Relação entre ingestão de vitamina K, gordura corporal, perfil lipídico e homeostase da glicose em adultos e idosos / Relationship between vitamin K intake, body fat, lipid profile and glucose homeostasis and in adults and elderly

Introdução: Especula-se que exista uma possível relação entre a ingestão de vitamina K e a diminuição da gordura corporal. Além disso, embora os resultados permaneçam controversos, há um número crescente de estudos que apoiam um papel chave dessa vitamina na melhora do perfil lipídico, da sensibilidade à insulina e na redução do risco de diabetes mellitus tipo 2, contudo pouco se sabe sobre quais mecanismos estariam envolvidos. Objetivo: Investigar as relações entre a ingestão de vitamina K (na forma de filoquinona - PK), gordura corporal, perfil lipídico e marcadores da homeostase da glicose em adultos e idosos. Métodos: Estudo transversal com 298 indivíduos de ambos os sexos, participantes do inquérito ISA - Capital 2015. Amostras de sangue foram coletadas para determinação do perfil lipídico, glicemia de jejum e concentrações de insulina; e índice de estimativa de resistência à insulina (HOMAIR), índice de estimativa da função de células β-pancreáticas (HOMA-β) e índice de estimativa da sensibilidade à insulina (QUICKI) foram calculados. A ingestão de vitamina K foi avaliada por meio de um recordatório alimentar de 24hrs (repetido em 75% da amostra), e a investigação quantitativa da massa gorda foi conduzida por meio da absorciometria de feixe duplo (DXA). Indivíduos com ingestão de vitamina K inferior aos valores de AI foram divididos em subgrupos de acordo com o estado nutricional e faixa etária. Foi realizada a Correlação de Spearman em grupos estratificados de acordo com o Índice de Massa Corporal (IMC) e com o Índice de Gordura Corporal (IGC). Para avaliar as associações entre a ingestão de vitamina K e cada uma das medidas bioquímicas e de adiposidade, foi realizada a regressão linear múltipla. Resultados: Dentre os avaliados, 46% eram do sexo masculino (n=136), com idade mediana de 61 anos (20 - 94 anos), e 56,4% apresentavam sobrepeso ou obesidade (n=168). A mediana de ingestão de vitamina K foi de 102,7 μg, ou 59,9 μg,/1000 kcal, sem diferença de acordo com sexo ou idade. A ingestão de vitamina K apresentou correlação negativa com o HOMA-IR (r = -0,603; p = 0,0134) e correlação positiva com QUICKI (r = 0,603; p = 0,0134) entre os adultos eutróficos do sexo masculino (n = 16). Em idosas com baixo peso (n = 12), a ingestão de vitamina K foi negativamente correlacionada com o Colesterol Total (CT) (r = -0,644; p = 0,0443). Entre as mulheres com elevado IGC e ingestão de vitamina K inferior aos valores de AI (n = 117), foram observadas correlações negativas entre a ingestão de vitamina K e HOMA-IR (r = -0,187; p = 0,0451) e correlações positivas com QUICKI (r = 0,187; p = 0,0451). Conclusões: Os resultados encontrados sugerem uma possível relação entre a ingestão dietética de filoquinona, gordura corporal, perfil lipídico e marcadores da homeostase da glicose, em amostra de adultos e idosos

