Introdução: Dispepsia funcional é uma doença que possui critérios diagnósticos definidos por reuniões de consenso, conhecidos por critérios de Roma. Apresenta alta prevalência mundial, grande impacto social e redução na qualidade de vida do indivíduo. Helicobacter pylori está envolvida na patogênese da dispepsia funcional, sendo indicada sua detecção e erradicação no tratamento dos pacientes dispépticos funcionais. H. pylori também tem sido sugerida como um importante agente na etiologia de níveis baixos de Vitamina B12 no soro. A hiperhomocisteinemia secundária à deficiência de Vitamina B12 e folato podem constituir um risco para as doenças cardiovasculares. Objetivo: investigar a relação entre os níveis séricos de Vitamina B12, folato e homocisteína e infecção pelo H. pylori em pacientes dispépticos funcionais. Métodos: Foram incluídos pacientes dispépticos funcionais, pelos critérios de Roma III do estudo HEROES (Helicobacter Eradication Relief of Dyspeptic Symptoms) - ClinicalTrials.gov número NCT00404534. Os pacientes dispépticos que apresentaram positividade para H. pylori foram randomizados para erradicação da bactéria com antibiticoterapia oral ou placebo. Após doze meses realizaram o segundo exame endoscópico com mesma metodologia. Da amostra total, 77 continuaram positivos para a infecação por H. pylori e 77 tiveram como resultado a erradicação da bactéria H. pylori, ou seja, negativaram. O material biológico foi previamente coletado e armazenado, além dos respectivos dados demográficos e clínicos. As amostras foram armazenadas a -80◦C em ependorf e realizadas medidas em soro dos níveis de vitamina B12 e folato e homocisteína. Resultados: Da amostra total, 77 pacientes eram H. pylori positivo (15 homens e 62 mulheres) e 77 eram H.pylori erradicados (21 homens e 56 mulheres). A média de idade foi de 47,8±11,5, em relação à idade e gênero não houve diferença significativa entre os grupos (p > 0,05). Quanto aos resultados reunidos em categorias (níveis de vitamina B12, folato e homocisteína), conforme os pontos de corte usados na literatura, não foi observada diferença estatisticamente significativa entre os dois grupos de pacientes (p > 0,6). Não houve correlação entre idade e níveis de vitamina B12 (p = 0,924). Houve diferença entre gêneros para homocisteína (p = 0,035), porém não houve significância para vitamina B12 (p = 0,584) e folato (p = 0,312). Não houve diferença entre níveis de homocisteína de pacientes H. pylori positivos e H. pylori erradicados para ambos os gêneros (p > 0,5). Conclusões: O presente estudo demonstrou que não houve relação significativa entre os níveis séricos de Vitamina B12, folato e homocisteína e infecção por H. pylori em relação aos H. pylori erradicados nos dispépticos funcionais. E quanto aos níveis de homocisteína comparados entre gêneros, os valores foram mais altos em homens. / Introduction: Functional dyspepsia a disease which has diagnosis criteria defined by consensus gatherings, known as the Rome criteria. It is highly prevalent worldwide, has great social impact, and reduces the quality of life of individuals. Helicobacter pylori is involved in the pathogenesis of functional dyspepsia, and its detection and eradication are indicated in the treatment of functional dyspepsia patients. H. pylori has also been suggested as an important agent in the etiology of low levels of vitamin B12 in serum. A hyperhomocysteinemia secondary to vitamin B12 and folate deficiencies could pose a risk for cardiovascular diseases. Objective: To investigate the relationship among the serum levels of Vitamin B12, folate and homocysteine, and the H. pylori infection in functional dyspeptic patients. Methodology: A group of patients with functional dyspepsia was included, following the Rome III criteria from the study HEROES (Helicobacter Eradication Relief of Dyspeptic Symptoms) – ClinicalTrials.gov number NCT00404534. The dyspeptic patients who were positive for H. pylori in tissue biopsy were randomized to eradication of the bacteria with oral antibiotic therapy or placebo. After twelve months, a second endoscopy was performed with the same methodology. Of the total sample, 77 patients remained positive for H. pylori and 77 patients had as a result the eradication of H. pylori bacteria, that is, they became negative. The biological material was previously collected and stored, besides its demographic and clinical data. The samples were stored at -80◦C in Eppendorf, they were measured in the serum of vitamin B12 folate and homocysteine levels. Results: Of the total sample, 77 patients were positive for H. pylori (15 men, 62 women) and 77 patients had the eradication of H. pylori (21 men, 56 women). The average age of the sample was about 47,8±11,5,regarding age and gender, it was not observed significant difference between the groups (p > 0,05). Concerning the results gathered into categories (the levels of vitamin B12, folate, and homocysteine), as the cut off points used in the literature, it was not observed statistically significant difference between the two groups of patients (p > 0,6). There was no correlation between age and vitamin B12 levels (p = 0,924). There was difference between genders for homocysteine (p = 0,035), but there was no significant difference for vitamin B12 (p = 0,584) and folate (p = 0,312). There was no difference between homocysteine levels of positive patients for H. pylori and H. pylori eradication in both genders (p > 0.5). Conclusions: The study showed no significant relationship between the serum levels of vitamin B12, folate, and homocysteine and the H. pylori infection in relation to H. pylori eradication in functional dyspeptic patients. Regarding homocysteine levels compared between genders, the values were higher in men.