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Metabolic Bone Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The clinical features of rickets are impaired skeletal growth, bony deformities, weakness and symptoms of hypocalcaemia (see RICKETS AND OSTEOMALACIA: CLINICAL FEATURES AT A GLANCE, Table 5.1 and Table 5.3).
Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Vitamin D is produced by skin exposed to ultraviolet light and is integral to normal calcium metabolism. Notably, vitamin D deficiency is associated with rickets. Skeletal anomalies comparable to rickets in humans were found in rats born to mothers who were vitamin D deficient during gestation (Warkany, 1943). No congenital anomalies were observed in a clinical case series of 15 children born to hypoparathyroid women who took more than 200 times the RDA of vitamin D throughout pregnancy (Goodenday and Gordon, 1971). Vitamin D deficiency was associated with an increased frequency of congenital heart defects in a case-control study of 345 infants (Koster et al., 2018).
Miscellaneous Topics
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Prateek Behera, Karthick Rangasamy, Nirmal Raj Gopinathan
Rickets is a common metabolic disorder resulting from the defective mineralization of immature bones (Figure 18.1).1 Rickets can result from vitamin D deficiency, abnormal metabolism of vitamin D, or an abnormal metabolism and/or excretion of inorganic phosphate and/or calcium.
Towards equitable medical education resources: Challenging the representation of ethnicity in clinical vignettes
Published in Medical Teacher, 2023
Arjun Ahluwalia, Ashna Arif, Muhammad Hamza Shah, Sakshi Roy
To illustrate this concept, we have the following examples from a questionbank used by medical students across the UK: A 2-year-old girl from a South Asian background has not yet begun walking. She is currently growing well, measuring in the 25th percentile for weight. However, she has bowed legs and infrequent bowel movements. You suspect rickets as your preliminary diagnosis.A man from Bangladesh, aged 41, arrives at the emergency department with a history of haemoptysis, weight loss, fever and dyspnea spanning four weeks. The medical team suspects that he may have tuberculosis. As you can see from these examples, links have been drawn in the context of ethnicity that seem to associate certain conditions with one’s background. The two-year-old girl’s South Asian origin is mentioned, but her ethnicity is not relevant to her diagnosis of rickets. This information could lead to assumptions about her family’s dietary habits or cultural practices that have no relevance for this question to be answered. Similarly, the 41-year-old Bangladeshi man is presented as having symptoms that immediately suggest tuberculosis (TB), but this oversimplifies the complex social determinants of health which influence disease transmission and susceptibility.
Vitamin D: sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D and its metabolites
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Jiří Janoušek, Veronika Pilařová, Kateřina Macáková, Anderson Nomura, Jéssica Veiga-Matos, Diana Dias da Silva, Fernando Remião, Luciano Saso, Kateřina Malá-Ládová, Josef Malý, Lucie Nováková, Přemysl Mladěnka
Symptoms of vitamin D deficiency are logically linked to the malfunction of vitamin D-dependent processes. The deficit causes decreased absorption of dietary calcium and phosphate, which affects the quality of bones. In childhood, vitamin D deficiency manifests as rickets. This disease is characterized by a delay in closure of the fontanels, bowing of long bones, malformations in knees and wrists, scoliosis or kyphosis, and poor growth [192,213,222]. Additionally, hypocalcemic seizures may often occur in the first year of life [222]. In adults, vitamin D deficiency causes osteomalacia and osteoporosis, diseases characterized by demineralization of bones with an increased risk of fractures [216,223]. Bone deformities are not common symptoms in adults, in contrast to children [192]. Unlike osteoporosis, osteomalacia is accompanied by isolated or generalized bone pain [224,225].
Prevalence and management of vitamin D deficiency in children with newly diagnosed coeliac disease: cohort study
Published in Paediatrics and International Child Health, 2021
Akhshayaa G, Anju Seth, Praveen Kumar, Anju Jain
Informed, written consent was given by the children’s parent/guardian and from adolescents themselves. The study subjects and controls were evaluated by means of a pre-structured proforma. The demographic parameters (age, sex, religion, socio-economic status) were recorded. The mean daily dietary calcium intake was calculated by 24-hour recall. The degree of sun exposure was measured by calculating the mean 3-day ultraviolet (UV) score, taking into account the total body surface area exposed to the sun (Lund and Browder chart) [8] and the average time spent outdoors per day (in minutes) during the period of direct sunlight (9.00 a.m. to 3.00 p.m.). The UV score was obtained by multiplying these two variables (min/m2/day). The enrolled subjects were clinically evaluated for features of rickets. The anthropometric results were recorded and interpreted using WHO reference standards [9] for children <5 years and the Indian reference standards [10] for those >5 years of age.