ascorbic-acid and Scurvy

In 1747, an important milestone in the history of clinical research was set, as the Scottish surgeon James Lind conducted the first randomized controlled trial. Lind was interested in scurvy, a severe vitamin C deficiency which caused the death of thousands of British seamen. He found that a dietary intervention with oranges and lemons, which are rich in vitamin C by nature, was effective to recover from scurvy. Because of its antioxidative properties and involvement in many biochemical processes, the essential micronutrient vitamin C plays a key role in the human biology. Moreover, the use of vitamin C in critical illness-a condition also resulting in death of thousands in the 21st century-has gained increasing interest, as it may restore vascular responsiveness to vasoactive agents, ameliorate microcirculatory blood flow, preserve endothelial barriers, augment bacterial defense, and prevent apoptosis. Because of its redox potential and powerful antioxidant capacity, vitamin C represents an inexpensive and safe antioxidant, with the potential to modify the inflammatory cascade and improve clinical outcomes of critically ill patients. This narrative review aims to update and provide an overview on the role of vitamin C in the human biology and in critically ill patients, and to summarize current evidence on the use of vitamin C in diverse populations of critically ill patients, in specific focusing on patients with sepsis and coronavirus disease 2019.

Topics: Antioxidants; Ascorbic Acid; COVID-19; Critical Illness; Humans; Male; Microcirculation; Scurvy; Vitamins

Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Delayed Diagnosis; Diagnosis, Differential; Humans; Scurvy

Topics: Antioxidants; Ascorbic Acid; Endoplasmic Reticulum; Endoplasmic Reticulum Stress; Homeostasis; Humans; Mixed Function Oxygenases; Oxidation-Reduction; Scurvy; Signal Transduction

Severe and long-term vitamin C deficiency can lead to fatal scurvy, which is fortunately considered rare today. However, a moderate state of vitamin C (vitC) deficiency (hypovitaminosis C)-defined as a plasma concentration below 23 μM-is estimated to affect up to 10% of the population in the Western world, albeit clinical hallmarks in addition to scurvy have not been linked to vitC deficiency. The brain maintains a high vitC content and uniquely high levels during deficiency, supporting vitC's importance in the brain. Actions include both antioxidant and co-factor functions, rendering vitamin C deficiency likely to affect several targets in the brain, and it could be particularly significant during development where a high cellular metabolism and an immature antioxidant system might increase sensitivity. However, investigations of a non-scorbutic state of vitC deficiency and effects on the developing young brain are scarce. This narrative review provides a comprehensive overview of the complex mechanisms that regulate vitC homeostasis in vivo and in the brain in particular. Functions of vitC in the brain and the potential consequences of deficiency during brain development are highlighted, based primarily on findings from experimental animal models. Perspectives for future investigations of vitC are outlined.

Topics: Animals; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Brain; Carnitine; Fatty Acids, Unsaturated; Homeostasis; Humans; Mice, Knockout; Models, Animal; Neuroglia; Neurons; Scurvy; Sodium-Coupled Vitamin C Transporters

Scurvy is a nutritional disorder resulting from vitamin C deficiency. Although rare in developing countries, scurvy continues to develop in settings of limited dietary intake such as post-gastrointestinal surgery and restrictive dietary habits. The disease primarily affects the skin and soft tissue. As the state of deficiency persists, hematological and immunological sequelae may develop. The classic signs of scurvy are not always present and can be altered by the presence of other comorbidities. In this article, we present a challenging case of scurvy in an older male from an urban tertiary healthcare setting. We review the atypical and uncommon clinical and pathological findings of scurvy including those seen in the skin, blood, and bone marrow. We also review contemporary research findings that provide a better understanding of the pathogenicity and clinical manifestations of vitamin C deficiency.

Topics: Ascorbic Acid; Disease Progression; Feeding Behavior; Humans; Male; Scurvy; Skin

Scurvy, the disease resulting from vitamin C deficiency, is perceived as being rare and occurring predominantly in the past. However, scurvy continues to exist and may be encountered in children with medical/developmental conditions and/or restricted diet. Diagnosis can be challenging given the perceived rarity of the condition and nonspecific symptoms, including gingival disease.. We present a series of two cases of scurvy in which the affected children presented to medical attention with dental complaints. Additional cases of scurvy are described, based on the literature review of case reports/series published in the last 10 years.. Literature review yielded 77 relevant case reports published in the English language since 2009. Most affected children had a previous diagnosis of a medical or developmental condition (especially autism spectrum disorder). Intraoral features (gingival swelling, pain, and bleeding) were noted in most of the identified cases of scurvy. Improvement in the oral features of scurvy occurred within days of vitamin C therapy initiation.. Recognizing classic signs and symptoms of scurvy enables prompt diagnosis and avoids invasive investigations. Dentists may be in a unique position to facilitate prompt and accurate diagnosis of a condition that is relatively easy and safe to treat once identified.

Topics: Ascorbic Acid; Autism Spectrum Disorder; Child; Developmental Disabilities; Gingival Diseases; Humans; Scurvy

For decades, the potential beneficial effect of vitamin C on human health-beyond that of preventing scurvy-has been subject of much controversy. Hundreds of articles have appeared either in support of increased vitamin C intake through diet or supplements or rejecting the hypothesis that increased intake of vitamin C or supplementation may influence morbidity and mortality. The chemistry and pharmacology of vitamin C is complex and has unfortunately rarely been taken into account when designing clinical studies testing its effect on human health. However, ignoring its chemical lability, dose-dependent absorption and elimination kinetics, distribution via active transport, or complex dose-concentration-response relationships inevitably leads to poor study designs, inadequate inclusion and exclusion criteria and misinterpretation of results. The present review outlines the differences in vitamin C pharmacokinetics compared to normal low molecular weight drugs, focusses on potential pitfalls in study design and data interpretation, and re-examines major clinical studies of vitamin C in light of these.

Topics: Ascorbic Acid; Diet; Dietary Supplements; Humans; Scurvy; Vitamins

Vitamin C deficiency may be more common than is generally assumed, and the association between vitamin C deficiency and adverse psychiatric effects has been known for centuries. This paper aims to systematically review the evidence base for the neuropsychiatric effects of vitamin C deficiency.. Relevant studies were identified via systematic literature review.. Nine studies of vitamin C deficiency, including subjects both with and without the associated physical manifestations of scurvy, were included in this review. Vitamin C deficiency, including scurvy, has been linked to depression and cognitive impairment. No effect on affective or non-affective psychosis was identified.. Disparate measurement techniques for vitamin C, and differing definitions of vitamin C deficiency were apparent, complicating comparisons between studies. However, there is evidence suggesting that vitamin C deficiency is related to adverse mood and cognitive effects. The vitamin C blood levels associated with depression and cognitive impairment are higher than those implicated in clinical manifestations of scurvy. While laboratory testing for ascorbic acid can be practically difficult, these findings nonetheless suggest that mental health clinicians should be alerted to the possibility of vitamin C deficiency in patients with depression or cognitive impairment. Vitamin C replacement is inexpensive and easy to deliver, although as of yet there are no outcome studies investigating the neuropsychiatric impact of vitamin C replacement in those who are deficient.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Cognitive Dysfunction; Depression; Humans; Scurvy; Vitamins

We report three cases of scurvy in previously healthy children referred to us for leg pain and refusal to walk. All children had no significant medical history, symptoms had started months before and subtly advanced. Two of them presented with gingival hyperplasia and petechiae, another one reported night sweats and gingival bleeding in the past few weeks. Two had vitamin D deficiency, and all had microcytic anaemia (in one case requiring transfusional support). A nutritional screening revealed low or undetectable levels of ascorbic acid. This, along with the clinical and radiological findings, led to a diagnosis of scurvy. Vitamin C supplementation was started with rapid improvement of the children's clinical condition. Scurvy is a rare disease in the 'first world', but there are anecdotal reports of scurvy in children without any of the known risk factors for this condition. In our cases, a selective diet was the only risk factor.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Diagnosis, Differential; Dietary Supplements; Humans; Male; Movement Disorders; Musculoskeletal Pain; Scurvy; Vitamin D; Vitamin D Deficiency; Vitamins; Walking

Numerous cases of scurvy secondary to diet limitations have been reported in the literature with most being boys with special needs. To date, the focus of the literature describing vitamin C deficiency has been the medical sequelae of the deficiency. There has been little attention given underlying diet limitations causing the vitamin C deficiency.. A five-year-old female with typical development initially presented with rash, then later for pain in both lower extremities. After evaluation revealed vitamin C deficiency, she was admitted into an intensive day treatment feeding program. A feeding assessment found she had life-long problems with eating and had a diet that never exceeded ten foods. Across the course of treatment, she learned to eat 29 new foods. At six-month follow-up her body mass index had increased from the 1st to the 61st percentile. At one-year follow-up her body mass index was at the 85th percentile. All sequalae of her deficiency resolved.. This case is unusual as most reported studies describe males with special needs. The severity of her eating issues suggest providers may consider referral to allied health professionals to address diet limitations for both children identified with nutrient deficiencies as well as children whose selective eating places them at risk for nutritional deficiencies or problems with growth. The child we described was anemic, like 42% of children described in the case literature on scurvy and like 32% of the children in this literature, our patient was underweight. In the literature, comorbid nutrient deficiencies were reported in 22% of the scurvy case studies. We suggest vitamin C supplementation is a necessary component for addressing vitamin C deficiency, but insufficient for addressing the diet limitations causing the nutrient deficiency.

Topics: Ascorbic Acid; Autism Spectrum Disorder; Body Mass Index; Child; Child, Preschool; Feeding and Eating Disorders; Feeding Behavior; Female; Humans; Male; Scurvy; Vitamins

The aim of this article is to correct a very general error in scientific articles, in textbooks and in the Internet that has become an accepted fact. In this literature, the term "vitamin E″ is used for several similar molecules (both tocopherols and tocotrienols) that have never been shown to have vitamin property, i.e. a protective effect against the human deficiency disease. In fact, the name "vitamin E″ should only be used to define molecules that prevent the human deficiency disease "Ataxia with Vitamin E Deficiency" (AVED). Only one such molecule is known, α-tocopherol. This error may confuse consumers as well as medical doctors, who prescribe vitamin E without realizing that the current use of the name includes molecules of unknown, if not unwanted functions.

Topics: alpha-Tocopherol; Antioxidants; Ascorbic Acid; Ataxia; Calcitriol; Dietary Supplements; Humans; Rickets; Scurvy; Stereoisomerism; Terminology as Topic; Tocotrienols; Vitamin E; Vitamin E Deficiency

Recent advances have uncovered a previously unknown function of vitamin C in epigenetic regulation. Vitamin C exists predominantly as an ascorbate anion under physiological pH conditions. Ascorbate was discovered as a cofactor for methylcytosine dioxygenases that are responsible for DNA demethylation, and also as a likely cofactor for some JmjC domain-containing histone demethylases that catalyze histone demethylation. Variation in ascorbate bioavailability thus can influence the demethylation of both DNA and histone, further leading to different phenotypic presentations. Ascorbate deficiency can be presented systematically, spatially and temporally in different tissues at the different stages of development and aging. Here, we review how ascorbate deficiency could potentially be involved in embryonic and postnatal development, and plays a role in various diseases such as neurodegeneration and cancer through epigenetic dysregulation.

Topics: Aging; Ascorbic Acid; Ascorbic Acid Deficiency; Dioxygenases; DNA Methylation; Embryonic Development; Epigenesis, Genetic; F-Box Proteins; Histones; Humans; Jumonji Domain-Containing Histone Demethylases; Neoplasms; Neurodegenerative Diseases; Scurvy

Scurvy remains prevalent in certain populations, including addicts, people of low socioeconomic status, and the severely malnourished. It classically presents as follicular hyperkeratosis and perifollicular hemorrhage of the lower extremities, as well as bleeding in other areas such as the gingiva and joints. This case presentation and literature review highlights the common pathophysiological findings associated with scurvy and current methods of diagnosis and treatment.. The patient described in this case presented with sudden oligoarthritis and purpura of the lower extremities. Following progression of the patient's symptoms and a low vitamin C serum concentration, the patient was treated with vitamin C supplementation and dramatically improved. This was considered to be the result of an underlying vitamin C deficiency secondary to insufficient fruit and vegetable intake due to allergies.. This case highlights the importance of maintaining a high index of suspicion for scurvy in atypical presentations of purpura not better explained by another disease or in additional populations at high risk of vitamin C deficiency. Early diagnosis by either a primary care physician or dermatologist can expedite the treatment process and improve patient prognosis.

Topics: Aged; Arthritis; Ascorbic Acid; Female; Humans; Panniculitis; Purpura; Scurvy; Vitamins

This paper reviews the rheumatological manifestations of scurvy, based on articles published in English from 1965 until October 2014, with a particular focus on rheumatological manifestations. Scurvy is a rare, uncommon disease in developed countries. Due to its clinical heterogeneity, the disease can easily mimic rheumatologic conditions leading to a delay in diagnosis and treatment.

Topics: Arthritis; Ascorbic Acid; Diagnosis, Differential; Humans; Rheumatic Diseases; Scurvy

Topics: Antioxidants; Ascorbic Acid; Autistic Disorder; Black or African American; Child; Diagnosis, Differential; Humans; Male; Osteomyelitis; Risk Factors; Scurvy; Treatment Outcome

Vitamin C is a water soluble vitamin which is mainly fresh fruits and vegetables foodborne. Vitamin C deficiency is most often due to a lack of daily amount. Scurvy is characterized by the occurrence of fatigue, myalgia, arthralgia, purpura, bleeding disorders, and later by dental manifestations. Biological signs are nonspecific: anemia, hypocholesterolemia, hypoalbuminemia. Clinical suspicion is confirmed by the decrease in ascorbic acid level (< 2 mg/L). It must be interpreted in light of the acute phase reactants. The treatment is the administration of 1 g of vitamin C per day for 15 days. Vitamin C depletion (ascorbic acid: 2 to 5 mg/L) could induce long-term complications. The recommended dietary allowance of vitamin C protect from these risks.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Disease Progression; Humans; Neoplasms; Prevalence; Scurvy

To report 3 cases of scurvy seen in a large urban medical center over a 6-month period, referred for evaluation of rheumatologic symptoms and findings in the presence of elevated inflammatory markers. The relevant literature is reviewed and unusual manifestations highlighted.. Descriptive case reports of 3 patients ultimately diagnosed with scurvy and a review of the relevant literature with an emphasis on rheumatologic manifestations (PubMed search, 1965 through August 2009).. Three patients presented with symptoms including fatigue, purpuric rash, synovitis with effusion, anemia, and markedly elevated erythrocyte sedimentation rate and C-reactive protein levels. One patient presented with severe pulmonary hypertension. Careful nutritional history revealed a diet deficient in vitamin C. Examination revealed hemarthrosis, skin findings characteristic of scurvy, and deficiency in vitamin C on laboratory analysis. Symptoms resolved with vitamin C supplementation. Characteristics and frequency of rheumatologic manifestations are reviewed.. While scurvy is usually described in poorer countries, individuals who have psychiatric disorders, or alcoholics with poor nutrition, it can occur even in otherwise normal populations in affluent countries. Such patients often present to rheumatologists with rheumatologic symptoms and awareness of the disease is necessary to make the proper diagnosis.

Topics: Adult; Aged; Ascorbic Acid; Female; Humans; Male; Rheumatic Diseases; Scurvy; Treatment Outcome

Topics: Ascorbic Acid; Avitaminosis; Beriberi; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Pellagra; Rickets; Scurvy; Vitamins

The literature on the content and stability of vitamin C (ascorbic acid, AA) in citrus juices in relation to industrial practices is reviewed. The role of vitamin C from citrus juices in human diet is also reviewed. Citrus fruits and juices are rich in several types of bioactive compounds. Their antioxidant activity and related benefits derive not only from vitamin C but also from other phytochemicals, mainly flavonoids. During juice processing, temperature and oxygen are the main factors responsible for vitamin C losses. Non-thermal processed juices retain higher levels of vitamin C, but economic factors apparently delay the use of such methods in the citrus industry. Regarding packing material, vitamin C in fruit juice is quite stable when stored in metal or glass containers, whereas juice stored in plastic bottles has a much shorter shelf-life. The limiting step for vitamin C absorption in humans is transcellular active transport across the intestinal wall where AA may be oxidized to dehydroascorbic acid (DHAA), which is easily transported across the cell membrane and immediately reduced back to AA by two major pathways. AA bioavailability in the presence of flavonoids has yielded controversial results. Whereas flavonoids seem to inhibit intestinal absorption of AA, some studies have shown that AA in citrus extract was more available than synthetic ascorbic acid alone. DHAA is reported to possess equivalent biological activity to AA, so recent studies often consider the vitamin C activity in the diet as the sum of AA plus DHAA. However, this claimed equivalence should be carefully reexamined. Humans are one of the few species lacking the enzyme (L-gulonolactone oxidase, GLO) to convert glucose to vitamin C. It has been suggested that this is due to a mutation that provided a survival advantage to early primates, since GLO produces toxic H2O2. Furthermore, the high concentration of AA (and DHAA) in neural tissues could have been the key factor that caused primates (vertebrates with relative big brain) to lose the capacity to synthesize vitamin C. Oxidative damage has many pathological implications in human health, and AA may play a central role in maintaining the metabolic antioxidant response. The abundance of citrus juices in the Mediterranean diet may provide the main dietary source for natural vitamin C.

Topics: Animals; Antioxidants; Ascorbic Acid; Beverages; Carotenoids; Citrus; Collagen; Diet; Flavonoids; Food Handling; Humans; Limonins; Nutrition Policy; Protective Agents; Rats; Scurvy

Vitamin C is a pivotal redox modulater in many biological reactions of which several remain poorly understood. Naturally, vitamin C has been the subject of many investigations over the past decades in relation to its possible beneficial effects on cardiovascular disease primarily based on its powerful yet general antioxidant properties. However, growing epidemiological, clinical and experimental evidence now suggests a more specific role of ascorbate in vasomotion and in the prevention of atherosclerosis. For example, in contrast to most other biological antioxidants, administration of vitamin C can apparently induce vasodilation. Millions of people worldwide can be diagnosed with vitamin C deficiency according to accepted definitions. In this perspective, the present review examines the evidence for a specific link between vitamin C deficiency and increased risk of atherosclerosis as well as the possible mechanisms by which vitamin C may exert its protective function.

Topics: Animals; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Atherosclerosis; Coenzymes; Disease Models, Animal; Dyslipidemias; Endothelium, Vascular; Humans; Lipid Metabolism; Lipids; Nitric Oxide; Nitric Oxide Synthase; Scurvy; Vasodilation

Although ascorbic acid is an important water-soluble antioxidant and enzyme cofactor in plants and animals, humans and some other species do not synthesize ascorbate due to the lack of the enzyme catalyzing the final step of the biosynthetic pathway, and for them it has become a vitamin. This review focuses on the role of ascorbate in various hydroxylation reactions and in the redox homeostasis of subcellular compartments including mitochondria and endoplasmic reticulum. Recently discovered functions of ascorbate in nucleic acid and histone dealkylation and proteoglycan deglycanation are also summarized. These new findings might delineate a role for ascorbate in the modulation of both pro- and anti-carcinogenic mechanisms. Recent advances and perspectives in therapeutic applications are also reviewed. On the basis of new and earlier observations, the advantages of the lost ability to synthesize ascorbate are pondered. The increasing knowledge of the functions of ascorbate and of its molecular sites of action can mechanistically substantiate a place for ascorbate in the treatment of various diseases.

Topics: Animals; Anticarcinogenic Agents; Antioxidants; Ascorbic Acid; Cell Transformation, Neoplastic; Dealkylation; Endoplasmic Reticulum; Glypicans; Histones; Humans; Hydroxylation; Mitochondria; Nucleic Acids; Organelles; Oxidation-Reduction; Proteoglycans; Scurvy; Vitamins

Scurvy is a thousand-year-old stereotypical disease characterized by apathy, weakness, easy bruising with tiny or large skin hemorrhages, friable bleeding gums, and swollen legs. Untreated patients may die. In the last five centuries sailors and some ships' doctors used oranges and lemons to cure and prevent scurvy, yet university-trained European physicians with no experience of either the disease or its cure by citrus fruits persisted in reviews of the extensive but conflicting literature. In the 20(th) century scurvy was shown to be due to a deficiency of the essential food factor ascorbic acid. This vitamin C was synthesized, and in adequate quantities it completely prevents and completely cures the disease, which is now rare. The protagonist of this medical history was James Lind. His report of a prospective controlled therapeutic trial in 1747 preceded by a half-century the British Navy's prevention and cure of scurvy by citrus fruits. After lime-juice was unwittingly substituted for lemon juice in about 1860, the disease returned, especially among sailors on polar explorations. In recent decades revisionist historians have challenged normative accounts, including that of scurvy, and the historicity of Lind's trial. It is therefore timely to reassess systematically the strengths and weaknesses of the canonical saga.

Topics: Ascorbic Acid; Citrus; Clinical Trials as Topic; Humans; Naval Medicine; Scurvy; Sunlight; United Kingdom

Topics: Alcoholism; Anorexia; Ascorbic Acid; Diagnosis, Differential; Early Diagnosis; Erythrocyte Transfusion; Exanthema; Fatigue; Gingival Hypertrophy; Hematoma; Humans; Lethargy; Male; Middle Aged; Muscle Weakness; Prognosis; Risk Factors; Scurvy

Dialogues in Dermatology, a monthly audio program from the American Academy of Dermatology, contains discussions between dermatologists on timely topics. Commentaries from Dialogues Editor-in-Chief Warren R. Heymann, MD, are provided after each discussion as a topic summary and are provided here as a special service to readers of the Journal of the American Academy of Dermatology.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Diagnosis, Differential; Humans; Scurvy

Vitamin C or ascorbic acid is a hydrosoluble vitamin derived from glucose metabolism. It acts as a reductor agent required for synthesis of collagen fibers through hydroxylation of proline and lysine. It also protects the body against damage caused by the free radicals. Humans cannot synthesize ascorbic acid as they lack an enzyme called gulonolactone oxidase. Concentrations in plasma and leukocytes reflect the levels of the diet and body deposits respectively of this vitamin. Among foods with high vitamin C levels are tomatoes, potatoes, and citrus fruits such as limes, oranges and lemons. The current recommendation of daily intake of vitamin C is 90 mg/d for men and 75 mg/d for women. Patients with chronic diseases such as cancer or diabetes or those who smoke need higher doses in their usual diet. Ascorbic acid deficiency gives rise to the appearance of scurvy. This disease is rarely seen in developed countries. The symptoms develop with plasma levels below 0.15 mg/dL. Scurvy is characterized by the presence of weakness, joint pain or skin lesions in form of petechias, gum bleeding, ease of developing bruises or delay in wound healing. The most characteristic skin manifestations are purpuric perifollicular hyperkeratotic papules and the presence of kinky hair.

Topics: Antioxidants; Ascorbic Acid; Clinical Trials as Topic; Humans; Scurvy

Scurvy is the clinical manifestation of vitamin C deficiency. It is historically linked to the era of great maritime expeditions. But it is remerging in Western countries as in France.. Nowadays, scurvy mainly affects homeless populations of large occidental cities and the isolated and malnourished inhabitants of developing countries. The clinical presentations of scurvy are numerous and often misleading and its evolution without treatment is always lethal. After years of wanderings and research, the physiopathological mechanisms of scurvy were finally understood, due to the will of outstanding personalities who took the risk to brave the established superstitions in order to apply a strict medical approach.. Scurvy must still be prevented in at risk-populations. Indeed a pocket meal enriched with vitamin C is distributed to homeless people in Paris.

Topics: Ascorbic Acid; France; Humans; Ill-Housed Persons; Prognosis; Risk Factors; Scurvy

Scurvy, a disease rarely seen in modern times, results from dietary deficiency of vitamin C and is characterized in adults by hemorrhagic diathesis, hair follicle abnormalities, and osteopenia. We present a 59-year-old man with perifollicular petechiae of the extremities, a painful lower extremity hematoma, and sacral osteopenia, who was repeatedly misdiagnosed with leukocytoclastic vasculitis. The patient's dietary history revealed several months of virtually no vitamin C intake. The patient rapidly improved with vitamin C replacement. We review the biochemical basis and pathophysiology of scurvy, clinical scenarios in which it occurs, clinical signs and radiologic features of the condition, and recommendations for its diagnosis and treatment.

Topics: Ascorbic Acid; Diagnosis, Differential; Humans; Male; Middle Aged; Scurvy; Vasculitis, Leukocytoclastic, Cutaneous

To study the dietary factors, clinical findings, plasma vitamin C level and post-treatment outcome of scurvy in pediatric patients at Queen Sirikit National Institute of Child Health.. A retrospective study.. The medical and radiographic records of pediatric patients, diagnosed with scurvy at Queen Sirikit National Institute of Child Health from 1995 to 2002 were reviewed.. Twenty-eight pediatric patients were diagnosed with scurvy. Their ages ranged between 10 months-9 years 7 months (median age of 29 months). 93 per cent of the cases were between 1-4 years of age. All were fed with well-cooked foods and small amounts or no vegetables and fruits. Supplementation with ultra heat temperature (UHT) milk was found in 89 per cent, average 5.8 boxes/day and 14.3 months in duration. Eighty-six per cent of cases were misdiagnosed previously. Clinical manifestations involved limp or inability to walk (96%), tenderness of lower limbs (86%), bleeding per gum (36%), fever (18%), and petechial hemorrhage (3.6%). All cases had abnormal radiographic findings compatible with scurvy and 2 cases had epiphyseal separation. All had clinical improvement within the first week after vitamin C supplementation.. Vitamin C deficiency was found in the children's intake of small amounts or no vegetables and fruits together with UHT-milk. Frequent manifestations were limping and inability to walk and pain in the lower limbs. Response to vitamin C treatment was dramatic.

Topics: Ascorbic Acid; Child; Child, Preschool; Female; Humans; Infant; Male; Retrospective Studies; Risk Factors; Scurvy; Thailand

Topics: Antioxidants; Ascorbic Acid; Biological Availability; Humans; Intestinal Absorption; Neoplasms; Nutritional Requirements; Research Design; Scurvy

The current recommended dietary allowance (RDA) for vitamin C for adult nonsmoking men and women is 60 mg/d, which is based on a mean requirement of 46 mg/d to prevent the deficiency disease scurvy. However, recent scientific evidence indicates that an increased intake of vitamin C is associated with a reduced risk of chronic diseases such as cancer, cardiovascular disease, and cataract, probably through antioxidant mechanisms. It is likely that the amount of vitamin C required to prevent scurvy is not sufficient to optimally protect against these diseases. Because the RDA is defined as "the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all healthy individuals in a group," it is appropriate to reevaluate the RDA for vitamin C. Therefore, we reviewed the biochemical, clinical, and epidemiologic evidence to date for a role of vitamin C in chronic disease prevention. The totality of the reviewed data suggests that an intake of 90-100 mg vitamin C/d is required for optimum reduction of chronic disease risk in nonsmoking men and women. This amount is about twice the amount on which the current RDA for vitamin C is based, suggesting a new RDA of 120 mg vitamin C/d.

Topics: Adult; Antioxidants; Ascorbic Acid; Cardiovascular Diseases; Cataract; Clinical Trials as Topic; Female; Humans; Lipid Peroxidation; Male; Neoplasms; Nutrition Policy; Scurvy

Unlike most animals, which form ascorbic acid by metabolizing glucose, humans require an exogenous source. Vitamin C occurs primarily in fruits and vegetables, and scurvy develops from inadequate consumption of these sources, usually because of ignorance about proper nutrition, psychiatric disorders, alcoholism, or social isolation. The earliest symptom of scurvy, occurring only after many weeks of deficient intake, is fatigue. The most common cutaneous findings are follicular hyperkeratosis, perifollicular hemorrhages, ecchymoses, xerosis, leg edema, poor wound healing, and bent or coiled body hairs. Gum abnormalities, which occur only in patients with teeth, include gingival swelling, purplish discoloration, and hemorrhages. Pain in the back and joints is common, sometimes accompanied by obvious hemorrhage into the soft tissue and joints. Syncope and sudden death may occur. Anemia is frequent, leukopenia occasional. Treatment with vitamin C results in rapid, often dramatic, improvement. (J Am Acad Dermatol 1999;41:895-906.). At the conclusion of this learning activity, participants should be familiar with the history, pathogenesis, clinical features, and treatment of scurvy in adults.

Topics: Adult; Animals; Ascorbic Acid; Cardiovascular Diseases; History, 15th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Nutrition Policy; Respiratory Tract Diseases; Scurvy; Skin Diseases

Topics: Ascorbic Acid; Citrus; Diagnosis, Differential; Female; Humans; Infant; Leg; Magnetic Resonance Imaging; Radiography; Scurvy; Venous Thrombosis

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Diagnosis, Differential; Humans; Infant; Prognosis; Purpura; Scurvy

Topics: Ascorbic Acid; Diagnosis, Differential; Endoscopy, Gastrointestinal; Gastrointestinal Diseases; Humans; Male; Middle Aged; Scurvy

Although gingival bleeding is a manifestation of both scurvy and inflammatory periodontal disease, the two conditions are distinctly separate entities. The defective collagen synthesis associated with scurvy also manifests many of the same symptoms as deficient vitamin C physiology, but neither condition is associated with periodontal disease. Unlike scurvy, the various periodontal diseases are caused by oral plaque microorganisms. The body's reaction to these microorganisms is strongly influenced by the compromised functioning of leucocytes and monocytes. Although certain infections and systemic diseases cause gingival bleeding, avitaminosis-C does not cause commonly encountered periodontitis. Vitamin C should not be used for the prophylaxis or cure of periodontal disease in otherwise healthy, well-nourished individuals. A patient with bleeding gingivae warrants referral to a periodontist, oral medicine specialist, or appropriately qualified dentist for examination and treatment.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Collagen; Dental Plaque; Diagnosis, Differential; Gingival Hemorrhage; Humans; Leukocytes; Monocytes; Mouth Diseases; Periodontal Diseases; Periodontitis; Scurvy

Topics: Antioxidants; Ascorbic Acid; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; Humans; Nutritional Requirements; Scurvy

Topics: Animals; Antioxidants; Ascorbic Acid; Diabetes Complications; Diabetes Mellitus; Glucose; Glycosylation; Humans; Iron; Oxidants; Oxidation-Reduction; Oxidative Stress; Proteins; Scurvy

The clinical description of scurvy is well recorded in the history of medicine. Yet, because scurvy is relatively uncommon in industrially developed countries, it is often underdiagnosed, and unnecessary tests are performed. The result of a prolonged deficiency of ascorbic acid, scurvy is classically manifested by perifollicular hemorrhages, corkscrew hairs, large ecchymoses and hemorrhagic gingivitis. Although the disease is considered uncommon in the United States, two populations at greatest risk--the institutionalized elderly and alcoholics--are increasing.

Topics: Ascorbic Acid; Humans; Male; Middle Aged; Scurvy

Vitamin C deficiency is associated with defective connective tissue, particularly in wound healing. Ascorbate is required for hydroxylation of proline residues in procollagen and hydroxyproline stabilizes the collagen triple helical structure. Consequently, ascorbate stimulates procollagen secretion. However, collagen synthesis in ascorbate-deficient guinea pigs is decreased with only moderate effects on proline hydroxylation. Proteoglycan synthesis, which does not require ascorbate, also is decreased and both effects are correlated with the extent of weight loss during scurvy. Fasting, with ascorbate supplementation, produces similar effects. Both functions are inhibited in cells cultured in sera from either scorbutic or starved guinea pigs and inhibition is reversed with insulin-like growth factor (IGF)-I. The inhibitor appears to consist of two IGF-binding proteins induced during vitamin C deficiency and starving and may be responsible for in vivo inhibition of collagen and proteoglycan synthesis.

Topics: Animals; Ascorbic Acid; Carrier Proteins; Cartilage; Cells, Cultured; Collagen; Humans; Hydroxylation; Insulin-Like Growth Factor Binding Proteins; Insulin-Like Growth Factor I; Procollagen; Proteoglycans; Scurvy; Starvation

Scurvy is caused by severe deficiency of vitamin C or ascorbic acid, and is usually diagnosed by the overt clinical signs which appear at an advanced stage. Laboratory examinations, and in particular ascorbic acid assays, do not yet enable subclinical vitamin C deficiency to be reliably detected; hence the importance of knowing the situation which expose to this deficiency.

Topics: Ascorbic Acid; Diet; Humans; Scurvy

Topics: Amino Acid Sequence; Animals; Ascorbic Acid; Base Sequence; DNA; Humans; L-Gulonolactone Oxidase; Molecular Sequence Data; Mutation; RNA, Messenger; Scurvy; Sugar Alcohol Dehydrogenases

Examination of the physiological activity of flavonoids in relation to their antiscorbutic properties shows that some of these compounds, the flavan-3-ols, have a particular nutritional impact and consequently should be distinguished from the rest of the flavonoids and polyphenols. Therefore, the use of the term 'Vitamin P' and 'Bioflavonoids' is also discussed.

Topics: Animals; Ascorbic Acid; Capillary Permeability; Flavonoids; Humans; Nutritional Physiological Phenomena; Scurvy

The importance of vitamin C is reflected in its multifunctional roles which include participation in collagen and carnitine syntheses, promotion of iron absorption and the more recently discovered participation in noradrenaline synthesis, inactivation of free radical chain reactions, prevention of N-nitroso compound formation and more. Given the many extra-antiscorbutic functions of the vitamin, the Recommended Dietary Allowances (RDA) should not just prevent deficiency disease but should aim at providing sufficient amounts for all vitamin C-dependent functions to operate at full capacity. The concept of vitamin C tissue saturation is best able to meet this demand. The use of kinetic models has shown that the body pool is saturated with a daily intake of 100 mg vitamin C in non-smokers and 140 mg in smokers, amounts that may be regarded as optimal RDA values. Certain disease states may be accompanied by still higher vitamin C requirements but the exact amounts are not yet known.

Topics: Animals; Ascorbic Acid; Humans; Kinetics; Nutritional Requirements; Scurvy; Species Specificity

Topics: Animals; Ascorbic Acid; Bone Diseases; Dog Diseases; Dogs; Hip Dislocation, Congenital; Hip Dysplasia, Canine; Osteochondritis; Scurvy

Topics: Animals; Ascorbic Acid; Chemical Phenomena; Chemistry; Chromaffin System; Collagen; Electron Transport; Half-Life; Homeostasis; Hormones; Humans; Hydroxylation; Immunity; Models, Biological; Norepinephrine; Nutritional Requirements; Oxidation-Reduction; Pharmaceutical Preparations; Scurvy; Species Specificity

Scurvy and periodontitis both manifest gingival bleeding but constitute separate entities. Defective collagen in scurvy reflects many symptoms emanating from deficient vitamin C physiology. The various periodontal diseases are caused by oral plaque micro-organisms, the body's reaction to which is strongly influenced by inadequate functioning of leucocytes and monocytes. Although certain infections and systemic diseases cause gingival bleeding, avitaminosis C does not cause commonly encountered periodontal disease, but will aggravate established periodontitis. Vitamin C should not be used for prophylaxis or cure of periodontitis in healthy well-nourished individuals. A patient with bleeding gingivae warrants referral to oral medicine and periodontics specialists for examination and treatment.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Chronic Disease; Humans; Male; Periodontal Diseases; Periodontitis; Scurvy

Vitamin C (ascorbic acid) has been known to prevent scurvy for many years. Recent research has shown its importance in lipid and iron metabolism. Vitamin C may also have some effect on the immune system. There is not as yet conclusive evidence that ascorbic acid may cure or prevent colds or cancer. The vitamin has few side effects even when ingested in large quantities. Several methods for analysis of ascorbic acid have been developed. These include titration and fluorometric methods, a ferrozine technique automated for centrifugal analyzers, a high performance liquid chromatography method, and a dip-stick for urine ascorbic acid.

Topics: Aged; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Chemical Phenomena; Chemistry; Child; Common Cold; Female; Guinea Pigs; Humans; Infant; Lipid Metabolism; Male; Mice; Rabbits; Scurvy

Topics: Adult; Animals; Ascorbic Acid; Deferoxamine; Ferritins; Guinea Pigs; Haplorhini; Hemochromatosis; Hemosiderin; Humans; Iron; Iron Chelating Agents; Liver; Male; Rats; Scurvy; Spleen; Thalassemia

Topics: Adult; Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Humans; Leukocytes; Male; Middle Aged; Nutritional Requirements; Scurvy; Seasons

Ascorbic acid in physiological doses is essential for the normal functioning of the human body. Larger doses are required to treat a severe deficiency of vitamin C intake, as in the case of scurvy. Occasionally, massive doses may be required to treat a metabolic defect involving ascorbic acid. There has been some mention of megadose therapy with ascorbic acid for the prevention of colds, the improved healing of wounds and even the treatment of cancer, but no acceptable scientific data have been presented. In fact, in a few instances, such therapy has proved injurious.

Topics: Ascorbic Acid; Chediak-Higashi Syndrome; Common Cold; Female; Humans; Immunity; Infant; Male; Neoplasms; Scurvy; Wound Healing

Topics: Ascorbic Acid; Biotin; Choline; Hartnup Disease; Humans; Inositol; Nicotinic Acids; Nutritional Physiological Phenomena; Nutritional Requirements; Pantothenic Acid; Scurvy; Vitamin B Complex

Host resistance to neoplastic growth and invasiveness is recognized to be an important factor in determining the occurrence, the progress, and the eventual outcome of every cancer illness. The factors involved in host resistance are briefly reviewed, and the relationship between these factors and ascorbic acid metabolism is presented in detail. It is shown that many factors involved in host resistance to neoplasia are significantly dependent upon the availability of ascorbate.

Topics: Animals; Ascorbic Acid; Carcinogens; Collagen; Extracellular Space; History, 18th Century; History, 20th Century; Humans; Hyaluronoglucosaminidase; Immunity; Neoplasm Invasiveness; Neoplasms; Pituitary-Adrenal System; Scurvy

Topics: Animals; Ascorbic Acid; Flavins; Guinea Pigs; Haplorhini; Humans; Kinetics; Lactones; Molecular Weight; Scurvy; Species Specificity; Sugar Alcohol Dehydrogenases

Topics: Acute Disease; Animals; Arteriosclerosis; Ascorbic Acid; Ascorbic Acid Deficiency; Bile Acids and Salts; Cholesterol; Cholesterol, Dietary; Chronic Disease; Fatty Liver; Humans; Hypercholesterolemia; Lipid Metabolism; Liver Cirrhosis; Scurvy

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Cholesterol; Cholesterol, Dietary; Cholic Acids; Humans; Hypercholesterolemia; Scurvy

Topics: Animals; Ascorbic Acid; Child; Female; Gingival Diseases; Hemorrhage; Humans; Infant; Joint Diseases; Nutritional Requirements; Scurvy

Topics: Animals; Ascorbic Acid; Chick Embryo; Collagen; Glycine; Granuloma; Guinea Pigs; Hydroxyproline; Iron; Ketoglutaric Acids; Procollagen-Proline Dioxygenase; Proline; Rats; Scurvy; Skin

Topics: Adult; Age Factors; Anemia; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Bone Diseases, Developmental; Capillaries; Child; Collagen Diseases; Connective Tissue; Creatinine; Dentin; Gingival Hemorrhage; Hemorrhage; Humans; Hydroxyproline; Infant; Scurvy; Skin Diseases; Species Specificity

Topics: Animals; Ascorbic Acid; Aspartic Acid; Biological Evolution; Dehydroascorbic Acid; Diabetes Mellitus; Guinea Pigs; Histamine; Humans; Kidney; Liver; Microsomes; Organ Specificity; Rats; Scurvy; Species Specificity

Topics: Administration, Oral; Aged; Antigen-Antibody Reactions; Ascorbic Acid; Aspirin; Child; Common Cold; Female; Fenfluramine; Humans; Hypersensitivity; Leukemia; Leukocytes; Lung Neoplasms; Male; Mouth Mucosa; Nutritional Requirements; Scurvy

Topics: Adrenal Glands; Alcohol Oxidoreductases; Alloxan; Animals; Ascorbic Acid; Caseins; Dactinomycin; Diabetes Mellitus, Experimental; Diet; Dietary Proteins; Guinea Pigs; Hormones; Humans; Insulin; Liver; Metals; Phagocytosis; Pituitary Gland; Rats; RNA; Scurvy; Thyroid Gland

Topics: Age Factors; Animals; Ascorbic Acid; Child; Common Cold; Female; Guinea Pigs; Health; Humans; Kidney; Leukocytes; Male; Nutritional Requirements; Scurvy; Sex Factors

Topics: Adrenal Glands; Animals; Ascorbic Acid; Dactinomycin; Guinea Pigs; Immunochemistry; Male; Precipitin Tests; Protein Biosynthesis; Puromycin; Rabbits; Scurvy; Time Factors; Tyrosine 3-Monooxygenase

Topics: Animals; Ascorbic Acid; Cell Division; Glycosaminoglycans; Hormones; Humans; Hyaluronoglucosaminidase; Neoplasms; Neoplasms, Experimental; Scurvy

Topics: Animals; Ascorbic Acid; Birds; Carbon Isotopes; Chiroptera; Drug Stability; Fishes; Glucose; Guinea Pigs; Humans; Organ Specificity; Oxidation-Reduction; Plants; Primates; Rats; Scurvy; Species Specificity; Sulfur Isotopes; Sulfuric Acids; Tritium

Topics: Animals; Ascorbic Acid; Fishes; Guinea Pigs; Humans; Male; Rats; Scurvy; Sulfuric Acids

Topics: Animals; Ascorbic Acid; Carbon Isotopes; Cells, Cultured; Collagen; Culture Techniques; Dopamine beta-Hydroxylase; Granuloma; Guinea Pigs; Hydroxylation; Hydroxylysine; Hydroxyproline; Keto Acids; Lysine; Mixed Function Oxygenases; Oxidation-Reduction; Procollagen-Proline Dioxygenase; Proline; Protein Precursors; Scurvy; Tritium; Urine

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Common Cold; Depression; Guinea Pigs; Humans; Male; Miliaria; Nutritional Requirements; Scurvy; Sjogren's Syndrome; Skin Manifestations; Urinary Bladder Neoplasms

Topics: Animals; Antigens; Ascorbic Acid; Growth Inhibitors; Hormones; Hydrolases; Islets of Langerhans; Lysosomes; Metamorphosis, Biological; Mitosis; Mixed Function Oxygenases; Odorants; Scurvy

Topics: Animals; Ascorbic Acid; Biochemical Phenomena; Biochemistry; Chemistry Techniques, Analytical; Collagen; Glycosides; Humans; Oxidation-Reduction; Plants; Scurvy; Steroids; Tyrosine

Topics: Adult; Anemia, Hemolytic; Anemia, Macrocytic; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Cell Count; Bone Marrow Cells; Erythrocytes; Erythropoiesis; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemolysis; Hemorrhagic Disorders; Humans; Iron; Leukocytes; Liver; Reticulocytes; Scurvy; Tissue Extracts; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adaptation, Physiological; Ascorbic Acid; Common Cold; Humans; Scurvy

Topics: Adult; Ascorbic Acid; Carbon Dioxide; Carbon Isotopes; Chromatography, Thin Layer; Clinical Trials as Topic; Creatinine; Diet; Humans; Male; Models, Theoretical; Nitrogen; Nutritional Physiological Phenomena; Nutritional Requirements; Scurvy; Time Factors

Topics: Adult; Ascorbic Acid; Carbon Isotopes; Clinical Trials as Topic; Diet; Electrocardiography; Electroencephalography; Enteral Nutrition; Eye Diseases; Feces; Glucose Tolerance Test; Hematology; Hemorrhage; Humans; Keratosis; Male; Nutritional Physiological Phenomena; Nutritional Requirements; Oral Hemorrhage; Scurvy; Skin Diseases; Urine

Topics: Adult; Ascorbic Acid; Clinical Trials as Topic; Humans; Iron; Male; Oxalates; Oxidation-Reduction; Scurvy; Siderosis; South Africa

Symptomatic vitamin C deficiency, scurvy, is a relatively rare disease in developed countries, but it has been reported in patients with autism spectrum disorder or developmental delay who tend to have selective diets. Patients with scurvy often demonstrate musculoskeletal manifestations with unknown pathophysiology. Herein, we report a case of scurvy in an 11-year-old boy who presented with iron-deficiency anaemia, systemic osteomyelitis, myositis predominantly in the lower extremities, and right ventricular volume overload with mild pulmonary hypertension and was diagnosed with scurvy. He had a mild developmental disorder and a selective diet, which resulted in severe vitamin C deficiency. He received intravenous and oral vitamin C supplementation, which relieved his arthralgia and muscle pain in a week. Following 4 months of vitamin C supplementation, he demonstrated no abnormal manifestations on laboratory or imaging examination and recovered without sequelae. Inflammatory cytokine and chemokine evaluations demonstrated elevated levels of interleukin (IL)-6, IL-17A, and IL-23, which are associated with T-helper (Th) 17 cell activation. This study is the first to suggest the association between the inflammation seen in scurvy, rheumatic manifestations in the patient, and Th17 cell activation. Further analysis of the association between the inflammation and vitamin C supplementation may contribute to new insights for the comprehension and treatment of other inflammatory diseases, such as rheumatic diseases.

