Pseudotumor cerebral asociado a hipovitaminosis A, B6 y D: A propósito de dos casos / Pseudotumor cerebri associated with hypovitaminosis A, B6 and D: About two cases

La hipertensión endocraneana idiopàtica se asocia infrecuentemente con la hipovitaminosis A y D. Se presenta el caso de una paciente femenina de 8 años con visión borrosa de 24 horas y papiledema bilateral. Resonancia magnética nuclear normal. Presión de apertura de líquido cefalorraquídeo: 260 mm^O. Presentó déficit de vitamina A y D, e inició un tratamiento sustitutivo. El segundo caso corresponde a un paciente masculino de 12 años con fiebre y odinofagia de 3 días. Con antecedente de glomerulonefritis y sobrepeso. Presentaba edema bipalpebral y papiledema. Tomografia axial computada de la órbita: aumento de líquido en la vaina de ambos nervios ópticos. Resonancia magnética nuclear: aracnoidocele intraselar. Presión de apertura de líquido cefalorraquídeo: 400 mm^O. Presentó déficit de vitamina D y B6, e inició el tratamiento sustitutivo. La elevación de la presión intracraneal desencadena mecanismos de compensación que, al fallar, pueden comprometer la vida o provocar graves discapacidades neurológicas. Reconocer la causa para un enfoque terapéutico preciso es clave para disminuir la morbimortalidad asociada a esta patología.

Idiopathic endocranial hypertension is infrequently associated with hypovitaminosis A and D. The case of an 8-year-old female with 24-hour blurred vision and bilateral papilledema is presented. Nuclear magnetic resonance was normal. Opening pressure of cerebrospinal fluid: 260 mm^O. She presented vitamin A and D deficiency and started replacement therapy. The second case corresponds to a 12-year-old male with fever and odynophagia of 3 days. History of glomerulonephritis and overweight. He had bipalpebral edema and papilledema. Computed tomography scan of the orbit: increase of fluid in the sheath of both optic nerves. Nuclear magnetic resonance: intrasellar arachnoidocele. Opening pressure of cerebrospinal fluid: 400 mmH2O. He presented vitamin D and B6 deficiency and started replacement treatment. The elevation of intracranial pressure triggers compensation mechanisms that, when they fail, can compromise life or cause serious neurological disabilities. Recognizing the cause for an accurate therapeutic approach is key to reduce the morbidity and mortality associated with this pathology.

Sensory Polyneuropathy Associated with Pyridoxine Overdose

Pyridoxine deficiency and excess have both been implicated as causes of peripheral neuropathy. A 74-year-old man presented with paresthesia in both legs that first appeared 2 months previously. A nerve conduction study revealed axonal sensory polyneuropathy. He had consumed 100 milligrams of pyridoxine every day for 1 year, in the form of vitamin tablets. His blood levels of vitamin B6 were markedly elevated to above 250 nmol/L. This case indicates that the consumption of high-dose pyridoxine can cause sensory polyneuropathy.

