Vit B12 Research Articles

2244-PUB: Role of B Vitamins (B1, B6, B12) in Managing Diabetic Peripheral Neuropathy (DPN): A Systematic Review

Introduction: DPN affects approximately 50% of diabetic individuals worldwide1. B Vits are used in DPN management although evidence supporting treatment outcomes vary. Objective: Evaluate the evidence supporting B Vits usage in DPN. Methods: Literature search: Medical Subject Headings and text words in Pubmed/EMBASE identified 226 clinical trials published between 1978 - Nov 2018. Using PRISMA guidelines, data was extracted from eligible studies and risk of bias assessed was assessed by 2 authors. Main Results: Fifty-one studies involving 4621 patients were selected [40 RCTs (Placebo-controlled: 7; Active-control: 34) and 10 single-arm study]. Results from placebo-control studies involving daily B vitamin(vit) monotherapy [benfotiamine 300- 600mg OR methylcobalamin 1500μg (MC)] OR Superoxide Dismutase (SOD), Alpha Lipoic Acid (ALA), Acetyl L-Carnitine (AC) and Vit B12 combination showed significant improvement in neuropathy-related scores/symptoms vs. control. One study (150mg pyridoxine daily) showed no improvement in nerve conduction was noted vs. placebo. Vit B6 80mg + 800mg ALA/day showed no inflammatory marker improvement. When Mono- or combination B Vits was compared to active controls[e.g.: micronutrients/herbs(ALA; ALC; Traditional Chinese Medicine), drugs (pregabalin; nortriptyline; venlafaxine) and lifestyle interventions (moxibustion; low-fat plant-based diet)], 29 studies showed improvements in DPN symptoms relative to control. Two studies showed less effectiveness compared to venlafaxine and cytidinie triphosphate. All single arm B Vit studies (IM MC 500μg 1/day OR 3/week OR benfotiamine/Vit B1/B12) showed improvement in nerve function. Conclusion: B Vits had positive effect on neurophysiological symptoms and/or functions compared to baseline in 38 studies. RCTs evaluating the efficacy of B Vits in standardized combination/doses are limited. Further studies are required to elucidate optimum treatment combination/doses and duration. Disclosure J. Liew: None. A. Barlow: None. L. Lim: Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. K. Suastika: None. Y. Yasahardja: None. S. Chan: None. A. Soh: None. L.S. Li: None. A.T. Tan: None.

Pyridoxine impact on patients with myelodysplastic syndromes with ring sideroblasts: Single institution retrospective study.

e18549 Background: Many vitamin deficiencies can cause anemia. It is prudent prior to diagnosing a myeloid neoplasm, to check for vitamin deficiencies and correct them. Myelodysplastic syndromes with ring sideroblasts (MDS-RS) are associated with anemia. Pyridoxine (Vit B6) replacement may improve anemia found in sideroblastic anemia. The study was to determine how frequently Vit B6 was assessed, replaced and impact replacement had on outcomes in MDS-RS. Methods: Study subjects were from the Mayo Clinic Myelodysplastic syndrome (MDS) database which contains 1315 patients (pts). Appropriate IRB approval was obtained. Diagnosis of MDS and its sub-classification was done according to World Health Organization 2016 criteria. A response was any improvement in hemoglobin. Overall survival (OS) estimates were calculated using Kaplan-Meier curves and univariate and multivariate analysis was done using JMP software version 13. Results: Among 1315 pts with MDS, 161 pts had a diagnosis of MDS-RS. Median age was 73, and 55 (34%) pts were females. Thirty-nine (36%) pts had very low, 53 (50%) low, 9 (8%) intermediate, 3 (3%) high, and 2 (1%) had very high revised international prognostic score. The median white blood cell count was 5.4 x109, platelet count was 255 x109, and hemoglobin was 9.9 gm/dL. Five pts (3%) had a Vit B6 levels done; out of whom, 4 (80%) were not Vit B6 deficient. Among 42 (26%) pts who had Vit B6 replacement, 21 (50%) had no response, 4 (10%) had a response and 17 (40%) had unknown response. 103 (64%) of the pts were transfusion independent (TI). Overall survival in pts who are transfusion dependent was 68 months compared to 85 in pts who are TI (Wilcoxon P =.03). There was an improvement in OS in the group that had Vit B6 replacement compared to the group with no Vit B6 replacement (92 months vs 68 months, Wilcoxon P =.07). Response to Vit B6 replacement did not show OS benefit. Acute Leukemia transformation in Vit B6 replacement was 2% and 6% in pts. who did not have Vit B6 replacement (P= .4). Conclusions: Vit B6 was not checked often in MDS-RS pts. There was a borderline improvement in OS in Vit B6 replacement group (p= .07). Response did not affect OS. A larger prospective study is needed to study Vit B6 role in MDS-RS.

