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Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.

Ernest Shackleton, an accomplished Antarctic explorer, developed a life-threatening illness during the Discovery Antarctic expedition of 1901–4. His documented signs and symptoms included inflamed gums attributed to scurvy, severe dyspnea, and exercise intolerance, presenting in a setting of nutritional deficiency. Physical examinations at a later date, also following a prolonged diet of limited fresh food, revealed a pulmonary systolic murmur. Thiamine deficiency with cardiomyopathy, either alone or subsequently exacerbated by advanced scurvy, may have been a prominent cause of Shackleton’s condition.

Background The demographics, weight statuses, and dietary patterns of people with autism or the broad autism phenotype who experience a severe nutrient deficiency disease due to symptoms of avoidant/restrictive food intake disorder have not been well established. Objective The primary objective of this review was to examine the relationship between the demographics, weight statuses, dietary patterns, and nutrient deficiency diseases that characterize the most severe manifestations of avoidant/restrictive food intake disorder symptomology associated with autism or the broad autism phenotype. Methods A systematic review of English and non-English articles published up to August 29, 2019, on the Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature Plus electronic databases was conducted. Additional cases were identified through the reference list of all included articles. The search terms used were “autis∗ AND (deficiency OR scurvy)”. Only case reports or case series in which a person of any age who had been identified as having a formal diagnosis of autism or autism symptoms and a disease of nutritional deficiency due to self-imposed dietary restrictions were included. Data were independently extracted by 8 authors using predefined data fields. Results A total of 76 cases (patients were aged 2.5 to 17 years) from 63 articles that were published from 1993 through 2019 were found. More than 85% cases (65 of 76 patients) were from articles published in the past 10 years. The largest percentage of published cases (69.7% [53 of 76]) involved scurvy, a vitamin C deficiency. The second-largest percentage of published cases (17.1% [13 of 76]) involved eye disorders secondary to vitamin A deficiency. Other primary nutrient deficiencies reported were thiamin, vitamin B-12, and vitamin D. In 62.9% (22 of 35) of the patients for which a body mass index or a weight percentile for age was provided, the patient was within normal weight parameters, per Centers for Disease Control weight status categories. Conclusions Based on the 63 articles extracted for this systematic review, nutritional deficiency diseases related to inadequate intakes of vitamin A, thiamin, vitamin B-12, vitamin C, and vitamin D were found in individuals with autism and the broad autism phenotype who had severe self-imposed dietary restrictions. When weight information was provided, most of the youth in these cases were not reported to be underweight. Individuals of any weight who present with symptoms of avoidant/restrictive food intake disorder can benefit from early and frequent screening for adequacy of micronutrient intake, regardless of whether they have a clinical diagnosis of autism.

Ascorbic acid (vitamin C) functions as a cofactor and antioxidant within the human body that enables tissue growth and repair, but vitamin C is not intrinsically produced. Scurvy, or ascorbic acid deficiency, has traditionally been viewed as a historical disease. With the incidence of autism spectrum disorder and food restriction on the rise, children's hospitals may see increasing cases of scurvy. This is a single-center, retrospective case series including patients aged 7 to 14 years who were admitted to the Kentucky Children's Hospital with scurvy in the 2018–2019 period. Although selective or restricted eating is not an uncommon behavior among children, especially toddlers, parents of autistic children frequently report their children to be exceedingly selective eaters. However, there currently are conflicting findings on whether this leads to nutritional inadequacy. Although no guidelines exist for the treatment of scurvy, the mainstay of therapy is reintroduction of vitamin C. Oral therapy is generally preferred, but vitamin C can be given parenterally when necessary. In conclusion, oral aversion is a symptom commonly seen in patients with autism spectrum disorder and other developmental delays, potentially leading to increased cases of scurvy. Treatment of scurvy includes reintroduction of vitamin C into the diet. However, oral supplementation may pose unique challenges in this patient population.

El escorbuto es una enfermedad causada por la deficiencia de vitamina C o ácido ascórbico. Sus manifestaciones clínicas son variadas debido a que esa vitamina es un cofactor de enzimas que intervienen en numerosos procesos, como la síntesis de colágeno y la absorción de diferentes nutrientes. La expresión cutánea característica son las petequias foliculares con pelos en cuello de cisne y en tirabuzón. El compromiso mucoso se manifiesta como hipertrofia y hemorragia gingival, gingivitis y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática o leucocitaria. El tratamiento se basa en el aporte suplementario de esa vitamina. Se presenta el caso de un paciente de 32 años con escorbuto debido a una dieta casi exclusivamente a base de harinas y carente de frutas y verduras.

Vitamin C (ascorbic acid) is an essential water-soluble antioxidant, and deficiency (ie, plasma level

Scurvy is a rare disease caused by a vitamin C deficiency. Vitamin C is a water-soluble vitamin found in vegetables and fruits, but it is lost after boiling. A 59-year-old man presented with gingival pain after having a tooth extracted five years previously. Following the procedure, his diet comprised boiled vegetables to prevent pain. He then experienced bilateral lower leg pain, and computed tomography revealed intramuscular bleeding. His serum vitamin C level was below the detectable limit. His symptoms immediately improved with vitamin C administration. This case emphasized that consuming only boiled vegetables can lead to the onset of scurvy.

International audience; A 42 year-old patient presented with circulatory failure and lactic acidosis. Clinical features, later coupled with biological tests, led to the diagnosis of wet beriberi syndrome and scurvy. Echocardiography showed a pattern of thiamine deficiency with high cardiac output and low vascular resistance. The patient's condition and biological parameters immediately improved after treatment injections of thiamine. Wet BeriBeri is often overlooked in western countries and is a diagnosis that must be considered based on history, and clinical and echocardiographical findings.

The story of vitamin C (L-ascorbic acid) as an antioxidant and a cofactor in numerous biochemical reactions is a part of its long history and it is well known today. However, many questions of its mechanism of action and the benefits that it has on human health are still emerging. This applies not only to the recommended doses but also to the route of its administration. Besides, there are numerous questions about the therapeutic efficacy of vitamin C in various human (infectious) diseases, as well as its immune system function and antiviral potential. The fact that vitamin C can act as a reductant (antioxidant) and a prooxidant further emphasizes its oxidation-reduction (redox) potential in real physiological conditions. Today, the question of the intravenous administration of vitamin C effect in patients with SARS-CoV-2 requires special attention. This review aims to showcase known facts about vitamin C and its mechanisms of action to better understand the current new challenges related to vitamin C.

