PERNICIOUS ANEMIA
 Glossitis (swollen red tongue) due to B12 deficiency
Description:
 also known as Biermer's anemia, Addison's anemia, or
Addison–Biermer anemia
 is one of many types of the larger family of megaloblastic
anemias.
 caused by loss of gastric parietal cells, and subsequent
inability to absorb vitamin B12.
The loss of ability to absorb vitamin B 12 is the most
common cause of adult vitamin B 12 deficiency. Such a loss may be
due to pernicious anemia (with loss of intrinsic factor) or to a
number of other conditions which decrease production of gastric
acid, which also plays a part in absorption of vitamin B12 from foods.
The "pernicious" aspects of the disease were peripheral
nerve damage and - prior to the discovery of treatment - a prognosis
as poor and certain as that of leukemia before it could be treated.
However, in the time since elucidation of the cause of the disease,
modern tests which specifically target B 12 absorption can be used to
diagnose the disease before it becomes clinically apparent. In such
cases, the disease may be diagnosed and treated without the patient
ever becoming ill.
Signs and Symptoms:
Pernicious anemia presents insidiously, and many of the
signs and symptoms are due to anemia itself, where anemia is
present. While it may consist of the triad of paraesthesias, sore
tongue and weakness, this is not the chief symptom complex. The
patient may complain of fatigue, depression, forgetfulness, difficulty
concentrating, low-grade fevers, nausea and gastrointestinal
symptoms (heartburn), weight loss. Because PA may affect the
spinal cord, the patient may also complain of impaired urination,
loss of sensation in the feet, unsteady gait, weakness and
clumsiness. Anemia may cause tachycardia (rapid heartbeat) and
cardiac murmurs, along with a waxy pallor. In severe cases, the
anemia may cause evidence of congestive heart failure.
Long term complications may include gastric cancer and carcinoids.
Many signs and symptoms are attributed to pernicious anemia:
 Fatigue, low blood pressure, rapid heart rate, high blood
pressure, pallor, depression, muscle weakness and
shortness of breath (known as 'the sighs')
 Difficulty in proprioception
 Mild cognitive impairment, including difficulty
concentrating and sluggish responses, colloquially referred
to as cognitive dysfunction|brain fog
 Neuropathic pain
 Frequent diarrhea
 Paresthesias, such as pins and needles sensations or
numbness in fingers or toes, due to B 12 deficiency affecting
nerve function
________________________________________________________________________________________________________________________
CRETINISM
 Jaundice due to impaired formation of blood cells
 May present with hyperthyroidism or hypothyroidism
 Personality or memory changes[5]
Etiology:
The present concept of pernicious anemia is one of a
simple deficiency disease, and the lacking substance is supposed to
be one which is required for the maturation of hematopoietic cells,
since the histological picture of pernicious anemia in relapse is one
of marrow hyperplasia and immaturity.
Castle has established the principle that cure of pernicious
anemia results when a dietary factor contained in the vitamin B
complex is acted upon by a constitutent of normal gastric juice. This
constituent is absent from the gastric juice of the patient with
pernicious anemia. Minot has established the therapeutic effect of
liver extract, and from these two studies the triple origin of the
lacking substance in pernicious anemia has become accepted. This
theory supposes that an extrinsic factor, A, is acted upon by an
intrinsic factor, B, to give a third factor, C, which is present in liver.
Treatment:
The treatment of pernicious anemia varies from country to
country and from area to area. There is no permanent cure for
pernicious anemia, although repletion of vitamin B 12 should be
expected to result in a cessation of anemia-related symptoms, a halt
in neurological deterioration, and (in cases where neurological
problems not advanced) neurological recovery and a complete and
permanent remission of all symptoms, so long as B 12 is
supplemented. Repletion of B12 can be accomplished in a variety of
ways.
The most accessible and inexpensive method of repletion is through
dietary supplementation, in the form of oral or sublingual B 12
tablets. B12 supplements are widely available at supermarkets,
health food stores, and drug stores, though quality and cost may
vary. In some countries, the cobalamin preparation may be available
only via prescription. Doctors can prescribe cobalamin tablets that
contain doses higher than what is commercially available.
Prevention:
There is no known way to prevent this condition. However,
with early detection and treatment of vitamin B12 deficiency,
complications can be minimized.
Oral Manifestation:
Oral signs and symptoms, includes glossitis, angular
cheilitis, recurrent oral ulcer, oral candidiasis, diffuse erythematous
mucositis and pale oral mucosa, difficulty in eating certain types of
food (mainly banana and tomato) because of a burning sensation
and the presence of red stains on the inside of her cheeks and on
her tongue.
Description
 a condition of severely stunted physical and mental
growth due to untreated congenital deficiency of thyroid
hormones (congenital hypothyroidism) due to maternal
nutritional deficiency of iodine
 a condition caused by extreme hypothyroidism during fetal
life, infancy, and childhood
 reasons very life-threatening retardation of physical and
mental progress
 if the situation is left untreated, progress is stunted and
the physical stature progress is that of a dwarf
Types of Cretinism
1. Myxedematous Cretinism
 has a less ascetic degree of mental detainment than
the neurological cretin
 Insufficient production of thyroid hormone
 In infant it may occur due the lack or insufficient
expansion of thyroid gland.
 Abnormal iodide uptake
 Removal of thyroid gland due to any reason
 Uses of radioactive iodine
 Infection in the thyroid hormone
 Medicine such as Nitroprusside, lithium, or iodides
 Congenital defects
Treatment
 proper iodine supplementation.
 intramuscular injections of iodized oil
 taking Levothyroxine sodium tablets
 Some medicine such as Levothyroid, Levoxyl,
Synthroid are also useful for this disease.
 Patient of this disease may have to
use medicine for their whole life
Prevention