Prediction of Iron Deficiency by Red Cell Distribution Width, Mean Corpuscular Volume and Haemoglobin Concentration in Pregnant Women

Background: Red cell distribution width (RDW) is a routine parameter in fully automated hematology auto analyzer, can give the idea of iron deficiency before haemoglobin and mean corpuscular volume in early iron deficiency or latent stage. Patient can be benefited by doing complete blood count including RDW for the diagnosis of early iron deficiency as a cheaper test than iron profile. This study was aimed to predict early iron deficiency by RDW, mean corpuscular volume and haemoglobin concentration in pregnant women.
 Methods: In this study, 190 pregnant women were included from Gynae and Obstetric outdoor of Bangabandhu Sheikh Mujib Medical University from august 2008-2009. Complete blood count including haemoglobin percentage, mean corpuscular volume and RDW and iron profile were done. RDW was compared with haemoglobin concentration and mean corpuscular volume in various stages of iron deficiency.
 Results: RDW was more significant than haemoglobin concentration in latent iron deficiency when haemoglobin level was normal (p<0.05). In mild and moderate iron deficiency anemia, RDW was increased progressively though haemoglobin level was reduced. RDW was more significant than mean corpuscular volume level in latent iron deficiency, mild and moderate iron deficiency anemia. The difference of mean corpuscular volume and RDW was statistically significant (p<0.05) in latent iron deficiency, mild iron deficiency anaemia and moderate iron deficiency anaemia (p value of 0.001, 0.001 and 0.011). In this study RDW had sensitivity 82.3% and specificity 97.4%. haemoglobin concentration and mean corpuscular volume had sensitivity 56.6% and 29.2 % and specificity 90.9% and 98.7 % respectively. Based on the receiver-operator characteristic (ROC) curves RDW had the best area (0.925) under curve compared to haemoglobin and mean corpuscular volume.
 Conclusion: Latent iron deficiency without other existing disease like haemoglobinopathy, early folate / vit B12 deficiency could be predicted early by increased RDW when haemoglobin concentration and mean corpuscular volume were normal.
 Birdem Med J 2019; 9(2): 111-116

Prevalence of autoimmune diseases and clinical significance of autoantibody profile: Data from National Institute of Hygiene in Rabat, Morocco

AimThe objective of this study was to explore the prevalence of various autoimmune diseases (AIDs) in a large cohort of patients and to characterize the autoantibody profile in the patients with and without AIDs to confirm the diagnosis and to refine the Moroccan databases. Patients and methodRetrospective study was conducted in the Laboratory of autoimmunity National Institute of Hygiene (NIH) of Rabat in Morocco. A total of 3182 consecutive Moroccan patients (2183 females and 999 males) whose sera were tested for 14 autoantibody profile between 2010 and 2016. ResultsOnly 944 (29.7%) patients were diagnosed with AIDs of those suspected. The prevalence of systemic lupus erythematosus (SLE), intestinal malabsorption (IM) and arthritis polyarthralgia (AP) were the highest (4.2, 4.1 and 4%), subsequently followed by rheumatoid arthritis (RA) (2.8%), cholestatic syndrome (CS) (1.8%), interstitial lung disease (ILD) (1.6%).In females IM, AP and SLE also showed the highest prevalence (5.4%, 5.3% and 4.9% respectively), while of male, SLE showed the highest prevalence (1.9%). The prevalence of ANA was increased in most patients with systemic especially in neuropathy (NP), hemolytic anemia (HA), primary Sjogren’s syndrome (pSS), dermatomyositis (DM), thrombocytopenia (Tb), systemic sclerosis (SSc), ANCA-associated vasculitis (AAV), AP, Renal impairment (RI), SLE, and mixed connective tissue disease (MCTD). Anti-dsDNA antibodies were higher in SLE and ENA showed the highest titers in MCTD. Others are relatively specific for certain disease, such as anti β2GP1 for thrombosis syndrome, anti ANCA for primary sclerosing cholangitis (PSC), AAV, ILD and RI, anti CCP2 for RA, ILD and AP. the prevalence of anti AMA was higher in primary biliary cirrhosis (PBC), followed in CS, also, ANA have been identified in up to 25% of patients with primary biliary cirrhosis. The prevalence of anti-SMA was higher in PBC, treated patients for Chronic hepatitis C (HCV), and autoimmune hepatitis (AIH) and anti-PCA was higher in biermer anemia patients with vitamin B12 deficiency (BA/Def vit B12). The prevalence of IgA EMA, IgA tTG and IgA AGA were higher in patients IM and celiac disease (CD). The prevalence of anti thyroperoxidase (TPO) was significantly increased in the autoimmune thyroiditis (AIT). ConclusionOur study shows the diagnostic value of auto antibodies in AIDs. It would be interesting to carry out prospective studies on each pathology separately, in order to fill the classic vagaries of the retrospective study and objectively estimate the prevalence in different AIDs. These data on the prevalence of each autoimmune disease are valuable for the public health system.

