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Purpose: Recreational nitrous oxide (N2O) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from N2O misuse. Methods: A retrospective audit of hospitalised patients referred for rehabilitation for N2O toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected via medical record audit and analysed via descriptive and non-parametric statistics. Results: 16 eligible cases were identified, aged 18–43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75–93] to 117[112–123], p <.001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Conclusions: Demand for inpatient rehabilitation for disabling N2O toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge. IMPLICATIONS FOR REHABILITATION: There appears to be rising demand for multidisciplinary rehabilitation to manage neurological disabilities from recreational Nitrous Oxide (N2O) misuse. Heavy N2O misuse can cause serious impairments and activity limitations across sensorimotor, cognitive and psychosocial domains. Intensive, multidisciplinary rehabilitation can improve functional independence for people with disabling N2O toxicity; specialist rehabilitation services should be involved in optimising care of this population. Ongoing disability and the need for longer-term rehabilitation and support following hospital discharge were evident in severe cases of N2O toxicity. [ABSTRACT FROM AUTHOR]

Over the last decade, research has produced overwhelming evidence confirming the beneficial impact of vegan diet on health, as well as on implementation in the communicable disease prevention. Despite its various advantages, it may lead to nutritional deficiencies, which can have adverse effects on the human body. The objective of this paper was to raise awareness of the potential risks associated with an imbalanced vegan diet during pregnancy and its impact on obstetric outcomes. A comprehensive data analysis was conducted, focusing on the roles of nutrients that are often deficient in a vegan diet. The paper is based on a critical analysis of literature from databases such as PubMed, Google Scholar, Embase, Elsevier, and academic textbooks. The analysis of scientific studies showed that during pregnancy, there is an increased demand for specific nutrients that are often deficient in a vegan diet (protein, individual amino acids, omega-3 polyunsaturated fatty acids, iron, calcium, iodine, zinc, vitamin D, and vitamin B12). Literature data confirmed that long-term cobalamin deficiency leads to serious health consequences such as: megaloblastic anemia, hyperhomocysteinemia and methylmalonic acidosis. Prevention of these disorders involves vitamin B12 supplementation. A vegan diet can be safely followed during pregnancy if it is properly balanced and supplemented under the supervision of medical personnel. Nutritional deficiencies, particularly of vitamin B12, can negatively affect the course of pregnancy and obstetric outcomes. [ABSTRACT FROM AUTHOR]

Background: Pernicious anemia, also called Biemer's disease, is an autoimmune disease and the most common cause of cobalamin deficiency globally. Various genetic, environmental, and immunological factors interplay to lead to its presentation. Pernicious anemia has a myriad of presentations, which can range from hematological and skin-related to neurological. Pernicious anemia has been reported among people of all ages worldwide, especially those over 60 years old. Its prevalence in the general population is about 0.1% and 1.9% for elderly patients over 60 years old. Like most other autoimmune diseases, females are more affected than males. However, there are case reports of pernicious anemia occurring in individuals at 40 years of age. The prevalence of pernicious anemia in Africa has been reportedly low, possibly owing to underdiagnosis. Case presentation: This case identifies a 51-year-old Ugandan man from the tribe of Ankole who presented with lower limb weakness for about 2 months. He had a similar presentation 7 years prior for which he was treated for vitamin B12 deficiency. Initial blood counts revealed macrocytic anemia. Considering the recurrence of symptoms, serum cobalamin levels and serum intrinsic factor autoantibodies were tested and the diagnosis of pernicious anemia was confirmed. The patient improved on parenteral methylcobalamin therapy. Conclusion: This case report highlights the importance of a high index of suspicion in early diagnosis of vitamin B12 deficiency as a cause of neurological symptoms and in considering the diagnosis and empiric therapy for pernicious anemia in a resource-limited context. [ABSTRACT FROM AUTHOR]

Objective: To describe the demographic, clinical, laboratory, and radiological findings, and the clinical course of seven patients with severe N2O-induced subacute combined degeneration of the spinal cord (SACD). Methods: Retrospective study with prospective follow-up of patients with SACD associated with N2O abuse presenting at a single center between 2014 and 2024. Results: The median age (range) of the seven patients (one woman, six men) was 24 (18–33) years. Prior to disease onset, patients had consumed N2O daily over a median (range) of 12 (3-20) weeks, with a mean (SD; range) inhalation dosage of 2376.7 (2872.7; 160–9000) g of N2O per day. Clinical presentations included paresthesia and paresis in the legs and gait disturbances. All patients exhibited characteristic signal alterations in the posterior columns spanning from C1 to T10 on T2-weighted spinal MRIs. Electrophysiology demonstrated polyneuropathies in all but one patient. Vitamin B12 levels were decreased in four, but normal in three patients. Methylmalonic acid levels were elevated in all patients. Although the median (interquartile range [IQR]) modified Rankin Scale score improved from 3.0 (3.0–4.0) at baseline to 1.0 (1.0–2.0; p < 0.05, Wilcoxon matched-pairs signed-rank test) at follow-up after the start of vitamin B12 supplementation, all five patients who could be examined on follow-up exhibited persistent deficits on the last follow-up assessment at a median (range) of 5 (3-116) months after disease onset. Conclusions: N2O abuse over a few weeks can lead to severe SACD. The diagnosis is supported by characteristic findings on spinal MRI and elevated methylmalonic acid levels, while normal vitamin B12 levels do not rule out N2O-induced SACD. Although there was some clinical improvement upon cessation of N2O abuse and vitamin B12 supplementation, residual deficits persisted. [ABSTRACT FROM AUTHOR]

Background: Some evidence highlights individuals lacking an adequate level of vitamins may experience heightened susceptibility to post-anesthesia complications. The current study summarized the previous evidence assessing the impact of deficient vitamin levels on complications and outcomes following anesthesia. Methods: A comprehensive search in scientific English databases was conducted from January 2000 to January 2024. The inclusion and exclusion criteria were applied, the full-texts were thoroughly analyzed, and the risk-of-bias was assessed. Results: A multitude of 1322 published articles were discovered based on search strategy and 14 eligible papers were enrolled. The mean age of patients was 39.3 years and the majority were male. Patients with vitamin B12 deficiency experienced both neurological and hematologic consequences post-anesthesia. Delirium was observed among patients lacking sufficient levels of vitamin D, and those deficient in vitamin K presented symptoms indicative of epidural hematoma. Post-anesthesia consequences were manifested with a delay, ranging from hours to days following the anesthesia procedure in vitamin K and B12 deficiency, while patients deficient in vitamin C and B1 experienced an acute onset of symptoms during surgery. Significantly, a notable proportion (42%) had pre-existing risk factors for vitamin deficiency prior to the surgery, while 35% of the risk-factors for vitamin deficiency were diagnosed after the surgery. There was a wide range of complete or partial recovery periods following surgical intervention, spanning over a few days up to several months according to the severity of symptoms. Conclusions: Based on the evidence from the reviewed studies, this study robustly suggests that serum vitamins level before surgery should be measured among patients who are at risk of vitamin deficiency or have some related clinical symptoms. [ABSTRACT FROM AUTHOR]

