Search Results (34)

Background and clinical significance: Scurvy, resulting from vitamin C deficiency, is rare in the 21st century, particularly in high-income settings. Its nonspecific presentation and ability to mimic a wide range of conditions make diagnosis incredibly challenging. Pseudovasculitic petechial lesions of the lower limbs may be misdiagnosed as systemic vasculitis, often leading to extensive investigations and delayed treatment. Case presentation: We report the case of a 45-year-old woman who presented with progressive lower limb pain, swelling, and vasculitis-like petechial rash with ecchymoses. Extensive investigations for autoimmune, infectious, malignant, and vascular causes, including skin biopsy, were unremarkable. A detailed dietary history revealed markedly restrictive intake. Characteristic dermatological findings, including perifollicular haemorrhage, ecchymoses and hair shaft abnormalities, raised suspicion for scurvy. Profoundly reduced serum ascorbic acid levels confirmed vitamin C deficiency. Conclusions: This case highlights the importance of thorough dietary assessment, recognition of characteristic cutaneous features, and identification of risk factors such as restrictive eating patterns or chronic gastrointestinal symptoms. It underscores the need for a high index of clinical suspicion for scurvy, even in contemporary high-income settings. Early diagnosis and vitamin C supplementation can result in rapid clinical improvement and prevent avoidable morbidity. Full article

Background and Clinical Significance: Scurvy, caused by chronic vitamin C deficiency, is re-emerging in Western countries, particularly among pediatric patients with highly selective diets. While its musculoskeletal and mucocutaneous manifestations are well-known, its association with pulmonary arterial hypertension (PAH) is rare and poorly understood. Ascorbic acid and iron are essential cofactors for prolyl hydroxylases (PHD), which regulate Hypoxia-Inducible Factors. Their combined deficiency may trigger a “pseudohypoxic” state, leading to pulmonary vascular remodeling and vasoconstriction. Case Presentation: A 30-month-old female presented with a one-month history of limping, lower limb pain, and gingival hypertrophy. Dietary history revealed an almost exclusive cow’s milk-based intake. Physical examination showed diffuse petechiae, pallor, and right knee edema. Laboratory findings confirmed scurvy (undetectable vitamin C), severe iron-deficiency anemia (Hb: 72 g/L; ferritin: 22 mcg/L; RDW: 30%), folate deficiency, and hyperhomocysteinemia. Notably, elevated copper and vitamin B12 levels suggested a state of metabolic dysregulation. Echocardiography revealed moderate PAH phenotype (estimated sPAP: 47–50 mmHg) and a hyperdynamic contractility. A “perfect storm” mechanism was hypothesized, involving iron–ascorbate-dependent PHD impairment, high-output state, and oxidative-stress-induced hepcidin dysregulation (suggested by elevated copper). Following intravenous vitamin C and multivitamin supplementation, pulmonary pressures normalized within one week. Conclusions: PAH phenotype in scurvy represents a reversible metabolic disruption of pulmonary vascular tone rather than a structural disease. This case underscores the synergistic role of vitamin C, iron, and folate in vascular homeostasis. Clinicians should maintain high suspicion for scurvy in children with selective diets and unexplained PAH, as nutritional restoration is curative. Full article

