Vitamin C – definition and benefits

Vitamin C: Definition and Benefits

 

It has been understood for decades that adequate absorption of vitamin C is imperative to good health. Found in food, dietary supplements, and certain cosmetics, this essential vitamin can be taken by mouth or through injection. Although some of the health benefits are still being researched, experts agree that improper amounts of vitamin C in the body can be devastating.

What Is Vitamin C?

Often referred to as ascorbic acid, vitamin C is an important vitamin found in many types of food such as kale, kiwi, broccoli, oranges, bell peppers, etc. This water-soluble vitamin is a safe and mandatory nutrient for humans and animals. As a powerful antioxidant, evidence has shown that the disease scurvy is both treated and prevented by adequate consumption of this vitamin. Unfortunately, the human body cannot produce its own vitamin C, thus it must be consumed via food or supplements.

The Top 12 Health Benefits

While research has shown that the consumption of vitamin C may not prevent the common cold, there is still evidence to suggest that the vitamin may shorten its duration. Furthermore, vitamin C supports collagen production in the body, thereby helping to stabilize proper cell function. Vitamin C deficiency may lead to the formation of spongy gums, mucous membrane bleeding, and spotty skin. Beyond that, vitamin C offers the following health benefits:

  1. Decreases hypertension

Unmanaged hypertension can lead to cardiovascular disease.

  1. Cures lead toxicity

Lead toxicity can lower IQ and create behavioral problems in children and young adults.

  1. Treats vasodilation

Improper dilation of blood vessels can lead to angina, congestive heart failure, and other life-threatening diseases.

  1. Cures cataracts

Decreased blood supply to the ocular nerves can cause blindness.

  1. Prevents stroke

Maintaining proper blood pressure levels keeps a potential stroke at bay.

  1. Enhances mood

Decreased production of neurotransmitters can put you in a foul mood.

  1. Minimizes the risk of certain cancers

A diet deficient of fruits and veggies with high Vitamin C densities can cause cancerous cells to grow.

  1. Heals wounds

Skin with collagen cells that aren’t properly supported doesn’t heal quickly.

  1. Boosts immunities

Stimulated white blood cells help prevent certain types of sickness.

  1. Reduces the symptoms of asthma

Adequate levels of ascorbic acid reduce the painful side effects of asthma and support healthy oxygen levels.

  1. Combats diabetes

One of the main causes of diabetes is an ascorbic acid deficiency.

  1. Fights heart disease

Clogged arteries and high levels of toxicity in the blood can lead to heart disease and other cardiac issues.

Special Precautions

While vitamin C is essential and considered safe when taken in healthy doses, consuming too much may have the opposite effect. Taking more than 2-3 grams can cause indigestion, nausea, diarrhea, or abdominal cramping, especially if you consume it on an empty stomach. The effect may be prevented by taking vitamin C in the form of sodium or calcium ascorbate. Before taking a supplement or changing your diet, be sure to consult with a doctor or nutritionist.

 

 


Structure of the spinal cord

Structure of the Spinal Cord

The Spinal cord is a long cylindrical bundle of nerves, nervous tissue & support cells running from the base of the brain or medulla oblongata through the vertebral column to the lumbar region of the backbone. The spinal cord and the brain form the central nervous system. The spinal cord is around eighteen inches or forty five centimeters long in men and around seventeen inches or forty three centimeters long in women. It has varying thickness as it extends from the occipital bone to the foramen magnum and downtown through the spinal canal, where it meets the cervical vertebrae and finally ends at the lumbar vertebrae. The spinal cord is around half an inch thick in both cervical and lumbar vertebrae. It is around quarter of an inch thick in thoracic vertebrae.

 

The human spinal cord has different segments, each of which has a pair of roots. These roots are nerve fibers. One pair is towards the back and is known as dorsal roots while the other is away from the back and is known as ventral roots. The diameter of the spinal cord is around two centimeters for adults. It is responsible for the transmission of signals from nerves in the motor cortex to different parts of the body. It also transmits signals from afferent fibers in the sensory neurons to the sensory cortex. The spinal cord controls reflexes, various kinds of electrical communication up and down the tube, establishes direct contact between the brain and different parts of the body and coordinates contraction & expansion of muscles to help facilitate motion.

Brain, Spinal Cord, and Meninges

The spinal cord is encased in the vertebral column, its protective skeletal structure.

