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Zingela Z, Stroud L, Cronje J, Fink M, van Wyk S. Management and outcomes of catatonia: A prospective study in urban South Africa. SAGE Open Med 2022; 10:20503121221105579. [PMID: 35756352 PMCID: PMC9218450 DOI: 10.1177/20503121221105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Rapid intervention for catatonia with benzodiazepines and electroconvulsive therapy can prevent fatal complications. We describe the management and treatment response of 44 patients with catatonia in a psychiatric unit in urban South Africa. The objective was to screen admissions for catatonia and investigate management, treatment response, and treatment outcomes. Method We used a prospective, descriptive, observational study design and collected data using a data collection sheet, the Bush Francis Catatonia Screening Instrument, the Bush Francis Catatonia Rating Scale, and the Diagnostic Statistical Manual-5 to assess catatonia in new admissions from September 2020 to August 2021. Results Of the 241 participants screened on admission, 44 (18.3% of 241) screened positive for catatonia on the Bush Francis Catatonia Screening Instrument, while 197 (81.7% of 241) did not. Thirty-eight (86.4% of 44) received lorazepam, seven (15.9%) received clonazepam, and two (4.6%) received diazepam, implying that three (6.8%) of the 44 participants with catatonia received more than one benzodiazepine sequentially. Ten (22.7% of 44) patients received electroconvulsive therapy. Seven of those treated with electroconvulsive therapy (15.9% of 44 and 70% of 10) responded well and were discharged, whereas 22 (50% of 44 and 64.7% of 34) of those given lorazepam were discharged. Patients treated with electroconvulsive therapy had a higher initial Bush Francis Catatonia Rating Scale score. One patient (2.3%) relapsed within 4 weeks of discharge. Twenty (45.5%) of the 44 patients with catatonia had low average iron levels, 14 (31.8%) had low vitamin B12, and 24 (54.6%) had high creatinine kinase. Conclusion Both lorazepam and electroconvulsive therapy were found to be effective treatments for catatonia with good response and outcomes. The length of hospital stay of patients with catatonia was similar to that of patients without catatonia. Treatment guidelines for catatonia need to include the role and timing of electroconvulsive therapy to augment current treatment protocols for the use of lorazepam.
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Affiliation(s)
- Zukiswa Zingela
- Executive Dean’s Office, Nelson Mandela University, Gqeberha, South Africa
| | - Louise Stroud
- Department of Psychology, Nelson Mandela University, Gqeberha, South Africa
| | - Johan Cronje
- Department of Psychology, Nelson Mandela University, Gqeberha, South Africa
| | - Max Fink
- Stony Brook University, Stony Brook, NY, USA
| | - Stephan van Wyk
- Department of Psychiatry and Human Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa
- Nelson Mandela Academic Hospital, Mthatha, South Africa
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2
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Bode SA, Bienfait HP, Adriaansen HJ, van Suijlen JDE. No Laughing Matter: Burning Feet. J Appl Lab Med 2021; 6:1067-1071. [PMID: 33444452 DOI: 10.1093/jalm/jfaa220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Saskia A Bode
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Henri P Bienfait
- Department of Neurology, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Henk J Adriaansen
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Jeroen D E van Suijlen
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, the Netherlands
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3
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Lacombe V, Chabrun F, Lacout C, Ghali A, Capitain O, Patsouris A, Lavigne C, Urbanski G. Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer. Sci Rep 2021; 11:13361. [PMID: 34172805 PMCID: PMC8233305 DOI: 10.1038/s41598-021-92945-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022] Open
Abstract
Elevated plasma vitamin B12 has been associated with solid cancers, based on a single B12 measurement. We evaluated the incidence of solid cancers following B12 measurement in patients with persistent elevated B12, compared to patients without elevated B12 and to patients with non-persistent elevated B12. The study population included patients with at least two plasma B12 measurements without already known elevated-B12-related causes. Patients with elevated plasma B12 (≥ 1000 ng/L) at first measurement (n = 344) were matched for age and sex with patients having 2 normal B12 measurements (< 1000 ng/L) (NN group, n = 344). The patients with elevated plasma B12 at first measurement were split into 2 groups, according to the presence (EE group, n = 144) or the absence (EN group, n = 200) of persistent elevated plasma B12 at second measurement. We compared the cancer-free survival during 60 months between the groups after adjustment for the other elevated-B12-related causes in a survival competing risk model. Compared to the NN group, a persistent elevated plasma B12 ≥ 1000 ng/mL was strongly associated with the occurrence of solid cancer (HR 5.90 [95% CI 2.79-12.45], p < 0.001), contrary to non-persistent plasma B12 elevation (p = 0.29). These results could help to select patients in whom the screening for solid cancers would be of interest.