Introduction: Recent research have investigated a possible inverse relationship between vitamin K intake and body fat. In addition, although the results remain controversial, there is an increasing number of studies supporting a key role of this vitamin in improving lipid profile, insulin sensitivity and reducing the risk of type 2 diabetes mellitus, but little is known about what mechanisms would be involved. Objective: To investigate the relationship between vitamin K intake (in the form of phylloquinone - PK), body fat, lipid profile and markers of glucose homeostasis in adults and elderly. Methods: Cross-sectional study with 298 individuals of both sexes, participants in the ISA - Capital 2015 survey. Blood samples were collected for determination of lipid profile, fasting glycemia and insulin concentrations, and homeostasis model assesment estimate for insulin resistance (HOMA-IR), homeostasis model assessment estimate for β-cell function (HOMA-β) and the quantitative insulin sensitivity check index (QUICKI) were calculate accordingly. Vitamin K intake was assessed by a 24-hour dietary recall (repeated in 75% of the sample) and quantitative investigation of fat mass was conducted using dual-energy x-ray absorptiometry (DXA). Subjects with vitamin K intake lower than AI values were divided into subgroups according to nutritional status and age group. Spearman correlation was performed in stratified groups according to Body Mass Index (BMI) and Fat Mass Index (FMI). To evaluate the associations between vitamin K intake and each of the biochemical and adiposity measures, multiple linear regression were performed. Results: Among the sample, 46% were male (n = 136), with a median age of 61 years (20 - 94 years), and 56.4% were overweight or obese (n= 168). The median vitamin K intake was 102.7 μg, or 59.9 μg, / 1000 kcal, with no difference according to sex or age. Vitamin K intake presented negative correlation with HOMA-IR (r = -0.603; p = 0.0134) and positive correlation with QUICKI (r = 0.603; p=0.0134) among normal weight male adults (n=16). In underweight elderly women (n=12), vitamin K intake was negatively correlated with total cholesterol (TC) (r = -0.644, p = 0.0443). Among females with high FMI and vitamin K intake lower than AI values (n=117), vitamin K intake was negatively correlated with HOMA-IR (r = -0.187; p = 0.0451) and positively correlated with QUICKI (r 12 = 0.187; p = 0.0451). Conclusions: Results suggest a possible relationship between dietary intake of phylloquinone, body fat, lipid profile and glucose homeostasis, among a sample of adults and elderly

Vitamin K: content in food consumed in São Paulo, Brazil

ABSTRACT Recent research on Vitamin K has shown its importance in maintaining vascular and bone health. Brazilian food composition tables do not show phylloquinone content in national foods. These data are needed to obtain more reliable results in nutritional status assessment studies of individuals in relation to this vitamin as studies have shown a geographical influence in food phylloquinone content. This study aims to determine phylloquinone (Vitamin K1) levels in its most important source: dark green leaved vegetables. Several varieties of vegetables were purchased directly from CEAGESP (General Warehouse Company of São Paulo) at different times. Phylloquinone was extracted using organic solvents and quantified by High Performance Liquid Chromatography - HPLC. Results show the concentrations of phylloquinone in commonly consumed foodstuffs. In general, results showed variations with data from literature on the amount of Vitamin K in the plants analysed.

Intoxicaciones con rodenticidas superwarfarínicos / Superwarfarin rodenticide poisoning

Introducción: en la actualidad existe utilización masiva de rodenticidas y su venta no está restringida al público. Las etiologías de intoxicación por estos agentes son variadas pudiendo ser de tipo intencional o accidental. Objetivo: analizar estudios realizados en torno a intoxicaciones con rodenticidas superwarfarínicos en humanos con el propósito de reunir información que oriente a un adecuado tratamiento. Metodología: se realizó una revisión integradora en las bases de datos electrónicas PubMed, TripDataBase, Cochrane, además de Google Scholar y SciELO, libros de divulgación científica, documentos de convenciones, páginas web de instituciones públicas, privadas y artículos vinculados a efectos, cuadro clínico y tratamiento de exposiciones a rodenticidas en seres humanos. Se analizaron los documentos y la información se organizó en tres temáticas: toxicidad de los rodenticidas superwarfarínicos, cuadro clínico y tratamiento médico, y rodenticidas no anticoagulantes disponibles en Chile. Resultados: la dosis tóxica mínima reportada en adultos es de 1 mg de principio activo; en pacientes pediátricos ingestas accidentales rara vez producen síntomas. Los síntomas se observan de forma tardía y su toxicidad es variable. El examen de elección es el International Normalized Ratio (INR) y se realiza en todo paciente con factores de riesgo presentes. El antídoto no se administra de forma profiláctica y la dosis se ajusta individualmente. Conclusión: en niños las ingestas accidentales no son riesgosas por lo que pueden ser observados en el hogar. Pacientes con ingestas masivas requieren controles de INR por meses por lo que es importante que posterior al alta médica exista una óptima coordinación con nivel primario de atención.

