Pneumonia and Vitamin A in China

now um I'm going to carry on now and look at the research from China now I know people might be getting a bit bored by now so I'll put this up as a whole video at first and then I'll put it up as two halfes so you can um watch the whole thing or watch in two lumps whatever you would like um but it's some pretty interesting stuff actually it really is bemusing that the wh uh forget well I don't know if they forgot but they didn't put it on their website anyway when they were talking about those other things that we are already uh aware of and have been it's fair to say have been discussed on other platforms uh right let's sorry L's serious matter let's get on with it let's go let's done with get going with this vitamin A deficiency this is the paper is associated with severe micoplasma pneumoni now that's in italics because that's the name of the organism that's the name of the bacteria micoplasma pneumoni that's how you pronounce it pneumoni uh is the organism and that causes micoplasma pneumonia pneumonia a pneumonia of course is the uh infection in the lower parts of the lungs in the alveoli particularly vital for gaseous exchange now uh this P This research was actually done in Beijing where coincidentally this outbreak occurs so particularly surprising so presumably in its Library the wh have got a copy of this paper of a particular deficiency with this particular micoplasma pneumonia disease identified in 2020 And yet when there's an outbreak of this specific disease in the specific area they don't mention it on their press release anyway can't explain that but right so this was done in Beijing where this outbreak of the micoplasma currently is uh 122 children that got sick not to 15 years of age it doesn't sound like many for a research study but these are all children that got sick so it's a pretty good sample from that size now uh 52 had a severe uh micoplasma pneumoni pneumonia so the severe form of the pneumonia um 70 had uh the non severe form so they still had the pneumonia but they weren't as ill so 52 were very ill 70 were infected with pneumonia still had pneumonia so this infection was still in the tissue of the lung that's probably the simplest definition of pneumonia infection in the tissue of the lung as opposed to bronchitis which would be the upper upper Airways pneumonia is the lung tissue itself the lung parenchima the Alvi the gaseous exchange areas of the lung now very interesting study serum levels of vitamin A D and E were measured and compared and correlated with severe uh microplasma and uh sorry non severe microplasma and less severe microplasma now what did they find very interesting uh the age uh was older in the severe cases uh the severe children than in the non severe so the age was older in the severe on so these ones had the more severe disease average age of 7.12 years as opposed to 4.0 zero years so that is uh that is interesting the age was older in the severe ones so looks like these children had more severe disease and slightly older children uh so older children suffer more severe infections right now vitamin A deficiency was present in both the nonsevere uh micoplasma pneumonia and the severe mopas so both had vitamin A deficiency vitamin A levels were significantly lower in the severe ones uh than the non severe levels so what we see is the children with the most severe form of the uh micoplasma pneumonia um people with the children with the most severe forms of the pneumonia had the lowest levels of vitamin A the children with the higher levels of vitamin A had the less severe form so lower vitamin A Levels more severe disease higher vitamin A Levels less severe disease and these were very statistically significant when they did the statistical analysis of this um and they were the vitamin A Levels that they found with era bars that they're just rough figures vitamin A deficiency was defined at less than um 0.2 mg per liter so we see here um well these are less that's well less than 0.2 isn't it so even these children here with 0.19 with the less severe disease still had deficiency they were still below the 0.2 so what we're seeing is the majority of children with non severe and severe micoplasma pneumonia had vitamin A deficiency but the children with the lowest levels of vitamin A had the most severe micoplasma disease it's it's a pretty clear correlation um subclinical deficiency was 0.2 to 0.3 normal range was 0 .3 to 0.7 so we see normal range 0.3 to 0.7 and the people with the uh the most severe form of dis disease only had 0.15 um we can see that the levels were really quite uh low that's about what five times lower than than that approximately so um quite uh quite interesting correlation there and of course doesn't necessarily really tell you it's causal but we know that vitamin A is so important in immunity anyway you would surely think it's something well worth thinking about right so children with lower vitamin A Levels suffered more severe infections children with lower vitamin A Levels suffered more severe infections vitamin E and D levels were also measured in children with severe samples and these are the figures that they found that the blood levels that they found there uh but both the severe and the non severe did not show deficiency of vitamins e and D so this is the key thing here so they looked at vitamins uh a and found that um there was a lot of children deficient in vitamin A and the children that were more deficient had more severe disease and the children with suboptimal levels are more likely to get even non severe pneumonia but in this population they didn't find a lot of deficiency in vitamin E and vitamin D so it's vitamin A which seems to be the problem in this particular population and as I say I've seen this commonly in uh Asia I've seen vitamin A deficiency in children in India several parts of India um Cambodia Thailand common in Asia don't know specifically about China haven't worked there but um but this did this study clearly showed from the Beijing doctors and scientists that it is a big problem there um vitamin A deficiency odds ratio was heck it's it's like that's like a thousand times more likely to get really sick up to about a third