Efectos del déficit de vitaminas B9 y B12 en la génesis de la anemia megaloblástica

La anemia megaloblástica pertenece al subgrupo de anemias carenciales. Con el objetivo de describir el efecto del déficit de vitaminas B9 y B12 en la génesis de la anemia megaloblástica se realizó la presente investigación. La anemia megaloblástica se presenta cuando los niveles de ácido fólico (Vitamina B9) y cianocobalamina (vitamina B12) son bajos, generando así una disminución en la capacidad celular de sintetizar ácido desoxirribonucleico, lo que ocasiona alteraciones hematológicas en todas las líneas celulares de la médula ósea (eritrocitos y plaquetas), principalmente provocando la generación de hematíes de gran tamaño y con baja concentración de hemoglobina. Las vitaminas B9 y B12 participan en la síntesis normal de ácidos nucleicos, implicándose directamente en la síntesis de purinas y pirimidinas, así como la maduración celular. El déficit de estas vitaminas tiene efecto sobre el funcionamiento del sistema nervioso central.

Megaloblastic anemia belongs to the subgroup of deficiency anemias. With the objective of describing the effect of B9 and B12 vitamins deficiency on the genesis of megaloblastic anemia, this research was carried out. Megaloblastic anemia occurs when the levels of folic acid (Vitamin B9) and cyanocobalamin (vitamin B12) are low, thus generating a decrease in the cellular capacity to synthesize deoxyribonucleic acid, which causes hematological alterations in all cell lines of the marrow bone (erythrocytes and platelets), mainly causing the generation of large red blood cells with low hemoglobin concentration. Vitamins B9 and B12 participate in the normal synthesis of nucleic acids, being directly involved in the synthesis of purines and pyrimidines, as well as cell maturation. The deficiency of these vitamins has an effect on the central nervous system functioning.

Conocimientos sobre el ácido fólico periconcepcional en mujeres puérperas del hospital de la mujer, La Paz-Bolivia / Awareness of periconceptional folic acid in postpartum women at the hospital de la mujer, La Paz-Bolivia

INTRODUCCIÓN Y/O ANTECEDENTES: Los defectos del tubo neural se encuentran entre las anomalías congénitas más comunes en todo el mundo, el ácido fólico (0.4-0.8 ug/día) reduce el riesgo de ocurrencia y recurrencia, por lo que se recomienda su uso concepcional y periconcepcional. El conocimiento de sus efectos protectores varía mucho en la población. OBJETIVOS: Describir el conocimiento de las puérperas sobre el uso correcto del ácido fólico y sus alcances como factor protector. MATERIAL Y MÉTODO: Se condujeron encuestas entre un grupo de mujeres puérperas del Hospital de la Mujer mediante cuestionarios estructurados para obtener información el conocimiento del uso del ácido fólico periconcepcional. RESULTADOS: Entrevistamos 87 puérperas. El conocimiento y el uso del ácido fólico entre las entrevistadas fue bajo, 51% y 48.3% respectivamente. La escolaridad en este grupo poblacional es un factor predictivo del conocimiento y uso correcto del ácido fólico. DISCUSIÓN, CONCLUSIONES Y RECOMENDACIONES: El conocimiento del ácido fólico es relativamente bajo entre las mujeres puérperas entrevistadas, su uso durante el embarazo es insuficiente y la suplementación con antes de la concepción es nula. Aún nos queda un largo camino por recorrer. Se recomienda promover el conocimiento y el uso del ácido fólico en etapa periconcepcional, así como mayor información sobre los alimentos fortificados.

INTRODUCTION AND BACKGROUND: Neural tube defects are among the most common congenital anomalies worldwide; folic acid reduces their risk of occurrence and is strongly recommended for conceptional and periconceptional use. Awareness of its protective effects varies widely among populations. OBJECTIVES: To measure the awareness of postpartum women about the correct use of folic acid and its protectants. MATERIALS AND METHODS: A survey was conducted in one group of postpartum women using structured questionnaires to obtain information on awareness and use of folic acid. RESULTS: We interviewed 87 postpartum women. Awareness and use of folic among the interviewees were low, 51% and 48.3% respectively. Schooling is a predictor of folic acid correct use and awareness. DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS: Awareness of folic acid is relatively low among pregnant Bolivian women, its use during pregnancy is insufficient and supplementation before conception is zero. We still have a long way to go. We recommend the promotion of awareness and the use of folic acid in pregnant women.

Effect of a combination of gliptin and metformin on serum vitamin B12, folic acid, and ferritin levels

SUMMARY OBJECTIVE: The primary objective of this study was to explore the impact of metformin and metformin/gliptin combination therapy on the serum concentrations of vitamin B12, ferritin, and folic acid in individuals diagnosed with type 2 diabetes. METHODS: This study included 118 patients, classified into two groups: 59 patients using only metformin and 59 patients using a combination of metformin/gliptin. Among the latter group, 35 patients used vildagliptin/metformin, and 24 used sitagliptin/metformin. The study recorded the demographic data such as the age and gender of the patients, as well as their initial and 1-year follow-up blood parameters. RESULTS: Folic acid decreased significantly in the metformin group but not in the metformin/gliptin group. Vitamin B12 and ferritin decreased significantly in both groups. The decrease in vitamin B12 and ferritin was not significantly different between the two groups. The decrease in fasting plasma glucose was more significant in the metformin/gliptin group than in the metformin group. CONCLUSION: After 1 year, both groups taking metformin and metformin/gliptin showed low serum ferritin and vitamin B12 levels. Therefore, vitamin B12 levels in patients using these drugs should be closely monitored. Ferritin levels can be used to indicate whether glycemic control has been achieved.