Vitamins are vital nutrients that are required for different body functions properly, and they are provided to the body externally through diet. Vitamin C, also known as ascorbic acid, is an essential nutrient that is required for the proper running of different body functions. It is a water-soluble vitamin and lost during the processing of food. The main sources of vitamin C are citrus fruits (kakadu plum, acerola cherries, guavas, kiwi, lemon, lychees, kale, oranges, peaches, tomatoes, black currant, thyme, parsley, rose hips, kale and strawberries), green leafy vegetables (chilli peppers, tomato, sweet yellow peppers, parsley, brussel sprouts, potatoes, mustard spinach and broccoli), fortified cereal and some animals. Vitamin C deficiency leads to scurvy, which mainly affects older, malnourished adults. Vitamin C acts as a strong antioxidant, and this property enriches various biological activities. It is believed that high dose of vitamin C may help in reducing the risk of various diseases like cancer, diabetes, cardiovascular disorders, blood pressure, respiratory syndromes, common cold, reproduction, cognitive diseases, skin problems, age-related muscular degeneration, cataract and may enhance immunity. This mini-review article has been planned to discuss sources, deficiency symptoms, daily requirements, therapeutic potential, and various biological activities of vitamin C. Various therapeutic and pharmacological activities of vitamin C will be discussed in detail with suitable examples.

Humans have lost their vitamin C-synthesizing capacities during evolution. Therefore, the uptake of this essential compound from external sources is mandatory in order to prevent vitamin C-deficient conditions resulting in severe morbidities such as scurvy. The potent antioxidant, immunomodulatory, and antiinfectious effects of vitamin C are known since the 1930s. We here (i) review the impact of vitamin C on innate and adaptive immune functions, (ii) provide an overview of its antimicrobial, antibacterial, antiviral, antiparasitic, and antifungal properties, and finally, (iii) discuss vitamin C as an adjunct treatment option for the combat of human infections by bacteria, particularly by emerging multidrug-resistant species.

Pulmonary arterial hypertension (PAH) describes a rare, progressive disease of the pulmonary vasculature, involving a group of clinical conditions that result in precapillary pulmonary hypertension (PH). PAH is characterized by proliferative vasculopathy, and subsequent right heart failure. For the past several decades research has focused on identification of underlying molecular causes of this disease. Recently, there have been a number of reported cases of patients with scurvy developing pulmonary arterial hypertension. Thus, it has been hypothesized that vitamin C deficiency results in non-hypoxic activation of hypoxia inducible transcription factors (HIF) and low nitric oxide (NO) level in the pulmonary vasculature, leading to subsequent pulmonary vasculopathy and an exaggerated pulmonary vasoconstrictive response. Immediate supplementation of vitamin C is considered the definitive treatment, preventing an otherwise fatal outcome. In this paper, we describe a patient with a fatal case of scurvy related PAH, who was admitted with ecchymosis, oral ulceration, and dyspnea.

Although the symptoms related to vitamin C deficiency were known in ancient Egypt and eighteenth century Scottish surgeon James Lind found that scurvy (a disease resulting from insufficient dietary ingestion of vitamin C) could be effectively treated with citrus fruit, this vitamin was discovered only in the year 1912 and then after 21 years it was chemically synthetized and introduced to the market as the first vitamin supplement [...]

Introduction The classical dermatological signs of vitamin C deficiency are now rare. The diagnosis of Scurvy was initially unrecognised in a 16-year-old boy. Aim To describe a challenging case of vitamin C deficiency. Subject and Method A 16-year-old boy with intestinal failure due to short bowel syndrome. He had been on home parenteral nutrition (PN) for 14 years. He had restricted dietary intake due to intestinal rapid transit. He presented with 4 weeks history of non-pruritic rash on his legs and 2 weeks of bruising with ankle and knee pain. On examination, he was systemically well. There were numerous peri-follicular petechiae distributed symmetrically over his lower legs with a few scattered lesions on the arms and trunk. (see figures 1, 2). Initial investigations did not reveal blood dyscrasia, infection, or autoimmune disorder. Vitamin A, D, E, B1, B12, folate, Zinc, Copper, Selenium, and Manganese were within normal limits. Rheumatology and dermatology opinions were sought; diagnosis of Scurvy was suspected. Skin Biopsy showed perifolliculitis with erythrocyte extravasation suggestive of Scurvy. Four days after starting vitamin C supplement, symptoms completely resolved. Subsequently, plasma vitamin C level came back low at 1.6 μmol/L ( Immediate contact was made with the compounding company and an enquiry revealed inadvertent use of a uni-layer bag for his home PN, allowing accelerated degradation despite addition of the appropriate amount at manufacture. Summary and discussion PN is a lifesaving treatment for patients who cannot be adequately nourished by other feeding routes. Despite this, nutritional deficiencies still occur, warranting close nutritional monitoring. Analysis of ascorbic acid in the uni-layer bag showed degradation by 50% every 24 hours due to oxidation and by 14 days virtually none was detected. Our patient used bags stored for up to 14 days. In a multi-layer bag, 50% degradation occurs over 14 days, but the amount remaining in the bag was above the recommended daily allowance of 100 mg/day. Rate of vitamin C decay depends on the constituents of PN, storage environment and the bag containing it (1, 2). Conclusion This case is a reminder of the Scurvy’s clinical presentation. Diagnosis was initially challenging; however, starting treatment on clinical suspicion while awaiting lab results relieved the symptoms and substantiated the diagnosis. Scurvy is preventable and may occur with well monitored PN support as well as in fully enterally fed children (3). We advise to ensure home PN bags are multi-layered and practice stock rotation not only when nearing the expiry date. Note: Consent was obtained to publish the photos. References Gibbons E, Allwood MC, Neal T, Hardy G. Degradation of dehydroascorbic acid in parenteral nutrition mixtures. J Pharm Biomed Anal. 2001;25(3–4):605–611 Gorman SR, Armstrong G, Allen KR, et al. Scarcity in the midst of plenty: enteral tube feeding complicated by Scurvy. J Pediatric Gastroenterology Nutr 2002; 35:93–5

