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Indian Journal of Pediatrics Oct 2023To define the vitamin B12 levels and other micronutrients status in severe acute malnutrition (SAM) children.
OBJECTIVES
To define the vitamin B12 levels and other micronutrients status in severe acute malnutrition (SAM) children.
METHODS
This was a prospective hospital based cross-sectional study.
INCLUSION CRITERIA
Children with severe acute malnutrition as per WHO criteria.
EXCLUSION CRITERIA
(i) Pernicious anemia (ii) Autoimmune gastritis (iii) SAM children on exclusive vitamin B12 supplementation. All enrolled children underwent a detailed clinical history, general physical examination with more emphasis on clinical features of vitamin B12 and other micronutrients deficiencies. Three ml of venous blood was collected to estimate vitamin B12 and other micronutrients. Primary outcome was percentage of deficiency of serum vitamin B12, zinc, copper, selenium, manganese, molybdenum and cobalt in SAM children.
RESULTS
Fifty children were included in the study. The mean age of children was 15.60±12.90 mo with male to female ratio 0.85:1. The common clinical presentation in order of frequency were upper respiratory infection (URI) symptoms 35 (70%), hepatomegaly 24 (48%), Hyperpigmentation 17 (34%), angular cheilitis 14 (28%), tremors 11 (22%), edema 07 (14%), and hypotonia 05 (10%). Anemia was found in 44 (88%) children. Prevalence of vitamin B12 deficiency was 34%. Other micronutrient deficiencies observed were cobalt 24 (100%), copper 05 (12%), zinc 04 (9.5%), and molybdenum 03 (12.5%). No statistical significance was found between clinical symptoms and levels of vitamin B12 with different age and sex.
CONCLUSIONS
Prevalence of low vitamin B12 and cobalt were more common than other micronutrients.
Topics: Child; Humans; Male; Female; Copper; Zinc; Selenium; Vitamin B 12; Manganese; Molybdenum; Cobalt; Cross-Sectional Studies; Prospective Studies; Malnutrition; Micronutrients; Severe Acute Malnutrition; Prevalence
PubMed: 37142858
DOI: 10.1007/s12098-023-04520-0 -
Zhonghua Gan Zang Bing Za Zhi =... Feb 2023
Topics: Humans; Portasystemic Shunt, Transjugular Intrahepatic; Hypertension, Portal; Esophageal and Gastric Varices; Jaundice; Treatment Outcome
PubMed: 37137835
DOI: 10.3760/cma.j.cn501113-20220502-00235 -
The Journal of the Association of... Jan 2023Prevalence of vitamin B12 deficiency is occasionally found to be coexisting in patients with hypothyroidism causing persistence of symptoms concomitant to both diseases...
INTRODUCTION
Prevalence of vitamin B12 deficiency is occasionally found to be coexisting in patients with hypothyroidism causing persistence of symptoms concomitant to both diseases even on adequate thyroxine supplementation.
MATERIALS
A single-centric non-interventional cross sectional study was carried over a period of 1 year. 100 hypothyroid patients were evaluated for prevalence of anemia, and investigated for the etiology. Serum Vitamin B12 was obtained and an association was studied between Vitamin B12 and anti TPO and anti Thyroglobulin antibodies. Here, vitamin B12 deficiency was defined as <160 pg/mL.
RESULT
Among 100 hypothyroid patients, 31% were males and 69% were females. The mean age of patients was 36.09±12.864 years. 68% patients were found to be Vitamin B12 deficient, and 73.5% of this deficient population were females. 78.6% patients with raised Anti TPO antibodies had vitamin B12 deficiency (p-value = 0.01), while 78% patients with raised Anti Thyroglobulin antibodies were vitamin B12 deficient (p-value = 0.07). The Pearson correlation coefficient (r) was -0.302 (p = 0.002) and -0.253 (p = 0.011) between Vitamin B12 anti anti TPO and anti Thyroglobulin antibodies respectively, thus showing a negative correlation between both.