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-08-03T18:51:56Z No. of bitstreams: 1 RenatoLeal Associação de polimorfismos nos genes....pdf: 1146092 bytes, checksum: dc3d04e8dbf3baaa5becc9279b8cc89f (MD5) / Made available in DSpace on 2012-08-03T18:51:56Z (GMT). No. of bitstreams: 1 RenatoLeal Associação de polimorfismos nos genes....pdf: 1146092 bytes, checksum: dc3d04e8dbf3baaa5becc9279b8cc89f (MD5) Previous issue date: 2008 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / Níveis elevados de homocisteína (Hcy) no plasma têm sido associados à presença de polimorfismo no gene da Metilenotetrahidrofolato Redutase (MTHFR), Metionina Sintase (MS) e Cistationina beta Sintetase (CBS) ou relacionados com quadros nutricionais, que podem alterar uma das duas vias metabólicas que envolvem os precursores do metabolismo da Hcy, remetilação ou trans-sulfuração. Desta forma, os polimorfismos gênicos associados ao metabolismo da vitamina B12, folato podem conferir níveis elevados de homocisteína, assim como diminuição nos níveis de folato e vitamina B12 plasmático, produzindo complicações durante a gravidez bem como, alterações na metilação do DNA e conseqüentemente evoluir para doenças cardíacas, vasculares, câncer, síndrome de Down, defeitos de fechamento de tubo neural e baixo peso ao nascer. Considerando o metabolismo anormal de folato, vitamina B12 e homocisteína às mutações do gene de enzimas envolvidas no metabolismo destes podem ser marcadores de fatores de risco materno. O objetivo deste trabalho foi investigar em 240 mães e 240 recém-nascidos (RNs) associações entre os polimorfismos presentes em genes responsáveis no metabolismo da homocisteína e seus substratos caracterizando de forma hematológica, bioquímica e molecular. Foram investigados os polimorfismos C677T e A1298C no gene da MTHFR; A2756G no gene da metionina sintase (MS) e a inserção 844ins68 no gene da enzima cistationina beta sintetase (CBS), utilizando a técnica de PCR – RFLP. Os níveis séricos de homocisteína, vitamina B12 e folatos foram determinados pela técnica de quimioluminescência. As freqüências alélicas dos polimorfismos entre 191 mães e 226 recém-nascidos foram 27,7%. e 25,6%, respectivamente, para o polimorfismo C677T da MTHFR; 14,0% e 14,6%, respectivamente, para o polimorfismo A1298C da MTHFR; 23,9% e 24,5%, respectivamente, para o polimorfismo A2756G da MS; e 22,3% e 20,2%, respectivamente, para a inserção 844ins68 da CBS. Os níveis de Folatos e Vitamina B12 entre mães normais e portadores para os diversos genótipos estudados não demonstraram diferenças estatisticamente significativas. Porém, para os RNs diferenças estatisticamente significantes foram encontradas para os portadores do polimorfismo A2756G e níveis de vitamina B12 (p=0,0023). Diferenças estatísticas significantes foram encontradas entre mães normais e portadores para o polimorfismo A1298C e níveis de homocisteína (p=0,0002). Também foram encontradas diferenças estatisticamente significantes para a ocorrência dos polimorfismos C667T da MTHFR e valores de leucócitos (p=0,0482); A2756G da MS e valores de leucócitos (p=0,0168) e de Ht (p=0,0103); e 844ins68 da CBS e valores de Hb (p=0,0432) no grupo de mães.Para o grupo de RNs os dados hematológicos apresentaram significância estatística apenas entre os valores de plaquetas (p=0,0247) e HCM (p=0,0278) e o polimorfismo A1298C. Os resultados deste estudo contribuem para o entendimento de fatores genéticos relacionados com nutrientes indicando a grande importância de apontar os fatores de risco que possam ser prevenidos e definir estratégias intervencionistas que reduzam os riscos maternos, bem como os cuidados que devem ser tomados durante o acompanhamento pediátrico relacionado aos níveis séricos de Vitamina B12 e folatos e a ocorrência de alterações genéticas de enzimas, uma vez que a presença destas pode conduzir a associação de riscos relacionados a doenças genéticas. / High levels of homocysteine (Hcy) in plasma have been associated with the presence of the polymorphism in the gene MTHFR, Methionine Synthase (MS) and Cystathionine beta Synthase (CBS) or related to nutrition tables, which can alter one of two metabolic pathways involving the precursors of metabolism of Hcy, remethylation or trans-sulphuration. Thus the gene polymorphisms associated with the metabolism of vitamin B12, folate can give high levels of homocysteine, as well as reduction in the levels of folate and vitamin B12 plasma, producing complications during pregnancy as well as changes in methylation of DNA and thus evolve into heart disease, vascular, cancer, Down syndrome, defects in the neural tube closure and low birth weight. Considering the abnormal metabolism of folate, vitamin