Background: Both vitamin B6 deficiency and vitamin B12 deficiency can present with symptoms that appear like polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, with painful peripheral neuropathy and sensorimotor dysfunction. There are rare reports of an association between vitamin B12 deficiency and POEMS syndrome, and even rarer reports of an association between vitamin B6 deficiency and POEMS syndrome. To our knowledge, this is the first described case with deficiencies in both vitamin B6 and vitamin B12 in association with POEMS syndrome. Case presentation: A man in his 40s presented with fatigue, imbalance, and painful numbness and tingling. Initial evaluation revealed low vitamin B12 level, and he received oral and IV supplementation for one month with an improvement in vitamin B12 levels, but without improvement in symptoms. Further evaluation revealed both a vitamin B6 deficiency and an IgA lambda monoclonal spike, prompting further investigation and an eventual diagnosis of POEMS syndrome. He underwent an autologous stem cell transplant and has had improvement in his symptoms. Conclusions: Patients with POEMS syndrome may have symptoms that are difficult to distinguish from deficiencies in vitamin B6 or vitamin B12. Management of POEMS should include screening of vitamin B6 and B12 to ensure other possible associated causes of symptoms are appropriately treated. [ABSTRACT FROM AUTHOR]

The identification of vitamin B12 (B12) deficiency in the newborn may prevent neurological damage and a delay in the normal growth. In this study we characterized the incidence of B12 deficiency in newborns, the costs associated to the clinical diagnosis and management, and the relevance to optimize the use of cobalamin biomarkers during treatment follow-up. Starting from a continuous case series of 146,470 screened newborns (November, 1st 2021- December, 3rd 2023), the Regional Reference Laboratory for Neonatal Screening identified 87 newborns having altered levels of biomarkers of cobalamin metabolism measured by newborn screening. These subjects were confirmed with a nutritional B12 deficiency of maternal origin by performing the serum B12 measurements and plasma homocysteine (Hcy) both on the newborns and respective mothers. A cost analysis was performed to characterize the costs/year of identifying and managing B12 deficiency cases. At baseline, median (interquartile range) serum B12 levels of 185.0 (142.3–246.0) ng/L and threefold increased plasma Hcy concentrations above the normal level confirmed a severe condition of deficiency in the newborns. After intramuscular B12 supplementation, serum B12 measured at the first follow up visit showed a fivefold increase, and the levels of Hcy returned to normal. From the healthcare perspective, the costs for diagnosing and managing all newborns with B12 deficiency is 188,480 €/year. Preventing B12 depletion in newborns lowers healthcare costs and likely improves their health outcomes. Further studies are however required to address the clinical pathway to identify, treat and monitor pregnant women with marginal and low B12 status, in order to achieve these goals. [ABSTRACT FROM AUTHOR]

Background: Neurologic symptoms seen in patients receiving immune checkpoint inhibitors (ICI) may not be entirely caused by immunotoxicity. We aim to highlight these confounding conditions through clinical cases to encourage early recognition and management. Methods: We describe a series of seven cases from our institution that were treated with ICI and presented with Neurologic symptoms and were diagnosed with superimposed conditions beyond immunotoxicity. Results: A total of 7 cases are described that include acute motor axonal neuropathy with vitamin B12 deficiency, lumbosacral radiculopathy with Wernicke's, Herpes simplex virus (HSV) encephalitis reactivation, central nervous system vasculitis with renal vasculitis, myositis with fasciitis, myositis with fixed clinical deficit at resolution, and synovitis with accompanying carpal tunnel syndrome. Primary cancer site included lung adenocarcinoma (2/7), melanoma (4/7), and oropharyngeal squamous cell carcinoma (1/7). All patients had received treatment with more than one ICI. Median number of cycles prior to neurotoxicity was 3 cycles. Discussion: Neurologic symptoms seen in patients receiving ICI may include other causes beyond immunotoxicity. [ABSTRACT FROM AUTHOR]

Sepiapterin reductase deficiency (SRD) is a rare dopa-sensitive neurotransmitter disorder caused by autosomal recessive mutations in the sepiapterin reductase gene. The triad of paroxysmal stiffening, oculogyric crises, and hypotonia are highly suggestive in some patients. However, in other patients, the clinical picture may be nonspecific and remain under-recognized and misdiagnosed as cerebral palsy. We present a nine-month-old boy who initially presented with hypotonia and developmental delay, diagnosed as vitamin B12 deficiency. Upon he did not respond to vitamin replacement treatment, he was diagnosed with SRD by whole-exome sequencing (WES). The boy improved dramatically under treatment with L-dopa, 5-hydroxytryptophan and BH4. We aim to emphasize that SRD can present with nonspecific symptoms, leading to a diagnostic delay for this rare but treatable disease. Moreover, our case is the first to demonstrate the clinical benefit of BH4 add-on treatment. Early intervention is crucial for good outcome and neurodevelopment. [ABSTRACT FROM AUTHOR]

Celiac disease is a chronic inflammatory condition of the small bowel caused, in genetically predisposed subjects, by the ingestion of gluten and characterised by a broad clinical polymorphism, ranging from patients with an asymptomatic or paucisymptomatic disease. The clinical presentation ranges from the presence of minor, apparently unrelated symptoms or first-degree kinship with known patients to severe intestinal malabsorption and all its clinical consequences and complications. Even if a large body of research improved our understanding of the molecular basis of celiac disease pathophysiology, enhancing the identification of new targets for future new treatments, an accurate gluten-free diet remains the mainstay of the therapy for this condition, restoring a normal absorptive mucosa. It is very rare, nowadays, to deal with patients with severe malabsorption syndrome secondary to celiac disease. Consequently, physicians are currently less prone to search for nutritional deficiencies in celiac disease. To pinpoint the possibility of both a disease-related and a diet-induced vitamin deficiency, we reviewed the literature on vitamin deficiency in this condition and reported the impact both in untreated and treated patients with celiac disease. A gluten-free diet must be tailored for each patient to meet nutritional targets: the pre-existence or diet-induced intake inadequacies should be carefully considered for an effective management of celiac disease. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Methods Conclusion Vitamin B12 (B12), playing the role of a coenzyme in one‐carbon metabolism, is an important vitamin necessary for human health.To systematically review evidence to identify the complications of B12 deficiency among women.We conducted a systematic search of quantitative studies on disorders associated with B12 deficiency among women, published in English in the last 25 years (1999–2024), using electronic databases such as Scopus, Web of science, CINAHL, PubMed, and Medline.The search produced 28 full‐text articles. B12 deficiency prevalence among women identified by the selected studies ranges from 0.6% to 45.5%. The deficiency of B12 is connected with the risk for depression/post‐partum depression, breast cancer, recurrent pregnancy loss, gestational diabetes mellitus, insulin resistance, and obesity among women. It is necessary to monitor and correct the B12 deficiency among women in order to prevent complications [ABSTRACT FROM AUTHOR]