All the way from the base of our skull to the filum terminale, which is the fibrous extension that marks the end of the spinal cord, the bundle of nerves runs through spaces inside the vertebral column. These nerves are called spinal nerves and they are named as per the region where they originate. These regions are neck or cervical, chest or thoracic, abdominal or lumbar, pelvic or sacral and tailbone or coccygeal. There are eight cervical

nerves, named as C1, C2 & C3 and so on till C8. All these are in the neck. There are twelve thoracic nerves, na

med as T1 and so on till T12. These are in the chest. The five lumbar nerves are named L1 to L5 and are in the abdominal region. There are five sacral nerves named as S1 to S5 and one coccygeal nerve named as Co in the pelvic region and tailbone respectively.

 

The vertebral or spinal column is longer than the spinal cord. Most adults have their spinal cord end at the first lumbar vertebrae or just before the second lumbar vertebrae. If you cut open a part of the spinal cord and look at a cross-section then you will find grey matter and white matter. The grey matter is at the center, shaped like a butterfly, surrounded by white matter. The grey matter is the core and it has two dorsal and two ventral roots. The grey matter comprises of neurons and inter-neurons as well as glial cells. The white matter has axons or nerve fibers. There are ascending and descending bundles of axons called tracts. These facilitate the communication to and from the brain, also between different segments of the spinal cord.


Recognition of Occupational Injury & Illness

Recognition of Occupational Injury & Illness

An employer takes the employee as is and is responsible for medical conditions caused or made worse by employment. An injury or disease must occur while carrying out the interest of the employer. The actual injury or disease does not have to occur on the employer’s premises to be covered by workers’ compensation.

The word “injury” under the Workers’ Compensation Act means more than it does in every day speech. For workers’ compensation purposes, the following situations are considered injuries:

  1. A specific incident at work causing an injury, i.e.: “Fall at work” is the most common.
  2. A series of repetitive actions resulting in a disability, i.e.: Carpal Tunnel Syndrome.
  3. A pre-existing condition that has been aggravated by work. i.e.: Asthma.
  4. An earlier work related disability which recurs causing a later disability, i.e.: Back injury.

Recognition of Occupational Injury & Illness

Some diseases related to certain occupations are recognized specifically as occupational diseases.

  1. Tuberculosis and hepatitis for nurses, blood processors, and related professionals who are exposed to these diseases.
  2. Disease of the heart and lungs for firemen who have four or more years of service.
  3. Pneumoconiosis and silicosis for any occupation that involves direct contact with or exposure to coal dust.
  4. Specific types of chemical poisoning (i.e.: lead, arsenic, mercury) for occupations that involve direct contact or exposure, or to the preparation or compounds.

 

Other diseases not specifically mentioned can be compensable if they meet certain criteria for determining whether a disease is occupationally related. The determination if a disease is compensable depends on the following:

  1. The employee is exposed to the disease by reason of his/her employment.
  2. The disease is causally related to the employee’s industry or occupation.
  3. The occurrence of the disease is substantially greater in that industry or occupation than it is in the general population.

Teaching Occupational Medicine

Teaching Occupational Medicine

Despite its relevance to medical practice, occupational medicine has been poorly represented in undergraduate training. This article describes a model for the teaching of occupational medicine to student doctors.

Methods

The model comprises two didactic lectures, a student‐selected component (SSC) of five interactive two‐hour sessions and one occupational medicine objective structured clinical examination (OSCE) station in the final MB ChB clinical exam. Interested final‐year students are invited to join the SSC. In session 1, students discuss the scope of occupational medicine practice, which includes a job title–occupational illness quiz, the use of environmental measurements and audiovisual recordings of selected workplaces.

Teaching Occupational Medicine

Sessions 2–4 involve visits to workplaces such as a laundry, a foundry and a bakery, during which students are asked to record relevant hazards to health, their controls, health effects and how occupational causality might be determined. The final session allows students to present their findings and gain feedback from the occupational physicians and their peers.


Brain, Spinal Cord, and Meninges

Brain, Spinal Cord, and Meninges

This chapter focuses on the diagnosis of neurosurgical biopsy and resection specimens from the central nervous system (CNS) and within the cranial-spinal vault. First, it presents ways to identify and manage various surgical specimens and tools that help with this process. Then, it provides a reference guide first to reactive changes and then to major etiologic categories of disease processes: infectious, inflammatory, demyelinating, cerebrovascular, neoplastic, degenerative, and developmental diseases. Toxic, metabolic, and traumatic diseases are noted where appropriate. The focus is on diseases seen by the surgical pathologist.