The Role of Thyroid Hormones, Vitamins, and Microelements in Female Infertility / O papel dos hormônios da tiroide, das vitaminas e dos microelementos na fertilidade feminina

Abstract Objective It is well known that female infertility is multifactorial. Therefore, we aimed to compare the effects of thyroid dysfunction, vitamin deficiency, and microelement deficiency in fertile and infertile patients. Materials and Methods Between May 1st, 2017, and April 1st, 2019, we conducted a retrospective case-control study with of 380 infertile and 346 pregnant patients (who normally fertile and able to conceive spontaneously). The fertile patients were selected among those who got pregnant spontaneously without treatment, had a term birth, and did not have systemic or obstetric diseases. The levels of thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-thyroid peroxidase (anti-TPO), vitamin D, vitamin B12, folic acid, ferritin, and zinc of both groups were compared. Results There was no difference between patients in the infertile and pregnant groups in terms of low normal and high serum T3 and T4 levels (p = 0.938; p > 0.05) respectively, nor in terms of normal and high anti-TPO levels (p = 0.182; p > 0.05) respectively. There was no significant difference regarding patients with low, insufficient, and sufficient vitamin D levels in the infertile and pregnant groups (p = 0.160; p >0.05) respectively. The levels of folic acid, ferritin, and zinc of the infertile group were significantly lower than those of the pregnant group. Conclusion The serum levels of folic acid, ferritin, and zinc in infertile patients presenting to our outpatient clinic were lower than those o the fertile patients.

Resumo Objetivo Sabe-se que a infertilidade feminina é multifatorial. Portanto, nosso objetivo foi comparar os efeitos da disfunção tireoidiana, deficiência de vitaminas e deficiência de microelementos em pacientes férteis e inférteis. Materiais e Métodos Entre 1° de maio de 2017 e 1° de abril de 2019, realizamos um estudo retrospectivo caso-controle com 380 pacientes inférteis e 346 grávidas (normalmente férteis e capazes de conceber espontaneamente). As pacientes férteis foram selecionadas entre aquelas que engravidaram espontaneamente sem tratamento, tiveram parto a termo e não apresentavam doenças sistêmicas ou obstétricas. Os níveis de hormônio estimulante da tireoide (TSH), triiodotironina (T3), tiroxina (T4), antitireoide peroxidase (anti-TPO), vitamina D, vitamina B12, ácido fólico, ferritina e zinco de ambos os grupos foram comparados. Resultados Não houve diferença entre as pacientes dos grupos inférteis e gestantes em relação aos níveis altos de sérumT3 e T4 normais baixos e altos (p = 0,938; p > 0,05), respectivamente nem aos níveis normais e altos de anti-TPO (p = 0,182; p > 0,05), respectivamente. Não houve diferença significativa em relação aos pacientes com níveis baixos, insuficientes e suficientes de vitamina D nos grupos inférteis e gestantes (p = 0,160; p > 0,05), respectivamente. Os níveis de ácido fólico, ferritina e zinco do grupo infértil foram significativamente menores do que os do grupo grávida. Conclusão Os níveis de sérum de ácido fólico, ferritina e zinco nas pacientes inférteis atendidas em nosso ambulatório foram menores do que nas pacientes férteis.

Impact of Maternal Folic Acid Supplementation on Descendants' Kidney in Adulthood / Impacto da suplementação materna com ácido fólico no rim dos descendentes na vida adulta

Abstract Supplementation with folic acid (FA) during gestation has been recommended by medical society all over the world, but some studies have shown that intake of high folic acid diet may unleash damages to the descendants. Objectives: Describing the effects of maternal supplementation with FA during gestation on offspring's kidney at late life stages. Data Source: It is a systematic review by which were consulted the following databases: Medline, through Pubmed, Lilacs, and SciELO. The research was performed using the keywords "Folic acid", "Gestation" and "Kidney". Study Selection: Eight studies were regarded for this systematic review. Data Collection: Only studies that evaluated folic acid consumption during gestation and its effects exclusively on descendants' kidney at several phases of life were regarded. Results: Gestational FA intake did not change the renal volume, glomerular filtration rate and the expression of some essential genes in the kidney of puppies whose dams were supplemented with FA. Maternal consumption of double FA plus selenium diet was effective in preserving antioxidant enzymes activity in the kidney of descendants from mothers exposed to alcohol. FA supplementation decreased some gross anomalies in the puppies caused by teratogenic drug despite of had not been effective in preventing some renal architectural damages. Conclusion: FA supplementation did not cause renal toxicity; it exerted an antioxidant protective effect and mitigated some renal disorders caused by severe aggressions.

Resumo A suplementação com ácido fólico (AF) durante a gestação tem sido recomendada pela sociedade médica em todo o mundo, mas alguns estudos têm mostrado que a ingestão de altas quantidades de ácido fólico na dieta pode desencadear danos aos descendentes. Objetivos: Descrever os efeitos da suplementação materna com AF durante a gestação no rim da prole em fases tardias da vida. Fonte de Dados: Trata-se de uma revisão sistemática realizada através da consulta das seguintes bases de dados: Medline, através da Plataforma Pubmed, Lilacs e Scielo. A pesquisa foi realizada utilizando-se as palavras-chave "Ácido Fólico", "Gestação" e "Rim". Seleção dos Estudos: Oito estudos foram considerados para esta revisão sistemática. Coleta de Dados: Foram incluídos estudos que abordaram o consumo de ácido fólico durante a gestação e seus efeitos exclusivamente no rim dos descendentes em diferentes fases da vida. Resultados: O consumo gestacional de AF não alterou o volume renal, a taxa de filtração glomerular e a expressão de alguns genes essenciais no rim dos filhotes de mães suplementadas com AF. A associação de AF e selênio na dieta materna foi eficaz na preservação da atividade de enzimas antioxidantes no rim da prole de mães expostas ao álcool. O consumo de AF diminuiu algumas anomalias importantes nos filhotes causadas por drogas teratogênicas, apesar de não ter sido eficiente na prevenção de alguns danos a arquitetura renal. Conclusão: A suplementação com AF não causou toxicicdade renal, exerceu efeito protetor antioxidante e mitigou algumas desordens renais causadas por agressões severas.

