Study of Serum Homocysteine and Vitamin B12 levels in Eclampsia, Pre-Eclampsia, and the effectiveness of treatment with Inj vitamin B12 on the outcome of these patients.
The present study was carried out to evaluate the occurrence of association between homocysteine, and vitamin B12 in patients with Preeclampsia , Eclampsia and those with history of previous PIH. 30 such patients from obstetric ward were studied for estimation of serum homocysteine, and vitamin B12 over a period of Jan10 to Jun 2011. Serum homocysteine and vitamin B12 were determined by means of Immulite 1000 analyzer. The statistical analysis of study group of preeclampsia compared with normotensive control group, showed significant alterations in serum homocysteine, and vitamin B12 concentrations in preeclampsia and eclampsia group. Inverse association between serum homocysteine and vitamin B12 levels were observed in preeclampsia and eclampsia. The present study found hyperhomocysteinemia and deficiency of vitamin B12 along with increased blood pressure as a risk factor in preeclampsia. Final outcome of these patients after Inj Vitamin B12 therapy has improved at par with control group without any neonatal or maternal mortality in all four groups
Handbook of parenteral fluid & nutrition therapy current literature reviewDr Iyan Darmawan
This handbook covers the four types of parenteral fluid therapy, namely resuscitation fluid therapy, repair fluid therapy, maintenance fluid therapy and parenteral nutrition therapy. Although we have tried to discuss many aspects of parenteral fluid therapy which have been compiled by medical advisors of the Leader in Infusion Therapy with many years of experience in the related scientific activities and medical writing, this handbook is still far from completeness and perfection and we look forward to receiving your feedback and criticism.
ABSTRACT- Introduction: Importance of measurement of glycated hemoglobin (HbA1c) has been recommended for
the diagnosis of diabetes and pre-diabetes. However, various epidemiological studies conducted different parts of the
universe have shown significant discordance between HbA1c and glucose-based tests. Glycated hemoglobin (HbA1c) is
assumed to be the gold standard for monitoring glycemic control in patients with diabetes mellitus disorder. The Glycated
hemoglobin (HbA1c) assay provided an accurate, precise measure of chronic glycemic levels, and associates with the risk
of diabetes complications.
Materials and Methods: This is a cross sectional prospective study. A total of 868 individuals attended to the medicine
outpatient clinic at Lord Buddha Koshi Medical College, Saharsa, Bihar between Jan 2016 to Dec 2016 were selected for
the study after screening a large cohort visited OPD. The results of FPG, OGTT, and HbA1c for 868 individual were
analyzed as well as all grouped as diabetic patients, glucose intolerant (pre-diabetes) patients, and non-diabetic patients
according to new ADA criteria for the diagnosis of diabetes.
Results: Diagnostic sensitivity of all diabetic criteria were 80.33% for A1c; 75% for OGTT and only 41.87% for FPG
respectively.
Conclusion: The proposed A1c diagnostic criteria have greater diagnostic than FPG and 2-h OGTT regarding a diagnosis
of diabetes mellitus disorder.
Key-words- Glycated Hemoglobin, Fasting Plasma Glucose, Oral glucose tolerances test (OGTT), Diabetes Mellitus,
and Pre- diabetes
ADA EASD Management of hyperglycemia in type 2Mgfamiliar Net
Management of Hyperglycemia in Type 2 Diabetes:
A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
Inzucchi SE, Bergenstal RM, Buse JB, et al.
Diabetes Care. 2012 Apr 19.
Handbook of parenteral fluid & nutrition therapy current literature reviewDr Iyan Darmawan
This handbook covers the four types of parenteral fluid therapy, namely resuscitation fluid therapy, repair fluid therapy, maintenance fluid therapy and parenteral nutrition therapy. Although we have tried to discuss many aspects of parenteral fluid therapy which have been compiled by medical advisors of the Leader in Infusion Therapy with many years of experience in the related scientific activities and medical writing, this handbook is still far from completeness and perfection and we look forward to receiving your feedback and criticism.
