Vitamin B12 Deficiency Research Articles

P-482. Evaluating Vitamin B12 Deficiency in People Living with HIV Compared to Metformin Users

Abstract Background Vitamin B12 is a water-soluble vitamin critical for the development and function of the central nervous system, as well as the formation of red blood cells and DNA synthesis. Both HIV and metformin use have been associated with vitamin B12 deficiency. The degree of vitamin B12 deficiency in HV has not been quantified compared to other known causative conditions. Our study aims to describe the incidence of vitamin B12 deficiency in HIV-infected individuals compared to metformin-induced vitamin B12 deficiency. Our secondary goal is to describe the demographics of HIV patients requiring B12 replacement therapy. Methods This database study evaluated de-identified medical records from 01/01/2015 to 07/01/2023 at a single large academic institution. We evaluated two study populations: HIV patients and metformin users. For inclusion, both populations required a lab test for vitamin B12 level after starting metformin or the diagnosis of HIV. We defined vitamin B12 deficiency as starting B12 replacement therapy within 4 months of the lab test. Results We identified 3,253 HIV and 50,751 metformin-use patients for our study. Among all HIV patients, 717 received a B12 lab test, and 144 (20%, 95% CI 0.173 to 0.232) required replacement therapy. Metformin users had 7773 individuals that received a B12 lab test, and 1187 (15%, 95% CI 0.145 to 0.161) required replacement therapy. The rate of B12 deficiencies was higher among the HIV population (20%) than the metformin (15%), p=0.0007. The relative risk for vitamin B12 deficiency among the HIV population is 1.315 (95% CI 1.126 to 1.536). The number of HIV patients not on metformin with a B12 lab test was 631, and 124 required replacement therapy (19.7%). The HIV population was primarily men (84%), with 50% in the age range of 40-60 years and 63% identified as white. Conclusion Vitamin B12 deficiency is a known problem associated with metformin administration and HIV infection. This study identified that our HIV population has higher rates of vitamin B12 deficiency than the metformin group. The cause of this deficiency is unknown. Improved awareness of vitamin B12 deficiency in HIV patients may facilitate improved monitoring and supplementation, which in turn may decrease HIV-associated comorbidities such as dementia and neuropathy. Disclosures Lee Nguyen, PharmD, APh, BCPS-AQ ID, BCIDP, Merck & Co: Grant/Research Support

Quando un deficit nutrizionale simula una displasia midollare

A 12-year-old patient with epilepsy, autism spectrum disorder and a selective diet presents with severe macrocytic anaemia and weight loss.Tests reveal deficiencies in vitamin B12 and folate, leading to a diagnosis of megaloblastic anaemia. Malnutrition related to the diet is suspected, and investigations are ongoing to rule out malabsorption or underlying congenital conditions Scuola di Specializzazione in Pediatria, UO di Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria Pisana

Therapeutic nutrition in chronic kidney disease: prioritizing a plant-based diet

In recent years, there has been increasing evidence of the benefits of a plant-based diet for the prevention and treatment of most somatic diseases, including chronic kidney disease (CKD). Improving the nutritional properties of foods by increasing the proportion of plant ingredients while reducing the total amount of animal proteins can reduce the need for nephroprotective drugs, complications of renal diseases and may favorably affect disease progression and patient survival. In this article, we analyze the data available in the world literature on a diet with a predominance of plant products, which has a positive effect on the prevention of renal pathology, the incidence and CKD progression, metabolic acidosis, hyperphosphatemia, arterial hypertension, uremic toxicity, the need for renal replacement therapy and quality of life. Attention is also paid to hyperkalemia and vitamin B12 deficiency, which are often associated with plant-based nutrition, but with the participation of a nutritionist, these risks can be significantly minimized. Therefore, taking into account the risk-benefit ratio, the approach to therapeutic nutrition for CKD is confidently shifting to the plant-based diet.

