Acute Osmotic Central Pontine Demyelination in an Alcoholic Patient With Normal Sodium Levels and a Vitamin B6 Deficiency.

We report a Native American male in his 50s with a complex medical history including alcohol use disorder and seizure disorder who presented with complaints of generalized weakness and multiple falls. The patient was admitted for altered mental status, community acquired pneumonia, sepsis, and bacteremia. On hospital day 23, the patient reported a sudden onset of sensation of food stuck in his upper chest. Brain MRI confirmed osmotic demyelination syndrome (ODS) within the central pons. Further workup revealed this finding was likely due to malnutrition, alcoholism, hypoalbuminemia, and vitamin B6 deficiency. However, the patient presented with normonatremia throughout his entire hospital stay. After acute onset of ODS, the patient was transferred to the ICU where he continued to decline. After 68 days from initial presentation, the patient died in hospice care from myelinolysis complications. This case demonstrates a case of ODS of the central pons in a patient with normonatremia, hypoalbuminemia, and severe vitamin B6 deficiency.

Factors influencing vitamin B6 status in domestic cats: age, disease, and body condition score.

Limited studies are available on vitamin B6 status in domestic cats. To this end, we evaluated glutamate-oxaloacetate transaminase (GOT) activity in hemolysates with and without pyridoxal 5'-phosphate addition in two feline populations: a cohort of 60 healthy, domestic (sexually intact and specific pathogen-free) cats maintained under strictly controlled conditions with appropriate diets housed at the Feline Nutrition and Pet Care Center, and a cohort of 57 cats randomly selected between December 2022 to January 2023 that visited the Veterinary Medicine Teaching Hospital to seek care under different circumstances. The GOT activity expressed as the ratio with and without pyridoxal 5'-phosphate addition (primary activation ratio; PAR) decreased significantly with age in the healthy cohort. The PAR values normalized to age established a cut-off for vitamin B6 deficiency in both cohorts, identifying 17 of 101 animals as vitamin B6 deficient. Using machine learning, a partition-based model (decision tree) was built to identify the most important factors that predicted vitamin B6 deficiency while using the resulting tree to make predictions for new observations. This analysis, performed with all 101 cats, revealed that the diagnosis of an infectious, chronic or acute condition (0.55) was the main contributor, followed by age (0.26), and body condition score (optimal-overweight; 0.19). Thus, our study supports that vitamin B6 supplementation may be indicated in junior to adult animals diagnosed with an infectious, chronic, or acute conditions or healthy cats with body weight ranging from optimal to overweight. In older cats, even if healthy, underweight to optimal cats appear to be at risk of vitamin B6 deficiency.

Vitamin B6 deficiency cooperates with oncogenic Ras to induce malignant tumors in Drosophila.

Vitamin B6 is a water-soluble vitamin which possesses antioxidant properties. Its catalytically active form, pyridoxal 5'-phosphate (PLP), is a crucial cofactor for DNA and amino acid metabolism. The inverse correlation between vitamin B6 and cancer risk has been observed in several studies, although dietary vitamin B6 intake sometimes failed to confirm this association. However, the molecular link between vitamin B6 and cancer remains elusive. Previous work has shown that vitamin B6 deficiency causes chromosome aberrations (CABs) in Drosophila and human cells, suggesting that genome instability may correlate the lack of this vitamin to cancer. Here we provide evidence in support of this hypothesis. Firstly, we show that PLP deficiency, induced by the PLP antagonists 4-deoxypyridoxine (4DP) or ginkgotoxin (GT), promoted tumorigenesis in eye larval discs transforming benign RasV12 tumors into aggressive forms. In contrast, PLP supplementation reduced the development of tumors. We also show that low PLP levels, induced by 4DP or by silencing the sgllPNPO gene involved in PLP biosynthesis, worsened the tumor phenotype in another Drosophila cancer model generated by concomitantly activating RasV12 and downregulating Discs-large (Dlg) gene. Moreover, we found that RasV12 eye discs from larvae reared on 4DP displayed CABs, reactive oxygen species (ROS) and low catalytic activity of serine hydroxymethyltransferase (SHMT), a PLP-dependent enzyme involved in thymidylate (dTMP) biosynthesis, in turn required for DNA replication and repair. Feeding RasV12 4DP-fed larvae with PLP or ascorbic acid (AA) plus dTMP, rescued both CABs and tumors. The same effect was produced by overexpressing catalase in RasV12 DlgRNAi 4DP-fed larvae, thus allowing to establish a relationship between PLP deficiency, CABs, and cancer. Overall, our data provide the first in vivo demonstration that PLP deficiency can impact on cancer by increasing genome instability, which is in turn mediated by ROS and reduced dTMP levels.

