Scurvy- Nutritional
Cause
Scurvy is a Non-Infectious Nutritional Disease caused by severe and chronic vitamin C (ascorbic acid) deficiency. It is most prominent commonly in people with mental disorders, abnormal eating habits and Alcoholism
Signs, Symptoms and Effects
Scurvy causes widespread symptoms. Signs of Scurvy begin after at least four weeks of severe, continual vitamin C deficiency. It usually takes three or more months for symptoms to develop and become of notice to the patient.
Signs
Signs are identified when the person acknowledges the presence or occurrence of Scurvy.
These include:
• Aching legs
• Irritability- easily irritated or annoyed; readily excited to impatience or anger.
• Low-grade fever
• Reduced Appetite
• Unexplained Exhaustion
• Weakness- the state or quality of being weak; lack of strength, firmness, vigor, or the like; feebleness.
Symptoms
Symptoms are identified when the person acknowledges Scurvy through the phenomenon and/or circumstances accompanying and/or serving as evidence for it.
These include:
• Anaemia- when the blood lacks enough red blood cells or haemoglobin
• Areas of red/blue/black bruising, on the legs and feet
• Blurred vision
• Bruising raised bumps at hair follicles, on the shins, with central hairs that appear twisted and can break easily.
• Diarrhoea
• Eye dryness, irritation, and haemorrhaging in the whites of the eyes (conjunctiva) or optic nerve.
• Gastrointestinal bleeding¬- is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum.
• Gingivitis, or red, soft, and tender gums that bleed easily
• Headache
• Light sensitivity
• Irritability and depression
• Nausea- unpleasant, diffuse sensation of unease and discomfort, often perceived as an urge to vomit
• Reduced wound healing and immune health
• Shortness of breath
• Small bleeding around hair follicles visible in the skin
• Tender, swollen joints
• Tooth decay
Effects
If these symptoms are left untreated for an extended amount of time complications can arise leading to:
• Coma
• Convulsions- where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body
• Death
• Delirium- is an organically caused decline from a previously baseline level of mental function
• Hemolysis- a type of anaemia where red blood cells break down
• Internal haemorrhaging- is a loss of blood that occurs from the vascular system into a body cavity or space
• Neuropathy and/or numbness and pain usually in the lower limbs and hands
• Organ failure
• Severe jaundice- which is yellowing of the skin and eyes
• Tooth loss
Prevention Methods
After diagnosis through a physician, a physical exam is conducted which leads to lab tests to assess vitamin C levels within the blood. Scurvy can be prevented by simply consuming vitamin in the diet, and or supplement form.
The Nutrient Reference Values for Australia and New Zealand by the Australian National Health and Medical
Research Council (NHMRC) and the New Zealand Ministry of Health (MoH) show the recommendations of Vitamin C intake by Life Stage and Gender on Pg. 5
Treatment and/or management
To treat and manage Scurvy, Vitamin C which can be administrated through supplements by mouth or injection. Vitamin C is widely available. Citrus fruits like oranges, limes, and lemons have traditionally been used to prevent and treat scurvy.
In severe, chronic, cases of scurvy, it is recommended high-doses of oral vitamin C supplements for several weeks to months. There’s no compromise on a specific dose for severe scurvy. For these cases it is recommended that high doses of oral vitamin C are used for several weeks or longer.
Patients usually see an improvement in some symptoms within a day or two of treatment such as decreased pain, exhaustion, confusion, headache and mood swings. More symptoms may take a few weeks to improve following treatment such as weakness, bleeding, bruising and jaundice. After 3 months, a complete recovery is possible except in the case of severe dental damage.
Epidemiological Study- Incidence, Prevalence and Mortality Rates
Incidence
NHANES 2004
Men Women Total Average
(Ethnicity)
Non-Hispanic White 11.8% 8.2% 10%
Non-Hispanic Black 8.9% 5% 6.95%
Mexican 7.7% 4.2% 5.95%
Total Average
(Sex) 9.5% 5.8%
This table represents the NHANES 2004 study on the American Incidence rate for Scurvy. In Sex and Ethnicity comparison we can see that Non-Hispanic White Men have a slightly increased risk of obtaining Scurvy in comparison to Non-Hispanic White Women (3.6% difference). Non-Hispanic Black Men have an increased risk over Non-Hispanic Black Women (3.9% difference). Mexican Men also have an increased risk of Scurvy (3.7%).
This study shows Scurvy to be prevalent in Men than Women with a 3.7 % difference. Mexican Males and Females were least at risk. The common assumption for these results is the Mexican Diet is rich in chilies, tomatoes, and squashes, which are high in vitamin C.
Prevalence
NHANES 1994
MALE FEMALE AVERAGE
14% 10% 12%
NHANES 2003-2004
MALE FEMALE AVERAGE
8.2% 6% 7.1%
NHANES 2005-2006
(among men and women older than 6 years)
AVERAGE
3.6%
This table represents the overall Scurvy prevalence rate within the American Population.