P-39 A LATE ONSET CASE OF CHYLOMICRON RETENTION DISEASE

Abstract Introduction Chylomicron retention disease (CRD) is an uncommon genetic disorder caused by a mutation in the SAR1B gene, which encodes the Sar1b protein. Sar1b plays a role in transporting chylomicrons from the endoplasmic reticulum to the Golgi apparatus. Often diagnosed in the early stages of life, CRD typically presents with failure to thrive, gastrointestinal symptoms and malabsorption of fat, which leads to secondary clinical conditions such as hepatomegaly, neuromuscular disorders, hypolipidemia and deficiencies of fat soluble vitamins (A, D, E, K). Clinical Case A 56-year-old male patient was referred to our endocrinology outpatient clinic with low blood lipid levels. He expressed pain on his hands and feet. He also described vomiting after fat-rich meals since his childhood. He had no history of smoking or alcohol consumption. His father had diabetes mellitus and hypertension, and his uncle had coronary artery disease. His physical examination was normal besides a peripheral sensorial neuropathy. His laboratory findings showed hypolipidemia and hypochromic microcytic anemia, alongside with vitamin B12, vitamin D and iron deficiency (Table 1). An abdominal ultrasonography was performed, the dimensions of both the liver and the spleen was normal, though a grade 1 hepatosteatosis was observed. An electromyelography was performed and the findings were compatible with axonal polyneuropathy. The patient was referred to the department of genetics for evaluation of familial lipid disorders. A genetic analysis was performed, and the analysis revealed a likely pathogenic heterozygous mutation in the NM_016103.4 c.243dupA p.A82fs*35 area of the SAR1B gene. The patient was diagnosed with chylomicron retention disease. He was referred to a dietetician for a low-fat diet. A bone mineral density scan was planned and oral vitamin D treatment was initiated, alongside with oral iron and vitamin B12 treatment. The patient was also referred to departments of neurology, ophtalmology and cardiology for possible systemic involvement. He was also referred to gastroenterology for endoscopic and colonoscopic scanning. Moreover, his close relatives were advised to be evaluated for CRD. Later on, one of his grandchildren was diagnosed with CRD and is currently under treatment in another institution. Conclusion Though rarely diagnosed during adulthood, CRD should still be included in the differential diagnosis of patients with hypolipidemia; especially in cases with vitamin deficiencies. Gastrointestinal symptoms often encountered during childhood may be absent or vague in adulthood, but careful systemic assessment and physical examination gives valuable clues in the diagnosis of CRD, alongside with appropriate laboratory and genetic analysis. Once diagnosed, other family members, especially children, of CRD patients should also be evaluated about this rare genetic disease. Financial disclosures: None Funding resources: NoneTable 1:Laboratory findings of the patient

Effect of Metformin usage on Vitamin B12 deficiency in patients with Type 2 Diabetes Mellitus

Metformin is the most commonly used drug in antihyperglycemic treatment in patients with type 2 diabetes mellitus (T2 DM). In recent years, there have been many studies reporting B12 deficiency in diabetic individuals using metformin drug. This study evaluates B12 deficiency in individuals with T2 DM diagnosis using metformin in our hospital. This study is a cross-sectional and descriptive research. In this study, the data of 786 patients who applied to the Mugla Education and Research Hospital Internal Medicine outpatient clinic with T2DM diagnosis and used metformin between January 01, 2018 and March 01, 2019 were evaluated. Demographic data, vitamin B12, HbA1c levels of the patients were obtained retrospectively from the hospital information system records. Patients with missing data were excluded from the study.347 (44.1%) male and 439 (55.9%) female patients were included in the study. Metformin dose of 248 (31.6%) of the patients was 1000 mg or less, 123 (15.6%) was 1700 mg, 414 (52.8%) was 2000 mg or more. According to the distribution of medication use, 161 (20.5%) patients were receiving metformin only, 322 (41%) patients were receiving metformin + other oral antidiabetic agents (OAD), and 303 (38.5%) patients were receiving metformin + insulin treatment. Vitamin B12 deficiency (57.8%) was higher in patients aged 60 years old and was over who used metformin (p<0.001). 347 (44.1%) of the patients included in the study received vitamin B12 replacement. We detected serious B12 deficiency in patients with T2DM who used metformin, especially in patients aged over 60 years old. Therefore, we emphasize the importance to monitor vitamin B12 levels in patients who are started on metformin and to perform B12 replacement in patients who are found to be deficient.

Folate and Vitamin B12 Status among Non-Pregnant, Non-Lactating Women of Reproductive Age and Predicted Risk for Neural Tube Defects, Morogoro Region, Tanzania.