Seizures due to pyridoxine deficiency in Parkinson's disease.

Parkinson's disease (PD) is a complex neurodegenerative disorder characterized not only by its hallmark motor symptoms but also by a myriad of non-motor manifestations, including cognitive decline, autonomic manifestations, and gastrointestinal disturbances. Amidst these, a lesser-known but critical aspect is the increased risk of functional deficiency of pyridoxine (vitamin B6) in patients with PD, which is linked to an increased risk of seizures. This review investigates the intersection of PD, new-onset seizures, and pyridoxine deficiency, aiming to elucidate the significance of these associations and their contributions to the neurologic burden in PD. Case reports documenting the occurrence of seizures in patients with PD, particularly in the context of high-dose dopaminergic therapy and the subsequent revelation of pyridoxine deficiency were included. These cases, which often featured extensive workups revealing unremarkable findings aside from pyridoxine deficiency, underscore the multifaceted nature of PD and its treatment-related complications. The findings in these case reports suggest that dietary insufficiencies, gastrointestinal dysfunctions, and drug-nutrient interactions may eventually precipitate pyridoxine deficiency, which in turn may lead to seizures by disrupting GABAergic neurotransmission. This sheds the light on the need for increased clinical awareness and routine monitoring of pyridoxine levels in patients with PD, especially those undergoing significant therapeutic adjustments or exhibiting comorbidities that might interfere with their dietary intake such as gastrointestinal manifestations or depression. Such proactive measures could potentially mitigate the impact of this complication in patients with PD, ultimately enhancing patient care and quality of life.

Pseudotumor cerebral asociado a hipovitaminosis A, B6 y D: A propósito de dos casos / Pseudotumor cerebri associated with hypovitaminosis A, B6 and D: About two cases

La hipertensión endocraneana idiopàtica se asocia infrecuentemente con la hipovitaminosis A y D. Se presenta el caso de una paciente femenina de 8 años con visión borrosa de 24 horas y papiledema bilateral. Resonancia magnética nuclear normal. Presión de apertura de líquido cefalorraquídeo: 260 mm^O. Presentó déficit de vitamina A y D, e inició un tratamiento sustitutivo. El segundo caso corresponde a un paciente masculino de 12 años con fiebre y odinofagia de 3 días. Con antecedente de glomerulonefritis y sobrepeso. Presentaba edema bipalpebral y papiledema. Tomografia axial computada de la órbita: aumento de líquido en la vaina de ambos nervios ópticos. Resonancia magnética nuclear: aracnoidocele intraselar. Presión de apertura de líquido cefalorraquídeo: 400 mm^O. Presentó déficit de vitamina D y B6, e inició el tratamiento sustitutivo. La elevación de la presión intracraneal desencadena mecanismos de compensación que, al fallar, pueden comprometer la vida o provocar graves discapacidades neurológicas. Reconocer la causa para un enfoque terapéutico preciso es clave para disminuir la morbimortalidad asociada a esta patología.

Idiopathic endocranial hypertension is infrequently associated with hypovitaminosis A and D. The case of an 8-year-old female with 24-hour blurred vision and bilateral papilledema is presented. Nuclear magnetic resonance was normal. Opening pressure of cerebrospinal fluid: 260 mm^O. She presented vitamin A and D deficiency and started replacement therapy. The second case corresponds to a 12-year-old male with fever and odynophagia of 3 days. History of glomerulonephritis and overweight. He had bipalpebral edema and papilledema. Computed tomography scan of the orbit: increase of fluid in the sheath of both optic nerves. Nuclear magnetic resonance: intrasellar arachnoidocele. Opening pressure of cerebrospinal fluid: 400 mmH2O. He presented vitamin D and B6 deficiency and started replacement treatment. The elevation of intracranial pressure triggers compensation mechanisms that, when they fail, can compromise life or cause serious neurological disabilities. Recognizing the cause for an accurate therapeutic approach is key to reduce the morbidity and mortality associated with this pathology.

