Anemia severa por déficit de vitamina b 12 asociado a consumo de metformina / Severe anemia caused by vitamin b12 deficiency associated to metformin use

Resumen La Diabetes Mellitus tipo 2 se ha convertido en un problema de salud pública en el mundo por su alta carga de morbimortalidad y costos por las complicaciones a corto y largo plazo. La Metformina es el antidiabético más comúnmente ordenado para el tratamiento por su costoefectividad y seguridad cardiovascular(1). Presentamos un paciente con sincope por anemia severa megaloblástica causada por déficit de Vitamina B 12 donde la única explicación fue consumo crónico de Metformina. Recibió manejo con Cianocobalamina y presentó recuperación de los parámetros eritrocitarios. Es importante llamar la atención en la monitorización periódica de los niveles de vitamina B 12 en esta población, sobretodo en pacientes que se presentan con síntomas de neuropatía periférica o anemia.

Abstract Type 2 Diabetes Mellitus has become a public health concern globally due to its high morbidity, mortality and costs caused by short and long-term complications. Metformin is the antidiabetic drug most frequently prescribed because its cost-effectiveness and cardiovascular safety. We present the case of a patient with syncope caused by a severe megaloblastic anemia associated to Vitamin B12 deficiency, in which the only possible cause found was the chronic use of Metformin. Patient received treatment with Cyanocobalamin and showed improvement in erythrocyte indices. It is relevant to highlight importance of the periodic monitoring of Vitamin B12 levels in this type of patients, especially in those presenting symptoms of peripheral neuropathy or anemia.

Metabolismo mineral óseo en pacientes con enfermedad renal crónica: Revisión sobre su fisiopatología y morbimortalidad / Bone mineral metabolism in patients with chronic kidney disease: review of its pathophysiology and morbimortality

La enfermedad mineral ósea (EMO) es un término amplio que incluye a las alteraciones séricas del calcio, fósforo, vitamina D, paratohormona, anormalidades en el crecimiento, mineralización ósea y/o a las calcificaciones extraesqueléticas que acompañan al paciente con enfermedad renal crónica (ERC). Está presente en casi la totalidad de pacientes en diálisis y con el trasplante renal puede no siempre mejorar. Se han identificado nuevos factores y hormonas; como klotho y factor de crecimiento de fibroblastos-23 (FGF-23) que interactúan con la vitamina D y con la paratohormona en el manejo renal del calcio y fósforo. Ciertos reportes indican que son marcadores precoces del desarrollo de EMO, incluso cuando la función renal está levemente disminuida y los niveles de paratohormona son normales. La EMO ha sido asociada con mayor mortalidad, principalmente por su vinculación con la calcificación vascular. Este proceso conlleva a un incremento de eventos cardiovasculares que constituyen la principal causa de morbimortalidad en pacientes con ERC, sobre todo aquellos que se encuentran en diálisis, independientemente de la modalidad que los pacientes sigan. La forma de presentación de la EMO puede ser de alto o bajo recambio. Aunque no está completamente definido qué es lo que determina que se exprese una en particular, se ha encontrado que la enfermedad de bajo recambio se relaciona con malnutrición, uso inadecuado de calcitriol y diálisis ineficiente. El conocimiento de la EMO es relevante por su asociación con las complicaciones mencionadas y porque constituye un parámetro para evaluar la terapia instalada.