Folic acid supplementation during pregnancy and postpartum depressive symptoms / Suplementação de ácido fólico na gestação e sintomas depressivos pós-parto

ABSTRACT OBJECTIVE To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort. METHODS This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity). RESULTS The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum. CONCLUSION There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.

RESUMO OBJETIVO Verificar se a suplementação de ácido fólico durante a gestação está associada com a ocorrência de sintomas depressivos maternos aos três meses pós-parto, na Coorte de Nascimentos de Pelotas de 2015. MÉTODOS Este estudo incluiu 4.046 mulheres, que foram classificadas em três grupos: sem suplementação de ácido fólico na gestação; uso durante apenas um trimestre da gestação;e uso durante dois ou três trimestres. Os sintomas depressivos foram avaliados aos três meses pós-parto, através da Escala de Depressão Pós-Natal de Edimburgo (EPDS), nos pontos de corte ≥ 10 (sintomas leves) e ≥ 13 (intensidade moderada a grave). RESULTADOS A prevalência geral de sintomas leves foi de 20,2% (IC95% 19,0-21,5),e moderados e graves de 11% (IC95% 10,0-12,0). Entre as mulheres que não fizeram uso de ácido fólico, a prevalência de EPDS ≥ 10 foi de 26,8% (IC95% 24,0-29,5) e 18,1% tanto entre as que utilizaram durante um trimestre da gestação (IC95% 16,1-20,1), quanto entre as que utilizaram por dois ou três trimestres (IC95% 16,0-20,2). Já a prevalência de EPDS ≥ 13 foi 15,7% (IC95% 13,5-17,9) entre as que não utilizaram ácido fólico, 9,1% (IC95% 7,5-10,6) entre as que utilizaram durante um trimestre e 9,4% (IC95% 7,8-11,0) entre as que utilizaram por dois ou três trimestres. Nas análises ajustadas, não houve associação estatisticamente significativa entre o uso de ácido fólico na gestação e a ocorrência de sintomas depressivos aos três meses pós-parto. CONCLUSÃO Não se observou associação entre a suplementação de ácido fólico na gestação e depressão pós-parto aos três meses.

Hematological and renoprotective effects of folic acid and lentil extract in diclofenac sodium exposed rats / Efeitos hematológicos e renoprotetores do ácido fólico e do extrato de lentilha em ratos expostos ao diclofenaco de sódio

Abstract Excessive intake of non-steroidal anti-inflammatory drugs such as, diclofenac sodium (DS) may lead to toxicity in the rats. In this work, we aimed to examine the protective impact of lentil extract (LE) and folic acid (FA) on the hematological markers, the kidney tissue oxidative stress and the renal function against diclofenac sodium (DS) in male albino rats. The rats (120-150 g) were divided into four equal groups randomly, the first group kept as the untreated control. The second group was administrated with DS (11.6 mg/kg b.wt. orally once/day). The third group was received DS+FA (11.6 mg/kg b.wt.+76.9 microgram/kg b.wt.) orally once/day. The fourth group was treated with DS+LE (11.6 mg/kg b.wt.+500 mg/kg b.wt.) orally once/day. After four weeks, the results revealed that DS produced a significant decrease in the values of red blood cells (RBCs), hemoglobin concentration (Hb), hematocrit (HCT) and white blood cells (WBCs). On the other hand, there was a significant increase in the platelets count. Also, DS induced a renal deterioration; this was evidenced by the significant increase in the serum levels of urea, creatinine, uric acid, Na, Ca, Mg as well as the nitric oxide (NO) level in the kidney tissue. Also, there were a significant reduction in the serum levels of potassium (K) and reduced glutathione (GSH) in the kidney homogenates. Moreover, the findings in the rats treated by DS+LE or DS+FA showed a potential protection on the hematological markers, oxidative stress in the kidney tissue and the renal function disturbed by DS. LE and FA could play a potent role for the prevention the adverse hematological, the kidney tissue oxidative stress and the renal dysfunction caused by DS via their anti-oxidative and bioactive phytochemicals.

Resumo A ingestão excessiva de anti-inflamatórios não esteroidais, como o diclofenaco de sódio (DS), pode causar toxicidade em ratos. Neste trabalho, objetivamos examinar o impacto protetor do extrato de lentilha (LE) e ácido fólico (AF) em marcadores hematológicos, no estresse oxidativo do tecido renal e na função renal contra o diclofenaco de sódio (DS) em ratos albinos machos. Os ratos (120-150 g) foram divididos em quatro grupos iguais aleatoriamente, sendo o primeiro grupo mantido como controle não tratado. O segundo grupo foi administrado com DS (11,6 mg / kg de peso corporal por via oral uma vez / dia). O terceiro grupo recebeu DS + FA (76,9 mg / kg de peso corporal por via oral uma vez / dia). O quarto grupo foi tratado com DS + LE (500 mg / kg de peso corporal por via oral uma vez / dia). Após quatro semanas, os resultados revelaram que o DS produziu uma diminuição significativa nos valores de glóbulos vermelhos (RBCs), concentração de hemoglobina (Hb), hematócrito (HCT) e glóbulos brancos (WBCs). Por outro lado, houve um aumento significativo na contagem de plaquetas. Além disso, o DS induziu uma deterioração renal; isso foi evidenciado pelo aumento significativo dos níveis séricos de ureia, creatinina, ácido úrico, Na, Ca, Mg e também do nível de óxido nítrico no tecido renal. Além disso, houve uma redução significativa nos níveis séricos de potássio (K) e glutationa reduzida (GSH) nos homogenatos renais. Além disso, os achados nos ratos tratados com DS + LE ou DS + FA mostraram uma proteção potencial sobre os marcadores hematológicos, estresse oxidativo no tecido renal e função renal perturbada pelo DS. LE e AF podem desempenhar um papel potente na prevenção do estresse hematológico adverso, do estresse oxidativo do tecido renal e da disfunção renal causada pelo DS por meio de seus fitoquímicos antioxidantes e bioativos.

