Comparative analysis of vitamin B 12 levels and effects of its deficiency in selected adult population diagnosed with various clinical conditions

Back ground: vitamin B12 deficiency has been associated with various clinical conditions and co-morbidities however none of the individual symptom, or group of symptoms could be ascertaining directly to its declined status. Mostly older population is affected and documented causes of deficiency are hematologic or neurological, followed by gastrointestinal and a possible altered vascular symptoms

Aim: the present prospective observational study was initiated to compare analytical levels of vitamin B12 and evaluation of underlying clinical condition and symptoms associated with possible vitamin B12 deficiencies. Materials and Methods: The study was prospective observational and carried out for the assessment period of 1st January 2000 till 30th Dec 2010. After two years of assessment, 290 patients [males, n = 156 and females, n = 134] were inducted in the study and finalized during the period 1st January 2002 to 30th December 2009. Age ranges were from 16 to 70 years, and categorized in two groups as > 60 yrs. and < 60 years. Several blood parameters [serum folate, B12, CBC, LDH, creatinine, Hb] were analyzed by standardized methods on automated analyzers

Results and Conclusion: vitamin B12 deficiency was found to be more prevalent in females and when compared with other groups the percentage increased up to 58.20% in individuals with vitamin B12 <150 pg/ml. The most common condition was malnourishment followed by anemia [n = 75; 46.01 %] and weakness [n = 55, 33. 74%] as the more frequent clinical findings. Other clinical conditions were neuropsychiatric, whereas less frequent findings were paresthesia and gastrointestinal symptoms. Moreover, hypertension was more prevalent in vitamin B12 deficient individuals followed by diabetes, dementia, stroke, ischemic heart disease and Parkinson's disease

Short title: vitamin B12 deficiency in clinical conditions

Tumor markers: chemistry, diagnostic utility and prognostic significance: a review

According to National Cancer Institute [NCI-NIH-USA], tumor markers are substances that are produced by cancer or by other cells of the body in response to cancer or certain benign [noncancerous] conditions. Most tumor markers are made by normal cells as well as by cancer cells; however, they are produced at much higher levels in cancerous conditions. These substances can be found in the blood, urine, stool, tumor tissue, or other tissues or bodily fluids of some patients with cancer1. Most tumor markers are proteins. However, more recently, patterns of and changes to DNA have also begun to be used as tumor markers. Markers of the latter type are assessed in tumor tissue specifically

A detailed information available on the website of NCI-NIH that so far more than 20 different tumor markers have been characterized and are in clinical use. Some are associated with only one type of cancer, whereas others are associated with two or more cancer types. There is no "universal" tumor marker that can detect any type of cancer [NCI-NIH-USA, accessed 3/13/2013]

There are some limitations to the use of tumor markers. Sometimes, noncancerous conditions can cause the levels of certain tumor markers to increase. In addition, not everyone with a particular type of cancer will have a higher level of a tumor marker associated with that cancer. Moreover, tumor markers have not been identified for every type of cancer [1, NCI-NIH-USA, accessed 3/13/2013]. The present review details the chemistry, structure, diagnostic and prognostic utilities of 7 tumor makers including CA 27.29, CEA, CA 19.9, AFP, CA 125, PSA and CA 15-3 for current information and upgrading regarding its usefulness and significance in disease evaluation, progression and treatments. The information provided below gathered mainly through PubMed search engine of nearly 300 articles from year 2000 to 2013, Wikipedia, cancer related sites and American Family Physician journal [2003/vol 68,, Perkins et al. , 2003]

Determination of neuron specific enolase [NSE] in small cell lung carcinoma [SCLC] and non-small cell lung carcinoma [NSCLC] patients

