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Perspectives on Peripheral Neuropathy as a Consequence of Metformin-Induced VitaminB12Deficiency in T2DM Peripheral neuropathy (PN) is a primary complication of type 2 diabetes mellitus (T2DM) and a direct manifestation of vitaminB12deficiency. Examining the effects of metformin use on PN status became imperative following clinical studies that showed the vitaminB12-lowering effect of the medication. The complexity of the topic and the inconsistency of the results warrant consideration
Pseudothrombotic microangiopathy and vitaminB12deficiency in pernicious anemia VitaminB12deficiency may present as pseudothrombotic microangiopathy. Pseudothrombotic microangiopathy is anemia, thrombocytopenia, and schistocytosis caused by vitaminB12deficiency. Pseudothrombotic microangiopathy may be mistaken for microangiopathic hemolytic anemia, confounding appropriate treatment. Evaluation of lactate dehydrogenase, reticulocyte count, bilirubin, and platelet count are most helpful (...) in differentiating pseudothrombotic microangiopathy from a true microangiopathic hemolytic anemia. A case of pseudothrombotic microangiopathy due to severe vitaminB12deficiency is presented.
Neuropsychiatric and neurological problems among VitaminB12deficient young vegetarians To assess the frequency of neuropsychiatric and neurological problems in apparently healthy young vegetarians and estimate serum VitaminB12, methylmalonic acid (MMA), and folic acid levels.This prospective study was conducted in the Department of Biochemistry, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan, in the years of 2012 and 2013. The data (...) % in the omnivore (p=0.002), paresthesias were 11% compared with 3% in the omnivores (p=0.04), peripheral neuropathy was 9% compared with 2% in the omnivores (p=0.05), psychosis was found in 11% subjects compared with 3% in the omnivores (p=0.04).Vegetarians have VitaminB12deficiency and are more prone to developing neuropsychiatric and neurological problems.
Long-term Metformin Use and VitaminB12Deficiency in the Diabetes Prevention Program Outcomes Study. VitaminB12deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use.To assess the risk of B12deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS).Secondary analysis from the DPP/DPPOS. Participants were assigned to the placebo group (PLA) (n = 1082) or the metformin group (MET) (n = 1073) for 3.2 years (...) % confidence interval, 1.06–1.20). Anemia prevalence was higher in MET, but did not differ by B12 status. Neuropathy prevalence was higher in MET with low B12 levels.Long-term use of metformin in DPPOS was associated with biochemical B12deficiency and anemia. Routine testing of vitaminB12 levels in metformin-treated patients should be considered.
Investigation of the vitaminB12deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin The relationship between vitaminB12deficiency and peripheral neuropathy has been shown in a number of previous studies. Metformin is the indispensable first-line treatment for type 2 diabetes mellitus (DM) worldwide. One of the adverse effects of the use of metformin is vitaminB12deficiency. In the present study, we investigated the relationship between (...) vitaminB12deficiency and peripheral neuropathy due to the use of metformin.Patient's laboratory and electromyography (EMG) data were retrospectively reviewed. Patients with no EMG report and other necessary information were excluded from the study.Eighty-six patients with type 2 DM using metformin were included in the study. Of these patients, 26 were males and 60 were females. The mean age of the patients was 55.1±7.7 years. The mean body mass index of the patients was 29.1±9.01 kg/m2. The mean
Rapid Onset of B12Deficiency in the Setting of Worsening Multiple Myeloma: Correlations between B12Deficiency and Multiple Myeloma A 67-year-old female with a relapse of multiple myeloma after being in remission for approximately 2 years following autologous stem cell transplant presented with worsening pancytopenia, over a three-month period. There were an increase in her monoclonal spike at 3.13 g/dL on serum protein electrophoresis, low serum B12 levels, and positive intrinsic factor (...) antibodies. Three months before, she had normal B12 levels and a significantly lower monoclonal spike of 1.07 g/dL. She was diagnosed with B12deficiency with pernicious anaemia in the setting of her worsening myeloma. Multiple myeloma (MM) has been linked with B12deficiency and pernicious anaemia. Several mechanisms have been described regarding the pathogenesis of B12deficiency in such patients. Increased tumour activity can further perpetuate the development of B12deficiency in such patients