Introduction Scurvy, or vitamin C deficiency, is rare. The goal of this study is to highlight the common risk factors and identify the orthopaedic presentation of scurvy in children. Methods A retrospective chart and radiograph review was performed of all patients consulted to the pediatric orthopaedic service from 2010 to 2019 who ultimately had the diagnosis of scurvy confirmed by an abnormally low serum vitamin C level. Data extracted included: patient age, sex, neurological conditions, prematurity, psychiatric conditions, dietary abnormalities, bone pain, arthritis, limb swelling, inability to walk, skin changes, child abuse evaluations, radiographic findings, additional vitamin deficiencies, lab studies, additional tests, response to treatment. Descriptive statistics were performed. Results Nine patients (7 males, 2 females) with scurvy were studied. The average age was 7 years (range 3 to 13 y). The average body mass index was 21.4 (range, 14 to 30). Five had autism, 2 had a neurological disorder. Two had been born premature. Two had a psychiatric disorder. Seven had an abnormal diet. One presented with bone pain. Four presented with limb swelling. Seven had unilateral and 2 had bilateral leg symptoms. Five presented with inability to walk. Six demonstrated skin changes with ecchymosis or petechiae. Three presented with gingival bleeding. Radiographic findings included subperiosteal hematoma in 2, ring epiphysis in 3, Pelkan spurs in 1, metaphyseal white lines (Frankel sign) in 6, and a metaphyseal zone of rarefaction (Trummerfeld zone) in 3. Seven had additional vitamin deficiencies including: A, B1, B6, B9, D, E, K, iron and zinc. Four had a bone marrow biopsy and 1 had lumbar puncture. All were anemic. The average erythrocyte sedimentation rate was 25.7 (range 6 to 35) and C-reactive protein was 1.5 (range 0.55 to 5.64). Six had a computed tomography, 3 had a magnetic resonance imaging. After treatment with vitamin C lasting 3.4 months (range, 2 wk to 7 mo), all symptoms gradually resolved, including leg pain and swelling. All children began to walk. Conclusion The pediatric orthopaedic surgeon should have an increased awareness about the diagnosis of scurvy when consulted on a child with bone pain or inability to walk. The most common orthopaedic presentation was the refusal to bear weight, the most common radiographic finding was the metaphyseal line of increased density (Frankel sign) and treatment with vitamin c supplementation was excellent in all cases.

Context The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility. Objectives (1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility. Data sources Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging. Results In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were 48 μmol/L or unknown (respective standardized mean differences: −0.23, 95%CI, −0.45 to −0.01, P Conclusion Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake.

Introduction. Pulmonary hypertension secondary to scurvy is a rare manifestation that historically has not been well studied and is only described in a handful of case reports. Case. Our case is about a 35-year-old female with a history significant for drug and tobacco abuse, obesity, poor diet, anxiety, and major depressive disorder who was found to have severe pulmonary hypertension in the setting of vitamin C deficiency (

Vitamin C is an essential nutrient that must be obtained through the diet in adequate amounts to prevent hypovitaminosis C, deficiency and its consequences—including the potentially fatal deficiency disease scurvy. Global vitamin C status and prevalence of deficiency has not previously been reported, despite vitamin C’s pleiotropic roles in both non-communicable and communicable disease. This review highlights the global literature on vitamin C status and the prevalence of hypovitaminosis C and deficiency. Related dietary intake is reported if assessed in the studies. Overall, the review illustrates the shortage of high quality epidemiological studies of vitamin C status in many countries, particularly low- and middle-income countries. The available evidence indicates that vitamin C hypovitaminosis and deficiency is common in low- and middle-income countries and not uncommon in high income settings. Further epidemiological studies are required to confirm these findings, to fully assess the extent of global vitamin C insufficiency, and to understand associations with a range of disease processes. Our findings suggest a need for interventions to prevent deficiency in a range of at risk groups and regions of the world.

This paper explores the role of vitamin C (ascorbic acid) in the foodways of hunter-gatherers—both ethnohistoric and Paleolithic—whose diet seasonally or over much of the year, of necessity, was comprised largely of animal foods. In order to stave off scurvy, such foragers had to obtain a minimum of about 10 mg per day of vitamin C. However, there is little to no vitamin C in muscle meat, being concentrated instead in various internal organs and brain. Even ruminant stomach contents, despite the abundance of partially digested plants, contains almost none. Moreover, many of the “meatiest” anatomical units in a carcass, such as the thigh muscles or “hams” associated with the femur, are extremely lean in most wild ungulates, making them nutritionally much less valuable to northern foragers than archaeologists commonly assume (for example, Inuit and other indigenous peoples of the arctic and subarctic commonly use the thigh meat as dog food). Vitamin C is also the most unstable vitamin, rapidly degrading or disappearing when exposed to water, air, light, heat, and pH levels above about 4.0. As a consequence, common methods of preparing meat for storage and consumption (e.g., drying, roasting, boiling) may lead to significant loss of vitamin C. There are two effective methods of minimizing such loss: (1) eating meat raw (fresh or frozen); and (2) eating the meat after it has been putrefied. Putrefaction has distinct advantages that make it a common, if not essential, way of preparing and preserving meat among northern latitude foragers and, for the same reasons, very likely also among Paleolithic foragers in the colder climes of Pleistocene Eurasia. Putrefaction “pre-digests” the meat (including the organs), making it much less costly to ingest and metabolize than raw meat; and it lowers the pH, greatly increasing the stability of vitamin C. These observations offer insights into critical nutritional constraints that likely had to be addressed by Neanderthals and later hominins in any context where their diet was heavily meat-based for a substantial part of the year.

Pneumonia is a severe lower respiratory tract infection that is a common complication and a major cause of mortality of the vitamin C-deficiency disease scurvy. This suggests an important link between vitamin C status and lower respiratory tract infections. Due to the paucity of information on the vitamin C status of patients with pneumonia, we assessed the vitamin C status of 50 patients with community-acquired pneumonia and compared these with 50 healthy community controls. The pneumonia cohort comprised 44 patients recruited through the Acute Medical Assessment Unit (AMAU) and 6 patients recruited through the Intensive Care Unit (ICU), mean age 68 &plusmn, 17 years, 54% male. Clinical, microbiological and hematological parameters were recorded. Blood samples were tested for vitamin C status using HPLC with electrochemical detection and protein carbonyl concentrations, an established marker of oxidative stress, using ELISA. Patients with pneumonia had depleted vitamin C status compared with healthy controls (23 &plusmn, 14 &micro, mol/L vs. 56 &plusmn, 24 &micro, mol/L, p &lt, 0.001). The more severe patients in the ICU had significantly lower vitamin C status than those recruited through AMAU (11 &plusmn, 3 &micro, mol/L vs. 24 &plusmn, mol/L, p = 0.02). The pneumonia cohort comprised 62% with hypovitaminosis C and 22% with deficiency, compared with only 8% hypovitaminosis C and no cases of deficiency in the healthy controls. The pneumonia cohort also exhibited significantly elevated protein carbonyl concentrations compared with the healthy controls (p &lt, 0.001), indicating enhanced oxidative stress in the patients. We were able to collect subsequent samples from 28% of the cohort (mean 2.7 &plusmn, 1.7 days, range 1&ndash, 7 days). These showed no significant differences in vitamin C status or protein carbonyl concentrations compared with baseline values (p = 0.6). Overall, the depleted vitamin C status and elevated oxidative stress observed in the patients with pneumonia indicates an enhanced requirement for the vitamin during their illness. Therefore, these patients would likely benefit from additional vitamin C supplementation to restore their blood and tissue levels to optimal. This may decrease excessive oxidative stress and aid in their recovery.