Evaluation of vitamin B6 intake and status of 20- to 64-year-old Koreans

BACKGROUND/OBJECTIVES: Recent research regarding vitamin B6 status including biochemical index is limited. Thus, this study estimated intakes and major food sources of vitamin B6; determined plasma pyridoxal 5'-phosphate (PLP); and assessed vitamin B6 status of Korean adults. MATERIALS/METHODS: Three consecutive 24-h diet recalls and fasting blood samples were collected from healthy 20- to 64-year-old adults (n = 254) living in the Seoul metropolitan area, cities of Kwangju and Gumi, Korea. Vitamin B6 intake and plasma PLP were analyzed by gender and by vitamin B6 supplementation. Pearson's correlation coefficient was used to determine associations of vitamin B6 intake and plasma PLP. RESULTS: The mean dietary and total (dietary plus supplemental) vitamin B6 intake was 1.94 +/- 0.64 and 2.41 +/- 1.45 mg/day, respectively. Median (50th percentile) dietary intake of men and women was 2.062 and 1.706 mg/day. Foods from plant sources provided 70.61% of dietary vitamin B6 intake. Only 6.3% of subjects consumed total vitamin B6 less than Estimated Average Requirements. Plasma PLP concentration of all subjects was 40.03 +/- 23.71 nmol/L. The concentration of users of vitamin B6 supplements was significantly higher than that of nonusers (P < 0.001). Approximately 16% of Korean adults had PLP levels < 20 nmol/L, indicating a biochemical deficiency of vitamin B6, while 19.7% had marginal vitamin B6 status. Plasma PLP concentration showed positive correlation with total vitamin B6 intake (r = 0.40984, P < 0.0001). CONCLUSIONS: In this study, vitamin B6 intake of Korean adults was generally adequate. However, one-third of subjects had vitamin B6 deficiency or marginal status. Therefore, in some adults in Korea, consumption of vitamin B6-rich food sources should be encouraged.

A Study on Premenstrual Syndrome (PMS), Nutrient Intake, Psychological Index according to the Obesity Degree of College Women / 대한지역사회영양학회지

This study was designed to compare the incidence and severity of premenstrual syndrome (PMS) between normal (N = 85) and overweight or obese (N = 28) college female students and investigated correlation between PMS, nutrient intake, hematological index and psychological index (depression, anxiety, stress). Each subject was asked a Menstrual Discomfort Questionnaire (MDQ) for PMS by 5 Likert scale. The PMS scores of women in the normal weight subjects ranked in order of severity were water retention (2.71), followed by behavioral change (2.58), negative affect (2.46), pain (2.31), autonomic reaction (2.27), decreased concentration (2.16). The symptoms of 'pain' and 'behavioral change' of overweight or obese subject were significantly higher than those of normal subject (p < 0.05). And total cholesterol concentration of overweight or obese subjects was significantly higher than in normal subject (p < 0.05). There was a significant positive correlation (p < 0.05) between the symptoms of 'negative effect' and BMI. And the triglyceride concentration was positively related with 'water retention (p < 0.01)'. The symptoms of 'decreased concentration' were negatively correlated with calcium (p < 0.01) and vitamin B6 intake (p < 0.05). The depression score were positively related with symptoms of 'behavioral change (p < 0.05)', 'negative affect' (p < 0.01), and the anxiety score was positively correlated with 'behavioral change (p < 0.05)' and 'decreased concentration (p < 0.05)'. The stress score was positively correlated with 'decreased concentration (p < 0.01)', 'behavioral change (p < 0.05)' and 'negative affect (p < 0.05)'. This suggests that PMS represents the clinical manifestation of a calcium, vitamin B6 deficiency and psychological disorder. Therefore we concluded that nutrient supplementation, depression and stress management may help to relieve PMS symptoms.

High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi

Effect of vitamin B6 deficiency on antioxidative status in rats with exercise-induced oxidative stress

This study investigated the effect of vitamin B6 deficiency on antioxidant enzyme activities and lipid profile in rats with exercise-induced oxidative stress. Forty eight rats were fed either a vitamin B6 deficient diet (B6-) or a control diet (control) for 4 weeks and then subdivided into 3 groups: pre-exercise (PreE); post-exercise (PostE); recess after exercise (recessE). Compared to those of control group, plasma catalase and hepatic cytosol superoxide dismutase (SOD, EC 1.15.1.1) activities of B6- group were lower regardless of exercise. The ratio of reduced glutathione/oxidized glutathione (GSH/GSSG) of B6- group was lower in PreE and there was no difference between PostE and recessE. The level of malondialdehyde (MDA) of B6- was significantly higher in PreE and PostE. High-density lipoprotein-cholesterol (HDL-C) level of B6- group was lower regardless of exercise. Atherosclerotic index of B6- group was higher in PreE and there was no difference between PostE and recessE. It is suggested that a reduction in antioxidative status caused by vitamin B6 deficiency may be aggravated under exercise-induced oxidative stress.

