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Joshi SM, Thomas TC, Jadavji NM. Impact of increasing one-carbon metabolites on traumatic brain injury outcome using pre-clinical models. Neural Regen Res 2024; 19:1728-1733. [PMID: 38103238 PMCID: PMC10960300 DOI: 10.4103/1673-5374.389629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023] Open
Abstract
Traumatic brain injury is a major cause of death and disability worldwide, affecting over 69 million individuals yearly. One-carbon metabolism has been shown to have beneficial effects after brain damage, such as ischemic stroke. However, whether increasing one-carbon metabolite vitamins impacts traumatic brain injury outcomes in patients requires more investigation. The aim of this review is to evaluate how one-carbon metabolites impact outcomes after the onset of traumatic brain injury. PubMed, Web of Science, and Google Scholar databases were searched for studies that examined the impact of B-vitamin supplementation on traumatic brain injury outcomes. The search terms included combinations of the following words: traumatic brain injury, dietary supplementation, one-carbon metabolism, and B-vitamins. The focus of each literature search was basic science data. The year of publication in the literature searches was not limited. Our analysis of the literature has shown that dietary supplementation of B-vitamins has significantly improved the functional and behavioral recovery of animals with traumatic brain injury compared to controls. However, this improvement is dosage-dependent and is contingent upon the onset of supplementation and whether there is a sustained or continuous delivery of vitamin supplementation post-traumatic brain injury. The details of supplementation post-traumatic brain injury need to be further investigated. Overall, we conclude that B-vitamin supplementation improves behavioral outcomes and reduces cognitive impairment post-traumatic brain injury in animal model systems. Further investigation in a clinical setting should be strongly considered in conjunction with current medical treatments for traumatic brain injury-affected individuals.
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Affiliation(s)
- Sanika M. Joshi
- College of Osteopathic Medicine, Midwestern University, Glendale, CA, USA
- Department of Biomedical Sciences, Midwestern University, Glendale, CA, USA
| | - Theresa Currier Thomas
- Department of Child Health, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Nafisa M. Jadavji
- College of Osteopathic Medicine, Midwestern University, Glendale, CA, USA
- Department of Biomedical Sciences, Midwestern University, Glendale, CA, USA
- Department of Child Health, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
- College of Veterinary Medicine, Midwestern University, Glendale, CA, USA
- Department of Neuroscience, Carleton University, Ottawa, Canada
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2
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Hoss GRW, Sperb-Ludwig F, Tonon T, Poloni S, Behringer S, Blom HJ, Maillot F, Schwartz IVD. Homocysteine and methylmalonic acid in Phenylketonuria patients. Genet Mol Biol 2024; 46:e20230103. [PMID: 38591937 PMCID: PMC11000623 DOI: 10.1590/1678-4685-gmb-2023-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
Hyperhomocysteinemia and vitamin B12 deficiency have been reported in patients with phenylketonuria. In this study, total homocysteine (tHcy) and methylmalonic acid (MMA) levels were analyzed in samples from 25 phenylketonuria (PKU) patients. Comparisons were made between pre- and post-treatment values (n= 3); on treatment values, between periods with high and normal/low phenylalanine (Phe) levels (n= 20); and in women before, during and after pregnancy (n= 3). THcy levels decreased after treating PKU with metabolic formula (p=0.014). Except for a pregnant woman before pregnancy, none of the patients had tHcy values above the normal range. In fact, tHcy was < 5 μmol/L in 34% of the samples. We observed a decrease in Phe, tHcy, and tyrosine levels during pregnancy. MMA levels did not differ significantly, with values remaining in the normal range. These data indicate that there was no B12 deficiency in patients who adhere to the diet. In conclusion, in PKU patients treated with metabolic formula, tHcy is frequently not elevated, remaining even in the lower normal range in some patients. Thus, clinical follow-up and adherence to dietary treatment are crucial to prevent B12 deficiency.
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Affiliation(s)
- Giovana Regina Weber Hoss
- Hospital de Clínicas de Porto Alegre, Laboratório BRAIN, Porto
Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de
Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
| | - Fernanda Sperb-Ludwig
- Hospital de Clínicas de Porto Alegre, Laboratório BRAIN, Porto
Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de
Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
| | - Tássia Tonon
- Hospital de Clínicas de Porto Alegre, Laboratório BRAIN, Porto
Alegre, RS, Brazil
| | - Soraia Poloni
- Hospital de Clínicas de Porto Alegre, Laboratório BRAIN, Porto
Alegre, RS, Brazil
| | - Sidney Behringer
- University Medical Centre, Laboratory of Clinical Biochemistry and
Metabolism, Freiburg, Germany
| | - Henk J. Blom
- Erasmus Universiteit Rotterdam, Laboratory of Clinical Genetics, The
Netherlands
| | - François Maillot
- University Hospital of Tours, Department of Internal Medicine,
Tours, France
- UMR INSERM 1253, Tours, France
- Reference Center for Inherited Metabolic Diseases, Tours,
France
| | - Ida Vanessa Doederlein Schwartz
- Hospital de Clínicas de Porto Alegre, Laboratório BRAIN, Porto
Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de
Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica,
Porto Alegre, RS, Brazil
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Alomar OO, Rabbani U. Patients' Perspectives on Type 2 Diabetes, Vitamin B12 Deficiency, and Supplementation in Buraidah, Saudi Arabia. Cureus 2024; 16:e55345. [PMID: 38559501 PMCID: PMC10981927 DOI: 10.7759/cureus.55345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Long-term metformin is associated with vitamin B12 deficiency. There is a significant misunderstanding among both physicians and patients regarding vitamin B12 indications. This study aims to identify knowledge gaps and attitudes toward vitamin B12 among diabetic patients. Materials and methods A cross-sectional study was conducted among type 2 diabetic patients visiting four primary healthcare centers in Buraidah, Saudi Arabia. The data were collected using a structured self-administered questionnaire. Data were collected on diabetes and vitamin B12 knowledge and attitude toward vitamin B12 supplementation. Logistic regression analyses were used to assess the predictors of knowledge and attitude. Results Of the 388 participants, 192 (49.5%) were male. About 84.5% of the total diabetics were on metformin. Nearly three-fourths (72.7%) were taking vitamin B12. A large proportion, 160 (41.2%), believed that it is necessary to take vitamin B12 for every diabetic patient. Nearly half, 193 (49.7%), did not know the factors affecting vitamin B12 deficiency. Young (less than 39 years) diabetics were more likely to perceive that vitamin B12 is recommended for all diabetics, OR (95% CI) [6.26 (1.86-21.06)], as compared to participants aged more than 59. Similarly, younger patients were more likely to assume vitamin B12 necessary, OR (95% CI) [3.71 (1.26-10.89)]. Conclusion We found the knowledge and attitude of diabetic patients regarding vitamin B12 to be poor. It is, therefore, recommended that primary health care providers educate their patients about vitamin B12 supplementation to reduce the number of medications and financial burden. Further large-scale studies are also needed to generate stronger evidence of the problem.
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Affiliation(s)
- Osama O Alomar
- Family Medicine, Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
| | - Unaib Rabbani
- Family Medicine, Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
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Wang S, Li Z, Shi Y, Wang T, Jin W. Nitrous oxide induced subacute combined degeneration of the spine cord: A case report. Medicine (Baltimore) 2024; 103:e37032. [PMID: 38335379 PMCID: PMC10860927 DOI: 10.1097/md.0000000000037032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE In recent years, recreational use of inhaled nitrous oxide (N2O) is on the increase among young people, accompanied by a corresponding rise in reports about its toxicity. Subacute combined degeneration of the spine cord (SCD) is the typical clinical picture of the nervous system disorder caused by N2O intoxication, as a result of metabolic disturbance of vitamin B12. PATIENT CONCERNS, DIAGNOSES, INTERVENTIONS AND OUTCOMES We report a 28-year-old female of SCD due to prolonged use of N2O, presented with paresthesia and unsteady in walking progressing within 1 month. Symptoms gradually improved with the treatment of intramuscular injections of hydroxocobalamin combined with N2O abstinence, and the patient recovered completely with normal neurological examination after 4 months of follow-up. LESSONS Clinicians should be aware of the clinical features and pathogenesis of SCD caused by N2O intoxication in order to lead effective treatment as soon as possible. Recreational N2O use should always be considered as an etiology when dealing with patients presented with myelopathy and/or neuropathy suspected of vitamin B12 deficiency.
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Affiliation(s)
- Shuo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhe Li
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yuanyuan Shi
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Tianjun Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Jin
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
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Bošković A, Ćuk A, Mandrapa V, Šimić AD, Cvetković I, Vlaho MO, Krešić T, Tomić T, Tomić V. Association of MTHFR polymorphism, folic acid and vitamin B12 with serum homocysteine levels in pregnant women. Biomol Biomed 2024; 24:138-143. [PMID: 37622180 PMCID: PMC10787622 DOI: 10.17305/bb.2023.9260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Homocysteine is known to be associated with adverse vascular and metabolic effects, as well as pregnancy complications. Its serum levels are influenced by the function of the enzyme methylenetetrahydrofolate reductase (MTHFR) and the dietary intake of folic acid, vitamin B12, and methionine. In this cross-sectional study, we investigated the association of genetic polymorphisms of the MTHFR gene with vitamin status in pregnant women during mandatory folic acid supplementation. The study included 102 pregnant women between 24 and 28 weeks of gestation who were attending regular outpatient examinations at the maternity clinic. Homocysteine, folic acid, vitamin B12 levels, and MTHFR gene polymorphisms (C677T and A1298C) were analyzed. Significant associations were found between vitamin B12 and folic acid levels with homocysteine (P < 0.001), with lower serum levels of these vitamins being associated with higher homocysteine levels. Surprisingly, there was no significant association between MTHFR genetic polymorphisms and serum homocysteine levels, likely attributed to the supplementation of folic acid and vitamin B12 in vitamin supplements for pregnant women, which counteracts the effect of the mutation. Remarkably, a high prevalence of MTHFR gene mutations was found, with the C677T polymorphism present in 56.9% and the A1298C polymorphism in 87.2% of pregnant women. These findings emphasize the importance of adequate folic acid and vitamin B12 intake during pregnancy to regulate homocysteine levels. Although the MTHFR gene mutations were highly prevalent, their influence on homocysteine levels in this population appears to be mitigated by vitamin supplementation. Further research is warranted to explore the impact of these mutations on other aspects of pregnancy outcomes. The trial is registrated at Clinicaltrail.gov (NCT04952324).
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Affiliation(s)
- Ana Bošković
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ana Ćuk
- Department of Laboratory Diagnostics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Vedrana Mandrapa
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ana Dugandžić Šimić
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivona Cvetković
- Department of Laboratory Diagnostics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Martina Orlović Vlaho
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Faculty of Health Studies, University Mostar, Mostar, Bosnia and Herzegovina
- Faculty of Medicine, University Mostar, Mostar, Bosnia and Herzegovina
| | - Tanja Krešić
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Tanja Tomić
- Faculty of Health Studies, University Mostar, Mostar, Bosnia and Herzegovina
| | - Vajdana Tomić
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Faculty of Health Studies, University Mostar, Mostar, Bosnia and Herzegovina
- Faculty of Medicine, University Mostar, Mostar, Bosnia and Herzegovina
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Aghayeva S, Sonmezer M, Şükür YE, Jafarzade A. The Role of Thyroid Hormones, Vitamins, and Microelements in Female Infertility. Rev Bras Ginecol Obstet 2023; 45:e683-e688. [PMID: 38029770 PMCID: PMC10686760 DOI: 10.1055/s-0043-1772478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE It is well known that female infertility is multifactorial. Therefore, we aimed to compare the effects of thyroid dysfunction, vitamin deficiency, and microelement deficiency in fertile and infertile patients. MATERIALS AND METHODS Between May 1st, 2017, and April 1st, 2019, we conducted a retrospective case-control study with of 380 infertile and 346 pregnant patients (who normally fertile and able to conceive spontaneously). The fertile patients were selected among those who got pregnant spontaneously without treatment, had a term birth, and did not have systemic or obstetric diseases. The levels of thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-thyroid peroxidase (anti-TPO), vitamin D, vitamin B12, folic acid, ferritin, and zinc of both groups were compared. RESULTS There was no difference between patients in the infertile and pregnant groups in terms of low normal and high serum T3 and T4 levels (p = 0.938; p > 0.05) respectively, nor in terms of normal and high anti-TPO levels (p = 0.182; p > 0.05) respectively. There was no significant difference regarding patients with low, insufficient, and sufficient vitamin D levels in the infertile and pregnant groups (p = 0.160; p >0.05) respectively. The levels of folic acid, ferritin, and zinc of the infertile group were significantly lower than those of the pregnant group. CONCLUSION The serum levels of folic acid, ferritin, and zinc in infertile patients presenting to our outpatient clinic were lower than those o the fertile patients.
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Affiliation(s)
- Sveta Aghayeva
- Department of Obstetrics and Gynecology, Koru Hospital Ankara, Ankara, Turkey
| | - Murat Sonmezer
- Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
| | - Aytaj Jafarzade
- Department of Obstetrics and Gynecology, Koru Hospital Ankara, Ankara, Turkey
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Alqurashi RM, Aladwani A, Alosaimi TH, Yousef DB, Alkhaldi MH, Amer MG. Awareness of the Effect of Vitamin B12 Deficiency on the Nervous System Among the General Population in Taif, Saudi Arabia. Cureus 2023; 15:e49343. [PMID: 38143656 PMCID: PMC10749181 DOI: 10.7759/cureus.49343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Vitamin B12 is important for the health of the nervous system, its deficiency leads to various neurological manifestations such as visual problems, ataxia, peripheral neuropathy, dementia, etc. The deficiency can be caused by malnutrition, malabsorption, or increased demand. Early detection is important for the control and prevention of complications. METHOD In December 2021, a population-based cross-sectional survey was carried out among Saudi males and women at least 18 years old. There were 383 participants in the sample. An electronic survey distributed over social media was used to collect the data. SPSS version 28 was used to analyze the data. RESULTS The majority of the respondents were female (88%). Most participants were aged 18-25 years (44%). Regarding participants' awareness and knowledge of vitamin deficiency, 64% were aware of vitamin B12 deficiency. 41.7% of participants knew about food sources of vitamin B12, 29.0% knew how to prevent it, and 30.0% took vitamin B12 supplements. (92.2%) of the participants were not following vegetarian or vegan diets. Difficulty concentrating accounted for the highest number of reported symptoms by the respondents (53.8%). CONCLUSION This study recommends a scientific approach encouraging patients to self-report their B12 deficiency in medical institutions. In addition, a study about the relationship between B12 deficiency and other neurodegenerative disorders is also a recommendation of this study.
