1
|
Chandra J, Dewan P, Kumar P, Mahajan A, Singh P, Dhingra B, Radhakrishnan N, Sharma R, Manglani M, Rawat AK, Gupta P, Gomber S, Bhat S, Gaikwad P, Elizabeth KE, Bansal D, Dubey AP, Shah N, Kini P, Trehan A, Datta K, Basavraja GV, Saxena V, Kumar RR. Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
2
|
Abstract
Standard treatment of vitamin B12 deficiency has not been well established in childhood, the ideal amount of supplemental vitamin B12 is not clear. Vitamin B12 deficiency is classically treated with intramuscular injections. In this study, we aimed to investigate the efficacy of oral therapy in children with vitamin B12 deficiency. Patients with serum cobalamin concentrations <300 pg/mL aged between 6 months to 18 years were included in this prospective study. Children were treated orally either with a combination of multivitamin tablet daily or vitamin B12 ampules. Serum specimens were obtained at the end of first and third months of treatment for vitamin B12 levels. A total of 79 patients were included in the study. The mean pretreatment vitamin B12 level increased from 182±47.6 pg/mL to 482±318 pg/mL after 1 month of treatment in the whole cohort. Comparison of the pretreatment vitamin B12 levels with first and third month posttreatment values showed significant difference (P-value, 0.001 and 0.028, respectively). In this study, oral cyanocobalamin was found effective for the treatment of vitamin B12 deficiency in children.
Collapse
|
3
|
Toresson L, Steiner JM, Suchodolski JS, Spillmann T. Oral Cobalamin Supplementation in Dogs with Chronic Enteropathies and Hypocobalaminemia. J Vet Intern Med 2015; 30:101-7. [PMID: 26648590 PMCID: PMC4913667 DOI: 10.1111/jvim.13797] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 09/12/2015] [Accepted: 10/22/2015] [Indexed: 01/06/2023] Open
Abstract
Background Cobalamin deficiency is commonly associated with chronic enteropathies (CE) in dogs and current treatment protocols recommend parenteral supplementation. In humans, several studies have reported equal efficacy of oral and parenteral cobalamin administration of cobalamin. Objectives To retrospectively evaluate whether oral cobalamin supplementation can restore normocobalaminemia in dogs with CE and hypocobalaminemia. Animals Fifty‐one client‐owned dogs with various signs of CE and hypocobalaminemia. Material and Methods Retrospective study based on a computerized database search for dogs treated at Evidensia Specialist Animal Hospital, Helsingborg, Sweden during January 2012–March 2014. Inclusion criteria were dogs with signs of CE, an initial serum cobalamin ≤270 ng/L (reference interval: 234–811 ng/L) and oral treatment with cobalamin tablets. Serum cobalamin for follow‐up was analyzed 20–202 days after continuous oral cobalamin supplementation started. Results All dogs became normocobalaminemic with oral cobalamin supplementation. The mean increase in serum cobalamin concentration after treatment was 794 ± 462 ng/L. Serum cobalamin concentrations were significantly higher after supplementation (mean 1017 ± 460 ng/L; P < .0001) than at baseline (mean 223 ± 33 ng/L). Conclusion and Clinical Importance Our results suggest that oral cobalamin supplementation is effective in normalizing serum cobalamin concentrations in dogs with CE. Prospective studies comparing cellular cobalamin status in dogs being treated with parenteral versus oral cobalamin supplementation are warranted before oral supplementation can be recommended for routine supplementation.
