RESUMEN
OBJECTIVES: Transcobalamin II (TC) promotes the cellular uptake of cobalamin (Cbl) through receptor-mediated endocytosis of the TC-cbl complex in peripheral tissues. TC deficiency is a rare disorder that causes intracellular Cbl depletion. It presents in early infancy with a failure to thrive, diarrhea, anemia, agammaglobulinemia, and pancytopenia. Data from five TC-deficient patients including clinical, biochemical, and molecular findings, as well as long-term outcomes, were collected. CASE PRESENTATION: Mutation analysis revealed one unreported pathogenic variant in the TCN2 gene. One patient had exocrine pancreatic insufficiency. We conducted a retrospective analysis of C3 and C3/C2 from dried blood samples, as this is implemented for newborn screening (NBS). We detected a marked increase in the C3/C2 ratio in two samples. Treatment was based on parenteral Cbl. Three patients treated before six months of age had an initial favorable outcome, whereas the two treated later or inadequately had neurological impairment. CONCLUSIONS: This is the first report of Argentinean patients with TC deficiency that detected a new variant in TCN2. NBS may be a tool for the early detection of TC deficiency. This data emphasizes that TC deficiency is a severe disorder that requires early detection and long-term, aggressive therapy. Accurate diagnosis is imperative, because early detection and treatment can be life-saving.
Asunto(s)
Errores Innatos del Metabolismo de los Aminoácidos , Anemia Macrocítica , Deficiencia de Vitamina B 12 , Recién Nacido , Humanos , Vitamina B 12/uso terapéutico , Transcobalaminas/genética , Estudios Retrospectivos , Deficiencia de Vitamina B 12/diagnóstico , Deficiencia de Vitamina B 12/tratamiento farmacológico , Deficiencia de Vitamina B 12/genética , Errores Innatos del Metabolismo de los Aminoácidos/tratamiento farmacológico , Diagnóstico PrecozRESUMEN
Vitamin B12 (B12) is necessary for the proper functioning of the central and peripheral nervous systems. Although there is no exact definition for B12 levels, a value of 200 pg/mL is compatible with deficiency, 200-299 pg/mL is considered borderline, and 300 pg/mL is considered normal. In population studies, the prevalence of B12 deficiency ranges between 2.9% and 35%. Furthermore, many medications, such as metformin [for type 2 diabetes mellitus (T2DM)], can cause B12 deficiency. The objectives of this study were to determine the population status of B12 in southwestern Colombia (and the status of B12 in subjects with T2DM). In the total population (participants with and without T2DM), the prevalence of B12 deficiency was 17.8%; that of borderline was 19.3%; and that of normal levels was 62.9%. The prevalence of deficiency increased with age and was significantly higher in those aged ≥60 years (p = 0.000). In T2DM subjects, the prevalence of deficiency was significantly higher concerning those without T2DM (p = 0.002) and was significantly higher in those who received >1 gm/day of metformin (p = 0.001). Thus, the prevalence of deficiency and borderline levels of B12 in our population was high, particularly in those >60 years of age. B12 deficiency was significantly higher in individuals with T2DM than in individuals without T2DM, especially among those receiving high doses of metformin.
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Diabetes Mellitus Tipo 2 , Metformina , Deficiencia de Vitamina B 12 , Humanos , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Vitamina B 12/uso terapéutico , Hipoglucemiantes/uso terapéutico , Colombia/epidemiología , Deficiencia de Vitamina B 12/epidemiología , Deficiencia de Vitamina B 12/tratamiento farmacológico , Metformina/uso terapéuticoRESUMEN
OBJECTIVE: Vitamin B12 deficiency can be seen in the cases with sleeve gastrectomy. Because the chief factor in vitamin B12 deficiency is gastric atrophy, we aimed to evaluate the effect of atrophy on postoperative vitamin B12 levels in patients who underwent sleeve gastrectomy. MATERIAL AND METHODS: Sixty patients were included in this study. Vitamin B12 levels were compared with presence of atrophy before the operation and after vitamin B12 supplementation. RESULTS: Atrophy was observed in 37 (61.7%) of the cases; 23 (38.3%) patients had no atrophy. There was a statistically significant difference between the presence of atrophy and vitamin B12 levels (p = 0.024). Despite vitamin B12 support, there were statistically significant low vitamin B12 levels after the operation in female patients having atrophy (p = 0.023). The same significance was not observed in males (p = 0.480). CONCLUSION: Vitamin B12 deficiency following obesity surgery is a condition that must be monitored and prevented. We found that histopathologically confirmed atrophy had an adverse effect on postoperative vitamin B12 levels. These findings can be a guide for the clinicians in the management of these cases.