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Brochado AI, Marques Dias J, Azevedo Ferreira M, Grilo A, Gonçalves A. Pernicious Anemia With Spuriously Normal B12 Levels. Cureus 2023; 15:e48937. [PMID: 38106734 PMCID: PMC10725556 DOI: 10.7759/cureus.48937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
We present a 29-year-old man admitted to our hospital with fatigue for two months of duration and recent palpitations, lightheadedness, blurred vision and nausea. Workup showed pancytopenia with severe macrocytic anemia, laboratory and blood smear features of hemolysis, low reticulocyte percentage and a negative direct Coombs test. B12 and folate levels were normal. As bone marrow aspirate was suggestive of megaloblastic anemia and upper endoscopy showed atrophic gastritis, we ordered homocysteine (elevated) and intrinsic factor (IF) antibodies (positive). The workup led to the diagnosis of pernicious anemia with spuriously normal B12 levels. Replacement therapy allowed a rapid recovery. We highlight that the presence of IF antibodies can interfere with the competitive binding assays commonly used to measure B12 levels.
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Affiliation(s)
| | | | | | - Ana Grilo
- Internal Medicine Department, Hospital Beatriz Ângelo, Loures, PRT
| | - Ana Gonçalves
- Intensive Care Unit Department, Hospital Beatriz Ângelo, Loures, PRT
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Genc FT, Nalbant A, Genc AC, Kaya T. Effect of a combination of gliptin and metformin on serum vitamin B12, folic acid, and ferritin levels. Rev Assoc Med Bras (1992) 2023; 69:e20230641. [PMID: 37909618 PMCID: PMC10610761 DOI: 10.1590/1806-9282.20230641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The primary objective of this study was to explore the impact of metformin and metformin/gliptin combination therapy on the serum concentrations of vitamin B12, ferritin, and folic acid in individuals diagnosed with type 2 diabetes. METHODS This study included 118 patients, classified into two groups: 59 patients using only metformin and 59 patients using a combination of metformin/gliptin. Among the latter group, 35 patients used vildagliptin/metformin, and 24 used sitagliptin/metformin. The study recorded the demographic data such as the age and gender of the patients, as well as their initial and 1-year follow-up blood parameters. RESULTS Folic acid decreased significantly in the metformin group but not in the metformin/gliptin group. Vitamin B12 and ferritin decreased significantly in both groups. The decrease in vitamin B12 and ferritin was not significantly different between the two groups. The decrease in fasting plasma glucose was more significant in the metformin/gliptin group than in the metformin group. CONCLUSION After 1 year, both groups taking metformin and metformin/gliptin showed low serum ferritin and vitamin B12 levels. Therefore, vitamin B12 levels in patients using these drugs should be closely monitored. Ferritin levels can be used to indicate whether glycemic control has been achieved.
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Affiliation(s)
| | - Ahmet Nalbant
- Sakarya University, Faculty of Medicine, Department of Internal Medicine – Sakarya, Turkey
| | - Ahmed Cihad Genc
- Hendek State Hospital, Department of Internal Medicine – Sakarya, Turkey
| | - Tezcan Kaya
- Sakarya University, Faculty of Medicine, Department of Internal Medicine – Sakarya, Turkey
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Bowden A, Ekeh O, Brownstone ND, Hsu S. Acneiform Eruption Secondary to Over-the-Counter Vitamin B12. Cureus 2023; 15:e43275. [PMID: 37692729 PMCID: PMC10492573 DOI: 10.7759/cureus.43275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Treating an acneiform eruption requires the discovery of its etiology. Often, the removal of the offending agent can lead to the resolution of the eruption, resulting in an excellent prognosis. Herein, we present a rare case of a vitamin B12-induced acneiform eruption occurring in a 68-year-old female due to an over-the-counter supplement.
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Affiliation(s)
- Acacia Bowden
- Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Odera Ekeh
- Dermatology, Cooper Medical School of Rowan University, Camden, USA
| | | | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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Khan MAN, Ghani U, Surani S, Aftab A. Vitamin B12 Deficiency, a Rare Cause of Isolated Thrombocytopenia in Adults. Cureus 2023; 15:e44162. [PMID: 37753039 PMCID: PMC10519260 DOI: 10.7759/cureus.44162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Isolated thrombocytopenia in adults is a common clinical problem, often caused by various hematological disorders. However, vitamin B12 deficiency as a rare cause of isolated thrombocytopenia has been rarely reported in the medical literature. This case report aims to highlight the diagnostic challenges associated with atypical presentations of thrombocytopenia and emphasizes the importance of considering nutritional deficiencies, such as vitamin B12 deficiency, in the diagnostic workup. We report the case of a 38-year-old male who presented with generalized weakness, fatigue, and a history of bruises without trauma. Physical examination and laboratory investigations revealed thrombocytopenia (42 K/µL) with normal red blood cell morphology and no apparent abnormalities in other hematological parameters. Serum vitamin B12 levels were significantly diminished (128 pg/ml). The patient was treated with subcutaneous mecobalamin 1000 mcg supplementation, resulting in improvements in serum vitamin B12 levels (772 pg/ml) and platelet count (154 × 109/L) values. This case highlights the importance of considering vitamin B12 deficiency as a potential cause of isolated thrombocytopenia in adults. The lack of hypersegmented neutrophils and characteristic signs of macrocytic anemia in the context of vitamin B12 deficiency emphasizes the necessity for a thorough investigation to rule out other possible causes. Hematological problems associated with thrombocytopenia caused by vitamin B12 deficiency can be treated early to resolve them and avoid complications.
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Affiliation(s)
| | - Usman Ghani
- Cardiology, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Salim Surani
- Internal Medicine, Texas A&M University, College Station, USA
| | - Ayeman Aftab
- Internal Medicine, Mahsa University, Kuala Lumpur, MYS
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12
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Gupta R, Choudhary S, Chatterjee T. A Study on Vitamin B12 Levels in Hypothyroid Patients Presenting to a Tertiary Care Teaching Hospital. Cureus 2023; 15:e44197. [PMID: 37767262 PMCID: PMC10521342 DOI: 10.7759/cureus.44197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Background and aims The prevalence of vitamin B12 deficiency is found to coexist in hypothyroid patients, causing the persistence of symptoms concomitant to both diseases even on adequate thyroxine supplementation. Primary objective To study vitamin B12 levels in patients with hypothyroidism. Secondary objective To study the clinical profile of patients with hypothyroidism with special reference to anemia, and to study the association between vitamin B12 deficiency with anti-thyroid peroxidase (anti-TPO) antibodies and anti-thyroglobulin (anti-Tg) antibodies in patients with hypothyroidism. Methods and results A single-centric cross-sectional study was carried out over a period of one year. Among 100 hypothyroid patients, 68% were found to be vitamin B12 deficient, among whom 73.5% were females. Of patients with raised anti-TPO antibodies, 78.6% had vitamin B12 deficiency (p = 0.01), while 78% of patients with raised anti-Tg antibodies were vitamin B12 deficient (p = 0.07). The Pearson correlation coefficient (r) of vitamin B12 with anti-TPO and anti-Tg antibodies was -0.302 (p = 0.002) and -0.253 (p = 0.011), respectively. Conclusion There is a predilection of hypothyroid patients toward developing anemia, with vitamin B12 deficiency as a major etiology. This finding can be correlated with the hematopoietic action of thyroid-stimulating hormones as well as autoimmune thyroid disease predisposing to pernicious anemia.
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Affiliation(s)
- Ritu Gupta
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | - Sushma Choudhary
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | - Trisha Chatterjee
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
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13
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Banjongjit A, Sutamnartpong P, Mahanupap P, Phanachet P, Thanakitcharu S. Nitrous Oxide-Induced Cerebral Venous Thrombosis: A Case Report, Potential Mechanisms, and Literature Review. Cureus 2023; 15:e41428. [PMID: 37546135 PMCID: PMC10403680 DOI: 10.7759/cureus.41428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Cerebral venous thrombosis can result from hypercoagulation, either genetic or acquired. Hyperhomocysteninemia was previously thought to be linked with thrombophilia, although this is still controversial to this present day. In recent years, there has been a notable surge in the recreational use of nitrous oxide, which could potentially lead to hyperhomocysteinemia. We present a case of a 19-year-old female who was diagnosed with cerebral venous thrombosis with intracerebral hemorrhage. She had a history of nitrous oxide abuse, which is known to cause dysfunction of vitamin B12. Additionally, we conducted a literature review of cerebral venous thrombosis following nitrous oxide usage. Investigation showed that her serum vitamin B12 level was <100 pg/mL (reference range 197-771 pg/mL), and homocysteine level was 100.6 µmol/L (reference range 5.0-15.0 µmol/L). After receiving a vitamin B12 supplement, both serum vitamin B12 and homocysteine levels returned to normal. No other risk factors for thrombophilia were detected. Previously reported cases predominantly demonstrated hyperhomocysteinemia. The most likely mechanism of her cerebral venous thrombosis was hyperhomocysteinemia due to vitamin B12 deficiency caused by nitrous oxide abuse. This finding supports the hypothesis that hyperhomocysteinemia can induce cerebral venous thrombosis.
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Affiliation(s)
| | | | | | - Pariya Phanachet
- Nutrition and Biochemical Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, THA
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14
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Portillo S, Guevara NA, Francis-Morel G. Psychosis and Seizures Attributed to Severe Vitamin B12 Deficiency: A Case Report. Cureus 2023; 15:e39889. [PMID: 37404443 PMCID: PMC10315186 DOI: 10.7759/cureus.39889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Vitamin B12 deficiency is known to cause a variety of symptoms, including megaloblastic anemia, glossitis, and neuropsychiatric disorders. This case report describes a patient who presented with cognitive decline, psychosis, and seizures due to a severe vitamin B12 deficiency. Following treatment with vitamin supplementation therapy, the patient's condition significantly improved. The literature has also documented similar neuropsychiatric manifestations of vitamin B12 deficiency, highlighting the potential for symptom reversal with prompt and appropriate treatment. Therefore, early diagnosis and treatment of vitamin B12 deficiency are critical to preventing potentially irreversible neurological damage.
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15
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Ghazal F, Zur M, Silver A. Combined Presentation of Acute Confusion and Severe Pancytopenia in Vitamin B12 Deficiency. Cureus 2023; 15:e40236. [PMID: 37435265 PMCID: PMC10332886 DOI: 10.7759/cureus.40236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Vitamin B12 deficiency is more prevalent in the elderly and can develop as a result of malnutrition, malabsorption, chronic alcoholism, and chronic use of common medications (e.g. metformin, PPI, methotrexate) along with other causes. A wide spectrum of hematological and neuropsychiatric manifestations exist with the most common being Megaloblastic anemia and subacute combined degeneration, respectively. The mechanisms leading to the manifestations specific to these two organ systems are thought to be different. The severity of neuropsychiatric presentation is reported to be inversely proportional to that of hematological presentation, thus making it uncommon for both to be readily apparent simultaneously. Regardless of the severity of the clinical presentation, a good response to vitamin B12 replacement therapy is reported despite the lack of guidelines regarding dosing, frequency, or duration of treatment needed to note improvement in manifestations. The aim of this report is to increase the provider's knowledge that a severe combined hematological and neuropsychiatry manifestation can co-exist and report the management used for recovery.
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Affiliation(s)
- Fatima Ghazal
- Internal Medicine, University of Connecticut School of Medicine, Farmington, USA
| | - Michelle Zur
- Internal Medicine, University of Connecticut Health, Farmington, USA
| | - Aaron Silver
- Hospital Medicine, Hartford Hospital, Hartford, USA
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16
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Bijaya M, Ansari Z, Koshy B, Sunder A. Immune Thrombocytopenia Secondary to COVID-19 in a Vitamin B12-Deficient Patient: A Diagnostic Dilemma and Therapeutic Challenge. Cureus 2023; 15:e40199. [PMID: 37435254 PMCID: PMC10330955 DOI: 10.7759/cureus.40199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Immune thrombocytopenia (ITP) caused by infectious and non-infectious conditions has been reported in coronavirus disease 2019 (COVID-19) patients too. Here we present a 64-year-old male patient with post-COVID-19 pneumonia who presented with a gastrointestinal bleed and was found to have severe isolated thrombocytopenia (22,000/cumm) diagnosed as ITP with extensive investigations. He was treated with pulse steroid therapy and later was also given intravenous immunoglobin in view of poor response. The addition of eltrombopag also resulted in a sub-optimal response. He was also having low vitamin B12, and his bone marrow also supported the megaloblastic picture. Hence, injectable cobalamin was added to the regimen, which resulted in a sustained rise in platelet count that reached 78,000/cumm, and the patient got discharged. This shows the possible hindrance to treatment response by concomitant B12 deficiency. Vitamin B12 deficiency is not an uncommon entity and should be tested in those who show no or slow response to thrombocytopenia.
