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    Alcoholic Pellagra as a Cause of Altered Mental Status in the Emergency Department.
    J Emerg Med 2017 Oct 20;53(4):554-557. Epub 2017 Jul 20.
    Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan.
    Background: Pellagra, which is caused by a deficiency of niacin and tryptophan, the precursor of niacin, is a rare disease in developed countries where alcoholism is a major risk factor due to malnutrition and lack of B vitamins. Although pellagra involves treatable dementia and psychosis, it is often underdiagnosed, especially in developed countries.

    Case Report: In Japan, a 37-year-old man presented to the emergency department with altered mental status and seizures. Read More

    Necrolytic Acral Erythema in Seronegative Hepatitis C.
    Case Rep Dermatol 2017 Jan-Apr;9(1):69-73. Epub 2017 Mar 17.
    Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
    Necrolytic acral erythema (NAE) is a distinctive skin disorder. The exact cause and pathogenesis is still unclear. Most studies report an association of NAE with hepatitis C virus (HCV) infection. Read More

    Meat Intake and the Dose of Vitamin B3 - Nicotinamide: Cause of the Causes of Disease Transitions, Health Divides, and Health Futures?
    Int J Tryptophan Res 2017 3;10:1178646917704662. Epub 2017 May 3.
    Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
    Meat and vitamin B3 - nicotinamide - intake was high during hunter-gatherer times. Intake then fell and variances increased during and after the Neolithic agricultural revolution. Health, height, and IQ deteriorated. Read More

    Severe pellagra masked by concurrent plaque psoriasis: a case report of a hidden diagnosis.
    Dermatol Online J 2017 May 15;23(5). Epub 2017 May 15.
    Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, California.
    Despite characteristic features, psoriasis can mimic other dermatologic conditions, such as seborrheic dermatitis, lichen simplex chronicus, and certain nutritional deficiencies such as pellagra. We present a patient with a longstanding history of severe plaque psoriasis who presented with disfiguring scaly plaques involving greater than 80% body surface area. The patient's disease was minimally responsive to multiple therapies. Read More

    'Shrouded in a dark fog': comparison of the diagnosis of pellagra in Venice and general paralysis of the insane in the United Kingdom, 1840-1900.
    Hist Psychiatry 2017 Jun 1;28(2):166-181. Epub 2017 Feb 1.
    University of Leicester, UK.
    The debate on the causes and the nature of pellagra in Italy during the nineteenth century resembles and evokes the similar debate on General Paralysis of the Insane (GPI) that was growing at the same time in the United Kingdom. Pellagra and GPI had a massive and virulent impact on the populations of Italy and the UK, respectively, and contributed to a great extent to the increase and overcrowding of the asylum populations in these countries. This article compares the two illnesses by examining the features of their nosographic positioning, aetiology and pathogenesis. Read More

    Depletion of Epidermal Langerhans Cells in the Skin Lesions of Pellagra Patients.
    Am J Dermatopathol 2017 Jun;39(6):428-432
    *Department of Dermatology, University of the Ryukyus, Okinawa, Japan; †Department of Dermatology, Tone-chuo Hospital, Numata, Japan; ‡Department of Dermatology, Gunma University, Maebashi, Japan; §Department of Dermatology, Wakayama Medical University, Wakayama, Japan; ¶Department of Dermatology, Nagasaki University, Nagasaki, Japan; and ‖Department of Dermatology, Saitama Medical University Saitama Medical Center, Kawagoe, Japan.
    Pellagra is a nutrient deficiency disease caused by insufficient niacin levels. Recent studies have shown that numbers of epidermal Langerhans cells decreased in other diseases caused by nutritional deficiencies, including necrolytic migratory erythema and acrodermatitis enteropathica. Epidermal Langerhans cells are capable of modulating or even halting the inflammatory reaction. Read More

    An Outbreak of Pellagra in the Kasese Catchment Area, Dowa, Malawi.
    Am J Trop Med Hyg 2017 May 13;96(5):1244-1247. Epub 2017 May 13.
    Department of Family and Community Medicine, University of Texas Southwestern, Dallas, Texas.
    AbstractPellagra is a deficiency of niacin or its amino acid precursor, tryptophan, which presents with the classic four Ds: the characteristic dermatitis, diarrhea, dementia, and eventually death if left untreated. The incidence of pellagra is quite rare presently because of increased awareness and strategies such as vitamin fortification. However, the deficiency is still present in cultures that rely on maize as their primary source of sustenance. Read More