Mineral Bone Disorder (MBD) is a broad term that includes abnormal serum calcium, phosphorus, vitamin D, parathyroid hormone, growth abnormalities, bone mineralization and/or extraskeletal calcifications in patients with chronic kidney disease (CKD ). It is present in almost all patients on dialysis and may not always improve with a kidney transplant. New factors and hormones have been identified, such as Klotho and fibroblast growth factor-23 (FGF-23) that interact with vitamin D and the parathyroid hormone in the renal management of calcium and phosphorus. Some reports indicate that they are early markers of the development of MBD, even when kidney function is slightly decreased and parathyroid hormone levels are normal. MBD has been associated with higher mortality, mainly because of its link with vascular calcification. This process leads to an increase in cardiovascular events which are the leading cause of morbidity and mortality in CKD patients, especially those who are on dialysis, regardless of the modality that the patients follow. The presentation of the BMD can be of high or low turnover. Although it is not completely defined what determines that a particular form of presentation is expressed, it has been found that the low turnover disease is related to malnutrition, inappropriate use of calcitriol and inefficient dialysis. Knowledge of BMD is relevant for its association with the complications mentioned above and because it constitutes a parameter for assessing the instituted therapy.

Bilateral Vestibulopathy with Alcohol Abuse and Vitamin Deficiency / 대한평형의학회지

Bilateral vestibulopathy (BV) is a clinical entity with impaired function of bilateral peripheral vestibular system, which is characterized by movement-induced vertigo, oscillopsia and gait unsteadiness. Among various etiologies of BV, alcohol and vitamin B deficiency has rarely been reported. We experienced a case of BV with vitamin B deficiency in a 24-year-old man who was previously exposed to alcohol. He had osillopsia and gait unsteadiness as a primary symptom, and was treated successfully with vestibular rehabilitation and vitamin supplement. Bithermal caloric test, rotatory chair test and head impulse test showed the result compatible with BV.

La anemia como manifestación de la infección por Helicobacter pylori / Anemia as a manifestation of helicobacter pylori infection

Helicobacter pylori es el agente causal de infección más frecuente de la especie humana, con una marcada desventaja entre los países desarrollados y los países en vía de desarrollo, donde es mucho más frecuente. Si bien la infección por Helicobacter pylori cursa asintomática en la mayoría de los individuos infectados también es claro que está íntimamente relacionada con enfermedades malignas del estómago como el cáncer gástrico y el linfoma MALT; y enfermedades benignas como la gastritis crónica y la úlcera péptica duodenal y gástrica. A partir del momento en que se conoció que la mucosa gástrica podía ser colonizada por una bacteria, en la literatura médica mundial indexada (PubMed) se han informado alrededor de una centena de manifestaciones extragástricas que involucran a especialidadesmédicas tan disímiles como la cardiología, la dermatología, la endocrinología, la ginecoobstetricia, la hematología, la neumología, la neurología, la odontología, la oftalmología, la otorrinolaringología, la pediatría, la siquiatría y vascular periférico, algunas de ellas con mayor o menor acervo probatorio de la relación entre la infección por Helicobacter pylori y el desarrollo de la enfermedad. Esta revisión de la literatura médica mundial se centra en el análisis de la relación de la infección por Helicobacter pylori con las deficiencias de hierro y de vitamina B12, con o sin anemia. Se presentan para ambas formas de anemia, una visión general del problema, las evidencias de la asociación de cada una de ellas con la infección por Helicobacter pylori, la fisiopatología y el manejo en la era poshelicobacter.

Helicobacter pylori is the most common causative agent of human infection, with a marked disadvantage between developed and developing countries. Although Helicobacter pylori infection is asymptomatic in majority of individuals infected, it is also clear their close relation with malignant diseases of the stomach as gastric cancer and gastric MALT lymphoma; and benign diseases such as chronic gastritis and duodenal and gastric peptic ulcer. Since the moment that was known that the gastric mucosa can be colonized by bacteria, it has been informed about a hundred extragastric events in the indexed world medical literature (PubMed), that involves medical specialties as diverse as cardiology,dermatology, endocrinology, obstetrics and gynecology, hematology, pulmonology, neurology, dentistry, ophthalmology, otolaryngology, pediatrics, psychiatry, and peripheral vascular. Some of these with varying proofs of relation between Helicobacter pylori infection and disease development. This review was focuses on the analysis of the relationship between Helicobacter pylori infection with the iron and vitamin B12 deficiencies, with or without anemia. The information is presented for both forms of anemia, the problem overview, evidence of the association with Helicobacter pylori infection, the pathophysiology and management in poshelicobacter era.