Introduction: Currently there is a widespread use of rodenticides, unrestricted to the public. The exposure to these agents may varied being intentional or accidental. Objective: To analyze studies about superwarfarin poisoning in humans, with the purpose of gathering information to guide proper treatment. Methodology: It was conducted an integrative review in the electronic databases PubMed, TripDataBase, Cochrane, Google Scholar and SciELO, science books (reference textbooks), convention documents, websites from public and private institutions and articles about the effects, clinical manifestations and treatment of human exposures to rodenticides. Documents were analyzed and the information organized into three themes: superwarfarin toxicity, clinical features and medical treatment, and non-anticoagulant rodenticides available in Chile. Results: In adults, the minimum dose reported to cause toxicity is 1 mg of active ingredient. In pediatric patients, accidental intakes rarely produce symptoms. The symptoms of poisoning are usually delayed and its toxicity is variable. The test of choice is International Normalized Ratio (INR) and it is performed in all patients with risk factors. The antidote must not be administered prophylactically and the dose is adjusted individually. Conclusions: Accidental intakes in children are not risky and they can be observed at home. Patients with massive intakes require INR monitoring for months so, it is important that an optimal coordination with primary care facilities still exists after medical discharge.

Effects of phylloquinone supplementation on lipid profile in women with rheumatoid arthritis: a double blind placebo controlled study

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is associated with an excess mortality from cardiovascular disease which is likely attributed to an atherogenic lipid profile. Among nutritional factors vitamin K has been recently focused as a pivotal nutrient in improvement of lipid related markers. Thus, this study was designed to determine the effects of vitamin K on lipid profile in this disease. SUBJECTS/METHODS: Fifty eight patients with definitive RA were participated in the present double blind placebo controlled study. They were randomly allocated into two groups to receive vitamin K1 as phylloquinone [10 mg/day] (n = 30) or placebo pills (n = 28), for eight weeks. In order to control the effects of probable confounders dietary intakes, anthropometric measurements including weight and height, clinical status using disease activity score-28 (DAS-28), physical activity and anxiety status were evaluated at baseline. Moreover, serum levels of lipid related markers including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured at baseline and at the end of intervention. RESULTS: There were no significant differences between the two groups regarding any of the baseline characteristics. After adjusting for some relevant confounders, in comparison between two groups, we observed no significant changes in lipid related markers at the end of intervention. Also, there was no significant difference between before and after intervention values within groups (P > 0.05). CONCLUSIONS: Function of vitamin K1 in lipid profile modification remains still controversial. This study showed that vitamin K1 has no effect on lipid profile in women with rheumatoid arthritis. Further studies with a longer follow-up are required to determine the effects of vitamin K on atherogenic lipid profile.

Effects of phylloquinone supplementation on lipid profile in women with rheumatoid arthritis: a double blind placebo controlled study

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is associated with an excess mortality from cardiovascular disease which is likely attributed to an atherogenic lipid profile. Among nutritional factors vitamin K has been recently focused as a pivotal nutrient in improvement of lipid related markers. Thus, this study was designed to determine the effects of vitamin K on lipid profile in this disease. SUBJECTS/METHODS: Fifty eight patients with definitive RA were participated in the present double blind placebo controlled study. They were randomly allocated into two groups to receive vitamin K1 as phylloquinone [10 mg/day] (n = 30) or placebo pills (n = 28), for eight weeks. In order to control the effects of probable confounders dietary intakes, anthropometric measurements including weight and height, clinical status using disease activity score-28 (DAS-28), physical activity and anxiety status were evaluated at baseline. Moreover, serum levels of lipid related markers including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured at baseline and at the end of intervention. RESULTS: There were no significant differences between the two groups regarding any of the baseline characteristics. After adjusting for some relevant confounders, in comparison between two groups, we observed no significant changes in lipid related markers at the end of intervention. Also, there was no significant difference between before and after intervention values within groups (P > 0.05). CONCLUSIONS: Function of vitamin K1 in lipid profile modification remains still controversial. This study showed that vitamin K1 has no effect on lipid profile in women with rheumatoid arthritis. Further studies with a longer follow-up are required to determine the effects of vitamin K on atherogenic lipid profile.