Purpose: Proximal gastrectomy is an alternative to total gastrectomy (TG) for early gastric cancer (EGC) treatment in the upper stomach. However, its benefits in terms of perioperative and long-term outcomes remain controversial. The aim of this study was to compare the perioperative, body compositional, nutritional, and survival outcomes of patients undergoing proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG for pathological stage I gastric cancer in upper stomach. Materials and Methods: The study included 506 patients who underwent gastrectomy for pathological stage I gastric cancer in the upper stomach between 2015 and 2019. Clinicopathological, perioperative, body compositional, nutritional, and survival outcomes were compared between the PG-DTR and TG groups. Results: The PG-DTR and TG groups included 197 (38.9%) and 309 (61.1%) patients, respectively. The PG-DTR group had a lower rate of early complications (p=0.041), lower diagnosis rate of anemia and vitamin B12 deficiency (all p < 0.001), and lower replacement rate of iron and vitamin B12 compared to TG group (all p < 0.001). The PG-DTR group showed reduced incidence of sarcopenia at 6-months postoperatively, preserved higher amount of visceral fat after surgery (p=0.032 and p=0.040, respectively), and showed a higher hemoglobin level (p=0.007). Oncologic outcomes were comparable between the groups. Conclusion: The PG-DTR for EGC located in the upper stomach offered advantages of fewer complications, lower incidence of anemia and vitamin B12 deficiency, less decrease in visceral fat volume, and similar survival compared to TG. Consequently, PG-DTR may be considered a superior alternative treatment option to TG. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis aimed to evaluate the vitamin B12 status and intake of Seventh-day Adventists following a plant-based diet and compare it with omnivore controls to investigate their susceptibility for vitamin B12 deficiency. Data Source: Peer-reviewed articles were identified through a comprehensive search in PubMed, Scopus, and Google Scholar databases from inception up to the year 2024 using specific keywords related to vitamin B12 and Seventh-day Adventists. Study Inclusion and Exclusion Criteria: Observational studies published in the English language were included if they reported on vitamin B12 status or intake among plant-based Adventists and compared it with omnivore controls who may or may not have been Adventists. Studies that did not present distinguishable results for vegetarian/vegan from omnivore Adventists or only reported on food item intake without specific vitamin B12 data were excluded. Data Extraction: Two independent reviewers extracted data on study characteristics, vitamin B12 intake, and serum levels using a customised data extraction form, resolving discrepancies through consultation with a third reviewer. Data Synthesis: A meta-analysis was conducted using random-effect models due to anticipated heterogeneity, without any subgroup analysis due to the low number of studies. Sensitivity analysis was performed using the 'leave-on-out' method to assess individual study influence on overall effect size and heterogeneity. Results: Four studies met inclusion criteria, encompassing 1994 participants. Meta-analysis showed no significant differences in serum vitamin B12 levels (MD: −9.85 pmol/L; 95% CI: −45.64 to 25.94 pmol/L; P = 0.54, I2 = 50%) or daily intake (MD: 3.31 mcg/d; 95% CI: −4.70 to 11.32 mcg/d; P = 0.42, I2 = 90%) between plant-based Adventists and omnivore controls, although there was high heterogeneity between the studies. Conclusion: Adventists following a vegan or vegetarian diet did not demonstrate increased risk of vitamin B12 deficiency due to the widespread consumption of fortified foods and supplements. The findings underscore the importance of supplementation and the consumption of fortified foods for maintaining adequate B12 status among vegan or vegetarian Adventists but highlight the need for further studies to confirm these observations in diverse geographical areas. [ABSTRACT FROM AUTHOR]

Background: The SNP rs855791 has been linked to increased hepcidin levels, variations in serum iron, transferrin saturation and red blood cell indices. Our goal was to determine the prevalence of this polymorphism among COPD patients and to assess its impact on iron status parameters in patients with stable COPD. Methods: We analysed iron status parameters and genetic data from 29 COPD patients with wild-type genotype (WT group) and 65 COPD patients with either homozygous or heterozygous genotype (HH group). Additionally, the prevalence of SNP rs855791 was assessed in 192 volunteers. Results: The frequency distribution of SNP rs855791 was comparable between the COPD patients and control subjects (p= 0.791). Iron status parameters were within their respective reference values and showed neither statistically nor clinically significant difference between the WT and HH group of COPD patients. However, after excluding patients with (sub)clinical vitamin B12 deficiency and/or hypoxemia, WT group of patients exhibited significantly lower erythropoietin levels (p=0.015). The area under the curve for erythropoietin was 0.688 (95% Cl: 0.545-0.830, p=0.015), with an optimal cut-off of 9.74, sensitivity of 61.2% (95% Cl: 58.1-64.3) and specificity of 65.0% (95% Cl: 61.8-68.3). Conclusions: Iron status parameters do not differ between WT and HH groups of stable COPD patients. Statistical but not clinical difference in EPO levels was observed in a subgroup of patients. In addition to promoting erythropoiesis, EPO may regulate hepcidin levels and thus influence the development of iron deficiency and/or anaemia. Also, EPO's direct effect on immune cells and down-regulation of inflammatory reactions should be considered in this context. [ABSTRACT FROM AUTHOR]

Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of thrombocytopenia in acutely ill children, their identification, and treatments, with special attention paid to septic patients. The mechanisms of thrombocytopenia include decreased production and sequestration, but the most common reason is increased destruction or consumption. This review specifically reviews and compares the presentation, pathogenesis, and treatment of disseminated intravascular coagulation (DIC) and the thrombotic microangiopathic spectrum (TMA), including thrombocytopenia-associated multiorgan failure (TAMOF), hemolytic uremic syndrome, and other diagnoses. The other etiologies discussed include HLH/MAS, immune thrombocytopenia, and dilutional thrombocytopenia. Finally, this review analyzes platelet transfusions, the various thresholds, and complications. [ABSTRACT FROM AUTHOR]

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Abstract Objective To describe the demographic, clinical, laboratory, and radiological findings, and the clinical course of seven patients with severe N2O-induced subacute combined degeneration of the spinal cord (SACD). Methods Retrospective study with prospective follow-up of patients with SACD associated with N2O abuse presenting at a single center between 2014 and 2024. Results The median age (range) of the seven patients (one woman, six men) was 24 (18–33) years. Prior to disease onset, patients had consumed N2O daily over a median (range) of 12 (3-20) weeks, with a mean (SD; range) inhalation dosage of 2376.7 (2872.7; 160–9000) g of N2O per day. Clinical presentations included paresthesia and paresis in the legs and gait disturbances. All patients exhibited characteristic signal alterations in the posterior columns spanning from C1 to T10 on T2-weighted spinal MRIs. Electrophysiology demonstrated polyneuropathies in all but one patient. Vitamin B12 levels were decreased in four, but normal in three patients. Methylmalonic acid levels were elevated in all patients. Although the median (interquartile range [IQR]) modified Rankin Scale score improved from 3.0 (3.0–4.0) at baseline to 1.0 (1.0–2.0; p

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

Samaher Z AlSaad,1 Razan K AlHadlaq,2 Enas Fahad Alaraik,2 Abdullah O Alnomany,3 Haytham I AlSaif,4 Turky H Almigbal,4 Mohammed A Batais,4 Abdullah A Alrasheed4 1Department of Family Medicine, Riyadh Third Cluster, Riyadh, Saudi Arabia; 2Department of Family medicine, King Saud Medical City, Riyadh, Saudi Arabia; 3College of Medicine, Majmaah University. Majmaah, Riyadh, Saudi Arabia; 4Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Abdullah A Alrasheed, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia, Email aalrasheed1@ksu.edu.saBackground 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.Keywords: knowledge, attitude, practice, vitamin B12 deficiency, Type 2 diabetes mellitus

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.