Clinical efficacy of pemetrexed disodium in maintenance treatment of advanced lung adenocarcinoma / 中国基层医药

Objective:To investigate the clinical efficacy and adverse reactions of pemetrexed disodium in the maintenance treatment of advanced lung adenocarcinoma after chemotherapy with pemetrexed disodium and platinum.Methods:The clinical data of 35 patients with stage Ⅳ lung adenocarcinoma who received chemotherapy with pemetrexed disodium and platinum and were well treated in Beijing Huairou Hospital from January 2013 to August 2020 were retrospectively analyzed. Maintenance therapy with pemetrexed disodium was initiated after the completion of combination chemotherapy until disease progression. The clinical characteristics, therapeutic effects, adverse reactions, progression-free survival, and overall survival of the 35 patients were evaluated.Results:Among the 35 patients, no patients had complete remission, 11 patients had partial remission, 22 patients had stable disease, and 2 patients had progressive disease. The objective remission rate was 31.4%, disease control rate was 94.3%, median progression-free survival was 9.53 months, median overall survival was 18.21 months, 1-year survival rate was 68.6%, 2-year survival rate was 31.4%, and 3-year survival rate was 11.4%. Gender, age, smoking, and the baseline characteristics of patients undergoing first-line pemetrexed disodium or second-line pemetrexed disodium treatment had no effects on progression-free survival (all P > 0.05). Positive gene mutation and receiving four or more chemotherapy cycles had a protective effect on progression-free survival (both P < 0.05). Chemotherapy-related adverse reactions mainly included myelosuppression, nausea, elevated transaminase, and nephrotoxicity, all of which were mild and were relieved after symptomatic treatment. Conclusion:Pemetrexed disodium is effective and safe in the maintenance treatment of advanced lung adenocarcinoma. The results of this study are scientific.

Hematological and renoprotective effects of folic acid and lentil extract in diclofenac sodium exposed rats / Efeitos hematológicos e renoprotetores do ácido fólico e do extrato de lentilha em ratos expostos ao diclofenaco de sódio

Excessive intake of non-steroidal anti-inflammatory drugs such as, diclofenac sodium (DS) may lead to toxicity in the rats. In this work, we aimed to examine the protective impact of lentil extract (LE) and folic acid (FA) on the hematological markers, the kidney tissue oxidative stress and the renal function against diclofenac sodium (DS) in male albino rats. The rats (120-150 g) were divided into four equal groups randomly, the first group kept as the untreated control. The second group was administrated with DS (11.6 mg/kg b.wt. orally once/day). The third group was received DS+FA (11.6 mg/kg b.wt.+76.9 microgram/kg b.wt.) orally once/day. The fourth group was treated with DS+LE (11.6 mg/kg b.wt.+500 mg/kg b.wt.) orally once/day. After four weeks, the results revealed that DS produced a significant decrease in the values of red blood cells (RBCs), hemoglobin concentration (Hb), hematocrit (HCT) and white blood cells (WBCs). On the other hand, there was a significant increase in the platelets count. Also, DS induced a renal deterioration; this was evidenced by the significant increase in the serum levels of urea, creatinine, uric acid, Na, Ca, Mg as well as the nitric oxide (NO) level in the kidney tissue. Also, there were a significant reduction in the serum levels of potassium (K) and reduced glutathione (GSH) in the kidney homogenates. Moreover, the findings in the rats treated by DS+LE or DS+FA showed a potential protection on the hematological markers, oxidative stress in the kidney tissue and the renal function disturbed by DS. LE and FA could play a potent role for the prevention the adverse hematological, the kidney tissue oxidative stress and the renal dysfunction caused by DS via their anti-oxidative and bioactive phytochemicals.

A ingestão excessiva de anti-inflamatórios não esteroidais, como o diclofenaco de sódio (DS), pode causar toxicidade em ratos. Neste trabalho, objetivamos examinar o impacto protetor do extrato de lentilha (LE) e ácido fólico (AF) em marcadores hematológicos, no estresse oxidativo do tecido renal e na função renal contra o diclofenaco de sódio (DS) em ratos albinos machos. Os ratos (120-150 g) foram divididos em quatro grupos iguais aleatoriamente, sendo o primeiro grupo mantido como controle não tratado. O segundo grupo foi administrado com DS (11,6 mg / kg de peso corporal por via oral uma vez / dia). O terceiro grupo recebeu DS + FA (76,9 mg / kg de peso corporal por via oral uma vez / dia). O quarto grupo foi tratado com DS + LE (500 mg / kg de peso corporal por via oral uma vez / dia). Após quatro semanas, os resultados revelaram que o DS produziu uma diminuição significativa nos valores de glóbulos vermelhos (RBCs), concentração de hemoglobina (Hb), hematócrito (HCT) e glóbulos brancos (WBCs). Por outro lado, houve um aumento significativo na contagem de plaquetas. Além disso, o DS induziu uma deterioração renal; isso foi evidenciado pelo aumento significativo dos níveis séricos de ureia, creatinina, ácido úrico, Na, Ca, Mg e também do nível de óxido nítrico no tecido renal. Além disso, houve uma redução significativa nos níveis séricos de potássio (K) e glutationa reduzida (GSH) nos homogenatos renais. Além disso, os achados nos ratos tratados com DS + LE ou DS + FA mostraram uma proteção potencial sobre os marcadores hematológicos, estresse oxidativo no tecido renal e função renal perturbada pelo DS. LE e AF podem desempenhar um papel potente na prevenção do estresse hematológico adverso, do estresse oxidativo do tecido renal e da disfunção renal causada pelo DS por meio de seus fitoquímicos antioxidantes e bioativos.