Population risk for neural tube defects (NTDs) can be determined using red blood cell (RBC) folate. However, a paucity of biomarker and surveillance data among non-lactating, non-pregnant women of reproductive age (NPWRA) from Africa limits accurate assessment. Our study assessed folate and vitamin B12 status among non-lactating NPWRA and predicted population risk of NTDs in Tanzania. A cross-sectional biomarker survey of non-lactating NPWRA (15-49 years) in the Morogoro region, Tanzania was conducted during June-October 2019. Questionnaire interview responses and non-fasting blood samples were collected. Folate was assessed using the CDC microbiologic assay kit and vitamin B12 was measured using an electrochemiluminescence immunoassay. Complex survey design analyses were conducted using SAS-callable SUDAAN (v11.0.1). Of the 761 participating non-lactating NPWRA, 294 (39.8%) had RBC folate insufficiency (<748 mol/L). The prevalence of RBC folate insufficiency was lower among non-lactating NPWRA living in urban than rural areas (PR: 0.72, 95% CI: 0.52-0.99) but did not differ by age or household wealth index. Vitamin B12 insufficiency was uncommon (< 221 pmol/L, 2.7%). The estimated NTD risk was 10.5 (95% uncertainty interval: 8.1-13.3) per 10,000 births. Elevated NTD risk was predicted in the Morogoro region of Tanzania, where ∼ 40% of non-lactating NPWRA had RBC folate insufficiency and < 3% had vitamin B12 insufficiency. The NTD risk is consistent with surveillance data for the area, limited folic acid fortification of staple foods, and low vitamin B12 insufficiency. Further studies are needed to better understand the context of these findings, especially the impact of micronutrient fortification in Tanzania.

P0226 Postoperative recurrence after a definitive ostomy in Crohn's disease. A nationwide retrospective series from the Eneida registry

Abstract Background Although the concept of postoperative recurrence (POR) in Crohn’s disease (CD) has been limited to patients undergoing intestinal resection with anastomosis, some small-sized retrospective series with short follow-up periods suggest that clinical POR may occur in up to 30% of patients with a definitive ostomy. This may explain the lack of recommendations for monitoring and preventive strategies in this clinical setting. Our aim was to assess the risk of POR and current monitoring strategies in this population. Methods Retrospective study from the ENEIDA database of GETECCU. Patients with CD and a permanent ostomy were included. Demographic, clinical characteristics, evolution, and monitoring data were analyzed. Results Overall, 263 patients who underwent permanent ostomy between 1979 and 2023 were included, of whom 70% had an ileostomy and 30% a colostomy with 65% having previous ileal involvement in both groups. Proctectomy had been performed in 57% of them. Medical prevention for POR was started in 38% of patients (44% thiopurines, 43% biologics, and 13% 5ASA). Regarding monitoring strategies in asymptomatic patients, 25% underwent ileoscopy, 43% had radiological examinations and 53% faecal calprotectin measurements. Moreover, 37% underwent radiological examinations and 55% ileoscopy due to the development of symptoms or elevation of biomarkers. After a median follow-up of 142 months (IQR 75-267), 32% developed clinical POR, 16% biological POR, 37% endoscopic POR, 37% radiological POR, and 14% surgical POR. Among those with POR, 37% started medical therapy (9% 5ASA, 24% thiopurines, 65% biologics). The cumulative probability of clinical POR at 3, 5, and 10 years was 16%, 20%, and 28%, respectively. The cumulative probability of surgical POR at 3, 5, and 10 years was 5%, 8%, and 12%, respectively. In the multivariate analysis, risk factor for clinical POR was having colostomy vs. ileostomy (OR 2.05, 95% CI 1.05-3.99; P=0.035). As for complications during follow-up, 40%, 24%, and 18% of patients developed iron-deficiency anemia, vitamin B12 deficiency, or renal insufficiency, respectively. Conclusion More than one third of patients with CD and a permanent ostomy develop POR in the long-term, and 10% requiring a new resection. These findings underscore the need for recommendations on monitoring strategies and preventive approaches n this clinical scenario.

Study of clinical manifestations and etiologies of megaloblastic anemia in children.

