RESUMO
RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.
ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Estomatite Aftosa/complicações , Deficiência de Vitamina B 12/tratamento farmacológico , /tratamento farmacológico , Deficiências Nutricionais , Deficiência de Ácido Fólico/tratamento farmacológicoRESUMO
There is no doubt that folic acid fortification can be effective for reducing the incidence of neural tube defects. The degree of efficacy depends on both the level of folate depletion and other, yet to be fully characterized, genetic and/or environmental factors. This article summarizes briefly data on neural tube defect reduction and other benefits of folic acid fortification as these have been reviewed in more detail elsewhere. More attention is drawn to questions that have been raised about the possible adverse effects of folic acid fortification including the incidence of colorectal cancer and immune function. The main question addressed here is whether folic acid fortification can exacerbate the adverse effects of vitamin B12 deficiency. Most analyses of this question have been conducted in wealthier countries based on data from elderly populations - which have the highest prevalence of vitamin B12 deficiency. However, of potentially greater concern is the increasingly common practice of folic acid fortification in developing countries, where folate status is probably often adequate even prior to fortification, and vitamin B12 depletion or deficiency is common. To add to this information, data from a group of Chilean elderly with a range of vitamin B12 status and exposed to high levels of folic acid fortification will be presented.
Assuntos
Deficiência de Ácido Fólico/epidemiologia , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Deficiência de Vitamina B 12/epidemiologia , Vitamina B 12/administração & dosagem , Idoso , Chile , Farinha , Deficiência de Ácido Fólico/tratamento farmacológico , Humanos , Defeitos do Tubo Neural/tratamento farmacológico , Estado Nutricional , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Deficiência de Vitamina B 12/tratamento farmacológicoRESUMO
INTRODUCTION: Phenytoin and carbamazepine were the antiepileptic drugs most frequently used in Mexico and throughout the world. Epileptic patients who take these drugs have a variety of collateral effects including the decrease of folates plasmatic level. Low seric folic acid concentration has been associated with a decline in cognitive functions. The administration of a combined treatment with folic acid could ameliorate these difficulties. OBJECTIVE: To describe the effect of the folic acid in the cognitive function in epileptic patients who take phenytoin and carbamazepine. METHODS: We chose patient who have epilepsy and that are being treated with phenytoin, carbamazepine or both and formed two groups. The study group was treated with a daily dose of 5 mg of folic acid and the control group was administered placebo for a period of six months, with nine patients in each group of same age, sex, education level, epilepsy's evolution, frequency of seizures, EEG abnormalities and antiepileptic drugs plasma levels. We registered data at the beginning (basal) and at the end of the study. RESULTS: Measurements of basal folic acid plasma levels in both groups were under the referential value. The neuropsychological assessment at the beginning (Mini-Barcelona test) showed a deficit in the verbal memory skills in both groups. After six months of treatment with folic acid (study group), the folic acid plasma level was 12.2 mg/mL (p < 0.01) higher than the basal value. Verbal memory test has improved with respect to the basal value (p < 0.05). The numbers of seizures and the plasma levels of the antiepileptic drugs remained unchanged. On the other hand, the group treated with placebo did not improve. CONCLUSION: Treatment with folic acid is safe and without side effects, it improved the cognitive function in patients with epilepsy treated with phenytoin and carbamazepine.
