Evolution of plasma vitamin B12 in patients with solid cancers during curative versus supportive care

IntroductionThe direction of the causal link between solid cancers and elevated plasma vitamin B12 (B12) remains uncertain.Material and methodsWe retrospectively included patients having two B12 measurements with a B12 initially ≥ 1000 ng/l and a solid cancer diagnosed between the measurements. Patients were included in the Curative or Supportive group according to their treatments.ResultsB12 changes over time differed among groups (p = 0.001): +157.4 ng/L/month in the Supportive care group versus -171.6 ng/L/month in the Curative care group.ConclusionsThe decrease of plasma B12 in cases of curative care could suggest that this B12 elevation is secondary to solid cancers.

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Methylmalonic acid in the diagnosis of cobalt deficiency in barley-fed lambs

British Journal Of Nutrition ◽

10.1079/bjn19890073 ◽

1989 ◽

Vol 62 (3) ◽

pp. 729-738 ◽

Cited By ~ 24

Author(s):

F.P.M. O'Harte ◽

D. G. Kennedy ◽

W. J. Blanchflower ◽

D. A. Rice

Keyword(s):

Methylmalonic Acid ◽

Statistical Significance ◽

Plasma Concentrations ◽

Vitamin B ◽

Plasma Vitamin ◽

Elevated Plasma ◽

Normal Range ◽

Cobalt Deficiency ◽

Upper Level ◽

Liquid Chromatographic

Eight lambs were fed on a cobalt-deficient whole-barley diet supplemented with urea, vitamins and minerals. Four control lambs were fed on the same diet which had been further supplemented with Co. Plasma vitamin B12 levels in the Co-depleted group declined rapidly, falling below the normal range within 5 weeks. Differences between the live weights of the animals in the two groups approached statistical significance by week 14. However, methylmalonic acid (MMA) rose above normal levels in the Co-depleted group within 7 weeks. This suggested that an elevated plasma concentration of MMA is a comparatively early indicator of functional vitamin B12 deficiency. It is recommended that 10 μmol/l be the upper level of normality for plasma MMA concentration in barley-fed animals, in contrast with the level of 5 μmol/l for grass-fed animals. Changes in the plasma concentrations of MMA and ethylmalonic acid associated with feeding the barley-based diet per se did not significantly affect the validity of the gas-liquid chromatographic assay for MMA.

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Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer

Scientific Reports ◽

10.1038/s41598-021-92945-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Valentin Lacombe ◽

Floris Chabrun ◽

Carole Lacout ◽

Alaa Ghali ◽

Olivier Capitain ◽

...

Keyword(s):

Vitamin B12 ◽

Risk Model ◽

Plasma Vitamin ◽

Solid Cancer ◽

Elevated Plasma ◽

Free Survival ◽

Group A ◽

Study Population ◽

Persistent Elevation ◽

Age And Sex

AbstractElevated plasma vitamin B12 has been associated with solid cancers, based on a single B12 measurement. We evaluated the incidence of solid cancers following B12 measurement in patients with persistent elevated B12, compared to patients without elevated B12 and to patients with non-persistent elevated B12. The study population included patients with at least two plasma B12 measurements without already known elevated-B12-related causes. Patients with elevated plasma B12 (≥ 1000 ng/L) at first measurement (n = 344) were matched for age and sex with patients having 2 normal B12 measurements (< 1000 ng/L) (NN group, n = 344). The patients with elevated plasma B12 at first measurement were split into 2 groups, according to the presence (EE group, n = 144) or the absence (EN group, n = 200) of persistent elevated plasma B12 at second measurement. We compared the cancer-free survival during 60 months between the groups after adjustment for the other elevated-B12-related causes in a survival competing risk model. Compared to the NN group, a persistent elevated plasma B12 ≥ 1000 ng/mL was strongly associated with the occurrence of solid cancer (HR 5.90 [95% CI 2.79–12.45], p < 0.001), contrary to non-persistent plasma B12 elevation (p = 0.29). These results could help to select patients in whom the screening for solid cancers would be of interest.

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Maternal Vitamin B12 Status and Risk of Cleft Lip and Cleft Palate Birth Defects in Tamil Nadu State, India

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621998394 ◽

2021 ◽

Vol 58 (5) ◽

pp. 567-576

Author(s):

Ronald G. Munger ◽

Rajarajeswari Kuppuswamy ◽

Jyotsna Murthy ◽

Kalpana Balakrishnan ◽

Gurusamy Thangavel ◽

...