Hematological and renoprotective effects of folic acid and lentil extract in diclofenac sodium exposed rats

Abstract Excessive intake of non-steroidal anti-inflammatory drugs such as, diclofenac sodium (DS) may lead to toxicity in the rats. In this work, we aimed to examine the protective impact of lentil extract (LE) and folic acid (FA) on the hematological markers, the kidney tissue oxidative stress and the renal function against diclofenac sodium (DS) in male albino rats. The rats (120-150 g) were divided into four equal groups randomly, the first group kept as the untreated control. The second group was administrated with DS (11.6 mg/kg b.wt. orally once/day). The third group was received DS+FA (11.6 mg/kg b.wt.+76.9 microgram/kg b.wt.) orally once/day. The fourth group was treated with DS+LE (11.6 mg/kg b.wt.+500 mg/kg b.wt.) orally once/day. After four weeks, the results revealed that DS produced a significant decrease in the values of red blood cells (RBCs), hemoglobin concentration (Hb), hematocrit (HCT) and white blood cells (WBCs). On the other hand, there was a significant increase in the platelets count. Also, DS induced a renal deterioration; this was evidenced by the significant increase in the serum levels of urea, creatinine, uric acid, Na, Ca, Mg as well as the nitric oxide (NO) level in the kidney tissue. Also, there were a significant reduction in the serum levels of potassium (K) and reduced glutathione (GSH) in the kidney homogenates. Moreover, the findings in the rats treated by DS+LE or DS+FA showed a potential protection on the hematological markers, oxidative stress in the kidney tissue and the renal function disturbed by DS. LE and FA could play a potent role for the prevention the adverse hematological, the kidney tissue oxidative stress and the renal dysfunction caused by DS via their anti-oxidative and bioactive phytochemicals.

Resumo A ingestão excessiva de anti-inflamatórios não esteroidais, como o diclofenaco de sódio (DS), pode causar toxicidade em ratos. Neste trabalho, objetivamos examinar o impacto protetor do extrato de lentilha (LE) e ácido fólico (AF) em marcadores hematológicos, no estresse oxidativo do tecido renal e na função renal contra o diclofenaco de sódio (DS) em ratos albinos machos. Os ratos (120-150 g) foram divididos em quatro grupos iguais aleatoriamente, sendo o primeiro grupo mantido como controle não tratado. O segundo grupo foi administrado com DS (11,6 mg / kg de peso corporal por via oral uma vez / dia). O terceiro grupo recebeu DS + FA (76,9 mg / kg de peso corporal por via oral uma vez / dia). O quarto grupo foi tratado com DS + LE (500 mg / kg de peso corporal por via oral uma vez / dia). Após quatro semanas, os resultados revelaram que o DS produziu uma diminuição significativa nos valores de glóbulos vermelhos (RBCs), concentração de hemoglobina (Hb), hematócrito (HCT) e glóbulos brancos (WBCs). Por outro lado, houve um aumento significativo na contagem de plaquetas. Além disso, o DS induziu uma deterioração renal; isso foi evidenciado pelo aumento significativo dos níveis séricos de ureia, creatinina, ácido úrico, Na, Ca, Mg e também do nível de óxido nítrico no tecido renal. Além disso, houve uma redução significativa nos níveis séricos de potássio (K) e glutationa reduzida (GSH) nos homogenatos renais. Além disso, os achados nos ratos tratados com DS + LE ou DS + FA mostraram uma proteção potencial sobre os marcadores hematológicos, estresse oxidativo no tecido renal e função renal perturbada pelo DS. LE e AF podem desempenhar um papel potente na prevenção do estresse hematológico adverso, do estresse oxidativo do tecido renal e da disfunção renal causada pelo DS por meio de seus fitoquímicos antioxidantes e bioativos.

Association of folic acid with the development and progression of liver cancer / 临床肝胆病杂志

So far, liver cancer is still a highly malignant tumor with a high incidence rate in China, and it seriously affects the life and health of Chinese people. Previous studies have shown that the development of liver cancer is associated with various factors such as virus, smoking, drinking, and nonalcoholic fatty liver disease. With continuous exploration, more and more studies have pointed out that nutritional factors and living environment are associated with the development and progression of liver cancer. Folic acid is a necessary nutrient for cell growth and reproduction, and its level in human body has an impact on the growth of tumor cells and is closely associated with liver cancer. This article reviews the research advances in the association between folic acid and liver cancer in recent years, so as to provide new reference and basis for the prevention and treatment of liver cancer.