    Diets derived from maize monoculture cause maternal infanticides in the endangered European hamster due to a vitamin B3 deficiency.
    Proc Biol Sci 2017 Jan;284(1847)
    Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France.
    From 1735 to 1940, maize-based diets led to the death of hundreds of thousands of people from pellagra, a complex disease caused by tryptophan and vitamin B3 deficiencies. The current cereal monoculture trend restricts farmland animals to similarly monotonous diets. However, few studies have distinguished the effects of crop nutritional properties on the reproduction of these species from those of other detrimental factors such as pesticide toxicity or agricultural ploughing. Read More

    Photodermatoses: Kids are not just little people.
    Clin Dermatol 2016 Nov - Dec;34(6):724-735. Epub 2016 Jul 12.
    University of Connecticut School of Medicine, Department of Dermatology, Farmington, CT.
    Photodermatoses are a group of skin disorders caused by abnormal reaction to ultraviolet radiation. Photodermatoses are divided into four groups: (1) immunologically mediated photodermatoses; (2) chemical- and drug-induced photodermatoses; (3) photoaggravated dermatoses; and (4) hereditary photodermatoses. This contribution discusses differences in the approach and diagnosis of pediatric and adult patients with suspected photodermatoses, focusing on immunologically mediated photodermatoses and chemical- and drug-induced photodermatoses. Read More

    Drug-induced photosensitivity: new insights into pathomechanisms and clinical variation through basic and applied science.
    Br J Dermatol 2017 Apr 28;176(4):902-909. Epub 2017 Feb 28.
    Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, LL57 2PY, U.K.
    Drug-induced photosensitivity occurs when a drug is capable of absorbing radiation from the sun (usually ultraviolet A) leading to chemical reactions that cause cellular damage (phototoxicity) or, more rarely, form photoallergens (photoallergy). The manifestation varies considerably in presentation and severity from mild pain to severe blistering. Despite screening strategies and guidelines in place to predict photoreactive drugs during development there are still new drugs coming onto the market that cause photosensitivity. Read More

    Pellagra Secondary to Medication and Alcoholism: A Case Report and Review of the Literature.
    Nutr Clin Pract 2016 Dec 19;31(6):785-789. Epub 2016 Aug 19.
    2 Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
    Pellagra usually results from niacin deficiency and presents with the classic triad of dermatitis, diarrhea, and dementia. It is most commonly associated with malnutrition and poverty and is extremely rare in industrialized societies. Furthermore, pellagra can be induced by special clinical conditions that interfere with the intake, absorption, and metabolism of niacin. Read More

    Hereditary lactate dehydrogenase M-subunit deficiency with late-developing pustular psoriasis-like lesions.
    J Dermatol 2016 Dec 23;43(12):1429-1432. Epub 2016 Jul 23.
    Department of Dermatology, Faculty of Medicine, Oita University, Yufu, Japan.
    Hereditary lactate dehydrogenase (LDH) M-subunit deficiency is very rare and we have found reports of close to a dozen cases in the published work, two of which were associated with pustular psoriasis-like lesions. We report a third case of pustular psoriasis-like eruptions associated with LDH M-subunit deficiency, which occurred 24 years after the diagnosis of LDH M-subunit deficiency. These cases indicate that abnormal activity of LDH can induce pustular psoriatic lesions in the long term. Read More

    Nicotinamide Riboside Is a Major NAD+ Precursor Vitamin in Cow Milk.
    J Nutr 2016 May 6;146(5):957-63. Epub 2016 Apr 6.
    Department of Biochemistry, Carver College of Medicine, Interdisciplinary Graduate Program in Genetics, and
    Background: Nicotinamide riboside (NR) is a recently discovered NAD(+) precursor vitamin with a unique biosynthetic pathway. Although the presence of NR in cow milk has been known for more than a decade, the concentration of NR with respect to the other NAD(+) precursors was unknown.

    Objective: We aimed to determine NAD(+) precursor vitamin concentration in raw samples of milk from individual cows and from commercially available cow milk. Read More

    Skin diseases among elderly patients attending skin clinic at the Regional Dermatology Training Centre, Northern Tanzania: a cross-sectional study.
    BMC Res Notes 2016 Feb 22;9:119. Epub 2016 Feb 22.
    Regional Dermatology Training Centre, Moshi, Tanzania.
    Background: As global population of the elderly continues to rise, a critical need to provide it with health services, including dermatology, will be significant, especially in developing countries like Tanzania. To adequately meet their dermatologic needs, knowledge of local patterns of skin conditions is vital. This study was aimed to describe the spectrum of skin diseases among elderly patients attending skin clinic at the Regional Dermatology Training Centre (RDTC) in Northern Tanzania. Read More