Keyword(s):

Cleft Palate ◽

Tamil Nadu ◽

Cleft Lip ◽

Maternal Nutrition ◽

Case Control ◽

Vitamin B ◽

Plasma Vitamin ◽

Maternal Vitamin ◽

Increased Risk ◽

Tamil Nadu State

Background and Objective: The causal role of maternal nutrition in orofacial clefts is uncertain. We tested hypotheses that low maternal vitamin B12 and low folate status are each associated with an increased risk of isolated cleft lip with or without cleft palate (CL±P) in a case–control study in Tamil Nadu state, India. Methods: Case-mothers of CL±P children (n = 47) and control-mothers of unaffected children (n = 50) were recruited an average of 1.4 years after birth of the index child and plasma vitamin B12, methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured at that time. Logistic regression analyses estimated associations between nutrient biomarkers and case–control status. Results: Odds ratios (ORs) contrasting biomarker levels showed associations between case-mothers and low versus high plasma vitamin B12 (OR = 2.48, 95% CI, 1.02-6.01) and high versus low plasma MMA, an indicator of poor B12 status (OR = 3.65 95% CI, 1.21-11.05). Case–control status was not consistently associated with folate or tHcy levels. Low vitamin B12 status, when defined by a combination of both plasma vitamin B12 and MMA levels, had an even stronger association with case-mothers (OR = 6.54, 95% CI, 1.33-32.09). Conclusions: Mothers of CL±P children in southern India were 6.5 times more likely to have poor vitamin B12 status, defined by multiple biomarkers, compared to control-mothers. Further studies in populations with diverse nutritional backgrounds are required to determine whether poor maternal vitamin B12 or folate levels or their interactions are causally related to CL±P.

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Relation of short-term pyridoxine-HCI supplementation to plasma vitamin B−6 vitamers and amino acid concentrations in young women

American Journal of Clinical Nutrition ◽

10.1093/ajcn/55.4.865 ◽

1992 ◽

Vol 55 (4) ◽

pp. 865-872 ◽

Cited By ~ 6

Author(s):

S A Kang-Yoon ◽

A Kirksey

Keyword(s):

Amino Acid ◽

Young Women ◽

Vitamin B ◽

Plasma Vitamin ◽

Short Term ◽

Amino Acid Concentrations

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Folic acid and vitamin B12 status of vervet monkeys used for nutritional research

Laboratory Animals ◽

10.1258/002367793781082386 ◽

1993 ◽

Vol 27 (1) ◽

pp. 59-64 ◽

Cited By ~ 5

Author(s):

F. S. Venter ◽

H. Cloete ◽

J. V. Seier ◽

M. J. Faber ◽

J. E. Fincham

Keyword(s):

Folic Acid ◽

Inverse Relationship ◽

Atherogenic Diet ◽

The Other ◽

Vitamin B ◽

Plasma Vitamin ◽

Vervet Monkeys ◽

Adult Males ◽

Competitive Protein Binding ◽

Apparently Healthy

Plasma and red blood cell (RBC) folic acid levels, as well as plasma vitamin B12 levels were determined in Vervet monkeys ( Cercopithecus aethiops). All the vervets were apparently healthy and without symptoms or lesions typical of folic acid and/or vitamin B12 deficiencies. Competitive protein binding radioassays were used to determine folate and vitamin B12 values in animals fed 4 different diets. The B12 levels for all the groups ranged between 866 and 5867 pg/ml and showed an inverse relationship with the FA measurements. The lowest mean RBC folic acid content in a group fed an atherogenic diet for 3 years was 12·8 ng/ml. For the other 3 diets, mean RBC folic acid levels were 90·7, 132·3 and 152·8 ng/ml, respectively. A megadose of 25·6 mg of folic acid per day for 99 days was given to 3 adult males. No obvious toxic effects were observed in these animals although mean RBC folic acid levels increased to 1013 ng/ml.

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Connected care for endocarditis and heart failure patients: a hospital-at-home programme

Netherlands Heart Journal ◽

10.1007/s12471-021-01614-2 ◽

2021 ◽

Author(s):

J. van Ramshorst ◽

M. Duffels ◽

S. P. M de Boer ◽

A. Bos-Schaap ◽

O. Drexhage ◽

...

Keyword(s):

Heart Failure ◽

Home Care ◽

Nurse Practitioners ◽

Care Group ◽

Proof Of Concept ◽

Home Setting ◽

Curative Care ◽

Care At Home ◽

Hospital At Home ◽

At Home

Abstract Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

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Methylprednisolone Treatment Versus Standard Supportive Care for Adult Covid19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients

10.21203/rs.3.rs-609419/v1 ◽

2021 ◽

Author(s):

Masood Ur Rahman ◽

Satish Chandra Nair ◽

Mehraj Ud Din ◽

Mohd Dar ◽

Murriam Masood ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Length Of Stay ◽

