12th Part
Q Ariboflavinosis (SN) 5
Q List the clinical features and measures you would adopt to prevent the following disorders: 5
(a) Ariboflavinosis
A Ariboflavinosis (Riboflavin deficiency)
This is a nutritional deficiency which occurs due to reduced intakes of riboflavin through the diet. Riboflavin deficiency is one of the most common among Vitamin B-complex deficiencies. It is common among poor people where diets contain negligible amounts of pulses and milk. Meat is consumed, but very rarely. As a result, riboflavin deficiency is very common in our country among the poor population.
Clinical Features: The major clinical features of ariboflavinosis include:-
a) Angular Stomatitis: One of the clinical signs of ariboflavinosis is angular stomatitis. The subjects develop cracks on both the sides (angles of upper and lower lips) of the mouth. This is a very common sign noticed among children. As high as 30-35% of the children exhibit angular stomatitis. Since it doesn’t cause much discomfort children and the adults ignore it.
b) Glossitis: This is particularly common among women, especially during pregnancy. The tongue becomes raw and red. There will be a burning sensation whenever foods that are hot and rich in spices are consumed. The tip of the tongue is affected first. In severe deficiency, the tongue may develop cracks as well.
c) Cheilosis: The lips develop cracks and become red.
Preventive measures -
Milk is a good source of riboflavin. We have to make sure that the communities include foods rich in riboflavin like green leafy vegetables, whole cereals, and pulses, and cheaper nuts in their everyday diet to prevent ariboflavinosis.
Q Clinical features of pellagra (SN) 5
A Pellagra (Niacin deficiency)
This is a nutritional deficiency which occurs due to reduced intakes of niacin, one of the B-complex group vitamins in the diet. Though it is not as common as ariboflavinosis, pellagra is more frequently seen in the Telengana & adjoining parts of Maharashtra and Karnataka.
Clinical features: Pellagra is characterized by typical skin changes, diarrhoea, and mental changes. The patients suffering from pellagra exhibit typical skin changes. These changes are symmetrical and are evident only on the parts of the body that are exposed to the sun like forearms and legs, face, and the exposed parts of the neck. The skin becomes dry and scaly.
Diarrhoea i.e. loose motions is also present among some patients. Patients of pellagra have slight mental changes. These include irritability, forgetfulness, and loss of orientation. There may be headaches and sleeplessness, tremors of hands and legs, and mental depression. Mental changes may be very noticeable when the patient suffers from severe niacin deficiency.
Prevention - We should encourage the communities to consume which are rich in niacin like mixed cereal diets, pulses, Milk, Nuts, oilseeds, and organ meats are also good sources.
Q Beri-Berl 5
Q Clinical features of Beriberi 4
A Beriberi (Thiamine deficiency)
Beriberi is a nutritional deficiency disease caused by the deficiency of the vitamin thiamine in the diet. This disease is rare in our country.
Clinical features - The individual experiences loss of appetite, weakness, and heaviness in the legs. The person also becomes tired easily.
The patient complains of the feeling of pins and needles and numbness in the legs.
There may be loss of sensation i.e. loss of the feeling of touch over the legs. The disease occurs in two forms as wet beriberi or dry beriberi. In the case of wet beriberi, there is an accumulation of fluid in the body. This can ultimately lead to heart failure.
In the case of dry beriberi, the patient will feel a weakness in the legs, if the disease advances the patient becomes completely bedridden.
Causes: The disease is due to the inadequacy of thiamine in the diet. The disease is very common in communities where polished rice is consumed frequently. This is due to the fact that polishing the thin outer layer of rice (which contains thiamine) is removed.
Prevention - Prevention: Consumption of paraboiled rice or hand pounded rice is the best source of thiamine. An increase in the consumption of pulses and other thiamine-containing foods like yeast and whole wheat flour and millets prevents beri-beri.
Q Describe the clinical features of Vitamin D deficiency in children 5
Q Osteomalacia 2
Q Enumerate the clinical features and measures for the control of Rickets
A Rickets is a disease that occurs due to the deficiency of vitamin D among growing children in which the bones become soft and deformed. Osteomalacia is the adult form of vitamin D deficiency.
Clinical features -
Rickets - In the initial stages of the disease, children become restless, muscles lose their firmness and become flabby. The abdominal muscles also lose their firmness. Due to Rickets, teeth erupt late in children. The children suffering from rickets take more time than normal children to sit and crawl. In some cases, the child is too weak and is unable to walk.
Due to this disorder, there are deformities seen in the bones. Deformities of the chest with the breast bone are common. This symptom is called pigeon chest. Some children may have "bow legs" (bent like a bow) or "knock knees when both the knees will be touching each other, unlike in normal children. Deformities of the backbone also may develop if the disease continues beyond the age of 2 years.