A Study about the Cause and Clinicopathologic Findings of Injection-Induced Dermatitis

BACKGROUND: Cases of dermatitis induced by the injection of certain drugs have been reported. OBJECTIVE: The aim of this study was to assess the cause and clinicopathologic findings of injection-induced dermatitis, and to reveal whether the reaction has any relation to the patient's age, injection site, drug concentration, and time interval from the injection to the occurrence of the skin lesion. METHODS: In this study, we enrolled 10 patients who developed erythematous skin lesions after the injection of causative drugs. The lesions were compared to each other according to the injection site, time interval from the injection to the occurrence of the skin lesion, and clinical characteristics. We performed intradermal and patch tests in each patient with different concentrations of causative drugs. RESULTS: The most common causative drugs were diclofenac and vitamin K1. The eczematous type was the most frequent clinical type. The intradermal test showed more positive results than the patch test. The patch tests with diclofenac (as is, 2.5%, 5%, and 10%) and vitamin K1 (10%) were all negative in 10 patients. Furthermore, intradermal tests with diclofenac (as is) and vitamin K1 (0.1%, 1%, and 10%) were performed in 8 patients. Six patients had a positive reaction, consisting of erythema, induration, and vesiculation, after 1 and 2 days. CONCLUSION: Our results showed that the most common causative agents were diclofenac and vitamin K1. Moreover, it seems that that intradermal test is more useful than the patch test in the diagnosis of injection-induced dermatitis.

Effect of vitamin K1 supplementation on left colon healing in rats with extrahepatic biliary obstruction

PURPOSE: To evaluate the effects of vitamin K1 on wound healing in the left colon of rats with experimental biliary obstruction. METHODS: Sixteen male rats, divided into four groups of four animals each (L, M, LK, and MK), underwent colostomy followed by bowel suture in the left colon. Seven days before, animals in the L and LK groups had undergone common bile duct ligation. The animals in groups MK and LK received vitamin K1 supplementation. On day 7 after bowel suture, repeat laparotomy was performed for evaluation of colonic healing by burst pressure measurement and collection of samples for histopathological analysis. Changes in body weight were evaluated in the four groups. RESULTS: Weight loss was lower in animals supplemented with vitamin K. No significant differences were observed in burst pressure among the four groups (p>0.05). Histological analysis showed more hemorrhage and congestion in the biliary obstruction groups. Supplemented animals exhibited increased collagen formation and less edema and abscess formation. CONCLUSION: Vitamin K supplementation attenuated weight loss and improved colonic wound healing in rats. .

Teores de vitamina K em hortaliças consumidas na cidade de São Paulo / Levels of vitamin K in vegetables consumed in the city of São Paulo

Estudos sobre a vitamina K têm evidenciado seu papel na manutenção da saúde óssea e vascular. A atuação desta vitamina em tecidos extra-hepáticos não é considerada na recomendação dietética da DRI de 2001, sendo reconhecidas necessidades maiores para função óssea em pessoas acima dos 60 anos e em indivíduos que fazem uso de medicamentos antivitamina K. Visando colaborar com pesquisas futuras, onde o conhecimento do teor de vitamina K1 é relevante, além de contribuir com dados para Tabela Brasileira de Composição de Alimentos - TBCA-USP, o presente trabalho foi conduzido para determinação do teor de filoquinona (vitamina K1) de hortaliças consumidas na cidade de São Paulo. As hortaliças analisadas foram escolhidas após a conclusão de um inquérito alimentar realizado, com adultos e idosos, num projeto de pesquisa desenvolvido junto ao Departamento de Alimentos e Nutrição Experimental da FCF/USP visando a análise da ingestão diária de vitamina K. Desta forma, foram analisadas as hortaliças mais consumidas por esses grupos, submetidas ou não ao processo de cocção. Estas amostras foram adquiridas diretamente na CEAGESP - Companhia de Entrepostos e Armazéns Gerais de São Paulo. As metodologias empregadas na determinação da filoquinona (vitamina K1) foram extração e purificação pelo método líquido-líquido utilizando solventes orgânicos e quantificação através da Cromatografia Líquida de Alta Eficiência (CLAE). Os resultados mostraram que as amostras de hortaliças de colorações verdes mais escuras apresentaram os maiores teores da vitamina como: salsa 491,05 µg/100g; espinafre 375,01 µg/100g, quando comparados com as amostras de colorações verdes mais claras as quais como é o caso da alface americana 113,42 µg/100g e a couve-flor 32,55 µg/100g. A maioria das hortaliças analisadas apresentaram variações entre as diferentes épocas do ano e quando comparadas com dados da literatura

