Deficiency or dementia? Exploring B12 deficiency after urostomy

Lack of Clinical Evidence Regarding the Guidelines for Vitamin B12 Deficiency: An Analysis From Literature and Recommendations From Clinical Practice

BACKGROUND

Vitamin B12 deficiency is a critical medical condition that, if left untreated, can lead to severe symptoms and potentially serious and life-threatening complications. Clinical guidelines are designed to provide a standardized approach to diagnosis and treatment, aiming for consistency and effectiveness. However, it is well-established that not all patients fit into general guidelines.

OBJECTIVE

To investigate the clinical relevance of the submitted research to support these protocols for diagnosing and treating a B12 deficiency.

APPROACH

Conducting a literature review of the references focused and used on diagnosing and treating vitamin B12 deficiency in adults and children.

RESULTS

No robust clinical trial nor RCT has been found to back up the current protocols. The research used is primarily based on assumptions rather than solid clinical evidence.

CONCLUSION

Existing guidelines for vitamin B12 deficiency need to be significantly revised and improved through clinical research, clinical experience by experts in the field with input from patient groups worldwide.

[Cobalamin in the complex treatment and prevention of cognitive impairment]

Cognitive impairment (CI) develops not only in structural damage to the central nervous system, but also in encephalopathies of dysmetabolic and deficiency etiology. Recently, special attention is focused on the appearance of CI due to the deficiency of cobalamin (vitamin B₁₂) and folic acid (FA), the change in the level of homocysteine (HC). To detect vitamin B₁₂ deficiency is possible by examining key biomarkers in serum based on a decrease in the levels of vitamin B₁₂ and holotranscobalamin, and levels of methylmalonic acid (MMA) and HC. The article presents an analysis of studies conducted in Norway, Korea, India, and other countries to assess the risks of CI in the presence of reduced levels of vitamin B₁₂ in the elderly, which demonstrated a decrease in brain volume in the elderly (according to MRI data) in combination with altered test parameters that assess cognitive functions. In many studies, female patients with reduced levels of vitamin B₁₂ predominated among the studied patients. Also, some studies have demonstrated the effectiveness of complex CI therapy with the inclusion of vitamin B₁₂ (both for oral and intravenous administration). Oral vitamin B₁₂ therapy at a dose of 1000 μg has been shown to be adequate for the treatment of vitamin B₁₂ deficiency. Also, the administration of vitamin B₁₂ for prophylactic purposes is recommended for patients with subnormal or borderline concentrations of vitamin B₁₂ in the blood serum.

Nutrition risk and assessment process in patients with bladder cancer undergoing radical cystectomy

Malnutrition and depleted muscle stores adversely affect bladder cancer patients and contribute to poorer outcomes. These nutrition-related problems are often not addressed, in part because they are not being identified with screening and assessment tools. In this essay, we discuss validated nutrition screening and assessment tools such as the Patient-Generated Subjective Global Assessment; however, each healthcare team must decide on the one which will work best for their clinic. Patients with bladder cancer may be at risk for specific nutrient deficiencies which should be monitored and corrected to improve outcomes and overall health.