Collapse
Affiliation(s)
- L Toresson
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, Helsinki, Finland.,Evidensia Specialist Animal Hospital, Helsingborg, Sweden
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX
| | - T Spillmann
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, Helsinki, Finland
| |
Collapse
|
4
|
|
5
|
Keenan A, Whittam B, Rink R, Kaefer M, Misseri R, King S, Cain M. Vitamin B12 deficiency in patients after enterocystoplasty. J Pediatr Urol 2015; 11:273.e1-5. [PMID: 26165193 DOI: 10.1016/j.jpurol.2015.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/12/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Serum B12 deficiency is a known sequlae of enterocystoplasty. The complications of B12 deficiency include megaloblastic anemia, neuropsychiatric disease, and demyelinating diseases such as peripheral neuropathy. Some studies have suggested that underlying disease states may be more important than enteric absorptive capacity in predicting acquired B12 deficiency. A 38% incidence of low or low-normal serum B12 in patients who have undergone enterocystoplasty has previously been reported, and oral B12 supplementation has been demonstrated to be an effective short-term therapy; however, the long-term results remain unclear. AIMS This study hypothesized that oral vitamin B12 supplementation in patients with B12 deficiency following enterocystoplasty is an effective long-term treatment. Additionally, it sought to determine if underlying disease state predicts B12 deficiency following enterocystoplasty. DESIGN Children who underwent enterocystoplasty at the present institution prior to August 2007 were reviewed. Patients with non-ileal augment, insufficient follow-up or hematologic disorders were excluded. Patients with low or low-normal B12 levels were included. Treatment consisted of daily oral therapy of 250 mcg or monthly parenteral therapy of 1000 mcg IM. Separately, the institutional database of 898 patients who underwent enterocystoplasty was searched and patients with at least one post-operative B12 level were highlighted. The indication for enterocystoplasty was classified as neuropathic or non-neuropathic. RESULTS Twenty-three patients met inclusion criteria. The mean follow-up was 49 months (range 5-85) following initial abnormal B12 level. On the last follow-up, 4/23 (17%) patients had normal serum B12 levels. No patients reported sequelae of long-term B12 deficiency. In the secondary investigation, 113 patients met inclusion criteria. A total of 101 had neuropathic indications for enterocystoplasty, and 12 had non-neuropathic indications. At any time during follow-up, 48/101 (47.5%) neuropathic patients had low or low-normal B12 levels, and 4/12 (33.3%) non-neuropathic patients had low or low-normal B12 levels during follow-up (P = 0.54) (Figure). DISCUSSION The initial success of oral B12 deficiency treatment following enterocystoplasty does not persist over time. This contradicts previous results with short duration follow-up. Underlying disease as the indication for enterocystoplasty did not predict B12 deficiency risk. The study was limited by the small number of patients with B12 deficiency who were started on treatment, as well as by the small number of patients with non-neuropathic indications for enterocystoplasty. CONCLUSION The aims of the study were met. Further investigation is required to assess predictors of B12 deficiency following enterocystoplasty.
Collapse
Affiliation(s)
- Alison Keenan
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Benjamin Whittam
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Richard Rink
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Martin Kaefer
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Rosalie Misseri
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Shelly King
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| | - Mark Cain
- Indiana University Health Riley Hospital for Children in Indianapolis, IN, USA.
| |
Collapse
|
6
|
Loftus C, Wood H. Emerging Concepts in Transitional Care of Congenital Genitourinary Reconstructions. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Boucher M, Bryan S, Dukes S. Deficiency or dementia? Exploring B12 deficiency after urostomy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:594-7. [PMID: 26067796 DOI: 10.12968/bjon.2015.24.11.594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin B12 level was identified and treatment commenced. She was transferred to a community hospital and her family were told to 'prepare for the worst'. It was, in fact, the vitamin B12 deficiency that was causing her symptoms of vascular dementia, and once treatment was established she underwent a 'miraculous' improvement, returning to normal life. This article discusses vitamin B12 deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of the stoma care nurse and his or her knowledge of the patient; explores the importance of testing vitamin B12 levels in this group of patients; and discusses key learning and recommendations for practice.