Association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid and preterm delivery in women / 北京大学学报(医学版)

OBJECTIVE@#To explore the association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid(MMFA) and risk of preterm delivery in women with natural conception, singleton pregnancy and vaginal delivery.@*METHODS@#A retrospective cohort study was performed based on the prenatal health care system and hospital information system of Tongzhou Maternal and Child Health Hospital of Beijing and the women who had their prenatal care in the hospital from January 2015 to December 2018 were included. The information of 16 332 women who conceived naturally, had a singleton pregnancy, and delivered vaginally was collected. Compliance scores were constructed based on the time of initiation and the frequency of taking nutritional supplements. The association between maternal periconceptional micronutrient supplementation, including pure folic acid (FA) pills or MMFA and the rate of preterm delivery was evaluated using Logistic regression models.@*RESULTS@#The preterm delivery rate (gestational week < 37 weeks) of the study population was 3.8%, and the mean (standard deviation) of gestational age was (38.98±1.37) weeks. A total of 6 174 (37.8%) women took FA during the periconceptional period, 8 646 (52.9%) women took MMFA, and 1 512 (9.3%) women did not take any nutritional supplements. The association between periconceptional supplementation of FA or MMFA and risk of preterm delivery in women was not statistically significant [adjusted odds ratio (aOR)=1.01, 95%CI: 0.74-1.37]. The associations with preterm birth were not statistically significant in further analysis by the type of nutritional supplements, time of initiation, and the frequency of supplementation. In addition, the association between the compliance score of taking supplements and the rate of preterm delivery was not statistically significant, either.@*CONCLUSION@#This study did not find an association between the risk of preterm delivery and the use of FA or MMFA during the periconcep-tional period in women with natural conception, singleton pregnancy, and vaginal delivery. In the future, multicenter studies with large-scale prospective cohort or population-based randomized controlled trials are warranted to confirm the association between taking FA or MMFA during the periconceptional period and preterm delivery among women.

Construction of folate receptors and mitochondria targeting celastrol-loaded PAMAM nano-drug delivery system and its in vitro anti-inflammatory effect / 药学学报

Pro-inflammatory macrophages play key regulatory role in the occurrence and development of rheumatoid arthritis (RA). In this study, we constructed a celastrol (Cel)-loaded polyamide-amine dendrimer (PAMAM) drug delivery system, which could target folate receptor and mitochondria. It could target inflammatory macrophages and realize chemo-photothermal synergistic therapy. Using PAMAM as the nano-carrier, folate receptor-targeting group folic acid (FA) and mitochondria-targeting group IR808 (also known as the photothermal agent) were conjugated with PAMAM through amide reaction, and then complexed with anti-inflammatory drug Cel to prepare the FA-PAMAM-IR808/Cel nanocomplex. In vitro characterization results showed that the drug loading efficiency of the nanocomplex was 50.90%, particle size was between 130 and 160 nm, average potential was between 1.0 and 3.5 mV, the drug release showed pH sensitivity, temperature reached to 42.5 ℃ after near-infrared (NIR) light irradiation for 10 min. In vitro cellular uptake experiments showed that the nanocomplex had obvious folate receptor-targeting and mitochondria-targeting ability. Following irradiation with NIR light, the cytotoxicity and cellular apoptosis enhanced. The secretion of pro-inflammatory factors tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-6 and nitric oxide (NO) decreased in a concentration-dependent manner. This study provided insights for the development of novel anti-RA nanomedicines.

Clinical significance and changes of homocysteine, vitamin B12 and folic acid in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the changes of serum homocysteine(Hcy), vitamin B12(VitB12)and folic acid in the serum of patients with diabetic retinopathy(DR), and to explore their significance in the occurrence and development of DR.METHODS: A case-control study was designed. A total of 95 patients with DR(DR group), 94 patients with diabetes mellitus(DM group)treated in endgcrinology department and 87 patients with age-related cataract(normal control group)from the ophthalmology department of Shenzhen People's Hospital between July 2021 and January 2022 were selected. Fasting venous blood was collected and serum was separated. The concentration of Hcy in serum was detected by enzyme linked immunosorbent assay(ELISA), and chemiluminescence immunoassay was used to detect the concentration of VitB12 and folic acid. Pearson linear correlation analysis was used to evaluate the correlation between Hcy and clinical parameters. Multivariate linear regression analysis was used to evaluate the main factors which affect Hcy level. Receiver operating characteristic(ROC)curve was designed to analyze the diagnostic value of serum Hcy, VitB12 and folic acid in DR.RESULTS: The concentration of serum Hcy in DR group was 16.52±3.54 μmol/L, which was significantly higher than that in DM group(10.86±3.47 μmol/L)and control group(6.84±1.39 μmol/L; all P&#x0026;#x003C;0.05); The concentration of VitB12 in the serum of the control group was 501.79±108.95 pmol/L, which was higher than that in DM group(478.57±57.85 pmol/L)and DR group(455.88±181.49 pmol/L), but the difference was not statistically significant(P=0.054); The concentration of folic acid in serum of control group was 10.31±2.43 nmol/L, which was higher than that of DM group(9.94±1.90 nmol/L)and DR group(7.27±2.79 nmol/L), and the difference between DR group and DM group was statistically significant(P&#x0026;#x003C;0.05); In DR group, Hcy expression was weakly positively correlated with triglyceride and low density lipoprotein(r=0.208, P=0.043; r=0.240, P=0.019). Multivariate linear regression showed that low density lipoprotein was an important factor which affect the expression of Hcy in DR patients. ROC curve shows that Hcy has important value in the diagnosis of DR.CONCLUSIONS: Hcy, VitB12 and folic acid are differentially expressed in DR group, DM group and normal control group. Hcy may be involved in the pathogenesis of DR, and it has important value in the diagnosis of DR. In addition, low density lipoprotein is also an important factor which affects the expression of Hcy.