OBJETIVO: La deficiencia de vitamina B12 se puede observar en los casos de gastrectomía en manga. Debido a que el factor principal en la deficiencia de vitamina B12 es la atrofia gástrica, nuestro objetivo fue evaluar el efecto de la atrofia en los niveles posoperatorios de vitamina B12 en pacientes que se sometieron a gastrectomía en manga. MATERIAL Y MÉTODOS: se incluyeron 60 pacientes en este estudio. Los niveles de vitamina B12 se compararon con la presencia de atrofia antes de la operación y después de la suplementación con vitamina B12. RESULTADOS: Se observó atrofia en 37(61.7%) de los casos; 23 (38.3%) pacientes no presentaron atrofia. Hubo una diferencia estadísticamente significativa entre la presencia de atrofia y los niveles de vitamina B12 (p = 0.024). A pesar del apoyo de vitamina B12, hubo niveles bajos de vitamina B12 estadísticamente significativos después de la operación en pacientes femeninas con atrofia (p = 0.023). No se observó la misma significación en los hombres (p = 0.480). CONCLUSIONES: La deficiencia de vitamina B12 luego de una cirugía de obesidad es una condición que debe ser monitoreada y prevenida. Encontramos que la atrofia confirmada histopatológicamente tuvo un efecto adverso sobre los niveles posoperatorios de vitamina B12. Estos hallazgos pueden ser una guía para los médicos en el manejo de estos casos.
Asunto(s)
Obesidad Mórbida , Deficiencia de Vitamina B 12 , Atrofia , Suplementos Dietéticos , Femenino , Gastrectomía , Humanos , Masculino , Obesidad Mórbida/cirugía , Vitamina B 12 , Deficiencia de Vitamina B 12/tratamiento farmacológico , Deficiencia de Vitamina B 12/etiologíaRESUMEN
Vitamins are organic compounds present in low concentrations in food, performing vital and specific cell metabolism functions. Vitamin B12 is essential for red blood cell formation in the bone marrow and its deficiency is caused, mainly, by gastrointestinal malabsorption. In addition to systemic manifestations, oral signs and symptoms have also been associated to this condition such as glossitis, papillary atrophy, painful erythema areas, burning sensation, dysgeusia, lingual paresthesia and itching. This study aims to report four cases of oral manifestations caused by vitamin B12 deficiency. All patients presented oral mucosa lesions. Vitamin B12 deficiency was diagnosed based in clinical characteristics and complementary exams. Oral supplementation for vitamin B12 deficiency was conducted/realized in three patients, while one patient was treated with parenteral doses. All of them showed partial or total remission of the signs and symptoms.
Asunto(s)
Glositis , Enfermedades de la Lengua , Deficiencia de Vitamina B 12 , Glositis/complicaciones , Glositis/tratamiento farmacológico , Humanos , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/complicaciones , Deficiencia de Vitamina B 12/diagnóstico , Deficiencia de Vitamina B 12/tratamiento farmacológicoRESUMEN
This comprehensive review establishes the role of vitamin B12 as adjunct therapy for viral infections in the treatment and persistent symptoms of COVID-19, focusing on symptoms related to the muscle-gut-brain axis. Vitamin B12 can help balance immune responses to better fight viral infections. Furthermore, data from randomized clinical trials and meta-analysis indicate that vitamin B12 in the forms of methylcobalamin and cyanocobalamin may increase serum vitamin B12 levels, and resulted in decreased serum methylmalonic acid and homocysteine concentrations, and decreased pain intensity, memory loss, and impaired concentration. Among studies, there is much variation in vitamin B12 doses, chemical forms, supplementation time, and administration routes. Larger randomized clinical trials of vitamin B12 supplementation and analysis of markers such as total vitamin B12, holotranscobalamin, total homocysteine and methylmalonic acid, total folic acid, and, if possible, polymorphisms and methylation of genes need to be conducted with people with and without COVID-19 or who have had COVID-19 to facilitate the proper vitamin B12 form to be administered in individual treatment.
