Tooth wear as a result of pica

Surviving Critical Low Hemoglobin Levels and Pica

Iron deficiency is the most common nutritional deficiency. Pica is commonly associated with iron deficiency anemia (IDA). A case of a 40-year-old female who presented with a critical record of low hemoglobin (Hgb) (1.6 g/dL) with severe iron deficiency and pica with no lasting deficits despite such low hemoglobin is discussed in this article. The patient presented to the emergency room with complaints of weight loss, weakness, palpitation, fatigue, dysphagia, and on-and-off vomiting for about a year and severe menorrhagia for about one and a half years. She also has had pica for the past several years where she eats and chews toilet paper. Several of her female family members also have pica. She was found to have critically low hemoglobin of 1.6 g/dL and serum iron of 8 ug/dL and ferritin of less than 1 ng/mL. The patient was treated with six units of packed red blood cells and IV and oral iron supplementation. She was discharged with a hemoglobin of 7.3 g/dL. She was later found to have a 9.6 cm uterine mass that is consistent with leiomyoma (fibroid) in transvaginal ultrasound and is following up with a gynecologist for the definitive management. She did not have lasting deficits from the critically low hemoglobin and has stopped engaging in pica behavior.

Geophagic Materials Characterization and Potential Impact on Human Health: The Case Study of Maputo City (Mozambique)

This study aims to characterize and estimate risk assessment associated with geophagic materials consumption in Maputo city (Mozambique). Samples were collected in extraction mines, unprepared and prepared ones, and in Maputo markets. Fractions < 2 mm (total consumed material) and <63 μm were analyzed to determine pH, EC, OM, chemical composition (XRF), and mineral phases present (XRD). The results revealed pH from slightly acidic to slightly alkaline, and electrical conductivity ranging from 13 to 47 μS/cm in mine unprepared and prepared samples, while 264–465 μS/cm in sampled sold in markets. Organic matter content was <2.76%, except in one sample (8.14%), suggesting a potential risk of containing bacteria. Textural analysis revealed that sand-size particles were more representative in all samples (57.2–93.02%). Mineralogical phases identified in the consumed sample were ranked quartz (>60%) > Fe oxides/hidroxides > phyllosilicates (micas and kaolinite) > feldspars, suggesting a risk of dental enamel damage and perforation of the sigmoid colon. The chemical concentration of some elements was higher than recommended daily dose, suggesting a potential risk. However, geophagic materials’ chemical composition does not pose a carcinogenic risk.

Pica in Pediatric Sickle Cell Disease

Pica is the developmentally inappropriate consumption of non-nutritive items for at least one month. Pica can lead to many adverse outcomes, but the exact pathophysiology of pica is unknown or variable across populations. Several studies have evidenced that there is a high prevalence of pica among youth with sickle cell disease (SCD). However, the lack of knowledge regarding the correlates of pica contributes to overlooking the condition, inaccurate diagnoses, and a lack of evidence-based treatments once pica is identified. This review examines the literature to develop a biopsychosocial model of pica in SCD. Elucidating the potential relationships among the proposed biological, psychological, and social factors, and pica will inform our understanding of this phenomenon in pediatric SCD and may guide future research and clinical recommendations.

Demographic, clinical, and biochemical predictors of pica in a large cohort of blood donors

BACKGROUND

Pica is characterized as repeatedly eating or chewing a non-nutritious substance including, but not limited to ice, clay and dirt, starch, raw pasta, chalk, coal, paint, or paper. Pica symptoms can be intense and addiction-like and disrupt quality of life. It is strongly linked to iron deficiency. Since substantial iron loss occurs during blood donation, blood donors may be susceptible to development of pica behaviors.

METHODS

We investigated demographic, clinical, hematological, and biochemical factors associated with pica using univariable and multivariable logistic regression analysis in a cohort of 11,418 racially diverse blood donors. Pica was defined by questionnaire responses as consuming at least 8 oz of ice daily and/or consumption of non-ice substances regardless of the amount and frequency.

RESULTS

Pica was present in 2.2% of the donors. The sensitivity and specificity of pica in iron-deficient donors were 36% and 82%, respectively. Lower ferritin (p = .001), non-Asian race (p < .001), higher red cell distribution width (p < .001), younger age, and restless legs syndrome (p = .008) were independently associated with pica. Female sex is associated with iron deficiency but was not an independent predictor of pica suggesting that iron deficient males and females were equally susceptible to the development of pica behaviors. Donors with normal ferritin levels also reported pica, reinforcing the role of non-iron related factors in its presentation.

CONCLUSIONS

We have identified demographic, clinical, and biochemical predictors of pica that help identify those most at risk for developing pica behaviors, and thereby assist in its clinical diagnosis and treatment.

The geochemistry of geophagic material consumed in Onangama Village, Northern Namibia: a potential health hazard for pregnant women in the area

Ingestion of geophagic materials might affect human health and induce diseases by different ways. The purpose of this study is to determine the geochemical composition of geophagic material consumed especially by pregnant women in Onangama Village, Northern Namibia and to assess its possible health effects. X-ray fluorescence and inductively coupled plasma mass spectrometry were used in order to determine the major, and trace elements as well as anions concentrations of the consumed material. The geochemical analysis revealed high concentrations of aluminium (Al), calcium (Ca), iron (Fe), magnesium (Mg), manganese (Mn), potassium (K), sodium (Na), and silica (Si); and trace elements including arsenic (As), chromium (Cr), mercury (Hg), nickel (Ni) and vanadium (V) as well as sulphate (SO₄^2-), nitrate (NO₃^-), and nitrite (NO₂^-) anions comparing to the recommended daily allowance for pregnant women. The pH for some of the studied samples is alkaline, which might increase the gastrointestinal tract pH (pH < 2) and cause a decrease in the bioavailability of elements. The calculated health risk index (HRI > 1) revealed that Al and Mn might be a potential risk for human consumption. Based on the results obtained from the geochemical analysis, the consumption of the studied material might present a potential health risk to pregnant women including concomitant detrimental maternal and foetal effects.