Topics: Arthritis, Rheumatoid; Ascorbic Acid; Ascorbic Acid Deficiency; Autism Spectrum Disorder; Child; Humans; Inflammation; Interleukin-17; Interleukin-23; Interleukin-6; Male; Scurvy

We describe diffuse microporotic lesions observed in most of the scattered skeletal remains belonging to a ≈ 6 months-old female (genetic sexing) prehispanic (antiquity ≈ 600 years BP) individual recovered from a small recess of a basaltic burial cave in the highlands (2300 m above sea level) of Tenerife. Although sphenoid wings were lacking, microporotic lesions were present in several bones, especially in the hard palate, basilar part of the occipital bone, outer aspect of the maxilla, and proximal half of the right humerus, accompanied by a subtle periosteal reaction. Although non-specific, bone lesions may be compatible with scurvy, possibly in the context of malnutrition, that probably also affected the mother, given the young age of the infant and her dependence on maternal feeding. Pathophysiological connections among iron deficiency, vitamin C deficiency and vitamin D deficiency are discussed. Both observational reports on paleopathological cases of diffuse microporotic lesions as well as experimental studies devoted to discern the relative and combined effects of hypoxia-mediated bone marrow expansion, protein-calorie malnutrition, ascorbate, vitamin D or iron deficiency on such lesions are needed.

Topics: Ascorbic Acid; Bone and Bones; Female; Humans; Infant; Scurvy; Vitamin D; Vitamins

Topics: Adolescent; Anemia; Ascorbic Acid; Humans; Neoplasms; Scurvy; Thrombocytopenia

Topics: Ascorbic Acid; Diagnosis, Differential; Humans; Scurvy; Vasculitis

Scurvy is a deadly disease caused by a lack of vitamin C in the diet. Although frequently considered a disease from the past, it still occurs in modern-day society, including in developed countries.. We report a case of an 18-year-old male who was admitted with bleeding into his legs, prolonged prothrombin time and partial thromboplastin time, and anemia requiring a blood transfusion. His history included congenital deafness and a restrictive eating pattern primarily consisting of fast food. He was deficient in folic acid, vitamin K, and vitamin C. Scurvy best explained the bleeding, and he improved with vitamin supplementation.. Scurvy is a collagen production disorder that can cause bleeding on the skin and mucous membranes. Although rare in industrialized nations, scurvy is typically the result of a restrictive diet or malnutrition. Those who are at a particularly high risk are the elderly, alcohol abusers, and those with eating disorders.. Scurvy is easily treatable but can be missed; therefore, a high level of suspicion should be present in patients at risk for malnutrition. Those diagnosed with scurvy should be screened for concomitant nutritional deficiencies.

Topics: Adolescent; Aged; Anemia; Ascorbic Acid; Humans; Male; Scurvy; United States

Scurvy is taught in history class and most doctors consider it a disease of the past. However, several studies show that vitamin C deficiency is highly prevalent among alcoholics, but also in elderly, people with low socioeconomic status, mental disorders or a restricted diet (7.1 - 25%). Besides the classical signs of scurvy, individuals exhibit a wide variety of symptoms. We present three recent cases of patients with vitamin C deficiency, with symptoms of bleeding, lethargy and edema, in whom supplementation greatly improved symptoms. As our cases illustrate having a high suspicion of scurvy and starting ascorbic acid might be a low cost and very effective intervention.

Topics: Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Mental Disorders; Scurvy

Vitamin C (VC) is implicated in many physiological pathways. Vitamin C deficiency (VCD) can compromise the health of patients with metabolic and bariatric surgery (patients). As symptoms of VCD are elusive and data on VCD in patients is scarce, we aim to characterize patients with measured VC levels, investigate the association of VCD with other lab abnormalities, and create predictive models of VCD using machine learning (ML).. A retrospective chart review of patients seen from 2017 to 2021 at a tertiary care center in Northeastern USA was conducted. A 1:4 case mix of patients with VC measured to a random sample of patients without VC measured was created for comparative purposes. ML models (BayesNet and random forest) were used to create predictive models and estimate the prevalence of VCD patients.. Of 5946 patients reviewed, 187 (3.1%) had VC measures, and 73 (39%) of these patients had VC<23 μmol/L(VCD. When comparing patients with VCD to patients without VCD, the ML algorithms identified a higher risk of VCD in patients deficient in vitamin B1, D, calcium, potassium, iron, and blood indices. ML models reached 70% accuracy. Applied to the testing sample, a "true" VCD prevalence of ~20% was predicted, among whom ~33% had scurvy levels (VC<11 μmol/L).. Our models suggest a much higher level of patients have VCD than is reflected in the literature. This indicates a high proportion of patients remain potentially undiagnosed for VCD and are thus at risk for postoperative morbidity and mortality.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Bariatric Surgery; Humans; Machine Learning; Obesity, Morbid; Retrospective Studies; Scurvy; Vitamins

Severe vitamin C deficiency, or scurvy, presents as a syndrome of multisystem abnormalities associated with defective collagen synthesis and antioxidative functions. The many clinical features of scurvy lead to frequent misdiagnoses, as they can often point to other diseases, such as vasculitis, venous thrombosis and musculoskeletal disorders. As such, an extensive workup is recommended in cases in which scurvy is suspected.. A 21-month-old male patient and a 36-month-old female patient presented with difficulty in walking, painful joint movements, irritability, gingival hypertrophy and bleeding. After exhaustive investigations and risky invasive procedures, vitamin C deficiency was diagnosed in both cases, and the symptoms improved dramatically with vitamin C treatment.. The importance of taking a dietary history in pediatric patients is highly recommended. In cases where scurvy is considered, serum ascorbic acid levels should be checked to confirm the diagnosis prior to conducting invasive tests.

Topics: Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Child, Preschool; Female; Humans; Infant; Male; Scurvy; Vitamins

Multiple vitamin deficiencies together with endocrinopathy may be encountered in individuals presenting with critical illness. Following the surprise postmortem diagnosis of concomitant scurvy, Wernicke, and hypothyroidism in an elderly woman presenting with a mix of atypical symptoms, patients considered at risk were tested for TSH, vitamin C, and thiamin levels. Between September 1, 2018, and December 31, 2022, 801 vitamin C levels in 679 patients were measured in our rural hospital and 309 (39%) were found <0.4 mg/dL. In this population, 39% of 626 thiamin levels were found to be low. Twenty-two patients with vitamin C and/or thiamin deficiency and elevated TSH levels were identified. Two patients died from scurvy; one also had myxedema. The incidence of vitamin C and thiamin deficiency in our patient population was higher than expected. Further studies should determine if this is unique to our rural setting or part of a bigger trend associated with poor dietary choices.

Topics: Aged; Ascorbic Acid; Female; Humans; Hypothyroidism; Scurvy; Thiamine; Thyrotropin

Topics: Ascorbic Acid; Humans; Scurvy; Vitamins

BACKGROUND Despite being considered a disease of the past, pediatric scurvy is increasingly reported in developed countries, especially among children with autism spectrum disorder, developmental delays, or a restrictive diet. Pediatric patients typically present with lower extremity pain or refusal to walk. This case study features an atypical presentation of scurvy in a non-ambulatory patient. CASE REPORT A 14-year-old boy with arthrogryposis multiplex congenita displayed a late-stage scurvy symptom: a necrotic gastrostomy tube site, indicative of poor wound healing due to vitamin C deficiency. The usual telltale symptoms of scurvy were camouflaged due to his non-ambulatory status, which may have contributed to a delayed presentation. Nevertheless, a comprehensive clinical evaluation, incorporating diet history, gingival symptoms, petechiae, and characteristic radiological signs, eventually led to the correct diagnosis. Although acute osteomyelitis was initially suspected, it was subsequently ruled out. Upon initiation of vitamin C therapy, the patient's symptoms subsided within a few days, and the necrotic tissue surrounding the gastrostomy tube healed completely within two weeks. CONCLUSIONS The highlighted case underscores the importance of including scurvy in the differential diagnosis for pediatric patients with lower extremity pain without fever. A detailed dietary history focusing on vitamin C intake is crucial during clinical evaluation. Early initiation of vitamin C therapy, when scurvy is suspected, may prevent unnecessary and extensive diagnostic workup for other potential causes, offering timely relief to the patient.

Topics: Adolescent; Ascorbic Acid; Autism Spectrum Disorder; Child; Gastrostomy; Humans; Male; Pain; Scurvy

Topics: Ascorbic Acid; East Asian People; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Humans; Malnutrition; Scurvy

We present a 17-month-old girl with postencephalitic sequelae only on high-calorie cereal milk through a nasogastric tube. She presented with a 3-week history of swelling and decreased lower limb movements. Synovial fluid analysis ruled out septic arthritis. Plain radiograph and magnetic resonance imaging (MRI) were suggestive of scurvy. She was diagnosed to have pseudoparalysis secondary to scurvy. She was started on vitamin C supplements, after which she showed good clinical improvement.. This case report is to re-emphasize the need for awareness of the possibility of scurvy in children with poor nutritional status due to feeding difficulties.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child, Preschool; Female; Humans; Infant; Magnetic Resonance Imaging; Radiography; Scurvy

The 1st millennium BCE in Italy was a time of agricultural intensification of staple cereal production which shaped sociocultural, political, and economic spheres of pre-Roman groups. The lifeways and foodways of the Etruscans, the greatest civilization in western Europe before Roman hegemony, are traditionally inferred from secondary written sources, funerary archaeology, archaeobotany, and zooarchaeology. However, no direct data extrapolated from the study of human skeletal remains are available to evaluate the extent to which agricultural intensification and decreased dietary diversity impacted health and the expression of skeletal indicators of metabolic disease. Macroscopic and radiological analyses were conducted on an archaeological skeletal sample of non-adults (n = 29) recovered from Pontecagnano (southern Italy) dating to the Orientalizing period (730-580 BCE). This allowed us to identify five cases of scorbutic non-adults and to assign diagnostic values to skeletal lesions of scurvy that have not been previously described in the literature. The onset of scurvy in the examined sample is related to the increased reliance of Etruscans on crops lacking vitamin C in this period of agricultural intensification. The skeletal expression of scurvy varied among the non-adults, with differences in location and disease severity; these were interpreted considering the age-at-death of the individuals coupled with feeding behaviors and interindividual variability.

Topics: Archaeology; Ascorbic Acid; Ascorbic Acid Deficiency; Diet; Europe; Humans; Scurvy

Hypovitaminosis C, or scurvy, is thought to be an uncommon condition. Although prevalent in the 19th century, its ease of absorption and availability in a general diet has greatly reduced its incidence. Vitamin C is necessary for a number of physiological processes and deficiency can result in a number of complications including bleeding/bruising, anaemia and gingival hyperplasia. This case report demonstrates a case of hypovitaminosis C presenting to a tertiary hospital related to poor dietary intake in a patient with behavioural medical conditions. Treatment consisted of oral supplementation of vitamin C with almost immediate resolution of presenting symptoms.

Topics: Ascorbic Acid; Humans; Scurvy; Vitamins

A 23-year-old man with a diagnosis of thalassaemia major on regular blood transfusions presented with complaints of intermittent gum bleeds, joint pain, palpable purpura and ecchymoses in both lower limbs, which was confirmed to be scurvy. He improved dramatically with vitamin C supplementation.

Topics: Ascorbic Acid; Diet; Dietary Supplements; Erythrocyte Transfusion; Humans; Male; Scurvy; Thalassemia; Young Adult

Scurvy is a rare disease caused by a vitamin C deficiency. Vitamin C is a water-soluble vitamin found in vegetables and fruits, but it is lost after boiling. A 59-year-old man presented with gingival pain after having a tooth extracted five years previously. Following the procedure, his diet comprised boiled vegetables to prevent pain. He then experienced bilateral lower leg pain, and computed tomography revealed intramuscular bleeding. His serum vitamin C level was below the detectable limit. His symptoms immediately improved with vitamin C administration. This case emphasized that consuming only boiled vegetables can lead to the onset of scurvy.

Topics: Ascorbic Acid; Diet; Humans; Male; Middle Aged; Musculoskeletal Pain; Scurvy; Vegetables; Vitamins

Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.

Topics: Ascorbic Acid; Child; Humans; Leg; Male; Middle Aged; Pain; Purpura; Scurvy; Vitamins

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.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Crohn Disease; Female; Humans; Myasthenia Gravis; Scurvy; Vitamins

A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and upper and lower extremity ecchymoses that had been present for 3 weeks. His initial laboratory results showed a normocytic anaemia, normal platelet count, slightly abnormal coagulation studies and normal inflammatory markers. Arthrocentesis of the left knee revealed haemarthrosis, and additional laboratory workup found an undetectable serum vitamin C (ascorbic acid) level consistent with scurvy. It was determined that scurvy had predisposed the patient to injury, leading to haemarthrosis. Following vitamin C supplementation, dietary and activity modifications, and acetaminophen as needed, the patient's serum vitamin C level normalised and his left knee pain and swelling improved. Scurvy is a rare cause of haemarthrosis, but it should be recognised in at-risk patients since treatment is effective.

Topics: Ascorbic Acid; Diet; Hemarthrosis; Humans; Lower Extremity; Male; Scurvy

In modern society, scurvy is well known in its historical perspective rather than clinical relevance. Scurvy is classically thought to manifest with signs of 'bleeding painful gums' in the undernourished. Little is known regarding its ability to mimic a wide range of rheumatological, orthopaedic, neurological and haematological illnesses. Due to the rarity of its occurrence, there is a poor understanding among present-day clinicians, and so scurvy can easily deceive the uninitiated. We report a school-aged boy with normal neurodevelopment who presented with lower limb pain and difficulty in walking. He was seen by multiple specialist doctors before the clinical diagnosis of scurvy was made by a general paediatrician. Investigations showed that this child had X-ray changes typical of scurvy with low serum ascorbic acid levels. On supplementation with vitamin C, he showed dramatic improvement in symptoms and gradually achieved complete recovery.

Topics: Ascorbic Acid; Child; Humans; Male; Pain; Scurvy; Vitamins; Walking

Topics: Ascorbic Acid; Humans; Scurvy

A man in his 50s with dialysis-dependent end-stage renal disease, several weeks history of progressive skin bruising and acute-onset gastrointestinal bleeding presented to the emergency department following a syncopal event during routine haemodialysis owing to profound hypotension. He was found to have a severe normocytic, normochromic anaemia requiring several blood transfusions. He followed a diet lacking fruits and vegetables and stopped taking renal multivitamins. All parameters of coagulation were unremarkable, but serum vitamin C level was undetectable, supporting a diagnosis of scurvy. Although typically associated with individuals who are at risk of malnourishment, such as those with alcohol use disorder, malabsorption, and those who experience homelessness, scurvy should be considered in patients receiving renal replacement therapy as vitamin C is removed during haemodialysis.

Topics: Anemia; Ascorbic Acid; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Renal Dialysis; Scurvy; Vitamins

Vitamin C deficiency, historically known as scurvy, was associated with sailors in the Victorian times, however, a global review in 2020 suggests it still exists in certain at-risk groups.A case is presented of a young non-verbal child with learning difficulties and on a restricted diet, in which the primary symptom was gingival inflammation. It posed a diagnostic dilemma due to the non-specific symptoms, and a delay in the diagnosis, until vitamin C deficiency was confirmed.Gingival inflammation is one of the common findings in vitamin C deficiency and dental professionals may be the first point of contact. The importance of dietary evaluation, identifying and looking for other signs and liaising with the medical colleagues are discussed.This case highlights the role of the dentist in identifying latent cases of vitamin C deficiency and to consider this as a differential diagnosis especially in certain at-risk groups.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Diagnosis, Differential; Humans; Inflammation; Scurvy

Scurvy is a rare disease in developed countries and few cases have been reported in adults within the last years. We aimed to report and discuss a case of a 35-year-old male with a medical history of irritable bowel syndrome (IBS) who initially presented to the emergency department with complaints of right leg pain, swelling, and weakness. Physical exam revealed low degree fever associated with right knee and ankle ecchymosis and edema, in addition to a well healing laceration on the anterior tibia with hyperpigmentation. Laboratory results showed elevated inflammatory markers. Due to the high suspicion of bone or soft tissue infection, antibiotic treatment was started without improvement. Upon reassessment and closer inspection of the skin, the patient was noted to have follicular hyperkeratosis and perifollicular hemorrhage; that in combination with a restrictive diet due to IBS, raised the suspicion of scurvy. Vitamin C levels were.

Topics: Adult; Ascorbic Acid; Diagnostic Errors; Edema; Humans; Irritable Bowel Syndrome; Male; Scurvy; Skin

Topics: Ascorbic Acid; Humans; Scurvy; Skin

Topics: Ascorbic Acid; Child; Hematoma, Epidural, Cranial; Humans; Male; Scurvy

Scurvy results from a deficiency of ascorbic acid. This disease first appeared in children during the 19th century with the emergence of new dietary habits; in particular, heating milk that leads to a loss of ascorbic acid. Even though scurvy has become a rare condition in western countries, many cases are still reported in pediatric patients, especially in those who lack proper nutrition due to neurological or psychiatric illnesses. Symptoms include bleeding and swollen gums, loosening of teeth, bone abnormalities, arthralgia, delayed wound healing, anemia, petechiae, and purpura. Bone lesions are mainly irregularities of long bones metaphyses. We report the case of a five-year-old boy who presented with arthralgia and limb deformation (genu valgum). The patient was investigated for vitamin deficiencies to exclude rickets. The radiologic investigations revealed metaphyseal signs compatible with scurvy. During the hospitalization, the patient was observed to have abnormal eating patterns and the scurvy was attributed to malnutrition. Although the occurrence of scurvy is rare, it remains essential to detect this disease in children at risk of developing vitamin deficiencies. Without targeted treatment, the complications of scurvy can be serious and potentially fatal.

Topics: Anemia; Arthralgia; Ascorbic Acid; Child; Child, Preschool; Humans; Male; Nutritional Status; Scurvy

Dear Editor, Scurvy is a nutritional disorder which can develop after prolonged (>1-3 months) severe vitamin C deficiency. Vitamin C is a cofactor in several enzyme reactions involved in collagen synthesis. The defect in collagen causes blood vessel fragility, poor wound healing, mucocutaneous bleedings, hair abnormalities, bone pains, and joint contractures due to periosteal and intraarticular bleeding (1,2). Risk factors for scurvy development are undernutrition, low socioeconomic status, older age, male sex, alcoholism, tobacco smoking, and severe psychiatric illnesses (1-3). The required daily intake for vitamin C is ~60 mg, and this amount of vitamin C can be found in only one medium-sized orange. For this reason, the disease is rarely encountered in developed countries and is often underrecognized by healthcare personnel. Herein, we present an illustrative case of scurvy in order to raise the awareness of this disorder. A 61-year-old Caucasian man was admitted to hospital due to fatigue, hypotension (80/50 mmHg), severe normocytic anemia (hemoglobin 76 g/L), kidney failure (estimated glomerular filtration rate of 6 mL/min/1.73m2) and mild elevation in C-reactive protein (30.9 mg/L). Prior medical history included radical cystoprostatectomy with an ileal conduit performed eight years ago due to a bladder tumor and moderate chronic kidney disease with recurrent urinary tract infections. The patient was also an alcoholic and tobacco smoker, with a very low-income and a poor diet. He did not use any medications. Heteroanamnestically, the current clinical state had developed slowly over several weeks. At admission, the patient was afebrile, lethargic, malnourished, and immobile due to generalized weakness, bone pains, and hip and knee contractures. He had generalized edema, mostly related to kidney failure, as well as severe hypoalbuminemia (serum albumin 19 g/L). There were multiple ecchymoses (Figure 1, a) and perifollicular bleedings (Figure 1, b) in the skin. The teeth were defective, and the patient's facial hair had a "corkscrew" appearance (Figure 1, c). The platelet count was normal, as was the serum fibrinogen level and the prothrombin- and activated partial thromboplastin times. Vancomycin-resistant Enterococcus faecium and multi-drug-resistant Acinetobacter baumanii were isolated from the urine. Therefore, hemodialysis, linezolid, and colistin were started. However, the patient continued to be lethargic, immobile, and with prominent skin bleed

Topics: Anemia; Anticoagulants; Ascorbic Acid; Ascorbic Acid Deficiency; C-Reactive Protein; Colistin; Contracture; Fatigue; Fibrinogen; Humans; Linezolid; Male; Middle Aged; Prothrombin; Renal Insufficiency; Scurvy; Serum Albumin; Thromboplastin; Vancomycin; Vitamins

Patients with inflammatory bowel disease (IBD) are prone to several nutritional deficiencies. However, data are lacking on vitamin C deficiency in Crohn's disease (CD) and ulcerative colitis (UC) patients, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.. To determine proportions and factors associated with vitamin C deficiency in CD and UC patients.. In this retrospective study, we obtained clinical, laboratory and endoscopic data from CD and UC patients presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. All patients had an available plasma vitamin C level. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301 ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency (≤ 11.4 μmol/L) rates in IBD. Secondary analyses compared proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.. Of 301 IBD patients, 21.6% had deficiency, including 24.4% of CD patients and 16.0% of UC patients. Patients with elevated C-reactive protein (CRP) (39.1%. Vitamin C deficiency was common in IBD. Patients with elevated inflammatory markers and penetrating disease had higher rates of vitamin C deficiency.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Biological Products; Biomarkers; C-Reactive Protein; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Leukocyte L1 Antigen Complex; Prevalence; Retrospective Studies; Scurvy; Vitamin D Deficiency

Scurvy, a disease caused by a severe lack of vitamin C in the diet, is most often associated with 17th-century sailors. Its 21st-century manifestation is a disease of the poor, sick, and those living in remote rural neighborhoods in which fresh, nutritious food is hard to come by. It is caused by a deficiency of Vitamin C and is rare in the United States. We describe the radiographic and MRI findings of a case of scurvy in a child with Noonan syndrome who is a "picky eater". MRI is rarely performed in scurvy as its radiographic findings are generally well known and sufficient for a diagnosis. However, due to the rarity of the disease in the US, MRI features of scurvy have been described in only a few case reports, to date. The rarity of this disease also causes scurvy to be kept lower, if at all in the differential diagnosis list.

Topics: Ascorbic Acid; Child; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Scurvy

The incidences of pediatric scurvy has decreased substantially, particularly in developed countries, but there are still reports of it from developing countries. Unusual manifestations have led to delays in diagnosis and treatment. Nevertheless, there are few publications regarding misdiagnosis of scurvy. The objective is to determine dietary factors, clinical manifestations, laboratory and radiologic findings, treatment, and outcomes of scurvy cases. The occurrence of misdiagnosis and its associated factors are also explored.. The medical records of 0-18 year-old children from 2003 to 2016, diagnosed with scurvy, were included and reviewed. Clinical data, and data regarding feeding history, nutritional status, laboratory and radiologic findings, and misdiagnosis were collected. Univariate and logistic regression analysis were used for identification of the independent associated factors.. The study consisted of 106 children. The boys-to-girls ratio was 2.2:1, and their mean age was 44.65 months ± 30.50 months. The common manifestations were refusal to walk, tenderness, and swelling at the lower extremities. Four participants had unusual manifestations including proptosis and scalp hematoma. Low serum vitamin C level and abnormal radiologic findings were detected in most patients. All of them fully recovered after receiving vitamin C supplementation. Misdiagnosis was identified in 74 cases (69%). Logistic regression analysis revealed that temperature higher than or equal to 38 °C, participants aged 3 years or below, and swelling at lower extremities were independently associated with misdiagnosis (adjusted OR 5.91, 3.78, and 3.56 respectively).. Scurvy still exists, and misdiagnosis often occurs. Taking a careful medical history and conducting a physical examination are still the best way to diagnose scurvy.

Topics: Adolescent; Ascorbic Acid; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Neglected Diseases; Nutritional Status; Scurvy; Vitamins

A previously healthy university student presents to Health Services with sudden onset of pain, fatigue, bruising, and a rapidly progressive anemia. There was not any previous significant health history. The case discussion will emphasize the critical overlap of physical and mental health assessments in identifying the cause and cure of a potentially life-threatening health crisis for a young adult student.

Topics: Acute Pain; Ascorbic Acid; Fatigue; Humans; Malnutrition; Scurvy; Students; Universities; Young Adult

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Scurvy

Topics: Ascorbic Acid; Child; Diet; Humans; Scurvy

Topics: Aged; Anemia; Ascorbic Acid; Avitaminosis; Cognition Disorders; Contusions; Diagnosis, Differential; Diet; Dizziness; Hemoglobins; Humans; Male; Melena; Scurvy

Topics: Alcoholism; Ascorbic Acid; Ecchymosis; Foot; Humans; Leg; Male; Middle Aged; Purpura; Scurvy; Vitamins

Topics: Ascorbic Acid; Bone Marrow; Edema; Humans; Scurvy

Topics: Ascorbic Acid; Cohort Studies; Humans; Scurvy

Topics: Ascorbic Acid; Child; Diagnosis, Differential; Humans; Scurvy; Vitamins

Paediatric scurvy is uncommon in the modern age but cases have been reported in children with neurodevelopmental issues and restricted dietary habits. The broad clinical picture is frequently overlooked as primarily other systemic diseases are considered first leading to extensive investigations and delay in diagnosis. A 4-year-old boy with autism and bilateral lower limb pain and refusal to walk is reported. His restricted diet and radiographic findings were highly suggestive of scurvy which was confirmed by the extremely low levels of ascorbic acid. Treatment with ascorbic acid replenishment and maintenance resulted in remarkable improvement. This case highlights the importance of a high index of suspicion in at-risk children so as to avoid unnecessary invasive investigations and procedures.

Topics: Ascorbic Acid; Child; Child, Preschool; Diagnostic Errors; Feeding Behavior; Humans; Male; Scurvy; Walking

Limping is a common chief complaint in the pediatric emergency department (ED) and can be difficult to assess in pediatric patients, particularly if they have developmental delay.. We present a case of a 5-year-old male with nonverbal autism who presented with a progressive limp, weakness, pain, and rash over the course of 1 month. A magnetic resonance imaging scan of the pelvis performed while the patient was sedated revealed multifocal osseous marrow signal abnormalities, ultimately consistent with vitamin C deficiency or scurvy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Scurvy can present with nonspecific limp, rash, and bony pain and should be considered in pediatric patients with developmental/sensory delay who may restrict their diets. Emergency physicians should broaden their differential diagnoses to nutritional deficiencies such as scurvy in the evaluation of pediatric patients with limp.

Topics: Ascorbic Acid; Autistic Disorder; Child; Child, Preschool; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Scurvy

We present a case of an otherwise healthy 3-year-old child who presented with limping, bone pain, fatigue, and agitation. Differential diagnosis included an infection of the bone, malignancy, an inflammatory bone disease, and metabolic bone disease. Magnetic resonance imaging of the lower limbs and the spine was consistent with scurvy, and the diagnosis was confirmed by very low levels of vitamin C. Further history taking revealed a diet based entirely on dairy pudding, with no fruits or vegetables, and being a "picky eater" was the sole reason. Intravenous treatment with vitamin C led to full recovery. Previous reports of scurvy were in patients with other medical conditions, such as malabsorption, or behavioral conditions as in autism. This case demonstrates that scurvy, an almost forgotten condition from past centuries, can occur in otherwise healthy children and should raise awareness regarding the importance of a balanced diet and proper nutritional history taking. Following growth charts as the only screening tool for balanced and inclusive nutrition may not be sufficient.

Topics: Ascorbic Acid; Child, Preschool; Diagnosis, Differential; Diet; Feeding Behavior; Humans; Mobility Limitation; Pain; Scurvy; Treatment Outcome; Vitamins

Topics: Abnormalities, Multiple; Ascorbic Acid; Darier Disease; Diet; Eyebrows; Hemosiderin; Humans; Male; Middle Aged; Scurvy

An 18-year-old man presented to our hospital with muscular pain, diffuse petechiae, spontaneous thigh ecchymosis, edema and pain of the right knee, bilateral pretibial subcutaneous nodules, and gingival hypertrophy and hemorrhage. His history was positive for a mixed anxiety-depressive disorder and a restrictive diet caused by self-diagnosed food allergies. Skin lesions appeared like hyperkeratotic papules with coiled hairs and perifollicular hemorrhages. A diagnosis of scurvy was made upon demonstration of low serum levels of ascorbic acid. An allergy evaluation found cross-reactivity between pollens and food, related to the presence of panallergens. Moreover, we found that our patient was also affected by celiac disease. In conclusion, scurvy should be considered in the differential diagnosis of patients with petechiae and ecchymosis, especially when food restriction, malabsorption, or psychiatric disorders are present.

Topics: Adolescent; Ascorbic Acid; Diagnosis, Differential; Humans; Male; Scurvy; Skin Diseases

Scurvy, or vitamin C deficiency, is rare. The goal of this study is to highlight the common risk factors and identify the orthopaedic presentation of scurvy in children.. A retrospective chart and radiograph review was performed of all patients consulted to the pediatric orthopaedic service from 2010 to 2019 who ultimately had the diagnosis of scurvy confirmed by an abnormally low serum vitamin C level. Data extracted included: patient age, sex, neurological conditions, prematurity, psychiatric conditions, dietary abnormalities, bone pain, arthritis, limb swelling, inability to walk, skin changes, child abuse evaluations, radiographic findings, additional vitamin deficiencies, lab studies, additional tests, response to treatment. Descriptive statistics were performed.. Nine patients (7 males, 2 females) with scurvy were studied. The average age was 7 years (range 3 to 13 y). The average body mass index was 21.4 (range, 14 to 30). Five had autism, 2 had a neurological disorder. Two had been born premature. Two had a psychiatric disorder. Seven had an abnormal diet. One presented with bone pain. Four presented with limb swelling. Seven had unilateral and 2 had bilateral leg symptoms. Five presented with inability to walk. Six demonstrated skin changes with ecchymosis or petechiae. Three presented with gingival bleeding. Radiographic findings included subperiosteal hematoma in 2, ring epiphysis in 3, Pelkan spurs in 1, metaphyseal white lines (Frankel sign) in 6, and a metaphyseal zone of rarefaction (Trummerfeld zone) in 3. Seven had additional vitamin deficiencies including: A, B1, B6, B9, D, E, K, iron and zinc. Four had a bone marrow biopsy and 1 had lumbar puncture. All were anemic. The average erythrocyte sedimentation rate was 25.7 (range 6 to 35) and C-reactive protein was 1.5 (range 0.55 to 5.64). Six had a computed tomography, 3 had a magnetic resonance imaging. After treatment with vitamin C lasting 3.4 months (range, 2 wk to 7 mo), all symptoms gradually resolved, including leg pain and swelling. All children began to walk.. The pediatric orthopaedic surgeon should have an increased awareness about the diagnosis of scurvy when consulted on a child with bone pain or inability to walk. The most common orthopaedic presentation was the refusal to bear weight, the most common radiographic finding was the metaphyseal line of increased density (Frankel sign) and treatment with vitamin c supplementation was excellent in all cases.

Topics: Adolescent; Ascorbic Acid; Body Mass Index; Child; Child, Preschool; Dietary Supplements; Female; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Musculoskeletal Pain; Orthopedics; Pennsylvania; Radiography; Retrospective Studies; Risk Factors; Scurvy; Ultrasonography; Vitamins; Walking

Topics: Ascorbic Acid; Hematemesis; Hemorrhage; Humans; Scurvy

Although the symptoms related to vitamin C deficiency were known in ancient Egypt and eighteenth century Scottish surgeon James Lind found that scurvy (a disease resulting from insufficient dietary ingestion of vitamin C) could be effectively treated with citrus fruit, this vitamin was discovered only in the year 1912 and then after 21 years it was chemically synthetized and introduced to the market as the first vitamin supplement [...].

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Citrus; Diet; Dietary Supplements; Humans; Scurvy; Vitamins

Scurvy is a disease caused by chronic vitamin C deficiency. The greater prevalence was found in the paediatric population with neurodevelopmental disorders such as autism spectrum disorders due to their restricted dietary intake. Our case reported a child with autism who presented with arthralgia and anaemia. Systemic lupus erythematosus was the first diagnostic impression, resulting in over investigation and delayed diagnosis of vitamin C deficiency. After the child was treated with ascorbic acid, the child's symptoms resolved. This case highlighted the importance of developmental and nutritional history taking in the paediatric population. Furthermore, parents and physicians should be concerned about nutritional status, especially in children with restrictive dietary intake.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Autism Spectrum Disorder; Child; Humans; Lupus Erythematosus, Systemic; Scurvy

In October 2016, we received reports of five deaths among prisoners with leg swelling of unknown etiology in southwestern Ethiopia. A descriptive cross-sectional study was conducted to investigate the outbreak. A suspected case was defined as a prisoner with leg swelling of unknown etiology noted between May 15, 2016 and November 29, 2016. A total of 118 suspected cases were identified with unilateral or bilateral leg swelling without an identifiable cause from a total of 2,790 prisoners. Eight of the suspected cases were thoroughly examined, and seven of these suspected cases had clinical findings consistent with scurvy. Three of the clinical cases had undetectable vitamin C levels in the serum. The attack rate for the prison was 4.2% (118/2,790), and 11 deaths were identified, making the case fatality rate 9.3% (11/118). Clinical cases of scurvy had symptoms of fatigue, myalgia, arthralgia, and signs of follicular hyperkeratosis, petechiae, peripheral edema, and oral lesions. All clinical cases had severe anemia with hemoglobin < 6.0 g/dL. The diet provided by the prison excluded fruits and vegetables. Scurvy was determined to be the cause of the outbreak, and vitamin C supplementation was promptly initiated. All symptomatic prisoners improved, and no further cases were identified in a 4-week follow-up period of active surveillance.

Topics: Adult; Ascorbic Acid; Cross-Sectional Studies; Diet; Disease Outbreaks; Ethiopia; Hemoglobins; Humans; Lower Extremity; Male; Prisons; Scurvy

BACKGROUND Scurvy secondary to deficiency of vitamin C is a rare condition in children. The polymorphism of clinical signs and symptoms makes scurvy diagnosis a challenge for the pediatrician. CASE REPORT A 3-year-old girl came to our observation because she refused to walk and to stand, she showed petechiae, follicular hyperkeratosis on the limbs, and bleeding gums. After a physical exam, laboratory tests, and X-ray examinations, we suspected scurvy disease and started treatment with vitamin C. During the hospitalization, some relationship difficulties of the little girl emerged such as absence of eye contact, smiling and laughter without reason, solitary play activities, poor interaction with strangers, non-communicative language, and gestural stereotypes. Therefore, we suspected an autism spectrum disorder, which is often associated with vitamins intake deficiency secondary to food selectivity. After the administration of vitamins, there was a clinical improvement. Due to the suspicion of autism spectrum disorder, the neuropsychiatric team started neuro-psychomotor and speech therapy. CONCLUSIONS This case shows that although the incidence of scurvy has been greatly reduced in Western Europe, this pathology can still manifest itself, especially in vulnerable children, and its prompt diagnosis and therapy are important considering the excellent response to treatment.

Topics: Ascorbic Acid; Autism Spectrum Disorder; Child, Preschool; Female; Humans; Scurvy; Vitamins; Walking

Scurvy is seldom encountered in modern day clinical practice. Children can present with nonspecific features which can mimic several other common conditions. We describe here a four-year-old child who presented with severe pain and weakness of bilateral lower limbs and found to be severely malnourished. The diagnosis of scurvy was suspected in the context of underlying malnutrition after excluding other ominous pathologies. Pathognomic radiological changes clinched the diagnosis, and the best supportive evidence was the dramatic response to vitamin C supplementation.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child, Preschool; Dietary Supplements; Humans; Leg; Male; Malnutrition; Pain; Radiography; Scurvy; Treatment Outcome; Vitamins

Ten patients with scurvy were evaluated by rheumatology; we review their clinical, laboratory, and dietary presentations. Eight patients had developmental delay or autism. All had elevated inflammatory markers. These clinical and laboratory features with imaging findings can mimic rheumatic conditions such as arthritis, vasculitis, and chronic nonbacterial osteomyelitis (CNO).

Topics: Adolescent; Arthritis, Juvenile; Ascorbic Acid; Ascorbic Acid Deficiency; Autistic Disorder; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Diagnosis, Differential; Diet; Female; Humans; Inflammation; Male; Musculoskeletal Pain; Osteomyelitis; Rheumatology; Scurvy; Vasculitis; Young Adult

Autism spectrum disorder (ASD) may be associated with self-imposed dietary restrictions causing nutritional deficiencies, and the anesthesiologist must be aware of their potential clinical implications. Because humans are unable to produce ascorbic acid through endogenous metabolic pathways and children with ASD may avoid vitamin C-containing foods, vitamin C deficiency, or scurvy, may develop in patients scheduled for general anesthesia. Vitamin C deficiency may cause dysfunction in autonomic nervous system processes or pulmonary hypertension resulting in unexpected hemodynamic lability. We describe a child with ASD and limited dietary options leading to undiagnosed scurvy and intraoperative hypotension.

Topics: Administration, Intravenous; Adolescent; Anesthesia, General; Ascorbic Acid; Autism Spectrum Disorder; Colonoscopy; Endoscopy, Digestive System; Humans; Intraoperative Complications; Male; Scurvy; Treatment Outcome

Scurvy, due to vitamin C deficiency, is commonly referenced as a "forgotten" or "historical" disease. A growing number of case reports challenge this notion. Bone health providers are often consulted early in the presentation of scurvy to evaluate musculoskeletal complaints resulting from impaired collagen production and disrupted endochondral bone formation. In this report, we describe two cases of childhood scurvy. Our objective is to summarize the key features of scurvy for bone health providers, with the goal of raising awareness and facilitating diagnosis in future cases.. Case one occurred in a 12-year-old non-verbal, non-ambulatory female on a ketogenic diet for refractory epilepsy. Clinical findings included hemarthrosis, transfusion dependent anemia, elevated inflammatory markers, and epiphysiolysis. Magnetic resonance imaging (MRI) revealed multi-focal bone marrow signal abnormalities and physeal irregularities. Case two occurred in a typically developing 5-year-old male presenting with limp and knee pain. Symptoms progressed despite casting and immobilization. Mild anemia, elevated inflammatory markers, and multi-focal marrow and physeal MRI abnormalities were identified. Subsequent dietary history revealed total absence of fruit or vegetable consumption. The diagnosis of scurvy was confirmed in both cases by undetectable plasma vitamin C concentrations. Treatment with vitamin C led to rapid clinical improvement.. Scurvy can no longer be considered a historical diagnosis and should not be forgotten when evaluating children with musculoskeletal ailments. Early recognition of the signs, symptoms, and imaging findings of scurvy can reduce the clinical burden of this disease with the timely initiation of vitamin C therapy.

Topics: Ascorbic Acid; Bone Density; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Scurvy; Vitamins

Since ancient times, scurvy has been considered one of the most fearsome nutritional deficiency diseases. In modern developed countries, this condition has become very rare and is only occasionally encountered, especially in the pediatric population. Underlying medical conditions, such as neuropsychiatric disorders, anorexia nervosa, celiac disease, Crohn disease, hemodialysis, and severe allergies to food products may enhance the risk of developing scurvy.. We report the case of an otherwise healthy 3-year-old white boy who developed scurvy due to a selective restrictive diet derived from his refusal to try new food. He presented to our clinic with asthenia and refusal to walk. During hospitalization he developed severe anemia and hematochezia. A diagnosis of scurvy was assessed on the basis of nutritional history, clinical features, radiographic findings, and laboratory findings. Supplementation of ascorbic acid enabled a prompt resolution of symptoms.. Scurvy is caused by vitamin C deficiency. Cutaneous bleeding, mucosal bleeding, and anemia represent typical manifestations of the disease. These symptoms are directly connected to ascorbic acid involvement in collagen biosynthesis. Some radiographic findings can be useful for the diagnosis. Treatment aims to normalize serum levels of vitamin C in order to counteract the deprivation symptoms. The present case report demonstrates that scurvy may sporadically occur in pediatric patients, even in individuals with no predisposing medical conditions and/or potential risk factors.

Topics: Anemia; Ascorbic Acid; Asthenia; Child Nutritional Physiological Phenomena; Child, Preschool; Diet; Gastrointestinal Hemorrhage; Humans; Male; Nutritional Status; Risk Factors; Scurvy; Vitamins

Topics: Adult; Ascorbic Acid; Female; Humans; Scurvy; Treatment Outcome; Vitamins

A 66-year-old Caucasian woman was admitted with deteriorating mental health in the setting of background history of schizophrenia and depression. Her husband reported that she had increasing negative thoughts and decreased motivation regarding her self-care over a few weeks with no obvious stressors. Initial laboratory tests were unremarkable except for isolated normocytic anaemia. Physical examination revealed widespread bilateral upper limb ecchymoses and lower limb petechial rash. After an extensive investigation with no definitive results to explain her clinical presentations, diagnosis of scurvy was suspected and confirmed with severely low serum vitamin C level. Her clinical symptoms improved markedly with oral supplementation, which further supported the diagnosis of scurvy. Although it is now a rare condition in developed countries, this case will remind modern medical practitioners that patients with scurvy may present with non-specific symptoms and clinical findings such as depression and anaemia.

Topics: Aged; Anemia; Ascorbic Acid; Depression; Female; Humans; Scurvy

Vitamin C deficiency results in the clinical presentation of scurvy, a disease that is rare among the adolescent population. Individuals with unusual dietary habits, mental illness, or physical disability are more prone to develop scurvy. We present a case report of a previously healthy 16-year-old female presented to the hospital with a 12-month history of anorexia nervosa, restrictive subtype. She was admitted to the intensive care unit and transferred to a tertiary care pediatric eating disorder program for the treatment of extreme weight loss, cardiovascular instability, and refeeding syndrome. On examination, she had multiple tiny hyperpigmented perifollicular petechial papules on the lower abdomen, dorsum thighs, and extensor surfaces of the arms with corkscrew hairs on the abdomen. Dermatologic examination and laboratory investigations were consistent with a diagnosis of scurvy. The patient's vitamin C serum level was 21 μmol/L (.23 mg/dL; reference range 25-114 μmol/L [.28-1.28 mg/dL]). She was treated with ascorbic acid orally. Objective cutaneous findings improved within 4 weeks of supplementation, and after 6 weeks, repeat levels of vitamin C levels were 102 μmol/L (1.15 mg/dL). To the best of our knowledge, this is the first case of an adolescent female with anorexia nervosa and cutaneous manifestations of scurvy that resolved after the oral administration of vitamin C.