Asunto(s)
COVID-19 , Deficiencia de Vitamina B 12 , Eje Cerebro-Intestino , Suplementos Dietéticos , Ácido Fólico , Homocisteína , Humanos , Músculos , SARS-CoV-2 , Vitamina B 12 , Deficiencia de Vitamina B 12/tratamiento farmacológicoRESUMEN
OBJECTIVE: To evaluate the clinical outcomes at age 1.5 ± 0.5 years of infants with vitamin B12 deficiency identified by newborn screening (NBS). STUDY DESIGN: Prospective multicenter observational study on health outcomes of 31 infants with vitamin B12 deficiency identified by NBS. Neurodevelopment was assessed by the Denver Developmental Screening Test. RESULTS: In 285â862 newborns screened between 2016 and 2019, the estimated birth prevalence of vitamin B12 deficiency was 26 in 100â000 newborns, with high seasonal variations (lowest in summer: 8 in 100â000). Infants participating in the outcome study (N = 31) were supplemented with vitamin B12 for a median (range) of 5.9 (1.1-16.2) months. All achieved age-appropriate test results in Denver Developmental Screening Test at age 15 (11-23) months and did not present with symptoms characteristic for vitamin B12 deficiency. Most (81%, n = 25) mothers of affected newborns had a hitherto undiagnosed (functional) vitamin B12 deficiency, and, subsequently, received specific therapy. CONCLUSIONS: Neonatal vitamin B12 deficiency can be screened by NBS, preventing the manifestation of irreversible neurologic symptoms and the recurrence of vitamin B12 deficiency in future pregnancies through adequate treatment of affected newborns and their mothers. The high frequency of mothers with migrant background having a newborn with vitamin B12 deficiency highlights the need for improved prenatal care.
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Deficiencia de Vitamina B 12 , Vitamina B 12 , Adolescente , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Tamizaje Neonatal , Evaluación de Resultado en la Atención de Salud , Embarazo , Estudios Prospectivos , Deficiencia de Vitamina B 12/diagnóstico , Deficiencia de Vitamina B 12/tratamiento farmacológico , Deficiencia de Vitamina B 12/epidemiología , VitaminasRESUMEN
Abstract Background: In most countries, contrary to some disadvantages, such as pain, relatively higher cost, and poor adherence to treatment, intramuscular (IM) route is still the primary treatment method for Vitamin B12 (VB12) deficiency. In recent years, because of these difficulties, new treatment methods are being sought for VB12 deficiency. Objectives: We aimed to compare sublingual (SL) and IM routes of VB12 administration in children with VB12 deficiency and to compare the efficacy of methylcobalamin and cyanocobalamin therapy in these children. Methods: This retrospective study comprised 129 patients with VB12 deficiency (serum Vitamin 12 level ≤ 200 pg/mL) aged 5-18 years. Based on the formulations of Vitamin 12, we divided the patients into three treatment groups as IM cyanocobalamin, SL cyanocobalamin, and SL methylcobalamin. Results: After Vitamin 12 therapy, serum Vitamin 12 levels increased significantly in all patients, and there was a statistically significant difference between the treatment groups (p < 0.05). Conclusions: SL cyanocobalamin and methylcobalamin were found as effective as IM cyanocobalamin for children with Vitamin 12 deficiency in correcting serum Vitamin 12 level and hematologic abnormalities.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Vitamina B 12/administración & dosificación , Vitamina B 12/análogos & derivados , Complejo Vitamínico B/administración & dosificación , Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Administración Sublingual , Estudios Retrospectivos , Inyecciones IntramuscularesRESUMEN
BACKGROUND: In most countries, contrary to some disadvantages, such as pain, relatively higher cost, and poor adherence to treatment, intramuscular (IM) route is still the primary treatment method for Vitamin B12 (VB12) deficiency. In recent years, because of these difficulties, new treatment methods are being sought for VB12 deficiency. OBJECTIVES: We aimed to compare sublingual (SL) and IM routes of VB12 administration in children with VB12 deficiency and to compare the efficacy of methylcobalamin and cyanocobalamin therapy in these children. METHODS: This retrospective study comprised 129 patients with VB12 deficiency (serum Vitamin 12 level ≤ 200 pg/mL) aged 5-18 years. Based on the formulations of Vitamin 12, we divided the patients into three treatment groups as IM cyanocobalamin, SL cyanocobalamin, and SL methylcobalamin. RESULTS: After Vitamin 12 therapy, serum Vitamin 12 levels increased significantly in all patients, and there was a statistically significant difference between the treatment groups (p < 0.05). CONCLUSIONS: SL cyanocobalamin and methylcobalamin were found as effective as IM cyanocobalamin for children with Vitamin 12 deficiency in correcting serum Vitamin 12 level and hematologic abnormalities.
Asunto(s)
Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitamina B 12/análogos & derivados , Vitamina B 12/administración & dosificación , Complejo Vitamínico B/administración & dosificación , Administración Sublingual , Adolescente , Niño , Preescolar , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Estudios Retrospectivos , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/uso terapéuticoRESUMEN
OBJECTIVE: To evaluate a systematic newborn screening (NBS) strategy for vitamin B12 deficiency. STUDY DESIGN: In a prospective single-center NBS study, a systematic screening strategy for vitamin B12 deficiency was developed and evaluated. Tandem-mass spectrometry screening was complemented by 2 second-tier strategies, measuring methylmalonic/3-OH-propionic/methylcitric acid, and homocysteine from dried blood spots. RESULTS: In a cohort of 176â702 children screened over 27 months, 33 children were detected by NBS in whom (maternal) vitamin B12 deficiency was confirmed. Homocysteine was the most sensitive marker for vitamin B12 deficiency, but only combination with a second-tier strategy evaluating methylmalonic acid allowed for detection of all 33 children. Mothers were of various ethnic origins, and 89% adhered to a balanced diet. Treatment in children was performed predominantly by oral vitamin B12 supplementation (84%), and all children remained without clinical symptoms at short-term follow-up. CONCLUSIONS: Vitamin B12 deficiency is a treatable condition but can cause severe neurologic sequelae in infants if untreated. The proposed screening strategy is feasible and effective to identify moderate and severe cases of vitamin B12 deficiency. With an incidence of 1:5355 newborns, vitamin B12 deficiency is more frequent than inborn errors of metabolism included in NBS panels. Treatment of vitamin B12 deficiency is easy, and additional benefits can be achieved for previously undiagnosed affected mothers. This supports inclusion of vitamin B12 deficiency into NBS but also stresses the need for increased awareness of vitamin B12 deficiency in caregivers of pregnant women.
Asunto(s)
Tamizaje Neonatal , Deficiencia de Vitamina B 12/diagnóstico , Algoritmos , Alemania , Humanos , Recién Nacido , Estudios Prospectivos , Salud Pública , Resultado del Tratamiento , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/tratamiento farmacológicoRESUMEN
RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.
ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Estomatitis Aftosa/complicaciones , Deficiencia de Vitamina B 12/tratamiento farmacológico , /tratamiento farmacológico , Enfermedades Carenciales , Deficiencia de Ácido Fólico/tratamiento farmacológicoAsunto(s)
Hiperpigmentación/etiología , Paraparesia/etiología , Deficiencia de Vitamina B 12/complicaciones , Vitamina B 12/administración & dosificación , Niño , Humanos , Hiperpigmentación/diagnóstico , Hiperpigmentación/tratamiento farmacológico , Inyecciones Intramusculares , Imagen por Resonancia Magnética , Masculino , Paraparesia/diagnóstico , Paraparesia/tratamiento farmacológico , Deficiencia de Vitamina B 12/tratamiento farmacológico , Complejo Vitamínico B/administración & dosificaciónRESUMEN
We describe 3 patients with short bowel syndrome who had persistently elevated serum methylmalonic acid (MMA) levels while being treated for vitamin B12 deficiency. Following treatment for presumed small bowel bacterial overgrowth, MMA levels normalized. Among patients with short bowel syndrome, MMA levels may have limited specificity for vitamin B12 deficiency.