B12 and homocysteine to mutations of the gene of enzymes involved in the metabolism of these can be markers of risk factors mother. The research aimed to investigate in 240 mothers and 240 newborns (NBs) associations between polymorphisms in these genes responsible for the metabolism of homocysteine and their way of characterizing substrates hematological, biochemical and molecular. We investigated the C677T and A1298C polymorphisms in the gene MTHFR; A2756G in the gene of methionine synthase (MS) and 844ins68 insertion in the gene of the enzyme cystathionine beta synthase (CBS), using the technique of PCR - RFLP. Serum levels of homocysteine, vitamin B12 and folate were determined by the technique of chemiluminescences. Allelic frequencies of polymorphisms between 191 mothers and 226 newborns were 27.7%. and 25.6% respectively, for the MTHFR C677T polymorphism, 14.0% and 14.6% respectively in the A1298C of MTHFR polymorphism, 23.9% and 24.5% respectively in the A2756G polymorphism of MS, and 22.3% and 20.2% respectively in the integration of CBS 844ins68. The levels of Folate and Vitamin B12 between mothers and normal carriers for the various genotypes studied showed no statistically significant differences. But for NBs statistically significant differences were found to carry the A2756G polymorphism and levels of vitamin B12 (p = 0.0023). Significant statistical differences were found between normal and mothers bearers for the polymorphism A1298C and levels of homocysteine (p=0.0002).Were also found statistically significant differences in the occurrence of the MTHFR C667T polymorphism and values of white blood cells (p = 0.0482); A2756G of MS and values of white blood cells (p = 0.0168) and Ht (p = 0.0103) and 844ins68 of CBS and values of Hb (p = 0.0432) in the group of mothers. For the group of NBs data hematological statistically significant only between the values of platelets (p = 0.0247) and HCM (p = 0.0278) and A1298C polymorphism. The results of this study contribute to the understanding of genetic factors related nutrients indicating the great importance of pointing the risk factors that can be prevented and interventionist strategies that reduce risks maternal, and the care that must be taken during the pediatric related to the serum levels of vitamin B12 and folate and the occurrence of genetic modification of enzymes, since the presence of these can lead to association of risks related to genetic diseases.

Avsaknad av en ”gyllene standard” och en låg sensitivitet hos förstahandsmarkören total B12 har varit de stora begränsningarna i diagnostiken av vitamin B12-brist anemier. Med syftet att förbättra diagnostiken av bristanemier vid Länssjukhuset Ryhov, Jönköping utvärderades användningen av aktivt B12 vid bristanemiutredningar och en metodverifiering för analysen genomfördes på ARCHITECT i2000SR. Sambandet mellan aktivt B12 och totalt B12 undersöktes med en korrelationsanalys för totalt B12-nivåer: låg (n=10, <148 pmol/L), gråzonen (n=10, 149–200 pmol/L) och normal (n=10, 201-250 pmol/L). För bestämning av träffsäkerheten hos aktivt B12 studerades 14 bristanemifall. Ett receiver operating characteristic (ROC) diagram skapades och arean under kurvan (AUC) beräknades. Variationskoefficient (CV) för mellanliggande- och inomserieprecision för aktivt B12 var 4,4 % respektive 2,4 %. Svag korrelation observerades i alla B12-nivåer, men sammantaget resulterade nivåerna i en medelstark korrelation (R=0,600). Aktivt B12 med ett gränsvärde på 40 pmol/L resulterade i en hög specificitet (75 %) och sensitivitet (80 %) med en AUC på 90 %. Analys av aktivt B12 på ARCHITECT i2000SR möjliggör en precis mättning av aktivt B12 i humant serum och därför är lämplig för rutinmässig användning. Träffsäkerheten hos aktivt B12 var hög och markören kan därmed rekommenderas för användning vid bristanemiutredningar vid Länssjukhuset Ryhov, Jönköping. / Diagnosis of vitamin B12-defiency anemia has been challenging due to lack of ”gold standard” and poor sensitivity of total B12 as a first line marker. With the aim of improving diagnostic of anemia investigations at county hospital Ryhov, Jönköping, we performed a method verification for active B12 on ARCHITECT i2000SR and evaluated the usefulness of active B12 in diagnosing anemia. Correlation analysis was performed using samples with different total B12 ranges: low (n=10, <148 pmol/L), grey zone (n=10, 149-200 pmol/L) and normal (n=10, 201-250 pmol/L). Receiver operating characteristic (ROC) curve was created and area under the curve (AUC) was calculated for determining accuracy of active B12 using 14 deficiency cases. Coefficient of variation (CV) for within-run and total imprecision, for active B12 was 2,4 % and 4,4 %, respectively. Weak correlation was found between B12-ranges, however a moderate correlation (R=0,600) was found including all groups. Active B12 with the cut-off value of 40 pmol/L resulted in high specificity (75%) and sensitivity (80%) and had an AUC of 90 %. Active B12 assay on ARCHITECT i2000SR allows a precise measurement of active B12 in human serum and therefore is adequate for routine use. Active B12 had high accuracy and can be recommended in anemia investigations in county hospital Ryhov, Jönköping.