Topics: Adolescent; Anorexia Nervosa; Ascorbic Acid; Feeding Behavior; Female; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Humans; Kidney Calculi; Scurvy

A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have

Topics: Antineoplastic Agents, Immunological; Ascorbic Acid; Bacteremia; Colectomy; Colorectal Neoplasms; Diagnosis, Differential; Ecchymosis; Female; Humans; Klebsiella; Lower Extremity; Malnutrition; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Nutritional Support; Pelvic Exenteration; Scurvy; Skin; Treatment Outcome; Vitamins

Plaque-induced gingivitis, a common condition in children, responds well to proper oral hygiene practices. Persistent severe gingivitis, on the other hand, should prompt investigation of etiological factors. Nutritional elements are implicated in periodontal health. This case report describes a pediatric patient with severe persistent gingivitis caused by vitamin C deficiency. The events that led to a diagnosis of scurvy and a resolution of the systemic and localized manifestations of the disease, after vitamin C administration, are presented. It is recommended that vitamin C deficiency be considered in cases of refractory gingivitis, especially in pediatric patients with special health care needs who have aversion to foods rich in ascorbic acid.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Dental Plaque; Gingivitis; Humans; Scurvy

Scurvy is a rare disease in developed nations. In the field of pediatrics, it primarily is seen in children with developmental and behavioral issues, malabsorptive processes, or diseases involving dysphagia. We present the case of an otherwise developmentally appropriate 4-year-old boy who developed scurvy after gradual self-restriction of his diet. He initially presented with a limp and a rash and was subsequently found to have anemia and hematuria. A serum vitamin C level was undetectable, and after review of the MRI of his lower extremities, the clinical findings supported a diagnosis of scurvy. Although scurvy is rare in developed nations, this diagnosis should be considered in a patient with the clinical constellation of lower-extremity pain or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and anemia. This case highlights the importance of carefully assessing a child's dietary and developmental status at well-child visits, which can help avoid a more invasive workup.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Diet; Exanthema; Hematuria; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Scurvy; Vitamin D Deficiency

While scurvy is considered to be a rare disease in the modern era, the disease still presents in certain populations with nutritional deficiencies such as those with poor nutritional absorption secondary to gastrointestinal disorders and in patients with poor nutritional intake. We present a case of scurvy in a patient who had eosinophilic oesophagitis which limited his oral intake. He presented with the classic symptoms of scurvy including a perifollicular rash, arthralgia, gingivitis and anaemia. He was treated with intravenous vitamin C initially followed by an oral course after which he showed improvement. This case demonstrates that it is important to consider vitamin C deficiency in patients with who present with anaemia and bleeding stigmata specifically in those who have poor nutritional intake. Furthermore, additional consideration should be given to patients with malnutrition as part of the preoperative evaluation.

Topics: Administration, Intravenous; Anemia; Ascorbic Acid; Biopsy; Diagnosis, Differential; Eosinophilic Esophagitis; Humans; Iron; Physical Examination; Scurvy; Severity of Illness Index; Skin; Treatment Outcome; Vitamins

Topics: Adult; Arthralgia; Ascorbic Acid; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Scurvy

Pulmonary hypertension in children is commonly caused by underlying cardiac and pulmonary disease. Within the past 10 years, scurvy has been identified as a cause for pulmonary hypertension. We describe the case of a 3-year-old autistic boy with undiagnosed scurvy who was scheduled for cardiac catheterization. Immediately after induction, the patient became hemodynamically unstable, which worsened with administration of nitrous oxide. Cardiac catheterization revealed pulmonary hypertension, which dramatically improved with administration of vitamin C. Anesthesiologists should be aware that scurvy is more common than previously thought, even in developed countries and can cause unexpected circulatory collapse from pulmonary hypertensive crisis.

Topics: Anesthesia, General; Ascorbic Acid; Autistic Disorder; Cardiac Catheterization; Child, Preschool; Humans; Hypertension, Pulmonary; Male; Nitrous Oxide; Scurvy; Treatment Outcome

Topics: Ascorbic Acid; Diet; Humans; Scurvy

Topics: Adult; Ascorbic Acid; Dental Caries; Gingival Hypertrophy; Humans; Male; Scurvy; Tooth

A 69-year-old man presented with unilateral calf pain, swelling, and erythematous rash. He was initially treated with antibiotics for suspected cellulitis. A venous duplex ultrasound, performed to exclude deep venous thrombosis, revealed multiple heterogeneous hypoechoic foci of unknown etiology throughout the calf musculature. His condition did not improve with antibiotics, instead progressing to a necrotic ulcer along the medial malleolus. Clinical suspicion of vascular insufficiency or vasculitis prompted an extensive imaging work-up. CT and MRI revealed the intramuscular abnormalities observed on previous ultrasound represented foci of intramuscular hemorrhage. Marrow signal abnormality was also noted in the proximal tibia. A punch biopsy of the skin rash ultimately demonstrated distorted hair follicles with perifollicular inflammation and hemorrhage concerning for scurvy. The diagnosis was confirmed by low vitamin C levels and dietary history. A resurgence of scurvy has occurred in the pediatric population in recent years. However, this diagnosis remains uncommon in adults, with limited reports of the potential advanced imaging findings in the current literature.

Topics: Aged; Ascorbic Acid; Contrast Media; Diagnosis, Differential; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Scurvy; Tomography, X-Ray Computed

Scurvy is a disease that is rarely encountered in modern medicine. A condition that was classically associated with sailors, its incidence has decreased dramatically since the discovery of its association with vitamin C deficiency. We present the case of a 2-year-old boy, whose treatment for neuroblastoma was complicated by gastrointestinal disease, which necessitated enteral feeding. While still undergoing treatment, he started to complain about increasing pain in his lower limbs, which appeared to be markedly tender on palpation. Radiographic findings suggested a diagnosis of scurvy, which was subsequently confirmed on serum biochemistry. This was an unexpected finding, as the child had been receiving adequate vitamin C in his enteral feeds. However, his absorption had become severely impaired due to pseudomembranous gastritis and enteritis, leading to his deficient state. He significantly improved after intravenous ascorbic acid replacement and demonstrated a full recovery, both clinically and radiologically. This case highlights the importance of considering scurvy in the differential diagnosis for at-risk patients. Early recognition can facilitate the simple treatment of this potentially serious condition.

Topics: Ascorbic Acid; Diagnosis, Differential; Enteral Nutrition; Enteritis; Gastritis; Humans; Infant; Leg; Male; Neuroblastoma; Scurvy

Topics: Abdomen; Ascorbic Acid; Dermoscopy; Extremities; Humans; Male; Middle Aged; Purpura; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Critical Illness; Guinea Pigs; Humans; Primates; Scurvy

Scurvy is a rare entity in developed countries and the diagnosis may often be delayed resulting in unnecessary investigations and/or potentially severe complications. A recent increase in the number of patients diagnosed with scurvy in our hematology clinics indicated the need to review the literature on the diagnosis and optimal management of similar patients.. We conducted a retrospective chart review of patients referred to hematology at our tertiary care centre between 2010 and 2018, who were ultimately diagnosed with scurvy. Data collected from electronic medical records included baseline characteristics, clinical features on presentation, bloodwork results from initial consultation, treatment plan as well as response to treatment.. Twenty-two adults patient had a diagnosis of scurvy with a mean vitamin C level of 6 μmol/L. Iron deficiency anemia (54%) and gastrointestinal disorders (54%) were the most common comorbidities noted in our cohort. Proton-pump inhibitors use was noted in 54% of patients. Bleeding (45%) and bruising (45%) were the most commonly reported clinical features. Eleven patients received oral supplementation, five had intravenous (IV) vitamin C and six were not treated. Two patients required a transition from oral to IV supplementation. Vitamin C dosing ranged between 250 and 2000 mg and the frequency varied from daily for oral therapy to every few weeks or months for IV.. Awareness of scurvy and its associated risk factors and clinical presentation is important in the evaluation of a patient with bleeding tendency. Treatment plan should be individualized, and a careful review of patients' diet, medial history and medications is warranted.

Topics: Adult; Ascorbic Acid; Contusions; Diet; Hemorrhage; Humans; Medical History Taking; Precision Medicine; Proton Pump Inhibitors; Retrospective Studies; Scurvy

Topics: Adolescent; Ascorbic Acid; Chest Pain; Cholecalciferol; Dietary Supplements; Echocardiography; Gingiva; Hemorrhage; Humans; Hypertension, Pulmonary; Iron; Leg; Male; Pain; Scurvy; Wounds and Injuries

Topics: Adult; Arthralgia; Ascorbic Acid; Diagnosis, Differential; Feeding Behavior; Female; Humans; Image Enhancement; Knee Joint; Magnetic Resonance Imaging; Scurvy

A 28-year-old man with fever, atraumatic lower limb pain and rash was noted to have multiple areas of ecchymosis involving both lower limbs. He was anaemic and also had a grossly swollen left leg. Differential diagnoses of compartment syndrome, vascular tear, platelet and clotting factor disorders, vasculitis and myositis were ruled out. Scurvy was only considered after failing to reach a diagnosis. A dietary history revealed consumption of a restricted diet with no fresh fruits or vegetables. Diagnosis was supported by an undetectable vitamin C level in blood and a rapid improvement of symptoms on oral vitamin C replacement. Prevalence of vitamin C deficiency in developed countries is also discussed.

Topics: Administration, Oral; Adult; Ascorbic Acid; Australia; Diagnosis, Differential; Humans; Male; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Beriberi; Humans; Scurvy; Vitamin A; Vitamins

Topics: Abscess; Adult; Aged; Ankle Joint; Arthralgia; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Hematoma; Humans; Knee Joint; Male; Middle Aged; Postoperative Complications; Scurvy

Scurvy is one of the oldest diseases known to mankind. Although presently rare in the developed world, scurvy was a common potentially fatal disease. In recent times, the most common risk factors for scurvy include alcoholism, low socioeconomic status, and severely poor nutrition or dietary restriction secondary to psychiatric illness or developmental disorders. Our case demonstrates the importance of having a high index of clinical suspicion of an uncommon disease in developed countries and emphasizes the necessity of a dietary screening that could potentially reduce extensive work-up in patients with nonspecific complaints.. We report a case of a 3-year-old previously healthy female originally seen in the rheumatology clinic for limp. She developed weakness and was admitted to the hospital for further evaluation. She underwent extensive diagnostic testing including blood work, magnetic resonance imaging, lumbar puncture, electromyogram, and nerve conduction studies. Ultimately, her vitamin C level returned undetectable. She had immediate and complete improvement upon starting vitamin C supplementation.. Despite being developmentally appropriate, our patient's refusal to eat fruits or vegetables had limited her diet, emphasizing the importance of obtaining a diet history in a child presenting with an unknown diagnosis. In addition, our patient had no other characteristic features of scurvy, which further supports the need to consider this diagnosis in a child presenting with lower extremity weakness or abnormal gait.

Topics: Arthralgia; Ascorbic Acid; Child, Preschool; Diagnosis, Differential; Feeding and Eating Disorders of Childhood; Female; Food Preferences; Gait Disorders, Neurologic; Humans; Muscle Weakness; Scurvy

Topics: Ascorbic Acid; History, Ancient; History, Medieval; Humans; Scurvy; Sepsis

Topics: Animals; Ascorbic Acid; England; History, 20th Century; History, 21st Century; Humans; Nutritional Sciences; Pellagra; Protein-Energy Malnutrition; Scurvy

Scurvy is a nutritional disease caused by ascorbic acid deficiency and is potentially fatal. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Its prevalence has declined markedly over the years but has still been described sporadically in certain countries. A 22-year-old woman with an anxiety disorder and anorexia nervosa, recent pregnancy and ongoing breast feeding, presented with a 10-day history of spontaneous haematomas in the lower limbs, gingivorrhagia and fatigue. The examination was remarkable for signs of minor bleeding without haemodynamic compromise, gonalgia and pale skin. Work-up studies revealed the presence of anaemia. Direct anamnesis identified a diet based solely of tea and carbohydrates due to distorted body image. With the working diagnosis of scurvy, nutritional support and oral vitamin C supplementation was initiated. Her symptoms and anaemia resolved in 30 days and the diagnosis was confirmed biochemically.

Topics: Adult; Anemia; Anorexia Nervosa; Anxiety Disorders; Ascorbic Acid; Breast Feeding; Diagnosis, Differential; Diet; Dietary Carbohydrates; Dietary Supplements; Fatigue; Female; Gingival Hemorrhage; Hematoma; Humans; Scurvy; Tea; Young Adult

A 73-year-old man presented with bilateral leg pain and swelling, and no history of trauma or bleeding disorders. Clinical examination, biochemistry and magnetic resonance imaging of the thighs were suggestive of muscle haematomas. These progressed significantly during the admission, requiring blood transfusion. Normal vascular anatomy on computed tomography, renal and liver function, and absence of infection made a bleeding diathesis more likely. This may be caused by coagulation defects, platelet disorders and vascular fragility. An undetectable serum ascorbic acid level confirmed the clinical suspicion of scurvy, and administration of vitamin C resulted in rapid improvement. Our case provides a structured approach to the diagnosis of bleeding disorders and scurvy, a treatable and potentially fatal disease which is often forgotten.

Topics: Aged; Ascorbic Acid; Hematoma; Humans; Male; Scurvy

Topics: Aging; Ascorbic Acid; Ascorbic Acid Deficiency; Double-Blind Method; Humans; Purpura; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Double-Blind Method; Humans; Purpura; Scurvy

Topics: Ascorbic Acid; Diet; Embryo Culture Techniques; Evidence-Based Medicine; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Rationalization; Research Design; Scurvy

Topics: Anemia; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Diet, Healthy; Humans; Male; Middle Aged; Scurvy

Historically linked to sea voyagers in the 18th century, scurvy has become extremely rare during the last century in developed countries. However, it is still present in some at-risk populations and often overlooked in pediatric patients with restricted diets due to behavioral, neurodevelopmental, or psychiatric problems. So far, the only known etiology of developing scurvy is nutritional deficiency of vitamin C. In this report, we describe the case of a 3-year-old previously healthy Swiss girl without any history of previous poor dietary intake, who presented a picture of systemic inflammation including persisting fever, palpable purpura located on the extensor sides of the extremities, refusal to bear weight, and gingival bleeding. Blood tests revealed a significant increase of inflammatory markers and hypoalbuminemia. Full-body MRI revealed symmetrical bone marrow edema consistent with findings in previously reported cases of children with scurvy. After starting a high-dose oral vitamin C supplementation, the patient showed rapid clinical, laboratory, and radiologic improvement, but after stopping the treatment 4 months later, the patient developed relapse symptoms with pronounced fatigue, refusing to walk, and hair loss. These symptoms led us to restart the oral supplementation, which resulted in secondary normalization of her condition. The cause of her symptoms still remains unclear and presents the first case to our knowledge describing scurvy symptoms that are not directly linked to deficient dietary intake.

Topics: Ascorbic Acid; Child, Preschool; Diagnosis, Differential; Dietary Supplements; Female; Humans; Magnetic Resonance Imaging; Recurrence; Scurvy

Chronic kidney disease and dialysis brings with it a plethora of complications, including malnutrition. Strict dietary restrictions in hemodialysis (HD) patients further complicate the picture as it increases the risk of deficiency of micronutrients, specifically water-soluble vitamins. Today, there is a lack of concrete guidelines concerning recommendations on vitamin supplementation in HD patients. This lack of data is partly due to our incomplete understanding of handling of vitamins in a uremic state. There is a dire need for more data on the impact of dialysis and uremic state on water-soluble vitamins to facilitate appropriate preventative supplementation. We present a case of scurvy in a HD patient that will contribute toward the understanding of vitamin status in HD. We hope it will aid in screening HD patients for vitamin C deficiency and individualizing supplementation of vitamin C.

Topics: Adult; Ascorbic Acid; Humans; Male; Renal Dialysis; Renal Insufficiency, Chronic; Scurvy

Over a five-month period, clinicians in Tana River County Kenya observed an increasing number of patients presenting to health facilities with a common collection of symptoms including fevers, joint pains and gum hypertrophy. After initial investigative and management strategies failed to reveal a diagnosis, patients were empirically commenced on ascorbic acid for presumed scurvy. This strategy resulted in the rapid resolution of symptoms in 65 patients within two weeks.

Topics: Ascorbic Acid; Diagnosis, Differential; Disease Outbreaks; Humans; Kenya; Scurvy

Topics: Ascorbic Acid; Diagnosis, Differential; Hematoma; Humans; Leg; Male; Middle Aged; Scurvy

Topics: Ascorbic Acid; Child; Diet; Food Hypersensitivity; Fructose; Fruit; Humans; Malabsorption Syndromes; Male; Scurvy

Topics: Ascorbic Acid; Dietary Supplements; Humans; Jaw Fractures; Male; Middle Aged; New Zealand; Periodontal Diseases; Scurvy; Ulcer; Vitamin D

Topics: Alcoholic Intoxication; Ascorbic Acid; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Purpura; Scurvy; Vasculitis

Topics: Administration, Oral; Ascorbic Acid; Crohn Disease; Diet; Dietary Supplements; Humans; Male; Risk Factors; Scurvy; Smoking; Treatment Outcome; Young Adult

Topics: Ascorbic Acid; Humans; Male; Middle Aged; Scurvy; Vitamins

Topics: Ascorbic Acid; Failure to Thrive; Female; Humans; Infant, Newborn; Leg; Scurvy; Torso

Scurvy is often diagnosed at the state of well-established signs as, for example, skin and visceral purpura, gums involvement, loss of healthy teeth, which derive mostly from disturbance of collagen metabolism. Little is known about the state of latent scurvy, which symptoms are nonspecific and may mimic more common conditions such as weakness, leg pain, and muscle aching.. We report 3 cases of extreme lassitude and leg pain in alcoholics. In 2 of the 3 cases, discreet classic symptoms such as petechiae or hyperkeratosis of the legs involving collagen metabolism were also present.. Latent scurvy has been diagnosed thanks to historical experimental data reporting and undetectable ascorbic acid levels.. In addition to the treatments recommended by the French Alcohol Society, patients were given oral vitamin C 500 mg to 1000 mg per day for at least three months.. Vitamin C supplementation allowed the regression of the symptoms, greatly improved the quality of life, and gave the possibility to return to work. Cartinine, requiring vitamin C for its hydroxylation, is an essential cofactor in the transport of long-chain fatty acid into mitochondrial matrix. Therefore, it plays an important role in energy production via beta-oxidation. It is thought that carnitine metabolism impairment is responsible for weakness or muscle aching.. We recommend being aware of the possibility of latent scurvy in chronic alcohol abusers. The vitamin C supplementation and dietetic recommendation eating fresh fruit and vegetables may help to cure tiredness and to return more easily to socialization and to work.

Topics: Adult; Alcoholism; Ascorbic Acid; Dietary Supplements; Fatigue; Humans; Leg; Male; Middle Aged; Myalgia; Scurvy; Vitamins

Scurvy, or "Barlow's disease", is a widely described disease involving cutaneous and mucosal lesions resulting from vitamin C deficiency. Herein, we report a case of scurvy in a 48-year-old woman that was unusual in its atypical cutaneous-mucosal presentation as well as its association with anorexia nervosa.. A 48-year-old woman treated for depression for several years was admitted to hospital for her impaired general state of health. Over the last year, she had presented palmoplantar rash and episodes of perimalleolar oedema. The clinical examination showed the patient to have wasting syndrome, with a BMI of 11.9kg/m. The absence of classical buccal-dental symptoms and the presence of keratotic dermatosis with fissures and ulcers on the hands and feet are atypical in scurvy; however, this diagnosis was confirmed by the existence of purpura evoking capillary fragility, the patient's drastically low vitamin C level and the rapid subsidence of symptoms following treatment with oral vitamin C alone. Anorexia nervosa was doubtless the cause of deficiency. This situation is rare and a systematic review of the literature in Medline via PubMed showed that only three reports of scurvy associated with mental anorexia have been published since 1975.

Topics: Anorexia Nervosa; Ascorbic Acid; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Middle Aged; Scurvy; Wasting Syndrome

Until recently scurvy has been viewed in developed countries as a disease of the past. More recently there have been reports of case series of children with scurvy who have had a delayed diagnosis after an extensive diagnostic workup that included imaging. Most of these children have had underlying neurologic conditions such as autism.. To review the medical records of children diagnosed with vitamin C (ascorbic acid) deficiency based on serum ascorbic acid levels at a large pediatric health care system, to determine imaging findings and utility of imaging in management, and to identify at-risk pediatric populations.. We retrospectively identified cases of vitamin C deficiency in children tested for serum ascorbic acid levels during the last 5 years. We used the criteria of normal ascorbic acid >23 μmol/L and included children with ascorbic acid levels <23 μmol/L. We evaluated their clinical history, underlying medical condition, imaging studies obtained and imaging findings.. We identified 32 children with vitamin C deficiency. All of these children had underlying medical conditions, most commonly iron overload from multiple transfusions related to sickle cell anemia or thalassemia (20), neurologic disorders (4) and bone marrow transplant/chemotherapy (3). No cases of scurvy from dietary deficiency in otherwise normal children were identified. All except two children had multiple imaging studies, primarily related to their underlying conditions. Three of these children had extensive imaging workups related to diffuse musculoskeletal pain. Imaging findings included ill-defined sclerotic and lucent metaphyseal bands (mainly at the knee) on radiography and MRI studies that showed diffuse increased T2-weighted signal in the bilateral lower-extremity long-bone metaphyses, periosteal reaction and adjacent soft-tissue edema.. Vitamin C deficiency is not uncommon in large pediatric health care facilities, and it is frequently missed on clinical evaluation and diagnostic imaging. At-risk populations include those with iron overload, neurologic conditions and history of chemotherapy. Scurvy related to dietary deficiency in otherwise normal children was not encountered. When characteristic MRI findings are seen, particularly in children with a predisposing condition for vitamin C deficiency, scurvy should be considered and a serum ascorbic acid level checked to potentially confirm a diagnosis prior to further invasive tests.

Topics: Adolescent; Ascorbic Acid; Child; Child, Preschool; Chromatography, High Pressure Liquid; Diagnosis, Differential; Diagnostic Imaging; Humans; Lower Extremity; Male; Retrospective Studies; Scurvy; United States; Young Adult

Topics: Adolescent; Arthralgia; Ascorbic Acid; Autistic Disorder; Diagnosis, Differential; Exanthema; Humans; Male; Scurvy

Topics: Aged; Ascorbic Acid; Contusions; Diagnosis, Differential; Dietary Supplements; Female; Humans; Scurvy

Topics: Aged; Ascorbic Acid; Ecchymosis; Humans; Leg Dermatoses; Male; Scurvy

Scurvy was diagnosed in seven children at Boston Children's Hospital. All of the children had a developmental disorder and autism was the most common. They had a long-standing history of food selectivity with diets devoid of fruits and vegetables, and none of the children were supplemented with a multivitamin. They presented with limp, and an elaborate panel of tests and procedures were undertaken before the diagnosis of scurvy was made. Treatment with vitamin C led to rapid recovery of symptoms. This report emphasizes the importance of considering nutritional causes of musculoskeletal symptoms in children with autism and restrictive diets.

Topics: Ascorbic Acid; Autistic Disorder; Child; Child, Preschool; Food Preferences; Humans; Male; Scurvy; Vitamins

Scurvy results from a deficiency of vitamin C, a nutrient otherwise known as ascorbic acid. Today, scurvy is rare yet emerges in select patients. The patient reported herein developed scurvy secondary to deliberate avoidance of vitamin C-rich foods. Classic cutaneous manifestations of scurvy include follicular hyperkeratosis and perifollicular hemorrhage encompassing coiled "corkscrew" hairs and hairs bent into "swan-neck" deformities. Ecchymoses, purpura, and petechiae are also characteristically prominent. Classic oral abnormalities include erythematous, swollen gingivae that hemorrhage from subtle microtrauma.Subungual linear splinter hemorrhages may also manifest as a sign of the disease. To establish the diagnosis requirements include characteristic physical exam findings, evidence of inadequate dietary intake, and rapid reversal of symptoms upon supplementation. Although unnecessary for diagnosis, histological findings demonstrate perifollicular inflammation and hemorrhage, fibrosis, and hyperkeratosis, amongst dilated hair follicles and keratin plugging. Although citrus fruit allergies have been historically documented, ascorbic acid has not been previously reported as an allergen. Although lacking absolute certainty, this report suggests a presumed case of ascorbic acid allergy based on patient history and favorable response to ascorbic acid desensitization therapy.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Diagnosis, Differential; Drug Eruptions; Fast Foods; Humans; Male; Middle Aged; Scurvy; Skin; Vitamins

Scurvy results from a dietary deficiency of vitamin C (ascorbic acid) and is rarely thought of in modern day medicine. It now almost always occurs in pediatric patients with behavioral diagnoses, nutritionally restricted diets, and food allergies. Symptoms of scurvy include ecchymoses, bleeding gums, and arthralgias. Here, we present a 17-year-old male with autism spectrum disorder and a diet severely deficient in ascorbic acid due to textural aversion and food preferences. He presented with recurrent arthritis, hemarthrosis, bruising, and anemia. His vitamin C level was low, and his symptoms improved promptly after treatment with ascorbic acid.

Topics: Adolescent; Ascorbic Acid; Autism Spectrum Disorder; Hemorrhage; Humans; Male; Scurvy

Patients with chronic kidney disease (CKD) or end-stage renal disease are at risk for vitamin C deficiency and scurvy due to diet restriction, increased urinary loss of the water-soluble vitamin C with diuretics, and in case of patients who are on dialysis, through dialysates. The condition may be overlooked as the clinical manifestation of scurvy may be subtle, and some presentations may mimic clinical signs in CKD. We reported a case of scurvy presenting with gingival bleeding and blood dialysate in a 6-year-old girl with end-stage renal disease who was on continuous ambulatory peritoneal dialysis. Physical examination showed gingival hyperplasia and bleeding, and the pathognomonic bleeding of perifollicular hemorrhage. The typical radiographic changes were present. The clinical signs and symptoms resolved after ascorbic acid treatment. This case underscores the importance of awareness of the increased risk for vitamin C deficiency in patients with CKD and receiving dialysis.

Topics: Ascorbic Acid; Child; Dialysis Solutions; Female; Gingival Hemorrhage; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Renal Dialysis; Scurvy

Topics: Ascorbic Acid; Child, Preschool; Developmental Disabilities; Humans; Magnetic Resonance Imaging; Male; Scurvy

Topics: Ascorbic Acid; Cerebral Palsy; Child; Child Nutrition Disorders; Disabled Children; Enteral Nutrition; Female; Food, Formulated; Humans; Male; Nutrition Therapy; Rett Syndrome; Scurvy; Treatment Outcome; Vitamins

Topics: Ascorbic Acid; Exanthema; Fluid Therapy; Gingival Hemorrhage; Humans; Immobilization; Male; Malnutrition; Middle Aged; Scurvy; Social Isolation; Thiamine; Treatment Outcome; Vitamins

Scurvy, or vitamin C deficiency, is rarely presented to a rheumatology clinic. It can mimic several rheumatologic disorders. Although uncommon, it may present as pseudovasculitis or chronic arthritis. Scurvy still exists today within certain populations, particularly in patients with neurodevelopmental disabilities, psychiatric illness or unusual dietary habits.Scurvy presentation to the rheumatologist varies from aches and mild pains to excruciating bone pain or arthritis. Musculoskeletal and mucocutaneous features of scurvy are often what prompts referrals to pediatric rheumatology clinics. Unless health care providers inquire about nutritional habits and keep in mind the risk of nutritional deficiency, it will be easy to miss the diagnosis of scurvy. Rarity of occurrence as compared to other nutritional deficiencies, combined with a lack of understanding about modern-day risk factors for nutritional deficiency, frequently leads to delayed recognition of vitamin C deficiency. We report a case of scurvy in a mentally handicapped Saudi child, who presented with new onset inability to walk with diffuse swelling and pain in the left leg. Skin examination revealed extensive ecchymoses, hyperkeratosis and follicular purpura with corkscrew hairs, in addition to gingival swelling with bleeding. Clinical diagnosis of scurvy was rendered and confirmed by low serum vitamin C level. The patient did extremely well with proper nutritional support and vitamin C supplementation. It has been noticed lately that there is increased awareness about scurvy in rheumatology literature. A high index of suspicion, together with taking a thorough history and physical examination, is required for diagnosis of scurvy in patient who presents with musculoskeletal symptoms. Nutritional deficiency should also be considered by the rheumatologist formulating differential diagnosis for musculoskeletal or mucocutaneous complaints in children, particularly those at risk.

Topics: Arthritis; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Chronic Disease; Dietary Supplements; Humans; Male; Pain; Refusal to Participate; Scurvy; Treatment Outcome; Walking

Scurvy is one of the oldest diseases in human history. Nowadays, although scurvy tends to become a forgotten disease in developed country, rare cases still occur, especially in people undergoing extreme diet, old people or children with poor diet and patients with malabsorption. We describe three cases of scurvy. The first case is a patient diagnosed with Crohn's disease, the second one is in a context of anorexia nervosa and drug addiction, and the third case is in a context of social isolation. Early recognition of scurvy can be difficult because symptoms may appear nonspecific and can mimic more common conditions. In any patient with spontaneous hematoma and purpura, in the context of nutritional disorder, scurvy should be systematically considered. As this disease can lead to severe complications, such as bone pain, heart failure or gastrointestinal symptoms, nothing should delay vitamin C supplementation, which is a simple and rapidly effective treatment.

Topics: Adult; Anorexia Nervosa; Ascorbic Acid; Crohn Disease; Dietary Supplements; Female; Humans; Male; Middle Aged; Scurvy; Social Isolation; Substance-Related Disorders; Vitamins

Scurvy is the classic and most severe form of vitamin C deficiency. This condition has become extremely rare among children in the industrialized countries.. We report the case of two boys presenting bone pain associated with haemorrhagic gingivitis, with perifollicular purpura of the lower limbs in one boy. The children had an unbalanced diet. Scurvy was associated with vitamin D and iron deficiency. The dermatological and radiological abnormalities seen were characteristic and a favourable outcome was rapidly obtained following supplementation.. The possibility of this forgotten historical illness should not be overlooked in the presence of these dermatological and rheumatologic signs, since this can help avoid unnecessary or excessively aggressive investigations.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child; Diagnosis, Differential; Gingival Hemorrhage; Humans; Lower Extremity; Male; Purpura; Rare Diseases; Risk Factors; Scurvy; Severity of Illness Index; Treatment Outcome; Vitamin D Deficiency; Vitamins

Topics: Ascorbic Acid; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Hungary; Philately; Scurvy; United Kingdom; United States

Senescence marker protein-30 (SMP30)/gluconolactonase (GNL) knockout (KO) mice are incapable of synthesizing L-ascorbic acid (AA) in vivo. As AA is known to be a water-soluble anti-oxidant, we assessed protein oxidation levels in livers from SMP30/GNL KO mice maintained in an AA-insufficient condition.. Livers were collected from male SMP30/GNL KO mice at the ages of 3, 6 and 12 months, and wild-type (WT) mice at the ages of 3, 6, 12 and 24 months. To assess protein oxidation, we measured the content of protein carbonyl, which is a major protein oxidation marker. AA levels were measured by 2,4-dinitrophenylhydrazine method using high-performance liquid chromatography.. Livers of SMP30/GNL KO mice had just ∼5% as much AA as those of WT mice from 3 to 12 months-of-age. Protein carbonyl levels in livers from SMP30/GNL KO mice were a significant 1.8- to 2.3-fold higher than those from age-atched WT mice. To establish that the AA-insufficiency caused this difference, we added AA to some drinking water, and examined the effect on AA and protein carbonyl levels in livers from SMP30/GNL KO and WT mice. Livers from SMP30/GNL KO mice given extra AA had a significantly higher content than those from their deprived counterparts. Furthermore, protein carbonyl levels in livers from AA-supplemented SMP30/GNL KO mice were significantly lower than those from the SMP30/GNL KO mice without AA supplementation. However, added AA did not affect the protein carbonyl levels in WT mice.. These results strongly suggest that AA plays an important role in preventing protein oxidation in vivo, thus enhancing overall health.

Topics: Aging; Animals; Antioxidants; Ascorbic Acid; Calcium-Binding Proteins; Carboxylic Ester Hydrolases; Chromatography, High Pressure Liquid; Disease Models, Animal; Intracellular Signaling Peptides and Proteins; Lipid Metabolism; Liver; Male; Mice; Mice, Knockout; Oxidation-Reduction; Protein Carbonylation; Scurvy

Topics: Aged; Ascorbic Acid; Ecchymosis; Gingival Hemorrhage; Humans; Male; Scurvy; Vitamins

Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2-3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment.

Topics: Alcoholism; Ascorbic Acid; Humans; Male; Middle Aged; Niacinamide; Pneumonia, Bacterial; Riboflavin; Scurvy; Thiamine; Vitamin B 6; Vitamin B Complex; Vitamins

Vitamin C deficiency in developed countries is typically observed in patients with unique clinical conditions such as cystic fibrosis or anorexia nervosa, or in patients on long-term tube feeds. We report here a clinical observation in six pediatric and adolescent patients (median age 17.5 yr, range 9.8-23.5 yr) with chronic GVHD with mucous membrane involvement found to be vitamin C deficient. These patients' baseline serum vitamin C levels ranged from <0.12 to 0.94 mg/dL (normal value 0.20-1.90 mg/dL), with a mean level 0.56 ± 0.36 mg/dL and a median level 0.6 mg/dL. Among these patients, signs and symptoms of mucositis failed to respond to standard chronic GVHD therapy. After receiving treatment with 2000 mg of ascorbic acid by mouth, daily patients displayed increased serum vitamin C levels. Clinically, this correlated with a remarkable improvement in patients' mucositis and ability to eat.

Topics: Administration, Oral; Adolescent; Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Chronic Disease; Graft vs Host Disease; Humans; Leukemia, Myeloid, Acute; Mucositis; Mucous Membrane; Myelodysplastic Syndromes; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Scurvy; Stem Cell Transplantation; Young Adult

Scurvy is rare in developed countries but is known to cause lower-extremity pain and refusal to ambulate in children. Since the discovery of the link between scurvy and dietary deficiency of ascorbic acid, there has been a substantial decrease in its prevalence and recognition. Here we describe 3 cases of scurvy in young children presenting with difficulty walking. Only 1 of 3 patients had gingival lesions at the initial presentation. Two cases underwent an extensive evaluation for hematologic and rheumatologic diseases before the diagnosis of scurvy was made. Dietary histories eventually revealed that all 3 patients had sharply limited intake of fruits and vegetables secondary to oral aversion, and 1 patient had autism. Radiographic changes of long bones were observed in all patients. Interestingly, all patients had concomitant vitamin D deficiency. After replacement with vitamin C, all patients recovered and started to walk again with improved leg pain. These clinical manifestations and radiologic findings highlight the importance for rheumatologists to have a higher index of suspicion for scurvy in nonambulatory children.

Topics: Ascorbic Acid; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Mobility Limitation; Scurvy; Walking

A 49-year-old man presented to hospital with severe orthostatic hypotension, gingival dysplasia and a purpuric rash involving his extremities. The orthostatic hypotension failed to respond to fluids and, on the basis of physical examination and dietary history, the patient was given a preliminary diagnosis of scurvy (ascorbic acid deficiency). Serum ascorbic acid levels were undetectable and the orthostasis was resolved within 24 h of ascorbic acid replacement. The pathogenesis of orthostatic hypotension in the setting of scurvy appears to involve impaired catecholamine synthesis and attenuated vasomotor response to α-adrenergic stimulation. We believe that this case describes a rare presentation of scurvy and highlights a previously under-reported connection between scurvy and vasomotor instability.

Topics: Ascorbic Acid; Gingival Diseases; Humans; Hypotension, Orthostatic; Male; Middle Aged; Purpura; Scurvy; Vitamins

Topics: Alcoholism; Ascorbic Acid; Diet; Folic Acid; Humans; Male; Middle Aged; Scurvy; Treatment Outcome

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Autistic Disorder; Child; Down Syndrome; Humans; Male; Purpura; Scurvy

Topics: Anemia; Ascorbic Acid; Colonic Diseases; Deglutition Disorders; Ecchymosis; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Middle Aged; Rectum; Scurvy; Stomach Diseases

Scurvy, a disease caused by a deficiency of ascorbic acid (vitamin C), is not very common disease especially in pediatric age. In the late nineteenth century, instead, we assisted to increase incidence of this problem for the use of heated milk and convenience foods. We report two cases of scurvy: a child of 3 years old came to our observation for an important gums' stomatitis, fever, widespread petechiae and ecchymosis on the skin of the lower limbs; in the second moment he had pain in upper and lower limbs with difficulty in walking; a second child of 4 years came to our observation for pain lower limbs and maintained the posture of the legs down, inability to walking, with reduced muscle tone and trophism in all limbs; at the instrumental examination he had an alveolar hemorrhage. The two boys had a history of a diet completely lacking in fruits and vegetables; they were drinking almost only milk. They carried various laboratory and instrumental tests, in particular X-ray of lower limbs that showed "a thick sclerotic metaphyseal line with beak-like excrescences of tibiae and femur". The characteristic radiological appearance, the particular clinical aspects, the dietary history and the dosage of vitamin C, have led us to the diagnosis of scurvy. They started therapy with vitamin C and they had a progressive improvement in general condition.

Topics: Ascorbic Acid; Child; Child, Preschool; Humans; Male; Pain; Scurvy; Treatment Outcome; Vitamins; Walking

Scurvy, a severe form of vitamin C deficiency, killed scores of people until its cause and treatment were firmly established at the end of the eighteenth century. Since then, cases have surged periodically around the world, mostly in developing countries and during times of war and famine. In developed countries, scurvy is still endemic and evidence is growing that vitamin C deficiency might affect up to 30 percent of the population. Low socio-economic status, alcoholism, severe psychiatric illness leading to poor nutrition and critical illness are significant risk factors. We hereby report the case of a patient admitted in a Swiss intensive care unit of a tertiary teaching hospital and presenting with clinical signs and symptoms of severe vitamin C deficiency.

Topics: Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Critical Illness; Endemic Diseases; Humans; Intensive Care Units; Male; Risk Factors; Scurvy; Severity of Illness Index; Switzerland

Topics: Aged, 80 and over; Ascorbic Acid; Female; Humans; Scurvy; Treatment Outcome; Vitamins

Scurvy, caused by lack of vitamin C, was a major problem for polar explorers. It may have contributed to the general ill-health of the members of Scott's polar party in 1912 but their deaths are more likely to have been caused by a combination of frostbite, malnutrition and hypothermia. Some have argued that Oates's war wound in particular suffered dehiscence caused by a lack of vitamin C, but there is little evidence to support this. At the time, many doctors in Britain overlooked the results of the experiments by Axel Holst and Theodor Frølich which showed the effects of nutritional deficiencies and continued to accept the view, championed by Sir Almroth Wright, that polar scurvy was due to ptomaine poisoning from tainted pemmican. Because of this, any advice given to Scott during his preparations would probably not have helped him minimise the effect of scurvy on the members of his party.

Topics: Antarctic Regions; Ascorbic Acid; Ascorbic Acid Deficiency; Expeditions; Famous Persons; History, 20th Century; Humans; Scurvy; United Kingdom

Topics: Ascorbic Acid; Child; Child Nutrition Disorders; Diagnosis, Differential; Femoral Neoplasms; Femur; Humans; Male; Protein-Energy Malnutrition; Radiography; Scurvy; Treatment Outcome

The view of scurvy being exclusively a nutritional disorder needs to be updated. Genetic polymorphisms of HFE and haptoglobin (Hp) may explain the geographic variability of mortality caused by the European famine of the mid-19th century. In this period, potatoes had fallen victim to the potato blight and Ireland was more severely hit than continental Europe. Hereditary hemochromatosis is a genetic disorder with mutations in the HFE gene, characterized by iron overload (with a reduced vitamin C stability) and with a predominance of affected men. The Irish have the world's highest frequency of the C282Y mutation and the particular iron metabolism of the Irish helps to understand the size of the catastrophe and the observed overrepresentation of male skeletons showing scurvy. Hp is a plasma α2-glycoprotein characterized by 3 common phenotypes (Hp 1-1, Hp 2-1 and Hp 2-2). When the antioxidant capacity of Hp is insufficient, its role is taken over by hemopexin and vitamin C. The relative number of scurvy victims corresponds with the Hp 2-2 frequency, which is associated with iron conservation and has an impact on vitamin C stability. As iron is more abundant in males, males are overrepresented in the group of skeletons showing scurvy signs.

Topics: Ascorbic Acid; Europe; Genotype; Haptoglobins; Hemochromatosis; Hemochromatosis Protein; Histocompatibility Antigens Class I; History, 19th Century; Humans; Iron; Iron Overload; Male; Membrane Proteins; Phenotype; Polymorphism, Genetic; Scurvy; Starvation; White People

Topics: Adult; Ascorbic Acid; Humans; Lymphangiectasis, Intestinal; Male; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Expeditions; Humans; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Expeditions; Humans; Scurvy

Topics: Arthritis; Ascorbic Acid; Autistic Disorder; Calcinosis; Child; Gingival Hypertrophy; Humans; Knee Joint; Male; Radiography; Scurvy

Topics: Aged, 80 and over; Ascorbic Acid; Fatal Outcome; Humans; Male; Malnutrition; Scurvy; Skin Diseases

We present a case of scurvy in a 6-year-old boy with autism and an unbalanced diet. The patient was admitted with difficulties in walking. Magnetic resonance imaging findings of the thigh showed diffuse signal abnormality in the bone marrow, periosteum, and the femoral muscle. A biopsy specimen of the femur showed hematoma, proliferative fibroblasts, and few collagen fibers, which suggested a deficiency of vitamin C. Although recurrent periosteal hematoma may be suggestive of scurvy, this finding was subtle in the current case. It is important to be aware of this rare disease because it is easily cured with vitamin C supplementation.

Topics: Ascorbic Acid; Autistic Disorder; Child; Femur; Hematoma; Humans; Magnetic Resonance Imaging; Male; Prognosis; Scurvy; Thigh

Topics: Ascorbic Acid; Developing Countries; Female; Gingival Hemorrhage; Hematoma; Humans; Scurvy; Skin Diseases, Vascular; Young Adult

We report a case of chronic glossitis in a 4-year-old boy due to scurvy. The boy showed up in our department with a patchy depapillated tongue. A detailed dietary history revealed an unbalanced diet without any fruit or vegetable. The biological investigations showed a low serum ascorbic acid. The boy was treated by oral ascorbic acid during 15 days. The glossitis improved within one week and serum levels of vitamin C returned to the normal range. In industrial countries, scurvy became a rare disease in healthy children. However, since a few years, cases are reported in children and teenagers with unbalanced diet coming from economically favoured families. These extreme cases are one of the signs of a more general deterioration of dietary habits in paediatric populations in our societies. This emphasizes the importance of effective nutritional education programs aimed towards both parents and children.

Topics: Ascorbic Acid; Child, Preschool; Glossitis; Humans; Male; Scurvy; Vitamins

We describe the case of a 40-year-old female patient who developed severe pulmonary hypertension and life-threatening right-sided heart failure in association with dietary scurvy and iron deficiency. Supplementation with oral vitamin C and iron very likely contributed to her complete cure. Scurvy-associated pulmonary arterial hypertension could result from impaired availability of endothelial nitric oxide, but inappropriate activation of the hypoxia-inducible family (HIF) of transcription factors could play an even more important role. HIF coordinates the body's responses to hypoxia, and its activity is regulated by oxygen-dependent prolyl hydroxylases, which need vitamin C and iron as cofactors. Deficiency of these cofactors could lead to uncontrolled HIF activity and pulmonary vasoconstriction responsive to vitamin C and iron administration.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Ascorbic Acid Deficiency; Dietary Supplements; Echocardiography; Female; Heart Failure; Humans; Hypertension, Pulmonary; Iron; Scurvy; Treatment Outcome; Vasoconstriction

Endoplasmic reticulum (ER) thiol oxidases initiate a disulfide relay to oxidatively fold secreted proteins. We found that combined loss-of-function mutations in genes encoding the ER thiol oxidases ERO1α, ERO1β, and PRDX4 compromised the extracellular matrix in mice and interfered with the intracellular maturation of procollagen. These severe abnormalities were associated with an unexpectedly modest delay in disulfide bond formation in secreted proteins but a profound, 5-fold lower procollagen 4-hydroxyproline content and enhanced cysteinyl sulfenic acid modification of ER proteins. Tissue ascorbic acid content was lower in mutant mice, and ascorbic acid supplementation improved procollagen maturation and lowered sulfenic acid content in vivo. In vitro, the presence of a sulfenic acid donor accelerated the oxidative inactivation of ascorbate by an H(2)O(2)-generating system. Compromised ER disulfide relay thus exposes protein thiols to competing oxidation to sulfenic acid, resulting in depletion of ascorbic acid, impaired procollagen proline 4-hydroxylation, and a noncanonical form of scurvy.