Folic acid and vitamin B[6] deficiencies related hyperhomocysteinemia in apparently healthy Pakistani adults; is mass micronutrient supplementation indicated in this population?

To determine the plasma/serum levels of homocysteine, and vitamins folate, B6 and B12, in Pakistani healthy adults. Cross-sectional study. The Aga Khan University, from October 2006 to April 2008. Fasting levels of plasma/serum folic acid, pyridoxal phosphate [PLP], vitamin B12 and homocysteine were determined in 290 apparently healthy hospital personnel from institutions in two cities of Pakistan. Spearman correlation test and linear regression analysis was conducted. There were 219 males and 71 females with mean age of 46 +/- 10.5 years and mean body mass index of 23.5 +/- 3.8. Mean plasma homocysteine levels in Pakistani normal adults were found to be 17.95 +/- 8.4 mol/l. Mean concentrations of plasma/serum folate, vitamin B12 and PLP were found to be 5 +/- 3.9 ng/ml, 522 +/- 296 pg/ml and 21.6 +/- 14 nmol/l, respectively. Serum/plasma levels of folate, vitamin B12 and PLP were negatively correlated with plasma homocysteine [rho coefficient=-0.367, p < 0.001; -0.173, p=0.004; -0.185, p=0.002, respectively]. Serum folate and plasma PLP levels were inversely related with plasma homocysteine, adjusted for gender, age, smoking and body mass index [p < 0.001 and p=0.003, respectively]. Percent deficiency values of folate, vitamin B6 and vitamin B12 were 39.7%, 52.8% and 6.6% respectively. The high levels of plasma homocysteine could indicate a reason for mass micronutrient supplementation to prevent the high incidence of cardiovascular disease observed in Pakistani population

Effect of pyridoxine deficiency on the structural and functional development of hippocampus.

In this study it was attempted to understand the effect of pyridoxine deficiency on the structural and functional development of the hippocampus. Hippocampus has been closely associated with complex neuroendocrine control of physiological activities as well as behavioural responses including learning process and memory retention. Prenatal, preweanling and weanling deficiency of pyridoxine was induced in the experimental rats by feeding dams with diet deficient in pyridoxine during pregnancy and lactation. The general growth profile for pyridoxine deficient (PD) rats is compared with control ones. The structural changes in the hippocampus of pyridoxine deficient rats was investigated using the histological techniques. Hippocampal electrical activity was recorded from in vitro brain slice preparation. The study clearly showed the structural impairment in the hippocampus of PD rats. These anatomic anomalies might be related to poor neurointegrative development and neurophysiological deficits that occur in young one. The electrical activity recorded from hippocampal slices of PD rats showed significant variation when compared to controls. Pyridoxine deficiency is common in pregnant women who used anovulatory steroids before pregnancy. The pyridoxine deficiency of the mother may result in permanent behavioural abnormality and intellectual deficit in the progeny.

Pyridoxine-dependent seizures: a review.

Pyridoxine-dependent seizure is a rare autosomal recessive disorder that usually presents with neonatal intractable seizures. This syndrome results from an inborn abnormality of the enzyme glutamic acid decarboxylase, which results in reduced pyridazine-dependent synthesis of the inhibitory neurotransmitter gamma amino butyric acid. The full range of symptomatology is unknown; but can be associated with autism, breath holding and severe mental retardation, bilious vomiting, transient visual agnosia, severe articulatory apraxia motor dyspraxia, microcephaly and intrauterine seizures. Parenteral pyridine injection test is a highly effective and reproducible test in confirming the diagnosis. Pyridoxine should be administered as a diagnostic test in all cases of convulsive disorders of infancy in which no other diagnosis is evident. Epileptic seizure discharges subside within 2-6 minutes after the intravenous injection of 50-100 mg of pyridaoxine. Once the diagnosis is confirmed, maintenance therapy should be continued indefinitely and doses increased with age or intercurrent illnesses. The maintenance dose of Bg needed is still not clear. There is a relatively wide range for the daily B6 dose necessary to control the seizure i.e., 10-200 mg/day.

