Vitamin K acts a cofactor for the gamma-carboxylation of several proteins in the coagulation cascade. The clinical spectrum of vitamin K deficiency (VKD) can be asymptomatic to a significant bleeding. VKD is classically seen in newborns. However, this can manifest later in patients with risks such as sub-optimal nutrition, fat malabsorption, medications including antibiotics. A 17-year-old male with spinal muscular atrophy (SMA) Type 1, tracheostomy with ventilator dependent, gastrostomy tube feeding was seen by the gastroenterologist following treatment for small intestinal bacterial overgrowth (SIBO). Investigations showed coagulopathy following which he was transferred to the Pediatric ICU. Labs revealed prothrombin time (PT) 114 s [Normal 9.4-12.5 s], INR (International normalized ratio) 12.6 [Normal < 1.1] and partial thromboplastin time (PTT) 90 s [Normal 25.1-36.5 s]. Mixing studies and coagulation assays were consistent with VKD (low Factor VII and Factor IX with normal Factor V). His home blenderized feeding regimen met the caloric requirement but not the adequate intake (AI) values for vitamin K and other minerals. He received intravenous vitamin K (phytonadione) for five consecutive days with resolution of the coagulopathy (PT 13.2 s, PTT 37.1 s, INR 1.2). The patient was discharged on enteral vitamin K and additional supplements following dietary review by a nutritionist. Clinicians should be cognizant of VKD in patients on blenderized tube feeds which may not meet the adequate intake (AI) goals. In patients who are not receiving nutritionally complete formulas or receiving inadequate volumes, it is important to monitor macro and micronutrients.

No description available.

Vitamin D deficiency at Middenbeemster and Hattem is the result of cultural variables that limit an individual’s exposure to sunlight. During growth spurts, such as the pubertal growth spurt, high demand for vitamin D puts individuals at an increased risk for developing conditions such as rickets. This thesis aims to determine whether adolescent rickets can be identified in archaeological skeletal remains, and how to quantify the observed changes. The current work also aims to use the prevalence of adolescent rickets to understand the underlying social changes affecting individuals in the Netherlands in the 17th to 19th centuries. Two collections of archaeological human remains from the 17th to 19th century Dutch sites of Middenbeemster (n=246) and Hattem (n=117) were evaluated using macroscopic, metric, radiographic, and micro-CT analysis of skeletal remains. Adolescent individuals were evaluated for signs of active adolescent rickets, and adults were evaluated for signs of residual adolescent rickets. Statistical analysis found that measurements quantifying shape changes at the distal ulna, medial clavicle, and sacral angle can be used to identify adolescent rickets in a skeletal sample. Adolescent rickets at Middenbeemster and Hattem was found to be distributed equally amongst males and females and was found to occur less frequently than rickets in infants and children from the same population. Rickets in adolescents was most likely caused by the onset of new jobs or roles resulting in individuals remaining indoors for long periods of time. Rickets may have also been caused by illness. By identifying rickets in adolescents, this thesis provides a window to view the changing roles of individuals as they begin to occupy new spaces in their transition from children into adults, thus providing a novel way to investigate the lives of adolescents. / Thesis / Master of Arts (MA)

Yes / Background: The incidence of self-reported premature hair graying (PHG) seems to be on the rise. PHG has a profound impact on the patient's quality of life. It remains an incompletely understood etiology with limited and modest treatment options. Aim: The evaluation of the demographic and clinical profile of patients with premature canities, and exploration of the association of this entity with certain systemic disorders suspected to be related to its etiology. Methods: Seventy-one cases of premature canities (onset noticed by patients before 25 years of age) presenting to an urban skin clinic in Gurugram, India, between September 2012 and September 2015 with this complaint were retrospectively analyzed. The patient records were retrieved that provided details of the onset, duration and pattern of involvement, history, and examination findings (scalp, cutis, and general physical). Since all these patients had been screened for anemia, thyroid disorder, fasting blood glucose, and Vitamin B12 levels at the time of presentation, these parameters were also available for analysis. Results: The mean age at onset of graying was 10.2 ± 3.6 years (range: 5–19 years), with an almost equal gender distribution. The earliest age of onset recorded was 5 years. A positive family history of PHG (at least one of the biological parents or siblings) was obtained in 64 (90.1%) of the cases. The temporal regions of the scalp (35.2%) were most commonly involved followed by the frontal region (18.3%). Hypovitaminosis B12 and hypothyroidism showed significant association with the disorder, whereas anemia, serum ferritin, and fasting blood glucose did not. Conclusion: The age of onset of hair graying can be as low as 5 years. Temporal and frontal areas are the most commonly involved sites. A strong family history, Vitamin B12 deficiency, and hypothyroidism are strongly associated with PHG. Larger case–control studies are mandated for discerning the correlation of these and other risk factors with PHG.