Topics: Animals; Ascorbic Acid; Cells, Cultured; Connective Tissue; Disease Models, Animal; Disulfides; Endoplasmic Reticulum; Female; Glycoproteins; Male; Mice; Mice, Mutant Strains; Mutation; Oxidation-Reduction; Oxidoreductases; Peroxiredoxins; Procollagen; Protein Folding; Protein Processing, Post-Translational; Scurvy; Sulfenic Acids; Transforming Growth Factor beta

Scurvy is a disease that results from a vitamin C deficient diet. Since vitamin C is available in many food products, and especially in citrus fruits, the disease is rare in developed countries. Clinical manifestations of scurvy include general weakness, cutaneous and gum bleeding, pain in the lower limbs and inability to stand and walk (pseudo paralysis). The diagnosis of scurvy requires a high level of clinical suspicion, typical radiographic features and low Levels of vitamin C in the plasma. We report a case of a 7-year-old patient with a medical history of hydrocephalus, failure to thrive and severe psychomotor retardation due to complications of prematurity. On admission she had gum bleeding, severe anemia, pain in the lower limbs and refused to stand and walk. According to her parents, her diet was restricted, without vegetables or fruit consumption. Our investigation ruled out coagulopathy, malignancy and infection. Serum vitamin C levels were low and radiographic findings were consistent with the diagnosis of scurvy. The patient improved rapidly after the initiation of vitamin C supplements. Despite being rare, scurvy should be considered in the differential diagnosis of bleeding and pain in the lower limbs, especially in a malnourished patient.

Topics: Anemia; Ascorbic Acid; Blood Transfusion; Child; Child Nutrition Disorders; Citrus; Developmental Disabilities; Enteral Nutrition; Failure to Thrive; Feeding Behavior; Female; Gingival Hemorrhage; Humans; Infusions, Intravenous; Mobility Limitation; Musculoskeletal Pain; Phytotherapy; Radiography; Scurvy; Treatment Outcome

Ascorbic acid is a small-molecule reductant with multiple functions in vivo. Reducing ascorbic acid intake leads to a lack of hydroxylation of prolines and lysines, causing a looser triple helix and resulting in scurvy. Ascorbic acid also acts as an antioxidant to prevent oxidative stress. Because ascorbic acid is related to disease states, rapid and convenient detection of ascorbic acid should be useful in diagnosis. Nitroxide is reduced to the corresponding hydroxylamine by ascorbic acid and a sensitive and novel approach to its detection employs covalent coupling of nitroxide with a fluorophore, leading to intramolecular quenching of fluorescence emission by electron-exchange interactions. Here, we developed a new fluorophore-nitroxide probe, Naph-DiPy nitroxide, for ascorbic acid. Naph-DiPy nitroxide rapidly reacted with ascorbic acid and showed fluorescence enhancement, but not in response to other reductants or reactive oxygen species. To confirm the practical usefulness of the fluorophore-nitroxide probe, we demonstrated the use of Naph-DiPy nitroxide for the measurement of ascorbic acid in the plasma of osteogenic disorder Shionogi rats when fed an ascorbic acid-deficient diet. The results suggest that this novel fluorophore-nitroxide probe could sensitively and easily detect ascorbic acid and be useful as a tool for the diagnosis of disease states.

Topics: 1-Naphthylamine; Animals; Antioxidants; Ascorbic Acid; Blood Chemical Analysis; Bone Diseases, Developmental; Cyclic N-Oxides; Fluorescent Dyes; Free Radicals; Male; Oxidants; Rats; Scurvy

The term 'scurvy' for the disease resulting from prolonged vitamin C deficiency had origins in 'scorbutus' (Latin), 'scorbut' (French), and 'Skorbut' (German). Scurvy was a common problem in the world's navies and is estimated to have affected 2 million sailors. In 1747, James Lind conducted a trial of six different treatments for 12 sailors with scurvy: only oranges and lemons were effective in treating scurvy. Scurvy also occurred on land, as many cases occurred with the 'great potato famine' in Ireland in 1845. Many animals, unlike humans, can synthesize their own vitamin C. Axel Holst and Theodor Frölich fortuitously produced scurvy in the guinea pig, which like humans requires vitamin C in the diet. In 1928, Albert Szent-Györgyi isolated a substance from adrenal glands that he called 'hexuronic acid'. Four years later, Charles Glen King isolated vitamin C in his laboratory and concluded that it was the same as 'hexuronic acid'. Norman Haworth deduced the chemical structure of vitamin C in 1933.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Citrus; Guinea Pigs; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Scurvy

Topics: Adult; Ascorbic Acid; Female; Humans; Scurvy; Treatment Outcome

A diet restricted to rice and boiled fruit and vegetables leads to vitamin C deficiency. We describe the third case, to our knowledge, of retinal hemorrhages related to scurvy. Reduced bilateral visual acuity in a 50-year-old patient was associated with macrocytic anemia, denutrition, and cutaneous ecchymoses. Oral vitamin C treatment provided subjective clinical improvement and regression of the retinal hemorrhages on fundus examination, with no side effects. Vitamin C plays an important role in collagen stability in vascular and bone walls.

Topics: Anemia, Macrocytic; Ascorbic Acid; Collagen; Cooking; Diet, Vegetarian; Ecchymosis; Emergencies; Gastritis, Atrophic; Humans; Male; Middle Aged; Retinal Hemorrhage; Scurvy; Vitamin B 12 Deficiency

We report the case of the case of a 56 year old female with sepsis on a background of rheumatoid arthritis and steroid use manifesting with overt clinical features of scurvy. Ascorbic acid assays were able to demonstrate severe deficiency and confirm a diagnosis of scurvy. Clinical resolution of signs and symptoms following commencement of vitamin C replacement was rapid. The intensivist and dietitian need to consider this diagnosis even in the first world setting, particularly in the presence of sepsis, inflammatory conditions, steroid use and importantly malnutrition.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Female; Humans; Intensive Care Units; Middle Aged; Military Personnel; Plague; Scurvy; Sepsis

Topics: Adiponectin; Antioxidants; Ascorbic Acid; Humans; Scurvy; Stroke

Topics: Ascorbic Acid; Hemoglobins; Humans; Male; Middle Aged; Schizophrenia, Paranoid; Scurvy; Vitamins

Topics: Ascorbic Acid; Canada; Edema; Female; Humans; Lower Extremity; Magnetic Resonance Imaging; Middle Aged; Pain; Purpura; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Fractures, Bone; Humans; Scurvy

Scurvy is well known since ancient times, but it is rarely seen in the developed world today owing to the discovery of its link to the dietary deficiency of ascorbic acid. It is very uncommon in the pediatric population, and is usually seen in children with severely restricted diet attributable to psychiatric or developmental disturbances. The condition presents itself by the formation of perifollicular petechiae and bruising, gingival inflammation and bleeding, and, in children, bone disease. We report a case of scurvy in a 10-year-old developmentally delayed boy who had a diet markedly deficient in vitamin C resulting from extremely limited food choices. He presented with debilitating bone pain, inflammatory gingival disease, and perifollicular hyperkeratosis. The diagnosis was made based on clinical and radiographic findings. The importance of diet history is emphasized. We present this case with the aim to help the clinician identify scurvy and implement treatment for a potentially fatal but easily curable disease.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Developmental Disabilities; Diagnosis, Differential; Diet; Humans; India; Male; Scurvy

We report on a 13-month-old boy who experienced pain while mobilising, and had bruising and swelling of the lower limbs. Laboratory examinations revealed anaemia and skeletal x-rays showed irregularity and thickening of the provisional zones of calcification of lower and upper limbs. The boy had been fed with only goat milk, homogenised meat, fruits and vegetables, all of which had been boiled together. Forty-eight hours after starting oral vitamin C supplementation, the patient showed dramatic clinical improvement. The clinical presentation, laboratory and imaging findings, together with the good response to vitamin C intake, allowed us to confirm the diagnosis of infantile scurvy. Scurvy is a disease that can be found among children, especially among groups with restrictive eating pattern. Fortunately, once diagnosed, scurvy is an easily treatable disease by administration of vitamin C and a correct diet that is rich in fruits, vegetables and fresh meat, all of which contained vitamin C.

Topics: Ascorbic Acid; Growth; Humans; Infant; Male; Scurvy; Vitamins

Topics: Adult; Ascorbic Acid; Conscience; England; History, 20th Century; Human Experimentation; Humans; Male; Scurvy; Vitamins

The aim of this study was to systematically screen hospitalized elderly patients for clinical symptoms of scurvy and to confirm the diagnosis with biological measures.. Geriatric acute care ward.. Scurvy symptoms (one or more among perifollicular hyperkeratosis, petechiae or bruises, haemorrhagic features caused by venous puncture, severe gingivitis). We compared associated diseases, nutritional status, need for assistance for feeding, serum albumin, transthyretin, B9 and B12 vitamins, iron status and Serum Ascorbic Acid Level (SAAL) and outcome (in-hospital mortality) between scurvy and scurvy free patients.. 18 patients with clinical symptoms of scurvy (scurvy group) were identified out of 145 consecutive patients (12%). They were compared to 23 consecutive control patients with no clinical symptoms of scurvy (scurvy-free group). SAAL was significantly lower (1.09 +/- 1.06 vs 4.87 +/- 4.2 mg x L-1, p < .001) and vitamin C deficiency more frequent (94 vs 30 %, p < .001) in the scurvy group. Moreover, in scurvy group, coronary heart disease (39 vs 9 %, p=.028), need for assistance for feeding (56 vs 13 %, p=.006) and in-hospital deaths (44 vs 9 %, p=.012) were more frequent.. Ninety-four percent of patients with clinical symptoms of scurvy had vitamin C deficiency. Our results suggest that in hospitalized elderly patients, clinical symptoms allow scurvy diagnosis. Scurvy could be a frequent disease in elderly patients admitted to acute geriatric ward.

Topics: Aged; Aged, 80 and over; Ascorbic Acid; Biomarkers; Case-Control Studies; Female; Geriatric Assessment; Hospital Mortality; Hospitalization; Humans; Male; Mass Screening; Nutrition Assessment; Nutritional Status; Scurvy

A 68-year-old female with an extensive history of unexplained problems presented at the Department of Internal Medicine for an analysis of painful cutaneous abnormalities of the lower legs. A systemic cause could not be found. Later on the general practitioner noted haematoma and petechiae and subsequently a hypovitaminosis C. The patient received active vitamin C supplement for this. The cutaneous abnormalities on the legs had significantly improved after 3 weeks. This patient was found to have symptomatic hypovitaminosis C, also known as scurvy, as a complication of an psychiatric disorder. Although scurvy might appear to be a disease of the past that rarely occurs nowadays, it should nevertheless be given due consideration. This requires a good history taking.

Topics: Aged; Ascorbic Acid; Female; Hematoma; Humans; Scurvy; Treatment Outcome; Vitamins

Scurvy is a well-known disease of vitamin C deficiency that still occurs in industrialized countries. The clinical manifestations of follicular hyperkeratosis, perifollicular petechiae, corkscrew hairs, and easy bruising are due to defective collagen synthesis and can be mistaken for small vessel vasculitis. Populations at risk for development of scurvy include elderly patients, alcohol and drug users, individuals who follow restrictive diets or have eating disorders, patients with malabsorption, and individuals with mental illness. We report an acute case of scurvy presenting in the inpatient/hospital setting with clinical findings initially thought to represent vasculitis. A high index of suspicion for scurvy must be kept in the appropriate clinical context, and a thorough medical history and physical examination are vital to make the diagnosis.

Topics: Acute Disease; Ascorbic Acid; Humans; Male; Middle Aged; Scurvy; Vasculitis

Scurvy, the rare but potentially mortal manifestation of severe and prolonged lack of vitamin C, is often confused with hypovitaminosis C, i.e. the mere definition of vitamin C deficiency. While the latter condition can be diagnosed in millions, the clinical consequences (if they exist) remain largely unknown, since only a tiny fraction of those deficient in vitamin C actually develop clinical scurvy. Is hypovitaminosis C itself a problem at all then? Yes, it may well be in some cases. Recent data from our laboratory suggest that the neonatal brain is particularly susceptible to vitamin C deficiency and that this condition may adversely affect early brain development.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Brain; Humans; Infant; Infant, Newborn; Models, Biological; Scurvy

Several conifers have been considered as candidates for "Annedda", which was the source for a miraculous cure for scurvy in Jacques Cartier's critically ill crew in 1536. Vitamin C was responsible for the cure of scurvy and was obtained as an Iroquois decoction from the bark and leaves from this "tree of life", now commonly referred to as arborvitae. Based on seasonal and diurnal amino acid analyses of candidate "trees of life", high levels of arginine, proline, and guanidino compounds were also probably present in decoctions prepared in the severe winter. The semi-essential arginine, proline and all the essential amino acids, would have provided additional nutritional benefits for the rapid recovery from scurvy by vitamin C when food supply was limited. The value of arginine, especially in the recovery of the critically ill sailors, is postulated as a source of nitric oxide, and the arginine-derived guanidino compounds as controlling factors for the activities of different nitric oxide synthases. This review provides further insights into the use of the candidate "trees of life" by indigenous peoples in eastern Canada. It raises hypotheses on the nutritional and synergistic roles of arginine, its metabolites, and other biofactors complementing the role of vitamin C especially in treating Cartier's critically ill sailors.

Topics: Arginine; Ascorbic Acid; Canada; History, 16th Century; History, 17th Century; Humans; Indians, North American; Naval Medicine; Nitric Oxide; Nitric Oxide Synthase; Phytotherapy; Plant Preparations; Plants, Medicinal; Scurvy; Tracheophyta

Topics: Animals; Ascorbic Acid; Biomedical Research; Famous Persons; History, 20th Century; Humans; Nobel Prize; Scurvy

Topics: Adult; Ascorbic Acid; Humans; Leg Dermatoses; Male; Purpura; Scurvy; Vitamins

Combined antioxidant deficiencies of selenium and vitamin E or vitamin E and vitamin C in guinea pigs result in clinical illness. We hypothesized that combined selenium and vitamin C deficiency would have clinical consequences because in vitro interactions of these antioxidant nutrients have been reported. Because guinea pigs are dependent on dietary vitamin C, weanling male guinea pigs were fed selenium-deficient or control diet for 15 weeks before imposing vitamin C deficiency. Four dietary groups were formed and studied 3 weeks later: controls, vitamin C deficient, selenium deficient, and doubly deficient. Deficiencies were confirmed by determinations of glutathione peroxidase activity and vitamin C concentration in liver and skeletal muscle. Plasma creatine phosphokinase activity and liver, kidney, heart, and quadriceps histopathology were determined. Doubly deficient animals had moderately severe skeletal muscle cell death as judged by histopathology and plasma creatine phosphokinase activity of 6630 +/- 4400 IU/L (control, 70 + or - 5; vitamin C deficient, 95 + or - 110; selenium deficient, 280 + or - 250). Liver, kidney, and heart histology was normal in all groups. Muscle alpha-tocopherol levels were not depressed in the doubly deficient group, but muscle F2 isoprostane concentrations were elevated in them and correlated with markers of cell death. We conclude that combining selenium and vitamin C deficiencies in the guinea pig causes cell death in skeletal muscle that is more severe than the injury caused by selenium deficiency. The elevation of muscle F2 isoprostanes is compatible with the cell death being caused by oxidative stress.

Topics: alpha-Tocopherol; Animals; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Cell Death; Creatine Kinase; Diet; F2-Isoprostanes; Glutathione Peroxidase; Guinea Pigs; Lipid Peroxidation; Male; Muscle, Skeletal; Necrosis; Scurvy; Selenium

Topics: Ascorbic Acid; History, 18th Century; History, 19th Century; Humans; Scurvy

We report an unusual case of scurvy where a six-year-old female presented with clinical and radiological features suggestive of juvenile idiopathic arthritis. However, follow-up radiological examination, carried out in view of refractory arthritis, was diagnostic for scurvy and the patient later responded well only with vitamin C therapy.

Topics: Ascorbic Acid; Child; Female; Humans; Scurvy

A 5 year old female developed features of complex regional pain syndrome (CRPS) i.e excessive pain to touch, decreased sweating and edema of left ankle 2 years after fracture of left tibia. Gum bleeding, petechiae and pseudoparalysis and suggestive radiograph characterized scurvy. Hyperesthesia improved and child walked with support following administration of vitamin C.

Topics: Ascorbic Acid; Child, Preschool; Female; Humans; Knee Joint; Radiography; Reflex Sympathetic Dystrophy; Scurvy; Vitamins

Scurvy is a rare disease occurring because of a nutritional deficiency of vitamin C. In the paediatric age group the disease is usually characterized by musculoskeletal manifestations. Treatment is straightforward and consists of vitamin C administration. However, if the patient is left untreated, scurvy may be life-threatening. We report here the case of a 16-month-old infant with scurvy. After proper treatment, the complaints disappeared in a very short time period and the boy grew up as a completely normal child during the 12 years follow-up. Nowadays only few physicians have experience with this disease, and ascorbic acid deficiency can thus easily be overlooked. With this paper we aimed to remind of the efficacy of vitamin C administration for patients with scurvy.

Topics: Ascorbic Acid; Femur; Humans; Infant; Male; Radiography; Scurvy; Vitamins

Topics: Adult; Arthralgia; Ascorbic Acid; Ascorbic Acid Deficiency; Edema; Epistaxis; Gastrointestinal Hemorrhage; Humans; Knee Joint; Male; Pigmentation Disorders; Scurvy

Topics: Ascorbic Acid; Centers for Disease Control and Prevention, U.S.; Dose-Response Relationship, Drug; Female; Glutathione Transferase; Humans; Male; Nutrition Policy; Scurvy; Sex Characteristics; United States; Vitamin D Deficiency

Topics: Ascorbic Acid; Citrus; Expeditions; Famous Persons; History, 17th Century; History, 18th Century; Humans; Naval Medicine; Scurvy; United Kingdom

We report three cases of scurvy, with differing musculoskeletal presentations, from a tertiary teaching hospital in Sydney, Australia. Case 1 was a man with cerebral palsy who presented with knee swelling following a minor injury. In Case 2, a patient with thalassaemia major presented with purpuric rash, difficulty walking and distal thigh swelling and ecchymosis. Case 3 was a man with Down's syndrome who presented with acute ankle arthritis. Scurvy in Cases 1 and 3 were related to abnormal dietary preferences, whereas in Case 2, scurvy was thought to be related to thalassaemia. All three cases responded rapidly to vitamin C replacement. The subjects did not appear malnourished as they had adequate carbohydrate and protein intake.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; beta-Thalassemia; Cerebral Palsy; Down Syndrome; Feeding Behavior; Hospitals, Teaching; Humans; Male; Scurvy; Treatment Outcome

Topics: Aged; Ascorbic Acid; Cellulitis; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Scurvy; Vitamins

Topics: Adult; Ascorbic Acid; Contusions; Female; Humans; Leg; Scurvy; Skin Diseases

Epilepsy is a symptom of cerebral dysfunction, where there is a sudden and disorganised discharge of electrical activity from a group of neurones, producing symptoms that range from sensory absences to convulsive movements and unconsciousness. Fasting is recognised as reducing the frequency of epileptic seizures in difficult to control patients. The ketogenic diet is a high fat, low carbohydrate and adequate protein diet that mimics the biochemical effects of fasting. It is deficient in some essential elements that require supplementation.. A 9-year old girl with learning difficulties, developmental delay and refractory epilepsy was placed on the ketogenic diet in 2003. Prior to starting the diet she had had as many as 12 tonic seizures/day, with prolonged periods of non-convulsive status epilepticus. Subsequent to being placed on the diet, the frequency of her seizures reduced markedly; there were long periods during which she had none. In late 2006, the patient inhaled a primary molar. This was retrieved by emergency bronchoscopy and at the same time the remaining primary teeth were extracted. Three weeks later she was admitted to hospital with low-grade fever, persistently bleeding sockets, oedema of her hands and feet, a petechial rash and bruising. A differential diagnosis included: liver disease, bleeding dyscrasia, oncological pathology or scurvy. The most striking finding amongst a number of investigations was a vitamin C level of 0.7 micromol/l (Deficiency: < 11 micromol/l). Accordingly a diagnosis of scurvy was made.. The patient was prescribed ascorbic acid 500 mg twice/day. Three weeks later the patient's vitamin C level was 141.5 micromol/l; the dose was therefore reduced to 250 mg once/day.. At two-month review, the signs and symptoms of scurvy had resolved.. Inhaling a tooth and scurvy are both rare occurrences. Paediatric dentists should be aware of the possible implications of a ketogenic diet.

Topics: Ascorbic Acid; Child; Diet, Ketogenic; Epilepsy; Female; Gingival Hemorrhage; Humans; Scurvy; Tooth Loss; Treatment Outcome

Topics: Aged; Alcoholism; Ascorbic Acid; Dermoscopy; Erythrocytes; Fibrosis; Fruit; Hair Follicle; Humans; Keratosis; Male; Malnutrition; Mouth, Edentulous; Purpura; Remission Induction; Scurvy; Skin Pigmentation; Vegetables

Topics: Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Female; Humans; Kidney Transplantation; Liver Failure; Liver Transplantation; Membrane Lipids; Oxidative Stress; Renal Insufficiency; Scurvy; Tissue and Organ Procurement; Tocopherols

First described in the 1500 s, scurvy is infrequently seen in industrialized countries today, although vulnerable patient groups remain. A 15-yr-old girl underwent liver transplantation at age 26 months for a primary diagnosis of biliary hypoplasia, and subsequently developed late allograft failure and progressive renal insufficiency culminating in listing for combined liver retransplantation and kidney transplantation at age 13 yr. She required regular hemodialysis treatment for 12 months prior to deceased donor organ availability, with a complicated clinical course including recurrent septic episodes and severe cachexia. Ten months after initiation of hemodialysis, she presented with severe bone pain, purpura, ecchymoses, gingival hyperplasia, mucosal bleeding, and subconjunctival hemorrhages. Serial serum ascorbic acid levels were found to be extremely low (<10 micromol/L) despite routine supplementation both in her dialysate and via regular oral supplementation. Histopathology from skin biopsy revealed purpura, hyper- and parakeratosis, and follicular plugging. She had ECG and 2D echocardiogram disturbances, as well as osteopenia and sclerosis of the extremities on radiological evaluations. Therapy with high-dose ascorbic acid (1 g/day orally) led to complete resolution of skin lesions. This case highlights the importance of awareness and recognition of this historic diagnosis, and particularly in children with end-stage organ disease with severely compromised nutrition.

Topics: Adolescent; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Biopsy; Female; Humans; Kidney Transplantation; Liver Failure; Liver Transplantation; Renal Dialysis; Renal Insufficiency; Reoperation; Scurvy; Tissue and Organ Procurement

Topics: Airway Obstruction; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Ascorbic Acid; Child, Preschool; Edema; Fentanyl; Gingivitis; Hemorrhage; Humans; Intubation, Intratracheal; Laryngeal Masks; Leg; Male; Methyl Ethers; Propofol; Scurvy; Sevoflurane; Vitamins

Nitroglycerin (GTN) acts through release of a nitric oxide (NO)-related activator of soluble guanylate cyclase in vascular smooth muscle. Besides enzymatic GTN bioactivation catalysed by aldehyde dehydrogenase, non-enzymatic reaction of GTN with ascorbate also results in the formation of a bioactive product. Using an established guinea pig model of ascorbate deficiency, we investigated whether endogenous ascorbate contributes to GTN-induced vasodilation.. Guinea pigs were fed either standard or ascorbate-free diet for 2 or 4 weeks prior to measuring the GTN response of aortic rings and isolated hearts. The effects of ascorbate on GTN metabolism were studied with purified mitochondrial aldehyde dehydrogenase (ALDH2) and isolated mitochondria. Ascorbate deprivation led to severe scorbutic symptoms and loss of body weight, but had no (2 weeks) or only slight (4 weeks) effects on aortic relaxations to a direct NO donor. The EC(50) of GTN was increased from 0.058 +/- 0.018 to 0.46 +/- 0.066 and 5.5 +/- 0.9 microM after 2 and 4 weeks of ascorbate-free diet, respectively. Similarly, coronary vasodilation to GTN was severely impaired in ascorbate deficiency. The potency of GTN was reduced to a similar extent by ALDH inhibitors in control and ascorbate-deficient blood vessels. Up to 10 mM ascorbate had no effect on GTN metabolism catalysed by purified ALDH2 or liver mitochondria isolated from ascorbate-deficient guinea pigs.. Our results indicate that prolonged ascorbate deficiency causes tolerance to GTN without affecting NO/cyclic GMP-mediated vasorelaxation.

Topics: Aldehyde Dehydrogenase; Animals; Aorta; Ascorbic Acid; Ascorbic Acid Deficiency; Disease Models, Animal; Female; Guinea Pigs; Heart; Heart Rate; Male; Mitochondria, Liver; Nitroglycerin; Regional Blood Flow; Scurvy; Vasodilation; Vasodilator Agents

Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.. We report the case of a 57-year-old male who presented with a combined vitamin C deficiency (scurvy) and a Zinc deficiency.. He came to the emergency department complaining of a painful swollen ecchymotic leg and dyspnea. Prescriptions for narcotics did not relieve his symptoms. When a detailed dietary history was obtained, we added scurvy to the differential diagnosis. An extensive evaluation excluded trauma, coagulopathies, neoplasia, and vasculitides.. The combination of a classic skin biopsy and a low vitamin C level confirmed the diagnosis.. This presentation illustrates the necessity of including scurvy in the differential diagnosis of ecchymoses and demonstrates specific populations at risk: single adults and the elderly with deficient diets.

Topics: Alabama; Ascorbic Acid; Biopsy; Diagnosis, Differential; Humans; Male; Middle Aged; Scurvy; Zinc

We report a 10-month-old boy with inflammatory and necrotic gingival lesions, fever, irritability, and pseudoparalysis of the legs. Laboratory examinations revealed moderate anemia and skeletal X-rays showed osteopenia, scorbutic rosary at the costochondral junctions, and "corner sign" on the proximal metaphyses of the femora. The boy had been fed only with diluted cow's milk. He had never taken solid food, vitamin C, or iron complement. Seventy-two hours after starting oral vitamin C supplementation, there was significant improvement in the patient's gingival lesions and general health. The clinical presentation and laboratory and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy. Scurvy, a dietary disease due to the deficient intake of vitamin C, is uncommon in the pediatric population. In an infant who has never received vitamin C, the combination of gingival lesions, pseudoparalysis, and irritability strongly suggests a diagnosis of scurvy. The clinical picture, together with the laboratory data, radiological studies, and therapeutic response to vitamin C administration, confirmed the diagnosis.

Topics: Ascorbic Acid; Folic Acid; Humans; Infant; Iron; Male; Scurvy; Vitamin D

Scurvy is a nearly-forgotten disease in developed countries where adequate nutrition is easily available. It still may occur, however, when, for a variety of reasons, people fail to eat a diet containing adequate vitamin C. We report the case of a 52-year-old patient with depression who developed scurvy.

Topics: Ascorbic Acid; Depression; Fluid Therapy; Gingivitis; Humans; Male; Middle Aged; Scurvy; Treatment Outcome; Vitamins

Ascorbic acid (vitamin C) is necessary for the formation of collagen, reducing free radicals, and aiding in iron absorption. Scurvy, a disease of dietary ascorbic acid deficiency, is uncommon today. Indeed, implementation of dietary recommendations largely eradicated infantile scurvy in the US in the early 1900s. We present a case of an otherwise healthy 2-year-old Caucasian girl who presented with refusal to walk secondary to pain in her lower extremities, generalized irritability, sleep disturbance, and malaise. The girl's parents described feeding the patient an organic diet recommended by the Church of Scientology that included a boiled mixture of organic whole milk, barley, and corn syrup devoid of fruits and vegetables. Physical examination revealed pale, bloated skin with edematous, violaceous gums and loosening of a few of her teeth. Dermatologic findings included xerosis, multiple scattered ecchymoses of the extremities, and perifollicular hemorrhage. Laboratory and radiographic evaluation confirmed the diagnosis of scurvy. The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid and significant dietary modification. In this case report, we revisit the old diagnosis of scurvy with a modern dietary twist secondary to religious practices. This case highlights the importance of taking a detailed dietary history when evaluating diseases involving the skin.

Topics: Administration, Oral; Ascorbic Acid; Child, Preschool; Diet; Edema; Female; Gingival Diseases; Humans; Religion; Scurvy; Tooth Mobility; Vitamins

Topics: Adult; Ascorbic Acid; Female; Humans; Leg Injuries; Scurvy

Nutritional deficiency may be a presenting sign of undiagnosed psychiatric illness. In this case, we present a patient with scurvy as a complication of fixed psychotic delusions regarding his diet. Dermatologists may play a crucial role in the recognition of psychiatric illnesses and appropriate referral for care.

Topics: Ascorbic Acid; Diet; Humans; Male; Middle Aged; Psychotic Disorders; Scurvy

Scurvy is a rarely seen disease resulting from a deficiency of vitamin C. We present a case of scurvy in a 65-year-old man. The patient reported heavy alcohol abuse over the last several years. He also reported that his diet consisted of cheese pizzas only. On physical examination, he was noted to have spontaneous ecchymosis of his lower extremities (denying any history of trauma); poor dentition; and corkscrew hairs on his chest, abdomen, and legs, with associated perifollicular petechia. Punch biopsy of his skin lesions revealed perivascular lymphohistiocytic inflammation, with some focal perifollicular erythrocyte extravasation. A serum ascorbic acid level was <0.12 mg/dL (normal range, 0.20-1.9 mg/dL). A diagnosis of vitamin C deficiency was made. The patient was successfully treated with 1 g/d vitamin C for the first 5 days, followed by a dose of 500 mg/d. Though scurvy is rarely seen in modern times, it is important to identify who is at risk and to recognize the clear and classic signs and symptoms associated with scurvy. Failure to diagnose this disease can potentially lead to expensive and unnecessary medical tests, as well as missing a very simple treatment that can prevent infection and even death.

Topics: Aged; Alcoholism; Ascorbic Acid; Diagnosis, Differential; Humans; Male; Risk Factors; Scurvy; Treatment Outcome

Ascorbic acid (vitamin C) is prone to oxidation in vivo. The human plasma protein haptoglobin (Hp) shows a genetic polymorphism with 3 major phenotypes (Hp 1-1, Hp 2-1, and Hp 2-2) that show important functional differences. Despite an adequate nutritional supply, in Hp 2-2 individuals (most common among Asian populations) vitamin C is markedly lower in concentration and particularly prone to oxidation in vivo. Therefore, susceptibility to subclinical and clinical vitamin C deficiency (scurvy) is partly genetically determined. The genetic advantage of the Hp1 allele as a vitamin C stabilizing factor helps to elucidate the direction and successes of long-distance sea crossing human migrations in history. Clinical trials demonstrated Hp phenotype-related effects of antioxidant treatment. Because vitamin C is a first line antioxidant, Hp polymorphism and its effects on vitamin C have major clinical consequences; a marked difference in genetic susceptibility toward atherosclerosis between Hp phenotypes is attributable to variation in LDL oxidation. The classical view of vitamin C and scurvy being a pure nutritional condition needs to be updated. These findings should foster research investigating the role of Hp polymorphism in human disease, and in vitamin C deficiency and atherosclerosis in particular.

Topics: American Indian or Alaska Native; Ascorbic Acid; Ascorbic Acid Deficiency; Asian People; Diet; Gene Frequency; Genetic Predisposition to Disease; Haptoglobins; History, 16th Century; History, 17th Century; History, 19th Century; History, Medieval; Humans; Polymorphism, Genetic; Scurvy; White People

Topics: Ascorbic Acid; Autistic Disorder; Bone and Bones; Bone Marrow; Child; Diagnosis, Differential; Exanthema; Gingival Hypertrophy; Humans; Male; Osteomyelitis; Pain; Radiography; Rheumatic Diseases; Scurvy; Skin

Topics: Anemia; Ascorbic Acid; Diagnosis, Differential; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Scurvy; Treatment Outcome

Scurvy is an ancient disease. Over the years, with advances in the understanding of the disease, general improvement in health standards and nutrition, scurvy is now rarely encountered. The few cases of scurvy reported in the 21st century mainly occurred in the neglected elderly, alcoholics and food faddist. We describe scurvy due to food selection in a 37-year-old woman with underlying eating and obsessive-compulsive disorders. With vitamin C replacement, psychiatric medication and cognitive behavioural therapy, there was a dramatic improvement in her condition. This case serves as a reminder to the clinician that, even though rare in today's practice, ascorbic acid deficiency is still encountered, and when recognised, is an easily treatable disease.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Follow-Up Studies; Humans; Risk Assessment; Scurvy; Singapore; Treatment Outcome

Topics: Administration, Oral; Aged; Antioxidants; Ascorbic Acid; Drug Therapy, Combination; Folic Acid; Humans; Male; Scurvy; Time Factors; Treatment Outcome

Topics: Ascorbic Acid; History, 16th Century; History, 17th Century; History, 18th Century; History, 20th Century; Humans; India; Naval Medicine; Netherlands; Scurvy; South Africa

We originally identified senescence marker protein 30 (SMP30) as a distinctive protein whose expression decreases in an androgen-independent manner with aging. Here, we report its sequence homology found in two kinds of bacterial gluconolactonases (GNLs) by using the blast search. Then, through a biochemical study, we identify SMP30 as the lactone-hydrolyzing enzyme GNL of animal species. SMP30 purified from the rat liver had lactonase activity toward various aldonolactones, such as d- and l-glucono-delta-lactone, d- and l-gulono-gamma-lactone, and d- and l-galactono-gamma-lactone, with a requirement for Zn(2+) or Mn(2+) as a cofactor. Furthermore, in SMP30 knockout mice, no GNL activity was detectable in the liver. Thus, we conclude that SMP30 is a unique GNL in the liver. The lactonase reaction with l-gulono-gamma-lactone is the penultimate step in l-ascorbic acid (AA) biosynthesis, and the essential role of SMP30 in this synthetic process was verified here by a nutritional study using SMP30 knockout mice. These knockout mice (n = 6), fed a vitamin C-deficient diet, did not thrive; i.e., they displayed symptoms of scurvy such as bone fracture and rachitic rosary and then died by 135 days after the start of receiving the deficient diet. The AA levels in their livers and kidneys at the time of death were <1.6% of those in WT control mice. In addition, by using the SMP30 knockout mouse, we demonstrate that the alternative pathway of AA synthesis involving d-glucurono-gamma-lactone operates in vivo, although its flux is fairly small.

Topics: Aging; Amino Acid Sequence; Animals; Ascorbic Acid; Biomarkers; Body Weight; Calcium-Binding Proteins; Carboxylic Ester Hydrolases; Intracellular Signaling Peptides and Proteins; Kinetics; Mice; Mice, Knockout; Molecular Sequence Data; Rats; Scurvy; Sequence Alignment; Sequence Homology, Amino Acid; Substrate Specificity; Sulfotransferases

ODS rat has a hereditary defect in ascorbic acid biosynthesis and is a useful animal model for elucidating the physiological role of ascorbic acid. We previously demonstrated by using ODS rats that ascorbic acid deficiency changes the hepatic gene expression of acute phase proteins, as seen in acute inflammation. In this study, we investigated the effects of ascorbic acid deficiency on the production of inflammatory chemokine, cytokine-induced neutrophil chemoattractant-1 (CINC-1), in ODS rats. Male ODS rats (6 wk of age) were fed a basal diet containing ascorbic acid (300 mg/kg diet) or a diet without ascorbic acid for 14 d. Obvious symptoms of scurvy were not observed in the ascorbic acid-deficient rats. Ascorbic acid deficiency significantly elevated the serum concentration of CINC-1 on d 14. The liver and spleen CINC-1 concentrations in the ascorbic acid-deficient rats were significantly elevated to 600% and 180% of the respective values in the control rats. However, the lung concentration of CINC-1 was not affected by ascorbic acid deficiency. Ascorbic acid deficiency significantly elevated the hepatic mRNA level of CINC-1 (to 480% of the value in the control rats), but not the lung mRNA level. These results demonstrate that ascorbic acid deficiency elevates the serum, liver and spleen concentrations of CINC-1 as seen in acute inflammation, and suggest that ascorbic acid deficiency stimulate the hepatic CINC-1 gene expression.

Topics: Animals; Apolipoprotein A-I; Apolipoproteins E; Ascorbic Acid; Ascorbic Acid Deficiency; Blotting, Northern; Body Weight; Chemokine CXCL1; Chemokines, CXC; Gene Expression; Genetic Predisposition to Disease; Haptoglobins; Liver; Lung; Male; Organ Size; Rats; Rats, Mutant Strains; RNA, Messenger; Scurvy; Spleen

A 53-year-old woman, known with a schizophrenic disorder and a history of drug addiction, was referred because of progressive hematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums, tooth hypermobility and anaemia. Scurvy was diagnosed as a result of an insufficient diet due to drug addiction and a paranoid psychosis. After suppletion of vitamin C and starting highly nutritious food a rapid amelioration of the scurvy related complaints was observed. While dreaded and often fatal in earlier eras, in the 21st century scurvy is easily treatable if this diagnosis is recognised.

Topics: Anemia; Antioxidants; Ascorbic Acid; Female; Humans; Middle Aged; Schizophrenia; Scurvy; Substance-Related Disorders; Tooth Mobility; Treatment Outcome

Topics: Ascorbic Acid; Citrus; History, 15th Century; History, 18th Century; History, 19th Century; Humans; Naval Medicine; Philately; Portugal; Scurvy; United Kingdom

Topics: Ascorbic Acid; Humans; Male; Nutrition Policy; Scurvy

Topics: Administration, Oral; Aged; Ascorbic Acid; Calcium; Diagnosis, Differential; Ecchymosis; Folic Acid; Follow-Up Studies; Humans; Male; Periodontitis; Scurvy; Time Factors; Treatment Outcome; Vitamin D

The skin manifestations, except for hyperpigmentation, are uncommon in Whipple's disease (WD). We present the case of a 48-year-old male with chronic diarrhea and long course general syndrome associated to neurological manifestations. Skin examination revealed lesions in the lower limbs and gums that were clinically consistent with scurvy and were confirmed by histological study and measurement of blood vitamin C levels. Furthermore, he had lesions that were clinically and histologically consistent with acquired ichthyosis. The digestive tract biopsy study showed non-necrotizing epithelioid granulomas without the presence of PAS positive macrophages. The patient was diagnosed of Whipple's disease through the identification of genomic fragments of Tropheryma Whippelii by PCR in duodenal samples. He was treated with antibiotics for two years with resolution of the cutaneous and digestive picture but with partial improvement of the neurological symptoms. In the literature reviewed, we did not find any case of acquired ichthyosis associated to WD and only one of scurvy secondary to this rare disease.

Topics: Anti-Bacterial Agents; Ascorbic Acid; Endoscopy, Gastrointestinal; Humans; Ichthyosis; Intestinal Mucosa; Male; Middle Aged; Scurvy; Skin; Treatment Outcome; Whipple Disease

Vitamin C deficiency (scurvy) is an uncommon disease in modern times, and therefore easily misdiagnosed when it appears. While visiting prisoners in East Africa, health delegates of the International Committee of the Red Cross (ICRC) encountered prisoners suffering from a hitherto undiagnosed 'mysterious' illness, consisting mainly of swollen and hard legs, that had not responded to various treatments given by the local health centre or hospital. The ICRC set out to investigate the nature of this disease and examined 133 prisoners with the suspected clinical symptoms described as 'wooden leg' syndrome in 10 different prisons. Serum ascorbic acid levels were measured and a food basket analysis done. The diagnosis of scurvy was confirmed. All patients responded to standard treatment with oral ascorbic acid. The clinical presentation of scurvy in these East African prisons seems to be somewhat different from the classic descriptions, but is in line with historic records of the disease. Treatment is easy and cheap, and response to treatment is quick. Scurvy remains a problem in prisons in Africa and clinicians working in prisons need to be aware of its presence and its presentations.

Topics: Adolescent; Adult; Africa, Eastern; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Diet; Humans; Leg; Male; Middle Aged; Prisoners; Scurvy

Topics: Ascorbic Acid; Deglutition Disorders; Exanthema; HIV Infections; Humans; Male; Middle Aged; Scurvy; Vitamins

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with modern medical trials and quality improvement processes. I will also review the reasons why evidence is not used and consider what factors facilitate the uptake of evidence. Understanding these concepts will make it easier for individual clinicians and institutions to change clinical behaviour and provide a starting point for those looking at implementing 'new' practices, new therapies and clinical guidelines. Finally, I will offer a list of criteria that clinicians might choose to consider when deciding on whether or not to adopt a new practice, treatment or concept.

Topics: Animals; Ascorbic Acid; Attitude of Health Personnel; Bloodletting; Calcium Compounds; Citrus sinensis; Diffusion of Innovation; Europe; Evidence-Based Medicine; Female; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Leeches; Male; Naval Medicine; Pneumonia; Practice Guidelines as Topic; Pregnancy; Puerperal Infection; Scurvy

Topics: Adult; Alcoholism; Ascorbic Acid; Humans; Male; Purpura; Scurvy; Treatment Outcome

Insufficient ascorbate intake causes scurvy in certain species. Beyond its known functions, it has been suggested that ascorbate participates in oxidative protein folding in the endoplasmic reticulum (ER). Because redox imbalance in this organelle might cause ER stress and apoptosis, we hypothesized that this might contribute to the pathology of scurvy. Guinea pigs were divided into 7 groups: the control group was fed a commercial guinea pig food containing 0.1 g/100 g ascorbate for 4 wk, 5 groups consumed an ascorbate-free food for 0, 1, 2, 3, or 4 wk and 1 group was fed this scorbutic diet for 2 wk and then the commercial food plus 1 g/L ascorbate in drinking water for 2 wk. TBARS generation and the expression of some ER chaperones and foldases were determined in hepatic microsomes. The apoptotic index was assessed in histological sections. Although ascorbate, measured by HPLC, was undetectable in the livers of the guinea pigs after they had consumed the scorbutic diet for 2 wk, the microsomal TBARS level was elevated relative to the initial value only at wk 4. Western blot revealed the induction of GRP78, GRP94, and protein disulfide isomerase at wk 3 and 4. Apoptosis was greater than in the control, beginning at wk 3. None of the alterations occurred in the groups fed the commercial guinea pig food or ascorbate-free food followed by ascorbate supplementation. Therefore, persistent ascorbate deficiency leads to ER stress, unfolded protein response, and apoptosis in the liver, suggesting that insufficient protein processing participates in the pathology of scurvy.

Topics: Animals; Apoptosis; Ascorbic Acid; Blotting, Western; Body Weight; Endoplasmic Reticulum; Endoplasmic Reticulum Chaperone BiP; Guinea Pigs; Heat-Shock Proteins; Liver; Male; Membrane Glycoproteins; Microsomes, Liver; Molecular Chaperones; Organ Size; Proteins; Scurvy; Thiobarbituric Acid Reactive Substances

Infantile Tremor Syndrome is a distinct clinical entity most commonly seen in Indian Subcontinent. Syndrome consists of tremors, mental and developmental retardation, abnormal skin pigmentation and anemia in children between 6 months to 2 years. The etiology is still elusive. Amongst various theories, nutritional theory is the most accepted. So far there are no cases reported of vitamin C deficiency in ITS. In this article, three cases of ITS associated with vitamin C deficiency are reported.

Topics: Age Factors; Ascorbic Acid; Ascorbic Acid Deficiency; Folic Acid; Humans; Infant; Iron; Male; Malnutrition; Propranolol; Scurvy; Socioeconomic Factors; Syndrome; Treatment Outcome; Tremor

Scurvy is a nondiscriminatory disease process resulting from a nutritional deficiency of ascorbic acid (vitamin C). The severe vitamin deficiency produces a breakdown in the cellular structure of the body. This case report describes a middle-age woman with a history of edema, bruising of the lower extremities, anemia, and severe periodontal disease. Her presentation and medical history are classic for the signs of scurvy. Scurvy is now only uncommonly seen in developed countries, but there are still vulnerable populations whose nutritional status can lead to scurvy. The aim of this report is to help the clinician identify and treat scurvy, a disease that was once feared for its high mortality but is now easily treatable, even in cases that have progressed to multiple organ dysfunction and failure.

