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Background: Pancytopenia is characterized by a decrease in all three types of blood cells. Instead of being a standalone disease, it acts as a common outcome resulting from various factors, including infections, autoimmune disorders, genetic issues, nutritional deficiencies, and malignancies. Pinpointing the root cause of pancytopenia poses a challenge but is essential for devising an effective treatment plan and predicting the likely prognosis. Vitamin B12 deficiency is a common cause of megaloblastic anemia, pancytopenia, and various neuropsychiatric symptoms. However, diagnosing vitamin B12 deficiency lacks a definitive gold standard. Case Presentation: We present two cases where patients initially exhibited pancytopenia with seemingly normal vitamin B12 levels. Based on a bone marrow biopsy, they were initially diagnosed with myelodysplastic syndrome (MDS). Subsequent investigations revealed elevated serum methylmalonic acid (MMA) levels, leading to a revised diagnosis of vitamin B12 deficiency. Both patients showed positive responses to adequate vitamin B12 supplementation. Conclusion: Our case series highlights the importance of ruling out alternative causes of dysplasia in MDS when solely morphological abnormalities are observed on a bone marrow biopsy. It also underscores the crucial aspect of assessing MMA and homocysteine levels in individuals with normal vitamin B12 levels when there is a high clinical suspicion of B12 deficiency. [ABSTRACT FROM AUTHOR]

Objectives: Nitrous oxide has long been used as an anesthetic agent. The recreational use and abuse are rapidly increased in Western countries and lead to many neurological complications. Methods: Retrospectively review of seven patients. Results: Seven patients aged 19–32 years, mean 22.6 years. They inhaled nitrous oxide between 1 month to 1 year prior to the symptom onset. They all presented with acute or subacute ataxia or motor, and sensory dysfunction. The two had coexisting encephalopathy. Electrodiagnosis showed sensorimotor axonal polyneuropathy. All patients had borderline or low serum vitamin B12 level. Two had high serum homocysteine or methylmalonic acid levels. Cervical spine MRI in two patients showed posterior column lesion. At average 2 month-follow up, all patients had minimal improvement. While at more than 6 month-follow up, most patients had moderate to complete recovery. Conclusion: Seven patients with nitrous oxide induced neurological disease are reported. All patients present with acute myelopathy and sensorimotor polyneuropathy. Short term outcome is generally not favorable while long term outcome shows remarkable improvement. [ABSTRACT FROM AUTHOR]

The article discusses the management of antipsychotic-induced weight gain (AIWG) and the role of metformin in reducing weight gain in patients with severe mental illness. It highlights the importance of early initiation of metformin to prevent further weight gain and addresses concerns about its efficacy and safety. The article also emphasizes the need for a more patient-centered approach to weight management in psychiatry and suggests the use of pharmacological adjuncts beyond metformin for effective AIWG management. Overall, the article calls for a paradigm shift in obesity management within psychiatric settings. [Extracted from the article]

Vitamin B12 deficiency is usually simple to diagnose. However, our patient demonstrates that in difficult cases, the ordinary clinician may need a transdisciplinary approach. The finding of a double haploinsufficiency as a possible cause of vitamin B12 deficiency in our patient, illustrates the usefulness of performing large panel clinical exome sequencing. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case report emphasizes the crucial need to include vitamin B12 deficiency in the differential diagnosis of hemolytic anemia, despite its rarity as a presentation. The case illustrates that non‐immune hemolytic anemia can occur secondary to severe vitamin B12 deficiency, which can be effectively treated with vitamin B12 supplementation. Early recognition and comprehensive evaluation are essential for identifying this uncommon yet significant cause of hemolysis, ensuring prompt and appropriate treatment to improve patient outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT: Purpose: Undernutrition in children is a critical worldwide concern that hampers both their physical and cognitive growth. The nutritional status of school-going children and adolescents remains insufficiently addressed with no comprehensive data. This is the first study from the Himalayan foothills that aims to assess the clinical and laboratory aspects of anemia with micronutrient status in undernourished children above the age of five along with association of clinical features with anemia severity. Materials and Methods: A cross-sectional study was conducted involving children aged 5-18 years with undernutrition in a tertiary hospital in North India over eighteen months. We observed the prevalence of anemia, its morphological type, micronutrient status, clinical features, and demographic parameters of these children. The association of various clinical features and anthropometric parameters with the severity of anemia was determined. Results: Of the 200 children who were enrolled in the study, 77% were found anemic, with the proportion of mild, moderate, and severe anemia being 18.2%, 46.8%, and 35%, respectively. Iron (67%) was the most common micronutrient deficient in these children with a significant number suffering from vitamin B12 (53.9%) deficiency. Folic acid deficiency was relatively low (10.4%). Body mass index (P = 0.009), fatigability (P = 0.001), pallor (P ≤ 0.001), poor academic performance (P = 0.023), and knuckle hyperpigmentation (P = 0.018) were significantly associated with the severity of anemia. Conclusion: Despite the significant tread in various aspects of human development, undernutrition and anemia remain a formidable challenge, especially in developing countries. A high proportion of anemia in undernutrition indicates the gravity of the issue, yet not received the deserved attention. [ABSTRACT FROM AUTHOR]

Simple Summary: Decreased serum cobalamin (vitamin B12) concentrations are common in cats with chronic gastrointestinal disease, but the underlying alterations in the metabolism of cobalamin are currently not exactly known and may differ from those in other species. Cobalamin transport to peripheral tissues requires binding to transcobalamin (TC), but this transport molecule has not been investigated in cats. Thus, an immunoassay to measure TC in serum samples from cats was established, its performance validated, and it was used to measure serum TC concentrations in cats with chronic gastrointestinal disease in comparison to healthy controls and cats with other conditions. Significantly decreased serum TC levels were seen in cats with chronic gastrointestinal disease, but these were not related to the concentrations of cobalamin in serum. Severely increased serum TC concentrations, on the other hand, were frequently detected in cats with increased serum cobalamin levels, particularly cats with advanced chronic kidney disease (CKD). Reduced serum TC levels in cats with chronic gastrointestinal disease could be linked to the inflammatory process or development of autoantibodies. Possible links between serum TC levels and cobalamin availability in tissues, response to supplementation, and CKD need further study. Hypocobalaminemia is common in cats with chronic enteropathy (FCE). However, the disruptions in cobalamin metabolism are not fully understood and may vary across species. Cobalamin is distributed to target tissues via binding to transcobalamin (TC) in blood, which has not been evaluated in cats. Thus, an in-house sandwich-ELISA was established to evaluate serum total TC concentrations in cats with FCE. Surplus sera served to analytically validate the assay, and serum TC concentrations were compared among cats with FCE and other diseases (gastrointestinal neoplasia, cholangiohepatopathy, and other neoplastic or non-neoplastic conditions) and healthy controls. Observed-to-expected ratios for serial dilutions ranged from 72.4 to 145.6% and were 75.1–126.7% for spiking-and-recovery. Intra- and inter-assay variability was <17.7% and <17.2% and the preliminary reference interval for feline serum TC was <160–2795 aU/L (lower detection limit: 160 aU/L). Serum TC levels were significantly decreased (p = 0.0067) but not correlated with paired cobalamin concentrations in FCE. Hypertranscobalaminemia predominated with hypercobalaminemia, reaching the highest levels in advanced-stage chronic kidney disease (CKD) cases. TC variations in cobalamin deficiency states with FCE may be linked to inflammation or autoantibodies. This and possible links between serum TC variation in FCE, intracellular cobalamin availability, response to supplementation, and concurrent CKD require further exploration. [ABSTRACT FROM AUTHOR]

This document explores the relationship between antiepileptic drugs (AEDs), folate, one-carbon metabolism, genetics, and epigenetics. It highlights the potential complications that can arise from AEDs interfering with folate metabolism, such as cognitive, mood, and psychiatric issues. The document also discusses the risks associated with the use of valproate, a commonly used AED, and emphasizes the importance of folic acid supplementation during pregnancy, especially for women taking AEDs. Further research is needed to fully understand the mechanisms involved and develop preventive measures. The document does not provide any specific recommendations or conclusions. [Extracted from the article]