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Affiliation(s)
- Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Floris Chabrun
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Alaa Ghali
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | | | | | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France.
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 rue Larrey, 49000, Angers, France.
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Abu-Shanab A, Zihlif M, Rbeihat MN, Shkoukani ZW, Khamis A, Isleem U, Dardas LA. Vitamin B 12 Deficiency Among the Healthy Jordanian Adult Population: Diagnostic Levels, Symptomology and Risk Factors. Endocr Metab Immune Disord Drug Targets 2020; 21:1107-1114. [PMID: 32875992 DOI: 10.2174/1871530320999200831230205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/26/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. OBJECTIVE To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cut-off) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. METHODS A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as the main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. RESULTS Low dairy intake habits, age, recurrent headaches, heartburn, and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. CONCLUSION Low dairy intake, older ages, recurrent headaches, heartburn, and peptic ulcer disease all could be considered as risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. The cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.
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Affiliation(s)
- Amer Abu-Shanab
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Malek Zihlif
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Momen N Rbeihat
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Zakaria W Shkoukani
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Alia Khamis
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Ula Isleem
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Latefa A Dardas
- Department of Psychology, Faculty of Nursing, University of Jordan, Queen Rania Street, Amman, Jordan
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Nitrous oxide-induced demyelination: Clinical presentation, diagnosis and treatment recommendations. J Neurol Sci 2020; 414:116817. [PMID: 32302804 DOI: 10.1016/j.jns.2020.116817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recreational use of nitrous oxide (NO) in the general public has led to increasing reports of NO-induced demyelination (NOID). We describe the varying clinical presentations and pathophysiology, and offer a treatment paradigm. METHODS A literature search of MEDLINE and EMBASE resulted in 42 publications with 37 studies meeting the inclusion criteria, for a total of 51 patients. Our case series included 5 patients seen from 2014 to 2018 followed over 3-60 months. RESULTS Those with sensory symptoms and subjective weakness were categorized as having "mild" symptoms (25%). Symptoms indicating involvement outside the dorsal columns such as observer-graded weakness were categorized as "moderate" (61%). Patients with the aforementioned plus cognitive effects were categorized as "severe" (12%). There was no dose-dependent relationship between the amount of NO used and clinical impairment. There was a trend between the severity of neurologic impairment and serum levels of B12. Two patients were noncompliant. One initiated only oral therapy and did not improve. One received injections a month apart and worsened. CONCLUSIONS Patients with NOID tend to have worse symptoms when presenting with lower serum vitamin B12 levels and have good recovery rates when treated with intramuscular B12 and oral supplementation.
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Strength of the Association of Elevated Vitamin B12 and Solid Cancers: An Adjusted Case-Control Study. J Clin Med 2020; 9:jcm9020474. [PMID: 32050436 PMCID: PMC7073937 DOI: 10.3390/jcm9020474] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 02/05/2023] Open
Abstract
The association between elevated plasma vitamin B12 (B12) level and solid cancers has been documented by two national registries. However, their design did not allow for the adjustment for other conditions associated with elevated B12. The objectives of this study were to confirm this association after the adjustment for all causes of elevated B12, and to study the variations according to the increasing B12 level, the type of cancers, and the presence of metastases. We compared 785 patients with B12 ≥ 1000 ng/L with 785 controls matched for sex and age with B12 < 1000 ng/L. Analyses were adjusted for the causes of elevated B12: myeloid blood malignancies, acute or chronic liver diseases, chronic kidney failure, autoimmune or inflammatory diseases, and excessive B12 supplementation. A B12 ≥ 1000 ng/L was associated with the presence of solid cancer without metastases (OR 1.96 [95%CI: 1.18 to 3.25]) and with metastases (OR 4.21 [95%CI: 2.67 to 6.64]) after adjustment for all elevated B12-related causes. The strength of the association rose with the increasing B12 level, in particular in cases of metastases. No association between liver cancers and elevated B12 level was found after adjustment for chronic liver diseases. In conclusion, unexplained elevated B12 levels should be examined as a possible marker of solid cancer.