Asunto(s)
Síndrome del Asa Ciega/diagnóstico , Ácido Metilmalónico/sangre , Síndrome del Intestino Corto/complicaciones , Deficiencia de Vitamina B 12/diagnóstico , Biomarcadores/sangre , Síndrome del Asa Ciega/sangre , Síndrome del Asa Ciega/etiología , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Síndrome del Intestino Corto/microbiología , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/sangre , Deficiencia de Vitamina B 12/tratamiento farmacológico , Deficiencia de Vitamina B 12/etiología , Complejo Vitamínico B/uso terapéuticoAsunto(s)
Degeneración Combinada Subaguda/diagnóstico por imagen , Deficiencia de Vitamina B 12/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Degeneración Combinada Subaguda/tratamiento farmacológico , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/sangre , Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitaminas/uso terapéuticoRESUMEN
BACKGROUND: It is uncertain whether vitamin B-12 supplementation can improve neurophysiologic function in asymptomatic elderly with low vitamin B-12 status or whether folate status affects responses to vitamin B-12 supplementation. OBJECTIVE: We assessed the effects of a single intramuscular injection of 10 mg vitamin B-12 (which also contained 100 mg vitamin B-6 and 100 mg vitamin B-1) on vitamin B-12 status and neurophysiologic function in elderly community-dwelling Chileans with low serum vitamin B-12 concentrations who were consuming bread fortified with folic acid. DESIGN: A pretreatment and posttreatment study was conducted in 51 participants (median ± SD age: 73 ± 3 y; women: 47%) with serum vitamin B-12 concentrations <120 pmol/L at screening. Vitamin B-12 status was defined by combining vitamin B-12, plasma total homocysteine (tHcy), methylmalonic acid (MMA), and holotranscobalamin into one variable [combined indicator of vitamin B-12 status (cB-12)]. The response to treatment was assessed by measuring cB-12 and neurophysiologic variables at baseline and 4 mo after treatment. RESULTS: Treatment increased serum vitamin B-12, holotranscobalamin, and cB-12 (P < 0.001) and reduced plasma tHcy and serum MMA (P < 0.001). Treatment produced consistent improvements in conduction in myelinated peripheral nerves; the sensory latency of both the left and right sural nerves improved on the basis of faster median conduction times of 3.1 and 3.0 ms and 3.3 and 3.4 ms, respectively (P < 0.0001). A total of 10 sensory potentials were newly observed in sural nerves after treatment. Participants with high serum folate at baseline (above the median, ≥33.9 nmol/L) had less improvement in cB-12 (P < 0.001) than did individuals whose serum folate was less than the median concentration (i.e., with a concentration <33.9 nmol/L). CONCLUSION: Asymptomatic Chilean elderly with poor vitamin B-12 status displayed improved conductivity in myelinated peripheral nerves after vitamin B-12 treatment and an interaction with folate status, which was detected only with the use of cB-12. This trial was registered at www.controlled-trials.com as ISRCTN02694183.
Asunto(s)
Suplementos Dietéticos , Ácido Fólico/sangre , Fibras Nerviosas Mielínicas/efectos de los fármacos , Conducción Nerviosa/efectos de los fármacos , Nervios Periféricos/efectos de los fármacos , Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitamina B 12 , Anciano , Chile , Femenino , Alimentos Fortificados , Homocisteína/sangre , Humanos , Masculino , Ácido Metilmalónico/sangre , Fibras Nerviosas Mielínicas/fisiología , Estado Nutricional , Nervios Periféricos/fisiología , Vitamina B 12/sangre , Vitamina B 12/farmacología , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/sangre , Complejo Vitamínico B/sangre , Complejo Vitamínico B/farmacología , Complejo Vitamínico B/uso terapéuticoAsunto(s)
Melanosis/etiología , Deficiencia de Vitamina B 12/complicaciones , Adulto , Anemia Megaloblástica/tratamiento farmacológico , Anemia Megaloblástica/etiología , Diagnóstico Tardío , Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico Diferencial , Femenino , Gota/complicaciones , Humanos , Hipertensión/complicaciones , Liquen Plano/inducido químicamente , Liquen Plano/diagnóstico , Enfermedades de la Uña/etiología , Inducción de Remisión , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/diagnóstico , Deficiencia de Vitamina B 12/tratamiento farmacológicoRESUMEN
BACKGROUND: Micronutrients are essential to neurocognitive development; yet their role in educational outcomes is unclear. OBJECTIVE: We examined the associations of micronutrient status biomarkers with the risk of grade repetition and rates of school absenteeism in a cohort of school children. METHODS: We recruited 3156 children aged 5-12 y from public schools in Bogota, Colombia. Circulating ferritin, hemoglobin, zinc, vitamin A, and vitamin B-12; erythrocyte folate; and mean corpuscular volume (MCV) were measured in blood samples obtained at the beginning of the year. Absenteeism was recorded weekly during the school year, and grade repetition was determined the next year. Risk ratios for grade repetition and rate ratios for absenteeism were estimated by categories of micronutrient status indicators with use of Poisson regression, adjusting for potential confounders. RESULTS: The risk of grade repetition was 4.9%, and the absenteeism rate was 3.8 d per child-year of observation. Vitamin B-12 deficiency (<148 pmol/L) was associated with an adjusted 2.36-fold greater risk of grade repetition (95% CI: 1.03, 5.41; P = 0.04) compared with plasma concentrations ≥148 pmol/L. Other micronutrients were not related to grade repetition. Vitamin B-12 deficiency was also associated with school absenteeism rates. Compared with children with plasma vitamin B-12 concentrations ≥148 pmol/L, vitamin B-12-deficient children had a 1.89-times higher adjusted rate (95% CI: 1.53, 2.34; P < 0.0001). Anemia was related to a 72% higher rate (95% CI: 48%, 99%; P < 0.0001), whereas every 5-fL difference in MCV was associated with a 7% lower adjusted rate (95% CI: 4%, 10%; P < 0.0001). CONCLUSIONS: Vitamin B-12 deficiency was associated with risk of grade repetition and school absenteeism rates in school children from Bogota, Colombia. The effects of correcting vitamin B-12 deficiency on educational outcomes and neurocognitive development of school children need to be determined in intervention studies.
