BackgroundVitamin B12 deficiency has been associated with peripheral neuropathy, loss of sensation in the peripheral nerves, and weakness in the lower extremities. Methylcobalamin is the most effective analogue of vitamin B12 used to treat or prevent the complications associated with vitamin B12 deficiency. The current study aimed to compare the serum cobalamin levels after administration of two different regimes of methylcobalamin in peripheral neuropathy patients.MethodsThe present study was a prospective, randomized, comparative study. The study consisted of two parallel groups, group A (methylcobalamin 500 µg injection intramuscularly three times a week) and group B (methylcobalamin 1500 µg injection intramuscularly once a week). A control group of healthy volunteers was also included.ResultsA total of 24 patients (12 in each group) were included in the study. Five healthy volunteers were also included as a control in each group. At the end of treatment, serum cobalamin levels were significantly (P = 0.028) higher in group A (1892.08 ± 234.50) as compared with group B (1438.5 ± 460.32). The serum cobalamin levels in Group A healthy volunteers were also two times higher than that of group B (P = 0.056). Both the LANSS scale and DN4 questionnaire reported similar results at end of treatment.ConclusionsThe 500 µg methylcobalamin thrice weekly regime is more effective in increasing the serum cobalamin levels as compared to the 1500 µg methylcobalamin once weekly regime.

Mixed connective tissue disease (MCTD) is a term involving the features of lupus systemic sclerosis, polymyositis, rheumatoid arthritis and high titre of anti ribonucleoprotein (RNP) antibodies however the exact etiology of the disease is not known. MCTD is characterized by microvascular damage, along with activation of the immune system leading to inflammation and excessive deposition of collagen in the skin, lungs, heart, gastrointestinal tract and kidneys. The females are more affected, especially after childbirth may be because of the hypothesis of microchimerism. The pathogenesis being a two way migration of fetal cells through the placenta. Although it cannot be cured completely but treatment with corticosteroids is helpful. The complications were preeclampsia, preterm labor, fetal growth restriction, eclampsia, thrombocytopenia and infections like pneumonia, sepsis like syndrome. The maternal mortality rate is approximately around 325/100000. We encountered a similar case of mixed connective tissue disorder in a patient aged 24 years at 29 weeks of gestation. The patient had conceived spontaneously after 5 yrs of diagnosis and had presented with all the known complications of the disease including lung fibrosis, FGR, preeclampsia and ascites. However she delivered and thereafter stabilized, although her baby had to be treated for a prolonged period at the NICU.

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