ABSTRACT: Introduction: Anaemia is a major problem which affects half of young Indian women, impacting their health, education, and offspring. Despite ongoing efforts, a comprehensive understanding of anaemia remains limited. This study aims to assess the prevalence of anaemia among young women in rural Haryana and explore its causes comprehensively, which would help in tailoring targeted interventions for anaemia at a primary health care level. Methods: Young, non-pregnant women aged 15–24 years (n = 422) were assessed for socio-demographic details, menstrual/diet history, and anthropometry. Dietary diversity was assessed using Minimum Dietary Diversity for Women scale. Venous haemoglobin (Hb) was estimated using an auto-analyser. Serum ferritin, folate, and vitamin B12 were assessed for 260 participants. Anaemia was classified based on micronutrient deficiency. The morphology of anaemia was classified based on Red Blood Cell (RBC) indices. Multivariable analysis examined associations of anaemia with socio-demographic and clinical variables. Results: The prevalence of anaemia was 60.7%. Among those participants tested for micronutrient deficiency (n = 260), 170 (65.4%), 48 (18.5%), and 124 (47.7%) participants had deficiency of ferritin, folate, and vitamin B12, respectively. Iron deficiency anaemia (39.1%) and dimorphic anaemia (38.5%) were the two most common types of anaemia. The mixed morphology of RBCs was the most common morphology (41.8%). Almost all participants (98.2%) had inadequate dietary diversity. Being overweight was associated with lesser odds of having anaemia [OR = 0.41; 95% CI: 0.24 – 0.71 (P = 0.01)]. Conclusion: The high magnitude of anaemia is high, and there is a need for nutrition-based interventions for anaemia at a primary health care level among young women in rural India. [ABSTRACT FROM AUTHOR]

Approximately half of pregnant women in India are anemic, representing over 7.5 million women. Few studies have assessed the relationship between multiple micronutrient deficiencies and anemia during pregnancy or the trajectory of hemoglobin (Hb) during pregnancy in low‐resource settings. We enrolled 200 pregnant women from the Maternal and Newborn Health (MNH) registry, a population‐based pregnancy and birth registry in Eastern Maharashtra, India to address these gaps. The women provided capillary (finger‐prick) and venous blood specimens at enrollment (<15 weeks), and a second capillary specimen in the 3rd trimester (>27 weeks). Capillary specimens were analyzed at the time of collection with a HemoCue Hb 201+; venous specimens were shipped on dry ice to a laboratory for cyanmethemoglobin assessment. In the 1st trimester, mean Hb concentration and anemia (Hb<11.0 g/dL) prevalence using capillary specimens were 10.9 ± 1.5 g/dL and 51.1%; mean Hb concentration using venous blood specimens was estimated to be 11.3 ± 1.3 g/dL and anemia prevalence was 37.5%. The prevalence of iron, vitamin B12 and folate deficiencies were 40%, 30% and 0%, respectively. Among women with anemia in the 1st trimester (venous blood), 56% had concurrent iron deficiency (inflammation‐adjusted serum ferritin <15 µg/L) indicating that their anemia may be amenable to iron supplementation. In total, 21% of women had ID and anemia, 19% ID in the absence of anemia, 16.5% anemia in the absence of ID and 43.5% had neither. By the 3rd trimester, mean Hb from capillary specimens had declined to 10.1 ± 1.35 g/dL and anemia prevalence increased to 70.7%, despite 99.4% mothers reporting receipt of iron‐folic acid (IFA) supplements during her current pregnancy, and 83.9% reporting IFA consumption the previous day. Significant predictors of anemia in the 1st trimester (both venous and capillary) included the number of weeks gestation at the time of Hb assessment and inflammation‐adjusted serum ferritin. For 3rd trimester anemia, significant predictors included 1st trimester height, BMI and IFA consumption during the 3rd trimester (but not 1st trimester micronutrient biomarkers), indicating that IFA supplementation over the course of pregnancy may have influenced micronutrient status and anemia risk. Our findings highlight the severity of the burden of anemia and micronutrient deficiencies in Eastern Maharashtra, but also highlight that in many cases, ID and anemia affect different individuals. Preventing and managing anemia in pregnancy in India will require strengthening both clinical and community‐based strategies targeting iron deficiency, as well as other causes of anemia. Key messages: Anemia, iron deficiency and vitamin B12 deficiency were all highly prevalent in pregnant women in Eastern Maharashtra, India. The prevalence of anemia increased over the course of pregnancy despite high reported rates of receipt (99.4%) and consumption of iron folic acid supplements (83.9% in the previous day).Measuring hemoglobin concentration from single‐drop capillary blood specimens (from finger pricks) with a point‐of‐care analyzer (i.e. HemoCue Hb 201+) resulted in lower concentration estimates (10.9 g/dL vs. 11.3 g/dL) and higher anemia prevalence (51.1% vs. 37.5%) in the 1st trimester of pregnancy than venous blood tested in a laboratory with the cyanmethemoglobin method.Addressing anemia during pregnancy in India, and other Low‐ and Middle‐income country settings, will require strengthening clinical and community‐based strategies addressing iron deficiency, but also other nutritional and non‐nutritional causes of anemia. When possible, hemoglobin assessment should be conducted on venous blood specimens. [ABSTRACT FROM AUTHOR]

Vitamin B12 deficiency is a common condition that causes a variety of disorders ranging from the development of megaloblastic anemia to the building up of neurological damage. Historically one of the leading causes of B12 deficiency appears to be secondary to malabsorption in part caused by the development of atrophic gastritis in pernicious anemia. More recently B12 deficiency could also depend on dietary restrictions. Cobalamin deficiency also appears to be closely related to folate metabolism, causing a reduction in methionine synthase activity. This results in the accumulation of 5-methyltetrahydrofolate (5-MTHF) and defective DNA synthesis. It has been hypothesized that reduced activity of the enzyme methylene-tetrahydrofolate reductase (MTHFR) could reduce the production of 5-MTHF, thereby shifting folate metabolism to thymidylate synthesis and promoting proper DNA synthesis. Our aim was to investigate the role of the C677T and A1298C MTHFR gene polymorphisms, which are associated with reduced enzyme activity, in predisposing to the development of anemia, neurological symptoms, and atrophic gastritis in a population of 105 consecutive Italian patients with cobalamin deficiency. We found statistically significant correlations between the degree of anemia and thrombocytopenia and the C677T MTHFR polymorphism, while hemoglobin levels alone significantly correlated with A1298C polymorphism, contradicting the potential protective role of these polymorphisms. Furthermore, in patients with atrophic gastritis, we found an association between the absence of parietal cell antibodies and the presence of the C677T polymorphism in homozygosity. Our results suggest a role for MTHFR enzyme activity in the severity of hematologic manifestations of vitamin B12 deficiency and as an independent mechanism of predisposition to the development of atrophic gastritis. [ABSTRACT FROM AUTHOR]

Background and Aim: Long-term metformin use in Type 2 Diabetes Mellitus (T2DM) patients is associated with Vitamin B12 deficiency. This study aims to evaluate physicians' knowledge, attitudes, and practices regarding Vitamin B12 screening and supplementation in this context. Methods: A survey was administered to physicians across various specialties in government hospitals and primary care centers in Riyadh, Saudi Arabia, from January 2019 to January 2020. The survey assessed their knowledge, attitudes, and practices concerning Vitamin B12 deficiency screening and supplementation. Results: Of the 402 participating physicians, 94.0% (378 respondents) demonstrated sufficient knowledge about Vitamin B12 deficiency. However, 26.1% believed that Vitamin B12 supplementation does not necessitate screening. 55.7% did not prescribe Vitamin B12 prophylactically, 41.5% omitted neurological examinations in patients presenting with neuropathy, and 22.4% were unaware of the recommended Vitamin B12 supplement dose. Only 49.8% routinely screened for Vitamin B12 deficiency in symptomatic patients. Physicians with more extended years of experience showed significantly better knowledge about Vitamin B12 screening and supplementation (p< 0.001). Conclusion: While most physicians were knowledgeable about Vitamin B12 deficiency and supplementation, a substantial gap in translating this knowledge into practice was observed. There is a critical need for institutional oversight to ensure adherence to American Diabetes Association (ADA) guidelines for Vitamin B12 screening and supplementation in T2DM patients on long-term metformin therapy. [ABSTRACT FROM AUTHOR]

Purpose: Undernutrition in children is a critical worldwide concern that hampers both their physical and cognitive growth. The nutritional status of school-going children and adolescents remains insufficiently addressed with no comprehensive data. This is the first study from the Himalayan foothills that aims to assess the clinical and laboratory aspects of anemia with micronutrient status in undernourished children above the age of five along with association of clinical features with anemia severity. Materials and Methods: A cross-sectional study was conducted involving children aged 5-18 years with undernutrition in a tertiary hospital in North India over eighteen months. We observed the prevalence of anemia, its morphological type, micronutrient status, clinical features, and demographic parameters of these children. The association of various clinical features and anthropometric parameters with the severity of anemia was determined. Results: Of the 200 children who were enrolled in the study, 77% were found anemic, with the proportion of mild, moderate, and severe anemia being 18.2%, 46.8%, and 35%, respectively. Iron (67%) was the most common micronutrient deficient in these children with a significant number suffering from vitamin B12 (53.9%) deficiency. Folic acid deficiency was relatively low (10.4%). Body mass index (P = 0.009), fatigability (P = 0.001), pallor (P ≤ 0.001), poor academic performance (P = 0.023), and knuckle hyperpigmentation (P = 0.018) were significantly associated with the severity of anemia. Conclusion: Despite the significant tread in various aspects of human development, undernutrition and anemia remain a formidable challenge, especially in developing countries. A high proportion of anemia in undernutrition indicates the gravity of the issue, yet not received the deserved attention.

