VITAMIN E DEFICIENCY

DOC I HAVE VITAMIN E DEFICIENCY

Vitamin E Deficiency is a medical condition caused by the deficiency of the human body of Vitamin E as a result of inadequate dietary intake or impaired absorption.

Vitamin E is present in all living human tissues as an important fat soluble antioxidant compound of cell metabolism.

It also help to control membrane premeabilty and stability.

It may have a role in the normal differentiation of fetal tissues.

In laboratories it has been found to increase fertilty in mice.

Vitamin E is found primarily in
1.animal sources - eggs, butter and milk.
2.vegetable sources: Vitamin E is found in fresh green and yellow vegetables and cereals.

Optimal requirements of Vitamin E are:
1.adults and children above puberty: 30 mg to 60 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg per kgm daily
Infants can get sufficient Vitamin E in breast milk

Functions of Vitamin E:
1.Vitamin E together is essential for the formation and maintenance of intercellular substances such as connective tissue, bones and cartilage.

2.Vitamin E is involved in the skin wound healing

3.Vitamin E improves the blood circulation in the human body

It is therefore useful in the prevention of people with low immunity to illnesses.

4.Vitamin E also interacts with Vitamin C, folic acid, iron, Vitamin B12 and protein and other minerals to form the red blood cells.

Causes of Vitamin E Deficiency:
Vitamin E Deficiency occurs
1.when there is Vitamin E deficiencies due to
a.diet - lactating mothers should take more Vitamin E
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin E deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin E Deficiency:
1.Vitamin E Deficiency is a silent disease.
People with Vitamin E Deficiency often do not know that they have the condition.

2.Mucous membrane-mucosa of the internal organs is affected by deficiency of Vitamin E

3.Skin- hyperkeratosis and metaplasia of skin  may occur and lead to increased susceptibilty to infection.

4.Body function-weakness and fatique

Diagnosis of Vitamin E Deficiency:
1.Blood Vitamin E levels are low

Treatment of Vitamin E Deficiency:
The goal of Vitamin E Deficiency treatment is the prevention of increased fragility of red blood cells and low Vitamin E.

Therefore, prevention of Vitamin E Deficiency is as important as treatment. Vitamin E Deficiency treatment and prevention measures are:

Medications:
Vitamin E supplements
Vitamin E is given at 37.5 mg to 45 mg per day orally until the response is adequate.

There is no proof that Vitamin E is useful to prevent heart disease or help in fertilty.

Side effects are:
1.Vitamin E may enhance anticoagulant activity and cause hemorrhage in bleeding prone patients.

2.nausea

3.headache

4.poor vision

5.fatique

Prognosis of Vitamin E Deficiency:
1.good response to treatment in Vitamin E deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin E Deficiency.

Prevention of Vitamin E Deficiency:
take more diary products,cereals and vegetables.

VITAMIN A DEFICIENCY

DOC I HAVE VITAMIN A DEFICIENCY

Vitamin A Deficiency is a medical condition caused by the deficiency of the human body of Vitamin A as a result of inadequate dietary intake or impaired absorption.

Vitamin A (retinol) is found primarily in
1.animal sources - fish liver oil, liver , dairy products and meat.
2.vegetable sources: Vitamin A precursor (carotene) is found in green and yellow vegetables and fruits such as tomatoes, carrots. papaya, etc.
However only one third of the carotene is converted to Vitamin A.

Optimal requirements of Vitamin A are:
1.adults and children above puberty: 5000IU daily
2.Infants and children before puberty: 1500-2500 IU daily

Functions of Vitamin A:
1.Vitamin A together with protein opsin form the light-sensitive
pigments in the cones and rods of the retina and is thus important for clear vision.

2.Vitamin A also acts to maintain the integrity of epithelial tissues and mucous membranes by preventing metaplasia of the squamous type. It is therefore important for good skin function.

3.Vitamin A is also peripheral antagonist to estrogen.
It is therefore useful in the treatment of people with overly high
estrogens.

Causes of Vitamin A Deficiency:
Vitamin A Deficiency occurs
1.when there is vitamin A deficiencies due to
a.diet - insufficienct vitamin C in diet
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis
c.Failure to convert carotene to Vitamin A
d.rapid loss of Vitamin A from the body

2.Severity of Vitamin A deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin A Deficiency:
1.Vitamin A Deficiency is a silent disease.
People with Vitamin A Deficiency often do not know that they have the condition.

2.Vision-Initial manifestation of inadequate Vitamin A may be night blindness with progression to xeropthalmia and keratomalacia.
Corneal perforation may occur followed by blindness.

Bitot's spots which are superficial patches exposed bulbar conjunctiva are a pathognomic changes of Vitamin A deficiciency in the eye.

3.Skin- hyperkeratosis and metaplasia of mucous membrane may occur and lead to increased susceptibilty to infection.

Reversal of corticosteroid induced impairment of wound healing has been reported after topical application of Vitamin A.

4.Growth-growth retardation, loss of appetite and anemia is common in cildren with Vitamin A deficiciency

5.Mental-Brain dysfunction may occur in children with Vitamin A deficiciency.

Diagnosis of Vitamin A Deficiency:
1.Blood Vitamin A levels are low

Treatment of Vitamin A Deficiency:
The goal of Vitamin A Deficiency treatment is the prevention of vision defects and skin problems.

Therefore, prevention of Vitamin A Deficiency is as important as treatment. Vitamin A Deficiency treatment and prevention measures are:

Medications:
Vitamin A supplements
Vitamin A is given at 25.000 to 50,000 IU per day orally until the response is adequate.