ABSTRACT- Introduction: Importance of measurement of glycated hemoglobin (HbA1c) has been recommended for
the diagnosis of diabetes and pre-diabetes. However, various epidemiological studies conducted different parts of the
universe have shown significant discordance between HbA1c and glucose-based tests. Glycated hemoglobin (HbA1c) is
assumed to be the gold standard for monitoring glycemic control in patients with diabetes mellitus disorder. The Glycated
hemoglobin (HbA1c) assay provided an accurate, precise measure of chronic glycemic levels, and associates with the risk
of diabetes complications.
Materials and Methods: This is a cross sectional prospective study. A total of 868 individuals attended to the medicine
outpatient clinic at Lord Buddha Koshi Medical College, Saharsa, Bihar between Jan 2016 to Dec 2016 were selected for
the study after screening a large cohort visited OPD. The results of FPG, OGTT, and HbA1c for 868 individual were
analyzed as well as all grouped as diabetic patients, glucose intolerant (pre-diabetes) patients, and non-diabetic patients
according to new ADA criteria for the diagnosis of diabetes.
Results: Diagnostic sensitivity of all diabetic criteria were 80.33% for A1c; 75% for OGTT and only 41.87% for FPG
respectively.
Conclusion: The proposed A1c diagnostic criteria have greater diagnostic than FPG and 2-h OGTT regarding a diagnosis
of diabetes mellitus disorder.
Key-words- Glycated Hemoglobin, Fasting Plasma Glucose, Oral glucose tolerances test (OGTT), Diabetes Mellitus,
and Pre- diabetes
ADA EASD Management of hyperglycemia in type 2Mgfamiliar Net
Management of Hyperglycemia in Type 2 Diabetes:
A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
Inzucchi SE, Bergenstal RM, Buse JB, et al.
Diabetes Care. 2012 Apr 19.
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. A1C testing should be performed routinely in all patients with diabetes. The frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the clinician’s judgment. Some patients with stable glycemia well within target may do well with testing only twice per year. Unstable or highly intensively managed patients (e.g., pregnant type 1 diabetic women) may require testing more frequently than every 3 months.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The expediency of using glycated hemoglobin to assess the level of diabetes' compensation. Present-day parameters of carbohydrate metabolism' evaluation are presented.
Professor Rinaldo Bellomo is an Intensivist at the Austin Hospital in Melbourne. He is Professor of Medicine at Melbourne University, and Honorary Professor of Medicine at Monash University, Melbourne and The University of Sydney.
He is one of the most eminent researchers in Intensive Care Medicine today and has been named one of the most influential scientific minds of our time.
In this thought-provoking talk Professor Bellomo discusses glycemic control of critically ill diabetic patients in the ICU.
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. A1C testing should be performed routinely in all patients with diabetes. The frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the clinician’s judgment. Some patients with stable glycemia well within target may do well with testing only twice per year. Unstable or highly intensively managed patients (e.g., pregnant type 1 diabetic women) may require testing more frequently than every 3 months.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The expediency of using glycated hemoglobin to assess the level of diabetes' compensation. Present-day parameters of carbohydrate metabolism' evaluation are presented.
Professor Rinaldo Bellomo is an Intensivist at the Austin Hospital in Melbourne. He is Professor of Medicine at Melbourne University, and Honorary Professor of Medicine at Monash University, Melbourne and The University of Sydney.
He is one of the most eminent researchers in Intensive Care Medicine today and has been named one of the most influential scientific minds of our time.
In this thought-provoking talk Professor Bellomo discusses glycemic control of critically ill diabetic patients in the ICU.
Similar to Study of Serum Homocysteine and Vitamin B12 levels in Eclampsia, Pre-Eclampsia, and the effectiveness of treatment with Inj vitamin B12 on the outcome of these patients.