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Affiliation(s)
| | - Zeya Ansari
- Internal Medicine, Manipal Tata Medical College, Jamshedpur, IND
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Binu Koshy
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Ashok Sunder
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
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17
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Genc S, Yagci T, Vageli DP, Dundar R, Doukas PG, Doukas SG, Tolia M, Chatzakis N, Tsatsakis A, Taghizadehghalehjoughi A. Exosomal MicroRNA-223, MicroRNA-146, and MicroRNA-21 Profiles and Biochemical Changes in Laryngeal Cancer. ACS Pharmacol Transl Sci 2023; 6:820-828. [PMID: 37200807 PMCID: PMC10186621 DOI: 10.1021/acsptsci.3c00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 05/20/2023]
Abstract
Laryngeal squamous cell carcinoma (LSCC) is one of the most aggressive cancers, and its early diagnosis is urgent. Exosomes are believed to have diagnostic significance in cancer. However, the role of serum exosomal microRNAs, miR-223, miR-146, and miR-21, and phosphatase and tensin homologue (PTEN) and hemoglobin subunit delta (HBD) mRNAs in LSCC is unclear. Exosomes were isolated from the blood serum of 10 LSCC patients and 10 healthy controls to perform scanning electron microscopy and liquid chromatography quadrupole time-of-flight mass spectrometry analyses to characterize them and to undergo reverse transcription polymerase chain reaction to identify miR-223, miR-146, miR-21, and PTEN and HBD mRNA expression phenotypes. Biochemical parameters, including serum C-reactive protein (CRP) and vitamin B12, were also obtained. Serum exosomes of 10-140 nm were isolated from LSCC and controls. Serum exosomal miR-223, miR-146, and PTEN were found to be significantly decreased (p < 0.05), in contrast to serum exosomal miRNA-21 (p < 0.01), and serum vitamin B12 and CRP (p < 0.05) were found to be significantly increased, in LSCC vs controls. Our novel data show that the combination of reduced serum exosomal miR-223, miR-146, and miR-21 profiles and biochemical alterations in CRP and vitamin B12 levels may be useful indicators of LSCC that could be validated by large studies. Our findings also suggest a possible negative regulatory effect of miR-21 on PTEN in LSCC, encouraging a more extensive investigation of its role.
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Affiliation(s)
- Sidika Genc
- Faculty
of Medicine, Department of Medical Pharmacology, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
| | - Tarik Yagci
- Faculty
of Medicine, Department of ENT, Bilecik
Seyh Edebali University, Bilecik 11230, Turkey
| | - Dimitra P. Vageli
- Yale
Larynx Laboratory, Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, Connecticut 06510, United States
| | - Riza Dundar
- Faculty
of Medicine, Department of ENT, Bilecik
Seyh Edebali University, Bilecik 11230, Turkey
| | - Panagiotis G. Doukas
- Yale
Larynx Laboratory, Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, Connecticut 06510, United States
| | - Sotirios G. Doukas
- Department
of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Peter University Hospital, New Brunswick New Jersey 08901-1780, United States
- Department
of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Maria Tolia
- Department
of Radiology, Faculty of Medicine, University
of Crete, 71003 Heraklion, Greece
| | - Nikolaos Chatzakis
- Otorhinolaryngologist
Consultant, ENT Department of University
Hospital of Crete, 71003 Heraklion, Greece
| | - Aristidis Tsatsakis
- Department
of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Ali Taghizadehghalehjoughi
- Faculty
of Medicine, Department of Medical Pharmacology, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
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18
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Subramaniam A, Ramasamy S, Palanisamy S, Punniyamurthy A, Murugaiyan S. Low Vitamin B12 Levels and Its Association With Insulin Resistance: A Potent Cardiovascular Risk Indicator in Childhood Asthma. Cureus 2023; 15:e39422. [PMID: 37362491 PMCID: PMC10288390 DOI: 10.7759/cureus.39422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction As insulin resistance metabolically affects the body mass index (BMI), obese asthma children have more severe diseases than children with normal body mass index. A low level of vitamin B12 (Vit B12) is a known atherogenic factor by increasing the homocysteine level and therefore promotes cardiovascular morbidity and mortality. Limited studies have evaluated the role of serum B12 and insulin resistance among poorly controlled asthma in children. The purpose of the study was to compare the cardio-metabolic risk factor such as BMI, waist-hip ratio (WHR), insulin resistance, and vitamin B12 in well-controlled and poorly-controlled asthma patients and to determine the relationship between these parameters with the severity of asthma as assessed by Pulmonary Function Test. Methodology Based on the asthma control questionnaire and Global Initiative for Asthma (GINA) criteria, chronic asthma patients (n=60) of age 10-15 years were divided into two groups, namely well-controlled and poorly-controlled (30 each). Anthropometry was assessed by BMI and waist-hip ratio, and fasting blood samples were collected for the estimation of blood glucose, insulin, and serum vitamin B12 levels. Insulin resistance (HOMA-IR) was calculated using the formula- fasting glucose (mg/dL) x fasting insulin (µIU/mL)]/405. Forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured to assess the pulmonary function test. Results There were significant differences in the values of the BMI, insulin resistance, vitamin B12, and pulmonary function tests between poorly controlled and well-controlled asthma (p<0.01). The FEV1: FVC% was negatively correlated with BMI (r=0.53), WHR (r=0.50), glucose (r=0.68), insulin (r=0.68), Insulin resistance (r=0.80), and positive correlation with Vit B12 (0.73). In addition, Vit B12 and HOMA-IR correlate negatively (r=0.76). Conclusion This study concludes that the level of Vit B12 is decreased and insulin resistance is increased in poorly controlled asthmatic children in comparison to well-controlled asthma. These factors along with the increased BMI in poorly controlled asthma can predispose to cardiometabolic risk which needs attention.
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Affiliation(s)
- Arulvijayavani Subramaniam
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research Karaikal, Karaikal, IND
| | - Sathiya Ramasamy
- Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, IND
| | | | - Athisankaran Punniyamurthy
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research Karaikal, Karaikal, IND
| | - Sathishbabu Murugaiyan
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research Karaikal, Karaikal, IND
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19
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Park EJ. Association between vitamin B12 status and heart rate variability in patients with ischemic stroke. Medicine (Baltimore) 2023; 102:e33428. [PMID: 37083795 PMCID: PMC10118344 DOI: 10.1097/md.0000000000033428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
Autonomic dysfunction is common in patients with ischemic stroke. An ischemic stroke may induce abnormalities in autonomic tone, resulting in poor heart rate regulation and an increased risk of severe cardiac arrest and sudden death. Heart rate variability (HRV) is a reliable index for evaluating autonomic dysfunction. Vitamin B12 deficiency is frequent among older adults and is a known risk factor for ischemic stroke. As vitamin B12 deficiency affects the peripheral nerves and the central nervous system, it can lead to autonomic dysfunction. However, no study has been published on the correlation between HRV and vitamin B12 status in patients with ischemic stroke. This study aimed to investigate the relationship between HRV and vitamin B12 status and to determine whether the serum vitamin B12 level can be a predictor of HRV parameters. This retrospective study enrolled patients with ischemic stroke between January 2015 and December 2022. The patients underwent serum vitamin B12 level measurements and 24-h Holter monitoring. Pearson correlation analysis was used to investigate the correlation between serum vitamin B12 levels and HRV parameters. The impact of serum vitamin B12 status on HRV parameters was determined using multiple linear regression analysis. A total of 87 patients with ischemic stroke were included in this study. HRV parameters were significantly correlated with serum vitamin B12 status in the frequency domain. In multiple linear regression analysis, the serum vitamin B12 status was a significant predictor of HRV parameters. HRV parameters may be correlated with serum vitamin B12 status in patients with ischemic stroke. Therefore, the serum vitamin B12 status may be a significant predictor of autonomic dysfunction. Our results may provide objective evidence for the impact of serum vitamin B12 status on autonomic dysfunction in patients with ischemic stroke.
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Affiliation(s)
- Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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20
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Alexander Muacevic, John R Adler. Evaluation of the Relationship Between Smoking and Insulin Resistance: A Case-Control Study. Cureus; 15:e36684. [PMID: 36987444 PMCID: PMC10039987 DOI: 10.7759/cureus.36684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 03/28/2023] Open
Abstract
Introduction: In recent years, there has been a surge in research focusing on the link between smoking and insulin resistance in the context of obesity and diabetes. In this study, our objective was to investigate the relationship between smoking and insulin resistance. Materials and Methods: This is a case-control study. The case and control groups were formed using the hospital patient information database and clinically randomized using data obtained, including age, gender, height, and weight. The case group for this study consisted of smokers, whereas the control group consisted of non-smokers. Chi-square tests were used to compare numbers and rates, and independent sample t-tests were used for the averages. Binary logistic regression analysis was performed between the case and control groups. Results: According to logistic regression analysis, the odds ratio for non-smokers was 0.59 (0.31-1.14). The risk of insulin resistance is decreased by 41% non-significantly in non-smokers. The odds ratio for age was 1.03 (1.01-1.05). When the age variable increases by one unit, the risk of insulin resistance increase by 1.03 times. Conclusion: Our study found no significant relationship between smoking and insulin resistance in healthy individuals. The relationship between smoking and insulin resistance, as reported in the scientific literature, may be suggestive of an association in which smoking exacerbates insulin resistance as a result of other contributing factors rather than serving as a direct causal factor. Further studies are warranted to elucidate the potential mechanisms underlying this association fully.
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21
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Muacevic A, Adler JR, Moya M, Menowsky M, Cruz RA. A Case Report of Subacute Combined Degeneration Due to Nitrous Oxide-Induced Vitamin B12 Deficiency. Cureus 2023; 15:e34514. [PMID: 36788992 PMCID: PMC9912992 DOI: 10.7759/cureus.34514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/04/2023] Open
Abstract
Nitrous oxide, also known as "laughing gas," is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, its recreational use is on the rise. We present a case of subacute combined degeneration (SCD) due to nitrous oxide-induced vitamin B12 deficiency. The patient presented with bilateral lower extremity paresthesia, weakness, and ataxic gait. The patient was found to have vitamin B12 deficiency. An MRI of the cervical spine revealed an abnormal T2 signal within the cervical spinal cord extending from the level of C2-C6 affecting only the posterior column. On the fifth day of hospitalization, the patient reported that he had been inhaling nitric oxide from whipped cream cans for recreational use. According to his clinical presentation and laboratory and imaging findings, we concluded that the patient had SCD. The patient slowly improved after receiving vitamin B12 supplementation therapy. Patients presenting with paresthesia, weakness, and laboratory studies indicating vitamin B12 deficiency should be questioned about nitrous oxide recreational use since the incidence is increasing.
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22
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Akbulut S. An assessment of serum vitamin B12 and folate in patients with Crohn's disease. Medicine (Baltimore) 2022; 101:e31892. [PMID: 36550821 PMCID: PMC9771213 DOI: 10.1097/md.0000000000031892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Crohn's disease is a chronic inflammatory condition that can involve any area in the gastrointestinal tract often involving the distal ileum where vitamin B12 is specifically absorbed. The aim of this study was to ascertain serum vitamin B12 and folate levels in order to investigate the correlation among these vitamin levels and disease activation, localization, duration and age at the onset of the disease. Study population included 103 patients with Crohn's disease and a healthy control group of 114 individuals. C-reactive protein, vitamin B12, folate levels were studied along with hemogram analyses. The results were evaluated in statistical comparisons. While serum vitamin B12 levels and serum folate levels were 161.9 ± 63.2(73-496) pg/mL and 4.9 ± 1.4(1.2-9.4) ng/mL in the Crohn's patient group respectively, they were 321.7 ± 126.3(85-680) pg/mL and 7.6 ± 3.8(3-25.1) ng/mL in the control group respectively. Vitamin B12 and folate levels were distinctly lower in patients with Chron's disease than those of the control group (P < .001). The intragroup analysis of the patient group revealed that low vitamin B12 levels were significantly lower in the moderate group classified according to the Crohn's Disease Activity Index (P < .001), along with those in the L1 group with terminal/distal ileal involvement (P < .001). Vitamin B12 and folate deficiencies are quite prevalent in patients with Crohn's disease while this condition can lead to various complications and they prove to be important risk factors associated especially with thrombosis and its complications. Patients must be regularly followed-up for vitamin B12 and folate levels to supplement them where needed.
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Affiliation(s)
- Sabiye Akbulut
- Department of Gastroenterology, University of Health Sciences, Kartal Koşuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
- * Correspondence: Sabiye Akbulut, Department of Gastroenterology, University of Health Sciences, Kartal Koşuyolu High Specialty Training and Research Hospital, Istanbul 34865, Turkey (e-mail: )
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23
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Muacevic A, Adler JR, Tehseen Z, Khemani V, J SK, Nousherwani MD, Saleem F, Abdelhameed AN. Effect of Metformin on Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus and Factors Associated With It: A Meta-Analysis. Cureus 2022; 14:e32277. [PMID: 36628003 PMCID: PMC9816920 DOI: 10.7759/cureus.32277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
The current meta-analysis aims to explore the effect of metformin use on vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM) and the factors associated with it. This meta-analysis followed the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed and EMBASE from January 1, 2010, to October 31, 2022, to collect the studies that reported the effect of metformin on the deficiency of vitamin B12 in patients with T2DM and the factors associated with it. A total of 17 studies were included in the current meta-analysis. Among all the included studies, 13 were cross-sectional studies, 3 were retrospective cohorts, and one was a case-control study. The pooled rate of deficiency of vitamin B12 in patients receiving metformin (23.16%) was significantly higher compared to patients who were not on metformin (17.4%) (OR: 2.95, 95% CI: 2.18-4.00, p-value: 0.001). Factors significantly associated with vitamin B12 deficiency in patients with T2DM and receiving metformin include the duration of metformin use and a greater dose of metformin. In conclusion, our meta-analysis found that the prevalence of vitamin B12 deficiency is greater in patients receiving metformin compared to patients who did not receive metformin. Given the importance of vitamin B12 in nutrition, metformin-induced B12 decrease may be harmful to patients with T2DM. Supplemental vitamin B12 may be advantageous for those on metformin.
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24
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Elsayad OA, Abdou SM. Relation between Vitamin B12 Levels and Smell Affection in COVID-19 Patients. Int Arch Otorhinolaryngol 2022; 26:e533-e537. [PMCID: PMC9668420 DOI: 10.1055/s-0042-1755311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Olfactory and gustative alterations are frequent in the initial stages of the COVID-19 infection. Vitamin B12 deficiency has been linked to olfactory dysfunction.
Objective
The present study aimed to assess the relationship between vitamin B12 levels and smell affection in COVID-19 patients.
Methods
The present study included 201 laboratory-confirmed COVID-19 patients. Smell affection was assessed using self-rated olfactory function. Serum vitamin B12 levels were assessed using commercial enzyme-linked immunosorbent assay (ELISA) kits.