Introduction: Parietal cell antibody (PCA)-mediated auto-immune gastritis is known to increase the risk of iron-deficiency and pernicious anaemia in adults with type 1 diabetes mellitus. However, in children and young adults with type 1 diabetes, these data are scarce. We aimed to study the prevalence of parietal cell antibodies (PCAs) and its clinical associations in people with type 1 diabetes with onset below 30 years. Methods: In a cross-sectional study, 224 children and young adults with type 1 diabetes and 171 healthy controls were enrolled. We measured haemoglobin, serum ferritin, vitamin B12, PCA, thyroid peroxidase, and anti-tissue transglutaminase antibodies in all patients. Mann–Whitney U test for continuous data and Chi square test for categorical data were used. Linear regression analysis was performed with haemoglobin as a dependent variable. Results: The prevalence of PCA was significantly higher in patients than in controls (22% vs 10.2%; P = 0.002). Patients with PCA had a higher frequency of anaemia (60% vs 30%, P < 0.001), lower haemoglobin [7.3 (1.6) vs 7.8 (1.1) mmol/L; P = 0.002], and lower serum ferritin [46.9 (70.8) pmol/L vs 66.0 (105.3) pmol/L; P = 0.04], as compared to those without PCA. On multivariate analysis, haemoglobin was associated with PCA (β = -0.174, P = 0.005) and serum ferritin (β =0.247, P < 0.001). Conclusion: Presence of PCA was an independent risk factor for iron deficiency and anaemia in children and young adults with type 1 diabetes.

Abstract Objectives Nitrous oxide has long been used as an anesthetic agent. The recreational use and abuse are rapidly increased in Western countries and lead to many neurological complications. Methods Retrospectively review of seven patients. Results Seven patients aged 19–32 years, mean 22.6 years. They inhaled nitrous oxide between 1 month to 1 year prior to the symptom onset. They all presented with acute or subacute ataxia or motor, and sensory dysfunction. The two had coexisting encephalopathy. Electrodiagnosis showed sensorimotor axonal polyneuropathy. All patients had borderline or low serum vitamin B12 level. Two had high serum homocysteine or methylmalonic acid levels. Cervical spine MRI in two patients showed posterior column lesion. At average 2 month-follow up, all patients had minimal improvement. While at more than 6 month-follow up, most patients had moderate to complete recovery. Conclusion Seven patients with nitrous oxide induced neurological disease are reported. All patients present with acute myelopathy and sensorimotor polyneuropathy. Short term outcome is generally not favorable while long term outcome shows remarkable improvement.

Introduction: Vitamin B12 is an essential micronutrient involved in various metabolic processes, including DNA synthesis and neurological function. B12 deficiency can lead to significant hematological and neurological disorders. This study aimed to evaluate changes in serum vitamin B12 levels in patients admitted to the internal medicine department over the past 5 years and examine their relationship with admission diagnosis. Methods: This retrospective study included 500 patients hospitalized in the Internal Medicine Department at University of Health Sciences Turkey, İstanbul Training and Research Hospital between January 2020 and 2024. Patient data were obtained from the hospital information system and categorized according to demographic variables, reason for hospitalization, chronic diseases, vitamin B12 supplementation, metformin use, and serum vitamin B12 levels. Results: The study cohort comprised 500 patients with a mean age of 63.1 years. No significant differences in B12 levels were found between different age groups or genders, nor across the years studied. However, patients hospitalized for pancreatitis and those using metformin had significantly lower B12 levels (p

Introduction Anaemia is a major problem which affects half of young Indian women, impacting their health, education, and offspring. Despite ongoing efforts, a comprehensive understanding of anaemia remains limited. This study aims to assess the prevalence of anaemia among young women in rural Haryana and explore its causes comprehensively, which would help in tailoring targeted interventions for anaemia at a primary health care level. Methods Young, non-pregnant women aged 15–24 years (n = 422) were assessed for socio-demographic details, menstrual/diet history, and anthropometry. Dietary diversity was assessed using Minimum Dietary Diversity for Women scale. Venous haemoglobin (Hb) was estimated using an auto-analyser. Serum ferritin, folate, and vitamin B12 were assessed for 260 participants. Anaemia was classified based on micronutrient deficiency. The morphology of anaemia was classified based on Red Blood Cell (RBC) indices. Multivariable analysis examined associations of anaemia with socio-demographic and clinical variables. Results The prevalence of anaemia was 60.7%. Among those participants tested for micronutrient deficiency (n = 260), 170 (65.4%), 48 (18.5%), and 124 (47.7%) participants had deficiency of ferritin, folate, and vitamin B12, respectively. Iron deficiency anaemia (39.1%) and dimorphic anaemia (38.5%) were the two most common types of anaemia. The mixed morphology of RBCs was the most common morphology (41.8%). Almost all participants (98.2%) had inadequate dietary diversity. Being overweight was associated with lesser odds of having anaemia [OR = 0.41; 95% CI: 0.24 – 0.71 (P = 0.01)]. Conclusion The high magnitude of anaemia is high, and there is a need for nutrition-based interventions for anaemia at a primary health care level among young women in rural India.

Infantile Tremor Syndrome (ITS) is a complex neurological syndrome that affects exclusively breastfed infants, typically seen between 9 to 12 months of age. However, in the present case, it started at the ages of three months and four months, respectively. ITS is characterised by the presence of megaloblastic anaemia-like features, developmental regression, and the onset of tremors. Here, authors report two cases of ITS, whereby megaloblastic anaemia was present because of drug (phenytoin) intake in mothers. Phenytoin intake in mothers leads to low serum vitamin B12 levels in both the mother as well as the baby. Early onset of ITS in progeny has very rarely reported in the literature. Exclusive breastfeeding is generally considered nutritionally sufficient for infants below six months of age, and the onset of ITS is typically associated with the improper introduction of weaning foods beyond six months. However, in the present cases, although the babies were exclusively breastfed, they developed nutritional deficiencies that manifested as early onset ITS. Phenytoin intake and the associated vitamin B12 deficiency in the mothers are proposed as the causes of this presentation. Such an early presentation is also associated with severe pneumonia and was found to be fatal in one of the two reported causes. The authors would like to make a pertinent point that if pregnant mothers are taking any drugs that can lead to vitamin B12 deficiency, they should ideally be checked with relevant investigations and receive supplements if required, to prevent potentially fatal outcomes in their children.

Abstract Dietary vitamin B12 deficiency is one of the most common micronutrient deficiencies worldwide, with over a billion individuals suffering from low levels of the vitamin. While ruminant-derived meat and dairy products play a crucial role in providing the recommended B12 dietary allowance (2.4 µg/day), increasing the production and consumption of meat and milk entails substantial environmental ramifications. Spirulina blue-green algae (Arthrospira platensis) has been widely proposed as healthier and more sustainable substitutes for meat, milk, and dairy products (also known as meat and milk analogues). However, previous research has shown that while Spirulina contain desirable macro- and micro-nutrients (e.g., essential amino acids, calcium, potassium, magnesium, iron), the majority of vitamin B12 found in so-called traditional Spirulina is a non-active, pseudo-form (cobamide), unavailable to humans, referred to as pseudo-vitamin B12. This renders traditional Spirulina a limited alternative to animal-source foods. As a response, in this exploratory in vitro study, we ask whether light conditions may enhance active vitamin B12 production in Spirulina. We describe the use of scalable photobioreactors, artificially illuminated, located in the Hengill area of Iceland. These systems are used to cultivate Photosynthetically Controlled Spirulina (PCS), to produce carbon–neutral and nutritious biomass containing unopposed, biologically active vitamin B12, in levels comparable to beef (1.64 µg/100g in PCS with a standard deviation of 5% versus 0.7–1.5 μg/100g in beef). In terms of mitigating global vitamin B12 deficiency, we explore production scale up scenarios. In one scenario, by re-allocating the electricity currently consumed by heavy industry, Iceland could produce 277,950 tonnes of Spirulina biomass per year, which translates into approximately 4555 g per year of active vitamin B12, able to meet the recommended dietary allowance (RDA) of over 13.8 million children aged 1–3. More ambitious production scenarios could see Iceland providing the RDA for over 26.5 million children aged 1–3, and over 50 million children aged 0–6 months.