Studies on vitamin K have shown its role in maintaining bone and vascular health. The role of this vitamin in extrahepatic tissues is not considered in the dietary recommendation of DRI 2001. Increased need for vitamin K intake is recognized for the bone function in people over age 60 and individuals who use anti-vitamin K drugs. Aiming at supporting future research, where knowledge of vitamin K1 is relevant, and contribute data to the Brazilian Table of Food Composition - TBCA-USP, this study was conducted to determine the level of phylloquinone (vitamin K1) of vegetables consumed in the city of São Paulo. The vegetables studied were chosen after completion of a nutrition survey carried out with adults and elderly people, a research project developed by the Department of Food and Experimental Nutrition FCF / USP aimed at analyzing the daily intake of vitamin K. Therefore, we analyzed the most consumed vegetables by these groups submitted or not to the cooking process. These samples were acquired directly at CEAGESP - General Warehouses Company of São Paulo. The methodologies employed in the determination of phylloquinone (vitamin K1) were extraction and purification method using liquid-liquid organic solvents followed by High Performance Liquid Chromatography (HPLC). The results showed that the samples of darker green vegetables showed the highest levels of vitamin such as parsley (491.05 µg/100g) and spinach (375.01 µg/100g), when compared with samples of lighter coloration (e.g. 113.42 µg/100g lettuce, and 32.55 µg/100g cauliflower). Most vegetables analyzed showed variation in results when compared to the different seasons and the literature data

Inter and intra ethnic variation of vitamin K epoxide reductase complex and cytochrome P450 4F2 genetic polymorphisms and their prevalence in South Indian population.

BACKGROUND: Genetic variation in the vitamin K epoxide reductase complex (VKORC1) and cytochrome P450 4F2 (CYP4F2) genes were found to be strongly associated with the oral anticoagulant (OA) dose requirement. The distribution of genetic variation in these two genes was found to show large inter‑ and intra‑ethnic difference. MATERIALS AND METHODS: A total of 470 unrelated, healthy volunteers of South Indians of either sex (age: 18‑60 years) were enrolled for the study. A 5 ml of venous blood was collected and the genomic deoxyribonucleic acid (DNA) was extracted by using phenol‑chloroform extraction method. Real‑time quantitative polymerase chain reaction (RT‑PCR) method was used for genotyping. RESULTS: The variant allele frequencies of VKORC1 rs2359612 (T), rs8050894 (C), rs9934438 (T) and rs9923231 (A) were found to be 11.0%, 11.8%, 11.7% and 12.0%, respectively. The variant allele VKORC1 rs7294 was (80.1%) more frequent and the variant allele CYP4F2 * 3 was found to be 41.8% in South Indians. The allele, genotype and haplotype frequencies of VKORC1 and CYP4F2 gene were distinct from other compared HapMap populations (P < 0.0001). CONCLUSION: The findings of our study provide the basic genetic information for further pharmacogenetic based investigation of OA therapy in the population.

Estimation of vitamin K intake in Koreans and determination of the primary vitamin K-containing food sources based on the fifth Korean National Health and Nutrition Examination Survey (2010-2011)

There is little information on dietary vitamin K intake and nutritional status of daily requirements of vitamin K in Korea. The objective of this study was to investigate the vitamin K intake and major food sources of Vitamin K in Koreans. The survey data from the 2010-2011 Korean National Health and Nutrition Examination Survey of 7,792 subjects (aged 19-64 years) were examined. Total vitamin K intake was calculated from 24-hour dietary recall using a vitamin K food database, Computer Aided Nutritional analysis Program and the United States Department of Agriculture database. The geometric mean of vitamin K was estimated as 322.40 +/- 6.33 ug/day for men and 271.20 +/- 4.92 ug/day for women. Daily vitamin K intake increased significantly with age (p for trend < 0.001). The main food source of vitamin K was vegetables (72.84%), including cabbage kimchi (19.26%), spinach (17.38%), sesame leaves (7.11%), radish leaves (6.65%), spring onions (6.28%), and laver (4.82%), followed by seaweed, seasonings, and fat and oils. We observed that the vitamin K intake of Koreans was relatively higher than that reported by other studies in Western countries and differed depending on age.

Vitamin K1 Dermatitis / 대한피부과학회지

Vitamin K1 dermatitis is a cutaneous adverse reaction to vitamin K1, and this malady presents as an erythematous eczematoid patch or pseudoscleroderma. At first, liver disease was thought to be related to vitamin K1 dermatitis. However, it is no longer considered as being related to liver disease due to the increasing case reports of patients with vitamin K1 dermatitis and who are without liver disease. Type IV hypersensitivity reaction was suspected to be the cause of this reaction. This disease can be easily ignored because of its low incidence. We hereby report on a case of vitamin K1 dermatitis that was confirmed by a skin test.

