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Reikersdorfer KN, Singh A, Young JD, Batty MB, Steele AE, Yuen LC, Momtaz DA, Weissert JN, Liu DS, Hogue GD. The Troubling Rise of Scurvy: A Review and National Analysis of Incidence, Associated Risk Factors, and Clinical Manifestations. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00012. [PMID: 39018570 PMCID: PMC11251681 DOI: 10.5435/jaaosglobal-d-24-00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION In the era of modern medicine, scurvy has been thought of as a rare disease of ancient times because of improved emphasis on diet and nutrition; however, isolated case reports are plentiful. This investigation presents a comprehensive review of scurvy, including an analysis on its rising incidence, with specific focus on its orthopaedic manifestations and commonly associated diagnoses. METHODS This comprehensive review includes a retrospective analysis of 19,413,465 pediatric patients in the National Inpatient Sample database from 2016 through 2020. Patients with scurvy were identified by the ICD-10 code, and an estimated incidence of scurvy in the inpatient pediatric population was calculated. Concurrent diagnoses, musculoskeletal reports, and demographic variables were collected from patient records. Comparisons were made using analysis of variance or chi-square with Kendall tau, where appropriate. RESULTS The incidence of scurvy increased over the study period, from 8.2 per 100,000 in 2016 to 26.7 per 100,000 in 2020. Patients with scurvy were more likely to be younger (P < 0.001), male (P = 0.010), in the lowest income quartile (P = 0.013), and obese (P < 0.001). A majority (64.2%) had a concomitant diagnosis of autism spectrum disorder. Common presenting musculoskeletal reports included difficulty walking, knee pain, and lower limb deformity. Burden of disease of scurvy was markedly greater than that of the average inpatient population, with these patients experiencing greater total charges and longer hospital stays. CONCLUSION Clinicians should be aware of the increasing incidence of scurvy in modern medicine. In cases of vague musculoskeletal reports without clear etiology, a diagnosis of scurvy should be considered, particularly if risk factors are present. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Kristen N. Reikersdorfer
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Aaron Singh
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Jason D. Young
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Miles B. Batty
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Amy E. Steele
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Leslie C. Yuen
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - David A. Momtaz
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Joleen N. Weissert
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - David S. Liu
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Grant D. Hogue
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
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Lešić S, Ivanišević Z, Špiljak B, Tomas M, Šoštarić M, Včev A. The Impact of Vitamin Deficiencies on Oral Manifestations in Children. Dent J (Basel) 2024; 12:109. [PMID: 38668021 PMCID: PMC11049216 DOI: 10.3390/dj12040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/29/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Vitamins play a vital role in human health, particularly in the development and maintenance of oral health in children. These nutrients are broadly categorized into fat-soluble and water-soluble types, crucial for children's well-being. The objective of this study is to investigate the impact of vitamin deficiencies on the oral health of children, focusing on how these deficiencies contribute to various oral health issues and determining the relationship between specific vitamin shortages and oral diseases. Findings indicate that shortages in vitamins A and D lead to enamel issues and a higher susceptibility to dental diseases, vitamin E assists in treating oral mucositis, and vitamin K is essential for blood clotting in dental surgeries. Deficits in B-complex and vitamin C result in enamel hypomineralization and soft tissue ailments, including aphthous stomatitis and gingival petechiae. Additionally, a lack of vitamin B7 compromises the immune response, increasing oral candidiasis risk. Therefore, vitamin deficiencies markedly affect children's oral health, highlighting the need for joint efforts between dental professionals and caregivers for effective pediatric care. Addressing vitamin deficiencies through supplementation and tailored dental care emphasizes the significance of nutritional health in children's overall and dental well-being, advocating for a collaborative approach to achieve optimal health outcomes.
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Affiliation(s)
- Stjepanka Lešić
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia; (S.L.); (Z.I.)
| | - Zrinka Ivanišević
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia; (S.L.); (Z.I.)
| | - Bruno Špiljak
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Matej Tomas
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia; (S.L.); (Z.I.)
| | - Magdalena Šoštarić
- Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Aleksandar Včev
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia;
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Golder JE, Bauer JD, Barker LA, Lemoh CN, Gibson SJ, Davidson ZE. Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review. Nutr Rev 2024:nuad157. [PMID: 38219216 DOI: 10.1093/nutrit/nuad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVES In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHODS A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. RESULTS Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P = 0.031) (n = 160). CONCLUSIONS VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).