Background: Vitamin C deficiency remains an under-recognized condition in children, especially in Southeast Asia. This study aimed to study the clinical characteristics, dietary risk factors, and outcomes of pediatric vitamin C deficiency in a tertiary hospital in Southern Thailand. Methods: This retrospective study reviewed the medical records of children aged 1 to 15 years diagnosed with vitamin C deficiency from 2004 to 2024. Diagnosis was based on serum ascorbic acid levels below 0.4 mg/dL, or clinical-radiographic findings. Data collected included demographics, developmental status, dietary history, clinical presentations, radiological and laboratory results, treatment, and outcomes. Results: Forty-six children were diagnosed; the median age was 4.8 years, and 60% were male; developmental delay was present in 54.4%. The majority had poor dietary intake, with 73% not consuming adequate fruits and vegetables; no significant differences were observed when classified by developmental status. Common clinical signs included: limb pain (76.1%), refusal to walk (52.2%), and bleeding gums (39.1%). Radiographs showed osteopenia in 73.8% and white line of Frankel in 47.6%. Serum ascorbic acid deficiency was significantly associated with low fruit and vegetable intake and excessive milk consumption over the recommendations (p < 0.05). Treatment with oral vitamin C resulted in clinical improvement; although, residual symptoms persisted in some cases. Conclusions: As pediatric vitamin C deficiency is still of concern, this study highlights the importance of early detection in at-risk children and the critical role of detailed dietary history to identify inadequate nutrition. Prompt recognition and intervention can prevent misdiagnosis and improve clinical outcomes. Hence, strengthening parental education on nutritional intake is essential to reduce future incidences. Full article

The medlar (Mespilus germanica) is a deciduous tree that belongs to the Rosaceae family. This plant has been valued throughout history for its culinary uses and medicinal applications. Medlar fruit contains a high amount of vitamin C, carbohydrates, and pectin, making it a valuable remedy for treating scurvy. In folk medicine, medlar is used to treat constipation and other digestive issues. This study investigates the quantitative composition and seasonal variation in phenolic compounds in flowers, leaves, and fruits of Mespilus germanica L. using high performance liquid chromatography, as well as total phenolic content and antioxidant activity. The predominant class of phenolics in flowers were flavonols, with 52.5% of the total phenolic content. On the other hand, dominant phenolics in fruits were flavan-3-ols, with procyanidin B2 and epicatechin being most abundant, whereas in leaves, hydroxycinnamic acids were the most prevalent phenolic compounds. Seasonal variations were noted for analyzed compounds in various plant parts. This study highlights significant changes in the phenolic profile of M. germanica during various harvesting periods and suggests that both fruits and leaves are rich sources of bioactive compounds. However, its nutraceutical potential might depend on harvesting time. Full article

Background: Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring radiological investigations. Objective: This study aims to describe the radiological signs of scurvy on pelvic magnetic resonance imaging (MRI) in children presenting with musculoskeletal symptoms and to highlight features that may help differentiate it from other conditions with similar presentations. Methods: We conducted a retrospective study including children admitted for musculoskeletal symptoms requiring a pelvic MRI and who were subsequently diagnosed with scurvy. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. Results: We identified ten patients with a median age at disease onset of 45 months (range 17–133 months) admitted between 2016 and 2022. All ten patients included in the study were male. All had at least one of the following symptoms: limping, pain in the lower limbs, or refusal to walk, in addition to gum bleeding (7/10), hypertrophic gums (5/10), purpura (3/10), irritability (3/10), and fever (2/10). In all patients, pelvic MRI showed a bilateral, patchy, abnormal, water-like signal intensity pattern in the sacroiliac area. Sacroiliitis was detected in three children and hip effusion in another child. Seven out of these ten patients had a previous pelvis X-ray that was negative. Conclusions: In scurvy, the pelvis is often prematurely affected, with bone marrow accumulating water and joints showing inflammatory changes, particularly at the hips and sacroiliac joints. Due to its ability to assess soft tissues and its high sensitivity to water content, MRI is the ideal imaging tool to assess these changes. In contrast, plain radiography is less sensitive and specific and may be uninformative in the early stages of the disease. Full article

Vitamin C, also known as ascorbic acid, is an essential nutrient that humans cannot synthesize, making its intake crucial for health. Discovered nearly a century ago, vitamin C is widely recognized for its ability to prevent scurvy and has become one of the most commonly used supplements. Beyond its antioxidant activity, vitamin C is pivotal in regulating lipid metabolism, promoting angiogenesis, enhancing collagen synthesis, modulating remodeling, and stabilizing the extracellular matrix. While preclinical studies have shown promising results, clinical trials have yielded inconsistent findings, due to suboptimal study design, results misinterpretation, and misleading conclusions. This review provides a holistic overview of existing evidence on the pleiotropic role of vitamin C in cardiovascular diseases, identifying both the strengths and limitations of current research and highlighting gaps in understandings in vitamin C’s underlying mechanisms. By integrating molecular insights with clinical data and evaluating the pleiotropic role of vitamin C in cardiovascular disease management and prevention, this review aims to guide future research toward personalized, evidence-based therapeutic strategies in clinical practice. Full article

Background/Objectives: Assessment of vitamin C status rarely occurs in hospital patients within high-income countries on the assumption that vitamin C deficiency (VCD) is rare, and evidence on prevalence, risk factors, and clinical outcomes of VCD is limited. This study aimed to describe the prevalence of VCD, characteristics of patients with VCD, and identify risk factors and clinical outcomes associated with VCD status in adult hospitalised patients. Methods: This retrospective observational study included adult inpatients from five metropolitan hospitals within a single public health service in Australia which provides tertiary, acute, and sub-acute care, over a 3.5-year period. Non-fasting vitamin C levels were examined for the prevalence of VCD, defined as <11.4 µmol/L. Multivariate regression models were used to identify risk factors and clinical outcomes associated with VCD. Results: The prevalence of VCD was 22.9% (n = 1791), comprising 23.2% (n = 1717) and 16.2% (n = 74) within acute and sub-acute settings, respectively. VCD prevalence was high in acute setting subgroups including patients with malnutrition (30%, n = 611) and patients admitted to ICU during hospitalisation (37.3%, n = 327). Malnutrition (OR 1.50, 95% CI 1.19–1.91, p < 0.001) and male gender (OR 1.47, 95% CI 1.17–1.86, p = 0.001) were associated with VCD. VCD was not associated with clinical outcomes including in-hospital death, hospital or intensive care unit LOS, or hospital-acquired complications. Conclusions: VCD exists within adult hospital patients in high-income countries, and early, targeted detection of VCD in this setting is warranted. Further research is needed to explore the impact of VCD on hospital clinical outcomes. Full article

Since Albert Szent-Györgyi discovered it and it became used in treating scurvy, vitamin C has attracted interest in many studies due to its unique properties. It is an important cofactor in the synthesis of collagen and hormones, and it is involved in immunity, iron absorption, and processes requiring antioxidants. Thus, this review aims to emphasize the importance and usefulness of vitamin C in improving quality of life and preventing various diseases (e.g., chronic diseases, cardiovascular diseases, cancer) but also for its use in treatments against infections, neurodegenerative diseases, and cancer. Although the studies presented provide essential information about the properties of VIC and its beneficial effect on health, some studies contradict these theories. In this respect, further studies on larger samples and over a longer period are needed to demonstrate the therapeutic potential of this nutrient. However, VIC remains a necessary vitamin that should be consumed daily to maintain optimal health and prevent deficiencies that can lead to scurvy and its associated complications. Full article

Vitamin C is an organic compound biosynthesized in plants and most vertebrates. Since its discovery, the benefits of vitamin C use in the cure and prevention of various pathologies have been frequently reported, including its anti-oxidant, anti-inflammatory, anticoagulant, and immune modulatory properties. Vitamin C plays an important role in collagen synthesis and subsequent scurvy prevention. It is also required in vivo as a cofactor for enzymes involved in carnitine and catecholamine norepinephrine biosynthesis, peptide amidation, and tyrosine catabolism. Moreover, as an enzymatic cofactor, vitamin C is involved in processes of gene transcription and epigenetic regulation. The absence of the synthesis of L-gulono-1,4-lactone oxidase, a key enzyme in the pathway of vitamin C synthesis, is an inborn metabolism error in some fishes and several bird and mammalian species, including humans and non-human primates; it is caused by various changes in the structure of the original GULO gene, making these affected species dependent on external sources of vitamin C. The evolutionary cause of GULO gene pseudogenization remains controversial, as either dietary supplementation or neutral selection is evoked. An evolutionary improvement in the control of redox homeostasis was also considered, as potentially toxic H₂O₂ is generated as a byproduct in the vitamin C biosynthesis pathway. The inactivation of the GULO gene and the subsequent reliance on dietary vitamin C may have broader implications for aging and age-related diseases, as one of the most important actions of vitamin C is as an anti-oxidant. Therefore, an important aim for medical professionals regarding human and animal health should be establishing vitamin C homeostasis in species that are unable to synthesize it themselves, preventing pathologies such as cardiovascular diseases, cognitive decline, and even cancer. Full article