Pica: A Common Condition that is Commonly Missed - An Update Review

BACKGROUND

Pica is a common condition in childhood that is commonly missed.

OBJECTIVE

To familiarize physicians with the clinical evaluation and management of children with pica.

METHODS

A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated.

CONCLUSION

Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.

Effect of dried sunflower seeds on incisal edge abrasion: A rare case report

Tooth surface loss (TSL) is a complex phenomenon characterized by the loss of hard tooth structure at various locations of the teeth, usually due to more than one factor. TSL due to abrasion can be significant in patients consuming coarse, abrasive diet. The present case reports an interesting incisal edge abrasion in a female patient, attributed to a particular dietary behavior of long-term consumption of sunflower seeds. All her family members and most of the people from her native place were also reported to have similar lesions by the patient. Larger epidemiological studies to assess the prevalence and severity of such abrasive lesions in geographic areas with this particular dietary habit need to be carried out so that people may be made aware and educated about alternative ways of eating sunflower seeds that will not cause any form of tooth wear.

Is Pica under-reported in children with sickle cell disease? A pilot study in a Belgian cohort

BACKGROUND

For centuries, writers have recorded their observations on pica. Nevertheless the association of pica with sickle cell disease (SCD) was poorly documented.

METHODS

Cross-sectional evaluation performed on SCD children and caregivers attending the outpatient clinic who were invited to complete questionnaires assessing behavior of pica.

RESULTS

Out of 55 sickle cell children, 31(56.4%) reported practicing pica regularly. Substances ingested by patients covered a broad spectrum. Compared with the non-pica group, subjects who reported pica were younger and had lower hemoglobin (8.3 g/dl (7.6-9.7) vs. 9.1 g/dl (7.9-10.5): P < 0.01). The level of ferritin, zinc, copper, and lead was similar between the pica and non-pica groups (P > 0.05). Discussion In this series, there are many substances consumed by SCD children and adolescents, and we did not find an occurrence of similar substances among this select group. Pica children were younger and more anemic than non-pica patients.

CONCLUSION

This study suggests that pica remains an unknown and under-reported clinical problem in children with SCD and seems to be related to the severity of anemia. The next step of this project aims to clarify causal mechanisms for pica and its association with SCD in a larger population.

Pica in children with sickle cell disease: two case reports

Children with sickle cell disease (SCD) are at greater risk for developing pica compared to other children. This comorbidity can result in harmful medical and nutritional, and neurodevelopmental consequences. This article will describe the medical, nutritional, and psychosocial functioning in two children with SCD and pica in order to illustrate the potential complications and correlates of this co-morbidity. In addition, the clinical implications of pica in children with SCD will be discussed.

Geophagy during pregnancy in Africa: a literature review

INTRODUCTION

Geophagy is a form of pica characterized by craving and eating of soil. The main materials ingested include anthill soils and soft stone. In this review, our objectives were to study the prevalence of geophagy in pregnancy (GiP), establish the risk factors for GiP, assess the effects of GiP on pregnancy outcomes, and recommend possible interventions for reducing GiP.

PREVALENCE

Geophagy among pregnant women is common in many cultures. In some African countries, GiP prevalence of up to 84% has been observed. In Nigeria, the most populous country in Africa, the prevalence of GiP is estimated at 50%. The practice has been associated with religious practice, culture, and famine.

RISKS

It is postulated that GiP is due to micronutrient deficiencies, cultural influences, and gastrointestinal upsets. Despite their potential to supply micronutrients, soils interfere with bioavailability of micronutrients leading to micronutrient deficiency and can also act as a pathway for ingestion of geohelminths and heavy metals, putting woman and fetus at risk. GAPS: Despite its association with anemia, pregnancy, and micronutrients, many antenatal care guidelines or National guidelines on micronutrient deficiency control are silent on GiP. The guidelines generally recommend iron supplementation and deworming of pregnant women as anemia control measures. However, not all women seek antenatal services; hence, there is need for more innovative ways of addressing micronutrient deficiencies in pregnancy.

RECOMMENDATIONS

It is imperative to enquire whether pregnant women are geophagous and discourage geophagy, strengthen and expand the existing supplementation programs, and mandate flour fortification to enhance population-wide iron supply and safer pregnancies.

TARGET AUDIENCE

Obstetricians & Gynecologists and Family Physicians.

LEARNING OBJECTIVES

After completing this CME activity, physicians should be better able to analyze the prevalence of GiP, identify the risk factors for GiP, and assess the effects of GiP on pregnancy outcomes. In addition to propose remedial interventions for reducing GiP.

Pica in iron deficiency: a case series

INTRODUCTION

Pica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported.

CASE PRESENTATION

We describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia.

CONCLUSION

Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, were aware of the importance of their pica related symptoms. Pica symptoms abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. We believe pica is an important sign of iron deficiency that should never be ignored, and the craving for any unusual substance should compel clinicians to search for occult blood loss with secondary iron deficiency.