Encefalopatía de Wernicke y polineuropatía asociada a déficit de complejo B después de una cirugía bariátrica / Wernicke´s encephalopathy and polyneuropathy associated with vitamin B complex deficiency after a bariatric surgery

La cirugía bariátrica es un tratamiento que garantiza una pérdida de peso sustancial y duradera, y beneficios tangibles respecto a condiciones médicas asociadas a la obesidad. El aumento del número de cirugías bariátricas ha llevado también a un aumento de las complicaciones relacionadas con ella, incluyendo la encefalopatía de Wernicke y la polineuropatía por deficiencia de vitaminas del complejo B. En este artículo se reporta un caso de encefalopatía de Wernicke siete semanas después de la cirugía, enfatizando en la importancia de reconocer el espectro de la sintomatología para hacer un diagnóstico temprano, que permita intervenir en la fase reversible de esta enfermedad potencialmente letal.

Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.

Deficiência de riboflavina em frangos de corte (Gallus gallus) - relato de caso / Riboflavin deficiency in broiler chickens (Gallus gallus) - a case report / Deficiencia de riboflavina en pollos de engorde (Gallus gallus) - relato de caso

Os micronutrientes executam funções bioquímicas específicas nos seres vivos, algumas das quais são fundamentais à vida. Dentre os micronutrientes, as vitaminas merecem atenção por participarem como cofatores de reações metabólicas e permitirem maior eficiência dos sistemas de síntese no organismo animal. Em meio às vitaminas, a riboflavina apresenta algumas particularidades, especialmente para aves, por ser provavelmente a vitamina mais limitante nesta espécie. A riboflavina está envolvida no metabolismo de carboidratos, gorduras e proteínas, apresentando papel preponderante na cadeia transportadora de elétrons, no processo de respiração celular e no processo de obtenção de energia por parte da célula, atuando na manutenção da integridade das membranas mucosas, pele, olhos e sistema nervoso. A deficiência de riboflavina resulta em alterações no metabolismo e efeito patológico em vários tecidos, sendo a epiderme e a bainha de mielina dos axônios as mais comprometidas. O principal sinal clínico da deficiência de riboflavina em aves jovens é a paralisia dos dedos curvos. O trabalho tem como objetivo relatar a ocorrência de um caso clínico de deficiência de riboflavina em um lote comercial de frangos de corte (Gallus gallus) alimentado exclusivamente com dieta de origem vegetal, que apresentou paralisia dos dedos curvos aos quatro dias de idade. Após diagnóstico presuntivo, o lote foi suplementado com 2,5mg/Kg de riboflavina via água de bebida, e apresentou melhora significativa horas após o início da suplementação, em que 95% das aves se recuperaram até os doze dias pós suplementação e os 5% restante persistiram com os sinais clínicos até o abate.

Micronutrients perform specific biochemical functions in living organisms, some of which are essential to life. Among the micronutrients, vitamins deserve special attention for participating as cofactors in metabolic reactions and allowing greater efficiency of synthesis systems in an animal organism. In the midst of vitamins, riboflavin presents some particularities, especially for poultry, because it is probably the most limiting vitamin in this species. Riboflavin is involved in the metabolism of carbohydrates, fats and proteins, presenting key role in the electron transport chain, the process of cellular respiration and in the process of obtaining energy from the cell, acting in the maintenance of the integrity of mucous membranes, skin, eyes and nervous system. Riboflavin deficiency results in changes in metabolism and pathological effect in various tissues in which the epidermis and the myelin sheath of axons are the most involved. The main clinical sign of riboflavin deficiency in young poultry is the curled toe paralysis. This paper aims to report the occurrence of a clinical case of riboflavin deficiency in a batch of commercial broiler chickens (Gallus gallus) fed exclusively with vegetable diet that had curled toe paralysis at four days of age. Following presumptive diagnosis, the batch was supplemented with 2.5 mg/kg of riboflavin in drinking water, and showed significant improvement some hours after the beginning of supplementation; 95% of the poultry recovered up to twelve days after supplementation and the remaining 5% had persistent clinical signs until slaughter.