Background: Vitamin B12 deficiency has been reported to be associated with a spectrum of neurological disorders among which is subacute combined degeneration of the spinal cord. Method: We report a case of subacute combined degeneration of the spinal cord secondary to vitamin B12 deficiency and discussed the clinical presentation and management challenge. Result: The diagnosis was made through a high index of suspicion when the clinical presentation ranked highly with the mode of presentation of Vitamin B12 deficiency. Patient responded well to parentheral vitamin B12 preparation but subsequently defaulted from follow up for 8 years after which he represented with paraparesis and urinary incontinence. He was managed gain with parentheral vitamin B12 preparations with good outcome and total resolution of symptoms at discharge. Conclusion: A high index of suspicion is needed in identifying vitamin B12 deficiency related paraparesis in paediatric practice while the need for indefinite treatment and follow up is hereby emphasized.

Background: Imerslund-Gräsbeck syndrome (IGS) is an autosomal recessive disorder characterized by selective vitamin B12 malabsorption, resulting in vitamin B12 deficiency and impaired reabsorption of proximal tubular proteins.This case highlights a previously unidentified compound heterozygous variant in the Amnionless (AMN) gene that causes IGS syndrome and underscores the importance of long-term oral vitamin B12 replacement therapy in managing the condition. Case presentation: In this retrospective analysis, we present the clinical data of a 3-year and 6-month-old female child diagnosed with IGS at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China, in November 2018. The child was admitted to the hospital due to a history of anemia persisting for over a month. There was no previous significant medical history. The admission examination revealed megaloblastic anemia with proteinuria. Serum vitamin B12 levels were decreased, while folic acid and renal function were normal. The patient was diagnosed with megaloblastic anemia and started long-term oral vitamin B12 replacement therapy. Throughout the follow-up period, blood tests consistently showed normal results, while proteinuria persisted. In November 2019, the child and her parents underwent whole exome sequencing analysis, which revealed a novel compound heterozygous variant in the AMN gene: c.162 + 1G > A and c.922 C > T (p.Q308X) in the child, c.162 + 1G > A in the father, and c.922 C > T (p.Q308X) in the mother. Therefore, this child was further diagnosed with IGS. Conclusions: In this case, whole exome sequencing proves to be highly practical in daily healthcare for diagnosing and refining rare or ultra-rare diseases with ambiguous phenotypes or genetic diversity. It is also valuable for prognostic evaluation and personalized management. Additionally, the oral vitamin B12 treatment demonstrated positive clinical effects for the child, offering a new option for patients unable to undergo intramuscular vitamin B12 replacement therapy. [ABSTRACT FROM AUTHOR]

Introduction: Parietal cell antibody (PCA)-mediated auto-immune gastritis is known to increase the risk of iron-deficiency and pernicious anaemia in adults with type 1 diabetes mellitus. However, in children and young adults with type 1 diabetes, these data are scarce. We aimed to study the prevalence of parietal cell antibodies (PCAs) and its clinical associations in people with type 1 diabetes with onset below 30 years. Methods: In a cross-sectional study, 224 children and young adults with type 1 diabetes and 171 healthy controls were enrolled. We measured haemoglobin, serum ferritin, vitamin B12, PCA, thyroid peroxidase, and anti-tissue transglutaminase antibodies in all patients. Mann–Whitney U test for continuous data and Chi square test for categorical data were used. Linear regression analysis was performed with haemoglobin as a dependent variable. Results: The prevalence of PCA was significantly higher in patients than in controls (22% vs 10.2%; P = 0.002). Patients with PCA had a higher frequency of anaemia (60% vs 30%, P < 0.001), lower haemoglobin [7.3 (1.6) vs 7.8 (1.1) mmol/L; P = 0.002], and lower serum ferritin [46.9 (70.8) pmol/L vs 66.0 (105.3) pmol/L; P = 0.04], as compared to those without PCA. On multivariate analysis, haemoglobin was associated with PCA (β = -0.174, P = 0.005) and serum ferritin (β =0.247, P < 0.001). Conclusion: Presence of PCA was an independent risk factor for iron deficiency and anaemia in children and young adults with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: Metformin, widely used in diabetes treatment, is linked to reduced cobalamin (vitamin B12) levels, potentially exacerbating diabetic peripheral neuropathy (PN) and increasing the risk of lower limb amputations. Studies suggest that black individuals might be less prone to vitamin B12 deficiency, but the impact of metformin on vitamin B12 levels in this group is unclear. Objective: This study investigated the prevalence of vitamin B12 deficiency in diabetics on metformin and examined the relationship between metformin use and PN. Methods: A retrospective review of patient records from Edendale Hospital's diabetes clinic in Pietermaritzburg (January 1, 2017, to December 31, 2018) was conducted. Patients over 18 years of black descent with documented vitamin B12 levels were included. The study extracted data on diabetes treatment, vitamin B12 levels, and PN indicators. Results: Of 668 patients, 558 met the criteria. Metformin was used by 341 patients (61.1%), alone or with other treatments, while 217 (38.9%) did not use metformin. Glycaemic control was similar in both groups (median HbA1C 9.4% (IQR 7.8–11.0) in metformin users vs. 9.46% (IQR 7.1–11.0) in non-users, p = 0.80). Absolute vitamin B12 deficiency was equally rare in both groups (6 [1.8%] in metformin users vs. 4 [1.8%] in non-users, p = 1.0), but metformin users had significantly lower median vitamin B12 levels (299.0 pmol/l vs. 340.0 pmol/l in non-users, p < 0.05). PN prevalence was similar in both groups (31.7% in metformin users vs. 25.1% in non-users, p = 0.12). However, those with borderline-low vitamin B12 levels (≤ 269 pmol/l) had a higher risk of PN (OR 1.6; 95% CI: 1.1–2.3, p = 0.015). Conclusion: Metformin users showed lower median serum vitamin B12 levels than non-users, with an association between metformin use and borderline-low vitamin B12 levels. Higher metformin doses correlated with lower vitamin B12 levels, yet a direct link between metformin use and PN was not established. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer, particularly oral squamous cell carcinoma (OSCC), is a widespread health problem with limited treatment options and poor survival rates. Metformin, a common medication for managing diabetes, has recently shown promise as a potential treatment for various cancers, including OSCC. This review examines the potential benefits of repurposing metformin to treat oral cancer. Studies have shown that metformin can reduce the growth of cancer cells, induce cancer cell death, and improve the effectiveness of existing treatments. It works by affecting several pathways involved in cancer development, such as those related to cell energy and inflammation. However, using metformin for cancer treatment comes with challenges, including possible side effects and interactions with other medications. More research and clinical trials are needed to understand how metformin can be effectively used in cancer treatment and to ensure its safety. If proven effective, metformin could provide a new, cost-effective option for treating oral cancer, potentially improving outcomes and quality of life for patients. Oral cancer, particularly oral squamous cell carcinoma (OSCC), is a significant global health challenge because of its high incidence and limited treatment options. Major risk factors, including tobacco use, alcohol consumption, and specific microbiota, contribute to the disease's prevalence. Recently, a compelling association between diabetes mellitus (DM) and oral cancer has been identified, with metformin, a widely used antidiabetic drug, emerging as a potential therapeutic agent across various cancers, including OSCC. This review explores both preclinical and clinical studies to understand the mechanisms by which metformin may exert its anticancer effects, such as inhibiting cancer cell proliferation, inducing apoptosis, and enhancing the efficacy of existing treatments. Preclinical studies demonstrate that metformin modulates crucial metabolic pathways, reduces inflammation, and impacts cellular proliferation, thereby potentially lowering cancer risk and improving patient outcomes. Additionally, metformin's ability to reverse epithelial-to-mesenchymal transition (EMT), regulate the LIN28/let-7 axis, and its therapeutic role in head and neck squamous cell carcinoma (HNSCC) are examined through experimental models. In clinical contexts, metformin shows promise in enhancing therapeutic outcomes and reducing recurrence rates, although challenges such as drug interactions, complex dosing regimens, and risks such as vitamin B12 deficiency remain. Future research should focus on optimizing metformin's application, investigating its synergistic effects with other therapies, and conducting rigorous clinical trials to validate its efficacy in OSCC treatment. This dual exploration underscores metformin's potential to play a transformative role in both diabetes management and cancer care, potentially revolutionizing oral cancer treatment strategies. [ABSTRACT FROM AUTHOR]