more likely to get really sick so even if it's only like a third more likely to get sick with optimized vitamin A Levels um that's well worth doing and it could be it could be that because this is due to the small sample size that we've got these wide Arab bars so it could be that children with high vitamin A levels are a thousand times or adequate vitamin A levels are a thousand times less likely to get disease or three times less likely to get disease but even if it's anywhere between those hey that is worth having and let's notice here that this is very unlikely the p p is .09 very unlikely this Rose chance uh this result arose by chance so this is protecting against severe uh microplasma pneumonia deficiency uh of vitamin A vitamin A deficiency under six years now so under the age of six 85% of children were deficient in vitamin A over the age of 6 62.5% of children so in this area in Beijing um they found the children coming in who were ill 85% of these children were short of uh vitamin A well between 62.5 and 85% short of vitamin A so we've got all these factors we know that vitamin A is necessary for mucosal immunity we know that vitamin A is necessary for the normal functioning working with vitamin D in the normal function of as far as I know all the immune cells in the body but certainly the T lymphocytes as we looked at that specific research study on so we know it's necessary for mucosal immunity uh we know it's necessary for the um functioning of the white blood cells the immune cells and and other cells um we know that up to 85% of children were deficient the children that were most deficient had the most severe disease it's a pretty compelling case for testing the vitamin A levels in these children and optimizing the vitamin A levels in these children and uh the authors do really seem to firmly believe this vitamin A supplement could reduce the incidence of severe myoplasmic pneumonia this is theth now the authors can't say this based on the study that they did but this is based on their reading of the adjacent literature and putting everything together as we have just done so really very likely now the conclusions that the authors come to here and again I think it goes with without saying isn't that that vitamin A is remarkably cheap remarkably cheap um new drugs perhaps to treat micoplasma pneumonia could end up being expensive I mean maybe not but who who knows expensive drugs could be invented could be never know but vitamin A essentially free right conclusions of the author authors vitamin A deficiency is associated with severe uh microplasma pneumonia and more likely present present in the younger uh children um now I know there's some conflict here with the age levels but just go with this General conclusion it does make sense therefore it's important to monitor the supplement and supplement vitamin A in micoplasma pneumonia pneumoni pneumonia patients so let's just clarify that this is what the authors are saying therefore it is important to Monitor and supplement vitamin A in micoplasma pneumoni pneumonia patients these children and that seems to be what's causing this outbreak in China at the moment now this is potentially good news for Western countries because although there has been this micoplasma pneumonia increases in the amount we're seeing in in China Denmark France Netherlands possibly in Ohio there's more of that there um but in Western countries adults and uh children are much less likely to be vitamin A deficient but it does show the importance of uh monitoring this and uh doing doing um we we need to do much more nutritional screening than we are doing um we've talked about this in the context of vitamin D but it now looks like it's also the case of vitamin A but basic nutritional uh you know talking about what diet children eat and and talking to mothers about diet uh and as long as the foods available could potentially well I would have thought completely essentially completely eliminate vitamin A deficiency so a very obvious thing to do therefore it's important to Monitor and supplement vitamin A in micoplasma pneumonia patients so problem in Asia um could this spread to areas of the world Pakistan Bangladesh India uh southeast Asia where vitamin A deficiency is more common in children I'm afraid that is a real possibility is it likely to be a particularly big problem in Western Country where vitamin A deficiency is not there we would hope significantly less so the other variable here of course is is there some new virus in China now of course the micoplasma is not a virus it is a bacterium so what am I talking about well any viral infection of the respir passages is going to predispose potentially predisposed to secondary bacterial infection so is there some new virus going around in China spreading rapidly predisposing many children to the micoplasma pneumonia exacerbated by the deficiency in vitamin A if there is a new virus of course that virus could potentially spread causing respiratory infections around the world and therefore increasing the probability of uh post viral bacterial respiratory infections we simply don't have the data to answer that question just a few more details from the paper micoplasma pneumonia frequently causes community acquired pneumonia in children and this occurs throughout the year so very often we don't have the seasonality that's why the seasonality in China could be secondary V secondary uh to viral infection that's quite possible can be transmitted by droplets presumably by aerosols children of all ages are susceptible particularly if they're short of vitamin A it would appear in recent years the number of children with uh micoplasma pneumonia is increased so it's becoming more common at least in China and they have a prolonged course of the disease so what these authors are saying is there's more of this around in China more of it and the children are getting sicker the disease is taking longer for the children to clear which is why they're so Keen to publicize their findings on vitamin A deficiency typical symptoms fever wheezing difficulty in breathing chest pain and chills microplasma pneumonia particularly refractory or severe often results in plural fusions atelectasis so