Los micronutrientes desempeñan funciones bioquímicas específicas en los seres vivos, algunas de las cuales son fundamentales a la vida. Entre los micronutrientes, las vitaminas merecen atención por participaren como cofactores de reacciones metabólicas y permiten mayor eficiencia de los sistemas de síntesis en el organismo animal. Entre las vitaminas,nla riboflavina presenta algunas peculiaridades, especialmente para las aves, siendo probablemente la vitamina más limitanteb en esta especie. La riboflavina está implicada en el metabolismo de carbohidratos, grasas y proteínas, presentando papel importanteen la cadena de transporte de electrones, en el proceso de respiración celular y en el proceso de obtención de energía de la célula, actuando en el mantenimiento de la integridad de las membranas mucosas, piel, ojos y sistema nervioso. La deficiencia de riboflavina resulta en alteraciones en el metabolismo y efecto patológico en varios tejidos, siendo la epidermis y la vaina de mielina de los axones las más comprometidas. La principal señal clínica de la deficiencia de riboflavina en aves jóvenes es la parálisis de los dedos curvados. El estudio tiene como objetivo relatar la ocurrencia de un caso clínico de deficiencia de riboflavina en un lote comercial de pollos de engorde (Gallus gallus), alimentados exclusivamente con dieta de origen vegetal, que mostró parálisis de los dedos curvados en cuatro días de edad. Después del diagnóstico presuntivo, el lote fue suplementado con 2,5 mg / kg de riboflavina vía agua potable, y presentó mejora significativa horas después del inicio de la suplementación, donde 95% de las aves se recuperaron hasta los doce días pos suplementación y los 5% restante persistieron con señales clínicos hasta la matanza.

Nutritional Requirements for Growth of Agaricus brasiliensis / Requerimentos nutricionais para o crescimento micelial de Agaricus brasiliensis

The nutritional requirements of A. brasiliensis in culture media were assessed by supplementing a basal medium (g L-1): (glucose, 10, KH2PO4, 1, MgSO4.7H2O, 0.5, [NH4]2SO4, 1, pH 5.5) with CaCl2, trace elements (FeSO4.7H2O; MnCl2.4H2O; ZnSO4.7H2O; CuSO4.5H2O), casein, yeast extract, peptone, B-vitamins or amino acids. Evaluations were based on the mycelial growth in solid or liquid culture (mm day-1 or mg day-1) and visual analysis of the colony. The addition of CaCl2 and trace elements was very important for the major mycelial growth of the fungi. The addition of casein and inositol to the medium did not have a significant effect on growth. The best growth result in solid medium was obtained with the basal medium plus the addition of yeast extract and peptone. In relation to the other nutrient sources, the mycelial growth in the presence of amino acids darkened the medium after two weeks. The addition of B-vitamins to the basal medium lead to slower mycelial growth; however, growth was more visually dense when compared to other nutritional sources. B-vitamins added separately did not have the same result, suggesting that the fungus requires two or more vitamins at the same time for better mycelial growth.

