Abstract T P377: Vitamin B12 Deficiency - A Poorly Recognised and Treatable Childhood Stroke Risk Factor

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Zarah Yusuf ◽  
Jayanthi Alamelu ◽  
Ming Lim ◽  
Nomazulu Dlamini
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Vitamin B12 ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Care Hospital ◽  
Childhood Stroke ◽  
Stroke Risk Factor ◽  
B12 Deficiency ◽  
Age Range

Introduction: Risk factors in childhood stroke are multiple and causality hard to determine. Current guidelines recommend prothrombotic workup, yet yield is variable, often without therapeutic consequence. Raised homocysteine is associated with vitamin B12 deficiency (B12), which is not routinely measured. Hypothesis: We hypothesised that B12 deficiency is a treatable risk factor for stroke in children not reliably identified by analysis of homocysteine only. Method: We retrospectively reviewed paediatric stroke patients admitted to a tertiary care hospital from 2010-2014. All patients with plasma homocysteine measured as part of their prothrombotic workup were selected. All clinical data closest to stroke diagnosis were reviewed. B12 deficiency was defined as low total and/or holo (functional) vitamin B12 with/without raised methylmalonic acid (MMA). Parental prothrombotic workup and B12 status was analysed where available. Results: Of 134 patients, 61 had homocysteine levels, 20 were tested for vitamin B12 (age range 0-14.8 years), 14/20 for MMA. B12 deficiency was found in 7/20 with median age of acute stroke presentation of 1 day (25th percentile= 0; 75th percentile= 51days). Median age of stroke presentation in B12 replete group was 3.5 years (25th percentile=2.0;75th percentile=7.0years). There was a statistical difference in age of stroke presentation between the B12 deficient and replete groups (Kruskal-Wallis, p=0.001). Raised homocysteine (10/20) was not sensitive in detecting B12 deficiency (sensitivity 42.8%, 95% CI 15.82-74.95). Two of seven had additional risk factors (1/7 iron deficiency, 1/7 MTHFR 667 homozygous). Seizures were the most common stroke presentation regardless of B12 status. Vitamin B12 (im) was given in 4/7 children and 3/9 parents (2 mothers, 1 father). Five of seven were breast fed. All treated parents were vegetarian. Conclusion: Our study suggests vitamin B12 deficiency is associated with early childhood stroke. Homocysteine alone is not a sensitive screen for this. Investigation with functional biomarkers such as holo B12 and MMA would allow for improved detection of a treatable risk factor in childhood stroke. Further studies may support this recommendation being added to guidelines.

scholarly journals Prevalence and Correlates of Vitamin B12 Deficiency among Depressive Patients Presenting in the Tertiary Care Hospital of Gandaki Province of Nepal

2020 ◽  
Vol 4 (3) ◽  
pp. 822-825
Author(s):  
Jai Bahadur Khattri ◽  
Srijana Thapa Godar ◽  
Anil Subedi
Keyword(s):  
Vitamin B12 ◽  
Tertiary Care ◽  
Geographical Area ◽  
Vitamin B12 Deficiency ◽  
Demographic Variables ◽  
Care Hospital ◽  
B12 Deficiency ◽  
Depressive Episodes ◽  
Depressive Patients

