A STUDY OF ASSOCIATION OF SERUM FOLIC ACID LEVEL WITH PRE ECLAMPSIA IN DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY AT SMS MEDICAL COLLEGE, JAIPUR

Background: In this study was carried out to determine the relation between serum levels of Folic Acid and preeclampsia among pregnant women. Methods: Methods- Hospital based comparative study was conducted at Department of Obstetrics and Gynaecology, SMS medical college, Jaipur. Results: In PIH group, 20.00% women folic acid level was 3.1-7.8 ng/ml, 40.00% women folic acid level was 7.9-12.6 ng/ml, 35.00% women folic acid level was 12.7-17.5 ng/ml and 5.00% women folic acid level was 17.6-20.00 ng/ml. In normotensive group, 5.00% women folic acid level was 3.1-7.8 ng/ml, 25.00% women folic acid level was 7.9-12.6 ng/ml, 50.00% women folic acid level was 12.7-17.5 ng/ml and 20.00% women folic acid level was 17.6-20.00 ng/ml. Conclusion: We conclude that folic acid is not the only element in preventing the preeclampsia, however, its serum level in case group is significantly less than control group. Keywords: Eclampsia, Folic acid, Hypertension

Vitamin B12, Folic acid and Homocysteine Levels in female metabolic syndrome patients and their relationship with Heart rate variability.

Background: Metabolic syndrome (MeS) is a well-recognized risk factor for cardiovascular diseases. It is associated with hyperhomocysteinemia resulting from deficiency of vitamin B12 and folic acid. Both the MeS and hyperhomocysteinemia adversely affect heart rate variability. Objectives: To assess vitamin B12, folic acid and homocysteine levels in female metabolic syndrome patients and their relationship with heart rate variability. Methods: After taking ethical clearance from Institutional Review Board (IRB) of Bangabandhu Sheikh Mujib Medical University (BSMMU) this cross sectional study was conducted on 80 female subjects of 25-45 years of age. Among them 40 metabolic syndrome patients were included in the study group and 40 age matched apparently healthy female constituted control group. All the patients were enrolled from Outpatient Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh according to selection criteria. Serum vitamin B12, folic acid, homocysteine level was estimated by chemiluminescent immunoassay and frequency domain parameters of Heart Rate Variability (HRV) was recorded by a data acquisition device, Powerlab 8/35, AD instruments, Australia. Statistical aalysis was done by independent sample ‘t’ test and pearson correlation test. Results: In this study, among frequency domain HRV variables Total power(TP), low frequency power(LF), high frequency power (HF), HF normalized unit(nu) were significantly lower (p<0.05) and LF nu, LF/HF were significantly higher (p<0.05) in MS patients compared to those of control. In addition, no significant changes (p>0.05) were found in serum vitamin B12, folic acid and homocysteine levels between these two groups. But on correlation analysis only the folic acid level was significantly negatively correlated (p<0.05) with LF and HF power. Conclusion: The present study revealed that the folic acid level but not the vitamin B12 and homocysteine levels has significant negative correlation with heart rate variability in female MS. J Bngladesh Soc Physiol 2021;16(1): 24-32