Os requerimentos nutricionais de A. brasiliensis foram avaliados, com a suplementação de um meio basal (g L-1): (glicose, 10, KH2PO4, 1, MgSO4.7H2O, 0.5, [NH4]2SO4, 1, pH 5.5) com CaCl2, micronutrientes (FeSO4.7H2O; MnCl2.4H2O; ZnSO4.7H2O; CuSO4.5H2O), caseína, extrato de levedura, peptona, vitaminas do complexo B ou aminoácidos. O crescimento micelial foi avaliado em meio sólido e líquido, considerando velocidade de crescimento e produção de massa micelial (mm dia-1 ou mg dia-1) e análise visual da colônia. A adição de CaCl2 e micronutrientes foi muito importante para o melhor crescimento micelial do fungo, enquanto que a adição de caseina e inositol não apresentou efeito significativo sobre o crescimento. O melhor crescimento em meio sólido foi obtido quando o meio basal foi suplementado com extrato de levedura e peptona. Quando o fungo foi cultivado no meio basal suplementado com aminoácidos, observou-se um escurecimento do meio após duas semanas de cultivo. A adição de vitaminas proporcionou um crescimento micelial mais lento no meio sólido, entretanto, mais denso em relação ao meio suplementado com outros nutrientes. Quando as vitaminas do complexo B foram adicionadas separadamente não se observou o mesmo resultado, o que sugere que o fungo requer duas ou mais vitaminas no meio para melhorar o crescimento micelial.

Role of carnitine in cancer chemotherapy-induced multiple organ toxicity

In the last few years, cancer chemotherapy has been successfully employed in the treatment of different types of human tumours. Unfortunately, the optimal clinical usefulness of this important treatment modality is usually limited secondary to the development of life-threatening multiple organ toxicity. Cancer chemotherapy may cause these toxic effects by mechanisms not involved in their anticancer activity that can severely affect the life of patients and represent a direct cause of death. Several experimental and clinical studies have demonstrate that some important anticancer drugs interfere with the absorption, synthesis, and excretion of carnitine in non-tumour tissues, resulting in a secondary carnitine deficiency which is reversed by carnitine treatment without affecting anticancer therapeutic efficacy. Prototypes of anticancer drugs that alter carnitine system are doxorubicin, cisplatin, carboplatin, oxaliplatin, cyclophosphamide and ifosfamide. Furthermore, cachectic cancer patients are especially at risk for carnitine deficiency due to decreased oral intake and/or increased renal losses. Altered serum and urine carnitine levels have been reported in cancer patients with various forms of malignant diseases. Recent studies in our laboratory have demonstrated that carnitine deficiency constitute a risk factor and should be viewed as a mechanism during development of oxazaphosphorines-induced cardiotoxicity in rats. Similarly, inhibition of gene expression of heart fatty acid-binding protein and organic cation/carnitine transporter in doxorubicin cardiomyopathic rat model has been reported. In view of these facts and in view of irreplaceability of these important anticancer drugs, this review aimed to highlight the role of carnitine depletion and supplementation during development of chemotherapy-induced multiple organ toxicity

Hiper-homocisteinemia e risco cardiometabólico: [revisão] / Hyperhomocysteinemia and cardiometabolic risk: [review]

A hiper-homocisteinemia, quando considerada como fator causal de doenças vasculares, tem suscitado muitas discussões. Estudos caso-controle, retrospectivos e prospectivos têm identificado relação entre concentrações plasmáticas elevadas de homocisteína e doenças vasculares. Na presente revisão, objetivou-se compreender melhor a inter-relação entre as concentrações plasmáticas de homocisteína e doenças vasculares, além do envolvimento de fatores de risco clássicos para a doença: os genéticos, como as mutações em genes que codificam as enzimas envolvidas no metabolismo da homocisteína, e os nutricionais, como a deficiência de vitaminas do complexo B. Foram consultadas as publicações das principais bases de dados em saúde, no período de 1962 a 2009. O mecanismo pelo qual a hiper-homocisteinemia atua como fator de risco para doenças vasculares ainda não está totalmente esclarecido; entretanto, sugere-se o envolvimento da disfunção endotelial e da peroxidação lipídica. O tratamento da hiper-homocisteinemia fundamenta-se na suplementação alimentar e medicamentosa, com ácido fólico e vitaminas B6 e B12.