Beta-thalassemia is an inherited blood disorder. It results from the impaired production of β -globin chains,
leading to a relative excess of alpha-globin chains. Adipocytokines may play a role in the development of complications in β -thalassaemia
Albumin versus fresh frozen plasma in managing diuretic resistant edema in ch...iosrphr_editor
This study was carried out to compare the efficacy, cost effectiveness and outcome of albumin with fresh frozen plasma (FFP) in the treatment of diuretic resistant edema in childhood idiopathic nephrotic syndrome.Methods: Fifty four patients with idiopathic NS were enrolled in this prospective analytic study. Patients with moderate to severe edema with serum albumin <15 gm/L were given albumin and FFP dividing into two groups. Group-A, received intravenous albumin- 1 gm/kg/day and Group-B intravenous FFP 15ml/kg/day. Total number of albumin and FFP infusion were determined by edema reduction. Cost effectiveness was also calculated. Results: Diagnosis of NS and biochemical parameters were same in both groups. Dry weight was achieved in Group-A in 6.66± 3.710 days and in Group-B 6.66± 3.038 days. In Group-A the number of albumin infusion required was 1.44±0.697 and Group-B FFP infusion required was 3.11± 1.5 (p=0.0001). Group A needed 4608.00 ($57.6) taka for albumin whereas Group B needed only 2177.00($ 27.2) taka for FFP (p=0.0001). No significant complications were observed in both the groups.Conclusion: FFP costs half than albumin and same duration required reducing edema but the cost-effectiveness may place FFP as a better choice especially in developing countries of the world.
Serum Total Bilirubin levels in Diabetic Retinopathy - A case control studyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Objective: The aim of this research study is to compare ferrous fumarate and bovine lactoferrin as regard treatment of anemia in a pregnant patient with iron deficiency anemia.
Study design: A prospective open label randomized clinical trial which was conducted at Ain Shams University Maternity Hospital outpatient clinic in the period from 15 February 2016 to 15 August 2016. The study included 146 pregnant women suffering from iron deficiency anemia and divided in two groups.
“A Study on Coagulation Profile in Pregnancy Induced Hypertension Cases”iosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
III Curso Anemia Perioperatoria. "Nuevas Perpectivas del Patient Blood Management." Servicio de Anestesiología y Reanimación. Hospital Universitario Puerta de Hierro. Majadahonda (Madrid). 8 y 9 de Mayo. Acreditado CFC
Nephrotic Syndrome Induced Dyslipidemia in Children and Need for Early Assess...QUESTJOURNAL
Background: Hyperlipidemia, an important characteristic of idiopathic nephrotic syndrome in children (NS), thereby makes them prone to develop premature atherosclerosis and related complications. Methods: We have investigated the changes in different fractions of lipids and apolipoproteins level in thirty children of 1-12 years of age with idiopathic nephrotic syndrome. Twenty six age and sex matched hospitalized children, suffering from non-renal diseases, were enrolled as controls. Results: The results revealed that ApoB along with cholesterol, triglyceride,and LDL-cholesterol, were significantly increased (p<0.001),><0.001)><0.001) in patients of nephrotic syndrome. Conclusions: Therefore there is a need to evaluate the lipid and lipoprotein levels early and so that appropriate therapy can be offered to selective candidates.
Potential role of uric acid in correlation with epidemics of hypertension and...Apollo Hospitals
Diabetic nephropathy (DN) is a microvascular complication of Type 2 diabetes mellitus. Uric acid (UA) is the end product of purine nucleotide metabolism and its primary mode of clearance is by renal excretion. Modifiable factors such as blood pressure, albuminuria, glycemic control, etc., play an important role in the progression of DN and none of them are curative. Hence, there is a pressing interest to identify other potentially modifiable factors such as UA in the progression of DN.