Efeito das pilulas anticoncepcionais sobre o metabolismo da vitamina B6, acido folico, ferro serico, glicemia, hemoglobina e hematocrito. / Effect of oral contraceptives upon the metabolism of vitamin B6, folic acid serum iron, glycemia, hemoglobin and hematocrit

Os autores relatam a experiencia obtida com 21 pacientes, em relacao aos efeitos adversos ocasionados pelas pilulas anticoncepcionais e a sua correcao pelo uso de um complexo vitaminico especialmente formulado. Assinalam tambem ser este o primeiro trabalho da literatura nacional. Fazem inicialmente um levantamento bibliografico focalizando principalmente as alteracoes sobre o metabolismo da vitamina B6, acido folico, hidratos de carbono, ferro serico, hematocrito, hemoglobina e vitamina A. Das 21 pacientes 18 eram sintomaticas e tres nao. Todas elas foram submetidas a complementacao vitaminico-mineral formulada, durante dois meses, quando entao novos controles clinicos e laboratoriais foram realizados. Nos seus resultados salientam que 10 entre 18 sintomaticas apresentaram evidentes melhoras em relacao a administracao da vitamina B6 e a melhoria alcancada pela complementacao com o acido folico. Nao houve alteracoes significantes em relacao ao ferro serico, e nem foi possivel demonstrar a validade do efeito antidiabetogenico da formula empregada, devido a exiguidade da amostra.Todos estes dados exceto os da hemoglobina se encontram de acordo com a literatura medica

Efecto de dieta materna deficiente en vitamina B6 sobre el crecimiento de ratas lactantes / Effect of feeding rat dams with a B6 vitamin deficient diet on the growth of their pups

En el presente trabajo se estudió el efecto que produce el alimentar ratas madres con una dieta baja en Vitamina B6 sobre el crecimiento de las crías. Se encontró: a) La dieta pobre en Vitamina B6 se traduce en una menor ingesta de alimento y consecuentemente en un menor peso corporal por parte de las madres experimentales. b) Los lactantes experimentales presentan una tasa de crecimiento menor que los controles. c) Un aumento en la ingesta de alimento de las madres experimentales, se traduce en un aumento en la tasa de crecimiento de los lactantes. d) Un aumento en la ingesta de alimento de los lactantes experimentales, por disminución del número de los mismos en las camadas, se traduce en una tasa de crecimiento similar a la de las crías controles. e) El crecimiento del cerebro se ve también afectado en los lactantes experimentales, pero en menor grado que el crecimiento corporal. Los resultados se explican considerando que la dieta pobre en Vitamina B6 disminuye el apetito de las ratas madres. Las menor ingesta de alimento se traduce en una menor producción de leche. La menor disponibilidad de leche, se traduce en una desnutrición de la cría, lo cual afecta su crecimiento corporal

Responsabilidade do fator hemodinâmico na gênese da síndrome do túnel do carpo nos pacientes hemodialisados / Haemodynamic factor responsibility in the genesis of the carpal tunnel syndrome in haemodialyzed patients

A patologia esquelética representa uma complicaçäo importante no paciente dialisado a longo prazo, sendo numerosas as síndromes clínico-radiológicas de osteoartropatia com ela relacionadas. Entre essas, a síndrome de túnel do carpo é, sem dúvida, a mais importante e frequente. Muitos fatores säo mencionados como responsáveis na gênese da CTS no paciente dialisado crônico. Tendo presente o problema etiopatogênico, até hoje discutido, e considerando alguns dados clínicos verificados em 80 pacientes tratados na Divisäo de Cirurgia Plástica, iniciou-se um estudo com a finalidade de evidenciar o possível papel patogênico do fator hemodinâmico na gênese da síndrome do túnel do carpo no paciente hemodialisado. Os autores, com base nos resultados de um estudo retrospectivo, realizaram um estudo controlado, evidenciando o papel do fator hemodinâmico na gênese da síndrome do túnel do carpo no paciente hemodialisado. Os autores, com base nos resultados de um estudo retrospectivo, realizaram um estudo controlado, evidenciando o papel do fator hemodinâmico sobre os agentes etiológicos, no sentido de facilitar a determinaçäo da síndrome do túnel do carpo

Exposiçäo ocupacional ao sulfeto de carbono e hipovitaminose B6 / The occupational exposure to carbon disulphide and the hypovitaminosis B6

A teoria da inibiçäo da piridoxamina pelo CS2 e a conseqüência interferência no metabolismo do triptofano, tem sido estudada por alguns autores e se apresenta como muito promissora para a elucidaçäo de um dos mecanismos de açäo tóxica desse solvente industrial. A funçäo da Vitamina B6 no organismo humano, principalmente sobre o metabolismo do triptofano e a excreçäo do seu principal metabilito, o ácido xanturenico, é estudada no presente trabalho, correlacioando-se a exposiçäo ocupacional ao sulfeto de carbono