Topics: Adult; Anemia; Ascorbic Acid; Female; Gingivoplasty; Halitosis; Humans; Periodontal Diseases; Purpura; Scurvy; Tooth Extraction; Vitamins

Scurvy can occur in hospitalized patients despite vitamin supplementation.. A 63 Year-old patient who had spent several weeks in intensive care developed an unexplained anemia and ecchymoses. Despite daily administration of 130 mg/day of vitamin C since his admission, his ascorbic acid blood levels had collapsed. Administration of 1g/day relieved the symptoms within four weeks.. Whether a deficiency had existed prior to admission or not, scurvy developed during the week of intensive care despite parenteral nutrition supplying a daily dose of 130 mg of vitamin C. Such deficiencies decompensated in surgical situations remain a reality in developed countries.. In certain pathological contexts and in all the growing number of cases in elderly patients and many surgical indications, the need for vitamin C supplementation has to be defined. The needs at that particular time must be taken into account and the prior nutritional status.

Topics: Ascorbic Acid; Critical Care; Female; Follow-Up Studies; Humans; Middle Aged; Parenteral Nutrition; Risk Factors; Scurvy; Surgical Procedures, Operative; Time Factors

To determine whether ascorbic acid might be of benefit for the treatment of spontaneous osteoarthritis (OA) when administered over a long period of time.. We investigated the effects of 8 months' exposure to low, medium, and high doses of ascorbic acid on the in vivo development of histologic knee OA in the male Hartley guinea pig. The low dose represented the minimum amount needed to prevent scurvy. The medium dose was the amount present in standard laboratory guinea pig chow and resulted in plasma levels comparable with those achieved in a person consuming 200 mg/day (5 fruits and vegetables daily). The high dose was the amount shown in a previous study of the guinea pig to slow the progression of surgically induced OA.. We found an association between ascorbic acid supplementation and increased cartilage collagen content but, in contrast to findings in a previous study of surgically induced OA in the guinea pig, ascorbic acid worsened the severity of spontaneous OA. Active transforming growth factor beta (TGF beta) was expressed in marginal osteophytes, whose size and number were significantly increased with increasing intake of ascorbic acid. Synovial fluid levels of cartilage oligomeric matrix protein, a biomarker of cartilage turnover, corroborated the histologic findings.. Ascorbic acid has been shown to activate latent TGF beta. Prolonged intraarticular exposure to TGF beta has been shown to cause OA-like changes. We found expression of active TGF beta in osteophytes, a prominent feature of the joint histology seen in association with ascorbic acid treatment. Thus, the deleterious effects of prolonged ascorbic acid exposure may be mediated in part by TGF beta. This worsening of OA with ascorbic acid supplementation suggests that ascorbic acid intake should not be supplemented above the currently recommended dietary allowance (90 mg/day for men and 75 mg/day for women).

Topics: Animals; Antioxidants; Ascorbic Acid; Bone Density; Cartilage; Collagen; Disease Models, Animal; Extracellular Matrix Proteins; Glycoproteins; Guinea Pigs; Least-Squares Analysis; Male; Matrilin Proteins; Osteoarthritis, Knee; Scurvy; Severity of Illness Index; Synovial Fluid; Transforming Growth Factor beta; Weight Gain

Topics: Ascorbic Acid; Hemorrhage; Humans; Meningitis, Meningococcal; Oxidative Stress; Scurvy

Topics: Ascorbic Acid; Diagnosis, Differential; Diet; Fruit; Humans; Male; Middle Aged; Scurvy; Vegetables

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Ascorbic Acid; Complementary Therapies; History, 16th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Modern 1601-; Humans; Nonlinear Dynamics; Pharmacokinetics; Pharmacology; Scurvy

The custom of allowing British seamen the regular use of fermented liquor is an old one. Ale was a standard article of the sea ration as early as the fourteenth century. By the late eighteenth century, beer was considered to be at once a food (a staple beverage and essential part of the sea diet), a luxury (helping to ameliorate the hardship and irregularity of sea life) and a medicine (conducive to health at sea). In particular, beer and its precursors, wort and malt, were administered with the aim of preventing and curing scurvy. This paper examines the use of malt and beer during late eighteenth century British sea voyages, particularly their use as antiscorbutic agents, focusing on James Cook's three voyages during the period 1768-1780. Cook administered sweet wort (an infusion of malt), beer (prepared from an experimental, concentrated malt extract), and spruce beer (prepared mainly from molasses), among many other items, in his attempts to prevent and to cure scurvy. Despite the inconclusive nature of his own experiments, he reported favourably after his second voyage (1772-1775) on the use of wort as an antiscorbutic sea medicine (for which purpose it is now known to be useless). Cook thereby lent credibility to erroneous medical theories about scurvy, helping to perpetuate the use of ineffective treatments and to delay the discovery of a cure for the disorder.

Topics: Alcoholic Beverages; Ascorbic Acid; Ascorbic Acid Deficiency; Beer; Edible Grain; England; Famous Persons; Fermentation; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; Humans; Naval Medicine; Scurvy

SHR-od is a novel strain of rat that spontaneously develops hypertension and has a defect of ascorbic acid (AsA) biosynthesis. The osteogenic disorder Shionogi (ODS) rat is normotensive and also unable to synthesize AsA. To investigate whether or not genetic hypertension affects AsA metabolism, we compared the AsA metabolisms of SHR-od and ODS rats. In this study, a physiological dose of AsA equivalent to the AsA requirement in ODS rats was administered to rats intraperitoneally (i.p. group) or orally (oral group). We measured AsA concentrations in the serum, liver, kidney, adrenal glands, and spleen, and the amount of AsA excreted into the urine. At 25 wk of age (hypertensive status), the AsA concentrations of all tissues tested were significantly lower in SHR-od than in ODS rats in both the i.p. and oral groups. In the i.p. group, the amount of urinary AsA in SHR-od was also lower than that in ODS rats. At 4 wk of age (before the onset of hypertension), liver and spleen AsA concentrations in SHR-od were lower than those in ODS rats in both the i.p. and oral groups. Urinary AsA excretion from SHR-od was not different between the two groups. Our data suggest that the requirement for AsA in SHR-od is increased to maintain tissue AsA concentrations equivalent to those in ODS rats, and that a larger part of the AsA administered to rats in this study is degraded in SHR-od as compared to ODS rats.

Topics: Adrenal Glands; Animals; Ascorbic Acid; Hypertension; Kidney; Liver; Male; Osteogenesis; Rats; Rats, Inbred SHR; Scurvy; Spleen; Thiobarbituric Acid Reactive Substances

In previous studies, we showed that docosahexaenoic acid (DHA) ingestion enhanced the susceptibility of rat liver and kidney to lipid peroxidation, but did not increase lipid peroxide formation to the level expected from the relative peroxidizability index (P-index) of the total tissue lipids. The results suggested the existence of some suppressive mechanisms against DHA-induced tissue lipid peroxide formation, as increased tissue ascorbic acid (AsA) and glutathione levels were observed. Therefore, we focused initially on the role of AsA for the suppressive mechanisms. For this purpose, we examined the influence of different levels of dietary AsA (low, moderate, high and excessive levels were 100, 300 (control), 600 and 3000 mg/kg diet respectively) on the tissue lipid peroxide and antioxidant levels in AsA-requiring Osteogenic Disorder Shionogi/Shi-od/od (ODS) rats fed DHA (6.4 % total energy) for 32 or 33 d. Diets were pair-fed to the DHA- and 100 mg AsA/kg diet-fed group. We found that the lipid peroxide concentrations of liver and kidney in the DHA-fed group receiving 100 mg AsA/kg diet were significantly higher or tended to be higher than those of the DHA-fed groups with AsA at more than the usual control level of 300 mg/kg diet. Contrary to this, the liver alpha-tocopherol concentration was significantly lower or tended to be lower in the DHA and 100 mg AsA/kg diet-fed group than those of the other DHA-fed groups. However, tissue lipid peroxide formation and alpha-tocopherol consumption were not suppressed further, even after animals received higher doses of AsA. The present results suggest that higher than normal concentrations of tissue AsA are not necessarily associated with the suppressive mechanisms against dietary DHA-induced tissue lipid peroxide formation.

Topics: alpha-Tocopherol; Animals; Ascorbic Acid; Bone Diseases, Metabolic; Dietary Fats, Unsaturated; Docosahexaenoic Acids; Glutathione; Kidney; Lipid Peroxidation; Lipid Peroxides; Liver; Male; Osteogenesis; Rats; Rats, Inbred Strains; Scurvy; Testis

A series of novel acylated ascorbic acid derivatives, 6-O-acyl-2-O-alpha-D-glucopyranosyl-L-ascorbic acids with a branched-acyl chain (6-bAcyl-AA-2G) were recently developed in our laboratory as stable and lipophilic ascorbate derivatives. In this study, the bioavailability of 6-bAcyl-AA-2G was investigated in guinea pigs. Various tissue homogenates from guinea pigs hydrolyzed 6-bAcyl-AA-2G to give ascorbic acid (AA), 2-O-alpha-D-glucopyranosyl-L-ascorbic acid (AA-2G), and 6-O-acyl AA. The releasing pattern of the three hydrolysates suggested that 6-bAcyl-AA-2G was hydrolyzed via 6-O-acyl AA to AA as a main pathway and via AA-2G to AA as a minor pathway. The former pathway seems to be of advantage, because 6-O-acyl AA, as well as AA, can have vitamin C activity. In addition, we found that a derivative with an acyl chain of C(12), 6-bDode-AA-2G, had a pronounced therapeutic effect in scorbutic guinea pigs by its repeated oral administrations. These results indicate that 6-bAcyl-AA-2G is a readily available source of AA in vivo, and may be a promising antioxidant for skin care and treatment of diseases associated with oxidative stress.

Topics: Acylation; Alkaline Phosphatase; alpha-Glucosidases; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Biological Availability; Brain; Esterases; Guinea Pigs; Hydrolysis; Intestine, Small; Kidney; Liver; Scurvy; Weight Loss

In March 2002, there were reports of a hemorrhagic fever outbreak in western Afghanistan. It was later confirmed that the hemorrhagic symptoms and increased mortality were actually due to scurvy. Most aid workers did not include scurvy in the initial differential diagnosis because it is uncommon throughout the world and has mainly been reported in refugee populations in recent times. A rapid assessment confirmed the cases clinically, estimated a prevalence rate of 6.3% (a severe public health problem), and determined that the attack rates peaked each year in January and February (the end of the winter). Many Afghans have limited dietary diversity due to isolated locations, lengthy winters, the continuing drought of the last four years, asset depletion, and loss of livelihood. After numerous food and fortification options to prevent future outbreaks had been considered, vitamin C tablet supplementation was selected because of the relatively rapid response time as compared with other prevention methods. A three-month course of vitamin C tablets was distributed to 827 villages in at-risk areas. The tablets were acceptable and compliance was good. No cases of scurvy were reported for the winter of 2002-03. The case study from Afghanistan demonstrates that scurvy can occur in nonrefugee or nondisplaced populations; vitamin C supplementation can be an effective prevention strategy; there is an urgent need to develop field-friendly techniques to diagnose micronutrient-deficiency diseases; food-security tools should be used to assess and predict risks of nutritional deficiencies; and the humanitarian community should address prevention of scurvy in outbreak-prone areas.

Topics: Adolescent; Adult; Afghanistan; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Child, Preschool; Dietary Supplements; Disease Outbreaks; Humans; Infant; Infant, Newborn; Middle Aged; Oral Hemorrhage; Patient Compliance; Scurvy; Seasons

Topics: Ascorbic Acid; Enteral Nutrition; Enteritis; Gastrostomy; Humans; Infant; Leg; Male; Milk Hypersensitivity; Nutritional Requirements; Pain; Scurvy; Weight Loss

The bioavailability of a series of novel acylated ascorbic acid derivatives, 6-O-acyl-2-O-alpha-D-glucopyranosyl-L-ascorbic acids (6-Acyl-AA-2G), as an ascorbic acid (AA) supplement was investigated in rats and guinea pigs. Oral administration of 6-Acyl-AA-2G to rats resulted in an increase in the plasma AA level. However, the intact form was not detectable in the plasma by high-performance liquid chromatography, indicating its hydrolysis through the process of absorption. After an intravenous injection to rats of 6-Octa-AA-2G as a representative derivative, the intact form rapidly disappeared from the plasma, being followed by a prolonged and marked elevation of the plasma AA level. Various tissue homogenates from guinea pigs were examined for their releasing activity of AA, 2-O-alpha-D-glucopyranosyl-L-ascorbic acid (AA-2G) and 6-O-acyl-AA from 6-Acyl-AA-2G. High activity was observed in the small intestine. These hydrolytic activities to AA and 6-O-acyl-AA were completely inhibited by castanospermine, an alpha-glucosidase inhibitor, and AA-2G was observed as the only resulting hydrolysate, suggesting the participation of alpha-glucosidase and esterase in the in vivo hydrolysis of 6-Acyl-AA-2G. 6-Octa-AA-2G was found to exhibit an obvious therapeutic effect in scorbutic guinea pigs from its repeated oral administration. These results indicate that 6-Acyl-AA-2G is a readily available source of AA activity in vivo, and may be useful as an effective pharmacological agent and as a promising food additive.

Topics: alpha-Glucosidases; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Biological Availability; Brain; Dietary Supplements; Esterases; Guinea Pigs; Hydrolysis; Intestine, Small; Liver; Male; Rats; Rats, Wistar; Scurvy; Skin

Scurvy is an extremely rare complication of anorexia nervosa. Despite the poor intake of nutrients, anorexia nervosa is not commonly associated with vitamin deficiencies. We report a case of early scurvy complicating long-standing anorexia nervosa. Anorexia nervosa appears to be increasing in incidence. Although scurvy is unusual, this case shows the importance of its recognition as a nutritional consequence of anorexia nervosa.

Topics: Anorexia Nervosa; Ascorbic Acid; Female; Humans; Middle Aged; Scurvy

We describe a case of scurvy in a 32-year-old woman. The disease was associated with bilateral tumours of the quadriceps muscles and malignancy was considered. Adrenal insufficiency was also diagnosed. All abnormalities subsided in response to vitamin C therapy. It is unknown whether there is a causal link between the two diseases, but evaluation of adrenal function seems justified in future cases of scurvy.

Topics: Adrenal Insufficiency; Adult; Ascorbic Acid; Diagnosis, Differential; Female; Humans; Muscle Neoplasms; Scurvy

Topics: Ascorbic Acid; Celiac Disease; Humans; Scurvy

Lind is revered as the first doctor to conduct systematic clinical trials of potential cures for scurvy-trials in which oranges and lemons came out as decisive winners. The following paper argues that our modern understanding of scurvy and vitamin C has hindered our understanding of Lind's own conception of his work and of the place within it of his clinical trials. Lind conceived of scurvy not as a disease of dietary deficiency, but of faulty digestion. In the full context of his Treatise of the Scurvy, and of his own medical practice, the seeming decisiveness of the trials fades, to be replaced by a sense of Lind's bafflement at the nature of the disease to which he had devoted his career.

Topics: Ascorbic Acid; Citrus; Clinical Trials as Topic; History, 18th Century; Humans; Scurvy

The biological activity of L-dehydroascorbic acid (DHA), which is easily formed from L-ascorbic acid (ASC) during storage and cooking processes, has been considered to be equivalent to that of ASC on the basis of studies made several decades ago, when a specific method to determine ASC was not available. The nutritional activity of orally ingested DHA has now been evaluated by comparing ASC concentrations in 12 tissues of rats administered four different doses of ASC. Determinations were made by using the specific and sensitive method, which had been developed by us. Here it is shown that the efficiency of DHA was almost 10% of that of ASC on a molar basis, based on animal experiments using the inherently scorbutic ODS rat, which is a convenient human model animal to investigate the metabolism of vitamin C. On the basis of these findings, it is proposed that it is necessary to reevaluate the nutritional requirement of vitamin C based on both ASC and DHA contents of foods.

Topics: Administration, Oral; Animals; Ascorbic Acid; Dehydroascorbic Acid; Disease Models, Animal; Male; Nutritional Requirements; Nutritive Value; Rats; Scurvy; Tissue Distribution

Topics: Animals; Arteriosclerosis; Ascorbic Acid; Collagen; Disease Models, Animal; Disease Progression; Extracellular Matrix; Humans; Mice; Myocardial Infarction; Protein Processing, Post-Translational; Scurvy

Topics: Ascorbic Acid; Gingival Hemorrhage; Humans; Mouth Mucosa; Scurvy

Topics: Abdomen; Ascorbic Acid; Humans; Male; Middle Aged; Purpura; Scurvy; Skin Diseases

Topics: Aged; Ascorbic Acid; Diagnosis, Differential; Hemodynamics; Humans; Male; Multiple Organ Failure; Scurvy

Topics: Ascorbic Acid; Femoral Fractures; Humans; Infant; Male; Radiography; Scurvy

Previous studies indicate that benzanthrone, an anthraquinone dye intermediate, caused significant depletion of ascorbic acid (AsA). In this investigation the effect of benzanthrone on the status of different forms of AsA and other bio-antioxidants such as glutathione (GSH) was studied. Oral administration of benzanthrone (50, 125 or 250 mg/kg body weight) resulted in a significant increase of urinary AsA levels with a concomitant decrease in the urinary dehydroascorbic acid (DHA) content in both rats and guinea-pigs. Benzanthrone caused a dose-dependent decrease in hepatic, adrenal and serum AsA levels with a subsequent increase in DHA and diketogulonic acid (DKA) levels in both rats and guinea-pigs. Following benzanthrone treatment, rats showed an increase in the scorbutic index (to 1.01-1.21) of the liver, adrenal glands and serum compared to controls (0.12-0.24). The scorbutic indices of liver, adrenal glands and serum were also substantially increased (to 3.61-11.20) in benzanthrone-treated guinea-pigs compared to controls (0.16-0.38). Single oral administration of benzanthrone to guinea-pigs caused a dose-dependent depletion of GSH in liver (15-51%), adrenal glands (27-64%) and serum (32-86%). Furthermore, the depletion of GSH by benzanthrone in rats was of a lesser degree. This suggests that continued exposure of guinea-pigs to benzanthrone may lead to scurvy-type changes in this animal species but not to the same extent in rats, since the latter has the enzymatic capacity to synthesise AsA. Therefore, it can be hypothesised that benzanthrone per se, or its metabolites, interact with reduced GSH thereby causing its depletion. Furthermore, in order to replenish the depleted GSH levels, AsA might be oxidized to DHA and hence the decrease in AsA with the simultaneous increase in DHA was observed.

Topics: 2,3-Diketogulonic Acid; Adrenal Glands; Animals; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Benz(a)Anthracenes; Dehydroascorbic Acid; Dose-Response Relationship, Drug; Glutathione; Guinea Pigs; Liver; Male; Rats; Scurvy

Vitamin C deficiency or scurvy is a disease now rarely seen except for certain populations at risk. When it occurs, diagnosis can be difficult as it can mimic other disorders. Its manifestations are primarily due to an abnormality in collagen formation causing bleeding in the skin, joints, muscles, or gastrointestinal tract and dystrophic hair deformities. We describe a case of scurvy in a 43-year-old man who presented with new onset hemarthrosis with no history of bleeding disorder. He was found to have perifollicular hyperpigmentation and corkscrew hairs, highly suggestive of scurvy. He admitted to completely eliminating fruits and vegetables from his diet and his serum vitamin C level was markedly decreased. Treatment with daily vitamin C supplement led to relief of symptoms and resolution of skin changes.

Topics: Adult; Ascorbic Acid; Diagnosis, Differential; Hemarthrosis; Humans; Hyperpigmentation; Male; Scurvy; Skin

An 8-year-old child with cerebral palsy came with progressive purpuric rash affecting the trunk and legs. He had tenderness on palpation of his extremities. Physical examination revealed a moderately pale and cachectic boy. There was bleeding per swollen gums and petichiae on the hard palate. Generalized multiple discrete palpable petichiae spots at hair follicles along the whole body, more on both legs, were observed. He also had tenderness on palpation of his extremities. His hemoglobin was 6.6 g/dl. Platelet count and coagulogram were normal. Roentgenographic findings showed generalized osteoporosis, metaphyseal white line of distal femur, proximal tibia. proximal fibula, distal radius, and distal ulna with submetaphyseal lucency bilaterally. Skin biopsy showed dilated hair follicles, filled with keratinous material and a small corkscrew hair. A diagnosis of scurvy was made; and vitamin C at a dosage of 300 mg per day was given. His swollen gums, bleeding per gums and muscle tenderness improved within 2 days. Perifollicular hemorrhage, follicular hyperkeratosis, and anemia improved in 2 and 3 weeks respectively.

Topics: Ascorbic Acid; Cerebral Palsy; Child; Humans; Iron Compounds; Male; Prognosis; Scurvy; Severity of Illness Index; Thailand; Treatment Outcome

Scurvy has been known since ancient times, but the discovery of the link between the dietary deficiency of ascorbic acid and scurvy has dramatically reduced its incidence over the past half-century. Sporadic reports of scurvy still occur, primarily in elderly, isolated individuals with alcoholism. The incidence of scurvy in the pediatric population is very uncommon, and it is usually seen in children with severely restricted diets attributable to psychiatric or developmental problems. The condition is characterized by perifollicular petechiae and bruising, gingival inflammation and bleeding, and, in children, bone disease. We describe a case of scurvy in a 9-year-old developmentally delayed girl who had a diet markedly deficient in vitamin C resulting from extremely limited food preferences. She presented with debilitating bone pain, inflammatory gingival disease, perifollicular hyperkeratosis, and purpura. Severe hypertension without another apparent secondary cause was also present, which has been previously undescribed. The signs of scurvy and hypertension resolved after treatment with vitamin C. The diagnosis of scurvy is made on clinical and radiographic grounds, and may be supported by finding reduced levels of vitamin C in serum or buffy-coat leukocytes. The response to vitamin C is dramatic. Clinicians should be aware of this potentially fatal but easily curable condition that is still occasionally encountered among children.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Developmental Disabilities; Diet; Epilepsy; Female; Fruit; Humans; Knee Joint; Magnetic Resonance Imaging; Radiography; Scurvy

A reduction of dehydroerythorbic acid (DERA) to erythorbic acid (ERA) in vitamin C-deficient guinea pigs was evaluated and compared with that of dehydroascorbic acid (DASA). Thirty-six guinea pigs were fed with vitamin C-deficient diets for 18 days. On day 19, the guinea pigs were divided into four groups for the administration of 100 mg of DERA, ERA, ascorbic acid (ASA), or DASA every day. After 12 days of oral administration, the concentration of DERA, ERA, ASA, and DASA in the liver, adrenal, spleen, kidney, and plasma of guinea pigs was determined by HPLC. A recovery from scurvy was measured in terms of weight gain and serum alkaline phosphatase activity. All four groups showed similar recovery, indicating that the oral administration of relatively high concentrations of DERA reversed the effects of scurvy in vitamin C-deficient guinea pigs. In spite of DERA or DASA administration, ERA or ASA was mainly detected in the tissues. The reduction ratios of DEAR and DASA were similar (approximately 80%) in all tissues except spleen. These results suggest that both DASA and DERA are taken up and reduced to ASA or ERA in vivo.

Topics: Animals; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Dehydroascorbic Acid; Guinea Pigs; Male; Scurvy

We report three new cases of patients presenting scurvy. In the year 2000 this rare disease still occurs in France.. The three patients, 2 men and a woman respectively 51, 50, and 73 years-old were alcoholics, and lived alone in difficult social conditions. Dietary survey indicated in the 3 cases inadequate vitamin C intake, and a regimen including solely bread, rice, pasta, and packet soup devoid of fresh vegetables and fruit. The cutaneous findings attributed to scurvy were: in the first patient, a woody inflammatory and painful oedema of the left leg associated with perifollicular petechial haemorrhages over the lower limbs, and hyperpigmentation of the facial skin with slate-gray spotty pigmentation of the tongue (pseudo-addisonian hyperpigmentation); in the second patient, an accentuation of a pre-existing acne becoming more inflammatory and extensive; and in the third patient, a diffuse petechial eruption on the abdomen and lower extremities. The diagnosis of scurvy was confirmed by low plasma ascorbic acid levels (< 6 mumol/l). All patients were treated with 1 to 2 g of oral ascorbic acid daily for 2 weeks resulting in rapid and dramatic response.. Scurvy is a rare disease in industrialized nations. Its incidence is unknown because of absence of total census. Dietary vitamin C deficiency represents the main risk factor exposing for scurvy among adults, often alcoholics and living in social isolation. Cutaneous features supporting the diagnosis of scurvy are described in our observations. The recognition of these cutaneous abnormalities is important because their association can be misleading, and erroneously interpreted as a sign of systemic vasculitis, or connective tissue disease. The diagnosis of scurvy is confirmed by the measurement of plasma ascorbic acid levels. Treatment is simple and based on the administration of vitamin C, which results in dramatic improvement.

Topics: Aged; Alcoholism; Ascorbic Acid; Cross-Sectional Studies; Diagnosis, Differential; Feeding Behavior; Female; Humans; Incidence; Life Style; Male; Middle Aged; Scurvy

Topics: Ascorbic Acid; Diagnosis, Differential; Diet; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 21st Century; Humans; Scurvy; Ships; Travel

In order to determine if the absence of vitamin C in the diet of capybaras (Hydrochoerus hydrochaeris) causes scurvy, a group of seven young individuals were fed food pellets without ascorbic acid, while another group of eight individuals received the same food with 1 g of ascorbic acid per animal per day. Animals in the first group developed signs of scurvy-like gingivitis, breaking of the incisors and death of one animal. Clinical signs appeared between 25 and 104 days from the beginning of the trial in all individuals. Growth rates of individuals deprived of vitamin C was considerably less than those observed in the control group. Deficiency of ascorbic acid had a severe effect on reproduction of another population of captive capybaras. We found that the decrease in ascorbic acid content in the diet affected pregnancy, especially during the first stages. The results obtained suggest that it is necessary to supply a suitable quantity of vitamin C in the diet of this species in captivity.

Topics: Animals; Animals, Zoo; Argentina; Ascorbic Acid; Diet; Female; Male; Pregnancy; Pregnancy Complications; Random Allocation; Retrospective Studies; Rodent Diseases; Rodentia; Scurvy

We describe a healthy 18-month-old child who developed a painful limp, without a history of trauma or fever. The initial laboratory investigations showed normal results but the radiological findings were suggestive of scurvy. Diagnosis was confirmed by blood tests and by a rapid recovery following replacement therapy.

Topics: Ascorbic Acid; Follow-Up Studies; Gait; Humans; Infant; Leg; Male; Pain; Radiography; Scurvy; Treatment Outcome

The risk of vitamin C deficiency is underestimated in industrialized countries and is only disclosed in rare cases of severe scurvy.. We report three cases of scurvy presenting with ecchymotic purpura and hemorrhagic ulcerations of the lower limbs. Vitamin C supplementation led to rapid improvement of the skin lesions.. Clinical diagnosis of low-grade deficiency can be difficult. Biological diagnosis requires special care in sample taking and transport.

Topics: Aged; Aged, 80 and over; Ascorbic Acid; Ascorbic Acid Deficiency; Diagnosis, Differential; Ecchymosis; Female; Hemorrhage; Humans; Leg Dermatoses; Leg Ulcer; Purpura; Risk Factors; Scurvy

A case of scurvy occurred in an apparently well-nourished 5-year-old boy with normal growth parameters. Only after the diagnosis of scurvy was raised on clinical grounds did we discover the peculiar dietary habits that were responsible for his deficiency of ascorbic acid. His case is a reminder to the clinician that nutritionally based disease may occur in any socioeconomic setting and that nutritional screening remains an important part of every child's general health care.

Topics: Ascorbic Acid; Child, Preschool; Contusions; Diagnosis, Differential; Feeding Behavior; Gait; Humans; Male; Scurvy

Topics: Adolescent; Ascorbic Acid; Female; Gingival Hemorrhage; Humans; Pain; Radiography; Retrobulbar Hemorrhage; Scurvy; Visual Acuity

Topics: Ascorbic Acid; beta-Thalassemia; Child; Erythrocyte Transfusion; Humans; Male; Prognosis; Radiography; Risk Assessment; Scurvy; Treatment Outcome

Topics: Ascorbic Acid; Child, Preschool; Cultural Characteristics; Deficiency Diseases; Female; Humans; India; Infant; Male; Scurvy; Socioeconomic Factors

Topics: Ascorbic Acid; Child; Diagnosis, Differential; Diet; Humans; Louisiana; Male; Scurvy

In scurvy-prone animals ascorbic acid uptake is regulated by the number of intestinal "brush-border" carriers available for transport. The number of carriers is negatively affected by an increasing dietary ascorbic acid intake, thus limiting the maximum attainable uptake. We tested a new approach towards manipulating the accumulation of ascorbic acid in rainbow trout by repeatedly feeding a 10 day ascorbic acid allowance in a 1 or 3 day "pulse" followed by withdrawal, rather than spread out over the entire 10 day period. Pulse dosing led to initially increased mortalities compared to continuous dosing, but this was reversed after 55 days. Although individual weight and cumulative mortality were not significantly different after 88 days, total liver ascorbic acid levels were significantly higher in the 1-day pulse group (16.3 +/- 3.9 micrograms/g) than in the 3-day pulse (9.8 +/- 0.9 micrograms/g) or continuous (9.3 +/- 0.9 micrograms/g) groups. This led us to conclude that after an initial adaptation phase a feeding profile with intermittent ascorbic acid withdrawal results in a compensatory increase in uptake of ascorbic acid from the diet and/or a better conservation of the body pool of ascorbic acid, opening interesting new avenues for ascorbic acid dosing and therapy.

Topics: Animals; Ascorbic Acid; Biological Availability; Diet; Intestinal Absorption; Models, Biological; Nutritional Status; Oncorhynchus mykiss; Scurvy

Topics: Adenocarcinoma; Ascorbic Acid; Ascorbic Acid Deficiency; Gingivitis; Humans; Lung Neoplasms; Male; Middle Aged; Polycythemia Vera; Scurvy

Topics: Adrenal Glands; Africa; Americas; Ascorbic Acid; Citrus; Dietary Supplements; Europe; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Scurvy

The ability of rainbow trout liver and kidney preparations to produce L-ascorbic acid with an added source of L-gulono-gamma-lactone oxidase (GLO) and the absence of their own GLO activity suggested that the reason for the absence of L-ascorbic acid biosynthesis in fish and in guinea pig, a scurvy-prone mammal, can be similar. Nevertheless, results of rat GLO cDNA expression in guinea pig cells and in rainbow trout proved different. In guinea pig cells, rat GLO was expressed in a functional form. Regardless of recombinant GLO transcripts detected in rainbow trout embryos, alevins and in juvenile fish, neither GLO protein nor GLO activity were found. Furthermore, production of L-ascorbic acid in transgenic rainbow trout was not revealed in feeding tests with vitamin C-free diets or after direct administration of L-gulono-gamma-lactone. These results indicate that conditions required for translation or stability of rat GLO are absent in rainbow trout tissues.

Topics: Animals; Animals, Genetically Modified; Ascorbic Acid; Ascorbic Acid Deficiency; Base Sequence; Diet; DNA Primers; DNA, Complementary; Gene Expression; Gene Transfer Techniques; Guinea Pigs; L-Gulonolactone Oxidase; Oncorhynchus mykiss; Polymerase Chain Reaction; Rats; Scurvy; Species Specificity; Sugar Alcohol Dehydrogenases

Topics: Adult; Ascorbic Acid; Diet; Ecchymosis; Erythema; Humans; Male; Scurvy; Skin

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Cardiovascular Diseases; Chromatography, High Pressure Liquid; Cystic Fibrosis; Humans; Scurvy; Thiobarbituric Acid Reactive Substances

An account of the journey around the world by the Austrian ship's doctor Eduard Schwarz on a sailing ship from 1857 to 1859, his successful cure of nightblindness among the sailors, and how he was maligned by some of the Viennese medical press for his view that nightblindness is a nutritional disorder.

Topics: Ascorbic Acid; Deficiency Diseases; History, 19th Century; Humans; Hungary; Military Personnel; Naval Medicine; Night Blindness; Scurvy; Vitamin A

The evidence for the role of ascorbic acid in gene expression or protein synthesis in vivo is limited. To investigate this role of ascorbic acid, we surveyed proteins whose tissue levels are changed by ascorbic acid deficiency by using ODS rats with a hereditary defect in ascorbic acid biosynthesis. Male ODS rats (7 wk old, body weight approximately 130 g) were fed a basal diet containing ascorbic acid (300 mg/kg diet) or an ascorbic acid-free diet for 14 d. Ascorbic acid deficiency decreased a renal protein with an apparent molecular mass of 17 kDa. The amino-terminal amino acid sequence of 16 residues of this 17-kDa protein was identical to a kidney fatty acid-binding protein known to be generated by proteolytic degradation of alpha2u-globulin, a major urinary protein of adult male rats. alpha2u-Globulin is synthesized in liver, secreted into blood and excreted into urine, but partially reabsorbed by renal proximal tubules. It exists in kidney in a proteolytically modified form. Ascorbic acid deficiency lowered the renal level of kidney fatty acid-binding protein to 53% (P < 0.05) and lowered the serum level of alpha2u-globulin to 52% (P < 0.05) of the level of the control group, but did not affect the amount of alpha2u-globulin excreted into urine. The hepatic level of alpha2u-globulin mRNA of the ascorbic acid-deficient rats was significantly lower (30%) than that of the control rats. These results suggest that in male ODS rats, ascorbic acid deficiency decreases the renal level of kidney fatty acid-binding protein by lowering alpha2u-globulin gene expression in liver.

Topics: Alpha-Globulins; Amino Acid Sequence; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Base Sequence; Blotting, Northern; Carrier Proteins; Disease Susceptibility; DNA Primers; Dose-Response Relationship, Drug; Electrophoresis, Polyacrylamide Gel; Fatty Acid-Binding Protein 7; Fatty Acid-Binding Proteins; Female; Gene Expression Regulation; Kidney; Liver; Male; Molecular Sequence Data; Myelin P2 Protein; Neoplasm Proteins; Nerve Tissue Proteins; Rats; Rats, Mutant Strains; Rats, Wistar; RNA, Messenger; Scurvy; Weight Gain

Bleeding into the muscles and joints can be the presenting manifestation of scurvy, as illustrated by two case-reports. One patient presented with hemarthrosis of the tibiotalar joint due to an insufficiency fracture and was suspected to have scurvy based on the presence of purpura and hypertrophy of the gums with loss of teeth. In the other patient, multiple hematomas in the lower limbs were found at presentation and the presence of coiled hairs suggested the diagnosis. Both patients had completely eliminated fruit and vegetables from their diet. Low levels of ascorbic acid were found in serum and urine. A full recovery was achieved in both cases under ascorbic acid supplementation.

Topics: Adult; Ascorbic Acid; Hemarthrosis; Humans; Male; Middle Aged; Rheumatic Diseases; Scurvy

We report a case of scurvy, which is rarely encountered in Japan. A 75-year-old male was hospitalized with diffuse subcutaneous hemorrhaging of both feet, pain on walking, and shortness of breath. A remarkably low serum level of vitamin C was confirmed. Administration of ascorbic acid dramatically improved his clinical symptoms. Improvement paralleled the increase of serum vitamin C level. This case underscores the important role of vitamin C on the integrity function of the vessel wall.

Topics: Aged; Ascorbic Acid; Foot Diseases; Hemorrhage; Humans; Japan; Male; Pain; Scurvy; Skin

This study used the scorbutic Osteogenic Disorder Shionogi rat model and a specific diet to reliably induce a state of sub-scurvy scorbutus. Under these conditions overall somatic growth was assessed, as well as that of the caudal vertebrae, as an example of scorbutic bone growth. Tail loops were then used to mechanically stress mature caudal vertebrae under scorbutic conditions, and the vertebrae's adaptation to these applied forces was assessed, using measurements of bend deformation and histologic analysis of osteogenesis. Scorbutic animals exhibited significant somatic growth retardation (p < 0.05), and abnormal reductions in osteogenesis and periosteal responsiveness to growth. Scorbutic vertebrae also showed greater bend angles of deformation (p < 0.05), and a marked reduction in cortical osseous remodelling and periosteal differentiation. It appeared that the sub-scurvy scorbutic bones were smaller, weaker and less able to adapt to physical stresses: this pattern was reflected at the histologic level.

Topics: Animals; Ascorbic Acid; Body Composition; Bone Remodeling; Disease Models, Animal; Epiphyses; Female; Growth; Male; Osteogenesis; Periosteum; Rats; Rats, Inbred Strains; Scurvy; Spine; Stress, Mechanical

Transfer of the gene for L-gulono-gamma-lactone oxidase, the missing enzyme in L-ascorbic acid biosynthesis in scurvy-prone animals, into medaka (Oryzias latipes) was successfully done. The expression plasmid pSVL-GLO, carrying rat liver L-gulono-gamma-lactone oxidase cDNA, was microinjected into the cytoplasm of fertilized eggs during the one-cell stage. Four male F0 fish having the transgene in their germ cells came to maturity, and F1 progeny derived from one of the F0 fish possessed L-gulono-gamma-lactone oxidase activity, indicating that the transgene was functionally expressed in the fish. Genomic Southern blot analysis demonstrated that the transgene existed in both chromosome-integrated and extrachromosomal forms.

Topics: Animals; Animals, Genetically Modified; Ascorbic Acid; Base Sequence; DNA Primers; Fish Diseases; Gene Expression; L-Gulonolactone Oxidase; Male; Molecular Sequence Data; Oryzias; Polymerase Chain Reaction; Rats; Scurvy; Sugar Alcohol Dehydrogenases

Latent scurvy is characterized by a reversible atherosclerosis that closely resembles the clinical form of this disease. Acute scurvy is characterized by microvascular complications such as widespread capillary hemorrhaging. Vitamin C (ascorbate) is required for the synthesis of collagen, the protein most critical in the maintenance of vascular integrity. We suggest that in latent scurvy, large blood vessels use modified LDL--in particular lipoprotein(a)--in addition to collagen to maintain macrovascular integrity. By this mechanism, collagen is spared for the maintenance of capillaries, the sites of gas and nutrient exchange. The foam-cell phenotype of atherosclerosis is identified as a mesenchymal genetic program, regulated by the availability of ascorbate. When vitamin C is limited, foam cells develop and induce oxidative modification of LDL, thereby stabilizing large blood vessels via the deposition of LDL. The structural similarity between vitamin C and glucose suggests that hyperglycemia will inhibit cellular uptake of ascorbate, inducing local vitamin C deficiency.

Topics: Animals; Arteriosclerosis; Ascorbic Acid; Collagen; Diabetes Complications; Diabetes Mellitus; Foam Cells; Humans; Hyperglycemia; Lipoprotein(a); Metaplasia; Models, Biological; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; History, 20th Century; Scurvy

The human body is unable to synthesise Vitamin C and a diet deficient in Vitamin C leads to scurvy. Scurvy may mimic other medical conditions, like bleeding diasthesis or deep vein thrombosis, leading to delay in diagnosis and treatment, thus prolonging sufferings of patients. Often, scurvy could have been diagnosed if it is thought of and features of scurvy carefully looked for. Scurvy is easily treated with high dose of oral vitamin C. Recurrences may occur. Education of care providers cannot be overemphasised. We report three local cases of scurvy to highlight the existence of the disease in our modern society.

Topics: Adult; Ascorbic Acid; Diagnosis, Differential; Humans; Male; Oral Hemorrhage; Scurvy; Singapore

The purpose of this study was to determine whether carnitine metabolism or histamine degradation would be useful parameters for investigating the optimal requirement for vitamin C.. Twenty-two non-scorbutic subjects with subnormal vitamin C status (plasma vitamin C < 28 mumol/L) were placed on a metabolic diet low in vitamin C for 3 weeks and repleted with graded doses of vitamin C: 10, 30 and 60 mg vitamin C daily (group 1) or 10,125 and 250 mg vitamin C daily (group 2) for weeks 1, 2 and 3, respectively. Fasting blood samples were collected weekly and analyzed for plasma vitamin C, plasma free carnitine and blood histamine.. Group 1 subjects remained in a subnormal vitamin C state throughout the 3-week study, and blood histamine and plasma free carnitine were not impacted by the experimental treatment. Plasma vitamin C in group 2 subjects rose significantly during the study, and these subjects finished the study with an ample vitamin C status indicative of vitamin C intakes above the recommended dietary allowance. Both blood histamine and plasma free carnitine were inversely related to vitamin C status in group 2 subjects.. These data indicate that blood histamine and plasma free carnitine are altered in individuals with subnormal, non-scorbutic vitamin C status and provide evidence that metabolic changes independent of collagen metabolism occur prior to the manifestation of scurvy. Thus utilizing scurvy as an end-point to determine vitamin C requirements may not provide adequate vitamin C to promote optimal health and well-being.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Carnitine; Female; Histamine; Humans; Male; Scurvy

Topics: Adult; Ascorbic Acid; Blood Cell Count; Hair Diseases; Humans; Joint Diseases; Male; Scurvy; Skin; Skin Diseases

The antiscorbutic activity of 6-bromo-6-deoxy-L-ascorbic acid (I) in guinea pigs was compared to that of ascorbic acid (AsA). The growth test results in guinea pigs did not show any significant difference between the body weight increase in the respective 2 groups given compound (I) and that in the group given AsA. Scorbutic guinea pigs were found to completely recover from the disease after administration of the compound (I). There were no significant differences in the plasma alkaline phosphatase activity and the hydroxyproline content in the tibia between the group given compound (I) and that given AsA. The total vitamin C contents in the various tissues were similar in the 2 groups given compound (I) and the C-deficient group but they were lower than the levels for the group given AsA. It was shown that antiscorbutic activity was characteristic of compound (I) and it was almost equal to the effect of AsA.

Topics: Alkaline Phosphatase; Animals; Ascorbic Acid; Body Weight; Brain Chemistry; Guinea Pigs; Hydroxyproline; Kidney; Liver; Male; Scurvy; Spleen; Tibia

We examined the possibility that bilirubin physiologically acts as an antioxidant by using scurvy-prone ODS-od/od rats treated with endotoxin (lipopolysaccharide: LPS). Recently, bilirubin oxidative metabolites were isolated from human urine and named biotripyrrin-a and biotripyrrin-b. The LPS injection markedly increased bilirubin oxidative metabolites in urine of rats fed an ascorbic acid-free diet. This increase was supressed by feeding an adequate amount of ascorbic acid, a physiological antioxidant. the concentrations of biotripyrrin-a and -b in urine collected 6.5-10 h after the LPS injection were lower in rats fed an ascorbic acid-supplemented diet than in rats fed an ascorbic acid-free diet. Moreover, feeding with ascorbic acid suppressed the elevation of hepatic mRNA level of heme oxygenase-1, the rate-limiting enzyme of bilirubin biosynthesis, in rats injected with LPS. These findings suggest that bilirubin is oxidized in rats treated with LPS and acts as a physiological antioxidant synergistically with ascorbic acid in vivo.

Topics: Animals; Antioxidants; Ascorbic Acid; Base Sequence; Bilirubin; Free Radical Scavengers; Heme Oxygenase (Decyclizing); Lipopolysaccharides; Male; Molecular Sequence Data; Oligodeoxyribonucleotides; Oxidation-Reduction; Rats; Rats, Mutant Strains; RNA, Messenger; Scurvy

We report a 66 years-old man case that was admitted with abdominal wall hemorrhagic swelling ecchymosis on inferior extremities and perifollicular purpura with hyperkeratosis of the follicles, which gives it an appearance of palpable purpura, together with gingival hemorrhage and moderate anemia. He was a well-nourished sick man but who made a peculiar diet, practically free from fruit and vegetables which developed a pure and serious form of scurvy. We report this case because we consider that the features which appear are illustrative to provide the immediate clinical diagnosis of this uncommon disease, potentially mortal, but easy to diagnose, if we think about it in the adequate clinical contexts, and which it is quickly curable with the administration of ascorbic acid.

Topics: Abdominal Muscles; Aged; Ascorbic Acid; Avitaminosis; Ecchymosis; Feeding Behavior; Hematoma; Hemorrhage; Humans; Male; Scurvy

We report a case of scurvy. This case is interesting by the unilateral character of the ecchymotic leg's purpura. Ascorbic acid assays do not yet enable subclinical vitamin C deficiency to be reliably detected. Hence the importance of knowing the situation which expose to this deficiency.

