Clinical analysis of 14 cases of niacin deficiency / 中华全科医师杂志

The clinical data of 14 patients with niacin deficiency diagnosed and treated in Department of Dermatology, Affiliated Hospital of Jining Medical College from 2012 to 2021 were retrospectively analyzed. There were 11 males and 3 females aged 26-65 years. The etiological factors were alcoholism in 8 cases, gastrointestinal disease in 3 cases, medication history in 1 case, and unknown etiology in 2 cases.Patients had typical skin lesions, 1 case also had both digestive system and nervous system symptoms, and 3 cases had combined digestive system symptoms and 2 cases had neurological symptoms. All patients were systematically treated with oral nicotinamide and vitamin B complex, and also with topical drugs; and they all improved after 14-52 days of treatment. During regular follow-up, 2 cases of alcoholics and 1 case with diarrhea had recurrence. It is suggested that the typical clinical triad of niacin deficiency is uncommon, and the diagnosis is based on the medical history, clinical manifestations and relevant laboratory test, and the treatment with nicotinamide and vitamin B complex is usually effective; alcoholism is the main cause in male patients and is prone to recurrence.

El hambre oculta y la fibromialgia: Una revisión sistemática / The hidden hunger and fibromyalgia: A systematic review

RESUMEN Recientemente há sido discutida la posibilidad de una relación causal entre la fibromialgia (FM) y la deficiencia de micronutrientes, un tipo de deficiencia nutricional conocida como "hambre oculta". Sin embargo, los estudios son pocos y los resultados controversiales, lo que genera debates sobre la influencia real del "hambre oculta" en el proceso de la enfermedad en las personas con fibromialgia. En está revisión se presentan y discuten evidencias científicas relacionadas con la deficiencia de micronutrientes y FM, destacando los principales micronutrientes relacionados. El levantamiento de información fue realizado en los bases de datos de PubMed y Science Direct en estudios observacionales publicados entre los años 2000 y 2017. Fueron seleccionados 14 estudios, ocho dirigidos a la asociación de la deficiencia de vitamina D y la presencia de FM y seis enfocados en la asociación de la deficiencia de minerales con FM. Se sugiere una relación entre la deficiencia de vitamina D y el aumento de la sensibilidad al dolor en la FM. Aunque esa insuficiencia también está asociada a otras enfermedades muscoesqueléticas crónicas. Además, parece que la deficiencia mineral (p.ej.o., hierro, magnesio, zinc y calcio) también desempeña un papel importante en el inicio de la FM y sus principales síntomas.

ABSTRACT Recently the possibility of a causal link between fibromyalgia (FM) and micronutrient deficiency, a type of malnutrition known as "hidden hunger", has been suggested. However, the results are controversial, which raises questions and debates on the actual influence of "hidden hunger" on the development of FM. In this review, we present and discuss scientific evidence related to micronutrient deficiencies and FM, highlighting key micronutrients involved. We searched PubMed and Science Direct databases for all observational studies published between 2000 to March 2017. We selected fourteen observational studies, eight studies aimed at linking vitamin D deficiency to the presence of FM and six studies focused on the association of mineral deficiency with FM. The association between vitamin D deficiency and increased pain sensitivity in FM is suggested, although such insufficiency is also associated with other chronic musculoskeletal disorders. It appears that mineral deficiency (e.g., iron, magnesium, manganese, zinc and calcium) plays an important role in the onset of FM and its main symptoms.

