Vit a print

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Vit a print

  1. 1. VITAMIN By Dr. INDRAJEET KUMAR TUTOR DEPARTMENT OF COMMUNITY MEDICINE Facebook: psm dept
  2. 2. FACTS ABOUT VITAMINS They are micronutrients. They have no calorie value. Types : Fat soluble: Vitamin -A, D, E & K Water soluble: Vitamin - C & B-complex
  3. 3. VITAMIN A
  4. 4. Forms: PRE – FORMED VITAMIN A PRO – VITAMIN A “BETA – CAROTENE” (INACTIVE FORM) INTEST INE “RETINOL” (ACTIVE FORM)
  5. 5. SOURCES  ANIMAL FOODS :-as “RETINOL e.g: fish liver oils(Halibut/ Cod*), egg, butter, whole milk, meat.  PLANT FOODS:-as “BETA - CAROTENE” 1. Green leafy veg.* like spinach**& amaranth 2. Yellow fruits: e.g papaya, mango, pumpkin. 3. Roots: e.g carrot*.  FORTIFIED FOOD:- vanaspati, baby food, milk
  6. 6. STORAGE & TRANSPORTATION Vit A is stored in Liver in it’s active form ‘RETINOL PALMITATE” but it is highly toxic. Therefore transported in circulation in combination with a protein “RETINOL BINDING PROTEIN” produced by liver Deficiency of protein (PEM) leads to deficiency of Vit-A
  7. 7. FUNCTION:  Normal vision & dim vision : important component of rhodopsin(Rods)  Maintain the integrity and normal functioning of the glandular & epithelial tissue. e.g : intestinal, respiratory, urinary, skin & eyes.  Support growth: skeletal growth.  Anti – infective: role in immune response.  Anti-cancer vitamin: Protect against some epithelial cancer e.g. Bronchial cancer.
  8. 8. EPIDEMIOLOGY OF VIT-A DEFICIENCY (XEROPHTHALMIA)  INADEQUATE INTAKE:  AGE: common in children between 1-3yrs. Related to ‘faulty weaning practices’ & ‘PEM.’  INFECTION: Diarrhoea, Measles & Respiratory tract infections.  EPIDEMIC OF XEROPHTHALMIA: associated with food donation programme involving “skimmed milk”  SOUTHERN & EASTERN STATES: rice eating state
  9. 9. DEFICIENCY FEATURES 1. OCULAR (xerophthalmia) 2. EXTRA - OCULAR  Night blindness.  Follicular  Conjunctival Xerosis. hyperkeratosis.  Anorexia.  Growth retardation.  Increase in morbidity & mortality.  Bitot’s Spot.  Corneal Xerosis.  Corneal ulceration.  Keratomalacia.
  10. 10. Xerophthalmia Conjunctival Xerosis: Corneal xerosis: Normally wet, smooth & shiny ( muddy, dull, dry & wrinkled.) Normally wet, smooth, shiny (dry, dull, opaque)
  11. 11. BITOT’S SPOT Triangular pearly white or yellowish foamy spots on bulbar conjunctiva on either side of the cornea.
  12. 12. Corneal ulcer
  13. 13. Follicular hyperkeratosis (Thorny skin / Phrynoderma) Cone shaped elevated papules due to thickening of Stratum corneum.
  14. 14. ROSE BENGAL DYE TEST (Tetra-chloro tetra-iodo fluorescin) 1% of the dye applied on the conjunctiva Development of PINK COLOUR stain on conjunctiva xerosis present
  15. 15. TREATMENT Normal requirement: 600mcg of Vit.A (retinol) = 2000 IU of retinol Palmitate. Vitamin A : > 12month of age: 2,00,000 (2lakh) I.U of retinol palmitate orally on two consecutive days. < 12month of age: 1,00,000 (1lac) I.U of retinol palmitate orally on two consecutive days.
  16. 16. PREVENTION SHORT TERM ACTION MEDIUM TERM ACTION LONG TERM ACTION
  17. 17. SHORT TERM ACTION (quick result but short lived) By giving large doses of vit.a to the vulnerable groups at periodic intervals. INDIVIDUAL ORAL DOSE OF RETINOL PALMITATE TIMING New born 50,000 IU At birth Children < 12m 1,00,000 IU Every 6month Children > 12m 2,00,000 IU Women of child bearing age 3,00,000 IU Within 1 month of giving birth Pregnant & lactating 5000 IU 20,000 IU Every day Weekly ,,
  18. 18. MEDIUM TERM ACTION Fortification: addition of some nutrient to an edible substance to increase its nutritive value. By fortification of certain foods with Vitamin A. e.g : Dalda (vanaspati). Baby food. Dried skimmed milk. Under consideration: sugar, salt, tea etc.
  19. 19. LONG TERM MEASURES Action is slow but long lasting.  Health education: advised to take vitamin A rich diet. How to prepare a balanced diet. How to prepare proper weaning diet.  Promote Breast Feeding: Exclusive breast feding upto 6month. Colostrum is rich in vitamin A and antibodies.  Immunization: against infectious diseases particularly measles.
  20. 20. VISION 2020 ‘The RighT To SighT”  a global initiative, launched by WHO: 18th February 1999 India: 14th October 2004  Objective: to reduce avoidable blindness (preventable & treatable) by the year 2020. e.g: vit-A def, cataract, glaucoma, refractive error etc  Goal: reduce the prevalence of blindness in india to 0.5% by the year 2020 (current is 1%)
  21. 21. VITAMIN-A PROPHYLAXIS PROGRAMME  2,00,000 IU of Vitamin-A (retinol palmitate) for children between 1-6 yrs.  family is kept under surveillance for 1yr and children for 5yrs. NOTE: Vitamin-A solution has been incorporated into the “National Immunization Schedule” given at 9m – 18m – 24m – 30m – 36m (total 5 doses)
  22. 22. VITAMIN- A PROPHYLAXIS  Every child between 9m – 3yrs of age given 5 doses of vitamin A.  1st dose at 9month 1,00,000 IU or 1ml along with measles vaccine.  2nd dose at 16month 2,00,000 IU or 2ml along with booster of DPT.  3rd dose after 6month 2L IU  4th dose after 6month 2L IU  5th dose after 6month 2L IU

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