Nutritional anaemia: clinical and haematological presentation in children

Background: There are three main causes of anemia, decreased production of RBCs, and excessive destruction of RBCs or Excessive blood loss. In India, the main reason of anaemia is the decreased production due to nutritional deficiency. The main nutrients required in the process of haemoglobin production are iron, folic acid and cyanocobalamine. The objective of the present study was to find the clinical presentations and hematological changes in children with nutritional anaemia.Methods: This Cross-sectional study was conducted from January 2018 to October 2018 in the department of Paediatrics of Ashwini Rural Medical College Hospital and Research Centre, Solapur. Children visiting the paediatric OPD due to any illness and having clinical suspicion of anemia were initially screened for inclusion in the study. Detailed laboratory investigation such as CBC, peripheral blood for Leishman’s stain and reticulocyte count were performed. Serum Ferritin, vitamin B12, folic acid levels were also done to ascertain the cause of anemia. World Health Organization recommended criteria were used to diagnose and grade the anemia.Results: A total of 405 anemic children were included in the study. Out of that 213 were boys and 192 were girls. A total of 226 children presented with mild anemia. The most common clinical presentation was respiratory tract infection, found in 62.22 % of children followed by fever in 53.09 % of children. Maximum numbers of patients were suffering from iron deficiency anemia, followed by folic acid deficiency. Deficiency of both of these nutrients was also common. Vit B12 deficiency was found in only 5 children.Conclusions: The study concluded that iron deficiency anemia was the commonest nutritional anemia in children in the age group of 5 to 15 years. Second most common deficiency was of folic acid. Majority of the anemic patients presented with respiratory tract infection and fever.

Etiologyical Analysis of 133 Patients with Elderly Macrocytic Anemia and Diagnostic Significance of Laboratory Tests

To study the etiology of macrocytic anemia in elderly patients and to evaluate the diagnostic significance of laborotory tests. 133 elderly macrocytic anemia patients, whose age>60 years old, hemoglobin<100 g/L, mean red cell volume(MCV)>100 fL, and bone marrow cell test was performed, and these patients were grouped according to diseases, and the bilirubin, lactate dehydrogenase, folic acid, vit B12 and serum ferritin were tested, then the results of tests were compared and analyzed. The majority of the cases were diagnosed as megaloblastic anemia (MA), myelodysplasia syndrome (MDS), acute leukemia/multiple myeloma (AL/MM) and hemolytic anemia (HA). Usually HA was a simple anemia, while others were accompanied by decrease of other 1 or 2 series. HA patients were often with significant high level of well volume (MCV), red cell distribution width(RDW), reticulocytes (RC) and indirect bilirubin (IBIL) (P<0.01). However, MA patients were often with high level of LDH. Serum ferritin (SF) level was significantly higher in both MDS and AL/MM groups (P<0.01). Common causes of macrocytic anemia in elderly patients are MA, MDS, AL/MM and HA. The combination detection of MCV, RDW, RC, LDH, IBIL and SF contributes to enhancing the accuracy of diagnosis.