Introduction: The prevalence of vitamin B12 deficiency in depression is not clear and more research is needed. Objectives: The objective of this study is to find the prevalence of deficiency of vitamin B12 level in the depressed patient. The second objective is to find the prevalence of deficiency of vitamin B12 according to different socio-demographic variables. Methodology: The patients diagnosed as depressive episodes according to the International Classification of Disease – 10 Classification of Mental and Behavioural Disorders were selected from the Psychiatric Out-Patient Department of Manipal Teaching Hospital, Pokhara.  The proforma was used to collect the socio-demographic profile of the patient. The serum sample of the 50 patients was sent for vitamin B12 estimation. Serum concentrations less than 239 pg/ml was considered deficient in this study. Results: The overall prevalence of vitamin B12 deficiency was 22% in the depressed patients. The mean age of the total patients were 39.2 years with the standard deviation of 13.75 years. Vitamin B12 deficiency was more prevalent in the socio-demographic variables like age above 61 years, Brahmin and Chhetri caste, female gender, unmarried groups, and in the patients living in the urban area as compared to other variables. Conclusion: The result shows that vitamin B12 deficiency is common in the patients with depression. Clinicians should be aware of the risk for vitamin B12 deficiency in depressive patients.  As this study was done in limited geographical area and sample size being small, further larger studies are needed before generalizing these results.

scholarly journals Clinicohematological profile of pancytopenia: a study from a tertiary care hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 478
Author(s):  
Rakesh Kumar Yadav ◽  
Sujit Kumar
Keyword(s):  
Vitamin B12 ◽  
Tertiary Care Hospital ◽  
Megaloblastic Anemia ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Clinical Feature ◽  
Study Group ◽  
Care Hospital ◽  
Female Ratio ◽  
B12 Deficiency

Background: Pancytopenia is common clinical condition which we encounter in our daily clinical practice. Pancytopenia is characterized by decrease in all the three major components of blood like Red Blood Corpuscles, White blood Corpuscle, and platelets. This study was carried out to look for causes of pancytopenia and clinical presentations at tertiary care hospital in north India.Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between June 2018 to July 2019. Total 125 patients who attended department of medicine were screened for study. After exclusion 94 patients were studied prospectively.Results: Out of 94 patients 59 were males, and 35 females in the study group. Male to female ratio was 1.6:1. Maximum patients were between 20 years to 35years of age group. Pallor and weakness were most common clinical feature in this study group. Out of various etiological causes vitamin B12 deficiency was the commonest in our study. 48(51%) patients had megaloblastic anemia due to vitamin B12 deficiency. Second most common etiological factor was hypo plastic/aplastic anemia. Other etiological abnormalities were hypersplenism, dengue, malaria, sepsis, myelodysplastic syndrome and multiple myeloma.Conclusions: Bone marrow examinations, aspiration cytology or biopsy are important tool for diagnosis of pancytopenia. Underlying cause and severity of disease determine the outcome of pancytopenia. The present study concluded that most of patients with pancytopenia have treatable cause so early diagnosis will be helpful for management of patients.

scholarly journals Profile of Vitamin B12 Deficiency and Analysis of Contributory Factors among Inpatients in a Tertiary Care Hospital in Madurai, South India

2020 ◽  
Vol 7 (46) ◽  
pp. 2674-2679
Author(s):  
Vairapraveena Ramesh ◽  
Sangeetha Ashokan ◽  
Anu Sengottaiyan ◽  
Vijay Anto James
Keyword(s):  
Vitamin B12 ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Cooking Methods ◽  
Care Hospital ◽  
Contributing Factors ◽  
History Of ◽  
B12 Deficiency

