencia foram demonstradas. O Programa consistia na dose macica de vitamina A distribuida a cada seis meses para criancas de 0-5 anos lactentes na regiao do semi-arido Paraibano. Nas outras regioes do Estado a distribuicao de vitamina A para escolares, lactantes e pre-escolares foi feita anualmente. Apos um mes de suplementacao oral verificou-se que os resultados foram altamente satisfatorios, sendo para amostra longitudinal P 0.0001 (Wilcoxon Test) e P 0.0001 para amostra transversal (X2).

Diagnóstico da situaçäo da hipovitaminose A e da anemia nutricional na populaçäo do Vale do Jequitinhonha, Minas Gerais, Brasil / Diagnosis of hypovitaminosis A and nutritional anemia status in the population of Vale do Jequitinhonha, Minas Gerais, Brazil

Com o objetivo de avaliar o estado nutricional em realçäo à hipotivaminose A e à anemia nutricional ferropriva, com vistas a se implantar o "-rograma de Combate à Hipovitaminose A e a Anemia Nutricional Ferropriva em Bolsöes de Pobreza de Minas Gerais" pelo Instituto Nacional de Alimentaçäo e Nutriçäo (INAN), uma amostra aleatória de 2,357 crianças das cidades de Turmalina, Minas Novas e Capelinha (Vale do Jequitinhonha), Minas Gerais, Brasil (1,604 da regiäo urbana e 753 da regiäo rural),foram submetidas a exame ocular, sendo colhido sangue em uma subamostra também aleatória destas crianças (157 na área urbana e 107 na regiäo rural) com o objetivo de se detectarem possíveis problemas nutricionais. Foram encontrados os seguintes resultados (pré-escolares e escolares respectivamente): 1- Hemoglobina: 23.9 e 20% na área urbana; 34.6 e 18% na área rural, de valores deficietes e baixos; 2 - Hematócrito: 1.5 e 2.2% na área urbana ; 17.3 e 5.5% na átrea rural, de valores baixos; 3 - Vitamina A: 8.9 e 4.4% na área urbana e 5.8 e zero% na área rural, de valores deficientes (<10µg/;dl); 26.9 e 31.1% na área urbana, 26.9 e 23.6% na área rural de valores baixos (10 - 20µg/dl. Os resultados encontrados sugerem a ocorrência de anemia nutricional e hipovitaminose A nas crianças estudadas. Exame ocular realizado nas 2,357 crianças mostrou alta incidência de xerose conjuntival com mancha de Bitot, dois casos (0.08%) de xerose corneal e um caso (0.04%) de ceratomalácia. O teste terapêutico com 200,000 UI de vitamina A oral mostrou-se mais eficiente em pré-escolares (90.3% de respostas positivas) que em escolares (25.9% de respostas positivas), estando em estudo as causas das diferentes respostas