Aims: Nutritional vitamin B12 deficiency remains a significant public health issue. This study aimed to compare the efficacy of an oral combination of thiamine, pyridoxine, cyanocobalamin, and parenteral cyanocobalamin treatment among adolescents with nutritional vitamin B12 deficiency. Methods: This retrospective study included patients aged 12-18 years who applied to University of Health Sciences Türkiye, Gülhane Training and Research Hospital General Pediatrics Polyclinic between 2018 and 2019, and serum vitamin B12 levels were measured before and after parenteral or oral combination of thiamine, pyridoxine, and cyanocobalamin treatment. Results: Of the subjects with post-treatment serum vitamin B12 levels above the target level of 200 pg/mL, parenteral cyanocobalamin was given to 34 patients with a median age of 16 years [interquartile range (IQR), 14 to 16 years], and girls (52.9%), and oral cyanocobalamin was given to 51 patients with a median age of 15 years (IQR, 13 to 16 years), and girls (58.8%). The mean serum vitamin B12 levels before parenteral and oral cyanocobalamin treatment were 150.32±6.49 pg/mL parenteral and 132.35±4.67 pg/mL in oral replacement groups (p>0.05). The mean serum vitamin B12 levels after parenteral and oral cyanocobalamin treatments were 566.0±62.77 pg/mL and 463.1±36.97 pg/ mL, respectively (p>0.05). Both parenteral and oral cyanobalamin treatments caused a significant increase in serum vitamin B12 levels compared with before treatment (p<0.001 for both). Conclusions: In adolescents with nutritional vitamin B12 deficiency, an oral combination of thiamine, pyridoxine, and cyanocobalamin may be preferred to parenteral cyanocobalamin because it is non-invasive and provides an increase in serum vitamin B12 levels similar to parenteral cyanocobalamin treatment. [ABSTRACT FROM AUTHOR]

Background: The population in Latin America and Caribbean (LAC) has experienced a major demographic transition with increased numbers of older adults (OA). This change brings opportunities in the public health sector to implement health prevention interventions and delay the onset of geriatric syndromes. Micronutrients play an important role in the maintenance of biological function which contributes to longevity. Micronutrient deficiencies (MD) in OA increase the risk for onset of chronic comorbidities and geriatric syndromes. Aim: To review and summarize the existing data on micronutrient status in OA in the LAC region and discuss the gaps and challenges in public health approaches to address deficiencies. Methods: Literature review in Medline for records describing nutritional biomarkers in older adults (≥ 60y) from community dwelling and population-based studies in LAC. Results: Few countries (including Chile, Ecuador, Costa Rica, Brazil, and Mexico) have documented one or more nutritional deficiencies for OA in national health surveys, however across the entire region, evidence of micronutrient levels is scarce. Some surveys have documented a high prevalence and large heterogeneity in the prevalence of vitamin D followed by B12 deficiency, being the 2 MDs most studied due their effects on cognition, frailty, and bone mineral density in the OA population. Other MD including C, E, A, copper, zinc, iron, and selenium have also been reported. Conclusion: Information on the micronutrient status in OA from LAC is poorly documented. Research and capacity building initiatives in the region are crucial to develop tailored strategies that address the specific nutritional needs and challenges faced by the ageing population in Latin America. Plain language title: Micronutrients Deficiencies in Older Adults in Latin American Plain language summary: For the first time, there are more older adults (OA) than children worldwide. In the Latin America and Caribbean (LAC) region, OA represents 13.2% of the population, and it is projected to increase to 30% (220 millions) by 2030. This demographic shift represents an opportunity in the public health sector to implement health prevention strategies and public health policies to delay the onset of geriatric syndromes in the younger generation. Vitamins and minerals (micronutrients) are necessary in our body to maintain biological function. Deficiencies in older ages have been associated with the onset of geriatric syndromes (such as sarcopenia, frailty, cognitive impairment, and falls, among others). Therefore, it is relevant to understand the magnitude and distribution of micronutrient deficiencies in OA in the LAC region. This will help to inform decision-makers to further implement early actions to maintain good nutrition and health status in the population. In this narrative review, we highlight that few countries in the LAC region documented one or more nutritional deficiencies for OA in their national health surveys. Across the entire region, evidence of micronutrient levels in OA is scarce. Vitamin D and vitamin B12 are the 2 most reported micronutrients in the OA population. Research and capacity-building in the region are crucial to develop tailored strategies to address specific nutritional needs and challenges faced by the aging population in Latin America. [ABSTRACT FROM AUTHOR]

Background: Data have shown that vitamin B12 has immunomodulatory effects via different pathways, which could influence the pathophysiology of sepsis. The objective of this study was to investigate whether vitamin B12 levels, assessed by the measurement of holotranscobalamin (HTC), total vitamin B12 (B12), and methylmalonic acid (MMA, which accumulates in case of B12 deficiency), are associated with the development of sepsis in patients with onset of bacterial infection. Methods: This was a single-center, prospective observational pilot study. Adult patients who presented to the emergency department with bacterial infection confirmed by a positive microbiological culture result were included in the study and followed up for 6 days to assess whether they developed sepsis or not. The primary objective was to compare HTC concentration in patients who developed sepsis to those who did not develop sepsis. Secondary objectives were the evaluation of B12 and MMA concentrations in those two groups. Multiple logistic regression models were used, with presence of sepsis as the outcome variable, and HTC, B12, and MMA concentrations as predictor variables, separately, and adjusted for potential confounders. Results: From 2019 to 2022, 2131 patients were assessed for eligibility, of whom 100 met the inclusion criteria. One patient was excluded from the analysis due to missing data. Of the 99 patients, 29 developed sepsis. There was no evidence for an association between HTC or B12 concentration and the development of sepsis (OR 0.65, 95% CI 0.31–1.29, p = 0.232, OR 0.84, 95% CI 0.44–1.54, p = 0.584, respectively). There was an association between MMA concentration and the development of sepsis, with a positive effect, i.e. with increasing MMA, the odds for sepsis increased (OR 2.36, 95% CI 1.21–4.87, p = 0.014). This association remained significant when adjusted for confounders (OR 2.72, 95% CI 1.23–6.60, p = 0.018). Conclusions: Our study found an association between elevated MMA concentration and the development of sepsis. We did not find an association between HTC and B12 concentrations and the development of sepsis. Further, larger studies are warranted, as it could lead to interventional trials investigating whether B12 supplementation provides a clinical benefit to patients with infection or sepsis. Trial registration: The study was registered on ClinicalTrials.gov under the identifier NCT04008446 on June 17, 2019. [ABSTRACT FROM AUTHOR]

Vitamin B12, or cobalamin, is an essential nutrient required for diverse physiological functions secondary to its role as a critical cofactor for two mammalian enzymes, methionine synthase and methylmalonyl‐CoA mutase. While essential throughout all life stages, several pathways that require vitamin B12, including hematopoiesis, myelination, and DNA/histone methylation, are particularly critical during pregnancy and fetal development. This narrative review aims to describe vitamin B12 in pregnancy, with emphasis on the placenta's role in ensuring adequate nutrition of the fetus and impacts of vitamin B12 deficiency on placental development and function. Our literature search included preclinical model systems and human cohorts and interventions. Our review identified evidence of B12 deficiency resulting in impaired placental development, greater placental inflammation, and modulation of placental docosahexaenoic acid concentration, collectively suggestive of vitamin B12 deficiency as a determinant of both maternal and fetal health outcomes. Heterogeneity in study design complicated generalization of findings. Future studies should consider selecting a B12 marker that is relatively stable across pregnancy, such as holotranscobalamin, while accounting for important confounders such as maternal folate. [ABSTRACT FROM AUTHOR]