Results
According to the smell function assessment, the patients were classified into three categories: normal osmesis (
n
= 77), hyposmia (
n
= 49), and anosmia (
n
= 75) (
Fig. 1
). Four weeks later, 195 patients (97.0%) had their normal smell function restored. The remainder 6 patients included 4 anosmic and 2 hyposmic patients. Patients with hyposmia or anosmia had significantly lower vitamin B12 levels when compared with patients with normal osmesis (median [IQR]: 363.0 [198.0–539.0] versus 337.0 [175.0–467.0] and 491.0 [364.5–584.5] pg/ml, respectively,
p
< 0.001).
Conclusion
Vitamin B12 appears to have some contribution to smell affection in patients with COVID-19 infection.
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Affiliation(s)
- Osama A. Elsayad
- Benha University Faculty of Medicine, Tanta University Faculty of Medicine, Tanta, Egypt,Address for correspondence Osama A. Elsayad Benha University Faculty of Medicine, Tanta University Faculty of MedicineEl Bahr St.، Tanta Qism 2, Tanta, Gharbia Governorate 31111Egypt
| | - Said Mohammed Abdou
- Benha University Faculty of Medicine, Tanta University Faculty of Medicine, Tanta, Egypt
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25
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Li Z, Zheng R, Xue H, Zhu H. Vitamin B12 as a novel risk biomarker of spinal fractures. Medicine (Baltimore) 2022; 101:e30796. [PMID: 36397346 PMCID: PMC9666216 DOI: 10.1097/md.0000000000030796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Spinal fractures are common intra-articular fractures. Osteoporosis is a common and frequent disease among the elderly with a poor prognosis and a high risk of spinal fractures. However, the underlying factors for spinal fractures in patients with osteoporosis are unclear. A total of 105 patients with osteoporosis were recruited. Clinical and followed-up information was recorded. And vitamin B12, vitamin B2, vitamin A, and vitamin B9 in the blood were tested. Pearson's chi-squared and spearman tests were performed to analyze the correlation between spinal fractures and relative parameters. Univariate and multivariate logistic regression, univariate and multivariate Cox proportional hazards regression analysis. There exists strong relation between the expression level of vitamin B12 and spinal fractures. Pearson's chi-square and Spearman correlation test showed a strong association between vitamin B12 and vitamin B9 and a spinal fracture. Univariate logistic regression analysis showed that vitamin B12 and vitamin B9 were significantly associated with a spinal fracture. Multivariate logistic regression analysis showed that vitamin B12 was associated considerably with a spinal fracture. In addition, Cox regression analysis showed that vitamin B12 expression was significantly associated with maintenance time from recovery to recurrence (MTRR) of spinal fractures in patients with osteoporosis. Enhanced vitamin B12 is significantly correlated with the poor prognosis of patients with osteoporosis and the increasing incidence of a spinal fracture. The higher the vitamin B12, the higher the risk of spinal fracture and the shorter the time to spinal fracture recurrence.
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Affiliation(s)
- Zheng Li
- Department of Orthopedic, the Second Central Hospital of Baoding, Zhuozhou, P.R. China
| | - Rugeng Zheng
- Department of Orthopedic, the Second Central Hospital of Baoding, Zhuozhou, P.R. China
| | - Hui Xue
- Department of Orthopedic, the Second Central Hospital of Baoding, Zhuozhou, P.R. China
| | - Hao Zhu
- Department of Orthopedic, the Second Central Hospital of Baoding, Zhuozhou, P.R. China
- * Correspondence: Hao Zhu, Department of Orthopedic, the Second Central Hospital of Baoding, No. 57 Fanyang Zhong Road, Zhuozhou 072750, P.R. China (e-mail:)
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26
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Jazdarehee A, Huget-Penner S, Pawlowska M. Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0100. [PMID: 35212265 PMCID: PMC8897593 DOI: 10.1530/edm-21-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Abstract
SUMMARY Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting. LEARNING POINTS Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.
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- hypolipidaemia
- hyperactivity
- hyperacusis
- hyperandrogenaemia
- hypercalciuria
- hypercapnea
- hypercholesterolaemia
- hypercortisolaemia
- hyperflexibility
- hyperglucagonaemia
- hyperhidrosis
- hyperhomocysteinaemia
- hypernasal speech
- hyperopia
- hyperoxaluria
- hyperpigmentation
- hyperplasia
- hyperpnoea
- hypersalivation
- hyperseborrhea
- hypersomnia
- hyperthermia
- hypertrichosis
- hypertrophy
- hyperuricaemia
- hyperventilation
- hypoadrenalism
- hypoalbuminaemia
- hypocalciuria
- hypocitraturia
- hypomagnesaemia
- hypopigmentation
- hypoplastic scrotum
- hypopotassaemia
- hypoprolactinaemia
- hyporeflexia
- hyposmia
- hypospadias
- hypotension
- hypothermia
- hypotonia
- hypoventilation
- hypovitaminosis d
- hypovolaemia
- hypovolaemic shock
- hypoxia
- immunodeficiency
- impulsivity
- inattention
- infections
- inflexibility
- insomnia
- instability
- intussusception
- irritability
- ischaemia
- ischuria
- itching
- jaundice
- keratoconus
- ketonuria
- ketotic odour
- kidney dysplasia
- kidney stones
- kyphoscoliosis
- kyphosis
- labioscrotal fold abnormalities
- laceration
- late dentition
- learning difficulties
- leg pain
- legs - increased length
- leukaemia
- leukocytosis
- libido increase
- libido reduction/loss
- lichen sclerosus
- lips - dry
- lips - thin
- little finger - in-curved
- little finger - short
- liver masses
- lordosis
- lordosis (loss of)
- lymphadenectomy
- lymphadenitis
- lymphocytosis
- lymphoedema
- macroglossia
- malaise
- malaise (post-exertional)
- malodorous perspiration
- mania
- marcus gunn pupil
- mastalgia
- meckel's diverticulum
- melena
- menorrhagia
- menstrual disorder
- mesenteric ischaemia
- metabolic alkalosis
- microalbuminuria
- microcephaly
- micrognathia
- micropenis
- milk-alkali syndrome
- miscarriage
- mood changes/swings
- mouth - down-turned
- mouth - small
- movement - limited range of
- mucosal pigmentation
- muscle atrophy
- muscle freezing
- muscle hypertrophy
- muscle rigidity
- myalgia
- myasthaenia
- mydriasis
- myelodysplasia
- myeloma
- myoclonus
- myodesopsia
- myokymia
- myopathy
- myopia
- myosis
- nail clubbing
- nail dystrophy
- nasal obstruction
- nausea
- neck - loose skin (nape)
- neck - short
- neck mass
- neck pain/discomfort
- necrolytic migratory erythema
- necrosis
- nephrocalcinosis
- nephropathy
- neurofibromas
- night terrors
- nipple change
- nipple discharge
- nipple inversion
- nipple retraction
- nipples widely spaced
- nocturia
- normochromic normocytic anaemia
- nose - depressed bridge
- nose - flat bridge
- nose - thickening
- nystagmus
- obsessive-compulsive disorder
- obstetrical haemorrhage
- obstructive sleep apnoea
- odynophagia
- oedema
- oesophageal atresia
- oesophagitis
- oligomenorrhoea
- oliguria
- onychauxis
- oophoritis
- ophthalmoplegia
- optic atrophy
- orbital fat prolapse
- orbital hypertelorism
- orthostatic hypotension
- osteoarthritis
- osteopenia
- otitis media
- ovarian cysts
- ovarian hyperplasia
- palatoschisis
- pallor
- palmar erythema
- palpebral fissure (downslanted)
- palpebral fissure (extended)
- palpebral fissure (reduced)
- palpebral fissure (upslanted)
- palpitations
- pancreatic fibrosis
- pancytopaenia
- panic attacks
- papilloedema
- paraesthesia
- paralysis
- paranoia
- patellar dislocation
- patellar subluxation
- pedal ulceration
- pellagra
- pelvic mass
- pelvic pain
- penile agenesis
- peptic ulcer
- pericardial effusion
- periodontitis
- periosteal bone reactions
- peripheral oedema
- personality change
- pes cavus
- petechiae
- peyronie's disease
- pharyngitis
- philtrum - long
- philtrum - short
- phosphaturia
- photophobia
- photosensitivity
- pleurisy
- poikiloderma
- polydactyly
- polydipsia
- polyphagia
- polyuria
- poor wound healing
- postmenopausal bleeding
- post-nasal drip
- postprandial fullness
- postural instability
- prehypertension
- premature birth
- premature labour
- prenatal growth retardation
- presbyopia
- pretibial myxoedema
- proctalgia fugax
- prognathism
- proptosis
- prosopagnosia
- proteinuria
- pruritus
- pruritus scroti
- pruritus vulvae
- pseudarthrosis
- psoriatic arthritis
- psychiatric problems
- psychomotor retardation
- psychosis
- pterygium colli
- ptosis
- puberty (delayed/absent)
- puberty (early/precocious)
- puffiness
- pulmonary embolism
- purpura
- pyelonephritis
- pyloric stenosis
- pyrexia
- pyrosis
- pyuria
- rash
- rectal pain
- rectorrhagia
- refractory anemia
- reluctance to weight-bear
- renal agenesis
- renal clubbing
- renal colic
- renal cyst
- renal failure
- renal insufficiency
- renal phosphate wasting (isolated)
- renal tubular acidosis
- respiratory failure
- reticulocytosis
- retinitis pigmentosa
- retinopathy
- retrobulbar pain
- retrograde ejaculation
- retroperitoneal fibrosis
- salivary gland swelling
- salpingitis
- salt craving
- salt wasting
- sarcoidosis
- schizophrenia
- scoliosis
- scotoma
- seborrhoeic dermatitis
- seizures
- sensory loss
- sepsis
- septic arthritis
- septic shock
- shivering
- singultus
- sinusitis
- sixth nerve palsy
- skeletal deformity
- skeletal dysplasia
- skin - texture change
- skin infections
- skin necrosis
- skin pigmentation - spotty
- skin thickening
- skin thinning
- sleep apnoea
- sleep difficulties
- sleep disturbance
- sleep hyperhidrosis
- slow growth
- slurred speech
- social difficulties
- soft tissue swelling
- somnambulism
- somniloquy
- somnolence
- sore throat
- spasms
- spastic paraplegia
- spasticity
- speech delay
- spider naevi
- splenomegaly
- sputum production
- steatorrhoea
- stomatitis
- strabismus
- strangury
- striae
- stridor
- stroke
- subfertility
- suicidal ideation
- supraclavicular fat pads
- supranuclear gaze palsy
- sweating
- syncope
- syndactyly
- tachycardia
- tachypnoea
- teeth gapping
- telangiectasias
- telecanthus
- tetraparesis
- t-reflex (absent)
- t-reflex (depressed)
- tetany
- thermodysregulation
- thrombocytopenia
- thrombocytosis
- thrombophilia
- thrush
- tics
- tinnitus
- toe clubbing
- toe deformities
- toes - thick
- toes - widely spaced
- tongue - protruding
- tracheo-oesophageal compression
- tracheo-oesophageal fistula
- tremulousness
- tricuspid insufficiency
- umbilical hernia
- uraemia
- ureter duplex
- uricaemia
- urinary frequency
- urinary incontinence
- urogenital sinus
- urticaria
- uterine hyperplasia
- uterus duplex
- vagina duplex
- vaginal bleeding
- vaginal discharge
- vaginal dryness
- vaginal pain/tenderness
- vaginism
- ventricular fibrillation
- ventricular hypertrophy
- vertigo
- viraemia
- virilisation (abnormal)
- vision - acuity reduction
- vision - blurred
- visual disturbance
- visual field defect
- visual impairment
- visual loss
- vitiligo
- vocal cord paresis
- vomiting
- von graefe's sign
- weight gain
- weight loss
- wheezing
- widened joint space(s)
- xeroderma
- xerostomia
- 3-methoxy 4-hydroxy mandelic acid
- 17-hydroxypregnenolone (urine)
- 17-ketosteroids
- 25-hydroxyvitamin-d3
- 5hiaa
- aberrant adrenal receptors
- acid-base balance
- acth stimulation
- activated partial thromboplastin time
- acyl-ghrelin
- adrenal antibodies
- adrenal function
- adrenal scintigraphy
- adrenal venous sampling
- afp tumour marker
- alanine aminotransferase
- albumin
- albumin to creatinine ratio
- aldosterone (24-hour urine)
- aldosterone (blood)
- aldosterone (plasma)
- aldosterone (serum)
- aldosterone to renin ratio
- alkaline phosphatase
- alkaline phosphatase (bone-specific)
- alpha-fetoprotein
- ammonia
- amniocentesis
- amylase
- angiography
- anion gap
- anti-acetylcholine antibodies
- anticardiolipin antibody
- anti-insulin antibodies
- anti-islet cell antibody
- anti-gh antibodies
- antinuclear antibody
- anti-tyrosine phosphatase antibodies
- asvs
- barium studies
- basal insulin
- base excess
- apolipoprotein h
- beta-hydroxybutyrate
- bicarbonate
- bilirubin
- biopsy
- blood film
- blood pressure
- bmi
- body fat mass
- bone age
- bone biopsy
- bone mineral content
- bone mineral density
- bone mineral density test
- bone scintigraphy
- bone sialoprotein
- bound insulin
- brca1/brca2
- c1np
- c3 complement
- c4 complement
- ca125
- calcifediol
- calcium (serum)
- calcium (urine)
- calcium to creatinine clearance ratio
- carcinoembryonic antigen
- cardiac index
- catecholamines (24-hour urine)
- catecholamines (plasma)
- cd-56
- chemokines
- chest auscultation
- chloride
- chorionic villus sampling
- chromatography
- chromogranin a
- chromosomal analysis
- clomid challenge
- clonidine suppression
- collagen
- colonoscopy
- colposcopy
- continuous glucose monitoring
- core needle biopsy
- corticotropin-releasing hormone stimulation test
- cortisol (9am)
- cortisol (plasma)
- cortisol (midnight)
- cortisol (salivary)
- cortisol (serum)
- cortisol day curve
- cortisol, free (24-hour urine)
- c-peptide (24-hour urine)
- c-peptide (blood)
- c-reactive protein
- creatinine
- creatine kinase
- creatinine (24-hour urine)
- creatinine (serum)
- creatinine clearance
- crh stimulation
- ctpa scan
- ct scan
- c-telopeptide
- cytokines
- deoxypyridinoline
- dexa scan
- dexamethasone suppression
- dexamethasone suppression (high dose)
- dexamethasone suppression (low dose)
- dhea sulphate
- discectomy
- dldl cholesterol
- dmsa scan
- dna sequencing
- domperidone
- down syndrome screening
- ductal lavage
- echocardiogram
- eeg
- electrocardiogram
- electrolytes
- electromyography
- endoscopic ultrasound
- endoscopy
- endosonography
- enzyme immunoassay
- epinephrine (plasma)
- epinephrine (urine)
- erythrocyte sedimentation rate
- estimated glomerular filtration rate
- ethanol ablation
- ewing and clarke autonomic function
- exercise tolerance
- fbc
- ferritin
- fine needle aspiration biopsy
- flow cytometry
- fludrocortisone suppression
- fluticasone-propionate-17-beta carboxylic acid
- fmri
- folate
- ft3
- ft4
- gada
- gallium nitrate
- gallium scan
- gastric biopsy
- genetic analysis
- genitography
- gh day curve
- gh stimulation
- gh suppression
- glp-1
- glp-2
- glucose suppression test
- glucose (blood)
- glucose (blood, fasting)
- glucose (blood, postprandial)
- glucose (urine)
- glucose tolerance
- glucose tolerance (intravenous)
- glucose tolerance (oral)
- glucose tolerance (prolonged)
- gluten sensitivity
- gnrh stimulation
- gonadotrophins
- growth hormone-releasing peptide-2 test
- gut hormones (fasting)
- haematoxylin and eosin staining
- haemoglobin
- haemoglobin a1c
- hcg (serum)
- hcg (urine)
- hcg stimulation