Respiratory Distress Syndrome ◽

Supportive Care ◽

Respiratory Distress ◽

Distress Syndrome ◽

Hospital Length Of Stay ◽

Care Group ◽

Mechanically Ventilated ◽

Methylprednisolone Treatment

Abstract A myriad of symptoms presented by severely ill mechanically ventilated Covid19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. Covid19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for Covid19, the aim of the current study was to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID19 patients with severe covid pneumonia. Data was collected retrospectively from the electronic patient medical records, and inter-rater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome and the Chi-Square test used to determine association between the outcomes and other independent variables. Patients. Sixty-one percent (43/70) of the Covid19 ARDS patients received standard supportive care, and the remainder were administered. methylprednisolone (40 mg daily to 40 mg q 6 hours). A 28-day all-cause mortality rate, in the methylprednisolone group was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU-length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone treated group was significantly lower (p < 0.01), when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU LOS, and ventilator days in mechanically ventilated Covid 19 patients with respiratory distress syndrome.

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Use of Manometry for Laryngeal Mask Airway Reduces Postoperative Pharyngolaryngeal Adverse Events

Anesthesiology ◽

10.1097/aln.0b013e3181cf4346 ◽

2010 ◽

Vol 112 (3) ◽

pp. 652-657 ◽

Cited By ~ 90

Author(s):

Edwin Seet ◽

Farhanah Yousaf ◽

Smita Gupta ◽

Rajeev Subramanyam ◽

David T. Wong ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Adverse Events ◽

Group Versus ◽

Routine Care ◽

Laryngeal Mask ◽

Care Group ◽

Routine Practice ◽

Number Needed To Treat ◽

Intracuff Pressure ◽

Usual Practice

Background Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (<44 mmHg) with patients under routine care. Method Two hundred consenting patients who underwent ambulatory surgery were randomly allocated to pressure-limiting and routine care groups. Anesthesia was induced with propofol and fentanyl, and maintained with desflurane in air-oxygen. An LMA was inserted, and the cuff was inflated as per usual practice. The patients breathed spontaneously. Research assistants measured the LMA intracuff pressure. In the pressure-limiting group, LMA intracuff pressure was adjusted to less than 44 mmHg. No intervention was performed in the routine care group. Sore throat, dysphonia, and dysphagia were assessed at 1, 2, and 24 h postoperatively. Composite pharyngolaryngeal complications were compared using chi-square test. Results Baseline demographic data were comparable between groups. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group (40 +/- 6 vs. 114 +/- 57 mmHg, P < 0.001). The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group (13.4 vs. 45.6%, P < 0.001), with a relative risk reduction of 70.6%, and a number needed to treat of three (95% CI 2.2-7.5). Conclusion Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.

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Stroke: roles of B vitamins, homocysteine and antioxidants

Nutrition Research Reviews ◽

10.1017/s0954422409990023 ◽

2009 ◽

Vol 22 (1) ◽

pp. 49-67 ◽

Cited By ~ 43

Author(s):

Concepción Sánchez-Moreno ◽

Antonio Jiménez-Escrig ◽

Antonio Martín

Keyword(s):

Vitamin E ◽

Fruits And Vegetables ◽

Cell Function ◽

Biological Marker ◽

Developed Countries ◽

B Vitamins ◽

Antioxidant Vitamins ◽

Vitamin B ◽

Plasma Vitamin ◽

Increased Risk

In the present review concerning stroke, we evaluate the roles of B vitamins, homocysteine and antioxidant vitamins. Stroke is a leading cause of death in developed countries. However, current therapeutic strategies for stroke have been largely unsuccessful. Several studies have reported important benefits on reducing the risk of stroke and improving the post-stroke-associated functional declines in patients who ate foods rich in micronutrients, including B vitamins and antioxidant vitamins E and C. Folic acid, vitamin B6and vitamin B12are all cofactors in homocysteine metabolism. Growing interest has been paid to hyperhomocysteinaemia as a risk factor for CVD. Hyperhomocysteinaemia has been linked to inadequate intake of vitamins, particularly to B-group vitamins and therefore may be amenable to nutritional intervention. Hence, poor dietary intake of folate, vitamin B6and vitamin B12are associated with increased risk of stroke. Elevated consumption of fruits and vegetables appears to protect against stroke. Antioxidant nutrients have important roles in cell function and have been implicated in processes associated with ageing, including vascular, inflammatory and neurological damage. Plasma vitamin E and C concentrations may serve as a biological marker of lifestyle or other factors associated with reduced stroke risk and may be useful in identifying those at high risk of stroke. After reviewing the observational and intervention studies, there is an incomplete understanding of mechanisms and some conflicting findings; therefore the available evidence is insufficient to recommend the routine use of B vitamins, vitamin E and vitamin C for the prevention of stroke. A better understanding of mechanisms, along with well-designed controlled clinical trials will allow further progress in this area.

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