Déficit de vitamina B12 en la práctica psiquiátrica / Vitamin B12 deficiency in psychiatric practice / Déficit de Vitamina B12 na prática psiquiátrica

RESUMEN Es común la solicitud de los niveles de vitamina B12 en pacientes evaluados por psiquiatría y específicamente en las unidades de pacientes agudos, pero, a pesar de la creciente literatura disponible sobre la correlación entre esta hipovitaminosis y los síntomas neuropsiquiátricos, aún existen muchas dudas sobre los grupos poblacionales de riesgo que se deben tamizar, el tipo de examen que se debe solicitar, la forma de hacer el tratamiento y la utilidad real de la reposición vitamínica en la resolución de los síntomas afectivos, cognitivos o psicóticos. Este artículo es una revisión narrativa de la literatura disponible con el objetivo de poder evaluar de forma crítica los interrogantes teóricos y prácticos más relevantes para el psiquiatra actual, con énfasis en la evidencia sobre la correlación entre niveles bajos de vitamina B12 y déficit cognitivo, depresión y algunos trastornos psicóticos.

SUMMARY Levels of vitamin B12 are commonly requested in psychiatric patients, specifically in units for acute patients. Despite the abundant literature available about the correlation between this hypovitaminosis and neuro-psychiatric symptoms, there are still many doubts about the risk groups that should be screened, the tests that should be applied, how to treat, and the real usefulness of vitamin supplementation in the resolution of affective, cognitive or psychotic symptoms. This article presents a narrative review of the available literature, and summarizes the main recommendations about theoretical and practical questions concerning this subject matter, with emphasis on the correlation between low levels of vitamin B12 and cognitive impairment, depression and psychotic disorders.

RESUMO É comum a solicitação de níveis de vitamina B12 em pacientes avaliados por psiquiatria e especificamente nas unidades de pacientes agudos, mas apesar da crescente literatura disponível sobre a correlação entre esta hipovitaminose e os sintomas neuropsiquiá- tricos, ainda existem muitas dúvidas sobre os grupos populacionais de risco que devem tamisar, o tipo de exame que se deve solicitar, a forma de fazer o tratamento e a real utilidade da reposição vitamínica na resolução dos sintomas afetivos, cognitivos ou psicóticos. Este artigo pretende fazer uma revisão narrativa da literatura disponível com o objetivo de poder avaliar de forma crítica os interrogantes teóricos e práticos mais relevantes para o psiquiatra atual, fazendo ênfase na evidência sobre a correlação entre níveis baixos de vitamina B12 e déficit cognitivo, depressão e alguns transtornos psicóticos.

Frequência de hipovitaminose D em mulheres adultas / Frequency of hipovitaminose D in adult women

Objetivo ­ Verificar níveis séricos de vitamina D em mulheres adultas através da análise de seus exames laboratoriais. Métodos ­ Estudo retrospectivo de 30 prontuários de pacientes subdivididos em dois grupos (Grupo A ­ 20 a 40 anos) e (Grupo B ­ 41 a 59 anos) que estiveram em consulta endocrinológica no período de janeiro de 2015 a janeiro de 2016. Resultados ­ Observa-se maior frequência de hipovitaminose D, 27% no grupo com idade de 41 a 59 anos, sendo que insuficiência de vitamina D apresenta o mesmo percentual (40%) em ambos os grupos. Os valores de normalidade ficou abaixo de (50%) nas pacientes avaliadas. Conclusão ­ Os resultados obtidos indicam que o total da população estudada apresentou níveis de vitamina D abaixo da normalidade. Portanto torna-se necessário a triagem da deficiência dessa vitamina extensivo a demais grupos populacionais, informando a sua prescrição em campanha de saúde pública

Objective ­ To verify serum levels of vitamin D in adult women through the analysis of their laboratory tests. Methods ­ Retrospective study of 30 patient charts subdivided into two groups (Group A ­ 20 to 40 years old) and (Group B ­ 41 to 59 years old) who underwent endocrinological consultation from January 2015 to January 2016. Results ­ Observations highest frequency of hypovitaminosis D, 27% in the group aged 41 to 59 years, and vitamin D insufficiency presents the same percentage (40%) in both groups. Normal values were below (50%) in the patients evaluated. Conclusion ­ The results indicate that the total population studied had vitamin D levels below normal. Therefore, it is necessary to screen the deficiency of this extensive vitamin to other population groups, informing its prescription in public health campaign

Effect of Pre-treatment Nutritional Status, Folate and Vitamin B12 Levels on Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia.