Prevention: Adequate exposure to sunlight is the most important factor in protecting the child from rickets. Dietary sources are few and the vitamin is found chiefly in fish liver oils and egg yolk.
OSTEOMALACIA -
Osteomalacia is the adult form of the deficiency of Vitamin D. Osteomalacia is common among women of reproductive age (15-45 years of age). This is more common among women who have had multiple (many) pregnancies. The disease is frequently seen among women belonging to low socio-economic groups depending on poor diets and who are confined to the house.
Clinical features: Pain in ribs, hip bone, lower back, and legs is the most common complaint. There are muscular weakness and the woman suffering from disease usually finds it difficult to climb stairs. There will be pain on the application of pressure on the bones like the hipbone. Sometimes there may be fractures of the bones. Deformities of the backbone are common.
Prevention - Vitamin D supplements are given to suspected patients like pregnant women who are generally confined indoors and in women who had multiple pregnancies.
Q Enumerate the clinical features and measures for the control of Scurvy. 8
A Scurvy is a nutritional deficiency disorder that occurs due to a deficiency of vitamin C in the diet. It is observed among people who don’t consume fresh fruits and vegetables in their diet for a very long time period.
Clinical features: The most important clinical sign of scurvy is spongy, bleeding gums. The gums are swollen, particularly in the region between the teeth. They bleed even on slight touch. The infection of gums is also very common.
Causes: Scurvy is due to the consumption of diets that do not contain fresh fruits and vegetables for very long periods. This leads to a deficiency of vitamin C or ascorbic acid.
Prevention: Amla, guava, citrus fruits (lime, orange), are rich sources of vitamin C. Amla is, in fact, the richest source of vitamin C. Similarly sprouted (germinated) pulses like whole Bengal gram are good sources of vitamin C. Communities should be educated to include one of these foods in the diet regularly.
Q Differentiate between dental and skeletal fluorosis. 4
Q Describe the causes and clinical features of Fluorosis 6
A Fluorosis is a disease which is caused due to consumption of excessive amounts of the mineral fluorine for a very long time period. Fluorosis is an important health problem in some districts in the States of Andhra Pradesh, Punjab, Karnataka, Tamil Nadu, and Rajasthan.
Causes: The main source of fluoride for human consumption in India is drinking water. Drinking water should contain less than 1 mg per liter of fluoride. In areas where fluorosis is common, the fluoride content of water is as high as 3-12 mg/liter.
Clinical features: Fluorosis can be seen as changes that take place in the teeth (dental fluorosis) and in bones (skeletal fluorosis).
Dental Fluorosis: Among children who are living in areas where fluorosis is common, the disease affects the teeth. The teeth lose their shine and chalky, white patches appear on them. This is known as mottling of teeth. Mottling is considered as an early sign of fluorosis. Later, these white patches become yellowish. In severe cases of fluorosis, the enamel gets eroded ultimately leading to depressions on the teeth. This is known as pitting.
Skeletal Fluorosis: In older individuals, fluorosis leads to changes in the bones because of the consumption of excess quantity of fluoride for prolonged periods. Initially, the individual will have pain in the neck and stiffness of the back. As the disease progresses it will lead to difficulty in the movement of the neck and back. We can see the changes in bones when X-rays are taken of patients suffering from skeletal fluorosis. In severe cases of skeletal fluorosis the patient will be completely bed-ridden.
Prevention: Fluorosis can be prevented hut cannot be cured. The best method to prevent fluorosis is to consume water that has less than 1 mg per litre of fluoride. In other words, steps should be taken to supply drinking water with safe levels of fluoride to the communities to prevent fluorosis. Where this is not possible defluoridation (removal of excess fluorine) of water is the only alternative.
Q Describe the causes and clinical features of Lathyrism. 6
A Larhyrism is a disease of the nervous system which is caused by the consumption of a pulse, kesari dal for a prolonged period.
Causes: Kesari dal (Lathyrus sativus) contains a toxin that affects the nervous system (neurotoxin). The toxin causes damage to the nervous system. This disease is common among landless agricultural labourers in Madhya Pradesh, Bihar, and Uttar Pradesh. In fact, kesari dal is a hardy crop that can survive even in severe droughts when much of the wheat crop is damaged. Particularly during drought seasons, the agricultural laborers depend solely on kesari dal. The agricultural labourers in these areas receive the dal from the landlords as wages. They prepare rotis using the dal and consume the same.