2. Endemic cretinism  Cretinism is a condition of hypothyroidism during

 develops from a diet inadequate in iodine fetal life, infancy, and childhood. It is caused by a
deficiency of Iodine, lack of a thyroid gland, or
Signs & Symptoms inability of the thyroid gland to produce enough
hormones that are crucial to the development of a
 Skin color may change to yellow-orange
child. Cretinism can be prevented in one way by
 Weight gain
adding iodine into the persons diet.
 Fatigue
 Low metabolic rate Foods rich in Iodine
 Irregular periods
 Loss of hair  Asparagus
 Puffy face  Dulse
 Hearing problem  Garlic
 Poor feeding  Kelp
 Heart defects with birth  Lima beans
 Short stature  Mushrooms
 Jaundice  Seafood
 Cool and pale skin  Sea salt and fortified salt
 Constipation  Seaweed
 Rough voice  Sesame seeds
 Swollen eyelids  Soybeans
 Enlarged thyroid gland  Spinach
 Depression  Summer squash
Etiology  Swiss chard
 Turnip greens

________________________________________________________________________________________________________________________

CELIAC DISEASE

▪ a digestive disorder that runs in families and interferes with the digestion and absorption of the nutrients in foods
▪ triggered by an immune reaction to gluten, a protein found in wheat, barley, rye, and triticale (a grain that is a cross between wheat and
rye)
▪ duration: may be lifelong
Description: ▪ when a person with celiac disease eats foods containing
gluten, the tissues that line the walls of the intestine
 become inflamed because of an immune reaction Treatment:
▪ the tissues gradually lose their villi
▪ over time the patient may develop some symptoms in the ▪ no cure for celiac disease
digestive tract until the body’s failure to absorb nutrients
▪ managed by keeping one’s diet completely free of gluten
from the food
and products containing gluten

Etiology:
▪ should meet with a dietitian, who is a health care
professional with special training in nutrition and in
▪ inflammation of the tissues lining the small intestine due
planning specialized diets
to an immune reaction to gluten
▪ the villi in the lining of the small intestine
Consultation with a skilled dietitian
gradually flatten out and disappear, leading to an
intestinal surface that is not able to absorb Education about the disease
enough nutrients from food to foster growth (in Lifelong adherence to a gluten-free diet
children) or prevent weight loss and other
Identification and treatment of nutritional deficiencies
complications in adults
▪ it is not known exactly what triggers the onset of celiac Access to an advocacy group
disease; it can occur at any age Continuous long-term follow up by a multidisciplinary team
▪ in adults, celiac disease often appears after a trauma of
Prevention:
some kind, such as infection, physical injury, the stress of ▪ no known way to prevent celiac disease because the
pregnancy, or surgery factors that trigger the appearance of the disease are not
yet understood
Signs and Symptoms:
Complications:
 diarrhea, often with watery or frothy stools that have a
very foul odor and are usually light tan or gray in color ▪ malnutrition leading to stunted growth in children and
 large amounts of intestinal gas osteoporosis in adults
 weight loss ▪ epilepsy
 fatigue and muscle weakness related to poor absorption of ▪ lactose intolerance
nutrients ▪ kidney stones
 abdominal cramps ▪ cancer, particularly lymphoma and intestinal cancer
 anemia ▪ an underfunctioning spleen
 loss of bone strength ▪ miscarriage of a pregnancy or birth defects in the baby
 seizures or tingling numbness in the legs from nerve
damage
Oral Manifestation:
 in women, missed menstrual periods, difficulty getting
 recurrent aphthous stomatitis, canker sores
pregnant, or repeated miscarriages
 atrophic glossitis
 pale sore inside the mouth
 xerostomia
 tooth discoloration or loss of tooth enamel
 squamous cell carcinoma
 an itchy skin rash known as dermatitis herpetiformis
 enamel defects
 bone or joint pain

