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Indian Journal of Psychiatry Apr 2024
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Cureus Mar 2024This case outlines the complications of Roux-en-Y gastric bypass surgery (RYGBS) and demonstrates clinical manifestations of several vitamin deficiencies. We present a...
This case outlines the complications of Roux-en-Y gastric bypass surgery (RYGBS) and demonstrates clinical manifestations of several vitamin deficiencies. We present a 45-year-old female patient who was admitted to our hospital with generalized weakness, anasarca, hypotension, and failure to thrive, a year after she had her RYGBS. After the procedure, she had nausea, vomiting, and diarrhea with progressive inability to tolerate any oral intake. Subsequently, the patient lost over 200 pounds and got bedridden. Initially, after the procedure, the patient had a dilatation of her anastomotic stricture, but after her surgeon moved out of town she was lost to follow up until she presented to our hospital. Upon arrival, the patient was hypotensive, tachycardic, and appeared dehydrated. The exam also revealed several clinical manifestations of vitamin deficiencies including dermatitis concerning Pellagra, follicular hyperkeratosis, and Bitot spots. Laboratory data showed significantly low albumin, protein, acute kidney injury, and several electrolyte abnormalities. The patient had to be admitted to the ICU for pressure support along with colloid and electrolyte replacement. An Esophagogastroduodenoscopy (EGD) was performed which revealed a clean-based ulcer and a 10-mm anastomotic stricture. She was started on Total Parenteral Nutrition (TPN). After the dilatation of the stricture, the patient was able to tolerate oral intake and TPN was subsequently discontinued upon discharge. The patient was educated extensively on the importance of compliance with daily vitamin supplementation and regular follow-up with bariatric physicians at discharge.
PubMed: 38618465
DOI: 10.7759/cureus.56101 -
Indian Journal of Dermatology 2023Photodermatoses represent a broad spectrum of skin diseases caused because of exposure to ultraviolet radiation. It is categorized mainly as idiopathic photosensitive...
Photodermatoses represent a broad spectrum of skin diseases caused because of exposure to ultraviolet radiation. It is categorized mainly as idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. Despite being under the photodermatoses umbrella, the pathophysiology of each type of photodermatoses varies. We reported 4 cases of photodermatoses including azathioprine induced pellagra, adult onset actinic prurigo, and photoallergic contact dermatitis due to NSAIDs and cutting fluids. Photoprotection with the usage of photoprotective clothing, broad-spectrum sunscreen application and avoidance of photosensitizing drugs and chemicals are crucial.
PubMed: 38371556
DOI: 10.4103/ijd.ijd_542_23 -
Annals of Medicine and Surgery (2012) Jan 2024Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological...
INTRODUCTION
Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological presentation of pellagra in a long-term alcohol and substance abuser, emphasizing the diagnostic challenges in resource-constrained settings.
CASE PRESENTATION
A 36-year-old male with a history of substance abuse presented with multiple symptoms, including hallucinations and neurological deficits. His complex clinical history included alcohol dependence, seizures, and relapses. Physical and neurological examinations revealed characteristic signs of pellagrous encephalopathy. Laboratory findings confirmed anemia and a fatty liver.
DISCUSSION
Alcoholic pellagrous encephalopathy (APE) presents a diagnostic challenge due to its atypical symptoms, overlapping with other alcohol-related disorders. Niacin deficiency, central to its pathogenesis, affects neurotransmitter synthesis, contributing to neurological symptoms. Diagnosis relies on clinical presentation, but laboratory tests for niacin levels can aid in confirmation. Neuroimaging can exclude alternative causes. This case underscores the importance of considering pellagrous encephalopathy in alcohol-related disorders with neurological symptoms.
CONCLUSION
This case underscores the importance of recognizing atypical presentations of APE in chronic alcohol-dependent individuals. Prompt diagnosis, nutritional correction, and addressing alcohol use are vital for successful management. Healthcare providers must be aware of the diagnostic complexities and socioeconomic barriers hindering timely intervention in APE.
PubMed: 38222748
DOI: 10.1097/MS9.0000000000001497 -
Cureus Nov 2023Vitamin B3 is called niacin, an essential nutrient for the human body. In diet, it exists in three forms - niacin, nicotinamide, and nicotinamide riboside and can also...