Korean Patients with Superwarfarin Intoxication and Their Outcome

This observational study aimed at evaluating recent superwarfarin intoxication of Korean patients. Ten patients were diagnosed as or highly suspicious for superwarfarin intoxication. Case report forms described by attending hematologists of the patients were collected and analyzed. Bleeding symptoms were varied among the patients. Patients uniformly showed prolonged prothrombin time (PT) and activated thromboplastin time (aPTT) with decreased activity of vitamin K dependent coagulation factors. Positive serum brodifacoum test results in 4 of 5 requested patients contributed to confirmatory diagnosis. Psychiatric interview revealed an attempted ingestion in one patient. High dose vitamin K1 therapy promptly corrected prolonged PT and aPTT, but hasty discontinuation caused repeated bleeding diathesis in 6 patients. Route of intoxication was unknown or not definite among 8 of 10 patients. Three patients had a possibility of environmental exposure considering their occupations: there might be intoxication by transdermal absorption or inhalation. Therefore, high dose and prolonged use of vitamin K1 therapy is necessary for effective detoxification. Further detailed investigation on environmental exposure and efforts to improve availability of the blood level test in clinic are requested.

Analysis of thirteen cases with secondary coagulation disorder caused by raticide exposure / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics of secondary coagulation disorders caused by exposure to poison (raticide) in children and to investigate the diagnosis and corresponding treatment.</p><p><b>METHOD</b>The process of diagnosis, clinical characteristics, response to treatment and the prognosis were analyzed.</p><p><b>RESULTS</b>The main clinical manifestation was mucosal bleeding (66.6%), including epistaxis, gingival bleeding, hematomas and so on. All these children were previously well and had no history of bleeding. Activated partial thromboplastin time (APTT) and prothrombin time (PT) were prolonged, factor II was undetectable and the levels of factors VII, IX, and X were lower. The fibrinogen was normal. A raticide was detected in blood and urine of 13 children although 12 of the patients had no definite history of raticide ingestion. Prothrombin complex, fresh frozen plasma and vitamin K(1) were effective in these cases. However, 2 - 3 weeks later, 6 patients presented with recurrent bleeding.</p><p><b>CONCLUSION</b>For children with secondary coagulation disorders of unknown cause, intoxication of raticide should be considered. The administration of blood coagulation factors and vitamin K(1) are effective in early treatment, and the treatment period should be more than 2 months. The PT and APTT should be followed up. Vitamin K(1) should be stopped when PT and APTT are normal.</p>

Interaction between Warfarin and the Herbal Product Shengmai-Yin: A Case Report of Intracerebral Hematoma

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

Interaction between Warfarin and the Herbal Product Shengmai-Yin: A Case Report of Intracerebral Hematoma

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

Risk factors of acquired prothrombin complex deficiency syndrome: a case-control study.

BACKGROUND: Idiopathic vitamin K deficiency in infancy or acquired prothrombin complex deficiency (APCD) is a serious bleeding disorders in infants. It leads to a high mortality rate and permanent neurological sequele among the survivors. A low vitamin K intake by infants is suggested to have a major role in the pathogenesis. To reduce the incidence of this syndrome, its risk factors have to be identified. OBJECTIVE: To determine the risk factors of the acquired prothrombin complex deficiency syndrome in the early infantile period. MATERIAL AND METHOD: A case-control study was conducted in 20 cases and 60 age- and sex-matched controls who were admitted to the Queen Sirikit National Institute of Child Health in Bangkok during August 1991 to August 1993. Feeding type, maternal history of herb-liquor extracts (herbal medicine) use and no history of vitamin K1 prophylactics at birth were identified to be risk factors of the syndrome. All subjects were fed by breast milk with or without formula milk. None of the subjects fed by formula milk were in the case group (Chi-square for trend = 14.77, p = 0.001). RUSULTS: The rate of a maternal history of herb-liquor extracts use in the case group was significantly higher than that of the control group (p = 0.03). Vitamin K2MK4 level in breast milk obtained from the mothers of the infants with maternal history of herb-liquor extracts use was lower than that obtained from the mothers of the infants without maternal history of herb-liquor extracts use (p = 0.03). No infant with history of intramuscular K1 prophylactics was in the case group. Three out of eight infants with history of oral vitamin K1 regimen were cases. Although vitamin K1 and K2MK4 level in breast milk obtained from the cases' mothers were significantly lower than that obtained from the controls' mothers (p = 0.015 and p = 0.003 respectively), there was an overlapping of vitamin K levels among these two groups. CONCLUSION: This study demonstrated that vitamin K in breast milk has a main role in the pathogenesis of this disease. Herb-liquor extracts may be a cause of the APCD syndrome. Intramuscular vitamin K1 prophylactics should be routinely given to all newborn babies who will receive breast feeding. Effectiveness of oral vitamin K1 prophylactics regimen must be studied urgently.