CONCLUSION
Thyroid hormones affect erythropoiesis, thus causing anemia in a deficient condition. In iodine sufficient areas, most common cause of hypothyroidism is autoimmune, predisposing individuals to other autoimmune diseases, one being pernicious anemia. In the studied anemic hypothyroid population, Vitamin B12 deficiency was found correlated with raised levels of serum anti-TPO and anti-Thyroglobulin antibodies. Supplementation of B12 may alleviate hypothyroid symptoms, thus making itself a novel addition in the routine hypothyroid prescription. References Aon M, Taha S, Mahfouz K, et al. Vitamin B12 (cobalamin) deficiency in overt and subclinical primary hypothyroidism. Clin Med Insights Endocrinol Diabetes 2022;15:11795514221086634. Ness-Abramof R, Nabriski DA, Shapiro MS, et al. Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci;332(3):119-122.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Cross-Sectional Studies; Tertiary Healthcare; Hypothyroidism; Vitamin B 12 Deficiency; Vitamin B 12; Anemia; Hospitals, Teaching
PubMed: 37116022
DOI: No ID Found -
The Journal of the Association of... Jan 2023Autoimmune polyendocrine syndrome (APS) type II (Schmidt's syndrome) is defined by the coexistence of autoimmune Addison's disease with autoimmune thyroid disease and/or...
INTRODUCTION
Autoimmune polyendocrine syndrome (APS) type II (Schmidt's syndrome) is defined by the coexistence of autoimmune Addison's disease with autoimmune thyroid disease and/or type 1 diabetes mellitus. Patients also present with other organ specific autoimmune disorders like hypergonodotropic hypogonadism, vitiligo, chronic atrophic gastritis, pernicious anaemia, autoimmune chronic hepatitis and celiac disease. Many circulating organ-specific antibodies directed against endocrine organs.
MATERIALS
A 40 year old female presented to the casualty with multiple episodes of vomiting and giddiness. Patient known case of hypothyroidism since past 4 years but was not on medications recently 1 month back patient was started on Thyroxine supplementation. History of menopause 8 years back present (premature). On examination patient had cold clammy extremity with signs of dehydration. Hyperpigmentation of face and gums was noted. PR -120/min thready pulse BP- 70/50 mmhg. Blood pressure was stabilised with fluid resuscitation. On investigation hyponatremia with hyperkalemia was present. In view of adrenal insufficiency co-syntropin stimulation test was done which came in favour of PRIMARY ADRENAL INSUFFICIENCY. TSH > 100 and anti TPO was positive suggesting AUTOIMMUNE THYROIDITIS. FSH was elevated and estradiol was reduced in favour of HYPERGONADOTROPIC HYPOGONADISM.ANA IF was positive. Therefore diagnosis of APS type 2 was made and appropriate substitution therapy was initiated.
RESULT
Autoimmune endocrine gland disorders may regularly coexist with other endocrine autoimmune diseases. Neufeld and Blizzard organized and classified these clinical conditions and defined them as polyglandular autoimmune diseases or autoimmune polyendocrine syndromes (APS). Oegle first reported the association between Addison's disease, caused by bilateral tuberculous destruction of the adrenal glands, and diabetes mellitus in 1886. Schmidt's excisional biopsy detected lymphocytic infiltration of the adrenal cortex and thyroid gland in a patient who died from adrenal insufficiency in 1926. From that time, the coexistence of Addison's disease and autoimmune thyroid disease has been known as Schmidt's syndrome. APS II typically occurs in early adulthood with a peak onset during the third or fourth decades and is three times more common in females than in males.
CONCLUSION
Autoimmune poly glandular syndrome can be treated with respective substitution therapy. Thyroxine therapy when initiated first may precipitate Addisonian crisis in patients with Schmidt's syndrome through increasing cortisol clearance and metabolic rate as evident in our case. Early detection of the disease and appropriate management may reduce morbidity and mortality significantly in the patients with autoimmune poly glandular syndrome.