Efecto de dieta materna deficiente en vitamina B6 sobre el desarrollo del nervio óptico de ratas lactantes / Effect of maternal diet deficient in vitamin B6 on the development of the optic nerve of suckling rats

En el presente trabajo se estudió el efecto que produce el alimentar ratas madres con una dieta baja en vitamina B6, sobre el desarrollo del nervio óptico de las crías. Se encontró que: a) Los nervios ópticos de los animales experimentales presentan un mayor número de axones no mielinizados y un menor número de axones mielinizados, b) La distribución relativa de los axones mielinizados, agrupados según el número de sus lamelas, no se vió prácticamente afectada por las condiciones experimentales y c) el número de axones mielinizados con área de sección pequeña es mucho mayor en los animales experimentales que en los controles. Se concluye que la condición experimental se tradujo en una disminución en el número de axones mielinizados, sin producir efecto alguno sobre la velocidad de mielinización

Nutritional status of institutionalized elderly in south Florida

To assess the nutritional status of an elderly nursing home population of South Florida, forty-seven persons with ages ranging from 65 to 96 years were studied. Complete clinical examination and anthropometric measures were performed, along with blood cell count, biochemical blood parameters and assessment of water-soluble vitamins levels. The most common clinical finding were edentulous (67%), general pallor (44%), hyperpigmentation (33%), dry skin (26%) and arcus corneitis (26%). Thirty-five percent of the studied population had cholesterol levels greater than 220 mg/dl. Triglyceride levels were also significantly elevated in a considerable subset of our subjects, with 30% having levels above threshold value of 150 mg/dl. Small proportions of subjects showed low levels of albumin (6%), total protein (28%), ascorbic acid (2%), and thiamin (9%). Forty-five percent of males were pyridoxine deficient, while 63% of the females presented such deficiency. This study underscores the need to define, with greater precision, the nutritional status of aged populations as well as improve our inadequate standards associated with the normal aging process. Nutritional intervention--only possible when appropriate standards are defined--can potentially serve not only to prevent the occurrence of significant morbidity and mortality, but can also be employed to enhance quality of life in the elderly individuals

Estudo da interaçäo de niacina, vitamina B6 e zinco em ratos recebendo etanol / Interaction of niacin, vitamin B6 and zinc in rats with etanol administration

O presente trabalho foi realizado com a finalidade de verificar a possível interaçäo entre as deficiências de niacina, vitamina B6 e zinco; o efeito da falta simultânea desses nutrientes e a influência da repleçäo com um desses nutrientes, sobre o estado nutricional relativo aos outros nutrientes em ratos recebendo etanol. Foram estudados 150 ratos machos, Wistar, jovens. Eles foram inicialmente divididos em Grupos Deficiente, Controle de Milho e Controle de Caseína. Os do Grupo Deficiente receberam durante um período de depleçäo, de quatro semanas uma dieta deficiente à base de milho degerminado sem a adiçäo de niacina, vitamina B6 e zinco. Receberam também, durante este período uma soluçäo alcoólica, com posta de etanol e sacaraose. Após quatro semanas a soluçäo alcoólica foi substituida por água deionizada e os animais restantes foram divididos em seis sub-grupos de 10 animais. Um sub-grupo continuou recebendo a dieta deficiente e cada um dos demais recebeu respectivamente dieta deficiente acrescida de: niacina, vitamina B6, zinco, zinco + ácido picolínico e niacina + vitamina B6 + zinco durante o período de repleçäo que durou duas semanas. Um grupo de cinco ratos do Grupo Deficiente foi pareado com outros cinco animais que receberam isocaloricamente dieta controle de milho. Os animais eram pesados semanalmente e a cada semana, eram sacrificados 5 ratos de cada Grupo tanto no período de depleçäo como de cada sub-grupo no período de repleçäo. O sacrifício dos animais foi realizado por decapitaçäo, após a coleta de urina por um período de 24 horas. Colhia-se também sangue e o fêmur direito dos animais. Foram determinados por técnicas de cromatografia de alta pressäo os níveis de excreçäo urinária de N'metilnicotinamida, N'metil-2-piridona-5-carboxamida e de ácido 4-piridóxico e de zinco, os níveis plasmáticos de zinco, o teor de zinco noa fêmures e a atividade da enzima pirofosforilase nos eritrócitos...(AU) &P