An Electrochemical Sensor for Determination of Vitamin B2 and B6 Based on AuNPs@PDA-RGO Modified Glassy Carbon Electrode

Insufficient or excessive consumption of Vitamin B2 (Vit B2) and Vitamin B6 (Vit B6) can cause harmful effects on human health conditions, it is therefore very important to control their content in supplements and food products. In this work, we report on a simple, sensitive and selective electrochemical sensor based on gold nanoparticles (AuNPs) on glassy carbon electrode (GCE) modified by a hybrid of polydopamine and reduced graphene (PDA-RGO), for determination of Vit B2 and Vit B6. The hybrid nanomaterial comprising PDA-RGO supported AuNPs is constructed through a one-step GCE modification process for electrochemical quantification of Vit B2 and Vit B6 in pharmaceutical formulations. Cyclic voltammetry result reveals that the effective response to Vit B2 and Vit B6 is according to the high electrical conductivity of AuNPs and the large surface area of PDA-RGO. Meanwhile, the sensor modified with a composite film shows a synergistic effect for catalyzing the analytes. Under optimized experimental conditions, these sensors show wide linear ranges of 0.02−60.0 μM and 0.03−600.0 μM, with the detection limits (LODs) of 0.0096 μM and 0.025 μM for Vit B2 and Vit B6, respectively. Additionally, the constructed sensors have been applied for quantifying Vit B2 and Vit B6 in pharmaceutical formulations. Such an effective electrochemical platform could be potentially applied for analyzing various components for therapeutic drug monitoring.

Oral Doxycycline as an alternative initial treatment for desquamative gingivitis

Oral Doxycycline as an alternative initial treatment for desquamative gingivitis

Vitamin B6 reduces oxidative stress in lungs and liver in experimental sepsis.

Sepsis is a life-threatening organ dysfunction induced by a disrupted host response to infecting pathogens. Inflammation and oxidative stress are intrinsically related to sepsis progression and organ failure. Vitamin B6 is an important cellular cofactor for metabolic processes and has anti-inflammatory and antioxidant properties. We aimed at evaluating the effect of vit B6 on inflammation and oxidative stress markers in the liver and lung of rats subjected to a relevant animal model of polymicrobial sepsis. Adult male Wistar rats were submitted to cecal ligation and perforation model and immediately after sepsis induction, vit B6 was administered as a single dose (600 mg/kg, subcutaneous). Twenty-four hours later, the lung and liver were harvest for neutrophil infiltration, oxidative markers to lipids and protein and antioxidant activity of endogenous enzyme. Vitamin B6 diminished neutrophil infiltration in both organs, oxidative markers in the liver and restored catalase activity levels in the lung of septic animals. Vitamin B6 exerts anti-inflammatory and antioxidant effects in peripheral organs after polymicrobial sepsis.

Oxidation of cystatin imparted by riboflavin generated free radicals: Spectral analysis

Thiol Protease inhibitors (cystatins) are endogenous natural inhibitors of cysteine proteases. They are present in all mammalians cells and body fluids. Cystatin are allocated into three major families. Family –I stefins, family –II cystatins and family –III kininogens, according to their amino acid sequence, molecular weight, carbohydrate content and disulphide bonds. It has been investigated that thiol proteases (cathepsin) and their endogenous inhibitor, cystatins have been closely associated with diseases like Alzheimer's, Prions, neurodegenerative diseases, cancer and diabetes. Photodynamic effect of various sensitizers' have long been applied to delineate structural and functional properties of biologically active proteins. Flavins are well known to photo oxidize amino acids which effects conformation of proteins. Riboflavin (Vit B2) with a recommended daily requirement of approximately 2–3 mg is a yellow pigment, It is widely distributed in human tissues and blood, in both free and conjugated forms.In the present Study it has been shown that cystatin purified from buffalo brain (BC) is susceptible to reactive oxygen species generated by photo activation of riboflavin. It was observed that Photo activated riboflavin leads to inactivation of BC. Major Loss of tryptophan intensity was observed in the presence of purified thiol protease inhibitor upon incubation with 50 μM of riboflavin.In order to inspect the type of reactive oxygen species involved in inactivation of the inhibitor, different scavenger's were used namely glucose, potassium Iodide, sodium azide, manitol, thiourea, sodium benzoate, curcumin, quercetin, ascorbic acid and uric acid. It was found that Glucose, Potassium Iodide and sodium azide, have preventive effect on photo inactivation of the purified cystatin whilst other scavengers illustrated diminutive defensive effect.