Topics: Male; Female; Humans; Adult; Polyendocrinopathies, Autoimmune; Addison Disease; Thyroxine; Syndrome; Thyroiditis, Autoimmune; Hashimoto Disease; Diabetes Mellitus, Type 2
PubMed: 37116019
DOI: No ID Found -
MedRxiv : the Preprint Server For... Mar 2023Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive enzymatic disorder, particularly prevalent in Africa, Asia and the Middle East. In the US,...
BACKGROUND
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive enzymatic disorder, particularly prevalent in Africa, Asia and the Middle East. In the US, about 14% of black men are affected. Individuals with G6PD deficiency are often asymptomatic but may develop hemolysis following an infection or upon consumption of specific medications. Despite some evidence that G6PD deficiency affects the immune system, the long- term health risks associated with G6PD deficiency had not been studied in a large population.
METHODS
In this retrospective cohort study, health records from G6PD deficient individuals were compared to matched controls in a national healthcare provider in Israel (Leumit Health Services). Rates of infectious diseases, allergic conditions and autoimmune disorders were compared between groups.
RESULTS
The cohort included 7,473 G6PD deficient subjects (68.7% men) matched with 29,892 control subjects (4:1 ratio) of the same age, gender, socioeconomic status and ethnic group, followed during 14.3±6.2 years.Significantly increased rates for autoimmune disorders, infectious diseases and allergic conditions were observed throughout this period. Notable increases were observed for rheumatoid arthritis (OR 2.41, p<0.001), systemic lupus erythematosus (OR 4.56, p<0.001), scleroderma (OR 6.87, p<0.001), pernicious anemia (OR=18.70, P<0.001), fibromyalgia (OR 1.98, p<0.001), Graves' disease (OR 1.46, P=0.001), and Hashimoto's thyroiditis (OR 1.26, P=0.001). These findings were corroborated with elevated rates of positive autoimmune serology and higher rates of treatment with medications commonly used to treat autoimmune conditions in the G6PD deficient group.
CONCLUSION
G6PD deficient individuals suffer from higher rates of autoimmune disorders, infectious diseases, and allergic conditions.
PubMed: 37090544
DOI: 10.1101/2023.03.23.23287616 -
The American Journal of Tropical... Jun 2023Prior to the understanding of malaria as a parasitic disease, malaria cachexia was a loosely defined syndrome consisting of severe anemia and splenomegaly in a...
Prior to the understanding of malaria as a parasitic disease, malaria cachexia was a loosely defined syndrome consisting of severe anemia and splenomegaly in a chronically wasted individual living in a malarious area. Entire rural populations in diverse areas such as the Thames estuary, Marseilles marshes, and the Mississippi valley were said to have cachexia on the basis of chronic malaria "poisoning," which accounted for their poor socioeconomic health. Malaria cachexia appeared to disappear as the marshes were drained, agriculture improved, and quinine or iron treatments were administered. Malaria cachexia's association with plasmodia in the blood was uncertain once blood smears were examined in the twentieth century. Modern studies have raised the question of chronic Plasmodium vivax in the spleen as a possible etiology; historical specimens could be examined to clarify malaria cachexia.
Topics: Humans; Plasmodium vivax; Malaria, Vivax; Cachexia; Malaria; Plasmodium
PubMed: 37068752
DOI: 10.4269/ajtmh.22-0761 -
Journal of Clinical Medicine Mar 2023Vitamin B12 (cobalamin CBL) is a water-soluble vitamin required to form hematopoietic cells (red blood cells, white blood cells, and platelets). It is involved in the...
BACKGROUND
Vitamin B12 (cobalamin CBL) is a water-soluble vitamin required to form hematopoietic cells (red blood cells, white blood cells, and platelets). It is involved in the process of synthesizing DNA and myelin sheath. Deficiencies of vitamin B12 and/or folate can cause megaloblastic anemia (macrocytic anemia with other features due to impaired cell division). Pancytopenia is a less frequent exordium of severe vitamin B12 deficiency. Vitamin B12 deficiency can also cause neuropsychiatric findings. In addition to correcting the deficiency, an essential aspect of management is determining the underlying cause because the need for additional testing, the duration of therapy, and the route of administration may differ depending on the underlying cause.