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Affiliation(s)
- Janet E Golder
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Nutrition and Dietetics Department, Allied Health, Monash Health, Melbourne, Victoria, Australia
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa A Barker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher N Lemoh
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne, Victoria, Australia
| | - Simone J Gibson
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Simonit R, Maudet S, Giuffra V, Riccomi G. Infantile scurvy as a consequence of agricultural intensification in the 1st millennium BCE Etruria Campana. Sci Rep 2023; 13:21396. [PMID: 38049537 PMCID: PMC10696072 DOI: 10.1038/s41598-023-48455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023] Open
Abstract
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.
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Affiliation(s)
- Rachele Simonit
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulia Riccomi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Bhattacharyya P, Schemann K, Min SS, Sullivan DR, Fuller SJ. Serum vitamin C status of people in New South Wales: retrospective analysis of findings at a public referral hospital. Med J Aust 2023; 219:475-481. [PMID: 37875282 DOI: 10.5694/mja2.52132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/11/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To examine the relationship between vitamin C status and demographic factors in New South Wales on the basis of serum vitamin C test results undertaken at the central pathology laboratory in Sydney, and to assess associations with age, gender, social disadvantage, and geographic remoteness. DESIGN, SETTING Retrospective observational study; analysis of vitamin C test results undertaken at the Royal Prince Alfred Hospital, 1 January 2017 - 31 December 2021. MAIN OUTCOME MEASURES Vitamin C status (normal, serum concentration ≥ 40 μmol/L; hypovitaminosis C, 12-39 μmol/L; significant deficiency, < 12 μmol/L); associations of vitamin C status with year of testing, age, gender, socio-economic status (Index of Relative Socio-Economic Advantage and Disadvantage quintile), and geographic remoteness (Australian Statistical Geography Standard); rate of hypovitaminosis C or significant deficiency test results (relative to findings of normal levels; per 100 000 estimated resident population) by Statistical Area 3. RESULTS Of 17 507 vitamin C tests undertaken during 2017-2021, 4573 were excluded (multiple tests for individuals); of 12 934 included results, 6654 were for women (51.5%), 9402 for people living in major cities (73.5%), and 81 for people in remote or very remote areas (0.6%). In multivariable multinomial regression analyses, significant deficiency (relative to normal test results) was more likely for men than women (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.27-1.52); the likelihood of hypovitaminosis C (IRSAD quintile 1 v 5, aOR, 1.35; 95% CI, 1.19-1.53) or significant deficiency (aOR, 2.07; 95% CI, 1.79-2.40) generally increased with postcode-level socio-economic disadvantage. Several of the population areas with the highest low vitamin C rates were areas of greatest disadvantage in NSW. CONCLUSIONS The prevalence of vitamin C deficiency among older people and people living in areas of socio-economic disadvantage indicates that population assessment of vitamin C levels would be appropriate.
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Affiliation(s)
- Puja Bhattacharyya
- Sydney Medical School, the University of Sydney, Sydney, NSW
- Blacktown Hospital, Blacktown, NSW
| | | | - San San Min
- Royal Prince Alfred Hospital, Sydney, NSW
- NSW Health Pathology, Sydney, NSW
| | - David R Sullivan
- Royal Prince Alfred Hospital, Sydney, NSW
- NSW Health Pathology, Sydney, NSW
| | - Stephen J Fuller
- Sydney Medical School, the University of Sydney, Sydney, NSW
- Nepean Hospital, Penrith, NSW
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6
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Kinlin LM, Weinstein M. Scurvy: old disease, new lessons. Paediatr Int Child Health 2023; 43:83-94. [PMID: 37795755 DOI: 10.1080/20469047.2023.2262787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Scurvy, the condition associated with severe vitamin C deficiency, is believed to be one of the oldest diseases in human history. It was particularly prevalent during the Age of Sail, when long sea voyages without access to fresh food resulted in an epidemic which claimed millions of lives; however, scurvy has existed across time and geography, occurring whenever and wherever diets are devoid of vitamin C. Young children, specifically, were affected by the emergence of 'infantile scurvy' in the 19th century owing to the use of heated milk and manufactured infant foods of poor nutritional quality. Scurvy continues to occur in at-risk groups. In children and youths, it is primarily observed in the context of autism spectrum disorder and feeding problems such as a limited food repertoire and high-frequency single food intake. Diagnosis may be delayed and invasive testing undertaken owing to clinicians' lack of familiarity with the disease, or the mistaken assumption that it is exclusively a disease of the past. The aetiology, clinical manifestations and treatment of scurvy are described. Its long history and current epidemiology are also reviewed, demonstrating that scurvy is very much a disease of the present. It is suggested that future efforts should focus on (i) anticipatory guidance and early nutritional intervention, informed by an understanding of scurvy's epidemiology, with the aim of preventing the disease in those at risk, and (ii) prompt recognition and treatment to minimise morbidity and healthcare costs.Abbreviations: ASD: autism spectrum disorder.