DIVERTICULAR DISEASE

Nature and etiology

 Diverticulum - is a small tubular sac that protrudes from a main canal of cavity in the body.
 Formation and presence of small diverticula protruding from the intestinal lumen, usually the colon, produce the condition
diverticulosis.
 When pressures become sufficiently high in one of these segments and dietary fiber is insufficient diverticula become
infected and inflamed from fecal irritation and colon bacteria. This disease state is called diverticulitis.
 The commonly collective term covering diverticulosis and diverticulitis is diverticular disease.
Causative factor  Progressive increase in pressure within the bowel
from segmental circular muscle contractions that
 normally move the remaining food mass along and Nutritional management
form the feces for elimination.  Diverticular disease is often accompanied by
malnutrition.
Clinical signs and symptoms  Aggressive nutrition therapy hastens recovery from
an attack, shortens hospital stay, and reduces costs.
 Pain and tenderness (localized in the lower left side
 Eating lots of fruit and vegetables (esp.soluble fiber)
of the abdomen accompanied by nausea, vomiting,
will help keep your bowel healthy and help to stop
distention, diarrhea, intestinal spasm, and fever)
diverticular disease getting worse.
 Chills
Treatment
 Fever
 mild cramps  Surgery
 bloating  High-fiber diet
 Constipation  Pain-killer medicines
 Rectal bleeding  Antibiotics
 Change in bowel habits
*Many people that have diverticulosis have no symptoms. Prevention
Occasionally they can cause bleeding or become infected  Proper diet
(diverticulitis).  Eat foods rich in fiber

BERI BERI

Description: Etiology:
is a nervous system ailment caused by a thiamine  Thiamine deficieny
deficiency (deficiency of vitamin B1) in the diet  Malnutrition
Symptoms:  Alcoholism
  include weight loss
  emotional disturbances Treatment and Prevention
 impaired sensory perception (Wernicke's *The goal of treatment is to provide the thiamine the body is
encephalopathy) lacking.
 weakness and pain in the limbs and periods of *This is done with thiamine supplements which are given by
irregular heart rate.  injection or taken by mouth.
*Edema(swelling of bodily tissues) is common. It may  vitamins may also be recommended
increase the amount of lactic acid and pyruvic acid within the  Subsequent blood tests will determine if the
blood. In advanced cases, the disease may cause heart thiamine supplements are being effective
failure and death  thiamine hydrochloride, (tablet form or injection)

ECZEMA

Description:
*It is a form of dermatitis, or inflammation of the epidermis (the outer layer of the skin)

Symptoms: Etiology:
 dry, reddened skin that itches or burns  The exact cause of eczema is unknown, but it's
 Intense itching (generally the first symptom) thought to be linked to an overactive response by
 blisters and oozing lesion the body's immune system to unknown triggers.
 dry and scaly skin.  In addition, eczema is commonly found in families
**Repeated scratching may lead to thickened, crusty skin. with a history of other allergies or asthma.
  bubble baths
 dust mites
 food allergies
Treatment and Prevention:  overheating and sweating
avoiding known triggers, such as:  wool and polyester clothing
 harsh soaps  keeping your child's skin well-moisturized

KAWASAKI DISEASE

 also known as Kawasaki syndrome, lymph node syndrome and Mucocutaneous lymph node syndrome.

 is an autoimmune disease that manifests as a systemic necrotizing medium-sized vessel vasculitis and is largely seen in children under 5 years of age.
 It affects many organ systems, mainly those including the blood vessel, skin, mucous membrane and lymph nodes; however, its most serious effect is on
 the heart where it can cause severe coronary artery aneurysm in untreated children. 