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Absentismo , Ácido Fólico/sangre , Hierro/sangre , Vitamina A/sangre , Deficiencia de Vitamina B 12/sangre , Vitamina B 12/sangre , Anemia Ferropénica/sangre , Biomarcadores/sangre , Índice de Masa Corporal , Niño , Preescolar , Colombia , Eritrocitos/metabolismo , Femenino , Ferritinas/sangre , Hemoglobinas/metabolismo , Humanos , Masculino , Micronutrientes/sangre , Estado Nutricional , Estudios Prospectivos , Factores Socioeconómicos , Deficiencia de Vitamina B 12/tratamiento farmacológico , Zinc/sangreRESUMEN
Embora o quadro clássico de mielopatia por deficiência de vitaminaB12 seja a degeneração subaguda combinada da medula, a manifestaçãoclínica pode ser variável. Homem branco de 36 anos de idade com hipotireoidismo e vitiligo apresentou dormência nas mãos de início súbito. Exame físico: sinal de Lhermitte e hipoestesia nas palmas. Evidenciada alteração de sinal na ressonância magnética (RM) da medula cervical. Foram evidenciados nível sérico de vitamina B12 de 150 pg/mL, gastrite atrófica e hemograma normal. Paciente foi tratado com reposição intramuscular de vitamina B12. Após seis meses, houve remissão completa dos sintomas com normalização do exame de imagem em um ano. O presente caso ilustra discreta alteração clínica e lesão extensa na RM (dissociação entre a clínica e o exame de imagem) na deficiência de B12. A melhora dos sintomas precedeu a resolução da alteração no exame de imagem, no presente caso.
Although the classic manifestation of myelopathy due to vitamin B12deficiency is a subacute combined degeneration of the spinal cord, the clinical manifestation may be varied. A 36-year-old white man with hypothyroidism and vitiligo presented sudden onset of numbness in hands. Physical examination: Lhermitte's sign and hypoesthesia in palms. Signal change on magnetic resonance image (MRI) of the cervical spinal cord was evidenced. Serum vitamin B12 of 150 pg/mL, gastric atrophy and normal hemogram were shown. The patient was treated with intramuscular vitamin B12 replacement. After six months there was complete remission of the symptoms, and within one year the MRI was normal. This case illustrates mild clinical signs and extensive changes on MRI (dissociation between clinic and image) in B12 deficiency. Resolution of MRI was observed after the clinical signs, in the present case.
Asunto(s)
Humanos , Masculino , Adulto , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/etiología , Deficiencia de Vitamina B 12/complicaciones , Deficiencia de Vitamina B 12/diagnóstico , Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitamina B 12/administración & dosificación , Vitamina B 12/uso terapéutico , Inducción de Remisión , Imagen por Resonancia Magnética , Factores de Riesgo , Resultado del Tratamiento , Paraparesia/etiología , Hipoestesia/etiologíaRESUMEN
CONTEXT: Decreased vitamin B12 concentration does not usually result in clinical or hematological abnormalities. Subacute combined spinal cord degeneration and pancytopenia are two serious and rarely displayed consequences that appear in severe deficits. CASE REPORT: We present the case of a patient with subacute combined spinal cord degeneration and pancytopenia secondary to severe and sustained vitamin B12 deficiency. Such cases are rare nowadays and have potentially fatal consequences. CONCLUSIONS: Vitamin B12 deficiency should be taken into consideration in the differential diagnosis in cases of blood disorders or severe neurological symptoms. Early diagnosis and treatment can avoid irreversible consequences.