Background: The etiology of nephrotic syndrome can vary, with underlying metabolic diseases being a potential factor. Cobalamin C (cblC) defect is an autosomal recessive inborn error of metabolism caused by mutations in the MMACHC gene, resulting in impaired vitamin B12 processing. While cblC defect typically manifests with hematological and neurological symptoms, renal involvement is increasingly recognized but remains rare. Case Presentation: We describe a 7-month-old male patient presenting with fatigue and edema. His initial laboratory findings showed anemia, thrombocytopenia, hypoalbuminemia and proteinuria. Further examinations reveals hemolysis in peripheral blood smear. During his follow up respiratory distress due to pleural effusion in the right hemithorax was noticed. And fluid leakage to the third spaces supported a diagnosis of nephrotic syndrome. The patient's condition deteriorated, leading to intensive care admission due to, hypertensive crisis, and respiratory distress. High total plasma homocysteine and low methionine levels raised suspicion of cobalamin metabolism disorders. Genetic testing confirmed biallelic MMACHC gene mutations, establishing the diagnosis of cblC defect. Treatment with hydroxycobalamin, folic acid, and betaine led to remarkable clinical improvement. Discussion/Conclusion: This case underscores the significance of recognizing metabolic disorders like cblC defect in atypical presentations of nephrotic syndrome. Early diagnosis and comprehensive management are vital to prevent irreversible renal damage. While cblC defects are more commonly associated with atypical hemolytic uremic syndrome, this case highlights the importance of considering cobalamin defects in the differential diagnosis of nephrotic syndrome, especially when associated with accompanying findings such as hemolysis. Our case, which has one of the highest homocysteine levels reported in the literature, emphasizes this situation again. [ABSTRACT FROM AUTHOR]

COVID-19, a global epidemic of infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), not only initially refers to acute manifestations but also chronic symptoms known as Long COVID-19. Long COVID-19 represents a significant burden to healthcare systems worldwide. This syndrome encompasses a wide range of continuing health problems with variable durations and consequences for patients' everyday lives. A notable aspect of Long COVID-19 is the emergence of new-onset autoimmune diseases that could be triggered in predisposed patients with altered immune responses. Common autoimmune conditions that arise in post-COVID patients include autoimmune hemolytic anemia, immune thrombocytopenic purpura, autoimmune thyroid diseases, Kawasaki disease, Guillain-Barre syndrome, etc., but with unclear evidence of associated disease occurrence. We present a case of a female rheumatoid arthritis patient who developed autoimmune thyroid disease, latent autoimmune diabetes of adults (LADA), and pernicious anemia after SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background: 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. Aims & Objectives: To assess the prevalence of Vitamin B12 deficiency among hypothyroid patients. Materials & Methods: A cross sectional study was conducted among 50 patients. Haemoglobin (Hb), mean corpuscular volume (MCV), anti thyroid antibodies, thyroid function tests and vitamin B12 levels were measured. In Mean age was 42.4 years. 36(72%) were females and rest 14 were males. Vit B12 defiency was seen in 31(62%) patients with mean TSH of 4.3 was seen. 72% of them were already receiving levothyroxine therapy with mean dose of 98.4μg was seen. Conclusion: There is a high (62%) prevalence of B12 deficiency in hypothyroid patients. Just the symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. [ABSTRACT FROM AUTHOR]

Anaemia occurs when the haemoglobin (Hgb) value falls below a certain reference range. It requires many blood tests, radiological images, and tests for diagnosis and treatment. By processing medical data from patients with artificial intelligence and machine learning methods, disease predictions can be made for newly ill individuals and decision‐support mechanisms can be created for physicians with these predictions. Thanks to these methods, which are very important in reducing the margin of error in the diagnoses made by doctors, the evaluation of data records in health institutions is also important for patients and hospitals. In this study, six hybrid models are proposed to classify non‐anaemia records, Hgb‐anaemia, folate deficiency anaemia (FDA), iron deficiency anaemia (IDA), and B12 deficiency anaemia by combining artificial intelligence and machine learning methods TreeBagger, Crow Search Algorithm (CSA), Chicken Swarm Optimization Algorithm (CSO) and JAYA methods. The proposed hybrid models are analysed with two different approaches, with/without applying the SMOTE technique to achieve high performance by better emphasizing the importance of parameters. To solve the multiclass anaemia classification problem, fuzzy logic‐based parameter optimization is applied to improve the class‐based accuracy as well as the overall accuracy in the dataset. The proposed methods are evaluated using ROC criteria to build a prediction model to determine the anaemia type of anaemic patients. As a result of the study on the dataset taken from the Kaggle database, it is observed that the six proposed hybrid methods outperformed other studies using the same dataset and similar studies in the literature. [ABSTRACT FROM AUTHOR]

Aim: Vitamin B12 deficiency is common in the elderly population. Standard treatment via intramuscular injections, however, has several disadvantages. Safer and more convenient dosage forms such as intranasal are therefore being explored. This study compares the effects of two intranasal vitamin B12 dosage regimens in elderly vitamin B12‐deficient patients. Methods: Sixty patients ≥65 years were randomly assigned to either a loading dose (daily administration for 14 days followed by weekly administration) or a no loading dose (administration every 3 days) regimen for 90 days. Each dose contained 1000 μg cobalamin. Total vitamin B12, holotranscoblamin (holoTC), methylmalonic acid (MMA) and total homocysteine (tHcy) levels in serum were measured on days 0, 7, 14, 30, 60 and 90. Results: Both dosage regimens resulted in a rapid increase of vitamin B12 and holoTC concentrations and normalization of initial high, MMA and tHcy concentrations. The loading dose regimen resulted in the fastest and greatest increase to a median vitamin B12 of 1090 pmol/L (reference 350‐650 pmol/L) concentration after 14 days. Following weekly administration, B12 rapidly decreased to a median concentration of 530 pmol/L after 90 days. The no loading dose regimen resulted in a steady increase to a median vitamin B12 of 717 pmol/L after 90 days. Conclusions: Intranasal vitamin B12 administration is an effective and suitable way to replenish and sustain vitamin B12 levels in elderly patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Early recognition and management of seronegative celiac disease, even in the absence of typical serological markers, can prevent complications and ensure better health outcomes in pediatric patients. Consideration of a gluten‐free diet in similar cases can lead to significant clinical improvement. Celiac disease, characterized by its diverse clinical manifestations, often necessitates adherence to a gluten‐free diet, particularly in pediatric patients for optimal growth and development. This report presents the case of an 11‐year‐old male who exhibited recurrent symptoms of fever and diarrhea progressing to edema and pallor, with a history dating back to age 3. Laboratory findings revealed pancytopenia, hypoalbuminemia, and proteinuria. Despite negative serological markers, noninvasive tests, along with clinical improvement on a gluten‐free diet and supportive measures within a month, suggested celiac disease complicated by transient protein‐losing enteropathy and vitamin B12 deficiency. It is important to note that other malabsorption disorders can also show clinical improvement following a gluten‐free diet. Additionally, the antibiotic treatment received by the patient could have addressed other possible causes of malabsorption, complicating the differential diagnosis. This case highlights the importance of early recognition and management of celiac disease, especially in pediatric patients, to prevent complications and promote optimal health outcomes. [ABSTRACT FROM AUTHOR]

Methylmalonic acidemia (MMA), propionic acidemia (PA), and cobalamin C deficiency (cblC) share a defect in propionic acid metabolism. In addition, cblC is also involved in the process of homocysteine remethylation. These three diseases produce various phenotypes and complex downstream metabolic effects. In this study, we used an untargeted metabolomics approach to investigate the biochemical differences and the possible connections among the pathophysiology of each disease. The significantly changed metabolites in the untargeted urine metabolomic profiles of 21 patients (seven MMA, seven PA, seven cblC) were identified through statistical analysis (p < 0.05; log2FC > |1|) and then used for annotation. Annotated features were associated with different metabolic pathways potentially involved in the disease's development. Comparative statistics showed markedly different metabolomic profiles between MMA, PA, and cblC, highlighting the characteristic species for each disease. The most affected pathways were related to the metabolism of organic acids (all diseases), amino acids (all diseases), and glycine and its conjugates (in PA); the transsulfuration pathway; oxidative processes; and neurosteroid hormones (in cblC). The untargeted metabolomics study highlighted the presence of significant differences between the three diseases, pointing to the most relevant contrast in the cblC profile compared to MMA and PA. Some new biomarkers were proposed for PA, while novel data regarding the alterations of steroid hormone profiles and biomarkers of oxidative stress were obtained for cblC disease. The elevation of neurosteroids in cblC may indicate a potential connection with the development of ocular and neuronal deterioration. [ABSTRACT FROM AUTHOR]