Neuron specific enolase [NSE] is routinely used as tumor marker in Small cell lung carcinoma [SCLC], and to some extent in non-small cell lung carcinoma [NSCLC]. In Pakistan, tumor marker technology is not a new one. It is however mostly directed towards uses in hepatic, breast, ovarian, uterine and colorectal cancers, whereas availability and general practice of its use for diagnosis of respiratory metastasizing disease such as lung cancer is seldom and rare, especially the SCLC/NSCLC specific NSE. The aim of present study is to determine the potential usefulness of NSE in diagnosis and prognosis of SCLC and NSCLC patients in our setting. Fifty-eight patients of lung cancer were identified and selected, between January 2004 to December 2007, and divided into various groups depending upon their clinical stage of disease. NSE level was determined in all patients and clinical history data and related pathophysiological components of all selected patients were carefully assessed and compulsorily followed to avoid any bias. Cancer status of patients were evaluated by data available from multiple bronchoscopies, X rays, cytology and histopathology examinations and grouped as SCLC with all five stages [I, II, IIIA, IIIB and IV] and NSCLC with only stage IV. NSE level was also determined in Healthy subjects and patients with non-malignant lung diseases [NMLD] for comparison. We observed significant elevation in levels in NSE for different stages of SCLC and NSCLC in comparison with healthy and NMLD groups. Most significant increase was noted in SCLC stage IV not only in comparison with healthy [P <0.001] and NMLD groups [P < 0.001] but also with stage I [P <0.001] within the group. Elevated difference in NSE levels was also correlated with stage II, IIIA and IIIB of SCLC group. As regard NSCLC, where patients belonged only to stage IV of disease, significant difference was observed with healthy [P <0.01] when compared with NSCLC, whereas non-significant difference in NSE levels was noted in group-SCLC stage II, IIIA and IIIB. In comparison, all stage IV patients [n=7] of SCLC exhibited higher levels of NSE with a range of 136.19 ng/ml to 175.01 ng/ml, higher than detected in patents of stage IV in NSCLC. The result of our study suggests that NSE appears to be a useful tumor marker for SCLC and to some extent, NSCLC. Moreover, NSE exhibits higher levels in some stages of SCLC suggesting, its specificity, not only for advanced stage of SCLC but also for SCLC in general as compared to NSCLC. Its determination, therefore, is beneficial in the diagnosis, treatment and a possible follow-up for patients survival

Evaluation of Carcino-embryonic antigen [CEA] and diagnostic significance in adult patients suffering from Colorectal Carcinoma [CRC] and GIT malignancies

Carcinoembryonic antigen [CEA] is a classic tumor marker for CRC, and has been used to monitor CRC recurrence and as a prognostic factor for CRC patients. The CEA molecule is an onco-development human tumor marker and bears the cluster differentiation designation of CD66e. It has a molecular weight of 180 kDa. Due to considerable clinical merit of CEA for diagnosis, prognosis and treatment, a study was carried out to assess its levels in patients suspected of or diagnosed with GIT cancers, with special reference to colorectal carcinoma [CRC]. A total of 106 patients, 71 [66.98%] males and 35 [33.01%] females, were included in the study with age range of 46 to 79 years. Out of 71 males, 33 [46.47%] have malignant conditions and exhibited elevated levels of CEA whereas 38 have non-malignant complications with normal or non-significant CEA concentrations. The malignant conditions in males [n = 33] are sub-grouped and were determined to be pancreatic [n = 2, 6.06%], gastric [n = 10, 30.30%], colorectal [n = 18, 54.54%] and hepatic [n = 3, 9.09%] cancers. Furthermore, in female group of 35 patients, 15 [42.85%] were diagnosed with malignant condition of pancreatic [n = 1; 6.66%], gastric [n = 5; 33.33%], colorectal [n = 7; 46.66%] and hepatic [n = 2; 13.335] cancers and exhibited elevated levels of CEA. In present study all malignant conditions, either metastasizing or not, showed significantly elevated levels of CEA. In male-malignant cancer patents' groups, average CEA values were 102.20 40 ng/ml, 298.40 21 ng/ml, 451.65 16 ng/ml and 176.10 5 ng/ml for pancreatic, gastric, colorectal and hepatic cancers, respectively. Similarly in females elevated levels of CEA were noted in pancreatic [99 ng/ml], gastric [169.25 22 ng/ml] CRC [441.15 16 ng/ml] and hepatic [128.54 20 ng/ml]. At present, serial CEA-monitoring is considered the best non-invasive technique for detecting CRC and its recurrence. It is also substantiated that intensive follow-up CEA assays facilitate the identification of treatable recurrence at an early stage

Evaluation of vitamin B12 and folic acid deficiencies in selective middle aged and elderly male and female patients