Comparative Evaluation of the Nutrient Composition and Phytochemical Content of Selected Vegetables Consumed in Nigeria

This study evaluated the phytochemical and nutrient composition of four selected vegetables consumed in Nigeria, namely, bush mallow (ahihara), garden egg leaf (okpokwa), African spinach (inine), and bush okro (ewedu). They were analyzed for proximate, minerals, vitamins and phytochemical contents. Proximate values maintained the following ranges: moisture 6.73% to 91.22%, protein 7.05% to 32.12%, crude fiber 2.75% to 6.36%, ether extract 3.15% to 6.81%, ash content 2.81% to 6.81% and carbohydrate 48.75% to 72.62% while energy value ranged from 340.54kcal to 363.07kcal. The vitamin contents for these vegetables ranged as follows: vitamin A 0.13.mg/100g to 370.64mg/100g, thiamin (vit B1) 3.12mg/100g to 7.45mg/100g, riboflavin (vit B2) 0.08mg/100g to 3.96mg/100g, vitamin B3 (niacin) 0.17mg/100g to 1.91mg/100g, and vitamin C 39.84mg/100g to 98.75mg/100g. The mineral content, namely, calcium ranged from 45.61mg/100g to 430.69mg/100g, magnesium 11.05mg/100g to 198.14mg/100g, potassium 49.82mg/100g to 708.28mg/100g, sodium 2.36mg/100g to 22.98mg/100g. Also the phytochemical contents of the vegetables for phytate ranged from 0.47% to 3.04%, tannin 0.10% to 1.01%, saponin 0.16% to 2.56% and oxalate 0.63% to 0.72%. The results obtained from these vegetables show that they can contribute qualitatively to the nutritional need of the Nigerian population especially among the rural dwellers where vegetables is major food source.

Correlation of Vit B12 levels with metformin usage among type 2 diabetic patients in a tertiary care hospital

Background: T2DM is a metabolic disorder that is increasingly becoming a public health concern. The disease is associated with a variety of systemic macrovascular and microvascular complications. Diabetic peripheral neuropathy (DPN) is the most common complication, and it may eventually develop in up to 50% of patients. It is assumed that prolonged use of metformin causes vitamin B12 deficiency. The clinical presentation of vitamin B12 deficiency generally includes haematological and neurological manifestations. The aim of the study is to correlate vit b12 levels in relation to duration of usage of metformin for a period of more than 1 year.Methods: The study was conducted from November 2017 to June 2018 for a period of 7 months which included 50 subjects from both sex groups, aged 18 years and above, on metformin with subjective evidence of neuropathy and compared with vit b12 levels.Results: The study results indicate that there is no significant drop in vit b12 levels in metformin users in significant proportions to cause vitb12 deficient-neuropathy. The p value being 0.658 comparing vit b12 with metformin usage years (&lt;2 yrs, 2-5yrs, 5-8yrs, ≥8yrs).Conclusions: This cross-sectional study indicates that diabetic patients who were on metformin were not having any vit b12 deficiency, though all patients had subjective neuropathy. This suggests that neuropathy is not related to metformin induced Vit B12 deficiency. Therefore, prescribing of vit b12 supplementation in any long term metformin treated patients is no longer necessary and reduces patients financial burden.

The Effectiveness of using oranges to delay fatigue appearance and improve the skill level of swimming specialized students

This research aims to identify the effect of the use of oranges on: Biochemical variables (Vitamin C or Acid Ascorbic- glutathione GSH- Vit B2- MDA) of swimming specialized students. Improving the skill level of crawl stroke, backstroke and breaststroke swims (50 m timing- 50 m performance) and enduring swimming for 3 min for swimming specialized students. From the results that the researchers reached and within the limits of the research sample they concluded the following: There are statistically significant differences between the post measurements of the experimental and control groups in the level of some biochemical variables (vitamin C or ascorbic acid - glutathione GSH - Vit B2 – MDA) in favor of the experimental group. There are statistically significant differences between the post measurements of the experimental and control groups in the digital level of crawl stroke, backstroke and breaststroke swims (50 m timing- 50 m performance) and enduring swimming for 3 min in favor of the experimental group. Recommendations: In light of the research results and the limits of the sample, the researcher recommends the following: The use of oranges before training delays the fatigue appearance and improves the skill level of swimming specialized students. The trainers’ attention to the swimmers nutrition side, especially eating orange before the starting of the training to contribute in improving the skill level. Conduct other studies on nutrition that delay fatigue appearance and improve the skill level of swimmers. Conduct other studies on oranges for other sports.