Effect of folic acid coated-crosslinked urethane-doped polyester elastomer nerve conduit on promoting the repair of long distance peripheral nerve injury in rats / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of folic acid coated-crosslinked urethane-doped polyester elastomer (fCUPE) nerve conduit in repairing long distance peripheral nerve injury.@*METHODS@#Thirty-six 3-month-old male Sprague Dawley rats weighing 180-220 g were randomly assigned to 3 groups, each consisting of 12 rats: CUPE nerve conduit transplantation group (group A), fCUPE nerve conduit transplantation group (group B), and autologous nerve transplantation group (group C), the contralateral healthy limb of group C served as the control group (group D). A 20-mm-long sciatic nerve defect model was established in rats, and corresponding materials were used to repair the nerve defect according to the group. The sciatic function index (SFI) of groups A-C was calculated using the Bain formula at 1, 2, and 3 months after operation. The nerve conduction velocity (NCV) of the affected side in groups A-D was assessed using neuroelectrophysiological techniques. At 3 months after operation, the regenerated nerve tissue was collected from groups A-C for S-100 immunohistochemical staining and Schwann cell count in groups A and B to compare the level of nerve repair and regeneration in each group.@*RESULTS@#At 3 months after operation, the nerve conduits in all groups partially degraded. There was no significant adhesion between the nerve and the conduit and the surrounding tissues, the conduit was well connected with the distal and proximal nerves, and the nerve-like tissues in the conduit could be observed when the nerve conduit stents were cut off. SFI in group A was significantly higher than that in group C at each time point after operation and was significantly higher than that in group B at 2 and 3 months after operation ( P<0.05). There was no significant difference in SFI between groups B and C at each time point after operation ( P>0.05). NCV in group A was significantly slower than that in the other 3 groups at each time point after operation ( P<0.05). The NCV of groups B and C were slower than that of group D, but the difference was significant only at 1 month after operation ( P<0.05). There was no significant difference between groups B and C at each time point after operation ( P>0.05). Immunohistochemical staining showed that the nerve tissue of group A had an abnormal cavo-like structure, light tissue staining, and many non-Schwann cells. In group B, a large quantity of normal neural structures was observed, the staining was deeper than that in group A, and the distribution of dedifferentiated Schwann cells was obvious. In group C, the nerve bundles were arranged neatly, and the tissue staining was the deepest. The number of Schwann cells in group B was (727.50±57.60) cells/mm 2, which was significantly more than that in group A [(298.33±153.12) cells/mm 2] ( t=6.139, P<0.001).@*CONCLUSION@#The fCUPE nerve conduit is effective in repairing long-distance sciatic nerve defects and is comparable to autologous nerve grafts. It has the potential to be used as a substitute material for peripheral nerve defect transplantation.

Epilepsia y embarazo: particularidades y tratamiento / Epilepsy and pregnancy: particularities and treatment

Resumen ANTECEDENTES: La prevalencia de epilepsia en mujeres embarazadas es del 0.3 al 0.5%. Si bien es una enfermedad de baja frecuencia es importante saber cómo el embarazo modifica el curso de la enfermedad y cómo la enfermedad modifica el curso del embarazo y cuál es la seguridad de los tratamientos durante el embarazo y cuáles son los consensos obstétricos actuales a este respecto. OBJETIVO: Actualizar los conocimientos acerca de cómo el embarazo modifica el curso de la enfermedad, cómo la enfermedad modifica el curso del embarazo, cuán seguros son los tratamientos durante el embarazo y los consensos obstétricos actuales a este respecto. METODOLOGÍA: Revisión bibliográfica efectuada en dos bases de datos (PubMed y Scopus) con los siguientes criterios de búsqueda (MeSH): "epilepsy'' y "pregnancy'' de artículos publicados entre el 2015 y mayo del 2022, escritos en inglés o español: metanálisis, revisiones sistemáticas, narrativas o ensayos clínicos. RESULTADOS: Se identificaron 310 registros. Después de la eliminación por duplicación y otras causas se seleccionaron 20 artículos, más otros utilizados como complemento del tema. CONCLUSIONES: El embarazo de una paciente con epilepsia debe considerarse de alto riesgo y, por lo tanto, adecuar su seguimiento. La planificación del embarazo resulta fundamental, con el propósito de indicar el tratamiento antiepiléptico adecuado y el suplemento con ácido fólico, si es necesario.

Abstract BACKGROUND: The prevalence of epilepsy in pregnant women is 0.3 to 0.5%. Although it is a low frequency disease, it is important to know how pregnancy modifies the course of the disease and how the disease modifies the course of pregnancy and what is the safety of treatments during pregnancy and what are the current obstetric consensuses in this regard. OBJECTIVE: To update knowledge about how pregnancy modifies the course of the disease, how the disease modifies the course of pregnancy, how safe are the treatments during pregnancy and the current obstetric consensus in this respect. METHODOLOGY: Literature review conducted in two databases (PubMed and Scopus) with the following search criteria (MeSH): "epilepsy" and "pregnancy" of articles published between 2015 and May 2022, written in English or Spanish: meta-analyses, systematic reviews, narratives or clinical trials. RESULTS: 310 records were identified. After elimination for duplication and other causes, 20 articles were selected, plus others used to complement the topic. CONCLUSIONS: Pregnancy in a patient with epilepsy should be considered high risk and therefore follow-up should be appropriate. Pregnancy planning is essential in order to indicate the appropriate antiepileptic treatment and folic acid supplementation, if necessary.