- hdl cholesterol
- hearing test
- heart rate
- hepatic venous sampling with arterial stimulation
- high-sensitivity c-reactive protein
- histopathology
- hla genotyping
- holter monitoring
- homa
- homocysteine
- hyaluronic acid
- hydrocortisone day curve
- hydroxyproline
- hydroxyprogesterone
- hysteroscopy
- igfbp2
- igfbp3
- igg4/igg ratio
- immunocytochemistry
- immunohistochemistry
- immunoglobulins
- immunoglobulin g2
- immunoglobulin g4
- immunoglobulin a
- immunoglobulin m
- immunostaining
- inferior petrosal sinus sampling
- inhibin b
- insulin (fasting)
- insulin suppression
- insulin tissue resistance tests
- insulin tolerance
- intracranial pressure
- irm imaging
- ketones (plasma)
- ketones (urine)
- kidney function
- lactate
- lactate dehydrogenase
- laparoscopy
- laparoscopy and dye
- laparotomy
- ldl cholesterol
- leuprolide acetate stimulation
- leukocyte esterase (urine)
- levothyroxine absorption
- lipase (serum)
- lipid profile
- liquid-based cytology
- liquid chromatography-mass spectrometry
- liver biopsy
- liver function
- lumbar puncture
- lung function testing
- luteinising hormone releasing hormone test
- macroprolactin
- magnesium
- mag3 scan
- mammogram
- mantoux test
- metanephrines (plasma)
- metanephrines (urinary)
- methoxytyramine
- metoclopramide
- metyrapone cortisol day curve
- metyrapone suppression
- metyrapone test dose
- mibg scan
- microarray analysis
- molecular genetic analysis
- mri
- myocardial biopsy
- nerve conduction study
- neuroendocrine markers
- neuron-specific enolase
- norepinephrine
- ntx
- oct
- octreotide scan
- octreotide suppression test
- osmolality
- ovarian venous sampling
- p1np
- palpation
- pap test
- parathyroid scintigraphy
- pentagastrin
- perchlorate discharge
- percutaneous umbilical blood sampling
- peripheral blood film
- pet scan
- ph (blood)
- phosphate (serum)
- phosphate (urine)
- pituitary function
- plasma osmolality
- plasma viscosity
- platelet count
- pneumococcal antigen
- pneumococcal pcr
- polymerase chain reaction
- polysomnography
- porter-silber chromogens
- potassium
- pregnancy test
- proinsulin
- prostate-specific antigen
- protein electrophoresis
- protein fingerprinting
- protein folding analysis
- psychiatric assessment
- psychometric assessment
- pulse oximetry
- pyelography
- pyridinium crosslinks
- quicki
- plasma renin activity
- radioimmunoassay
- radionuclide imaging
- raiu test
- red blood cell count
- renal biopsy
- renin (24-hour urine)
- respiratory status
- renin (blood)
- renin plasma activity
- rheumatoid factor
- salt loading
- sdldl cholesterol
- secretin stimulation
- selective parathyroid venous sampling
- selective transhepatic portal venous sampling
- semen analysis
- serotonin
- serum osmolality
- serum free insulin
- sestamibi scan
- sex hormone binding globulin
- shbg
- skeletal muscle mass
- skin biopsy
- sleep diary
- sodium
- spect scan
- supervised 72-hour fast
- surgical biopsy
- sweat test
- synaptophysin
- systemic vascular resistance index
- tanner scale
- thoracocentesis
- thyroid transcription factor-1
- thyroglobulin
- thyroid antibodies
- thyroid function
- thyroid scintigraphy
- thyroid ultrasonography
- total cholesterol
- total ghrelin
- total t3
- total t4
- trabecular thickness
- transaminase
- transvaginal ultrasound
- trap 5b
- trh stimulation
- triglycerides
- triiodothyronine (t3) suppression
- troponin
- tsh receptor antibodies
- type 3 precollagen
- type 4 collagen
- ultrasound-guided biopsy
- ultrasound scan
- urea and electrolytes
- uric acid (blood)
- uric acid (urine)
- urinalysis
- urinary free cortisol
- urine 24-hour volume
- urine osmolality
- vaginal examination
- vanillylmandelic acid (24-hour urine)
- visual field assessment
- vitamin b12
- vitamin e
- waist circumference
- water deprivation
- water load
- weight
- western blotting
- white blood cell count
- white blood cell differential count
- x-ray
- zinc
- abscess drainage
- acetic acid injection
- adhesiolysis
- adrenalectomy
- amputation
- analgesics
- angioplasty
- arthrodesis
- assisted reproduction techniques
- bariatric surgery
- bilateral salpingo-oophorectomy
- blood transfusion
- bone grafting
- caesarean section
- cardiac transplantation
- cardiac pacemaker
- cataract extraction
- chemoembolisation
- chemotherapy
- chemoradiotherapy
- clitoroplasty
- continuous renal replacement therapy
- contraception
- cordotomy
- counselling
- craniotomy
- cryopreservation
- cryosurgical ablation
- debridement
- dialysis
- diazoxide
- diet
- duodenotomy
- endonasal endoscopic surgery
- exercise
- external fixation
- extracorporeal shock wave lithotripsy
- extraocular muscle surgery
- eye surgery
- eyelid surgery
- fasciotomy
- fluid repletion
- fluid restriction
- gamma knife radiosurgery
- gastrectomy
- gastrostomy
- gender reassignment surgery
- gonadectomy
- heart transplantation
- hormone replacement
- hormone suppression
- hypophysectomy
- hysterectomy
- inguinal orchiectomy
- internal fixation
- intra-cardiac defibrillator
- islet transplantation
- ivf
- kidney transplantation
- laparoscopic adrenalectomy
- laryngoplasty
- laryngoscopy
- laser lithotripsy
- light treatment
- liver transplantation
- lumpectomy
- lymph node dissection
- mastectomy
- molecularly targeted therapy
- neuroendoscopic surgery
- oophorectomy
- orbital decompression
- orbital radiation
- orchidectomy
- orthopaedic surgery
- osteotomy
- ovarian cystectomy
- ovarian diathermy
- oxygen therapy
- pancreas transplantation
- pancreatectomy
- pancreaticoduodenectomy
- parathyroidectomy
- percutaneous adrenal ablation
- percutaneous nephrolithotomy
- pericardiocentesis
- pericardiotomy
- physiotherapy
- pituitary adenomectomy
- plasma exchange
- plasmapheresis
- psychotherapy
- radiofrequency ablation
- radionuclide therapy
- radiotherapy
- reconstruction of genitalia
- resection of tumour
- right-sided hemicolectomy
- salpingo-oophorectomy
- small bowel resection
- speech and language therapy
- spinal surgery
- splenectomy
- stereotactic radiosurgery
- termination of pregnancy
- thymic transplantation
- thyroidectomy
- tracheostomy
- transcranial surgery
- transsphenoidal surgery
- transtentorial surgery
- vaginoplasty
- vagotomy
- 5-alpha-reductase inhibitors
- 17?-estradiol
- abiraterone
- acarbose
- acetazolamide
- acetohexamide
- adalimumab
- albiglutide
- alendronate
- alogliptin
- alpha-blockers
- alphacalcidol
- alpha-glucosidase inhibitors
- amiloride
- amlodipine
- amoxicillin
- anastrozole
- angiotensin-converting enzyme inhibitors
- angiotensin receptor antagonists
- anthracyclines
- antiandrogens
- antibiotics
- antiemetics
- antiepileptics
- antipsychotics
- antithyroid drugs
- antiseptic
- antivirals
- aripiprazole
- aromatase inhibitors
- aspirin
- astragalus membranaceus
- ativan
- atenolol
- atorvastatin
- avp receptor antagonists
- axitinib
- azathioprine
- bendroflumethiazide
- benzodiazepines
- beta-blockers
- betamethasone
- bexlosteride
- bicalutamide
- bisphosphonates
- bleomycin
- botulinum toxin
- bromocriptine
- cabergoline
- cabozantinib
- calcimimetics
- calcitonin (salmon)
- calcium
- calcium carbonate
- calcium chloride
- calcium dobesilate
- calcium edta
- calcium gluconate
- calcium-l-aspartate
- calcium polystyrene sulphonate
- canagliflozin
- capecitabine
- captopril
- carbimazole
- carboplatin
- carbutamide
- carvedilol
- ceftriaxone
- chlorothiazide
- chlorpropamide
- cholecalciferol
- cholinesterase inhibitors
- ciclosporin
- cinacalcet
- cisplatin
- clodronate
- clomifene
- clomiphene citrate
- clopidogrel
- co-cyprindiol
- codeine
- colonic polyps
- combined oral contraceptive pill
- conivaptan
- cortisone acetate
- continuous subcutaneous hydrocortisone infusion
- continuous subcutaneous insulin infusion
- coumadin
- corticosteroids
- cortisol
- cyproterone acetate
- dacarbazine
- danazol
- dapagliflozin
- daunorubicin
- deferiprone
- demeclocycline
- denosumab
- desmopressin
- dexamethasone
- diazepam
- diethylstilbestrol
- digoxin
- diltiazem
- diphenhydramine
- diuretics
- docetaxel
- dopamine agonists
- dopamine antagonists
- dopamine receptor agonists
- doxazosin
- doxepin
- doxorubicin
- dpp4 inhibitors
- dutasteride
- dutogliptin
- eflornithine
- enoxaparin
- empagliflozin
- epinephrine
- epirubicin
- eplerenone
- epristeride
- equilenin
- equilin
- erlotinib
- ethinylestradiol
- etidronate
- etomidate
- etoposide
- everolimus
- exenatide
- fenofibrate
- finasteride
- fluconazole
- fluticasone
- fludrocortisone
- fluorouracil
- fluoxetine
- flutamide
- furosemide
- gaba receptor antagonists
- gefitinib
- gemcitabine
- gemigliptin
- ginkgo biloba
- glibenclamide
- glibornuride
- gliclazide
- glimepiride
- glipizide
- gliquidone
- glisoxepide
- glp1 agonists
- glucose
- glyclopyramide
- gnrh analogue
- gnrh antagonists
- heparin
- hrt (menopause)
- hydrochlorothiazide
- hydrocortisone
- ibandronate
- ibuprofen
- idarubicin
- idebenone
- imatinib
- immunoglobulin therapy
- implanon
- indapamide
- infliximab
- iron supplements
- isoniazid
- insulin aspart
- insulin glargine
- insulin glulisine
- insulin lispro
- interferon
- intrauterine system
- iopanoic acid
- ipilimumab
- ipragliflozin
- irbesartan
- izonsteride
- ketoconazole
- labetalol
- lactulose
- lanreotide
- leuprolide acetate
- levatinib
- levodopa
- levonorgestrel
- levothyroxine
- linagliptin
- liothyronine
- liraglutide
- lithium
- lisinopril
- lixivaptan
- loperamide
- loprazolam
- lormetazepam
- losartan
- low calcium formula
- magnesium glycerophosphate
- magnesium sulphate
- mecasermin
- medronate
- medroxyprogesterone acetate
- meglitinides
- menotropin
- metformin
- methadone
- methimazole
- methylprednisolone
- metoprolol
- metyrapone
- miglitol
- mitotane
- mitoxantrone
- mozavaptan
- mtor inhibitors
- multivitamins
- naproxen
- natalizumab
- nateglinide
- nelivaptan
- neridronate
- nifedipine
- nilutamide
- nitrazepam
- nivolumab
- nsaid
- octreotide
- oestradiol valerate
- olanzapine
- olpadronate
- omeprazole
- opioids
- oral contraceptives
- orlistat
- ornipressin
- otelixizumab
- oxandrolone
- oxidronate
- oxybutynin
- paclitaxel
- pamidronate
- pancreatic enzymes
- pantoprazole
- paracetamol
- paroxetine
- pasireotide
- pegvisomant
- perindopril
- phenobarbital
- phenoxybenzamine
- phosphate binders
- phosphate supplements
- phytohaemagglutinin induced interferon gamma
- pioglitazone
- plicamycin
- potassium chloride
- potassium iodide
- pramlintide
- prazosin
- prednisolone
- prednisone
- premarin
- promethazine
- propranolol
- propylthiouracil
- protease inhibitors
- proton pump inhibitors
- pyridostigmine
- quetiapine
- quinagolide
- quinestrol
- radioactive mibg
- radioactive octreotide
- radioiodine
- raloxifene
- ramipril
- relcovaptan
- remogliflozin etabonate
- repaglinide
- risperidone
- risedronate
- rituximab
- romidepsin
- rosiglitazone
- salbutamol
- saline
- salmeterol
- salt supplements
- satavaptan
- saxagliptin
- selective progesterone receptor modulators
- selenium
- sglt2 inhibitors
- sildenafil
- simvastatin
- sirolimus
- sitagliptin
- sodium bicarbonate
- sodium chloride
- sodium polystyrene sulfonate (kayexalate)
- somatostatin analogues
- sorafenib
- spironolactone
- ssris
- statins
- streptozotocin
- steroids
- strontium ranelate
- sucralfate
- sulphonylureas
- sunitinib
- tamoxifen
- taspoglutide
- temazepam
- temozolomide
- teplizumab
- terazosin
- teriparatide
- testolactone
- testosterone enanthate esters
- tetrabenazine
- thalidomide
- thiazolidinediones
- thyrotropin alpha
- tibolone
- tiludronate
- tiratricol (triac)
- tofogliflozin
- tolazamide
- tolbutamide
- tolvaptan
- tramadol
- trastuzumab
- trazodone
- triamcinolone
- triamterene
- trimipramine
- troglitazone
- tryptophan
- turosteride
- tyrosine-kinase inhibitors
- valproic acid
- valrubicin
- vandetanib
- vaptans
- vildagliptin
- vinorelbine
- voglibose
- vorinostat
- warfarin
- zaleplon
- z-drugs
- zoledronic acid
- zolpidem
- zopiclone
- cardiology
- dermatology
- gastroenterology
- general practice
- genetics
- geriatrics
- gynaecology
- nephrology
- neurology
- nursing
- obstetrics
- oncology
- otolaryngology
- paediatrics
- pathology
- podiatry
- psychology/psychiatry
- radiology/rheumatology
- rehabilitation
- surgery
- urology
- insight into disease pathogenesis or mechanism of therapy
- novel diagnostic procedure
- novel treatment
- unique/unexpected symptoms or presentations of a disease
- new disease or syndrome: presentations/diagnosis/management
- unusual effects of medical treatment
- error in diagnosis/pitfalls and caveats
- february
- 2022
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Affiliation(s)
- Aria Jazdarehee
- Department of Medicine and Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sawyer Huget-Penner
- Division of Endocrinology and Metabolism, Fraser Health Authority, British Columbia, Canada
| | - Monika Pawlowska
- Division of Endocrinology and Metabolism, University of British Columbia, British Columbia, Canada
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Fuchs HE, O’Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. Vitamin B 12 Supplementation and Vitamin B 12 Blood Serum Levels: Evaluation of Effect Modification by Gender and Smoking Status. Nutr Cancer 2022; 74:2373-2383. [PMID: 34817305 PMCID: PMC9761981 DOI: 10.1080/01635581.2021.2007271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Research suggests that high intake of supplemental vitamin B12 may be associated with increased risk of cancer, with some evidence that this association may vary by gender and smoking status. This investigation evaluates if similar patterns in association are observed for data for 11,757 adults from the National Health and Nutrition Examination Survey (1999-2006). Survey-weighted multivariable-adjusted linear regression was used to evaluate the association between regular B12 supplement use and log-transformed serum B12 levels. Persons taking vitamin B12 through a multivitamin/multimineral (MVMM) had a median supplemental intake of 12 mcg/day (Q1: 6, Q3: 25), compared to 100 mcg/day (Q1: 22, Q3: 500) for persons reporting supplemental B12 intake through a MVMM-exclusive source. MVMM users had a geometric mean serum B12 26% (95% CI: 23%-30%) higher than nonusers, whereas MVMM-exclusive users' geometric mean was 61% (95% CI: 53%-70%) higher than nonusers (p-trend < 0.001). Although a positive trend (p-trend < 0.001) was observed for both men and women, the association was stronger among women (p-interaction < 0.001). No interaction was observed for smoking status (p-interaction = 0.45). B12 supplementation is associated with higher levels of serum B12, with significant interaction by gender but not smoking. Further work is needed to better understand the interplay of B12 and gender.