Topics: Anemia, Hypochromic; Ascorbic Acid; Darier Disease; Humans; Male; Middle Aged; Purpura; Scurvy

Two patients developed the clinical picture of scorbut and simultaneous wet beriberi. The diagnosis was confirmed by low concentrations of ascorbic acid and thiamin and thiaminfosfate-ester in serum and in whole blood. Treatment with ascorbic acid led to a rapid reversal of scorbutic changes, but the changes due to the wet beri-beri persisted. Thiamine supplementation was given only perorally in the first patient, and a severe catabolic state in the other delayed the improvement in the beriberi. Direct determination of ascorbic acid and thiamin and thiaminfosfate-esters in serum and in whole blood may confirm the diagnosis of vitamin deficiencies.

Topics: Aged; Alcohol Drinking; Ascorbic Acid; Beriberi; Humans; Male; Nutrition Disorders; Scurvy; Thiamine

Topics: Ascorbic Acid; Exudates and Transudates; Humans; Male; Middle Aged; Retinal Diseases; Retinal Hemorrhage; Scurvy

Various conditions can imitate cutaneous vasculitis. Scurvy is a less appreciated cause of rash that can resemble vasculitis. Three patients were referred to our rheumatology service for "vasculitis," who subsequently were found to have scurvy. Findings included a purpuric skin rash, myalgias, and malaise. The patients had low vitamin C levels and findings on skin biopsy specimens indicative of scurvy. The three patients were on idiosyncratic diets deficient in vitamin C, and the two patients who allowed us to administer vitamin C therapy improved clinically. We emphasize the importance of a careful dietary history. Early recognition of scurvy is important because it can be treated specifically, and toxic treatment of vasculitis can be avoided.

Topics: Adult; Ascorbic Acid; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Nutrition Assessment; Scurvy; Skin Diseases, Vascular; Vasculitis

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Child; Diet; Female; Fruit; Gingivitis; Grief; Humans; Scurvy; Spain; Vegetables

Duplicate lots of 150 Atlantic salmon (Salmo salar), average weight 0.5 g, were fed NRC diet H-440 base containing L-ascorbic acid (C1) or L-ascorbyl-2-sulfate (C2S); or L-ascorbyl-2-monophosphate (C2MP): at 0 or 100 mg C1; 50, 100, 300 mg C2S; or 50, 100 mg C2MP per kg dry diet in 12 degrees C freshwater tanks. After 12 weeks, negative controls (no vitamin C) exhibited reduced growth, scoliosis, lordosis, and petechial hemorrhages typical of fish scurvy. All other lots grew normally. Four 100-fish lots of scorbutic salmon, average weight 3.3 g, were placed on recovery diets of 0, 50, or 300 mg C2S, or 100 mg C2MP per kg dry diet. After 5 weeks, fish fed either level of C2S intake had recovered and resumed growth. Negative controls continued to develop acute scurvy. The 41 survivors in this no-vitamin-C group all had advanced scurvy, whereas all fish in both C2S-fed recovery groups appeared normal. Tissue assays for C vitamers disclosed normal levels of C1 and C2S in the recovery groups. All other test treatment lots containing C1, C2S, or C2MP had fish with normal appearance and no significant differences in growth response for the 17-week test period. C2S at 50 mg or more per kg diet as the sole vitamin C source promoted normal growth in young Atlantic salmon for more than 20-fold increase in weight.

Topics: Animals; Ascorbic Acid; Body Weight; Fish Diseases; Liver; Salmon; Scurvy

Four cases of scurvy diagnosed within a period of two years are reported. They comprised 2 male patients with heavy nicotine and alcohol abuse, a 35-year-old woman with malnutrition due to food supplements phobia, and a 69-year-old woman with malnutrition due to dementia and social isolation. All four patients were adynamic and anemic. Three patients showed typical dermatologic signs with hemorrhagic hyperceratosis, suffusions or cork-screw hair. Two patients complained of parodontol disorders. Other symptoms were gastrointestinal bleeding, sicca syndrome, retinal bleeding, subdural hematoma, edema and arthralgia. Associated disorders were folic acid and vitamin B12 depletion in two cases, and nephropathy and pneumonia with pneumothorax in one case each. In all cases the serum asorbic acid concentration was below the scorbutic level of 11 mumol/l. Historical data, pathogenesis, incidence, clinical presentation, diagnosis and therapy of scurvy are discussed. We conclude that scurvy can be observed even in a developed country such as Switzerland at the end of the 20th century. The real incidence may be underestimated because symptoms are not well known and disappear rapidly after admission because of sufficient vitamin C content in normal diet. Patients at risk are socially isolated alcoholics, old people, psychiatric patients and diet enthusiasts. Usually scurvy occurs in conjunction with other deficiencies. Smoking and acute illness enhance ascorbic acid depletion. With a knowledge of the symptomatology of scurvy, it is easy to diagnose and treatment is simple and effective.

Topics: Adult; Aged; Alcoholism; Ascorbic Acid; Dementia; Female; Humans; Male; Middle Aged; Nutrition Disorders; Periodontal Diseases; Scurvy; Smoking; Social Isolation

A 29-year-old man was admitted to hospital, unconscious and with extensive bleedings in skin and muscles. For many weeks he had been practically starving himself with suicidal intent. Physical examination revealed signs of anaemia and gingivitis with hypertrophy of the tooth borders and bleeding gums, as well as bright blood on rectal examination. There were extensive ecchymoses and petechiae, especially in the legs. Some of the body hair was corkscrew-curly. Haemoglobin level was 7.2 g/dl, mean corpuscular volume 93 fl, reticulocyte count 29/1000. The Rumpel-Leede test was abnormal (60 petechiae/4 cm2), as were the vitamin C level (0.026 mg/dl whole blood) and the ascorbic acid tolerance test. As these findings indicated scurvy, vitamin C was administered, 1 g daily intravenously for 5 days, followed by 500 mg daily by mouth. Remarkable improvement was apparent as early as 72 hours after onset of treatment. The endogenous depression, the underlying cause of the suicide attempt, was treated with clomipramine. When the patient was discharged after 13 days his physical and mental state was much improved.

Topics: Adult; Ascorbic Acid; Clomipramine; Depressive Disorder; Erythrocyte Count; Erythrocyte Indices; Hemoglobins; Humans; Male; Reticulocytes; Scurvy; Self-Injurious Behavior; Starvation; Suicide, Attempted

Topics: Ascorbic Acid; Darier Disease; Humans; Leg Dermatoses; Male; Middle Aged; Purpura; Scurvy

L-threo-hex-2-enaro-1,4-lactone ethyl ester (II) was synthesized by the modified Fisher's esterification and its sodium salt was obtained almost quantitatively. Confirmation of the compound was made by elementary analysis, as well as IR, UV, MS and NMR spectra. The antiscorbutic activity was compared to that of ascorbic acid and the result showed that (II) did not have Vitamin C activity. The results of this investigation indicate that a close relationship exists between the chemical structure of the C-6 position of ascorbic acid analogues and the development of vitamin C activity.

Topics: Alkaline Phosphatase; Animals; Ascorbic Acid; Body Weight; Brain Chemistry; Guinea Pigs; Hydroxyproline; Kidney; Liver; Male; Scurvy

This report is on a patient, who presented purpura and hemarthrosis in a context of vitamin C deficiency. This case gives us the opportunity to discuss the differential diagnosis, the clinical features, the pathogenicity and the treatment of this rare condition.

Topics: Ascorbic Acid; Diagnosis, Differential; Hemarthrosis; Humans; Male; Middle Aged; Purpura; Scurvy

Previous studies showed that administration of ascorbate to glutathione (GSH)-deficient newborn rats and guinea pigs prevented toxicity and mortality and led to increased tissue and mitochondrial GSH levels; ascorbate thus spares GSH. In the present work, we tried to answer the converse question: Does administration of GSH spare ascorbate? Because administered GSH is not well transported into most cells, we gave GSH monoethyl ester (which is readily transported and converted into GSH intracellularly) to guinea pigs fed an ascorbate-deficient diet. We found that treatment with GSH ester significantly delays appearance of the signs of scurvy and that this treatment spares ascorbate; thus, the decrease of tissue levels of ascorbate was delayed. The findings support the conclusions that (i) GSH is essential for the physiological function of ascorbate because it is required in vivo for reduction of dehydroascorbate and (ii) there is metabolic redundancy and overlap of the functions of these antioxidants. The sparing effect of GSH in scurvy may be mediated through an increase in the reduction of dehydroascorbate (which would otherwise be degraded) and to antioxidant effects of GSH that are also produced by ascorbate. Other studies indicate that GSH deficiency in adult mice stimulates ascorbate synthesis in liver. During this work we found that administration of GSH itself is highly toxic to ascorbate-deficient guinea pigs when given in divided i.p. doses totaling 3.75 mmol/kg daily.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Brain; Glutathione; Guinea Pigs; Kidney; Liver; Lung; Male; Mitochondria; Mitochondria, Liver; Scurvy

A four-year-old male child was reported with sudden inability to stand walk of 10 days duration. Acute paralytic poliomyelitis was diagnosed in the presence of fever, respiratory infection, muscle tenderness, and weakness in lower extremity in an unimmunized child. Reevaluation after a week showed swelling, thickening, and tenderness of left femur. Plain x-ray of the left thigh was advised to exclude underlying osteomyelitis of the femur. X-ray showed features of scurvy. The child responded well to parenteral vitamin C therapy and resumed normal walking with in two weeks. Scurvy can present as pseudoparalysis of acute onset without any other signs even in older children. It emphasized the need for an index of suspicion of scurvy in a case of suspected paralysis. Dramatic response to vitamin C therapy can be used to confirm the diagnosis in the absence of laboratory support. Health education can be accelerated to prevent a disease like scurvy.

Topics: Ascorbic Acid; Child, Preschool; Diagnosis, Differential; Humans; Knee; Male; Paralysis; Poliomyelitis; Radiography; Scurvy

Scurvy is now an uncommon condition in the western world. We report a case of scurvy in a 14-year-old female with an inadequate diet who developed a purpuric rash affecting her trunk and legs. The rash resolved dramatically with ascorbic acid therapy.

Topics: Adolescent; Ascorbic Acid; Diet; Female; Humans; Purpura; Scurvy; Skin

This analysis of a large, population based, cross-sectional survey demonstrates that the association of smoking with decreased serum ascorbic acid (AA) levels is independent of the reduced AA intake found in smokers. Smokers have a threefold higher incidence of low serum AA levels (< or = 11 mumol/L) which could place them at increased risk for the clinical manifestations of AA deficiency. Smokers not taking vitamin supplements who consumed less than 15 servings weekly of fruits and vegetables were especially prone to have serum AA levels less than 11 mumol/L. An AA intake of > or = 200 mg was necessary to provide smokers with equivalent protection from hypovitaminosis AA as had nonsmokers whose AA intake exceeded the recommended dietary allowance (RDA [60 mg]). This level of dietary AA intake is considerably higher than the newly increased RDA for smokers of 100 mg. Although the simplest and most direct method to increase the low serum vitamin C levels found in many smokers would be to stop smoking, markedly increasing dietary AA consumption is appropriate when this is unsuccessful. However, if dietary modification fails to sufficiently increase AA intake, then vitamin supplementation may be necessary to significantly reduce the high prevalence of hypovitaminosis AA present in smokers.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Ascorbic Acid; Ascorbic Acid Deficiency; Cross-Sectional Studies; Diet; Female; Humans; Male; Middle Aged; Nutrition Surveys; Nutritional Requirements; Odds Ratio; Prevalence; Regression Analysis; Risk Factors; Scurvy; Smoking; United States

A case of vascular purpura of the lower limbs in a 67 year old man is described. A diagnosis of scurvy was made in consideration of the absence of signs of vasculitis on skin biopsy, the history of a diet extremely poor in vitamin C and the prompt resolution of clinical picture with administration of vitamin C. The authors emphasize the importance of taking into consideration scurvy in the differential diagnosis of vascular purpura: this may spare expensive investigations and a dangerous delay in appropriate therapy.

Topics: Aged; Ascorbic Acid; Diagnosis, Differential; Humans; Leg; Male; Purpura; Scurvy

The osteogenic disorder Shionogi (ODS) rat is a mutant Wistar rat that is subject to scurvy, because it lacks L-gulono-gamma-lactone oxidase, a key enzyme in L-ascorbic acid biosynthesis. Sequencing of polymerase chain reaction-amplified cDNAs for mutant and normal rat L-gulono-gamma-lactone oxidases demonstrated that the mutant cDNA has a single base mutation from G to A at nucleotide 182, which mutation alters the 61st amino acid residue from Cys to Tyr. To test the effect of this mutation on the expression of L-gulono-gamma-lactone oxidase, we inserted a region of the cDNAs coding for normal and mutant L-gulono-gamma-lactone oxidases into an expression vector, pSVL, and transfected COS-1 cells with such vectors. The result indicated that the defined amino acid substitution does decrease both the amount of immunologically detectable protein and the level of enzyme activity to about one-tenth of their normal values, while it does not affect the amount of the mRNA produced in the transfected cells. This situation is similar to our previous observation that L-gulono-gamma-lactone oxidase is expressed in the liver of the ODS rat at a very low level irrespective of the presence of a normal amount of L-gulono-gamma-lactone oxidase-specific mRNA of a normal size (Nishikimi, M., Koshizaka, T., Kondo, K., and Yagi, K. (1989) Experientia (Basel) 45, 126-129). Thus it became clear that the Cys-->Tyr substitution is responsible for the L-gulono-gamma-lactone oxidase deficiency in the ODS rat.

Topics: Animals; Ascorbic Acid; Base Sequence; Blotting, Northern; Cell Line, Transformed; Cells, Cultured; DNA; Genetic Predisposition to Disease; L-Gulonolactone Oxidase; Molecular Sequence Data; Mutation; Polymerase Chain Reaction; Rats; Rats, Mutant Strains; RNA, Messenger; Scurvy; Sugar Alcohol Dehydrogenases

Topics: Ascorbic Acid; Diagnosis, Differential; Ecchymosis; Humans; Male; Middle Aged; Scurvy

Topics: Arthrography; Ascorbic Acid; Bone and Bones; Female; Humans; Infant; Scurvy

We present a case of a child with iron-deficiency anemia, folic acid deficiency, and scurvy. His anemia proved refractory to treatment with iron until he received both folic acid and vitamin C supplementation. This case illustrates the importance of the evaluation of ascorbic acid and folate status in treating iron-deficiency anemia initially refractory to iron supplementation, because multiple nutrient deficiencies may coexist.

Topics: Anemia, Hypochromic; Ascorbic Acid; Child; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Scurvy

Topics: Animals; Ascorbic Acid; Blood Pressure; Clinical Trials as Topic; Humans; Hypertension; Scurvy

Scurvy, a rare disease, is still found today in malnourished patients. We recently diagnosed a case of scurvy in a 64-year-old woman resulting from a self-imposed diet. She had severe anemia and the characteristic gingival and skin lesions, which responded dramatically to ascorbic acid therapy. We report this case to make physicians aware of the possibility of scurvy and of its clinical symptoms.

Topics: Ascorbic Acid; Diet; Female; Humans; Middle Aged; Scurvy

The Osteogenic Disorder Shionogi (ODS) rat, Clea Inc., Tokyo, Japan lacks the ability to synthesize L-ascorbic acid (AA). As with man, monkey and the guinea pig, this rat lacks L-gulonolactone oxidase necessary for the synthesis of AA from glucose. This study shows this animal to be an alternative to the guinea pig in AA studies. The anti-scorbutic potency of Ester C (EC), a calcium ascorbate and calcium threonate mixture, was compared with an AA dose of equal ascorbate activity equivalents (AAE) for anti-scorbutic activity in the ODS rat. The minimal anti-scorbutic dose of EC was determined to be 0.44 mg/kg/day (AAE), while an AA dose of 0.51 mg/kg/day (AAE) was not anti-scorbutic in a 24 day study. At 24 days EC rats gained 125% of initial body weight (BW) and the AA rats only 45% BW. Scorbutic signs at 24 days were scored on a 0 (min) to 3 (max) scale. The EC/AA ratio scores were: hemorrhage 0/1.4, behavior change 0/2.0, piloerection 0/2.2, mobility 0.4/2.2, dysbasia 0.6/2.8 and ataxia 0.4/1.0. Pearson's correlation coefficient for BW versus AAE was r = .34 for the AA group and r = .90 for the EC group. The morbidity index for EC was 0/5 and for the AA group 2/5. The AAE dose of AA which was 16% higher/day than the EC AAE dose was not anti-scorbutic, while the EC dose was anti-scorbutic. EC rats had 3.5X greater weight gain, a sensitive indicator of scurvy, than the AA rats. EC rats had 3-4 times less, if any, scorbutic signs than AA rats. The results clearly show that, based on ascorbate activity equivalents, EC has more available ascorbate activity/potency than AA. The mechanism of this increased potency is believed to be due to the facilitated transport of AAE into the cell by the threonate (a normal in vivo metabolite of AA) present in the EC product. In addition, previous studies have shown EC (AAE) to be higher in plasma and excreted less rapidly than the AAE derived from AA administered orally.

Topics: Animals; Ascorbic Acid; Body Weight; Dehydroascorbic Acid; Drug Combinations; Random Allocation; Rats; Rats, Mutant Strains; Scurvy; Threonine

Actinomycetes, involved in oral and periodontal diseases, cause serious infections in immunocompromised hosts. Severely scorbutic guinea pig leukocytes killed only 12% of phagocytosed actinomycetes, had distorted nuclear morphology, had 16 times less ascorbate, and had no chemotactic responses in vitro. Ascorbate reversed these indices and also prevented nitrosamine formation by oral organisms. Degranulating leukocytes release lactoferrin and ascorbate that chelate iron, essential for microorganisms. Ascorbic acid, 2,2'-bipyridine and 1,10-phenanthroline were bactericidal to several bacterial pathogens at millimolar concentrations. Iron alone reversed this effect. In in vivo experiments an Actinomyces viscosus monoflora was implanted in rhesus monkeys. Plaque and serum samples showed decreased (by six orders of magnitude) bacterial counts and decreased actinomycete antibody titers in animals given 1 g ascorbate/d. Removing ascorbate returned counts and titers to preascorbate concentrations. Fifteen marmosets, receiving twice daily topical applications of ascorbate or water, had comparatively lower gingival, calculus, and plaque indices and only slightly lowered actinomycete counts.

Topics: Actinomyces viscosus; Animals; Antimutagenic Agents; Ascorbic Acid; Bacteria; Callithrix; Guinea Pigs; Macaca mulatta; Male; Mouth; Neutrophils; Nitroso Compounds; Oral Hygiene; Phagocytosis; Scurvy; Therapeutic Irrigation

Topics: Ascorbic Acid; History, 20th Century; Humans; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Female; Humans; Infant, Newborn; Radiography; Scurvy

Topics: Aged; Ascorbic Acid; Humans; Male; Scurvy

Bioavailability of a newly-synthesized and chemically-stable 2-O-alpha-D-glucopyranosyl-L-ascorbic acid (AA-2G) as a vitamin C supplement was investigated in rats and guinea pigs. Oral administration of AA-2G to the animals resulted in an increase of serum ascorbic acid (AA) levels. However, in these sera the intact form was not detectable by the high performance liquid chromatography (HPLC) method, indicating its hydrolysis through the process of absorption. After an intravenous injection of AA-2G, the intact form diminished rapidly from the serum, followed by prolonged and marked elevation of serum AA levels. Various tissue homogenates from rats and guinea pigs were examined for their releasing activity of AA from AA-2G. High activity was observed in kidney, small intestine and serum of rats and in small intestine and kidney of guinea pigs. These hydrolytic activities were completely inhibited by castanospermine, a specific alpha-glucosidase inhibitor, suggesting the participation of alpha-glucosidase in the in vivo hydrolysis of AA-2G. AA-2G was found to exhibit obvious therapeutic effect in scorbutic guinea pigs by its repeated oral administrations. These results indicate that AA-2G is a readily available source of vitamin C activity in vivo.

Topics: Administration, Oral; alpha-Glucosidases; Animals; Ascorbic Acid; Biological Availability; Guinea Pigs; Hydrolysis; Injections, Intravenous; Male; Rats; Rats, Inbred Strains; Scurvy

Topics: Aged; Ascorbic Acid; Ecchymosis; Gingivitis; Humans; Leg; Male; Scurvy; Thrombophlebitis

Topics: Ascorbic Acid; Humans; Male; Middle Aged; Scurvy

Topics: Ascorbic Acid; Europe; History, 16th Century; History, 17th Century; Humans; Phytotherapy; Plants, Medicinal; Scurvy

Topics: Ascorbic Acid; Calorimetry; Chromatography, High Pressure Liquid; Erythrocytes; Humans; Leukocytes; Scurvy; Specimen Handling

Topics: Ascorbic Acid; Female; Humans; Leg; Radiography; Scurvy

The objective of this study was to determine the effect of a broad range of dietary intake levels of ascorbate on the distribution of both total and reduced ascorbate in guinea pig tissues. Young male Hartley guinea pigs were fed for 2 mo a modified Reid-Briggs purified diet containing five different levels of total ascorbate that provided 0.8-52 mg ascorbate/d. We also fed aged guinea pigs two different levels of ascorbic acid (1.5 or 60 mg/d) for 2 mo. Reduced and total ascorbate was measured in eye lens and aqueous humor, liver, kidney and plasma. The data indicate that it is possible to markedly enhance the level of ascorbate in tissues above that obtained by feeding a diet that contains only enough ascorbate to prevent scurvy. In all tissues, as the level of total ascorbate present in the tissue increased, so did the proportion present in the reduced form. In old guinea pigs, the eye lens was the only tissue in which both reduced and total ascorbate were significantly lower than in the young guinea pigs at both high and low intake levels.

Topics: Animals; Ascorbic Acid; Body Weight; Diet; Female; Guinea Pigs; Male; Reference Values; Scurvy; Tissue Distribution

In the Horn of Africa, scurvy is a serious public health problem for refugees who are dependent on standard relief food (cereals, legumes, and oil). To assess the risk factors and to quantify the potential magnitude of scurvy among these displaced communities, we reviewed data collected from 1985 to 1987 by relief programmes in five refugee camps in Somalia and one in the Sudan. Outbreaks of clinical scurvy occurred among refugees in all the camps from 3 to 4 months after their arrival. The incidence of scurvy in two camps was, respectively, 14% over a period of 4 months and 19.8% over a period of 18 months. Prevalences of scurvy estimated from random population samples in the six study camps ranged from 13.6% to 44%. The risk of developing scurvy increased significantly with the length of time that refugees had been in the camps and was also significantly higher among those who were older and among females, particularly those of childbearing age. The prevalence of scurvy among refugees was similar, irrespective of whether or not they had attended supplementary feeding programmes. The control measures that were implemented had a moderate and slow impact on the disease. In both Somalia and the Sudan the relief food distributed to the refugees was almost completely deficient in vitamin C, while the environment where the camps were located precluded an adequate supply of fresh food. To avoid scurvy among refugee communities in this area of Africa it is therefore recommended that vitamin C supplements be added to the relief food at an early stage of a crisis.

Topics: Adolescent; Adult; Ascorbic Acid; Child; Child, Preschool; Cohort Studies; Cross-Sectional Studies; Disease Outbreaks; Ethiopia; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Refugees; Risk Factors; Scurvy; Somalia; Sudan

Osteogenic disorder syndrome rats are unable to synthesize ascorbic acid owing to the lack of l-gulonolactone oxidase, and become scorbutic within a few weeks without the supply of ascorbic acid. We studied effects of ascorbic acid deficiency on the ovarian aromatase activity in vivo using osteogenic disorder syndrome rats. The ovarian aromatase activity in ascorbic acid-deficient osteogenic disorder syndrome rats was significantly higher than that in normal or ascorbic acid-supplied osteogenic disorder syndrome rats. The activity in hypophysectomized immature rats was extremely low, but increased after treatment with pregnant mare serum gonadotropin, regardless of the presence or absence of ascorbic acid. The extent of the increase was the same among experimental groups. The present results indicate that ascorbic acid at physiological level lowers the ovarian aromatase activity, whereas it does not impair the responsiveness of the aromatase activity to gonadotropins.

Topics: Animals; Aromatase; Ascorbic Acid; Female; Hypophysectomy; Male; Organ Size; Ovary; Rats; Rats, Mutant Strains; Scurvy; Testosterone

Gulonolactone oxidase, a key enzyme in the biosynthesis of ascorbic acid, is missing from guinea pigs and certain other scurvy-prone species. Weekly intraperitoneal injections of glutaraldehyde cross-linked immunoprecipitates of this enzyme have been shown to provide guinea pigs with the capability of synthesizing their own ascorbic acid and of surviving without an exogenous source of this vitamin. This protocol, however, was successful in only a small percentage of the animals tested. The reasons for the limited therapeutic success were investigated. Apparently, the gulonolactone oxidase-treated guinea pigs fed without ascorbic acid were receiving insufficient nutrition. By supplementing these enzyme-treated animals with vitamins A, B, D and E and selenium, we successfully maintained a high proportion of guinea pigs fed without vitamin C.

Topics: Animals; Ascorbic Acid; Cross-Linking Reagents; Electrophoresis, Polyacrylamide Gel; Glutaral; Guinea Pigs; Immunosorbent Techniques; L-Gulonolactone Oxidase; Male; Nutritional Status; Scurvy; Sugar Alcohol Dehydrogenases; Weight Gain

Old people living alone and in poverty are most at risk for developing scurvy, but the diagnosis may be missed unless the physician is aware of it. A 42-year-old immigrant living in poverty was treated surgically at the Hôtel-Dieu Hospital in Montreal for a compartment syndrome of the leg. She had ecchymoses on the skin of the leg and an interstitial hematoma in both posterior compartments. Three weeks later, she was readmitted with more swelling in the leg, gingivitis, hemorrhagic folliculitis, petechiae and gastrointestinal hemorrhage. Her response to vitamin C was remarkable and confirmed the diagnosis of scurvy.

Topics: Adult; Ascorbic Acid; Compartment Syndromes; Feeding Behavior; Female; Humans; Leg; Poverty; Scurvy

Our recent studies suggested that decreased collagen synthesis in bone and cartilage of scorbutic guinea pigs was not related to ascorbate-dependent proline hydroxylation. The decrease paralleled scurvy-induced weight loss and reduced proteoglycan synthesis. Those results led us to propose that the effects of ascorbate deficiency on extracellular matrix synthesis were caused by changes in humoral factors similar to those that occur in fasting. Here we present evidence for this proposal. Exposure of chick embryo chondrocytes to scorbutic guinea pig serum, in the presence of ascorbate, led to effects on extracellular matrix synthesis similar to those seen in scorbutic animals. The rates of collagen and proteoglycan synthesis were reduced to approximately 30-50% of the levels in cells cultured in normal guinea pig serum plus ascorbate, but proline hydroxylation and procollagen secretion were unaffected. Similar results were obtained with serum from fasted guinea pigs supplemented in vivo with ascorbate. The growth rate of the chondrocytes was not significantly affected by scorbutic guinea pig serum.

Topics: Animals; Ascorbic Acid; Blood; Cartilage; Cells, Cultured; Chick Embryo; Collagen; Extracellular Matrix; Guinea Pigs; Procollagen; Proline; Proteoglycans; Scurvy

Ascorbic acid (AsA) concentrations in plasma exert a modulating effect on the activity of liver enzymes. Since UDP-glucuronyl transferase is a liver enzyme, which is responsible for bilirubin glucuronidation, the effect of varied amounts of AsA on this enzyme activity was studied. Sixty male guinea-pigs were randomly allocated to the following six groups: controls, scorbutic and groups given 2, 5, 10 or 20 mg of ascorbic acid, respectively. All the animals with the vitamin C deficient diet presented clinical signs of scurvy at the end of the experimental period, and had lost both body and liver weight compared to all other groups. Scorbutic animals had very low levels of AsA in the liver compared with controls (0.20 +/- 0.10 and 1.65 +/- 0.45 mg/g liver, respectively) (p less than 0.001). Liver AsA levels increased as the AsA dose increased. The UDP-glucuronyl transferase activity was lower in scorbutic animals than in controls (6.20 +/- 1.95 and 23.85 +/- 4.20 mg bilirubin/g protein/h, respectively) (p less than 0.001). The other groups C, D, E and F also had higher mean levels of UDP-GT activity than the scorbutic group B. Finally, no correlation was found between UDP-glucuronyl transferase activity and ascorbic acid intake.

Topics: Animals; Ascorbic Acid; Glucuronosyltransferase; Guinea Pigs; Liver; Male; Scurvy

Topics: Ascorbic Acid; History, 20th Century; Humans; Scurvy

Adoptive immunotherapy of human cancer was investigated in our institution as part of a National Cancer Institute extramural group study. This treatment, for patients with metastatic malignant melanoma, hypernephroma, and colon carcinoma, consisted of three phases: (a) 5 days of i.v. high-dose (10(5) units/kg every 8 h) interleukin 2, (b) 6 1/2 days of rest plus leukapheresis; and (c) 4 days of high-dose interleukin 2 plus three infusions of autologous lymphokine-activated killer cells. Toxicities included fever, chills, tachycardia, hypotension, vomiting, diarrhea, and fluid retention. Ascorbic acid is known to be important to cell-mediated immunity, and it has been reported to be depleted during physiologically stressful events. Therefore, we determined plasma ascorbic acid levels in patients (n = 11) before adoptive immunotherapy and before and after Phases 1, 2, and 3 of treatment. Patients entering the trial were not malnourished. Mean plasma ascorbic acid levels were normal (0.64 +/- 0.25 mg/dl) before therapy. Mean levels dropped by 80% after the first phase of treatment with high-dose interleukin 2 alone (0.13 +/- 0.08 mg/dl). Mean plasma ascorbic acid levels remained severely depleted (0.08 to 0.13 mg/dl) throughout the remainder of the treatment, becoming undetectable (less than 0.05 mg/dl) in eight of 11 patients during this time. Values obtained from 24-h urine collections on two of two patients indicated that ascorbate was not excreted in the urine. Plasma ascorbic acid normalized in three of three patients tested 1 mo after the completion of treatment. Unlike the results for ascorbic acid, blood pantothenate and plasma vitamin E remained within normal limits in all 11 patients throughout the phases of therapy. Responders (n = 3) differed from nonresponders (n = 8) in that plasma ascorbate levels in the former recovered to at least 0.1 mg/dl (frank clinical scurvy) during Phases 2 and 3, whereas levels in the latter fell below this level.

Topics: Adult; Ascorbic Acid; Evaluation Studies as Topic; Female; Humans; Immunization, Passive; Immunotherapy; Interleukin-2; Killer Cells, Natural; Male; Middle Aged; Neoplasms; Pantothenic Acid; Scurvy; Vitamin E

Topics: Ascorbic Acid; Diet; Humans; Male; Middle Aged; Scurvy

Topics: Ascorbic Acid; Female; Humans; Infant; Radiography; Scurvy

The plasma level of ascorbic acid has been used as a measure of both dietary intake and body reserve of the vitamin. In growing children, ascorbic acid is particularly important for the enhancement of the formation of bone matrix. Although the occurrence of scurvy in the tropics is exceptional and rarely reported in children, available data on plasma ascorbic acid level in children especially in Nigeria is almost non-existent. An earlier report found the mean plasma ascorbic level for Nigerian children to be 0.25mg/100ml. Using a modification of Kuther's method, blood plasma from 50 subjects was analysed for plasma ascorbic acid concentration. The subjects were primary school children in the Niger Delta Region of Nigeria, both sexes, aged between 8 and 12 years. Their mean plasma ascorbic acid level was found to be 0.71mg/100ml with a standard deviation of 0.118mg/100ml.68% of them were normal and 32% subnormal. None was deficient. There was no relationship among the children, between plasma ascorbic level and sex, age, weight or environment.

Topics: Ascorbic Acid; Child; Diet; Female; Humans; Male; Nigeria; Reference Values; Scurvy

The antiscorbutic effect of dehydro-L-ascorbic acid (DAsA) was investigated in vitamin C-deficient guinea pigs. Male guinea pigs were fed vitamin C-deficient diets for 16 days to deplete body L-ascorbic acid (AsA) pools and then fed the deficient diet supplemented with DHA and/or AsA intraperitoneally for 14 days. During the repletion period, most of the animals injected with 0.5 mg DAsA/day developed scurvy, their body weights decreased and their mortality rate was higher than that of the other groups injected with 0.5 mg AsA/day or 5 mg DAsA/day. Injecting animals with 0.5 mg AsA/day resulted in the disappearance of the typical scorbutic symptoms and regaining of body weight. These data indicate that DAsA has considerably less antiscorbutic activity than AsA in vitamin C-deficient guinea pigs.

Topics: Adrenal Glands; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Body Weight; Dehydroascorbic Acid; Guinea Pigs; Kidney; Liver; Male; Scurvy; Spleen

Reaction of immunoprecipitated L-gulonolactone oxidase with glutaraldehyde allows multiple administrations of large amounts of this enzyme extracted from either chicken or rats to guinea pigs. L-Gulonolactone oxidase converts L-gulonolactone to ascorbic acid, and its absence from guinea pigs and primates results in their requirement for this vitamin. By administration of this enzyme guinea pigs are able to survive on an ascorbic-acid-deficient regimen.

Topics: Animals; Ascorbic Acid; Chickens; Guinea Pigs; L-Gulonolactone Oxidase; Rats; Scurvy; Sugar Alcohol Dehydrogenases

Topics: Alcohol Amnestic Disorder; Ascorbic Acid; Humans; Male; Middle Aged; Scurvy

Topics: Ascorbic Acid; Child Abuse; Diagnosis, Differential; Female; Humans; Infant; Leg; Nutritional Requirements; Radiography; Scurvy

The biosynthetic activation of many hormonal peptides requires enzymatic alpha-carboxyamidation via glycine-extended intermediate forms. By specific radioimmunochemical measurement on extracts of guinea pig antra, we found that vitamin C deficiency induced a 30-fold increase in glycine-extended (i.e. inactive) gastrins. The results indicate that ascorbic acid is necessary for alpha-carboxyamidation in vivo, and thus, that the biosynthetic activation of hormonal peptides can be modified by simple dietary means.

Topics: Animals; Ascorbic Acid; Diet; Gastrins; Glycine; Guinea Pigs; Peptide Fragments; Scurvy

Topics: Adult; Ascorbic Acid; Humans; Male; Scurvy

Previous studies suggested that decreased type I collagen synthesis in calvaria of ascorbate-deficient guinea pigs was correlated with weight loss rather than defective proline hydroxylation. The generality of this correlation was examined in articular cartilage, which synthesizes mainly type II collagen, by measuring collagen synthesis and proline hydroxylation in vitro in tissue from ascorbate-supplemented and scorbutic guinea pigs. Ascorbate concentrations in tissues were almost completely depleted after 1 week of deficiency, but proline hydroxylation remained normal until after approximately 3 weeks, when it had decreased only by 10%. At that point collagen synthesis had decreased to about 50% of the control value. There was little additional effect on proline hydroxylation but collagen synthesis decreased further to 20% of normal. Procollagen mRNA levels in cartilage, as measured by dot-blot hybridization with a type II-specific cDNA probe, were unchanged after 2 weeks of scurvy, which correlated with the lack of effect on collagen synthesis during that period. Thereafter, during the period when collagen synthesis decreased, procollagen mRNA levels decreased to 20% of control values. Refeeding ascorbate to acutely scorbutic animals led to reversal of defective proline hydroxylation within 24 h with a slower increase in collagen synthesis and mRNA levels. Collagen synthesis returned to the normal level after 4 days with no further increase, while mRNA levels continued to increase to 2.7 times the control values after 7 days. Thus the major mechanism for regulation of collagen synthesis in articular cartilage during scurvy and ascorbate repletion occurs independently of the effect on proline hydroxylation and is associated with changes in mRNA levels. The lack of precise coordination between collagen synthesis and mRNA levels during repletion, however, suggests that there may be additional regulation through post-transcriptional mechanisms.

Topics: Animals; Ascorbic Acid; Cartilage, Articular; Collagen; Female; Growth; Guinea Pigs; Hydroxylation; Proline; RNA, Messenger; Scurvy

The effects of ascorbic acid deficiency and acute fasting (with ascorbate supplementation) on the synthesis of collagen and proteoglycan in costal cartilages from young guinea pigs was determined by in vitro labeling of these components with radioactive proline and sulfate, respectively. Both parameters were coordinately decreased by the second week on a vitamin C-free diet, with a continued decline to 20-30% of control values by the fourth week. These effects were quite specific, since incorporation of proline into noncollagenous protein was reduced by only 30% after 4 weeks on the deficient diet. The time course of the decrease in collagen and proteoglycan synthesis paralleled the loss of body weight induced by ascorbate deficiency. Hydroxylation of proline in collagen synthesized by scorbutic costal cartilage was reduced to about 60% of normal relatively early, and remained at that level thereafter. Neither collagen nor proteoglycan synthesis was returned to normal by the addition of ascorbate (0.2 mM) to cartilage in vitro. Administration of a single dose of ascorbate to scorbutic guinea pigs increased liver ascorbate and restored proline hydroxylation to normal levels by 24 h, but failed to increase the synthesis of collagen or proteoglycan. Synthesis of both extracellular matrix components was restored to control levels after four daily doses of ascorbate. A 96-h total fast, with ascorbate supplementation, produced rates of weight loss and decreases in the synthesis of these two components similar to those produced by acute scurvy. There was a linear correlation between changes in collagen and proteoglycan synthesis and changes in body weight during acute fasting, scurvy, and its reversal. These results suggest that it is the fasting state induced by ascorbate deficiency, rather than a direct action of the vitamin in either of these two biosynthetic pathways, which is the primary regulatory factor.

Topics: Animals; Ascorbic Acid; Body Weight; Collagen; Diet; Fasting; Guinea Pigs; Hydroxylation; In Vitro Techniques; Proline; Proteoglycans; Ribs; Scurvy; Sulfates

The Dutch Nutrition Council recommends an average daily intake of at least 50 mg of vitamin C. In a Dutch centre for nursing and rehabilitation this amount in the food as consumed by 272 patients and as served by the kitchen was calculated to be below 20 mg. About half of the patients consumed additional food - rich in vitamin C - each day either bought or acquired. Symptoms pertaining to the disease scorbut, were observed in a considerable number of these patients, but these may also be caused by other diseases. Patients completely dependent on food served by the central kitchen, had very low values of plasma vitamin C, in contrast to patients who used extra fruit each day. Centres for nursing and rehabilitation are recommended to serve 150 ml vitamin C-rich fruit juice each day, thereby combining the advantages of providing enough fluid intake and preventing obstipation.

Topics: Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Chromatography, High Pressure Liquid; Humans; Nursing Homes; Nutritional Requirements; Scurvy

Topics: Animals; Ascorbic Acid; Collagen; Fasting; Female; Guinea Pigs; Male; Rats; Rats, Inbred Strains; RNA, Messenger; Scurvy

Guinea pig prostate was found to actively participate in the biosynthesis and catabolism of ascorbic acid. The key ascorbic acid biosynthetic enzyme L-gulono-gamma-lactone oxidase and the other two lactonases were found to be present in guinea pig prostate. The activities of dehydroascorbatase and diketogulonate decarboxylase, the enzymes for ascorbic acid degradation, were also detected in guinea pig prostate. Male guinea pigs kept under scorbutic condition for 7, 14, 21 and 28 days, were examined for prostatic metabolism of ascorbic acid. A significant but gradual decrease in the concentration of L-ascorbic acid was observed in prostate, total blood and leukocytes with the progression of scorbutic condition. There was an appreciable decrease in the rate of lipid peroxidation under the scorbutic condition. In the tissue fraction of scorbutic guinea pigs, the activities of biosynthesizing enzymes, measured in vitro, under optimum conditions were found to be higher with no significant alterations in the catabolizing enzymes. The implications of these findings are discussed in this paper.

Topics: Animals; Ascorbic Acid; Guinea Pigs; Leukocytes; Lipid Peroxides; Male; Organ Size; Prostate; Scurvy

The amount of oral ascorbic acid that a patient can tolerate without diarrhea, increases somewhat proportionately to the "toxicity" of his disease. Clinically, in a disease ameliorated by ascorbate, there is a suppression of symptoms only with very high doses and approximately to that extent which a nonrate-limited, antioxidant free radical scavenger, might be expected to affect that disease process if all harmful free radicals and highly reactive oxidizing substances were quenched. In most pathologic processes, the rate at which free radicals and highly reactive oxidants are produced, exceeds the rate at which the ordinary rate-limited antioxidant free radical scavenging mechanisms can quench those free radicals and oxidants. When ascorbate acts as a scavenger, dehydroascorbate is formed; but if the ascorbate/dehydroascorbate (AA/DHA) ratio is kept high (the redox potential kept reducing) until the unstable dehydroascorbate undergoes hydrolysis or can be reduced back to ascorbate, the dehydroascorbate will do no harm. Since even at very high doses, ascorbate is virtually nontoxic, it may be given in the enormous doses necessary to quench almost all unwanted free radicals and oxidants. The wide spectrum of infectious diseases ameliorated by massive doses of ascorbate indicates some common pathologic processes in these diseases.

Topics: Acquired Immunodeficiency Syndrome; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Diarrhea; Dose-Response Relationship, Drug; Free Radicals; Glucosephosphate Dehydrogenase Deficiency; Humans; Infant; Kidney Calculi; Kinetics; Oxidation-Reduction; Scurvy; Sudden Infant Death

With reference to a case of vitamin C deficiency in a strict vegetarian, the authors recall the clinical findings and current diagnostic procedures in scurvy. Serum and urine ascorbic acid assays are now available and established the diagnosis. Management rests upon vitamin C given in a curative dosage of 1 to 2 g per day for 15 days followed by a preventive dosage of 10 mg per day.

Topics: Adult; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Diet; Humans; Male; Purpura; Scurvy

Topics: Ascorbic Acid; Child; Humans; Infant; Iron; Male; Scurvy; Thalassemia

A 9-year-old girl had the insidious development of lethargy, gingival erosions, and follicular hyperkeratosis with perifollicular hemorrhage. A dietary history disclosed that she consumed only one kind of sandwich and beverage and took no other foods. A skin biopsy specimen was consistent with the diagnosis of scurvy, and marked improvement occurred with ascorbic acid therapy. Although it is an uncommon disorder in the United States, scurvy may occur in persons with prolonged and peculiar dietary habits.

Topics: Ascorbic Acid; Child; Feeding Behavior; Female; Folliculitis; Gingiva; Gingivitis; Hemorrhage; Humans; Keratosis; Leg; Scurvy

A bilateral distal femoral epiphysiolysis was observed in a 28-month-old child suffering from scurvy. We explain the mechanisms of the separation of the epiphysis due to loss of strength in the calcification zone of the cartilage columns.

Topics: Ascorbic Acid; Child, Preschool; Epiphyses, Slipped; Femur; Humans; Male; Radiography; Scurvy

The question whether ascorbate regulates collagen production solely through its direct role in proline hydroxylation was investigated. Proteins in calvarial bones from control and scorbutic weanling guinea pigs were labeled in short-term cultures with radioactive proline. Proteins were digested with purified bacterial collagenase to distinguish between effects on collagen polypeptide production and hydroxyproline formation. There was a preferential decrease in the absolute rate of collagen biosynthesis beginning after 2 wk of ascorbate deficiency, and this effect was temporally dissociated from decreased proline hydroxylation. There were no significant changes in the absolute rates of collagen degradation or noncollagen protein production. In vitro inhibition of proline hydroxylation in normal bone with alpha, alpha'-dipyridyl did not affect the relative rate of collagen synthesis, further dissociating these functions. Ascorbate added to scorbutic bone cultures reversed defective proline hydroxylation but not defective collagen synthesis, suggesting that the latter was an indirect effect of scurvy. There was a linear correlation between the extent of body weight lost during the 3rd and 4th wk of scurvy and the rate of collagen synthesis in scorbutic bone. This correlation also applied to control animals receiving ascorbate, but with weight loss induced by food restriction. These studies establish for the first time that ascorbate deficiency in guinea pigs leads to a specific decrease in collagen polypeptide synthesis and suggest that this decrease results from the reduced food intake and/or weight-loss characteristic of scurvy.