Collapse
Affiliation(s)
- Michelle Boucher
- Stoma Care Clinical Nurse Specialists, Salisbury NHS Foundation Trust, Wiltshire
| | - Sandra Bryan
- Stoma Care Clinical Nurse Specialists, Salisbury NHS Foundation Trust, Wiltshire
| | - Suzie Dukes
- Stoma Care Clinical Nurse Specialists, Salisbury NHS Foundation Trust, Wiltshire
| |
Collapse
|
8
|
Zeuschner CL, Hokin BD, Marsh KA, Saunders AV, Reid MA, Ramsay MR. Vitamin B₁₂ and vegetarian diets. Med J Aust 2015; 199:S27-32. [PMID: 25369926 DOI: 10.5694/mja11.11509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/29/2012] [Indexed: 01/13/2023]
Abstract
Vitamin B₁₂ is found almost exclusively in animal-based foods and is therefore a nutrient of potential concern for those following a vegetarian or vegan diet. Vegans, and anyone who significantly limits intake of animal-based foods, require vitamin B₁₂-fortified foods or supplements. Vitamin B₁₂ deficiency has several stages and may be present even if a person does not have anaemia. Anyone following a vegan or vegetarian diet should have their vitamin B₁₂ status regularly assessed to identify a potential problem. A useful process for assessing vitamin B₁₂ status in clinical practice is the combination of taking a diet history, testing serum vitamin B₁₂ level and testing homocysteine, holotranscobalamin II or methylmalonic acid serum levels. Pregnant and lactating vegan or vegetarian women should ensure an adequate intake of vitamin B₁₂ to provide for their developing baby. In people who can absorb vitamin B₁₂, small amounts (in line with the recommended dietary intake) and frequent (daily) doses appear to be more effective than infrequent large doses, including intramuscular injections. Fortification of a wider range of foods products with vitamin B₁₂, particularly foods commonly consumed by vegetarians, is likely to be beneficial, and the feasibility of this should be explored by relevant food authorities.
Collapse
Affiliation(s)
| | | | - Kate A Marsh
- Northside Nutrition and Dietetics, Sydney, NSW, Australia
| | - Angela V Saunders
- Corporate Nutrition, Sanitarium Health and Wellbeing, Berkeley Vale, NSW, Australia
| | - Michelle A Reid
- Corporate Nutrition, Sanitarium Health and Wellbeing, Berkeley Vale, NSW, Australia
| | - Melinda R Ramsay
- Sanitarium Health and Wellbeing Services, Sanitarium Health and Wellbeing, Sydney, NSW, Australia
| |
Collapse
|
9
|
Long-Term Outcomes Following Bladder Augmentation in Children with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0268-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
10
|
Bahadir A, Reis PG, Erduran E. Oral vitamin B12 treatment is effective for children with nutritional vitamin B12 deficiency. J Paediatr Child Health 2014; 50:721-5. [PMID: 24944005 DOI: 10.1111/jpc.12652] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
AIM Despite being one of common preventable deficiency disorders, vitamin B12 (vit-B12) deficiency can lead to serious health problems both in children and adult. The familiar treatment through parenteral route for vit-B12 deficiency frequently leads to poor adherence, and adequate response to treatment has lead to interest in oral supplementation. This study investigates the efficacy of oral vit-B12 treatment in children with nutritional vit-B12 deficiency. METHODS Forty-seven children (from 1 month to 17 years) with vit-B12 levels below 200 pg/mL were allocated either of two study groups: Group 1 (1-20 months) and Group 2 (6-17 years) which were subdivided according to the duration of treatment (Group 1A&2A: 4 months; Group 1B&2B: 8 months of 1000 μg oral vit-B12, every day for a week, every other day for 2 weeks, 2 days a week for 2 weeks, then once a week). RESULTS Vit-B12 levels among all groups were significantly restored following high oral vit-B12 doses (P = 0.013, P = 0.001), the regimen being more effective in Group1A and Group1B. Correlation analysis of serum vit-B12 levels and age at the end of treatment revealed a decreasing trend with the increasing patient age (corelation respectively -65.2%, P = 0.08; -35.4%; P = 0.25). CONCLUSION Data from this study indicate that oral vit-B12 (1000 μg) for 4 months is effective, giving clinicians more choice, for treatment of children with nutritional vit-B12 deficiency. However, despite this high dose, lower levels were achieved in older children indicating the necessity of dosage adjustment in accordance with body weight.