Comparative Evaluation of the Nutrient Composition and Phytochemical Content of Selected Vegetables Consumed in Nigeria

This study evaluated the phytochemical and nutrient composition of four selected vegetables consumed in Nigeria, namely, bush mallow (ahihara), garden egg leaf (okpokwa),African spinach(inine), and bush okro (ewedu). They were analyzed for proximate, minerals, vitamins and phytochemical contents. Proximate values maintained the following ranges: moisture 6.73% to 91.22%, protein 7.05% to 32.12%, crude fiber 2.75% to 6.36%, ether extract 3.15% to 6.81%, ash content 2.81% to 6.81% and carbohydrate 48.75% to 72.62% while energy value ranged from 340.54kcal to 363.07kcal. The vitamin contents for these vegetables ranged as follows: vitamin A 0.13.mg/100g to 370.64mg/100g, thiamin (vit B1) 3.12mg/100g to 7.45mg/100g, riboflavin (vit B2) 0.08mg/100g to 3.96mg/100g, vitamin B3(niacin) 0.17mg/100g to 1.91mg/100g, and vitamin C 39.84mg/100g to 98.75mg/100g. The mineral content, namely, calcium ranged from 45.61mg/100g to 430.69mg/100g, magnesium 11.05mg/100g to 198.14mg/100g, potassium 49.82mg/100g to 708.28mg/100g, sodium 2.36mg/100g to 22.98mg/100g. Also the phytochemical contents of the vegetables for phytate ranged from 0.47% to 3.04%, tannin 0.10% to 1.01%, saponin 0.16% to 2.56% and oxalate 0.63% to 0.72%. The results obtained from these vegetables show that they can contribute qualitatively to the nutritional need of the Nigerian population especially among the rural dwellers where vegetables is major food source.

Evaluation of Vitamin B12 Deficiency and Associated Factors in Patients With Systemic Sclerosis.

In patients with systemic sclerosis (SSc) gastrointestinal (GI) involvement, nutritional status and medications may lead to cobalamin (Vit B12) deficiency. We aimed to determine the frequency and the potential causes of Vit B12 deficiency in SSc patients. We conducted a cross-sectional analysis of 62 SSc patients in a single center in 1 year period. Medical history and physical examination of patients were reevaluated. Data about organ involvements were obtained from hospital file records. The nutritional status of the patients was assessed with Malnutrition Universal Screening Tool (MUST). Vit B12, homocysteine (except in three patients) and Helicobacter Pylori Immunoglobulin G (H. Pylori IgG) levels were measured in all patients. Vit B12 deficiency was considered as serum Vit B12 level <200 pg/mL or being on Vit B12 replacement therapy. Serum Vit B12 levels of the patients were also grouped as low (<200 pg/mL), borderline (200-300 pg/mL) and normal (>300 pg/mL). Plasma homocysteine levels of the patients were classified as elevated (>9 μmol/L) and hyperhomocysteinemia (>15 μmol/L). Mann-Whitney U and Kruskal-Wallis tests were used to compare parameters among the groups. Correlation was tested by Spearman's correlation coefficient. Forty-four (71.0%) patients were defined as Vit B12 deficient; 22 had Vit B12 level <200 pg/mL (four were on Vit B12 replacement therapy) and the remaining 22 had Vit B12 >200 pg/mL and were already on Vit B12 replacement therapy. The percentage of the patients with hyperhomocysteinemia was significantly higher in the group with Vit B12 <200 pg/mL as compared to other groups (P = 0.004) but only 33.3% (7/21) of the patients with Vit B12 <200 pg/mL had hyperhomocysteinemia. There were no statistically significant differences between patients with and without Vit B12 deficiency regarding age, mean disease duration, MUST scores, mean hemoglobin levels, H. Pylori IgG positivity and organ involvements (P > 0.05 for all). Vit B12 deficiency is frequent in SSc and has multiple causes. All patients should be monitored for Vit B12 deficiency. The homocysteine levels seem unlikely to be helpful for confirmation of Vit B12 deficiency.

The effects of vitamin B12 on the brain damages caused by methamphetamine in mice.