Megaloblastic anemia (MA) is a rare pathology in childhood due, in the majority of cases, to a deficiency of folic acid and/or vitamin B12 (cobalamin). This study aims to determine the epidemiological, clinical, and paraclinical profiles of MA in children and to specify its etiologies, therapeutic modalities, and treatment responses. This is a retrospective descriptive study of MA cases in children carried out in the General Pediatrics Department of the Hedi Chaker University Hospital of Sfax over a period of 42years, from January 1979 to December 2021. We included all the patients under 16years old with a myelogram showing megaloblastosis. The selected patients' demographic characteristics, physical signs, laboratory findings, and treatment responses were recorded. Twenty cases of MA were collected, including 11 boys and 9 girls. The incidence of MA in children was 0.014%. The median age at diagnosis was 3.37years. The clinical presentation was anemic syndrome with pallor and asthenia in all the cases. Neurological manifestations were noted in 2 cases and digestive disorders in 10 cases. Seven infants had psychomotor delays. On admission, all our patients had anemia with an average value of 5.6g/dl. It was macrocytic in 19 cases. The blood count also revealed leukopenia (7 cases), thrombocytopenia (10 cases), and pancytopenia (5 cases). The myelogram showed megaloblastosis in all the cases and sideroblasts in one. A brain MRI was performed on five patients, and it showed abnormalities in three cases. The etiological investigations revealed a vitamin B12 deficiency secondary to a maternal Biermer's disease (6 cases), malnutrition (3 cases), Imerslund's disease (3 cases), congenital deficiency in transcobalamin II (3 cases), Biermer's disease (1 case), giardiasis (1 case), folic acid deficiency secondary to a poor dietary intake (1 case), mitochondrial cytopathy with vitamin B12-Folic acid deficiency (1 case), and Pearson syndrome (1 case). Our treatment included symptomatic measures, replacement therapy, and etiological treatment. Favorable evolution was noted in 11 cases. Five patients had neurological sequelae, and one patient died. Our study highlights the rarity and heterogeneity of the etiological contexts of MA in children. Early diagnosis and therapeutic support can improve the long-term neurological prognosis.

Lettuce fortification through vitamin B12-producing bacteria - proof of concept study.

Vitamin B12 (cobalamin) can be produced de novo only by certain bacteria and archaea. It plays a crucial role in the health of animals and humans, which obtain it only through diet, mainly from animal products. This study aimed to identify endophytic bacterial strains capable of synthesizing vitamin B12 and enriching edible plants with it as a potential solution for vitamin B12 deficiency in vegetarians, vegans, and people with poor diets. An in silico genome analysis was performed on 66 bacterial genomes, including the reference strain Pseudomonas denitrificans ATCC 13867, a known vitamin B12 producer. The genomes were analyzed using the Rapid Annotations using Subsystems Technology (RAST) server and the MetaCyc database to verify the presence and completeness of the vitamin B12 metabolic pathway. The ability of the strains to produce vitamin B12 was confirmed with a high-performance liquid chromatography with diode-array detection (HPLC-DAD) analysis of pure culture extracts. Eleven strains produced detectable amounts of vitamin B12 under tested conditions. The best performing candidates were further tested for their efficacy in producing vitamin B12 in lettuce grown under sterile conditions on Murashige and Skoog (MS) medium with or without CoCl2 supplementation. Methylobacterium sp. strain P1-11 produced detectable amounts of vitamin B12 in planta: 1.654 and 2.559 μg per g of dry weight without and with CoCl2 supplementation, respectively. This is the first time a bacterial endophyte was used to produce vitamin B12 in planta, suggesting that bacterial endophytes could be utilized to enhance the nutraceutical values of plant-based foods. © 2025 The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Differential diagnosis in immune checkpoint inhibitors neurotoxicity.

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. 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. 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. Neurologic symptoms seen in patients receiving ICI may include other causes beyond immunotoxicity.

Exploring the Intricate Connection Between Vitamin B12 Deficiency and Hearing Loss: A Systematic Literature Review.