Signs and Symptoms
 Kawasaki disease can't be prevented, but usually has telltale
symptoms and signs that appear in phases.
 The first phase, which can last for up to 2 weeks, usually involves
a persistent fever higher than 104° Fahrenheit (39° Celsius) and
lasts for at least 5 days.
Other symptoms that typically develop includes:
 severe redness in the eyes
 a rash on the stomach, chest, and genitals
 red, dry, cracked lips
 swollen tongue with a white coating and big red bumps
 sore, irritated throat
 swollen palms of the hands and soles of the feet with a purple-red
color
 swollen lymph nodes
 During the second phase, which usually begins within 2 weeks of
when the fever started, the skin on the hands and feet may begin
to peel in large pieces. The child also may experience joint pain,
diarrhea, vomiting, or abdominal pain. 
Causes
 The cause of Kawasaki disease is presumably the interaction of
genetic and environmental factors, possibly including an infection.
The specific cause is unknown, but current theories center
primarily on immunological causes for the disease.
Treatment
 Children with Kawasaki disease should be hospitalized and cared
for by a physician who has experience with this disease. 
 Intravenous immunoglobulin (IVIG) is the standard treatment for
Kawasaki disease.
 Salicylate therapy, particularly aspirin remains an important part
of the treatment but salicylates alone are not as effective as IVIG.

OSTEOMALACIA

Description:
 involves softening of the bones caused by a deficiency of vitamin D or problems with the metabolism of this vitamin.
 Osteomalacia means soft bones.
 Like osteoporosis, osteomalacia weakens the bones and makes bones more likely to break. However, the process is
different from that in osteoporosis. In osteoporosis, bone is broken down faster than it is re-formed. In osteomalacia, the
two activities are balanced, but the bone that is formed does not become dense and hard (mineralized).

Sign and Symptoms:

Adult osteomalacia may produce vague symptoms of bone or muscle pain and tenderness. Fractures are rare and usually
asymptomatic. Occasionally a marked proximal myopathy leads to a characteristic 'waddling' gait. Deformity is uncommon. In
modern practice many cases are detected biochemically in high-risk patients, especially those with gastrointestinal disease or
surgery, before clear symptoms are present. Occasionally, tetany or other hypocalcaemic features may occur.

Etiology:
Osteomalacia has been associated with many mesenchymal tumours which are believed to produce a humoral factor
'phosphatonin' which increases phosphate excretion. Treatment of the tumour results in remineralization. Cause of Osteomalacia

Vitamin D deficiency is usually due to inadequate sunlight exposure, particularly in Asian women in Western countries whose
clothing covers their skin, and whose diet may contain only small amounts of vitamin D. The elderly who are immobile and
housebound similarly are not exposed to sunlight. Anticonvulsant therapy may affect vitamin D metabolism; these drugs are also
toxic to osteoblasts. Malabsorption of vitamin D rarely occurs in gastrointestinal disease.
Treatment and Prevention:

Health education to ensure a balanced diet, adequate exposure to sunlight and, where appropriate in high-risk individuals
or communities, dietary vitamin D supplementation are all important aspects of prevention. Treatment should be directed towards
correction of the cause where possible, with increase in dietary vitamin D intake and sunlight exposure.

PARKINSON’S DISEASE

DESCRIPTION:
• also known as Parkinson's, Parkinson disease, or PD
• is a degenerative disorder of the central nervous system that impairs motor skills, cognitive processes, and other functions.
PD is the most common cause of chronic progressive syndrome characterized by tremor, rigidity, bradykinesia and postural
instability.
• PD is also called "primary parkinsonism" or "idiopathic PD" (meaning having no known cause), although some cases have a
genetic origin. Many risk and protective factors have been investigated, showing an increased risk of PD in those living in
rural environments and those exposed to pesticides; and a reduced risk in smokers.

SIGNS AND SYMPTOMS:

• Parkinson's disease affects movement, producing motor symptoms. Non-motor symptoms, which include autonomic
dysfunction, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common but are under-
appreciated.
• MOTOR
-Four motor symptoms are considered cardinal in PD: tremor, rigidity, bradykinesia and postural instability.
- Tremor is the most apparent and well-known symptom. It is most commonly a rest tremor
- Rigidity is due to joint stiffness and increased muscle tone, which combined with a resting tremor produce a
ratchety, "cogwheel rigidity" when the limb is passively moved.
- Bradykinesia (slowness of movement) is the most characteristic clinical feature of PD and it produces difficulties
not only with the execution of a movement but also with its planning and initiation.
-
ETIOLOGY:
Most people with Parkinson's disease are described as having idiopathic Parkinson's disease (having no specific known cause). A viral
origin has been proposed. A small proportion of cases are known to originate as genetic factors.
• Genetic
- PD traditionally has been considered a non-genetic disorder, however around 15% of individuals with PD have a first-
degree relative who also has the disease. At least 5% of the patients are now known to have monogenic forms of the disease. Other
genes act as risk factors for sporadic cases of the disease.

