Frequency Of Vitamin B12 Deficiency Research Articles

Vitamin B12 Deficiency among Cases of Helicobacter Pylori Gastritis: A Cross Sectional Study

Background: Helicobacter pylori (H. pylori) is a gram-negative bacterium associated with various gastrointestinal diseases, including peptic ulcer disease, gastric cancer, and vitamin B12 deficiency. Recent research has highlighted a potential link between chronic H. pylori infection and significant malabsorption of vitamin B12, particularly in populations with high prevalence rates of infection. Objective: This study aims to investigate the frequency of vitamin B12 deficiency among patients with H. pylori gastritis and to explore the association between H. pylori infection and vitamin B12 levels. Methods: A cross-sectional study was conducted from September 2023 to March 2024 at the Department of Medicine, Ayub Teaching Hospital, Abbottabad. A total of 120 patients presenting with symptoms of gastritis were enrolled after obtaining ethical approval from the hospital’s review board. Exclusion criteria included patients already on vitamin B12 supplementation. Diagnostic testing for H. pylori was performed using stool antigen tests, and vitamin B12 levels were assessed through serum measurements. Data analysis was conducted using IBM SPSS Statistics version 23, with the Chi Square test applied to examine the association between H. pylori infection and vitamin B12 deficiency, setting the level of significance at p ≤ 0.05. Results: Out of the 120 patients studied, 49 (40.8%) tested positive for H. pylori. Vitamin B12 deficiency was observed in 35 (29.2%) patients. Among those infected with H. pylori, 51.0% (25 patients) also had vitamin B12 deficiency, compared to 14.1% (10 patients) among those not infected (p = 0.0001). Conclusion: The findings indicate a significant association between H. pylori infection and vitamin B12 deficiency. This study suggests that H. pylori is a potential risk factor for vitamin B12 deficiency, underscoring the need for screening and appropriate management of H. pylori in patients presenting with vitamin B12 deficiency.

Serum Vitamin B12 Deficiency in Chronic Hemodialysis Patients.

Introduction Essential vitamins like folate and vitamin B12 are crucial for many physiological functions. Patients with renal failure undergoing regular hemodialysis in the general population may experience harmful effects from vitamin B12 deficits. Therefore, this study aimed to determine the frequency of vitamin B12 deficiency in hemodialysis patients and its association with other clinical parameters. Methods This cross-sectional study was conducted at the dialysis unit of Patel Hospital and Lifeline Hospital, Karachi, using a non-probability consecutive sampling technique after obtaining ethical approval from Lifeline Hospital (LLH/HR/02-22). The study duration was sixmonths, from January 10, 2023, to July 22, 2023. A total of 135 adult renal failure patients with ages >18 and <70 yearson maintenance hemodialysis for >1 year were included in the study. The chi-square testwas usedto determine the association between vitamin B12 deficiency and age and gender. A p-value of 0.05 was considered statistically significant. Results The study findings showed that out of 135 patients, 82 (60.7%) were males and 53 (39.3%) were females, with a mean age of 50.80 ± 10.03 years. The duration of hemodialysis was approximately 1-2 years in 98 (72.6%) patients, 2-3 years in 27 (20.0%) patients, and 3-4 years in only 9 (6.7%) patients. The mean serum vitamin B-12 levels were 411.61 ± 224.95 pg/ml, with 30 (22.2%) of the subjects being deficient. In terms of duration of hemodialysis, there was a significant association (p= 0.013). Between patients withnormal4 (4%) and deficient 5 (17%) vitamin B12 and 3-4 years of hemodialysis. Conclusion In this study, we found that a significant proportion of patients on chronic hemodialysis had vitamin B12 deficiency. Moreover, vitamin B12 deficiency was significantly associated with duration of hemodialysis. Therefore, we recommend periodic vitamin B12 testing in hemodialysis patients to avoid any associated complications.

Risk of Anemia and Vitamin B12 Deficiency in Patients with Type 2 Diabetes Mellitus on Metformin Therapy: A Systematic Review and Meta-Analysis

Introduction Metformin is a commonly used medication for the treatment of Type 2 Diabetes Mellitus (T2DM). It has also been hypothesized to reduce the absorption of vitamin B12 in the GI tract. Development of B12 deficiency due to metformin-associated reduced absorption would take years to develop, because vitamin B12 has sufficient stores for 3-10 years. As such, the present systematic review and meta-analysis aims to evaluate the effect of metformin on anemia and vitamin B12 deficiency, with outcomes stratified by duration and dosage of metformin exposure. Methods Electronic searches were conducted on MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to June 2023, supplemented with manual citation search. Two reviewers independently and in duplicate assessed titles, abstracts, and full-text articles, with discrepancies resolved by a third member. Studies considered for inclusion were randomized controlled trials (RCTs) and non-randomized studies (NRS) in any language, evaluating anemia risk in T2DM patients using metformin compared to standard-of-care non-metformin treatments for T2DM . The primary outcome was frequency of anemia. Secondary outcomes included frequency of vitamin B12 deficiency, changes in serum hemoglobin and vitamin B12 levels, folate deficiency, changes in serum folic acid, and homocysteine levels. Results were stratified based on the Metformin Use Index (MUI), which categorizes daily metformin dose in mg x duration in years/1000 into three subgroups: MUI ≤ 5, MUI &amp;gt; 5, and MUI Unspecified (when the primary study did not report or stratify based on metformin dosage and duration). Mantel-Haenszel random effects model was used to synthesize binary and continuous endpoints, providing odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Results 7443 studies were retrieved from electronic databases and 26 studies comprising 6 RCTs, and 20 NRS were included. In total, 17343 patients were included in this systematic review. Overall, the risk of anemia did not significantly differ between the metformin and control group (OR 1.10 [95%CI 0.64, 1.91]). Subgroup analysis also revealed no significant differences between metformin and control in the MUI ≤ 5 group (OR 1.58 [95%CI 0.54, 4.58]) and the MUI &amp;gt; 5 group (OR 1.12 [95%CI 0.48, 2.65]). Metformin was associated with an increased risk of vitamin B12 deficiency compared to control (OR 2.32 [95%CI 1.51, 3.57]). Subgroup analysis demonstrated that the difference was only significant in the MUI &amp;gt; 5 (OR 3.57 [95%CI 2.98, 4.27]) and the MUI Unspecified groups (OR 2.24 [95%CI 1.48, 3.38]), but not in the MUI ≤ 5 group (OR 1.01 [95%CI 0.83, 1.23]). The subgroup differences were significant (p&amp;lt;0.01). Metformin was associated with a decrease in serum vitamin B12 level (MD -71.55 pmol/L [95%CI -89.27, -53.82]), and change in serum hemoglobin could not be pooled given only one primary study. Serum homocysteine was higher in the metformin group (MD 2.45 µmol/L [95%CI 1.48, 3.41]), and there were no significant differences between metformin and control in both incidence of folate deficiency and change in serum folic acid. Conclusion Metformin use does not appear to increase the risk of anemia compared to placebo or other standard-of-care treatments in T2DM. Vitamin B12 deficiency is associated with metformin use, however likely only in those with longer/greater-dose (metformin use index &amp;gt; 5). Monitoring and supplementation of vitamin B12 level are likely beneficial in this population. Our study is limited by heterogenous criteria for anemia and vitamin B12 deficiency across jurisdictions. Further studies on the safety profile of metformin are recommended to include anemia as an outcome and result-stratification based on metformin dose and duration.

Prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin, a cross-sectional study in primary healthcare.

Several studies documented that metformin use contributes to vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM). However, there has been a lack of data assessing this issue in Jordan. Assess the vitamin B12 serum levels, frequency of vitamin B12 deficiency, and related factors among Jordanian patients with T2DM patients treated with metformin. a total of 447 subjects attending a primary health care center were included in this cross-sectional study consisting of T2DM patients who use metformin and a control group of non-diabetics. Serum B12 levels were evaluated and B12 deficiency was defined as serum B12 levels ≤ 200 pmol/L. Associations of B12 serum levels or B12 deficiency with other factors like gender, age, and duration of T2DM were analyzed. There was no significant difference in serum B12 levels nor the frequency of vitamin B12 deficiency between T2DM metformin-treated patients and control groups. Among metformin-treated patients there was no difference relating to age, type 2 diabetes mellitus duration, proton pump inhibitors use, and metformin use (duration, dose) between patients with or without B12 deficiency. The prevalence of vitamin B12 deficiency among T2DM patients on metformin treatment in this study was high (48.9%). However, the treatment with metformin and the dose of metformin use was not associated with vitamin B12 deficiency.

Vitamin B12 deficiency in turkish patients with Type 2 Diabetes Mellitus

Objective: Type 2 diabetes (T2DM) disease and related changes in blood parameters bring essential health risks. This study was carried out to determine the frequency of vitamin B12 deficiency in T2DM patients, the effect of B12 deficiency on blood glucose, HbA1c control and lipid parameters, and the B12 level in diabetes patients using metformin. Material and Methods: 287 patients with T2DM who were followed up in the Endocrinology department of Istanbul Training and Research Hospital were evaluated. After the patients called for control had fasted for 8 hours, blood tests were performed, and biochemical parameters were determined with standard laboratory techniques. Vitamin B12 &lt;180 mg/dl was accepted as a deficiency, and patients were divided into groups regarding vitamin B12 deficiency. The chemiluminescence method was used to determine serum Vitamin B12 levels. Data were analyzed using SPSS version 22.0 (IBM Corporation, Armonk, NY, USA). Results: A total of 287 T2DM patients were included in the study. B12 deficiency is present in 29.8% of T2DM patients. Vitamin B12 values were found to be lower in patients with T2DM using metformin (280.2 pg /ml ±151.06 pg/ml, p&lt;0.05); however, lower vitamin B12 values did not have a significant effect on blood sugar control (p=0,3), and hypovitaminosis Vitamin B12 was associated with elevated hypertriglyceridemia (p=0,03). Conclusion: According to the current study, serum vitamin B12 level was not associated with blood glucose and HbA1c; a relationship was found between vitamin B12 deficiency and higher hypertriglyceridemia. A significant proportion of T2DM patients using metformin had lower levels of vitamin B12 compared to T2DM patients not using metformin. Vitamin B12 levels should be monitored regularly in the follow-up of patients with T2DM using metformin.

VITAMIN B12 DEFICIENCY IN CONTINUOUS METFORMIN TREATMENT

As we know type 2 diabetes is a global disease with many complications. The long-term treatment with metformin as a first line of therapy has been proven to cause low levels of cobalamin /vit. B12/. The main purpose of this analysis is to show the frequency of vitamin B12 deficiency among patients treated with biguanides. The RSNC/regional non-profit association/ “Diabetes Care” in Burgas conducted the study. Patients on metformin treatment for 5 to 10 years were included in it. From January to September 2022 was the period when all the data was collected. Information on the duration of metformin treatment was collected through an anamnesis. All patients were tested for vitamin B12 levels and the average value was found to be &lt; 145 pmol/L - according to certified laboratory reference values - from 145 to 569 pmol/l. All participants in this study had laboratory evidence of anemia and were deficient in this vitamin . Vitamin B12 deficiency is preventable and these data show us the need of regular screening in patients on long-term treatment with metformin. This will allow the identification of patients with vitamin deficiency and the addition of treatment with it or/and discontinuation of metformin treatment.

Is vitamin B12 deficiency a risk factor for gastroparesis in patients with type 2 diabetes?

BackgroundDiabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was hypothesized to be implicated in the development of diabetic gastroparesis. This study was conducted to explore the possible association between vitamin B12 deficiency and gastroparesis in patients with type 2 diabetes (T2D).MethodsA total of 100 T2D patients with diabetes duration > 10 years and 50 healthy controls matched for age and sex were recruited for this study. T2D patients were divided into 2 groups: patients with gastroparesis and patients without gastroparesis. The diagnosis of gastroparesis was based on Gastroparesis Cardinal Symptom Index (GCSI) Score ≥ 1.9 and ultrasonographic findings including gastric emptying ˂ 35.67% and motility index ˂ 5.1. Anthropometric measurements, plasma glucose, glycosylated hemoglobin (HbA1c), lipids profile, vitamin B12 and transabdominal ultrasonography were assessed.ResultsThe frequency of vitamin B12 deficiency in total patients with T2D was 35% (54.5% in patients with gastroparesis vs. 11.1% in patients without gastroparesis, P < 0. 001). Vitamin B12 level was negatively correlated with GCSI Score whereas, it was positively correlated with gastric emptying and motility index. Vitamin B12 deficiency was an independent predictor for gastroparesis in patients with T2D; it predicts gastroparesis at a cut off value of 189.5 pmol/L with 69.1% sensitivity and 64.4% specificity, P = 0.002.ConclusionsBeside the known risk factors of diabetic gastroparesis, vitamin B12 deficiency is an independent predictor of diabetic gastroparesis in patients with T2D.

Vitamin B12 levels in thyroid disorders: A systematic review and meta-analysis.

Numerous studies have found an association between vitamin deficiency and thyroid disorders (TD). The presence of anti-parietal cell antibodies is indicative of reduced ability to absorb vitamin B12. Thus, this study reviewed the existing studies with the objective of assessing differences in the serum levels of vitamin B12 among patients with and without TD, the frequency of vitamin B12 deficiency in patients with TD, and the presence of anti-parietal cell antibodies in patients with TD. A meta-analysis of random-effects model was conducted to calculate pooled frequencies, mean differences (MD), and their respective 95% confidence intervals (CI). We identified 64 studies that met our inclusion criteria (n = 28597). We found that patients with hypothyroidism had lower vitamin B12 levels than healthy participants (MD: -60.67 pg/mL; 95% CI: -107.31 to -14.03 pg/mL; p = 0.01). No significant differences in vitamin B12 levels were observed between healthy participants and patients with hyperthyroidism (p = 0.78), autoimmune thyroid disease (AITD) (p = 0.22), or subclinical hypothyroidism (SH) (p = 0.79). The frequencies of vitamin B12 deficiency among patients with hypothyroidism, hyperthyroidism, SH, and AITD were 27%, 6%, 27%, and 18%, respectively. Patients with hypothyroidism had lower levels of vitamin B12 than healthy participants. No significant differences were observed between vitamin B12 levels and hyperthyroidism, AITD, or SH. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324422, identifier (CRD42022324422).

Frequency of Vitamin B12 Deficiency in patients of Pancytopenia

Background: Vitamin B12 insufficiency is prevalent in developing nations. It often causes megaloblasticanemia, but it may also impact the other two cell lines, i.e. platelets and leukocytes (pancytopenia), and may be misdiagnosed as cancer or bone marrow failure. A therapeutic test may be performed, providing a prompt diagnosis and preventing a high death rate. Aim To find frequency of vitamin B12 deficiency in children having pancytopenia. Methodology: This cross sectional study was done at Children's Hospital &amp;The Institute of Child Health Lahore in 6 months. This study involved 242 children of 6 months to 14 years age of both genders admitted in Children Hospital Lahore and had pancytopenia on their CBC. Results: The age of the patients ranged from 6 months to 14 years with a mean of 6.4±2.8 years. There were 111(45.9%) male and 131 (54.9%) female patients with a male to female ratio of 1:1.2. A total of 6.2% patients were found to have B12 deficiency. Conclusion: It is concluded that, 6.2% of patients with pancytopenia had a deficiency of B12; thus, patients may be routinely evaluated for pancytopenia and its reasons, since many of them are entirely curable and others are managed. Keywords: Vitamin B12 deficiency, cobalamin, Pancytopenia, Megaloblastic

Vitamin B12 Status in Long-Term Metformin Treated Type 2 Diabetes Mellitus Patients

Background: The association between long-term use of metformin and low vitamin B12 levels in patients with type 2 diabetes mellitus (T2DM) has been proven. However, the prevalence among metformin induced vitamin B12 deficiency in T2DM patients showed considerable variations among the studies. The potential of deficiency to cause new onset or worse preexisting peripheral neuropathy in T2DM patients has been investigated with conflicting results.The objective of this study is to determine the frequency of vitamin B12 deficiency among patients with T2DM patients on metformin therapy compared to those who are not taking metformin. Methods: This crosssectional analytical study was conducted at the Department of Medicine, in Sylhet M. A. G. Osmani Medical College &amp;Hospital, Sylhet. Total 100 patients’ withT2DM were selected according to inclusion and exclusion criteria following informed written consent. They were divided into two groups; each groups contains 50 patients. Group-I included patients who were taking metformin for e”1 year and Group-II included patients who were not taking metformin for at least 1 year. Detailed history taking, proper clinical examinations and relevant investigations were done. After collection of all the required data, final analysis was carried out by using the SPSS version 22.0. Results: Among 100 patients of T2DM, mean age were 55.4±15.62 and 55.24±16.76 years, respectively among Group- I and Group-II. They were similar in terms of demographic profile. About 16.0% patients of group- I had vitamin B 12 deficiency and 6.0% had vitamin B 12 deficiency in Group-II. The mean serum Vitamin B 12 was 481.52±283.37 (pgm/mL) in group-I and 600.85±294.2 (pgm/mL) in group-II. The difference of serum Vitamin B 12 was statistically significant (p&lt;0.041) between two groups. Reduced vitamin B 12 also found to be positively associated with duration of metformin intake (p&lt;0.05) and presence of neuropathy (p&lt;0.05). Conclusion: Metformin is significantly associated with decrease the level of vitamin B12. Bangladesh J Medicine 2022; 33: 43-48

Can Vitamin B12 Deficiency Really Cause Vasovagal Syncope? Retrospective Analysis of 469 Pediatric Vasovagal Syncope Cases

Objective: Syncope is a frequent reason for referral to pediatric cardiology clinics. Vitamin B12 deficiency is frequently diagnosed in pediatric patients. In this study, we determined the frequency of vitamin B12 deficiency in pediatric vasovagal syncope (VVS). Methods: This study was designed retrospectively. VVS patients were identified from the hospital registry system with ICD code ‘R55, syncope, and fainting’. The frequency of VVS and vitamin B12 levels of the patients were evaluated. Below 200 ng/L was considered vitamin B12 deficiency. Results: Eight hundred twelve patients were identified with ICD code R55, syncope, and fainting’ in pediatric cardiology hospital records. Two hundred sixteen patients were excluded from the study due to insufficient hospital records. Four hundred and sixty-nine patients were diagnosed with VVS. One hundred and seventy-three patients were excluded from the study because of non-available vitamin B12 level. Ninety-six patients had epileptic sezure/suspected VVS, 28 patients had psychogenic syncope and 3 patients had cardiac syncope. Demographic characteristics, hemoglobin and vitamin B12 levels, and the frequency of vitamin B12 deficiency were similar in the patient and control groups (p&gt;0.05). Two hundred and sixty-four patients had normal vitamin B12 level, whereas 32 patients were diagnosed with vitamin B12 deficiency. Fifty-six patients who had normal vitamin B12 levels experienced frequent VVS and 6 patients with vitamin B12 deficiency experienced frequent VVS (21.2% vs 23.0%, p&gt;0.05). Conclusion: Although VVS can cause serious concern in patients and families, it is unlikely to be a serious underlying disease. Vitamin B12 deficiency was not found at a high rate in this disease as in other studies.

Frequency of Vitamin B12 Deficiency Amongst Elderly Patients Presenting with Dementia

Background: A persistent and chronic illness called dementia is associated with cognitive decline, changes in personality, poor thinking, and problems with executive function. Various studies linked vitamin B12 deficiency with the dementia in elderly patients. Objective: To find out the frequency of vitamin B12 deficiency amongst elderly patients presenting with dementia Methodology: The current study was descriptive cross-sectional carried out at the Medicine Department, Fauji Foundation Hospital, Peshawar Cantt for duration of six months from January 2022 to June 2022. All the data like age, sex and other relevant information were recorded in the pre-designed Performa. IBM SPSS version 23 was used for the statistical analysis of the data. Results: In the current study, totally 250 patients were enrolled. There were 188 (75.2%) males and 62 (24.8%) females with the mean (±SD) age of 81 (±2.99) years. Vitamin B12 deficiency was observed amongst 95 (38%) patients while it was not observed amongst 155 (62%) patients. Based on the stratification of vitamin B12 level in serum with the age and gender, no significant association was observed (p˃0.05). Conclusion: In the current study we observed that the frequency of vitamin B 12 deficiency in elder patients with dementia was 38%. Other studies in multiple centers with large number of dementia should be carried out to get better results. Key words: Vitamin B12 deficiency; Elderly patients; Dementia

Frequency of Vitamin B12 Deficiency in Type 2 Diabetic Patients Taking Metformin.

IntroductionType 2 diabetes mellitus (DM) is a prevalent global health problem and is on a constant rise, especially in middle- and low-income countries. Vitamin B12 malabsorption is one of the reported side effects of metformin. Our study aims to assess the correlation of B12 deficiency in type 2 diabetics using metformin for their treatment.MethodsThis case-control study was conducted in a tertiary care hospital in Pakistan from February 2021 to December 2021. Patients (n=100) with a documented diagnosis of type 2 DM on metformin monotherapy for a minimum of six months were enrolled via consecutive convenient non-probability sampling. Another 100 patients without a history of diabetes were included in the study as a control group for comparison.ResultsSerum vitamin B-12 levels were higher in the non-diabetic participants as compared to the diabetic group (301.71 ± 72.12 vs. 189.25 ± 31.22; p-value: <0.0001). Hypovitaminosis was more significant in the diabetic group (p-value: 0.0000). Serum vitamin B12 levels were found to be declining with the increasing duration of metformin use (p-value: <0.0001).ConclusionOur study found a significant effect of vitamin B12 deficiency in metformin-treated patients. Therefore, it is prudent to recognize B12 deficiency as a potential side effect of long-term use of metformin. A periodic screening of B12 in such patients and subsequent supplementation of vitamin B12 is an effective and safe means of prevention of development or worsening of peripheral nerve damage and other clinical manifestations.

Dyslipidemia and atherogenic index of plasma in gestational diabetes mellitus with vitamin B12 deficiency.

Objective: To determine frequency of vitamin B12 deficiency and dyslipidemia and calculate atherogenic index of plasma (AIP) in Gestational Diabetes mellitus (GDM). Study Design: Observational study. Setting: Department of Biochemistry, Liaquat University Jamshoro. Period: January 2018 to December 2019. Material &amp; Methods: 216 cases of GDM were selected by inclusion criteria. Venous blood sampling collected blood sample that were centrifuged to get sera. Glucose, vitamin B12, and blood lipids were estimated by standard methods. Atherogenic Index of Plasma (AIP) was calculated as log TAG/HDLc ratio. Data was analysed by SPSS 21.0 ver. at 95% CI (P≤0.05). Results: Vitamin B12 deficiency and Dyslipidemia were noted in 151 (69.9%) and 165 (23.61%) of GDM cases respectively (P=0.0001). Vitamin B12 was found low as 156.62±82.9 ng/mL. TC (244.07±49.11), TAGs (699.4±249.5), and LDLc (137.9±40.84) were found high and HDLc (33.13±5.71) was low. High and medium risk AIP was noted in 17 (7.87%) and 29 (13.4%) of GDM cases (P=0.0001). Vitamin B12 proved negative TC (r= -0.25, P=0.02), TAG (r= -0.23, P=0.02), LDLc (r= -0.79, P=0.0001) and positive correlation with HDLc (r= 0.76, P=0.0001). Conclusion: Vitamin B12 deficiency and Dyslipidemia were noted in 151 (69.9%) and 165 (23.61%) of GDM cases respectively. High and medium risk AIP was noted in 17 (7.87%) and 29 (13.4%) of GDM cases.

Investigation of Vitamin B12 Deficiency in Patients with Acute Coronary Syndrome and its Relationship with Gensini Score.

Vitamin B12 deficiency is not an independent risk factor for cardiovascular disease. However, anemia due to vitamin B12 deficiency and also hyperhomocysteinemia are among the cardiovascular risk factors. The study aimed to determine the frequency of vitamin B12 deficiency in patients with acute coronary syndrome. We also aimed to ascertain whether there is a significant difference between obstructive coronary artery disease presence and its severity in patients with and without vitamin B12 deficiency using the Gensini score. Patients who underwent coronary angiography due to acute coronary syndrome between June 1, 2018, and November 30, 2019, and whose vitamin B12 levels were measured were retrospectively analyzed. Coronary angiography results of the patients were evaluated with the Gensini scoring system. Anemia was observed in 32.6% (n = 135) of the patients who underwent coronary angiography with a diagnosis of acute coronary syndrome, and vitamin B12 deficiency was observed in 14.7% (n = 61). The median age was 69 years in anemic patients and 68 years in those with Vitamin B12 deficiency and was significantly higher than patients without anemia and vitamin B12 deficiency (p < 0.001 and p = 0.038, respectively). There was no statistically significant differences between the patients' Gensini scores with or without Vitamin B12 deficiency (p = 0.554). We concluded that anemia and vitamin B12 deficiency were higher in elderly patients with acute coronary syndrome. We found no significant difference when the Gensini score was used to evaluate obstructive coronary artery disease presence and its severity according to anemia and vitamin B12 deficiency. Investigating vitamin B12 levels in elderly patients with acute coronary syndrome should not be ignored.

Frequency of Vitamin B12 Deficiency in Pregnant Women with Gestational Diabetes Mellitus

Objective: To determine the prevalence of vitamin B-12 deficiency in pregnant women with gestational diabetes mellitus. Study Design: Retrospective study Place and Duration of Study: Department of Medicine, OMC Hospital, Jail Road Lahore from January, 2020 to December, 2020. Methods: Two hundred and thirty pregnant females were enrolled age between 18-45 years. Detailed demographics of enrolled cases age, gestational age, gravidity and body mass index were recorded after taking informed written consent. Among 230 cases, 100 women were non GDM (group I) and 130 had gestational diabetes mellitus (group II). Blood samples were taken from all the patients for measuring vitamin B12 status. Vitamin B12 was defined as &lt;300 pg/ml. Results: Mean age of the patients in group I was 31.64±7.45 years with mean BMI 25.88±8.65 kg/m2 while mean age among GDM group was 34.55±5.71 years with mean BMI 27.36±9.44 kg/m2. Mean gestational age in group I was 33.72±4.21 weeks and in group II 35.08±9.27 weeks. In group I 20 (20%) had vitamin B12 deficiency and in group II rate ofvitamin B12 deficiency was high among 90 (69.2%) cases. We found a significantly relation between vitamin B12 and GDM with p value &lt;0.0007. Conclusion: The prevalence of vitamin B-12 deficiency among pregnant women of gestational diabetes mellitus was significantly high as compared to normal pregnant women. Keywords: Pregnant Women, Gestational Diabetes Mellitus, Vitamin B12 deficiency

Genel Pediatri Polikliniği Vakalarında B12 Vitamini Eksikliği

Objective: This study aims to determine the frequency of vitamin B12 deficiency in children and how it varies according to age groups. Vitamin B12 is an essential vitamin that has an important role in nucleic acid synthesis, erythrocyte maturation, and nervous system development. Vitamin B12 deficiency commonly causes anemia. However, severe deficiency in children can cause permanent neurological damage. Therefore, early detection and treatment of vitamin B12 deficiency make it possible to prevent its permanent effects. In addition, determining the age groups at risk allows early diagnosis. Material and Method: The study included children aged 0-18 years admitted to anambulatory pediatric outpatient clinic. Serum vitamin B12 values of children were examined. Vitamin B12 levels below 200 pg/mL were considered a deficiency and between 200-300 pg/mL a marginal level. Descriptive methods, Chi-square, and Independent Samples T-Test were used in the statistical analysis of the data. Results: The study evaluated data from 3115 children. 49.6% of the participants were girls, and 50.4% were boys. The mean age was 8.2±5.4 years. The mean serum vitamin B12 level was 436 ± 174 pg/mL. This mean was 442±172 pg/mL in girls and 431±177 pg/mL in boys. Mean vitamin B12 levels did not differ by gender. The frequency of serum vitamin B12 deficiency was 4.1%. However, it was significantly higher in boys than in girls (5.2%-3.0%). The frequency of marginal level was 18.4%. The frequency of vitamin B12 deficiency differed according to age groups. Serum vitamin B12 deficiency was seen at the highest rate between 0-6 months, with 11%. This rate was 7.1% in the 6-24-month group. Conclusion: This study showed the frequency of serum vitamin B12 deficiency in children admitted to anambulatory pediatric outpatient clinic and in certain age groups. In addition, it was seen that vitamin B12 deficiency was common, especially in infancy and adolescence. However, multicenter prospective studies are needed to determine the prevalence and causes of deficiency in a wide area.

Association of Vitamin B-12 Deficiency with use of metformin in diabetic patients.