Background: Vitamin B12 is an essential nutrient crucial for overall health, and deficiencies can lead to hearing loss. Objective: The aim of the systematic review was to explore the intricate connection between vitamin B12 deficiency and hearing loss using a systematic literature review. Methods: A systematic literature search was carried out to identify the articles exploring the connection between vitamin B12 deficiency and hearing loss. Electronic databases such as PubMed, Scopus, and Cochrane databases were used to identify the relevant studies. Results: A total of 612 studies were identified from 3 databases, and after stepwise screening, 9 articles were found eligible for the data extraction and inclusion in the review. Most of the studies had observed statistically-significant differences in the hearing thresholds with low vitamin B12 levels. However, few studies found hearing loss in the low frequencies (250 and 500 Hz), and others have found elevated thresholds above 4 KHz. Factors such as age, gender, and treatment for vitamin B12 did not show any significant changes in the hearing thresholds. Conclusion: The systematic review revealed that individuals with lower vitamin B12 levels tended to have a higher prevalence of hearing impairment than those with normal or elevated levels. Vitamin B12 deficiency, coupled with high homocysteine levels and low folate concentrations, may contribute to different degrees of hearing loss, particularly in the elderly. Lower serum levels of vitamin B12 have been associated with slight to mild hearing loss, while cochlear dysfunction and poorer hearing thresholds have also been observed in individuals with vitamin B12 deficiency. These findings highlight the importance of maintaining optimal levels of vitamin B12 for preserving hearing health and warrant further investigation into potential interventions.

Management of thrombocytopenia detected in occupational health examinations: A review article

Introduction: The accidental discovery of thrombocytopenia is a medical challenge and may be of little clinical importance or indicate a serious disease affecting the hematopoietic system. In this article, we have discussed how to manage incidental isolated thrombocytopenia identified during occupational health examinations. Materials and Methods: In this study, to effectively address the thrombocytopenia found accidentally in screening tests, researchers searched reliable databases such as Scopus, PubMed, Google Scholar, and others. Results: In general, thrombocytopenia may result from a decrease in platelet production, an increase in platelet consumption, or an increase in platelet separation from the circulatory system. In dealing with thrombocytopenia, a thorough history, physical examination, and targeted laboratory tests can identify patients who need immediate intervention. Common causes of thrombocytopenia include false thrombocytopenia, drug use, congenital thrombocytopenia, chronic liver disease, distributed thrombocytopenia, concurrent deficiency of folic acid and vitamin B12, immune thrombocytopenia purpura, thrombotic thrombocytopenic purpura, viral infections, and systemic autoimmune disorders. Additionally, assessing the risk of bleeding in these individuals should be considered. Conclusion: Thrombocytopenia discovered in screening tests is a relatively common finding and has numerous underlying causes. A systematic approach is required to identify its underlying causes. Knowing the list of common benign causes of isolated thrombocytopenia and the alarm symptoms of this disorder can help an occupational health specialist identify high-risk people and take the necessary measures.

Proximal Gastrectomy Is Associated with Lower Incidence of Anemia and Vitamin B12 Deficiency Compared to Total Gastrectomy in Patients with Upper Gastric Cancer.

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. 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. 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. 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.

Unclear symptoms, early diagnosis and perfect outcome: a case diagnosed as sepiapterin reductase deficiency hidden behind vitamin B12 deficiency

Abstract Objectives 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. Case presentation 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. Conclusions 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.

Unraveling of Multifactorial Etiology and Risk Factors of Severe Anemia HB ≤ 6 g/dL

Background: Anemia is an alarming worldwide health condition affecting individuals from modernized and countries that underdeveloped, with significant implications for human health and socio-economic development. Aims: This research aimed to find the primary risk factors linked with severe anemia (HB ≤ 6 g/dL) and assess the relative contribution of different factors, including nutritional status, chronic diseases, infections, and genetic factors. Methodology: A cross-sectional study investigated the fundamental causes and risk factors of disease anemia (HB≤ 6 g/dL). The following study was conducted at the Abbas Institute of Medical Sciences, Muzaffarabad AJK Pakistan. The data was collected through a nonprobability purposive sampling technique. Multivariate analysis was applied using logistic regression to identify specific risk factors for severe anemia. Results: The mean age of the patients was 34.2 years (SD 10.8), with 60% from low socioeconomic status. The mean iron level was 30.4 (SD 12.5) and the mean vitamin B12 level was 190.3 pg/mL (SD 2.3). 46.7% had a history of chronic diseases, with 20.0% having type 2 diabetes and 13.3% having renal diseases. 26.7% were suffering from infections. Chronic disease history significantly increases the risk (OR 2.50, p=0.004). Conclusion: The study population had low hemoglobin and iron levels, with a high proportion of patients having chronic diseases. Severe anemia was significantly associated with low iron levels and Vitamin B12 deficiency, chronic diseases, and infections, increasing the risk of severe anemia