TREATMENT:
There is no cure for Parkinson's disease. Treatment centers on the administration of medication to relieve symptoms. The Food and
Drug Administration (FDA) also has approved a surgically-implanted device that lessens tremors. In some severe cases, a surgical
procedure may offer the greatest benefit.
Medication selection and dosage is tailored to each individual patient. In deciding on a treatment, the physician considers
factors such as severity of symptoms, age, and presence of other medical conditions. No two patients respond identically to a
particular drug or dosage level, so this process involves experimentation, persistence, and patience.

PREVENTION:
There may be several alleged ways of preventing Parkinson's disease, but the fact is that researchers have not yet discovered a way
to prevent this condition. Some researchers believe that free radicals may be one of the causes of Parkinson's disease.
-Antioxidants may help protect cells from free-radical damage and, thereby, reduce the risk of developing Parkinson's
disease. However, more research is necessary to support this claim.
ORAL MANIFESTATION:
- Includes difficulty in swallowing and excess salivation

PELLAGRA

Alternative names: Vitamin B3 deficiency; Niacin deficiency

DESCRIPTIONS:
 is a systemic nutritional wasting disease caused by a cellular deficiency of vitamin B3 (niacin), which is an essential
component of several coenzymes
  It is frequent in Asia and Africa where the diet is nicotinic acid deficient or corn-based with inadequate animal protein,
fruits and vegetables.
 Typically is an adult disease. Adolescents and young children could develop pellagra if exposed to a pellagragenic diet.
Pellagra rarely occurs during infancy. Historically, the dermatitis of kwashiorkor has been mistaken as infantile pellagra.

ETIOLOGY:

Pellagra is caused by a deficiency in niacin. This can occur in 2 ways:

 Primary pellagra results from inadequate niacin and/or tryptophan in the diet (mainly in developing countries or poverty
stricken areas)
 Secondary pellagra occurs when there is enough niacin in the diet but something prevents its absorption and processing.
Causes of secondary pellagra include:
 Chronic alcoholism
 Prolonged diarrhoea
 Gastrointestinal diseases such as ulcerative colitis
 Liver cirrhosis
 Carcinoid tumours
 Hartnup disease (tryptophan metabolism disorder)
 Drugs e.g. isoniazid, azathioprine

SIGNS AND SYMPTOMS:

Pellagra is classically described by "the four D's": diarrhea, dermatitis, dementia and death.

Site Clinical features

Skin  The first sign is reddened skin with superficial scaling in areas exposed to sunlight, heat & friction.
This may resemble severe sunburn then gradually subsides leaving a dusky brown-red coloration.
(High sensitivity to sunlight)
 The rash is usually symmetrical with a clear edge between affected and unaffected skin
 There may be itching or a burning sensation
 In time the skin becomes thick, hard, scaly and cracked. Bleeding may result in blackened crusts
 Lesions may occur anywhere on the body especially the hands, arms, lower legs, feet, face, and neck
(known as Casal's necklace)
 Lips, tongue and gums may be sore and peeling

Gastrointestinal  Diarrhea occurs in 50% of cases

 Poor appetite, abdominal pain, nausea and vomiting are common
 It may be difficult to eat and drink, leading to further malnutrition
Neurological  Initially symptoms of apathy and slight depression may go unnoticed
 Other symptoms include headache, confusion, irritability, restlessness, anxiety, tremor, delusions,
disorientation and psychosis, insomnia, ataxia, paralysis of extremities, peripheral neuritis
 Patients eventually become stuporous, comatose and may die

More specific  Psycho-sensory disturbances (impressions as being painful, annoying bright lights, odours
psychological intolerance causing nausea and vomiting, dizziness after sudden movements)
symptoms  Psycho-motor disturbances (restlessness, tense and a desire to quarrel, increased preparedness for
motor action)
 Emotional disturbances

ORAL MANIFESTATION:
 The oral mucosa is involved with edema, redness and intense burning sensation
 The tongue is smooth because of desquamation of papillae
 Gingivitis
 dry and fissured lips
 angular cheilitis; and
 dysphagia

TREATMENT:
Pellagra can be effectively cured with intravenous or oral niacin or nicotinamide. Adequate doses to treat secondary
pellagra are quite hard to get hold of in New Zealand!
An improvement in primary pellagra should be seen within two days of commencing treatment. A high protein diet
supplemented with B-group vitamins is needed for complete recovery. Secondary pellagra may be harder to treat in view of its
possible causes.
Skin lesions may be treated with topical emollients. Sun protection is important during the recovery phase. Cover up and
apply a broad spectrum sunscreen to all exposed areas daily.

GLOSSITIS

-Deficiencies in B12, folate, zinc or iron.