Made available in DSpace on 2015-05-14T13:21:12Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3333692 bytes, checksum: e71b4d85905df1c6c6682ec93607bd12 (MD5) Previous issue date: 2011-11-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / In this work was developed a luminometer for analysis by chemiluminescence, coupled to a flow-batch analysis automatic system. The performance of the developed instrument was evaluated by means of the determination of vitamin B12 in pharmaceutical formulations. The chemical principle is based on the catalytic effect of cobalt (II) ion over luminol oxidation by hydrogen peroxide in alkaline medium whose reaction product emits electromagnetic radiation in visible region (more precisely at 425 nm). The detection system of the developed instrument consisted of a silicon photodiode and a module for amplification of analytical signals. The univariate calibration model was validated by means of Analysis of Variance (ANOVA) and used later in the quantification of vitamin B12 in real samples. The limits of detection and quantification obtained were 0.11 and 0.36 μg L-1 of vitamin B12. The analytical frequency was estimated in 90 samples h-1. The accuracy of the proposed instrument was attested by means of recovery tests whose obtained recovery rates were between 98 and 102%. The proposed instrument yielded results with satisfactory precision, as revealed by low value of overall standard deviation. Such results demonstrated that is possible to quantify vitamin B12 employing a simple, economic and robust method which generate low amount of waste to the environment. / Neste trabalho foi desenvolvido um luminômetro para análise por quimiluminescência, acoplado a um sistema automático de análise em fluxo-batelada. O desempenho do instrumento desenvolvido foi avaliado por meio da determinação de vitamina B12 em medicamentos. O princípio químico do sistema baseia-se no efeito catalítico do íon cobalto (II) sobre a oxidação do luminol pelo peróxido de hidrogênio em meio alcalino cujo produto da reação emite radiação eletromagnética na região visível (mais precisamente em 425 nm). O sistema de detecção do instrumento desenvolvido consiste de um fotodiodo de silício e de um módulo para amplificação dos sinais analíticos. O modelo de calibração univariado foi validado por meio da Análise de Variância (ANOVA) e usado posteriormente na quantificação de vitamina B12 em amostras reais. Os limites de detecção e quantificação obtidos foram 0,11 e 0,36 μg L-1 de vitamina B12. A frequência analítica foi estimada em 90 amostras h-1. A exatidão do instrumento proposto foi atestada por meio de testes de recuperação cujas taxas obtidas foram entre 98 e 102%. O instrumento proposto forneceu resultados com precisão satisfatória, como revelado pelo baixo valor de desvio padrão conjunto. Tais resultados obtidos demonstram que é possível quantificar vitamina B12 utilizando um método simples, econômico, robusto e que produz baixa quantidade de resíduos para o meio ambiente.

Introdução: Dispepsia funcional é uma doença que possui critérios diagnósticos definidos por reuniões de consenso, conhecidos por critérios de Roma. Apresenta alta prevalência mundial, grande impacto social e redução na qualidade de vida do indivíduo. Helicobacter pylori está envolvida na patogênese da dispepsia funcional, sendo indicada sua detecção e erradicação no tratamento dos pacientes dispépticos funcionais. H. pylori também tem sido sugerida como um importante agente na etiologia de níveis baixos de Vitamina B12 no soro. A hiperhomocisteinemia secundária à deficiência de Vitamina B12 e folato podem constituir um risco para as doenças cardiovasculares. Objetivo: investigar a relação entre os níveis séricos de Vitamina B12, folato e homocisteína e infecção pelo H. pylori em pacientes dispépticos funcionais. Métodos: Foram incluídos pacientes dispépticos funcionais, pelos critérios de Roma III do estudo HEROES (Helicobacter Eradication Relief of Dyspeptic Symptoms) - ClinicalTrials.gov número NCT00404534. Os pacientes dispépticos que apresentaram positividade para H. pylori foram randomizados para erradicação da bactéria com antibiticoterapia oral ou placebo. Após doze meses realizaram o segundo exame endoscópico com mesma metodologia. Da amostra total, 77 continuaram positivos para a infecação por H. pylori e 77 tiveram como resultado a erradicação da bactéria H. pylori, ou seja, negativaram. O material biológico foi previamente coletado e armazenado, além dos respectivos dados demográficos e clínicos. As amostras foram armazenadas a -80◦C em ependorf e realizadas medidas em soro dos níveis de vitamina B12 e folato e homocisteína. Resultados: Da amostra total, 77 pacientes eram H. pylori positivo (15 homens e 62 mulheres) e 77 eram H.pylori erradicados (21 homens e 56 mulheres). A média de idade foi de 47,8±11,5, em relação à idade e gênero não houve diferença significativa entre os grupos (p > 0,05). Quanto aos resultados reunidos em categorias (níveis de vitamina B12, folato e homocisteína), conforme os pontos de corte usados na literatura, não foi observada diferença estatisticamente significativa entre os dois grupos de pacientes (p > 0,6). Não houve correlação entre idade e níveis de vitamina B12 (p = 0,924). Houve diferença entre gêneros para homocisteína (p = 0,035), porém não houve significância para vitamina B12 (p = 0,584) e folato (p = 0,312). Não houve diferença entre níveis de homocisteína de pacientes H. pylori positivos e H. pylori erradicados para ambos os gêneros (p > 0,5). Conclusões: O presente estudo demonstrou que não houve relação significativa entre os níveis séricos de Vitamina B12, folato e homocisteína e infecção por H. pylori em relação aos H. pylori erradicados nos dispépticos funcionais. E quanto aos níveis de homocisteína comparados entre gêneros, os valores foram mais altos em homens. / Introduction: Functional dyspepsia a disease which has diagnosis criteria defined by consensus gatherings, known as the Rome criteria. It is highly prevalent worldwide, has great social impact, and reduces the quality of life of individuals. Helicobacter pylori is involved in the pathogenesis of functional dyspepsia, and its detection and eradication are indicated in the treatment of functional dyspepsia patients. H. pylori has also been suggested as an important agent in the etiology of low levels of vitamin B12 in serum. A hyperhomocysteinemia secondary to vitamin B12 and folate deficiencies could pose a risk for cardiovascular diseases. Objective: To investigate the relationship among the serum levels of Vitamin B12, folate and homocysteine, and the H. pylori infection in functional dyspeptic patients. Methodology: A group of patients with functional dyspepsia was included, following the Rome III criteria from the study HEROES (Helicobacter Eradication Relief of Dyspeptic Symptoms) – ClinicalTrials.gov number NCT00404534. The dyspeptic patients who were positive for H. pylori in tissue biopsy were randomized to eradication of the bacteria with oral antibiotic therapy or placebo. After twelve months, a second endoscopy was performed with the same methodology. Of the total sample, 77 patients remained positive for H. pylori and 77 patients had as a result the eradication of H. pylori bacteria, that is, they became negative. The biological material was previously collected and stored, besides its demographic and clinical data. The samples were stored at -80◦C in Eppendorf, they were measured in the serum of vitamin B12 folate and homocysteine levels. Results: Of the total sample, 77 patients were positive for H. pylori (15 men, 62 women) and 77 patients had the eradication of H. pylori (21 men, 56 women). The average age of the sample was about 47,8±11,5,regarding age and gender, it was not observed significant difference between the groups (p > 0,05). Concerning the results gathered into categories (the levels of vitamin B12, folate, and homocysteine), as the cut off points used in the literature, it was not observed statistically significant difference between the two groups of patients (p > 0,6). There was no correlation between age and vitamin B12 levels (p = 0,924). There was difference between genders for homocysteine (p = 0,035), but there was no significant difference for vitamin B12 (p = 0,584) and folate (p = 0,312). There was no difference between homocysteine levels of positive patients for H. pylori and H. pylori eradication in both genders (p > 0.5). Conclusions: The study showed no significant relationship between the serum levels of vitamin B12, folate, and homocysteine and the H. pylori infection in relation to H. pylori eradication in functional dyspeptic patients. Regarding homocysteine levels compared between genders, the values were higher in men.

Introdução: Dispepsia funcional é uma doença que possui critérios diagnósticos definidos por reuniões de consenso, conhecidos por critérios de Roma. Apresenta alta prevalência mundial, grande impacto social e redução na qualidade de vida do indivíduo. Helicobacter pylori está envolvida na patogênese da dispepsia funcional, sendo indicada sua detecção e erradicação no tratamento dos pacientes dispépticos funcionais. H. pylori também tem sido sugerida como um importante agente na etiologia de níveis baixos de Vitamina B12 no soro. A hiperhomocisteinemia secundária à deficiência de Vitamina B12 e folato podem constituir um risco para as doenças cardiovasculares. Objetivo: investigar a relação entre os níveis séricos de Vitamina B12, folato e homocisteína e infecção pelo H. pylori em pacientes dispépticos funcionais. Métodos: Foram incluídos pacientes dispépticos funcionais, pelos critérios de Roma III do estudo HEROES (Helicobacter Eradication Relief of Dyspeptic Symptoms) - ClinicalTrials.gov número NCT00404534. Os pacientes dispépticos que apresentaram positividade para H. pylori foram randomizados para erradicação da bactéria com antibiticoterapia oral ou placebo. Após doze meses realizaram o segundo exame endoscópico com mesma metodologia. Da amostra total, 77 continuaram positivos para a infecação por H. pylori e 77 tiveram como resultado a erradicação da bactéria H. pylori, ou seja, negativaram. O material biológico foi previamente coletado e armazenado, além dos respectivos dados demográficos e clínicos. As amostras foram armazenadas a -80◦C em ependorf e realizadas medidas em soro dos níveis de vitamina B12 e folato e homocisteína. Resultados: Da amostra total, 77 pacientes eram H. pylori positivo (15 homens e 62 mulheres) e 77 eram H.pylori erradicados (21 homens e 56 mulheres). A média de idade foi de 47,8±11,5, em relação à idade e gênero não houve diferença significativa entre os grupos (p > 0,05). Quanto aos resultados reunidos em categorias (níveis de vitamina B12, folato e homocisteína), conforme os pontos de corte usados na literatura, não foi observada diferença estatisticamente significativa entre os dois grupos de pacientes (p > 0,6). Não houve correlação entre idade e níveis de vitamina B12 (p = 0,924). Houve diferença entre gêneros para homocisteína (p = 0,035), porém não houve significância para vitamina B12 (p = 0,584) e folato (p = 0,312). Não houve diferença entre níveis de homocisteína de pacientes H. pylori positivos e H. pylori erradicados para ambos os gêneros (p > 0,5). Conclusões: O presente estudo demonstrou que não houve relação significativa entre os níveis séricos de Vitamina B12, folato e homocisteína e infecção por H. pylori em relação aos H. pylori erradicados nos dispépticos funcionais. E quanto aos níveis de homocisteína comparados entre gêneros, os valores foram mais altos em homens. / Introduction: Functional dyspepsia a disease which has diagnosis criteria defined by consensus gatherings, known as the Rome criteria. It is highly prevalent worldwide, has great social impact, and reduces the quality of life of individuals. Helicobacter pylori is involved in the pathogenesis of functional dyspepsia, and its detection and eradication are indicated in the treatment of functional dyspepsia patients. H. pylori has also been suggested as an important agent in the etiology of low levels of vitamin B12 in serum. A hyperhomocysteinemia secondary to vitamin B12 and folate deficiencies could pose a risk for cardiovascular diseases. Objective: To investigate the relationship among the serum levels of Vitamin B12, folate and homocysteine, and the H. pylori infection in functional dyspeptic patients. Methodology: A group of patients with functional dyspepsia was included, following the Rome III criteria from the study HEROES (Helicobacter Eradication Relief of Dyspeptic Symptoms) – ClinicalTrials.gov number NCT00404534. The dyspeptic patients who were positive for H. pylori in tissue biopsy were randomized to eradication of the bacteria with oral antibiotic therapy or placebo. After twelve months, a second endoscopy was performed with the same methodology. Of the total sample, 77 patients remained positive for H. pylori and 77 patients had as a result the eradication of H. pylori bacteria, that is, they became negative. The biological material was previously