Overall between 1994-2004 we can see the Male sex at highest Prevalence for Scurvy. In the 1994, we see that the average is 12%, and over 9-10 years we see a drop of 4.9%. In 2005-2006, the average drastically drops to 3.6%.
Mortality
After continuous research through websites and reports such as the NHANES 2004, Scurvy seems to be a disease with no mortality rate recorded. Assuming that this is the case, death records could have not been published for privacy reasons. After establishing Signs, Symptoms and Effects, an inference under my common assumption would be that people would notice these Signs, Symptoms and Effects and take the necessary action to treat and/or prevent the effects of Scurvy.
Asbestosis- Environmental
Cause
Asbestosis is a chronic lung disease (form of pulmonary fibrosis) where scarring of the lungs occurs. It is caused and developed by being exposed to Asbestos fibres. Some of the airborne fibres can become wedged within the alveoli (the tiny sacs inside your lungs where oxygen is exchanged for carbon dioxide in your blood). The asbestos fibres scar lung tissue, causing the lungs to become rigid. This makes it difficult to breathe. As asbestosis progresses, more and more lung tissue becomes scarred. Then leading to the lung tissue becoming so rigid that it can’t contract and expand normally.
Signs, Symptoms and Effects
Signs and Symptoms
Signs are identified when the person acknowledges the presence or occurrence of Scurvy and Symptoms are identified when the person acknowledges Scurvy through the phenomenon and/or circumstances accompanying and serving as evidence for it.
These will be conjoined as they reflect each other.
Asbestosis is usually a progressive disease, so signs and symptoms don’t start to appear until approximately 10 to 40 years after exposure to asbestos.
These include:
• Appetite loss
• Chest pain and tightness in your chest
• Crackling sound when inhaling and exhaling
• Fatigue
• Finger and toe clubbing- enlarged fingertips
• Loss of weight
• Nail deformities
• Persistent dry cough
• Shortness of breath
Effects
If these symptoms are left untreated for an extended amount of time, complications can arise.
As noted before Asbestosis is usually a progressive disease. Patients who have and/or are suffering from Asbestosis have many increased risks of developing:
• Bronchitis- inflammation of the larger airways in your lungs, causing an ongoing cough
• Heart related issues- Enlargement of Heart, Abnormal heart rhythm and Heart failure
• Lung Cancer- is the uncontrolled growth of abnormal cells that start off in one or both lungs
• Pneumonia- lung inflammation in the air sacs which will fill with pus and may become solid.
Inhalation of asbestos fibres can also lead to four types of non-cancerous abnormalities in the lining of the chest cavity which include:
• Diffuse thickening and fibrosis of the pleura
• Fluid in the pleural space- pleural effusion
• Folded lung or rounded atelectasis- occurs when an area of pleural fibrosis rolls into the lung making an area of the lung airless
• Localized deposits of collagen- pleural plaques
Prevention Methods
Elimination of all exposure will eliminate any risk of developing asbestosis. Asbestos fibres are found dominantly in the work place, so the use of other materials and respiratory protection (i.e. Face mask) and overall body protective gear minimises exposure.
Effects can also be prevented by the cessation of smoking and Immunisation against pneumonia and influenza which will prevent future effects.
Treatment and/or management
Even though Asbestosis is irreversible, there is treatment to help patients live through their diagnosis. Treatment focuses on the patient’s ability to breathe without the discomfort that comes with asbestosis.
Doctors recommend medications which include:
• Bronchodilators (inhalers)- help relax airways which provide relief
• Medications to thin secretions
• Supplemental oxygen- Oxygen is transferred from a tank through a plastic tube that has two prongs that fit into your nostrils. This helps with breathing
• Pain medications- reducing pain and inflammation
In more severe cases surgery may be recommended and rarely will call upon a lung transplant.
Epidemiological Study- Incidence, Prevalence and Mortality Rates
Incidence
Quite like the outcome for mortality rates in Scurvy, Incidence studies for Abestosis were not available for use.
Prevalence
This graph is the compensated claims for asbestosis: number by sex, 2002 to 2011. It shows a form of prevalence for Abestosis within Australia. In this graph we see the male sex being dominant with Females number of claims stays neutral (under 50 claims). In 2002, the Male number of claims was 300+. We see a slight incline then a quite dramatic drop which stops in 2006 at 200 claims. A record low is record at 100 claims in 2011.
Mortality
Annual deaths where death certificates mentioned asbestosis but not mesothelioma, and excluding the IIDB cases 1978-2017
This graph shows an increasing rate over the years 1978-2013. In comparison between these dates we see a 28.6% increased from an estimated 100 death rate to 500 (2013 onward).
From this study, HSE mentions that in recent years, around 2-3% of these deaths were among women.
Average annual male death rates based on death certificates mentioning asbestosis but not mentioning mesothelioma by age and time period, 1978-2016.
There are many distinct inconsistencies between the rates between the different age groups which will touched on later.
The table shows us the link between age and death rates in males. Death rates from ages 60-69 years have been falling since 1980
Between ages 45-90+ we see a dramatic comparison. Common assumptions and statistical observations may suggest that males of older age dealt with higher levels asbestos fibres due to the time period.