To characterize the nutrients and bioactive compounds in grape berries and to explore the real cause of the “French paradox” phenomenon, we performed metabolomic analysis of 66 grape varieties worldwide using liquid chromatography–tandem mass spectrometry (LC-MS). A nontargeted metabolomics approach detected a total of 4889 metabolite signals. From these, 964 bioactive and nutrient compounds were identified and quantified, including modified flavonoids, medicinal pentacyclic triterpenoids, vitamins, amino acids, lipids, etc. Interestingly, metabolic variations between varieties are not explained by geography or subspecies but can be significantly distinguished by grapes’ color, even after excluding flavonoids and anthocyanins. In our analysis, we found that purple grape varieties had the highest levels of key bioactive components such as flavonoids, pentacyclic triterpenes, and polyphenols, which are thought to have a variety of health benefits such as antioxidant, anti-inflammatory, and antitumor properties, when compared to grapes of other colors. In addition, we found higher levels of vitamins in red and pink grapes, possibly explaining their role in preventing anemia and scurvy and protecting the skin. These findings may be a major factor in the greater health benefits of wines made from purple grapes. Our study provides comprehensive metabolic profiling data of grape berries that may contribute to future research on the French paradox. Full article

L-ascorbic acid (AsA, vitamin C) plays a vital role in preventing various diseases, particularly scurvy. AsA is known for its antioxidant properties, which help protect against reactive oxygen species generated from metabolic activities; however, at high doses, it may exhibit pro-oxidative effects. The final step in AsA biosynthesis is catalyzed by L-gulono-γ-lactone oxidase (GULO). This enzyme is present in many organisms, but some animals, including humans, guinea pigs, bats, and other primates, are unable to synthesize AsA due to the absence of a functional GULO gene. The GULO enzyme belongs to the family of aldonolactone oxidoreductases (AlORs) and contains two conserved domains, an N-terminal FAD-binding region and a C-terminal HWXK motif capable of binding the flavin cofactor. In this review, we explore AsA production, the biosynthetic pathways of AsA, and the localization of GULO-like enzymes in both animal and plant cells. Additionally, we compare the amino acid sequences of AlORs across different species and summarize the findings related to their enzymatic activity. Interestingly, a recombinant C-terminal rat GULO (the cytoplasmic domain of the rat GULO expressed in Escherichia coli) demonstrated enzymatic activity. This suggests that the binding of the flavin cofactor to the HWXK motif at the C-terminus is sufficient for the formation of the enzyme’s active site. Another enzyme, GULLO7 from Arabidopsis thaliana, also lacks the N-terminal FAD-binding domain and is strongly expressed in mature pollen, although its activity has not been specifically measured. Full article

The income and residue production from agriculture has a strong impact in Spain. A circular economy and a bioeconomy are two alternative sustainable models that include the revalorization of agri-food by-products to recover healthy biomolecules. However, most crops are conventional, implying the use of pesticides. Hence, the reutilization of agri-food by-products may involve the accumulation of pesticides. Even though the waste-to-bioproducts trend has been widely studied, the potential accumulation of pesticides during by-product revalorization has been scarcely assessed. Therefore, in this study, the most common pesticides found in eight highly productive crops in Spain are evaluated according to the available published data, mainly from EFSA reports. Among these, oranges, berries and peppers showed an increasing tendency regarding pesticide exceedances. In addition, the adverse effects of pesticides on human and animal health and the environment were considered. Finally, a safety assessment was developed to understand if the reutilization of citrus peels to recover ascorbic acid (AA) would represent a risk to human health. The results obtained seem to indicate the safety of this by-product to recover AA concentrations to avoid scurvy (45 mg/day) and improve health (200 mg/day). Therefore, this work evaluates the potential risk of pesticide exposure through the revalorization of agri-food by-products using peels from citruses, one of the major agricultural crops in Spain, as a case study. Full article