- inflammation or infection of the tongue. It causes the tongue to swell and change color.
Finger-like projections on the surface of the tongue (papillae) may be lost, causing the tongue to appear smooth.

SIGN AND SYMPTOMS

-Tongue swelling.
-Smooth appearance to the tongue due to
-Pernicious anemia (vitamin B12 deficiency).
-Tongue color changes (usually dark "beefy" red).
-Sore and tender tongue.
-Difficulty with chewing, swallowing, or speaking.

ETIOLOGY  -Mechanical irritation or injury from burns,

 -Bacterial or viral infections (including rough edges of teeth or dental appliances, or
oral herpes simplex). other trauma
 -Poor hydration and low saliva in the mouth  -Tongue Piercings
may allow bacteria to grow more readily.  -Exposure to irritants such
as tobacco, alcohol, hot foods, or spices.
  -Allergic reaction to toothpaste, mouthwash,
breath fresheners, dyes in confectionery,
plastic in dentures or retainers, or certain
blood-pressure medications (ACE inhibitors).
 -Administration of ganglion blockers (eg.
Tubocurarine, Mecamylamine).
TREATMENT
 --The goal of treatment is to reduce
inflammation.
 --Treatment usually does not require
hospitalization unless tongue swelling is
severe.
 --Good oral hygiene is necessary, including
thorough tooth brushing at least twice a day,
and flossing at least daily.
 Corticosteroids such as
prednisone may be given to
reduce the inflammation of
glossitis. For mild cases, topical
applications (such as a
prednisone mouth rinse that is
not swallowed) may be
recommended to avoid the side
SCURVY
 is a condition characterized by
- general weakness
- Anemia
- gum disease (gingivitis)
- and skin hemorrhages
- **resulting from a lack of ascorbic
acid (vitamin C) in the diet
Most Common Causes of Scurvy
 Inadequate diet
 Scurvy develops when the diet lacks adequate amounts of vitamin C
 Certain conditions increase the body's demand for vitamin C increasing the risk of deficiency
 Conditions include pregnancy, breastfeeding, diarrhea, inflammatory diseases, burns, surgery, and exposure to
intense heat or cold
 Alcoholism
 Scurvy is most often found in alcoholic peoples
 Stress
 Another important cause of scurvy is stress which increases the utilization of ascorbic acid
Common Signs and Symptoms
 General weakness
effects of swallowed or injected
corticosteroids.
 --Antibiotics, antifungal medications, or
other antimicrobials may be prescribed if the
cause of glossitis is an infection.
 --Anemia and nutritional deficiencies must
be treated, often by dietary changes or other
supplements.
 --Avoid irritants (such as hot or spicy foods,
alcohol, and tobacco) to minimize the
discomfort.
PREVENTION
 -Good oral hygiene (thorough tooth brushing
and flossing and regular professional cleaning
and examination) may be helpful to prevent
these disorders.
 -Drinking plenty of water and the production
of enough saliva, aid in the reduction of
bacterial growth.
 -Minimize irritants or injury in the mouth
when possible. Avoid excessive use of any
food or substance that irritates the mouth or
tongue.
 Scurvy is now most frequently seen in older
& malnourished adults
Alternative Names of Scurvy
*Vitamin C deficiency
*Deficiency - vitamin C
*Scorbutus
 The first signs of the disease are exhaustion
and general weakness
  At the later stages, there is bleeding of the  The blood capillaries become fragile in the
gums, because the lack of vitamin C (ascorbic deficiency of vitamin-c.
acid) makes the capillaries fragile and their  Bleeding from old scars
rupture is common  Internal bleeding occurs in the affected area of the
 Loosening of Teeth body
 It is a commonest symptom of scurvy  Fatigue
 If not treated earlier, it may be lead to chronic  Anemia
condition  Due to the deficiency of ascorbic acid, there
 Tiredness will be shortage of blood in the body.
 In the deficiency of vitamin-c, there is a feeling  Common cold/sore throat
of tiredness  Heart attack
 Irritability  Joint pain
 Aches and pains  Black-and-blue marks on the skin
 Due to the deficiency of vitamin-c, there  Poor healing of bruises
would be pain in different parts of body  Gum disease
 Weak capillaries  Spongy gums
 Thin hair

Common Home Remedies for the Treatment of Scurvy

 Lime and Lemon:
 The use of lime and lemon is highly beneficial in the prevention and treatment of scurvy. Being rich sources of vitamin
C, lime and lemon are regarded as foods of exceptional therapeutic value
 Potato
 Potato is regarded as an excellent food remedy for scurvy
 Vinegar
 Vinegar is very effective for the treatment of scurvy.
 Aspirin
 If there is pain in your body due to the deficiency of ascorbic acid, take 1 tab after meal.
 Tomato
 The presence of vitamin C in tomatoes helps it to fight diseases like scurvy. By drinking tomato juice everyday you can
see the difference