A PROSPECTIVE STUDY OF SERUM FOLATE CONCENTRATION AND HEMOGLOBIN IN CERVIX CARCINOMA PATIENTS

Objective: The study aimed to have a prospective study of serum folate concentration and hemoglobin (Hb%) in cervical carcinoma patients. Methods: The study was conducted on women suffering from carcinoma cervix. The research was conducted in the Gynecological Outpatient Department (OPD) of the Oncology Unit in Mahavir Cancer Sansthan Patna, Bihar. The study period was from May 2016 to April 2017. The sample was collected after face to face interview by Figo staging and the sample was taken regularly. As a result strong association of Hb% and carcinoma cervix was found with the mean value of lower than 11.12, which is lower than the normal range of Hb%. As per the further estimation of folic acid, the level of cervical cancer is low. Results: The data were estimated with help of tools such as SPSS 16.0 and PRISMA 5.0. The Hb% the mean value of patients was estimated to be lower than 11.12, which is not under the normal range of Hb%, that is, nearly 12.5 mg/dl. The low mean value shows less Hb% content which leads to anemia in normal beings as well as in patients with cervical cancer. A strong association of Hb% which affected to patients in carcinoma cervix can be seen in the graph that the mean value of patients low 11.12±0.20 which not comes under normal range of Hb%, that is, 12.5 mg/dl. The R square value is 0.9556. Conclusion: As per our study, we have estimated that the folic acid level in cervical cancer is low. The -normal range of folic acid level in plasma serum is 2.2–20 ug/ml. The mean of 20 control cases, new cervical cancer patients, on treating patients, and follow-up patients is 11.08, 2.206, 3.554, and 2.783, respectively. The control 11.08 shows the better level in plasma serum level comes under a normal range of folic acid level.

Efficacy of Oral Low-Dose Isotretinoin in the Treatment of Acne Vulgaris in Vietnam

BACKGROUND: Oral isotretinoin is an effective therapy for acne. However, isotretinoin can induce hyperhomocysteinemia and decreased serum folic acid level, which may be a risk for cardiovascular disease and thrombosis, as well as psychoses. Besides, many recent types of research emphasise the safety and effects of the low dose isotretinoin therapy. AIM: The aim of our study was to evaluate the effect of the low-dose isotretinoin on the plasma homocysteine and serum folic acid level in the Vietnamese population. METHODS: We conducted a longitudinal study to evaluate the effectiveness of the low-dose therapy on the plasma homocysteine and serum folic acid level of 52 acne patients after 6-8-week treatment at University Medical Center Ho Chi Minh City, Viet Nam. Patients had moderate-severe acne with the prolonged course, and most of them had a scar. RESULTS: With a low dose of oral isotretinoin (0.37 ± 0.11 mg/kg/day), after 6-8-week treatment, patients dropped the severity of disease, increased the plasma homocysteine level and decreased the serum folic acid level with significant differences in comparison to those before treatment. However, these changes do not exceed the normal range. CONCLUSION: In overall, low dose isotretinoin treatment had effectiveness in decrease the severity of disease and no increasing the plasma homocysteine level as well as the serum folic acid level.

Prevalence of Folic Acid Deficiency and Cost Effectiveness of Folic Acid Testing: A Single Center Experience

Study Objective According to the National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 the prevalence of folic acid deficiency in the United States has decreased from 16% to 0.5% since the dietary folic acid fortification program started in the late 1990s. Routine testing for folic acid deficiency remains quite common in the workup of anemia, dementia, alcoholism and other high risk populations. The objective for this study were to determine the prevalence of folic acid deficiency in order to analyze whether routine testing for deficiency should be discouraged or targeted to specific patient populations. In addition to this, we want to assess the economic burden that folic acid level testing adds to the high cost of care of our health system. Methods Cross sectional chart review of all adults tested for folic acid level from March 2014 to March 2015 from the Hospital and Ambulatory Care Center of the Community Hospital was undertaken. Folic acid deficiency was defined as ≤4ng/dl. Folic acid level were further classified as low (≤10ng/dl ), intermediate (10-20ng/dl) and high (>20ng/dl). Age, race, body mass index, hemoglobin, mean corpuscular volume levels and billing details were recorded of all patients and information was also collected regarding known conditions correlated to the folic acid levels including Vitamin B12 deficiency( <300 ng/dl), dementia, alcoholism, pregnancy malabsorption, sickle cell disease, bariatric surgery, inflammatory bowel syndrome, and drug therapy with HAART (Highly Active Anti-Retroviral Therapy) , TMP-SMX(Trimethoprim/sulfamethoxazole), phenytoin, valproic acid and/or methotrexate (Table 1). Statistical testing using t-test, logistic / linear regressions with α level at 0.05 was used for analysis of data. Results A total of 957 charts of patients who were tested for folic acid between March 2014 to March 2015 at our Heath- Care System were reviewed. 413 (43%) patients were male and 544 (57%) were female. There were 394 (41 %) Hispanics, 325 (34%) African American, 202 (21%) Caucasian and 36 (4%) were from other ethnicity. The mean age was 59.7 years and a mean Hb was 11. 6 g/ dl. Mean folic acid level was 14.5 ng/dl. 16 patients from total of 957 (2 %) had folic acid deficiency with value ≤4ng/dl . Additional results from the study are described in Table 1, Table 2 and Table 3. Conclusion The prevalence of folic acid deficiency was 2%, About 33,000 dollars per year were used to identify such a low prevalent disease which can be treated at a low cost (2 cents/day) by oral supplementation. Low levels of folic acid were statistically associated with male sex, African American race, dementia and coexistence of vitamin B12 deficiency. Empiric supplementation of folic acid and possibly limiting testing for folic acid level to this group of patients may represent a more cost effective strategy. Disclosures No relevant conflicts of interest to declare.