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Affiliation(s)
- Laura M Kinlin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Weinstein
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Robin CJ, Robin KJ, Maier MA, Stevens ES. A Rare Presentation of Scurvy in a Well-Nourished Patient. Cureus 2023; 15:e46379. [PMID: 37927702 PMCID: PMC10620061 DOI: 10.7759/cureus.46379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Vitamin C deficiency, otherwise known as scurvy, is a rare diagnosis among populations with adequate nutritional resources. We present a 37-year-old female patient with bilateral lower extremity edema, episodic anasarca, petechiae, and easy bruising who was diagnosed with scurvy. Given the clinical presentation, a broad differential was investigated with no findings suggestive of hematologic or cardiovascular pathology. Initial laboratory studies were unremarkable. Progression of cutaneous symptoms and subsequent laboratory findings demonstrating low vitamin C levels supported a diagnosis of scurvy. Classical symptoms of scurvy include mucocutaneous petechiae, poor wound healing, ecchymosis, hyperkeratosis, corkscrew hair, gingival swelling, and bleeding gums. Following standard enteral supplementation of vitamin C, repeat vitamin C levels failed to adequately respond with the patient remaining to be symptomatic. Given a lack of insufficient nutritional intake or known systemic illness, gastrointestinal malabsorptive etiology was suspected. Though rare in the United States, scurvy should be considered in patients with manifestations of a bleeding disorder. A gastrointestinal workup may be indicated if other nutritional deficiencies are identified, or a source of inadequate intake cannot be established.
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Affiliation(s)
- Connor J Robin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Kaleb J Robin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Mark A Maier
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Elyse S Stevens
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
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Newsom NR, Kara A, Ladd L. Musculocutaneous manifestations of scurvy. BMJ Case Rep 2023; 16:e253648. [PMID: 37567736 PMCID: PMC10423777 DOI: 10.1136/bcr-2022-253648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Nicholas Ryan Newsom
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Areeba Kara
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lauren Ladd
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Shaw D, Fozdar S, Owen C. Purpuric rash on the lower legs. BMJ 2023; 381:e075249. [PMID: 37348904 DOI: 10.1136/bmj-2023-075249.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Daniel Shaw
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Siddiq Fozdar
- Haslingden Healthcare, Haslingden, Rossendale, Lancashire, UK
| | - Caroline Owen
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
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Mirza A, Bitar J, Simoncini A, Olanrewaju A. The Curious Case of a Boy Who Could Not Walk: A Case Report. Clin Pediatr (Phila) 2023; 62:55-58. [PMID: 35822848 DOI: 10.1177/00099228221110120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aymen Mirza
- Department of Pediatrics, Louisiana State University-Shreveport, Shreveport, LA, USA
| | - Joyce Bitar
- Metropolitan New York Health and Hospital, New York City, NY, USA
| | - Alberto Simoncini
- Department of Radiology, Louisiana State University-Shreveport, Shreveport, LA, USA
| | - Adijat Olanrewaju
- Department of Pediatrics, Louisiana State University-Shreveport, Shreveport, LA, USA
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Unveiling the nature of interactions in the supramolecular complex of Cucurbit [7-8] uril with ascorbic acid, dopamine and uric acid for biosensing applications: a computational study. Struct Chem 2022. [DOI: 10.1007/s11224-022-01945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Trapani S, Rubino C, Indolfi G, Lionetti P. A Narrative Review on Pediatric Scurvy: The Last Twenty Years. Nutrients 2022; 14:nu14030684. [PMID: 35277043 PMCID: PMC8840722 DOI: 10.3390/nu14030684] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Sandra Trapani
- Pediatric Unit, Department of Health Sciences, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy
- Correspondence: ; Tel.: +39-055-5662480
| | - Chiara Rubino
- Pediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50137 Florence, Italy;
| | - Giuseppe Indolfi
- Pediatric Unit, Department of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
| | - Paolo Lionetti
- Gastroenterology Unit, Department of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