The approach to diagnosis employed in this chapter relies principally on histologic evaluation of hematoxylin and eosin (H&E;)–stained sections, with incorporation of smear preparations, histochemical stains, electron microscopy, and immunohistochemical preparations as supplemental aids in diagnosis.

The pathologist should always know, at a minimum, the age and sex of the patient, the precise location of the targeted lesion, and imaging characteristics. Knowledge about past medical history (e.g., previous CNS or primary neoplasms, connective tissue disease, immunosuppressive disease) is critical to interpretation. Likewise, knowledge about preoperative therapy (e.g., corticosteroids, chemotherapy, radiation therapy, radiosurgery) is also critical to interpretation of findings (e.g., necrosis, vascular fibrosis).

Brain, Spinal Cord, and Meninges

Major categories of lesions of the brain, spinal cord, and meninges, such as solitary or multiple masses, cysts, vascular malformations, or abscesses, are likely to be recognized by imaging or upon viewing a gross specimen.

Any undefined lesion should be biopsied and inspected by both cytologic preparation and frozen sections. Cytologic preparations add fine nuclear detail and the presence or absence of (a) glial-type processes; (b) discohesiveness in pituitary adenomas, oligodendrogliomas, medulloblastomas, and lymphomas; and (c) “epithelioid” features, with cellular cohesion (suggesting junctions) in carcinomas.

Optimal management of a specimen requires knowledge of the aim of the procedure. Three major types of neurosurgical procedures routinely yield tissue: (a) primary biopsies, (b) secondary biopsies, and (c) therapeutic resections. A primary biopsy seeks a diagnosis. Secondary biopsies may try again to establish a diagnosis or monitor consequences of therapy. Biopsies can be performed using CT- or MRI-guided stereotactic needle biopsy or using an open technique. Therapeutic resections attempt gross total excision of lesional tissue. Individual cases may combine more than one procedure at a single operation. For example, open biopsy for diagnosis of an intramedullary spinal cord tumor may proceed directly to a therapeutic resection if the intraoperative evaluation suggests ependymoma.

Source: Sternberg’s Diagnostic Surgical Pathology


Seborrheic dermatitis

Seborrheic dermatitis

Seborrheic dermatitis is a common dermatosis which affects up to 1–3% of the population. There is a male predominance. It presents in infants, with a second peak affecting adults. There is often a family history of the disease. It particularly affects those areas where sebaceous glands are most numerous, i.e., the scalp, forehead, eyebrows, eyelids, ears, cheeks, presternal and interscapular areas.

Occasionally, the flexural regions are affected (intertrigo). Often the lesions of seborrheic dermatitis are sharply marginated, dull red or yellowish, and covered by a greasy scale. 43 they are thereforeeasily confused with psoriasis.

Seborrheic dermatitis

Dandruff and cradle cap are also sometimes included within the spectrum of seborrheic dermatitis.

Seborrheic dermatitis is one of the most common dermatoses seen in patients with acquired immunodeficiency syndrome (aIDS). Seborrheic dermatitis has also been associated with stress and neurological disorders including parkinson’s disease, syringomyelia, and trigeminal nerve injury.

Source: P. McKee, J. Calonje – McKee’s Pathology of the Skin (Elsevier)


Bazex syndrome (acrokeratosis paraneoplastica)

Bazex syndrome (acrokeratosis paraneoplastica)

Bazex syndrome denotes an acral psoriasiform dermatosis in association with internal malignancy. Elderly patients, usually males, present with a symmetric erythematous or violaceous, scaly eruption affecting the ears, nose, fingers, and toes. The knees and elbows may sometimes be involved. Vesicles and bullae are less common manifestations. In patients with black or darkbrown skin, the lesions can present with hyperpigmentation.

Palmoplantar lesions are keratodermatous and nail involvement ranges from paronychia, horizontal or vertical ridging, yellow discoloration and thickening to onycholysis and subungual keratotic debris.