Micronutrient deficiency status in children below 2 year of age with delayed milestones

Background: Micronutrient deficiency have strong association with delayed achievement of milestones. Objective of present study was to know the micronutrient deficiency status in children below 2 years of age with delayed milestones.Methods: Study was carried out among 50 children below 2year of age with delayed milestones without any known cause for it. These children were evaluated for hematopoietic micronutrient deficiency and they were compared with controls.Results: A total of 50 children (22 male and 28 female) of delayed milestone were enrolled. Maximum number of children were in age group 7-12 months. Majority of children (62%) were from BPL families. Majority of children had Wt/ Ht -1 to -2 SD. Breastfeeding was initiated late (2-6 hr) in 38%. Sixty four percent children were exclusively breast fed up to six month of age, in the rest top milk feeding was also given along with BF. No complimentary feeding was started in 51.1% children after 6 months of age. In 73% of those in whom complimentary feeding was started the amount was inadequate. Maximum children were given complimentary feeding at the age of 9-12 month. In this study significant number of patients (p = <0.001) had low levels of serum vit. B12 (78% v/s 10% in control), iron deficiency (66% v/s 6% in control) and deficient folic acid level (16% v/s nil in control).Conclusions: Association was found between hematopoietic micronutrient deficiency and delayed milestone in children below 2 years age without any other risk factors.

Impact of type 2 Diabetes and Metformin use on Vitamin B12 Associated Biomarkers - an Observational Study

Aims Assessment of the impact of type 2 diabetes (T2DM) and metformin use on vitamin B12 (VB12) associated biomarkers and their suitability to represent VB12 supply. Methods Differences of VB12, holotranscobalamine (HoloTc), the biologically active fraction (%AB12)=HoloTc/VB12*100 and homocystein (Hcy) were analysed i) among diabetic outpatients with (DMMet+ ) and without metformin use (DMMet-) and ii) in comparison to an external non-diabetic reference group with low VB12 (<200 pmol/L). Results VB12 associated biomarkers were distributed equally between DMMet+ (n=29, 58%) and DMMet- (n=21, 42%). Significant differences in %AB12 in diabetic patients with low VB12 (n=19) compared to the non-diabetic reference group (n=31) were found. Higher %AB12 was associated with diabetes. Hcy levels were significantly associated with age, folic acid level, renal function and HoloTc but not with VB12. Conclusions In T2DM patients with low VB12, %AB12 was confirmed as being higher in comparison to nondiabetic patients. The effect was not clearly attributable to metformin use. HoloTc was unaffected by the lowering of VB12 and significantly associated with the functional marker Hcy. Both findings support the use of HoloTc for the assessment of VB12 supply in diabetic patients.