BACKGROUND Type 2 Diabetes Mellitus (T2DM) is an endocrine disorder and a heterogeneous group of syndromes characterised by an elevation of fasting blood glucose that is caused by a relative or absolute deficiency in insulin. Serum vitamin B12 levels have been reported to be inversely associated with the dose and duration of metformin use. Vitamin B12 deficiency is a treatable condition. However, there is insufficient data regarding prevalence of vitamin B12 deficiency in the South Indian population. Hence, the study was undertaken to evaluate serum vitamin B12 levels in T2DM on metformin therapy. MATERIALS AND METHODS A total of 100 T2DM patients attending Outpatient Department (OPD) or admitted under Department of General Medicine of KIMS, Hubli, during the time period of 2 years were taken for study considering the inclusion and exclusion criteria. Qualifying patients underwent detailed history, clinical examination, routine investigation and vitamin B12 estimation. RESULTS Majority were in the age group of 45-59 years making 42% of the total. The age group in most patients having vitamin B12 deficiency was >60 years. Males had more vitamin B12 deficiency forming 54.5%. Vitamin B12 deficiency was more in hypertensive group accounting for 71.4%, which was statistically significant. Most of the vitamin B12 deficiency patients had diabetes duration >10 years. Most of the vitamin B12 deficient patients were taking metformin therapy for longer years (≥10 years) and in higher dose (>2 g/day). Most of the vitamin B12 deficient diabetes patients were overweight forming 52.5% of the total. CONCLUSION Longer duration of diabetes increases the risk of developing vitamin B12 deficiency on metformin therapy. The higher dose of metformin intake had inverse relation with vitamin B12 levels. Longer duration of metformin intake causes vitamin B12 deficiency and hence should be screened for vitamin B12 deficiency and can be supplemented with vitamin B12.
Paraquat {PQ}, a herbicide available as 20% solution can cause lethal effects due to production of free radicals formed by the cyclic oxidation-reduction reactions of the compound with tissues resulting in multiorgan failure. Symptoms of PQ ingestion are usually dose-dependent, and intoxication can be categorized to mild, moderate, and fulminant. Most common symptoms being vomiting (100%) followed by oral ulceration (59%), dysphagia (53%) and dyspnea (41%). Diagnosis of PQ poisoning is usually made based on circumstantial evidences. PQ levels can be estimated and is of prognostic significance. Almost always PQ causes morbidty and mortality except in few cases where dose is inadequate. Here we present a case of 25 year old patient with PQ poisoning which resulted in oral mucosal and upper gastrointestinal ulcerations which subsequently healed with antioxidants, antibiotics and local applications of povidine iodine. As there were no respiratory symptoms cyclophosphamide or steroids was not used. Patient was discharged after 1 month of hospital admission with all parameters within normal limits. . In spite of advances in medical care, prompt treatment, and supportive care, mortality still remains high mainly due to multiorgan failure.
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