Chronic kidney disease and dialysis brings with it a plethora of complications, including malnutrition. Strict dietary restrictions in hemodialysis (HD) patients further complicate the picture as it increases the risk of deficiency of micronutrients, specifically water-soluble vitamins. Today, there is a lack of concrete guidelines concerning recommendations on vitamin supplementation in HD patients. This lack of data is partly due to our incomplete understanding of handling of vitamins in a uremic state. There is a dire need for more data on the impact of dialysis and uremic state on water-soluble vitamins to facilitate appropriate preventative supplementation. We present a case of scurvy in a HD patient that will contribute toward the understanding of vitamin status in HD. We hope it will aid in screening HD patients for vitamin C deficiency and individualizing supplementation of vitamin C.

This case describes an obese adult male peritoneal dialysis patient who presented with a pruritic follicular rash. Nutrient deficiency was not suspected initially in this case because there was no history of protein-calorie malnutrition, but the patient reported a diet devoid of fruits and vegetables and had not been taking his dialysis vitamin as prescribed. Skin biopsy showed follicular hyperkeratosis with fragmented hair shafts and corkscrew hairs consistent with scurvy. After supplementation with ascorbic acid 500 mg twice daily for 2 weeks, the rash resolved completely. Dialysis patients are at increased risk for vitamin C deficiency due to indiscriminant clearance of the nutrient with dialysis, but scurvy is rarely seen.

Background: Unlike most of animal species, human beings lack the enzymatic process for the conversion of glucose to ascorbic acid (vitaminC), and therefore getting the vitamin from food sources is essential. The association of the various signs caused by a deficiency of vitamin C is called scurvy or Barlow’s disease, an easily treatable disease but can be fatal. It is rare in the developed countries and even economically underdeveloped societies in which the basic diet is already rich in ascorbate. Methods: We describe here the case of a 4-year-old girl with cerebral palsy, in whom diagnosis concerns were oriented for osteomyelitis, based upon clinical presentation, ultrasonic and magnetic resonance imaging, led to a surgery revealing subperiosteal hematomas that argues in favor of scurvy. Results: After vitamin C therapy, the symptoms are gone and the general condition of the patient improved despite persistent radiological signs. Conclusion: Recent studies of sporadic cases report a high incidence of scurvy in children with autism or psychomotor retardation and the fact that musculoskeletal manifestations are more common. The mosaics of the symptoms of scurvy are varied and include dermatological, dental, bone and systemic manifestations, making it a forgotten and misdiagnosed illness. A heightened awareness is needed to avoid an unnecessary surgery, unnecessary tests and procedures and to be able to start treatment for a potentially fatal but easily curable disease.

Vitamin C (ascorbate) is an essential micronutrient with many functions in the body. Wound healing is the complex physiologic process by which skin is repaired in response to injury. A number of biological activities of vitamin C may impact on wound healing. These include the promotion of collagen formation, the ability to regulate the inflammatory response, particularly neutrophil function, and the capacity of vitamin C to interact with cell signaling pathways. Hypoxia is an important determinant of healing outcomes, and the ability of vitamin C to regulate the transcription factor, hypoxia-inducible factor, is likely to influence the function of many cells during wound healing. There is evidence to suggest that the prolonged and severe deficiency of vitamin C observed in scurvy dramatically impairs wound healing. In this review, we discuss the biology of cutaneous wound healing and consider the evidence for the use of vitamin C to promote the healing of chronic wounds. Chronic wounds occur when the normal acute healing process becomes impaired or halts, often in the inflammatory phase, and they are a growing problem worldwide. Preliminary data suggest that many individuals with chronic wounds may be vitamin C deficient. However, the extent to which low vitamin C status contributes to the burden of chronic wounds is unknown, with only a handful of randomized controlled trials conducted to determine whether oral vitamin C supplementation can improve healing outcomes. More research is required to determine whether this vitamin could provide a simple and safe intervention for those with chronic wounds.

This perennial herb is found in China, Asia, Europe, and North Africa. In Unani medicine, aerial parts are described as deobstruent, counterirritant, diuretic, emmenagogue, lithotriptic, anti-inflammatory and antipyretic, and used for urine and menstrual retention, to help in delivery and expulsion of placenta. The plant has been used for cancerous lesions, indurations, scirrhus, especially of spleen, stomach and uterus. Infusion of leaves and flowering tops is administered in nervous and spasmodic affections, in asthma and diseases of the brain; leaves are smoked to alleviate asthma. In the Philippines and Brazil, leaves are widely used as analgesic, anti-inflammatory and antispasmodic agents. In Java, poultices of the herb are applied to old sores, scurvy and other skin afflictions. Native Americans used leaf decoction for bladder ailments, cold, bronchitis, colic, dysmenorrhea, epilepsy, fever, gout, hysteria, kidney ailments, poisoning, sciatica, rheumatism, worms and wounds. Fresh plant is said to ease itch of poison ivy. Russians use the herb for abortion, amenorrhea, dysmenorrhea, bladder stones, cold, convulsions, cramps, epilepsy, fever, fear, gall stones, gastritis, inflammation, as diuretic, for kidney stones, labor, nervousness, neurasthenia, rickets, sores, tuberculosis, and wounds. The leaves, per 100 g contain 35 calories, protein, fat, carbohydrate, fiber, ash, Ca, P, iron, β-carotene, thiamine, riboflavin, niacin, and ascorbic acid. EO contains mainly cineol, along with quebrachitol, tauremisin, sitosterol, tetracosanol, fernenol, thujone, α-amyrin, stigmasterol, β-sitosterol, and α- and β-pinene. Aqueous infusion of aerial parts protects mice against CCl4-hepatotoxicity. Pretreatment of mice with aqueous-methanol extract of aerial parts significantly reduced toxin-induced rise in plasma ALT and AST, against D-galactosamine- and LPS-induced hepatitis.