Hyperhomocysteinemia, when considered as a causal factor of vascular diseases, has been subject of much discussion. Case-control, retrospective and prospective studies have identified a relationship between high plasma concentrations of homocysteine and vascular disease. The aim of the present review was to better understand the interrelation between plasma concentrations of homocysteine and vascular diseases, as well as the involvement of classical risk factors for the disease: genetic factors, such as mutations in the genes that codify the enzymes involved in the metabolism of homocysteine, and nutritional factors, such as complex B vitamin deficiency. The publications of the main databases in health were consulted for the period 1962 to 2009. The mechanism by which hyperhomocysteinemia acts as a risk factor for vascular diseases still has not been fully clarified, but involvement of endothelial dysfunction and lipid peroxidation is suggested. The treatment of hyperhomocysteinemia is based on food supplements and medication, with folic acid and vitamins B6 and B12.

Chronic psychosis associated with vitamin B12 deficiency.

B12 deficiency is widely prevalent and usually presents with haematologic and neuropsychiatric manifestations. Psychiatric symptoms seldom precede anaemia and present as the principal manifestation of B12 deficiency. A report an unusual presentation of long standing psychotic symptoms without anaemia in a 31 year old male, who presented to a tertiary care psychiatric facility. His physical examination revealed hyper pigmentation of extremities and posterior column involvement. Laboratory investigations confirmed normal haemoglobin and low serum B12 levels. He recovered dramatically with short term anti psychotic medication and intramuscular cobalamin supplementation. He remained asymptomatic and functionally independent at two years follow up.

Biotin responsive limb weakness.

We report acute onset quadriplegia in a ten year old boy associated with basal ganglia lesions due to biotin deficiency. Prolonged raw egg consumption was identified as predisposing factor for biotin deficiency. Treatment with biotin resulted in remarkable recovery.

The effect of both protein and vitamin b complex deficiency on the morphoquantitative features of the myenteric plexus of the ascending colon of adult rats / Efeito da carência de proteínas e vitaminas do complexo b sobre aspectos morfoquantitativos do plexo mioentérico do colo ascendente de ratos adultos / Efecto de la carencia de proteínas y vitaminas del complejo b sobre aspectos morfo-cuantitativos del plexo mioentérico del regazo ascendiente en ratones adultos

O objetivo deste estudo foi estudar os efeitos da desnutrição protéica e da carência de vitaminas do complexo B sobre o plexo mioentérico do colo ascendente de Rattus norvegicus. Vinte ratos foram divididos em dois grupos, sendo que, para um dos grupos foi oferecida ração com teor protéico de 22% (controle) e, para outro, ração com teor protéico de 8% com menor teor de vitaminas do complexo B, durante 120 dias. Coramos os preparados de membrana do colo ascendente pelo método de Giemsa e pela técnica da NADH-diaforase. Os ratos desnutridos apresentaram peso corporal 14,8% menor que o grupo controle, média da área do colo 54,2% menor, e a média da densidade neuronal foi 26,7% maior com a técnica de Giemsa e 27% com a técnica da NADH-diaforase. Como a redução da área não foi acompanhada por um aumento inversamente proporcional na densidade de neurônios, sugere-se que a condição imposta causou perda de neurônios mioentéricos.

This study was performed in order to study the effects of protein desnutrition and vitamin B complex deficiency on the myenteric plexus of the ascending colon of Rattus norvegicus. Twenty rats were divided into two groups; one had been fed with a 22%-protein-level ration, and the other with a 8%-protein-level without vitamin-B-complex supplementation, for 120 days. The whole-amounts of the ascending colon were stained with either Giemsa or NADH-diaphorase technique. The disnurtured rats showed a 14.8% smaller body weight than the control group, and the area of colon of the sample group was 54.2% smaller. The average neuronal density was 26.7% greater with the Giemsa technique and 27% greater with the NADH-diaphorase technique. As the decrease in area was not accompanied by an inversely proportional increase in neuronal density, it is suggested that the experimental condition led to a myenteric neuron loss.