Background: Dizziness and unstable gait with resultant falls are common symptoms among the older adults. Most of studies have focused on statistical analysis regarding single factor related to dizziness and unstable gait. On the other hand, there are very few comprehensive studies using a large number of patients except several review papers. Methods: We retrospectively analyzed a total of 164 aged patients with dizziness and unstable gait. The patients underwent description of the Japanese version of the Dizziness Handicap Inventory (DHI), measurements of vestibular function, handgrip muscle strength, physical performance, height-adjusted appendicular skeletal muscle mass, and vitamin B1 and B12, a full-night polysomnography study, cognition test and visual test. Results: Average age was 80.5 ± 6.1 years and ranged from 59 to 91 years. Forty-eight were males and 116 females. Three causative factors, namely vestibular hypofunction, muscle dysfunction and sleep disturbance, were independently and combinedly associated with dizziness and unstable gait in over 93% of the patients. Patients with higher scores defined by these three causative factors had higher scores of DHI. 23% of the patients showed vitamin B1 and/or B12 deficiency, which was highly associated with sarcopenia/frailty. Cognitive and visual impairment were recognized in 4.9% and 5.0%, respectively. Conclusion: Dizziness and unstable gait were mainly associated with vestibular hypofunction, muscle dysfunction and sleep disturbance. In addition, vitamin B1 and B12 deficiency, and cognitive and visual impairment secondarily contribute to dizziness and unstable gait. Appropriate selection of treatment according to the underlying causes would prevent accidental falls among the older adults. [ABSTRACT FROM AUTHOR]

Background: Vitamin B12 deficiency is a prevalent issue among pregnant women in Northern India, particularly due to predominant vegetarian dietary practices. This deficiency is closely linked to the development of anemia, which can adversely affect maternal and fetal health. METHODS: This cross-sectional study involved 100 pregnant women at ESIC Medical College and Hospital, Bihta, Patna, from April 2022 to April 2023. Participants underwent blood tests to determine vitamin B12 levels and were screened for anemia. Statistical analysis was used to examine the relationship between B12 deficiency and anemia. Results: Out of the participants, 55% had vitamin B12 deficiency and 65% were anemic. A significant association was found between B12 deficiency and anemia, particularly in the second and third trimesters of pregnancy. Conclusion: The high prevalence of vitamin B12 deficiency and its correlation with anemia highlights the need for improved nutritional management and awareness in pregnant women in Northern India. Effective interventions, including supplementation and dietary counseling, are crucial for preventing complications associated with these deficiencies. [ABSTRACT FROM AUTHOR]

Megaloblastic anemia, which results from vitamin B12 or folate deficiency, "is a common public health problem in children. The present study was a cross-sectional observational study designed to establish the prevalence of vitamin B12 deficiency in pediatric patients with megaloblastic anemia attending a tertiary care hospital in JNUIMSRC, Jaipur. A total of 150 children, aged 6 months to 18 years," were recruited and divided into two groups: seventy-five children with megaloblastic anemia (cases) and seventy-five apparently healthy children without anemia (controls) were selected from the same community with regards to age, sex, and family income. The participants of the study group had a very high level of vitamin B12 deficiency compared to the control group with 68% of the participants being deficient while 20% of the control group were deficient. Physical findings including pallor, fatigue, glossitis, and growth failure were more frequent in the study group, with more frequent neurological involvement, including peripheral neuropathy. The work also revealed that children on vegetarian diets and kids with low-income families were at a greatly enhanced risk of vitamin B12 deficiency. Blood indices also reflected anemia by showing lower hemoglobin concentrations, and increased mean corpuscular volume (MCV) in the deficient group. Despite these implications, the results of this study may not be generalizable due to its single-site design, and the possibility of selection bias due to the sample drawn from a hospital setting. Subsequent research should examine community dwelling participants and long term follow up to determine the effects of vitamin B12 supplementation in later life. This paper concluded that there is a need to continue the public health interventions to promote vitamin B12 supplementation and nutritional education, especially in regions where there is a high prevalence of vegetarian families &/or low-income group. [ABSTRACT FROM AUTHOR]

Objectives: To identify the cost-effectiveness of four policy options related to folic acid supplements after considering the side effects of masking vitamin B12 (B12) deficiency in primary stroke prevention for hypertensive patients in China. Study Design: A cost-effectiveness analysis. Methods: Four policies were considered: Policy A, Do nothing to address folate status in hypertensive patients at risk for stroke; Policy B, Folate supplementation without pre-screening for vitamin B12 deficiency; Policy C, Folate supplementation with pre-screening all patients for B12 deficiency and add B12 supplements if B12 is deficient; and Policy D, Folate supplementation only for those whose folate is deficient, pre-screen all patients for both B12 and folate deficiencies and add B12 supplements if B12 is deficient. A decision tree with a five-year period of intervention based on the China Stroke Primary Prevention Trial (CSPPT) from the Chinese healthcare system perspective estimated incremental cost-effectiveness ratio (ICER) for Policy B, Policy C and Policy D vs. Policy A. Results: At a willingness to pay (WTP) threshold of 3 times the national GDP per capita ($38,198), Policy B was not cost-effective compared to Policy A, with an ICER of $47,968 per QALY due to QALYs lost introduced by the delayed diagnosis of B12 deficiency and the potentially underestimated costs associated with treating neuropathy. However, Policy C and Policy D were cost-effective compared to Policy A, with an ICER of $32,615 and $20,287 per QALY, respectively. A probabilistic sensitivity analysis showed that there would be a 72.7% and 83.5% chance that the additional cost of Policy C and Policy D, compared with Policy A, was at or below the WTP threshold. Conclusions: Folate supplementation with integrated screening for B12 and folate deficiencies is considered the most cost-effective strategy for primary stroke prevention in hypertensive elderly patients in China. Future research should focus on advancing precision medicine to assess the feasibility and cost-effectiveness of nationwide implementation across diverse sub-populations within the context of integrated screening, ensuring efficient and tailored public nutrition strategy delivery. [ABSTRACT FROM AUTHOR]