Mosambi (sweet lime) belonging to the family Rutaceae is a citrus fruit grown mostly in the Southeast Asia. Mosambi is popular in India and usually bears fruit within 5–7 years. It is a rich source of water-soluble vitamin, vitamin C, minerals and total polyphenols and has good antioxidant properties. Mosambi (sweet lime) possesses several health benefits as it aids digestion and helps in curing scurvy, diabetes, urinary disorder and skin problems. Mosambi is fibre-rich fruit with low-glycaemic index. The by-products derived from mosambi wastes can act as a source of nutraceuticals, and low-cost nutritional dietary supplements can be produced in pharmaceutical, nutraceutical and food industries. This chapter summarized the detailed description of antioxidant components and the health benefits of the mosambi.

Autism spectrum disorder (ASD) may be associated with self-imposed dietary restrictions causing nutritional deficiencies, and the anesthesiologist must be aware of their potential clinical implications. Because humans are unable to produce ascorbic acid through endogenous metabolic pathways and children with ASD may avoid vitamin C-containing foods, vitamin C deficiency, or scurvy, may develop in patients scheduled for general anesthesia. Vitamin C deficiency may cause dysfunction in autonomic nervous system processes or pulmonary hypertension resulting in unexpected hemodynamic lability. We describe a child with ASD and limited dietary options leading to undiagnosed scurvy and intraoperative hypotension.

Vitamin C deficiency results in the clinical presentation of scurvy, a disease that is rare among the adolescent population. Individuals with unusual dietary habits, mental illness, or physical disability are more prone to develop scurvy. We present a case report of a previously healthy 16-year-old female presented to the hospital with a 12-month history of anorexia nervosa, restrictive subtype. She was admitted to the intensive care unit and transferred to a tertiary care pediatric eating disorder program for the treatment of extreme weight loss, cardiovascular instability, and refeeding syndrome. On examination, she had multiple tiny hyperpigmented perifollicular petechial papules on the lower abdomen, dorsum thighs, and extensor surfaces of the arms with corkscrew hairs on the abdomen. Dermatologic examination and laboratory investigations were consistent with a diagnosis of scurvy. The patient's vitamin C serum level was 21 μmol/L (.23 mg/dL; reference range 25–114 μmol/L [.28–1.28 mg/dL]). She was treated with ascorbic acid orally. Objective cutaneous findings improved within 4 weeks of supplementation, and after 6 weeks, repeat levels of vitamin C levels were 102 μmol/L (1.15 mg/dL). To the best of our knowledge, this is the first case of an adolescent female with anorexia nervosa and cutaneous manifestations of scurvy that resolved after the oral administration of vitamin C.

The aim of this article is to correct a very general error in scientific articles, in textbooks and in the Internet that has become an accepted fact. In this literature, the term “vitamin E″ is used for several similar molecules (both tocopherols and tocotrienols) that have never been shown to have vitamin property, i.e. a protective effect against the human deficiency disease. In fact, the name “vitamin E″ should only be used to define molecules that prevent the human deficiency disease “Ataxia with Vitamin E Deficiency” (AVED). Only one such molecule is known, α-tocopherol. This error may confuse consumers as well as medical doctors, who prescribe vitamin E without realizing that the current use of the name includes molecules of unknown, if not unwanted functions.

Background At least a third of the world’s population consumes alcohol regularly. Patients with alcohol use disorders (AUDs) are frequently hospitalized for both alcohol-related and unrelated medical conditions. It is well recognized that patients with an AUD are thiamine deficient with thiamine replacement therapy being considered the standard of care. However, the incidence of vitamin C deficiency in this patient population has been poorly defined. Methods In this retrospective, observational study, we recorded the admission vitamin C level in patients with an AUD admitted to our medical intensive care unit (MICU) over a 1-year period. In addition, we recorded relevant clinical and laboratory data including the day 2 and day 3 vitamin C level following empiric treatment with vitamin C. Septic patients were excluded from this study. Results Sixty-nine patients met the inclusion criteria for this study. The patients’ mean age was 53 ± 14 years; 52 patients (75%) were males. Severe alcohol withdrawal syndrome was the commonest admitting diagnosis (46%). Eighteen patients (26%) had cirrhosis as the admitting diagnosis with 18 (13%) patients admitted due to alcohol/drug intoxication. Forty-six patients (67%) had evidence of acute alcoholic hepatitis. The mean admission vitamin C level was 17.0 ± 18.1 μmol/l (normal 40–60 μmol/l). Sixty-one (88%) patients had a level less than 40 μmol/l (subnormal) while 52 patients (75%) had hypovitaminosis C (level

A vitamina C também denominada ácido ascórbico é um antioxidante, cuja função está relacionada a melhora do sistema imune, proteção contra doenças cardiovasculares, auxilia no combate ao estresse, além de proteção de unhas, cabelos e olhos. Sabendo de sua importância para imunidade e levando em consideração sua atuação como agente preventivo de doenças, o objetivo desse trabalho consistiu em realizar um levantamento bibliográfico sobre a atuação da vitamina C em relação a imunidade e como ela age contra a doença COVID – 19 também conhecida como Corona vírus, apresentando a importância dessa vitamina e seus mecanismos de ação no organismo humano. A partir da revisão realizada, notou-se que a vitamina C é essencial para o sistema imunológico e que a falta dessa leva a uma doença chamada de escorbuto, além disso notou-se que o ácido ascórbico se encontra modo natural em alguns alimentos, principalmente cítricos, e o mesmo ainda é adicionado em outros suplementos. Com relação a vitamina C como agente preventivo da COVID-19 mostrou que pacientes tratados com alta dose tiveram melhora significativas tanto em adultos quanto crianças. Sendo assim e considerando os estudos realizados conclui-se que a vitamina C possui que a vitamina C melhora o sistema imunológico estando associada na regulação de uma vida saudável.

Oladeji, O. Titrimetric application of 2-bromo-bis-1, 10-phenanthroline-copper (II) bromide as a titrant in determination of ascorbic acid in pure form, fruits and vegetables. 2016. Lebanese Science Journal, 17(2): 193-199. Ascorbic acid is very important to man and the consumption has been linked to the prevention of degenerative diseases such as scurvy and serves as an antioxidants. There have been different approaches in the determination of ascorbic acid in fruits and vegetable. In recent times, new methods were introduced by scientists. Therefore, in order to prove the authenticity of these methods, the concentrations obtained were compared with the conventional methods. The results show that orange has maximum ascorbic acid content when compared to cashew and in vegetables Vermonia baldwinii has maximum and Solanium incanum has low ascorbic acid content. The amount of ascorbic acid determined by 2, 6-dichlorophenol-indophenol and copper (II) complex (2-bromo-bis-1, 10-phenanthroline-copper (II) bromide) are comparable. Therefore, 2-bromo-bis-1, 10-phenanthroline-copper (II) bromide can serve as a titrant in titrimetric determination of ascorbic acid in pure form, fruits and vegetables.