El objetivo de este estudio fue analisar los efectos de la desnutrición proteica y de la carencia de vitaminas del complejo B sobre el plexo mioentérico del regazo ascendiente de Rattus norvegicus. Veinte ratones fueron divididos en dos grupos, siendo que, para uno de los grupos se ofreció ración con contenido proteico de 22% (control) y, para el otro, ración con contenido proteico de 8% con menor contenido de vitaminas del complejo B, durante 120 días. Coloreamos los preparados de membrana del regazo ascendiente por el método de Giemsa y por la técnica de la NADH-diaforasis. Los ratones desnutridos presentaron peso corporal 14,8% menor que el grupo control, promedio del área del regazo de 54,2% menor, y el promedio de la densidad neuronal fue 26,7% mayor con la técnica de Giemsa y 27% con la técnica de la NADH-diaforasis. Como la reducción del área no fue acompañada por un aumento inversamente proporcional en la densidad de neuronas, se cree que la condición impuesta causó pérdida de neuronas mioentéricos.

Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India.

The study was undertaken to asses the impact of drought on childhood illnesses and nutrition in under five children of rural population using three stage sampling design. The study has been carried out in 24 villages belonging to 6 tehsils of Jodhpur district which was a drought affected desert district of Western Rajasthan in 2003. A total of 914 under five children (0-5 years) could be examined for their childhood illnesses, malnutrition, dietary intake and clinical signs of nutritional deficiency. Childhood illnesses observed at the time of drought were respiratory (7.5 %), gastroentrological (7.5%), and 5.6% fever (viral, malaria and jaundice), higher in males than females. Children suffered from recent and long term malnutrition were 39% and 26% respectively as per National Centre for Health Statistics (NCHS) standards. The extent of malnutrition was significantly higher in females than in males (p<0.01). Vitamin A & B complex deficiencies were 0.7% and 3/% respectively. The protein energy malnutrition (PEM) was observed in 44.4%. Overall mean calorie and protein intake deficit was observed to be very high (76.0 & 54.0 %). The comparison of present drought results with earlier studies in normal and drought conditions showed higher prevalence of PEM and deficiencies of calories & proteins in their diet. Respiratory, gastroentrological and fever were main childhood illnesses observed and were higher in males at the time of drought. PEM, vitamin A & B- complex deficiencies, anemia along with deficit in calories and proteins in their diet was observed higher in present study as compared to non desert areas, which may be due to the harsh environmental conditions in desert areas and paucity in the consumption of daily food intake. Due to inadequate consumption of daily food, the children were suffering from PEM resulting in several childhood illnesses. Effective measures making availability of adequate calories and proteins to all age groups especially to under five children through the ongoing nutrition programs needs to be ensured.

Sodium valproate -- induced skeletal myopathy.

The authors report a case of skeletal myopathy in a four-year-old boy on long-term sodium valproate therapy for secondary epilepsy due to neurocysticercosis. He presented with clinical features of limb girdle weakness. EMG revealed features of myopathy. Carnitine deficiency due to sodium valproate was suspected and plasma carnitine levels were found to be low. Sodium valproate was withdrawn. L-carnitine supplementation resulted in marked clinical recovery as well as rise in plasma carnitine levels.

Acido fólico y vitamina B12 en niños, adolesdentes y mujeres embarazadas en Venezuela / Folic acid and vitamin B12 in children, adolescents and pregnant women in Venezuela