Impact of baseline vitaminB12 status on the effect of vitaminB12 supplementation on neurologic function in older people: secondary analysis of data from the OPEN randomised controlled trial. The available evidence from randomised controlled trials suggests that vitaminB12 supplementation does not improve neurologic function in older people with marginal but not deficientVitaminB12 status. This secondary analysis used data from the Older People and Enhanced Neurological function (OPEN (...) ) randomised controlled trial to assess whether baseline vitaminB12 status or change in vitaminB12 status over 12 months altered the effectiveness of dietary vitaminB12 supplementation on neurologic function in asymptomatic older people with depleted vitaminB12 status at study entry.Vitamin B12 status was measured as serum concentrations of vitaminB12, holotranscobalamin, homocysteine and via a composite indicator (cB12). Neurological function outcomes included eleven electrophysiological measures
Vitamin D deficiencyVitamin D deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Vitamin D deficiency Last reviewed: February 2019 Last updated: July 2018 Summary The most common nutritional deficiency worldwide, characterised by serum 25-hydroxyvitamin D <50 nanomol/L (<20 nanograms/mL). Vitamin D insufficiency is regarded as a serum 25-hydroxyvitamin D level between 52 and 72 nanomol/L (21 and 29 nanograms (...) /mL). Main causes include sun avoidance, using sun protection, increased skin pigmentation, inadequate dietary and supplemental vitamin D intake, malabsorption syndromes, obesity, and medication use. Acquired and inherited disorders that either reduce or prevent the metabolism of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D also present with biochemical and skeletal abnormalities seen with vitamin D deficiency, but in a more severe form. Most patients are asymptomatic. Severe, prolonged vitamin
Vitamin B3 deficiencyVitamin B3 deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Vitamin B3 deficiency Last reviewed: February 2019 Last updated: January 2018 Summary Traditionally caused by consuming a diet mainly composed of corn and maize. Severe deficiency leads to pellagra, which is characterised by dermatitis, dementia, diarrhoea, and eventually death. Lean meat, poultry, fish, and peanuts are rich (...) in vitamin B3 (niacin); milk and eggs are rich sources of tryptophan, the precursor of niacin. Deficiency of vitamins B2 (riboflavin) and/or B6 (pyridoxine) reduces the synthesis of niacin from tryptophan and may lead to secondary vitamin B3 deficiency. Rare in developed countries, although there are still outbreaks in Africa, India, and China, particularly in refugees and displaced people. In developed countries, deficiency is most commonly associated with chronic alcohol abuse, GI malabsorption
Vitamin B1 deficiencyVitamin B1 deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Vitamin B1 deficiency Last reviewed: February 2019 Last updated: May 2018 Summary The underlying cause of several clinical syndromes, including Wernicke's encephalopathy, wet beriberi, and dry beriberi, rather than a single clinical condition or diagnosis. Clinical presentation depends on the chronicity of the vitamin B1 (...) (thiamine) deficiency. As signs and symptoms are non-specific, the presence of risk factors raises suspicion of the diagnosis. Risk factors include alcohol dependence, malabsorption, and a diet low in thiamine (e.g., based on polished rice). As there is no rapid diagnostic test for the condition, presumptive treatment should be commenced immediately if vitamin B1 deficiency is suspected. Untreated vitamin B1 deficiency in the form of Wernicke's encephalopathy can result in the need for institutional
Tissue distribution of oral vitaminB12 is influenced by B12 status and B12 form: an experimental study in rats Hydroxocobalamin (HOCbl) is the dominating Cbl form in food, whereas cyanocobalamin (CNCbl) is common in vitamin pills and oral supplements. This study compares single-dose absorption and distribution of oral HO[57Co]Cbl and CN[57Co]Cbl in Cbl-deficient and normal rats.Male Wistar rats (7 weeks) were fed a 14-day diet with (n = 15) or without (n = 15) Cbl. We compared the uptakes (...) of HO[57Co]Cbl (free or bound to bovine transcobalamin) and free CN[57Co]Cbl administered by gastric gavage (n = 5 in each diet group). Rats were sacrificed after 24 h. Blood, liver, kidney, brain, heart, spleen, intestines, skeletal muscle, 24-h urine and faeces were collected, and the content of [57Co]Cbl was measured. Endogenous Cbl in tissues and plasma was analysed by routine methods.Mean endogenous plasma-Cbl was sevenfold lower in deficient vs. normal rats (190 vs. 1330 pmol/L, p < 0.0001