Clinical features: This is a disease of the nervous system. In the initial stages, the individual exhibits a gait (walking style) which looks awkward. At this stage, if the dal is withdrawn further progress of the disease can be controlled.
In the first stage, the patient will walk with jerky movements without the aid of a stick. This is called the no-stick stage. As the disease progresses, the patient can walk only with the support of a stick. This is called the one stick stage. During this stage, the patient walks on his toes with the support of a stick with the knees slightly bent. While walking, there is the crossing of legs, one over the other.
When the symptoms are more severe, the patient can walk only with the support of
Two sticks (two stick stage). The gait is slow and clumsy. The legs cross one over the other while walking and the knees are markedly bent. The patient gets tired very easily while walking even for short distances. Ultimately the knees are bent completely and the patient can only crawl. This is called the crawling stage. Young agricultural labourers are affected by the disease.
Prevention - Banning of the crop is the surest way of preventing the disease. In fact, under the Prevention of Food Adulteration Act of Government of India, kesari dal is banned in all forms i.e. whole dal and flour. Unfortunately, it is not being effectively operated in States like Madhya Pradesh and Bihar where the problem of lathyrism is common.
Q Explain the dietary management of Diarrhoea, Measles 6+6
A Diarrhoea -
The dietary considerations include :
I) Advice the mothers to continue breastfeeding especially if the child is breastfed or alternatively gives milk feeds mixed with an equal amount of boiled, clean water.
2) Serve soft, well-mashed, non-spicy foods to the child which are easy to digest. For example, soft well-cooked rice with dal preparation or khichri, soups, eggs, fish, etc. can be given to the child.
3) Give the child foods rich in potassium such as fruit juices, mashed bananas, potatoes, carrots, well-cooked whole grain cereals.
4) Give the child food as much as he wants and at least 5-7 times a day.
5) As soon as diarrhoea starts, give the child more fluids than usual for example, rice water(kanjee), fruit juice, coconut water, buttermilk (lassi), dal soup, diluted milk, tea, nimbu'pani (fresh lime m water), barley water or any other fluid available at home and acceptable to the child.
6) Give oral rehydration solution (ORS) to the child. ORS is a solution made from sugar and salt dissolved in water. This solution helps in regaining of the fluids and electrolytes that lost in the stools due to diarrhoea.
Measles -
Dietary considerations to be advocated are: -
a) If the child is breastfed, advise the mother to continue breastfeeding the baby.
b) Give to the child liquids like milk or semi-solid preparations like Kanjee, soft khichri; nutritious potridges which have been thinned by the addition of ARF.
{ARF is nothing but a few grams of germinated wheat powder which has the ability to instantly break down the thickness of gruels and to make them much easier for a sick child to swallow.}
c) If the child also has diarrhoea, the mother should be advised to give the child oral rehydration solution to prevent dehydration.
d) All children with measles should get a large dose of vitamin A (200,000 IU.) orally by mouth.
e) Ensure proper feeding of the child suffering from measles. If the child is properly fed the reduction in body weight will be much less.
Q Oral Rehydration Therapy 5
A ORS is a solution made from sugar and salt dissolved in water. Take one liter of clean water (preferably boiled and cooled), add three-finger pinch of common salt and four-finger scoop of sugar, and mix well. This mixture is as good as the electrolyte mixtures available in the market. It is now known that salt (as stated above) added to one litre of thin rice kanjee or barley water will also serve as well. The child should be fed this solution as frequently as possible and after every loose stool.
Q Explain the effect of malnutrition on the infection. 5
A a)- Reduction in antibody production: Due to the consumption of the right kind of nutrients in sufficient amounts, normal children have disease-fighting substances called antibodies that prevent infections and in case he does get infected, he recovers fast from infections. Moreover, the ill effects of the infections are also negligible in the normal child. However, in the case of severe PEM, or vitamin A deficiency there is a reduction in antibody production thereby, making the child more prone to infections.
b) Effect on skin and mucous membrane: Among the normal fed children, the skin, mucous membranes, and other tissues are healthy and they prevent the entry of infectious agents in the body. These tissues act as barriers and prevent the entry of bacteria and germs from entering the human body. In children suffering from malnutrition (PEM), such a protective mechanism is absent. The secretion of mucous may be reduced and the mucous membrane becomes permeable. Consequently, a malnourished child can catch infections easily.
c) PEM and worm infestation:- Proper mobility (movement) of the digestive tract is important for normal digestion. In individuals with malnutrition this mobility of the digestive tract slows down, as a result of it, there is more time available for the worms to multiply. In such individuals worm infections like roundworm disease may become severe. In addition, gastrointestinal infections may also become severe in malnourished individuals.