Collapse
Affiliation(s)
- Aysenur Bahadir
- School of Medicine, Department of Pediatric Hematology, Karadeniz Technical University, Trabzon, Turkey
| | | | | |
Collapse
|
11
|
Reinfeldt Engberg G, Lundberg J, Chamorro CI, Nordenskjöld A, Fossum M. Transplantation of autologous minced bladder mucosa for a one-step reconstruction of a tissue engineered bladder conduit. BIOMED RESEARCH INTERNATIONAL 2013; 2013:212734. [PMID: 24288669 PMCID: PMC3833032 DOI: 10.1155/2013/212734] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/12/2013] [Accepted: 09/18/2013] [Indexed: 11/18/2022]
Abstract
Surgical intervention is sometimes needed to create a conduit from the abdominal wall to the bladder for self-catheterization. We developed a method for tissue engineering a conduit for bladder emptying without in vitro cell culturing as a one-step procedure. In a porcine animal model bladder, wall tissue was excised and the mucosa was minced to small particles. The particles were attached to a tube in a 1 : 3 expansion rate with fibrin glue and transplanted back by attaching the tube to the bladder and through the abdominal wall. Sham served as controls. After 4-5 weeks, conduits were assessed in respect to macroscopic and microscopic appearance in 6 pigs. Two pigs underwent radiology before termination. Gross examination revealed a patent conduit with an opening to the bladder. Histology and immunostaining showed a multilayered transitional uroepithelium in all cases. Up to 89% of the luminal surface area was neoepithelialized but with a loose attachment to the submucosa. No epithelium was found in control animals. CT imaging revealed a patent channel that could be used for filling and emptying the bladder. Animals that experienced surgical complications did not form conduits. Minced autologous bladder mucosa can be transplanted around a tubular mold to create a conduit to the urinary bladder without in vitro culturing.
Collapse
Affiliation(s)
- Gisela Reinfeldt Engberg
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Q3:03 Astrid Lindgren Children's Hospital, 171 76 Stockholm, Sweden
- Pediatric Surgery, Unit of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Clara Ibel Chamorro
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Q3:03 Astrid Lindgren Children's Hospital, 171 76 Stockholm, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Q3:03 Astrid Lindgren Children's Hospital, 171 76 Stockholm, Sweden
- Pediatric Surgery, Unit of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Q3:03 Astrid Lindgren Children's Hospital, 171 76 Stockholm, Sweden
- Pediatric Surgery, Unit of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden
| |
Collapse
|
12
|
Augmentation cystoplasty: diagnosis, treatment and outcome. Eur Surg 2012. [DOI: 10.1007/s10353-012-0106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Elshal AM, Abdelhalim A, Hafez AT, Abol-Enein H. Ileal Urinary Reservoir in Pediatric Population: Objective Assessment of Long-term Sequelae With Time-to-event Analysis. Urology 2012; 79:1126-31. [DOI: 10.1016/j.urology.2012.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/08/2012] [Accepted: 01/16/2012] [Indexed: 11/30/2022]
|
14
|
Blackburn SC, Parkar S, Prime M, Healiss L, Desai D, Mustaq I, Cuckow P, Duffy P, Cherian A. Ileal bladder augmentation and vitamin B12: levels decrease with time after surgery. J Pediatr Urol 2012; 8:47-50. [PMID: 21183408 DOI: 10.1016/j.jpurol.2010.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated vitamin B12 deficiency following ileocystoplasty in children. METHODS Patients who underwent ileocystoplasty between December 1993 and September 2006 were included and B12 levels were retrospectively analysed. Patients with a serum B12 of less than 150 pg/ml were considered deficient. The distance of the ileal segment from the ileocaecal valve was recorded. RESULTS There were 105 patients in the series; 61 were male. Mean age at surgery was 7.7 years (SD = 3.9). The mean interval from surgery to most recent B12 level was 50 months (SD = 30). None of the patients were on B12 supplementation. Two patients were B12 deficient, both more than 7 years after surgery; 44% of patients with levels available 7 years after surgery had a B12 below 300 pg/ml. There was a significant negative correlation between B12 level and length of follow up (Spearman's rank, P < 0.01). Twenty patients with an ileal segment sparing 60 cm from the ileocaecal valve had a higher mean B12 (524 vs 419, SEM 60 vs 28). This was not statistically significant. CONCLUSION We demonstrate a reduction in serum B12 level with time following ileocystoplasty. These patients should have their B12 levels measured in the long term.
Collapse
Affiliation(s)
- S C Blackburn
- Department of Urology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | | | | | | | | | | | | | | | | |
Collapse
|