    Wernicke encephalopathy and pellagra in an alcoholic and malnourished patient.
    BMJ Case Rep 2015 Oct 21;2015. Epub 2015 Oct 21.
    Department of General Internal Medicine, Tsukuba University, Mito, Ibaraki, Japan.
    Deficiency of multiple vitamins can be identified in alcoholic and malnourished patients. We report a patient with Wernicke encephalopathy, a B1 deficiency and pellagra, a niacin deficiency. A 61-year-old Japanese man presented with generalised weakness. Read More

    [An Uncommon Diagnosis].
    Praxis (Bern 1994) 2015 Oct;104(21):1151-6
    1 Universitätsklinik für Endokrinologie, Diabetologie und Klinische Ernährung, Inselspital Bern.
    We report on a 61-year-old patient who suffered from severe protein-energy malnutrition due to an inadequately treated exocrine pancreatic insufficiency. In this context, a thiamine deficiency was not recognized and there were clinical manifestations of beriberi disease with decompensated biventricular heart failure. In the course of time, a manifest niacin deficiency (pellagra) with dermatitis, diarrhea and persistent delirium occurred, which was recognized and could be treated. Read More

    Niacin (Vitamin B3) Supplementation in Patients with Serotonin-Producing Neuroendocrine Tumor.
    Neuroendocrinology 2016 4;103(5):489-94. Epub 2015 Sep 4.
    Background/aims: Tryptophan is the precursor of serotonin and niacin (vitamin B3). The latter is critical for normal cellular metabolism. Tryptophan and niacin can be deficient in patients with serotonin-producing neuroendocrine tumors (NETs). Read More

    Goose skin in a girl with Ehlers-Danlos syndrome.
    J Community Hosp Intern Med Perspect 2015 1;5(4):28216. Epub 2015 Sep 1.
    Department of Dermatology, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis, México;
    Pellagra is a nutritional disorder secondary to niacin deficiency. The classical triad is dermatitis, diarrhea, and dementia. We report the case of a young girl with hypermobility-type Ehlers-Danlos syndrome who exhibited the classical pellagra symptoms, despite apparent adequate nutritional intake. Read More

    Pellagra Pre-Goldberger: Rupert Blue, Fleming Sandwith, and The "Vitamine Hypothesis".
    Trans Am Clin Climatol Assoc 2015 ;126:20-45
    Columbia, South Carolina.
    The conquest of pellagra is commonly associated with one name: Joseph Goldberger of the US Public Health Service, who in 1914 went south, concluded within 4 months that the cause was inadequate diet, spent the rest of his life researching the disease, and--before his death from cancer in 1929--found that brewer's yeast could prevent and treat it at nominal cost. It does Goldberger no discredit to emphasize that between 1907 and 1914 a patchwork coalition of asylum superintendents, practicing physicians, local health officials, and others established for the first time an English-language competence in pellagra, sifted through competing hypotheses, and narrowed the choices down to two: an insect-borne infection hypothesis, championed by the flamboyant European Louis Westerna Sambon, and the new "vitamine hypothesis," proffered by Casimir Funk in early 1912 and articulated later that year by two members of the American Clinical and Climatological Association, Fleming Mant Sandwith and Rupert Blue. Those who resisted Goldberger's inconvenient truth that the root cause was southern poverty drew their arguments largely from the Thompson-McFadden Pellagra Commission, which traces back to Sambon's unfortunate influence on American researchers. Read More

    A Nampt inhibitor FK866 mimics vitamin B3 deficiency by causing senescence of human fibroblastic Hs68 cells via attenuation of NAD(+)-SIRT1 signaling.
    Biogerontology 2015 Dec 2;16(6):789-800. Epub 2015 Sep 2.
    School of Nutrition, Chung Shan Medical University, Taichung, Taiwan.
    Vitamin B3 (niacin) deficiency can cause pellagra with symptoms of dermatitis, diarrhea and dementia. However, it is unclear whether the vitamin B3 deficiency causes human aging. FK866 (a Nampt inhibitor) can reduce intracellular NAD(+) level and induce senescence of human Hs68 cells. Read More

    Niacin metabolism and indoleamine 2,3-dioxygenase activation in malnourished patients with flaky paint dermatosis.
    Nutrition 2015 Jun 31;31(6):890-2. Epub 2014 Dec 31.
    Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil.
    Flaky paint dermatosis, characterized by extensive, often bilateral areas of flaking and pigmentation, mostly in sun unexposed areas is considered a feature of kwashiorkor in both children and adults, and must be differentiated from other dermatosis, including chapped and xerotica skin, and pellagra. In this case series we provide evidence that malnourished patients with flaky paint dermatosis and infection/inflammation shown laboratory data suggestive of indoleamine 2,3-dioxygenase (IDO) activation, besides decreased urinary excretion of N1-methylnicotinamide (N1 MN), a marker of pellagra. We study nine adult patients showing flaky paint dermatosis and clinical features of infection or inflammation, and increased serum C-reactive protein, characteristic of the presence of acute phase response syndrome. Read More