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Polytarchou K, Dimitroglou Y, Varvarousis D, Christodoulis N, Psachoulia C, Pantziou C, Mourouzis I, Pantos C, Manolis AS. Methylmalonic acid and vitamin B12 in patients with heart failure. Hellenic J Cardiol 2019; 61:330-337. [PMID: 31740360 DOI: 10.1016/j.hjc.2019.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/01/2019] [Accepted: 10/16/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Vitamin B12 deficiency among patients with heart failure (HF) may have been underestimated. High serum levels of methylmalonic acid (MMA) have been identified in several studies as an early indicator of vitamin B12 deficiency. Furthermore, MMA seems to constitute a biomarker of oxidative stress and mitochondrial dysfunction. There are scarce data regarding vitamin B12 and MMA in patients with HF. The aim of this study was to investigate vitamin B12 and MMA serum levels in patients with HF. METHODS One hundred five consecutive patients admitted to our hospital with symptoms and signs of acute decompensated HF were included in the study. Demographic and clinical characteristics as well as comorbidities and medical treatment before hospital admission were recorded. Transthoracic echocardiography was performed in all patients. Blood samples were collected during the first 24 hours of hospitalization and measured for complete blood count, biochemical profile, vitamin B12, N-terminal prohormone of brain natriuretic peptide, and MMA levels. Finally, 51 healthy individuals constituted the control group. RESULTS A total of 43.8% of patients with HF had elevated MMA levels, but only 10.5% had overt vitamin B12 deficiency, defined as serum cobalamin levels below 189 pg/ml. Mean MMA level was higher in patients with HF than in controls (33.0 ± 9.6 vs. 19.3 ± 6.3 ng/ml; p < 0.001). This difference remained significant when adjusted for age, sex, vitamin B12, and folate serum levels and kidney function (B = 14.7 (9.6-19.7); p < 0.001). MMA levels were higher in patients with acutely decompensated chronic HF than in those with newly diagnosed acute HF (34.7 ± 10.5 vs. 30.7 ± 7.8 ng/ml; p = 0.036). Correlation analysis revealed significantly negative correlation between MMA and vitamin B12 levels only in patients without comorbidities. CONCLUSION Patients with HF have elevated MMA levels, independent of age, gender, HF category, or comorbidities, possibly indicating subclinical vitamin B12 deficiency. Further research is needed to investigate subclinical vitamin B12 deficiency in patients with HF and/or to clarify whether MMA constitutes a biomarker of oxidative stress.
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Affiliation(s)
- Kali Polytarchou
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece; First Department of Cardiology, Evagelismos Hospital, Athens, Greece
| | - Yannis Dimitroglou
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | | | | | | | | | - Iordanis Mourouzis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Costas Pantos
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece; First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Stanley E, Appleman E, Schlag A, Siegel A. Relationship between cobalamin and folate deficiencies and anemia in dogs. J Vet Intern Med 2018; 33:106-113. [PMID: 30499147 PMCID: PMC6335522 DOI: 10.1111/jvim.15348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/08/2018] [Indexed: 12/01/2022] Open
Abstract
Background Megaloblastic, nonregenerative anemia is a well‐known consequence of cobalamin or folate deficiencies in humans but is not recognized in hypocobalaminemic or hypofolatemic dogs. Establishment of relationships between hypocobalaminemia or hypofolatemia and hematologic disease would encourage vitamin B testing, and potentially supplementation, in anemic dogs. Objectives To determine the prevalence of anemia in hypocobalaminemic or hypofolatemic dogs and to report the prevalence of hypocobalaminemia and hypofolatemia and nonregenerative anemia, macrocytosis, and anisocytosis in anemic dogs. Animals One hundred and fourteen client‐owned dogs with known serum cobalamin and folate concentrations and CBCs and 42 client‐owned anemic dogs. Methods Retrospective comparison of anemia prevalence in hypocobalaminemic or hypofolatemic and normocobalaminemic or normofolatemic dogs was performed. Prospective measurement of erythrocyte variables and cobalamin and folate concentrations in anemic dogs was carried out; relationships among hypocobalaminemia and regenerative status, mean corpuscular volume, and red cell distribution width were evaluated. Results Significant differences in prevalence of anemia between hypocobalaminemic (36%) and normocobalaminemic dogs (26%; P = .23) or between hypofolatemic (31%) and normofolatemic dogs (30%; P = .99) were not detected. Between hypocobalaminemic and normocobalaminemic dogs, no significant differences in prevalence of nonregenerative anemia (69% vs 63%; P = .65), macrocytosis (17% vs 0%; P = .53), or anisocytosis (28% vs 0%; P = .14) were detected. Anemic dogs had high prevalence of vitamin B deficiencies (nonregenerative: 64% hypocobalaminemic, 18% hypofolatemic; regenerative: 57% hypocobalaminemic, 21% hypofolatemic). Conclusions and Clinical Importance The association between cobalamin and folate deficiencies and macrocytic, nonregenerative anemia established in humans is not routinely present in dogs.