BACKGROUND It is well known that Vitamin B12 deficiency is common among vegetarians as Vitamin B12 is obtained predominantly from animal sources. However, recent reports show that Vitamin B12 deficiency is becoming more common among nonvegetarians too and surprisingly the major factor attributing to this is found to be due to dietary deficiency. We hypothesized that this could also be due to the type of non-vegetarian food consumed, cooking methods, type of utensil used, and other modifiable risk factors like smoking, alcohol and diseases causing Vitamin B12 deficiency. We wanted to assess the proportion of vegetarians and nonvegetarians with vit. B12 deficiency and analyse the contributing factors among inpatients with vitamin B12 deficiency in a tertiary care hospital in South India. METHODS This observational, prospective study was done between June and September 2019 & involved 200 Vitamin B12 deficiency patients in the age group of 20 - 50 years of both the genders. Patients were identified after reviewing their medical records and laboratory tests for MCV, MCH, MCHC, Hb & vitamin B12. A detailed history of their food habits, practices & other relevant factors was obtained using a questionnaire. Statistical analysis was done using Mann Whitney U test. RESULTS There was no statistical difference (p = 0.379) in the vitamin B12 levels among vegetarians and non-vegetarians. 54.6 % of participants consumed poultry, 32.5 % consumed fruits & vegetables less than 4 times a week, 36 % & 42 % consumed fried & boiled food, 58 % used ever-silver vessels for cooking, 70.6 % used packaged milk, 23 % consumed alcohol & 21 % were smokers. CONCLUSIONS Vitamin B12 deficiency is common both among vegetarians and non-vegetarians. Among non-vegetarians, deficiency is seen more with poultry eaters, packaged milk consumers, with fried / boiled method of cooking using ever-silver vessels. Alcoholism, caffeinated beverages, smoking, presence of other diseases like diabetes, hypertension, peptic ulcer, drug intake also contributes to Vitamin B12 deficiency. KEYWORDS Vitamin B12 Deficiency, Non-Vegetarians, Vegetarians, Contributing Factors

scholarly journals Vitamin B12 deficiency in psychiatric patients admitted in a tertiary care hospital

2020 ◽  
Vol 4 (2) ◽  
pp. 196
Author(s):  
Sunayna Pandey ◽  
NimeshC Parikh ◽  
HarshJ Oza ◽  
ShreyaseeS Bhowmick
Keyword(s):  
Vitamin B12 ◽  
Tertiary Care Hospital ◽  
Psychiatric Patients ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Care Hospital ◽  
B12 Deficiency

scholarly journals Prevalence of vitamin D and B12 deficiency in pregnant women in Jammu, India

2020 ◽  
Vol 8 (4) ◽  
pp. 1245
Author(s):  
Sapneet Kaur ◽  
Harleen Kaur
Keyword(s):  
Vitamin D ◽  
Vitamin B12 ◽  
Pregnant Women ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Care Hospital ◽  
Jammu And Kashmir ◽  
Vitamin D Levels ◽  
Good Nutrition ◽  
B12 Deficiency

Background: Micronutrient deficiency is pandemic proportions among pregnant women in India, but there is scarcity of searchable data on  coexistence vitamin D status  and Vitamin B 12 in pregnant women in Jammu and Kashmir, hence we have assessed the vitamin D as well as Vitamin B12 status in pregnant women attending outpatient department in a tertiary care hospital Jammu.Methods: The study was conducted in the department of Biochemistry Government Medical College Jammu during June 2019 to February, 2020 and after obtaining informed consent, a total of 150 pregnant women, attending SMGS Hospital Jammu were screened for their vitamin D (25 OH-D) and vitamin B12 status by using Abbott architect chemiluminescent micro particle immunoassay.Results: A total of 150 pregnant women were  screened in the study , 129 (86%) were found to be having insufficient vitamin D levels in their blood (<30 ngm/dl) and 105 ( 70%)  women showed severe deficiency with vitamin D levels below 20 ngm/dl.108 (72%) pregnant women had vitamin B12 deficiency with levels below 200 pgm/ml.Conclusions: The study revealed a high prevalence of coexistence of Vitamin D and Vitamin B12 deficiency in pregnant women, despite of abundant sunshine throughout the year and also with the consideration that people of this region are well off economically and can afford good nutrition.

scholarly journals Correlation of Vit B12 levels with metformin usage among type 2 diabetic patients in a tertiary care hospital

2018 ◽  
Vol 5 (5) ◽  
pp. 1128 ◽  
Author(s):  
Vishnu A. Nareddy ◽  
Indeevar P. Boddikuri ◽  
Shaik K. Ubedullah ◽  
Abhinaya Papareddy ◽  
Manoj Kumar Miriyam
Keyword(s):  
Vitamin B12 ◽  
Financial Burden ◽  
Microvascular Complications ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Health Concern ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Study Results ◽  
B12 Deficiency