Objective: To evaluate pre-treatment undernutrition, and folate and B12 deficiency in children with acute lymphoblastic leukemia, and their correlation with complications and outcome of induction chemotherapy. Design: Observational study. Setting: Tertiary care teaching hospital in Northern India. Participants: 50 children with acute lymphoblastic leukemia. Procedure: Children were assessed for nutritional status (Weight for age Z-score, serum albumin, folate and B12) at presentation, and were followed-up during induction for bone marrow response, counts and outcome. Folate and B12 were repeated twice at monthly intervals after induction. Univariate and multivariate analyses were done to determine the association of nutritional parameters with the outcome variables. Results: Baseline undernutrition was observed in 66%, hypoalbuminemia in 32.6%, folate deficiency in 41.3% and B12 deficiency in 36.9% of included children. Significant decline in folate levels was noted on serial assays during chemotherapy (P=0.001). Folate deficient children had higher risk for delayed marrow recovery and counts on day 14 (P=0.007 and P=0.001). Hypoalbuminemia (P=0.04), B12 deficiency (P=0.001) and folate (P=0.03) deficiency were associated with toxic deaths during induction. Conclusion: Baseline nutritional deficiencies negatively influence the outcome and occurrence of complications during induction chemotherapy in children with acute lymphoblastic leukemia.

Elevated Plasma Level of Homocysteine is an Independent Risk Factor for Peripheral Neuropathy.

Introduction: Elevated plasma level of homocysteine (eHcy) is associated with increased prevalence of peripheral neuropathy (PN) in diabetic patients. However, it is not known whether eHcy is an independent risk factor for the development of PN. Methods: We retrospectively reviewed clinic and laboratory data of patients with PN, and patients with headaches serving as controls. The study consisted of two separate cohorts in two different settings. Setting-A was designed to address whether the isolated eHcy is relevant to PN and setting-B to analyze various risk factors in patients with PN. Results: Fifty seven and 217 subjects with PN and 42 and 252 individuals with headache were included in the setting-A and setting-B, respectively. A significantly elevated level of homocysteine was observed in the patients with PN in both setting-A and setting-B (11.3±7.1 and 13.4±14.6 mmol/L, mean±SD) than in the patients with headaches (8.6±2.8 and 8.1±2.5, P=.02 and P=.02, respectively). In addition, significantly increased frequency of eHcy was observed in PN (21% and 38% in setting- A and setting-B) than that in headache controls (4.5% and 4.8%; P= .05 and P= .002, respectively). Conclusion: eHcy may potentially act as an independent risk factor for the development of PN.

Concentrações de 25-hidroxivitamina D e níveis pressóricos em idosos hipertensos / 25-hydroxyvitamin D concentrations and blood pressure levels in hypertensive elderly patients

OBJETIVO: Avaliar fatores relacionados à prevalência da hipovitaminose D e relação com pressão arterial em 91 idosos hipertensos de João Pessoa, PB/BR. MATERIAIS E MÉTODOS: Em estudo transversal, níveis de 25-hidroxivitamina D foram comparados com dados bioquímicos, antropométricos, dietéticos, tipo de pele, exposição solar e pressão arterial. RESULTADOS: A prevalência da inadequação da vitamina (25-hidroxivitamina D < 29 ng/mL) foi 33%. A concentração sérica de 25-hidroxivitamina D associou-se inversamente com a pressão arterial sistólica e positivamente com frequência semanal do consumo de peixes. As outras variáveis estudadas não mostraram associação significativa com 25-hidroxivitamina D. CONCLUSÃO: A prevalência da inadequação das concentrações de vitamina D foi elevada e relacionada com maior pressão arterial em idosos. Por outro lado, um maior consumo semanal de peixe está ligado a maiores concentrações da 25-hidroxivitamina D.