Background: The clinical manifestations of subacute combined degeneration of spinal cord (SCD) in children are complex and vary greatly. Notably, some SCD patients may be complicated with autoimmune diseases, leading to high early misdiagnosis and missed diagnosis rates. Case presentation: In this study, a case involving an adolescent female with repetitive severe anemia, multiple joint swelling and pain in the left limbs, and paralysis of the bilateral lower limbs with serum vitamin B12 deficiency, polyglandular involvement, and various positive auto-antibodies (anti‑intrinsic factor antibody, anti‑parietal cell antibody, thyroid peroxidase antibody, thyroid globulin antibody and perinuclear anti‑neutrophil cytoplasmic antibody) is reported. The patient was diagnosed with SCD co-existing with autoimmune polyglandular syndrome type 3b (APS 3b) and undifferentiated connective tissue disease (UCTD) based on the symptoms and laboratory tests. However, treatment with high-dose intravenous methylprednisolone pulses, intravenous immunoglobulin, oral naproxen (changed to hydroxychloroquine after 2 weeks), vitamin B12, levothyroxine sodium tablets supplementation, blood transfusion, and rehabilitation significantly improved the patient's condition. Conclusion: Co-existence of APS 3b, UCTD, and SCD is rare in children with significantly different clinical manifestations. Nonetheless, early diagnosis and timely treatment of SCD are crucial for improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background:Dibothriocephalus nihonkaiense (previously known as Diphyllobothrium nihonkaiense) infection is not common in Hong Kong. D. nihonkaiense is a fish-borne cestode parasite that infects humans after consuming raw or insufficiently cooked fish containing plerocercoids. Case presentation: We reported a case of D. nihonkaiense infection in a 40-year-old woman who presented with a complaint of epigastric pain and diarrhea. A curvilinear opacity was seen at the upper quadrant of the abdomen via abdominal X-ray. An incomplete 80 cm long strobila of D. nihonkaiense without a scolex and neck was found in her feces. A grayish-brown oval egg with an inconspicuous operculum and small knob at the abopercular end was also found. Species-level identification was performed using Nanopore sequencing. Complete blood count and serum vitamin B12 level were tested to check for megaloblastic anemia and vitamin B12 deficiency, respectively. Laboratory investigations demonstrated an elevated percentage of monocytes in peripheral blood. A single oral dose of praziquantel (25 mg/kg) was prescribed to the patient. There was no evidence of relapse after the treatment. Conclusions: We reported a case of D. nihonkaiense infection using Oxford Nanopore NGS as a tool for accurate parasite identification. [ABSTRACT FROM AUTHOR]

The editorial discusses the implications of non-anaemic iron deficiency in patients undergoing surgery, highlighting the complexity of the issue and the lack of clear treatment guidelines. The study by Miles et al. focused on patients undergoing colorectal surgery for cancer and found no significant difference in outcomes between those with and without iron deficiency. The editorial emphasizes the need for further research in diverse patient populations to better understand the impact of iron deficiency on surgical outcomes. [Extracted from the article]

A 68-year-old man described a progressive, painless, and bilateral reduction of visual acuity, with greater difficulties in central vision, over a period of 3 years. His past medical history was unremarkable, and he admitted a long exposure to tobacco smoking and moderate daily alcohol intake. The first ophthalmological evaluation confirmed a bilateral reduction of visual acuity, without other major findings. Visual fields showed a central scotoma in the right eye and a temporal pseudo-hemianopia in the left eye. The neurological examination was unremarkable. A slight cobalamin deficiency was detected after the first panel of investigations, and he was diagnosed and treated for the cause that seemed most obvious. Surprisingly, nutritional optic neuropathy was not his final diagnosis. This case shows how the paraclinical findings may help to address the correct diagnosis, summarizing a comprehensive approach to patients with progressive and bilateral visual loss and highlighting the main differential diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Oral health plays a primary role in nutrition intake. Tooth loss can affect mastication, leading to nutritional deficiencies such as vitamin B12 and folic acid which affect fetal development. This study is aimed to assess the oral health, vitamin B12 and folic acid in mothers with children of non-syndromic cleft lip with or without cleft palate (CL±P). Methods: This is a quantitative correlational and an observational cross-sectional design. The population was mothers of non-syndromic CL±P children, who attend at Yayasan Pembina Penderita Celah Bibir dan Langit-Langit (YPPCBL), Sekeloa, Bandung. The inclusion criteria was mothers of non-syndromic CL±P children, aged 0-12 months and the exclusion criteria was mothers with a family history of CL±P. Collecting data through the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Oral health was evaluated using the Decayed, Missing, Filled Tooth (DMF-T) index and posterior occlusal support area (POSA) assessed based on the Eichner Index, with classifications A1-A3 and B1-B3. Spearman rank correlation test with a significance level, p<0.05. Results: A total of 38 subjects participated in this study. High DMF-T index was found in 63.2% of the subjects, mean score was 6.3. POSA with A1-A3 classification were identified in 63.2% of the subjects. Around 60.5% had sufficient vitamin B12 intake and 86.8% had insufficient folic acid intake. There were no significant correlation between the DMF-T index with vitamin B12 (p>0.05) and folic acid (p>0.05) intake. Similarly, no significant correlation between the POSA with vitamin B12 (p>0.05) and folic acid (p>0.05) intake. Conclusion: There is no correlation between POSA and DMFT index with vitamin B12 and folic acid in this study. [ABSTRACT FROM AUTHOR]

Aim: Anemia is a common pregnancy complication, with iron, folate, and vitamin B12 deficiencies being the most frequent causes. This study aimed to evaluate the role of micronutrient deficiencies in the etiology of anemia during the first trimester of pregnancy. Material and Method: Between January 2023 and January 2024, 271 pregnant women aged 18–50 years who presented to the Obstetrics and Gynecology Outpatient Clinic of a tertiary university hospital were included in this study. Demographic data and hemoglobin, serum iron, total iron binding capacity (TIBC), ferritin, folate, and vitamin B12 levels were obtained retrospectively from medical records. According to the Centers for Disease Control and Prevention (CDC), 1st trimester hemoglobin <11 g/dl and hematocrit <33% were considered as anemia, ferritin <15 ng/ml as iron deficiency, serum folate <3 ng/ml, and vitamin B12 <200 pg/ml as a deficiency. Results: In total, 107 (39.5%) pregnant women had anemia. Pregnant women with and without anemia were similar in terms of age, gravidity, parity, abortion, gestational week, infant birth weight, APGAR scores at 1 and 5 min, folate levels, and vitamin B12 deficiency levels. Those with anemia had significantly lower serum iron (p=0.006) and ferritin levels (p<0.001), and higher TIBC levels (p<0.001) than those without anemia. Ferritin was <15 ng/ ml in 61.7% (n=66) of those with anemia (p<0.001). Vitamin B12 deficiency was present in one of the three pregnant women with anemia. There were only four pregnant women with folate deficiency, and none of them had anemia. Conclusion: Providing adequate micronutrient support before and during pregnancy prevents anemia. Therefore, pregnancy follow-up protocols should emphasize regular screening for micronutrient deficiencies. [ABSTRACT FROM AUTHOR]