Background: T2DM is a metabolic disorder that is increasingly becoming a public health concern. The disease is associated with a variety of systemic macrovascular and microvascular complications. Diabetic peripheral neuropathy (DPN) is the most common complication, and it may eventually develop in up to 50% of patients. It is assumed that prolonged use of metformin causes vitamin B12 deficiency. The clinical presentation of vitamin B12 deficiency generally includes haematological and neurological manifestations. The aim of the study is to correlate vit b12 levels in relation to duration of usage of metformin for a period of more than 1 year.Methods: The study was conducted from November 2017 to June 2018 for a period of 7 months which included 50 subjects from both sex groups, aged 18 years and above, on metformin with subjective evidence of neuropathy and compared with vit b12 levels.Results: The study results indicate that there is no significant drop in vit b12 levels in metformin users in significant proportions to cause vitb12 deficient-neuropathy. The p value being 0.658 comparing vit b12 with metformin usage years (<2 yrs, 2-5yrs, 5-8yrs, ≥8yrs).Conclusions: This cross-sectional study indicates that diabetic patients who were on metformin were not having any vit b12 deficiency, though all patients had subjective neuropathy. This suggests that neuropathy is not related to metformin induced Vit B12 deficiency. Therefore, prescribing of vit b12 supplementation in any long term metformin treated patients is no longer necessary and reduces patients financial burden.

Increased monocyte to HDL cholesterol ratio in vitamin B12 deficiency: is it related to cardiometabolic risk?

2020 ◽  
pp. 1-8
Author(s):  
Sanem Kayhan ◽  
Nazli Gulsoy Kirnap ◽  
Mercan Tastemur
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Uric Acid ◽  
Vitamin B12 ◽  
Cardiometabolic Risk ◽  
Vitamin B12 Deficiency ◽  
Left Ventricular ◽  
Cardiometabolic Risk Factors ◽  
B12 Deficiency ◽  
Deficiency Group

Abstract. Vitamin B12 deficiency may have indirect cardiovascular effects in addition to hematological and neuropsychiatric symptoms. It was shown that the monocyte count-to-high density lipoprotein cholesterol (HDL-C) ratio (MHR) is a novel cardiovascular marker. In this study, the aim was to evaluate whether MHR was high in patients with vitamin B12 deficiency and its relationship with cardiometabolic risk factors. The study included 128 patients diagnosed with vitamin B12 deficiency and 93 healthy controls. Patients with vitamin B12 deficiency had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), MHR, C-reactive protein (CRP) and uric acid levels compared with the controls (median 139 vs 115 mmHg, p < 0.001; 80 vs 70 mmHg, p < 0.001; 14.2 vs 9.5, p < 0.001; 10.2 vs 4 mg/dl p < 0.001; 6.68 vs 4.8 mg/dl, p < 0.001 respectively). The prevalence of left ventricular hypertrophy was higher in vitamin B12 deficiency group (43.8%) than the control group (8.6%) (p < 0.001). In vitamin B12 deficiency group, a positive correlation was detected between MHR and SBP, CRP and uric acid (p < 0.001 r:0.34, p < 0.001 r:0.30, p < 0.001 r:0.5, respectively) and a significant negative correlation was detected between MHR and T-CHOL, LDL, HDL and B12 (p < 0.001 r: −0.39, p < 0.001 r: −0.34, p < 0.001 r: −0.57, p < 0.04 r: −0.17, respectively). MHR was high in vitamin B12 deficiency group, and correlated with the cardiometabolic risk factors in this group, which were SBP, CRP, uric acid and HDL. In conclusion, MRH, which can be easily calculated in clinical practice, can be a useful marker to assess cardiovascular risk in patients with vitamin B12 deficiency.

Sign in / Sign up

Export Citation Format

Share Document