Intervención educativa sobre riesgo preconcepcional en mujeres de un Área de salud en Guantánamo / Knowledge intervention on preconception risk in women from a health area in Guantánamo

Fundamento: La salud reproductiva está presente durante el ciclo vital de las mujeres y los hombres; en la que juega un papel decisivo la planificación familiar, el conocimiento y manejo del riesgo reproductivo. Objetivo: Evaluar la efectividad de una intervención educativa, en mujeres de edad fértil con riesgo preconcepcional, pertenecientes al consultorio "La Colonia", del Policlínico "Rafael Teope Fonseca", "El Salvador", Guantánamo, desde septiembre 2017 a abril 2019. Metodología: Se realizó un estudio cuasiexperimental, tipo intervención educativa sobre riesgo preconcepcional, con diseño antes y después. El universo fue de 65 mujeres en edad fértil. Se utilizó muestreo no probabilístico intencional. La muestra fue de 45 mujeres con riesgo preconcepcional. La investigación se realizó en 3 etapas: diagnóstica, intervención y evaluación. La información se recogió en una encuesta semiestructurada que se aplicó antes y después de la intervención. Las variables fueron: métodos para planificar el embarazo, edad óptima para el embarazo, antecedentes obstétricos desfavorables, importancia del consumo de ácido fólico antes del embarazo y conocimiento general sobre el tema. Se determinó el test de McNemar para el análisis estadístico e índice de kappa para determinar efectividad de la intervención. Resultados: Antes de la intervención se diagnosticó nivel de conocimiento inadecuado sobre los métodos para planificar el embarazo (42 %), edad óptima para el embarazo (40 %) y en los antecedentes obstétricos (36 %). Posterior a la intervención el nivel de conocimiento adecuado fue significativo (p<0.05) en todas las variables. El índice kappa arrojó acuerdo considerable. Conclusiones: La intervención educativa fue efectiva.

Background: Reproductive health is present during women and men's life cycle, so family planning, knowledge and management of reproductive risk play a significant role. Objective: To evaluate the effectiveness of a knowledge intervention in fertile age women with preconception risk, at "La Colonia" clinic, in "Rafael Teope Fonseca" Polyclinic, "El Salvador", Guantánamo, from September 2017 to April 2019. Methodology: A quasi-experimental study was conducted, of educational intervention type on preconception risk, with formerly and subsequently designs. The universe was 65 women of fertile age. Intentional non-probabilistic sampling was used. The sample was 45 women with preconception risk. The research was conducted in 3 stages: diagnosis, intervention and evaluation. The information was collected in a semi-structured survey applied before and after the intervention. The variables were: methods for planning pregnancy, optimal age for pregnancy, unfavorable obstetric history, importance of folic acid intake before pregnancy, and general knowledge on the subject. The McNemar test was determined for the statistical analysis and the Kappa index to determine the effectiveness of the intervention. Results: Before the intervention, an inadequate level of knowledge was diagnosed about the methods for planning pregnancy (42 %), the optimal age for pregnancy (40 %) and the obstetric history (36 %). After the intervention, the adequate level of knowledge was significant (p<0.05) in all the variables. The Kappa index showed considerable agreement. Conclusions: The educational intervention was effective.

A Systematic review of factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India.

Background: Iron-folic acid deficiency is the most common complication during pregnancy. Iron deficiency is responsible for various health complications among pregnant women. Compliance with IFA supplementation is variable across India several factors are associated with compliance with IFA supplementation. Objective: The objective of this systematic review is to assess the factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India. Methods: The primary search was carried out using PubMed, Google scholar, the WHO website, and Research Gate which provide access to full?text research articles from January 2012 to 25th January 2022 published data were searched. Result: A total of 74 studies were identified, and 20 were included in this review. Out of the 20 studies, sixteen were cross-sectional, two mixed methods, and two randomized control trials. knowledge of IFA, education, socioeconomic status, the timing of registration and number of antenatal visits, type of family, and age of the pregnant women were the factors that affect the compliance of IFA supplementation. Conclusion: Knowledge of iron-folic acid supplementation, Timing of registration and number of Antenatal Care visits, educational level of the pregnant women, and age of the pregnant women were factors associated with the compliance of IFA supplementation among pregnant women in India.

Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric HematologyOncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

Justification: Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. Objective: To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. Process: These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. Recommendations: We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

Megaloblastic anemia in children from Eastern Odisha, India: A clinical and hematological profile analysis

Background: Anemia can have severe implications on the health of children including motor development, behavioral and cognitive development. Furthermore, morbidity from infectious disease is higher in anemic children. Nutritional anemia is a major concern in rural India. Aim and Objective: We aimed to observe the percentage of megaloblastic anemia among the anemic children and their clinical and hematological parameters. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, this cross-sectional study was conducted from September 2018 to August 2021. The setting was a tertiary care hospital in the eastern part of Odisha, India. Children of 1� years of age presenting with anemia were included in the study. Details clinical examination and blood tests namely mean corpuscular volume, red blood cell count, total leucocyte count, and platelet count were carried out from venous blood. Descriptive statistical analyses were conducted in STATA software version 15.1. Results: Among the total 150 anemic patients, the majority (126 [84%]) were in the 11� years of age group followed by 24 (16%) in 6� years of age (P < 0.0001). Girls were more (94 [62.7%]) than boys (56 [37.3%]), P < 0.0001. Anorexia was the most frequently encountered clinical symptom (99.3%) followed by pallor (94%), weakness (86%), fatigue (62%), and hyperpigmentation (37.4%). According to hemoglobin level, 40% were suffering from severe anemia, 38.7% was having moderate, and 21.3% was having mild anemia. The majority (74%) were having both Vitamin B12 and folic acid deficiency followed by 16.7% Vitamin B12, and 9.3% folic acid deficiency. Conclusion: Girls were presenting with megaloblastic anemia more than boys. Majority of them were suffering from both Vitamin B12 and folic acid deficiency. Children suffering from megaloblastic anemia present with anorexia, pallor, weakness, and fatigue. A proper health promotion program may be designed to aware the parents about the prevention of nutritional anemia.