    Generalised hyperpigmentation in vitamin B12 deficiency.
    J Assoc Physicians India 2014 Aug;62(8):714-6
    In developing countries like India, nutritional deficiencies are prevalent and hyperpigmentation due to protein energy malnutrition, zinc deficiency and pellagra are common. Indian women, especially vegetarian are prone to vitamin B12 deficiency. Vitamin B12 deficiency can present as anaemia, neurological defect, gastrointestinal symptoms or dementia. Read More

    Ethionamide-induced Pellagra.
    J Trop Pediatr 2015 Aug 30;61(4):301-3. Epub 2015 Mar 30.
    Pediatric TB Clinic, B J Wadia Hospital for Children, Mumbai 400012, India Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai 400056, India
    Pellagra is a disorder characterized by dermatitis, diarrhea, dementia and eventually death, resulting from a deficiency of niacin or its precursor tryptophan. Ethionamide (a second-line antituberculosis agent)-induced pellagra is rarely encountered in clinical practice. Prompt diagnosis and treatment with nicotinamide can prevent life-threatening complications. Read More

    [Niacin deficiency and cutaneous immunity].
    Nihon Rinsho Meneki Gakkai Kaishi 2015 ;38(1):37-44
    Swiss Institute of Allergy and Asthma Research, Davos, Switzerland.
    Niacin, also known as vitamin B3, is required for the synthesis of coenzymes, nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP). Niacin binds with G protein-coupled receptor (GPR) 109A on cutaneous Langerhans cells and causes vasodilation with flushing in head and neck area. Niacin deficiency due to excessive alcohol consumption, certain drugs or inadequate uptake in diet causes pellagra, a photosensitivity dermatitis. Read More

    Louis Sambon and the Clash of Pellagra Etiologies in Italy and the United States, 1905-14.
    J Hist Med Allied Sci 2016 Jan 4;71(1):19-42. Epub 2015 Mar 4.
    University of Leicester, University Road, Leicester LE1 7RH, UK.
    This article explores the extent to which the bacterial concept of disease acted as an obstacle to the understanding of deficiency diseases, by focusing on explorations into the cause of pellagra in the early twentieth century. In 1900, pellagra had been epidemic in Italy for 150 years and was soon to become so in the United States, yet the responses of medical investigators differed substantially. To account for these, the article reconstructs the sharply contrasting reactions to a provocative theory proposed by Louis Sambon. Read More

    Fortification and health: challenges and opportunities.
    Adv Nutr 2015 Jan 15;6(1):124-31. Epub 2015 Jan 15.
    Office of Dietary Supplements, NIH, Bethesda, MD; and.
    Fortification is the process of adding nutrients or non-nutrient bioactive components to edible products (e.g., food, food constituents, or supplements). Read More

    Exploiting Nutritional Value of Staple Foods in the World's Semi-Arid Areas: Risks, Benefits, Challenges and Opportunities of Sorghum.
    Healthcare (Basel) 2015 Mar 30;3(2):172-93. Epub 2015 Mar 30.
    Food and Veterinary Toxicology Unit, Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
    Sorghum (Sorghum bicolor (L.) Moench) is a drought-resistant crop and an important food resource in terms of nutritional as well as social-economic values, especially in semi-arid environments. Cultivar selection and processing methods have been observed to impact on composition and functional and nutritional value of sorghum. Read More

    Mechanisms of the pellagragenic effect of leucine: stimulation of hepatic tryptophan oxidation by administration of branched-chain amino acids to healthy human volunteers and the role of plasma free tryptophan and total kynurenines.
    Int J Tryptophan Res 2014 4;7:23-32. Epub 2014 Dec 4.
    Department of Psychiatry, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.
    The pellagragenic effect of leucine (Leu) has been proposed to involve modulation of L-tryptophan (Trp) metabolism along the hepatic kynurenine pathway. Here, we discuss some of the mechanisms suggested and report the effects in healthy volunteers of single doses of Leu (4.05-6. Read More