Recent studies have offered an abundance of evidence which indicates that night blindness is caused by vitamin A deficiency. Both adults and children have been used to investigate the relationship between vitamin A deficiency and night blindness.

Thesis (D.P.H.)--University of Michigan, 1994.

Thesis (D.P.H.)--University of Michigan, 1994.

As exogenously administered RA suppressed the expression of the RA synthesizing enzymes, further investigation on whether this would lead to deficiency in endogenous RA concentrations was conducted. Results showed that exogenously administered RA significantly reduced the endogenous RA level in the head region with C57 embryos showing a greater reduction than ICR embryos. / In addition, detailed morphological and histological studies were conducted to determine if RA treatment caused early embryonic changes with strain difference. When compared with ICR embryos, C57 embryos exhibited more pronounced responses to RA, including developmental retardation, underdevelopment of the anterior neural plate and absence of or smaller optic pit/optic vesicle formation. However, RA treatment did not cause abnormal apoptosis in the early stages in both strains. / Since the teratogenic effect of RA is highly developmental stage-dependent, it is possible that there is a difference in the developmental stage between these 2 mouse strains at the time of RA injection. Indeed, it was found that the developmental stage of ICR embryos was approximately 6 hours ahead of C57 embryos. However, the role that this factor plays in the differential strain susceptibility to RA can be excluded since C57 fetuses were still 3 times more susceptible to developing anophthalmia/microphthalmia than ICR fetuses that were subject to RA treatment at equivalent developmental stages. Comparison of susceptibility to RA-induced anophthalmia/microphthalmia was also made among heterozygous fetuses obtained from reciprocal matings between C57 and ICR male and female mice, and those in homozygous ICR and C57 fetuses. Results showed that the C57 strain has conferred both genetic predisposition and maternal effects in increasing the embryo's susceptibility to RA-induced ocular defects. / Since the type of RA-induced ocular defects mimic those that developed in Raldh2 null mutant embryos, the effect of RA treatment on the expression of RA synthesizing enzymes, Raldh2 and Raldh3, and the RA-inducible gene Cyp26a1, as well as some early eye development genes were examined. Exogenously administered RA reduced the mRNA expression levels of Raldh2, Raldh3 and Cyp26a1 in the head region, with C57 embryos showing a greater reduction than ICR embryos. / Taken together, results of this thesis suggest that there is a strain difference in susceptibility to RA-induced ocular defects in which exogenously applied RA suppresses the expression of RA synthesizing enzymes and leads to endogenous RA deficiency. This finding may shed light on understanding why both excess and deficiency of RA can lead to similar types of ocular defects. / To determine if there are strain differences in the susceptibility to RA-induced ocular defects, two mouse strains were used. They are C57BL/6J (C57), mice that spontaneously develop ocular defects and ICR mice, which are not prone to developing ocular defects. Detailed time and dose response studies were conducted and eye defects were examined in near-term fetuses. C57 fetuses were found to be significantly more susceptible to RA-induced anophthalmia/microphthalmia than ICR fetuses. / Vitamin A (retinol) and its most active metabolite, all- trans retinoic acid (RA) is essential for vision in the adult and for eye development in the embryo. It is well documented that in humans, excess intake or deficiency of vitamin A or RA is associated with congenital ocular defects such as microphthalmia. However, the underlying mechanism remains unclear. The aim of this study is to examine the pathogenic mechanism of RA-induced developmental ocular defects. / Lau, Wing Sze Josephine. / Source: Dissertation Abstracts International, Volume: 71-01, Section: B, page: 0240. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 186-211). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.