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Affiliation(s)
- Hannah E. Fuchs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kelli O’Connell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mengmeng Du
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandi L. Navarro
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Theodore M. Brasky
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth D. Kantor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Elizabeth D. Kantor, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, Phone: 646.888.8247,
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Orhan Kiliç B, Kiliç S, Şahin Eroğlu E, Gül E, Belen Apak FB. Sublingual methylcobalamin treatment is as effective as intramuscular and peroral cyanocobalamin in children age 0-3 years. Hematology 2021; 26:1013-1017. [PMID: 34871525 DOI: 10.1080/16078454.2021.2010877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Vitamin B12 deficiency is a cause of preventable growth and developmental retardation in children. In this respect, alternative methods such as oral and sublingual treatments are being tried. We aimed to compare the efficacy of oral, sublingual, and intramuscular vitamin B12 treatments in children aged 0-3 years. METHODS The study included 158 patients with serum vitamin B12 deficiency (serum vitamin B12 level <300 ng/L) aged 0-3 years retrospectively. According to the vitamin B12 treatment modalities, the patients were divided into three groups as oral cyanocobalamin (group 1), sublingual methylcobalamin (group 2), and intramuscular cyanocobalamin (group 3). RESULTS The mean values of vitamin B12 levels increased to above 300 ng/L in all three groups. This increase was statistically significant for Group 1,2 and 3 (p<0.05). CONCLUSION Sublingual methylcobalamin was determined as effective as oral and intramuscular cyanocobalamin improving vitamin B12 levels aged 0-3 years. What's already known about this topic?It is already known that intramuscular and oral cyanocobalamin treatments are effective in vitamin B12 deficiency of children.What does this article add?Sublingual methylcobalamin treatment, which is a new treatment method, was found to be as effective as oral and intramuscular cyanocobalamin treatments. To our knowledge, there is no study about sublingual treatment in children and comparing oral cyanocobalamin, intramuscular cyanocobalamin, sublingual methylcobalamin.
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Affiliation(s)
- Betül Orhan Kiliç
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Serhat Kiliç
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Elif Şahin Eroğlu
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Eylem Gül
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Fatma Burcu Belen Apak
- Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey
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Abstract
Objective: Vitamin B12 deficiency can lead to many different types of neurological symptoms and seizure can be seen as the first symptom. In the present study, we aimed to evaluate patients with seizures who were found to have vitamin B12 deficiency and whose seizures resolved with vitamin B12 treatment. Methods: A total of 26 infants were included in this retrospective study. The patients were evaluated in terms of clinical findings, laboratory tests including homocysteine, electrophysiological studies, neuroimaging studies, and other neurological examination findings. Results: Of 26 patients, 14 (53.8%) were male. The mean age of the patients was 8±4.8 months. Sixteen patients had generalized tonic-clonic seizures, and two patients had epileptic spasm (West syndrome)-type seizures. Six patients had abnormal discharge on electroencephalography. Twelve patients had abnormal findings in brain magnetic resonance imaging studies. Homocysteine level was high in all patients at admission. Conclusion: The presence of seizures, including infantile spasm, is a very important and treatable manifestation of vitamin B12 deficiency. Considering the irreversible sequelae of increased homocysteine, vitamin B12 supplementation administered for an appropriate period and at an appropriate dose both prevents the use of unnecessary antiepileptic drugs and eliminates the need for unnecessary tests and examinations.
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Affiliation(s)
- Serkan Kirik
- Pediatric Neurology, Fırat University School of Medicine, Elazig, TUR
| | - Zekiye Çatak
- Department of Medical Biochemistry and Clinical Biochemistry, Elazig Fethi Sekin City Hospital, Elazig, TUR
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Abstract
Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Abstract
Subacute combined degeneration (SCD) is caused by demyelination of spinal cord white matter secondary to vitamin B12 (cobalamin) deficiency leading to core symptoms of spastic paresis and vibratory and proprioceptive deficits. Most common causes of B12 deficiency revolve around malabsorption and pernicious anemia; however, nitrous oxide (N2O) can also indirectly cause B12 deficiency by inactivating its biologically active form. We report a case of a patient who took advantage of the unregulated N2O market and presented with signs and symptoms of SCD secondary to N2O abuse. Prior to symptom onset, the patient reported approximately 3,000g of N2O inhalation within five days prior to symptom onset in addition to daily use three weeks prior. Work up revealed laboratory and imaging abnormalities consistent with SCD, although B12 levels were normal intrinsic-factor-blocking (IFB) antibodies were present. Appropriate treatment was undertaken, and the patient was followed up at one week and one month with noticeable clinical improvements. Similarities of this patient to literature include the classic presenting symptoms of SCD and the gradual symptomatic improvement with B12 injections and N2O abstinence. This case is remarkable due to SCD occurrence after recreational N2O abuse, objective quantification of N2O intake over a specified time period to induce SCD, occurrence secondary to N2O inhalation, positive IFB antibodies, and symptomatic presentation with B12 values within normal limits. This report highlights the dangers associated with N2O abuse and moving forward awareness of this case can be referenced to aid in educating members of our communities at risk for substance abuse.
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Affiliation(s)
- Arthur M Samia
- Division of Neurology, Brody School of Medicine at East Carolina University, Greenville, USA
| | - Joseph Nenow
- Division of Neurology, Brody School of Medicine at East Carolina University, Greenville, USA
| | - Donald Price
- Division of Neurology, Vidant Medical Center/East Carolina University, Greenville, USA
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Abstract
Vitamin B12 (B12), also known as cobalamin, is a water-soluble vitamin. It is a cofactor in DNA synthesis and is involved in the metabolism of every cell of the human body, including the central nervous system. Those with a deficiency of B12 can present with peripheral neuropathy, pernicious anemia, or a cognitive disorder. Previous studies have revealed that a deficiency of B12 is associated with cognitive decline or Alzheimer disease.The data of 2991 people were evaluated from 2 years of the Korean Frailty and Aging Cohort Study, a nationwide multicenter survey. To assess cognitive function, a short form of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) was used. Of the CERAD-K tests, we included the Mini-Mental State Examination in the Korean version of the CERAD assessment packet (MMSE-KC), the word list: memory/recall/recognition, digit span (forward, backward), trail making test-A, and the frontal assessment battery. B12 concentrations were classified into clinically relevant categories, insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). A linear regression analysis was used to evaluate the relationship between cognitive function and B12 levels.The mean age of the 2991 participants was 76.4 ± 3.9 years old. Overall, 414 (13.8%) were classified as B12 insufficient, and 2577 (86.2%) as B12 sufficient. The sufficient B12 group performed better in the MMSE-KC, Wordlist: memory, Wordlist: recognition, TMT-A test, digit span, and FAB tests. This was statistically significant (P < .05). However, in the multivariable linear regression analysis, after adjusting for age, sex, education period, marriage, smoking and drinking habits, and comorbidities, the association between the B12 group and cognitive function was not statistically significant.Although our study does not show that B12 insufficiency is a direct risk factor to cognitive decline, B12 levels could be a contributing factor to cognitive function. Our results suggest that cognition was affected by the B12 levels, along with demographic and sociological variables.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation Medicine
| | - Do Hun Lee
- Department of Physical Medicine and Rehabilitation Medicine
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Abstract
Vitamin B12 deficiency is classically associated with megaloblastic anemia. Possible cobalamin deficiency is not investigated once hemolysis is seen. Around 2.5% of cases can present as pseudo-thrombotic microangiopathy (TMA). A swift identification of this means the difference between an easy solution and a protracted one for the patient. A 74-year-old man with no past medical history presented with exertional dyspnea, fatigue, and increasing anorexia over two weeks. Physical examination including a neurological examination was normal. Laboratory tests revealed pancytopenia, unconjugated hyperbilirubinemia, elevated LDH (lactate dehydrogenase), low haptoglobin, and fragmented red blood cells (RBCs) on the peripheral smear, but normal FDP (fibrinogen degradation product) and fibrinogen. The absolute reticulocyte count was reduced as opposed to the expected elevation. Vitamin B12 levels were undetectable, and severe cobalamin deficiency from pernicious anemia was found to be the paramount etiology. Cobalamin deficiency causing pseudo-TMA baffles most physicians. Advanced pernicious anemia is thought to cause intramedullary hemolysis, resulting in peripheral pancytopenia. The fragile RBCs are easily sheared, producing schistocytosis without platelet microthrombi. In contrast to hemolytic anemias, reticulocyte count is low given the unavailability of B12 for erythropoiesis. Reticulocytopenia is a universal finding in cases of pseudo-TMA. Around 38.8% of cases with pseudo-TMA are misdiagnosed as thrombotic thrombocytopenic purpura and treated with plasma product therapy. Keeping an eye out for reticulocytopenia in cases of hemolysis could mean a world of difference for the patient.
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Affiliation(s)
- Swathi Rao
- Internal Medicine, MacNeal Hospital, Berwyn, USA
| | | | | | | | - Stephanie Berg
- Hematology and Oncology, Loyola University Medical Center, Maywood, USA
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Abstract
The association of hyperhomocysteinemia with thrombosis has provoked debate in the medical literature. Although studies have found associations between moderate homocysteine elevations and thrombotic events, others dispute this relationship. We present herein the case of a 24-year-old male who presented with unprovoked bilateral submassive pulmonary emboli. Extensive hypercoagulability workup was notable for an elevated homocysteine level, in addition to low vitamin B12 and folate levels. Of note, the patient had a history of small bowel resection after trauma, which may have contributed to the aforementioned metabolic derangements, potentially increasing his risk for thrombosis and interfering with the efficacy of his anticoagulation.
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Affiliation(s)
- Olga Kovalenko
- Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Ahmad N Kassem
- Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, USA
| | - Melissa Jenkins
- Infectious Disease, MetroHealth Medical Center, Cleveland, USA
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35
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Abstract
Pure nutritional deficiency of folate and vitamin B12 is very unusual in developed countries, where most of the food items are fortified with essential vitamins and minerals. We hereby present a case of a middle-aged lady who declined to eat any other food items and survived only on pasta and sea salt for two years before presenting to the emergency department with pancytopenia.