Vitamin C (Ascorbic Acid), the antiscorbutic vitamin, cannot be synthesized by humans and other primates, and has to be obtained from diet. Ascorbic acid is an electron donor and acts as a cofactor for fifteen mammalian enzymes. Two sodium-dependent transporters are specific for ascorbic acid, and its oxidation product dehydroascorbic acid is transported by glucose transporters. Ascorbic acid is differentially accumulated by most tissues and body fluids. Plasma and tissue vitamin C concentrations are dependent on amount consumed, bioavailability, renal excretion, and utilization. To be biologically meaningful or to be clinically relevant, in vitro and in vivo studies of vitamin C actions have to take into account physiologic concentrations of the vitamin. In this paper, we review vitamin C physiology; the many phenomena involving vitamin C where new knowledge has accrued or where understanding remains limited; raise questions about the vitamin that remain to be answered; and explore lines of investigations that are likely to be fruitful.

We present a case of an otherwise healthy 3-year-old child who presented with limping, bone pain, fatigue, and agitation. Differential diagnosis included an infection of the bone, malignancy, an inflammatory bone disease, and metabolic bone disease. Magnetic resonance imaging of the lower limbs and the spine was consistent with scurvy, and the diagnosis was confirmed by very low levels of vitamin C. Further history taking revealed a diet based entirely on dairy pudding, with no fruits or vegetables, and being a "picky eater" was the sole reason. Intravenous treatment with vitamin C led to full recovery. Previous reports of scurvy were in patients with other medical conditions, such as malabsorption, or behavioral conditions as in autism. This case demonstrates that scurvy, an almost forgotten condition from past centuries, can occur in otherwise healthy children and should raise awareness regarding the importance of a balanced diet and proper nutritional history taking. Following growth charts as the only screening tool for balanced and inclusive nutrition may not be sufficient.

Aronia Melanocarpa fruits are high in vitamin C. Vitamin C is an antioxidant necessary for the human body to prevent scurvy, gum disease, bone and blood vessels and boost immunity. The paper also highlighted the determination of vitamin C in the Aronia Melanocarpa fruits, and studies on the stability of vitamin C in different pH environments in the process of oxidation in atmospheric oxygen. Ascorbics acid oxidation reaction proceeds through a chained mechanism. In 1936 Barron et all. [1], conducted the first study of auto-oxidation of ascorbic acid to dehydroascorbic acid. Through this research, we highlight areas where vitamin C pH will be stable.

IntroductionDegradation of ascorbic acid due to oxygen presence in parenteral nutrition (PN) is well documented.1 Although patients on home parenteral nutrition (HPN) are routinely monitored for some vitamin deficiencies, plasma vitamin C is rarely measured in this population.We report a case of clinical vitamin C deficiency in a patient with severe dysmotility for whom the only source of nutrition was parenteral nutrition with continuous infusion over 24 hours.MethodsA 6 years old girl with severe gastrointestinal dysmotility following a fundoplication tolerated no enteral feed and could not have time off PN due to hypoglycaemic episodes. She presented with gingival bleeding and epistaxis and also complaining of pain on her arms and shoulders. A clotting was requested which showed prolonged INR and she was treated with IV vitamin K. An x-ray of her wrist and shoulder showed osteopenia but no other abnormalities. Vitamin C measurement was requested.ResultsPlasma vitamin C was low at 3.5 micromol/L (26.1–84.6) which confirmed the diagnosis of scurvy. She was treated with 3 doses of Pabrinex® over 3 days (providing total of 450 mg vitamin C). 100 mg of ascorbic acid were also added to her PN, providing double the baseline amount. Plasma vitamin C measured after two weeks had risen to normal at 45 micromol/L. Her bleeding and pains resolved over a few days. During the next year plasma vitamin C was measured every three months and remained within reference range. She remained clinically well with no recurrence of bleeding. Due to methodology limitations, the amount of vitamin C in the PN bag could not be tested. Therefore we decided to measure plasma vitamin C in two other patients that had PN as the only source of nutrition and given over 12 hours. In both cases the result was within the reference range at 58.7 and 38 micromol/L respectively. Published literature2 suggests that temperature contributes to vitamin C degradation. The PN fluid would have been at room temperature for around 24 hours for the patient that developed scurvy, compared to half this time in the other two.ConclusionsThis case highlights that there is a significant risk of vitamin C degradation due to the oxygen present within the PN bag. However, the fact that for the other 2 patient’s plasma vitamin C was normal suggests that presence of oxygen alone might not be enough to cause vitamin C insufficiency. Temperature might be a contributing factor to vitamin C degradation, as has been shown with enteral feed.3 From these cases we concluded that measurement of vitamin C during HPN would be indicated not only if there were suggestive symptoms, but should also be added in to routine monitoring in any patient with a 24 hour infusion time and extremely restricted enteral intake.ReferencesNHS Pharmaceutical Quality Assurance Committee, Standard protocol for derivation and assessment of stability Part 4 – Parenteral Nutrition, May 2016Turmezei J, Javorszky E, Szabo E, et al. Effect of storage temperature on stability of total parenteral nutrition admixtures prepared for infants. Acta Poloniae Pharmaceutica, Drug Research 2015:72:843–9Gorman SR, Armstrong G, Allen KR, et al. Scarcity in the midst of plenty: enteral tube feeding complicated by scurvy. Journal of Pediatric Gastroenterology and Nutrition 2002;35:93–95