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Affiliation(s)
- Emma Stanley
- Internal Medicine Service, The Animal Medical Center, New York, New York
| | - Elizabeth Appleman
- Internal Medicine Service, The Animal Medical Center, New York, New York
| | - Ariel Schlag
- Surgery Service, Colonial Veterinary Hospital, Ithaca, New York
| | - Andrea Siegel
- Clinical Pathology, IDEXX Laboratories, New York, New York
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van Loon SL, Wilbik AM, Kaymak U, van den Heuvel ER, Scharnhorst V, Boer AK. Improved testing for vitamin B 12 deficiency: correcting MMA for eGFR reduces the number of patients classified as vitamin B 12 deficient. Ann Clin Biochem 2018; 55:685-692. [PMID: 29874929 DOI: 10.1177/0004563218778300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Methylmalonic acid (MMA) can detect functional vitamin B12 deficiencies as it accumulates early when intracellular deficits arise. However, impaired clearance of MMA from blood due to decreased glomerular filtration rate (eGFR) also results in elevated plasma MMA concentrations. Alternative to clinical trials, a data mining approach was chosen to quantify and compensate for the effect of decreased eGFR on MMA concentration. Methods Comprehensive data on patient's vitamin B12, eGFR and MMA concentrations were collected ( n = 2906). The relationship between vitamin B12, renal function (eGFR) and MMA was modelled using weighted multiple linear regression. The obtained model was used to estimate the influence of decreased eGFR on MMA. Clinical impact was examined by comparing the number of patients labelled vitamin B12 deficient with and without adjustment in MMA. Results Adjusting measured MMA concentrations for eGFR in the group of patients with low-normal vitamin B12 concentrations (90-300 pmol/L) showed that the use of unadjusted MMA concentrations overestimates vitamin B12 deficiency by 40%. Conclusions Through a data mining approach, the influence of eGFR on the relation between MMA and vitamin B12 can be quantified and used to correct the measured MMA concentration for decreased eGFR. Especially in the elderly, eGFR-based correction of MMA may prevent over-diagnosis of vitamin B12 deficiency and corresponding treatment.