Topics: Animals; Ascorbic Acid; Body Weight; Bone and Bones; Collagen; Female; Guinea Pigs; Hydroxyproline; Liver; Procollagen-Proline Dioxygenase; Protein Biosynthesis; Scurvy

Topics: Ascorbic Acid; Blood Platelet Disorders; Female; Hemorrhage; Humans; Middle Aged; Renal Dialysis; Scurvy

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Scurvy

Topics: Animals; Ascorbic Acid; Brain; Ceruloplasmin; Guinea Pigs; Humans; Male; Schizophrenia; Scurvy

Topics: Age Factors; Ascorbic Acid; Female; Humans; Infant; Italy; Male; Scurvy

Radiolabelled U-14C oxalic acid uptake was measured in the intestine of scorbutic and ascorbic acid (AA) supplemented guinea pigs. The feeding of vitamin C deficient diet to the animals for 26 days resulted in a significant fall in the ascorbic acid levels in the various tissues studied. Supplementation of vitamin C (10, 25 or 50 mg per 200 g body weight) increased ascorbic acid levels of spleen, adrenals, liver and leucocytes. The intestinal uptake of oxalate follows a passive diffusion mechanism in normally fed guinea pigs. The oxalate uptake rate was significantly increased (p less than 0.001) in the vitamin C administered group. Vitamin C depletion significantly decreased the oxalate uptake rate as compared to control animals. The changes observed in the uptake rate appear to be related with the chemical aberrations produced in the brush border membranes.

Topics: Animals; Ascorbic Acid; Body Weight; Diet; Guinea Pigs; Intestinal Absorption; Male; Oxalates; Oxalic Acid; Scurvy; Tissue Distribution

Young weanling guinea piglets were placed on a diet deficient only in vitamin C. When they reached a state of severe scorbutus, they were given vitamin C and the morphological differentiation of various mesenchymal cells in the proximal end of the tibia was followed over 7 days. The altering metaphyseal cellular pattern is recorded descriptively as well as quantitatively. Levels of mesenchymal cells, preosteoblasts, osteoblasts, and osteocytes remained relatively steady for 24 h. However, by 48 h there was a precipitous decline of mesenchymal cells with a concomitant rise in recognizable osteogenic cells; this change continued until the 7th day of repletion. At this time, with the exception of the preosteoblasts, the cellular population had returned to about the level in the control animals. Osteoclastic and endothelial cellular movements fluctuated widely during the period of repletion under examination. These results support the concept of separate lines of differentiation for osteoclasts and osteoblasts in the postnatal animal. Moreover, mesenchymal cells appear to be precursors of osteogenic cells.

Topics: Animals; Ascorbic Acid; Bone and Bones; Cell Count; Cell Differentiation; Guinea Pigs; Osteogenesis; Scurvy

Both reduced and oxidized ascorbates were measured in aqueous, neural retina, and pigment epithelium-choroid complex (PE-C) of pigmented guinea pigs. Normal values for total ascorbate of 16 mg/dl in aqueous, 22 mg/dl in neural retina, and 7 mg/dl in PE-C were found. After mild photic damage caused by varying lengths of exposure of 10,000 to 20,000 lux of fluorescent lighting, reduced ascorbate concentrations generally decreased in the neural retina, while oxidized ascorbate generally increased in PE-C. In both normal and light-exposed retinas, reduced ascorbate was predominant in the neural retina, and oxidized ascorbate was predominant in the PE-C. Histochemical localization of reduced ascorbate occurred in the Müller cell fibers and at the apices of the retinal pigment epithelium.

Topics: Animals; Ascorbic Acid; Choroid; Chromatography, High Pressure Liquid; Dehydroascorbic Acid; Guinea Pigs; Histocytochemistry; Oxidation-Reduction; Pigment Epithelium of Eye; Retina; Scurvy

Topics: Ascorbic Acid; Humans; Male; Middle Aged; Mouth Diseases; Orthomolecular Therapy; Scurvy; Substance Withdrawal Syndrome; Substance-Related Disorders

Studies in animal models suggest that ascorbic deficiency impairs T-cell-mediated immunity. We studied five normal volunteers hospitalized on a metabolic unit and consuming a strictly controlled diet deficient in ascorbic acid I) after a 5-wk control period of ascorbic acid supplementation (75 mg/day) and 2) after a 9-wk period of no supplementation. Three of the subjects were restudied after a 5-wk period of ascorbic acid supplementation after the deficient period. At the end of both control periods ascorbic acid levels in plasma ranged from 0.9 to 1.3 mg/dl and in leukocytes from 19 to 30 microgram/10(8) cells. At the end of the deficient period levels of ascorbic acid in plasma ranged from 0.09 to 0.15 mg/dl and in leukocytes from 6.2 to 10 microgram/10(8) cells, levels at or below those frequently found in frank scurvy. None of the T-cell parameters tested including mitogen responsiveness to phytohemagglutinin and percentage of T-cells bearing receptors for IgM (helper cells) and IgG (suppressor cells) was different in the deficient period compared to the control periods. One patient with spontaneous scurvy (plasma ascorbic acid 0.07 mg/dl, leukocytic ascorbic acid 4.9 microgram/10(8) cells) was studied at the time of admission and after vigorous ascorbic acid repletion. All T-cell parameters after repletion were unchanged from admission. We conclude that in man ascorbic acid deficiency, even at the scorbutic level, does not alter T-cell numbers or impair in vitro T-cell function.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Leukocytes; Male; Middle Aged; Phytohemagglutinins; Receptors, Immunologic; Scurvy; T-Lymphocytes

Scurvy occurred in an elderly man with fatigue, dyspnea on exertion, and extensive ecchymoses and brawny edema of the legs. Platelet count, prothrombin time, and partial thromboplastin time were normal, but serum ascorbic acid level was very low. Other signs considered to be classic and almost pathognomonic for were absent: bleeding gums, hyperkeratotic follicles, coiled hairs, and perifollicular hemorrhages. Reliance on these well-known features of scurvy may obscure or delay diagnosis of an easily cured disorder Severe scurvy is most commonly suggested by tenderness, extensive ecchymoses, and brawny edema of the lower extremities.

Topics: Aged; Ascorbic Acid; Diet; Dyspnea; Ecchymosis; Edema; Fatigue; Humans; Male; Mouth, Edentulous; Scurvy

A 46-year-old man presented with two weeks of progressive paraparesis and large confluent ecchymoses of both thighs. There was a history of poor dietary intake and daily alcohol use. He had had similar problems each of the past two winters. In 1979 he required hospitalization for "sciatica." In 1980 he was bedridden for two months because of lower extremity weakness. Examination revealed poorly fitting dentures, large confluent ecchymoses of both thighs, perifollicular hemorrhages, and a low serum ascorbic acid concentration. Oral ascorbic acid was begun in the hospital and all clinical symptomatic consequences of scurvy rapidly resolved. We present this case to reiterate the clinical presentation of scurvy and to emphasize the importance of recognizing early signs of nutritional deficiencies that may be confused with more common, but often less treatable, diseases.

Topics: Ascorbic Acid; Humans; Male; Middle Aged; Scurvy

Guinea pigs fed an ascorbic acid-deficient diet develop scurvy because of the absence of the enzyme L-gulonolactone oxidase. In theory if this enzyme is provided and its substrate L-gulonolactone is present at adequate concentrations ascorbic acid will be synthesized and the development of scurvy prevented. Using this model we tested whether a viable segment of intestine could be used to contain the administered enzyme and act as an artificial organ for the production of ascorbic acid. A surgical procedure was developed to prepare an externalized pouch of intestine with its circulation left intact. When enzyme is inserted in this intestinal bag it is not toxic and not antigenic in some animals, whereas, enzyme injected intraperitoneally is clearly antigenic. Synthesis of ascorbic acid by this artificial organ could not, however, be detected by elevation of plasma concentrations of the vitamin.

Topics: Animals; Artificial Organs; Ascorbic Acid; Ascorbic Acid Deficiency; Bioprosthesis; Disease Models, Animal; Evaluation Studies as Topic; Guinea Pigs; Intestine, Small; L-Gulonolactone Oxidase; Male; Scurvy; Sugar Alcohol Dehydrogenases

Topics: Adolescent; Ascorbic Acid; Child; Fruit; Humans; Iron; Male; Scurvy; Vegetables; Vitamins

Topics: Animals; Ascorbic Acid; Guinea Pigs; L-Gulonolactone Oxidase; Scurvy; Sugar Alcohol Dehydrogenases

Topics: Ascorbic Acid; Collagen; History, 18th Century; History, Ancient; Humans; Hydroxyproline; Procollagen-Proline Dioxygenase; Scurvy

Young adult nonhuman primates were initially fed an ascorbic-acid free diet and, subsequently, a diet with a suboptimal level of the vitamin. Following approximately 12 weeks of this dietary regime, five of seven experimental animals of the gingival sulcular epithelium to 3H-inulin, but not to 14C-butyric acid or 14C-urea, had increased significantly (+86%, P less than 0.01) in the experimental group as compared to ad libitum or pair-fed controls. This defect in the intercellular permeability barrier of the sulcular epithelium could have contributed to the pathogenesis of scorbutic gingivitis.

Topics: Animals; Ascorbic Acid; Gingiva; Gingivitis; Macaca fascicularis; Male; Permeability; Scurvy

Topics: Acute Disease; Animals; Ascorbic Acid; Brain; Guinea Pigs; Liver; Male; Pituitary Gland; Scurvy

Topics: Ascorbic Acid; Humans; Male; Middle Aged; Scurvy

Scurvy was diagnosed in two elderly alcoholic men in our emergency department. Both were ambulatory and had perifollicular petechiae and ecchymoses of the lower extremities and hypertrophic erythematous gingival lesions. There diets were deficient in fresh fruits and vegetables. Treatment with oral ascorbic acid resulted in dramatic resolution of the signs and symptoms. The first patient was admitted to the hospital, where extensive diagnostic studies failed to reveal other etiological explanations for the cutaneous lesions. The second patient was successfully treated as an outpatient.

Topics: Aged; Alcoholism; Ascorbic Acid; Diagnosis, Differential; Humans; Male; Middle Aged; Nutritional Requirements; Purpura; Scurvy

The role of daily administration of anorectic drugs (fenfluramine, mazindol and diethylpropion) with or without Vitamin C supplement, in the appetite and brain ascorbic acid, had been investigated in guineapigs receiving a daily Vitamin C-deficient diet for 24 days. Food intake was reduced by diethylpropion in the scorbutic male and female guineapigs but to a smaller extent by fenfluramine or mazindol. Supplementary Vitamin C daily significantly inhibited the anorectic actions of these drugs. In relation to the brain ascorbic acid level in the scorbutic gunieapigs, the initial stable level of brain ascorbic acid was significantly reduced by fenfluramine in both sexes by day 24, (P less than 0.05). Both mazindol and diethylpropion did not cause such reductions in the initial brain ascorbic acid. The three anorectic drugs prevented the rise in brain ascorbic acid normally associated with supplementary Vitamin C. It appears that brain ascorbic acid level can make metabolic readjustment during anorexia caused by diethylpropion and mazindol but not that caused by fenfluramine in guineapigs.

Topics: Animals; Appetite; Appetite Depressants; Ascorbic Acid; Brain Chemistry; Diet; Diethylpropion; Female; Fenfluramine; Guinea Pigs; Male; Mazindol; Scurvy

A method of utilizing vitamin C in amounts just short of the doses which produce diarrhea is described (TITRATING TO BOWEL TOLERANCE). The amount of oral ascorbic acid tolerated by a patient without producing diarrhea increase somewhat proportionately to the stress or toxicity of his disease. Bowel tolerance doses of ascorbic acid ameliorate the acute symptoms of many diseases. Lesser doses often have little effect on acute symptoms but assist the body in handling the stress of disease and may reduce the morbidity of the disease. However, if doses of ascorbate are not provided to satisfy this potential draw on the nutrient, first local tissues involved in the disease, then the blood, and then the body in general becomes deplete of ascorbate (ANASCORBEMIA and ACUTE INDUCED SCURVY). The patient is thereby put at risk for complications of metabolic processes known to be dependent upon ascorbate.

Topics: Administration, Oral; Adult; Ascorbic Acid; Diarrhea; Drug Tolerance; Humans; Intestine, Large; Scurvy; Stress, Physiological; Surgical Procedures, Operative

Topics: Administration, Oral; Adult; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Deferoxamine; Female; Guinea Pigs; Hemosiderosis; Humans; Injections, Subcutaneous; Iron; Male; Scurvy; Thalassemia; Transfusion Reaction

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Humans; Iron; Scurvy; Thalassemia; Transfusion Reaction

Female guinea pigs were fed a scorbutigenic diet supplemented with either L-ascorbic acid or D-isoascorbic acid or combinations of these. Their responses were judged by changes in body weight, serum alkaline phosphatase levels, wound healing, and tooth structure. Large additions (100 mg daily) of D-isoascorbic acid to the scorbutigenic diet resulted in normal growth over a 7-wk period and normal serum alkaline phosphatase levels, tooth structure development, and collagen formation after wounding. The addition of 0.5 or 5.0 mg of L-ascorbic acid to this high D-isoascorbic diet improved neither growth rate nor collagen deposition during wound healing. On the basis of changes in tooth structure, D-isoascorbic acid has 1/20 the potency of L-ascorbic acid. Its effect is additive to subminimal maintenance levels of L-ascorbic acid implying that there is no competitive inhibition in the utilization of the two compounds. The relatively weak activity of D-isoascorbic acid is probably due to poor transport to the tissues and ineffective binding to functional sites. This explains why the onset of scurvy is much more rapid after withdrawal of D-isoascorbic acid from the diet when it had been the sole antiscorbutic dietary constituent. It is concluded that D-isoascorbic acid is a "weakly" antiscorbutic agent on the basis that it is both poorly absorbed and retained by the tissue; that in fact it may, to the degree that it is taken up by the tissues and retained, be equal in antiscorbutic potency to L-ascorbic acid.

Topics: Alkaline Phosphatase; Animals; Ascorbic Acid; Dose-Response Relationship, Drug; Female; Growth; Guinea Pigs; Incisor; Scurvy; Stereoisomerism; Structure-Activity Relationship; Wound Healing

Topics: Ascorbic Acid; Humans; Interferons; Scurvy

Topics: Arctic Regions; Ascorbic Acid; Expeditions; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Inuit; Nutritional Sciences; Scurvy

Effects of L-ascorbate 2-sulfate (AAS) on fatty liver and hyperlipidemia induced by various treatments were studied in rats and guinea pigs. L-Ascorbic acid (AA) (50 or 175 mg/kg), a reference compound, lowered the lipid levels in the serum and/or liver in guinea pigs, while AA had little effect in rats. On the other hand, AAS (300 mg/kg) was effective in both animals. In rats, AAS lowered cholesterol and triglycerides in the serum from ethionine-treated animals and in the liver from orotic acid-supplemented animals. In guinea pigs, this compound lowered cholesterol and triglycerides in the serum from ethionine-treated animals, lipids in the liver from cholesterol-supplemented animals, and lipids in the serum and liver from scorbutic animals. AA markedly increased the content of AA in the organs in all experiments, while AAS had a slight effect. Thus, it is suggested that AAS exerts its hypolipidemic and lipotropic effects by the specific actions of AAS.

Topics: Animals; Ascorbic Acid; Cholesterol; Ethionine; Fatty Liver; Female; Guinea Pigs; Hyperlipidemias; Lipids; Male; Orotic Acid; Rats; Scurvy; Sulfuric Acids; Triglycerides

Severe ocular alkali burns in rabbits result in a decrease in aqueous humor ascorbate levels to one-third normal levels. If this deficiency is reversed by immediate treatment with parenteral or topical ascorbate, there is a significantly decreased incidence of subsequent corneal ulceration and perforation. The morphologic changes in these ulcerating corneas are typical of those noted in scorbutus (scurvy). It is concluded that alkali injury to the ciliary epithelial transport processes or ciliary body vasculature results in localized deficiency of ascorbic acid in the aqueous humor and cornea. The development of corneal ulceration is thought to be based on this deficiency which results in the failure of fibroblasts to produce sufficient collagen for repair. A randomized clinical trial of ascorbic acid in the treatment of human alkali burned eyes is now underway.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Injuries; Corneal Ulcer; Disease Models, Animal; Eye Burns; Rabbits; Scurvy

Topics: Animals; Ascorbic Acid; Body Temperature; Body Weight; Catecholamines; Diet; Guinea Pigs; Male; Reserpine; Scurvy; Sympathetic Nervous System; Time Factors

The part of ascorbic acid in the blood capillary wall is shown by deficiency experiment. The pictures obtained by electron microscopy show that, non only is the ascorbic acid needed for the structure integrity of the basement membrane, but also for the permeability of the capillary wall, which when this compound is lacking becomes too important.

Topics: Animals; Ascorbic Acid; Basement Membrane; Capillaries; Capillary Permeability; Cartilage; Guinea Pigs; Microscopy, Electron; Ribs; Scurvy

Rhesus monkeys fed an ascorbic acid-free, purified liquid diet, developed scurvy in 70 to 105 days as evidenced by loss of weight, anemia, bleeding gums, inflamed palate, diarrhea, and inability to stand. Oral administration of either 10 mg/kg body weight of ascorbic acid or an equimolar amount of the magnesium salt of 1-ascorbic acid phosphate cured all symptoms of scurvy. Similarly, oral administration of 1-ascorbic acid phosphate cured all symptoms of scurvy in the guinea pig and resulted in liver ascorbate levels equal to those of animals feed ascorbic acid. It is concluded that ascorbic acid phosphate is a readily available source of ascorbic acid activity in vivo.

Topics: Animals; Ascorbic Acid; Body Weight; Guinea Pigs; Haplorhini; Liver; Macaca mulatta; Male; Organophosphorus Compounds; Scurvy; Species Specificity; Structure-Activity Relationship

Topics: Ascorbic Acid; History, 20th Century; Humans; Scurvy

Vitamin C stimulates the formation of PGE1 in human platelets. The effect occurs over the physiologically relevant range of concentrations. PGE1 is required for T lymphocyte function and plays a major part in the regulation of immune responses. PGE1 is also important in the regulation of collagen and ground substance metabolism, in cholesterol metabolism and in regulation of responsiveness to insulin. It is proposed that defective formation of PGE1 could account for many of the features of scurvy and for many of the reported therapeutic effects of vitamin C. If correct, vitamin C will be of value only in conjunction with an adequate supply of dihomogammalinolenic acid, the precursor of PGE1. Essential fatty acids, pyridoxine and zinc are all required to achieve this.

Topics: Animals; Arachidonic Acids; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Platelets; Cats; Cholesterol; Collagen; Dental Caries; Drug Therapy, Combination; Glycosaminoglycans; Humans; Linolenic Acids; Neoplasms; Platelet Aggregation; Prostaglandins E; Salivation; Scurvy; Sjogren's Syndrome; Stimulation, Chemical

A case of scurvy presenting in a patient with Crohn's disease is reported. A normal response to replacement therapy is seen. Vitamin C (ascorbic acid) deficiency was found in 7 out of 10 patients with clinically quiescent Crohn's disease, 4 of whom had an adequate oral intake of vitamin C. There was no significant difference in oral intake between patients with Crohn's disease and matched controls but there was a significant difference (P less than 0.001) in leucocyte ascorbic acid levels. It is recommended that patients with Crohn's disease be screened for vitamin C deficiency and receive prophylactic vitamin C supplements daily.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Crohn Disease; Female; Humans; Leukocytes; Male; Scurvy

Topics: Antarctic Regions; Ascorbic Acid; Climate; Diet; Humans; Leukocytes; Male; Nutritional Requirements; Scurvy

Willow ptarmigan chicks raised on a diet containing 265 mg ascorbic acid/kg develop scury-like symptoms and die by 4 weeks of age. If blueberry plants are given as an ad libitum supplement to this diet, the malady is prevented. We have described the clinical, pathological and histological changes which accompany this malnutrition and conclude that they are in accord with the description of scurvy in guinea pig and man. Biochemical determination of ascorbic acid synthesis in the kidney of ptarmigan chicks indicated a rate of synthesis five times that found in livers of growing white rats. Blueberry plants and many other plants found in the natural diet of ptarmigan chicks contain 2,000 to 5,000 mg ascorbic acid/kg dry weight. Feeding experiments showed that the pathological signs were avoided and that already afflicted chicks recovered if the vitamin C content of the diet was raised to 750 mg/kg dry weight of food. Since the food intake of the chicks was 5 to 8 g/day the daily requirement of external vitamin C is about 150 mg/kg body weight. To our knowledge this is the first example of an animal which, while producing vitamin C itself, requires substantial amounts of external vitamin C to survive.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Behavior, Animal; Birds; Nutritional Requirements; Osteochondritis; Osteochondrodysplasias; Scurvy; Tibia

Authors present six cases of scurvy admitted in their hospital from September 1977 to July 1978. Symptoms were similar in the majority of them: irritability, skin haemorrhages, swollen gums, scorbutic rosary, swelling and tenderness lower limbs. Radiographic findings more common were: Fraenkels' line "ground glass" appearance, corner sign, Wymberger sign, and in some cases subperiosteal haemorrhages with calcification. Ascorbic acid levels were below normal values in all cases, and overload test showed typical pattern found on patients with scurvy. Special mention is made on the low incidence of this disease in the last few years and also the causes that have motived the existence of this six cases in such a short period of time are analyzed.

Topics: Ascorbic Acid; Child, Preschool; Female; Humans; Infant; Male; Scurvy

The effect of ascorbic acid deficiency on adrenal hydroxylation of cholesterol and deoxycorticosterone in guinea pigs was studied by using mitochondria and isolated cytochrome P-450 fractions. The effects obtained were compared with the effects of long-term treatment with ACTH. Advanced scurvy as well as treatment with ACTH resulted in an increase in the weight of the adrenals, the total amount of cytochrome P-450, the cholesterol side-chain cleavage activity, the cortisol level in plasma, and the excretion of unconjugated cortisol in urine. Total 11beta- and 18-hydroxylation of deoxycorticosterone were not stimulated or were stimulated only to a small extent. It is suggested that the major effects observed in advanced scurvy are due to ACTH, the level of which was significantly increased, most probably as a consequence of the stress. In animals kept on a scorbutogenic diet for 2-4 weeks or, with a small dose of ascorbate added, for several weeks, changes were observed that could not be fully explained as effects of ACTH on normal adrenals. Although the plasma levels of ACTH and cortisol were increased only to a small extent and excretion of unconjugated cortisol in urine was unaffected, there was a significant increase in the total capacity of adrenal mitochondria to hydroxylate exogenous cholesterol. It is concluded that the level of ascorbate in the adrenals might be of some importance for the capacity to convert cholesterol into pregnenolone. The normal feed-back regulation is, however, intact in moderate ascorbate deficiency and the plasma level of cortisol is kept within normal limits.

Topics: Adrenal Glands; Adrenocorticotropic Hormone; Animals; Ascorbic Acid; Cholesterol; Cholesterol Side-Chain Cleavage Enzyme; Cytochrome P-450 Enzyme System; Guinea Pigs; Hydrocortisone; Hydroxylation; Male; Mitochondria; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Scurvy; Sudden Infant Death

Diffusion of ascorbic acid takes place through intestinal lipoid membrane of guinea-pigs. In consequence, plasma and leucocyte concentrations of ascorbic acid increase. Intestinal absorpiton of ascorbic acid in scorbutic guinea-pigs is impaired in contrast to that in normal and saturated guinea-pigs as shown by the accumulation of ascorbic acid in the intestinal mucosal cells of guinea-pigs.

Topics: Animals; Ascorbic Acid; Female; Guinea Pigs; Intestinal Absorption; Intestinal Mucosa; Leukocytes; Male; Scurvy

The vitamin C status of 35 men, over 70 years of age from a residential home has been studied by measuring the plasma and leucocyte vitamin C levels and by assessing the intake of vitamin C. The mean plasma vitamin C level of the group was 16 +/- 15 mumol/l which was significantly lower (P less than 0.005) than that of a similar group of elderly men living alone (26 +/- 20 mumol/l). The mean leucocyte vitamin C levels of the two groups did not differ significantly. Twenty-nine (83 percent) of the institution group had plasma vitamin C levels below 23 mumol/l and 13 men (37 percent) had leucocyte vitamin C levels below 10 microgram/10(8)WBC. The residents who supplemented the institution diet with their own fresh fruit supplies had higher plasma and leucocyte vitamin C levels than the men who did not (P less than 0.01). Some clinical signs possible related to vitamin C deficiency were recorded but these could not later be statistically related to either plasma or leucocyte vitamin C levels. A case is made for vitamin C supplementation of puddings in institutional meals for the elderly.

Topics: Aged; Alcohol Drinking; Ascorbic Acid; Ascorbic Acid Deficiency; Diet; Fruit; Homes for the Aged; Humans; Leukocytes; Male; New Zealand; Scurvy

Testes of pre- and post-pubertal guinea pigs were examined histologically and biochemically to see if ascorbic acid deficiency brought about any changes in their structure or function. Apart from a slight but significant fall in gonadal cholesterol there was no apparent change in the histology or testosterone content in scorbutic guinea pigs. Plasma cholesterol and testosterone were also similar in the control and scorbutic animals.

Topics: Animals; Ascorbic Acid; Cholesterol; Guinea Pigs; Male; Scurvy; Testis; Testosterone

There is a certain presumptive evidence for believing than AA has functions other than the simple prevention of classical scurvy; whether these extra-antiscorbutic functions are attributable to AA itself, or to one or more of its metabolites, is not known. Tissue saturation with AA would appear to provide a good insurance against defects in these extra-antiscorbutic areas. ttissue saturation is attainable by a daily intake of 100-150 mg in man; there are no compelling reasons for using megadoses of AA and the emphasis should be on the avoidance of chronic hypovitaminosis C. There is suggestive evidence that megadoses of AA could be physiologically disadvantageous--particularly with regard to in-utero exposure and in persons exposed to high environmental levels of toxic metals.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Cholesterol; Common Cold; Humans; Longevity; Metals; Scurvy

The case is reported of a 29-year-old previously healthy female patient who developed the typical clinical picture of scurvy eight months after changing to a diet exclusively containing cooked cereals. Serum levels of B12, folic acid, and calcium were lowered and the alkaline phosphatase was slightly raised due to the dietary lack of vitamins A, D, B12 and folic acid. No clinical signs of these deficiencies could be observed. Addition of vitamin C to this diet resulted in complete cure in a matter of days. Signs and symptoms of scurvy are discussed in the light of the recent literature. This rare disease is particularly worth considering if one of the following situations is encountered: hemorrhages in the skin, muscles, joints or mucous membranes without apparent cause; therapy-resistant ulcers of mucous membranes in elderly patients; Sicca syndrome and/or wounds exhibiting poor healing.

Topics: Adult; Ascorbic Acid; Diet Fads; Female; Humans; Scurvy; Vitamin A Deficiency; Vitamin B 12 Deficiency; Vitamin D Deficiency

Topics: Ascorbic Acid; Diagnosis, Differential; Female; Humans; Infant, Newborn; Radiography; Scurvy

Topics: Adult; Ascorbic Acid; Humans; Leukocytes; Male; Purpura, Thrombocytopenic; Scurvy

Topics: Animals; Ascorbic Acid; Chemistry; Guinea Pigs; History, 20th Century; Pennsylvania; Scurvy

Topics: Animals; Ascorbic Acid; Collagen; England; Folic Acid; Guinea Pigs; History of Medicine; Humans; Iron; Scurvy; Tyrosine

Oral administration of 10 mg per kilogram of body weight of ascorbic acid (AA) completely prevented development of scurvy in juvenile rhesus monkey (Mucaca mulata) fed an AA-free liquid diet. The same dose cured scurvy when injected intramuscularly. An equimolar dose of ascorbic acid 2-sulfate (AA-2-S) did not prevent or cure scurvy. Neither AA nor AA-2-S altered serum cholesterol. AA but not AA-2-S reduced serum triglyceride. A case of scurvy in an AA-2-S treated monkey is described in detail.

Topics: Alkaline Phosphatase; Animals; Ascorbic Acid; Body Weight; Cholesterol; Drug Stability; Haplorhini; Macaca; Macaca mulatta; Scurvy; Species Specificity; Triglycerides

Experiments were conducted to determine the nature of the effect of dietary ascorbic acid on selenium nutrition in the chick. Results showed that ascorbic acid resulted in increased activities of the selenium-containing enzyme glutathione peroxidase in plasma, accompanied by an apparent reduction in the dietary selenium requirement of the vitamin E-deficient chick. The ascorbic acid contents of plasma, liver, kidney and adrenals were not affected by selenium or vitamin E deficiencies, indicating that selenium-vitamin E deficient chicks are not rendered scrobutic. Absorption experiments using ligated duodenal loops or oral doses indicated that dietary ascorbic acid promoted the enteric absorption of selenium but did not affect the absorption of vitamin E. These results support the hypothesis previously reported that factors which inhibit the oxidation of dietary selenium promote its absorption and, perhaps, its post-absorptive utilization in metabolically active components of the cell.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Chickens; Dose-Response Relationship, Drug; Duodenum; Glutathione Peroxidase; Intestinal Absorption; Nutritional Requirements; Oxidation-Reduction; Scurvy; Selenium; Vitamin E; Vitamin E Deficiency

Scurvy developed in a 56-year-old man with poor dietary intake and was associated with knee hemarthroses and synovial thickening. The synovial membrane showed interstitial hemorrhage and many large fibroblasts but little collagen and some disarray of vascular basement membrane. Hemarthroses and all knee symptoms completely resolved on a normal diet. To our knowledge, these are the first electron-microscopic studies of synovial membrane in human scurvy, and our findings support a defect in collagen synthesis as a factor in etiology.

Topics: Ascorbic Acid; Collagen; Humans; Knee; Male; Microscopy, Electron; Middle Aged; Scurvy; Synovial Membrane

Topics: Adrenal Glands; Animals; Ascorbic Acid; Body Weight; Brain; Citrus; Flavonoids; Guinea Pigs; Hesperidin; Leukocytes; Liver; Male; Scurvy; Spleen

A five year old girl presented with short femora, cupped distal metaphyses and flexion deformity of the knees suggesting previous epiphyseo-metaphyseal damage. The aetiology was suggested by finding a history of previous infantile scurvy with separated distal femoral epiphyses. The rarity of this complication and possible contributing factors are discussed.

Topics: Ascorbic Acid; Bone Diseases, Developmental; Child, Preschool; Epiphyses; Female; Humans; Infant; Radiography; Scurvy; Tibia

Topics: Airway Resistance; Animals; Ascorbic Acid; Guinea Pigs; Male; Prostaglandin Antagonists; Prostaglandins; Prostaglandins E; Prostaglandins F; Scurvy; Trachea

Topics: Ascorbic Acid; Child Nutritional Physiological Phenomena; Citrus; Fruit; Humans; Scurvy

Topics: Animals; Ascorbic Acid; Incisor; Rats; Scurvy; Tooth Fractures

1. In guinea-pigs fed an ascorbic-acid-free diet, as the ascorbic acid levels decreased the histamine levels in blood and urine rose steadily to maxima in about 10-12 days. The elevated histamine levels persisted in the blood and urine of scorbutic guinea-pigs and the histamine levels in lung, gastric mucosa and spleen also increased. The increased histamine content of the urine, blood and other tissues in the ascorbic-acid-depleted condition could be brought back to normal levels by administration of a single dose of ascorbic acid 5 mg/100 g body wt. guinea-pig. 3. The drop in the elevated histamine level was not due to an indirect effect of ascorbic acid on histamine forming capacity, histaminase activity or histamine release.

Topics: Amine Oxidase (Copper-Containing); Animals; Ascorbic Acid; Guinea Pigs; Histamine; Histamine Release; Male; Mast Cells; Peritoneum; Scurvy

Topics: Animals; Ascorbic Acid; Beriberi; Child; Child, Preschool; Europe; Female; History, 19th Century; History, 20th Century; Humans; Infant; Male; Nicotinic Acids; Pellagra; Rickets; Scurvy; Thiamine; United States; Vitamin A; Vitamin D; Vitamins

Recommended Daily Allowances (US RDA) of the Food and Drug Administration for ascorbic acid are higher than Recommended Dietary Allowances (set by the Food and Nutrition Board) for adults. There is a 6-fold margin between the requirement to prevent scurvy and the US RDA. The high requirement reported for the rhesus monkey may be needed to compensate for oxidative catabolism of ascorbic acid in this species. The rate of production of ascorbic acid, in mammals that synthesize it has been listed as 3-19 g/70 kg per day. If this high rate of synthesis represents the requirement of such animals, mutations that caused a loss of ascorbic-acid-synthesizing ability would be eliminated by natural selection on diets that failed to supply these large quantities. The loss of ascorbic-acid-synthesizing ability by human beings could indicate a low requirement, which has enabled our species to spread to regions of the earth where dietary sources of ascorbic acid are poor.

Topics: Animals; Ascorbic Acid; Haplorhini; Humans; Nutritional Requirements; Scurvy; Species Specificity; United States; United States Food and Drug Administration

Man does not catabolize ascorbate to CO2, whereas the monkey does catabolize ascorbate and ascorbate sulfate to CO2 when these compounds are given orally. However, it takes the same length of time to produce frank scurvy in both man and the monkey, thus indicating that the comparative storage, rate of use, and mode of metabolism of ascorbate is similar in both species. Preliminary feeding and isotope studies conducted on monkeys are in agreement with the fact that only a small amount of labeled ascorbate or ascorbate sulfate equilibrated with body stores. These results are in agreement with published ascorbic acid requirements of 10 mg/kg body weight. In our experiments, 250 mg/day had to be fed to a 10-kg monkey to completely clear all signs of scurvy and return blood ascorbate levels to normal. Ascorbic acid administered intravenously to monkeys appears to equilibrate completely with the ascorbate pool(s). Ascorbate sulfate was found to be a urinary metabolite of both ascorbic-1-14C acid and ascorbic-6-14C acid fed orally to monkeys.

Topics: Animals; Ascorbic Acid; Carbon Dioxide; Diet; Haplorhini; Humans; Macaca mulatta; Nutritional Requirements; Scurvy; Species Specificity; Sulfuric Acids

Although vitamin C nutritional status in man may be determined on the basis of dietary intake findings and on clinical signs of a dietary deprivation, biochemical measurements represent the most objective approach. Without the availability of a functional biochemical procedure that relates to vitamin C status, information concerning inadequacies in this nutrient has been derived mainly from measuring ascorbate levels in serum (plasma), leukocytes, blood, and urine. The measurement of serum levels of ascorbic acid is the most commonly used and practical procedure for determining vitamin C nutritional status in individuals or population groups. Although leukocyte ascorbate levels provide information concerning the body stores of the vitamin, the measurement is technically more difficult to perform, and, hence, its use is largely confined to clinical situations as an aid in the diagnosis of scurvy. The clinical diagnosis of scurvy can be aided also by information on the urinary levels of ascorbic acid and the use of vitamin C loading or saturation tests. With recognized limitations, ascorbic acid can be measured in biological samples with the use of automated or manual colorimetric and fluorometric procedures. Nutrition surveys conducted in Canada and the United States have indicated vitamin C deficits among certain population groups.

Topics: Adolescent; Adult; Age Factors; Ascorbic Acid; Ascorbic Acid Deficiency; Australia; Canada; Child; Child, Preschool; Europe; Female; Humans; Infant; Leukocytes; Male; Nutrition Surveys; Nutritional Requirements; Scurvy; Sex Factors; United States

Topics: Adult; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Brain; Chick Embryo; Chickens; Diet; Embryo, Mammalian; Embryo, Nonmammalian; Eye; Female; Guinea Pigs; Humans; Liver; Myocardium; Nutritional Requirements; Pregnancy; Scurvy; Tongue

Topics: Animals; Ascorbic Acid; Cartilage; Collagen; Fishes; Gills; Scurvy; Skin; Species Specificity; Trout; Wound Healing

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Folic Acid; Formates; Humans; Leucovorin; Male; Middle Aged; Scurvy; Tetrahydrofolates

Topics: Adult; Animals; Ascorbic Acid; Child, Preschool; Female; Guinea Pigs; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Infant; Male; Norway; Scurvy; United Kingdom; United States

Topics: Ascorbic Acid; England; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Scurvy

Topics: Animals; Ascorbic Acid; Body Weight; Consummatory Behavior; Dose-Response Relationship, Drug; Eating; Female; Food Preferences; Guinea Pigs; Nutritional Physiological Phenomena; Nutritional Requirements; Scurvy; Taste; Time Factors

Scorbutic guinea pig neutrophils (PMN) were found to produce H2O2 and kill Staphylococcus aureus as well as control PMN, suggesting that ascorbate does not contribute significantly to phagocyte H2O2 production or bacterial killing. Total and reduced ascorbate contents of human PMN was observed to fall upon phagocytosis, whereas dehydroascorbate increased to a lesser extent. These observations are consistent with the view that ascorbate constitutes a functional part of the PMN's redox-active components and may thus function to protect cell constituents from denaturation by the oxidants produced during phagocytosis.

Topics: 2,3-Diketogulonic Acid; Animals; Ascorbic Acid; Carbon Dioxide; Carbon Radioisotopes; Dehydroascorbic Acid; Guinea Pigs; Humans; Hydrogen Peroxide; Neutrophils; Phagocytosis; Scurvy

Topics: Adult; Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Burns; Child; Contraceptives, Oral; Depression; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infections; Leg Ulcer; Pyridoxine; Scurvy; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency; Vitamins; Wound Healing; Zinc

Topics: Adult; Ascorbic Acid; Australia; Calcium, Dietary; Canada; Child; Diet; Dietary Proteins; Dietetics; Female; Humans; Individuality; Infant; Male; Nutritional Requirements; Pregnancy; Scurvy; United Kingdom; United States

Microsomes from livers of scorbutic guinea-pigs showed a reduced rate of acetanilide hydroxylation. The response of "scorbutic" liver microsomes to the inhibitor Metyrapone (2-methyl-1,2 di (3-pyridyl) propan-1-one) was different from that of liver microsomes from non-scorbutic guinea-pigs.

Topics: Acetanilides; Adrenal Glands; Animals; Ascorbic Acid; Guinea Pigs; Hydroxylation; Male; Metyrapone; Microsomes, Liver; Scurvy; Spleen

South African Bantu patients with a scurvy-type skin, which developed after a prolonged, iron-induced hemosiderosis, were studied with ascorbic acid-1-C14 and the 2 gm tryptophan load test. The metabolism of the two compounds was found to be abnormal in these patients. The data suggested that ascorbic acid was rapidly (iron accelerated) metabolized to monodehydroascorbate, a compound that rapidly reacts with tissue DPNH to form DPN. This mechanism could reduce tissue levels of DPNH such that the feed-back control of tryptophan pyrolase enzyme was depressed. The change in control level of the pyrrolase enzyme permitted large quantities of tryptophan to be converted into the kynurenine pathway products, and a smaller quantity for the serotonin pathway. This mechanism could contribute to the abnormal tryptophan metabolism found in chronic pellagrins with dementia.

Topics: Ascorbic Acid; Female; Hemosiderosis; Humans; Iron; Male; Middle Aged; Scurvy; Tryptophan

Topics: Adult; Ascites; Ascorbic Acid; Ascorbic Acid Deficiency; Cardiomegaly; Edema; Female; Humans; Leg; Scurvy

Topics: Animals; Ascorbic Acid; Carbon Radioisotopes; Carrageenan; Chick Embryo; Chromatography, Paper; Collagen; Granulation Tissue; Granuloma; Guinea Pigs; Hydroxyproline; Liver; Lung; Muscles; Proline; Proteins; Scurvy; Skin; Ultrafiltration

Topics: Adult; Animals; Ascorbic Acid; Blood Cell Count; Blood Proteins; Ethnicity; Female; Folic Acid; Food Handling; Hematocrit; Hemoglobins; Humans; Iron; Kenya; Leukocytes; Male; Middle Aged; Milk; Nutritional Physiological Phenomena; Pregnancy; Rural Population; Scurvy; Sex Factors; Vitamin B 12

Topics: Animals; Arteriosclerosis; Ascorbic Acid; Disease Models, Animal; Guinea Pigs; Humans; Lipid Metabolism; Scurvy; Time Factors

Topics: Animals; Ascorbic Acid; Cheek; Desmosomes; Dose-Response Relationship, Drug; Epithelial Cells; Epithelium; Female; Guinea Pigs; Male; Microscopy, Electron; Scurvy

In a study of the vitamin C status of 50 patients with malignant disease, 46 had leucocyte levels less than the lower limit of the normal range (18-50,μg/10(8) W.B.C.) and of these 30 had very low levels (< 12.5 μg/10(8) W.B.C.). Physical signs compatible with subclinical scurvy were frequently recorded and there was a significant decrease in capillary fragility in those with the lowest levels. Most patients had an inadequate dietary intake of ascorbic acid-containing foods and this was felt to be the major factor in producing the vitamin depletion.

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Bronchial Neoplasms; Capillary Fragility; Colonic Neoplasms; Diet; Humans; Leukocytes; Lymphatic Diseases; Neoplasms; Rectal Neoplasms; Scurvy; Stomach Neoplasms

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Humans; Leukocytes; Scurvy; Tyrosine

Topics: Aged; Ascorbic Acid; Blood Sedimentation; Depression; Diazepam; Diet; Ecchymosis; Family Practice; Fruit; Hemoglobins; Humans; Imipramine; Leukocyte Count; Male; Prothrombin Time; Scurvy; Urea

Topics: Animal Feed; Animals; Ascorbic Acid; Cysteine; Guinea Pigs; Oxidation-Reduction; Scurvy

Scorbutic guinea pigs were wounded and the influence of administering ascorbic acid 6 days later was studied with respect to cellular morphology, ribosomal distribution and protein synthesis. Electron-microscopic studies revealed that the dilated endoplasmic reticulum observed in the fibroblasts of scorbutic wound tissue had reverted to a normal configuration 24h after intraperitoneal injection of 100mg of ascorbate. Quantitative determination of the distribution of free and membrane-bound ribosomes indicated a significant increase in membrane-bound ribosomes in wound tissue from ascorbate-supplemented (recovery) animals. Sucrose-density-gradient centrifugation indicated a significant increase in the proportion of large membrane-bound polyribosomes in the range 300-350S and a concomitant decrease in 80S monoribosomes in the ribosome sedimentation profile of recovery tissue. Determination of the synthesis of non-diffusible [(3)H]hydroxyproline in scorbutic and recovery wounds showed a 3-4-fold stimulation in peptidyl-proline hydroxylation in recovery tissues. Studies carried out in which scorbutic and recovery tissues were incubated with [(14)C]leucine indicated that general protein synthesis, as measured by (14)C incorporated into non-diffusible material/mug of DNA, was unaltered by ascorbate supplementation. Similar studies of [(3)H]proline incorporation suggested that in recovery tissues there was a small but significant increase in [(3)H]proline incorporated/mug of DNA, which probably represents an increase in protocollagen synthesis. This observation correlates well with the increase seen in recovery tissues of large polyribosomes on which collagen precursor polypeptides are known to be synthesized. Preliminary characterization of the repair collagen synthesized by recovery animals showed it to be a typical Type I collagen having the chain composition (alpha(1))(2)alpha(2). The extent of glycosylation of the hydroxylysine of the newly synthesized collagen was greater than that reported for either normal guinea-pig dermal collagen or dermal scar collagen.