Objective(s):Methamphetamine (METH) is a powerful stimulant drug that directly affects the brain and induces neurological deficits. B12 is a water-soluble vitamin (vit) that is reported to attenuate neuronal degeneration. The goal of the present study is to investigate the effect of vitamin B12 on METH’s neurodegenerative changes.Materials and Methods:Two groups of 6 animals received METH (10 mg/kg, interaperitoneally (IP)) four times with a 2 hr interval. Thirty mins before METH administration, vit B12 (1 mg/kg) or normal saline were injected IP. Animals were sacrificed 3 days after the last administration. Caspase proteins levels were measured by Western blotting. Also, samples were examined by TUNEL assay to detect the presence of DNA fragmentation. Reduced glutathione (GSH) was also determined by the Ellman method.Results:The pathological findings showed that vit B12 attenuates the gliosis induced by METH. Vit B12 administration also significantly decreased the apoptotic index in the striatum and the cerebral cortex (P<0.001). It also reduced caspase markers compared to the control (P<0.01 and P<0.001, respectively). Interestingly, co-administration of METH and Vit B12 elevates the levels of GSH in both regions of the brain and returned it to normal levels compared to the METH group.Conclusion:The current study suggests that parenteral vit B12 at safe doses may be a promising treatment for METH-induced brain damage via inhibition of neuron apoptosis and increasing the reduced GSH level. Research focusing on the mechanisms involved in the protective responses of vit B12 can be helpful in providing a novel therapeutic agent against METH-induced neurotoxicity.

The effect of protein supplementation on body muscle mass and fat mass in post-bariatric surgery: a randomized controlled trial (RCT) study protocol

BackgroundSevere weight loss through means of bariatric surgery has been associated with loss of muscle mass due to lack of absorption of protein. The aim of this RCT is to investigate the effectiveness of protein supplementation in reducing the risk of developing protein malnutrition and muscle wasting in post-bariatric surgery patients in Qatar.Methods and analysisThe study was based at the Department of bariatric and metabolic surgery, Doha metropolitan and regional areas. It is envisaged that approximately 160 post-bariatric surgery patients will be randomized and followed up for 6 months. These will be males and females obese (BMI >35) Qatari patients between the aged 18–60 years. Subjects with renal or liver disease and those with past history of bariatric surgery will be excluded. By the completion of the trial, patients who took less than 80% of the supplement will be further excluded from the final analysis. Protein supplement (Cubitan,Protein, Nutricia, Netherlands) that contain daily intake of 20 g of protein to be taken orally 3 times a day throughout the study period. The placebo group will receive identical ampule containing zero-protein with exact instructions as per the intervention group. Body weight, muscle and fat mass, total protein, albumin, vit B12, Magnesium and Zinc will be measured at baseline and every follow up/study visit. Study variables will be compared between the 2 groups at different stages of the trial, including baseline, using Sample T-test (paired and unpaired) and the significance level will be confirmed with the 95% confidence interval with alpha error set to 0.05.Ethics and disseminationProtein supplementation for post-bariatric patients is not yet a standard procedure at Hamad Medical Corporation in Qatar and requires an RCT to establish evidence-based clinical practice guidelines. This study was approved by the Hamad Medical Corporation IRB and MRC committees (approval no. 16433/16).Trial registrationClinicalTrials.gov NCT03147456 (registration date: 18 April 2017).Strengths and limitations of this studyOne major strength of our study is that our population is a distinctive population (Qatari Obese patients) where results from international studies may not apply to the local and unique context. A local study like ours will provide healthcare providers in Qatar an opportunity to ensure good clinical practice and healthy and sustainable weight loss following bariatric surgery.The well-designed double-blinded RCT will almost certainly provide us with the evidence-based clinical practice guideline that we seek as health professionals.One limitation of our study is the slight discrepancy in caloric content of the intervention and the placebo (250 cal and 100 cal, respectively). However, it is the intervention that has the higher caloric content, in which case it may not influence the results in the direction of our hypothesis that protein supplementation leads to lower fat mass and higher muscle mass.Another limitation is that the use of the intervention and the placebo are not objectively measured. However, all efforts will be made to ensure compliance and reporting of consumption of products.A third limitation could be loss to follow up. Participants may cease to participate, particularly, once they have lost “sufficient’ weight and gained the fitness to consume any type of foods they desire. This is common in late stages of post-bariatric surgery (beyond 3 months). We feel that this may be a challenge, particularly in reference to our specific population. However, such findings albeit negative, should serve in improving the clinical practice delivered by healthcare providers.