METHODS
Here, we present a series of four patients hospitalized for megaloblastic anemia (MA) in pancytopenia. All patients diagnosed with MA were studied for a clinic-hematological and etiological profile.
RESULTS
All the patients presented with pancytopenia and megaloblastic anemia. Vitamin B12 deficiency was documented in 100% of cases. There was no correlation between the severity of anemia and deficiency of the vitamin. Overt clinical neuropathy was present in none of the cases of MA, while subclinical neuropathy was seen in one case. The etiology of vitamin B12 deficiency was pernicious anemia in two cases and low food intake in the remaining cases.
CONCLUSION
This case study emphasizes the role of vitamin B12 deficiency as a leading cause of pancytopenia among adults.
PubMed: 36902847
DOI: 10.3390/jcm12052059 -
Journal of Gastroenterology Mar 2023The Japanese diagnostic criteria for autoimmune gastritis (AIG) were established by the "Study Group on the establishment of diagnostic criteria for type A gastritis,"...
The Japanese diagnostic criteria for autoimmune gastritis (AIG) were established by the "Study Group on the establishment of diagnostic criteria for type A gastritis," which is related to a workshop associated with the Japan Gastroenterological Endoscopy Society (JGES) and the Committee of AIG Research Group (CARP). The criteria were set as follows: the cases of confirmed diagnosis are patients in whom either the endoscopic or histological findings, or both, meet the requirements for AIG and who are confirmed to be positive for gastric autoantibodies (either anti-parietal cell or anti-intrinsic factor antibodies, or both). The presentation of endoscopic findings of early-stage AIG in the diagnostic criteria was withheld owing to the need for further accumulation and characterization of endoscopic clinical data. Therefore, diagnosis of early-stage AIG only requires histological confirmation and gastric autoantibody positivity. Suspected cases are patients in whom either the endoscopic or histological findings, or both, meet only the requirements for AIG. Histological findings only meet the requirements for early stage. AIG has been underdiagnosed in the past, but our study group's newly proposed diagnostic criteria will enable a more accurate and early diagnosis of AIG. The criteria can be used to stratify patients into various high-risk groups for gastric tumors and pernicious anemia. They would allow the establishment of an appropriate surveillance system in the coming years. Nevertheless, issues such as establishing the endoscopic findings of early-stage AIG and obtaining Japanese insurance coverage for gastric autoantibody tests require attention.
Topics: Humans; Autoimmune Diseases; Japan; Gastritis; Autoantibodies; Endoscopy
PubMed: 36855000
DOI: 10.1007/s00535-022-01954-9 -
Molecular and Clinical Oncology Mar 2023Gastric cancer (GC) ranks fifth on the list of the most common malignancies worldwide. In Peru, gastric neoplasms are considered the second leading cause of mortality...
Gastric cancer (GC) ranks fifth on the list of the most common malignancies worldwide. In Peru, gastric neoplasms are considered the second leading cause of mortality among males. Among the molecular subgroups of GC, microsatellite instability presents a favorable prognosis due to its hypermutated phenotype, which activates immunosurveillance. The present study describes the case of a 75-year-old patient, who was admitted in the hospital with a history of upper gastrointestinal bleeding and recurrent hospital admission, due to severe anemia. The patient presented with pale skin, normal vital functions, slight swelling of the lower extremities, and abdominal distention and bloating upon a physical examination. An endoscopic examination revealed an infiltrating circular ulcerated lesion. The histopathological analysis identified a moderately differentiated intestinal-type adenocarcinoma with pathological stage T3N0M0. Tumor genomic profiling demonstrated alterations in 15 different genes with a tumor mutational burden of 28 mutations/Mb. Finally, the patient underwent a partial gastrectomy without pre-operative chemotherapy. After 4 days, the patient presented with post-operative complications for which he was re-operated on. The patient did not survive. To the best of our knowledge, in the present case, pernicious anemia was an early sign of GC and a gastroscopy had to be performed. Furthermore, MutS homolog 3 alterations probably conditioned the presence of multiple frame-shift mutations.
PubMed: 36798468
DOI: 10.3892/mco.2023.2612