Bazex syndrome (acrokeratosis paraneoplastica)

Patients with Bazex syndrome invariably have an associated systemic malignancy, most often affecting the oropharynx, larynx, esophagus, and lung, in descending order of frequency. Cervical lymph node metastases are commonly present. persistence of the cutaneous lesions is rare and they commonly regress following successful treatment of the underlying malignancy.

Source: P. McKee, J. Calonje – McKee’s Pathology of the Skin (Elsevier)


Immunization coverage

Immunization coverage

Stark inequalities in access to vaccination exist within and between countries, with children living in disadvantaged circumstances having considerably lower uptake. The reasons for these inequalities are complex but ultimately they reduce population immunization coverage, prevent achievement of herd immunity, and increase the chance of continuing or re-emerging epidemics of infectious disease. Another major threat to immunization coverage is an unfounded lack of professional and parental confidence in the safety and effectiveness of immunization.

In industrialized countriesthis usually reflects exaggerated or erroneous fears of adverse reactions, often following media scares. In developing countries this can reflect false beliefs about infectious disease and immunization. Problems in maintaining an adequate supply of vaccine and new developments leading to frequent changes to immunization schedules also impede high coverage.
Developing and delivering an effective vaccination policy is challenging for any country. Issues to consider include having comprehensive documented policies/guidelines, clear lines of responsibility, ensuring an adequate and safe vaccine supply chain, ensuring professionals.

delivering vaccination are adequately trained and supported, and fostering confidence in and engagement with the immunization program.

Immunization coverage

Many of these issues have been clearly set out by the World Health organization in Immunization in Practice: A Practical Resource Guide for Health Workers.
Interventions to increase vaccination coverage can be patient,
provider, or system orientated. Examples of interventions of proven effectiveness include:
* robust patient call–recall and reminder systems;
* provider prompt systems (for example computer ‘pop-ups’ that flag when a child attending any health care setting is overdue vaccinations);
* multifaceted education programs for professionals and parents;
* generally increasing the accessibility of immunization (including providing accessible immunization clinics and making immunization available in other settings such as hospital outpatients and Accident and Emergency departments);
* ensuring vaccination providers receive regular assessment of and feedback on their performance relative to vaccination targets;
* integrating immunization into general mother and child health programs;
* ensuring parents and providers do not incur costs associated with vaccination.

Making complete vaccination a requirement for children to enter childcare or school is effective in increasing coverage and is used in some countries. This approach has not been adopted in the UK due to the potentially damaging consequences of overriding parental choice. Ensuring the availability of high-quality information on the target population population that would benefit from vaccination is also important in developing effective recall systems and monitoring performance. Achieving and maintaining high vaccination coverage is an important effective measure to reduce health inequalities.

Source: Forfar and Arneil’s Textbook of Pediatrics, 7E


Prevention in neonatal period

Prevention in neonatal period

Good intrapartum obstetric care and subsequent effective monitoring, investigation and treatment of the many disorders from which the newborn infant may suffer are important preventive measures. Such disorders include asphyxia, birth injury, low birth weight and hyperbilirubinemia. Neonatal screening procedures are discussed in the section
on Child health surveillance and screening.

The promotion of breast-feeding is a crucial preventive measure. Breast-feeding reduces the risk of necrotizing enterocolitis, diarrheal disease, lower respiratory infections, otitis media, and other serious neonatal infections. It also appears to reduce the risk of childhood obesity, probably through better development of appetite control. Recent evidence has further linked lack of breast-feeding with poorer intellectual development, possibly due to the lack of certain long chain fatty acids, essential for normal brain development, in most breast milk substitutes, although it is difficult to totally exclude the possibility of confounding from these studies.

Frequent breast-feeds given over a prolonged period also significantly reduce fertility and increase the birth interval, with indirect benefits to both mother and infant. WHO and UNICEF are coordinating a global initiative (the Baby Friendly Hospital Initiative) to promote breast-feeding and to improve health service support for breast-feeding mothers. Hospital routines and practices can discourage women from breast-feeding or make it difficult for them to do so successfully hence good practice guidelines have been developed for maternity hospitals. Key features of good practice include ‘rooming in’, i.e. allowing mother and babies to remain together, supporting skin-to-skin contact and the first breast-feed soon after birth, encouraging subsequent feeding on demand, and education of staff and mothers to promote good positioning and attachment of the baby.

