Vitamin C: From Bench to Bedside

Fixed-dose combinations in pharmacotherapy of chronic venous diseases

Chronic venous diseases are the most common vascular diseases of the lower extremities, negatively affecting all components of the quality of life in the modern society. Due to their high prevalence, the prevention and treatment of chronic venous diseases are one of the priorities of national healthcare systems in industrially developed countries. In recent years, numerous experimental and clinical studies have uncovered an important role of vascular inflammation and endothelial dysfunction in the pathogenesis of chronic venous diseases, which determine not only a wide range of vein-specific symptoms, but are also the main drivers of pathological remodelling of the vein wall and its valve apparatus, followed by the development of varicose syndrome and more severe chronic venous insufficiency. Modern knowledge of the pathogenesis of chronic venous diseases enables us to identify several priority strategies aimed at managing the basic pathophysiological mechanisms of the development and progression of the disease. Pharmacotherapy with phlebotropic drugs is one of them. Some of these drugs are able to inhibit the vein-specific inflammation, improve the microcirculatory bed regulation, increase the vein tone and contractility and, as a result, have a positive effect on the clinical signs of chronic venous disease. This review presents the mechanism of action of a phlebotropic drug that is new to the Russian Federation. It is a combination of Ruscus aculeatus extract (Ruscus extract) with hesperidin methyl chalcone (HMC) and ascorbic acid. Studies showed a high level of evidence of clinical efficacy and safety of this drug for the treatment of patients with various forms of chronic venous diseases. Due to the unique features of its mechanisms of action, the optimal focus groups for its use may include patients of different age groups with early-stage disease, in which vein-specific symptoms predominate, and patients with chronic venous oedema.

Lessons learned from "the great mimicker disease": A retrospective study of 18 patients with scurvy

Purpose

Scurvy is an uncommon medical condition that affects children and is caused by an inadequate intake of vitamin C. This study presents the characteristics of patients with scurvy to raise awareness of the diagnostic process in developing countries where laboratory testing for vitamin C levels is often not available.

Methods

A retrospective study was performed from period of 2018 to 2023. Data extraction includes patient age, sex, body mass index, constitutional symptoms, musculoskeletal, mucosal, cutaneous symptoms, other accompanying disorders, anemia, erythrocyte sedimentation rate, C-reactive protein, radiographic examination, vitamin C dose, and duration of treatment. Descriptive statistical analysis was performed in this study.

Results

Eighteen cases (17 males, 1 female) of scurvy were referred to our institution. Thirteen of 18 patients were misdiagnosed before referral. The median age at presentation was 4.5 (range, 2-11) years. The average body mass index was 13.93 ± 0.63 kg/m2. Half of patients had healthy weight. All patients presented with lower limb pain and 17 of 18 with refusal to walk. The median onset of diagnosis was 11 (range 4-48) weeks. White line of Frankel was described in all patients. Seven had anemia and 6 of 18 had increase in erythrocyte sedimentation rate and/or C-reactive protein levels. Only one patient had ascorbic acid levels evaluation before treatment since it was not readily available in our country. Treatment length varied from 2 weeks to 6 months.

Conclusion

The diagnosis of scurvy is frequently delayed due to its extreme rarity in modern society and its ability to mimic numerous other conditions. In children presenting with limb pain and/or reluctance to walk and pathognomonic radiological findings, physicians must prioritize scurvy as a differential diagnosis. In scurvy, vitamin C supplementation is curative.

A Narrative Review on Pediatric Scurvy: The Last Twenty Years

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.