Anaemia - B12 and folate deficiency Anaemia - B12 and folate deficiency - NICE CKS Share Anaemia - B12 and folate deficiency: Summary Deficiency of vitaminB12 or folate are the most common causes of megaloblastic anaemia. Megaloblastic anaemia is characterized by the development of larger than normal red blood cells (macrocytosis), with immature nuclei due to defective DNA synthesis. This results in red cells with a mean cell volume (MCV) above the normal range (greater than 100 femtolitres (...) ). Pernicious anaemia (an autoimmune disorder which results in reduced production of intrinsic factor) is the most common cause of severe vitaminB12deficiency in the UK. Other causes of vitaminB12deficiency are rare, but include: Drugs — colchicine, metformin, nitrous oxide, protein pump inhibitors, H2-receptor antagonists. Gastric causes — total or partial gastrectomy, congenital intrinsic factor deficiency or abnormality, Zollinger-Ellison syndrome. Inherited — intrinsic factor receptor deficiency
An update on vitaminB12-related gene polymorphisms and B12 status VitaminB12 is an essential micronutrient in humans needed for health maintenance. Deficiency of vitaminB12 has been linked to dietary, environmental and genetic factors. Evidence for the genetic basis of vitaminB12 status is poorly understood. However, advancements in genomic techniques have increased the knowledge-base of the genetics of vitaminB12 status. Based on the candidate gene and genome-wide association (GWA (...) ) studies, associations between genetic loci in several genes involved in vitaminB12 metabolism have been identified.The objective of this literature review was to identify and discuss reports of associations between single-nucleotide polymorphisms (SNPs) in vitaminB12 pathway genes and their influence on the circulating levels of vitaminB12.Relevant articles were obtained through a literature search on PubMed through to May 2017. An article was included if it examined an association of a SNP
Consequences of Inadequate Intakes of Vitamin A, VitaminB12, Vitamin D, Calcium, Iron, and Folate in Older Persons This review broadly discusses the consequences of inadequate consumption, by deficit or excess, of selected micronutrients on the quality of life and morbidity during aging, specifically considering increases in life expectancy and the costs of care in the older persons.A literature review of the periods 2012 to 2018, focusing on vitamins A, B12, and D, calcium, iron and folate (...) , was completed as these micronutrients are found to significantly affect the aging process. Causation and application of these micronutrients to disorders related to aging are controversial and mixed. This review highlights research needs and controversial points on the role of these micronutrients.Micronutrient deficiencies are a common and avoidable contributor to decreased quality of life and healthcare costs in the older persons. Further research is needed to determine adequate intakes and innovative
risk should be further elucidated. Controversies are explained by heterogeneity of methodologies used for the diagnosis of vitaminB12 and also by differences among populations investigated on the studies.A real effect of vitaminB12deficiency in bone health and the mechanisms associated with bone metabolism is not well established yet. It is extremely important to carry out more clarifying studies about this theme, especially with vulnerable groups such as postmenopausal and elderly women (...) VitaminB12, bone mineral density and fracture risk in adults: A systematic review. To consolidate information available on the effect of vitaminB12 on bone mineral density and fracture risk, with emphasis on clinical trials, observational and longitudinal data conducted in humans.A systematic review of the literature of the past decade on the role of vitaminB12 in bone mineral density and fracture risk in subjects of all ages and both sexes was performed by means of a PubMed, Science Direct
Vitamin C deficiencyVitamin C deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Vitamin C deficiency Last reviewed: February 2019 Last updated: December 2017 Summary Scurvy is a rare disorder, with epidemics typically affecting populations subject to famine or displacement during wartime. Most key clinical manifestations are related to impaired collagen synthesis. These include bleeding complications (...) (spontaneous petechiae and ecchymoses), friable gingiva and loose teeth, bone pain, and joint effusions. Other complications include heart failure, encephalopathy, and entrapment neuropathies. If not treated promptly, scurvy can be fatal. Complete recovery is anticipated in most patients. Definition Scurvy is a life-threatening condition due to dietary vitamin C deficiency. Those affected are mostly refugees or victims of famine, alcoholics, older people, fad dieters, or children with autism