Vitamin B3 is called niacin, an essential nutrient for the human body. In diet, it exists in three forms - niacin, nicotinamide, and nicotinamide riboside and can also be produced from an amino acid - tryptophan in the gut. During the digestive process, these dietary forms of vitamin B3 get converted into nicotinamide adenine dinucleotide (NAD), which behaves as a cofactor and substrate in critical cellular reactions and thus plays a pivotal role in energy metabolism. The deficiency of this particular vitamin in the body, which manifests in different ways, is called Pellagra. We discuss one such case of niacin deficiency presenting with multisystem involvement in a chronic alcoholic.
PubMed: 38152783
DOI: 10.7759/cureus.49482 -
International Journal of Molecular... Dec 2023Amorphous silica as a food additive (E 551) is used in food materials (e.g., sweeteners, dairy products) for its anti-caking properties. The physicochemical properties...
Amorphous silica as a food additive (E 551) is used in food materials (e.g., sweeteners, dairy products) for its anti-caking properties. The physicochemical properties of SiO also make it suitable to serve as a carrier of active substances in functional foods, dietary supplements, and drugs. Deficiency of niacinamide (vitamin B3, niacin) leads to several pathologies in the nervous system and causes one of the nutritional diseases called pellagra. The present study focuses on the use of hybrid ordered mesoporous silicas (SBA-15/SBA-16) functionalized with amino groups introduced through grafting or co-condensation with (N-vinylbenzyl)aminoethylaminopropyltrimethoxysilane (Z-6032) as novel carriers of niacinamide. They combine the characteristics of a relatively stable and chemically inert amorphous silica matrix with well-defined structural/textural parameters and organic functional groups that give specific chemical properties. The highest degree of carrier loading with niacinamide (16 wt.%) was recorded for the unmodified SBA-15. On the other hand, the highest degree of niacinamide release characterizes the functionalized SBA-15 sample (60% after 24 h), indicating that the presence of amino groups affects the release profile of niacinamide from the structure of the mesoporous silica.
Topics: Silicon Dioxide; Niacinamide; Niacin
PubMed: 38139403
DOI: 10.3390/ijms242417567 -
Cureus Oct 2023This case report documents a rare occurrence of pellagra in a chronic alcoholic individual, characterized by a pruritic rash and gastrointestinal symptoms. The patient,...
This case report documents a rare occurrence of pellagra in a chronic alcoholic individual, characterized by a pruritic rash and gastrointestinal symptoms. The patient, a Caucasian male in his 60s, with a history of alcohol use disorder, presented with worsening skin lesions and non-bloody diarrhea. Laboratory findings revealed significant deficiencies in niacin and related metabolites, confirming the diagnosis. Prompt initiation of niacin supplementation, dietary adjustments, and supportive care led to notable improvements. This case shows the critical importance of recognizing pellagra in chronic alcoholism, emphasizing the triad of symptoms - rash, diarrhea, and malnutrition - as key diagnostic markers. Early intervention holds the potential to significantly enhance the patient's well-being and prevent disease progression.
PubMed: 38034227
DOI: 10.7759/cureus.47909 -
Journal of the American College of... Dec 2023
PubMed: 38029019
DOI: 10.1002/emp2.13065 -
The South African Journal of Psychiatry... 2023The case report depicts the complex interplay between mental and physical illness and contests the notion of mind-body dualism in medicine. It emphasises the importance...
INTRODUCTION
The case report depicts the complex interplay between mental and physical illness and contests the notion of mind-body dualism in medicine. It emphasises the importance of holistic management of patients and the misnomer of schizophrenia as a purely mental illness.
PATIENT PRESENTATION
Mr S is a 35-year-old male who presented to a South African specialist psychiatric hospital via the forensic system. He had multiple physical symptoms involving the abdominal, haematological, dermatological and neurological systems, in addition to an eight year duration of untreated psychosis with a marked decline in cognition and functioning.
MANAGEMENT AND OUTCOME
An extensive medical examination during his admission excluded conditions such as early onset dementia, Huntington's disease, pellagra, Wilson's disease, autoimmune encephalitis and substance-related complications. A definitive diagnosis of schizophrenia was made, and both physical and psychiatric symptoms responded well to the administration of an antipsychotic resulting in an eventual discharge from the hospital.
CONCLUSION
Mind-body dualism can result in a delayed diagnosis of schizophrenia and subsequent increased duration of untreated psychosis and other complications.
CONTRIBUTION
This case emphasises the flaws of mind-body dualism, and the interplay of mental and physical illness.
PubMed: 37795458
DOI: 10.4102/sajpsychiatry.v29i0.2081