Anemia and micronutrient deficiencies in infancy are common in low-income settings. These are partly due to maternal malnutrition and may impair child health and development. We studied the impact of maternal food and micronutrient supplementation, duration of exclusive breastfeeding (EBF), growth and infection on infant anemia and micronutrient status. In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early or Usual promotion of enrolment in a food supplementation program and to one of three daily micronutrient supplements. Capsules containing 400µg folic acid and (a) 30 mg iron (Fe30Fol), (b) 60 mg iron (Fe60Fol), (c) 30 mg iron and other micronutrients (MMS) were provided from week 14 of gestation. Capsule intake was assessed with the eDEM device recording supplement container openings. Blood samples (n=2377) from women at week 14 and 30 were analyzed for hemoglobin (Hb). Duration of EBF and infant morbidity was based on monthly maternal recalls. Infants were weighed and measured monthly. Blood samples (n=1066) from 6-months-old infants were analyzed for Hb and plasma ferritin, zinc, retinol, vitamin B12 and folate. In women, Hb increase per capsule reached a plateau at 60 Fe60Fol capsules, indicating that nine weeks of daily supplementation produced maximum Hb response. Anemia was common (36%) at capsule intakes &gt;60 indicating other causes of anemia than iron deficiency. In infants, vitamin B12 deficiency prevalence was lower in the MMS (26.1%) than in the Fe30Fol group (36.5%), (p=0.003) and zinc deficiency prevalence was lower in the Usual than in the Early group. There were no other differential effects of food or micronutrient supplementation on infant anemia or micronutrient status. Infants exclusively breast-fed for 4-6 months had a higher mean plasma zinc concentration (9.9±2.3 µmol/L) than infants exclusively breast-fed for &lt;4 months (9.5±2.0 µmol/L), (p&lt; 0.01). No other differences in anemia, iron or zinc status were observed between EBF categories. Infection, low birth weight and iron deficiency were independent risk factors for infant anemia. Regardless of studied interventions, prevalence of anemia (43%), deficiency of zinc (56%), vitamin B12, vitamin A (19%) and iron (22%) in infancy was high and further preventive strategies are needed. / MINIMat