Scurvy is a nutritional deficiency caused by low vitamin C levels that has been described since ancient times. It leads to a varied presentation, affecting multiple organ systems due to its role in the biochemical reactions of connective tissue synthesis. Common manifestations include gingival bleeding, arthralgias, skin discoloration, impaired wound healing, perifollicular hemorrhage, and ecchymoses. Although there has been a dramatic reduction in the prevalence of scurvy in modern times owing to vitamin C supplementation and intake, sporadic cases still occur. In developed countries, it is mainly diagnosed in the elderly and malnourished individuals and is associated with alcoholism, low socio-economic status, and poor dietary habits. Scurvy has been an unusual cause of gastrointestinal (GI) bleeding among other GI manifestations. It can be adequately treated and prevented via vitamin C supplementation. Full article

Salicornia is a halophyte plant that has been used in traditional medicine for the treatment of scurvy, goiter, and hypertension. It is commercialized in Europe and Asia as fresh salads, pickled vegetables, green salt, or tea powder. This work is the first to assess the potential anti-obesity and anti-dyslipidemic effects of Salicornia arabica decocted extract (SADE). SADE was characterized by its significant in vitro radical scavenging activity (using DPPH and ABTS assays). The effect of SADE on food intake, weight loss, serum biochemical parameters, liver and kidney weights, adiposity index and on liver histology was investigated in the Tunisian gerbil Psammomys obesus (P. obesus), which is recognized as a relevant animal model of human obesity and diabetes. P. obesus animals were firstly randomly divided into two groups: the first received a natural low-calorie chow diet (LCD), and the second group received a high-calorie diet (HCD) over 12 weeks. On day 90, animals were divided into four groups receiving or not receiving SADE (LCD, LCD + SADE, HCD, and HCD + SADE). If compared to the HCD group, SADE oral administration (300 mg/kg per day during 4 weeks) in HCD + SADE group showed on day 120 a significant decrease in body weight (−34%), blood glucose (−47.85%), serum levels of total cholesterol (−54.92%), LDL cholesterol (−60%), triglycerides (−48.03%), and of the levels of hepatic enzymes: ASAT (−66.28%) and ALAT (−31.87%). Oral administration of SADE restored the relative liver weight and adiposity index and significantly limited HCD-induced hepatic injury in P. obesus. SADE seems to have promising in vivo anti-obesity and anti-dyslipidemic effects. Full article

The acquisition of large prey by hominins living during the Marine Isotope Stage 3, including Neanderthals and Anatomically Modern Humans, had nutritional and bioenergetic implications: these contain high fat amounts, provide a high energy return, and the strategies and skills required to acquire small prey were different from those required to acquire the former. Vitamin C availability at several MIS 3 periods could have had a strong seasonal variability and would have been decisive for hominin groups’ survival. During the cold periods of the MIS 3, Paleolithic hominins had variable available amounts of vitamin C-containing plants only in the short summers, and for the remainder of the year, viscera would have been their best source of vitamin C. Meanwhile, the dependence on small mammals could have caused an erratic distribution of viscera to be consumed by such hominins, thus leading to chronic scurvy, and compromising their survival. Then, the hunting of large mammals would have helped to meet the daily vitamin C needs, besides an efficient energy supply. Therefore, the decline of large prey during the MIS 3 could have been critical for hominins survival, and thus the efficient exploitation of alternative vitamin C-rich food resources such as birds and aquatic animals could have favored the evolutionary success of hominin populations. Full article