Objective: Vitamin B12 deficiency, an essential vitamin for the human body, is common in Turkey, and infants are at risk in this regard. This study was intended to investigate the effect of vitamin B12 levels of breastfeeding mothers with infant vitamin B12 and homocysteine levels. Material and Methods: A total of 214 infants aged 1-6 months and their mothers who applied to the infancy outpatient clinic of İstanbul Medeniyet University Göztepe Training and Research Hospital were included in the study. In this study, vitamin B12 levels of the mothers, vitamin B12, folic acid, and homocysteine levels in the infants were primarily analyzed, and the associated risk factors were secondarily determined. Results: The rate of adequate vitamin B12 levels in infants was 20.09% (n=43), and the rate of normal homocysteine levels in mothers of infants with sufficient vitamin B12 and normal homocysteine levels was 383.93 pg/mL and 379.07 pg/mL. 66.27% sensitivity and 75.56% specificity were calculated when 220 pg/mL was taken as the vitamin B12 cut-off value, which predicts homocysteine elevation. Conclusion: This study predicted that only one in five infants had sufficient vitamin B12 levels, but if breastfeeding mothers had sufficient vitamin B12 levels, infants were much less likely to have vitamin B12 deficiency. Since adequate vitamin B12 levels are important for infants, especially in terms of neurodevelopment, we believe that it is necessary to evaluate pregnant women in our society in terms of vitamin B12 levels and to provide vitamin B12 support. [ABSTRACT FROM AUTHOR]

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This article discusses the case of an elderly farmer who was misdiagnosed with bronchial asthma when he was actually suffering from severe anemia caused by hookworm infestation. The patient experienced weakness, breathlessness, and pallor, but after being dewormed and prescribed iron plus vitamins, his symptoms improved. The article emphasizes that pallor is not always indicative of anemia and highlights other potential causes, such as chronic kidney disease, infections, autoimmune disorders, internal bleeding, malnutrition, liver disease, and thyroid disorders. The importance of seeking medical attention for persistent symptoms and the role of early detection and treatment are emphasized. [Extracted from the article]

Background: Bariatric surgery can lead to short-mid-term vitamin deficiencies, but the long-term vitamin deficiencies is unclear. This study aimed to conduct a meta-analysis regarding the long-term prevalence (≥ 5 years) of vitamin deficiencies after bariatric surgery. Methods: We searched the EMBASE, PubMed, and CENTRAL databases for clinical studies until June 2023. Meta-analysis, sensitivity, subgroup, and meta-regression analyses were performed. Results: This meta-analysis included 54 articles with follow-up duration ranging from 5 to 17 years. The most prevalent vitamin deficiencies after surgery were vitamin D (35.8%), followed by vitamin E (16.5%), vitamin A (13.4%), vitamin K (9.6%), and vitamin B12 (8.5%). Subgroup analyses showed that the prevalence of vitamin A and folate deficiencies increased with the follow-up time. Roux-en-Y gastric bypass had a higher rate of vitamin B12 deficiency than sleeve gastrectomy and biliopancreatic diversion with duodenal switch (BPD-DS). Studies conducted in Europe had higher vitamin A deficiency (25.8%) than in America (0.8%); Asian studies had more vitamin B12 but less vitamin D deficiency than European and American studies. Meta-regression analysis displayed that publication year, study design, preoperative age, BMI, and quality assessment score were not associated with vitamin A, B12, D, and folate deficiencies rate. Conclusion: A high prevalence of vitamin deficiencies was found after bariatric surgery in the long-term follow-up, especially vitamin D, E, A, K, and B12. The variation in study regions, surgical procedures, and follow-up time are associated with different postoperative vitamin deficiencies; it is necessary to develop more targeted vitamin supplement programs. [ABSTRACT FROM AUTHOR]

Background: Heightened scrutiny surrounds the inappropriate use of proton pump inhibitors (PPIs) due to concerns regarding potential serious adverse effects (AEs). Understanding the impact of these AEs on real-world practice is crucial. This study aimed to assess physicians’ perceptions, experiences, awareness, and beliefs regarding published data on potential AEs associated with PPIs. Additionally, it sought to determine alterations in PPI prescribing patterns resulting from these AEs, explore attitudes towards PPI use, and ascertain recommendations for PPI use in clinical scenarios with varying levels of risk for upper gastrointestinal bleeding (UGIB). Method: A quantitative, cross-sectional study utilized a self-administered questionnaire, inviting 282 physicians from 55 primary healthcare centers and 334 internal medicine physicians from seven governmental hospitals to participate. Results: With a response rate of 87.8% (541/616), 74% (95% CI: 70.2–77.7) of respondents were somewhat or very familiar with published data on PPI AEs. Among the familiar, 69.5% (CI: 65.2–73.5) had somewhat or very much changed their PPI prescribing patterns. General concerns about AEs when prescribing PPIs were reported by 62% (CI: 56.7–65.1). Respondents displayed awareness of a median (IQR) of 15 (9) different AEs associated with long-term PPI use, including osteoporosis or osteopenia (90.2%), hypomagnesemia (81.5%), vitamin B12 deficiency (80.6%), and bone fracture (80.0%). Respondents believed that PPIs elevate the risk for a median (IQR) of 7 (6) different AEs, with osteoporosis or osteopenia (81.8%) being the most common, followed by hypomagnesemia (67.1%), and vitamin B12 deficiency (62.3%). The most common strategies for PPI de-escalation were PPI discontinuation (61%) and using PPI on-demand/as needed (57.9%). The majority (87.4%) agreed or strongly agreed that PPI overuse is prevalent in Kuwait and 78.2% emphasized the necessity for large-scale education on rational PPI use for medical staff and the public. In the UGIB prevention scenarios, 43.6% recommended appropriately the PPI discontinuation in the minimal-risk scenario, while 56% recommended appropriately the PPI continuation in the high-risk scenario. Associations and comparative analyses revealed predictors influencing physicians’ practices and attitudes toward PPI usage. Conclusion: These findings lay the foundation for future research and targeted interventions aimed at optimizing PPI prescribing practices and ensuring patient safety. [ABSTRACT FROM AUTHOR]

The etiology of cerebral venous sinus thrombosis (CVST) is multifactorial. Although many acquired and genetic factors have been recognized as risk factors, hyperhomocysteinemia (hHcy) is independently associated with CVST. We describe three cases of CVST in this case series. All of them presented with headache. Two patients had papilledema and visual disturbances. On evaluation, there was CVST, and prothrombotic workup showed hHcy. In addition, two of them reported very low Vitamin B12 levels. All of them were treated with low-molecular-weight heparin followed by oral anticoagulation and Vitamin B6, B9, and B12 supplements. All of them responded to treatment, and follow-up imaging studies in two of them showed resolution of thrombosis. hHcy should be considered in the evaluation of CVST, especially in the setting of a pure vegetarian diet. Fortification of the diet with Vitamin B12 may be considered the majority of Indians consume predominantly vegetarian food. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This Study aimed to determine the frequency of sensory neuropathy in the feet of asymptomatic people with type II diabetes mellitus. METHODOLOGY: This cross-sectional Study was conducted at the medical department of MTI/Lady Reading Hospital, Peshawar, between April - October 2022. A total of 133 patients were observed using a non-probability consecutive sampling technique. Patients aged 25-60 years who had type II diabetes mellitus for more than one year were included, while patients with vitamin B12 deficiency who used multivitamins were excluded from the study. SPSS version 20 was used for statistical analysis. RESULTS: Age-wise distribution 25-30 Years (4.5%), 31-40 Years (21.8%), 41-50 Years (45.9%), and 51-60 Years (27.8%) (mean 45.56±3.3). Gender-wise, 104 (78.2%) were male and 29 (21.8%) were female. Regarding education level, 57 (42.9%) were illiterate, 46 (34.6%) had secondary education, and 30 (22.6%) had higher education. Residency status indicated 105 (78.9%) from urban areas and 28 (21.1%) from rural areas. Socioeconomic status was distributed as follows: 53 (39.8%) with a monthly income >100,000 Rs, 46 (34.6%) with an income range of 50,000 to 100,000 Rs, and 34 (25.6%) with an income range <50,000 Rs. Sensory neuropathy was found in 60 (45.1%) patients and absent in 73 (54.9%). CONCLUSION: The Study revealed a notably high prevalence of sensory neuropathy. Prompt identification and focused treatment are essential, especially for patients over 40, sedentary lifestyles, and those with diabetes for more than two years. [ABSTRACT FROM AUTHOR]