Assuntos
Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Epilepsia/tratamento farmacológico , Deficiência de Ácido Fólico/induzido quimicamente , Ácido Fólico/uso terapêutico , Fenitoína/efeitos adversos , Adulto , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/sangue , Anticonvulsivantes/uso terapêutico , Carbamazepina/administração & dosagem , Carbamazepina/sangue , Carbamazepina/uso terapêutico , Transtornos Cognitivos/prevenção & controle , Quimioterapia Combinada , Epilepsia/complicações , Feminino , Ácido Fólico/sangue , Deficiência de Ácido Fólico/tratamento farmacológico , Deficiência de Ácido Fólico/psicologia , Humanos , Testes de Linguagem , Masculino , Memória/efeitos dos fármacos , Testes Neuropsicológicos , Fenitoína/administração & dosagem , Fenitoína/sangue , Fenitoína/uso terapêutico , Projetos Piloto , Desempenho Psicomotor/efeitos dos fármacos , Aprendizagem Verbal/efeitos dos fármacosRESUMO
Introduction. Phenytoin and carbamazepine were the antiepileptic drugs most frequently used in Mexico and throughout the world. Epileptic patients who take these drugs have a variety of collateral effects including the decrease of Mates plas-matic level. Low serie folie acid concentration has been associated with a decline in cognitive functions. The administration of a combined treatment with folie acid could ameliorate these difficulties. Objective.To describe the effect of the folie acid in the cognitive function in epileptic patients who take phenytoin and carbamazepine. Methods. We chose patient who have epilepsy and that are being treated with phenytoin, carbamazepine or both and formed two groups. The study group was treated with a daily dose of 5 mg of folie acid and the control group was administered placebo for a period of six months, with nine patients in each group of same age, sex, education level, epilepsy's evolution, frequency of seizures, EEG abnormalities and antiepileptic drugs plasma levels. We registered data at the beginning (basal) and at the end of the study. Results.Measurements of basal folie acid plasma levels in both groups were under the referential value. The neuropsychological assessment at the beginning (Mini-Barcelona test) showed a deficit in the verbal memory skills in both groups. After six months of treatment with folie acid (study group), the folie acid plasma level was 12.2 mg/mL (p < 0.01) higher than the basal value. Verbal memory test has improved with respect to the basal value (p < 0.05). The numbers of seizures and the plasma levels of the antiepileptic drugs remained unchanged. On the other hand, the group treated with placebo did not improve. Conclusion.Treatment with folie acid is safe and without side effects, it improved the cognitive function in patients with epilepsy treated with phenytoin and carbamazepine.
Introducción. La difenilhidantoína (DFH) y la carbamazepina (CBZ) son los antiepilépticos más empleados en México y en el mundo, los pacientes con epilepsia que emplean estos fármacos presentan una disminución en las concentraciones séricas de ácido fólico, una de las causas que pueden contribuir a un deterioro cognitivo, por lo que la terapia sustitutiva con ácido fólico pudiera mejorar estas alteraciones. Objetivo. Describir el efecto de la disminución del ácido fólico en la cognición de pacientes con epilepsia tratados con difenilhidantoína y carbamazepina. Material y métodos. Incluimos pacientes tratados con carbamazepina, fenitoína o ambos, con epilepsia. Formamos dos grupos: Un grupo experimental recibió ácido fólico 5 mg/día y otro grupo control recibió placebo durante seis meses, nueve pacientes en cada grupo; pareados en la edad, sexo, escolaridad, tiempo de evolución, námero de crisis, alteraciones EEG, niveles séricos de anticonvulsivos, realizamos estudios neuropsicológicos al inicio (básales) y al final del estudio a ambos grupos. Resultados. Las básales del ácido fólico en ambos grupos estuvieron por debajo del valor de referencias. En las pruebas neuropsicológicas (básales) (prueba de Mini-Barcelona) se halló un déficit en el área de la memoria verbal en ambos grupos. Después de seis meses de tratamiento con ácido fólico (grupo experimental) los niveles de ácido fólico alcanzaron 12.2 ng/mL (p < 0.01) con respecto a su basal; las pruebas de memoria verbal mejoraron con respecto a su basal (p < 0.05); el námero de crisis y los niveles séricos de los anticonvulsivos no se modificaron. El grupo con placebo no presentó ninguna mejoría. Conclusiones. El tratamiento coadyuvante con ácido fólico es seguro, libre de efectos adversos y mejoró las alteraciones cognitivas (memoria verbal) de estos pacientes.
