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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]

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]

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]

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]

Introduction: Iron deficiency anemia (IDA) is a major public health issue, particularly in developing countries like India, where malnutrition and limited access to healthcare exacerbate the problem. In the Sub-Himalayan region, the coexistence of IDA with deficiencies in Vitamin B12 and folic acid poses an additional challenge to healthcare providers. This study focuses on the prevalence of these combined deficiencies and aims to shed light on the complex interplay between iron, Vitamin B12, and folic acid metabolism in anemia. Aims: To assess the prevalence of iron deficiency anemia among patients in a tertiary care hospital in the Sub-Himalayan region Materials and Methods: This is a cross-sectional observational study conducted at a tertiary care hospital in the Sub-Himalayan region of India. The study was carried out over a period of 1 year, focusing on patients diagnosed with anemia.100 Patients were included in this study. Result: In our study, 5 (5.0%) patients had Normal Range, 13 (13.0%) patients had Mild Deficiency, 15 (15.0%) patients had Moderate Deficiency and 67 (67.0%) patients had Severe Deficiency. The value of z is 9.1335. The value of p is < .00001. The result is significant at p < .05. In our study, 1 (1.0%) patient had Alfa thalassemia trait, 1 (1.0%) patient had Beta thalassemia trait, 1 (1.0%) patient had HbE carrier, 7 (7.0%) patients had HbE disease, 14 (14.0%) patients had HbE trait and 76 (76.0%) patients had Normal Pattern in HPLC. Conclusion: This study demonstrates a strong correlation between iron deficiency anemia and deficiencies in Vitamin B12 and folic acid in the Sub-Himalayan region of India. The coexistence of these deficiencies complicates the management of anemia and necessitates a more comprehensive diagnostic approach. The findings underline the need for nutritional interventions and public health strategies to address these deficiencies in resource-limited settings. [ABSTRACT FROM AUTHOR]

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<0.05), whereas patients in palliative care or those with malignancies had significantly higher levels (p<0.05). The use of vitamin B12 supplements was correlated with significantly higher serum B12 levels (p<0.05). Conclusion: The serum vitamin B12 levels of patients admitted to the internal medicine department remained stable over the past 5 years. However, certain subgroups, such as patients with pancreatitis, malignancies, and metformin use, exhibited significant variations in B12 levels. Regular monitoring of B12 levels in high-risk groups, such as patients with diabetes receiving metformin, is recommended to prevent deficiency-related complications. Elevated B12 levels in patients with cancer should prompt further investigation into the underlying malignancies. [ABSTRACT FROM AUTHOR]

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]

Introduction: Thiamine-responsive megaloblastic anemia syndrome (TRMA) is a rare autosomal recessive disease with a homozygous or compound-heterozygous mutation in the SLC19A2 gene characterized by megaloblastic anemia, diabetes mellitus (DM), and sensorineural hearing loss with onset in childhood. Folic acid and vitamin B12 in serum are normal with dysplastic erythropoiesis in the bone marrow often mimicking myelodysplastic neoplasms (MDS) as a potential differential diagnosis. Thiamine substitution leads to normalization of anemia, without effects on hearing loss or DM. Case Presentation: We report about a 38-year-old male patient, presented with a 12-year history of anemia, insulin dependent DM, optic neuropathy, and a cataract since early childhood. The laboratory showed megaloblastic anemia. Other values were normal. The bone marrow smear showed dysplastic erythropoiesis with megaloblastic changes, and normal findings in cytogenetic and molecular genetic examinations. Next-generation sequencing-based diagnostics revealed a heterozygous missense variant in the SLC19A2 gene on the maternal allele and a 3.4 Mb inversion in the chromosomal region 1q24.2 with breaking points in FAM78B and SLC19A2 on the paternal allele. Treatment with oral thiamine 100 mg daily was initiated, and 12 weeks later hemoglobin levels and bone marrow morphology had normalized. Conclusion: Late-onset TRMA should be considered in adult patients with indicative comorbidities and a typical phenotype, which may mimic features of MDS. [ABSTRACT FROM AUTHOR]

The article discusses the use of ChatGPT-4V, an artificial intelligence tool, for diagnosing oral diseases and conditions. The study evaluated the tool's performance in analyzing medical images and providing accurate diagnoses. ChatGPT-4V demonstrated a success rate of 80.5% when analyzing cases based on written information, images, or a combination of both. The study highlights the potential of AI in aiding dentists in diagnosing oral diseases, although there are limitations in interpreting complex clinical presentations and images. [Extracted from the article]

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]

Pancytopenia is a hematological condition characterized by a decrease in three blood cell lines: erythrocytes, leukocytes, and platelets. This condition is not an independent disease, but a manifestation of various underlying diseases. Pancytopenia can be caused by impaired blood cell production in the bone marrow or increased destruction of blood cells in the periphery. Precise and prompt identification of the etiology is essential, given that pancytopenia can be life-threatening if not treated properly. This study aims to analyze and identify the causes of pancytopenia in patients at Batang Regency Hospital, as well as provide recommendations for appropriate treatment based on the etiology found. The methods used were clinical observation, laboratory examination, and diagnostic imaging in a 58-year-old patient with the main complaint of weakness and a history of pancytopenia. The examination includes a complete blood count, a smear of peripheral blood, and a clinical evaluation. The results showed that the patient had central type pancytopenia, with a suspected etiology of aplastic anemia or myelodysplastic syndrome. Other differential diagnoses include vitamin B12 deficiency. Although a bone marrow biopsy is necessary to confirm the diagnosis, initial therapy with blood transfusions and nutritional improvements has shown an improvement in the patient's condition. The conclusion of this study is the importance of a thorough evaluation to identify the etiology of pancytopenia. Proper treatment should be based on the underlying cause, which will affect the prognosis and prevent recurrence. A comprehensive approach can improve patients' quality of life and reduce the risk of complications. [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]