Thesis (MSc) -- Stellenbosch University, 1990. / ENGLISH ABSTRACT: The main aim of this workpiece was to establish the physiological parameters against which a vitamin Bu deficiency could be measured. A comparison between the hematological values of healthy patients and those suffering from pernicious anemia due to vitamin Bu deficiency was done. A specific case of pernicious anemia was used in the comparison of abnormal values to the values of normal healthy patients. The comparison consisted of blood analyses with the help of specified instruments, photomicrographs of bone marrow and blood smears and statistical data. A Coulter Counter Model ZF was used for the hematological analyses of blood, a radio-isotope assay for serum vitamin B u was done and photomicrographs were taken with a NIKON Microflex camera with photomicrographic attachments. The importance of vitamin Bu has been shown in this workpiece. With the use of techniques and certain instruments, the effects of a shortage of vitamin Bu has been shown. Analyses of the blood from normal ,healthy patients was compared to that of patients suffering from pernicious anemia. It was demonstrated that pernicious anemia is characterized by a low erythrocyte count, hematocrit (Het), hemoglobin (Hb) and vitamin Bu levels together with a higher mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV). In severe cases of pernicious anemia these levels are extremely high or low as the case may be. Together with these values, the investigation of pernicious anemic blood and bone marrow smears revealed abnormally large erythrocyte precursors and fewer leucocytes than normal. Abnormally shaped cells, called macrocytes, were seen which was due to the disruption in deoxyribonucleic acid (DNA) synthesis caused by the vitamin Bu deficiency. This study produced a set of hematological reference values. The comparative study between healthy and pernicious anemic patients demonstrated a significant drop in serum vitamin B12 values during pernicious anemia. The hematological effect was illustrated by the Coulter Counter blood analysis results and the microscopic examination revealed the presence of megaloblastic erythrocytes, oval erythrocytes, pear-shaped poikilocytes and polymorphonuclear neutropbils with hypersegmented nuclei in blood smears I during vitamin B12 deficiency. This dianoses can be supported by the presence of megaloblasts and metamyelocytes in pernicious anemic bone marrow. / AFRIKAANSE OPSOMMING: Die hoof doel van hierdie werkstuk was om fisiologiese grense te bepaal waarteen 'n vitamien B12 tekort gemeet kan word. 'n Vergelyking tussen die hematologiese waardes van gesonde persone en die van pasiente met pernisieuse anemie wat ontstaan het as gevolg van 'n vitamien B12 tekort was uitgevoer. Die waardes verkry vanaf 'n spesifieke geval van pernisieuse anemie. was vergelyk met waardes vanaf normale gesonde persone. Hierdie vergelyking het bestaan uit bloed analises, fotomikrograwe van bloed en beenmurg smere en statistiese data. Die hematologiese bloed analises was met behulp van 'n Coulter Teller model ZF uitgevoer. 'n Radio-isotoop bepaling vir serum vitamien B12 was gedoen en fotomikrograwe was met 'n NIKON Microflex kamera geneem. Die belang van 'n vitamien B12 tekort was in hierdie werkstuk gedemonstreer. Die effek van hierdie tekort is deur die gebruik van sekere instrumente en tegnieke aangedui en die resultate hiervan is vergelyk tussen gesonde persone en pasiente met 'n vitamien B12 tekort. Hierdie studie het bevestig dat pernisieuse anemie gekenmerk word deur verlaagde eritrosiet, hematokrit (Het), hemoglobien (Hb) en vitamien B12 vlakke tesame met verhoogde gemene korpuskulere hemoglobien (GKH) en gemene korpuskulere volume (GKV) vlakke. Gedurende ernstige gevalle van pernisieuse anemie kan hierdie waardes uitermatig hoog of laag wees. Benewens hierdie waardes het die ondersoek van bloed en beenmurg gedurende vitamien B12 tekort, abnormale groot eritrosiet voorgangers en 'n verminderde hoeveelheid leukosiete getoon. Abnormale sel vorms was ook sigbaar a.g.v. die onderbreking in DNA sintese wat deur 'n vitamien B12 tekort veroorsaak word. Pernisieuse anemie word verkry wanneer daar 'n vitamien B12 en/of folaat tekort in die dieet is of wanneer hierdie vitamiene nie geabsorbeer kan word nie. Die teenwoordigheid van makrosiete, ovaal eritrosiete, peervormige poikilosiete en polimorfonuklere neutrofiele met hipergesegmenteerde keme in bloedsmere dui op 'n megaloblastiese anemie. Hierdie diagnose kan ondersteun word deur die aanwesigheid van megaloblaste en reuse metamielosiete in die beenmurg. Die bepaling van vitamien B12 en folaat vlakke in die bloed kan as addisionele bewysstukke vir 'n volledige diagnose dien. Gedurende hierdie studie is daar 'n stel hematologiese verwysingswaardes vasgestel. Die vergelykende studie tussen gesonde persone en pasiente met pernisieuse anemie het getoon dat daar 'n beduidende verlaging in serum vitamien B12 waardes gedurende pernisieuse anemie is. Die hematologiese effek was ook duidelik waameembaar in die Coulter teller se bloed analiese en mikroskopiese ondersoeke het die · teenwoordigheid van makrosiete, ovaal eritrosiete, peervormige poikilosiete en polimorfenuklere neutrofiele met hipersegmenteerde keme in bloedsmere aangedui. Hierdie diagnose kan ondersteun word deur die aanwesigheid van megaloblaste en reuse metamielosiete in die beenmurg. / This study was financially aided by a bursary from the CSIR.