Improving hospital practices and staff skills in line with these guidelines has been shown to improve breast-feeding rates across all ethnic and socio-economic groups. Policy statements on breast-feeding by pediatric associations have been used to raise awareness amongst pediatric staff of the need to promote breast-feeding, to promote good practice and to advocate for inclusion of breast-feeding topics in the undergraduate medical and nursing curricula and in postgraduate courses for pediatricians, obstetricians, general practitioners, midwives and maternal and child health nurses.

Prevention in neonatal period

Vitamin K should be given to all babies at birth to prevent the rare but serious disorder hemorrhagic disease of the newborn (HDN). Vitamin K administered either as one intramuscular injection shortly after birth or as multiple oral doses (with more doses required for breast-fed babies) over the first few weeks of life is effective at preventing early, classic, and late HDN. As compliance is higher and costs are lower with the IM route, that is the regimen that is usually preferred. This was questioned following the publication of one case–control study in 1992 that reported an association between administration of vitamin K via the intramuscular route to neonates and the subsequent development of childhood leukemia. Later studies and systematic reviews have failed to replicate this finding however, and the consensus view is now that IM vitamin K does not increase the risk of cancer. Current advice from the Department of Health for England states that all babies should be offered vitamin K but does not state which regimen should be followed.
The risks of HIV transmission are now better understood, leading to guidelines for the management of HIV-positive mothers to reduce vertical transmission of infection. Key interventions include universal antenatal screening of mothers for HIV infection, antiretroviral therapy for those found to be infected along with elective Cesarian section delivery and avoidance of breast-feeding in areas where it is safe to do so.

Source: Forfar and Arneil’s Textbook of Pediatrics, 7E


Chorionic Villus Sampling

Chorionic Villus Sampling

What is chorionic villus sampling?

Chorionic villus sampling (CVS) is a prenatal test that diagnoses chromosomal abnormalities such as Down syndrome, as well as a host of other genetic disorders. The doctor takes cells from tiny fingerlike projections on your placenta called the chorionic villi and sends them to a lab for genetic analysis.

CVS and another test called amniocentesis produce a karyotype – a picture of your baby’s chromosomes – so that your caregiver can see for sure if there are any problems.

Women who choose to have CVS or amniocentesis are often those at increased risk for genetic and chromosomal problems, in part because these tests are invasive and carry a small risk of miscarriage.

The main advantage of CVS over amniocentesis is that you can have it done earlier — generally between 10 and 13 weeks of pregnancy. For an amnio, you’ll have to wait until you’re at least 16 weeks pregnant.

What kind of problems does CVS diagnose?

Like amniocentesis, CVS can identify:

  • Nearly all chromosomal abnormalities, including Down syndrome, trisomy 13, trisomy 18, and sex chromosome abnormalities (such as Turner syndrome). The test can diagnose these conditions, but it can’t measure their severity.
  • Several hundred genetic disorders, such as cystic fibrosis, sickle cell disease, and Tay-Sachs disease. The test is not used to look for all of them, but if your baby is at increased risk for one or more of these disorders, CVS can usually tell you whether he has the disease.

Chorionic Villus Sampling

Unlike amniocentesis, CVS cannot detect neural tube defects, such as spina bifida. If you opt for CVS, you’ll be offered a blood screening test in your second trimester to determine whether you’re at increased risk for neural tube defects. Most neural tube defects can be detected by a detailed second-trimester ultrasound done at a state-of-the-art academic center.

Be aware that if you have CVS, there’s a 1 to 2 percent chance of getting an unclear result. This is called a confined placental mosaicism, in which some of the cell lines cultured from the placenta contain abnormal chromosomes and some are normal. If your CVS detects a mosaicism, you’ll have to have amniocentesis and possibly other testing to determine whether your baby is affected.

Is there any way to reduce the risks of CVS?

Ask your practitioner or genetic counselor to refer you to an experienced doctor who does a lot of CVS procedures and who is expert at both the transabdominal and transcervical procedures, so your doctor can choose the procedure that’s safest for you. You may also want to ask about the estimated rate of procedure-related miscarriage for the doctor or the center where you’re considering having the procedure done.

You’ll also want to make sure that an experienced registered diagnostic medical sonographer provides continuous ultrasound guidance during the procedure. This greatly increases the chances that the doctor will be able to obtain enough tissue on the first try, so you won’t have to repeat the procedure.