Frequency of raised plasma homocysteine levels in patients of ischemic stroke

This descriptive study was conducted at Mayo Hospital, Lahore. A total number of 37 continuous patients with ischemic stroke were registered in one month. Imaging of the brain was done in each case. Both male and female patient of all age groups were included. Among these, 27 were males and 10 were females with the age range from 20 to 90 years. Nineteen patients [51.35%] had raised plasma homocysteine levels more than 15umol/l. Among patients with raised homcysteine levels, 14 [73.6%] were males and 5 [26.3%] were females. Eighteen [48.64%] patient fell in to group between 41-60 years of age. Eleven patients were younger than 40 and 8 were more than 60 years of age at the time of presentation. Out of 19 patients with raised plasma homocysteine levels 5 [26.3%] were also smokers and others were either non smokers or had stopped smoking more than 5 years back from the time of presentation. Four out of 19 [21.04%] patients had no other known cause of their stroke except raised plasma homocysteine. Theses patients were all males and were 23, 42, 60 and 68 years old. From our study we conclude that in our population, plasma homocysteine levels are raised commonly in patients of ischemic strokes, and it has already been established, as risk factor for all vascular events. We recommend routine measurements of Homocysteine levels in all Ischemic stroke patients and administration of Folic acid and Vitamin B12 as secondary preventive therapy

Comparison of oral folic acid and folinic acid on blood homocysteine level of patients on hemodialysis

Hyperhomocysteinemia is common in patients with chronic kidney disease. There is a direct relationship between cardiovascular mortality and increase of blood homocysteine. Folic acid is used as common treatment in such patients. Folinic acid, a shortened form of folic acid, is not affected by inhibitors of dihydrofolate reductase enzyme such as methoterxate. This study was performed to evaluate the effect of oral folinic acid on the blood homocysteine level of hemodialysis patients, in comparison with folic acid. This clinical trial was performed on 60 hemodialysis patients. The participants were divided into 2 groups to receive either 15 mg of oral folic acid or 15 mg of oral folinic acid, daily. Blood homocysteine levels were measured before dialysis and after the study period. Folic acid and folinic acid decreased the blood homocysteine levels by 33.0% and 28.7%, respectively [P < .001]. However, only 3 patients [6.5%] enjoyed a normalized homocysteine level. Our study showed that both folic and folinic acid decreased the blood homocysteine level and no meaningful difference was observed between them; therefore, we suggest they can be used interchangeably

The C677T thermolabile variant of methylene tetrahydrofolate reductase on homocysteine, folate and vitamin B12 in a hemodialysis center

Homocysteine is a risk factor for cardiovascular disease. Mutations in a key enzyme in homocysteine metabolism, methylenetetrahydrofolate reductase, may contribute to hyperhomocysteinemia and alter folate and cobalamin levels. After starting hemodialysis, 10 mg oral folate daily and 500 micrograms intravenous methylcobalamin once weekly were prescribed to 27 hemodialysis patients (time on hemodialysis > or = 12 months) and two groups were defined: Group A normal; Group B heterozygous. Initial, third and twelfth month measurements of homocysteine, serum folate and vitamin B12 levels were collected and analyzed. Heterozygous state of methylenetetrahydrofolate reductase prevalence was 48

. Hyperhomocysteinemia was present in both groups. Cobalamin final levels were significantly lower in Group B compared to Group A. Homocysteine, serum folate and cobalamin levels at third and twelfth month were significantly different from baseline levels but non-different between them in both groups. In Group B, vitamin B12 at third month was significantly higher than initial, but final measurements were not different from baseline determinations. In conclusion, the heterozygous prevalence of the enzyme in hemodialysis patients is similar to that reported in the general population; hyperhomocysteinemia is frequent in hemodialysis patients and final levels in heterozygous patients are significantly higher than in normal patients. Cobalamin levels are lower in the heterozygous group. After one year of treatment, homocysteine tends to increase, suggesting a secondary resistance phenomenon to vitamin supplementation in heterozygous patients.