Background: Historically used as a marker for inherited disorders, the current interest in plasma homocysteine measurement lies in its ability to provide valuable information about the metabolic and nutritional status of patients. Specifically, nitrous oxide (N2O) abuse can lead to functional vitamin B12 deficiency by oxidation and increase oxidative stress, resulting in elevated plasma homocysteine levels, which mimic neurological conditions such as Guillain–Barré syndrome. Rapid identification of hyperhomocysteinemia is crucial for timely intervention and avoiding costly, unnecessary treatments. Objective: This study evaluates the performance of a rapid immunoassay technique (Snibe) compared to mass spectrometry (LC-MS/MS) for measuring plasma homocysteine levels in patients with nitrous oxide abuse and non-inherited caused of elevated homocysteine, aiming to enhance differential diagnosis related to oxidative stress. Methods: 235 patients from Lille University Hospital were included. EDTA blood samples were collected and analyzed using both rapid immunoassay (Snibe) and LC-MS/MS. Neurological assessment was performed using the peripheral neuropathy disability (PND) score. Results: Firstly, significant elevations in plasma homocysteine levels were observed in patients abusing nitrous oxide measured by LC-MS/MS. Secondly, the immunoassay provided rapid results, essential for early clinical decision-making, but tended to underestimate high values compared to LC-MS/MS. A good correlation was found between the methods for low and moderate values. Conclusion: The immunoassay tended to underestimate high-value samples compared to LC-MS/MS, which is a common problem with the competitive methodology. The rapid immunoassay technique is effective for initial screening and early intervention, aiding in the differential diagnosis of conditions related to oxidative stress. Therefore, it is recommended to use the CLIA method for initial screening and confirm with mass spectrometry if there are abnormal samples. Integrating both techniques can enhance diagnostic accuracy and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: The etiology of telogen effluvium (TE) includes situations that may cause physiological stress, surgical trauma, inflammatory, infectious, iatrogenic causes, medications and nutritional deficiencies. TE has been associated with iron deficiency, vitamin B12 deficiency and thyroid diseases. In recent years, the use of over‐the‐counter food supplements containing vitamins and minerals such as biotin, vitamin D, zinc (Zn), copper (Cu) and selenium (Se) has been increasing in TE patients. The aim of this study is to investigate whether there are differences in nutritional status, vitamin and mineral levels by comparing individuals with TE and a control group. Materials and Methods: This case–control study included 90 female patients diagnosed with chronic telogen effluvium (CTE), and 90 female controls volunteered to participate in the study who consulted for reasons other than TE. Both groups aged 18 and over and applied to dermatology polyclinic between 01.09.2022 and 01.09.2023. A detailed anamnesis was taken from all patients, a hair pull test was performed, and TE was diagnosed after a dermoscopic examination was performed on all areas of the scalp. Then, serum vitamin D, Zn, Cu, Se levels and biotin levels in serum and urine were measured. Hemoglobin (Hb), ferritin, vitamin B12 and thyroid function tests were retrospectively scanned from the hospital database. Results: It was determined that Zn levels were significantly lower in CTE patients than in controls. Se levels were found to be significantly higher in patients than in controls. There was no difference in Hb, ferritin, vitamin B12, thyroid function tests, vitamin D, Cu levels, serum and urine biotin levels between the two groups. Zn, Cu/Zn and Se levels were found to have statistically significant diagnostic performance in predicting the diagnosis of CTE. Cu/Zn ratio and Se value were found to be significant predictors of CTE. Conclusion: This study shows us that nutritional deficiencies are not as common as thought in patients diagnosed with TE. Other causes that may cause TE should be investigated by a detailed anamnesis and a good physical examination. After all, tests for suspected conditions should be performed and individualized treatment options should be created for each patient. [ABSTRACT FROM AUTHOR]

Blind loop syndrome (BLS) is a rare and significant gastrointestinal pathology, frequently associated with surgical interventions such as gastric bypass or intestinal resections. It manifests through the stagnation of intestinal contents, which promotes bacterial overgrowth and leads to malabsorption and nutritional deficiencies, especially in vitamins B12 and D. Symptoms include diarrhea, steatorrhea, abdominal pain, and neurological disturbances, such as subacute combined degeneration. The diagnosis requires a thorough clinical evaluation and advanced imaging studies. The management of BLS involves medical treatments, antibiotic therapy, surgical interventions to correct anatomical defects, and nutritional care to address underlying deficiencies. Severe complications include subacute combined degeneration, osteomalacia, and retroperitoneal hematoma. Patient education and prevention play essential roles in managing this condition. BLS presents a significant clinical challenge, requiring early diagnosis and effective therapeutic management to prevent complications and improve the quality of life for affected patients. This review explores the etiology, pathophysiology, diagnosis, and therapeutic options for BLS, highlighting the importance of a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To describe the clinical features and the risk of developing gastric tumors in patients with autoimmune gastritis (AIG). METHODS: This was a retrospective, longitudinal, multicenter study conducted at 8 Italian tertiary referral centers. We retrieved clinical data from all histologically proven patients with AIG. Differences between Helicobacter pylori-exposed vs H. pylori-naive and anti-parietal cell antibody (PCA)-positive vs PCA- negative patients were investigated. The rate of gastric adenocarcinoma and type 1 gastric neuroendocrine neoplasm (gNEN) was assessed. A multivariable model for factors associated with gNEN was fitted. RESULTS: A total of 1,598 patients with AIG (median age 58 years, interquartile range 46–68; F:M ratio 2.7:1) were included. H. pylori-naive patients were more likely to have a first-degree family history of AIG (14.7% vs 8.9%; P 5 0.012), type 1 diabetes mellitus (4.9% vs 2.3%; P 5 0.025), and pernicious anemia (30.9% vs 21.1%; P 5 0.003). PCA-positive patients had significantly more associated autoimmune diseases (59.0% vs 42.9%; P < 0.001) and were more likely to have been diagnosed by a case-finding strategy (15.3% vs 2.6%; P < 0.001). Overall, 15 cases (0.9%) of gastric adenocarcinoma and 153 cases (9.6%) of gNEN occurred, with a global rate of 0.12 (95% confidence interval [CI] 0.07–0.20) and 1.22 (95% CI 1.03–1.42) per 100 person/year, respectively. Having a vitamin B12/ iron deficiency manifestation at AIG diagnosis was associated with a 16.44 (95% CI 9.94–27.20 P < 0.001) hazard ratio of gNEN. DISCUSSION: The “pure” AIG pattern has typical features of an autoimmune disease and seems to be unrelated to H. pylori. In a tertiary referral setting, the risk of developing overt gastric adenocarcinoma is low, while patients with vitamin B12 deficiency complications at onset may benefit from a more intense endoscopic follow-up for early gNEN detection. [ABSTRACT FROM AUTHOR]