Similar to Study of Serum Homocysteine and Vitamin B12 levels in Eclampsia, Pre-Eclampsia, and the effectiveness of treatment with Inj vitamin B12 on the outcome of these patients. (20)
Intrauterine insemination versus fallopian tube sperm perfusion in non tubal ...Internet Medical Journal
Background: Controlled ovarian hyper stimulation (COH) combined with intrauterine insemination (IUI), using a volume of 0.5 mail of inseminate is commonly offered to couples with non tubal infertility. Another method is Fallopian tube sperm perfusion (FSP) which is based on a pressure injection of 4 ml of sperm suspension while attempting to seal the cervix to prevent semen reflux. This technique ensures the presence of higher sperm density in the fallopian tubes at the time of ovulation than standard IUI. The aim of this study was to compare the efficiency of IUI and FSP in the treatment of infertility.
Methods: 200 consecutive patients with infertility in 404 stimulated cycles were included in the study. Those randomized to standard IUI included 100 patients in 184 cycles [158 Clomiphene citrate/human menopausal gonadotrophin cycles and 26 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group A). Patients subjected to FSP included 100 patients in 220 cycles (193 Clomiphene citrate/human menopausal gonadotrophin cycles and 27 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group B). Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34-37 hours after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4ml inseminate was used.
Results: In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81%per cycle over four cycles) and this difference was statistically significant (p<0.05).
Conclusions: For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).
Key Words: Intrauterine insemination, Fallopian tube sperm perfusion, Non-tubal infertility.
Authors: Dr. Col (Retd) G S Shekhawat, MD(Obst & Gyn) * (Corresponding. Author), Dr Priyanka S, MBBS+
Intrauterine insemination versus fallopian tube sperm perfusion in non tubal ...
Study of Serum Homocysteine and Vitamin B12 levels in Eclampsia, Pre-Eclampsia, and the effectiveness of treatment with Inj vitamin B12 on the outcome of these patients.
1. Title of the article: Study of Serum Homocysteine and Vitamin B12 levels in
Eclampsia, Pre-Eclampsia, and the effectiveness of treatment with Inj vitamin B12 on
the outcome of these patients.
Type of article: Original article
Name of the Author:
Dr.Radha Yegnanarayan MD (Pharmacology)* (Corresponding & Principal Author)
Dr G S Shekhawat MD (Obst & Gyn) +
Dr Hemant S Damle MD(Obst & Gyn )≠
Place of Research work: Dept of Pharmacology and Dept of Obstetrics &
Gynecology, Smt Kashibai Navale Medical College, Narhe, Pune-411041,
Maharashtra.
Email of Principal & co worker: gsshekhawata@yahoo.co.in (M) 09372897090 and
drradha @sknmcgh.org, Tel :( O) (020-24106155)
Address of the corresponding Author:
Dr.Radha Yegnanarayan (Prof & HODPharmacology)
Smt Kashibai Navale Medical College, Narhe, Pune-411041, Maharashtra.
*Professor &HOD (Pharmacology), Associate Professor (Obstetrics & Gynecology), ≠
+
Professor (Obstetrics & Gynecology), S mt Kashibai Navale Medical College, Narhe,
Pune-411041, Maharashtra.
Word Count: 2464
2. Abstract
The present study was carried out to evaluate the occurrence of association between
homocysteine, and vitamin B12 in patients with Preeclampsia , Eclampsia and those
with history of previous PIH. 30 such patients from obstetric ward were studied for
estimation of serum homocysteine, and vitamin B12 over a period of Jan10 to Jun 2011.