Vitamin B1, B2 and B6 deficiency in primary school children infected with hookworm.

One thousand and seven hundred thirty-six school children from two districts in Nakhon Si Thammarat Province were screened for hookworm infection using the Kato-Katz stool examination technic. Two hundred students who have at least 2,000 eggs per g of stool were recruited into the program. The students were divided into six groups: groups 1, 2 and 3 were from Tha Sala district while groups 4, 5 and 6 were from Ronpibul district. Three milliliter blood samples were obtained from the cubital vein of each subject and were evaluated for erythrocyte transketolase activity (ETK) for vitamin B1, erythrocyte glutathione oxidoreductase activity (EGR) for vitamin B2, and erythrocyte aspartate aminotransferase activity (EAST) for vitamin B6. The school children were divided into three groups: those infected only with hookworm, those with both hookworm and Trichuris trichiura, and those whose stools show no parasite eggs. The results show that 10-20% of the school children are vitamin B1 deficient, about 40% to 80% are vitamin B2 deficient, and about 14% to 23% are vitamin B6 deficient. No correlation could be made between vitamin deficiencies and parasitic infection.

Responsabilidade do fator hemodinâmico na gênese da síndrome do túnel do carpo nos pacientes hemodialisados / Haemodynamic factor responsibility in the genesis of the carpal tunnel syndrome in haemodialyzed patients

A patologia esquelética representa uma complicaçäo importante no paciente dialisado a longo prazo, sendo numerosas as síndromes clínico-radiológicas de osteoartropatia com ela relacionadas. Entre essas, a síndrome de túnel do carpo é, sem dúvida, a mais importante e frequente. Muitos fatores säo mencionados como responsáveis na gênese da CTS no paciente dialisado crônico. Tendo presente o problema etiopatogênico, até hoje discutido, e considerando alguns dados clínicos verificados em 80 pacientes tratados na Divisäo de Cirurgia Plástica, iniciou-se um estudo com a finalidade de evidenciar o possível papel patogênico do fator hemodinâmico na gênese da síndrome do túnel do carpo no paciente hemodialisado. Os autores, com base nos resultados de um estudo retrospectivo, realizaram um estudo controlado, evidenciando o papel do fator hemodinâmico na gênese da síndrome do túnel do carpo no paciente hemodialisado. Os autores, com base nos resultados de um estudo retrospectivo, realizaram um estudo controlado, evidenciando o papel do fator hemodinâmico sobre os agentes etiológicos, no sentido de facilitar a determinaçäo da síndrome do túnel do carpo

Effect of pyridoxine deficiency on maturation of neuromotor coordinations.

In the present study the effect of preweaning pyridoxine deficiency indicates that the body weight and brain weight of pyridoxine deficient rats were significantly lower when compared to the control rats. Onset and stabilisation of reflex reactions were also delayed in the pyridoxine deficient rats. Maturation of neuromotor coordination in the vitamin deficient group was significantly slow as compared to the control groups. This suggests that the importance of maternal pyridoxine supplementation cannot be overlooked in pregnant women especially after prolonged use of anovulatory steroids.

Restoration of tissue antioxidants and prevention of renal stone deposition in vitamin B6 deficient rats fed with vitamin E or methionine.

Observed loss in body weight gain, increased lipid peroxidation reaction, decreased concentrations of antioxidants, ascorbic acid, alpha-tocopherol and reduced glutathione and antioxidant enzymes, glutathione peroxidase and catalase and increased concentration of hydroperoxides and hydroxyl radicals in vitamin B6 deficient rat liver [J Nutri Biochem, 2 (1991) 245] and kidney [Biochem International, 21 (1991) 599] were nearly normalized on feeding with vitamin E or methionine. Accumulation of oxalate and calcium during vitamin B6 deficiency was abolished by feeding vitamin E or methionine. Calcium oxalate deposition observed in vitamin B6 deficient kidney was completely prevented when fed along with vitamin E or methionine. However the hyperoxaluria and hypercalciuria persisted even after feeding with vitamin E or methionine.