Background: Pernicious anemia (PA) is believed to be highly prevalent in Western countries but has rarely been reported in China. The study explores whether PA, an autoimmune disease, is an uncommon cause of cobalamin (vitamin B12) deficiency anemia in China. Methods: Clinical and hematological data were collected from 90 cobalamin deficiency-caused megaloblastic anemia (MA) patients between July 2014 and December 2021. Through anti-intrinsic factor antibody (IFA) and anti-parietal cell antibody (PCA) testing, PA was distinguished from other causes of cobalamin deficiency leading to MA. Meanwhile, 30 healthy controls (HCs) were included to estimate the positive rates of IFA and PCA. Results: Of the 30 HCs, only one tested positive for IFA, and all 30 tested negative for PCA. Among the 90 patients with cobalamin deficiency-caused MA, 76.7% were positive for IFA, and 47.8% were positive for PCA; a total of 76 patients (84.4%) were diagnosed with PA. The mean follow-up time was 41.0 ± 16.3 months. During the follow-up period, no case relapsed among the continuous cobalamin-supply treatment patients, while 24.4% of patients relapsed due to the interruption of maintenance cobalamin-supplement therapy (the median recurrence time was 54.0 ± 17.7 months). Conclusions: The proportion of PA in cobalamin deficiency-caused MA patients in Hainan province was higher than 80%, which was more common than expected. Therefore, screening for IFA, PCA, endoscopic biopsy, and thyroid-related parameters are recommended for all cobalamin deficiency-caused MA patients. Furthermore, maintenance cobalamin-supplement therapy is important for PA patients. Plain Language Summary: This research examines pernicious anemia (PA), a type of anemia caused by vitamin B12 deficiency, which has been widely reported in Western countries but is less known in China. The study focuses on determining if PA is also a significant cause of this deficiency in Hainan, China. Researchers gathered data from patients with megaloblastic anemia (a blood disorder) due to lack of vitamin B12, comparing them with healthy individuals to see how common PA is. The findings reveal that a very high percentage of the patients studied have PA, much higher than expected. This suggests that PA is not as rare in this region of China as previously thought. The study also highlights the importance of continuous treatment with vitamin B12 to prevent the recurrence of the anemia. Based on these results, the researchers recommend that all patients with vitamin B12 deficiency should be tested for PA and continuously receive vitamin B12 supplements to maintain their health once diagnosed with PA. This strategic insight is of paramount importance to medical practitioners in China, potentially paving the way for enhanced clinical management protocols for individuals afflicted by this ailment. [ABSTRACT FROM AUTHOR]

Objectives: Tobacco use remains a leading cause of preventable diseases, adversely impacting numerous physiological processes, including vitamin metabolism. Vitamin B12 deficiency, essential for cellular function and DNA synthesis, is particularly concerning in smokers due to their exposure to harmful tobacco constituents. This research examines the association between smoking habits, nutritional health and salivary vitamin B12 levels, with an emphasis on the broader public health implications of smoking-induced nutritional deficiencies. Method: This cross-sectional study involved 240 participants, equally divided into 120 smokers and 120 non-smokers. Salivary samples were collected under standardized conditions and vitamin B12 concentrations were measured using the ELISA technique. A 24-hour dietary recall assessed nutritional adequacy, categorized into four levels: excellent, adequate, barely adequate and not adequate. Statistical analyses were conducted using the Mann-Whitney U test to compare vitamin B12 levels and chi-square tests to evaluate the relationship between smoking and dietary adequacy. Results: Smokers exhibited significantly lower salivary vitamin B12 levels compared to non-smokers, with mean ranks of 107.27 and 133.73, respectively (Mann-Whitney U = 8787.5, p = 0.003). Nutritional scores highlighted that smokers had poorer dietary quality, with a higher prevalence of inadequate diets. A significant association between smoking and nutritional adequacy was identified (chi-square value = 12.790, p = 0.005). These findings suggest smoking negatively impacts both vitamin B12 levels and dietary habits. Conclusion: This study highlights that smokers experience significantly lower salivary vitamin B12 levels and poorer dietary adequacy compared to non-smokers. The findings emphasize the need for targeted nutritional interventions, dietary education and public health strategies tailored to mitigate smoking-induced nutritional deficiencies. Future research should explore the interaction between smoking, other micronutrients and the potential benefits of dietary supplementation for smokers.. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chemical fortification and dose supplementation of vitamin B12 are widely implemented to combat deficiency symptoms. However, in situ, fortification of vitamin B12 in food matrixes can be a promising alternative to chemical fortification. The present study aimed to produce vitamin B12‐rich, probiotic guava juice fermented with Levilactobacillus brevis strain KU15152. Pasteurized fresh guava juice was inoculated with 7.2 log CFU mL−1L. brevis strain KU15152 and incubated for 72 h at 37 °C anaerobically. The antioxidants, total phenolic compounds, vitamin B12 production, sugars, organic acids, pH and viable count were analyzed at 24, 48 and 72 h of incubation. The fermented juice was stored at 4 °C, and the changes in its functional properties were analyzed at 7‐day intervals up to 28 days of storage. RESULTS: During fermentation, the bacteria cell count was increased from 7.01 ± 0.06 to 9.76 ± 0.42 log CFU mL−1 after 72 h of fermentation and was decreased to 6.94 ± 0.34 CFU mL−1 during storage at 4 °C after 28 days. The pH, total soluble solids, crude fiber, citric acid and total sugars decreased, while titratable acidity, total protein, antioxidants, phenolic compounds and lactic acid contents increased during fermentation. The fermented guava juice exhibited higher 1,1‐diphenyl‐2‐picrylhydrazyl (DPPH) and 2,2′‐azino‐bis‐(3‐ethylbenzothiazoline‐6‐sulfonic acid (ABTS)) radical scavenging activities (85.97% and 75.97%, respectively) at 48 h of fermentation. The concentration of active vitamin B12 in the sample reached 109.5 μg L−1 at 72 h of fermentation. However, this concentration gradually decreased to 70.2 μg L−1 during the storage period. During storage for 28 days at 4 °C, both the fermented and control guava juices exhibited a decline in antioxidant and phenolic compound concentrations. Furthermore, the addition of 20% honey and guava flavor enhanced the organoleptic properties and acceptability of fermented guava juice. CONCLUSION: The value‐added fermented guava juice could be a novel functional food product to combat vitamin B12 deficiency. © 2024 The Author(s). Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Our study aimed to determine the prevalence of Peripheral Neuropathy (using nerve conduction studies (NCS)) in children with transfusion-dependent thalassemia aged between 5 to 18 years and to study its correlation with chronic anemia, ferritin levels, chelation status, annual transfusion requirement, deficiency of serum Vitamin B12, and Folate levels. Methods: In this hospital-based cross-sectional study, 100 eligible children were enrolled in a tertiary care teaching hospital in New Delhi, India. Neurological examinations focusing on peripheral neuropathy followed by NCS were performed on all the patients. Age-wise cutoff values outside of 2.5 SD of normal were taken as abnormal. Results: None of the children had clinical features of peripheral neuropathy, although 77% had abnormalities in NCS. Of these, 33% had pure motor nerve changes, 7% had pure sensory nerve changes, 1% had abnormal F responses, and 26% had mixed nerve changes. These changes correlated significantly with chronic anemia and duration of iron chelation but not with other factors. Conclusion: In children with transfusion-dependent thalassemia who do not exhibit any neurological signs or symptoms, however, it is not uncommon to observe abnormal NCS at an average hemoglobin (Hb) level of less than 9.5 g/dl. Further comprehensive case-control studies are necessary to determine if a more specific Hb target range of 9.5 to 10.5 g/dl is appropriate and to investigate the potential impact of chelation therapy on these changes. [ABSTRACT FROM AUTHOR]