Herbal Remedies for Scurvy

 Sharpunkha ---This herb is very effective for the treatment of scurvy
 Arjuna ----It helps to fulfill the requirement of vitamin-c in the body
 Pitpada ---It is used for the healing purpose due to the deficiency of vitamin-c

____________________________________________________________________________________________________________
INSOMIA

DESCRIPTION
 By definition, insomnia is "difficulty initiating or maintaining  sleep, or both" or the “perception of poor quality sleep.”
 A calcium, iodine, potassium and magnesium deficiency.
 may therefore be due to inadequate quality or quantity of sleep. 

Classification of insomnia  It is typically more common in people in lower

 transient insomnia socioeconomic (income) groups,  chronic
¤symptoms lasting less than one week alcoholics, and mental health patients. 
 short-term insomnia
¤symptoms between one to three weeks  SIGNS AND SYMPTOMS
 chronic insomnia  Stress 
¤those longer than three weeks -most commonly triggers short-term or acute
insomnia. (If you do not address your insomnia,
Statistics on Insomnia however, it may develop into chronic insomnia.)
“Insomnia affects all age groups.“  Poor concentration and focus
 Among adults, insomnia affects women more  Difficulty with memory
often than men.  Impaired motor coordination (being uncoordinated)
  Irritability and impaired social interaction
 Motor vehicle accidents because of fatigued, sleep-
deprived drivers
ETIOLOGY OF INSOMIA
Many of the causes of transient and short-term
insomnia are similar and they include:
 Jet lag
 Changes in shift work
 Excessive or unpleasant noise
 Uncomfortable room temperature (too hot or too
cold)
 Stressful situations in life (exam preparation, loss of
a loved one, unemployment, divorce, or separation)
 Presence of an acute medical or surgical illness or
hospitalization
 Withdrawal from drug, alcohol, sedative, or
stimulant medications
 Insomnia related to high altitude (mountains)
TREATMENT
Insomnia Non-Medical treatment and Behavioral Therapy
 Non-pharmacologic or non-medical therapies are sleep
hygiene, relaxation therapy, and stimulus control. These
also are referred to as cognitive behavioral therapies.
Sleep Hygiene
 Sleep hygiene is one of the components of behavioral
therapy for insomnia. Several simple steps can be taken
to improve a patient's sleep quality and quantity. These
steps include:
1. Sleep as much as you need to feel rested; do not
oversleep.
2. Exercise regularly at least 20 minutes daily, ideally
4-5 hours before your bedtime.
3. Avoid forcing yourself to sleep.
4. Keep a regular sleep and awakening schedule.
5. Do not drink caffeinated beverages later than the
afternoon (tea, coffee, soft drinks etc.)
6. Avoid "night caps," (alcoholic drinks prior to going
to bed). PREVENTION
General recommendations for prevention of insomnia include
7. Do not smoke, especially in the evening.
the following:
8. Do not go to bed hungry.
9. Adjust the environment in the room (lights,
temperature, noise, etc.)
10. Do not go to bed with your worries; try to resolve
them before going to bed.
Relaxation Therapy
it involves measures such as:
_______________________________________________________________________________________________________
RICKETS
 The origin of the word "rickets" is probably from the
Old English dialect word “wrickken”, meaning “to
twist” .
 meditation and muscle relaxation
 dimming the lights and playing soothing music prior to
going to bed.
Stimulus Control
This also consists of a few simple steps that may help
patients with chronic insomnia.
1. Go to bed when you feel sleepy.
2. Do not watch TV, read, eat, or worry in bed. (Your
bed should be used only for sleep and sexual
activity.)
3. If you do not fall asleep 30 minutes after going to
bed, get up and go to another room and resume
your relaxation techniques.
4. Set your alarm clock to get up at a certain time each
morning, even on weekends. Do not oversleep.
5. Avoid taking long naps in the daytime.
Insomnia Medications and Medical Therapies
Prescription Sleep Aids
 Benzodiazepine sedatives: (it include):
a)  temazepam (Restoril)
b) flurazepam (Dalmane)
c) triazolam (Halcion)
d) estazolam (ProSom, Eurodin),
e) lorazepam(Ativan)
f) clonazepam (Klonopin)
 Nonbenzodiazepine sedatives: (it include)
a)  eszopiclone (Lunesta)
b) zaleplon (Sonata)
c) zolpidem (Ambien)
Over-the-Counter (OTC) Medication
 Antihistamines 
used in treating insomnia as they may induce
drowsiness, but they do not improve sleep and should
not be used to treat chronic insomnia.