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Masci D, Rubino C, Basile M, Indolfi G, Trapani S. When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital. Front Pediatr 2022; 10:981908. [PMID: 36186634 PMCID: PMC9519129 DOI: 10.3389/fped.2022.981908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The limping child frequently represents a diagnostic challenge. The differential diagnosis is broad and should include vitamin C deficiency. Scurvy, resulting from vitamin C deficiency, is the oldest-known nutritional disorder. Despite its rarity in developed countries, scurvy has been increasingly reported in recent years in pediatric patients, particularly those with autism or neurological disabilities. In the present retrospective study, we describe the clinical, laboratory, and radiological features of 8 patients diagnosed with scurvy in the Pediatrics Unit of Meyer Children's University Hospital, between January 2016 and December 2021. The majority (87%) were males, and the median age was 3.7 years. Half of the patients had comorbidities known to be risk factors for scurvy, while the remaining patients were previously healthy. All the children were admitted for musculoskeletal symptoms, ranging from lower limb pain (87%) to overt limping (87%). Mucocutaneous involvement was observed in 75% cases. Microcytic anemia and elevated inflammatory markers were common laboratory findings. Bone radiographs, performed on all patients, were often interpreted as normal at first, with osteopenia (62%) as the most frequent finding; notably, after re-examination, they were reported as consistent with scurvy in four patients. The most common magnetic resonance imaging findings were multifocal symmetrical increased signal on STIR sequence within metaphysis, with varying degrees of bone marrow enhancement, adjacent periosteal elevation and soft tissue swelling. Differential diagnosis was challenging and frequently required invasive diagnostic procedures like bone marrow biopsy, performed in the first three patients of our series. The median time frame between clinical onset and the final diagnosis was 35 days. Notably, the interval times between admission and diagnosis become progressively shorter during the study period, ranging from 44 to 2 days. Treatment with oral vitamin C led to improvement/resolution of symptoms in all cases. In conclusion, scurvy should be considered in the differential diagnosis in a limping child, performing a detailed dietary history and careful physical examination, looking for mucocutaneous lesions. A quick and correct diagnostic path avoids invasive diagnostic procedures and reduces the risk of long-term complications.
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Affiliation(s)
- Daniela Masci
- Post-graduate School of Pediatrics, University of Florence, Florence, Italy
| | - Chiara Rubino
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Massimo Basile
- Radiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Giuseppe Indolfi
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.,Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, Meyer Children's University Hospital, University of Florence, Florence, Italy
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Moya-Martínez C, Haya-Martínez L, Fuertes-Vega L, Santonja C, Requena L. Co-occurring features of scurvy and phrynoderma in the same patient. JAAD Case Rep 2021; 19:14-17. [PMID: 34901361 PMCID: PMC8640163 DOI: 10.1016/j.jdcr.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Lara Haya-Martínez
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Fuertes-Vega
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Santonja
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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15
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Byard RW. Casper's sign in the elderly. MEDICINE, SCIENCE, AND THE LAW 2021; 61:309-312. [PMID: 34018856 DOI: 10.1177/00258024211015096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Casper's sign refers to the absence of external signs of trauma despite severe and often lethal internal injuries. It occurs because the elasticity and resilience of the skin results in it deforming and moving rather than sustaining injuries from being tethered and relatively immobile. Given the known increase in skin and soft-tissue fragility in the elderly with a greater vulnerability for bruising and skin tears, a study was undertaken to determine whether Casper's sign may be present or not in older populations. A review of autopsy files at Forensic Science SA over a 20-year period from January 2000 to December 2019 was performed in individuals ≥80 years of age where death involved blunt chest trauma, blunt abdominal trauma or multiple blunt-force injuries. Four cases were identified. All of the decedents were males aged 82-89 years (Mage=86 years) with deaths associated with a fall (n=1) and vehicle impacts (n=3). Despite significant and often lethal internal chest/abdominal injuries, none of the cases had external injuries to their torsos. Thus, as Casper's sign may be present at all ages, the absence of external injury in the elderly may be no reflection of the force of the impact or the degree of resultant skeletal and/or internal organ disruption. This may be pertinent in cases of elder abuse.