OBJECTIVE: To evaluate the prevalence of inadequate vitamin D status and its relationship with associated factors in 91 elderly hypertensive patients in João Pessoa, PB/BR. MATERIALS AND METHODS: In a cross-sectional study, levels of 25-hydroxyvitamin D of 91 elderly patients were compared with biochemical, anthropometric, and dietary data, type of skin, exposure to sunlight, and blood pressure. RESULTS: The prevalence of inadequate vitamin concentrations (25-hydroxyvitamin D < 29 ng/mL) was 33%. The concentration of serum 25-hydroxyvitamin D was inversely associated with systolic blood pressure and positively associated with weekly fish consumption. The other variables showed no significant association with 25-hydroxyvitamin D. CONCLUSION: The prevalence of inadequate vitamin D concentrations was related with higher blood pressure in elderly patients. Moreover, greater fish weekly consumption influenced greater 25-hydroxyvitamin D concentration.

Impact of NGO run mid day meal program on nutrition status and growth of primary school children.

Objective. To study the impact of wholesome mid day meal (MDM) program run by an NGO on the growth of the primary school students in rural area of Mathura district. Methods. This intervention study involved children enrolled in Government run rural primary schools in Mathura district in Uttar Pradesh from March 06 through August 07. A wholesome, nutritionally balanced MDM provided by an NGO for the students in the 6 primary schools was selected as intervention group. Control group consisted of children in 8 schools which received locally prepared MDM by village panchayats. Height, weight, change in height/month, change in weight/month, prevalence of protein-energy malnutrition and prevalence of signs of vitamin deficiencies, were measured. Results. Food was provided for 221 days in one year. Within group and between groups repetitive measures were compared using generalized estimating equation (GEE). Within both intervention and control groups height and weight had significantly increased (p < 0.05), while there was no significant difference between the groups. There was no change in prevalence of malnutrition within either of the groups. Reduction in vitamin A deficiency signs was 38% more in intervention group (p < 0.001). Prevalence of Vitamin D deficiency reduced by 50% more in intervention group. No such differences between groups were observed for vitamin B complex and vitamin C. Conclusions. MDM provided by the NGO has no better impact on growth of the primary school children, however, it reduced prevalence of vitamin deficiency significantly in comparison to the MDM run by Village Panchayats.

Deficiencia de vitamina B12: tratamiento oral o parenteral / Vitamin B12 deficiency: Oral or parenteral treatment

El tratamiento tradicional de la deficiencia de vitamina B12 ha sido la administración de cobalamina en inyecciones intramusculares periódicas siguiendo diferentes esquemas, en dependencia de la severidad del déficit y el cuadro clínico instalado. A pesar de que desde los años 50 y 60 del pasado siglo se planteó que la terapia con vitamina B12 por vía oral es tan eficaz como las inyecciones en el tratamiento de esta deficiencia, en la práctica este parece ser un hecho poco aceptado. Las investigaciones encaminadas a evaluar esta alternativa y el por qué aún su uso no ha sido del todo extendido, sugieren que el cambio de los pacientes a tratamiento oral con vitamina B12 implica ahorros sustanciales en términos de costos financieros, tiempo aportado por médicos y personal de salud e inconvenientes y molestias a los pacientes, los que por lo general, aceptan bien el cambio de terapia.

Traditional treatment of Vitamin B12 deficiency has been the Cobalamin administration via periodic intramuscular injections following different rules depending from deficit severity and clinical picture present. Despite that from 50s and 60s of past century, it was established that oral B12 therapy is as effective as injections ones in treatment of this type of deficiency, in practice it looks like a not very accepted fact. Researches aimed to assess this alternative, and why still its use has not been completely understood, suggest that the change to a Vitamin B12 treatment implicates significant savings in terms of financial costs, time of physicians and health staff, and the drawbacks and annoyances for patients, whom in general, accept well the change of therapy.