Serum homocysteine and vitamin B12 were determined by means of Immulite 1000
analyzer. The statistical analysis of study group of preeclampsia compared with
normotensive control group, showed significant alterations in serum homocysteine, and
vitamin B12 concentrations in preeclampsia and eclampsia group. Inverse association
between serum homocysteine and vitamin B12 levels were observed in preeclampsia
and eclampsia. The present study found hyperhomocysteinemia and deficiency of
vitamin B12 along with increased blood pressure as a risk factor in preeclampsia. Final
outcome of these patients after Inj Vitamin B12 therapy has improved at par with control
group without any neonatal or maternal mortality in all four groups
Keywords : Homocysteine ,Vitamin B12 , Pre Eclampsia, Eclampsia
Introduction
Pregnancy induced hypertension may occur in about 3–10% of all pregnancies [1]. It
remains a major cause of perinatal and maternal morbidity and mortality world-wide,
because of complications such as eclampsia, fetal growth retardation, premature birth
or abruptio placentae[1][2]. An increased concentration of total circulating homocysteine
in serum is recognized as an independent risk factor for Pre eclampsia[3][4]. Moreover,
3. determinants of hyperhomocysteinemia, such as low concentrations of folic acid and
vitamin B12 involved in homocysteine metabolism are also associated with increased
risk of vascular damage & Pre eclampsia [5]. It is uncertain whether
hyperhomocysteinemia per se or low concentrations of vitamin B12 and folic acid are
atherogenic factors that trigger Pre eclampsia[6]. The present study was undertaken to
determine the levels of serum homocysteine, and vitamin B12 and their correlation ship
in patients with preeclampsia. We also studied the effectiveness of treatment with
Injection B12 in patients who showed low levels of vitamin B12.
Material & Methods
This study was carried out at Department of Pharmacology and Department of
Obstetrics & Gynecology, Smt Kashibai Navale Medical College and General Hospital
Pune after obtaining Institutional Ethics Committee approval. All participants completed
a medical history form and provided informed consent. 40 patients in the age group of
18–35 years were studied for estimation of serum total homocysteine, and vitamin B12
over a period of 18 months. Detailed dietary history with reference to vegetarian or non
vegetarian status and consumption of folate rich foods were recorded in all cases.
Peripheral blood smears were examined in all 40 cases for presence of megaloblasts.
In all those cases where homocysteine concentrations were high and vitamin B12 levels
were low, we administered Injection B12, 1500 µgm I/M in three divided doses.
Inclusion Criteria
This prospective study was conducted among 40 patients, who were divided in 04
groups. 10 patients with Eclampsia, 10 patients with pre-eclampsia , 10 patients with
past history of pre- eclampsia/eclampsia and another 10 normotensive patients as
control without any sign, symptoms, lab test suggestive of pre-eclampsia were included.
4. Besides routine base line ANC investigations, all patients were subjected to special
investigation including renal, liver and coagulation function tests for pre- eclampsia /
eclampsia patients.
Exclusion Criteria
Patients having use of medications (therapy involving S-adenosyl-methionine,
carbamazepine, phenytoin, 6-azauridine, xanthopterin, antifolic acids, anticonvulsant
agents, tamoxifen, and theophylline), cancer, severe anemia, systemic illness and those
with major illness were excluded from study [7].
Blood Sample Collection
Venous blood samples were collected in test tube with aseptic precautions. After 2 h of
collections sample was centrifuged at 3000 rpm for 5 min. Serum was separated and
collected in polythene tube with cork. The sera with no sign of haemolysis were coded
and used for the analysis of total circulating homocysteine and vitamin B12. The
investigator carrying the estimation was unaware of the clinical history and treatment
status of the patients.
Biochemical Analysis
Serum homocysteine concentration was measured by competitive chemiluminescent
enzyme immunoassay method [6]. Serum vitamin B12 concentration was evaluated by
solid phase, competitive chemiluminescent assay method. We used fully automated
enzyme amplified chemiluminescent immuno assay based Immulite 1000 analyzer.
Hyperhomocysteinemia was defined as a serum homocysteine concentration greater
than 15 µmoles/l. Vitamin B12 deficiency was defined as Vitamin B12 level lower
than223 pg/ml.
Statistical Analysis
5. Numerical variables were reported in terms of mean and standard deviation or standard
error of mean. Statistical analysis of results was done by Student t test with correction
&Yates corrected chi square test wherever applicable. In this analysis, variables
showing P-value less than 0.05 and 0.001 were considered to be statistically significant
and highly significant, respectively. Pearson correlation test was used to test correlation.