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Affiliation(s)
- Roger W Byard
- Adelaide Medical School, The University of Adelaide, Australia
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Pappan N, Sarma D, Rabe T, Petroccione R. Identifying Social Determinants of Health Leads to the Diagnoses of Scurvy in the Developed World. Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1215-1217. [PMID: 33681707 PMCID: PMC7910790 DOI: 10.1007/s42399-021-00834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 12/03/2022]
Abstract
Identifying social determinants of health can help diagnose certain nutritional deficiencies. By overcoming these barriers, we can prevent future hospitalizations and better public health. We present a unique case where a 46-year-old man presents with bilateral lower extremity swelling secondary to vitamin C deficiency. Throughout history taking, his social determinants of health were identified and he was diagnosed with scurvy from the suspected poor nutritional intake. His poor nutritional intake could have resulted from a lack of financial stability and a harsh home environment. This case is evidence that social determinants of health can directly impact a patient’s well-being, and as physicians, we need to identify them to provide the most resources we can to help improve patient care. This in turn can decrease unnecessary emergency room visits and hospitalizations.
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Ganske A, Kolbe AB, Thomas K, Hull N. Pediatric scurvy MRI appearance. Radiol Case Rep 2021; 16:1148-1152. [PMID: 33747331 PMCID: PMC7960501 DOI: 10.1016/j.radcr.2021.02.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022] Open
Abstract
We present a rare case of pediatric scurvy in a 9-year-old male who presented with nontraumatic knee pain. MRI was obtained due to the puzzling presentation. MRI demonstrated a systemic bone marrow abnormality which led to a conversation with the clinician and further elucidation of an extremely narrow diet lacking sufficient vitamin C (ascorbic acid). Diagnosis was confirmed biochemically with undetectable ascorbic acid level and clinically with compatible exam and history. This case highlights a thought process for unexpected bone marrow abnormality on MRI.
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Affiliation(s)
- Alec Ganske
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Amy B Kolbe
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Kristen Thomas
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Nathan Hull
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
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Furkan M, Khan RH. Process, Outcomes and Possible Elimination of Aggregation with Special Reference to Heme Proteins; Likely Remediations of Proteinopathies. Curr Protein Pept Sci 2021; 21:573-583. [PMID: 32013844 DOI: 10.2174/1389203721666200204122732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 01/13/2023]
Abstract
Protein folding is a natural phenomenon through which a linear polypeptide possessing necessary information attains three-dimension functionally active conformation. This is a complex and multistep process and therefore, the presence of several intermediary structures could be speculated as a result of protein folding. In in vivo, this folding process is governed by the assistance of other proteins called molecular chaperones and heat shock proteins. Due to the mechanism of protein folding, these intermediary structures remain major challenge for modern biology. Mutation in gene encoding amino acid can cause adverse environmental conditions which may result in misfolding of the linear polypeptide followed by the formation of aggregates and amyloidosis. Aggregation contributes to the pathophysiology of several maladies including diabetes mellitus, Huntington's and Alzheimer's disease. The propensity of native structure to form aggregated and fibrillar assemblies is a hallmark of amyloidosis. During aggregation of a protein, transition from α helix to β sheet is observed, and mainly β sheeted structure is visualised in a mature fibril. Heme proteins are very crucial for major life activities like transport of oxygen and carbon dioxide, synthesis of ATP, role in electron transport chain, and detoxification of free radicals formed during biochemical reactions. Any structural variation in the heme proteins may lead to a fatal response. Hence characterization of the folding intermediates becomes crucial. The characterization has been deciphered with the help of strong denaturants like acetonitrile and TFE. Moreover, possible role of elimination of these aggregates and prevention of protein denaturation is also discussed. Current review deals with the basic process and mechanism of the protein folding in general and the ultimate outcomes of the protein misfolding. Since Native conformation of heme proteins is essential for some vital activities as listed above, we have discussed possible prevention of denaturation and aggregation of heme proteins such as Hb, cyt c, catalase & peroxidase.
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Affiliation(s)
- Mohammad Furkan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University Aligarh, UP, 202002, India
| | - Rizwan Hasan Khan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University Aligarh, UP, 202002, India
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Guellich A, Tella E, Mahé E. [Scurvy presenting with low-extremity necrotic and purpuric ulcers: Two cases]. Rev Med Interne 2020; 42:214-217. [PMID: 33203540 DOI: 10.1016/j.revmed.2020.10.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scurvy is a clinical syndrome resulting from ascorbic acid deficiency. Although presently rare in the developed world, it continues to occur within certain susceptible populations, particularly the elderly and those with dietary habits with low vitamin C intake. CASES Two men aged 87 and 69 were referred with multifactorial, progressive ulceration of the lower limbs, without scarring, in a context of arterial disease and other associated comorbidities. In both cases, the level of vitamin C was undetectable. An improvement in the necrotic component and in the purpura was promptly observed after vitamin C supplementation. CONCLUSIONS Diagnosis of scurvy can be challenging. This report highlights the importance of maintaining a high index of suspicion for scurvy in atypical necrotic ulcerations of lower extremities with poor response to standard therapy especially in populations at high risk of vitamin C deficiency. Early diagnosis can improve patient prognosis.