Summary: A young adult African American female presented with normocytic microangiopathic haemolytic anaemia, elevated lactate dehydrogenase and thrombocytopenia. The patient responded to therapeutic plasma exchanges (TPE) for presumed thrombotic microangiopathy caused by thrombotic thrombocytopenic purpura (TTP). After relapsing, the patient was found to have pancytopenia, megaloblastic bone marrow and low vitamin B12 consistent with pernicious anaemia, which improved with intramuscular B12 and discontinuation of TPE. B12‐deficient macrocytosis was not seen at presentation due to concomitant alpha‐thalassaemia. Initial clinical/laboratory improvement is attributed to B12 present in TPE plasma. B12 deficiency can mimic TTP. Vigilance is needed regarding atypical presentations of pernicious anaemia. [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 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]

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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.

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]

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]

Background Methods Results Conclusions Anemia due to malnutrition may develop as a result of iron, folate and vitamin B12 deficiencies. This situation poses a higher risk of morbidity and mortality in the geriatric population than in other age groups. Therefore, early diagnosis of anemia and early initiation of treatment is very important. This study aims to predict the diagnosis of anemia with using machine learning (ML) methods in geriatric patients followed in an outpatient clinic.In line with the purpose of the study, anemia classification was made by analysing patients' hemogram and biochemistry blood values and medical data such as malnutrition, physical and cognitive activity scores with ML methods.In our data set consisting of 438 patient observations, the most successful ML algorithm was the J48 algorithm with 97.77% accuracy. In the continuation of the study, the predictive performance of anemia was investigated by excluding blood values and selecting only attributes consisting of malnutrition and physical activity scores. In this case, the most successful prediction was obtained with the Random Forest algorithm with 85.39% accuracy.The study showed that anemia can be predicted with high accuracy in geriatric patients without hemogram data. Additionally, our geriatric data set was shared with researchers for future research. Thus, it has contributed to the literature by opening a new path for studies on subjects such as comparing classification performances with new methodologies or predicting different diseases in geriatric patients. [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]

essential in cases of suspected neurosyphilis, including a detailed sexual history and appropriate laboratory testing.The fourth article explores the use of virtual reality (VR) therapy in the rehabilitation of patients with stroke-related upper limb motor impairment. The study found that VR therapy was effective in improving upper limb motor function and activities of daily living in stroke patients. The use of VR technology provides an immersive and engaging rehabilitation experience, which may enhance motivation and adherence to therapy. Further research is needed to determine the optimal parameters and protocols for VR therapy in stroke rehabilitation.The fifth article discusses the potential role of neurofeedback training in the treatment of attention-deficit/hyperactivity disorder (ADHD). Neurofeedback training involves teaching individuals to self-regulate their brain activity through real-time feedback. The study found that neurofeedback training was effective in reducing ADHD symptoms and improving cognitive function in children and adolescents. However, more research is needed to determine the long-term effects of neurofeedback training and its efficacy compared to other treatment options for ADHD.Overall, these articles provide valuable insights into various neurological disorders and potential treatment approaches. Further research is needed to validate and expand upon these findings, but they offer promising avenues for improving the diagnosis, treatment, and rehabilitation of individuals with neurological conditions. [Extracted from the article]

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]

This article discusses a case of a male patient with persistent testicular pain and elevated levels of human chorionic gonadotropin (hCG). The patient underwent various diagnostic tests, including ultrasound, blood testing, and MRI, which showed abnormalities in the right testicle. The patient eventually underwent a right orchiectomy, but the hCG levels remained elevated after surgery. Further laboratory studies were conducted to rule out other causes of elevated hCG levels, and the results suggested the presence of familial hCG syndrome. The article emphasizes the need to consider different factors that could contribute to elevated hCG levels in male patients. Additionally, the article compares different methods used to detect hCG in clinical samples, finding that Immulite was the most effective in detecting all forms of hCG. The importance of using multiple methodologies and familial testing for accurate diagnosis is also highlighted through case studies of patients with testicular cancer and sulfated hCG. [Extracted from the article]

Pernicious anaemia is a rare condition which is classed as an autoimmune disease. It is most frequently diagnosed in those over the age of 60, but can occur at any age. It presents with variable symptoms, many of which are shared with those of other diseases, making the condition difficult to diagnose, leading to missed diagnosis and a greater risk of complications. This article gives an overview of its diagnosis, management, and complications, with the aim of helping general practice nurses (GPNs) and non-medical prescribers recognise symptoms and get early treatment, reducing the risk of long-term adverse effects and improving quality of life for all those affected by this complex disease. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 12-year-old boy with autism who was admitted to the hospital due to progressive vision loss. Topics include the patient's symptoms and diagnostic challenges, including fluctuating vision issues and difficulty seeing details, the background of his premature birth and perinatal hypoxia, and the ongoing evaluation of his condition which included changes in vision and additional symptoms like puffiness and crusting of the eyes.

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]