Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus.

Background/Objectives: Vitamin B12 deficiency can cause variable symptoms, which may be irreversible if not diagnosed and treated in a timely manner. We aimed to develop a widely accepted expert consensus to guide the practice of diagnosing and treating B12 deficiency. Methods: We conducted a scoping review of the literature published in PubMed since January 2003. Data were used to design a two-round Delphi survey to study the level of consensus among 42 experts. Results: The panelists agreed on the need for educational and organizational changes in the current medical practices for diagnosing and treating B12 deficiency. Recognition of clinical symptoms should receive the highest priority in establishing the diagnosis. There is agreement that the serum B12 concentration is useful as a screening marker and methylmalonic acid or homocysteine can support the diagnosis. Patient lifestyle, disease history, and medications can provide clues to the cause of B12 deficiency. Regardless of the cause of the deficiency, initial treatment with parenteral B12 was regarded as the first choice for patients with acute and severe manifestations of B12 deficiency. The use of high-dose oral B12 at different frequencies may be considered for long-term treatment. Prophylactic B12 supplementation should be considered for specific high-risk groups. Conclusions: There is a consensus that clinical symptoms need to receive more attention in establishing the diagnosis of B12 deficiency. B12 laboratory markers can support the diagnosis. The severity of clinical symptoms, the causes of B12 deficiency, and the treatment goals govern decisions regarding the route and dose of B12 therapy.

Role of metformin in the initiation of pharmacotherapy for type 2 diabetes: an Asian-Pacific perspective.

Increases in the prevalence of type 2 diabetes of 30-60% will occur in many Asian-Pacific countries by 2025, driven by urbanisation, sedentary habits and energy-rich diets. Obesity, insulin resistance, metabolic syndrome and diabetes are closely interrelated. Optimal control of diabetes and associated risk factors has reduced the risk of diabetes-related complications. In the UK Prospective Diabetes Study (UKPDS), metformin reduced the risk of macrovascular complications and retrospective analyses have confirmed the efficacy of metformin in improving clinical outcomes in type 2 diabetic patients with a history of cardiovascular disease. This growing body of evidence has led to the recommendation of metformin as optimum initial pharmacotherapy in overweight type 2 diabetic patients. Obesity is less prevalent in the Asian-Pacific population than in Caucasian populations. Nevertheless, metformin has multiple beneficial metabolic effects, which provide sufficient rationale for it to be recommended as the initial oral anti-diabetic pharmacotherapy, alone or in combination, irrespective of body mass index. This recommendation is consistent with global guidelines and regional recommendations for the Asian-Pacific region from the International Diabetes Federation. These recommendations can serve as templates for development of local guidelines for Asian people with diabetes, given the ethnic and cultural diversity within the region.

The factual status of diabetes mellitus – glucoza tolerant declining, related factors and hospital management status in Hanoi city

A survery was conducted on 1069 subjects aged 20- 74 years old(male 47%, female 53%) living in Ha Noi, concerning the diabetes status. Results showed no difference in term of genders but geographically, in urban areas the prevalence was 2 times higher than in the suburb. The number of diabetes patients of under secondary level were 21 times higher than the higher level. Among the hand worker, the prevalence was lower than in sedentary workers. The prevalence was also low in the intellectuals.

A More evidence confirming the state of iodine deficiency in Mekong Delta

Iodine concentrations of water samples, vegetable samples and soil samples in Kien Thanh commune (KT) – Cho Moi district – An Giang province were compared with those of Duyen Ha commune (DH) – Thanh Tri district – Ha Noi city. Iodine intake of KT people was about 60 mg daily. 70.1% of urine samples had low iodine concentration. Iodine concentration in water, soil and vegetable in both communes were in the low range and had statistically significant differences. In ND, mean iodine concentration in the soil was lower than in DH (2.63530 mg/kg vs 3.0360 mg/kg). In the water iodine mean concentration was lower in KT than in DH (0.00127 mg/kg vs 0.00173 mg/kg) and in vegetable 0.96100 mg/kg vs 1.15770 mg/kg respectively

Study on the eddects of "Tru ngua B" tablets in the model of allergic contact dermatitis

“Antiitchy B” tablets were processed from herbal medicines including prepared Rchmannia glutinosa, Angelica sinensis, Paeonia lactiflora, Salvia miltiorrhiza, Glycyrrhiza uralensis, and Sophora flavescens, plus shells of Ostrea gigas and Ketotifen. Experimental study carried on mice with allergic contact dermatitis showed that “antiitchy B” tablets significantly inhibited dinitrofluobenzene induced allergic inflammation in mice ears epidermis

Influence of nutrition al habit and physical activities on the disturbance of sugar metabolism

Research on 1060 people who from 20 to 74 years old live in Hanoi. 47% of them was man and 53% was woman. Result: eating and drinking habit has importance effect to the development of diabetes disease. People who eat much fat, drink much beer and eat little vegetable have higher risk of suffering diabetes to use little fat, don’t drink beer and smoke tobacco, and eat more vegetable. People who live in city eat vegetable, fruit and smoke less than suburban but they drink beer much than suburban. Body activity has close relation to the disease condition

The effects of Luu Hoang (sulphur)

Luu Hoang with its yellow colour, spongy consistency, sour taste, toxicity, can infultrate inward through the medians of kidney and large bowel. Oral use of Luu Hoang can tossify the “fire”, assiste the “yang”. Topic use can detoxicate, kill the parasite, treat the pimples, Luu Hoang abates the itch in cases of scale, fungi on skin, eczema. Luu Hoang is used in the conditions of boil, the cold in kidney, coldish impaired “yang”, coldish secretion, difficulty in faces exerete and urinate. Oral use of 1-3 g in powder and pill, topic use with powder spreaded in the wound… are the most common methods. Counter indications are in the cases of impaired “iin”, exceeded “fire”, pregnancy, and incompatible with Phac Tieu