The SARS-Cov-2 pandemic that currently affects the entire world has been shown to be especially dangerous in the elderly (≥65 years) and in smokers, with notably strong comorbidity in patients already suffering from chronic diseases, such as Type 2 diabetes, cancers, chronic respiratory diseases, obesity, and hypertension. Inflammation of the lungs is the main factor leading to respiratory distress in patients with chronic respiratory disease and in patients with severe COVID-19. Several studies have shown that inflammation of the lungs in general and Type 2 diabetes are accompanied by the degradation of glycosaminoglycans (GAGs), especially heparan sulfate (HS). Several studies have also shown the importance of countering the degradation of HS in lung infections and Type 2 diabetes. D-xylose, which is the initiating element for different sulfate GAG chains (especially HS), has shown regeneration properties for GAGs. D-xylose and xylitol have demonstrated anti-inflammatory, antiglycemic, antiviral, and antibacterial properties in lung infections, alone or in combination with antibiotics. Considering the existing research on COVID-19 and related to D-xylose/xylitol, this review offers a perspective on why the association between D-xylose and antibiotics may contribute to significantly reducing the duration of treatment of COVID-19 patients and why some anti-inflammatory drugs may increase the severity of COVID-19. A strong correlation with scurvy, based on gender, age, ethnicity, smoking status, and obesity status, is also reviewed. Related to this, the effects of treatment with plants such as Artemisia are also addressed. Chemical compounds D-xylose; xylitol; l-ascorbic Acid; D-glucuronic acid; N-acetylglucosamine; D-N-acetylglucosamine; N-acetylgalactosamine; galactose., Graphical abstract Unlabelled Image, Highlights • D-xylose significantly stimulated the biosynthesis of sulfated GAGs, especially HS. • Risk factors: age/gender/smoking/obesity & ethnicity are not specific to COVID-19. • D-xylose has anti-inflammatory and antiviral properties in lung infections. • D-xylose/xylitol improves antibiotic activity and has antiglycemic properties. • D-xylose interacts with some NSAIDs.

Abstract. The history of the discovery of vitamins was the history of their deficiency disorders. Casimir Funk, the father of vitaminic therapy, studied the interrelationships in the human body of those elements that Christiaan Eijkman demonstrated in animals, particularly birds. In 1911, he designated these factors vitamins (vita = life and amine, a nitrogenous substance essential for life); this name was accepted by the scientific community in 1912. Here, we intend to give an illustrative view on the early days of vitamin research as carried out by Casimir Funk.

Skin is the largest organ of the body. The dermis is primarily collagen. A collagen deficit results in skin failure with thinning to the point of transparency and disruption. (pressure wounds). The media of blood vessels is also primarily collagen. Here a deficit causes capillary fragility and purpura. A collagen fiber is a triple strand of protein. Plates initially produce three strands of procollagen which twist around each other, first to the left, then right and left again. The result is a fiber more flexible and stronger than a steel wire of the same diameter. Strength is due to cross linking between fibers at the frequent amino acid proline and lysine positions after hydrogenation by vitamin C. It was observed that patients referred for pressure wound care had scurvy at the time of consult. Diagnosing a collagen, i.e. Vitamin C deficit during the admission skin assessment is straight forward by bed side observation for dermal atrophy, purpura or skin tears. If an ample profile of all micro-nutrients with 1 gm of vitamin C was started along with biofilm control and adequate wound dressings, the existing pressure wounds promptly improved and new wounds were prevented.

After Glisson’s description of rickets, it took two centuries to realize that rickets was due to the absence of antirachitic nutrients in the diet or lack exposure of the skin to ultraviolet rays. This bone disease caused by vitamin D deficiency was one of the most common diseases of children 100 years ago. This paper explores how the definition, diagnosis, and treatment of rickets shifted in the first decades of the twentieth century. Although benefits of cod liver oil as food were known as early as the seventh century, cod liver oil was only proposed as medicinal for rickets in Northern Europe at the end of the eighteenth century. The relationship between rickets and nutritional deficiency was suspected and demonstrated between 1880 and 1915, at the same time of the discovery of other vital substances (vitamins) needed to prevent beriberi, scurvy, and pellagra. Understanding that the lack of photosynthesized vitamin D or the lack of dietary vitamin D was a similar risk of rickets was an important turn in the comprehension of the disease. We look at the sequence and turn of events related to the discovery of vitamin D. Rickets has been recognized first as a disease of urban living people. Cod liver oil had been used since 1700 as a nonspecific treatment for a range of diseases. Generations of children in cities of the north of Europe had learned to hate the taste and smell of the black oily liquid and then grown up to be parents who, in turn, hated to force it down their children’s throats. Occasional papers before 1900 pointed to its efficacy for rickets, and most textbooks of the early 1900s mentioned it only as a treatment option. The discovery in the early 1900s that artificial and natural ultraviolet rays had both antirachitic activity allowed to produce antirachitic foods just by food irradiation with artificial ultraviolet irradiation. Clinical guidelines were adopted to propose exposure to sunlight or to artificial ultraviolet radiation to prevent rickets in children. By the mid-1920s, rickets was promoted as universal, at times invisible to non-experts, but present to some degree in nearly every young child regardless of race or class. It was thus used to promote the young disciplines of preventive medicine, pediatrics, and public health. Innovative advances were made in the understanding of vitamin D synthesis from 1915 to 1935. A public health campaign of the 1930s was a success to eradicate rickets, using irradiated ergosterol from yeast to enrich milk and other foods with vitamin D, ensuring that the general population was consuming sufficient vitamin D. Rickets therefore provides an excellent window into the early politics of preventive health and the promotion of targeted interventions in the world. It is also a relevant historical counterpoint for current debates over the role of risk factors (absence of light or sun) for disease (today’s so-called “lifestyle” diseases).

Background Some children with autism spectrum disorder (ASD) have highly specific food selectivity and therefore are prone to nutritional deficiencies of different kinds. Patients We document three children with ASD who presented with refusal to walk and gingivitis who underwent comprehensive evaluations before establishing the diagnosis of vitamin C deficiency (scurvy). The symptoms resolved after treatment with vitamin C. Conclusions Prevention of nutritional deficiencies in children with ASD is essential, and providing multivitamin supplementation whenever high food selectivity is noted may prevent significant morbidity.

Onion (Allium cepa L.) is widely employed as a food ingredient as well as traditional remedy to treat fever, burns, and scurvy. The present study focused on the modulator efficacy of the quercetin rich onion juice on lipid profile and antioxidant status in mildly hypercholesterolemic subjects. Twenty-four healthy subjects with mild hypercholesterolemia (≧ 200 mg/dL) were recruited and divided into two groups, and they consumed 100 mL of onion juice or placebo every day for 8 weeks. Fasting blood samples were collected at initial, 2nd, 6th, 8th, 10th week for estimating various biochemical assays, as well as anthropometric indices. After 8 weeks of intervention, onion juice greatly decreased (p < 0.05) waist circumference, total cholesterol and LDL-c. In addition, it elevates (p < 0.05) total antioxidation capacity and prolong lag-time of LDL oxidation were also noted. To conclude, drinking onion juice could markedly suppress cholesterol level and elevate total antioxidation capacity. Hence, onion juice was probably recommended for combating various cardiovascular diseases.