The protective effect of folic acid and Vit B12 supplementation on albino rat lung injury due to cadmium inhalation

Background Folic acid and vitamin B12 are very important vitamins needed for normal cellular metabolic activities. Cadmium is a heavy metal that occurs naturally in the environment and Cadmium poisoning can occur through man-made pollution through agricultural and industrial activities. Aim Study of the effect of Cadmium of lung tissue of albino rats and the possible protective effect of administration of both Folic acid and vit B12 combination. Materials and Methods Thirty adult male albino rats were divided into 3 groups, a control group, Cadmium group, where rats received nebulized Cadmium chloride (CaCl2) and Cadmium + vit. group received Cadmium nebulization and both Folic acid and vit B12 supplementation. The lungs of rats of the 3 groups were collected and prepared for histopathological examination. Results Cadmium group sections showed disturbed lung architecture, shrunken alveoli and increased thickness of the alveolar wall. Vacuolation of the cytoplasm of some pneumocytes were noticed and some slides showed dilated congested blood sinusoids. Transmission electron microscopic sections revealed type II pneumocyte with hyperchromatic nucleus, perinuclear dilatation, dilated and mildly degenerated lamellar bodies. Cadmium + vit group showed that the lung tissue appears nearly normal with areas of mild thickening of the alveolar wall septa and mild edema inside alveoli. Conclusion It was concluded that both Folic acid and vit B12 supplementation proved to have a protective role against the harmful effects of Cadmium administration on the lung tissues of albino rats.

A descriptive study of clinico-hematological profile of megaloblastic anemia in a tertiary care hospital

BackgroundMegaloblastic Anemia (MA) is a relatively common disease, yet the data on prevalence of MA remains scarce. This study was conducted to study the prevalence and clinico-hematological profile of MA. MethodsThis was a cross-sectional study done on 1150 adult anemic patients. All patients diagnosed to have MA were studied for clinico-hematological and etiological profile. Nerve conduction studies (NCS) were done in all. ResultsMA was present in 3.6% cases of anemia. Severe anemia was seen in 9.7% of anemic patients and 75% of MA cases (p<0.05). Forty five percent of MA patients presented with pancytopenia. Vitamin B12 and folic acid deficiency were documented in 40% and 25% cases respectively while combined deficiency was noted in 35% of all MA cases. There was no co-relation between severity of anemia and deficiency of either of the vitamins (Fischer exact test: 0.530). Among MA patients, 35% were vegetarians while 65% consumed mixed diet. There was no association between vegetarian diet and Vit B12 deficiency (p=0.3137). An additional etiology was more commonly found in patients on mixed diet [92%; 24/26] as compared to those on vegetarian diet [50%; 7/14] (p=0.04). NCS was abnormal in 14 patients (35%). Overt clinical neuropathy was present in 12 cases of MA, while subclinical neuropathy was seen in 2 cases. ConclusionMA is one of common causes of pancytopenia and severe anemia. Diet plays an important role in causation of MA in vegetarians. An alternative etiology is however, more likely to be found in patients on mixed diet. While overt neurological abnormalities are common in MA, subclinical neuropathy is uncommon.

Dilemas en la enfermedad crónica avanzada: ¿prevención o desprescripción?

Objectives1-To know the preventive prescription (statin, antiplatelet drugs, bisphosphonates, calcium and vitamin D and Vit B12) of elderly patients previously identified as a CCD (with a complex chronic disease) and ACD (with advanced chronic disease and lifetime expectancy of less than 12 months) who died during 2015. 2-To assess the correct indication of Proton Pump Inhibitors (PPI) to determine potentially avoidable medication. DesignRetrospective observational study. LocationFour Primary Health Centres, Castellar del Vallès (Barcelona). Participants128 patients, 70 ACD and 58 PCC. Main measurementsNumber of drugs at the time of death from the 6 selected group, deprescription (6 months prior to death due to advanced chronic disease), primary or secondary prevention and inappropriate prescription of PPI. ResultsAverage age of 85’3 years (10,3). 40% took an antiplatelet drug, avoidable in 60% of the ACD, since they did not present any previous cardiovascular episode. 20% of the patients took statins, in which 48% of the cases were primary prevention. The PPI prescription was 67% with inadequate indication for use in 49% of these cases. 20% took calcium / Vitamin D and 1,6% of the ACD a bisphosphonate. There was a 16% deprescription. ConclusionsA high percentage of our patients with advanced chronic disease and short life expectancy still continue to take preventive and avoidable treatments, potentially dangerous due to their side effects. There is a need to reflect on what we do with these vulnerable patients.