plural Fusion collection of fluid around the plal membranes atelectasis is problems with the lower Airways particularly and other organ damage now uh if it's uh particularly severe so so severe means the disease is severe refractory means basically it's not responding to treatment uh and this is a problem because of the antibiotic resistance so part of this could be the antibiotic resistance which we reported on in the last study uh again from data uh from peer review information from China vitamin deficiencies lead to higher instance of respiratory and digestive diseases particular diseases particularly in children so again yes we know this is true because it the vitamin A deficiency uh reduces the quality the the uh the uh the Integrity of the external and respiratory and gastrointestinal integuments vitamin uh uh but vitamins also significantly impact on disease prognosis so children that are shter vitamins generally they're going to stay sicker for longer and they're less likely to recover uh our findings show that vitamin deficiency vitamin A deficiency um was significantly correlated with severe micoplasma pneumonia and more likely occurred in the younger children vitamin A plays an important pelot trophic role in supporting normal mucosa bar it does many things in supporting the normal mucosal barrier so important to stop the disease getting in in the first place so hopefully most diseases is not doesn't get into the body tissu fluid spaces at all um because it's uh it's prevented from getting in there through the mucosal barriers so only when it gets through into the systemic parts of the body that the white cells need to kick in and do their job so um working on both levels as we said with a result of increasing risk of invasive pathogens so you get invasive pathogens if they get through the barrier if they get through the mucus of the respiratory tract if they get through the uh mucus of the gastrointestinal tract then they're more likely to get into the um the uh the areas inside the body that should be sterile um more information still from this paper uh children who uh presented vitamin A deficiency we're more likely to get an acute respirat tract infection and diarrhea so again vitamin A preventing uh respiratory and diarrhea illness it regulates cyto kind so they're more likely to get sick of the short of vitamin A the function of macras that's these eating cells big eating cells nutrifil and natural killer cells were impaired neutrophils are particularly active as antiviral sorry as antibacterial cells and natural killer cells which will kill virally infected cells so it's working against a range of organisms here with a range of Whit blood cells and the protective function of the respir mucosa was also decreased in the deficiency of vitamin A as we said so um quite clear in the author's conclusions um vitamin A deficient Rats of thicker alveola basement membranes that doesn't sound good does it um so again experimental evidence from animals being consistent all this is consistent it all seems to be adding up to a very coherent uh picture um the incidence and severity of infectious diseases are increased in vitamin A deficient children this is simply what doctors and nurses see on the ground epidemiological surveys show that the incidence of vitamin A deficiency is significantly associated with age younger the age the higher the instance of vitamin A deficiency this is a in children and we've seen that this microplasma pneumonia is primarily a problem of children in China um the younger the age the higher the incidence of vitamin A deficiency vitamin A deficiency was associated with severe micoplasma pneumonia and the supplementation of vitamin A May reduce the occurrence of severe disease in children makes perfect sense several studies showed that supplementation of vitamin A could reduce the incidence of respiratory infections and shorten the course of their disease good strange as the ho didn't mention this uh vitamin A deficiency was more likely present in in uh younger severe patients with severe micoplasma neonia suggesting that supplementation of vitamin A is more important in younger children who have potential micoplasma pneumonia infection final thing congratulations if you're still here um in our study although we did not find a significant correlation between vitamins E and D levels with non severe and severe pneumonia uh vitamins D and E should be maintained at at least the normal levels it's just that they didn't find the deficiency in this study so it all kind of hangs together there the vitamin A deficiency could be a big factor if this is the case it's probably good news for Western countries the as far as we know many thousands and thousands of children being admitted to hospital in China um might not occur in countries which have uh adequate levels of vitamin A in their children but I am concerned for Asian poor particularly poorer areas rural areas slum areas of uh Asian countries where vitamin A deficiency is highly prevalent um this could lead to a big problem for the children of Asia and you would think ideally what we would have is an international organization that would say you know what um there's a big risk here of myoplasmic pneumonia in children and we know that lack of vitamin A is a big factor in this disease therefore let's start optimizing the vitamin A levels in children with vitamin E and D as necessary and nutrients optimize the immune efficiency of these children and make it much more less likely they'll get disease and if they do get disease make it less likely they get severe disease P we haven't got such an I mean what could we call an organization like that that would do that anyway can't think of anything at the moment but um Food For Thought indeed and uh if we do this hopefully we won't need um new novel expensive experimental treatments having said that new treatments are always good as long as they're affordable by people uh people can afford them um but of course prevention is always better than cure thank you for watching

Channel: Dr. John Campbell

Views: 140,326

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: PCNpu7dYFuw

Length: 22min 14sec (1334 seconds)

Published: Wed Dec 06 2023