Assuntos
Adulto , Feminino , Humanos , Masculino , Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Epilepsia/tratamento farmacológico , Deficiência de Ácido Fólico/induzido quimicamente , Ácido Fólico/uso terapêutico , Fenitoína/efeitos adversos , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/sangue , Anticonvulsivantes/uso terapêutico , Carbamazepina/administração & dosagem , Carbamazepina/sangue , Carbamazepina/uso terapêutico , Transtornos Cognitivos/prevenção & controle , Quimioterapia Combinada , Epilepsia/complicações , Deficiência de Ácido Fólico/tratamento farmacológico , Deficiência de Ácido Fólico/psicologia , Ácido Fólico/sangue , Testes de Linguagem , Memória/efeitos dos fármacos , Testes Neuropsicológicos , Projetos Piloto , Fenitoína/administração & dosagem , Fenitoína/sangue , Fenitoína/uso terapêutico , Desempenho Psicomotor/efeitos dos fármacos , Aprendizagem Verbal/efeitos dos fármacosRESUMO
A twenty-one-year-old female known to suffer from bipolar type I disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurrence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.
Assuntos
Adulto , Feminino , Humanos , Deficiência de Vitamina B 12 , Transtorno Bipolar , Demência , Deficiência de Ácido Fólico/complicações , Vitamina B 12 , Deficiência de Vitamina B 12 , Demência , Ácido Fólico/uso terapêutico , Deficiência de Ácido Fólico/tratamento farmacológicoRESUMO
A twenty-one-year-old female known to suffer from bipolar type 1 disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.(Au)
Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Transtorno Bipolar/complicações , Demência/etiologia , Deficiência de Ácido Fólico/complicações , Deficiência de Vitamina B 12/complicações , Demência/diagnóstico , Ácido Fólico/uso terapêutico , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/tratamento farmacológico , Vitamina B 12/uso terapêutico , Deficiência de Vitamina B 12/tratamento farmacológicoRESUMO
Lately, folic acid deficiency is gaining a predominant role in the pathogenesis of congenital malformations and cardiovascular diseases in adults. The planning of individual and population preventive strategies for these diseases must consider this deficiency. This paper reviews the anatomical, biochemical and molecular bases of neural tube defects and cardiovascular diseases in adults. In these two frequent diseases, folic acid supplementation has shown a clear cut protective effect.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Deficiência de Ácido Fólico/tratamento farmacológico , Ácido Fólico/uso terapêutico , Hematínicos/uso terapêutico , Defeitos do Tubo Neural/prevenção & controle , Adulto , Doenças Cardiovasculares/etiologia , Suplementos Nutricionais , Feminino , Homocisteína/metabolismo , Humanos , Lactente , Recém-Nascido , Defeitos do Tubo Neural/etiologia , GravidezRESUMO
A twenty-one-year-old female known to suffer from bipolar type I disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurrence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.
Assuntos
Transtorno Bipolar/complicações , Demência/etiologia , Deficiência de Ácido Fólico/complicações , Deficiência de Vitamina B 12/complicações , Adulto , Demência/diagnóstico , Feminino , Ácido Fólico/uso terapêutico , Deficiência de Ácido Fólico/tratamento farmacológico , Humanos , Vitamina B 12/uso terapêutico , Deficiência de Vitamina B 12/tratamento farmacológicoRESUMO
A medida que los países mejoran sus índices de salud, las malformaciones congénitas pasan a ocupar el primer lugar en las causas de mortalidad infantil. El énfasis en el tratamiento de las malformaciones congénitas debe hacerse con buenas estrategias de prevensión primaria. Al respecto, durante los últimos años el uso del ácido fólico ha adquirido un rol preponderante. El uso periconcepcional de ácido fólico ha mostrado un claro efecto protector en relación a algunas malformaciones congénitas frecuentes, especialmente en los defectos de cierre del tubo neural. Considerando la importancia de la prevención primaria en la morbimortalidad a cualquier edad, se ha considerado fundamental planificar estrategias de prevención aplicables en el ámbito individual y poblacional. Se presentan las bases embrionarias, anatómicas, bioquímicas y moleculares de los defectos de cierre del tubo neural y la importancia de iniciar estrategias a nivel poblacional que aseguren una ingesta suficiente de ácido fólico en las poblaciones objetivo