Results
Demographic data of pre eclamptic patients such as mean age of patients showed
significant fall (P<0.05). Systolic blood pressure (SBP) and diastolic blood pressure
(DBP) were significantly increased (P<0.05) in pre eclamptic/ eclamptic group as
compared with control group (Table 1). Table 2 depicts changes in serum profile when
control group was compared with study group of preeclampsia. As can be seen,
significant increase (P<0.05) were observed in serum homocysteine whereas, vitamin
B12 levels showed significant decrease (P<0.05). A negative and significant correlation
was observed between serum homocysteine when compared with vitamin B12 (Table
2and 3). All patients of Eclampsia and pre eclampsia were treated with vitamin B12
whereas only 02 patients with past history of pre eclampsia needed Vitamin B12
treatment as their homocysteine levels were above normal ( Table 3).
When pre and post vitamin B12 levels were compared, decrease & normalization of
homocysteine levels and increase & normalization in vitamin B12 levels were seen after
Inj B12 treatment in both eclampsia and pre eclampsia patients.(Table 4) This
improvement was statistically highly significant (p<0.001). A negative and statistically
significant correlation (r = -0.335 and P<0.05) was found between serum homocysteine
and vitamin B12 in preeclampsia(Table 5). Final outcome of these patients after Inj
Vitamin B12 therapy has improved at par with control group without any neonatal or
6. maternal mortality in all four groups, however maternal and perinatal morbidity was
much higher among preeclamptic and eclamptic group because of pre existing
pathology (Table 6).
Discussion
Our findings suggest that levels of serum homocysteine, and vitamin B12 are altered in
preeclampsia and eclampsia patients as compared in age-matched normotensive
pregnant control subjects.The present study shows that there was significant hyper
homocystinemia & deficiency of Vitamin B12 in patients with preeclampsia and
eclampsia. Several prospective studies with rather small cohorts of patients with
preeclampsia have shown an independent association between elevated serum
homocysteine level and untoward obstetric outcome [7] [8]. Several factors may
increase homocysteine levels in women with preeclampsia [9]. Metabolism in the kidney
is the major route by which homocysteine is cleared from plasma and this route of
elimination may be affected by preeclamptic changes in the kidney [10].
Hyperhomocysteinemia in preeclamptic patients found in our study might be due to
modulation in homocysteine metabolism, which corroborates with the work of Walker et
al, Hogg et al , Vollset et al. Several studies have demonstrated serum concentrations
of elevated homocysteine in preeclampsia [11]. These studies support our results. In
our study, the levels of vitamin B12 were also significantly lower in the preeclamptic and
eclamptic group as compared to control groups ,suggesting raised homocysteine was
due to vitamin B12 deficiency. Carmel R found differences in folic acid concentrations
between preeclamptic and normal pregnant women. Similarly, in a systematic review by
7. Mignini et al., folic acid and vitamin B12 concentrations were lower in preeclamptic
women when compared with those of normotensive women[12] . In another study, there
was no difference in folic acid and vitamin B12 levels between pooled normal and
preeclamptic groups but these levels were significantly lower in patients with the 677 CT
mutation of MTHFR[13]. The serum homocysteine was found to have negative and
insignificant correlation with serum folic acid in preeclamptic patients. In our study
negative and statistically significant correlation (r = -0.335 and P<0.05) was found
between serum homocysteine and vitamin B12 in preeclampsia. There are two
pathways by which homocysteine is metabolized:- remethylation and transsulfuration.
Folic acid and vitamin B12 are required for the remethylation of homocysteine to
methionine; vitamin B6 is required for the transsulfuration of homocysteine to cysteine.
A good correlation between serum homocysteine, and vitamin B12 levels observed in
our study support this view. It is justifiable to administer Inj vitamin B12, 1500µgm to all
patients developing pre eclampsia as prophylactic dose to prevent further complications
of PIH.