collected and stored, besides its demographic and clinical data. The samples were stored at -80◦C in Eppendorf, they were measured in the serum of vitamin B12 folate and homocysteine levels. Results: Of the total sample, 77 patients were positive for H. pylori (15 men, 62 women) and 77 patients had the eradication of H. pylori (21 men, 56 women). The average age of the sample was about 47,8±11,5,regarding age and gender, it was not observed significant difference between the groups (p > 0,05). Concerning the results gathered into categories (the levels of vitamin B12, folate, and homocysteine), as the cut off points used in the literature, it was not observed statistically significant difference between the two groups of patients (p > 0,6). There was no correlation between age and vitamin B12 levels (p = 0,924). There was difference between genders for homocysteine (p = 0,035), but there was no significant difference for vitamin B12 (p = 0,584) and folate (p = 0,312). There was no difference between homocysteine levels of positive patients for H. pylori and H. pylori eradication in both genders (p > 0.5). Conclusions: The study showed no significant relationship between the serum levels of vitamin B12, folate, and homocysteine and the H. pylori infection in relation to H. pylori eradication in functional dyspeptic patients. Regarding homocysteine levels compared between genders, the values were higher in men.

Bakgrund: Alzheimers sjukdom (AD) utgör vanligaste formen av demenssjukdomar i Sverige. Alzheimers sjukdom klassas som en neurodegenerativ sjukdom och karaktäriseras av proteininlagringar samt av hjärnatrofi. Ungefär 150 000 personer i Sverige lever idag med demenssjukdomar, varav 90 000 lider av AD och varje år insjuknar ytterligare 20 000 i demens. Vitamin B12 och folat anses utgöra en viktig del med avseende på hjärnans kognitiva funktioner. Låga nivåer av vitamin B12 och/eller folatbrist medför en höjning av Homocystein (Hcy) i blodet. Syfte: Syftet med examensarbetet var att undersöka det eventuella sambandet mellan nivåerna av vitamin B12, folat respektive Hcy och risken för att drabbas av Alzheimers sjukdom. Utifrån syftet ställdes 2 frågeställningar upp. Frågeställning 1: Finns det en risk att utveckla AD vid förändrade nivåer av folat, vitamin B12 och Hcy. Frågeställning 2: Finns det ett samband mellan förändrade nivåer av folat, vitamin B12 och Hcy vid diagnosticerad AD. Metod: Detta arbete är en litteraturstudie baserat på 7 vetenskapliga artiklar. Resultat: Samtliga fem studier utifrån frågeställning 2 visade att AD-patienter hade höga nivåer av Hcy än kontrollpatienterna. Två av dessa studier visade även att AD-patienterna hade lägre nivåer av både vitamin B12 och folat än kontrollindividerna. Två ytterligare studier av de fem samtliga visade också lägre nivåer av folat än kontrollgruppen.  Totalt 4 av 5 studier visade lägre nivåer av folat. Utifrån frågeställning 1 visade studie 1 att det var enbart de låga nivåerna av folat från baslinjen som förespråkade till insjuknande i AD. Studie 2 indikerade att individer med låga nivåer av vitamin B12 och folat har 2 gånger högre risk för att insjukna i AD. Slutsats: Det är fortfarande oklart idag huruvida nivåerna av vitamin B12, folat och Hcy påverkar riskerna för att utveckla AD. Studierna visar att det finns ett samband mellan markörerna kopplat till AD. Det krävs mer forskning för att fastställa det eventuella sambandet mellan vitamin B12, folat och Hcy. Fler patienter måste undersökas och flera studier bör utföras för att kunna fastställa associationerna av dessa ämnen med AD. Studierna visar att det finns ett samband mellan markörerna kopplat till AD. Fler studier som tar hänsyn till inklusionskriterierna med avseende på nutritionsstatus bör göras.  Detta eftersom lågt BMI (Body Mass Index) kan vara av betydelse för uppkomsten samt riskerna för att insjukna i AD. / Background: Alzheimer's disease (AD) is the most common form of dementia in Sweden. Alzheimer's disease is classified as a neurodegenerative disease and is characterized by protein deposits in certain parts of the brain accompanied with brain atrophy. 150 000 people in Sweden today suffer from dementia, of whom 90 000 suffer from AD and every year another 20 000 dementia cases reside. The highest risk factor of developing AD is old age. After the age of 65, the risk is considerably higher for developing AD. Vitamin B12 and folate is considered to be an important part with respect to the brain's cognitive functions. Folate acts as a donor of the methyl groups in a reaction catalysed by methionine synthase, which produce methyl cobalamin which needs to be metabolised to methionine from Homocystein (Hcy). Low levels of vitamin B12 and/or folate deficiency leads to an increase of Hcy in the blood. Objective: The aim of this study was to investigate the possible link between low levels of vitamin B12, folate and Hcy and the risk of developing Alzheimer's disease. Two question based on the objective of the study were set. Question 1: Is there any risk of developing AD with altered levels of folate, vitamin B12 and Hcy? Question 2: Is there a relationship between altered levels of folate, vitamin B12 and Hcy in diagnosed AD? Methods: This work is a literature study based on 7 scientific articles. Results: All five studies from question 2 showed that AD patients had high levels of Hcy compared to control patients. Two of these studies also revealed that AD patients had lower levels of both vitamin B12 and folate than control individuals. Furthermore 2 out of the 5 studies also displayed lower levels of folate compared to the control group, resulting in a total of 4 out of 5 studies showing lower levels of folate. Based on question 1, study 1 presented that only low levels of folate at baseline correlated with developing AD. Study 2 indicated that individuals with low levels of vitamin B12 and folate had twice times higher risk of developing AD. Conclusion: It is still unclear whether the levels of vitamin B12, folate and Hcy affect AD. The studies investigated show that there is a correlation between the investigated markers linked to AD. However, more research is needed to be able to determine the possible link between vitamin B12, folate and Hcy. More patients must be investigated and several studies should be performed to determine the associations of these subjects with AD.  More studies that take in consideration of nutritional status must be carried out, due to the fact that low BMI (Body Mass Index) may be of importance for the risk of developing AD.