Significant prevalence of vitamin B12 and folate deficiencies supported by biochemical evidence has been reported in the world. It was indicated that these biochemical evidences are associated with prevalence of anaemia in elderly. The major reasons of vitamin deficiencies, especially that of B-12, was reported to be inadequate dietary intake and, in the elderly, malabsorption of the vitamin from food. Vitamin deficiencies especially that of B-12 are usually diagnosed on the basis of serum or plasma vitamin concentrations. Due to dilemma of management and diagnoses of mal-nutrition and vitamin deficiencies in elderly population, the present study was undertaken to ascertain vitamin B12, folate and RBC folate status in selected middle aged and elderly male and female patients. A total of 132 patients [period March 2004 to November 2007], were selected according to gender and age. For males [n = 72]; age groups were 50-60, 61-70, 71-80 yrs and greater than 80 yrs and for females [n = 60]; age groups were 52-61, 62-69, 70-79 and greater than 80 yrs. The results clearly depicts that elderly patients in both gender between the age groups of 71 and greater than 80 had significantly low vitamin concentrations [p < 0.001] than the middle age groups of 61 to 70 [P < 0.01]. Correspondingly, their hemoglobin levels were also relates to the overall picture of either normal or low concentrations of vitamins in all groups. In males the lowest concentration of 3.5 ng/ml for folate, Vitamin B12 of 228 pg/ml and 168 ng/ml for RBC folate were observed in > 80 years group preceded by 6.2 ng/ml, 278 pg/ml and 170 ng/ml respectively, in 71 to 80 years group, whereas in females, the observations were 2.5 ng/ml for folate, 220 pg/ml for B12 and 110 ng/ml for RBC folate concentrations in > 80 years age group of patients. In conclusion few management strategies were suggested for therapy of vitamin deficient older patients

Assessment of lipoprotein abnormalities in diabetic and non-diabetic patients with hyperlipidemia

Background: Hyperlipoproteinaemia is a metabolic abnormal condition and is largely regulated by Apolipoproteins types and subtypes. Moreover, lipoprotein abnormalities contribute significantly to the risk of developing cardio vascular disease and diabetes. Additionally, abnormal glycemic state, lipid and lipoprotein abnormalities have also been shown to contribute in early atherosclerosis

Objectives: Our present study evaluates the status of apolipo-protein A and B in hyperlipidemic patients with both diabetic and non-diabetic conditions

Methods: Study period was May 2006 to Dec 2007. 63 patients of both gender [males = 36, females = 27] sub-grouped as n = 46 non-diabetic hyperlipidemic [NDHL] and n = 17 diabetic hyperlipidemic [DHL] patients were included in the study. All parameters were determined with standard methods on IVD instruments with recommended pathological and normal controls

Results: Total cholesterol and Apo B was noted to be significantly higher in DHL than NDHL patients. Moreover, levels of Apo B was higher than Apo A in both DHL and NDHL groups when compared with Healthy group. Elevated levels of triglyceride and total cholesterol in both DHL and NDHL groups depicts a strong hyperlipidemic state

Conclusion: Conclusion were drawn from present study that diabetes and hyperlipidemia are important risk factors, in addition to the fact that higher levels of Apo B and A and that of higher Apo B than Apo A are indicative of dyslipidemic state and thus significant parameters for assessing the prevailing conditions and extent of risk for developing coronary heart disease [CHD] and atherosclerosis

Diagnostic importance of neuron specific enolase [NSE] in pleural effusion from patients with malign

Background: Several past and recent investigations have focused on the detection and use of reliable tumor markers, such as CEA, NSE and CYFRA 21-1 in pleural fluids, as a less invasive replacement method. Some studies have dealt with the NSE levels of pleural fluid in diseases such as NSCLC, SCLC and benign pulmonary disease such as tuberculosis

Aim: Therefore the present study was undertaken to assess NSE levels in serum and pleural fluid of patients with pulmonary cancer and to compare the data with NSE levels of tuberculosis pleurisy to determine its diagnostic utility and efficacy

Materials and Methods: Pleural fluids were obtained from 13 patients with carcinomatous pleurisy due to SCLC, 6 patients with carcinomatous pleurisy due to non-small cell lung cancer, and 29 patients with tuberculosis pleurisy for comparison purpose. Determination of NSE levels was performed by ECL technology according to the manufacturerAEuro[™]s instructions