From the above discussion we can assume that biochemical screening such as
homocysteine, vitamins B12 are of paramount importance in preeclampsia. The inverse
relation between homocysteine, and vitamin B12 indicates that severity associated with
metabolic disturbances in preeclampsia can contribute to obstetric complications[14].
On the other hand, there is an absolute need for large studies designed to answer the
question as to whether hyper homocysteinemia and vitamin B12 deficiency are
associated with increased risk for pre eclampsia and whether therapy of these disorders
might influence maternal mortality & morbidity [15]. Further studies should help define
8. the role of genetic polymorphism in enzymes of homocysteine, folic acid, vitamin B12
metabolism and their role in pre eclampsia [16].
References
1. Hogg BB, Tamura T, Johnston KE, DuBard MB, Goldenberg MA, Goldenberg
RL. Second-trimester plasma homocysteine levels and pregnancy-induced
hypertension, preeclampsia, and intrauterine growth restriction. Am J Obstet
Gynecol. 2000; 183:805–9.
2. Vollset SE, Refsum H, Irgens LM, Emblem BM, Tverdal A, Gjessing HK, et al.
Plasma total homocysteine, pregnancy complications, and adverse pregnancy
outcomes: the Hordaland homocysteine study. Am J Clin Nutr. 2000;71:962–8.
3. Gambhir D S, Gambhir J K (2000) Homocysteine metabolism in health &
disease, Indian Heart Journal 52(suppl) 59-515 .
4. Hankey G L, Eikelboom J W(2000) Homocysteine and vascular disease. Indian
Heart Journal, 52 (suppl) 518-526.
5. Barron WM, Murphy MB, Lindheimer MD. Management of hypertension during
pregnancy. In: Laragh GH, Brenner BM, editors. Hypertension: pathophysiology,
diagnosis and management. Raven: New York; 1990. p. 1809–27.
6. Desouza C, Keebler M, McNamara D M & Fonseca V(2002)- Drugs affecting
homocysteine metabolism; Drugs 62(4) 605-606.
7. Clarke R, Daly L, Robinson K, Naughten E Cabalane S, et al (1991)
Hyperchromocystenemia; an independent risk factor in vascular disease, New
England Journal of Medicine 324 (17) 1149-1155.
9. 8. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease:
evidence on causality from a meta-analysis. Br Med J. 2002; 325:1202–6.
9. Voutilainen S, Rissanen TH, Virtanen J, Lakka TA, Salonen JT. Low dietary folic
acid intake is associated with an excess incidence of acute coronary events: the
Kuopio ischemic heart disease risk factor study. Circulation. 2001; 103:2674–80.
10. Klerk M, Verhoef P, Clarke R. MTHFR studies collaboration group. MTHFR 677C
T polymorphism and risk of coronary heart disease: a meta-analysis. J Am Med
Assoc. 2002; 288:2023–31.
11. Ueland PM, Refsum H, Stabler SP, Malinow MR, Andersson A, Allen RH. Total
homocysteine in plasma or serum: methods and clinical applications. Clin Chem.
1993; 39:1764–79.
12. Walker MC, Smith GN, Perkins SL, Keely EJ, Garner PR. Changes in
homocysteine levels during normal pregnancy. Am J Obstet Gynecol. 1999;
180:660–4.
13. Bostom AG, Lathrop L. Homocysteinemia in end-stage renal disease:
prevalence, etiology, and potential relationship to arteriosclerotic outcomes.
Kidney Int. 1997;52:10–20.
14. Mignini L, Latthe P, Villar J, Kilby M, Carroli G, Khan K. Mapping the theories of
preeclampsia: the role of homocysteine. Obstet Gynecol. 2005;105: 411–25.
15. Lachmeijer AM, Arnigrimsson R, Bastiaans EJ, Pals G, ten Kate LP, de Vries
JIP. Mutation in the gene for methylenetetrahydrofolate reductase, homocysteine
levels and vitamin status in women with history of preeclampsia. Am J Obstet
Gynecol. 2001;184:394–402.