Improvement of the Positive Culture Rate Using New Enriched Broth in Cellulitis / 대한피부과학회지

BACKGROUND: Staphylococcus aureus and Group A beta-hemolytic Streptococci are the etiologic agents most commonly associated with cellulitis, but many other bacteria have also been shown to cause this condition. The positive bacterial culture rate is the most important factor in the treatment of cellulitis. However, the positive bacterial culture rate in the commonly used media, tends to be quite low. OBJECTIVE: The principal objective of this study was to improve the positive culture rate in cellulitis patients by using a new enriched broth. METHODS: Brewer modified thioglycollate medium (BTM) and Columbia broth (CB), both of which are widely utilized in clinical bacteriology for enriched growth, were compared with several novel enriched broths. These new enriched broths were mixtures of BTM-CB broth and added growth supplement factors. They included BTM-CB (BC), Modified BTM-CB (MBC) and supplement VX-BTM-CB (VXBC). MBC media included several growth supplements, such as hemin, vitamin K1, VX supplement, and Campylobacter growth supplement. Strains utilized in this study were common pathogens (Staphylococcus aureus, Streptococcus pyogenes, et al.), anaerobes, fastidious pathogens (Bacteroides fragilis, Campylobacter jejuni, Prevotella melaninogenica), uncommon pathogens (Actinobacter baumannii, Enterococcus faecalis, Streptococcus agalactiae). Positive culture rates were evaluated in each medium and measured via spectrophotometry at 660 nm. RESULTS: In vitro, all strains used in this study grew more quickly and densely in MBC media. CONCLUSION: Our results suggest that MBC media in a new enriched broth may improve bacterial culture rates in cellulitis patients. It will be necessary to study the efficacy of the MBC media in the culturing etiologic agents from tissues of cellulitis patients.

A Case of Vitamin K1 Dermatitis due to Intralesional Injection for Cosmetic Purpose / 대한피부과학회지

Vitamin K is a lipid-soluble vitamin used in the treatment of hypoprothrombinemia found in diseases of the liver, biliary tract and small intestine. Vitamin K1 (Phytonadione) is the natural form of vitamin K. Recently, a cream containing vitamin K1 has been marketed for topical use in the treatment of periorbital hyperpigmentation, telangiectasia and rosacea. Vitamin K1 dermatitis is a cutaneous adverse reaction to vitamin K1 and can cause acute pruritic, erythematous, eczematoid, indulated plaques or slowly-appearing sclerodermatous plaques. We present a case of dermatitis caused by a vitamin K1 intralesional injection for treatment of facial telangiectasia and flushing.

Vitamin K epoxide reductase complex 1 gene polymorphism and warfarin dose requirement in Chinese patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the possible relationship between vitamin K epoxide reductase complex 1 (VKORC1) gene polymorphism and warfarin dose requirements in Chinese patients.</p><p><b>METHOD</b>Genotyping for the C1173T polymorphism in the VKORC1 gene was performed using a restriction enzyme digestion of PCR-amplified DNA in 102 Chinese patients treated with warfarin.</p><p><b>RESULTS</b>TT genotype was found in 83 patients (81.4%), CT genotype in 16 patients (15.7%) and CC genotype in 3 patients (2.9%). To achieve similar target INR range (1.5 - 2.5), the warfarin dose requirement was significantly lower in patients with TT genotype than that in patients with CT/CC genotypes (P < 0.01).</p><p><b>CONCLUSION</b>C1173T polymorphism in the VKORC1 gene might be one important determinant for warfarin dose requirement in Chinese patients.</p>