A Study of Vitamin B12 Deficiency in Type-II Diabetic Patients on Metformin Therapy in Eastern Reason of Nepal

Background Diabetes mellitus, a metabolic disorder marked by elevated blood glucose level, requires effective management to prevent complications. Metformin, a common frontline treatment for type -II diabetes, is linked to Vitamin B12 deficiency, which may trigger severe health disorders like anemia and neurological problems if remain undiagnosed for a longer duration. This study aims to assess the prevalence of Vitamin B12 deficiency among type 2 diabetic patients on metformin therapy. The objective is to assess the distribution of patients affected by this deficiency and understand how metformin therapy influences B12 levels among these patients. The Study was conducted at B&amp;C Medical College Teaching Hospital and Research Center, Birtamod, Jhapa, Nepal. Methods A total of 200 diabetes patients on metformin were included in the study. Patients were included if they were diagnosed with type -II diabetes, were currently undergoing metformin therapy, and had been on the medication for at least 6 months. Data collected comprised patient age, gender, duration of metformin use, and serum vitamin B12 levels measured using chemiluminescence immunoassay (CLIA). Vitamin B12 deficiency was defined as serum levels &lt;200 pg/mL, insufficiency as 200-300 pg/mL, and sufficiency as &gt;300 pg/mL. Statistical analysis involved descriptive statistics and Chi-square tests. Results Out of the 200 diabetic patients taking metformin, 45% exhibited Vitamin B12 deficiency based on serum levels (&lt;200 pg/mL), 30% had insufficient Vitamin B12 levels (200–300 pg/mL), and 25% had sufficient levels (&gt;300 pg/mL) Deficiency rates were similar across genders but higher in patients over 47 years. A significant correlation was observed between longer metformin use and lower Vitamin B12 levels. Conclusion The results highlight a prominent rate of Vitamin B12 deficiency among diabetes patients prescribed metformin, especially in older patients and those on long-term therapy. Routine monitoring of vitamin B12 levels is recommended for these patients to prevent serious complications and improve health outcomes

Effect of Vitamin B12 Deficiency on Thyroid Function Tests Among Adults Visiting Tertiary Health Care Centre in Eastern Nepal

Background Vitamin B12 deficiency is commonly observed in hypothyroidism and autoimmune thyroiditis. Low vitamin B12 can disrupt thyroid function. Though the prevalence of this deficiency has been documented in various regions of Nepal, studies in Eastern Nepal are limited. The objective of this study was to assess the percentage distribution of vitamin B12 deficiency among adults visiting the tertiary health care centre in Eastern Nepal and to find out the effect of vitamin B12 deficiency on thyroid function test. Methods This study, conducted at Nobel Medical College from January 2022 to December 2023, was cross-sectional in design and included 379 patients. Subjects underwent general health check-ups, including Vitamin B12 and thyroid function tests. Descriptive analysis was performed, and Pearson’s correlation assessed the relationship between vitamin B12 levels and thyroid hormones. Independent t-tests compared hormone levels between groups. P value &lt; 0.05 was considered as statistically significant. Results The vitamin B12 status distribution was as follows: 62.5% normal (&gt;300pg/ml), 18.2% borderline deficient (200-300pg/ml), and 19.3% deficient (&lt;200pg/ml). Prevalence was higher among females. Group II subjects (vitamin B12 &lt;300pg/dl) had significantly lower mean free triiodothyronine (FT3) levels (2.82±0.742 vs. 3.14±0.49 pg/mL, p=0.003) and higher mean thyroid stimulating hormone (TSH) levels (4.69±3.56 vs. 2.55±1.47 mIU/L, p&lt;0.001) compared to group I (B12 &gt;300pg/ml). Vitamin B12 showed a negative correlation with TSH (p=0.013). Conclusion The study indicates a decrease in FT3 levels and an increase in TSH levels among those with vitamin B12 deficiency or borderline cases