Side effects are:
1.painful and tender swellings of the bones

2.dry rough skin

3.headache

4.weakness

5.liver and spleen enlargement

6.Massive overdosage of Vitamin A may lead cerebral edema, liver failure, convulsions and death

Prognosis of Vitamin A Deficiency:
1.good response to treatment in vitamin A deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin A Deficiency.

3.eye damage may not be reversible

4.Overdosage symptoms usually disappear within 1-4 weeks after stopping high vitamin A dosage.

A Family Doctor's Tale - OSTEOMALACIA

DOC I HAVE OSTEOMALACIA

Osteomalacia is a metabolic bone condition in adults characterized by the lack of nineralization of the bone or osteoid matrix although the osteoid is otherwise normal and the osteoid bone is unaltered.

Causes:
Osteomalacia occurs
1.when there is vitamin D deficiencies due to
a.diet
b.malabsorption

2.Vitamin D deficiecy is common in the elderly especially people who have dark skin and are not exposed to the sun

3.Malabsorption of Vitamin D may occur in gluten enreropathy or post gastectomy

4.Renal disease and anticonvulsant drugs may reduce the formation of active metabolites of vitamin D

5.Certain medications can cause Osteomalacia. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

6.Rarely calcium deficiecy is a cause of osteomalacia

Symptoms:
1.Osteomalacia is a silent disease.
People with Osteomalacia often do not know that they have the condition.

2.Fractures from Osteomalacia commonly occur in the wrist, spine and hip.
Persons with fractures may complain of pain and deformities as a result of the fractures.

3.Muscle weakness may occur when serum calcium is very low

Diagnosis:
1.Blood calcium and organic phiosphates are low or low normal

2.Blood alkaline phosphatase is increased

3.Blood Vitamin D levels are low

4.X-rays showed typical fractures (Looser zones) in pelvis, long bones, metacarpals and metatarsals

Treatment:
The goal of Osteomalacia treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength.

Therefore, prevention of Osteomalacia is as important as treatment. Osteomalacia treatment and prevention measures are:

A.Lifestyle Changes:
Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density.

B.Medications:
1.Vitamin D
An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength.
Vitamin D is important in several respects:

Vitamin D helps the absorption of calcium from the intestines.
A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.
Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.
Vitamin D comes from the diet and the skin.
Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions can produce most of the vitamin D they need from their skin.

2.Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes.
Calcium supplements are safe and generally well tolerated. Side effects are indigestion and constipation.

3.Medications that stop bone loss and increase bone strength, such as
alendronate (Fosamax),
risedronate (Actonel),
raloxifene (Evista),
ibandronate (Boniva),
calcitonin (Calcimar);

Prognosis:
1.good response to treatment in vitamin D deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of osteomalacia.

A Family Doctor's Tale - ROTATOR CUFF INJURIES

DOC I HAVE A ROTATOR CUFF INJURY


Rotator Cuff Injuries is a common disorder of the shoulder characterized by the injury and damage to the rotator cuff muscles or tendon resulting in pain and restriction of movement.

The rotator cuff muscles consists of 4 muscles that are used to stabilize the shoulder and move the shoulder.

It is more common in people above the age of 40.

The risk of injury increases with age.

The causes of Rotator Cuff Injuries are:
Several conditions has been blamed:
1.Repetitive movements of the shoulder- Swimmers, rowers and tennis players who use repetitive movements are at higher risk of rotator cuff injuries.

2.Heavy lifting or pulling:lifting and pulling an object that is too heavy or lifting in the wrong way can cause a strain or tear to the rotator cuff muscle or tendon.

Household tasks such as carrying a heavy load, lifting things overhead or hanging the clothes out may also cause rotator cuff injury.

3.Normal wear and tear- with age the blood supply to the tendons of the rotator cuff muscles is reduced resulting in degeneration of the cuff muscles and tendons.
This degeneration can be aggravated if there is repetitive shoulder movements resulting in a tear in the tendons or muscles.

4.trauma - injury to the rotator muscles such as a fall or direct hit to the shoulder muscles may cause a tear in the muscles resulting in tightening of the injured muscles around the shoulder joint.

5.Poor posture. Sloughing forward of the head and neck cause the rotator muscles to be strained leading to inflammation and tears.

Symptoms:
1.Pain in the shoulder when lifting the arm

2.Pain can occur when trying to comb the hair

3.Certain movements makes the pain worse

4.weakness and tenderness of the the shoulder with pain when sleeping on the affected arm

5.complaints of stiffness of the shoulder and loss of range of movement of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:
1.apprehensive patient who holds the arm protectively

2.Generalized tenderness of rotator cuff

3.Limited shoulder movement

4..Range of muscle movement is reduced in all directions

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the shoulder

2.Ultrasound and MRI will show if there a tear is present as it can identify all rotator tears from degeneration to partial or complete tears

The Treatment of Rotator Cuff Injuries are:
Conservative treatment:
1.rest of the shoulder

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

5.Physiotherapy such as traction, shortwave diathermy help to increase shoulder strength and improve flexibility

6.gradual mobilization and exercises to loosen the tight muscles surrounding the shoulder

Surgery is usually indicated in Rotator Cuff Injuries if the condition does not improve with conservative treatment.

A keyhole or arthroscopic repair is done to remove the torn edges of the cuff muscles and retach them to the bone using absorbable or metal anchors.

After surgery patients are put in a sling or brace.

Physiotherapy starts the day after surgery.

Prognosis depends on the underlying cause.

In most cases Rotator Cuff Injuries may resolve itself with conservative treatment