    The biochemical pathways of central nervous system neural degeneration in niacin deficiency.
    Neural Regen Res 2014 Aug;9(16):1509-13
    Department of Physiology, M.S. Ramaiah Medical College, Bangalore, India.
    Neural degeneration is a very complicated process. In spite of all the advancements in the molecular chemistry, there are many unknown aspects of the phenomena of neurodegeneration which need to be put together. It is a common sequela of the conditions of niacin deficiency. Read More

    Tissue vitamin concentrations are maintained constant by changing the urinary excretion rate of vitamins in rats' restricted food intake.
    Biosci Biotechnol Biochem 2014 13;78(12):2102-9. Epub 2014 Aug 13.
    a School of Human Cultures, Department of Nutrition , The University of Shiga Prefecture , Hikone , Japan.
    We previously reported that mild food restriction induces a reduction in tryptophan-nicotinamide conversion, which helps to explain why death secondary to pellagra is pandemic during the hungry season. In this study, we investigated the levels of B-group vitamins in the liver, kidney, blood, and urine in rats that underwent gradual restriction of food intake (80, 60, 40, and 20% restriction vs. ad libitum food intake). Read More

    The Thompson-McFadden Commission and Joseph Goldberger: contrasting 2 historical investigations of pellagra in cotton mill villages in South Carolina.
    Am J Epidemiol 2014 Aug 24;180(3):235-44. Epub 2014 Jun 24.
    As pellagra reached epidemic proportions in the United States in the early 20th century, 2 teams of investigators assessed its incidence in cotton mill villages in South Carolina. The first, the Thompson-McFadden Commission, concluded that pellagra was likely infectious. The second, a Public Health Service investigation led by Joseph Goldberger, concluded that pellagra was caused by a dietary deficiency. Read More

    Pellagra in a patient with primary Sjögren's syndrome.
    BMJ Case Rep 2014 Jun 18;2014. Epub 2014 Jun 18.
    Department of Internal Medicine, University of Tunis El Manar, Tunis, Tunisia.
    A 27-year-old woman presented with persistent dryness of the mouth and eyes. She presented with permanent photodistributed rash involving the face and distal extremities. Laboratory tests showed positive Sjögren's syndrome (SS)-A and SS-B antibodies. Read More

    Evidence and conjecture about mechanisms of cutaneous disease in photodermatology.
    Exp Dermatol 2014 Aug;23(8):543-6
    Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK.
    Photosensitivity disorders are caused by a variety of mechanisms. Three common themes are as follows: excess chromophore allowing visible light energy to cause photodynamic damage, reduced DNA repair capacity to UV-induced DNA damage, and enhanced sensitivity to light-induced allergens mediated immunologically. Although the cause of each condition may be known, the precise pathogenesis underlying the photosensitivity has taken longer to understand. Read More

    Livedo reticularis due to pellagra in a two year old child.
    Indian J Dermatol 2014 May;59(3):317
    Department of Dermatology, Command Hospital, Pune, India.
    A two-year-old girl child was admitted with complaints of diarrhoea of one week duration in the paediatric ward. She was referred to the skin OPD for gradually progressive skin rashes on both lower limbs noticed since two days. Dermatological examination revealed finding of livedo reticularis. Read More

    Pellagra: a non-eradicated old disease.
    Clin Pract 2014 Mar 28;4(1):637. Epub 2014 Apr 28.
    1 Department of Internal Medicine, Papageorgiou University Hospital of Thessaloniki , Thessaloniki, Greece.
    We report a case of a 50-year old homeless male who presented with pellagra and pellagrous encephalopathy. The characteristic - if not pathognomonic - skin lesions of pellagra support its diagnosis on solely clinical grounds. Clinicians should keep a high index of suspicion, in certain patient groups, in order to early diagnose and cure this potentially fatal but treatable disease. Read More

    Functional abdominal pain causing Scurvy, Pellagra, and Hypovitaminosis A.
    F1000Res 2014 4;3:35. Epub 2014 Feb 4.
    Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA 94143, USA.
    Severe vitamin deficiency disease is rarely seen in developed countries. We present an atypical case of a young man with scurvy, pellagra, and hypovitaminosis A, caused by longstanding functional abdominal pain that severely limited his ability to eat. Read More

    Black urine due to urobilinogen in a patient with alcoholic pellagra.
    Clin Biochem 2014 Aug 5;47(12):1132-5. Epub 2014 Apr 5.
    Center for Advanced Laboratory Medicine, Department of Pathology, University of California, San Diego Health System, San Diego, CA, USA.
    Objectives: Systemic exposure to drugs, chemicals and foods can cause abnormally colored urine. Food exposures are typically benign, but urine discoloration due to chemicals or drugs may indicate a potentially dangerous condition. Discolored urine can also be caused by medical problems. Read More

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