Late-medieval and post-medieval writings report that scurvy was a widespread condition in medieval and early historical Poland. Archaeological and historical data indicate that the diet of children was based on foods poor in vitamin C and contained small amounts of raw plant products. Also, historians emphasise that in medieval and post-medieval Poland, there were seasonal fluctuations in food availability, frequently accompanied by poor harvests. Both resulted in long periods of poor nutrition, which affected children most severely. The aim of this study was to investigate skeletal manifestations of scurvy in subadult remains from medieval and post-medieval Poland. Following standards described by Ortner and colleagues, anatomical sites pathognomonic of scurvy in subadults (

Historically linked to sea voyagers in the 18th century, scurvy has become extremely rare during the last century in developed countries. However, it is still present in some at-risk populations and often overlooked in pediatric patients with restricted diets due to behavioral, neurodevelopmental, or psychiatric problems. So far, the only known etiology of developing scurvy is nutritional deficiency of vitamin C. In this report, we describe the case of a 3-year-old previously healthy Swiss girl without any history of previous poor dietary intake, who presented a picture of systemic inflammation including persisting fever, palpable purpura located on the extensor sides of the extremities, refusal to bear weight, and gingival bleeding. Blood tests revealed a significant increase of inflammatory markers and hypoalbuminemia. Full-body MRI revealed symmetrical bone marrow edema consistent with findings in previously reported cases of children with scurvy. After starting a high-dose oral vitamin C supplementation, the patient showed rapid clinical, laboratory, and radiologic improvement, but after stopping the treatment 4 months later, the patient developed relapse symptoms with pronounced fatigue, refusing to walk, and hair loss. These symptoms led us to restart the oral supplementation, which resulted in secondary normalization of her condition. The cause of her symptoms still remains unclear and presents the first case to our knowledge describing scurvy symptoms that are not directly linked to deficient dietary intake.

Introduction We previously published the case of a woman taking warfarin who was found to have scurvy, a disease caused by a deficiency of vitamin C. This led us to hypothesize that patients taking warfarin who consume a diet limited in vitamin K rich foods may be at risk for other nutrient deficiencies. To test our hypothesis, we studied dietary nutrient intake in patients taking warfarin compared to patients with heart disease not taking warfarin. Methods The warfarin (n=59) and control groups (n=24) comprised convenience samples of patients with heart disease over age 60 years. Patients completed a three-day food diary and reported use of supplements. Results Based on diet history, the most common deficiencies were vitamin D (100% both groups), vitamin E (93% warfarin, 92% control), vitamin A (71% warfarin, 71% control), vitamin K (66% warfarin, 58% control), vitamin C (58 % warfarin, 46% control) and pantothenic acid (69% warfarin, 71% control) with no significant differences in intake deficiencies between warfarin and control groups. Conclusion All of our patients had nutritional intake deficiencies. This may be due to Appalachian dietary habits and not the low vitamin K diet. It seems prudent to recommend multivitamins, however, universal multivitamin supplementation has not been supported by randomized controlled trials. More study is needed to determine the reason for poor nutritional intake in our Appalachian population and to determine whether similar results are evident in a larger sample.

The vitamin C deficiency disease scurvy is characterised by musculoskeletal pain and recent epidemiological evidence has indicated an association between suboptimal vitamin C status and spinal pain. Furthermore, accumulating evidence indicates that vitamin C administration can exhibit analgesic properties in some clinical conditions. The prevalence of hypovitaminosis C and vitamin C deficiency is high in various patient groups, such as surgical/trauma, infectious diseases and cancer patients. A number of recent clinical studies have shown that vitamin C administration to patients with chronic regional pain syndrome decreases their symptoms. Acute herpetic and post-herpetic neuralgia is also diminished with high dose vitamin C administration. Furthermore, cancer-related pain is decreased with high dose vitamin C, contributing to enhanced patient quality of life. A number of mechanisms have been proposed for vitamin C’s analgesic properties. Herein we propose a novel analgesic mechanism for vitamin C; as a cofactor for the biosynthesis of amidated opioid peptides. It is well established that vitamin C participates in the amidation of peptides, through acting as a cofactor for peptidyl-glycine α-amidating monooxygenase, the only enzyme known to amidate the carboxy terminal residue of neuropeptides and peptide hormones. Support for our proposed mechanism comes from studies which show a decreased requirement for opioid analgesics in surgical and cancer patients administered high dose vitamin C. Overall, vitamin C appears to be a safe and effective adjunctive therapy for acute and chronic pain relief in specific patient groups.

Vitamins are indispensable nutrients for metabolism. Adequate vitamin intake plays vital role in physiological processes including embryonic development, cellular and immunity proliferation and differentiation, DNA synthesis and oxidative response. In contrast, insufficient vitamin levels usually lead to a large number of clinical manifestations including xerophthalmia, nyctalopia, hyperpigmentation, vitiligo, jaundice, megaloblastic anemia, glossitis, scurvy, stroke, cancer, coronary heart disease, Alzheimer's disease, multiple sclerosis and Parkinson's disease. In recent years, more and more researches have focused on the relationship between vitamin family and otorhinolaryngologic diseases. This review will summarize the current knowledge of vitamin family and vitamin-mediated regulating role in those related otorhinolaryngologic diseases.

Vitamin C is an essential dietary component must be ingested for survival. Because of not being produce in the body it must be supplied exogenously by foods and supplements. Citrus limon L. (Lemon) is a citrus fruits, cheap but rich sources of vitamin C. Due to high levels of vitamin C content, it can prevent and cure the vitamin C related disease including gum bleeding, poor wound healing, skin diseases, tiredness, joint pain and edema. A total of 200 people (105 were males and 95 were females) were selected for the study. In order to assess vitamin C status, symptoms like gum bleeding, poor wound healing, hyperkeratosis, excessive tiredness, joint pain and edema were collected by means of a structured questionnaires. People were then divided into two groups randomly. One group was the focus of the lemon supplementation group and another was the non-supplementation group. Then we supplied lemon to the individuals (2piece/day) of lemon supplementation group for 4 months and no lemon was provided to the non-supplementation group during the study period. After four months, we found that symptoms like gum bleeding (92.5%), poor wound healing (89.29%), hyperkeratosis (50%), excessive tiredness (89.83%), joint pain (69.23%) and edema (30%) have been cured in lemon supplementation group. On the other hand, after four months gum bleeding, poor wound healing, hyperkeratosis, excessive tiredness, joint pain and edema in non-supplementation group have not been cured like lemon supplementation group. The percentages were 20%, 21.05%, 33.33%, 25%, 14.81% and 14.29% respectively.