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Affiliation(s)
- Salim R Surani
- Internal Medicine, Texas A&M Health Science Center, Temple, USA
| | - Munish Sharma
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
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Cui J, Wang Y, Zhang H, Cui X, Wang L, Zheng H. Isolated subacute combined degeneration in late-onset cobalamin C deficiency in children: Two case reports and literature review. Medicine (Baltimore) 2019; 98:e17334. [PMID: 31574870 PMCID: PMC6775410 DOI: 10.1097/md.0000000000017334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Subacute combined degeneration (SCD) is a disease caused by decreased vitamin B12 intake or metabolic disorders. It is more common in the elderly and rarely seen in children. Here, we report 2 pediatric cases of SCD in late-onset cobalamin C (CblC) deficiency. PATIENT CONCERNS The patients complained of unsteady gait. Their physical examination showed sensory ataxia. Magnetic resonance imaging showed classic manifestations of SCD. The serum vitamin B12 level was normal, but urine methylmalonic acid and serum homocysteine levels were high. DIAGNOSIS The pathogenic gene was confirmed as MMACHC. The 2 patients each had 2 pathogenic mutations C.482 G>A and C.271dupA and C.365A>T and C.609G>A in this gene. They were diagnosed with combined methylmalonic acidemia and homocysteinemia-CblC subtype. INTERVENTIONS The patients were treated with methylcobalamin 500 μg intravenous injection daily after being admitted. After the diagnosis, levocarnitine, betaine, and vitamin B12 were added to the treatment. OUTCOMES Twelve days after treatment, the boy could walk normally, and his tendon reflex and sense of position returned to normal. The abnormal gait seemed to have become permanent in the girl and she walked with her legs raised higher than normal. LESSONS To the best of our knowledge, this is the first report of 2 cases of isolated SCD in children with late-onset CblC disorder. Doctors should consider that SCD could be an isolated symptom of CblC disorder. The earlier the treatment, the lower the likelihood of sequelae.
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Affiliation(s)
- Junling Cui
- Department of Neurosurgery, The Second Hospital of Hebei Medical University
| | - Yuanyuan Wang
- Second Department of Neurology, The Children's Hospital of Hebei Province
| | - Huifeng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaopu Cui
- Second Department of Neurology, The Children's Hospital of Hebei Province
| | - Lihui Wang
- Second Department of Neurology, The Children's Hospital of Hebei Province
| | - Huacheng Zheng
- Second Department of Neurology, The Children's Hospital of Hebei Province
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王 云, 汪 仁, 洪 闻, 焦 劲, 彭 丹, 刘 尊, 田 朝, 金 淼, 董 明, 段 晓, 刘 蕾, 孙 青, 孙 少, 王 丽. [Clinical features of long segmental myelopathy caused by nitrous oxide]. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51:288-292. [PMID: 30996370 PMCID: PMC7441217 DOI: 10.19723/j.issn.1671-167x.2019.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To analyze the clinical and imaging characteristics of the neurological damage caused by nitrous oxide (N2O). METHODS In the study, 10 patients in the Department of Neurology of China-Japan Friendship Hospital from October 2015 to February 2018 were retrospectively analyzed for the demographic data, the history of inhaled N2O, clinical features, blood examination, electrophysiological examination, spinal magnetic resonance imaging and therapeutic efficacy profiles. RESULTS The male-to-female ratio was 4:6 and it presented with an age-of-onset 17-26 years [the average age: (20.80±3.12) years]. The time from inhaled N2O to onset was 1 month to 1 year [the average time: (6.95±4.19) months]. Paralysis in all the patients and numbness in 9 patients were the main clinical features, while positive Lhermitte's sign in 3 patients, urinary and defecation disturbance in 4 patients were also found. Blood examination indicated anemia in 2 patients, giant cell anemia in 1 case and small cell hypochromic anemia in 1 case. 3 cases had been treated with vitamin B12 in an external hospital, and the other 7 cases had abnormal increase in homocysteine levels. Electrophysiological examinations showed sensory and motor nerve involvement in 9 patients, and motor nerve involvement in 1 patient. The severity of lower extremity lesion was significantly heavier than that of upper extremity. Spinal magnetic resonance imagings showed that long segmental lesions were present in the cervical spinal cord of all the patients, 3 cases with long segmental lesions of the thoracic cord and 2 cases with spinal cord swelling. In 6 cases, the horizontal axis had an "inverted V-type" T2 high signal, 1 case was classified as "crescent", and 3 cases were "eight-shaped". The symptoms in these 10 cases were alleviated in varying degrees after stopping the inhalation of nitrous oxide, actively supplementing high doses of vitamin B12 and doing early rehabilitation exercises. CONCLUSION Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the "inverted V-type". Treatment with high doses of vitamin B12 is effective.
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Affiliation(s)
- 云云 王
- 中日友好医院 保健部二部, 北京 100029The Second Health and Medical Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - 仁斌 汪
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 闻 洪
- 中日友好医院 放射诊断科, 北京 100029Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 劲松 焦
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 丹涛 彭
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 尊敬 刘
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 朝晖 田
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 淼 金
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 明睿 董
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 晓慧 段
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 蕾 刘
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 青 孙
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 少杰 孙
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 丽 王
- 中日友好医院 神经内科, 北京 100029Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
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Kabagambe EK, Lipworth L, Labadie RF, Hood LJ, Francis DO. Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003-2004 National Health And Nutrition Examination Survey (NHANES). Eur J Clin Nutr 2018; 72:720-727. [PMID: 29379142 PMCID: PMC5948125 DOI: 10.1038/s41430-018-0101-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Studies based on food frequency questionnaires suggest that folate and vitamin B12 intake could protect against hearing loss. We investigated whether erythrocyte folate and serum vitamin B12 levels are independently associated with hearing loss in humans. SUBJECTS/METHODS Participants in the 2003-2004 US National Health and Nutrition Examination Survey who had data on hearing, folate, and vitamin B12 levels were included. Pure-tone average (PTA) at 0.5, 1.0, 2.0, and 4.0 kHz was computed for each ear. We used weighted logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the relation between quartiles of folate and vitamin B12, and hearing loss (present if PTA > 25 dB in either ear and absent if PTA ≤ 25 dB in both ears). RESULTS Participants (n = 1149) were 20-69 (mean 42) years old and 16.4% had hearing loss in at least one ear. Our data suggest a U-shaped relationship between folate and hearing loss. Compared to the 1st quartile, the ORs (95% CIs) for hearing loss were 0.87 (0.49-1.53), 0.70 (0.49-1.00), and 1.08 (0.61-1.94) for the 2nd, 3rd, and 4th quartile of erythrocyte folate in analyses adjusted for age, sex, vitamin B12, smoking, alcohol use, body mass index, race/ethnicity, exposure to noise, income, and education. Although we observed inverse associations between vitamin B12 and hearing loss, the associations were not statistically significant (P > 0.05). CONCLUSIONS Our data show a U-shaped relationship between erythrocyte folate levels and hearing loss, suggesting a need to evaluate whether optimizing blood folate levels could prevent hearing loss.
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Affiliation(s)
- Edmond K Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Linda J Hood
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David O Francis
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
BACKGROUND The relationship between vitamin intake and pancreatic cancer (PC) risk is disputed. We aimed to investigate the association between vitamin intake and the risk of PC via meta-analysis. METHODS We conducted a meta-analysis of studies concerning vitamin intake and the risk of PC from EMBASE, MEDLINE, and Cochrane Library. The search yielded 25 correlative studies including 1,214,995 individuals. The relative risks (RR) were examined by a random-effect model or fixed-effect model. Subgroup analysis, dose-response analysis, sensitivity analysis, meta-regression, and publication bias analysis were used to analyze studies. RESULTS The RR of PC in the highest vitamin intake group was 0.90 (95% confidence interval, 0.83-0.98) compared with that in the lowest vitamin intake in the prospective studies. Different increments of vitamin intake and the risk of PC were examined with dose-response analysis, and a decrease in the risk of PC was observed with vitamin D (25%) and vitamin B12 (27%). CONCLUSIONS This meta-analysis found that vitamin intake can decrease the risk of PC, particularly vitamin D and vitamin B12.
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Affiliation(s)
- Ying Liu
- Department of Oncology, The 3rd Affiliated Hospital, Qiqihar Medical University, Qiqihar
| | - Xiaojie Wang
- Heilongjiang Institute of Dermatology and Sexually Transmitted Disease, Harbin
| | - Xuejia Sun
- Department of Radiology, The 3rd Affiliated Hospital, Qiqihar Medical University
| | - Shengnan Lu
- Department of Ultrasound, The 2nd Affiliated Hospital, Qiqihar Medical University
| | - Shi Liu
- Department of General Surgery, The 3rd Affiliated Hospital, Qiqihar Medical University, Qiqihar, China
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Soofi S, Khan GN, Sadiq K, Ariff S, Habib A, Kureishy S, Hussain I, Umer M, Suhag Z, Rizvi A, Bhutta Z. Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data. BMJ Open 2017; 7:e018007. [PMID: 29275342 PMCID: PMC5770950 DOI: 10.1136/bmjopen-2017-018007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan. METHODS A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels <12 g/dL, vitamin B12 deficiency as serum vitamin B12 levels of <203 pg/mL (150 pmol/L) and folate deficiency as serum folate levels <4 ng/mL (10 nmol/L). RESULTS A total of 11 751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95% CI 1.04 to 1.09) P<0.00, food insecure with moderate hunger (RR 1.03; 95% CI 1.00 to 1.06) P=0.02, four or more pregnancies (RR 1.03; 95% CI 1.01 to 1.05) P<0.00, being underweight (RR 1.03; 95% CI 1.00 to 1.05) P=0.02, being overweight or obese (RR 0.95; 95% CI 0.93 to 0.97) P<0.00 and weekly intake of leafy green vegetables (RR 0.98; 95% CI 0.95 to 1.00) P=0.04. For vitamin B12 deficiency, a positive association was observed with rural population (RR 0.81; 95% CI 0.66 to 1.00) P=0.04, living in Khyber Pakhtunkhwa province (RR 1.25; 95% CI 1.11 to 1.43) P<0.00 and living in Azad Jammu and Kashmir (RR 1.50; 95% CI 1.08 to 2.08) P=0.01. Folate deficiency was negatively associated with daily and weekly intake of eggs (RR 0.89; 95% CI 0.81 to 0.98) P=0.02 and (RR 0.88; 95% CI 0.78 to 0.99) P=0.03. CONCLUSIONS In Pakistan, anaemia, and vitamin B12 and folate deficiencies are a severe public health concern among WRA. Our findings suggest that further research is needed on culturally appropriate short-term and long-term interventions within communities and health facilities to decrease anaemia, and vitamin B12 and folate deficiencies among Pakistani women.
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Affiliation(s)
- Sajid Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kamran Sadiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Atif Habib
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sumra Kureishy
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imtiaz Hussain
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Umer
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zamir Suhag
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Bhutta
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Global Child Health at the Hospital for Sick Children, Toronto, Canada
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Olt S, Oznas O. Investigation of the vitamin B12 deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin. North Clin Istanb 2017; 4:233-6. [PMID: 29270571 DOI: 10.14744/nci.2017.98705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/07/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: The relationship between vitamin B12 deficiency and peripheral neuropathy has been shown in a number of previous studies. Metformin is the indispensable first-line treatment for type 2 diabetes mellitus (DM) worldwide. One of the adverse effects of the use of metformin is vitamin B12 deficiency. In the present study, we investigated the relationship between vitamin B12 deficiency and peripheral neuropathy due to the use of metformin. METHODS: Patient’s laboratory and electromyography (EMG) data were retrospectively reviewed. Patients with no EMG report and other necessary information were excluded from the study. RESULTS: Eighty-six patients with type 2 DM using metformin were included in the study. Of these patients, 26 were males and 60 were females. The mean age of the patients was 55.1±7.7 years. The mean body mass index of the patients was 29.1±9.01 kg/m2. The mean HbA1c level of the patients was 8.6%±2.1%. The mean duration of diabetes was 8.02±5.4 years. The incidence of vitamin B12 deficiency was 38.4%. Peripheral neuropathy was detected in 33.7% patients. There was no statistically significant difference in vitamin B12 levels between patients with peripheral neuropathy and those without peripheral neuropathy (p=0.64). CONCLUSION: Therefore, it can be concluded that the lack of vitamin B12 secondary to the use of metformin did not significantly increase the frequency of peripheral neuropathy.
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Abstract
BACKGROUND Cobalamin (Cbl) is an essential vitamin for human health. While an increasing body of evidence supports the negative impact of Cbl deficiency on cognition, the causality has yet to be determined, and the reported therapeutic responses after Cbl supplement therapy have been inconsistent. Besides, few reports have described neuroimaging characteristics associated with the therapeutic response. METHODS To describe and compare technetium-99m ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT) findings in 2 patients with Cbl deficiency with distinct therapeutic responses. RESULTS Case 1 scored 12/30 in the mini-mental state examination (MMSE) and 34/100 in the cognitive abilities screening instrument (CASI). Profound deficits in mental manipulation, drawing, short-term/long-term memory, and verbal fluency were noted. Case 2 scored 24/30 in the MMSE and 78/100 in the CASI, mainly due to impaired mental manipulation, abstract thinking, and borderline performance in short-term memory and verbal fluency. While both cases showed widespread hypoperfusion within bilateral frontotemporal regions and thalamus on Tc-99m-ECD SPECT, Case 2 demonstrated relatively preserved radio-uptake in the frontal regions, especially the anterior cingulate cortex (ACC) and prefrontal cortex (PFC), consistent with the better therapeutic response (Case 1: 12/30 to 11/30 in the MMSE; Case 2: 24/30 to 28/30 in the MMSE). CONCLUSION Given that the ACC integrates the limbic system and frontosubcortical circuits and the PFC governs executive function, the extent and severity of hypofrontality may be responsible for the worse prognosis. Our Tc-99m-ECD SPECT observations revealed that the negative impact on cerebral metabolic tone is relevant to the severity of Cbl deficiency, and the functional integrity of the ACC and PFC is highly associated with the preservation of global cognitive function in our cases with Cbl deficiency.