Topics: Animals; Ascorbic Acid; Centrifugation, Density Gradient; Collagen; Guinea Pigs; Hydroxylysine; Lysine; Male; Microscopy, Electron; Polyribosomes; Proline; Ribosomes; Scurvy; Skin; Wound Healing

Topics: Animals; Ascorbic Acid; Cholesterol; Guinea Pigs; Hydroxylation; Oxidation-Reduction; Rats; Scurvy

Topics: Adult; Ascorbic Acid; Black People; Carbon Dioxide; Carbon Radioisotopes; Chromatography, Paper; Hemosiderosis; Humans; Male; Middle Aged; Oxalates; Scurvy; South Africa; Time Factors

Topics: Administration, Oral; Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Body Weight; Guinea Pigs; Hemorrhage; Hindlimb; Injections, Intraperitoneal; Joints; Liver; Male; Ribs; Scurvy; Structure-Activity Relationship; Sulfuric Acids

Topics: Africa; Ascorbic Acid; Black People; Ethnicity; Female; Hemosiderosis; Humans; Male; Models, Chemical; Pellagra; Scurvy; Tryptophan

Topics: Adrenal Glands; Age Factors; Animals; Ascorbic Acid; Body Weight; Circadian Rhythm; Common Cold; Diet; Female; Gonadal Steroid Hormones; Guinea Pigs; Hematopoiesis; Humans; Hydrogen-Ion Concentration; Iron; Leukocytes; Liver; Male; Saliva; Scurvy; Sex Factors; Time Factors

Topics: Adult; Animals; Ascorbic Acid; Genes; Goats; Humans; Nutritional Requirements; Scurvy

Topics: Adenosine Diphosphate; Adult; Aged; Animals; Ascorbic Acid; Blood; Blood Cell Count; Blood Coagulation Factors; Blood Platelets; Collagen; Humans; Leukocytes; Methods; Platelet Adhesiveness; Purpura; Scurvy; Snakes; Venoms

Topics: Ascorbic Acid; Cervix Mucus; Common Cold; Female; Humans; Infertility, Female; Pregnancy; Scurvy; Self Medication

Topics: Ascorbic Acid; Breast Feeding; Communication; Diet Therapy; Health Education; Hospitals; Infant Nutrition Disorders; Protein-Energy Malnutrition; Scurvy; Social Change; South Africa

Topics: Ascorbic Acid; Common Cold; Food, Fortified; Humans; Scurvy; Tetracycline

Topics: Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Carbon Dioxide; Carbon Isotopes; Dose-Response Relationship, Drug; Enzyme Induction; Guinea Pigs; Male; Scurvy; Time Factors; Urine

Topics: Animals; Ascorbic Acid; Cholesterol; Cholesterol, Dietary; Female; Guinea Pigs; Male; Rodent Diseases; Scurvy; Sex Factors; Time Factors

Topics: Amino Acids; Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Infant; Kidney Tubules; Male; Radiography; Scurvy

Topics: Administration, Oral; Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Erythrocytes; Female; Humans; Male; Middle Aged; Scurvy; Vitamin B 12

Topics: Alkaline Phosphatase; Amino Acids; Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Collagen; Fishes; Fractures, Bone; Hydroxyproline; Pigmentation Disorders; Radiography; Scurvy; Spinal Diseases; Spine

Topics: Adrenal Glands; Animals; Ascorbic Acid; Benzopyrans; Brain; Catechols; Drug Stability; Flavonoids; Guinea Pigs; Kidney; Liver; Male; Oxidation-Reduction; Rutin; Scurvy; Spleen; Structure-Activity Relationship

Topics: Ascorbic Acid; Bacterial Infections; Common Cold; Gingivitis; Humans; Scurvy

Topics: Adrenal Glands; Ammonium Sulfate; Animals; Ascorbic Acid; Chemical Precipitation; Chromatography; Chromatography, Gel; Cytoplasm; Dactinomycin; Dialysis; Enzyme Induction; Guinea Pigs; Hydroxyapatites; Male; Precipitin Tests; Puromycin; Rabbits; Scurvy; Tyrosine 3-Monooxygenase

Topics: Acid-Base Equilibrium; Animals; Ascorbic Acid; Guinea Pigs; History, 20th Century; Scurvy; Vegetables

Topics: Aged; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Common Cold; Diet; Food; Food Handling; Humans; Nutritional Physiological Phenomena; Nutritional Requirements; Rats; Scurvy

Topics: Ascorbic Acid; Australia; Diet; Emigration and Immigration; Ethnicity; Greece; Health Education; Humans; Infant; Infant Care; Italy; Lebanon; Leg; Radiography; Scurvy; Yugoslavia

Topics: Adult; Anemia; Ascorbic Acid; Blood Transfusion; Carcinoma, Squamous Cell; Citrus; Diet; Epistaxis; Female; Gastrointestinal Diseases; Hemoglobins; Humans; Intestinal Absorption; Iron; Leukocytes; Male; Middle Aged; Peptic Ulcer; Pharyngeal Neoplasms; Scurvy; Smoking; Stomatitis, Aphthous

Topics: Anemia, Hemolytic; Animals; Ascorbic Acid; Guinea Pigs; Hemoglobinometry; Intestinal Absorption; Iron; Male; Scurvy; Spleen

Topics: Adult; Arousal; Arthropathy, Neurogenic; Ascorbic Acid; Behavior; Depression; Humans; Hypochondriasis; Hysteria; Leg; Male; Memory; Middle Aged; MMPI; Motivation; Nervous System Diseases; Physical Fitness; Psychological Tests; Psychomotor Disorders; Scurvy

Topics: Adenosine Triphosphate; Aminobutyrates; Animals; Arteriosclerosis; Ascorbic Acid; Carbon Isotopes; Glycoproteins; Growth; Guinea Pigs; Homocysteine; In Vitro Techniques; Lactones; Microsomes, Liver; Phosphorus Isotopes; Scurvy; Skin; Sulfates; Sulfonic Acids; Sulfur Isotopes; Thiophenes

Topics: Age Factors; Animals; Ascorbic Acid; Avitaminosis; Endotoxins; Escherichia coli; Guinea Pigs; Lung; Myocardium; Scurvy; Shock, Septic

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Male; Middle Aged; Respiratory Tract Infections; Scurvy

Topics: Ascorbic Acid; Carbon Isotopes; Humans; Male; Nutritional Requirements; Scurvy

Topics: Adult; Antigens; Ascorbic Acid; Blood Glucose; Blood Protein Disorders; Body Weight; Carbon Isotopes; Cholesterol; Diet Therapy; Epinephrine; Epithelium; Fatigue; Gingival Diseases; Hemorrhage; Humans; Immunization; Insulin; Joint Diseases; Keratosis; Lipids; Male; Middle Aged; Muscular Diseases; Nutritional Requirements; Pain; Plasma; Scurvy; Time Factors; Typhoid Fever; Water

Topics: Ascorbic Acid; Carbon Isotopes; Diet Therapy; Humans; Male; Methods; Scurvy; Statistics as Topic; Time Factors; Tritium; Urine

Topics: Adolescent; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Humans; Infant; Infant Nutrition Disorders; Nutrition Disorders; Scurvy

Topics: Adrenal Glands; Animals; Ascorbic Acid; Female; Guinea Pigs; Male; Salicylates; Scurvy; Sodium

Topics: Animals; Ascorbic Acid; Humans; Male; Nutritional Requirements; Scurvy

Topics: Animals; Ascorbic Acid; Brain; Carbon Dioxide; Carbon Isotopes; Cerebrosides; Fatty Acids; Guinea Pigs; Scurvy; Subcellular Fractions

Topics: Alkaline Phosphatase; Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Body Weight; Diet; Dietary Fats; Guinea Pigs; Male; Scurvy; Vitamin E

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Diet Therapy; Humans; Male; Nutrition Disorders; Oral Manifestations; Scurvy

Topics: Ascorbic Acid; Scurvy

Topics: Animals; Ascorbic Acid; Blood Vessels; Bone and Bones; Bone Development; Dilatation; Fibroblasts; Guinea Pigs; Lymphocytes; Male; Osteoblasts; Scurvy; Veins

Topics: Adrenal Glands; Animals; Ascorbic Acid; Body Weight; Glucosephosphate Dehydrogenase; Guinea Pigs; Histocytochemistry; L-Lactate Dehydrogenase; Male; Scurvy; Staining and Labeling; Succinate Dehydrogenase; Time Factors

Topics: Aged; Ascorbic Acid; Biopsy; Blood Vessels; Capillaries; Collagen; Endoplasmic Reticulum; Fibroblasts; Hemorrhage; Humans; Lysosomes; Male; Microscopy, Electron; Scurvy; Skin

Topics: Acetoacetates; Adenosine Triphosphatases; Alkaline Phosphatase; Animals; Ascorbic Acid; Catalase; Enzyme Activation; Glucose; Guinea Pigs; Male; Proteins; Scurvy; Succinate Dehydrogenase

Topics: Ascorbic Acid; Child, Preschool; Epiphyses, Slipped; Female; Femur; Hemorrhage; Hemorrhagic Disorders; Humans; Infant; Male; Radiography; Scurvy

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Capillaries; Glycoproteins; Glycosaminoglycans; Guinea Pigs; Microscopy, Electron; Phosphatidylcholines; Scurvy

Topics: Animals; Ascorbic Acid; Biological Transport; Depression, Chemical; Guinea Pigs; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; Methionine; Scurvy; Serous Membrane

Topics: 17-Ketosteroids; Adrenocorticotropic Hormone; Aged; Ascorbic Acid; Humans; Hydrocortisone; Male; Metyrapone; Middle Aged; Pituitary-Adrenal System; Scurvy

Topics: Ascorbic Acid; Basement Membrane; Culture Media; Culture Techniques; Epithelium; Fluorescent Antibody Technique; Hydroxyproline; Neoplasms, Experimental; Proline; Scurvy; Tritium

Ascorbic acid is a required cofactor in the conversion of dopamine to norepinephrine in vitro, and the deficiency of this vitamin in guinea pigs is associated with degeneration of autonomic ganglion cells and with cardiac supersensitivity to norepinephrine. Because of these findings, we tested the hypothesis that ascorbic acid deficiency in man alters autonomic cardiovascular reflexes and vasomotor responses to adrenergic stimuli. We studied five normal volunteers who had been deprived of ascorbic acid for a period of 3 months; they had developed symptoms and signs of scurvy and their plasma levels of ascorbic acid averaged 0.178 +/-SE 0.07 mg/100 ml. We repeated the studies after giving the subjects vitamin C for a period of 4 months; they had become asymptomatic and their plasma ascorbic acid had increased to an average of 1.68 +/-0.151 mg/100 ml. Blood flow to the left forearm (plethysmograph), arterial and central venous pressures, and heart rate were measured before and after exposure of the lower half of the body to subatmospheric levels of pressure and before and after intravenous and intra-arterial (left brachial artery) infusions of norepinephrine and tyramine. Average values of blood flow (7.9 +/-1.4 ml/min per 100 ml), arterial pressure (91.2 +/-4.6 mm Hg), heart rate (68 +/-4.4 beats/min), central venous pressure (6.1 +/-1.1 mm Hg), and plasma catecholamines (0.68 +/-0.20 mug/liter) obtained during ascorbic acid deficiency were not altered significantly after correction of the deficiency. Vasoconstrictor responses to intra-arterial norepinephrine and tyramine were augmented after vitamin repletion. During ascorbic acid deficiency, four subjects had reduced responsiveness of resistance vessels of the forearm to lower body negative pressure as compared to the responsiveness observed after vitamin repletion. Reflex tachycardia during lower body negative pressure and reflex bradycardia during the pressor responses to intravenous tyramine and norepinephrine were similar during the two studies. The results suggest that the decreased vascular responsiveness to intra-arterial norepinephrine and tyramine and to lower body negative pressure during ascorbic acid deficiency is caused by a defect in the ability of resistance vessels to constrict in response to adrenergic stimuli. Ascorbic acid deficiency in man does not interrupt autonomic reflexes and does not appear to cause significant depletion of endogenous norepinephrine.

Topics: Ascorbic Acid; Autonomic Nervous System; Blood Pressure; Catecholamines; Central Venous Pressure; Constriction; Forearm; Heart Rate; Humans; Male; Norepinephrine; Plethysmography; Reflex; Regional Blood Flow; Scurvy; Tyramine; Vasomotor System

Topics: Acetanilides; Animals; Ascorbic Acid; Cytochromes; Guinea Pigs; Kinetics; Microsomes, Liver; Mixed Function Oxygenases; Scurvy

Topics: Anemia; Ascorbic Acid; Deficiency Diseases; Growth Disorders; Hepatomegaly; Humans; Infant; Male; Rickets; Scurvy; Splenomegaly; Thrombocytopenia; Vitamin D

Topics: Ascorbic Acid; Australia; Child; Child, Preschool; Female; Humans; Infant; Infant Nutrition Disorders; Male; Native Hawaiian or Other Pacific Islander; Scurvy

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Dental Caries; Diet; Humans; Keratoconjunctivitis; Lacrimal Apparatus; Male; Middle Aged; Oral Manifestations; Salivary Gland Diseases; Scurvy; Sjogren's Syndrome; Skin Manifestations; Xerostomia

Topics: Aminopyrine; Animals; Ascorbic Acid; Biotransformation; Cytochromes; Enzyme Induction; Female; Guinea Pigs; Male; Methylcholanthrene; Microsomes, Liver; Oxygenases; Phenobarbital; Scurvy; Stimulation, Chemical

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Collagen; Diet Therapy; Female; Humans; Leukocyte Count; Male; Scleroderma, Systemic; Scurvy; Skin Tests

Topics: Animals; Ascorbic Acid; Biological Assay; Chemical Phenomena; Chemistry; Chromatography, Thin Layer; Guinea Pigs; Honey; Hydrazones; Indophenol; Iran; Male; Methods; Scurvy

Topics: Acetoacetates; Animals; Ascorbic Acid; Glucose; Guinea Pigs; Liver; Mixed Function Oxygenases; Phenylpyruvic Acids; Scurvy; Tyrosine

Topics: Animals; Ascorbic Acid; Body Weight; Guinea Pigs; Ileum; Intestinal Absorption; Intestinal Mucosa; Leukocytes; Scurvy

Topics: Administration, Oral; Adrenal Glands; Animals; Ascorbic Acid; Benz(a)Anthracenes; Guinea Pigs; Injections, Intraperitoneal; Liver; Male; Scurvy

Topics: Adrenal Glands; Animals; Ascorbic Acid; Collagen; Guinea Pigs; Histocytochemistry; Lung; Methods; Scurvy; Silicon Dioxide; Silicosis; Silver

Topics: Adrenocorticotropic Hormone; Animals; Ascorbic Acid; Cholelithiasis; Female; Guinea Pigs; Hydrocortisone; Male; Scurvy

Topics: Adult; Ascorbic Acid; Femoral Nerve; Hemorrhage; Humans; Male; Peripheral Nervous System Diseases; Scurvy

Topics: Ascorbic Acid; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Naval Medicine; Plants, Medicinal; Scurvy

Topics: Animals; Ascorbic Acid; Capillaries; Cartilage, Articular; Decalcification, Pathologic; Epiphyses; Female; Guinea Pigs; Male; Mandibular Condyle; Scurvy; Tibia

Topics: Aged; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Edema; Hematoma; Humans; Hydrarthrosis; Male; Middle Aged; Scurvy; Single Person

Topics: Achlorhydria; Adult; Aged; Ascorbic Acid; Blood Coagulation Tests; Extremities; Glomerular Filtration Rate; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Oral Hemorrhage; Scurvy

Topics: Animal Feed; Animals; Aqueous Humor; Ascorbic Acid; Guinea Pigs; Male; Scurvy

Topics: Ascorbic Acid; Child, Preschool; Female; Humans; Infant; Male; Radiography; Scurvy

Topics: Animals; Ascorbic Acid; Deoxyribonucleases; Guinea Pigs; Lysosomes; Male; Scurvy; Testis

Topics: Aged; Ascorbic Acid; Humans; Male; Microscopy, Electron; Scurvy

Topics: Aged; Ascorbic Acid; Blood Sedimentation; Extremities; Hemorrhage; Humans; Male; Oral Manifestations; Periodontal Diseases; Scurvy; Skin Manifestations

Topics: Aged; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Diet Therapy; Humans; Nutritional Requirements; Scurvy

Topics: Animals; Ascorbic Acid; Blood Proteins; Cortisone; Erythrocytes; Growth; Guinea Pigs; Iodine; Iodine Isotopes; Kidney; Liver; Male; Organ Size; Protein Binding; Scurvy; Thyroid Gland; Thyroxine; Triiodothyronine

Topics: Adult; Aged; Ascorbic Acid; Female; Humans; Male; Scurvy

Topics: Acute Disease; Adrenal Glands; Animals; Aorta; Arteriosclerosis; Ascorbic Acid; Ascorbic Acid Deficiency; Brain Chemistry; Cholesterol; Diet, Atherogenic; Fatty Acids; Guinea Pigs; Intestine, Small; Liver; Male; Models, Biological; Phospholipids; Scurvy

Topics: Acetanilides; Aminopyrine; Animals; Ascorbic Acid; Cytochromes; Ethionine; Guinea Pigs; Liver; Methylcholanthrene; Microsomes; Oxygenases; Phenobarbital; Scurvy; Stimulation, Chemical

Topics: Adult; Alcoholic Intoxication; Ascorbic Acid; Ascorbic Acid Deficiency; Aspirin; Blood Cell Count; Capillary Fragility; Diet; Female; Gastrointestinal Hemorrhage; Humans; Kwashiorkor; Leukocytes; Male; Middle Aged; Peptic Ulcer Hemorrhage; Scurvy

Topics: Adrenocorticotropic Hormone; Amino Acids; Ascorbic Acid; Biopsy; Bone Development; Dentition; Diet Therapy; Female; Glycosaminoglycans; Hernia, Umbilical; Humans; Hydroxyproline; Infant; Mucopolysaccharidosis I; Phenylalanine; Scurvy; Skin; Tyrosine; Wound Healing

Topics: Anemia, Pernicious; Ascorbic Acid; Biochemistry; History, 20th Century; Research; Rickets; Scurvy; Stereoisomerism; Thioctic Acid; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin E; Vitamin E Deficiency; Vitamin K; Vitamins

Topics: Ascorbic Acid; Diet Therapy; Female; Humans; Infant; Mucopolysaccharidosis I; Scurvy

Topics: Ascorbic Acid; Humans; Infant; Knee; Male; Osteoporosis; Radiography; Scurvy; Spinal Diseases; Spine; Wrist

Topics: Animals; Ascorbic Acid; Collagen; Cytoplasm; Dendrites; Endoplasmic Reticulum; Female; Ganglia, Autonomic; Guinea Pigs; Injections, Intraperitoneal; Microscopy, Electron; Mitochondria; Neurons; Organoids; Scurvy

Topics: Adult; Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Chronic Disease; Depression; Diet; Diet Therapy; Edema; Female; Hemorrhage; Humans; Keratosis; Middle Aged; Scurvy

Topics: Animals; Ascorbic Acid; Collagen; Colloids; Connective Tissue; Electrochemistry; Female; Guinea Pigs; Hyaluronoglucosaminidase; Macromolecular Substances; Scurvy; Wound Healing

Topics: Animals; Ascorbic Acid; Collagen; Culture Techniques; Fibroblasts; Rats; Scurvy; Vitamin D; Wound Healing

Topics: Anemia, Pernicious; Ascorbic Acid; Ascorbic Acid Deficiency; Diet; Humans; Leukocytes; Male; Middle Aged; Nutrition Disorders; Postgastrectomy Syndromes; Radionuclide Imaging; Scurvy; Splenic Rupture; Thrombocytopenia; Ultrasonics

Topics: Ascorbic Acid; Birth Weight; Breast Feeding; Diagnosis, Differential; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Milk, Human; Osteoporosis; Prognosis; Radiography; Rickets; Scurvy; Syphilis, Congenital

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Chlorides; Dermatologic Agents; Diet; Guinea Pigs; Muscles; Potassium; Scurvy; Sodium; Tannins; Water-Electrolyte Balance

Topics: Acid Phosphatase; Alkaline Phosphatase; Animals; Ascorbic Acid; Guinea Pigs; Histocytochemistry; Injections, Intramuscular; Male; Prostate; Scurvy; Succinate Dehydrogenase

Topics: Age Factors; Ascorbic Acid; Child; Child, Preschool; Humans; Scurvy

Topics: Aged; Anemia, Macrocytic; Ascorbic Acid; Erythropoiesis; Folic Acid; Hemoglobinometry; Humans; Male; Reticulocytes; Scurvy

Topics: Adult; Ascorbic Acid; Depression; Diet Fads; Female; Folic Acid; Folic Acid Deficiency; Gingivitis; Humans; Medicine, East Asian Traditional; Protein Deficiency; Scurvy

Topics: Adult; Anemia, Hypochromic; Ascorbic Acid; Black People; Gingival Hypertrophy; Humans; Male; Nigeria; Scurvy

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Body Weight; Deoxyribonucleases; DNA; Guinea Pigs; Kidney; Liver; Lysosomes; Male; Muscles; Organ Size; Scurvy; Spleen; Testis

Topics: Animals; Ascorbic Acid; Blood Platelets; Guinea Pigs; Scurvy

Topics: Ascorbic Acid; Blood Chemical Analysis; Blood Platelet Disorders; Blood Platelets; Female; Folic Acid; Humans; Leukocytes; Male; Middle Aged; Scurvy

Topics: Ascorbic Acid; Cardiomyopathies; Diagnosis, Differential; Electromyography; Female; Humans; Male; Middle Aged; Periodontal Diseases; Scurvy; Tooth Extraction

Topics: Adrenal Glands; Animals; Ascorbic Acid; Centrifugation; Dihydrolipoamide Dehydrogenase; Electron Transport; Guinea Pigs; Liver; Male; Microsomes; Mitochondria; Mitochondria, Liver; NAD; NADP; Oxidoreductases; Scurvy; Spectrophotometry; Time Factors

Topics: Acid Phosphatase; Alkaline Phosphatase; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Guinea Pigs; Histocytochemistry; Lipids; Male; Scurvy; Spermatozoa; Succinate Dehydrogenase; Testis

Topics: Animals; Ascorbic Acid; Body Weight; Diet; Guinea Pigs; Male; Nutritional Physiological Phenomena; Scurvy

Topics: Adult; Aged; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Folic Acid; Humans; Leucovorin; Male; Middle Aged; Scurvy

Topics: Abdomen; Alkaline Phosphatase; Animals; Ascorbic Acid; Back; Body Weight; Guinea Pigs; Histocytochemistry; In Vitro Techniques; Injections, Subcutaneous; Intestine, Small; Liver; Magnesium; Male; Organ Size; Phosphates; Scurvy; Skin

Topics: Animals; Ascorbic Acid; Guinea Pigs; In Vitro Techniques; Intestine, Small; Scurvy

Topics: Abortion, Spontaneous; Anemia, Hemolytic, Congenital; Animals; Ascorbic Acid; Ergocalciferols; Female; Humans; Hydrocephalus; Infant, Newborn; Infant, Newborn, Diseases; Jaundice, Neonatal; Maternal-Fetal Exchange; Osteomalacia; Pregnancy; Pregnancy, Prolonged; Pyridoxine; Rats; Scurvy; Seizures; Skull; Vitamin A; Vitamin B 12; Vitamin E; Vitamin K; Vitamins

Topics: Animals; Ascorbic Acid; Brain; Brain Chemistry; Cytoplasm; Guinea Pigs; Histocytochemistry; In Vitro Techniques; Scurvy

Topics: Animals; Ascorbic Acid; Body Weight; Diet; Guinea Pigs; Indoles; Liver; Scurvy

Topics: Ascorbic Acid; Bone and Bones; Child, Preschool; Epiphyses, Slipped; Female; Humans; Humeral Fractures; Muscular Dystrophies; Osteoporosis; Radiography; Scurvy

Topics: Ascorbic Acid; Humans; Infant; Scurvy

Topics: Alcohol Oxidoreductases; Ascorbic Acid; Humans; Liver; Metabolism, Inborn Errors; Scurvy

Topics: Alveolar Process; Animals; Ascorbic Acid; Citrates; Gingiva; Guinea Pigs; Kidney; Male; Scurvy; Ubiquinone

Topics: Aged; Anemia; Ascorbic Acid; Humans; Iron; Male; Scurvy; Vitamin B 12

Topics: Adrenal Glands; Ascorbic Acid; Ascorbic Acid Deficiency; Kidney; Liver; Lung; Scurvy

Topics: Ascorbic Acid; Humans; Metabolism, Inborn Errors; Scurvy

Topics: Alkaline Phosphatase; Animals; Ascorbic Acid; Guinea Pigs; Male; Scurvy

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Biochemical Phenomena; Biochemistry; Death, Sudden; Drug Therapy; Humans; Infant; Infant Nutritional Physiological Phenomena; Metabolism; Radiography; Scurvy

Topics: Anemia; Ascorbic Acid; Drug Therapy; Geriatrics; Humans; Iatrogenic Disease; Scurvy

Topics: Animals; Ascorbic Acid; Guinea Pigs; Insulin; Kidney; Metabolism; Pharmacology; Phosphoric Monoester Hydrolases; Phosphorus; Phosphorus, Dietary; Research; Scurvy

Topics: Ascorbic Acid; Blood; Bodily Secretions; Breast Feeding; Diet; Erythrocyte Count; Female; Hemoglobinometry; Humans; Lactation; Leukocyte Count; Metabolism; Milk, Human; Physiology; Pregnancy; Scurvy; Urine

Topics: Adrenal Glands; Anaphylaxis; Animals; Ascorbic Acid; Guinea Pigs; Histamine; In Vitro Techniques; Scurvy

Topics: Acetanilides; Adrenal Glands; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Fumarates; Guinea Pigs; Liver; Microsomes; Mitochondria; NADP; Scurvy

Topics: Aging; Anemia, Hypochromic; Ascorbic Acid; Birth Order; Canada; Child, Preschool; Education; Ethnology; Hospitalization; Humans; Indians, North American; Infant; Infant Nutrition Disorders; Occupations; Radiography; Rickets; Scurvy; Social Conditions; White People

Topics: Adrenal Glands; Animals; Ascorbic Acid; Bile; Bone and Bones; Digestive System; Feces; Guinea Pigs; In Vitro Techniques; Kidney; Liver; Lung; Manganese; Myocardium; Radioisotopes; Scurvy; Spleen; Urine

Topics: Animals; Ascorbic Acid; Collagen; Dermatologic Agents; Guinea Pigs; Scurvy; Tannins

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Electrons; Erythrocytes; Glycosaminoglycans; Granulation Tissue; Guinea Pigs; Microscopy; Microscopy, Electron; Research; RNA; Scurvy

Topics: Achlorhydria; Anemia; Ascorbic Acid; Blood Transfusion; Folic Acid; Geriatrics; Humans; Scurvy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Acclimatization; Adaptation, Physiological; Africa; Africa, Northern; Ascorbic Acid; Desert Climate; Electrocardiography; Electroencephalography; Metabolism; Neuromuscular Junction; Physiology; Scurvy; Water-Electrolyte Balance

Topics: Ascorbic Acid; Child; Diagnosis; Humans; Infant; Pathology; Scurvy; Teaching Rounds

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Chemistry Techniques, Analytical; Guinea Pigs; Health; Liver; Research; Scurvy

Topics: Animals; Ascorbic Acid; Collagen; Guinea Pigs; Hydroxyproline; Hyperthyroidism; Hypothyroidism; Metabolism; Pharmacology; Research; Ribosomes; RNA; RNA, Messenger; Scurvy; Thyroxine; Wound Healing

Topics: Animals; Ascorbic Acid; Biological Transport, Active; Carbohydrate Metabolism; Glucose; Guinea Pigs; In Vitro Techniques; Insulin; Intestinal Absorption; Intestine, Small; Pharmacology; Research; Scurvy

Topics: Alpha-Globulins; Amyloidosis; Animals; Ascorbic Acid; Beta-Globulins; Blood Protein Electrophoresis; Blood Proteins; gamma-Globulins; Glycoproteins; Guinea Pigs; Histocytochemistry; Liver; Research; Scurvy; Spleen; Toxicology; Turpentine

The changes in scorbutic wounds following the administration of ascorbic acid have been investigated using the techniques of electron microscopy, histochemistry, and autoradioggraphy. Particular attention has been paid to the changes seen in the endoplasmic reticulum of the fibroblasts and to the identity of the extracellular filamentous material characteristic of scorbutic wounds. Seven-day-old wounds in scorbutic guinea pigs were examined prior to and from one to 72 hours following the administration of vitamin C. Fibroblasts from wounds of normal animals demonstrate a characteristic configuration of the ribosomes of the endoplasmic reticulum which is suggested to be analogous to polyribosomes described in cells synthesizing protein such as the reticulocyte. Tangential views of the membranes of the ergastoplasm show the ribosomes to be grouped in paired rows which take both straight and curved paths. This configuration is lost in scurvy and can be seen to begin to reappear as early as 4 hours after giving ascorbic acid. With increasing time, the morphology of the ribosomal aggregates approximates that seen in normal cells, so that by 24 hours their reorientation is complete. It is suggested that one of the disturbances in scurvy may relate to an alteration either in messenger RNA, in the ability of the ribosomes to relate to the messenger, or in the membranes of the ergastoplasm. In addition, the lack of formation of hydroxyamino acids necessary for completing collagen synthesis may be related to the architecture of the ribosomal aggregates. Extracellular collagen fibrils appear concomitant with the restoration of ribosomal and ergastoplasmic morphology as early as 12 hours after administration of ascorbic acid, with complete disappearance of the scorbutic extracellular material within 24 hours. Observations of this scorbutic material do not support the concept that it is a collagen precursor.

Topics: Animals; Ascorbic Acid; Autoradiography; Collagen; Electrons; Endoplasmic Reticulum; Fibroblasts; Guinea Pigs; Histocytochemistry; Microscopy; Microscopy, Electron; Pharmacology; Polyribosomes; Research; Ribosomes; RNA, Messenger; Scurvy; Wound Healing

Topics: Ascorbic Acid; Bone Diseases; Calcinosis; Diagnosis, Differential; Ergocalciferols; Fractures, Bone; Humans; Infant; Osteoporosis; Radiography; Rickets; Scurvy; Streptomycin; Vitamin A

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Bone and Bones; Bone Diseases, Metabolic; Hematoma; Humans; Infant; Pathology; Radiography; Scurvy

Topics: Animals; Ascorbic Acid; Biochemical Phenomena; Biochemistry; Biomedical Technology; Biophysical Phenomena; Biophysics; Chromatography; Collagen; Deuterium; Deuterium Oxide; Equipment and Supplies; Guinea Pigs; Histology; Hydroxyproline; Medical Laboratory Science; Pathology; Pharmacology; Polyvinyls; Proteins; Rats; Research; Scurvy; Skin; Tendons; Wound Healing

Topics: Anemia; Anemia, Macrocytic; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Cell Count; Blood Chemical Analysis; Blood Coagulation Tests; Blood Proteins; Bone Marrow Examination; Folic Acid; Gastric Acidity Determination; Geriatrics; Hemoglobins; Hemolysis; Hemorrhagic Disorders; Humans; Scurvy; Urine; Urobilin

Topics: Alpha-Globulins; Animals; Ascorbic Acid; Blood Protein Disorders; Blood Proteins; Glycoproteins; Haplorhini; Macaca mulatta; Mucoproteins; Pharmacology; Research; Scurvy; Serum Albumin; Serum Globulins

Topics: Animals; Ascorbic Acid; Diet; Dietary Proteins; Dietary Supplements; Guinea Pigs; Pharmacology; Protein Deficiency; Research; Scurvy; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Humans; Osteoporosis; Scurvy

Topics: Ascorbic Acid; Dietary Supplements; Humans; Insulin; Lipids; Scurvy

Topics: Ascorbic Acid; Carbohydrate Metabolism; Dietary Supplements; Humans; Lipid Metabolism; Scurvy

Topics: Ascorbic Acid; Hospitalization; Humans; Infant; Scurvy

Topics: Ascorbic Acid; Child; Geriatrics; Humans; Infant; Scurvy

Topics: Animals; Ascorbic Acid; Diet; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Food, Formulated; Guinea Pigs; Lipid Metabolism; Research; Scurvy; Vitamin A

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Carrageenan; Collagen; DNA; Eukaryota; Granulation Tissue; Granuloma; Guinea Pigs; Hydroxyproline; Polysaccharides; Research; Scurvy

Topics: Ascorbic Acid; Health Education; Humans; Infant; Infant Nutritional Physiological Phenomena; Scurvy

Topics: Ascorbic Acid; Humans; Scurvy

Topics: Adrenal Glands; Animals; Animals, Newborn; Ascorbic Acid; Blood Chemical Analysis; Erythrocyte Count; Guinea Pigs; Hemoglobinometry; Liver; Metabolism; Pantothenic Acid; Research; Scurvy; Urine; Vitamin B Deficiency

Topics: Adrenal Glands; Ascorbic Acid; Carbohydrate Metabolism; Cysteine; Glucose Tolerance Test; Glutathione; Glycogen; Guinea Pigs; Intestines; Kidney; Liver; Liver Glycogen; Muscles; Pancreas; Pharmacology; Research; Scurvy

Topics: Ascorbic Acid; Eye Diseases; Eye Hemorrhage; Geriatrics; Hemorrhage; Humans; Scurvy

Topics: Animals; Ascorbic Acid; Carbohydrate Metabolism; Guinea Pigs; Indoles; Scurvy

Topics: Animals; Ascorbic Acid; Guinea Pigs; Scurvy; Vitamins

Topics: Ascorbic Acid; Carbohydrate Metabolism; Hemochromatosis; Humans; Iron; Scurvy; Skin Diseases; Vitamins

Topics: Ascorbic Acid; Germ-Free Life; Humans; Infections; Scurvy

Topics: Ascorbic Acid; Collagen; Granulation Tissue; Hexosamines; Hydroxyproline; Scurvy

Topics: Ascorbic Acid; Diet; Guinea Pigs; Scurvy

Topics: Ascorbic Acid; Collagen; Eye; Guinea Pigs; Scurvy

Topics: Ascorbic Acid; Carbohydrate Metabolism; Cardiovascular Agents; Flavonoids; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Carbohydrate Metabolism; Flavonoids; Guinea Pigs; Scurvy; Tea; Vitamins

Topics: Ascorbic Acid; Biochemical Phenomena; Carbohydrate Metabolism; Guinea Pigs; Pentobarbital; Phosphates; Scurvy

Topics: Animals; Ascorbic Acid; Guinea Pigs; Scurvy; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Dairy Products; Dietary Supplements; Humans; Milk; Scurvy; Vitamins

Topics: Ascorbic Acid; Capillaries; Capillary Resistance; Flavonoids; Growth; Guinea Pigs; Scurvy; Vitamin A; Vitamin D; Vitamin K; Vitamins

Topics: Ascorbic Acid; Scurvy

The skin of severely scorbutic guinea pigs which were losing weight contained no detectible neutral salt-extractible collagen. Conditions of growth (weight gain) which actively induced the formation of neutral salt-extractible collagen in the skin of normal guinea pigs failed to do so in the animal with ascorbic acid deficiency. No excess of non-collagenous proline was found in neutral salt extracts of scorbutic skin as compared with normal. Fractionation of these extracts failed to reveal the presence of significant amounts of a soluble component containing unusual proportions of glycine and proline relative to hydroxyproline. It is concluded that deficiency of ascorbic acid either interferes with the synthesis of new collagen in intact skin or causes its destruction and removal as rapidly as it is produced.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Collagen; Guinea Pigs; Proline; Scurvy; Skin

Topics: Animals; Ascorbic Acid; Biomedical Research; Dairy Products; Humans; Milk; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Child; Humans; Infant; Infant Nutritional Physiological Phenomena; Milk; Scurvy; Vitamins

Topics: Adrenal Glands; Ascorbic Acid; Brassica; Brassicaceae; Carbohydrate Metabolism; Guinea Pigs; Scurvy; Vegetables

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Cartilage; Chondroitin; Guinea Pigs; Scurvy; Sulfates; Sulfur

Topics: Ascorbic Acid; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Diphtheria; Guinea Pigs; Immunization; Scurvy; Vaccination

Topics: Ascorbic Acid; Brain; Central Nervous System; Scurvy; Vitamins

Topics: Ascorbic Acid; Collagen; Collagen Diseases; Connective Tissue; Humans; Rheumatic Diseases; Scurvy; Vitamins

Topics: Ascorbic Acid; Collagen; Glycine; Hydroxyproline; Proline; Scurvy; Skin Physiological Phenomena

Topics: Ascorbic Acid; Humans; Liver Diseases; Scurvy; Vitamins

Topics: Ascorbic Acid; Connective Tissue; Connective Tissue Diseases; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Female; Growth Disorders; Humans; Pregnancy; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Carbohydrate Metabolism; Guinea Pigs; Mental Disorders; Scurvy; Stress, Physiological

Topics: Animals; Ascorbic Acid; Avitaminosis; Diet; Guinea Pigs; Humans; Scurvy

Topics: Animals; Ascorbic Acid; Diphtheria; Guinea Pigs; Immunity; Scurvy

Topics: Ascorbic Acid; Digestion; Food; Gastric Juice; Humans; Scurvy; Vitamins

Topics: Administration, Oral; Ascorbic Acid; Electrophoresis; Guinea Pigs; Niacin; Niacinamide; Nicotinic Acids; Scurvy; Vitamins

Topics: Adrenal Cortex Hormones; Ascorbic Acid; Dermatologic Agents; Glucocorticoids; Muscles; Scurvy

Topics: Ascorbic Acid; Carbohydrate Metabolism; Health; Humans; Scurvy; Vitamins

Topics: Adult; Anemia; Anemia, Megaloblastic; Ascorbic Acid; Humans; Scurvy

Topics: Ascorbic Acid; Blood; Humans; Leukocytes; Oxidation-Reduction; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Body Fluids; Humans; Scurvy; Urine; Vitamins

Topics: Ascorbic Acid; Female; Humans; Mental Disorders; Pregnancy; Pregnancy Complications; Schizophrenia; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Coagulation; Blood Coagulation Tests; Guinea Pigs; Scurvy; Vitamin A; Vitamin D; Vitamin K; Vitamins

Topics: Animals; Ascorbic Acid; Guinea Pigs; Imidazoles; Scurvy; Thyroxine; Vitamins

Topics: Ascorbic Acid; Disease; Gingiva; Gingival Diseases; Humans; Scurvy; Vitamins

Topics: Adrenocorticotropic Hormone; Ascorbic Acid; Hematopoietic System; Humans; Scurvy

Topics: Animals; Ascorbic Acid; Guinea Pigs; Islands; Islets of Langerhans; Pancreas, Exocrine; Scurvy

Topics: Animals; Ascorbic Acid; Diet; Gingiva; Scurvy; Wound Healing

Topics: Ascorbic Acid; Hematopoiesis; Scurvy; Vitamins

Topics: Antisocial Personality Disorder; Ascorbic Acid; Female; Humans; Mental Disorders; Pregnancy; Schizophrenia; Scurvy; Vitamins

Topics: Adrenal Cortex; Adrenal Glands; Ascorbic Acid; Ascorbic Acid Deficiency; Cortisone; Guinea Pigs; Scurvy

Topics: Adrenal Glands; Ascorbic Acid; Desoxycorticosterone; Guinea Pigs; Scurvy; Vitamins

Topics: Amino Acids; Ascorbic Acid; Ascorbic Acid Deficiency; Child; Humans; Infant; Scurvy; Urine; Vitamins

Topics: Acetates; Anemia; Anemia, Macrocytic; Ascorbic Acid; Chromatography; Phenylacetates; Scurvy; Steatorrhea; Urine

Topics: Ascorbic Acid; Biological Transport; Blood; Hostility; Inactivation, Metabolic; Penicillins; Scurvy; Vitamins

Topics: Ascorbic Acid; Humans; Scurvy; Smoking

Topics: Adrenal Cortex; Ascorbic Acid; Guinea Pigs; Hyperthyroidism; Scurvy; Thiouracil; Thyroxine; Vitamins

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Liver; Lung; Muramidase; Scurvy; Spleen

Topics: Ascorbic Acid; Hemodynamics; Humans; Kidney; Scurvy

Topics: Ascorbic Acid; Humans; Scurvy; Tyrosine

Topics: Ascorbic Acid; Humans; Reinforcement, Psychology; Scurvy; Vitamins

Topics: Aged; Ascorbic Acid; Disease; Humans; Middle Aged; Research; Scurvy; Vitamins

Topics: Ascorbic Acid; Avitaminosis; Cartilage; Guinea Pigs; Physiological Phenomena; Scurvy; Vitamins

Topics: Ascorbic Acid; Cortisone; In Vitro Techniques; Liver; Research; Scurvy; Vitamins

Topics: Adult; Anemia; Ascorbic Acid; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Hemorrhage; Humans; Retina; Retinal Hemorrhage; Scurvy; Vitamins

Topics: Anemia; Ascorbic Acid; Folic Acid; Humans; Scurvy; Vitamins

Topics: Adrenal Glands; Ascorbic Acid; Carbohydrate Metabolism; Ethanol; Guinea Pigs; Scurvy

Topics: Ascorbic Acid; Child; Humans; Infant; Infant Nutritional Physiological Phenomena; Scurvy; Vitamins

Topics: Ascorbic Acid; Glycosaminoglycans; Guinea Pigs; Mast Cells; Polysaccharides; Scurvy; Skin; Skin Physiological Phenomena; Vitamins; Wound Healing; Wounds and Injuries

Topics: Arthralgia; Ascorbic Acid; Child; Humans; Infant; Penicillins; Scurvy; Syphilis; Syphilis, Congenital; Vitamins

Topics: Ascorbic Acid; Biometry; Child; Humans; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Biotin; Dehydroascorbic Acid; Guinea Pigs; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Dehydroascorbic Acid; Guinea Pigs; Scurvy; Thiamine

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Folic Acid; Guinea Pigs; Humans; Scurvy; Vitamins

Topics: 4-Aminobenzoic Acid; Ascorbic Acid; Ascorbic Acid Deficiency; Guinea Pigs; Scurvy; Vitamins

Topics: Animals; Ascorbic Acid; Cortisone; Guinea Pigs; Scurvy

Topics: Ascorbic Acid; Aspirin; Cortisone; Scurvy; Tooth; Vitamins

Topics: Ascorbic Acid; Carbohydrate Metabolism; Dehydroascorbic Acid; Glutathione; Guinea Pigs; Scurvy

Topics: Ascorbic Acid; Berberis; Flavoring Agents; Fruit; History, 16th Century; History, 17th Century; History, 18th Century; Ligustrum; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Food; Greenland; Humans; Scurvy

Topics: Ascorbic Acid; Blood; Bone and Bones; Growth; Humans; Phosphoric Monoester Hydrolases; Scurvy; Vitamins

Topics: Ascorbic Acid; Blood Proteins; Glycoproteins; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Avitaminosis; Diet; Dietetics; Fetus; Humans; Nutritional Sciences; Nutritional Status; Scurvy; Vitamins

Topics: Adrenal Glands; Ascorbic Acid; Cholesterol; Guinea Pigs; Scurvy; Vitamins

Topics: Adrenocorticotropic Hormone; Animals; Ascorbic Acid; Cortisone; Guinea Pigs; Scurvy; Vitamins; Wound Healing; Wounds and Injuries

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Animals; Ascorbic Acid; Folic Acid; Folic Acid Deficiency; Scurvy; Tracheophyta

Topics: Androgens; Ascorbic Acid; Avitaminosis; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Female; Humans; Milk, Human; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Deficiency Diseases; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Humans; Peritoneum; Peritonitis, Tuberculous; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Capillaries; Cardiovascular System; Diffusion; Humans; Scurvy; Vitamins

Topics: Adrenal Cortex; Ascorbic Acid; Cortisone; Desoxycorticosterone; Scurvy; Tissue Extracts; Vitamins

Topics: Ascorbic Acid; Brassica; Brassicaceae; Scurvy; Vitamins

Topics: Ascorbic Acid; Calcification, Physiologic; Calcinosis; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Hernia, Diaphragmatic; Hernia, Hiatal; Humans; Scurvy

Topics: Accidents; Ascorbic Acid; Health Services Needs and Demand; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Capillaries; Cardiovascular System; Humans; Scurvy; Vitamins

Topics: Ascorbic Acid; Scurvy

Topics: Ascorbic Acid; Humans; Scurvy; Vitamin B Complex; Vitamins

Topics: Ascorbic Acid; Fusobacterium Infections; Gingivitis, Necrotizing Ulcerative; Scurvy; Vitamins

Topics: Alanine; Animals; Ascorbic Acid; Carbohydrate Metabolism; Dihydroxyphenylalanine; Guinea Pigs; Kidney; Liver; Metabolism; Scurvy

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Folliculitis; Humans; Scurvy; Vitamin A; Vitamins

Topics: Adrenal Glands; Ascorbic Acid; Carbohydrate Metabolism; Epinephrine; Humans; Scurvy; Tissue Extracts

Topics: Ascorbic Acid; Humans; Scurvy; Vertigo

Topics: Ascorbic Acid; Humans; Scurvy

Topics: Ascorbic Acid; Blood; Hematologic Tests; Humans; Intradermal Tests; Scurvy; Vitamins

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Carbohydrate Metabolism; Carbohydrates; Guinea Pigs; Hypoxia; Oxygen; Scurvy

Topics: Ascorbic Acid; Humans; Scurvy

Topics: Ascorbic Acid; Humans; Scurvy