Autoimmune encephalitis (AE) can present as first-episode psychosis (FEP) in children. An FEP diagnostic algorithm has been proposed, but how this algorithm applies to children is unknown. We assess the FEP diagnostic algorithm in children with FEP. The FEP algorithm was applied to a retrospective cohort of children with FEP without other neurological symptoms. Twenty-four patients were included, with five AE (anti- N -methyl-d-aspartate receptor encephalitis) and 19 non-AE patients (12 primary psychiatric, two headaches, mycoplasma-related encephalitis, post–coronavirus disease 2019 encephalitis, drug reaction with eosinophilia and systemic symptoms [DRESS] syndrome, cobalamin C deficiency, and two unknown). Some non-AE patients (five of 19 = 26%) received immunotherapies, with symptom resolution in one of five (20%) with immunotherapy and in four of 14 (29%) without immunotherapy. The FEP algorithm recommended cerebrospinal fluid (CSF) testing in all (five of five = 100%) patients with AE and in six of 19 (32%) non-AE patients, resulting in 100% sensitivity (95% confidence interval [CI]: 100% to 100%) and 45.5% specificity (95% CI: 16% to 75%), with a negative predictive value of 100% (95% CI: 100% to 100%). FEP can occur in children from different causes, including AE and metabolic conditions. Evaluation of FEP should be broad, especially without CSF evidence of inflammation. The FEP algorithm is useful to assess patients who would benefit from CSF testing and should be assessed in larger cohorts. [ABSTRACT FROM AUTHOR]

The dietary intake of vitamin B12 among unsupplemented vegans is notably lower compared to both vegetarians and omnivores. Prolonged low intakes of vitamin B12, such as seen in those adhering to a vegan diet, lead to physiological deficiency of vitamin B12 and an elevated risk of B12‐related morbidity. However, while serum B12 serves as a conventional biomarker for assessing B12 status, its utility is limited given its sensitivity and specificity in ascribing physiological deficiency of B12 and the functional vitamin B12 status of those adhering to vegan diets is unclear. We conducted a systematic review and meta‐analysis using data based on the full panel of biomarkers of vitamin B12 status to test whether adherence to a vegan diet is associated with an elevated risk of functional vitamin B12 deficiency compared to vegetarian or omnivorous diets. In addition, subgroup analysis was carried out to look at the effect of vitamin B12 supplement use on B12 status among vegans. Our search identified 4002 records, of which 19 studies met the inclusion criteria for the systematic review and 17 studies were taken forward for the meta‐analysis. Meta‐analysis results revealed significantly lower serum B12, pmol/ (−0.72 [−1.26, −0.18]; p = 0.01) and elevated total homocysteine, μmol/L (tHcy) (0.57 [0.26, 0.89]; p < 0.001) concentrations, alongside elevated methylmalonic acid, nmol/L (MMA) (0.28 [−0.01, 0.57]; p = 0.06) and lower holotranscobalamin, pmol/ (HoloTC) (−0.42 [−0.91, 0.07]; p = 0.09) levels among vegan adults compared to omnivores, indicating increased functional B12 deficiency in addition to low vitamin B12 status in vegan adults. There were no differences between vegans and vegetarians in HoloTC (0.04 [−0.28, 0.35]; p = 0.814) or MMA (−0.05 [−0.29, 0.20]; p = 0.708), but differences were found in serum B12 (−0.25 [−0.40, −0.10]; p = 0.001) and for tHcy (0.24 [0.09, 0.39]; p = 0.002) concentrations. Subgroup analyses indicated that the use of vitamin B12 supplements among vegans contributes to significant improvements in all biomarker concentrations compared to their unsupplemented counterparts. Our findings underscore the need for improved strategies to redress poor vitamin B12 status with appropriate B12 supplementation use among those adhering to vegetarian and vegan diets. [ABSTRACT FROM AUTHOR]

The article discusses the importance of folate and one-carbon metabolism in fetal, embryo, and child development, as well as brain health at all ages. It highlights the relationship between folate, vitamin B12, and the synthesis of methyl groups crucial for DNA and RNA regulation. The text also explores how antiepileptic drugs can interfere with folate metabolism, potentially contributing to cognitive, mood, and psychiatric complications of epilepsy. Additionally, it delves into the impact of valproate on folate and methylation cycles, emphasizing the need for further research to understand the congenital and developmental risks associated with antiepileptic drugs. [Extracted from the article]

Parkinson's disease (PD) has been linked to a vast array of vitamins among which vitamin B12 (Vit B12) is the most relevant and often investigated specially in the context of intrajejunal levodopa infusion therapy. Vit B12 deficiency, itself, has been reported to cause acute parkinsonism. Nevertheless, concrete mechanisms through which B12 deficiency interacts with PD in terms of pathophysiology, clinical manifestation and progression remains unclear. Recent studies have suggested that Vit B12 deficiency along with the induced hyperhomocysteinemia are correlated with specific PD phenotypes characterized with early postural instability and falls and more rapid motor progression, cognitive impairment, visual hallucinations and autonomic dysfunction. Specific clinical features such as polyneuropathy have also been linked to Vit B12 deficiency specifically in context of intrajejunal levodopa therapy. In this review, we explore the link between Vit B12 and PD in terms of physiopathology regarding dysfunctional neural pathways, neuropathological processes as well as reviewing the major clinical traits of Vit B12 deficiency in PD and Levodopa-mediated neuropathy. Finally, we provide an overview of the therapeutic effect of Vit B12 supplementation in PD and posit a practical guideline for Vit B12 testing and supplementation. [ABSTRACT FROM AUTHOR]

Background In older patients, frailty and anemia frequently coexist. However, only few studies have been conducted in older patients with multimorbidity and several overlapping causes of anemia, such as inflammation, inadequate nutrition, or certain pathologies. This analysis aims to decipher potential factors associated with anemia in older hospital patients with frailty. Methods Patients (n  = 208, age: 62–98 years) were categorized as prefrail (n  = 68) and frail (n  = 140) using the Fried frailty phenotype. We quantified serum concentrations of markers of iron metabolism (iron, ferritin, transferrin, soluble transferrin receptor, and hepcidin), inflammation (interleukin [IL]-6 and IL-10 C-reactive protein), and hematology (hemoglobin). Principal component analysis was conducted to evaluate biomarker patterns and associations with frailty were assessed with logistic regression analysis. Results Anemia prevalence was higher in patients with frailty (84.3% vs 70.6%, p  = .021). Three principal components (PC1–3) were identified. PC1 was characterized by high factor loadings representing inflammation and factor scores differed between patients with prefrailty and frailty (−0.04 (interquartile range [IQR]: 1.45) vs −0.51 (IQR: 0.87), p  < .001]. PC2 represents macrocytic anemia and thus vitamin B12 or folate deficiency, whereas PC3 indicates hematological pathologies. Only PC1 was associated with frailty status when controlled for age, sex, number of drugs, and comorbidities (OR: 2.018, 95% CI: 1.316; 3.094, p  = .001). PC2 and PC3 were not associated with frailty. Conclusions Our results suggest that anemia in patients with frailty is driven by inflammation rather than being disease-related or solely the result of micronutrient deficiencies. [ABSTRACT FROM AUTHOR]