Results: NSE results of cytology-positive SCLC were significantly elevated [P<0.001] when compared with those of cytology-negative SCLC, NSCLC and tuberculosis. Pleural effusion of all 29 tuberculosis patients and two NSCLC patients showed moderate significance [P<0.05 and P<0.01, respectively] as compared to SCLC patients

Conclusion: It is concluded that determination of pleural fluid NSE levels seems to be an effective means to differentiate carcinomatous pleurisy due to SCLC from that of due to NSCLC, tuberculosis pleurisy and cytology-negative pleural effusions in SCLC. However, it is suggested that further studies with larger group of patients is needed to strengthen diagnostic specificity and sensitivity

Determination of urinary protein to creatinine ratio as a predictor of renal insuffeciency and end-stage renal disease

Renal failure occurs as a consequence of the loss of important homeostatic regulation that the kidneys provide. Moreover, end-stage renal disease [ESRD] and the resulting uremic syndrome may caused by a wide variety of factors such as chronic glomerulonephritis, chronic pyelonephritis, immunological diseases, hypertension, and toxic and ischemic damage to kidneys. It is reported that in patients with various renal diseases, reducing urinary protein excretion [proteinuria] slows the rate of decline in the glomerular filtration rate [GFR]. Analyses have also shown a strong correlation between the degree of proteinuria and the rate of progression of renal failure. It has been observed 'that in patients with chronic proteinuric nephropathies, the ratio of protein to creatinine predicted the rate of decline in GFR and the progression to ESRD. Several research studies have suggested that patients with a urinary protein: creatinine [P:C] ratio of less than 1.0 had slow pace of renal anomalies with no ESRD where as those with a ratio of 1.0 or greater than 1.0 had decrease in GFR and a higher risk of ESRD. The presented study includes the data of assessment of urinary: creatinine ratio in patients with renal disease such as ARF, CRF. It was observed that those with P:C ratio greater than 1.0 were undergoing dialysis and a decline in renal functions relates to rise in P:C ratio and subsequent manifestation of ESRD

Cyclosporine induced nephrotoxicity in renal transplant recipients: clinical significance of fractional excretion of sodium, potassium and magnesium

Evaluation of fractional excretion of Sodium, Potassium and Magnesium as indicators of cyclosporine [CsA] toxicity in de-novo renal transplant recipients. A prospective study was conducted on 59 live related renal allograft recipients. Fractional excretion [FE] of sodium [Na[+]], potassium [K+] and magnesium [Mg[2+]] were calculated on day 1,3, 5 and 10 post transplant. Graft dysfunctions were evaluated by colour-doppler, CsA levels and renal biopsy. Normal ranges were determined on 30 healthy subjects. The mean creatinine on dayl was 3.1 + 1.3 mg/dl and declined to 1.6+1.2 on daylO. FE of Na[+], K[+] ; and Mg[2+] were 12+9%, 34+20% and 13+10% respectively on day 1 and reduced to 2.2+2%, 11+14% and 11+14% on day 10. Of the 59 recipients, 38 [64%] had uneventful recovery [group A], 21[36%] had graft dysfunction [6 acute rejection [group B] and 15 either acute tubular necrosis or high CsA [group C]]. In group A, on dayl, FENa+, FEK+ and FEMg[2+] were 5+4%, 24+12% and 6.6+3% respectively and these declined to 1.2+0.6%, 4.6+0.7% and 6+3% respectively on day 10. Compared to group A, group C had significantly high values on day 1, FENa[+] 1 5+8%, FEK+ 36+24% and FEMg[2+] 21 + 10% [p<0.0001] and on day 10, FENa[+] 3.7+ 2.7%, FEK+ 20+15% and FEMg[2+] 15+8% [p<0.05]. In the group B, day 1 and day10 levels were FENa[+] 6+3%, FEK[+]26+13% and FEMg[2+] 7+2.8% and FENa[+] 1.2+0.7%, FEK+ 4.2+0.5%, FEMg[2+] 7+4% respectively. CsA levels and AUC did not correlate with CsA toxicity. FE of magnesium is a useful marker of CsA toxicity independent of CsA blood levels. FE studies can supplement renal biopsy findings