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Affiliation(s)
- Min-Chien Tu
- Department of Neurology
- School of Medicine, Tzu Chi University, Hualien
| | - Chung-Ping Lo
- Department of Radiology
- School of Medicine, Tzu Chi University, Hualien
| | - Ching-Yuan Chen
- Department of Nuclear Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung
- School of Medicine, Tzu Chi University, Hualien
- Graduate Institute of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Correspondence: Ching-Yuan Chen, Department of Nuclear Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., Taichung City 427, Taiwan (R.O.C.) (e-mail: )
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Abstract
Mounting evidence shows that hyperhomocysteinemia is a risk factor for cognitive decline. This study enrolled subjects with normal serum levels of B12 and folate and performed thorough neuropsychological assessments to illuminate the independent role of homocysteine on cognitive functions.Participants between ages 50 and 85 were enrolled with Modified Hachinski ischemic score of <4, adequate visual and auditory acuity to allow neuropsychological testing, and good general health. Subjects with cognitive impairment resulting from secondary causes were excluded. Each of the participants completed evaluations of general intellectual function, including the Mini-Mental State Examination, Cognitive Abilities Screening Instrument, Clinical Dementia Rating, and a battery of neuropsychological assessments.This study enrolled 225 subjects (90 subjects younger than 65 years and 135 subjects aged 65 years or older). The sex proportion was similar between the 2 age groups. Years of education were significantly fewer in the elderly (7.49 ± 5.40 years) than in the young (9.76 ± 4.39 years, P = 0.001). There was no significant difference in body mass index or levels of vitamin B12 and folate between the 2 age groups. Homocysteine levels were significantly higher in the elderly group compared to the younger group (10.8 ± 2.7 vs. 9.5 ± 2.5 μmol/L, respectively, P = 0.0006). After adjusting for age, sex, and education, only the Digit Symbol Substitution (DSS) score was significantly lower in subjects with hyperhomocysteinemia (homocysteine >12 μmol/L) than those with homocysteine ≤12 μmol/L in the elderly group (DSS score: 7.1 ± 2.7 and 9.0 ± 3.0, respectively, beta = -1.6, 95% confidence interval [CI] = -2.8∼-0.5, P = 0.001) and borderline significance was noted in the combined age group (beta = -1.1, 95% CI = -2.1∼-0.1, P = 0.04). We did not find an association between hyperhomocysteinemia and other neuropsychological assessments.This is the first study to demonstrate a significant association between hyperhomocysteinemia (>12 μmol/L) and low DSS score, suggesting that DSS score may be an independent marker of cognitive impairment in response to hyperhomocysteinemia, especially in the elderly. Further replication studies with larger cohorts are needed to confirm our results.
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Affiliation(s)
- Wen-Chuin Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University
- Dementia Center
| | - Yi-Chuan Chu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University
- Dementia Center
| | - Hon-Chung Fung
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University
- Dementia Center
| | - Yau-Yau Wai
- Department of Radiology and Intervention, Chang Gung Memorial Hospital Linkou Medical Center
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital, Linkou
- Department of Diagnostic Radiology Chang Gung Memorial Hospital Keelung
- Healthy Ageing Research Center, Chang Gung University, Taoyuan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou
| | - Jiann-Der Lee
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chun Chen
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University
- Dementia Center
- Correspondence: Yi-Chun Chen, Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan (e-mail: )
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Tedesco AK, Biazotto R, Gebara TSES, Cambi MPC, Baretta GAP. PRE- AND POSTOPERATIVE IN BARIATRIC SURGERY: SOME BIOCHEMICAL CHANGES. Arq Bras Cir Dig 2016; 29Suppl 1:67-71. [PMID: 27683780 PMCID: PMC5064264 DOI: 10.1590/0102-6720201600s10017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022]
Abstract
Background The bariatric surgery may cause some nutritional deficiencies. Aim To compare the serum levels of biochemical markers, in iimmediate post-surgical patients who were submitted to bariatric surgery. Methods Non-concurrent prospective cross-sectional study. The analysis investigated data in medical charts of pre-surgical and immediate post-surgical patients who were submitted to bariatric surgery, focusing total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C reactive protein, vitamin B12 levels, folic acid, homocysteine values, iron and serum calcium at the referred period. Results Twenty-nine patients of both genders were evaluated. It was observed weight loss from 108.53 kg to 78.69 kg after the procedure. The variable LDL-c had a significant difference, decreasing approximately 30.3 mg/dl after the surgery. The vitamin B12 serum average levels went from 341.9 pg/ml to 667.2 pg/ml. The triglycerides values were in a range of 129.6 mg/dl-173.3 mg/dl, and 81.9 mg/dl-105.3 mg/dl at the pre- and postoperative respectively. CRP levels fall demonstrated reduction of inflammatory activity. The variable homocysteine was tested in a paired manner and it did not show a significant changing before or after, although it showed a strong correlation with LDL cholesterol. Conclusion Eligible patients to bariatric surgery frequently present pre-nutritional deficiencies, having increased post-surgical risks when they don´t follow an appropriate nutritional follow-up.
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Silva RDA, Malta FMF, Correia MFFSC, Burgos MGPDA. SERUM VITAMIN B12, IRON AND FOLIC ACID DEFICIENCIES IN OBESE INDIVIDUALS SUBMITTED TO DIFFERENT BARIATRIC TECHNIQUES. Arq Bras Cir Dig 2016; 29Suppl 1:62-66. [PMID: 27683779 PMCID: PMC5064275 DOI: 10.1590/0102-6720201600s10016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/07/2016] [Indexed: 11/23/2022]
Abstract
Background Different surgical techniques to combat obesity combine malabsorption with restrictive procedures and can lead to metabolic problems, such as micronutrient deficiencies. Aim Assess vitamin B12, iron and folic acid deficiencies associated with the lifestyle of obese individuals having been submitted to different bariatric techniques. Methods A retrospective analysis was performed using the electronic charts of patients submitted to bariatric surgery involving adjustable gastric banding and Roux-en-Y gastric bypass at the São João Hospital Center in the city of Porto, Portugal, between 2005 and 2010. The following data were collected: surgical technique, sex, age, marital status, serum concentrations of vitamin B12, iron and folic acid and postoperative lifestyle. A 5% significance level was used for the statistical analysis (p<0.05). Results Among 286 individuals evaluated, females accounted for 90.9% of the overall sample (both techniques). Gastric banding was performed more (68.9%), but greater nutrient deficiencies were found following gastric bypass. Iron was the most prevalent deficiency (21.3%), followed by vitamin B12 (16.9%) and folic acid (4.5%). Mild to moderate alcohol intake, adherence to the diet and the use of multivitamins reduced the frequency, but did not avoid micronutrient deficiency. Conclusion Vitamin B12, iron and folic acid deficiencies were found in the first and second year following the two bariatric techniques analyzed and were more frequent among individuals submitted to gastric bypass.
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Drake AJ, O'Shaughnessy PJ, Bhattacharya S, Monteiro A, Kerrigan D, Goetz S, Raab A, Rhind SM, Sinclair KD, Meharg AA, Feldmann J, Fowler PA. In utero exposure to cigarette chemicals induces sex-specific disruption of one-carbon metabolism and DNA methylation in the human fetal liver. BMC Med 2015; 13:18. [PMID: 25630355 PMCID: PMC4310040 DOI: 10.1186/s12916-014-0251-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal smoking is one of the most important modifiable risk factors for low birthweight, which is strongly associated with increased cardiometabolic disease risk in adulthood. Maternal smoking reduces the levels of the methyl donor vitamin B12 and is associated with altered DNA methylation at birth. Altered DNA methylation may be an important mechanism underlying increased disease susceptibility; however, the extent to which this can be induced in the developing fetus is unknown. METHODS In this retrospective study, we measured concentrations of cobalt, vitamin B12, and mRNA transcripts encoding key enzymes in the 1-carbon cycle in 55 fetal human livers obtained from 11 to 21 weeks of gestation elective terminations and matched for gestation and maternal smoking. DNA methylation was measured at critical regions known to be susceptible to the in utero environment. Homocysteine concentrations were analyzed in plasma from 60 fetuses. RESULTS In addition to identifying baseline sex differences, we found that maternal smoking was associated with sex-specific alterations of fetal liver vitamin B12, plasma homocysteine and expression of enzymes in the 1-carbon cycle in fetal liver. In the majority of the measured parameters which showed a sex difference, maternal smoking reduced the magnitude of that difference. Maternal smoking also altered DNA methylation at the imprinted gene IGF2 and the glucocorticoid receptor (GR/NR3C1). CONCLUSIONS Our unique data strengthen studies linking in utero exposures to altered DNA methylation by showing, for the first time, that such changes are present in fetal life and in a key metabolic target tissue, human fetal liver. Furthermore, these data propose a novel mechanism by which such changes are induced, namely through alterations in methyl donor availability and changes in 1-carbon metabolism.
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Affiliation(s)
- Amanda J Drake
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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Misiak B, Frydecka D, Slezak R, Piotrowski P, Kiejna A. Elevated homocysteine level in first-episode schizophrenia patients--the relevance of family history of schizophrenia and lifetime diagnosis of cannabis abuse. Metab Brain Dis 2014; 29:661-70. [PMID: 24682777 PMCID: PMC4125810 DOI: 10.1007/s11011-014-9534-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/18/2014] [Indexed: 01/24/2023]
Abstract
Accumulating evidence indicates that elevated homocysteine (Hcy) level occurs in first-episode schizophrenia (FES) patients. We included 56 FES patients and 53 healthy controls (HC). Plasma level of Hcy was significantly higher in FES patients than HC (p = 0.044). In addition, plasma levels of high-density lipoproteins (HDL) and folate were significantly lower in FES than in HC (p < 0.001). Positive family history of schizophrenia was associated with lower plasma HDL (p = 0.041) and vitamin B12 (p = 0.017), as well as higher level of Hcy (p = 0.017). Patients with FES, who abused cannabis, had higher levels of Hcy (p = 0.017), as well as lower levels of vitamin B12 (p = 0.017) and HDL (p = 0.041). Plasma Hcy negatively correlated with duration of untreated psychosis (r = -0.272, p = 0.042). There was a positive correlation between Hcy level and the severity of negative symptoms (r = 0.363, p = 0.006) and general psychopathology (r = 0.349, p = 0.008) assessed using Positive and Negative Syndrome Scale (PANSS). Vitamin B12 level was negatively associated with the severity of negative symptoms (r = -0.406, p = 0.002), while folate level negatively correlated with general psychopathology score (r = -0.365, p = 0.006) in PANSS. These results indicate that the severity of one-carbon metabolism alterations and HDL deficiency might be associated with family history of schizophrenia and cannabis abuse. Lower vitamin B12 and folate along with elevated Hcy may influence the severity of FES psychopathology.
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Affiliation(s)
- Blazej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367, Wroclaw, Poland,
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Kocaoglu C, Akin F, Çaksen H, Böke SB, Arslan Ş, Aygün S. Cerebral atrophy in a vitamin B12-deficient infant of a vegetarian mother. J Health Popul Nutr 2014; 32:367-371. [PMID: 25076673 PMCID: PMC4216972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, simulating aplastic anaemia or leukaemia. In addition to haematological symptoms, infants may experience weakness, fatigue, failure to thrive, and irritability. Other common findings include pallor, glossitis, vomiting, diarrhoea, and icterus. Neurological symptoms may affect the central nervous system and, in severe cases, rarely cause brain atrophy. Here, we report an interesting case, a 12-month old infant, who was admitted with neurological symptoms and diagnosed with vitamin B12 deficiency.
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Affiliation(s)
| | - Fatih Akin
- Konya Education and Research Hospital, Meram, Konya, Turkey
| | - Hüseyin Çaksen
- Necmeddin Erbakan University School of Medicine, Konya, Turkey
| | | | - Şükrü Arslan
- Konya Education and Research Hospital, Meram, Konya, Turkey
| | - Serhat Aygün
- Konya Education and Research Hospital, Meram, Konya, Turkey
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Krishnaveni GV, Veena SR, Karat SC, Yajnik CS, Fall CHD. Association between maternal folate concentrations during pregnancy and insulin resistance in Indian children. Diabetologia 2014; 57:110-21. [PMID: 24162586 PMCID: PMC3855580 DOI: 10.1007/s00125-013-3086-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/30/2013] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS In an Indian birth cohort, higher maternal homocysteine concentration in pregnancy was associated with lower birthweight of the offspring. Lower maternal vitamin B12 and higher folate concentrations were associated with higher offspring insulin resistance. Disordered one-carbon metabolism during early development may increase later metabolic risk. We explored these associations in another birth cohort in India at three age points. METHODS We measured plasma vitamin B12, folate and homocysteine concentrations at 30 ± 2 weeks' gestation in 654 women who delivered at one hospital. Neonatal anthropometry was recorded, and the children's glucose and insulin concentrations were measured at 5, 9.5 and 13.5 years of age. Insulin resistance was estimated using HOMA of insulin resistance (HOMA-IR). RESULTS Maternal homocysteine concentrations were inversely associated with all neonatal anthropometric measurements (p < 0.05), and positively associated with glucose concentrations in the children at 5 (30 min; p = 0.007) and 9.5 years of age (120 min; p = 0.02). Higher maternal folate concentrations were associated with higher HOMA-IR in the children at 9.5 (p = 0.03) and 13.5 years of age (p = 0.03). Maternal vitamin B12 concentrations were unrelated to offspring outcomes. CONCLUSIONS/INTERPRETATION Maternal vitamin B12 status did not predict insulin resistance in our cohort. However, associations of maternal homocysteine and folate concentrations with birth size, and with childhood insulin resistance and glycaemia in the offspring, suggest a role for nutritionally driven disturbances in one-carbon metabolism in fetal programming of diabetes.
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Affiliation(s)
- Ghattu V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, P.O. Box 38, Mandi Mohalla, Mysore, 570021, India,
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Sanchez H, Albala C, Lera L, Dangour AD, Uauy R. Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354). Nutr J 2013; 12:124. [PMID: 24016218 PMCID: PMC3848755 DOI: 10.1186/1475-2891-12-124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/31/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 μg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION Our findings suggest that foods fortified with 1.4 μg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs.
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Affiliation(s)
- Hugo Sanchez
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Cecilia Albala
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Lydia Lera
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
| | - Alan D Dangour
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Uauy
- Nutrition and Public Health, Aging, and Genetic Epidemiology Unit, Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Casilla 138–11, Santiago, Chile
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