Dementia is prevalent among elderly people. As the world population ages, it is projected that the number of people affected by dementia may triple in the next 50 years. Over the last two decades, research has focused on identifying potentially modifiable risk factors in development and progression of dementia, such as vitamin B12 and folate. Results concerning the effects of low folate and vitamin B12 on cognitive performance are mixed. The main objective of the present study was to investigate the effects of vitamin deficiency on cognitive functioning in a clinical sample of elderly individuals with cognitive problems using a comprehensive neuropsychological assessment. A retrospective chart-review was performed on the 102 records of patients from the Geriatrics Clinic at the University of North Texas Health Science Center who presented with cognitive deficits. Charts were reviewed to obtain data on vitamin supplementation, vitamin status, history of chronic conditions and other biochemical data. The available database was used to obtain data on neuropsychological assessment. The study demonstrated mild association between vitamin B12 and folate status and cognitive deficits. There appeared to be a higher cut-off level that is above the traditionally used levels for vitamin B12 and folate deficiency concentrations at which cognitive deficits became more pronounced. Clinical applications, limitations and suggestions for future research were discussed.

Orientadores: Nelci Fenalti Höehr, Joyce Maria Annichino-Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:13:12Z (GMT). No. of bitstreams: 1 Barnabe_Aline_D.pdf: 1712567 bytes, checksum: 647e2ea59dbddb21e153a8e6ceae61cc (MD5) Previous issue date: 2014 / Resumo: Folato, vitamina B12 e ferro são nutrientes essenciais, cujas deficiências afetam indivíduos em todas as faixas etárias, sendo consideradas um problema de Saúde Pública no mundo. Níveis reduzidos de folato e vitamina B12 podem estar associados com níveis elevados de homocisteína (Hcy), e que eventualmente resultam em complicações. Entretanto, no Brasil, poucos estudos avaliaram a prevalência dessas deficiências, principalmente de folato e vitamina B12, após a fortificação de farinhas com ácido fólico e ferro. Os objetivos do presente estudo foram: avaliar a prevalência das deficiências de folato, vitamina B12 e ferro em idosos, crianças, gestantes e lactantes após a fortificação de farinhas com ácido fólico e ferro adotado pela ANVISA em 2004; e investigar a contribuição de polimorfismos genéticos sobre os níveis de folato, vitamina B12 e Hcy nestes indivíduos. Os indivíduos foram recrutados em Centros de Saúde da cidade de Campinas entre 2006 a 2007. No total, 719 indivíduos incluindo, 262 idosos, 106 crianças, 291 gestantes e 60 lactantes foram incluídos. As concentrações destes nutrientes foram mensuradas por eletroquimioluminescência; a dosagem de Hcy foi realizada por cromatografia líquida de alta eficiência (CLAE); e os polimorfismos foram investigados por PCR-RFLP. Os resultados mostraram que a prevalência das deficiências de folato, vitamina B12 e ferro no grupo total de indivíduos foram de 0,3%, 5,3% e 12,6%, respectivamente. Praticamente não se observou a deficiência de folato, presente apenas em um idoso e uma gestante, enquanto que a deficiência de vitamina B12 foi prevalente em gestantes (8,9%) e idosos (4,2%). Além disso, a deficiência de ferro e anemia ferropriva foram prevalentes em crianças (9,9% e 4,9%, respectivamente), e gestantes (25,1% e 5,5%, respectivamente). A hiperhomocisteinemia esteve presente principalmente em idosos (34,3%). Com relação aos polimorfismos, apenas as gestantes carreadoras dos alelos CT+TT do polimorfismo no gene MTHFR (C677T) mostraram níveis reduzidos de folato (p=0,030). Através da análise múltipla, observamos que os níveis de Hcy foram determinados principalmente pelo folato (p<0,001), vitamina B12 (p<0,001), gênero (p<0,001) e idade (p<0,001) em idosos; vitamina B12 (p= 0,011) em crianças e folato (p=0,002) em gestantes. Nossos resultados demonstraram que na população avaliada, após 2 anos do início da fortificação de farinhas com ácido fólico e ferro, a deficiência de folato é praticamente inexistente, ao contrário da deficiência de ferro e de vitamina B12. A elevada prevalência da deficiência de vitamina B12 em idosos e gestantes deve ser valorizada na prática, devido ao risco de complicações. O mesmo deve ser observado em relação à deficiência de ferro, prevalente em crianças e gestantes. Portanto, medidas como suplementação e a dosagem desses nutrientes, para grupos populacionais de risco, devem ser implementados em políticas de Saúde Pública. Além disso, a hiperhomocisteinemia observada em idosos pode ser um fator de risco ou um marcador de doença arterial, que é comum nesses indivíduos / Abstract: Folate, vitamin B-12 and iron are essential nutrients, whose