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Affiliation(s)
- Saskia Lm van Loon
- 1 Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands.,2 Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,3 Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, The Netherlands
| | - Anna M Wilbik
- 3 Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, The Netherlands
| | - Uzay Kaymak
- 3 Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, The Netherlands
| | - Edwin R van den Heuvel
- 4 Department of Mathematics and Computer Science, Eindhoven University of Technology, The Netherlands
| | - Volkher Scharnhorst
- 1 Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands.,2 Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,5 Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
| | - Arjen-Kars Boer
- 1 Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands.,2 Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,5 Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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10
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Bruins MJ, Bird JK, Aebischer CP, Eggersdorfer M. Considerations for Secondary Prevention of Nutritional Deficiencies in High-Risk Groups in High-Income Countries. Nutrients 2018; 10:E47. [PMID: 29304025 PMCID: PMC5793275 DOI: 10.3390/nu10010047] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 12/26/2022] Open
Abstract
Surveys in high-income countries show that inadequacies and deficiencies can be common for some nutrients, particularly in vulnerable subgroups of the population. Inadequate intakes, high requirements for rapid growth and development, or age- or disease-related impairments in nutrient intake, digestion, absorption, or increased nutrient losses can lead to micronutrient deficiencies. The consequent subclinical conditions are difficult to recognize if not screened for and often go unnoticed. Nutrient deficiencies can be persistent despite primary nutrition interventions that are aimed at improving dietary intakes. Secondary prevention that targets groups at high risk of inadequacy or deficiency, such as in the primary care setting, can be a useful complementary approach to address persistent nutritional gaps. However, this strategy is often underestimated and overlooked as potentially cost-effective means to prevent future health care costs and to improve the health and quality of life of individuals. In this paper, the authors discuss key appraisal criteria to consider when evaluating the benefits and disadvantages of a secondary prevention of nutrient deficiencies through screening.
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Affiliation(s)
- Maaike J Bruins
- DSM Nutritional Products, Wurmisweg 576, Kaiseraugst CH-4303, Switzerland.
| | - Julia K Bird
- DSM Nutritional Products, Wurmisweg 576, Kaiseraugst CH-4303, Switzerland.
| | - Claude P Aebischer
- DSM Nutritional Products, Wurmisweg 576, Kaiseraugst CH-4303, Switzerland.
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Gupta K, Jain A, Rohatgi A. An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy. Diabetes Metab Syndr 2018; 12:51-58. [PMID: 28882470 DOI: 10.1016/j.dsx.2017.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/20/2017] [Indexed: 02/08/2023]
Abstract
METHODS A descriptive, observational study was completed in a tertiary care hospital between November 2014 and March 2016. Fifty consecutive patients of Type 2-Diabetes Mellitus who had been on metformin therapy for at least three months were included in our study. Several Parameters were compared with vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS) and Nerve Conduction Velocity). These included the duration of diabetes, duration of metformin usage, dietary history, and HbA1c levels. Definite B12 deficiency was defined as B12<150pg/ml and possible B12 deficiency as <220pg/ml. RESULTS In our study, we found a negative correlation between duration of metformin use and Vitamin B12 levels(r=-0.40). The mean Vitamin B12 levels seen in our study was 212.3pg/mL. There is a positive correlation between the duration of metformin therapy and peripheral neuropathy (r=0.40). The mean TCSS score was 6.8. The percentage of patients with mild neuropathy was 28%, with moderate neuropathy was 20% and severe neuropathy in 12% of the patients. The average duration of metformin use in patients without peripheral neuropathy was 5.5yrs whereas the average length of metformin use in patients with peripheral neuropathy was 10.4 yrs. CONCLUSION Patients on long-term metformin therapy are at a high risk for Vitamin B12 deficiency and peripheral neuropathy. Interval Screening for peripheral neuropathy is recommended for patients on metformin even if Vitamin B12 levels appear to be normal.
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Affiliation(s)
- Kamesh Gupta
- Department of Medicine, Lady Hardinge Medical College, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, 110001, India.
| | - Anand Jain
- Department of Medicine, Lady Hardinge Medical College, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, 110001, India.
| | - Anurag Rohatgi
- Department of Medicine, Lady Hardinge Medical College, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, 110001, India.
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Abstract
Maintaining optimal health and well-being in the older adult requires understanding of how physiologic changes influence nutritional status, familiarity with the available validated tools to assess status, identification of factors predisposing older adults to malnutrition, and evidence-based practice regarding the nutritional needs of this age group. Evidence-based guidance on these core practice components is provided to the clinician in this article.