10. 16. Finkelstein JD. Methionine metabolism in mammals. J Nutr Biochem.
1990;1:228–37.
Table 1 Demographic data in controls
Parameters Eclampsia Pre- Past History Control group P-value
group eclampsi of PET/ without any
(n=10) a Eclampsia past history or
Group group (n=10) PET/
(n = 10) Eclampsia
in present
pregnancy
(n = 10)
Age (years) 21.6±2.3 22.1±3.1 25.5±3.3 25.1±2.4 <0.05
Gestation age 32 36 36 36
(weeks)
Parity P1=02 P1=06 Eclampsia=02 P1=04
P2=06 P2=02 Pre P2=4
P3=02 P3=02 eclampsia=06 P3=02
SBP (mm of Hg) 158.7±7.1 144.3±4.6 118.1±8.2 120.3±6.1 <0.05
DBP (mm of Hg) 108.1±5.2 96.3±3.1 90.6±2.9 84.0±3.9 <0.05
Proteinuria Significant Significant Not Significant Absent <0.05
mg/24hr
The results were compared between preeclampsia/eclampsia groups & control group.
The values are presented as mean ± S.D.
11. Table2–Baseline Serum total homocysteine and vitamin B12 levels in four groups.
Parameters Eclampsia Pre- Past History Control P-value
group eclampsia of PET/ group
(n=10) Group Eclampsia (n = 10)
(n = 10) group
(n=10)
Homocysteine 34.1±6.2 22.3±4.8 10.97±1.61 8.8±3.2 <0.01
(μmol/l)
Vitamin B12 131.9±20.5 157.4±44.8 411.4±8.3 624.6±11.9 <0.05
(pg/ml)
Hb% 9.28±2.5 9.39±3.2 9.22±3.8 9.65±1.9 >0.05
The results were compared between preeclampsia/eclampsia groups & control.
The values are presented as mean ± SEM.
Table 3:- No of patients treated with Inj B12 in each group.
Drug Eclampsia Pre-eclampsia Past History P-value
group Group of PET/
(n=10) (n = 10) Eclampsia
group
(n=02)
Vitamin B12 10 10 02 <0.05
(pg/ml)
Table 4:- Serum homocysteine & Vit B12 levels after Inj B12 treatment in each
group. The values are presented as mean ± SEM.
12. Drug Eclampsia Pre-eclampsia P-value
group Group
(n=10) (n = 10)
Homocystein(µmol/l 14.51±7.14 11.03±2.34 <0.001
)
Vitamin B12 (pg/ml) 1239.1±755.7 1412.4±615.1 <0.01
Table 5 -Correlation of total homocysteine and vitamin B12 in preeclampsia
patients
Parameters ‘r’ Value P-value
Homocysteine -0.71 <0.0001
Vitamin B12 (pg/ml) -0.52 <0.01
r = Correlation coefficient
Table 6- Obstetric and perinatal outcome among all 04 groups
13. Parameters Eclampsia Pre- Past Control P-value
group eclampsia History group
(n=10) Group of PET/ (n = 10)
(n = 10) Eclampsia
group
(n=10)
Perinatal outcome
Low Birth weight 100% 40% 20% 10% <0.001
IUGR 60% 30% 20% 10% <0.001
IUD 10% 0% 0% 0% -
Abruptio Placentae 10% 0% 0% 0% -
Need for NICU 80% 60% 20% 20% <0.001
Need for 60% 40% 10% 10% <0.001
Resuscitation
1 Min APGAR<7 40% 30% 20% 10% <0.001
Maternal outcome
Normal delivery 40% 60% 70% 80% <0.001
Cesarean Section 40% 40% 30% 10% <0.001
Instrumental 20% 0% 0% 10% -
Delivery( Forceps/
Vacuum)
DIC 2% 0% 0% 0%