Nutritional status of institutionalized elderly in south Florida

To assess the nutritional status of an elderly nursing home population of South Florida, forty-seven persons with ages ranging from 65 to 96 years were studied. Complete clinical examination and anthropometric measures were performed, along with blood cell count, biochemical blood parameters and assessment of water-soluble vitamins levels. The most common clinical finding were edentulous (67%), general pallor (44%), hyperpigmentation (33%), dry skin (26%) and arcus corneitis (26%). Thirty-five percent of the studied population had cholesterol levels greater than 220 mg/dl. Triglyceride levels were also significantly elevated in a considerable subset of our subjects, with 30% having levels above threshold value of 150 mg/dl. Small proportions of subjects showed low levels of albumin (6%), total protein (28%), ascorbic acid (2%), and thiamin (9%). Forty-five percent of males were pyridoxine deficient, while 63% of the females presented such deficiency. This study underscores the need to define, with greater precision, the nutritional status of aged populations as well as improve our inadequate standards associated with the normal aging process. Nutritional intervention--only possible when appropriate standards are defined--can potentially serve not only to prevent the occurrence of significant morbidity and mortality, but can also be employed to enhance quality of life in the elderly individuals

Vitamin B1, B2 and B6 status of vegetarians.

The vitamin B1, B2 and B6 status was determined in 132 healthy vegetarians, age range 25-57 years who have been practising vegetarianism for 1-22 years. Sixty-eight healthy non-vegetarians were chosen as controls. The conventional methods to measure the activation coefficient alpha ETK, alpha EGR and alpha EAST were applied to assess the vitamin status of B1, B2 and B6 respectively. The value of 1.25 alpha ETK, 1.5 alpha EGR and 2.0 alpha EAST and above indicate a deficiency in the vitamin status. The results showed significantly poorer vitamin B1 and B6 status in vegetarians than in non-vegetarians, whereas, no significant difference in vitamin B2 status was found. None of the non-vegetarians were deficient in vitamin B1 but 3 of them (4.4%) were deficient in vitamin B6. On the other hand, 10 of vegetarians (7.6%) were deficient in vitamin B1; 38 (28.8%) in vitamin B6. A high prevalence of riboflavin deficiency was found in 32 (24.2%) of the vegetarians; as well as in 15 (22.2%) of the non-vegetarians. Only riboflavin status was significantly related with the duration of vegetarianism practiced. Vegetarians should be considered as the vulnerable group for vitamin B2 and vitamin B6 deficiencies. B-vitamins status should be checked and efforts should be made to improve through dietary counselling and nutritional education should be included and stress in the health education program in order to improve nutritional deficiencies.

Effect of riboflavin or pyridoxine deficiency on inflammatory response.

Inflammatory response has been assessed in riboflavin or pyridoxine deficient rats. Edema was increased by 54% in pyridoxine deficiency as compared to weight-matched control rats. Food restriction per se reduced the volume of edema by 63%. In pyridoxine deficiency, concentrations of thiobarbituric acid reactive substances (which indicate the extent of lipid peroxidation) increase by 30 and 43% respectively in the edematous tissues of the paw as well as in the wounded skin. Both these parameters were not affected by riboflavin deficiency. Activities of NADPH oxidase and superoxide dismutase in elicited leukocytes from peritoneal cavity were reduced by 54 and 52%, respectively, in riboflavin deficiency but were unaltered in pyridoxine deficiency. Superoxide level and acid phosphatase activity were not influenced by either of the deficiencies, whereas hydrogen peroxide level was increased by 48% in riboflavin deficiency. Food restriction did not affect leukocyte enzymes or the levels of reduced oxygen species. The data suggest that inflammation is enhanced in pyridoxine deficiency but not in riboflavin deficiency.