deficiencies are considerable public health problems worldwide, affecting all age groups. Low levels of folato and vitamin B12 have been associated with high concentrations of homocysteine (Hcy) and can lead to complications. In Brazil, a few studies evaluated the prevalence of these nutrients, especially, folate and vitamin B12, post acid folic and iron fortification era. The aim of this study was to assess folate, vitamin B12 and iron deficiencies in distinct Brazilian populations including elderly, children, pregnant and lactating women, after the initiation of folic acid and iron fortification by Brazilian authorities. We also investigated the contribution of polymorphisms on folate, vitamin B12 and Hcy levels in these individuals. Folate, vitamin B12 and ferritin levels were measured by chemiluminescence immunoassays, and Hcy levels were determined by high-performance liquid chromatography. Genotype analyses of RFC1 A80G, GCPII C1561T and MTHFR C677T polymorphisms were performed by PCR-RFLP. The individuals were recruited from primary care centers in Campinas ¿ Brazil, between 2006 - 2007. In total 719 individuals, including elderly (262), children (106), pregnant women (291) and lactating women (60) were included. The overall prevalence of low folate, vitamin B-12 and iron status was 0.3%, 5.3% and 12.6%, respectively. Folate deficiency was practically inexistent and was observed only in elderly (n=1) and pregnant women (n=1), whereas vitamin B12 deficiency was frequent in pregnant women (8.9%) and elderly (4.2%). Moreover, iron deficiency and iron deficiency anemia were prevalent in children (9.9% and 4.9%, respectively) and pregnant women (25.1% and 5.5%, respectively). Plasma Hcy concentrations were significantly higher in the elderly (34.3%). Pregnant women carrying the MTHFR 677T allele (CT+TT) showed lower serum folate levels (p=0.030), but none of the polymorphisms investigated in this study affected folate, vitamin B12 and Hcy levels in elderly, children and lactating women. After a multivariate analysis, Hcy levels were predicted by variables such as folate (p<0.001), vitamin B12 (p<0.001), gender (p<0.001) and age (p<0.001) in elderly; vitamin B12 (p= 0.011) in children; and folate (p = 0.002) in pregnant women. Our results demonstrated that folate deficiency is practically inexistent in this population, two years after the initiation of folic acid fortification, in contrast to vitamin B12 and iron deficiency. The high prevalence of vitamin B12 deficiency in elderly and pregnant women is relevant due to health complications. Supplementation and measure of nutrients in some groups of the population should be indicated by Public Health¿s policies. Furthermore, hiperhomocysteinemia in elderly can be a risk factor or a marker of arterial disease, which is common in these individuals / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

Background: Folate and cobalamin are essential cofactors for homocysteine (HCY) metabolism. Hyperhomocysteinemia, a multifactorial condition, may reflect B vitamin deficiency and is associated with increased risk of cardiovascular disease, thrombosis, and neurodegenerative and chronic gastrointestinal diseases in humans. Hyperhomocysteinemia has been reported in Greyhounds with suspected chronic enteropathy. Objectives: To evaluate the frequencies of and the association between hypofolatemia and hyperhomocysteinemia in Greyhounds. Animals: Data and serum samples from 559 Greyhounds. Methods: Nested case-control study. The frequency of hypofolatemia in Greyhounds was determined by a laboratory database search. The relationship between hyperhomocysteinemia (measured by gas chromatography-mass spectrometry) and hypocobalaminemia and hypofolatemia was evaluated, and its frequency compared between healthy Greyhounds and Greyhounds with thrombosis or chronic diarrhea. Results: Hypofolatemia was identified in 172 of 423 (41%) Greyhounds and was more common in hypo- than in normocobalaminemic dogs (49% vs. 35%; P = .0064). Hyperhomocysteinemia was detected in 53 of 78 (68%) of Greyhounds, being more common in hypo- than in normofolatemic dogs (88% vs. 59%; P = .0175). All healthy Greyhounds, 21 of 30 (70%) of dogs with chronic diarrhea and 6 of 8 (75%) of those with thrombosis, were hyperhomocysteinemic. Serum HCY concentrations were inversely correlated with serum folate concentration (q = -0.28; P = .0386) and were positively associated with serum albumin concentration (q = 0.66; P = .0022). Conclusions and Clinical Relevance: Hyperhomocysteinemia occurs frequently in the Greyhound population. Its association with hypofolatemia suggests decreased intracellular availability of B vitamins, but the functional implications warrant further investigation. Hyperhomocysteinemia in Greyhounds potentially may serve as a spontaneous canine model to further investigate hyperhomocysteinemia in humans.