 Learn to relax. Self-hypnosis, biofeedback and
relaxation breathing are often helpful.
 Control your environment.
a) Avoid light, noise, and excessive temperatures.
b) Use the bed only to sleep and avoid using it for
reading and watching TV.
c) Sexual activity is an exception.
 Establish a bedtime routine. Fix wake time.
 The Greek derived word "rachitis" (meaning
"inflammation of the spine") was later adopted as the
 scientific term for rickets, due chiefly to the words
similarity in sound.
 DESCRIPTION
 is a disorder caused by a lack of vitamin D,
calcium, or phosphate. It leads to softening and
weakening of the bones.
 is a softening of bones in children potentially
leading to fractures and deformity.
 Rickets is among the most frequent childhood
diseases in many developing countries.
 Although it can occur in adults, the majority of
cases occur in children suffering from severe
malnutrition, usually resulting from famine or
starvation during the early stages of childhood.
 Osteomalacia is the term used to describe a
similar condition occurring in adults, generally due
to a deficiency of vitamin D.
 SIGNS and SYMPTOMS
 Bone pain or tenderness
 Arms
 Legs
 Pelvis
 Spine
 Dental deformities
 Delayed formation of teeth
 Decreased muscle tone (loss of muscle
strength)
 Defects in the structure of teeth; holes in
the enamel
 Increased cavities in the teeth (dental
caries)
 Progressive weakness
 Impaired growth
 Increased bone fractures
 Muscle cramps
 Short stature (adults less than 5 feet tall)
 Skeletal deformities
 Asymmetrical or odd-shaped skull
 Bowlegs
 Bumps in the ribcage (rachitic rosary)
 Breastbone pushed forward (pigeon
chest)
 Pelvic deformities
 Spine deformities (spine curves
abnormally, including scoliosis or
kyphosis)
 CAUSES
 Vitamin D helps the body control calcium and
phosphate levels. If the blood levels of these minerals
become too low, the body may produce hormones
that cause calcium and phosphate to be released
from the bones. This leads to weak and soft bones.
Vitamin D is absorbed from food or produced by the skin
when exposed to sunlight. Lack of vitamin D production by
the skin may occur in people who:
 Live in climates with little exposure to sunlight
 Must stay indoors
 Work indoors during the daylight hours
You may not get enough vitamin D from your diet if you:
 Are lactose intolerant (have trouble digesting milk
products)
 Do not drink milk products
 Follow a vegetarian diet
 Infants who are breastfed only may develop
vitamin D deficiency. Human breast milk
does not supply the proper amount of
vitamin D. This can be a particular problem
for darker-skinned children in winter months
(when there are lower levels of sunlight).
 Not getting enough calcium and
phosphorous in your diet can also lead to
rickets. Rickets caused by a lack of these
minerals in diet is rare in developed
countries, because calcium and phosphorous
are found in milk and green vegetables.
 Your genes may increase your risk of
rickets. Hereditary rickets is a form of the
disease that is passed down through families.
It occurs when the kidneys are unable to
hold onto the mineral phosphate. Rickets
may also be caused by kidney disorders that
involve renal tubular acidosis.
 Disorders that reduce the digestion or
absorption of fats will make it more difficult
for vitamin D to be absorbed into the body.
 Occasionally, rickets may occur in children
who have disorders of the liver, or who
cannot convert vitamin D to its active form.
 TREATMENT
 Replacing calcium, phosphorus, or vitamin
D that is lacking will eliminate most
symptoms of rickets. Dietary sources of
vitamin D include fish, liver, and processed
milk. Exposure to moderate amounts of
sunlight is encouraged. If rickets is caused
by a metabolic problem, a prescription for
vitamin D supplements may be needed.
 Positioning or bracing may be used to
reduce or prevent deformities. Some
skeletal deformities may require corrective
surgery.
 Plenty of sunlight, fresh air and muscular
exercise are essential.
 PREVENTION
 You can prevent rickets by making sure
that your child gets enough calcium,
phosphorus, and vitamin D in the diet.
 People who have gastrointestinal or other
disorders may need to take supplements.
Ask your child's health care provider.
 Kidney (renal) causes of poor vitamin D
absorption should be treated right away.
People who have renal disorders should
have their calcium and phosphorus levels
monitored regularly.
 Genetic counseling may help people who
have a family history of inherited disorders
that can cause rickets.