Las consecuencias de la deficiencia de ácido fólico y vitamina B12 en el apropiado desarrollo y funcionamiento del organismo están bien documentadas. Este trabajo tiene como objetivo determinar la magnitud de la deficiencia de ácido fólico y vitamina B12 en grupos vulnerables, pertenecientes a los estratos socioeconómicos bajos (Graffar IV y V) en Venezuela. La muestra proviene de tres encuestas de Condiciones de Vida, cuyo trabajo de campo ejecutó Fundacredesa, entre los años 2001 y 2003 en 14 ciudades del país, en la Gran Caracas y en el Estado Vargas. Se procesaron 5658 muestras de suero y se determinó ácido fólico y vitamina B12 por radio inmuno ensayo, de infantes, niños, adolescentes y mujeres embarazadas de los estratos más pobres. La prevalencia de deficiencia de ácido fólico varió entre 27,5 a 81,79 por ciento en los diferentes grupos estudiados. La deficiencia de vitamina B12 en la muestra de las principales ciudades (Nacional) fue de 11,4 por ciento, pero existió también un porcentaje similar de exceso de vitamina B12 sérica. La prevalencia de deficiencia de ácido fólico y vitamina B12 en embarazadas de la Gran Caracas fue de 36,32 y 61,34 por ciento, respectivamente. La prevalencia de deficiencia de ácido fólico fue alta, especialmente en mujeres en edad reproductiva, adolescentes embarazadas y en la población estudiada en el Estado Vargas. Es perentorio que esta situación reciba una intervención inmediata, por medio de programas de suplementación a los grupos vulnerables y la ampliación del espectro de la fortificación de alimentos con este nutriente

Role of nutritional supplementation in reducing the levels of homocysteine.

Elevated plasma homocysteine level is a risk factor for atherosclerotic disease. Plasma homocysteine levels are influenced by genetic, physiological and lifestyle factors. Among the lifestyle factors, diet plays a significant role. Dietary intakes of folate, vitamins B12, B6 and B2 have been reported to be inversely related to plasma homocysteine concentration. Prevalence of subclinical deficiencies of these vitamins is high in Indian population. Folate status is the major determinant of plasma homocysteine level and there is a strong inverse correlationship between plasma homocysteine level and serum or erythrocyte folate levels. A combination therapy with B vitamins--folate, vitamins B12 and B6 is an effective means to reduce elevated homocysteine levels in general people and in patients with myocardial infarction. To maintain low plasma homocysteine concentration, people should be advised to increase their consumption of pulses, eggs, green leafy vegetables and fruits which are rich in B vitamins.

B vitamins, vitamin C and hematological measurements in overweight and obese Thais in Bangkok.

The dynamic changes of socio-economics leading to the industrialisation of countries are known to affect lifestyle and nutritional behaviours of the population. Review of the literature on the prevalence of obesity showed increasing numbers of the overweight and obese during the past decade. However, information on health and nutritional status of the obese in Thailand has not been widely publicized. This study reveals the vitamin status and hematological picture in 270 overweight and obese Thais in Bangkok, Thailand, compared with 175 normal subjects. No statistically significant differences in haemoglobin and hematocrit were observed in the overweight compared with the control subjects. The prevalence of anaemia was 9.8 per cent among male and 17.2 per cent among female overweight and obese subjects compared with 2.6 per cent and 21.2 per cent in male and female normal controls using the cut-off point of haemoglobin concentration as an indicator of anaemia. Prevalence of hypertension was exhibited in both male and female overweight and obese subjects. Even if there were no statistically significant differences in vitamin B1, B2 and B6 in overweight and obese subjects compared with the controls, high percentages of vitamin C and vitamin B2 deficiencies were observed. Vitamin B2 deficiency was detected in 19.7 per cent of overweight and obese males as well as in 28.7 per cent of overweight and obese females using glutathione reductase activity coefficient (alpha EGR) < 1.5 as the cut-off point. However, clinical signs of vitamin B2 deficiencies were rare. There was also a high percentage of vitamin C (antioxidant vitamin) deficiency in 51.5 per cent of the overweight and obese subjects and 41.7 per cent of the controls, respectively. The results suggest more attention should be paid to health study and nutritional problems for the overweight and obese population, especially concerning vitamins and oxidative stress. Further research is still needed in these aspects.