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Affiliation(s)
- A Guellich
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - E Tella
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - E Mahé
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France.
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20
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Byard RW. Death in the Arctic - the tragic fate of members of the Franklin expedition (1845). Forensic Sci Med Pathol 2020; 17:161-166. [PMID: 32845447 DOI: 10.1007/s12024-020-00305-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 01/01/2023]
Abstract
In May 1845 HMS Terror and HMS Erebus left England under the command of Sir John Franklin to find the Northwest Passage linking the north Atlantic and Pacific Oceans. The ships had been specially equipped for arctic conditions with central heating, auxiliary steam engines and reinforced steel bows to cut through the ice, however, despite these modern additions neither the vessels nor any of the 129 crew members would ever return. Recently the wrecks of the ships have been located in the waters around King William Island, Nunavut, Canada. Numerous theories have been advanced to explain the deaths that involve lead poisoning, scurvy and zinc deficiency. It is most likely, however, that the deaths were the result of multiple factors such as starvation, hypothermia, infection and general physical and mental decline. Cannibalism occurred but whether this involved the use of already dead sailors or the culling of the weak for food is not determinable. The essential point is that the crews were trapped in the Arctic, many thousands of miles from their homes and families, with dwindling food supplies and minimal chances of rescue.
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Affiliation(s)
- Roger W Byard
- Adelaide School of Medicine, The University of Adelaide, Level 2 Helen Mayo North Building, Frome Road, Adelaide, SA, 5005, Australia.
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21
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Charlier P, Augias A, Benmoussa N, Rainsard P, Froesch P, Richardin P, Froment A, Bianucci R, Appenzeller O, Perciaccante A, Lippi D, Prades L. The mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:172-174. [PMID: 31185300 DOI: 10.1016/j.jormas.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/19/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recent paleopathological cases have shown the usefulness of interdisciplinary odontological studies in the investigation of historical figures. OBSERVATION A macroscopic examination of the mandible of Saint-Louis (13th c. AD), conserved in the cathedral of Notre-Dame (Paris, France) was carried out, and compared with biographical data about the life and death of the King, and contemporaneous cases of infectious/inflammatory diseases. We found post-mortem tooth loss associated with moderate signs of infectious and inflammatory diseases, which precise diagnoses are discussed facing historical chronicles and sources: main diagnosis is scurvy, potentially associated with bacterial infection. DISCUSSION Our results support the identification of the relics, and improve the knowledge about the saint's circumstances of death related to metabolic deficiencies and infections.
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Affiliation(s)
- P Charlier
- Musée du quai Branly-Jacques-Chirac, 222, rue de l'Université, 75007 Paris, France; UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France.
| | - A Augias
- UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - N Benmoussa
- UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - P Rainsard
- UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | | | - P Richardin
- Centre de restauration et de recherche des musées de France, Paris, France
| | - A Froment
- National Museum of Natural History, Paris, France
| | - R Bianucci
- Legal Medicine Section, Department of Public Health and Pediatric Sciences, University of Turin, Italy
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361, Big Horn Ridge Dr. NE, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801, Mountain Road NW, Albuquerque, NM, USA
| | - A Perciaccante
- Department of Medicine, "San Giovanni di Dio" Hospital, Gorizia, Italy
| | - D Lippi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - L Prades
- Cathedral of Notre-Dame de Paris, Paris, France
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Djonic D, Byard RW. Unusual osteological findings in sacred relics from the LESJE monastery in central Serbia. Forensic Sci Med Pathol 2018; 15:319-323. [PMID: 30535907 DOI: 10.1007/s12024-018-0059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
An adult male skeleton was submitted to the Department of Anatomy at the University of Belgrade for evaluation. It was believed to represent the remains of a second to third century Christian saint from the Lesje Monastery in central Serbia. Examination of the remains revealed an old crush fracture of a thoracic vertebra and an unusual, probably congenital, malformation of the atlanto-occipital joint with deformation of the left occipital condyle and resultant narrowing of the foramen magnum. Although the occipital malformations were most likely congenital, they may still have caused, or contributed to, death by compression of the underlying upper cervical spinal cord.
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Affiliation(s)
- Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Roger W Byard
- School of Medicine, The University of Adelaide, and Forensic Science South Australia (FSSA), Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5005, Australia.
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