Clinical and Haematological evaluation of Nutritional anemias in Pediatric age group (1–14 years) in correlation with Biochemical studies

Introduction - Anemia is a major health problem worldwide more importantly in India, mostly in rural areas. It is one of the leading causes of morbidity and mortality in pediatric age group. The term ‘Nutritional anaemia” encompasses all pathological conditions in which the blood haemoglobin concentration drops to an abnormally low level, due to deficiency in one or several nutrients. Iron deficiency is the most common cause of nutritional anaemia worldwide. Folic acid deficiency and vitamin B12 deficiency are less widespread . It is important to know the clinical manifestations andhaematological changes in children with nutritional anaemia to define the correct management approach. Aims and objectives -1)To study the causes of nutritional anaemia in children 2)Clinical &amp; haematological evaluation of nutritional anaemia in correlation with biochemical studies in children. Materials and methods – A 2 years prospective study was done on 100 children with anemia in the department of pathology, Chalmeda Anand Rao Institute of Medical Sciences for a period of 2years from January 2022 to December 2023.

Clinical and Hematological Characteristics of Vitamin B12 Deficiency and Evaluation of the Therapeutic Response to Vitamin B12 Supplementation.

Background Vitamin B12 deficiency, or cobalamin deficiency, is common among populations with low consumption of animal-based products, mainly in India, due to religious and socioeconomic factors, which significantly increase the deficiency rate. The condition has been characterized by a wide range of clinical and hematological symptoms, mainly affecting the blood and nervous system. This study aims to assess the clinical and hematological characteristics of patients with vitamin B12 deficiency and assess the therapeutic response to supplementation with vitamin B12. Methodology This two-year, in-hospital study was conducted at K. J. Somaiya Medical College and Hospital. The study involved 180 patients aged between 18 and 70 years with hemoglobin below 13 g/dL for males, less than 12 g/dL for females, and serum vitamin B12 levels below 250 pg/mL. Data on demographic and clinical characteristics of the patients, along with hematological parameters, including complete blood count, peripheral smear, reticulocyte count, and bone marrow examination, were collected. Each patient received six intramuscular injections per week of 1,000 µg of vitamin B12. The hematological parameters were measured at different follow-up intervals, and the therapeutic response was measured using the one-way analysis of variance. We employed Pearson's correlation coefficient to investigate the relationship between the severity of anemia and vitamin B12 level. Results The study showed a higher prevalence of male patients, accounting for 105 (58.3%) of the sample, with the majority of patients aged between 46 and 60 years, totaling 70 (38.9%). Common comorbidities included hypertension in 60 (33.3%) and diabetes in 45 (25%) patients. The most frequently reported symptom was fatigue, present in 120 (66.7%) patients, followed by neurological symptoms such as tingling and numbness in the extremities reported by 98 (54.4%) patients. Baseline hematological assessments indicated macrocytic anemia, with a mean hemoglobin level of 9.7 g/dL and an elevated mean corpuscular volume (MCV) of 104.7 fL. At the end of six weeks of vitamin B12 therapy, there were notable improvements, with hemoglobin levels rising to 12.6 g/dL, MCV decreasing to 91.3 fL, and reticulocyte count increasing to 2.1%. A strong positive correlation was observed between hemoglobin levels and serum vitamin B12 concentrations (r = 0.75, p < 0.001). Conclusions Vitamin B12 deficiency leads to clinical and hematological abnormalities, including macrocytic anemia and neurological symptoms. This study demonstrates that vitamin B12 supplementation effectively reverses these abnormalities, improving both hematological and neurological outcomes. Given the prevalence of deficiency, routine screening and supplementation are recommended, particularly for at-risk populations such as vegetarians and older adults. Further research is needed to assess the long-term effects of supplementation, particularly its potential role in reducing cardiovascular risk in individuals with vitamin B12 deficiency.

Dizziness and unstable gait in the older adults are associated with vestibular hypofunction, muscle dysfunction and sleep disturbance: impact on prevention of accidental falls

BackgroundDizziness 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.MethodsWe 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.ResultsAverage 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.ConclusionDizziness 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.