Previous studies have suggested that exposure to air pollutants may be associated with specific blood indicators or anemia in certain populations. However, there is insufficient epidemiological data and prospective evidence to evaluate the relationship between environmental air pollution and specific types of anemia. We conducted a large-scale prospective cohort study based on the UK Biobank. Annual average concentrations of NO2, PM2.5, PM2.5-10, and PM10 were obtained from the ESCAPE study using the Land Use Regression (LUR) model. The association between atmospheric pollutants and different types of anemia was investigated using the Cox proportional hazards model. Furthermore, restricted cubic splines were used to explore exposure-response relationships for positive associations, followed by stratification and effect modification analyses by gender and age. After adjusting for demographic characteristics, 3-4 of the four types of air pollution were significantly associated with an increased risk of iron deficiency, vitamin B12 deficiency and folate deficiency anemia, while there was no significant association with other defined types of anemia. After full adjustment, we estimated that the hazard ratios (HRs) of iron deficiency anemia associated with each 10 μg/m3 increase in NO2, PM2.5, and PM10 were 1.04 (95%CI: 1.02, 1.07), 2.00 (95%CI: 1.71, 2.33), and 1.10 (95%CI: 1.02, 1.20) respectively. The HRs of folate deficiency anemia with each 10 μg/m3 increase in NO2, PM2.5, PM2.5-10, and PM10 were 1.25 (95%CI: 1.12, 1.40), 4.61 (95%CI: 2.03, 10.47), 2.81 (95%CI: 1.11, 7.08), and 1.99 (95%CI: 1.25, 3.15) respectively. For vitamin B12 deficiency anemia, no significant association with atmospheric pollution was found. Additionally, we estimated almost linear exposure-response curves between air pollution and anemia, and interaction analyses suggested that gender and age did not modify the association between air pollution and anemia. Our research provided reliable evidence for the association between long-term exposure to PM10, PM2.5, PM2.5-10, NO2, and several types of anemia. NO2, PM2.5, and PM10 significantly increased the risk of iron deficiency anemia and folate deficiency anemia. Additionally, we found that the smaller the PM diameter, the higher the risk, and folate deficiency anemia was more susceptible to air pollution than iron deficiency anemia. No association was observed between the four types of air pollution and hemolytic anemia, aplastic anemia, and other types of anemia. Although the mechanisms are not well understood, we emphasize the need to limit the levels of PM and NO2 in the environment to reduce the potential impact of air pollution on folate and iron deficiency anemia. [ABSTRACT FROM AUTHOR]

Whether the long-term treatment of patients with proton pump inhibitors (PPIs) with different diseases [GERD, Zollinger–Ellison syndrome (ZES), etc.] can result in vitamin B12 (VB12) deficiency is controversial. In this study, in 175 patients undergoing long-term ZES treatment with anti-acid therapies, drug-induced control acid secretory rates were correlated with the presence/absence of VB12 deficiency, determined by assessing serum VB12 levels, measurements of VB12 body stores (blood methylmalonic acid (MMA) and total homocysteine[tHYC]), and other features of ZES. After a mean of 10.2 yrs. of any acid treatment (5.6 yrs. with PPIs), 21% had VB12 deficiency with significantly lower serum and body VB12 levels (p < 0.0001). The presence of VB12 deficiency did not correlate with any feature of ZES but was associated with a 12-fold lower acid control rate, a 2-fold higher acid control pH (6.4 vs. 3.7), and acid control secretory rates below those required for the activation of pepsin (pH > 3.5). Over a 5-yr period, the patients with VB12 deficiency had a higher rate of achlorhydria (73% vs. 24%) and a lower rate of normal acid secretion (0% vs. 49%). In conclusion, in ZES patients, chronic long-term PPI treatment results in marked acid hyposecretion, resulting in decreased serum VB12 levels and decreased VB12-body stores, which can result in VB12 deficiency. [ABSTRACT FROM AUTHOR]

Cobalamin (Vitamin B12) is a cofactor for many enzymes, including those in bacteria, archaea, algae, and mammals. In humans, cobalamin deficiency can lead to pernicious anaemia as well as gastrointestinal and neurological disorders. In contrast to marine ecosystems, there is a great paucity of information on the role of soils and terrestrial plants in the supply of cobalt and cobalamin to microorganisms and animals. The content of cobalt cations in most soils is usually sufficient to maintain growth, and the density of cobalamin-producing soil prokaryotes is high in comparison to water bodies. The cobalt content of most soils is usually sufficient in comparison with water, and the density of cobalamin-producing soil prokaryotes is high. Therefore, terrestrial plants are an important cobalt source for cobalamin-producing rumen and gut prokaryotes. The major source of cobalamin for most other animals is the meat of ruminants as well as other animal-derived products, bacteria in insects, and coprophagy, e.g., by rodents. In addition, faecal deposits, and fertilizers as well as soil bacteria add to the cobalamin supply. However, those archaea and bacteria that do not produce cobalamin obtain this coenzyme or its analogues from the environment. Therefore, presence or absence of cobalamin-producing species in soil affects the whole soil microbiome. However, our knowledge concerning microbial producers and consumers of cobalamin in soils is still limited, despite some recent advances. The main reasons are a low cobalamin content in soils and challenging methods of determination. In this regard, advanced analytical knowledge and technical equipment are required, which are usually unavailable in soil laboratories. This review provides relevant methodological information on sample homogenization, extraction, concentration, and purification as well as analysis of cobalamin. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vitamin B12 and both of its active forms, cyanocobalamin and hydroxycobalamin are essential micronutrients for cellular metabolism and division. Vitamin B12 is mostly obtained from animal-derived proteins, and its deficiency generates a systemic compromise with mainly neurologic and hematologic signs and symptoms. CLINICAL CASE: A 47-year-old male patient with positive family history for pernicious anemia and several other autoimmune affections presented to the Emergency department with medullary aplasia due to vitamin B12 deficiency. Diagnostic studies showed low levels of vitamin B12, a conclusive biopsy and positive anti-parietal cell antibodies confirmed pernicious anemia. Patient's symptoms were relieved with vitamin B12 supplementation. CONCLUSIONS: A genetic panel testing for AMN, CUBN, GIF, and holocortine mutations --all related to the vitamin B12 metabolic pathway--, as well as for the HLA-DRB1*03 and DRB1*04 haplotypes is suggested in young patients presenting with pernicious anemia and positive family history. [ABSTRACT FROM AUTHOR]

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Background: Anaemia is a common but treatable condition that predicts adverse clinical outcomes. However, standards of anaemia management vary considerably. Aim: To estimate the prevalence of anaemia and extent of screening for common underlying causes in the healthcare system in the Republic of Ireland. Design & setting: We conducted a retrospective cohort study of 112 181 adult patients, aged ≥18 years, who had a full blood count performed in 2013, using data from the National Kidney Disease Surveillance System. Method: The prevalence of anaemia was determined across demographic and clinical subgroups, according to World Health Organization (WHO) definitions. The proportion screened for iron, vitamin B12, and folate deficiency was determined within a 3-month follow-up period and the corresponding prevalence for each deficiency determined. Results: The overall prevalence of anaemia was 12.0% (95% confidence interval [CI] = 11.8% to 12.2%) and was higher in women than men (13.2% versus 10.5%, P<0.001). Anaemia increased with advancing age (33.4% for those aged >75 years) and worsening kidney function (8.2%, 10.9%, 33.2%, and 63.8% for each estimated glomerular filtration rate [eGFR] categories >90, 60–89, 30–59 and <30 ml/min/1.73 m², respectively, P<0.001). After 3-months' follow-up, the proportion screened for iron deficiency was 11.2% based on transferrin saturation and 33.7% using serum ferritin. Screening for folate and B12 deficiency was 17.6% and 19.8%, respectively. Among screened patients, the prevalence of iron deficiency, B12, and folate deficiency was 37.0%, 6.3%, and 5.8%, respectively. Conclusion: The burden of anaemia in the healthcare system is substantial especially for older patients and those with advanced kidney disease. Low screening rates for iron, B12, and folate deficiency are common and warrant quality improvement initiatives. [ABSTRACT FROM AUTHOR]

Vitamin B12 deficiency is commonly known to cause hematological, neurological, and gastrointestinal disturbances including anemia, pancytopenia, sub-acute combined degeneration, and glossitis, among others. Hemolytic anemia is a rare but possible presentation of vitamin B12 deficiency. We present a case series of three elderly females with different past medical histories but with similar presentations of severe anemia. Initial investigation revealed pancytopenia and hemolytic anemia. Further evaluation indicated vitamin B12 deficiency and subsequently, pernicious anemia, as confirmed by low serum vitamin B12 levels and positive intrinsic cell antibody respectively. These findings directed the diagnosis toward vitamin B12 deficiency-induced hemolytic anemia, a rare clinical entity. All three patients responded to treatment with intramuscular vitamin B12 injections, showing significant improvement in their pancytopenia and hemolytic anemia. This case series highlight the importance of considering vitamin B12 deficiency as a potential cause of hemolytic anemia in patients presenting with pancytopenia and ineffective hematopoiesis. Further research is necessary to illuminate the therapeutic implications of this rare condition.