Hypovitaminosis C in the context of the COVID-19 pandemic

Sayés, Alicia; Sogbe, Miguel; Alegre, Félix

doi:10.1016/j.medcle.2023.07.022

array:23 ["pii" => "S2387020623005363" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.07.022" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6396" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2024;162:39-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S2387020623005168" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.07.014" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6388" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Gitelman syndrome and type 1 diabetes mellitus: An uncommon association" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "41" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Gitelman y diabetes mellitus tipo 1: una asociación infrecuente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Silvia Patricia Alonso, Marta Domínguez-López" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Silvia Patricia" "apellidos" => "Alonso" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Domínguez-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775323004621" "doi" => "10.1016/j.medcli.2023.07.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323004621?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623005168?idApp=UINPBA00004N" "url" => "/23870206/0000016200000001/v2_202401260813/S2387020623005168/v2_202401260813/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020623005211" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.06.045" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6343" "copyright" => "The Author(s)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2024;162:35-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Clinical report" "titulo" => "Autoimmune encephalitis related to LGI1 antibodies with negative MRI study: Description of two cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "38" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encefalitis autoinmune relacionada con anticuerpos LGI1 con estudio de RM negativo: descripción de dos casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 869 "Ancho" => 1207 "Tamanyo" => 123653 ] ] "descripcion" => array:1 [ "en" => "Typical magnetic resonance imaging (MRI) images of six anti-LGI1-related encephalitis patients. As shown by the white arrows, increased signals on MRI fluid-attenuated inversion recovery or T2 sequences can be seen in the left MTL (A), right MTL (B), bilateral MTL (C), left BA (D), and bilateral BA (E), and hippocampal atrophy can be seen (F)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Xia Lian, Kai Zheng, Wenchao Chen, Dongfang Li, Fang Xue, Gaiqing Wang" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Xia" "apellidos" => "Lian" ] 1 => array:2 [ "nombre" => "Kai" "apellidos" => "Zheng" ] 2 => array:2 [ "nombre" => "Wenchao" "apellidos" => "Chen" ] 3 => array:2 [ "nombre" => "Dongfang" "apellidos" => "Li" ] 4 => array:2 [ "nombre" => "Fang" "apellidos" => "Xue" ] 5 => array:2 [ "nombre" => "Gaiqing" "apellidos" => "Wang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623005211?idApp=UINPBA00004N" "url" => "/23870206/0000016200000001/v2_202401260813/S2387020623005211/v2_202401260813/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Hypovitaminosis C in the context of the COVID-19 pandemic" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "39" "paginaFinal" => "40" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alicia Sayés, Miguel Sogbe, Félix Alegre" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Alicia" "apellidos" => "Sayés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Miguel" "apellidos" => "Sogbe" "email" => array:1 [ 0 => "msogbe@unav.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Félix" "apellidos" => "Alegre" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pulmonary Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipovitaminosis C en el contexto de la pandemia COVID-19" ] ] "textoCompleto" => "The COVID-19 pandemic has far-reaching consequences, some of which are only now coming to light. Beyond the physical effects of the disease, there are also biopsychosocial impacts, including depression and social isolation resulting from fear of infection.The purpose of this letter to the editor is to report a case of scurvy that occurred in the context of the COVID-19 pandemic.A 65-year-old male with a past medical history of bilateral retinal detachments leading to blindness, as well as obsessive-compulsive disorder, presented to our hospital with fatigue and ecchymoses in the abdomen, persisting for one month. These areas correlate with the chafing zone of the belt and underpants. He denied any family history of bleeding or hematologic disease. Following the COVID-19 pandemic, the patient experienced social isolation and remained without leaving home for several months. The patient adopted a diet primarily composed of food ordered from the supermarket and consumed at home. This diet consisted of rice, chickpeas, peanuts, chocolate milk, and cheese. The patient reported no intake of fruits and vegetables.On physical examination, oral cavity examination revealed no abnormalities. Ecchymosis in the inferior abdomen and right groin were evident. Laboratory findings showed hemoglobin of 10.4g/dL, a mean corpuscular volume of 92.4fL, platelets 189×109/L, and a white blood cell count of 3.8×109/L. Coagulation and platelet function assays yielded normal results, and the peripheral smear did not reveal any significant findings.Considering the clinical presentation with diffuse superficial ecchymoses and the patient's dietary history, a diagnosis of hypovitaminosis C was suspected. Scurvy was confirmed by a reduced serum vitamin C level (0.3mg/dL, normal range: 0.4–2mg/dL). Other nutritional deficiencies were observed, including low levels of zinc, vitamin D, and vitamin A.To address the condition, oral vitamin C was initiated at a dose of 1g once daily, accompanied by nutritional education and correction of other deficiencies. Subsequently, the ecchymosis resolved within a few days after commencing vitamin C supplementation.Humans are among the rare vertebrates that do not synthesize vitamin C. The only source of vitamin C is diet. Hypovitaminosis C may be secondary to lack of intake, decreased absorption, and increased demand (such as oxidative states, like smoking and alcohol consumption). The total body pool of vitamin C is 1500mg, and clinical manifestations of scurvy occur when this pool is reduced to less than 350mg. Vitamin C must be eliminated from the diet for 60–90 days to reach such a low level. The Food and Drug Administration recently increased the recommended dietary allowance for vitamin C to 75mg daily for women and 90mg daily for men. For example, a single orange contains 50mg of vitamin C. Scurvy is uncommon today, although specific populations remain at risk. At-risk groups include people experiencing poverty (because of reduced access to groceries), psychiatric disorders (e.g., depression, schizophrenia, or anorexia), and individuals with purported allergies to multiple fruits and vegetables. Alcoholic persons represent one of the largest groups at risk for scurvy because they may have poorly balanced diets. Vitamin C contributes to soft tissue maintenance through collagen synthesis and elastic fiber stabilization. Hypovitaminosis C produces blood vessel fragility and poor wound healing, classifying scurvy as a disease of soft tissue. The diagnosis of scurvy is generally based on dietary history and clinical features such as gingival bleeding, perifollicular hemorrhage, follicular hyperkeratosis with corkscrew hairs, and blood vessel fragility (which manifests as ecchymoses). A rapid resolution of signs and symptoms is seen after vitamin supplementation. Laboratory investigations may be necessary to confirm less typical cases.The COVID-19 pandemic can produce psychological disorders that can lead to social isolation. Social isolation, when occurring in people with pre-existing physical and psychiatric comorbidities, can cause changes in diet, bringing back old diseases such as scurvy.A literature search was performed looking for case reports of scurvy in the context of the COVID-19 pandemic out between 2020 and 2023 in the following database: MEDLINE on PubMed. Study retrieval was performed by using “scurvy”, as free text words combined with “COVID19”, and “pandemic”.This is the second case of scurvy reported during COVID-19 pandemic. The previous case involved a 28-year-old male patient who developed scurvy due to increased alcohol consumption and a diet primarily consisting of meat (sausage, chicken, burgers) and eggs.Ethical considerationsWritten informed consent was obtained.FundingNone declared.Conflicts of interestNone declared." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000001/v2_202401260813/S2387020623005363/v2_202401260813/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000001/v2_202401260813/S2387020623005363/v2_202401260813/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623005363?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 162. Issue 1.

Pages 39-40 (January 2024)

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Medicina Clínica (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Medicina Clínica (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Medicina Clínica

Tools

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter