Vitamin B12 Deficiency Research Articles

The correlation between vitamin B12 serum levels and migraine: a case-control study

ABSTRACT Objectives Migraine represents the prevailing form of primary headache with no fully described etiology and pathophysiology. This study aimed to assess the association between vitamin B12 serum levels and both chronic and episodic migraine. Patients and methods This study was conducted as a case-control study, including 90 migraineurs, divided into 48 with episodic migraine and 42 with chronic migraine as the case group, and 90 matched healthy participants as the control group. The serum level of vitamin B12 was measured using enzyme-linked immunosorbent assay (ELISA) for all subjects. Its association with the Migraine Disability Assessment (MIDAS) scale and migraine attack severity, measured using the Visual Analog Scale (VAS), was analyzed. Results Migraineurs exhibited a notable reduction in serum vitamin B12 levels compared to the control group (243.97 ± 124.85 pg/ml vs. 302.69 ± 143.69 pg/ml, p = 0.014). Furthermore, chronic migraine patients had significantly lower serum vitamin B12 levels when compared to episodic migraine patients (202.7 ± 75.62 pg/ml vs. 269.17 ± 143.31 pg/ml, p = 0.026). A significant negative correlation was found between serum vitamin B12 levels and the severity of migraine attacks, as measured by the VAS (r = -0.407, p = 0.036). Conclusion The current study highlighted that vitamin B12 deficiency is highly associated with migraine and its severity. Further interventional research is highly recommended to investigate the potential causality of this association.

Evaluating the research parameters available on the Sysmex® XN-series hematology analyzers as markers of dysplasia in peripheral blood

Abstract Objectives Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by peripheral blood cytopenias, cellular dysplasia and risk for progression into acute leukemia. Recent studies reveal that some research parameters available on Sysmex XN-1000® hematology analyzers, including immature platelet fraction (IPF), Neutrophil Granularity Index (Neu-GI), or platelet distribution width (PDW), show a relationship with dysplasia in peripheral blood. The objective of this study was to examine the association between classic and research blood count parameters and the presence of dysplasia. The secondary objective was to develop a multivariate model that allows the prediction of dysplasia with high probability. Methods Seventy-five patients older than 60 years with anemia, leukopenia or thrombocytopenia, without vitamin B12 and folate deficiency or hematological diseases underwent testing with the Sysmex XN-1000 analyzer. Results Dysplasia was confirmed in 32 % of patients, with significant differences in Neu-GI, PDW and IPF count between the groups of patients with and without dysplasia. Neu-GI was the parameter with the highest predictive value (AUC=0.98), with such value not increasing significantly after the addition of PDW or PIF. A Neu-GI value≤146ch predicts dysplasia with a positive predictive value=90 %. Conclusions Neu-GI is the parameter most strongly associated with dysplasia. A Neu-GI value≤146ch indicates a high probability of dysplasia and supports indication for a blood smear review. Additionally, values>152ch indicate a low probability of dysplasia.

The Association between Vitamin B12 Deficiency and Metformin Therapy in Libyan Diabetic Patients

Metformin is the first line treatment of diabetic hyperglycaemia. However, numerous studies have shown that long-term use of metformin can result in a vitamin B12 deficiency. In this study, we sought to assess the prevalence of vitamin B12 deficiency in diabetic patients taking metformin on a long-term basis as well as the association between vitamin B12 deficiency and diabetic neuropathy. Across sectional study was conducted on 143 Libyan diabetic patients attending endocrinology outpatient diabetic centre in Benghazi, who are on metformin for at least 6 months, and eligible to the inclusion criteria. Data on metformin intake and confounding variables were collected from questionnaires. Serum vitamin B12 levels were estimated, and vitamin B12 deficiency was defined as serum B12 less than 196pg/ml. Data analysis was performed using the statistical package for social sciences (SPSS) version 28. The study involved 143 patients, with a majority being women (50.3%) and men (49.7%). The mean duration of diabetes was 10.52 ± 7.260 years. The mean daily dose of metformin was 1435.42 ± 377.766 mg for females and 1495.77 ± 392.678 mg for males. The mean duration of metformin intake was 7.93 ± 5.859 years for females and 7.34 ± 5.780 years for males. The mean serum vitamin B12 level was 469.78 ± 233.477 pg/mL, with males having non-significantly higher levels than females. 59.2% of male patients had vitamin B12 levels ≤420 pg/mL, while 51.4% of female patients had levels ≤420 pg/mL. Nevertheless, no patient had a vitamin B12 deficit. No significant correlation was observed between serum vitamin B12 levels with metformin dose, duration of action, or patient characteristics. Despite the high prevalence of peripheral neuropathy (36.4%), there was no significant difference in B12 levels between patients with and without neuropathy.

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.

Association Between Homocysteine Levels and Risk of Depression in Office Workers With Vegan Diet in Jakarta

Depression is a significant global public health concern, and the rising prevalence of vegan diets is currently linked to an increased risk of depression in adults. One contributing factor may be vitamin B12 deficiency in vegans, which can elevate homocysteine levels. This study aims to examine the relationship between homocysteine levels and depression risk among vegan office workers in Jakarta. The research employs a quantitative, cross-sectional design. The population consists of all vegan office workers in Jakarta, with a sample of 58 respondents selected through purposive sampling. Data collection involved interviews, anthropometric measurements, and laboratory tests. The data were analyzed using univariate and bivariate analyses via SPSS version 20. The findings revealed that the average plasma homocysteine level in participants was 3.48 μg/L, considered low. The average PHQ-9 score was 4.75, indicating no depression or moderate depression. Bivariate analysis showed no significant association between homocysteine levels and depression risk, with a p-value of 0.412, suggesting no correlation between homocysteine levels and depression risk in vegan office workers in Jakarta

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.

Like mother like daughter, the role of low human capital in intergenerational cycles of disadvantage: the Pune Maternal Nutrition Study.

Maternal nutrition promotes maternal and child health. However, most interventions to address undernutrition are only implemented once pregnancy is known, and cannot address broader risk factors preceding conception. Poverty and socio-economic status are considered systemic risk factors, but both economic growth and cash transfers have had limited success improving undernutrition. Another generic risk factor is low human capital, referring to inadequate skills, knowledge and autonomy, and represented by traits such as low educational attainment and women's early marriage. Few studies have evaluated whether maternal human and socio-economic capital at conception are independently associated with maternal and offspring outcomes. Using data on 651 mother-child dyads from the prospective Pune Maternal Nutrition Study in rural India, composite markers were generated of "maternal human capital" using maternal marriage age and maternal and husband's education, and 'socio-economic capital' using household wealth and caste. Linear and logistic regression models investigated associations of maternal low/mid human capital, relative to high capital, with her own nutrition and offspring size at birth, postnatal growth, education, age at marriage and reproduction, and cardiometabolic risk at 18 years. Models controlled for socio-economic capital, maternal age and parity. Independent of socio-economic capital, and relative to high maternal human capital, low human capital was associated with shorter maternal stature, lower adiposity and folate deficiency but higher vitamin B12 status. In offspring, low maternal human capital was reflected in shorter gestation, smaller birth head girth, being breastfed for longer, poor postnatal growth, less schooling, lower fat mass and insulin secretion at 18 years. Daughters married and had children at an early age. Separating maternal human and socio-economic capital is important for identifying the aspects which are most relevant for future interventions. Low maternal human capital, independent of socio-economic capital, was a systemic risk factor contributing to an intergenerational cycle of disadvantage, perpetuated through undernutrition, low education and daughters' early marriage and reproduction. Future interventions should target maternal and child human capital. Increasing education and delaying girls' marriage may lead to sustained intergenerational improvements across Sustainable Development Goals 1 to 5, relating to poverty, hunger, health, education and gender equality.

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.

Chronic Benign Tubular Albuminuria From Compound Heterozygous Variants in CUBN: A Case Report

Rationale: Albuminuria is a commonly used parameter for predicting decline in kidney filtration function. Cubilin, encoded by CUBN, is a critical protein involved in protein reabsorption in the proximal tubule. Mutations in CUBN lead to Imerslund-Gräsbeck syndrome (IGS), a disorder characterized by vitamin B12 deficiency (and consequences related to that) with or without albuminuria. Recent evidence suggests that C-terminal variants in CUBN may lead to albuminuria without other features of IGS. Presenting concerns of the patient: Here, we report a case of a 52-year-old male with chronic, albumin-predominant, subnephrotic range proteinuria since his teenage years, but preserved estimated glomerular filtration rate (eGFR). Interventions: Neither angiotensin-converting enzyme (ACE) inhibition nor angiotensin Type II (AT-II) receptor blockade reduced his degree of albuminuria. Diagnosis: Genetic testing identified 3 distinct pathogenic variants in CUBN that were confirmed by segregation analysis to be a compound heterozygous mode of inheritance. All variants were downstream of the intrinsic factor-vitamin B12 binding domain of cubilin. The patient had normal vitamin B12 levels and did not exhibit any features of IGS. Outcomes: Kidney biopsy was not pursued for this patient as diagnostic clarification was achieved by non-invasive genetic testing alone. Novel findings: This case highlights several important lessons. First, not all albuminuria is made equal, and forms of tubular albuminuria can exist without compromising kidney filtration function. Second, identifying genetic forms of tubular albuminuria is key to avoiding ineffective interventions (eg, ACE inhibition, AT-II receptor blockade, sodium-glucose cotransporter-2 [SGLT2] inhibition) and unnecessary invasive procedures (eg, kidney biopsy). Third, the location of CUBN variants dictates phenotypic consequences, with C-terminal variants leading to albuminuria without vitamin B12 deficiency.

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.

Audiological Profile in Patients with Tinnitus accompanied with Vitamin B12 Deficiency

Audiological Profile in Patients with Tinnitus accompanied with Vitamin B12 Deficiency