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Affiliation(s)
- Hope Barkoukis
- Department of Nutrition, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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13
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Hannibal L, Lysne V, Bjørke-Monsen AL, Behringer S, Grünert SC, Spiekerkoetter U, Jacobsen DW, Blom HJ. Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency. Front Mol Biosci 2016; 3:27. [PMID: 27446930 PMCID: PMC4921487 DOI: 10.3389/fmolb.2016.00027] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022] Open
Abstract
Vitamin B12 (cobalamin, Cbl, B12) is an indispensable water-soluble micronutrient that serves as a coenzyme for cytosolic methionine synthase (MS) and mitochondrial methylmalonyl-CoA mutase (MCM). Deficiency of Cbl, whether nutritional or due to inborn errors of Cbl metabolism, inactivate MS and MCM leading to the accumulation of homocysteine (Hcy) and methylmalonic acid (MMA), respectively. In conjunction with total B12 and its bioactive protein-bound form, holo-transcobalamin (holo-TC), Hcy, and MMA are the preferred serum biomarkers utilized to determine B12 status. Clinically, vitamin B12 deficiency leads to neurological deterioration and megaloblastic anemia, and, if left untreated, to death. Subclinical vitamin B12 deficiency (usually defined as a total serum B12 of <200 pmol/L) presents asymptomatically or with rather subtle generic symptoms that oftentimes are mistakenly ascribed to unrelated disorders. Numerous studies have now established that serum vitamin B12 has limited diagnostic value as a stand-alone marker. Low serum levels of vitamin B12 not always represent deficiency, and likewise, severe functional deficiency of the micronutrient has been documented in the presence of normal and even high levels of serum vitamin B12. This review discusses the usefulness and limitations of current biomarkers of B12 status in newborn screening, infant and adult diagnostics, the algorithms utilized to diagnose B12 deficiency and unusual findings of vitamin B12 status in various human disorders.
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Affiliation(s)
- Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Vegard Lysne
- Department of Clinical Sciences, University of Bergen Bergen, Norway
| | | | - Sidney Behringer
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Sarah C Grünert
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Ute Spiekerkoetter
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Donald W Jacobsen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic Cleveland, OH, USA
| | - Henk J Blom
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
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Duma A, Cartmill C, Blood J, Sharma A, Kharasch ED, Nagele P. The hematological effects of nitrous oxide anesthesia in pediatric patients. Anesth Analg 2015; 120:1325-30. [PMID: 25658315 DOI: 10.1213/ane.0000000000000642] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prolonged administration of nitrous oxide causes an increase in plasma homocysteine in children via vitamin B12 inactivation. However, it is unclear whether nitrous oxide doses used in clinical practice cause adverse hematological effects in pediatric patients. METHODS This retrospective study included 54 pediatric patients undergoing elective spinal surgery: 41 received nitrous oxide throughout anesthesia (maintenance group), 9 received nitrous oxide for induction and/or emergence (induction/emergence group), and 4 did not receive nitrous oxide (nitrous oxide-free group). Complete blood counts obtained before and up to 4 days after surgery were assessed for anemia, macrocytosis/microcytosis, anisocytosis, hyperchromatosis/hypochromatosis, thrombocytopenia, and leukopenia. The change (Δ) from preoperative to the highest postoperative value was calculated for mean corpuscular volume (MCV) and red cell distribution width (RDW). RESULTS No pancytopenia was present in any patient after surgery. All patients had postoperative anemia, and none had macrocytosis. Postoperative MCV (mean [99% confidence interval]) peaked at 86 fL (85-88 fL), 85 fL (81-89 fL), and 88 fL (80-96 fL) and postoperative RDW at 13.2% (12.8-13.5%), 13.3% (12.7-13.8%), and 13.0% (11.4-14.6%) for the maintenance group, the induction/emergence group, and the nitrous oxide-free group. Two patients in the maintenance group (5%) developed anisocytosis (RDW >14.6%), but none in the induction/emergence group or in the nitrous oxide-free group (P = 0.43). Both ΔMCV (P = 0.52) and ΔRDW (P = 0.16) were similar across all groups. CONCLUSIONS Nitrous oxide exposure for up to 8 hours is not associated with megaloblastic anemia in pediatric patients undergoing major spinal surgery.
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Affiliation(s)
- Andreas Duma
- From the *Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri; and †Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
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15
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Toprak B, Yalcın HZ, Colak A. Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders? Int J Lab Hematol 2013; 36:409-14. [DOI: 10.1111/ijlh.12158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/12/2013] [Indexed: 12/21/2022]
Affiliation(s)
- B. Toprak
- Department of Clinical Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
| | - H. Z. Yalcın
- Department of Clinical Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
| | - A. Colak
- Department of Clinical Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
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