Objective: To find out the frequency of vitamin B12 deficiency in patients with type II diabetes mellitus using metformin. Methodology: Ninety two patients were involved after getting informed consent. This cross – sectional study was done at department of Medicine, Nishtar Hospital, Multan. HbA1 c, body mass index and blood pressure and deficiency for vitamin B12 was assessed by using electro-chem-iluminescence immunoassay method. B12 levels were categorized as normal (&gt;220pg/ml), possibly deficient (150 to 220 pg/ml) and definitely deficient (&lt;150pg/ml). Neuropathy was assessed and was classified by using Toronto clinical scoring system by the researcher himself. All the data was subjected to statistical analysis using computer software SPSS version 23. Continuous variables were analyzed by their mean and standard deviation while quantitative variables were analyzed by frequency and percentages. Chi square test was applied and P value less than or equal to 0.05 was taken as significant. Results: Mean Serum B-12 levels were 378.42±161.27 pg/ml and 488.90±147.02 pg/ml in metformin and non-metformin groups, respectively. The difference was statistically significant (p=0.001). The patients who were possibly deficient and definitely deficient were 15 (28.30%) and 5 (9.43%) in metformin group and were significantly more (p=0.006) than non-metformin group i.e. 4 (10.26%) and 0. The mean Toronto Neuropathy Score was statistically different (p&lt;0.001) between metformin group (6.03±1.73) and non-metformin group (4.13±1.75). The patients who had mild neuropathy and moderate neuropathy were 23 (43.39%) and 5 (9.43%) in metformin group, while 6 (15.38%) and 2 (5.13%) in non-metformin group. Statistically, both the groups were significantly different (p=0.005). Conclusion: At the end of this study conclusion can be made that metformin use for type II diabetes mellitus is strongly associated with vitamin B12 deficiency and worsening of already susceptible neuropathy. Keywords: vitamin B12, Type II diabetes mellitus, neuropathy. DOI: 10.7176/JMPB/68-06 Publication date: December 30 th 2020

Vitamin B12 Deficiency in Newborns and their Mothers\u2014Novel Approaches to Early Detection, Treatment and Prevention of a Global Health Issue

SummaryVitamin B12 deficiency, mostly of maternal origin in newborns, is a well treatable condition but can cause severe neurologic sequelae. In women of childbearing age and pregnant women worldwide vitamin B12 deficiency has been reported with frequencies of 10%–50%. Children with vitamin B12 deficiency are asymptomatic at birth but may develop severe multisystemic symptoms, including irreversible developmental impairment in the second half-year of life. Early detection of vitamin B12 deficiency allows for presymptomatic treatment. This article provides an overview over the function of vitamin B12 and discusses causes and frequency of vitamin B12 deficiency in newborns, infants, and women of childbearing age. It describes novel successful approaches to newborn screening (NBS) for vitamin B12 deficiency and results of a pilot study which performed systematic NBS for vitamin B12 deficiency using so-called second-tier strategies by measuring homocysteine and methylmalonic acid in dried blood spots. Recommendations for diagnostics in mothers of children with vitamin B12 deficiency are described as well as results of systematic work-up in mothers and treatment and follow-up of children with vitamin B12 deficiency detected by NBS. Treatment options of vitamin B12 deficiency are presented including a newly developed standardized supplementation scheme with exclusively oral vitamin B12 supplementation. Recommendations for preventive approaches to vitamin B12 deficiency for children and mothers are stated. Many children worldwide could benefit from systematic inclusion of vitamin B12 deficiency into NBS panels. In addition, preventive approaches to maternal vitamin B12 deficiency should be implemented systematically during maternal care.

The frequency of vitamin B12 deficiency and the neurologic complications caused by N2O exposure in operating room among the staff of Shahid Beheshti Hospital of Isfahan in 2017-2018

Background: The purpose of this study was to determine the level of vitamin B12 among personnel working in the operating room of Shahid Beheshti Hospital in Isfahan. Methods: This study was conducted on 51 personnels of Shahid Beheshti Hospital operating room. First, demographic information of the participants was obtained. Then blood samples were acquired for determining the level of vitamin B12 and subsequently, a neurologist examined the health status of the participants’ nervous system. Results: Low levels of vitamin B12 were reported in 25 participants, and 26 participants had normal levels of vitamin B12. The participants were divided into two groups: vitamin B12 deficiency group and normal vitamin B12 group. There were no significant differences between the two groups regarding age, work experience, working hours per day, working days per week and neurological examinations (P > 0.05). Anesthesiology technicians were at a higher risk for vitamin B12 deficiency compared to the surgical technologists, nurses and practical nurses (P < 0.001). In all occupations, the results showing normal examinations were more than impaired examinations, but these differences were not significant (P > 0.05). Conclusion: Vitamin B12 deficiency is observed in a significant proportion of individuals in the study, and anesthesiology technicians have lower levels of vitamin B12 than other operating room personnel. There was no significant association between reduced vitamin B12 levels and neurologic complications in this study.